A review of the potential side effects and limitations of physical activity in osteoporosis patients is outlined in the table below [1]Chilibeck, P.D., et al., Evidence-based risk assessment and recommendations for physical activity: arthritis, osteoporosis, and low back pain. Appl Physiol Nutr Metab, 2011. 36 Suppl 1: p. S49-79.
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|
Patient |
Physical activity |
Level of evidence* |
Recommendation grades** |
|---|---|---|---|
|
At high risk of fracture |
Avoid trunk flexion exercise, as this may increase spine fracture risk; however, trunk extension exercise and abdominal stabilization exercise are safe. |
Level 2 |
Grade A |
|
Recovering from hip fracture |
Physical therapy exercises should not be performed for more than 15–30 min per session early in the rehabilitation process, as this increases the risk of orthopaedic complications. |
Level 2 |
Grade A |
|
With osteoporosis |
Aerobic physical activity and progressive resistance training are safe. Intensity of the exercise sessions should initially be light to moderate and progressively increased based on the individual’s capability |
Level 2 |
Grade A |
| With osteoporosis | They should avoid powerful twisting movements of the trunk | Level 3 | Grade C |
|
With spinal cord injury and osteoporosis of the lower limbs |
Avoid maximal strength testing with electrical stimulation of the lower limbs |
Level 3 |
Grade C |
|
With spinal cord injury, |
Progressive lower limb resistance training, cycling and ambulation (all assisted by electrical stimulation) or body-weight-supported treadmill |
Level 2 |
Grade A |
|
*Level of evidence: 1, RCTs; 2, RCTs with limitation or very convincing observational studies; 3, observational studies; 4, anecdotal evidence. |
|||
Adapted from Chilibeck et al., Appl Physiol Nutr Metab, 2011 [1]Chilibeck, P.D., et al., Evidence-based risk assessment and recommendations for physical activity: arthritis, osteoporosis, and low back pain. Appl Physiol Nutr Metab, 2011. 36 Suppl 1: p. S49-79.
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Generally, exercise for individuals with osteoporosis, exercise recommendations are similar to those for the elderly. However, with existing osteoporosis, caution should be applied with activities and sports that have the potential of severe injury. Individuals at increased risk of osteoporosis fractures should avoid deep backbends and activities that involve forward bending of the spine, particularly while carrying an object, as this movement in the presence of osteopenia increases the risk of anterior compression fractures of the thoracic vertebrae.
Involving a health care professional is essential in designing an exercise programme as supervised, targeted exercise programmes are recommended. Programmes that include muscle strengthening, balance training and coordination exercises are highly recommended.
In frail elderly individuals with poor balance, mobilization without balance and strength training may increase the risk of fracture. Thus, mobilization should be supervised by physiotherapists and supported by strength and balance training.
Exercise, especially physiotherapy, can also play a crucial role in rehabilitation [2]Auais, M.A., O. Eilayyan, and N.E. Mayo, Extended exercise rehabilitation after hip fracture improves patients' physical function: a systematic review and meta-analysis. Phys Ther, 2012. 92(11): p. 1437-51.
. Muscle strengthening exercises can help to rebuild bone in those who have developed osteoporosis and can also provide relief from pain. People with osteoporosis or previous fractures should consult their medical professional before starting an exercise programme. Read more in post-fracture rehabilitation and exercise.
Kyphosis
Chronic pain is most problematic in people with kyphosis, most often due to osteoporosis fractures of the vertebrae. Kyphosis causes loss of height, poor posture, and a shift in the centre of gravity. In the worst cases, the curvature of the spine is so severe the rib cage is pressed against the pelvis. Forced into this posture, patients can suffer severe pain and have trouble breathing.
Exercise can help relieve the pain and some of the symptoms of kyphosis. By strengthening the muscles in the back, the spine can be brought more upright. This has been shown to increase mobility and reduce pain [3]Malmros, B., et al., Positive effects of physiotherapy on chronic pain and performance in osteoporosis. Osteoporos Int, 1998. 8(3): p. 215-21.
. This type of therapy can greatly improve the quality of life of the patient. Read more about exercise following fracture and immobilization.
Further reading and resources
Osteoporosis Canada’s “Are you too fit to fracture” multicomponent exercise recommendations, developed by expert consensus, combine muscle strengthening and balance training as a means of reducing falls and resulting fractures for people living with osteoporosis.
→ Read it here
The UK Royal Osteoporosis Society’s “Strong, Steady and Straight” initiative, also developed by expert consensus to provide information and tools to advise patients on exercises via a quick guide summary and statement.
→ Read it here