Jeg blev meget overrasket over at opnå så gode resultater på kun 20 minutter om ugen i Concept 10 10.

Jeg er blevet stærkere, fået mere energi og føler mig bedre tilpas.

Jeg har tidligere haft mange rygproblemer og mange smerter. Efter kort tid i Concept 10 10 blev det meget bedre og min ugentlige træning ville jeg meget nødigt undvære.

 

 

Niels Chr. Meyer (BUBBER).

Susan Kniffen started working out at Concept 10 10 in May, not long after she first read about the unique program in è Bella magazine.
“I was interested in the concept of it all,” Susan said.
The former Upstate New York resident decided to visit the North Naples fitness center for a free one-session trial.
“I was very impressed with the whole setup,” Susan said. “I was attracted to the cleanliness. It wasn’t anything like a gym. I don’t like gyms,” she said.
While the first session led to her purchasing more sessions, which never expire and require no contract, she said it took a couple more workouts to see just how beneficial it was.
“For me, working out isn’t a social thing. It’s something I need to accomplish,” Susan said.
“I want to maintain my physique somewhat– no, a lot,” said the 56-year-old.

She knew weight training should have always been a component of her fitness regimen, but until Concept 10 10, that was an area of physical fitness she lacked.
“I would not do this in a gym and that’s the only other place I’d likely be around weight training,” Susan said. Previously, she took swim and aerobic or dance-type exercise classes.
“The time commitment to this is key,” she said of the 20-minute, once-a-week session. “It’s intense, but very brief.”
Muscle tone became visible in fewer than five sessions, with exceptional results now that she’s more than six months into doing Concept 10 10, Susan said.
“My legs, arms, torso, my abs,” she says with her eyes widening. “I haven’t been able to do that as quickly with any other measures,” Susan said.
While big muscles groups are an obvious bonus, Susan says it’s the little things that also improved with Concept 10 10. Listen to Susan’s story on how Concept 10 10 affected her travels and other areas of life here. Susan Kniffen: \”The little things can make a big difference\”

Concept 10 10 can be your business with a franchise or license.
People from around the world would like a Concept 10 10 center in their area. Some of these people want it nearby so they can get a weekly training session. Others want to learn about the possibilities and requirements for starting their own facility by becoming a franchisee or licensee of Concept 10 10.

No specific background is needed to start a Concept 10 10 facility. A franchisee or licensee is chosen based on his or her personality and interest in the concept. All the training and all the tools necessary to start and run the business will then be provided. The training takes place in the Concept 10 10 facility in Naples, Florida.  New franchisees from all over the world will come there to learn and practice.

The cost to start a Concept 10 10 facility can vary, but in general a minimum of $200,000 is needed. More information can be obtained by e-mailing info@concept1010.com.

Heavy hitters: Concept 10 10 gets golfers hitting full-swing

Golf takes practice. It also takes strength. Golfers are learning that by committing to just 20 minutes each week at Concept 10 10 in North Naples they are driving their game skills to new heights. Moreover, they’re doing it in much less time than they’ve spent with even some top-notch golf trainers.

Eli Egozi of North Naples admits that given his time commitments on the golf course, at the driving range and with a golf trainer, it was the idea that he need only commit to 20 minutes a week at Concept 10 10 to gain optimal results in increasing his strength.

“That’s the only thing that brought me here. That’s why I came to try it even if I didn’t believe it at first,” Eli said as he prepared for his fifth session at Concept 10 10 recently.

It took his third training session at Concept 10 10 to make him a believer, he said.

“After the first session, I was still not completely convinced yet,

 

but I said “let’s give it a shot”.

It was precisely the shot he needed.

Eli takes lessons at one of the world’s best golf courses, Tiburon Golf Club in North Naples.  The Rick Smith Golf Academy there is top-rated.

“They always said the next step is to just get stronger.”

That Eli did with Concept 10 10.

“I was hitting an extra five yards here, 10 yards there. I feel… I know, I keep getting better,” Eli said.

The proven results are in the distance shots for Eli. But, the bonus is the decrease in fatigue during each round of golf.

