Just Squats for Osteoporosis Increases Bone Mineral Content

Maximal strength training in postmenopausal women with osteoporosis or osteopenia. Mosti MP1, Kaehler N, Stunes AK, Hoff J, Syversen U. J Strength Cond Res. 2013 Oct;27(10):2879-86.

Abstract
Current guidelines recommend weight-bearing activities, preferably strength training for improving skeletal health in patients with osteoporosis. What type of strength training that is most beneficial for these patients is not established. Maximal strength training (MST) is known to improve 1-repetition maximum (1RM) and rate of force development (RFD), which are considered as important co-variables for skeletal health. Squat exercise MST might serve as an effective intervention for patients with low bone mass. We hypothesized that 12 weeks of squat exercise MST would improve 1RM and RFD in postmenopausal women with osteoporosis or osteopenia and that these changes would coincide with improved bone mineral density (BMD) and bone mineral content (BMC), and serum markers of bone metabolism. The participants were randomized to a training group (TG, n = 10) or control group (CG, n = 11). The TG underwent 12 weeks of supervised squat exercise MST, 3 times a week, with emphasis on rapid initiation of the concentric part of the movement. The CG was encouraged to follow current exercise guidelines. Measurements included 1RM, RFD, BMD, BMC, and serum bone metabolism markers; type 1 collagen amino-terminal propeptide (P1NP) and type 1 collagen C breakdown products (CTX). At posttest, 8 participants remained in each group for statistical analyses. The TG improved the 1RM and RFD by 154 and 52%, respectively. Lumbar spine and femoral neck BMC increased by 2.9 and 4.9%. The ratio of serum P1NP/CTX tended to increase (p = 0.09), indicating stimulation of bone formation. In conclusion, squat exercise MST improved 1RM, RFD, and skeletal properties in postmenopausal women with osteopenia or osteoporosis. The MST can be implemented as a simple and effective training method for patients with reduced bone mass.

My comments:

This is a great study! It has a pretty good review of strength training for reversing osteoporosis and then had the patients perform only one exercise; a squat machine for 2 warm-up sets of 8-12 reps (at ~50% of the persons max) then 4 sets of 3-5 reps at 85-90% of their max. The exercises were done 3 times per week for 12 weeks and the result was an increase in hip (femoral neck) bone mineral content of 4.9% (that’s a lot in osteoporosis studies), and an increase in lumbar spine bone mineral content of 2.9%. The strength had improved 154%.

It’s worth talking more about how they did the reps which was explosively with the subjects exploding upwards with the weights as fast as they could. They called this “Maximal Strength Training” (MST) which is a new term for me but sounds identical to Compensatory Acceleration Training (CAT) coined by Fred Hatfield back in the 80’s. Some say tomato and some say potato but either way I expect the exploding with the weights throughout the concentric (upward) motion is a better way to train. As I recall studies from the 90’s showing it increased strength better than conventional weight lifting exercises with college students being the subjects. When I was doing Olympic Weightlifting at NAU, pretty much all our reps were explosive. So it’s cool to see explosive training with weights being applied to and helping elderly women with osteoporosis. It goes to show, yet again, that the best techniques for physical therapy come out of the weight room rather than the classroom.

As always, if you have any further questions or need for clarifications, please don’t hesitate to ask. Being aware that some of my blog ideas are contentious and occasionally a bit out of the field of my expertise, I encourage my readers to come forth with any questions/comments that are of interest or concern. Your comments are valued and welcomed.

Chad Reilly is a licensed physical therapist, located in North Phoenix, practicing science based medicine with treatment protocols unique and effective enough to proudly serve patients from Phoenix, Scottsdale, Mesa, Chandler, Tempe, Peoria, and Glendale.

2 thoughts on “Just Squats for Osteoporosis Increases Bone Mineral Content

  1. I have osteoporosis and would like to do this type of squats and don’t know what kind of machine to use. Can you describe the machine?
    Thanks.

    • Hi Donna,

      The paper didn’t describe the squat machine used, but I would expect any weight stack or plate loaded type machine where the resistance is applied to your shoulders would work. A leg press would load the hips, but not the lumbar spine, or at least not in a good way. In my office I use free weight squats, lunges and RDLs for osteoporosis, which is more technique intensive than machines but also works more stabilizer muscles. Either way, people usually have to get used to training with weights heavier than they expect in order for it to be effective. For home treatment I’m really liking lunges, jumping lunges, pushups, side planks and and what I’m calling a “supine single leg all body bridge.” I describe them all in detail on my new site SpinalFlowYoga.com. Though it’s geared for low back and neck pain, I think it’s a really good option for osteopenia and osteoporosis, especially if you don’t have access to a good gym. It’s basically a total body workout, where I do my best to incorporate all my weights principles and stress levels in a spine safe exercise program. And it does not have any of the spine stretches (in fact it has no spine stretches) that one paper reported likely to cause vertebral compression fractures. I haven’t finished the Spinal Flow site yet, but the exercise program is up. If I can answer any more questions about it or anything else please don’t hesitate to ask.

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