Effects of a 12-Month Supervised, Community-Based, Multimodal Exercise Program Followed by a 6-Month Research-to-Practice Transition on Bone Mineral Density, Trabecular Microarchitecture, and Physical Function in Older Adults: A Randomized Controlled Trial

被引:54
作者
Daly, Robin M. [1 ]
Gianoudis, Jenny [1 ]
Kersh, Mariana E. [2 ]
Bailey, Christine A. [3 ]
Ebeling, Peter R. [3 ,4 ]
Krug, Roland [5 ]
Nowson, Caryl A. [1 ]
Hill, Keith [6 ]
Sanders, Kerrie M. [3 ]
机构
[1] Deakin Univ, Sch Exercise & Nutr Sci, Inst Phys Act & Nutr Res, Geelong, Vic, Australia
[2] Univ Illinois, Dept Mech Sci & Engn, Urbana, IL USA
[3] Univ Melbourne, Dept Med, Melbourne, Vic, Australia
[4] Monash Univ, Sch Clin Sci Monash Hlth, Dept Med, Melbourne, Vic, Australia
[5] Univ Calif San Francisco, Sch Med, Dept Radiol & Biomed Imaging, San Francisco, CA USA
[6] Curtin Univ, Sch Physiotherapy & Exercise Sci, Perth, WA, Australia
基金
英国医学研究理事会;
关键词
BONE MINERAL DENSITY; EXERCISE; FALLS; RANDOMIZED CONTROLLED TRIAL; TRABECULAR BONE MICROARCHITECTURE; POSTMENOPAUSAL WOMEN; FRAGILITY FRACTURES; ERLANGEN FITNESS; RISK-FACTORS; OSTEOPOROSIS; PREVENTION; STRENGTH; FALLS; MICROSTRUCTURE; INTERVENTIONS;
D O I
10.1002/jbmr.3865
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Multicomponent exercise programs are recommended to reduce fracture risk; however, their effectiveness in real-world community settings remain uncertain. This 18-month randomized controlled trial investigated the effects of a 12-month, community-based, supervised multicomponent exercise program followed by a 6-month "research-to-practice" transition on areal bone mineral density (BMD), trabecular bone microarchitecture, functional performance, and falls in older adults at increased fracture risk. One-hundred and sixty-two adults aged >= 60 years with osteopenia or at increased falls risk were randomized to the Osteo-cise: Strong Bones for Life multicomponent exercise program (n = 81) or a control group (n = 81). Exercise consisted of progressive resistance, weight-bearing impact, and balance training (3-days/week) performed at community leisure centers. Overall 148 (91%) participants completed the trial, and mean exercise adherence was 59% after 12 months and 45% during the final 6 months. After 12 months, there were significant net beneficial effects of exercise on lumbar spine and femoral neck BMD (1.0% to 1.1%, p < 0.05), muscle strength (10% to 13%, p < 0.05), and physical function (timed stair climb 5%; four-square step test 6%; sit-to-stand 16%, p ranging <0.05 to <0.001), which persisted after the 6-month transition. There were no significant effects of the 18-month intervention on distal femur or proximal tibia trabecular bone microarchitecture or falls incidence, but per protocol analysis (>= 66% exercise adherence) revealed there was a significant net benefit of exercise (mean [95% confidence interval] 2.8% [0.2, 5,4]) on proximal tibia trabecular bone volume fraction (Osteo-cise 1.5% [-1.2, 4.2]; controls -1.3% [-2.6, 0.1]) after 18 months due to changes in trabecular number (Osteo-cise 1.7% [-0.9, 4.3]; controls -1.1% [-2.4, 0.2]) but not trabecular thickness (Osteo-cise - 0.2% [-0.5, 0.2]; controls -0.2% [-0.4, 0.0]). In conclusion, this study supports the effectiveness of the Osteo-cise: Strong Bones for Life program as a real-world, pragmatic, evidence-based community exercise program to improve multiple musculoskeletal health outcomes in older adults at increased fracture risk. (c) 2019 American Society for Bone and Mineral Research.
引用
收藏
页码:419 / 429
页数:11
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