Just what are the best exercises for healthy bones?

An article just came out last month in the NY Times on “The
Best Exercises for Healthy Bones”.  It was interesting to
say the least. The writer suggested that hopping was the
best exercise to build bone but gave no context or
guidelines to incorporate hopping or jumping safely into
an exercise program! I decided to pull together the best
information from the top researchers in the field of bone
and exercise. I like to look at the groups who have been
doing this kind of research for a long time.  I was at a bone
symposium last week and was able to ask Beth Lambright,
the Oregon State University exercise teacher of all the
main studies during the past 15 years if jumping rope or
mini-trampolines build bone. The answer was “No, you
need 4-8x body weight impact to stimulate bone. For
children this means jumping off a 24″ box and for adults
this means jumping off an 8″ step. They progress from 4″
to 6″ to 8” very slowly and prepare the knees and hips
with step-ups, heel raises, squats, lunges and faux jumps
before jumping off the steps. So what else will give us
healthy bones?
1. Walking does not build bone and should not be
considered an osteoporosis exercise. (However, walking is
great for your heart if you keep up a good pace.)
Palombaro KM. “Effects of walking-only interventions on
bone mineral density at various skeletal sites: a metaanalysis.”
J Geriatr Phys Ther. 2005;28(3):102-7.

2. Weighted vests with lunges, squats, step ups, side
lunges and small jumps 3 x per week builds bone in the
hip according to Christine Snow’s bone research lab at
Oregon State University.
(Long-term Exercise Using Weighted Vests Prevents Hip
Bone Loss in Postmenopausal Women by Christine M.
Snow, Janet M. Shaw, Kerri M. Winters, and Kara A. Witzke
Journal of Gerontology: 2000, Vol. 55A, No. 9, M489-
M491)
They are continuing their long-term studies and the
latest one should be published next month!
3. Sinaki has the best long-term research on exercise for
building bone and fracture prevention in the spine
(vertebral bodies).
(Sinaki, M., et al. 1986.”Relationship between bone
mineral density of spine and strength of back extensors in
healthy postmenopausal women.” Mayo Clinic
Proceedings, 61 (2), 116-22.)

(Sinaki, M., et al. 1996. “Can strong back extensors
prevent vertebral fractures in women with osteoporosis?”
Mayo Clinic Proceedings, 71 (10), 951-56.)
(Sinaki, M, et al. 2002. “Stronger back muscles reduce the
incidence of vertebral fractures: A prospective 10 year
follow-up of postmenopausal women.” Bone, 30 (6), 836-
41.)

(Sinaki, M”The role of physical activity in bone health: a
new hypothesis to reduce risk of vertebral fracture.” Phys
Med Rehabil Clin N Am. 2007 Aug;18(3):593- 608)

4. Loren Fishman has some ongoing research on Yoga for
osteoporosis and is getting some increases in BMD with
his program.
(Yoga for Osteoporosis: A Pilot Study by Loren M.
Fishman, MD. Topics in Geriatric Rehabilitation. Vol. 25,
No. 3, pp. 244-250: 2009)

Main Points for Exercising Your Bones:

  • Hip Bone Building: Jumping is best. (If your T- score is below a -3.0 do not jump!) Prepare for jumping by doing forward and side lunges, squats, step ups, heel raises and standing balance exercises. Consider using a weighted vest up to 10% of your body weight. Mini-trampolines are a good warm-up or for cardiovascular work but they do not build bone.
  • Spine Bone Building: Prone (face down) Back Extension Exercises are best.
  • Walking briskly on uneven terrain up and down hills is great for your heart but should not be considered a bone building exercise.
  • Yoga and Pilates in general are not considered bone building exercises YET! They may be effective programs to increase variety and pleasure with exercise and are a good body awareness fracture prevention and preparation for the bone loading exercises necessary to stimulate bone formation!
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11 Comments

Filed under Osteoporosis

11 responses to “Just what are the best exercises for healthy bones?

  1. Avishag Pundak Gazit

    Hi,
    thanks for the amazing site and for all the great evidence based helpful information.
    I’m a physical therapist and Pilates instructor working in Oakland , CA (moved here from Israel few months ago).
    I have a few questions regarding this great post:
    1)the jumping exercises: is there any evidence based material supporting the help of the preparations you mention in preventing injuries, osteoarthritis ect.
    2) what is the recommended frequency for jumping (for how long, how many times a week) in order to build bone.
    3) is it through that a sedentary person will profit at the beginning from walking (bone building wise) even without a weight west and only after few week of training there should be a change like small jumps, adding west ect?
    thanks
    Avishag

    • Thanks for your questions!

      1) Christine Snow of Oregon State University Bone Research Lab did these original studies. OA of the knee was the biggest hurdle to jumping. She recommended that the participants give themselves at LEAST 3 weeks of preparations for building muscle strength in the lower extremities before they give up due to pain. I am not sure if she collected data on OA in her studies…you can find a lot of info about strengthening for OA of the knee and hip in our PT literature.

      2) The OSU groups did 10 jumps 3x per week and saw gains in the hip!

      3) A sedentary person should see the most gains in bone early on when beginning an exercise program. What’s important is that you change and progress your exercises to continue to “surprise” the bones and see gains. When a person plateaus, it might be time to change the exercises…add jumps, weighted vests, join a dance class, etc. Remember that exercisers tend to have stronger bones even if the density doesn’t improve.

      Thanks again! I am glad you like the website!

  2. Hi,

    Please have a look at Bones for Life applied Feldenkrais website: http://www.bonesforlife.com/ there have been interesting results on preventing and reverting Osteoporosis with this program.

    Best,

    Candia

  3. Oh, and by the way thanks for your article, is an excelent review. Zest. C*

  4. Avishag Pundak Gazit

    thank you so much for your detailed answers! reading this important materials made me change some of my perspectives about treating patients with osteopenia/osteoporosis and realize how much the research in this area is still lucking. a lot to think about, thank you again for all the important and useful knowledge,
    Avishag

  5. veronica beechey

    two questions:
    1.Can you please recommend any exercises for remobilization after two vertebral compression fractures (L5 and T12).

    2. Also, I live in London and am having difficulty getting good advice. I am particularly interested in taking up yoga again. Do you happen to know of any pilates or yoga teachers who might be able to help me?

    many thanks

    • Hi Veronica,
      1. Please avoid any flexion (forward bending) of your spine. The vertebrae above and below the fracture sites are at high risk for fractures so you want to protect them. I advocate extension exercises (Lying face down and lifting your chest off the floor to strengthen the spinal muscles, prevent fracture and build bone.
      2. I have taught may courses in London and can recommend lots of good teachers. Just go to my website at http://www.therapilates.com/links and scroll down to find a teacher in England who has been trained to work with clients who have osteoporosis. Best of luck to you!

  6. Pingback: Bonin’ Up: What’s the best exercise Rx for improving bone mineral density? | FemFusion Fitness

  7. Avishag R Pundak-Gazit

    Hi Sherri,

    Hope this discussion in still active:)

    I have an exercise safety question: Is the cat stretch in quadrant (on all fours) position is safe for people with Osteopinia/porosis?

    Thank you,

    Avishag

    • Hi Avishag,
      It is best that the cat back flexion stretch be avoided in people with osteopenia or osteoporosis. The spine is at risk for compression fractures and this position encourages the very position we are most trying to avoid. Please take a look at the “Do it Right! And Prevent Fractures” booklet that is posted and available for download at http://www.therapilates.com homepage. THe booklet shows alternatives to this stretch. Let me know if you still have questions!

      Thank you for your interest and inquiry!
      Sherri

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