The loading of bones through exercise and the use of external weights is well recognized to enhance bone strength. While everyone benefits from osteogenic loading, small, slender individuals, in particular, should exercise with additional weights to help maintain and build bone density. As Swedish researchers suggested, the advantage of using a weight belt for osteoporosis instead of a vest or backpack is that “there is load only on the lower extremities and no unwanted load on the back, shoulders and chest, which may be especially important where frail older people are concerned.”
Here at the Center for Better Bones, we have long recommend the use of women’s weighted vests and now are pleased to find scientists using a weighted belt as another safe and easy-to-use bone-building tool.
Three studies have shown positive results using a weighted belt to safely build bone strength among specific populations at high risk for osteoporosis:
Study #1: Using a weighted belt to reduce the bone loss associated with breast cancer treatment.
In 2008, researchers at Yale University asked an interesting question: Could postmenopausal women undergoing treatment for breast cancer safely reduce their bone loss by exercising with a weighted belt? The results of this innovative study were both informative and positive. The 16- to 24-week study looked at women diagnosed with Stage I or II breast cancer, most of whom (65%) had completed adjuvant chemotherapy and/or radiation therapy within the past 3 years. All of the women were within 2 years of menopause, itself a period of accelerated bone loss, and some of the study subjects were being treated with estrogen suppressing drugs, which exacerbates the normal menopause bone loss.
These women were at especially high risk of excessive bone loss for two main reasons. First, breast cancer treatment itself is associated with accelerated bone loss. Second, they were in early menopause, which is a time of accelerated bone loss (with the average woman losing 10% of her bone mass between the first year before her last period and five years after).
Participants underwent supervised, progressive treadmill walking exercises performed 3 times per week with a weighted belt and a backpack. The waist belt provided loading of the hip and the backpack provided further loading of the upper body. The walking exercise was increased each week, as were the weights carried in the belt and backpack.
The training program looked like this:
– Each session, the women did a 5-minute warm up and a 5-minute cool-down along with the walking exercise using the weighted belt.
– Week #1, the women did three 10- to 20-minute walking sessions on a treadmill with 1 lb weight in the waist pack and 1 lb in a backpack.
– Weights in the weighted belt and backpack began at 1 lb, increasing in 1-lb increments to 5 lb in both the waist belt and backpack by week 5.
– By week 16, participants walked 45 minutes each day with a 5-lb belt and 5 lb backpack weights.
Over these first five weeks, the maximum heart rate was gradually increased to 75%.
The results of this remarkable, innovative Yale University study were clearly positive: This weight-loading exercise program protected their bones and allowed them to maintain stable bone density despite their high risk of bone loss.
Study #2: Exercising with a weighted belt for women on long-term hormone replacement therapy with persistent low bone density.
Studies suggest that even on long-term hormone replacement therapy (HRT), women with low bone density still lose bone at a rate of about 0.3 % a year. In fact, 42–59% of women on hormone therapy have been reported to have osteoporosis or osteopenia.
This particular study tested the use of a weight-bearing exercise program to help maintain bone density in women on long-term HRT. The objective was to determine the bone density impact of a long-term exercise program using a weighted belt to load the lower body and compare this to the effect using resistance training to strengthen the upper body.
This was a large exercise trial with 189 participants ages 59 to 78. The women were divided into two groups, one underwent lower extremity training using weighted belts and the other loading the upper body with elastic band exercises and dumbbells. Both groups exercised three times a week with 35 minutes of resistance training and 5 minutes of warm-up and cool-down.
The result was that both upper- and lower-body exercise regimes significantly enhanced hip, spinal, and total bone density over this two-year study.
Details of the lower-body strength training program:
– Initial loading of the weight belt was 6% of the woman’s body mass (7.5 lbs for 125lb woman). Weights were added based on fatigue and ability to maintain correct form.
– The exercises using the weighted belt included chair rises (16.7-inch rises) and step ups (progressing from a 6-inch to a 8.6-inch step up). The speed at which these exercises were done increased over the trial.
– Heel drops were completed with 10 repetitions using both feet, followed by 3 sets of 10 drops on each side.
– Ankle weights were used one leg at a time to flex the hip from standing position with the support of the chair. The range of motion was from 0° to 90° flexion with three sets of 10 repetitions at slow speed. Over the trial the resistance in the ankle weights increased from 2.2 lbs to 7.9 lbs.
Details of upper body training program:
– Seven exercises were performed at each session, with two sets of 10 to 14 repetitions for each exercise (total of 140–196 repetitions among all the exercises).
– Every session included 4 elastic band exercises. These were horizontal chest press with external shoulder rotations, shoulder external rotation, shoulder abduction, and overhead press.
– In addition, 3 of 9 possible dumbbell and body mass exercises were done by all women.
Nine of the 13 exercises were performed in a seated position. Two dumbbell exercises (triceps kick back and one-arm rows) were performed standing with one hand on chair.
One dumbbell exercise, the upright row, was done from standing position without support. Modified pushes up from one’s knees were also included.
All dumbbell exercises were introduced at 6 months, and the weight was progressively increased based on ability to complete 12 to 14 repetitions with good form.
Study #3: Weighted belt exercises to enhance function after hip fracture
A novel Swedish pilot study looked at the possibility that exercise with a weighted belt might speed recovery after a hip fracture in frail older women. These women (ages 78–82) had experienced a hip fracture at least 6 months before and were experiencing mobility problems, including impaired lower limb strength balance, instability and gait problems. In this pilot study, three elderly, frail women underwent a 10-week exercise program wearing a weighted belt. Again, the study was successful in that the women gained greater balance and improvement in their gait over the 10 weeks.
The exercise program looked like this:
– The women did 19 exercise sessions of 40 minutes each while wearing a weighed belt. The belt was worn while the women completed the following exercises which are designed to stress the major muscle groups in the legs and also to challenge the balance:
– Sit and stand
– Stair climbing
– Step-ups with varying heights
– Toe raises
– Moving center of gravity side to side and forward/lateral lunges
– Two sets of 6–10 repetitions were completed for each exercise. Initially, the weighted belt was loaded with about 6% of the subject’s own body weight and weights were added or removed as necessary. Exercises were performed at approximately 80% of maximum capacity.
The strength-enhancing effects of this weighted belt exercise were impressive after only 10 weeks:
– Gait speed improved by 16–38%.
– Step performance improved 36–76%.
– Dynamic leg assessment showed increases for the leg press but not for the overall isometric leg strength.
– The effects of dynamic muscle strength in accounts balance and gait speed were reflected in increased activity levels and lesser dependence on walking aids.
– The subject’s experience of the training was positive in subjects also reported a reduction in pain.
What the studies show
In all of these studies, we see women with significant risk of bone loss and fracture — including, in one study (#3), women who had already had a major fracture event — using weighed belts and backpacks as a way of producing added load on the bones and obtaining important improvements to bone strength, balance, and overall health.
The third study, while small, is particularly encouraging because it highlights the ability of bone to restore itself even after a catastrophic injury in very old and frail persons. It supports what I have always maintained: It’s never too late to improve your bone health!
Knobf MT, Insogna K, DiPietro L, et al. An aerobic weight-loaded pilot exercise intervention for breast cancer survivors: Bone remodeling and body composition outcomes. Biological Research for Nursing 2008;10(1):34-43.
Judge, JO, Kleppinger A, Kenny A, et al. Home-based resistance training improves femoral bone mineral density in women on hormone therapy. Osteoporosis International 2005;16:1096-1108.
Lindelöf N et al. Weighted belt exercise for frail older women following hip fracture- a single subject design. Advances in Physiotherapy 2002;4:54-64.