Community-based osteoporosis prevention: Physical activity in relation to bone density, fall prevention, and the effect of training programmes : The Vadstena Osteoporosis Prevention Project

This thesis is based on studies of the ten-year community-based intervention programme entitled, the Vadstena Osteoporosis Prevention Project (VOPP). The specific aims of the research were to describe the effects of physical activity and training programmes on bone mass and balance performance in adults, to determine whether a fall risk prevention programme could motivate personal actions among the elderly, to ascertain whether the intervention programme could reduce the incidence of forearm and hip fractures. Two studies addressed training programmes for middle-aged and old people. First, VOPP participants who were aged 40–70 years and had low forearm bone mineral density (BMD) values were invited to take part in a one-year weight-bearing training study. Thirty of those individuals were included in the investigation. Additional bone mass measurements were performed at the hip and the lumbar spine, and balance and aerobic capacity were also tested. The training programme was performed twice a week (I). In the second study, healthy persons aged 70–75 years were invited to participate in a balance-training study. Fifteen persons joined an exercise group, and another fifteen were controls. The training programme comprised specific balance exercises and was carried out twice a week for nine weeks (II). The association between forearm BMD values and several lifestyle factors was explored in random samples of the population aged 20–72 years (n=880) in a cross-sectional study (III). Another study explored the association between calcaneal stiffness, forearm BMD, and lifestyle factors amongst participants aged 20–79 years (n=956) at the final registration of the VOPP (V). Effects of the VOPP interventions directed at environmental risk factors for falls and the promotion of physical activity were examined in people aged ≥ 65 years (IV). The incidence of forearm and hip fractures was studied amongst middle-aged and elderly individuals in the intervention and the control communities during the study period 1987–2001 (VI). The exercise group (n=15) in the weight-bearing training study showed increases in BMD at the greater trochanter (p&lt;0.01), one-leg stance balance with the eyes closed and coordination tests (p&lt;0.05), and aerobic capacity (p&lt;0.05). No significant difference was found when the groups were compared concerning changes in the different tests during the intervention period (I). In the balance-training study, the exercise group showed post-training improvement in the following tests: standing on the right leg with eyes closed (p&lt;0.01), standing on the right leg (p&lt;0.01) and on the left leg (p&lt;0.05) while turning the head, and walking 30 metres (p&lt;0.01). There were significant differences between the groups in these tests when changes were compared at the post-intervention test (II). Age (p&lt;0.0001) and body mass index (p≤.0001) were associated with forearm BMD in both sexes. Reported moderate physical activity levels in men were positively associated with forearm BMD (p&lt;0.05) (III). In both sexes, reported moderate (p&lt;0.05) and high (women p&lt;0.05 and men p&lt;0.001) physical activity levels were positively associated with calcaneal stiffness. The correlation coefficient between forearm BMD and calcaneal stiffness was 0.58 in women and 0.34 in men (V). Persons aged ≥ 65 years at the follow-up in 1994 reported more use of shoe/cane spikes and moderate physical activity levels compared to controls (IV). There was no change in the general incidence of forearm and hip fractures between the communities for the study period. However, there was a tendency towards decreasing incidence of forearm and trochanteric hip fracture in both sexes during the late intervention period in the intervention community (VI). A community-based intervention programme aimed at reducing the incidence of osteoporotic fractures must be regarded as a long-term project and should preferably be monitored over an extended post-intervention period.On the day of the public defence the statuses of articles IV and V were Submitted and VI was Manuscript</p

Osteoporosis School in Primary Health Care-A Pilot Study

An osteoporosis school was introduced as a pilot study in a Swedish primary health care center. Women aged 50 years and over with healed fragility fractures were asked to participate. The aim was to increase awareness amongst the participants and to advise them about life-style and fall prevention strategies to prevent a secondary fragility fracture. The osteoporosis school was scheduled to once a week for eight weeks and included theory and exercise training sessions. Eleven women with mean age 74 years participated. Clinical tests such as back straightening test and balance tests were performed, pain was estimated by the visual analogue scale, and health-related quality of life was measured by the SF-36 questionnaire. Straightening of the back improved 0.6 cm (p&lt;0.05), worst estimated pain decreased from 5.8 to 4.0 (p&lt;0.05), and the SF-36 bodily pain domain improved (p&lt;0.05). The participants completed an average of 7 out of 8 sessions. The exercise training sessions were the most appreciated part of the program

Community-based osteoporosis prevention: Physical activity in relation to bone density, fall prevention, and the effect of training programmes : The Vadstena Osteoporosis Prevention Project

