Training Aims and Risk Categorization in The Area of Exercise and Fracture Prevention. Targets for Individualized Training Programs

In basic exercise science, defining relevant training aims and their individualized assignment to the specified subject or cohorts is the first step of any training strategy. In the complex area of exercise and fracture prevention, several aspects have to be considered. Whilst pharmaceutic therapy focuses solely on bone, exercise training aims for fracture prevention include all the main determinants (or reasons) of fractures, i. e. "bone strength", "fall frequency" and "fall-induced impact (on bone)". However, the relevance of trainings aims covering maintenance or boosting bone strength, reduction of fall frequency and fall-induced impact differs significantly depending on the different cohorts at risk for fractures. In the present work, we differentiate five cohorts classified according to several aspects relating predominately to bone status, fall risk and physical capacity. When allocating the corresponding cohorts to their primary training aim(s), the primary training aim for (1) people with osteopenia and increased bone turnover without increased fall risk and for (2) people with osteoporosis, no fractures and without increased fall risk, is to maintain or increase bone strength. Reducing fall frequency and fall-related impact becomes increasingly relevant for cohorts with (3) people with osteoporosis, no fractures but multiple risk factors for falls and (4) people with vertebral fractures and multiple risk factors for falls. Finally, for (5) people with multiple fractures, high risk of falling and very low physical capacity, the relevance of bone strength as a training aim becomes negligible, partly because the majority of this cohort is provided with a pharmaceutic therapy that focuses on bone. We feel that the early and individualized assignment of training aims facilitates the further training process and represents a crucial aspect in the area of optimized training protocols for fracture prevention.