NSPA's Personal Training Journal
Exercise and Osteoporosis
Paul Sorace, M.S., RCEP, CCS
Clinical Exercise Physiologist
The Forum Fitness Club, New Jersey
Pathophysiology
As we age, we all experience some bone loss through the years. The activity
of bone forming cells begins to decrease around 35 years of age. Bone
remodeling still occurs but the reabsorbing activity is greater than the
forming activity. This will cause a steady decrease (0.5%-1% per year) in
bone mineral density (BMD). A reduced total BMD is called osteopenia. Once
bone loss becomes so significant that minor falls cause fractures, the
condition of osteopenia becomes osteoporosis. A bone scan (DEXA) will
officially diagnose osteopenia or osteoporosis. The most common fracture
sites are the hip, lower (lumbar) spine, and the wrist. Although men do get
osteoporosis, this is considered to be a woman's disease.
There are essentially two types of osteoporosis. Type I usually sets in
between the ages of 50-75. The presumed mechanism is an estrogen deficiency,
which usually occurs with menopause. This reduction in estrogen causes
acceleration in the loss of BMD. Type II usually occurs after the age of 70
and seems to be caused primarily by a vitamin D deficiency and secondary
hyperparathyroidism.
Risk Factors
1. Female gender
2. Caucasion \ Asian race
3. Positive family history
4. Advanced age
5. Premature menopause
6. Prolonged premenopausal amenorrhea
7. Nulliparity (never beared children)
8. Low body weight
9. Lack of physical activity
10. Chronic smoking
11. Excessive alcohol \ caffeine consumption
12. Low calcium intake
Exercise Effects
While there is no consistent evidence that exercise alone will increase bone
mass in individuals with osteoporosis, there is significant evidence that
exercise can slow and even halt the loss of bone mass with age and possibly
prevent osteopenia from becoming osteoporosis.
Along with losing bone mass through the years, we also lose muscle with age.
This is accelerated with physical inactivity. As our muscle tissue
decreases, there is less muscle pulling on our bones and the "use it or lose
it" theory takes place. Since there is less stress on the bones, our bones
lose mass due to the reduced need for extra mass. Strength (weight) exercise
will increase muscle mass and this in turn stimulates our bones to increase
or maintain the existing level of mass.
People with osteoporosis, many times become inactive due to the fear of
falling and fractures. This sets off a vicious cycle. The lack of physical
activity accelerates the decline in bone mass and also increases the risk for
heart disease.
A complete exercise program, along with a proper diet, can prevent osteopenia
from becoming osteoporosis. It can also stop osteoporosis from progressing.
There is even some evidence hat some individuals, who are on hormone
replacement therapy, have experienced an increase in bone density with
exercise. Exercise will also condition the heart and lungs to reduce heart
disease risk.
Program Design \ Exercise Prescription
The goal of the exercise program should be to increase BMD during and shortly
after growth spurts, maintain BMD in adults, and improve balance to promote
fall prevention.
Medical clearance from a client's physician is required before initiating an
exercise program. The program should be well balanced and include both
aerobic (preferably weight bearing) and weight training exercises.
Cardiovascular exercise should be performed at least 3x per week for at least
20-30 minutes with an intensity inside of their appropriate training zone.
The treadmill or walking is a great mode to use since it is weight bearing.
Recent research has shown that walking provides a sufficient stimulus on bone
BMD in certain individuals. Caution should be used however with the
treadmill. If an individual has experienced vertebral fractures in the past,
their center of gravity and balance may have been altered. Holding on the
handles or rails may be a good precautionary measure to prevent a possible
fall.
Passive, static and PNF stretching is recommended to maintain and increasing
joint flexibility and range of motion. Stretching should occur after an
aerobic warm-up and the major joint of the body should be emphasized.
Weight training for osteopenia \ osteoporosis works best with a "heavy"
weight for 8-12 repetitions per set. Exercises should be used that emphasize
the hips, thighs, lower back, and torso. Exercises to strengthen the hip
abductors and knee extensors should be included. Increased muscular strength
in these areas has been shown to increase lateral stability. This will, in
turn, promote better balance and reduce the risk of falling. Exercises that
involve trunk flexion (i.e. - ab crunches) should be avoided since this
movement increases the likelihood of compression wedge fractures in the
lumbar spine. Exercises that incorporate spinal stability should be used to
promote proper posture and a neutral spine.
It is important to note that strength exercises performed in a seated
position (except hip abduction) have little effect on BMD in the hip (femoral
neck). A leg press has actually been shown to have a greater impact on the
lumbar spine than the femoral neck. Incorporate, whenever possible, lower
body exercises in a standing position. Wall squats is a good exercise since
balance can usually be maintained.
Water exercise, although not as effective on BMD as weight training and
walking, can be used as an alternative. It essentially eliminates the risk
of falling and is effective for aerobic conditioning, which will reduce heart
disease risk.
##########
This article is worth 2 CEC Credits. Each credit cost is $10.00 for a total of $20.00 for this article. All major credit cards accepted.
CLICK BELOW FOR QUESTION SHEET ABOUT THIS ARTICLE - You will be required to login to register and complete the test questions and provide payment. You will be sent via email your Certificate of Completion.
