Читать книгу Pathy's Principles and Practice of Geriatric Medicine - Группа авторов - Страница 199

Finally, exercise may counteract undesirable side effects of standard medical care, a use of exercise that is just emerging in the literature. Such use of exercise would include resistance training for patients receiving corticosteroid treatment to counteract the associated proximal myopathy and osteopenia, substituting exercise for psychotropic medications to prevent falls,¹⁷² or neutralising the adverse effects of energy‐restricted diets in obesity or protein‐restricted diets in chronic renal failure,¹⁷³ for example.

Osteopenia associated with corticosteroid usage appears to be eliminated by concurrent progressive resistance training, which should be recommended for all such patients. Although bisphosphonates have also been shown to be very effective for corticosteroid osteopenia, they do not address the coexisting steroid myopathy as resistance training does and are therefore an insufficient antidote for corticosteroid side effects. An excellent target group for such health promotion efforts would be older men with steroid‐dependent chronic lung disease, in whom pulmonary cachexia, malnutrition, tobacco use, steroid myopathy, and osteoporosis combine to produce profound wasting, osteoporotic fracture, and impaired exercise tolerance. Aerobic training will improve functional status in this clinical cohort but is insufficient to address musculoskeletal wasting.