EFFECT OF AN ADAPTED PHYSICAL ACTIVITY (APA) PROGRAM ON QUALITY OF LIFE, FEAR OF FALLING AND PHYSICAL PERFORMANCE OF WOMEN WITH OSTEOPOROTIC VERTEBRAL FRACTURES: EFFECT SIZE FOCUS

INTRODUCTION Bone fractures are the main consequences of osteoporosis as representing a serious obstacle to aging in good health and compromising independence, quality of life and lifespan. Patients with a vertebral fracture should be considered for anti-fracture therapy including physical activity [Kendler, 2016]. The aim of this study was to measure the efficacy of our APA protocol in terms of quality of life, fear of falling and physical fitness and, in particular, to evaluate if the adherence had an effect on these outcomes. METHODS The APA group performed 1 hour twice a week for 6 months exercise protocol, specific for osteoporosis, while the Control Group (CG) received the generic indication on the importance of physical activity. The outcomes assessed at the baseline and at the end of the study were: quality of life (ECOS-16), fear of falling (FES-1), functional exercise capacity (6MWT), balance and gait (Tinetti Scale), flexibility of the column (Chair Sit & Reach). Effect sizes (EF) were calculated using Cohen’s d. To assess the potential impact of adherence, we divided the APA group according to the adherence percentage: 75% versus >75%, to evaluate if there is an effect on the main outcomes. RESULTS All patients who completed the study and participated in more than 50% of lessons were included in the analyses (40 women): 22 of the APA group and 18 of the CG. The adherence calculated as number of sessions performed compared to the sessions proposed was 75.8% (from 56.4% to 97.8%). According to Cohens’ d, a "big" effect (>0.8) of the intervention was observed for 6 outcomes (ECOS-16, ES: 1.204; FES-I, ES: 1.007; 6MWT, ES: 1.390; Tinetti Scale, ES: 0.871; Balance, ES: 0.969; Chair Sit & Reach Left, ES: 1.000) and a "medium" effect (>0.5) for 4 outcomes (VAS, ES: 0.510; Borg Scale, ES: 0.654; Gait, ES: 0.639; Chair Sit & Reach Right, ES: 0.739). The number of sessions attended by APA group did not have a significant impact on the results, but slightly influenced the effect size of some items such as: Tinetti Scale (ES: 0.903), Gait (ES: 0.889) and Balance (ES: 0.863). CONCLUSION The big effect sizes suggest that our APA protocol have clinical significance in addition to being statistically significant. There is no significant dependence demonstrated by Cohen's d between improvement in tests and adherence. Therefore, the improvement can be also achieved in those who do not reach the cut-off of 75%, but who nevertheless attended at least 50%. REFERENCES Kendler DL et al, Vertebral Fractures: Clinical Importance and Management. Am J Med 2016,129(2):221.e1-10. doi: 10.1016/j.amjmed.2015.09.020.