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Community-based osteoporosis prevention: Physical activity in relation to bone density, fall prevention, and the effect of training programmes: The Vadstena Osteoporosis Prevention Project
Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Primary Health Care Centres.
2003 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This thesis is based on studies of the ten-year community-based intervention programme entitled, the Vadstena Osteoporosis Prevention Project (VOPP). The specific aims of the research were to describe the effects of physical activity and training programmes on bone mass and balance performance in adults, to determine whether a fall risk prevention programme could motivate personal actions among the elderly, to ascertain whether the intervention programme could reduce the incidence of forearm and hip fractures.

Two studies addressed training programmes for middle-aged and old people. First, VOPP participants who were aged 40–70 years and had low forearm bone mineral density (BMD) values were invited to take part in a one-year weight-bearing training study. Thirty of those individuals were included in the investigation. Additional bone mass measurements were performed at the hip and the lumbar spine, and balance and aerobic capacity were also tested. The training programme was performed twice a week (I). In the second study, healthy persons aged 70–75 years were invited to participate in a balance-training study. Fifteen persons joined an exercise group, and another fifteen were controls. The training programme comprised specific balance exercises and was carried out twice a week for nine weeks (II). The association between forearm BMD values and several lifestyle factors was explored in random samples of the population aged 20–72 years (n=880) in a cross-sectional study (III). Another study explored the association between calcaneal stiffness, forearm BMD, and lifestyle factors amongst participants aged 20–79 years (n=956) at the final registration of the VOPP (V). Effects of the VOPP interventions directed at environmental risk factors for falls and the promotion of physical activity were examined in people aged ≥ 65 years (IV). The incidence of forearm and hip fractures was studied amongst middle-aged and elderly individuals in the intervention and the control communities during the study period 1987–2001 (VI).

The exercise group (n=15) in the weight-bearing training study showed increases in BMD at the greater trochanter (p<0.01), one-leg stance balance with the eyes closed and coordination tests (p<0.05), and aerobic capacity (p<0.05). No significant difference was found when the groups were compared concerning changes in the different tests during the intervention period (I). In the balance-training study, the exercise group showed post-training improvement in the following tests: standing on the right leg with eyes closed (p<0.01), standing on the right leg (p<0.01) and on the left leg (p<0.05) while turning the head, and walking 30 metres (p<0.01). There were significant differences between the groups in these tests when changes were compared at the post-intervention test (II). Age (p<0.0001) and body mass index (p≤.0001) were associated with forearm BMD in both sexes. Reported moderate physical activity levels in men were positively associated with forearm BMD (p<0.05) (III). In both sexes, reported moderate (p<0.05) and high (women p<0.05 and men p<0.001) physical activity levels were positively associated with calcaneal stiffness. The correlation coefficient between forearm BMD and calcaneal stiffness was 0.58 in women and 0.34 in men (V). Persons aged ≥ 65 years at the follow-up in 1994 reported more use of shoe/cane spikes

and moderate physical activity levels compared to controls (IV). There was no change in the general incidence of forearm and hip fractures between the communities for the study period. However, there was a tendency towards decreasing incidence of forearm and trochanteric hip fracture in both sexes during the late intervention period in the intervention community (VI).

A community-based intervention programme aimed at reducing the incidence of osteoporotic fractures must be regarded as a long-term project and should preferably be monitored over an extended post-intervention period.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2003. , 50 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 788
Keyword [en]
Vadstena Osteoporosis Prevention Project (VOPP), weight-bearing training study, physical activity, training programmes, elderly, forearm bone mineral density (BMD), balance-training
National Category
Surgery
Identifiers
URN: urn:nbn:se:liu:diva-5212ISBN: 91-7373-547-7 (print)OAI: oai:DiVA.org:liu-5212DiVA: diva2:21156
Public defence
2003-05-08, Berzeliussalen, Campus US, Linköpings universitet, Linköping, 13:00 (English)
Opponent
Supervisors
Note
On the day of the public defence the statuses of articles IV and V were Submitted and VI was ManuscriptAvailable from: 2003-05-19 Created: 2003-05-19 Last updated: 2013-09-05Bibliographically approved
List of papers
1. Effects of physical exercise on bone mass, balance skill and aerobic capacity in women and men with low bone mineral density, after one year capacity in women and men with low bone mineral density, after one year: a prospective study
Open this publication in new window or tab >>Effects of physical exercise on bone mass, balance skill and aerobic capacity in women and men with low bone mineral density, after one year capacity in women and men with low bone mineral density, after one year: a prospective study
1998 (English)In: Scandinavian journal of medicine & science in sports, ISSN 0905-7188, Vol. 8, no 5 Pt 1, 290-298 p.Article in journal (Refereed) Published
Abstract [en]

