# Exercise as it relates to Disease/Increasing the activity of women in our aged care facilities with low bone mass

Increasing the activity of women in our aged care facilities with low bone mass
This Wikibooks page is an analysis of the research article "Effects of short-term step aerobics exercise on bone metabolism and functional fitness in postmenopausal women with low bone mass" by Wen, H.J., Huang, T.H., Li, T.I., Chong, P.N., Ang B.S. (2017)

## What is the background?

    Although not a disease, menopause is a natural biological process when a woman’s menstrual period ceases permanently and they are no longer able to bear children. In conjunction with this process, there are several serious consequences of menopause including, but not always, urogenital atrophy, Alzheimer’s disease, atherosclerosis and osteoporosis

## Where is this research from?

    This study was conducted in Taiwan with participants from one of the larger counties, Hualien County. Lactose intolerance in adulthood is most prevalent in people of East Asian descent, affecting more than 90 percent of adults in some of these communities. Other researchers have also found that Taiwanese had a comparatively low calcium intake.

## What kind of research was this?

    This was an intervention study of two groups of 24 postmenopausal women with low bone mass. Each group was randomly selected to participate in a ten-week program, one in a group based step aerobics program and the other was the control group of a continuing normal lifestyle.

## What did the research involve?

      * A ten-week group based step aerobics class;
      * Certified step aerobics instructor;
      * Moderate to high intensity exercise level (75-85% heart rate reserve);
      * Three times per week;
      * 90-minute sessions;
      * The exercise group had an attendance rate of 96.73% ±.94;

## What were the basic results?
### Participant Characteristics

      * The women were aged 58.2 years with a range of ±3.4 years:
      * Their postmenopausal year was 7.5 years ± 4.08 years;
      * A BMI of 21.97 ±2.48kg/m2;
      * With low bone mass based on lumbar spine bone mass density:
      * Participants were excluded for using certain medications such as biophosphonates, raloxifene, hormone replacement or glucocorticoids within the preceding 12 months or during the trial.

### Measurement Methods

      * Functional fitness comprised of back scratch, chair stand, sit-and-reach, 8-foot up-and-go, arm curl and 2-minute step test;
      * Blood sampling, two days pre and two days post intervention, to determine serum osteocalcin and Type I collagen for estimating bone formation and resorption activities;
      * A dual energy X-ray absorptiometry (DEXA) was carried out pre-test and after the intervention to measure total body fat percentage, bone mineral density and bone mineral content of the whole body and total hip. As a criterion for inclusion, the lumbar spine was scanned pre-test to determine their T-score.

### Considerations

      * From the original group of 48 participants, two women withdrew from the control group for personal reasons;
      * The subjects were instructed to maintain their normal diet;
      * The subjects were instructed to maintain their normal lifestyle;
      * The subjects were asked to refrain from any other physical activity routine or exercise during the study period;
      * Calcium intake was not monitored;

## What were the basic results?

    There were no significant changes in body weight, BMI and lipid profiles in either group after the intervention. As would be expected, there was a significant reduction of body fat percentage and improvement of all six functional fitness components in the exercise group. The results at the completion of the intervention were similar for the control group as to their pre-intervention results.

## What conclusions can we take from this research?

    A short-term exercise program will have very little bearing on the improvement of bone density, bone formation and bone resorption to a person with reduced bone mass density. It will, however, greatly improve their functional fitness which will serve as a protective factor for falls and fracture risks.

## Practical advice

    As a base for evidence, this intervention could be expanded to cover a long-term study. The data produced showed some improvement in the participants bone density when compared to their pre-intervention data and the control groups pre- and post-intervention data. The study could be used as a basis to promote activity within aged care facilities and elderly communities to highlight the functional fitness benefits has in preventative matters.
    The social atmosphere of the group based exercise class creates a low cost, inclusive and interactive platform with which the community can remain connected. The benefits of improving functional fitness in the aging population will have a positive effect on the national health bill. Improved proprioception, sleep quality, cardiovascular health, self-satisfaction and quality of life will lead to a reduced reliance on health services. The aging population, from improved nutrition and advances in science, has become a burgeoning area of employment.
    Wolff’s Law states that bone in a healthy person will adapt to the loads under which it’s placed. Conversely, if the loading decreases the bone will become weaker. With an impact type exercise as in step aerobics, it follow’s the bone density should increase. This alone is not enough to increase the functional fitness and bone density of an aging person, resistance training, balance exercises, proprioceptive exercises and stretching must be incorporated to be of full benefit.

## Further information/resources

   * http://medicinetoday.com.au/2017/april/feature-article/osteoporosis-postmenopausal-women-key-aspects-prevention-and-treatment
   * Watson, S.L., Weeks, B.K., Weis, L.J., Horan, S.A., Beck, B.R. Heavy resistance training is safe and improves bone, function, and stature in postmenopausal women with low to very low bone mass: novel early findings from the LIFTMOR trial. Osteoporos Int (2015) 26: 2889.
   * Moreira, Linda Denise Fernandes, Oliveira, Mônica Longo de, Lirani-Galvão, Ana Paula, Marin-Mio, Rosângela Villa, Santos, Rodrigo Nolasco dos, & Lazaretti-Castro, Marise. (2014). Physical exercise and osteoporosis: effects of different types of exercises on bone and physical function of postmenopausal women. Arquivos Brasileiros de Endocrinologia & Metabologia, 58(5), 514-522.
   * Xu, J., Lombardi, G., Jiao, W. et al. Sports Med (2016) 46: 1165. https://doi.org/10.1007/s40279-016-0494-0
   * Zhao, R., Zhao, M. & Xu, Z. The effects of differing resistance training modes on the preservation of bone mineral density in postmenopausal women: a meta-analysis. Osteoporos Int (2015) 26: 1605.

## References

* ↑ Wen, H.J., Huang, T.H., Li, T.I., Chong, P.N., Ang B.S. (2017) Osteoporos Int (2017) 28:539–547
* ↑ http://www.lenus.ie/hse/bitstream/10147/235574/1/SEP10art1.pdf
* ↑ https://ghr.nlm.nih.gov/condition/lactose-intolerance#statistics
* ↑ Tsai, K.S. & Tai, T.Y. Osteoporos Int (1997) 7(Suppl 3): 96