I recently downloaded a PDF ‘Osteoporosis and You’ from the Osteoporosis New Zealand website. Fifteen pages of content, with barely half a page of non-specific exercise information, yet they somehow managed 2 and a half pages of dietary guidance for optimal bone health! I shouldn’t be surprised, but……of course, I still am! Disappointed, disheartened!
I’m not sure whether it’s that exercise is not really valued, or that these organisations are just too afraid to provide anything more than very general guidelines. Regardless, the net result is that there is really nothing presented to encourage individuals to include physical activity in their struggles with deteriorating bone health. Other organisation’s websites (for example those from the USA, UK, Canada and Australia) are more helpful but still don’t really provide any structure or progression for exercise. So, I thought why not carry on the conversation from an earlier blog (Exercise Interruptus), stick my neck out and brashly offer a little more guidance around exercise for bone health.
The advice presented here is in no way intended as a substitute for medical consultation. If you have been diagnosed with osteopenia (asymptomatic but reduced bone density) or osteoporosis, please consult with your medical practitioner for exercise advice. If you have other existing medical conditions or injuries, and/or signs or symptoms of conditions, please consult with your preferred healthcare provider concerning the safety of commencing exercise and for appropriate exercise advice and safety precautions.
I’m not about to enter into the debate about the efficacy of exercise and dietary interventions for bone health. Far too chicken for that!! Perhaps exercise helps bone mineral content, maybe it has minimal influence. Regardless, exercise certainly helps encourage bone remodeling and better bone structure. And we know that exercise has many other positives to offer, some of which indirectly impact on bone integrity. The dilemma is of course that the loading typically considered necessary to produce stronger bones is unlikely to be well tolerated by individuals with weakened bones. Exercise advice therefore wisely emphasises protecting bone from fracture, with an increase in bone strength (density and organisation) as a secondary goal.
I’m offering some of the standard exercise and bone health guidelines, but have also included some of the more adventurous exercise suggestions – cos that’s what a 10th man should do! An exercise programme targeting bone health should focus on preventing fractures through three strategies;
- developing and retaining muscle strength and endurance,
- promoting good balance and stability to help prevent falls,
- helping to preserve bone health.
Some exercises should be approached with caution or avoided;Movements that involve trunk flexion (bending forward) and trunk rotation are thought to place undue stress on a vulnerable spine. So abdominal exercises like sit-ups, performed dynamically and continuously are not advised.
Twisting movements involving the spine, such as a golf swing, some yoga and pilates style exercises could also be considered hazardous.
Abrupt or explosive loading of muscles and bones and high impact loading, as would be required in skipping and jumping activities, are considered unsafe.
Exercises that could be unsafe if technique is poor. When building basic fitness and introducing new activities and exercises, the focus should be on good body alignments so that the forces of muscle contraction and weight bearing can be transferred through bones and joints in an anatomically sound manner
The guidelines suggest a weekly routine that includes
1. as the effects of resistance exercise, bone and muscle loading are site-specific, an optimal programme should target all body areas select a mix of upper limb, lower limb, and trunk exercises
2. for effectiveness and consistency aim for 2–3 sessions/week. With time this could grow to more variety and more often
3. for simplicity initially select no more than 10 exercises
4. complete a single or 2 sets of 10-15 repetitions of each exercise. If it is difficult to add load to an exercise aim for 15 repetitions, otherwise make 10 repetitions your goal.
5. by a second or third resistance training session, the last 3-5 repetitions of the final set of each exercise should be challenging.
6. exercise movements should be smooth, slow, and controlled. This enables individuals to concentrate on good limb and body alignment during exercises so that forces are being transferred through bone and joints in an anatomically appropriate manner.
7. progression could be through increased load/difficulty, increased repetitions, increased sets, or through replacing exercises with more challenging options (see below).
- repetitive non-impact where muscle tension is developed through continuous activity without impacts ( activities like swimming and cycling)
- repetitive low-impact there is continuous muscle loading with some minor impacts but a lot of repetition (e.g. walking and running)
- high-magnitude loading with slow well coordinated and controlled movements without impacts (resistance training would fit into this category)
- odd-impact loading where there are spasmodic impacts, through with quick turns, stops and starts and spurts of running ( tennis, badminton and a lot of team sports spring to mind), and
- high-impact loads that we would see with vertical jumping and landing (as in volleyball, netball, basketball and gymnastics).
Iwamoto (2013) has advocated that optimal exercise for post-menopausal women should include high-magnitude loading (resistance training), some high impacts (skipping, stamping, marching and low amplitude jumps and landings), plus persisting with back muscle strengthening.
- T.S, Srinivasan, S. (2006) Building bone mass through exercise: could less be more? Br J Sports Med 40;2–3. doi: 10.1136/bjsm.2004.016972
- Kohrt, W.M., et al (2004) Physical Activity and Bone Health. Medicine & Science In Sports & Exercise DOI: 10.1249/01.MSS.0000142662.21767.58
- Iwamoto, J. (2013) Effects of Physical Activity on Bone: What type of Physical Activity and how much is Optimal for Bone Health? Osteopor Phys Act, 1:1
- Nikander, R. et al (2010). Cross-sectional geometry of weight-bearing tibia in female athletes subjected to different exercise loadings. Osteoporosis International, 21(10), 1687-94. doi:http://dx.doi.org.ezproxy.otago.ac.nz/10.1007/s00198-009-1101-0