title: Effects of exercise training with weighted vests on bone turnover and isokinetic strength in postmenopausal women. Falls, injuries due to falls, and the risk of admission to a nursing home. A randomized walking trial in postmenopausal women: effects on physical activity and health 10 years later. Effect of brisk walking in 1 or 2 daily bouts and moderate resistance training on lower-extremity muscle strength, balance, and walking performance in women who recently went through menopause: a randomized, controlled trial. A home-based, transtheoretical change model designed strength training intervention to increase exercise to prevent osteoporosis in Iranian women aged 40-65 years: a randomized controlled trial. Exercise on prescription for women aged 40-74 recruited through primary care: two year randomised controlled trial Effects of strength and endurance training on antioxidant enzyme gene expression and activity in middle-aged men. Training or EPT in perimenopause on balance and flushes How to estimate treatment effects from reports of clinical trials. I: Continuous outcomes. Physical activity is associated with incident disability in community-based older persons. Prospective association between physical activity and falls in community-dwelling older women The effect of unilateral and bilateral strength training on the bilateral deficit and lean tissue mass in post-menopausal women Effects of diet and exercise in men and postmenopausal women with low levels of HDL cholesterol and high levels of LDL cholesterol. An epidemiological study of falls in older community-dwelling women: the Randwick falls and fractures study. Exercise training, vascular function, and functional capacity in middle-aged subjects. The Independent Effects of Exercise and Estrogen on Lipids and Lipoproteins in Postmenopausal Women Effect of resistance exercise on bone mineral density in premenopausal women. Effect of alendronate and exercise on bone and physical performance of postmenopausal women: a randomized controlled trial. The effect of exercise on physical fitness and quality of life in postmenopausal women. Effect of two training regimens on bone mineral density in healthy perimenopausal women: a randomized controlled trial. Controlling balance decline across the menopause using a balance-strategy training program: a randomized, controlled trial The effect of an individualized fall prevention program on fall risk and falls in older people: a randomized, controlled trial. Group- vs home-based exercise training in healthy older men and women. A community-based clinical trial.
abstract: The effects of 12 wk of exercise training using weighted vests on bone turnover and isokinetic strength were evaluated in postmenopausal women r and omly assigned as exercisers ( EX ; n = 9 ) or controls ( CON ; n = 7 ) .  Training included 3 multimodal exercise sessions per wk wearing weighted vests . The vest load was progressively increased each wk to a maximum of 15 % of body weight . Bone turnover was determined from resting levels of serum osteocalcin and NTx . Knee and ankle strength were measured at 60 degrees/s and 180 degrees/s using an isokinetic dynamometer . After 12 wk , NTx decreased by 14.5 % ( P < or= .05 ) in EX , with no significant changes in osteocalcin . EX also showed a 40 % ( P < or= .05 ) improvement in ankle plantar-flexion strength at 60 degrees/s . Relative body fat significantly decreased and fat-free mass increased in EX . Exercise compliance was 80 % . These findings support the use of progressive exercise training using weighted vests in postmenopausal women BACKGROUND Falls warrant investigation as a risk factor for nursing home admission because falls are common and are associated with functional disability and because they may be preventable . METHODS We conducted a prospect i ve study of a probability sample of 1103 people over 71 years of age who were living in the community . Data on demographic and medical characteristics , use of health care , and cognitive , functional , psychological , and social functioning were obtained at base line and one year later during assessment s in the participants ' homes . The primary outcome studied was the number of days from the initial assessment to a first long-term admission to a skilled-nursing facility during three years of follow-up . Patients were assigned to four categories during follow-up : those who had no falls , those who had one fall without serious injury , those who had two or more falls without serious injury , and those who had at least one fall causing serious injury . RESULTS A total of 133 participants ( 12.1 percent ) had long-term admissions to nursing homes . In an unadjusted model , the risk of admission increased progressively , as compared with that for the patients with no falls , for those with a single noninjurious fall ( relative risk , 4.9 ; 95 percent confidence interval , 3.2 to 7.5 ) , those with multiple noninjurious falls ( relative risk , 8.5 ; 95 percent confidence interval , 3.4 to 21.2 ) , and those with at least one fall causing serious injury ( relative risk , 19.9 ; 95 percent confidence interval , 12.2 to 32.6 ) . Adjustment for other risk factors lowered these ratios to 3.1 ( 95 percent confidence interval , 1.9 to 4.9 ) for one noninjurious fall , 