Advertisement

Osteoporosis International

, Volume 25, Issue 8, pp 2017–2025 | Cite as

The effect of exercise and education on fear of falling in elderly women with osteoporosis and a history of vertebral fracture: results of a randomized controlled trial

  • C. F. Olsen
  • A. Bergland
Original Article

Abstract

Summary

This article explores the effect of a group-based exercise program and an educational session on the fear of falling among 89 women with osteoporosis and a history of vertebral fracture. This randomized clinical trial showed that the intervention had a positive and durable effect on the fear of falling.

Introduction

The aim of this study was to evaluate the effect of an intervention on fear of falling in women with osteoporosis and a history of vertebral fracture.

Methods

The study was a parallel-group randomized clinical trial with a blinded assessor. The participants were 89 community-dwelling elderly women with osteoporosis and a history of vertebral fracture. The intervention group (IT, n = 47) received a 3-month group-based circuit exercise program combined with a 3-h educational session focusing on the reduction of the risk of falls and challenges specific to osteoporosis and vertebral fractures. The control group (CT, n = 42) continued with their usual activities. Clinical outcomes were assessed at baseline, postintervention and 12 months after randomization. This article reports on the secondary outcome Falls Efficacy Scale—International (FES-I) from a previously reported trial.

Results

We found a significantly better result for the IT group compared with the CT group, both at 3 months (p = 0.004) and 12 months (p < 0.001) follow-up. The effect size at 3 months was small (0.4) and at 12 months moderate (0.7). Multiple regression analysis confirmed the effect of the intervention.

Conclusion

The intervention had a positive and durable effect on fear of falling as measured with the FES-I.

Keywords

Fear of falling Moderate-intensity circuit exercises Osteoporosis Vertebral fracture 

Notes

Acknowledgements

The project was funded by “The Norwegian Fund for Post-Graduate Training in Physiotherapy”, which had no role in the project implementation, analysis, interpretation or writing up of the project. We acknowledge Hilde Thorsen and Rannveig Kåresen for their contributions to data collection and Milada Cvancarova Småstuen (Oslo and Akershus University College of Applied Sciences (HIOA), Oslo) for statistical advice in this project.

Conflicts of interest

None.

