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PubMed1983

Relationship between habitual physical activity and serum lipoprotein levels in white male adolescents.

It is currently thought that increased physical activity can have a positive influence on high-density lipoprotein cholesterol (HDL-C) levels in adults. However, only a limited amount of research has been directed at studying the influence of physical activity on HDL-C in adolescents. This study correlated the reported levels of physical activity, exercise capacity, physical measurements, and 48-hr dietary intake of 50 white male adolescents with their levels of HDL-C, ratio of total serum cholesterol (T.Chol) to HDL-C, and ratio of low-density lipoprotein (LDL-C) to HDL-C. Using multiple regression, age (r = -0.42) was the strongest predictor of HDL-C, followed in order by TV watched/night (r = -0.42) and height (r = -0.31) (R2 = 0.28). Age (r = 0.38) was the strongest predictor of the T.Chol/HDL-C ratio, followed by days jogged/week (r = -0.32), TV watched/night (r = 0.29), and systolic blood pressure (r = 0.30) (R2 = 0.30). The days jogged per week (r = -0.32) was the best predictor of the LDL-C/HDL-C ratio, followed in order by hours spent reading/day (r = 0.27) and systolic blood pressure (r = 0.23) (R2 = 0.23). Maximum exercise capacity was not related to these lipoprotein components. These findings suggest that the level of habitual physical activity in white male adolescents may be associated with the level of HDL-C in relation to T.Chol and LDL-C.

Activities of Daily Living↗

PubMed1997

Arthroscopic extra-articular Bankart repair for the treatment of recurrent anterior shoulder dislocation.

This study describes a new arthroscopic procedure for the stabilization of recurrent anterior shoulder dislocations. The technique involves two important features. The first is the anterior inferior transmuscular approach through the subscapularis muscle, which permits self-locking implants to be inserted into the anterior inferior third of the glenoid rim so that they oppose the direction of pull of the capsule. This approach was studied on 79 cadaveric shoulders before clinical application. The second feature is the extracapsular (extra-articular) location of the self-locking implants, which permits a superomedial capsular shift as required. The technique offers a high degree of capsular stability. Of a total of 318 patients undergoing this procedure, the first 100 shoulders (98 patients) were evaluated postoperatively at an average of 35 months (range, 18 to 62 months). The diagnosis in all cases was traumatic recurrent anterior shoulder dislocation. Repair of the capsule was performed initially with screws and later with absorbable tacks. The overall recurrence rate was 9% (9 shoulders). Excluding the first 30 shoulders to take account of the learning curve, the recurrence rate for the subsequent 70 shoulders was only 5.7%. Limitation of external rotation at 0 degrees abduction averaged 6.7 degrees and 6.1 degrees at 90 degrees abduction for all shoulders; 61% of participants in overhead sports and 70% of participants in contact sports resumed their preinjury activities. The recurrence rate for patients involved in overhead sports was 10% and for collision sports it was 14%. There were no recurrences in the case of patients whose sports involve minimum risk to the shoulder (cycling, jogging). Most recurrences were observed in patients with lax shoulders and small Bankart lesions.

Adolescent↗

PubMed2003

The effect of screw length and position on fixation of four-stranded hamstring grafts for anterior cruciate ligament reconstruction.

The aim of this study was to examine interference screw fixation of four strand hamstring grafts for anterior cruciate ligament reconstruction in vitro. Bovine tibiae and cannon tendons were used. Screws were introduced from 'outside-in'. The tendons were loaded cyclically to 150 N to simulate walking and 450 N to simulate jogging. Slippage of the tendon from the anchorage was recorded after 100, 300 and 1000 cycles. Cortico-cancellous and cancellous only fixations were compared using a 7-mm screw in an 8-mm tunnel with a 7-mm graft. The effect of screw length was studied by comparing 8 x 25 and 8 x 45 mm screws. Graft slippage with cancellous only fixation was significantly greater than with cortico-cancellous screw fixation (P 0.105), the longer screws gave more consistent behaviour. We concluded that the screw should be placed so that its head engages the cortex, while increasing screw length within cancellous bone did not significantly improve graft fixation. Cyclical load testing reflects the repetitive forces imposed in the early post-operative period following hamstring anterior cruciate ligament reconstruction and is important for the evaluation of graft fixations.

