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The effect of magnetic therapy and active exercise on bone mineral density in elderly women with osteoporosis

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Purpose: To evaluate the effect of pulsed electro-magnetic therapy and exercise training on bone mineral density (BMD) in elderly women with osteoporosis. Material and Methods: A total of 30 elderly women with osteoporosis aged from 60 to 70 years old were randomly divided into two groups: A magnetic group consisting of 15 women who received pulsed electro-magnetic therapy at a frequency of 33 Hz and an intensity of 50 gauss for 50 min per session and an exercise group consisting of 15 women who practiced active exercises that included treadmill walking and selected exercises for hip and back muscles for 50 min per session. Both interventions were applied for three sessions/week for three months at a physical therapy clinic. Dual-energy X-ray absorptiometry was used to measure the BMD of the neck of the femur and the lumbar spine (L3-L5) before and after intervention. Results: Statistical analysis revealed that the BMD of the neck of the femur and the lumbar spine significantly increased in the two groups without a significant difference between them. Conclusion: Pulsed electro-magnetic therapy and exercises can increase BMD at the neck of the femur and the lumbar spine in elderly women. Physical therapists could apply pulsed electro-magnetic therapy or exercise training to increase BMD in elderly women.
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THE EFFECT OF MAGNETIC THERAPY AND ACTIVE
EXERCISE ON BONE MINERAL DENSITY IN ELDERLY
WOMEN WITH OSTEOPOROSIS
Al-Sayed A. Shanb
,
, Enas F. Youssef
,
§
,
††
, Mohamed G. El-Barkouky
,
Rasha M. Kamal
||
and Ahmed M. Tawck

Physical Therapy Department
College of Applied Medical Sciences
University of Dammam, KSA
Department of Physical Therapy for Cardiopulmonary
Disorders and Geriatrics
Faculty of Physical Therapy, Cairo University
Physical Therapy Department
College of Applied Medical Sciences
University of Dammam, KSA
§
Department of Physical Therapy for Musculoskeletal Disorder and Its Surgery
Faculty of Physical Therapy, Cairo University
Orthopedic Surgery Department, Alhelal Hospital, Cairo University
||
Department of Diagnostic Radiology-Faculty of Medicine, Cairo University

Agouza Rehabilitation Hospital, Cairo
††
drefyoussef@hotmail.com
Accepted 10 June 2012
Published 27 July 2012
ABSTRACT
Purpose: To evaluate the effect of pulsed electro-magnetic therapy and exercise training on bone
mineral density (BMD) in elderly women with osteoporosis. Material and Methods: A total of
30 elderly women with osteoporosis aged from 60 to 70 years old were randomly divided into two
groups: A magnetic group consisting of 15 women who received pulsed electro-magnetic therapy at a
frequency of 33 Hz and an intensity of 50 gauss for 50 min per session and an exercise group consisting
of 15 women who practiced active exercises that included treadmill walking and selected exercises for
Journal of Musculoskeletal Research, Vol. 15, No. 3 (2012) 1250016 (9 pages)
© World Scientic Publishing Company
DOI: 10.1142/S0218957712500169
1250016-1
hip and back muscles for 50 min per session. Both interventions were applied for three sessions/week
for three months at a physical therapy clinic. Dual-energy X-ray absorptiometry was used to measure
the BMD of the neck of the femur and the lumbar spine (L3-L5) before and after intervention. Results:
Statistical analysis revealed that the BMD of the neck of the femur and the lumbar spine signicantly
increased in the two groups without a signicant difference between them. Conclusion: Pulsed
electro-magnetic therapy and exercises can increase BMD at the neck of the femur and the lumbar
spine in elderly women. Physical therapists could apply pulsed electro-magnetic therapy or exercise
training to increase BMD in elderly women.
Keywords: Osteoporosis; Pulsed magnetic eld; Treadmill walking; Aerobic exercise.
INTRODUCTION
Osteoporosis is a serious and common condition
in which bones become thin, brittle and easy to
break, even with mild stresses such as bending
over or forced coughing.
10
It is called a silent
disease as it develops gradually and progresses
without symptoms until the fracture occurs.
38
Fractures that result from osteoporosis are the
major cause of morbidity in elderly individuals
and place a huge nancial burden on health ser-
vices. Osteoporosis dramatically increases with
advancing age.
22
Many risk factors have been
found for osteoporosis, including menopause,
prolonged cortisone therapy, low calcium intake,
smoking, alcohol intake and lack of physical
activity.
3
Hormone replacement is the most widely pre-
scribed pharmacotherapy used for the treatment
of osteoporosis.
10,16
However, calcium, vitamin D,
exercise training and smoking cessation are con-
sidered to be the primary preventive measures for
osteoporosis and consequent fractures and ade-
quate intake of calcium and vitamin D should be
emphasized as cornerstones for the prevention
and effective treatment of osteoporosis.
10,13,14,16,17
There is an agreement in the literature that
physical activities improve muscle mass and
strengthen the bone.
2,5,23,37
Active exercises have
signicant osteogenic effects on bone structure,
even during youth and periods of skeletal growth,
and they can, for example, reduce fracture risk in
later decades.
6,18,39
Active exercises serve to
encourage calcium absorption in bone as a result of
increased blood ow, which aids the deposition of
vital nutrients and minerals such as calcium from
general circulation in compressed sites.
