Osteoporosis: High and Low Impact

Impact is not the same as intensity. Impact refers to the force the body has to exert in order to perform a certain exercise and the joint load during the exercise. Intensity is characterised by the degree of difficulty and exhaustion after training.

High Impact Training: High Impact or High Intensity Training can be used for strength and endurance training. In strength training, the HIT is characterised by short and hard training units with a longer recovery time. The growth stimulus for the musculature is thereby set by high load intensity up to muscular exhaustion, whereby the total load range is relatively small.

Training is done with a high weight, short holding periods and few repetitions (e.g. 6-8 second holding period with 6-10 repetitions and 2 series, the last repetition is characterized by a drop in performance and momentary muscle failure, as the energy production via the oxygen supply is no longer sufficient. (anaerobic area). In order to determine the limit of the aerobic, anaerobic threshold individually, performance diagnostics and performance control are necessary at regular intervals during continuous training, so that the training stimulus can be adjusted accordingly by changing the training program.

High Impact Training in the endurance area is characterised by short, intensive strains beyond the aerobic threshold (energy production for the muscles through conversion of carbohydrates by lactic acid fermentation without oxygen, increase in volume of the muscle fibres). The energy yield is much lower during anaerobic training, and a faster loss of performance during longer periods of stress is the result. HIT in endurance training not only increases the ability to sprint, but also significantly improves endurance performance.

Typical sports are jogging, short sprint intervals with high load, jumping . Training is done at about 75-80% of the maximum heart rate. Low Impact Training: gentle training with less stress on the joints.

This works with low training loads, e.g. during slow endurance running. Low Impact Training can be done in the aerobic range (carbohydrates are converted into energy by means of oxygen) as well as with high intensity in the anaerobic range. Hiking, Nordic Walking, swimming and light cardio training on a crosstrainer are among the typical Low Impact sports, as one foot is always on the ground during training.

Increases in training intensity, e.g. during walking, can be achieved by inclines on the path, additional weights, intervals with higher speeds. Low Impact endurance training is performed at approx. 65-70% of the maximum heart rate.

Osteoporosis: Guideline

The guideline published in 2008 provides the basis for osteoporosis therapy from a physiotherapeutic point of view. Guidelines summarise the current research and consensus results to a clinical picture. The results summarised in the guideline can be directly implemented in practice and serve as orientation for movement and physiotherapy.

The guideline on osteoporosis deliberately distinguishes between physiotherapy and exercise therapy. In the primary preventive exercise programmes, physiotherapy overlaps to a large extent with sports therapy, whereas in secondary and tertiary prevention, the focus is primarily on individual physiotherapeutic therapy for older patients with osteoporosis. These patients often have already suffered fractures and may suffer from the consequences of the fracture (pain, loss of mobility, loss of independence).

Primary prevention: Target group: People who have not yet developed osteoporosis. The PPV is aimed at healthy people who are prepared to avoid risky behaviour and maintain their health through prevention with healthy food and sport. PPV is basically to be aimed at, better prevention than cure.

Measures in PPV: Secondary prevention: Target group: Informed, health-conscious patients who are in the first or second stage of osteoporosis and who are prepared to take their own precautions and implement decisive rules of behaviour. Prevention of the progression (progression) of osteoporosis through targeted osteoporosis treatment and activity. Measures in the SP: Tertiary prevention: target group: informed patients who maintain the “state of the disease” (2nd and 3rd stage of osteoporosis) and want to prevent worsening through targeted osteoporosis treatment and rehabilitation.

Avoidance of complications and secondary diseases e.g. due to fractures. Measures in the TP:

Sports training already in early adolescence, lifelong
Training in old age still has positive effects on the bone bank
Movement therapy in the group
Strength Training
Fall prophylaxis
Posture training, flexibility, training of everyday procedures
Pain reduction
Movement therapy in the group
Physiotherapeutic individual treatment for strengthening and trunk stability, posture training and mobility
Physiotherapeutic treatment after fractures, for pain and movement restrictions (caution with manual therapy, increased risk of fracture)
Fall prophylaxis with targeted strength training

The “ONE” osteoporosis program does not exist! Although it can be proven with certainty that sport has a positive effect on the development of bone mass and on the fear of falling and the incidence of falls, there are no uniformly defined training and exercise programmes for which the optimal effectiveness can be proven.

This is particularly due to the different target groups and the variety of training goals. The most common mistake is the subliminal training as well as in the strength and endurance area. In the best case, subliminal training has a preserving effect on bone density, fracture risk and cardiovascular endurance performance.

Less than 10% of women do a sufficiently dosed training 2-3/week. Target group: women and men, average age approx. 50 years, no fractures so far, average training condition: Equipment: 0.5 -2 kg dumbbell, 0.5 – 2 kg weight cuffs, Airpad Training goals: Strengthening the back and neck muscles in the direction of straightening up (risk of developing a rounded back due to wedge-shaped vertebral fractures), the abdominal muscles to stabilise the spine, the leg muscles to relieve the back.

In training theory, the focus is increasingly no longer on fixed load values, but on the individual feeling of exertion. If the user reaches his or her individual performance limit feeling (I can’t go on!) with an increasing number of repetitions, 2-3 more repetitions of the exercise are added.

