Influence of physical activity on quality of life in postmenopausal women with osteoporosis

Abstracts

O presente estudo teve por objetivo realizar uma revisão sobre a associação entre exercício físico e qualidade de vida em mulheres pós-menopáusicas com osteoporose. Foi realizada busca nas bases de dados PubMed, Scielo, SpringerLink e Sport Discus a fim de identificar artigos relevantes que tratassem dessa associação. Utilizaram-se os seguintes descritores, em língua inglesa e portuguesa: osteoporosis, exercise, menopause, women, physical activity, quality of life/osteoporose, exercício físico, menopausa, mulheres, atividade física, qualidade de vida. Com relação à qualidade de vida e aspectos físicos como força e equilíbrio, com exceção de dois estudos encontrados, os demais relataram melhoria na qualidade de vida e nos indicadores físicos das participantes. A intervenção com exercício físico demonstrou ser fundamental para o aprimoramento da qualidade de vida de mulheres na pós-menopausa que sofrem de osteoporose. Atividades que têm por objetivo o aperfeiçoamento da força e do equilíbrio são essenciais para evitar a ocorrência de quedas e, consequentemente, reduzir a incidência de fraturas nessa população.

Osteoporose; Qualidade de vida; Exercício físico


The objective of this study is to conduct a review on the association between exercise and quality of life in postmenopausal women with osteoporosis. A search was performed in PubMed, SciELO, SpringerLink and Sport Discus databases to identify relevant articles that addressed this association. We used the following descriptors in the English and Portuguese languages: osteoporosis, exercise, menopause, women, physical activity, quality of life/osteoporose, exercício físico, menopausa, mulheres, atividade física, qualidade de vida. Regarding quality of life and physical aspects like muscle strength and balance, with the exception of two studies, all others have reported improvement in quality of life and in physical domain of participants. Intervention with exercise has proved essential to improving the quality of life of women with postmenopausal osteoporosis. Activities that aim at the improvement of muscle strength and balance are essential to prevent falls, and consequently to reduce the incidence of fractures in this population.

Osteoporosis; Quality of life; Physical activity


Introduction

Osteoporosis is a systemic skeleton disease, being characterized by reduced bone density and deterioration of bone tissue architecture.1Glaser DL, Kaplan FS. Osteoporosis: Definition and CinicalPresentation. Spine. 1997;2:12–6. This disease has a higher incidence in the female population, due to the lower peak bone mass in this group, and to the consequences of menopause.2WHO. Prevention and management of osteoporosis. Genebra: WHO; 2003.

Menopause is a period of transformation in women's lives, in which they are confronted with medical and psychological problems. In addition of hot flushes, headaches, sweating, fatigue, sexual dysfunction and reduction of estrogen, menopause may cause a massive and rapid loss of bone mass.3Schapira D. Aerobics and postmenopausal osteoporosis. Stress Medicine. 1990;6:157–63.

Once established the menopause, the prevalence of osteoporosis and related fractures increases according to the duration of this hormonal disorder and the woman's age.4Steiner ML, Fernandes CE, Strufaldi R, Azevedo LHd, StephanC, Pompei LM, et al. Accuracy study on “Osteorisk”: a newosteoporosis screening clinical tool for women over 50 yearsold. Sao Paulo Medical Journal. 2008;126:23–8. In this population, the prevalence of osteoporosis at the lumbar spine ranges from 15.8% in women aged 50-59 years to 54.5% in women over 80 years, and the prevalence of fractures varies between 20% and 82% for the same age groups, respectively.5Bandeira F, Carvalho EFd. Prevalência de osteoporose e fraturas vertebrais em mulheres na pós-menopausa atendidas em serviços de referência. Revista Brasileira de Epidemiologia. 2007;10:86–98.

