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Osteoporosis Prevention & Resistance Training Strategies

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  1. Chapter 4 Resistance-Training Strategies for Individuals with Osteoporosis

  2. Osteoporosis Overview • Also known as brittle bone disease • Means “porous bone” • Erodes bone tissue until it becomes fragile and breaks

  3. Osteoporosis Overview • Osteopenia • Low bone density • Precursor to osteoporosis • Resistance training helps prevent

  4. Prevalence of Osteoporosis • Affects approximately 10 million Americans over age 50 • Approximately 34 million Americans have osteopenia • Annual fracture rates from weak bones affect 1.5 million Americans

  5. Prevalence of Osteoporosis • By 2020, half of all Americans age 50 or more will have osteopenia and/or osteoporosis unless prevention measures implemented • Predominantly affects small-framed Caucasian and Asian women

  6. Prevalence of Osteoporosis • Non-Hispanic black women and Mexican-American women at lower risk • Fracture risk for women: • Age 50 = 9.8 percent • Age 80 = 21.7 percent • Wrist, hip, and spine • Common fracture sites

  7. Economic Impact of Osteoporosis • Up to $20,000 per incident for treatment and rehabilitation for fractures • Approximately $80,000 per incident for lifetime care from one hip fracture • More than $17 billion annually to care for bone fractures

  8. Bone Modeling • Defined as bone shape growth and alterations • Occurs during puberty and young adulthood • Peak bone mineral density occurs around age 20

  9. Bone Remodeling • Maintains bone mineral density, structural integrity, or strength of bone area • Well-balanced across genders during 20s and 30s

  10. Remodeling Occurs via Two Processes • Resorption • Osteoclasts dissolve bone mineral • Deposition • Osteoblasts rebuild bone

  11. Menopause and Osteoporosis • Women entering perimenopause lose one percent bone annually • Lack of estrogen production causes rapid bone loss for five or more years • Resorption rate exceeds deposition rate • Resulting in less dense bone

  12. “Swiss Cheese” Appearanceof Osteoporosis

  13. Cortical (Compact) Bone • Comprises 80 percent of skeleton • 90 percent more dense than trabecular bone • Apparent density = 1.8 g/cm3 • Grams per cubic centimeter • Comprises more than 90 percent of diaphyseal shaft of long bone

  14. Trabecular Bone • Also known as cancellous and spongiosa bone • Comprises 20 percent of skeleton • Apparent density = 0.2 g/cm3 • Comprises approximately 70 percent of spine

  15. Trabecular Bone • Bone loss causes loss of stature, hunch back, forward position of head, thoracic kyphosis, and rounded shoulders

  16. Comparison of Corticaland Trabecular Bone

  17. Bone Loss Ratios • Ratio of cortical to trabecular bone varies within specific bones: • Trochanteric region of hip = 50:50 • Proximal femur of hip = 57:43 • Gender affects bone loss • Women lose 50 percent of trabecular bone • Men lose 20 percent of trabecular bone

  18. World Health Organization (WHO) Bone Mineral Density Classification System • Normal • Bone mineral density (BMD) within 1 standard deviation (SD) of young adult mean • 1 SD • Osteopenia • BMD 1 to 2.5 SD below young adult mean • -1 to -2.5 SD

  19. World Health Organization (WHO) Bone Mineral Density Classification System • Osteoporosis • BMD 2.5 SD or more below young adult mean • > -2.5 SD • Severe osteoporosis • BMD > 2.5 SD below young adult mean and plus fractures

  20. Primary Osteoporosis • Marked acceleration of bone mass loss • Three types include: • Postmenopausal • Type I • Senile • Type II • Idiopathic osteoporosis • Unknown cause of origin

  21. Secondary Osteoporosis • Consequential condition • Results from another disease process and/or its treatment • E.g., corticosteroid treatment for asthma, rheumatoid arthritis

  22. Benefits of Resistance Training • Focuses only on skeletal benefits • Assists in maintaining bone mass and affects bone morphology • Enables skeleton to resist fracture-causing loads

  23. Benefits of Resistance Training • Improves muscular fitness • Helping prevent and/or improve spine deformity • Reduces risk of falls and related injuries • Helps individuals functioning optimally in daily life

