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1.  Muscular strength and adiposity as predictors of adulthood cancer mortality in men 
BACKGROUND
We examined the associations between muscular strength, markers of overall and central adiposity and cancer mortality in men.
METHODS
Prospective cohort study including 8,677 men aged 20-82 years followed from 1980 to 2003. Participants were enrolled in The Aerobics Centre Longitudinal Study, the Cooper Clinic in Dallas, Texas, U.S. Muscular strength was quantified by combining 1-repetition maximal measures for leg and bench presses. Adiposity was assessed by body mass index (BMI), percent body fat, and waist circumference.
RESULTS
Cancer death rates per 10,000 person-years adjusted for age and examination year were: 17.5, 11.0, and 10.3 across incremental thirds of muscular strength (P=0.001); 10.9, 13.4, and 20.1 across BMI groups of 18.5-24.9, 25.0-29.9, and ≥30kg/m2, respectively (P=0.008); 11.6 and 17.5 for normal (<25%) and high percent body fat (≥25%), respectively (P=0.006); and 12.2 and 16.7 for normal (≤102 cm) and high waist circumference (>102 cm), respectively (P=0.06). After adjusting for additional potential confounders, hazard ratios (95% confidence intervals) were 1.00 (referent), 0.65 (0.47-0.90), and 0.61 (0.44-0.85) across incremental thirds of muscular strength, respectively (P=0.003 for linear trend). Further adjustment for BMI, percent body fat, waist circumference, or cardiorespiratory fitness had little effect on the association. The associations of BMI, percent body fat, or waist circumference with cancer mortality did not persist after further adjusting for muscular strength (all P≥0.1).
CONCLUSIONS
Higher levels of muscular strength are associated with lower cancer mortality risk in men, independent of clinically established measures of overall and central adiposity, and other potential confounders.
doi:10.1158/1055-9965.EPI-08-1075
PMCID: PMC3762582  PMID: 19366909
Muscular strength; obesity; cancer; cardiorespiratory fitness; resistance exercise
2.  Meeting Physical Activity Guidelines and Musculoskeletal Injury: The WIN Study 
Introduction
The United States Department of Health and Human Services disseminated physical activity guidelines for Americans in 2008. The guidelines are based on appropriate quantities of moderate-to-vigorous aerobic physical activity and resistance exercise associated with decreased morbidity and mortality risk and increased health benefits. However, increases in physical activity levels are associated with increased risk of musculoskeletal injuries. We related the amount and type of physical activity conducted on a weekly basis with the risk of musculoskeletal injury.
Methods
Prospective, observational study using weekly Internet tracking of moderate-to-vigorous physical activity and resistance exercise behaviors and musculoskeletal injuries in 909 community-dwelling women for up to 3 years. Primary outcome was self-reported musculoskeletal injuries (total, physical activity-related, and non physical activity-related) interrupting typical daily work and/or exercise behaviors for ≥2 days or necessitating health care provider visit.
Results
Meeting versus not meeting physical activity guidelines was associated with more musculoskeletal injuries during physical activity (hazard ratio [HR] = 1.39, 95% confidence interval [CI] = 1.05 – 1.85, P = 0.02), but was not associated with musculoskeletal injuries unrelated to physical activity (HR = 0.99, 95% CI = 0.75 – 1.29, P = 0.92), or with musculoskeletal injuries overall (HR = 1.15, 95% CI = 0.95 – 1.39, P = 0.14).
Conclusions
Results illustrate the risk of musculoskeletal injury with physical activity. Musculoskeletal injury risk rises with increasing physical activity. Despite this modest increase in musculoskeletal injuries, the known benefits of aerobic and resistance physical activities should not hinder physicians from encouraging patients to meet current physical activity guidelines for both moderate-to-vigorous exercise and resistance exercise behaviors with the intent of achieving health benefits.
doi:10.1249/MSS.0b013e31825a36c6
PMCID: PMC3445731  PMID: 22525778
MODERATE; PREVALENCE; STRENGTHENING; VIGOROUS
3.  Long-Term Tracking of Physical Activity Behaviors in Women: The WIN Study 
Purpose
Interest lies in the prevalence of community-living women meeting 2008 Department of Health and Human Services physical activity guidelines across time. The purpose was to report prevalence and stability of long-term (up to 125 weeks) tracking of physical activity behaviors and compare self-reported physical activity behaviors using different measures.
