Osteoporosis Exercises

Now you know the two best types of exercise for osteoporosis and have a wealth of exercise tutorials to get you started. But there’s still a burning question to answer. “Is exercise alone enough to increase bone density?” Well, the short answer is no. At least not outright.

Exercise can increase your bone density, but it’s not enough to counterbalance the natural bone loss you experience when you’re around 40-years-old and above. See, when you reach this age, your natural bone remodeling process becomes unbalanced. Your bone-resorbing osteoclasts start to remove bone quicker than your bone-building osteoblasts can replace it. In fact, you can expect to lose about 1% of your bone density every year from 40 onwards.¹⁴

The majority of studies on exercise and bone mineral density (BMD) show exercise can slow bone loss, but it isn’t sufficient to increase bone density alone. In fact, we had our Resident Bone Health Expert, Lara Pizzorno, take a deep-dive into the medical journals for every relevant study she could find. The studies fell into one of two categories:

1. Studies that examine the relationship between exercise and fracture risk
2. Studies that examine the relationship between exercise and BMD

Exercise and Fracture Risk

Only one study on the effects of exercise and fracture risk was of high enough quality for us to include here.

Name: The role of physical activity in the prevention of osteoporosis in postmenopausal women-An update.

Type of study: A review of relevant randomized controlled trials (RCTs) and prospective cohort studies. A prospective cohort study is a study that follows a group of similar individuals for a prolonged time. The individuals tend to differ concerning certain factors of the study, to determine how these factors affect a certain outcome.

Summary: Of the seven studies reviewed, three were RCTs, one was a controlled, un-randomized study, and three were prospective cohort studies. The RCTs drew differing conclusions on whether exercise increases BMD. But two of the prospective cohort studies found that exercise is linked with a reduced risk of hip fracture.

In fact, one study found that participants who exercised for 24 MET hours or more a week had a 55% lower of hip fracture compared to participants who exercised for only 3 MET hours or less a week. (If you’re not sure what an MET hour is don’t worry, we explain it with examples a little further down the page.)

Results: This review supports the theory that exercise can reduce the risk of fractures, particularly hip fractures.¹⁵

Exercise and Bone Mineral Density

Six studies on the relationship between exercise and bone mineral density met the quality requirement to be deemed genuinely insightful and useful. Click on the studies below for a summary and the main outcomes of each:

If you’d like to see the studies that we didn’t deem high enough quality to include in our review, click on the icon below:

As you can see, the majority of studies support the theory that exercise slows bone loss and helps to balance out the natural bone remodeling process, but can’t increase BMD outright. Still, losing less bone than you would naturally is still a step in the right direction! But as you’ll see in just a moment, increasing bone density is possible with some help from nutrition. In addition to slowing bone loss, exercise provides the following bone health benefits too:

When it comes to bone health and osteoporosis specifically, exercise provides the following benefits:

Combats Sarcopenia

A little earlier, we mentioned that increasing your muscle strength will help you prevent sarcopenia. Sarcopenia is a common condition associated with aging where you start to lose your muscle mass and replace it with fat.²² The exact amount of muscle loss varies from person to person, but recent research suggests that the average rate of loss for people over 70 is 0.5-1% per year.²³ As you can imagine, losing muscle mass means you become weaker. Plus, it further affects the decline in balance associated with aging.²⁴ And this significantly increases the risk of fracturing a bone from a fall! What’s more, a decrease in muscle strength leads to a decrease in bone strength too.²⁵ The skeletal and muscular systems are tightly intertwined and the strongest mechanical forces on your bones are those created by muscle contractions. These muscle contractions condition your bone density, strength, and microarchitecture (the internal structure of your bones.) So that’s the bad news. But the good news is that you can stave off sarcopenia, or even reverse it, with the muscle-strengthening exercises we outlined above!

Activates Your Osteocytes & Extends Their Lifespan

You may already know that you have specialized cells called osteoblasts. Your osteoblasts build new bone after your old, worn out bone is broken down by osteoclast cells. After your osteoblasts have completed their bone-building, they become embedded in the bone matrix they’ve produced and turn into osteocytes. Osteocytes are very long-lived cells (their average half-life is 25 years) that form a signaling network in your bones. This network is like the nervous system in the rest of your body; it transmits signals to direct and balance the activity of your bone-building osteoblasts and your bone-resorbing osteoclasts.²⁶ And here’s where exercise comes in: osteocytes tend to die off as you get older. Especially if they’re not stimulated by “mechanotransduction.” Now, in plain English, mechanotransduction means a movement that puts stress on muscles, which in turn puts stress on bones. In other words, exercise!

