The Effectiveness of Physical Exercise on Bone Density in Osteoporotic Patients

Physical exercise is considered an effective means to stimulate bone osteogenesis in osteoporotic patients. The authors reviewedthe current literature to define the most appropriate features of exercise for increasing bone density in osteoporotic patients.Two types emerged: (1) weight-bearing aerobic exercises, i.e., walking, stair climbing, jogging, and Tai Chi. Walking alone did notappear to improve bone mass; however it is able to limit its progressive loss. In fact, in order for the weight-bearing exercises tobe effective, they must reach the mechanical intensity useful to determine an important ground reaction force. (2) Strength andresistance exercises: these are carried out with loading (lifting weights) or without (swimming, cycling). For this type of exerciseto be effective a joint reaction force superior to common daily activity with sensitive muscle strengthening must be determined.These exercises appear extremely site-specific, able to increase muscle mass and BMD only in the stimulated body regions. Othersuggested protocols are multicomponent exercises and whole body vibration. Multicomponent exercises consist of a combinationof different methods (aerobics, strengthening, progressive resistance, balancing, and dancing) aimed at increasing or preservingbonemass. These exercises seem particularly indicated in deteriorating elderly patients, often not able to perform exercises of purereinforcement. However, for these protocols to be effective they must always contain a proportion of strengthening and resistanceexercises. Given the variability of the protocols and outcome measures, the results of these methods are difficult to quantify.Training with whole body vibration (WBV): these exercises are performed with dedicated devices, and while it seems they haveeffect on enhancing muscle strength, controversial findings on improvement of BMD were reported. WBV seems to provide goodresults, especially in improving balance and reducing the risk of falling; in this, WBV appears more efficient than simply walking.Nevertheless, contraindications typical of senility should be taken into account.