Bone health is integral to our overall health, and like most things, it is easier to prevent a problem than solve one. Our peak bone mass occurs by age 30-35, so if you are still young, now is the time to make sure that your exercise, nutrition, and other habits are supporting your bone health. If your thirties are in the rear view mirror, fear not! There is still plenty you can do to help maintain and build bone density.
Just a Minute for the Science:
Your body is a dynamic system. In addition to taking in oxygen and nutrients, pumping blood, filtering waste, using electrical signals to create movement...and on and on…one of the things our bodies do regularly is remodel the skeletal structure. We are constantly reabsorbing bone tissue and laying new bone down. As we age, the rate at which we reabsorb bone tissue starts to out-pace our new bone creation, which is why we start to lose bone density. If we lose enough bone mass (osteoporosis or osteopenia) fractures can become a serious concern.
(Whew… glad that’s over.)
Every human is different, and hormones, nutrition, as well as genetics can all contribute to how much bone loss occurs, but both nutrition and physical activity can tip the scales in your favor. There is a “law” in physiology that states new bone is laid down in accordance with stress put upon that bone. Because of this, the recommendations for exercise to support bone density are weight bearing or impact activities and resistance training
The current ACSM (American College of Sports Medicine) recommendation for anyone over 65, or those 50 and over who have been diagnosed with osteoporosis or osteopenia, is as follows:
30 min/ 5 days a week of moderate intensity aerobic exercise
At least 10 min every day of some type of impact activity -If you chose an impact activity for your aerobic exercise, like running, you don’t need to add more on those days. -The higher the impact, the more effect it can have on your bone density, but this also increases the risk of stress fracture. So, if you aren’t sure what level of impact is safe for you, you may want to discuss your options with a physician or physical therapist before adding anything new.
2-3 days/week of resistance training with 48 hours of recovery time in between. -8-10 exercises of at least one set of 8-15 repetitions each. -Try to choose weight bearing, multi-joint loading, and resisted exercises
2-3 days/week of neuromotor control like balance, agility, coordination -Even though this doesn’t directly increase your bone density, it will help decrease your risk of fractures by reducing your risk of falling.
I’d first like to advocate that you should make sure your routine fits into these guidelines. That said, there are dozens of options when it comes to choosing what exercises and activities to do, while fitting into these categories.
So, what are my 5 favorite exercises for building bone density?
These exercises are multi-joint activities (meaning you will get more bang for your buck when it comes to fitting them into your busy schedule) are easy to make more or less challenging depending on your personal skill level, and try to emphasize what we know about supporting bone density.
Research has shown that power jumping-- jumping as high as you can, using arm swing-- can build bone mineral density in the hip when performed consistently (10-20 times, twice a day). Power jumping may not be appropriate for those with high fracture risk or poor balance, but can be modified to hopping for 2 min. once a day and achieve similar effects with less impact per jump (and allows those with limited balance to use their hands on a counter or other support).
If you are needing a little more challenge or just want to make it a bit more interesting, doing box jumps, jumping rope, or adding a 180 deg turn to each jump might add a little spice to this exercise.
Shuffle Lateral lunge
This exercise combines lower body resistance, coordination, and impact while moving in a direction that we definitely need more of.
To do this exercise you will alternate a right lateral lunge with a left lateral lunge linking them with one or two quick shuffle steps to move from the right side to the left side and back again.
The lateral lunge provides great resistance strengthening to the hip muscles while the quick change-over works coordination and increases “strain rate,” or the speed at which the forces on our bones change.
Higher strain rates have been linked to improved adaptive processes in bone. As you become more proficient, loading your body by holding weights in each hand can also increase your return.
Goblet Squat to Overhead Press + Heel Raise
This exercise combines a lot of different movements and components, so it can seem a little complicated or intimidating, but once you get the rhythm down it is really rather easy. Plus, with all the different components there is room to modify wherever you need and still get plenty out of the exercise.
Start with your feet a little wider than shoulder width apart, holding a weight in front of your body with both hands. Keeping your pelvis and spine in neutral squat all the way down so that your bottom is below your knees. Try to keep your chest up so that your body and the lower part of your leg at about the same angle.
Then press all the way up to standing while bringing both arms overhead--be careful not to let the shoulders hike up toward your ears.
Lastly, rise up onto your toes, keeping weight even between the big and little toes.
It is a great loading exercise for the legs, spine, and shoulders; additionally the ability to complete a heel raise and/or a deep squat are both markers for decreased falls risk and overall longevity.
Chops, or wood-chops, is a great core exercise that focuses on the rotational strength and stability from the oblique abdominal muscles.
To do this, stand with your feet hip width apart and knees bent, you can do this either with your feet parallel or in a lunge stance.
With a weight held in both hands, you are going to lift and lower the weight on the diagonal, working from above one shoulder to below the opposite hip, twisting through the spine.
Just remember to keep pelvis in neutral and don’t let your thoracic or lumbar spine round forward. The spine is often one of the first places to show signs of bone loss, so loading through the spine as when the weight is overhead in this activity, as well as the stabilization from oblique strength will help prevent the kind of bone loss that leads to compression fractures of the vertebral bodies.
Loaded carries are simple, efficient, and they work your whole body. It seems so simple: pick up a weight and walk; and it is true that this is the most “uncomplicated” exercise on my list, but it demands a lot of work to do correctly. It is another great spinal loading exercise, and increases your body’s overall work capacity, while targeting a number of individual muscles groups.
For example, core muscles must keep the spine in a neutral alignment, the ribs down, and shoulder muscles must support the weight.
One of the best parts of this exercise is that it is endlessly variable. You might carry weights in each arm and walk with a high-march step, load the weight asymmetrically from side to side, or hold your weight (or weights) overhead. All kinds of modifications can change the specifics on muscle activation and loading, while still working to build bone density.
This list is by no means exhaustive, and there are many reasons why these or any other exercise you find online might not be appropriate for you. So, if you have been diagnosed with osteoporosis or osteopenia, or have any questions about where to start or how to progress your exercises for bone health, talk with your primary care provider, or contact us at firstname.lastname@example.org or 404-907-4196
Thanks for reading!
Sarah Terpin, PT, DPT
After experiencing a variety of different approaches to physical therapy practice in Oregon and Utah, Sarah found her home in Functionize’s private-pay model giving the direction and decision-making power back to the patient. A firm believer in taking the whole human into account as opposed to focusing on a symptom, she is adept at creative approaches that lead to ah-ha moments around the root cause for pain or limitation.
At Functionize Health & Physical Therapy we work with athletes and active people at all levels to develop individualized treatment plans to help them safely and fully recover from injuries and get them back to the activities they love. If you have worked with us one-on-one, you know that we don’t subscribe to generic protocols or programs; it is never one-size-fits-all, and that applies to these tips as well. If you are recovering from an injury, talk to your PT about how stretching and or foam rolling may affect you.