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To ascertain whether decrements in knee extensor muscle strength persist years after a traumatic ligamentous or meniscal knee injury, with reference to (1) the type of muscle activity, (2) the dominance of injury, and (3) the time since injury, 36 subjects with previous unilateral knee injuries were assessed. Peak voluntary quadriceps muscle strength was measured using the KinCom 500H dynamometer during isometric, concentric (30 degrees.s-1 and 120 degrees.s-1) and eccentric contractions (30.s-1), and the findings for each type of contraction were compared. Significant differences in quadriceps muscle strength were seen between (1) the injured and uninjured limbs during maximal voluntary isometric (P = 0.0003), concentric (P < 0.0001) and eccentric (P < 0.0001) contractions, and (2) the isometric and concentric decrements (P = 0.004), and the isometric and eccentric decrements (P = 0.012) within the same injured limb. The decrements in eccentric strength were significantly greater if they affected the dominant rather than the non-dominant limb (P = 0.0186). No relationship was seen between the time since injury and the degree of isometric or dynamic decrement. Deficits in quadriceps muscle strength remained for a long time after traumatic knee injury, with exercise levels rarely returning to the previously uninjured state. The degree of decrement in muscle strength was dependent upon the type of muscle activity, with concentric and eccentric activity showing greater decrements than those seen with isometric activity. Deficits in the type of activity varied widely in the same individual, and eccentric decrements were significantly worse following dominant knee injuries. Possible explanations for these findings and the implications for rehabilitation following knee injury are discussed.

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The aim of this study was to establish whether asymmetry of the strength of the leg and trunk musculature is more prominent in rowers than in controls. Nineteen oarsmen and 20 male controls matched for age, height and body mass performed a series of isokinetic and isometric strength tests on an isokinetic dynamometer. These strength tests focused on the trunk and leg muscles. Comparisons of strength were made between and within groups for right and left symmetry patterns, hamstring: quadriceps ratios, and trunk flexor and extensor ratios. The results revealed no left and right asymmetries in either the knee extensor or flexor strength parameters (including both isometric and isokinetic measures). Knee extensor strength was significantly greater in the rowing population, but knee flexor strength was similar between the two groups. No difference was seen between the groups for the hamstring: quadriceps strength ratio. In the rowing population, stroke side had no influence on leg strength. No differences were observed in the isometric strength of the trunk flexors and extensors between groups, although EMG activity was significantly higher in the rowing population. Patterns of asymmetry of muscle activity were observed between the left and right erector spinae muscles during extension, which was significantly related to rowing side (P < 0.01). These observations could be related to the high incidence of low back pain in oarsmen.

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The human voluntary force:velocity relationship frequently fails to demonstrate the expected high eccentric forces. Possible explanations include unique activation strategies which might be affected by neural learning mechanisms. We investigated the effect of practicing eccentric contractions on (1) the force:velocity relationship of the human knee extensor muscles and (2) the extent of agonist and antagonist muscle activity. Eight healthy adults [seven women, group mean age 31 (SEM 5) years +/-] practiced twice a week for 4 weeks using their non-dominant legs. Each session comprised three isokinetic concentric and eccentric maximal voluntary contractions (MVC) at randomised angular velocities of 100, 200 and 300 degrees.s-1. Before and after, the force:velocity relationship was determined bilaterally (angular velocities 0-300 degrees.s-1). There were no significant differences in the forces generated or relative electromyogram (EMG) activity after practice, although there was a trend for dynamic forces to increase. Beforehand, the bilateral eccentric MVC forces were lower than isometric (P < 0.0025); afterwards they were broadly similar. The agonist EMG was similar during isometric and eccentric contractions, but lower during concentric (P < 0.03). Antagonist EMG activity showed considerable individual variation, was similar during all contraction types and tended to be greater during dynamic contractions. These data indicate that neither central learning mechanisms nor total muscle activation strategies underlie the human failure to produce the expected high eccentric voluntary forces in humans.

