Kurt A. Kennel, M.D., from the Division of Endocrinology, Diabetes, Metabolism, and Nutrition, and Alynn C. Dukart, P.T., D.P.T., from the Healthy Living Program, discuss the importance of exercise to optimize bone health and what the Healthy Living Program offers to create an individualized exercise program for Mayo Clinic patients.
Learn about the Healthy Living Program offerings to optimize bone health and create an individualized exercise program. [MUSIC PLAYING] KURT KENNEL: Hello, my name is Dr. Kurt Kennel. I'm an Endocrinologist at Mayo Clinic in Rochester, Minnesota. As a physician specializing in osteoporosis, I assess risk of falling and fractures and then educate patients regarding options to reduce these risks. This may include starting medications to improve spinal strength or stopping a medication associated with risk of falling. In addition to providing written advice, I might refer a patient for assessment of the safety of their living environment. Although the evidence that exercise prevents fractures is limited, there is no question that community and home-based exercise programs can reduce the risk of falling by developing functional fitness. Even so, many of my patients who do exercise mostly focus on aerobic activity. Others lack familiarity with how to exercise to develop functional fitness. Or they might feel unsafe exercising with osteoporosis. Lastly, some patients with increased risk of fracture initially decline medication but are willing to invest more in their fitness. Joining me today is physical therapist Alynn Dukart, who works at the Mayo Clinic Healthy Living Program. Hello, Alynn. ALYNN DUKART: Hi, thanks so much for having me. KURT KENNEL: So what do I do with my patient who believes they're active-- they exercise, they say-- but what they really mean is maybe just taking an occasional walk or two? Can they do better than that for osteoporosis and fracture risk reduction. ALYNN DUKART: Yeah, there's so many things that this population can be doing to help improve and/or at least maintain their bone density. So when it comes to cardio, there's certain things that we can tweak to be even more beneficial. So some research alludes to doing more of a faster-paced walk and/or potentially some interval walking to have a little bit more benefit if that's safe for them. So that's where, when I work with people, I like to assess and figure out what that safe activity level is. But in addition to walking, strength training is so important. So when we think about strength training, we're thinking about things like weight-bearing, multi-joint, multi-muscle activities, as well as multi-directional movement. So a lot of research shows that bone responds to movement that's in multiple directions. So a lot of times we're just assessing someone's current functional status to determine what are the most appropriate exercises for them. KURT KENNEL: My patient with osteoporosis might wonder if that's safe to do. You're talking about resistance, like weightlifting and that kind of thing. ALYNN DUKART: Yes, and it looks different for everyone. So there's really no one-size-fits-all approach. I mean, when I work with anyone from ranges of a younger 50-year-old woman with osteopenia all the way up to an 80-year-old woman with significant osteoporosis-- so certainly those two demographics are not going to have the same exercise program. So basically, when people come in, I start off with a thorough assessment of looking at their foundational strength, body awareness, alignment, muscle flexibility, because that determines what that good baseline is for them. We want to find exercises that challenge someone. But we want to find that fine balance, where it's not too easy and not too hard. Specifically with strength training, there are some movements we need to be careful with in this population. And that mainly involves some spinal flexion, potentially some rotation or side-bending. And then for the hips, some of the precautions are more with significant internal or external rotation. But again, those precautions look different for everyone, depending on their T-score and a variety of other factors. So again, it's kind of finding that fine line of we want to be safe and avoid fracture, but we don't want to restrict so much movement that then we develop joint stiffness and eventually chronic pain down the road. KURT KENNEL: When I think of flexion, I think of things like yoga, which sometimes seems like a great exercise-- balanced, posture, maybe-- but then again, maybe not always safe for patients with osteoporosis? ALYNN DUKART: Exactly. You really hit the nail on the head. So there's pros and cons to yoga and Pilates. And so it really is an individualized approach. So when I meet with people, if yoga and Pilates is something that they're interested in continuing to participate in then basically what we do is we practice a lot of the moves. And we see if they're able to safely modify them. There's some moves that we are just going to flat-out avoid. But the majority of them, it's just modifying. And then there's a select few moves that are actually really beneficial for bone density and balance. And then we really kind of emphasize those, saying these are the ones that are actually really, really good for you to do. So again, pros and cons in weighing that individual. KURT KENNEL: So the key thing I hear here, again, is an individualized approach. And it sounds like the sort of thing you can't really accomplish in a two-minute office visit. ALYNN DUKART: (LAUGHING) Yes. KURT KENNEL: How does my patient get involved? How does my patient have the opportunity to learn this path? ALYNN DUKART: Yeah, so at the Mayo Clinic healthy living program, we have two different offerings. We have a 45-minute private session and a 90-minute private session. So it depends on how in-depth someone wants to go with this. But that's why we have those two different offerings. And what that entails is a thorough assessment to start with. And then a lot of it is talking through and practicing some of these movement precautions to prevent fracture, but then really spending the majority of the time talking about all the good things that they can do for bone density and practicing those bone beneficial exercises. And they can just call our program. So again, it's Mayo Clinic Healthy Living Program. They can call our number. It's open to anyone and everyone. And it's just something that I really enjoy doing. And it's so great to see these patients leave with confidence, because I'm sure you know, there's a lot of fear in this realm of-- KURT KENNEL: Absolutely ALYNN DUKART: --I want to do something, but I don't want to hurt myself. So where's that balance? KURT KENNEL: Absolutely. Absolutely. Well, this has been very informative, Alynn. Thank you very much. I appreciate your expertise and the offerings that you have for our patients with osteoporosis. ALYNN DUKART: Well, thanks so much for having me. It's great to chat about this. [MUSIC PLAYING]