Leisure-time physical activity levels and changes in relation to risk of hip fracture in men and women.

The Copenhagen Center for Prospective Population Studies, Danish Epidemiology Science Center at the Institute of Preventive Medicine, Copenhagen University Hospital, Copenhagen, Denmark.
American Journal of Epidemiology (Impact Factor: 5.23). 08/2001; 154(1):60-8.
Source: PubMed


The authors prospectively studied the effect of leisure-time physical activity level on hip fracture risk along with the influence of within-subject changes in activity levels, while taking possible confounding by other health behaviors and poor health into account. Analyses were based on pooled data from three population studies conducted in Copenhagen, Denmark. Among 13,183 women and 17,045 men, 1,121 first hip fractures were identified during follow-up. In comparison with being sedentary, the relative risk (RR) of hip fracture associated with being moderately physically active 2-4 hours per week was 0.72 (95% confidence interval (CI): 0.59, 0.89) in women and 0.75 (95% CI: 0.55, 1.03) in men after adjustment for confounders. Being in the most active leisure activity category did not decrease the risk of hip fracture further. Adjustment for poor health affected the risk estimates only modestly. Subjects who, during follow-up, reduced their physical activity level from the highest or the intermediate activity level to a sedentary level had a higher risk of hip fracture than did those who remained moderately physically active at the intermediate level (multivariate adjusted RR = 2.19, 95% CI: 1.00, 4.84 and RR = 1.89, 95% CI: 1.21, 2.95, for reduction from the highest and intermediate levels, respectively). There was no evidence of a fracture-protective effect from increasing physical activity. In conclusion, moderate levels of physical activity appear to provide protection against later hip fracture. Decline in the physical activity level over time is an important risk factor for hip fracture.

