Физическая реабилитация пациентов с остеопорозом

Закрыть метаданные

Остеопороз — одно из наиболее распространенных заболеваний, которое наряду с сердечно-сосудистой патологией, сахарным диабетом и онкологическими болезнями занимает ведущее место в структуре заболеваемости и смертности населения. Сочетание фармакологических и нефармакологических мероприятий является основополагающим для лечения и профилактики остеопении и остеопороза. В статье представлены реабилитационные мероприятия, которые имеют большое значение для улучшения функционирования опорно-двигательного аппарата, качества жизни пациентов с остеопорозом. Физическая реабилитация направлена на приостановление разрушения костной ткани, ее укрепление, устранение болевого синдрома, снижение напряжения с пораженных участков и восстановление нормальной функции суставов и костей. Предложенные виды физической активности способствуют не только повышению прочности костной ткани и укреплению мышечной массы, но и уменьшают риск падения — ведущую причину остепоротических переломов. Программы физических упражнений, разработанные для пациентов с остеопорозом, должны включать силовые и нагрузочные упражнения, а также упражнения на гибкость, коррекцию осанки, координацию движений и равновесие. Тренировки должны быть регулярными, разнообразными и определенной длительности. В статье рассмотрены преимущества и недостатки каждого вида активности.

Ключевые слова:

остеопороз

остеопоротические переломы

реабилитация

упражнения

баланс

Авторы:

Егудина Е.Д.

ГУ «Днепропетровская медицинская академия» МОЗ Украины, Днепр, Украина

Калашникова О.С.

ГУ «Днепропетровская медицинская академия» МОЗ Украины, Днепр, Украина

Список литературы:

