Exercise has the potential to be a highly effective treatment option for the prevention and management for osteoporosis. Osteoporosis is a significant global health problem, affecting hundreds of millions of people. There is no consensus for the exact best way to exercise to manage or prevent osteoporosis but what we do know is that all forms of exercise have at least some effect, and strength training is the most effective. In today’s article, we’re going to talk about ways to make strength training particularly effective for the prevention and management of osteoporosis, as well as look at some of the best exercises for osteoporosis.

Here is my Youtube video on this same subject if you would rather watch than read:

What is Osteoporosis?

Osteoporosis is caused by excess bone loss, or when the body doesn’t make enough bone, or both. Bone is actually very dynamic tissue, with cells constantly laying down new bone cells and removing old ones. If the processes that drive bone loss are working faster than those that replace bone, the result is gradual bone loss that eventually results in weakness and most importantly, increased risk of fracture.

Osteoporosis is more common in women than men, with an estimated 200 million women affected worldwide. Age is a significant risk factor for osteoporosis, with 70% of women over 80 in north America being affected. Although more prevalent in women than men, men have a greater likelihood of dying as a result of an osteoporosis related fracture. Men also need to be conscientious about their bone health.

Osteoporosis itself has no symptoms, but it does create a significant and dangerous increased risk of fall and fracture. When someone with healthy or normal bone mass falls down, they may not be hurt at all, whereas someone with osteoporosis may severely fracture a bone or multiple bones. These injuries can contribute to a loss of functional independence negatively impact quality of life. Maintaining healthy bone mass is an essential component of healthy aging, and exercise plays a crucial role.

Can Exercise Help Prevent Osteoporosis?

There are steps to be taken to prevent osteoporosis at all stages of life. For children, lots of active play will help them achieve higher levels of peak bone mass in early adulthood, reducing the likelihood of more severe levels of osteoporosis as they age.

For adults, all forms of exercise can play a role in preventing osteoporosis. Research has shown that 7.5 miles of walking per week, just over one mile per day, significantly increased bone density in young women compared to women who walked only one mile per week.

Other studies have shown a positive association between general fitness as measured by VO2 max and bone density.

It’s clear that physical activity and exercise of any kind can have a significant impact on preserving bone health, but strength training is the most effective approach. How do we design a training program to prioritize bone health? What are the details that really make a difference?

As with all exercise interventions for disease prevention or management, adherence is a major limiting factor to the success of the intervention. Exercise is the wonder drug, but it only works if you do it and if you keep doing it. Keeping things as simple and as straight forward as possible is essential.

Designing an Exercise Program for Osteoporosis

The exact optimal frequency, duration, and intensity of an exercise intervention for osteoporosis has not been established. We can extrapolate based on what we know about good training practices and exercise strategies for other chronic conditions. Moderate intensity sessions of 30 minutes or more in duration done two or three times per week is enough to achieve a clinically relevant effect and also provide many of the other benefits of strength training.

Importantly, peak load, or the maximum amount of force produced, or weight lifted, has a greater impact on bone density than the maximum number of repetitions performed. And higher impact exercises have been shown to have a greater effect than lower impact exercises. This might be surprising or even confusing to some. High impact training or heavy lifting probably isn’t what comes to mind when you think about training for people concerned about osteoporosis. So, before we talk about any exercises, let’s get a few things straight.

Load, impact, and intensity, are all relative. “Heavy” for a 20-year-old football player and heavy for a 65-year-old grandmother are not the same. Rather than focussing on the absolute weight lifted, think about something being RELATIVELY heavy. For that grandmother, maybe lifting an 8 lb weight for 5-6 reps is close to her max strength, so that is heavy for her, and thus categorized as heavy lifting in this context.

High impact is relative too. A box-jump onto a 4-inch box might be a high impact exercise for older adults and beginners concerned about bone health.

And of course, any time we’re talking about exercise for an at-risk population, it needs to be appropriately facilitated by qualified exercise professionals.

Another important driver of bone growth is longitudinal loading of bone, or when weight comes down along the long axis of the bone. This sends a signal to the cells that create bone, osteoblasts, to do exactly that.

The Best Exercises for Osteoporosis

It stands to reason that the most effective exercises for osteoporosis are relatively heavy, high-impact, exercises that longitudinally load the bones. Given the high-intensity nature of this type of training and the fact that it’s for a clinical application, a low volume, relatively low frequency approach is required to allow for adequate recovery between training sessions.

The best exercises for osteoporosis that tick all of these boxes and provide the most bang for our buck will look familiar. Squats, deadlifts, and split squats or step ups for the lower body, and push-ups and presses for the upper body.

These exercises should be used whenever possible taking care to not force the issue around any mobility constraints or other frailty concerns. Take the squat for example. I would default to using a goblet squat, or something similar like a goblet box squat. In the event that holding the weight goblet style is problematic for the wrist, we could look at doing the same movement with the weight being pulled off the floor, which is therefor technically a deadlift, but the effect as it relates to bone health would be similar.

I am partial to the incline push-up for the upper body,  using a smith machine if we’re in a gym, or an appropriately secured table or couch if we are training at home. There is no reason to avoid pressing movements, but push-ups provide the added benefit teaching someone to control their own body weight. Over a long period of time, I would absolutely look to include both push-ups and pressing variations.

An overhead press would be an extremely effective exercise for osteoporosis, but many older adults have a kyphotic or rounded upper back posture and a resulting lack of mobility that makes barbell or even dumbbell pressing contraindicated. For folks like this, I like to use the landmine, as we would still get the longitudinal loading effect without needing that end range shoulder flexion that so many people are lacking. A full-size barbell is often too heavy for beginners, so using two arms to press the bar up, and one to lower it down, is a great modification that makes it much more accessible.

How Qualified Exercise Professionals Can Help

These are just some examples of how to adapt these foundational strength training exercises to be particularly helpful for the goal of promoting bone health.

As always, we must take steps to ensure that the exercise program is appropriate for the person doing it. Qualified exercise professionals can manage and minimize the risk associated with exercise and help people gain the benefits of strength training while minimizing risk.

Load is the great equalizer. An older person, or a beginner can do exercises with just their body weight. Even if you start with 2 sets of 5 sit to stands getting up out of a chair, that can be the starting point towards moving under load with good technique and building strong and healthy bones.

From my own experience, I have coached many senior women, previously untrained, to being able to deadlift well over 100 lbs for multiple reps. This is done slowly and progressively, but we get there. Beyond simply building strong bone, getting demonstrably strong does wonders for people’s self-confidence, and can help them make the most of their retirement years too.

In 2021, I will be launching a strength training program specifically for seniors. If you want to improve your bone health, and get seriously strong, safely, get in touch and reserve your spot today.

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