Introduction 1 2 3 4 5 6 7 6 8 12 13 14 2 15 16 17 18 3 16 19 21 22 The purpose of the present study was to investigate the effect of a 12-month balance training program on functional and static balance, mobility and falling frequency in women with osteoporosis. Patients and methods Patient sample 23 24 25 The patients were randomized consecutively into two groups: the group submitted for the Balance Training Program (Intervention Group), consisting of 34 patients; and the Control group, consisting of 32 patients without intervention. The Control group only received treatment for osteoporosis and orientation to prevent falls and return regularly (3-monthly follow-ups) to the Osteometabolic Disease Outpatient Clinic. All patients read and signed a term of free informed consent that described the procedures which would be realized during the research. Measured variables: interview and medical chart records Personal, family and clinical data were evaluated through an interview and medical chart records, with emphasis on the history of fractures, number of falls in the preceding year, use of medication for osteoporosis, and use of medication that favored the risk of falling, such as hypnotics, hypotensors and antidepressants. Functional state evaluation Static and dynamic balance and mobility were evaluated in all patients, before and at the end of the trial, by a physiotherapist who was blinded to the distinct group (Intervention, Control). Functional balance 26 26 27 Static balance Static balance was evaluated by the Clinical Test of Sensory Interaction for Balance (CTSIB), which consists of six sensory conditions (1: eyes open and firm surface, 2: eyes closed and firm surface, 3: eyes open, visual conflict and firm surface, 4: eyes open and unstable surface, 5: eyes closed and unstable surface, and 6: eyes open, visual conflict and unstable surface). 28 Improvement in the test was defined as the capacity to complete the test during the final evaluation when unable to complete the same in the initial evaluation. Functional mobility 29 Elderly individuals without balance deficit are capable of completing the test in less than 10 seconds. Falls 30 At the end of the study, the difference in the number of falls/patient (final evaluation - initial evaluation) was compared between the Intervention Group and Control. Intervention 3 11 3 Basic warm-up and stretching exercises Prior to training, the patients participated in 15 min of warm-up and stretching exercises, consisting of head rotation, shoulder rotation and stretching of the upper and lower limbs. Walking was performed for 15 min with the supervision of a physiotherapist, who associated exercises for the upper limbs throughout the walk. Balance training 3 31 Home-based exercises The patients were instructed and encouraged to continue the same exercises at home at least three times a week for 30 min. A manual with instructions and illustrations for each exercise was distributed. The frequency of participation in the home-based exercises was noted each week by the physiotherapist. Data analysis n n n n n t P Results 1 Table 1 Data at the onset of the study in relation to anthropometric parameters, fracture history, medication use and bone mineral density values (T-score) in the Intervention and Control groups Variable n n p Age, years 74.57 ± 4.82 73.40 ± 4.61 0.342* 2 24.39 ± 4.49 26.51 ± 5.32 0.100* n 13 (43.3) 16 (53.3) 0.438*** n 2.37 ± 1.50 2.30 ± 0.88 0.498** n 6 (20.0) 7 (23.3) 0.754*** n 14 (46.7) 16 (53.3) 0.606*** Lumbar spine, T-score −2.83 ± 1.07 −2.62 ± 1.12 0.470** Femur neck, T-score −2.70 ± 0.75 −2.75 ± 0.90 0.821** Total femur, T-score −2.10 ± 1.26 −2.10 ± 1.09 0.990** ± BMI: body mass index, OP: Osteoporosis t **Mann-Whitney test ***Chi-square test p 2 Table 2 Data at the onset of the study for: Berg Balance Scale (BBS) score, number of patients that could not complete the Clinical Test of Sensory Interaction for Balance (CTSIB: condition 1: eyes open and firm surface; condition 2: eyes closed and firm surface; condition 3: eyes open, visual conflict and firm surface; condition 4: eyes open and unstable surface; condition 5: eyes closed and unstable surface; condition 6: eyes open, visual conflict and unstable surface), Timed “Up & Go” Test (TUGT), and number of falls/patient in the preceding year in Intervention Group and Control   n n p BBS, score 48.80 ± 4.10 48.13 ± 5.36 0.900* n 0 (0.0) 1 (3.3) 1.000** n 2 (6.7) 1 (3.3) 1.000** n 2 (6.7) 2 (6.7) 1.000** n 4 (13.3) 4 (13.3) 1.000** n 15 (50.0) 12 (40.0) 0.604** n 12 (40.0) 9 (30.0) 0.589** TUGT, seconds 14.31 ± 4.03 13.86 ± 3.43 0.610* n 1.20 ± 1.88 0.87 ± 0.86 0.745* ± *Mann-Whitney test **Fisher’s exact test Adherence rate A high level of adherence was observed. Sixty percent of the patients participated in all of the exercise sessions at the club and absences occurred with the following justifications: doctor’s appointment, the realization of laboratory exams or for personal reasons. In relation to home-based exercise, 76.67% of the patients realized exercises at least once a week, 40% of the patients exercised every day and 36.67% from one to four times a week. Comparison between the Intervention Group and Control p 3 Table 3 Differences (final evaluation—initial evaluation) in: Balance Berg Scale (BBS) score, number of patients showing improvement in Clinical Test of Sensory Interaction for Balance (CTSIB condition 5: eyes closed and unstable surface; condition 6: eyes open, visual conflict and unstable surface), time of Timed “Up & Go” Test (TUGT), and number of falls/patient in the Intervention Group and Control   n n p Difference BBS, score  5.5 ± 5.67 −0.5 ± 4.88 <0.001* n 13 (43.3) 1 (3.3) <0.001** n 12 (40.0) 1 (3.3) 0.001** Difference TUGT, seconds −3.65 ± 3.61 +2.27 ± 7.18 <0.001* n −0.77 ± 1.76 +0.03 ± 0.96 0.018* ± *Mann-Whitney test **Chi-square test p p 3 p 3 p 3 Discussion Few studies have been developed regarding balance training in patients with osteoporosis. The present longitudinal prospective study demonstrated that a program of balance training realized over a period of 12 months was effective in improving the functional and static balance, mobility and diminishing the number of falls in elderly women with osteoporosis. 32 33 34 35 24 36 36 37 38 39 39 40 17 35 41 3 42 43 35 44 26 28 29