Women with polycystic ovary syndrome (PCOS) have a clustering of cardiovascular risk factors, such as obesity, lipid abnormalities, impaired glucose tolerance, insulin resistance, and hypertension. Exercise is reported to lower the incidence of cardiac events. The effect of exercise on plasma homocysteine concentrations, an independent cardiovascular risk factor, has not been previously reported in women with PCOS. We examined the effects of exercise on plasma total homocysteine concentrations in young overweight or obese PCOS women [age (mean +/- SD), 30.6 +/- 6.6 yr; body mass index, 35.49 +/- 7.57 kg/m(2)]. Twenty-one women consented to a 6-month exercise program; 12 women (exercisers) adhered to the program, whereas 9 (nonexercisers) did not. In both groups of women, the following parameters were recorded at baseline and 6 months: body mass index, waist-to-hip ratio, and aerobic capacity (maximal oxygen consumption); blood samples were taken after an overnight fast for plasma total homocysteine, insulin, and other biochemical parameters. A significant decrease in plasma total homocysteine concentrations (P < 0.001) and waist-to-hip ratio (P = 0.041) and a significant increase in maximal oxygen consumption (P = 0.019) were recorded at 6 months, compared with baseline in the exercise group. This decrease in homocysteine was not explained by changes in anthropometric or biochemical parameters. In contrast, no significant changes in any of the variables were observed in the nonexercise group. Our study has provided the first evidence that regular exercise significantly lowers plasma homocysteine in young overweight or obese women with PCOS, a group at increased risk of premature atherosclerosis. The precise mechanism by which exercise is associated with a reduction in homocysteine remains to be elucidated.

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Additional Information:• NOTICE: this is the author's version of a work that was accepted for publication in Bone.Changes resulting from the publishing process,

Regular exercisers have lower fracture risk, despite modest effects of exercise on bone mineral content (BMC). Exercise may produce localized cortical and trabecular bone changes that affect bone strength independently of BMC. We previously demonstrated that brief, daily unilateral hopping exercises increased femoral neck BMC in the exercise leg versus the control leg of older men. This study evaluated the effects of these exercises on cortical and trabecular bone and its 3D distribution across the proximal femur, using clinical CT. Fifty healthy men had pelvic CT scans before and after the exercise intervention. We used hip QCT analysis to quantify BMC in traditional regions of interest and estimate biomechanical variables. Cortical bone mapping localized cortical mass surface density and endocortical trabecular density changes across each proximal femur, which involved registration to a canonical proximal femur model. Following statistical parametric mapping, we visualized and quantified statistically significant changes of variables over time in both legs, and significant differences between legs. Thirty-four men aged mean (SD) 70 (4) years exercised for 12-months, attending 92% of prescribed sessions. In traditional regions of interest, cortical and trabecular BMC increased over time in both legs. Cortical BMC at the trochanter increased more in the exercise than control leg, whereas femoral neck buckling ratio declined more in the exercise than control leg. Across the entire proximal femur, cortical mass surface density increased significantly with exercise (2.7%; p < 0.001), with larger changes (> 6%) at anterior and posterior aspects of the femoral neck and anterior shaft. Endocortical trabecular density also increased (6.4%; p < 0.001), with localized changes of > 12% at the anterior femoral neck, trochanter, and inferior femoral head. Odd impact exercise increased cortical mass surface density and endocortical trabecular density, at regions that may be important to structural integrity. These exercise-induced changes were localized rather than being evenly distributed across the proximal femur.

1. This study examined the influence of brisk walking on skeletal status in post-menopausal women. 2. Subjects were 84 healthy women aged 60-70 years. Who were previously sedentary and at least 5 years post-menopausal. Subjects were randomly assigned to walking (n = 43) and control (n = 41) groups. Walkers followed a 12-month, largely unsupervised programme of brisk walking. The bone mineral density of the lumbar spine, femoral neck and calcaneus and broadband ultrasonic attention of the calcaneus were measured at baseline and after 12 months. 3. Forty control subjects and 38 walkers completed the study. Walkers built up to 20.4 +/- 3.8 min/day (mean +/- SD) of brisk walking. Body mass increased in control subjects relative to walkers [mean change (SE) +0.9 (0.3) and -0.1 (0.3) kg respectively; P = 0.04]. Predicted maximum oxygen uptake increased in walkers by 2.1 (0.9) ml min-1 kg-1 (P = 0.02). Bone mineral density in the lumbar spine and calcaneus fell in control subjects [-0.005 (0.004) and -0.010 (0.004) g/cm2, respectively] but not in walkers [+0.006 (0.004) and +0.001 (0.004) g/cm2]. The difference in response between groups was significant in the calcaneus (P = 0.04) but not in the lumbar spine (P = 0.08). Mean femoral neck bone mineral density did not change significantly in either group, although changes in walkers were related to the amount of walking completed (r = 0.51, P = 0.001). The change in broadband ultrasonic attenuation of the calcaneus differed between groups [control subjects, -3.7 (0.8); walkers, -0.7 (0.8) dB/MHz; P = 0.01]. 4. Walking decreased bone loss in the calcaneus and possibly in the lumbar spine. It also improved functional capacity and enabled walkers to avoid the increase in body mass seen in control subjects.

