# Exercise as it relates to Disease/Osteocise: Exercise and its impact on bone mineral density and falls risk

This is an analysis of a journal article on the effect of exercise on bone mineral density and falls. It is being written as an assignment for the unit: Health Disease and Exercise, at the University of Canberra. The article is "Effects of a targeted multimodal exercise program incorporating high speed power training on falls and fracture risk in older adults" by Gianoudis et al (2014).

## What is the background to this research
### What is osteoporosis?

Osteoporosis is a skeletal disease characterised by the thinning of bone, resulting in more brittle bones that are at an increased risk of fracture. It is diagnosed through the use of a bone density scan which will determine if any action is required.
| Score | Result |
| 0 to -1 | Normal |
| -1 to -2 | Osteopenia |
| < -2 | Osteoporosis |

### Osteoporosis and falls

Both osteoporosis and falls effect over 1 million people throughout Australia and both place a significant burden on our healthcare resources. One of, if not the most common consequences of a fall, is a fracture and often results in severe disability and an increased risk of mortality. Therefore the prevention of falls and fractures is of vital importance.

### Exercise as a treatment

Exercise is widely recommended as one of the best strategies in fighting osteoporosis and its associated fractures however a consensus surrounding the most appropriate form of exercise has yet to be agreed upon. As well as being recommended as a quality strategy in fighting osteoporosis, research has also shown exercise to be effective in reducing falls
This study set out to determine whether or not previous research has been accurate in their hypothesis that exercise is an effective treatment strategy for both osteoporosis and falls.

## Where is the research from?

This research was conducted in Melbourne, Australia. The authors conducted their research out of the University of Melbourne, Deakin University and Curtin University in Australia. The study was approved by the Melbourne Health Human Research Ethics Committee, registered with the Australian New Zealand Clinical Trials Registry and published in the Journal of Bone and Mineral Research.

## What kind of research was this?

This was a community based randomised controlled trial in which participants were randomly separated into two groups.
| Randomised Controlled Trial | A study where people are allocated by random to receive one of several clinical interventions. The two groups included an exercise/education group, and a standard self-management control group. |

## What did the research involve?

This trial included 162 participants who were identified as having low bone mineral density or had an increased risk of falls. Participants were invited to have a bone mineral density scan and a falls risk assessment both before and after the intervention. Participants were then randomly allocated into two groups; an ‘Osteo-cise’ group and a ‘Self-Management’ control group. The Oseteo-cise group were given a targeted osteoporosis and falls prevention exercise program, as well as behavioural change strategies and osteoporosis education. In the Self-Management group, participants were asked to continue their usual osteoporosis care and were provided with some further information about osteoporosis. The authors set out to look for changes in bone mineral density, muscle strength, functional muscle power/performance and falls rates.
Osteo-cise exercise program$^5$:
| A) High velocity weights training | High speed lift - specific targeted muscle groups |
| B) Moderate impact weight bearing exercises | Stomping, mini tuck jumps, box step-ups, backwards/forwards pogo jumps, side to side shuffle, lateral box jumps - all dependent on level |
| C) Balance/Functional training | Single leg standing, heel-toe walking etc |

## Results

The program required participants to exercise 3 days a week for 12 months. The results showed that after the 12 month program, the Osteo-cise participants had improvements in bone mineral density in both their leg bone and their back bone. As well as this, the Osteo-cise group also had improvements in muscle strength, functional performance, and balance relative to the Self-Management group. Although there were strong improvements in these areas, there was no difference in falls rates between the two groups

## Conclusions

From this research we can see that undertaking the right kind of targeted exercise 3 days a week, not only can improve your bone mineral density, but it can also improve your strength and your balance. Improved bone mineral density means a decreased chance of breaking bones, and improved strength/balance will lessen your chance of falling, meaning that exercise is an important treatment component in both osteoporosis and falls.

## Practical Advice

Osteoporosis and falls effect millions of people worldwide. If you have been diagnosed with osteoporosis, there are steps you can take to improve your bone density, and ultimately reduce your chance of breaking a bone.
1) Get as much information as you can about osteoporosis: this can be done through websites below, as well as through your local GP.
2) Talk to your local physiotherapist or exercise physiologist about an appropriate exercise program for a person with osteoporosis.
3) Make the commitment to exercising at least 3 days a week. Not only will it help your bones, it will improve your life.

## Further Information

1. http://www.osteoporosis.org.au/ - Information about osteoporosis, its risk factors and its diagnosis
2. https://www.nof.org/ - Includes news and resources for life long bone health.
3. http://www.niams.nih.gov/Health_Info/Bone/ - Information on the underlying causes and treatment of osteoporosis

## References

* ↑ Gianoudis, J., Bailey, C. A., Ebeling, P. R., Nowson, C. A., Sanders, K. M., Hill, K., & Daly, R. M. (2014). Effects of a Targeted Multimodal Exercise Program Incorporating High‐Speed Power Training on Falls and Fracture Risk Factors in Older Adults: A Community‐Based Randomized Controlled Trial. Journal of bone and mineral research, 29(1), 182-191.
* ↑ Osteoporosis Australia. (Jan, 2014). About Osteoporosis. Retrieved from http://www.osteoporosis.org.au/about-osteoporosis
* ↑ Lips P (1997) Epidemiology and predictors of fractures associated with osteoporosis. Am J Med 103(2A):3S–11S
* ↑ Center JR, Nguyen TV, Schneider D, Sambrook PN, Eisman JA (1999) Mortality after all major types of osteoporotic fracture in men and women: an observational study. Lancet 353:878–882
* ↑ Gianoudis, J., Bailey, C. A., Sanders, K. M., Nowson, C. A., Hill, K., Ebeling, P. R., & Daly, R. M. (2012). Osteo-cise: strong bones for life: protocol for a community-based randomised controlled trial of a multi-modal exercise and osteoporosis education program for older adults at risk of falls and fractures. BMC musculoskeletal disorders, 13(1), 1.
* ↑ Hill, K. D., Hunter, S. W., Batchelor, F. A., Cavalheri, V., & Burton, E. (2015). Individualized home-based exercise programs for older people to reduce falls and improve physical performance: A systematic review and meta-analysis. Maturitas, 82(1), 72-84.