Читать книгу Pathy's Principles and Practice of Geriatric Medicine - Группа авторов - Страница 179

Significant changes in the femur, lumbar spine, and radius have been seen following high‐impact aerobic training, resistance training, and combined programmes of aerobic and resistive exercise. Unlike results obtained in younger women, isolated high‐impact training (jumping, skipping, heel drops) has not yet been found to be effective in studies of postmenopausal women. High dropout rates (30–50%) are problematic in these trials, raising the issue of generalisability and sustainability of the outcomes observed. This is particularly relevant to fracture prevention efficacy of exercise, as several studies have shown complete or partial reversal of gains in bone mineral density (BMD) after the cessation of training.

For older men and women, a combination of decreased anabolic hormones (oestrogen, testosterone, growth hormone), increased catabolic milieu (higher leptin and cortisol associated with visceral adipose tissue), the emergence of musculoskeletal and other diseases, retirement, and reduced recreational activities have a major negative impact on both bone and muscle tissue. The majority of studies demonstrating the efficacy of exercise on bone density have been conducted in women between 50 and 70 years of age, and it is not yet known if efficacy would be similar in women over 80 with multiple comorbidities, who have often been excluded from such trials. However, the most recent studies suggest that optimal adaptations continue to accrue with high‐intensity resistance and power training in older adults.⁷⁰