5.5 ( 95 percent confidence interval , 2.1 to 14.2 ) for two or more noninjurious falls , and 10.2 ( 95 percent confidence interval , 5.8 to 17.9 ) for at least one fall causing serious injury , but the association between falls and admission to a nursing home remained strong and significant . The population attributable risk of long-term admission to a nursing home for these three groups ( the proportion of admissions directly attributable to the three categories of falls ) was 13 percent , 3 percent , and 10 percent , respectively . CONCLUSIONS Among older people living in the community falls are a strong predictor of placement in a skilled-nursing facility ; interventions that prevent falls and their sequelae may therefore delay or reduce the frequency of nursing home admissions BACKGROUND It is important to determine if permanent lifestyle changes may result from physical activity interventions and whether health may be affected by these changes . OBJECTIVE To conduct a 10-year follow-up of physical activity and self-reported health status in participants of a r and omized clinical trial of walking intervention .  METHODS Of the original 229 volunteer postmenopausal women who participated in the original clinical trial , 196 ( N = 96 intervention and 100 controls ) completed the 10-year follow-up telephone interview . The interview protocol included questions on  self-reported walking for exercise  and purpose s other than exercise , the Paffenbarger sport and exercise index , functional status , and various chronic diseases and conditions . RESULTS The median values for both usual walking for exercise and total walking  were significantly higher for walkers compared with controls ( for both , P = .01 ) , with median differences of 706 and 420 kcal/wk , respectively . After excluding women who reported heart disease during the original trial , 2 women in the walking group ( 2 % ) and 11 women in the control group ( 12 % ) reported physician-diagnosed heart disease over the last 10 years ( P = .07 ) . There were also fewer hospitalizations , surgeries , and falls among women in the walking group , although these differences were not statistically significant ( P>.05 ) . CONCLUSIONS Although limited by self-report , this study may be the first to demonstrate long-term exercise compliance to a r and omized control trial in older women and to suggest that health benefits may have ensued as a result of these increased activity levels BACKGROUND AND PURPOSE Menopause may induce a phase of rapid decreases in bone mineral density , aerobic fitness , muscle strength , and balance , especially in sedentary women . The purpose of this study was to examine the effects and feasibility of an exercise program of 1 or 2 bouts of walking and resistance training on lower-extremity muscle strength ( the force-generating capacity of muscle ) , balance , and walking performance in women who recently went through menopause . SUBJECTS AND METHODS The subjects were 134 women who recently went through menopause . The study was a 15-week , r and omized , controlled trial with continuous and fractionated exercise groups . The outcomes assessed were lower-extremity muscle strength , balance , and walking time over 2 km . Feasibility was assessed by question naires , interviews , and training logs . RESULTS One hundred twenty-eight women completed the study .  Adherence to the study protocol was 92 % . Both continuous and fractionated exercise groups improved equally in lower-extremity muscle strength and walking time but not in balance . Almost 70 % of the subjects considered the program to be feasible . Two daily walking sessions caused fewer lower-extremity problems than did continuous walking . DISCUSSION AND CONCLUSION Brisk walking combined with moderate resistance training is feasible and effective . Fractionating the walking into 2 daily sessions is more feasible than continuous walking Physical activity ( PA ) helps to prevent osteoporosis , but older women are often sedentary . This study used a pre-post r and omized controlled design to evaluate a 12-week exercise education intervention program based on the stages of change ( SoC ) and processes of change from the transtheoretical change model ( TTM ) to improve adherence with strength and balance training recommendations at levels sufficient to prevent osteoporosis in Iranian women aged 40 - 65 years . The home-based exercise prescription consisted of strength and balance training that was progressive , individually tailored and included a walking program . Individuals in the training group ( n=61 ) had a positive , significant progression in psychological SoC ( P<0.001 ) , whereas no progression in stages occurred in the control group ( n=55 ) . After the intervention , the training group demonstrated significant improvements in PA , lower body muscle strength , static and dynamic balance , with no significant changes in the control group . These results support the applicability of the TTM for a PA intervention and indicate that this training program is very effective in improving balance and lower body strength in older women Objective To assess the effectiveness of a primary care based programme of exercise on prescription among relatively inactive women over a two year period . Design R and