THE EFFECTS or EXERCISE AND DEIRAINING ON THE STIFFNESS OF BONE Dissertation for the Degree of Ph. D. MICHIGAN STATE UNIVERSITY ANNE ELIZABETH IRWIN 1976 LIBRAR Y Wakigi“ 3.59:3 U323 4*? .' 1.5.17 This is to certify that the thesis entitled THE EFFECTS OF EXERCISE AND DETRAINING ON THE STIFFNESS OF BONE presented by Anne Elizabeth Irwin has been accepted towards fulfillment of the requirements for Ph.D. Biomechanics & Engineering Mechanics W&m Major professor 2M! 4» 7? 1%.; NW. degree in Date 51' as; #94 0-7639 ABSTRACT THE EFFECTS OF EXERCISE AND DETRAINING ON THE STIFFNESS OF BONE By Anne Elizabeth Irwin The purpose of this study was to investigate the effects of two chronic exercise programs and a period of detraining on the stiffness of rat femurs. Eighty normal, 72-day-old, male, albino rats of the Sprague-Dawley strain were randomly assigned to one of three treatment groups and to one of five duration periods. Prior to the start of the treatments, all animals were allowed a twelve-day adjustment period to adapt to laboratory conditions. The treatments were: sedentary-control (CON); short-duration, high-intensity interval running (SHT); and long-duration, low-intensity endurance running (LON). The animals had access to a commercial animal diet and water ad libitum. The treat- nents were administered under controlled environmental conditions once a day, five days per week (Monday through Friday), for either eight or sixteen weeks. Eight- and sixteen-week periods of detraining followed Anne Elizabeth Irwin during which all animals remained in their cages and no exercise was administered. Animals were sacrificed after zero, eight, six- teen, twenty-four, and thirty-two weeks of treatments. The animals chosen for sacrifice were selected on the bases of their apparent health and their training per- formances. The final sample included sixty animals. Each animal was sacrificed by an intraperitoneal injec- tion of a 6.48 percent sodium pentobarbital (Halatal) solution. The right and left femurs were surgically removed while they were continuously moistened with Ringer's saline solution. Bone stiffness (modulus of elasticity) was determined by bending tests. These tests were designed to determine the load-deformation relationship for bone. All bones were tested within a temperature range of 22-260C and within one week of sacrifice. Double point loading was used. The distance to thickness ratios ranged from 1:1 to 2:1. The average strain rate was 6.01 X 10-4/sec. A cross-section of the bone, at the point of load application, was obtained by using a jeweler's saw. The crossésection was placed in a micro- scopic projector; its image was projected onto graph paper; and the image was traced. The elastic modulus and the moment of inertia of the bone cross—section were calculated. Anne Elizabeth Irwin After dependence of stiffness on strain rate was eliminated through a regression technique, a univariate- repeated measures technique was used to test differences at the .10 level of significance between elastic moduli of the three training groups, the five duration groups, and the right and left bones. The Newman-Keuls method was used to find the source of each significant univariate F-ratio. Means and standard deviations were computed for the elastic modulus for all groups. Over all treatments and durations there was no significant difference between the right and left bones. The only significant difference among treatment groups occurred after the sixteen-week training period at which time the bones of the LON group were less stiff than those of either the SHT group or the CON group. The SHT treatment did not significantly affect bone stiffness. The bones of the CON and SHT groups significantly increased in stiffness after sixteen weeks of training and then became less stiff after sixteen weeks of de- training. Therefore, some factor, such as the aging process, may cause rat femurs to gain stiffness before and lose stiffness after 196 days of age. At no dura- tion did the LON treatment cause a significant increase in bone stiffness above the original level. THE EFFECTS OF EXERCISE AND DETRAINING ON THE STIFFNESS OF BONE By Anne Elizabeth Irwin A DISSERTATION Submitted to Michigan State University in partial fulfillment of the requirements for the degree of DOCTOR OF PHILOSOPHY Departments of: Health, Physical Education and Recreation; Metallurgy, Mechanics and Materials Science 1976 ACKNOWLEDGMENTS The author wishes to thank Dr. William W. Heusner (Department of Health, Physical Education and Recreation), for acting as my thesis director and for guidance in the development of this dissertation. In