Purpose
Clinical trials have shown that high intensity resistance and impact training (HiRIT) improves bone, muscle and function in older women and men with low bone mass, but the risk of fracture to frail skeletons, comorbid conditions, and lack of Medicare funding creates doubt that it is a practical therapy for osteoporosis. A dedicated research clinic was therefore established to examine effectiveness, safety and feasibility in a real-world clinical practice. The current report describes bone and functional outcomes along with falls and minimal trauma fractures following 12 months of HiRIT at The Bone Clinic.
Methods
Clinic clients undergo comprehensive testing for biometrics, BMD, muscle, function, falls and fractures at baseline and annually thereafter. Twice-weekly supervised HiRIT is undertaken on a voluntary client basis. Adherence and injuries are recorded. Clients with >30% HiRIT adherence were included in the current analyses. In the absence of a control group in this clinical sample, outcomes were examined using repeated measures GLM comparing baseline and follow-up visit, adjusting for adherence.
Results
Outcomes from 432 Clinic clients (62.1 ± 7.0 yrs, 162.4 ± 11.2 cm, 62.1 ± 12.6 kg, at baseline) with 70.1 ± 22.0% adherence to HiRIT are reported. Improvements were observed in LS BMD (P = 0.002), FN BMD (P = 0.013), FN area (P = 0.024) and percent fat (P < 0.001) along with functional reach, back extensor strength, tandem walk, timed up and go, sit to stand, and dietary calcium (all P < 0.001). Fewer falls and fractures were sustained (P<0.001).
Conclusions
12 months of real-world supervised HiRIT improved bone and function and reduced falls and fractures in individuals with low to very low bone mass. Dietary advice improved calcium consumption. Ongoing monitoring of this unique translational dataset continues to confirm the effectiveness and feasibility of targeted supervised exercise therapy for osteoporosis.