Vadstena is a small community in the county of Ostergötland, Sweden, where a project began in 1989 to prevent osteoporosis and to lower the expected incidence of osteoporotic fractures. Persons aged 40-70 years who had a low bone mineral density (BMD) value at screening of the distal radius by single-photon absorptiometry (SPA) were invited to participate in a training study during one year. The definition of low BMD was a densitometry value below -1 SD (standard deviation) from a sex- and age-specific reference value (z-score). Fifteen persons wanted to exercise in a group and 15 persons wanted to become a control group. All participants answered a questionnaire about lifestyle, occupation, diseases, medication and heredity. Clinical tests were made regarding mobility of the joints and muscles, balance and physical fitness. BMD for the hip and the lumbar spine were assessed by dual-energy X-ray absorptiometry (DXA) before and after the investigation period. The training programme was carried out for 60 min twice a week during one year and had the intention to improve bone mass, muscle strength and flexibility, balance skill and aerobic capacity. After the training period there was a significant increase in BMD at the greater trochanter (P < 0.01), in balance skill (standing on one leg with closed eyes and "ski step"-test) (P < 0.05) and in oxygen uptake capacity (P < 0.05) in the exercise group. In the control group, there was a significant increase in BMD at the lumbar spine (P < 0.05). However, these results should be judged with caution because several participants were over the age of 60, and at that age degenerative changes in the lumbar spine may increase to a greater or lesser extent. Regular weight-bearing exercises during one year seem to influence BMD at the greater trochanter in a training group comprising both women and men. However, our study was small in number and further training studies are needed to assess the effect of weight-bearing training on bone mass in different sex- and age-specific groups.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13678 (URN)
Available from: 2003-05-19 Created: 2003-05-19
2. The effect of short-term balance training on community-dwelling older adults
Open this publication in new window or tab >>The effect of short-term balance training on community-dwelling older adults
2001 (English)In: Journal of Aging & Physical Activity, ISSN 1063-8652, Vol. 9, no 1, 19-31 p.Article in journal (Refereed) Published
Abstract [en]

This study evaluated a balance-training program's influence in healthy older adults. Fifteen community-dwelling participants aged 70Ð75 years were randomized to an exercise group, and 15 gender- and age-matched participants, to a control group. The 9-week training program comprised ordinary-life balance, vestibular-habituation, and ball exercises and station training. Clinical balance tests were conducted before and after training. Tests that showed significant improvement in the exercise group after the intervention included standing on the right leg with eyes closed, standing on the right leg and the left leg while turning the head and walking 30 m. Significant between-group differences were found at posttest. A significant decrease was seen in the control group in the walking-forward test, and this change was significantly different between groups. The study indicates that balance performance in healthy older adults might be improved by balance training including exercises that stimulate multiple sensory systems and their central integration.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13679 (URN)
Available from: 2003-05-19 Created: 2003-05-19 Last updated: 2009-05-15
3. Association between physical activity and forearm bone mineral density in 20-72-year-olds
Open this publication in new window or tab >>Association between physical activity and forearm bone mineral density in 20-72-year-olds
Show others...
2002 (English)In: Advances in Physiotherapy, Vol. 4, no 2, 87-96 p.Article in journal (Refereed) Published
Abstract [en]

Physical activity may influence bone mineral density (BMD) in different ways. In the present study the amount of physical activity and the associations between forearm BMD, body mass index, physical activity and several other lifestyle factors were explored. A random sample of the population in a Swedish municipality was invited to the study and examined by a questionnaire and by forearm bone mineral measurements using single photon absorptiometry. Forearm BMD was measured in 880 subjects. Forearm BMD was stable from 20 to 50 years of age in women and from 20 to 60 years of age in men. Reported moderate leisure-time physical activity levels in men were significantly associated with higher forearm BMD than low leisure-time physical activity levels ( p = 0.042). The findings that moderate levels of leisure-time physical activity in men were associated with higher forearm BMD, give some support to the hypothesis that increased amount of physical activity in a population might be of benefit in the prevention of osteoporosis. Further longitudinal studies of the effect of physical activity in the prevention of osteoporosis, falls and fractures are warranted.

Keyword
Body Mass Index, Cross-SECTIONAL, Osteoporosis, Population-BASED, Prevention
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13680 (URN)10.1080/140381902320141498 (DOI)
Available from: 2003-05-19 Created: 2003-05-19 Last updated: 2009-08-18
4. Evaluation of an osteoporosis and fall risk intervention program for community-dwelling elderly.: a quasi-experimental study of behavioural modifications
Open this publication in new window or tab >>Evaluation of an osteoporosis and fall risk intervention program for community-dwelling elderly.: a quasi-experimental study of behavioural modifications
Show others...
2006 (English)In: Aging Clinical and Experimental Research, ISSN 1594-0667, Vol. 18, no 3, 235-241 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND AND AIMS: Osteoporosis and fall fractures are increasing problems amongst the elderly. The aim of this study was to explore whether combined population-based and individual interventions directed at risk factors for osteoporosis and falls result in behavioral changes in an elderly population.

METHODS: A quasi-experimental design was used for the study. Persons aged >or=65 years were randomly selected in the intervention and control community. An intervention program was managed from the primary health care center and delivered to the community. Health education was designed to increase awareness of risk factors for the development of osteoporosis and falling. Questionnaires about lifestyle, health, previous fractures, safety behavior and physical activity level were distributed at baseline in 1989 and at the follow-ups in 1992 and 1994 in both communities.