Eli has a free gym to use in his gated community. It’s just not for him– the waiting for machines, other people’s sweat, risking injury and not pushing himself to do more each week the way the one-on-one trainers at Concept 10 10 do.

 

The short, 20-minute duration of the workout does not reflect the challenge, he said.

“Don’t try to play golf the same day you do this,” Eli said. ”Your muscles are just not the same.”

Concept 10 10 licensing: Want to be a part of increasing other people’s game skills?

Learn about the possibilities and requirements for starting a Concept 10 10 by becoming a franchisee or licensee.

No specific background is needed to start a Concept 10 10 facility. A franchisee or licensee is chosen based on his or her personality and interest in the concept.  All the training and all the tools necessary to start and run the business will then be provided.  The training takes place in the Concept 10 10 Naples, Florida location and is done in approximately 10 days.  New franchisees from all over the world will come there to learn and practice.

The cost to start a Concept 10 10 can vary, but in general a minimum of $200,000 is needed. More information can be obtained by e-mailing info@concept1010.com

Working out shouldn’t be a pain in the neck

 

Tracye Zlobl spent too much time in the doctor’s office. Sure, Tracye is a doctor, but still, enough was enough.

Dr. Tracye Zlobl is a 52-year-old OB/GYN practicing in Naples. She has enjoyed physical fitness almost her entire life. That was until earlier this year when neck and upper back pain left her unable to workout as frequently as she would like for nearly six months.

She was spending thousands of dollars and dozens of hours in other clinicians’ offices. Changing her fitness routine from Pilates to Concept 10 10, saved her the hassle of spending all that time and money at the physical therapist’s, chiropractor’s and acupuncturist’s offices.

 

Now, however, Zlobl’s sessions of deep tissue massage are precipitated only by an appreciation for relaxation—not by any literal pain in the neck.

Hear in the doctor’s own words how Concept 10 10 saves Dr. Zlobl time and money by clicking here Dr. Zlobl saves time and money with Concept 10 10.

Zlobl learned about Concept 10 10 from a friend, a woman who is her client and used to do Pilates with her. Almost immediately the lack of impact and contact involved in Concept 10 10 attracted Zlobl. The relatively short time commitment of just 20 minutes each week was also appealing for the busy doctor.

Zlobl started with a free trial. She liked the cleanliness and set up of the fitness club. Her trainer, Peter, was professional and made her feel comfortable.

It was enough to attract her to buy a few more sessions. However, it wasn’t until her third week, or third session, that she was completely sold on it, she said. In total she worked out with Concept less than an hour at that point and saw more muscle tone and experienced more strength gain than at any of the multitude of exercise studios she experimented with over the years.

“Concept 10 10 literally saved me time and money,” she said.

 

See the Video Here

Dr Tracye Zlobl

Getting into the Concept 10 10 business is no pain in the neck either

Inquiries from around the world are coming in from people who would like a Concept 10 10 center in their area. Some of these people want it nearby so they can get a weekly training session. Others want to learn about the possibilities and requirements for starting their own facility by becoming a franchisee or licensee of Concept 10 10.

No specific background is needed to start a Concept 10 10 facility. A franchisee or licensee is chosen based on his or her personality and interest in the concept.  All the training and all the tools necessary to start and run the business will then be provided.  The training takes place in the Concept 10 10 facility in Naples, Florida and is done in approximately 10 days.  New franchisees from all over the world will come there to learn and practice.

The cost to start a Concept 10 10 facility can vary, but in general a minimum of $200,000 is needed. More information can be obtained by e-mailing info@concept1010.com

Vert Mooney, M.D., San Diego
Professor of Orthopaedics UCSD, Medical Director Orthomed Center, San Diego

 

It is now recognized that chronicity of musculoskeletal pain is associated with inhibited motor function and a phenomenon called „deconditioning“. Under these conditions reoccurrence of pain inducing episodes with the usual life event of the „unguarded moment“ can be expected. Significant sudden changes in physical demands, either increased or decreased, are often associated with this phenomenon.

