In our last blog we discussed the importance of education in managing conditions of low bone density, osteoporosis and osteopenia (OP). By becoming more knowledgeable about how your condition and how it applies to your current situation, you can exercise with more confidence and less fear.
Individuals affected by OP may be uncertain of what they should or shouldn’t do, specifically when it comes to exercise. This may be influenced by information/advice they receive from their doctors, concerned family members or bits of information they take from the internet.
For those that have had a fracture, there may be even a lot of fear around exercise. What if I have another fracture?
The fact is, in order to maintain and improve bone density, one must engage in regular physical activity and exercise. Exercise, specifically resistance training, increases the size, strength and capacity of your muscles. As muscles are worked, so too is load and strain placed on your bones, making them stronger.
What is the best exercise for bone strengthening?
According to the literature, high impact and strength training exercise - use of weights, bands and weighted vests is most beneficial.
Weight-bearing exercise is best - e.g. brisk walking, jogging, skipping, basketball/netball, tennis, dancing, impact aerobics, stair walking.
These types of exercises stress both bone and muscle helping to build stronger bones. Exercises like swimming and cycling (non-weight-bearing) have little benefit on bone health, but do have a cardiovascular benefit, so are still useful in overall health and well-being.
See the chart below for classifications of high, moderate, low and non- osteogenic forms of exercise. It is not necessarily appropriate for everyone with OP to do highly osteogenic forms of exercise - if you have many risk factors, a low T_score and history of fracture it may be appropriate to start with low to moderate osteogenic forms of exercise. This is something that is best discussed with your GP, Osteoporosis Specialist or Physiotherapist.
What are the Guidelines Exercise for Osteoporosis?
Exercise Guidelines include:
Frequency: at least 3x/week
Progression and overload: should progress over time (weight used, degree of difficulty, height of jumps) to challenge bones and muscles
8-12 reps of 5-8-10 perceived exertion with good technique
Exercise routines should be varied, performed in short, intensive bursts.
Goals of exercise:
Balance Exercise and Preventing Falls
Balance and mobility exercise DO NOT improve bone or muscle strength, but can help reduce falls.
Balance exercises may include: standing on one leg, Tai Chi, Qi gong, heel-toe walking
Movements to Avoid
If you have osteoporosis, don't do the following types of exercises:
High-impact exercises. Activities such as jumping, running or jogging can lead to fractures. In general, jerky and rapid movements should be avoided. Exercises should involve more slow and controlled movements.
If you're generally fit and strong despite having osteoporosis you might be able to engage in somewhat higher-impact exercise than can someone who is frail or who has had a fracture.
These guidelines should always consider your individual differences. If you are ever unsure please discuss with your healthcare professional.
Bending and twisting. Exercises in which you bend forward at the waist and twist your waist, such as touching your toes or doing sit-ups, can increase your risk of compression fractures in your spine.
Other activities which should be avoided: golf, tennis, bowling, some yoga poses involving deep hip flexion and spine rotation.
Exercise considerations for Osteoporosis with Fragility Fracture History
NO jarring activities – running, jumping – compression spine
NO forced forward flexion – collapse front of vertebra
NO high risk sports – skydiving
NO lifting > 20 lbs, safe lifting techniques
Bone Health Benefits of Pilates
When done with correct form and technique, Pilates can help people with low bone density by:
Decreasing the risk of spinal fractures by reducing thoracic kyphosis (rounded spine)
Strengthening back extensor muscles
Improving balance and thus decreasing the risk of falls that may result in bone fracture
Improving postural awareness (positions to avoid positions and movements that increase the risk of fracture)
Increasing bone density when body parts move against the force of gravity and use of resistance bands, etc.
Pilates Exercise Considerations
Attend classes that are specific to bone health, with knowledgeable instructor
Avoid risk of over flexing the spine with uncontrolled repetitive or sudden movements of the spine in a curved position (e.g. sit-ups)
Use alternative moves that keep your back straight or allow you to bend in a controlled and comfortable way to reduce the risk of injury
Little things you can do to get the most out of your exercise class.
Is your instructor knowledgeable and do they have adequate training in exercise for those with Osteoporosis
Get informed and be able to ask, having low bone density, should I be doing that exercise? Modify yourself if unsure. You have to take charge of your own body.
Incidental balance practice - e.g. while brushing your teeth
Be mindful when opening the oven, bending down, lifting or pushing up with heavy loads
Be aware of your posture when sitting for prolonged periods e.g. watching TV, working on the computer
Do back extension exercises at home
Specific group classes for bone health or with a physio, classes that have terms or progression
Do not feel pressured to follow your friend or others in the class
Check out Part 1: Exercise for Bone Health - What You Need to Know