Short- and Long-Term Effects of Balance Training on Physical Activity in Older Adults With Osteoporosis: A Randomized Controlled Trial Balance training with multi-task exercises improves fall-related self-efficacy, gait, balance performance and physical function in older adults with osteoporosis: a randomized controlled trial Long-term effects of a progressive and specific balance-training programme with multi-task exercises for older adults with osteoporosis: a randomized controlled study Progressive load training for the quadriceps muscle associated with proprioception exercises for the prevention of falls in postmenopausal women with osteoporosis: a randomized controlled trial Effect of Tai Chi on body balance: randomized controlled trial in men with osteopenia or osteoporosis. Effectiveness of balance training programme in reducing the frequency of falling in established osteoporotic women: a randomized controlled trial Effectiveness of exercise interventions on physical function in community-dwelling frail older people: an umbrella review of systematic reviews 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 Efficacy of a short multidisciplinary falls prevention program for elderly persons with osteoporosis and a fall history: a randomized controlled trial. Balance training program is highly effective in improving functional status and reducing the risk of falls in elderly women with osteoporosis: a randomized controlled trial A 12-month randomized controlled trial of balance training in elderly women with osteoporosis: improvement of quality of life. Vibration or balance training on neuromuscular performance in osteopenic women. The effect of 4-week aerobic exercise program on postural balance in postmenopausal women with osteoporosis The relationship of intrinsic fall risk factors to a recent history of falling in older women with osteoporosis. Effects of exercise and nutrition on postural balance and risk of falling in elderly people with decreased bone mineral density: randomized controlled trial pilot study The Influence of Back Pain on Balance and Functional Mobility in 65- to 75-Year-Old Women with Osteoporosis
 Effects of exercise programs on balance in older women with age-related visual problems: a pilot study. Positive effects of exercise on falls and fracture risk in osteopenic women Physical activity, muscle function, falls and fractures Exercise interventions for osteoporosis prevention in postmenopausal women. A home-based, transtheoretical change model designed strength training intervention to increase exercise to prevent osteoporosis in Iranian women aged 40-65 years: a randomized controlled trial. UK clinical guideline for the prevention and treatment of osteoporosis Association between vitamin D receptor gene polymorphisms, falls, balance and muscle power: results from two independent studies (APOSS and OPUS)
Background and Purpose : We have developed a 12-week balance training program for older adults shown to improve fall-related concerns , gait speed , balance performance , and physical function . We hypothesized that this balance training would also contribute to higher habitual physical activity ( PA ) levels and improved health-related quality of life ( HRQoL ) . The primary aim was to evaluate short- and long-term effects of the balance training program on objective ly measured habitual PA in older adults with osteoporosis . Secondary aims were to assess the effects of the balance training on HRQoL , and to study whether any effects on PA were associated with changes in HRQoL , gait speed , balance performance , fall-related concerns , and physical function . Methods : A r and omized controlled trial with follow-up at 3 , 9 , and 15 months , including 91 participants with osteoporosis ( 75.6 ± 5.4 years ) , compared a balance training group  ( n = 61 ) with a control group ( n = 30 ) . The primary outcome was effect on habitual PA measured as steps/day , dichotomized into less than 5000 or 5000 or more steps/day . Physical activity was assessed with pedometers ( Yamax ) and accelerometers ( Actigraph ) , HRQoL with the Short Form-36 ( SF-36 ) , gait with a GAITRite walkway , balance performance with Modified-Figure-Eight test and one-leg stance , fall-related concerns with Falls Efficacy Scale International , and physical function with the advanced lower extremity subscale of the question naire Late Life Function and Disability Instrument . Statistical methods used were multivariate logistic regression and logistic generalized estimating equation . Results : Sixty-eight participants completed the short-term follow-up at 3 months , and 53 participants completed the long-term follow-up at 15 months . Per- protocol analysis ( n = 68 ) showed that the odds ratio for having a daily step count of 5000 or more at 3 months was 6.17 ( 95 % confidence interval , 1.23 - 30.91 ) , P = .027 , for the intervention group compared with the control group . The longitudinal analysis ( n = 91 ) showed that the odds ratio for having a daily step count of 5000 or more at 15 months was 2.02 ( 95 % confidence interval , 0.88 - 4.64 ) , P = .096 , for the intervention group compared with the control group . The mental component sum of the SF-36 improved significantly from baseline to 3 months in the intervention group , and the physical component sum improved in both groups , but no statistically significant differences were found between groups . No associations were found between PA and changes in covariates . Discussion and Conclusions : The short-term evaluation showed that balance training increased