7/17/2009. Bone Health and Osteoporosis, 2004 Report of the Surgeon General

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UCSF 6th Annual Osteoporosis: New Insights in Research, Diagnosis & Clinical Care Objectives Physical Activity & Bone Health Wendy Katzman, PT, DPTSc, OCS UCSF Department of

fitness level and risk factors specific indications contraindications Effects of Exercise Maximizes peak bone mass achieved in youth Maintains bone mass or reduce age-related

1 UCSF 6th Annual Osteoporosis: New Insights in Research, Diagnosis & Clinical Care Objectives Physical Activity & Bone Health Wendy Katzman, PT, DPTSc, OCS UCSF Department of Physical Therapy & Rehabilitation Science School of Medicine Review BMD development across the lifespan Systematic reviews (2) exercise effects on bone Recommendations age, fitness level and risk factors specific indications contraindications Effects of Exercise Maximizes peak bone mass achieved in youth Maintains bone mass or reduce age-related bone loss Preserves muscle strength & postural stability (Beck & Snow, 2001) Bone Health and Osteoporosis, 2004 Report of the Surgeon General 1

Children & Adolescents Hind, K, 2007 Children & Adolescent Hind, K, 2007 Combined age effects

5 Premenopausal Women Wallace BA, 2000 Premenopausal Women Wallace BA, 2000 Effect of

Snow-Harter Total Non Impact Lumbar Spine IMPACT EXERCISES NON IMPACT EXERCISES -20-10 0 10

2 Children & Adolescents Hind, K, 2007 Children & Adolescent Hind, K, 2007 Combined age effects of exercise over 6 mos. Site Min (%) Max (%) Femoral neck Lumbar spine Premenopausal Women Wallace BA, 2000 Premenopausal Women Wallace BA, 2000 Effect of Exercise on BMD Bassey Heinonen Snow-Harter Total Impact Blimke Dornemann Lohman Sinaki Snow-Harter Total Non Impact Lumbar Spine IMPACT EXERCISES NON IMPACT EXERCISES Effect of Exercise on BMD Femoral Neck Bassey Heinonen Snow-Harter Total Impact IMPACT EXERCISES

3 Postmenopausal Women Wallace BA, 2000 Postmenopausal Women Wallace BA, 2000 Effect of Exercise on BMD Lumbar Spine Bassey Bravo Ebrahim Grove Hatori Lau Martin McMurdo Prince Total Impact Nelson Notelovitz Pruitt Revel Sinaki Smidt Total Non Impact IMPACT EXERCISES NON IMPACT EXERCISES Effect of Exercise on BMD Femoral Neck Bassey Bravo Ebrahim Lau Prince Total Impact Nelson Pruitt Smidt Total Non Impact IMPACT EXERCISES NON IMPACT EXERCISES Effects of Exercise Premenopausal women Wallace, BA, 2000 % annualized effect (95% CI) Spine, impact 1.5% (0.6%-2.4%) Spine, non-impact 1.3% (0.8%-1.8%) Femoral neck, impact 0.7% (-0.3% 0.3%-1.7%) Femoral neck, non-impact Postmenopausal women Insufficient data Spine, impact 1.3% (0.7%-1.9%) Spine, non-impact 1.0% (0.4%-1.6%) Femoral neck, impact 0.5% (0.1%-0.9%) 0.9%) Femoral neck, non-impact 1.4% (0.2%-2.6%) 2.6%) Optimal Strain Maintains and Builds Bone Overload (Fuchs, 2002, Martin RB, 2000) Novel stimulus (Fuchs 2002, Frost HM, 2001) Specificity (Kelley GA, 2000) Reversibility Diminishing returns (Robling, 2001) Reversibility (Martin, RB, 2000; Turner, CB, 1995) 3

Exercise Strengthens Bone and Muscle High-Impact Weight-Bearing

gymnastics (Frost HM, 2001; Martin RB, 2000) Exercise Strengthens

tubing body weight (Kelley GA, 1998; Kerr D, 1996) Exercise Prevents

(Tinetti, ME, 1994; Wolff, SL, 2003, 2006; Chan, K, 2004)

