Durreesamin Journal (ISSN: 2204-9827)

November Vol 3 Issue 3, Year 2017

Physical activity recommended for osteoporosis prevention

Brunilda Subashi
Research Center for Scientific Research
Universiteti "Ismail Qemali" Vlore
brunasubashi@gmail.com

Saad Masood Butt

Computer Science Department
Atlantic International University, USA
drsaad.butt@ieee.org
saadmasoodbutt444@gmail.com

Fatjona Kamberi
Research Center for Scientific Research
Universiteti "Ismail Qemali" Vlore
fatjonakamberi@gmail.com

Glodiana Sinanaj
Research Center for Scientific Research
Universiteti "Ismail Qemali" Vlore
g.sinanaj78@hotmail.com

Yllka Bilushi
Research Center for Scientific Research
Universiteti "Ismail Qemali" Vlore
yllkabilushi@hotmail.com

1
 Durreesamin Journal (ISSN: 2204-9827)
November Vol 3 Issue 3, Year 2017

Abstract
Introduction: Osteoporosis is a real economic, social and health problem in many countries,
especially in the first world.
Purpose: To identify the types and duration of recommended physical activity for osteoporosis
prevention.
Methods: A literature review was conduced with the search of PubMed database where are
selected only the studies of 2017, of wich only 8 of these were involved in this study with regard
to the physical prevention of osteoporosis. Information is also received by WHO webpage and
others official websites.
Results:
*Types of physical activity that are recommended for prevention of osteoporosis are: cardio-
vascular exercise, resistance exercises, balance exercises, exercise training.
*The duration of the physical activity recommended for preventing osteoporosis for each age
group resulted: for children and adolescents from 5 to 17 years old, it is recommended to exercise
at least 60 minutes a day with moderate or intense physical activity; for persons over than 18 year-
olds, it is recommended to practice at least 150 minutes of moderate weekly physical activity, or
at least 75 minutes a week with intense physical activity or an equal combination of both activities.
Key words: physical activity, prevention, osteoporosis.

Introduction
According to the World Health Organization, osteoporosis is a systemic skeletal disease
characterized by a reduction in bone density and a structural deterioration of bone tissue, which
causes bone fragility, increasing the risk of fractures, especially those of the hips, shoulders and
hands.
Osteoporosis affects both sexes, but is mostly the most common in female sex, due to the hormonal
deficit occurring in menopause, affecting more than 200 million women worldwide and is not
always linked to the age factor by being a real economic, social and health problem in many
countries, especially in the first world.
Osteoporotic fractures relate to mortality, morbidity, chronic pain, reduced quality of life,
hospitalization, and high health care costs.
High worldwide prevalence of osteoporosis means that it is considered a serious concern for public
health, which can lead to physical disability and a higher mortality rate.

2
 Durreesamin Journal (ISSN: 2204-9827)
November Vol 3 Issue 3, Year 2017

Osteoporosis can be defined as a real pandemic that affects a large part of the population and,
being silent and not giving any obvious symptoms during its suffering, can lead to serious health
consequences.
Although osteoporosis is known as a silent disease that affects aging population, its primary
symptoms remain the pain.

Literature riview
Osteoporosis is estimated to affect 200 million women worldwide - approximately one-tenth of
women aged 60, one-fifth of women aged 70, two-fifths of women aged 80 and two-thirds of
women aged 90.
Worldwide, osteoporosis causes more than 8.9 million fractures annually, resulting in an
osteoporotic fracture every 3 seconds.
10 million Americans have osteoporosis.
Acording to International Osteoporosis Foundation, the cost of osteoporosis, including
pharmacological intervention in the EU in 2010 was estimated at €37 billion – out of which: Costs
of treating incident fractures represented 66%, Pharmacological prevention 5% and Long-term
fracture care 29%.
In Europe is estimated to have an annual cost of 13 billion euros due to this disease.
The aging U.S. population is predicted to contribute to as much as a 50% increase in prevalence
by 2025. Although common, osteoporosis can be clinically silent, and without prevention and
screening, the costs of osteoporotic fracture–related morbidity and mortality will burden the U.S.
healthcare system. This is a particularly relevant concern in the context of diminishing health care
resources.
The total health burden osteoporosis in the EU was estimated at 1,180,000 lost QALYs (Quality
Adjusted Life Years) for the EU. The majority of the QALYs lost were a consequence of prior
fractures. Assigning a QALY the value of 2xGDP, the total value of QALYs lost in 2010 was
estimated at €60.4 billion.
Osteoporosis affects 22 million women in the European Union between the ages of 50 and 84
years. It is estimated that this figure will reach 33.9 million women by the year 2025
The number of QALYs lost annually due to fractures in the EU will increase from 1.2 million in
2010 to 1.4 million in 2025, corresponding to an increase of 20%.
Nearly 3 million people have osteoporosis in Spain, most women are women and 30 in every 100
women suffer from menopause.
Every year, osteoporosis causes over 1.3 million spinal cord, hip and hands in the world, the most
severe of which is the hip fractures.

