The Effects of Cycling on Bone Health in Senior Athletes
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Micah Hettinger, SPT, Chesney Nagel, SPT, Ember Newman, SPT, & Ashley Wilson, SPT
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Micah Hettinger, SPT, Chesney Nagel, SPT, Ember Newman, SPT, & Ashley Wilson, SPT
USD PT Research 
This is the most interesting thing I’ve read. I’m definitely going to cite your study with my patients. I’m curious about the cyclist bone health compared to the general population. Can it be inferred that cycling offers some osteo benefit as their bone health was far better than the general population? Cycling is one of the lowest impact activities out there, why would cyclists have better bone health than the general population? I’m also curious to know about which population of athletes had the highest bone health – I know this wasn’t your research topic, so I will be chomping at the theraband for a f/u study in the coming years. Specifically, I’d be curious to know about the triathlon group. How’s their bone health. I’ve heard it once said that a triathlon is a “swim to a bike race with a run for a cool down.”
Go Yotes.
James
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Hi James! Thank you for your comments and questions. When compared to the general population, the senior athletes engage in more exercise overall than the general population and all groups tested in our research did report more than double the recommended amount of cardiovascular exercise, keeping in mind this was subjective. Even though cycling is a low impact activity, those who cycle are doing more exercise than those who don’t (general population). This is one reason we believe why we found that male cyclists have better bone health than the general population since any type of exercise is better for bone health than none at all. We were curious about Triathalon athletes as well, however, we did not look deeply into this group in order to keep our variables within reason. Looking back at some of our stats we did run on Triathalon athletes for prevalence of low bone health, only 21 out of 109 reported having either osteoporosis or osteopenia during the health and sport history questionnaire which did not turn out to be statistically significant. We also agreed this would be a great follow up study idea. We also did not run bone health prevalence’s on every athlete population since this was not the topic of our research, so we are not able to answer your question of who had the highest bone health at this time. Please let us know if you have any other questions. Thanks!
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First off, great job on the poster! It’s both visually appealing and extremely interesting to read about! One of the more interesting things I found in your results was that male senior athlete cyclists had significantly higher grip strength than all other senior athletes. What is your theory behind these results? My other question is a more general one. I am just curious if there were any specific results in this study that you found particularly surprising? I feel like most of the information pointing to better bone health in the more athletic population seems to be on par with other studies. That being said, was there anything in there that struck you as surprising or odd?
Again, great job!
Kelsey Grosshuesch
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Hi Kelsey! Thanks for your questions. I also found it interesting that male cyclists had a significantly higher grip strength. I would speculate that this finding is due to one of two reasons. The first of which being that their grip strength is higher due to the relatively high use of their hands that is required by their sport. Tightly gripping the handle bars of a bicycle during hours of training each week could be enough to strengthen their hands over time. The second possibility is that bicycling is a higher intensity activity than some of the other sporting events at the senior games, meaning those who are competing in the event will have a higher level of overall vigor, which we know correlates with higher grip strength. These two factors would be my guess as to why we found this difference. In response to your second question, one thing that I found surprising was the results of a similar study that also focused on bone health in this population. Researchers at the Senior Olympics measured athletes bone density with DEXA scan rather than self-reported questionnaire and found that their rate of osteoporosis was similar to that of the general population. This, of course, is a sharp contrast to our results, likely due to the fact we did not any measurements. This would then indicate that the senior athlete population is equally at risk for osteoporosis, but they are not getting tested, likely due to their self-perceived good health. The combination of our results with this other study indicate we should be educating healthy and active aging adults to get screened just as much as the typical elderly.
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I really enjoyed reading your research! I found it very easy to read and follow, and it was very appealing to the eye! It is clear that high levels of activity are beneficial to bone health per your study, but in the beginning, you mentioned that less than 25% of older adults meet weekly activity recommendations. In your opinion, how can we use the information obtained from your study to stress the importance of activity/exercise with seniors who currently don’t exercise regularly? And to stem further from that, what type of exercises would you recommend for an older adult who is just beginning with weekly exercises (resistance training, cycling, etc)?
