Physiotherapists often prescribe standing and other weight bearing exercises for patients in an effort to reduce the loss of bone mineral density leading to osteoporosis. We know that during periods of immobility bone mineral density starts to decline. This can be due to spinal cord injury, acquired brain injury and stroke, fracture and prolonged medical illness. This loss of bone mineral density then places the patient at a higher risk of fracture including pathological fracture, which is a fracture in an area of bone that is weakened, and is not usually associated with any kind of trauma.
We know that bone density starts to decline in people as they age. This occurs in people who are still mobile and active, just maybe not as much as they used to be. So how much standing should people perform when they are immobile for reasons such as those stated above? Much research has been done on this topic to assist health professionals guide patients in the right direction.
Goktepe et al (2008) studied the effects of standing in 92 patients at least 1 year post spinal cord injury. They found no significant difference between 3 groups of patients; those that stood for more than 1 hour per day, those that stood for less than 1 hour per day, and those that did not perform any standing at all. Similarly, a study by Ben et al (2005) found that standing for 30 minutes, 3 times per week did not change bone mineral density in patients following spinal cord injury.
On the other hand, Alenka at al (2008) studied a group of patients following spinal cord injury. These patients were randomly allocated to either a standing or non-standing group. The standing group performed equal to, or greater than 1 hour of standing per day, at least 5 days per week, for 2 years. The results showed that they had significantly higher bone mineral density after 2 years, than the group who did not perform any standing.
What these studies show us is that therapeutic standing has the potential to improve bone mineral density in people after spinal cord injury, though only if performed regularly. It appears that this standing needs to be performed daily, for at least an hour. Also, this is a long-term project, as the research suggests that upwards of 2 years may be required to see any significant improvement.
So the little take home message reads much like this, beneficial changes take time to see and this is a project for the long term. Should you be wanting to improve your bone mineral density, and reduce your chances of osteoporosis and fracture, then you need to be standing for an hour a day, most days of the week, for at least 2 years. Most of the literature available refers to the spinal cord injury population, so at this stage as health professionals all we can do is assume that the requirements would be the same or similar for other neurological populations.
Alenka, V., Tamulaitiene, M., Sinevicius, T., & Juocevicius, A. (2008). Effect of weight-bearing activities on bone mineral density in spinal cord injured patients during the period of the first two years. Spinal Cord, 46, 727-732.
Ben, M., Harvey, L., Denis, S., Glinsky, J., Goehl, G., Chee, S., & Herbert, R.D. (2005). Does 12 weeks of regular standing prevent loss of ankle mobility and bone mineral density in people with recent spinal cord injuries? Australian Journal of Physiotherapy, 51, 251-256.
Goktepe, A.S., Tugcu, I., Yilmaz, B., Alaca, R., & Gunduz, S. (2008). Does standing protect bone density in patients with chronic spinal cord injury? The Journal of Spinal Cord Medicine, 31, 197-201.