From THE DEPARTMENT OF NEUROBIOLOGY, CARE SCIENCES AND SOCIETY, DIVISION OF PHYSIOTHERAPY Karolinska Institutet, Stockholm, Sweden

Physical Activity and Health-Related Quality of Life in Older Adults with Osteoporosis

Ing-Mari Dohrn

Stockholm 2015

All previously published papers were reproduced with permission from the publisher. Published by Karolinska Institutet. Printed by Universitetsservice AB © Ing-Mari Dohrn, 2015 ISBN 978-91-7676-027-7

Physical activity and health-related quality of life in older adults with osteoporosis THESIS FOR DOCTORAL DEGREE (Ph.D.) By

Ing-Mari Dohrn Principal Supervisor: Professor Agneta Ståhle Karolinska Institutet Department of Neurobiology, Care Sciences and Society Division of Physiotherapy Co-supervisors: Associate Professor Maria Hagströmer Karolinska Institutet Department of Neurobiology, Care Sciences and Society Division of Physiotherapy Professor Mai-Lis Hellénius Karolinska Institutet Department of Medicine Division of Medicine Cardiology Unit

Opponent: PhD Patrik Wennberg Umeå University Department of Public Health and Clinical Medicine Division of Family Medicine Examination Board: Professor Lars Nyberg Luleå University of Technology Department of Health Sciences Division of Health and Rehab Professor Pernilla Åsenlöf Uppsala University Department of Neuroscience Division of Physiotherapy Associate Professor Ylva Trolle Lagerros Karolinska Institutet Department of Medicine Division of Medicine

Not everything that can be counted counts, and not everything that counts can be counted.

ABSTRACT An important part of the physical therapists’ role is to help older adults to remain active as they age. Regular physical activity is essential for healthy aging and can delay functional decline and reduce the risk of premature mortality. This thesis comprise four studies, all including participants from the BETA-OP study, a randomized controlled trial (RCT), assessing the effects of a 12-week balance-training intervention for community-dwelling older adults, aged 65 years or over, with osteoporosis and fall-related concerns. The overall aim of the thesis was to explore correlates for physical activity in older adults with osteoporosis and to evaluate whether a specific, progressive balance-training program focusing on dual- and multi-task exercises for older had any short- and long-term effects on objectively measured habitual physical activity and health-related quality of life (HRQoL). The aim was also to compare self-reported pedometer steps with accelerometer-derived steps in older adults with osteoporosis, under free-living conditions. Study I, a cross-sectional study (n=94), found that many older adults with osteoporosis are highly sedentary and a large proportion does not reach current health enhancing physical activity recommendations. A low daily step level,