Predictors of compliance with a home-based exercise program added to usual medical care in preventing postmenopausal osteoporosis: an 18-month prospective study

Effects of Integrating Wearable Activity Trackers With a Home-Based Multicomponent Exercise Intervention on Fall-Related Parameters and Physical Function in Older Adults: Randomized Controlled Trial

Background

Older adults with a history of falling often encounter challenges in participating in group exercise programs. Recent technological advances, such as activity trackers, can potentially enhance home-based exercise programs by providing continuous physical activity monitoring and feedback.

Objective

The aim of the study is to explore whether integrating wearable activity trackers with a home-based exercise intervention is effective in reducing fear of falling and improving physical function in older adults.

Methods

This was a 12-week, parallel-group, randomized controlled trial involving 30 older adults (≥60 years) with a history of falling. Participants were randomly assigned in a 1:1 ratio to either a group combining an activity tracker with a home-based multicomponent exercise intervention, which included in-person exercise sessions, exercise videos, and objective feedback via phone calls (AT+EX group) or to a group using the activity tracker only for self-monitoring (AT-only group). The primary and secondary outcomes included fall-related parameters (fear of falling assessed by the Activities-Specific Balance Confidence [ABC] and the Falls Efficacy Scale-International [FES-I] scales), depression (Short Geriatric Depression Scale), cognition (Montreal Cognitive Assessment), physical function (grip strength, Short Physical Performance Battery, Timed Up and Go [TUG] test, and 2-Minute Step Test), and body composition. Changes in the average daily step count were monitored and analyzed.

Results

Overall, 28 (mean age 74.0, SD 6.4 years; n=23, 77% female) participants completed the 12-week follow-up period (28/30, 93%). In the activity tracker and exercise group (AT+EX group), significant improvements were observed in fear of falling (15.5 points of ABC: P=.002; -5.1 points of FES-I: P=.01). The activity tracker alone group (AT-only group) also showed a significant improvement in FES-I score (-5.5 points: P=.01). Physical function significantly improved in the AT+EX group (1.1 points of Short Physical Performance Battery: P=.004; -1.4 seconds of TUG; P=.008; and 26.7 steps of 2-Minute Step Test: P=.001), whereas the AT-only group showed significant improvement only in the TUG test (-1.3 seconds: P=.002). However, no significant between-group differences were observed in the ABC score, FES-I score, or physical function. Despite no significant increase in daily step counts, both groups maintained close to 10,000 steps per day throughout the 12 weeks.

Conclusions

Both groups showed improvements in the FES-I and TUG test scores without significant between-group differences. Wearable technology, with or without an exercise intervention, seems to be an effective tool in reducing the fear of falling and improving physical function in older adults susceptible to falls.

Wearing an Activating Spinal Orthosis and Physical Training in Women With Osteoporosis and Back Pain: A Postintervention Follow-Up Study

Objective

To assess the duration of benefits on back pain and back extensor strength in women with osteoporosis who had previously participated in a randomized controlled trial (RCT) involving either exercise or wearing a spinal orthosis.

Design

A 6-month postintervention follow-up of women who were involved in the interventions in the RCT.

Setting

The study was conducted in a primary health care center in Stockholm, Sweden.

Participants

In this follow-up study 31 women participated in the spinal orthosis group, and 31 women participated in the exercise group, with a median age of 76 years in both groups (N=62). All women were diagnosed as having osteoporosis, had back pain with or without vertebral fracture, and were 60 years or older, which were the inclusion criteria in the RCT.

Interventions

The participants received no controlled supervision. The spinal orthosis group was asked to wear the orthosis, and the training group was asked to follow an exercise program for another 6 months voluntarily.

Main Outcome Measures

Back extensor strength was measured with a computerized device; back pain was estimated by the visual analog scale and by Borg CR-10.

Results

After 6 months there were no significant differences between the groups in back extensor strength or back pain. Analyses within the groups showed that achieved results during 6 months intervention in the RCT were maintained after 6 months of voluntary use of the spinal orthosis and training. In the spinal orthosis group, back extensor strength mean was 81.7 N, and back pain median was 3 mm. In the training group back extensor strength mean was 72.8 N, and back pain median was 3 mm. There were no changes for any other measurements performed.

