Physical Activity and Bone Health

Author: Desiree Dutton, MPT
Marcus Daly Rehabilitation
A service of Marcus Daly Memorial Hospital
1200 Westwood Drive
Hamilton, MT 59840

Physical Activity and Bone Health
Physical activity is an important tool for staying healthy in aging. Older adults who are physically active have a lower risk of developing heart disease, type 2 diabetes, stroke, hypertension, depression and some cancers. Weight bearing physical activity also has positive effects on bone health and is essential in both the prevention and treatment of osteoporosis. Regular exercise can also improve muscle strength, flexibility and balance.

Osteoporosis is a common disease characterized by low-bone density (thickness of the bone), decreased bone strength, and a change in bone structure - all which can lead to an increased risk of fracture. The normal bone structure may become more porous and lessens the ability of the bone to withstand typical forces. Fractures from osteoporosis and osteopenia can be very serious. The National Osteoporosis Foundation (NOF) estimates that 54 million Americans have either osteoporosis or low bone mass. The NOF reports that studies suggest 1 in 2 women and up to 1 in 4 men age 50 and older will break a bone due to osteoporosis.

Bone is a living tissue. In osteoporosis, bones weaken when not enough new bone is formed and/or too much bone is lost. Women have the greatest risk of developing osteoporosis and it commonly begins in women during the first 5 years of menopause, but it can also occur in men and in children. There are many factors that can cause a person to be more at risk for developing osteoporosis. Non-controllable risks include female gender, small build, hormone levels and predisposing medical conditions. Some medical conditions such as rheumatoid arthritis, multiple sclerosis, inflammatory bowel disease and spinal cord injuries can increase the likelihood of osteoporosis. Controllable risks (which we can prevent and treat) include cigarette smoking, excessive alcohol intake, an inactive lifestyle, lack of weight-bearing exercises, poor health and low vitamin D levels and calcium-poor diet. It is important to know your risks, so you can be proactive in your treatment.

The American College of Sports Medicine and the National Osteoporosis Foundation agree that weight bearing physical activity has beneficial effects on bone health across the age spectrum.

Peak bone mass is typically reached in ones 20s to 30s, so optimizing peak bone mass and strength is a primary strategy to reduce the risk of osteoporosis and related fractures later in life. The exercise component for bone building or slowing bone loss is specific and similar for all ages. Bone grows when it is sufficiently and appropriately stressed, just as muscle grows when challenged. Two types of exercise are optimal for bone health, weight-bearing and resistance exercises.

Be sure your child is physically active - childhood and young adulthood are the critical bone building years. Bone mass is higher in children who are physically active than those who are less active. In children and adolescents, physical activities such as gymnastics, plyometrics and resistance training augment bone mineral accrual. Participation in sports that involve running and jumping such as soccer and basketball are likely to be of benefit. And, there is some evidence to suggest the exercise-induced gain in bone mass in children is maintained into adulthood. Children should strive for 60 minutes of moderate intensity activity each day. The NOF position statement also points to the positive effects of calcium intake, especially during late childhood and puberty. Good evidence also supports the positive role of vitamin D and a detrimental effect of carbonated soft drink consumption on building bone.

During adulthood, the primary goal of physical activity should be to maintain bone mass density through weight bearing exercises. Weight bearing exercises may include tennis, stair climbing, jogging, dancing and activities that involve jumping. Physical activities that help preserve muscle mass such as resistance exercise may also be effective in preserving bone mass.

Resistance exercises may include weight lifting, use of exercise bands and gravity resistance such as yoga poses. If you are middle-aged and older, it is important to improve your posture, improve the strength of your back muscles and improve your hip strength and flexibility.

Typically exercises are performed for 30-60 minutes, 2 to 3 times per week as part of an overall fitness program. The recommendation that adults maintain a level of weight-bearing and resistance activities for bone health does not have an upper age limit. But, as age increases, so does the need for ensuring that the activities can be performed safely.

Due to the association of osteoporosis and fracture risk, it is also important to include exercises that improve dynamic balance and reduce the risk of falls. The most common site of fractures occurs at the hip, spine or wrist. According to the American College of Sports Medicine, there is considerable evidence that physical inactivity is a risk factor for hip fracture and the incidence of hip fracture has been found to be 20-40% lower in individuals who report being active than those who report a sedentary lifestyle. Many factors may contribute to falling including poor posture, poor vision, decreased muscle strength, impaired balance, and cognitive impairment as well as external factors such as medications or tripping hazards. Balance training is a crucial element of exercise interventions for older adults. A home safety evaluation with an Occupational Therapist can also be an important piece in reducing the risk of falls from external influences.

If you are diagnosed with osteoporosis or low bone density, a physical therapist can develop a specific program based on your individual needs to help improve your bone health. A physical therapist will prescribe weight bearing and resistance exercises to build bone or lessen the amount of bone loss at the regions most vulnerable to fracture. A PT will also recommend dynamic balance exercises to improve your balance to reduce your risk of falling. Osteoporosis can also affect the vertebrae in your spine leading to a stooped or hunched posture. Improving posture and your work and living environment are also an important piece of the physical therapy plan of care.

Healthy bone is built and maintained through a healthy and active lifestyle. Contact your physician for a referral to a physical therapist who specializes in the treatment of osteoporosis to get started on a more active and healthy lifestyle!

Questions and or comments regarding this week's health column please contact, Marcus Daly Rehabilitation Center and Services, a service of Marcus Daly Memorial Hospital, 1200 Westwood Drive, Hamilton, MT 59840.


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