Top

Published in:

01-03-2005 | Original Article

Predictors of compliance with a home-based exercise program added to usual medical care in preventing postmenopausal osteoporosis: an 18-month prospective study

Authors: M. A. Mayoux-Benhamou, C. Roux, A. Perraud, J. Fermanian, H. Rahali-Kachlouf, M. Revel

Published in: Osteoporosis International | Issue 3/2005

Abstract

This prospective 18-month study was designed to assess long-term compliance with a program of exercise aimed to prevent osteoporosis after an educational intervention and to uncover determinants of compliance. A total of 135 postmenopausal women were recruited by flyers or instructed by their physicians to participate in an educational session added to usual medical care. After a baseline visit and dual-energy X-ray absorptiometry, volunteers participated in a 1-day educational session consisting of a lecture and discussion on guidelines for appropriate physical activity and training in a home-based exercise program taught by a physical therapist. Scheduled follow-up visits were 1, 6, and 18 months after the educational session. Compliance with the exercise program was defined as an exercise practice rate 50% or greater than the prescribed training. The 18-month compliance rate was 17.8% (24/135). The main reason for withdrawal from the program was lack of motivation. Two variables predicted compliance: contraindication for hormone replacement therapy (odds ratio [OR] = 0.13; 95% confidence interval [95% CI], 0.04 to 0.46) and general physical function scores from an SF-36 questionnaire (OR=1.26; 95% CI, 1.03 to 1.5). To a lesser extent, osteoporosis risk, defined as a femoral T-score ≤−2.5, predicted compliance (OR=0.34; 95% CI, 0.10 to 1.16). Despite the addition of an educational session to usual medical care to inform participants about the benefits of exercise, only a minority of postmenopausal women adhered to a home-based exercise program after 18 months.

Cummings SR, Melton J (2002) Epidemiology and outcomes of osteoporotic fractures. Lancet 359:1761–1767CrossRefPubMed

Leblanc AD, Schneider VS, Evans HJ, Engelbretson DA, Krebs JM (1990) Bone mineral loss and recovery after 17 weeks of bed rest. J Bone Miner Res 5:843–850PubMed

Kannus P (1999) Editorials: preventing osteoporosis, falls and fractures among elderly people. BMJ 318:205–206PubMed

Kohrt WM, Snead DB, Slatopolsky E, Birge SJ (1995) Additive effects of weight-bearing exercice and estrogen on bone mineral density in older women. J Bone Miner Res 10:1303–1311PubMed

Rothert ML, Holmes-Rovner M, Rovner D, Kroll J, Breer L, Talarczyk G, Schmitt N, Padonu G, Wills C (1997) An educational intervention as decision support for menopausal women. Res Nurs Health 20:377–387CrossRefPubMed

Papaioannou A, Parkinson W, Adachi J, O’Connor A, Jolly EE, Tugwell P, Bedard M (1998) Women’s decisions about hormone replacement therapy after education and bone densitometry. CMAJ 159:1253–1257PubMed

Jamal SA, Ridout R, Chase C, Fielding L, Rubin LA, Hawker GA (1999) Bone mineral density testing and osteoporosis education improve lifestyle behaviors in premenopausal women: a prospective study. J Bone Miner Res 14:2143–2149PubMed

Rolnick SJ, Kopher R, Jackson J, Fischer LR, Compo R (2001) What is the impact of osteoporosis education and bone density testing for postmenopausal women in a managing care setting? Menopause 8:141–148CrossRefPubMed

Dunbar-Jacob J, Mortimer-Stephens MK (2001) Treatment adherence in chronic disease. J Clin Epidemiol 54[Suppl 1]:57–60

10.

Smith E, Gilligan C, McAdam M, Ensign C, Smith P (1989) Deterring bone loss by exercise intervention in premenopausal and postmenopausal women. Calcif Tissue Int 44:312–321PubMed

11.

Oldridge NB (1992) Compliance bias as a factor in longitudinal exercise research: osteoporosis. Sports Med 13:78–85PubMed

12.

Berard A, Bravo G, Gauthier P (1997) Meta-analysis of the effectiveness of physical activity for prevention of bone loss in postmenopausal women. Osteoporos Int 7:331–337PubMed

13.

Mayoux-Benhamou MA, Bagheri F, Roux C, Rabourdin JP, Auleley GR, Revel M (1997) Effect of psoas training on postmenopausal lumbar bone loss: a 3-year follow-up study. Calcif Tissue Int 60:348–353CrossRefPubMed

14.