Animals↗

PubMed2000

Nutrition for the Australian Rules football player.

This review summarises past and present nutritional practices of Australian Rules Football players, noting changes that have occurred as the footballers have become more receptive to scientific input. Australian Rules Football is a unique sport, with matches involving intermittent high intensity sprints between periods of jogging and walking and repeated physical contact. Endurance, speed, strength, power and agility are essential physical characteristics. Australian Rules footballers exhibit a wide range of anthropometrical attributes due to the positional requirements of the game. Dietary surveys indicate that footballers of the 1980's consumed a diet similar to that of the general Australian population consisting of 44%, 37.5%, 15% and 3.5% of carbohydrate (CHO), fat, protein and alcohol, respectively. However, as dietitians are becoming an integral part of the support staff of teams there is evidence that nutritional practices conducive to optimal sporting performance are now being followed. Due to the prolonged duration and intermittent high intensity activity pattern of Australian Rules, nutritional supplementation such as fluid and CHO intake during training and competition and creatine intake may be beneficial; however, further research needs to be conducted in the field to determine its importance in Australian Rules Football.

Anthropometry↗

PubMed2005

Time-motion analysis of elite field hockey during several games in succession: a tournament scenario.

International field hockey tournaments may require teams to play three games within a period of four days. Therefore, there is potential for residual fatigue to affect the movement patterns of players during subsequent games. The purpose of this study was to document changes in time-motion analysis of 14 elite male field hockey players during three games within a period of four days during an international tournament. In addition, the nature of and any changes in repeated-sprint activity were investigated using a criteria of a minimum of three sprints with a mean recovery duration between sprints of < 21 s. The percent of total game time spent standing significantly increased across all three games (7.4+/-.2, 11.2+/-2.7 and 15.6+/-5.6%, respectively, P<0.05). Conversely, the percent time spent jogging significantly decreased from game 1 to game 2 and from game 1 to game 3 (40.5+/-7.3, 34.8+/-7.4 and 29.4+/-5.7%, respectively, P<0.05). Furthermore, the percent time in striding significantly increased from game 1 to game 3 and from game 2 to game 3 (4.1+/-1.3, 5.1+/-0.9 and 5.8+/-1.4%, respectively. P<0.05). Changes in mean motion frequency and duration were recorded across games for the motions of standing, striding and sprinting. The frequency of exercise bouts that met the criteria for 'repeated-sprint' decreased across the three games (17, 11 and 8, respectively). In summary, the results suggest that when elite field hockey players play three games within four days there are significant changes in time-motion analysis.

Adult↗

PubMed1999

An analysis of movement and discomfort of the female breast during exercise and the effects of breast support in three cases.

Breast pain is common during exercise, occurring in up to 56% of subjects in some surveys. This pain is mainly associated with the movement of breast tissue. In an attempt to analyse this movement and the resulting pain, the movement of the female breast tissue was quantified in four conditions of breast support ("sports bra", "fashion bra", "crop top" and bare breasted) during four different activities (running, jogging, aerobics march and walking). These activities represented general patterns of exercise for adult females in Australian society. All three subjects were healthy, active, young women of varying breast size (12B, 14B & 14C) that were typical of young women. Two of the subjects had noted breast pain whilst exercising. The results showed that wearing external support for the breast tissue reduced absolute vertical movement and maximum downward deceleration force on the breast. Support also reduced perceived pain. When compared to other forms of breast support a "sports bra" (brassiere designed for breast support whilst exercising) provided superior support for the breast in relation to the amplitude of movement, deceleration forces on the breast, and perceived pain. The data indicates that adult females should wear appropriate breast support to reduce perceived breast discomfort or pain. Of the three garments examined in this study, the fitted sports bra provided superior support and pain reduction.

Adult↗

PubMed1975

Deuterium order parameters in relation to thermodynamic properties of a phospholiped bilayer. A statistical mechanical interpretation.

The physical properties of bilayers of dipalmitoyl-3-sn-phosphatidylcholine are analyzed in terms of a statistical model proposed by Marcelja (S. Marcelja (1974), Biochim. Biophys. Acta 367, 165). The model is used to calculate the segmental order parameters of the hydrocarbon chains, the transition temperature of the crystalline leads to liquid crystalline phase transition, the entropy change of the transition, the bilayer thickness, and the linear thermal expansion coefficient. The theoretical predictions are in excellent agreement with experimental results obtained by deuterium magnetic resonance, differential scanning calorimetry, and X-ray diffraction. The model yields the probabilities of trans and gauche conformations and also those of more specific conformational defects like kinks or jogs.