6,17,21
Weight-bearing bones are maximally affected by
gravitational forces and repetitive muscular
actions during weight-bearing exercises, e.g. run-
ning and walking.
29
It has been reported that
the bone mass of physically active individuals is
signicantly higher than their nonactive counter-
parts and that muscular contraction during
strengthening exercises and gravitational forces
create piezoelectric forces that affect bone
remodeling.
23,31,37
Accordingly, active exercises are one of the
most important methods to prevent bone loss
and to help maintain bone mineral density
(BMD).
23,31
In addition they enhance aerobic
capacity as well as increase muscle strength and
exibility, and improve posture and balance
performance.
2,4,21
The positive associations
between exercise and bone mass means that it is
recommendable that people engage in active
exercise programs to reduce the incidence of
osteoporotic fractures and the rate of morbidity
and/or mortality.
2,39
Brisk walking is suggested
to be an ideal and simple form of active exercise,
especially for osteoporotic postmenopausal
women. Treadmill exercises, a useful form of
walking and weight-bearing exercises, are low
A.-S. A Shanb et al.
1250016-2
impact aerobic workouts and are suitable for the
majority of elderly patients.
12,39
Recently the application of magnetic therapy
during physical therapy has shown promise in the
treatment of different disorders, e.g. osteoarthritis,
and other conditions via, for example, healing
bone and ulcers and relieving pain.
9,20,28,35
A
magnetic eld always exists when there is an
electrical current ow and it can penetrate
through highly resistant structures such as bone.
9
Exposure to pulsed electro-magnetic elds
(PEMFs) increases BMD in animals and humans
who are prone to osteoporosis.
11,28
Li-qun et al.
25
concluded that low-frequency PEMFs may
increase BMD and enhance bone cell formation in
secondary osteoporosis.
25
In a recent systematic review and meta-
analysis, it was postulated that there is still a
need for further well-designed randomized con-
trolled trials to quantify the effect of exercise on
bone strength and its structural determinants.
31
At the same time magnetic therapy has become a
therapeutic modality due to its positive osteo-
blastic effects. Furthermore, a large number of the
elderly cannot practice exercises as a result of
associated advanced complications and bed
recumbence, increasing the potential usefulness
of magnetic therapy.
Based on the related literature the aim of this
study was to evaluate the effect of active exercises
on BMD and to determine if magnetic therapy
can be considered an alternative therapeutic
modality to improve BMD and retard osteopo-
rosis progression.
METHODOLOGY
Study approval
The approval of this study was given by the in-
stitutional review board before starting patient
assessment and treatment.
Subjects
A total of 30 elderly women participated in this
study. Their ages ranged from 60 to 70 years old.
They were randomly selected from elderly nurs-
ing homes in Cairo with the following inclusion
criteria: A T-score of 2:5, with oral calcium
supplementation (1000 mg/day), alendronate
sodium (one 70 mg tablet/week) and vitamin D
(400 IU/day) and a Berge balance scale score of at
least 41 was used to select patients with a suf-
cient balance performance (low fall risk) to enable
them to perform the exercises.
27,30
Subjects were
excluded from the study if they had advanced
musculoskeletal problems, unstable cardiopul-
monary conditions, or were receiving hormone
replacement therapy or any medications that in-
terfere with balance. All participants were in-
formed that collected data would be submitted
for publication and they signed an informed
consent form before their participation.
Instrumentation
(A) Evaluative Instrumentation: Dual-energy
X-ray absorptiometry (DEXA; GE Medical
Systems, USA), a bone densitometer, was
used to measure the BMD at the neck of the
femur and the lumbar spine (L3-L5) in each
patient of the two groups before and after
the treatment programs.
(B) Therapeutic Instrumentation:
(1) ASA magnetic eld (Automatic PMT
Quattro PRO. ), which consists of an
appliance, motorized bed and solenoids.
It is provided with 1 couch with a 80 cm
diameter manually sliding solenoid and
two FLEXA applicators with vibrating
effect. The appliance is capable of gen-
erating PEMFs with a pulse repetition
frequency up to 100 Hz and an intensity
of 85 gauss.
Magnetic Therapy and Exercise for Osteoporosis
1250016-3
(2) Electronic treadmill (En Tred with a
computerized speed detector and heart
rate monitor to determine pulse rate
during walking exercises and support
bars for safety. It is with 1.0 to 4.0 HP
AC Motorized Treadmill with Taiwan
Alatech Controller, HRC, Healing, MP3
and USB Function. Zhejiang Outdo Fit-
ness Manufacturing Co. Ltd
(3) Wall bars were used to perform specic
exercise training from a standing position.
Assessment procedure
DEXA was used to measure the BMD of the neck
of the femur and the lumbar spine (L3-L5) for
every patient before and after the treatment
programs.
1,26
Treatment procedure
Magnetic group: A total of 15 patients received low
frequency and low-intensity pulsed magnetic
therapy. The magnetic device was applied to each
patient from a comfortable supine lying position.
After connection of the appliance to a power sup-
ply, the solenoid was adjusted over the affected
parts of the body (lumbar spine and hip regions).
Magnetic therapy was applied with a frequency of
33 Hz and intensity of 50 gauss for 50 min in each
session, three times per week for three months.
11,25
Exercise group: A total of 15 patients practiced
the exercise training program (treadmill and aer-
obic exercises) for 50 min, three times per week for
three months. This program consisted of a walking
exercise on the treadmill (20 min) in addition to
selected aerobic exercises for hip and lumbar
muscles (25 min) with a rest period (5 min) be-
tween the treadmill and aerobic exercises.
