Osteoporosis International

, Volume 22, Issue 6, pp 1863–1871 | Cite as

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

  • A. BerglandEmail author
  • H. Thorsen
  • R. Kåresen
Original Article



The aim of this randomized controlled trial was to evaluate the effect of a 3-month course of exercises on mobility, balance, disease-specific, and generic health-related quality of life (HRQOL) for women with osteoporosis and a history of vertebral fractures. Our results showed that exercises improved their mobility, balance, and HRQOL.


The aim was to evaluate the effect of a 3-month course of circuit exercises plus a 3-h lesson on how to cope with osteoporosis on mobility, balance, and the HRQOL for postmenopausal women (60–84 years) with osteoporosis and a history of vertebral fracture. Our hypothesis was that a 3-month course would have a significantly positive effect on the women's mobility and balance as well as on their HRQOL.


The participants (89) were randomized to an intervention group (IT) or a control group (CT) and assessed at baseline at 3 months and at 12 months with measurement of maximum walking speed (MWS), Timed Up and GO (TUG), Functional Reach (FR), the Quality of Life Questionnaire issued by the European Foundation for Osteoporosis (‘QUALEFFO-41’) and the General Health Questionnaire (GHQ-20). The sample size was calculated with reference to walking speed (primary outcome), and the statistical approaches used were Student's t test or the chi-square test.


At 3 months, better results were registered on the primary outcome, MWS as well as TUG, FR, sum score of GHQ-20, and “QUALEFFO-41: mental function” in the IT compared with the CT. At 12 months, those in the IT had a better result on the primary outcome, MWS as well as TUG, “QUALEFFO-41: total score” “QUALEFFO-41: mental function”, “QUALEFFO-41: physical function”, and “QULEFFO-41: pain” compared with CT.


Circuit exercises will improve mobility and health-related quality of life of elderly women with osteoporosis and a history of vertebral fractures.


Balance Health-related quality of life Mobility Moderate-intensity circuit exercises Osteoporosis Randomized controlled trial 



The project is funded by the Norwegian “Fond for etter-og videreutdanning av fysioterapeuter”.