According to the North American Menopause Society, the main clinical objective when treating osteoporosis is to reduce the fracture risk.6North American Menopause Society N. Management of osteoporosis in postmenopausal women: 2010 position statement of The North American Menopause Society. Menopause. 2010;17:25–54. The resulting pain of this change in body image and the loss of mobility and independence can have a strong impact on self-esteem and in the mood, making the prevention of falls the main point in preventing fractures. In the women with postmenopausal osteoporosis, the prevalence of falls is postmenopausal 51.1% against 29.3% of women without osteoporosis.7Silva RB, Costa-Paiva L, Oshima MM, Morais SS, Pinto-NetoAM. Frequência de quedas e associação com parâmetros estabilométricos de equilíbrio em mulheres na pós-menopausa com e sem osteoporose. Revista Brasileira deGinecologia e Obstetrícia. 2009;31:496–502.

The increase in life expectancy of the population and the costs generated by fractures, especially hip fractures, determine the importance of studying this disease, because hip fractures present with greater morbidity and mortality.8Dourador EB. Osteoporose Senil. Arquivos Brasileiros em Endocrinologia e Metabolismo. 1999;43:446–51.

Physical activity plays a key role in osteoporosis, mainly by reducing bone resorption.9Yamazaki S, Ichimura S, Iwamoto J, Takeda T, Toyama Y. Effect of walking exercise on bone metabolism in postmenopausal women with osteopenia/osteoporosis. Journal of Bone and Mineral Metabolism. 2004;22:500–8. The increase in muscle strength, stability, balance and mobility, improvement of the quality of life, reduction of pain and prevention of falls supplement the benefits generated by the systematic practice of exercise in patients with osteoporosis.1010 Bass SL, Forwood MR, Larsen JA, Saxon L. Prescribing Exercise for Osteoporosis. International Sport Med Journal. 2001;1:1–13.

The aim of this article is to conduct a review on the association between exercise and quality of life, in the psychological and physical domains, in postmenopausal women with osteoporosis.

Methodology

A systematic search was conducted and relevant articles that analyzed the influence of a structured exercise training program on quality of life in postmenopausal women with osteoporosis were selected. Theses and dissertations were not included due to the logistic infeasibility of a systematic search through these documents.

Those publications that met the inclusion criteria were evaluated, regardless of the journal nature. The selection of descriptors used throughout the review process was performed according to a Medical Subject Headings (MeSH) consultation.

A search was conducted in PubMed, SciELO, SpringerLink and Sport Discus databases and in the references of those identified articles. Search terms in English and Portuguese languages included: osteoporosis, exercise, menopause, women, physical activity, quality of life/ osteoporose, exercício físico, menopausa, mulheres, atividade física, qualidade de vida. In order to combine the descriptors and terms used in the search, we resorted to the logical operators “AND” and “OR”.

At first, 135 articles that presented a relation to the study subject were identified. Then, we selected those articles that met the following inclusion criteria: a) longitudinal studies including postmenopausal women with osteoporosis; and b) with a clinical diagnosis of osteoporosis obtained by examination of bone densitometry in the femoral neck or lumbar spine, and with no history of atraumatic fracture. The selected articles were analyzed according to the following criteria established by Downs & Black:1111 Downs SH, Black N. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Community Health. 1998;52:377–84.
  • Hypotheses and objectives of the study

  • Main outcomes measured

  • Characteristics of the subjects involved

  • Description of the interventions of interest and main outcomes

  • Description of the actual values for the main outcomes

  • Adequacy of appropriate statistical tests

  • Whether the measures used for the main outcomes were accurate

  • Whether the patients in different groups were recruited from the same population

  • Whether the main results presented sufficient power to detect an important effect where the probability value for a difference being due to a chance of less than 5%

After the first analysis, based on titles, 40 articles were eligible to the second phase of this review, which consisted of reading of abstracts. Subsequently to the evaluation of the abstracts, those studies that fulfilled the inclusion criteria had their full report retrieved. At this point, the review was conducted independently by two researchers. Finally, 10 publications were included in this review.

