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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

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Abstract

Summary

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.

Introduction

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.

Methods

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.

Results

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.

Conclusions

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

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Acknowledgments

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.

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Authors and Affiliations

  1. University of California, 1500 Owens Street, San Francisco, CA, 94158, USA

    W. B. Katzman & S. Wong

  2. University of California, 550 16th. Street, San Francisco, CA, 94158, USA

    E. Vittinghoff & F. Lin

  3. University of California, 4150 Clement St, San Francisco, CA, 94121, USA

    A. Schafer

  4. San Francisco Veterans Affairs Health Care System, 4150 Clement St, San Francisco, CA, 94121, USA

    A. Schafer

  5. University of California, 550 16th. Street, San Francisco, CA, 94143, USA

    R. K. Long

  6. Kaiser Permanente Northern CA, San Francisco Medical Center, 1635 Divisadero Street, Suite 300, San Francisco, CA, 94115, USA

    A. Gladin

  7. University of California, 400 Parnassus Avenue, San Francisco, CA, 94117, USA

    B. Fan

  8. Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02215, USA

    B. Allaire

  9. University of California, 9500 Gilman Dr, La Jolla, CA, 92093, USA

    D. M. Kado

  10. University of California, 4625 Second Avenue, Suite 2000, Sacramento, CA, 95616, USA

    N. E. Lane

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  1. W. B. Katzman
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  10. D. M. Kado
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  11. N. E. Lane
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Corresponding author

Correspondence to W. B. Katzman.

Ethics declarations

The study protocol was approved by the University of California San Francisco and Kaiser Permanente Northern California Institutional Review Boards.

Conflicts of interest

None.

Funding

This research was supported by the National Institute on Aging (NIA) RO1AG041921.

Additional information

D. M. Kado and N. E. Lane are joint senior authors.

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Katzman, W.B., Vittinghoff, E., Lin, F. et al. 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. Osteoporos Int 28, 2831–2841 (2017). https://doi.org/10.1007/s00198-017-4109-x

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