The Effects of Home Exercise in Older Women With Vertebral Fractures: A Pilot Randomized Controlled Trial
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Date
2020-04
Authors
Gibbs, Jenna C.
McArthur, Caitlin
Wark, John D.
Thabane, Lehana
Scherer, Samuel C.
Prasad, Sadhana
Papaioannou, Alexandra
Mittmann, Nicole
Laprade, Judi
Kim, Sandra
Journal Title
Journal ISSN
Volume Title
Publisher
Oxford
Abstract
Background
Regular exercise is advocated in osteoporosis guidelines to prevent fractures. Few studies have evaluated the effect of exercise on functional performance, posture, and other outcomes that are important to patients after vertebral fractures.
Objective
This pilot study will explore the effect of home exercise versus control on functional performance, posture, and patient-reported outcome measures.
Design
This study was a parallel 2-arm pilot feasibility trial with 1:1 randomization to exercise or attentional control groups.
Setting
This study took place in 5 Canadian and 2 Australian academic or community hospitals/centers.
Participants
This study included 141 women ≥65 years of age with radiographically confirmed vertebral fractures.
Intervention
A physical therapist delivered exercise and behavioral counseling in 6 home visits over 8 months and monthly calls. Participants were to exercise ≥3 times weekly. Controls received equal attention.
Measurements
Functional performance, posture, quality of life, pain, and behavior-change outcomes were assessed at baseline and after 6 (questionnaires only) and 12 months. Adherence to exercise was assessed by calendar diary. All t tests examined between-group mean differences (MD) in change from baseline in intention-to-treat and per-protocol analyses.
Results
There was a small effect of exercise on 5 times sit-to-stand test versus control (MD = −1.58 [95% CI = −3.09 to −0.07], intention-to-treat; MD = −1.49 [95% CI = −3.12 to 0.16], per-protocol). There were no other major or statistically significant MDs for any other measured outcomes after follow-up. Adherence declined over time.
Limitations
Treatment effects on variables may have been underestimated due to multiple comparisons and underpowered analyses.
Conclusions
Our exploratory estimate of the effect of exercise on functional leg muscle strength was consistent in direction and magnitude with other trials in individuals with vertebral fractures. Declining adherence to home exercise suggests that strategies to enhance long-term adherence might be important in future confirmatory trials.
Description
This is a pre-copyedited, author-produced version of an article accepted for publication in Physical Therapy following peer review. The version of record is available online at: https://doi.org/10.1093/ptj/pzz188
Keywords
exercise, osteoporosis, mobility, quality of life, rehabilitation, spinal fractures