omised controlled trial . Setting 17 primary care practice s in Wellington , New Zeal and Participants 1089 women aged 40 - 74 not undertaking 30 minutes of moderate intensity physical activity on at least five days of the week  Intervention Brief physical activity intervention led by nurse with six month follow-up visit and monthly telephone support over nine months . Main outcome measure Physical activity assessed at baseline and 12 and 24 months . Secondary outcomes were quality of life ( SF-36 ) , weight , waist circumference , blood pressure , concentrations of fasting serum lipids , glycated haemoglobin ( HbA1c ) , glucose , insulin , and physical fitness . Results Mean age was 58.9 ( SD 7 ) years . Trial retention rates were 93 % and 89 % at 12 and 24 months , respectively . At baseline , 10 % of intervention participants and 11 % of control participants were achieving 150 minutes of at least moderate intensity physical activity a week . At 12 months rates increased to 43 % and 30 % and at 24 months to 39.3 % and 32.8 % ( P<0.001 ) , respectively . SF-36 physical functioning ( P=0.03 ) and mental health ( P<0.05 ) scores improved more in intervention compared with control participants , but role physical scores were significantly lower ( P<0.01 ) . There were no significant differences in clinical outcomes . More falls ( P<0.001 ) and injuries ( P=0.03 ) were recorded in the intervention group . Conclusions This programme of exercise on prescription increased physical activity and quality of life over two years , although falls and injuries also increased . This finding supports the use of exercise on prescription programmes as part of population strategies to reduce physical inactivity . Trial registration Australian New Zeal and Clinical Trials Registry ( ANZCTR ) ANZCTRN012605000490673 This study was aim ed at investigating the effects of a 21-week period of progressive strength or endurance training on peripheral blood mononuclear cells ( P BMC ) antioxidant enzyme gene expression and activity in healthy middle-aged untrained men .  Strength ( n=11 ) and endurance ( n=12 ) training were performed twice a week , including resistance exercises to activate all the main muscle groups or cycle-ergometer pedaling , respectively . mRNA levels of catalase , glutathione peroxidase ( GPx ) , mitochondrial superoxide dismutase ( MnSOD ) and cytosolic superoxide dismutase ( CuZnSOD ) were increased after 21 weeks of strength training , while endurance training induced significant changes only in MnSOD and GPx mRNA levels . CuZnSOD protein content was significantly increased only in strength-trained subjects . The program of strength or endurance exercise training had no significant effects on the activity of any of the antioxidant enzymes . In conclusion , in a middle-aged population , 21 weeks of strength or endurance training was a sufficient stimulus to up-regulate mRNA levels of P BMC antioxidant enzymes , the strength training being a more optimal stimulus . However , the discrepancies between enzyme protein and mRNA levels suggest that the present systematic strength or endurance training period had no beneficial effects on enzymatic antioxidant defense mechanisms in previously untrained middle-aged men With advancing age , the postural balance function deteriorates as a consequence of decreased functional capacity . Deteriorating balance is a risk factor for bone fractures due to increased risks of falls . It has been suggested that the loss of estrogen , which occurs in relation to the menopause , may be associated with loss of balance . Regular physical exercise without balance training has , in some studies , been shown to have positive effects on the postural balance . The aim of the present study was to examine balance function during the perimenopausal period , and evaluate the effect of estrogen plus progesterone therapy ( EPT ) or  aerobic training  on balance .  Sixty perimenopausal women were recruited to the study . The subjects were then r and omised to either physical training ( n = 20 ) , EPT ( n = 20 ) , or to a control group ( n = 20 ) . The study period was 18 months . Postural stability was measured every third month using a custom‐made force platform . The women using EPT achieved better results in 3 of 6 parameters , after 18 months Properly conducted r and omised trials can aid clinical decision-making by providing unbiased estimates of the average size of treatment effects . This paper , the first of two , discusses how readers of clinical trials can extract simple estimates of treatment effect size from trial reports when trial outcomes are measured on a continuous scale . When making decisions about therapy for individual patients , these estimates can be modified on the basis of patient characteristics . Modified estimates of treatment effect size can be used to determine if the effect of treatment is likely to be large enough to be " clinical ly worthwhile " . This approach optimises clinical decision-making by combining unbiased estimates of the size of treatment effect from clinical trials with clinical intuition and patient preferences OBJECTIVES To examine the association between physical activity and the risk of incident disability , including impairment in activities of daily living ( ADLs ) and