Volume 13, Issue 4 (Winter 2019)                   Salmand: Iranian Journal of Ageing 2019, 13(4): 464-479 | Back to browse issues page


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Naderi A, Rezvani M H, Shaabani F, Bagheri S. Effect of Kyphosis Exercises on Physical Function, Postural Control and Quality of Life in Elderly Men With Hyperkyphosis. Salmand: Iranian Journal of Ageing. 2019; 13 (4) :464-479
URL: http://salmandj.uswr.ac.ir/article-1-1150-en.html
1- Department of Biological Sports, Faculty of Physical Education and Sport Sciences, Shahrood University of Technology, Shahrood, Iran. , ay.naderi@shahroodut.ac.ir
2- Department of Biological Sports, Faculty of Physical Education and Sport Sciences, Shahrood University of Technology, Shahrood, Iran.
3- Department of Motor Behaviour and Sports Psychology, Faculty of Physical Education and Sport Sciences, Allameh Tabataba'i University, Tehran, Iran.
4- Department of Sport Injury and Corrective Exercise, Faculty of Physical Education, University of Nahavand, Hamadan, Iran.
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Extended Abstract
1. Objectives

Hyperkyphosis in older adults generates severe complications such as limited physical function, balance impairment and reduced quality of life [1-5]. These can lead to falls, frequent fractures, and severe psychiatric complications [6-8]. However, limited studies have investigated the effect of exercises as an intervention for hyperkyphosis on physical function, balance and the quality of life among the elderly, especially elderly men. In most studies, only the effect of corrective training on the severity of hyperkyphosis has been evaluated [9-13]. Thus, the impact of training programs on the complications of hyperkyphosis has received little attention. Severe complications associated with hyperkyphosis have many negative consequences. Therefore, this study aimed to assess the effect of kyphosis corrective exercises on physical function, postural control, and the quality of life in elderly men with hyperkyphosis.

2. Methods and Materials
The study participants were 24 elderly men with hyperkyphosis (angle >50°). They were randomly divided into test (Mean±SD age=68.75±2.67 years; Mean±SD height=173.66±3.75 cm; Mean±SD weight=73.5±4.75 kg), and control (Mean±SD age=69.50±2.64 years; Mean±SD height=174.41±7.78 cm; Mean±SD weight=75.41±5.21 kg) groups, each with 12 samples. Inclusion criteria were 65-74 years of age; hyperkyphosis >50° ; physicians’ permission to participate in the training program; ability to stand for at least 1 minute and walk 10 meters or more independently or with a conventional cane; no consumption of sedatives or any particular medication affects postural control; the lack of any uncontrollable neurological, respiratory, vascular, metabolic and musculoskeletal diseases; and no serious hearing or visual impairment [5, 24]. 
Exclusion criteria were histories of depression, anxiety or other mental disorders; history of severe articular deformities in the lower extremities and trunk; history of joint replacement in lower extremities; history of balance disorders and vertigo; history of severe pain in the lower extremities and trunk; and receiving physiotherapy program recently or during study [5, 24]. Samples in the test group received a 12-week kyphosis corrective exercises program for 3 sessions per week. Exercises included spinal mobility, occipital muscle stretch, pectoral (chest) muscle stretch, strengthening cervical flexor muscle, and strengthening retractor muscles of the shoulder. 
The thoracic kyphosis angle was measured using a flexible ruler at a distance between T2 and T12 spinous processes. Physical function was examined by 6-min walk test; static balance by sharpened Romberg test (eyes closed and eyes open), and the quality of life by 36-item Short Form Health Survey (SF-36). For analyzing the collected data, Analysis of Covariance (ANCOVA) was performed considering a significance level of P<0.05.

3. Results
ANCOVA results suggest that the kyphosis corrective exercises had a significant effect on the quality of life of samples (F=6.94, P=0.04). Within group evaluation of scores by Independent t test revealed that the mean scores of the subscales of bodily pain (t=2.01, P=0.03), physical function (t=1.89, P=0.04), physical limitation (t=2.3, P=0.02), general health (t=1.93, P=0.04), and mental health (t=4.96, P=0.001), improved significantly after the intervention, compared to the pretest scores. However, posttest mean scores of vitality (t=0.16, P=0.87), social role (t=0.43, P=0.67), and mental limitation (t=1.37, P=0.18) showed no significant differences with their pretest mean scores.

