What kind of exercise should be used to treat osteoporosis?
Moderate- to high-intensity weight-bearing aerobic exercise,high-intensity progressive resistance training and high-impact loading (such as jumping) increase BMD (primarily in the spine)by an average of 1% in pre- and postmenopausal women,51,52 whereas exercise such as low-moderate intensity walking alone has inconsistent effects on preservation of bone density.53 By
contast, significant benefits of exercise for the femoral neck are not proven.54 More robust exercise interventions appear to produce greater effects. Inclusion of weight-lifting and balancetraining exercises should provide the widest range of benefits relevant to fracture protection, as well as reducing muscle weakness, falls risk and depression, and increasing muscle mass and mobility. Whether these benefits translate into hip fracture reduction is currently unknown, but it is reasonable to use exercise for risk factor modification pending completion of such studies.
Exercise is integral to the prevention, treatment, and rehabilitation
strategies necessary for the care of older adults. Exercise should be
prescribed, as is all other medical treatment, with consideration of
its unique risks and benefits, knowledge of appropriate modality
and dose (intensity, frequency, volume), monitoring for drug
interactions, benefits and adverse events, and utilization of the
strongest possible behavioral medicine techniques known to
optimize adoption and adherence. There is no age above which
physical activity ceases to have benefits across a wide range of
diseases and disabilities. Sedentariness is a lethal condition;
physical activity is the antidote, and health care practitioners
should be well-educated leaders and role models in the effort to
enhance functional independence, psychological well-being, and
quality of life through promotion of exercise for the aged, both fit
and frail. Importantly, frailty is not a contraindication to exercise.
It is, by contrast, one of the most important reasons to prescribe it.