Exercise for fracture prevention - evidence and consensus-based practice guideline of the osteology umbrella association (DVO).

Exercise is considered a cornerstone of fracture prevention in people at increased risk of fractures. However the most effective exercise strategy for preventing fractures has yet to be determined. The primary aim of the present evidence- and consensus-based guideline was thus to derive practice recommendations for effective, feasible and safe training programs to prevent fractures in various cohorts. A novelty of our approach was the assignment of dedicated cohorts at risk for fractures to training objectives that prioritized bone strength or/and fall risk or/and fall impact reduction. In summary, bone strength exercise protocols should include periods of high loading magnitude and rate provided by impact loading and dynamic strength/power training. Fall risk should be addressed by an individualized mix of balance, perturbation, functional, stepping and interactive cognitive-motor exercises. Simple and low-risk strategies for safe landing can be advised unreservedly, however more sophisticated strategies derived from martial arts require close and experienced supervision and high safety standards. If the latter strategies are chosen in interventions, they should be reserved for dedicated training periods. Training frequency should be set at least 2 (bone strength) or 3 (fall risk) sessions/week, possibly with a (block) periodized approach with intense periods intermitted by low/regenerative phases, with varying training aims focusing on progression.