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Using a gym – for young people with bone fragility conditions

This resource is written as an advice for teachers and gym instructors working with young people who have expressed an interest in attending a gym and have been diagnosed with a condition which affects the strength of their bones, such as osteogenesis imperfecta (brittle bone disease), osteoporosis or other rare bone conditions.

The NHS advises us that young people age 5 to 18 should partake in at least 60 minutes of physical activity per day with a range of moderate and vigorous activities.

As with anyone, exercise alongside a healthy diet is important for general health and the prevention of cardiovascular disease and type 2 diabetes. It is also fun, sociable and great for boosting mental health and self-confidence.

Common exercise worries when bones are fragile

Potential to break bones

Someone’s main concern might be their increased risk of breaking a bone and the time after spent in pain with reduced movement. But doing exercise is still important, as exercise and physical activity improves bone health.

Bones are more likely to break when they are under unusual stresses and strains such as twisting, the impact from a fall or from repetitive minor traumas (stress fractures). In some people with more fragile bones, breaks can happen from little or no obvious cause. It is possible for any bone to be fractured, including the individual bones of the spine known as the vertebrae. The main part of the vertebrae can be damaged if there is excessive force put through them such as landing from a height or directly onto the bottom, as may happen in ice-skating.

Joints

Often, people with bone fragility conditions can be ‘double jointed’ (hypermobile joints) which means they may get tired quickly, have reduced balance skills or find control of movements more tricky. Less often, joints are less mobile than they should be or do not move in the correct direction, perhaps when affected by an old fracture.

Short stature

Depending on the bone condition, a person may be shorter than average height or have different proportions, for example, limbs which are shorter than expected or a short sitting height. This requires the equipment to be adjusted accordingly or for the person to use free weights rather than static weight machines.

Fear

It might be daunting starting or returning to exercise after a fracture. Taking more care in the gym and advancing more slowly will help. With time, they will grow in confidence and get to their goals eventually – it can help to have smaller, more achievable goals.

Consider how busy the gym might be as some might feel vulnerable to being knocked and an accident happening. Make sure they can go to the gym during quieter times or select more sensible kids to attend if in schools. You could also try one-to-one support which may be useful to begin with.

Before advising a gym programme consider

  1. The degree of fragility or severity of the bone condition and check the programme is suitable with a physiotherapist or consultant familiar with the person.
  2. The goals of the person. For example, weight loss, general strengthening or specific strengthening.
  3. The height, sitting height and leg or arm length of the person. Make sure all equipment is adjusted appropriately, it might not be possible to achieve a good fit.
  4. If the equipment does not fit, ask: What are the alternatives? Are modified machines available? Can the exercise be replicated using free movement?
  5. The person’s specific bone deformities or problem areas.

Designing an exercise programme

Before using the gym, it is important to have an introduction to the gym and demonstration of how to use each piece of equipment. Gaining confidence is important and an instructor or teacher should be available for questions, reminders and tips. You could also advise the use of a personal trainer to begin with. Usually a person is aware of their limits and understands how their body can exercise, however people new to exercise may need more guidance.

Cardiovascular machines

With all equipment, make sure the person can enter and exit safely. It is possible they are quite nervous and you may need to reassure them about how to control and stop the machine.

Begin the cardiovascular exercise with lower resistance, increasing to the desired intensity as confidence grows. A very low resistance may feel hard to control or to stop, so make sure the machine is not too easy or fast. For example, pedals may hit the back of their legs if a foot slips off.

Encourage your usual gym safety advice and make a risk assessment of each piece of equipment.

Weights

Free weights are usually preferable to the use of weight machines. Weight machines should not be used unless it fits the person correctly as this may place unusual forces on the bone. Before using a weight machine, make sure that the joints used in the exercise are able to move through an appropriate range of motion and direction of movement for the machine to function. If a joint can’t move correctly then the bone maybe at risk of injury.

The amount of weight selected needs to be chosen according to the person’s strength and ability. Start lighter and concentrate on good technique.

Body control

Mat exercises such as body control and core strengthening are ideal.

A person may be challenged by deformity in one or more limbs and may need to consider an alternative way of doing something. You could incorporate daily movements, such as stepping up and down, or balancing on one leg. They may need hand support to offer more safety such as a rail or bar.

Spine care

All exercises should be performed in a good postural form.

Rowing machine

Don't
  • Do not over bend or flex the spine as this places excess force on the vertebrae.
Do
  • Ensure correct posture and teach the use of arm or leg strength.
  • Keep the resistance appropriate to ensure good posture.

Abdominal work

Do
  • During sit-ups, crunches and similar exercises, make sure the spine is not excessively flexed in effort.
  • Try to make sure a good technique is used throughout.
  • Use assistive devices if the person’s spine is weak or try alternative core strengthening type exercise.

Top tip

Information:

Always contact a physiotherapist if you are in any doubt regarding an exercise’s suitability.

The information in this resource has been provided by experienced physiotherapists working in this field. There is very little evidence available in the literature to support this information. Further research is required to understand the effects of exercise on young people with bone fragility conditions.

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Disclaimer

Please note: this is a generic information sheet relating to care at Sheffield Children’s NHS FT. These details may not reflect treatment at other hospitals. This information is not intended as a substitute for professional medical care. Always follow your healthcare professionals’ instructions. If this resource relates to medicines, please read it alongside the medicine manufacturer’s patient information leaflet. If this information has been translated into another language from English, efforts have been made to maintain accuracy, but there may still be some translation errors. If you are unsure about any of the guidance in this resource or have specific questions about how it relates to your child, always ask your healthcare professional for further advice.

Resource number: MBD10

Resource Type: Article

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