New aspects of physical therapy for osteoporosis

Summary

Fractures due to osteoporosis are among the leading causes of functional limitation, chronic pain, and greater morbidity in advanced age. Apart from bone, risk factors for osteoporotic fractures include non-osseous causes such as falls or reduced neuromuscular capacity. Muscle and coordination exercises enhance the patient’s abilities in daily life and prevent falls. In view of recent conclusions drawn from competitive sports, which stress the significance of muscles of the trunk with regard to reducing back pain and optimizing posture, we used sling exercises to determine whether they benefit patients with osteoporosis and are more useful than traditional physiotherapy. A stable ceiling construction was installed for sling exercise; slings were suspended from this construction. Fifty patients were randomized into two groups. Group A received traditional physiotherapy while group B was given sling exercises, in each case twice a week for a period of three months. The exercises were similar in the two groups. Both performed chair-rising exercises and pelvic lift in supine position; the sling exercise group used the slings for this purpose. The results of treatment (pre-post) were analyzed in terms of pain levels, mobility, trunk strength, and the shape of the back. For the latter we used the spine scanner Diers^®Formetric 4D to measure the spine surface of the patients with low radiation. After a further three months with no specific exercise treatment, we re-tested the patients to establish the long-term effects of the two types of exercises. Forty-four patients (88 %) completed the study. Patients were assigned to small groups for the exercises (a maximum of 5 patients each), and thus received individual attention and motivation. Positive training effects were achieved in both groups. Significantly better results in regard of improved mobility (8.2 ± 1.9 vs. 6.7 ± 1.4; p = 0.005) and pain at rest (3.1 ± 1.7 vs. 1.9 ± 1.4; p = 0.011) were registered in the sling exercise group. A comparison of the baseline values for these parameters to those reported at follow-up, without specific stabilization or strengthening exercises, it was found that the effect lasted for a minimum period of 3 months (p < 0.001). The results of the investigation confirm the known positive effects of physical therapy with regard to back pain in patients with osteoporosis. Simultaneously, sling exercise proved to be a treatment alternative that improves trunk strength and posture as well as provides greater mobility, thus improving quality of life in patients with osteoporosis.

Zusammenfassung

Die klinische Manifestation der Osteoporose ist die Fraktur. Sie zählt im Alter zu den Hauptursachen für funktionelle Einschränkungen, chronische Schmerzen und erhöhte Morbidität. Die Frakturrisiken sind einerseits ossär begründet, andererseits u. a. auf Stürze und eine verminderte neuromuskuläre Kapazität zurückzuführen. Muskuläres- und Koordinationstraining können helfen, die Leistungsfähigkeit im Alltag zu verbessern, Schmerzen zu lindern und zur Sturzprophy -laxe beizutragen. Vor dem Hintergrund neuer Erkenntnisse aus dem Leistungssport, die auf die Bedeutung der Rumpfmuskeln hinsichtlich vertebraler Schmerzreduktion und Haltungsoptimierung hinweisen, wählten wir das Schlingentraining, um zu untersuchen, ob auch Osteoporosepatienten davon profi -ti eren und welche Vorteile gegenüber traditioneller Physiotherapie bestehen. In beiden Gruppen konnten positive Trainingseffekte erzielt werden, wobei sich signifikant bessere Resultate hinsichtlich Ruheschmerz (3,1 ± 1,7 vs. 1,9 ± 1,4; p = 0,011) und Mobilität (8,2 ± 1,9 vs. 6,7 ± 1,4; p = 0,005) in der Schlingentrainingsgruppe fanden. Die Studienergebnisse werden als spezifische Anpassungen an die Trainingstherapie interpretiert.

Keywords

Osteoporosis - fall risk reduction - trunk strength - sling exercise therapy

Schlüsselwörter

Osteoporose - Sturzrisikoreduktion - Rumpfkraft - Schlingentraining

^* This overview is a fusion of two previously published articles. Refer to “Effects of physical therapy on quality of life in osteoporosis patients – a randomized clinical trial” (Health Qual Life Outcomes 2012; 10: 101) and “Trunk stabilization with sling in osteoporosis patients – a randomized clinical trial” (Eur Rev Aging Phys Act 2013 DOI 10.1007/s11556–013–0128–6).

