The word osteoporosis (from the Greek for ‘bone’ and ‘pore’) tells us that the affected bones have holes in their structure. Osteoporosis has been called the ‘silent disease’, progressing without any outward sign, sometimes for decades, until a fracture occurs. Today, regular bone mineral density (BMD) tests have broken this silence – the disease is now in the open, a challenge to be overcome with specific nutrition, supplements, medicine and exercise.
Like muscle, bone is living tissue that responds to exercise by becoming stronger. Exercise is a critically important way to help overcome osteoporosis, maintain general good health, and avoid other chronic diseases – it really is one of the fountains of youth.
HOW OSTEOPOROSIS DEVELOPS
Bone is not a hard and lifeless structure – think of an Aero chocolate compared with a solid bar. It is a complex living tissue that provides structural support for muscles, protects vital organs, and stores the calcium essential for its density and strength. The body’s 206 dynamic living bones renew themselves throughout our lives by means of a continual process known as remodelling. Cells in our bones include osteoblasts (that help form bone) and osteoclasts (that help eat away old bone).
During puberty, rapid increases in bone growth and density occur, with peak bone density achieved between the ages of 20 and 25. After this osteoclast and osteoblast activity remain in balance until age 45 to 50, when osteoclast activity (that breaks down bone) becomes greater and adults slowly begin to lose bone. At menopause women generally have an accelerated loss of bone mass for several years as they lose the protective effect of oestrogen. Other contributing factors are low vitamin D and calcium levels. Osteoporosis is also associated with the use of certain medication (e.g. steroids and thyroid hormone).
THE EXERCISE-HEALTH CONNECTION
Bone loss with age cannot be explained by declining physical activity alone, but if bones are not loaded at all, as during prolonged bed rest, they rapidly lose calcium. Many studies have shown that regular exercise increases bone mass before and after menopause. Weight-bearing exercises alone can stop the process of bone loss and add 1 to 2% a year to bone mineral density.
As well as improving cardiovascular fitness, exercise reduces stress and helps alleviate depression. Regular anti-stress activities are important, as stress hormones can cause coronary artery spasm and increase blood clotting. Exercise is not only good for our physical body, but for our psychological and spiritual well-being.
WHAT SORT OF EXERCISE?
Every one of us is unique, and exercise regimens should be tailored to the age and general health status of the individual. When you decide to start an exercise programme, it’s a good idea to consult a registered physiotherapist. Exercises should include stretching (to warm up), strength building, working the core muscles, and improving stability, balance and posture.
The US Centers for Disease Control and the American College of Sports Medicine state that research has shown moderate exercise, twice a day, to be more beneficial than exercise for longer periods, less often.
Strength exercises have the potential to restore lost bone and make virtually everything you do easier as you navigate through daily life. Why do they work so well? Muscles are attached to both sides of the bones surrounding a joint. For a muscle to cause movement, it has to contract. The shortening pulls on the bone and causes it to move, and it is this ‘tugging’ that bone finds stimulating.1 To be of benefit in osteoporosis, it’s not the duration or quantity of exercise, but the intensity that matters most.
Walking and cycling
All moderate outdoor exercise, including walking, is particularly beneficial because of the vitamin D that’s formed when the skin is exposed to sunlight. Brisk walking is an ideal exercise for most people who have osteoporosis. It can be done anywhere, requires no special equipment, costs nothing, and carries minimal risk of injury. The full benefit of walking depends on a regular schedule – at least 15 to 20 minutes, six days a week (twice a day is even better). If you haven’t been active for years, start with 10 minutes and slowly increase to 20. Walk briskly enough to become slightly short of breath as a little puffing shows that you’re working your body hard enough to improve your fitness. Inject as much fun into your routine walk as possible. As you up the duration and intensity of your walking, the short and long-term benefits will increase.
Workouts on a stationary exercise bicycle improve flexibility and cardiovascular health and are a good alternative when the weather is bad.
Rebounding on a mini-trampoline is an excellent form of low-impact, high-benefit exercise, but you need good muscle strength, especially in the abdominals and erector spinae (a group of muscles in the back), to do it safely. Only do 10 jumps in a row, then rest. Repeat until you can do 50 jumps. Get approval from your physiotherapist before attempting these exercises.
What to avoid
- Avoid exercises that put excessive stress on your bones, such as running or high-impact aerobics, or flexion exercises like sit-ups.
- Avoid rowing machines as too much deep forward-bending can lead to fracture of fragile vertebrae.
- Excessive exercise can cause micro-fractures in bones.
BALANCE AND CO-ORDINATION
Balance not only means steadiness on the feet – it means that the whole body, from head to toes, responds to changes in its environment and makes adjustments timeously. People often fall because of weak anterior tibialis muscles (these are the muscles in the front of the lower legs).
Sit in a chair and slowly count to 10 as you circle your right ankle just once. Could you do it? Was it a complete and smooth circle, or a series of jerky movements? Try circling the other foot. If ankle movements are compromised, or if there is a big difference between the two feet, you may have a balance problem. Do balance exercises, one day with shoes and the next day barefoot. The brain and sensory receptors in your feet will work harder to adjust to these variables.
A regular and well-designed exercise routine must include balance to catch and protect yourself. The importance of these skills for someone who has been diagnosed with osteoporosis cannot be stressed enough.
Incorporate balance into your daily activities as much as possible. Walk on your toes when at home – toe-walking will improve your balance when moving. It’s also good for improving calf strength and ankle flexibility. Try to choose activities you enjoy, and make them lifelong habits.
Posture is dynamic. It’s an interplay between your nervous system, muscles and bones, and even your emotional state – a dance. Achieving long-lasting and effortless good posture often requires structural change in the body – the ‘letting go’ of muscular contractions that cause subtle changes in your skeletal alignment. Good posture will make you look slimmer and younger. Make it a priority, and you could undergo a rejuvenating transformation.2
Stretching before and after exercise is beneficial. Stretch with a smooth movement, ending softly, and avoid aggressive stretches. Move slowly and with control to take your muscles into the fully stretched position. Never bounce in a stretch – this may cause injury. Don’t touch your toes with straight legs to stretch the back and hamstrings. This outdated stretch carries an increased risk of back injuries. For a hamstring stretch, it’s better to lie on your back with both knees bent and your feet flat on the floor. Check your pelvis tilt, tighten your abdominals, and lift one leg in towards your chest while keeping the knee bent. Hold the back of your thigh with both hands and slowly straighten your leg until you feel a stretch in the back of your raised thigh. Hold for a count of 10. Relax, return and repeat with the other leg.
Music has the potential to make exercise enjoyable, decrease perceived exertion and distract you from the physical demands of the activity.
The human being is built to move. Our muscles work in conjunction with the rest of our body, not just in isolated areas. Research has shown brief bouts of activity that load the skeleton to be the best kind of exercise for your bones.
Climbing the stairs instead of using the lift – you can do it! Walking with weights around your ankles for short periods every day – you can do it! For exercise to be effective, it must be a lifetime commitment. How will you make it part of your life? Just do it. Life’s responsibilities will always intrude but schedule it at the same time every day. And focus on how good you feel afterwards!
- Bassey J, Dinan S. Strong Bones. London: Carroll & Brown, 2001.
- Daniels D. Exercises for Osteoporosis. Long Island City: Hatherleigh Press, 2008.
National Osteoporosis foundation South Africa www.osteoporosis.org.za