no bones about it!what is osteoporosiswhat is ? low bone mass & deterioration of bone. it...
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Scott Josephson, M.S., R.D.Director of Operations Hippocrates Health Institute
Advisory Board of Sport Nutrition Vancouver 2010 Olympic Games
NO BONES ABOUT IT!Osteoporosis Programs and Prevention
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WHAT IS WHAT IS OSTEOPOROSIS?Low bone mass & deterioration of bone. It effects 30 million Americans. 80% are women.Osteoporosis is a silent disease. Bone loss occurs without symptoms.
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OSTEOPOROSISWHY? Bone breakdown occurs too quickly, or replacement occurs to slowly. 2 types:
1. Osteopenia: BMD deviation of 1 to 2.5 below normal values.
2. Osteoporosis: BMD deviation of greater than 2.5 below normal values.
DEXA: DUAL ENERGY X-RAY ABSORBIOMETRY
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OSTEOPOROSIS FACTSMost fractures occur in the spine, hip or wrist. ~~ 2 million a year, mostly in women with LBD.
Chemo & radiation usually cause osteoporosis.
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YOUR BONESWhat is bone? Living tissue of collagen & calcium. In life old bone is removed, & new bone is added.Bone loss occurs about 1% a year after 35.Bone breakdown exceeds bone formation.
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PHYSIOLOGY OF BONE 1. Cortical: Dense & compact.2. Trabecular: Spongy & porous.
99% of our calcium is stored in our bones.1% is stored in our blood at 9 to 11mg/dl.
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PHYSIOLOGY OF BONEWhen calcium drops the thyroid sends a signal:
1. Use calcium to form new bone = Osteoblasts. 2. Osteoblasts: Use calcium! Restore to normal level.3. Osteoclasts: Dissolve bone, ↓ calcium absorption.
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WHAT INCREASES OSTEOBLASTS?1. Vitamins C, D & K.2. Magnesium & boron.3. Isoflavones.4. Testosterone.5. Estrogen.
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WHAT INCREASES OSTEOCLASTS?1. Poor calcium to phosphorus ratio.2. A high fat protein diet. 3. Depleted hormones.4. Aluminum intake. 5. Excess sodium.
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TYPES OF OSTEOPOROSISACSM (2008) Exercise Management for Persons with Chronic Disease
Type IOsteoporosisOsteoporosis
(estrogen decline)
Type IIOsteoporosis(age related)
Age at onset ~~ 50 to 70 ~~ 70+
Bone loss Trabecular(spongy)
Cortical(dense)
Fracture sites VertebraeWrist
VertebraeHip
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WHO’S AT RISK?Small or thin boned Caucasian’s & Asian’s.
Family history of Osteo.
Early menopause before 45 or abnormal periods.
Excessive exercise can lead to amenorrhea & bone loss.
Eating disorders. Anorexia & Bulimia increase bone loss.
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WHO’S AT RISK?Glucocorticoids meds (cortisone, prednisone)
induce substantial bone loss during treatment.Cancer treatments & seizure medications.↓ Calcium & Vitamin D. Excessive caffeine.
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GLUCOCORTICOIDS USAGE
Endocrinology Dept at Wyeth Research, Translational Medicine, Collegeville, PA.
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OSTEOPOROSIS IN MEN?Affects over 2 million men.
Chances increase with:
Low testosterone levels.
Steroid medications.
Excessive alcohol.
Smoking.
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PUTTING CALCIUM TO USEHow it works? As we age, we become less efficient at absorbing calcium & other nutrients.Calcium passes through the intestines for absorption. This keeps blood levels consistent at 9-11mg/dl.
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CALCIUMFood first, then supplement.
Hijiki, kelp, kale & almonds!
~~ 600 mg at a time, do notexceed 2,500 mg (stones).
Liquid minerals ↑ absorption.
Dosage? 1000-1200 daily.Postmenopausal?
KALE
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Sedatives, Laxatives & Diuretics decrease calcium & Vitamin D absorption. Need D! 2000-4000IU daily.↑ doses of Vitamin A decrease absorption & bone!
DRUGS ↓CALCIUM ABSORPTION
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LACK OF VITAMIN B12?Deficiency can = anemia & ↓ BMD. Dosage: ~~ 2.5 micrograms daily. Stomach acid & aging ↓ absorption.
Vegan Sources: Algae, nuts, seeds & yeasts.
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FDA THERAPUTIC MEDSReclast: (2007) Yearly IV treatment for post menopause osteoporosis.Side effects? ↓↓ blood calcium, ↓↓ kidney function,↑ jaw decay (osteonecrosis), ↑ muscle & joint pain.
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FDA THERAPUTIC MEDSEstrogen Replacement Therapy: ↑ risk of endometrial cancer. Risk ↓ taken with progestin.
Fosamax, Actonel & Boniva are bis-phosphonates.They ↓ bone loss from gucocorticoid meds.
