Let’s build our bones!

Estelle Watson is a lecturer at the Centre for Exercise Science and Sports Medicine, Faculty of Health Sciences, University of the Witwatersrand and a member of the Biokinetics Association of Southern Africa (BASA) “Exercise is truly a fountain of youth from which we can all rejuvenate ourselves”. This quote by Menard and Stanish is particularly true in our aging years where age-related changes lead to loss of bone density and muscle strength, resulting in conditions such as osteoporosis. October is Osteoporosis Awareness month. Osteoporosis is a disorder that causes low bone mass and deterioration, or breaking down, of the structure of the bone itself. You are not alone Osteoporosis is a really common condition. Research estimates that it affects between 15-55% of the world’s population. In some countries, this equals around 10.2 million people or every fourth women and every 17th man over the age of 50 years. In the US, if we include below-normal bone mass (osteopenia) into these estimates, this number grows to 53 million people. Although osteoporosis does not discriminate between genders, it is usually more common in women from about 50 years onwards. Ouch! With osteoporosis, the bone breaks down faster than it can build up. This is a slow process that can usually occur undetected, or without symptoms, although one of the first signs of osteoporosis is commonly an acute bout of back pain. The most common sites for this bone breakdown are the upper and lower back, as well as the hip. Who, me? Since osteoporosis can often go unnoticed, it is important for those who are at risk to have a bone density test. There are certain factors that may place an individual at a higher risk of having a low bone density. Factors outside of our control include being female, being thin or having a small frame, advanced age, having immediate family members who have osteoporosis, being post menopausal and having low testosterone levels. Factors that we can control include insufficient calcium intake, an inactive lifestyle and excessive smoking or drinking as well as the use of certain medications such as corticosteroids. Why the worry? As a result of the low bone density, individuals with osteoporosis are more likely to break or fracture their bones when compared to the general population. Fractures can have a negative effect on chronic pain and quality of life as well as carrying huge costs for the healthcare system. And so it becomes incredibly important to try to reduce the risk of falling and prevention of fractures. Let’s build our bones Exercise and being active plays a really important role in the management of osteoporosis. For example, the stress that we place on our bones whilst exercising actually helps the bones to change their structure and therefore become stronger. There is a vast amount of evidence for the role of exercise in improving bone density, and as long as it’s done properly, can successfully (and cost effectively) help manage osteoporosis. What type of exercise should I do? For our general health, it is recommended that we participate in 150 minutes of moderate, or 75 minutes of vigorous, physical activity per week. It is important that previously sedentary people start an exercise programme slowly and progress slowly. Weight-bearing exercises such as walking, light jumping and vibration exercises are a great way to improve bone density, especially in the hip joint. Resistance training, which improves muscle strength using body weight, gym-machines, hand weights or resistance bands, helps to improve the strength of the bone at the specific joint being used. Balance exercises can also be effective in training our body awareness, and reactiveness, and therefore helps to reduce the risk of falling. Stretching exercises are also important to improve movement in the joints and help with flexibility. What should I avoid? Resistance and weight-bearing training that exceeds the bone’s ability to adapt should be avoided. Therefore, exercise should start slowly and progress slowly, and should avoid increases in intensity by more than 5% per week. Exercises or daily activities that encourage a slouched posture or rounded shoulders should be avoided, and careful attention should be paid to the correct technique for all exercises. Very high impact exercises (plyometric or jumping with a weight) should be avoided, as well as bending of the back when loaded (sit ups with resistance, and bending to pick up heavy loads). Exercise is one of the most effective ways to improve bone health, maintain independence and increase quality of life, in individuals with osteoporosis. Individuals with osteoporosis should always receive medical clearance before starting an exercise programme. They should also consider consulting a biokineticist who is trained to carefully consider the risk of injury and possible co-morbidities when prescribing a safe and effective exercise programme. We should not underestimate the powerful effects that a structured exercise programme can have on reducing the effects of osteoporosis, encouraging successful ageing, and living longer, healthier lives.