Learning Objectives 1. List 3 suggestions for using exercise equipment. 2. Describe at least 4 weight bearing exercise machines and their pros and cons in strengthening bones.

Exercise is an important component of an osteoporosis prevention and treatment program. Not only will exercise improve your bone health, but it increases muscle strength, coordination, balance, and leads to better overall health.

Why Exercise?

Like muscle, bone is living tissue that responds to exercise by becoming stronger. Young women and men who exercise regularly generally achieve greater peak bone mass (maximum bone density and strength) than those who do not. We have until between ages 25 and 35 to reach peak bone mass. After that time, we begin to lose bone. Women and men older than age 35 can slow bone loss with regular exercise.

The Best Bone Building Exercise

The best exercise for your bones is weight bearing exercise. This is exercise that forces you to work against gravity, such as walking, hiking, jogging, stair-climbing, tennis, and dancing. Some examples of non-weightbearing exercises are swimming or bicycling. However, these exercises, as well as many weight-bearing exercises, have excellent cardiovascular benefits.

Guidelines to Exercise By

If you have health problems, such as heart trouble, high blood pressure, diabetes, or obesity, or if you are over age 40, check with your doctor before you begin a regular exercise program.

Listen to your body. When starting an exercise routine, you may have some muscle soreness and discomfort at the beginning, but this should not be painful, or last more than 48 hours. If it does, you may be working too hard and need to ease up. STOP exercising if you have any chest pain or discomfort, and see your doctor before your next exercise session.

If you have osteoporosis, it is important that you consult with your doctor to learn which activities are safe for you. If you have low bone mass, you probably should avoid high impact exercise in order to lower the risk of breaking a bone. You might also want to consult with an exercise specialist to learn the proper progression of activity, and how to stretch and strengthen muscles safely, and to correct poor posture habits. An exercise specialist should have a degree in exercise physiology, physical education, physical therapy, or a similar specialty.

Be sure to ask them if they are familiar with the special needs of patients with osteoporosis.

A Complete Osteoporosis Program

Remember, exercise is only one part of an osteoporosis prevention or treatment program. Like a calcium-rich diet, exercise is a strategy that helps strengthen bones at any age. But these approaches may not be enough to stop bone loss caused by lifestyle, medical conditions, or menopause. It is important to speak with your doctor about medications that can help keep your bones strong.

THE USE OF EXERCISE MACHINES

This article is an response to the many questions we receive about exercise machines. Osteoporosis affects each person differently, so it is important to talk with your doctor about your particular situation and the safety of using these machines for you. Carefully consider your doctor's recommendations and your own strengths and limitations before using or purchasing any of these machines.

While all of these machines provide cardiovascular benefit, balance, muscle tone, and overall fitness they do not provide as much impact as walking briskly up and down hills out-of-doors. These machines are a good alternative in inclement weather and help users remain physically active and fit as they age.

Weight bearing Exercise

An osteoporosis treatment program usually includes some form of weight bearing and impact exercise. Weight bearing exercise is any activity you do on your feet that works the body against gravity. This includes walking, jogging, aerobic, or stair-climbing. Weight-bearing exercise not only helps prevent further bone loss, but also improves heart health, sense of balance, and muscle coordination, strength and control. An additional benefit of exercise is that it can help reduce the likelihood of falling.

Impact refers to the amount of force that is transferred to the bones while performing an activity. For example, when a person jogs, every footfall transfers impact from the ground to the bones of the leg, hip, and lower spine. However, the impact from jogging does not reach bones in the shoulders, arms, or upper back, so upper body bones do not benefit. Also, impact can be increased or decreased depending on the speed at which a person exercises. Slow walking delivers less impact than fast walking which delivers less impact than jogging. Racquet sports usually provide two areas of impact but only one area of weightbearing: the arm hitting the ball experiences impact and will have higher bone density than the arm that does not, and running around the court provides both impact and weightbearing to the bones in the legs, hips, and lower spine.