References

  1. 1.
    WHO (2003) WHO Scientific Group on the Prevention and Management of Osteoporosis. Prevention and management of osteoporosis: report of WHO scientific group. WHO Technical Report Series 2003: Vol. 921Google Scholar
  2. 2.
    Guillemin F, Martinez L, Calvert M, Cooper C, Ganiats T, Gitlin M et al (2013) Fear of falling, fracture history, and comorbidities are associated with health-related quality of life among European and US women with osteoporosis in a large international study. Osteoporos Int 24:3001–3010PubMedCrossRefGoogle Scholar
  3. 3.
    Kanis JA, McCloskey EV, Johansson H, Cooper C, Rizzoli R, Reginster JY (2013) European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int 24:23–57PubMedCentralPubMedCrossRefGoogle Scholar
  4. 4.
    Silverman SL, Mason J, Greenwald M (1993) The Osteoporosis Assessment Questionnaire (OPAQ): a reliable and valid self-assessment measure of quality of life in osteoporosis (abs 904). J Bone Miner Res 8:343Google Scholar
  5. 5.
    Silverman SL (2005) Quality-of-life issues in osteoporosis. Curr Rheumatol Rep 7:39–45PubMedCrossRefGoogle Scholar
  6. 6.
    Liu-Ambrose T, Eng JJ, Khan KM, Carter ND, McKay HA (2003) Older women with osteoporosis have increased postural sway and weaker quadriceps strength than counterparts with normal bone mass: overlooked determinants of fracture risk? J Gerontol A Biol Sci Med Sci 58:862–866CrossRefGoogle Scholar
  7. 7.
    Sinaki M, Brey RH, Hughes CA, Larson DR, Kaufman KR (2005) Balance disorder and increased risk of falls in osteoporosis and kyphosis: significance of kyphotic posture and muscle strength. Osteoporos Int 16:1004–1010PubMedCrossRefGoogle Scholar
  8. 8.
    Tinetti ME, Powell L (1993) Fear of falling and low self-efficacy: a case of dependence in elderly persons. J Gerontol 48:35–38PubMedCrossRefGoogle Scholar
  9. 9.
    Delbaere K, Crombez G, Vanderstraeten G, Willems T, Cambier D (2004) Fear-related avoidance of activities, falls and physical frailty. A prospective community-based cohort study. Age Ageing 33:368–373PubMedCrossRefGoogle Scholar
  10. 10.
    Legters K (2002) Fear of falling. Phys Ther 82:264–272PubMedGoogle Scholar
  11. 11.
    Scheffer AC, Schuurmans MJ, van Dijk N, van der Hooft T, de Rooij SE (2008) Fear of falling: measurement strategy, prevalence, risk factors and consequences among older persons. Age Ageing 37:19–24PubMedCrossRefGoogle Scholar
  12. 12.
    Zijlstra GA, van Haastregt JCM, van Eijk JT, van Rossum E, Stalenhoef PA, Kempen GI (2007) Prevalence and correlates of fear of falling, and associated avoidance of activity in the general population of community-living older people. Age Ageing 36:304–309PubMedCrossRefGoogle Scholar
  13. 13.
    Hadjistavropoulos T, Delbaere K, Fitzgerald TD (2011) Reconceptualizing the role of fear of falling and balance confidence in fall risk. J Aging Health 23:3–23PubMedCrossRefGoogle Scholar
  14. 14.
    Kressig RW, Wolf SL, Sattin RW, O’Grady M, Greenspan A, Curns A, Kutner M (2001) Associations of demographic, functional, and behavioral characteristics with activity-related fear of falling among older adults transitioning to frailty. J Am Geriatr Soc 49:1456–1462PubMedCrossRefGoogle Scholar
  15. 15.
    Delbaere K, Crombez G, Van Den Noortgate N, Willems T, Cambier D (2006) The risk of being fearful or fearless of falls in older people: an empirical validation. Disabil Rehabil 28:751–756PubMedCrossRefGoogle Scholar
  16. 16.
    Liu-Ambrose T, Khan KM, Donaldson MG, Eng JJ, Lord SR, McKay HA (2006) Falls-related self-efficacy is independently associated with balance and mobility in older women with low bone mass. J Gerontol A Biol Sci Med Sci 61:832–838PubMedCrossRefGoogle Scholar
  17. 17.
    Hadjistavropoulos T, Carleton RN, Delbaere K, Barden J, Zwakhalen S, Fitzgerald et al (2012) The relationship of fear of falling and balance confidence with balance and dual tasking performance. Psychol Aging 27:1–13PubMedCrossRefGoogle Scholar
  18. 18.
    Zijlstra GA, van Haastregt JCM, van Rossum E, van Eijk JTM, Yardley L, Kempen GI (2007) Interventions to reduce fear of falling in community-living older people: a systematic review. J Am Geriatr Soc 55:603–615PubMedCrossRefGoogle Scholar
  19. 19.
    Giangregorio LM, Macintyre NJ, Thabane L, Skidmore CJ, Papaioannou A (2013) Exercise for improving outcomes after osteoporotic vertebral fracture. Cochrane Database Syst Rev 1, CD008618PubMedGoogle Scholar
  20. 20.
    Liu-Ambrose T, Khan KM, Eng JJ, Lord SR, McKay HA (2004) Balance confidence improves with resistance or agility training. Increase is not correlated with objective changes in fall risk and physical abilities. Gerontology 50:373–382PubMedCentralPubMedCrossRefGoogle Scholar
  21. 21.
    Smulders E, Weerdesteyn V, Groen BE, Duysens J, Eijsbouts A, Laan R, van Lankveld W (2010) Efficacy of a short multidisciplinary falls prevention program for elderly persons with osteoporosis and a fall history: a randomized controlled trial. Arch Phys Med Rehabil 91:1705–1711PubMedCrossRefGoogle Scholar
  22. 22.
    Bonaiuti D, Arioli G, Diana G, Franchignoni F, Giustini A, Monticone M et al (2005) SIMFER rehabilitation treatment guidelines in postmenopausal and senile osteoporosis. Eur Med Phys 41:315–337Google Scholar
