title: Effects of a targeted multimodal exercise program incorporating high-speed power training on falls and fracture risk factors in older adults: a community-based randomized controlled trial. Power training is more effective than strength training for maintaining bone mineral density in postmenopausal women. Group treatment improves trunk strength and psychological status in older women with vertebral fractures: results of a randomized, clinical trial. Impact of Tai Chi exercise on multiple fracture-related risk factors in post-menopausal osteopenic women: a pilot pragmatic, randomized trial Exercise and fractures in postmenopausal women. Final results of the controlled Erlangen Fitness and Osteoporosis Prevention Study (EFOPS) Interpreting estimates of treatment effects: implications for managed care. Integration of balance and strength training into daily life activity to reduce rate of falls in older people (the LiFE study): randomised parallel trial Effects of an exercise and manual therapy program on physical impairments, function and quality-of-life in people with osteoporotic vertebral fracture: a randomised, single-blind controlled pilot trial Tai Chi and fall reductions in older adults: a randomized controlled trial. A Randomized Clinical Trial of Aquatic versus Land Exercise to Improve Balance, Function, and Quality of Life in Older Women with Osteoporosis. Effect of Tai Chi on body balance: randomized controlled trial in elderly men with dizziness. Effects of high-intensity strength training on multiple risk factors for osteoporotic fractures. A randomized controlled trial. The efficacy of home-based muscle training for the elderly osteoporotic women: the effects of daily muscle training on quality of life (QoL). Effect of low-intensity back exercise on quality of life and back extensor strength in patients with osteoporosis: a randomized controlled trial 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 Efficacy of home-based exercise for improving quality of life among elderly women with symptomatic osteoporosis-related vertebral fractures 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. Effect of strength and power training on physical function in community-dwelling older adults. Effects of tai chi exercise on posturography, gait, physical function and quality of life in postmenopausal women with osteopaenia: a randomized clinical study Home-based trunk-strengthening exercise for osteoporotic and osteopenic postmenopausal women without fracture –a pilot study Exercise effects on bone mass in postmenopausal women are site-specific and load-dependent. Resistance training programs on bone related variables and functional independence of postmenopausal women in pharmacological treatment: A randomized controlled trial. Once a week not enough, twice a week not feasible? A randomised controlled exercise trial in long-term care facilities [ISRCTN87177281]. Efficacy of a short multidisciplinary falls prevention program for elderly persons with osteoporosis and a fall history: a randomized controlled trial. Effect of resistance exercises on function in older adults with osteoporosis or osteopenia: a systematic review.
abstract: Multimodal exercise programs incorporating traditional progressive resistance training ( PRT ) , weight-bearing impact training and /or balance training are recommended to reduce risk factors for falls and fracture . However , muscle power , or the ability to produce force rapidly , has emerged as a more crucial variable to functional decline than muscle strength or mass . The aim of this 12-month community-based r and omized controlled trial , termed Osteo-cise : Strong Bones for Life , was to evaluate the effectiveness and feasibility of a multimodal exercise program incorporating high-velocity (HV)-PRT , combined with an osteoporosis education and behavioral change program , on bone mineral density ( BMD ) , body composition , muscle strength and functional muscle performance in older adults . Falls incidence was evaluated as a secondary outcome . A total of 162 older adults ( mean ± SD ; 67 ± 6 years ) with risk factors for falls and /or low BMD were r and omized to the Osteo-cise program ( n = 81 ) or a control group ( n = 81 ) . Exercise consisted of fitness center-based HV-PRT , weight-bearing impact and challenging balance/mobility activities performed three times weekly . After 12 months , the Osteo-cise program led to modest but significant net gains in femoral neck and lumbar spine BMD ( 1.0 % to 1.1 % , p < 0.05 ) , muscle strength ( 10 % to 13 % , p < 0.05 ) , functional muscle power ( Timed Stair Climb , 5 % , p < 0.05 ) and dynamic balance ( Four Square Step Test 6 % , p < 0.01 ; Sit-to-St and , 16 % , p < 0.001 ) relative to controls . There was no effect on total body lean mass or mobility ( timed-up- and -go ) , and no difference in falls rate ( incidence rate ratio [ IRR ] , 1.22 ; 95 % confidence interval [ CI ] , 0.72 - 2.04 ) . In conclusion , this study demonstrates that the Osteo-cise : Strong Bones for Life community-based , multimodal exercise program represents an effective approach to improve multiple musculoskeletal and functional performance measures in older adults with risk factors for falls and /or low BMD . Although this did not translate into a reduction in the rate of falls , further large-scale trials are needed to evaluate the efficacy of this multimodal approach on reducing falls and fracture Physical exercise has a favorable impact on bones , but optimum training strategies are still under discussion . In this study , we compared the effect of slow and fast resistance exercises on various osteodensitometric parameters .  