Effects of an exercise program on respiratory function, posture and on quality of life in osteoporotic women: a pilot study
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
References (25)
- et al.
Can strong extensor prevent vertebral fractures in women with osteoporosis?
Mayo Clin Proc
(1996) - et al.
Thoracic kyphosis, rib mobility, and lung volumes in normal women and women with osteoporosis
Spine
(1994) - et al.
Physiological effects of exercise on post-menopausal osteoporotic women
Physiotherapy
(1998) - et al.
Spinal compression fractures in osteoporotic women: patterns and relationship to hyperkyphosis
Radiology
(1988) - et al.
Inspiratoty muscle training in patients with COPD: effect on dyspnea, exercise performance and quality of life
Chest
(2001) - et al.
Relationship of lung function to severity of osteoporosis in women
Am Rev Respir Dis
(1990) - et al.
Substitution of arm span for standing height is important for the asssesment of predicted value of lung volumes in elderly people with osteoporosis
Chest
(1998) - American Thoracic Society. Standardization of spirometry—1994 update. Am J Respir Crit Care Med...
- et al.
Maximal respiratory pressures: normal values and relationship to age and sex
Am Rev Respir Dis
(1969) - et al.
Design strategies for longitudinal spirometry studies: study duration and measurement frequency
Am J Respir Crit Care Med
(2000)
Reference value of 6-minute walking distance in healthy middle-aged and older subjects
Eur Respir J
Six minute walking distance in healthy elderly subjects
Eur Respir J
Cited by (31)
Decreasing thoracic hyperkyphosis – Which treatments are most effective? A systematic literature review and meta-analysis
2021, Musculoskeletal Science and PracticeInfluence of physical activity on quality of life in postmenopausal womenwith osteoporosis
2014, Revista Brasileira de ReumatologiaExercise for improving age-related hyperkyphotic posture: A systematic review
2014, Archives of Physical Medicine and RehabilitationCitation Excerpt :Conversely, above average activity levels at baseline might limit the potential efficacy of the interventions or create variability that would obscure the ability to observe between group differences. However, most studies saw improvements in other physical function outcomes,13,30-35,38,40 suggesting that there was room for improvement. Finally, the external validity of the trials to date may be limited; few studies included men, and many excluded individuals with vertebral fractures and were single-center trials.