Skip to main content
CMAJ : Canadian Medical Association Journal logoLink to CMAJ : Canadian Medical Association Journal
. 1996 Oct 1;155(7):940–944.

Prevention and management of osteoporosis: consensus statements from the Scientific Advisory Board of the Osteoporosis Society of Canada. 5. Physical activity as therapy for osteoporosis.

J C Prior 1, S I Barr 1, R Chow 1, R A Faulkner 1
PMCID: PMC1335458  PMID: 8925493

Abstract

OBJECTIVE: To examine exercise as a therapy for people with osteoporosis. OPTIONS: Immobilization, standing low-load and high-load physical activities. OUTCOMES: Risk of injury, quality of life, risk of falls and fractures, strength and posture and pain management. EVIDENCE: Relevant epidemiologic studies, clinical trials and reviews were examined, including the large-scale FICSIT trial in the United States, a prospective 4-year study of women enrolled in an exercise program in Toronto and the large-scale Study of Osteoporotic Fractures. VALUES: Minimizing risk of injury and increasing quality of life were given a high value. BENEFITS, HARMS, AND COSTS: Moderate physical activity in people with osteoporosis can reduce the risk of falls and fractures, decrease pain and improve fitness and overall quality of life. It may also stimulate bone gain and decrease bone loss. Its positive effects are an adjunct to other interventions, such as hormonal therapy. It may give patients the confidence to resume regular activity and can provide social interaction and support. During exercise programs, proper nutrition is necessary to prevent excessive weight loss and impaired immune function resulting from inadequate protein, vitamin and mineral intake. RECOMMENDATIONS: Immobilization should be avoided if possible in anyone with osteoporosis or at increased risk for osteoporosis. Regular, moderate physical activity is recommended for those with osteoporosis. Elderly people should be assessed for risk of falling to identify those in greatest need of an exercise program. Community group exercise programs are beneficial. Younger people with osteoporosis also need exercise that will preserve or improve bone mass, muscular strength, endurance and cardiovascular fitness. Weight loss as a result of physical activity should be avoided and adequate intake of protein, vitamins and minerals assured. Because the benefits of physical activity are independent of the effect of other therapies, physical activity is an essential adjunct to appropriate nutrition and other therapies. Validation: These recommendations were developed by the Scientific Advisory Board of the Osteoporosis Society of Canada at its 1995 Consensus Conference. They are in agreement with the position taken on osteoporosis and exercise by the United States Center for Disease Control and Prevention and the American College of Sports Medicine. SPONSORS: Sponsors of the 1995 conference included the Dairy Farmers of Canada, Eli Lilly Canada, Inc., Hoffmann-La Roche Canada Ltd., Merck Frosst Canada Inc. and Procter & Gamble Pharmaceuticals Canada Inc.

