EXERCISE PRESCRIPTION IN OSTEOPOROSIS Mrs M lived close to the local leisure centre and agreed to attend a Tai Chi class as one of her friends also attended. She was not keen on attending the gym but together with her daughter and grandchildren started to walk regularly in the local park. Over the course of the next 6 months, she gradually increased her distances, venturing into town and even to the countryside occasionally. She found Tai Chi beneficial from her increased physical confidence and also from the social perspective. A follow-up DXA scan early the next year (recommended 3 years after initial diagnosis) showed a marginal improvement in T-score at the femoral neck, with no deterioration at the spine. Impact or weight bearing activities suitable in osteoporosis include walking, jogging, dancing, stair climbing and fitness classes such as aerobics, pilates and Tai Chi. Swimming and cycling, while of benefit in maintaining strength and musculoskeletal health, do not load bone as effectively. The emphasis should be on incorporating activities that the patient enjoys into their daily routine. Ballistic, plyometric and other explosive types of activity should be avoided in osteoporotic individuals; along with activities involving spinal flexion due to the potential risk of fracture. Resistance training involving body weight exercises and targeting large muscle groups with 3-4 sets of 10-20 repetitions will help to load bone. This can be very helpful in maintaining bone mass and should be ideally performed at least twice per week. Exercise targeting co-ordination and balance may be of additional benefit in fall prevention. Proprioceptive benefit will be gained through the various aerobic and resistance activities already mentioned. For those who are particularly unsteady, specialist physiotherapy advice and supervision is recommended. Tai Chi is a form of martial arts performed slowly and with control, which if available, is an excellent low-moderate intensity method of improving proprioceptive awareness and muscle strength.
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