SÃO PAULO, Brazil—Balance training alone or in combination with strength, agility and jumping can reduce the risk of falls and prevent frailty in women with or at risk of osteoporosis, according to three studies in the April issue of Osteoporosis International.^1-3

"These interventions need to be instituted in frail elders and will make a difference in fracture risk and quality of life," said Nancy E. Lane, MD. Dr. Lane is director of the Aging Center and professor of medicine and rheumatology at the University of California at Davis Medical Center, in Sacramento, and a member of the CIAOMed Editorial Board. "What are we waiting for?" she asked. "The epidemic of frail elders who fall is growing at an extremely fast rate."

Balance training reduces falls in elderly women with osteoporosis

In one study, 34 women who participated in a 12-month balance training program showed greater improvements in functional and static balance, mobility, and had fewer falls than did 32 control patients who received only treatment for osteoporosis and orientation to prevent falls.

The balance training program consisted of 1 hour of exercising each week for a total of 40 weeks. This involved a warm-up of stretching and walking, followed by 30 minutes of walking in tandem, walking on tip toes and on the heel, walking sideways, walking while raising the leg and the contralateral arm, standing on one leg, and standing in tandem.

Participants gradually increased the period of time that they stood on one leg and stood in tandem. They were asked to continue these exercises at home at least three times a week for 30 minutes.

"[B]alance training performed once a week, supervised by a physiotherapist, and complemented by home-based exercises, is very effective in the improvement of functional and static balance and mobility, and in the reduction of falls in elderly women with osteoporosis," report the researchers led by Rosa Maria R. Pereira, MD, at the Universidade de São Paulo, in Brazil.

Resistance training plus jumping training prevents functional decline and bone fragility

In a second study, 149 healthy women aged 70 to 78 were assigned to one of four groups:

• A resistance training group
• A jumping training group
• A combination group consisting of resistance training and jumping training
• A nontraining control group

Women trained three times a week for 1 year. Each class included a 7-to-10 minute warm-up, up to 30 minutes of training, followed by an 8-to-10 minute postexercise period.

Participants in the combination group reported improvements in self-rated physical functioning, while their counterparts in the control group reported declines in this measure. The mean intergroup difference was 10%. The mean increase in the leg extensor force was higher in the resistance training group (14%) and the combination group (13%) compared with controls (10%). Dynamic balance improved in the jumping group by 6% and in the combination group by 8%, the study showed.

There were no differences between the groups in terms of bone mineral content at the proximal femur. However, women in the combination group who trained at least twice a week had 2% less weakening in the tibial shaft structure than did the control women.

"This study showed that combination of strength, balance, agility and jumping training prevented functional decline and bone fragility in home-dwelling elderly women," conclude researchers led by Saija Karinkanta, PT, MSc, with the UKK Institute for Health Promotion Research, in Tampere, Finland. "The finding supports the idea that it is possible to maintain good physical functioning by [a] multicomponent exercise program and thus postpone the age-related functional problems."

Balance retraining may prevent subsequent vertebral fractures

In a third study, osteoporosis patients who had vertebral fractures were more likely to have balance impairments than patients who had thoracic kyphosis but not fractures. Twenty-two people with osteoporosis were divided into two groups, one with and without diagnosed fractures and one with low and high thoracic kyphosis. Researchers from the University of Melbourne, in Victoria, Australia, compared balance measures between the fracture and kyphosis groups.

The range and root mean square of sheer force and range of displacement were greater in the fracture group in the anterior-posterior direction. No differences between the groups were seen when the balance was compared based on the extent of thoracic kyphosis.

"These findings highlight the need for intervention in the form of balance retraining in this population in which there is a greater risk of subsequent vertebral fractures from a fall," the study authors conclude.

"These are all important studies that needed to be done as earlier studies were small, short term and showed questionable significance," Dr. Lane said. "Strength and balance training and teaching elders how to fall safely are probably as important as initiating a medication because most individuals do not fracture their hips unless they fall."

References

1. Madureira MM, Takayama L, Gallinaro AL, et al. Balance training program is highly effective in improving functional status and reducing the risk of falls in elderly women with osteoporosis: a randomized controlled trial. Osteoporos Int. 2007;18:419-425.
2. Karinkanta S, Heinonen A, Sjevänen H, et al. A multi-component exercise regimen to prevent functional decline and bone fragility in home-dwelling elderly women: randomized, controlled trial. Osteoporos Int. 2007;18:453-462.
3. Grieg AM, Bennell KL, Briggs AM, et al. Balance impairment is related to vertebral fracture rather than thoracic kyphosis in individuals with osteoporosis. Osteoporos Int. 2007;18:543-551.