Körperliches Training zur Frakturprophylaxe des älteren Menschen: Evidenz und trainingsmethodische Umsetzung am Beispiel der Erlanger Fitness und Osteoporose-Präventions-Studie (EFOPS)
Kemmler W, Kohl M, Engelke K, von Stengel S (2019)
Publication Type: Journal article
Publication year: 2019
Journal
Book Volume: 28
Pages Range: 192-201
Journal Issue: 3
DOI: 10.1055/a-0945-1376
Abstract
Exercise might be one of the most effective therapies to prevent low-traumatic fractures. However, there is still no definite evidence for fracture-preventing effects of exercise on bone. Further, the multiple training aims (i. e. bone strengthening, fall- and fall-impact reduction), corresponding types of exercise and proper composition of exercise parameters, designing effective, safe and customized exercise protocols makes this far from trivial. Moreover, bearing in mind that subjects should maintain exercise life-long, the attractiveness of the exercise program is highly relevant. The aim of the present article is to (a) provide evidence for the fracture-preventing effect of exercise and (b) discuss the generation of effective exercise strategies based on the Erlanger Fitness and Osteoporosis Prevention Study (EFOPS), a 16-year intervention study focusing on low-traumatic clinical fractures. Hundred thirty-seven (137) early postmenopausal women with osteopenia were included in the EFOPS project in 1998. Due to the long-term approach of the study, we applied a non-randomized design with a non-equally balanced distribution of the exercise (EG: n = 86) vs. control (CG). The primary endpoint was the fracture rate of low-traumatic clinical fractures; secondary endpoints were rate of major osteoporotic fractures and development of bone mineral density (BMD). However, apart from these main study aims, several exercise-related issues were addressed in sub-studies particularly during the first six study years. After 16 years, 105 participants with 1680 participant years were included in the final analysis. The fracture rates of low-traumatic fractures (0.42; 95 % CI: 0.20-0.86) and osteoporotic main fractures (0.37; 95 % CI: 0.14-0.88) were significantly lower in the EG compared to the CG. The exercise effect on BMD at the lumbar spine (EG: -1.5 ± 5.0 % vs. CG: -5.8 ± 6.4 %; p <.001) and femoral neck (-6.5 ± 4.6 % vs.-9.6 ± 5.0 %, p <.001) consistently increased during the study course. Sub-studies focusing on BMD and strength effects indicated among others that (a) power trainings is superior to strength training to affect BMD; (b) periodized approaches might be more effective for increasing strength and BMD and maintaining compliance compared with strategies relying on progression only; (c) exercise frequency below 2 sessions/week did not affect BMD even with high strain magnitude and rates. In summary, a sport-scientific approach that clearly scheduled exercise type, exercise parameters and exercise principles and adequately incorporating basic principles of bone metabolism and fall risk might be the most promising strategy to address fracture risk in older people. Apart from sport-science and medicine, however, it is essential to implement the program in an attractive social setting that enables regular, individualized and effective, but also safe and pleasurable exercise training to facilitate subjects' adherence.
Authors with CRIS profile
Wolfgang Kemmler
Lehrstuhl für Medizinische Physik und Mikrogewebetechnik
Klaus Engelke
Lehrstuhl für Medizinische Physik und Mikrogewebetechnik
Simon von Stengel
Lehrstuhl für Medizinische Physik und Mikrogewebetechnik
Involved external institutions
Germany (DE)How to cite
APA:
Kemmler, W., Kohl, M., Engelke, K., & von Stengel, S. (2019). Körperliches Training zur Frakturprophylaxe des älteren Menschen: Evidenz und trainingsmethodische Umsetzung am Beispiel der Erlanger Fitness und Osteoporose-Präventions-Studie (EFOPS). Osteologie, 28(3), 192-201. https://doi.org/10.1055/a-0945-1376
MLA:
Kemmler, Wolfgang, et al. "Körperliches Training zur Frakturprophylaxe des älteren Menschen: Evidenz und trainingsmethodische Umsetzung am Beispiel der Erlanger Fitness und Osteoporose-Präventions-Studie (EFOPS)." Osteologie 28.3 (2019): 192-201.
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