Effect of home exercise on functional performance, posture, quality of life and pain in older women with vertebral fractures: A pilot feasibility trial

Guidelines for osteoporosis management advocate for regular exercise to prevent falls and fractures, but there is limited evidence on the safety and efficacy of exercise in individuals at high risk of fracture. Purpose: We conducted a pilot randomized controlled trial to evaluate the feasibility of recruitment, retention and adherence to 12 months of home exercise compared to control among older women with vertebral fractures. Herein we present an exploratory analysis of the effect of the home exercise program on secondary outcomes, including functional performance, posture, quality of life and pain. Methods: Community‐ dwelling women aged 65 years and older with at least one radiographically‐confirmed Genant Grade 2 vertebral compression fracture were recruited at seven sites in Canada and Australia. We randomized participants in a 1:1 ratio to a 12‐month home exercise program (n=71) or equal attention control group (n=70), both delivered by a physical therapist over six home visits and monthly phone calls. The exercise program included progressive strength, posture, balance and endurance training and behavioral counseling. Adherence was defined as the completion of strength or balance exercises at least three days per each seven‐day period in daily diaries. Functional performance tests, occiput‐to‐wall distance, health‐related quality of life questionnaires and pain scales were performed at baseline and 12 months by a blinded research assistant. T‐tests explored between‐group mean differences (MD) in change from baseline in intention‐to‐treat (ITT) and per‐protocol analyses. Results: There was a positive effect of exercise on five times sit‐to‐stand test time versus control (MD: ‐1.58 seconds, 95% CI: ‐3.09, ‐0.07, ITT; MD: ‐1.49 seconds, 95% CI: ‐3.12, 0.16, per‐protocol). There were no other significant between‐group differences for functional mobility, balance, posture, quality of life and pain. Average adherence to the exercise program over months 1 to 11 was 73%; yet, adherence declined from 68% at month 6 to 59% at month 11. Conclusions: The effect of home exercise on functional leg muscle strength was consistent in direction and magnitude to the effects of exercise on mobility outcomes in other trials in individuals with vertebral fractures. Declining adherence to home exercise suggests that strategies to enhance long‐term adherence or more supervision might be important in future exercise trials in older women with vertebral fractures. (Figure Presented).