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Both resistance and agility training reduce back pain and improve health-related quality of life in older women with low bone mass


The purpose of the study was to compare the effects of three different types of group-based exercise programs (resistance training, agility training and general stretching) on back pain and health-related quality of life in older (aged 75–85 years) community-dwelling women with low bone mass (i.e., osteopenia or osteoporosis). The design was a 25-week randomized controlled trial. Participating were 98 community-dwelling women with low bone mass between the ages of 75 to 85 years old. We assessed back pain and its related disability and health-related quality of life. All three types of group-based exercise programs significantly reduced back pain and its related disabilities, but only resistance and agility training significantly improved health-related quality of life in community-dwelling older women with low bone mass. Baseline physical activity level and class attendance were significant predictors of change in health-related quality of life. Change in back pain and its related disabilities after 25 weeks of exercise intervention was significantly correlated with change in health-related quality of life and changes in the domains of pain and physical function. Resistance and agility training significantly enhanced health-related quality of life and may have done so by increasing social interactions and support, enhancing self-efficacy of physical abilities and modifying the experience of back pain. These data provide valuable insight into the specifics of exercise prescription for older women with low bone mass. Future studies may wish to use individualized quality of life measures to further delineate the effects of different types of exercise on quality of life in older adults with low bone mass.

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  1. 1.

    Cummings SR, Melton LJ (2002) Epidemiology and outcomes of osteoporotic fractures. Lancet 359:1761–1767

    Article  PubMed  Google Scholar 

  2. 2.

    Ettinger B, Black D, Nevitt M, Rundle A, Cauley J, Cummings S, Genant H (1992) Contribution of vertebral deformities to chronic back pain and disability. The Study of Osteoporotic Fractures Research Group. J Bone Miner Res 7:449–456

    CAS  PubMed  Google Scholar 

  3. 3.

    Ryan P, Evans P, Gibson T, Fogelman I (1992) Osteoporosis and chronic back pain: a study with single-photon emission computed tomography bone scintigraphy. J Bone Miner Res 7:1455–1460

    Google Scholar 

  4. 4.

    Malmros B, Mortensen L, Jensen MB, Charles P (1998) Positive effects of physiotherapy on chronic pain and performance in osteoporosis. Osteoporos Int 8:215–221

    Article  CAS  PubMed  Google Scholar 

  5. 5.

    Bravo G, Gauthier P, Roy PM, Payette H, Gaulin P, Harvey M, Peloquin L, Dubois MF (1996) Impact of a 12-month exercise program on the physical and psychological health of osteopenic women. J Am Geriatr Soc 44:756–762

    Google Scholar 

  6. 6.

    Gold D, Stegmaier K, Bales C, Lyles K, Westlund R, Drezner M (1993) Psychosocial functioning and osteoporosis in late life: Results of a multidisciplinary intervention. J Womens Health 2:149–155

    Google Scholar 

  7. 7.

    Gold D (2001) The nonskeletal consequences of osteoporotic fractures: psychologic and social outcomes. Rheum Dis Clin North Am 27:271–280

    Google Scholar 

  8. 8.

    Helmes E, Hodsman A, Lazowski D, Bhardwaj A, Crilly R, Nichol P, Drost D, Vanderburgh L, Pederson L (1995) A questionnaire to evalaute disability in osteoporotic patients with vertebral compression fractures. J Gerontol 50:91–98

    Google Scholar 

  9. 9.

    Papaioannou A, Adachi J, Winegard K, Ferko N, Parkinson W, Cook R, Webber C, McCartney N (2003) Efficacy of home-based exercise for improving quality of life among elderly women with symptomatic osteoporosis-related vertebral fractures. Osteoporosis Int 14:677–682

    Article  Google Scholar 

  10. 10.

    Prior J, Barr S, Chow R, et al (1996) Prevention and management of osteoporosis: Consensus statements from the Scientific Advisory Board of the Osteoporosis Society of Canada. 5. Physical activity as therapy for osteoporosis. Can Med Assoc J 155:940–944

    Google Scholar 

  11. 11.

    World Health Organization (1949) Constitution of the World Health Organization. WHO, Geneva

  12. 12.

    Liu-Ambrose T, Khan K, Eng J, Janssen P, Lord S, McKay H (2004) Both resistance and agility training reduce fall risk in 75–85 year old women with low bone mass: A 6-month randomized controlled trial. J Am Geriatr Soc 52:657–665

    Article  Google Scholar 

  13. 13.

    Liu-Ambrose T, Khan KM, Eng J, Heinone A, McKay HA (2004) Both resistance and agility training increase cortical bone density in 75–85-year-old women with low bone mass: a 6-month randomized controlled trial. J Clin Densitom (in press)

  14. 14.

    WHO Study Group (1994) Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. In: WHO Technical Report Series. World Health Organization, Geneva

  15. 15.

    Folstein MF, Folstein SE, McHugh PR (1975) “Mini-mental state.” A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12:189–198

    Article  CAS  PubMed  Google Scholar 

  16. 16.

    Krieger N, Tenenhouse A, Joseph L, Mackenzie M, Poliquin S, Brown J, et al (1999) The Canadian multicentre osteoporosis study. Can J Aging 18:376–387

    Google Scholar 

  17. 17.