habitual PA in community-dwelling older adults with osteoporosis . A significantly higher proportion of participants in the intervention group reached a level of 5000 or more steps/day , which is important for overall health . This effect was not associated with improvements in HRQoL , gait speed , balance performance , or fall-related concerns , and did not persist through the long-term follow-up . To accomplish a sustained PA change , a prolonged intervention or more support regarding habitual PA may be required , such as reinforcement with personalized behavior change counseling or PA on prescription Objective : To evaluate the effects of a balance training program including dual- and multi-task exercises on fall-related self-efficacy , fear of falling , gait and balance performance , and physical function in older adults with osteoporosis with an increased risk of falling and to evaluate whether additional physical activity would further improve the effects . Design : R and omized controlled trial , including three groups : two intervention groups ( Training , or Training+Physical activity ) and one Control group , with a 12-week follow-up . Setting : Stockholm County , Sweden . Participants : Ninety-six older adults , aged 66 - 87 , with verified osteoporosis . Interventions : A specific and progressive balance training program including dual- and multi-task three times/week for 12 weeks , and physical activity for 30 minutes , three times/week . Main measures : Fall-related self-efficacy ( Falls Efficacy Scale-International ) , fear of falling ( single-item question – ‘ In general , are you afraid of falling ? ’ ) , gait speed with and without a cognitive dual-task at preferred pace and fast walking ( GAITRite ® ) , balance performance tests ( one-leg stance , and modified figure of eight ) , and physical function ( Late-Life Function and Disability Instrument ) . Results : Both intervention groups significantly improved their fall-related self-efficacy as compared to the controls ( p ≤ 0.034 , 4 points ) and improved their balance performance . Significant differences over time and between groups in favour of the intervention groups were found for walking speed with a dual-task ( p=0.003 ) , at fast walking speed ( p=0.008 ) , and for advanced lower extremity physical function ( p=0.034 ) . Conclusions : This balance training program , including dual- and multi-task , improves fall-related self-efficacy , gait speed , balance performance , and physical function in older adults with osteoporosis Objective : To evaluate long-term effects of balance-training on concerns about falling , gait , balance performance , and physical function in older adults with osteoporosis and increased risk of falling . Design : R and omized controlled trial , including three groups ( training , training+physical activity , and control group ) , with follow-ups at three , nine , and 15 months . Short-term , three-month follow-up , benefits for those who fulfilled the first follow-up ( n = 69 ) have previously been reported . Setting : Stockholm , Sweden . Participants : A total of 96 elderly , age 66–87 , with verified osteoporosis . Interventions : Balance-training programme including dual- and multitasks , with or without supplementary physical activity , three times/week over 12 weeks . Measurements : Concerns about falling Falls Efficacy Scale -International ( FES-I ) , walking at preferred speed with and without a cognitive dual-task and at fast speed , balance tests ( one-leg stance and modified figure-of-eight ) , and physical function Late-Life Function and Disability Instrument ( LLFDI ) . Results : Participants in the training group maintained positive effects throughout the study period for concerns about falling ( baseline vs. 15 months , median 27.5 vs. 23 points , p < 0.001 ) and walking performance ( baseline vs. 15 months , p ⩽ 0.05 with an improvement of 0.9–1.4 m/s ) . The Training+physical activity group declined to baseline values at the nine-month follow-up , and were even lower at the 15-month follow-up for concerns about falling ( median 26 vs. 26 points ) , walking performance ( changes of −0.02 to 0.04 m/s ) , and physical function ( mean 44.0 vs. 42.9 points ) . The control group remained unchanged throughout the study period . Conclusions : This balance-training programme reduced concerns about falling , and also improved gait in older adults with osteoporosis and increased risk of falling in a long-term perspective – important issues for fall prevention Summary This study aims to evaluate the effect of 18-week progressive muscular strength and proprioception training program on the muscle strength of the quadriceps , in prevention of falls in postmenopausal women with osteoporosis . The incidence of falls in the intervention group was significantly lower than in the control group ( incidence rate ratio ( IRR ) = 0.263 , 95 % CI 0.10–0.68 ) . Introduction This study aims to evaluate the effect of a progressive muscular strength and proprioception training program on the muscle strength of the quadriceps , balance , quality of life , and reduction in the risk of falls in postmenopausal women with osteoporosis . Methods One hundred sedentary postmenopausal women with osteoporosis , ages ranging from 55 to 75 , were selected and r and omized into two groups : the intervention group comprised of 50 patients who underwent a 18-week of progressive load training for the quadriceps muscle ( 50 % up to 80 % of 1-RM — one maximum repetition ) and proprioception training associated to a drug treatment of osteoporosis and the  control group that included 50 patients who only underwent a drug treatment of osteoporosis .  