1. Rehabilitation and Osteoporosis Salekzamani Y. MD Physical Medicine & rehabilitation Research center

2. Rehabilitation Modalities Exercise Orthotics

3. TRAINING PRINCIPLE اصول اساسی تمرينات اختصاصی بود ن افزايش تدريجی اضافه با ر قابل بازگشت يکنواختی

4. EXERCISE PLANING PRINCIPLES تعداد تکرار - تعداد جلسات ورزشی در هفته شدت - سطح استرسهای فیزیولوزیک وارد شده به بدن در ورزش مدت - مدت زمان یک جلسه ورزشی نوع فعاليت ورزشی با توجه به هدف مورد نظر DURATION

5. Exercise effects in osteoporosis Increasing peak bone mass Decreasing bone loss Improvement of physical fitness Increasing muscular power Increasing reaction time Balance improvement Reducing risk of falling Mental effect and mood improvement

6. Aerobic exercise / weight bearing Low impact / brisk walking, low impact aerobics, stair climbing Mod impact/ power walking(brisk walking with vigorous arm movements or with hand weights High impact/jumping, jogging, running

7. Weight bearing: walking, jogging, stair climbing, step aerobic, running 3-5 days of the week/ at least 150 min per week Moderate to vigorous intensity (slightly breathles but still able to speak) 20-60 minutes continuously or for 10 minutes at a time, 2-3 times per day Improved heart health and bone strength, reduced fracture risk

8. Posture training Safe movements, awareness of position and posture Every day Less pressure on the spine/ reduce risk of fall and fracture mainly at sine

9. Standing-gait

10. Wall arch

11. Chest stretch

12. Chin tuck

13. Back posture exercise-shoulder blade squeeze

14. Upper back lift-back and shoulder stretch

15. Pelvic tilt-sitting knee extension

16. Strength training Help to increase bone mass,increase lean body mass Site specific,: trunk extensors, hip abdoctors and extensors free weights, machines, exercise bands or body weight 2-3 days of the week 2-3 sets of 8-12 rep/ all major groups Improved muscle and bone strength, posture and mobility

17. Resistive exercise program

18. Triceps extension

19. Biceps curl

20. Seated row

21. Knee extension

22. Leg press

23. Toe raise

24. Balance training Tai chi, yoga, other exercise 2-3 days of the week/ total 120 min/ incorporate balance with weight bearing or strength training Beginners: static exercises (standing in one spot holding a posture) /Advanced with challenge balance posture) Improved mobility and balance/ fall reduction

25. Principles of exercise for osteoporosis Stimulating effect of rapid, short bursts of high intensity or high impact activates instate of sustained and low impact one No effect of non weight bearing aerobic exercises ( cycling and swimming Higher weight better than low weight in resistive exercise Rapid resistive exercise is more effective Short burst exercise with rest better than long time exercises Changes in direction or pattern more stimulating than repetitive movements Should be progressive

26. Exercise based on BMD

27. T score<-1 NL Jogging short distance Weight training Aerobics Abdominal and back strengthening

28. -1< T score<-2.5 osteopenia Back strengthening program Limit load lifting less than 10-20 pound Aerobic exercise/walking 40 min per day Strengthening exercise /3 days per week Postural exercise/WKO-pelvic tilt exercises Balance and fall preventive exercise

29. ROM, strengthening, coordination Back extensor strengthening Walking 40 min per day as tolerated Balance exercise Aquatic exercise 1-2 per week Fall prevention program Postural exercise/ WKO program Limit lifting/ less than 5-10 pound Strengthening program/ with 1-2 pound up to 5 pound Hip protection measure T score>-2.5 osteoporosis

30. Special Considerations Because of high risk for atherosclerotic disease need for exercise testing. For resistance training need for initial training sessions Exercises that involve explosive movements or high-impact loading should be avoided. Low impact weight-bearing activity is characterized by always having one foot on the floor. Ballistic movements or jumping (both feet off floor) is termed high impact training. Exercises that cause twisting (e.g. golf swing), bending or compression of the spine (e.g. rowing or other dynamic abdominal exercises including sit-ups) should also be avoided.

31. Body Mechanics Avoid forward bending Carry loads close to the body Tighten your stomach when you lift items Never twist with a load Change positions every 30 min Sleep with back straight

32. Making your home safe Floors Lighting Nightlights Telephone access Electrical cords secured Rugs

33. Contraindicated Exercise

34. Extension and isometric abdominal Exercise

37. Orthotics

38. Definition-Orthoses Any device applied to the external surface of an extremity that provide: -Better positioning -Immobilizes -Prevents deformities -Maintains correction -Relives pain -Mobilizes joints -Exercises parts -Assist or support weakened parts

39. Key principles in choosing an orthoses Should enhance normal movement Decreasing the presence of abnormal postures and tone Should be simple lightweight, durable and strong Should be easy to use and maintain Should augment functional independence

40. Objective of orthosis in osteoporosis Prevention of fracture (Hip protectors) Increasing bone mass (weighted vest exercise) Management of acute vertebral fracture Post surgical management of hip joint (hip abduction brace) Postural training (weighted kypho- orthosis) Chronic pain management (Spinomed)

41. Hip Protectors for prevention of hip fracture

43. Weighted-Vest Exercise:

44. Orthosis for acute vertebral fracture Rigid thoracoloumbar orthosis to promote extension of the spine The CASH or Jewett brace Goal of these braces is to provide forces to encourage hyperextension Drawback to these orthoses is the limited compliance because of their rigid configuration

45. Cruciform anterior spinal hyperextension orthosis Jewett hyperextension orthosis

46. Hip Abduction Brace Wearing following hip procedure. Its purpose is to provide support and stabilization to hip joint by limiting motion of leg in relation to body. It is designed to keep leg out to the side of body, holding the thigh bone in the hip socket, allowing for proper healing to take place.

47. Posture training support Weighted kypho-orthosis (WKO) PTS (Posture Training Support) type, or the newer postural training support vest with weights (PTSW) made of a softer material, gained popularity because of their improved comfort and increased compliance The postural training support is worn over the shoulders similar to a mini-backpack and has a pocket into which small weights (total 1.75 lb) weights are added. Decreasing kyphosisand iliocostal friction syndrome Increasing strength of back extensor muscles and their reeducation Decresinf falling risk Indicated in severe kyphosis with iliocostal contact Mechanism:reducing anterior compressive force and active back extension

49. Posture training program Application of WKO for 20 min 2-3 times a day

50. Spinomed orthosis Consist of metallic back pad/moldabele without heating Managing chronic pain from vertebral compression fracture