Osteoporosis, falls and exercise

Abstract

Osteoporosis, a manifestation of bone atrophy that leads to great susceptibility to fractures, is a very important public health problem today because of its great morbidity, mortality and important economic repercussions. It is a problem that will tend to become more serious with the increase in the number of elderly persons. Bone mass is gained during adolescence, reaches a plateau during the third decade and remains stable until approximately age 50, after which a progressively gradual loss is observed. There is no real cure for osteoporosis, but a series of strategies can be used to reduce bone loss and improve bone mass. Osteoporosis has been considered a disease that accompanies the process of ageing; however, this fatalistic attitude should be discarded, as it is possible to correct and decrease the risk factors. Intervention strategies are based on three pillars: nutrition, physical activity and pharmacological agents. Physical activities and exercise programmes are important because they not only can counter the loss of bone mass but also improve neuromuscular capacity, maintaining and increasing strength and muscle mass, which can help to avoid falls and reduce their impact and consequences. The general principles that apply to any exercise programme also apply to preventing bone mass loss. They also can be applied to persons with osteoporosis. However, to understand the peculiarities of these programmes, the propensity for suffering fractures of these former groups should be kept in mind. Special care should be taken to avoid falls and injuries. Weight-bearing exercise and resistance training are recommended for the prevention programmes. Other activities such as tai-chi, dancing, gymnastic or callisthenic exercises can help to improve balance, gait and muscle coordination and diminish the risk of falling. These programmes should be complemented with postural education and a series of safety precautions.

The Effect of Exercise on Bone Mineral Density, Bone Markers and Postural Stability in Subjects with Osteoporosis

“…And so the major effect did not lie in changing the physiology of the load but rather in improving body posture, adjusting muscle imbalances and postural stability. Melendez-Ortega (2007) states that the amplitude of the load plays a more important role for bone density than number of repetitions. Repeated strain of bones above the physiological limit might lead to injury or even bone fracture.…”

“…In order to maintain desirable optimal amount of BMD, it is required to keep an optimal level of tension relating to functional load given by physical activity (Melendez-Ortega, 2007). Mechanic load, induced in the course of exercise, is essential for adaptation of bone architecture in the place of the load (Vainionpää et al, 2005).…”

Effects of water-based exercise on bone health of middle-aged and older adults: a systematic review and meta-analysis

“…It is well known that avoidance of tobacco and adequate serum levels of calcium and vitamin D are essential for bone health 34–36. Physical activity has been shown to be an effective nonpharmacological approach to improve bone mass; however, not all types of exercise have been definitively shown to promote positive effects on bone metabolism 37.…”

Avaliação prospectiva de um programa de exercícios aquáticos sobre parâmetros morfométricos vertebrais em mulheres na pós menopausa

“…No contexto da indicação dos exercícios para a prática segura de mulheres com fraturas, atividades na água para aqueles indivíduos mais debilitados e com riscos de fraturas parecem funcionar adequadamente. A resistência na água permite variação de carga alterando velocidade de movimentação, área de contato e amplitude para regulação, ao mesmo tempo em que este meio suporta o peso corporal e oferece segurança para a prática (BRAVO et al, 1997;DEVEREUX et al, 2005;MELÉNDEZ-ORTEGA, 2007;ROTSTEIN et al, 2008). Além disto, o meio aquático abrange praticantes como idosos, pessoas com limitações físicas, gestantes e indivíduos com osteoporose que podem não estar aptos a desenvolver exercícios em solo por várias razões.…”