Roserveare D. World Congress on Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (WCO-IOF-ESCEO 2018) Osteoporosis Int. 2018;29(1):149-565. https://doi.org/10.1007/s00198-018-4465-1
Sözen T, Özışık L, Çalık Başaran N. An overview and management of osteoporosis. Eur J Rheumatol. 2017;4(1):46-56. https://doi.org/10.5152/eurjrheum.2016.048
Ballane G, Cauley JA, Luckey MM, El-Hajj Fuleihan G. Worldwide prevalence and incidence of osteoporotic vertebral fractures. Osteoporos Int. 2017;28(5):1531-1542. https://doi.org/10.1007/s00198-017-3909-3
Looker AC, Sarafrazi Isfahani N, Fan B, Shepherd JA. Trends in osteoporosis and low bone mass in older US adults, 2005—2006 through 2013—2014. Osteoporos Int. 2017;28(6):1979-1988. https://doi.org/10.1007/s00198-017-3996-1
Hernlund E, Svedbom A, Ivergård M, Compston J, Cooper C, Stenmark J, McCloskey EV, Jönsson B, Kanis JA. Osteoporosis in the European Union: medical management, epidemiology and economic burden. A report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch Osteoporos. 2013;8(1-2):136. https://doi.org/10.1007/s11657-013-0136-1
Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, Martin FC, Michel JP, Rolland Y, Schneider SM, Topinková E, Vandewoude M, Zamboni M; European Working Group on Sarcopenia in Older People. Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on sarcopenia in older people. Age Ageing. 2010;39(4):412-423. https://doi.org/10.1093/ageing/afq034
Reginster JV, Beaudart C, Buckinx F, Bruyère O. Osteoporosis and sarcopenia: two diseases or one? Curr Opin Clin Nutr Metab Care. 2016;19(1):31-36. https://doi.org/10.1097/MCO.0000000000000230
Лесняк О.М. Остеопороз. Руководство для врачей. М.: ГЭОТАР-Медиа; 2016.
Schousboe JT. Epidemiology of Vertebral Fractures. J Clin Densitom. 2016;19(1):8-22. https://doi.org/10.1016/j.jocd.2015.08.004
Griffith JF. Identifying osteoporotic vertebral fracture. Quant Imaging Med Surg. 2015;5(4):592-602. https://doi.org/10.3978/j.issn.2223-4292.2015.08.01
Akkawi I, Zmerly H. Osteoporosis: Current Concepts. Joints. 2018;6(2):122-127. https://doi.org/10.1055/s-0038-1660790
Kanis JA, Harvey NC, Johansson H, Odén A, Leslie WD, McCloskey EV. FRAX Update. J Clin Densitom. 2017;20(3):360-367. https://doi.org/10.1016/j.jocd.2017.06.022
Cosman F, de Beur SJ, LeBoff MS, Lewiecki EM, Tanner B, Randall S, Lindsay R; National Osteoporosis Foundation. Clinician’s Guide to Prevention and Treatment of Osteoporosis. Osteoporosis Int. 2014;25(10):2359-2381. https://doi.org/10.1007/s00198-014-2794-2
Adler RA, El-Hajj Fuleihan G, Bauer DC, Camacho PM, Clarke BL, Clines GA, Compston JE, Drake MT, Edwards BJ, Favus MJ, Greenspan SL, McKinney R Jr, Pignolo RJ, Sellmeyer DE. Managing Osteoporosis Patients after Long-Term Bisphosphonate Treatment: Report of a Task Force of the American Society for Bone and Mineral Research. J Bone Miner Res. 2016;31(1):16-35. https://doi.org/10.1002/jbmr.2708
Resnick B, Nahm ES, Zhu S, Brown C, An M, Park B, Brown J. The Impact of Osteoporosis, Falls, Fear of Falling and Efficacy Expectations on Exercise Among Community Dwelling Older Adults. Orthop Nurs. 2014;33(5):277-286. https://doi.org/10.1097/NOR.0000000000000084
Castronuovo E, Pezzotti P, Franzo A, Di Lallo D, Guasticchi G. Early and late mortality in elderly patients after hip fracture: a cohort study using administrative health databases in the Lazio region, Italy. BMC Geriatr. 2011;11:37. https://doi.org/10.1186/1471-2318-11-37
Nazrun AS, Tzar MN, Mokhtar SA, Mohamed IN. A systematic review of the outcomes of osteoporotic fracture patients after hospital discharge: morbidity, subsequent fractures, and mortality. Ther Clin Risk Manag. 2014;10:937-948. https://doi.org/10.2147/TCRM.S72456
Granito RN, Aveiro MC, Renno AC, Oishi J, Driusso P. Comparison of thoracic kyphosis degree, trunk muscle strength and joint position sense among healthy and osteoporotic elderly women: a cross-sectional preliminary study. Arch Gerontol Geriatr. 2012;54:199-202. https://doi.org/10.1016/j.archger.2011.05.012
Krause KE, McIntosh EI, Vallis LA. Sarcopenia and predictors of the fat free mass index in community-dwelling and assisted- living older men and women. Gait Posture. 2011;35:180-185. https://doi.org/10.1016/j.gaitpost.2011.09.003
Radaei F, Gharibzadeh S. Relationship between Bone Mineral Density and Balance Disorders in Osteoporotic Patients. Front Bioeng Biotechnol. 2013;1:5. https://doi.org/10.3389/fbioe.2013.00005
