Q2. What is the purpose of a PRT program for low-risk individuals?
Progressively challenging balance, posture and mobility exercises should be a greater focus than for low-risk individuals, to prevent falls.
Q3. What is the role of exercise in preventing falls in older adults?
As kyphotic posture is associated with impaired balance in the elderly with osteoporosis 57 , back extension exercise may indirectly reduce falls risk.
Q4. What is the role of exercise in preventing fractures in the elderly?
In light of the strong association between falls and osteoporotic fractures, any exercise programdesigned to prevent fractures in the elderly, particularly those with known risk factors for falling, should include activities to optimise muscle function, balance and gait stability.
Q5. What is the role of exercise in the prevention and management of low bone mass?
As bone is a dynamic tissue with the capacity to adapt to changing load requirements, exercise iswidely recognised as a vital physical stimulus for the development and maintenance of optimal bone strength throughout life.
Q6. How many people would be required to recruit for a definitive exercise intervention trial?
It has been estimated that to power the definitive exercise intervention trial for a hip fracture endpoint in women, a sample size of over 7000 individuals at high risk of low trauma fracture would be required, which would take many years to recruit at a prohibitive financial cost 76 .
Q7. What are the commonly affected bones?
Osteoporotic fracture can occur at virtually any skeletal site; however, the bones most frequently affected are the spine, hip, wrist, humerus and pelvis.
Q8. What are some of the benefits of combining PRT and high impact activities?
Some exercise programs that have combined both high intensity PRT and moderate-to-high impact activities such as running, jumping, skipping and high impact aerobics have improved multiple musculoskeletal outcomes for both older women and men, including BMD, and muscle mass, strength and function 48, 49 .
Q9. How many studies have reported benefits of exercise to BMD in adulthood?
Many trials have reported relatively modest benefits of exercise to BMD in adulthood - preventing loss or promoting gains in the order of only 1-3% following exerciseinterventions of between 24 and 104 weeks 32 .
Q10. How do you improve bone health in children and adolescents?
RCTs and meta-analyses indicate that exercise training involving certain forms of weight-bearing impact exercise, such as hopping and jumping, and/or progressive resistance training (PRT), alone or in combination (multi-modal programs), can improve the bone health of children and adolescents 28 , pre29 and postmenopausal women 30 , and older men 31 .
Q11. What are the caveats for avoiding deep forward flexion activities?
Individuals with known vertebralosteoporosis/kyphosis should avoid deep forward flexion activities, particularly when lifting a load or carrying an object (e.g. rowing, lifting weights with a flexed spine, yoga, Pilates, bowling, sit-ups, house and yard work), in order to avoid vertebral wedge fractures.
Q12. What are the caveats for high-impact activities and exercises?
high-impact activities and exercises that require rapid and/or loaded twisting, and explosive or abrupt actions (e.g., golf, racquet sports) may be contraindicated for some individuals at high risk of low trauma fracture, particularly those with vertebral osteoporosis, poor balance, or osteoarthritis.
Q13. What is the evidence that walking can increase the risk of fracture?
There is also evidence that the inclusion of walking in an exercise program can expose previously sedentary or frail older adults to an increased risk of falling, thereby increasing the risk of fracture 13 .
Q14. What are the feasible activities to optimise bone health at different stages of life?
More feasible activities to optimise bone health at different stages of life have been examined in randomised controlled trials (RCTs) designed to employ the principles of optimal loading from animal studies.
Q15. What is the role of exercise in preventing falls in older people?
In most cases, falls prevention programs that are focused on balance and mobility, including Tai Chi or the well-known Otago Home Exercise Program, do not induce the necessary bone strain to stimulate adaptive skeletal benefits in older people 51, 52 , but may play a vital role in neuromuscular conditioning 53 .
Q16. How many impacts are required to stimulate the response in premenopausal women?
Relatively few impacts (10-50/day, 3 times/week) 42 are required to stimulate the response in premenopausal women, but added benefit may be derived from more frequent exposure (4-7 days/week) 43 .