Calorimetry↗

PubMed2003

[Regeneration capacity of skeletal muscle].

The organotypic stem cell of skeletal muscle has previously been known as satellite cell. They allow muscle fiber growth during ontogenesis, enable fiber hypertrophy and are responsible for the very efficient repair of muscle fibers. This efficient apparatus is to some degree counterbalanced by an enormous use of the satellite cell pool: fiber atrophy probably is accompanied by loss of myonuclei such that every reversal of atrophy is bound to use new myonuclei i.e. satellite cells. How often in life does this occur? Hard to say. Moreover, the potent repair capacity is challenged by an unexpected vulnerability of skeletal muscle fibers: Passive stretching of contracted muscles may cause multiple "microdamage," disruption of contractile elements or tiny areas of true necrosis (focal necrosis). How often does this happen? Well, for many of us at least once per year when we go up and down mountains during vacation time, followed by sour muscles. Others may decide to change his/her (locomotor) behaviour by severe onset of jogging; it may happen that they suffer kidney failure on Monday due to muscle microdamage and the transfer of myoproteins into the serum over weekend. Also 20 minutes of stepping up and down something like a chair will do: There is a remarkable increase in kreatin kinase and other muscle derived proteins which lasts for days and is bound to reflect some muscle damage. How about sportsmen and worker who repeatedly use their muscles in such a way? We don't have answers yet to most of these questions, but considerable amount of information has been collected over the last years both in animal and--less--in human. What is common in all cases of growth and repair is the proliferation of the satellite cells and their consequent incorporation and fusion with the parent fiber. This way focal damage is repaired often without visible reminders. We would run out of satellite cells were they not stem cells: After division one daughter remains a satellite cell while the other is free to divide. Divide how often? Important for the human cells since the cell ages and proliferates slower and slower till it stops to divide at all, at least in culture. The same is true for the new satellite cell. This we know from recent experiments in which human biopsies derived myogenic cells were grown in vitro and in vivo (by implanting them into skeletal muscles of immunoincompetent mice): Growth correlates negatively with age of the donor. Between age 2 and some 70 years, about two divisions are performed by each satellite cell in human vastus lateralis and biceps brachii muscle in 10 years in the average. Most important for the older among us: at age 76 there are still some 13 divisions left before complete exhaustion. However, there are diseases like Duchenne Muscular Dystrophy (DMD) in which muscle fibers lack a structural protein with the effect of enhanced vulnerability to mechanical stress. There the enhanced use of the satellite cell pool makes the remaining growth capacity in an 8-years-old child as low as otherwise found at age 80. Some time ago, implantation of genetically intact myoblasts obtained from healthy relatives has been proposed as a treatment of DMD. Every logic would have predicted that some local implantation of whatever numbers of cells was bound to fail rescue the complete masculature or at least the muscles for breathing. The human as guinea pig? Now, even years later, we still collect the basic information on growth of human myoblasts and start thinking of ways for systemic application and quantitatively relevant incorporation of the myogenic stem cell or other--possibly pluripotent--stem cells derived from bone marrow.

Adolescent↗

PubMed2000

The effect of heart rate controlled low resistance circuit weight training and endurance training on maximal aerobic power in sedentary adults.

The effects of a 12-week low resistance circuit weight training (CWT) on cardiovascular and muscular fitness were studied in 90 healthy sedentary adults. The subjects were randomized into three equally fit groups: CWT, Endurance (END) and Control (CON) according to their maximal aerobic power (VO2max). Both training groups exercised for 12 weeks, 3 days a week in sessions of 40 min, with a heart rate (HR) level of 70-80% HRmax. The CWT group trained with air resistance machines. Heart rate was controlled by setting the speed of movement. The END group walked, jogged, cross-country skied or cycled. The net differences (between pre- and posttraining changes) between the CWT and CON groups was statistically significant for VO2max (2.45 ml x min(-1) x kg(-1), 95% CI 1.1; 3.8), for abdominal muscles (3.7 reps, CI 0.3; 7.1), for push-ups (1.1 reps, CI 0.2; 2.1), and for kneeling (2.25 reps, CI 0.01; 4.5). The net difference (between pre- and posttraining changes) in the END and CON groups was statistically significant for VO2max (2.75 ml(-1) x min(-1) x kg(-1), 95% CI 0.9; 4.6), and kneeling (3.0 reps, CI 0.7; 5.3). Low resistance CWT with moderately hard HR level has effects comparable to an equal amount of endurance training on the cardiovascular fitness of sedentary adults. The CWT model was benefical also on muscular fitness. Based on the results, this type of exercise can be recommended for beginners because of its multilevel effects.