Increases Your Production of Osteoblasts and Muscle Cells

Those osteocytes we were just talking about have even more bone benefits! In response to exercise, osteocytes send signals that increase the pool of mesenchymal stem cells– cells that can grow up to become osteoblasts, adipocytes (fat cells), or muscle cells. And here’s the catch; you tend to produce fewer mesenchymal stem cells as you age. Plus, most of them become fat cells — unless you exercise. The cycle goes like this:

1. Exercise turns on your osteocytes
2. Having more osteocytes increases the number of mesenchymal stem cells you produce…
3. …AND tells them to become osteoblasts or muscle cells instead of fat cells

It’s a win-win situation! What’s more, only one other strategy will effectively increase your production of mesenchymal stem cells AND convince them to become either osteoblasts or muscle cells instead of fat cells. Consuming enough of the omega 3s, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). (We’ll cover omega 3s in more depth in “The Importance of Nutrition for Your Bones” section below). Lastly, when osteocytes are turned on in response to mechanical loading (putting stress on muscle through exercise), they stop secreting a protein called sclerostin. Plus, they increase the secretion of proteins involved in Wnt signaling. Now, sclerostin inhibits the development of osteoblasts and bone formation.²⁷ And Wnt signaling promotes the production of both bone-building osteoblasts and myocytes (muscle cells).²⁸ Another win-win!

You wouldn’t tell an athlete to forget protein because all they need for building strong muscle is exercise, right? Well, the same principle applies to your bone density. You can’t rely on exercise alone. In fact, there are three main pillars of increasing bone density:

1. Getting the essential bone-building nutrients

Nutrition steals the show when it comes to increasing your bone density. In fact, our award-winning studies show you can increase your bone density by providing your bones with proper nutrition alone– even without exercise. But to maximize your bone-building results, you’ll need the supporting cast. We’ll outline the nutrients that directly impact your exercise efforts below and the 13 minerals and 3 vitamins essential for supporting healthy bones in “The Nutrition Roundup” section a little further down.

1. Regular weight-bearing and muscle-strengthening exercise

We’ve already seen how exercise slows your bone loss, combats sarcopenia, reduces your risk of a hip fracture, and activates your bone-building osteoblasts. But when you incorporate proper nutrition with your exercise the benefits are maximized (as you’ll soon discover.)

1. Minimal exposure to harmful toxins

Everyday things like smoking, certain prescription drugs, and even refined sugar cause inflammation in your body. If this inflammation persists, it can become chronic. And chronic, low-grade inflammation can accelerate your bone loss! Check out the “Overexposure to Toxins” section of our “Osteoporosis Causes” page for more information. This trio of factors will give you the best results when it comes to strong, healthy bones. Now, as far as the essential bone-building nutrients are concerned, there are 13 minerals and a handful of vitamins that are essential for supporting healthy bones. You can read all about them on our “Osteoporosis Diet and Nutrition” page. But there are also several nutrients (some of which are also the essential bone-building nutrients) that directly impact the benefit of your osteoporosis exercises. So let’s take an in-depth look at those now.

Calcium

You know that calcium is the cornerstone of bone health, right? But what you might not know is that getting enough calcium is the deciding factor in whether exercise delivers anti-fracture benefits or not. It’s true! Overwhelming evidence shows that people who don’t get enough calcium have lower bone mass (and a greater risk of fracture) compared to people the same age who consume adequate or high levels of calcium. And that goes for young people as well as older folk too!

So how much calcium do you need to see bone benefits from exercise? Well, research suggests the minimum amount of calcium you need to consume is 1,000 mg/day. Anything less than this amount, and exercise has little to no effect on increasing bone mass.²⁹ A review of data from 16 exercise intervention trials in peri- or postmenopausal women demonstrated this “calcium threshold” for exercise.³⁰ The review studied the effects of calcium intake and exercise on BMD in the spine and radius (the shorter and smaller bone of the two long bones in the forearm). Increasing calcium intake without the stimulus of exercise had a very minor effect on BMD in the spine. But when the participants consumed less than 1,000 mg of calcium per day, exercise didn’t improve spine BMD at all! It took both exercise and sufficient calcium to increase BMD.