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Hi Nicci! Thanks for your questions! I think we can use our results to encourage exercise in the older adult population by emphasizing the positive effects it will have on their overall quality of life, which is of interest due to the natural decline we see in adults as they age. As we know, exercise has both mental and physical benefits that we can use to encourage older adults to stay active. Of interest in our study, specifically, was bone health. Bone health is important to stay on top of due to risk of fractures that can be very debilitating to an older adult. Throughout our research process we discussed that older adults should be engaging in weight bearing activities that include a variety of higher impact movements vs. activities that require more repetitive, lower impact motions. Random, high impact movements will put the most stress on the the muscles, and therefore the most stress on the bones, discouraging the loss of bone mass and encouraging bone remodeling. Of course, activities like cycling that are less weight bearing are still very beneficial to ones health and this can be used in conjunction with other weight bearing activities. Resistance training has been associated with improved bone health, so this is an area that should be emphasized as well. As always, safety is a concern with our older patients, so these activities would have to be tailored to their current physical function and ability. And it is also important to discuss with this population that even high level athletes can be subject to conditions such as osteopenia and osteoporosis, so getting screened is critical for all older adults regardless of their physical status. Hope that answers your questions!
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Great job, this poster is very eye catching and informative! I find it very interesting that female cyclists have a higher prevalence of osteoporosis than the general population while the male cyclists have a lower prevalence than the general population. Since female cyclists have low bone density and low grip strength, would you recommend any precautions to these athletes about safety while biking?
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Hi, Cassidy! Thank you for the question. We also found this interesting, and although we cannot be certain why, there are many possibilities as to why we found this. It is important to note that total low bone health diagnoses were significantly lower in both male and female cyclists compared to the general population (this may not have been clear on our poster but is covered in the presentation). In contrast, when separately looking at osteopenia and osteoporosis in females, there was a significant difference for osteoporosis as you have mentioned.
We were expecting there to be higher rates of osteoporosis AND osteopenia in both male and female cyclists compared to other senior athletes, but this was only true for osteoporosis in female cyclists. Cycling lacks significant weight-bearing, which may contribute to low bone health. Similar effects are seen in swimming senior athletes, another low-impact sport, in which males show a higher prevalence of osteoporosis when compared to age-matched sedentary males.
Other research shows that cardiovascular training does not improve bone health, however strength training does. As you can see in our graphs, female senior athlete cyclists spent most of their training time cardiovascular training rather than strength training. Compared to other senior athletes, time spent cardiovascular training was significantly more in female cyclists. We did not have comparative data for the general population. Strength training was less for female cyclists with low bone health compared to female cyclists without low bone health, however this was not significant.
It is also possible that rates at which these populations are tested for low bone density is different. For example, female senior athlete cyclists could have higher rates of testing for low bone density and therefore reported higher rates of osteoporosis diagnoses. Another possibility is inaccurate reporting, a limitation of this study.
Aside from the osteoporotic findings specific to female cyclists, participation in the NSG shows a profoundly positive impact on bone health of aging men and women when compared to the general population. With that being said, we would encourage seniors to participate in the NSG. We would also encourage strength training regardless of sport, but especially in cyclists and other low-impact sports such as swimming. By looking at the objective data such as grip strength, you can see that female cyclists with low bone health have a significantly lower grip strength, which indicates decreased overall muscle strength. Because of this, it would be beneficial for female senior cyclists to increase the amount of strength training they are doing. Strength training is most effective when dosed appropriately, so we would encourage seniors to consult with a health professional, such as a PT, to prescribe correct exercises.
I would not give any extra or special precautions to female senior athlete cyclists, however would encourage them to contact a PT to assess their balance to reduce their fall risk, improve posture, prescribe resistance exercises, and ensure proper technique of resistance exercises. As a PT, I would also consult their physician for pharmaceutical interventions. I hope this answers your question. If you have further questions, please let us know!
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Great job everybody! I love hearing about senior athletes and what all exercise can do to benefit the elderly population as a whole. Why do you think males in the general population had a higher prevalence of low bone health compared to senior athletes? I may need to review some literature and lectures and correct me if I’m wrong, but don’t females have a higher risk and prevalence of osteoporosis/osteopenia compared to males?
