Designing Exercise Regimens to Increase Bone Strength

Turner, Charles H.; Robling, Alexander G.

doi:10.1097/00003677-200301000-00009

Cited by 404 publications

(412 citation statements)

References 12 publications

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“…The findings from animal models are corroborated, to a certain extent, in human studies that report increased areal bone mineral density following high impact exercise [14][15][16][17] Areal BMD is not a suitable surrogate measure of bone strength with exercise interventions [18] since animal studies report large changes in bone strength despite only modest changes in density [1,19]. This is supported in cross-sectional studies of athletes using peripheral Quantitative Computed Tomography (pQCT), which describe a thicker cortex in the playing arm of tennis players [20], the tibia of triple jumpers [21] and in athletes from impact sports [22] compared with matched controls, with little or no differences in density [23].…”

Section: Introductionmentioning

confidence: 67%

Increased density and periosteal expansion of the tibia in young adult men following short-term arduous training

Izard¹,

Fraser

Negus³

et al. 2016

Bone

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2 AbstractPurpose: Few human studies have reported early structural adaptations of bone to weightbearing exercise, which provide a greater contribution to improved bone strength than increased density. This prospective study examined site-and regional-specific adaptations of the tibia during arduous training in a cohort of male military (infantry) recruits to better understand how bone responds in vivo to mechanical loading.Methods: Tibial bone density and geometry were measured in 90 British Army male recruits (ages 21 + 3 y, height 1.78 ± 0.06 m, body mass 73.9 + 9.8 kg) in weeks 1 (Baseline) and 10 of initial military training. Scans were performed at the 4%, 14%, 38% and 66% sites, measured from the distal end plate, using pQCT (XCT2000L, Stratec Pforzheim, Germany).Customised software (BAMPack, L-3 ATI) was used to examine whole bone cross-section and regional sectors. T-tests determined significant differences between time points (P<0.05).Results: Bone density of trabecular and cortical compartments increased significantly at all measured sites. Bone geometry (cortical area and thickness) and bone strength (i, MM i and BSI) at the diaphyseal sites (38 and 66%) were also significantly higher in week 10. Regional changes in density and geometry were largely observed in the anterior, medial-anterior and anterior-posterior sectors. Calf muscle density and area (66% site) increased significantly at week 10 (P<0.01). Conclusions:In vivo mechanical loading improves bone strength of the human tibia by increased density and periosteal expansion, which varies by site and region of the bone.These changes may occur in response to the nature and distribution of forces originating from bending, torsional and shear stresses of military training. These improvements are observed early in training when the osteogenic stimulus is sufficient, which may be close to the fracture threshold in some individuals.3

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Section: Introductionmentioning

confidence: 67%

Increased density and periosteal expansion of the tibia in young adult men following short-term arduous training

Izard¹,

Fraser

Negus³

et al. 2016

Bone

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“…Muscle weakness and lean mass have a strong relationship with BMD in this group [38][39][40], just as in other populations [101][102]. A muscle-bone relationship is not surprising, given that muscle forces provide mechanical strain essential for bone formation [103]. Bone health may be enhanced through improvement of muscle strength and preservation of muscle mass.…”

Section: Exercise To Improve and Maintain Bone Health Poststrokementioning

confidence: 81%

Balance, falls, and bone health: Role of exercise in reducing fracture risk after stroke

Eng

Pang

Ashe

2008

JRRD

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Abstract-Fractures occur frequently in people living with stroke and have high personal, social, and economic costs for these individuals, their families, and the community. Exercise to reduce the risk of fragility fractures is a relatively new application in stroke rehabilitation but is a promising treatment with the potential to reduce the incidence of falls as well as maintain or improve bone health. In this article, we outline fracture risk factors and provide an overview of exercise interventions aimed at reducing fracture risk poststroke. Although randomized controlled trials support the use of exercise to reduce fracture risk factors poststroke, the body of literature is small and further studies are required. Further, the optimal dose of exercise and the additive effects of pharmacology on fracture risk need to be determined. Given the many health benefits associated with exercise, it should be considered an important modality for the management of falls and maintenance of bone health following stroke.

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“…As bone formation is stimulated by muscle forces [26][27], muscle strength may be a key factor affecting bone mineralization in the stroke population. Hand-held dynamometry (Nicholas MMT, Lafayette Instruments, Lafayette, IN, USA) was used to assess muscle strength in both upper extremities.…”

Section: Arm Muscle Strengthmentioning

confidence: 99%

Muscle strength is a determinant of bone mineral content in the hemiparetic upper extremity: Implications for stroke rehabilitation

Pang

Eng

2005

Bone

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Individuals with stroke have a high incidence of bone fractures and approximately 30% of these fractures occur in the upper extremity. The high risk of falls and the decline in bone and muscle health make the chronic stroke population particularly prone to upper extremity fractures. This was the first study to investigate the bone mineral content (BMC), bone mineral density (BMD) and soft tissue composition of the upper extremities and their relationship to stroke-related impairments in ambulatory individuals with chronic stroke (onset >1 year). Dual-energy X-ray absorptiometry (DXA) was used to acquire total body scans on 56 (22 women) communitydwelling individuals (≥50 years of age) with chronic stroke. BMC (g) and BMD (g/cm 2 ), lean mass (g) and fat mass (g) for each arm were derived from the total body scans. The paretic upper extremity was evaluated for muscle strength (hand-held dynamometry), spasticity (Modified Ashworth Scale), impairment of motor function (Fugl-Meyer Motor Assessment) and amount of use of the paretic arm in daily activities (Motor Activity Log). Results showed that the paretic arm had significantly lower BMC (13.8%, p<0.001), BMD (4.5%, p<0.001) and lean mass (9.0%, p<0.001) but higher fat mass (6.3%, p=0.028) than the non-paretic arm. Multiple regression analysis showed that lean mass in the paretic arm, height and muscle strength were significant predictors (R 2 =0.810, p<0.001) of the paretic arm BMC. Height, muscle strength and gender were significant predictors (R 2 =0.822, p<0.001) of lean mass in the paretic arm. These results highlight the potential of muscle strengthening to promote bone health of the paretic arm in individuals with chronic stroke.

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Designing Exercise Regimens to Increase Bone Strength

Cited by 404 publications

References 12 publications

Increased density and periosteal expansion of the tibia in young adult men following short-term arduous training

Increased density and periosteal expansion of the tibia in young adult men following short-term arduous training

Balance, falls, and bone health: Role of exercise in reducing fracture risk after stroke

Muscle strength is a determinant of bone mineral content in the hemiparetic upper extremity: Implications for stroke rehabilitation

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