Tiivistelmä.

With an emphasis on exercise and its effect on bone, this text includes sections on basic anatomy and the physiology of the structure and function of bone as well as exercises to maintain a healthy skeleton through to old age.

Current options for maintaining or slowing aging-related bone mineral density (BMD) loss in postmenopausal women primarily include pharmaceutical agents. More recently, physical activity and exercise have been suggested as highly effective, low cost alternatives. Weighted aerobic exercise, utilizing load carriage systems (LCS), is known to increase the gravitational forces impacting bone, creating a higher osteogenic stimulus than standard aerobic exercise. In response to the positive research on aerobic exercise with well-designed LCS, Dr. Lawrence Petrakis, MD, developed a unique 5.44 kg uniformly weighted exercise suit. This study aimed to examine the effects of the uniformly weighted exercise suit on serum biochemical markers of bone formation (Amino- Propeptide of Type 1 Collagen [P1NP]; Carboxy-Terminal Propeptide of Type 1 Collagen [P1CP] and resorption (Carboxy-Terminal Telopeptide of Type 1 Collagen [CTX]) in response to submaximal aerobic exercise in postmenopausal women with low bone density. Nine volunteer, sedentary to lightly active, healthy postmenopausal women (Age: 58.7±1.1 years, BMI: 28.2±1.0, BMD T-score: -1.2±0.5) participated in this within-subjects study, wherein each participant exercised under two counterbalanced conditions (aerobic exercise with [ES] or without [NS] the exercise suit). During each condition, participants walked on a treadmill at 65%-75% of their age-predicted maximum heart rate until they reached their goal caloric expenditure (400kcal). There was a seven-day washout period between sessions. Serum was processed using ELISA protocols to investigate the change in biomarker at 24 and 72 hours post exercise, relative to baseline. The results indicated, when compared to the NS condition, the ES condition elicited a greater positive change in P1CP at 24 hours (Phours following exercise (P0.05). There was no effect of condition on P1NP at any time point (P>0.05). In sum, submaximal aerobic exercise while wearing the uniformly weighted exercise suit elicited an antiresorptive effect on bone collagen resorption with a simultaneous increase in bone collagen formation 24 hours post exercise.

Rats that undergo hindlimb unloading (HU) as a simulation for microgravity experience bone responses similar to that seen by astronauts in space flight. A recent study showed that a resistance exercise regimen mitigated bone loss because of disuse. Controlled muscle stimulation was applied to the lower left limb to produce eccentric muscle contractions. The recent study, which showed beneficial effects on bone, did not show mitigation of muscle loss. The purpose of this project is to determine the bone response to a modified stimulation protocol by optimizing parameters to benefit bone and muscle. Forty-six 5.5-month-old male rats were divided into 4 groups: baseline control (BC), cage control (CC), hindlimb unloaded no exercise (HU), and hindlimb unloaded with exercise (HU+Ex). Hindlimb unloading was achieved by tail suspension. The left leg of the HU+Ex group was exercised every other day for 28 days. The right leg of the HU+Ex group and the HU group served as disuse controls. The previous protocol consisted of 4 sets of 10 contractions, with 500ms stimulations, while the current protocol uses 4 sets of 5 repetitions at 1s stimulations. Eccentric contraction strength was changed from 120% peak isometric torque to 100%. Mechanical properties of the bone were measured at the proximal tibia metaphysis by using reduced platen compression (RPC) testing, directly loading only the cancellous compartment. Results show ultimate stress levels in the HU+Ex group that are dramatically higher than HU values (+368%) and CC values (+275%), compared to 215% and no difference, respectively, for Alcorn's study. Ultimate stress values in HU and CC were not significantly different. The elastic modulus for the HU+Ex group tended to be 26% higher than that of the HU group, but was not statistically significant. The volumetric bone mineral density (vBMD) for HU+Ex was significantly higher than HU at the tibial metaphysis (+16.8%), as compared to 11% in the previous study (Alcorn). Also, the vBMD for HU+Ex was greater than HU at the tibial midshaft (7%) after 28 days of unloading. These results show that the countermeasure effectively mitigated bone degradation induced by hindlimb unloading.

This is the first book of its kind to focus solely on the female athlete triad - its origins, its recognition, and most importantly, its management. Since the symptoms themselves cover a range of medical specialties, chapters are written by experts in a number of relevant fields - sports medicine, orthopedics, endocrinology, and pediatrics - with an eye toward overall care of the young female athlete. Additionally, each chapter includes suggestions on how to educate and communicate with young athletes and their parents, as well as trainers and coaches, on how to manage the illness outside of the direct clinical setting. The female athlete triad is often seen in sports where low body weight is emphasized, such as gymnastics, figure skating, and running, though it can appear in any sport or activity. The interrelated symptoms - eating disorders, amenorrhea, and low bone mass - exist on a spectrum of severity and are serious and potentially life-threatening if not properly treated. Psychological problems, in addition to medical ones, are not uncommon. The Female Athlete Triad: A Clinical Guide discusses all of these areas for a well-rounded and in-depth approach to the phenomenon and will be a useful reference for any clinician working with female athletes across the lifespan.