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Few studies have investigated peripheral muscle strength and quality in patients with cystic fibrosis (CF). The present study tested the isometric and isokinetic strength of the quadriceps and hamstrings using an isokinetic dynamometer and a strength-testing chair in 25 CF adults and 25 controls. Total body and leg muscle mass were determined by dual-energy X-ray absorptiometry, and bone mineral density (BMD) was also measured. Both muscle strength and muscle mass (total body and leg) were decreased in the CF group. In both groups there was a highly significant relationship between quadriceps strength and leg muscle mass (CF, r=0.7, P=0.0002; controls, r=0.6, P=0.0013). When strength was normalized for muscle size, there was no significant difference between the two groups. Total body and leg BMD were significantly reduced in CF subjects compared with controls. However, when corrected for height, the differences disappeared. There was a significant relationship found between leg muscle mass and leg BMD. We conclude that CF adults are significantly weaker than controls. This is due to lower muscle mass, and not to a reduced force-generating capacity of the muscle, implying that there is no decrease in the quality of CF muscle. BMD is also reduced in CF subjects, and this appears to be related to shorter stature in this group.

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OBJECTIVE: To assess if any long-term decrements in balance occur after unilateral musculoskeletal injury. The relation between the size of decrement and the dominance, the type, and the time since injury were also considered. DESIGN: With eyes open and closed, postural sway in one-legged standing was recorded for 10 seconds in 48 subjects who sustained a unilateral musculoskeletal injury 6 months to 42 years earlier. Comparative data were also collected in 108 healthy subjects with no previous injury. SETTING: A university physiologic laboratory. PATIENTS: Injured subjects were recruited locally via the district general hospital, sports injury clinic, and the university, and had not received any treatment within the past 6 months. MAIN OUTCOME MEASURE: Postural sway of the injured and uninjured limb (or dominant and nondominant limb in the uninjured subjects). RESULTS: Postural sway was significantly greater in the injured limb compared with the uninjured limb (p = .0118). The ratio of the postural sway of the injured limb compared with the uninjured limb (I/UI%) was significantly lower in the group with nondominant injuries (p = .0085). Subjects with nondominant injuries performed significantly better than those with dominant injuries (p = .0085). No relation was found between the decrements in balance performance and the type of injury and time since injury. CONCLUSIONS: Full recovery is frequently not achieved and perhaps recovery does not continue to improve once the formal rehabilitation period is over.

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OBJECTIVES: To examine whether there is a role for exercise in improving bone mineral density (BMD), particularly in postmenopausal women. The effects of different types of exercise are examined together with their effects at selected skeletal sites. The role of activity in reducing falls and hip fractures will also be considered as well as the potentially negative effects of excessive exercise. METHODS: A literature search over the past 20 years was conducted and landmark papers selected. RESULTS: Certain types of exercise have been found to exert moderate benefits on BMD of the wrist, spine, and hip. Most studies do not detect a difference between the effects of endurance activities and strength training for BMD of the spine. It has been more difficult to isolate the optimal type of activity for effecting an osteogenic response at the hip, but recent evidence suggests that high impact work such as stepping and jumping may be effective at this site. The combination of hormone replacement therapy and exercise would appear to be more effective than either intervention on its own. Certain types of exercises have additional benefits, such as muscle strengthening, which could reduce the incidence of falls. Excessive exercise can lead to menstrual disturbances in female athletes and this in turn can cause bone loss, particularly from the spine. CONCLUSIONS: Exercise across the life span should be encouraged in order to maximise peak bone mass, reduce age related bone loss, and maintain muscle strength and balance. Although the effects of exercise on BMD later in life are small, epidemiological evidence suggests that being active can nearly halve the incidence of hip fractures in the older population. This effect is most probably multifactorial through the positive effects on bone, muscle strength, balance, and joint flexibility. Younger women should be aware of the dangers to the skeleton of menstrual disorders.