    Washburn RA, Smith KW, Jette AM, Janney CA (1993) The physical activity scale for the elderly (PASE): development and evaluation. J Clin Epidemiol 46:153–162

    Article  CAS  PubMed  Google Scholar 

  18. 18.

    Washburn RA, McAuley E, Katula J, Mihalko SL, Boileau RA (1999) The physical activity scale for the elderly (PASE): evidence for validity. J Clin Epidemiol 52:643–651

    Google Scholar 

  19. 19.

    Fairbank J, Couper J, Davies J, O’Brien J (1980) The Oswestry Low Back Pain Disability Questionnaire. Physiotherapy 66:271–273

    CAS  PubMed  Google Scholar 

  20. 20.

    Gronblad M, Hupli M, Wennerstrand P, Jarvinen E, Lukinmaa A, Kouri J, Karaharju E (1993) Intercorrelation and test-retest reliability of the Pain Disability Index (PDI) and the Oswestry Disability Questionnaire (ODQ) and their correlation with pain intensity in low back pain patients. Clin J Pain 9:189–195

    Google Scholar 

  21. 21.

    Lips P, Agnusdei D, Caulin F, Cooper C, Johnell O, Kanis J, Liberman U, Minne H, Reeve J, Reginster JY, de Vernejoul MC, Wiklund I (1996) The development of a European questionnaire for quality of life in patients with vertebral osteoporosis. Scand J Rheumatol Suppl 103:84–85

    Google Scholar 

  22. 22.

    Oleksik A, Lips P, Dawson A, Minshall ME, Shen W, Cooper C, Kanis J (2000) Health-related quality of life in postmenopausal women with low BMD with or without prevalent vertebral fractures. J Bone Miner Res 15:1384–1392

    CAS  PubMed  Google Scholar 

  23. 23.

    Braith RW, Graves JE, Leggett SH, Pollock ML (1993) Effect of training on the relationship between maximal and submaximal strength. Med Sci Sports Exerc 25:132–138

    Google Scholar 

  24. 24.

    Liu-Ambrose T, Eng JJ, Khan KM, Mallinson A, Carter ND, McKay HA (2002) The influence of back pain on balance and functional mobility in 65- to 75-year-old women with osteoporosis. Osteoporos Int 13:868–873

    Article  CAS  PubMed  Google Scholar 

  25. 25.

    Liddle SD, Baxter GD, Gracey JH (2004) Exercise and chronic low back pain: what works? Pain 107:176–190

    Article  Google Scholar 

  26. 26.

    Vuori I (2001) Dose-response of physical activity and low back pain, osteoarthritis, and osteoporosis. Med Sci Sports Exerc 33S:S551–S586

    Google Scholar 

  27. 27.

    Philadelphia Panel (2001) Philadelphia Panel evidence-based clinical practice guidelines on selected rehabilitation interventions for low back pain. Phys Ther 81

  28. 28.

    Khalil T, Asfour S, Martinez L, Waly S, Rosomoff R, Rosomoff H (1992) Stretching in the rehabilitation of low-back pain patients. Spine 17:311–317

    Google Scholar 

  29. 29.

    Wager TD, Rilling JK, Smith EE, Sokolik A, Casey KL, Davidson RJ, Kosslyn SM, Rose RM, Cohen JD (2004) Placebo-induced changes in fMRI in the anticipation and experience of pain. Science 303:1162–1167

    Article  Google Scholar 

  30. 30.

    Hrobjartsson A (2002) What are the main methodological problems in the estimation of placebo effects? J Clin Epidemiol 55:430–435

    Google Scholar 

  31. 31.

    Lydick E, Zimmerman S, Yawn B, Love B, Kleerekoper M, Ross P, Martin A, Holmes R (1997) Development and validation of a discriminative quality of life questionnaire for osteoporosis (the OPTQoL). J Bone Miner Res 12:456–463

    CAS  PubMed  Google Scholar 

  32. 32.

    Bandura A (1977) Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev 84:191–215.

    Article  Google Scholar 

  33. 33.

    Latham NK, Bennett DA, Stretton CM, Anderson CS (2004) Systematic review of progressive resistance strength training in older adults. J Gerontol A Biol Sci Med Sci 59:M48–61

    Google Scholar 

  34. 34.

    Dijkers MP (2003) Individualization in quality of life measurement: instruments and approaches. Arch Phys Med Rehabil 84:S3–14

    Article  Google Scholar 

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The Vancouver Foundation (BCMSF) and the BC Women’s Hospital Osteoporosis Program supported this project. The South Slope YMCA was a partner of this research project. Drs. Khan and Eng are Canadian Institutes of Health Research (Institute of Musculoskeletal Health and Arthritis) New Investigators. Drs. McKay and Eng are Michael Smith Foundation for Health Research Career Scholars. Dr. Liu-Ambrose is a Michael Smith Foundation for Health Research Post Doctoral Fellow and a Canadian Institutes of Health Research ICE Postdoctoral Fellow.

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Correspondence to Karim M. Khan.

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Liu-Ambrose, T.Y.L., Khan, K.M., Eng, J.J. et al. Both resistance and agility training reduce back pain and improve health-related quality of life in older women with low bone mass. Osteoporos Int 16, 1321–1329 (2005).

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  • Agility training
  • Back pain
  • Health-related quality of life
  • Low bone mass
  • Resistance training