Exercise for osteoporosis--is walking enough? The case for site specificity and resistive exercise

Considerations in treating physically active older adults and aging athletes

Life spans are increasing and research is showing more and more how important exercise is to successful aging. Medical practitioners need to appreciate the physiologic and physical changes that occur with age, as well as the significant benefits of physical activity, so they not only can properly treat their older patients but also so they can promote the benefits of exercise to their sedentary older patients.

The effectiveness of walking as an intervention for low back pain: a systematic review

As current low back pain (LBP) guidelines do not specifically advocate walking as an intervention, this review has explored for the effectiveness of walking in managing acute and chronic LBP. CINAHL, Medline, AMED, EMBASE, PubMed, Cochrane and Scopus databases, as well as a hand search of reference lists of retrieved articles, were searched. The search was restricted to studies in the English language. Studies were included when walking was identified as an intervention. Four studies met inclusion criteria, and were assessed with a quality checklist. Three lower ranked studies reported a reduction in LBP from a walking intervention, while the highest ranked study observed no effect. Heterogeneity of study design made it difficult to draw comparisons between studies. There is only low-moderate evidence for walking as an effective intervention strategy for LBP. Further investigation is required to investigate the strength of effect for walking as a primary intervention in the management of acute and chronic LBP.

Association between moderate physical activity, spinal motion and back muscle strength in postmenopausal women with and without osteoporosis

OBJECTIVE

The purpose of this study was to determine whether physical activity levels of postmenopausal women were associated with their bone mineral density (BMD), back extensor strength (BES), severity of thoracic kyphosis and range of spinal motion.

METHOD

This study adopted a cross-sectional design. 189 female subjects from 50 to 80 years of age were divided into moderately active (n=63) and sedentary (n=126) groups according to their physical activity level, which is measured by the physical activity score. BMD (lumbar spine and hip), BES, severity of thoracic kyphosis and range of spinal motion in the sagittal and frontal plane were measured in each subject.

RESULTS

The groups differed significantly in the range of spinal motion in the sagittal plane (p = 0.01) (moderately active: 26.9 +/- 10.8; sedentary: 23.0 +/- 10.2), as well as in the right frontal plane (p < 0.001) (moderately active: 27.1 +/- 6.4; sedentary: 23.4 +/- 7.5) and left frontal plane (p < 0.001) (moderately active: 27.6 +/- 6.5; sedentary 23.7 +/- 7.4). There were no significant differences in BMD (active: 0.88 +/- 0.18 g/cm2; sedentary: 0.98 +/- 0.15 g/cm2), severity of thoracic kyphosis (active: 52.9 +/- 12.4; sedentary: 51.9 +/- 11.8) or BES (active: 49.0 N +/- 14.6; sedentary: 46.6 N +/- 15.1).

CONCLUSIONS

This study demonstrates that active women had better range of spinal motion than sedentary women, but they did not differ significantly in severity of thoracic kyphosis, BES and BMD.

Health behaviors in breast cancer survivors experiencing bone loss

PURPOSE

To describe the baseline healthy lifestyle behaviors (dietary, calcium, vitamin D, caffeine and alcohol intake, smoking history, and physical activity) of postmenopausal breast cancer survivors (BCS); and to identify any relationship of healthy lifestyle behaviors with bone mineral density (BMD) at the forearm, total hip and spine, L1-L4.

DATA SOURCES

Self-reported responses to a demographic and health status questionnaire, to a 3-day Diet Record, and to the 7-Day Physical Activity Questionnaire-Adapted provided data for the lifestyle behaviors. Baseline BMD (g/cm(2)) was determined with dual-energy x-ray absorptiometry (DEXA). Height, weight, and body mass index (BMI) were also measured in each of the 249 postmenopausal BCS.

CONCLUSIONS

There was an imbalance between consumed kilocalories and expenditure of energy. The majority of BCS were overweight or obese. They consumed less fruit and vegetable servings than recommended by the new 2005 U.S. Department of Agriculture's dietary guidelines, less dairy products, below average recommended grains and fiber, less protein and carbohydrate intake, and a slightly higher fat gram intake. Approximately, 43% did not take any supplemental calcium, with 46% taking less than 1000 mg a day. Likewise, 52.59% consumed less than 400 IU of vitamin D with both supplemental and dietary intake. This group of BCS consumed below accepted levels of caffeine and alcohol. Only 18 BCS continued to smoke. This group spent an average of 10.36 h in light (sedentary) activities on a daily basis. There were significant negative relationships with bone mass (g/cm(2)) at the total hip and daily intake of caffeine/mg and daily grams of alcohol. Weight and BMI both demonstrated a significant relationship with bone mass (g/cm(2)) at the total hip, spine L1-L4, and the forearm.

IMPLICATIONS FOR PRACTICE

The healthcare provider must incorporate appropriate teaching strategies, intensive counseling, and coaching, along with a support mechanism, to enable BCS to understand the importance of a healthy diet, calcium, and vitamin D supplement, and a regular strength/weight program that will be integrated into their daily lifestyle. Early DEXA screens should be part of the protocol with BCS, and there is a particular need for forearm DEXA screens to be included in the treatment protocol for BCS.

The effect of weighted vest walking on metabolic responses and ground reaction forces

PURPOSE

This study examined how oxygen consumption, relative exercise intensity, vertical ground reaction forces (VGRF), and loading rate (LR) were affected while using a weighted vest (WV) during treadmill walking.

