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Nat Rev Endocrinol ;— ICAPS: a multilevel program to improve physical activity in adolescents. Diabetes Metab ;—9. Physical fitness in relation to transport to school in adolescents: the Danish youth and sports study. Scand J Med Sci Sports ;— Eval- uation of a randomized controlled trial in the management of chronic lower back pain in a French automotive industry: an observational study. Arch Phys Med Rehabil ; Objective: To evaluate a specific workplace intervention for the management of chronic lower back pain among employees working in assembly positions in the automotive industry.

Design: Randomized controlled trial. Setting: On site at the workplace of a French automotive manufacturer. Intervention: The experimental group followed a supervised minute session, 3 times per week, of muscle strengthening, flexibility, and endurance training during 2 months. The control group received no direct intervention. Evaluation took place at baseline, 2 months, and 6 months. Perceived pain intensity was evaluated using the numerical rating scale, and physical out- come measures were evaluated using specific indicators flex- ibility, Biering-Sorensen Test, Shirado test.

The multivariate analysis of variance, t test, and Wilcoxon signed-rank test were used for statistical analysis. An increase in the practice of physical activity outside the workplace was noted in both groups at 2 months but persisted at 6 months for the experimental group. Conclusions: This study reinforces the multiple health bene- fits of physical activity and physical therapy modalities in the workplace by assisting individuals at risk who have chronic LBP.

MSD compensation in generated a loss of 8. Our understanding of LBP and its management has improved after several evidence based-research studies. The burden of work disability is shared by the worker, the industry, and the general economy. No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organi- zation with which the authors are associated.

The relationship between pain, disability, and work offers various fields of study in ergonomics and health-related work issues. Jobs that can lead to or worsen LBP symptoms are those that require highly repeated movements, overexertion, and static work maintained over time. The correlation between physical demands at work and LBP is complex. Risk factors include biome- chanical, psychosocial, and individual factors. In addition, several confounding variables such as age, gender, social and psychological status cannot be excluded and should be taken into consideration.

The environment and the coping demands of the work are also confounding variables. A low level of education affecting lifestyle factors and older age are other associations that might increase the incidence of LBP. Although key risk factors have been identified, the incidence of LBP has been increasing during the past years, rendering its management a persistent challenge. Effective manage- ment of chronic LBP, which is described by a persistent long- term effect, is an important factor in decreasing the burden of LBP in general.

The workplace is a good environment to reach a large proportion of the general population. We tested the hypothesis that a fully supervised workplace intervention results in improvements in physical and pain-related parameters. Through this study, we aimed to promote the importance of on-site interventions for increasing physical activity and managing LBP.

The random allocation sequencing was generated by the physician with the use of a random number table. The EXP group followed a supervised workplace inter- vention of exercise and physiotherapy during 2 months. Work- ers were informed of their rights as participants in scientific research according to the Helsinki Declaration.

Inclusion Criteria Voluntary workers men and women 18 years and older currently working in the assembly department of the Mulhouse site and who had chronic LBP were included in the study. Exclusion Criteria After a medical consultation, patients with recent surgery or serious pathologic conditions related to the onset of LBP or interfering with the designed monitoring measurements ma- lignant, traumatic, or inflammatory LBP, cardiac or respiratory problems, and severe psychological disorders were excluded from the study.

Intervention Based on the American College of Sports Medicine exercise guidelines edition 18 for muscle strengthening, flexibility training, and cardiovascular endurance, the EXP group per- formed minute sessions of physical therapy and physical exercise 3 times per week during 2 months. All sessions were administered to groups of 2 to 6 patients and fully supervised by an in-house physical therapist and a physical educator.

For organizational purposes within the workplace and for proper supervision, the participants were divided into 3 groups that started the intervention at different stages throughout the year January, July, and December The intensity of the exercises during the intervention was person- ally adapted to each participant, and all the sessions took place within the workplace medical department.

The types of exer- cise performed during the intervention included joint flexion and extension, stretching, stability, coordination, and muscle- strengthening exercises. The overall aim was to facilitate movement and to encourage workers to remain physically active and be aware of inappropriate postures or movements that might increase pain and discomfort. Advice to change maladaptive behavior and general advice about healthy life- style were also offered. Participants in the CONT group re- ceived no direct intervention but were free to consult exter- nally.

All participants received medical and paramedical consultation on the benefits of physical activity and proper working posture positions as part of a global workplace policy and strategy. Data Collection Strategy A data collection grid was prepared before the beginning of the intervention.

Information and measurements were collected by the physician or the physiotherapist on-site and then trans- ferred to the IRMES for statistical analysis while maintaining confidentiality. Outcome Measures and Monitoring Criteria Demographic characteristics. Collected data were age, body mass index, practice of regular physical activity, and medical history.

