The Use of Resistance Training in the 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 bone fragility 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 injury

In 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 Factors

Inherited Factors Environmental FactorsCaucasian or Asian FemaleOsteoporotic fracture in the first degree relativeHeight <170cmWeight < 58kg

Below normal weightLoss of menstrual function Low calcium or vitamin D intakeInactivityProlonged corticosteroid useSmokingExcessive alcohol intakeCaffeine 4

Risk Factors

The risk of osteoporosis increases with ageAbout 3.4% of Australians have osteoporosis. More than eight out of 10 of these people are females and most 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.

Bone Density Scanner

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Signs and SymptomsPeak 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

Fractures are often the first sign of osteoporosis and by this time an

individual may have lost up to 30% of their peak bone mass.

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 related declines in bone health by maintaining or increasing bone mineral density.

Table 1. Resistance Training Program

Intensity Frequency Duration Progression Goals Special Considerations

15 reps of 8-10 exercises (may require less strenuous program initially)

2 days per week (reference) Could be progressed to 3 days per week

1 or 2 sets up to 30-60 mins

Add a set after initial 2 weeks

3 – 4 days per week at 10-12 reps per set

•Avoid spinal flexion•Use slow and controlled movements•Target legs and back

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Resistance Training Exercises

Exercises including Thero bands, steps, soup tins and raising from a chair may increase the compliance to exercise for individuals as they are easy to administer, cost effective and can be done in the privacy of one’s own home being ideal for those who are self-conscious and lack confidence to exercise in 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.

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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, however particular measures need to be taken by those who have inherited and environmental risk factors. Resistance training is a suitable method for both the prevention and treatment of osteoporosis and should become a part of a daily lifestyle. A combination of aerobic exercise and a healthy diet should be incorporated into everyday life in order to minimise 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/

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Australia, 2004–05, cat. no. 4364.0, ABS, Canberra. (Figure 1)6. Osteoporosis Australia, 06 July 2011; Available from:http://www.osteoporosis.org.au

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