instrumental activities of daily living ( IADLs ) , in community-based older persons free of dementia . DESIGN Prospect i ve , observational cohort study . SETTING Approximately 40 retirement communities across the Chicago metropolitan area . PARTICIPANTS More than 1,000 older persons from the Rush Memory and Aging Project , an ongoing longitudinal clinical -pathological study of common chronic conditions of old age . MEASUREMENTS All participants underwent detailed annual clinical evaluations that included assessment s of  physical activity , ADLs , IADLs , and gait performance . The associations between  physical activity , mortality , and incident disability were examined using a series of Cox proportional hazards models controlled for age , sex , education , and baseline gait . RESULTS At baseline , participants spent a mean+/-st and ard deviation of 3.0+/-3.5 hours per week engaging in physical activity ( range 0 - 35 ) . In a proportional hazards model , the risk of death decreased 11 % ( hazard ratio (HR)=0.89 , 95 % confidence interval (CI)=0.83 - 0.95 ) for each additional hour of physical activity per week . For those who were not disabled at baseline , the risk of developing disability in ADLs decreased 7 % ( HR=0.93 , 95 % CI=0.88 - 0.98 ) for each additional hour of physical activity per week . Similarly , the risk of disability in IADLs decreased 7 % ( HR=0.93 , 95 % CI=0.89 - 0.99 ) for each additional hour of physical activity . CONCLUSION For community-based older persons without dementia , physical activity is associated with maintenance of functional status , including a reduced risk of developing impairment in ADLs and IADLs Objective : To explore associations between physical activity and the risk of falls and fractured bones in community-dwelling older women . Design , setting and participants : A prospect i ve observational survey with three and six-year follow-ups . The sample included 8188 healthy , community-dwelling women , aged 70–75 years in 1996 , who completed surveys as participants in the Australian Longitudinal Study on Women ’s Health . Women who reported a recent serious injury from falling were excluded . Outcomes were reports of a fall to the ground , injury from a fall , and a fractured bone in 1999 and 2002 . The main predictor variable was physical activity level in 1996 , categorised on the basis of weekly frequency as none/very low , low , moderate , high and very high . Covariates were demographic and health-related variables . Logistic regression models were computed separately for each outcome in 1999 and 2002 . Main results : In multivariable models , very high physical activity was associated with a decreased risk of reporting a fall in 1999 ( odds ratio ( OR ) 0.67 ; 95 % CI 0.47 to 0.95 ) and in 2002 ( OR 0.64 ; 95 % CI 0.43 to 0.96 ) . High/very high physical activity was associated with a decreased risk of a fractured bone in 2002 ( OR 0.53 ; 95 % CI 0.34 to 0.83 ) . No significant association was found between physical activity and injury from a fall . Conclusions : The results suggest that at least daily moderate to vigorous-intensity physical activity is required for the primary prevention of falls to the ground and fractured bones in women aged 70–75 years Some have observed maximal strength of simultaneous bilateral homologous limb contraction is less than the sum of strengths of right and left limbs contracting alone ; a phenomenon referred to as the bilateral deficit ( BLD ) . There is controversy on whether there is a BLD for all exercises . We assessed whether a BLD occurs across different exercises ( leg press , knee extension , and lat pull-down ) , whether the BLD could be altered with unilateral or bilateral training , and whether unilateral versus bilateral training was more beneficial for increasing lean tissue mass ( LTM ) . Post-menopausal women ( ~57 years ) were r and omized to bilateral ( n=14 ) and unilateral ( n=12 ) training , or non-training control ( n=24 ) groups .  Bilateral training involved seven exercises performed with bilateral contractions ( two sets , 3 days week−1 , 26 weeks ) . Unilateral training involved the same exercises performed with one limb at a time . A BLD was found for leg press and lat pull-down , but not for knee extension . Bilateral training  decreased the BLD ; whereas unilateral training had minimal effect on the BLD . The unilateral-training  group had a greater increase in lower-body LTM compared to the control group ( P<0.05 ) ; however , there were no differences between unilateral and bilateral training groups . Both training groups had greater increases in LTM of the upper- and whole-body compared to the control group . We conclude that the BLD is apparent for some exercises ( i.e. , the leg press and lat pull-down ) but not others ( i.e. , knee extension ) . Bilateral training  reduces the BLD ; whereas unilateral training has minimal effect on the BLD BACKGROUND Guidelines established by the National Cholesterol Education Program ( NCEP ) promote exercise and weight loss for the treatment of abnormal lipoprotein levels . Little is known , however , about the effects of exercise or the NCEP diet , which is moderately low in fat and cholesterol , in persons with lipoprotein levels that place them at high risk for coronary heart