Osteoporosis is a serious chronic condition that is characterised by reduced total bone mass and bone mineral density that can lead to fractures mainly of the vertebrae, hips and wrist following a fall. The World Health Organisation has identified that approximately 30% of postmenopausal women are inflicted with the condition (WHO, 1994). Additionally, it is estimated to cause over 1.5 billion fractures in those over the age of 50 in the USA (Layne & Nelson, 1999). Osteoporosis treatment has many options and can vary, however there is strong evidence in the literature that exercise can be one of the most effective options to increase bone mineral density for those with osteoporosis.
The Role of Exercise
Although a few studies have shown that bone mineral density can actually be improved, the main aim of exercise in osteoporosis treatment is to slow the rate of deterioration for those with both osteoporosis and osteopenia. A major benefit of using exercise over pharmaceuticals for osteoporosis treatment is the ancillary benefits that exercise provides. Not only can bone density be improved or maintained, but multiple risk factors can also be addressed such as improved strength, balance, cardiovascular fitness, and increased metabolism. Decreasing falls risk is another such area where exercise can have a positive impact. The risk of falls is known to be decreased through strengthening the musculature that acts on the affected joints. Falls risk is a major target area and is extremely important in osteoporosis treatment.
The common undermining theme in all exercise prescription for osteoporosis treatment is the need for weight bearing exercise. Both aerobic and resistance exercises can be utilised to impact bone mineral density scores. Weight bearing exercise provides the necessary load on the bone (via the muscle) that is required for healthy bone development and maintenance. Wolff’s law states that stress or mechanical loading applied to the bone via the muscle and tendons has a direct effect on bone formation and remodelling (Chamay & Tschantz, 1972).
The main form of aerobic exercise recommended for osteoporosis treatment is simply walking. Walking is critical as it is both weight bearing and also neurotically challenging enough to assist in general balance and subsequently decreases falls risk.
Frequency: 3-5 sessions per week
Duration: 30-60 minutes of continuous aerobic exercise per session
Intensity: 50-70% of Heart Rate Reserve
Type: Weight bearing aerobic exercise is preferred
- Walking (with intermittent jogging acceptable)
- Cycling/elliptical machine (if weight bearing is not possible)
A Heart Rate Monitor like this may help you. Or you can manually check your Heart Rate every few minutes to ensure your intensity is appropriately challenging
Although weight bearing exercise is ideal, if walking causes increasing pain then exploring alternative aerobic exercise is important. It is also important that if walking on the street you take caution in order to prevent the risk of falling which can lead to increased risk of injury for those with osteoporosis.
There have been numerous research articles indicating there is a strong correlation between strength and bone density at various sites in the body (Layne & Nelson, 1999). It is well established that resistance training is critical in osteoporosis treatment and prevention.
Frequency: 2-3 times per week
Sets: 2-3 sets per exercise
Reps: 8-12 repetitions per set
Intensity: 80-100% of 10RM (ten repetition maximum – i.e. the maximum weight that can be performed for 10 repetitions)
Type: Weight bearing exercise is ideal. But also exercises acting upon sites with the lowest T-scores is also beneficial.
- Sit to stands/Squats
- Glute bridges/Back extensions
- Lat Pulldown
- Seated row
- Plank exercise
Exercise prescription should be individualised based on each person’s special circumstances. Ensure that the correct technique is used for all resistance exercises.
Osteoporosis treatment can take many forms but through clinical research and experience both aerobic exercise and resistance exercise can be utilised in order to help improve or maintain bone mineral density. By following the exercise recommendations in this post you can help regain control over your bone health. Be sure to take appropriate precautions and avoid falls throughout all exercises.
Layne, J.E. and Nelson M.E. The effects of progressive resistance training on bone density: a review. Medicine and science in sports and exercise. 3(1):25 -30, 1999
Bonaiuti D, Shea B, Iovine R, Negrini S, Welch V, Kemper HHCG, Wells GA, Tugwell P, Cranney A. Exercise for preventing
and treating osteoporosis in postmenopausal women. Cochrane Database of Systematic Reviews 2002, Issue 2
Chamay, A., and Tschantz, P. Mechanical influences in bone remodeling. Experimental research on Wolff’s law. J. Biomech. 5:173-180, 1972.
Wolff I., van Croonenborg J.J., Kemper H.C.G., Kostense P.J. and Twisk J.W.R. The Effect of Exercise Training Programs on Bone Mass: A Metaanalysis of Published Controlled Trials in Pre- and Postmenopausal Women. Osteoporosis Int 9:1–12, 1999