Results

Table 1 shows the publications that were included in this review. Among the criteria established for our analysis, the clarity in the description of the objectives was compromised only in the study by Carter et al.1212 Carter ND, Khan KM, Petit MA, Heinonen A, Waterman C, Donaldson MG, et al. Results of a 10 week community based strength and balance training programme to reduce fall risk factors: a randomised controlled trial in 65-75 year old women with osteoporosis. British Journal of Sports Medicine. 2001;35:348–51. With respect to the studied outcomes, the quality of life was measured in 10 studies.1212 Carter ND, Khan KM, Petit MA, Heinonen A, Waterman C, Donaldson MG, et al. Results of a 10 week community based strength and balance training programme to reduce fall risk factors: a randomised controlled trial in 65-75 year old women with osteoporosis. British Journal of Sports Medicine. 2001;35:348–51.2121 Tüzün S, Aktas I, Akarirmak Ü, Sipahi S, Tüzün F. Yoga might be an alternative training for the quality of life and balance in postmenopausal osteoporosis. European Journal of Physical and Rehabilitation Medicine. 2010;46:69–72. The other outcomes studied were: balance,1212 Carter ND, Khan KM, Petit MA, Heinonen A, Waterman C, Donaldson MG, et al. Results of a 10 week community based strength and balance training programme to reduce fall risk factors: a randomised controlled trial in 65-75 year old women with osteoporosis. British Journal of Sports Medicine. 2001;35:348–51.,1313 Arnold CM, Busch AJ, Schachter CL, Harrison EL, Olszynski WP. A Randomized Clinical Trial of Aquatic versus Land Exercise to Improve Balance, Function, and Quality of Life in Older Women with Osteoporosis. Physiotherapy Canada. 2008;60:296–306.,1515 Aveiro MC, Navega MT, Granito RN, Rennó ACM, Oishi J. Efeitos de um programa de atividade física no equilíbrio e na força muscular do quadríceps em mulheres osteoporóticas visando uma melhoria na qualidade de vida. Revista Brasileira de Ciência e Movimento. 2004;12:33–8.1717 Devereux K, Robertson D, Briffa NK. Effects of a water-based program on women 65 years and over: A randomised controlled trial. Australian Journal of Physiotherapy. 2005;51:102–8.,2121 Tüzün S, Aktas I, Akarirmak Ü, Sipahi S, Tüzün F. Yoga might be an alternative training for the quality of life and balance in postmenopausal osteoporosis. European Journal of Physical and Rehabilitation Medicine. 2010;46:69–72.2323 Madureira MM, Takayama L, Gallinaro AL, Caparbo VF, Costa RA, Pereira RMR. Balance training program is highly effective in improving functional status and reducing the risk of falls in elderly women with osteoporosis: a randomized controlled trial. Osteoporos International. 2007;18:419–25. muscle torque,1515 Aveiro MC, Navega MT, Granito RN, Rennó ACM, Oishi J. Efeitos de um programa de atividade física no equilíbrio e na força muscular do quadríceps em mulheres osteoporóticas visando uma melhoria na qualidade de vida. Revista Brasileira de Ciência e Movimento. 2004;12:33–8. lower limb strength,1212 Carter ND, Khan KM, Petit MA, Heinonen A, Waterman C, Donaldson MG, et al. Results of a 10 week community based strength and balance training programme to reduce fall risk factors: a randomised controlled trial in 65-75 year old women with osteoporosis. British Journal of Sports Medicine. 2001;35:348–51.,1616 Carter ND, Khan KM, McKay HA, Petit MA, Waterman C, Heinonen A, et al. Community-based exercise program reduces risk factors for falls in 65- to 75-year-old women with osteoporosis: randomized controlled trial. Canadian Medical Association Journal. 2002;167:997–1004.,2222 Aveiro M, Granito R, Navega M, Driusso P, Oishi J. Influence of a physical training program on muscle strength, balance and gait velocity among women with osteoporosis. Revista Brasileira de Fisioterapia. 2006;10:441–8. gait speed,2222 Aveiro M, Granito R, Navega M, Driusso P, Oishi J. Influence of a physical training program on muscle strength, balance and gait velocity among women with osteoporosis. Revista Brasileira de Fisioterapia. 2006;10:441–8. fear of falling,1717 Devereux K, Robertson D, Briffa NK. Effects of a water-based program on women 65 years and over: A randomised controlled trial. Australian Journal of Physiotherapy. 2005;51:102–8. frequency of falls,2323 Madureira MM, Takayama L, Gallinaro AL, Caparbo VF, Costa RA, Pereira RMR. Balance training program is highly effective in improving functional status and reducing the risk of falls in elderly women with osteoporosis: a randomized controlled trial. Osteoporos International. 2007;18:419–25. respiratory function, posture and submaximal exercise capacity.2020 Renno ACM, Granito RN, Driusso P, Costa D, Oishi J. Effects of an exercise program on respiratory function, posture and on quality of life in osteoporotic women: a pilot study. Physiotherapy. 2005;91:113–8.