Evista: is a Select Estrogen Receptor Modulates.SERM’s ↑↑ BMD without the side effects of ERT.
Miacalcin: Deposits calcium were needed.
Forteo: Takes calcium from bone to blood.
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MEDICATION SIDE EFFECTS
BISPHOSPHONATES Fosomax, Actonel & Boniva.
Nausea, & irritation of the esophagus.↓↓ magnesium & potassium absorption.↑↑ joint pain, diarrhea, skin irritation, kidney damage & jaw decay (osteonecrosis).
MIACALCIN ↑ joint pain, diarrhea, nnausea & rashes.Can’t take with certain allergies.
EVISTA (SERM’S) ↑ joint pain, diarrhea, urinary infections.
FORTEO Can cause small holes in your bones.
ERT ↑ risk of endometrial cancer.
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WHAT TO DO WITH TYPE 2?Type 2: OLDER woman (men?) diagnosed with osteoporosis, their need is to maintain function. Emphasize multi joint “fixed range of motion”movements. (open chain vs. closed)↑↑ muscle strength & BMD to preserve bone mass.
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TYPE 2 PROTOCOLSExtensive focus on balance & mobility.Assess Functional Squat. Using hands indicates weak hips & knee flexion.
Create a circular pathCreate a circular pathor cone path.or cone path.
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FUNCTIONAL STEPPING ON VARIOUS HEIGHTSPlace stable objects side by side.
Assess stepping up with both feet then down.
66””44””
44””22””
66””
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ASSESS NEUROMUSCULAR FUNCTIONAssess Weak Muscles: Quads,Hams,Gluets,etc.Check pliability & ROM for program design.
Assess Balance: ~10 seconds, wide & narrow.
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FRACTURE OF THE VERTEBRAEA vertebrae fracture = kyphosis. An ↑ risk of falling.Lower intensity cardio. Weak lower back.Caution with floor work. Swiss balls can be unstable.
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ACTIONS TO AVOIDNO forward flexion.NO spinal rotations.
↓↓ eccentric actions.Monitor for back pain.
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PREVENTION PROGRAM
YOUNGER woman's goal ↑BMD & ↓ risks.
Strength correlates to ↑ BMD.
High load training increasesBMD at the hip & spine.
High load training provides much better BMD than low.
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B.E.S.T. PROGRAM FOR BMDB= Bone Mineral Density E= Estrogen S= StrengthT= Training…….weight bearing & core.7-8 repetitions at 60-80% of the 1RM is moreeffective than 15-20 reps at 20-40% of the 1RM.ACSM (2006) Exercise with Chronic Disease, International J SportACSM (2006) Exercise with Chronic Disease, International J Sports Vol 2 p.116s Vol 2 p.116--125. 125.
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TRAINING FOR INCREASED BMDProgressive weight bearing ↑ BMD & osteoblasts.Increase upper body strength. 5 up & 1 down.Exercises standing, (recruits) & ↑ bone loading. Flexibility ↑ tendon strength. Use confusion principle!
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ADD HIP & SPINE BONE LOADING
Squat Close Stance
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HIP & SPINE BONE LOADING
Lunges Walking Lunges
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HIP & SPINE BONE LOADING
Heel Drop Plie, Position 2.
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HIP & SPINE BONE LOADING
Static Contraction
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DEAD LIFTSNeutral spine & scapula retracted works lower back, glutes & hamstrings.
Dead lifts work multiple muscles & mimic movements we do all day!
“Bending over to pick things up”.
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BENEFITS OF REBOUNDING↑ blood & oxygen in the body. blood & oxygen in the body. ↑ immune system.immune system.↑ lymphatic system (eliminate toxins & waste)lymphatic system (eliminate toxins & waste)↓ varicose veins by strengthening vein walls.varicose veins by strengthening vein walls.
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K’s BURNED REBOUNDING VS. JOGGING
Body Wt Jogging 1 Mile (12 mins) Rebounding (12 mins)
100 47 58110 52 63120 56 72140 66 77150 71 82160 75 86170 80 91180 85 96 190 89 100200 94 105
Research: Victor L. Katch, Ph.D., Department of PE Univ of Michigan.
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Core stability recruits the trunk muscles to “control the lumbar spine” during movements.
Core Moves
CORE FOR SURE!
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PLYOMETRICSTranslation from Greek meaning more measure.Quick powerful movements using a pre-stretch.
Impact jumps are absorbed by the neck of the Femur.
FEMUR
NECK
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PLYOMETRICS PHYSIOLOGYMuscle energy is ↑ with a stretch, followed by a concentric action. The energy is released ↑ the force.
Simple Explanation:
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PLYOMETRIC EXERCISES
TWO FOOT HOP BOX JUMP TWO FOOT ANKLE
JUMP SQUATS STEP FROM BOX
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PLYOMETRIC EXERCISES
SPLIT SQUAT JUMP
LEG PUSH OFF
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