Facing Osteoporosis: A Guide for Patients and Their Families by Theodore Stern

Author:Theodore Stern [Stern, Theodore]
Language: eng
Format: epub
Tags: Medical - Osteoporosis
Publisher: MGH Psychiatry Academy
Published: 2019-12-09T17:00:00+00:00

Lifting heavy weights

Twisting movements

Making abrupt, sudden, or high-impact movements

Side-bending exercises

Conventional weight-bearing aerobic exercise recommendations tend to be conservative. Heavy resistance training (e.g., weight lifting) has generally been discouraged due to insufficient data and perceived fear of fractures from high-intensity loading. Yet evidence is growing in support of high-intensity exercise (heavier resistance training and jumping activities) as effective or more effective than moderate-intensity exercise for improving BMD in postmenopausal women with osteopenia and osteoporosis (Watson et al 2018; Watson et al, 2015; LaFontaine et al, in press). According to the IOF, high-intensity supervised exercise programs offer benefits for maintaining and/or improving BMD (IOF, 2018b). An individualized, slow, gradual progression to a high-intensity exercise program that includes high-impact aerobic exercise, jumping sequences, and strength training (bench press, barbell rows, squats, power cleans, and walking, stair climbing with weighted vests) showed improvements in strength and endurance and reduced bone loss in women with low BMD (Kemmler et al, 2004).

The LIFTMOR (Lifting Intervention for Training Muscle and Osteoporosis Rehabilitation) trial (Watson et al, 2018) found 8 months of twice weekly, 30-minute supervised high-intensity resistance and impact training (HiRIT) sessions improved BMD and functional measures (i.e., sit-to-stand, functional capacity, and back and leg strength) in postmenopausal women. HiRIT was effective and safe, with no adverse events. The previously considered more conservative exercise recommendations were challenged when preliminary HiRIT data showed osteoporosis benefits and intervention safety for postmenopausal women with low and very low bone mass (Watson et al, 2015). HiRIT offered BMD benefits for women beyond those offered by more conservative weight-bearing approaches and was well tolerated and safe for women with low BMD and even clinically diagnosed osteoporosis. LIFTMOR data for men with low BMD remains unavailable (Harding et al, 2017).

Community-based HiRIT programs also support using HiRIT in women with low BMD and/or osteoporosis. The Older Women on Weights (OWOW) program is closely supervised by the ACSM (American College of Sports Medicine) registered CEP author (TPL) (LaFontaine et al, in press). The OWOW program utilizes an individualized, HiRIT two to four times per week for 60 to 90 minutes, including lifting heavy weights (e.g., deadlift, bench press, power cleans, overhead press, squats). Pre- and post- dual-energy X-ray absorptiometry (DXA) scans were collected on 13 postmenopausal OWOWs with a clinical diagnosis of osteopenia or osteoporosis who frequently lifted loads between 80% and 100% of their maximal capacity (one repetition maximum). Following 2.2 years of OWOW participation, BMD improved; pre-OWOW DXA spine results indicated osteoporosis classification, whereas post-OWOW DXA spine results showed osteopenia classification (LaFontaine et al, in press). No major injuries or fractures were experienced. Despite safety precautions from major organizations, the OWOW and LIFTMOR programs support the use and safe application of HiRIT to improve BMD in postmenopausal women with low BMD (Watson et al 2018; Watson et al, 2015; LaFontaine et al, in press). Based on this data, a HiRIT program for women with low BMD should follow these

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