  24. Osteoporosis Prevention • Start in puberty by getting: • Adequate intake of calcium • Vitamin D-rich foods • Judicious sun exposure • Daily weight-bearing physical activity

  25. Benefits of Strain on Bone Tissue • Bone mass maintenance • Bone formation • Morphology changes that improve strength • Increases in cross-sectional size of bone and thickness of cortical bone • Biochemical signals that influence bone cell function and keep osteocytes vital

  26. Strain Needs to be in Right Amount • Multiple strain repetitions unnecessary for bone modeling or maintenance • Strain magnitude and rates must be higher than normal to signal bone production • Inadequate strain or inactivity causes bone loss

  27. Strain Needs to be in Right Amount • Too much strain causes fractures • Approximately 3000  • Strain between 700 to 1500  maintains bone mass

  28. Building New Bone • Strain needs to be between 1500 and 3000  • High-impact exercise provides enough strain rate and magnitude • E.g., weight bearing activity, resistance training, impact activities (one- or two-footed jumping)

  29. Building New Bone • High-impact exercise must be maintained for long-term • Or bone loss will result

  30. Research Supports Resistance Training • Regular, progressive resistive exercise increases bone density at hip and spine by 0.5 percent to 3 percent • Benefits both young and postmenopausal women • Needs to occur two to four times per week

  31. Research Challenges • Men often not adequately studied • Difficult to separate impact of multiple therapies • Terms such as strength training, weight-bearing, weighted exercise, resistive training used interchangeably

  32. Research Challenges • Subjects often have osteopenia, osteoporosis, and no/low risk of low bone density • Currently, no studies conclude that resistance training prevents fractures

  33. Regular Resistance Training Program • Improves and maintains overall muscular strength and bone health of older adults • Benefits physical functioning and mobility • Positively impacts negative sequelae • Accompanies aging

  34. Regular Resistance Training Program • Main goals: • Improve strength/functioning • Reduce risk of falls/vertebral fractures

  35. Cautions • Consider overall health status • Understand that resistance training may exacerbate existing medical problems, increase muscle/joint injuries, induce heart attack (rare)

  36. Cautions • Understand condition • Some exercises indicated for osteopenia contraindicated for osteoporosis • Involve physician • Understand severity of disease

  37. Program Design Considerations • Trainer must understand bone loading, unloading, and overloading principles • As well as accompanying risks • Modify general resistance training guidelines to manage specific medical issues related to varying severities of disease • Refer to Chapter 3

  38. Program Design Considerations • Programs designed to prevent osteoporosis will be more aggressive/have more training options

  39. To Prevent or Improve Spine Deformity • Focus on strengthening abdominal, neck, erector spinae, scapular, and gluteal muscles • Include exercises that stretch anterior body structures • Include spinal extension exercises • Remain alert to signs training too aggressive for individual

  40. Strength Testing Considerations • Obtain physician clearance • Ensure safe environment • Perform all testing in upright posture • Use 10 RM testing for strength assessment

  41. Strength Testing Considerations • Perform maximal isometric muscle strength assessment if not contraindicated • Hypertension • Perform falls risk assessment • Perform cardiopulmonary exercise test if suspect patient at risk for heart disease

  42. Strength Testing Considerations • Be aware of contraindicated tests • E.g., spinal flexion, sit-and-reach, 1 RM strength assessment • Have standard emergency medical procedures in place

  43. Program Components and Exercise Selection • Perform all exercises with slow, controlled movements • Perform flexibility exercises almost daily • Precede all activity with five- to 10-minute warm-up on upright cycle • Without load

  44. Program Components and Exercise Selection • Conclude activity with 10- to 20-minute cooldown stretching • Follow ACSM guidelines for progression with special considerations for osteoporotic older adult

  45. Program Components and Exercise Selection • Perform assessments of physical performance measures at baseline and 12-week intervals

  46. Program Overview • Individual should train twice per week with high-force loading • May need to begin with two- to four-week acclimatization period • Progress from 1 to 2 sets of 8 repetitions at progressive load

  47. Program Overview • Maintain rating of perceived exertion (RPE) of “somewhat hard” to “hard” • Target all major muscle groups • Give extra emphasis on lower body and back extensor strengthening • Review sample 24-Week Program

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