# Exercise as it relates to Disease/The impact of exercise on elderly patients with osteoporosis

This Wikibooks fact sheet provides a summary and critiques the article “The impact of adding weight-bearing exercise versus nonweight bearing programs to the medical treatment of elderly patients with osteoporosis” written by Alsayed A. Shanb and Enas F. Youssef (2014).

## What is the background to this research?

* Osteoporosis is a bone disease in which the body cannot regenerate bone as fast as the body is breaking it down and makes it brittle. This disease is silent and does not display any symptoms or warning until a fracture occurs, but you can assess the risk by having a bone density scan most commonly done through a dual-energy x-ray absorptiometry or bone densitometry. This disease can take effect at any age, but is most common in the elderly population, especially females after the onset of menopause. Both males and females have a high chance of getting osteoporosis after they reach the age of 50, with statistics showing that 1 in 5 men and 1 in 3 women over 50 have osteoporosis.

## Where is the research from?

* The research has been conducted by Alsayed A. Shanb and Enas F. Youssef who are both from the department of physical therapy at the university of Damman, both authors of this study have taken part in multiple other published articles within the same domain. The article its self comes out from the Journal of Family and Community Medicine (JFCM), which is the official journal of the Saudi community. This journal is internationally recognised as peer reviewed indicating the articles are approved by experts in the selected field who are not a part of the editorial board

## What kind of research was this?

* The research within this article was conducted as an experimental study. This type of study is commonly used to compare two or more groups or measures, usually one variable is manipulated to see if it has an effect on the other. This type of research is commonly used to test the hypothesis of the researcher.

## What did the research involve?

* The sample of participants used in this study included 27 females and 13 males, who were chosen at random from nursing homes from Cairo, Egypt. The participants were all between the ages of 60 and 67 years of age. These participants were split into two groups. The division of the participant sample was done by a blinded and independent research assistant, randomly assigning them into two groups with no predisposition as to the significance of each participant. Group 1, the weight bearing group, consisted of 14 females and 6 males, and Group 2, the non-weight-bearing group, consisting of 13 females and 7 males, providing an even split between the groups to allow for an accurate comparison of results.
* Throughout the study, all participants took part in the same amount of sessions, training 45-60 minutes, twice a week, for a six-month period. Incorporated into the sessions were a 10-minute warm up walk, and a brisk 5-minute walk as their cool down. Alongside these sessions, all participants were undergoing the same medical treatment.
* Group one.
** Group 1 was the group that underwent the program that involved weight bearing exercise. The program structure outlined the following weight bearing exercises:
*** Bench press
*** Double leg press
*** Quarter squats
*** Wide stance mini squat
*** Quadruped position and step up exercises
*** Wall slides with upper limb
*** Standing on one leg with arm support
* Group 2.
** Group 2 was the group that underwent the non-weight bearing exercise program. The structure of this program consisted of an even mixture of upper and lower body exercises. The exercises asked of them were as follows:
*** Extension and abduction of the hips
*** Leg extension
*** Bicep curls
*** Tricep extensions
*** Quadriceps and hamstring curls
*** Wrist curls
*** Back extension from standing
* Limitations
** With regard to the load the participants went through, the data provided isn’t clear for Group 1, so we are unaware of how many reps of the exercises were performed. Whereas in the data for Group 2, it was noted that they performed 3 sets of 8 reps of the exercises and the resistance was set to 25% of their 1 repetition max. Not having all of the information for Group 1 makes it hard to replicate this study or make a comparison between the two groups.
** When comparing the two programs against each other, Group 1 was more lower body dominant, whereas Group 2 was an even mixture. This discrepancy between the two groups may influence Group 1 showing better results in regards to the effects on the lower body.

## What were the basic results?

* When looking into the results of the program, two things were assessed; the first being the bone mineral density (BMD) and the second being the quality of life of the participants. After the completion of the programs, the BMD was remeasured and showed significant difference between the mean t-score of the lumbar spine, neck of femur and the right distal radial head in both Group 1 and Group 2. The results of these areas were compared to measurements undertaken before the participants took part in the exercise programs and showed no significant difference in the mean T-score in any of the three examined areas.
* However, comparing the research groups after the programs, Group 1 showed a significant difference in the mean T-score compared to Group 2, through a higher improvement percentage. When the quality of life was measured after the completion of the programs, the mean value had significantly increased in both Groups 1 and 2. This improvement was measured through a questionnaire in regards to health related quality of life, showing a decrease in the score indicating good results and noticeable improvements. Group 1 showed a significant decrease from (47.3% ± 4.7%) to (34.8% ± 3.3%) and Group 2 also showing a decrease from (41.1% ± 4.3%) to (34% ± 3.2%), but was proven to show no significant difference between the two focus groups.

## What conclusions can we take from this research?

* From this research, we can see that the addition of both weight bearing and non-weight bearing programs prescribed alongside medical treatment, have a positive influence on improving the BMD within an elderly population, with the weight bearing programs proving to be more beneficial, although both types of programs have been shown to provide and equal level of improvement when it comes to the health-related quality of life in the participants.

## Practical advice

* If possible, it is advised to take measures into trying to prevent the onset of osteoporosis happening earlier, if at all. Undergoing everyday activities such as the following, will all assist in maintaining bone strength, but also improve everyday living:
** Adequate consumption of calcium
** Getting out in the sun to be exposed to vitamin D to assist in calcium absorption
** Participating in regular physical exercise to improve muscle strength.
* If more advice or information Osteoporosis Australia provides information on the following topics;
** About Osteoporosis
*** What it is
*** Risk factors
*** Diagnosis
** Prevention
*** Calcium
*** Vitamin D
*** Exercise
** Living with Osteoporosis
*** Treatment
*** Recovery
*** Real stories
* https://www.osteoporosis.org.au/

## References

* 1 2 3 4 5 6 7 8 9 10 11 12 Shanb A, Youssef E. The impact of adding weight-bearing exercise versus nonweight bearing programs to the medical treatment of elderly patients with osteoporosis. Journal of Family and Community Medicine [Internet]. 2014 [cited 14 September 2018];21(3):176. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4214007/
* 1 2 Osteoporosis Australia [Internet]. Osteoporosis.org.au. 2018 [cited 12 September 2018]. Available from: https://www.osteoporosis.org.au
* ↑ Osteoporosis | Bone Density Loss - Diagnosis, Evaluation and Treatment [Internet]. Radiologyinfo.org. 2018 [cited 13 September 2018]. Available from: https://www.radiologyinfo.org/en/info.cfm?pg=osteoporosis
* 1 2 FACTS AND STATISTICS [Internet]. International Osteoporosis Foundation. [cited 17 September 2018]. Available from: https://www.iofbonehealth.org/facts-statistics
* 1 2 Kluwer W. Journal of Family and Community Medicine : About us [Internet]. Jfcmonline.com. 2010 [cited 14 September 2018]. Available from: http://www.jfcmonline.com/aboutus.asp
* ↑ Overview of Experimental Research - Center for Innovation in Research and Teaching [Internet]. Cirt.gcu.edu. [cited 13 September 2018]. Available from: https://cirt.gcu.edu/research/developmentresources/research_ready/experimental/overview