PT on the Net Research

Osteoporosis: A Case Study

The intent of this case study is to bridge the gap between academic and everyday worlds by putting scientific fact and theory into application. Personal trainers can use the following "real life" client profile to add to and/or enhance their current program design process.

The case study can be used in conjunction with other specialized textbooks to gain an understanding of how training programs are planned, designed, manipulated and progressed.

Exploring case studies can form the links between scientific fact, theory and actuality. For example, if you are already working with a client with similarities to the client in this case study, you should try to see how the content of the article relates to your experience. This will encourage thought and help to develop skills you will use for the rest of your career.

This article will cover the following:

Client Introduction

Diane is 47 years old and has just been diagnosed with severe osteoporosis. When Diane first came into the gym, her primary objectives were to improve strength (doctor’s recommendation), lose fat, improve general fitness and in her words, "Tone up to look good in a bathing suit."

Diane came to me frustrated with her previous trainer and the lack of results from her exercise program. She was concerned that her program was not individualized for her condition. She had been working with a trainer for four months with no improvement. When reviewing her exercise program, it mainly consisted of lower body exercises performed on guided machines (i.e., leg extension, leg curl, butt blaster) and two 30-minute treadmill sessions per week (intensity unknown).

Diane is a secretary and sits most of the day. On a scale of 1 to 10, she has expressed that her career and home stress level is a 7. She is a very fragile and thin looking woman. She has had two C-sections in the past 14 years. Currently, she is going through menopause and is taking estrogen to regulate her hormones. She has committed to three 60-minute training sessions per week.

When I assessed Diane’s natural posture, my observations were she had a slight forward head, slight protracted shoulder girdle and slight anterior tilt with noticeable abdomen distention.

Length/tension assessments showed predominate tightness of the levator, upper traps and hip flexors (rectus femoris). Diane also complained her neck was "tight," especially after a day on the computer.

Diane’s core (lumbo-pelvis-hip complex) assessments showed marked weakness in strength and coordination. Movement quality was poor when assessing body weight squat technique and walking.

Before viewing the sample program, it is essential to know what osteoporosis is, the associated risks and general guidelines. This information is not only necessary for the program design process but also can be reproduced and used as an information handout for your client’s awareness. This "caring approach" goes along way!

Clarification of the Main Condition 

What is osteoporosis? Simplistically speaking, osteoporosis is a condition of decreased bone density causing ones bones to be more susceptible to fracture. A fall, blow or lifting action that would normally not bruise or strain an average person may cause fracture in a person with severe osteoporosis.

According to the National Osteoporosis Foundation, more than 24 million Americans currently suffer from this condition. Eight times as many women suffer compared to men. Most of these women are of the mature population whose bone mass have dropped significantly following menopause.

Associated Risks 

Now that we’ve briefly described what osteoporosis is and the risks associated, lets explore a general guideline trainer’s should use when dealing with a client with osteoporosis.

General Guidelines 

Sample Program 

We have provided you with a sample of Diane’s phase one program.

Diane’s program is specific to her goals, needs, wants, levels of control and, most importantly, her medical condition. The following exercises and program can be used as an educational guideline when dealing with a client with osteoporosis. We have provided a space for INDIVIDUAL MODIFICATION. By using general guidelines along with your current assessment knowledge, you will be on the path to individualized programming. Individualized programming truly separates the average trainer (one who memorizes protocol) from the professional (a program designer)!

NOTE: Because all clients are different, one should not assume that the sample programs and exercises in this article fit all clients. As a trainer, it is your job to extract useable information from this article and formulate your own hypothesis, depending on your client's needs.

Diane's Stretching Program 

Levator/upper trap 3 each side 15 seconds
Standing hip flexor 3 each side 15 seconds
Figure 1 Figure 2

Diane's Strengthening Program 

Objectives Exercise Tips
  • Increase bone density
  • Increase muscle mass and strength
  • Improve balance and everyday function
  • Warm-up prior to exercise
  • Perform individual stretches prior to workout
  • Always move through a pain-free range!
  1. Preparation
    • Place/hold medicine ball on top of the chest
    • Feet should be comfortably apart in a "stand tall" position
  2. Movement
    • Draw your belly button inward toward the spine
    • Descend in a controlled manner maintaining proper posture
    • Ascend to start position and repeat required reps
  1. medicine ball
  2. front squat
standing 12 2-1-2 1–2m 1-3 * Resistance movements should be directed to the large groups that are important in everyday activities
  1. cable cross
  2. bi-lateral push
standing 10 3-0-3 1.5m 1-3 * Each repetition is performed slowly through a pain free range of motion.
  1. cable cross over
  2. uni-lateral pull
standing 10 3-0-3 1.5m 1-3 Performing the movement more quickly will not enhance gains and may increase the risk of injury
  1. exercise mat
  2. 4-point abdomen draw
kneeling on hands & knees 10-12 10 sec. holds 1m 1-3 *Start with 1 set of each 3 times a week. Progress to 3 sets as the body grows accustomed
  1. Preparation
    • Adjust cable arms to the level of your shoulders. Grasp handles
    • Assume a "stand tall" position with a split stance
  2. Movement
    • From the start position, draw your belly button inward toward your spine
    • Maintaining the "stand tall" position and push the handles forward, DO NOT OVER EMPHASIZE PUSHING MOTION WITH ARMS!
    • Return to start position and repeat required reps
  1. Preparation
    • Adjust cable arms low. Grasp handle
    • Assume a "stand tall" position with split stance
  2. Movement
    • From the start position, draw your belly button inward toward your spine
    • Maintaining the "stand tall" position, pull the handle toward your body
    • Return to start position and repeat required reps
  1. Preparation
    • Assume a 4-point stance
    • Maintain neutral spinal alignment
  2. Movement
    • Maintaining spinal alignment draw your belly button inward toward your spine
    • Hold position for recommended time and repeat required reps

Diane’s Cardiovascular Program

Activity type Heart Rate Zone Duration Frequency
Walking 76 – 95 BPM 15-20min 3 times/wk

Diane’s goals and wants (lose fat/look good in a bathing suit), needs (core strength/flexibility) and functional abilities (inability to coordinate everyday movements) led to this functionally balanced program design. Diane’s program not only follows the medical exercise guideline for osteoporosis, but also addresses:

As one can explore, Diane’s phase one program offers multiple benefits!

Designing programs with a balanced mind set can improve your client’s posture, balance, flexibility, stability and coordination, leading to efficiency in movement, both in and out of the gym. These factors make a person feel good, both physically and psychologically, allowing them to walk away with a positive outlook on each fitness experience. Isn’t that what personal training is all about?