Exercise for improving outcomes after osteoporotic vertebral fracture

Area of Science:

• Gerontology
• Physical Therapy
• Orthopedics

Background:

• Vertebral fractures increase morbidity and mortality, with therapeutic exercise often recommended for pain and functional improvement.
• This is an update of a 2013 Cochrane Review on exercise interventions for vertebral fractures.

Purpose of the Study:

• To assess the benefits and harms of exercise interventions (≥4 weeks) versus non-exercise interventions in adults with vertebral fractures.
• To evaluate exercise effects on incident fragility fractures, falls, pain, physical performance, quality of life, and adverse events.

Main Methods:

• Searched multiple databases (Cochrane, MEDLINE, Embase, etc.) up to November 2017 for relevant trials.
• Included randomized controlled trials and quasi-randomized trials comparing exercise/active physical therapy with placebo/non-exercise/no intervention.
• Data extracted and risk of bias assessed using Cochrane's tool; outcomes grouped by follow-up duration.

Main Results:

• Nine trials (749 participants) were included; substantial variability prevented most data pooling.
• No significant difference found for exercise versus control in incident fragility fractures or falls (very low-quality evidence).
• Exercise showed a small improvement in Timed Up and Go test (moderate-quality evidence), but not clinically meaningful improvements in pain or quality of life (very low-quality evidence).

Conclusions:

• Insufficient evidence exists to determine exercise effects on incident fractures, falls, or adverse events.
• Exercise may slightly improve physical performance (Timed Up and Go), but not to a clinically significant degree.
• High-quality randomized trials are needed to establish the safety and effectiveness of exercise for vertebral fracture patients.