# Exercise as it relates to Disease/Resistance Exercise Interventions for Post Menopausal Osteoporosis
## Background

Post Menopausal Osteoporosis is a progressive bone degenerative disease that causes the bone to decrease in mass and density. The degeneration of bone can be accelerated due to a lack of oestrogen, a hormone that inhibits bone resorption and increases bone formation. As oestrogen decreases upon onset of menopause, women above the age of 50 are at a high risk of developing post menopausal osteoporosis. The degrading effects of osteoporosis as well as the risk of developing osteoporosis can be minimised through the implementation of a resistance training regime.

### Osteoporosis

Osteoporosis degenerates the bone into a porous, weak structure capable of fracturing easily. Osteoporosis commonly affects the elderly population, especially women. Approximately 25-30% of women between the ages of 60–70 years old have osteoporosis. As age increases, the incidence rate of osteoporosis also increases – approximately 70% of women have osteoporosis by the age of 80.

##### Signs and Symptoms

Osteoporosis is known as the “silent disease” due to its lack of outward symptoms. Most people affected by this disease are unaware they have developed it until their bones become so brittle that they fracture from a sudden movement or bump. The cancellous bone is the structure that is most affect by osteoporosis. The degradation of the cancellous bone causes the vertebrae, and the neck of the femur to be at the most risk of fracturing. Osteoporosis can be diagnosed through a DXA Scanner. This scanner assesses the bone density the hip and vertebrae.

##### Risk Factors

* Age
* Gender
* Diet
* Smoking Status
* Ethnicity
* Insufficient Exercise
* Hormone Related Conditions

### Menopause

Menopause' is the natural and permanent cessation of the woman's ability to reproduce which occurs at approximately 40 to 50 years old. For the majority of women, their periods become irregular for roughly 2 years. Once their period has been absent for a year, menopause has occurred and the woman is now said to be “post menopausal”. Once menopause has taken place, the woman is incapable of becoming pregnant in the traditional way- although IVF is still possible. In addition to the cessation of the period, oestrogen and progesterone levels begin to drop.

##### Signs and Symptoms

* Hot Flashes
* Night Sweats
* Migraines
* Rapid Heart Rate
* Dysfunctional Vaginal Bleeding
* Frequent Urination
* Muscle and Joint Pain
* Mood Disturbances
* Decreased Libido

## Mechanism of Post Menopausal Osteoporosis

Bone remodelling is a necessary lifelong process where previous bone tissue is removed through bone resorption and then subsequently replaced in a process called ossification. The frequency of this process is determined by the functional stresses and demands placed on the body. The hormone oestrogen inhibits bone resorption and promotes ossification. As menopause develops, the production of oestrogen slows. As the oestrogen level is lowered, the inhibition of bone resorption is not as effective. This leads to the acceleration of bone degradation as well as the deceleration of bone ossification. The erosion of the bone produces a high risk of developing post menopausal osteoporosis.

## Resistance Exercise

Stress must be placed on the bone structure to induce bone ossification. This stress will aid in the prevention of bone degradation whilst also slowing down the process of post menopausal osteoporosis. The most beneficial exercises to induce stress are resistance exercises. Resistance Exercises are exercises that bear weight on the person's body which in turn forces muscular contractions which places stress on the bones. A consistent resistance exercise regime produces overall health benefits including increased muscle mass and strength, tendon and ligament strength as well as improved bone density.

### Recommendations

Frequency – 3-5 times per week Intensity – Moderate to high (Must be performed at a comfortable level) Time – 30–60 minutes per session

##### Example Resistance Exercises

A mixture of different types of resistance and weight bearing exercises may be important for overall health and the prevention of post menopausal osteoporosis. Some example resistance and weight bearing exercises include:
* Jogging
* Stair Climbing
* Hill Walking
* Dancing
* Yoga
It may also be beneficial to include a range of gym equipment exercises that will aid in increasing muscular strength and endurance as well as providing a safe environment to exercise in. Please note that these exercises are best executed with a qualified health professional present to minimise risk of injury. Some exercises include:
* Leg Press
* Leg Curls
* Assisted Squats
* Bench Press
* Bicep Curls
* Shoulder Press

## Further reading

General Facts on Osteoporosis Osteoporosis as it Relates to Menopause Osteoporosis. Better Health Channel Video. Postmenopausal Osteoporosis Activation

## References

* 1 2 Feldman, R. (2011). Development across the lifespan (pp. 483, 543)
* 1 2 3 4 Johnson, K. (2012). Osteoporosis and menopause. Retrieved from http://www.webmd.com/menopause/osteoporosis-menopause
* 1 2 3 4 5 Marieb, E. N., & Hoehn, K. (2013). Human anatomy & physiology (pp. 186-194)
* 1 2 3 4 Powers, S., & Howley, E. (2012). Exercise physiology: Theory and application to fitness and performance (8th ed., pp. 384-386)
* 1 2 3 4 Hailes, J. (2014). Osteoporosis. Retrieved from http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Osteoporosis
* 1 2 3 4 Robb-Nicholson, C. (January 2008). Eight for 2008: Eight things you should know about osteoporosis and fracture risk.15(5), 30th September 2014.
* 1 2 Hailes, J. (2014). Menopause. Retrieved from http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Menopause
* 1 2 Baechle, T., & Earle, R. (2008). Essentials of strength training and conditioning (pp. 332)