Otago运动训练对老年骨质疏松症患者平衡能力和跌倒风险的影响

Effects of Otago exercise training on balance ability and fall risk of elderly patients with osteoporosis

目的评估Otago运动训练对老年骨质疏松症患者躯体平衡功能和跌倒风险的影响。方法将113例年龄>60岁可独立行走的骨质疏松症患者采用数字表法随机分为运动训练+抗骨质疏松组(试验组)和抗骨质疏松组(对照组)。分别在干预前、干预后6个月、12个月行简易躯体能力测试(short physical performance battery,SPPB)和跌倒效能量表评分(modified falls efficacy scale,MFES)检测。在干预前和干预12个月应用双能X线骨密度仪行骨密度(bone mineral density,BMD)检查。两组分别记录12个月内的跌倒和是否跌倒导致骨折的次数。结果干预前试验组和对照组SPPB试验组(7.01±1.35)分,对照组(6.93±1.04)分]和MFES评分试验组(6.62±1.32)分,对照组(6.54±2.06)分]差异无统计学意义(P>0.05)。对照组干预前和干预后6个月SPPB干预前(6.93±1.04)分,干预后6个月(7.37±1.25)分]和MFES干预前(6.54±2.06)分,干预后6个月(6.81±1.27)分]评分差异无统计学意义(P>0.05);12个月SPPB(7.83±1.38)分,MFES(7.76±1.74)分]和干预前比较,差异有统计学意义(P<0.05)。试验组干预后6个月及12个月SPPB6个月(7.89±1.96)分,12个月(8.91±1.17)分]和MFES6个月(7.64±1.03)分,12个月(8.53±1.21)分]评分均显著提高(P<0.05),且在6个月和12个月时SPPB和MFES评分高于对照组(P<0.05)。两组BMD值在干预后12个月对照组腰椎BMD(0.786±0.130)g/cm^(2),髋部BMD(0.782±0.115)g/cm^(2);试验组腰椎BMD(0.798±0.113)g/cm^(2),髋部BMD(0.773±0.104)g/cm^(2)]较干预前对照组腰椎BMD(0.738±0.102)g/cm^(2),髋部BMD(0.741±0.103)g/cm^(2);试验组腰椎BMD(0.745±0.087)g/cm^(2),髋部BMD(0.747±0.122)g/cm^(2)]均明显升高(P<0.05),但组间比较差异无统计学意义(P>0.05)。结论Otago运动训练12个月能够提高老年骨质疏松症患者平衡能力并减少跌倒的发生。

Objective To evaluate the effects of Otago exercise training on body balance and fall risk in elderly patients with osteoporosis.Methods Totally 113 osteoporosis patients over 60 years old walking independently without assistance,were randomly divided into two groups.Exercise training group:exercise training and anti-osteoporosis therapy and control group:anti-osteoporosis group.Short physical performance battery(SPPB)and modified falls efficiency scale(MFES)were measured before intervention,6 months and 12 months after intervention.Bone mineral density(BMD)was measured by dual energy X-ray before and at 12 months after intervention.The number of falls within 12 months and the number of osteoporotic fractures caused by falls were recorded in the two groups.Results There was no significant difference in SPPB[exercise training group(7.01±1.35),control group(6.93±1.04)]and MFES[exercise training group(6.62±1.32),control group(6.54±2.06)]scores between the exercise training group and the control group before intervention(P>0.05).There was no significant difference in SPPB[before(6.93±1.04),6 months(7.37±1.25)]and MFES[before(6.54±2.06),6 months(6.81±1.27)]scores before and 6 months after intervention in the control group(P>0.05),but there was significant difference between 12 months[SPPB(7.83±1.38),MFES(7.76±1.74)]and before intervention(P<0.05).The scores of SPPB[6 months(7.89±1.96),12 months(8.91±1.17)]and MFES[6 months(7.64±1.03),12 months(8.53±1.21)]in the exercise training group were significantly increased at 6 and 12 months(P<0.05).At 6 and 12 months,the scores of SPPB and MFES in the exercise training group were better than those in the control group(P<0.05).After 12 months of intervention,the BMD values[control group lumbar BMD(0.786±0.130)g/cm^(2),hip BMD(0.782±0.115)g/cm^(2);exercise training group lumbar BMD(0.798±0.113)g/cm^(2),hip BMD(0.773±0.104)g/cm^(2)]of the two groups were increased[control group lumbar BMD(0.738±0.102)g/cm^(2),hip BMD(0.741±0.103)g/cm^(2);exercise training group lumbar BMD(0.745±0.087)g/cm^(2),hip BMD(0.747±0.122)g/cm^(2)],and there was no difference between the two groups(P>0.05).Conclusion Otago exercise training for 12 months can improve the balance ability of elderly patients with osteoporosis and reduce the incidence of falls.