Elsevier

Physiotherapy

Volume 91, Issue 2, June 2005, Pages 113-118
Physiotherapy

Effects of an exercise program on respiratory function, posture and on quality of life in osteoporotic women: a pilot study

https://doi.org/10.1016/j.physio.2004.09.020Get rights and content

Abstract

Objectives

To investigate the effects of an exercise program on respiratory function, thoracic kyphosis, tolerance to exercise and quality of life in women with osteoporosis.

Design

Pilot observational study.

Setting

Department of Physiotherapy, Federal University of Sao Carlos, Brazil.

Participants

Fourteen women with densitometric diagnosis of osteoporosis in the spine.

Interventions

An exercise program comprising of three sessions per week, lasting 1 hour each, over an 8-week period. Each session incorporated: 5 minutes of stretching exercises, including the lower limb and upper limb muscles; 15 minutes of posture exercises; 20 minutes of walking; 15 minutes of exercises to improve the strength of respiratory muscles and a 5-minutes, cool-down and relaxation.

Main outcome measures

Respiratory function evaluation, submaximal exercise tolerance test measurement of the thoracic kyphosis angle, and the Osteoporosis Assessment Questionnaire (OPAQ) to measure the quality of life at baseline and at 8-week follow-up.

Results

At follow-up, increases of between 12% and 23% in respiratory pressures were noted. The results also suggest an increase of 13% in submaximal exercise tolerance and a small increase of approximately 5% in the magnitude of thoracic curvature. The value of the OPAQ for this group of subjects is questionable. Sample size calculations based on the results of this pilot study are provided.

Conclusions

After an 8-week exercise program, benefits to the fitness of the participants were observed. The results suggest that exercise may have a role in the management of this group of patients. The outcome measures, with the possible exception of the OPAQ, and the protocol used in this pilot study would be feasible for a definitive study. Further research is recommended in a sufficiently powered study and should include an appropriate control group.

Introduction

Osteoporosis is a clinical syndrome in which bone mass is lower than expected for individuals of a given age and race, resulting in bone weakness and increased susceptibility to fractures [1]. Osteoporosis represents a severe health threat to elderly people and it has recently been recognised as a major public health problem [2].

The main clinical manifestation is the increased risk of fractures [2], [3]. Vertebral fractures are the most frequent and often involve the mid-thoracic, lower-thoracic and lumbar vertebrae [1]. These fractures result in wedging and compression of the vertebrae, causing alterations in the physiological spinal curvatures, such as scoliosis, kyphoscoliosis and an accentuation in the degree of thoracic kyphosis [4].

Accentuated thoracic kyphosis alters the shape of the thoracic cage, increases the antero-posterior diameter of the thorax, reduces the distance between xiphisternun and pubis, and alters the position of the rib cage so that it surrounds the abdominal cavity. The spinal deformity and alterations in the rib cage cause a decrease in rib mobility and an impairment in the mechanics of the respiratory system, placing the respiratory muscles at a mechanical disadvantage and resulting in a decrease in respiratory muscle strength [5]. These changes are reported to be responsible for the impairment in respiratory function found in osteoporotic subjects [1], [6], [7]. Culhan et al. [1] found a significant reduction in vital capacity and inspiratory capacity in elderly women with osteoporosis, compared with normal subjects of the same age.

It is thought that exercise has an important role in management of the physical and psychological consequences of osteoporosis. The results of a previous study suggested that exercise may maintain, or even increase, bone mass, flexibility and muscle force; thus improving balance, gait and quality of life in these subjects [2].

The increase in the degree of thoracic kyphosis can be considered as one of the most important clinical manifestations of osteoporosis. Improvements in posture may reduce the level of pain, lessen the risk of falls and increase respiratory function. Consequently, an improvement in respiratory function and aerobic fitness may affect physical activity levels and result in improvement in quality of life. Little is known about the effects of exercise on posture and respiratory function in osteoporotic patients.

The purpose of this study was to determine the effects of a general physical exercise program on respiratory function, posture, submaximal exercise capacity and quality of life in women with osteoporosis.

Section snippets

Methods

This work constituted a pilot study. Subjects were recruited by telephone from a population of more than 250 osteoporotic women of the Institute of Rheumatic Diseases in Brazil. From those, 26 women, with a densitometric diagnosis of osteoporosis in the spine, showed an interest in participating.

Criteria for inclusion were: 65 years of age or older, caucasian, non-smoking, sedentary (having not performed any type of exercise for at least one year) with no previous fractures and a minimum of 75%

Results

Seven women were excluded from the study; two were smokers and a further five due to asthma. Nineteen women were recruited and commenced the exercise program. However, a further five were excluded due to low rates of attendance defined as attendance at less than 75% of the sessions. Thus at the end of the 8-week training program, data for 14 subjects were used in the analysis (Table 2). The remainder attended, on average, for 95% of the physical exercise sessions.

All subjects were diagnosed

Discussion

The results of this pilot study suggest that physical exercise may have a role in improving the range of variables evaluated in this group of patients. However, an adequately powered study is now required to confirm these tentative findings. It is also possible that the improvements noted in respiratory function and the degree of thoracic kyphosis may have contributed to the increase in the distance walked in 6-MWT and in the quality of life reported by these patients. Moreover, with the data

Conclusion

The results of this pilot study cannot be generalised to the osteoporotic population as a whole. However, despite the lack of a control group and the small size of the sample studied, the results suggest that further study is warranted. With the possible exception of the OPAQ, the methods of evaluation were found to be appropriate for measurement of the parameters proposed and preliminary data have been provided to allow sample size calculation for a definitive study. The improvements observed

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