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How to Exercise When You Have Osteoporosis

At-a-Glance:

  • Good exercise gets you moving. Great exercise prepares you for your day.
  • Exercising to improve stability, mobility, and strength will keep you safer. 
  • Ultimately, it’s all about working your body so your body works for you.
    Anxiety Word Cloud

    By Dr. John Neustadt

    Good exercise gets you moving. Great exercise prepares you for your day. Whether getting in and out of a car, carrying groceries, bending to unload the dishwasher, or reaching to put the dishes away, exercise can help you do them all easier and safer. Ninety-five percent of all fractures happen because someone falls. So, it’s simple—prevent yourself from falling, and you’ve prevented yourself from breaking a bone, hitting your head, having a nasty bruise, or any other problems caused by taking a spill. 

    Exercising to improve stability, mobility, and strength will keep you safer. 

    The beautiful thing about moving more is that it improves all areas of your health—cardiovascular, emotional, mental, and musculoskeletal—and reduces your risk of dying. That includes reducing your risk of dying from a hip fracture. Moderate physical activity is associated with decreasing hip fracture risk by 45%.1 That’s better than bisphosphonates like alendronate (Fosamax) and Zometa. And all you have to do is get off your keister and move. 

    Movement is cumulative

    While setting aside time for exercise is important, don’t forget that what you do normally during the day can also count. When I read this study, a lightbulb went on. I do something around the house every day, and I’m sure you do, too. Whether it’s unloading the dishwasher, reaching up to grab a glass, bending down to get a plate out of a cupboard, or typing at my computer, I now intentionally see this as an opportunity to get stronger.  

    For example, when you reach for a glass, try standing slightly further away to stretch your back muscles. Maybe move a little slower when you do it and hold your arm out fully extended a little longer to get an even better stretch. When I vacuum, I switch between my dominant and non-dominant arms so I’m giving them more equal work.  

    Ultimately, it’s all about working your body so your body works for you. And just like professional work, you’re only limited by your imagination. To get started, change the way you think about exercise. You don’t have to go to the gym or carve large chunks of time out of your day. Between exercise apps, videos, and the things you already have in your house (stairs, floor space to do squats and jogging in place), your office (stairs, the block around your building), and your neighborhood (speed walking hills around in your neighborhood), you’ll easily get in 20 minutes of movement a day. Most people probably waste more than 20 minutes daily scrolling mindlessly on social media. So instead, put on a podcast, an audiobook, or some good music and move.

    Moderate vs vigorous exercise

    There’s a lot of confusion out there about what counts as moderate or vigorous exercise. The simplest way to understand it is with the “Talk Test.” Moderate exercise means you’re moving your body enough to be a bit winded but can still carry on a conversation; however, you won’t be able to sing. Similarly, you know you’re doing vigorous exercise if you’re so winded you can’t continue a conversation. You can use this simple gauge to understand if you’re exercising intensely enough to get the benefit you’re after. 

    How long you should exercise

    A 2015 article published in the Journal of the American Medical Association (JAMA) concluded that it only takes 15 minutes per day of moderate exercise for people to start experiencing health benefits.2 People who did this lost weight saw improvements in their blood pressure and blood sugar control and reduced their risk of getting cancer and their risk of death.  Similar results can be achieved with 5-10 minutes of vigorous exercise (such as jogging) per day.  

    While 15 minutes a day of moderate exercise can improve your health, you can get even greater improvement if you want to exercise longer. The health benefits of exercise increase with longer duration or intensity until about 90 minutes per day, but then plateau beyond that. 

    Weights or no weights

    Weight-bearing exercises promote bone growth and improve balance. Non-weight-bearing exercises improve your strength and balance. I recommend doing a mix of the two. The exercises you do are only limited by your imagination and an evaluation of what is safe and appropriate. Examples of moderate exercise include brisk walking, bicycling (at a pace slower than 10 miles per hour), water aerobics, ballroom dancing, general gardening, or housework. If cycling is your thing, consider riding a recumbent bike since it puts less pressure on the spine and hips than a standard upright bike. Vigorous exercise includes jogging, running, swimming laps, aerobic dancing, jumping rope, or hiking up a mountain with a heavy backpack. Using exercise poles while walking and hiking will improve core strength and balance. The point here is that there are lots of options. Pick what sounds fun.  

    The Stork Exercise

    I like simple solutions, and this is one almost anyone can do. The Stork Exercise improves balance and reduces fall risk and injuries. Storks are famous for standing on one leg, which is what you will do every time you brush your teeth.  

    Stand on one leg while spending one minute on the bottom teeth. You can grab the counter to steady yourself, but work to let go. When you move to the top teeth, stand on the other leg for another minute. Again, steady yourself as needed. And that’s your two minutes, twice a day. 

    If you have an electric toothbrush, like a Sonicare or something similar, it keeps track of the two minutes for you. Many electric toothbrushes beep to let you know when it’s time to switch to the top teeth and are programmed to turn off automatically when time’s up. If your toothbrush isn’t as fancy, set the timer on your phone.  

    Once you master the Stork Exercise, brush your teeth with your opposite hand to create a new challenge for your brain and balance. 

    The Stork Exercise tightens your core, engages the supporting muscles in your legs, improves your balance, and can reduce the risk of falling, reducing your risk of all fall-related injuries. I’ve been teaching patients this simple and powerful exercise for years. Like any exercise, you must do it consistently to get the most out of it. Try it twice a day for a few weeks. You’ll feel steadier, stronger, and more confident knowing you’re taking a powerful step toward reducing your fracture risk.  

    Walking and All-Cause Mortality

    One of the beautiful things about exercise is that it can accommodate nearly anyone’s preference. If you’d rather track your steps than how long you exercise, you can do that. In a clinical trial published in 2021, researchers looked at the risk for death in more than 2110 volunteers they followed for nearly 11 years. During that time, they tracked the number of steps and how vigorously they walked (the intensity). They found that people who took 7,000-10,000 steps daily had a 50-70% decreased risk of dying from any cause compared to those who took less than 7,000 steps daily. Taking more than 10,000 steps was not associated with greater benefits.3 Another study showed again that more isn’t necessarily better. They confirmed that taking around 7,000 steps per day is associated with a decreased risk of dying, but there wasn’t any increased benefit for people taking 12,000 steps.4

    But 7,000-10,000 steps is a wide range. Is there an ideal number of steps that give the greatest benefit? Fortunately, another group of researchers asked this question and discovered that the health benefit plateaued at 7,500 daily steps.5  

    These studies were a breath of fresh air for me. While the 10,000-step goal always felt a bit overwhelming, 7,000-7,500 steps a day is certainly something I can do. So, how far are 7,000 steps? People take about 2,000 steps to walk a mile, so 7,000 steps would be about 3.5 miles a day.  

    The beautiful thing is that all the steps you take during the day accumulate to help you reach your goal. While you can carve out a specific block of time to get them in, you don’t have to. Add steps to your day by parking farther from the entrances of stores, taking the stairs instead of the elevator or escalator, pacing or walking around the block while you’re on the phone, or taking your dog for a walk. And if you want to know how you’re doing, use a step tracker app on your smartphone or buy a separate fitness tracker and get those 7,000 steps in a day.  

    Pvolve

    Over the years, I’ve taken lots of classes and lifted weights. While those have all been helpful, I’ve recently fallen in love with Pvolve. This new exercise method is low-impact, backed by research, doesn’t require specialized equipment, and, most importantly, gives results. According to a research study conducted at the University of Exeter, 72 women ages 40-60 years either did four Pvolve workouts a week for 30-55 minutes each or followed standard physical guideline activities recommending 150 minutes of exercise weekly. The women in the exercise group experienced a 23% improvement in energy, a 7.2% self-reported improvement in quality of life, increased lean muscle mass, and improved lower body strength by 19%. Additionally, balance and mobility improved, and flexibility increased by 21%. They also saw a significant decrease in cholesterol and triglycerides.6 

    Before you start 

    It’s important to recognize that there isn’t a one-size-fits-all recommendation. Lifting weights or doing sit-ups may be safe for someone with mild osteoporosis but dangerous for people with severe osteoporosis. To find the right exercise for you, you must carefully evaluate and define the type, intensity, and duration of a program that will be safe. Some yoga or Pilates exercises may be fantastic for improving balance and strength in someone with osteoporosis. Yet without modifications and an instructor trained as an osteoporosis exercise specialist, even gentle yoga or Pilates may cause fractures in people with osteoporosis where the bones are already quite fragile.  

    For example, flexion exercises—where you bend forward—like sit-ups and crunches put a lot of stress on the front of your spine and can cause fractures. Add in kyphosis, and you’re at even more risk. Kyphosis, also called Dowager’s hump, is a head-forward posture with a hump in the upper back that puts an abnormal amount of pressure on the front of the spine. These fractures are called compression fractures because the added pressure on your spine breaks the bones. 

    A study in 1984 evaluated different types of exercises in 59 volunteers with postmenopausal osteoporosis. This was the first study to evaluate the effects of specific types of exercises—flexion, extension, or a combination—on fracture risk. Women were prescribed one of four different exercise routines: 

      1. Extensions while lying down. Imagine lying with your stomach and arching your back to the sky. This is sometimes called the Superman Extensions.
      2. Extensions in a seated position. Picture sitting in a chair and arching backward. 
      3. Stretching the back muscles by bending forward while sitting in a chair. 
      4. Sit ups. 

