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
Roghani, Taybeh; Khalkhali Zavieh, Minoo; Rahimi, Abbas et al. (2018) The reliability and validity of a designed setup for the assessment of static back extensor force and endurance in older women with and without hyperkyphosis. Physiother Theory Pract 34:882-893
Katzman, W B; Vittinghoff, E; Lin, F et al. (2017) 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. Osteoporos Int 28:2831-2841
Katzman, Wendy B; Huang, Mei-Hua; Kritz-Silverstein, Donna et al. (2017) Diffuse Idiopathic Skeletal Hyperostosis (DISH) and Impaired Physical Function: The Rancho Bernardo Study. J Am Geriatr Soc 65:1476-1481
Roghani, Tayebeh; Zavieh, Minoo Khalkhali; Manshadi, Farideh Dehghan et al. (2017) Age-related hyperkyphosis: update of its potential causes and clinical impacts-narrative review. Aging Clin Exp Res 29:567-577
Katzman, Wendy B; Parimi, Neeta; Mansoori, Ziba et al. (2017) Cross-Sectional and Longitudinal Associations of Diffuse Idiopathic Skeletal Hyperostosis and Thoracic Kyphosis in Older Men and Women. Arthritis Care Res (Hoboken) 69:1245-1252
Katzman, Wendy B; Vittinghoff, Eric; Kado, Deborah M et al. (2016) Study of Hyperkyphosis, Exercise and Function (SHEAF) Protocol of a Randomized Controlled Trial of Multimodal Spine-Strengthening Exercise in Older Adults With Hyperkyphosis. Phys Ther 96:371-81
Katzman, W B; Vittinghoff, E; Kado, D M et al. (2016) Thoracic kyphosis and rate of incident vertebral fractures: the Fracture Intervention Trial. Osteoporos Int 27:899-903
Katzman, Wendy B; Harrison, Stephanie L; Fink, Howard A et al. (2015) Physical function in older men with hyperkyphosis. J Gerontol A Biol Sci Med Sci 70:635-40
Kado, Deborah M; Miller-Martinez, Dana; Lui, Li-Yung et al. (2014) Hyperkyphosis, kyphosis progression, and risk of non-spine fractures in older community dwelling women: the study of osteoporotic fractures (SOF). J Bone Miner Res 29:2210-6
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

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