 

Physical therapy in the form of manual therapy and surface supplied modalities to decrease pain, often offer short-term relief. There is no documentation, however, that these forms of treatment to change the natural course of disease and recurrence. There is no consensus even as to the most effective pain diminishing physical therapy modality. One reason for the lack of consensus is our inability to measure the dose of the therapeutic modality, and objectively measure the results of treatment. On the other hand, resistance training is measurable and the results of training, aside from the subjective statement of diminished pain, are likewise measurable by strength and endurance testing. The use of equipment, however, is necessary to achieve measurement.
In our own studies, recurrence of pain complaint after completion of a strength training program on chronic back pain patients, all which had failed previous physical therapy, was 10 %. This is at 1-year follow-up. Other studies using more passive therapies quote recurrence rates of up to 50%.

 

The future of this form of treatment, Le. physical training, depends upon transfer of care responsibility to the patient away from the „healer“. This is not easy to accomplish and the duration of training necessary to have the desired insurance. The feasible solution for this dilemma is the medicalization of health clubs. In this environment, musculoskeletal disorders are treated as ailments not diseases, and physical therapy becomes physical training supervised by qualifield staff who are comfortable with treatment of musculoskeletal disorders ideally such facilities would have the back up of appropriate medical professionals. Nonetheless, the treatment theme will have to be the pleasure of self-care in a supportive environment of training. A key component of training must be however, feedback of measured performance which requires appropriately designed equipment.

Vert Mooney, M.D, San Diego
Professor of Orthopaedics UCSD, Medical Director Orthomed Center, San Diego

 

This study compared lumbar extension strength between healthy asymptomatic geriatric females and symptomatic females of about the same age seeking medical attention for chronic low back pain. The mean age was 68.3 years. The symptomatic group used MedX lumbar extension machines to preform isotonic exercises two times per week at first and later, once a week. There was an average of 20 visits with an average length of treatment of 97 days.

 

Range of motion and strength were significantly different between the symptomatic and asymptomatic groups. The asymptomatic group was tested in the same manner as the symptomatic group and at the start of treament there was a considerable deficit in strength in the symptomatic group. However, at the completion of treatment, strength and range were near the same as in the asymptomatic group. The strength had increased an average of 71 % with pain reduction average at 60%. Two patients did not signifcantly improve in their pain. One with a pseudarthrosis and one with severe degenerative scoliosis.

 

The study does indicate the possibility of signifcant improvement in strength, even in a non-athletic eiderly population. lt also demonstrates the validity of norms, which was confirmed by testing of the non- symptomatic group and the retum to these levels of strength when the symptomatic group had finished training and improved their strength. There appears to be a correlation with strength and pain reduction in the majority of patients.

 

This paper was published in the Joumal of Spinal Disorders, volume 9, pages 17-22, 1996.

Maria A. Fiatarone Singh, M.D., Boston

 

Over the past 10 years we have pioneered the use of high intensity progressive resistance training in frail elders between 80 and 105 years of age. The concept of using this mode of exercise in such an aged population was generated by the realization that sarcopenia and its associated muscle dysfunction and metabolic consequences is a major impediment to attainment of the fullest possible quality of life in this cohort. While most individuals in the ninth and tenth decades of life have survived or not suffered major cardiovascular events, and most chronic diseases they will experience have already expressed themselves by this time, their health status may be markedly influenced by syndromes for which general medical care has had little ability to prevent or treat, including mobility impairment, gait and balance disorders, weakness, functional decline, falls, depression, insomnia, anorexia and wasting.

 

Loss of muscle tissue (sarcopenia) increases the risk for weakness, functional decline, impaired gait, falls, infections, glucose iontolerance, and osteoporotic fracture, among other things, and is therefšre a prime target for intervention in this age group. Potential mediators of sacropenia include biologic aging of the neuromuscular system, malnutrition, physical inactivity, withdrawal of anabolic hormonal influences, and catabolic diseases and medications. It is known that progressive resistance training may lead to muscle hypertrophy, whereas cardiovascular endurance training does not in general improve either muscle strength or mass. Therefšre, it makes sense to direct the exercise prescription in this way to target sarcopenia. In addition, multiple physical impairments and ambulatory difficulties as well as cardiovascular disease often make the prescription of endurance training difficult or impossible in this population, whereas seated resistive exercises can be applied to a much broader range of individuals.

