Osteoporosis and Exercise Guidelines - Literature review Example

?Literature Review: Osteoporosis and Exercise Guidelines Introduction Osteoporosis is one of the most common diseases affecting older adults. It is also a disease which can lead to other health issues, including fractures, sprains, and strained muscles. This paper shall consider the various studies which have been carried out on osteoporosis, including its management and treatment. It shall also consider the various exercise guidelines for the disease. Osteoporosis, overview This disease is characterized by the decrease in the density of the bones, manifesting with a decrease in the strength of the bones which eventually causes the fragility of the bones (Shiel, 2012). Bones are made up of protein, calcium, and collagen which all combine in order to give bone strength. The spine, hips, ribs, and wrists are the most common sites of fractures and injuries for osteoporosis patients (Shiel, 2012). In the US alone, about 44 million suffer from low bone density, and this population represents about 55% of the US population above the age of 50 (Shiel, 2012). The global numbers more or less represent similar numbers, with Caucasian women often suffering fractures at higher incidence rates as compared to their male counterparts. The cost for the management of this disease registers at billions of dollars which does not even reflect indirect costs including days out of work and decreased productivity (Shiel, 2012). With the increased number of aging adults, the incidence rate for this disease will likely manifest higher numbers. Main elements affecting the incidence of osteoporosis include genetics, lack of exercise, low calcium and Vitamin D levels, previous history of fracture during adulthood, smoking, excessive alcohol consumption, low body weight, and a family history of osteoporosis. There are various treatments for osteoporosis. In general, these treatments include medications, quitting smoking, reducing excessive alcohol intake, exercise, and increased intake of calcium and Vitamin D. This paper shall specifically cover exercise as a means of managing the disease. Literature review Various studies have been carried out on osteoporosis and its management, including the use of exercise as an intervention. In the paper by Arnold, et.al., (2008) the authors carried out their study in order to compare the use of aquatic versus land exercise in improving the balance, function, and quality of life among older women with osteoporosis. The study chosen by the authors was very timely and significant to the current issue of osteoporosis. With the increasing number of the aging population, the need to establish the efficacy of some forms of treatment against other forms of treatment for osteoporosis has become even more imperative. The authors also considered the limited studies comparing aquatic and land exercises in the management of osteoporosis, and based their study on such limitations in order to ensure that their research contributes crucial data to the current considerations on osteoporosis treatment. The specific applicability of these exercises on women also adds to the relevance of this study because women are more likely than men to suffer from osteoporosis. Their study covered 68 women, 60 years and above and randomly assigned to undergo aquatic, land based-exercises, or no exercise (Arnold, et.al., 2008). This study revealed that only one balance measure – the backward tandem walk – significantly improved during aquatic exercises; this did not imply a significant impact on the patient’s self-function. In general, there was also no significant difference in the exercise intervention and in the no exercise group, except in relation to global or overall improvements. In this case, the aquatic and land exercise groups, as compared to the no exercise group, manifested improvements in balance, function, and quality of life (Arnold, et.al., 2008). The authors therefore concluded that although there were no differences seen in the balance, function, and the quality of life for women with osteoporosis who used the aquatic exercise or land exercise program (against those who did not do any exercise), there were significant global changes in the aquatic and land exercise group as compared to the no exercise group in the management of osteoporosis (Arnold, et.al., 2008). Their study implied therefore the importance of exercise for osteoporosis patients, with exercises either being land or water-based, for as long as some form of exercise is applied. All in all, the study provides credible and reliable results and research processes. Primarily, the authors were able to randomly assign their respondents into the three categories. Random methods are important processes of research which help provide credibility and reliability to the study. It is also a process which increases the generalizability of results to a larger population. The wait-list design and the non-equivalent control group reassigned to intervention also reduced the internal validity of the study because the control group was not taken from an independent population (Arnold, et.al., 2008). Nevertheless, the design chosen by the authors was cost-effective and it helped reduce difficulties in recruiting sufficient numbers for implementing a true randomized controlled trial for three groups (Arnold, et.al., 2008). Future studies however need to consider a larger population in order to improve reliability measures for the assessment of three intervention groups. The results were also based on well supported statistical measures. Moreover, the conclusion was based on the results and discussion of the authors with no logical fallacies apparent from the study. In a more recent study by Madureira and colleagues (2010), the authors discussed how physical and psychological incapacity, which often includes fear of falling is often linked to the decreased quality and satisfaction in life among osteoporosis sufferers. Their study was carried out in order to assess the impact of a 12-month Balance Training Program in improving the quality of life, in improving functional balance, and in reducing falls among elderly osteoporotic women (Madureira, et.al., 2010). The authors were able to cover 60 consecutive