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Introduction
Why Exercise?
Exercises That Increase Bone Density
Other Types of Exercises Important for Osteoporosis Prevention and Treatment
Dangerous Exercises to Avoid
Important Principles of Exercise
Important Components of a Walking Program
Daily Living Activities
Custom-Designed Exercise Programs
Conclusion

Introduction

More than 28 million Americans are at risk for osteoporosis, and the numbers continue to increase as baby boomers reach menopause. Osteoporosis causes the bones to become weak and brittle. Brittle bones can lead to fractures and other health concerns. The good news is that proper medical management, a well-designed exercise program, and nutritional counseling can minimize the effects or reduce the risk of developing osteoporosis.

Why Exercise?

Exercise is an important component in the comprehensive treatment of osteoporosis. Exercise can decrease bone loss, increase bone density, and reduce the risk of fractures. It is important to understand the principles of proper exercise for preventing and treating osteoporosis to ensure that a program is both safe and effective.

Exercises That Increase Bone Density

Both weight-bearing and resistance exercises have been shown to increase bone density.

Weight-bearing exercises refer to activities where the weight of the body is transmitted through the bones, working against gravity. Your bones respond to this force by growing stronger. Walking, jogging, dancing, hiking, stair climbing, and aerobic exercises are all examples of weight-bearing exercises. Bike riding and swimming, although good exercises, are not weight-bearing. Weight-bearing exercises should be performed at least three to five times per week. The goal is to work up to 45 minutes or more per session. If you have osteoporosis, you should not perform high impact activities such as jogging or high-impact aerobics. These exercises cause too much jarring of the spine and can increase the risk of vertebral fractures.

Resistance exercises generate muscle tension on the bones. This strengthens the muscles and stimulates the bones to grow stronger. Exercising with weights or resistance bands are examples of this type of exercise. If you have osteoporosis, make sure to review your strength training program in advance with your physician or physical therapist. Resistance exercises should be performed two to three times a week.

Other Types of Exercises Important for Osteoporosis Prevention and Treatment

Postural exercises decrease harmful stress on the back. By performing these exercises, you can reduce your risk of spinal fractures and the rounded shoulders commonly seen with osteoporosis. These exercises should be performed throughout the day to reinforce good posture. Postural exercises help maintain proper body alignment and decrease harmful stress on the back. Stretching the muscles of the chest and strengthening the back muscles help promote good posture. One example is a shoulder stretch. In this exercise, you pull your shoulder blades together while visualizing your spine stretching up and lengthening.

Balance exercises help maintain equilibrium and can reduce the risk of falling. These exercises should be performed daily.

Dangerous Exercises to Avoid

Individuals with osteoporosis and osteopenia should avoid any exercises that increase forward bending or rounding of the spine. These exercises include sit-ups, toe touches, and the use of exercise equipment that applies flexion forces (some abdominal machines). Forward-bending exercises have been found to increase the incidence of spinal fractures in women who have osteoporosis.

Excessive twisting places large compressive forces on the spine. Individuals with osteoporosis and osteopenia should avoid exercises such as windmill toe touches, since there is added stress to the spine when forward bending is combined with rotation.

Important Principles of Exercise

Individuals with osteoporosis or osteopenia should keep in mind a few exercise principles that can promote health and prevent injury.

Perform extension (backward-bending) exercises: Strengthening the back muscles can help counteract the rounded posture often seen in osteoporosis and can reduce the incidence of spinal fractures. Women with stronger back muscles were shown to have a significant increase in spinal bone-mineral density. Many exercise programs fail to include spinal extension or backward-bending exercises, which should be an integral part of any osteoporosis program.

Target areas most prone to fractures: Exercise has been shown to be site-specific. Exercising the right elbow does not have any effect on the left hip. For osteoporosis treatment and prevention, it is important that an exercise program target the areas most affected by the disease, which would be the spine, hips, and wrists.

Exercise needs to be continued to maintain benefits: Bone-mineral density gains from exercise are only maintained as long as the exercise is continued at the same level of intensity.

