# Exercise as it relates to Disease/Effectiveness of Exercise in Female Osteoporosis Sufferers

This is an analysis of the journal article “The effectiveness of a basic exercise intervention to improve strength and balance in women with osteoporosis” by Montserrat Otero, Izaro Esain, Ángel M González-Suarez, and Susana M Gil (2017).

## What is the background to this research?

Osteoporosis is classed as skeletal disorder which is associated with an increased risk of fractures most commonly in the hip, vertebrae and wrist. This is due to the lower bone density and micro architectural deterioration of the bony tissue.
The mechanical load that exercise provides, induces peripheral bone adaptions through endosteal resorption and periosteal apposition. Resistance bearing exercises have been shown to increase the diameter of the bone thus, providing the bone with more resistance to compression tension and shear forces.
Resistance exercises seems to be the most effective way to strengthen the bones and muscles. Unfortunately the use of strength equipment only found in gyms often is the only way for osteoporosis sufferers to receive this stimulus. The problem is that cost can then become a factor due to having to be supervised by a personal trainer plus the cost of a gym membership. The use of common household objects and common light weights are a much more cost effective solution, although it would mean that the exercise program would be of a lesser intensity, due to the restriction of equipment that can be used.

## Where is the research from?

Montserrat Otero and Angel M González-Suarez are from the Department of Physical Education and Sport, Faculty of Education and Sport Sciences, University of the Basque Country (UPV/EHU), Vitoria-Gasteiz.
Izaro Esain and Susana M Gil are from the Department of Physiology, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Bizkaia, Spain.
This research was conducted at Landako Health Center in the Basque Country, phone numbers of women with postmenopausal osteoporosis and had expressed interest in the study were provided.

## What kind of research was this?

This is a quantitative research study, as it uses a series of tests to compile numerical data to support its conclusion.

## What did the research involve?

A random sample of 65 women suffering from postmenopausal osteoporosis participated in the study. These women were then split randomly into two groups, a 24 week exercise program group (experimental group, N= 33, age= 57.4±4.8 years) and a group asked to not modify their daily routine (control group, n=32, age =58.8±4.5 years). The selection criteria caused there to be a slight limitation on the amount of participants that were involved as they randomly selected 65 out of 75 women that expressed interest.
| Test | Information Collected |
| Questionnaire | To identify any risk factors that could prevent them from exercising. |
| Personal data Questionnaire | To gather information variables such as age,years post menopause and years with hormonal treatment. |
| Anthropometric Measurements | Height and weight gathered to determine BMI. |
| Static Balance | The number of attempts they would need complete 1 minute of balancing on one foot with eyes closed without falling. |
| Dynamic Balance | Time to complete the “8 foot and go test” |
| Upper Body Strength | Number of repetitions completed in 30 seconds of a 2.3kg arm curl. |
| Lower Body Strength | Number of repetitions completed in 30 seconds of the seated to standing test. |

##### Intervention

For the exercise group participants, it involved them going to the same health centre 3 times a week for 60 minutes for 6 months. They were monitored by a technician who had a degree in Sport and Exercise Science in each of these sessions. The sessions involved only equipment they you could find in a normal home such as light weights that ranged from 0.370kg – 1.350kg, water bottles filled with water, sand or marbles. The structure of each session went as follows:
| Phase | Types of Exercises Used |
| Warm up (10min) | •Mobility •Stretching •Walking |
| Static Balance (10min) | •Visual support •Gait support •Support of upper limbs •Participation of Lower limb (positioned with and without movement) •Vestibular System |
| Dynamic Balance (10min) | •Changes in visual support •Walking with different objects •Vestibular System |
| Muscle Strengthening (20min) | •Exercises that involve multiple muscles |
| Cool Down (10min) | •Stretching •Relaxation |

##### Limitations

The limitations that they found in the program is that they didn’t get to study the quality of life that the participants had and whether or not it improved as they progressed through the program. They were unable to study this due to time constraints.

## What were the basic results?

The exercise group increased strength in both upper and lower body strength, whereas the control group had a decline in upper and lower body strength.
| Strength Type | Exercise Group | Control Group |
| Upper Body | +47.4% | −15.9% |
| Lower Body | +80.2% | −10.5% |
Exercise group also had an improvement in the static balance and dynamic balance test, whereas the control group had a decline in both these tests.
| Balance Type | Exercise Group | Control Group |
| Static | +36.7% | −18.1% |
| Dynamic | +21.2% | −12.5% |
And there was also a correlation between participants in the exercise group that had a significant increase in both upper and lower body strength and there improvement in both static and dynamic balance.

