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BMD Improvements Following FaME (Falls Management Exercise) in Frequently Falling Women Age 65 and Over: An RCT

The aim of this study was to investigate the effect of a 9-month group exercise intervention (FaME), compared with a control intervention on bone mineral density (BMD) of the lumbar spine and hip.

Dawn Alexandra Skelton, HealthQWest, School of Health and Social Care, Glasgow Caledonian University; Karin Stranzinger, HealthQWest, School of Health and Social Care, Glasgow Caledonian University, UK; Susie M. Dinan, School of Primary Care and Population Sciences, University College London & School of Health Informatics, Derby University, UK; Olga M. Rutherford, Division of Physiology, King’s College London, London, UK



Introduction: Exercise to improve balance and strength is a key part of a multifactorial intervention to reduce falls (1, 2). The FaME (Falls Management Exercise) program (3) has been shown to reduce falls in community dwelling women aged 65 and over with a history of 3 or more falls in the previous year (4). Fractures are a major burden on both the individual and on health care budgets but are a rare consequence of falls (2, 5). Although there have been many trials examining falls prevention with exercise as the intervention, none have also had bone mineral density as an outcome measure (6).

Aims: To investigate the effect of a 9-month group exercise intervention (FaME), compared with a control intervention on bone mineral density (BMD) of the lumbar spine and hip.

Subjects: Community dwelling, independent women aged 65 years and over with a history of 3 or more falls in the previous year. Data are presented for 32 exercisers and 15 controls who had BMD pre and post intervention/control period, with a mean age of 72.38 (SD 5.23) years.

Methods: Informed consent was obtained and local ethics approved. Subjects were unequally randomized into a control or an exercise group. Controls performed home-based seated flexibility training. Exercisers attended weekly 1-hr tailored dynamic balance and strength exercise classes and performed home exercise (Otago; 7) twice weekly for 9 months. BMD of the spine (L1-L4 and L2-L4) and the hip (total, neck of femur and Ward’s triangle) was measured using DEXA (Hologic QDR-4500A). The coefficient of variation of this technique in the laboratory used was between 1% and 2%. Further information on trial design is available (4).

Results: Exercisers showed no significant changes in BMD at any of the sites measured over the 9-month period (SPSS, ver. 14, paired t tests). In the controls there was a significant loss in neck BMD (mean 0.82 (SD 0.09) to 0.79 (0.08) g/cm2, p < .02) and at Ward’s triangle (mean 0.73 (SD 0.13) to 0.68 (0.14) g/cm2, p < .005). The difference between groups (ANOVA repeated measures) was significant at Ward’s triangle (p < .02) but did not reach significance at L2-L4 (p < .08).

Conclusions: A 9-month specific, progressive balance and strength exercise program that is effective at reducing further falls and injuries in community dwelling women with a history of falls is also effective at maintaining BMD compared with a sham intervention. The potential positive benefits of FaME to bone health maintenance support the use of such an intervention in a wider multifactorial intervention to reduce falls and injuries.

References:

(1) Gillespie LD et al. The Cochrane Database of Systematic Reviews, 2005 (Issue 5).

(2) Skelton DA, Todd C. WHO Health Evidence Network, WHO, Denmark. 2004.

(3) Skelton DA, Dinan SM. Physiotherapy: Theory and Practice. 1999;15:105-120.

(4) Skelton DA et al. Age Aging 2005;34(6):636-639.

(5) Department of Health. NSFOP: Modern Standards and Service Models, London, HMSO, 2001.

(6) Gardner MM, et al. Br J Sports Med. 2000;34:7-17.

(7) Campbell AJ, et al. Brit Med J 1997;315:1065-69.




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