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01-03-2015 | Original Article

Too Fit To Fracture: outcomes of a Delphi consensus process on physical activity and exercise recommendations for adults with osteoporosis with or without vertebral fractures

Authors: L. M. Giangregorio, S. McGill, J. D. Wark, J. Laprade, A. Heinonen, M. C. Ashe, N. J. MacIntyre, A. M. Cheung, K. Shipp, H. Keller, R. Jain, A. Papaioannou

Published in: Osteoporosis International | Issue 3/2015

Abstract

Summary

An international consensus process resulted in exercise and physical activity recommendations for individuals with osteoporosis. Emphasis was placed on strength, balance, and postural alignment. Rather than providing generic restrictions, activity should be encouraged while considering impairments, fracture risk, activity history, and preference, and guidance on spine sparing techniques should be provided.

Introduction

The objectives of this study were to establish expert consensus on key questions posed by patients or health care providers regarding recommended assessment domains to inform exercise prescription, therapeutic goals of exercise, and physical activity and exercise recommendations for individuals with osteoporosis or osteoporotic vertebral fracture.

Methods

The Too Fit To Fracture expert panel identified researchers and clinicians with expertise in exercise and osteoporosis and stakeholder groups. We delivered a modified online Delphi survey (two rounds) to establish consensus on assessment, exercise, and physical activities for three cases with varying risk (osteoporosis based on bone mineral density; 1 spine fracture and osteoporosis; multiple spine fractures, osteoporosis, hyperkyphosis, and pain). Duplicate content analyses of free text responses were performed.

Results

Response rates were 52 % (39/75) and 69 % (48/70) for each round. Key consensus points are the following: (a) Current physical activity guidelines are appropriate for individuals with osteoporosis without spine fracture, but not for those with spine fracture; (b) after spine fracture, physical activity of moderate intensity is preferred to vigorous; (c) daily balance training and endurance training for spinal extensor muscles are recommended for all; (d) providing guidance on spine-sparing techniques (e.g., hip hinge) during activities of daily living or leisure, considering impairments, fracture risk, activity history, and preference, is recommended rather than providing generic restrictions (e.g., lifting <10 lbs, no twisting), but for those with vertebral fracture, especially in the presence of pain, multiple fractures, or hyperkyphosis, the risks of many activities may outweigh the benefits—physical therapist consultation is recommended. Examples of spine-sparing techniques and exercise prescription elements are provided.

Conclusions

Our recommendations guide health care providers on assessment, exercise prescription, and safe movement for individuals with osteoporosis.

According to FRAX and Canadian Association of Radiologists and Osteoporosis Canada criteria.

Reader should consult clinical practice guidelines adopted by their country for recommended risk calculator. Example risk calculators available online include the FRAX risk calculator (http://www.shef.ac.uk/FRAX/), CAROC risk calculator (http://www.osteoporosis.ca/health-care-professionals/clinical-tools-and-resources/fracture-risk-tool/), Garvan Risk Calculator (http://garvan.org.au/promotions/bone-fracture-risk/calculator/)

A fall is defined as an event which results in a person coming to rest inadvertently on the ground or floor or other lower level (http://www.who.int/mediacentre/factsheets/fs344/en/).

The consensus process did not extend to a consensus on the type of assessments to be used for falls or physical function, only the domains to be assessed. The AGS/BGS Guidelines include more detailed suggestions regarding assessment of fall risk and physical function for fall prevention. However, some domains that may inform exercise prescription (e.g., aerobic capacity, strength) may not be adequately represented in the AGS/BGS guidelines—http://www.americangeriatrics.org/health_care_professionals/clinical_practice/clinical_guidelines_recommendations/prevention_of_falls_summary_of_recommendations. The cut points that have been used to define slow gait speed as it pertains to predicting adverse health outcomes or mortality vary from <0.8 to <1.0 m/s [15, 16].

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Title: Too Fit To Fracture: outcomes of a Delphi consensus process on physical activity and exercise recommendations for adults with osteoporosis with or without vertebral fractures
Authors: L. M. Giangregorio
S. McGill
J. D. Wark
J. Laprade
A. Heinonen
M. C. Ashe
N. J. MacIntyre
A. M. Cheung
K. Shipp
H. Keller
R. Jain
A. Papaioannou
Publication date: 01-03-2015
Publisher: Springer London
Published in: Osteoporosis International / Issue 3/2015
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI: https://doi.org/10.1007/s00198-014-2881-4

At a glance: The STEP trials

Springer Medicine

Too Fit To Fracture: outcomes of a Delphi consensus process on physical activity and exercise recommendations for adults with osteoporosis with or without vertebral fractures

Abstract

Summary

Introduction

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Summary

Introduction

Methods

Results

Conclusions

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