[Physical training for fracture prevention : Evidence- and consensus-based practice recommendations of the updated...

Exercise is an effective intervention for preventing low-trauma fractures, but optimized training recommendations for different target groups are not available in terms of the desired level of detail or with the desired practical orientation.

The primary aim of this evidence- and consensus-based guideline was, therefore, to derive personalized practice recommendations for effective, safe, and transferable training programs for fracture prevention. The present approach is based on assigning training goals according to the determinants of fracture risk that are relevant to the individual, such as bone strength, fall risk, and risk of fall-related injury.

Training protocols for maintaining or improving bone strength should generally include phases of intensive mechanical loading, which can be achieved through weight-bearing exercises and dynamic strength training. The fall risk should be addressed through an individualized combination of balance training, including perturbation training, step training, and interactive cognitive-motor and functional strength training. Simple, low-risk strategies for landing safely during or after a fall can be recommended without reservation; however, more demanding falling techniques require close supervision by experienced staff and high safety standards. Ideally, the frequency of training should be three sessions per week across all training goals. We advise (block) periodized approaches with phases of different focus, as well as consistent, individual adaptation and progression throughout the training process.