Pain and its impact. To evaluate the subjective perceived pain intensity, a numerical rating scale NRS, 0—10 was used. The questionnaire is divided into 4 parts: 1 impact of pain on daily activity Ddaily ; 2 impact of pain on work and recreational activity Dwork-rec ; 3 impact of work on anxiety and depression symptoms Danx-dep ; and 4 impact of pain on social activity Dsocial.

The Tampa Scale for Kinesiophobia 0—56 was used to measure kinesiophobia fear of movement. The use of this large selection of questionnaires was chosen to strengthen our understanding and verify that the changes observed are in accordance and follow a similar trend. Physical parameters. To evaluate the flexibility of major lower muscles, the muscular hypoextensibility was evaluated for each of the hip flexors, the hamstrings, and the quadriceps. We evaluated the flexibility of the hip flexors by measuring the knee to table distance KTD position with the worker lying face down.

For the hamstrings, we measured the finger to tip of toes distance FTD with the worker sitting on the ground with the legs straight. For the quadriceps, we measured the heel- buttock distance HBD with the worker lying face down. All measurements are in centimeters. To estimate the isometric endurance of trunk extensor and abdominal muscles, the So- rensen19 and the Shirado endurance tests in seconds were chosen.

To evaluate overall flexibility, the anterior flexion was measured by the finger to floor distance FFD. Our decision to measure the above-mentioned physical parameters was in re- lation to the effect of LBP on gait and the activity of the lumbar erector spinae. We used outcome measures as dependent variables and the time and group as independent variables. Level of significance was set at a P value of less than. Outcome measures baseline, 2 and 6mo were described, and we compared the measurements at 2 months and 6 months with baseline using the Student t test and Wilcoxon test as appropriate, for the 2 groups separately.

Data were analyzed using the R version 2. The total mean gain was calculated between the mean score difference at 6 months and at baseline. For better interpretation and since there is no consensus for the minimum important difference between groups, we evalu- ated the results according to different approaches: 1 statistical significance using MANOVA to test the global effect of time and interaction of time by group, and 2 Student t test or Wilcoxon test to evaluate the difference between the 2 time points and baseline.

Demographic data, physical activity practice, and an- thropometric measurements are shown in table 1. There was no statistically significant difference between the 2 groups. Participants who were more compliant and present for the follow-up measurements were younger than the absent or sick ones. The ratio of men to women did not change through- out the study. The most frequent reason for missing data was absence or sickness on the day of the measurement.

Subjects could not be reevaluated on another day because of organiza- tional reasons within the company. Detailed Assessment of Outcome Measures In all outcome measures, MANOVA revealed that there were an effect of time and an interaction between time and group, except for 2 measures: the Dsocial and the Shirado test table 2. Pain-Related Parameters The evolution of pain-related parameters with time and according to group are presented in figures 2 and 3.

The mean scores for all the outcome measures at baseline, 2 months, and 6 months with the P values difference between each times for groups separately are presented in table 3. The mean scores of flexibility and endurance at each time in both groups are presented in figure 4. Abbreviation: BMI, body mass index.

Perceived pain NRS. At 2 months, the total mean differ- ence was significantly lowered compared with the CONT group 1. At 6 months, however, the total mean difference no longer differed between groups 1. Kinesiophobia Tampa scale. We observed a statistically significant decrease in the EXP group at 2 and 6 months.

These 11 subjects who recovered had lower scores at baseline. The total mean difference was significantly lowered by 5. The CONT group had a general tendency in score amelioration, but it was not statistically signif- icant. Dallas Pain Questionnaire percentage. The effect was statistically significant for the EXP group at both time points. After the interven- tion at 2 months, the status was reversed. The EXP group had fewer anxiety and depression symptoms, with an average of Incli Time.

CONT group No statistically significant change was observed in either group at 2 or 6 months. Physical Parameters Flexibility. Results are presented in figure 4. Hypoextensibility hamstrings FTD. The mean baseline FTD was not equivalent in both groups. The EXP group had a mean distance of At 2 months, the mean FTD distance increased by 7.

The total mean gain was 4. Hypoextensibility quadriceps HBD. The total mean net gain is 4. Hypoextensibility hip flexors KTD. A mean total increase of 3. Sorensen and Shirado. The EXP group gained For the Shirado test, the EXP group showed a significant improvement only at 2 months. For the CONT group results were not significant. Anterior Inclination FFD. The results for the CONT group were significant at 6 months.