3
 Durreesamin Journal (ISSN: 2204-9827)
November Vol 3 Issue 3, Year 2017

Most of them require a delicate and costly surgical operation that does not provide the perfect
recovery of the patient.
20% of patients who have suffered a hip fracture, die in the first 6 months, some remain partially
invalids and require special care.

Preventive physical activity

Osteoporosis prevention is complex and involves all ages.
Numerous authors refer to the importance of physical activity in the period of childhood and
adolescence as a determining factor for achieving the greatest mass of adult bone, the benefits
gained in the early stages of life have a greater consistency over time than those of performed in
more advanced stages of life.
Physical activity, both moderate and intense, is beneficial to health.
This includes activities carried out during work, games, travel, housework and entertainment
activities.
Proper exercise and sport activity at each stage of life are important strategies for preventing
osteoporosis.

Levels of osteoporosis prevention

Primary prevention: It is aimed at promoting determinants of normal bone development to achieve
maximum bone mass, taking preventive measures from childhood up to 25 or 35 years, when
maximum bone mass is achieved.
Secondary Prevention: It aims to avoid the factors that accelerate the physiological loss of bone
mass, especially in high risk individuals to suffer a faster loss.
Tertiary prevention: It aims to avoid fractures in individuals with a significant reduction of bone
mass, preventing collapse and avoiding excessive backbone overload or immediate movements
and exercises.
The objective of each intervention is to avoid the occurrence of pathological fractures.

Duration of the recommended physical activity

Acording to WHO:
Children and adolescents from 5 to 17 years old, should exercise at least 60 minutes a day with
moderate or intense physical activity.

4
 Durreesamin Journal (ISSN: 2204-9827)
November Vol 3 Issue 3, Year 2017

Adults 18-64 years and adults over 65 years of age, should practice at least 150 minutes of
moderate weekly physical activity, or at least 75 minutes per week with intense physical activity
or an equal combination of moderate and intense activity.
The intensity with which various forms of physical activity are practiced varies according to the
person. To achieve cardio-respiratory health benefits, the entire activity should be performed over
a period of at least 10 minutes.

The recommended physical activity types

Exercises for osteoporosis prevention include: cardio-vascular exercise, resistance exercises,
equilibrium exercises, exercise training.
The best exercises for bones are weight-bearing exercises that force you to work against gravity
Some examples of weight-bearing exercises are: walking, hiking, jogging, climbing stairs, tennis,
and dancing. Examples of exercises that are not weight-bearing include swimming and bicycling,
which help to maintain and strengthen muscles and have excellent cardiovascular benefits but are
not the best way to exercise bones.
Dance exercise, strength training muscle and weight gain plus muscle strengthening exercises
increase the density of bone minerals in young adults and women before menopause.
Exercises and sports are an important tool for improving bone health in pre and postmenopausal
women.
Walking, weight aerobic exercises, muscle strengthening exercise, and weight training plus muscle
strengthening preserve or increase bone mineral density in postmenopausal women.
Multi-purpose exercise programs have demonstrated beneficial effects on various risk factors and
menopause and / or age-related diseases and should therefore be applied with preference for
primary or secondary prevention in postmenopausal women.
Weight training, performed 3-4 times a week, is the best way to prevent osteoporosis.
Exercise for strength and balance helps to avoid crashes that can cause bone fractures.
Osteoporosis prevention is indicated by weight-related activities such as walking, jogging or
horseriding, while for patients with high risk of osteoporosis or fractures, weights against weight,
tennis, golf or bouling, and activities recommended such as swimming, hydro- gymnastics and
static bicycle.
Physical balance training and strength exercises performed with simple and readily available
equipment is able to significantly improve the strength and balance of osteoporosis women.
These people have a moderate physical condition as a result of lower mobility, so is advisable a
good physical exercise program with low intensity, at least in the beginning.

