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Too Fit-to-Fracture Exercise Book
- 1. Too Fit toFracture: Managing Osteoporosis through Exercise Osteoporosis Canada 1-800-463-6842 www.osteoporosis.ca
- 2. Disclaimer: The informationin this booklet is not meant to replace advice from your doctor. Are you new to exercise? Do you want to change your exercise program? First, speak to your healthcare provider or speak to a fitness professional who knows safe exercises for someone with osteoporosis.
- 3. Contents Part 1 What types of exercise do you need?. . . . . . . . . . . . . . . . . .1 How active are you? Part 2 How to do strength exercises. . . . . . . . . . . . . . . . . . . . . . 3 Start your plan Part 3 How to do posture exercises. . . . . . . . . . . . . . . . . . . . . . .7 Add posture exercises to your plan Part 4 How to do balance exercises. . . . . . . . . . . . . . . . . . . . . . 10 Add balance exercises to your plan Part 5 How to do aerobic physical activity. . . . . . . . . . . . . . . . . . 16 Add aerobic physical activity to your plan Part 6 Flexibility exercises can also help . . . . . . . . . . . . . . . . . . 20 Part 7 Are yoga and Pilates safe for you?. . . . . . . . . . . . . . . . . . . 21 Part 8 Tips and worksheets for your plan . . . . . . . . . . . . . . . . . . 22 Exercise Guide My Activity Plan: Worksheet A My Activity Plan: Worksheet B Part 9 Ways to stick to your exercise plan. . . . . . . . . . . . . . . . . . 26 Part 10 Ways to prevent spine fractures. . . . . . . . . . . . . . . . . . . . 28 Part 11 Helpful resources. . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
- 4. About this booklet Thisbooklet is for people with osteoporosis and for people who have had a fracture (broken bone) because of osteoporosis. This type of broken bone is called a fragility fracture. Osteoporosis is a bone disease. Bones become porous and weak. Weakened bones are more likely to break. The most common breaks are in the wrist, shoulder, hip and spine (back). Osteoporosis Canada Osteoporosis Canada is a national charity. It helps people who have or who may develop osteoporosis. It provides information and many other services. In this booklet, Osteoporosis Canada shows you ways to manage osteoporosis with exercise. You can find out how to start an exercise plan. For more information about osteoporosis, go to: www.osteoporosis.ca Bone Fit™ professionals Osteoporosis Canada has a program called Bone Fit™. The program provides education and training to health and fitness professionals. They learn what exercises are safe and effective for people with osteoporosis. A Bone Fit™ professional can help you plan an exercise program. Are there Bone Fit™ professionals in your area? You can check the Bone Fit™ website at: www.bonefit.ca/locator/ Osteoporosis Canada acknowledges the input and guidance from the Canadian Physiotherapy Association and the University of Waterloo Inside a normal bone Normal Osteoporosis Inside a bone with osteoporosis Osteoporosis can cause fragility fractures. The bone breaks easily because it is weak. •• A person might break a bone when they cough, sneeze, reach, lift or bend. •• A person might break a bone when they trip and fall. Photography copyright of Bone Fit™ and University of Waterloo
- 5. 1Part 1: Whattypes of exercise do you need? Exercise is recommended for all people with osteoporosis, even people who have had a spine or hip fracture. Consider speaking to a physical therapist or kinesiologist to get advice on exercises that are right for you. Experts recommend 4 types of exercise: 1. Strength exercises — at least 2 times per week 2. Posture exercises — every day 3. Balance exercises — every day 4. Aerobic physical activity that is weight bearing — at least 150 minutes per week Why are these types of exercise important? Strength exercises keep you strong and fit. Posture exercises keep you standing tall, not stooped. Balance exercises help you be more stable on your feet. You can walk more easily. Good balance helps prevent falls. Aerobic physical activity (moderate to vigorous intensity) improves your overall health. It can reduce your risk of disease. It may improve your bone strength. Part 1: What types of exercise do you need? My Notes:
- 6. 2 Part 1:What types of exercise do you need? How active are you? Read statements 1 to 6. Then, answer yes or no for each statement. 1. I do activities to increase muscle strength twice a week or more. For example, I lift weights or work with exercise bands. Yes No 2. Most days, I do activities that challenge my balance. For example, I do balance exercises, Tai Chi or dance. Yes No 3. On 5 days a week or more, I do physical activity for 20 to 30 minutes. My heart beats faster than when I do normal daily activities. Yes No 4. I do exercises to improve my posture every day. Yes No 5. I pay attention to my posture during the day. I try to avoid twisting or bending forward too much. Yes No 6. I make my exercises more difficult over time. I try to challenge myself. Yes No Did you answer no to any of the statements? Think about adding exercises into your daily routine. You can get ideas in this booklet. Did you answer yes to any of the statements? Good for you! Now, you can slowly increase how often, how long or how hard you do the activities. You can get ideas in this booklet.
