Hyperkyphosis is an accentuated forward thoracic curvature that is an independent risk factor for impaired physical function, reduced quality of lif, and other serious adverse health consequences. Although hyperkyphosis commonly affects older individuals, there are currently no evidence-based treatments to prevent or treat it. However, there is strong preliminary evidence that kyphosis-specific strengthening exercises done regularly over a three month period can improve kyphosis and physical function in older hyperkyphotic persons. Therefore, to build upon these preliminary findings, we now propose to conduct a randomized, controlled trial among 100 men and women aged 60 or older with hyperkyphosis to test if an exercise intervention that includes kyphosis-specific spinal muscle strengthening exercises compared to a non-specific stretching control will improve kyphosis and physical function assessed by the modified Physical Performance Test and gait speed. We will also assess whether the exercise intervention improves secondary measures of physical function and health related quality of life. Finally, to gain a better understanding of the mechanisms by which kyphosis-specific exercises may affect kyphosis and physical function, we will specifically measure spinal muscle strength via the Biodex and perform CT scan measurements of spinal muscle density to assess how muscle changes may mediate the effects of change in kyphosis on physical function. To date, exercise trials have used lower extremity strengthening exercise to improve physical function in older adults with demonstrated success, but none have targeted spinal strengthening, per se. Our specific focus on decreasing spinal hyperkyphosis represents a fundamental paradigm shift in exercise intervention strategies. This proposal is timely as the number of affected persons with hyperkyphosis is projected to increase with the aging population and currently, there are no standard prevention or treatment strategies to offer these patients. To address this important health problem and the National Institute of Aging's objective of maintaining physical functional ability in older persons, we have assembled an experienced team that includes experts in the design and conduct of randomized controlled trials, musculoskeletal medicine and physical therapy, geriatrics and biostatistics - a truly collaborative effort across multiple disciplines of expertise.

Public Health Relevance

Hyperkyphosis commonly affects older persons and is associated with substantial disability in older adults. Physicians and physical therapists currentl have no standard of care by which to treat affected persons. This study will address this void of inadequate clinical information by rigorously testing whether kyphosis-specific exercises compared to non-specific stretching exercises will improve kyphosis among older persons who suffer from this condition. The overall objective will be to develop an effective intervention to prevent and treat hyperkyphosis, and as a result, optimize aging and maximize independence among older persons.

Agency
National Institute of Health (NIH)
Institute
National Institute on Aging (NIA)
Type
Research Project (R01)
Project #
5R01AG041921-02
Application #
8548220
Study Section
Aging Systems and Geriatrics Study Section (ASG)
Program Officer
Joseph, Lyndon
Project Start
2012-09-30
Project End
2017-05-31
Budget Start
2013-09-01
Budget End
2014-05-31
Support Year
2
Fiscal Year
2013
Total Cost
$484,061
Indirect Cost
$151,469
Name
University of California San Francisco
Department
Physical Medicine & Rehab
Type
Schools of Medicine
DUNS #
094878337
City
San Francisco
State
CA
Country
United States
Zip Code
94143
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Katzman, Wendy B; Miller-Martinez, Dana; Marshall, Lynn M et al. (2014) Kyphosis and paraspinal muscle composition in older men: a cross-sectional study for the Osteoporotic Fractures in Men (MrOS) research group. BMC Musculoskelet Disord 15:19
Nardo, Lorenzo; Lane, Nancy E; Parimi, Neeta et al. (2014) Diffuse idiopathic skeletal hyperostosis association with thoracic spine kyphosis: a cross-sectional study for the Health Aging and Body Composition Study. Spine (Phila Pa 1976) 39:E1418-24
Bansal, Symron; Katzman, Wendy B; Giangregorio, Lora M (2014) Exercise for improving age-related hyperkyphotic posture: a systematic review. Arch Phys Med Rehabil 95:129-40
Katzman, Wendy B; Huang, Mei-Hua; Lane, Nancy E et al. (2013) Kyphosis and decline in physical function over 15 years in older community-dwelling women: the Study of Osteoporotic Fractures. J Gerontol A Biol Sci Med Sci 68:976-83