Physical Activity Guidelines for Skeletal Health and Aging: Too Fit - PowerPoint PPT Presentation

Disclosures UCSF license Stand Tall TM exercise program Physical Activity Guidelines for Skeletal Health and Aging: “Too Fit to Fracture” Wendy Katzman, PT, DPTSc (DSc), OCS Professor, UCSF 16 th Annual Osteoporosis Update  Thanks to Dr. Lora Giangregorio and Osteoporosis Canada US Department of Health and Human Services Objectives Guidelines for physical activity essential to healthy aging :  Present best evidence for exercise and physical  Avoid inactivity activity in promotion of skeletal health in aging  For substantial health benefits,  Review US Department of Health and Human • At least 150 minutes a week moderate-intensity, or Services Physical Activity Guidelines for Older Adults • 75 minutes a week vigorous-intensity aerobic activity  Learn how guidelines change for skeletal health prevention and treatment of osteoporosis and • For greater health benefits, aerobic activity 300 minutes osteoporotic fractures a week moderate intensity, or 150 minutes a week vigorous intensity aerobic activity • National Osteoporosis Foundation  Muscle-strengthening moderate or high intensity and • Osteoporosis Canada “Too Fit to Fracture” involve all major muscle groups on 2 or more days a week https://health.gov/PAGuidelines/ CSM 2/17/2017

Exercise for preventing and treating Effect of Exercise on Bone Density osteoporosis in postmenopausal women in Postmenopausal Women Pooled results from randomized controlled trial Howe et al, Cochrane Database Syst Rev, 2012 Effect of exercise varies by activity Hip Lumbar Outcome Participants Quality Comments General (all studies pooled) 4% absolute difference, - + Total number of 539 high but not statistically High force dynamic (running, jumping) fractures (4 studies) significant + - Low force dynamic (walking) - + Bone mineral density Significant difference % change: spine 1441 high between groups Progressive resistance + + (24 studies) 0.85% less bone loss Resistance (low weights) - - Bone mineral density No significant Combination: High impact/progressive + + % change: femoral 1338 low difference between resistance neck (19 studies) groups Howe et al, Cochrane Database Sys Rev, 2012 High ‐ Intensity Resistance and Impact Training Improves Bone Mineral High ‐ Intensity Resistance and Impact Training Improves Bone Mineral Density and Physical Function in Postmenopausal Women With Density and Physical Function in Postmenopausal Women With Osteopenia and Osteoporosis: Osteopenia and Osteoporosis: The LIFTMOR Randomized Controlled Trial The LIFTMOR Randomized Controlled Trial • Between-group differences in 8 ‐ month exercise training 2x/week for 30 minutes among change in lumbar spine and femoral postmenopausal women with low bone mass (n = 101) neck BMD • +2.9 ± 2.8% EX vs • Supervised high-intensity  Independent, low-intensity, resistance and impact home-based exercises -1.2 ± 2.8% CON, p < 0.001 • +0.3 ± 2.6% EX vs • Deadlift, squat, and overhead -1.9 ± 2.6% CON, p = 0.004 press • 80–85% of one repetition • Between-group differences in maximum change in all functional performance outcomes, p<0.001 • Jumping chin ups with drop landing • 5 sets of 5 repetitions Watson, S, et.al. JBMR, 2018 Watson, S, et.al. JBMR, 2018 CSM 2/17/2017

