A Review of Service Provision for men aged 50+ (Belfast)

Friday 26th September 2014 saw the launch of a report which examines service provision for men aged 50+ in the greater-Belfast area. This research was undertaken by a team from Queen’s University Belfast on behalf of the Older Men’s Steering Group within Age Partnership Belfast. The research sought to: (i) review the extent and impact of current community, voluntary, statutory or private sector services which are aimed at combating social isolation among men in the Belfast area, and (ii) identify how these services are meeting current need, and ways in which they may be developed to meet future requirements. The report is now available online at: www.volunteernow.co.uk/fs/doc/publications/men-aged-50-final-report.pdf

Effects of resistance exercise and fortified milk on skeletal muscle mass, muscle size, and functional performance in middle-aged and older men: an 18-mo randomized controlled trial

Limited data have suggested that the consumption of fluid milk after resistance training (RT) may promote skeletal muscle hypertrophy. The aim of this study was to assess whether a milk-based nutritional supplement could enhance the effects of RT on muscle mass, size, strength, and function in middle-aged and older men. This was an 18-mo factorial design (randomized control trial) in which 180 healthy men aged 50–79 yr were allocated to the following groups: 1) exercise + fortified milk, 2) exercise, 3) fortified milk, or 4) control. Exercise consisted of progressive RT with weight-bearing impact exercise. Men assigned to the fortified milk consumed 400 ml/day of low-fat milk, providing an additional 836 kJ, 1000 mg calcium, 800 IU vitamin D3, and 13.2 g protein per day. Total body lean mass (LM) and fat mass (FM) (dual-energy X-ray absorptiometry), midfemur muscle cross-sectional area (CSA) (quantitative computed tomography), muscle strength, and physical function were assessed. After 18 mo, there was no significant exercise by fortified milk interaction for total body LM, muscle CSA, or any functional measure. However, main effect analyses revealed that exercise significantly improved muscle strength (∼20–52%, P < 0.001), LM (0.6 kg, P < 0.05), FM (−1.1 kg, P < 0.001), muscle CSA (1.8%, P < 0.001), and gait speed (11%, P < 0.05) relative to no exercise. There were no effects of the fortified milk on muscle size, strength, or function. In conclusion, the daily consumption of low-fat fortified milk does not enhance the effects of RT on skeletal muscle size, strength, or function in healthy middle-aged and older men with adequate energy and nutrient intakes.

Effects of lifetime loading history on cortical bone density and its distribution in middle-aged and older men

We have reported previously that long-term participation of weight-bearing exercise is associated with increased QCT-derived cortical bone size and strength in middle-aged and older men, but not whole bone cortical volumetric BMD. However, since bone remodeling and the distribution of loading-induced strains within cortical bone are non-uniform, the aim of this study was to examine the effects of lifetime loading history on cortical bone mass distribution and bone shape in healthy community dwelling middle-aged and older men. We used QCT to assess mid-femur and mid-tibia angular bone mass distribution around its center (polar distribution), the bone density distribution through the cortex (radial distribution), and the ratio between the maximum and minimum moments of inertia (I_max/I_min ratio) in 281 men aged 50 to 79 years. Current (> 50 years) and past (13–50 years) sport and leisure time activity was assessed by questionnaire to calculate an osteogenic index (OI) during adolescence and adulthood. All men were then categorized into a high (H) or low/non impact (L) group according to their OI scores in each period. Three contrasting groups were then formed to reflect weight-bearing impact categories during adolescence and then adulthood: H–H, H–L and L–L. For polar bone mass distribution, bone deposition in the anterolateral, medial and posterior cortices were 6–10% greater at the mid-femur and 9–24% greater at mid-tibia in men in the highest compared to lowest tertile of lifetime loading (p < 0.01– < 0.001). When comparing the influence of contrasting loading history during adolescence and adulthood, there was a graded response between the groups in the distribution of bone mass at the anterior-lateral and posterior regions of the mid-tibia (H–H > H–L > L–L). For radial bone density distribution, there were no statistically significant effects of loading at the mid-femur, but a greater lifetime OI was associated with a non-significant 10–15% greater bone density near the endocortical region of the mid-tibia. In conclusion, a greater lifetime loading history was associated with region-specific adaptations in cortical bone density.

Reasons for referral to bone densitometry in men and women aged 20-49 years : population-based data

Introduction Osteoporosis poses a significant public health problem for ageing Australians. However, approximately 25 % of Australian adults aged 20–49 years have osteopenia, a precursor condition to osteoporosis. Despite this, little is known about bone density testing in this age group.

Methods Reasons for referral to dual energy X-ray absorptiometry (DXA) were examined in 2,264 patients aged 20–49 years, referred in 2001–2010 to the Geelong Bone Densitometry Service, Geelong Hospital, Victoria. Referral reasons were determined from clinical indication codes derived from patient records. Age, sex and bone mineral density (BMD) T scores were ascertained for each patient.

Results The most common reason for referral for women reflected glucocorticoid use, and for men reflected fracture. Compared to women, men were more likely to have been referred because of minimal trauma fracture or low BMD (41.7 versus 27.1 %, p < 0.001). No further differences were identified between the sexes, with similar numbers of referral observed for secondary osteoporosis, and monitoring of drug therapy. At the spine, and for all indications, men had a significantly greater BMD deficit compared to women (all p ≤ 0.002). After age adjustment, men who were tested due to fracture or glucocorticoid reasons had significantly greater BMD at the total hip (p ≤ 0.03). No further associations were seen after age adjustment between referral reason and BMD.

