# Exercise as it relates to Disease/Pilates as treatment for symptoms related to Osteoporosis

This is an analysis of the journal article "The effect of the clinical pilates exercises on kinesiophobia and other symptoms related to osteoporosis: Randomised controlled trial." Oksuz, S. and Unal, E. (2017).

## What is the background to this research?

The National Osteoporosis Foundation (NOF) defines osteoporosis as "a bone disease that occurs when the body loses too much bone, makes too little bone, or both". This will cause the bones to look like a honeycomb from under a microscope. Which lowers bone density, this causes bones to be weak and could break from a fall. As a result from brittle bones, patient who suffer from osteoporosis will suffer from other complications. For example; kinesiophobia, back pain, caused by a fractured or collapsed vertebra, loss of height over time, stooped posture, bone fracture that occurs much more easily than expected.
Kinesiophobia is a serious complication of osteoporosis, it is defined as "an excessive, irrational, and debilitating fear of physical movement and activity resulting from a feeling of vulnerability due to painful injury or reinjury". It can be simplified into fear of movement, this is quite common to patients with osteoporosis as they have fragile bodies and would be afraid to injure or re-injure themselves.
Thus far there is no specific exercise protocol for treating osteoporosis. This study looks at Clinical Pilates (CP) as an individual program made for patients' specific issues.

## Where is the research from?

Oksuz from Eastern Mediterranean University in Cyprus and Unal Hacettepe University in Turkey, conducted this research with volunteers who attended to the Rheumatologic Rehabilitation Unite of the Physiotherapy and Rehabilitation department with an osteoporosis diagnosis.

## What kind of research was this?

This was a randomised control trial where they underwent a functional status assessment, conducted by physiotherapists, all of the participants were asked to complete a questionnaire.

## What did the research involve?

All 40 participants where females who had been diagnosed with osteoporosis from the Rheumatologic Rehabilitation Unite of the Physiotherapy and Rehabilitation department. Each participant's specific demographic data such as age, height, weight and body mass index. The participant were asked to fill out multiple pain questionnaires throughout this study, the questionnaires the volunteers were asked to complete included; Tampa Kinesiophobia Scale (TSK), Visual analogue scale (VAS), Short-Form McGill Pain Questionnaire (SF-McGill), Pain Disability Index (PDI), Oswestry Low Back Pain Disability Scale (ODI). The volunteers were also asked to complete tests, they were compromised of; The Berg Balance Test (BBT), Timed Up and Go Test (TUG), Chair Sit and Stand Test (CSST), The Chair Sit and Reach Test (CSRT), The Back Scratch Test (BST). The participants were also asked to fill out more questionnaires in regards to quality of life, such as; The Quality of Life Questionnaire of the European Foundation for Osteoporosis (QUALEFFO-41), The Hospital Anxiety and Depression Scale (HADS), Health Assessment Questionnaire (HAQ), Satisfaction with Life Scale (SLS). At the end of the study the participants would be asked to retake the tests and to fill in each questionnaire again.
| Questionnaire | Information collected |
| Tampa Kinesiophobia Scale (TSK) | Measures each patient's level of fear and avoidance associated with movement |
| Visual analogue scale (VAS) | Evaluate the pain intensity of patients in the mornings, at rest and during performance of activities |
| Short-Form McGill Pain Questionnaire (SF-McGill) | Multidimensional evaluation of pain |
| Pain Disability Index (PDI) | Determine the influence of patients' general pain intensity on their daily life activities |
| Oswestry Low Back Pain Disability Scale (ODI) | Assess the functional disability caused by the patients' lower back pain |
| Test | Information collected |
| The Berg Balance Test (BBT) | Evaluate risk of falling |
| Timed Up and Go Test (TUG) | Assess patients' functional balance and mobility |
| Chair Sit and Stand Test (CSST) | Measure the strength and endurance of patients' lower extremity proximal muscles |
| The Chair Sit and Reach Test (CSRT) | Assess the functional flexibility of the lower extremities by measuring the distance between each patient's fingers and toes |
| The Back Scratch Test (BST) | Evaluate the functional flexibility of the patient's upper extremities |
| Quality of life Questionnaire | Information Collected |
| The Quality of Life Questionnaire of the European Foundation for Osteoporosis (QUALEFFO-41) | Assess each patient according to the five dimensions of health in osteoporosis: pain, physical functioning, social activities, general health assessment and mental functioning |
| The Hospital Anxiety and Depression Scale (HADS) | Assess patients' anxiety and depression levels |
| Health Assessment Questionnaire (HAQ) | Evaluate whether patients had chronic functional impairment caused by rheumatic diseases |
| Satisfaction with Life Scale (SLS) | Assess patients' personal well-being, as well as their overall life satisfaction |

