By Natasha Persaud
Over 52 million men and women in the United States have low bone density or the brittle bone disease osteoporosis, according to the National Osteoporosis Foundation (NOF). For these individuals, a slip, a fall or a rapid twist may result in not just a bruise, but a painful bone fracture.
Eating calcium-rich foods and getting enough vitamin D every day helps protect your skeleton. But don't neglect your other defense: regular exercise. "When you were a child, exercise helped you build strong bones," says Karen Kemmis, a physical therapist and adjunct professor at SUNY Upstate Medical University in Syracuse, New York. "After age 30, you start to lose more bone than you gain, but exercising will help preserve your bone mass. As a woman approaches menopause, working out becomes crucial: Declining estrogen levels speed up her bone loss, but engaging in regular physical activities can slow it down."
Even if you already have low bone density or osteoporosis, according to Kemmis, who is affiliated with the NOF, doing the right exercises can improve your balance, reduce your risk of falls and help keep you strong and limber.
An Exercise Prescription
So what counts as exercise? "Physical activities that are purposeful and repetitive—and that go beyond your everyday activities," says Kemmis. To protect your bone health, you need a mix of balance, weight-bearing and strengthening exercises, she says.
Balance exercises improve your movements and help you maintain muscle control while performing activities such as standing up from a chair, climbing stairs and stepping on or off a curb. An example you might recognize: walking down a hallway, stepping toe to heel, as if you were walking a tight rope.
Weight-bearing exercises include activities you do while standing upright, such as brisk walking, doing low impact aerobics or using the elliptical trainer. Your muscles and bones work against gravity to grow stronger. Swimming, biking and water aerobics are not weight bearing, so they are less beneficial to your bone health.
In strength-training exercises, you use your body weight, an exercise band or free weights to strengthen the muscles and bones in your arms, back, trunk and legs.
Weekly Workout Goals
- Do balance and functional exercises, such as the walking on a tightrope activity (above), a few minutes every day. Tai chi is another good option.
- Engage in weight-bearing exercises, such as brisk walking and low impact aerobics, for 30 minutes or more on most days of the week. Or do three 10-minute sessions every day.
- Do muscle-strengthening exercises, such as biceps curls and squats 2 to 3 times per week. Aim for one exercise for each of the major muscle groups (such as, upper, middle and lower back; shoulders; upper arms; forearms; chest; abdominal muscles; hips; thighs; and calves).
See Your Doctor Before You Start an Exercise Program
It's important to talk to a physician before you start an exercise program, says Kemmis. "You'll want to know if you have low bone density or limitations due to medications or other health problems. Even if you don't have weak bones, you may want to adjust your exercise routine for safety if you notice you are having trouble doing your normal activities." Your doctor can refer you to an exercise specialist, such as a physical therapist, who is skilled in treating patients with low bone mass or osteoporosis. Personal trainers at the gym usually don't have that specialized training.
Questions to Ask Your Doctor about Bone Health
- Do I have low bone density or osteoporosis? What are my chances of developing weak bones in the future?
- When should I have a bone density test?
- What other tests should I have?
- Do any medications I take put me at greater risk of osteoporosis?
- Do health problems I have put me at greater risk of osteoporosis?
If you have low bone mass...
- What are the chances I will fracture a bone within the next 10 years (i.e., what's my FRAX® score)?
- What precautions should I take when exercising?
- Where can I find an exercise specialist skilled in treating people with low bone density?
If you have had a fracture...
- How long should I wait before I resume exercise?
- How can I protect my bones to prevent a second fracture?
Consult an Exercise Specialist
Choose an exercise specialist (for example, a physical therapist) who is knowledgeable about treating people with osteoporosis. The specialist will perform a fitness assessment to check your posture, balance and core strength. Then, you'll receive a set of exercises that are safe and appropriate for you. To prevent injury and get a good workout, the exercise specialist will teach you correct form and guide you through the exercises.
Questions to Ask an Exercise Specialist
- How is my posture? How can I correct a poor posture?
- I'm just starting to exercise after being sedentary. How can I ease into an exercise program?
- What warm-up activities and stretches should I do?
- What exercises can I do to maintain strength?
- How many minutes should I spend on each activity? At what intensity (low, medium, high)? For strength-training activities, how many repetitions should I do? How many days a week should I do this activity?
- How much weight (in pounds) can I safely lift?
- Which movements, activities and sports should I avoid? perform with care?
- Can you give me a well-rounded exercise program to do each week?
Exercise Dos and Don'ts
If your bones have started to thin, you'll need to protect them during exercise and everyday activities. "Avoid activities that require reaching overhead, bending forward, rapid twisting motions and heavy lifting," explains Kemmis. "The movements may injure your spine, lead to a fall or cause a fracture."
Don't bend forward from the waist while your legs are straight, as you would do in a toe touch. Do: A better bet: Bend at the knees to pick up a package or a small child, then push up with your legs.
Don't stand slouched with your head jutting forward. Do: Stand upright while you walk, and when you do tasks such as vacuuming, sweeping and pushing a shopping cart (many of us hunch our backs in the shape of a "C"). You'll also want to avoid exercises that curl the spine such as sit-ups, abdominal crunches and certain positions in bowling.
Don't twist your torso (trunk) to an extreme. You're twisting your spine when you turn your upper body all the way to look behind you. The beginning and end of a golf swing or a tennis swing also involve these motions.
Don't carry heavy packages or lift heavy items overhead, such as to place a vase on a shelf.
Don't reach too far, such as to grab an item way back on a shelf. You run the risk of losing your balance and falling.
Is it Safe to do Yoga or Pilates?
Yoga and Pilates have many benefits including improved muscle strength, balance and flexibility, says Kemmis. But some of the postures or movements in these exercises—such as bending forward and reaching far—are not safe for people at risk of spine fractures.
Similarly, sports that require bending or twisting, such as bowling, tennis and golf, also carry risks. That doesn't mean that they're always off limits. "First get your doctor's approval,” says Kemmis. "Then, describe your limitations to your yoga or Pilates instructor, or the tennis, golf or bowling professional. Ask the instructor to teach you modified postures that won't stress or strain your bones."
Choose Low- to Moderate-Impact Activities
If you have weak bones, it's a good idea to shift from high-impact activities, such as running and hiking, to lower impact exercises, such as walking on a level surface and doing low-impact aerobics, says Kemmis. Other options: walk on a treadmill; use an elliptical trainer; or use a stair step machine at a slow speed.
Use Lighter Weights, Do More Reps
Instead of lifting, say, a 25-pound hand weight, use a lighter weight and increase the number of repetitions. "Generally, you want to do 15 to 20 repetitions before getting tired—but it shouldn't be so easy that your muscles are not fatigued at all," says Kemmis.
Performed the right way, exercise can help protect your bones and maintain your strength and day-to-day functionality. Adds Kemmis, "It’s never too late to start reaping the bone health benefits of exercise."