 

We have seen that high intensity progressive resistance training is feasible, safe, and effective in nonagenarians in a variety of settings: nursing home, chronic hospital, outpatient clinics, continuing care communities, and individual homes. The injury rate is extremely low, and very few medical conditions are incompatible with its usage. It can be administered by individuals themselves, family, caregivers, students and volunteers after simple training courses. The benefits we have seen to date include improvements in muslcle strength, muscle mass, gait speed, balance, stairclimbing ability, overall physical activity levels, functional status, morale, depression, sleep, and nutritional intake. Muscle biopsy samples indicate activation of satellite cells and myogenic precursor appearance, as well as expression of developmental myosin and IGF-1, all indicative of the plasticity and remodeling of the skeletal muscle at this very advanced age. Current studies are exploring the benefits of vahous combinations of strength, power, balance, and endurance training in this group, as well as the specific effects of resistance training on patients with congestive heart failure, chronic renal failure, osteoarthritis, and Type 2 diabetes.

Eilington Darden, Ph.D., Gainesville

 

The purpose of the Living Longer Stronger program is to provide middle-aged people with a course at action to rebuild muscle mass. An average adult in the United States , for example, loses one-half pound of muscle per year between the ages of 20 and 50. As a 50-year old, his or her body is 15 pounds less muscular than at age 20.

Rebuilding atrophied, weakened muscle entails proper strength training. Proper strength training requires an understanding of the concepts of exercise intensity, progression, form, duration, frequency, and variation. With correct application of the above concepts, an average adult can add from 3 to 4 pounds of muscle during an initial, six-week, strength-training program. Thereafter, the muscle-building results decrease by approximately 25 percent with each successive six-week training period.

 

Resarch shows that the typical 50-year-old man or woman can rebuild 15 pounds of atrophied muscle in 18 months. Accomplishing this feat will help this individual live a stronger, leaner, and more productive life.

Dr. John Ethefington, London
St Thomas Hospital , London

 

The aim of this retrospective cohort study was to estimate the changes in bone mineral density (BMD) as a consequence of exercise in female ex-athletes and age matched controls. Eighty-three ex-elite female athletes (67 middie and long distance runners, 16 tennis players, currently aged 40-65) were recruited from the original records of their sporting associations. Controls were 585 age matched females. The main outcome measures were BIVID of lumbar spine (LS) femoral neck (FN) and forearm, estimated by DXA scan. Levels of physical activity were assessed using a modified Allied Dunbar Fitness Survey scale and classified as a) Ex-athletes b)

Active controls ( > 1 hour of vigorous physical activity currently and in the past) c) Low activity controls with inconsistent or intermediate levels of activity d) Inactive controls (<15 minutes exercise per week). Results: after adjustment for differences in age, weight, height and smoking, athletes had greater BIVIDs than controls; 8.7% at the LS (95% CI 5.4 – 12.0, p< 0.001) and 12.1% at FN (9.0 – 15.3, p< 0.001). The benefits of exercise appeared to persist after cessation of sporting activity. Active controls (n = 22) had greater BIVIDs than the Inactive group (n = 347) : 7.9% LS (2.0 – 13.8, p = 0.009) and 8.3% FN (2.7 – 13.8, p = 0.004). The Low activity controls (n = 216) had an intermediate BMD. Tennis players had greater BMDs compared to runners; 12.0% LS (5.7 – 18.2 p = 0.0004), 6.5 % FN (- 0.2 – 13.2, p = 0.066). The BIVID of Tennis players’ dominant forearms were greater than their non-dominant forearms. In conclusion, regular vigorous weight bearing exercise of one hour or more per week is associated with an increase in BIVID within a normal population. This study confirms long term weight-bearing exercise as an important factor in the regulation of bone mass and fracture prevention.

Motion og Osteoporose

Lis Mosekilde.