disease . METHODS We studied plasma lipoprotein levels in 180 postmenopausal women , 45 through 64 years of age , and 197 men , 30 through 64 years of age , who had low high-density lipoprotein ( HDL ) cholesterol levels ( < or = 59 mg per deciliter in women and < or = 44 mg per deciliter in men ) and moderately elevated levels of low-density lipoprotein ( LDL ) cholesterol ( > 125 mg per deciliter but < 210 mg per deciliter in women and > 125 mg per deciliter but < 190 mg per deciliter in men ) . The subjects were r and omly assigned to aerobic exercise , the NCEP Step 2 diet , or diet plus exercise , or to a control group , which received no intervention . RESULTS Dietary intake of fat and cholesterol decreased during the one-year study ( P<0.001 ) , as did body weight , in women and men in either the diet group or the diet-plus-exercise group , as compared with the controls ( P<0.001 ) and the exercise group ( P<0.05 ) , in which dietary intake and body weight were unchanged . Changes in HDL cholesterol and triglyceride levels and the ratio of total to HDL cholesterol did not differ significantly among the treatment groups , for subjects of either sex . The serum level of LDL cholesterol was significantly reduced among women ( a decrease of 14.5+/-22.2 mg per deciliter ) and men ( a decrease of 20.0+/-17.3 mg per deciliter ) in the diet-plus-exercise group , as compared with the control group ( women had a decrease of 2.5+/-16.6 mg per deciliter , P<0.05 ; men had a decrease of 4.6+/-21.1 mg per deciliter , P<0.001 ) . The reduction in LDL cholesterol in men in the diet-plus-exercise group was also significant as compared with that among the men in the exercise group ( 3.6+/-18.8 mg per deciliter , P<0.001 ) . In contrast , changes in LDL cholesterol levels were not significant among the women ( a decrease of 7.3+/-18.9 mg per deciliter ) or the men ( 10.8+/-18.8 mg per deciliter ) in the diet group , as compared with the controls . CONCLUSIONS The NCEP Step 2 diet failed to lower LDL cholesterol levels in men or women with high-risk lipoprotein levels who did not engage in aerobic exercise . This finding highlights the importance of physical activity in the treatment of elevated LDL cholesterol levels Seven hundred and four women aged between 65 and 99 years ( mean age 74.6 years ) , who were r and omly selected from the community , took part in a study to determine whether health and lifestyle factors were associated with falls . In the 12 months before the survey , 66.1 per cent of the subjects experienced no falls , 19.7 per cent fell once and 14.2 per cent fell on two or more occasions . The proportion of women who fell outside the home decreased with age , with a corresponding increase in the proportion who fell inside the home on a level surface . The most common causes of falls reported were trips , slips and loss of balance . Some ( 27 per cent ) suffered injuries as a result of a fall , and the proportion suffering injuries increased with age . Those who rated their health and balance as impaired , those with a limitation in activities of daily living , those receiving community services , those taking psychoactive drugs , and those taking four or more drugs had significantly more falls . On the other h and , those taking part in planned exercise and those active for seven or more hours per week had fewer falls . Smoking and alcohol consumption were not significantly associated with falls . Stepwise logistic regression analysis revealed poor vision , inactivity and subjective fall risk as variables that were independently and significantly associated with falling . These findings highlight possible intervention strategies for reducing falls risk in older people PURPOSE The aim of this study was to investigate the effect of 8 wk of exercise training on functional capacity , muscular strength , body composition , and vascular function in sedentary but healthy subjects by using a r and omized , crossover protocol . METHODS After familiarization sessions , 19 subjects aged 47 + /- 2 yr ( mean + /- SE ) undertook a r and omized , crossover design study of the effect of 8 wk of supervised circuit training consisting of combined aerobic and resistance exercise .  Peak oxygen uptake ( .VO(2peak ) ) , sum of 7 maximal voluntary contractions and the sum of 8 skinfolds and 5 segment girths were determined at entry , crossover , and 16 wk . Endothelium-dependent and -independent vascular function were determined by forearm strain-gauge plethysmography and intrabrachial infusions of acetylcholine ( ACh ) and sodium nitroprusside ( SNP ) in 16 subjects . RESULTS Training did not alter ACh or SNP responses . .VO(2peak ) , ( 28.6 + /- 1.1 to 32.6 + /- 1.3 mL.kg(-1).min(-1 ) , P < 0.001 ) , exercise test duration ( 17.4 + /- 1.1 to 22.1 + /- 1.2 min , P < 0.001 ) , and muscular strength ( 465 + /- 27 to 535 + /- 27 kg , P < 0.001 ) significantly increased after the exercise program , whereas skinfolds decreased ( 144 + /- 10 vs 134 + /- 9 mm , P < 0.001 ) . CONCLUSION These results suggest that moderate intensity circuit training design ed to minimize the involvement of the arms improves functional capacity , body composition , and strength in healthy , middle-aged subjects without significantly influencing upper limb vascular function . This