Too Fit to Fracture: Guidelines for Skeletal Health and Aging

[Music] good evening thank you all for coming it's really nice to be here there are several people in the audience who I recognized so welcome to you and welcome to everybody else tonight we're gonna talk about to fit to fracture some guidelines for a skeletal health and aging and I'd like to acknowledge them especially my colleague dr. Laura Gian Gregorio from University of Waterloo and she paired with osteoporosis Canada to develop the to fit to fracture guidelines that I'll present tonight and she's also been gracious enough to lend me some of her slides for my talk tonight and I'd also like to mention that UCSF has the license for the stand tall exercise program and DVD so tonight what I hope that you all will come away with is understanding why we've developed osteoporotic fractures and we're going to review the best evidence for exercise and physical activity in the prevention of osteoporosis and we'll cover the guidelines for physical activity that are essential to healthy aging as well as learn how these guidelines change for skeletal health and the prevention and treatment of osteoporosis and osteoporosis so first I want to go through a little bit of background about what osteoporosis is it's a skeletal disorder and it's characterized by compromised bone strength and predisposes an individual to fracture and in this picture you can see on your left there's a nice healthy bone that has a honeycomb-like structure to it that makes it very strong if you've ever held a honeycomb it's light as a feather but if you try to squeeze it and break it it really doesn't break it's very very strong our bones are like that when they're healthy when our bones are unhealthy you can see the picture on your right where the integrity the structural integrity of the bone is lost and it predisposes that bone to fracture it's very fragile and it loses its structural integrity one of the problems with osteoporosis is it's painless you don't know what's happening until unfortunately you have a fracture or you experience significant height loss about 44 million people in the United States are at risk for osteoporosis and for fracture 10 million of them have us - your purses another 34 million have low bone mass 4 out of 5 of those are women so we are at greater risk for osteoporosis and fractures and all ethnic groups are affected osteoporotic fractures have a higher incidence than stroke breast cancer and heart attack combined however most people are more fearful of those other diagnoses than they are of osteoporosis half of all women and 20% of all men after the age of 50 will sustain an osteoporotic fracture in their lifetime and once a fracture occurs a future fracture is much more likely and spine fractures are significantly more prevalent than hip fractures again hip fractures get a lot more attention but spine fractures are significantly more prevalent and to understand fractures it helps to understand bone mineral density and what determines adult bone mineral density and on this slide you're seeing across the x-axis age from birth to 70 on the y-axis we're looking at bone mass and from birth to about the age of 30 we're in a very rapid phase of bone acquisition and 50% of our increase in bone mineral density occurs during adolescence alone then we reach a plateau and we have a slow gradual rate of loss of about 1% a year now women when we go through menopause there's a rapid phase of about five years where we lose about 20% of our bone mass in the five years after menopause and then we level off and we go at the same slow rate of about one maybe two percent loss per year so what determines this peak bone mass well genetics gender women are more at risk race and ethnicity white and and Asians are more at risk body weight low body weight delayed timing of puberty decreases the formation of peak bone mass I'm not getting enough calcium during those developmental years and also not getting enough exercise our bones like weight-bearing they like the compression they like the bending force and that stimulates the bone growth during adolescence and our bone density as an adult is a function of the peak bone mass - the bone loss so if we don't reach peak bone mass by the time we're about thirty we basically don't have much in our bone Bank and it's very easy to drop below the fracture threshold and develop a fracture later on in life so I'm going to step back a little bit and look at the cellular level of what's happening with bone remodeling there's this constant state of bone resorption where these little bones called the osteoclasts they come into the scene and they eat away some bone and they create this tiny pit in the bone and then they die then as they're dying this reversal happens in these osteoblasts the bone building cells come on to the scene and they start to fill in that pit that's formed and so the osteoblasts then new bone and then they mineralize that bone so there's this constant state of resorption and formation at any given time and it takes about ten years for our skeleton to normally go through this process of remodeling our skeleton so that we basically can heal any kinds of fractures micro fractures that occur also so that we can release calcium for our normal metabolism so there's reasons why our bone is constantly remodeling and as long as