Conclusions

Voluntary use of the spinal orthosis or exercise during a 6-month follow-up period maintained the increase in back extensor muscle strength obtained during the RCT. Estimation of back pain was not influenced. This indicates that the women had continued to use the spinal orthosis and exercise.

Modern Technologies in the Rehabilitation of Patients with Multiple Sclerosis and Their Potential Application in Times of COVID-19

Background and Objectives: The COVID-19 pandemic required the adoption of new technologies to improve access to healthcare at an unprecedented speed, as social distancing became mandatory. The aim of this systematic review was to analyze the effectiveness of using new technologies in the rehabilitation of multiple sclerosis (MS) patients and discuss their potential role during the COVID-19 pandemic. Material and Methods: The studies were identified by searching two online databases-PUBMED and Web of Science. Combinations of the key words "Multiple sclerosis" and "e-health"; "Multiple sclerosis" and "virtual reality"; "Multiple sclerosis" and "telerehabilitation"; "Multiple sclerosis" and "new technologies"; "Multiple sclerosis" and "tele-exercise" were used to find suitable publications. Results: A total of 17 studies were included. Although the overall number of participants in all the studies was 904, two of the studies were conducted on the same group. Thus, a total of 854 participants were involved in the studies included. All participants were diagnosed with MS. In 10 studies, participants had to be diagnosed according to the McDonald criteria. Of the included studies: five involved intervention at participants' home, six were conducted using Xbox Kinect, and seven studies reported no adverse outcomes. Conclusion: The review proves telerehabilitation to be an effective motivational tool to restore and maintain both physical and cognitive function in patients with MS. Remote communication technologies seem to be measures of high effectiveness in rehabilitating and supporting MS patients especially during the COVID-19 pandemic, as the traditional rehabilitation option is less accessible or in some cases inaccessible for these patients.

Exercise or manual physiotherapy compared with a single session of physiotherapy for osteoporotic vertebral fracture: three-arm PROVE RCT

BACKGROUND

A total of 25,000 people in the UK have osteoporotic vertebral fracture (OVF). Evidence suggests that physiotherapy may have an important treatment role.

OBJECTIVE

The objective was to investigate the clinical effectiveness and cost-effectiveness of two different physiotherapy programmes for people with OVF compared with a single physiotherapy session.

DESIGN

This was a prospective, adaptive, multicentre, assessor-blinded randomised controlled trial (RCT) with nested qualitative and health economic studies.

SETTING

This trial was based in 21 NHS physiotherapy departments.

PARTICIPANTS

The participants were people with symptomatic OVF.

INTERVENTIONS

Seven sessions of either manual outpatient physiotherapy or exercise outpatient physiotherapy compared with the best practice of a 1-hour single session of physiotherapy (SSPT).

MAIN OUTCOME MEASURES

Outcomes were measured at 4 and 12 months. The primary outcomes were quality of life and muscle endurance, which were measured by the disease-specific QUALEFFO-41 (Quality of Life Questionnaire of the European Foundation for Osteoporosis - 41 items) and timed loaded standing (TLS) test, respectively. Secondary outcomes were (1) thoracic kyphosis angle, (2) balance, evaluated via the functional reach test (FRT), and (3) physical function, assessed via the Short Physical Performance Battery (SPPB), 6-minute walk test (6MWT), Physical Activity Scale for the Elderly, a health resource use and falls diary, and the EuroQol-5 Dimensions, five-level version.

RESULTS

A total of 615 participants were enrolled, with 216, 203 and 196 randomised by a computer-generated program to exercise therapy, manual therapy and a SSPT, respectively. Baseline data were available for 613 participants, 531 (86.6%) of whom were women; the mean age of these participants was 72.14 years (standard deviation 9.09 years). Primary outcome data were obtained for 69% of participants (429/615) at 12 months: 175 in the exercise therapy arm, 181 in the manual therapy arm and 173 in the SSPT arm. Interim analysis met the criteria for all arms to remain in the study. For the primary outcomes at 12 months, there were no significant benefits over SSPT of exercise [QUALEFFO-41, difference -0.23 points, 95% confidence interval (CI) -3.20 to 1.59 points; p = 1.000; and TLS test, difference 5.77 seconds, 95% CI -4.85 to 20.46 seconds; p = 0.437] or of manual therapy (QUALEFFO-41, difference 1.35 points, 95% CI -1.76 to 2.93 points; p = 0.744; TLS test, difference 9.69 seconds (95% CI 0.09 to 24.86 seconds; p = 0.335). At 4 months, there were significant gains for both manual therapy and exercise therapy over SSPT in the TLS test in participants aged < 70 years. Exercise therapy was superior to a SSPT at 4 months in the SPPB, FRT and 6MWT and manual therapy was superior to a SSPT at 4 months in the TLS test and FRT. Neither manual therapy nor exercise therapy was cost-effective relative to a SSPT using the threshold of £20,000 per quality-adjusted life-year. There were no treatment-related serious adverse events.

