In Parts 1 & 2  I have introduced you to the definition of and issues surrounding osteporosis. We have begun to look in some depth at and how to train to prevent or offset its effects. Here I conclude by looking in more detail at aspects of training, results of studies and nutrition.  

Progression

Progressive increases in load stimulate increases in muscle and bone strength.

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For example:

Using 5 resistance exercises – hip extension, knee extension, lateral pull-down, back extension and abdominal flexion (3 sets of 8 repetitions at 80% 1RM)- twice per week for 1 year, studies reported femoral neck bone mineralization density increases of +1% versus controls –2.5%.

Lumbar spine increases were similar with +1% in the exercise group versus –1.8% in controls.

This study increased the load at each training session as tolerated for each muscle group³.

Research on the relationship between exercise and bone health

Current research suggests that effective routines must be site specific, high load and/or high impact, progressive, and provide adequate recovery time between challenging exercise sessions.

Research also shows that exercise improves bone health and lowers fracture risk in ways not measurable by bone scan³

Strength training and balance

In initial strength training sessions, the fitness professional should focus on teaching form and technique so that the client feels competent and safe practicing the routine.

Where to start

Begin with as few as 4 strength exercises using 5–6 repetitions with a light load, including a squat variation, a press, a pull, and an abdominal exercise. Balance exercises should also be included as they lessen the fear and danger of falling.

Clients can practice a brief strength and balance routine 2–3 times a week, adding 1–2 repetitions per session until they can complete 2 sets of 8 repetitions.

To increase fitness level

Rather than adding more sets or repetitions, the client increases the load in small increments as tolerated by each muscle group.

When a short routine is mastered, gradually add more exercises until the patient is practicing a full routine.

Contraindications

Being an active older athlete, progressive resistance training is a good strategy to prevent osteoporosis.

However, there are safety concerns especially in the beginning of a resistance program for an osteoporotic patient.

Some contraindications are avoiding exercises of high impact such as bounding, pylometric jumping, depth jumps of up to 16-21 inches. These exercises can increase chances for falls, and excessive loading to the spine.

Exercises should be done with proper form and posture and should be done in an upright position (ideally sitting or standing).

osteoporosis treatment_7Always get medical clearance from your primary care physician before starting a resistance program.

The beginning fitness client should always seek the advice from a certified strength and conditioning/fitness expert before attempting a new exercise program.

Nutrition

Medications for osteoporosis for a physically fit older adult may not be necessary if they are engaging in daily activity/sports. However the client may have other co morbidities and may be on medications to control some of these existing disease processes.

A medical examination should be done before administering any resistant training program.

The senior athlete should be taking vitamin and mineral supplementation to help control the development of osteoporosis. The micronutrients of calcium and vitamin D are very important.

There are 2 forms of calcium supplementation: calcium citrate and calcium carbonate. Calcium citrate can be more easily absorbed than Calcium carbonate.

Studies show that an adequate intake of 1,000-1,300 mg per day is appropriate for elderly people (mostly women) to take. Those elderly women (postmenopausal) that have shown signs of osteoporosis through bone scans would benefit from taking at least 1,500 mg of calcium per day.

All recommendations should be checked by a licensed Dietician before suppliementation².

Calcium and vitamin D supplementation can increase bone mineral density, prevent bone loss and decrease bone turnover².

The combination of calcium, vitamin D, resistance training has been shown in studies to induce more bone density mass than either by themselves1,3,5.

For the physically fit mature athlete

By using exercise to improve bone strength reverts back to the basics of training for muscle strength for senior athletes³.

High-load routines that stimulate muscle development in the hips, spine, and extremities build bone strength in  vulnerable areas.

If form is excellent, the routine will be safe for all except those with severe osteoporosis³.

A well designed strength-training program of adequate intensity will dramatically lower lifetime fracture risk, even without measurable increases in bone mineralization density.

When it comes to bones, reduced fracture risk is the desired result³.

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References:

1. Petranick, Kimberly and Berg, Kris; The effects of Weight Training on Bone Density of Premenopausal, Postmenopausal, and Elderly Women: A Review, The Journal of Strength and Conditioning Research, 1997, 11(3), 200-208

2. Nguyen, VuH MeD, Loethen Joanne, Lafontaine Tom; Resistance Training and Dietary Supplementation for Persons with Reduced Bone Mineral Density, Strength and Conditioning Journal, Vol. 30, number 5, October 2008

3. Mansfield M. Elaine; Designing Exercise Programs to Lower Fracture Risk in Mature Women  Strength & Conditioning Journal, Vol. 28, Number 1, February 2006, pages 24-29

4. Wolff, I. J, Van Croonenborg, H, Kemper, P Kostense, and J. Twisk; The effects of exercise training programs on bone mass; Osteoporosis International, 9: 1-12 1999

5. Dickey, Christa; Strength Training Increases Bone Mineral Density in Postmenopausal Women; American College of Sports Medicine; January 14, 2003 accessed on 10/09/2009

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