Full text

PDF
940

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Berg K. O., Wood-Dauphinee S. L., Williams J. I., Maki B. Measuring balance in the elderly: validation of an instrument. Can J Public Health. 1992 Jul-Aug;83 (Suppl 2):S7–11. [PubMed] [Google Scholar]
  2. Campbell W. W., Crim M. C., Dallal G. E., Young V. R., Evans W. J. Increased protein requirements in elderly people: new data and retrospective reassessments. Am J Clin Nutr. 1994 Oct;60(4):501–509. doi: 10.1093/ajcn/60.4.501. [DOI] [PubMed] [Google Scholar]
  3. Campbell W. W., Crim M. C., Young V. R., Evans W. J. Increased energy requirements and changes in body composition with resistance training in older adults. Am J Clin Nutr. 1994 Aug;60(2):167–175. doi: 10.1093/ajcn/60.2.167. [DOI] [PubMed] [Google Scholar]
  4. Chandra R. K. Effect of vitamin and trace-element supplementation on immune responses and infection in elderly subjects. Lancet. 1992 Nov 7;340(8828):1124–1127. doi: 10.1016/0140-6736(92)93151-c. [DOI] [PubMed] [Google Scholar]
  5. Chow R., Harrison J. E., Notarius C. Effect of two randomised exercise programmes on bone mass of healthy postmenopausal women. Br Med J (Clin Res Ed) 1987 Dec 5;295(6611):1441–1444. doi: 10.1136/bmj.295.6611.1441. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Cummings S. R., Nevitt M. C., Browner W. S., Stone K., Fox K. M., Ensrud K. E., Cauley J., Black D., Vogt T. M. Risk factors for hip fracture in white women. Study of Osteoporotic Fractures Research Group. N Engl J Med. 1995 Mar 23;332(12):767–773. doi: 10.1056/NEJM199503233321202. [DOI] [PubMed] [Google Scholar]
  7. Dalsky G. P., Stocke K. S., Ehsani A. A., Slatopolsky E., Lee W. C., Birge S. J., Jr Weight-bearing exercise training and lumbar bone mineral content in postmenopausal women. Ann Intern Med. 1988 Jun;108(6):824–828. doi: 10.7326/0003-4819-108-6-824. [DOI] [PubMed] [Google Scholar]
  8. Farmer M. E., Harris T., Madans J. H., Wallace R. B., Cornoni-Huntley J., White L. R. Anthropometric indicators and hip fracture. The NHANES I epidemiologic follow-up study. J Am Geriatr Soc. 1989 Jan;37(1):9–16. doi: 10.1111/j.1532-5415.1989.tb01562.x. [DOI] [PubMed] [Google Scholar]
  9. Frost H. M. The role of changes in mechanical usage set points in the pathogenesis of osteoporosis. J Bone Miner Res. 1992 Mar;7(3):253–261. doi: 10.1002/jbmr.5650070303. [DOI] [PubMed] [Google Scholar]
  10. Grisso J. A., Chiu G. Y., Maislin G., Steinmann W. C., Portale J. Risk factors for hip fractures in men: a preliminary study. J Bone Miner Res. 1991 Aug;6(8):865–868. doi: 10.1002/jbmr.5650060812. [DOI] [PubMed] [Google Scholar]
  11. Harrison J. E., Chow R., Dornan J., Goodwin S., Strauss A. Evaluation of a program for rehabilitation of osteoporotic patients (PRO): 4-year follow-up. The Bone and Mineral Group of the University of Toronto. Osteoporos Int. 1993 Jan;3(1):13–17. doi: 10.1007/BF01623171. [DOI] [PubMed] [Google Scholar]
  12. Heaney R. P., Recker R. R. Effects of nitrogen, phosphorus, and caffeine on calcium balance in women. J Lab Clin Med. 1982 Jan;99(1):46–55. [PubMed] [Google Scholar]
  13. Hemenway D., Colditz G. A., Willett W. C., Stampfer M. J., Speizer F. E. Fractures and lifestyle: effect of cigarette smoking, alcohol intake, and relative weight on the risk of hip and forearm fractures in middle-aged women. Am J Public Health. 1988 Dec;78(12):1554–1558. doi: 10.2105/ajph.78.12.1554. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Jaglal S. B., Kreiger N., Darlington G. Past and recent physical activity and risk of hip fracture. Am J Epidemiol. 1993 Jul 15;138(2):107–118. doi: 10.1093/oxfordjournals.aje.a116833. [DOI] [PubMed] [Google Scholar]
  15. Krølner B., Toft B., Pors Nielsen S., Tøndevold E. Physical exercise as prophylaxis against involutional vertebral bone loss: a controlled trial. Clin Sci (Lond) 1983 May;64(5):541–546. doi: 10.1042/cs0640541. [DOI] [PubMed] [Google Scholar]
  16. Marcus R., Drinkwater B., Dalsky G., Dufek J., Raab D., Slemenda C., Snow-Harter C. Osteoporosis and exercise in women. Med Sci Sports Exerc. 1992 Jun;24(6 Suppl):S301–S307. doi: 10.1249/00005768-199206001-00013. [DOI] [PubMed] [Google Scholar]
