I recently read a great quote by the Founding Director of the National Institute on Aging, Robert Butler, MD. He wrote, “If doctors could prescribe exercise in a pill form, it would be the single most widely prescribed drug in the world.”
Almost all of us who are invested in our health already know that exercise is one of the most important factors in living a long and healthy life, but many of us are too busy to make time for it.
If you’re serious about maintaining strong and healthy bones throughout your life — and despite the wide prevalence of osteoporosis and osteopenia, it is entirely possible — exercise should move up on your list of priorities. But what type of exercise is best for bones? You may have heard that high intensity forms of exercise are good for bone-building. But it comes as a surprise to many women that mindful exercises like yoga or tai chi are also very helpful.
If your bones could talk…
If your bones could talk, they would say, “Show me you really need me!” Though it feels and looks solid, living bone is dynamic tissue that is constantly altered in response to motion and movement. The more your bones are called upon to carry weight, the more your body puts its resources into building them to support that weight. Bone and muscle are part of the same unit, and as you build muscle, you build bone by default. Here’s why: muscles are attached to bones by tendons. When muscles contract, the tendons tug on your bones, stimulating them to grow. The stronger the muscle, the more powerful the stimulation on the bone.
The best news is that everyone, from a young athlete to an elderly person confined to a wheelchair, can build bone mass with a combination of exercise, an alkaline diet, and bone-healthy nutritional supplements. And there are many options out there for you to explore (see the box above). From hopping on one or both legs during the commercial breaks of your favorite TV show to biking back and forth to work, there’s a way for you to make exercise a part of your life, and once your bones are called upon, their mass will increase.
What and how much exercise helps build bone?
As I have written in my book, Better Bones, Better Body, regular lifelong exercise is best for bone, but it’s never too late to begin building bone density with exercise. Your age, gender, current bone mass, and training history are all factors that will influence your choice of exercise for bone health. (Curious about your bones? Take our Bone health profile.)
The optimal exercise routines for men’s and women’s bone health is unknown and subject to much debate. But we do know that different forms of exercise benefit bone mineralization and the mechanical properties of bone in different ways for men and women of different age groups.
Mix it up!
Your bones respond best to unusual, unexpected bursts and varying combinations of forces, rather than routine workouts. Here are some ideas to help you achieve this:
- Jump, skip or break into a jog when you wouldn’t normally.
- Vary your weight-lifting repetitions, mixing heavier weights than you’re used to with lighter ones.
- Include several bursts in your workout, where you increase your heart rate for a minute or so.
- If you always use the treadmill, try dancing or yoga exercises every other work-out.
- Try a whole body vibration platform if there’s one in your area
The standard party line is that exercise that requires high forces or generates high impact on the body (such as gymnastics, dance, or weight-lifting) is necessary to improve bone density. Generally speaking, the greater the force or impact, the more bone-growth stimulation. Scientific evidence does suggest we most efficiently build bone mass with a combination of high-impact exercise (such as jumping) and weight-lifting (which can include push-ups, yogic arm balances, using a weighted vest, etc.).
But other properties of bone besides mass make it resilient, such as its water content and cross-sectional geometry. That’s why non-weight-bearing or resistance exercise such as swimming, biking, and isometric exercise (like using the OsteoBall®) also have value, in that they can increase your bones’ flexibility and compression strength. Resistance exercise also decreases your risk of falling and fractures by enhancing balance, coordination, and muscle strength.
East meets West — osteoporosis and yoga, t’ai chi, qi gong, and Pilates
One way to increase the forces of resistance on your bones is with Eastern forms of exercise such as yoga, t’ai chi, or qi gong, and other alternative systems such as Pilates. We’re just now beginning to understand that the benefits we gain from such mind–body disciplines extend much further than simply strength and flexibility.
Practices like yoga and t’ai chi can improve balance, coordination, and focus — not to mention providing a boost in confidence! As we age, many of us become less confident when moving about, and while it’s good to be careful, hesitancy can make us more likely to fall and possibly fracture. And whether you’ve been diagnosed with osteoporosis or osteopenia or not, falling puts you at risk of fracture.