the formation and the resorption are in balance we're in good shape and we don't lose bone mass however with hormonal changes particularly menopause as I mentioned we lose about 20% of our bone mass in the first five years after menopause for women for men testosterone loss is accompanied by loss of bone mineral density as well I'm not enough physical activity or not enough skeletal loading not enough calcium I mentioned earlier and many diseases such as cancer gastrointestinal disorders any inflammatory disorders and then the drugs that are used to treat these diseases often have an effect and decrease this normal bone remodeling process and as long as there's a check-and-balance we're okay unfortunately oftentimes we end up losing bone mineral density and that puts us at risk for fracture so one of the ways we know what our bone density is like is we have a deck so many of you have probably had a DEXA scan the National Osteoporosis foundation recommends that 65 that all women get a baseline scan and all men at 70 get a baseline scan to get an idea of what your bone mineral density is like but bone density is only one factor that's used to predict adult fracture risk a decrease of one standard deviation in the hip is associated with a three-fold increase in for hip fracture in older men and and so this bone mineral density is measured as a t-score and a t-score is expressed as a standard deviation so it compares your bone mineral density to a healthy 30 year old who has achieved peak bone mass so plus one or minus one standard deviation below this peak bone mass is considered normal and then minus one two minus two point five standard deviations below it's considered low bone mineral density and if it's minus 2.5 standard deviations or lower you have technically osteoporosis so besides bone mineral density because only 15 percent of the fracture risk is explained by bone mineral density as I mentioned age and gender risk factors body mass index so having a small thin frame puts you at risk because your bones don't have as much stimulation from weight bearing if you've had a prior adult fracture you're at risk if your parent fracture the hip if you're on steroid medications steroids are not good for the bones but they may be necessary to treat other underlying disease if you smoke or drink excessive amounts of alcohol if you have rheumatoid arthritis or if you have secondary osteoporosis which you develop from other kinds of disease processes these I'll put you at risk for osteoporosis and if you go to this website the World Health Organization fracks website they ask questions and you can answer these questions and it predicts your 10-year risk for a hip fracture that's called the fraks model unfortunately the fraks model does not consider all of these other risk factors like poor physical conditioning a tendency to fall too much load when lifting excessive spinal curvature or hyper kyphosis so these are risk factors that actually are modifiable with particularly I'm changing your physical activity modifying the way you do things increasing or targeting your exercise and those are some of the things that I'm going to be focusing on tonight so essentially why do we fracture well really simply we fracture when the load that supplied exceeds the strength of the bone so the load is like the direction or the rate of a fall the compression that occurs on the spine when you lift something heavy the amount of spinal curvature that you have because it loads the Front's of your vertebrae or weak back back muscles because they control how well or not well you load the Front's of your vertebrae and the strength of the bone is determined by the density and the quality of the bone the size shape and structure of the bone as well as how that mass is distributed so how what are the effects of exercise and physical activity on skeletal health so I'm going to talk a little bit more about how exercise and physical activity can affect fractures bone mineral density Falls mechanical load on the spine as well as spinal curvature or hypertrichosis so I'm gonna present some pooled results from randomized controlled trials which is considered the gold standard for for evidence and much of the research on bone mineral density effects some exercise on bone mineral density and fractures that it's been done in postmenopausal women so it's hard to generalize across across all ages as well as across the sexes but nonetheless here's data on numerous randomized controlled trials on the effects of exercise for preventing and treating osteoporosis and postmenopausal women and there were four studies about 500 people with fracture endpoints so they determine the effects of exercise on fractures the quality of the evidence was high and while there was a 4% absolute difference in those who exercised compared to those who didn't it was not statistically significant now if we looked at the bone mineral density in the spine we looked at change in spine BMD as the endpoint there were 24 studies including almost 14 or almost 1500 postmenopausal women the quality was high and there was a significant difference between the groups so those who exercised had a positive effect on the lumbar spine about less than 1% and what did I say earlier as we get older we lose about 1 to 2 percent with aging and so targeted spine strengthening exercise can slow that