Presentation on theme: "Kuinka vaalia ikääntyvää luuta? Liikunta Ari Heinonen Department of Health Science, University of Jyväskylä."— Presentation transcript:
Kuinka vaalia ikääntyvää luuta? Liikunta Ari Heinonen Department of Health Science, University of Jyväskylä
Development of bone mineral mass and goals for exercise programs Vuori, 1996 Increase peak bone mass Maintenance (built bone) Reduce bone loss & prevent falls Goals of exercise interventions vary across lifespan Age, yr Bone mass, %
Comparison between strength and impact sports Triple jumpers (mean: 22 yr, 172 cm, 65 kg) (Heinonen et al. 2003) –extremely high impact forces, up to 22 times BW –tibiae are exposed to extreme torques during performance Weightlifters (mean: 30 yr, 164 cm, 67 kg) (Heinonen et al. 2003) –lower extremities experience large compressive stresses
Show-Harter (1992) Friedlander (1995) Lohman (1995) Heinonen (1996) Bassey (1998) Vainionpää (2005) Grove (1992) Bassey (1998) Hatori (1992) Kerr (1996) Heinonen (1998) 0 1 2 3 4 5 6 7 Percent change (%) SpineFemoral neck ns * * * * * * * * * * * * * * * p < 0.05 ( troch.) Summary of bone mass changes observed in randomized controlled intervention trials High-impact training Premenopausal Early postmenopausal ns No exercise effect on spine or femoral neck: Humpries et al. (2000), Maddalozzo & Snow (2000), Kerr et al. (1996), Uusirasi et al. 2003
lumbar spine Femoral neck distal radius distal tibia tibial shaft -6-4-2 0 246 % Change difference, %, 95% CI Exercise vs. non exercise (Efficacy > 2 x vk) +1.8% 0 Effect of alendronate and exercise on bone and physical performance of postmenopausal women A 12 month randomised controlled trial BMC, g Distal tibia Bone strength index (mm 3 ) +4.6% Uusi-Rasi et al. Bone 2003;33:132-143.
Intensity of exercise Vainionpää et al. Osteoporos Int 2006; 17: 455-463 -The average acceleration peak values for different exercise patterns measured by accelerometer-based method. - accelerations levels exceeding 3.9 g correlated positively with the BMD change in the hip and L 1 12-month randomized exercise trial
A Multi-Component Exercise Regimen to Prevent Functional Decline and Bone Fragility in Home-Dwelling Elderly Women: Randomized, Controlled Trial
Study design Originally, 149 healthy 70 to 78-years old women were randomly assigned to the four groups: –a resistance training group (RES) –a balance-jumping training group (BAL) –a combination group doing resistance training and balance-jumping training (COMB) –a non-training control group (CON). (Karinkanta et al. Ostpor Int, in press) 144 completed a 12-month randomized, controlled exercise intervention trial. 120 (83%) participated in the 12-month follow-up measurements one-year after the end of the intervention
Resistance training –5 movements emphasizing lower limbs –3x8-10 reps –target level 75-80% of 1RM 1. Training protocol during the intervention (Karinkanta et al. Ostpor Int, in press)
Balance & agility- jumping training: –aerobic/step aerobic –based program –Including: jumps, impacts, changes of direction, balance- and agility training sessions 2. Training protocol during the intervention (Karinkanta et al. Ostpor Int, in press)
Combination of strength and agility- jumping training: – in every second week: strength or balance-jumping training 3. Training protocol during the intervention (Karinkanta et al. Ostpor Int, in press)
Training protocol during the intervention Supervised training sessions (45 min) 3x week for 12 months - progressive protocol 4. Control group – were asked to maintain the current physical activity (Karinkanta et al. Ostpor Int, in press)
PHYSICAL PERFORMANCE Intervention effect (Karinkanta et al. Osteopor Int, in press) : Leg extensors force: - RES: 13% (95% CI: 5 to 22) - BAL: 10% (3 to 19) groups - COMB: 8%; (0 to 16) Dynamic balance: - BAL: 5% (1 to 8) - COMB: 7% (3 to 10) compared with the CON group One year after the intervention: Dynamic balance: - COMB: 6% (95% CI; 2 to 11%) - BAL group: 5% (1 to 9%) compared with the CON group Isometric leg extensor force and self-rated physical functioning: there were no between-groups differences (Karinkanta et al. Ostpor Int, in press)
BONE MEASUREMENTS Intervention effect (Karinkanta et al. Osteopor Int, in press) : Intention-to-treat: there were no training effect in density- weighted polar section modulus (BSI) of tibia or femoral neck section modulus (Z) BSI efficacy analyses (who trained at least twice a week): - RES: 1.5% (95% CI: 0.2 to 2.8) - BAL: 0.8% (-0.6 to 2.2) groups - COMB: 1.9% (0.6 to 3.3.) compared with the CON group One year after the intervention: Intentio-to-treat: there were no training effect in density-weighted polar section modulus (BSI) of tibia or femoral neck section modulus (Z) BSI efficacy analyses (who trained at least twice a week): - RES: 0.3% (95% CI: -1.0 to 1.6) - BAL: 0.1% (-1.2 to 1.5) groups - COMB: 1.3% (0.0 to 2.7) compared with the CON group
High-impact exercise effect: (Wallace & Cumming 2000, CTI, 67:10-18, A systematic review) – Lumbar spine BMD: 1.6% in postmenopausal and 1.5 in premenopausal women, exercisers vs. controls – Femoral neck BMD: 1.0% in postmenopausal and 0.9 in premenopausal women, exercisers vs. controls Strength training effect: (Kelley et al. Am J Phys Med Rehabil 2001;80:65-77.Martyn-St James & Carrol Osteopor Int 2006; 17:1225- 1240) – Lumbar spine BMD: 1.3% in postmenopausal, exercisers vs. controls – Femoral neck BMD: 0.9% in postmenopausal, exercisers vs. controls – radius BMD: 2.7% in postmenopausal, exercisers vs. controls Meta-analyses of exercise effect
Exercise prescription is recommended to help preserve bone health during adulthood ACSM 2004 ModeWeight bearing endurance activities (tennis, stair climbing, jogging) activities that involve jumping (volleyball, basketball, aerobics) and resistance exercise Intensity moderate to high, in terms of bone loading forces (3.6 g) Frequencyweight-bearing endurance activities 3-5 times per week; resistance exercise 2-3 times per week Duration30-60 min/day of a combination of weight-bearing endurance activities, activities that involve jumping, and resistance exercise that targets all major muscle groups Kohrt et al. Med Sci Sports Exerc 2004
high-impact training is beneficial to skeleton in young girls, pre- and postmenopausal women high-impact exercise can be recommended as a “Bone Exercise” for young girls, pre- and postmenopausal women Summary
Luustoon vaikuttavan liikunnan ominaisuudet uLiikunta vaikuttaa vain kuormitettuihin luihin uImpakti (isku)-tyyppinen kuormitus on osoittautunut tehokkaimmaksi uLiikunnan pitää olla dynaamista ja vaihtelevaa uLiikunnan pitää ylittää “normaali päivittäinen kuormitus” ollakseen vaikuttavaa...
uVaikka impakti-tyyppinen liikunta on tehokasta premenopaussivuosien aikana, iäkkäämmillä henkilöillä se voi olla liian rajua. uVoimaharjoittelu iäkkäämmillä on osoittautunut tehokkaaksi ja turvalliseksi uHyvin iäkkäillä tasapainoa ja liikkumisvarmuutta lisäävä liikunta on myös tärkeää...