addition, appreciation is also extended to Dr. Robert W. Little (Departments of Mechanical Engineering and of Metallurgy, Mechanics and Materials Science), for guidance in my engineering courses of study and for assistance in the development of this dissertation. Thanks are also given to the other members of the Guidance Committee: to Dr. wayne D. Van Huss (Depart- ment of Health, Physical Education and Recreation), to Dr. wade O. Brinker (Department of Small Animal Surgery and Medicine), and to Dr. William N. Sharpe, Jr. (Department of Metallurgy, Mechanics and Materials Science) for their guidance and support. In addition, gratitude is expressed to Dr. Gary L. Cloud (Department of Metallurgy, Mechanics and Materials Science), for guidance during the early stages of organizing and calibrating the experimental apparatus; to Mr. Edgar Conley for assistance in designing and building the testing apparatus; to Mr. Robert L. Wells for assistance ii with the electrical and electronic aspects of the experiment; to Mr. David Anderson for assistance in drawing the figures; and to Dr. George Piotrowski and the Florida State University System for their assistance in processing data through their computer. iii TABLE OF CONTENTS LIST OF TABLES LIST OF FIGURES Chapter I. II. III. INTRODUCTION Bone Stiffness . Need for the Study Purpose of the Study Scope of the Study . Limitations of the Study Definitions . REVIEW OF LITERATURE Mechanical Properties of Bone Bending Tests Rates of Loading . . Elastic Modulus Values Experimental Effects on Bone . Storage . Temperature . Delayed Testing . Effects of Exercise and Detraining on Bone Exercise . Detraining Paired Bones RESEARCH METHODS . Experimental Animals Treatment Groups Control (CON) Short (SHT) Long (LON) . Duration Periods Sample Size Experimental Procedures Animal Care iv Page vi vii \IN \I \J'IU'IUJNNN H Chapter Page Sacrifice Procedures . . . . . . . 22 Bone Stiffness Analysis . . . . . . 23 Mechanical Testing Techniques . . . . 23 Elastic Modulus Equation . . . . . 34 Elastic MOdulus of the Bone . . 39 Equation for the MOment of Inertia of a Cross- section . . . 4O Moment of Inertia of the Bone Cross- section . . . . . . . . 43 Strain Rate Equation . . . . . . . 44 Strain Rate of the Bone . . . . . . 45 Treatment of the Data . . . . . . . 46 Design . . . . . . . 46 Significance Level . . 47 Eliminating the Dependence of Stiffness on Strain Rate . . . . . . . . 47 Statistical Procedures . . . . . . 48 IV. RESULTS AND DISCUSSION . . . . . . . 50 Results . . . . . . . . . . . . 50 Question I . . . . . . . . . . 50 Question II . . . . . . . . . . 55 Question III . . . . . . . . . 57 Question IV . . . . . . . . . . 58 Discussion . . . . . . . . . . . 60 V. SUMMARY, CONCLUSIONS, AND RECOMMENDATIONS. 63 Conclusions . . . . . . . . . . 64 Recommendations . . . . . . . . . 65 REFERENCES CITED . . . . . . . . . . . 67 APPENDICES . . . . . . . . . . . . . 77 A. TRAINING PROGRAMS . . . . . . . . 78 B. FEMUR LENGTHS . . . . . . . . . . 83 c. FEMUR WEIGHTS . . . . ' . . . . . . 85 Table 10. LIST OF TABLES A Review of the Literature of Bending Tests A Review of the Literature of the Mechanical Properties of Bone Subjected to Bending Tests . . . . . . . . . . A Review of the Literature of the Experi- mental Properties of Bone Subjected to Bending Tests . Final Cell Frequencies A 3X5X2 Factorial Design with Cell Fre- quencies . . . . . Means and Standard Deviations for the Stiffness of Rat Femurs Presented by Treatment, Duration, and Paired Bones (km /cm2 Analysis of Variance for Bone Stiffness with a Repeated-measures Option for the Right and Left Bones of the Animal . . Means and Standard Deviations for the Stiffness of Rat Femurs Presented by Treatment, Duration, and Animal Differences Between the Mean Elastic Moduli (R + L) of the Treatment Groups within each Treatment Duration . . . Differences Between the Mean Elastic Moduli (R + L) of the Duration Groups within each Treatment Group . . . . . vi Page ll 14 20 46 51 55 S6 58 59 Figure \OCDNmU'IJ-‘UJN 10. ll. 12. 13. 