This thesis is based on studies of the ten-year community-based intervention programme entitled, the Vadstena Osteoporosis Prevention Project (VOPP). The specific aims of the research were to describe the effects of physical activity and training programmes on bone mass and balance performance in adults, to determine whether a fall risk prevention programme could motivate personal actions among the elderly, to ascertain whether the intervention programme could reduce the incidence of forearm and hip fractures. Two studies addressed training programmes for middle-aged and old people. First, VOPP participants who were aged 40–70 years and had low forearm bone mineral density (BMD) values were invited to take part in a one-year weight-bearing training study. Thirty of those individuals were included in the investigation. Additional bone mass measurements were performed at the hip and the lumbar spine, and balance and aerobic capacity were also tested. The training programme was performed twice a week (I). In the second study, healthy persons aged 70–75 years were invited to participate in a balance-training study. Fifteen persons joined an exercise group, and another fifteen were controls. The training programme comprised specific balance exercises and was carried out twice a week for nine weeks (II). The association between forearm BMD values and several lifestyle factors was explored in random samples of the population aged 20–72 years (n=880) in a cross-sectional study (III). Another study explored the association between calcaneal stiffness, forearm BMD, and lifestyle factors amongst participants aged 20–79 years (n=956) at the final registration of the VOPP (V). Effects of the VOPP interventions directed at environmental risk factors for falls and the promotion of physical activity were examined in people aged ≥ 65 years (IV). The incidence of forearm and hip fractures was studied amongst middle-aged and elderly individuals in the intervention and the control communities during the study period 1987–2001 (VI). The exercise group (n=15) in the weight-bearing training study showed increases in BMD at the greater trochanter (p&lt;0.01), one-leg stance balance with the eyes closed and coordination tests (p&lt;0.05), and aerobic capacity (p&lt;0.05). No significant difference was found when the groups were compared concerning changes in the different tests during the intervention period (I). In the balance-training study, the exercise group showed post-training improvement in the following tests: standing on the right leg with eyes closed (p&lt;0.01), standing on the right leg (p&lt;0.01) and on the left leg (p&lt;0.05) while turning the head, and walking 30 metres (p&lt;0.01). There were significant differences between the groups in these tests when changes were compared at the post-intervention test (II). Age (p&lt;0.0001) and body mass index (p≤.0001) were associated with forearm BMD in both sexes. Reported moderate physical activity levels in men were positively associated with forearm BMD (p&lt;0.05) (III). In both sexes, reported moderate (p&lt;0.05) and high (women p&lt;0.05 and men p&lt;0.001) physical activity levels were positively associated with calcaneal stiffness. The correlation coefficient between forearm BMD and calcaneal stiffness was 0.58 in women and 0.34 in men (V). Persons aged ≥ 65 years at the follow-up in 1994 reported more use of shoe/cane spikes and moderate physical activity levels compared to controls (IV). There was no change in the general incidence of forearm and hip fractures between the communities for the study period. However, there was a tendency towards decreasing incidence of forearm and trochanteric hip fracture in both sexes during the late intervention period in the intervention community (VI). A community-based intervention programme aimed at reducing the incidence of osteoporotic fractures must be regarded as a long-term project and should preferably be monitored over an extended post-intervention period.On the day of the public defence the statuses of articles IV and V were Submitted and VI was Manuscript</p

Long-term effects of a ten-year osteoporosis intervention program in a Swedish population-A cross-sectional study.

The aim of the study was to explore long-term effects seven years after the completion of a ten-year community-based osteoporosis intervention program in Vadstena, Sweden. The association between calcaneal bone mineral density and several life style factors, and the impact of risk factors for sustaining a fracture after the age of 50 were also studied. Previous participants in the intervention group, and matched subjects were invited to calcaneal bone mass measurement by a portable device including the dual X-ray and laser (DXL) technology by Calscan, and to complete a questionnaire in 2006. A total of 417 persons (63% of those invited) in the intervention (I) group, and 120 persons (47% of those invited) in the control (C) group participated. Mean age was 63 years (37-94 years). There was somewhat more knowledge of osteoporosis in the I-group (M = 18) than in the C-group (M = 17) (p &lt; 0.05), and more use of shoe/cane spikes in elderly women in the I-group (67%) than in the C-group (40.5%). The fully adjusted model of logistic regression showed that participants with an osteoporotic DXL T-score (≤- 2.5) had a 3-fold increased risk (95%CI 1.48-6.89) of having a history of a self-reported fracture after the age of fifty compared to women with a calcaneal T-score &gt;- 2.5. The long-term effects of a ten-year, community-based, osteoporosis intervention program on knowledge and behavior were modest seven years after its completion

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

Experiences of using an activating spinal orthosis in women with osteoporosis and back pain in primary care

Women with osteoporosis and back pain took part in focus group interviews and described their experiences of using and handling an activating spinal orthosis. The women described the back orthosis as being like a "close friend", a support in everyday life and a reminder to maintain a good posture. Purpose The purpose of this study was to describe and gain a deeper understanding of the views of older women with osteoporosis and back pain seeking primary care regarding their use and handling of an activating spinal orthosis. Method We chose a qualitative method whereby information was gathered via focus group interviews and analysed using inductive content analysis. Women who previously participated in a randomised controlled trial and wore an activating spinal orthosis for 6 months were asked. Out of 31 women, 18 agreed to participate. Five focus group interviews were conducted. Results The analysis resulted in an overall theme in which the experiences of wearing the spinal orthosis were described as follows: "A well-adapted spinal orthosis could develop into a long-lasting friendship that provided support and help in daily life". The overall theme was based on three main categories: impact on daily life, individual adaptation and personal relationship. The main categories were well differentiated from each other but had an interdependency. All three categories involved cases in which the spinal orthosis was perceived as relieving symptoms and making daily life easier, as well as when it was perceived as being hard to manage and provided no symptom relief. Conclusion In older women with osteoporosis and back pain, an activating spinal orthosis could be perceived as being a "close friend" and a support in everyday life. To facilitate acceptance of the spinal orthosis, it was important for it to be well adapted and for follow-ups to be carried out regularly.Funding Agencies|Karolinska InstituteKarolinska Institutet</p

