Knee Extension Strength Is a Significant Determinant of Static and Dynamic Balance as Well as Quality of Life in Older Community-Dwelling Women with Osteoporosis

Background: Determinants of balance have not been well studied in women with osteoporosis yet falls are the major cause of fracture in this population. Objective: To describe the associations among knee extension strength, medication history, medical history, physical activity and both static and dynamic balance in women diagnosed with osteoporosis. Methods: We assessed health history, current medication and quality of life by questionnaire in 97 community-dwelling women with osteoporosis. Static balance was measured by computerized dynamic posturography (Equitest), dynamic balance by timed figure-eight run, and knee extension strength by dynamometry. Results: The 97 participants (mean (SD) age 69 (3.2) years) had a mean lumbar spine BMD of T = –3.3 (0.7) and total hip BMD of –2.9 (0.4). In stepwise linear regression, the significant determinants of static balance that explained 18% of total variance were knee extension strength (10%, p < 0.001), age (5%, p < 0.01) and tobacco use (3%, p < 0.05). The significant predictors of dynamic balance were knee extension strength (26%, p < 0.001), medications (6%, p < 0.05), age (4%, p < 0.05), height (4%, p < 0.001), as well as years of estrogen use (2%), tobacco use (2%) and weight (2%) (all p < 0.05). Knee extension strength was also associated with quality of life (r2 = 0.12, p < 0.001). Based on these models, a 1 kg/cm (∼3%) increase in mean knee extension strength was associated with 1.2, 2.4 and 3.4% greater static balance, dynamic balance and quality of life, respectively. Conclusions: Knee extension strength is a significant determinant of performance on static and dynamic balance tests in 65- to 75-year-old women with osteoporosis. In this cross-sectional study, knee extension strength explained a greater proportion of the variance in balance tests than did age. Investigation into the effect of intervention to improve knee extension strength in older women with osteoporosis is warranted.

[1]  H. Menz,et al.  Falls in Older People: Risk Factors and Strategies for Prevention , 2000 .

[2]  W. Frontera,et al.  Strength conditioning in older men: skeletal muscle hypertrophy and improved function. , 1988, Journal of applied physiology.

[3]  A Heinonen,et al.  Associations of Physical Activity and Calcium Intake with Bone Mass and Size in Healthy Women at Different Ages , 1998, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[4]  O. Johnell,et al.  Quality of Life in Patients with Vertebral Fractures: Validation of the Quality of Life Questionnaire of the European Foundation for Osteoporosis (QUALEFFO) , 1999, Osteoporosis International.

[5]  Diane Podsiadlo,et al.  The Timed “Up & Go”: A Test of Basic Functional Mobility for Frail Elderly Persons , 1991, Journal of the American Geriatrics Society.

[6]  M. Hammar,et al.  Effects of Hormonal Replacement Therapy on the Postural Balance Among Postmenopausal Women , 1996, Obstetrics and gynecology.

[7]  Lester M. Wolfson,et al.  Balance and Strength Training in Older Adults: Intervention Gains and Tai Chi Maintenance , 1996, Journal of the American Geriatrics Society.

[8]  S. Folstein,et al.  "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. , 1975, Journal of psychiatric research.

[9]  S. Wolf,et al.  Reducing Frailty and Falls in Older Persons: An Investigation of Tai Chi and Computerized Balance Training , 1996, Journal of the American Geriatrics Society.

[10]  S. Lord,et al.  Physiological Factors Associated with Falls in an Elderly Population , 1991, Journal of the American Geriatrics Society.

[11]  W. Evans,et al.  Changes in power with resistance training in older and younger men and women. , 1999, The journals of gerontology. Series A, Biological sciences and medical sciences.

[12]  E Heikkinen,et al.  Reaction and Movement Times in Men of Different Ages: A Population Study , 1986, Perceptual and motor skills.

[13]  M. Järvinen,et al.  The Injury Mechanisms of Osteoporotic Upper Extremity Fractures Among Older Adults: A Controlled Study of 287 Consecutive Patients and Their 108 Controls , 2000, Osteoporosis International.

