Körperliches Training zur Frakturprophylaxe des älteren Menschen

Zusammenfassung

Körperliches Training kann alle Größen des Frakturrisikos positiv beeinflussen, ein direkter Nachweis des frakturreduktiven Potentials fehlt indes. Ziel dieser Übersicht ist es, den frakturpräventiven Effekt körperlichen Trainings zu belegen und die trainings-wissenschaftlich/organisatorische Vorgehensweise am Beispiel der Erlanger Fitness- und Osteoporose Präventions-Studie zu diskutieren.

137 früh-postmenopausale Frauen mit Osteopenie verteilten sich 1998 auf die Trainings- (TG) und die Kontrollgruppe (KG) der Studie. Primärer Endpunkt war die Häufigkeit niedrig-traumatischer klinischer Frakturen.

Nach 16-jähriger Studiendauer wurden 105 Teilnehmerinnen mit 1680 Teilnehmerjahren in die Analyse eingeschlossen. Die Frakturrate niedrig-traumatischer Frakturen (0,42; 95 % CI: 0,20–0,86) sowie osteoporotischer Hauptfrakturen (0,37; 0,14–0,88) lagen in der TG signifikant niedriger als in der KG. Die Knochendichte an Lendenwirbelsäule (TG: –1,5 ± 5,0 % vs. KG: –5,8 ± 6,4 %) und Schenkelhals (TG: –6,5 ± 4,6 % vs. KG: –9,6 ± 5,0 %) nahm in beiden Gruppen z.T. signifikant ab, die Reduktion in der KG war jedoch für beide Regionen signifikant (p ≤ .001) deutlicher. Im Rahmen der EFOPS durchgeführte Substudien zu trainingswissenschaftlichen Aspekten zeigten weiterhin, dass (1) ein schnellkräftig durchgeführtes (Kraft-)Training signifikant günstigere Effekte auf die Knochendichte ausübt als ein mit moderater oder langsamer Bewegungsgeschwindigkeit durchgeführtes Training. (2) Eine Trainingsperiodisierung im Vergleich zur simplen Progression der Belastung günstigere Effekte auf Muskelkraft, Knochendichte und Teilnehmer-Compliance hat und (3) dass eine Trainingsfrequenz von weniger als zwei Trainingseinheiten/Woche auch bei hoher Reizintensität und -rate keinerlei positive Effekte auf die Knochendichte auslöst.

Das unter besonderer Berücksichtigung physiologischer und trainingswissenschaftlicher Prinzipien sowie Vorgaben des ambulanten Rehabilitationssports durchgeführte Projekt belegt den klinisch hochrelevanten, frakturpräventiven Effekt eines körperlichen Trainings bei früh-postmenopausalen Frauen.

Abstract

Exercise might be one of the most effective therapies to prevent low-traumatic fractures. However, there is still no definite evidence for fracture-preventing effects of exercise on bone. Further, the multiple training aims (i. e. bone strengthening, fall- and fall-impact reduction), corresponding types of exercise and proper composition of exercise parameters, designing effective, safe and customized exercise protocols makes this far from trivial. Moreover, bearing in mind that subjects should maintain exercise life-long, the attractiveness of the exercise program is highly relevant. The aim of the present article is to (a) provide evidence for the fracture-preventing effect of exercise and (b) discuss the generation of effective exercise strategies based on the Erlanger Fitness and Osteoporosis Prevention Study (EFOPS), a 16-year intervention study focusing on low-traumatic clinical fractures.

Hundred thirty-seven (137) early postmenopausal women with osteopenia were included in the EFOPS project in 1998. Due to the long-term approach of the study, we applied a non-randomized design with a non-equally balanced distribution of the exercise (EG: n = 86) vs. control (CG). The primary endpoint was the fracture rate of low-traumatic clinical fractures; secondary endpoints were rate of major osteoporotic fractures and development of bone mineral density (BMD). However, apart from these main study aims, several exercise-related issues were addressed in sub-studies particularly during the first six study years.

After 16 years, 105 participants with 1680 participant years were included in the final analysis. The fracture rates of low-traumatic fractures (0.42; 95 % CI: 0.20–0.86) and osteoporotic main fractures (0.37; 95 % CI: 0.14–0.88) were significantly lower in the EG compared to the CG. The exercise effect on BMD at the lumbar spine (EG: –1.5 ± 5.0 % vs. CG: –5.8 ± 6.4 %; p < .001) and femoral neck (–6.5 ± 4.6 % vs.–9.6 ± 5.0 %, p < .001) consistently increased during the study course. Sub-studies focusing on BMD and strength effects indicated among others that (a) power trainings is superior to strength training to affect BMD; (b) periodized approaches might be more effective for increasing strength and BMD and maintaining compliance compared with strategies relying on progression only; (c) exercise frequency below 2 sessions/week did not affect BMD even with high strain magnitude and rates.

In summary, a sport-scientific approach that clearly scheduled exercise type, exercise parameters and exercise principles and adequately incorporating basic principles of bone metabolism and fall risk might be the most promising strategy to address fracture risk in older people. Apart from sport-science and medicine, however, it is essential to implement the program in an attractive social setting that enables regular, individualized and effective, but also safe and pleasurable exercise training to facilitate subjects’ adherence.

Schlüsselwörter

Körperliches Training - niedrig traumatische Fraktur - osteoporotische Hauptfraktur - Trainingsstrategie

Key words

Exercise - low-traumatic fracture - osteoporotic main fracture - exercise strategy

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