 

Lis Mosekilde var speciallæge i Intern Medicin og arbejdede ved Anatomisk Institut, Aarhus Universitet fra 1982 indtil hendes død 18 juni 2002. Hun var anerkendt internationalt som en verdens autoritet indenfor knogle forskning. Hun var en særdeles produktiv forsker og var en hyppigt inviteret foredragsholder ved kongresser over hele verden. Med hendes alt for tidlige død har osteoporose forskningen mistet en meget engageret og dygtig forsker. Osteoporoseforeningen vil derfor gerne minde Lis Mosekilde ved at bringe en forkortet version af hendes artikel “Motion og Osteoporose”, som blev udgivet af Månedskrift for Praktisk Lægegerning i september 1998. Efterskriftet er sammensat fra andre af Lis’ artikler.

 

Hvert skridt man tager, hvert løft man foretager registreres af celler beliggende centralt i knoglevævet. Hvorledes afspejler den mekaniske belastnings betydning sig i klinikken?

 

 

Human biologi – knoglevævets påvirkelighed af belastning

Den helt specielle indre og ydre struktur knoglerne opnår i vækstperioden skyldes i høj grad mekanisk belastning. Det meget fine trabekulære netværk centralt i hvirvellegemerne og i lårbenshalsen (Figur 1) opnås således kun ved belastning imod tyngdekraften. Børn, som er meget langvarigt sengeliggende, vil ikke udvikle den meget særprægende og stærke strukturelle opbygning. På den anden side vil børn og unge, som træner meget, opnå større knogletilvækst og dermed større og stærkere knogler end stillesiddende jævnaldrende [1].

 

Betydningen af mekanisk belastning kommer også tydeligt frem hos patienter med paraplegi (lammelse af begge ben). De mister 50–60% af deres knoglemasse i løbet af ganske få måneder efter rygmarvslæsionen (et tab der dog kan mindskes, hvis de kommer op at stå, således at knoglerne belastes mod tyngdekraften).

 

Belastningens indflydelse på knoglevævet er undersøgt i en række motionsstudier. Næsten alle studier (interventionsstudier) har kunnet vise en lille, 2–4% øgning i knogletætheden som følge af fysisk træning [2]. Effekten har vist sig størst hos yngre [1], men har også kunnet påvises hos kvinder omkring menopausen [3], hos kvinder med osteoporose [4] og hos ældre mennesker i det hele taget [5].
Dette betyder således, at knoglevævet livet igennem er påvirkeligt for den ydre belastning, det udsættes for. Knoglevævet fungerer som en såkaldt “mechanostat” også i den humane biologi.

 

 

Nedsat knoglestyrke – osteoporotiske brud

Osteoporose er en tilstand, hvor netop nedsat knogletæthed og strukturel kontinuitet fører til nedsat styrke og dermed til brud selv efter ganske ringe ydre påvirkning (Figur 2). Men der er forskel på osteoporotiske brud i hvirvler og lårbenshals (de 2 typiske steder).

 

Brud på hvirvellegemerne er hyppigere hos kvinder end hos mænd. Tidligere mente man, at kønsratio var 10:1 mellem kvinder og mænd. Men undersøgelser publiceret i 1996 har vist, at dette ikke er korrekt, og at kønsratio er 1,9:1 mellem kvinder og mænd [6]. Disse brud optræder allerede i 60–70 års alderen, men ofte giver de ingen kliniske symptomer, og de er sjældent invaliderende. De optræder ofte uden et fald dvs uden større ydre påvirkning. De opstår derfor helt overvejende alene på grund af nedsat knoglemasse og styrke.

Hoftefrakturerne, som er de virkeligt belastende brud både samfundsmæssigt og for det enkelte individ, optræder ikke før i 75–85 års alderen. Disse brud er heller ikke typiske for kvinder. Der er således i Danmark, hvad angår incidensen af hoftefraktur, en kønsratio på ca. 2:1 mellem kvinder og mænd (efter alderskorrektion). Kønsratio for faldulykker i denne alder er også 2:1, og hoftebruddene er altid relateret til et fald.