[14]  Ari Heinonen,et al.  Randomised controlled trial of effect of high-impact exercise on selected risk factors for osteoporotic fractures , 1996, The Lancet.

[15]  R. Fielding.  The role of progressive resistance training and nutrition in the preservation of lean body mass in the elderly. , 1995, Journal of the American College of Nutrition.

[16]  Peterka Rj,et al.  AGE-RELATED CHANGES IN HUMAN POSTURE CONTROL: SENSORY ORGANIZATION TESTS , 1990 .

[17]  P. Kannus,et al.  Physical Activity and Bone Health , 2001 .

[18]  E. Seeman,et al.  The bone density of female twins discordant for tobacco use. , 1994, The New England journal of medicine.

[19]  S. Grant,et al.  Physiological Effects of Exercise on Post-menopausal Osteoporotic Women , 1998 .

[20]  J. Nichols,et al.  Effects of Resistance, Balance, and Gait Training on Reduction of Risk Factors Leading to Falls in Elders , 1997 .

[21]  S. Wood-Dauphinée,et al.  The Balance Scale: reliability assessment with elderly residents and patients with an acute stroke. , 1995, Scandinavian journal of rehabilitation medicine.

[22]  F O Black,et al.  Age-related changes in human posture control: sensory organization tests. , 1990, Journal of vestibular research : equilibrium & orientation.

[23]  S. Welle,et al.  Effect of age on muscle hypertrophy induced by resistance training. , 1996, The journals of gerontology. Series A, Biological sciences and medical sciences.

[24]  H. Suominen,et al.  Effects of hormone replacement therapy and high-impact physical exercise on skeletal muscle in post-menopausal women: a randomized placebo-controlled study. , 2001, Clinical science.

[25]  M. Woollacott,et al.  Visual, vestibular and somatosensory contributions to balance control in the older adult. , 1989, Journal of gerontology.

[26]  J. Judge,et al.  Balance improvements in older women: effects of exercise training. , 1993, Physical therapy.

[27]  P. Kannus.  Preventing osteoporosis, falls, and fractures among elderly people , 1999, BMJ.

[28]  S. Studenski,et al.  Functional reach: a new clinical measure of balance. , 1990, Journal of gerontology.

[29]  A Heinonen,et al.  Effect of Two Training Regimens on Bone Mineral Density in Healthy Perimenopausal Women: A Randomized Controlled Trial , 1998, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[30]  S. Lord,et al.  Prediction of osteoporotic fractures by postural instability and bone density. , 1993, BMJ.

[31]  A. Campbell,et al.  Randomised controlled trial of a general practice programme of home based exercise to prevent falls in elderly women , 1997, BMJ.

[32]  J. Chandler,et al.  Exercise to improve physiologic and functional performance in old age. , 1996, Clinics in geriatric medicine.

[33]  M. Tinetti,et al.  Risk factors for falls among elderly persons living in the community. , 1988, The New England journal of medicine.

[34]  M. Tinetti,et al.  A multifactorial intervention to reduce the risk of falling among elderly people living in the community. , 1994, The New England journal of medicine.

[35]  A Straube,et al.  Visual stabilization of posture. Physiological stimulus characteristics and clinical aspects. , 1984, Brain : a journal of neurology.

[36]  M. Tinetti,et al.  The effects of exercise on falls in elderly patients. A preplanned meta-analysis of the FICSIT Trials. Frailty and Injuries: Cooperative Studies of Intervention Techniques. , 1995, JAMA.

[37]  K. Häkkinen,et al.  Bilateral and unilateral neuromuscular function and muscle cross-sectional area in middle-aged and elderly men and women. , 1996, The journals of gerontology. Series A, Biological sciences and medical sciences.

[38]  Keith D. Hill,et al.  A new test of dynamic standing balance for stroke patients : Reliability, validity and comparison with healthy elderly , 1996 .

[39]  Leon Flicker,et al.  Falls among healthy, community‐dwelling, older women: a prospective study of frequency, circumstances, consequences and prediction accuracy , 1999, Australian and New Zealand journal of public health.

[40]  P. Charles,et al.  Positive Effects of Physiotherapy on Chronic Pain and Performance in Osteoporosis , 1998, Osteoporosis International.

