Recommended Weight-Bearing Exercises for Osteoporosis
For patients with osteoporosis, a combination of weight-bearing aerobic activities, resistance training, balance exercises, and functional movements should be performed 4-5 days per week to reduce fracture risk and maintain bone density. 1
Types of Recommended Exercises
Weight-Bearing Aerobic Exercises (4 days/week)
- Walking with proper posture - moderate intensity (able to speak but not sing)
- Stair climbing - 60-70% of maximum heart rate
- Low-impact aerobic dance - avoiding high-impact movements
- Tai Chi - particularly beneficial for balance and fall prevention
Resistance Training (2-3 days/week)
- Progressive resistance training with:
- 1 set of 10-15 repetitions at low intensity (40% of 1-RM)
- 1 set of 8-10 repetitions at moderate intensity (41-60% of 1-RM)
- 1 set of 6-8 repetitions at higher intensity (>60% of 1-RM) 1
- Focus on major muscle groups, particularly those supporting posture
- Allow 48 hours between sessions for the same muscle group
Balance and Functional Exercises (5-7 days/week)
- Chair stands
- Heel raises
- Standing on one foot
- Functional movements that mimic daily activities 1
Exercise Prescription Parameters
Frequency
- Weight-bearing aerobic activities: 4 days/week
- Resistance training: 2-3 days/week
- Balance/flexibility exercises: 5-7 days/week 1
Duration
- 30-60 minutes per session for aerobic activities
- 20-30 minutes for resistance training sessions
- Total weekly exercise time: at least 150 minutes 1
Intensity
- Moderate intensity for aerobic exercises (60-70% of maximum heart rate)
- For resistance training:
- Begin with 40-50% of 1-RM for those new to exercise
- Progress to 60-70% of 1-RM for intermediate exercisers 1
Exercises to Avoid
- High-impact activities like jumping, jogging, or high-impact aerobics
- Explosive movements that place sudden stress on bones
- Dynamic abdominal exercises with excessive trunk flexion and twisting (e.g., traditional sit-ups, golf swings)
- Bending while picking up objects - use proper lifting techniques instead 1
Implementation Strategy
- Begin with assessment of current fitness level and bone health status
- Start conservatively with lower intensity and duration
- Progress gradually by increasing duration first, then intensity
- Monitor for pain or discomfort - exercises should not cause pain
- Reassess every 8-12 weeks and adjust program as needed
Special Considerations
- For severely limited patients, chair exercises and gentle resistance bands can be used initially
- For those with vertebral fractures, avoid exercises that flex or twist the spine
- For those with balance issues, perform balance exercises near a wall or sturdy furniture for support
- For those with peripheral neuropathy, non-weight-bearing exercises like recumbent cycling may be safer 1
Additional Recommendations
- Ensure adequate calcium (1,000-1,200 mg/day) and vitamin D (800-1,000 IU/day) intake 1
- Combine exercise with fall prevention strategies like home safety assessment
- Avoid smoking and limit alcohol consumption 1
- Consider bone-modifying medications for those with T-scores ≤-2.5 or high fracture risk 1
Weight-bearing exercise has been shown to reduce hip fracture risk through both modest preservation of bone density and reduction in fall risk 1, 2. The most recent evidence indicates that resistance training has the most convincing impact on bone mineral density, while core-strengthening and balance exercises help prevent falls 3.