Hsu WL, Chen C-Y, Tsauo J-Y, Yang R-S. Balance control in elderly people with osteoporosis. J Formos Med Assoc. 2014;113(6):334-339. https://doi.org/10.1016/j.jfma.2014.02.006
Bennell KL, Matthews B, Greig A, Briggs A, Kelly A, Sherburn M, Larsen J, Wark J. Effects of an exercise and manual therapy program on physical impairments, function and quality-of-life in people with osteoporotic vertebral fracture: a randomised, single-blind controlled pilot trial. BMC Musculoskelet Disord. 2010;11:36. https://doi.org/10.1186/1471-2474-11-36
Huntoon EA, Schmidt CK, Sinaki M. Significantly fewer refractures after vertebroplasty in patients who engage in back-extensor-strengthening exercises. Mayo Clin Proc. 2008;83(1):54-57. https://doi.org/10.4065/83.1.54
Wong CC, McGirt MJ. Vertebral compression fractures: a review of current management and multimodal therapy. J Multidiscip Health. 2013;6:205-214. https://doi.org/10.2147/JMDH.S31659
Garber CE, Blissmer B, Deschenes MR, Franklin BA, Lamonte MJ, Lee IM, Nieman DC, Swain DP; American College of Sports Medicine. American College of Sports Medicine. American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc. 2011;43(7):1334-1359. https://doi.org/10.1249/MSS.0b013e318213fefb
Li WC, Chen YC, Yang RS, Kuo KN, Chen CY, Tsauo JY. Taiwanese chinese translation and validation of the quality of life questionnaire of the european foundation for osteoporosis 31 (qualeffo-31) J Formos Med Assoc. 2013;112(10):621-629. https://doi.org/10.1016/j.jfma.2012.09.015
Bergland A, Thorsen H, Karesen R. Effect of exercise on mobility, balance, and health-related quality of life in osteoporotic women with a history of vertebral fracture: a randomized, controlled trial. Osteoporos Int. 2011;22(6):1863-1871. https://doi.org/10.1007/s00198-010-1435-7
Kemmler W, Kohl M, von Stengel S. Long-term effects of exercise in postmenopausal women: 16-year results of the Erlangen Fitness and Osteoporosis Prevention Study (EFOPS). Menopause. 2017;24(1):45-51. https://doi.org/10.1097/GME.0000000000000720
Hong AR, Kim SW. Effects of Resistance Exercise on Bone Health. Endocrinol Metab (Seoul). 2018;33(4):435-444. https://doi.org/10.3803/EnM.2018.33.4.435
Burke TN, Franca FJ, Meneses SR, Pereira RM, Marques AP. Postural control in elderly women with osteoporosis: comparison of balance, strengthening and stretching exercises. A randomized controlled trial. Clin Rehabil. 2012;26(11):1021-1031. https://doi.org/10.1177/0269215512442204
Farmer ME, Harris T, Madans JH, Wallace RB, Cornoni-Huntley J, White LR. Anthropometric indicators and hip fracture. The NHANES I epidemiologic follow-up study. J Am Geriatr Soc. 1989;37:9-16.
Hamilton CJ, Swan VJ, Jamal SA. The effects of exercise and physical activity participation on bone mass and geometry in postmenopausal women: a systematic review of pQCT studies. Osteoporos Int. 2010;21:11-23. https://doi.org/10.1007/s00198-009-0967-1
Pucher J, Buehler R, Bassett D, Dannenberg A. Walking and Cycling to Health: A Comparative Analysis of City, State, and International Data. Am J Public Health. 2010;100(10):1986-1992. https://doi.org/10.2105/AJPH.2009.189324
Dionyssiotis Y, Paspati I, Trovas G, Galanos A, Lyritis GP. Association of physical exercise and calcium intake with bone mass measured by quantitative ultrasound. BMC Womens Health. 2010;7(10):12. https://doi.org/10.1186/1472-6874-10-12
Muir J, Ye C, Bhandari M, Adachi JD, Thabane L. The effect of regular physical activity on bone mineraldensity in post-menopausal women aged 75 and over: a retrospective analysis from the Canadian multicentre osteoporosis study. BMC Musculoskelet Disord. 2013;14:253. https://doi.org/10.1186/1471-2474-14-253
Wilhelm M, Roskovensky G, Emery K, Manno C, Valek K, Cook C. Effect of Resistance Exercises on Function in Older Adults with Osteoporosis or Osteopenia: A Systematic Review. Physiother Can. 2012;64(4):386-394. https://doi.org/10.3138/ptc.2011-31BH
Hongo M, Itoi E, Sinaki M, Miyakoshi N, Shimada Y, Maekawa S, Okada K, Mizutani Y. Effect of low-intensity back exercise on quality of life and back extensor strength in patients with osteoporosis: a randomized controlled trial. Osteoporos Int. 2007;18(10):1389-1395. https://doi.org/10.1007/s00198-007-0398-9
Senderovich H, Kosmopoulos A. An Insight into the Effect of Exercises on the Prevention of Osteoporosis and Associated Fractures in High-risk Individuals. Rambam Maimonides Med J. 2018;9(1):e0005. https://doi.org/10.5041/RMMJ.10325