effect on the loss of bone mineral density in the spine for the hip the bone mineral density changes in the hip there were about 20 studies about 1,300 older women postmenopausal women the quality unfortunately was low and there was no significant between no significant difference between the groups now if we break those studies down and we look at the again the effect of exercise on bone mineral density in postmenopausal women that general effect as I mentioned no effect on the hip there was a positive effect on the lumbar spine but if we look at the type of exercise intervention high force dynamic like running and jumping it had a positive effect on the hip in terms of bone mineral density changes no effect on the spine if we look at low force dynamics I'm just walking there was no effect on the hip but there was a positive effect on the lumbar spine if we look at progressive resistance exercises where you're constantly working at at either max or sub max intensity to increase the strength it actually increases bone mineral density in the hip as well as the lumbar spine if you look at resistance exercises where you use low weights it actually has no significant effect at either the hip or the spine suggesting that low weight resistance training my be a waste of time if you're interested in in changes in your bone mineral density but if you want the most benefit high impact loading such as jumping or running combined with resistance training at the hip and at the spine there was significant improvement in the hip and the lumbar spine now if we look at there's been many observational studies longitudinal cohorts that have enrolled people and followed them over many years and looking at the fracture endpoints over time and there's a lot of good evidence to suggest that physical activity does have a positive effect on reducing fractures and older adults this is the Nurses Health Study with about 6,000 postmenopausal women they were enrolled and followed for 12 years there was a lower risk of hip fracture compared to a sedentary lifestyle among those with increased standing regular walking and brisk walking pace and if we look a little more carefully at the results of this study standing for ten hours or more a week reduced your hip fracture risk by 30 percent compared to just being a couch potato four hours a week of walking reduce the risk by 40% eight hours a week of walking reduced it by fifty five percent and fast pace walking reduced the risk by 65% more than slow paced walking this is another a meta-analysis of 13 prospective cohort studies and they determined that moderate to vigorous activity reduce the incidence of hip fracture by 45 percent among older adults they found interestingly enough that there was a potential for increased risk of fracture though among the least active which kind of makes sense the least active they're probably the more most frail they had an increased risk for fracture as well as the most active suggesting that there that you can put yourself risk if you push yourself beyond your limits and beyond your physical skill this is a study that looked at physical activity over the long-term and the lifelong physical activity continuing after the age of 65 maintains better bone health so starting young and continuing throughout life really is important there is a positive Association of bone measures and self-reported physical activity not only in midlife but in old age 65 and older and then throughout life so maintaining that throughout life had the best effect on the bone measures and similarly in this study they enrolled about 400 men and women they followed them for 10 years and they found that the rate of bone loss was less than 1% less in active individuals so again if you think about we normally lose about 1 to 2 percent of our bone density each year with aging and exercise can reduce that or slow that loss by approximately 1% it's not going to prevent the bone loss that occurs with aging but it looks as if it will slow that loss there's numerous studies on the effects of exercise on Falls and if we can prevent Falls we can prevent a substantial number of hip fractures and spine fractures there's numerous studies on interventions for community dwelling older adults Tai Chi gait balance training are all effective home safety assessment so going into your home putting grab bars pulling up throw rugs keeping lights on at night or a nightlight on when you go to the bathroom those can all be effective in those who are at high risk for Falls even having your cataracts removed can be helpful in reducing fall risk and going back again to to a meta-analysis here we're looking at the pooled estimate of the effects of exercise on the rate of Falls and there's about a 16% reduction with all types of exercise programs now if we look at them by the type of exercise it varies here we're looking at exercise with moderate or high challenge to balance and there were 43 studies that examined this type of exercise and they could they reduce the rate by 22 percent exercise that had a high challenge to balance reduce the rate to by 25 percent those that had a total exercise dosage of 50 hours sorry yep 50 hours decreased the rate by 23% those that just included walking reduced it only 10% and a high-risk population actually was able to reduce the rate of Falls by 10% and then this is some new data