The muscular strength , balance , functional mobility , and quality of life were evaluated in the beginning and end of the research . The number of falls was evaluated 24 weeks post-treatment . Results Eighty-five patients concluded the research . The program promoted a significant difference among the groups for SF-36 in the eight sub-scales ( p ≤ 0.0018 ) , Timed Up & Go Test ( p < 0.0001 ) , 1-RM test ( p < 0.0001 ) , Berg Balance Scale ( p < 0.0001 ) and also a decrease in the number of falls in the intervention group compared to control ( IRR = 0.263 , 95 % CI 0.10–0.68 , p = 0.0064 ) . Conclusion The association of progressive strength training for the quadriceps and the proprioceptive training is effective for the prevention of falls , increasing the muscle power , the static and dynamic balance and increasing the speed of the motor responses , therefore improving the performance of daily activities The purpose of this study was to assess the effect of 18-week Tai Chi training on body balance in dynamic trial among elderly men . The study covered 49 subjects from age 60 to 82.1 years , who had osteopenia or osteoporosis . The subjects were recruited from the community by direct mailings and community efforts to participate in studies . The participants were r and omly assigned to either the exercise intervention ( n = 25 ) or control groups ( n = 24 ) . The Tai Chi group participated in an 18-week exercise class held for 45 min , twice a week . Body balance was assessed using a Computer Posturographic System PE 90 produced by the Military Institute of Aviation Medicine in Warsaw with modified software made in Pro-Med . During the measurement of body balance , the capacity to perform specific tasks was analyzed ( deflections in the set scope and direction ) . In the Tai Chi group , an increase ( p < or = 0.01 ) in effectiveness of balance task performance was noted from 80.95 % to 84.45 % after the training . In the control group , no statistically significant improvement in the level of body balance was found in the same period . Thus , an 18-week period of Tai Chi exercises twice a week for 45 min is beneficial for dynamic balance . It can be important for reducing fall risk factors Objective : To investigate the effect of a 12-month sensomotor balance exercise programme on postural control and the frequency of falling in women with established osteoporosis . Design : R and omized controlled trial where the intervention group was assigned the 12-month Balance Training Programme and the control group did not undertake any intervention beyond regular osteoporosis treatment . Subjects : A total of 100 osteoporotic women – at least with one osteoporotic fracture – aged 65 years old and above . Main measures : Balance was assessed in static and dynamic posture both with performance-based measures of balance , such as the Berg Balance Scale and the Timed Up and Go Test , and with a stabilometric computerized platform . Interventions : Patients in the intervention group completed the 12-month sensomotor Balance Training Programme in an outpatient setting , guided by physical therapists , three times a week , for 30 minutes . Results : The Berg Balance Scale and the Timed Up and Go Test showed a statistically significant improvement of balance in the intervention group ( p = 0.001 and p = 0.005 , respectively ) . Balance tests using the stabilometer also showed a statistically significant improvement in static and dynamic postural balance for osteoporotic women after the completion of the Balance Training Programme . As a consequence , the one-year exercise programme significantly decreased the number of falls in the exercise group compared with the control group . Conclusion : The Balance Training Programme significantly improved the balance parameters and reduced the number of falls in postmenopausal women who have already had at least one fracture in the past Objectives : This umbrella review aim ed to determine the effectiveness of exercise interventions , alone or in combination with other interventions , in improving physical function in community-dwelling older people identified as pre-frail or frail . Introduction : Exercise is said to have a positive impact on muscle mass and strength which improves physical function and hence is beneficial for the treatment of frailty . Several systematic review s discuss the effects of exercise interventions on physical function parameters , such as strength , mobility , gait , balance and physical performance , and indicate that multi-component exercise , including resistance , aerobic , balance and flexibility training , appears to be the best way in which to improve physical function parameters in frail older people . However , there is still uncertainty as to which exercise characteristics ( type , frequency , intensity , duration and combinations ) are the most effective and sustainable over the long-term . Inclusion criteria : Participants were adults , 60 years or over , living in the community and identified as pre-frail or frail . Quantitative systematic review s , with or without meta- analysis that examined the effectiveness of exercise interventions of any form , duration , frequency and intensity , alone or in combination with other interventions design ed to alter physical function parameters in frail older people , were considered . The quantitative outcome measures were physical function , including muscular strength , gait , balance , mobility and