Successful Translation of Better Bones and Balance: a Community-Based Fall and Fracture Risk Reduction Exercise Program for Older Adults

Better Bones and Balance (BBB) is a community-based exercise program designed to improve bone health and reduce fall risk among older adults through balance and resistance training, and impact activities. Prior research has shown that when the program is delivered by researchers under controlled conditions, BBB participants improved strength, balance and power. Whether participants benefit from BBB delivered by trained instructors in the community setting is unknown. PURPOSE: Our aim was to examine fall risk factors in postmenopausal BBB participants (n= 69, age 70.1 + 7.7 yrs) and age-matched sedentary controls (n=46, age 68.1 + 7.7 yrs). METHODS: Current BBB participants (> 1 year of BBB attendance) were recruited from 15 BBB classes in Western Oregon and compared to controls. Women were excluded if they were <5 years postmenopausal, taking bone altering medications, or unable to complete activities of daily living. Performance-based fall risk factors were measured using the 30- second chair stand, timed Up and Go (TUG), tandem walk (TW), and the tandem and one-leg stance tests. Health history, BBB participation history, balance efficacy (BES), and physical activity were assessed by questionnaires. Lean mass was measured using DXA. Analysis of covariance (ANCOVA), controlling for age and lean mass, was used to assess group differences in performance measures. Age adjusted ANCOVA was used to compare group differences in number of falls in the previous 12 months, BES and worry about falling. RESULTS: BBB participants scored between 11% and 46% better than controls on all performance measures (tandem stance: 56.6 + 1.6 vs. 50.6 + 1.9 sec.; TW: 13.7 + 1.7 vs. 21.3 + 2.0 sec.; one leg stance: 26.9 + 0.9 vs. 20.5 + 1.1 sec.; TUG: 5.8 + 0.16 vs. 6.8 + 0.19 sec; chair stand: 20.1 + 0.55 vs. 16.3 + 0.67 reps); and reported higher BES compared to controls (95.3 + 9.8 vs. 89.8 + 1.2, p=0.001). There were no significant differences in worry about falling or number of falls in the previous year. CONCLUSIONS: Older women participating in community-based BBB classes delivered by trained instructors, exhibit better outcomes on fall related risk factors compared to sedentary controls. While a longer, prospective study is needed to determine the effect of BBB on fall incidence, these data suggest BBB ameliorates fall risk among postmenopausal women.