4,23,38
(A) Walking exercise: Each patient was asked to
walk with normal breathing for 20 min on
the treadmill at zero inclination, three times
per week for three months. The treadmill
was stopped if there was any symptom that
limited the exercise such as fatigue, balance
disturbance, excessive sweating, breathless-
ness, chest pain or leg cramps. Walking ex-
ercise included:
(i) Warm up phase: Each patient was asked
to walk for 5 min on the treadmill at the
lowest speed.
(ii) Stimulus Phase: Each patient was asked
to walk for 10 min on the treadmill at a
greater intensity (from 40% to 60% of the
pre-determined individualized maximal
heart rate) or according to patient toler-
ance. The intensity was increased only
by increasing the speed of the treadmill
in a horizontal position.
(iii) Cool down phase: Each patient was
asked to walk for 5 min on the treadmill
at the lowest speed.
(B) Hip and lumbar muscle exercises
40
: Each
patient practiced these exercises for 25 min
every session, three times per week for three
months. A sustained 5 s muscle contraction
for each exercise was followed by 10 s of
relaxation. Each exercise was repeated
10 times for both the lower limbs and back
and each patient took 30 s rests between each
type of exercise.
(i) Hip extensor exercise from a comfort-
able standing position: Each patient
stood facing the wall bars with one foot
distance between both her feet, rmly
grasped the wall bars at chest level,
extended the right lower limb backward
as far as possible and maintained this
position for a few seconds before relax-
ing. Each patient did the same exercise
for the left hip.
(ii) Hip abductor exercise from a comfort-
able standing position: Each patient was
A.-S. A Shanb et al.
1250016-4
asked to abduct her right lower limb
sideways as much as possible and to
maintain this position for a few seconds,
before returned to the starting position
and relaxing. Each patient did the same
exercise for the left hip.
(iii) Hip abductor exercise from a comfort-
able left side lying position with exed
left knee: Each patient was asked to raise
up her right lower limb, held straight, as
high as she could and to maintain this
position for a few seconds before
returning to the starting position. Each
patient did the same exercise for the left
hip from the right side lying position.
(iv) Back exercise from crook lying position:
With both feet rested on a plinth, each
patient was asked to raise her waist as
high as she could to make a bridge and
to maintain this position for a few sec-
onds before returning to the starting
position and relaxing.
(v) Back exercise from sitting position: From
a sitting position on a comfortable chair
with a pillow behind her back, each
patient was asked to push backward
against the pillow and to maintain this
position for a few seconds before
returning to the starting position and
relaxing.
STATISTICAL ANALYSIS
The collected data were analyzed using SPSS
(Version 16.0). A paired t-test was used to com-
pare the mean T-score values of the neck of the
femur and the lumbar spine before and after in-
tervention within each group. An independent
t-test was used to compare the mean T-score
values of the neck of the femur and the lumbar
spine before (pre-test) and after treatment (post-
test) between both groups. Statistical signicance
was determined at a p-value <0:05 and con-
dence interval of 0.95.
RESULTS
A paired t-test was used to determine the sig-
nicance of changes in the T-score, which repre-
sents the BMD, of the neck of the femur and the
lumbar spine before and after intervention in
both the magnetic therapy and exercise training
groups. Analysis showed a signicant increase in
the T-score after exposure to both magnetic
therapy (p<0:05; Table 1) and the exercise
training program (p<0:05; Table 2).
However, comparison between the two groups
using an independent t-test showed that there
were non signicant differences (p>0:05) be-
tween the T-score of the neck of the femur
(Table 3) and the lumbar spine (Table 4) of the
magnetic and exercise groups before and after
intervention.
Table 1 The Mean Values of the T-Score
Pre and Post Treatment in Magnetic Group.
Variables Neck of Femur Lumbar Spine
Pre Post Pre Post
Mean 2.78 2:32.83 2:47
SD 0.67 0.5 0.48 0.39
T-value 3.67 4.23
p-value 0.002* 0.00*
Table 2 The Mean Values of the T-Score Pre
and Post Treatment of the Exercise Group.
Variables Neck of Femur Lumbar Spine
Pre Post Pre Post
Mean 2:74 2:31 2:69 2:44
SD 0.46 0.47 0.57 0.33
T-value 5.67 2.63
p-value 0.00* 0.01*
Magnetic Therapy and Exercise for Osteoporosis
1250016-5
DISCUSSION
In the current study, BMD was evaluated by
DEXA with the nding that the mean T-score
values of the neck of the femur and the lumbar
spine (L3-L5) of elderly women signicantly in-
creased after magnetic therapy. These results are
supported by previous experimental studies
performed in rats, where it was found that elec-
tromagnetic elds of low intensity and frequency
signicantly suppresses trabecular bone loss and
restores trabecular bone structure in bilateral
ovariectomized rats and that PEMF stimulation
for eight weeks enhances BMD in rats with disuse
osteoporosis.
7,34
The improvements in bone metabolism due to
magnetic therapy can be explained by a number
of mechanisms. It stimulates osteogenesis by si-
multaneously increasing osteoblastic activity and
decreasing osteoclast formation, thereby shifting
the metabolic process towards bone osteogene-
sis.
7,15,28,37
It also enhances brocartilage turn-
over to bone cells and increasing ionic calcium
channels.
