L9c: Exercise Prescription for Bone Health Flashcards
When does bone loss start?
Once skeletal maturity is achieved Osteoclasts become more active than osteoblasts
When does bone loss occur due to menopause?
No longer producing oestrogen
What is osteoporosis?
pathological loss of bone mineral density
What are 2 reasons for exercise prescription when optimising bone health in old age?
Non-osteoporotic groups
- Bone loading
Osteoporotic patients
- Preventing falls & fractures
Bone loss is highest particularly several years immediately post-_____
menopause
What are 3 results for bone mineral density scans?
- Normal
- Osteopenia
- Osteoporosis
What are 3 factors that management of bone health depends on?
- Scans of bone mineral density
- Age
- Functional status
What is the aim (in a non-osteoporotic woman)?
Maintain or improve bone mineral density by loading bone
What are the 2 aims (in an osteoporotic older person)?
- Shifts from loading bone
- Preventing falls and improving function
What is Wolff’s Law?
If loading on a particular bone increases, the bone will remodel itself over time to become stronger to resist that sort of loading
Bone will respond to loading with osteogenesis
What is osteogenesis?
the formation of new bone
When are 2 scenarios when osteogenesis is most effective? Why?
- Bone loading is varied Incorporates numerous forces and activities (to which the bone is not normally accustomed)
- Bone responds to novel exercise so movements or loading patterns that are not usual practice
What are 6 of the most common osteoporotic fracture sites?
- Vertebrae
- Pelvis
- Proximal Femur
- Ribs
- Proximal Humerus
- Distal Radius
↑ Habitual loading should promote ↑ bone mass; but ___ and ____ loading is key
novel; varied
Sedentary older adults will benefit from a(n) _____ (increase/decrease/no change) in habitual loading
increase
Any exercise or any increase in loading
Older adults with established exercise regimes will require ‘____’ exercises to stimulate an effect
new
What are the exercise guidelines for osteoporotic patients?
What are 4 effective mechanical loading for bone health?
- Intermittent dynamic (e.g. jumping), rather than static loads
- Loads which are high in magnitude and applied at a high strain rate
- Few loading cycles/repetitions needed to elicit bone formation
- Novel loading patterns to which the bone is not typically accustomed
What exercise is contraindicated for people with osteoporosis / fracture history?
High-impact exercise
Jumping, bounding exercises
- Stair-climbing
- Dancing
- Gymnastics
- Skipping
- Aerobics
What are 3 reasons why jumping, bounding exercises are contraindications for people with osteoporosis / fracture history?
- Impact upon landing
- Ground reaction forces, > bodyweight
- Acceleration & deceleration forces
What is muscle pull?
Progressive resistance training
Direct action of the muscle pulling on bone
What is the intensity for muscle pull exercises?
High loads, low repetitions
Speed of contraction and force of contraction (short and fast contractions –> power = greatest osteogenic effect)
70-80% 1RM (Progressively work up to this! (even in elderly))
What are 2 ways osteogenesis is stimulated?
- Direct action of muscle pulling on bone
- ↑ Effect of gravity acting on bone when the skeleton supports heavy weights
What are 7 examples of progressive resistance training?
- Triceps extension
- Forearm pronation/supination
- Leg Press
- Partial Squats
- Hip abduction/adduction
- Hamstring curl
- Hip flexion/extension
What are 2 examples of how exercise can include loading through weight bearing?
- Push ups against wall (partial WB)
- Activities in 4 point kneeling
- Allows progression Isolate WB through both or one LL
What are 8 aims for exercise for osteoporotic patients?
- Low impact
- Falls prevention
- Function
- Posture
- Flexibility
- Pain relief
- Education
- Mobility
_____ re-education and dynamic _____ for the trunk and limb girdles is important for osteoporosis. This is important for normalising ______forces
Postural; stabilisation; mechanical
Usually patients with osteopenia/osteoporosis present with _____.
Thoracic kyphosis
What are 3 treatment aims of osteoporotic patient with thoracic kyphosis?
- Minimise flexion loads of spine
- Encourage extended postures
- Improve chest expansion
What are 4 characteristics of exercises designed for a osteoporotic patient with thoracic kyphosis?
- Encourage diaphragmatic breathing
- Strengthen hip, back and neck extensors and scapular retractors
- Stretch major upper and lower limb muscles
- Having stronger back extensors = smaller thoracic kyphosis
Why is postural re-education important?
What are 4 features in balance and falls prevention?
- Limits of stability
- Reaching
- Stepping tasks
- Novel balance challenges
What exercise is beneficial for balance and falls prevention?
Tai Chi
When a patient has difficulty taking a protective step when trying to regain balance, what is something to work on?
Specifically work on training reactive stepping
When a patient has balance deficits when performing daily activities (eg. reaching from a high shelf), what is something to work on?
Require patient to move COM to limits of stability while reaching
What is important to understanding when training balance?
balance challenges are enough to bring out a training effect
Eg. reach outside BOS, provide targets that will really stretch them
Encourage patient to move outside there comfort zone
What are 3 exercises to avoid in osteoporotic patients?
- Hight impact loading
- Abrupt or explosive movements
- Trunk flexion, twisting movements and dynamic abdominal exercises
Why are:
- Hight impact loading
- Abrupt or explosive movements
- Trunk flexion, twisting movements and dynamic abdominal exercises
exercises to avoid?
Risk of wedge/compression fractures
Why are forward flexion exercises something to be avoided?
Increase anterior compression of spine
Avoid movements or postures that cause the patient to adopt a slumped, head forward posture, forward flexion of the waist, rotating the spine to a point of strain, reach too far (item on high shelf) which will result in loss of ____ or increase _____ and lead to a potential ____.
balance; compression; injury