Conclusions Our study presents the first data examining reasons for referral to DXA among Australians aged 20–49 years. Understanding health service utilisation regarding bone health in young adults is fundamental to understanding future risk, informing effective public health messages and raising awareness of osteoporosis.

Mid-femoral and mid-tibial muscle cross-sectional area as predictors of tibial bone strength in middle-aged and older men

While it is widely acknowledged that bones adapt to the site-specific prevalent loading environment, reasonable ways to estimate skeletal loads are not necessarily available. For long bone shafts, muscles acting to bend the bone may provide a more appropriate surrogate of the loading than muscles expected to cause compressive loads. Thus, the aim of this study was to investigate whether mid-thigh muscle cross-sectional area (CSA) was a better predictor of tibial mid-shaft bone strength than mid-tibia muscle CSA in middle aged and older men. 181 Caucasian men aged 50–79 years (mean±SD; 61±7 years) participated in this study. Mid-femoral and mid-tibial bone traits cortical area , density weighted polar moment of area and muscle CSA [cm²] were assessed with computed tomography. Tibial bone traits were positively associated with both the mid-femur (r=0.44 to 0.46, P<0.001) and the mid-tibia muscle CSA (r=0.35 to 0.37, P<0.001). Multivariate regression analysis, adjusting for age, weight, physical activity and femoral length, indicated that mid-femur muscle CSA predicted tibial mid-shaft bone strength indices better thn mid-tibia muscle CSA. In conclusion, the association between a given skeletal site and functionally adjacent muscles may provide a meaningful probe of the site-specific effect of loading on bone.

Physiological responses to psychological stress: importance of adiposity in men aged 50-70 years

We tested the hypothesis that overweight/obese men aged 50–70 years will have a greater salivary cortisol, salivary alpha amylase and heart rate (HR) responses to psychological stress compared with age matched lean men. Lean (BMIZ20–25 kg/m2; nZ19) and overweight/obese (BMIZ27–35 kg/m2; nZ17) men (50–70 years) were subjected to a well-characterised psychological stress (Trier Social Stress Test, TSST) at 1500 h. Concentrations of cortisol and alpha amylase were measured in saliva samples collected every 7–15 min from 1400 to 1700 h. HR was recorded using electrocardiogram. Body weight, BMI, percentage body fat, resting systolic and diastolic blood pressure and mean arterial pressure were significantly higher (P!0.05) in overweight/obese men compared with lean men. Both groups responded to the TSST with a substantial elevation in salivary cortisol (372%), salivary alpha amylase (123%) and HR (22%). These responses did not differ significantly between the groups (time!treatment interaction for salivary cortisol, salivary alpha amylase and HR; PZ0.187, PZ0.288, PZ0.550, respectively). There were no significant differences between the groups for pretreatment values, peak height, difference between pretreatment values and peak height (reactivity) or area under the curve for salivary cortisol, salivary alpha amylase or HR (PO0.05 for all). The results showed that, for men with a moderate level of overweight/obesity who were otherwise healthy, the response of salivary cortisol, salivary alpha amylase and HR to acute psychological stress was not impaired.

The effect of overweight/obesity on cardiovascular responses to acute psychological stress in men aged 50-70 years.

To determine the effect of adiposity in males aged 50-70 years on cardiovascular responses to acute psychological stress.

Cardiovascular fitness and cardiovascular risk factors among obese men and women aged 58 years and older, in Portugal

Background: A better physical fitness may have survival advantages in adults. Aim: To analyze the relationship between cardiorespiratory fitness and cardiovascular risk factors among obese subjects aged 58 years and older. Material and Methods: Cardiorespiratory fitness using the six-minute walk test, body composition by dual-energy x-ray absorptiometry and blood pressure were measured in a non-representative sample of 76 obese Portuguese subjects aged 58 to 87 years (55 women). Participants were stratified in tertiles of walking capacity according to the six-minute walk test. Results: Six minutes walk test results were negatively correlated with percentage body fat (r = -0.28; p = 0.012) and systolic blood pressure (r = -0.23; p = 0.045). Participants located in the lowest tertile for the six minutes walk test had an odds ratio of 4.34 (95% confidence intervals: 1.02-18.43) for elevated blood pressure. Conclusions: A lower six minutes walk test result is associated with a higher risk for high blood pressure. (Rev Med Chile 2012; 140: 1164-1169).

A comparison of risky sexual behaviours between circumcised and uncircumcised men aged 30-44 years in Botswana.

Background: The principal mode of HIV transmission in Southern Africa is through sexual intercourse, and this has prompted uptake of safe male circumcision. Engaging in risky sexual behaviour by circumcised men increases the risks of acquiring HIV, though male circumcision coupled with preventive behaviour reduces this risk. Objective: To compare the factors associated with risky sexual behaviour among circumcised and uncircumcised men in Botswana. Methods: Nationally representative data from the Botswana AIDS Impact Survey III were used. A sample of 313 sexually active men was used. The data was analysed by cross-tabulation and logistic regression. Results: The study revealed that uncircumcised men (odds ratio, 5.711) were more likely to have sex while intoxicated with alcohol compared to circumcised men. Low levels of education (odds ratio, 8.736), urban residency (city/town: odds ratio, 1.238 and urban village: odds ratio, 1.098) were more likely to influence risky behaviour (more than one sexual partner) for circumcised men. The results also show that marital status (never married) (odds ratio, 1.947) influences risky behaviour (having sex while intoxicated with alcohol) among uncircumcised men. Conclusion: Low level of education, place of residence and alcohol consumption influences risky sexual behaviour for both circumcised and uncircumcised men. Policies and programmes should thus focus on the attitudes underlying sexual behaviour.