Exercise & Osteoporosis
Exercise can play an important part in helping to reduce your risk of osteopenia/ Osteoporosis and it is also an important aspect of treatment.
If you have been diagnosed with either, we recommend that you be assessed when possible by a chartered physiotherapist with a special interest in bone health. A physiotherapist can assess what exercises are safe and appropriate for you to do at home and what ones you should avoid, such as regular sit-ups, kickboxing or any stretch that puts additional stress on your vertebrae. If you are participating in a class or attending a gym, a physiotherapist can also advise you in this regard.
Bone is scaffolding which supports the body against the force of gravity. Bones resist the pull of our muscles to allow movement. As bone is a living tissue, it reacts to appropriate weight-bearing exercise by growing stronger. This is how you support the weight of your own body.
The safe and sensible way to begin an exercise programme is to take your time and listen to your body. The type of exercise you do depends on your risk of fracture, your age, your medical history and your DXA scan results.
Please remember that over-exercising is very harmful for your bones. In general, we recommend 30 minutes weight-bearing exercise a day, both for your bones and overall health. This can be broken up into 3-5 minutes at a time, 3 sets of 10 minutes or 30 minutes continuously. Children should be encouraged to do 60 minutes of moderate-high impact exercise daily (30 minutes weight-bearing and 30 minutes for overall general health). This is especially important prior to puberty as bone strength can be significantly increased to reduce the risk of Osteoporosis in later life.
Examples of weight bearing activities include tennis, hockey, football, basketball, running, jogging, team sports and dancing. Walking is a weight-bearing exercise, however it is important to change your pace intermittently.
Some activities can be done in many places, and can be included in a busy daily routine. Stair climbing is good for your spine and hip but should only be done by those who are steady on their feet and using a rail. Ten times up and down an average flight of stairs (10-12 steps) is a third of your daily weight-bearing requirements.
Intermittent jogging is great for people who find running or jogging too strenuous. Walk for a few minutes and than jog for 30-60 seconds. This helps to increase bone density (strength) in the spine and hips but you should be medically cleared by your doctor.
Advice regarding Exercise for Adults with Osteopenia
Speak to your doctor and a chartered physiotherapist to find out what activities are appropriate for you. A chartered physiotherapist with a special interest in bone health will take into account your DXA scan results, your medical history, your risk of fracture and the areas most affected before prescribing an appropriate exercise programme.
Start slowly and gradually build up the amount and the intensity until you have reached the target prescribed by your physiotherapist. Never increase the speed and intensity at the same time, and add only one new exercise in the each session. This way if you experience a problem with an exercise you can identify which one it is.
Some exercises can specifically benefit your area of bone loss, e.g. the spine or hip. Exercise to promote good posture and balance are also recommended. Pilates and Tai Chi may be beneficial, ideally in small classes and preferably run by a chartered physiotherapist.
STOP your exercise programme if you experience pain and have the area of pain reassessed. If pain persists, it could be a sign of an over-use injury, which means you should stop exercising until the injury heals. If you are feeling unwell, exercise is not recommended.
If you experience stiffness after exercising, this is your body saying that you have done too much, too soon. A slow walk could help to loosen up your muscles.
Exercise must be taken regularly to have any benefit. Little and often is the best strategy. Regular exercise must be a permanent lifestyle decision because if you stop, it’s beneficial effects gradually wear off. Muscles adapt to extra use within weeks but bones take several months.
Note that your exercise programme should be reassessed at intervals.
Advice regarding Exercise for Adults with Osteoporosis
Have an assessment when possible, with a chartered physiotherapist with a special interest in bone health, who will work with you to design an individualized programme of weight-bearing and muscle-strengthening exercises specifically for your needs.
Although it is important to avoid stresses that may cause fractures, avoiding all exercise and activities will only serve to diminish your bone health.
In general, avoid the following:
- Excessive forward bending of your back e.g. regular sit-ups and touching your toes with your legs straight
- Exercises that involve bending and twisting of your spine at the same time.
- High impact exercise as this increases your risk of developing or aggravating a back, hip, knee or ankle problem as well as the Osteoporosis itself.
Remember that Osteoporosis affects people of all ages. An exercise programme for a 20, 45 and 70 year old will all differ.
If you have sustained a fracture as a result of a fall, then advice may be given by your physiotherapist on how to reduce your risk of further falls. A large amount of falls can be prevented, e.g. by wearing good walking shoes in your home instead of slippers. Removing throw rugs from your home and getting regular eye exams can also help.
Basic Rules for Exercising
Clothes: Wear runners and comfortable clothing.
Environment: Make sure you have enough space to move and that you will not get too hot or too cold.
Warm Up: Start slowly, doing gentle exercise like marching on the spot. Do safe stretching exercises before you begin your main exercise and cool down and stretch after the activity to reduce your risk of injury. Always stretch slowly and never bounce as this can cause an injury. Ideally you should hold the stretch for 30 seconds.
Type of Exercise: Try to pick an activity that you know you like, so you will not dread having to do it. Varying your activities reduces your risk of getting bored and will stimulate more bone growth.
Progression of your activity: Gradually build up the intensity and the amount of time.
Weight training for women and men
Resistance training using weights and gym machines has been shown to promote bone health by increasing your muscle strength and bone density. This consists of lifting heavy (but we recommend moderate if you have Osteoporosis) weights in a slow, controlled manner.
You should always warm up first and alternately work the arms and legs. Begin with two leg exercises followed by one upper body exercise. Begin lifting the weights slowly and take ten seconds in between each lift. Breathe in as you lift and breathe out as you lower the weight.
To avoid an injury, begin with weights that are 25 % of the maximum you can lift. As you slowly and steadily progress, increase the weights to 85% of your maximum; this should be done over 3-4 months. In young healthy individuals, begin with 50% of your maximum, increasing to 85% over 3-4 months.
If you weight train regularly, it is best to take a days rest in between training days.
Getting advice from a chartered physiotherapist with an interest in bone health should help you avoid an injury. You need to be especially careful with weight training if you have back pain combined with Osteoporosis risk factors. Remember that strenuous weight training can cause a serious injury if you have undiagnosed Osteoporosis.
For more information on exercise and Osteoporosis, the IOS has a book available entitled 'Exercise for Strong Bones, your easy-to-follow guide to reducing your risk of Osteoporosis'. It costs €20 and can be purchased by calling Lo-call 1890 252 751 or online in the IOS Shop.