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Don Ostdiek, DPT Osteoporosis is known as the “silent killer” because often times the patient doesn’t show symptoms until they have suffered posture changes or fractures. With the recent onset of tests, patients and doctors are better able to detect early signs of osteoporosis and osteopenia. Also, much research has been directed at maintaining bone mass and even increasing bone mass in post-menopausal women. Exercise has been proven over and over to improve bone mass. Unfortunately, most individuals are unaware of the proper forms and durations of exercise. The intent of this presentation is to provide information for a general exercise program to improve bone mass loss. It should be understood that no program can be specific to meets every individuals need, however, the exercises should prove beneficial to the majority of us. Bone is a changing, living tissue. It is in a constant state of breaking down and remodeling. Bones tend to be at their strongest at age 25. By around age 40, bone mass begins to decline slowly. After menopause, women lose bone mass because of a drop in estrogen level. An early sign of osteoporosis is called osteopenia. Osteopenia is detected by the studies that measure bone mass with measurements that are lower than normal but not low enough to be diagnosed as osteoporosis. Bones that have less mass are more likely to break or fracture, even in a minor fall. Early detection and treatment is important to prevent fractures. Those at risk include:
This program will focus on exercise. There are many resources that focus on the other risk factors and they are listed at the end of the hand-out. Exercise groups will be divided into those with osteoporosis/osteopenia and those without. Whether you have been diagnosed with osteoporosis or not, exercises or physical activity that place weight on your bones or increase the force of gravity against them can help you maintain bone mass. These activities include dancing, cross-country skiing, stair climbing, tennis and walking. Exercise also helps you move more easily and keeps your balance decreasing your risk of falls. If you do not have osteoporosis and want to gain the benefits of exercise, do some type of weight-bearing exercise for 30 minutes most days of the week. You can exercise 10-15 minutes at a time if you have trouble doing it all at once. You should check with your physician before beginning an exercise program if you have been inactive or have heart disease, high blood pressure, stroke; high cholesterol or a family history of heart disease; pain or pressure in the chest, neck, shoulder or arm after exercising; dizziness or extreme shortness of breath after mild exertion. Exercise builds bone mass more readily in younger women, particularly those who have not reached peak bone mass. Nevertheless, even post-menopausal women may be able to build bone mass by exercising regularly. We found that the sooner after menopause you begin, the more beneficial the exercise. The best exercises are those that work the muscles harder than they would work normally. Activities such as weight lifting, walking, dancing, stair climbing, step aerobics, jogging, hiking, and tennis are all effective at building bone. Study after study has shown that weight training may be the best exercise for increasing bone density. The increase is directly proportional to the amount of stress applied. We recommend that you start with weights that are 50% of your repetition maximum and increase weights by 10% every 2 weeks. Before each session, warm up with a few stretches. You may also want to increase your heart rate by walking or jogging in place for a few minutes. We recommend two sets of 8-12 repetitions, separated by one minute rest periods. If you are at high risk for osteoporosis, you should not do typical abdominal strengthening because it causes too much flexion force on the spinal column. Lumbar stabilization is better and safer. For the first month or two, try to plan four sessions a week of muscle strengthening exercises to keep your muscles conditioned and help protect your bones. Thereafter three sessions per week will suffice. Free weight such as barbells and dumbbells, may be convenient because you can use them at home, but they can increase the risk of injury. Free weights should never be used by women who have osteopenia or osteoporosis without strict supervision and instruction. For those diagnosed with osteoporosis, a physical therapist can custom-design a safe and effective exercise program to meet your needs, whatever your age or physical condition. While regular exercise is essential in the treatment of osteoporosis, caution must be used to avoid fractures. Calisthenics which curve the spine forward, such as sit-ups, curl-ups and toe touches, should be avoided. Also, the following exercise machines should be avoided: abdominal exercises, bicep-curl machines, cross country ski machines, rowing machines, stationary bicycles with moving handlebars, and any other machine that involves trunk rotation or forward bending. These devices can cause vertebral fractures in people with significant osteoporosis. Sports that twist the spine, such as tennis, golf and bowling should also be avoided if you are at high risk for a fracture. Walking regularly is highly recommended; it is weight bearing and not likely to harm the bony structure. For the best results, walking must be done regularly. Start out by making a commitment to yourself that you will stick with a program for 4-6 weeks. Begin by walking at whatever pace and distance your body will tolerate. Gradually work up to 30 to 45 minutes of brisk walking at least 4 times a week. You don’t have to walk 30 minutes at a time, 10 minutes here and 10 minutes there is fine, but it has to be at least 10 minutes at any one time to benefit. Swimming is not considered good exercise for osteoporosis because it is not weight bearing. Walking in the water is encouraged if you are not strong enough to tolerate land walking. After water exercises and walking in the water, you may be able to progress to walking and exercises out of the water. Enclosed in the folder is a booklet with eight exercises for individuals that have been diagnosed with osteoporosis. Resources:
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