 

Vi står altså – hvad angår hoftebruddet – med en anden problemstilling. Der er her tale om en brudtype, som opstår ikke alene på grund af nedsat knoglemasse og styrke, men også på grund af ydre omstændigheder (fald).
Der er her tale om et brud, som:

1. Altid er relateret til et fald.
2. Rammer ældre over 75 år.
3. Rammer mænd og kvinder næsten lige (hvis der korrigeres for faldratio).
4. Er stærkt invaliderende og medfører stor risiko for nedsat livskvalitet.

Hvis forebyggelse mod knogleskørhed primært stiler mod at forebygge hoftebruddene, er det vigtigt at belyse, ikke blot de aldersbetingede forandringer i knoglemasse og styrke [7], men også at se på de ydre faktorer, der påvirker disse aldersbetingede forandringer og de ydre omstændigheder, som medfører fald.

 

Forekomst af lårbenshalsbrud – ydre faktorer

Allerede for 30 år siden viste Chalmers & Ho , at hoftebrud var specielt hyppige i den industrialiserede del af verden (specielt i Nordeuropa og USA) – dvs, områder hvor man i dagligdagen har talrige tekniske hjælpemidler og derfor ikke behøver at udføre så meget tungt fysisk arbejde. De påpegede også, at det kun er i den industrialiserede verden, at der er en kønsforskel, hvad angår denne brudtype. I det fjerne Østen forholder det sig helt anderledes. I en by som Hong Kong er der lige mange mænd og kvinder, der får brud på lårbenshalsen, og i Singapore, er der dobbelt så mange mænd som kvinder, der får denne brudtype [8]. Begge steder er den generelle brudhyppighed dog langt lavere end i Skandinavien. Det blev fremhævet, at hvis vi ikke ændrede vores livsstil i den industrialiserede verden og blev mere fysisk aktive, ville der komme endnu flere hoftebrud både hos kvinder og hos mænd i løbet af de næste 20–30 år [8]. Der er nu gået mere end 30 år siden denne “profeti” blev fremsagt.

 

Hvad er der sket i disse 30 år?

1. Antallet af hoftebrud er steget 100–200% i Skandinavien [9–11].
2. Antallet af nye brud er steget mere for mænd end for kvinder [10,11].
3. Antallet af hoftebrud er også steget andre steder i verden, som har overtaget vores livsstil – f.eks. i det fjerne Østen [12].

Forklaringen er meget klar: vi har ikke øget vores fysiske aktivitet – tværtimod. Helt nye epidemiologiske undersøgelser fra Europa støtter yderligere Chalmers og Ho’s udsagn.

 

Nye epidemiologiske undersøgelser angående hoftebrud

I 1993 publicerede Kanis en ny stor undersøgelse over forekomsten af hoftebrud i Europa (Sponsoreret af WHO) [13]. Denne undesøgelse viste, at vi i Skandinavien har 10 gange så mange brud per 100.000 indbyggere som i flere Syd- og Østeuropæiske lande (også efter alderskorrektion). Undersøgelsen viste også, at kønsratio varierede stærkt fra land til land, og i nogle Europæiske lande sås en større hyppighed hos mænd end hos kvinder.

 

En oversigtsartikel af Melton fra 1995 viser, at Skandinavien har – ikke blot Europas men verdens – højeste incidens af hoftefrakturer. Der er her 400 gange så mange tilfælde per 100.000 individer (alderskorrigeret) i forhold til de lande, hvor der er færrest [14].

 

Konklusionen fra Kanis’ studie var, at man skulle søge årsagen til de fundne store “Intraeuropæiske” forskelle i livsstilfaktorer – specielt fysisk aktivitet. Det blev også fremhævet, at betydningen af menopausen (østrogen bortfald) for udviklingen af osteoporose var stærkt overdrevet [13].

