Risk - effective engagement v. Management tick box exercise?
Effective exercise for osteoporosis in the real world ...
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-10 -5 0 5 10 15 20 Background Methods Results Conclusion Effective exercise for osteoporosis in the real world: Three year observations from The Bone Clinic Belinda Beck 1,2,3 and Lisa Weis 3 1 Menzies Health Institute Queensland, Griffith University, Gold Coast campus, Australia 2 School of Allied Health Sciences, Griffith University, Gold Coast campus, Australia 3 The Bone Clinic, Brisbane, Australia • We recently demonstrated that brief, high intensity resistance and impact training (HiRIT) was safe and improved BMD, muscle force and function in postmenopausal women with low to very low bone mass when supervised under randomized controlled trial conditions 1 • Whether similar benefits could be achieved in ‘the real world’ was unknown • We therefore established a translational research clinic to examine effectiveness, feasibility and acceptability of the HiRIT program (Onero™) when delivered on a user-pays basis to patients with osteopenia and osteoporosis • Systematic longitudinal monitoring of clients provides the ability to examine the effectiveness of the Onero™ program in a ‘real world’ setting • The aim of the current work was to examine client outcomes from the first 3 years of operation of the Clinic • Clinic clients undergo comprehensive testing for biometrics, LS, total hip, and FN BMD, lean and fat mass, kyphosis angle, back extensor strength, functional performance (tandem walk, timed up-and-go, functional reach, 5-times-sit-to-stand), falls and fracture at baseline and annually thereafter • Dietary consults for daily calcium are conducted at the same timepoints (AusCal diet Q 2 ) • Twice-weekly supervised HiRIT with balance training (Onero™) is adopted on a voluntary, user-pays basis • Compliance (attendance and weight lifted) and adverse events are recorded • Clients with >30% HiRIT compliance (32/96 sessions/yr) were included in the current analyses • In the absence of a control group in this real world sample, training effects were examined using one-sample T-tests of percent change in outcome measures (2-tailed, α = 0.05) • We report outcomes from the first 121 Clinic clients to complete 12 mths of Onero™ training • Average compliance of the sample was 84.9 ± 30.2% (100% = 2 sessions x 50 weeks) • Improvement was observed in 15 of 18 measured outcomes, and positive trends were observed in the remaining 3 (Table 1, Figure 1) • While mean LS BMD improvement was 4%, 86% of clients gained bone at the spine (maximum +18.8%; Figure 2) and 69% gained at the hip (maximum +18.6%; Figure 3) • Number of falls decreased 46.6% and fractures decreased 95.2% • 20 minor soft tissue injuries were sustained in a combined total of 27,840 training sessions • The dietary consult increased Ca consumption from food sources 23.5% • Supervised, bone-targeted, high intensity resistance and impact exercise notably improves bone and other factors of risk for osteoporotic fracture in postmenopausal women with low to very low bone mass in a ‘real world’ clinical setting • Excellent compliance and safety suggest the program is feasible for and acceptable to the population at greatest risk • Ongoing monitoring of this unique translational dataset will determine the long term success of exercise as a first line intervention for osteoporosis References 1. Watson SL, Weeks BK, Weis L, Horan SA, and Beck BR: Heavy resistance training is safe and improves bone, function and stature in postmenopausal women with low to very low bone mass: Novel early findings from the LIFTMOR trial. Osteoporosis Int, 26(12): 2889-2894, 2015 2. Beck BR, Weeks BK, and Norling TL: A novel Australian calcium-specific diet questionnaire: Validity and reliability, Osteoporosis Int, 22(Suppl. 