June 28 - 29, 2007 Advisory Committee Meeting Minutes

Musculoskeletal Health

Dr. Kohrt provided an overview of musculoskeletal health broken out in 3 distinct areas, bone health, joint health and muscle health.

Bone health should be addressed as a continuum across the life span. For example, physical activity, or lack of physical activity, early in life may be a determinant of bone health later in life. A second factor is things that influence the rate of loss with aging.

An issue that will be a challenge to address is whether physical activity influences bone strength. While one can see and measure favorable effects from physical activity on the parameters of bone, one cannot actually measure bone strength.

Another area to address is the non-skeletal effects of exercise on risk for osteoporosis. An issue in this area is whether there is a dose-response effect or how to evaluate dose response. The basic science seems to indicate intensity as a key influencer on bone health. Intensity, however, is difficult to quantify and easily explain to the lay person. An added layer of complexity is the fact that we are really interested in the magnitude of loading force, which may be unrelated to percentage of VO2 max or percentage of heart rate max.

It will be very important to get a better understanding of how we will weigh evidence from randomized controlled trials versus observational cohort studies, because it is only from the latter that we have information on fractures.

In terms of joint health, osteoarthritis is going to be very important to address. On the other hand, it will be very difficult to address whether physical activity is a benefit or a risk. This will need to be considered very seriously in order to make recommendations for physical activity that should be maintained throughout the lifespan if that does confer increased osteoarthritis risk.

For muscle health there isn't necessarily a link between disease and physical activity both in terms of impact on muscle quantity, muscle mass and muscle quality. Presumably much of the work here will be linked with other groups.

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