Stengel SV, Kemmler W, Pintag R. Power training is more effective than strength training for maintaining bone mineral density in postmenopausal women. J Appl Physiol. 2005;99(1):181-188. https://doi.org/10.1152/japplphysiol.01260.2004
Shanb AA, Youssef EF. The impact of adding weight-bearing exercise versus nonweight bearing programs to the medical treatment of elderly patients with osteoporosis. J Family Community Med. 2014;21(3):176-181. https://doi.org/10.4103/2230-8229.142972
Skerry TM, Lanyon LE. Systemic and contralateral responses to loading of bones. J Bone Miner Res. 2009;24(4):753. https://doi.org/10.1002/jbmr.101
Lirani-Galvão AP, Lazaretti-Castro M. Physical approach for prevention and treatment of osteoporosis. Arq Bras Endocrinol Metabol. 2010;54(2):171-178.
Benedetti MG, Furlini G, Zati A, Mauro GL. The Effectiveness of Physical Exercise on Bone Density in Osteoporotic Patients. Biomed Res Int. 2018;4840531. https://doi.org/10.1155/2018/4840531
Liu-Ambrose TY, Khan KM, Eng JJ, Heinonen A, McKay HA. Both resistance and agility training increase cortical bone density in 75- to 85-year-old women with low bone mass: a 6-month randomized controlled trial. J Clin Densitom. 2004;7:390-398.
Marques EA, Mota J, Carvalho J. Exercise effects on bone mineral density in older adults: a meta-analysis of randomized controlled trials. Age (Dordr). 2012;34(6):1493-1515. https://doi.org/10.1007/s11357-011-9311-8
Martyn-St James M, Carroll S. Meta-analysis of walking for preservation of bone mineral density in postmenopausal women. Bone. 2008;43:521-531. https://doi.org/10.1016/j.bone.2008.05.012
Muir J, Ye C, Bhandari M, Adachi JD, Thabane L.. The effect of regular physical activity on bone mineraldensity in post-menopausal women aged 75 and over: a retrospective analysis from the Canadian multicentre osteoporosis study. BMC Musculoskelet Disord. 2013;14:253. https://doi.org/10.1186/1471-2474-14-253
Dionyssiotis Y. Exercise in Osteoporosis and Falls Prevention. Athens: Monography (in Greek) published for Hellenic Institution of Osteoporosis (HELIOS) Hylonome Editions; 2008.
Horlings CG, Kung UM, van Engelen BG, Voermans NC, Hengstman GJ, van der Kooi AJ, Bloem BR, Allum JH. Balance control in patients with distal versus proximal muscle weakness. Neuroscience. 2009;164(4):1876-1886. https://doi.org/10.1016/j.neuroscience.2009.09.063
Madureira MM, Takayama L, Gallinaro AL, Caparbo VF, Costa RA, Pereira RM. Balance training program is highly effective in improving functional status and reducing the risk of falls in elderly women with osteoporosis: a randomized controlled trial. Osteoporos Int. 2007;18(4):419-425. https://doi.org/10.1007/s00198-006-0252-5
Mu WQ, Huang XY, Zhang J. Effect of Tai Chi for the prevention or treatment of osteoporosis in elderly adults: protocol for a systematic review and meta-analysis. BMJ Open. 2018;8(4):e020123. https://doi.org/10.1136/bmjopen-2017-020123
Zou L, Wang C, Chen K, Shu Y, Chen X, Luo L, Zhao X. The Effect of Tai Chi Practice on Attenuating Bone Mineral Density Loss: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Int J Environ Res Public Health. 2017;14(9):1000. https://doi.org/10.3390/ijerph14091000
Huntoon EA, Schmidt CK, Sinaki M. Significantly fewer refractures after vertebroplasty in patients who engage in back-extensor-strengthening exercises. Mayo Clin Proc. 2008;83(1):54-57. https://doi.org/10.4065/83.1.54
Sinaki M. Yoga spinal flexion positions and vertebral compression fracture in osteopenia or osteoporosis of spine: case series. Pain Pract. 2013;13(1):68-75. https://doi.org/10.1111/j.1533-2500.2012.00545.x
Jepsen DB, Thomsen K, Hansen S, Jørgensen NR, Masud T, Ryg J. Effect of whole-body vibration exercise in preventing falls and fractures: a systematic review and meta-analysis. BMJ Open. 2017;29:7(12):e018342. https://doi.org/10.1136/bmjopen-2017-018342
Ma C, Liu A, Sun M, Zhu H, Wu H. Effect of whole-body vibration on reduction of bone loss and fall prevention in postmenopausal women: a meta-analysis and systematic review. J Orthop Surg Res. 2016;17(11):24. https://doi.org/10.1186/s13018-016-0357-2
Rauch F, Sievanen H, Boonen S, Cardinale M, Degens H, Felsenberg D, Roth J, Schoenau E, Verschueren S, Rittweger J; International Society of Musculoskeletal and Neuronal Interactions. Reporting whole-body vibration intervention studies: recommendations of the International Society of Musculoskeletal and Neuronal Interactions. J Musculoskelet Neuronal Interact. 2010;10:193-198.

Закрыть метаданные