Fifty-three postmenopausal women were r and omly assigned to a strength training ( ST ) or a power training group ( PT ) . Both groups carried out a progressive resistance training , a gymnastics session , and a home training over a period of 12 mo . During the resistance training , the ST group used slow and the PT group fast movements ; otherwise there were no training differences . All subjects were supplemented with Ca and vitamin D. At baseline and after 12 mo , bone mineral density ( BMD ) was measured at the lumbar spine , proximal femur , and distal forearm by dual-energy X-ray absorptiometry . We also measured anthropometric data and maximum static strength . Frequency and grade of pain were assessed by question naire . After 12 mo , significant between-group differences were observed for BMD at the lumbar spine ( P < 0.05 ) and the total hip ( P < 0.05 ) . Whereas the PT group maintained BMD at the spine ( + 0.7 + /- 2.1 % , not significant ) and the total hip ( 0.0 + /- 1.7 % , not significant ) , the ST group lost significantly at both sites ( spine : -0.9 + /- 1.9 % ; P < 0.05 ; total hip : -1.2 + /- 1.5 % ; P < 0.01 ) . No significant between-group differences were observed for anthropometric data , maximum strength , BMD of the forearm , or frequency and grade of pain . These findings suggest that power training is more effective than strength training in reducing bone loss in postmenopausal women OBJECTIVES To assess whether group exercise and coping classes reduce physical and psychological impairments and functional disability in older women with prevalent vertebral fractures ( VFs ) . DESIGN R and omized , controlled trial ( modified cross-over ) with site as unit of assignment ; testing at baseline and 3 , 6 , 9 , and 12 months . SETTING Nine North Carolina retirement communities . PARTICIPANTS One hundred eighty-five postmenopausal Caucasian women ( mean age 81 ) , each with at least one VFs . INTERVENTION The intervention group had 6 months of exercise ( 3 meetings weekly , 45 minutes each ) and coping classes ( 2 meetings weekly , 45 minutes each ) in Phase 1 , followed by 6 months of self-maintenance . The control group had 6 months of health education control intervention ( 1 meeting weekly , 45 minutes ) in Phase 1 , followed by the intervention described above . MEASUREMENTS Change in trunk extension strength , change in pain with activities , and change in psychological symptoms . RESULTS Between-group differences in the change in trunk extension strength ( 10.68 foot pounds , P<.001 ) and psychological symptoms ( -0.08 , P=.011 ) were significant for Phase 1 . Changes in pain with activities did not differ between groups ( -0.03 , P=.64 ) ; there was no change in the pain endpoint . In Phase 2 , controls showed significant changes in trunk strength ( 15.02 foot pounds , P<.001 ) and psychological symptoms ( -0.11 , P=.006 ) from baseline . Change in pain with activities was not significant ( -0.03 , P=.70 ) . During self-maintenance , the intervention group did not worsen in psychological symptoms , but improved trunk extension strength was not maintained . CONCLUSION Weak trunk extension strength and psychological symptoms associated with VFs can be improved in older women using group treatment , and psychological improvements are retained for at least 6 months Background Tai Chi ( TC ) is a mind-body exercise that shows potential as an effective and safe intervention for preventing fall-related fractures in the elderly . Few r and omized trials have simultaneously evaluated TC 's potential to reduce bone loss and improve fall-predictive balance parameters in osteopenic women . Methods In a pragmatic r and omized trial , 86 post-menopausal osteopenic women , aged 45 - 70 , were recruited from community clinics . Women were assigned to either nine months of TC training plus usual care ( UC ) vs. UC alone . Primary outcomes were changes between baseline and nine months of bone mineral density ( BMD ) of the proximal femur and lumbar spine ( dual-energy X-ray absorptiometry ) and serum markers of bone resorption and formation . Secondary outcomes included quality of life . In a sub sample ( n = 16 ) , quiet st and ing fall-predictive sway parameters and clinical balance tests were also assessed . Both intent-to-treat and per- protocol analyses were employed . Results For BMD , no intent-to-treat analyses were statistically significant ; however , per protocol analyses ( i.e. , only including TC participants who completed ≥ 75 % training requirements ) of femoral neck BMD changes were significantly different between TC and UC ( + 0.04 vs. -0.98 % ; P = 0.05 ) . Changes in bone formation markers and physical domains of quality of life were also more favorable in per protocol TC vs. UC ( P = 0.05 ) . Changes in sway parameters were significantly improved by TC vs. UC ( average sway velocity , P = 0.027 ; anterior-posterior sway range , P = 0.014 ) . Clinical measures of balance and function showed non-significant trends in favor of TC . Conclusions TC training offered through existing community-based programs is a safe , feasible , and promising intervention for reducing multiple fracture risks . Our results affirm the value of a more definitive , longer-term trial of TC for osteopenic women , adequately powered to detect clinical ly relevant effects of TC on attenuation of BMD loss and reduction of fall risk in this population .Trial Registration Clinical Trials.gov : Summary The EFOPS trial clearly established the positive effect of long-term exercise on clinical low-trauma fractures in postmenopausal women at risk . Bearing in mind that the complex anti-fracture exercise protocol s also affect a large variety of diseases of increased age , we strongly encourage older adults to perform multi purpose exercise programs . Introduction Physical exercise may be an efficient option for autonomous fracture prevention during increasing age . The aim of the study was to evaluate the effect of exercise on clinical overall fracture incidence and bone mineral density ( BMD ) in elderly subjects at risk . Methods In 1998 initially , 137 early-postmenopausal , osteopenic women living in Erlangen-Nuremberg , Germany , were included in the EFOPS trial . Subjects of the exercise group ( EG ; n = 86 ) conducted two supervised group and two home exercise sessions/week while the control group ( CG ; n = 51 ) was requested to maintain their physical activity . Primary study endpoints were clinical overall low-trauma fractures determined by question naires , structured interviews , and BMD at the lumbar spine and femoral neck assessed by dual-energy X-ray absorptiometry . Results In 2014 , 105 subjects ( EG : n = 59 vs. CG : n = 46 ) representing 1680 participant-years were included in the 16-year follow-up analysis .  