Several recent scientific studies document the positive effects of yoga on bone health in women of all ages. Results showed increased bone density in the spine and hips as measured by DEXA scans, as well as reduced markers of bone turnover.
In addition to the physical effects, there’s often a psychological benefit to Eastern practices. This can help enhance our natural mind-body connection and calm the autonomic nervous system, lowering adrenaline and cortisol, our primary stress hormones. These actions ultimately help bone and whole-body health. As Dr. Paul Lam notes on his Tai Chi for Osteoporosis DVD, “Practicing Tai Chi strengthens from the inside out.” When beginning from our hearts and minds, we are capable of great things in the whole body.
If it seems overwhelming to join a class to learn exercises, you might try familiarizing yourself first with the concepts with a DVD like the ones we offer on our website or take a look at a YouTube video on-line. You may find you prefer practicing in the comfort of your own home, or that you’re ready to find a local class. What I like about attending a class is that most instructors lead the class to move in different ways each session, rather than sticking with the same routine. And variety is great for bone.
Caption: Even gentle, low-impact exercises like those shown here can help build muscle and bone. Consult your physician before starting any new exercise program, and work with a physical therapist if there is concern about your risk of fracture.
Top row, left, leg lifts are performed lying flat on your back on a firm surface (a floor with a mat, for example). Top row, center, leg lifts on hands and knees – keep your back parallel to the ground and lift your leg only as high as is comfortable. Top row, right, arm squeeze in which you bring your elbows together in front of your face and return to a position perpendicular to the spine (do not twist at waist or turn or bend the spine.) Middle row, left, sit upright in a chair and squeeze your shoulder blades together. Do this holding weights if you can. Middle row, center, lift arms straight from your sides up above your head, with weights if you can. Middle row, right, raise yourself up on your toes, hold for as long as you can, then slowly lower yourself down again. Bottom: Start in a seated position with a chair in front of you for balance, raise yourself to your feet while maintaining upright posture. Lift your body using the muscles in your legs, buttocks, and lower back, not the muscles in your arms or upper back (extend your arms to the front chair for balance, but do not press upon the chair back).
Exercising for your bones — simple ideas to get you started
- Go dancing with a friend or partner.
- Take a walk each night after dinner or try wearing a pedometer during the day to track how much you walk.
- Ride your bike to friends’ houses, stores, and work.
- Run up and down your stairs a few times a day.
- Purchase or borrow a Nintendo Wii Fit program (includes dance parties, yoga, tennis games, boxing, and more).
- Jump rope or simply hop on one leg, then the other — or on both.
- Try the OsteoBall, Bosu Ball, or rubber flex bands (e.g., Thera-Band).
- Try my Exercising for Bone Health DVD to sample Pilates, yoga, isometric training, weight-bearing exercises and strength training.
- Try bursting several times during your regular exercise routine.
- Use an X-iser step machine for a few minutes a day. Use steppers, free weights, and other strength training devices at your local gym, or wear a weight vest or belt during your workout.
Exercise: one way to stem menopausal bone loss
While both men and women can develop osteoporosis, women are far more likely than men to experience bone loss, and the critical time in their lives for bone health is the menopause transition. For years we’ve been told that women can lose up to one-fifth of their bone mass during the menopause transition, and that estrogen is the crucial player. But there is actually much more to the story — waning estrogen doesn’t make it impossible to build bone in perimenopause and menopause. Women’s bodies maintain bone best when our hormones are balanced, not just when they’re present at certain premenopausal levels. It also helps to exercise, eat an alkalizing diet, and take a quality multivitamin designed for bone building, like the ones we offer in our Better Bones Package.
I always tell women, the bone you’ve got is good. Let’s keep it! Exercise is an excellent way to maintain the bone you already have during this crucial transition time, and more rigorous strength training can make a big difference to bone mineral density during the early postmenopausal years.
