Better Bones and Balance: Evaluation of a bone and falls specific community-based exercise program
Summer LIFE Scholar Program participant: Cathy Couey
Study Mentors: Adrienne McNamara , PhD Candidate & Kathy Gunter, PhD
2008 LIFE Scholars Program – Oregon State University Center for Healthy Aging Research
Introduction
Findings to Date
Methods
All testing is conducted in the OSU Bone Research Laboratory where participants complete questionnaires and are measured for height,
weight and fitness parameters.
For many older Americans, falls are a chronic condition requiring medical
management. The health and economic burden of falls in this population is
large.
Among the most costly outcomes are fall-related hip fractures.
Additionally, the prevalence of osteoporosis is increasing and the total number of
annual fractures and costs associated with osteoporosis are predicted to rise.
Bone Strength and Structural Measures
Subjects
Bone parameters are measured for each participant using dual energy x-ray
absorptiometry (DXA) bone scan (fig. 3) to assess bone mineral density of
their hip, spine and whole body. Bone scan data are used to determine bone
mass and bone structural outcomes. Statistical analysis will be used to : 1)
examine the relationship between participation in the BBB program and bone
health in comparison to non-participating sedentary controls; 2) examine the
relationship between participation in the BBB program and fall risk factors ;
and 3) determine dose-response relationship between duration of
participation in BBB and bone mass and hip structure.
Estrogen deplete, postmenopausal women (n=50) currently participating in the
BBB exercise program for at least one year, will be recruited from existing classes
in the Willamette Valley via flyers, informational sessions held at classes and word
of mouth from the class instructors. Estrogen deplete, sedentary, postmenopausal
age matched controls (n=50) will be recruited from the Corvallis community via
flyers posted on the OSU campus, at the Corvallis Senior Center and in the
Corvallis community as well as by word of mouth. A subset of BBB participants
(n=40) will be recruited to partake in the descriptive sub-study.
The need persists to identify successful, evidence-based, comprehensive
interventions to improve function and prevent falls and osteoporosis related
injuries among community-dwelling older adults. Weight bearing, balance and
resistance exercises have been shown to improve bone mass and reduce the
risk of falls, however most exercise data come from laboratory based or shortterm community-based exercise trials. The effects of long-term participation in
bone specific exercise on bone mass and structure in older women is still
unknown.
Descriptive Statistics Tables
In order to promote exercise for the prevention of osteoporosis, exercise
programs must translate out of the laboratory and into the community. In doing
so they must be safe, enjoyable and sustainable in order to keep individuals
participating. To date, there have been several studies examining communitybased fall prevention programs, but few have focused on bone specific
community-based exercise with the intent of both improved bone and reduced
fall risk factors.
Variable
Means + SD
Age (years)
72.7 + 8.8
Time postmenopausal (years)
19.9 + 9.0
Body fat (percent)
33.2 + 6.1
Height (cm)
162.2 + 7.3
Weight (kg)
66.7 + 10.8
The Better Bones and Balance exercise program (BBB) is a fall and hip fracture
risk reduction exercise program that began with 27 postmenopausal women in
1994 and has grown to include an enrollment of over 300 participants in Linn and
Benton counties, with more throughout the states of Oregon, Washington and
California. The program has proven to be both enjoyable and sustainable as
there are participants who have been regularly attending classes for over 14
years. We now have the opportunity to examine the relationship between
participation in a true community-based bone loading and fall prevention
program and parameters of bone health (hip bone mass and hip structure),
strength and balance. Due to consistent long term participation, we also have
the opportunity to examine a dose-response relationship between duration of
participation in BBB and outcomes related to bone mass and structure.
t-score (SD)
AP Lumbar Spine t-score
(-)1.28 + 1.29
Femoral Neck t-score
(-)1.62 + 0.95
Trochanter t-score
(-)1.29 + 0.62
Total Hip t-score
(-)1.3 + 0.64
Note: a t-score of 0 indicates "average" value for that of a 24 year old.
Time in BBB (years)
7.2 + 4.3
Table 1: Means and SD of demographics
Figure 3:
Test
Doctoral student Adrienne
McNamara conducts a bone
scan on a research
participant.
Bone Variable
Table 2: Mean t-scores of 4 bone values
Score
National Age-Matched Norms
8-ft up-and-go
6.17 + 1.47
7.1 - 4.9 seconds
30-second chair stands
18.8 + 4.2
10 rep - 15 rep
Bicep curl
23.7 + 5.2
12 rep - 17 rep
108.0 + 18.4
68 -101 steps
2-min step test
Figure 1: Better Bones and Balance participants lunging, balancing, and jumping during a BBB class.
Table 3: Group means for strength and balance and age-matched national norms
Questionnaire-based Measures
Perspectives
Questionnaires will assess cognitive function, health history, balance self-efficacy,
physical activity, and nutrition. Nutritional status will be assessed using The
Block 2005 Food Frequency Questionnaire. A health history questionnaire will
be used to compile demographic statistics of our population as well as potential
medications or diseases that may affect bone. BBB participants will complete a
questionnaire detailing their historical involvement in the BBB program. The
Aerobics Center Longitudinal Study Physical Activity Questionnaire will be used to
assess regular levels of generalized, non-bone specific physical activity to
compare activity levels between groups. The Bone-Specific Physical Activity
Questionnaire (BPAQ) will be used to assess past and current physical activity
patterns that may specifically influence the skeleton. The Mini-Mental State
Examination will be used to assess cognitive impairment that might hinder the
participant’s ability to participate in this study.
