Exercises for Osteoporosis

Strengthening Exercises for Osteoporosis patients need to be done safely with doctor's permission. Disuse osteoporosis can be minimized by the regular use of isometric or isotonic exercises.

Disuse Osteoporosis

It has been well documented in the literature that bed restmicrogravityimmobility, and a lack of muscle activity can significantly reduce bone mineral density. Accelerated bone loss of tibia, for example, is found in the subjects on prolonged bed rest, and their losses of bone mineral density are similar to those seen in persons treated with chronic corticosteroids or who have osteoporosis that is due to menopause. Non-weight bearing over several weeks can cause a significant trabecular and endosteal (and later cortical) mineral bone loss in the tibia, which requires 1 to 1.5 years to return to baseline level with normal activity. Bone mass begins to decline in the fourth and fifth decades of life, occurring most rapidly in women in the first 5 to 7 years after menopause, and the addition of inactivity and non-weight bearing definitely aggravates bone mineral loss.

After spinal cord injury, a mismatch also occurs between bone growth and bone loss. Soon after initial injury, osteoblastic activity diminishes, and a rapid loss of bone occurs, resulting in severe osteopenia in the paralyzed region of the body. Even relatively minor muscle dysfunction can result in bone loss regionally. Persons with rotator cuff ruptures have been shown to have significantly decreased bone mineral density as compared with controls and with bone density proportional to the remaining shoulder function. Immobilization of forearms and wrists for a period of almost 5 weeks resulted in significant loss of bone mineral density in both men and women, which was not ameliorated after almost 5 weeks of remobilization and hand therapy.

In a study of stroke patients with paralysis and immobility, the serum and urine indices of bone resorption did not decline with time from onset of stroke but rather actually continued during the period of immobility. This suggests that osteopenia resulting from combined immobility and paralysis is not self-limiting and that immobility is an important factor in osteopenia in such patients. Immobilization osteopenia is also a risk factor for hip fracture, especially in elderly patients.

Osteopenia that is due to immobilization is characterized by a loss of calcium and hydroxyproline from the cancellous portion of long bone, epiphyses, metaphyses, and cortical bone near the marrow cavity. To what degree an increase in bone resorption plays a part in the process of disuse osteoporosis needs further research. However, during 12 weeks of bed rest, it has been found that bone resorption and osteoclastic activity became a later factor in the bone mineral loss because of immobility. These ill effects of immobility can be minimized by exercises for osteoporosis.

Exercises for Osteoporosis

  • The importance of exercise in overcoming inactivity-induced osteopenia should not be overlooked. Disuse osteoporosis can be minimized by the regular use of isometric or isotonic exercises.
  • Ambulation, or at least standing on a tilt table or in a standing frame, may retard the loss of calcium. Bourrin and associates studied the effect of controlled exercise on rats immobilized by tail suspension.
  • In all the rats thus treated, there were significant decreases in bone density and bone formation. Abnormalities were especially seen in trabecular bone.
  • Animals who received specific limb exercise in addition to normal remobilization not only recovered bone mass parameters but also had improvement in the trabecular patterns; nonexercised animals had persisting trabecular alterations.
  • In patient groups at highest risk for significant osteopenia those either with paralysis or with hormonally based osteoporosis care should be taken when exercising to prevent fracture.
  • Despite this risk of pathologic fracture, weight-bearing exercise is particularly important to these groups to prevent progression of bone loss. Additionally, in the elderly, exercise targeted at strengthening limb-girdle muscles and lessening the chance of falls is an important adjunct.

Principle and Framework of Exercises for Osteoporosis

  • Understand and recognize immobility and the lack of loading as a risk factor either by itself or in combination with other factors.
  • Understand the musculoskeletal adaptability to weight bearingmuscle contraction, and mechanical loading in the development of disuse osteopenia.
  • Understand the value of remobilization, weight bearing, and physical activity, including resistance exercises, in prevention and treatment.

Resistance Exercises for osteoporosis

There is great deal of evidence that resistive exercise can increase bone mass. Studies have demonstrated that there is a significant correlation between muscle strength and bone mineral density. For example, the strength of paraspinal muscles correlates with mineral density of the lumbar spine. Reduced back extensor muscle strength is associated with a higher incidence of vertebral fractures, thus suggesting that immobility plays an important role in development of osteoporosis in women. Low mineral density of the spine can be improved with back extensor exercises.

Typical Prescription

  • Progressive resistive strengthening exercise training for back extensors, hip extensors and abductors, and shoulder girdle muscles
  • Posture training and ambulation
  • Avoidance of flexion exercise of lumbar spine or high-impact exercises (e.g., jogging, step aerobics), especially when vertebral fractures or advanced osteoporosis are suspected.

Exercises for osteoporosis (Video Series)

Hold onto a chair with your weight on both feet, lift one heel and drop it down on the floor as demonstrated by a fitness instructor in this free video on exercise.

When doing postural exercises for someone with osteoporosis it's important to use resistance training to help get those bones stronger. Increase bone mass and strength with tips from a certified personal fitness trainer in this free video postural exercises for people with osteoporosis.

Expert physio guidance for how to safely exercise to improve your hip bone density as you protect your pelvic floor. Ideal for most women with osteoporosis or decreased bone density who are seeking to exercise, use weights safely and protect their pelvic floor. This video is also ideal for women who have previous pelvic surgery.

Step-by-step guidance for safe effective spine strengthening exercises and posture retraining. Ideal for women with low to moderate (T score above -2.5) risk of spinal fracture due to osteoporosis. These exercises for osteoporosis require very little equipment and can be performed in the comfort of your own home. Women with T score lower than -2.5 with high fracture risk require medical approval prior to commencing these and any strength exercises.

Further reading

  • Osteoporosis Exercise. WebMD
  • Exercise for Strong Bones. National Osteoporosis Foundation
  • Osteoporosis & Musculoskeletal Disorders. International Osteoporosis Foundation
  • Osteoporosis - Prevention. NHS.UK
  • Exercise for Your Bone Health. The NIH Osteoporosis and Related Bone Diseases
  • Bonaiuti D, Shea B, Iovine R. Exercise for preventing and treating osteoporosis in postmenopausal women. Cochrane Database Syst Rev. 2002;(3):CD000333.
  • S J Birge and G Dalsky. The role of exercise in preventing osteoporosis. Public Health Rep. 1989 Sep-Oct; 104(Suppl): 54–58.
  • Bourrin S, Palle S, Genty C, Alexandre C. Physical exercise during remobilization restores a normal bone trabecular network after tail suspension-induced osteopenia in young rats. J Bone Miner Res. 1995 May;10(5):820-8.

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