The amount and type of weightbearing exercise a person does must be adapted to that person's bone status, health, fitness, and abilities. The greater the bone loss, the more cautious the person must be when participating in an exercise program.

People who exercise in health clubs or gyms have access to treadmills, ski machines, stair-climbers, and exercise bicycles. Also, more and more people are purchasing exercise equipment for home use and want to know which of these machines provide the best weightbearing exercise. While all these machines provide some degree of weightbearing exercise, there have not been any research studies comparing the different machines and evaluating their impact on bone health. This article provides general guidelines to consider if you are planning to use or purchase an exercise machine.

Suggestions For Using Exercise Equipment

    •     Wear well-cushioned foot wear and loose-fitting clothes.

    •     Do stretching exercises before getting on the machine.

    •     Warm up and cool down on the machine for 2 to 5 minutes before beginning and ending your program.

The Treadmill

A treadmill is a machine that allows a person to walk, jog, or run indoors on a cushioned platform. Treadmills provide both weightbearing and impact exercise. Motorized treadmills have platforms that move at speeds that can be increased or decreased by the push of a button; nonmotorized ones are propelled by the person's walking pace.

What To Look For

Before purchasing a machine, try several. All treadmills should have cushioned platforms to absorb shock and protect joints and safety rails for the person to grasp. These rails should be high enough that the user can hold on without bending or leaning forward from the waist. Experiment with the incline and speed controls. When you test a treadmill, take it up to top speed or the fastest you can walk/run. Quality treadmills can reach 8-12 mph. Walk or run for more than a few minutes, then wait a day or two to see how your legs and feet feel.

Motorized and Non-motorized Treadmills

A good, heavy-duty motorized treadmill is expensive, with the average one costing about $1000. However, spending a little more money usually ensures a better quality machine. The treadmill motor should be able to handle the strain of your regular training regimen. The higher the horsepower, the stronger the machine. As a rule, look for machines that have a continuous motor rating of 1.5 horsepower. Given the choice of AC or DC, choose the DC motor. DC motors are quieter, ofter a wider range of speeds, start slower, and go faster. Choose a control panel with push pads rather than controls that require turning a knob or sliding a lever to adjust speed or height.

Safety Note: Always choose a treadmill that has an emergency stop button or a string that attaches from the machine to your clothing so that the machine automatically stops if you lose your balance and begin to fall.

Some treadmills have built-in programs that automatically vary the length, speed, and incline of the exercise routine. These programs are not necessary and often increase the price of the machine.

Non-motorized treadmills are less expensive and take up very little room. They may or may not have an adjustable incline. Your stride has to push the belt backwards, and they provide a serious workout.

Elevation

Both motorized and non-motorized treadmills come with an incline adjustment that creates the sensation of walking up hill. The ability to change the incline of the hill is a valuable feature because walking or jogging flat on a treadmill is like running slightly downhill. Increasing the incline allows you to make the workout harder. Motorized treadmills gradually raise or lower the incline with the push of a button. Elevation changes on a manual treadmill may be as convenient as on a motorized one as long as the hand crank that raises and lowers the platform is in front of you and easy to reach.

Belt Size

The belt is what you walk or run on, and it is important to get a treadmill with an adequate belt. Inexpensive treadmills tend to have shorter, narrower belts which can cause problems. Belts should be at least 50 inches long and 16 inches wide. Longer, wider belts are safest, with the ideal belt being 18-20 inches wide and 54 inches long.

Handrails

A handrail is an important safety feature that can be used in case you lose your balance. However, leaning on the handrail reduces the amount of weightbearing effort and throws off your posture. You should never grasp the handrails and bend forward at the waist while using a treadmill. When using a treadmill, do swing your arms naturally as you do when walking or running. If you don't have an incline feature, consider using hand-held weights to increase your heart workout. Always land heel first on the belt, and keep your head up.