Resistance levels should be increased: Bone responds to the mechanical forces placed upon it. By providing weight through the bone that is greater than the normal forces the body is accustomed to, bone density increases. Weight-bearing and resistance exercises can produce this stimulus if there is sufficient weight. It is important to gradually increase the levels of resistance in order to continue to increase bone density.

Bone density increases with low-repetition, high-weight programs: Studies have shown that post-menopausal bone density can be significantly increased by a low-repetition, high-weight program, but not by a high-repetition, low-weight program. Individuals with osteoporosis and those at risk should perform at least one set of eight to ten repetitions of an exercise. Optimally, they should strive to achieve three sets of an exercise with a one- to two-minute rest interval between sets. Once ten repetitions can be performed easily, the weight should be gradually increased in order to continue to build bone density. It is important to speak with your physician before beginning an exercise program.

Increase the weights slowly: Before you begin exercising with weights, it is important to perform the exercise without weights to make sure you can do it using proper mechanics and without pain. I recommend one-pound weights and gradually increase the weight, as tolerated. Again, speak with your physician concerning any weight limitations you may have. Dr. Mehrsheed Sinaki, from the Mayo Clinic, recommends that individuals with osteoporosis not exceed five pounds in each hand during upper-extremity weight lifting. This is a safe, conservative approach. In my experience, however, heavier weights may be used under the guidance of a physical therapist. It is important to reinforce the critical role of proper posture and body mechanics when performing these exercises.

Important Components of a Walking Program

Walking is an excellent weight-bearing exercise.

Warm up by walking at a slow-to-normal pace for five minutes.
Increase speed gradually until walking briskly.
Always make sure comfortable talking is possible while walking.
Try to keep walking at a level that can be maintained for at least 20 minutes.
Work up to a 45-minute walk.
Cool down with a five-minute slow walk.
Perform gentle stretches before and after walking.

Studies have shown that women who walked briskly achieved gains in bone density. It is most beneficial to walk at your target heart rate.

Daily Living Activities

While exercising, we focus on posture and strength. But what about the rest of the day? Do we bend or lift properly? We can improve body function and reduce the risk of injury from osteoporosis by the proper performance of activities of daily living. By using good posture and body mechanics, excessive forces on the spine can be significantly reduced.

Guidelines for proper performance of daily life activities include:

Sitting without slouching: It is important to avoid sitting in a slumped position that rounds out the lower back. This posture puts forceful pressure on the lower back, upper back and neck regions, and can lead to injury. A towel roll, lumbar roll or back support can help maintain a good sitting posture. This support should be placed in the small of your lower back to help maintain its natural curve. It is helpful to get up frequently from sitting—at least once an hour.

Bending from the hips: It is important to bend from the hips and knees and not the waist. The hips are located deep in the folds where your legs join your trunk. It is helpful to visualize your body as being divided into an upper and lower half, with the hips as the dividing line. Your movement should take place at the hips. This maneuver avoids forward bending of the back, which increases the incidence of spinal fractures.

Stabilizing the back while coughing or sneezing: The sudden force of a cough or sneeze can cause your spine to bend forward suddenly. This natural event can lead to injuries of the spine and vertebral fractures. One method of protecting your back is to place one hand in the small of the low back during the cough or sneeze.

Custom-Designed Exercise Programs

A physical therapist can design an exercise program that is safe and appropriate for both prevention and treatment of osteoporosis. Physical therapists are trained to teach proper ways to perform daily activities that can help prevent fractures. Many individuals with osteoporosis will have postural changes, muscle, and soft tissue tightness that requires the hands-on treatment of a physical therapist.

Conclusion

By learning the basic principles of safe, effective exercises to prevent and treat osteoporosis, you can begin your lifelong journey to good health. Not only will it help reduce your risk or degree of osteoporosis, but it will improve your overall fitness and quality of life. If you have questions or need further guidance, contact a physical therapist or physician.