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Hi Colton! Thanks for the question. You are correct that females have a higher risk and prevalence of low bone health, which is reflected by our graphs in the poster. The graphs reflecting bone health are split by gender and then reflect the difference in self-reported low bone health of senior athletes compared to low bone health diagnoses of the general population. For each gender, those in the general population show a higher prevalence than the gender matched senior athletes. The highest prevalence was in the general population females, as expected. So to answer the question, we do not think males in the gen pop had a higher prevalence than senior athletes in general, but higher than male senior athletes.
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Great job on this presentation! Overall, I think that it was very informative in regards to the older adult population as well as senior cyclists. How have the results you have found impacted your view/opinion on cycling for older athletes? If you had a patient interested in becoming competitive/getting started with training for multiple events in that national senior games, would you steer them towards events/training besides cycling? I am curious what your thoughts would be along with possible responses to the patient depending upon their gender.
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Thank you for your questions Jenny! I think as a group we were just excited to be around older adults who were interested in staying active and maintaining a good quality of life, so though our results do not paint cycling in the best light as far as bone health goes, especially for women, we still believe cycling is a great way to stay active if it is done in conjunction with other types of activities. If I had a patient interested in participating in the senior games I would not necessarily steer them away from cycling, but I would encourage them to participate in other events that involve more weight bearing and movements such as jumping and cutting that would promote bone remodeling as long as it is safe for the patient. Cycling aside, women are more prone to have a higher prevalence of bone health diagnoses, so this could go into your thought process regarding a response to each gender regarding cycling recommendations. However, both older men and women are at risk of having decreased bone health, therefore they should all be screened regularly and participate in a variety of weight bearing and non-weight bearing activities. Hope that answers your questions!
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Great presentation! I found your research very interesting and applicable to our future patients, as we can show them that even low impact activities help combat the aging process. As stated above, it is known that strength training leads to improved bone health, but cardiovascular training can lead to improvements in VO2 max. VO2 max is a great predictor for overall health and longevity, and is known to decrease as we age. If you looked at the effects of cycling on VO2 max in senior athletes instead of bone health, do you think how cycling is viewed in correlation to health may be changed? Great job again!
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Excellent question, McKenze! If our study were to have focused on VO2 max rather than bone health, the results would likely indicate that cycling is an excellent form of exercise to maintain good health and longevity, as we already know. The intention of this study was not to have cycling viewed as a poor form of exercise for aging adults, but rather to improve understanding that overall wellness is best achieved through a variety of exercise types. What one form of exercise may lack (load bearing impact for maintenance of bone health), it will likely make up for in another area (VO2 max improvement). Thus, developing our understanding of various exercise pros and cons helps us to establish a well balance exercise routine. Thank you for your question!
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Great job everyone! This presentation really encompasses the importance of seniors remaining active for overall general health as well as bone health throughout the aging process. One thing that caught my eye was the use of grip strength as a measure of an individual’s overall muscle strength. Is this usually the go-to method or were there other methods your group considered using to measure overall muscle strength? Also, with grip strength, how did you standardize the results (time of day, etc.)? Again, great job!
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Hey Michaela, thanks for your questions! Grip strength has been researched and is a proven measurement often used to represent an individual’s overall muscle strength and is an indicator of frailty and future disability. Here are a couple of our research articles we used in our paper about grip strength. Grip strength is an easy way to quickly assess someone’s overall body strength, therefore many people use this as an outcome measure. Grip strength is also part of the Senior Athlete Fitness Exam (SAFE), so there was no other option to assess grip strength because our research was based off the senior athletes participating in the SAFE. We standardized grip strength by completing the assessment the same way with each athlete. Every athlete who completed the SAFE completed grip strength. We had every athlete complete a “trial” run on each hand and then we documented their 2nd trial as their final grip strength. We then used every athletes’ higher grip strength of their two hands as what we recorded in our research. Let us know if you have any other questions! Thanks!