## What were the basic results?

Oksuz & Unal found that when retesting age, height, weight and BMI the control group and the exercise group were found to be similar. All questionnaires were completed again by all 40 participants at the end of the 6-week intervention. There was a statistically significant difference between the two groups was observed in VAS pain scores, SF-McGill scores, and PDI and ODI scores. When the tests were completed once again, BBT, TUG, BST had no significant changes between the groups in their initial and post 6 weeks scores. However, there was a difference between the groups for the CSST and CSRT. There were again significant differences between the two groups when re-assessing QUALEFFO-41 especially pertaining to social activities, HADS, HAQ, and SLS.

## What conclusions can we take from this research?

The exercise group showed a significant improvement in their almost all their parameters at the reassessment of their tests and questionnaires. This shows Clinical pilates had a positive affect on kinesiophobia, pain, functional status and quality of life in patients with osteoporosis. It has to be noted most of the results were based on questionnaires, these have a reputation of self reporting bias. They rely on truthful responses from the volunteers, which can be affected by the individual’s idea of what is an acceptable answer and may portray an incorrect image of themselves.

## Practical advice

Osteoporosis affects many men and women, most people do not know the have osteoporosis until they have a fall or break something. Over 65years old you have a high chance of having osteoporosis, check with a qualified medical practitioner if you may believe to you have osteoporosis.

## Further information/resources

For further information regarding Osteoporosis read below:
* What is Osteoporosis and What Causes It?: https://www.nof.org/patients/what-is-osteoporosis/
* Osteoporosis Australia: http://www.osteoporosis.org.au
* Real stories of other osteoporosis sufferers: http://www.osteoporosis.org.au/real-stories
* What is Kinesiophobia: http://www.professionalptandtraining.com/general-health-information/what-is-kinesiophobia/

## References

* 1 2 3 Oksuz, S. and Unal, E. (2017). The effect of the clinical pilates exercises on kinesiophobia and other symptoms related to osteoporosis: Randomised controlled trial. Complementary Therapies in Clinical Practice, [online] 26, pp.68-72
* ↑ National Osteoporosis Foundation. (2017). Learn What Osteoporosis Is and What It’s Caused by. [online] Available at: https://www.nof.org/patients/what-is-osteoporosis/
* ↑ KAPLAN, R. and SINAKI, M. (1993). Posture Training Support: Preliminary Report on a Series of Patients With Diminished Symptomatic Complications of Osteoporosis. Mayo Clinic Proceedings, 68(12), pp.1171-1176
* ↑ Larsson, C., Ekvall Hansson, E., Sundquist, K. and Jakobsson, U. (2016). Kinesiophobia and its relation to pain characteristics and cognitive affective variables in older adults with chronic pain. BMC Geriatrics, 16(1).
* ↑ Dermansky, M. (2013). What is the difference between Pilates and Clinical Pilates ?. [online] MD Health Pilates. Available at: http://www.mdhealth.com.au/clinical-pilates-vs-pilates-what-is-the-difference/
* ↑ Swinkels-Meewisse, E., Swinkels, R., Verbeek, A., Vlaeyen, J. and Oostendorp, R. (2003). Psychometric properties of the Tampa Scale for kinesiophobia and the fear-avoidance beliefs questionnaire in acute low back pain. Manual Therapy, 8(1), pp.29-36
* ↑ Carlsson, A. (1983). Assessment of chronic pain. I. Aspects of the reliability and validity of the visual analogue scale. Pain, 16(1), pp.87-101
* ↑ Melzack, R. (1987). The short-form McGill pain questionnaire. Pain, 30(2), pp.191-197
* ↑ Tait, R., Chibnall, J. and Krause, S. (1990). The Pain Disability Index: psychometric properties. Pain, 40(2), pp.171-182
* ↑ Niskanen, R. (2002). The Oswestry Low Back Pain Disability Questionnaire a Two-Year Follow-Up of Spine Surgery Patients. Scandinavian Journal of Surgery, 91(2), pp.208-211
* ↑ They rely on truthful responses from participants which can be affected by the individual’s idea of what is a socially acceptable answer and may portray a desirable image of themselves