This first-ever Surgeon General's Report on bone health and osteoporosis illustrates the large burden that bone disease places on our Nation and its citizens. Like other chronic diseases that disproportionately affect the elderly, the prevalence of bone disease and fractures is projected to increase markedly as the population ages. If these predictions come true, bone disease and fractures will have a tremendous negative impact on the future well-being of Americans. But as this report makes clear, they need not come true: by working together we can change the picture of aging in America. Osteoporosis, fractures, and other chronic diseases no longer should be thought of as an inevitable part of growing old. By focusing on prevention and lifestyle changes, including physical activity and nutrition, as well as early diagnosis and appropriate treatment, Americans can avoid much of the damaging impact of bone disease and other chronic diseases. This Surgeon General's Report brings together for the first time the scientific evidence related to the prevention, assessment, diagnosis, and treatment of bone disease. More importantly, it provides a framework for moving forward. The report will be another effective tool in educating Americans about how they can promote bone health throughout their lives. This first-ever Surgeon General's Report on bone health and osteoporosis provides much needed information on bone health, an often overlooked aspect of physical health. This report follows in the tradition of previous Surgeon Generals' reports by identifying the relevant scientific data, rigorously evaluating and summarizing the evidence, and determining conclusions.

It is beyond dispute that physical activity is good for us, but what are the benefits, challenges and impacts of sport on health? This is the first book to focus on football in the context of health from individual, public and population-level perspectives. Football as Medicine examines the effects of football training on the three main types of fitness (cardiovascular, metabolic and musculoskeletal) and on specific target populations (for example, children, type 2 diabetes patients, cancer patients, people with mental health conditions, the socially deprived and older people). It discusses the significance of football for public health and assesses the efficacy of football interventions by clubs and community sport development programs. With its multi-disciplinary approach, this is a valuable resource for students, researchers and practitioners working in physical activity and health, public health, health promotion and medicine, as well as football and sport business management, sport and exercise science, and the sociology of sport.

Marcus and Feldman's Osteoporosis, Fifth Edition, is the most comprehensive, authoritative reference on this disease. Led by a new editorial team, this fifth edition offers critical information on reproductive and hormonal risk factors, new therapeutics, ethnicity, nutrition, therapeutics, management and economics, comprising a tremendous wealth of knowledge in a single source not found elsewhere. Written by renowned experts in the field, this two-volume reference is a must-have for biomedical researchers, research clinicians, fellows, academic and medical libraries, and any company involved in osteoporosis drug research and development. - Summarizes the latest research in bone biology and translational applications in a range of new therapeutic agents, including essential updates on therapeutic uses of calcium, vitamin D, SERMS, bisphosphonates, parathyroid hormone, and new therapeutic agents - Recognizes the critical importance of new signaling pathways for bone health, including Wnt, OPG and RANK, of interest to both researchers who study bone biology and clinicians who treat osteoporosis - Offers new insights into osteoporosis associated with menopause, pre-menopause, chronic kidney disease, diabetes, HIV and other immune disorders

Physical inactivity is a key determinant of health across the lifespan. A lack of activity increases the risk of heart disease, colon and breast cancer, diabetes mellitus, hypertension, osteoporosis, anxiety and depression and others diseases. Emerging literature has suggested that in terms of mortality, the global population health burden of physical inactivity approaches that of cigarette smoking. The prevalence and substantial disease risk associated with physical inactivity has been described as a pandemic. The prevalence, health impact, and evidence of changeability all have resulted in calls for action to increase physical activity across the lifespan. In response to the need to find ways to make physical activity a health priority for youth, the Institute of Medicine's Committee on Physical Activity and Physical Education in the School Environment was formed. Its purpose was to review the current status of physical activity and physical education in the school environment, including before, during, and after school, and examine the influences of physical activity and physical education on the short and long term physical, cognitive and brain, and psychosocial health and development of children and adolescents. Educating the Student Body makes recommendations about approaches for strengthening and improving programs and policies for physical activity and physical education in the school environment. This report lays out a set of guiding principles to guide its work on these tasks. These included: recognizing the benefits of instilling life-long physical activity habits in children; the value of using systems thinking in improving physical activity and physical education in the school environment; the recognition of current disparities in opportunities and the need to achieve equity in physical activity and physical education; the importance of considering all types of school environments; the need to take into consideration the diversity of students as recommendations are developed. This report will be of interest to local and national policymakers, school officials, teachers, and the education community, researchers, professional organizations, and parents interested in physical activity, physical education, and health for school-aged children and adolescents.