The Ski Machine

A ski machine provides weightbearing exercise with little or no impact, so it is easy on the joints of the knee and hip. Some machines allow you to adjust the resistance and the incline to change the difficulty of your workout.

A ski machine has a front upright bar that has a padded bolster against which you lean your stomach. It has either movable ropes or poles for arm movement and either ski-like boards on rollers or foot pads on wheels for leg movement.

What To Look For

There are two types of ski machines. Those with "dependent" skis have skis that are linked. In this case, moving one ski forward pushes the other ski backward. Those with "independent" skis allow you to move each ski individually _ each ski slides back and forth separately. The dependent skis force the legs into an awkward, still shuffle, while independent skis feel more natural but require coordination and practice to master. When you get your arms and legs moving properly, you will mimic the action of cross-country skiing.

Despite the greater difficulty mastering the independent ski machine, you will probably enjoy it more. The gait is smoother, more ski-like, and provides a potentially more vigorous workout. However, if you have tried to master the motion of the independent machines without success, the dependent motion machine is a good alternative.

The Stair-Climber

Stair-climbers consist of two pedals that alternately drop under your weight to simulate climbing up stairs or ladder rungs. Steppers may come with handles that are stationary or mobile. Motorized stair climbers allow the user to change the resistance or effort required for each step, which allows a more intensive workout. While stair-climbers tend to provide less impact and, therefore, less jarring to the knees and hip joints, they do strengthen the muscles to the legs, hips, and spine. Stair climbers provide weightbearing exercise with more impact than the ski machine but less impact than the treadmill.

Stair-climbing machines require a lot of effort on the part of the user and may be too difficult for people who are out of shape.

What To Look For

Make sure that the machine is sturdy, i.e., it can't be tipped over if you lean too far in any direction. When you use the stairclimber, be sure that your feet remain parallel to the floor. The stair-climbers most commonly seen in health clubs have peddles that function independently of each other, remain parallel to the ground, and allow the resistance to be adjusted.

The Exercise Bicycle

Of all the available exercise equipment, exercise bicycles are the easiest to use. They require the least learning, balance, or coordination. On models with rigid handlebars, you can even read while exercising. Exercise bicycles are also the most durable of the machines discussed in this article. The pedals on exercise bicycles turn a large flywheel, fan, or both. Resistance can be changed on flywheel models without increasing speed. On fan models, the only way to increase the resistance is to pedal faster. The user can pedal in two different positions: the conventional, upright position with a small bicycle seat, or the reclining bike which has a bucket-type seat, that allows you to sit back on a comfortable chair and peddle in front of your body. Each version exercises different muscles. Reclining cycles are safest for people with balance problems or back, neck, or shoulder problems.

The drawback to cycling is that the activity uses fewer muscles than the other machine workouts, and it provides no impact, so it is not as good for the bones. In the reclining position especially, the skeleton does not bear much weight.

Exercycles are bicycles that are motor driven and programmable. You can choose the degree of difficulty and resistance.

What to Look For

The seat should feel comfortable and should be adjustable. The height should adjust so that your legs extend almost completely when the pedal is all the way down. Alignment of your knee and ankle is also important.

The flywheel or fan should not stop turning the moment you stop pedaling. If it does, it is very difficult to resume pedaling.

Considerations Before Making Your Purchase

Before purchasing any machine, try it out for at least 5 to 10 minutes. In fact, it would be best if you could use the machine on several different occasions before purchasing it.

Regardless of which type of mahine you buy, it should feel sturdy, move smoothly, be reasonably quiet, and allow you to get on and off easily. The machine should also fit your body size comfortably without cramping your movements or forcing you to lean forward, stoop, stretch, or twist.

An exercise machine should be considered an addition or variation to your existing exercise program, not a substitution for it. For most people, exercise machines provide too little weightbearing or impact type exercise to protect current bone health.

Source: National Osteoporosis Foundation

Rerpinted with permission