physical performance . Methods : An iterative search strategy for ten bibliometric data bases and gray literature was developed . Critical appraisal of seven systematic review s was conducted independently by two review ers using a st and ard Joanna Briggs Institute tool . Data was extracted independently by two review ers using a st and ard Joanna Briggs Institute data extraction tool and summarized using a narrative synthesis approach . Results : Seven systematic review s were included in this umbrella review , with a total of 58 relevant r and omized controlled trials and 6927 participants . Five systematic review s examined the effects of exercise only , while two systematic review s reported on exercise in combination with a nutritional approach , including protein supplementations , as well as fruit and dairy products . The average  exercise frequency was 2–3 times per week ( mean 3.0 ± 1.5 times per week ; range 1–7 weekly ) for 10–90 minutes per session ( mean of 52.0 ± 16.5 mins ) and a total duration of 5–72 weeks with the majority lasting a minimum of 2.5 months ( mean 22.7 ± 17.7 weeks ) . Multi-component exercise interventions can currently be recommended for pre-frail and frail older adults to improve muscular strength , gait speed , balance and physical performance , including resistance , aerobic , balance and flexibility tasks . Resistance training alone also appeared to be beneficial , in particular for improving muscular strength , gait speed and physical performance . Other types of exercise were not sufficiently studied and their effectiveness is yet to be established . Conclusions : Interventions for pre-frail and frail older adults should include multi-component exercises , including in particular resistance training , as well as aerobic , balance and flexibility tasks . Future research should adopt a consistent definition of frailty and investigate the effects of other types of exercise alone or in combination with nutritional interventions so that more specific recommendations can be made Objective —To test the efficacy of a community based 10 week exercise intervention to reduce fall risk factors in women with osteoporosis . Methods —Static balance was measured by computerised dynamic posturography ( Equitest ) , dynamic balance by timed figure of eight run , and knee extension strength by dynamometry . Subjects were r and omised to exercise intervention ( twice weekly Osteofit classes for 10 weeks ) or control groups . Results —The outcome in 79 participants ( 39 exercise , 40 control ) who were available for measurement 10 weeks after baseline measurement is reported . After confounding factors had been controlled for , the exercise group did not make significant gains compared with their control counterparts , although there were consistent trends toward greater improvement in all three primary outcome measures . Relative to the change in control subjects , the exercise group improved by 2.3 % in static balance , 1.9 % in dynamic balance , and 13.9 % in knee extension strength . Conclusions —A 10 week community based physical activity intervention did not significantly reduce fall risk factors in women with osteoporosis . However , trends toward improvement in key independent risk factors for falling suggest that a study with greater power may show that these variables can be improved to a level that reaches statistical significance OBJECTIVE To evaluate the efficacy of the Nijmegen Falls Prevention Program ( NFPP ) for persons with osteoporosis and a fall history in a r and omized controlled trial . Persons with osteoporosis are at risk for fall-related fractures because of decreased bone strength . A decrease in the number of falls therefore is expected to be particularly beneficial for these persons . DESIGN R and omized controlled trial . SETTING Hospital . PARTICIPANTS Persons with osteoporosis and a fall history ( N=96 ; mean ± SD age , 71.0±4.7y ; 90 women ) . INTERVENTION After baseline assessment , participants were r and omly assigned to the exercise ( n=50 ; participated in the NFPP for persons with osteoporosis [ 5.5wk ] ) or control group ( n=46 ; usual care ) . MAIN OUTCOME MEASURES Primary outcome measure was fall rate , measured by using monthly fall calendars for 1 year . Secondary outcomes were balance confidence ( Activity-specific Balance Confidence Scale ) , quality of life ( QOL ; Quality of Life Question naire of the European Foundation for Osteoporosis ) , and activity level ( LASA Physical Activity Question naire , pedometer ) , assessed posttreatment subsequent to the program and after 1 year of follow-up . RESULTS The fall rate in the exercise group was 39 % lower than for the control group ( .72 vs 1.18 falls/person-year ; risk ratio , .61 ; 95 % confidence interval , .40-.94 ) . Balance confidence in the exercise group increased by 13.9 % ( P=.001 ) . No group differences were observed in QOL and activity levels . CONCLUSION The NFPP for persons with osteoporosis was effective in decreasing the number of falls and improving balance confidence . Therefore , it is a valuable new tool to improve mobility and independence of persons with osteoporosis Introduction The purpose of this study was to investigate the effect of a 12-month Balance Training Program on balance , mobility and falling frequency in women with osteoporosis . Methods Sixty-six consecutive elderly women were selected from the Osteometabolic Disease Outpatient Clinic and r and omized into 2 groups : the ‘ Intervention ’ , su bmi tted for balance training ; and the ‘ Control ’ , without intervention .  