28
In addition, it increases blood supply
at the site of application, which is considered to
improve bone healing.
25
Furthermore it has an
inhibitory effect on the resorption phase of
wound healing that leads to early callus forma-
tion.
35
Many authors consider magnetic therapy
to be of an interesting physical modality because
it has many advantages. For example, it is a
noninvasive, easy, safe and focused method of
treatment for the concerned site in the body.
15,25
It also can save many elderly people from un-
dergoing surgery and it is being suggested that
magnetic therapy be the rst line of treatment for
osteoporosis.
11
However, in contrast to our results, some
authors found that treatment with magnetic
therapy did not cause a signicant increase in
BMD.
15
The variability in these results may be
due to a number of differences between the two
studies: First, the mean age of their sample was
more advanced (>75 years old) than in the cur-
rent study (60 to 70 years old). Secondly, mag-
netic therapy in their study was not used in
conjunction with sufcient calcium and vitamin
D supplementation, while in our study all
patients received one alendronate tablet of
70 mg/week, oral calcium (1000 mg/day) and
vitamin D (400 IU/day) during the entire treat-
ment period. Thirdly, there was a difference be-
tween the magnetic therapy parameters that was
100 Hz vs 33 Hz in this study).
15
Many other
studies have shown that BMD is higher after 34
months of magnetic therapy
11,25
and the benets
of three months of PEMFs were previously
proved in a randomized controlled trial.
19
It has
been suggested recently that standardization of
frequency, intensity and session time of magnetic
therapy is required, as parameter differences are
considered to be one of the limitations of mag-
netic therapy.
11
The second nding is that the BMD of the neck
of the femur and the lumbar spine of the elderly
Table 3 The Mean Values of the T-Score at the Neck of
Femur Pre and Post Treatment in Both Groups.
Variables Group A Group B Group A Group B
Pre Pre Post Post
Mean 2:78 2:74 2:32:31
SD 0.67 0.46 0.5 0.47
T-value 0.22 0.18
p-value 0.830.86
Table 4 The Mean Values of the T-Score at Lumbar
Spine of Both Groups.
Variables Group A Group B Group A Group B
Pre Pre Post Post
Mean 2:83 2:69 2:47 2:44
SD 0.48 0.57 0.39 0.33
T-value 0.83 0.3
p-value 0.410.76
A.-S. A Shanb et al.
1250016-6
women was also improved by an exercise pro-
gram. This improvement has also been shown
previously.
12,37
A program of weight-bearing
training and aerobic and balance exercises
undergone by elderly women for 12 months
improved bone density as well as muscle strength
and walking ability.
12
Another study found that
elderly women who exercise regularly have 30%
denser bones than similar individuals who do not
exercise.
37
Many explanations for the benets of weight-
bearing exercises can be found in the literature.
For example, the mechanical loads of weight-
bearing activities are transmitted to the skeleton
by muscle pull and gravitational forces where the
bone cells selectively respond to different me-
chanical stresses to increase or decrease BMD.
31,32
In addition the bone tissue responds to dynamic,
rather than static, loading as dynamic loading
creates uid movement in the bone network,
which in turn generates shear stresses on the
plasma membranes of osteocytes and osteo-
blasts.
39
There is agreement in the literature that
exercises not only improve BMD but also increase
muscle strength, exibility, postural stability,
balance and reduces risk of falling.
5,21,32,40
Resistance training and weight-bearing aerobic
exercises are recommended for osteoporosis
treatment by some investigators.
32,40
These exer-
cises are the main components of our exercise
program. Treadmill walking was used in the
current study because it is the best known way to
prevent bone loss in the elderly.
38
Walking adds
the stress required to the hip joint and lumbar
spine to build bone density in a natural way and
thus increases BMD in lumbar vertebrae and the
neck of femurs.
24,38
In addition the specic
strengthening exercises can retard and even re-
verse bone loss in healthy postmenopausal
women.
33
Therefore, in the current study active
exercises of hip and back were used to obtain
maximum benets.
12,39
The exercise program in our study was applied
three times per week and maintained for 50 min
to inuence BMD, a training regime whose ef-
cacy is supported by the literature.
32,38
While
there is controversy regarding the total duration
of the exercise program in the literature, some
authors recommend 12 months of training.
12,38
Others practiced eight months of specic exercise
on postmenopausal women to increase the BMD
of the lumbar spine,
15
while in another study a
combined aerobic and anaerobic exercise regime
was applied in overweight postmenopausal
women for 12 weeks.
36
Furthermore, in more
recent studies, Chang et al.
8
applied treadmill
exercise for 36 weeks on ovariectomized rats
8
and
Westcott et al.
40
applied strength and aerobic
workouts for 36 weeks on subjects that ranged in
age from 39 to 82 years. Consequently we se-
lected three months (12 weeks), as previously
used,
36
because intervention in the present study
included, for one group, magnetic therapy, for
which three months has previously been shown
to be an efcient duration of exposure.
11,20,25
The third nding of the current study is that
no signicant difference was found in the BMD
of the neck of the femur or the lumbar spine
between the magnetic and exercise groups. As far
as we know, no clinical study has compared these
two types of intervention. Consequently it is
recommended that more clinical studies with
larger sample sizes and longer treatment periods
are conducted in order to better compare both
interventions.
CONCLUSION
Either magnetic therapy or an exercise program
can increase BMD in elderly osteoporotic women.