4): S626, 2011 Characteristic Baseline 12 months % change P value Age (yr) 64.1 ± 10.1 65.8 ± 6.4 Height (cm) 161.4 ± 7.0 161.5 ± 7.0 0.04 ± 0.4 0.368 Weight (kg) 59.8 ± 11.5 60.6 ± 11.2 1.3 ± 3.3 <0.0001 Lean (kg) 37.9 ± 7.3 38.5 ± 7.4 1.8 ± 4.2 <0.0001 Fat (%) 35.9 ± 9.0 35.4 ± 8.7 -0.8 ± 10.6 0.409 LS BMD (g/cm 2 ) LS T score 0.798 ± 0.136 -2.25 ± 1.0 0.829 ± 0.143 -2.01 ± 1.08 3.9 ± 4.2 15.6 ± 59.6 <0.0001 0.006 TH BMD (g/cm2) 729.2 ± 82.9 739.5 ± 79.3 1.5 ± 3.4 <0.0001 FN BMD (g/cm 2 ) FN T Score 0.674 ± 0.079 -2.26 ± 0.67 0.688 ± 0.074 -2.11 ± 0.62 2.3 ± 4.5 4.87 ± 17.4 <0.0001 0.003 Functional reach (cm) 35.9 ± 5.3 38.4 ± 5.1 8.1 ± 12.2 <0.0001 Timed up and go (s) 6.6 ± 1.0 5.7 ± 0.9 -12.1 ± 12.9 <0.0001 Tandem walk (s) 36.8 ± 23.6 24.7 ± 6.7 -20.3 ± 29.4 <0.0001 Sit to stand (s) 11.1 ± 2.2 9.7 ± 1.7 -10.4 ± 17.5 <0.0001 Back extensor strength (kg) 31.8 ± 13.1 38.7 ± 13.1 27.3 ± 49.4 <0.0001 Kyphosis angle (◦) 35.0 ± 10.4 33.6 ± 11.8 3.0 ± 41.6 0.326 Falls (n/x/%) 45/0.39/2.4 25/0.22/2.4 -44.4 <0.041 Previous 12m fx (n/x/%) 42/0.36/2.4 2/0.02/0.2 -95.2 <0.0001 Dietary calcium (mg) 890 ± 391 1016 ± 461 23.5 ± 63.0 <0.0001 Table 1. Client characteristics at baseline and 12 months (n=121, 6.7% men) Figure 1. Mean % improvement in bone and functional outcomes after 12-months supervised in-clinic HiRIT LS lumbar spine, FN femoral neck, WB whole body, T total, BMD bone mineral density, Kyphosis R kyphosis relaxed standing, F Reach functional reach, TUG timed up and go, STS sit to stand, BES back extensor strength Figure 2. Individual 12 month % change in LS BMD after supervised in-clinic HiRIT (n=121) 31/121 (25.6%) simultaneously taking long term bone medications (mean 32.3 ± 15.5 mths) 0 5 10 15 20 25 30 0 0.5 1 1.5 2 2.5 3 3.5 4 4.5 % Change % change * p < 0.0001 * * * * * * * * * * 3.9% 2.2% 1.5% 1.8% -0.8% -3.0% 8.1% -20.3% -12.1% -10.4% 27.3% 0.0% 86% of clients increased LS BMD -10 -5 0 5 10 15 20 Figure 3. Individual 12 month % change in FN BMD after supervised in-clinic HiRIT (n=121) 69% of clients increased FN BMD 2.3% 1.3% Figure 4. Example of individual 12 month change in LS BMD after supervised in-clinic HiRIT * CONTACT : [email protected]
Transcript of Effective exercise for osteoporosis in the real world ...
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Background
Methods
Results
Conclusion
Effective exercise for osteoporosis in the real world: Three year observations from The Bone ClinicBelinda Beck1,2,3 and Lisa Weis3
1 Menzies Health Institute Queensland, Griffith University, Gold Coast campus, Australia2 School of Allied Health Sciences, Griffith University, Gold Coast campus, Australia
3 The Bone Clinic, Brisbane, Australia
• We recently demonstrated that brief, high intensity resistance and impacttraining (HiRIT) was safe and improved BMD, muscle force and function inpostmenopausal women with low to very low bone mass when supervisedunder randomized controlled trial conditions1
• Whether similar benefits could be achieved in ‘the real world’ wasunknown
• We therefore established a translational research clinic to examineeffectiveness, feasibility and acceptability of the HiRIT program (Onero™)when delivered on a user-pays basis to patients with osteopenia andosteoporosis
• Systematic longitudinal monitoring of clients provides the ability toexamine the effectiveness of the Onero™ program in a ‘real world’ setting
• The aim of the current work was to examine client outcomes from the first3 years of operation of the Clinic
• Clinic clients undergo comprehensive testing for biometrics, LS,total hip, and FN BMD, lean and fat mass, kyphosis angle, backextensor strength, functional performance (tandem walk, timedup-and-go, functional reach, 5-times-sit-to-stand), falls andfracture at baseline and annually thereafter
• Dietary consults for daily calcium are conducted at the sametimepoints (AusCal diet Q2)
• Twice-weekly supervised HiRIT with balance training (Onero™)is adopted on a voluntary, user-pays basis
• Compliance (attendance and weight lifted) and adverse eventsare recorded
• Clients with >30% HiRIT compliance (32/96 sessions/yr) wereincluded in the current analyses
