I have a 23-year-old client with Osteogenesis Imperfecta (I think Type 1). His last fracture was at the age of 15. I am having trouble finding specific exercise guidelines for this condition, besides those for Osteoporosis/Osteopenia. I know for Osteoporosis that spinal flexion and seated hip abduction/adduction machine use is generally counterindicated, but do you have more information on this? His goal is to improve upper body visible muscle mass and lose fat (particularly abdominal). He is not interested in swimming or doing any lower body resistance exercise. Also, he has never gotten a bone density test because he is under the impression that it is invasive and/or painful.
I agree that there is little information available with regards to exercise prescription and osteogenesis imperfecta. The sparse information that does exist tends to be very general advice rather than any specific exercise considerations.
If your client is suffering from a mild form of O.I. then it could be either Type I or Type IV. The difference if that Type I is a deficiency of the right type of collagen, whereas Type IV is if the individual has the wrong type of collagen. Although this is significant, it does not really make a difference to how you train them. In this case, the client is 23 and has not had a fracture since the age of 15. It may therefore be that he has grown out of the condition for now. Although his bones may not be as susceptible to fracture as they were, in later life there may be a regression as bone mineral density decreases and the bones become more brittle. For this reason, it is appropriate to consider weight-bearing exercises that strengthen the bones now and decrease the risk of fracture following middle age.
Recommendations for swimming and walking are appropriate for fracture rehabilitation and for individuals not able to participate in more strenuous exercise. In this case, it sounds like your client is better suited to resistance exercise. With regards to general exercise considerations, you have to ask what use an exercise is to the individual. You could just prescribe the upper body bodybuilding exercises that will help your client to reach his goals, but you won’t really be helping him as much as you could. He might not want to train his lower body, but if he wants to resist future fractures, then it is vitally important that you introduce him to functional weight-bearing exercises such as the squat. I would also recommend that the sort of exercises you include increase stress through the bones while maintaining good posture. Press ups, even if they are the last exercise for upper body, will be useful as a functional means of increasing joint and bone strength and may help to prevent an upper body fracture or dislocation following a fall.
As well as promoting bone strength, individuals with O.I. also tend to suffer from joint laxity. For this reason, you should consider exercises that will strengthen the joints through a normal range of motion. I do not want to list eight exercises you should use exclusively in your program, but I will recommend that you utilize functional movements that promote joint integrity and stress the bones through normal postures. Obviously, you need to work with your client in terms of his capabilities. You should start with high repetition sets and aim to reduce reps and increase resistance over a period of several months.
In conjunction with the exercise program, you should also make recommendations to your client regarding proper nutrition. Although most dietary advice tends to concentrate on the importance of a balanced diet, you need to make your recommendations according to the foods your client is best suited to. In particular, you need to ensure he is getting adequate amounts of protein and the bone minerals. The proteins should cover all the essential amino acids and be taken in at regular periods throughout the day.
Finally, a key concern for clients with O.I. is posture. You should carry out a thorough postural and movement-based analysis and ensure that you correct any misalignments before commencing resistance training. It is imperative that your client train efficiently without overstressing any particular bone or joint. There is a vast array of exercises available on the PT on the NET Exercise Library, and your client would benefit from a holistic, functional, resistance-based program. To assist with his fat loss, you can prescribe cardiovascular exercise as you see appropriate. It would be useful to monitor bone mineral density on a yearly basis. The test is not intrusive and only involves lying still for a couple of minutes while the machine moves around above the body.