Trial lecture title: Occurrence of hip fractures in Norway over time. What are the reasons for the decline in recent years and what does it say about the future?
Ordinary opponents:
- First opponent: Professor Lars Nyberg, Luleå University of Technology
- Second opponent: Professor Berit Schei, Norwegian University of Science and Technology (NTNU)
- Chair of the committee: Professor Vigdis Aas, Faculty of Health Sciences, Oslo Metropolitan University
The leader of the public defense is Associate Professor Yngve Røe, OsloMet.
The main supervisor is Professor Astrid Bergland, Faculty of Health Sciences, OsloMet. The co-supervisor is Head of Department, Hege Bentzen, Faculty of Health Sciences, OsloMet.
Abstract
Osteoporosis and vertebral fractures represent a major health-burden worldwide and affects more women than men. The prevalence of osteoporosis is expected to increase as the world’s population ages.
Vertebral fractures represent a substantial risk of new fractures and are associated with increased mortality, morbidity, declined physical function, reduced health-related quality of life (HRQoL) and back pain. Exercise is often recommended as a part of the treatment to prevent bone loss, falls and fractures.
However, research evaluating the effects of exercise for people with osteoporosis and vertebral fractures is scarce and uncertainty still exists regarding the efficacy and safety of exercise. More adequately powered high-quality randomized controlled trials (RCTs) on the effects of exercise for this population is required, as no guidelines for this population currently exist.
Aims
The overall aim of this PhD-project was to investigate the effects of a multicomponent resistance and balance exercise programme in a group of community-dwelling older women with osteoporosis and vertebral fractures. Within the overall aim of the study, there were different sub-aims.
The first sub-aim of the thesis was to provide an in-depth background for the study, with detailed information on the project procedures to enhance the transparency of the project and further reduce publication bias.
The second sub-aim was to explore the associations between HRQoL, physical function and pain in older women with osteoporosis and vertebral fractures. The third sub-aim was to examine the short- and longer-term effects of a multicomponent resistance and balance exercise programme in older women with osteoporosis and vertebral fractures.
Methods
Results from paper II, where the relationship between HRQoL and physical function as well as pain is explored, show that a higher level of HRQoL is associated with a lower level of pain and better physical function, measured by habitual walking speed.
Paper III reports that for the primary outcome, habitual walking speed, no statistically significant difference between the groups were shown. Further results from Paper III show that there were statistically significant between-group differences in favour of the intervention group on balance, lower limb strength and upper limb strength (Senior Fitness test), as well as on fear of falling at three months follow-up (short-term).
There were no statistically significant differences between-groups on HRQoL. Paper IV shows that the improvements on balance, muscle strength and fear of falling sustained at six months follow-up (longer-term). In addition, there was a statistically significant difference in favour of the intervention group on mobility. For habitual walking speed and HRQoL, none statistically difference between-groups were shown at six months follow-up.
Conclusion
Pain and physical function are significantly associated with HRQOL in a group of older women with osteoporosis and vertebral fracture. A supervised multicomponent resistance and balance exercise programme showed short-term effects on improved muscle strength, balance and fear of falling in older women with osteoporosis and vertebral fractures after three-months follow-up as well as longer-term effects on the same outcomes.
There were no effects of the programme, neither on short- or longer-term, on habitual walking speed and HRQoL. There is still a need of more research on the effect of exercise on physical fitness and HRQoL for individuals with osteoporosis and vertebral fractures to inform exercise prescription and to improve health services for individuals with vertebral fractures.