Methods
The WIN study tracks nearly real-time physical activity behaviors in community-living women. At baseline, 918 women began weekly Internet reporting of physical activity behaviors, accessing a secure Internet site and answering 8 questions about physical activity behaviors for the previous week. Measures included days and minutes of moderate, vigorous, walking, and strengthening activities, and pedometer steps recorded weekly.
Results
Prevalence of meeting physical activity guidelines depended on the criterion used. Weekly averages across the surveillance period indicated 25% reported ≥150 mins of moderate physical activity, 47% reported ≥75 mins of vigorous physical activity, 57% reported ≥150 mins of moderate-to-vigorous physical activity, 63% conducted ≥500 MET-mins of physical activity, 15% reported ≥2 days of strengthening activities per week, and 39% reported ≥7500 steps per week. Alpha coefficients (≥.97) indicated stable physical activity behaviors across all measures.
Conclusion
Across reporting methods, it is estimated that approximately 50% or more of these community-living women engage in sufficient physical activity for health benefits weekly across long-term follow-up. Self-report physical activity behaviors are stable across long periods in these community-living women not participating in a specific physical activity intervention.
doi:10.1249/MSS.0b013e3181e61937
PMCID: PMC2980794  PMID: 20473221
pedometers; self-report; strength; walking
4.  Clinical Implications for Muscle Strength Differences in Women of Different Age and Racial Groups: The WIN Study 
Background
Reduction in muscle strength is strongly associated with functional decline in women, and women with lower quadriceps strength adjusted for body weight are more likely to develop knee osteoarthritis.
Objective
To compare body weight--adjusted strength among women of different age/racial groups.
Study Design
Cross-sectional study of muscle strength in 918 women aged 20--83 (M ± SD = 52 ± 13).
Methods
An orthopedic examination was conducted including measurement of handgrip and lower extremity strength (hip abductors/external rotators, knee flexors/extensors). Data were grouped into young (20--39 years, n = 139), middle (40--54 years, n = 300), and older (55+ years, n = 424) ages for white (n = 699) and African American (AA) (n = 164) women. Means and standard deviations for strength adjusted for body weight were calculated for each age and racial group and compared using 2-way multivariate analysis of variance and post hoc tests.
Results
No significant age-by-race interaction (P = .092) but significant main effects for age and race (P < .001). Pairwise comparisons revealed significant differences in knee extensor and flexor strength between all age groups. For grip and hip external rotator strength, significant differences were found between the middle and older groups. Differences in hip abductor strength were found between the young and middle-aged groups. AA women had lower strength than white women in all muscle groups (P < .05) except hip external rotators.
Conclusions
Strength decreased with age in all muscle groups but magnitude of decrease varied by muscle. Strengthening programs should target different muscles, depending on a woman's age and race.
doi:10.1097/JWH.0b013e318212570c
PMCID: PMC3111145  PMID: 21666779
African American; osteoarthritis; physical activity guidelines
5.  Relations of Meeting National Public Health Recommendations for Muscular Strengthening Activities With Strength, Body Composition, and Obesity: The Women’s Injury Study 
American journal of public health  2011;101(10):1930-1935.
Objectives
We examined the relations of meeting or not meeting the 2008 Physical Activity Guidelines for Americans recommendations for muscular strengthening activities with percentage of body fat, body mass index (BMI; defined as weight in kilograms divided by height in meters, squared), muscular strength, and obesity classification in women.
Methods
We analyzed data on 918 women aged 20 to 83 years in the Women’s Injury Study from 2007 to 2009. A baseline orthopedic examination included measurement of height, body weight, skinfolds, and muscle strength.
