As per our Accreditation body, Exercise & Sports Science Australia, we have put together this blog to discuss the benefits of exercise on Osteoporosis including the recommended types and amount of exercise for prevention and management of the condition.

Why Exercise?

Exercise is crucial for preventing and managing osteoporosis/osteopenia. These conditions actually can be combatted in your younger years by laying down strong bones early, as by the age of roughly 25, we are unable to increase our bone mineral density as effectively. The earlier you can load your bones up, the better your long-term outcome. It has been suggested that achieving 10% higher bone mass in your younger years could delay the onset of osteoporosis by roughly 13 years and decrease your risk of fracturing any bones in your lifetime by up to 50%.

Exercise also is very useful for maintaining functionality and independence to do the things you want to do. This is hugely important for people with Osteoporosis as individuals who have experienced a fracture may have entered what we call the "cycle of falls" and may be fearful to remain engaged in activities they once enjoyed, just because they might fall. This is very common and sometimes expected but part of the role of exercise is to reduce these fears and increase our confidence to do the task we fell during or a task that we might fall during. (please see "Osteoporosis/Osteopenia" blog for more information on the cycle of falls)

The main types of exercise that we will utilise to manage osteoporosis/osteopenia are;

Progressive Resistance/Strength Training

This is an umbrella term for any form of exercise where you are exerting force against a weight, object or resistance, including gravity! It can look like lifting weights, pulling bands, squatting, walking through water etc.
Progressive resistance training is simply increasing the difficulty of the exercise as you improve to continually provide you with new challenging stimuli so the body can keep getting stronger.

Balance Training

This encompasses three main ideas explained later on for being able to challenge your balance abilities

Impact Training

This is similar to resistance training but is at a higher velocity and exposes you to greater forces through your bones.
Often this type of training includes jumping, hopping, stomping or other impactful exercises.

Purpose of Resistance Training

Resistance training will expose our muscles, bones and connective tissues to larger loads to increase their strength.

In the case of bones, when we expose them to different types of forces or larger forces, new bone will begin to form in areas that need more support to do the job well. This is called Wolffs law and essentially involves the bone remodelling to better handle loads they are exposed to.

So, by utilising resistance training, we are encouraging bone to grow in new areas or bones to thicken so they can support the movement you are overloading. This can help to delay the progression of osteoporosis but also is key in preventing the development of osteoporosis in the first place.

We talk about making sure our resistance training is progressive or utilising "progressive overload" principles. In simple terms, this means when the weight or load you are exercising with becomes easy, you add more weight or a higher load to make it hard again. This will mean that you are constantly challenging your muscles and your bones so they continue to strengthen.

ESSA's recommendations for resistance training to prevent Osteoporosis.

Progressive resistance training at high to very high intensities (80-85% 1RM) is recommended to prevent osteoporosis. Your Exercise Physiologist can help you determine what is classed as high and very high intensities for your body.

ESSA states that this should be taken part in twice a week with 2-3 sets and 8 repetitions per exercise.

They also want you to consider including high velocity resistance training to help build muscle power and enhance its function.

ESSA's recommendations for resistance training to manage Osteoporosis.

Resistance training recommendations are exactly the same for both prevention and management.

However, people managing osteoporosis should perform these exercises under supervision of an Exercise Physiologist and within reach of something secure for support such as a railing or chair, especially if they are frail individuals.

Purpose of Balance training

Due to the higher risk of fracture if we fall down with Osteoporosis/Osteopenia, it only makes sense to train our balance skills to reduce our risk and incidence of falls.

There are 3 main types of balance we will focus on when prescribing a program for your management. These are;

Stationary Balance (Static). This is for any time you are trying to hold still, for example, washing you hair in the shower, placing your foot on a stool to tie your shoelace, and standing on your tippy toes to reach something out of your top cupboard.
Balance while moving (Dynamic). This is for anytime you need balance while moving like when you are climbing stairs, navigating uneven or moving terrains, or turning quickly for instance.
Regaining balance if you lose balance (Reflexes and balance control). This is for times when you might get bumped into by someone in public, you might trip over a rock while walking, or you might get distracted by something, someone, or your own thoughts and lose your balance as a result of the loss of focus.