CONCLUSIONS

This is the largest RCT to date assessing physiotherapy in participants with OVFs. At 1 year, neither treatment intervention conferred more benefit than a single 1-hour physiotherapy advice session. The focus of future work should be on the intensity and duration of interventions to determine if changes to these would demonstrate more sustained effects.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN49117867.

FUNDING

This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 44. See the NIHR Journals Library website for further project information.

Evidence-based guidelines for fall prevention in Korea

Falls and fall-related injuries are common in older populations and have negative effects on quality of life and independence. Falling is also associated with increased morbidity, mortality, nursing home admission, and medical costs. Korea has experienced an extreme demographic shift with its population aging at the fastest pace among developed countries, so it is important to assess fall risks and develop interventions for high-risk populations. Guidelines for the prevention of falls were first developed by the Korean Association of Internal Medicine and the Korean Geriatrics Society. These guidelines were developed through an adaptation process as an evidence-based method; four guidelines were retrieved via systematic review and the Appraisal of Guidelines for Research and Evaluation II process, and seven recommendations were developed based on the Grades of Recommendation, Assessment, Development, and Evaluation framework. Because falls are the result of various factors, the guidelines include a multidimensional assessment and multimodal strategy. The guidelines were developed for primary physicians as well as patients and the general population. They provide detailed recommendations and concrete measures to assess risk and prevent falls among older people.

The feasibility of progressive resistance training in women with polycystic ovary syndrome: a pilot randomized controlled trial

BACKGROUND

To evaluate the feasibility of executing a randomized controlled trial of progressive resistance training (PRT) in women with polycystic ovary syndrome (PCOS).

METHODS

Women with PCOS were randomized to an experimental (PRT) group or a no-exercise (usual care) control group. The PRT group was prescribed two supervised and two unsupervised (home-based) training sessions per week for 12 weeks. Feasibility outcomes included recruitment and attrition, adherence, adverse events, and completion of assessments. Secondary outcomes, collected pre and post intervention, included a range of pertinent physiological, functional and psychological measures.

RESULTS

Fifteen participants were randomised into the PRT group (n = 8) or control group (n = 7); five women (n = 2 in PRT group and n = 3 in control group) withdrew from the study. The most successful recruitment sources were Facebook (40 %) and online advertisement (27 %), while least successful methods were referrals by clinicians, colleagues and flyers. In the PRT group, attendance to supervised sessions was higher (95 %; standard deviation ±6 %) compared to unsupervised sessions (51 %; standard deviation ±28 %). No adverse events were attributed to PRT. Change in menstrual cycle status was not significantly different between groups over time (p = 0.503). However, the PRT group significantly increased body weight (p = 0.01), BMI (p = 0.04), lean mass (p = 0.01), fat-free mass (p = 0.005) and lower body strength (p = 0.03), while reducing waist circumference (p = 0.03) and HbA1c (p = 0.033) versus the control group. The PRT group also significantly improved across several domains of disease-specific and general health-related quality of life, depression, anxiety and exercise self-efficacy.

CONCLUSION

A randomized controlled trial of PRT in PCOS would be feasible, and this mode of exercise may elicit a therapeutic effect on clinically important outcomes in this cohort. The success of a large-scale trial required to confirm these findings would be contingent on addressing the feasibility hurdles identified in this study with respect to recruitment, attrition, compliance, and collection of standardized clinical data.

TRIAL REGISTRATION

Australia New Zealand Clinical Trials Registry; ACTRN12614000517673 Registered 15 May 2014.

