Healing Through Exercise: Scientifically Proven Ways to Prevent and Overcome Illness and Lengthen Your Life (11 page)

Drugs for osteoporosis have been shown to have no noteworthy clinical effect. The blockbuster is a substance called Alendronate, with annual sales of about $3 billion. The product’s molecules migrate into the bone tissue and raise its density. In one study, women with an average age of 68 took the drug for four years, and the risk of hip fractures was allegedly reduced by 56 percent.
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Yet the American physician and author John Abramson took a closer look at the study; he was curious about what this number actually meant.
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How many fractures of the hip were actually averted? The older participants who did not take the drug had a 99.5 percent chance of living one year without a hip fracture (among 1000 women, 995 would stay healthy). Among the women who actually took the drug, that chance was 99.8 percent (among 1000 women, 998 would stay healthy). In other words, the daily consumption of the drug changed the risk for a fracture from 0.5 to 0.2 percent. In the study, this modest result was boasted as a relative risk reduction of 56 percent.

Translated into real life, the drug’s benefit looks like this: 81 women with low bone density must take the drug for 4.2 years (at a total cost of $300,000) in order to avoid
one
hip fracture.
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Not only is this effect dearly paid for, there are also indications that it vanishes with time anyway. While a ten-year trial with the substance showed that the value of the bone density was increased, there was no proof that the risk of fractures had gone down—although that was the reason for this pharmacological intervention.
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But if the drug increases bone density, why is it not preventing fractures? Alendronate may increase bone density, but the bone density is, at best, only an indirect indicator of stability. The basic method for measuring the bone density, densitometry, targets the surface of the bone (the cortical bone). However, it is the inner structure (the trabecular bone) that mainly determines the stability of the big bones. Unfortunately, substances like Alendronate have a much greater effect on cortical bones than on trabecular bones. Thus, the pharmacological effect increases the reading for the bone density—yet the stability of the bones is not considerably increased.

In reality, there are other factors that influence the risk of fracture to a much greater extent. More important, for example, are the motor functions of older people and their ability to walk safely. Ninety-five to 98 percent of all fractures among older people occur because of a fall. In fact, it might be more suitable to talk about a “falling-down disease” rather than osteoporosis. Other key factors are the mass of the bone and its geometrical shape. In the United States, one out of three adults 65 years old or older falls each year, with hip fractures resulting in the greatest number of related deaths and serious health problems. Women account for 80 percent of the 300,000 hip fractures that occur annually.

In contrast to the bone density (which is weight per volume), the absolute bone mass indicates how much bone substance a human actually has. The bone mass peaks in young adulthood, and thereafter declines with age. In rare cases this loss is, for genetic reasons, extremely pronounced and hard to stop. Those affected may become hunchbacks relatively early in life.

Ordinarily, bone density is most determined by an environmental factor: exercise. Whenever we use our muscles, they, by exerting strain, increase the bone mass. Thus, in most cases osteoporosis is not a fateful disorder of bone metabolism but simply the direct result of decades of physical inactivity. And where gynecologists and employees of pharmaceutical companies blame menopausal changes as the cause of osteoporosis, they divert attention from the more important reason for the problem and conceal the most efficient remedy.

The muscular system has been found to determine 80 percent of bone stability. It was the German anatomist and surgeon Julius Wolff (1836-1902) who proposed this in his “law of the bone transformation,” now known as Wolff’s law. This law says that bones in a healthy person will adapt to the strains they are placed under. If loading on a particular bone increases, the bone will remodel itself over time to become stronger.

In the 1960s, the American orthopedist Harold M. Frost expanded this theory by emphasizing that muscles and bones comprise a single physiological unit: He proposed that the body must have specific sensors capable of recognizing mechanical forces and of relaying this information so that the bone grows according to this load. Whereas strain during muscle training triggers the growth of bone tissue, physical inactivity leads to loss of bone tissue.

Eckhard Schönau at the University Hospital in Cologne, Germany, along with colleagues, recently confirmed this hypothesis using CT imaging. The researchers put 349 healthy children and adolescents in CT scanners and determined precisely the composition of their bones and muscles. The data from this high-tech measurement fitted nicely into the old law of muscle transformation, and indeed suggested that the muscular system had determined the makeup of the bones. The sensors that Harold M. Frost had proposed as the reason for this were also discovered: bone cells are connected to each other by dendrites, and the resulting vast network can sense physical strain and adapt to it.
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The process of bone development begins early. An unborn baby, kicking away inside his mother’s womb, gives his bones the mechanical strain needed to grow properly. Children need no advice to run and tumble and play; all that perpetual activity promotes the development of robust and healthy bones.

Neither milk nor calcium pills can substitute for exercise. A normal diet does contain enough calcium, but the body will flush it out swiftly if a person is not in motion. If you want the calcium to become part of your bones, you just have to heed Wolff’s law and start using your muscles.

Actually the situation with osteoporosis drugs is quite similar. They can be beneficial for patients with severe loss of bone substance because they alleviate pain. Yet unless the consumption of the pills is accompanied with physical activity, they cannot compensate for the consequences of letting the body waste away.