Hans D, Genton L, Drezner MK, Schott AM, Pacifici R, Avioli L, Slosman DO, Meunier PJ (2002) Monitored impact loading of the hip: initial testing of a home-use device. Calcif Tissue Int 71:112–120CrossRefPubMed

15.

Papaioannou A, Adachi JD, Winegard K, Ferko N, Parkinson W, Cook RJ, Webber C, McCartney N (2003) Efficacy of home-based exercise for improving quality of life among elderly women with symptomatic osteoporosis-related vertebral fractures. Osteoporos Int 14:677–682CrossRefPubMed

16.

Ware JE, Sherbourne CD (1992) The MOS 36-item short-form health survey (SF-36), I: conceptual framework and item selection. Med Care 30:473–483PubMed

17.

Baecke JAH, Burema J, Frijters JER (1982) A short questionnaire for the measurement of habitual physical activity epidemiological studies. Am J Clin Nutr 36:932–942

18.

Bigard AX, Duforez F, Portero P, Gezennec CY(1992) Détermination de l’activité physique par questionnaire: validation du questionnaire de Baecke. Sci Sport 7:215–221

19.

Perneger TV, Leplege A, Etter JF, Rougemont A (1995) Validation of a French language version of the MOS 36-Item Short Health Survey (SF-36) in young healthy adults. J Clin Epidemiol 48:1051–1060CrossRefPubMed

20.

Revel M, Mayoux-Benhamou MA, Roux Ch, Bagheri F, Rabourdin JP (1993) One year psoas training can prevent lumbar bone loss in postmenopausal women: a randomized controlled trial. Calcif tissue Int 53:307–311PubMed

21.

Hosmer DW, Lemeshow S (eds) (1989) Applied logistic regression. Wiley, New York

22.

Strentröm CH, Arge B, Sundbom A (1997) Home exercise and compliance in inflammatory rheumatic diseases—a prospective clinical trial. J Rheumatol 24:470–476PubMed

23.

Gutin B, Kasper MJ (1992) Can vigorous exercise play a role in osteoporosis prevention? A review. Osteoporos Int 2:55–69PubMed

24.

Heinonen A, Kannus P, Sievanen H, Oja P, Panasen M, Rinne M et al (1996) Randomised controlled trial of effect of high-impact exercise on selected risk factors for osteoporotic fractures. Lancet 348:1343–1347CrossRefPubMed

25.

Kerr D, Morton A, Dick I, Prince R (1996) Exercise effects on bone mass in postmenopausal women are site-specific and load dependent. J Bone Miner Res 2:218–225

26.

Haapasalo H, Kannus P, Sievänen H, Heinonen A, Oja P, Vuori I (1994) Long term unilateral loading and bone mineral density and content in female squash players. Calcif Tissue Int 54:249–255PubMed

27.

Rubin CT, Lanyon LE (1985) Regulation of bone mass by mechanical strain magnitude. Calcif Tissue Int 37:411–417PubMed

28.

Johnson CA, Corrigan SA, Dubbert PM, Gramling SE (1990) Perceived barriers to exercise and weight control practice in community women. J Women Health 16:177–191

29.

Pate RR, Pratt M, Blair SN, Haskell WL, Macera CA, Bouchard C et al (1995) Physical activity and public health: a recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medecine. JAMA 273:402–407CrossRefPubMed

30.

Cauley JA, Cummings SR, Black DM, Mascioli SR, Seeley DG (1990) Prevalence and determinants of estrogen replacement therapy in elderly women. Am J Obstet Gynecol 163:1438–1444PubMed

31.

Coope J, March J (1992) Can we improve compliance with long-term HRT? Maturitas 15:151–158PubMed

32.

Ryan PJ, Harrison R, Blake GM, Fogelman I (1992) Compliance with hormone replacement therapy (HRT) after screening for post-menopausal osteoporosis. BJOG 99:325–328

33.

Utian WH, Schiff I (1994) NAMS-Gallup survey on women’s knowledge, information sources, and attitudes to menopause and hormone replacement therapy. Menopause 1:39–48

34.

Harrison JE, Chow R, Dornan J, Goodwin S, Strauss A and Mineral Group of the University of Toronto (1993) Evaluation of a program for rehabilitation of osteoporotic patients (PRO): 4-year follow-up. Osteoporos Int 3:13–17PubMed

35.