Predictors of adherence to home-based physical therapies: a systematic review

PURPOSE

Self-managed, home-based physical therapy (HBPT) is an increasingly common element of physical therapy rehabilitation programmes but non-adherence can reach 70%. Understanding factors that influence patients' adherence to HBPTs could help practitioners support better adherence. Research to date has focussed largely on clinic-based physiotherapy. The objective of this review, therefore, was to identify specific factors, which influence adherence to home-based, self-managed physical therapies.

METHOD

A systematic review was conducted, in which eight online databases were searched using combinations of key terms relating to physical therapies, adherence and predictors. Matching records were screened against eligibility criteria and 30 quantitative articles were quality assessed and included in the final review. Relevant data were extracted and a narrative synthesis approach was taken to aggregating findings across studies.

RESULTS

There was relatively strong evidence that the following factors predicted adherence to HBPTs: intention to engage in the HBPT, self-motivation, self-efficacy, previous adherence to exercise-related behaviours and social support.

CONCLUSIONS

This review has identified a range of factors that appear to be related to patients' adherence to their self-managed physical rehabilitation therapies. Awareness of these factors may inform design of interventions to improve adherence. Implications for Rehabilitation Non-adherence to physical rehabilitation therapies is often high - particularly in self-managed, home-based programmes, despite good adherence being important in achieving positive outcomes. The findings of this systematic review indicate that greater self-efficacy, self-motivation, social support, intentions and previous adherence to physical therapies predict higher adherence to HBPTs. Assessment of these domains before providing individuals with their HBPT regimes may allow identification of 'risk factors' for poor adherence. These can then potentially be addressed or managed prior to, or alongside, the therapy. Interventions to support patients' self-managed physical rehabilitation should include elements designed to enhance patients' self-efficacy, self-motivation and social support given the evidence that these factors are good predictors of adherence.

Use of pragmatic community-based interventions to enhance recruitment and adherence in a randomized trial of Tai Chi for women with osteopenia: insights from a qualitative substudy

OBJECTIVE

This study aims to qualitatively evaluate the feasibility of using a pragmatic network of community-based Tai Chi schools to deliver 9-month exercise interventions to women with osteopenia and to explore the impact of this design feature on facilitators and barriers to trial recruitment and participant adherence during and after the trial.

METHODS

In a randomized trial comparing 9 months of Tai Chi plus usual care with usual care alone for postmenopausal women with moderately low bone mass, exit interviews were conducted with 43 participants randomized to the pragmatically delivered Tai Chi intervention. Transcripts were digitially recorded, transcribed, and imported into NVivo, a computer-assisted qualitative data analysis software. Qualitative content analysis was used to code the data. Patterns emerging from among the codes were further examined and clustered into themes.

RESULTS

Analyses revealed features of pragmatically delivered Tai Chi programs that both facilitated and impeded study participation and/or posttrial adherence. Direct facilitators included convenience of class locations and times, alternative learning modalities, quality of teaching, community and social support, and perceived health benefits. Barriers consisted primarily of time-related issues. A possible causal mechanism (self-efficacy) was also identified.

CONCLUSIONS

Factors related to the use of pragmatically delivered interventions are beneficial for fostering both study participation and posttrial adherence to the Tai Chi programs. This qualitative substudy is valuable for identifying these factors and a possible causal mechanism. These findings will assist in the design and conduct of future studies exploring the use of Tai Chi in fracture prevention and health-related quality of life in postmenopausal women.

The Effect of the Modified Eighth Section of Eight-Section Brocade on Osteoporosis in Postmenopausal Women: A Prospective Randomized Trial

