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Effects of exercise and nutrition on postural balance and risk of falling in elderly people with decreased bone mineral density: randomized controlled trial pilot study

University Hospital Zurich, Department of Rheumatology and Institute of Physical Medicine, Zurich, jaap.swanenburg{at}usz.ch

Eling Douwe de Bruin

Institute for Human Movement Sciences and Sport, Swiss Federal Institute of Technology, ETH-Zentrum, Zurich

Marguerite Stauffacher

University Hospital Zurich, Department of Rheumatology and Institute of Physical Medicine, Zurich, Switzerland

Theo Mulder

Centre for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands

Daniel Uebelhart

University Hospital Zurich, Department of Rheumatology and Institute of Physical Medicine, Zurich, Switzerland

Objective : To compare the effect of calcium/vitamin D supplements with a combination of calcium/vitamin D supplements and exercise/protein on risk of falling and postural balance.

Design : Randomized clinical trial.

Setting : University hospital physiotherapy department.

Subjects : Twenty-four independently living elderly females aged 65 years and older with osteopenia or osteoporosis and mean total hip T-score (SD) of —1.8 (0.8).

Interventions : A three-month programme consisting of exercise/protein including training of muscular strength, co-ordination, balance and endurance. Calcium/ vitamin D was supplemented in all participants for a 12-month period.

Outcome measures : Assessment took place prior to and following the months 3, 6, 9 and at the end of the study; primary dependent variables assessed were risk of falling (Berg Balance Test) and postural balance (forceplate). Secondary measures included body composition, strength, activity level, number of falls, bone mineral content, biochemical indices, nutritional status and general health.

Results : Significant reductions of risk of falling (repeated measures ANOVA F = 8.90, P = 0.008), an increase in muscular strength (ANOVA F = 3.0, P = 0.03), and an increase in activity level (ANOVA F = 3.38, P = 0.02) were found in the experimental group as compared to the control group. Further on, there was 89% reduction of falls reported in the experimental group (experimental pre/post 8/1 falls; control group pre/post 5/6 falls).

Conclusion : This study provides support for our intervention programme aimed at reducing the risk of falling in elderly participants diagnosed with osteopenia or osteoporosis. The data obtained from the pilot study allow the calculation of the actual sample size needed for a larger randomized trial.

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