Osteoporosis and reduction and/or prevention of worsening symptoms are imperative to those practitioners and trainers who assist the elderly in rehabilitation or training in order to improve their quality of life. Physical therapists, health care practitioners, exercise physiologists, kinesiologists, and trainers alike should know what osteoporosis/osteopenia are, as well as indications and contraindications of exercise for this population. Over the years, numerous studies have been conducted on exercise and its effects on bone density Studies looking at Pilates and its effects on osteoporosis have also been published. Overall, the benefits have been quite favorable. Articles have shown prevention of continued bone loss, as well as improved quality of life and perceived physical function.1•2 Studies specifically have been conducted on Pilates in comparison with er exercise interventions and the overall effect and results have also been favorable.3 Extensive research on Pilates and which exercises are most beneficial for use with this population have also been completed.4•5 These articles, as well as numerous others, certainly indicate the benefits of exercise and the utilization of exercises in the Pilates repertoire for promoting good bone health.6
The purpose of this case study was to demonstrate that Pilates exercise intervention can help reduce the effects of osteoporosis and reduce the progression of osteopenia in a 52-year-old man. Mr. H was a 52-year-old man who had a diagnosis of osteoporosis/osteopenia since the age of 34 years. His medical history included bilateral total hip replacements because of his poor bone density, a rotator cuff repair, and a torn Achilles tendon. His orthopedic history had been quite extensive. In 1998 after magnetic resonance imaging was performed, it was revealed that he had avascular necrosis in both hips. He was immediately prescribed a series of medications to increase his blood circulation. This intervention was not successful, and his symptoms actually worsened.
Toward the end of 1999, he was limping badly and having to utilize a cane. It was at this time he decided to interview doctors in Louisiana, Dallas, and New York areas and finally settled on a doctor in New York who was both an MD/orthopedic surgeon and a biomechanical engineer. He had invented a new type of hip replacement with a different point of view regarding “weight-bearing.” He was also the only doctor who had at the time performed a bilateral replacement at the same time.
Surgery was performed in February 2000. Three years later, his MD noted that his bone density was significantly worse. He was given Fosamax (alendronate) and testosterone. In 2008, he was not very active and was still having back issues and mobility challenges. He came to Core for gait training and overall conditioning. Working with our team, he discovered Pilates!! By 2013, he could no longer be prescribed Fosamax because 10 years was the limit. Once he was taken off the Fosamax, his bone density testing got much worse and fell into the osteoporosis range. His preliminary results as of December 2013 were as follows: bone mineral density (BMD), 0.815; T-score, -2.5; z-score, -2.2; diagnosis, osteoporosis. In 2014, Mr H. was instructed to start a specific Pilates repertoire focusing on exercises designed and executed for a client with osteoporosis (Figures 1 and 2). He was retested in 2014, and his results were significantly improved: BMD, 0.893; T-score, -1.8; z-score, -1.4; diagnosis, osteopenia (Table 1).
The general protocol that was utilized for Mr. H. was as follows: He was seen in 2014 for Pilates training 3 times per week for the last 48 weeks. Baseline sessions included Pilates exercise on the Reformer (closed-chain footwork on jump board, jumping on jump board, abdominal training, supine arm circles, hundred prep in neutral pelvic positioning, quadruped abdominals, kneeling arm series chest expansion, hug a tree, salute, etc, and leg in strap) and standing VMO (Vastus Medialis Obliquus) press on Wunda Chair (Table 2). Additional exercise peppered in per session.
OUTCOMES OF THE PROTOCOL
Mr. H.’s outcome was quite favorable. His osteoporotic diagnosis was reduced to one of osteopenia. His MD was rather astonished and pleased with the improvement. The client reported a significant reduction in pain and improved strength, flexibility, posture, and overall well-being.
The results of this case study were extremely favorable. Further research with an increased number of participants and a very specific protocol to follow would be recommended. As the lifespan expectancy of the elderly continues to increase, it is imperative that health care practitioners know how to best work with this client population to improve their quality of life and health.
1 Angin E, Erden Z, Can F. The effects of clinical Pilates exercises on bone mineral density, physical performance, and quality of life of women with postmenopausal osteoporosis. J Back Musculoskelet Rehabil. 2015;28(4):849-858. doi: 10.3233/BMRl 50604.
2 Kucukcakir N, Altan L, Korkmaz N. Effects of Pilates exercises on pain, functional status and quality of life in women with postmenopausal osteoporosis. J Bodyw Mov Tber. 2013;17(2):20+ 211. doi:10.1016/j.jbmt.2012.07.003.
3 Moreira LD, de Oliveira ML, Lirani-Galvao AP, Marin-Mio RV. dosSantos RN, Lazaretti-Castro M. Physical exercise and osteoporosis: effects of different types of exercises on bone and physical function of postmenopausal women. Arq Bras Endocrinol Metabol. 2014;58(5):514-522. http://www.ncbi.nlm.nih. gov/pubmed/25166042. Accessed August 3, 2016.
4 Rotstein R. Exercising your bones. International Osteoporosis Foundation Web site. https://www.iofbonehealth.org/news/exercising-your-bones. Published June 16, 2014. Accessed August 5, 2016.
5 Rotstein R. Stand tall with four simple exercises for healthy posture. International Osteoporosis Foundation Web site. https://www. iofbonehealth.org/news/stand-tall-four-simple-exercises-healthy posture. Published July 15. 2014. Accessed August 5. 2016.
6 Rotstein R. How to improve your balance. International Osteoporosis Foundation website. https://www.iofbonehealth.org/news/how-improve-your-balance. Published August 20. 2014. Accessed August 5. 2016