 


 

ANCOVA results demonstrated that kyphosis exercises had a significant effect on balance, walking, and physical function among samples with hyperkyphosis >50° (P<0.05). Within group comparison results indicated that, in the test group, the mean score of static balance with eyes open (t=2.9, P=0.009), and physical function (t=3.8, P=0.001) improved significantly after the intervention. However, the mean score of static balance with eyes closed (t=1.37, P=0.018) showed no significant improvement. Moreover, kyphosis exercises significantly affected the kyphotic angle in the samples (P<0.05). With respect to this effect, within group comparison results revealed that the mean score of kyphotic angle in both groups significantly reduced after the intervention (t=3.74, P=0.001) (Table 1).

4. Conclusion
Kyphosis exercises including stretching exercises, strengthening exercises and spinal movements could improve postural control, physical function, and the quality of life in elderly people with hyperkyphosis >50°. Improving these factors can be effective in reducing the financial burden of diseases and ageing-related problems, and can provide a basis for life satisfaction in the elderly. Therefore, we recommend this intervention program in order to improve physical function, postural control, and the quality of life in the elderly with hyperkyphosis. However, due to some study limitations, more comprehensive research is required to confirm the obtained results.

Ethical Considerations
Compliance with ethical guidelines

All ethical principles were considered in this article. The participants were informed about the purpose of the research and its implementation stages; they were also assured about the confidentiality of their information; Moreover, They were allowed to leave the study whenever they wish, and if desired, the results of the research would be available to them.

Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Authors contributions
Conceptualization: Aynollah Naderi and Shahabeddin Bagheri; Draft preparation: Fatemeh Shaabani, Aynollah Naderi, and Shahabeddin Bagheri; Investigation and resources: Fatemeh Shaabani and Mohammad Hossain Rezvani; Editing: Mohammad Hossain Rezvani and Aynollah Naderi.

Conflict of interest
The authors declared no conflict of interest.

Acknowledgements
Authors would like to thank the authorities of Welfare Organization and the elderly care centers in of Hamedan For their valuable cooperation.



 
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Type of Study: Applicable | Subject: Rehabilitation Management
Received: 2018/05/12 | Accepted: 2018/10/27 | Published: 2019/01/01

