Mark J. Kasper

Can vigorous exercise play a role in osteoporosis prevention? A review

AbstractPart of the reduction in bone density observed in older people is due to disuse rather than the aging process itself. While some mechanical stress is needed to maintain optimal bone density, it is not clear just which types of exercise are most valuable or whether appropriate exercise might reduce the need for estrogen therapy in postmenopausal women. Cross-sectional studies. Physical activity, aerobic fitness, and strength have all been correlated with bone density. Young people who use a specific part of the body in vigorous exercise exhibit enhanced bone density in that part of the body, but not necessarily in other regions. Older people who have been active for many years seem to exhibit generally enhanced bone density. Prospective studies. Most regimens which used vigorous aerobic and strength training enhanced bone density, but walking is relatively ineffective for prevention of postmenopausal bone loss. Most studies using specific bone-loading exercise have shown substantial increases in bone density at the specific sites loaded. Elderly people seem capable of responding favorably to vigorous exercise. No direct comparisons of exercise and estrogen therapy have been reported. Excessive exercise. Extremely high volumes of exercise may overwhelm a persons adaptive capacity, leading to stress fractures. For example, young women athletes who suffer from menstrual dysfunction exhibit reduced bone density and musculoskeletal disorders. Clinical implication. Although the evidence is far from conclusive, an exercise regimen should probably include vigorous total body exercise, including strength and aerobic training.

The Need for Comprehensive Educational Osteoporosis Prevention Programs for Young Women: Results From a Second Osteoporosis Prevention Survey

OBJECTIVE To assess osteoporosis knowledge, beliefs, and preventive behaviors among young adult women and to identify sources that they would mostly likely utilize to learn more about the disease. METHODS Information was gathered through a cross-sectional survey of 321 women (mean age 21.6 years; 63.5% were white, 29.2% were black) enrolled in a required undergraduate health course at a southeastern state university. RESULTS Two hundred seventy-seven (86%) of the survey participants had heard about osteoporosis, but only 3.8% of respondents reported getting both adequate exercise and the recommended 1,200 mg of calcium per day. Respondents believed that they were unlikely to develop osteoporosis and that osteoporosis is less serious than other common causes of morbidity and mortality in women, such as heart disease and breast cancer (P < 0.0001). Brochures, magazines, and short counseling sessions were preferred information sources for learning about osteoporosis. CONCLUSIONS. The majority of young women studied are at risk for developing premature osteoporosis. They prefer brochures, magazines, and short counseling sessions during medical office visits to learn about osteoporosis.

Young Women's Knowledge and Beliefs about Osteoporosis: Results from a Cross-Sectional Survey of College Females.

Abstract Background: About 40% of White American women over age 50 experience osteoporosis–related fracture of the hip, spine, or wrist during their lives. Purpose: The purpose of this study was to determine the level of osteoporosis knowledge and beliefs among young women. Methods: University women (n=302) completed a self–administered osteoporosis risk factor questionnaire. Statistical analysis included descriptive statistics, chi–square analysis, analysis of variance, and the paired samples t–test. Results: Just 6 out of the 16 osteoporosis risk factors listed were correctly identified by at least 50% of the respondents; the mean risk factor knowledge score was 9.41 out of 20. Respondents strongly believed that osteoporosis is a serious disease, but less serious than heart disease and breast cancer. They also believed that they were somewhat responsible for getting osteoporosis, but less so than heart disease. In addition, they believed they were more likely to develop, and were more concerned about, breast cancer. African American women had lower knowledge scores than White women, were less likely to identify five of the risk factors correctly, and were less likely to believe they would develop osteoporosis. Discussion: The findings suggest that there are gaps in young womens ability to identify osteoporosis risk factors, and that they are somewhat complacent about the disease. Translation to Health Education Practice: This data suggests that educational programs concerning the prevention of osteoporosis in young women are warranted.

A screening and counseling program for prevention of osteoporosis.

Prevention of osteoporosis is an increasingly salient public health concern as our society ages. This report describes the procedures used at an osteoporosis center to which people come for screening and counseling. The patients on whom this report is based were 53 non-smoking women, 1–10 years postmenopausal at the time of their first visit to the center, who chose not to undertake estrogen therapy, and who returned for a second visit in 12–18 months. They were classified as to adequacy of calcium intake (at least 750 mg/day) and exercise (at least 3 h/week of weight-bearing exercise) at both visits; complete data on calcium intake and exercise were available on 46 of the women. Bone densities were measured at the femoral neck and lumbar spine with dual energy X-ray absorptiometry, and at the distal radius with single photon absorptiometry. At the first visit, 67% of the women reported adequate exercise and 43% reported adequate calcium intake. At the second visit, the percentages in the adequate categories had increased to 74% for exercise (p=0.06) and 70% for calcium intake (p=0.02). Age at the first visit was inversely correlated with femoral (r=−0.40,p=0.003) and spinal (r=−0.36,p=0.009) bone densities; the correlation with radial bone density did not achieve significance (r=−0.27,p=0.55). Rather than declining, as would be expected in early postmenopausal women, bone density rose slightly, but not significantly, between visits for all three sites. Neither the first visit values nor the changes between visits were significantly different between groups divided on the basis of adequacy of calcium intake or exercise. These data suggest that bone density is related to age, that a visit to an osteoporosis center may help early postmenopausal women to maintain and improve healthy exercise and eating behaviors, and that bone density does not necessarily decline over a 12–18 month period in women who maintain such behaviors.

Emphasis on Cardiovascular Fitness as a Barrier toward Mobilizing the Sedentary Individual

Abstract The purpose of this paper is to investigate the view that in efforts to mobilize the sedentary individual too much emphasis has been placed on developing and maintaining cardiovascular fitness. Instead, encouraging low level physical activity may be the first step in mobilizing the sedentary individual as well as favorably altering their heart disease risk factor profile. Second, the view that the major barriers in adapting physical activity of any intensity are partly a result of the beliefs held toward cardiovascular fitness is presented. Finally, suggestions on how these beliefs may be altered as well as suggestions for future research are proposed.