Effects of an 18-month community-based, multifaceted, exercise program on patient-reported outcomes in older adults at risk of fracture: secondary analysis of a randomised controlled trial.

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• As we age our risk of fractures and falls increases, which can affect QoL.
• However, regular exercises combining strength and resistance training could improve QoL, but only if individuals adhere to programmes. It is still unclear if fracture and fall risk is decreased.

Introduction

• The occurrence of fractures is associated with reduced quality of life (QoL), increased mortality, and an increase in healthcare resources.
• Resistance training, weight bearing impact and balance training have been shown to reduce fracture risk and may prevent fractures in older people, thereby impacting QoL.
• This study aimed to determine the effect of an exercise programme (Osteo-cise: Strong Bones for Life) on patient reported QoL.

Methods

• 162 Australian-based individuals were allocated to one of two groups Osteo-cise (n=81) or standard care control group (n=81) as part of an 18-month randomised, controlled trial. 12 months of the programme was supervised by the research team, and the final 6 months was managed via community leisure centres.
• All individuals were prescribed 1000 IU vitamin D and 700mg calcium for 18 months.
• Participants were >60 years, had a BMI <40 kg/m2 and had not been diagnosed with osteoporosis or had any fractures in the previous 6 months.
• The Osteo-cise programme consisted of traditional and high velocity resistance training, moderate-intensity weight-bearing exercises and high challenge balance and mobility exercises ( x3 session per week).
• Exercises were progressively increased throughout the study.
• Control group received educational material on reducing fracture risk.
• QoL was recorded using the Euro-QoL questionnaire.

Results

• Adherence to exercise was 55%.
• Individuals who strictly adhered to the exercise programme (per protocol analysis ≥ 66% adherence) showed improvements based on one of the measures of QoL related to mobility, self-care, activities of daily living, pain and discomfort, and anxiety and depression after 12 (P=0.024) and 18 months ( P=0.029).
• These individuals also showed an improvement in osteoporosis knowledge after 18 months (P=0.014).
• Those who didn’t strictly adhere to Osteo-cise showed no improvement in QoL, osteoporosis knowledge or health beliefs.

Conclusion

• The QoL of adults who are at an increased risk for falls and fractures may benefit from targeted exercise strategies so long as adherence is managed.

• Exercise programmes that incorporate strength and balance exercises are important for the QoL of older adults at risk of fractures and falls.
• However, benefits are more likely if patients more strictly adhere to such programmes.
• It is unclear if this translates to a reduction in fracture and fall risk based on this research.
• A combination of resistance training, weight bearing impact, and balance and mobility exercises should be performed under supervision for adherence, consistency, and progression.
• Once the exercises are understood and are followed, individuals may need less supervision.

• Future research could help to understand if the Osteo-cise programme also translates into measured physiological benefits, not just self-reported ones.
• Measurements of number of falls and fractures following a long-term Osteo-cise programme could be assessed.

Consideration to strategies to enhance exercise adherence are warranted.