  23. 23.
    Sinaki M (2012) Exercise for patients with osteoporosis: management of vertebral compression fractures and trunk strengthening for fall prevention. PM R 4:882–888PubMedCrossRefGoogle Scholar
  24. 24.
    Bergland A, Thorsen H, Karesen R (2011) 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. Osteoporos Int 22:1863–1871PubMedCrossRefGoogle Scholar
  25. 25.
    Kanis JA (1994) Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: synopsis of a WHO report. WHO Study Group. Osteoporos Int 4:368–381PubMedCrossRefGoogle Scholar
  26. 26.
    Folstein M, Folstein S, McHugh P (1975) Mini-mental state. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12:189PubMedCrossRefGoogle Scholar
  27. 27.
    Lips P, Cooper C, Agnusdei D, Caulin F, Egger P, Johnell O et al (1999) Quality of life in patients with vertebral fractures: validation of the Quality of Life Questionnaire of the European Foundation for Osteoporosis (QUALEFFO). Working Party for Quality of Life of the European Foundation for Osteoporosis. Osteoporos Int 10:150–160PubMedCrossRefGoogle Scholar
  28. 28.
    Yardley L, Beyer N, Hauer K, Kempen G, Piot-Ziegler C, Todd CJ (2005) Development and initial validation of the Falls Efficacy Scale-International (FES-I). Age Ageing 34:614–619PubMedCrossRefGoogle Scholar
  29. 29.
    Helbostad JL, Taraldsen K, Granbo R, Yardley L, Todd CJ, Sletvold O (2010) Validation of the Falls Efficacy Scale-International in fall-prone older persons. Age Ageing 39:259PubMedCrossRefGoogle Scholar
  30. 30.
    Tinetti ME, Richman D, Powell L (1990) Falls efficacy as a measure of fear of falling. J Gerontol 45:239–243CrossRefGoogle Scholar
  31. 31.
    Halvarsson A, Franzén E, Ståhle A (2013) Assessing the relative and absolute reliability of the Falls Efficacy Scale-International questionnaire in elderly individuals with increased fall risk and the questionnaire’s convergent validity in elderly women with osteoporosis. Osteoporos Int 24:1853–1858PubMedCrossRefGoogle Scholar
  32. 32.
    Kempen GIJM, Todd CJ, Van Haastregt JCM, Zijlstra GAR, Beyer N, Freiberger E et al (2007) Cross-cultural validation of the Falls Efficacy Scale International (FES-I) in older people: results from Germany, the Netherlands and the UK were satisfactory. Disabil Rehabil 29:155–162PubMedCrossRefGoogle Scholar
  33. 33.
    Nordell E, Andreasson M, Gall K, Thorngren K-G (2009) Evaluating the Swedish version of the Falls Efficacy Scale-International (FES-I). Adv Physiother 11:81–87CrossRefGoogle Scholar
  34. 34.
    Delbaere K, Close JCT, Mikolaizak AS, Sachdev PS, Brodaty H, Lord SR (2010) The Falls Efficacy Scale International (FES-I). A comprehensive longitudinal validation study. Age Ageing 39:210–216PubMedCrossRefGoogle Scholar
  35. 35.
    Ersoy Y, MacWalter RS, Durmus B, Altay ZE, Baysal O (2009) Predictive effects of different clinical balance measures and the fear of falling on falls in postmenopausal women aged 50 years and over. Gerontology 55:660–665PubMedCrossRefGoogle Scholar
  36. 36.
    Connelly DM, Stevenson TJ, Vandervoort AA (1996) Between- and within-rater reliability of walking tests in a frail elderly population. Physiother Can 48:47–51Google Scholar
  37. 37.
    Duncan PW, Weiner DK, Chandler J, Studenski S (1990) Functional reach: a new clinical measure of balance. J Gerontol 45:192–197CrossRefGoogle Scholar
  38. 38.
    Finch E (2002) Physical rehabilitation outcome measures. A guide to enhanced clinical decision making, 2nd edn. Canadian Physiotherapy Association: Lippincott Williams & Wilkins, OntarioGoogle Scholar
  39. 39.
    Pallant J (2010) SPSS survival manual. A step by step guide to data analysis using SPSS, 4th edn. Open University Press, MainheadGoogle Scholar
  40. 40.
    Cohen J (1988) Statistical power analysis for the behavioral sciences, 2nd edn. Lawrence Erlbaum associates, HillsdaleGoogle Scholar
  41. 41.
    Howland J, Lachman ME, Peterson EW, Cote J, Kasten L, Jette A (1998) Covariates of fear of falling and associated activity curtailment. The Gerontologist 38:549–555PubMedCrossRefGoogle Scholar
  42. 42.
    Madureira MM, Bonfa E, Takayama L, Pereira RM (2010) A 12-month randomized controlled trial of balance training in elderly women with osteoporosis: improvement of quality of life. Maturitas 66:206–211PubMedCrossRefGoogle Scholar
  43. 43.
    Pacala JT, Judge JO, Boult C (1996) Factors affecting sample selection in a randomized trial of balance enhancement: the FICSIT Study. J Am Geriatr Soc 44:377–382PubMedGoogle Scholar
  44. 44.
    Zijlstra GA, van Haastregt JC, Ambergen T, van Rossum E, van Eijk JT, Tennstedt SL, Kempen GI (2009) Effects of a multicomponent cognitive behavioral group intervention on fear of falling and activity avoidance in community-dwelling older adults: results of a randomized controlled trial. J Am Geriatr Soc 57:2020–2028PubMedCrossRefGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2014

Authors and Affiliations

  1. 1.Kingosgate Rehabilitation CenterNursing Home AgencyOsloNorway
  2. 2.Oslo and Akershus University College of Applied Sciences (HIOA)OsloNorway

Personalised recommendations