Menopause and Osteoporosis: how can exercise help?
Menopause is the most significant health event in a womens life. It is defined as the last menstrual period and the average age of onset is 51 years. With the average life span of a female in Australia now extended to 84.6 years, most women will spend more than one third of their life time beyond the menopause years.
Symptoms through menopause transition are created by changes, mainly decreasing levels of hormones including oestrogen, progesterone and testosterone. These changes usually happen over months or years as you approach menopause. We also know that menopause can often lead to an increase in other health conditions, including Osteoporosis. The main hormone that comes into focus here is oestrogen, which is considered a bone protective hormone, however its levels can drop by up yo 90% during menopause which leads to a disproportionate increase in bone resorption compared to formation.
The most bone loss occurs in the first 3-5 years of menopause transition, and can be as much as 10-20% before slowing to a more normal age related rate of loss. Low bone mass increases the risk of acute bone injury including fractures, especially from a fall or trip, which is the most common reason Australian's aged over 65years are hospitalised each year.
The good news is that exercise can help to reduce bone loss in post-menopausal women, as well as decrease falls risk. But not all exercise is equally effective when it comes to bone health.
Walking or low intensity exercise are shown to have minimal effect on post-menopausal bone health, as well as having little to no effect on reducing fracture related risk factors including muscle mass, strength and balance.
Current exercise guidelines for Osteoporosis management includes three key areas:
1. Progressive Resistance Training:
Aka weight training, is recommended at least 2 sessions per week, with heavy loading (5-8 reps) which generates high bone strain too stimulate an adaptive response from bone tissue. Exercises which target large muscle groups crossing the spine and hip joint have been shown to be most effective, and regular change in exercise programming to include multi-directional load offers greater adaptive responses.
Previously, the medical profession and osteoporotic patients had concerns abut performing higher intensity resistance training with the notion that it posed as a risk for acute bone injury/ fractures. However multiple researches have shown this type of training, under supervision to be the most effective in improving bone mineral density scores without such injury occurring.
2. Impact Training:
This involves exercises that increase our ground force reactions, examples include jumping, skipping, step drops, stomping, assisted landings. Relatively few impacts are required per day, 10-50 reps in fact help stimulate bone adaptive responses. Impact exercises are recommended on at least 4-7 days per week. If you are new to exercise or de-conditioning is a concern for injury - a period of progressive resistance training is advised in order to develop adequate strength before commencing, in addition to performing such exercise under guided supervision. Exercise modifications can also be made if joint pain or injury is present from other health conditions.
3. Balance skills training:
Balance training is recommended to be completed up to 4 times per week to specifically improve balance and co-ordination skills to reduce falls risk. For higher risk populations supervision is always advised. Balance training exercises include single leg balance, step balance, balance on unsteady surfaces, balancing and multitasking, tai chi, yoga based activity.
Remember to always consult an exercise professional before beginning any new exercise routine, especially one that is focused on improving bone health. Physiotherapists and Exercise Physiologists are the most qualified allied health exercise professionals to help assess, develop and supervise the osteoporosis exercise programming fundamentals listed above.
For more information on Osteoporosis and exercise management, please don't hesitate to contact our clinic on (02) 4861 1224 for assessment with one of our Physiotherapists, or head on down to the ONTRAC Specialised Health Clinic in Bowral (next to Eastbrooke Medical Centre) for supervised exercise classes with their Accredited Exercise Physiologists.