Balance , mobility and falling frequency were evaluated before and at the end of the trial , using the Berg Balance Scale ( BBS ) , the Clinical Test Sensory Interaction Balance ( CTSIB ) and the Timed “ Up & Go ” Test ( TUGT ) . Intervention used techniques to improve balance consisting of a 1-hour session each week and a home-based exercise program . Results Sixty women completed the study and were analyzed . The BBS difference was significant higher in the Intervention group compared to Control ( 5.5 ± 5.67 vs −0.5 ± 4.88 score , p < 0.001 ) . Similarly , the number of patients in the Intervention group presented improvement in two conditions of CTSIB compared to Control ( eyes closed and unstable surface condition : 13 vs one patient , p < 0.001 and eyes open , visual conflict and unstable surface condition : 12 vs one patient , p < 0.001 ) . Additionally , the differences between the TUGT were reduced in the Intervention group compared to Control ( −3.65 ± 3.61 vs 2.27 ± 7.18 seconds , p < 0.001 ) . Notably , this improvement was paralleled by a reduction in the number of falls/patient in the Intervention group compared to Control ( −0.77 ± 1.76 vs 0.33 ± 0.96 , p = 0.018 ) . Conclusion This longitudinal prospect i ve study demonstrated that an intervention using balance training is effective in improving functional and static balance , mobility and falling frequency in elderly women with osteoporosis OBJECTIVE Physical and psychological incapacity , including fear of falling is related to decreased satisfaction with life in osteoporosis ( OP ) . The impact of a balance exercise program on improving the quality of life is not well established . We have , therefore , investigated the effect of 12-month Balance Training Program in quality of life , functional balance and falls in elderly OP women . METHODS Sixty consecutive women with senile OP were r and omized into a Balance Training Group ( BT ) of 30 patients and no intervention control group ( CG ) of 30 patients . The BT program included techniques to improve balance over a period of 12 months ( 1h exercise session/week and home-based exercises ) . The quality of life was evaluated before and at the end of the trial using the Osteoporosis Assessment Question naire ( OPAQ ) , functional balance was evaluated by Berg Balance Scale ( BBS ) . Falls in the preceding year were noted and compared to the period of study . RESULTS The comparison of OPAQ variations ( INITIAL-FINAL ) revealed a significant improvement in quality of life in all parameters for BT compared to CG : well-being ( 1.61+/-1.44 vs. -1.46+/-1.32 , p<0001 ) , physical function ( 1.30+/-1.33 vs. -0.36+/-0.82 , p<0.001 ) , psychological status ( 1.58+/-1.36 vs. -1.02+/-0.83 , p<0.001 ) , symptoms ( 2.76+/-1.96 vs. -0.63+/-0.87 , p<0.001 ) , social interaction ( 1.01+/-1.51 vs. 0.35+/-1.08 , p<0.001 ) . Of note , this overall benefit was paralleled by an improvement of BBS ( -5.5+/-5.67 vs. + 0.5+/-4.88 p<0.001 ) and a reduction of falls in 50 % in BT group vs. 26.6 % for the CG ( RR : 1.88 , p<0.025 ) . CONCLUSION The long-term Balance Training Program of OP women provides a striking overall health quality of life improvement in parallel with improving functional balance and reduced falls Maintaining neuromuscular function in older age is an important topic for aging societies , especially for older women with low bone density who may be at risk of falls and bone fracture . This r and omized controlled trial investigated the effect of resistive exercise with either whole-body vibration training ( VIB ) or coordination/balance training ( BAL ) on neuromuscular function ( countermovement jump , multiple 1-leg hopping , sit-to-st and test ) . 68 postmenopausal women with osteopenia or osteoporosis were recruited for the study . 57 subjects completed the 9-month , twice weekly , intervention period . All subjects conducted 30 min of resistance exercise each training day . The VIB-group performed additional training on the Galileo vibration exercise device . The BAL-group performed  balance training .  An " intent-to-treat " analysis showed greater improvement in the VIB-group for peak countermovement power ( p=0.004 ) . The mean [ 95 % confidence interval ] effect size for this parameter was a + 0.9[0.3 to 1.5 ] W/kg greater change in VIB than BAL after 9 months . In multiple 1-leg hopping , a significantly better performance in the VIB-group after the intervention period was seen on a " per- protocol " analysis only . Both groups improved in the sit-to-st and test . The current study provides evidence that short- duration whole-body vibration exercise can have a greater impact on some aspects of neuromuscular function in post-menopausal women with low bone density than proprioceptive training The aim of this study is to evaluate the effect of submaximal aerobic exercise program on postural balance in postmenopausal women with osteoporosis . Twenty-five postmenopausal women without osteoporosis and 28 postmenopausal women with osteoporosis enrolled in this study .  