Conflicts of interest



  1. 1.
    Elkan R, Kendrick D, Dewey M, Hewitt M, Robinson J, Blair M, Williams D, Brummell K (2001) Effectiveness of home based support for older people: systematic review and meta-analysis. Br Med J 323:719–724CrossRefGoogle Scholar
  2. 2.
    Kanis J (1994) The WHO study group. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: synopsis of a WHO report. Osteoporos Int 4:368–381PubMedCrossRefGoogle Scholar
  3. 3.
    Shea B, Bonaiuti D, Iovine R, Negrini S, Robinson V, Kemper HC, Wells G, Tugwell P, Cranney A (2004) Cochrane review on exercise for preventing and treating osteoporosis in postmenopausal women. Eur Medicophys 40:199–209Google Scholar
  4. 4.
    Silverman SL (1992) The clinical consequences of vertebral compression fracture. Bone 13:S27–S31PubMedCrossRefGoogle Scholar
  5. 5.
    Nevitt MC, Ettinger B, Black DM, Stone K, Jamal SA, Ensrud K, Segal M, Genant HK, Cummings SR (1998) The association of radiographically detected vertebral fractures with back pain and function: a prospective study. Ann Intern Med 128:793–800PubMedGoogle Scholar
  6. 6.
    Liu-Ambrose TYL, Khan KM, Eng JJ, Lord SR, Lentle B, McKay HA (2005) Both resistance and agility training reduce back pain and improve health-related quality of life in older women with low bone mass. Osteoporosis Int 16:1321–1329CrossRefGoogle Scholar
  7. 7.
    Carter ND, Khan KM, McKay HA, Petit MA, Waterman C, Heinonen A, Janssen PA, Donaldson MG, Mallinson A, Riddell L, Kruse K, Prior JC, Flicker L (2002) Community- based exercise program reduces risk factors for falls in 65- to 75-year-old women with osteoporosis: randomized controlled trial. Can Med Assoc J 167:997–1004Google Scholar
  8. 8.
    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 14:677–682CrossRefGoogle Scholar
  9. 9.
    Bonaiuti D, Arioli G, Diana G, Franchignoni F, Giustini A, Monticone M, Negrini S, Maini M (2005) SIMFER rehabilitation treatment guidelines in postmenopausal and senile osteoporosis. Eur Medicophys 41:315–337Google Scholar
  10. 10.
    Moher D, Schulz KF, Altman DG, CONSORT (2001) The CONSORT statement: revised recommendations for improving the quality of reports of parallel group randomized trials. BMC Med Res Methodol 1:2PubMedCrossRefGoogle Scholar
  11. 11.
    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
  12. 12.
    Finch E, Brooks D, Stratford PW, Mayo NE (2002) Physical rehabilitation outcome measures: a guide to enhanced clinical decision making. Williams & Wilkins, BaltimoreGoogle Scholar
  13. 13.
    Connelly D, Stevenson TJ, Vandervoort AA (1996) Between-and within-rater reliability of walking tests in a frail elderly population. Physiother Can 48:47–51Google Scholar
  14. 14.
    Podsiadlo D, Richardson S (1991) The Timed Up & Go: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 39:142–148PubMedGoogle Scholar
  15. 15.
    Duncan PW, Weiner DK, Chandler J, Studenski S (1990) Functional reach: a new clinical measure of balance. J Gerontol 45:M192PubMedGoogle Scholar
  16. 16.
    Goldberg DP (1972) The detection of psychiatric illness by questionnaire. In: Maudsley Monograph No 21. London: Oxford University PressGoogle Scholar
  17. 17.
    Naughton M, Wiklund I (1996) Dimension-specific instruments that may be used across cultures. Quality of life and pharmacoeconomics in clinical trials, 2nd edn. Lippincott-Raven Publishers, Philadelphia, pp 633–658Google Scholar
  18. 18.
    Malt U, Mongstad T, Refnin I (1989) Goldberg’s general health questionnaire (In Norwegian)’. Tidsskr Nor Laegeforen 109:1391–1394PubMedGoogle Scholar
  19. 19.
    Malt UF (1989) The validity of the general health questionnaire in a sample of accidentally injured adults. Acta Psychiatr Scand Suppl 355:103–112PubMedCrossRefGoogle Scholar
  20. 20.
    Spilker B (1996) Quality of life and pharmacoeconomics in clinical trials. Philadelphia, PN: Lippincott-Raven PhiladelphiaGoogle Scholar
  21. 21.
    Wilkin D, Hallam L, Doggett MA (1992) Measures of need and outcome for primary health care. Oxford University Press, OxfordGoogle Scholar
  22. 22.
    Lips P, Cooper C, Agnusdei D, Caulin F, Egger P, Johnell O, Kanis JA, Kellingray S, Leplege A, Liberman UA, McCloskey E, Minne H, Reeve J, Reginster JY, Scholz M, Todd C, de Vernejoul MC, Wiklund I (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
  23. 23.
    Lips P, van Schoor NM (2005) Quality of life in patients with osteoporosis. Osteoporos Int 16:447–455. doi: 10.1007/s00198-004-1762-7 PubMedCrossRefGoogle Scholar
  24. 24.
    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 15:1384–1392PubMedCrossRefGoogle Scholar
  25. 25.
    King MB, Whipple RH, Gruman CA, Judge JO, Schmidt JA, Wolfson LI (2002) The performance enhancement project: improving physical performance in older persons. Arch Phys Med Rehabil 83:1060–1069PubMedCrossRefGoogle Scholar
  26. 26.
    Streiner DL (2008) Health measurement scales: a practical guide to their development and use. Oxford University Press, OxfordGoogle Scholar
  27. 27.
    Pallant JF (2007) SPSS survival manual: a step by step guide to data analysis using SPSS. Allen & UnwinGoogle Scholar
  28. 28.
    Perera S, Mody SH, Woodman RC, Studenski SA, Perera S, Mody S, Woodman R, Studenski S (2006) Meaningful change and responsiveness in common physical performance measures in older adults. J Am Geriatr Soc 54:743–749PubMedCrossRefGoogle Scholar
  29. 29.
    Madureira MM, Takayama L, Gallinaro AL, Caparbo VF, Costa RA, Pereira RMR (2007) Balance training program is highly effective in improving functional status and reducing the risk of falls in elderly women with osteoporosis: a randomized controlled trial. Osteoporosis Int 18:419–425CrossRefGoogle Scholar
  30. 30.
    Malmros B, Mortensen L, Jensen M, Charles P (1998) Positive effects of physiotherapy on chronic pain and performance in osteoporosis. Osteoporosis Int 8:215–221CrossRefGoogle Scholar
  31. 31.
    Kronhed G, Hallberg I, Odkvist L, Moller M (2009) Effect of training on health-related quality of life, pain and falls in osteoporotic women. Adv Physiother 11:154–165CrossRefGoogle Scholar
  32. 32.
    Karinkanta S, Heinonen A, Sievänen H, Uusi-Rasi K, Pasanen M, Ojala K, Fogelholm M, Kannus P (2007) A multi-component exercise regimen to prevent functional decline and bone fragility in home-dwelling elderly women: randomized, controlled trial. Osteoporosis Int 18:453–462CrossRefGoogle Scholar
  33. 33.
    De Amici D, Klersy C, Ramajoli F, Brustia L, Politi P (2000) Impact of the Hawthorne effect in a longitudinal clinical study: the case of anesthesia. Control Clin Trials 21:103–114PubMedCrossRefGoogle Scholar
  34. 34.
    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 44:377PubMedGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2010

Authors and Affiliations

  1. 1.Faculty of Health SciencesOslo University CollegeOsloNorway
  2. 2.Department of PhysiotherapyHospital of Fredrikstad and SarpsborgFredrikstad and SarpsborgNorway

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