Adult↗

PubMed2002

Stability of leisure-time physical activity during adolescence--a longitudinal study among 16-, 17- and 18-year-old Finnish youth.

Participation in physical activity during childhood and adolescence is frequently mentioned as one factor likely to promote a more active lifestyle in adulthood with its health benefits. We studied the changes in leisure-time physical activity pattern and self-reported fitness during a three-year period in adolescence and investigated whether the type of sports has an effect on stability of physical activity at leisure. A questionnaire with identical physical activity items was sent to Finnish twins on their 16th and 17th birthdays and 6 months after the 18th birthday. A total of 1338 boys and 1596 girls responded to all three questionnaires, with response rates of 73.6% and 86.5%. The proportions of very active adolescents and adolescents with very good self-reported fitness seem to be alike at each age. Among girls, 23.7% to 27.7% reported being very active (4-5 times a week) and 13.7% to 15.1% considered their physical fitness to be very good at the ages of 16, 17 and 18. Among boys, the comparable percentages were 31.5% to 35.5% and 30.6% to 34.4%. However, the longitudinal three-year follow up showed substantial changes over time among individuals from one physical activity group to another. Only 19.1% of boys and 11.2% of girls were persistent exercisers (i.e., very active on all three years) and 15.6% of boys and 5.1% of girls were persistently fit (i.e., very good self-reported fitness on all three years). Stability of leisure-time physical activity was highest among those who participated in several different types of sports. Among boys the proportion of persistent exercisers was highest for those who participated in cross-country skiing, jogging and body-building (22.0-41.5%) and among girls for those who participated in ball games (11.9-28.6%). Those who participated in organised sports were more often persistent exercisers than those who did not (odds ratio = 13.2 for boys (CI 9.4-18.7) and 8.9 for girls (CI 6.4-12.5)). Also, those who participated in organised sports were more often persistently fit (odds ratio = 7.3 for boys (CI 5.2-10.2) and 10.4 for girls (CI 6.4-16.9). Adolescents are recommended to participate in and try different types of sports, and especially for girls ball games would appear to favour long-term maintenance of leisure-time physical activity.

Adolescent↗

PubMed1980

Competition of internal and external information in an exercise setting.

During physical exercise, individuals have access to internal sensory and external environmental cues that compete for attentional focus. Two experiments examined when attention to external cues attenuates the perception of physical symptoms and fatigue. In Experiment 1, subjects' physical performance was held constant during exercise on a treadmill. Subjects hearing distracting sounds reported less fatigue and fewer symptoms than subjects hearing an amplification of their own breathing. In Experiment 2, subjects jogging equal length cross-country and lap courses evinced faster times on the former, where increased external attention was necessary. Self-reports of symptoms and fatigue, however, were comparable on the two courses. The results are interpreted in terms of attentional focus shifting from one information source to another as needed, with attention to any one source diminishing attention to others.

Awareness↗

PubMed1991

Stress reactivity and exercise training in premenopausal and postmenopausal women.

Examined the influence of ovarian function on psychophysiological stress responses and determined if aerobic exercise reduced stress reactivity. Fifty premenopausal and postmenopausal women initially were subjected to a public speaking task and an ice-on-the-forehead procedure, during which time their blood pressure and heart rate were monitored and continuous blood samples were obtained. Subjects also underwent aerobic fitness evaluations with a maximum-exercise treadmill test. Subjects were then randomly assigned to a 12-week exercise program of either aerobic exercise (e.g., walking and jogging at a prescribed exercise intensity) or non-aerobic strength and flexibility training and were then reevaluated. Results indicated that postmenopausal women exhibited lower resting epinephrine levels but greater epinephrine reactivity to the speaking task compared to the premenopausal women. There were no differences between premenopausal and postmenopausal women with respect to cardiovascular or catecholamine responses during the cold challenge. Premenopausal and postmenopausal women also achieved comparable improvements in aerobic fitness. However, results of the mental stress testing were complex and provided only partial support for the role of aerobic exercise in reducing stress responses.

