# Exercise as it relates to Disease/Exercise for elderly Women with Osteoporosis; Does it Reduce Falls Risks?

This is a fact sheet written for a University of Canberra Assignment for the unit Health Disease and Exercise, 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 condition in which bones lose their strength and thickness (density) leading to a higher risk of fractures than normal. Osteoporosis occurs when bones lose minerals such as calcium more quickly than the body can replace them. Osteoporosis is a common skeletal condition, with around 700,000 current doctor-diagnosed cases across Australia. More than eight out of 10 of these are women and most are aged 55 and over. Keeping in consideration the amount of undiagnosed cases there would be, the numbers could be a lot higher. Osteoporosis is largely a ‘silent disease’ that does not show any obvious signs and symptoms. Most people do not realise they have osteoporosis until a fracture occurs, which means that many cases go undiagnosed. 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.

## 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.
| Advantages | Disadvantages |
| Useful to osteoporosis sufferers | Small time Frame |
| Good for studying links in exercise and mobility | Limitations to population causing generalised results |
| Typically inexpensive | Larger group with more high risk participants would potentially prove more effective |

## What did the research involve?

This study involved the random selection of previously diagnosed osteoporosis suffering community dwelling women aged between 65-75. A total of 456 women aged between 65 to 75 years of age were contacted, however only 108 women agreed to the trial and of that 108 only 79 agreed to fully participate in the trial. Before beginning the trial all women had to undergo laboratory testing by an experienced neuroscientist clinician where their balance, strength and anthropometry was assessed. Their overall health, current exercise regime, medical conditions and previous falls history was also analyzed through the use of a questionnaire. After this data was gathered, the women were placed into randomized groups, to either be control or exercise (40 control, 39 exercise). The control group were encouraged to continue with their current exercise regime and daily routine for 20 weeks, while the exercise group were required to take part in osteofit classes for a period of 20 weeks, attending twice per week. "Osteofit" is a community based exercise programme for people with osteoporosis; it aims to reduce the risk of falling and improve functional ability and therefore enhance quality of life. 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?

Both the exercise and control groups did not differ in their baseline age, height and weight. Of the 108 who began the trial only 79 females fully 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.
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 can be safe for patients with osteoporosis, and such a programme produced trends towards increased knee extensions, static balance, and dynamic balance in the 65-75 year old women. However, the intervention did not achieve statistically significant changes in the falls risk profile of the participants and this may be due to the short time period in which the programme was completed in which suggests that analysis of a longer intervention is warranted. 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 can we take from this research?

This research has clearly shown that exercises that improve strength and balance such as the “osteofit” programme are an essential component for reducing the risk of falls in osteoporosis sufferers. Although the time and numbers of this study were relatively small and did not produce overwhelming amounts of large improvement, exercise programmes are less expensive and have far lower personal risk in comparison to drugs and specialist medical interventions.

## What real-world implications does this research have?

The Authors of this study 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. A longer 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. It is also important to note that exercise intervention studies appeal to those who are healthy and motivated, and the women who volunteered for this study were particularly fit for their age. This limits the population to which results can be generalised.

## Helpful Resources

For further information on osteoporosis and the benefits of exercise read below; alternatively contact your GP for additional information.
* Finding local osteoporosis help services: http://www.osteoporosis.org.au/osteoporosis-services
* Real stories of other osteoporosis sufferers: http://www.osteoporosis.org.au/real-stories
* National Osteoporosis Foundation: https://www.nof.org

## 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.
* ↑ http://med.monash.edu.au/sphpm/womenshealth/docs/definition-diagnosis-and-causes-of-osteoporosis.pdf
* ↑ Professor John A. Kanis, L. Joseph Melton III, Claus Christiansen, Conrad C. Johnston, Nikolai Khaltaev (1994) 'The Diagnosis of Osteoporosis', Society For Bone and Mineral Research, Vol 9.
* ↑ 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.
* ↑ 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.
* ↑ Khan, K. M., et al. "Osteofit, a community-based exercise program is effective for improving dynamic balance in 69 year old women who have osteoporosis." 23rd Annual Meeting of the American Society of Bone and Mineral Research. Vol. 16. No. Supp. 1. American Society for Bone and Mineral Research, 2001.
* ↑ https://en.wikibooks.org/wiki/Exercise_as_it_relates_to_Disease/Exercise_to_Reduce_Risk_Factors_for_Falls_in_Older_Women_with_Osteoporosis
* ↑ Campbell, A. John. "Preventing fractures by preventing falls in older women." Canadian Medical Association Journal 167.9 (2002): 1005-1006.
* ↑ Pacala, James T., James Oat Judge, and Chad Boult. "Factors affecting sample selection in a randomized trial of balance enhancement: the FICSIT Study." Journal of the American Geriatrics Society 44.4 (1996): 377-382.