Changes in physical activity levels and relationship to balance performance, gait speed, and self-rated health in older Swedish women : a longitudinal study

Background and aim Physical activity levels in older people often decrease and may mean impaired physical functioning leading to an increased fall risk. The aim of this study was to investigate self-reported change in physical activity dose and deterioration in balance performance, gait speed, and self-rated health (SRH) in older women between two time points in a follow-up study. Methods A cohort of community-living women, aged 69-79 years (n = 351) were evaluated by questionnaire and clinical tests on balance, gait speed, and SRH at baseline. One hundred and eighty-six women were followed-up by these tests 8.5 years after inclusion. The non-parametric Wilcoxon signed-rank test and Mann-Whitney U test were used for the analysis. Results The greatest changes were seen in one-leg standing time (OLST) with eyes closed (- 60%) and eyes open (- 42%). The population was divided into high exercise (HE, n = 49) and low exercise (LE, n = 51) groups. At baseline the HE group had an OLST of 19 s with eyes open and 3 s with eyes closed. In the LE group, these values were 7.3 s and 2 s. At follow-up, differences between HE and LE concerning tandem walk forwards (steps) (HE = 8.5; LE = 2.5) and backwards (HE = 11; LE = 3.5) emerged. The HE group estimated SRH (VAS-scale) 30 mm higher at baseline and 17 mm higher at follow-up than the LE group. Conclusion Greater physical activity seems to be an important predictor for maintaining physical function and SRH in older women.Funding Agencies|Karolinska InstituteKarolinska Institutet</p

Effect of treatment on back pain and back extensor strength with a spinal orthosis in older women with osteoporosis: a randomized controlled trial

The treatment effect of an activating spinal orthosis on back pain and back extensor strength was compared to a training group and to a control group. Between the groups, there was no significant difference in back pain, back extensor strength, or kyphosis index after the 6months of treatment.PurposeThe aim of this study was to study the effect of treatment with an activating spinal orthosis on back pain, back extensor strength, and kyphotic index. Our hypothesis was that an activating spinal orthosis may be an alternative treatment to decrease back pain and increase back extensor strength.MethodsA total of 113 women aged 60years with back pain and osteoporosis, with or without vertebral fractures, were randomized to three groups: a spinal orthosis group, an equipment training group, and a control group. All three groups were examined at baseline and followed up after 3 and 6months. Statistical analyses were performed with a mixed model for repeated measures according to intention to treat (ITT) and per protocol (PP).ResultsA total of 96 women completed the study. Between the groups, there was no significant difference in baseline characteristics. Comparison between groups showed no significant difference in back pain, back extensor strength, or kyphosis index at the follow-up after 6months according to ITT and PP analyses. Analysis in each group showed that the back extensor strength had increased by 26.9% in the spinal orthosis group, by 22.1% in the exercise training group and by 9.9% in the control group.ConclusionsSix months treatment by an activating spinal orthosis showed no significant difference in back pain, back extensor strength, or kyphosis index between the three groups. In the spinal orthosis group, present back pain decreased slightly and back extensor strength increased by 26.9% which indicates that the spinal orthosis may become an alternative training method.Clinicaltrials.com ID: NCT03263585Funding Agencies|Stockholm County Council</p

Experiences of participating in a structured osteoporosis school in persons with established spinal osteoporosis - an interview study

IntroductionPatient education in combination with physical activity has been proposed as a way of increasing health-related quality of life and functional capacity in patients with osteoporosis. A randomised pilot study called the School of Osteoporosis in Linkoping (SOL) was conducted in 2018 for persons aged &amp;gt;= 60 years with established spinal osteoporosis. The SOL was scheduled for ten weeks with once-weekly theory education with or without additional supervised physical group training. The purpose of the present study was to explore the experiences of having participated in an osteoporosis school in persons with established spinal osteoporosis.Materials and methodsTen participants who had completed the SOL with patient education and supervised physical group training were invited to individual interviews, while six persons were accepted to participate. Qualitative content analysis was conducted with an inductive approach.FindingsThree main categories were identified from the interviews: The structure of the osteoporosis school; Gained knowledge related to the education in the osteoporosis school; and Experiences of health status one-year post-intervention. Seven associated subcategories were identified. Increased knowledge and perceptions of improved health acquired by the interventions were emphasised. However, continued supervised group training was requested and there were also concerns about worsened health at the one-year post-intervention follow-up.ConclusionThe tailored content and the group aspects of the structured osteoporosis school were experienced as the most important factors for successful results