5
 Durreesamin Journal (ISSN: 2204-9827)
November Vol 3 Issue 3, Year 2017

The recommended program should include aerobic activities such as swimming, walking, cycling,
and strength, always taking into account each person's conditions.
Description of the exercises depends on whether the purpose is prevention, treatment or
rehabilitation.
For osteoporosis prevention are indicated weight-related activities such as walking, jogging or
hiking. In these cases, activities such as swimming, hydro-gymnastics and stationary bicycle
pedaling are recommended.
While for patients with high-risk osteoporosis or fractures are contraindicated weight-related
activities.
In all cases muscle strengthening exercises, especially abdominal and lumbar muscles, are
essential, as well as avoiding exercises that require flexion of the spine or rotation of the trunk.
For this reason, there is no indication of the practice of tennis, golf or buling.
Pilates training affects positively kinesiophobia, pain, functional condition, and quality of life, it
can be recommended for osteoporosis patients as a safe exercise model.
Insufficient physical activity, one of the world's most important mortality risk factors, is growing
in many countries, which worsening the burden of non-transmissible diseases and affects the
overall health status of the population across the planet.
People who do not perform enough physical exercise represent a mortality risk of between 20%
and 30% more than those who are sufficiently active.

Conclusions
Osteoporosis is a social problem, because of the consequences it brings, so the realization of
physical activity is an effective alternative to its prevention.
It is necessary to carry out physical activity at an early age, high impact exercises, in order to
achieve a good level of bone mass density.
It is imperative to avoid the risk of fractures, increasing bone density, maintaining motor skills,
coordination, and equilibrium.

References

Asociación Española con la Osteoporosis y la Artrosis. (s.f.). Ejercicios. Obtenido de

http://www.aecos.es/ejercicios/

Asociación Española con la Osteoporosis y la Artrosis. (s.f.). Qué es la osteoporosis? Obtenido de

http://www.aecos.es/que-es-la-osteoporosis/

6
 Durreesamin Journal (ISSN: 2204-9827)
November Vol 3 Issue 3, Year 2017

Beato, P. B., & Contreras, G. L. (s.f.). Actividad Física y Osteoporosis. Spain, Granada. Obtenido
de
http://www.ugr.es/~swimsci/SwimmingScience/page4/page16/page59/files/Osteoporosis%20en
%20E.F..pdf

Catalano, A., Martino, G., Morabito, N. et al. Drugs Aging (2017) 34: 755. HYPERLINK
"https://doi.org/10.1007/s40266-017-0492-4" https://doi.org/10.1007/s40266-017-0492-4

(2015). Exercise for Your Bone Health. Related Bone Diseases National Resource Center.

FisioterapiaHoy. (5 de may de 2013). Fisioterapia y osteoporosis. Obtenido de

http://fisioterapiahoy.blogspot.al/2013/05/fisioterapia-y-osteoporosis.html

Fuchs, R.K., Kersh, M.E., Carballido-Gamio, J. et al. Curr Osteoporos Rep (2017) 15: 43.
https://doi.org/10.1007/s11914-017-0343-6

Go4Life National Institute on Aging at NIH. (s.f.). Exercise and Osteoporosis. Obtenido de
https://go4life.nia.nih.gov/tip-sheets/exercise-and-osteoporosis

Hernlund E, Svedbom A, Ivergard M, Compston J, et. al. Osteoporosis in the European Union:
Medical Management, Epidemiology and Economic Burden. A report prepared in collaboration
with the International Osteoporosis Foundation (IOF) and the European Federation of
Pharmaceutical Industry Associations (EFPIA). Arch Osteoporos 2013 8:136
DOI 10.1007/s11657-013-0136-1

Johnell O and Kanis JA (2006) An estimate of the worldwide prevalence and disability associated
with osteoporotic fractures. Osteoporos Int 17:1726.

