TRAINING A CLIENT WITH OSTEOPOROSIS OSTEOPOROSIS - Medical Fitness Tour

TRAINING A CLIENT WITH
OSTEOPOROSIS

OSTEOPOROSIS

Objectives
1. Learn about osteopenia and osteoporosis and its
prevalence

2. Factors that increase the risk of osteoporosis

3. Learn how to create a safe and effective exercise
program for osteoporosis

4. How to help your client prevent vertebral fractures by
modifying their activities of daily living

What is Osteoporosis?
• A disease characterized by low bone mass and an increase
 in bone fragility and susceptibility to fracture

• Osteopenia is the precursor to osteoporosis

• Bone loss can affect you in your 20’s, 30’s and 40’s

• Early signs and symptoms of bone loss

• Osteoporosis can be deadly

• There are 700,000 vertebral fractures per year

Remodeling

Risk Factors
Osteoporosis occurs primarily in older people and in
women who have gone through menopause.

• Decreased estrogen in women, and lowered testosterone
    levels in men.
•   Cancer treatments and surgery
•   Sustaining a fracture after age 50
•   Being Caucasian or Asian
•   Smoking
•   Being thin
•   Doing little exercise or too much exercise
•   A diet without sufficient vitamin D and calcium
•   Having any of these conditions: rheumatoid arthritis, type
    1 diabetes, anorexia, premature menopause, asthma,
    multiple sclerosis, cancer, lupus, and thyroid,
    gastrointestinal, blood and renal disorders

Does Your Client Have Osteoporosis?
• Over age 50 should take a bone density test

• Vertebral fractures lead to more fractures and kyphosis
 leads to more kyphosis.

• Test bone density on a DEXA scan

• The T-score compares bone density to that of a 25-year-
 old and focuses on the lower spine and hip.

• A score of -1 to -2.5 indicates osteopenia

• A T-score of more than -2.5 is considered osteoporosis.

Osteoporosis Medication Side Effects
• Teriparatide/Forteo
• Denosumab/Prolia
• Zoledonic acid/Reclast
• Risendronate/Actonel
• Ibandronate/Boniva
• Alendronate/Fosamax
• Raloxifene/Evista

Side effects: bone, joint or muscle pain, bone loss in the
jaw (osteonecrosis), abnormal heart rhythm, heartburn,
irritation of the esophagus, and gastric ulcers, flu-like
symptoms, fever, headache leg cramps and dizziness

The Components of an Osteoporosis
Exercise Program
• Posture and balance exercises

• Weight bearing exercises
  150 min/week of moderate or 75 min /week of vigorous activity f
  Impact exercise for some clients
  Swimming and biking

• Strength training exercise
  2 to 3 days a week, 1 to 3 sets, exercising all major muscle groups

• Relaxation

Forward Head Posture
• Muscle strain, disc herniation, nerve impingement, and
 the early onset of arthritis

• Decreased respiratory muscle strength and breathing
 ability

• Disrupted proprioceptive and sensory input
• Loss of balance and coordination and increased
 probability of sustaining a fall

Strength Training
• Increases bone density -stimulates bone-building cells

• Improve proprioception, and improves balance,
 coordination and agility

• Start with light weights and progress slowly, emphasizing
 the common fracture sites of the hip, spine, and wrist.

• If the client suffered a previous spine fracture keep
 exercise at low to moderate intensity and always
 concentrate on alignment

• Vary the exercises

Exercise Program Level A
• Start with a balance assessment.

• Balance on one leg for ten seconds.

• Balance exercises: walking the tight rope, grapevine, walk
 backwards, walk on toes, low impact aerobics and
 dancing

• Add calf raises, Tai Chi, Qigong, modified Yoga and
 Pilates

• Level A clients should practice getting up and down from a
 chair in squat form with various assistance devices

Exercise Progression Level B
• If a client can balance on one leg for twenty seconds, they can
 perform legs lift while holding onto a chair with two fingers

• Jump with toes on the ground, modified lung and start walking up
 hills.

• The intensity of their aerobic exercise of choice can start to increase
 according to their history of fracture, orthopedic issues and general
 health. Ex: running is not considered safe for those that fractured
 without trauma.

