Recommended Weight-Bearing Exercises for Individuals with Osteoporosis
For individuals with osteoporosis, a comprehensive program combining 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
Recommended Weight-Bearing Exercises
Aerobic Weight-Bearing Activities
- Walking: Brisk walking at moderate intensity (able to speak but not sing) for 30-60 minutes, 4 days per week 1
- Stair climbing: At 60-70% of maximum heart rate 1
- Low-impact aerobic dance: Avoiding high-impact movements 1
- Tai Chi: Particularly beneficial for balance and fall prevention 1, 2
Resistance Training
- Progressive resistance training:
- Focus on major muscle groups, particularly those supporting posture 1
- Allow 48 hours between sessions for the same muscle group 1
- Perform 2-3 days per week for 20-30 minutes per session 1
Balance and Functional Exercises
- Chair stands, heel raises, standing on one foot 1
- Functional movements that mimic daily activities 1
- Perform 5-7 days per week 1
Exercise Prescription Parameters
Frequency and Duration
- Total weekly exercise time should be at least 150 minutes 1
- Programs showing significant intervention impacts were typically undertaken for 60+ minutes, 2-3 times/week for 7+ months 2
Intensity
- Moderate intensity for aerobic exercises (60-70% of maximum heart rate) 1
- For resistance training, begin with 40-50% of 1-RM for beginners and progress to 60-70% of 1-RM for intermediate exercisers 1
Exercises to Avoid
- High-impact activities like jumping, jogging, or high-impact aerobics 1
- Explosive movements that place sudden stress on bones 1
- Dynamic abdominal exercises with excessive trunk flexion and twisting (e.g., traditional sit-ups, golf swings) 1
- Bending while picking up objects 1
Special Considerations
For Severely Limited Patients
- Chair exercises and gentle resistance bands can be used initially 1
For Those with Vertebral Fractures
- Avoid exercises that flex or twist the spine 1
For Those with Balance Issues
- Perform balance exercises near a wall or sturdy furniture for support 1
Evidence for Effectiveness
The most recent evidence from the WHO guidelines (2020) indicates that physical activity has a significant but small effect on bone health, particularly in lumbar BMD 2. Programs involving higher doses and multiple exercise types or resistance exercise appear to be more effective 2. The programs that showed the most benefit involved weight-bearing exercises that challenged balance and function, plus additional components such as resistance and/or endurance training 2.
A meta-analysis of randomized controlled exercise trials in premenopausal women showed significant improvements in femoral neck and lumbar spine BMD following weight-bearing exercise training, highlighting the utility of exercise for improving BMD at weight-bearing sites 2.
Nutritional Support
Weight-bearing exercise should be combined with:
- Adequate calcium (1,000-1,200 mg/day) and vitamin D (800-1,000 IU/day) intake 1
- Optimization of weight status 2
Implementation Tips
- 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
- Reassess every 8-12 weeks and adjust program as needed 1
By following these evidence-based recommendations for weight-bearing exercise, individuals with osteoporosis can help maintain bone density, improve balance and strength, and reduce their risk of fractures.