Exercises including weight vests and a patient education program for women with osteopenia: a feasibility study of the OsteoACTIVE rehabilitation program.

STUDY DESIGN: Prospective case series with 1-year follow-up. OBJECTIVES: The primary aim was to describe the OsteoACTIVE rehabilitation program and evaluate its feasibility in terms of progression, adherence, and adverse events in patients with low bone mineral density (BMD) and a healed forearm fracture. The secondary aim was to assess changes in measures of function and quality of life. BACKGROUND: Previous studies have shown benefits of weight-bearing activities, resistance exercises, and balance and coordination training for women with low BMD and older adults. However, no studies, to our knowledge, have described or examined a rehabilitation program combining the use of weight vests and patient education in patients with low BMD. METHODS: Forty-two postmenopausal women with osteopenia and a healed forearm fracture attended the OsteoACTIVE program for 6 months (3 sessions of 60 minutes per week). Feasibility was assessed by documenting training progression (load and exercises), program adherence (aiming for greater than 80%), and adverse events (joint pain, muscle soreness, and falls). Secondary measures included quadriceps strength, BMD, dynamic balance, walking ability, and self-report functional outcome measures. All outcome measures were recorded preintervention (baseline), postintervention, and at 1-year follow-up. RESULTS: Thirty-five women (83%) completed the 6-month program and 31 women (74%) attended all the follow-up measurement sessions. All participants progressed during the rehabilitation program for both load and type of exercises. Furthermore, 87% of the participants met the a priori goal of 80% adherence, and no participants reported adverse events. Improvements in quadriceps strength and BMD of the femoral trochanter were noted at the end of the 6-month training period (P<.05). At 1-year follow-up, there were significant improvements in quadriceps strength and dynamic balance compared to baseline (P<.05). CONCLUSION: The OsteoACTIVE rehabilitation program was feasible and achieved progression of training level, had high adherence, and had no adverse events. Positive improvements were established in lower extremity function and femoral trochanter BMD. Clinical trial registered at ClinicalTrials.gov (NCT01357278). LEVEL OF EVIDENCE: Therapy, level 4.

Postmenopausal women with osteopenia and a healed wrist fracture have reduced physical function and quality of life compared to a matched, healthy control group with no fracture.

BACKGROUND: Fractures lead to reduced physical function and quality of life (QOL), but little is known about postmenopausal women with osteopenia and a healed wrist fracture. The purpose was to evaluate physical function in terms of quadriceps strength, dynamic balance, physical capacity and QOL in postmenopausal women with osteopenia and a healed wrist fracture compared to a matched, healthy control group with no previous fracture. METHODS: Eighteen postmenopausal women with osteopenia (patients) (mean age 59.1 years, range 54 - 65) and a healed wrist fracture were matched to 18 healthy control subjects on age (mean age 58.5 years, range 51 - 65), height, weight and body mass index (BMI). We measured quadriceps strength at 60°/sec and at 180°/sec with Biodex 6000, dynamic balance with the Four Square Step Test (FSST), physical capacity with the six-minute walk test (6MWT) followed by the Borg's scale (BS), and QOL with the Short Form 36 (SF-36), bone mineral density (BMD) with dual x-ray absorptiometry (DXA) and physical activity level with the Physical Activity Scale for the Elderly. RESULTS: The patients had 17.6% lower quadriceps strength at 60°/sec (p = 0.025) at left limb and 18.5% at 180°/sec (p = 0.016) at right limb, and 21% lower at 180°/sec (p = 0.010) at left limb compared to the controls. Impaired performance for the patients was found with 2.4 seconds (p = 0.002) on the FSST, 74 metres (p < 0.001) on the 6MWT, and 1.4 points (p = 0.003) on the BS compared to the controls. The patients scored lower on the sub-scales on the SF-36 role limitations-physical (p = 0.014), bodily pain (p = 0.025) and vitality (p = 0.015) compared to the controls. CONCLUSIONS: The patients with osteopenia and a healed wrist fracture scored significantly lower on quadriceps strength, dynamic balance, physical capacity and QOL compared to the matched controls. Greater focus should be put on this patient group in terms of rehabilitation and early prevention of subsequent fractures.

Inter- and intrarater reliability of isokinetic thigh muscle strength tests in postmenopausal women with osteopenia.

OBJECTIVE: To evaluate inter- and intrarater reliability of isokinetic muscle strength measurements during knee extension and flexion in postmenopausal women with osteopenia. DESIGN: Reliability study assessing inter- and intrarater reliability. SETTING: General community. PARTICIPANTS: A convenience sample of 27 postmenopausal women (mean age ± SD, 68.2±7.3y) with defined osteopenia from a bone mineral density T score of less than 1.5 and a wrist fracture within the last 2 years. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Isokinetic concentric muscle strength during knee extension and flexion was measured for 2 test conditions: 5 repetitions at 60°/s, and 25 repetitions at 180°/s. Agreement between tests was evaluated with the intraclass correlation coefficient (ICC(2,1)). Mean difference between tests, standard error of measurement (SEM and SEM%), and smallest real difference (SRD and SRD%) were calculated with 95% confidence intervals. SRD% and SEM% are emphasized in the results to allow congruent comparisons between the different test conditions. RESULTS: ICC(2,1) reflected high agreement both for inter- and intrarater reliability, with most of the values .90 or greater. There were no significant differences between the left and the right leg at any of the 3 tests. Some differences were apparent between the test sessions, but these were not systematic. Agreements were overall higher for assessments during knee extension than knee flexion. The SEM% was between 3.5% and 10.2% for knee extension, and 7.0% and 17.7% for knee flexion. SRD% was suggested to be between 15% and 20% for knee extension, and 25% and 30% for knee flexion. CONCLUSIONS: Isokinetic assessments of thigh muscle strength in postmenopausal women with osteopenia are of high reliability, with a level of agreement comparable to the levels found in previous reliability studies concerning both the healthy elderly and elderly with different health conditions. The measurement errors are small to moderate. The established SRD% provides thresholds for whether observed changes in strength in this patient group represent true change, which allows evaluations of minimal clinical importance in future studies.