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    • "In recent years a number of studies have demonstrated the benefits of promoting an increase in PA to reduce pain and improve quality of life in the adult population with MSDs, [19-21] to reduce musculoskeletal impairment in the elderly, [20] and reduce pain for those with low back pain (LBP) [22], neck pain, and shoulder pain [23]. Physical activity has also been shown to play a role in protecting against later hip fracture in an adult population [24] and reducing the incidence of osteoporotic vertebral fractures in an elderly population [25]. Results from a systematic review also support the effectiveness of PA to treat and prevent a number of chronic disorders [26]. "
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    ABSTRACT: Background Physical activity (PA) plays an important role in the prevention and management of a number of chronic conditions. Aim: to investigate the evidence for effectiveness of pedometer-driven walking programs to promote physical activity among patients with musculoskeletal disorders (MSDs). Method A comprehensive systematic review was performed using 11 electronic databases up to 20 February 2014. Keywords and MeSH terms included “musculoskeletal disorders”, “walking”, and “pedometer”. Randomized controlled trials, published in English, that examined the effects of a pedometer-based walking intervention to increase physical activity levels and improve physical function and pain in patients with musculoskeletal disorders were included. Result Of the 1996 articles retrieved, seven studies ranging in date of publication from 1998 to 2013 met the inclusion criteria, allowing data extraction on 484 participants with an age range of 40 to 82 years. Interventions lasted from 4 weeks to 12 months and the results across studies showed significant increases in step count (p < 0.05) following the intervention. Across these studies, there was a mean increase in PA of 1950 steps per day relative to baseline. Four studies reported improved scores for pain and/or physical function at the intervention completion point relative to controls. Conclusion This study provides strong evidence for the effectiveness of pedometer walking interventions in increasing PA levels for patients with MSDs. Our findings suggest that a combination of interventions is likely to be the most effective strategy to maximize health benefits in the short term. Further research should include larger sample sizes, and longer intervention durations are required to support the role of pedometer walking interventions as a long term intervention for management of musculoskeletal disorders.
    BMC Musculoskeletal Disorders 07/2014; 15(1):231. DOI:10.1186/1471-2474-15-231 · 1.72 Impact Factor
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    • "During the last few decades, physical inactivity has been shown to be associated with a greater hip fracture risk among older people [7]. In large, prospective studies, moderate or high leisure time physical activity has been associated with a 28-42% reduction in hip fracture risk [6,8-10]. Physical activity has several advantages, including increased bone strength [11] and decreased risk of falling [12]. "
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    ABSTRACT: Background Several risk factors are associated to hip fractures. It seems that different hip fracture types have different etiologies. In this study, we evaluated the lifestyle-related risk factors for cervical and trochanteric hip fractures in older women over a 13-year follow-up period. Methods The study design was a prospective, population-based study consisting of 1681 women (mean age 72 years). Seventy-three percent (n = 1222) participated in the baseline measurements, including medical history, leisure-time physical activity, smoking, and nutrition, along with body anthropometrics and functional mobility. Cox regression was used to identify the independent predictors of cervical and trochanteric hip fractures. Results During the follow-up, 49 cervical and 31 trochanteric fractures were recorded. The women with hip fractures were older, taller, and thinner than the women with no fractures (p < 0.05). Low functional mobility was an independent predictor of both cervical and trochanteric fractures (HR = 3.4, 95% CI 1.8-6.6, and HR = 5.3, 95% CI 2.5-11.4, respectively). Low baseline physical activity was associated with an increased risk of hip fracture, especially in the cervical region (HR = 2.5, 95% CI 1.3-4.9). A decrease in cervical fracture risk (p = 0.002) was observed with physically active individuals compared to their less active peers (categories: very low or low, moderate, and high). Moderate coffee consumption and hypertension decreased the risk of cervical fractures (HR = 0.4, 95% CI 0.2-0.8, for both), while smoking was a predisposing factor for trochanteric fractures (HR = 3.2, 95% CI 1.1-9.3). Conclusions Impaired functional mobility, physical inactivity, and low body mass may increase the risk for hip fractures with different effects at the cervical and trochanteric levels.
    BMC Musculoskeletal Disorders 09/2012; 13(1):173. DOI:10.1186/1471-2474-13-173 · 1.72 Impact Factor
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    • "All of their suggestions seem plausible and are substantiated by empirical studies. Their arguments, plus the findings of Huang et al. (1996), that reduced arm muscle areas were significantly and inversely related to subsequent hip fracture risk in persons with poor nutritional status, along with findings that men and women with fresh hip fractures display significant reductions in the size of Table 4 Evidence that physical activity participation reduces hip fracture risk Authors Study design Finding Cooper et al. (1988) Case–control study of 300 elderly men and women with hip fracture and 600 controls matched for age and sex Daily activity, including standing and walking protected against hip fracture Coupland et al. (1993) Population based, case–control study of 197 patients older than 50 years with hip fracture and 382 controls matched by age and sex Customary physical inactivity is an independent determinant of hip fracture in the elderly Grisso et al. (1997) Case–control study of 34 hospitals and 356 men with first hip fracture and 402 control men matched for age and geographic location Physical activity was markedly protective Hoidrup et al. (2001) Prospective study of leisure-time physical activity levels and changes in relation to risk of hip fracture among 1211 men and women with first hip fractures Moderate levels of physical activity appear to protect against later hip fracture; declining physical activity over time is an important risk factor for hip fracture Joakimsen et al. (1997) Meta-analysis of studies on the association between physical activity and hip fractures The association is present for physical activity from childhood to adult age, and is consistent across populations; daily chores, such as stair climbing and walking, plus leisure activities protect against hip fracture Kanis et al. (1999) Case–control study of 730 European men with hip fracture and 1132 age-stratified controls were followed prospectively Decreased physical activity and exposure to sunlight accounted for the highest attributable risks among a number of different risk factors Lau et al. (1988) Case–control study of 400 Chinese men and women with hip fractures and 800 controls Daily walking outdoors, upstairs, uphill, or with a load protected against fracture, as did higher levels of reported activity in middle life, independent of smoking or alcohol consumption Nieves et al. (1992) Case–control study of 161 white women with hip fracture and 168 cases matched by age, hospital and frequency of utilization services Recreational activities in adolescence and early adulthood afford protection against hip fracture; greater protection seemed afforded by the frequency of participation Suriyawongpaisal et al. (2001) Case–control study of 187 Thai men over 51 years of age with hip fracture and 177 age-matched community controls Physical activity was independently associated with reduced risk of hip fracture after controlling for confounding factors Wickham et al. (1989a) Fifteen years follow-up study of 1688 community-dwelling subjects "
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    ABSTRACT: This review examines all pertinent literature sources published in the English language between 1966 to the present concerning hip fracture epidemiology, hip fracture injury mechanisms, and hip fracture management strategies. These data reveal hip fractures have several causes, but among these, the impact of falls and muscle weakness, along with low physical activity levels seems to be the most likely explanation for the rising incidence of hip fracture injuries. Related determinants of suboptimal nutrition, drugs that increase fall risk and lower the safety threshold and comorbid conditions of the neuromuscular system may also contribute to hip fracture disability. A number of interventions may help to prevent hip fracture injuries, including, interventions that optimize bone mass and quality, interventions that help prevent falls and falls dampening interventions. Rehabilitation outcomes may be improved by comprehensive interventions, prolonged follow-up strategies and ensuring that all aging adults enjoy optimal health.
    Ageing Research Reviews 02/2003; 2(1):57-93. DOI:10.1016/S1568-1637(02)00045-4 · 4.94 Impact Factor
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