women with senile osteoporosis, randomly assigning them to undergo the Balance Training group or the no intervention group (Madureira, et.al., 2010). Through the BT program, techniques which sought to improve balance were carried out on the patient for 12 months with one hour exercise sessions per week, as well as home-based exercises. The quality of the patient’s life was assessed before and after the 1-year intervention period. The assessment tool used was the Osteoporosis Assessment Questionnaire and the patient’s functional balance was assessed through the Berg Balance Scale (BBS) (Madureira, et.al., 2010). The incidents of fall in the preceding year was compared to the year when the study was carried out (Madureira, et.al., 2010). After the study was carried out, the authors were able to establish that a significant improvement in the quality of life of the patients undergoing the BT program as compared to the control group was observed. Observed improvements in the quality of life were seen in terms of physical functioning, general well-being, psychological condition, symptoms, as well as social interactions (Madureira, et.al., 2010). Improvements in the BBS measures were also apparent, as well as a 50% reduction in falls. In general, the authors were able to establish conclusive results in support of the use of the Balance Training Program in the management of osteoporosis among elderly osteoporotic women. Observed limitations on this study include the fact that respondents were recruited at an academic tertiary centre; these patients may represent those with severe manifestations of the disease as well as comorbid conditions which in the end may not represent the condition of community-dwelling osteoporotic patients (Madereira, et.al., 2010). This study is nevertheless relevant because it is one of the first studies to illustrate that the implementation of a balance program of exercise can assist in implementing global change in the health of osteoporosis patients. The randomized designation of respondents to the intervention groups helped establish generalizability of results, however, such generalizability could have been improved further with a bigger number of respondents based in the community population. The ethical elements of research, in terms of securing informed consent were not detailed by the researchers. This also reduced the credibility of the research due to the fact that human respondents are involved and informed consent must be an essential part of the research process. Tolomio and his colleagues (2010) also carried out their study in order to assess the importance of exercise in osteoporosis; their study however focused more on the role of exercise in preventing the disease, reducing risks of fracture, and in improving muscle mass, strength, and balance. Their study is also relevant and related to the overall purpose of this literature review because it covers the role of exercise in the prevention of issues which are often encountered by osteoporotic patients, in this case, problems which relate to falls, balance, and reduced muscle strength (Tolomio, et.al., 2010). Their focus is also on elderly women, but they also included the postmenopausal women as respondents. They sought to evaluate the impact of a specific exercise program on the mass and quality of bones and the physical function capacity among postmenopausal women with decreased bone mineral density (Tolomio, et.al., 2010). This study followed the same trend for previous studies, covering women who are more prone to experience osteoporosis. This study covered a larger population, 125 respondents with the subjects taking part in an 11-month exercise program, mostly on improvements for strength, aerobic capacity, balance, and joint mobility; the other respondents did not undergo any exercise (Tolomio, et.al., 2010). Evaluations before and after the program were carried out on the respondents. After the training program, it was apparent to note that the femoral neck T-score for the exercise group was improved; for the control group, their bone quality was significantly decreased, while the exercise group did not manifest any differences in their bone quality (Tolomio, et.al., 2010). The exercise group also improved their capacity for physical functioning; no improvements along these same measures were seen in the control group. The authors concluded that implementing a specific exercise program focusing on osteoporosis would help improve physical function capacity; it can also reduce physiological bone loss, and maintain bone quality among postmenopausal women (Tolomio, et.al., 2010). The authors were able to utilize effective methods for their study, helping to ensure that credible tools for data gathering were used. The design of the study was appropriate because it was able to ascertain a strong correlation between the variables; it was also able to assess the variables within the clinical setting. The limitations of the study were mostly related to the physical activity program which did not help establish support for the current exercise program used by the authors. Future studies must therefore be related to randomized control trials covering three groups – land, water, and land plus water based exercises (Tolomio, et.al., 2010). Such a study would fill in the gaps of this current study. Gunendi, et.al., (2008) considered the direction of their study towards the assessment of the impact of submaximal aerobic exercise program in assessing postural balance among postmenopausal women having osteoporosis. This study, in a similar light with previous studies, also sought to assess the effect of exercise on osteoporosis management. Their research however was more specific to the application of the submaximal aerobic exercise program in patient management (Gunendi, et.al., 2008). The authors were able to ascertain that there was a marked improvement in the balance scores among postmenopausal women with osteoporosis after they underwent exercise training; for those who did not undergo any training, no significant changes were seen in their balance scores (Gunendi, et.al., 2008). The study was able to reveal similar results as seen in previous studies – that indeed exercises are an important addition to the management of osteoporosis (Gunendi, et.al., 2008). Once again however, this study also suffers from a very limited population, hence, its generalizability is limited. Nevertheless, most of the results of this study are well supported by previous studies and other literature on the subject matter. The methodology of this study is sound, with appropriate patterns of research established via statistical tools assessment tools. Limitations of this study pertain mostly to its limited time covered; it was too short for the authors to make an interpretation in terms of the effects of exercise on falls (Gunendi, et.al., 2008). Future studies must therefore be directed towards filling in such limitations. Based on the above studies reviewed, the importance of exercise in the management of osteoporosis, as well as in the improvement of the quality of lives of osteoporotic patients has been clearly established. It is therefore important to consider exercise guidelines which can be applied by osteoporosis patients. In the study by Petit, Hughes, and Warpeha (2008), the authors recommended the application of the Osteofit, an exercise-based program, created by the staff members of the British Columbia Hospital Centre Osteoporosis Program in Vancouver, Canada. This program showed much promise in increasing ability of the patients to carry out their ADLs, in decreasing their back pain, increasing their general well-being, and reducing their fall risks. As with most exercises, this program starts with warm-up, then proceeds to the work-out itself, and ends with a period of relaxation (Petit, et.al., 2008). The warm-up is composed of 10-15 minutes exercises which start off with gentle range motion activities; unlike regular exercises however, no static stretching is included in the warm-up. This warm-up then ends with walking or with dance routines (Petit, et.al., 2008). The workout itself includes strengthening and stretching exercises which are meant to improve posture. These exercises may then proceed to activities which seek to improve balance and coordination – heel raises as well as toe pulls, two-legged heel-toe rock, tandem walks, and obstacle courses (Petit, et.al., 2008). Hip stabilization is managed through leg exercises; functional ability improvements are carried out through chair squats and getting up and down from the floor. The repetitions are usually at 8 and 16 with light weight lifting in order to prevent fatigue (Petit, et.al., 2008). The more strenuous activities are usually at the end of the workout set. Finally, the relaxation portion involves deep breathing, progressive relaxation and visualizations. Waryasz and McDermott (2008) establish an important aspect of implementing exercises for osteoporosis – that is, the concept of patient preference. Patient preference is important in exercise because it can be difficult to implement on patients, especially elderly patients. Consulting with the patient in relation to what activities can be carried out is therefore important to the implementation of exercise. The American College of Sports Medicine (2009) also recognize the importance of considering patient circumstances. They recommend that low-risk patients can participate in maximal and vigorous exercises without seeking medical clearance; for moderate risk patients, they can participate in submaximal exercises and moderate intensity activities without medical clearance; but for high risk patients, they need to seek medical attention before staring moderate-intensity activities (ACSM, 2009). Waryasz and McDermott (2008) also discuss aerobic exercises, including repetitive movements which can increase heart rate for a sustained period of time. Walking, running, swimming, and cycling can help achieve these goals. Resistance training is also recommended for muscles to generate force in moving or resisting weight (Waryasz and McDermott, 2008). All in all these activities help achieve improved body build up, muscle resistance, muscle strength, and endurance with the end goal of improving dexterity, flexibility, and movements. Conclusion Based on the above discussion, it is apparent to note how exercises play a major role in managing osteoporosis. The studies illustrate that exercise can also improve the quality of patients’ lives, and they can provide improve outcomes for these patients. Recommendations for exercise include the Osteofit program, aerobic exercises as well as resistance training. These are activities which fit the patient’s osteoporotic condition and these can eventually improve the lives of these patients in terms of increasing their movements and securing a better quality of life. References Arnold, C., Busch, A., Schachter, C., Harrison, E and Olszynski, W., 2008. A randomized clinical trial of aquatic versus land exercise to improve balance, function, and quality of life in older women with osteoporosis. Physiotherapy Canada, 60(4), 296-306. Association College of Sports Medicine, 2009. ACSM's Guidelines for Exercise Testing and Prescription, 8th edition. Pennsylvania: Lippincott Williams and Wilkins. Gunendi, Z., Ozyemisci-Taskiran, O., and Demirsoy, N., 2008. The effect of 4-week aerobic exercise program on postural balance in postmenopausal women with osteoporosis. Rheumatol Int, pp. 1-6 Madureira, M., Bonfa, E., Takayama, L., and Pereira, R., 2010. A 12-month randomized controlled trial of balance training in elderly women with osteoporosis: Improvement of quality of life. Maturitas, 66, pp. 206–211. Petit, M., Hughes, J. and Warpeha, J., 2008. Exercise prescription for people with osteoporosis. Resource Manual for Guidelines for Exercise Testing and Prescription, pp.1-16 Shiel, W., 2009. Osteoporosis. Medicine.net [online] Available at: http://www.medicinenet.com/osteoporosis/article.htm#tocs [Accessed 25 April 2012]. Tolomio, S., Ermolao, A., Lalli, A. and Zaccaria, M., 2010. The effect of a multicomponent dual- modality exercise program targeting osteoporosis on bone health status and physical function capacity of postmenopausal women. Journal of Women & Aging, 22(4), pp. 241-254 Waryasz, G. and McDermott, A., 2010. Exercise prescription and the patient with type 2 diabetes: A clinical approach to optimizing patient outcomes. Journal of the American Academy of Nurse Practitioners, 22, pp. 217–227 Read More