针对老年人脊柱强化运动和姿势训练方案以减少脊柱后凸：来自脊柱后凸、运动和功能研究（SHEAF）随机对照试验的结果。
Targeted spine strengthening exercise and posture training program to reduce hyperkyphosis in older adults: results from the study of hyperkyphosis, exercise, and function (SHEAF) randomized controlled trial.
机构信息
University of California, 1500 Owens Street, San Francisco, CA, 94158, USA.
University of California, 550 16th. Street, San Francisco, CA, 94158, USA.
出版信息
Osteoporos Int. 2017 Oct;28(10):2831-2841. doi: 10.1007/s00198-017-4109-x. Epub 2017 Jul 8.
UNLABELLED
A 6-month randomized controlled trial of spine-strengthening exercise and posture training reduced both radiographic and clinical measures of kyphosis. Participants receiving the intervention improved self-image and satisfaction with their appearance. Results suggest that spine-strengthening exercise and postural training may be an effective treatment option for older adults with hyperkyphosis.
INTRODUCTION
The purpose of the present study is to determine in a randomized controlled trial whether spine-strengthening exercises improve Cobb angle of kyphosis in community-dwelling older adults.
METHODS
We recruited adults ≥60 years with kyphosis ≥40° and enrolled 99 participants (71 women, 28 men), mean age 70.6 ± 0.6 years, range 60-88, with baseline Cobb angle 57.4 ± 12.5°. The intervention included group spine-strengthening exercise and postural training, delivered by a physical therapist, 1-h, three times weekly for 6 months. Controls received four group health education meetings. The primary outcome was change in the gold standard Cobb angle of kyphosis measured from standing lateral spine radiographs. Secondary outcomes included change in kyphometer-measured kyphosis, physical function (modified Physical Performance Test, gait speed, Timed Up and Go, Timed Loaded Standing, 6-Min Walk), and health-related quality of life (HRQoL) (PROMIS global health and physical function indexes, SRS-30 self-image domain). ANCOVA was used to assess treatment effects on change from baseline to 6 months in all outcomes.
RESULTS
There was a -3.0° (95% CI -5.2, -0.8) between-group difference in change in Cobb angle, p = 0.009, favoring the intervention and approximating the magnitude of change from an incident vertebral fracture. Kyphometer-measured kyphosis (p = 0.03) and SRS-30 self-esteem (p < 0.001) showed favorable between-group differences in change, with no group differences in physical function or additional HRQoL outcomes, p > 0.05.
CONCLUSIONS
Spine-strengthening exercise and posture training over 6 months reduced kyphosis compared to control. Our randomized controlled trial results suggest that a targeted kyphosis-specific exercise program may be an effective treatment option for older adults with hyperkyphosis.
TRIAL REGISTRATION NUMBER AND NAME OF TRIAL REGISTER
ClinicalTrials.gov; identifier NCT01751685.
目的
本研究旨在通过随机对照试验确定脊柱强化锻炼是否能改善社区居住的老年驼背患者的 Cobb 角。
方法
我们招募了 Cobb 角≥40°的≥60 岁的成年人，共纳入 99 名参与者（71 名女性，28 名男性），平均年龄 70.6±0.6 岁，年龄范围 60-88 岁，基线 Cobb 角为 57.4±12.5°。干预措施包括由物理治疗师进行小组脊柱强化锻炼和姿势训练，每周 3 次，每次 1 小时，持续 6 个月。对照组接受 4 次小组健康教育会议。主要结局是从站立位侧位脊柱 X 线片上测量的金标准 Cobb 角的变化。次要结局包括 kyphometer 测量的后凸角度变化、身体功能（改良体能测试、步态速度、计时起立行走、计时站立负荷、6 分钟步行）和健康相关生活质量（HRQoL）（PROMIS 全球健康和身体功能指数、SRS-30 自我形象领域）。使用协方差分析（ANCOVA）评估所有结局从基线到 6 个月的治疗效果。
结果
Cobb 角的组间差异为-3.0°（95%CI-5.2，-0.8），p=0.009，干预组更有利，接近新发椎体骨折的变化幅度。kyphometer 测量的后凸角度（p=0.03）和 SRS-30 自尊（p<0.001）的组间变化差异有利，身体功能或其他 HRQoL 结局无组间差异，p>0.05。
结论
6 个月的脊柱强化锻炼和姿势训练与对照组相比，降低了后凸角度。我们的随机对照试验结果表明，针对特定后凸的锻炼计划可能是老年驼背患者的有效治疗选择。
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