1. EXERCISE AND BONE HEALTH Tracy O’Mahony (MISCP) Senior Physiotherapist 3/10/2015

2. Key messages for exercise and bone health  Exercise needs to be unusually loading i.e. something the bone is not used to doing all the time

4. Key messages for exercise and bone health  Moderate weight bearing exercise protects the bone  Too little (inactivity) or excessive loading results in bone loss

5. Effective exercises for maintaining bone health Stair climbing Aerobics SkippingJumping Dancing JoggingSprinting Any bone loading activity

6. Ineffective exercises for bone health o Flat road cycling o Swimming o Walking at a regular pace o trampolining

7. BUT Not all effective exercises are appropriate exercises Each person must be individually assessed

8. Aims of physiotherapy in osteoporosis and osteopenia Maintain / increase BMD Education to improve knowledge Minimise early bone loss post menopause Maintain / improve muscle strength Prevent fractures Improve posture

9. Aims of physiotherapy Prevent / Reduce falls Personal empowerment Improve balance / co-ordination Improve psychological well- being

10. How?  Design individual exercise programme  Balance training  Posture correction  Ergonomic advice / lifting technique  Pain management (incl acupuncture /TENS)  address other conditions e.g. pelvic floor insufficiency or weight-bearing joint OA

11. Exercise programmes for osteoporosis  Low impact  Stair climbing  Tai Chi  Aqua-aerobics  Modified pilates  Strength training (short levers)

12. Exercise programmes for mild / moderate osteopenia  High impact if pre-menopausal  Skipping, jogging, walk / jog  Medium impact if post- menopausal  Stair climbing, step aerobics,  Brisk / power walking  Resisted gluteal / quads

13. Exercise for marked osteopenia  Low / medium impact  Stair climbing  Brisk walking  Strength training (short levers)  Aqua-aerobics  Tai-Chi  Hydrotherapy  Pain relief

14. Precautions – The “Don’ts” Avoid trunk flexion – no dynamic abdominal exercises Avoid lifting more than moderate weight Avoid twisting trunk Avoid touching toes or low bending from waist Avoid high / medium impact loading activities

15. Key groups practice nurses may see School students especially early pubertal Peri / post menopausal women Pregnant and post-natal women breastfeeding mothers Teenage pregnancies Women with 2 pregnancies close together