Module D
Module E
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Section 5: What about high impact exercise?

The Potential of HIGH IMPACT Programs

The mechanostat theory16dictates that bone adaptation is a response system likened to a thermostat in which a set point, or minimum effective strain (MES), is determined by internal & external factors and therefore respond to loads above or below these MES points with either bone formation or resorption. Simply put, load the bone above its natural MES, and it will adapt the bone to support the new demand; conversely, unloading the bone (below its MES) and the BMD will decline to meet its new metabolic environment.

Bottom Line

Theoretically, brief, unique, high impact exercise should induce bone formation. Research supporting this theory exists in premenopausal women, however physiologic factors (ie., hormonal, co-morbidities, aging) may prevent similar adaptions in older adults, and other factors (pain, restrictions with co-morbidities, fear, etc.) may prevent the safe or successful implementation of high impact programs in older adults.

LIFTMOR trial, Watson et al. (2018)4

  • supervised group exercise, high intensity resistance training (deadlift, overhead press, back squat) at 80-85% 1RM (5 sets of 5 reps) + impact loading (jumping chin ups with drop landing)
  • 8 months, 2x/week, 30 minutes
  • 101 (52 control, 49 exercise) healthy older adults with osteoporosis and no underlying musculoskeletal or cardiovascular comorbidities (excluded people with a recent fracture)
  • 1 participant reported low back strain, but did not withdraw from the study
  • Found improved lumbar spine and femoral neck BMD compared to control group, and improved lower extremity and back extensor strength, TUG, five time sit to stand, and functional reach test
  • BUT did not measure vertebral fractures post and excluded people with a recent fracture – silent could have occurred throughout program