Section 1: Exercise for osteoporosis in general Copy

A Guide for an OSTEOPOROSIS EXERCISE ACTION PLAN.

Locate a Bone Fit trained instructor: English: 1-800-463-6842 / French: 1-800-977-1778 or www.bonefit.ca

Type	How often per week?	How hard should I work?	Examples and Comments
Strength Training	≥2 days a week	8-12 repetitions per exercise. Intensity of 5-8 on a 0-10 scale 0=rest, 10=max	Min. 1 exercise each for: legs; arms; chest; shoulders; back. Use: exercise bands; weights, or body weight against gravity. 1-3 sets/exercise. Train at ↓ intensity initially if: sedentary; conditions affecting activity; high fracture risk; strength training novice. See “Intro to theraband” in videos.
Balance Training	Daily for ≥15-20min	Progress from “standing still” exercises” to dynamic.	Can do during daily walks or activities: Standing still: ↓ base of support e.g., Semi-tandem stance, one-leg stand; shift weight between heels & toes while standing Dynamic movements: Tai Chi; tandem walk, dancing
Aerobic Exercise	≥5 days per week, ≥30min/day	Moderate- to vigorous- intensity	Do bouts of 10 minutes or more – accumulate 30min/day. On a 0-10 scale where 0=rest, and 10=max.effort, aim for intensity of 5-8.
Spine Sparing	During Daily Activities	Alignment more important than intensity.	Modify activities that flex (bending forward) or twist the spine; most risky when rapid, repetitive, weighted, bending all the way forward, or twisting to the side. Videos: www.osteoporosis.ca/after-the-fracture/videos/
Back Extensor Training	Daily for 5-10 min	Perform “holds” 3-5 seconds.	Use Bone Fit back extensor strengthening exercises

Other POSITIVE EFFECTS of Exercise in OP:

Exercise reduces the risk of falls and fractures in osteopenic women already at risk

A 10-week comprehensive exercise & balance program reduced back pain, improved quality of life and balance (Lindsay, 2005) in post-menopausal women with vertebral fractures

A 12-week home-based trunk strengthening program enhanced quality of life in postmenopausal osteoporotic & osteopenic women (Chien, 2005)

A low-intensity back strengthening exercise program effectively improved quality of life in osteoporotic patients (Gillespie, 2009)

A recent Cochrane review (Hongo, 2007) determined that multiple component group exercise, Tai Chi in a group, and individually prescribed multiple component home exercise all reduces the rates of falls and risk of falling.

If the treatment goal is to prevent falls, a recent systematic review (Sherrington, 2008) indicates that the inclusion of balance retraining in an exercise program is important. Furthermore, the criterion for a minimal effective exercise dose would equate to a twice weekly program over 25 weeks. Lastly, the study revealed that exercise programs which did not include walking were more effective in prevention of falls. Therefore, walking programs should not be relied upon as a means to prevent falls.

References

Chien, M. Y., Yang, R. S., & Tsauo, J. Y. (2005). Home-based trunk-strengthening exercise for osteoporotic and osteopenic postmenopausal women without fracture--a pilot study. Clin Rehabil, 19(1), 28-36.

Gillespie, L.D., Robertson, M.C., Gillespie, W.J., Lamb, S.E., Gates, S., Cumming, R.G., Rowe, B.H.(2009). Interventions for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews, Issue 2. Art. No.: CD007146. DOI: 10.1002/14651858.CD007146.pub2.

Hongo, M., Itoi, E., Sinaki, M., Miyakoshi, N., Shimada, Y., Maekawa, S., et al. (2007). Effect of low- intensity back exercise on quality of life and back extensor strength in patients with osteoporosis: a randomized controlled trial. Osteoporos Int, 18(10), 1389-1395

Lindsay, R., Burge, R.T., Strauss, D.M. (2005). One year outcomes and costs following a vertebral fracture. Osteoporosis Int, 16:78-85.

Sherrington, C., Whitney, J.C., Lord, S.R., Herbert, R.D., Cumming, R.G., Close, J.C. (2008). Effective exercise for the prevention of falls: a systematic review and meta-analysis. J Am Geriatr Soc, 56(12): 2234-43.