Can resistance training increase bone mineral density in osteoporotic women?

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Can resistance training increase bone mineral
density in osteoporotic women?

• Tricia Backus and Christa Roessner

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Resistance Training

• Exercise during which a muscle contracts just a
  few times against a heavy load or with high
  tension.
• Distinct from endurance training during which
  muscles contract against little or no resistance.
• (Evans, 2005)

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What is Osteoporosis?

• A systemic skeletal disease
• More prevalent among women
• One in two women aged 50 and over will have an
  osteoporosis-related fracture in their lifetime
• After age 30
• Deliberating effect on independence and quality
  of life
• 10 million Americans (ACSM,
  2006)

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(www.familydoctor.com)
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(www.pinksunrise.com)
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www.imagins.com
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What is low bone mineral density?

• How it is measured
• DEXA video
• BMC results are put into T score to determine
  risk

T-Score WHO Criteria for Osteoporosis in Women T-Score WHO Criteria for Osteoporosis in Women
Normal BMD gt -1.0 below the young adult reference range
Low Bone Mass (Osteopenia) BMD is -1.0 to -2.5 SD below the young adult reference range
Osteoporosis BMD lt -2.5 SD below the young adult reference range
Severe Osteoporosis BMD lt -2.5 SD below the young adult reference range and the patient has one or more fractures
(mayoclinic.com)
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How to Prevent / Treat

• Supplements
• Calcium
• 500mg and 1500mg
• Alendronate
• 10mg
• Prescription medicine
• Lifestyle
• Healthy diet
• Exercise

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How Does BMD Increase?

• Multiple-Hormone System
• Blood calcium levels
• (Robergs Roberts, 1997).
• Physical Stress
• Bone tissue must have daily stimulus to
  increase/maintain BMD (Hamill, Knutzen 2003)
• Stresses help activate the osteoblasts and favor
  bone deposition (Hamill, Knutzen 2003)

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Types of Exercise looked at

• Strength
• Flexibility
• Agility
• Power

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Power vs Strength

• 53 postmenopausal women
• Resistance training, gymnastics session, and home
  training over 12 months
• Strength used slow movements
• Power used fast movements
• Power Strength/Time
• Used calcium and Vit. D
• Power training is more effective in reducing bone
  loss (significant at plt0.05)
• (Stengel, 2005)

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Hormone Replacement Therapy

• 28 women on HRT
• 75 and older
• Physical Frailty
• 9 months of supervised or home exercise
• PT, resistance, and endurance training
• Relatively vigorous exercise training
  significantly increases lumbar spine BMD
• No control group
• (Villareal, 2003)

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Frequency/Duration

• Resistance Training
• 2x/week 50 mins. (Liu-Ambrose, 2005)
• 2x/week 35 mins. (Judge, 2005)
• 2x/week 50 mins. (Lohman, 1995)
• 2x/week 45 mins. (Braith, 2003)
• 3x/week 60 mins. (Pruitt,1992)
• 3x/week 90-100 mins. (Villarel, 2003)
• 2x/ week 60 mins. (Stengel, 2005)
• Power Training
• 2x/week 60 mins. (Stengel, 2005)
• Agility Training
• 2x/week 50 mins. (Liu-Ambrose, 2005)
• Flexibility Training
• 2x/week 50 mins. (Liu-Ambrose, 2005)
• 2x/week 60 mins. (Villareal, 2003)

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Intensity

• Resistance training
• 2 sets 10-15 reps. 50-60 1 RM (Liu-Ambrose,
  2005)
• 1-3 Sets 10-12 reps. (Lohman, 1995)
• 2 sets 10-15 reps. 50-60 1 RM (Braith, 2003)
• 1-3 sets 12 reps. 65 1 RM (Villareal, 2003)
• Power Training
• 2 sets. 10-15 reps. (fast movements) (Stengel,
  2005)
• Agility Training
• Varied (relay races, obstacle courses, dance)
• (Liu-Ambrose, 2005)

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Diet

• A high ratio of dietary animal to vegetable PRO
  increases the rate of bone loss and the risk of
  fracture in postmenopausal women.
• More rapid femoral neck bone loss
• Suggest an increase in plant PRO and a decrease
  in animal PRO to prevent
• (Selmeyer, 2001
• Sports Nutrition Workshop)

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Helen Zechmeister, Age 91, Weight Lifter
(http//nihseniorhealth.gov)
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Summary of Findings

• Largest increases were shown in subjects using
  hormone replacement therapy or Alendronate in
  addition to resistance exercise
• Power training was shown to be best form of
  resistance training (Stengel, 2005)
• May not be best for older populations
• Therefore, resistance training still effective
• Exercise prescription
• Frequency 2-3x/week
• Duration 60 mins.
• Intensity 50-65 1 RM
• 2 sets 10-15 reps.
• Diet protein helps to decrease bone loss
  (Selmeyer, 2001)

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References

• Liu-Ambrose T., Khan K, Eng J, Lord S, Lentle B,
  McKay H. Both resistance and agility training
  reduce back pain and improve health-related
  quality of life in older women with low bone
  mass. Intl. Osteoporosis Foundation 2005 16
  1321-1329
• Villareal D, E Binder, K Yarasheski, et al.
  Effects of Exercise Training Added to Ongoing
  Hormone Replacement Therapy on Bone Mineral
  Density in Frail Elderly Women. J Am Geriatr
  2003 51 985-990
• Stengel SV, W Kemmler, R Pintag, et al. Power
  training is more effective than strength training
  for maintaining bone mineral density in
  postmenopausal women . J Applied Phys 2005
  99(1) 181-188
• Kelley GA, KS Kelley, ZV Tran. Resistance
  training and bone mineral density in women a
  meta-analysis of controlled trials. Am J Physical
  Med and Rehab 2001 80(1) 65-77
• Sports Nutrition Workshop Nutrition and
  Exercise. Nancy Clark MS RD William Evans PhD.
  Columbus, Ohio. Dec 2-3 2005
• Judge J, et al. Home-based resistance training
  improves femoral bone mineral density in women on
  hormone therapy. Osteoporosis Intl. 2005 16
  (9) 1096-1108
• Lohman T. et al. Effects of resistance training
  on regional and total bone mineral density in
  premenopausal women-a randomized prospective
  study. Journal of Bone and Mineral Research
  1995 10 (7) 1015-1024

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References (cont.)

• Braith RW et al. Resistance Training and
  alendronate reverse glucocorticoid-induced
  osteoporosis in heart transplant recipients.
  Journal of heart and lung transplantation 2003
  22 (10) 1082-1090.
• Pruitt LA et al. Weight training effects on
  bone-mineral density in early postmenopausal
  women. Journal of bone and mineral research
  1992 7 (2) 179-185.
• Hamill, Joseph and Knutzen, Kathleen.
  Biomechanical Basis of Human Movement. Lippincott
  Williams Wilkins, Philadelphia, PA 2003.
• ACSM Guidelines for Exercise Testing and
  Prescription. Lippincott Williams Wilkins
  2006.
• www.familydoctor.com
• www.pinksunrise.com
• www.imagins.com
• www.mayoclinic.com
• (Robergs Roberts, 1997).http//www.unm.edu/lkr
  avitz/Article20folder/bonemass.html