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What is osteoporosis?

Osteoporosis is a condition characterised by weak and fragile bones that are liable to fracture. Normal, strong and healthy bones contain large amounts of minerals, which make them strong. The amount of these bone minerals within our bones is referred to as our bone mineral density (BMD).

Our bones are in a constant state of flux, with bone being broken down and remodelled and rebuilt continuously. When bones break down faster than they rebuild, our bone mineral density decreases.

Our BMD is highest when we are aged in our 20s, and then as we get older our BMD gradually declines. If this loss of minerals from the bone is excessive, our BMD will become very low, and we will develop osteoporosis.

Osteoporosis is a common cause of fractures in older Australians, especially women. In women, the greatest rate of bone loss occurs in the years immediately following menopause.

How can exercise help?

Exercise to prevent osteoporosis: Regular weight-bearing exercise in children and teenagers helps produce strong bones; in adults it helps to maintain bone mass; after the menopause it can be part of an overall treatment plan that aims to slow the rate of bone loss; and in adults over 65 years physical activity can be used to both reduce the rate of bone loss and avoid injury to bones by improving muscle strength and balance. The strength of your bones also determines the type of exercise that is appropriate and safe for your bones.

Certain types of exercise have been shown to minimise the loss in BMD, and in some research studies to even produce an increase in BMD. This is beneficial for both the prevention and the treatment of osteoporosis.

If you already have osteoporosis or other medical conditions, you are over 60, or you are over 45 and have not exercised regularly in recent times, speak to your doctor about designing an exercise programme that is suitable for you.

Which types of exercise can help improve bone strength?

The best types of exercise for decreasing the risk of developing osteoporosis are:

regular weight-bearing exercise (such as walking, jogging and dancing); and
strength (resistance) training (such as lifting weights, push-ups and squats).

Exercises such as swimming and cycling help improve cardiovascular fitness and build muscle strength, but are not as effective at preventing osteoporosis as weight-bearing exercise. So if you are already swimming or cycling regularly but not doing any other forms of exercise, you should consider adding weight-bearing and/or resistance exercise to your weekly routine. Always check with your doctor before starting a new exercise regimen.

Weight-bearing exercise

Weight-bearing exercise is exercise that’s done while you are on your feet, with gravity exerting a force. According to Osteoporosis Australia, weight-bearing exercises that are high impact (e.g. aerobics, running and jumping) have an even more beneficial effect in improving bone strength than low-impact exercises (e.g. leisurely walking).

To maintain the bone-strengthening benefits of weight-bearing exercise, you need to keep up the exercise regularly, for the long term. If you stop exercising, the benefit wears off. Experts advise 45–60 minutes of weight-bearing exercise 3 days per week to increase the strength of your bones.

Strength (resistance) training

Strength (resistance) training involves lifting weights with your arms or legs. Resistance exercises can involve weights that you hold or have strapped to you, or resistance machines where you use a programmed weight. Alternatively, some resistance exercises use your own body weight as the load.

Strength training helps improve your bone health by putting strain on the bones, which helps make them stronger. As your body adapts to each new level, you will need to increase the resistance to continue to improve bone strength. There is some evidence indicating that progressing to heavier resistances is most effective in preventing the loss of, and encouraging an increase in, BMD. Doing a programme of resistance exercises 2-3 times a week has been shown to help maintain and even increase bone mineral density in women who have gone through menopause. Resistance training also helps to build up and maintain muscle mass, which helps reduce the risk of falls.

Talk to your doctor or physiotherapist before starting a resistance training regimen.

Balance exercises

Balance training is an important part of looking after your bones. Working on your balance can improve your stability and help prevent falls, which is important because falls can cause fractures.

Recommended balance exercises include:

standing on one leg;
tai chi; and
balancing with a rocker board under your feet.

Start with a balance exercise that you find easy and work up to those you find harder — you can also challenge yourself by closing your eyes during exercises that you’ve mastered.

Weight-bearing and resistance training for all

Since the prevention of osteoporosis is a far better strategy than trying to reverse it, all adults should undertake regular weight-bearing and/or resistance training regardless of their age. In young people this will help to increase their BMD to higher peak levels, which will then reduce the risk of it declining to osteoporotic levels later in life. Continuing with this exercise throughout your life will minimise the decline in BMD that occurs with age and further reduce the risk of osteoporosis in old age.

General precautions

Remember, if you are unfit or have any medical problems, you should check with your doctor before starting an exercise regimen. Almost everybody will benefit from weight-bearing and resistance exercise, but if you are unfamiliar with it, starting off with low-impact exercise and working your way up to high-impact exercise may be the best approach. If you are uncertain, seek professional advice.

Osteoporosis prevention resistance training exercises

First, check with your doctor whether the exercises shown here are suitable for you. This is especially important if you have other medical conditions, or you are over 45 and have not exercised regularly in recent times.
These exercises are not designed for people who already have osteoporosis. Do not go ahead with these exercises if you already have osteoporosis — instead, see your doctor for an exercise programme that is suited to your needs.

Equipment

For this exercise programme you’ll need a sturdy chair (without arms) that has a high back, approximately level with your waist. If your chair is the correct size, when sitting with good upright posture, your bottom should rest against the back of the chair while your feet are flat on the floor and the backs of your knees touch the seat of the chair.

You’ll also need a pair of portable or strap-on wrist weights and a pair of strap-on ankle weights. When starting out, use the lightest weights you can lift comfortably. However, you will need to increase the weight as you grow stronger. This is vital for building strength. Wear comfortable, non-restrictive clothing, thick socks and comfortable exercise shoes.

