Exercise and osteoporosis
Exercise is considered a modifiable risk factor for osteoporosis because an individual can choose whether or not to exercise. Other modifiable risk factors include nutrition, cigarette smoking, alcohol intake, and stress levels.
Although many daily lifestyle choices can aid in preventing osteoporosis, there are also non-modifiable risk factors. Examples of these can include a history of falls or fractures, older age, gender, white ethnic background, and a family history of osteoporosis (Pouresmaeili et al., 2018). For example, an older white postmenopausal woman will have a higher risk than a younger woman or a man of the same age.
Although many factors can predispose one to osteoporosis, physical inactivity is a large risk factor that an individual can easily control. Adding physical activity into your daily routine can lead to positive outcomes in many aspects of your life.
Being physically inactive can lead to bone loss which can cause osteoporotic bones. Bone loss is also common in the first 5-10 years after menopause due to the rapid change in estrogen levels (Pouresmaeili et al., 2018). In addition, low bone density can lead to hip fractures or bone fractures in the upper back. Because of these risks, older women should maintain some level of physical activity. According to the Bone Health and Osteoporosis Foundation, those with osteoporosis should perform strength training 2-3 times per week and do 30 minutes of weight-bearing exercise on most days of the week.
Types of exercises for bone health
Resistance training, balance exercises, and weight-bearing exercises are key to improving bone health. These exercises are crucial for those at risk for or diagnosed with osteoporosis (Benedetti et al., 2018). Below we will review each type of exercise.
- Resistance training: This type of exercise uses weight to build muscle strength and build bone strength. The added resistance or pressure on your bones and muscles prompts a growth response for new tissues. Although you can use free weights or weight machines, resistance training can also include resistance bands or your body weight (think of exercises like squats and push-ups).
- Balance exercises: This type of exercise involves safely challenging your balance. When you practice being off-balance, you get better at handling real-world activities that might cause falls. These activities typically involve exercises while standing on one leg, standing on an uneven surface, or performing multiple tasks while standing or walking. They are critical for fall prevention.
- Weight-bearing exercises: These include low-impact exercises that involve putting weight through your bones and joints. Anything that involves placing weight on your hands (think push ups and planks) and feet (walking, stair climbing, elliptical, squats) are weight-bearing exercises.
Some exercises provide a combination of these types of exercises. For example, a single leg balance is a weight-bearing exercise but also involves balance. A squat is a weight-bearing exercise but also is a type of resistance exercise. For some, a squat might involve some balance training as well.
All of these exercises also benefit your overall health. However, they need to be part of a routine to reap the benefits. Keep these guidelines in mind as you begin a new program:
- Perform 20-30 repetitions (or 2-3 sets of 10) of each exercise.
- Perform some type of exercise routine 3-4 times per week. This will elicit an effect to promote new growth and a noticeable change in strength.
- It takes 8-12 weeks for your body to make real physiological changes from a strength training program, so be patient!
Why resistance training matters
Strength training is important for osteoporosis for several reasons. As we age, we tend to be less physically active. We also have a more challenging time building and maintaining muscle mass and bone density. Losing strength can lead to a cascade effect of losing the ability to perform daily activities, increased risk of falls, and less support around your joints. Resistance training can help negate these risks and improve overall bone health,
Workouts involving resistance exercises, whether with dumbbells, bands, machines, or bodyweight, will challenge muscles and bones. When this happens, your muscles and bones will be prompted to grow newer and stronger cells. New bone cells will improve bone mineral density. Muscle strengthening will protect your bones and allow the body to move more safely.
Below are some examples of resistance exercises and their benefits:
- Squats: Squats strengthen your glutes and legs, which allow greater ease with standing up, walking, and going up and down the stairs. The muscles that get stronger from squats protect your hip and thigh bones, which are common fracture sites for older adults. These can be performed with or without weights. Weighted squats can be performed with resistance bands, dumbbells, a barbell, or a kettlebell. You can even use objects from around your home, such as a backpack, a water bottle, or a laundry detergent jug.
- Bicep curls: Curls strengthen your biceps muscles, allowing greater ease with lifting objects around your home or when shopping. When these muscles are strong, they also protect your arm and shoulder bones if you fall.
- Push ups: Push ups strengthen your chest and upper arm muscles, which help with activities such as rolling out of bed, pushing yourself up off of the floor, and standing up from a chair. When these muscles get stronger, they also protect your upper arms bones if you fall.
- Sit ups: Sit ups are a popular exercise to improve your core strength. The core muscles are the biggest supporting muscles of your spine. Many back injuries can occur when the core is weak. However, sit-ups can be risky for some who already have a low bone density in their spine. Please talk to your doctor before adding sit-ups into your routine. Other core exercises such as planks might be a better option for you.
How balance exercises help
Improving balance skills can help decrease the risk of falling in the future. Balance exercises are especially important for older adults who tend to have more difficulty maintaining balance with daily activities. Unfortunately, this population also has a higher risk of fracture; making falls much more dangerous.
Balance exercises challenge your ability to hold your body upright when faced with more challenging tasks, such as a narrow base of support or an uneven surface. Practicing these exercises will better prepare you for unpredictable obstacles around your home or in the community. It is common for physical therapists to prescribe these exercises to someone after they have fallen. It could be beneficial to seek physical therapy preventatively to safely challenge your balance and reduce your risk of falling.
Some balance exercises include:
- Single leg balance
- Tandem stance balance
- Feet together balance
- Obstacle course training
Do not perform these exercises alone if you think you have balance issues.
Why you need weight-bearing activities
Weight bearing exercises have many benefits for your overall health. Any physical activity that keeps your body upright against gravity is considered a weight-bearing exercise. When weight is placed on your bones, it triggers a response at the cellular level, which produces new bone cells, thus improving bone mass.
Weight bearing activities can include high-impact activities, such as running and jumping. Other weight-bearing activities include low-impact exercises, such as walking, pilates, or tai chi. It is important to note that many low-impact exercises are not weight bearing. The most common low-impact non-weight-bearing exercises are swimming and cycling. Although these activities are great forms of regular exercise, they do not provide the same bone health benefits as weight bearing exercises.
Other activities are considered weight bearing that don’t necessarily involve a routine workout. For example, everyday activities such as gardening or stair climbing are weight bearing and can lead to healthy bones.
Osteoporosis and high-impact exercise
High-impact exercise is great for muscle strengthening, tissue flexibility, and joint health but is not for everyone. Typically those with a history of fractures, at higher risk of falls or those with more advanced osteoporosis might want to avoid higher impact activities. Some examples of high-impact exercises include stair climbing, step aerobics, tennis, and running.
If you are unsure if these activities are right for you, discuss your options with your healthcare provider.
Exercise alone isn't enough
Exercise can only go so far for your bone health. Without proper nutrition, your body will not have the right resources to build new bone. There are certain nutritional considerations one should take to avoid osteoporosis or keep osteopenia from progressing.
Postmenopausal women are often prescribed calcium and Vitamin D to decrease their risk of osteoporosis. But there is more to it than that. Other vitamins might be recommended, and certain foods should be avoided to benefit bone health.
Osteoporosis exercises library
Starting a new exercise routine can be scary, especially if you are new to exercise in general or if you have just been diagnosed with osteoporosis. The most considerable resistance to exercise is the fear of injuring oneself.
Wellen’s exercise library provides hundreds of weight-bearing, balance, and resistance exercises that promote bone growth. Written instructions and visuals accompany these videos so you can follow along safely at home. Whether you are a novice or advanced exerciser, we hope to educate you on the proper form and techniques that make exercising safe and easy. We also hope to empower you to take your bone health into your own hands.