Exercise Education for Individuals With Osteoporosis: An Evidence-Based Review

Abstract

Background: People with osteoporosis should be actively engaged in safe resistance, balance, posture, and weight-bearing exercise; however, many patients stop before, during, or after recommended exercise programs because of low knowledge of their condition/limited exercise knowledge, low exercise confidence, or fear of falling. The aim of this study was to determine if osteoporosis-specific education regarding exercise resulted in direct and indirect effects on exercise adherence via changes in exercise self-efficacy and fear of falling.

Methods: A quantitative, cross-sectional explanatory design was employed. Data were obtained from 500 adults with medically confirmed osteoporosis attending Mother Theresa University Hospital Center and Pegasus Med Clinic in Tirana, Albania. A structured questionnaire measured osteoporosis-specific exercise education, exercise self-efficacy, fear of falling, and exercise adherence. Partial least squares structural equation modelling was used to assess the measurement model, structural relationships, predictive relevance, and parallel mediation effects.

Results: The measurement model demonstrated acceptable indicator reliability, internal consistency, convergent validity, discriminant validity, and collinearity. Osteoporosis-specific exercise education significantly predicted exercise adherence, exercise self-efficacy, and reduced fear of falling or greater falls confidence. Exercise self-efficacy and reduced fear of falling also significantly predicted exercise adherence. The model explained 46.2% of the variance in exercise adherence, 31.7% in exercise self-efficacy, and 42.1% in fear of falling. Exercise self-efficacy and fear of falling demonstrated complementary partial mediation, with the fear-related pathway producing the stronger indirect effect.

Conclusion: Osteoporosis-specific exercise education had been associated with improved adherence both directly and through psychological mechanisms. Clinically, education programmes should have combined clear information with supervised demonstrations, confidence-building, balance training, fall-prevention guidance, goal setting, and follow-up support across the participating healthcare institutions in Tirana, Albania.