29 May 2013

Exercise aids rehabilitation

Exercise can play a major role in preventing osteoporosis and fractures.


Exercise can play a major role in preventing osteoporosis and fractures. Teréza Hough, CEO for the National Osteoporosis Foundation of South Africa (NOFSA) discusses this.

In addition to this, it also has a crucial role in rehabilitation. Remember, muscle strength and bone strength is related. Muscle strengthening exercises can help to rebuild bone in those who have developed osteoporosis and it can also provide relief from one of the most debilitating symptoms of osteoporosis: pain.

Exercise and vertebral fractures

Chronic pain is perhaps most problematic in people with curvature of the spine. This is a consequence of osteoporosis that is very often seen in older women and is commonly attributed to “just another symptom of ageing.” In fact, this is almost always due to osteoporotic fractures of the vertebrae, particularly in the region of the upper back.

When vertebrae become weakened, they can no longer support the weight of the body and they begin to get compressed. This compression, typically at the front edge of the vertebrae, leads to forward curvature of the spine, commonly recognised as a Dowager’s spine. This causes loss of height, poor posture and a shift in the centre of gravity. Because of these changes, people with kyphosis have a greater risk of falling and possibly having a fracture.

In the worst cases, the curvature of the spine is so severe that the rib cage is pressed down against the pelvis. This most often happens when vertebral fractures lead to an additional loss of height. Forced into this posture, patients can suffer chronic, severe pain, and can also have trouble breathing. Patients with this condition find it difficult to cope with daily life and are prone to suffering from depression.

Exercise can help relieve the pain and some of the symptoms of this condition. By strengthening the muscles in the back, the spine can be brought more upright. This has been shown to increase mobility and reduce pain. This type of therapy can greatly improve the quality of life of the patient.

Exercise can also be an important part of a treatment regimen designed to prevent future fractures. Patients with kyphosis often suffer from multiple vertebral fractures over time. It has been shown that the “time since last fracture” is a major determinant of the quality of life of these patients. The physiotherapist therefore has a big role to play in the rehabilitation of patients with known vertebral fractures. It does seem as if posture and muscle strengthening exercises help with pain management

Aid hip fractures recovery

Hip fractures may be the most serious complication that can arise from osteoporosis. In addition to the incapacitation, mortality rates in those who have suffered a hip fracture are up to 20 percent higher than in subjects of the same age and sex.

More than 95 percent of patients require surgery to repair their hip fracture, and of these, less than one-third will regain normal functioning and more than half of the rest will never be able to function independently with many needing institutionalisation and nursing care. This puts a considerable burden on patients, family members and health care systems.

Less than one out of three patients who have surgery to repair a hip fracture will function independently.

Recent studies have shown that intensive exercise training can lead to improvements in strength and function in elderly patients who have had hip replacement surgery. Patients who received the exercise therapy were significantly better at a variety of daily living fundamentals, such as getting up, walking, climbing stairs and maintaining posture.

For example, they walked on average 50% faster and climbed stairs about 30 % faster than patients who did not receive the exercise regimen. Exercise after fracture aims to relieve pain and to help patients regain range of motion and independence. Supervision from a physiotherapist is vital to ensure that an exercise programme is best suited to individual needs, and to help reduce the risk of further injury through falling. Often exercise in warm water is the first step before other exercises are attempted.

Maintain a balanced, healthy diet and lifestyle, as exercise alone cannot prevent osteoporosis. Calcium and vitamin D are also required for building and maintaining bone mass, and smoking and excessive alcohol intake can contribute to bone loss. For some individuals, where appropriate, prescription drugs may also be required to keep bone loss in check.


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Healthy Bones

Tereza is the CEO of the National Osteoporosis Foundation and worked as a Nursing Sister in the field of Osteoporosis for 18 years prior to her appointment with the Foundation. She used to be the Educational Officer for the Foundation and co-wrote the patient brochure on Osteoporosis. Read more

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