finding contrasts with previous studies in subjects with type 2 diabetes and heart failure that employed an identical training program Objective : To assess the effects of a moderate exercise program with and without oral estrogen replacement on levels of lipids and lipoproteins in postmenopausal women . Methods : One hundred one postmenopausal women were r and omized into four groups : control or sedentary ( N=20 ) , exercise alone ( N=25 ) , estrogen replacement using 0.625 mg conjugated equine estrogen ( N=28 ) , and exercise supplemented with conjugated equine estrogen ( N=28 ) . The exercise groups were placed on a moderate exercise program . Following baseline testing , each group returned at 3 and 6 months for cardiorespiratory fitness testing and serum lipid and lipoprotein profiles . Results : We found a significant decrease in systolic blood pressure ( P < 05 ) in all treatment groups . The maximum oxygen uptake increased by 9.0 and 7.8 % in the exercise and conjugated equine estrogen/ exercise groups , respectively , compared to the other groups ( P < 05 ) . These responses were seen at both 3 and 6 months . Total exercise time ( time spent on the treadmill until exhaustion during testing ) significantly increased in the exercise group by 21 % ( P < 01 ) . Exercise alone was associated with significant decreases in total cholesterol ( 5.2 % P < 05 ) , triglycerides ( 2percnt ; P < 05 ) , and low-density lipoprotein ( LDL ) cholesterol ( 10 % P < 01 ) , and a significant increase in the high-density lipoprotein ( HDL ) cholesterol-LDL ratio ( 17.2 % P < 01 ) . Significant changes were noted in these values , as well as increases in HDL cholesterol ( 16 and 14.8 % P < 01 ) and apolipoprotein Aj ( 25.6 and 26.5 % P < 001 ) in the conjugated equine estrogen and conjugated equine estrogen/ exrespectively . However , there were no differences in the changes observed in the conjugated equine estrogen groups with versus without exercise . No direct correlation was seen between measures of exercise performance and the changes seen in lipids and lipoproteins . Conclusions : Estrogen therapy alone had the greatest beneficial effect on lipids and lipoproteins . Exercise alone result ed in a significant reduction in cholesterol , triglycerides , and LDL cholesterol , and an increase in the HDL-LDL ratio . However , combined conjugated equine estrogen and exercise did not demonstrate an added improvement in lipid metabolism . Physical fitness levels increased in the exercise groups , but not in the control group or the estrogen-alone treated women . ( Obstet Gynecol 1994;83:167 - 72 OBJECTIVE To assess the effect of 9 months of strength training on total body and regional bone mineral density ( BMD , g/cm(2 ) ) in 58 premenopausal women aged 30 - 50 years . METHODS Participants were r and omized to either twice weekly supervised strength training for 15 weeks followed by 24 weeks of unsupervised training ( treatment group ) or control group . Height , weight , maximal muscular strength , nutrient intake and physical activity were assessed . Total body dual energy X-ray absorptiometry ( DXA , Lunar Prodigy ) scans were taken and analyzed for body composition ( lean and fat mass ) , and BMD for total body and its sub-regions ( spine , hip , arms and legs ) . All measurements were performed at baseline , 15 and 39 weeks . Analysis of covariance was used to assess group differences in BMD change adjusted for baseline BMD , weight , energy and calcium intake . RESULTS At baseline , the two groups had similar BMD and body size characteristics ( P<0.05 for all ) , except that the treatment group had lower body weight ( -7.1 kg ) , and higher energy ( + 259 kJ/d ) and calcium ( + 232 mg/d ) intake at baseline . Adjusted % change in BMD over 15 weeks ( 0.5 % vs. 0.4 % ) or 39 weeks ( 0.9 % vs. 1.2 % ) did not differ significantly between the exercise and control groups , respectively . The exercise group increased BMD at the spine and legs ( 1 - 2.2 % ) , while there was no change in the controls , but differences between groups were not significant . CONCLUSION Strength training over 9 months did not lead to significantly greater change in total body or regional BMD in premenopausal women In this r and omized , double-blind , placebo-controlled 12-month trial we evaluated effects of weight- bearing jumping exercise and oral alendronate , alone or in combination , on the mass and structure of bone , risk factors for falling ( muscle strength and power , postural sway , and dynamic balance ) , and cardiorespiratory fitness in postmenopausal women . A total of 164 healthy , sedentary , early postmenopausal women were r and omly assigned to one of four experimental groups : ( 1 ) 5 mg of alendronate daily plus progressive jumping exercise , ( 2 ) 5 mg alendronate , ( 3 ) placebo plus progressive jumping exercise , or ( 4 ) placebo . The primary endpoint was 12-month change in bone mass and geometry ( measured with dual-energy X-ray absorptiometry and peripheral computed tomography at several axial and limb sites ) and physical performance ; the secondary endpoint was change in biochemical markers of bone turnover . The jumping exercise was conducted an average 1.6 + /- 0.9 ( mean + /- SD ) times a week . Alendronate daily was effective in increasing