Risk ratio in the EG for overall low-trauma fractures was 0.51 ( 95 % confidence interval ( 95 % CI ) 0.23 to 0.97 , p = .046 ) , rate ratio was 0.42 ( 95 % CI 0.20 to 0.86 , p = .018 ) . Based on comparable baseline values , lumbar spine ( MV −1.5 % , 95 % CI −0.1 to −2.8 vs. −5.8 % , −3.3 to −7.2 % ) and femoral neck ( −6.5 % , −5.2 to −7.7 vs. −9.6 % , −8.2 to 11.1 % ) BMD decreased in both groups ; however , the reduction was more pronounced in the CG ( p ≤ .001 ) . Conclusion This study clearly evidence d the high anti-fracture efficiency of multi purpose exercise programs . Considering furthermore the favorable effect of exercise on most other risk factors of increasing age , we strongly encourage older adults to perform multi purpose exercise programs How should health care professionals choose among the many therapies cl aim ed to be efficacious for treating specific disorders ? The practice of evidence -based medicine provides an answer . Advocates of this approach urge health care professionals to base treatment choices on the best evidence from systematic research on both the efficacy and adverse effects of various therapeutic alternatives . Ideally , health care professionals would compare different treatments by referring to r and omized , double-blind , head-to-head trials that compared the treatment options . Although individual medications are typically well research ed when these placebo-controlled studies are performed , studies that directly compare treatments are rare . In the absence of direct head-to-head trials , other evidence comes from indirect comparisons of two or more therapies by examining individual studies involving each treatment . This article provides an introductory review of methods of such indirect comparisons of therapies across studies , provides examples of how these methods can be used to make treatment decisions , and presents a general overview of relevant issues and statistics for readers interested in underst and ing these methods more thoroughly Objectives To determine whether a lifestyle integrated approach to balance and strength training is effective in reducing the rate of falls  in older , high risk people living at home . Design Three arm , r and omised parallel trial ; assessment s at baseline and after six and 12 months . R and omisation done by computer generated r and om blocks , stratified by sex and fall history and concealed by an independent secure website . Setting Residents in metropolitan Sydney , Australia . Participants Participants aged 70 years or older who had two or more falls or one injurious fall in past 12 months , recruited from Veteran ’s Affairs data bases and general practice data bases . Exclusion criteria were moderate to severe cognitive problems , inability to ambulate independently , neurological conditions that severely influenced gait and mobility , resident in a nursing home or hostel , or any unstable or terminal illness that would affect ability to do exercises . Interventions Three home based interventions : Lifestyle integrated Functional Exercise ( LiFE ) approach ( n=107 ; taught principles of balance and strength training and integrated selected activities into everyday routines ) , structured programme ( n=105 ; exercises for balance and lower limb strength , done three times a week ) , sham control programme ( n=105 ; gentle exercise ) . LiFE and structured groups received five sessions with two booster visits and two phone calls ; controls received three home visits and six phone calls . Assessment s made at baseline and after six and 12 months . Main outcome measures Primary measure : rate of falls over 12 months , collected by self report . Secondary measures : static and dynamic balance ; ankle , knee and hip strength ; balance self efficacy ; daily living activities ; participation ; habitual physical activity ; quality of life ; energy expenditure ; body mass index ; and fat free mass . Results After 12 months ’ follow-up , we recorded 172 , 193 , and 224 falls in the LiFE , structured exercise , and control groups , respectively . The overall incidence of falls in the LiFE programme was 1.66 per person years , compared with 1.90 in the structured programme and 2.28 in the control group . We saw a significant reduction of 31 % in the rate of falls for the LiFE programme compared with controls ( incidence rate ratio 0.69 ( 95 % confidence interval 0.48 to 0.99 ) ) ; the corresponding difference between the structured group and controls was non-significant ( 0.81 ( 0.56 to 1.17 ) ) . Static balance on an eight level hierarchy scale , ankle strength , function , and participation were significantly better in the LiFE group than in controls . LiFE and structured groups had a significant and moderate improvement in dynamic balance , compared with controls . Conclusions The LiFE programme provides an alternative to traditional exercise to consider for fall prevention . Functional based exercise should be a focus for interventions to protect older , high risk people from falling and to improve and maintain functional capacity . Trial registration Australia and New Zeal and Clinical Trials Registry 12606000025538 Background This r and omised , single-blind controlled pilot trial aim ed to determine the effectiveness of a physiotherapy program , including exercise and manual therapy , in reducing impairments and improving physical function and health-related quality of life in people with a history of painful osteoporotic vertebral fracture . Methods 20 participants were r and omly allocated to an intervention ( n = 11 ) or control ( n = 9 ) group . The intervention