Bone is living tissue that responds to exercise by becoming stronger. You know that your muscles get bigger and stronger when you use them. Bones are similar. They get stronger and denser when you make them work. And “work” for bones means handling impact, the weight of your body or more resistance. Currently, we know the most about two types of exercises that are important for building and maintaining bone density. These are weight-bearing and muscle-strengthening exercises:

Weight-bearing exercises

These exercises include activities that make you move against gravity while staying upright. Weight-bearing exercises can be high-impact or low-impact.

High-impact weight-bearing exercises help build bones and keep them strong. If you have broken a bone due to osteoporosis or are at risk of breaking a bone, you may need to avoid high-impact exercises. People who are frail or who fall easily should also avoid high-impact exercises. If you’re not sure, you should check with your healthcare provider. Some examples of high-impact weight-bearing exercises are:

• Dancing
• Doing high-impact aerobics
• Hiking
• Jogging/running
• Jumping Rope
• Stair climbing
• Tennis

Low-impact weight-bearing exercises can also help keep bones strong and are safer for people who cannot do high-impact exercises. If you can’t do high-impact weight-bearing activities, try lower-impact ones. Some examples of low-impact weight-bearing exercises are:

• Using elliptical training machines
• Doing low-impact aerobics
• Using stair-step machines
• Fast walking on a treadmill or outside

Muscle-Strengthening Exercises

These exercises include activities where you move your body, a weight or some other resistance against gravity. They are also known as resistance exercises.

• Lifting weights
• Using elastic exercise bands
• Using weight machines
• Lifting your own body weight
• Functional movements, such as standing and rising up on your toes

Yoga and Pilates can also improve strength, balance and flexibility. However, certain positions may not be safe for people with osteoporosis or those at increased risk of broken bones. For example, exercises that have you bend forward may increase the chance of breaking a bone in the spine. A physical therapist should be able to help you learn which exercises are safe and appropriate for you.

Non-Impact Exercises

Non-impact exercises can help you to improve balance, posture and how well you move in every day activities. These exercises can also help to increase muscle strength and decrease the risk of falls and broken bones. Some of these exercises include:

• Balance exercises. Exercises that strengthen your legs and test your balance, such as Tai Chi, can decrease your risk of falls.
• Posture exercises. Exercises that improve your posture and reduce rounded or “sloping” shoulders can help you decrease the chance of breaking a bone, especially in the spine.
• Functional exercises. Exercises that improve how well you move can help you with everyday activities and decrease your chance of falling and breaking a bone. For example, if you have trouble getting up from a chair or climbing stairs, you should do these activities as exercises (try standing up and sitting down several times until you are tired).

A physical therapist can teach you balance, posture and functional exercises. NOF’s publication, Boning Up on Osteoporosis, offers step-by-step instructions and illustrations for posture exercises, hip and back strengthening exercises, balance exercises and functional exercises.

Non-Weight-Bearing, Non-Impact Exercises

These exercises can be part of a well-rounded exercise program, but do not benefit the bones. If you like these activities, try to add other exercises that are good for your bone health.

Some of these exercises include:

• Bicycling/indoor cycling
• Deep-water walking
• Stretching and flexibility exercises
• Swimming
• Water aerobics

Starting a New Exercise Program

If you haven’t exercised regularly for a while, check with your healthcare provider before beginning a new exercise program—particularly if you have health problems such as heart disease, diabetes or high blood pressure. If you’re at high risk of breaking a bone, you should work with a physical therapist to develop a safe exercise program.

Once you have your healthcare provider’s approval, start slowly. If you’ve already broken bones in the spine because of osteoporosis, be very careful to avoid activities that require reaching down, bending forward, rapid twisting motions, heavy lifting and those that increase your chance of a fall.

How Much Exercise Should I Do?

Weight-bearing exercises should be done for a total of 30 minutes on most days of the week.

• Aim for 30 minutes at one time or break it up during the day. For example, 3 sessions for 10 minutes each will provide the same benefits to your bones as one 30-minute session.
• If you can’t fit 10 minutes in, spread your impact exercises throughout your day by taking the stairs or by parking farther from the store or work.

Muscle-strengthening exercises should be done two to three days per week.

• Try to do one exercise for each major muscle group for a total of 8-12 different exercises. Some of the major muscle groups include:
  • Upper back
  • Middle back
  • Lower back
  • Shoulders
  • Upper arms
  • Forearms (wrists)
  • Chest
  • Abdominals
  • Hips
  • Thighs
  • Calves (lower legs)
• Try to do one or two sets of 8 to 10 repetitions for each exercise. For example, if you lift a weight 10 times in a row and then stop, you have completed one set of 10 repetitions. You should also rest for about 30 seconds to one minute between each set.
• If you can’t do 8 repetitions in a row, the weight is too heavy or resistance is too much.
• If you can do more than 10 repetitions in a row, you may want to increase the weight or resistance.
• If you have osteoporosis or are frail, you may want to do 10 to 15 repetitions of a lighter weight to prevent injury.

If you don’t have much time for strengthening/resistance training, do small amounts at a time. You can do just one body part each day. For example do arms one day, legs the next and trunk the next. You can also spread these exercises out during your normal day.

Balance, posture and functional exercises can be done every day. You may focus on one area more than the others. If you have fallen or lose your balance, spend time doing the balance exercises. If you are getting rounded shoulders, work more on the posture exercises. If you have trouble climbing stairs or getting up from the couch, do more functional exercises. You can also perform these exercises at one time or spread them during your day.

As you get started, your muscles may feel sore for a day or two after you exercise. If soreness lasts longer, you may be working too hard and need to ease up. Exercises should be done in a pain-free range of motion.

CAUTION: If you are frail, have had a broken bone, fall often or have osteoporosis you should be cautious. Certain movements like twisting the spine, high impact aerobics or bending from the waist can be harmful. NOF recommends that before starting any exercise program, you should talk to your doctor or other healthcare provider about your risk of breaking a bone.

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