Arousal↗

PubMed1988

Effects of aerobic exercise training, age, and physical fitness on memory-search performance.

We investigated the effects of exercise training on memory performance. One group of 13 men (M = 42.92 years of age) participated in supervised aerobic exercise (jogging) three times a week for 12 weeks. A second group of 15 men (M = 43.67 years of age) performed anaerobic exercise (strength training) for the same period of time. Subjects' reaction time (RT) performance in a memory-search task was assessed both before (Time 1) and after (Time 2) the 12 weeks of exercise training. Results indicated that there was no significant change in memory-search performance over time as a function of exercise training. Analyses of the Time 2 RTs demonstrated that aspects of memory-search performance were related significantly both to subjects' initial (Time 1) level of fitness and to age, but not to the amount of change in fitness associated with aerobic exercise training over this 12-week duration in this age group.

Adult↗

PubMed2004

Aging and the perception of biological motion.

Two experiments examined how observers' ability to perceive biological motion changes with increasing age. The observers discriminated among kinetic figures, depicting walking, jogging, and skipping. The direction, duration, and temporal correspondence of the motions were manipulated. Quantitative differences occurred between the recognition performances of younger and older observers, but these differences were often modest. The older and younger observers' performances were comparable for most conditions at stimulus durations of 400 ms. The older observers also performed well above chance at shorter durations of 240 and 120 ms. Unlike their performance on other 2- or 3-dimensional motion tasks, older observers' ability to perceive biological motion is relatively well preserved.

Aged↗

PubMed2006

A workplace intervention to promote stair climbing: greater effects in the overweight.

OBJECTIVE: Stair climbing is a lifestyle physical activity that uses more calories per minute than jogging. This study tested an intervention designed to promote stair climbing in a workplace. Because previous studies provide only equivocal evidence of the effects of increased stair climbing in worksites, a formal comparison of the effects of the intervention on stair ascent and descent was made. RESEARCH METHODS AND PROCEDURES: In a five-story public sector building, a 2-week baseline was followed by 6 weeks of an intervention involving a 23(1/2)- x 16(1/2)-inch poster in the lobby, the same poster and six messages affixed to the stair risers between floors, and an 11(3/4)- x 8(1/4)-inch point-of-choice prompt at the elevators. Stair and elevator choices (n = 26,806) were videotaped throughout and subsequently coded for direction of travel, traveler's sex, and traveler's load. Weight status was coded using silhouettes beside the computer monitor. RESULTS: A significant effect of the intervention on stair climbing was greater in those coded as overweight (+5.4%; odds ratio = 1.33) than in individuals of normal weight (+2.5%; odds ratio = 1.12). Although stair descent was more common than ascent, the intervention had similar effects for both directions of travel. DISCUSSION: Stair climbing at work has few barriers and seems to be a type of physical activity that is acceptable to overweight individuals. The relatively weak effect of workplace interventions compared with results for public access staircases may reflect uncontrolled effects such as the immediate availability of the elevator for the traveler.

Elevators and Escalators↗

PubMed2001

Dietary and lifestyle factors in relation to plasma leptin concentrations among normal weight and overweight men.

