The quality of evidence is downgraded by study limitations (lack of blinding), and by inconsistency (variability in results).
A Cochrane review [Abstract] 1 included 9 studies with a total of 749 participants (of which 68 were male) with history of osteoporotic vertebral fracture. Exercise interventions of 4 weeks or greater (alone or as part of a physical therapy intervention) were compared to non-exercise/non-active physical therapy intervention (e.g. educational intervention), no intervention or placebo. Studies that involved exercise interventions of any kind (such as muscle strengthening or resistance training exercises, aerobic exercise, balance training, Tai Chi, or individualized exercise prescribed by a physical therapist) were included. Adherence to exercise varied across studies.
Differences between studies prevented meaningful pooling in meta-analyses for most outcomes. Individual studies demonstrated between-group differences in favor of exercise, but there were also individual studies reporting no between-group differences. There was no difference in incident fragility fractures (RR 0.54, 95% CI 0.17 to 1.71; 1 study, n=78) or incident falls (RR 1.06, 95% CI 0.53 to 2.10; 1 study, n=89) after 52 weeks between exercise and control groups. There were small between-group differences in favor of exercise for Timed Up and Go (TUG) test, self-reported physical function measured by QUALEFFO-41 physical function subscale score, and disease-specific quality of life measured by the QUALEFFO-41 total score (table T1). Three studies reported 4 adverse events related to the exercise intervention (costal cartilage fracture, rib fracture, knee pain, irritation to tape).
| Outcome | Follow-up | Control | Exercise (95% CI) | Participants (studies) | |
|---|---|---|---|---|---|
| Physical performance (performance-based measures):TUG test* | 4 to 12 weeks | The mean TUG score in the control group was 7.9 seconds | The TUG score in the exercise group was 1.09 seconds lower (-1.78 to -40) | 139 (3 studies) | |
| Physical performance (self-report questionnaires): Physical function subscale from the QUALEFFO-41** | 12 weeks | The mean QUALEFFO-41 physical function score in the control group was 22.7 points | The mean QUALEFFO-41 physical function score in the exercise group was 2.84 points lower (-5.57 to -0.11) | 109 (2 studies) | |
| Disease-specific quality of life:QUALEFFO-41 total score** | 12 weeks | The mean QUALEFFO-41 total score in the control group was 31.8 points | The mean QUALEFFO-41 total score in the exercise group was 3.24 points lower (-6.05 to -0.43) | 109 (2 studies) | |
| * Minimal clinically important difference (MCID) for the TUG test has not been established in individuals with vertebral fractures, but the TUG test MCID typically ranges from 1.4 seconds to 3.4 seconds in other populations with chronic musculoskeletal conditions **Scale from 0 to 100 and lower scores indicate better physical function/quality of life | |||||
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