• References

• 1 NIH Consensus Development Panel on Osteoporosis Prevention. Diagnosis and Therapy: Osteoporosis Prevention, diagnosis and Therapy. JAMA 2001; 285: 785-795.
• 2 Hadji P, Klein S, Gothe H. et al. Epidemiologie der Osteoporose: Bone Evaluation Study. Eine Analyse von Krankenkassen-Routinedaten. Dtsch Arztbl 2013; 110 (04) 52-57.
• 3 Felsenberg D. Wie man Frakturen verhindern kann. Physio- und Bewegungstherapie zur Prävention von osteoporosebedingten Knochenbrüchen - aktueller Stand der Wissenschaft. Deutsches Ärzteblatt 2009; 106 (47) 2027-2028.
• 4 Bianchi ML, Orsini MR, Saraifoger S. et al. Quality of life in post-menopausal osteoporosis. Health Qual Life Outcomes [serial on the Internet] 2005; 03: 78 Internet: doi:10.1186/1477-7525-3-78.
• 5 Lips P, Cooper C, Agnusdei D. et al. Quality of life as outcome in the treatment of osteoporosis. the development of a questionnaire for quality of life by the European Foundation for Osteoporosis. Osteoporosis International 1997; 07: 36-38.
• 6 Morin S, Lix L, Azimaee M. et al. Mortality rates after incident non-traumatic fractures in older men and women. Osteoporosis International [serial on the Internet] 2010; 1-10. Internet: doi: 10.1007/s00198–010–1480–2.
• 7 Delbaere K, Close JC, Brodaty H. et al. Determinants of disparities between perceived and physiological risk of falling. BMJ 2010; 341: c4165.
• 8 Preisinger E. Physiotherapie und Bewegung bei Osteoporose und Folgeerkrankungen. Zeitschrift für Rheumatologie 2009; 68 (07) 534-538.
• 9 Bergland A, Thorsen H, Kåresen R. Effect of exercise on mobility, balance, and health-related quality of life in osteoporotic women with a history of vertebral fracture: a randomized, controlled trial. Osteoporosis International 2010; 22 (06) 1863-1871.
• 10 Teixeira LEPP, Silva KNG, Imoto AM. et al. Progressive load training for the quadriceps muscle associated with proprioception exercises for the prevention of falls in postmenopausal women with osteoporosis: a randomized controlled trial. Osteoporosis International 2010; 21 (04) 589-596.
• 11 de Kam D, Smulders E, Weerdesteyn V. et al. Exercise interventions to reduce fall-related fractures and their risk factors in individuals with low bone density: a systematic review of randomized controlled trials. Osteoporos Int 2009; 20: 2111-2125.
• 12 Iwamoto J, Suzuki H, Tanaka K. et al. Preventative effect of exercise against falls in the eldery: a randomized controlled trial. Osteoporosis International 2009; 20 (07) 1233-1240.
• 13 Kemmler W, von Stengel S. Trainingshäufigkeit als Erfolgsprädiktor eines körperlichen Trainings zur Osteoporoseprophylaxe. Minimale effektive Dosis der Trainingshäufigkeit für postmenopausale Frauen mit Osteopenie. Osteologie 2013; 01 (22) 32-38.
• 14 Schwesig R, Müller K, Hottenrott K. et al. Sensomotorisches Training im Alter und bei Osteoporose. Bewegungstherapie und Gesundheitssport 2006; 22 (02) 62-68.
• 15 von Stengel S, Kemmler W, Engelke K. et al. Effects of whole body vibration one bone mineral density and falls: results of the randomized controlled ELVIS study with postmenopausal women. Osteoporos Int 2011; 22 (01) 317-325.
• 16 Kirkesola G. Sling Exercise Therapy – ein Konzept zur Behandlung von Beschwerden am Bewegungssystem. Zeitschrift für Physiotherapeuten 2001; 53 (03) 428-438.
• 17 Meier H. Neue Aspekte der Gelenkstabilisation – das Sling-Training. Leistungssport 2006; 02: 19-23.
• 18 Rosenberger WF, Lachin JM. Randomization in clinical trials. Theory and practice [monograph on the Internet]. New York: Wiley; 2002. Internet: http://site.ebrary.com/lib/alltitles/docDetail.action?docID=10275034.
• 19 Boeckh-Behrens W, Buskies W. Fitness-Krafttraining. Die besten Übungen und Methoden für Sport und Gesundheit. 14. Aufl., Orig.-Ausg. Reinbek bei Hamburg: Rowohlt Taschenbuch; 2010
