Strong, steady and straight:
UK consensus statement on physical activity and exercise for osteoporosis
Key recommendations from the consensus were three-fold:
Resistance training and impact exercises should be utilized to maximize bone strength.
Resistance training and balance activities should be utilized to decrease fall risk.
Spinal extension exercises should be utilized to reduce the risk of progressive kyphotic posture development, which may reduce the risk of vertebral fracture in this population.
The authors also emphasized that the benefits of physical activity in this population outweigh the risks, and that the risk of significant harm is limited.
"specific and highly challenging balance and muscle-strengthening exercises, supervised by a trained health or exercise professional, are recommended,"
interventions should be
"tailored to suit the individual to ensure that they challenge balance without increasing fall risk"
"Strong"
The recommendation for maximizing bone strength, consists of muscle strengthening activities 2-3x/week with loads that allow 8-12 repetitions per set. They advocated training all major muscle groups of the body for 1-3 sets, per exercise.
Specific Recommendations
For individuals without vertebral fractures or multiple low-trauma fractures,
50+ impacts per session accrued through moderate impact exercises like stamps, hops, and jumps.
For individuals with vertebral fractures or multiple low-trauma fractures,
impact activities that build to the level of brisk walking.
For individuals who are frail or otherwise less able to exercise,
physical activity and exercise according to individual ability, with an emphasis of reducing fall risk.
"Steady"
the authors’ recommendation for reducing fall risk, is based around integration of muscle strengthening activities that include balance and/or balance specific task practice.
"Straight"
the recommendation related to reducing the risk of vertebral fracture and progressive kyphotic posturing, is summed up nicely by the authors. "A positive and reassuring approach is recommended to reduce fear, enhance confidence and control - ‘how to’ rather than ‘don’t do’, especially as most people with osteoporosis are unlikely to experience a vertebral fracture during these activities." The list of recommendations in this section was vast, but primarily distilled down to training the spinal extensor musculature and avoiding sustained, loaded, end-range spinal flexion during daily activities and exercise. In individuals with diagnosed vertebral fracture, advice and exercise is encouraged in a holistic treatment model to reduce fear and maintain mobility/function.
We hope these guidelines empower rehabilitation providers and fitness professionals to challenge their clients with progressive strengthening, impact, and balance activities that reflect their individual status; versus the diagnosis they carry.
Adapted from: Brooke-Wavell K, Skelton DA, Barker KL, et al. Strong, steady and straight: UK consensus statement on physical activity and exercise for osteoporosis. Br J Sports Med. Published online May 16, 2022:bjsports-2021-104634
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