that just came out looking at the at the trial level characteristics and what's the best type of exercise to reduce Falls and those exercise programs that provide high challenge balance training they reduced Falls by 21 percent those that included three hours a week of an intervention and that includes balance as well as any kind of exercise it reduced the rate by 30% if you had a high challenge sorry neither high challenge or not three hours a week so basically not doing a lot of either one it reduced your rate by 10% but those exercise programs that provided a high challenge to balance and three hours per week of exercise reduced Falls by almost 40% which is very impressive so what is high challenge to balance I'm going to show you that in just a little bit I'm going we're going to come back to that but essentially it includes I mean moving the center of mass so when I lean forwards I've moved my center of mass forward of my base of support and likewise if I move it backwards I'm moving my center of mass backwards back of my base of support and the challenge here is to maintain my balance when I shift my center of mass also narrowing my base of support so if you stand with your feet wide apart it's easier to maintain your balance when you shift your Center your your center of mass over your base of support but if you put your feet together or you put one foot in front of the other called tandem you narrow your base of support and it's harder to maintain your balance but it's also a good way to challenge yourself and give yourself a high challenge balance the training experience likewise if you begin with holding on and use upper extremity support to maintain your balance and then begin by letting go and not using your hands and challenge yourself by shifting your weight narrowing your base of support you've now added a high higher challenge to your balance obviously people who are in better shape and have better balance need to challenge themselves at a higher level in order to maintain that high challenge of to balance but those are some of the components to a good balanced training program and we'll come back to that in just a bit so let's talk about mechanical loads mechanical loads can increase vertebral fracture risk here we're looking at body posture and activity and bending forwards where you're rounding your back you're compressing your vertebrae that increases the mechanical load on the spine and increases the risk of fracture likewise Falls if you have a fall and there's a large mechanical load that can impact your your spine and and result in a vertebral fracture people who've got really long torsos really tall they can't it's harder to control and reduce the mechanical load during activities and also if you have greater weight you're potentially going to increase the load in your vertebrae your muscle forces if you when your muscles contract that increases the load to the vertebrae as does spinal curvature increases the load to the vertebrae and I love this picture because it looks at forward head posture normally your head weighs about 12 pounds and when your head is over your shoulders which is over your pelvis and your feet so that concept of center of mass again when your head is over your center of mass it weighs 12 pounds approximately but when your head begins to shift forward relatively there's an increase in mechanical load and that 12 pound head is now increased to an effective 32 pounds it's physics and when you goes out farther that load the mechanical load to the spine is now 42 pounds so it's really important to reduce the mechanical load on the spine to keep your head over your center of mass over your base of support when your discs degenerate the discs absorb the shock and the strain and it consequently increases the mechanical load to the vertebrae above and below as well as poor neuromuscular control if you don't have good control over your back muscles it's hard to maintain you increase the load to the to the vertebrae and the problem with all of that is if your bone mineral density is low or the bone quality is not good when you increase the mechanical load you increase the risk for vertebral fracture and this is a diagram that shows that when you have excessive curvature also called hyper kyphosis the back muscles are lengthened the lever arms are shorter and it requires larger forces to stabilize the spine and larger forces in mechanical load and over here the larger forces that are required to stabilize the spine there's the center of mass above the vertebrae moves forward and that increases this flexion stress or flexion moment on the vertebrae that increases compression to the vertebrae so the weight of the head the torso and the muscle forces all contribute to this increased compression in the vertebral body and that compression increases the risk for fractures and once you've had a fracture it increases the risk of casas and then you've got this vicious cycle going here but you can do something about it there have been a small number of clinical trials that report us that report modest improvements in kyphosis or spinal curvature with exercise and the emphasis has been on back extensor muscle strength and endurance however previously there a limited number of trials that were variable trial quality but we just finished the shieff randomised control trial we've submitted