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Using the KinCom 500H isokinetic dynamometer the first part of this study measured the characteristics of the force velocity relationship curve for the human knee extensors between -1.57 (eccentric) and 3.67 (concentric) rads x s(-1) (-90 and 210 degrees s(1)) for both legs in 4 subjects. A significant increase in force generation was seen in eccentric activity at 0.52 rads x s(-1) (30 degrees s(-1)) but not at 1.57 rads x s(-1) (90 degrees s(-1)) compared to maximum voluntary isometric force (P < 0.005). This increase was, however, lower than would be expected from the classical force-velocity relationship. The second part of the study examined whether restricting the range of movement was able to further increase the eccentric forces. In a further 6 subjects, the eccentric contractions were repeated during either an 80 degrees (15-95 degrees flexion) and a 50 degrees (45-95 degrees flexion) range of movement. Significant increases in force were seen over the shorter range of movement at 0.52 rads x s(-1) (30 degrees s(-1)) (P = 0.006) and 1.57 rads x s(-1) (90 degrees s(-1)) (P < 0.001).

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OBJECTIVE: To ascertain if long-term deficits in quadriceps, hamstring, and plantarflexor muscle strength remain after unilateral lower-limb musculoskeletal injury and to quantify whether improvements in performance continue once a subject concludes rehabilitation and returns to everyday activities. The relation between the size of decrement and limb dominance, type of injury, and time since injury was also considered. DESIGN: Isometric and/or dynamic muscle strength of both legs was measured (using the KinCom 500H isokinetic dynamometer) in 48 subjects. SETTING: A physiological laboratory at Brunel University. PATIENTS: Patients were recruited locally via a district general hospital, sports injury clinic, and university. MAIN OUTCOME MEASURES: Muscle strength in the injured limb, reported as a percentage of muscle strength in the uninjured limb. It was assumed that the preinjury state of the injured limb was similar to that of the uninjured limb. RESULTS: Decrements were seen in mean isometric and peak isometric, concentric, and eccentric quadriceps activity (p < .0001) and isometric plantarflexor activity (p < .05) in the injured limb, with the type of injury influencing the size of the decrement. Minimal difference was found in the hamstring muscles. CONCLUSIONS: The decrements in performance in the quadriceps muscle imply that full recovery (as defined by the preinjury state) is frequently not achieved and stress the need for accurate, objective assessment of muscle strength and further investigation into the nature and duration of rehabilitation after musculoskeletal injury.

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Amenorrheic athletes have been likened to postmenopausal women, with low estrogen levels and osteopenia. It has been suggested that estrogen exerts its antiresorptive actions on bone via a nitric oxide (NO)-dependent mechanism. This study investigated whether the mechanism of bone loss in amenorrheic athletes is similar to that of postmenopausal women with reduced NO levels and high bone turnover. Eleven amenorrheic athletes, 15 eumenorrheic athletes, and 10 sedentary controls were studied. Spine and hip bone mineral density was measured using dual-energy x-ray absorptiometry. Bone turnover was assessed by biochemical markers of formation (osteocalcin and bone-specific alkaline phosphatase) and resorption (deoxypyridinoline). NO metabolites were measured from 24-h urine samples using a chemiluminescence assay. Spine, but not hip, bone mineral density was reduced in the amenorrheic group, compared with the eumenorrheic (P = 0.0001) and control (P = 0.04) groups. Osteocalcin, bone-specific alkaline phosphatase, and deoxypyridinoline were similar in all groups. NO metabolites were lower in the amenorrheic group, compared with controls (P = 0.035), despite a higher dietary intake of nitrates. Unlike postmenopausal women, amenorrheic athletes do not have raised bone turnover but do have reduced NO metabolites and spinal osteopenia. The results show, however, that reduced NO production is a common denominator in both conditions and further support the importance of NO in estrogen-mediated protection of skeletal mass and strength.

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The effects of voluntary versus electrically stimulated isometric strength training of the adductor pollicis on muscle strength were compared. The adductor pollicis of one hand was trained using voluntary contractions at 50% of the maximum voluntary contraction force, and the other with 30 Hz tetani (stimulated contractions), which produced a force equivalent to 30-50% of the maximum voluntary force. Tetani were delivered with surface electrodes placed over the ulnar nerve at the wrist. Both protocols resulted in large, significant increases in maximum voluntary strength of 79+/-44% (voluntary) and 74+/-41% (stimulated) (mean+/-s; P< 0.002). The time course of the changes was very similar for both protocols and there was no significant difference between the strength increases produced by the two protocols. The large gains resulting from stimulated training argues against central adaptations as a major contributor to the strength increases following training.