Purpose
The purpose of this study is to determine relationships between participation
in BBB and bone and health risk factors. Specifically we will address the
following research questions:
Data Analysis
Statistical analysis will be used to : 1) examine the relationship between
participation in the BBB program and bone health in comparison to nonparticipating sedentary controls; 2) examine the relationship between
participation in the BBB program and fall risk factors ; and 3) determine
dose-response relationship between duration of participation in BBB and
bone mass and hip structure.
Differences in
BMD and hip structural parameters between BBB
participants and controls will be assessed using Analysis of Covariance
(ANCOVA), controlling for age, lean body mass and bone-specific physical
activity. Differences between groups in strength, and balance parameters
will be assessed using Multivariate Analysis of Covariance (MANCOVA),
controlling for age. Stepwise regression will be used to address the
relationship between duration of BBB participation (years) and BMD. Means
and standard deviations of data presented in this poster were calculated
using SPSS software. When available, group means were compared to
national normative data (Riki and Jones, 2002).
Functional Measures
1) Do estrogen deplete postmenopausal women who have been
participating in BBB for a least one year have enhanced bone mass
(BMD) and hip structure compared to non-participating age matched
controls?
2) Is there a dose-response relationship between duration of participation in
BBB and bone mass and hip structure?
3) Do estrogen deplete postmenopausal women who have been
participating in BBB for at least one year have reduced risk factors for
falls (greater leg strength, greater balance) than age matched nonparticipating controls?
Participants height, weight, and fitness parameters including strength, balance, and
cardio-respiratory fitness are also being measured. Components of the Senior
Fitness Test will be used to assess underlying physical parameters associated with
functional ability. This test includes the one-leg stance (fig. 2A ) to assess static
balance; the bicep curl (fig. 2B) to assess upper body strength; the 30-second
chair stand (fig. 2C) to assess lower body strength needed for daily tasks as
well as strength to reduce the risk of falling; the 2-minute step test (fig. 2D) to
assess aerobic endurance; the 8-foot up-and-go to assess agility and
dynamic balance; the tandem stance (fig. 2E) and the tandem walk (fig. 2 F) to
assess dynamic balance.
Progress to Date
Recruitment
We have successfully recruited thirty-eight estrogen deplete BBB
participants into the study who meet all of the inclusion criteria. An
additional twenty-five participants were screened and did not meet inclusion
criteria. Informational sessions are underway for a second round of
recruiting among the BBB participants. Recruitment of control participants is
beginning this month and we expect to have all control participants tested by
the end of March 2009.
Senior Fitness Test Components
A
B
C
D
Study Findings
E
Figure 2: Components of the Senior Fitness Test. One legged stance (A); Bicep curl (B); 30-second chair stands (C); 2-minute
step test (D); Tandem stance (E); Tandem walk (F)
F
To date, twenty-seven BBB participants have been tested. A descriptive
statistics data analysis was performed with data collected to date from
twenty-three participants, as shown in tables 1, 2 and 3. Means and
standard deviations of demographic parameters are included in table 1.
Mean t-score values for lumbar spine, femoral neck, trochanter and total hip
are included in table 2. Group means for the strength and balance
assessments are included in table 3, along with age-matched national
norms.
We are unable to draw any conclusions as we are still collecting data on participants.
However, it is apparent from the descriptive data (when compared to normative data) that
BBB participants consistently out perform the average older adult female. The t-score
values are used to diagnose osteoporosis. Based on the mean t-score values, there is no
indication of osteoporosis at any bone site in the twenty-three BBB participants who were
tested.
Experience as a Life Scholar
The first observation made while working as a Life Scholar was that research projects do
not always go as planned. There were a few setbacks initially, so I was able to assist one of
Dr. Gunter’s Master’s students with her project for a time. The first set back came with a
project revision that required we wait for the Institutional Review Board to review the project
changes. I came to understand that even doctoral students and faculty have to revise and
edit projects based on feedback from experts and mentors. The second observation made
was the serious nature of working on a research project. I approached it with the same
care, respect and attention to detail that I put into my own work, realizing that the Bone
Research Laboratory team was trusting in and depending on me and that I was a part of the
research process. The third observation made was how carefully the data is handled during
data entry. It was required of anyone assisting with data entry, that the data be entered
once and then double checked for errors. It was a very time consuming, redundant and not
so interesting part of the research project, but vital to ensure the integrity of data outcomes
later during the analysis phase.
I considered it an honor to toil along side another
undergraduate student as we performed behind the scenes data entry work to advance the
project. I learned it is no small thing to promote the success and ultimately the credibility of
a master’s student or a doctoral candidate. The part of the process to date that I enjoyed
the most as a Life Scholar was working directly with the BBB participants during the
participant screening and the Senior Fitness Testing.
Future Plans
Career plans after graduation are to work in the area of long -term
care as a director for assisted living. What excites me about this
research project is how it will positively impact the future of
healthy aging. Because of what I’ve learned as a Life Scholar,
instituting an exercise program like Better Bones and Balance,
that promotes healthy aging through improved balance, strength
and better bones, will be an important priority for me as a director
for assisted living .