Exercise & Osteoporosis

Exercise & Osteoporosis

Exercise & Osteoporosis

Our bones are one of the most vital components of our body. Above all, they provide us with the necessary structural support, a site of attachment for our body’s muscles and some even provide us with the protection of many vital organs.

Bone maintenance occurs whereby the daily removal of small amounts of bone mineral (a process called resorption), in adults, is balanced by an equal deposition of new mineral to allow for preservation of bone strength.

When this balance tips more towards excessive resorption, then the bones tend to weaken (causing osteopenia) and over time can eventually lead to osteoporosis.

What is Osteoporosis?

Osteoporosis is more commonly known as “brittle bones” is a condition where your bones become fragile and become more susceptible to fracturing and breaking.

This brittle nature occurs as our bones lose minerals faster than the body can replace it, that is a loss of bone mineral. In short, the risk of osteoporosis increases as we age.

It is reported that 1 in 2 men and 1 in 3 women will sustain a fracture as a resulting from osteoporosis.

Women are more susceptible as they can lose up to 20% of their bone mass in the first 5-7 years after menopause.

Osteoporosis increases our risk of fractures which can lead to a loss of mobility, long term disability and sometimes even death. To clarify, reports indicate that only ⅓ individuals who have a fall will return to independent living.

Risk Factors of Osteoporosis

  • Women are at a greater risk of developing osteoporosis due to the rapid decline in oestrogen levels during menopause. When oestrogen levels decrease, then bones tend to lose calcium and other mineral at a much faster rate.
  • Family history
  • Calcium & Vitamin D levels – low levels can increase the risk of developing osteoporosis
  • Medical history – certain conditions and medications can impact on your bone health. These may include: corticosteroids, low hormone levels (in women, early menopause and in men, low testosterone), thyroid conditions (overactive thyroid or parathyroid), conditions that may lead to malabsorption (eg. coeliac disease, inflammatory bowel disease), some chronic disease (eg. rheumatoid arthritis, chronic liver or kidney disease), and some medications for breast cancer, prostate cancer, epilepsy and some antidepressants
  • Lifestyle factors – low levels of physical activity, smoking, excessive alcohol intake, weight (thin body build or excess weight)

Benefits of Exercise

Bones act like muscles when they are placed under stress.

As our bones provide the structural support for our muscles, loading our muscles will also load our bones. This can help to increase the amount of your bone that is being laid down by specialised cells.

Some types of exercises can be more beneficial for promoting bone re-development. For example, the ability of certain exercises to have this “osteogenic” effect depends on the type of exercise.

Exercise has numerous benefits including:

  • Prevents age related bone loss
  • Improves bone mineral density
  • Improve muscle mass and strength
  • Improve balance
  • Reduce falls risk
  • Reduce rate of progression of Osteoporosis/osteopenia

How much exercise should I be doing?

Regular exercise plays an integral role in maintain healthy bones. It is recognised as one of the most effective lifestyle tools to assist in making our bone matter as strong as possible. This means you are reducing the risk of fractures that may occur later in life.

Specific forms of exercise are important for improving the strength of our bones.

Your bones will become stronger when a certain amount of impact or extra strain is placed on them. In short, there are different forms of exercises that are recommended for improving bone health. These include:

Aerobic Exercise

  • Weight bearing activities
  • 3-5 days per week
  • 30-60 minute duration

Weight bearing exercise allow your body to work against gravity. As a result you assist in strengthening your bones. For example this can include walking, climbing stairs, playing tennis, and dancing. Higher-impact activities will strengthen the bone more than lower-impact exercises. However it is important to only do what your fitness level allows and what your health professional recommends.

Resistance Training

  • 2-3 days per week
  • 20-40 minutes
  • Large muscle groups
  • Forms of resistance exercise: body-weighted, free weights or machine weights at home/gym, resistance bands/therabands, water-based exercise

Most importantly, resistance training is an essential part of any exercise program for someone who has osteopenia or osteoporosis.

Because of the attachment of the muscle to your bone material, when a stress activity such as weight lifting is performed, the stress is transferred onto your bone.

This process can stimulate the laying down of new bone cells at a faster rate. Consequently, this can help in reducing the rate of progression of osteoporosis or osteopenia.

Flexibility

  • 5-7 days per week
  • Large muscle groups
  • 30 seconds per stretch

Flexibility exercises are useful for keeping the muscles limber and joints adequately mobile. In addition, apart from stretching, other flexibility-based exercises may include yoga.

Therapeutic Exercise

  • Balance
  • Jumping (as per prescribed by an Accredited Exercise Physiologist)

Balance and mobility exercises may not assist in improving bone of muscle strength, but are effective in reducing the risk of falls.

It is important to remember that some forms of exercise may be more effective at building bones than others. The ability of exercise to build bone (or its osteogenic capacity) will depend on the specific way that stress is applied to your bones during that specific form of exercise.

So where is the evidence?

An experimental study conducted by Shanb, A. & Youssef, E (2014) examined the effects of adding weight-bearing exercise as opposed to non weight-bearing programs to the medical treatment of bone mineral density and health-related quality of life in elderly patients diagnosed with osteoporosis.

The study included 40 elderly patients aged 60 to 67 years old who were receiving medical treatment for osteoporosis.

All participants were randomly assigned into one of two groups.

Group 1 practiced weight-bearing exercises and group 2 completed non weight-bearing exercises.

All participants trained for 2 sessions per week, each lasting 45 to 60 minutes, for 6 months.

Each session comprised of a warm up routine which involved a brisk walk & gentle full body stretches and a cool down in the form of a brisk walk.

Each group then completed a series of exercises as detailed below.

Group 1: Weight-bearing exercise programGroup 2: Non weight-bearing exercise program
Bench pressDouble leg pressQuarter squatsWide stance mini squatQuadruped positionStep upsWall slides with upper limbStanding on one limb with arm supportHip exercises (extension & abduction)Leg extension exerciseArm exercisesBicep curlTricep curlQuadriceps & Hamstring curlWrist curl (flexion, extension, rotation)Back extension

Results collected from the study showed that the addition of weight-bearing exercise to the medical treatment of individuals with osteoporosis increases bone mineral density more than non weight-bearing exercise. In conclusion, both weight-bearing and non weight-bearing exercises significantly improved the quality of life of patients with osteoporosis.

Conclusion

A full exercise program entailing the above modes of exercise should be prescribed only by an Accredited Exercise Physiologist who has sound understanding of Osteoporosis and the impact of exercise.

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