14. LIST OF FIGURES A Rat Femur (left side) Micrometer and Jeweler's Saw Bending Text Fixture Testing Apparatus Specimen Grips Recording Apparatus Load, Deformation, and Time Strip Chart Load Versus Deformation Plot Microscopic Projector Tracing of the Cross-Sectional Area of the Bone Projection Free-body Diagram of a Beam in Pure Bending Bending Moments of a Cross-section Distance (Y) from the Centroid Average Elastic Moduli with Standard Error of the Means . . . . . . . vii Page 24 25 27 28 29 31 32 33 35 36 37 40 45 53 CHAPTER I INTRODUCTION Physicians and physical educators have recommended exercise for strengthening the human body. However, very little is known about the effects of exercise and de- training on bone. Many studies have been conducted over the last hundred years to investigate the physical and mechanical behavior of bone (21,34,49,71). During the past twenty years, engineering techniques have been employed to study the mechanical preperties of bone. Through the analysis of stress and strain in materials, researchers know that bone behaves as a transversely isotrOpic material and displays elastic, plastic, and viscoelastic properties. The elastic pr0perties of bone have been studied more extensibly than either the plastic or viscoelastic properties. Only within the last five years have there been studies to evaluate the effects of chronic exercise on the behavior of bone (58,75). None of these have included the effects of detraining. Bone Stiffness Bone stiffness is the resistence of bone to deformation. It is dependent on the rate of loading, the temperature, and the moisture content of the bone. The elastic modulus has most frequently been used as a measure of bone stiffness. It can be determined by using one of four methods of testing: bending, compression, tension, or torsion testing. A bending test is recommended because there is less chance of grip slippage (7). Need for the Study Not only is little known about the effects of exercise and detraining on bone, but there also is no information on different exercise training programs and their effects on bone stiffness. In addition, more evidence concerning the effects of exercise on paired bones is needed to verify whether changes are uniform between the right and the left bone. Purpose of the Study It was the purpose of this study to investigate the effects of two exercise training programs and a subsequent detraining program on bone stiffness. More specifically, an answer was sought to the following questions: Question I What is the stiffness of rat bones, as measured by the elastic modulus, after a planned program of exercise and detraining? Question II Does the elastic modulus vary between paired femurs? Question III Does the elastic modulus vary as a function of the various exercise treatments? Question IV Does the elastic modulus vary as a function of duration of the various exercise treatments? Scope of the Study The purpose of this study was to determine if bone stiffness is affected by a chronic exercise program and/or by a subsequent detraining program. The effects of exercise and detraining on the stiffness of paired bones also was examined. Eighty normal, male, albino rats were used in this study for several reasons. The rat is easily trained to run on a wheel. The running wheels were already constructed for use in a previous study. Also, the rat femur has been used in earlier bone stiffness studies. The design of this study included three treat- ments and five durations. The treatments were: sedentary-control (CON); short-duration, high-intensity interval running (SHT); and long-duration, low-intensity endurance running (LON). The animals within each group were sacrificed after five preselected treatment dura- tions. The durations were: prior to the start of the treatments, at eight weeks and sixteen weeks during the exercise program, and at twenty-four weeks and thirty- two weeks during the detraining programs The SHT and LON exercise training programs were implemented using electronically controlled running wheels (89). The wheels regulated the length and intensity of the running which in specific combination created programs of exercise designed to stimulate anaerobic and aerobic metabolic processes. Following common practice, these programs will hereinafter be referred to as "anaerobic" and "aerobic" types of exercise. The exercise programs increased in length and intensity for eight weeks. The exercise then was main- tained at this level for eight more weeks. At that time, no exercise was given for sixteen weeks of detraining. The sixteen weeks of training and the sixteen weeks of detraining were estimated to be of adequate length to cause a change in the stiffness of bone. Limitations of the Study 1. The design of this study, based on data from a previous study on muscle, included four animals per cell. This may not have been a large enough sample. 2. Shock was the stimulus used to motivate the animals to run. There was no control in this study for shock. In previous unpublished studies, the amount of shock used has been shown to be insufficient to produce a change in either skeletal or cardiac muscle. However, no information is available on the effects of the shock stimulus on bone tissue. 