Resistance Training for Osteoporotic Fractures?
According to NICE, women in England and Wales are living with an estimated 25,000 osteoporosis-related vertebral (spine) fractures at any one time. The risk of fracture increases with age largely due to a decline in the hormone oestrogen which keeps bones strong. This particularly impacts women during and after their menopause. Not only are these fractures linked to a 15% higher rate of death amongst patients but, along with hip and wrist fractures, are expected to cost the UK healthcare system £2.2 billion by 2025.
Exercise is a common recommendation for those with vertebral fractures. The objective is to improve patients’ balance and strength in order to help with everyday movement, prevent falls and reduce the incidence of further fractures by strengthening bones.
Despite being the most common osteoporotic fractures, the impact of exercise on the prevention and the management of vertebral fractures is not well researched. We looked at evidence from five studies and assessed whether exercise improved everyday mobility, balance and strength in menopausal women with vertebral fractures. Specifically we considered whether class-based resistance training improved outcomes. Resistance training is also known as weight training, but it refers to any form of exercise where you lift or pull against resistance. This could be using weights like kettlebells, your own bodyweight, or elastic resistance bands.
Who took part and how?
The five trials involved women aged over 50 with osteoporotic vertebral fractures. For 3-12 months, groups of women attended class-based resistance training (led either by physiotherapists or specialist instructors) whilst others simply continued life as normal. Classes were held at two to three times per week for 40-45 minutes.
What were the results?
Four trials used the commonly used “Timed Up And Go” (TUG) test to measure everyday mobility. In this test, participants are asked to rise from an armchair, walk for 3m, turn, walk back, and sit down again. There were notable improvements in times for those who took part in the classes, reducing their time by up to 0.6 seconds. This doesn’t sound like much but shows that participants were able to manage everyday movements more quickly than before.
The “Functional Reach” test notes how far someone can reach forwards before losing balance. Whilst not as clear-cut as other evidence, two studies found that patients’ functional reach increased by nearly 1cm, even 3 months after the trial. Again, whilst the numbers may not be large, the overall effect could be significant by strengthening bones and muscle, and reducing falls. Other tests included the “Four Square Step Test” (where patients step over canes laid like a “plus sign”, in a sequence) and the “Tandem Walk and Sway” (walking in a straight line with one foot immediately in front of the other, heel to toe). Both tests showed that those who had attended classes could successfully perform the tests faster than those who hadn’t. In other words, their balance was better.
Lastly, one study showed a strong link between resistance training and increased muscle strength which reduces the risk of a fall, protecting women from fractures. Those that didn’t train saw their muscle strength decline.
The bottom line
All the studies were slightly different, so their results are difficult to compare directly. But, overall, their findings are similar to other studies which suggest that regular resistance training develops everyday mobility, strength and balance to prevent and/or manage vertebral fractures.
It was encouraging that class attendance rates ranged between 77% and 89%, suggesting that patients either enjoyed classes or experienced benefit. This means that if women with vertebral fractures undertook similar training, they would not only improve their health but would also meet the UK's physical activity guideline of two strength training sessions per week.
How can I put this into action?
We developed this infographic to help healthcare professionals and those suffering from osteoporosis related vertebral fractures. If you have a smartphone or tablet simply click on the image and save it to your photos. Alternatively, right click it with a mouse and select the Print option. Then ask your GP, your local physiotherapist or sports centre about classes.
Do contact Rayne Roberts for the complete and fully referenced paper.