The exercises can be performed with or without weight load! – 60 – 70% of the maximum strength, weight load can be built up by the own body weight or equipment

Holding time per exercise: approx. 10 sec.
40-60 sec. break between the exercise series
3-4 series with 6-10 repetitions per exercise

Starting position: prone position, possibly a pillow under the belly or, in case of severe complaints in the area of the lumbar spine, place the upper body on a Pezzi ball or a fitness snail, the arms are lying long stretched out next to the head, dumbbells or weight cuffs in the hands, weight cuffs on the feet, legs slightly opened Exercise performance lower abdominal and pelvic floor muscles are tensed, both arms are raised, the shoulder blades are pulled together towards the trouser pockets, the arms are raised and lowered a little bit in a short, fast rhythm Starting position: Prone position, possibly with the feet in the middle of the body, with the feet in the middle of the body, with the feet in the middle of the body a pillow under the belly, the right/left arm is long stretched out and slightly spread, the thumbs point towards the ceiling, both legs are long stretched out and slightly spread, dumbbells or weight cuffs in the hands, weight cuffs on the feet Exercise: diagonally, arm and leg are slightly lifted and lowered from the floor towards the ceiling in a short, fast rhythm (small movement, not too high, otherwise the lumbar spine is too much strained), change sides each timeStarting position Kneeling in front of a fitness snail or a padded stool, place the upper body on the snail or stool up to the hips, the head hangs relaxed, the hands are folded behind the head Exercise a: lift the upper body towards the ceiling and lay it down again Exercise b: while lifting the upper part of the body, turn sideways towards the ceiling (right/left elbows towards the ceiling), then lower againStarting position: forearm support, elbows below the shoulder joints, forearms resting on the floor parallel to the palms of the hands, knees extended, feet raisedExercise a: the position above approx. 30 sec.

The body is stretched out parallel to the floor, abdomen and buttock muscles are tense. Exercise b: alternately lift one leg stretched out from the forearm support Exercise c: from the forearm support, lower and raise the upper body between the shoulders towards the mat: Quadruped position, knee joints are under the hip joints, hands under the shoulder joints, back straightened parallel to the floor by tensing the lower abdominal and pelvic floor muscles, weight cuffs on hands and feet Exercise position: diagonally extend one arm and one leg, then bring elbows and knees together under the body and extend againStarting position Quadruped position, the knee joints are below the hip joints, the hands below the shoulder joints, the back is straight and parallel to the floor, weight bands on hands and feet Exercise performance: one arm is stretched out laterally combined for inhalation and the upper body is opened towards the ceiling, with the exhalation the arm is carried out under the supporting arm, the upper body and the head (thoracic and cervical spine) bendStarting position Supine position, the legs are positioned close to the buttocks, the arms are stretched out on the mat sideways next to the body Exercise version a: With pelvic floor tension (pull the sphincter muscles inwards, pull them upwards) – and lower abdominal tension (pull the navel towards the spine) the spine is rolled up until the back is in the shoulder bridge. Then slowly and in a controlled manner unroll the back again. Exercise b: In the shoulder bridge, alternately lift the feet a little above the mat Exercise c: In the shoulder bridge, alternately stretch one leg so that the knee joints are at the same level The exercises can be performed with or without weight-bearing: Supine position, legs are in the “table position” (lower legs are in raised position parallel to the mat), soles of the feet touch each other, knees are open, arms are in the U-hold next to the head on the mat Exercise performance the elbows remain on the floor, the lumbar spine keeps contact with the mat, the weight of the legs is shifted to re/li towards the mat, start with a small movement, controlled increase Exercise: Elbows and knees are crossed and brought together above the navel, at the same time the free leg stretches over the mat from the starting position Supine position, the left leg is pulled towards the abdomen, the right leg stretches onto the mat, the right hand is at the knee joint of the left leg, the left hand behind the head, then change sides Exercise: the right hand and the left knee press against each other, the left leg presses on the mat, the left elbow remains open, then change sides, in addition the head can be lifted with the starting position Starting position: lateral position left, the legs are bent backwards at right angles, the left forearm rests on the mat, the right arm is stretched out on the body Exercise a: the pelvis is raised and lowered again Exercise b: the pelvis is raised, the right arm is carried out under the supporting arm and then raised upwards towards the ceiling, the upper body turns to exercise c: the pelvis is raised, the right arm extends towards the ceiling, the right leg stretches out, then elbows and knees are brought together above the raised pelvis and stretched out againStarting position Stand with legs straddled, the tips of the feet point slightly outwards, the arms are next to the body with the palms of the hands facing the floor Exercise a: Knee bends with the upper body inclined and stretched forward (by flexion in the hip joints), initiation of movement is by backward movement of the buttocks, thus relieving the knee joints Exercise b: from the bent forward position, perform short, quick up and down movements with the armsStarting position: Stand with legs straddled, the tips of the feet point slightly outwards, the arms hang in front of the body, a weight is in front of the feet (e.g., a weight on the back of the head, a weight on the shoulders, a weight on the shoulders, a weight on the shoulders, a weight on the shoulders) (e.g. full laundry basket or water crate) Exercise: knees bend over the toes, buttocks are pushed backwards and downwards, the stretched back moves forward, then the weight is lifted by stretching the legs and straightening the back

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