Exercise program for women with osteoporosis

How to start a program at your center

Developing an osteoporosis exercise program at your women’s center allows you to create access, provide screening, and offer referrals for women concerned about the disease, says Mary Heinonen, RN, director of the women’s health program at Keweenaw Memorial Medical Center in Laurium, MI.

Heinonen has been developing an osteoporosis program slowly over the last year. The program at Keweenaw is small, but she wants to expand it by offering a more structured exercise regimen. The last year has been trial and error, and she admits that her biggest problem has been getting referrals for physical therapy from the doctors. "I keep bumping into brick walls," she says. For example, from among 300 recent bone scans, only one referral for exercise was made. "If I got even 10 referrals, I’d be so happy I’d take all [the doctors] out to dinner, because that would mean we were getting through to them," Heinonen says.

To help other women’s center managers who may want to create or improve osteoporosis programs, Women’s Health Center Management talked to two health professionals who have been operating successful osteoporosis exercise programs.

The Osteoporosis Program at Lake Hospital System in Willoughby, OH, was developed from within the cardiac rehabilitation program several years ago, says the program’s director, Mary Ogrinc, RN, vice president of allied health services.

The eight-week program is for women who are developing osteoporosis or who already have the disease. They are admitted to the program by physician referral. Participants meet once a week to hear lectures on osteoporosis and on diet, participate in supervised exercise, receive individualized risk assessment, and enjoy social support among other women who are dealing with the same condition, she says.

Two exercise physiologists — both nurses — developed and run the program. Along with invited speakers, they present information in group sessions. Each participant is shown exercises she should and shouldn’t do based on her diagnosis. (For class descriptions, see story, p. 52.)

Ogrinc says her program focuses on the components of prevention. For a description of a more diagnostic program, WHCM contacted Fern Ritacca, MS, coordinator of the Osteoporosis CARE Program at the Lake Forest (IL) Health and Fitness Institute, which is part of Lake Forest Hospital. An acronym for Complete Aerobic/ Resistance Exercise and Education, CARE offers education and exercise twice a week for four weeks. Lecture topics include:

• general osteoporosis information;

• therapeutic options;

• stress management for chronic disease sufferers;

• proper ways to perform daily activities, such as standing, sitting, and reaching;

• physiology (taking a target heart rate, etc.);

• nutritional information, especially about calcium.

After each lecture, the participants exercise. Exercises are chosen ahead of time based on an individualized assessment from a physical therapist. The women can choose to walk on a track or a treadmill, or they can ride a bike, Ritacca says. Other exercises focus on general flexibility, with everything based on the "neutral spine position." She explains that most people with osteoporosis have lost the curved shape of their spine and are either "swaybacked" or "flat-backed." By demonstrating how the women can use their abdominal and gluteal muscles to achieve the neutral spine position, Ritacca can teach them how to lessen lumbar pressure by 15%, she says.

Participants are also taught which types of exercises not to do. Extension exercises, those involving bending backward from the waist, are recommended, whereas the women are warned against flexion exercises, those involving bending forward from the waist. Ritacca explains that flexion exercises can increase compression fractures and wedging of the vertebrae by as much as 90%.

Advice to get you started

If you create an osteoporosis program at your center, you should stress continued exercise, as well, Ritacca says. Here are a few more of her suggestions:

• Partner with an exercise physiologist who knows which exercises are important and which should be avoided by those with osteoporotic bones. If you can’t find an exercise physiologist, a physical therapist well-trained in evaluations of the spine could learn the exercises quickly.

• Don’t just demonstrate exercises and send the participants home with a page of instructions. The exercise sessions need to be of an adequate number so the person can continue on her own after the program ends. Participants also need education to understand their illness and keep up with their treatment plans.

Ritacca’s outcome studies show that participants in her program have increased vertical reach, strength, coordination, and stability, which are important for decreasing falls. Ogrinc has not measured outcomes from her program yet because she only recently added a bone density machine. However, she knows the program is worthwhile.

"The biggest positive that we hear from our evaluation of patients is that they feel better when they leave a program like this," Ogrinc says. "They are in better control of their care, and they also understand their bodies better. It’s a real educational process for them."