3. The sixteen-week periods of exercise and detraining may not have been long enough to produce changes in bone stiffness. 4. The results of this study are specific to the femur bones of male albino rats that begin a program of exercise at eighty-four days of age. The data apply only to the specific training and detraining regimens studied in this investigation. Definitions Stiffness A measure of the resistence of a material to deformation. -4 HI I..\ Pb - «\u — RAH Flt- Stress The internal force per unit area within a material resisting the deforming action of an outside force. Strain A measure of deformation per unit length within a material. Elastic Modulus The amount of stress theoretically required to produce a unit strain in a linear elastic material. Load A force or weight applied to an object. Deformation The amount an object changes in length or shape as a result of a load placed on it. CHAPTER II REVIEW OF LITERATURE This review of literature focuses on the mechani- cal properties of bone, the possible effects of testing conditions on bone, the effects of exercise and detraining on bone, and the comparative characteristics of paired bones. A discussion of the mechanical properties of bone includes bending tests, rates of loading, and the elastic modulus values determined in previous studies. Testing conditions which may effect the stiffness of bone are storage, temperature, and the delayed testing of bone. Mechanical Properties of Bone Bending Tests ‘ In the bones of living animals, the tension induced by bending is the most dangerous stress (23,69). Resistance to tension is more critical than resistance to compression. In research, the bending test is used because slippage of the testing grips is minimized (7). Also, a slightly curved test piece will not alter the value of the elastic modulus (21). However, in bending tests there are two assump- tions which are usually made (7): plane sections in bone 7 will remain plane, and bone material is both homogeneous and isotropic. In studies of bone strength and bone stiffness, bending tests have been performed by a number of investi- gators. Both whole bones and machined specimens were used. A ten-year review of the literature of bending tests is presented in Table 1. All of the studies of bending tests that were reviewed used a single point of loading. With a single loading point, normal strain occurs along with shearing strain at the maximum bending point. With double point loading, only normal strain occurs at the point of maximum bending. The central region is subjected to a constant bending moment, called pure bending (82). All investigators that have reported breaking stress values have used a stress formula for linearly elastic isotropic materials. The use of this formula should be restricted to isotropic substances and then is correct only when used within the linear range of stress values before breakage. However, bone shows some plastic yielding and is an anisotropic material (21). Burstein and co-workers found that, if a bending test is carried beyond the yield point, an elastic-plastic analysis must be performed (16). 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"° ‘1 Figure 9.--Microscopic Projector. 36 Figure 10.--Tracing of the Cross-Sectional Area of the Bone Projection. 32 when n<0 and xia, then fn(x) = 0, and when n<0 and x=a, then fn(x) is infinite; and where: at x=a, O is the unit step function, at x=a, 1 is the unit ramp function, _1 is the unit concentrated load function, and _2 is the unit concentrated moment function. 2! D' N I) G! Figure ll.--Free—body Diagram of a Beam in Pure Bending. 38 Integration of equation 3.1 four times results in equation 3.2 for the deflection of the beam at any position on the x-axis. ~ RAfx20>3 P3 P3 Clx3 szz +C4 3.2 The boundary conditions at x = 0 are III -V(x) = "EIV = 0 :9 C1 = 0’ Mb = -EivII = o =>c = o and (x) 2 ’ The boundary conditions at x = L+ are _ ~ III _ _ _ _ = Mb = -EIvII = o s>R L - P(L-a) - P(a) = o and (x) A ’ ~ RA(L)3 P(L-a)3 P(a)3 v = -EIv = o =>——3——— - —_—6___ - _—6—— + C3L==0. 3.3 Solving equations 3.3 simultaneously yields RB = P, RA = P, PL2 + P L-a)3 Pa3 C3 = ”’6‘“ L ‘+ 6L ' 3.4 39 substituting the values of equation 3.4 and x = % into the deflection equation (3.2) results in an equation for the center deflection (maximum deflection 6) of the beam: 6 = -v = Pa L2 - 82 3 5 Vmax if 7? 