• 20 Lips P, Cooper C, Agnusdei D. et al. Quality of life in patients with vertebral fractures. validation of the quality of life questionnaire of the European Foundation for Osteoporosis (QUALEFFO). Osteoporosis International 1999; 10: 150-160.
• 21 Baum E, Peters KM. Primäre Osteoporose – leitliniengerechte Diagnostik und Therapie. Deutsches Ärzteblatt 2008; 105 (33) 573-582.
• 22 Basler HD. Akutschmerztherapie in Pädiatrie und Geriatrie – Schmerzmessung: Welche Schmerzskala bei welchen Patienten?. Anästhesiol Intensivmed Notfallmed Schmerzther 2011; 46 (05) 334-342.
• 23 Drerup B, Ellger B, zu Meyer FBentrup, Hierholzer E. Rasterstereografische Funktionsaufnahmen. Eine neue Methode der biomechanischen Analyse der Skelettgeometrie. Der Orthopäde 2001; 30 (04) 242-250.
• 24 Asamoah V, Mellerowicz H, Venus J, Klöckner C. Oberflächenvermessung des Rückens. Wertigkeit in der Diagnostik der Wirbelsäulenerkrankungen. Der Orthopäde 2000; 29 (06) 480-489.
• 25 Schröder G, Knauerhase A, Kundt G, Schober HC. Effects of physical therapy on quality of life in osteoporosis patients – a randomized clinical trial. Health and quality of life outcomes [serial on the Internet] 2012; 10: 101 Internet: http://www.hqlo.com/content/10/1/101
• 26 Schröder G, Knauerhase A, Kundt G, Schober HC. Trunk Stabilization with sling training in osteoporosis patients – a randomized clinical trial. European Review of Aging and Physical Activity [serial on the Internet] 2013; 1-8. Internet: doi: 10.1007/s11556–013–0128–6.
• 27 Siegrist M, Lammel C, Jeschke D. Krafttraining an konventionellen bzw. oszillierenden Geräten und Wirbelsäulengymnastik in der Prävention der Osteoporose bei postmenopausalen Frauen. Deutsche Zeitschrift für Sportmedizin 2006; 57 (7/8): 182-188.
• 28 Kirkendall DT, Garrett WE. The Effects of Aging and Training on Skeletal Muscle. American Journal of Sports Medicine 1998; 26 (04) 598-602.
• 29 Mayer F, Scharhag-Rosenberger F, Carlson A. et al. The intensity and effects of strength training in the elderly. Deutsches Ärzteblatt International 2011; 108 (21) 359-364.
• 30 Zielinski R. Bewegung und Gesundheit. Gesicherte Effekte von körperlicher Aktivität und Ausdauertraining. Darmstadt: Steinkopff; 2006
• 31 Maeda S, Otsuki T, Iemitsu M. et al. Effects of leg resistance training on arterial function in older men. British Journal of Sports Medicine 2006; 40 (10) 867-869.
• 32 Richardson C, Hides J. Stabilität der Lenden-Becken-Region bei Gewichtsübernahme. In: Richardson C, Hodges P, Hides J. eds. Segmentale Stabilisation im LWS- und Beckenbereich. [therapeutische Übungen zur Behandlung von Low Back Pain]. München: Urban & Fischer Elsevier; 2009: 79-94.
• 33 O’Sullivan PB, Twomey LT, Allison GT. et al. Altered patterns of abdominal muscle activation in patients with chronic low back pain. Australian journal of Physiotherapy 1997; 43 (02) 91-98.
• 34 Schmoll S, Hahn D, Schwirtz A. Die Behandlung von chronischem LWS-Schmerz mithilfe des S-E-T-Konzeptes (Sling-Exercise-Therapy). Bewegungstherapie und Gesundheitssport 2008; 24 (02) 52-59.
• 35 Ross PD, Ettinger B, Davis JW. et al. Evaluation of Adverse Health Outcomes Associated with Vertebral Fractures. Osteoporosis International 1991; 01 (03) 134-140.
• 36 Sinaki M, Wollan PC, Scott RW. et al. Can Strong Back Extensors Prevent Vertebral Fractures in Women With Osteoporosis?. Mayo Clinic Proceedings 1996; 71 (10) 951-956.
• 37 Rohen JW. Funktionelle Anatomie des Menschen. Lehrbuch der makroskopischen Anatomie nach funktionellen Gesichtspunkten: mit 45 Tabellen. 8., durchges. und verb. Aufl. Stuttgart: Schattauer; 1995
• 38 Hongo M, Itoi E, Sinaki M. et al. Effect of lowintensity back exercise on quality of life and back extensor strength in patients with osteoporosis: a randomized controlled trial. Osteopor Int 2007; 18: 1389-1395.