 

En opbakning til denne konklusion var kort forinden kommet fra Law et al. (1991), der i deres analyse af forebyggelse af hoftebrud i England fremhæver, at hovedårsagen til den forventede fordobling af hoftebrud i England over de næste 20 år kan relateres direkte til manglende fysisk aktivitet (Dette kan også måles i form af faldende kalorieindtag: 11,9 MJ per person per dag i 1965 til 9,8 MJ i 1985). Law’s analyse har 2 hovedkonklusioner:

1. “Der er betydelig dokumentation for at fysisk aktivitet er den vigtigste faktor for at mindske risikoen for hoftebrud. Motion som forebyggelse kan samtidigt være både behageligt og socialt. Regelmæssig motion vil kunne reducere risikoen for hoftefraktur med mindst 50%.”
2. “Denne forebyggende indsats bør rettes mod hele befolkningen. En selektiv forebyggende indsats med farmaka rettet mod en lille del af befolkningen vil kun få ringe indflydelse på forekomsten af hoftefrakturer.” [15].

Motionsstudier, både tværssnits-undersøgelser og interventionsstudier har som tidligere nævnt bevist effekt af fysisk aktivitet på knoglemasse [2] og også på brudincidens [16]. Fysisk inaktiviteten er en uafhængig risiko faktor for hoftebrud hos ældre [17].

 

Træningsstudier – ældre

Når både incidensen af vertebrale og hoftenære frakturer stiger fra generation til generation og mere for mænd end for kvinder [7], skyldes dette at knogledensiteten og kvaliteten falder – og mest udtalt for mænd. Da det aldersbetingede tab af trabekulær knogle er ca. 1% pr. år hos både mænd og kvinder, vil der mistes 40–50% gennem er voksent liv. I den situation vil udgangsværdien: “Peak bone mass” og alderstabet (hældningen) have meget stor betydning. Begge er afhængige af mekanisk belastning – motion.

 

Hvor meget motion skal der til for at bevare knoglemassen hos ældre?

Krall et al. har vist, at en spadseretur dagligt på mindre end 1 mile (1,6 km) er nok til at hindre tabet. I et kontrolleret, longitudinelt studie over en 1 årig periode med kvinder mellem 43–72 år, viste det sig, at mens kontrolgruppen tabte knogledensitet, så bevaredes den hos de “trænende” gennem en almindelig, daglig spadseretur [18].

 

Hvor meget motion skal der til for at øge knoglemassen hos ældre?

Kohrt et al. har publiceret et studie, der viste, at godt 3 timers superviseret motion om ugen kunne øge knoglemassen signifikant [5]. Studiet var igen kontrolleret, longitudinelt med varighed på 1 år. Alle deltagerne var mellem 60 og 74 år. Der var 3 grupper:

1. Kontrol.
2. Motion (gang, jogging).
3. Motion (vægtløftning, roning).

Resultaterne viste at i gruppe 1 sås ingen ændring i knogledensitet eller muskelstyrke. I gruppe 2 sås efter 1 år en 2% stigning i knogledensitet i hele kroppen og i columna, mens stigningen var 6% i collum femoris. Samtidigt øgedes muskelstyrken ca. 10% i lårets ekstensorer og fleksorer. I gruppe 3 sås ligeledes en 2% stigning i hele kroppen, og columna, men ingen stigning i collum femoris. Derimod sås en øgning af muskelstyrken på 35–78%!

 

Dette studie har stor vægt, da det er yderst vel-planlagt og -gennemført. Det viser med al tydelighed at:

Motion kan øge knogledensiteten hos ældre (2–6% på 1 år).
Motion kan øge muskelstyrken hos ældre (35–78% på 1 år).
Studiet undersøgte motions indflydelse på knogledensiteten. Havde studiet belyst et nyt medikaments effekt på knogledensiteten, ville de fundne meget positive resultater have været ude i verdenspressen, og reklamer ville have fyldt fagpressen og lægernes brevkasser! Da motion og motionsstudier ikke er knyttet til nogen økonomiske interesser – er Kohrt’s studie sandsynligvis “dømt” til forglemmelse. Allerede i 1992 havde Nielsen et al [19] vist at 5 måneders gymnastik af 70–80 årige kunne øge muskelstyrken med 50–80% og samtidigt øge balanceevnen og koordinationen (i studiet fandtes ingen signifikant ændring af densitet, hvilket heller ikke ville kunne forventes efter kun 5 måneders træning).

 

 

Fysisk aktivitet øger således balanceevnen, koordinationen og muskelstyrken – også hos ældre i 60–80 års alderen [5,19]. Hoftebrud er altid relateret til et faldtraume, hvorfor det netop ville være en fordel at kunne øge balanceevnen og muskelstyrken hos ældre.