Magnetic therapy could be used for the treatment
of osteoporosis in elderly women who cannot
undergo exercise training as a result of common
associated chronic complications of the elderly.
Magnetic Therapy and Exercise for Osteoporosis
1250016-7
Limitations of this study
(1) A small number of patients were included in
the study (only 30 female elderly subjects in
total).
(2) The period of observation for both treatment
groups was three months, which may be
short to quantify signicant changes between
both treatment in T-score. So it would be
preferable to do follow-up at longer times for
the involved subjects.
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Magnetic Therapy and Exercise for Osteoporosis
1250016-9
... Osteoporosis is a chronic systemic skeletal disease which is usually characterized by gradual reduction of bone mineral density (BMD) [1,2]. Osteoporosis is one of the common causes of morbidity in elderly indi-viduals [3,4] and dramatically increases with advancing age [5,6] especially when combined with other risk factors such as menopause, prolonged cortisone therapy, low calcium intake, smoking, alcohol consumption and physical inactivity [5]. Osteoporosis increases risk of repeated fractures and co-morbid complications that may result from otherwise trivial trauma and mild stresses [2][3][4] and it places a huge financial burden on health services [5]. ...
... Osteoporosis is one of the common causes of morbidity in elderly indi-viduals [3,4] and dramatically increases with advancing age [5,6] especially when combined with other risk factors such as menopause, prolonged cortisone therapy, low calcium intake, smoking, alcohol consumption and physical inactivity [5]. Osteoporosis increases risk of repeated fractures and co-morbid complications that may result from otherwise trivial trauma and mild stresses [2][3][4] and it places a huge financial burden on health services [5]. Although pharmacological treatments including hormonal therapy, vitamin D and calcium are commonly prescribed as main line treatment [4], non-pharmacological management is a tangible part of the long-term prevention and treatment for osteoporosis [7]. ...
... Osteoporosis increases risk of repeated fractures and co-morbid complications that may result from otherwise trivial trauma and mild stresses [2][3][4] and it places a huge financial burden on health services [5]. Although pharmacological treatments including hormonal therapy, vitamin D and calcium are commonly prescribed as main line treatment [4], non-pharmacological management is a tangible part of the long-term prevention and treatment for osteoporosis [7]. Adequate intake of vital nutrients and minerals in addition to lifestyle changes and an increase in active exercise are emphasized as effective interventions [1,4,[7][8][9][10][11][12][13]. ...
Article
Full-text available
Background: Osteoporosis, which develops gradually and progresses without significant signs and symptoms, is one of the most common musculoskeletal conditions associated with aging. Objectives: To evaluate the effects of whole body vibration (WBV) or magnetic therapy in addition to standard pharmacological treatment on bone mineral density (BMD) in elderly individuals being treated for osteoporosis. Methods: Eighty-five participants, 60-75 years of age, were randomly divided into three groups. All three groups received the same standard pharmacological treatment comprised of vitamin D, calcium, and alendronate sodium. In Group I, thirty participants were also exposed to WBV in 25 minute sessions with two sessions per week for 4 months. In Group II, thirty participants were exposed to magnetic therapy in 50 minute sessions with two sessions per week for 4 months. In Group III, twenty-five participants received only pharmacological treatment. Dual-energy X-ray absorptiometry was used to measure BMD of the lumbar spine and femoral heads before and after interventions. Venus blood sample was drawn for analysis of calcium and vitamin D. Results: An ANOVA test detected significant (p < 0.05) differences in BMD after treatment among the three groups with no significant difference detected between patients receiving WBV and magnetic therapy. Statistical t-tests detected significant (p < 0.05) increases in BMD after application of WBV or magnetic therapy in combination with pharmacological treatment, but no significant increase after pharmacological treatment alone. Conclusions: Addition of either WBV or magnetic therapy to standard pharmacological treatment for osteoporosis significantly increased BMD in elderly subjects. No significant difference in effectiveness was detected between these two alternative therapy modalities. Consequently, either WBV or magnetic therapy could be effectively applied in conjunction with pharmacological treatment to increase BMD in elderly osteoporotic patients.
... In closed chain exercise (CKC), the body is made to move on a distal segment fixed or stabilised on a surface of support, with movement at joint determining concomitant movement at both distal and proximal joints in a way that can be more or less anticipated 17) . In open chain exercise, the distal segment (hand or foot) is not fixed but can move unhindered in space, with movements in neighbouring joints not necessarily occurring concomitantly 18,19) . Leg press strength is closely correlated to the BMD of L2-L4 of the lumbar spine and the neck of the femur. ...
... Open-chain exercises involve motions in which the distal segment (hand or foot) is free to move in space, without necessarily causing simultaneous motions at adjacent joints, It performed in non-weight-bearing positions while Closed-chain exercises involve motions in which the body moves on a distal segment that is fixed or stabilized on a support surface and Movement at one joint causes simultaneous motions at distal as well as proximal joints in a relatively predictable manner which stimulate joint and muscle mechanoreceptors, facilitate co-activation of agonists and antagonists (co-contraction), and consequently promote dynamic stability. Also, provide greater proprioceptive and kinesthetic feedback than open-chain training because multiple muscle groups that cross multiple joints are activated during closed-chain exercise, which provide more stress effect on bone that help for stimulation of osteogenesis more sensory receptors in more muscles and intra-articular and extra-articular structures are activated to control motion than during open-chain exercises that improve balance and postural control [17][18][19] . ...
