Exercises for osteoporosis

Stay active the safe way – improve bone health.

Supporting bone health includes regular exercise, and when osteoporosis is diagnosed, supervised exercise is also encouraged in combination with prescribed medication. Brisk walking, jogging, stair climbing, weight lifting and other specific types of exercise can help your bone density and strengthen bones and muscles to help reduce the risk of fractures. Exercise is an effective lifestyle strategy to build a stronger skeleton and maintain bone strength throughout life.

Remember to tailor your osteoporosis exercise routines to your health situation. Consult a healthcare professional (physiotherapist or exercise physiologist) to ensure safety and effectiveness. Balance exercises like tai chi can improve balance and posture, which can help prevent falls, a common concern in older osteoporosis patients.

Regular physical activity can also contribute to other health benefits such as heart function, mood and weight.

For people diagnosed with osteoporosis, especially those who have sustained a fracture, it’s important to avoid activities that twist or bend the spine due to the risk of causing fractures. However, supervised back-strengthening exercises can be important for supporting the spine.

Exercise should commence at the level of your fitness and then increase in intensity over time, and it should be regular. Exercise should be part of your weekly routine.

Elements of a good exercise program for bone health

Bones like exercise. You should not be intimidated by exercise if you have osteoporosis or osteopenia. Specific types of exercises are important for improving bone strength. Bones become stronger when a certain amount of impact or extra strain is placed on them. However, for people with diagnosed osteoporosis, exercise is recommended to be supervised by a physiotherapist or exercise physiologist and an individual program developed when first beginning an exercise program. This program should include a mix of the recommended types of exercise. For people not diagnosed with osteoporosis, the same types of exercise are recommended to help support bone health.

Recommended types of exercises for osteoporosis

Three types of exercises are recommended in an exercise program to support bone health, including for people with low bone density.

Weight Bearing Impact Loading

Exercises that work against gravity and use your body weight to stimulate the bone.

Resistance Training

Moves that have added weights or strains to enhance strength and stability.

Balance Training

Exercises that improve the muscle strength that keeps you upright such as your legs and core, helps to improve stability and mobility and assist in preventing falls.

Exercises to avoid

People with diagnosed osteoporosis should avoid exercises that involve twisting of the spine, and programs should be tailored when other conditions are present, for example, some arthritis in a joint or a shoulder issue. Forward flexion, such as toe touching or sit-ups, should also be avoided.

Weight-bearing exercises for osteoporosis

The goal is to place some stress on your bones with weight-bearing exercises (meaning your own weight or using a weighted vest or ankle weights). Examples of beneficial impact-loading exercises include:

Jumping (vertical and multidirectional) and Hopping

Jumping, whether vertical or multidirectional, is a dynamic movement that requires power and coordination, as it involves propelling the body off the ground using the strength of the leg and core muscles.

Skipping Rope

Skipping rope requires coordination and cardiovascular endurance, making your feet raise and plant on the ground. It helps strengthen the lower body as well as the upper body muscles. By using a skipping rope regularly, you can improve your overall fitness as well.

Bench Stepping (Step Ups)

Bench Stepping (Step Ups) is a great exercise to help strengthen legs. Regularly performing Bench Stepping (Step Ups) can improve balance, agility, coordination, strength and reflexes.

Drop Jumps

Drop Jumps is great for improving explosive power, balance, and agility. It involves jumping from a stationary position onto the ground and immediately jumping back onto the starting position.

TIP: Progress the intensity of the exercise program. This can be done by raising the heights for activities such as jumping, adding weighted vests, and changing the directions of your jumps more frequently.

Resistance Exercises

Combine weight-bearing exercise with progressive resistance training (PRT) for the best protection of your bones. PRT is often used to increase muscle strength. During the exercise, participants exercise their muscles against some type of resistance that is progressively increased as strength improves. Common equipment used for PRT includes exercise machines/gym equipment, free weights, and elastic bands.

Resistance exercises aim to increase loads over time and a tailored program may focus on muscles surrounding the bones more prone to fracture, such as the hip, wrist and spine.

Examples of such exercises include:

Lunges

Lunges are progressive resistance exercises that target the legs and core. This exercise works for all the major muscle groups in the lower body, such as the quadriceps, hamstrings, glutes and calves. When performed correctly, lunges can help improve balance, coordination and muscular strength.

