# Exercise as it relates to Disease/The use of resistance training in the prevention and treatment of osteoporosis in the elderly
## The use of Resistance Training in the Prevention and Treatment of Osteoporosis in the Elderly
#### What is Osteoporosis?

It is the decrease in bone density that enhances bone fragility and increases the risk of fractures and falls in the elderly. $^5$ Bone re-absorption outweighs bone deposit as a result of osteoblasts becoming less effective due to aging, adding to age related bone loss. The composition of the bone matrix remains normal, it is bone mass that is reduced and becomes porous and light.

#### Possible Causes

The elderly are effected due to:
   * Inadequate physical activity - which causes a decrease in bone mineral density
   * A poor diet
   * Previous chronic disease or injury Bone Density Scanner
   * Genetic factors such as race, frame size and/or family history may also have a negative effect

#### Diagnosis

First your GP will assess your risk factors for osteoporosis, including age, medical history and lifestyle. Osteoporosis is diagnosed through a bone density test (Dual-energy X-ray Absorptiometry; DXA).$^4$ - (See picture right) It measures the density (strength) of your bones, usually at the hip and spine. The result from this test is called a T-score. This score will either be: Normal: (higher than -1), Osteopenia: (low bone density): between -1 and -2.5 or Osteoporosis: (-2.5 or lower) $^5$

#### Prevention Methods

The first indicator of osteoporosis is often a fracture. This is why prevention strategies are ESSENTIAL.
   * Have a healthy dietary intake – in particular calcium and protein intake.
   * Regular participation in physical activity, most importantly resistance training (Refer to Table 1)$^2$
   * Quit smoking and decrease alcohol consumption
   * Increasing your exposure to limited sunlight to correct any vitamin D deficiencies, or with supplementation
   * Falls prevention measures (as falls can lead to fractures)

#### Treatment

   * Medication to stop further bone loss and prevent fractures $^5$ (Bisphosphonates,Strontium Ranelat and Monoclonal Antibodies (denosumab))
   * Hormone Replacement Therapy - Slows loss of bone but does not reverse osteoporosis
   * Selective Estrogen Receptor Modulator (SERMS)$^{2,4,5}$ - Mimics estrogen bone sparing properties without targeting breasts or uterus.
   * Calcium and Vitamin D supplements $^{2,5}$
   * Drinking fluoridated water - helps to harden the bones

## Resistance Training in the Prevention and Treatment of Osteoporosis

Regularly performed resistance training can offset the age related declines in bone health by maintaining or increasing bone mineral density. $^{3,6}$ Resistance training may also reduce the risk of osteoporotic fractures by improving dynamic balance, muscle mass and overall level of physical activity. $^6$ Benefits increase with additional hormonal and nutritional factors $^2$

#### Recommendations $^1$

   * Pre-existing medical conditions, exercise progression and nutritional status should be evaluated and risk factor questionnaire.
   * Exercise should focus on all areas of the body.$^3$
   * Less intensive exercise to start with. E.g. Using own body weight over a shorter period initially.
   * Progress into more intense exercises such as use of medicine balls and free weights.
   * Depending on individuals' capabilities, can add high velocity and power.
   * An increase of daily physical activity levels in areas such as transport, walking up stairs.

#### Table 1. Resistance Training Program $^2$

| Intensity | Frequency | Duration | Progression | Goals | Considerations |
| 15 reps of 8-10 exercises | 2 days per week | 1 or 2 sets up to 30-60 mins | Add a set after initial 2 weeks | 3 – 4 days per week at 10-12 reps per set | Avoid spinal flexion. Use slow and controlled movements. Target legs and back. |

#### Safety Considerations $^1$

   * Warm up & down 5-10 minutes before each exercise session, incorporating low to moderate activity, including stretching
   * Allow 48-72hrs recovery between sessions, which will also lessen the likelihood of over-training
   * Arrange a motion for each exercise that is pain free.
   * Ensure they have had advice from medical staff and quality supervision by an instructor or medical professional.

## Further Information

         * Osteoporosis Australia - http://www.osteoporosis.org.au/
         * Australian Bureau of Statistics - http://www.abs.gov.au/
         * World Health Organisation - http://www.who.int/en/

## Sources

1. Baechle, T.R. and R.W. Earle, Essentials of strength training and conditioning, 2008: Human Kinetics Publishers.
2. Ehrman, J.K., Clinical exercise physiology, 2009: Human Kinetics Publishers.
3. Layne, J.E. and M.E. Nelson, The effects of progressive resistance training on bone density: a review. Medicine & science in sports & exercise, 1999. 31(1): p. 25.
4. Marieb, E.N. and K. Hoehn, Human anatomy & physiology, 2007: Pearson Education.
5. Osteoporosis Australia, 6 July 2011; Available from:http://www.osteoporosis.org.au/about/about-osteoporosis/what-is-osteoporosis/.
6. Pollock, M.L., et al., American Heart Association. Circulation, 2000. 101(7): p. 828.