Osteoporosis and related fragility fractures represent a serious and global public health problem. To evaluate whether the modified eighth section of Eight-section Brocade (MESE) exercise could improve the symptom and indexes associated with osteoporosis in postmenopausal women. Guangzhou and Liuzhou hospital of traditional Chinese medicine in China. Women (n = 198) aged 50 to 75 years were randomized into Control, Ca, MESE, and MESE + Ca. Subjects in Ca and MESE groups were separately asked to consume thrice daily Calcium Carbonate Chewable D3 tablet and to perform thrice daily MESE exercise by 7 repetitions per time for 12 months. Subjects in MESE + Ca group performed such the combined treatment project for 12 months. Body height and Hospital for Special Surgery (HSS) scores of both knees, chronic back pain visual analogue scale scores (VAS), bone mineral density (BMD) at L2 to L4 and the left femoral neck, 3-feet Up and Go Test (3') and one-leg Stance (OLS). In our study, the improvement in chronic back pain of the patients in Ca, MESE, and MESE + Ca group was better than that in control group. There was 1.9% and 1.7%, 2.3%, and 2.1% net profit in left femoral neck and lumbar BMD after the treatment for 12 months in MESE and MESE + Ca groups. For the balance capacity, the subjects in MESE and MESE + Ca groups secured much better performance than those in Ca and control group after the treatment for 12 months (P < 0.001, P < 0.001). The treatment of MESE exercise is the most effective for the improvement of the symptom and indexes in postmenopausal women. Importantly, the low attrition and the high exercise compliance indicate that MESE exercise is safe, feasible, and well tolerated by postmenopausal women.

Are personal characteristics associated with exercise participation in patients with rheumatoid arthritis? A cross-sectional explorative survey

BACKGROUND

Organized exercise programs for patients with rheumatoid arthritis (RA) are useful to enhance physical activity and fitness. However, participation and adherence rates of these programs are low. This study aimed to identify demographic, personal and disease-related factors interfering with implementing an exercise program for RA.

METHODS

A random sample of ambulatory RA patients from a single centre was divided into two groups, depending on their willingness to participate in an exercise program. Subsequently, demographic data (gender, age, disease duration and educational level) and disease-related and personal factors were obtained (Disease Activity Score; Short Form 36 [SF-36]; Health Assessment Questionnaire; Global Disease Activity; and also the Utrecht Coping List [UCL], Illness Cognition Questionnaire; TAMPA scale and modified Baecke questionnaire).

RESULTS

Of the 154 people completing the survey, 113 (73%) indicated that they were willing to participate in an exercise program. These positive responders (PR) were more often female (p<0.05), and had a higher educational level (p<0.05). In the negative responders (NR), higher scores were found in the general health perception (54.7; [SD 18.3] versus 47.4; [SD 20.8]) and vitality (61.6 [SD 19.8] versus 53.7 [SD 20.1] sections of the SF-36, and a lower score was found on the reassuring thoughts subscale of the UCL (11.9 [SD 2.7] versus 12.9 [SD 2.7]) compared with the PR (all p<0.05).

CONCLUSIONS

Although few differences were found between the groups, some insights regarding pitfalls in implementing an exercise program were highlighted. Further insights into external and personal motivators for patients are needed.

Tai Chi for osteopenic women: design and rationale of a pragmatic randomized controlled trial

Background

Post-menopausal osteopenic women are at increased risk for skeletal fractures. Current osteopenia treatment guidelines include exercise, however, optimal exercise regimens for attenuating bone mineral density (BMD) loss, or for addressing other fracture-related risk factors (e.g. poor balance, decreased muscle strength) are not well-defined. Tai Chi is an increasingly popular weight bearing mind-body exercise that has been reported to positively impact BMD dynamics and improve postural control, however, current evidence is inconclusive. This study will determine the effectiveness of Tai Chi in reducing rates of bone turnover in post-menopausal osteopenic women, compared with standard care, and will preliminarily explore biomechanical processes that might inform how Tai Chi impacts BMD and associated fracture risks.

Methods/Design

A total of 86 post-menopausal women, aged 45-70y, T-score of the hip and/or spine -1.0 and -2.5, have been recruited from primary care clinics of a large healthcare system based in Boston. They have been randomized to a group-based 9-month Tai Chi program plus standard care or to standard care only. A unique aspect of this trial is its pragmatic design, which allows participants randomized to Tai Chi to choose from a pre-screened list of community-based Tai Chi programs. Interviewers masked to participants' treatment group assess outcomes at baseline and 3 and 9 months after randomization. Primary outcomes are serum markers of bone resorption (C-terminal cross linking telopeptide of type I collagen), bone formation (osteocalcin), and BMD of the lumbar spine and proximal femur (dual-energy X-ray absorptiometry). Secondary outcomes include health-related quality-of-life, exercise behavior, and psychological well-being. In addition, kinetic and kinematic characterization of gait, standing, and rising from a chair are assessed in subset of participants (n = 16) to explore the feasibility of modeling skeletal mechanical loads and postural control as mediators of fracture risk.