group attended individual sessions with an experienced clinician once a week for 10 weeks and performed daily home exercises with adherence monitored by a self-report diary . The control group received no treatment . Blinded assessment was conducted at baseline and 11 weeks . Question naires assessed self-reported changes in back pain , physical function , and health-related quality of life . Objective measures of thoracic kyphosis , back and shoulder muscle endurance ( Timed Loaded St and ing Test ) , and function ( Timed Up and Go test ) were also taken . Results Compared with the control group , the intervention group showed significant reductions in pain during movement ( mean difference ( 95 % CI ) -1.8 ( -3.5 to -0.1 ) ) and at rest ( -2.0 ( -3.8 to -0.2 ) ) and significantly greater improvements in Qualeffo physical function ( -4.8 ( -9.2 to -0.5 ) ) and the Timed Loaded St and ing test ( 46.7 ( 16.1 to 77.3 ) secs ) . For the perceived change in back pain over the 10 weeks , 9/11 ( 82 % ) participants in the intervention group rated their pain as ' much better ' compared with only 1/9 ( 11 % ) participants in the control group . Conclusion Despite the modest sample size , these results support the benefits of exercise and manual therapy in the clinical management of patients with osteoporotic vertebral fractures , but need to be confirmed in a larger sample .Trail registration BACKGROUND The authors ' objective was to evaluate the efficacy of a 6-month Tai Chi intervention for decreasing the number of falls and the risk for falling in older persons . METHODS This r and omized controlled trial involved a sample of 256 physically inactive , community-dwelling adults aged 70 to 92 ( mean age , 77.48 years ; st and ard deviation , 4.95 years ) who were recruited through a patient data base in Portl and , Oregon . Participants were r and omized to participate in a three-times-per-week Tai Chi group or to a stretching control group for 6 months . The primary outcome measure was the number of falls ; the secondary outcome measures included functional balance ( Berg Balance Scale , Dynamic Gait Index , Functional Reach , and single-leg st and ing ) , physical performance ( 50-foot speed walk , Up&Go ) , and fear of falling , assessed at baseline , 3 months , 6 months ( intervention termination ) , and at a 6-month postintervention follow-up . RESULTS At the end of the 6-month intervention , significantly fewer falls ( n=38 vs 73 ; p=.007 ) , lower proportions of fallers ( 28 % vs 46 % ; p=.01 ) , and fewer injurious falls ( 7 % vs 18 % ; p=.03 ) were observed in the Tai Chi group compared with the stretching control group . After adjusting for baseline covariates , the risk for multiple falls in the Tai Chi group was 55 % lower than that of the stretching control group ( risk ratio,.45 ; 95 % confidence interval , 0.30 to 0.70 ) . Compared with the stretching control participants , the Tai Chi participants showed significant improvements ( p<.001 ) in all measures of functional balance , physical performance , and reduced fear of falling . Intervention gains in these measures were maintained at a 6-month postintervention follow-up in the Tai Chi group . CONCLUSIONS A three-times-per-week , 6-month Tai Chi program is effective in decreasing the number of falls , the risk for falling , and the fear of falling , and it improves functional balance and physical performance in physically inactive persons aged 70 years or older PURPOSE Despite the decreased gravitational loading that is experienced in an aquatic environment , little research has been conducted on this exercise medium for women with osteoporosis ( OP ) .  Aquatic exercise ( AE ) may improve function and balance , thus ultimately decreasing fall risk and the potential for hip fractures in this high-risk population . METHOD A total of 68 women with OP , aged 60 years or older , were recruited into a r and omized clinical trial evaluating the impact of AE , l and exercise ( LE ) , and no exercise ( NE ) on balance , functional mobility , and quality of life ( QOL ) . RESULTS Only one balance measure ( backward t and em walk ) significantly improved with AE compared to LE , but this did not translate into a greater improvement in self-report function . There were no significant differences between the exercise interventions and NE , except for in ratings of global change , where participants in the AE group were three times more likely to report improvement than those in the NE group . CONCLUSION There were no differences in balance , function , or QOL in women with OP who followed an AE or LE programme compared to those in an NE control group . However , the significant differences in backward t and em walk between the AE and LE groups and self-reported global change between the AE and NE groups warrant further investigation . Significant improvements in balance and global change suggest that AE is a viable alternative for older women with OP who have difficulty exercising on l and The purpose of this study was to assess the effect of 18-week Tai Chi training on body balance in a dynamic trial among elderly men with dizziness . The study covered subjects aged 60 to 80 years . We identified 40 men who reported a history of dizziness . The subjects were recruited using direct mailings and a community information campaign . The participants were r and omly assigned to either the exercise intervention ( n = 20 ) or control group ( n = 20 ) . The Tai Chi group participated in an 18-week exercise class held for 45 minutes twice a week . Body balance was studied in two ways : using the " 8 foot up and go test " ( Rikli and Jones 2001 ) and using a Computer Posturographic System PE 90 ( manufactured by Military Institute of Aviation Medicine in Warsaw and outfitted with Pro-Med modified software ) . The ability to perform specific tasks ( maximal deflections in four directions ) was measured on the posturographic platform . The variation in results obtained on the first and second date of tests in the experimental