Exercise and osteoporosis
Exercise is important for everyone at all stages of their lives, but is especially important for people with osteoporosis and at risk of fracture.
Exercise is important in building strong bones in your early years but also throughout life in strengthening your muscles and bones and reducing your risk of a fragility fracture. Exercise does this partly by directly strengthening bone and partly by keeping you steady as you age, to make it less likely you will fall. Whether you have osteoporosis or not, finding out and engaging in suitable exercise will help you gain confidence and reduce your risk of breaking a bone.
Taking enough exercise will not only make you feel good and reduce your risk of osteoporosis and fractures but will also be beneficial for your heart and reduce your risk of many other conditions such as cancer. Exercise helps with many types of pain and stiffness, and specific exercises can also help with the pain and problems caused by fragility fractures.
Exercise and strong bones
Bone is a living tissue that reacts to increases in loads and forces put upon it by growing stronger. It does this all the time but any increase in ‘loading’ above normal levels has the best chance of increasing bone strength. Movement causes muscles to pull on bones, and if this pull is ‘loaded’, the force on the muscles is stronger and the effect on bone is greater. Body weight itself increases bone loading so if you are underweight there will be less pull on your skeleton and your bones may sometimes be less strong.
Weight-bearing exercise that uses your body weight (such as jogging) and weight-resisted exercise (which involves pushing against some resistance, as in strength training) both help to improve bone strength. In later life, exercises to improve muscle strength and balance will also help to prevent falls.
Weight-bearing exercise is any exercise in which you are supporting your own body weight through your feet and legs (or hands and arms).
- Choose exercise that is right for you, that fits in with your lifestyle and that you will enjoy and keep doing. Join a class or go to the gym if you would like to but, if not, there are many other ways to get the exercise your bones need.
- Be sensible about the amount of exercise you take. Excessive exercise without getting adequate nutrition can result in being underweight, which reduces hormone levels and may cause bone loss.
How do I know which exercises are right for me?
One of the challenges in knowing what exercises to do is that high-impact exercise can help to improve bone density and strength, but if bones are very fragile then this may risk causing a fracture.
If you have had a bone-density scan and have low bone density (osteoporosis or osteopenia) but are otherwise fit and healthy and have never broken a bone easily – including compression fractures in the spine – then your risk of fracture may not be very high and you may not need to moderate your exercise levels. In fact in some situations you may be advised to increase the exercise you do.
If, however, you have a high fracture risk and particularly if you have had fragility fractures already (including compression fractures in the spine), sudden new high-impact exercise (jogging, jumping etc.) would not be recommended. Exercise advice needs to be tailored to your own situation so a discussion with your doctor and a physiotherapist could be helpful.
Determining exactly how strong your bones are isn’t easy. A bone-density scan can help, though the results are best considered alongside other risk factors you may have including any history of fragility fractures and your age (fragile bones and fractures are more common in later life). Predicting your risk of breaking a bone in the near future can help to guide you in terms of the most appropriate exercises for you.
Some activities such as horse riding and skiing will obviously be more risky if your bones are less strong, but decisions about whether to do them will in the end be very personal to you, and will involve weighing up the perceived risks and benefits as best you can.
I have heard you shouldn’t bend forwards if you have osteoporosis. Is that true?
It isn’t as simple as that. In fact some experts have warned against being too cautious and making people with osteoporosis unnecessarily frightened about what movements they can and can’t do. Exercise is important for so many reasons and reducing exercise and activity levels because of a fear of what will happen can exacerbate problems, leading to increased tension, muscle weakness and further pain from existing fractures, as well as reduced bone strength and a greater risk of falling.
There was one research study that found that, in a group of people who already had spinal compression fractures, those who did forwardbending ‘touch your toes’-type exercises or abdominal crunches (lying on your back and lifting your upper body) were more likely to have further fractures than those who did backwards extension exercises (e.g. lying on your front and pushing up with your arms).
There are plenty of other ways to strengthen your tummy muscles, such as pulling them in while you are walking or lying face down on the floor and pulling them up towards your spine. It certainly seems sensible to always lift any object properly – keeping your back straight and bending your knees to avoid ‘loading’ your spine excessively in a way that might increase your risk of fractures. However, this doesn’t mean never leaning forwards or never lifting anything; rather, you should think before you move and try not to do awkward, painful, jerky, twisting movements that put unnecessary strain on your back.
If you are used to certain types of exercise (such as controlled, smooth movements in yoga) that are comfortable for you then it is probably appropriate to keep doing them. If you feel your back is under strain then discuss any concerns with your teacher or instructor, who may be able to suggest which exercises to avoid or how to adapt them. There are many useful exercises that will improve muscle strength in your back safely, thus supporting your spine and improving bone strength and back pain problems.
Exercising when you are young and for anyone with a low fracture risk – to build and maintain bone strength and to prevent fragility fractures.
Brief bouts of high-impact exercise, creating a large force that rises rapidly, are a good way to load your bones and ’bank’ as much bone as you can when you are young. You will then be in a better position to withstand the natural bone loss that we all experience in later life.
Team sports such as football, as well as participation classes such as dancing, are a great way of getting children involved in fitness from a young age. Key bone-building years are those up to about your mid-twenties, so plenty of weight-bearing exercise will build strength into young bones.
- Jumping on the spot or skipping is good for children and young people because it increases the impact on the bones. Aim for 50 jumps a day or skipping for five minutes each day.
A 20-minute jog three times a week is good for building bone in both the hip and spine in younger people. Intermittent jogging is also good, especially for people who find continuous jogging too strenuous. Walk then jog every 20 metres or so. Even a very brisk walk can be good for your bones.
- The slow, controlled lifting of weights, best done in a proper gym with advice from an instructor, will increase bone density and makes your muscles stronger. Try to train three times a week on non-consecutive days.
- Tennis is another high-impact but enjoyable sport that builds bone density. Research has shown that professional tennis players have much higher bone density in their serving arm than their non-serving arm!
- Classes that involve exercising to music, such as aerobics, circuit training and boxercise, can be effective. Anything that involves a variety of movements and high-impact exercise will boost both your bones and your heart when you are young.
Children should aim to undertake 60 minutes of moderate-intensity physical exercise every day.
Adults are advised to do 150 minutes of moderate exercise (any activity that makes you feel warmer and slightly out of breath) over a week, with muscle-strengthening exercises on at least two days a week (UK government recommendations).
Exercising if you at a high risk of fracture, especially if you are over 70 or have broken bones easily in the past – to keep fit safely without causing further fractures; to keep bones strong and prevent fragility fractures
Although you may not want to do all the things you did when you were younger and fitter or before you had fractures, exercise continues to play a vital part in preventing falls and fractures. As you get older, your risk of falling increases, which puts you in greater danger of breaking a bone, particularly the hip. However, falling isn’t inevitable, and doing strength and balance exercise is one of a number of ways to ensure you stay steady.
The most important factors are:
- keeping active
- maintaining muscle strength, especially in your legs
- maintaining a good sense of balance and coordination.
The term ‘active lifestyle’ means enjoying a variety of physical activities throughout the day that keep you on the move. These may include sport or leisure activities such as ballroom dancing or gardening as well as necessary activities such as housework and shopping. It can be as simple as climbing the stairs regularly or taking short, regular walks. You can adopt a more active lifestyle at any age, provided you begin with familiar activities that you enjoy and progress at an appropriate pace. Research has shown that you are never too old to start reaping the rewards of being more active. Here are some suggestions:
- Exercise safely. Always warm up, begin gradually and then increase intensity over time.
- Enjoying a walk every day is great for older people. It’s an easy and free way to a fitter, healthier older age. Over time you can add some extra weight to a well-fitted rucksack or weight belt. If you are prone to falling, increase the duration of the walk, not the speed, as brisk walking can increase your risk of falls.
- All types of dancing can provide enjoyable exercise and are especially good for balance as well as your bones. Choose a class that is suitable for your abilities.
- Tai Chi is an ancient form of Chinese martial arts that is good for improving posture and balance in older people. Choose a class that is suitable for your abilities.
- Swimming provides an excellent opportunity to improve stamina in a weight-supported environment. It can help to improve the flexibility of joints and can also help with pain. Try walking about in the water, sideways and backwards as well as forwards. If you progress to using paddles and equipment to resist the water (e.g. in aqua aerobics) then you may also see improvements in strength.
If you are prone to falls, it is best to find a groupbased programme led by a specialist falls instructor. Such a person can tailor the exercises to suit your needs and put a focus on falls prevention as well as bone health. Although much of the advice about exercising in later life aims to prevent you falling, there are also some simple exercises that may have a direct effect on the strength of your bones. Many can be done from the comfort of your own home. For example:
- To help strengthen your wrists, try some gentle press ups while you are standing against a wall or lift tins of food a number of times – you could do this while watching TV.
- You can also squeeze a tennis ball slowly 10 times a day with each hand.
- Stand on one leg (holding onto something if necessary for your balance) for a minute, three times a day on each leg – this will help your hips.
Adults over 65 years who are at risk of falls should exercise to improve balance and coordination on at least two days of the week and avoid sitting for extended periods (UK Department of Health recommendations).
Doesn’t exercise have to be high impact to make a difference to your bones?
The aim of increasing or maintaining exercise for osteoporosis is to reduce your risk of having a broken bone.
Although research has shown you probably need to do high-impact exercise to make significant improvements to your bone density, studies have also shown that just keeping active in older age seems to reduce the risk of fractures, especially a broken hip. This may be because of subtle changes in the strength of your bones or, most likely, because you have good balance and strong muscles, especially in your legs, so you are less likely to fall.
Studies have shown that step aerobics and exercise-to-music sessions improve bone health, and these exercises are not necessarily high impact. Unfortunately we don’t know exactly what exercise will reduce the risk of spinal fractures – apart from specific back exercises – although exercises that increase muscle strength and the pull on bones may also help to increase bone strength. There is emerging evidence that avoiding prolonged periods of sitting is favourable to bone health as well, so keeping moving and keeping active is important.