Zusammenfassung
Bei der Osteoporose handelt es sich um eine systemische Skeletterkrankung, die mit einer Verminderung der Skelettmasse gegenüber der alters- und geschlechtsentsprechenden Norm mit der Folge einer erhöhten Knochenfragilität und eines gesteigerten Frakturrisikos einhergeht. Körperliche Bewegung hat vielseitige Wirkungen auf das muskuloskeletale System, wobei mechanische Belastungsreize auf den Knochen als dynamisches Gewebe durch ständigen Umbau der trabekulären und kortikalen Strukturen wirken. Diese Übersichtsarbeit befasst sich mit dem Einfluss von Sport auf den Bewegungsapparat von Gesunden und an Osteoporose leidenden Patienten. Dem Sport bzw. der Bewegungstherapie kommt insbesondere hinsichtlich der Prävention, aber auch hinsichtlich der Therapie und Rehabilitation der Osteoporose eine besondere Bedeutung zu. Die wesentlichen Reize auf das Skelettsystem für einen Anstieg der Knochendichte sind Alltagsaktivitäten und Sportarten mit Gewichtsbelastung. Zu den Alltagsaktivitäten zählen Treppensteigen und Gehen, zu den Sportarten Radfahren, Jogging (Laufen), Skilanglauf, Tanzen, Bergwandern und dosiertes Gewichtheben. Das Training der Maximalkraft wirkt sich besonders positiv auf die Knochendichte aus. Sport spielt im Wachstumsalter insbesondere bis zum Erreichen der maximalen Knochendichte eine entscheidende Rolle für die Mineralisation des Knochens. Eine hohe Intensität an Sport scheint einen besseren Effekt auf die Knochendichte zu haben als eine geringe Intensität. Durch bestimmte körperliche Trainingsprogramme können das Sturzrisiko und damit indirekt das Frakturrisiko vermindert werden. Ein durch Ausdauertraining und psychische Anspannung im Rahmen von Leistungssport bedingtes chronisches Östrogendefizit kann zu einer Abnahme der Knochendichte und somit zur Osteoporose führen.
Abstract
Osteoporosis is a systemic skeletal disease characterised by low bone mass and changes in normal architecture of bone tissue. Bones become fragile and the risk of fractures is enhanced. Either a bone mineral density below the young normal mean or a previous fragility fracture is accepted as the definition of osteoporosis from a clinical perspective. Exercise may affect the musculoskeletal system in multiple ways. Mechanical stimuli (e. g., exercise) are necessary for the development of healthy bone by the effect of modelling and remodelling on bone architecture. This paper reviews the influence of exercise on healthy individuals as well as on osteoporosis patients. Exercise and kinesitherapy have special impact on prevention, therapy and rehabilitation of osteoporosis patients. Highly effective exercises for increasing bone mass are weight-bearing exercises of maximum intensity, e. g., stepping and walking as well as cycling, jogging, cross-country skiing, dancing, hiking and well-dosed weight-lifting exercises. During adolescence, bone mass increases until peak bone mass is reached at the age of about 28 years. During this period of life, exercise is especially important for increasing bone mass. Most likely, physical activity of high intensity has a better effect than such of low intensity. Special training programmes may decrease the risk of fall and therefore the risk of osteoporosis fractures. The combination of endurance training and psychological strain may lead to a chronic oestrogen deficit which causes a decrease in bone mass and therefore induces osteoporosis. For prevention of osteoporosis, we suggest a 1) combination of aerobics or different weight-bearing exercises, 2) weight-lifting and 3) flexibility or coordination exercises. Exercise should be considered supportive therapy for medical treatment of osteoporosis.
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Dr. med. Alexander K. Scheel
Abteilung für Nephrologie and Rheumatologie, Georg-August-Universität Göttingen
Robert-Koch-Straße 40
37075 Göttingen
Email: ascheel@gwdg.de