Table 1
Publications included in the review.

The characteristics of the subjects were presented using descriptive tables in nine studies.1212 Carter ND, Khan KM, Petit MA, Heinonen A, Waterman C, Donaldson MG, et al. Results of a 10 week community based strength and balance training programme to reduce fall risk factors: a randomised controlled trial in 65-75 year old women with osteoporosis. British Journal of Sports Medicine. 2001;35:348–51.,1313 Arnold CM, Busch AJ, Schachter CL, Harrison EL, Olszynski WP. A Randomized Clinical Trial of Aquatic versus Land Exercise to Improve Balance, Function, and Quality of Life in Older Women with Osteoporosis. Physiotherapy Canada. 2008;60:296–306.,1616 Carter ND, Khan KM, McKay HA, Petit MA, Waterman C, Heinonen A, et al. Community-based exercise program reduces risk factors for falls in 65- to 75-year-old women with osteoporosis: randomized controlled trial. Canadian Medical Association Journal. 2002;167:997–1004.,1919 Liu-Ambrose TYL, Khan KM, Eng JJ, Lord SR, Lentle B, McKay HA. Both resistance and agility training reduce back pain and improve health-related quality of life in older women with low bone mass. Osteoporos International. 2005;16:1321–9.2323 Madureira MM, Takayama L, Gallinaro AL, Caparbo VF, Costa RA, Pereira RMR. Balance training program is highly effective in improving functional status and reducing the risk of falls in elderly women with osteoporosis: a randomized controlled trial. Osteoporos International. 2007;18:419–25. The studies by Auad et al.,1414 Auad MA, Simões RP, Rouhani S, Castello V, Yogi LS. Eficácia de um programa de exercícios físicos na qualidade de vida de mulheres com osteoporose. Arquivos Brasileiros de Ciência da Saúde. 2008;33:31–5. Aveiro et al.1515 Aveiro MC, Navega MT, Granito RN, Rennó ACM, Oishi J. Efeitos de um programa de atividade física no equilíbrio e na força muscular do quadríceps em mulheres osteoporóticas visando uma melhoria na qualidade de vida. Revista Brasileira de Ciência e Movimento. 2004;12:33–8. and Devereux et al.1717 Devereux K, Robertson D, Briffa NK. Effects of a water-based program on women 65 years and over: A randomised controlled trial. Australian Journal of Physiotherapy. 2005;51:102–8. present this information on the text, in the Results section, having only the participants’ age as a descriptive variable. Most authors measured the quality of life using specific questionnaires;1212 Carter ND, Khan KM, Petit MA, Heinonen A, Waterman C, Donaldson MG, et al. Results of a 10 week community based strength and balance training programme to reduce fall risk factors: a randomised controlled trial in 65-75 year old women with osteoporosis. British Journal of Sports Medicine. 2001;35:348–51.2121 Tüzün S, Aktas I, Akarirmak Ü, Sipahi S, Tüzün F. Yoga might be an alternative training for the quality of life and balance in postmenopausal osteoporosis. European Journal of Physical and Rehabilitation Medicine. 2010;46:69–72. however, only two of them evaluated variables such as pain and number of falls.1818 Kronhed A-CG, Hallberg I, Ödkvist L, Möller M. Effect of training on health-related quality of life, pain and falls in osteoporotic women. Advances in Physiotherapy. 2009;11:154–65.,2323 Madureira MM, Takayama L, Gallinaro AL, Caparbo VF, Costa RA, Pereira RMR. Balance training program is highly effective in improving functional status and reducing the risk of falls in elderly women with osteoporosis: a randomized controlled trial. Osteoporos International. 2007;18:419–25.