bone mass at the lumbar spine ( alendronate vs placebo 3.5 % ; 95 % CI , 2.2 - 4.9 % ) and femoral neck ( 1.3 % ; 95 % CI , 0.2 - 2.4 % ) but did not affect other bone sites . Exercise alone had no effect on bone mass at the lumbar spine or femoral neck ; it had neither an additive nor an interactive effect with alendronate at these bone sites . However , at the distal tibia the mean increase of 3.6 % ( 0.3 - 7.1 % ) in the section modulus ( that is , bone strength ) and 3.7 % ( 0.1 - 7.3 % ) increase in the ratio of cortical bone to total bone area were statistically significant in the exercise group compared to the nonexercise group , indicating exercise-induced thickening of the bone cortex . Bone turnover was reduced in alendronate groups only . Alendronate had no effect on physical performance while the jumping exercise improved leg extensor power , dynamic balance , and cardiorespiratory fitness . As conclusion Alendronate is effective in increasing bone mass at the lumbar spine and femoral neck , while exercise is effective in increasing the mechanical properties of bone at some of the most loaded bone sites , as well as improving the participants ' muscular performance and dynamic balance . Together alendronate and exercise may effectively decrease the risk of osteoporotic fractures OBJECTIVES This study was design ed to determine the effect of exercise on the physical fitness level and quality of life in postmenopausal women . 81 volunteer postmenopausal women who entered the menopause naturally and have been taking hormone replacement treatment ( HRT )  were divided r and omly into two groups : exercise ( n=41 ) and control ( n=40 ) . METHODS Physical fitness tests and the Nottingham Health Profile ( NHP ) were used to assess physical fitness and quality of life in both groups , both before and after 6 weeks . The study group participated in an exercise programme , which was composed of sub-maximal aerobic exercises for a 6-week period 3 times a week . The statistical analyses were done by paired sample s t-test and independent sample s t-test . RESULTS At the end of 6 weeks exercise period , when the two groups were compared after the exercise period , we found statistically significant differences in strength , endurance , flexibility and balance parameters in the exercise group ( P<0.05 ) . There was also a statistically significant change in the exercise group for the NHP indicating an improvement in the quality of life ( P<0.05 ) . CONCLUSIONS In this study , it was concluded that the fitness level and quality of life on postmenopausal women could be improved by a regular and controlled exercise programme of 6 weeks The aim of this r and omized controlled trial was to evaluate the effects of 18 months of calisthenics and endurance training regimens on bone mineral density ( BMD ) in perimenopausal women . Clinical ly healthy sedentary female volunteers ( n = 105 ) aged 52 - 53 years were r and omly assigned to a calisthenics ( n = 36 ) , endurance ( n = 34 ) , or control ( n = 35 ) group . The calisthenics training ( 2.6 times per week on average , 50 minutes per session ) consisted of rhythmic strength-endurance exercises by large muscle groups , and the endurance training ( 3.2 times per week , 50 minutes ) consisted of walking , stair climbing , ergometer cycling , and jogging at a controlled heart rate zone corresponding to 55 - 75 % of the individual maximal oxygen uptake ( VO2max ) of the subjects . The control subjects performed a light stretching program once a week The BMD of the lumbar spine ( L2-L4 ) , right femoral neck , calcaneus , and distal radius was measured by dual-energy X-ray absorptiometry at 0 , 4 , 8 , 10 , 14 , and 18 months , and the maximal isometric strength during trunk extension and flexion , leg extension , and arm flexion and the VO2max by ergospirometry were evaluated at 0 , 8 , 10 , and 18 months of intervention . The VO2max improved significantly ( p = 0.021 ) in the endurance group . The linear trend of the femoral neck BMD in the endurance group , as determined by generalized linear models , was significantly different ( p = 0.043 ) from that of the control group , the trend indicating a maintenance of the pre study BMD . In the calisthenics group , the training effect was not significant . However , the distal radius BMD of the endurance group showed a significant negative trend ( p = 0.006 ) . These results suggest that multiexercise endurance training maintains the BMD the clinical ly important femoral neck of perimenopausal women . This form of endurance training proved also to be feasible for healthy perimenopausal women Objective To evaluate effectiveness and long-term benefits of a specific balance- strategy training program in sedentary women aged 40–60 years and whether participation leads to adoption of a more active lifestyle . Method Fifty healthy women were admitted to the r and omized , controlled trial on the basis of their activity level . Subjects were r and omly assigned to an intervention or control group , with the former attending twice-weekly for 12 weeks . Assessment s made pre- and post-intervention and at 9 months follow-up included : personal demographics , hormone replacement therapy medication , activity level , balance measures , somatosensory function , ankle flexibility and leg muscle strength . Results The intervention group showed improvement in balance measures ( p < 0.030 ) , right ankle tactile sensation ( p = 0.027 ) , ankle flexibility ( p < 0.000 ) and muscle strength ( p < 0.018 ) of quadriceps , hip abductors and external rotators , compared with the control group immediately after intervention . At 9 months follow-up , the intervention effect was maintained for all measures and a latent improvement of somatosensory measures ( tactile acuity of foot ( p < 0.05 ) , joint repositioning sense ( p < 0.010 ) , and vibration threshold of the left knee ( p < 0.016 ) ) revealed . The intervention group also adopted a more active lifestyle ( p = 0.000 ) . Conclusion These results provide evidence that this physiotherapist- design ed program preserves/reverses the balance decline associated with age and leads to adoption of a more active lifestyle OBJECTIVES To determine whether an individualized falls prevention program comprising exercise , visual , and counseling interventions can reduce physiological falls risk and falls in older people . DESIGN R and omized , controlled trial of 12 months ' duration . SETTING Falls Clinic , Royal North Shore Hospital , Sydney , Australia . PARTICIPANTS Six hundred twenty people aged 75 and older recruited from a health insurance company membership data base . INTERVENTIONS Participants in the extensive intervention group ( EIG ) received individualized interventions comprising exercise and strategies for maximizing vision and sensation ; the minimal intervention group ( MIG ) received brief advice ; and the control group ( CG ) received no intervention . MEASUREMENTS Accidental falls , vision , postural sway , coordinated stability , reaction time , lower limb muscle strength , sit-to-st and performance , and physiological profile assessment ( PPA ) falls risk scores . RESULTS At the 6-month follow-up , PPA falls risk scores were significantly lower in the EIG than in the CG . EIG subjects assigned to the extensive exercise intervention group showed significant improvements in tests of knee flexion strength and sit-to-st and times but no improvements in balance . EIG subjects assigned to the extensive visual intervention group showed significant improvements in tests of visual acuity and contrast sensitivity . The rate of falls and injurious falls within the trial period were similar in the three groups . CONCLUSION The individualized intervention program reduced some falls risk factors but did not prevent falls . The lack of an effect on falls may reflect insufficient targeting of the intervention to an at-risk group OBJECTIVE --To determine the effectiveness of group- vs home-based exercise training of higher and lower intensities among healthy , sedentary older adults . DESIGN --Year-long r and omized , controlled trial comparing ( 1 ) higher-intensity group-based exercise training ; ( 2 ) higher-intensity home-based exercise training ; ( 3 ) lower-intensity home-based exercise training ; or ( 4 ) assessment -only control . SETTING --General community located in northern California . PARTICIPANTS --One hundred sixty women and 197 men 50 to 65 years of age who were sedentary and free of cardiovascular disease . One out of nine persons contacted through a community r and om-digit-dial telephone survey and citywide promotion were r and omized . INTERVENTIONS --For higher-intensity exercise training , three 40-minute endurance training sessions per week were prescribed at 73 % to 88 % of peak treadmill heart rate . For lower-intensity exercise training , five 30-minute endurance training sessions per week were prescribed at 60 % to 73 % of peak treadmill heart rate . MAIN OUTCOME MEASURES --Treadmill exercise test performance , exercise participation rates , and heart disease risk factors . RESULTS --Compared with controls , subjects in all three exercise training conditions showed significant improvements in treadmill exercise test performance at 6 and 12 months ( P less than .03 ) . Lower-intensity exercise training achieved changes comparable with those of higher-intensity exercise training . Twelve-month exercise adherence rates were better for the two home-based exercise training conditions relative to the group-based exercise training condition ( P less than .0005 ) . There were no significant training-induced changes in lipid levels , weight , or blood pressure . CONCLUSIONS --We conclude that ( 1 ) this community-based exercise training program improved fitness but not heart disease risk factors among sedentary , healthy older adults ; ( 2 ) home-based exercise was as effective as group exercise in producing these changes ; ( 3 ) lower-intensity exercise training was as effective as higher-intensity exercise training in the home setting ; and ( 4 ) the exercise programs were relatively safe
target: This review found that muscle strength , balance , and endurance can be improved by physical activity in people aged 40 - 65 years .
  There were bigger effects on muscle strength from programs that used resistance exercises , indicating the need to include a resistance training component if strength enhancement is the goal
background: QUESTION Can physical activity  in adults aged 40 - 65 years enhance strength and balance and prevent falls ?