the manuscript for publication we enrolled 99 older adults for a six month exercise program and we reduced spinal curvature with spine strengthening exercise and postural training so there is a possibility that it's not an inevitable part of Aging all right so now I'm going to shift gears a little bit here and we're gonna step back and what are the guidelines for physical activity that are essential to healthy aging the American College of Sports Medicine and the Center for Disease Control both agree that if you're 65 years or older or generally fit and have no health conditions that would limit your physical activity you should be exercising a hundred and fifty minutes a day of moderate intensity aerobic exercise like brisk walking or 75 minutes of vigorous intensity aerobic activity like jogging or running every week and we training so resistance training twice a day or sorry twice a week to all the major muscle groups now the National Osteoporosis foundation they agree with those aerobic activity guidelines the strengthening guidelines but they also recommend daily posture exercise and balance training to prevent Falls and guess what this is a survey from the Center for Disease Control and looking at this light green only 20 to 25 percent of individuals in each of these states follow the recommended guidelines for the center of Disease Control California among them Colorado has better compliance so people in Colorado are more likely to participate and follow the exercise guidelines that are prescribed so not to put anybody on make people self-conscious if you want to raise your hands you can if you just want to answer this question these are the guidelines how many of you do moderate or vigorous intensity aerobic physical activity for at least 30 minutes on 5 days a week you can do it in about some 10 minutes or you can do it more what about exercises to increase your muscle strength such as lifting weights or working with resistance exercise bands twice a week or more how many of you do activities that challenge your balance on most days of the week how many of you do exercises to improve your posture every day how many of you pay attention to your posture during daily activities and how many of you progressively increase the intensity of the exercises that you do over time so that they're always challenging to you so this is what you should be doing if you want to be complying with with the guidelines now so my colleague Laura Jeon Gregorio and osteoporosis Canada they were interested in what's the best evidence for preventing fractures can exercise increase bone mineral density and how can we create guidelines and recommendations for our patients that also respect the differences because not everybody is the same some people have have other underlying diseases some people have osteoporosis some people have prior vertebral fractures but interestingly enough what are the patients or the clients or you guys what do you care about you care about what exercises are safe for me to do is it safe for me to do abdominal exercises how do I get rid of this hump in my back can I do yoga how much can i lift can I still play golf well my doctor told me to not to bend or twist does that mean I have to walk around like a robot and I know the exercises I should do but they're boring the things that I'd like to do I can't do anymore so the to fit to fracture program was born and they set out to develop evidence-based recommendations for exercise and physical activity specifically for individuals who had us to your purses with or without a prior fracture and they also use this expert consensus process the Delphi consensus process that brought in expert researchers and clinicians from all over the world to come up with the best evidence for for their clinical decision making and what they put together were exercise in physical activity recommendations for individuals who've got osteoporosis with it without fractures and they also developed research priorities on collaborations and other plans for action so guess what they found the to fit to fracture recommendations based on this expert consensus as well as the best evidence that I also presented to you all tonight it's an accumulation of 30 minutes or more a day of moderate to vigorous aerobic physical activity strength training two times a week balanced training everyday exercises for the back extensor muscles and posture every day and spine sparing exercises like hip hinge and step to turn to decrease that spinal low decrease the mechanical load teaching people how to move rather than teaching people to be afraid of moving and for individuals who have osteoporosis or osteopenia just go to the gym and do weight training or if you just do your thirty minutes of aerobic activity every day that's not enough don't engage in your aerobic training and exclude resistance or balance training and vice-versa don't engage in resistance and balance training and forget about the weight bearing training and if you happen to have osteoporosis or a fracture consider consulting a physical therapist to help you develop a safe and appropriate exercise program so I talked about better balance and high challenge for balance so here we've got some activities that move the center of mass so shifting your weights to the limits of stability and things like Tai Chi are great for that also doing