Physical activity is one of the major non-pharmacological methods for increasing and maintaining bone mineral density (BMD) and geometry. As such, it has an important role in maintaining peak bone mass and strength, thus reducing the risk of future osteoporotic fracture. However, not all exercise is effective, so a prescription in terms of optimal type, intensity, frequency and duration is required. Studies using animal models suggest that loading that is high in magnitude, rapidly applied and novel is most effective, whilst duration is less important beyond a threshold number of cycles. In human subjects cross-sectional studies comparing different athletic populations suggest that those who participate in high-or odd-impact sports have higher BMD; whilst impact exercise, strength training and brief high-impact-jump training interventions increase BMD in premenopausal women. In order to further elucidate exercise recommendations to optimise bone health in this population, the usefulness of brief high-impact unilateral exercises has been evaluated. Brief hopping exercises were shown to be feasible for sedentary premenopausal women, producing ground-reaction forces as high as those from jumping. Regularly performing these hopping exercises over 6 months was found to increase femoral-neck BMD of the trained leg relative to the control leg. Unilateral high-impact exercise may therefore improve bone strength of the trained limb and provide a useful model for comparing exercise prescriptions to help define the most efficient and effective exercise recommendations for the bone health of premenopausal women. Exercise: Bone mineral density: Premenopausal womenOsteoporosis is a condition of skeletal fragility whereby depleted bone mass and compromised bone structure weaken bone to such an extent that fractures occur from minimal trauma. The disease is a major public health problem with great social and economic importance. One in five men and one in two women in the UK > 50 years of age will suffer an osteoporosis-related fracture in their lifetime (1) and the annual cost for all fractures is £1 . 5 · 10 9(2) .Two mechanisms that principally determine adult bone health are peak bone mineral density (BMD) at skeletal maturity and the rate of bone loss with advancing age; thus, maximising premenopausal BMD is a critical strategy for the prevention of osteoporosis and resultant fractures later in life. A substantial body of literature has established that participating in regular physical activity can positively improve bone mineral status (3,4) . The advantage of exercise over methods such as dietary intervention is that it increases the skeleton's resistance to fracture by improving and maintaining both BMD and neuromuscular competency, thus reducing both skeletal fragility and predisposition to falls (4) .Exercise recommendations for cardiovascular fitness have already been precisely defined (5) , but it is unlikely that the same exercise prescription applies to cardiovascular health and skeletal health, and to both pre-a...

1This study assessed the 5 factor structure of the Compulsive Exercise Test and explored the 2 relationship between compulsive exercise and eating psychopathology in athletes. 3Confirmatory and exploratory factor analyses of the Compulsive Exercise Test were 4 conducted with 689 competitive athletes (aged 18 to 35 years). Convergent validity with the 5 Eating Disorders Examination Questionnaire was explored. The 5 factor structure showed a 6 poor fit; an alternative 3 factor structure is proposed. Exercising for weight control and to 7 avoid a negative mood were strongly associated with eating psychopathology. Implications 8 for using the Compulsive Exercise Test with athletes are discussed. 9

ObjectiveTo identify psychological and physiological correlates of stress fracture in female endurance athletes.DesignA cross-sectional design was used with a history of stress fractures and potential risk factors assessed at one visit.MethodsFemale-endurance athletes (58 runners and 12 triathletes) aged 26.0±7.4 years completed questionnaires on stress fracture history, menstrual history, athletic training, eating psychopathology and exercise cognitions. Bone mineral density, body fat content and lower leg lean tissue mass (LLLTM) were assessed using dual-x-ray absorptiometry. Variables were compared between athletes with a history of stress fracture (SF) and those without (controls; C) using χ², analysis of variance and Mann-Whitney U tests.ResultsNineteen (27%) athletes had previously been clinically diagnosed with SFs. The prevalence of current a/oligomenorrhoea and past amenorrhoea was higher in SF than C (p=0.008 and p=0.035, respectively). SF recorded higher global scores on the eating disorder examination questionnaire (p=0.049) and compulsive exercise test (p=0.006) and had higher LLLTM (p=0.029) compared to C. These findings persisted with weight and height as covariates. In multivariate logistic regression, compulsive exercise, amenorrhoea and LLLTM were significant independent predictors of SF history (p=0.006, 0.009 and 0.035, respectively).ConclusionsEating psychopathology was associated with increased risk of SF in endurance athletes, but this may be mediated by menstrual dysfunction and compulsive exercise. Compulsive exercise, as well as amenorrhoea, is independently related to SF risk.