Suzy Peerman
Consultant Physiotherapist
Croydon Health Services
Recommendation by Department
of Health 2011
Adults
30 mins moderate intensity physical activity
x 5/week
And physical activity to increase muscle strength
x 2/week
Older Adults (>65) at risk of falls
Specific exercises to increase balance/co-ordination x
2/week
And reduce amount of sedentary time
Definitions
• Physical activity – any movement eg activities of daily
living or leisure pursuits
• Exercise – planned/structured physical activity with an
aim eg to satisfy physical, psychological or social need,
or a mix
Exercise and Bone Strength
 Bone is a scaffold that supports body against gravity
and resists the pull of muscles
 Bone is living tissue that reacts to loads and forces by
growing stronger
 As we age bone density declines and most of us
become less active
 Exercise, healthy eating and lifestyle can slow that
bone loss
What type of Exercise?
 Weight bearing – supporting your weight through
feet/legs or hands/arms
 Choose something that is compatible with your
lifestyle, that you enjoy, so are more likely to stick with
it over time, and is effective for improving bone
strength
 eg swimming/cycling are useful for reducing heart
disease but not increasing bone density
Benefits of Exercise
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Minimises bone loss
Increases muscle strength
Improves balance
Enhances well being
Improves cognitive function
Improves activities of daily living
Improves posture
Reduces pain
Reduces risk of falls
Reduces risk of many medical conditions
Exercising Safely
• Pace – start slowly and build slowly
• Consistently – exercise regularly to have any effect
• Muscle stiffness after exercise stimulates improvement
(but not on-going pain)
• Falls – beware of exercises that increase your change of
falling
• Posture – maintain an upright posture, avoid too much
flexion (if had a fracture)
Contd
 Warm up and cool down – to prevent injury and gain
maximum benefit
 Consult your healthcare professional before starting
 Clothes/footwear – flat shoes/trainers and comfy
clothing
 Environment – ensure enough space to move and
temperature not too hot/cold
Warm up
 Muscles and joints work most effectively if warm, and
reduces the risk of injury
 Increase circulation - walk, march on spot, side step
 Range of motion – shoulder circles, side bends
 Balance – hold onto chair/wall/work top
Stretches
 To improve flexibility
 Should be done once the muscles are thoroughly
warm, at the end of the exercise session.
 Slow
 No bouncing
 Progress deeper into stretch, breath
 No pain
Exercises to influence bone
strength (those at low risk)
 Exercise to music/aerobics – high impact/co-
ordination/flexibility
 Home exercise programme – wall press, wrist curl, on
all 4s
 Weight training
 High impact (not if OA/OP) – jump, skip, jog, sport
Exercises for those who have
fractured their spine due to
osteoporosis (those at high risk)
Remaining active is very important, to:
 Reduce the risk of falls and further fracture
 Improve balance and posture
 Increase sense of well-being
 Reduce pain
 Increase muscle strength/stamina
Types – strength training (using body weight as
resistance), weight bearing aerobic, flexibility, stability
and balance
Exercises to avoid
 High impact fast moving eg jump, run, jog, skip
Do side step, march, walk instead
 Forward bending/twisting at waist eg touch toes, sit
ups, golf, tennis, bowls, yoga, horse riding, skiing
But can adapt technique so discuss with healthcare
professional
Strength training
 Muscles generate large forces through tendons that
attach to bone
 Bone responds to this extra stress by becoming
stronger
 Depends on resistance of gravity, adding weights eg
wall press, wrist curls, on all 4s, dorsal raises
 Weight bearing aerobic: walk, dance, cross trainer,
stairs – boosts cardiovascular system
(swimming/water aerobics has no influence on bone
strength)
Flexibility, stability and balance
exercises
Flexibility:
Stretches – hamstrings, quadraceps, calf
Stability:
Tai chi, Pilates
Balance - to reduce risk of falling:
Stand with feet together/in tandem/on 1 leg
Other exercises
 Hydrotherapy – can use water to resist muscles in non-
weight bearing, to reduce pain and increase strength
 Water exercises/aqua-robics
 Wii Fit/X-box
 Walking poles/Nordic walking
 Theraband
 Trampette (only for those at low risk)
Reference
 Exercise and Osteoporosis: How exercise can help with
bone health, fragile bones and fractures. National
Osteoporosis Society