Preventing Osteoporosis

Exercise

Regular physical activity on a long-term basis has a particularly important role in maintaining healthy bones. Exercise can maintain and increase bone strength by increasing bone mass or by slowing age-related bone loss. Muscle strength is also increased, which is important for supporting the joints and preventing falls.

Exercise has also been shown to improve co-ordination and balance, which helps to prevent falls and to improve general physical health and well-being.

Be aware that any positive gains in bone strength are lost when you stop exercising, so that it is important that your exercise is regular and ongoing.

Caution: Someone who has established osteoporosis (one or more fractures) may not be able to do as many types of activities as someone without osteoporosis. Talk to your doctor and physiotherapist about activities you can do.


Exercise helps to build and maintain strong bones, prevent falls and fractures and speed rehabilitation.


Physical Activity at Different Ages and Stages

 

Childhood /Adolescence

Bone status:
In girls, the major build up of bone occurs in the pre-teen years. Lifetime Peak Bone Density is reached during mid to late 20s.
Effect of exercise at this age:
Maximises peak bone density, which helps keep bones strong for longer in adulthood.

Early to Middle Adulthood

Bone status:
Bone loss starts to occur very gradually when a person reaches their thirties, although increases in bone density are still possible during middle adulthood. In women from 45 years on, bone loss begins to increase to 1- 2% per year.
Effect of exercise at this age:
Maintains bone strength by helping to slow bone loss, plus improve muscle strength, heart and lung fitness.

Postmenopausal Women

Bone status:
Bone loss speeds up to 2-4% per year at the onset of menopause.
Effect of exercise at this age:
Can maintain bone strength by helping to slow the rate of bone loss following menopause.

Men

Bone status:
Generally bone density tends to remain constant until later in life. Low testosterone or hypogonadism can cause bone loss similar to postmenopausal women.
Effect of exercise at this age:
Improvements in muscular strength, balance and coordination to help prevent falls and maintain general health. Testosterone combined with exercise may be beneficial for bone in men with hypogonadism.

Older Adults without osteoporosis

Bone status:
After 75 years of age further increases in bone loss occur in both sexes, especially from the neck of the femur (thigh bone). The risk of fracture increases as bone loss increases.
Effect of exercise at this age:
Helps to maintain bone strength and increase muscle strength, balance and co-ordination, which in turn help to prevent falls.

Older Adults with Osteoporosis/Fractures

Bone status:
Bones are increasingly thinner and brittle.
Effect of exercise at this age:
Exercises recommended by physiotherapists can improve general health, strength, balance and posture to prevent falls.


Exercises for bone health

(assumes you don't have osteoporosis, otherwise see section below on exercise if you have osteoporosis)

There are two main types of exercises that are beneficial to bone health:


Weight bearing exercise

Weight-bearing exercise means any exercise that is done while you are on your feet, so that gravity is exerting a force.

Your bones become stronger when they bear weight during exercise and when some amount of 'impact' or extra strain is placed on those bones.

If the 'strain' level is too low, then the bone will not become stronger and may still lose mass. Too much 'strain' could result in injury. The best 'strain' is from activities that may be new to your body, which means your bones are getting a variety of forces and loads on them.

Examples of weight-bearing activities are jogging, walking, tennis, dancing, golf and netball. Swimming and cycling are not considered weight-bearing exercises (but are good for muscle strength).

Activities that are high-impact, such as aerobics, running and jumping, have a greater effect on bone strength than 'low-impact' activities, such as walking and cycling. Everyday activities such as normal walking are not considered to be especially bone-building because they produce a strain that is 'normal' for the body, although very fast walking has been shown to help maintain bone strength.

High-impact activities may not be suitable for everyone, especially if you have problems with your joints or other medical conditions. If you are unfit or inactive, lower intensity exercise is a safe starting point and you can progress to more moderate intensive exercise over time.

Everyday ways to increase your level of weight-bearing exercise:

  • walking some or all of the way to work,
  • including some hills or specific exercises in your daily walk,
  • using stairs instead of lifts.

It is important to talk to your doctor or physiotherapist about the best type of weight bearing exercise before you start.

A very fast short walk (20 min) is better for bone than a long slow walk of 1 hour.

2. Resistance exercises (lifting weights with your arms or legs)

 

Resistance exercises, also called strength training, can have a good effect on the health of your bones and have been shown to reduce the number of falls in older people. The strong muscle contractions required to move a heavy weight place stress or 'strain' on the bone that the muscles are attached to. When bone feels a 'strain' repeatedly (as also happens in regular exercise training) it responds by increasing bone mass so as to become stronger.

Targeting specific muscle groups around the hip, spine and arms with weight-lifting is also a good idea.

Everyday activities do not produce enough 'strain' to change bone mass, so resistance exercises need to be increased as the body adapts to each new level.

This can be done by:

  • increasing the resistance
  • increasing the number of repetitions
  • changing the exercise so that a new strain pattern begins
  • when it starts to feel easy, you need to increase the weight and do more repetitions.

Planning Your Exercise Program

Before you start, it is important to talk to a doctor or physiotherapist about the best type of resistance exercise for you.


Exercise Tips for Strong Bones


  • To have an effect on bone, exercise needs to be REGULAR, FAIRLY VIGOROUS, HAVE VARIETY (put different loads on it), and include SHORT INTENSE BURSTS.
  • The amount and type of exercise will vary depending on your age and bone health. Overall, most people should aim to exercise for 30 ­ 40 minutes, four to six times each week, and include some weight-bearing and resistance exercises in the program. You can build up to this level over time.
  • Start slowly and progress gradually. Try to get into an exercise routine. You can break it up into several smaller amounts throughout the day.
  • Set short term goals for what you want to achieve. They must be realistic, achievable and measurable. For example, adding 50 jumps to your regular walk over a 3-month period.
  • The process of bone building is slow, it starts to happen as soon as you start regular exercise but it takes at least 6 months to be able to measure the effects.
  • Good exercises for bones: fast walking, jogging, dancing, tennis, volleyball and lifting weights. Choose exercises that you enjoy and vary your program to keep it interesting.
  • If you are having pain while exercising, stop and talk to your doctor or physiotherapist.

Exercise: if you have osteoporosis

If you have been diagnosed with osteoporosis and/or have already had a fracture, you should see your doctor or physiotherapist about starting an individual exercise program.

  • Your aim is to maintain bone strength and reduce the risk of fractures and falls by improving posture, balance and muscular strength.
  • Because of the higher risk of fracture, exercising at a level high enough to produce stress on the bones is not recommended.
  • Appropriate exercises include Tai Chi for balance, flexibility and muscle strength, gentle weights for muscle strength, water-based exercises (hydrotherapy) and walking.
  • Avoid high impact activities (eg running).
  • Avoid jarring & twisting movements (eg golf swing).
  • Avoid heavy lifting and lifting objects some distance from your body (eg picking up grandchildren).
  • Avoid abdominal curls (sit-ups).
  • Avoid bending forward from the waist.
  • Avoid sudden, abrupt movements.
  • Don't overdo it (especially if you have not done any activity for many years).