Osteoporosis International

, Volume 23, Issue 6, pp 1813–1822 | Cite as

The influence of participation in Better Bones and Balance™ on skeletal health: evaluation of a community-based exercise program to reduce fall and fracture risk

Original Article

Abstract

Summary

Older women participating in Better Bones and Balance™ (BBB) had similar bone mass at the hip compared to a sample of low active/sedentary controls. However, both groups had higher than expected hip BMD, despite higher risk for osteoporosis among BBB participants.

Introduction

BBB is a community-based fall and fracture risk reduction program shown to reduce bone loss at the hip in older women under controlled laboratory conditions. Whether bone benefits are derived from BBB as delivered in the community setting is unknown. The purpose of this study is to evaluate the relationship between community-based BBB participation and parameters of skeletal health in postmenopausal women.

Methods

Women were recruited from BBB classes (n=69) and compared to low active/sedentary controls (n=46); total sample aged 69 + 7.7 years. Bone mineral density (BMD) of the hip and spine was measured using DXA; hip bone structure [cross-sectional area, cross-sectional moment of inertia] at the narrow neck and intertrochanter were derived using hip structural analysis software. Diet, physical activity, and health history were assessed by questionnaires. Group differences in bone outcomes were determined using ANCOVA controlling for age and body mass.

Results

While controls were heavier and exhibited greater total body BMD compared to BBB participants (p<0.05), there were no differences between groups in hip or spine BMD or bone structural outcomes (p>0.05) despite BBB participants reporting more frequent prior diagnoses of or risk factors for osteoporosis compared to controls. Both controls and BBB participants had higher than average T-scores at the hip (p<0.05) when compared to an age-matched cohort from NHANES.

Conclusions

These data suggest that participation in BBB may not result in direct benefits to bone. However long-term participation may be associated with other positive outcomes.

