Targeted spine strengthening exercise and posture training program to reduce hyperkyphosis in older adults: results from the study of hyperkyphosis, exercise, and function (SHEAF) randomized controlled trial
- 972 Downloads
A 6-month randomized controlled trial of spine-strengthening exercise and posture training reduced both radiographic and clinical measures of kyphosis. Participants receiving the intervention improved self-image and satisfaction with their appearance. Results suggest that spine-strengthening exercise and postural training may be an effective treatment option for older adults with hyperkyphosis.
The purpose of the present study is to determine in a randomized controlled trial whether spine-strengthening exercises improve Cobb angle of kyphosis in community-dwelling older adults.
We recruited adults ≥60 years with kyphosis ≥40° and enrolled 99 participants (71 women, 28 men), mean age 70.6 ± 0.6 years, range 60–88, with baseline Cobb angle 57.4 ± 12.5°. The intervention included group spine-strengthening exercise and postural training, delivered by a physical therapist, 1-h, three times weekly for 6 months. Controls received four group health education meetings. The primary outcome was change in the gold standard Cobb angle of kyphosis measured from standing lateral spine radiographs. Secondary outcomes included change in kyphometer-measured kyphosis, physical function (modified Physical Performance Test, gait speed, Timed Up and Go, Timed Loaded Standing, 6-Min Walk), and health-related quality of life (HRQoL) (PROMIS global health and physical function indexes, SRS-30 self-image domain). ANCOVA was used to assess treatment effects on change from baseline to 6 months in all outcomes.
There was a −3.0° (95% CI −5.2, −0.8) between-group difference in change in Cobb angle, p = 0.009, favoring the intervention and approximating the magnitude of change from an incident vertebral fracture. Kyphometer-measured kyphosis (p = 0.03) and SRS-30 self-esteem (p < 0.001) showed favorable between-group differences in change, with no group differences in physical function or additional HRQoL outcomes, p > 0.05.
Spine-strengthening exercise and posture training over 6 months reduced kyphosis compared to control. Our randomized controlled trial results suggest that a targeted kyphosis-specific exercise program may be an effective treatment option for older adults with hyperkyphosis.
Trial registration number and name of trial register
ClinicalTrials.gov; identifier NCT01751685
KeywordsAging Clinical trials Exercise Radiology Skeletal muscle
This research was supported by the National Institute on Aging (NIA) RO1AG041921 and by the National Center for Advancing Translational Sciences, National Institutes of Health, through UCSF-CTSI Grant Number UL1 TR000004. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH. The authors wish to acknowledge the Data Safety Monitoring Board for their study oversight, Nicole King and Scott Puracchio for their assistance in data collection, and Lorenzo Nardo for data acquisition.
Compliance with ethical standards
The study protocol was approved by the University of California San Francisco and Kaiser Permanente Northern California Institutional Review Boards.
Conflicts of interest
This research was supported by the National Institute on Aging (NIA) RO1AG041921.
- 1.Takahashi T, Ishida K, Hirose D, Nagano Y, Okumiya K, Nishinaga M et al (2005) Trunk deformity is associated with a reduction in outdoor activities of daily living and life satisfaction in community-dwelling older people. Osteoporos Int 16(3):273–279. doi: 10.1007/s00198-004-1669-3 CrossRefPubMedGoogle Scholar
- 3.Katzman W, Cawthon P, Hicks GE, Vittinghoff E, Shepherd J, Cauley JA et al (2011) Association of spinal muscle composition and prevalence of hyperkyphosis in healthy community-dwelling older men and women. J Gerontol A Biol Sci Med Sci. doi: 10.1093/gerona/glr160
- 5.McDaniels-Davidson C, Davis A, Wing D, Nichols J, Kado D (2016) editors. Kyphosis, balance dynamics, and incident falls in community dwelling older adults. J Am Geriatr SocGoogle Scholar
- 7.Kado DM, Miller-Martinez D, Lui LY, Cawthon P, Katzman WB, Hillier TA et al (2014) Hyperkyphosis, kyphosis progression, and risk of non-spine fractures in older community dwelling women: the study of osteoporotic fractures (SOF). J Bone Miner Res 29(10):2210–2216. doi: 10.1002/jbmr.2251 CrossRefPubMedPubMedCentralGoogle Scholar
- 9.Katzman WB, Harrison SL, Fink HA, Marshall LM, Orwoll E, Barrett-Connor E et al (2014) Physical function in older men with hyperkyphosis. J Gerontol A Biol Sci Med Sci. doi: 10.1093/gerona/glu213
- 10.Katzman WB, Huang MH, Lane NE, Ensrud KE, Kado DM (2013) Kyphosis and decline in physical function over 15 years in older community-dwelling women: the Study of Osteoporotic Fractures. J Gerontol A Biol Sci Med Sci. doi: 10.1093/gerona/glt009
- 14.Katzman WB, Parimi N, Mansoori Z, Nardo L, Kado DM, Cawthon PM et al (2016) Cross-sectional and longitudinal associations of diffuse idiopathic skeletal hyperostosis (DISH) and thoracic kyphosis in older men and women. Arthritis Care Res. doi: 10.1002/acr.23115
- 15.Katzman WB, Miller-Martinez D, Marshall LM, Lane NE, Kado DM (2014) Kyphosis and paraspinal muscle composition in older men: a cross-sectional study for the Osteoporotic Fractures in Men (MrOS) research group. BMC Musculoskelet Disord 15:19. doi: 10.1186/1471-2474-15-19 CrossRefPubMedPubMedCentralGoogle Scholar
- 20.Katzman WB, Vittinghoff E, Kado DM, Schafer AL, Wong SS, Gladin A et al (2016) Study of hyperkyphosis, exercise and function (SHEAF) protocol of a randomized controlled trial of multimodal spine-strengthening exercise in older adults with hyperkyphosis. Phys Ther 96(3):371–381. doi: 10.2522/ptj.20150171 CrossRefPubMedGoogle Scholar
- 25.Van Dillen LR, Norton BJ, Sahrmann SA, Evanoff BA, Harris-Hayes M, Holtzman GW et al (2016) Efficacy of classification-specific treatment and adherence on outcomes in people with chronic low back pain. A one-year follow-up, prospective, randomized, controlled clinical trial. Man Ther 24:52–64. doi: 10.1016/j.math.2016.04.003 CrossRefPubMedPubMedCentralGoogle Scholar
- 39.Greendale GA, Huang MH, Karlamangla AS, Seeger L, Crawford S (2009) Yoga decreases kyphosis in senior women and men with adult-onset hyperkyphosis: results of a randomized controlled trial. J Am Geriatr Soc. doi: 10.1111/j.1532-5415.2009.02391.x
- 44.Lorbergs AL, O’Connor GT, Zhou Y, Travison TG, Kiel DP, Cupples LA et al (2016) Severity of kyphosis and decline in lung function: the Framingham study. J Gerontol A Biol Sci Med Sci. doi: 10.1093/gerona/glw124