# Exercise as it relates to Disease/Resistance training and osteoporosis
## Osteoporosis: The Silent Disease

Osteoporosis is a disease that causes a reduction in density and quality of bone matrix. These changes cause large increase in the risk of fractures, there are often no signs of osteoporosis until the first fracture. Osteoporosis is a disease often seen among the elderly. During early adulthood bone matrix is at its most dense, as we age bone matrix is absorbed while new matrix is formed, this is normally an even equation. Unfortunately as we age this equation can become unbalanced leading to a greater pace of bone absorption, this is the cause of osteoporosis.
Men and women over the age of 60 are at a higher risk of osteoporosis. Osteoporosis is diagnosed through a Bone Mineral Denisty (BMD) test. The most commonly used BMD test is DXA (dual-energy X-ray absorptiometry) which can detect changes in bone loss. Osteoporosis is diagnosed against a set of threshold values created by the World Health Organisation (WHO). Osteoporosis is diagnosed when a person’s BMD is equal to or more than 2.5 standard deviations below this value.

## Connection Between Resistance Training and Osteoporosis

Resistance Training has been shown to provide many benefits to athletes although is not of common practice in the older population. Wolff's law states that stress or mechanical loading applied to the bone via the muscle and tendons has a direct effect on bone formation and remodeling. Benefits of resistance training include gains in strength, endurance and maintenance/gains in BMD. These benefits can impact hugely on functionality for the elderly making tasks such as carrying groceries or getting up and down stairs easier to achieve.
The goal of resistance training in regards to osteoporosis is to maintain or increase BMD and therefore reduce the chance of suffering a fracture. Resistance training has been shown to improve BMD in site specific areas and should therefore be targeted at areas of high fracture risk such as the hips and lumbar spine. Targeted muscle areas should include all major muscle groups of both lower and upper extremities in order to help increase BMD of all major bones.

## Physical Activity Guidelines to Prevent/Manage Osteoporosis

When prescribing exercise programs for individuals with high risk of fractures such as those suffering from osteoporosis, with particular emphasis on the elderly, there are certain precautions and tests that should be conduced before undertaking exercise in avoid unforeseen calamities.

#### Precautions & Safety Concerns

* Ensure the individual has sought advice from a medical professional and has been cleared to undertake the program.
* Make sure the individual is under the supervision of a trained instructor to ensure proper use and technique of equipment and exercises are taking place.
* Reduce the risk factors of falls associated in physical activity environments such as dim lights, scattered objects and loose carpet or flooring.
* Depending on the additional needs of the individual in regards to vision and hearing the use of trochanteric pads may need to be arranged.
* Ensure that any medication taken will not effect or cause risk factors when physical activity is undertaken.

#### Recommended Physical Activity

When designing exercise programs for individuals with osteoporosis special attention and awareness of their like hood to suffer fractures needs to be kept in mind. Any resistance training session should start with a warm up and end with a cool down to ensure maximum muscle recovery. Resistance training should be undertaken at a minimum of two sessions per week containing a variety of exercises. Three sets of each exercise should be performed with 8 to 12 repetitions. It is recommended that the individual begins the program starting at 50% of the 1 repetition max with the goal of obtaining 85% of their 1 repetition max through repetitions. In addition to these recommendations the goal of any program should be long term adherence to the program, which will have the greatest benefit overall.

## Recommended Readings

For further information on osteoporosis and its effects please visit the following sources:
* http://www.nutritionaustralia.org/national/resource/osteoporosis
* http://www.osteoporosis.org.au/
* http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Osteoporosis
* http://www.abc.net.au/health/library/stories/2004/04/29/1831468.htm#.UIIsNsXMjVE
* http://www.osteoporosis.com.au/
* http://www.aihw.gov.au/media-release-detail/?id=6442464763
* http://www.iofbonehealth.org/diagnosing-osteoporosis

## References

* 1 2 3 "What is Osteoporosis?" Author:iofbonehealth. Retrieved from http://www.iofbonehealth.org/what-osteoporosis-0
* ↑ "Osteoporosis, falls and exercise" Author:Agustín Meléndez-Ortega. Retrieved from http://link.springer.com.ezproxy1.canberra.edu.au/article/10.1007/s11556-007-0027-9/fulltext.html
* ↑ "The effects of progressive resistance training on bone density: a review" Author:LAYNE, JENNIFER E.; NELSON, MIRIAM E.. Retrieved from http://zh9bf5sp6t.scholar.serialssolutions.com/?sid=google&auinit=JE&aulast=Layne&atitle=The+effects+of+progressive+resistance+training+on+bone+density:+a+review.&id=doi:10.1097/00005768-199901000-00006&title=Medicine+and+science+in+sports+and+exercise&volume=31&issue=1&date=1999&spage=25&issn=0195-9131
* ↑ "Physical approach for prevention and treatment of osteoporosis" Author:Ana Paula Rebucci Lirani-Galvão; Marise Lazaretti-Castro Retrieved from http://www.scielo.br/scielo.php?pid=S0004-27302010000200013&script=sci_arttext
* ↑ "Preventing Falls in the Elderly" Author:K.R. Tremblay Jr, C.E. Barber Retrieved from http://www.ext.colostate.edu/pubs/consumer/10242.html
* ↑ "Exercise recommendations for osteoporosis" Author:Mark R Forwood, Judy A Larsen Retrieved from http://web.archive.org/web/20060820094416/http://anzbms.org.au/resources/policies/osteo_exercise.pdf