Kuinka vaalia ikääntyvää luuta? Liikunta

1. Kuinka vaalia ikääntyvää luuta?Liikunta Ari Heinonen Department of Health Science, University of Jyväskylä

2. Development of bone mineral mass and goals for exercise programs Bone mass, % Age, yr Goals of exercise interventions vary across lifespan Increase peak bone mass Reduce bone loss & prevent falls Maintenance (built bone) Vuori, 1996

3. Comparison between strength and impact sports • Triple jumpers (mean: 22 yr, 172 cm, 65 kg) (Heinonen et al. 2003) • extremely high impact forces, up to 22 times BW • tibiae are exposed to extreme torques during performance • Weightlifters (mean: 30 yr, 164 cm, 67 kg) (Heinonen et al. 2003) • lower extremities experience large compressive stresses

4. Clinical trialsExercise intervention studies

5. Summary of bone mass changes observed in randomized controlled intervention trials * 7 Spine Femoral neck 6 5 4 * p < 0.05 Percent change (%) * 3 * * * * 2 * * * * * * (troch.) * * (troch.) 1 High-impact training ns ns ns ns ns ns ns 0 Hatori (1992) Heinonen (1998) Show-Harter (1992) Lohman (1995) Bassey (1998) Grove (1992) Friedlander (1995) Heinonen (1996) Vainionpää (2005) Bassey (1998) Kerr (1996) Early postmenopausal Premenopausal No exercise effect on spine or femoral neck: Humpries et al. (2000), Maddalozzo & Snow (2000), Kerr et al. (1996), Uusirasi et al. 2003

6. Effect of alendronate and exercise on bone and physical performance of postmenopausal women A 12 month randomised controlled trial BMC, g Exercise vs. non exercise (Efficacy > 2 x vk) lumbar spine Femoral neck distal radius +1.8% distal tibia tibial shaft +4.6% Bone strength index (mm3) Distal tibia 0 -6 -4 -2 2 4 6 % 0 Change difference, %, 95% CI Uusi-Rasi et al. Bone 2003;33:132-143.

7. Intensity of exerciseVainionpää et al. Osteoporos Int 2006; 17: 455-463 12-month randomized exercise trial • The average acceleration peak values for different exercise patterns measured by accelerometer-based method. • accelerations levels exceeding 3.9 g correlated positively with the BMD change in the hip and L1

8. A Multi-Component Exercise Regimen to Prevent Functional Decline and Bone Fragility in Home-Dwelling Elderly Women: Randomized, Controlled Trial

9. Study design • Originally, 149 healthy 70 to 78-years old women were randomly assigned to the four groups: • a resistance training group (RES) • a balance-jumping training group (BAL) • a combination group doing resistance training and balance-jumping training (COMB) • a non-training control group (CON). • (Karinkanta et al. Ostpor Int, in press) • 144 completed a 12-month randomized, controlled exercise intervention trial. • 120 (83%) participated in the 12-month follow-up measurements one-year after the end of the intervention

10. Background Characteristics

11. 1. Training protocol during the intervention • Resistance training • 5 movements emphasizing lower limbs • 3x8-10 reps • target level 75-80% of 1RM (Karinkanta et al. Ostpor Int, in press)

12. 2. Training protocol during the intervention • Balance & agility-jumping training: • aerobic/step aerobic –based program • Including: • jumps, impacts, changes of direction, balance- and agility training sessions (Karinkanta et al. Ostpor Int, in press)

13. 3. Training protocol during the intervention • Combination of strength and agility-jumping training: • in every second week: strength or balance-jumping training (Karinkanta et al. Ostpor Int, in press)

14. Training protocol during the intervention • Supervised training sessions (45 min) 3x week for 12 months - progressive protocol • 4. Control group • were asked to maintain the current physical activity (Karinkanta et al. Ostpor Int, in press)

15. PHYSICAL PERFORMANCE • Intervention effect (Karinkanta et al. Osteopor Int, in press) : • Leg extensors force: • - RES: 13% (95% CI: 5 to 22) • - BAL: 10% (3 to 19) groups • - COMB: 8%; (0 to 16) • Dynamic balance: • - BAL: 5% (1 to 8) • - COMB: 7% (3 to 10) compared with the CON group • One year after the intervention: • Dynamic balance: • - COMB: 6% (95% CI; 2 to 11%) • - BAL group: 5% (1 to 9%) compared with the CON group • Isometric leg extensor force and self-rated physical functioning: • there were no between-groups differences (Karinkanta et al. Ostpor Int, in press)

16. BONE MEASUREMENTS • Intervention effect (Karinkanta et al. Osteopor Int, in press): • Intention-to-treat: there were no training effect in density-weighted polar section modulus (BSI) of tibia or femoral neck section modulus (Z) • BSIefficacy analyses (who trained at least twice a week): • - RES: 1.5% (95% CI: 0.2 to 2.8) • - BAL: 0.8% (-0.6 to 2.2) groups • - COMB: 1.9% (0.6 to 3.3.) compared with the CON group • One year after the intervention: • Intentio-to-treat:there were no training effect in density-weighted polar section modulus (BSI) of tibia or femoral neck section modulus (Z) • BSIefficacy analyses (who trained at least twice a week): • - RES: 0.3% (95% CI: -1.0 to 1.6) • - BAL: 0.1% (-1.2 to 1.5) groups • - COMB: 1.3% (0.0 to 2.7) compared with the CON group

17. Meta-analyses of exercise effect • High-impact exercise effect:(Wallace & Cumming 2000, CTI, 67:10-18, A systematic review) • Lumbar spine BMD: 1.6% in postmenopausal and 1.5 in premenopausal women, exercisers vs. controls • Femoral neck BMD: 1.0% in postmenopausal and 0.9 in premenopausal women, exercisers vs. controls • Strength training effect: (Kelley et al. Am J Phys Med Rehabil 2001;80:65-77.Martyn-St James & Carrol Osteopor Int 2006; 17:1225-1240) • Lumbar spine BMD: 1.3% in postmenopausal, exercisers vs. controls • Femoral neck BMD: 0.9% in postmenopausal , exercisers vs. controls • radius BMD: 2.7% in postmenopausal, exercisers vs. controls

18. Exercise prescription is recommended to help preserve bone health during adulthoodACSM 2004 Kohrt et al. Med Sci Sports Exerc 2004

19. Summary • high-impact training is beneficial to skeleton in young girls, pre- and postmenopausal women • high-impact exercise can be recommended as a “Bone Exercise” for young girls, pre- and postmenopausal women

20. Luustoon vaikuttavan liikunnan ominaisuudet • Liikunta vaikuttaa vain kuormitettuihin luihin • Impakti (isku)-tyyppinen kuormitus on osoittautunut tehokkaimmaksi • Liikunnan pitää olla dynaamista ja vaihtelevaa • Liikunnan pitää ylittää “normaali päivittäinen kuormitus” ollakseen vaikuttavaa ...

21. ... • Vaikka impakti-tyyppinen liikunta on tehokasta premenopaussivuosien aikana, iäkkäämmillä henkilöillä se voi olla liian rajua. • Voimaharjoittelu iäkkäämmillä on osoittautunut tehokkaaksi ja turvalliseksi • Hyvin iäkkäillä tasapainoa ja liikkumisvarmuutta lisäävä liikunta on myös tärkeää