RESULTS: There was a difference of 17.7% between the dual intervention (receiving both population-based and individual interventions) and the control samples regarding the self-reported use of shoe/cane spikes, and a difference of 20.5% regarding the reported "moderate level" of physical activity in 1994. There was an increase in the number of participants in the dual intervention sample who, at baseline, had not reported equipping their homes with non-slip mats and removing loose rugs but who did report these changes in 1994. The increase in the reported use of shoe/cane spikes in the dual intervention sample was observed mainly for the period 1992-1994.

CONCLUSIONS: A public health intervention model, including both population-based and individual interventions, can contribute to behavioral changes in the prevention of falls and changed physical activity patterns amongst elderly people.

Keyword
Environmental hazard, fall prevention, population-based
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13681 (URN)
Available from: 2003-05-19 Created: 2003-05-19 Last updated: 2013-09-05
5. Is calcaneal stiffness more sensitive to physical activity than forearm bone mineral density?: A population-based study of persons aged 20-79 years
Open this publication in new window or tab >>Is calcaneal stiffness more sensitive to physical activity than forearm bone mineral density?: A population-based study of persons aged 20-79 years
Show others...
2004 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, Vol. 32, no 5, 333-339 p.Article in journal (Refereed) Published
Abstract [en]

Aims: The aim of this study was to investigate the associations between forearm bone mineral density (BMD), calcaneal stiffness, and physical activity levels in a normal population using different non-invasive methods.

Methods: The participants were invited to undergo bone measurements using single photon absorptiometry of the forearm and quantitative ultrasound (QUS) of the calcaneal bone, and also to complete a questionnaire. Physical activity levels were designated low, moderate, and high in the question on leisure-time activity.

Results: There were 956 participants included in the present study. Forearm BMD in the eighth age decade was 0.40 g/cm2 (95% CI 0.33 - 0.46 g/cm2) lower than in the third decade among women and 0.28 g/cm2 (95% CI 0.18 - 0.37 g/cm2) lower among men. The differences in calcaneal stiffness between the same age decades were 22.4 (95% CI 17.5 - 27.4) among women and 15.8 (95% CI 8.0 - 23.5) among men. The correlation between forearm BMD and calcaneal stiffness was 0.58 (95% CI 0.52 - 0.64) in women and 0.34 (95% CI 0.25 - 0.42) in men. Reported moderate and high leisure-time activity levels in both genders were associated with higher calcaneal stiffness but not with forearm BMD.

Conclusions: The QUS may be used to measure the effect of present physical activity levels on calcaneal bone at the population level. Further longitudinal studies are warranted in order to determine the most appropriate non-invasive method in population-based studies.

Keyword
community-based interventions, osteoporosis, prevention, quantitative ultrasound, questionnaire, reference values, single photon absorptiometry
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13682 (URN)10.1080/14034940410026273 (DOI)
Available from: 2003-05-19 Created: 2003-05-19 Last updated: 2013-09-05
6. Impact of a community-based osteoporosis and fall prevention program on fracture incidence
Open this publication in new window or tab >>Impact of a community-based osteoporosis and fall prevention program on fracture incidence
Show others...
2005 (English)In: Osteoporosis international, ISSN 0937-941X, Vol. 16, no 6, 700-706 p.Article in journal (Refereed) Published
Abstract [en]

Associations between a 10-year community-based osteoporosis and fall prevention program and fracture incidence amongst middle-aged and elderly residents in an intervention community are studied, and comparisons are made with a control community. A health-education program was provided to all residents in the intervention community, which addressed dietary intake, physical activity, smoking habits and environmental risk factors for osteoporosis and falls. Both communities are small, semi-rural and situated in Östergötland County in southern Sweden. The analysis is based on incidences of forearm fractures in the population 40 years of age or older, and hip fractures in the population 50 years of age or older. Data for three 5-year periods (pre-, early and late intervention) are accumulated and compared. In the intervention community, forearm fracture incidence decreased in women. There are also tendencies towards decreasing forearm fracture incidence in men, and towards decreasing trochanteric hip fracture incidences in women and in men in the late intervention period. No such changes in fracture incidences are found in the control community. Cervical hip fracture incidence did not change in the intervention and the control communities. Although the reported numbers of fractures are small (a total of 451 forearm and 357 hip fractures), the numbers are based on total community populations and thus represent a true difference. The decrease in forearm fracture incidence among women, and the tendency towards decreasing trochanteric hip fractures, in contrast to the absence of change in cervical hip fractures, might be mainly due to a more rapid effect of fall preventive measures than an increase in bone strength in the population. For the younger age groups an expected time lag between intervention and effect might invalidate the short follow-up period for outcome measurements. Thus, the effect of the 10-year intervention program on fracture incidence should be followed during an extended post-intervention period.

Keyword
Fracture outcome, Fragility fractures, Prevention, Quasi-experimental
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13683 (URN)10.1007/s00198-004-1732-0 (DOI)
Available from: 2003-05-19 Created: 2003-05-19 Last updated: 2013-09-05

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Grahn Kronhed, Ann-Charlotte

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