and control groups was confirmed statistically using four parameters , i.e. " 8 foot up to and go test ( H = 8.21;p = 0.003 ) , forward deflection ( H = 3.70;p = 0.050 ) , backward deflection ( H = 5.04;p = 0.024 ) and maximum sway area ( H = 8.86;p = 0.002 ) . Consequently , we found that the 18-week period of Tai-Chi exercises , with a frequency of twice a week for 45 minutes , is beneficial for dynamic balance , which is important for the reduction of fall risk factors among elderly men with dizziness OBJECTIVE To determine how multiple risk factors for osteoporotic fractures could be modified by high-intensity strength training exercises in postmenopausal women . DESIGN R and omized controlled trial of 1-year duration . SETTING Exercise laboratory at Tufts University , Boston , Mass. POPULATION Forty postmenopausal white women , 50 to 70 years of age , participated in the study ; 39 women completed the study . The subjects were sedentary and estrogen-deplete . INTERVENTIONS High-intensity strength training exercises 2 days per week using five different exercises ( n = 20 ) vs untreated controls ( n = 19 ) . MAIN OUTCOME MEASURES Dual energy x-ray absorptiometry for bone status , one repetition maximum for muscle strength , 24-hour urinary creatinine for muscle mass , and backward t and em walk for dynamic balance . RESULTS Femoral neck bone mineral density and lumbar spine bone mineral density increased by 0.005 + /- 0.039 g/cm2 ( 0.9 % + /- 4.5 % ) ( mean + /- SD ) and 0.009 + /- 0.033 g/cm2 ( 1.0 % + /- 3.6 % ) , respectively , in the strength-trained women and decreased by -0.022 + /- 0.035 g/cm2 ( -2.5 % + /- 3.8 % ) and -0.019 + /- 0.035 g/cm2 ( -1.8 % + /- 3.5 % ) , respectively , in the controls ( P = .02 and .04 ) . Total body bone mineral content was preserved in the strength-trained women ( + 2.0 + /- 68 g ; 0.0 % + /- 3.0 % ) and tended to decrease in the controls ( -33 + 77 g ; -1.2 % + /- 3.4 % , P = .12 ) . Muscle mass , muscle strength , and dynamic balance increased in the strength-trained women and decreased in the controls ( P = .03 to < .001 ) . CONCLUSIONS High-intensity strength training exercises are an effective and feasible means to preserve bone density while improving muscle mass , strength , and balance in postmenopausal women There is little evidence that home-based muscle training through exercise improves the muscle strength and QoL of elderly osteoporotic women . The efficacy of home-based daily exercise on muscle strength of the upper and lower extremities and QoL were examined in elderly osteoporotic women by means of a case-controlled study that was design ed and conducted between 2005 and 2006 . Sixty-three osteoporotic women over 60 years of age were r and omly assigned to 12 months of muscle exercise or to no intervention . The outcomes were changes in muscle strength and quality of life ( QoL ) . Ultimately , sixty-two participants completed the 12 months program . Before the start of home-exercise training , the lumbar spine bone mineral density ( BMD ) and femoral neck BMD values in the intervention group were significantly lower than those in the control group ( p<0.05 ) . Grip strength and maximum walking speed increased significantly in the intervention group ( p<0.05 ) . In terms of QoL , physical functioning was improved by home-based exercise in the intervention group ( p=0.05 ) , while there were no improvements in any of the categories of Short-Form 36 in the control group . Our results suggest that home-based training is effective for elderly osteoporotic women in improving not only muscle strength in upper and lower extremities but also physical functioning in Summary R and omized controlled study in 80 postmenopausal women with osteoporosis was conducted to investigate the effect of a home-based , simple , low-intensity exercise . Low-intensity back-strengthening exercise was effective in improving the quality of life and back extensor strength . Introduction and hypothesisBack-strengthening exercise is effective in increasing back extensor strength and decreasing risk of vertebral fractures . We hypothesized that a home-based , simple , low-intensity exercise could enhance back extensor strength and improve the quality of life and /or spinal range of motion in postmenopausal women in a short-term follow-up . Methods Eighty postmenopausal women with osteoporosis were r and omly assigned to a  control group ( n = 38 ) or an exercise group ( n = 42 ) . Subjects were instructed to lift their upper trunk from a prone position antigravity and maintain the neutral position . Isometric back extensor strength , spinal range of motion , and scores for quality of life were evaluated at baseline and 4 months . Results Back extensor strength significantly increased both in the exercise group ( 26 % ) and in the control group ( 11 % ) . Scores for quality of life increased in the exercise group ( 7 % ) , whereas it remained unchanged in the control group ( 0 % ) . There was a significant difference in quality of life score between the groups ( p = 0.012 ) . Conclusions Low-intensity back-strengthening exercise was effective in improving the quality of life and back extensor strength in patients with osteoporosis Summary The aim of this r and omized 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 . Introduction 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 . Methods The participants ( 89 ) were r and omized 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 Question naire issued by the European Foundation for Osteoporosis ( ‘ QUALEFFO-41 ’ ) and the General Health Question naire ( 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 . Results 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 . Conclusion Circuit exercises will improve mobility and health-related quality of life of elderly women with osteoporosis and a history of vertebral fractures This r and omized controlled trial was design ed to investigate the effect of a 6-month home-based exercise program versus control ( usual activities ) on