High ‐ Intensity Resistance and Impact Training Improves Bone Mineral Other Factors Affecting Fracture Risk Density and Physical Function in Postmenopausal Women With Osteopenia and Osteoporosis: load>>>strength The LIFTMOR Randomized Controlled Trial • Falls • Between-group differences in change in lumbar spine and femoral • Spinal curvature neck BMD • +2.9 ± 2.8% EX vs - • Body posture or activity 1.2 ± 2.8% CON, p < 0.001 • Neuromuscular control • +0.3 ± 2.6% EX vs -1.9 ± 2.6% CON, p = 0.004 • Between-group differences in change in all functional performance outcomes, p<0.001 • Bone strength increased in subset • Adverse events: 1 in EX group Christiansen & Bouxsein, Current Osteoporosis Reports, 2010; Briggs, Watson, S, et.al. JBMR, 2018 AM, et al. Osteoporos Int, 2007; McIntrye, N, et al. Osteoporos Int, 2013 Effect of Exercise on Falls National Osteoporosis Foundation Pooled estimate from 54 trials of exercise on the rate of falls indicates Guidelines for physical activity essential to healthy 16% reduction (pooled rate ratio 0.84 (95% CI: 0.77 – 0.91) aging, and prevent and treat osteoporosis: Reduction Component type or dose (number of studies) in falls If you're 65 years or older, generally fit, and have no limiting % % health conditions, Exercise with moderate or high challenge to balance (43) 22 14 - 30 • 150 minutes of moderate-intensity aerobic activity (i.e., brisk walking) OR 75 minutes of vigorous-intensity Exercise with a high challenge to balance (30) 25 15 - 43 aerobic activity (i.e., jogging or running) every week • weight training muscle-strengthening activities on 2 or Total exercise dose more than 50 hours (equivalent 2 23 13 - 32 hours/week for 6 months (30) more days a week that work all major muscle groups Inclusion of walking training (30) 10 0 - 22 (legs, hips, back, abdomen, chest, shoulders, and arms) • daily posture exercise and balance training to prevent A high risk population (39) 10 0 - 20 falls Sherrington et al., 2011, NSW Public Health Bulletin CSM 2/17/2017

Effect of Exercise on Falls Effect of Exercise on Hyperkyphosis Catherine Sherrington et al. Br J Sports Med, 2017 Results of multivariate meta-regression exploring impact of trial-level characteristics on • Recent randomized clinical trials report targeted the effect of exercise on falls in community-dwelling older populations. exercise prevents kyphosis progression and modest Variable Effect on falls, Incident rate ratio improvements in measures of kyphosis (95% CI), p-value • Emphasis on back extensor muscle High challenge balance training* 0.79 (0.71 - 0.88), <0.001 strength/endurance and postural training 3+ hours per week of intervention 0.70 (0.60 - 0.83), <0.001 • Importance of training and reinforcement Neither high challenge or 3+ hours 0.90 (0.82 - 0.99), 0.03 High challenge balance training AND 0.61 (0.53 - 0.72), <0.001 3+ hours per week of intervention** * High challenge includes: movement of center of mass, narrowing of the base of support and minimizing upper limb support. **Note: 72% heterogeneity explained by both variables; statistically significant comparisons in italics  Exercise reduces fall rates in community-dwelling older adults 21%. Bansal S, et al. Arch Phys Med Rehabil, 2014; Katzman, WB, et al. Osteoporos Int, 2017;  3 hours per week AND high challenge to balance reduces falls 39%! Katzman, WB, et al. BMC Musculoskeletal, 2017; Katzman, WB, et al. JMIR Aging, 2019 For Stronger Back Muscles For Better Posture What type of activity? Align: Supine isometrics  prone extension to neutral  core activation in • Back of head standing • Shoulder blades • Rib cage How often each week? • Buttocks/sacrum  5-10 minutes per day of posture exercises • Feet  Attention to posture during daily activities Tools: Floor mat or soft but supportive surface, mirror, wall Individuals with a history of a spine fracture:  Might need a pillow under head if spine is curved  Supine lying at intervals throughout the day “ unloads” spine, promotes spinal extension and stretches front shoulders and chest.  Consultation with a trained professional Practice best posture throughout the day Giangregorio LM, et al Too Fit To Fracture: Outcomes of a Delphi consensus process on physical activity and exercise recommendations for adults with osteoporosis with or without vertebral fractures.Osteoporos Int. 2014 CSM 2/17/2017