Iversen MD, Eaton HM, Daltroy LH (2004) How rheumatologists and patients with rheumatoid arthritis discuss exercise and influence of discussions on exercise prescriptions. Arthritis Rheum 51:63–72CrossRefPubMed

36.

den Tonkelaar I, Oddens BJ (2000) Determinants of long-term hormone replacement therapy and reasons for early discontinuation. Obstet Gynecol 95:507–512CrossRefPubMed

37.

Rejeski WJ, Brawley LR, Ettinger W, Morgan T, Thompson C (1997) Compliance to exercise therapy in older participants with knee osteoarthritis: implications for treating disability. Med Sci Sports Exerc 29:977–985PubMed

38.

Jalava T, Sarna S, Pylkkanen L, Mawer B, Kanis JA, Selby P et al (2003) Association between vertebral fracture and increased mortality in osteoporotic patients. J Bone Miner Res 18:1254–1260PubMed

39.

Gatchel RJ, Mayer T, Dersh J, Robinson R, Polatin P (1999) The association of the SF-36 health status survey with 1-year socioeconomic outcomes in a chronically disabled spinal disorder population. Spine 24:2162–2170CrossRefPubMed

40.

King AC, Pruitt LA, Phillips W, Oka R, Rodenburg A, Haskell WL (2000) Comparative effects of two physical activity programs on measured and perceived physical functioning and other health-related quality of life outcomes in older adults. J Gerontol A Biol Sci Med 55:M74–M83

41.

Salkeld G, Cameron ID, Cumming RG, Easter S, Seymour J, Kurrle SE, Quine S (2000) Quality of life related to fear of falling and hip fracture in older women: a time trade off study. BMJ 320:341–345CrossRefPubMed

42.

Elley CR, Kerse N, Arroll B, Robinson E (2003) Effectiveness of counselling patients on physical activity in general practice: cluster randomised controlled trial. BMJ 326:793–803CrossRefPubMed

43.

Kanis JA, Gluer CC (2000) An update on the diagnosis and assessment of osteoporosis with densitometry. Committee of Scientific Advisors, International Osteoporosis Foundation. Osteoporos Int 11:192–202CrossRefPubMed

44.

Rubin SM, Cumming SR (1992) Results of bone densitometry affect women’s decisions about taking measures to prevent fractures. Ann Intern Med 116:990–995PubMed

45.

Torgeson DJ, Donaldson C, Russell IT, Reid DM (1995) Hormone replacement therapy: compliance and cost after screening for osteoporosis. Obstet Gynecol 59:57–60

46.

Newton KM, Lacroix AZ, Leveille SG, Rutter C, Keenan NL, Anderson LA (1997) Women’s beliefs and decisions about hormone replacement therapy. J Womens Health 6:459–465PubMed

47.

Marci CD, Viechnicki MB, Greenspan SL (2000) Bone mineral densitometry substantially influences health-related behaviors of postmenopausal women. Calcif Tissue Int 66:113–118CrossRefPubMed

48.

Harland J, White M, Drinkwater C, Chinn D, Farr L, Howel D (1999) The Newcastle exercise project: a randomised controlled trial of methods to promote physical activity in primary care. BMJ 319:828–832PubMed

49.

Pinto BM, Goldstein MG, Marcus BH (1998) Activity counseling by primary care physicians. Prev Med 27:506–513CrossRefPubMed

Title: Predictors of compliance with a home-based exercise program added to usual medical care in preventing postmenopausal osteoporosis: an 18-month prospective study
Authors: M. A. Mayoux-Benhamou
C. Roux
A. Perraud
J. Fermanian
H. Rahali-Kachlouf
M. Revel
Publication date: 01-03-2005
Publisher: Springer-Verlag
Published in: Osteoporosis International / Issue 3/2005
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI: https://doi.org/10.1007/s00198-004-1697-z

At a glance: The STEP trials

Springer Medicine

Predictors of compliance with a home-based exercise program added to usual medical care in preventing postmenopausal osteoporosis: an 18-month prospective study

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 3/2005

Quantitative ultrasound calcaneus measurements: normative data for the Greek population

The impact of the use of multiple risk indicators for fracture on case-finding strategies: a mathematical approach

Skeletal status in adolescents with end-stage renal failure: a longitudinal study

Hypovitaminosis D, impaired bone turnover and low bone mass are common in patients with peripheral arterial disease

Rapid long-term bone loss following stroke in a man with osteoporosis and atherosclerosis

Longitudinal progression of fracture prevalence through a population of postmenopausal women with osteoporosis