  17. Meyer H. E., Tverdal A., Falch J. A. Risk factors for hip fracture in middle-aged Norwegian women and men. Am J Epidemiol. 1993 Jun 1;137(11):1203–1211. doi: 10.1093/oxfordjournals.aje.a116622. [DOI] [PubMed] [Google Scholar]
  18. Pate R. R., Pratt M., Blair S. N., Haskell W. L., Macera C. A., Bouchard C., Buchner D., Ettinger W., Heath G. W., King A. C. Physical activity and public health. A recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine. JAMA. 1995 Feb 1;273(5):402–407. doi: 10.1001/jama.273.5.402. [DOI] [PubMed] [Google Scholar]
  19. Pocock N., Eisman J., Gwinn T., Sambrook P., Kelly P., Freund J., Yeates M. Muscle strength, physical fitness, and weight but not age predict femoral neck bone mass. J Bone Miner Res. 1989 Jun;4(3):441–448. doi: 10.1002/jbmr.5650040320. [DOI] [PubMed] [Google Scholar]
  20. Podsiadlo D., Richardson S. The timed "Up & Go": a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc. 1991 Feb;39(2):142–148. doi: 10.1111/j.1532-5415.1991.tb01616.x. [DOI] [PubMed] [Google Scholar]
  21. Powell K. E., Thompson P. D., Caspersen C. J., Kendrick J. S. Physical activity and the incidence of coronary heart disease. Annu Rev Public Health. 1987;8:253–287. doi: 10.1146/annurev.pu.08.050187.001345. [DOI] [PubMed] [Google Scholar]
  22. Prince R. L., Smith M., Dick I. M., Price R. I., Webb P. G., Henderson N. K., Harris M. M. Prevention of postmenopausal osteoporosis. A comparative study of exercise, calcium supplementation, and hormone-replacement therapy. N Engl J Med. 1991 Oct 24;325(17):1189–1195. doi: 10.1056/NEJM199110243251701. [DOI] [PubMed] [Google Scholar]
  23. Prince R., Devine A., Dick I., Criddle A., Kerr D., Kent N., Price R., Randell A. The effects of calcium supplementation (milk powder or tablets) and exercise on bone density in postmenopausal women. J Bone Miner Res. 1995 Jul;10(7):1068–1075. doi: 10.1002/jbmr.5650100711. [DOI] [PubMed] [Google Scholar]
  24. Province M. A., Hadley E. C., Hornbrook M. C., Lipsitz L. A., Miller J. P., Mulrow C. D., Ory M. G., Sattin R. W., Tinetti M. E., Wolf S. L. The effects of exercise on falls in elderly patients. A preplanned meta-analysis of the FICSIT Trials. Frailty and Injuries: Cooperative Studies of Intervention Techniques. JAMA. 1995 May 3;273(17):1341–1347. [PubMed] [Google Scholar]
  25. Reid I. R., Ames R. W., Evans M. C., Sharpe S. J., Gamble G. D. Determinants of the rate of bone loss in normal postmenopausal women. J Clin Endocrinol Metab. 1994 Oct;79(4):950–954. doi: 10.1210/jcem.79.4.7962303. [DOI] [PubMed] [Google Scholar]
  26. Rubin C. T., Lanyon L. E. Regulation of bone formation by applied dynamic loads. J Bone Joint Surg Am. 1984 Mar;66(3):397–402. [PubMed] [Google Scholar]
  27. Sinaki M., Mikkelsen B. A. Postmenopausal spinal osteoporosis: flexion versus extension exercises. Arch Phys Med Rehabil. 1984 Oct;65(10):593–596. [PubMed] [Google Scholar]
  28. Tinetti M. E., Baker D. I., Garrett P. A., Gottschalk M., Koch M. L., Horwitz R. I. Yale FICSIT: risk factor abatement strategy for fall prevention. J Am Geriatr Soc. 1993 Mar;41(3):315–320. doi: 10.1111/j.1532-5415.1993.tb06710.x. [DOI] [PubMed] [Google Scholar]
  29. Tinetti M. E., Speechley M., Ginter S. F. Risk factors for falls among elderly persons living in the community. N Engl J Med. 1988 Dec 29;319(26):1701–1707. doi: 10.1056/NEJM198812293192604. [DOI] [PubMed] [Google Scholar]
  30. Treuth M. S., Hunter G. R., Weinsier R. L., Kell S. H. Energy expenditure and substrate utilization in older women after strength training: 24-h calorimeter results. J Appl Physiol (1985) 1995 Jun;78(6):2140–2146. doi: 10.1152/jappl.1995.78.6.2140. [DOI] [PubMed] [Google Scholar]
  31. Wolf S. L., Kutner N. G., Green R. C., McNeely E. The Atlanta FICSIT study: two exercise interventions to reduce frailty in elders. J Am Geriatr Soc. 1993 Mar;41(3):329–332. doi: 10.1111/j.1532-5415.1993.tb06713.x. [DOI] [PubMed] [Google Scholar]

Articles from CMAJ: Canadian Medical Association Journal are provided here courtesy of Canadian Medical Association

RESOURCES