title: Randomised controlled trial of the effectiveness of community group and home-based falls prevention exercise programmes on bone health in older people: the ProAct65+ bone study.
abstract: BACKGROUND
  exercise can reduce osteoporotic fracture risk by strengthening bone or reducing fall risk. Falls prevention exercise programmes can reduce fall incidence, and also include strengthening exercises suggested to load bone, but there is little information as to whether these programmes influence bone mineral density (BMD) and strength.
  
  
  OBJECTIVE
  to evaluate the skeletal effects of home (Otago Exercise Programme, OEP) and group (Falls Exercise Management, FaME) falls prevention exercise programmes relative to usual care in older people.
  
  
  METHODS
  men and women aged over 65 years were recruited through primary care. They were randomised by practice to OEP, FaME or usual care. BMD, bone mineral content (BMC) and structural properties were measured in Nottingham site participants before and after the 24-week intervention.
  
  
  RESULTS
  participants were 319 men and women, aged mean(SD) 72(5) years. Ninety-two percentage of participants completed the trial. The OEP group completed 58(43) min/week of home exercise, while the FaME group completed 39(16) and 30(24) min/week of group and home exercise, respectively. Femoral neck BMD changes did not differ between treatment arms: mean (95% CI) effect sizes in OEP and FaME relative to usual care arm were -0.003(-0.011,0.005) and -0.002(-0.010,0.005) g cm(-2), respectively; P = 0.44 and 0.53. There were no significant changes in BMD or BMC at other skeletal sites, or in structural parameters.
  
  
  CONCLUSIONS
  falls prevention exercise programmes did not influence BMD in older people. To increase bone strength, programmes may require exercise that exerts higher strains on bone or longer duration.
authors.affiliation: School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK Present Address: Centre for Physical Activity and Nutrition Research, Deakin University, Australia.
authors.forename: Rachel L
authors.initials: RL
authors.lastname: Duckham
authors.affiliation: Healthcare for Older People, Nottingham University Hospitals NHS Trust, Nottingham, UK.
authors.forename: Tahir
authors.initials: T
authors.lastname: Masud
authors.affiliation: Healthcare for Older People, Nottingham University Hospitals NHS Trust, Nottingham, UK.
authors.forename: Rachael
authors.initials: R
authors.lastname: Taylor
authors.affiliation: Department of Medicine, University of Nottingham, Nottingham, UK.
authors.forename: Denise
authors.initials: D
authors.lastname: Kendrick
authors.affiliation: Department of Medicine, University of Nottingham, Nottingham, UK.
authors.forename: Hannah
authors.initials: H
authors.lastname: Carpenter
authors.affiliation: Department of Primary Care & Population Health, University College London, London, UK.
authors.forename: Steve
authors.initials: S
authors.lastname: Iliffe
authors.affiliation: Department of Primary Care & Population Health, University College London, London, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Morris
authors.affiliation: School of Economics, University of Surrey, Guilford, UK.
authors.forename: Heather
authors.initials: H
authors.lastname: Gage
authors.affiliation: School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.
authors.forename: Dawn A
authors.initials: DA
authors.lastname: Skelton
authors.affiliation: Department of Primary Care & Population Health, University College London, London, UK.
authors.forename: Susie
authors.initials: S
authors.lastname: Dinan-Young
authors.affiliation: School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK.
authors.forename: Katherine
authors.initials: K
authors.lastname: Brooke-Wavell
mesh_terms: D015502:Absorptiometry, Photon; D000058:Accidental Falls / Q000517:prevention & control* / Q000706:statistics & numerical data; D000061:Accidents, Home / Q000517:prevention & control* / Q000706:statistics & numerical data; D000367:Age Factors; D000368:Aged; D015519:Bone Density; D005081:Exercise Therapy / Q000379:methods*; D017079:Exercise Tolerance / Q000502:physiology*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D058866:Osteoporotic Fractures / Q000453:epidemiology / Q000517:prevention & control*; D011320:Primary Health Care / Q000379:methods*; D006113:United Kingdom / Q000453:epidemiology
keywords: X-ray absorptiometry; aged; bone mineral density; exercise; men; osteoporosis; prevention; primary care, older people; women