Time and again, trials of menopausal women have confirmed that moderate aerobic and strength training make the spine stronger. And in order to reduce hip fractures, walking seems to be the best medicine. A study at Brigham and Women’s Hospital in Boston, which included investigators from the Harvard School of Public Health, showed that women who walked at least four hours per week had approximately 40 percent fewer hip fractures, compared with women who were mostly sedentary. Higher-impact exercise provided greater protection. Exercise equivalent to about three hours of jogging per week reduced the risk of hip fracture by approximately 50 percent. “The news about walking continues to be positive, and our study contributes further evidence that regular physical activity is a woman’s key to prevention of hip fractures,” said Diane Feskanich of Brigham and Women’s. “To reduce risk, women should know that any amount of activity is better than none.”
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A team of researchers at the University of Freiburg, Germany, were curious whether they could make frail people more sure-footed again and tested this idea with a specific exercise for balance and agility.
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Twenty volunteers from ages 60 to 80 practiced standing on one foot as they walked over wobbly planks and balanced on a rope on the floor. In their childhoods, these individuals would have laughed about how easy these tasks were—but now, after decades of nonuse of their bodies, they had to relearn these movements from scratch. At the end of the trial, the balance of participants was tested with clever tricks. They stood on a mat that would suddenly be pulled to one side and ran on a treadmill that was suddenly stopped. In comparison to those who had remained sedentary controls, the rate of tripping and losing balance was significantly reduced. This regained control over the motor skills is a good protection against falls.
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A survey in the United States compared the effectiveness of exercise with that of osteoporosis drugs. The study included 10,000 women over 65 and followed them for five years. The analysis of the data revealed that women who had trained for at least two hours per week had 36 percent fewer hip fractures than sedentary women, according to the journal
Annals of Internal Medicine
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In the course of one year, there were six fewer fractures per 1,000 women among the active group of women than among the inactive ones. This effect is actually twice as big as the one reported in the aforementioned study on Alendronate.

The only effective way to keep bones in good shape is to stay active for life. Research shows it is never too late—getting started at age 80 is better than never. Mobilizing of a body also improves balance and makes one sure-footed, which is very important because falls, as we saw, are the main reason for bone fractures among elderly people. Moderate strength training, for example, is a good way to avoid falls. Tai chi creates awareness and body control, thus also reducing the likelihood of falls in older age.

The trial results discussed here have led to a turning point in orthopedics that would have seemed unthinkable just a short while ago. Physical motion was traditionally believed to be the worst thing one could inflict on an aching joint—until the opposite turned out to be true.

Unfortunately, the new knowledge about the healing power of exercise has not reached all people suffering from aching joints and bones. At the same time, in a sedentary and aging population, the number of muscular-skeletal diseases is increasing to the extent that physicians wonder if treating all the resulting ailments is financially possible. But when orthopedists gathered recently at a conference in Berlin, they agreed on the culprit of all of these maladies, saying that physical inactivity is the number-one public health problem of the third millennium.
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A Sporting Cure for Back Pain

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AMES WEINSTEIN REACHED FORWARD TO LIFT A HEAVY BOX. SUDDENLY, he felt an extraordinary pain shooting through his back. Weinstein, a silver-haired professor, was unable to sit down, but somehow he managed to lie on the floor and rest. When Weinstein tried to get up after a while, it took a tremendous struggle.

Thousands of individuals all over the United States are in a similarly miserable situation at any given moment. From one second to the next, the world is a different place. It’s as if a glowing dagger were prodding the lumbar vertebrae. Happy people turn into creatures of misery.

But Weinstein immediately knew what to do. He is one of the most renowned back specialists in the United States and teaches at Dartmouth Medical School in Hanover, New Hampshire. Weinstein took an anti-inflammatory drug, put ice on the aching spot—and went jogging.
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This approach borders on heresy. People suffering from acute pain are usually asked to rest at least until the pain has markedly abated or completely disappeared. Yet the ailing professor merely heeded the advice he gives patients in his own back-pain program at Dartmouth: Hurt does not mean harm. “In other words, one can have pain and still function.”
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Weinstein is not the only physician to discover that exercise is the key to overcoming lower back pain and triggering the body’s power to heal itself. Increasingly, doctors encourage back-pain patients to stay active and to soldier on with their daily routines.

What a complete turnabout this is! Just a few years ago, people with lower-back pain were prescribed strict bed rest lasting one to two weeks. Afterward, they were ordered to take it easy and to avoid everything that would cause discomfort. However, a few physicians started to rebel against the common wisdom and demanded exactly the opposite. Patients suffering from lower-back pain, they thought, should stay physically active.

The British doctor Gordon Waddell was one of the first to question these contradicting approaches and tried to determine which one was right. He and two of his colleagues carried out a unique survey, analyzing all the scientific papers they could find that studied the effects of either bed rest, or an active recovery, on lower-back pain. It turned out that bed rest led to terrible outcomes. Consequently, Waddell and his colleagues wrote a paper demanding a radical reversal of the traditional bed-rest treatment: “A simple but fundamental change from the traditional prescription of bed rest to positive advice about staying active could improve clinical outcomes and reduce the personal and social impact of back pain.”
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In the wake of this revelation, medical guidelines and official recommendations gradually dropped the principle of complete rest.

Yet in many consultations, these revised recommendations are forgotten. This is particularly worrisome given that the mind-set and advice of a physician profoundly influences the development of an individual sickness. The general practitioner Annette Becker, of the University Hospital in Marburg, Germany, writes, “Thoughtless remarks or putative explanations like ascribing problems to ‘wear and tear,’ recommending rest, or repeated passive measures like massages and giving sick notes to exempt patients from certain obligations trigger, especially among fearful and dramatizing patients, only more worries about their well-being, like: ‘I must be careful with my back, I’ve worked too much in my life, I must think about myself now.’” This type of thinking can lead to a vicious circle. Individuals with chronic back pain stop using their bodies and slide into complete inactivity. Their backs continue to waste away, which triggers new waves of pain.
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