Bohannon RW. Grip strength: an indispensable biomarker for older adults. Clin Interv Aging. 2019;14:1681‐1691. doi:10.2147/CIA.S194543.
Bohannon RW. Hand-grip dynamometry predicts future outcomes in aging adults. J Geriatr Phys Ther. 2008;31:3-10.
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Thanks for your feedback and question Michaela! The SAFE screen we used to gather our data involves two measures of strength. These include grip strength, as you saw in our study, and the 5 times sit to stand test. We could have chosen to use either of these as a measure of strength but we decided to go with grip strength because it has been shown in the literature to be an accurate screening tool for the measurement of one’s overall strength whereas the 5 times sit to stand test is used more for a screen of lower extremity strength and transitional balance. In order to standardize grip strength, we had each patient in a seated position with a neutral wrist and arm at their side with 90 degrees of elbow flexion. In 2011-2017, each participant was given three tries using each hand. This past year, participants were given one practice trail and then a grip strength was recorded on each hand. The higher of the two sides was classified as ‘dominant’ and used for analysis. Time of day was not standardized because screening was completely voluntary and the senior athletes chose when they wanted to participate in the SAFE. Hope that helps!
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Great job on your group presentation! It was very organized and interesting to learn about senior cycling athletes. Did your study include any exclusion criteria for subject recruitment? Also, for further research studies would you include other measures of strength besides grip strength? If so, would you predict to see any changes to the results?
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Good questions Morgan! We didn’t necessarily have any exclusion criteria, but to be included in the study participants were required to be a registered athlete at the NSG and be at least 50 years old during the calendar year of the study. So anyone that did not fit in this category was, therefore, excluded. The other strength measurement that is part of the SAFE screen is the 5 times sit to stand test. This test is another measurement of strength, but is more often used for specifically lower extremity strength and transitional balance measures. If we would have used this as a measure of strength instead, I do believe our results could have looked a little different. That would be an interesting thing to look at in future years. Thanks for your feedback and questions!
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Very interesting and well organized presentation! I feel as though this is information that we can all take into our future practice as physical therapists, providing evidence based education to the older population. I’m curious if you guys looked at the bone health of each individual sport or just combined them like in your presentation? It would be interesting to know the trend among each sport! Also would you take this research in any other direction in the future if you were to continue with this topic?
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Thanks for your questions Courtney! We would have liked to look at the bone health of each individual sport but since our research was focused on senior athlete cyclists, we decided to keep variables to a minimum for time sake. We combined all athletes together so we could focus cyclists alone vs all senior athletes. This is just scratching the surface, however. We also think it would be interesting to know the bone health for each individual sport and of those who are multi-sport athletes. This would be one direction we would take if we could continue with this research. We would like to look further into athletes who compete in cycling along with other sports, athletes who compete in triathlons, and athletes who compete in other individual sports. This would give us a better idea of which sports have impacted bone health the most. Please let us know if you have any other questions, thanks!
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Great job everybody that was a very interesting and informative presentation! What exercise suggestions do you have for the female cyclists that have low bone density, but are still doing a significant amount of strength training? How would you communicate to a patient that they may need to lessen their cycling training and substitute it with weight bearing training? (I would assume many of them only cycle for cardio due to competitive purposes)
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Great question, JP! If a female cyclist has already incorporated a strength training into her routine, my exercise would revolve around any other problems she may be having, such as other forms of cardiovascular exercise to avoid overuse injuries from excessive cycling. If they are not having any other problems, I would say that a combination of strength training and cycling would be an adequate combination to cover all the essential bases of cardiovascular exercise, sport specific exercise, strengthening, and bone health maintenance. in reference to your second question, it can be difficult to convince any athlete to substitute other forms of exercise, such as strength training, for their sport specific exercise. This study is a perfect example of a resource you can utilize to help an athlete or patient understand the importance of diversifying their exercise routine. Also, it is helpful to point out the impact that other forms of training will have on their performance. Many athletes become plateaued out in their area of training, so you can discuss with them that improving in area of weakness through new sport or exercise is a great way to continue making progress. Thank you for the comment and question!