Of the studies evaluated, only that of Carter et al.1616 Carter ND, Khan KM, McKay HA, Petit MA, Waterman C, Heinonen A, et al. Community-based exercise program reduces risk factors for falls in 65- to 75-year-old women with osteoporosis: randomized controlled trial. Canadian Medical Association Journal. 2002;167:997–1004. included confounding factors in the selection and analysis of data. They were: height, weight, weight change during the study, years of estrogen use, number of medications taken, smoking, physical activity, age, mental state, quality of life score, number of fractures throughout life, number of falls in the last year and the presence of osteoarthritis or rheumatoid arthritis. Only one study describes adverse events of the intervention in participants.1919 Liu-Ambrose TYL, Khan KM, Eng JJ, Lord SR, Lentle B, McKay HA. Both resistance and agility training reduce back pain and improve health-related quality of life in older women with low bone mass. Osteoporos International. 2005;16:1321–9.

Because of ethical and methodological difficulty issues, four studies reported attempts of participants’ blinding,1212 Carter ND, Khan KM, Petit MA, Heinonen A, Waterman C, Donaldson MG, et al. Results of a 10 week community based strength and balance training programme to reduce fall risk factors: a randomised controlled trial in 65-75 year old women with osteoporosis. British Journal of Sports Medicine. 2001;35:348–51.,1616 Carter ND, Khan KM, McKay HA, Petit MA, Waterman C, Heinonen A, et al. Community-based exercise program reduces risk factors for falls in 65- to 75-year-old women with osteoporosis: randomized controlled trial. Canadian Medical Association Journal. 2002;167:997–1004.,1919 Liu-Ambrose TYL, Khan KM, Eng JJ, Lord SR, Lentle B, McKay HA. Both resistance and agility training reduce back pain and improve health-related quality of life in older women with low bone mass. Osteoporos International. 2005;16:1321–9.,2323 Madureira MM, Takayama L, Gallinaro AL, Caparbo VF, Costa RA, Pereira RMR. Balance training program is highly effective in improving functional status and reducing the risk of falls in elderly women with osteoporosis: a randomized controlled trial. Osteoporos International. 2007;18:419–25. and three studies did not undergo randomization.1515 Aveiro MC, Navega MT, Granito RN, Rennó ACM, Oishi J. Efeitos de um programa de atividade física no equilíbrio e na força muscular do quadríceps em mulheres osteoporóticas visando uma melhoria na qualidade de vida. Revista Brasileira de Ciência e Movimento. 2004;12:33–8.,2020 Renno ACM, Granito RN, Driusso P, Costa D, Oishi J. Effects of an exercise program on respiratory function, posture and on quality of life in osteoporotic women: a pilot study. Physiotherapy. 2005;91:113–8.,2222 Aveiro M, Granito R, Navega M, Driusso P, Oishi J. Influence of a physical training program on muscle strength, balance and gait velocity among women with osteoporosis. Revista Brasileira de Fisioterapia. 2006;10:441–8.