[41]  U Rosenhall,et al.  Degenerative patterns in the aging human vestibular neuro-epithelia. , 1973, Acta oto-laryngologica.

[42]  D. A. Ranney,et al.  Muscle performance, morphology and metabolic capacity during strength training and detraining: A one leg model , 2004, European Journal of Applied Physiology and Occupational Physiology.

[43]  L. Wolfson,et al.  Altered sensory function and balance in older persons. , 1993, Journal of gerontology.

[44]  Reaction Time, Strength, and Physical Activity in Women Aged 20–89 Years , 2001 .

[45]  K. Vranizan,et al.  Assessment of habitual physical activity by a seven-day recall in a community survey and controlled experiments. , 1985, American journal of epidemiology.

[46]  R. Marcus,et al.  Dynamic muscle strength alterations to detraining and retraining in elderly men. , 1997, Clinical physiology.

[47]  M. Järvinen,et al.  Epidemiology of Osteoporotic Pelvic Fractures in Elderly People in Finland: Sharp Increase in 1970–1997 and Alarming Projections for the New Millennium , 2000, Osteoporosis International.

[48]  H. Larsen,et al.  Performance in functional balance tests during menopausal hormone replacement: a double-blind placebo-controlled study. , 1999, Physiotherapy research international : the journal for researchers and clinicians in physical therapy.

[49]  J A Ward,et al.  Balance, reaction time, and muscle strength in exercising and nonexercising older women: a pilot study. , 1993, Archives of physical medicine and rehabilitation.

[50]  P. Kannus,et al.  Prevention of falls and subsequent injuries in elderly people: a long way to go in both research and practice. , 2001, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[51]  M. Sinaki,et al.  Balance characteristics of persons with osteoporosis. , 1997, Archives of physical medicine and rehabilitation.

[52]  T. Ledin,et al.  Estrogen Effects on Postural Balance in Postmenopausal Women Without Vasomotor Symptoms: A Randomized Masked Trial , 2000, Obstetrics and gynecology.

[53]  M B Macpherson,et al.  Effects of hormone replacement therapy on muscle performance and balance in post-menopausal women. , 1996, Clinical science.

[54]  M Lysholm,et al.  A performance test to monitor rehabilitation and evaluate anterior cruciate ligament injuries , 1986, The American journal of sports medicine.

[55]  S. Lord,et al.  Postural stability and associated physiological factors in a population of aged persons. , 1991, Journal of gerontology.

[56]  Florence Asombang,et al.  [The prevention of falls by the elderly]. , 1991, Servir.

[57]  C. Cooper,et al.  Health‐Related Quality of Life in Postmenopausal Women With Low BMD With or Without Prevalent Vertebral Fractures , 2000, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[58]  Jacques P. Brown,et al.  Research Notes: The Canadian Multicentre Osteoporosis Study (CaMos): Background, Rationale, Methods , 1999, Canadian Journal on Aging / La Revue canadienne du vieillissement.

[59]  M. Fiatarone,et al.  Effects of High-Intensity Strength Training on Multiple Risk Factors for Osteoporotic Fractures: A Randomized Controlled Trial , 1994 .

[60]  J. Judge,et al.  Training Balance and Strength in the Elderly to Improve Function , 1993, Journal of the American Geriatrics Society.

[61]  M. Järvinen,et al.  Majority of Hip Fractures Occur as a Result of a Fall and Impact on the Greater Trochanter of the Femur: A Prospective Controlled Hip Fracture Study with 206 Consecutive Patients , 1999, Calcified Tissue International.

[62]  R. Helfert,et al.  Balance and Aging , 1999, The Laryngoscope.

[63]  Philippa Williams,et al.  The Effect of a 12‐Month Exercise Trial on Balance, Strength, and Falls in Older Women: A Randomized Controlled Trial , 1995, Journal of the American Geriatrics Society.

[64]  L. Lipsitz,et al.  High-intensity strength training in nonagenarians. Effects on skeletal muscle. , 1990, JAMA.

[65]  H. Larsen,et al.  Better postural balance in elderly women receiving estrogens. , 1997, American journal of obstetrics and gynecology.