- 7. 3Part 2: Howto do strength exercises What are strength exercises? When you do strength exercises, you are working against resistance until your muscles feel tired. You can use many things for resistance: •• exercise bands •• weights •• lifting your body weight against gravity •• resistance training equipment We all lose muscle and get weaker with age. Strength exercises make your muscles stronger. They may also increase the strength of your bones. What muscle groups should you work on? •• upper back •• chest •• shoulders •• arms (for example, biceps and triceps) How many strength exercises should you do? Choose one or more exercises for each muscle group. Learn to do the exercises properly with good form and alignment. Make sure you can control the speed of the movement. How often should you do strength exercises? Do exercises for each muscle group at least 2 days per week. Is it okay to use gym equipment? Many gyms have equipment for strength training. You often have to bend and twist to adjust or get into the machines. If you don’t know how to use them safely, talk to an exercise professional. Part 2: How to do strength exercises Strength training is also called resistance training. Remember to do strength exercises 2 or 3 times a week. My Notes: •• upper legs (for example, hamstrings and quadraceps) •• lower legs
- 8. 4 Part 2:How to do strength exercises What do strength exercises look like? Here are some exercises where you work against resistance. Choose an exercise, and learn to do the movement safely and correctly. Each time you do the movement, it is called a repetition (rep). You often start with one set of 8 to 12 reps. Is it easy for you to finish 12 reps? Could you do a few more? Then, you can make the exercise a little harder. Over time, you can do 2 or 3 sets. You often rest for 1 to 2 minutes between sets. Do squats (see photo), step-ups, or sit-to-stand exercises for your legs and butt muscles. Do wall pushups for your chest and triceps (muscles in the back of your upper arm). Do bow and arrow pulls for your upper back and biceps (muscles in the front of your upper arm). Do heel raises for your lower legs. Do sash exercises for your shoulders, back and arms. exercise step exercise band
- 9. 5Part 2: Howto do strength exercises How hard should you work? Everyone is different. So first make sure you can do the exercise safely. After a few weeks, you can make the exercise a little harder. You want the last 2 or 3 reps to challenge you. If you have had a spine fracture, focus on how to do the exercise safely. Try to work with a Bone Fit™ professional. How can you increase bone and muscle strength over time? You must make your exercise program more difficult week by week and month by month. This is called progression. Here are some ways to progress your program: •• increase the number of reps up to 12 •• increase the number of sets •• increase the resistance or make the exercise harder •• increase the number of exercises Work with a Bone Fit™ professional Try to work with someone who has training in the Bone Fit™ program. For example, a physical therapist or kinesiologist. They can: •• help you choose exercises •• show you how to do the exercises correctly •• help you make your exercise program more difficult over time I’m feeling my muscles now …6…7… A rep (repetition) is each time you repeat an exercise movement. Are you ready to begin an exercise plan? Research shows that it helps if you write down your plan. You will be more likely to continue to exercise. Start your activity plan on the next page.
- 10. 6 Part 2:How to do strength exercises Start your plan Start to write down your activity plan. Use Worksheet A on page 24. 1. Pick at least 2 days for strength exercises. For example, Tuesdays and Fridays. 2. Decide when you will exercise. For example, at 10 a.m. 3. Add things that will remind you to exercise. For example, holding my favourite tea cup in the morning. 4. Add ways to motivate yourself. For example, I can hold my grandson. Weekly plan for: (month) My Activity Plan: Worksheet A Start to fill out this worksheet as you read through the booklet. Show your worksheet to your Bone Fit™ professional. Sunday Monday Tuesday Wednesday Thursday Friday Saturday What type of exercise will I do on each day? strength posture balance aerobic strength posture balance aerobic strength posture balance aerobic strength posture balance aerobic strength posture balance aerobic strength posture balance aerobic strength posture balance aerobic What time of day will I exercise? What will I use to remind me to exercise? What will motivate me to exercise? June strength at 10 a.m. strength at 10 a.m. strength reminder: favourite tea cup strength reminder: favourite tea cup I can hold my grandson.
- 11. 7Part 3: Howto do posture exercises What are posture exercises? When you do posture exercises, you pay attention to how the parts of your body line up with each other. Why are posture exercises important? Posture exercises work on the muscles in your back that help you stand straight. When these muscles get weak, you can develop a stooped posture (curve in your back). These muscles can help extend your back, improve your posture and protect your spine. How often should you do posture exercises? Do them every day. How long should you do the exercises for? Do them for 5 to 10 minutes every day. Also, pay attention to your posture during daily activities. Part 3: How to do posture exercises Many people have some curve in their upper back. This is normal. The upper back can curve more if you have fractures or weak back muscles. Rounding of the back is called kyphosis (say: ki-FO-sus). Poor posture when you bend means extra force (load) on your spine. Remember to do posture exercises every day. This photo shows good posture. The ear, shoulder, elbow, hip bone, knee and ankle line up. This photo shows good posture in a chair. You can use a small pillow to support your back.