Fig 2. Evolution of pain intensity, kinesiophobia, and work disability with timeThe gray line with triangles represents the CONT group; the black line with a square represents the EXP group. A Pain intensity using the NRS 0— EXP baseline: 4. CONT baseline: 4. B Kinesiophobia using the Tampa scale 0— EXP baseline: CONT baseline: D Work disability: impact of pain on daily life using the Quebec questionnaire 0— Practice of Physical Activity The number of workers who declared that they were prac- ticing a regular leisure-time physical activity increased in both groups.

At 6 months, the number increased to 15 The number of workers who declared that they were practicing walking also increased. The increase in the EXP group was from The group that started the intervention in July reported a slightly higher rate in the practice of physical activities outside the workplace 2 months after the intervention.

Our major finding is that the intervention proved to be clinically and statistically relevant in favor of the EXP group at 2 and 6 months. A higher difference in change is observed in the EXP group. Those results are in accordance with the current evidence suggesting that exercise treatment programs and regular physical activity are likely to be benefi- cial for chronic LBP by decreasing pain severity and reducing physical deconditioning.

Much of the latest available evidence on LBP is in support of interventions that tackle pain effectively. The effectiveness of this intervention was reflected by a significant decrease in perceived pain intensity NRS , work disability RMDQ, Quebec, and Dallas questionnaire , and kinesiophobia Tampa scale and an improvement in physical parameters and back-specific functions anterior inclination, Fig 3.

Evolution of the Dallas questionnaire. A Impact of pain on daily activity Ddaily. B Impact of pain on work and recreational activity Dwork-recr. C Impact of pain on anxiety and depression symptoms Danx-dep. D Impact of pain on social activity Dsocial. Those benefits translate into substantial health gains and are similar to findings in comparable studies.

The strength of this investigation compared with previous studies is that rehabilitation interventions took place at the workplace on workers with chronic LBP rather than in a hospital with patients on sick leave. H Baseline Q Baseline HF Baseline Incli Baseline In a recent cohort study26 evaluating the short-term and midterm effectiveness of a retrospective back school — , results proved to be positive on pain and functional status but inconclusive on health impact.

In addition, a 1-year cognitive-behavioral intervention resulted in a mean improvement of 2. The exact duration and type of physical activity have not been analyzed. The onset of LBP increases the risk of sedentary behavior because of fear of movement and pain, thus resulting with time in a decline of physical fitness, and a negative health impact and quality of life. Physical activity in the workplace offers an answer to the management of LBP, since all types of LBP benefit from exercise.

Scientific research has consistently proven that LBP is a form of age-related disorder because of biomechanical predisposition and postural evolution. It is aggravated or accelerated by several multifac- torial events and factors. On the contrary; a dilemma persists between physical activity and LBP prevalence and severity. The contribution of exercise to the onset and severity of LBP is still debatable. In a recent study29 aiming at clarify- ing the ambiguous evidence, results reveal that participating in physical activity contributes indirectly to the severity of LBP but has no effect on its prevalence.

We excluded workers with severe psychological problems to minimize the confounding variables. An important factor in- terfering with the analysis is the timing of the intervention that coincides with the peak of the economic crisis, affecting the automotive industry especially hard. Under similar stressful conditions, workers from both groups might have overesti- Fig 4. Evolution of flexibility and endurance.

CONT baseline: 9. C Flexibility: anterior inclination A. Incli by measuring the FFD. E Endurance of the back muscles using the Sorensen test. F Endur- ance of the abdominal muscles using the Shirado test. Despite the presence of similar underlying ex- ternal uncontrollable factors, which might have affected our results by overestimating some subjective parameters, the sta- tistical difference observed within this limited time in our study is strong and remains promising.

Furthermore, workers in our study showed a high degree of kinesiophobia and work disability scores at baseline. Reviews evaluating different types of physical exercise interventions have reported small to moderate changes in certain outcome measures pain intensity, return to work, physical parameters , and the progress was clinically more relevant in patients who had lower baseline scores.

From a broad spectrum, our results imply that an interven- tion combining physical activity promotion and exercise ther- apy, along with advice on a healthy lifestyle, is effective in the short-term, but needs to be maintained with a form of physical exercise for the benefits to persist. A targeted 2-month inter- vention at work helps employees decrease perceived pain, kinesiophobia, and work disability and improves their physical parameters more rapidly than leisure-time physical activity and advice alone.

Further research is needed in real work settings to add to these findings, to better understand the functionality and effi- ciency of physical activity promotion in workers with chronic LBP. Study Limitations Potential limitations in this study are as follows: 1 Because of the complexity of the workplace setting, there could be no patient blinding.