To increase the difficulty of the exercise, you can add a jump or pulse at the bottom of each lunge. Lunges can also be done with weights like dumbbells, kettlebells or barbells for added resistance. Doing lunges with added weight will challenge your muscle groups and help build strength faster.

Hip Abduction/Adduction with elastic exercise bands

This exercise works the muscles in your hip, such as your outer glutes and inner thighs. Elastic exercise bands can provide resistance to help strengthen these muscles and improve stability. The band should be held around both ankles while you stand on one leg.

To do the hip abduction exercise, raise your leg to the side with your toes pointing up, hold for a few seconds and then slowly return to the starting position. You can also do hip adduction with elastic bands by bringing your leg inwards towards the other foot instead of outward.

Adding a slight pulse or jump at the top of each rep can increase difficulty and intensity. For an extra challenge, use a thicker elastic band for more resistance. Doing these exercises regularly will help develop strong hips and better posture.

Squats with weights

Squats are a great exercise for strengthening your hips, legs, and core. They can help to improve balance and stability and reduce the risk of osteoporosis. To do a squat, stand with feet shoulder-width apart and slowly bend your knees while keeping your back straight.

Lower your body until your thighs are parallel to the ground, and then return to the starting position. Adding arm motions while doing squats will help engage more muscles. Doing squats regularly can also improve coordination, flexibility, and circulation.

Shoulder extension with elastic exercise bands

Shoulder extension with elastic exercise bands strengthens the back and shoulders. It also helps to improve posture and lower back pain.

To do this exercise, begin by standing on an elastic exercise band with feet hip-width apart. Hold the ends of the band in each hand. Raise your arms above your head and outward until they reach shoulder height, feeling the resistance from the band. Slowly lower your arms back to the starting position.

For increased difficulty, add a jump while doing this exercise. This will help engage more muscles and increase resistance. Doing shoulder extensions regularly can also help improve stability and coordination.

TIP: Regular workouts for at least 6-12 months assist bone density, and if you stop exercising, you will lose any benefits gained. Give yourself at least one day to recover between resistance training bouts before training again.

Back Extension

When performing the back extension exercise lying on your stomach, focus on using your core muscles to lift your chest and shoulders off the floor. Keep your head and neck neutral, avoiding any strain or tension.

Ensure you complete repetitions of this exercise to maximize strength gains. Take time between sets to rest and recover properly before repeating again.

Abdominal exercise for beginners

Start by raising just one arm and then alternate sides. Hold each limb up briefly before returning them to the ground. It’s important to keep your back straight and maintain balance as you progress with the exercise.

To target your abdominal muscles more effectively, engage them by tightening your stomach as you lift each limb. Repeat the sequence 10 times on each side for an effective workout. Finally, don’t forget to take a break between repetitions if needed – it’s important to listen to your body and not overwork yourself!

Abdominal exercise for intermediate

It involves getting into a tabletop position and lifting one arm and the opposite leg straight off the ground at the same time while maintaining balance and stability.

Keep your back straight throughout the exercise, which will help target your abdominal muscles more effectively. Repeat this exercise several times on each side for an effective workout.

Abdominal exercise for advanced

Process the same exercise as for the intermediate with arm and leg position modification. When lifting an opposite arm and leg, don’t do it straight but angled out from your body line on a diagnoal line.

Please Note: If you have never lifted weights before, consult an exercise professional before you begin to ensure you learn the correct technique and prevent injury. Although lifting quickly (power lifting) can be effective muscle training for healthy people, it may increase the risk of spinal fracture for people with low bone density; therefore, a measured lifting tempo is recommended instead.

Avoid lifting in deep spine flexion (touching toes position). Avoid exercises with extreme spine curving forward, such as toe touches and sit-ups.

TIP: It is recommended to select 8 exercises per session and rotate through different ones each training session.

TIP: you do not need to ‘pump heavy iron’ to enjoy the benefits of resistance training. Select a challenging weight, but you can repeat 8-12 times. When you are ready for more weight, only add limited amount (for example up to 0.5kg).

General Balance Training

The goal of balance exercises is to improve balance and prevent falls. Balance can be challenged by exercises while standing still (static balance), when moving (dynamic balance) and when dual tasking (doing something else while you’re trying to balance).

