Many people with osteoporosis are afraid to exercise because they might fall and break a bone. While falling is always a concern; exercise and common sense are great for people with osteoporosis. In fact, with a properly designed program, bones and muscles can grow stronger; balance and coordination can be improved and flexibility can be enhanced. These are all important benefits for people with osteoporosis.

The challenge is that there are not well-defined exercise guidelines for those with osteoporosis.  According to Karen Kemmis, DPT, and an expert for the National Osteoporosis Foundation; you want to improve or maintain bone density thru strength training while also including impact-style aerobic exercise.  In regards to what types of exercise you should be doing Kemmis says that “depends on your history, fractures and the severity of your osteoporosis. A person that has had a fracture would probably want to stick with a low to no-impact program while someone who doesn’t have severe osteoporosis and has not had any other injuries can do a higher-intensity exercise program (things like brisk walking or dancing).”

If you’re not sure about the severity of your osteoporosis, talk to your doctor about a bone density scan or revisit the results if you have already had one. “This test scans the most common sites of bone loss, usually the hips and spine. The type of bone in the spine also tends to change more quickly with age, so osteoporosis may show up there first. Interestingly, arthritis of the spine can give a false reading on a scan, since a bone spur from arthritis may appear as a denser part of the bone but doesn’t mean the bone is actually stronger,” Kemmis says. So be sure to notify your doctor if you have arthritis to confirm an accurate reading.

Exercising with osteoporosis means finding the safest, most enjoyable activities for you given your overall health and amount of bone loss. There’s no one-size-fits-all prescription, which is why it’s important to check with your doctor or physical therapist before you start a new workout program. That said, here are some general guidelines to follow when exercising with osteoporosis.

  • Strengthen Your Muscles – strengthening your muscles can slow the bone loss that happens with osteoporosis and may help prevent fall-related fractures. Your workouts should revolve around functional movements like squats, lunges, and pushups, and may incorporate free weights, exercise bands, machines, or just your own body’s weight as resistance. Kemmis recommends lifting in a range of eight to 12 reps and making proper form your top priority. “Using even light weights with poor posture can be dangerous for someone with osteoporosis,” she says. If the back is curved in a flexed posture while a weight is lifted, it can put strain in the vertebrae, which could result in a compression fracture. If you have good posture, you can tolerate much more. “Good posture, proper body mechanics, and keeping a neutral spine and not bending forward are most important.” If you’re not sure you should do a certain exercise, don’t. “You’re better to be safe than sorry.”
  • Use as Much Impact as You Can Safely Tolerate – this rule applies to weight-bearing aerobic activities, which involve doing aerobic exercise on your feet, with your bones supporting your weight. These types of exercise work directly on the bones in your legs, hips, and lower spine to slow mineral loss. They also provide cardiovascular benefits, which boost heart and circulatory system health. Weight-bearing aerobic exercise is an important element of your overall routine, but it’s up to you to select the appropriate amount of impact based on your health care team’s recommendations and your comfort level. “Depending on the degree of osteoporosis and baseline activity level, you might start out with low-impact exercise, like using an elliptical,” says David Geier, M.D., a sports medicine physician and orthopedic surgeon in Charleston, South Carolina. “Then you can advance to higher levels of impact, like jogging, hiking, stair climbing, or aerobic classes.”

While swimming and cycling have many benefits, they don’t provide the weight-bearing load your bones need to slow mineral loss. However, if you enjoy these activities, do them. Just be sure to also add weight-bearing activity as you’re able.

To spread the stress and impact to different parts of the body, Dr. Geier recommends cross training, or doing different types of exercises in any given week. For example, you could do the elliptical on Monday, resistance exercises on Tuesday, swimming on Wednesday, and so on.

“And always stop if pain develops and get checked out by a doctor,” Dr. Geier adds.

  • Allow Your Body Enough Time to Heal – jogging or doing any high-impact exercise daily or nearly every day may not allow your body enough time to heal, Dr. Geier says. “You already have decreased bone density, so the repetitive stress without enough time to heal the microscopic bone damage could build up and lead to a stress fracture,” he says.

Allow at least one full day between high-impact exercise, and gradually increase the number of workouts you do each week. Again, cross train by mixing in different types of workouts and you will help reduce the risk of fracture.

  • Avoid Forward Bends and Twists – yoga and Pilates are helpful for stretching and lengthening, but they also include forward-bending and twisting movements that can strain the spine. Any movement involving extreme spinal flexion, or forward bend, creates compression between the vertebrae and can trigger a “cascade of fractures,” Kemmis says. “Hinging forward at the hips is different than rounding your back and compressing the spine, which is more dangerous.”

You’ll want to avoid yoga or Pilates movements that involve bending forward or rotating the trunk:

    • Rollup, rollover, or rolling like a ball
    • Teaser or open leg rocker
    • Corkscrew or bicycle
    • Spine twist or any deep twists
    • Pigeon pose or deep hip stretches
    • Assisted stretching from teachers to increase range of motion

This doesn’t mean you can’t enjoy your favorite classes. Exercises like planks, spinal extensions (cobra pose), and balance moves (tree pose) can be safe and help improve strength. Be sure to arrive a few minutes early to talk to your instructor about your limitations. He or she will be able to provide recommendations or modifications to keep you safe—while still getting a great workout.

National Osteoporosis Foundation; Linda Melone, Silver Sneakers 5/18