Table 2 presents the results of studies that evaluated the quality of life in women with osteoporosis. Only the study by Carter et al.1616 Carter ND, Khan KM, McKay HA, Petit MA, Waterman C, Heinonen A, et al. Community-based exercise program reduces risk factors for falls in 65- to 75-year-old women with osteoporosis: randomized controlled trial. Canadian Medical Association Journal. 2002;167:997–1004. found no beneficial effects of exercise intervention on quality of life of the women studied. The other selected studies demonstrate a positive impact of this intervention on the quality of life of the women studied. Overall, the intervention with exercise had a positive effect on the following: general health, interaction, global scores, body image, activities of daily living, vitality, social function and mental health.

Table 2
Results of studies evaluating the quality of life in women with osteoporosis.

Muscle strength and balance were the most evaluated physical abilities. In examining Table 3, it is possible to verify that the exercise plays an important role in improving these abilities, as they are key components for the prevention of falls. Two studies showed no increase in these abilities in the group performing exercise.

Table 3
Results of studies that evaluated physical and functional domains of women with osteoporosis.

Discussion

Osteoporosis negatively affects the patients’ quality of life, limiting their performance in activities of daily living. The chronic pain generated by osteoporosis can lead to depression, anxiety, frustration and social isolation.2424 Gold D, Stegmaier K, Bales C, Lyles K, Westlund R, Drezner M. Psychosocial functioning and osteoporosis in late life: Results of a multidisciplinary intervention. Journal of Women’s Health. 1993;2:149–55. Then, exercise practice becomes a crucial intervention, by increasing the confidence of the woman to independently perform her tasks.1414 Auad MA, Simões RP, Rouhani S, Castello V, Yogi LS. Eficácia de um programa de exercícios físicos na qualidade de vida de mulheres com osteoporose. Arquivos Brasileiros de Ciência da Saúde. 2008;33:31–5.

In addition to a reduction in bone loss, the regular practice of exercise by women with osteoporosis has, as positive effects, overall health, socialization, self-esteem, mood and body awareness improvement; and reduction of depression, anxiety and fear of falls.1313 Arnold CM, Busch AJ, Schachter CL, Harrison EL, Olszynski WP. A Randomized Clinical Trial of Aquatic versus Land Exercise to Improve Balance, Function, and Quality of Life in Older Women with Osteoporosis. Physiotherapy Canada. 2008;60:296–306.,1717 Devereux K, Robertson D, Briffa NK. Effects of a water-based program on women 65 years and over: A randomised controlled trial. Australian Journal of Physiotherapy. 2005;51:102–8. Also, the family knowledge about the disease has critical importance, because it generates greater family support for the patient to treat her illness.1515 Aveiro MC, Navega MT, Granito RN, Rennó ACM, Oishi J. Efeitos de um programa de atividade física no equilíbrio e na força muscular do quadríceps em mulheres osteoporóticas visando uma melhoria na qualidade de vida. Revista Brasileira de Ciência e Movimento. 2004;12:33–8..

In the study by Liu-Ambrose et al.,1919 Liu-Ambrose TYL, Khan KM, Eng JJ, Lord SR, Lentle B, McKay HA. Both resistance and agility training reduce back pain and improve health-related quality of life in older women with low bone mass. Osteoporos International. 2005;16:1321–9. the authors report that exercises performed in pairs increased the social interaction between the participants. This effect, especially among the elderly with similar health status, is related to the fact that exercises practiced in group provide to its participants the share life experiences, new friendships and an increased sense of well-being, that influence positively on their permanence in the program.1818 Kronhed A-CG, Hallberg I, Ödkvist L, Möller M. Effect of training on health-related quality of life, pain and falls in osteoporotic women. Advances in Physiotherapy. 2009;11:154–65.

