Exercising Your Bones: Part 1 of 3
By Rebekah Rotstein, NCPT
You’ve been diagnosed with osteoporosis or osteopenia and told that exercise can help. But what type of exercise should you do? How do you know you won’t be hurting yourself? What if you’ve never exercised before – how do you even begin? Or what if you’re already an exercise devotee – what else can you do that you may have previously overlooked?
Let’s start by identifying how exercise can benefit your bones. Your bones are living tissue which change in thickness, mass and shape through use, just like your muscles. If you wanted to strengthen your muscles, you’d use them by pulling on objects (like lifting weights) and pushing against things (like doing push ups.) You can strengthen your bones in much the same way.
Your bones adapt and respond to load by reinforcing and strengthening themselves to sustain that same load again in the future. When you resist external forces like gravity or weights, your bones reap the reward. On the flip side, not using your bones results in weakening of their structure and composition. Ever seen the wrist of someone whose cast has just been removed? The wrist size has typically diminished compared to the other wrist because of its immobility and lack of use. Similarly, NASA research has demonstrated how the absence of gravity in space, which also limits the ability of muscles to pull on bones, causes reduction in bone mass.
In order to know what type of exercise to engage in, you need to understand that bone builds from three sources when it comes to activity:
1–Weight bearing
Any time you stand upright, you’re working against gravity and bearing your body’s weight. When you crawl or exercise on the ground supporting your body through your hands and wrists, you’re similarly weight-bearing through your forearm bones.
2–Resistance
Your muscles facilitate movement against additional forces such as weights, bands or pulleys when you exercise. They also contract in daily activities like carrying objects and moving furniture.
3–Impact
Your bones respond to compressive forces and receive further stimulus to strengthen when adding higher force that increases the gravitational effect. You’re probably familiar with the term “high impact” referring to activities like running and jumping, which some people find uncomfortable on their joints as they age. High impact may not be recommended if you have osteoporosis, and especially if you’ve experienced a fracture, but it’s important for building peak bone mass in younger individuals. Low impact can be achieved by stomping your feet or dropping your heels repeatedly.
To know which exercises to perform - and even what form of exercise (weight training, Pilates, yoga, HIIT, aerobics, as a few examples) - depends on your physical capacity, history of physical activity, and fracture history. (If you’ve had a fracture, you should be cleared by your health care professional to start an exercise program.)
To actually increase bone density through exercise alone after menopause, you likely need it to be high intensity (lifting heavy weights at loads of at least 80% of the most you can lift in a single repetition, along with high impact.) That assumes that you have no comorbidities (other conditions) or safety concerns which might make this contraindicated, plus that you have access to a gym and a trainer to supervise you.
You can also aim to maintain the bone density you have, training for strength and power and including impact at lower loads. No matter what, in order to avoid injury, you need to ensure good form throughout by mastering foundational movements and training for mobility to achieve the necessary range of motion in your joints.
So when the question arises of what’s the one exercise form that you should do for osteoporosis, there isn’t ONE! The three bone strengthening elements mentioned above are essential along with mobility training, but as the 2014 consensus paper “Too Fit to Fracture” pointed out, the best strategy is a multimodal approach that also combines balance and postural training (which we’ll address in a future part of this series.)
A few key things to consider when embarking on your exercise journey:
Be consistent. Just like any activity or skill, consistency is key to experiencing results and fostering motivation
Keep challenging yourself. Your bones and muscles are both adaptive organs. So to keep reaping the benefits of exercise, you need to continuously and progressively make things harder so you don’t plateau.
Make it enjoyable. If you find it tedious, you’re more likely to procrastinate and avoid it! The best exercise is the one that you will do.
Sometimes, getting started is the largest hurdle to overcome. Know that exercise affects more than just your bones and muscles, joints and soft tissues. It’s multisystemic, and can improve other systems of your body, like your digestion, your circulation, your cognition. Plus, the more physically active you become, the more empowered you feel. One of the aspects of osteoporosis that’s often overlooked is the emotional difficulty that patients experience, regardless of whether they’ve fractured. Taking charge of your health through exercise can be one of the best actions you can take to transform yourself from feeling fearful and fragile into feeling confident and capable.
Stay tuned for the next part of this series demonstrating specific postural training exercises you can integrate into your daily life. The smallest shift in body positioning can make a major difference in the experience and effects of your exercise program.
Remember, if you’re trying something new, always talk to your healthcare provider first.
EXERCISING YOUR BONES SERIEs By Rebekah Rotstein, NCPT
Rebekah Rotstein is an industry leader for Pilates, bone health and movement education. She is the founder of Buff Bones®, a medically-endorsed exercise system for bone and joint health with on-demand classes and trained instructors in more than 30 countries. A former ballet dancer, Rebekah also worked in the Sports Medicine department of Smith College as a student athletic trainer starting in 1994. Her ongoing study of the body includes cadaver dissections along with coursework in fascia research, somatic studies and visceral manipulation. A diagnosis of osteoporosis at age 28 motivated her to advocate for others with low bone mass and to provide them with innovative education and programming. She has presented at numerous conferences in the Pilates industry, at the International Osteoporosis Foundation Worldwide Conference and for the International Association for Dance Medicine and Science. Rebekah is a member of the Ambassador Leadership Council for the Bone Health and Osteoporosis Foundation, an ambassador for American Bone Health and worked as a partner of the U.S. Department of Health and Human Services Office of Women’s Health. She also serves on the Bone Health Working Group for the Society for Women's Health and Research, contributing to the 2021 recommendations published in the Journal for Women’s Health.