Women with osteoporosis and a history of vertebral fractures had improved balance and muscle strength and reduced fear of falling after participation in a supervised, multicomponent balance and resistance exercise program, according to study results published in Osteoporosis International.
Although exercise is recommended for patients with osteoporosis, evidence with respect to the effects of current osteoporosis exercise guidelines in patients with a history of vertebral fracture is limited. Researchers designed a single-blind parallel-group randomized controlled trial (ClinicalTrials.gov Identifier: NCT02781974) to assess the effect of a recommendation-based, multicomponent exercise program on health-related quality of life (HRQoL), physical fitness, and fear of falling in patients with osteoporosis. In total, 149 older women (aged ≥65 years; mean age, 74.2 years) who had been diagnosed with osteoporosis and had a history of vertebral fracture were recruited from an osteoporosis outpatient clinic and hospital outpatient clinics in and around Oslo, Norway.
The intervention group (n=76) attended a 1-hour, physiotherapist-led exercise group twice a week for 12 weeks, while the control group (n=73) received usual care. By the 3-month follow-up visit, attrition in the intervention group resulted in a total of 63 participants, and the control group was reduced to 59. Overall adherence to the scheduled exercise regimen was 82.6% in the intervention group with 75% of the women (n=57) having an adherence of 80% or more (>19 sessions). The primary outcome was 10-minute habitual walking speed, and secondary outcomes were HRQoL, physical fitness/function, International Physical Activity Questionnaire short form, Fall-Efficacy Scale International (FES-I), and adverse events. Measurements were taken at baseline and at 12 weeks (end of intervention).
For the primary outcome of walking speed, the between-group difference was not statistically significant (0.13 vs 0.08 m/s; mean difference, 0.04 m/s; 95% CI, -0.01 to 0.09; P =.132). However, statistically significant differences were noted for secondary outcomes and favored the intervention group for dynamic balance (mean difference for four square step test, -0.80 s; 95% CI, -1.57 to -0.02; P =.044), arm strength (mean difference for number of arm curls in 30 seconds with 5 pounds, 1.55; 95% CI, 0.49-2.61; P =.005), leg strength (mean difference for 30-second sit-to-stand, 1.85; 95% CI, 1.04-2.67; P <.001), and fear of falling (FES-I score mean difference, -1.45; 95% CI, -2.64 to -0.26; P =.018).
No statistically significant between-group differences were seen for HRQoL, grip strength, or manual and functional endurance. The per-protocol analysis demonstrated similar results. No serious intervention-related adverse events were reported; however, 2 participants withdrew from the exercise intervention because of increased sciatica and rheumatic pain.
Study investigators concluded that “a supervised multicomponent resistance and balance exercise programme for 12 weeks improved muscle strength and balance and reduced fear of falling in women with osteoporosis and a history of vertebral fractures. We observed no effect of exercise on walking speed or HRQoL in these community dwelling older women.”
Stanghelle B, Bentzen H, Giangregorio L, Pripp AH, Skelton D, Bergland A. Effects of a resistance and balance exercise programme on physical fitness, health-related quality of life and fear of falling in older women with osteoporosis and vertebral fracture: a randomized controlled trial [published online January 10, 2020]. Osteoporos Int. doi:10.1007/s00198-019-05256-4