Bad to the Bone:  Osteoporosis and Exercise

A frail, severely slumped elderly woman who coughs and fractures a rib or pushes a door and breaks a wrist, is the image of osteoporosis. It is true that older women are the demographic most commonly afflicted with osteoporosis, the debilitating disease where bones resemble Swiss cheese and ordinary actions can cause bones to break.

It is also true that significant numbers of men and women of all ages and races suffer from osteoporosis.  In fact, these numbers are increasing, according to the National Osteoporosis Foundation.  It’s theorized that as people live longer, younger people have less active lifestyles, and unhealthy eating habits prevail, the threat of osteoporosis will continue to rise.

It is somewhat rare for younger people to get osteoporosis, and there are usually other underlying medical conditions involved.  But youth is a critical time to build healthy bones to last a lifetime.  Bone mass develops from the womb and peaks at about age 30 to 35.  Maintaining a diet high in calcium and vitamin D, avoiding smoking, alcohol and soda, and adding-in exercise are the recipe for developing strong bones and preventing a disease that is primarily lifestyle-related.

shutterstock_14200360The best types of exercise to prevent osteoporosis are weight bearing exercise and strength training. Weight bearing exercise is defined as activities that make you move against gravity while upright.  Running, jumping rope, and high impact aerobic dancing are examples of good weight bearing exercise that increase bone mass.  Studies have shown that these jolting and jarring activities are good for thickening bones. Obviously these activities are not appropriate for every individual, and proper training with gradual progression is essential to avoid injury.

Strength training is use of resistance causing muscles to contract for the purpose of increasing muscular power, endurance and strength.  Since muscles don’t have eyes and simply respond to an increased load or force, that resistance may be a weight, elastic band or even your own body weight against gravity (for example a “push-up).

Historically, strength training was highly influenced by the sport of body building, where the goal is increased muscle size and definition.  More in line with most people’s goal of improved health and fitness, the current trend is functional strength training.  Functional strength training emphasizes movements from daily life, work or sports.  The movements tend to use more than one muscle group, unlike weight machines that isolate a specific muscle group.  Functional strength training has many added benefits including improved balance, posture, coordination, and core strength. “Sit-down, get-ups” and “step-ups” are examples of functional exercise since everyone needs to get up and down from chairs and climb stairs.

Exercise recommendations are different for those who have osteoporosis as opposed to those who are osteoporosis free or have osteopenia, a condition where the bones show mild mineral loss of 10% to 25% of normal. Once diagnosed with osteoporosis, certain exercise precautions should be taken.  While high impact weight bearing activities are appropriate in the prevention of osteoporosis, they should be avoided once diagnosed because of the risk of fractures. Low impact weight bearing activities such as walking, low impact aerobic dance and elliptical machines are a better choice.

Don’t confuse the term “low impact” with “low intensity”.  These terms are often mistakenly used interchangeably. Low impact exercise is when at least one foot remains weight bearing.  During high impact activities there is a brief period when both feet are weightless. Intensity is how hard you are working and is affected by many variables.  A slow jog is high impact/low intensity, but a fast walk, at the speed right before you feel like running, is low impact/high intensity.  Try it!

Other contraindicated movements are largely concerned with protecting the spine from fracture. Exercises that involve spinal flexion and spinal rotation should be avoided.  This includes most of the exercises that target the abdominals and waist such as crunches and crunches with a twist. These exercises tend to be over emphasized in many workout programs in a futile attempt to spot reduce belly fat. Instead, exercises that focus on core stabilization should play a bigger role in everyone’s exercise routine–not just those who have osteoporosis.shutterstock_30680680

Loading the spine with weights or any exercise that compresses the spine should be bypassed.  Squats with a bar across the upper back or calve raises with weight resting on the shoulders are two examples. Instead, perform the exercises holding the weights in your hands. Rather than completely avoiding an activity because certain moves are restricted, get some personal instruction and find out how to change the exercises for your benefit. Yoga and Pilates can be great exercise systems for people with osteoporosis when modified to meet their needs.

Most Americans, not only those with osteoporosis, need to target the muscles of the back for improved posture.  These are the muscles that hold us upright and keep the shoulders from rounding forward.   Perform movements that cause the spine to extend or straighten-up and the shoulder blades to retract such as dumbbell rows or the cobra pose from yoga.

Balance training becomes critical for those with osteoporosis when a fall could result in a broken bone or worse. Unfortunately for adults 65 and older, falls are the leading cause of injury death according to the Centers for Disease Control and Prevention.  A program that includes exercises that challenge static balance (stationary) and dynamic balance (moving) is vital.  One of the best programs is Silver Sneakers, which is geared toward the needs of older adults.  These classes are widely available and are very inexpensive or free to certain eligible Medicare recipients. Visit www.SilverSneakers.com for more information.

Article written by Paula Skinner, CPT for Destination Tampa Bay magazine