## What conclusions can we take from this research?

This research supports the idea that exercise no matter the intensity as long as it involves some form of resistance strengthening exercises and balancing exercises both static and dynamic, there will be a positive improvement in strength and balance. Compared to other studies, they found that the results were not as significant to the ones found in this study and this was due to possibly the type of exercises prescribed in the program, or the length of the program. As these studies all used different exercises and went for significantly shorter time periods than this study.
One study did support their idea, which the length of the exercise program plays a crucial role in the results that a study will receive. This was conducted in 2012, and used a program that consisted of Pilates and went for a duration 48 weeks. This study also found significant improvements in their participants lower body strength.
As such, being one of the most recent studies in this area of research, this research does have ample quantitative results to show that low intensity exercise can have significant results in strength and balance. But it also does recognize that high intensity exercise can produce results in a shorter period of time than low intensity exercise in some cases.

## Practical advice

The main implication is to insure that the exercises are being performed correctly, thus not increasing the chance of an injury. As well having the participant to maintain motivation to continue a program. As this research had both a technician supervising them do the exercises as well as the motivation for them to do the exercise as it was for the research. If these complications can be overcome then this could be a very effective program for someone suffering from osteoporosis.

## Further Reading

Community-based exercise program reduces risk factors for falls in 65- to 75-year-old women with osteoporosis: randomized controlled trial: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC134175/
Effects of tai chi exercise on posturography, gait, physical function and quality of life in postmenopausal women with osteopaenia: a randomized clinical study: https://www.ncbi.nlm.nih.gov/pubmed/20702512
Effects of Pilates exercises on pain, functional status and quality of life in women with postmenopausal osteoporosis: https://www.ncbi.nlm.nih.gov/pubmed/23561868

## References

* 1 2 3 4 5 6 7 8 Otero M, ESAIN I, González-Suarez Á, Gil S. The effectiveness of a basic exercise intervention to improve strength and balance in women with osteoporosis. Clinical Interventions in Aging. 2017;Volume 12:505-513.
* ↑ Christodoulou C. What is osteoporosis?. Postgraduate Medical Journal. 2003;79(929):133-138.
* ↑ Moreira L, Oliveira M, Lirani-Galvão A, Marin-Mio R, Santos R, Lazaretti-Castro M. Physical exercise and osteoporosis: effects of different types of exercises on bone and physical function of postmenopausal women. Arquivos Brasileiros de Endocrinologia & Metabologia. 2014;58(5):514-522.
* ↑ Dionyssiotis Y. Rehabilitation in Osteoporosis. Osteoporosis. 2012;.
* ↑ Beck B, Daly R, Singh M, Taaffe D. Exercise and Sports Science Australia (ESSA) position statement on exercise prescription for the prevention and management of osteoporosis. Journal of Science and Medicine in Sport. 2017;20(5):438-445.
* ↑ Cosman F, de Beur S, LeBoff M, Lewiecki E, Tanner B, Randall S et al. Clinician’s Guide to Prevention and Treatment of Osteoporosis. Osteoporosis International. 2014;25(10):2359-2381.
* ↑ Carter N. Results of a 10 week community based strength and balance training programme to reduce fall risk factors: a randomized controlled trial in 65-75 year old women with osteoporosis. British Journal of Sports Medicine. 2001;35(5):348-351.
* ↑ Chyu M, James C, Sawyer S, Brismée J, Xu K, Poklikuha G et al. Effects of tai chi exercise on posturography, gait, physical function and quality of life in postmenopausal women with osteopaenia: a randomized clinical study. Clinical Rehabilitation. 2010;24(12):1080-1090.
* ↑ Küçükçakır N, Altan L, Korkmaz N. Effects of Pilates exercises on pain, functional status and quality of life in women with postmenopausal osteoporosis. Journal of Bodywork and Movement Therapies. 2013;17(2):204-211.
* ↑ Teixeira L, Silva K, Imoto A, Teixeira T, Kayo A, Montenegro-Rodrigues R et al. Progressive load training for the quadriceps muscle associated with proprioception exercises for the prevention of falls in postmenopausal women with osteoporosis: a randomized controlled trial. Osteoporosis International. 2009;21(4):589-596.