What exercises help build bone density?

Bone-Building Exercise Recommendations

High-impact weight-bearing exercises combined with resistance training are the most effective for building bone density, requiring at least 60 minutes per session, 2-3 times weekly for a minimum of 7 months. 1

Most Effective Exercise Types

High-Impact Activities (Primary Recommendation)

• Jumping and plyometric exercises produce the greatest osteogenic effects by generating forces exceeding 4 times body weight 1
• Zig-zag hopping specifically optimizes tibial bone strengthening due to high strain rates 1
• Running alone is insufficient—it does not subject bones to high enough impacts for maximal bone formation 1, 2
• Focus on power generation rather than heavy landing, using only a few repetitions per session 1

Resistance Training (Essential Component)

• High-intensity progressive resistance training has the most profound site-specific effects on bone density compared to aerobic exercise alone 3, 4
• Weight-lifting exercises should be combined with high-impact activities for optimal results 1, 4
• Resistance exercises must exceed the intensity of common daily activities to be effective 5

Multicomponent Programs (Recommended for Older Adults)

• Combination programs including aerobic exercise, strengthening, progressive resistance, and balance training show superior results 1, 6
• These programs improved lumbar spine BMD by 3.22 standardized units and femoral neck BMD by 2.8% after 8 months 1, 6
• Particularly beneficial for older adults who cannot perform pure resistance exercises 5

Optimal Exercise Prescription

Frequency and Duration

• 2-4 short sessions per week (30-60+ minutes per session) 1
• Minimum duration of 7+ months required to maintain or improve bone mass 1
• Exercises should be performed on alternate days, as bone cells regain 98% of mechanosensitivity after 24 hours of rest 2

Intensity Requirements

• Weight-bearing exercises must reach mechanical intensity sufficient to generate important ground reaction forces 5
• High-impact activities should produce loads greater than 4 times body weight 1
• Resistance training intensity should be high with elevated speed of movement 4

Site-Specific Effects

Lumbar Spine (Strongest Evidence)

• Moderate-certainty evidence that physical activity improves lumbar spine BMD (standardized effect 0.17) 1
• Combination exercise programs most effective for spine (mean difference 3.22) 1

Hip/Femoral Neck (Lower Certainty)

• Low-certainty evidence for hip BMD improvement (standardized effect 0.09) 1
• Resistance training showed mean difference of 1.03 for femoral neck 1

Exercise Types with Limited Benefit

Ineffective Activities

• Walking alone does not improve bone mass—it only limits progressive loss 5
• Swimming and other unloaded exercises have no impact on bone mass 4
• Running without additional high-impact or resistance components provides minimal benefit 1, 2

Special Populations

Premenopausal Women

• Structured programs combining high-impact loading with resistance training significantly improve BMD at lumbar spine and femoral neck 1
• Weight-bearing exercise training shows significant improvements in both sites 1

Postmenopausal Women

• Exercise shows only mild increases or maintenance of BMD, but net changes relative to controls are beneficial for fracture risk reduction 4
• May require different protocols than premenopausal women, though optimal differences remain undefined 4

Cancer Survivors

• Combined resistance and impact exercise shows positive effects on lumbar spine BMD 1
• Exercise alone may not be sufficient without addressing underlying energy deficiency 1

Critical Caveats

Energy Availability

• