Barbells And Bone Health II: Osteoporosis

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Eric Bowman

Physiotherapist Ontario, Canada

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Meme courtesy of Owned.com

Before we begin – no this isn’t Star Wars where the installments are recorded out of order. The original Barbells and Bone Health article focusing on weight training for younger adults is here https://rebel-performance.com/barbells-bone-health-review-literature-says-building-strong-bones/

Osteoporosis is a condition that affects 1 in 4 women and 1 out of every 6-7 men. Osteoporosis is characterized by decreased bone mineral density causing an increased likelihood of fracture. 20% of men and 37% of women will die after fracturing their hip and many who suffer a fracture are likely to refracture. For people who have osteoporosis a fracture can cause a downward spiral of avoiding activity, becoming deconditioned, and then becoming more susceptible to a future fracture.

Fortunately, a well designed exercise program can help to offset the losses in bone density that occur with age and may even allow people to slightly increase their bone density. The purpose of this article is to show you which exercises can help people with osteoporosis based on the research.

Disclaimer: As I’ve said before on the website the information here is tailored for health & fitness professionals and is not intended so much for the layperson. If you are someone with osteoporosis or significant risk factors I encourage you to work with health professionals (e.g. doctors, physical therapists, kinesiologists) whom have formal education in prescribing exercise for people with osteoporosis.If you live in Canada you can find them through this link.

Disclaimer 2: A lot of lay people I talk to get osteoporosis and osteoarthritis confused as they sound similar but are two different conditions. Please read here to understand the differences between the two conditions http://www.osteoporosis.ca/osteoporosis-and-you/osteoporosis-and-osteoarthritis/

WHAT IS THE BEST EXERCISE TO HELP MY BONES?

The best exercises to help with bone density are weight training exercises and impact exercise. When a bone is loaded with more force than it’s used to, assuming it’s not so high as to cause a fracture, this starts a signalling process in the bone that causes bone building cells (osteoblasts) to lay down bone that adapts and remodels over time to get stronger.

The general guidelines for weight training for people with osteoporosis are as follows

  • Frequency: at least 2 times/week
  • Intensity/Time: 1-3 sets of 8-12 repetitions of each exercise
  • Type: 1 exercise per body part

Obviously I can’t give specifics without considering the individual, their health conditions, their general work capacity, and their goals but I hope this gives you something to start with.

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Daily balance exercise of up to 15-20 minutes per day is also recommended but obviously can be rather unfeasible due to time constraints. Balance needs to be challenged in order for it to be effective and balance exercises must be maintained as balance can decrease quickly.

Side note: I’ve found that balance exercises are sometimes the most challenging type of exercise to get people to do as some are very fearful of falling & will sometimes get more anxious during the exercise which decreases their balance & self-efficacy … and so on. With clients I find combining balance with strengthening or balance in daily activities works better than structured balance exercise. I also find, with these people, that you need to progress the exercises very slowly and also start wayyyyyyyy below their threshold – even if it looks like the exercises are fairly easy for them just to gain their trust.

The recommendations for impact exercise are…

  • For people with osteoporosis but without fractures: at least 50 moderate impacts a session (i.e. jogging, low level jumping, and hopping) are recommended and should be interspersed with walking activities. This may need to be modified for people with spinal or lower extremity pathology or for people with balance issues.
  • For people with vertebral or low trauma fractures brisk walking is recommended assuming that the individual is not at risk of falls

Again – this needs to be adjusted based on the individual. Some can tolerate this (or more) and some caan’t.

WHAT ABOUT POSTURAL EXERCISES?

The bulk of the research on postural corrective exercises (e.g. strengthening weak muscles and stretching tight muscles) doesn’t seem to be very effective in changing people’s posture, contrary to popular belief, but a small body of weaker evidence suggests that these exercises may be effective for very slightly reducing kyphosis in postmenopausal women. Postural exercises should focus on the scapular muscles and the spinal erectors to improve endurance.

WHAT ABOUT YOGA AND SPINAL FLEXION EXERCISE?

In 2013, when I researched exercise and osteoporosis at the University of Waterloo, the guidelines were very much anti-spinal flexion but have evolved over the years.

For people at lower risk of fracture yoga doesn’t pose too many issues but for people with moderate to high risk of fracture yoga poses involving spinal flexion and/or twisting (particularly under high load, repetitively, and/or to end range) should be avoided. Biomechanics research has shown us that osteoporotic vertebrae are more likely to fracture under flexion and rotation loads. By the same token I would advise staying away from traditional core exercises such as situps, twists and leg raises as they involve similar motions.

Some lower risk people who have built up the tolerance, flexibility, coordination, and muscle tone may be able to do these in low volumes but many people would increase their likelihood of fracturing.

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Some reading this article may say “oh well they can adapt.” But the research as a whole (aside from outlier studies and/or studies done in higher functioning individuals) shows that osteoporotic bones may slightly increase bone density, may maintain bone density, or may lose bone density at a slower rate than before. The adaptive capability of these bones is very limited compared to normal, healthy bone.

WHAT ABOUT WALKING?

Walking and other forms of cardiovascular exercise such as cycling and swimming fail to produce significant increases in bone density in most people as those exercises don’t provide enough of a loading stimulus to stimulate bone growth. While these exercises have other physical and psychosocial benefits just walking, cycling or swimming won’t do much for improving bone density.

However, as stated above, brisk walking may (theoretically) provide an impact stimulus for people who have suffered osteoporotic fractures and may not tolerate other high impact activities.

WHAT ABOUT CALCIUM AND VITAMIN D?

Even though I’m not a doctor or a dietician I do get asked a lot about the effects of Calcium and Vitamin D on osteoporosis. A recent review has shown that calcium & vitamin D supplementation doesn’t reduce fracture risk in community dwelling older adults when compared to placebo. It may be helpful with increasing bone density but it doesn’t make as big of a dent on fracture risk as many think.

I can’t safely give specific recommendations for supplementation as I don’t know your blood profile, bone density, allergies, health conditions or what medications you’re taking. At the risk of overstepping my boundaries if you (or your clients) are interested in supplementation I strongly encourage you to get blood work done to identify deficiencies as well as to talk to a registered dietician regarding it.

Osteoporosis is a condition that will continue to affect the health care system as the baby boomers age but proper exercise can help offset the natural decline in bone density with age and can also greatly improve quality of life. As always thanks for reading.

This was originally posted on Eric Bowman’s website. You can click here to read more blogs from him.

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About the Author

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Eric Bowman

Physiotherapist Ontario, Canada

Eric Bowman is a Registered Physiotherapist and Strength Coach in Ontario, Canada who works in the areas of chronic musculoskeletal pain, sports rehab, geriatric rehab, and strength & conditioning. He’s also intermittently involved with the University of Waterloo Kinesiology program and the Western University Physical Therapy program. He also competes occasionally as a powerlifter and has completed the CPU Coaching Workshop & Seminar.

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