EXERCISE PRESCRIPTION

FOR OSTEOPOROSIS
PREVENTION
By. Ade Jeanne D.L. Tobing

Dibacakan pada PIT PEROSI. Surabaya, October 27th, 2018

Muscle Strength Change in Aging
Willmore, Physiology of sports and exercise, 2008

3
 Exercise
Wollf theory
Prof. Julius Wolff (1892): “The Law of Bone Remodeling”
The bones became stronger in reponse to increased exercise,
wich would make the bones less likely to fracture.
Bonnick SL. The Osteoporosis Handbook

Weight bearing exercise

running, jumping

Muscle pump

Strong and Dense Bones

A report from Sweden examined the bone density in thighs:

A
64 world- class athletes:
B
• 11 weight lifters C
24 healthy men who
• 25 runners 15 men who did not exercise
exercised for fitness
• 15 soccer players
• 9 swimmers
• 4 throwers.
The nonathletes who exercise had a
all these athletes had a higher higher bone density than nonexercising
bone density than the nonathletes group.

The other interesting finding:

a difference among the athletes bone
density depending on the sport.
The weight lifters had the greatest
bone density, followed by the runners
and soccer players and swimmers came
last. Bonnick SL. The Osteoporosis Handbook
 Exercise prescription:
FITT= Frequency Intensity Time Type

Frequency:
• Weight-bearing aerobic activities 3-5 d.w-1
• Resistance exercise: 2-3 d.w-1
Intensity:
• Weight bearing aerobic activities: moderate, high
Osteoporosis: Moderate.
• resistance exercise: dumbell, barbel, elastic band, machine
8-10 major muscles, 8-12 repetition, 1-3 set
Time
• 30-60 min.d-1 of combination of weight bearing aerobic and resistance activities.
Type
• Weight bearing aerobic activities: tennis, stair climbing/desending, walking with
intermittent jogging
• Activities that involve jumping: volleyball, basketball
• Resistance exercise: weight lifting
ACSM’s Guidelines for Exercise Testing and Prescription. 8th edition. 2010
 Primary Secondary Tertiary
(healthy people) (Osteoporosis) (Severe Osteoporosis +
bone fracture)
Age Children-adolescent-  50 yo  70 yo
young adult (menopause) Post menopause

Target Prevent osteoporosis Prevent bone fracture Prevent recurrent fractures

Exercise Weight bearing Specific, individual, under Rehabilitation, gradually.

supervision.
Location of fractures due to osteoporosis:

LUMBAL

RADIUS

NECK FEMUR
 Stage of exercise

Warm up Main exercise Cool down

- Aerobic moderate Int
- Aerobic light intensity - Aerobic light intensity
- Strengthening
- Stretching - Stretching
- Balance
5-10’ 5-10’
20-60’
Warm up (5-10’)
- Chair aerobic light intensity
- Stretching
Main exercise (30-40’)
- Aerobic moderate Intensity
- Strengthening:
dumble, stick, calistenic,
matras
- Balance
Strengthening exercise Exercise is site specific
If you want strong spine you must exercise the
spine
If you want strong legs you must exercise the legs
Bonnick SL. The Osteoporosis Handbook

Strengthening wrist

Strengthening hip

Strengthening back
Back Extension Exercises Bonnick SL. The Osteoporosis Handbook

Sinaki M:
• Designed specifically for the woman with osteoporosis.
• Excellent exercises, even for the woman who is still limited
somewhat by pain from recent spinal fracture.
• Very safe even for a fragile spine
• The benefits are reduction in pain and increase in the strength of
the muscles that support the spine.
• Back fatique and weakness are reduced too.
Isometric Abdominal Exercises
• The abdominal muscles also help to support the back
• Many familiar exercises for the stomach mucles infolve trunk
flexion, eq: sit-ups
(Women with Osteoporosis: partial sit-up).

Partial sit-up Pelvic tilt

Cool down (5-10)
- Aerobic light intensity
- Stretching
 The Four Exercise DON’Ts for the Woman with Osteoporosis

DON’T perform any exercise or activity

• Impact loading of the spine.
No jumping, no high-impact aerobics, no jogging, no running.

• to bend forward from the waist with the back rounded (spinal flexion)
No sit –ups, to toe touches, no crunches, no rowing machines.

• makes falls.
No trampolines, step aerobics.

• move leg sideways or across body against resistance:

(abduction and adduction)
Avoid these exercises:

Bonnick SL. The Osteoporosis Handbook

 “Senam Pencegahan Osteoporosis Seri-1”
 Suwarno S. Tesis 2001
 46 healthy young women, 25-35
yo
 never done any exercise before

 3 times a week of this exercise for 3,5 months

 Bone Mineral Density (BMD)

• A significant increase of the ulna and vertebral lumbal.

 “Senam Osteoporosis”
• 34 women post menopause
• The average age of the subjects was 64.3 years
• Training 3 times a week for 1-4 years
• The mean BMD of the lumbar spine prior to exercise was -2.42
• Post exercise measurement the mean BMD was -2.10
• A significant increase of Lumbal bone mineral density.
“Senam Osteoporosis”
 53 post-menopausal women who were
joining the Senam Osteoporosis group.
 three times a week
 1-hour-exercise program
 for various durations from 2008 to 2011
 exercises were done using 1-kilogram
dumbell

After- before:
- hand grip strength test
- wrist BMD examination

a significant increase of hand grip strength

and wrist BMD (p=0.000 for both analysis)
Conclusion:
• Osteoporosis is preventable and treatable through many ways ,
one of them is exercise.
• The most important is strengthening exercise.
• Exercise is site specific.
• Exercise should be program individually.
Move it or lose it