Article
Full-text available
[Purpose] This study aimed to investigate how closed and open kinetic chain exercises differed in their impact on bone mineral density (BMD) and fall risk in postmenopausal women with osteoporosis. [Subjects and Methods] The research sample consisted of 40 postmenopausal women with osteoporosis with ages between 51 and 58 years old. They were divided at random into two groups of 20 each, respectively receiving closed and open kinetic chain exercises. These exercises were administered three times per week over a period of four sequential months. Prior to and following the treatment, Dual X-ray Absorptiometry (DEXA) was used to measure the BMD of the femur neck in every participant, while the Biodex Stability System (BSS) was used to estimate how likely each participant was to sustain a fall. [Results] The strongest effect on BMD and fall risk (p<0.0001) was recorded by the closed kinetic chain exercise. [Conclusion] Osteoporotic postmenopausal women should be prescribed closed kinetic chain exercise to diminish the effects of the disease and minimise their risk of fall.
... The patients had a warming up routine of a brisk walk and gentle stretch of arms, knee flexors, calf muscles, lower back muscles for 10 min, [18] finishing with cooling down in the form of a brisk walk for 5 min. [29] Group-I: Weight-bearing exercise program [1,19,24] included bench press and double leg press, [3] quarter squats up to right angle knee flexion, [12] wide stance mini-squat, [3] quadruped position and step-up exercises, [3] wall slides with upper limb, [10] and standing on one limb with arm support. [18] Group-II: Nonweight-bearing exercise program [1,19] included hip exercises (extension and abduction), [29] leg extension exercise, [23] arm exercises, biceps curl, triceps curl, [18] quadriceps and hamstrings curl, [3] wrist curl in (flexion, extension, rotation, [18] and back extension exercises from standing. ...
... [29] Group-I: Weight-bearing exercise program [1,19,24] included bench press and double leg press, [3] quarter squats up to right angle knee flexion, [12] wide stance mini-squat, [3] quadruped position and step-up exercises, [3] wall slides with upper limb, [10] and standing on one limb with arm support. [18] Group-II: Nonweight-bearing exercise program [1,19] included hip exercises (extension and abduction), [29] leg extension exercise, [23] arm exercises, biceps curl, triceps curl, [18] quadriceps and hamstrings curl, [3] wrist curl in (flexion, extension, rotation, [18] and back extension exercises from standing. [30] These exercises were performed in three sets, repeated 8 times. ...
Article
Full-text available
Background: Osteoporosis is a major public health problem affecting the elderly population, particularly women. The objective of the study was to evaluate the effects of adding weight-bearing exercise as opposed to nonweight-bearing programs to the medical treatment of bone mineral density (BMD) and health-related quality of life (HRQoL) of elderly patients with osteoporosis. Materials and Methods: Participating in the study were 40 elderly osteoporotic patients (27 females and 13 males), with ages ranging from 60 to 67 years, who were receiving medical treatment for osteoporosis. They were assigned randomly into two groups: Group-I: Twenty patients practiced weight-bearing exercises. Group-II: Twenty patients did nonweight-bearing exercises. All patients trained for 45-60 min/session, two sessions/week for 6 months. BMD of the lumbar spine, right neck of femur, and right distal radial head of all patients were measured by dual-energy X-ray absorptiometry before and after both treatment programs. In addition, the QoL was measured by means of the HRQoL “ECOS-16” questionnaire. Results: T-tests proved that mean values of BMD of the lumbar spine, right neck of femur and right distal radial head were significantly increased in both groups with greater improvement in the weight-bearing group. The QoL was significantly improved in both groups, but the difference between them was not significant. Conclusion: Addition of weight-bearing exercise program to medical treatment increases BMD more than nonweight-bearing exercise in elderly subjects with osteoporosis. Furthermore, both weight-bearing and nonweight-bearing exercise programs significantly improved the QoL of patients with osteoporosis.
... En un estudio con 30 mujeres con osteoporosis y una edad de entre 60 y 70 años, Shanb et al. (2012) compararon la efectividad de la terapia magnética pulsada con la del ejercicio físico en el mantenimiento de la densidad ósea. Las pacientes fueron distribuidas aleatoriamente en un grupo intervención, que recibió magnetoterapia durante 50 minutos, tres días a la semana, en un periodo de tres semanas, mientras que el grupo control realizó ejercicio físico durante 50 minutos también en un periodo de tres semanas. ...
Technical Report
En el año 2014 la Organización Mundial de la Salud publicó su nueva estrategia para la medicina tradicional y complementaria 2014-2023 marcada por tres objetivos principales: el desarrollo de una base de conocimientos y formulación de políticas nacionales; el fortalecimiento de la seguridad, la calidad y la eficacia mediante la reglamentación, y el fomento de la cobertura sanitaria universal por medio de la integración de servicios y la autoatención de salud en los sistemas nacionales de salud. Conscientes de esta situación y del debate que sigue generando la práctica y utilización de las terapias naturales y complementarias en nuestro contexto, en el año 2016 el Col·legi d’Infermeres i Infermers de Barcelona encargó al grupo de Investigación en Cuidados de la Salud (GRECS) del Instituto de Investigación Biomédica de Lleida la actualización de la guía con el fin de proporcionar una herramienta más amplia -incluyendo en esta ocasión terapias- que recogiera las mejores evidencias actualmente disponibles que demuestran los posibles efectos beneficiosos del uso de las terapias naturales y complementarias en las ciencias de la salud. Por supuesto, no en todas las terapias que se incluyen en la guía se han descrito dichos efectos y así también queda reflejado en el apartado de resultados, donde se describen tanto aquellas terapias que bien precisan de mayor evidencia científica, o bien aquellas que no aportan ningún beneficio para sus usuarios con los estudios actualmente disponibles. En definitiva, se trata de proporcionar conocimiento sobre las terapias naturales y complementarias de manera que su integración en los planes de estudio y en los sistemas de salud se realice de forma segura, eficaz y con la calidad necesaria.