7? ' ' Substituting the values a = .221 inches and L = .543 inches into equation 3.5 and solving for the elastic modulus yields the equation: E —3— (.01420) kgm/cmz, 3,6 612 load placed on the bone and measured by the load cell, where P 6 = center deflection measured by the strain clip gauge, and I = an equivalent moment of inertia of the cross—sectional area of bone. Elastic Modulus of the Bone Each bone to be analyzed was loaded until plastic yielding occurred. Load (P) versus deformation (6) was recorded on a Varian F-80 X—Y recorder. Load and deformation values along only the linear portion of the recording were used. Within this segment of the curve, the bone responded as a linearly elastic material. The obtained load and deformation values were used in equation 3.6. 40 Equation for the Moment of Inertia ofia Gross-section For the moment of inertia of the irregular cross-sectional area of a bone, a general case will be considered where the y- and z-axes are centroidal axes, not principal axes, and where bending will occur in the xy and xz planes as a result of the bending couples -My and -M2 (Figure 12). Figure 12.--Bending Moments of a Cross-section. 41 The positive curvature in the xy plane can be denoted by ky = 5L3 where Dy is the radius of curvature along Y the y-axis. The positive curvature in the xz plane can be denoted by k2 = iLy where oz is the radius of curva- pz ture along the z-axis. The stress at point A with coordinates y,z is o = + k EY + k EZ. 3.7 x y 2 Since the origin of the axes is at the centroid of the cross-section, the resultant force in the x-direction is zero. That is, fodi = 0 and kyEdeA + szdeA = 0. The moment about the y-axis is _ _ 2 -My - fondA — kyEfYZdA + szfZ dA 3.8 where Iy = IZZdA and Iyz = fYZdA. Therefore, equation 3.8 can be rewritten as M = -k EI — k EI . 3.9 Y Y yz Z Y The moment about the z-axis is -M = - fo YdA = -k EszdA - k EfYZdA, 3.10 z x y z where Iz = szdA and Iyz = fYZdA. Therefore, equation 3.10 can be rewritten as 42 M = k EI + k EI . 3.11 z y z z yz Solving equations 3.9 and 3.11 simultaneously yields M I z + MZI M IZ + MZI z k = '.I _ and k2 = - E(I_I——:_I_XZ). y y z yz y z yz 3.12 Substituting equations 3.12 into equation 3.7 yields the total bending stress at point A for the general case -(M I + M I )z + (M I + M I )Y y,z z yz 4y yz z y; . 0x = I'I - I 2 3'13 y z z Y In this study, the bending moment about the y-axis is equal to zero (My = 0). Therefore, equation 3.13 takes the form _ Mz (IyY - Iyzz). Ox - I I - I 2 Y z yz The curvature of bending is only in the xy plane, or k = z _ . y EZIyIz Iyz2) If the axes were principal axes, then Iyz = 0 and k = -%—u Since the axes are centroidal axes, the 43 equivalent moment of inertia of the irregular cross— section is I=Yz YZ- 3.14 Moment of Inertia of the Bone‘Cfoss-section Each cross-section to be analyzed was projected onto graph paper so that the outer contour would lie within a Cartesian field of 30 units by 30 units with a scale factor of 50 units/cm. Both the inner border and the outer border of the bone were described by a series of coordinate points which were selected arbitrarily. The coordinates were recorded on computer cards. The S.C.A.D.S.4 computer program developed by G. Piotrowski and G. I. Kellman (67) was used to compute all geometric properties of the cross-section. The program fills in a smooth curve between the input points to establish the cross-sectional geometry. The y-axis was the axis of load application. The line of load was determined as continuous from the point of load application through the cross-section bisecting the inner elliptical cavity. The cross-sectional area (A), the location of the centroid of the cross-section (§,§), and the various area moments of inertia (1y, Iz, Iyz) were calculated using the IBM 4 Sections. A Stress Calculator for Arbitrarily Drawn 44 5 System/370-165 computer of the N.E.R.D.C. The values calculated were used as the parameters for equation 3.13. Strain Rate Equation For the strain rate of each bone analyzed, the standard stress-strain relationship was used: 0 = Eex. 3.15 A stress equation can be formulated using bending moments and the moment of inertia of the cross-section as follows: MZY PaY g = _,_.= _,_3 3.1 x Iz 'Iz 6 substituting equation 3.16 into 3.15 yields PaY _ 1E: - Eex. 3.17 Strain rate was calculated by differentiating both sides of equation 3.17 with respect to time: dP aY Edex HE:=-Ti't_ Rewritten, this formula yields the following equation for strain rate: 5North East Regional Data Computing Center of the Florida State University System. 45 94% aY ._f_. 3.18 z [‘11 Strain Rate of the Bone Each bone to be analyzed was loaded until plastic yielding occurred. Lead versus time was recorded on a Sanborn 322 Dual Channel DC Amplifier recorder. Load and time values along the linear portion of the recording were used. The (Y) from the centroid of the cross-section to the outer surface of the bone along the y-axis was measured in millimeters (Figure 13). Values calculated and measured in this manner were used in equation 3.18. The average strain rate was 6.01 x 10-4/sec. This value was lower than the strain rate values used in other studies. Figure l3.