The occurrence of fractures has a stronger effect in reducing the quality of life, compared just to the illness itself.2222 Aveiro M, Granito R, Navega M, Driusso P, Oishi J. Influence of a physical training program on muscle strength, balance and gait velocity among women with osteoporosis. Revista Brasileira de Fisioterapia. 2006;10:441–8.,2525 Adachi JD, Ioannidis G, Olszynski WP, Brown JP, Hanley DA, Sebaldt RJ, et al. The impact of incident vertebral and non-vertebral fractures on health related quality of life in postmenopausal women. BMC Musculoskeletal Disorders. 2002:3. A hip fracture, for instance, generates a significant reduction in quality of life of affected individuals in a period of 12-15 weeks after the fracture.2626 Randell AG, Nguyen TV, Bhalerao N, Silverman SL, Sambrook PN, Eisman JA. Deterioration in Quality of Life Following Hip Fracture: A Prospective Study. Osteoporis International. 2000;11:460–6. Postmenopausal women with osteoporosis who do not exhibit complications caused by the disease and are physically active have similar quality of life to postmenopausal women without osteoporosis.2727 Bianchi ML, Orsini MR, Saraifoger S, Ortolani S, Radaelli G, Betti S. Quality of life in post-menopausal osteoporosis. Health and Quality of Life Outcomes. 2005:3.,2828 Navega MT, Oishi J. Comparação da Qualidade de Vida Relacionada à Saúde entre Mulheres na Pós-menopausa Praticantes de Atividade Física com e sem Osteoporose. Revista Brasileira de Reumatologia. 2007;47:258–64.

Only the studies by Carter et al.1212 Carter ND, Khan KM, Petit MA, Heinonen A, Waterman C, Donaldson MG, et al. Results of a 10 week community based strength and balance training programme to reduce fall risk factors: a randomised controlled trial in 65-75 year old women with osteoporosis. British Journal of Sports Medicine. 2001;35:348–51. and Kronhed et al.1818 Kronhed A-CG, Hallberg I, Ödkvist L, Möller M. Effect of training on health-related quality of life, pain and falls in osteoporotic women. Advances in Physiotherapy. 2009;11:154–65. reported no significant improvement in the physical domains of osteoporotic women after the intervention, both when compared to a control group as when compared to baseline values. Although not indicating significant changes in balance and knee extension strength after 10 weeks of training, Carter et al.1212 Carter ND, Khan KM, Petit MA, Heinonen A, Waterman C, Donaldson MG, et al. Results of a 10 week community based strength and balance training programme to reduce fall risk factors: a randomised controlled trial in 65-75 year old women with osteoporosis. British Journal of Sports Medicine. 2001;35:348–51. state that the participants of the exercise group showed an increase in knee extension strength that, despite not being of statistical significance, has important biological significance. However, the study by Carter et al.1616 Carter ND, Khan KM, McKay HA, Petit MA, Waterman C, Heinonen A, et al. Community-based exercise program reduces risk factors for falls in 65- to 75-year-old women with osteoporosis: randomized controlled trial. Canadian Medical Association Journal. 2002;167:997–1004. maintained the intervention group for a period of 20 weeks and found significant increases in dynamic balance and in knee extension strength, compared to the control group (4.9% and 12.8%, respectively).

A training program aiming to increase muscle strength, especially in the lower limbs, is required to prevent falls and fractures in this population. A reduction of balance increases the risk and fear of falling.1515 Aveiro MC, Navega MT, Granito RN, Rennó ACM, Oishi J. Efeitos de um programa de atividade física no equilíbrio e na força muscular do quadríceps em mulheres osteoporóticas visando uma melhoria na qualidade de vida. Revista Brasileira de Ciência e Movimento. 2004;12:33–8. The mobility results in more independence for the individual, reducing the likelihood of institutionalization.2323 Madureira MM, Takayama L, Gallinaro AL, Caparbo VF, Costa RA, Pereira RMR. Balance training program is highly effective in improving functional status and reducing the risk of falls in elderly women with osteoporosis: a randomized controlled trial. Osteoporos International. 2007;18:419–25.

