Osteoporosis Flashcards
Older Adults are considered
> or equal to 65 yr
or individuals that are 50-64 years with clinically sig conditions or physical limitations that affect movement, physical fitness, or PA
Todays average life expectancy
80 years
Health Status
considered a better indicator of ability to engage in PA than chronological age
if an individual has a chronic disease they need consultation and prescription
Physical Status of Older Adults
the least physically active of all age groups
there is a slight improvement of PA engagement
only 25% engage in regular PA
Aging effects on selected physiologic and health-related variable (chart)
Decrease in peak O2 transport of 5 ml/kg/min per decade b/w 25 and 65 years of age
25% decrease in peak muscle force and lean tissue from age 40 to 65
7% loss of flexibility per decade of adult life
Progressive decrease in bone calcium and deterioration of bone matrix beginning at age 25
Benefits of PA in older adults
Slowing physiologic changes of aging that impair exercise capacity
Optimizing age-related changes in body composition
Promoting psychological and cognitive well-being
Managing chronic diseases
Reducing the risks of physical disability
Increasing longevity
Initial workload for exercise testing
<3 METs
small increments
Naughton treadmill protocol
Treadmill workload needs to be adapted to walking ability by increasing grade not the speed
Adding a treadmill handrail support
if the patient had reduced balance, decreased muscular strength, poor neuromotor coordination and fear, gait abnormalities
*but this will reduce the accuracy of estimating peak MET capacity based on the exercise duration or peak workload achieved
A cycle ergometer testing
use for patients with poor balance and neuromotor coordination, impaired vision, impaired gait, weight-bearing limitations and/or foot problems
Muscle fatigue may be a factor for premature test termination
Prescribed medications might ___ during exercise
influence ECG readings and hemodynamic responses to exercise
Oldest segment of the population
> or equal to 75 yr and individuals with mobility limitations, has one or more chronic medical conditions
Other exercise limitations for older adults
likelihood of physical limitations increase with age
exercise-induced dysrhythmias are more frequent in older adults
Senior Fitness Test
30 s chair stand 30 s arm curls 8 ft up and go test 6 min walk test 2 min step test sit and reach back scratch test
Continuous scale performance test
long and short versions
performing ADLs in environments that have physical domains, scores range from 0-100 with higher scores representing better functioning
Characteristics of senior fitness test
Designed to meet practical and psychometric properties
Convenient and practical
Norm-reference standards
Currently used in several countries
Assesses a wide range of physical abilities
Continuous-scale scoring
Older adults are able to perform safely without need for medical release in most cases and without undue fatigue
Aerobic Frequency
> or equal to 5 days per week for moderate intensity
or equal to 3 days/wk vigorous intensity
3-5 d/wk for a combination of moderate and vig. intensity
Aerobic Time
30-60 min/day (mod)
20-30 min/day (vig)
Aerobic Type
Any modality that doesn’t impose excessive orthopedic stress (like walking)
aquatics and cycling are good for those who have limited weight-bearing engagement
Aerobic Intensity
5-6 physical exertion for mod. intensity and
7-8 for vig intensity
Frequency Resistance
> or equal to 2 days/wk
Intensity Resistance
light (40-50%) of 1 RM (mod)
60-80% 1 RM for vig
5-6 exertion for moderate and 7-8 exertion for vigorous
Time Resistance
8-10 exercises, 1-3 sets, 8-12 reps
Type Resistance
Progressive weight training programs or weight-bearing calisthenics, stair climbing, and other strengthening activities that use the major muscle groups
Neuromotor Exercises for frequent fallers
balance, agility and proprioceptive training
effective in reducing and preventing falls if it is performed 2-3 days/wk
General recommendations for older adults
progressively difficult postures that gradually reduce the base of support (two legged stand, semitandem stand, tandem stand, one-legged stand)
Dynamic movements that perturb the center of gravity (tandem walk and circle turns)