ESSA's recommendations for balance training to prevent Osteoporosis.

The balance exercises need to be challenging and as part of the resistance training and impact exercises where possible.

They recommend to participate in balance activities 4 days a week for 30 minutes

ESSA's recommendations for balance training to manage Osteoporosis.

Balance recommendations for management are very similar to prevention but are broken down further into exercises for stationary balance and maintaining balance while moving.

Both types should be challenging for the individual, supervised and within reach of a support.

Aim for 4 sessions week for 30 minutes each session

For stationary balance exercises try to achieve at least 10 seconds per exercise, and for balance while moving, achieving 10 steps forwards and backwards is the ideal.

For all balance exercises the longer and better you can perform them the safer you will feel and be, but they still need to be difficult or you will not improve.

Purpose of Impact training

When we complete impact training we are now increasing the amount of force that goes through our bones at a much faster rate, in part due to the pace and strength of the pull of the muscles to create a jump or other impact exercise, and in part because of your bodies hard and fast contact with the ground. This means that the Wolfs law we spoke about in the resistance training section, is put into hyperdrive as the bones recognise they cannot handle this force as effectively without building more bone, quickly!!

Now unfortunately bone doesn't grow overnight at significant rates, but with jumping, stomping, running, skipping, leaping, hopping, and more, you can help your bones stay stronger for longer, and can help foster growth of more bone more easily.

ESSA's recommendations for impact training to prevent Osteoporosis.

For preventing osteoporosis or the progression to osteoporosis ESSA recommends participating in moderate or high impact activities as they are tolerated.

For unaffected bones, experiencing impacts that are greater than 4 times your body weight should be included.

For Osteopenic bones, experiencing impacts that are greater than 2 times your body weight should be included

ESSA advises participating in this 4-7 days a week with 3-5 sets and 10-20 repetitions.

ESSA's recommendations for impact training to manage Osteoporosis.

The guidelines for the management of osteoporosis are very similar to that of the prevention recommendations, however there are slight differences.

For management, impact training should include activities 2-3 times your body weight as tolerated and within the limits of pain if it is present

They recommend participating in progressive resistance training first to develop the strength that is required to complete impact activities.

Aim to do this 4-7 days a week with 5 sets and 10 repetitions per exercise.

Your Exercise Physiologist can help you to pick and choose exercises that are equivalent to the 2-4x your body weight that will be safe and effective for you and your current presentation.

What about things like swimming?

Due to Resistance training and impact training combinations being our most bang for buck when it comes to Osteoporosis management, you are very unlikely to be prescribed hydrotherapy as part of your program because it reduces the amount of weight/force going through your bones.

However, if you are very weak, or experience a lot of pain, or are unfamiliar with exercise, your Exercise Physiologist may still start you in the water to get your body accustomed to exercise before you commence body weight training for your osteoporosis management. This will be a discussion between you and your clinician to work out what will be the best strategy to use exercise to manage your condition.

This is a lot, how can I manage this?

When you go back and add all of this up, it can seem very daunting to try to achieve every aspect of the guidelines. We want you to know that any exercise is good exercise, and that even a little bit is better than none at all!

Even starting with 1 or 2 exercises a day can be enough to get the ball rolling and develop you confidence to move so you can attempt more exercise later! My personal favourites to start with are sit to stands and marching on the spot with a stomp as these can be tolerated well early on and can be modified to make them easier or harder depending on your current levels of strength and fitness.

Please do not be deterred by the large amount of exercise that is recommended, and if you are feeling anxious or worried, know that reaching out to an Exercise Physiologist or a Physiotherapist can be very useful in getting you started and ensuring the exercise is appropriate for you.

See "Osteoporosis & Osteopenia" and "Diet and Osteoporosis/Osteopenia" to learn more about this condition.

Written by Gabby Baker

Exercise and Osteoporosis/Osteopenia