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Exercise is known to have long-term benefits on bone mass, but little is known about the short-term effects of exercise on bone turnover. The purpose of this study was to investigate whether acute effects of exercise on bone remodelling could be detected by measuring blood and urinary markers of bone turnover. We measured biochemical markers of bone turnover in ten healthy, young men before and up to 32 hours after 30 minutes of brisk treadmill walking. Blood samples were taken before, immediately after and at 0.5, 1, 8, 24 and 32 hours after the exercise. These were assayed for osteocalcin and bone specific alkaline phosphatase. Twenty-four hour urine samples were taken over three days (day before, day of and day after exercise) and measured for pyridinoline and deoxypyridinoline crosslinks. Crosslink excretion was standardised for total body bone mineral content (TBBMC) and urinary creatinine. Total body bone mineral density (and content) and body composition were measured by dual energy X-ray absorptiometry. No changes in the levels of either osteocalcin or alkaline phosphatase were seen at any time point following the exercise. Both urinary crosslinks exhibited an increase in levels on the day of the exercise and a further significant increase the day after (pyridinoline 38.7%, p = 0.05; deoxypyridinoline 42.3%, p = 0.025; median, corrected for TBBMC). There were significant negative correlations between the crosslinks, osteocalcin and body fat percentage. In conclusion, the exercise appears to have stimulated bone resorption within 32 hours of moderate exercise, but there was no measurable effect on bone formation after 32 hours. A longer study period may be necessary to detect changes in bone formation.

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1. The effect of the different phases of the menstrual cycle on skeletal muscle strength, contractile properties and fatiguability was investigated in ten young, healthy females. Results were compared with a similar group on the combined (non-phasic) oral contraceptive pill (OC). Cycle phases were divided into the early and mid-follicular, mid-cycle (ovulatory) and mid- and late luteal. Cycle phases were estimated from the first day of the menstrual bleed. 2. Subjects were studied weekly through two complete cycles. Measurements included quadriceps and handgrip maximum voluntary isometric force and the relaxation times, force-frequency relationship and fatigue index of the quadriceps during percutaneous stimulation at a range of frequencies from 1 to 100 Hz. 3. In the women not taking the OC there was a significant increase of about 11% in quadriceps and handgrip strength at mid-cycle compared with both the follicular and luteal phases. Accompanying the increases in strength there was a significant slowing of relaxation and increase in fatiguability at mid-cycle. No changes in any parameter were found in the women taking the OC. 4. The changes in muscle function at mid-cycle may be due to the increase in oestrogen that occurs prior to ovulation.

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Fifteen men and women (six men) between the ages of 50 and 73 years were recruited to begin keep-fit classes. They were matched for sex, age, menopausal status and mass to 15 non-exercising controls. The keep-fit classes were two to three times a week and included high-impact exercise, including step and jumping exercises specifically to load the proximal femur and spine. Proximal femur, lumbar spine and total body bone mineral density (BMD) were measured at 0 and 12 months. Urinary pyridinoline (Pyr) and deoxypyridinoline (dPyr) crosslinks were measured every 6 months to assess bone resorption. Quadriceps isometric strength was measured every 6 months. BMD increased non-significantly at the femoral neck [1.57 (0.8)%] and Wards triangle [1.97 (1.4)%], and significantly at the greater trochanter 2.21 (0.9)% (P = 0.02) in the exercise group. Femoral neck BMD decreased by -1.9(0.8)% (P = 0.049) in the control group, which was significantly different from the change in the exercise group (P = 0.009). BMD did not change at the Wards triangle or trochanter in the controls. Lumbar spine BMD did not change in either group. Total body BMD did not change in the exercise group, but decreased by -0.79 (0.3)% (P = 0.02) in the controls. Following 6 months of the exercise classes. Pyr and dPyr crosslinks were significantly reduced [-19.0 (7.2)%; P = 0.0019 and -20.0 (7.7)%; P = 0.021 respectively]. There was no significant change in crosslinks after 1 year, and no change at any time in the controls. Quadriceps strength changed by 5.4 (3.7)% in the exercise group and by -6.9 (2.5)% (P = 0.01) in the control group after 12 months, being significant between groups (P = 0.008). This study suggests that high-impact, aerobic exercise in postmenopausal women and men over 50 years old is feasible and effective at maintaining muscle strength and increasing proximal femur BMD but not spine or total body BMD.