• Progress slowly, preparing the body for higher impact activities

• Listen to your body, no straining, use good form, and stop if in pain.

Exercise Progression Level C
Over 30 seconds
• Reduce contact with support objects,
• Perform leg lifts adding leg weights and eventually
  adding another set.
• Progress from standing still to dynamic exercises
• Balance trainers can be introduced.
• Progress to strength training while on one leg
• Compound exercises-leg lift with bicep curl

Which Exercises are Safe?

• Sinaki & Mikkelson Vertebral Fracture & Exercise Study
• Flexion Group 89% had compression fractures
• Extension Group 16% had compression fractures
• Extension and Flexion 53% additional fracture
• No exercise 67% additional fractures

Forward Bending: Pressure on the
Vertebral Bodies

Unsafe Exercises
• Vertebral fractures are caused by flexing the spine and
 lifting heavy-use hip hinge

• Using a heavy weight to push upward places too much
 force on a fragile spine as does plopping down on a chair
 or floor

• Forward bends-toe touches, sit ups, or crunches

• Twisting

Yoga and Pilates

• Yoga must be modified (spine twists, forward folds,
 ploughs, shoulder stand)

• Supported flexion, not to end-range- modified downward
 dog with hip hinge using chair

• Pilates is beneficial, but more than half of the exercises
 involve forward flexion (no roll up, roll over, or jack knife)

Improve Core Strength

• Ball under scapula
• Hundreds, leg circles, corkscrew with head on floor
• Back extension exercise
• Bridge
• Plank on floor or wall

Use Caution During Physical Activity

• Do not jump if you have less than a -3.0 T-score in the
  spine or hip
• Do not do a sport with risk of falling-modify high impact
  activities to low impact
• Watch how your client picks up the weights and technique
  on machines.

Playing Golf

• Depends on the degree of bone loss
• Golf swings can begin in neutral spine, and the swing
  ends in spinal extension.
• Learn spine awareness and avoid flexion at the beginning
  of the swing and avoid extreme side-bending at the end of
  the swing (stay elongated as you finish the swing.)

Osteogenic Loading
• The amount of weight bearing that causes the bone to become more
 dense is called osteogenic loading. It takes a certain load to stimulate
 the bone building cells.

• Bones can be unloaded from prolonged bed rest or space travel

• Scientists in the United Kingdom, determined that the amount of
 loading required to stimulate the bone building process equals 4.2
 times body weight. For example, if you weigh 100 pounds, you need
 to load your bones with 420 pounds to build bone.

• When we stand, gravity applies a load to our bones equals our body
 weight. Running or jogging adds even more load, but it is higher
 impact activities like jumping or strength training that is needed to get
 to the over 4 times body weight in order to increase bone density.

• Jumping builds bone. Loading the femur with over 4 times body
 weight. Jumping on a mini-trampoline is not enough to increase
 density. Running may initially build bone but not after running for
 several years.

Resistance Training & Weight Bearing Exercise Studies
• Studies have shown that physically active women have higher bone
 mass than inactive women and that physically active persons
 experience fewer fractures even if they have osteoporosis.

• Studies have also shown that when people engage in a certain types
 and amounts of physical activity their bone mass may increase, or at
 least be protected against severe decreases.

• Of interest is a new study using high-intensity resistance training
 shows significant gains in bone-mineral density and strength in
 postmenopausal women with low bone mass. "Importantly, no
 fractures or major adverse events were observed, suggesting high-
 intensity resistance and impact training (HIRIT) may be safe for
 postmenopausal women with low to very low bone mass, despite
 previous safety concerns," report Steven L Watson, of Griffith
 University, in Queensland, Australia, and colleagues in the Journal of
 Bone and Mineral Research.

Modifying Activities of Daily Living

Add value as fitness professional by educating your clients
as to how to prevent fractures during their every day
activities.

• When lifting keep objects close to body.
• Use the hip hinge when you are
    • getting groceries out of the car
    • lifting from the floor
    • making the bed
    • tying your shoes

Summary
• Posture exercises
• Daily activities that challenge balance
• Strength training twice a week or more
• Avoid excessive twisting or forward bending.
• Moderate or vigorous intensity aerobic physical
• Concentrate on posture during daily activities,
• Slowly increase the intensity of the exercises
• Be consistent