quality of life for postmenopausal women with osteoporosis who had at least one vertebral fracture . Twelve-month assessment s of outcomes were completed to determine if women would continue exercising with minimal supervision and if benefit could be sustained . The home exercise program followed a " lifestyle exercise " approach where participants completed exercises 60 min per day , 3 days a week and could complete exercises in small periods of time throughout the day . Exercise activities included stretching , strength training and aerobics ( i.e. walking ) . Participants were assessed at baseline , 6 months , and 12 months using the Osteoporosis Quality of Life Question naire ( OQLQ ) , the Sickness Impact Profile ( SIP ) , a balance test , and the Timed Up And Go test . Bone mineral density was assessed at baseline and 12 months for both the lumbar spine and femoral neck . Quality of life ( OQLQ ) improved over 6 months in the exercise group compared to the control group in the domains of symptoms ( P=0.003 ) , emotion ( P=0.01 ) and leisure ( P=0.03 ) . Results from the balance test indicated a greater effect in the exercise group over 12 months ( P<0.05 ) . There were no significant differences between groups in measures of Timed Up and Go , SIP at 6 and 12 months , and femoral neck and lumbar spine bone mineral density at 12 months . Home-based exercise with minimal supervision improves quality of life in elderly women with vertebral fractures . Future research is needed to determine if home exercise programs reduce falls and fall-related injuries in the elderly A r and omized , controlled , single-blinded 25-wk prospect i ve study was conducted to compare the effects of group-based resistance and agility training on bone , as measured by both dual-energy X-ray absorptiometry ( DXA ) and peripheral quantitative computed tomography ( pQCT ) , in older women with low bone mass . Ninety-eight community-dwelling women aged 75 - 85 yr were r and omized to one of three experimental groups : resistance training ( n = 32 ) , agility training ( n = 34 ) , or stretching ( sham exercise ) ( n = 32 ) . Total hip , femoral neck , and trochanteric bone mineral density ( BMD ) were measured by DXA . Peripheral QCT measurements were performed at the tibia and radius . The pQCT outcome measures at the shaft regions were cortical bone content , cortical bone cross-sectional area , cortical bone density , and density-weighted polar section modulus ( SSI ) . The pQCT outcome measures at the distal sites were total bone content , total bone cross-sectional area , and total bone density . At trial completion , the agility training group significantly increased cortical bone density by 0.5 + /- 0.2 % ( SE ) at the tibial shaft compared with a 0.4 + /- 0.3 % loss in the stretching group . The resistance training group significantly increased cortical bone density ( 1.4 + /- 0.6 % ) at the radial shaft compared , with a 0.4 + /- 0.5 % loss in the agility training group . No significant between-group differences were observed in the other bone outcome measures ( by DXA or pQCT ) . Future research is needed to determine the mechanism(s ) responsible for the observed adaptation of the cortical bone to mechanical loading BACKGROUND The performance of daily tasks , such as stair climbing or lifting an object , requires both muscle strength and power . Age-associated reductions in strength and power can affect an older adult 's ability to complete daily tasks such as stair climbing and lifting a child . METHODS The purpose s of this study were to determine whether power training was more efficacious than strength training for improving whole-body physical function in older adults and to examine the relationship between changes in anaerobic power and muscle strength and changes in physical function . Thirty-nine men and women ( mean age + /- SD = 72.5 + /- 6.3 years ) with below-average leg extensor power were r and omly assigned to control ( C , n = 15 ) , strength-training ( ST , n = 13 ) or power-training ( PT , n = 11 ) groups . The ST and PT groups met 3 days per week for 16 weeks ; the C group maintained usual activity and attended three lectures during the course of the study . Primary outcome measures included the Continuous Scale Physical Functional Performance test , maximal strength , and anaerobic power . RESULTS After baseline was controlled for , the Continuous Scale Physical Functional Performance test total score was significantly greater for the PT group than for the ST ( p = .033 ) and C ( p = .016 ) groups . Maximal strength was significantly greater for the ST group than for the C group ( p = .015 ) after the intervention . There was no significant difference between groups for peak anaerobic power . CONCLUSIONS Power training was more effective than strength training for improving physical function in community-dwelling older adults Objective : To evaluate the effects of tai chi exercise on risk factors for  falls in postmenopausal women with osteopaenia through measurements of balance , gait , physical function and quality of life . Design : A r and omized , controlled , single-blinded , 24-week trial with stratification by age and bone mass . Setting : General community . Participants : Sixty-one independently living elderly females aged 65 years and older with low bone mass . Interventions : Subjects were recruited and r and omly assigned to 24 weeks of tai chi ( 60 minutes/session , three sessions/week , n = 30 ) or a control group ( n = 31 ) . Outcome measures : Computerized dynamic posturography , gait , ‘ timed up and go ’ , five-chair sit-to-st and and quality of life assessed at baseline , 12 and 24 weeks . Results : After 24 weeks , subjects in the tai chi group demonstrated an increase in stride width ( P = 0.05 ) and improvement in general health ( P = 0.008 ) , vitality ( P = 0.02 ) and bodily pain ( P = 0.03 ) compared with those in the control group . There was no significant difference in balance parameters , ‘ timed up and go ’ , five-chair