Nevertheless, our results reflect a real case scenario with challenges faced when applying recommenda- tions within the workplace. Engag- ing in an active lifestyle provides protective effects by reducing the negative impact of LBP. The contents of the program are not work specific and can be performed in different groups or settings. The results offer ample opportunities and perspectives. As such, a similar intervention strategy in the workplace can achieve substantial gain for the individual and the group by decreasing the burden of pain and physical deconditioning.

More randomized controlled trials with larger sample sizes are recommended to detect low to medium effect sizes. Schaal, Mr. Berthelot, Mr. Sedeaud, and Ms. El Helou for carefully reviewing the manuscript; and Mrs. Godon, A. Briquet, MD, and C.

Andlauer, MD, for their input and advice during the intervention. References 1. Accessed June, Exercise therapy for chronic nonspe- cific low-back pain. Best Pract Res Clin Rheumatol ; Joint Bone Spine ; A systematic review of low back pain cost of illness studies in the United States and internationally.

Spine J ; Epidemiology and natural history of low back pain. Eura Medicophys ; Interven- tion practices in musculoskeletal disorder prevention: a critical literature review. Appl Ergon ; Waddell G, Burton AK. Occupational health guidelines for the management of low back pain at work: evidence review. Occup Med Lond ; Back pain and work. Best Pract Res Clin Rheumatol ; Effec- tiveness of a multimodal treatment program for chronic low-back pain.

Pain ; Level of education and back pain in France: the role of demographic, lifestyle and physical work factors. Int Arch Occup Environ Health ; Multidisci- plinary biopsychosocial rehabilitation for subacute low back pain in working-age adults: a systematic review within the framework of the Cochrane Collaboration Back Review Group. Spine Phila Pa ; A systematic review.

BMC Med ; Exercise as a treatment for chronic low back pain. Spine J ; Low back pain: state of art. Eur J Pain Suppl ; Sustainable MSD prevention: management for continuous improvement between prevention and production. Meta- analysis of workplace physical activity interventions. Am J Prev Med ; American College of Sport Medecine.

Guidelines for exercise testing and prescription. Spinal muscle evaluation using the Sorensen test: a critical appraisal of the literature. Effects of chronic low back pain on trunk coordination and back muscle activity during walking: changes in motor control.

Eur Spine J ; Ann Readapt Med Phys ; Ann Phys Rehabil Med ; Clinically important outcomes in low back pain. What do the numbers mean? Normative data in chronic pain measures. A minimal clinically important difference was derived for the Roland-Morris Disability Questionnaire for low back pain.

J Clin Epidemiol ; Ann Readapt Med Phys ; Efficacy of a functional restoration program for chronic low back pain: prospective 1-year study. Advice for the management of low back pain: a systematic review of randomised controlled trials. Man Ther ; Physical activities and low back pain: a community-based study. Med Sci Sports Exerc ; Vuori IM. Dose-response of physical activity and low back pain, osteoarthritis, and osteoporosis. Med Sci Sports Exerc ; S; discussion Comparison of a functional restoration program with active individual physical therapy for patients with chronic low back pain: a randomized controlled trial.

Physical conditioning programs for workers with back and neck pain: a Cochrane systematic review. Spine Phila Pa ; E Exercise and chronic low back pain: what works?. Workplace stress, lifestyle and social factors as correlates of back pain: a representative study of the German working population. Group cognitive behavioural treatment for low-back pain in primary care: a randomised controlled trial and cost-effectiveness analysis.

Lancet ; Manchikanti L. Epidemiology of low back pain. Pain Physician ; Krismer M, van Tulder M. Strategies for prevention and manage- ment of musculoskeletal conditions. Low back pain non-specific. Man- aging pain in the workplace: a focus group study of challenges, strategies and what matters most to workers with low back pain. Disabil Rehabil ; Tucker P, Gilliland J. The effect of season and weather on phys- ical activity: a systematic review. Public Health ; Snook SH.

Work-related low back pain: secondary intervention. J Electromyogr Kinesiol ; Suppliers a. R Foundation for Statistical Computing. Warm-up duration per session: 10min. Proprioceptive exercises: For a better general mobility and balance. Preventing kinesiophobia by learning the benefits of movement duration per session: 15min. Muscular strengthening-endurance: Reinforcing major muscle groups back muscles, abdominals, buttock, psoas, hamstrings, latissimus dorsi, etc using simple techniques and workouts duration per session: 10min.

Warm pack physiotherapy: For optimal muscle relax- ation at the end of the session before resuming work and preventing muscle aches and uncomfortable positions duration per session: 15min. Total: 60 minutes per session An additional prevention course was given to explain anat- omy and biomechanics of LBP while describing the recom- mended prevention techniques and exercise guidelines. Warm-up Proprioceptive exercises A B C Muscular strengthening workout D E F Stretching H Practical demonstration with sample pictures.

