Linköping University Medical Dissertation No. 788

Community-based osteoporosis prevention: Physical activity in relation to bone density, fall prevention, and the effect of training programmes The Vadstena Osteoporosis Prevention Project

Ann-Charlotte Grahn Kronhed

Division of Social Medicine and Public Health Science Department of Health and Society Faculty of Health Sciences, Linköpings universitet SE-581 85 Linköping, Sweden Linköping 2003

Cover design: Vadstena a small town situated between the Östergötland plain and Lake Vättern – the skyline including the town hall, the castle, and the abbey – shown against a background of trabecular bone.

Nothing is great or little otherwise than by comparison. Jonathan Swift. Gulliver’s Travels. 1726. Part II, Chapter 1.

ISBN: 91-7373-547-7 ISSN: 0345-0082

ABSTRACT This thesis is based on studies of the ten-year community-based intervention programme entitled, the Vadstena Osteoporosis Prevention Project (VOPP). The specific aims of the research were to describe the effects of physical activity and training programmes on bone mass and balance performance in adults, to determine whether a fall risk prevention programme could motivate personal actions among the elderly, to ascertain whether the intervention programme could reduce the incidence of forearm and hip fractures. Two studies addressed training programmes for middle-aged and old people. First, VOPP participants who were aged 40–70 years and had low forearm bone mineral density (BMD) values were invited to take part in a one-year weight-bearing training study. Thirty of those individuals were included in the investigation. Additional bone mass measurements were performed at the hip and the lumbar spine, and balance and aerobic capacity were also tested. The training programme was performed twice a week (I). In the second study, healthy persons aged 70–75 years were invited to participate in a balance-training study. Fifteen persons joined an exercise group, and another fifteen were controls. The training programme comprised specific balance exercises and was carried out twice a week for nine weeks (II). The association between forearm BMD values and several lifestyle factors was explored in random samples of the population aged 20–72 years (n=880) in a cross-sectional study (III). Another study explored the association between calcaneal stiffness, forearm BMD, and lifestyle factors amongst participants aged 20–79 years (n=956) at the final registration of the VOPP (V). Effects of the VOPP interventions directed at environmental risk factors for falls and the promotion of physical activity were examined in people aged t 65 years (IV). The incidence of forearm and hip fractures was studied amongst middle-aged and elderly individuals in the intervention and the control communities during the study period 1987– 2001 (VI). The exercise group (n=15) in the weight-bearing training study showed increases in BMD at the greater trochanter (p