Effects of group-based exercise and educational program on physical performance and disease self-management in older adults with osteoporosis

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Authors (including presenting author) :
Liu BKP(1), Wong GHS(1), Chao CYL(1), Chan, ACM(1), Wong WP(2), Koo WK(2), Cheng WMW(2), Au-Yeung BYT(3)(4)
Affiliation :
(1)Physiotherapy Department, Queen Elizabeth Hospital, (2)Nursing Department, Queen Elizabeth Hospital (3)Department of Medicine, Queen Elizabeth hospital (4)Diabetes and Endocrine Centre, Queen Elizabeth Hospital
Introduction :
Osteoporosis is a structural deterioration of bone tissue due to progressive loss of bone mass resulting in increased susceptibility to fragility fracture. Exercise is a crucial form of non-pharmacological measures in maintaining or improving bone health. Evidence suggests that moderate intensity of progressive resistance, impact load exercise and balance training were associated with better bone mineral density, balance control and lesser falls. Educational programs with the intent to enhance self-efficacy for disease management are decisive for improving health outcomes. In this regards, a group-based osteoporosis program consisting of physical exercise and educational program component was developed in a team of doctors, physiotherapists and nurses for giving specialist oriented advice and training.
Objectives :
This study aimed to examine the effects of the group-based exercise and educational program on muscular strength, balance control, and self-perceived usefulness of the educational program for disease management in older people with osteoporosis.
Methodology :
82 older adults diagnosed with osteoporosis and attended the Multidisciplinary Joint Osteoporosis Clinic at the Diabetic and Endocrine Centre in the Queen Elizabeth Hospital participated in the program. Participants were stratified into either high fall risk group (n=27) or low fall risk group (n=55) according to their balance performance triaged by an experienced physiotherapist. The physical exercise part was conducted in group sessions and consisted of a progressive resistance, high/low impact load exercise and balance training. It was led by physiotherapists and tailored made for the high vs. low fall risk group. All participants were educated on how to avoid risky loads while maintaining full functional movements. The educational session was to increase participant’s knowledge concerning different aspects of their disease such as diet, medication, pain, postural control, fragility fracture, functional mobility, and psychological distress supplemented by an educational booklet. All participants were encouraged to continue practice the taught exercise for at least 30 minutes a day, 3 times a week regularly and registered all practiced exercise in a diary logbook. Program evaluation was recorded at the start of the program and at subsequent 6-month.
Result & Outcome :
Overall compliance to exercise was 85% in the high fall risk group and 70% in the low fall risk group. Upon 6 weeks of training, the total handgrip strength improved from 33.2±8.6 to 35.9±8.9 kgf (p=0.007), timed up and go test from 10.7±3.6 to 9.4±3.9 seconds (p=0.004), Berg Balance Scale Score from 48.0±8.5 to 50.8±5.8 (p=0.003). No statistically significant change was found in the Activity-specific Balance Confidence score and osteoporosis-specific quality-of-life questionnaire QUALEFFO-31. The satisfaction survey demonstrated that all participants perceived the group-exercise and educational program was useful that enhance their competences for having better self-efficacy disease management. The present group-based exercise and educational program conducted from a team of multidisciplinary professionals for people with osteoporosis had beneficial effects on muscle strength, balance control, and self-efficacy on disease management.

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