A Ret- roversion pelvic exercise on the balloon associated with respi- ration techniques and abdominal workout. B Proprioceptive exercises to improve balance and prevent injuries. C Mobility workout on unstable surface: sitting position, moving face down. D Progressive resistant work with elastic. E Specific muscular reinforcement, F Balance and resistance. G Stretching of the spine, the quadriceps, and the whole posterior chain. H Stretching of the lumbar muscles. Summary The increase of sedentary lifestyle in the French population and the decrease in the time daily devoted to physical activity has raised public concerns.

Promotional campaigns to raise energy expenditure and health awareness have recently increased. Nevertheless, although the recognition of such an imbalance is becoming more evident in the population, a real beneficial modification is still far from a full success. Numerous working groups are seeking to broaden the scope of action and take advantage of environments that facilitate the application of strategies.

Local settings such as schools, businesses, urban authorities and sports representatives clubs, leagues and associations progressively increase their engagement. S38 H. Nassif et al. Expertise Inserm. Global strategy on diet, physical activity and health. Physical activity promotion through the mass media: Inception, production, transmission and consumption.

Am J Prev Med ;S2. Octobre Promotion of physical activity in primary health care: update of the evidence on interventions. J Sci Med Sport ;7 Suppl Figure 1. Figure 2. Figure 3. Figure 4. Minimum amount of physical activity for reduced mortality and extended life expectancy: a prospective cohort study. The Lancet. Mortality of French participants in the Tour de France Eur Heart J.

Effects of endurance training on blood pressure, blood pressure- regulating mechanisms, and cardiovascular risk factors. The effect of baseline physical activity on cardiovascular outcomes and new-onset diabetes in patients treated for hypertension and left ventricular hypertrophy: the LIFE study. J Intern Med. Expertise Collective. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin.

Duclos M. Sci Sports. Praagh EV, Collectif. Bruxelles: De Boeck; Rev Neuropsychol Neurosci Cogn Clin. Lepers R, Cattagni T. Do older athletes reach limits in their performance during marathon running? European Commission. Ageing well: Under what conditions? Ageing is a complex universal process, un-programmed and multi-factorial. Within a species, genome organisation determines average life span but for each individual it is mainly shaped by outside constraints.

Lengthy old age remains the privilege of developed populations: the role of a clement environment, shaped by man, is of capital importance. But until when do we age? And under what conditions? Does the accumulation of present constraints limit our powers of adaptation at a time when certain asymptotes talk of a ceiling within one or two generations? Mal ou bien? Shakespeare, Macbeth V. Je veux pleurer des torrents de larmes.

Source : Berthelot G. Pour les dix premiers sauteurs en hauteur mon- diaux, hommes ou femmes, les meilleures marques ne progressent plus depuis 25 ans figure 5. Figure 5. The citius end : world records progression announces the end of a brief ultra-physiological quest.

Figure 7. Figure 6. Figure 8. Paris : Payot. Avant les mots, les langes de la vie. Exposition Paris. World records progression announces the end of a brief ultra-physiological quest. Athlete atypicity on the edge of human achievement : performances stagnate after the last peak, in A double exponential dependence toward developmental growth and time degradation explains perfor- mance evolution in individual athletes and human species.

Expertise col- lective. Measuring the mortality compression, Demog Res. Age-related changes in km ultra-marathon running per- formance. Age- associated changes in skeletal muscles. J Appl Physiol. Paris : Gallimard. Validation des tests physiques Diagnoform.

Fayard, Neural mecha- nisms underlying motivation of mental versus physical effort. PLoS Biol; vol. Genetic signatures of exceptional longevity in humans. How unrealistic optimism is maintained in the face of reality. Nature Neuroscience, vol. Timing of onset of cognitive decline : results from Whitehall II prospective cohort study. Brit Med J. A comparison of « The limits to growth » with 30 years of reality.

For commercial re-use, please contact journals. Email: juliana. In a study of life-span densities total number of life durations per birth date , we analyzed 19, Olympians and 1, supercentenarians deceased between and Among most Olympians, we observed a trend toward increased life duration.

This trend, however, decelerates at advanced ages leveling off with the upper values with a perennial gap between Olympians and supercentenarians during the whole observation period. Similar tendencies are observed among supercentenarians, and over the last years, a plateau attests to a stable longevity pattern among the longest-lived humans.

This topic is of great concern for public health and policymakers and has worldwide implications as it may affect the sustainability of modern societies and health care systems 1—3. Yet, the issue of longev- ity trends has divided researchers and remains a matter of controversy 4. The origin of this divergence is not only a philosophical matter, but it is also supported by differing methods of investigation.