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Changes in strength, speed and size of the quadriceps muscle have been investigated in elderly men and women after 6 months of isometric strength training. We have also indirectly investigated the role of metabolites as a stimulus for muscle hypertrophy by studying two training protocols. One thigh was trained using short, intermittent contractions (IC), while the other trained using long, continuous contractions (CC). This meant that there should be a greater metabolite change in the muscle performing CC, as the blood flow is occluded for longer. Nine subjects [eight women, mean (SE) age, 71.8 (2.9) years] were measured for contractile properties and strength before and after training, and compared to nine age-matched controls [71.5 (2.1) years]. The training group increased quadriceps strength by 48.7 (9.1)% (P < 0.005) and 53.1 (11.3)% (P < 0.005) following the IC and CC protocols, respectively. There was no change in muscle strength in the controls. Both muscles showed significant slowing after training as measured by the relaxation times and the force-frequency ratio. There were non-significant decreases in muscle fatigability after training. The control group also showed some significant decreases in fatigability and muscle speed. The training group showed significant increases in muscle (and bone) cross-sectional area of 4.0 (1.7)% and 4.9 (1.3)% following the CC and IC protocols, respectively. These increases were significantly different from the decrease observed in the control group. These findings suggest that people over the age of 55 still have the capacity to increase muscle strength and size, and that the training causes slowing of the muscle. Muscle hypertrophy does not seem to be strongly influenced by metabolite changes in this age group, as there were no differences in measurements observed between protocols.

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This study examined the role of high forces versus metabolic cost in the adaptations following strength training. Ten young, healthy male and female subjects trained one leg using concentric (CL) and the other using eccentric (EL) contractions of the quadriceps muscle for 20 weeks. EL used weights which were 35% higher than those used for CL. Isometric strength, and the length:tension and force:velocity relationship of the muscle were measured before and after training. Muscle cross-sectional area (CSA) was measured near the knee and hip using computed tomography. Increases in isometric strength were greater for CL compared to EL, the difference being significant with the knee at 1.57 rad (90 degrees) [mean (SD), 43.7 (19.6)% vs 22.9 (9.8)%, respectively; P = 0.01]. Increases in isokinetic strength tended to be larger for EL, although the differences were not significant. Significant increases in CSA occurred near the hip for both EL and CL. These results suggest that metabolic cost, and not high forces alone, are involved in the stimuli for muscle hypertrophy and strength gains following high-resistance training.

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The role of intramuscular metabolite changes in the adaptations following isometric strength training was examined by comparing the effect of short, intermittent contractions (IC) and longer, continuous (CC) contractions. In a parallel study, the changes in phosphate metabolites and pH were examined during the two protocols using whole-body nuclear magnetic resonance spectroscopy (NMRS). Seven subjects trained three time per week for 14 weeks. The right leg was trained using four sets of ten contractions, each lasting 3 s with a 2-s rest period between each contraction and 2 min between each set. The left leg was trained using four 30-s contractions with a 1-min rest period between each. Both protocols involved isometric contractions at 70% of a maximum voluntary isometric contraction (MVC). The MVC, length:tension and force:velocity relationships and cross-sectional area (CSA) of each leg were measured before and after training. The increase in isometric strength was significantly greater (P = 0.041) for the CC leg (median 54.7%; P = 0.022) than for IC (31.5%; P = 0.022). There were no significant differences between the two protocols for changes in the length:tension or force:velocity relationships. There were significant increases in muscle CSA for the CC leg only. NMRS demonstrated that the changes in phosphate metabolites and pH were greater for the CC protocol. These findings suggest that factors related to the greater metabolite changes during CC training results in greater increases in isometric strength and muscle CSA.