Frail individuals with impaired balance and movements can get the same benefits from the practice of conventional exercise, while exercising in the water.1010 Bass SL, Forwood MR, Larsen JA, Saxon L. Prescribing Exercise for Osteoporosis. International Sport Med Journal. 2001;1:1–13. The aquatic environment, in addition to stability and coordination, stimulates the visual, vestibular and perceptual systems. The water-based activity reduces the stress incident on joints and muscles due to the reduced impact, and improves the subject's range of motion.1717 Devereux K, Robertson D, Briffa NK. Effects of a water-based program on women 65 years and over: A randomised controlled trial. Australian Journal of Physiotherapy. 2005;51:102–8. According to Arnold et al.,1313 Arnold CM, Busch AJ, Schachter CL, Harrison EL, Olszynski WP. A Randomized Clinical Trial of Aquatic versus Land Exercise to Improve Balance, Function, and Quality of Life in Older Women with Osteoporosis. Physiotherapy Canada. 2008;60:296–306. exercises performed in water can be more effective, even considering the fact that exercises practiced out of the water have higher specificity and applicability with respect to functional tasks.

Questionnaires to assess the quality of life are used because of their low cost and easy application. In the case of the population concerned, there are specific tools for verification of this variable; for instance, Qualeffo, OQLQ - Osteoporosis Quality of Life Questionnaire, and OPAQ - Osteoporosis Assessment Questionnaire. The use of generic instruments such as the SF-36 questionnaire complicates the interpretation of the data, since this instrument was adopted for use in healthy individuals, despite the correlation between this and specific questionnaires.2626 Randell AG, Nguyen TV, Bhalerao N, Silverman SL, Sambrook PN, Eisman JA. Deterioration in Quality of Life Following Hip Fracture: A Prospective Study. Osteoporis International. 2000;11:460–6.,2929 Lemos MCD, Miyamoto ST, Valim V, Natour J. Qualidade de Vida em Pacientes com Osteoporose: Correlação entre OPAQ e SF-36. Revista Brasileira de Reumatologia. 2006;46:323–8. It is important that the instrument to be used is specific to the studied population, considering the reliability of the data.3030 Group OQoLS. Measuring Quality of Life in Women with Osteoporosis. Osteoporis International. 1997;7:478–87.

None of the studies reviewed analyzed body weight, height, prevalence of alcohol intake and smoking. It is known that these variables are risk indicators for falls and fractures in this population,3131 Voort DJMvd, Geusens PP, Dinant GJ. Risk Factors for Osteoporosis Related to their Outcome: Fractures. Osteoporis International. 2001;12:630–8.,3232 Papaioannou A, Kennedy CC, Ioannidis G, Brown JP, Pathak A, Hanley DA, et al. Determinants of health-related quality of life in women with vertebral fractures. Osteoporos International. 2006;17:355–63. and changes in body weight or in behavioral variables may indicate the effect of the intervention program. It is suggested that future research focus on anthropometric and behavioral variables, besides the quality of life and physical aspects.

Based on the articles selected, it is possible to conclude that the intervention with exercise is important to improve the quality of life of women with postmenopausal osteoporosis. Similarly, activities aimed at working on muscle strength and balanceare essential to prevent the occurrence of falls, and to consequently reduce the incidence of fractures in this population.

References

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    Steiner ML, Fernandes CE, Strufaldi R, Azevedo LHd, StephanC, Pompei LM, et al. Accuracy study on “Osteorisk”: a newosteoporosis screening clinical tool for women over 50 yearsold. Sao Paulo Medical Journal. 2008;126:23–8.
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Publication Dates

  • Publication in this collection
    Nov-Dec 2014

History

  • Received
    27 Aug 2013
  • Accepted
    18 Feb 2014
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