There are many factors that are often overlooked when developing an exercise plan, yet they are no less important. These include (Moreira et al., 2017):
-Wearing tight fitting shoes.
-Wearing shoes with a grippy sole.
-Warming up prior to exercise.
-Maintaining the correct posture during each exercise to prevent fracture and muscle strain.
-If undertaking exercises that improve proprioception (such as a wobble board) the patient should stand next to a wall to prevent a fall.
As abdominal muscles are used in the maintenance of good posture, daily activities and normal spine function, it is important to keep them well toned. One of the main actions of the abdominal muscles is spinal flexion, however this presents a problem. Nachemson (2006) found that spinal flexion exercises creates the most loading through the vertebral bodies of all the body positions. Sinaki and Mikkelsen (1984) found that, when assessing a group of osteoporotic women, after 2 years of performing spinal flexion exercises, 89% of them presented with vertebral fractures. Useful alternative exercises are as follows (Moreira et al., 2017):
-Isometric contractions with a physiological alignment of the spine (without a Valsalva manoeuvre).
-Hip flexion in a supine position.
-Hip anteversion and retroversion.
Another precaution is to avoid placing 100% trust in the results of a DEXA scan. The effects of corticosteroids must be considered here. Whilst the results of a DEXA scan may show normal values for a person's bone mass, the bones may still be of poor quality and fragile (Buehring et al., 2013). Fractures in those using oral corticosteroids occur at a higher rate than those with involuntary osteoporosis (Van Staa et al., 2007). Therefore it is important to consider other factors when considering a person's bone health such as (Taylor., 2004):
-Previous fracture rate and cause
-Vitamin D intake
Moreira, M.D.F, Oliveria, M.L., Lirani-Galvto, A.P., Marin-Mio, R.V., Santos, R.N., Lazarett-Castro, M. 2014. Physical exercise and osteoporosis: effects of different types of exercises on bone and physical function of postmenopausal women. Arquivos Brasileiros de Endocrinologia & Metabologia. 58(5). [viewed 23 October 2017]. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0004-27302014000500514#B12
Nachemson AMD. The load on lumbar disks in different positions of the body. Clin Orthop Relat Res. 1966;45:107-12.
Sinaki M, Mikkelsen BA. Postmenopausal spinal osteoporosis: flexion versus extension exercises. Arch Phys Med Rehabil. 1984;65(10):593-6.
Buehring B, Viswanathan R, Binkley N, Busse W. Glucocorticoid-induced osteoporosis: an update on effects and management. J Allergy Clin Immunol. 2013;132(5):1019-30.
Van Staa TP, Geusens P, Zhang B, Leufkens HG, Boonen A, Cooper C. Individual fracture risk and the cost-effectiveness of bisphosphonates in patients using oral glucocorticoids. Rheumatology (Oxford). 2007;46(3):460-6.
Taylor BC, Schreiner PJ, Stone KL, Fink HA, Cummings SR, Nevitt MC, et al. Long-term prediction of incident hip fracture risk in elderly white women: study of osteoporotic fractures. J. Am Geriatr Soc. 2004;52(9):1479-86.