Once most of us reach middle age, our metabolism slows down and becomes harder to keep muscle and bone mass1, which we lose at a rate of about 1% a year after we turn 40. Women are particularly vulnerable because bone density is affected by estrogen levels2.
A decrease in bone density means an increased risk of fractures or broken bones, or the long-term condition of osteoporosis, where the bone has deteriorated enough to pose considerable risk. Maintaining good bone density is key to maintaining independence and health throughout life.
Exercise for strong bones
Bone health is supported by exercising the muscles. Strength or resistance training puts stress on the muscles, which push and pull – put stress on – the bones they are attached to3. As your muscles grow stronger and denser to deal with the new demands on them, so to the bones.
What exercises will increase bone density?
Exercises to build or maintain bone density don’t have to be exhausting456. Regular walks and gentle weight bearing exercises are sufficient to keep your body physically healthy. The key is resistance: doing exercises where your body is working against gravity.
Below we’ve discussed three broad types of exercise recommended for building and maintaining bone density. Progressive strength training should comprise at least two of your workouts in a week. Bear in mind that current health recommendations are for 30 minutes of moderate exercise every day.
Progressive Strength Training (Isotonic)
Progressive strength training has been found to have the greatest benefit on bone density7. This type of training tends to target the hips, spine, and wrists (think squats or dumbbell exercises) which also happen to be the most at risk areas for someone with low bone density. Exercises that emphasise power and balance are particularly effective at improving overall strength and stability8. Try working your way up to one-legged squats!
Weight Bearing Aerobic Exercise (Steady State, or Isokinetic)
This is just exercise done while on your feet, so you are bearing your own weight. In this category are walking, jogging, skipping, dancing, and climbing the stairs. These are osteogenic exercise, meaning they can build bone due to the way stress is applied during the exercise.9
Swimming and cycling are aerobic exercises that are not osteogenic – they do not provide enough resistance to build bone. This does not mean they are in any way bad for you. If you prefer swimming or cycling, just make sure you do strength training as well twice a week.
Balancing Exercises (Isometric)
The better your sense of balance, the less likely you are to fall. Falls are one of the most common causes of fractures and pose a serious risk to someone with osteoporosis. Try standing on one leg for increasing amounts of time (with your eyes shut) or walking heel-to-toe in a straight line. Many classic yoga poses (such as Warrior) or planks are excellent balancing exercises. Your GP or a trainer at the gym will be able to give you more ideas.
Tai chi, although not a traditional static balancing exercise, provides a gentle workout that has been proven to increase balance and mobility1011. Classes are available in most towns and cities in Australia as well as online.
Everyday Tasks
Look for ways to increase your mobility and strength doing everyday tasks. Carry a shopping bag instead of putting it in a trolley. Take the stairs instead of the elevator. Even such small changes can make a positive difference.
Managing Existing Health Concerns
People who already have osteoporosis should avoid high impact exercise such as running or tennis, and some yoga poses can also be a problem12.
Strength training has been proven to help with many health conditions, however these and other injuries or illnesses you might have encountered in life can affect what exercise you do, at least to begin with.
When beginning a new exercise routine, it is important to consult with your GP first. If you are working with a personal trainer, it is essential this person is informed of your condition and if you notice any negative effects of the prescribed exercises.
Never begin heavy weight training without advice first.
A diet for strong bones
There are three key minerals that support bone density: calcium, vitamin D, and protein. Oily fish, dark leafy greens, nuts, legumes, eggs and dairy are all good dietary sources13. Always be careful when seeking your vitamin D from the sun!
Broadly speaking, a diet with a high proportion of plant-based, minimally processed foods is key to maintaining a good balance of vitamins and minerals in the body. With a highly varied diet it is likely you will get all the nutrients you need for good muscle and bone health. Follow general but proven dietary advice from reputable sources like the Australian Dietary Guidelines. Such guidelines are regularly adjusted in line with scientific developments and offer affordable, clear recommendations.
Discuss particular concerns with your GP, especially if you have food restrictions, and see a dietician if necessary.
Monitoring Your Health
Keeping track of changes in your body is important for health regardless of age or specific health goals. A regular body composition scan will allow you to keep an accurate record of your skeletal muscle mass, bone density and overall progress, as well as potentially flagging any long term health risks.
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[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3383520/
[3] https://www.health.harvard.edu/staying-healthy/strength-training-builds-more-than-muscles
[4] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3117172/
[5] http://perspectivesinmedicine.cshlp.org/content/8/3/a029785.short
[6] https://www.sciencedirect.com/science/article/pii/S2468867319300720