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Exercise for improving outcomes after osteoporotic vertebral fracture
Lora M Giangregorio1, Norma J Macintyre, Lehana Thabane
1Department of Kinesiology, University of Waterloo, Waterloo, Canada.mgiangr@uwaterloo.ca.
The Cochrane Database of Systematic Reviews
|February 27, 2013
Summary
Therapeutic exercise may improve pain and physical function in adults with vertebral fractures, but evidence is limited and inconsistent. More high-quality research is needed to confirm benefits and guide exercise prescription for this population.
Area of Science:
- Gerontology and Rehabilitation Science
- Orthopedics and Sports Medicine
- Physical Therapy and Exercise Science
Background:
- Vertebral fractures increase morbidity, including pain and reduced quality of life, and mortality.
- Therapeutic exercise is a recommended non-pharmacologic treatment for vertebral fractures to alleviate pain and improve function.
- Evidence on exercise benefits and harms for individuals with vertebral fractures requires systematic evaluation.
Purpose of the Study:
- To evaluate the benefits and harms of exercise interventions (≥4 weeks) versus non-exercise controls on future fractures and adverse events in adults with vertebral fractures.
- To examine secondary outcomes including falls, pain, posture, physical function, balance, mobility, muscle function, quality of life, and bone mineral density.
- To report exercise adherence in participants with a history of osteoporotic vertebral fracture(s).
Main Methods:
- Systematic search of multiple databases (Cochrane Library, MEDLINE, EMBASE, CINAHL, AMED, PEDro) and clinical trial registries up to November 2011.
- Inclusion of randomized controlled trials and quasi-randomized trials comparing exercise/active physical therapy with placebo/non-exercise/no intervention.
- Data extraction, risk of bias assessment using Cochrane Collaboration's tool, and grouping studies by follow-up duration (4-12, 16-24, 52 weeks).
Main Results:
- Seven trials with 488 participants were included; substantial variability precluded meaningful data pooling for most outcomes.
- No trials assessed exercise effects on incident fractures, adverse events, or falls.
- Individual trials suggested potential improvements in pain, Timed Up and Go test performance, walking speed, back extensor strength, trunk muscle endurance, and quality of life, but findings were inconsistent and of very low quality.
Conclusions:
- No definitive conclusions can be drawn regarding exercise benefits for individuals with vertebral fractures due to inconsistent findings and very low-quality evidence.
- Evidence on exercise effects, especially for men, is scarce, highlighting the need for high-quality randomized trials.
- Further research is essential to inform exercise prescription for individuals experiencing vertebral fractures.
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