Balance ability of all subjects was measured by timed up and go test ( TUG ) , four square step test ( FSS ) , Berg balance scale ( BBS ) and Kinesthetic ability trainer 3000 . After completion of initial measurements of balance , postmenopausal women with osteoporosis attended the submaximal aerobic exercise program on treadmill . At the end of the exercise program , balance tests were repeated . Balance tests of postmenopausal women without osteoporosis were repeated approximately 4-weeks after the initial measurement . There was statistically significant improvement in all balance scores in the postmenopausal women with osteoporosis after exercise training whereas there were no statistically significant differences in the scores of postmenopausal women without osteoporosis who did not exercise . This study showed that a 4-week submaximal aerobic exercise program provided significant improvements in static and dynamic balances in postmenopausal osteoporotic women STUDY DESIGN Cross-sectional descriptive analysis investigating intrinsic fall risk factors in postmenopausal women with osteoporosis . OBJECTIVE To examine the relationships between history of recent falls and balance , pain , quality of life , function , posture , strength , and mobility . BACKGROUND Women with osteoporosis who fall are at a high risk of fracture due to decreased bone strength . Identifying fall risk factors for older women with osteoporosis is a crucial step in decreasing the incidence of falls and fracture . METHOD AND MEASURES : Seventy-three women over 60 years of age with established osteoporosis participated in comprehensive testing of fall history , physical function , and quality of life . RESULTS Significant correlations were found between a recent history of falls and degree of kyphosis ( r = 0.29 ) , fear of falls/emotional status ( r = -0.27 ) , and balance ( r = -0.27 ) . Degree of kyphosis and fear of falls/emotional status explained 20 % of the variance of recent fall history using binary logistic regression . Women with an increased kyphosis were more likely to have had a recent fall ( odds ratio [ OR ] , 1.17 ; 95 % CI , 1.03 - 1.34 ) and those with better emotional status and less fear of falling were less likely to have had a recent fall ( OR , 0.61 ; 95 % CI , 0.38 - 0.97 ) . CONCLUSION Increased thoracic kyphosis and fear of falling are 2 intrinsic factors associated with recent falls in women with osteoporosis . To design more effective interventions to decrease fall risk in this population , future prospect i ve , longitudinal studies should monitor kyphosis , fear of falling , balance reactions , and other potential risk factors not identified in this study Objective : To compare the effect of calcium/vitamin D supplements with a combination of calcium/vitamin D supplements and exercise/protein on risk of falling and postural balance . Design : R and omized clinical trial . Setting : University hospital physiotherapy department . Subjects : Twenty-four independently living elderly females aged 65 years and older with osteopenia or osteoporosis and mean total hip T-score ( SD ) of —1.8 ( 0.8 ) . Interventions : A three-month programme consisting of exercise/protein including training of muscular strength , co-ordination , balance and endurance . Calcium/ vitamin D was supplemented in all participants for a 12-month period . Outcome measures : Assessment took place prior to and following the months 3 , 6 , 9 and at the end of the study ; primary dependent variables assessed were risk of falling ( Berg Balance Test ) and postural balance ( forceplate ) . Secondary measures included body composition , strength , activity level , number of falls , bone mineral content , biochemical indices , nutritional status and general health . Results : Significant reductions of risk of falling ( repeated measures ANOVA F = 8.90 , P = 0.008 ) , an increase in muscular strength ( ANOVA F = 3.0 , P = 0.03 ) , and an increase in activity level ( ANOVA F = 3.38 , P = 0.02 ) were found in the experimental group as compared to the control group . Further on , there was 89 % reduction of falls reported in the experimental group ( experimental pre/post 8/1 falls ; control group pre/post 5/6 falls ) . Conclusion : This study provides support for our intervention programme aim ed at reducing the risk of falling in elderly participants diagnosed with osteopenia or osteoporosis . The data obtained from the pilot study allow the calculation of the actual sample size needed for a larger r and omized trial Abstract : To determine whether the presence of back pain and its related disabilities are determinants of balance and functional mobility in a group of women with osteoporosis , we carried out a cross-sectional analysis of 93 community-dwelling women with osteoporosis between the ages of 65 and 75 years old . We assessed health history , anthropometrics , self-report of current physical activity level and self-report of back pain ( intensity and pain-related disabilities ) . Balance  was measured by computerized dynamic posturography and functional mobility was assessed by timed figure-of-eight test .  The prevalence of back pain was high ( 75 % ) in this cohort of older women with osteoporosis . Age was the major determinant of both balance and functional mobility and accounted for 9 % and 14 % of the variance , respectively . After accounting for age , back pain explained an additional 9 % of the variance in balance and 13 % of the variance in functional mobility . The high prevalence of back pain demonstrates the importance of pain management in the treatment of osteoporosis . Furthermore , the finding of self-reported back pain as a determinant of both balance and functional mobility suggests that this measure may deserve attention when screening women with osteoporosis for fracture risk . Prospect i ve studies are needed to determine whether pain management will improve balance and functional mobility AIM This study aim ed to compare the effects of two exercise programs on balance and risk of falls in older women with age-related visual dysfunction . METHODS Participants