13. Osteoporosis and exercise Flashcards
what is “too fit to fracture”?
- program with exercise and PA individuals for recommendations for individuals with osteoporosis with and without vertebral fracture
- establish research priorities, collaborations and plans fo action
- knowledge translation!
what are the 6 steps for screening and assessment for exercise with patients with osteoporosis?
- Medical history, comorbidities, exercise contraindications
- 10 year Fracture risk:FRAX or CAROC, or assessment of risk factors
- Fall risk –> red flag if: acute fall, ≥2 falls in past 12 months, gait/balance difficulties
- Physical performance:ability, impairment or pain during movements
- Standing posture:look for hyperkyphosis (forward curvature of spine), hyper- or hypolordosis (curve of lower spine)
- Barriers and facilitators to physical activity,e.g.,current physical activity, self-efficacy, time, access, preferences
what are 3 therapeutic goals of the too fit to fracture program?
1) fall prevention = main one!
- improve dynamic balance, mobility, muscle strength/power, and posture
2) safe movement or spine sparing strategies:
- attention to posture during movement to protect the spine
- train back extensor muscles to improve endurance
- stretch muscles restricting optimal posture
*focus on how to move safely!
3) prevention of further bone loss:(slow down age-related loss)
- exercise may not have a certain effect on bone mineral density
- muscle strengthening and weight-bearing/impact exercise
what are the 3 general PA recommendations for older adults with osteoporosis or osteoporotic vertebral fracture?
- We strongly recommend that individuals with osteoporosis engage in a MULTICOMPONENT exercise program that includes RESISTANCE training in combination with BALANCE training.
- We recommend that individuals with osteoporosis do NOT engage in aerobic training to the exclusion of resistance or balance training. (ie prioritize RT and balance training)
- Consultation with an exercise professional is recommended for older adults with vertebral fracture to ensure safe and appropriate exercise
what are the 5 recommendations for exercise and PA for patients with osteoporosis?
1) Resistance training ≥ 2x/week
2) Balance training daily
3) Exercises for back extensor muscles daily
4) ≥30 minutes/day aerobic physical activity (ideally weight-bearing)
5) Spine sparing strategies like hip hinge and step-to-turn can decrease spine loads –> how to move, rather than how not to move
Osteoporosis and exercise: RESISTANCE TRAINING
- how many times per week?
- examples of exercises?
- at least 2 days/week –> muscles working against a resistance (weights, bands, body weight)
ie: - Squats or lunges - legs and buttock muscles
- Heel raises - lower legs
- Counter/wall pushups – chest, triceps
- Bow & arrow “pulls” or seated rows - upper back, biceps
- Diagonal shoulder raises or upright rows - shoulders and upper back
Osteoporosis and exercise: BALANCE TRAINING
- define
- frequency?
- intensity?
- type?
- time?
4 types ish
- “the efficient transfer of body weight from one part of the body to another or challenges specific aspects of the balance systems (e.g., vestibular systems)”
F: train your balance daily!
I: should be challenging! >5sec but <30sec
T: can be done in one place (static) or moving around (dynamic)
T: aim to accumulate 2h of balance training weekly (15-20min per day)
- reduce base of support (stand with feet together, or 1 leg, or heels, or toes)
- shift your weight (move weight from 1 foot to another, lean side to side)
- respond to things that upset your balance (ie catch a ball)
- do activities that require coordination or shifting weight while moving around (dance, tai chi, tightrope walk)
Osteoporosis and exercise: endurance training for back extensor muscles
- how? (3)
- what about for individuals with history of vertebral fracture or high risk of fracture?
- examples of exercises?
- Start by paying attention to posture during daily activities
- Lying on back to “unload” the spine, a few minutes daily promotes extension of the spine and stretches front shoulders and chest
- Consult Bone Fit-trained instructor to learn exercises, e.g., supine presses/holds, core activation in standing
- Might need a pillow under head if spine is curved
- Should consult with a trained physiotherapist or kinesiologist before initiating back extensor exercises
- arm lengthener or press, chest lift, sash, leg lengthener
- shavasana!
Osteoporosis and exercise:
AEROBIC PA
- recommendation?
- move every ____min
- emphasis on what?
- those with vertebral fracture should aim for what intensity?
- > =150min of mod to vigorous PA a week or >= 30min/day
- move every 30min!
- weight-bearing aerobic PA, like walking or dancing
- should aim for mod intensity only! (RPE 5-6)
Osteoporosis and exercise: POSTURE TRAINING
- ___-____min/day
- attention to _________ > __________
- start with _______ and WHAT?
- progress to what?
*what are characteristics of bad vs good posture?
- 5-10min/day
- alignment > intensity
- start with “Shavasana” and looking at posture in mirror!
- progress to active exercises to improve back extensor endurance based on advice of a trained professional
BAD:
- forward head posture
- rounded shoulders and middle back
- slumped lower back
GOOD:
- balance weight on both feet, keep gaze straight, gently draw belly in, lift chest, straight line through ear, shoulder, hip and foot…
what is spine sparing?
how?
- Recommend that patients modify activities that apply rapid, repetitive, weighted or end-range flexion (forward bending) or twisting torque to the spine –> ie don’t do those movements
INSTEAD: - Hip hinge (ie bend at hips, not at spine, keep back straight)
- Step-to-turn
- Avoid lifting from or lowering to the floor
- Slow, controlled twist, not to end of range of motion
- Support trunk when flexing
- Hold weight close to body, not overhead (ie no tricep extensions)
what are the recommendations from Canadian PA guidelines for older adults? (24h guide)
VS too fit to fracture recs for individuals with osteoporosis NO vertebral fracture VS vertebral fracture
- 150min>wk of mode to vig aerobic PA
- muscle strengthening at least twice a week
- PA that challenge balance
- several hours of light PA, including standing
- 7-8h of good quality sleep
- limit sedentary time to 8h or less
- no more than 3h of recreational screen time
NO VERTEBRAL FRACTURE
- RT, 2x/wk, 8-12 reps per set
- balance exercises daily
- 150min/wk mod-vig intensity (5-8 RPE) aerobic PA in bouts of >=10min
* exercises to improve endurance in back extensor muscles, 5-10min/day
*spine-sparing strategies
WITH VERTEBRAL FRACTURE
- same, but only mod intensity (5-6 RPE)
- consider alignment > intensity, consulting bonefit trained instructor
- spine loads: lying on back < standing < sitting (worst for spine)
