L9c: Exercise Prescription for Bone Health

Question 1

When does bone loss start?

Answer 1

Once skeletal maturity is achieved Osteoclasts become more active than osteoblasts

Question 2

When does bone loss occur due to menopause?

Answer 2

No longer producing oestrogen

Question 3

What is osteoporosis?

Answer 3

pathological loss of bone mineral density

Question 4

What are 2 reasons for exercise prescription when optimising bone health in old age?

Answer 4

Non-osteoporotic groups

• Bone loading

Osteoporotic patients

• Preventing falls & fractures

Question 5

Bone loss is highest particularly several years immediately post-_____

Answer 5

menopause

Question 6

What are 3 results for bone mineral density scans?

Answer 6

1. Normal
2. Osteopenia
3. Osteoporosis

Question 7

What are 3 factors that management of bone health depends on?

Answer 7

1. Scans of bone mineral density
2. Age
3. Functional status

Question 8

What is the aim (in a non-osteoporotic woman)?

Answer 8

Maintain or improve bone mineral density by loading bone

Question 9

What are the 2 aims (in an osteoporotic older person)?

Answer 9

1. Shifts from loading bone
2. Preventing falls and improving function

Question 10

What is Wolff’s Law?

Answer 10

If loading on a particular bone increases, the bone will remodel itself over time to become stronger to resist that sort of loading

Bone will respond to loading with osteogenesis

Question 11

What is osteogenesis?

Answer 11

the formation of new bone

Question 12

When are 2 scenarios when osteogenesis is most effective? Why?

Answer 12

1. Bone loading is varied Incorporates numerous forces and activities (to which the bone is not normally accustomed)
2. Bone responds to novel exercise so movements or loading patterns that are not usual practice

Question 13

What are 6 of the most common osteoporotic fracture sites?

Answer 13

1. Vertebrae
2. Pelvis
3. Proximal Femur
4. Ribs
5. Proximal Humerus
6. Distal Radius

Question 14

↑ Habitual loading should promote ↑ bone mass; but ___ and ____ loading is key

Answer 14

novel; varied

Question 15

Sedentary older adults will benefit from a(n) _____ (increase/decrease/no change) in habitual loading

Answer 15

increase

Any exercise or any increase in loading

Question 16

Older adults with established exercise regimes will require ‘____’ exercises to stimulate an effect

Answer 16

new

Question 17

What are the exercise guidelines for osteoporotic patients?

Answer 17

Question 18

What are 4 effective mechanical loading for bone health?

Answer 18

1. Intermittent dynamic (e.g. jumping), rather than static loads
2. Loads which are high in magnitude and applied at a high strain rate
3. Few loading cycles/repetitions needed to elicit bone formation
4. Novel loading patterns to which the bone is not typically accustomed

Question 19

What exercise is contraindicated for people with osteoporosis / fracture history?

Answer 19

High-impact exercise

Jumping, bounding exercises

• Stair-climbing
• Dancing
• Gymnastics
• Skipping
• Aerobics

Question 20

What are 3 reasons why jumping, bounding exercises are contraindications for people with osteoporosis / fracture history?

Answer 20

1. Impact upon landing
2. Ground reaction forces, > bodyweight
3. Acceleration & deceleration forces

Question 21

What is muscle pull?

Answer 21

Progressive resistance training

Direct action of the muscle pulling on bone

Question 22

What is the intensity for muscle pull exercises?

Answer 22

High loads, low repetitions

Speed of contraction and force of contraction (short and fast contractions –> power = greatest osteogenic effect)

70-80% 1RM (Progressively work up to this! (even in elderly))

Question 23

What are 2 ways osteogenesis is stimulated?

Answer 23

1. Direct action of muscle pulling on bone
2. ↑ Effect of gravity acting on bone when the skeleton supports heavy weights

Question 24

What are 7 examples of progressive resistance training?

Answer 24

1. Triceps extension
2. Forearm pronation/supination
3. Leg Press
4. Partial Squats
5. Hip abduction/adduction
6. Hamstring curl
7. Hip flexion/extension

Question 25

What are 2 examples of how exercise can include loading through weight bearing?

Answer 25

1. Push ups against wall (partial WB) 2. Activities in 4 point kneeling * Allows progression Isolate WB through both or one LL

Question 26

What are 8 aims for exercise for osteoporotic patients?

Answer 26

1. Low impact 2. Falls prevention 3. Function 4. Posture 5. Flexibility 6. Pain relief 7. Education 8. Mobility

Question 27

\_\_\_\_\_ re-education and dynamic _____ for the trunk and limb girdles is important for osteoporosis. This is important for normalising \_\_\_\_\_\_forces

Answer 27

Postural; stabilisation; mechanical

Question 28

Usually patients with osteopenia/osteoporosis present with \_\_\_\_\_.

Answer 28

Thoracic kyphosis

Question 29

What are 3 treatment aims of osteoporotic patient with thoracic kyphosis?

Answer 29

1. Minimise flexion loads of spine 2. Encourage extended postures 3. Improve chest expansion

Question 30

What are 4 characteristics of exercises designed for a osteoporotic patient with thoracic kyphosis?

Answer 30

1. Encourage diaphragmatic breathing 2. Strengthen hip, back and neck extensors and scapular retractors 3. Stretch major upper and lower limb muscles 4. Having stronger back extensors = smaller thoracic kyphosis

Question 31

Why is postural re-education important?

Answer 31

Question 32

What are 4 features in balance and falls prevention?

Answer 32

1. Limits of stability 2. Reaching 3. Stepping tasks 4. Novel balance challenges

Question 33

What exercise is beneficial for balance and falls prevention?

Answer 33

Tai Chi

Question 34

When a patient has difficulty taking a protective step when trying to regain balance, what is something to work on?

Answer 34

Specifically work on training reactive stepping

Question 35

When a patient has balance deficits when performing daily activities (eg. reaching from a high shelf), what is something to work on?

Answer 35

Require patient to move COM to limits of stability while reaching

Question 36

What is important to understanding when training balance?

Answer 36

balance challenges are enough to bring out a training effect Eg. reach outside BOS, provide targets that will really stretch them Encourage patient to move outside there comfort zone

Question 37

What are 3 exercises to avoid in osteoporotic patients?

Answer 37

1. Hight impact loading 2. Abrupt or explosive movements 3. Trunk flexion, twisting movements and dynamic abdominal exercises

Question 38

Why are: * Hight impact loading * Abrupt or explosive movements * Trunk flexion, twisting movements and dynamic abdominal exercises exercises to avoid?

Answer 38

Risk of wedge/compression fractures

Question 39

Why are forward flexion exercises something to be avoided?

Answer 39

Increase anterior compression of spine

Question 40

Avoid movements or postures that cause the patient to adopt a slumped, head forward posture, forward flexion of the waist, rotating the spine to a point of strain, reach too far (item on high shelf) which will result in loss of ____ or increase _____ and lead to a potential \_\_\_\_.

Answer 40

balance; compression; injury