- 12. 8 Part 3:How to do posture exercises Do a simple yoga pose called Shavasana (say: sha-VAH-suh-na). Lie flat on your back on a firm mattress or floor mat. Place your arms on the floor with the palms up. Your legs are straight. If straight legs are uncomfortable, put a pillow under your knees or bend your knees (see photo). You should use a pillow under your head only if your head cannot reach the bed or floor (see photo). Lie in this pose for 5 to 10 minutes. Focus on your breath. Imagine your collarbones are wings. Spread your wings slightly but don’t pull your shoulders back. What type of posture exercises can you do? First, learn to sit and stand with good posture. Use the tips below. Then, add the yoga pose. It helps to extend your spine. To make the exercises harder, talk to a Bone Fit™ professional. Practise standing and sitting with good posture. Look at yourself in a mirror. Standing posture Balance your weight evenly on both feet. Gently pull the belly in. Look straight ahead. Gently tuck in your chin. Pull your breastbone up slightly. Sitting posture Put your feet flat on the floor. Sit up straight. Gently tuck in your chin. Pull your breastbone up slightly. Use a support for your lower back. For example, a pillow or a chair with back support. What tools do you need? •• mirror •• floor mat or firm mattress •• pillows (if needed)
- 13. 9Part 3: Howto do posture exercises Add posture exercises to your plan Go to page 24 and add posture exercises to Worksheet A. 1. Check the posture box for all 7 days. 2. Decide when you will exercise. For example, at 9 p.m. while I watch TV. 3. Add things that will remind you to exercise. For example, every commercial during the show. 4. Add ways to motivate yourself. For example, I can see myself standing tall. Here is a sample. Weekly plan for: (month) My Activity Plan: Worksheet A Start to fill out this worksheet as you read through the booklet. Show your worksheet to your Bone Fit™ professional. Sunday Monday Tuesday Wednesday Thursday Friday Saturday What type of exercise will I do on each day? strength posture balance aerobic strength posture balance aerobic strength posture balance aerobic strength posture balance aerobic strength posture balance aerobic strength posture balance aerobic strength posture balance aerobic What time of day will I exercise? What will I use to remind me to exercise? What will motivate me to exercise? June strength at 10 a.m. strength at 10 a.m. posture at 9 p.m. during TV show posture at 9 p.m. during TV show posture at 9 p.m. during TV show posture at 9 p.m. during TV show posture at 9 p.m. during TV show posture at 9 p.m. during TV show posture at 9 p.m. during TV show strength reminder: favourite tea cup strength reminder: favourite tea cup posture reminder: commercials posture reminder: commercials posture reminder: commercials posture reminder: commercials posture reminder: commercials posture reminder: commercials posture reminder: commercials I can hold my grandson. I can see myself standing tall.
- 14. 10 Part 4:How to do balance exercises Good balance can help prevent falls. It is important to keep your balance while you do daily activities. Exercises can help to improve your balance. How do you keep your balance? 1. When you are standing, the distance between your feet is your base of support. If your feet are far apart, your base of support is large. If they are close together, your base of support is small. A walker or cane can help with balance because it increases the base of support. 2. Your balance depends on your body position and how it moves around your base of support. If you lean forward too far, you might lose your balance and fall. 3. Your balance also depends on how you react when you become unstable. For example, if you stumble on the stairs, a good reaction might be to grab a handrail. If a dog jumps up at you, a good reaction might be to take a step backward. What are balance exercises? Balance exercises challenge your balance. They help to improve your balance and coordination. You may fall less often which helps prevent fractures. Part 4: How to do balance exercises My Notes: Tai Chi is a safe way to exercise. It helps your balance. If you do Tai Chi, you may fall less often. Good coordination means that you can easily move different parts of your body at the same time. base of support
- 15. 11Part 4: Howto do balance exercises These 4 types of exercises challenge your balance 1. Reduce your base of support •• Stand with feet together or on 1 leg (see photo). •• Balance on your heels only or on your toes only. •• Walk while you balance on your toes or heels only. •• Stand with 1 foot in front of the other. Your front heel touches your back toes. 2. Shift your weight •• Move your weight more to 1 foot than the other. •• Lean side to side or front to back. •• Shift your weight from toes to heels. 3. Respond to things that upset your balance •• Correct your balance after something upsets your balance. For example, play catch with balls of different sizes and weights, and correct your balance. •• Balance on an unstable surface. For example, a piece of foam or a BOSU ball. A BOSU ball has a flat bottom and a round top. It doesn’t roll. •• Do activities that require coordination or shifting weight while moving around. 4. Try line dancing or other types of dance. •• Do Tai Chi. •• Walk heel to toe in a line or in a figure eight. What tools do you need? •• support object (chair, counter or wall) to use or have nearby •• balls to catch •• shoes with good traction
- 16. 12 Part 4:How to do balance exercises Always use a support or have one nearby A support object will help prevent falls during balance exercises. Hold on to a support object or have one nearby to help you. Over time, reduce how much you hold on to the support, if you can. How often should you do balance exercises? Try adding balance exercises into your daily activities and into your exercise routine. For example: •• Shift your weight from toes to heels while you brush your teeth. You can stand on 1 or 2 legs. •• Add balance exercises to your daily walk. How hard should you work? Choose exercises that are hard enough so you have to focus on your balance. But be careful not to fall. You should make your exercises more difficult over time. Get help It is very important to get help from someone who knows about osteoporosis and exercise. For example, a Bone Fit™ professional can help you choose exercises that are safe for you. What can you use for support during balance exercises? •• sturdy chair •• table •• counter •• wall Remember to do balances exercises every day. My Notes:
- 17. 13Part 4: Howto do balance exercises Add balance exercises to your plan Go to page 24 and add balance exercises to Worksheet A. 1. Check the balance box for all 7 days. 2. Decide what time you will exercise. For example, morning and evening. 3. Write down things that will remind you to exercise. For example, when I brush my teeth. 4. Write down ways to motivate yourself. For example, I can feel confident that I won’t fall. Here is a sample. Weekly plan for: (month) My Activity Plan: Worksheet A Start to fill out this worksheet as you read through the booklet. Show your worksheet to your Bone Fit™ professional. Sunday Monday Tuesday Wednesday Thursday Friday Saturday What type of exercise will I do on each day? strength posture balance aerobic strength posture balance aerobic strength posture balance aerobic strength posture balance aerobic strength posture balance aerobic strength posture balance aerobic strength posture balance aerobic What time of day will I exercise? What will I use to remind me to exercise? What will motivate me to exercise? June strength at 10 a.m. strength at 10 a.m. posture at 9 p.m. during TV show posture at 9 p.m. during TV show posture at 9 p.m. during TV show posture at 9 p.m. during TV show posture at 9 p.m. during TV show posture at 9 p.m. during TV show posture at 9 p.m. during TV show balance in a.m. and p.m. balance in a.m. and p.m. balance in a.m. and p.m. balance in a.m. and p.m. balance in a.m. and p.m. balance in a.m. and p.m. balance in a.m. and p.m. balance reminder: brushing teeth balance reminder: brushing teeth balance reminder: brushing teeth balance reminder: brushing teeth balance reminder: brushing teeth balance reminder: brushing teeth balance reminder: brushing teeth strength reminder: favourite tea cup strength reminder: favourite tea cup posture reminder: commercials posture reminder: commercials posture reminder: commercials posture reminder: commercials posture reminder: commercials posture reminder: commercials posture reminder: commercials I can hold my grandson. I can see myself standing tall. I can feel confident that I won’t fall.
- 18. 14 Part 4:How to do balance exercises When should you change to a more difficult exercise? First, get advice about safe exercises for you. Then, move to the next exercise only if you can do it safely. Use a support or have one nearby. Here is an example of how to make balance exercises more difficult over time. Do each exercise for about 30 seconds. When you don’t waver and don’t need a support, you can move to the next exercise. You might do an exercise for a few days or weeks before you can move to the next exercise. Start with standing exercises Exercise 1: Stand with your feet together. Exercise 2: Shift your weight from your toes to your heels. Exercise 3: Progress to the inside of 1 heel touching the big toe of your other foot. Exercise 4: Stand with 1 foot in front of the other. The heel of 1 foot is right in front of the toes of the other foot. Then, do walking exercises Exercise 5: Walk in a line. Walk heel to toe (in tandem). Exercise 6: Walk in a line backwards. Walk heel to toe. Exercise 7: Walk in a line on a less stable surface. For example, on grass, sand or a trail. My Notes: You might do an exercise for a few weeks before you can make it harder.
- 19. 15Part 4: Howto do balance exercises How can you increase the challenge of balance exercises over time? As your balance improves, there are more ways to challenge your balance. For example: 1. Reduce how much you touch your support. 2. Shift your weight in standing exercises. For example, stand on one leg. Then, shift your weight between your heels and toes. 3. Close your eyes during standing-still exercises. 4. Do another activity while you do balance exercises. For example, count backwards from 100 while you walk on your toes. Standing exercise •• Stand with good posture. Hold on to a sturdy chair. •• Put the back of your right heel in front of the toes on your left foot. •• Hold for 10 seconds. Switch feet. How to increase the challenge 1. Put only 2 fingers on the chair. 2. Remove your hand from the chair. 3. Close your eyes. Standing to walking exercise •• Stand with good posture. Look straight ahead. •• Come up onto your toes. Hold for 5 seconds. Lower and repeat 3 times. To make it harder, do it on one foot. How to increase the challenge Walk a few steps on your toes. Lower your heels to the floor. Turn around. Repeat the toe walk. Consider getting advice on what exercises are right for you or how to progress your plan. 100 99 98 97 96 95 94 93… These examples show how to increase the challenge of 2 exercises over time.
- 20. 16 Part 5:How to do aerobic physical activity Aerobic physical activity What is aerobic physical activity? It is any continuous, rhythmic activity that you do without resting. You must do it for at least 10 minutes at a time. For example, you can walk, dance, run, climb stairs and use a stair-step machine. Your heart beats faster. You breathe harder than you do during normal daily activities. How often should you do aerobic physical activity? Experts recommend that all adults get 150 minutes of physical activity (moderate to vigorous) during the week. That means about 20 to 30 minutes per day. How hard should you work? The exercise should be moderate to vigorous intensity.You can use this scale from 0 to 10 to describe the intensity of an activity.* The scale describes how intense (hard) it feels for you to do an activity. For example, walking quickly might be hard — number 5. Part 5: How to do aerobic physical activity My Notes: Aerobic physical activity is good for your overall health. It feels like a 6 to me. Walking quickly feels like a 5 to me. *Source: Borg, G.V. (1982) Psychological basis of perceived exertion. Medicine and Science in Sports and Exercise, 14, 377-381. American College of Sports Medicine. Note: The word moderate was removed from 3 to reduce confusion, since we define moderate as 5 or 6. 0 = nothing at all 1 = very light 2 = fairly light 3 4 = somewhat hard 5 = hard 6 7 = very hard 8 9 10 = very, very hard { { 5 and 6 are moderate intensity. 7 and 8 are vigorous intensity.