Keywords

Bone health Community-based exercise Older women 

References

  1. 1.
    National Institutes of Health (2001) Osteoporosis prevention, diagnosis, and therapy. JAMA 285(6):785–795CrossRefGoogle Scholar
  2. 2.
    Burge R, Dawson-Hughes B, Solomon DH, Wong JB, King A, Tosteson A (2007) Incidence and economic burden of osteoporosis-related fractures in the United States, 2005–2025. J Bone Miner Res 22(3):465–475PubMedCrossRefGoogle Scholar
  3. 3.
    Engelke K, Kemmler W, Lauber D, Beeskow C, Pintag R, Kalender WA (2006) Exercise maintains bone density at spine and hip efops: A 3-year longitudinal study in early postmenopausal women. Osteoporos Int 17(1):133–142PubMedCrossRefGoogle Scholar
  4. 4.
    Going S, Lohman T, Houtkooper L, Metcalfe L, Flint-Wagner H, Blew R, Stanford V, Cussler E, Martin J, Teixeira P, Harris M, Milliken L, Figueroa-Galvez A, Weber J (2003) Effects of exercise on bone mineral density in calcium-replete postmenopausal women with and without hormone replacement therapy. Osteoporos Int 14(8):637–643PubMedCrossRefGoogle Scholar
  5. 5.
    Kohrt WM, Ehsani AA, Birge SJ Jr (1997) Effects of exercise involving predominantly either joint-reaction or ground-reaction forces on bone mineral density in older women. J Bone Miner Res 12(8):1253–1261PubMedCrossRefGoogle Scholar
  6. 6.
    Maddalozzo GF, Snow CM (2000) High intensity resistance training: effects on bone in older men and women. Calcif Tissue Int 66(6):399–404PubMedCrossRefGoogle Scholar
  7. 7.
    Maddalozzo GF, Widrick JJ, Cardinal BJ, Winters-Stone KM, Hoffman MA, Snow CM (2007) The effects of hormone replacement therapy and resistance training on spine bone mineral density in early postmenopausal women. Bone 40(5):1244–1251PubMedCrossRefGoogle Scholar
  8. 8.
    Liu-Ambrose TY, Khan KM, Eng JJ, Heinonen A, McKay HA (2004) Both resistance and agility training increase cortical bone density in 75- to 85-year-old women with low bone mass: a 6-month randomized controlled trial. J Clin Densitom 7(4):390–398PubMedCrossRefGoogle Scholar
  9. 9.
    Karinkanta S, Heinonen A, Sievanen 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. Osteoporos Int 18(4):453–462PubMedCrossRefGoogle Scholar
  10. 10.
    Englund U, Littbrand H, Sondell A, Bucht G, Pettersson U (2009) The beneficial effects of exercise on bmd are lost after cessation: a 5-year follow-up in older post-menopausal women. Scand J Med Sci Sports 19(3):381–388PubMedCrossRefGoogle Scholar
  11. 11.
    Winters KM, Snow CM (2000) Detraining reverses positive effects of exercise on the musculoskeletal system in premenopausal women. J Bone Miner Res 15(12):2495–2503PubMedCrossRefGoogle Scholar
  12. 12.
    Young CM, Weeks BK, Beck BR (2007) Simple, novel physical activity maintains proximal femur bone mineral density, and improves muscle strength and balance in sedentary, postmenopausal caucasian women. Osteoporos Int 18(10):1379–1387PubMedCrossRefGoogle Scholar
  13. 13.
    Shaw JM, Snow CM (1998) Weighted vest exercise improves indices of fall risk in older women. J Gerontol A Biol Sci Med Sci 53(1):M53–M58PubMedCrossRefGoogle Scholar
  14. 14.
    Snow CM, Shaw JM, Winters KM, Witzke KA (2000) Long-term exercise using weighted vests prevents hip bone loss in postmenopausal women. J Gerontol A Biol Sci Med Sci 55(9):M489–M491PubMedCrossRefGoogle Scholar
  15. 15.
    Oregon State University Extension Family and Community Health Program (2008) The Better Bones and Balance program. http://extension.oregonstate.edu/physicalactivity/bbb. Accessed October 10 2010
  16. 16.
    Schultz-Larsen K, Lomholt RK, Kreiner S (2007) Mini-mental status examination: a short form of mmse was as accurate as the original mmse in predicting dementia. J Clin Epidemiol 60(3):260–267PubMedCrossRefGoogle Scholar
  17. 17.
    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(3):189–198PubMedCrossRefGoogle Scholar
  18. 18.
    Rose D (2003) Fall proof! A comprehensive balance and mobility training program, 1st edn. Human Kinetics, ChampaignGoogle Scholar
  19. 19.
    Bennett JA, Winters-Stone K, Nail LM, Scherer J (2006) Definitions of sedentary in physical-activity-intervention trials: a summary of the literature. J Aging Phys Act 14(4):456–477PubMedGoogle Scholar
  20. 20.
    Kohl HW, Blair SN, Paffenbarger RS Jr, Macera CA, Kronenfeld JJ (1988) A mail survey of physical activity habits as related to measured physical fitness. Am J Epidemiol 127(6):1228–1239PubMedGoogle Scholar
  21. 21.
    Ainsworth BE, Haskell WL, Leon AS, Jacobs DR Jr, Montoye HJ, Sallis JF, Paffenbarger RS Jr (1993) Compendium of physical activities: classification of energy costs of human physical activities. Med Sci Sports Exerc 25(1):71–80PubMedCrossRefGoogle Scholar
  22. 22.
    Pereira MA, FitzerGerald SJ, Gregg EW, Joswiak ML, Ryan WJ, Suminski RR, Utter AC, Zmuda JM (1997) A collection of physical activity questionnaires for health-related research. Med Sci Sports Exerc 29(6 Suppl):S1–S205PubMedGoogle Scholar
  23. 23.
    Weeks BK, Beck BR (2008) The BPAQ: a bone-specific physical activity assessment instrument. Osteoporos Int 19(11):1567–1577PubMedCrossRefGoogle Scholar
  24. 24.
    Block G, Woods M, Potosky A, Clifford C (1990) Validation of a self-administered diet history questionnaire using multiple diet records. J Clin Epidemiol 43(12):1327–1335PubMedCrossRefGoogle Scholar