Static Balance Exercise

Reducing your base of support and raising your centre of gravity

Standing only on one foot, standing with your feet closer together, Standing as tall as possible, raising your arms above your head, one foot in front of the other

Moving your centre of gravity away from your base of support

Leaning forward, reaching, bending, then regaining your balance without using your arms

Dynamic Balance Exercise (done while moving)

Walking in small circles and changes in direction

Walking in small circles and changing direction can help improve dynamic balance and reaction time as the body reacts quickly to the changing environment. It is also a great way to practice your coordination and balance control, as the body must constantly adjust to the changing terrain.

Stepping over obstacles

Stepping over obstacles is a great way to challenge your balance and coordination by forcing you to react and adjust your body weight to maintain balance quickly. Additionally, it can help improve your motor skills, as you must be aware of the terrain and your body positioning to clear the obstacle without losing your balance.

Walking on your heels or toes

Walking on your heels or toes requires a lot of balance and concentration, as it shifts your centre of gravity and requires you to make subtle adjustments in your body to maintain your balance. This exercise is a great way to increase your agility and balance when dual-tasking.

Walking backwards, sideways or with arms above the head

Walking backwards, sideways or with arms above the head requires great core stability and balance, as you must maintain your centre of gravity while moving in different directions. This exercise is a great way to challenge your balance and improve coordination at the same time.

Walking on a beam

Walking on a beam requires a great deal of focus and coordination, as it is a very narrow surface and requires you to adjust the positioning of your body to stay balanced. You can use foam mats for added cushioning to reduce the risk of injury and maintain your balance while walking on the beam.

You can progress the difficulty of your balance exercise by increasing walking speed or stride length.

 Dual Tasking Exercise

Standing in a tandem stance and doing a task that requires you to think, such as counting backwards. Standing on one leg while throwing and catching a ball

TIP: Balance exercises are recommended as part of a weekly exercise program. It can easily be incorporated into normal daily activities as well (e.g. static exercise while in the home)

TIP: The exercises should challenge you, and once you achieve a milestone, try something harder. Structured activities can also help.

Exercise Recommendations

Staying active helps support your bone health and is important throughout life. The benefits of exercise far outweigh any risk, and a supervised exercise program can help you gain confidence. People with osteoporosis should remain active and not avoid exercise. Please note exercise is not a replacement for osteoporosis treatment.

Below is a summary of the 3 types of exercise recommendations. It is a general guide only. It explains weekly exertion levels, repetitions and frequency based on different individual ability levels. This information can be shared with a trainer for general exercise for bone health. For high-risk individuals (diagnosed with osteoporosis), a supervised program developed by a physiotherapist or exercise physiologist is recommended.

Mode	Components	Low-risk individuals1	Moderate-risk individuals2	High-risk individuals3
Weight Bearing Impact Loading	Vertical and multi-directional jumping, bounding, hopping, skipping rope, drop jumps and bench stepping with progressively increasing height	High impact activities 4-7 days per week 50 jumps per session	Moderate-High impact activities 4-7 days per week 50 jumps per session	Moderate impact activities 4-7 days per week Work up to 50 repetitions per session
Resistance Training (Progressive)	8 exercises per session targeting major muscle groups attached to the hip and spine. These include weighted lunges, hip abduction/adduction, knee extension/flexion, back extension, and abdominal exercises, or the smaller number of compound movements such as squats and deadlifts	2 days per week 2-3 sets of 8 repetitions Select 8 exercises per session and rotate through different ones each training session Technical Guide 80-85% 1RM* ≥ 8 on RPE scale**	2 days per week 2-3 sets of 8 repetitions Select 8 exercises per session and rotate through different ones each training session Technical Guide 80-85% 1RM* ≥ 8 on RPE scale**	2 days per week 2-3 sets of 8 repetitions Select 8 exercises per session and rotate through different ones each training session Technical Guide 80-85% 1RM* ≥ 8 on the RPE scale**
Balance Training	2 days per week 2-3 sets of 8 repetitions Select 8 exercises per session and rotate through different ones each training session Technical Guide 80-85% 1RM* ≥ 8 on the RPE scale**	Challenging tasks incorporating balance activities into strength and impact elements where possible	2 days per week 2-3 sets of 8 repetitions Select 8 exercises per session and rotate through different ones each training session Technical Guide 80-85% 1RM* ≥ 8 on the RPE scale**	Challenging tasks 4 sessions per week 30 minutes of a variety of balance exercises; at least 10 per step forward and back for mobility exercises

Frequently Asked Questions about Osteoporosis Exercises.