Results
Women who met muscle strengthening activity recommendations had significantly lower BMI and percentage of body fat and higher muscle strength. Women not meeting those recommendations were more likely to be obese (BMI≥30) compared with women who met the recommendations after we adjusted for age, race, and aerobic physical activity (odds ratio = 2.28; 95% confidence interval = 1.61, 3.23).
Conclusions
There was a small but significant positive association between meeting muscle strengthening activity recommendations and muscular strength, a moderate inverse association with body fat percentage, and a strong inverse association with obesity classification, providing preliminary support for the muscle strengthening activity recommendation for women.
doi:10.2105/AJPH.2011.300175
PMCID: PMC3174351  PMID: 21852647
6.  Internet Reporting of Weekly Physical Activity Behaviors: The WIN Study 
Background
Self-report measures have been validated and are widely used. Interest currently lies in the development of simple, valid methods that can be used in any location to determine level of PA in large populations/samples. The purpose of this report is to illustrate tracking of physical activity behaviors and musculoskeletal injury reports on a weekly basis via the Internet.
Methods
The Women’s Injury Study (WIN) methodology includes use of BRFSS-related physical activity items that are completed online by more than 800 women weekly for an average of 3 years.
Results
With more than 45,000 weekly physical activity and injury logs, the percentage of total logs submitted via online records is 91%. Self-reported pedometer steps are consistent with similar, smaller research samples.
Conclusions
This report suggests that Internet tracking is a viable means of assessing nearly real-time physical activity, describes the process of developing and monitoring self-reported physical activity behaviors via the Internet, and provides recommendations for others considering such methods.
PMCID: PMC2917263  PMID: 20683095
injury; MVPA; tracking
7.  Lumbar Spine Flexion and Extension Extremes of Motion in Women of Different Age and Racial Groups 
Spine  2010;35(16):1539-1544.
Study Design
Observational.
Objective
To provide normative values of lumbar flexion and extension for women of different age and racial groups.
Summary of Background Data
Spinal range of motion (ROM) is one of the AMA Guides criteria used to estimate level of impairment and subsequent compensation entitlement. Studies show that spinal ROM varies with age, gender, and possibly race/ethnicity, but adequate normative values for different age and racial/ethnic groups do not exist.
Methods
A cohort of free-living women was recruited for the Women's Injury Study at The Cooper Institute in Dallas. Originally, 917 women between the ages of 20 and 83 (M = 52 ± 13) underwent an orthopedic examination including lumbar spine flexion and extension measurement using an electronic inclinometer. Measurements were taken in the fully extended and flexed positions, respectively. This removes the influence of initial resting posture and is termed “extreme of motion” (EOM) as opposed to ROM. Age and racial groups were compared using a 2-way multivariate analysis of variance (MANOVA) followed with post hoc tests.
Results
Means (±SD) were calculated for racial (white, N = 619, African-American, N = 147) and age groups (young, 20–39 years, n = 126; middle, 40–59 years, n = 412; older, ≥60 years, n = 228). Lumbar extension for African-American women (60.1°) was significantly greater (P < 0.05) than for white women (52.6°), but flexion was not different (15.2° and 17.0°), respectively. Extension EOM for the young group (61.6°) was greater (P < 0.05) than the middle (56.6°) and older (50.8°) groups. Extension difference between the middle and older groups was significant. Flexion EOM for the young group (20.1°) was greater (P < 0.05) than the middle (15.2°) and older (12.8°) groups. The difference in flexion between the middle and older groups was not significant.
Conclusion
Normative values of lumbar extension are different for white and African-American women. Values for lumbar flexion and extension are different between age groups. Different criteria should be used to estimate impairment level in women of different racial and age groups.
doi:10.1097/BRS.0b013e3181b0c3d1
PMCID: PMC2888885  PMID: 20072092
normative values; electronic inclinometer; range of motion; African-American
8.  Association between muscular strength and mortality in men: prospective cohort study 
BMJ : British Medical Journal  2008;337(7661):92-95.
