Running Head: Osteoporosis in Postmenopausal Women Morgan Stover & Morgan Vitosh
Exercise Prescription
April 17, 2014
Mosti, M., Kaehler, N., Stunes, A., Hoff, J., Syversen, U.. (2013). Maximal strength training in
postmenopausal women with osteoporosis or osteopenia. National Strength and
Conditioning Association 27 (10), 2879-2886
1 Running Head: Osteoporosis in Postmenopausal Women 2 Postmenopausal women are the population with the highest prevalence of osteoporosis.
This chronic disease increases the risk of fracture due to reduced bone mineral density (BMD)
and compromised bone quality. According to the article, Maximal Strength Training in
Postmenopausal Women with Osteoporosis or Osteopenia, BMD in people with osteoporosis is
2.5 SD or more below the average BMD of young women. Osteopenia’s BMD values are
between 1 and 2.5 SD below the average. Osteoporosis can also cause a condition called
sarcopenia, which refers to the skeletal muscle atrophy and weakness that accompanies aging. It
has been shown that strength training at high intensities has resulted in the most effective
improvement of BMD in postmenopausal women.
We chose to examine osteoporosis for this research project because both of us think
bones are very interesting. We researched the topic of osteoporosis together previously in this
class and found that we wanted to look more into the topic. I, Morgan Vitosh, also have a bone
disease in my femur that is very similar to osteoporosis. Therefore, I have seen that a lot of the
exercise recommendations given to people with osteoporosis can be applied to my own exercise
and workout routines. We have learned that weight-bearing exercise can be very beneficial to
patients with osteoporosis, and we wanted to research more into why this is the case. We chose
the clinical population of postmenopausal women because it has the highest prevalence of
osteoporosis.
The study investigated twenty-one postmenopausal women with osteoporosis or
osteopenia. The parameters for the participants included: she had to be at least 2 years
postmenopausal, less than the age of 75, and had a BMD T score between -1.5 and -4.0 at the
lumbar spine, femoral neck, or total hip. Volunteers were excluded from the test if she had
suffered a fracture in the last two years, used glucocorticoids or treatment for osteoporosis, other
Running Head: Osteoporosis in Postmenopausal Women 3 than calcium and vitamin D, or if she had any condition that inhibited her from partaking in
exercise testing procedures or failed to participate in at least 80% of the planned training
sessions. Based on peak oxygen consumption (VO2peak), the twenty-one participants were
classified as normally fit for their age, however, none had been participating in a strengthtraining program during the last year.
The hypothesis for this study was, “that 12 weeks of squat exercise maximal strength
training (MST) would improve 1-repitition maximum (1RM) and rate of force development
(RFD) in postmenopausal women with osteoporosis or osteopenia and that this would correspond
with improvements in BMD, bone mineral content (BMC), and serum levels of bone metabolism
markers” (Mosti, Kaehler, Stunes, Hoff, & Syversen, 2013).
The study focused on two groups of participants, the training group (TG) consisted of 10
females and 11 females comprised the control group (CG). The TG underwent maximal strength
training (MST) 3 times a week for 12 weeks, totaling 36 sessions. MST incorporates high loads
and few repetitions. It emphasizes fast mobilization of force in the concentric part of movement
(Mosti,et al., 2013). One exercise, a squat exercise machine, was used in the training sessions.
The participants were asked to execute the squat from straight legs, down to a 90-degree angle in
the knee joint and then back to starting position. Each session began with a warm-up of 2 sets of
8-12 repetitions at 50% of the female’s training load. This was trailed by 4 sets of 3-5 repetitions
at 85-90% of 1RM. Each training session also consisted of an evaluation of training loads, to
assure progression of intensity. If more than five repetitions at one training load were conducted,
the load was increased by two-and-one-half kilograms. Rest periods of 2-3 minutes followed
each set of exercise.
Running Head: Osteoporosis in Postmenopausal Women 4 Testing was conducted to get results in maximal strength, RFD, and peak force, BMC
and BMD at the lumbar spine, femoral neck, and total hip, and aerobic capacity. Maximal
strength was acquired as 1RM using the squat machine. Lifts were performed increasing the load
by five kilograms each lift. RFD and peak force (PF) were obtained using the squat machine as
well. Using a force platform, loads corresponding to 80% of the individual’s pretest 1RM. The
participants were asked to execute the lift as rapidly as possible once the knee joint reached 90°.
BMC and BMD were measured using a dual X-ray absorptiometry (DXA) applying Hologic, by
a certified technician at the Department of Endocrinology. Treadmill tests were performed to
research any aerobic capacity among participants during intervention. A gas metabolic gas
analyzer was used to attain VO2peak, a heart rate monitor tested peak heart rate, and
concentration of lactate in blood was determined using blood samples. The primary outcome
variables were the 1RM and RFD (Mosti, et al., 2013).
