Published in The Toronto Star, 2009.
Photos by Vivian Song
Osteoporosis sufferers who bend over backwards trying to improve their bone mass with exercise could be doing more harm than good to their bodies – literally.
It's the classic prescription: Eat well and exercise, doctors tell patients diagnosed with osteoporosis or low bone-mineral density.
But that's where the message stops, prompting misguided patients to enrol in classes like yoga or Pilates or dropping to the floor to do sit-ups – some of the most hazardous exercises possible for increasing the risk of fracture, experts say.
"The doctor tells people `You need to exercise,' and that's all they're told," said Jo-Ann James, founder of Vital Steps, a fitness centre in Toronto that also features programs for osteoporosis patients.
"So they do regular exercises and assume that's enough. There's a lack of knowledge out there and these people are doing activities they shouldn't be doing."
James is certified as a medical exercise specialist with the American Academy of Health, Fitness and Rehabilitation Professionals in the U.S., where she was taught how to work with post-rehab patients.
"A lot of people were coming to me with a lot of different health issues. If you're a regular trainer and you don't take all their health issues into account, you're doing them a disservice."
After training with James for two years, Kala Solway, 62, improved the bone mineral density in her osteoporotic hip by 7 per cent, and the osteopenia – a mild form of bone loss – in her spine improved by 6 per cent.
And in spite of her doctor's advice, she did so without the use of medication.
"I'm always concerned about side effects," she said. "My own belief system is you take meds when you have no other option."
A fine mist of perspiration develops above Solway's upper lip as she demonstrates a few of the safe weight-bearing and balance moves for osteoporosis patients. She's strong, using slow, controlled movements as she squats down while lifting seven-pound free-weights for bicep curls with James' gentle guidance.
"I've got more energy now. I feel it's helped a lot," she said. "But the proof is in the pudding with my bone density scan."
For those who may not have access to a specialized trainer, Ottawa-based physical therapist Margaret Martin developed the MelioGuide, an online site that tailors exercise programs to the participant's fracture risk and activity level.
Instructional exercises as well as safety tips on how to safely lower onto the floor or pick up weights are demonstrated through YouTube videos.
The program is endorsed by the Ontario Physiotherapy Association and is also used by health practitioners across the country.
One of the reasons Martin developed the site was the vacuum of information for osteoporosis management, as well as the "one-size-fits-all" approach, she said.
But it was also to save people from potentially harmful exercises that are likely to induce spinal fractures rather than prevent them.
"One of the most common mistakes I see is when people do exercises that bring you into a forward, slouched position," she said in a phone interview from Ottawa. "Sit-ups, toe-touches and most yoga and Pilates moves are very harmful for individuals with osteoporosis."
The MelioGuide also teaches participants how to avoid the same slouching movement – also called forward flexion – with everyday activities like taking food out of the fridge, loading the dishwasher or tying their shoes.
At Osteosolution, a new medically supervised osteoporosis treatment centre in Toronto, orthopedic surgeon Dr. Ben Deheshi said another common mistake is to neglect other high risk fracture areas aside from the hip bones, like the spine, wrists and shoulders when exercising.
Walking is a commonly prescribed exercise which is good for loading the hip bones, Deheshi said. But if they don't improve their posture, they'll likely develop slouches in the thoracic spine area, which can lead to compact fractures and shave inches off their height.
"They need to do resistance exercises and lift weights to load the shoulders, wrists and upper body. Too often they're forgetting about upper extremities," he said.
Improving a patient's sense of balance is also important for fall prevention, added kinesiologist Anthony Crescenzi.
Core strengthening exercises on the stability ball help improve balance and posture.
"Sedentary seniors fall as dead weight," he said. "But if you keep the core muscles strong, that mind and body connection is made and they can catch themselves when they fall."
And though swimming and cycling may be good cardio workouts, they do little to improve bone health as there's little force placed on bones when in the water or when supported by a bike.
"Truth be told, most people don't exercise enough to build bones," Martin said. "You need to exercise pretty aggressively to build bone."
But longer periods of exercise and jacked-up intensity will be among some of the recommendations to be made in a new activity guideline for older adults, expected to be published in 2010, said Donald Paterson, research director of the Canadian Centre for Activity and Aging in London, Ont.
"Our new emphasis will be not just moderate exercise but vigorous exercise," he said. "They need to get 150 minutes of aerobic exercise."
"Rigorous" exercise for adults over the age of 65 would mean brisk walking or attaining 60 to 70 per cent of their maximum heart rate.
Previously, moderate activity like walking to and from the parking lot and taking the stairs was considered adequate.
"But it's not rigorous or long enough," Paterson said. "We're trying to emphasize that they really have to do structured physical activity."
The new guidelines are part of a joint project between The Canadian Society for Exercise Physiology and the Public Health Agency of Canada.
"That amount and intensity of exercise is optimal for reducing their chance of developing diseases like diabetes, heart disease and death."
And it also determines quality of life, added Martin.
"Exercising means the difference between independence and dependence."