# Exercise as it relates to Disease/Exercise to Reduce Risk Factors for Falls in Older Women with Osteoporosis

This is a fact sheet written for a University of Canberra Assignment, based upon the Study Community-Based Exercise Program Reduces Risk Factors for Falls in 65-to 75-year- old women with Osteoporosis: Randomised Controlled Trial written by N Carter, K.M Khan, H McKay, M.A Petit, C Waterman, A Heinonen, P.A Janssen, M.G Donaldson, A Mallinson, L Riddell, K Kruse, J. C Prior and L Flicker.

## What is the background to this research?

Osteoporosis is a chronic disease causing bones to become thinner and fragile, and often results in causing higher rates of broken bones, also known as ‘fractures’. One study estimated that the incidence of fractures caused by the disease osteoporosis, was approximately 9.0 million per year, in developed countries world-wide (Johnell, O & Kanis, JA 2006). With millions of suffers worldwide there is no doubt that Osteoporosis has a large financial impact on the health sector and therefore research into finding ways to prevent the occurrence of fractures in osteoporosis patients, is valuable to all. Even though research has proven that participating in exercise helps prevent falls and fractures in people with osteoporosis, this recent study has found that by participating in a formal exercise programme only minimal improvements in balance and agility were found in women aged 65 to 75 years. Exercise training has the ability to increase an individuals muscle strength which in time can reduce ones balance helping to reduce the risk of falling.

## Where is the research from?

The research for this study was conducted in Vancouver, Canada in 2002. The Study, “Community-based exercise program reduces risk factors for falls in 65-75-year-old women with Osteoporosis; randomised controlled trial” was published by the Canadian Medical Association, volume 167, issue 9.

## What kind of research was this?

The methodology for this study was a Randomised Control Trial in a population of older women aged between 65 and 75 years, who had been diagnosed with Osteoporosis between 1996 and 2000, at the British Columbia Women’s Hospital and Health Centre.

## What did the research involve?

The Study involved randomly selecting women who had previously been diagnosed with Osteoporosis. A total of 456 women aged between 65 to 75 years of age were contacted, however only 108 women agreed to participate in the trial. All women were required to undergo laboratory testing at the beginning to assess their general health including medications, current exercise, medical conditions and previous history of falls through the use of surveys. The participants also had their balance assessed which was tested using a dynamic balance transverse test, as well as measuring knee extension. The participants were divided randomly into either the control group, or the exercise group. The exercise group were required to participate in an “Osteofit” programme twice a week for a period of 20 weeks, whilst the control group were encouraged to continue about their daily life and routine for the same period. The “Osteofit” programme is specifically designed for people who suffer from Osteoporosis, and includes exercises to reduce the risk of falling. The pre-study assessments were repeated at the completion of the 20 week trial for all the participants, and the women were also required to report any falls. The study determined a fall to be “inadvertently coming to rest on the ground or another lower level with or without of consciousness and without the impact of an overwhelming external force”.

## What were the basic results?

Of the 108 who began the trial only 80 females completed the trial; 40 women representing the control group and 40 women representing the Intervention group. In total, 89% of all intervention classes were attended by the participants. The intervention group saw an improvement at static balance, and dynamic balance and knee extension. In terms of dynamic balance and knee extension the intervention group results were significantly greater than that of the control group. There was no significant difference between the two groups in regards to their perceived quality of life.
Table: Results Of Baseline and Final Tests
| | Control | | Intervention | |
| | Baseline (mean) | Final (mean) | Baseline (mean) | Final (mean) |
| Balance Score | 73.7 | 72.8 | 72.5 | 73.9 |
| Dynamic Balance Score (m/s) | 1.77 | 1.84 | 1.67 | 1.81 |
| Knee Extension Score (kg/m) | 32.2 | 31.6 | 30.6 | 31.7 |

## How did the researchers interpret the results?

From this study the authors found that an “Osteofit” intervention program helped to improve dynamic balance and knee extension which both can have a strong influence in the reduction of falls in the ageing population. The “Osteofit” program also influenced the participants “sway”. The authors interpreted the results of this study to say that exercise helped to stop the deterioration in movement when comparing the intervention group to the control group. The researchers could not find any change in quality of life and have linked this to the study participants having a good functioning body, even with the osteoporosis.