At the end of the training program, one participant withdrew from the TG and one was
left out from being unable to complete the required amount of training sessions. Three
participants withdrew from the CG, therefore eight women in each group completed the study.
The TG completed 87% of the planned program. Participants in the TG improved their 1RM in
the squat machine improved by 154 ± 75%, and their RFD increased by 52 ± 46%. These results
were significantly greater than in the CG. Peak force improved by 6.4 ± 4.6%. No changes
occurred in the endurance portion of the parameters.
The TG also saw significant improvements in their DXA measurements. BMC increased
at the lumbar spine by 2.9 ± 2.8% and at the femoral neck by 4.9 ± 5.6%. The bone area also
increased in both areas. The lumbar spine increased by 2.4 ± 2.0% and 5.2 ± 5.1% at the femoral
neck. The CG saw no changes in either BMC or bone area.
Running Head: Osteoporosis in Postmenopausal Women 5 These results determined that MST has the potential to prevent and treat osteoporosis.
The study also demonstrates that even applying only one exercise improves 1RM, RFD, and
BMC in patients with osteoporosis and osteopenia. “Because patients with low bone mass are
likely to benefit from 1RM and RFD improvements, and these changes coincided with skeletal
adaptations, MST may be established as a simple and beneficial training method for
postmenopausal women with osteoporosis or ostepenia” (Mosti, et al., p. 2885, 2013).
According to the FITT recommendations in the ACSM’s Guidelines for Exercise Testing
and Prescription, the goal of the training program for individuals with osteoporosis is to preserve
bone health. The frequency of weight-bearing aerobic activities is three to five days per week
and two to three days per week of resistance training exercise. The recommended intensity for
aerobic activities should be moderate at 40-60% of VO2R or HRR to vigorous ≥ 60% VO2R or
HRR. The intensity of the resistance training should be performed moderately at 60%-80% 1RM,
8-18 repetitions with exercises involving each major muscle group. Vigorous intensity should be
performed at 80-90% 1RM, 5-6 repetitions. Duration of the training sessions should be 30 to 60
minutes per day with a combination of weight bearing aerobic and resistance training activities.
The type of exercises includes weight bearing aerobic activities such as stair climbing and
walking. Resistance exercises may involve weightlifting that loads the spine.
Individuals with osteoporosis should exercise at an intensity that does not cause or
aggravate pain. Explosive movements, high-impact loading, exercises that involve twisting,
bending, or compression of the spine should all be avoided. We would also like to incorporate
exercises that improve balance to reduce the risk of falls.
______________________________________________________________________________
Running Head: Osteoporosis in Postmenopausal Women 6 Exercise Prescription Program – Week One
Monday
Weight-bearing aerobic
Warmup:
§ Walk for 5-10 minutes.
Weighted walk:
§ While wearing 10 lb. vest or holding dumbbells (choose weight which matches 60-70%
VO2R or HRR, or start with no weight)
§ 10 minutes
Stair-climbing or stepping
§ While wearing 10 lb. vest or holding dumbbells (choose weight which matched 60-70%
VO2R or HRR, or start with no weight)
§ 10 minutes
Balance exercises
§ Single-leg balancing progressing to single-leg toe raise (3 sets of 10 reps on each leg)
§ Single-leg body weight deadlift (3 sets of 10 reps on each leg)
§ Balance on a Thera-band stability discs
Cool Down
§ Walk for 5-10 minutes
§ Static stretching
Tuesday
Resistance Training
Warmup
§ Dynamic exercises (high knees, butt kicks, karaoke, slow shuffle, lunges, arm circles)
Exercise
1a Squat Press Machine
Load
85-90% of 1RM
Sets
4
Reps
3-5
1b Dumbbell Military Press
2a Lateral Lunges
2b Lat pull down
60-80% of 1RM
BW
60-80% of 1RM
3
3
3
8-12
8-12
8-12
3a Calf Raises
3b Seated Row
4a Hamstring curls
4b Tricep extension
Plank
Leg Lifts
BW
60-80% of 1RM
60-80% of 1RM
60-80% of 1 RM
BW
BW
3
3
3
3
3
3
8-12
8-12
8-12
8-12
20 sec.
10 each
leg
Cool Down: Static stretching
Wednesday
Weight-bearing aerobic
Rest
2-3
min.
60 sec.
60 sec.
60 sec.
60 sec.
60 sec.
60 sec.
60 sec.