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1. Growth hormone-deficient hypopituitary adults often complain of weakness and fatigue. The cause of the fatigue is unknown but could be an increased proportion of fast, fatiguable, type 2 fibres in the muscle. The aim of this study was to examine the contractile properties of the quadriceps muscle in a group of these patients compared with healthy controls. Changes in these properties were also examined in a small subset of the patients following growth hormone replacement. 2. Isometric strength, half-relaxation time from a twitch (t1/2) and the force-frequency relationship were measured using electrically evoked contractions in 14 growth hormone-deficient patients and 14 age- and sex-matched controls. Six patients were restudied following 6-24 month's replacement therapy with growth hormone (daily dose 0.04 +/- 0.01 i.u./kg). 3. The growth hormone-deficient patients had a significantly lower t1/2 than the controls (46.1 +/- 6.1 ms versus 56.1 +/- 10.5 ms respectively; P = 0.0072; mean +/- SD). The 10/100% ratio was also significantly lower in growth-hormone-deficient patients (38.6 +/- 9.9% versus 52.3 +/- 8.0%; P = 0.0005), as was muscle strength (349 +/- 99 N versus 493 +/- 215 N; P = 0.036). Following growth hormone replacement, muscle strength increased significantly (P < 0.05). The 10/100% ratio also increased towards control values, but this change was not significant. 4. These results demonstrate that the relaxation times of the quadriceps are significantly shorter and that the force-frequency relationship shifted to the right in growth hormone-deficient patients, which is consistent with a greater proportion of type 2 fibres within the muscles.(ABSTRACT TRUNCATED AT 250 WORDS)

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Lumbar spine, total body, and regional bone mineral densities (BMDs) were measured in eumenorrheic and amenorrheic runners and triathletes by using dual-energy X-ray absorptiometry (Lunar DPX). Values were also compared with age- and weight-matched reference data from the Lunar British database. The amenorrheic group had significantly lower lumbar spine (P = 0.003), arm (P = 0.018), trunk (P = 0.014), and total spine (P < 0.0001) BMDs compared with the eumenorrheic group and significantly lower lumbar (P = 0.002) and total spine (P < 0.001) values compared with the reference controls. Leg (P = 0.009) and arm (P < 0.001) densities were significantly higher than controls. All regions, apart from the lumbar spine, were significantly higher in the eumenorrheic group compared with the reference group. There were no within-group differences for the runners and triathletes. Compared with the eumenorrheic athletes, the amenorrheic women had significantly later age of menarche (P = 0.0032). The type of physical activity undertaken by these athletes can compensate for the loss of menses at the majority of skeletal sites with the exception of the spine.

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The aim of this study was to compare the effects of intense endurance vs strengthening exercise on bone mass and serum testosterone levels in male athletes. Bone mineral density (BMD) of the total body and spine and serum testosterone levels were measured in male rowers (n = 12), triathletes (n = 8) and sedentary controls (n = 13). The total body scan also gave values for percentage body fat and regional bone densities. Calcium intake and physical activity levels were measured by questionnaire. The rowers had significantly higher BMD in the spine and total body than the triathletes (P < 0.01 and P < 0.05 respectively) and sedentary controls (P < 0.01 and P < 0.05). There were no differences between the triathletes and controls. Serum testosterone levels were significantly lower in the triathletes than in the controls (P < 0.05); there was no significant difference between the rowers and controls. All groups fell within the normal range for testosterone. In a step-wise multiple regression, including age, body mass, height, calcium intake and activity, no single factor had a significant effect on spine BMD. Body mass had a significant effect on total body BMD and could account for the differences between the groups. A significant positive correlation was found between calcium intake and total body BMD. The heavy weight training typical of rowing training seemed to result in significant bone accretion. The low testosterone levels in the triathletes may have negated any positive effect of the increased exercise on BMD.

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