Interestingly, exercise only had very minor effects on the BMD of the radius, even when the participants were consuming adequate amounts of calcium. But there’s a logical explanation for that; most training programs don’t put sufficient stress on the radius to make a difference. Even very high-intensity resistance and impact training doesn’t increase BMD in postmenopausal women with osteopenia and osteoporosis. In the “LIFTMOR trial,” 101 postmenopausal women with low bone mass were randomly assigned to either: eight months of twice-weekly, 30-minute, supervised high-intensity resistance and impact training (HiRIT) or a home-based, low-intensity exercise program (CON).¹⁸ All participants (in both groups) increased their muscle strength. But, the CON group lost BMD at all sites measured. And the HiRIT group mostly maintained BMD, but some actually lost BMD. Remember, you lose about 1% of your bone density every year after the age of 40. So this study shows that even high-intensity exercise isn’t enough to counterbalance that loss. And what’s more, these women were consuming a diet that provided far more calcium than typical– around 900 mg or more a day. (Just under that magic threshold of 1,000 mg/day). Plus, this was a serious workout. As we mentioned in the “Does Exercise Alone Increase Bone Mineral Density?” section above, the ladies in this study were performing incredibly high-impact, high-intensity exercises like jumping chin-ups with drop landings. The good news is that no fragility fractures occurred. So, this study shows that women with osteopenia, or even osteoporosis, can engage in high impact training when supervised!

The bottom line: Exercise without sufficient calcium intake will not increase BMD. In postmenopausal women, exercise appears to provide a necessary stimulus for incorporating more calcium into the skeleton. But there has to be enough calcium present for bone-building to take place. And you need vitamins D and K2 to work with calcium to benefit your bones.

Protein

There’s a reason people take protein shakes after a workout…protein is crucial for muscle growth! And remember, your skeletal and muscular systems are tightly intertwined. So basically, protein builds your muscle mass, which helps to keep your bone health in check. But as you age, you become less able to convert protein into muscle. This is actually a contributing factor for sarcopenia! If you recall, in the “Benefits of Exercise for Bone Health” section, combatting sarcopenia was one of the benefits we listed. But to give yourself the best chance of avoiding sarcopenia eating enough protein is crucial too!

So how much protein is enough? Well, that’s where things get a little confusing. See, the original recommended daily allowance (RDA) of protein for older adults doesn’t appear to enough. The original RDA is 0.8 g of protein per kg of body weight. But that amount was set with preventing a deficiency in mind. Not for promoting optimal health. Experts are now suggesting that the original RDA could actually lead to muscle loss in older adults! Don’t worry though, you can read all about the new RDA for protein experts are suggesting in our “Everything You Need to Know About Protein and Bone Health” post. It covers the best sources of protein, and some more in-depth information on why it’s important for your bones too.

Vitamin D

You may know that you need vitamin D to be able to absorb the calcium you consume. But get this– vitamin D can help you boost your muscle growth and stay on your feet too! See, your muscle fiber membranes are loaded with vitamin D receptors. And when these receptors get a little vitamin D exposure, they trigger muscle growth! Now, the ‘Institute of Medicine’ still claims there isn’t sufficient evidence of vitamin D preventing sarcopenia. But in Europe, a panel of experts determined a vitamin D level of at least 30-44 ng/mL (nanograms per milliliter in your blood) was necessary for musculoskeletal health. The “at least” here is important. Even 44 ng/mL of vitamin D isn’t enough for your bones. Ideally, you need 50-80 ng/ml for bone and immune health.³¹

Omega 3 Fatty Acids

Omega 3s are renowned for their anti-inflammatory properties. (This makes omega 3s a vital piece of the bone health puzzle as chronic inflammation accelerates bone loss!) But omega 3s also help preserve lean body mass, too. Especially eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). These two omega 3s increase the activation of an enzyme called mTOR. Now, mTOR activation is a big deal. mTOR is the key regulator of muscle protein synthesis.³² And muscle protein synthesis is the process of repairing and building muscles tissue when you exercise! Plus, mTOR regulates a bunch of other vitally important cellular processes that enhance health and slow the aging process too!³³