- 21. 17Part 5: Howto do aerobic physical activity Moderate-intensity activity feels hard — 5 or 6 on the scale For these activities, your heart beats faster, and you breathe harder. You might be able to talk during these activities. But you could not sing. Vigorous-intensity activity feels very hard — 7 or 8 on the scale For these activities, your heart beats faster, and you breathe faster. It is hard to talk during these activities. Weight-bearing aerobic physical activity Try to make many of your aerobic physical activities weight bearing. This means you are supporting the weight of your body. For example, when you walk, your legs support your weight against gravity. This movement puts stress on your bones. Swimming and cycling are not weight bearing. When you swim, the water supports your weight. When you cycle, the bicycle supports your weight. You can still swim and cycle. But also include activities that are weight bearing. How hard should people with osteoporosis work? •• Low or moderate intensity exercise (3 to 6 on the scale) is good if you are new to exercise or have had a spine fracture. At first, exercise for about 10 minutes at a time. •• Moderate or vigorous intensity exercise (5 to 8 on the scale) is good if you are already active. Talk to a healthcare professional before you begin a new exercise program. Add up your activity for the day. You can include aerobic activities that you do for 10 minutes or longer. •• Walked quickly for 15 min. •• Swept for 10 min. •• Rode exercise bike for 10 min. Total = 35 minutes Remember to do aerobic physical activity that is weight bearing 5 or more days per week. My Notes:
- 22. 18 Part 5:How to do aerobic physical activity How can you make the exercises harder? Over time, you can: •• increase the amount of time you do the activity •• increase the times per day or week •• make the exercise more difficult Have you had a spine fracture or are you at risk of a spine fracture? You need to choose activities that are safe for you. Low-impact activities may be best. For example, walking or a beginner exercise class. Ask about low- impact fitness classes for people with osteoporosis. Are there activities that you should avoid? •• You may need to avoid high-impact activities. For example, running or jumping. •• You may need to avoid activities with too much twisting. For example, golf. •• You may need to avoid activities where you can fall easily. For example, skating. If you want to do these activities, talk to your doctor or a Bone Fit™ professional. Do you have balance problems? •• Use a walker or cane if your doctor suggests you use one. •• Choose an activity that feels safe to you. •• You can also ask a physical therapist or kinesiologist to help you choose effective and safe exercises. Don’t slip or trip! Make sure you have shoes with good traction. Avoid slippery floors and ground, and places with clutter. It is important to combine aerobic physical activity with exercises to improve strength, posture and balance. My Notes:
- 23. 19Part 5: Howto do aerobic physical activity Add aerobic physical activity to your plan Go to page 24 and add aerobic physical activity that is weight bearing to Worksheet A. 1. Check 5 or more days to do these exercises. 2. Decide what time you will exercise. For example, in the afternoon. 3. Write down things that will remind you to exercise. For example, put my running shoes next to my bed. 4. Write down ways to motivate yourself. For example, it is always hard to get started. But I always feel so good when I am finished. Here is a sample. Weekly plan for: (month) My Activity Plan: Worksheet A Start to fill out this worksheet as you read through the booklet. Show your worksheet to your Bone Fit™ professional. Sunday Monday Tuesday Wednesday Thursday Friday Saturday What type of exercise will I do on each day? strength posture balance aerobic strength posture balance aerobic strength posture balance aerobic strength posture balance aerobic strength posture balance aerobic strength posture balance aerobic strength posture balance aerobic What time of day will I exercise? What will I use to remind me to exercise? What will motivate me to exercise? June strength at 10 a.m. strength at 10 a.m. posture at 9 p.m. during TV show posture at 9 p.m. during TV show posture at 9 p.m. during TV show posture at 9 p.m. during TV show posture at 9 p.m. during TV show posture at 9 p.m. during TV show posture at 9 p.m. during TV show balance in a.m. and p.m. aerobic in afternoon balance in a.m. and p.m. aerobic in afternoon balance in a.m. and p.m. balance in a.m. and p.m. aerobic in afternoon balance in a.m. and p.m. aerobic in afternoon balance in a.m. and p.m. balance in a.m. and p.m. aerobic in afternoon balance reminder: brushing teeth aerobic reminder: shoes by bed balance reminder: brushing teeth aerobic reminder: shoes by bed balance reminder: brushing teeth balance reminder: brushing teeth aerobic reminder: shoes by bed balance reminder: brushing teeth aerobic reminder: shoes by bed balance reminder: brushing teeth balance reminder: brushing teeth aerobic reminder: shoes by bed strength reminder: favourite tea cup strength reminder: favourite tea cup posture reminder: commercials posture reminder: commercials posture reminder: commercials posture reminder: commercials posture reminder: commercials posture reminder: commercials posture reminder: commercials I can hold my grandson. I can see myself standing tall. I can feel confident that I won’t fall. It makes me feel good.