sit-to-st and and other domains of quality of life . Conclusion : Tai chi exercise may reduce risk factors for falls by increasing the stride width , and may improve quality of life in terms of general health , vitality and bodily pain in postmenopausal women with osteopaenia Objectives : To investigate whether a 12-week home-based programme of trunk-strengthening exercise could benefit spinal mobility , function and quality of life for osteoporotic and osteopenic postmenopausal women without fracture . Design s : R and omized controlled clinical trial . Setting : Department of Physical Therapy in National Taiwan University Hospital . Subjects : Twenty-eight postmenopausal women ( mean age 60.39=9.3 years ) diagnosed with osteoporosis or osteopenia without fracture history were recruited for this study . Subjects were r and omly assigned into exercise or control groups , each consisting of 14 subjects . Interventions : The 12-week exercise programme included strengthening routines for the trunk extensor and flexor muscles . The subjects performed three sets of 10 repetitions for each of the exercises , with programmes carried out three times per day at home . Main outcome measurements : Muscular strength , spinal range of motion ( ROM ) and motion velocity , Oswestry Disability Question naire ( ODQ ) and quality of life ( QOL ) were measured before the start and after completion of the exercise programme . Results : Statistically significant improvements were demonstrated in spinal ROM and motion velocity in the sagittal and frontal planes for the exercise group ( pB=0.05 ) . Further , the strength of the trunk flexors and extensors increased after exercise training ( pB=0.05 ) . ODQ measure was significantly reduced in the exercise group ( pB=0.05 ) , while the controls showed no significant change . Subjects in the exercise group showed better satisfaction in some domains of the Short-Form-36 Health Survey quality of life question naire ( pB=0.05 ) . Conclusions : This 12-week home-based trunk-strengthening exercise programme could improve trunk mobility and strength , and enhance QOL in osteoporotic and osteopenic postmenopausal women without vertebral fracture . Future study should recruit more cases or more severe subjects to verify the results It is considered that skeletal mass in humans may respond to loading or the number of loading cycles . The aim of this study was to examine the effect of a 1 year progressive resistance training program on the bone mass of 56 postmenopausal women . Assignment was by block r and omization to one of two resistance training groups : a strength trained group ( 3 x 8 repetition maximum ) or an endurance group ( 3 x 20 repetition maximum ) . The resistance exercises were selected to stress the ipsilateral forearm and hip region . The exercising side was r and omly assigned with one side exercised while the alternate side acted as the nonexercise control .  Bone mineral density ( BMD ) was measured every 3 months at the radial forearm and four hip sites using the Hologic QDR 2000 bone densitometer . A linear regression function was fitted for each individual 's bone density results , and the slope was compared for the exercise and control side using paired t-tests . The bone mass increase with the strength regimen was significantly greater at the trochanteric hip site ( control -0.6 + /- 2.2 % , exercise 1.7 + /- 4.1 % , p < 0.01 ) , at the intertrochanteric hip site ( control -0.1 + /- 2.1 % , exercise 1.5 + /- 3.0 % , p < 0.05 ) , Ward 's triangle ( control 0.8 + /- 5.2 % , exercise 2.3 + /- 4.0 % , p < 0.05 ) , and at the ultradistal radial site ( control -1.4 + /- 2.3 % , exercise 2.4 + /- 4.3 % , p < 0.01 ) . There was no significant increase in BMD with the endurance regimen except at the radius midsite ( control -1.0 + /- 2.3 % , exercise 0.1 + /- 1.4 % , p < 0.01 ) . In both the endurance and the strength group , muscle strength , tested by a one-repetition maximum ( 1RM ) test , increased significantly for all 10 exercises ( p < 0.01 ) and to a similar degree in the two groups . In the strength group but not the endurance group there were significant correlations between the slope of the change in BMD and the percentage increase in strength as follows : trochanter with leg press ; intertrochanter with leg press ( p < 0.05 ) ; and Ward 's triangle with hip extension and hip adduction ( p < 0.05 ) . Thus these results support the notion of a site-specific response of bone to maximal loading from resistance exercise in that although the trochanter and intertrochanter bone density was elevated by the resistance exercises undertaken , there was no effect on the femoral neck value . Postmenopausal bone mass can be significantly increased by a strength regimen that uses high-load low repetitions but not by an endurance regimen that uses low-load high repetitions . We conclude that the peak load is more important than the number of loading cycles in increasing bone mass in early postmenopausal women INTRODUCTION Osteoporosis is a chronic disease that leads to bone fragility and is associated with fracture risks and serious consequences for mobility . OBJECTIVE To verify the effects of two linear programs of resistance training ( RT ) on bone mineral density ( BMD ) , functional autonomy ( FA ) , muscular strength and quality of life ( QoL ) of postmenopausal women in pharmacological treatment . STUDY DESIGN R and omized controlled trial , code : RBR-6bqsw8 . METHODS 52 volunteers were distributed into three groups , according to r and omly parallel form : RT3times-per-week ( RT3 , n=20 ) ; RT2times-per-week ( RT2 , n=16 ) and control group ( CG , n=16 ) . The following assessment tools were used : bone mineral density ( BMD ) by dual X-ray absorptiometry , ' Latin America Group for maturity ' ( GDLAM ) protocol for FA , 10RM test for leg exercises and the ' Osteoporosis Assessment Question  naire ' ( OPAQ ) for QoL. The physical activities were planned for 13 months in cycles with different intensities . A two-way ANOVA with