1. Kuinka vaalia ikääntyvää luuta? Liikunta Ari Heinonen Department of Health Science, University of Jyväskylä

2. Development of bone mineral mass and goals for exercise programs Vuori, 1996 Increase peak bone mass Maintenance (built bone) Reduce bone loss & prevent falls Goals of exercise interventions vary across lifespan Age, yr Bone mass, %

3. Comparison between strength and impact sports Triple jumpers (mean: 22 yr, 172 cm, 65 kg) (Heinonen et al. 2003) –extremely high impact forces, up to 22 times BW –tibiae are exposed to extreme torques during performance Weightlifters (mean: 30 yr, 164 cm, 67 kg) (Heinonen et al. 2003) –lower extremities experience large compressive stresses

4. Clinical trials Exercise intervention studies

5. Show-Harter (1992) Friedlander (1995) Lohman (1995) Heinonen (1996) Bassey (1998) Vainionpää (2005) Grove (1992) Bassey (1998) Hatori (1992) Kerr (1996) Heinonen (1998) 0 1 2 3 4 5 6 7 Percent change (%) SpineFemoral neck ns * * * * * * * * * * * * * * * p < 0.05 ( troch.) Summary of bone mass changes observed in randomized controlled intervention trials High-impact training Premenopausal Early postmenopausal ns No exercise effect on spine or femoral neck: Humpries et al. (2000), Maddalozzo & Snow (2000), Kerr et al. (1996), Uusirasi et al. 2003

6. lumbar spine Femoral neck distal radius distal tibia tibial shaft -6-4-2 0 246 % Change difference, %, 95% CI Exercise vs. non exercise (Efficacy > 2 x vk) +1.8% 0 Effect of alendronate and exercise on bone and physical performance of postmenopausal women A 12 month randomised controlled trial BMC, g Distal tibia Bone strength index (mm 3 ) +4.6% Uusi-Rasi et al. Bone 2003;33:132-143.

7. Intensity of exercise Vainionpää et al. Osteoporos Int 2006; 17: 455-463 -The average acceleration peak values for different exercise patterns measured by accelerometer-based method. - accelerations levels exceeding 3.9 g correlated positively with the BMD change in the hip and L 1 12-month randomized exercise trial

8. A Multi-Component Exercise Regimen to Prevent Functional Decline and Bone Fragility in Home-Dwelling Elderly Women: Randomized, Controlled Trial

9. Study design Originally, 149 healthy 70 to 78-years old women were randomly assigned to the four groups: –a resistance training group (RES) –a balance-jumping training group (BAL) –a combination group doing resistance training and balance-jumping training (COMB) –a non-training control group (CON). (Karinkanta et al. Ostpor Int, in press) 144 completed a 12-month randomized, controlled exercise intervention trial. 120 (83%) participated in the 12-month follow-up measurements one-year after the end of the intervention

10. Resistance (n=37) Balance & agility (n=37) Combination (n=38) Control (n=37) Age, (years)73 72 Height, (cm)161159 158 Weight, (kg)74716974 BMI, (kg/m 2 )2928 30 Calcium, (mg/day)940960916894 Physical activity /week, (%) none or some51434046 brisk exercise 1x22 24 brisk exercise 2x27353730 Chronic diseases and symptoms, (%) high blood press.16322635 high cholesterol8221324 arthritis/joint pain81158 Background Characteristics

11. Resistance training –5 movements emphasizing lower limbs –3x8-10 reps –target level 75-80% of 1RM 1. Training protocol during the intervention (Karinkanta et al. Ostpor Int, in press)

12. Balance & agility- jumping training: –aerobic/step aerobic –based program –Including: jumps, impacts, changes of direction, balance- and agility training sessions 2. Training protocol during the intervention (Karinkanta et al. Ostpor Int, in press)

13. Combination of strength and agility- jumping training: – in every second week: strength or balance-jumping training 3. Training protocol during the intervention (Karinkanta et al. Ostpor Int, in press)

14. Training protocol during the intervention Supervised training sessions (45 min) 3x week for 12 months - progressive protocol 4. Control group – were asked to maintain the current physical activity (Karinkanta et al. Ostpor Int, in press)

15. PHYSICAL PERFORMANCE Intervention effect (Karinkanta et al. Osteopor Int, in press) :  Leg extensors force: - RES: 13% (95% CI: 5 to 22) - BAL: 10% (3 to 19) groups - COMB: 8%; (0 to 16)  Dynamic balance: - BAL: 5% (1 to 8) - COMB: 7% (3 to 10) compared with the CON group One year after the intervention:  Dynamic balance: - COMB: 6% (95% CI; 2 to 11%) - BAL group: 5% (1 to 9%) compared with the CON group  Isometric leg extensor force and self-rated physical functioning: there were no between-groups differences (Karinkanta et al. Ostpor Int, in press)

16. BONE MEASUREMENTS Intervention effect (Karinkanta et al. Osteopor Int, in press) :  Intention-to-treat: there were no training effect in density- weighted polar section modulus (BSI) of tibia or femoral neck section modulus (Z)  BSI efficacy analyses (who trained at least twice a week): - RES: 1.5% (95% CI: 0.2 to 2.8) - BAL: 0.8% (-0.6 to 2.2) groups - COMB: 1.9% (0.6 to 3.3.) compared with the CON group One year after the intervention:  Intentio-to-treat: there were no training effect in density-weighted polar section modulus (BSI) of tibia or femoral neck section modulus (Z)  BSI efficacy analyses (who trained at least twice a week): - RES: 0.3% (95% CI: -1.0 to 1.6) - BAL: 0.1% (-1.2 to 1.5) groups - COMB: 1.3% (0.0 to 2.7) compared with the CON group

17. High-impact exercise effect: (Wallace & Cumming 2000, CTI, 67:10-18, A systematic review) – Lumbar spine BMD: 1.6% in postmenopausal and 1.5 in premenopausal women, exercisers vs. controls – Femoral neck BMD: 1.0% in postmenopausal and 0.9 in premenopausal women, exercisers vs. controls Strength training effect: (Kelley et al. Am J Phys Med Rehabil 2001;80:65-77.Martyn-St James & Carrol Osteopor Int 2006; 17:1225- 1240) – Lumbar spine BMD: 1.3% in postmenopausal, exercisers vs. controls – Femoral neck BMD: 0.9% in postmenopausal, exercisers vs. controls – radius BMD: 2.7% in postmenopausal, exercisers vs. controls Meta-analyses of exercise effect

18. Exercise prescription is recommended to help preserve bone health during adulthood ACSM 2004 ModeWeight bearing endurance activities (tennis, stair climbing, jogging) activities that involve jumping (volleyball, basketball, aerobics) and resistance exercise Intensity moderate to high, in terms of bone loading forces (3.6 g) Frequencyweight-bearing endurance activities 3-5 times per week; resistance exercise 2-3 times per week Duration30-60 min/day of a combination of weight-bearing endurance activities, activities that involve jumping, and resistance exercise that targets all major muscle groups Kohrt et al. Med Sci Sports Exerc 2004

19. high-impact training is beneficial to skeleton in young girls, pre- and postmenopausal women high-impact exercise can be recommended as a “Bone Exercise” for young girls, pre- and postmenopausal women Summary

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