Discussion

Results of this study will provide preliminary evidence regarding the value of Tai Chi as an intervention for decreasing fracture risk in osteopenic women. They will also inform the feasibility, value and potential limitations related to the use of pragmatic designs for the study of Tai Chi and related mind-body exercise. If the results are positive, this will help focus future, more in-depth, research on the most promising potential mechanisms of action identified by this study.

Trial registration

This trial is registered in Clinical Trials.gov, with the ID number of NCT01039012.

Attitudes of postmenopausal women toward interactive video dance for exercise

AIMS

Although physical activity (PA) is universally recommended, most adults are not regular exercisers. Interactive video dance is a novel form of PA in widespread use among young adults, but interest among adults is not known. Postmenopausal women are an appropriate target for interventions to promote PA because they have an increased risk of health problems related to sedentary behavior. We explored perceived advantages and disadvantages of video dance as a personal exercise option in postmenopausal women.

METHODS

Forty sedentary postmenopausal women (mean age +/- SD 57 +/- 5 years), were oriented in eight small groups to interactive video dance, which uses a force-sensing pad with directional panels: the player steps on the panels in response to arrows scrolling on a screen, synchronized to music. Perceived advantages and disadvantages were elicited through a nominal group technique (NGT) process.

RESULTS

Participants generated 113 advantages and 71 disadvantages. The most frequently cited advantages were "it's fun" and "improves coordination" (seven of eight groups), the fact that challenge encourages progress (five of eight groups), the potential for weight loss (four of eight groups), and the flexibility of exercise conditions (three of eight groups). Concerns were the potentially long and frustrating learning process, cost (six of eight groups), and possible technical issues (two of eight groups).

CONCLUSIONS

The recreational nature of interactive dance exercise was widely appealing to postmenopausal women and might help promote adherence to PA. Initial support to learn basic technical and movement skills may be needed.

Effects on balance, falls, and bone mineral density of a home-based exercise program without home visits in community-dwelling elderly women: a randomized controlled trial

The aim of the present study was to investigate the effects of home-based exercise without home visits on physical function, falls, and bone mineral density in community-dwelling elderly women. Sixty community-dwelling, elderly (> or =65 years of age) women were recruited from a Japanese community. Subjects were randomly assigned to a home-based exercise group or a control group. The subjects assigned to the home-based exercise group performed home-based exercise without home visits 3 times per week for 6 months in their homes. Assessments of physical function and bone mineral density were carried out before and after intervention in both groups. Muscle strength, gait velocity, the timed up and go test (TUGT), single leg stance time, the bend reach performance test, and reaction time were measured to assess physical function. The patients' history of falls was also assessed before and after the 12-month follow-up. To determine bone mineral density, the speed of sound (SOS) at the right calcaneus was measured using a quantitative ultrasound device. There were no significant differences between the two groups in baseline characteristics. 82.6% of subjects completed the prescribed exercise program in the home-based exercise group. Compared to the control group, TUGT improved significantly (p<0.05) in the home-based exercise group. Home-based exercise without home visits can be adopted for community-dwelling elderly women, particularly since no specific place or instructor is needed.

Effects of exercise programmes on quality of life in osteoporotic and osteopenic postmenopausal women: a systematic review and meta-analysis

Objective: To examine the effect of exercise therapy on quality of life in postmenopausal women with osteoporosis or osteopenia.

Methods: We searched MEDLINE, CINAHL, PEDro, EMBASE and the Cochrane library from January 1966 to March 2007. Two reviewers independently selected all studies that met predetermined inclusion criteria. Randomized controlled trials that used the Short Form 36 of the Medical Outcome Study (SF-36) questionnaire or the Quality of Life Questionnaire of the European Foundation for Osteoporosis (QUALEFFO) as outcome measures were selected. The PEDro Scale was applied to rate the quality of each article. All studies had a quality score above 5/10. Meta-analysis was facilitated by RevMan 4.1.