Exercise tips

Warm up first

Warm up first by doing a repetitive, gentle movement such as walking for a few minutes or slowly going through the motions of a couple of the weight-training exercises, minus the weights. This helps circulate blood to your muscles and reduce the risk of an injury.

Slow repetitions

Perform each exercise slowly 8–10 times. A slow repetition means taking about 3 seconds to lift the weight, 1 second to rest, then 3 seconds to lower the weight. Repeat for the opposite leg or arm, where necessary. These 8–10 repetitions make up one ‘set’. An exercise session should consist of 2–3 sets each of 6–8 different types of resistance exercises. It’s best to rest for 10–14 seconds between repetitions.

Don’t hold your breath

Remember to breathe regularly during these exercises. For example, take a deep breath in, then breathe out slowly as you lift the weight; breathe in as you lower the weight. Do not hold your breath while lifting or lowering the weight.

You should not feel pain

You should need to use strong effort when lifting the weights in these exercises, but remember to stay within a range of movement that does not cause you pain.

Stretch your muscles

After you have completed all the exercises in the sequence, gently stretch, in turn, all of the muscles you have just worked.

A day of rest

Do these resistance exercises on 3 days of the week, always allowing a non-weight training day between weight-training days, so that your muscles can recover.

Progression

Do not increase the weight that you lift until you can easily complete the 8th repetition of an exercise. Gradually add enough weight to challenge your muscles, so that it feels hard or very hard to complete the repetitions. When you can lift a weight 8–15 times, then add more weight to challenge your muscles again. Repeating this process will help build strength. Make sure you don’t overdo it, however: if you can’t lift a weight 8 times in a row, it’s too heavy for you so use a lighter weight.

Talk to your doctor or a qualified fitness professional to make sure your exercise programme is right for you.

Sample exercise to prevent osteoporosis

	1. Calf raises. Wear ankle weights for this exercise if you can comfortably support the weight. Rest both hands on the back of your chair for balance. Lift your heels and rise up on the toes of both feet, hold, then slowly lower your heels. As you become stronger, you can rise up on one foot at a time, while you hold your other foot slightly off the ground.
	2. Knee flexion. Wear ankle weights for this exercise if you can comfortably support the weight. Rest both hands on the back of your chair for balance. Bend one knee and slowly lift this foot backwards, off the ground, while keeping the thigh of this leg still. Try to reach your foot towards the back of your thigh, hold, then slowly lower your foot to the ground. Repeat for the other leg.
	3. Hip extensions. Wear ankle weights for this exercise if you can comfortably support the weight. Rest both hands on the back of your chair for balance. Bend forward at the waist so that your torso is leaning towards your chair at about 45 degrees. Slowly lift one leg backwards while keeping your knee straight. Lift as high as you can without losing balance and without bending further forward. Hold, then slowly lower your leg. Repeat for the other leg.
	4. Hip flexion. Wear ankle weights for this exercise if you can comfortably support the weight. Stand side-on to the back of your chair, resting one hand on the back of the chair for support. Raise one knee towards your chest with your leg bent. Keep your back and waist and other leg straight. Hold, then slowly lower your leg. Repeat for the other leg.
	5. Lateral leg raises. Wear ankle weights for this exercise if you can comfortably support the weight. Rest both hands on the back of your chair for balance. Lift one leg slowly to the side with your knee straight. Hold as high as possible without losing your balance, then slowly lower to the ground. Repeat for the other leg.
	6. Leg raises. Wear ankle weights for this exercise if you can comfortably support the weight. Sit on your chair with good upright posture, your bottom against the back of the chair and your feet flat on the floor. Now hold onto the sides of the seat for balance and slide your bottom forward towards the front of the seat. Rest your shoulders against the back of the chair for support. Slowly raise both legs 5-10 cm off the ground with your knees straight and your feet together. Hold, then slowly lower your feet to the ground.
	7. Knee extensions. Wear ankle weights for this exercise if you can comfortably support the weight. Sit on your chair with good upright posture, your bottom against the back of the chair and your feet flat on the floor. Hold onto the sides of the seat for balance. Raise one foot slowly forward, aiming to straighten your knee as much as possible, while keeping your thigh on the chair. Hold, then slowly lower your leg. Repeat for the other leg.
	8. Shoulder strengthening. Wear wrist weights for this exercise if you can comfortably support the weight. Sit on your chair with good upright posture, your bottom against the back of the seat and your feet flat on the floor. Starting with your hands by your sides, slowly lift both hands outward, tracing a large circle that allows your hands to meet overhead, in a ‘prayer’ pose. Hold, then slowly lower your hands to your sides by retracing the same large circle.
	9. Triceps lift. Wear wrist weights for this exercise if you can comfortably support the weight. Sit on your chair with good upright posture, your bottom against the back of the seat and your feet flat on the floor. Raise both arms either side of your head, with elbows slightly bent. Bend one elbow so that your wrist moves down behind your head to the base of your neck (avoid bending your head forwards). Hold, then slowly raise your wrist to be level with your opposite wrist. Repeat for the other arm.
	10. Biceps curl. Wear wrist weights for this exercise if you can comfortably support the weight. Sit on your chair with good upright posture, your bottom against the back of the seat and your feet flat on the floor. Rest your hands on either side of the seat. Bend the elbow of one arm to raise your hand towards your shoulder. Hold, then slowly lower your hand. Repeat for the other arm.