--Distance (Y) from the Centroid. 46 Treatment of the Data Desigp The study was designed as a three-way factorial experiment with repeated measures on only the third factor. Factor A, training, had three levels: CON, SHT, and LON. Factor B, duration, had five levels: O-wk, 8-wk, l6-wk, 24-wk, and 32-wk. These two factors have been described previously. Factor C, right versus left, was included to permit repeated measures to be taken on paired bones of each animal. A tabular repre- sentation of the experimental design, with cell fre- quencies, can be seen in Table 5. TABLE 5.--A 3X5X2 Factorial Design with Cell Frequencies. Factor C: Right vs Left Factor A: Factor B: Training Durat1on Right Bone Left Bone (CON) (Oewk) 4 4 (8-wk) 4 4 (16 -wk) 4 4 (24-wk) 4 4 (32-wk) 4 4 (SHT) (O-wk) 4 4 (8—wk) 4 4 (16-wk) 4 4 (24-wk) 4 4 (32 -wk) 4 4 (LON) (O-wk) 4 4 (8-wk) 4 4 (l6-wk) 4 4 (24-wk) 4 4 (32-wk) 4 4 47 Significance Level The .10 level of significance was selected for all inferential statistical analyses. This choice reflected the fact that the sample size was limited to four observations per cell by practical considerations. At the present state of knowledge, the consequences of failing to detect a potentially important treatment effect seemed to be nearly as great as those associated with claiming a significant effect when none exists. Differences observed at the .10 level (more easily detected than at the usual .01 or .05 levels) might provide direction for future research. Therefore, the probability of making a Type II error was reduced even though the risk of committing a Type I error was increased. Eliminating the Dgpendence of Stiffness on Strain Rate Strain rate was not controlled during data collection. It was not randomized across treatments, durations, the right and left femur, or subjects. Thus, the effect of strain rate had to be eliminated between groups as well as within groups. A regression technique was used for this purpose. The assumptions of linearity of regression and homoscedasticity were met. The raw values of the elastic modulus were corrected to esti- mated values corresponding to the mean strain rate of 48 6.01 X 10-4/sec. This procedure did not alter the overall mean value of the elastic modulus. Statistical Procedures The statistical analyses used in this study, both inferential and descriptive, are indicated for each of the following research questions that were asked: Question I.--What is the stiffness of rat bones, as measured by the elastic modulus, after selected programs of exercise and detraining? Descriptive statistics, including means and standard deviations, were computed for the elastic modulus by treatment, duration, and right versus left sides of the body. Question II.-—Does the elastic modulus vary as a function of paired femurs? The MANOVA program (41) was used, with the univariate-repeated measures option, to test the sig- nificance of the difference between the elastic moduli of the right and the left femurs. Qpestion III.--Does the elastic modulus vary as a function of exercise? The MANOVA program (41) was used, with the univariate-repeated measures option, to test the 49 significance of the differences between the elastic moduli of the three training groups. Qpestion IV.--Does the elastic modulus vary as a ‘function of duration of exercise and detraining? The MANOVA program (41) was used, with the univariate-repeated measures option, to test the significance of the differences between the elastic moduli when the data were grouped by duration. CHAPTER IV RESULTS AND DISCUSSION The purpose of this study was to investigate the effects of two training programs and a subsequent detraining period on bone stiffness in adult male albino rats. More specifically, the study sought to determine the stiffness of the femur after planned programs of exercise and detraining as well as the individual effects of the exercise treatments and various treatment dura- tions. Bones from.the right and left sides of the body were compared. Results The results of both inferential and descriptive statistical procedures are reported here in an attempt to answer the four major questions posed earlier. Question I What is the stiffness of rat femurs, as measured by the elastic modulus, after planned programs of exer- cise and detraining? 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