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Osteoporosis
bells between 8 and 18kg) were used to exercise the gluteus training, the intensity should be increased to 70–80% of 1RM. The
maximus, erector spinae and shoulder girdle muscles. Lifts were second strength-training session consists of 12 to 15 different isometric
started from ground level to shoulder height. exercises predominantly dedicated to the trunk and both legs. In
addition, three different belt exercises of 15 to 20 repetitions are applied
• Class 3 – a vigorous, high-impact aerobic workout was performed to the upper trunk. After the first seven months, the belt training is
with the heart rate keeping between 70 and 85% of maximum, replaced by dumb-bell and weighted vest exercises:
which was estimated as being 220 beats per minute minus age.
• Additional Home Training Sessions – isometric, belt and stretching
In 2002, the first randomised prospective study demonstrating that exercises should also be performed at home twice weekly for 25
exercise in pre-menopausal women may not only increase BMD at the minutes. An additional rope-skipping programme can be introduced
lumbar spine but also decrease the risk of vertebral fractures was 20 weeks after the start of the training programme.
published by Mehrsheed Sinaki et al. They found that progressive,
resistive back-strengthening exercise performed five days a week over • Rehabilitation – an exercise programme for osteoporosis should
two years reduced the risk for vertebral fractures 10 years later. specifically target posture, balance, gait, co-ordination and hip and
trunk stabilisation rather than general aerobic fitness. The exercise
Recommendations for Post-menopausal Women programme should focus on strengthening back muscles, which are
Besides maintaining bone strength, the main goal of exercise therapy significantly correlated with a decreased risk of vertebral fractures and
in post-menopausal women is to increase muscle mass in order to kyphosis. Hyperkyphosis is a common disfiguration after vertebral
improve parameters of muscle function such as balance and strength, fracture and may result in severe impairments of quality of life. In
which are both important risk factors for falls and – independently of patients with severe kyphosis, pressure of the lower part of the rib
bone density – risk factors for bone fractures. Kemmler and colleagues cage over the pelvic rim causes considerable flank pain and tenderness
from Erlangen, Germany, described an exercise programme that is and compromises breathing. A typical class for osteoporotic patients
effective in maintaining bone density and skeletal health in post- should consist of a warm-up, a workout and a relaxation component.
menopausal women between 48 and 60 years of age with low bone
mass. The programme consists of four sessions per week with two Warm-up: The general 10- to 15-minute warm-up may be done to music
group sessions lasting 60 to 70 minutes each and two home training and starts with gentle range of motion exercises for the major joints,
sessions of 25 minutes each: which are performed either seated or standing. The warm-up may end
with walking and simple dances in order to achieve a heart rate of
• Warm-up/Endurance Sequence – for the first three months or so, between 110 and 125 beats per minute.
gradually increase walking and running (20 minutes) to get patients
accustomed to higher impact rates. Running games can be added to Workout: The workout may consist of strengthening and stretching
promote unusual strain distributions under weight-bearing conditions. exercises to improve posture by combating medially rotated shoulders,
After three months, 10 minutes of low- to high-impact aerobic chin protrusion, thoracic kyphosis and loss of lumbar lordosis. Exercises to
exercise with an increasing amount of high-impact aerobic exercise improve balance and co-ordination may progress from heel raises and toe
can conclude the sequence. pulls to more challenging tandem walks and obstacle courses.
• Jumping Sequence – The jumping sequence starts after six months of Relaxation: The last 5 to 10 minutes of the class may be devoted to
training, when a certain kind of training adaptation has been relaxation techniques, such as deep breathing, progressive muscle
achieved. For patients who are suffering from vertebral fractures, tensing and relaxing and perhaps visualisations to a background of soft
jumping should be substituted by walking in order to reduce the music and/or nature sounds.
impact on the spine. After an introductory rope-skipping phase, more
complicated jumps (e.g. closed-leg jumps) can be attempted. In a study to investigate the efficiency of such a programme by a
Canadian group from Vancouver in women aged 65 to 75 years with
• Strength Training Sequence – this consists of two sessions, one using osteoporosis, the women who completed the programme had an
resistance machines and the other isometric exercises, elastic belts, increased ability to undertake activities of daily living, decreased back
dumb-bells and weighted vests. On the hydraulic resistance machines pain, increased general health and decreased risk of falling, whereby no
specifically designed for seated rows, back extension, abdominal flexion patient suffered an exercise-related injury. A newly developed spinal
or bench-press exercises affecting all main muscle groups are orthosis, which is worn like a backpad, has been shown to improve
performed. Exercise intensity should be increased slowly. posture, trunk muscle strength and several parameters of quality of life in
postmenopausal women with vertebral fractures due to osteoporosis.
In the first three months, two sets of 20 repetitions at 50% of the one-
repetition maximum (1RM) are performed. The 1RM is the maximum Dietary recommendations should focus on an adequate intake of
mass of a free weight or other resistance that can be moved by a muscle calcium and vitamin D. Several randomised controlled clinical trials have
group through the full range of motion with good form one time only. shown that a supplementation with 800 international units (IU) of plain
Especially in patients with low bone mass, the 1RM should be determined vitamin D and 1200mg of elemental calcium per day may reduce the
very cautiously in order to avoid vertebral fractures. After three months, number of falls as well as the number of non-vertebral fractures in
two sets of 15 repetitions at 60% of 1RM and after five months two sets the ambulatory elderly at the age of 65 years or older and in frail
of 15 repetitions at 65% of 1RM are performed. After seven months of institutionalised persons. ■
94 EUROPEAN MUSCULOSKELETAL REVIEW 2007
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