Medicine (Northwest Academic Centre) - Theses
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ItemOsteo-cise: Strong Bones for Life: a multi-component, community-based exercise, falls prevention and osteoporosis education program, an 18-month RCT( 2012)Multi-component exercise programs incorporating high-intensity progressive resistance training (PRT), moderate-to-high impact weight-bearing activities and high-challenge balance training are recommended for optimising the bone and falls-related risk factors for fracture. However, few studies have evaluated their combined effectiveness in a ‘real world’ community setting. Furthermore recent evidence suggests that high velocity (power) training may be more effective for improving physical function and bone health than traditional slow-speed PRT, and thus should be the key focus of fracture prevention programs. Within this thesis, three studies were conducted. The first cross-sectional study investigated the relationship between lifetime loading activity and trabecular bone microarchitecture and condylar size at the proximal tibia assessed by 3-Tesla Magnetic Resonance Imaging. Increasing age was significantly associated with a deterioration in trabecular microarchitecture, but no association between loading activity and any bone parameter was observed at this site. Studies 2 and 3 are described below. Study 2: Osteo-cise: Strong Bones for Life: A 12-month multi-faceted community-based exercise, osteoporosis education and behavioural change program on bone mineral density and risk factors for falls Aims: To investigate the effects of a multi-component exercise and osteoporosis education program on bone density (aBMD), body composition, functional power and performance, and falls in older adults at risk of falls and fracture. Methods: 162 men and women aged 66.9 ± 6.0 (mean ± standard deviation) years were randomised to the: 1) Osteo-cise program (n=81) or 2) control group (n=81). Exercise comprised high velocity PRT, weight-bearing (60-180 impacts/session) and balance training 3 days per week for 12 months. Dual energy X-ray absorptiometry (DXA) was used to assess total body, arm and leg lean and fat mass and aBMD at the hip and spine at baseline and 12 months. Leg and back 1-RM muscle strength and functional power (Timed Stair Climb) and performance (Four Square Step test [FSST], Functional Reach, Timed Up and Go, 30 Second Sit to Stand [30-STS]) were assessed at baseline, 6 and 12 months. Results: 93% of participants completed the study and groups were matched at baseline. Exercise attendance averaged 59%. Exercise resulted in a significant 1-1.1% net gain in femoral neck and lumbar spine aBMD vs. controls. There were significant exercise-induced net gains in back (13% [95% CI 6, 20]) and leg (10% [3, 16]) muscle strength, stair climbing power (5% [95% CI 1, 9]), 30-STS performance (16% [9, 22]) and dynamic balance (FSST) (-6% [-10, -1]), but no differences between groups in weight, total body or regional (arm and leg) lean mass or fat mass or falls. Conclusion: This multi-component intervention program was effective for improving aBMD, functional muscle power and performance in older adults at risk of fracture. Study 3: Osteo-cise: Strong Bones for Life. An 18-month multi-faceted community-based exercise, osteoporosis education and behavioural change program on musculoskeletal health and risk factors for falls: Translating research into practise Aims and Methods: As per Study 2. The final 6 months of the program was a ‘translation’ phase, whereby the program continued to be carried out by the health and fitness centres with minimal input from research staff to assess the feasibility of the program in the ‘real-world’. Results: Exercise compliance average 45% during the last 6 months and 55% over 18 months. From 12 to 18 months, the Osteo-cise group maintained aBMD at the lumbar spine and femoral neck aBMD, while the control group significantly lost aBMD at the femoral neck (1.3% over 18 months). The Osteo-cise group also maintained their net gain in muscle strength, arm lean mass, functional muscle power and performance while no significant differences in falls rates were observed. Conclusion: Exercise-induced gains in aBMD, functional muscle power and performance were maintained at 18 months providing support for the viability of this program in the ‘real world’ community setting.