## What conclusions should be taken away from this research?

There is no question that exercise is a strong prevention technique in reducing the risk of falls with Osteoporosis patients, by working on their strength and balance. Although this study was small and did not present overwhelming numbers of significant improvement, exercise is a less expensive and low risk intervention when compared to drugs and specialist medical interventions.

## What are the implications of this research?

Further study of greater numbers of women in this age group would be required to assess whether improvements in balance and agility are significantly increased with a formal exercise programme. Also the cost benefit of such a programme would need to be analysed when looking at providing such a programme. The Authors of this study also suggest that any further studies should involve taking more laboratory measurements to assess for physical losses such as deterioration of muscle strength in the control group.

## References

* ↑ Carter N. D., Khan K.M., Mckay, H.A., Petit, M.A., Waterman, C. Heinonen, A. Janssen, P.A., Donaldson, M.G., Mallinson, A. Riddell, L. Kruse, K. Prior, J.C. and Flicker, L. (2002) 'Community-based exercise program reduces risk factors for falls in 65-75-year-old women with Osteoporosis; randomized controlled trial', Canadian Medical Association , 167(9), pp. 997-1004.
* ↑ 1. Johnell, O & Kanis, JA. 2006. An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporosis International, vol. 17, no. 12, pp. 1726-33.
* ↑ 6. Modi, A. Siris, E.S. Trang, J. Sen, S. (2015). Cost and consequences of noncompliance with osteoporosis treatment among women initiating therapy. Current Medical Research and Opinion, vol. 31, no. 4, pp. 757-765.
* ↑ 2. Den Ching A.L, Day L, Finch C.F, Hill K, Clemson L, McDermott F, Haines T.P. (2015). Investigation of Older Adults' Participation in Exercises Following Completion of a State-wide Survey Targeting Evidence-based Falls Prevention Strategies. Journal of Aging & Physical Activity, vol. 23, no. 22, pp. 256-64.
* ↑ 7. Lui- Ambrose, T. Eng, J.J. Khan, K.M. Carter, N.D. McKay, H.A. (2003). Older Women With Osteoporosis Have Increased Postural Sway and Weaker Quadriceps Strength Than Counterparts With Normal Bone Mass: Overlooked Determinants of Fracture Risk? The Journal of Gerontology, vol. 58, no. 9, pp. 862-866.
* ↑ 8. Ferrucci, L. Guralnik, J.M. Studenski, S. Fried, L.P. Cutler, G.B. Walston, J.D. (2004). Designing Randomized, Controlled Trials Aimed at Preventing or Delaying Functional Decline and Disability in Frail, Older Persons: A Consensus Report. Journal of the American Geriatrics Society, vol. 52, no. 4, pp. 625-634.
* ↑ 3. Osteofit- Fitness and Healthy Bones. 2011. About OSTEOFIT. [ONLINE] Available at: http://www.osteofit.org/. [Accessed 26 September 15].
* ↑ 4. Carter N, Khan K.M, Petit M.A, Heinonen A, Waterman C, Donaldson M.G, Janssen P.A, Mallinson A, Riddell L, Kruse K, Prior J.C, Flicker L, McKay H.A. (2001). Results of a 10 week community based strength and balance training programme to reduce fall risk factors: a randomised controlled trial in 65–75 year old women with osteoporosis. British Journal of Sport Medicine, vol. 35, no. 5, pp. 348-351.
* ↑ 5. Giangregorio L.M, McGill S, Wark J.D, Laprade J, Heinonen A, Ashe M.C, MacIntyre N.J, Cheung A.M, Shipp K, Keller H, Jain R, Papaioannou A. (2015). Too Fit To Fracture: outcomes of a Delphi consensus process on physical activity and exercise recommendations for adults with osteoporosis with or without vertebral fractures. Osteoporosis International, vol. 26, no. 3, pp. 891-910.