Strong, Steady and Straight - An Expert Consensus Statement on Physical Activity and Exercise for Os

Strong, Steady and Straight - An Expert Consensus Statement on Physical Activity and Exercise for Osteoporosis

By Jack March

Key P oi nts 1. Practitioners should promote physical activity consisting of resistance and impact exercise.

2. Practitioners should individualize and progress exercise programs depending upon physical ability and prior fractures.

3. Practitioners should provide reassuring messages and movement variety, not avoidance.

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BACKGROUND

In the UK over 1/3 women and 1/5 men will sustain a fragility fracture in their lifetime.

The prevalence of osteoporosis itself is difficult to determine and likely under reported.

However, in the UK over 1/3 women and 1/5 men will sustain a fragility fracture in their lifetime, and at age 75-84 the absolute 10-year risk for sustaining a fragility fracture is approximately 24% for women and 14% for men (1,2). It is also the most common “red flag” presentation for spinal pain.

There is significant variation between individual

exercises with variety as these have the best

practitioners’ understanding of what is safe

evidence behind them for promoting bone

and effective for those with osteoporosis or

strength. Impact exercise is recommended to

who have sustained an osteoporotic fracture.

be kept at a lower level for those with previous

This consensus statement aimed to reduce that

fractures due to the unknown risk of further

variation with evidence-based recommendations

fractures.

across three sections “strong, steady, straight”.

Balance exercises for those at risk of falls

These sections broadly cover increasing muscle

(steady), and safe techniques for lifting/

and bone strength, reducing falls, and promoting

avoidance of sustained, repeated or end range

confident, varied functional movements.

flexion (straight) are also recommended.

RECOMMENDATIONS

LIMITATIONS

Promote physical activity (strong), especially

It is important to note that there is a paucity of

weightbearing and muscle strengthening

evidence especially around osteoporosis in men (1,2), and with regards to recommendations for exercise prescription. There is a level of caution in those who have sustained vertebral fractures or multiple low trauma fractures that I suspect could be relaxed were appropriate trials to be

Clinically, the most effective physical activity for the individual will be the highest intensity they can tolerate.

undertaken showing it to be safe to do so.

There is also a paucity of evidence around specific movements and lifting as a cause for vertebral fractures, and the recommendations are mostly based around the theoretical biomechanical models of spinal movement.

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Clearly forward flexion creates higher forces at

a graded increase in intensity is necessitated by

the anterior portion of the vertebrae, but it is not

lack of evidence proving or disproving safety of

clear that this is causative.

impact exercise.

Reassurance is key for this population, and teaching varied options for movement rather

CLINICAL IMPLICATIONS

than avoiding movement will promote physical

Clinically, the most effective physical activity for

activity and reduce fear. It is very unlikely that

the individual will be the highest intensity they

someone will sustain a fracture from their

can tolerate. It is of importance to assess on an

resistance or impact exercises. It is much

individual basis current physical function, risk of

more likely they will sustain a fracture from a

further fractures/falls and design the program

fall or continued deterioration in Bone Mass

appropriately. In those with previous fractures

Density (1,2).

+ Study reference National Osteoporosis Society (2018) Strong, Steady and Straight: An Expert Consensus Statement on Physical Activity and Exercise for Osteoporosis.

Jack March

SUPPORTING REFERENCES 1.

Cauley J – Osteoporosis: fracture epidemiology update 2016, Current Opin Rheumatol 2017, 29:150–156

2.

Rosen CJ. The Epidemiology and Pathogenesis of Osteoporosis. [Updated 2017 Feb 21]. In: Feingold KR, Anawalt B, Boyce A, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000

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