METHODS

A sample of 10 (aged 23.4 +/- 1.7 yr) subjects performed a standardized walking test (4-min stages at 0.89, 1.12, 1.34, 1.56, and 1.79 m x s(-1)) on a treadmill under four weighted vest conditions (0, 10, 15, and 20% of body mass (BM)). Dependent variables included oxygen consumption (VO2), relative exercise intensity, first (F1) and second (F2) peaks of the VGRF curve, and LR.

RESULTS

Repeated-measures ANOVA revealed significant vest versus speed interaction for V O2 and relative exercise intensity. Follow-up contrasts showed significant vest effect differences between 0% BM and all other WV conditions, and between 10 and 20% BM at all speeds for V O2. Follow-up analysis of relative exercise intensity demonstrated no significant vest effect difference at slower speeds, but significant differences at higher speeds. A significant main effect for WV condition was found for F1, F2, and LR. Follow-up testing revealed F1 and F2 at 0% BM were significantly different than at 10, 15, and 20% BM. F1 and F2 at 10% BM were significantly different than 20% BM, whereas F1 at 15% BM was significantly different than at 20% BM. LR at 0% BM was significantly different than at 15 and 20% BM.

CONCLUSION

Using a weighted vest can increase the metabolic costs, relative exercise intensity, and loading of the skeletal system during walking.

Relationships between muscle strength and bone mineral density of three body regions in sedentary postmenopausal women

This cross-sectional study was designed to investigate correlations between muscle strength and regional bone mineral density (BMD) in sedentary postmenopausal women. Sixty-two women who ranged in age from 41 to 76 years were investigated. Hip and trunk muscle strength was measured by isokinetic dynamometry. Grip strength of the nondominant hand was measured using a hand-held dynamometer. Bone mineral density of the lumbar spine, femur, and distal radius was measured by dual-energy X-ray absorptiometry. Only the correlation between hip abductor strength and femoral BMD was significant (P = 0.009, r = 0.327). There was no correlation between trunk muscle strength and lumbar vertebral BMD or between grip strength and distal radius BMD. Subjects with osteoporosis (T score < -2.5) or osteopenia T (-2.5 to -1) and normal subjects (T > -1) exhibited similar isokinetic hip and trunk muscle strength. Women with osteoporotic distal radii had significantly lower grip strength than subjects who were osteopenic or normal at this site, but the osteoporotic group was also significantly older. In conclusion, our results indicate that the isokinetic strength of hip abductors weakly correlates with femoral BMD in postmenopausal women with and without osteoporosis. Trunk muscle strength did not correlate with lumbar vertebral BMD in either of these groups. The weaker handgrip we observed in the women with osteoporotic radii may be attributed to older age.

Weight lifted in strength training predicts bone change in postmenopausal women

PURPOSE

The aim of this study was to examine the relationship between weight lifted in 1 yr of progressive strength training and change in bone mineral density (BMD) in a group of calcium-replete, postmenopausal women.

METHODS

As part of a large clinical trial, 140 calcium-supplemented women, 44-66 yr old, were randomized to a 1-yr progressive strength-training program. Half of the women were using hormone replacement therapy. Three times weekly, subjects completed two sets of six to eight repetitions in eight core exercises at 70-80% of one repetition maximum. BMD was measured at baseline and 1 yr.

RESULTS

In multiple linear regression, the increase in femur trochanter (FT) BMD was positively related to total weight lifted (0.001 g.cm (-2)) for a SD of weight lifted, P< 0.01) after adjusting for age, baseline factors, HRT status, weight change, cohort, and fitness center. The weighted squats showed the strongest (0.002 g.cm(-2)) for a SD of weight lifted, P< 0.001), whereas the back extension exhibited the weakest (0.0005 g.cm(-2)) for a SD of weight lifted, P< 0.26) association with change in FT BMD. The amount of weight lifted in the weighted march exercise was significantly related to total body BMD (0.0006 g.cm(-2)) for a SD of weight lifted, P< 0.01). The associations between weight lifted and BMD for the femur neck or lumbar spine were not significant.

CONCLUSION

Evidence of a linear relationship between BMD change and total and exercise-specific weight lifted in a 1-yr strength-training program reinforces the positive association between this type of exercise and BMD in postmenopausal women.

Physical therapy and exercise in pain management

Physical therapy and exercise are fundamental to the interdisciplinary approach to pain management in the elderly. Physical modalities used in combination with exercise provide pain relief and help to prevent future pathology and physiologic changes in the elderly that often result in significant pain syndromes. This article provides an overview of effective modalities for pathology prevention, treatment of pain, and restoration of function that are the basis for pain management in geriatric patients.

The A, B, C's of bone building in adolescence

The majority of treatment for osteoporosis has focused on secondary and tertiary strategies that attempt to preserve acquired adult bone mass. However, the occurrence of osteoporosis and its related physical and economic sequelae continue to escalate, resulting in devastating morbidity and mortality in later adulthood because of bone fractures. Mounting evidence continues to support primary intervention strategies that target adolescents during skeletal maturation as effective in building bone mass reserves with the power to resist the threat of osteoporotic fractures. Nurse practitioners need to exercise their expertise as primary care providers by teaching adolescents and their families the A, B, Cs of bone building with calcium, vitamin D and exercise.