Objective To examine prospectively the association between muscular strength and mortality from all causes, cardiovascular disease, and cancer in men.
Design Prospective cohort study.
Setting Aerobics centre longitudinal study.
Participants 8762 men aged 20-80.
Main outcome measures All cause mortality up to 31 December 2003; muscular strength, quantified by combining one repetition maximal measures for leg and bench presses and further categorised as age specific thirds of the combined strength variable; and cardiorespiratory fitness assessed by a maximal exercise test on a treadmill.
Results During an average follow-up of 18.9 years, 503 deaths occurred (145 cardiovascular disease, 199 cancer). Age adjusted death rates per 10 000 person years across incremental thirds of muscular strength were 38.9, 25.9, and 26.6 for all causes; 12.1, 7.6, and 6.6 for cardiovascular disease; and 6.1, 4.9, and 4.2 for cancer (all P<0.01 for linear trend). After adjusting for age, physical activity, smoking, alcohol intake, body mass index, baseline medical conditions, and family history of cardiovascular disease, hazard ratios across incremental thirds of muscular strength for all cause mortality were 1.0 (referent), 0.72 (95% confidence interval 0.58 to 0.90), and 0.77 (0.62 to 0.96); for death from cardiovascular disease were 1.0 (referent), 0.74 (0.50 to 1.10), and 0.71 (0.47 to 1.07); and for death from cancer were 1.0 (referent), 0.72 (0.51 to 1.00), and 0.68 (0.48 to 0.97). The pattern of the association between muscular strength and death from all causes and cancer persisted after further adjustment for cardiorespiratory fitness; however, the association between muscular strength and death from cardiovascular disease was attenuated after further adjustment for cardiorespiratory fitness.
Conclusion Muscular strength is inversely and independently associated with death from all causes and cancer in men, even after adjusting for cardiorespiratory fitness and other potential confounders.
doi:10.1136/bmj.a439
PMCID: PMC2453303  PMID: 18595904
9.  Association between muscular strength and mortality in men: prospective cohort study 
Objective To examine prospectively the association between muscular strength and mortality from all causes, cardiovascular disease, and cancer in men.
Design Prospective cohort study.
Setting Aerobics centre longitudinal study.
Participants 8762 men aged 20-80.
Main outcome measures All cause mortality up to 31 December 2003; muscular strength, quantified by combining one repetition maximal measures for leg and bench presses and further categorised as age specific thirds of the combined strength variable; and cardiorespiratory fitness assessed by a maximal exercise test on a treadmill.
Results During an average follow-up of 18.9 years, 503 deaths occurred (145 cardiovascular disease, 199 cancer). Age adjusted death rates per 10 000 person years across incremental thirds of muscular strength were 38.9, 25.9, and 26.6 for all causes; 12.1, 7.6, and 6.6 for cardiovascular disease; and 6.1, 4.9, and 4.2 for cancer (all P<0.01 for linear trend). After adjusting for age, physical activity, smoking, alcohol intake, body mass index, baseline medical conditions, and family history of cardiovascular disease, hazard ratios across incremental thirds of muscular strength for all cause mortality were 1.0 (referent), 0.72 (95% confidence interval 0.58 to 0.90), and 0.77 (0.62 to 0.96); for death from cardiovascular disease were 1.0 (referent), 0.74 (0.50 to 1.10), and 0.71 (0.47 to 1.07); and for death from cancer were 1.0 (referent), 0.72 (0.51 to 1.00), and 0.68 (0.48 to 0.97). The pattern of the association between muscular strength and death from all causes and cancer persisted after further adjustment for cardiorespiratory fitness; however, the association between muscular strength and death from cardiovascular disease was attenuated after further adjustment for cardiorespiratory fitness.
Conclusion Muscular strength is inversely and independently associated with death from all causes and cancer in men, even after adjusting for cardiorespiratory fitness and other potential confounders.
doi:10.1136/bmj.a439
PMCID: PMC2453303  PMID: 18595904

Results 1-9 (9)