Introduction

There are only a few instances when resistance exercises are contraindicated. Resistance training is most often contraindicated during periods of acute inflammation and with some acute diseases and disorders. By carefully selecting the appropriate mode of exercise (static vs. dynamic; weight-bearing vs. non-weight-bearing) and keeping the initial intensity of the exercise at a very low to moderate level, adverse effects from resistance training can be avoided.

Precautions to Reduce the Risk of Pathological Fracture During Exercise

• Avoid high-intensity (high-load), high-volume weight training. Depending on the severity of osteoporosis, begin weight training at low intensities; initially, perform only one set of several exercises and keep the intensity low for the first 6 to 8 weeks.

• Progress intensity and volume (repetitions) gradually; eventually work up to three or four sets of each exercise at moderate levels of intensity, if appropriate.

• Avoid high-impact activities such as jumping or hopping. Perform most strengthening exercises in weight-bearing postures that involve low impact to no impact, such as lunges or step-ups/step-downs against additional resistance (hand-held weights, a weighted vest, or elastic resistance).

• Avoid high-velocity movements of the spine or extremities.

• Avoid trunk flexion with rotation and end-range resisted flexion of the spine that could place excessive loading on the anterior portion of the vertebrae, potentially resulting in anterior compression fracture, wedging of the vertebral body, and loss of height.

• Avoid lower extremity weight-bearing activities that involve torsional movements of the hips, particularly if there is evidence of osteoporosis of the proximal femur.

• To avoid loss of balance or falling during lower extremity exercises while standing, have the patient hold onto a stable surface such as a countertop for balance. If the patient is at high risk for falling or has a history of falls, perform exercises in a chair to provide weight bearing through the spine.

• In group exercise classes keep participant/instructor ratios low; for patients at high risk for falling or with a history of previous fracture, consider direct supervision on a one-to-one basis from another trained person.

Pain

If a patient experiences severe joint or muscle pain during active-free (unresisted) movements, dynamic resistance exercises should not be initiated. During testing, if a patient experiences acute muscle pain during a resisted isometric contraction, resistance exercises (static or dynamic) should not be initiated. If a patient experiences pain that cannot be eliminated by reducing the resistance, the exercise should be stopped.

Inflammation

Dynamic and static resistance training is absolutely contraindicated in the presence of inflammatory neuromuscular disease. For example, in patients with acute anterior horn cell disease (Guillain-Barre) or inflammatory muscle disease (polymyositis, dermatomyositis) resistance exercises may actually cause irreversible deterioration of strength as the result of damage to muscle. Dynamic resistance exercises are contraindicated in the presence of acute inflammation of a joint. The use of dynamic resisted exercise can irritate the joint and cause more inflammation. Gentle setting (static) exercises against negligible resistance are appropriate.

Severe Cardiopulmonary Disease

Severe cardiac or respiratory diseases or disorders associated with acute symptoms contraindicate resistance training. For example, patients with severe coronary artery disease, carditis, or cardiac myopathy should not participate in vigorous physical activities, including a resistance training program. Resistance training should be postponed for up to 12 weeks after myocardial infarction or coronary artery bypass graft surgery or until the patient has clearance from a physician.

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