Effectiveness of community group and home based falls prevention exercise programmes on bone health in older people: The proact65+ bone study

Abstract

Introduction: Exercise may reduce osteoporotic fracture risk through both increasing bone strength and reducing fall risk. Falls prevention exercise programmes can reduce fall incidence, and also include some strengthening exercises suggested to load bone but there is little information as to whether these programmes influence bone mineral density (BMD) and strength. The study compared home (Otago Exercise Programme, OEP) and group (Falls Exercise Management, FaME) falls prevention exercise programmes with usual care in older people to determine whether these interventions can improve bone strength. Participants and Methods: Men and women aged over 65 years were recruited through primary care. They were randomised by practice to OEP, FaME or usual care. Bone mineral density (BMD) was measured by dual X-ray absorptiometry (GE-Lunar Prodigy) prior to randomisation and following the 24 week intervention. Comparisons between treatment arms were made using random effects linear regression models to allow for clustering by practice, adjusted for baseline values, gender, medication use and comorbidities. Results: Participants were 319 older people (193 women and 126 men), aged (mean±SD) 72±5 years. 92 % of participants completed the trial. The OEP group completed 58±43 min/ week of home exercise, whilst the FaME group completed 39 ±16 and 30±24 min/week of group and home exercise respectively. Femoral neck BMDchanges did not differ between treatment arms, with mean effect sizes in OEP and FaME relative to usual care arms being -0.003 and -0.002 g/cm2 respectively (P=0.44 and 0.53). Effect sizes for section modulus were -8.5 and -6.9 mm3 in OEP and FaME respectively (P=0.21 and 0.28). There were no significant changes at other skeletal sites, or in sensitivity analyses excluding those taking medication or poor compliers with exercise. Conclusion: The OEP and FaME programmes did not influence bone mineral density in older people, although they have an important role in preventing fractures by preventing falls. To increase bone strength, programmes may need to incorporate exercise that exerts higher strains on bone and/or have a longer duration.