Osteologie 2023; 32(03): 171-175
DOI: 10.1055/a-2080-2362

Körperliches Training und Frakturprävention. Trainingsinhaltliche Empfehlungen zur Verbesserung der Knochenfestigkeit

Exercise and fracture prevention. Recommendations on types of exercise for bone strengthening
Sebastian Willert
1   Institut für Radiologie, Universitätsklinikum Erlangen, Erlangen, Deutschland
Simon von Stengel
1   Institut für Radiologie, Universitätsklinikum Erlangen, Erlangen, Deutschland
Matthias Kohl
2   Department of Medical and Life Sciences, Hochschule Furtwangen - Campus Villingen-Schwenningen, Villingen-Schwenningen, Deutschland
Franz Jakob
3   Bernhard-Heine-Centrum für Bewegungsforschung, Julius-Maximilians-Universität Würzburg, Würzburg, Deutschland
Katharina Kerschan-Schindl
4   Physikalische Medizin und Rehabilitation, Universität Wien, Wien, Österreich
Uwe Lange
5   Physikalische Medizin und Osteologie, Kerckhoff-Klinik GmbH, Bad Nauheim, Deutschland
Stefan Peters
6   Deutscher Verband für Gesundheitssport und Sporttherapie e.V., Hürth, Deutschland
Friederike Thomasius
7   Frankfurter Hormon- und Osteoporosezentrum, Frankfurt, Deutschland
1   Institut für Radiologie, Universitätsklinikum Erlangen, Erlangen, Deutschland
› Author Affiliations


„Trainingsinhalte“ sind „konkrete Maßnahmen zur Realisierung des/der geplanten Trainingsziel(e)s“. Im Bereich der Forschung am Knochen bietet sich eine Einteilung der Trainingsinhalte (oder Belastungstypen) in mechanisch lokale wie axiale Belastung, Muskelzugsbelastung, Belastungsverteilung sowie einen systemisch übergreifenden „Knochenfaktor“, die endokrine Komponente an. Crosssektionale Studien mit Sportlerkollektiven sowie longitudinale Untersuchungen mit untrainierten, älteren Kollektiven zeigen dabei, dass sich Trainingsinhalte mit hohem osteoanabolem Potenzial durch hohe axiale Belastung, hohe Muskelzugsbelastung, ungewöhnliche Belastungsverteilung und günstiges hormonelles Milieu auszeichnen. Ein günstiges hormonelles Milieu, also eine belastungsinduzierte erhöhte Konzentration anaboler Substanzen, kann dabei permissiv für die Effekte mechanischer Knochenfaktoren sein. Hohe axiale Trainingsreize kollidieren indes häufig mit dem körperlichen Status älterer Menschen. Ein dynamisches Krafttraining, idealerweise an Kraftgeräten, bietet die Möglichkeit auch intensive Methodenvarianten sicher und schmerzfrei zu applizieren. Insbesondere das Vehikel „Wassergymnastik“ bietet sich für besonders vulnerable Gruppen als Trainingsoption zur eigenverantwortlichen Osteoporosetherapie/Frakturprophylaxe an. Rehabilitationssport und Funktionstraining können dabei als geeignete Vehikel zur Umsetzung dienen.


In basic exercise science, training contents characterize the types of exercise needed to address the training aim. The usual classification of exercise contents into endurance, resistance or coordination exercise is hardly applicable for bone, however. As an example, endurance exercise includes various types of exercise that considerably vary in their mechanical demands (e. g. running vs. swimming). Following a more bone-specific approach, a classification of training contents into three site-specific, mechanical bone factors and one systemic endocrine factor is more appropriate. Applying bone factors, i. e. axial loading, muscular tension, load distribution and endocrine effect of exercise, enables the relevance of different sports for bone strength to be judged by analyzing their inherent exercise characteristic. Many cross-sectional studies focus on highly trained athletes because of the high training compliance and the long exercise exposure in this cohort. As confirmed by longitudinal exercise trials with older adults, the study results indicate that types of exercise with high demands on axial loading, muscular tension and load distribution, which in turn generate a favorable hormonal milieu, are particularly effective in increasing bone-strength parameters. Dynamic resistance exercise (DRT) or exercises with high impact (e. g. exercises with jumping or sprinting components) largely offer such favorable exercise characteristics. However, the physical status and safety aspects related to the predominately older cohorts prone to osteoporosis frequently conflict with the application of high-impact exercise. On the other hand, current evidence suggests that even high intensity DRT can be applied safely and pain-free in older cohorts with osteoarthritis. For particularly vulnerable cohorts, aquatic gymnastics can be recommended for increasing bone mineral density at the lumbar spine and proximal femur. As a sustainable vehicle for implementing exercise, consistently supervised “Rehabilitationssport” or “Funktionstraining” can be recommended as a feasible and widespread training option for fracture prevention.

Publication History

Received: 10 February 2023

Accepted: 26 March 2023

Article published online:
17 May 2023

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