dynamic balance like walking and figure eight patterns so that's moving the center of mass over the base of support and maintaining your balance the next component is narrowing the base of support so here we have a picture of a tandem stance so one foots in front of the other when you get home tonight try that you it's way harder I'm wobbly when I stand like that but I'm totally fine when I stand with my feet right next to each other and then the next challenge is minimizing the upper limb support so doing this these kinds of activities at night first holding on and then starting to brush your teeth and let go and really work on on maintaining your center of mass with a narrow base not using your arms and this is an example of other patterns like walking heel toe step aerobics to narrow to wide sideways walking or grapevine walking ways to really challenge yourself don't make it easy so for stronger back muscles what can we do supine presses I'm going to show you picture those in just a minute prone trunk extension to neutral to strengthen your back muscles even core activation and standing learning how to activate your abdominal muscles and your back muscles to stabilize you should be doing this five to ten minutes a day I've put some kind of posture exercise and paying attention to posture during your daily activities and everybody here seem to raise their hand when they when I ask that question so that's great for individuals who've got a history of a spine fracture if you're gonna lie down on your back you may need a pillow under your head to support the curvature in your spine but lying down at intervals during the day if you have back pain and if you have any fractures unloads the spine it also promotes extension of the spine and stretches out the tight front shoulders and hips that occur from prolonged sitting and also for those who've got a fracture really consider seeking out a trained professional this is an example very simple supine presses where you lie in a really good position you elevate your sternum then you just press your shoulder blades back into the into the ground this is another example for stronger Matt back muscles I call these alphabets if you guys want to do them with me this is the W okay press your squeeze your shoulder blades together good elbows into the back pockets I call it as well okay the V take your arms up over your head victory thumbs up to protect your shoulders press the shoulder that elbows back between your ears as much as you can engage your stomach muscles to keep your back in neutral but stretch your tight shoulders and squeeze the muscles between the shoulder blades good and lastly I'm not gonna have you do this because you're gonna smack your neighbor but tutti or you just bring your arms out palms up to to strengthen the muscles in the back and squeezing the shoulder blades together so you can do those several times during the day to get your five to ten minutes of back exercises in for those of you who want more challenge we use this exercise in our research study and this is a more demanding position lying on your stomach and lifting your torso up to neutral adding bands or weights to make it more challenging to build strength and to build endurance and then paying attention to your posture paying attention to the alignment of the back of the head over your shoulders over your ribcage over your pelvis and over your feet so sitting in the chair right now move your hips back into the chair uncross your legs make sure that your back is arched so restore that curvature and your lower back by really bringing your issue bones back in the chair sit up allow the upper back to be supported in the chair and bring your head back on top of your your shoulders and your pelvis okay good practice that when you're sitting practice that kind of posture when you're standing and here's some cues so imagine that the head is aligned over the shoulders the pelvis and the feet you can practice this next one when you're sitting lengthen through the crown of the head so the chin stays horizontal but as if you have a balloon lengthening the back of your neck to reduce the hyper kyphosis of roundedness in the upper back we tell the story of Romeo and Juliet so Romeo is down on the ground and he's the abdominal muscles Juliet is up on the balcony and she's the back muscles so Romeo is tightening the abdominals up to get to Juliet and Juliet's pressing her shoulders down to get to Romeo so there was this constant abdominals and back muscles working together to stabilize you in an upright posture show off your jeweled necklace okay spread your wings and then use your breath so use your diaphragmatic breathing to give you the core stability so breathe in to the pelvis into the back and lastly breathe into the chest rather than exclusively breathing into your chest which doesn't promote good posture real stability so again breathing into the nose into the belly into the back and then into the chest to help promote postural stability and then gently brace your abdomen as if someone's going to poke you in the stomach so just gently engage those abdominal muscles again to help to promote postural stability so what is spine sparing we talked about mechanical load if you lift a weight that's too heavy or your back is rounded spine sparing is ways that you can modify activities and prevent repetitive