Kanis JA (2007) WHO Technical Report, University of Sheffield, UK: 66.

Kemmler, W., Kohl, M., & von Stengel, S. (2017). Long-term effects of exercise in
postmenopausal women: 16-year results of the Erlangen Fitness and Osteoporosis Prevention
Study (EFOPS). Menopause.

Kling Juliana M., Clarke Bart L., and Sandhu Nicole P.. Journal of Women's Health. July 2014,
23(7): 563-572. HYPERLINK "https://doi.org/10.1089/jwh.2013.4611"
https://doi.org/10.1089/jwh.2013.4611

Mayo Clinic. (3 de may de 2016). Hacer ejercicio con osteoporosis: Haz actividad física pero con
seguridad. Obtenido de https://www.mayoclinic.org/es-es/diseases-conditions/osteoporosis/in-
depth/osteoporosis/art-20044989

MedlinePlus U.S. National Library of Medicine . (s.f.). Osteoporosis. Obtenido de

https://medlineplus.gov/osteoporosis.html

7
 Durreesamin Journal (ISSN: 2204-9827)
November Vol 3 Issue 3, Year 2017

Montserrat Otero, Izaro Esain, Ángel M González-Suarez, Susana M Gil

Clin Interv Aging. 2017; 12: 505–513. Published online 2017 Mar 14. doi: 10.2147/CIA.S127233
PMCID: PMC5358963

NIH Osteoporosis and Related Bone Diseases National Resource Center. (05 de 2015). Exercise
for Your Bone Health. Obtenido de https://www.bones.nih.gov/health-info/bone/bone-
health/exercise/exercise-your-bone-health

Oksuz, S., & Unal, E. (2017). The effect of the clinical pilates exercises on kinesiophobia and
other symptoms related to osteoporosis: Randomised controlled trial. In Complementary Therapies
in Clinical Practice , Volume 26, Pages 68-72.

Organización Mundial de la Salud. (2010). Recomendaciones mundiales sobre actividad física

para la salud. Obtenido de
http://apps.who.int/iris/bitstream/10665/44441/1/9789243599977_spa.pdf

Stattin, K., Michaëlsson, K., Larsson, S. C., Wolk, A. and Byberg, L. (2017), Leisure-Time
Physical Activity and Risk of Fracture: A Cohort Study of 66,940 Men and Women. J Bone Miner
Res, 32: 1599–1606. doi:10.1002/jbmr.3161

Villalba, J. C. (9 de may de 2017). Osteoporosis y ejercicio físico. Obtenido de

https://www.universidadviu.es/osteoporosis-ejercicio-fisico/

Webconsultas Revista de Salud y Bienestar. (29 de Octubre de 2017). Osteoporosis y ejercicio,

Actividad física recomendada en la osteoporosis. Obtenido de
http://www.webconsultas.com/ejercicio-y-deporte/ejercicio-y-enfermedad/actividad-fisica-
recomendada-en-la-osteoporosis-2422

World Health Organization . (s.f.). Global recommendations on physical activity for health.
Obtenido de http://www.who.int/dietphysicalactivity/factsheet_recommendations/en/

World Health Organization. (Feb de 2017). Physical activity. Obtenido de

http://www.who.int/mediacentre/factsheets/fs385/en/

World Health Organization. (s.f.). Physical Activity and Older Adults. Obtenido de
http://www.who.int/dietphysicalactivity/factsheet_olderadults/en/

8
 Durreesamin Journal (ISSN: 2204-9827)
November Vol 3 Issue 3, Year 2017

About the Author

Brunilda Subashi had a Bachelor’s Degree in General Nursing and

Master of Science in Sciences of Nursing from University “Ismail
Qemali” Vlore, Albania.

Currently is attending doctoral studies- Doctorate in Health Sciences

from Atlantic International University, USA.

Email: brunasubashi@gmail.com