References
1. Katzman WB, Vittinghoff E, Kado DM. Age-related hyperkyphosis, independent of spinal osteoporosis, is associated with impaired mobility in older community-dwelling women. Osteoporosis International. 2011; 22(1):85-90. [DOI:10.1007/s00198-010-1265-7] [DOI:10.1007/s00198-010-1265-7]
2. Kado DM, Huang MH, Karlamangla AS, Barrett-Connor E, Greendale GA. Hyperkyphotic posture predicts mortality in older community-dwelling men and women: A prospective study. Journal of the American Geriatrics Society. 2004; 52(10):1662-7. [DOI:10.1111/j.1532-5415.2004.52458.x] [DOI:10.1111/j.1532-5415.2004.52458.x]
3. Naderi E. [Does obesity affect the efficacy of therapeutic exercise on pain intensity and disability in patients with chronic non-specific low back pain (Persian)]. Journal of Applied Physics. 2017; 7(4):71-83.
4. Ensrud KE, Black DM, Harris F, Ettinger B, Cummings SR. Correlates of kyphosis in older women. Journal of the American Geriatrics Society. 1997; 45(6):682-7. [DOI:10.1111/j.1532-5415.1997.tb01470.x] [PMID] [DOI:10.1111/j.1532-5415.1997.tb01470.x]
5. Yalfani A, Anbarian M, Nikoo R, Naderi A. [Relationship between postural control with Sway-back malalignment in the non-athlete males (Persian)]. Journal of Ilam University of Medical Science. 2014; 22 (5):189-201.
6. Renno ACM, Granito RN, Costa D, Oishi J, Driusso P. Effects of an exercise program on respiratory function, posture and on quality of life in osteoporotic women: A pilot study. Physiotherapy. 2005; 91(2):113-8. [DOI:10.1016/j.physio.2004.09.020] [DOI:10.1016/j.physio.2004.09.020]
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10. Lorbergs AL, O'Connor GT, Zhou Y, Travison TG, Kiel DP, Cupples LA, et al. Severity of kyphosis and decline in lung function: The framingham study. The Journals of Gerontology. 2017; 72(5):689-94. [DOI:10.1093/gerona/glw124] [DOI:10.1093/gerona/glw124]
11. Naderi A, Shaabani F, Malki F, Khosravi F. [Kinematic changes of body alignment resulting from backpack weight, location and carrying duration in 10 to 12 years old boy schoolchildren (Persian)]. Journal of Applied Sport Physiology. 2017; 13(25):25-36. [DOI: 10.22080/jaep.2017.1585]
12. Sinaki M, Lynn SG. Reducing the risk of falls through proprioceptive dynamic posture training in osteoporotic women with kyphotic posturing: A randomized pilot study. American Journal of Physical Medicine & Rehabilitation. 2002; 81(4):241-6. [DOI:10.1097/00002060-200204000-00001] [PMID] [DOI:10.1097/00002060-200204000-00001]
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14. Ishikawa Y, Miyakoshi N, Kasukawa Y, Hongo M, Shimada Y. Spinal curvature and postural balance in patients with osteoporosis. Osteoporosis International. 2009; 20(12):2049-53. [DOI:10.1007/s00198-009-0919-9] [DOI:10.1007/s00198-009-0919-9]
15. Eum R, Leveille SG, Kiely DK, Kiel DP, Samelson EJ, Bean JF. Is kyphosis related to mobility, balance and disability. American Journal of Physical Medicine & Rehabilitation. 2013; 92(11):980-9. [DOI:10.1097/PHM.0b013e31829233ee] [DOI:10.1097/PHM.0b013e31829233ee]
16. Sinaki M, McPhee MC, Hodgson SF, Offord KP. Relationship between bone mineral density of spine and strength of back extensors in healthy postmenopausal women. IMayo Clinic Proceedings. 1986; 61(2):116-22. [DOI:10.1016/S0025-6196(12)65197-0] [DOI:10.1016/S0025-6196(12)65197-0]
17. Hongo M, Itoi E, Sinaki M, Miyakoshi N, Shimada Y, Maekawa S, et al. Effect of low-intensity back exercise on quality of life and back extensor strength in patients with osteoporosis: A randomized controlled trial. Osteoporosis International. 2007; 18(10):1389-95. [DOI:10.1007/s00198-007-0398-9] [DOI:10.1007/s00198-007-0398-9]
18. Lombardi JRI, Oliveira LM, Monteiro CR, Confessor YQ, Barros TL, Natour J. Evaluation of physical capacity and quality of life in osteoporotic women. Osteoporosis International. 2004; 15(1):80-5. [DOI:10.1007/s00198-003-1512-2] [DOI:10.1007/s00198-003-1512-2]
19. Sinaki M, Itoi E, Rogers JW, Bergstralh EJ, Wahner HW. Correlation of back extensor strength with thoracic kyphosis and lumbar lordosis in estrogen-deficient women. American Journal of Physical Medicine & Rehabilitation. 1995; 75(5):370-4. [DOI:10.1097/00002060-199609000-00013] [DOI:10.1097/00002060-199609000-00013]
20. Balouchy R, Ghiasi A, Naderi E, Sodoghi H. [The survey of cawthorne and cooksey exercise on the quality of life, balance and fatigue in patients with multiple sclerosis (Persian)]. Journal of Ilam University of Medical Science. 2014; 21(7):43-53.
21. Greendale GA, McDivit A, Carpenter A, Seeger L, Huang MH. Yoga for women with hyperkyphosis: Results of a pilot study. American Journal of Public Health. 2002; 92(10):1611-4. [DOI:10.2105/AJPH.92.10.1611] [PMID] [PMCID] [DOI:10.2105/AJPH.92.10.1611]
22. Pfeifer M, Begerow B, Minne HW. Effects of a new spinal orthosis on posture, trunk strength, and quality of life in women with postmenopausal osteoporosis: A randomized trial. American Journal of Physical Medicine & Rehabilitation. 2004; 83(3):177-86. [DOI:10.1097/01.PHM.0000113403.16617.93] [PMID] [DOI:10.1097/01.PHM.0000113403.16617.93]
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