If you want to build bone during the menopause transition, it may take a more intensive exercise plan. In the case of early post menopausal women with osteopenia, some research indicates that the isolated effect of simply increasing habitual physical activity does little to increase muscle strength. But don’t be discouraged by that — it just tells us that women with a diagnosis of osteopenia or who are otherwise at higher risk need a more deliberate exercise program than simply increasing habitual physical activity.
Exercise “dont’s” for those with osteoporosis or osteopenia
Some exercises aren’t recommended for those who have fractured or who have severe osteoporosis. Flexion exercises where you bend your spine significantly forward can increase the risk of vertebral fractures by putting excessive pressure on the vertebral bodies. Such exercises may include crunches where you round your back, touching your toes from a standing position, pulling your knees into your chest and lifting your chin and neck while on your back, or rounding your back over and downward while in a seated position. Extension exercises where you stretch up and flex backwards are generally safe for everyone.
Exercises that curve or bend the spine increase your chances of vertebral fracture.
It’s common for people diagnosed with osteoporosis or osteopenia to be a little afraid of exercise, because they are worried their bones might fracture with any unusual activity. Such caution is warranted in some situations, such as if your bone density is very low compared to other women your age, or if your body is in a very deconditioned state. But in the vast majority, this is not the case. Almost everyone can start with a program of walking, and most can safely undertake a significant bone-building exercise program with great success. But it’s important to work with your healthcare practitioner and take care not to put excessive stress on weakened bones.
Take a look at our Better Bones Exercise Plan to begin your process, and make sure you discuss your goals with your practitioner.
How to get results — a Better Bones approach
For most of us, almost any exercise — as long it’s regular and not so intensive it causes damage — is good bone exercise. Your bones are designed to naturally break down and rebuild themselves to support the demands you place on them. But truly amazing changes come about when all the body’s systems are working synergistically. Here are the three core elements of our integrative bone health approach:
Create an exercise plan. Because everyone is starting from a different place, we put together a guide to help you design Your Better Bones Exercise Plan in a way that fits your unique needs and lifestyle.
Eat a plant-based, alkalizing diet. Just by living and breathing, we create an internal acid load, and because our bones are the body’s great buffers, an overly acidifying diet leaches buffering minerals from the bones to alkalize the blood. In contrast, fruits and vegetables provide alkalizing mineral reserves to counterbalance acid-forming metabolic processes. (See our articles on acid-alkaline balance).
Boost your bone-building vitamins, minerals, essential fatty acids, and amino acids. Because even the healthiest diet doesn’t necessarily supply all that you need, I recommend taking high-quality nutritional supplements to ensure that you’re getting all 20 essential bone-building nutrients, such as vitamin D, vitamin K, calcium, potassium, and magnesium.
Combining these three elements — regular exercise, an alkalizing diet, and high-quality supplements — will make it much more likely for you to get the results you’re looking for. Adopting this approach can also give you a surprising bonus: improved energy and whole-body wellness, well into old age.
Tips for safe exercise
- Exercise within your comfort zone.
- Avoid movements that cause pain.
- Maintain good posture and avoid rounding your back.
- Be sure to warm up and stretch your muscles.
- Work with a physical therapist if you have experienced an osteoporotic fracture.
As a mother and busy practitioner myself, I know how tough it can be to find the time and inspiration to exercise regularly. But it’s so important for your bones, and I promise, when you find something you love doing, it will become second nature.
Be creative, explore, and be willing to try something new or combine different forms of exercise. Avoid anything that feels like one more chore. When you exercise in a way that replenishes you it triggers the reward cascade in your brain — you’ll know it when you experience it!
There is so much out there. Fully embracing your exercise routine will not only help you to maintain and build new bone, but will enhance your outlook, longevity, and whole-body health.
I’m Dr. Susan Brown. I am a nutritionist, medical anthropologist, writer, and speaker. Get my free weekly newsletter here.