... In addition, exercise as a nonpharmacological therapy without adverse effects is considered important for maintaining bone health, people with OP are strongly recommended to participate in various forms of exercise regularly 43 . Several studies have confirmed that exercise can increase the BMD of the femoral neck and lumbar spine in elderly patients with OP 44,45 . ...
Article
Full-text available
Objective: Physical exercise has obvious effects on bone loss, pain relief, and improvement of bone metabolism indexes in patients with osteoporosis, but currently lacks sufficient evidence. The aim of this systematic review and meta-analysis was to synthesize and present the best available evidence on the effectiveness and safety of exercises in the treatment of primary osteoporosis. Methods: Publications pertaining to the effectiveness of exercise on bone mineral density (BMD), visual analog scores (VAS), and biochemical markers of bone metabolism in primary osteoporosis (POP) from PubMed, Cochrane Library, Embase, VIP, CNKI, and Wanfang Database were retrieved from their inception to April 2020. Results: A total of 20 studies with 1824 participants were included. The results of the meta-analysis revealed that exercise therapy for lumbar spine and femoral neck BMD is statistically different from conventional therapy (lumbar spine BMD: SMD = 0.78, 95%CI: 0.46, 1.10, P < 0.00001, I2 = 85%; femoral neck BMD (SMD = 0.80, 95%CI: 0.34, 1.27, P = 0.0007, I2 = 88%), exercise therapy can significantly increase the lumbar spine BMD of patients with OP, especially in lumbar spine2-4 BMD (SMD = 0.47; 95%CI: 0.20, 0.75; P = 0.0008; I2 = 69%). Compared with conventional treatment, kinesitherapy also has significant differences in alleviating the pain of POP patients (SMD = -1.39, 95%CI: -2.47,-0.31, P = 0.01, I2 = 97%). Compared with conventional therapy, kinesitherapy has no significant difference in improving biochemical markers of bone metabolism such as bone glaprotein (BGP) (SMD = 2.59, 95%CI:0.90, 4.28, P = 0.003, I2 = 98%), N-terminal pro peptide of type I procollagen (PINP) (SMD = 0.77, 95%CI: -0.44 to 1.98, P = 0.21, I2 = 95%), serum phosphorus (SMD = 0.04, 95%CI: -0.13, 0.22, P = 0.61, I2 = 30%), alkaline phosphatase (ALP) (SMD = -0.08, 95%CI: -0.44, 0.27, P = 0.64, I2 = 76%), and serum calcium (SMD = 0.12, 95%CI: -0.18, 0.43, P = 0.42, I2 = 63%) in POP patients. Conclusions: Kinesitherapy significantly improved lumbar spine and femoral neck BMD, and relieve the pain of patients in the current low-quality evidence. Additional high-quality evidence is required to confirm the effect of exercise therapy on the biochemical markers of bone metabolism in POP patients.
... Individuals with OP are strongly recommended to regularly engage in multicomponent exercise programs [57]. Moreover, several studies have confirmed that exercise can increase BMD at the femoral neck and the lumbar spine in elderly women with osteoporosis [58,59]. is review is the first systematic review and meta-analysis to evaluate the effect of kinesitherapy on BMD on the lumbar spine and femoral neck in persons with POP from RCTs. is study Evidence-Based Complementary and Alternative Medicine involved 21 RCTs that included a total of 1840 subjects with POP (including SOP and PMOP). e duration of treatment varied from 3 to 24 months. ...
Article
Full-text available
Objective: Osteoporosis (OP) is a well-established age-related disease, pathologically characterized by bone microarchitectural deterioration, increased fragility, and low BMD. Primary osteoporosis (POP) is the most common type of OP. Methods: Publications pertaining to the effectiveness of kinesitherapy on BMD in POP from PubMed, SCI, Cochrane Library, Embase, VIP, CNKI, and Wanfang Database were retrieved from their inception to October 2019. Results: A total of 21 studies with 1840 participants were included. The results of the meta-analysis revealed that kinesitherapy plus antiosteoporosis medications had a positive effect on lumbar spine BMD when the duration of intervention was 6 months (MD = 0.11 g/cm2; 95% CI: 0.06-0.15; P < 0.0001) or >6 months (MD = 0.04 g/cm2; 95% CI: 0.02-0.06; P < 0.0001) compared with antiosteoporosis medications alone. Additional kinesitherapy plus antiosteoporosis medications were associated with improved femoral neck BMD compared with antiosteoporosis medications alone (MD = 0.09 g/cm2; 95% CI: 0.03-0.16; P=0.004). Conclusions: Kinesitherapy plus antiosteoporosis medications significantly improved lumbar spine and femoral neck BMD in the current low-quality evidence. Additional high-quality evidence is required to confirm the effect of kinesitherapy on BMD in patients with POP.
