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Back progressive resistive exercise program to reduce risk of vertebral fractures
Borgo MJ, Sinaki M
Journal fur Mineralstoffwechsel 2010;17(2):66-71
clinical trial
4/10 [Eligibility criteria: Yes; Random allocation: No; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: Yes; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

Axial loading of the spine in patients with bone loss can result in compression fracture. We report the efficacy of progressive resistive exercise (PRE) of paravertebral muscles from prone position, designed for increasing back strength without back pain. We conducted a randomized controlled trial of a PRE program to decrease vertebral fracture incidence several years after program discontinuation. In our study, 67 white women (age, mean (range), 56 (49 to 65) years) were randomly assigned to the control (n = 33) or exercise group (n = 34). Participants were instructed in proper dynamic and static posture principles. All participants had biplanar radiographs of the thoracic and lumbar spine to detect fracture at baseline, 2-year and 10-year follow up. Physical activity level and back extensor strength (BES) were evaluated monthly for 2 years. The exercise group performed PRE from prone position against measured and progressively increasing resistance 4 times weekly with 1 session per day; the control group performed no PRE. Isometric strength of back extensor muscles was measured with a special back strain-gauge dynamometer. For the strengthening exercises, 30% of maximum BES was prescribed. At 6 months into the study, the exercise group had an increase in BES (mean increase, 18.5 kg) that was approximately twice that of the control group (mean increase, 9.5 kg; p < 0.001). Eight years after program discontinuation, BES, spine bone mineral density, and vertebral fracture incidence were compared between the 2 groups. Statistical analysis showed significant difference between back extensor strength in the exercise group compared with the control group. At 10-year follow-up, spinal radiographs demonstrated that the number of controls with vertebral fractures was about 3 times greater than the back exercise group. This method of PRE of the back extensors was effective in decreasing incidence of vertebral fracture and resulted in increased strength of back extensors in the exercise group 8 years after the end of this study.

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