30 sec.
30 sec.
Running Head: Osteoporosis in Postmenopausal Women 7 Warm-up
§ 5 to 10 minutes on the stationary bike
Marching
With no weight at first
• 30 seconds on, 30 seconds off for 10 minutes
Jump rope routine
§ Regular, side to side, front to back, skipping, one-legged
§ 40 seconds on, 20 seconds off for 6 minutes
§ 2 sets
Tai Chi
§ 20 minutes
Cool Down
§ 5-10 minutes on stationary bike
Thursday
Resistance Training
Warmup: 5-10 minutes on rowing machine
Exercise
1a Squat to press
1b Toe raises/heel raises (Stand Straight, using a chair
if needed, rise up on toes and back onto heels)
2a Wall Slides
2b Machine Bench Press
3a Hip abductor strengthening (Use a chair if needed,
without bending at the knee or waist, point toes
forward, lift leg laterally)
3b Push-ups (can do modified or wall push-ups if
necessary)
4a Knee Extension
4b Bicep curls
Load
70% of
1RM
BW
Sets
3
Reps
10
Rest
Go to 1b
3
10
BW
70% of 1
RM
BW-may
use ankle
weights
BW
3
3
10
10
3
3
10
(each
leg)
10
Rest 90
seconds
Go to 2b
Rest 90
seconds
Rest 90
seconds
60% of 1
RM
70%
1RM
3
10
3
10
3
20
3
20
Sec
Reverse crunch
Side Planks
Cool Down
§ Walk for 5 minutes
§ Stretch for 5 minutes
BW
Rest 90
seconds
Go to 4b
Rest 90
Seconds
Rest 30
seconds
Rest 30
seconds
Running Head: Osteoporosis in Postmenopausal Women 8 Friday
Aerobics
Warm-up
§ Walk for 5 minutes
Step aerobics or step class
§ 30 min
Balance exercises
§ Single-leg balancing progressing to single-leg toe raise (3 sets of 10 reps on each leg)
§ Single-leg body weight deadlift (3 sets of 10 reps on each leg)
§ Balance on a Thera-band stability discs
Cool Down
§ Walk for 5 minutes
§ Static stretching
Saturday and Sunday
§ Choose from activities of dancing, golf, tennis, Tai Chi, or yoga
§ If the individual is not accustomed to these types of activities, they may not be for them.
§ Modifications may need to be made based on the individual, such as not completing a full
golf swing.
______________________________________________________________________________
Our exercise prescription includes various aerobic and resistance exercises that focus on
loading the spine. This is important to help build the BMD in affected areas. The first two weeks
of training will emphasize the use of proper technique; therefore exercises that can be used with
body weight will only be used with body weight. It should also be noted that any exercise could
be modified based on the needs of the individuals. Most of our exercises are done with 60-80%
of 1 RM, therefore we will need to test the individuals before the training sessions begin. Based
on the article, this testing will be done by having the participants perform several lifts with
increasing loads of five to ten pounds. The 1RM will be the highest load lifted successfully.
Our study only focused on training with one exercise, the machine squat. We wanted to
include a more complete and diverse program that an individual would stick with and not get
bored with if they have to complete it on their own. On the first day of resistance training,
Tuesday, we wanted to incorporate the exercise from our study, the machine squat. We would
Running Head: Osteoporosis in Postmenopausal Women 9 also like to keep the progression somewhat the same by testing the exercise every Tuesday. If the
individual can complete more than five repetitions at a certain amount of weight, we will
increase the weight by five pounds the following week. The resistance training portion of this
program will last four weeks. After four weeks, adjustments will be made to the resistance
training portion, incorporating new lifts as well as sets and repetitions. The aerobic component
may vary from week to week, with numerous types of different workouts.
Based on the results of the article, Maximal Strength Training in Postmenopausal Women
with Osteoporosis or Osteopenia, we have concluded that strength training can be very beneficial
in increasing bone mineral density and bone mineral content in women with osteoporosis.
Because of this conclusion, we designed a workout plan that we thought would be the most
advantageous to women in this category, which included weight bearing aerobic activities as
well as resistance training exercises that loaded the axial spine.
Running Head: Osteoporosis in Postmenopausal Women Works Cited
Mosti, M., Kaehler, N., Stunes, A., Hoff, J., Syversen, U.. (2013). Maximal strength
training in postmenopausal women with osteoporosis or osteopenia. National
Strength and Conditioning Association 27 (10), 2879-2886
Pescatello, L. (Eds.). (2014). ACSM’s Guidelines for exercise testing and prescription.
Philadelphia: Lippincott Williams & Wilkins. 10