$fractures ( Huang, 2006) Increased spinal loads (Briggs AM, 2007;$

4 Exercise Strengthens Bone and Muscle High-Impact Weight-Bearing jumping step aerobics and stairs dancing soccer racquet sports gymnastics (Frost HM, 2001; Martin RB, 2000) Exercise Strengthens Bone and Muscle Resistance and Strength Training weights elastic tubing body weight (Kelley GA, 1998; Kerr D, 1996) Exercise Prevents Falls Balance and coordination Tai Chi Unstable, uneven surface (Tinetti, ME, 1994; Wolff, SL, 2003, 2006; Chan, K, 2004) Hyperkyphosis Increases Fracture Risk Increased risk for future fractures ( Huang, 2006) Increased spinal loads (Briggs AM, 2007; Bouxsein ML, 2006) Flexion exercise increases fractures (Sinaki M, 2002; Itoi E, 1996, Sinaki M, 1994) 4

Risk Factors for Hyperkyphosis Exercise Reduces Hyperkyphosis Spinal extensor muscle weakness

Impaired balance and perception of upright (Sinaki M, 2005) Spinal extensor muscle

$Regular walkers have risk of hip fracture lifetime walker is best increased activity beneficial$ (Coupland, 1999; Krall, 1994) risk doubles weight bearing less than 4 hours a day (Cummings SR,

(Coupland, 1999; Krall, 1994) risk doubles weight bearing less than 4 hours a day (Cummings SR,

5 Risk Factors for Hyperkyphosis Exercise Reduces Hyperkyphosis Spinal extensor muscle weakness (Sinaki M, 1996) Decreased shoulder, hip, thoracic mobility (Hinman MR, 2004; Balzini L, 2003) Impaired balance and perception of upright (Sinaki M, 2005) Spinal extensor muscle strengthening, yoga, multi-dimensional group exercise (Pawlowsky S, 2009; Katzman WB 2007; Renno ACM, 2005; Benedetti MG, 2005; Sinaki M, 2002; Greendale G, 2002) 02) What About Walking? Regular walkers have risk of hip fracture lifetime walker is best increased activity beneficial (Coupland, 1999; Krall, 1994) risk doubles weight bearing less than 4 hours a day (Cummings SR, 2007) What About Running? Short bouts varied speed and intensity Over-exercise exercise detrimental to bones 5

6 What About Jumping? Strong osteogenic effect among children tibial strength in post-menopausal women (Uusi-Rasi, 2003) high rate of injury Guidelines for Exercise Children and adolescents: high-impact, impact, high-intensity intensity exercise minutes multiple times a day at least 3 days a week (American College of Sports Medicine Position Stand: Physical Activity and Bone Health, 2004; Bass S, 1998; MacKelvie JK, 2003; Bradney M, 1998) Guidelines for Exercise Healthy adults: moderate- to high-intensity intensity exercise weight-bearing activity 3-5 times per week resistance exercise 2-3 times per week minutes a day of a combination (American College of Sports Medicine Position Stand: Physical Activity and Bone Health, 2004) Guidelines for Exercise Healthy adults over 50: moderate intensity exercise weight-bearing activity 3-5 times per week resistance exercise 2-3 times per week minutes a day of a combination balance and coordination core stabilization and posture (American College of Sports Medicine Position Stand: Physical Activity & Bone Health, 2004) 6

$for fracture weight bearing and resistance exercises avoid high impact exercises$ postural training balance and coordination consult a physical therapist Precautions

postural training balance and coordination consult a physical therapist Precautions

$Exercise reduces fracture risk * Customize exercise prescriptions * Compliance is$

7 Guidelines for Exercise Those with osteoporosis, poor fitness, moderate/high risk for fracture weight bearing and resistance exercises avoid high impact exercises postural training balance and coordination consult a physical therapist Precautions Avoid flexion stress on the spine Postural alignment Caution re: yoga, pilates Safe Body Mechanics Avoid bending, twisting or flexing the spine Hip hinge Conclusions * Exercise reduces fracture risk * Customize exercise prescriptions * Compliance is key 7

8 Thank you! Activity Level and Fracture Risk Melioguide.com,

Kyphosis: Causes, Consequences. and Treatments. Disclosures. Roadmap. Sagittal Plane Alignment. None

Kyphosis: Causes, Consequences Disclosures and Treatments None Wendy Katzman, PT, DPTSc, OCS Department of Physical Therapy and Rehabilitation Science University of California San Francisco Roadmap Sagittal