title: Effect of impact exercise and its intensity on bone geometry at weight-bearing tibia and femur.
abstract: BACKGROUND
  Physical activity is known to enhance the mechanical competence of bone. However, information about the optimal type of exercise is limited. The aim of this study was to evaluate the contribution of jumping exercise to changes in bone geometry.
  
  
  METHODS
  We carried out a 12-month population-based trial with 120 women (aged 35-40 years), randomly assigned to an exercise group or to a control group. The exercise regimen consisted of supervised, progressive high-impact exercises three times per week and an additional home program. The intensity of impact loading was assessed as the magnitude of acceleration peaks using an accelerometer-based body movement monitor. The activity was analyzed as the daily number of impacts within five acceleration ranges (0.3-1.0g, 1.1-2.4g, 2.5-3.8g, 3.9-5.3g and 5.4-9.2g; g=acceleration of gravity, 9.81 m/s(2)). Bone geometry was assessed with spiral quantitative computed tomography (QCT) scanner at mid-femur, proximal tibia and distal tibia.
  
  
  RESULTS
  Thirty-nine women (65%) in the exercise group and 41 women (68%) in the control group completed the study. QCT and physical activity data were available from 65 subjects. The exercise group showed a significant 0.2% (p=0.033) higher gain in bone circumference compared to the control group at mid-femur. Subgroup analyses revealed geometric changes indicating up to a 2.5% increment in bone strength in favor of the most active exercisers (>66 exercise sessions during the 12 months) compared to the least active exercisers (<19 sessions). In pooled groups, the changes in cortical attenuation and cross-sectional moment of inertia correlated positively (p<0.05-p<0.01) with the number of impacts exceeding 1.1g, while changes in cortical thickness (p<0.05) and bone circumference (p<0.05-p<0.01) were positively associated with impacts 3.9g, or more. The number and intensity of impacts during the 12 months were the most significant predictors of changes in bone geometry explaining up to 36% of changes.
  
  
  CONCLUSIONS
  Bone geometry adapts to impact exercise and the adaptation is most marked at the mid-femur. The changes in bone geometry are associated with the number and intensity of daily impacts while the redistribution of bone mineral appears to be the main mechanism in the skeletal adaptation to varying intensities of exercise.
authors.affiliation: Department of Medical Technology, University of Oulu, Oulu, Finland. aki.vainionpaa@fimnet.fi
authors.forename: Aki
authors.initials: A
authors.lastname: Vainionpää
authors.forename: Raija
authors.initials: R
authors.lastname: Korpelainen
authors.forename: Harri
authors.initials: H
authors.lastname: Sievänen
authors.forename: Erkki
authors.initials: E
authors.lastname: Vihriälä
authors.forename: Juhani
authors.initials: J
authors.lastname: Leppäluoto
authors.forename: Timo
authors.initials: T
authors.lastname: Jämsä
mesh_terms: D000328:Adult; D015444:Exercise / Q000502:physiology*; D005260:Female; D005269:Femur / Q000033:anatomy & histology* / Q000502:physiology; D006801:Humans; D013314:Stress, Mechanical; D013977:Tibia / Q000033:anatomy & histology* / Q000502:physiology; D036542:Tomography, Spiral Computed