One of the most interesting studies to finish in the last couple years is the Erlangen Fitness and Osteoporosis Prevention Study (EFOPS), which ended in 2014 after 16 years. The study was based in Erlangen-Nuremberg, Germany and run by Wolfgang Kemmler, Ph.D., and his colleagues at the Institute of Medical Physics, University of Erlangen. Before EFOPS, very few studies followed subjects for more than two years. The study design was set up to allow post-menopausal women who met the study criteria to choose whether to be in the exercise group (EG) or the control group (CG). The goal was to have enough women at the end of 16 years to allow for valid statistical comparisons between the groups. BMD and other assessments were made every four years (4-, 8-, 12-, and 16-year follow-up). The key measurements were bone mineral density (BMD) for the lumbar spine (LS) and femoral neck (FN). It was clear by the first interim report after 4 years that exercise was associated with increased BMD, while the CG BMD decreased. The exercises evolved as the study progressed. By 2014, there were 105 women remaining in the study (EG: n = 59 vs. CG: n = 46). The overall conclusion based on the 16-year analysis was that older adults would benefit from doing exercises regularly that could stimulate bone growth as well as help prevent fractures due to falls.
If you are interested in learning more about EFOPS, read on. The most complete report online is #3.
1) The Erlangen Fitness Osteoporosis Prevention Study: a controlled exercise trial in early postmenopausal women with low bone density-first-year results
INTERVENTION: Fourteen months of exercise training, with 2 joint sessions and 2 additional home training sessions. Exercise and control groups were supplemented individually with calcium and cholecalciferol up to 1500mg of calcium and 500IU of vitamin D per day.
RESULTS: Bone density increased significantly at the lumbar spine for the exercise group (1.3%, P<.001) and decreased in the control group (-1.2%, P<.01). Differences at the total hip (-0.3%, not significant vs -0.8%, P<.05) and the femoral neck (-0.8%, P<.05 vs -1.8%, P<.001) were nonsignificant. Changes in isometric maximum strength were significant for each region (grip strength, trunk flexors and extensors, hip flexors, leg adductors and abductors, arm flexors and extensors) in the exercise group (11%-39%) compared with nonrelevant changes (-1.1% to 3.9%) in the control group. Between-group differences were significant (P<.01-.001) for all strength parameters. VO2max increased significantly by 11% (P<.001) in the exercise group but decreased in the control group by 4% (P<.05) while showing significant between-group differences.
Arch Phys Med Rehabil. 2003 May; 84(5):673-82
http://www.ncbi.nlm.nih.gov/pubmed/12736880
2) Exercise and fractures in postmenopausal women. Final results of the controlled Erlangen Fitness and Osteoporosis Prevention Study (EFOPS)
ABSTRACT: The EFOPS trial clearly established the positive effect of long-term exercise on clinical low-trauma fractures in postmenopausal women at risk. Bearing in mind that the complex anti-fracture exercise protocols also affect a large variety of diseases of increased age, we strongly encourage older adults to perform multipurpose exercise programs.
RESULTS: In 2014, 105 subjects (EG: n = 59 vs. CG: n = 46) representing 1680 participant-years were included in the 16-year follow-up analysis. Risk ratio in the EG for overall low-trauma fractures was 0.51 (95 % confidence interval (95 % CI) 0.23 to 0.97, p = .046), rate ratio was 0.42 (95 % CI 0.20 to 0.86, p = .018). Based on comparable baseline values, lumbar spine (MV -1.5 %, 95 % CI -0.1 to -2.8 vs. -5.8 %, -3.3 to -7.2 %) and femoral neck (-6.5 %, -5.2 to -7.7 vs. -9.6 %, -8.2 to 11.1 %) BMD decreased in both groups; however, the reduction was more pronounced in the CG (p ≤ .001).
Osteoporos Int. 2015 Oct;26(10):2491-9. doi: 10.1007/s00198-015-3165-3. Epub 2015 May 12.
http://www.ncbi.nlm.nih.gov/pubmed/25963237
3) Long-Term Exercise and Bone Mineral Density Changes in Postmenopausal Women—Are There Periods of Reduced Effectiveness?
ABSTRACT
The exercise protocol initially focused on a high-intensity strategy that addressed bone but increasingly shifted to a more comprehensive intervention. LS-BMD differences between the EG and CG continuously increased (year 4: 2.4% (95%- Confidence Interval 1.0% to 3.8%), year 8: 3.1% (1.6% to 4.7%), year 12: 3.9% (1.9% to 5.8), year 16: 4.5% (2.5% to 6.6%). Correspondingly, rising differences for FN-BMD (0.9% (–0.2% to 2.1%) versus 1.9% (0.4% to 3.3%) versus 2.0% (0.5% to 3.8%) versus 3.0% (1.0% to 5.0%)) were observed. However, in contrast to our hypothesis, group differences within the four 4-year periods were not consistently significant (LS, p = 0.001 to 0.097; FN, p = 0.026 to 0.673); further, BMD kinetics among the groups varied between LS and FN. Of particular importance, significant differences (p ≤ 0.030) for both regions were still found in the final period. We conclude that exercise—even when adapted for subjects' decreasing bone, health, and fitness status—is consistently effective in favorably affecting BMD in (initially) early-postmenopausal osteopenic women without any leveling-off effect after 16 years of exercise.
Journal of Bone and Mineral Research, Vol. 1, No. 1, Jan 2016
http://onlinelibrary.wiley.com/doi/10.1002/jbmr.2608/full - online Sept 2015
No comments:
Post a Comment