Falls Precede Fractures: Examining the Effects of an Online Exercise Program in People with an Osteoporotic Fracture

Participants with osteoporosis and a previous minimal trauma fracture will be randomly allocated to one of two treatment arms: 1) usual care for individuals with osteoporotic fractures. This involves pharmacologic intervention, specifically bisphosphonates for this age group (55-75 years), and education on engaging in bone-promoting activities within their lifestyle; 2) usual care for individuals with osteoporotic fractures, including pharmacologic intervention as well as, participating in a 6-month online exercise program. The pharmacologic intervention will encompass standard medication given to patients with osteoporosis and minimal trauma fracture. This includes antiresorptive agents (5mg zoledronic acid administered intravenously once per year), vitamin D supplementation if levels are <50 nmol/L, or calcium supplementation if required. The study physician will determine the requirement for pharmacologic intervention. Compliance to pharmacologic intervention will be determined through a follow-up phone call initially (2 months after treatment initiation) and via patient medical interviews at follow-up assessments (6 months, 12 months, and 24 months). The education component will involve all participants being given an information resource that outlines the benefits of exercise in relation to osteoporosis, and provides a general overview of the exercise modalities most suitable for bone health (weight-bearing exercise, strength training and balance training). It also contains some points on safety considerations and activities that are not conducive to bone health (e.g. nonweight-bearing aerobic exercise). This information resource is designed as a 2 page fact sheet and will be handed to participants during the study’s baseline assessment. The online exercise intervention will be delivered in real-time by an Accredited Exercise Physiologist, and will occur 2 times per week, with each session being 45 minutes in length. These classes will be designed to incorporate strength-based exercises, impact training and balance exercises to address the recommended national guidelines for exercise and osteoporosis. Considering the exercise program will be performed within the participants’ home environment, ensuring safety during exercise sessions will be paramount. The program will be set at moderate intensity (using the RPE 1-10 scale). The types of exercises included in the program will be strength-based (body weight and band exercises, e.g. sit-to-stands, standing hip abduction/extension, calf raises, incline push-ups, band pull-aparts, triceps extension), include moderate impact loading (e.g. heel drops, step-ups), and balance exercises (e.g. tandem stance, single leg stance). Regressions and progressions of each exercise will be instructed as an option for participants to engage in that is suited to their level. Attendance to the online exercise sessions will be recorded and used as a means to monitor adherence.