Given a society in which the proportion of the elderly is on the increase, physicians and physiotherapists are focussing an increasing share of their attention on back pain and osteoporosis. Various exercises programs are available for patients with osteoporosis. Their efficacy as regards improving of bone density and reducing the risk of falls has been proven [
8,
13]. Conclusions drawn by the Cochrane Collaboration refer - among other aspects - to the improvement of vertebral bone density in postmenopausal women by means of aerobic exercises, weight-bearing exercises, and resistance exercises [
8]. Our data concerning sling exercises for osteoporosis patients revealed a significant reduction in the perception of pain, a significant increase in physical performance, and a significant sensation of "feeling more healthy" among our patients. Especially worthy of mention is the enduring effect of this type of exercise on "feeling healthy" and pain relief. The effect persisted during the 3-month control period after completion of the training program. We have found no studies in the published literature reporting the results of sling exercises in patients with osteoporosis. The so-called conventional physiotherapy regimen used in our second group failed to achieve similar effects.
The relatively mild symptoms (50) experienced by our patients despite having undergone fractures is not easily explained (Table
3). Bianchi et al. [
22] investigated 100 postmenopausal patients with osteoporosis, aged 50 to 85 years, in respect of quality of life and depression. The results of the study showed that osteoporosis exerted a negative impact on the psyche and quality of life of the patients. The group that experienced fractures fared the worst. One explanation for the results achieved in our study might have been the fact that 88% of our patients performed regular sports twice a week. Furthermore, our patients went for a walk at least once daily. Accordingly, the initial score for the domain
physical function was rather low - which is indicative of a high degree of mobility in activities of daily living and household chores. This is contrasted by the relatively high level of pain before the start of the intervention. This was not significantly different in the sling exercises group (Table
3). Thus, patients benefited most in the domains of
pain und physical function. The effect of training in this domain was perceptible even three months after completion of the program. One explanation could be the plasticity of the human neuromuscular system, which is forced to adapt consistently to new environmental conditions. In our case the unstable slings fulfill this "new" requirement. The degree of elasticity is such that the person doing the exercises is exposed to a number of stimuli. In other words, he/she has a very small supportive surface and has to regulate and control motions very rapidly and with full concentration. The deep muscles of the spine that lie close to the joints (musculus multifidus, musculus transversus abdominis, pelvic floor muscles and the diaphragm) need to be activated. This is very significant for stabilization of the lumbar spine and pain relief in this region [
17,
23‐
25]. Local stabilizers appear to be atrophied in the presence of pain, and cannot be regulated or controlled properly [
25‐
29]. This causes instability in the respective segments of the spine. In the absence of exercise stimuli, the deep muscles are only regulated in a phasic manner. As a result an individual may lose his/her sensitivity to correct posture [
26,
27]. This explanatory approach has been established in the treatment of patients with back pain and the rehabilitation of sportsmen. Obviously, this fact cannot be immediately transferred to the treatment of patients with osteoporosis. However, the results of a study performed by Hongo et al. [
30] show that even exercises of mild intensity may improve the strength of spinal muscles and thus exert a positive effect on quality of life in patients with osteoporosis. Circuit training as performed in Bergland et al.'s [
9] study proved to be much more intensive. The authors had women with osteoporosis aged 60 to 84 years perform the training program for three months, twice a week, one hour per session, under the supervision of a physiotherapist. Based on their data Bergland et al. conclude that circuit training may exert a positive impact on mobility and quality of life. In other words, the regularity of exercise is a major factor. In order to design intensive exercises and provide individual care for patients with osteoporosis, it appears meaningful to limit the size of the group to a maximum of five persons. Immediate feedback from physiotherapists ensured that the patients were motivated, that they performed the exercises correctly (i.e. with no error), and this also increased the intensity of training. In sling exercises, the diversity of experience obtained in performing motions with the sling appears to exert a sustained effect on the sensomotor system of osteoporosis patients. Activities of daily living become easier when patients experience less pain. Improvement of sensomotor abilities appears to exert a positive impact on quality of life. Schwesig et al. [
14] performed sensomotor exercises with the Aero-Step in 20 healthy elderly persons and 27 patients with osteoporosis aged on average 66.6 years. After conclusion of the training program the authors observed improvements in sensomotor performance and general wellbeing. How the authors registered the gain in quality of life is not clearly discernible from this report.
Our study demonstrated a positive effect of sling exercises on pain, physical fitness and general body perception. Thus, sling exercises appear to be a favorable alternative to conventional physiotherapeutic procedures.