• In the absence of a control group in this real world sample,training effects were examined using one-sample T-tests ofpercent change in outcome measures (2-tailed, α = 0.05)
• We report outcomes from the first 121 Clinic clients to complete 12 mths of Onero™ training
• Average compliance of the sample was 84.9 ± 30.2% (100% = 2 sessions x 50 weeks)
• Improvement was observed in 15 of 18 measured outcomes, and positive trends wereobserved in the remaining 3 (Table 1, Figure 1)
• While mean LS BMD improvement was 4%, 86% of clients gained bone at the spine (maximum+18.8%; Figure 2) and 69% gained at the hip (maximum +18.6%; Figure 3)
• Number of falls decreased 46.6% and fractures decreased 95.2%
• 20 minor soft tissue injuries were sustained in a combined total of 27,840 training sessions
• The dietary consult increased Ca consumption from food sources 23.5%
• Supervised, bone-targeted, high intensity resistanceand impact exercise notably improves bone andother factors of risk for osteoporotic fracture inpostmenopausal women with low to very low bonemass in a ‘real world’ clinical setting
• Excellent compliance and safety suggest theprogram is feasible for and acceptable to thepopulation at greatest risk
• Ongoing monitoring of this unique translationaldataset will determine the long term success ofexercise as a first line intervention for osteoporosis
References 1. Watson SL, Weeks BK, Weis L, Horan SA, and Beck BR: Heavy resistance training is safe and improves bone, function and stature in postmenopausal women with low to very low bone mass: Novel early findings from the LIFTMOR trial. Osteoporosis Int, 26(12): 2889-2894, 2015 2. Beck BR, Weeks BK, and Norling TL: A novel Australian calcium-specific diet questionnaire: Validity and reliability, Osteoporosis Int, 22(Suppl. 4): S626, 2011
Characteristic Baseline 12 months % change P value
Age (yr) 64.1 ± 10.1 65.8 ± 6.4
Height (cm) 161.4 ± 7.0 161.5 ± 7.0 0.04 ± 0.4 0.368
Weight (kg) 59.8 ± 11.5 60.6 ± 11.2 1.3 ± 3.3 <0.0001
Lean (kg) 37.9 ± 7.3 38.5 ± 7.4 1.8 ± 4.2 <0.0001
Fat (%) 35.9 ± 9.0 35.4 ± 8.7 -0.8 ± 10.6 0.409
LS BMD (g/cm2) LS T score
0.798 ± 0.136-2.25 ± 1.0
0.829 ± 0.143-2.01 ± 1.08
3.9 ± 4.215.6 ± 59.6
<0.00010.006
TH BMD (g/cm2) 729.2 ± 82.9 739.5 ± 79.3 1.5 ± 3.4 <0.0001
FN BMD (g/cm2) FN T Score
0.674 ± 0.079 -2.26 ± 0.67
0.688 ± 0.074-2.11 ± 0.62
2.3 ± 4.54.87 ± 17.4
<0.00010.003
Functional reach (cm) 35.9 ± 5.3 38.4 ± 5.1 8.1 ± 12.2 <0.0001
Timed up and go (s) 6.6 ± 1.0 5.7 ± 0.9 -12.1 ± 12.9 <0.0001
Tandem walk (s) 36.8 ± 23.6 24.7 ± 6.7 -20.3 ± 29.4 <0.0001
Sit to stand (s) 11.1 ± 2.2 9.7 ± 1.7 -10.4 ± 17.5 <0.0001
Back extensor strength (kg) 31.8 ± 13.1 38.7 ± 13.1 27.3 ± 49.4 <0.0001
Kyphosis angle (◦) 35.0 ± 10.4 33.6 ± 11.8 3.0 ± 41.6 0.326
Falls (n/x/%) 45/0.39/2.4 25/0.22/2.4 -44.4 <0.041
Previous 12m fx (n/x/%) 42/0.36/2.4 2/0.02/0.2 -95.2 <0.0001
Dietary calcium (mg) 890 ± 391 1016 ± 461 23.5 ± 63.0 <0.0001
Table 1. Client characteristics at baseline and 12 months (n=121, 6.7% men)
Figure 1. Mean % improvement in bone and functional outcomes after 12-months supervised in-clinic HiRITLS lumbar spine, FN femoral neck, WB whole body, T total, BMD bone mineral density, Kyphosis R kyphosis relaxed
standing, F Reach functional reach, TUG timed up and go, STS sit to stand, BES back extensor strength
Figure 2. Individual 12 month % change in LS BMD after supervised in-clinic HiRIT (n=121)
31/121 (25.6%) simultaneously taking long term bone medications (mean 32.3 ± 15.5 mths)
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86% of clients increased LS BMD
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Figure 3. Individual 12 month % change in FN BMD after supervised in-clinic HiRIT (n=121)
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Figure 4. Example of individual 12month change in LS BMD aftersupervised in-clinic HiRIT
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CONTACT: [email protected]