    After one and a half to two years, 16% of women doing the extension exercises had new spine fractures, while 89% of those doing flexion exercises and 53% of those doing a combination of flexion and extension exercises had new spinal fractures.7

    Rapid twisting, like during a golf swing, can also cause a fracture. Certain yoga poses, like the pigeon pose that puts high amounts of stress on the pelvis, could result in a broken hip. Compression fractures can also occur during inverted poses and pulling your knees to your chest in a tight ball. Even riding your bike can injure your spine. These are all things that many at-risk people do daily because they’re familiar with, they feel good about, and no one has ever taught them the risks involved or evaluated the activities to make sure they’re safe. 

    Vetting your instructors

    An exercise professional must understand your goals and current condition to create a safe and effective program. They also must evaluate how you walk, whether you have a history of falls or surgery, and how you use your body throughout the day. For example, do you sit all day or stand for long stretches of time? They should identify anything that can change your risks before you start working out. Failure to do so can create abnormal and dangerous stresses on the body, with damaging consequences.  

    It’s dangerous to assume a Pilates or yoga instructor or a personal trainer understands how to work with someone with osteoporosis. Before you sign on with anyone, it’s important to interview them. Penelope recommends asking the following questions: 

      • Are you familiar with osteoporosis?
      • Do you have training in working with people who have osteoporosis?
      • Do you know which exercises to avoid in an osteoporosis exercise program?
      • Do you have other clients that have osteoporosis?

    The most intense exercises, such as high-impact activities, that are effective in increasing bone mass in young people may not be appropriate for some older people with osteoporosis. That said, there’s almost always something people can do to improve their balance and strength. 

    Your mindset matters

    A positive mindset about exercise can even lead to a cleaner house. It can produce great results if you perceive housework as beneficial and exercise. A 2007 study evaluated the effect of mindset on health in hotel maids.8 Some in the group of 84 women were told cleaning was good exercise and informed about the health benefits.  

    The following month, they were reminded of the health benefits. After four weeks, those who had been told that their work actually was exercise believed they were exercising more than before. But the effects weren’t all in their heads. Their weight, blood pressure, body fat, and waist-to-hip ratio all decreased. 

    Mix it up

    I suggest mixing things up so you’re not doing the same thing two days in a row. Variety is the spice of life! And that goes for exercise, too. When you’re moving your body, you’ll not only be doing something positive to reduce your fracture risk but also feel better because when you take these actions, you’ll release more of your body’s happy chemicals, like dopamine and serotonin. So get out there, move your butt, and have some fun.

    There’s so much you can do and explore. You can go for a walk. One study that reviewed data from nearly half a million healthy people looked at the effect regular walking has on the risk of developing cardiovascular disease. The study found that the people who walked the most experienced a 31% lower risk of developing cardiovascular disease and a 32% lower risk of dying than people who walked the least.9 And the more the person walked, the greater the benefit.  

    If strength training or working your flexibility or balance is more your thing, then pursue activities that help you improve those areas of your health. A study comparing the effects of aerobic exercise with yoga and tai chi found that all three types of exercise provide equal physical benefits, but only yoga and tai chi also improved mood and sleep.10 A published case study showed that salsa dancing can benefit patients with Alzheimer’s disease.11 Salsa dancing can also be a great aerobic workout to improve your balance. 

    There are many other activities to explore: swimming, gardening, modified Pilates, modified Yoga, paddle boarding, or practicing Qi gong. The opportunities to move your body and improve your health are endless. Get creative and have fun. You can take classes or enlist an exercise buddy or group of friends to help you stay motivated. The point is that regular physical activity will get you on the path to being too fit to fracture while also feeling and looking better, and who doesn’t want that?  

    If You Liked This, You Might Also Enjoy

    Your Body Was Built to Move 

    Collagen for Healthy Bones and Joints 

    MK4 or MK7, Which is Better for Bones? 

    References

    1 Moayyeri A. 2008;18(11):827-35. 

    2 Eijsvogels TM, Thompson PD. 2015;314(18):1915-6.

    3 Paluch AE, Gabriel KP, Fulton JE, et al. 2021;4(9):e2124516-e2124516. 

    4 Saint-Maurice PF, Troiano RP, Bassett DR, Jr., et al. 2020;323(12):1151-1160. 

    5 Lee I-M, Shiroma EJ, Kamada M, Bassett DR, et al. 2019;179(8):1105-1112. 

    6 Pvolve Healthy Aging Clinical Study. Accessed May 20, 2024. 

    7 Sinaki M, Mikkelsen BA. 1984;65(10):593-6. 

    8 Crum AJ, Langer EJ. 2007;18(2):165-71.

    9 Hamer M, Chida Y. 2007;42:238-243. 

    10 Siddarth D, Siddarth P, Lavretsky H. 2014;22(3):272-3. 

    11 Abreu M, Hartley G. 2013;36(2):100-8. 

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