Zusammenfassung
Eine wesentliche Limitation des Rehabilitationssports gemäß § 64 SGB IX ist die fehlende
Evidenz seiner Effektivität auf indikationsspezifische Größen. Ziel der vorliegenden
Untersuchung war es, den Effekt eines 18-monatigen Rehabilitationssport-Programmes
(RS-Programm) gemäß § 64 SGB IX auf Frakturgrößen postmenopausaler Frauen zu evaluieren.
246 selbstständig lebende (cdw) Frauen ≥ 65 Jahr wurden randomisiert einer RS-Gruppe
(RSG: n = 123) oder aktiven Kontroll-Gruppe (KG: n = 123) zugeteilt. Die RSG absolvierte
ein intensitätsorientiertes Training mit maximal 4 Trainingseinheiten/Woche, die KG
führte ein niedrig-intensives „Wellnessprogramm“ mit geringem Trainingsvolumen und
-häufigkeit durch. Studienendpunkte waren Knochendichte (BMD) und Sturzhäufigkeit.
Signifikante Unterschiede zwischen RSG und KG wurden für die BMD an LWS (TG: 1,8 ± 2.7 %
vs. 0,3 ± 3,1%; p = 0,001) und Schenkelhals (DXA: 1,0 ± 3,3 % vs. −1,1 ± 3,3%; p = 0,001)
sowie für die Sturzrate (TG: 1,00 ± 1,32 vs. KG: 1,66 ± 1,80; p = 0,002) beobachtet.
Unerwünschte Nebeneffekte oder Verletzungen wurden nicht berichtet.
Die vorliegende Untersuchung belegt klar, das RS positive Effekte auf Frakturgrößen
von Frauen im höheren Lebensalter ausüben kann.
Abstract
In Germany, the main application of exercise in the secondary and tertiary prevention
of fractures is based on group exercises in the framework of ‘Rehabilitationssport’
(RS) or ‘Funktionstraining’ (FT) according to German law (social code (SGB) IX, § 2,
§ 64). However, there is a lack of evidence that RS/FT significantly affects Bone
Mineral Density (BMD) and/or fall rates in older postmenopausal women at risk for
osteoporosis. Thus, the aim of the SEFIP study was to evaluate the effect of a multicomponent
RS programme on BMD and fall rate in older women with such risks.
Two-hundred forty-six postmenopausal women (69.1±4.0 years) living independently in
the Erlangen/Fürth/Nürnberg area (Germany) were randomly allocated to an 18-month
multi-component RS programme with high exercise intensity and moderate exercise volume
(RSG, n = 123) or to a low intensity, low frequency programme that focused on well-being
(CG, n = 123). Primary study outcome was BMD at lumbar spine and femoral neck and
fall rate as determined by the calendar method. Negative binominal regression was
used to compare fall rate between the groups. Apart from parameters directly related
to fracture risk, we determined other risk factors of advanced age i. e. body composition,
Metabolic Syndrome and maximum strength. Further, we addressed health care costs as
an experimental study outcome. Intention to treat analysis was applied to analyse
data.
Altogether 19 women (RSG: n = 8 vs. CG: n = 11) were lost to follow-up. Overall attendance
rate was 76±8 % in the RSG and und 72±9 % in the CG. Significant exercise effects
were observed for BMD of the lumbar spine (RSG 1.77%; 95%-CI: 1.26 % to 2.28 % versus
CG: 0.33 % 95%-CI: −0.24 % to 0.91%; p<.001), BMD of the femoral neck (RSG: 1.01%;
95%-CI: 0.37 % to 1.65 % vs CG: −1.05 % 95 % CI: −1.70 % to −0.40%; p<.001), and fall
rate/person during 18 months (RSG: 1.00; 0.76 to 1.24 vs CG: 1.66; 1.33 to 1.99; p=.002).
RSG effects on skeletal muscle mass, body fat, maximum strength of the leg extensors
and metabolic syndrome Z-Score were also significant (all p<.001). However, no significant
differences (RSG: 2255±2596 versus CG: 2780±331 €; p=.20) were observed for health
care costs.
For the first time, the present study clearly determines the favourable effect of
a multicomponent exercise programme strictly applied in the framework of Rehabilitationssport
with people with osteoporosis on bone mineral density and fall rate in this cohort
of older postmenopausal women. Apart from parameters directly related to ‘osteoporosis’,
the study provided evidence that a multicomponent RS-programme positively affects
body composition, strength and cardiometabolic risk, factors also important for older
people. Due to low demand for training materials, rooms, and instructors, this training
regimen might serve as a blueprint for the broad implementation of the SEFIP concept
in the secondary and tertiary prevention of fractures by means of Rehabilitationssport
in Germany.
Schlüsselwörter körperliches Training - Osteoporose - Knochendichte - Sturzrate
Key words exercise - osteoporosis - bone mineral density - falls
