Bone Up on Exercise Recommendations
Maybe you’ve been diagnosed with osteopenia or osteoporosis, and you’re seeking answers?
Your doctors may have told you that you have the bones of a 90 y/o, not to lift more than 30 pounds, or you must take prescription medications or your bones will crumble.
That’s enough to strike fear in anyone.
I’ve shared a Home Exercise Program for bone health and summarized 3 different studies looking at exercise and osteoporosis. Feel free to read the full studies in the links provided at the end.
So we’re on the same page, let’s define osteoporosis. It’s a disease characterized by low bone mass and deterioration of bone tissue, which can lead to increased risk of broken bones. Known as the “silent thief”, bone deterioration can occur over a number of years without presenting any symptoms.
Unfortunately, if detected at the time of a break, the disease is already fairly advanced. The most common fractures we see with osteoporosis are located in the hip, spine, and wrist.
Before we dive into the studies, here are a few select Home Exercises that are great for your bones.
- Heel Raise (add hand weights when ready)
- Hip Hinge (great to practice with a dowel to cue good alignment, improves posture and is a spine sparing technique to prevent spine fractures)
- Lunge (when strong enough with proper form, add hand weights if able)
- Back extensor strengthening
- Upper back extension mobility (draping over a round surface like a ball or roller)
Dr. Lora Giangregorio conducted studies through the University of Waterloo in Canada and these are her findings from her paper
“Too Fit to Fracture” for Osteoporosis Canada.
- There is strong evidence that exercise can reduce falls in older adults. (This is important for those with osteoporosis as your risk of breaking a bone with a fall is greater.)
- For individuals with osteoporosis:
- They strongly recommend that people with osteoporosis engage in a multicomponent exercise program (so not just one type of exercise).
- It should include resistance training (think bands and free weights) in combination with balance training.
- For people with fractures in their spine, the above two recommendations are the same however the exercise program should be supervised by a physical therapist.
Exercise Recommendations from Lora Giangregorio from Osteoporosis Canada
- Train your muscles for strength (weights or bands) ≥ 2x week
- Challenge your balance daily (tai chi, single leg balance, dynamic balance)
- Add aerobic physical activity (preferably walking, hiking, jogging, dancing)
- Walking is not enough
- Practice spine sparing strategies (like hip hinging)
- Pay attention to posture, train back extensor muscles daily
Here’s Dr. Giangregorio’s Too Fit to Fall or Fracture exercise handout free to download. It has some easy to understand exercises and visuals.
Another study that’s really exciting is the LIFTMOR Trial by Belinda Beck from Australia.
This trial predominantly looks at the effects of free weight training on bone and function.
Her team looked at the effects of high lifting loads (heavier weights than what we might normally see for people with osteoporosis or osteopenia) and impact (think landing from a height of 8 inches onto your feet after doing a chin up exercise on a bar)
Optimal bone loading and bone building requires higher weights and this is not traditionally recommended for people with osteoporosis because of a perceived high risk of fracture.
The purpose of the LIFTMOR trial was to determine the effectiveness of these techniques and to monitor for any fracture in postmenopausal women with low bone mass.
The intervention group consisted of 49 postmenopausal women over 8 months.
After 2 months of training proper posture and lifting techniques with no resistance, they progressed to doing:
Warm up deadlifts (lifting lower amount of weights from the floor with spine straight, knees bent)
Next they did 3 different lifting exercises at 80-85% of 1 repetition max.
That’s determined by how much weight you can lift 5x with good form and breathing and get to fatigue.
They did Deadlifts, Back Squats (with a barbell behind their head, hips and knees bending and straightening) and Overhead Press (pushing weights or a bar up above you as you stand tall. They did 5 sets of 5 repetitions for each of these.
The 4th exercise they did was impact loading, 5×5 sets of jumping chin ups with drop landings to their feet for bone building stimulus to the hips.
Pre- and post-intervention testing included X-rays of the low back and hip bone and measures of different functional performance physical therapy tests that measure walking speed, leg strength and balance.
Improvement in Bone Density and height in the intervention group
- Improved bone density at the hip of 2.9%
- Improved lumbar spine bone density of 0.3%
- Improved height of + 0.2% (yes their stronger back muscles and focus posture actually improved their height!)
Functional improvements in the intervention group
- Increased leg extensor strength by 37.1%
- Increased Back extensor strength by 36.3%
- Faster Gait speed by 4.3%
- Increased leg strength (stronger hip and leg muscles) by 11.6%
- Improved Balance by 5.5%
Contrary to current opinion, high intensity training with impact was effective and caused no injuries for postmenopausal women that were highly supervised.
This short video clip includes participants in this trial. The results are impressive but I shudder at the posture of the woman in the purple tank top and the woman in yellow at the end as they lift. We can do better with our posture and alignment.
Physical Therapist Management of Patients With Suspected or Confirmed Osteoporosis: A Clinical Practice Guideline From the Academy of Geriatric Physical Therapy
This paper published in 2022 is actually geared for physical therapists treating patients with osteoporosis. The team assembled clinical practice guidelines for the management of patients with suspected or confirmed osteoporosis. They examined 55 high quality randomized controlled trials of exercise for osteoporosis.
Key takeaway without too much detail for non PT’s include:
Do a combination of any two or more of the following exercise types below. Combining activities slows the decline of bone in the spine and hip.
Doing just one type of exercise won’t have the same effect on your bones.
An example of a combination for bone health would be Pilates and weight training or walking/jogging combined with Tai Chi.
Exercise Types as they defined them:
Static weight bearing exercise (Single leg balance to slow decline at femoral neck.)
Dynamic weight bearing low force (dynamic balance exercises, Tai Chi, walking, slow stair climbing as exercise to slow bone decline at the lumbar spine)
Dynamic weight bearing high force (jumping, dancing, jogging, basically if one or both feet leave the ground)
Non weight bearing exercise low force (Pilates mat, yoga)
Non weight bearing exercise high force (such as a circuit at a gym)
If you’re hungry for more, I encourage you to explore the full studies listed below.
Too Fit To Fracture: exercise recommendations for individuals with osteoporosis or osteoporotic vertebral fracture
L M Giangregorio 1, A Papaioannou, N J Macintyre, M C Ashe, A Heinonen, K Shipp, J Wark, S McGill, H Keller, R Jain, J Laprade, A M Cheung
High-Intensity Resistance and Impact Training Improves Bone Mineral Density and Physical Function in Postmenopausal Women With Osteopenia and Osteoporosis: The LIFTMOR Randomized Controlled Trial.
Watson S, Weeks B, Weis L, Harding A, Horan S, Beck B.J Bone Miner Res. 2019 Mar;34(3):572. doi: 10.1002/jbmr.3659. Epub 2019 Feb 25.PMID: 30861219
Physical Therapist Management of Patients With Suspected or Confirmed Osteoporosis: A Clinical Practice Guideline From the Academy of Geriatric Physical Therapy Hartley, Gregory W.; Roach, Kathryn E.; Nithman, Robert W.; Betz, Sherri R.; Lindsey, Carleen; Fuchs, Robyn K.; Avin, Keith G. Journal of Geriatric Physical Therapy. 45(2):80, April/June 2022.
If you’re a PT – I wrote a version of this blog, especially for PT’s! Download it here.