Results: Four randomized controlled trials met the inclusion criteria, involving a total of 256 participants. Results revealed that the exercise groups showed significant improvements in the domains of physical function, pain, role physical and vitality (P<0.05). Furthermore, intervention with combined exercise programmes had better effects on physical function, pain and vitality domains than controls. Group exercise programmes also produced better results in these three domains. A short-duration exercise programme produced more improvement in physical function, role physical and vitality, whereas a long-duration exercise programme resulted in more improvement in physical function and pain domains.

Conclusions: This meta-analysis revealed better improvement in physical function, pain, role physical and vitality in the exercise groups. Combined exercise and group exercise programmes showed better outcomes in the physical function, pain and vitality domains, but different durations of exercise programme showed improvement in different domains.

Multidisciplinary patient education in groups increases knowledge on osteoporosis: A randomized controlled trial

Introduction: Specific pharmacological treatment reduces the incidence of fractures significantly in patients with osteoporosis. Unfortunately, compliance with such therapy is low in clinical practice and is inversely related to educational level. We hypothesized that patients' knowledge of osteoporosis may be increased by a group-based multidisciplinary education programme. Methods: Three hundred patients, aged 45—81 years, recently diagnosed with osteoporosis and started on specific treatment, were randomized to either the "school'' or "control'' group. Teaching was performed by nurses, physiotherapists, dieticians, and doctors, and designed to increase the patient's empowerment. The patient's knowledge of osteoporosis was tested at study entry and at 3 months using a validated questionnaire. Results: At study entry, no differences in age or score (22 (18—24) (median (25—75 percentiles)) vs. 22 (18—24)) were seen between the school and control groups. The change in knowledge during the study, however, differed significantly between the two groups (p<0.001). In the school group, the increase in knowledge score correlated inversely with the level of education; that is, the lower the education level, the higher the gain in knowledge during the course (Rho=-0.25, p<0.01). Conclusions: A group-based multidisciplinary education programme significantly increases patients' knowledge of the disease.

Simple, novel physical activity maintains proximal femur bone mineral density, and improves muscle strength and balance in sedentary, postmenopausal Caucasian women

A simple, appealing, physical activity program can be prescribed to reduce the risk of falls in sedentary, postmenopausal, independent-living, Caucasian women. Foot stamping, progressively loaded squats, and in-line dancing positively influence proximal femoral bone mineral density, lower extremity strength, and static and dynamic balance.

INTRODUCTION

Foot stamping, squats exercises, and in-line dancing together create a suitable activity program for sedentary, independent-living older women.

METHODS

Forty-five postmenopausal women not taking medications for bone health were randomly assigned to one of three groups. All groups attended one line dance class per week. Two groups additionally performed progressively loaded squats five times per week. One group also performed four foot stamps, twice daily, five times per week. Broadband ultrasound attenuation (BUA), proximal femur (PF) and lumbar spine (LS) bone mineral density (BMD), squats number, and balance variables were measured.

RESULTS

There were no differences within or between groups in baseline and follow-up BUA, PF or LS BMD; however, a strong stamp compliance effect was apparent for BUA (r = 0.73) and PF BMD (r = 0.79). Number of squats (p < 0.01) and single leg stance time (p < 0.01) increased, while timed up and go time decreased (p < 0.01) for all participants.

CONCLUSIONS

Line dancing, particularly in concert with regular squats and foot stamping, is a simple and appealing strategy that may be employed to reduce lower extremity bone loss, and improve lower limb muscle strength and balance, in independent living, otherwise healthy, postmenopausal Caucasian women.

The effects of Tai Chi on bone mineral density in postmenopausal women: a systematic review

OBJECTIVE

To evaluate the evidence for Tai Chi as an intervention to reduce rate of bone loss in postmenopausal women.

DATA SOURCES

Literature search using Medline, Science Citation Index, Cochrane databases, China Biological Medicine Database, and additional manual reference searches of retrieved articles and personal libraries.

STUDY SELECTION

Randomized controlled trials (RCTs), prospective cohort studies, and cross-sectional studies that included Tai Chi as an intervention, and had at least 1 outcome related to measurement of bone mineral density (BMD).

DATA EXTRACTION

Authors critically reviewed studies, evaluated methodologic quality, and synthesized study results in a summary table.

