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Chapter 4

Chapter 4. Resistance-Training Strategies for Individuals with Osteoporosis. Osteoporosis Overview. Also known as brittle bone disease Means “porous bone” Erodes bone tissue until it becomes fragile and breaks. Osteoporosis Overview. Osteopenia Low bone density Precursor to osteoporosis

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Chapter 4

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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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