living in a residential home were r and omly allocated to Group I ( n=21 ) receiving a progressive , tailored multimodal exercise program in addition to the st and ard osteoporosis exercise program or Group II ( n=20 ) receiving the st and ard osteoporosis exercise program alone . At baseline , and after the 6-month exercise program outcomes were measured . RESULTS After the exercise program there was significant between-group difference in favor of the Group I in Timed Up and Go ( TUG ) test ( p=0.001 ) , but not in Berg Balance score ( p=0.130 ) , and Barthel Activity Index ( p=0.662 ) . In Group I the risk of falls reduced by 46 % , but this result was not significant ( RR=0.54 , 95 % CI 0.294 - 1.007 ) . The mean length of event-free time was significantly longer in the Group I than in Group II ( 18.5 weeks , 95 % CI 15.4 - 21.7 vs. 14.8 weeks , 95 % CI 11.1 - 18.4 ; p=0.049 ) . CONCLUSION If the current osteoporosis guideline is applied for older adults with low vision , it would be worthwhile putting more emphasis on the inclusion of patient-tailored strength and balance exercises to improve balance and potentially reduce the risk of falls Summary Exercise may affect osteopenic women at risk of falls and fractures .  A workstation approach to exercise was evaluated in a r and omised study of 98 women . The intervention group improved in measures of balance , strength and bone density . This study supports a preventative exercise approach that aims to reduce risk factors for fractures and falls , in women already at risk , through balance training and weight-bearing activity . Introduction The objective of this study was to determine the effects of a workstation balance training and weight-bearing exercise program on balance , strength and bone mineral density ( BMD ) in osteopenic women . A single-blinded r and omised controlled trial ( RCT ) was undertaken for 20 weeks with measurements at baseline and completion . Material s and methods Ninety-eight ( 98 ) community-dwelling osteopenic women aged 41–78 years were recruited through the North Brisbane electoral roll . Subjects were r and omised via computer-generated r and om numbers lists into either a control ( receiving no intervention ) , or exercise group ( two one-hour exercise sessions per week for 20 weeks with a trained physiotherapist ) . Assessment s at baseline and post-intervention included balance testing ( five measures ) , strength testing ( quadriceps , hip adductors / abductors / external rotators and trunk extensors ) , and DXA scans ( proximal femur and lumbar spine ) . Baseline assessment showed no significant differences between groups for all demographics and measures except for subjects taking osteoporosis medication . The percentage differences between pre- and post-intervention measurements were examined for group effect by ANOVA using an intention-to-treat protocol . Results Ninety-eight women ( mean age 62.01 years , SD 8.9 years ) enrolled in the study . The mean number of classes attended for the 42 participants in the  exercise group who completed the program was 28.2 of a possible 40 classes ( 71 % ) . At the completion of the trial the intervention group showed markedly significant better performances in balance ( unilateral and bilateral stance sway measures , lateral reach , timed up and go and step test ) ( p < 0.05 ) with strong positive training effects reflecting improvements of between 10 % to 71 % . Similarly there were gains in strength of the hip muscles ( abductors , adductors , and external rotators ) , quadriceps and trunk extensors with training effects between 9 % and 23 % . Conclusions Specific workstation exercises can significantly improve balance and strength in osteopenic women . This type of training may also positively influence bone density although further study is required with intervention over a longer period . A preventative exercise program may reduce the risk of falls and fractures in osteopenic women already at risk Study design A thematic review . Objectives To evaluate if physical activity enhances muscle strength , improves balance , and reduces the fall frequency and the fracture incidence .  Background One of the major medical problems of today is the increasing incidence of fragility fractures .  Muscle strength and fall is one of the major determinants of a fracture . If physical activity could increase muscle strength , improve balance and reduce the fall frequency , then training could be recommended as prevention for fractures . Methods The review used Medline ( Pub Med ) and the search words exercise , physical activity , muscle strength , balance , falls , fractures . R and omized controlled trials ( RCT ) were predominantly included , although this not is a systematic review . Results The evidence that physical activity modifies the risk factors for fall is compelling , although RCT with fractures as end point are lacking . Physical activity is associated with improved muscle strength , co-ordination and balance .  