DATA SYNTHESIS

Six controlled studies were identified by our search. There were 2 RCTs, 2 nonrandomized prospective parallel cohort studies, and 2 cross-sectional studies. The 2 RCTs and 1 of the prospective cohort studies suggested that Tai Chi-naive women who participated in Tai Chi training exhibited reduced rates of postmenopausal declines in BMD. Cross-sectional studies suggested that long-term Tai Chi practitioners had higher BMD than age-matched sedentary controls, and had slower rates of postmenopausal BMD decline. No adverse effects related to Tai Chi were reported in any trial.

CONCLUSIONS

Conclusions on the impact of Tai Chi on BMD are limited by the quantity and quality of research to date. This limited evidence suggests Tai Chi may be an effective, safe, and practical intervention for maintaining BMD in postmenopausal women. In combination with research that indicates Tai Chi can positively impact other risk factors associated with low BMD (eg, reduced fall frequency, increased musculoskeletal strength), further methodologically sound research is warranted to better evaluate the impact of Tai Chi practice on BMD and fracture risk in postmenopausal women.

The pathogenesis, epidemiology and management of glucocorticoid-induced osteoporosis

Oral glucocorticoids (GCs) are frequently used in the treatment of inflammatory conditions, such as rheumatoid arthritis or asthma. They have adverse skeletal effects, primarily through reductions in bone formation and osteocyte apoptosis. Several findings indicate that changes in the quality of bone may significantly contribute to the increased risk of fracture and that loss of BMD only partially explains the increased risk of fracture in oral GC users. Epidemiological studies have found that the increases in the risk of fracture in oral GC users are dose dependent and occur within three months of starting GC therapy. Daily doses of >2.5 mg prednisone equivalent have been associated with increases in the risk of fractures and randomised studies reported adverse skeletal effects with daily doses as low as 5 mg. After discontinuation of GC treatment, the risk of fracture may reduce towards baseline levels unless patients previously used high cumulative doses of oral GCs. Users of inhaled GCs have also an increased risk of fracture, especially at higher doses. But it is likely that this excess risk is related to the severity of the underlying respiratory disease, rather than to the inhaled GC therapy. It has been recommended that patients who start on oral GC therapy should receive calcium and vitamin D supplementation. Patients with a higher risk of fracture should also receive a bisphosphonate.

[Nonpharmacological treatments for osteoporosis]

OBJECTIVES

Study the effectiveness of nonpharmacological treatments for osteoporosis.

METHOD

Review and qualitative analysis of the literature concerning the effectiveness of nonpharmacological treatments: physical exercise, rehabilitation aiming to prevent falls, spinal orthosis, and vertebro- and kyphoplasty.

RESULTS

The level of evidence of the effectiveness of nonpharmacological treatment is unequal on the basis of randomized study. The practice of physical exercise by the ambulatory elderly people and home rehabilitation for those who have previously fallen prevent the occurrence of falls. For institutionalized people, the prevention of falls is achieved by multidisciplinary programs. The use of hip protectors to prevent fracture is controversial. Physical exercises prevent bone loss after menopause and during postmenopausaul and corticosteroid osteoporosis. The effectiveness of mobilization after fracture is not documented. Only one study concerning the use of spinal orthosis after vertebral fracture reports interesting results for pain and disability. No randomized study concerning vertebroplasty or kyphoplasty for osteoporotic vertebral fracture is described.

CONCLUSION

The nonpharmacological treatments of osteoporosis are considered therapeutic means of key importance. They aim at the prevention of falls and bone loss and the reduction of disability after fracture. Only physical exercise and rehabilitation have been shown to be effective in preventing falls or bone loss. Their ability to reduce the incidence of fractures remains to be evaluated.

Alternative therapies for osteoporosis

A variety of common complementary and alternative medicine therapies are now being examined for effectiveness in the management of osteoporosis. Short-term studies in postmenopausal women show beneficial effects of soy isoflavone supplementation on bone density, but its long-term effects require clarification. Prospective controlled trials have shown that physical training can increase bone density to varying degrees. Other therapies that have been examined include herbal formulae, essential fatty acids and vitamins A, C, and K, but few data regarding their effectiveness, mechanisms and safety have been published. Further randomized controlled trials are needed.