Based on past life table trends, the prolongevist side claims that life expectancy will con- tinue to increase linearly 5,6. Best practices research has proposed dramatic increases in longevity outcomes, affirming that most children born in developed countries since will reach years 7.

We propose an intermediate approach to investigate life-span trends with novel tools. The approach consists in analyzing life-span density trends of two highly selected populations with a propensity to live longer. Their current maximum life-span trends may figure the general popula- tion in the near future. Conversely, a deceleration among longer lived cohorts could be seen as a sign of a close life-span limit 2.

The first population selected was made up of all world- wide Olympic athletes that had participated in the Olympic Games and were already deceased. Other sources analyzing Olympians longevity, whether medallists or not, have demonstrated a similar advantage 12, To the best of our knowledge, Olympians consti- tute the sole worldwide well-defined population that has a proven survival advantage, including all ethnicities and dat- ing back to the 19th century.

The registered longest-lived member of any species defines its maximum life span The density analysis total number of life dura- tions per birth date reveals distinct life-span trends accord- ing to the number of subjects with time. Hence, it allows for a highly informative description of life-span upper limits and its relative relevance within the wide range of lifetime values.

Therefore, we aimed to describe life-span density trends of worldwide deceased Olympians and supercentenarians. Data came from the most authoritative source of Olympians biography The Olympians population is mostly composed of adults from high-income countries in Western Europe and North America Table 1. Study Population—Supercentenarians A verified and validated complete cohort of deceased supercentenarians born after was collected from the Gerontology Research Group The majority of supercentenarians also come from high-income countries Table 1.

Life-span Density Function The life-span density of Olympians and supercentenar- ians was estimated over a two-dimensional mesh. Analysis of the Dynamics of Life-span Trends in a Specific Time Frame To assess the trends among the life-span upper values, the superior contour of each density layers was smoothed through a two-dimensional convolution kernel.

The frame was defined within the intervals: X Olympians in [; ]; Y Olympians in [80; ]; and X supercentenarians in [; ]; Y supercentenarians in [; ]. The frame selected in X cor- responded to the first year forming a density layer up to the last year of a complete cohort. The selected frame in Y corresponded to a life span superior to 80 years up to its maximum values.

The life-span trends dynamics, for each birth date in the selected frame, was calculated by the sum of differences between adjacent densities in the Y life span direction see Supplementary Material. All analyses were performed using Matlab 7. Results Olympians and Supercentenarians Life-span Density The life-span density of worldwide Olympians and supercentenarians is presented in Figure 1.

The first Modern Games occurred in Thus, Olympians born before participated in the early edi- tions at a more advanced age Deaths under 40 years mainly correspond to two birth peri- ods: — and — and include men only. Thedenserareas,correspondingtothelifespanthatconcen- trates the highest number of subjects, is formed by Olympians born between and that died around years-old. None of the Olympians reached the status of supercen- tenarian; therefore, a gap separates the two populations throughout the entire period.

The denser area among the supercentenarians is formed by subjects born between and that died around years-old. Life-span Upper Limits The top-left corner in Figure 1 is the focus of the life- span upper limit analysis for both populations as they con- stitute the life-span upper values of both complete cohorts. Table 1. The superior layer, formed by the greatest life-span values of Olympians, creates a survival convex enve- lope at approximately 98 years.

The convex envelope points out the Olympians life-span upper limit observed. The density layers, below this convex envelope, move upward with birth date leveling off with the upper limit envelope. A similar pattern is present among supercentenarians. Their life span creates a survival convex envelope at approx- imately years. The densities layers above this envelope evolve with time, but the upper limit remains steady and a plateau may be visualized up to now.

Life-span Density Line Trends The superior contour of each density layers at the top- left corner on Figure 1 are illustrated in Figure 2A for both populations. We observe a different slope progression of the density lines according to the life span. The density slope of Olympians decelerates with time as their life span increases. Regarding supercentenarians, the density slope increases slightly with time at the beginning of the observation period, at a similar pace among the densities layers.

Then, the density slopes remains stable for the upper values. This results in a plateau attesting a stable phenomenon among supercentenarians in recent years. Densification Phenomenon Life span increase leveling off with the upper values entails an accumulation of individuals close to the survival convex envelope and reveals a densification phenomenon.

This phenomenon was assessed in the ancillary graphs Figure 2B and C. The graphs describe an increased densification trend more continuous and more intense among supercentenar- ians than among Olympians. Discussion Learning From Leaders This study demonstrates the life-span trends in popu- lations with a propensity to live longer, Olympians and supercentenarians.

