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Which exercises are best for people with osteoporosis?
Osteoporosis is a disease characterized by loss of bone that increases the risk of fracture, particularly in the wrist, spine, and hip. More than 10 million adults in America have osteoporosis, and 43 million more are estimated to have low bone mass, putting them at increased risk for the disease. Eight million of the 10 million people who have osteoporosis are women. Exercise can have a positive effect on bone mineral density and the strength of bone, but it is a complicated relationship because of many factors including genetics, age, gender, hormone and menopause status, activity level, and nutrient deficiencies. Age applies to everyone when it comes to the effect of exercise on building bone strength, and so I will review some of the age-related differences and then let you know what the guidelines are.
- Research shows that increases in estrogen in girls helps bone form (puberty is when estrogen rises), and exercise added during this time enhances the effect on bone density.
- Research shows that active youth have higher bone density than inactive children
- Research suggests that denser bone formed during childhood may track into adulthood. That is, if children and teens exercise enough to create denser bones than their sedentary peers, then they may have thicker bones as adults.
What is the effect of exercise on bone density?
The effect of exercise on bone density is most evident in athletic kids who participate in sports that cause the highest levels of ground reaction or impact forces like gymnastics and weight lifting, and less pronounced in low impact sports like swimming. Weight lifting is interesting because it's not always the ground reaction force that creates the increase in bone density, but simply the force applied where the muscle attaches to the bone and pulls on it during the lift. For instance, if you do lots of lifting with your biceps, which does not involve impact on the ground, the bone density in your arm may show some increase. An example of this is a professional tennis player's dominant arm (the arm they play with). Typically the dominant arm has bones that are larger than the non-dominant one because the athlete swings a racket with it all the time and so there is a training effect.
As for young adults, it is generally believed that peak bone density is reached by the time we reach our late 20s or early 30s, and research suggests that athletes in this age group have higher bone mineral density than sedentary individuals. Importantly, the effect of exercise on bone density is site-specific. That is, the exercise effect on bone density appears primarily in the bone that is involved in the activity. For example, if you do jumping exercises, then bones in your legs will show the greatest effect, whereas bones in your arms will show no effect. Bones in the spine will also show some effect with jumping, but perhaps not as much as the bones in the leg and hips that absorb the majority of the impact.
As for middle-aged and older adults, bone density decreases by about 5% per decade after the age of 40. Some scientists believe that during these times of life it may not be realistic to expect substantial increases in bone density, but rather we should expect a reduction, or attenuation, of the loss of bone that we experience as we age. These scientists may be right because there is little evidence that walking, weight lifting, or any other type of exercise, substantially increases bone density in older adults. In some studies, there is a trend or suggestion of more density, but the results seem to be small and clinically insignificant. What you can say with some certainty is that active individuals in these age groups do maintain their bone density while their sedentary peers do not. And that's a good thing.
How does exercise help your balance?
Equally important for older adults in terms of osteoporosis is the effect of exercise on the risk of falling. When individuals with osteoporosis fall, they typically break bones, and in fact, sometimes the bones are so brittle that they break before the person hits the ground; for example, just stepping off a curb could break a brittle bone in the hip, and then the individual falls as a result. People fall for many reasons, including poor balance, poor vision, decreased strength and range of motion, and cognitive impairments like dementia. Exercise can't help every factor, but studies show that exercises such as balance training (e.g., tai chi), leg strengthening, and flexibility training (e.g., yoga) can reduce the risk of falling in older adults.
It is important to note that the effects of exercise on bone density and falling in older adults may diminish if you become sedentary, so maintaining activity through one's lifetime is an essential step in maintaining healthy bones and reducing the risk of fractures.
Which exercises should I do if I have osteoporosis?
As for which exercises are best for people with osteoporosis, the simple answer is:
- Weight-bearing exercises that cause force on the bones like jogging, stair climbing, and walking briskly
- Resistance exercises that involve the bones you are concerned about
- Balance exercises if you are an older adult
Research is clear that you need some force-loading or weight-bearing on bones to have any effect on density and strength, but caution should be taken with exercise when you have osteoporosis. You should avoid:
- Exercises that might increase the risk of falling
- Movements like twisting of the spine and bending from the waist
- High-impact activities like high-intensity aerobics or jumping
- Excessive weight during resistance exercise
The American College of Sports Medicine recommends the following exercises for bone health for different age groups:
For children and teens:
- Type: Impact activities, such as gymnastics, jumping (sometimes called plyometric training), and moderate-intensity resistance training; participation in sports that involve running and jumping like soccer and basketball (although they concede that research to prove this is lacking)
- Intensity: high, in terms of bone-loading forces; for safety reasons, resistance training should be moderate, equivalent to 60% of the maximum lift
- Frequency: at least three days per week
- Duration: 10-20 minutes (two times per day or more may be more effective)
- For adults:
- Type: Weight-bearing endurance activities (tennis; stair climbing; jogging, at least intermittently during walking), activities that involve jumping (volleyball, basketball), and resistance exercise (weight lifting)
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