Prescribe evidence-based exercise

Bone health

26 Aug 2015

Delegates have been urged to use an evidence-based approach when prescribing exercise to older people to reduce their risk of osteoporosis, falls and fractures.

Speaking at ESA-SRB Annual Scientific Meeting Robin Daly, professor of exercise and ageing at Deakin University in Victoria had two main messages: exercise is important for bone and muscle health, but not all forms are equally effective; and exercise is medicine and as such should be prescribed in a similar way.

He discussed the optimal type and dose of exercise to improve bone health and prevent falls and fractures, emphasising the benefits of a multimodal approach.

“We’ve done lots of work in exercise intervention trials in older people to see what actually works and so we know for exercise programs around osteoporosis and fracture prevention you need to target not just the bone but the muscles and functional performance as well.”

Exercise that involves weight bearing exercise, resistance training and balance and functional activities can increase and maintain hip and spine bone density, improve muscle strength and mass, and help prevent falls, he said.

Professor Daly highlighted recent encouraging results in falls prevention with a newer form of high-velocity resistance training, or power training, which focuses on training muscles to move quickly through a resistance type activity to optimise balance, mobility and reaction time.

When used in combination with weight bearing and balance exercises for 12 months, power training improved bone density, muscle power, strength and balance in people aged over 60 years, he said.

Regular walking alone should not be recommended, he warned, as this has little or no effect on preventing bone and muscle loss, and may even increase the risk of falls and fractures.

As to whether exercise can reduce the risk of fractures, Professor Daly admitted the evidence, while encouraging, isn’t conclusive because of a lack of long-term and adequately powered randomised controlled trials.

Even so, he was vehement that exercise is one of the best medicines for bone health and falls and fracture prevention, so long as clinicians take it seriously and prescribe it correctly.

“When we tell people to exercise we need to be much more prescriptive in terms of what we’re telling them,” he told the limbic.

“We don’t expect clinicians to write a detailed exercise program: it’s more about them giving people the correct referral pathway so they can get the best program.”

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