- 24. 20 Part 6:Flexibility exercises can also help As people get older, joints can become stiff and less flexible. Joints can get stuck in position. For example, a person might develop a stooped, slouched posture. How can you become more flexible? For the chest and front shoulders, start with the yoga stretch called Shavasana (see page 8). For the front of your hips, add some longer strides when you walk. You can also include lunges in your strength training. For the muscles around your ankles, try a calf muscle stretch (soleus stretch). Calf muscle stretch This exercise stretches the calf muscle in your lower leg and the muscles around the ankle. 1. Put both hands on the wall at about eye level. 2. Lean into the wall. One leg is forward, and one leg is back. Bend the front leg at the knee and ankle. Your knee cap just touches the wall. Try not to raise your heels off the floor. 3. Hold this stretch for 30 seconds. 4. Repeat with the other leg. Part 6: Flexibility exercises can also help My Notes: Why is stretching important? Tight muscles can restrict movement. Tight calf muscles make it hard to lift your toes when you walk. Then, you might trip. This yoga stretch is called Shavasana.
- 25. 21Part 7: Areyoga and Pilates safe for you? Do you have osteoporosis? Before you do yoga or Pilates, talk to someone who knows about osteoporosis and exercise. For example, a Bone Fit™ professional. Yoga There are many types of yoga and different teaching styles. Yoga poses (movements) can help improve balance, flexibility and posture. But some poses may be risky if you have osteoporosis. Losing your balance and falling It can be easy to lose your balance and fall during balance poses. Make sure you have a wall or other support object nearby. Twisting and bending You may need to avoid or change some poses if you are at high risk of a spine fracture. For example: •• holding a twisting or bending pose •• bending all the way forward •• twisting all the way around Choosing different poses It is okay to change poses so they are safe to do. For example, if your class is doing a seated twist, you can do a gentle twist while on your back. Ask for advice. Pilates Pilates can help improve balance, flexibility and posture. But some Pilates exercises can be risky if you have osteoporosis. Forward bending, side bending and twisting In Pilates, you often do forward bending, side bending and twisting of the spine. You should avoid or change these movements if you are at high risk of fracture. Part 7: Are yoga and Pilates safe for you? Many yoga poses are wonderful for balance and posture. You can choose poses that are safe to do. You can find tips and worksheets for your plan in Part 8. My Notes:
- 26. 22 Part 8:Tips and worksheets for your plan This part of the booklet has an exercise guide and worksheets. You can use them to make your exercise plan. Exercise Guide Use the Exercise Guide on page 23 to help you make your plan: •• What types of exercises can you do? •• How often should you do them? •• How hard should you work? Start at a level that is safe for you. Think about your fitness level and risk of fracture. Increase how hard you work over time. My Activity Plan: Worksheets A and B Use Worksheet A on page 24 to write down your plan. Then cut or tear it out of the booklet. Put it in a place where you will see it each day. Use Worksheet B on page 25 together with your Bone Fit™ professional. You can download and print blank sheets at www.osteoporosis.ca/osteoporosis- and-you/too-fit-to-fracture/ Part 8: Tips and worksheets for your plan Exercise Guide What exercises? How often? How hard? How long? Strength Use exercise bands, hand weights, own body weight, resistance training equipment. At least 2 days a week You should be able to do 8 to 12 reps. The last 2 to 3 reps should feel hard to do. Do at least 2 sets of 8 to 12 reps per exercise. Include all major muscle groups. Posture Practice good posture when you stand and sit, do Shavasana, do back exercises that extend your spine. Every day Be aware of your posture. Use a mirror when you exercise. Pay attention to your posture during daily activities. Do posture exercises for 5 to 10 minutes daily. Balance Do Tai Chi, dance, walk heel to toe, reduce base of support, shift your weight, respond to things that upset your balance. Every day Beginners: Do exercises where you stand in one spot. Advanced: Challenge your balance while you are moving. Try to get help to choose exercises. Do balance exercises all at once or spread them out during the day. You can also build them into daily activities. Aerobic physical activity Walk quickly, dance, run, climb stairs, rake leaves. Most days (5 days or more) Some people can do moderate to vigorous intensity—5 to 8 on the scale. If you are new to exercise or if you have had a spine fracture, start at low to moderate intensity — 3 to 6 on the scale (see scale on page 16). Do aerobic physical activity for about 20 to 30 minutes per day. Exercise for at least 10 minutes at a time. In total, do 150 minutes or more per week. If you are new to exercise or if you have had a spine fracture, start with 10 minutes each day. Weekly plan for: (month) My Activity Plan: Worksheet A Start to fill out this worksheet as you read through the booklet. Show your worksheet to your Bone Fit™ professional. Sunday Monday Tuesday Wednesday Thursday Friday Saturday What type of exercise will I do on each day? strength posture balance aerobic strength posture balance aerobic strength posture balance aerobic strength posture balance aerobic strength posture balance aerobic strength posture balance aerobic strength posture balance aerobic What time of day will I exercise? What will I use to remind me to exercise? What will motivate me to exercise? My Activity Plan: Worksheet B What exercises will I do? For example: wall pushups, Shavasana, standing on one leg, dancing. How many minutes will I exercise for? How hard will I exercise? For example: number of reps and sets, or easy, moderate, hard. What materials will I need? For example: weights, chair. Strength Posture Balance Aerobic Fill out this worksheet with your Bone Fit™ professional. Month:
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- 30. 26 Part 9:Ways to stick to your exercise plan What might get in the way of your exercise plan? It can be hard to start and stick to an exercise plan. What can help you? Write your ideas in the chart below. Part 9: Ways to stick to your exercise plan 1. What things might stop me from exercising? 2. Some days, something might interfere with my exercise plan. How can I change my plan on those days? 3. Who can help me meet my goals? 4. How can these people help me? 5. Sometimes parts of the plan will not challenge me enough. What can I do to increase the challenge?