The Nutrition Roundup

Calcium, protein, vitamin D, and omega 3 fatty acids are the nutrients shown to boost the effect of, or maximize your exercises. But, if you recall, we mentioned there are a total of 13 minerals and 3 vitamins your bones crave too (not including protein and omega 3 fatty acids.) They are:

The 13 Essential Bone-Supporting Minerals

The Supporting Cast Of Vitamins

Getting all of the above into your diet is a challenge though. It’s almost impossible to regularly achieve the recommended daily intake of calcium for people over 50 (1,200mg/day). And taking enough supplements to cover every vitamin and mineral your bones need can cost a small fortune… and cause a real headache as far as scheduling is concerned! But thankfully, there’s an easy, convenient way to get everything your bones crave. AlgaeCal’s Bone Builder Pack (AlgaeCal Plus + Strontium Boost) provides all 13 of those bone-supporting minerals and the 3 vitamins too. That includes 720 mg of body-friendly, natural, plant-based calcium! (The average diet provides around 500 mg/day of calcium. So your diet + the Bone Builder Pack = the recommended daily intake of 1200 mg or more!)

What’s more, when you use the Bone Builder Pack, you’re guaranteed to see an increase in your bone mineral density at every follow-up DEXA scan! It’s the perfect nutrition companion to any osteoporosis exercise regimen and it’s 100% risk-free to give it a try! Now, the Bone Builder Pack doesn’t contain omega 3s. But Triple Power Omega 3 Fish Oil has you covered in that department. Triple Power provides over 1400 mg of omega 3s, including a combined 1200 mg of EPA and DHA which we covered above. And the best part? It’s naturally flavored with mango to make it the best-tasting fish oil product you’ll have ever tried. No fishy taste or fish-burps with Triple Power, and that’s a guarantee. That just leaves protein. Don’t worry though; it’s super easy to add protein-rich foods to your meals. In fact, you can discover the top protein sources in our “Everything You Need to Know About Protein and Bone Health” post.

Exercising when you already have osteoporosis can seem scary. You may think that performing a range of exercises and being more active than usual would increase your chance of taking a tumble and suffering a fracture.

But hopefully, the information we’ve provided on this page helps ease your mind and demonstrates that exercise is actually an important part of combating osteoporosis. But of course, you should approach osteoporosis exercises with your safety in mind and try to stay realistic. You know your body better than anyone, so listen to it and don’t try to take on too much too quickly, especially if you’re just starting out with osteoporosis exercises.

The exercise walkthroughs we provide are recommended specifically for people with osteoporosis, but many of them also have beginner versions for you to try first. If you’re just starting out on an osteoporosis exercise, we highly recommend that you check in with your doctor first. Your doctor knows your bone health history as well as your general health, so they can help you tailor an exercise program to your stage of osteoporosis, fitness level, and overall health.

Exercise Movements to Avoid and General Safety Rules

Below is a checklist to keep in mind to help keep you and your bones safe while exercising. Remember, exercise is beneficial for your bone health, but safety always comes first!

1. Avoid contraindicated exercises – You want to steer clear of any exercises that can cause you pain or injury. For osteoporosis exercises specifically, avoid exercises that involve forward flexion of the spine (bending forward at the spine to make a “C” shape) involve twisting actions or include excessive bending or bouncing stretches.
2. Focus on quality, not quantity –  Performing an exercise with the correct form will help protect you from injury. Try to exercise in front of a mirror if possible so you can keep an eye on your form!
3. Work at an intensity that suits you – When it comes to exercise, you need to push your body enough to gain a benefit. As you become stronger or more flexible, you’ll find the exercises you began with will become easier. These exercises won’t test your body enough anymore and you’ll cease to improve, so you need to gradually progress your exercises. But, you don’t want to put yourself at risk by taking too much of a leap. A great way to both progress your exercises and maintain your safety is to monitor the exercises you do. Let’s take a bicep curl as an example. Say you start off at two sets of 6 repetitions with a 2 pound weight. Record how the exercise feels every time you perform it, and when it gets too easy, try doing two sets of 10 repetitions with a 2 pound weight. And from there you can increase the weight, and the sets and so on!
4. Maintain your posture and technique – Keep your posture and technique in mind when you’re performing any exercise. These are both important to keep your body alignment in check so that you’re working the parts of your body the exercise is intended to work and to help you avoid injury too.
5. Take care of your joints – Looking after your joints is very important. After all, they support your body and help to keep you on your feet and independent! Now, the best way to care for your joints is to keep the muscles that support them strong. So, if you know your knees are a little on the weak side, for example, include some exercises in your regimen that work the surrounding muscles; your quadriceps, glutes, and calves.

