The Use of Resistance Training in the Prevention and Treatment of Osteoporosis in the Elderly.
The Use of Resistance Training inthe Prevention and Treatment of Osteoporosis in the Elderly Alicia Jackson
Outline• What is osteoporosis?• What causes it?• Who is affected and at risk?• How is it diagnosed?• What are the signs and symptoms?• What are prevention and treatment methods?• How does resistant training have a positive impact?• What do we need to consider when advising resistance training?• Conclusion
What is Osteoporosis?Osteoporosis is the decrease in bone density that enhances bonefragility and increases the risk of fractures and falls in the elderly• Type 1: Related to vertebrae and distal radius fractures effecting women 8x more than men.• Type 2: found in 70 year old and above: hip pelvic and distal humerous fractures - 2 x more common in women than men. 1 The difference between a normal and osteoporotic bone 2
Possible Causes• Inadequate physical activity - decrease in bone mineral density• Diet• Previous chronic disease or injuryIn the hormone-related condition:• Hyperthyroidism: low blood level of thyroid stimulating hormone• Diabetes mellitus• Particular gene LRP5: may play a role inhibiting release of serotonin by cells of the gut. Because Serotonin inhibits osteoblast growth, reducing serotonin synthesis, increases bone density. 3
Risk FactorsInherited Factors Environmental FactorsCaucasian or Asian Below normal weightFemale Loss of menstrual functionOsteoporotic fracture in the first degree relative Low calcium or vitamin D intakeHeight <170cm InactivityWeight < 58kg Prolonged corticosteroid use Smoking Excessive alcohol intake Caffeine 4
Risk FactorsThe risk of osteoporosis increases with ageAbout 3.4% of Australians have osteoporosis. More than eight out of 10 of these people are females andmost are aged 55 years and over (Figure 1). 5
Diagnosis• GP will conduct an assessment of the risk factors• A bone density test Dual-energy X-ray Absorptiometry; (DXA) will be performed. 6 7 Bone Density Scanner
Signs and Symptoms Peak bone mass: the highest amount of bone mass achieved in life. Maximal bone mass: the highest bone mass that could be possible achieved through life – this is effected by genetics and also physical activity, dietary intake and hormone regulation. 4
Prevention• Regular participation in physical activity, including resistance exercise• Healthy diet• Quit smoking• Decrease alcohol consumption• Increasing your exposure to limited sunlight• Falls prevention measures (as falls can lead to fractures) Calcium Vitamin D Exercise Prevention measures for osteoporosis
Treatment• Medication to stop further bone loss and prevent fractures. Types of medication include: – Bisphosphonates – Strontium Ranelat – Monoclonal Antibodies (denosumab)
Treatment (cont.)• Hormone Replacement Therapy.• Selective Estrogens Receptor Modulator (SERMS)• Calcium and Vitamin D supplements• Drinking fluoridated water
Resistance Training (Used for Prevention and Treatment)Regularly performed resistance training can offset the age relateddeclines in bone health by maintaining or increasing bonemineral density.Table 1. Resistance Training Program Intensity Frequency Duration Progression Goals Special Considerations15 reps of 8-10 2 days per week 1 or 2 sets up to Add a set after 3 – 4 days per •Avoid spinalexercises (may (reference) 30-60 mins initial 2 weeks week at 10-12 flexionrequire less Could be reps per set •Use slow andstrenuous progressed to 3 controlledprogram initially) days per week movements •Target legs and back 4
Resistance Training ExercisesExercises including Thero bands, steps, soup tins and raising from a chairmay increase the compliance to exercise for individuals as they are easy toadminister, cost effective and can be done in the privacy of one’s own homebeing ideal for those who are self-conscious and lack confidence to exercisein public (at a gym).
Recommendations• A pre-exercise evaluation should be completed just before beginning resistance training program. (In particular for elderly participants)• Resistance exercise should focus on all areas of the body.• Exercise intensity should be decreased initially.• Progression to cause positive adaptations• High velocity and power can be incorporated.• Aim for an increase in daily physical activity levels.8
Safety considerations• Warm up & down.• Allow 48-72hrs recovery between sessions• Lessen the likelihood of overtraining• A range a motion for each exercise that is pain free.• Ensure they have had advice from medical staff and quality supervision by an instructor or medical professional. 9
ConclusionOsteoporosis is a concern for all in terms of prevention, howeverparticular measures need to be taken by those who have inherited andenvironmental risk factors. Resistance training is a suitable method forboth the prevention and treatment of osteoporosis and shouldbecome a part of a daily lifestyle. A combination of aerobic exerciseand a healthy diet should be incorporated into everyday life in order tominimise the risk of other chronic diseases as well.For further information:• Osteoporosis Australia http://www.osteoporosis.org.au/• Wolrd Health Organisation http://www.who.int/chp/topics/Osteoporosis.pdf• Australian Bureau of Statistics http://www.abs.gov.au/
References1. Marieb, E.N. and K. Hoehn, Human anatomy & physiology, 2007: Pearson Education.2. Image – Bone Density 246 × 163 (Same size1.3x larger), 32KB. Normal and Osteoporotic bone. http://www.parathyroid.com/osteoporosis.htm3. Baechle, T.R. and R.W. Earle, Essentials of strength training and conditioning, 2008: Human Kinetics Publishers.4. Ehrman, J.K., Clinical exercise physiology, 2009: Human Kinetics Publishers.5. Australian Bureau of Statistics 2006c, National Health Survey: Summary of Results, Australia, 2004–05, cat. no. 4364.0, ABS, Canberra. (Figure 1)6. Osteoporosis Australia, 06 July 2011; Available from:http://www.osteoporosis.org.au/about/about- osteoporosis/what-is-osteoporosis/.7. Image – 428 × 320 (Same sizex larger), 28KB Dexa Scan http://www.nutritiongurus.com.au/your-body- composition8. Australian Institute of Health and Welfare 2005, Arthritis and musculoskeletal conditions in Australia, 2005, AIHW Cat. No. PHE67, AIHW, Canberra.9. Mazzeo R.S.; Tanaka H. Exercise Prescription for the Elderly: Current Recommendations, Sports Medicine, Volume 31, Number 11, 1 November 2001 , pp. 809-818(10)10. Pollock, M.L., et al., American Heart Association. Circulation, 2000. 101(7): p. 828.11. Layne, J.E. and M.E. Nelson, The effects of progressive resistance training on bone density: a review. Medicine & science in sports & exercise, 1999. 31(1): p. 25.