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Kuinka vaalia ikääntyvää luuta? Liikunta. Ari Heinonen Department of Health Science, University of Jyväskylä. 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.
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Kuinka vaalia ikääntyvää luuta?Liikunta Ari Heinonen Department of Health Science, University of Jyväskylä
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
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
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
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.
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
A Multi-Component Exercise Regimen to Prevent Functional Decline and Bone Fragility in Home-Dwelling Elderly Women: Randomized, Controlled Trial
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
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)
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)
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)
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)
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)
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
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
Exercise prescription is recommended to help preserve bone health during adulthoodACSM 2004 Kohrt et al. Med Sci Sports Exerc 2004
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
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 ...
... • 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