  25. 25.
    Mifflin MD, St Jeor ST, Hill LA, Scott BJ, Daugherty SA, Koh YO (1990) A new predictive equation for resting energy expenditure in healthy individuals. Am J Clin Nutr 51(2):241–247PubMedGoogle Scholar
  26. 26.
    Goldberg GR, Black AE, Jebb SA, Cole TJ, Murgatroyd PR, Coward WA, Prentice AM (1991) Critical evaluation of energy intake data using fundamental principles of energy physiology: 1. Derivation of cut-off limits to identify under-recording. Eur J Clin Nutr 45(12):569–581PubMedGoogle Scholar
  27. 27.
    Ott S (2010) Osteoporosis and bone physiology. http://courses.washington.edu/bonephys/opbmdtz.html#tcalc. Accessed October 2010
  28. 28.
    Looker AC, Wahner HW, Dunn WL, Calvo MS, Harris TB, Heyse SP, Johnston CC Jr, Lindsay R (1998) Updated data on proximal femur bone mineral levels of us adults. Osteoporos Int 8(5):468–489PubMedCrossRefGoogle Scholar
  29. 29.
    Kanis JA, Gluer CC (2000) An update on the diagnosis and assessment of osteoporosis with densitometry. Committee of scientific advisors, international osteoporosis foundation. Osteoporos Int 11(3):192–202PubMedCrossRefGoogle Scholar
  30. 30.
    Jessup JV, Horne C, Vishen RK, Wheeler D (2003) Effects of exercise on bone density, balance, and self-efficacy in older women. Biol Res Nurs 4(3):171–180PubMedCrossRefGoogle Scholar
  31. 31.
    Kemmler W, Engelke K, Lauber D, Weineck J, Hensen J, Kalender WA (2002) Exercise effects on fitness and bone mineral density in early postmenopausal women: 1-year EFOPS results. Med Sci Sports Exerc 34(12):2115–2123PubMedCrossRefGoogle Scholar
  32. 32.
    Kemmler W, Lauber D, Weineck J, Hensen J, Kalender W, Engelke K (2004) Benefits of 2 years of intense exercise on bone density, physical fitness, and blood lipids in early postmenopausal osteopenic women: results of the Erlangen Fitness Osteoporosis Prevention Study (EFOPS). Arch Intern Med 164(10):1084–1091PubMedCrossRefGoogle Scholar
  33. 33.
    Park H, Kim KJ, Komatsu T, Park SK, Mutoh Y (2008) Effect of combined exercise training on bone, body balance, and gait ability: a randomized controlled study in community-dwelling elderly women. J Bone Miner Metab 26(3):254–259PubMedCrossRefGoogle Scholar
  34. 34.
    Villareal DT, Binder EF, Yarasheski KE, Williams DB, Brown M, Sinacore DR, Kohrt WM (2003) Effects of exercise training added to ongoing hormone replacement therapy on bone mineral density in frail elderly women. J Am Geriatr Soc 51(7):985–990PubMedCrossRefGoogle Scholar
  35. 35.
    Uusi-Rasi K, Kannus P, Cheng S, Sievanen H, Pasanen M, Heinonen A, Nenonen A, Halleen J, Fuerst T, Genant H, Vuori I (2003) Effect of alendronate and exercise on bone and physical performance of postmenopausal women: a randomized controlled trial. Bone 33(1):132–143PubMedCrossRefGoogle Scholar
  36. 36.
    Sornay-Rendu E, Boutroy S, Munoz F, Delmas PD (2007) Alterations of cortical and trabecular architecture are associated with fractures in postmenopausal women, partially independent of decreased bmd measured by dxa: the OFELY Study. J Bone Miner Res 22(3):425–433PubMedCrossRefGoogle Scholar
  37. 37.
    Vico L, Zouch M, Amirouche A, Frere D, Laroche N, Koller B, Laib A, Thomas T, Alexandre C (2008) High-resolution pqct analysis at the distal radius and tibia discriminates patients with recent wrist and femoral neck fractures. J Bone Miner Res 23(11):1741–1750PubMedCrossRefGoogle Scholar
  38. 38.
    Nikander R, Sievanen H, Heinonen A, Daly RM, Uusi-Rasi K, Kannus P (2010) Targeted exercise against osteoporosis: a systematic review and meta-analysis for optimising bone strength throughout life. BMC Med 8:47PubMedCrossRefGoogle Scholar
  39. 39.
    McNamara A (2010) Translating the better bones and balance intervention program into the community setting: Effects of participation on skeletal health, fall risk indicators, and physical activity among older women. Dissertation, Oregon State University, CorvallisGoogle Scholar
  40. 40.
    Ensrud KE, Ewing SK, Stone KL, Cauley JA, Bowman PJ, Cummings SR (2003) Intentional and unintentional weight loss increase bone loss and hip fracture risk in older women. J Am Geriatr Soc 51(12):1740–1747PubMedCrossRefGoogle Scholar
  41. 41.
    Kelly TL, Wilson KE, Heymsfield SB (2009) Dual energy X-ray absorptiometry body composition reference values from NHANES. PLoS One 4(9):e7038PubMedCrossRefGoogle Scholar
  42. 42.
    Gunter KB, McNamara AJ (2010) Successful translation of better bones and balance: a community-based fall and fracture risk reduction exercise program for older adults. Med Sci Sports Exerc 42(5):s48Google Scholar
  43. 43.
    Jarvinen TL, Sievanen H, Khan KM, Heinonen A, Kannus P (2008) Shifting the focus in fracture prevention from osteoporosis to falls. BMJ 336(7636):124–126PubMedCrossRefGoogle Scholar
  44. 44.
    Nelson ME, Rejeski WJ, Blair SN, Duncan PW, Judge JO, King AC, Macera CA, Castaneda-Sceppa C (2007) Physical activity and public health in older adults: recommendation from the American College of Sports Medicine and the American Heart Association. Med Sci Sports Exerc 39(8):1435–1445PubMedCrossRefGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2011

Authors and Affiliations

  1. 1.Biological and Population Health SciencesOregon State UniversityCorvallisUSA

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