Among Olympians, we observe a trend of increasing life duration, which slows down at advanced ages. The dynamics observed leads to a densification phe- nomenon, as a result of a life span compression between the denser areas and the maximum ages. Olympic participants undergo a highly selective pheno- typic process based on rare physiological aptness At the age of cohort entry, they were healthy subjects under favorable conditions genetic and environmental 17 reaching high standards of physical performances.

Studies have shown that Olympians have healthier lifestyles after their career and maintain a good physical condition All these factors contribute to greater longevity 18— Birth date in years Life span in years 10 20 30 40 50 60 70 80 90 0 5 10 15 20 25 30 35 40 45 50 55 Density scale d 70 60 50 40 30 20 10 0 Figure 1. Window: X Olympians in ; ; Y Olympians in [10;]; X supercentenarians in [;]; and Y supercentenarians in [;].

The vertical dashed line delimitates the complete cohort, when the population has entirely died out. The horizontal dashed line delimits life span values superior to 80 years within the complete cohort. Isolated life spans are not represented in the figure because of their small density values. Accordingly, a longitudinal analysis of centenarians and supercentenarians has demonstrated a significant associa- tion between better physical function with survival advan- tage until years.

Beyond that age physical function or biomedical parameters may less accurately predict mortal- ity Despite the gap, Olympians and supercentenarians pre- sent similar life-span trends and densification phenomenon, intensified among supercentenarians. This common pattern may indicate that both populations are under similar mor- tality pressures, despite the different phenotypic selection criteria of each population. Such forces increase with age, and both populations respond similarly by a densification phenomenon.

Concerning supercentenarians, the increasing den- sity slope at the beginning of the observation period may be related to the greater number of recruited subjects and to a more reliable registry. Thereafter, the stable trends observed attest for a life-span plateau over the recent years. After this record, only a single person born in has lived for years, and since then, no one has lived to more than years. Accordingly, the life-span density trends provide no signs of a recent increased longevity pattern among the longest-lived, despite of an intense densification phenomenon.

This scenario seems to be represented here, through the densification phenomenon, alluding to a rectangularization of the survival curves 22, To sup- port life-span extension forecasts, we would expect to find signs of expansion trends, people living each time longer at advanced ages 2. Life-span Record Holders The fittest subjects of each country compose the world- wide Olympians cohort This population is mostly formed by athletes from regions that have historically dominated sport performances and the world record for life expectancy as well.

A Contour of the life-span density layers of Olympians and supercentenarians. Selected window: X Olympians in [;] first year forming a density layer up to the last year of a complete cohort ; Y Olympians in [80;]; and X supercentenarians in [;]; Y supercentenarians in [;]. Graphs B and C represent the increase of the density layers with time in the direction of the upper life span values measuring the densification phenomenon.

Even though in the absolute sense Olympians constitute a small subset of gifted athletes, validated super- centenarians compose an even smaller subset of outliers. The two periods concentrating most deaths under 40 years can be attributed to both world wars, which reveal that Olympian men were neither excluded from the war effort nor spared its consequences.

The trend among most Olympians toward an increased lifetime throughout the century is similar to what has been described in terms of life expectancy 5,24 and life-span modal analyses 3 in record-holding countries. Modal age at death, estimated in United States, Canada, and France, show similar increasing trends. Japan, however, has recently leveled off 3 comparably to Olympians life-span trend at advanced ages.

The Gap The gap between Olympians and supercentenarians may indicate a potential for further life expectancy increase. But even among a highly selected population of Olympians, surpassing the general population in terms of average age of death 11 , none reached the status of a supercentenar- ian attesting the exceptional character of reaching years The similar densification among Olympians and supercentenarians and their unclosing gap both strengthen the arguments defending that human biology may not allow most of us to become a centenarian Indeed, becoming one of them takes a complex sequence of rare and specific circumstances, involving constant favorable interactions between genetics 27 and environment Hence, it seems appropriate to distinguish the interpretation of actu- arial trends on all-cause mortality from biologic aging possibilities.

Method Considerations Our study reinforces biologic forecasts 10,25,29 con- trasting with extension claims 7,30, However, our period of observation is restricted, and the size of the pop- ulation studied is relatively small. In addition, life expec- tancy increase has been discontinuous due to historical changes; our cohorts could reveal a transitional trend only.

After this period, all demographic forecasts are based on period life tables death rates from a calendar year applied to peo- ple still alive and remain speculative 9. The underlying assumptions are deterministic—based on the premise that the future will repeat past trends. In addition, death rates at extremely older ages are uncertain Hence, analyzing a concrete cohort presenting a survival advantage may be an alternative method for understanding the present dynamics of maximal age trends.