waited or end range bending activities and how do you do that you hip hinge rather than round your back notice that in this figure the spine is straight but the hips are bent and the knees are bent when you go to turn keep your feet pointing in the direction of where you're going rather than planting your feet and twisting your spine avoid lifting something from the floor first lift it up to your body and then turn and then put it down so slow controlled movements avoiding twisting at the end of the range balancing loads on either side of the body supporting the trunk when bending so using your arms when you're if you're gonna bend over to pick something up use your hands on your thighs initially to give you stability hold the weight close to the body and not overhead so here are some pictures of how to pick up an object notice the hip hinge notice the bend at the hips and the knees you probably have all learned this in in physical therapy 101 first time you had a back injury the physical therapist taught you how to hip hinge and bend at your hips and knees lifting that load up to the spine rather than rounding the back okay and how to move an object ok lifting turning and placing lifting turning and placing rather than lifting twisting and placing which increases the mechanical load on the spine and increases risk of injury so are there harms of exercise yes there's unsafe exercises and many of those are exercises that increase flexion rounding twisting also abdominal exercises this type of abdominal exercise increases the flexion the compression on vertebrae and really is not should be avoided there's lots of good ways to strengthen the abdominal muscles keeping the spine protected and using the legs as weights rather than bending the spine and increasing the flexion of the spine many people get injured during unsafe transitions so you're good you go to exercise class you're lying on the floor you've got to get up and you twist yourself into a pretzel as you've got to get up and you hurt your back so learning how to roll and keep your spine safe transitions are really times to pay attention during exercise programs also tailoring exercises to ability you want to push yourself but you don't want to be overzealous and push yourself too much and oftentimes it helps to get professional advice to help you establish an exercise program that's at your level and then allows you to progress from there so should physical activity recommend recommendations vary across individuals well individuals who might have fractures different health conditions different prior levels of physical function different physical activity histories desires to play certain sports or do certain things those are things that that we as professionals need to consider and you all need to consider what your preferences are as well as what what your what your limitations are and if somebody has a really strong desire to do something rather than a thing don't do it how can we help you modify it how can you integrate spine sparing activities and do the kinds of activities that you're interested in doing but protect yourself at the same time for those who have fractures avoid high impact sports avoid high fall risk sports avoid the contact sports but consider low-impact and slower paced activities for those who have a fracture gait or balanced faculties excessive curvature in the spine or back pain spine sparing and alignment may be more important than intensity and moderate intensity instead of high intensity aerobic physical activity may be a safer bet again they may need a trained instructor for classes or physical therapists to help with activities of daily living and maybe get help beyond doing the light activities of daily living and avoid sitting for long periods of time and really consider unloading the spine during the day to promote extension and pain relief so the key messages today are that exercises can and may reduce fractures certainly exercise can prevent Falls even those who are at high risk for Falls exercise can main maintain bone density or at least slow the bone loss that occurs with aging and it may increase the bone strength as well certainly exercise can improve posture and it can reduce applied loads when you integrate spine sparing activities so there's strong and consistent evidence for exercise to reduce the risk of mortality disability and all kinds of health conditions and we recommend a multi-component exercise program that includes resistance aerobic training posture and balance activities so again what's the best evidence for preventing fractures and can exercise increase the bone mineral density hopefully tonight I've answered some of those questions but also recognize that each one of you has a particular interest a particular desire and hopefully you've learned tonight how to move rather than how not to move I've got some great resources for you if you want to go to the osteoporosis Canada to fit to fracture website they've got exercise videos that are just fantastic the National Osteoporosis foundation has great resources as does American bone health if you haven't been to the World Health Organization frac site to assess your ten year risk of hip fracture worth going to we have a couple of stand tall exercise videos one the American Physical Therapy Association has it on their website and our health and wellness