Physical training increases muscle strength also in octogenarians by up to 200 % , i.e. a much more pronounced effect than the corresponding increase in muscle volume or bone mass . There is also evidence that physical activity decreases the actual number of falls . Observational cohort and case-control studies imply that physical activity is associated with reduced hip fracture risk . If exercise reduces the number of vertebral fractures and other fragility fractures are less evaluated . Conclusions Physical activity in older ages can be recommended to improve muscle strength and balance , to reduce the risk to fall and fractures , although the highest level of evidence – RCT with fracture as endpoint – is lacking Osteoporosis is a bone disease associated with reduced bone mineral density result ing in debilitating bone fractures . According to the National Institutes of Health Women 's Health Initiative , effective interventions for bone loss need to be developed . The osteogenic stimulus provided by weight-bearing exercise indicates it is an important lifestyle factor that can be used for prevention of bone loss . Prospect i ve research studies have documented that both aerobic exercise and weight training can be effective in the maintenance and building of bone mineral density in postmenopausal women . Additional benefits of weight training include increased muscular strength , coordination , and balance which could decrease risk for falling and subsequent fractures Physical activity ( PA ) helps to prevent osteoporosis , but older women are often sedentary . This study used a pre-post r and omized controlled design to evaluate a 12-week exercise education intervention program based on the stages of change ( SoC ) and processes of change from the transtheoretical change model ( TTM ) to improve adherence with strength and balance training recommendations at levels sufficient to prevent osteoporosis in Iranian women aged 40 - 65 years . The home-based exercise prescription consisted of strength and balance training that was progressive , individually tailored and included a walking program . Individuals in the training group ( n=61 ) had a positive , significant progression in psychological SoC ( P<0.001 ) , whereas no progression in stages occurred in the control group ( n=55 ) . After the intervention , the training group demonstrated significant improvements in PA , lower body muscle strength , static and dynamic balance , with no significant changes in the control group . These results support the applicability of the TTM for a PA intervention and indicate that this training program is very effective in improving balance and lower body strength in older women Introduction In 2008 , the UK National Osteoporosis Guideline Group ( NOGG ) produced a guideline on the prevention and treatment of osteoporosis , with an up date in 2013 . This paper presents a major up date of the guideline , the scope of which is to review the assessment and management of osteoporosis and the prevention of fragility fractures in postmenopausal women and men age 50 years or over . Methods Where available , systematic review s , meta-analyses and r and omised controlled trials were used to provide the evidence base . Conclusions and recommendations were systematic ally grade d according to the strength of the available evidence . Results Review of the evidence and recommendations are provided for the diagnosis of osteoporosis , fracture-risk assessment , lifestyle measures and pharmacological interventions , duration and monitoring of bisphosphonate therapy , glucocorticoid-induced osteoporosis , osteoporosis in men , postfracture care and intervention thresholds . Conclusion The guideline , which has received accreditation from the National Institute of Health and Care Excellence ( NICE ) , provides a comprehensive overview of the assessment and management of osteoporosis for all healthcare professionals who are involved in its management Summary Fall prevention is a key strategy for reducing  osteoporotic fractures . We investigated the association between vitamin D receptor ( VDR ) polymorphisms and reported  falls in postmenopausal women . Bsm1 polymorphisms were associated with falls , balance and muscle power measurements . These results may explain some of the excess fracture risk associated with VDR in some studies . Introduction Fall prevention is a key strategy for reducing osteoporotic fractures . It has been suggested that vitamin D supplementation may reduce the incidence of falls by reducing body sway and increasing muscle power . The vitamin D receptor gene is a well-studied c and i date gene for osteoporosis . We investigated the association between VDR polymorphisms and reported  falls in postmenopausal women . Methods Falls data were collected in two separate population cohorts . Five polymorphisms of the VDR gene were analysed ( Cdx-2 , Fok-1 , BsmI , Taq1 and Apa1 ) in the Aberdeen Prospect i ve Osteoporosis Screening Study ( APOSS ) cohort . Results found in APOSS were then vali date d in an independent cohort — the Osteoporosis and Ultrasound ( OPUS ) study ( Bsm1 and Fok1 only ) , where muscle power and balance were also measured . Results Carriers of the ‘ B ’ allele ( Bsm1 ) showed an increased risk for falls . In APOSS , this was statistically significant for visit 3 multiple falls ( p = 0.047 ) and for recurrent falls ( p = 0.043 ) . Similar results were found in OPUS for visit 1 falls ( p = 0.025 ) and visit 1 multiple falls ( p = 0.015 ) . Bsm1 polymorphisms were also associated with balance and muscle power measurements . Conclusions In conclusion , these results demonstrate an association between the Bsm1 polymorphism and risk of falling that may explain some of the excess fracture risk associated with VDR in some studies
Balance training may significantly reduce the frequency of falls in patients with osteoporosis
BACKGROUND Balance training may be beneficial for patients with osteoporosis , although current results are inconclusive .
The aim of this systematic review and meta- analysis was to explore the effect of balance training on falls in patients with osteoporosis .