Fight osteoporosis and bone diseases with effective gym workouts

According to the estimates presented on the World Osteoporosis Day, every 3 seconds in the world there is a fracture from osteoporotic fragility in the femur, wrist, or vertebrae. In Italy, 25% of women over 40 years of age are affected by osteoporosis, worrying data and unfortunately destined to grow.

To answer the question of why so many women are affected, it is necessary to first analyze the causes of osteoporosis. Let's start by saying that the skeleton is subject to a continuous phase of remodeling given by the action of some cells that create the bone tissue (osteoblasts), and others that reabsorb it (osteoclasts). This action leads to the replacement of about 10% of the entire skeleton each year.

In a young and healthy person, the actions of bone resorption and production are in perfect balance, but with increasing age the actions of osteoblasts are no longer able to compensate those of osteoclasts, giving rise to a less dense bone structure: If the bone mineral density becomes so low as to be brittle, this is described as osteoporosis.

What is osteoporosis?

The low bone density causes a higher risk of fractures in areas supported by spongy bone such as the ends of long bones and the bodies of vertebrae. Classic osteoporosis effects in people everyday’s life can cause chronic pain, loss of function in daily life and a worsening of perceived quality of life.

Types of osteoporosis

Primary Osteoporosis is divided into 2 groups:

• Senile osteoporosis, this affects men and women alike after the age of 70, the bones most affected are the vertebrae and the neck of the femur.

• Post-menstrual osteoporosis: the central theme of this article and the reason osteoporosis is more prevalent in women than men. Among the main causes, we find the reduced secretion of estrogens that have the task of stimulating the greater absorption of calcium in the kidney circulation, promote intestinal absorption (after conversion of vitamin D), and increase the synthesis of calcitonin.

In just one year a woman can lose up to 5% of total bone mass, compared to a typical 1-2% annual loss for men of the same age.

As life expectancy in the modern era extends 30 years after the menopause, it is necessary to take action to reduce the negative effects of this systemic disease of the skeletal system as much as possible.

There is also a secondary type of osteoporosis (which we will not discuss in this article), which can onset at an earlier age, as a result of having other clinical conditions, chronic use of drugs, etc..

Preventing osteoporosis

The prevention of osteoporosis should start from the second decade of life, in which the bone peak (maximum density and hardness of the bone) is achieved, after this age, in fact, the reabsorption of the bone begins to prevail over its formation.

There are many factors that determine an individual’s peak bone mass:

• Genetics: body structure and bone dimensions, estrogen and androgen levels.
• Lifestyle: physical activity (how much and what kind), exposure to UV rays (vitamin D), smoking.
• Food: intake of calcium and vitamin D.
• Congenital diseases.
• Chronic use of drugs.

The dynamics of bone mineral density of skeletal apparatus can be influenced by lifestyle changes. Adopting behaviours early in life, during teenage years and twenties offer the greatest level of protection against osteoporosis.

Once the point of mineral density has reduced to a level diagnosed as osteoporosis, it is accepted that the process cannot be reversed, and the primary goal is to slow the rate of any further bone mineral loss as much as possible. Two types of approaches will be described here to achieve this aim, one specific to training and one related to nutrition.

Osteoporosis and training

When presented with the problem of designing a training program for osteoporosis the most obvious solutions might be swimming, non-impact cardio machines and gentle calisthenics. The purpose of these choices is to preserve a fragile structure by preventing it from receiving unnecessary trauma or compression of bone. Unfortunately, the reasons why you feel safe doing these activities (back in relief and no overload on bones and joints) are the same reasons they have no beneficial effects on bone mineral density.

Being a dynamic tissue, the bone is continuously remodeled and is perfectly able to adapt and respond to various stimuli, such as those resulting from physical exercise and mechanical vibration.

During specific training that impact or weight bearing activities, mechanical forces are exerted on the bones through reaction forces on the ground and through the contractile activity of the muscles, stimulating maintenance or gain of bone mass. Studies have already highlighted many of the mechanical stimuli of strength training that are beneficial to slow down osteoporosis, including some types of physical activity.

What activity is recommended for postmenopausal osteoporosis?

