Regular physical activity has numerous health benefits for individuals of all ages.The effects of exercise on BMD (bone mass density) have been documented in several populations of women and using several different exercise interventions. Overall, results show that exercise helps prevent the loss of BMD and may even result in small gains.
The challenge is to design an exercise program for osteoporosis prevention, that is safe, enjoyable, and effective. Therefore, we must look at the principles of specificity, overload, reversibility, initial values and diminishing returns.
- Specificity: The exercises must target the bone sites of interest, because loading is a localised effect. Muscular contraction affects bone primarily in the area where the tendons attach.
- Overload: The load must be more than regular daily habitual activity creates. Small, progressive increases in load must be greater than daily activities but not so great that they cause injury.
- Reversibility: If the training stops the bone density increases will be lost. Two to three times a week is required to stimulate bone development.
- Initial values: Those with the lowest bone density have the greatest potential for gain from exercise.
- Diminishing returns: Each person has a biological limit on how much training can help his or her bone density. Genetics, nutrition, lifestyle and history are also important and exercise cannot make up for these other factors.
Exercise guidelines: Specific guidelines for the prescription of exercises have been published by the American College of Sports Medicine.
ACSM guidelines for preserving bone health in adulthood
- Mode: Weight-bearing endurance activities (tennis; stair climbing; jogging, at least intermittently during walking), activities that involve jumping (volleyball, basketball), and resistance exercise (weight lifting). Include upper, lower limb and trunk (site specificity)
- Intensity: Moderate to high. Exercise at 70 to 80 per cent functional capacity or maximum strength.
- Frequency: Weight-bearing endurance activities three to five times per week; resistance exercise two to three times per week.
- Duration: 30 to 60 minutes per day of a combination of weight-bearing endurance activities, jumping activities, and resistance exercise that targets all major muscle groups.
For elderly women and men
Exercise programs for elderly women and men should include not only weight-bearing endurance and resistance activities aimed at preserving bone mass,but also activities designed to maintain balance, posture and prevent falls.Individuals who are frail, severely kyphotic, or suffer from pain or poor balance may benefit from water exercise (hydrotherapy).
Exercise goals for osteoporosis
- Muscle strength and endurance
- Balance and stability
- Mobility and quality of life
- Prevention of falls
Exercises to avoid in osteoporosis
- Dynamic abdominal exercises (e.g.Sit-ups)
- Twisting movements (e.g. Golf swing)
- Trunk flexion
- Abrupt or explosive loading
- High impact loading
Exercises to follow in osteoporosis
- Weight bearing exercises transmit the weight of the body through the bones,working against gravity. Walking, dancing,and hiking are examples. The goal is to work up to 45 minutes or more per session. Perform at least three to five times per week. For example, walking: Warm up by walking at a slow pace for five minutes. Increase speed gradually to a brisk pace. Cool down with a five-minute slow walk. Perform gentle stretches after walking.
- Resistance exercises generate muscle tension on the bones to strengthen muscles and stimulate bones to grow stronger. Examples are free weights, exercise machines and resistance bands. Start exercising without weights. Begin with a set of eight to 10 repetitions of each exercise, increasing gradually to two or three sets. Perform two to three times a week, but not on consecutive days.
- Postural exercises stretch and strengthen muscles to improve posture,decreasing harmful stress on the back,reduce the risk of spinal fractures, and minimise rounded shoulders seen in osteoporosis. Perform several times daily to reinforce good posture. For example, shoulder stretch: Sit at the edge of a chair. Draw shoulders back to a comfortable position pulling shoulder blades together. At the same time,visualise stretching and lengthening your spine. Hold for three seconds. Perform three to five repetitions.
- Balance exercises improve equilibrium,Increase muscle strength and reduce the risk of falling. Perform these exercises daily. For example, balancing on one leg: Stand in a comfortable, balanced position near a counter or sturdy chair for support. Keep knees soft (not locked) and toes facing forward. Tighten lower abdominal muscles and lift left knee to a comfortable position. Hold for five to 10 seconds. Alternate legs and perform five to 10 repetitions with each leg.For example, balancing on one leg: Stand in a comfortable, balanced position near a counter or sturdy chair for support. Keep knees soft (not locked) and toes facing forward. Tighten lower abdominal muscles and lift left knee to a comfortable position. Hold for five to 10 seconds. Alternate legs and perform five to 10 repetitions with each leg.
- Hydrotherapy, or water aerobics, is a term encompassing a range of therapeutic exercise activities carried out in heated pools by a variety of providers. Aquatic exercises have been widely used in physical therapy programs, especially when exercising under normal conditions of gravity is difficult and painful. Buoyancy of water reduces loading across joints affected by pain, which otherwise may be too difficult on land. Water turbulence can be used as a method of increasing resistance, and percentage of body weight borne across the lower limbs can be decreased. The warmth and pressure of water may further assist with pain relief and swelling. Aquatic exercise has been successfully used to improve balance and coordination in older individuals. Because aquatic exercise, whether through swimming or vertical water exercise, is either limited or non-weight bearing, when feasible, transition to a land-based exercise regimen that does involve more impact loading should follow, as it remains likely that aquatic exercise alone will not provide a major osteogenic stimulus.To know more regarding bone and joints health, please visit https://www.apollohospitals.com/departments/orthopedic