- 31. 27Part 9: Waysto stick to your exercise plan What barriers stop people from starting or sticking to an exercise plan? Here are 4 common barriers. 1. “I’m afraid of falling or breaking a bone.” Try to be extra careful when you exercise. •• Start slowly. •• Choose exercises that you can do with the support of a chair, counter or wall. •• Ask someone to stay near you when you exercise. 2. “I’m worried about going outside.” It’s okay to be cautious. Always wear shoes with good traction. Use your cane or walker if your healthcare professional suggests you use one. •• You can also do many exercises inside. •• You can do strength and balance exercises at home. •• You can exercise at a community centre, gym or shopping mall. 3. “I have a limited budget.” You can do most of the activities in this booklet for free. You can use exercise bands, food cans or your body weight for strength exercises. You can add exercises into your daily routine. It does cost money to see an exercise professional. But it may be worth it! A few visits will cost about $100 to $200. 4. “I don’t feel like exercising.” Sometimes you wake up tired, and you don’t want to exercise. What can you do? •• Try to exercise for 10 minutes. After that, you can stop if you need to. You might keep going! •• Find someone to exercise with. •• Turn on some fun music. •• Give yourself a reward. Part 9: Ways to stick to your exercise plan My Notes: Are any of the 4 barriers stopping you? Try writing them down and adding tips for yourself.
- 32. 28 Part 10:Ways to prevent spine fractures How does your spine work? There are 24 bones (vertebrae) in your spine. They are different shapes and sizes. They stack up one on top of the other and form 3 gentle curves. This alignment is called neutral spine. The neutral spine is the strongest and safest position for the spine. The ear is right over your shoulder. What movements can cause spine fractures if you have osteoporosis? Here are 3 movements that can cause spine fractures. 1. Twisting When you twist your spine, muscles pull strongly on the bones on one side of your spine. This force can break a bone in the spine. What should you avoid (not do)? •• Avoid twisting quickly — like turning to answer the phone. •• Avoid twisting over and over again — like if you are vacuuming. •• Avoid twisting too far or while sitting — like turning to reach something behind you. •• Avoid twisting while holding a heavy object — like picking up a box and turning to the side to put it down. Part 10: Ways to prevent spine fractures The 24 bones in the back are vertebrae (say: VER-ta-bray). My Notes:
- 33. 29Part 10: Waysto prevent spine fractures 2. Bending When you bend forward, you compress (squeeze together) the front part of each bone in your spine. Compressing the bones can cause a fracture. What should you avoid (not do)? •• Avoid bending all the way forward — like picking something off the floor. •• Avoid bending over and over again — like during sit-ups. •• Avoid bending while holding something heavy — like a bag of groceries. •• Avoid bending quickly — like picking up something that you drop. 3. Holding or lifting a heavy object Your spine must support extra weight when you carry or lift something heavy. This weight can cause a spine fracture. What should you avoid (not do)? •• Avoid holding heavy weights in your arms — like holding a heavy box of groceries or a child. •• Avoid lifting heavy objects into high or low storage areas — like lifting luggage into overhead storage. •• Avoid lifting heavy objects — like moving a couch. Do exercises for your back Do exercises for your back extensor muscles. These muscles help you stand upright. They can help protect your back when you twist, bend and lift things. Part 10: Ways to prevent spine fractures Even small changes in your posture can help to reduce stress on your spine. You may have less pain.
- 34. 30 Part 10:Ways to prevent spine fractures What are other ways you can prevent spine fractures? Don’t sit for too long. Get up and move around every 30 minutes! Sitting puts stress on the spine. There is less stress when you stand or walk. Bend with a neutral spine. Try not to bend your spine. Try to bend your knees, ankles and hips instead. How to sit tall (with a straight back) When you sit tall, your back is less rounded. There is less stress on your spine. At first, it may be hard to sit tall. Try this exercise. Sitting tall 1. Use a straight-back chair with a firm seat. Sit on the edge of the chair with your back straight. 2. Slide to the back of the chair. Your butt muscles should touch the back of the chair. 3. Put your feet flat on the floor. You can use a small pillow to support the curve of your lower back. Part 10: Ways to prevent spine fractures Don’t bend all the way forward like the man in this photo. You compress the spine a lot when you bend all the way forward. Try to bend your knees, ankles and hips, not your spine. Everyone should get up and move around every 30 minutes. Walk around the room. Do a balance exercise. My Notes:
- 35. 31Part 10: Waysto prevent spine fractures How to bend with a neutral spine When you bend with a neutral spine, your back is less rounded. There is less stress on your spine. At first, it may be hard to remember to bend this way. Try to bend using a hip hinge. You bend at your hips with a neutral spine. Hip hinge 1. Keep your back straight. Don’t bend or round your lower back. 2. Bend from your hips. Stick your tailbone out behind you, but not too much. How to do core exercises safely Some exercises work on your core muscles. For example, the plank in yoga. Core muscles are in the front and sides of your trunk (main part of your upper body). Try to choose core exercises where you have a neutral spine. Exercises that flex (bend) your spine put stress on the spine. So avoid sit-ups and ab machines at the gym. Do wall or floor planks instead. Part 10: Ways to prevent spine fractures My Notes: The next page has more ideas on how to move more safely!