Now you know why you should be exercising, the types of exercise that are most beneficial for your bones, and the safety tips to consider too. That just leaves how much exercise you should be doing…

Well, Metabolic Equivalent (MET) hours are used to measure the intensity of exercise. The MET measures the amount of energy you burn during exercise and various physical activities. For reference, 1 MET is equal to the number of calories burned at rest: 30-38 calories for every 30 minutes. And you burn 3-6 METs of energy with moderate exercise: 90-225 calories in a 30-minute workout.

So how many MET hours of exercise do you need a week? Well, active women with a minimum of 24 MET hours of at least moderate activity per week have a 55% lower risk of hip fracture according to The Nurses’ Health Study!³⁴ (But remember, this is relative risk compared to sedentary women getting less than 3 MET-hours per week). Now, the exact number of calories you burn will vary depending on two things. How much muscle mass you have, and how vigorously you use it during the exercise. The good news here is the more you exercise, the more muscle you will have, and the more calories you will burn. For an idea of how many MET hours various activities tally up on average, check out the following table:

7.8

Table Sources:

1. https://sites.google.com/site/compendiumofphysicalactivities/Activity-Categories/bicycling
2. http://www.whyiexercise.com/metabolic-equivalent.html
3. https://en.wikipedia.org/wiki/Metabolic_equivalent

To maximize the impact your exercise regimen has on your bone health, you should try to tick off everything on the following checklist.

• Exercise at least three times a week for 1 hour – An hour every day of some form of weight-bearing movement is even better when you feel ready for it!
• Be dynamic! Try to include exercise that involves faster movements opposed to slow, static movements
• Involve some impact – For example walking, jogging, or vigorous dancing, rather than cycling or swimming as we explained a little earlier
• Exceed a threshold intensity – Aim to exercise at least 70%, (preferably 85%) of your maximum effort. In other words, you should be short of breath and a little sweaty by the end
• Gradually make your exercises harder – Your exercise shouldn’t be too easy! Gradually increase the number of times you can work a muscle or muscle group because as you get stronger, what you’re doing will get easier (a very good sign!)
• Involve short bouts of intense exercise with less intense recovery periods – Bopping till you drop is no fun. It’s not effective either. Take short breaks between exercise sets, and you’ll come back stronger
• Impose an unusual loading pattern on your bones – You do want to repeat movements until the muscles you’re using get the message to get stronger. But you don’t want your entire workout to only include the same movement over and over again. That’s boring and ineffective. You want movements that involve a wide variety of muscle groups and movement direction.

A Word on Recovery: Exercising at 70% of your maximum effort is tough work! But did you know omega 3 fatty acids can maximize your workout by reducing inflammation in your body and reducing your recovery time too? Remember, Triple Power Omega 3 Fish Oil provides over 1400 mg of omega 3s per tablespoon. And it tastes so good you’ll want to workout just to be able to have a spoonful afterwards! And last, but definitely not least, your workouts should be combined with optimal nutritional support: protein, calcium, vitamin D3, vitamin K2, magnesium, boron and other trace minerals.

Increase Bone Density with AlgaeCal Plus and Strontium Boost

Exercise is an important aspect of your bone health. Especially weight-bearing and muscle-strengthening exercises. But exercise alone can’t improve your bone density. For that, you need to combine your exercise program with proper nutrition.

Specifically, your bones crave 13 minerals and 3 vitamins– all of which are provided in the Bone Builder Pack! Not only is the Bone Builder Pack a super convenient way to provide your bones with the nutrients they crave, it’s GUARANTEED to improve your bone mineral density! It’s the perfect companion for any bone-healthy exercise regimen. And remember, omega 3 fatty acids and protein can maximize the benefits of your exercise program too!