The effect of calisthenic home exercises on postmenopausal fractures—a long-term observational study

Abstract

Objectives: To evaluate the long-term effects of calisthenic home exercises on the incidence of fractures in postmenopausal women. Design: Controlled long-term observational study. Methods: Postmenopausal women between 45 and 75 years of age who had been randomly assigned to an exercise or control group in the course of a previous study conducted 5–10 years ago, were invited for follow-up. The number of fractures before and during the observation time were recorded by means of a questionnaire. Vertebral deformities due to fractures were diagnosed by X-rays at entry and at follow-up. Walking speed, muscle strength, static posturography, and maximum oxygen uptake were measured in addition. Results: After an average follow-up time of 7.6±1.1 years, 73 women of the exercise group and 64 subjects of the control group were investigated. Thirty-three per cent (n=24) of the exercise group reported to have exercised continuously at least three times a week for 20 min. No intergroup differences between the compliant and non-compliant exercisers and the control group were seen in the number of fractures. However, the incidence of fracture was lowest in women with a baseline bone mass less than one standard deviation (SD) below the mean for young adults (high BMC) and highest in those with more than 2.5 SD below the mean for young adults (low BMC) (P<0.001, odds ratio 2.9 [95% CI, 1.59–5.39]). Conclusion: This long-term follow-up did not produce any evidence that prescription of a calisthenic home exercise program may prevent fractures in postmenopausal women aged between 61±6.4 and 68±6.5 years.

Introduction

The high rate of fractures among postmenopausal and elderly women has become a major health problem in developed countries. Such fractures may cause pain and limit activities, thus reducing the quality of life [1], [2], [3]. As fracture management, pain relief, limitation of activities and nursing home care augment medical expenses [4], comprehensive preventive strategies are needed for subjects carrying a high risk of fracture, with a view to reduce the tremendous socioeconomic burden of vertebral and non-vertebral fractures. The effects of most drugs acting on bone metabolism are confined to increasing bone mass. However, muscle weakness, postural instability and limitations in activities of daily living are also strong predictors of fractures and require optimal improvement [5], [6], [7]. This would appear to suggest that an appropriate physical exercise program should be added to current preventive and therapeutic strategies for osteoporotic patients. Although there is evidence from some studies that an additional training program might reduce the incidence of fracture more effectively than drugs alone, [8], [9], [10], [11] the long-term effect is not yet evident.

At an outpatient clinic of Physical Medicine and Rehabilitation, a home exercise program was developed for postmenopausal women more than 10 years ago. In consideration of the fact that the human's postural and kinesthetic awareness is gradually lost with increasing age, this exercise program was aimed to improve vertebral posturing and to re-educate physiological movement patterns. In a previous study this mainly weight-bearing exercise program, if performed regularly, was found to slow postmenopausal bone loss [12].

The present prospective observational study was designed to evaluate whether this home exercise program had any effects on the incidence of fractures caused by minimal trauma in postmenopausal women.