- 36. 32 Part 10:Ways to prevent spine fractures How to move more safely Some movements can increase your risk of a spine fracture. Here are some examples of risky movements and safer ways to do these movements. Part 10: Ways to prevent spine fractures Risky Safer Bending all the way forward when you pick up an object from the floor. Bend with your knees and hips, not the spine. Use a grabber tool. Rotating or twisting the spine when you get out of a car or sweep the floor. Step and turn with your feet. Twist slowly and in control. Don’t over twist. Standing on an unstable footstool, chair or ladder. Use a wide step stool with non-slip grips on the steps and on the feet. Lifting heavy objects into high cupboards. Hold the object close to your body. Stand on a step stool. Lowering bags from overhead storage areas on a plane. Ask someone to do it for you or check your bags. Lifting objects into low cupboards. Avoid lowering or lifting from the floor. Store things at waist height. Lifting or moving furniture. Get someone else to do it. Rotating your body but not moving your feet while you vacuum or rake. Step to turn. Your leading foot and trunk should face the same direction. Walking or stepping into a room or pool area that has a slippery or wet floor. Wear shoes or slippers with good traction. Walk slowly and check the floor. Take a test step before you walk. Twisting or bending and lifting when you make your bed. Bend with your knees and hips, not the spine. Stand close to the bed. Twisting or bending and lifting when you shovel snow. Bend with your knees and hips, not the spine. Step to turn. Your leading foot and trunk should face the same direction. Moving from lying in bed to getting out of bed. Slide your arm out alongside your ear. Roll your whole body onto its side. Bend your knees to 90 degrees. Use your arms to push yourself up.
- 37. 33Part 11: Helpfulresources How to find a Bone Fit™ professional Osteoporosis Canada has a program called Bone Fit™. The program provides education and training to health and fitness professionals — physical therapists, kinesiologists and others. They learn what exercises are safe and effective for people with osteoporosis. A Bone Fit™ professional can help you plan an exercise program. Are there Bone Fit™ professionals in your area? Check the Bone Fit™ website at: www.bonefit.ca/locator/ Where to find more information about osteoporosis and exercise Too Fit to Fracture resources •• You can download and print the booklet Too Fit to Fracture. Go to: www.osteoporosis.ca/osteoporosis-and-you/too-fit-to-fracture/ •• You can download and print the 2-page handout Too Fit to Fall or Fracture. Go to: www.osteoporosis.ca/wp-content/uploads/OC-Too-Fit-to-Fall-or-Fracture.pdf •• You can watch the video series on exercise and osteoporosis. Watch as men and women with osteoporosis work with exercise professionals and learn how to exercise safely. Go to: www.osteoporosis.ca/osteoporosis-and-you/too-fit-to- fracture/video-series-on-exercise-and-osteoporosis/ Canadian Osteoporosis Patient Network (COPN) E-Newsletter resources •• You can read the 8-part exercise series called Boning Up on Exercise. Go to: www.osteoporosis.ca/osteoporosis-and-you/copn/coping-archives/copn-boning- up-on-exercise-series/ •• You can read the 4-part fall prevention series called You Can Prevent Falls and the Injuries They Cause. Go to: www.osteoporosis.ca/wp-content/uploads/COPING_February_14_2014.pdf After the Fracture resource After the Fracture is a booklet for people who have broken a bone due to osteoporosis. Go to: www.osteoporosis.ca/after-the-fracture/ Information Line (toll free) Osteoporosis Canada has a free information line. You can call and speak to an information counsellor. They can answer questions and send you information. Part 11: Helpful resources The information in this booklet is not intended to replace individual medical advice. Health and fitness professionals can get more information about the Bone Fit™ program at www.bonefit.ca. English: 1-800-463-6842 French: 1-800-977-1778
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- 39. Credits: Giangregorio LM,McGill S, Wark JD, Laprade J, Heinonen A, Ashe MC, MacIntyre NJ, Cheung AM, Shipp K, Keller H, Jain R, Papaioannou A. Too Fit To Fracture: outcomes of a Delphi consensus process on physical activity and exercise recommendations for adults with osteoporosis with or without vertebral fractures. Osteoporos Int. 2015 Mar;26(3):891-910. Giangregorio LM, Papaioannou A, Macintyre NJ, Ashe MC, Heinonen A, Shipp K, Wark J, McGill S, Keller H, Jain R, Laprade J, Cheung AM. Too Fit To Fracture: exercise recommendations for individuals with osteoporosis or osteoporotic vertebral fracture. Osteoporosis Int. 2014 Mar;25(3):821-35.
- 40. Osteoporosis Canada 1200 EglintonAve East, Suite 500 Toronto, Ontario, Canada M3C 1H9 1-800-463-6842 416-696-2663 Charitable Registration Number 89551 0931 RR0001 © June 2016 www.bonefit.ca www.osteoporosis.ca osteoporosiscanada OsteoporosisCA