 

Livsstilsfaktorers betydning for reduktion af nye hoftebrud

Lister man forskellige forebyggende indsatsers effekt (livsstilsorienterede og medicamentelle) mod hoftefraktur, ses det tydeligt, at motion kommer ind i toppen – og at der er forebyggende effekt både hos kvinder og mænd (Tabel 1). Også små indgreb som hjemmebesøg hos ældre kombineret med samtale med egen praktiserende læge, sanering af medicin og sanering af bolig (løse tæpper, belysning) har stor effekt [20]. Det samme gælder hoftebeskytter hos ældre på plejehjem [22]. En metaanalyse af Law et al [23] har vist, at også rygeophør kan reducere hyppigheden af hoftenære frakturer med 50%. Alle disse livsstilsændringer er ikke blot meget effektive, men de har effekt i relation både til kvinder og mænd. Angående medicamentel behandling har supplering med D-vitamin og calcium vist sig meget effektiv i et fransk studie [21]. Studiet var kun fokuseret på kvinder, men samme behandling ville uden tvivl også være effektiv overfor mænd. Det kan også læses at tabellen at livsvarig hormonsubstitutionsbehandling kun fører til en 25% reduktion – og kun hos det ene køn! I den henseende er det vigtigt at notere, at behandlingen skal være livsvarig – seponeres behandlingen, er effekten på knoglerne væk efter kun 6 år [24].

 

Motion og bivirkninger

Motion kan næppe siges at have nogen væsentlige negative bivirkninger. Men det er værd at nævne, at motion også hos ældre har talrige positive bivirkninger:

1. Øger muskelstyrke, balanceevnen og koordination.
2. Øger alment velbefindende
3. Reducerer incidencen af hjerte-kar sygdomme
4. Reducerer incidencen af flere maligne lidelser bl.a.: c. mammae (brystkræft), c. coli (tyktarmskræft) [25,26].
5. Modvirker adipositas.
6. Modvirker diabetes.

Konklusion

1. Skelettet er dynamisk – det ombygges hele livet igennem – hver eneste ombygning er påvirkelig for mekaniske faktorer – fysisk aktivitet.
2. Tværssnitsundersøgelser og interventionsstudier viser, at træning har en positiv virkning på knoglemasse og kan reducere frakturhyppighed [2,15].
3. Immobilisationsundersøgelser viser, at knoglemassen falder drastisk under strengt sengeleje – det tager lang tid at genvinde tabet, og det kan kun lade sig gøre, når remobilisation er etableret [27].
4. Træning af ældre kan føre til signifikant øgning af knoglemassen, samtidigt kan der ofte opnås en 50–80% øgning af muskelstyrken og en øgning af balanceevnen og derigennem en betydelig reduktion af risikoen for hoftefrakturer ca. 50% [5,15].
5. Epidemiologiske studier peger på fysisk aktivitet som den væsentligste forebyggende indsats mod hoftefrakturer [8,13].
6. Screening af dele af befolkningen med opfølgende livslang farmakologisk behandling vil være kostbar og have helt minimal indflydelse på antallet af nye hoftefrakturer [15,28].

 

Efterskrift

Osteoporose er ikke en kvindesygdom, men en livsstilsbetinget tilstand. Derfor bør forebyggelse af knogle- og mineraltab ikke primært baseres på måling af knoglemineralindhold hos kvinder omkring overgangsalderen med efterfølgende tilbud om homonsubstitionsbehandling (HRT). Forebyggelse af knogle- og mineraltab skal omfatte både kvinder og mænd, skal foregå livet igennem og skal primært baseres på optimering af livsstil: mere motion, rygefravalg, sund kost med tilstrækkeligt indhold af kalk og D-vitamin. Osteoporoseforeningen takker Lis’ ven og kollega cand. polyt., Ph.D. Jesper Skovhus Thomsen for hjælp med denne artikel og Månedskrift for Praktisk Lægegerning for tilladelse til at udgive artiklen.

 

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