Article
Aim. To explore the operative therapeutic methods of postmenopausal osteoporosis. Method. There were 45 postmenopausal osteoporosis women, randomly divided into three groups: estrin tent group, pulsed electromagnetic fields treatment group and therapeutic alliance treatment group. Record chief complaints and estimate BMD, gonadal hormone before treatment and posttreatment. Results. The effects of the therapeutic alliance treatment group was the best in three groups. The percentage of therapeutic alliance group was 93%, that of estrin treatment group was 60%, that of PEMFs treatment group was 80%. Conclusion. The therapeutic alliance treatment of postmanopausal osteoporosis is a comparatively operative methods.
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Osteoporosis is becoming a great social and medical problem due to the elderly population. Various forms of prevention and treatment are needed to deal this problem. It has been found that pulsed electromagnetic field therapy is safe and effective in treating osteoporosis. This review thus concentrates on the progress of recent studies done so far on pulse electromagnetic therapy in the treatment of osteoporosis.
Article
This study examined the effects of exercise alone and exercise and nutritional supplementation on lumbar spine bone mineral density, lean weight, and resting blood pressure. The subjects (N = 52) were placed into a Control Group [no exercise or nutritional supplements], an Exercise Group [strength training and aerobic activity; no nutritional supplementation]; and an Exercise and Nutrition Group [strength training and aerobic activity; supplementary protein, calcium, and vitamin D]. Changes in lumbar spine bone mineral density did not attain significance. Lean weight increased significantly in the Exercise and Nutrition Group. Resting SBP and DBP decreased significantly in the Exercise and Nutrition Group. These findings indicate that strength training, aerobic exercise, and nutritional supplements may be more effective than just exercise for increasing lean weight and for reducing resting blood pressure.
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Osteoporosis is a serious skeletal disease causing an increase in morbidity and mortality through its association with age-related fractures. Although most effort in fracture prevention has been directed at retarding the rate of age-related bone loss and reducing the frequency and severity of trauma among elderly people, evidence is growing that peak bone mass is an important contributor to bone strength during later life. Indeed, there has been a large emphasis on the prevention of osteoporosis through the optimization of peak bone mass during childhood and adolescence. The prepubertal human skeleton is sensitive to the mechanical stimulation elicited by exercise and there is increasing evidence that regular weight-bearing exercise is an effective strategy for enhancing bone mineral throughout growth. Physical activity or participation in sports needs to start at prepubertal ages and be maintained through pubertal development to obtain the maximal peak bone mass achievable. High strain eliciting sports like gymnastics, or participation in sports or weight bearing physical activity like soccer, are strongly recommended to increase peak bone mass. Many other factors also influence the accumulation of bone mineral during childhood and adolescence, including heredity, gender, diet and endocrine status. However, this review article will focus solely on the effects of physical activity and exercise providing a summary of current knowledge on the interplay between activity, exercise and bone mass development during growth. Due to the selection bias and other confounding factors inherent in cross-sectional studies, longitudinal and intervention studies only will be reviewed for they provide a greater opportunity to examine the influence of mechanical loading on bone mineral accretion over time.
Article
Background: The effect of pulsed electromagnetic fields (PEMFs) on bone formation and remodeling has been evaluated in several studies in the last 30 years, but the results of these studies have been equivocal. Objective: The aim of this study was to investigate the effects of PEMFs on bone mineral density (BMD) and the biochemical markers of bone turnover in patients with postmenopausal osteoporosis.Methods: In this single-blind, randomized study, 40 outpatients were exposed to 100-Hz PEMFs (n = 20) or to a placebo electromagnetic field (n = 20) for 60 minutes per day, 3 times a week for 3 months. BMD was measured at baseline and at the end of treatment, and biochemical markers of bone metabolism were measured at baseline, after 3 months' treatment, and 1 month after treatment cessation.Results: Treatment with PEMFs did not cause a significant increase in BMD in either group. However, in the group treated with 100-Hz PEMFs, a significant increase in serum osteocalcin and serum procollagen type I C-terminal propeptide was observed during treatment (P < 0.001 vs baseline); these parameters returned to baseline values 1 month after the end of treatment.Conclusions: These findings suggest that PEMFs may stimulate osteogenesis, possibly by increasing osteoblastic activity, in postmenopausal women with osteoporosis.
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There is increasing interest in the application of mag-netic/electromagnetic fields for therapeutic purposes. Mag-netotherapy provides non-invasive, safe and easy to apply methods to directly treat the site of injury, the source of pain and inflammation as well as other types of dysfunction. This review summarizes several decades of experience worldwide in studying biological and clinical effects initiated by various magnetic and electromagnetic fields. The physiological basis for tissue repair as well as physical principles of dosimetry and application of magnetic fields are discussed. An analysis of magnetic/electromagnetic stimulation is followed by a dis-cussion of the advantage of magnetic field stimulation com-pared with electric current stimulation. Finally, the proposed mechanisms of action are discussed.
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Overview: This article provides an overview of osteoporosis, describes current recommendations for its prevention and treatment, and discusses nursing implications. This is part two of a four-part series on postmenopausal health. Keywords: bisphosphonates, bone densitometry testing, bone health, bone mass, bone mineral density, bone strength, calcium, estrogen agonists/antagonists, hip fracture, menopause, osteopenia, osteoporosis, selective estrogen receptor modulators, vertebral fracture, vitamin D