department has them on our UCSF website for our department and finally I do teach the stand tall exercise class and their other great health and wellness exercise classes that the health and went wellness center offered by our department so with that said I would like to open it up for any questions yes probably depends on how you do it and what you do and you're on it I probably would avoid really high jumping but you know you can do some very light impact on a trampoline heel pops well you don't even lift your feet up to you know gentle gentle kind of running in place holding on so I think if you have done it for a long time and you're comfortable with it then I wouldn't stop doing it but if you're going to start doing it I would start it in a very protected way without a lot of high impact because you have osteoporosis there's impact from from yes there's less impact on a trampoline than there is on the ground because there's more ground reaction forces on a hard surface than there is on a softer surface and aside from that I don't know any studies that have been done to investigate the effects of trampoline exercise on bone mineral density thank you welcome yes sure so yeah sure so the question is about the muscle wasting that occurs with aging so it's also called sarcopenia and is there anything that we can do to prevent that and there's lots of good Studies on muscle strengthening exercises in older adults but even the highest trained athlete is going to lose some muscle mass as they get old because of the hormonal changes but we can do a lot to maintain or slow that loss of muscle mass that that occurs with aging there does appear to be a muscle bone interaction and there's been a lot of interest in that over the last years and as I mentioned earlier site specific exercise to the hip and to the spine does appear to increase not only muscle mass but bone mineral density so I think that you have to push yourself to make it high-intensity resistance training until you fatigue otherwise a low resistance is not going to build muscle and it's not going to build bone as well you're welcome also you know a lot of older people don't get enough protein and so making sure that you get enough protein to build muscle is also really important with aging yes yes sure sure so the question is can I talk more about the randomized controlled exercise trial with ketosis outcomes and what did I learn about what works and what doesn't work so I had I ran two trials recently one of them the score study and participants came in a group and they exercised for one hour twice a week and they did exercises that were designed to strengthen their back muscles as well as stretch the anterior the shoulders and the hips and they were also instructed to practice good posture every day at least three times a day and we found that kyphosis the curvature in the back did reduce so it got better people stood straighter they had better posture they also increased their trunk strength in the score trial and in that trial men and women both responded equally well to the exercise intervention hypothesis is expected to progress each year but participating in the exercise study prevented the progression and actually reversed the the curvature that had developed in the other study people came and did similar exercises three times a week for six months and in that study kyphosis improved and we took spinal radiographs and the curvature changed on the radiograph as well as clinically it changed and people in that study actually had a better sense of their physical self image from after the study they felt more confident in their physical images after after participation and you know that one of the exercises I showed in the in the talk is lying on your stomach and I was lying over a bolster lifting my torso up and that was one of the exercises that we included in the study as well as if you've ever done a bird dog exercise will you on your hands and knees you lift one arm up and the other leg back and then you switch and do the other side we included that exercise we also I mean there it's a whole whole slew of exercises that that I developed based on some of the muscle impairments that I knew were associated with that kind of postural impairment is that specific enough for you yes yes so we were able to reverse the curvature in the upper back we were able to decrease it more than they expected decline over five years so we actually changed the curvature in the spine on on x-ray and by doing those exercises yes yes yes the disks degenerate the vertebra get compressed the muscles get weak and all of those things contribute yes but we were able to target the muscles and train people what good posture was and we were able to make a difference and so this next study that we're going to be recruiting for the summer we're using an electronic training device to see whether just reminding people during the day to sit up straight to stand up straight whether that will change the curvature in the spine thank you guys for coming I really appreciate it and I hope you'll check out some of these websites [Applause] [Music] you

Channel: University of California Television (UCTV)

Views: 17,009

Rating: 4.8771329 out of 5

Keywords: skeletal health, aging, fracture, physicaltherapy

Id: ckTAh2QdDnQ

Length: 57min 28sec (3448 seconds)

Published: Mon Aug 07 2017