Bonferroni post-hoc test were used . RESULTS The results showed that the RT3/week was significantly more efficient ( p<0.05 ) compared with RT2/week , including : All BMD variables , FA ( Δ%=29.3 % ) , leg press at 45 ° ( Δ%=24.97 % ) and OPAQ ( Δ%=20.23 % ) . In addition , both RT3 and RT2 groups were more efficient ( p<0.05 ) compared with CG , including : total BMD ( Δ%=0.09 % ) and ( Δ%=0.06 % ) ; FA ( Δ%=7.1 % ) and RT2 ( Δ%=3.78 % ) ; Leg press at 45 ° ( Δ%=84.1 % ) and ( Δ%=59.1 % ) ; keen extension ( Δ%=15.28 % ) and ( Δ%=20.37 % ) ; OPAQ ( Δ%=57.61 % ) and ( Δ%=37.37 % ) , respectively . CONCLUSION The study showed that both experimental groups presented favorable results for BMD , strength , FA and QoL. However , the RT3 showed the best results compared to other groups after 13 months of intervention OBJECTIVE To evaluate the effectiveness of three different training protocol s on physical function of older adults living in long-term care facilities . Emphasis was placed on feasibility in real-life situations . METHODS Subjects ( N=224 ) were r and omised to 6 months of twice weekly ( 1 ) resistance training ; ( 2 ) all-round functional-skills training ; ( 3 ) a combination of both ; or ( 4 ) a control program .  Fitness and performance measures and self-reported disability were measured at baseline and after 24 weeks intervention . RESULTS Attendance to the strength training was 76 % , to the functional-skills training 70 % and to the combined training 73 % . In those who attended at least 75 % of all classes ( n=97 ) the functional-skills and combined training program improved several fitness and performance measures compared to the control group . CONCLUSION Twice weekly functional-skills training , or a combination of resistance and functional-skills training can improve several fitness and performance measures of institutionalised older people . PRACTICE IMPLICATION S An important finding from our study was that less than twice a week exercise training is not enough for functional improvement , while it proved difficult for the elderly subjects to exercise twice weekly . Education on the health benefits of regular exercise , and a larger availability of classes in long-term care facilities may improve attendance OBJECTIVE To evaluate the efficacy of the Nijmegen Falls Prevention Program ( NFPP ) for persons with osteoporosis and a fall history in a r and omized controlled trial . Persons with osteoporosis are at risk for fall-related fractures because of decreased bone strength . A decrease in the number of falls therefore is expected to be particularly beneficial for these persons . DESIGN R and omized controlled trial . SETTING Hospital . PARTICIPANTS Persons with osteoporosis and a fall history ( N=96 ; mean ± SD age , 71.0±4.7y ; 90 women ) . INTERVENTION After baseline assessment , participants were r and omly assigned to the exercise ( n=50 ; participated in the NFPP for persons with osteoporosis [ 5.5wk ] ) or control group ( n=46 ; usual care ) . MAIN OUTCOME MEASURES Primary outcome measure was fall rate , measured by using monthly fall calendars for 1 year . Secondary outcomes were balance confidence ( Activity-specific Balance Confidence Scale ) , quality of life ( QOL ; Quality of Life Question naire of the European Foundation for Osteoporosis ) , and activity level ( LASA Physical Activity Question naire , pedometer ) , assessed posttreatment subsequent to the program and after 1 year of follow-up . RESULTS The fall rate in the exercise group was 39 % lower than for the control group ( .72 vs 1.18 falls/person-year ; risk ratio , .61 ; 95 % confidence interval , .40-.94 ) . Balance confidence in the exercise group increased by 13.9 % ( P=.001 ) . No group differences were observed in QOL and activity levels . CONCLUSION The NFPP for persons with osteoporosis was effective in decreasing the number of falls and improving balance confidence . Therefore , it is a valuable new tool to improve mobility and independence of persons with osteoporosis PURPOSE To examine the effect of resistance exercises on self-reported physical function and activities of daily living ( ADL ) in older adults with osteoporosis or osteopenia . METHODS A search of available literature was conducted using PubMed , CINAHL , SPORTD iscus , PEDro , ProQuest Nursing and Allied Health Source , and Cochrane Controlled Trials Register . Studies were included if they involved ( 1 ) r and omized controlled trials ; ( 2 ) participants with osteoporosis or osteopenia ; ( 3 ) resistance exercise as an intervention ;  and ( 4 ) self-report of physical function or ADL . Articles were independently review ed for quality by two authors using the Physiotherapy Evidence Data base ( PEDro ) scale . Cohen 's d effect size was calculated by dividing st and ardized mean differences by the st and ard deviation to determine treatment effect in terms of physical function or ADL . RESULTS Five full-text articles were selected for inclusion . PEDro scores ranged from 5 to 7 ( out of 10 ) . Effect size mean differences as a result of resistance intervention ranged from 0.08 to 1.74 , suggesting " trivial " to " large " effects on self-reported physical function and ADL . CONCLUSION RESULTS suggest that interventions using resistance training have a beneficial impact on the domains of physical function and ADL in participants with osteoporosis or osteopenia . More high- quality studies are needed to lend further validity to this supposition
target: Conclusions A multicomponent exercise program of high-speed training combined with simulated functional tasks is promising to enhance functional outcomes .
  Due to substantial clinical heterogeneity of the target groups and specific dem and s of exercise modes , it is unclear which exercise program is optimal
background: Summary Osteoporosis affects many aspects of daily life .
  The aim of this systematic review was to assess the effects of exercise interventions on functional outcomes in persons with osteoporosis , in comparison with controls .