OBJECTIVE: Leptin, the product of the obesity (ob) gene, is a multi-functional polypeptide that is important in energy metabolism, which is strongly correlated with body fat mass and body mass index (BMI). In a recent prospective study, we found that leptin was positively associated with 4 y weight gain among overweight and obese men. This suggests that leptin resistance, marked by hyperleptinemia among obese subjects, may be an important marker for weight gain. The purpose of this study is to evaluate whether modifiable dietary and lifestyle factors are associated with plasma leptin concentrations among US men. METHODS: We included 268 men aged 47--83 y (who were free of cardiovascular disease, diabetes mellitus and cancer, except nonmelanoma skin cancer) from the ongoing Health Professionals Follow-up Study. These subjects completed a detailed dietary and lifestyle questionnaire (including cigarette smoking, alcohol drinking and physical activity) and provided a fasting venous blood sample in 1994. All blood samples were stored in a deep freeze (-70 degrees C) for 4--5 y before being analyzed. Plasma leptin concentrations were measured by radioimmunoassay. RESULTS: Men in the highest quintile of plasma leptin (mean=14.4 ng/ml) weighed more, were less physically active, and had higher total and saturated fat and cholesterol intake than men in the lowest quintile (mean=3.0 ng/ml). Physical activity and current smoking were inversely associated with plasma leptin concentrations (P<0.001). A 20 MET difference in physical activity per week (equivalent to approximately 3 h of jogging) was associated with 0.38--0.58 ng/ml lower plasma leptin concentrations for normal weight and overweight men after adjusting for total energy and fat intake, BMI and other confounding variables. Total fat and monounsaturated fat intakes were positively associated with plasma leptin concentrations even after adjusting for BMI and other confounding variables; however, this association was limited to men of normal weight (BMI<25 kg/m(2)). CONCLUSION: These data suggest that physical activity may be a significant determinant of plasma leptin concentrations in men. Increasing physical activity is associated with lower plasma leptin concentrations even after adjusting for BMI. Physical activity may lower leptin concentrations not only due to decreased body fat mass, but potentially through an increase in leptin sensitivity. International Journal of Obesity (2001) 25, 106-114

Aged↗

PubMed2005

Effects of physical activity intensity, frequency, and activity type on 10-y weight change in middle-aged men and women.

BACKGROUND: Increased physical activity is often recommended for weight maintenance and loss. OBJECTIVE: To examine how intensity, frequency, and type of recreational physical activity are associated with weight gain attenuation over a 10-y period. PARTICIPANTS: Over 15 000 adults between 53 and 57 y living in western Washington State recruited between 2000 and 2002. MEASUREMENTS: Self-reported measures of physical activity (using a questionnaire), height, and weight. METHODS: We examined associations between physical activity and weight change after age 45 y. All analyses controlled for age at baseline, weight at age 45 y (continuous), diet, education, smoking, and weight change between ages 30 and 45 y, and were stratified by sex and body mass index (BMI) at age 45 y (normal weight, overweight, or obese). RESULTS: Increasing MET-hours and sessions per week of high-, moderate- and low-intensity activities over 10 y were inversely related to weight gain after age 45 y. Generally, associations were stronger for women than for men and for obese compared to normal weight or overweight individuals. Obese women and men who participated in 75-100 min per week of fast walking gained 9 and 5 pound less than nonwalkers, respectively, and lesser amounts in normal weight and overweight women and men. Jogging, aerobics, and fast cycling were associated with weight gain attenuation in most sex and age 45 y BMI groups, while slow walking, swimming, and weight lifting were not. CONCLUSIONS: In this free-living population, long-term, regular physical activity, particularly common activities carried out at a moderate intensity such as walking, prevented some of the weight gain associated with aging.

Bicycling↗

PubMed2005

Brachial-ankle pulse wave velocity: an index of central arterial stiffness?

Brachial-ankle pulse wave velocity (baPWV) is a promising technique to assess arterial stiffness conveniently. However, it is not known whether baPWV is associated with well-established indices of central arterial stiffness. We determined the relation of baPWV with aortic (carotid-femoral) PWV, leg (femoral-ankle) PWV, and carotid augmentation index (AI) by using both cross-sectional and interventional approaches. First, we studied 409 healthy adults aged 18-76 years. baPWV correlated significantly with aortic PWV (r = 0.76), leg PWV (r = 0.76), and carotid AI (r = 0.52). A stepwise regression analysis revealed that aortic PWV was the primary independent correlate of baPWV, explaining 58% of the total variance in baPWV. Additional 23% of the variance was explained by leg PWV. Second, 13 sedentary healthy men were studied before and after a 16-week moderate aerobic exercise intervention (brisk walking to jogging; 30-45 min/day; 4-5 days/week). Reductions in aortic PWV observed with the exercise intervention were significantly and positively associated with the corresponding changes in baPWV (r = 0.74). A stepwise regression analysis revealed that changes in aortic PWV were the only independent correlate of changes in baPWV (beta = 0.74), explaining 55% of the total variance. These results suggest that baPWV may provide qualitatively similar information to those derived from central arterial stiffness although some portions of baPWV may be determined by peripheral arterial stiffness.

Adolescent↗