Study of Hyperkyphosis, Exercise and Function (SHEAF) Protocol of a Randomized Controlled Trial of Multimodal Spine-Strengthening Exercise in Older Adults With Hyperkyphosis

Katzman, Wendy B.; Vittinghoff, Eric; Kado, Deborah M.; Schafer, Anne L.; Wong, Shirley; Gladin, Amy; Lane, Nancy E.

doi:10.2522/ptj.20150171

Cited by 43 publications

(43 citation statements)

References 33 publications

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“…Participants were excluded for inability to straighten the thoracic spine at least 5°, cognitive impairment (unable to draw a normal clock or recall any words on the Mini-Cog) [19], inability to pass safety tests in the screening examination or any disorder or disease likely to prevent or interfere with safe participation in a group-based exercise class (see methods paper for details on safety tests, disorders, and diseases) [20]. …”

Section: Methodsmentioning

confidence: 99%

“…A licensed physical therapist led the exercise intervention, assisted by a trained research assistant to ensure a ratio of five participants to each instructor. The intervention was a multimodal group-based kyphosis-specific exercise program that targeted multiple musculoskeletal impairments known to be associated with hyperkyphosis, including spinal extensor muscle weakness [12, 21], impaired recruitment and activation of the spinal extensor muscles [22], decreased spinal mobility [23], and poor postural alignment (see methods paper for detailed exercises) [17, 18, 20]. Exercises were progressed in intensity during the study, with an emphasis on good-quality movement while maintaining a Borg Scale intensity of 4–5, based upon 70–80% of perceived exertion [1, 24].…”

Section: Methodsmentioning

confidence: 99%

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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

et al. 2017

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Summary 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

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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

et al. 2017

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“…Clinical trials are currently underway to determine the effect of multi-modal interventions targeting back extensor muscle strength, spinal mobility and postural awareness. This trial will investigate effects of targeted kyphosis-specific exercises on kyphosis, and it will also investigate causal pathways of change to determine whether change in strength and muscle density have a direct effect on change in kyphosis [60]. …”

Section: Spinal Extensor Muscles and Age-related Hyperkyphosismentioning

confidence: 99%

Age-related hyperkyphosis: update of its potential causes and clinical impacts—narrative review

et al. 2016

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The present study aims to qualitatively review the contributing factors and health implications of age-related hyperkyphosis. We conducted a narrative review of observational and cohort studies describing the risk factors and epidemiology of hyperkyphosis from 1955 to 2016 using the following key words: kyphosis, hyperkyphosis, posture, age-related hyperkyphosis, kyphotic posture, aetiology and causes. This review included 77 studies. Approximately 60–70 % of the most severe hyperkyphosis cases have no evidence of underlying vertebral compression fractures. Other proposed factors contributing to hyperkyphosis are degenerative disc disease, weakness of back extensor muscles and genetic predisposition. Strength and endurance of back extensor muscles are very important for maintaining normal postural alignment. Recent evidence suggests that age-related hyperkyphosis is not equivalent to spinal osteoporosis. Due to the negative impact of hyperkyphosis on physical function, quality of life and mortality rates, physicians should focus not only on osteoporosis, but also on age-related postural changes. More research about the relationship between spinal morphology and modifiable factors, especially the structural and functional parameters of trunk muscles, could further illuminate our understanding and treatment options for hyperkyphosis.

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“…While osteoporosis and hyperkyphosis are certainly related, no currently approved osteoporosis medications have been shown to directly improve or delay the progression of kyphosis. There have been small clinical trials that suggest a benefit of spinal strengthening exercises in improving hyperkyphosis and there are ongoing randomized controlled trials to test whether targeted spinal strengthening exercises may help to improve age-related kyphosis [20,21]. The results of the current study as well as the two previous studies that demonstrated an association between CT measured spinal muscle density and hyperkyphosis suggest that targeted muscle strengthening would be the first and most logical approach to intervention.…”

Section: Discussionmentioning

confidence: 67%

Trunk lean mass and its association with 4 different measures of thoracic kyphosis in older community dwelling persons

et al. 2017

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BackgroundThe causes of age-related hyperkyphosis (HK) include osteoporosis, but only 1/3 of those most severely affected have vertebral fractures, suggesting that there are other important, and potentially modifiable causes. We hypothesized that muscle mass and quality may be important determinants of kyphosis in older persons.MethodsWe recruited 72 persons >65 years to participate in a prospective study designed to evaluate kyphosis and fall risk. At the baseline visit, participants had their body composition measures completed using Dual Energy X-ray Absorptiometry (DXA). They had kyphosis measured in either the standing [S] or lying [L] position: 1) Cobb angle from DXA [L]; 2) Debrunner kyphometer [S]; 3) architect’s flexicurve ruler [S]; and 4) blocks method [L]. Multivariable linear/logistic regression analyses were done to assess the association between each body composition and 4 kyphosis measures.ResultsWomen (n = 52) were an average age of 76.8 (SD 6.7) and men 80.5 (SD 7.8) years. They reported overall good/excellent health (93%), the average body mass index was 25.3 (SD 4.6) and 35% reported a fall in the past year. Using published cut-offs, about 20–30% were determined to have HK. For the standing assessments of kyphosis only, after adjusting for age, sex, weight and hip BMD, persons with lower TLM were more likely to be hyperkyphotic.ConclusionsLower TLM is associated with HK in older persons. The results were stronger when standing measures of kyphosis were used, suggesting that the effects of muscle on thoracic kyphosis are best appreciated under spinal loading conditions.

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Study of Hyperkyphosis, Exercise and Function (SHEAF) Protocol of a Randomized Controlled Trial of Multimodal Spine-Strengthening Exercise in Older Adults With Hyperkyphosis

Cited by 43 publications

References 33 publications

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

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

Age-related hyperkyphosis: update of its potential causes and clinical impacts—narrative review

Trunk lean mass and its association with 4 different measures of thoracic kyphosis in older community dwelling persons

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