Osteoporosis

Question 1

Older Adults are considered

Answer 1

> 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

Question 2

Todays average life expectancy

Answer 2

80 years

Question 3

Health Status

Answer 3

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

Question 4

Physical Status of Older Adults

Answer 4

the least physically active of all age groups
there is a slight improvement of PA engagement
only 25% engage in regular PA

Question 5

Aging effects on selected physiologic and health-related variable (chart)

Answer 5

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

Question 6

Benefits of PA in older adults

Answer 6

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

Question 7

Initial workload for exercise testing

Answer 7

<3 METs
small increments
Naughton treadmill protocol
Treadmill workload needs to be adapted to walking ability by increasing grade not the speed

Question 8

Adding a treadmill handrail support

Answer 8

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

Question 9

A cycle ergometer testing

Answer 9

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

Question 10

Prescribed medications might ___ during exercise

Answer 10

influence ECG readings and hemodynamic responses to exercise

Question 11

Oldest segment of the population

Answer 11

> or equal to 75 yr and individuals with mobility limitations, has one or more chronic medical conditions

Question 12

Other exercise limitations for older adults

Answer 12

likelihood of physical limitations increase with age

exercise-induced dysrhythmias are more frequent in older adults

Question 13

Senior Fitness Test

Answer 13

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

Question 14

Continuous scale performance test

Answer 14

long and short versions
performing ADLs in environments that have physical domains, scores range from 0-100 with higher scores representing better functioning

Question 15

Characteristics of senior fitness test

Answer 15

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

Question 16

Aerobic Frequency

Answer 16

> 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

Question 17

Aerobic Time

Answer 17

30-60 min/day (mod)

20-30 min/day (vig)

Question 18

Aerobic Type

Answer 18

Any modality that doesn’t impose excessive orthopedic stress (like walking)
aquatics and cycling are good for those who have limited weight-bearing engagement

Question 19

Aerobic Intensity

Answer 19

5-6 physical exertion for mod. intensity and

7-8 for vig intensity

Question 20

Frequency Resistance

Answer 20

> or equal to 2 days/wk

Question 21

Intensity Resistance

Answer 21

light (40-50%) of 1 RM (mod)
60-80% 1 RM for vig
5-6 exertion for moderate and 7-8 exertion for vigorous

Question 22

Time Resistance

Answer 22

8-10 exercises, 1-3 sets, 8-12 reps

Question 23

Type Resistance

Answer 23

Progressive weight training programs or weight-bearing calisthenics, stair climbing, and other strengthening activities that use the major muscle groups

Question 24

Neuromotor Exercises for frequent fallers

Answer 24

balance, agility and proprioceptive training

effective in reducing and preventing falls if it is performed 2-3 days/wk

Question 25

General recommendations for older adults

Answer 25

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

Question 26

Special Considerations for older adults

Answer 26

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

Question 27

What is osteoporosis

Answer 27

- 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

Question 28

Stats about osteoporosis

Answer 28

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

Question 29

Primary osteoporosis Type 1

Answer 29

Most common in postmenopausal women

Question 30

Primary Osteoporosis Type 2

Answer 30

Decline in bone density and strength by aging (senile osteoporosis)

Question 31

Secondary Osteoporosis

Answer 31

Caused by something else, like a medical condition

Question 32

Osteopenia (BMD)

Answer 32

T score -1 to -2.5 low bone density, not yet osteoporosis

Question 33

Osteoporosis (BMD)

Answer 33

T-score less than -2.5

Question 34

Risk Factors for Osteoporosis

Answer 34

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

Question 35

Cortical Bone

Answer 35

``` 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 ```

Question 36

Trabecular Bone

Answer 36

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

Question 37

Osteoporosis and bone resorption

Answer 37

Bone resorption > bone formation

Question 38

Normal bone (resorption)

Answer 38

bone resorption = bone formation

Question 39

Osteopetrosis

Answer 39

Bone resorption < bone formation

Question 40

Osteoporosis Drugs

Answer 40

Antiresorptive medications | Anabolic drugs

Question 41

Antiresorptive medications

Answer 41

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

Question 42

Anabolic Drugs

Answer 42

Action on osteoblast increase the rate of bone formation teriparatide (only one kind of FDA)

Question 43

PA and osteoporosis

Answer 43

-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

Question 44

Leg ergometry osteoporosis

Answer 44

alternative to the treadmill | use in patients with severe vertebral osteoporosis for whom walking is painful

Question 45

Vertebral compression fractures...

Answer 45

can lead to a loss of height, spinal deformation, compromised ventilatory capacity, and result in forward shift in the center of gravity

Question 46

Avoid ___ types of exercise

Answer 46

explosive movements, or high-impact loading should be avoided, no twisting, bending or compression of the spine should also be avoided

Question 47

Activities that improve balance

Answer 47

should be incorporated for older women and men that are at risk for fall

Question 48

Other important notes about osteoporosis

Answer 48

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.

Question 49

Lifestyle Changes to help prevent osteoporosis (or its effects)

Answer 49

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

Question 50

Bottom line (osteoporosis)

Answer 50

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

Question 51

General recommendation for Ex Rx

Answer 51

moderate intensity exercise that does not cause or exacerbate pain, and avoid the said exercises