stressing postural muscles groups
reducing sensory input (standing with eyes closed)
Tai chi/yoga
Special Considerations for older adults
muscular strength decreases with age
They need proper instruction for weightlifting machines
start with weight lifting, endurance physical activities and then move to aerobic endurance
incorporate behavioral strategies
Provide regular feedback, positive reinforcement, and other behavioral/programmatic strategies to enhance adherence
What is osteoporosis
- skeletal disease
- low bone mineral density
- changes in the microarchitecture of bone that increases susceptibility to fracture
- BMD T score of < or equal to 2.5 at lumbar spine, femoral neck, forearm
Stats about osteoporosis
More than 10 million individuals in the US (50+) have it and 34 million are at risk
occurs mostly in postmenopausal women and then 50+ men
Primary osteoporosis Type 1
Most common in postmenopausal women
Primary Osteoporosis Type 2
Decline in bone density and strength by aging (senile osteoporosis)
Secondary Osteoporosis
Caused by something else, like a medical condition
Osteopenia (BMD)
T score -1 to -2.5 low bone density, not yet osteoporosis
Osteoporosis (BMD)
T-score less than -2.5
Risk Factors for Osteoporosis
Sex, age, certain races, family history, low BMI, low estrogen, history of fractures, amenorrhea, low sex hormones, inadequate PA, smoking, alcohol, low calcium, VIt D deficiency, Excessive intake of protein, sodium, caffeine and VIT A , certain meds/diseases, loss of height
Cortical Bone
Compact or solid bone Dense mineral deposits long bones, 80% of bone mass 20% of bone surface area Thin wall, more porous, pores develop in the shaft walls
Trabecular Bone
Spongy or cancellous bone
bone marrow fills the space
ends of long bone, vertebral bodies and calcaneus
20% of bone mass, 90% o bone surface area
fewer of them, thinner, vacant/space
Osteoporosis and bone resorption
Bone resorption > bone formation
Normal bone (resorption)
bone resorption = bone formation
Osteopetrosis
Bone resorption < bone formation
Osteoporosis Drugs
Antiresorptive medications
Anabolic drugs
Antiresorptive medications
action on the osteoclasts
bone loss is slowed
new bone is still made at the same pace
biphosphonates, calcitonin, denosumab, estrogen and estrogen antagonists/agonists
Anabolic Drugs
Action on osteoblast
increase the rate of bone formation
teriparatide (only one kind of FDA)
PA and osteoporosis
-may reduce the risk for osteoporotic fractures
enhances the peak bone mass
slows rate of bone loss and reduces the risk of falls
-inversely associated with risk of hip and spine fracture
-exercise training can increase or slow the decrease in spine and hip BMD
Leg ergometry osteoporosis
alternative to the treadmill
use in patients with severe vertebral osteoporosis for whom walking is painful
Vertebral compression fractures…
can lead to a loss of height, spinal deformation, compromised ventilatory capacity, and result in forward shift in the center of gravity
Avoid ___ types of exercise
explosive movements, or high-impact loading should be avoided, no twisting, bending or compression of the spine should also be avoided
Activities that improve balance
should be incorporated for older women and men that are at risk for fall
Other important notes about osteoporosis
even the frailest elderly should remain as physically active as his or health permits to preserve musculoskeletal integrity
There are no established guidelines regarding contraindications for exercise for individuals with osteoporosis.
Lifestyle Changes to help prevent osteoporosis (or its effects)
Get enough calcium and VIT D
engage in regular weight bearing and resistance training
ovoid tobacco and excessive alcohol
become educated about bone health
DXA scan and take medications if recommended
Bottom line (osteoporosis)
Weight bearing aerobic and resistance exercise are essential to individuals at risk for and with osteoporosis
It is difficult to quantify the magnitude o bone loading forces, but they generally increase in parallel with exercise intensity
PA plays an important role in prevention
General recommendation for Ex Rx
moderate intensity exercise that does not cause or exacerbate pain, and avoid the said exercises