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You guys did a great job! I thought your findings were interesting and I would like to see how a bigger sample size would effect the study. Do you guys have a hypothesis as to why female cyclists had a higher prevalence of osteoporosis compared to the general population, while the male cyclists had less prevalence of osteoporosis compared to the general population? Also, I found it interesting that female cyclists with low bone health spent 95 minutes strength training (Figure 3), which is similar to the strength training in female cyclists with normal bone health. So, I’m wondering why some have lower bone health than other female cyclists even though they strength train the same amount each week?
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Thanks for your comments and question, Emily! There are many possibilities as to why we found this. When separately looking at osteopenia and osteoporosis in females, there was a difference for osteoporosis as you have mentioned; however, this difference was not statistically significant when compared to the general population. Females in general are at risk for low bone health, and cycling may lack significant weight-bearing, which may contribute to low bone health. This combination would put female cyclists at an even greater risk for low bone health. It is also possible that rates at which these populations are tested for low bone density is different. For example, female senior athlete cyclists could have higher rates of testing for low bone density compared to the general population, and therefore report higher rates of osteoporosis diagnoses. Another possibility is inaccurate reporting, a limitation of this study.
In regards to training, we did not see any relationship between training time and bone health in females. Again, this could be due to inaccurate reporting. By looking at the objective data such as grip strength, you can see that female cyclists with low bone health have a lower grip strength, which indicates decreased overall muscle strength. Although it was only significant when compared to senior athletes, their grip strength was still less than senior athlete cyclists without low bone health. Although they are reporting a lot of strength training, we know strength training is most effective when dosed appropriately. Because of this we could hypothesize that female cyclists are not performing strength training with the correct dosage and/or technique. We should encourage seniors to consult with a health professional, such as a PT, for proper exercise prescription.
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Great job everyone with this presentation, I thought it was well organized and thought out. I am curious to see what future research on this topic will show as well. I found it interesting that when looking at strength training and bone health, there was a correlation between male cyclist with osteoporosis/osteopenia and lack of strength training, which makes sense. However, when looking at overall grip strength and bone health, the male senior cyclists had significantly higher grip strength than other senior athletes which would likely indicate overall muscle strength and lower prevalence of osteoporosis. What are your thoughts on this with a strong correlation between strength training and bone health among male cyclist, but then grip strength and bone health show male cyclist having significantly higher grip strength which should show lower prevalence of osteoporosis in male cyclists?
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Hi, Tristen! Thanks for you questions. Yes, male cyclists who reported low bone health diagnoses reported 0 minutes of strength training per week, which was statically significant from male cyclists without low bone health. Male cyclists with low bone health also had the lowest grip strength (the same group who reported 0 minutes of strength training). If you look at grip strength between these groups, you can see that male cyclists without low bone health have a higher grip strength than male cyclists with a low bone health diagnosis.
If you compare male cyclists to other senior athletes, yes male cyclists without low bone health diagnoses have a higher grip strength, but the cyclists with low bone health do not (Figure 5). In Figure 5, the cyclists are split into two groups based on their bone health in, whereas our comparison of low bone health diagnoses does not have the cyclists broken into groups based on low bone health (Figure 1). We did not compare grip strength to the general population like we did prevalence of low bone health. I hope this answers your question!
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Great presentation with lots of good information I should probably pass along to my cyclist dad who falls into this age group. I find it encouraging that cyclists have generally better bone health than the general population. It does seem notable that cyclists score worse than the other athletes though, since the list of senior games sports includes some low to no impact activities like non-ambulatory bowling, cornhole, golf, and shuffleboard. How do you think the cyclists would compare to the senior athletes if that all-inclusive category were divided into low impact and high impact sports?
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Thanks for your question Kyle! We believe that the lower impact sports such bowling, cornhole, golf, and shuffleboard may be on the lower end of have good bone health. However, this would be an interesting topic to see the exercise habits of all athletes, even ones who participate in these lower impact sports. They may be doing other activities outside of this sport that could contribute to better bone health. We believe the higher impact sport athletes would more than likely have better bone health as these athletes typically do more training to stay in shape. Please let us know if you have any other questions. Thank you!
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