Enjoyability And Acceptability Of Bone Targeted Exercise For Young Adult Women: The OPTIMA-Ex Trial

PURPOSE: While physical activity participation is recognized as an effective modifiable risk factor for osteoporosis, adherence and compliance present significant challenges. We aimed to explore the experiences related to a bone-targeted exercise intervention, determine enjoyment and acceptability of each exercise mode, and identify barriers and facilitators to osteogenic exercise for young adult women with low bone mass. METHODS: A mixed-methods study was conducted within the OPTIMA-Ex trial, a three-arm RCT comparing musculoskeletal outcomes from high-intensity impact training (IT), high-intensity resistance training (RT), and a home-based low-intensity exercise control (CON). All 32 participants (IT=10, RT=12, CON=10) who finished the trial completed questionnaires on physical activity enjoyment (PACES-8, Kruskal-Wallis and Friedman’s test), quality of life (AQoL-6D, repeated measures ANOVA), and semi-structured interviews to facilitate qualitative analysis (Leximancer v4.50) of participant experiences. RESULTS: At follow-up, RT had the highest total score for PACES-8 (48.6±4.7), while only the IT group experienced an increase in total score over the 10 months (34.8±4.1 to 41.4±6.9, p 0.06 points) for ‘mental health’, while IT improved for ‘senses’ and CON improved for ‘coping’ (p<0.05). The qualitative analysis revealed that overall trial exercises were viewed positively by all groups, yet the two high-intensity groups had the ‘richest’ exercise experiences, developing a more positive attitude to exercise. Barriers to exercise related to time, convenience, accessibility, and cost. Both IT and CON groups experienced a 41% drop out compared to 29% in the RT group. Compliance did not differ between CON (78.8±4.1%), IT (61.4±15.1%), or RT (66.4±11.2%) (p=0.085). CONCLUSIONS: While IT and RT provide enjoyable bone-targeted exercise experiences for young adult women, on balance RT appears most favorable. It seems prudent, that bone-targeted exercise interventions for this demographic address perceptions of time demands and environmental barriers to participation in order to maximize compliance and adherence.