In light of the continuous reductions in mortality rates at advanced ages in high-income countries 6 possibly the den- sification phenomenon will intensify in most developed coun- tries. For instance, compression of deaths above the mode—a comparable measure for densification—has been observed in high-income countries 3. Then, the probability of surviving people, pushing the limits forward and leading to a life-span extension may be bigger.

However, this scenario defended by prolongevists, seems to be possible only if nutritional, cli- matic, social, or economic conditions continuously improve. Important medical and technological advances may also lead to life extension 31 , but major health determinants already contribute to reduce life expectancy progression in developed countries 33, In addition, the current tendency in world climate change and environmental resources degradation may result in adverse health consequences especially affect- ing the eldest individuals Conclusion Most Olympians follow the general population tendency of a life span increase with time, a trend which deceler- ates as life span increases.

At advanced ages, the slow pace on life duration progression leads to a densification of subjects dying simultaneously after reaching the highest ages. The common trends between Olympians and supercen- tenarians indicate similar mortality pressures over both populations. These forces increase with age, scenario bet- ter explained by a biologic barrier limiting further life-span progression.

Although this forecast may be felt to be less optimistic, to consider the line of reasoning underlying it may contribute to a better understanding of life-span trends and better prevent what may decelerate further progression.

Kryger, and Carole Birkan- Berz for reading the manuscript and providing valuable advice. Conflicts of Interest The authors confirm that there are no conflicts of interest. All authors read and approved the final version of the manuscript. In search of Methuselah: estimat- ing the upper limits to human longevity. Increase of maxi- mum life-span in Sweden, Ouellette N, Bourbeau R.

Changes in the age-at-death distribution in four low mortality countries: a nonparametric approach. Demographic Res. Couzin-Frankel J. A pitched battle over life span. Oeppen J, Vaupel JW. Broken limits to life expectancy. Vaupel JW. Biodemography of human ageing. Ageing popu- lations: the challenges ahead.

Hayflick L. Biological aging is no longer an unsolved problem. Ann N Y Acad Sci. Prospects for human longevity. Survival of the fittest: retrospective cohort study of the longevity of Olympic medallists in the modern era.

Br Med J. Increased life expectancy of world class male athletes. Med Sci Sports Exerc. Mortality of top athletes, actors and clergy in Poland: follow-up study of the long term effect of physical activity. Eur J Epidemiol. Life at the extreme limit: phenotypic characteristics of supercentenar- ians in Okinawa. Coles LS. Validated worldwide supercentenarians, living and recently deceased. Rejuvenation Res. Disease-specific mortality among elite athletes. J Am Med Assoc.

Natural selection to sports, later physical activity habits, and coro- nary heart disease. Age-specific and sex- specific mortality in countries, a systematic analysis for the Global Burden of Disease Study Physical independence and mortality at the extreme limit of life span: supercentenarians study in Japan. The future of human longevity. In: Uhlenberg P, ed. International Handbook of Population Aging. New York: Springer; — Here you can find software that is useful to build a content management system for medical care.

This metapackage contains dependencies for software and that could be useful ro run a Hospital Information System. While there is continuous work going on to package a ready to install system currently only preconditions are finished but hopefully helpful in hospitals anyway. Help us to see Debian used by medical practitioners and biomedical researchers! Join us on the Salsa page. The Debian Med Pure Blend contains packages which are grouped by metapackages.

Each metapackage will cause the installation of packages for a specific topic. The following table lists the metapackages of Debian Med.

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Files for an exchange on tracker are given by users of a site, and the administration does not bear the responsibility for their maintenance. The request to not fill in the files protected by copyrights, and also files of the illegal maintenance! Here the log file with errors: lmgrd Rereading license file Please correct lmgrd license file and re-start daemons. In this case a floating license would work.

Thanks anyway! This is why I'm interested in the floating license. Thank you vvmlv , now it is working. Desired port was: Last error was: Server did not respond to initial request: Please check that port is available. Did not start the server. InstallServiceHandlerInternalException: An internal exception occurred inside the install service handler mechanism at com.

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User agreement, Privacy Policy For copyright holders Advertise on this site. The site does not give electronic versions of products, and is engaged only in a collecting and cataloguing of the references sent and published at a forum by our readers. Did not start the server. InstallServiceHandlerInternalException: An internal exception occurred inside the install service handler mechanism at com. MvmExecutionException: connector. Any suggestion? Help, please! If matlab is installed with a standalone license, RDP is possible only if matlab is already running on the host.

If we try to start matlab remotely, a license error occours. This is why I'm interested in the floating license May be you can try different remote programs Or this does not help? NoMachine and TeamViewer may be there are other variants are said to be working with standalone license or run matlab manually and use remotely. Please redownload it and try again.

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