Graduate Thesis Or Dissertation
 

Translating the Better Bones and Balance Intervention Program into the community setting: effects of participation on skeletal health, fall risk indicators, and physical activity among older women

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  • Better Bones and Balance (BBB) is a community-based exercise program to improve bone health and reduce fall risk among older adults. Prior research has shown that when the program is delivered by researchers under controlled conditions, participants improved strength and balance, and maintained bone mineral density (BMD) at the hip. Whether participants benefit from BBB delivered in the community setting is unknown. Purpose: The purpose of this study was 1) to evaluate the relationship between participation in BBB and skeletal health (hip, spine, whole body BMD; hip bone structure) and indicators of fall risk(strength, balance, balance confidence, fall worry, fall incidence) and 2) to quantify the dose of physical activity (min/week, ground reaction forces) from the BBB program. Methods: BBB participants (n=69) were recruited from BBB classes and compared to controls (n=46). Performance-based tests included the 30-second chair stand, “Up and Go”, tandem walk, tandem and one-leg stance. Self-reported indicators of fall risk were assessed by questionnaire. BMD and hip structure were measured using dual energy x-ray absorptiometry. To quantify the physical activity dose from BBB, 36 BBB participants were recruited from four BBB classes. Peak ground reaction forces (GRF) of the key exercises were measured using a force platform; duration and intensity of exercises were measured during class sessions using heart rate monitors and accelerometers. Results: BBB participants out-performed controls on all strength and balance tasks (p<0.01) except the tandem stance (p=0.02) and reported higher balance confidence (p<0.01). There were no group differences in fall worry, fall incidence, hip or spine BMD or bone structural outcomes. Both groups had higher than average hip t-scores compared to national norms (p<0.05). Mean one-leg GRFs associated with typical BBB exercises ranged from 1.3 to 2.4 x body weight and BBB participants performed 126 minutes per week of moderate to vigorous physical activity. Conclusions: BBB participation is associated with positive outcomes on performance and self-reported indicators of fall risk, and higher hip BMD compared to national norms. Additionally regular participation in BBB delivers an adequate dose of exercise to meet national guidelines for optimal health. BBB appears to be a safe and effective program for reducing fall risk indicators and enhancing general health among older women.
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