Physical activity and health-related quality of life in older adults with osteoporosis

Abstract

An important part of the physical therapists’ role is to help older adults to remain active as they age. Regular physical activity is essential for healthy aging and can delay functional decline and reduce the risk of premature mortality. This thesis comprise four studies, all including participants from the BETA-OP study, a randomized controlled trial (RCT), assessing the effects of a 12-week balance-training intervention for community-dwelling older adults, aged 65 years or over, with osteoporosis and fall-related concerns. The overall aim of the thesis was to explore correlates for physical activity in older adults with osteoporosis and to evaluate whether a specific, progressive balance-training program focusing on dual- and multi-task exercises for older had any short- and long-term effects on objectively measured habitual physical activity and health-related quality of life (HRQoL). The aim was also to compare self-reported pedometer steps with accelerometer-derived steps in older adults with osteoporosis, under free-living conditions.

Study I, a cross-sectional study (n=94), found that many older adults with osteoporosis are highly sedentary and a large proportion does not reach current health enhancing physical activity recommendations. A low daily step level, <5,000 steps per day, was associated with slower gait speed, poorer balance performance, lower HRQoL, and more sedentary time. Fall-related concerns were not associated with objectively assessed physical activity.

Study II included 71 older adults with osteoporosis and 73 with Parkinson’s disease and found that both the Yamax LS2000 pedometer and the Actigraph GT1M/GT3X+ accelerometers can be used to assess steps per day in older adults with osteoporosis, but for individuals with altered gait pattern, accelerometers should be preferred.

Study III, a RCT with 61 participants in the intervention group and 30 in the control group, showed that the balance-training program had beneficial short-term effects on habitual physical activity. The odds ratio (95% CI) for having a daily step-count ≥5,000 was 6.17 (1.23-30.91), p=0.027, for the intervention group compared to controls. The effect was not associated with improvements in gait speed, balance, or falls self-efficacy and did not persist through the long-term follow-up. No effect was found on HRQoL.

Study IV, was a qualitative study using inductive interpretive content analysis. Eighteen women were interviewed about perceptions and experiences of physical activity. We found that older women with a positive attitude to physical activity can manage to be physically active on their own if they feel secure about how much stress their bones can endure and which exercises are safe and suitable. Support and guidance from physical therapists, both individually and in group training, were important, but lack of advice from physicians about the benefits of physical activity on bone health was perceived as confusing.

In conclusion, these results indicate that a level of <5,000 steps/day can be associated with health risks and that objective assessment of physical activity is important to identify sedentary older adults with osteoporosis. The balance-training program had beneficial effects on habitual physical activity, but more support from physical therapists may be needed for sustained effects.