What exercise is best for bone?

It needs to be ‘weight-bearing’, right? Except that many types of exercise we might think fit that description won’t increase bone one iota.

A downward dog in yoga is certainly weight-bearing. But does it impact bone mass? Not a bit.

So what works?

The types of exercise that will make the most difference if our bone density is low are high-intensity resistance, balance, and impact training.

Balance is self-explanatory, though we need to challenge ourselves beyond standing still on one leg. I’ll get to high-intensity and impact training shortly.

It’s important to recognise that the kinds of exercise many of us lean towards — such as Pilates, yoga, walking, and maybe swimming or cycling — don’t build bone. We could be incredibly diligent with these and still be losing bone.

It’s not that they aren’t great exercises or don’t have a place.

Osteoporosis is a problem if we fall, and Pilates, yoga and tai chi can help reduce our risk of falling by increasing body awareness, mobility, strength and stability. They just don’t provide the intensity needed to build bone.

Walking, cycling and swimming improve endurance, reduce stress and help to keep our hearts and brains healthy. So keep them up. Just know that they won’t increase bone density.

Building bone, or even arresting bone loss, isn’t easy. It’s also very specific.

High-intensity resistance training means lifting weight that’s sufficiently heavy that we can’t do it more than about five to eight times. ‘Heavy’ is relative. It means lifting what’s heavy for us. But if we can do it 25 times, it’s not high-intensity.

Heavier weight has more bearing on bone and muscle. Of course, we have to gradually work up to this, and might need to modify it to accommodate injuries, illness, pelvic floor issues, hypermobile joints and so on.

A bone building program will focus on the big muscles of our back, core, glutes and legs. It needs close supervision from people with expertise in the area.

Joining your local gym and doing their standard beginners’ program won’t be specific enough. Many gyms also rely on machine weights. While these improve strength, exercise with equipment such as dumbbells or barbells requires more muscle activation and higher loads on bone.

But since not everyone can access high-intensity training, a compromise could be the kind of program featured on the Healthy Bones Australia (HBA) website. https://healthybonesaustralia.org.au/wp-content/uploads/2022/10/hba-exercise-brochure.pdf

It’s moderate rather than high-intensity, but the focus is on strengthening key muscle groups, plus balance and impact training. If you’re considering joining a gym to address your bone density, and you’ll be working with a trainer, you could direct them to this site.

Of course, before we start lifting much weight, we need to work on posture, stability, and proper form.

Impact training means jumping, hopping, skipping or stomping to create a vibrational stimulus in our bones. The HBA program provides examples of this, but a simple way to do it is to raise our heels off the floor and let them land with impact.

There was a time when we thought whole-body vibration equipment such as Power Plate might contribute to bone density, but research has now shown that it doesn’t.

An illustration: high vs low intensity

Here’s a story about a recent study by researchers from the Gold Coast. They investigated two things: the effect of high-intensity vs low-intensity exercise on bone, and the result of combining both types of exercise with bone medication.

They compared four regimes:

• high-intensity resistance exercise and impact training;
• high-intensity resistance exercise and impact training plus bone medication;
• Buff Bones Pilates; and
• Buff Bones Pilates plus

Buff Bones Pilates markets itself as a ‘medically endorsed system of movement for bone and joint health’.

The study participants were women with low bone density, on average in their 60s. Regardless of which regime they followed, all did two 40-minute exercise sessions per week for eight months.

The high-intensity program consisted of three strength exercises (deadlift, back squat, and overhead press), one high-impact exercise (a jump drop, i.e. raising up to a pull-up bar, then dropping to the floor with straight legs), and two balance exercises which varied each session.

Buff Bones included moves such as a side-lying leg lift and face-down ‘swimming’ where the opposite arm and leg are alternately raised and lowered. Other strengthening exercises (e.g. squats, push-ups, planks, bent-over rows and bicep curls) used bodyweight or 1 kg dumbbells. Balance, stretching and stomping for vibration rounded out the program.

After eight months high-intensity exercise alone had outstripped Buff Bones: it had improved bone density in the lumbar spine (Buff Bones didn’t) and showed greater gains in muscle strength and overall function.

Some women doing the high-intensity program gained height because stronger back muscles allowed them to stand taller.

In comparison, those doing Buff Bones alone lost a little bone density over the time, especially at the hip.

High-intensity exercise didn’t increase bone density at the hip, though there were changes to the bone structure reflecting greater strength. Mind you, eight months isn’t long. Usually we measure bone density at two-year intervals.

But the clear winner among the four regimes was high-intensity exercise plus medication.

When medication was added to the high-intensity program, hip bone density increased, including at the femoral neck — the narrow part that’s usually the site of hip fractures.

Adding medication to Buff Bones also brought about improvement at the spine and hip, which shows the difference it can make.

A downside of the study was that the numbers weren’t big. There were just over 40 in each of the exercise programs alone, but only 14 and 15 in the exercise plus medication groups. We need more research that looks at this interaction between exercise and medication.

But what if you still don’t like the idea of lifting heavy things?

Or it seems off your agenda because of previous injuries?

Remember that a modified version, along the lines of the HBA program, will be beneficial if it’s done consistently. And we all need to start small and slowly build up to what we can manage.

A lot of women don’t like gyms, and that’s fair. For some reason it’s popular to paint them black, they often have a blokey vibe, the music’s dreadful, and it feels like everyone else knows what they’re doing and belongs there, except you. But see what you can find. There are exceptions.

If you’re looking for a place to start, but don’t have access to or feel ready for weight training, Pilates teaches the fundamentals of posture, core strength and stability, shoulder position, and so on. It will likely include some balance, and facilities with equipment such as reformers can introduce you to resistance exercise.  You can do simple impact training at home — about 50 or 60 impacts, most days of the week.

It’s a shame, but there’s no one perfect exercise that does everything we need for all round health, and you might decide to stick with the activities you love rather than exploring high-intensity resistance because that’s the compromise that works for you. Any of us with low bone density has the challenge of making the best choices we can from the options available — exercise, diet, medication and so forth.

But some exercises are best avoided

Having said all that, there are a few movements to leave alone if your bone density is low. At the top of the list is twisting, and moving with a curved spine.

Fast twisting is especially problematic. Think golf. If you love it, you’ll need to limit your swing. We also need to curb our enthusiasm for hurling bags of pot mix and the like into car boots.

Yoga isn’t quick but it does involve twisting. So stabilise your core muscles and keep the movement small.  Avoid strong back-arching and rounding postures (camel or plough, for example).

The same goes for sit ups or crunches with a curved spine.

Finally, in everyday life we need to watch that we’re not bending, lifting, pushing or pulling with a rounded back. It works to stop and think about whether that thing we’re about to do is smart, i.e. think first, move second. Always a good mantra.

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