The advice for postmestrual osteoporosis that is often given is to keep moving and do a low-impact physical activity such as walking or cycling. Although beneficial for general health, studies have shown that non-impact activities, such as cycling, create a good muscle response but poor stimulation of bone. As far as walking is concerned, it could improve the bone mineral density (BMD) of the femur in post-menopausal women, but without having a positive impact on the BMD of the vertebrae.

If we consider that, as mentioned before, in postmenopausal women the greatest risk is to the vertebrae rather the femur, we understand that walking is not the best exercise to prevent or slow down osteoporosis.

Many authors agree that greater stimulation of BMD at both spine and femur level require training that combines strength, aerobic and impact exercises.

Training to prevent osteoporosis

Strength training creates a variety of stimuli that promote an osteogenic response. Through actions such as tension, compression, and twisting, electrical signals are created that are capable of stimulating bone metabolism and mineral application, increasing bone mineral density and slowing down bone resorption.

Some studies recommend a training program to slow down osteoporosis that includes moderate to high intensities (70-90% 1RM) with 3-4 sets of 6-12 reps per exercise, to be repeated 2-3 times a week. If these guidelines are followed for at least one year, it will be possible to maintain or improve hip and femur BMD in post-menopausal women, as well as improve the physical efficiency of daily life thanks to new and high levels of acquired strength. This type of training requires the action of type II muscle fibers, which can stimulate more bone formation than the weaker type I fibers.

To be more precise about the execution of the muscle strengthening training. Same researches recommend an optimal tempo of an explosive concentric contraction with a slow eccentric contraction (4 seconds).

It is important in fighting osteoporosis not only with muscles training of the legs but also the extensors of the back, in order to prevent the incidence of vertebral fractures and improve the balance of the body by reducing the risk of falls.

However, the starting situation of the person to be trained must be considered: in the case of post-menopausal osteoporosis, unlike common scenarios in senile osteoporosis, clients are less likely to have complications such as hypotonia, advanced stages of sarcopenia, etc. However, it is necessary to rely on a professional e.g. physiotherapist who can make an accurate history before drawing up the right training program.

As far as the reinforcement of the abdominal wall is concerned, exercises involving forceful flexion or rotation such as crunches are not recommended, especially in women at risk or with a vertebral fracture, while static stabilization exercises, such as plank, or antero and retroversion exercises performed in a supine position are recommended.

Osteoporosis and balance

When vertebral fractures occur because of the osteoporosis, the remaining vertebrae of the body tend to collapse, increasing hyper kyphosis, which can cause anteroposterior oscillations of the trunk with consequent loss of balance. The proprioceptors located in the paravertebral muscles will have a reduced sensitivity of the position of the trunk contributing to the increased risk of falls.

It is essential to devote part of the training program to proprioception exercises to stimulate the visual and vestibular system and help improve postural control.

Closed-eye exercises, with proprioceptive tables or limited support points, to be chosen according to the physical condition of the people in question. The level of balance challenge should be sufficient to stimulate activation of the proprioceptive systems but not so great as to risk falling.

It is also important to re-educate walking, to improve posture and balance during walking, with barefoot exercises, such as walking on heels, toes, transferring weight from one leg to another, single legged exercises and coordination between the upper and lower body, and when possible to perform small jumps.

Osteoporosis and swimming

As can be seen in several studies, skeletal apparatus responds to stress from gravitational forces and mechanical stimulations that induce muscle contraction. For this reason, the loads used during training should be greater than those handled by the bones in everyday life. The low gravitational impact given by the aquatic environment suggests that water activities are not ideal for their low osteogenic impact.

Water aerobics can be useful if performed with the body immersed up to the height of the iliac spines, to have a destabilization given by the movement of the water itself, and to give way to the muscles of the trunk to work to try to maintain balance during these oscillations. Swimming has a lower impact than strength training, but it is recommended to swim rather than not do training af all, for all the other health benefits that this activity brings.

The structure of the skeletal apparatus is continuously changing , this system has the primary function of supporting and protecting all the other organs and systems of the body and as such it deserves, regardless of sex or age, attention and care throughout the lifespan. If we look after the bones throughout life, there will be no need to sole problems in older age. With osteoporosis, prevention remains the best medicine.