Clinical Kit 30-1-2015 Too Fit to Fracture Exercise Recommendations

Hi

Too Fit To Fracture: Exercise recommendations for individuals with osteoporosis or osteoporotic vertebral fracture.

Defining Activity and Exercise

Not sure about you, but I find I regularly explain to clients the important difference between activity and exercise. Physical activity refers to “… any bodily movement produced by skeletal muscles that results in energy expenditure,” whereas exercise is defined as “… physical activity that is planned, structured, repetitive and purposive in the sense that improvement or maintenance of one or more components of physical fitness is an objective”. When looking at improving physical fitness components, the focus maybe strength, aerobic capacity, balance, flexibility or several at once.

Guideline Recommendations

For individuals with osteoporosis:

1. Strongly recommend that individuals with osteoporosis engage in a multicomponent exercise program that includes resistance training in combination with balance training.
2. Recommend that individuals with osteoporosis do not engage in aerobic training to the exclusion of resistance or balance training.

For individuals with osteoporotic vertebral fracture:

1. Consultation with a physical therapist is suggested to ensure safe and appropriate exercise. Strongly recommend that individuals with osteoporotic vertebral fracture engage in a multicomponent exercise program that includes resistance training in combination with balance training.
2. Recommend that individuals with osteoporotic vertebral fracture do not engage in aerobic training to the exclusion of resistance or balance training.

Potential Risks

The potential risk of falls or fractures during exercise should be considered in the design and execution of exercise programs in the target groups. Individuals at high risk of fracture should consider consulting a physical therapist with expertise in osteoporosis prior to initiating a new exercise program, and all individuals with osteoporosis should learn how to move safely or take precautions when performing twisting or bending during transitions between movements, when working with loads, when performing movements that challenge balance, or when performing activities outdoors in slippery weather.

Specifics

Progressive Resistance Training

Those with osteoporosis or osteoporotic vertebral fractures, should participate in a multicomponent exercise program that includes progressive resistance training program for all major muscle groups, a minimum of twice per week. Exercises target all large muscle groups, with a target intensity of two sets of at least 8–12 repetitions maximum for those that can tolerate it. New comers to resistance training will ideally seek professional guidance in structuring a program and learning to correctly perform exercises. Resistance training exercises can include those that use resistance bands or cables, free weights, or body weight to provide resistance.

Balance Training

The specific aim here is to accumulate 2 hrs. of balance training weekly (~15–20 min per day) , where daily training can be performed all at once, in short bouts throughout the day, or incorporated into daily activities. This could involve washing dishes on one leg, walking heel to toe along the hallway, standing behind sofa when watching television and performing shallow single leg squats, heel raises or single leg swings. The key here is to observe a high degree of safety while challenging balance systems by having proximity to a wall, sofa or bench.

Aerobic Training

Aerobic training is placed last, as it is often the case that health professionals firstly advocate walking as a form of fitness, often neglecting strength and balance training which are arguable equal or more important than walking. Common aerobic guidelines for duration, intensity and frequency are 150–300 min per week of moderate intensity or 75–150 min per week of vigorous intensity aerobic physical activity, in bouts of 10 minutes or more. Exercise intensity is often measured using a 0–10 scale, where 0 = sitting and 10 = working as hard as you can; moderate is 5–6, and vigorous is 7–8.

All the best,

Doug Cary FACP
Specialist Musculoskeletal Physiotherapist (awarded by Australian College of Physiotherapy, 2009)
PhD Candidate Curtin University
Clinical Director AAP Education

email: doug@aapeducation.com.au

ph/fx: 08 90715055

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