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This is a critique of the research article: Papaioannou A, Adachi J, Winegard K, Ferko N, Parkinson W, Cook R, et al. Efficacy of home-based exercise for improving quality of life among elderly women with symptomatic osteoporosis-related vertebral fractures. Osteoporosis International. 2003;14(8):677-82.



It was written for an assignment in the unit, Health, Disease and Exercise at the University of Canberra.

What is the background to this research?
Osteoporosis is defined as a systemic skeletal disease characterised by low bone mass and microarchitectural deterioation of bone tissue, which leads to increased bone fragility and higher risk of fracture.

Research into osteoporosis and how the severity of the condition can be alleviated or managed via the use of exercise is crucial as osteoporosis can occur in many populations and ethnic groups, with elderly people being at the greatest risk. Hence, the possible benefits that physical activity have on this disease need to be explored to help those suffering with the disease and possibly find new alternatives to be used in the future.

Where is the research from?
This research article was published in International Osteoporosis Journal.

The primary author of this article is Dr. Alexandra Papaioannou. She is a geriatrician and has a special interest in osteoporosis, pharmacology and falls and quality of life in the elderly population. She has been involved with many papers regarding osteoporosis. In addition, many of the other authors have completed research on osteoporosis in some capacity.

What kind of research was this?
This study was a randomized control trial. One group participated in the intervention and the control group did not participate in the intervention but were used for comparison later.

Randomized control trials are considered to be the most credible method of finding out whether a cause and effect relationship exists.

What did the research involve?
The study involved 74 female participants over the age of 60 split randomly into either an exercise or control group.

All subjects had to meet the following criteria:
 * Lumbar spine bone mineral density ≥ -2.5 SD below young adult mean
 * At least one vertebral fracture

In this study the exercise group had to complete exercises for 60 minutes a day, 3 days a week. Their exercises included stretching, upper and lower body resistance training and aerobics. The control group had no guidelines for exercise and were told to continue with their usual daily activities.

At baseline, 6 months and 12 months, participants had to complete the Osteoporosis Quality of Life Questionnaire (OQLQ), the Sickness Impact Profile (SIP), the sway test and the timed up and go test and at only baseline and 12 months participants had to undergo a dual-energy X-ray absorptiometry (DEXA) scan assessing bone mineral density at the lumbar spine and femoral neck.

A limitation of the study was that the OQLQ had not been validated, therefore the results might not actually be of any significance. Also, some of the participants had asymptomatic vertebral fractures, but it was thought that the intervention would be best suited for those with symptomatic fractures. Furthermore, 17 participants failed to complete the study and adherence to the intervention dropped after the first 6 months, this may be attributed to the fact that there was decreased supervision by the therapist.

What were the basic results?
6 Months
 * Exercise group had greater improvement in symptoms (P=0.03) specifically in lack of energy, pain from carrying, pain from standing, pain from walking and tiredness.
 * Change in emotion was displayed (P=0.01) specifically they were not as upset about having the disease.
 * Change in leisure/social (P=0.03) specifically being able to do more physical activity and being able to go on holidays.
 * In the sway test, participants had improved in range of displacement (P=0.01)

12 Months
 * Improvements were shown in symptoms (P=0.01) such as pain from bending, standing and walking were all maintained.
 * There was improvements in activities of daily living (P=0.04)
 * In the sway test there was significant improvements for results in lateral and anteroposterior directions as well as velocity of movement (P=0.01).

The results are consistent with what the researchers concluded. The researchers deducted that over a 6 month period, a home exercise program improved quality of life in symptoms, emotion, leisure and social activities. Furthermore they believed that if home based exercises are completed over 12 months, improvements recorded at 6 months will be sustained.

What conclusions can we take from this research?
Despite not having the largest final group size, this article has put forward evidence that home-based exercises can improve quality of life in post-menopausal women with osteoporosis related vertebral fractures. However, the validity of this evidence is negatively impacted due to not using a validated test (OQLQ) and low adherence to the intervention. In saying that the data provided is valuable in showing how quality of life can be improved in this population. The findings in this paper correlate with other research done in this area, in that exercise induces positive effects in women with osteoporosis whether or not they have a vertebral fracture. Nevertheless, more research should be conducted on what exercises prove to be more useful in improving quality of life and overall health of those suffering with osteoporosis and/or vertebral fractures.
 * Provide your own insights on the conclusion (it may not quite be the same as the authors)
 * How do the findings align with other research in the area (in particular more recent publications that won't be mentioned in the paper)

Practical advice

 * What real-world implications does this research have? Examples might includes:
 * criteria for not exercising,
 * recommendations on what exercises to do, how to do them,
 * recommendations on monitoring and progressing exercises within specific populations,
 * considerations for encouraging physical activity within a specific setting, etc
 * Are there other considerations readers should know about before taking on this practical advice? Perhaps health/safety more information/resources?

Further information/resources

 * What further reading may interested readers benefit from?
 * What website, or online organisations, offer further information/support to groups that are linked to your assignment?
 * Consider the audience you are pitching this information for - are the links appropriate (e.g. links to research papers are probably not appropriate if the information is for patients, but it may be if it is for other allied health professionals)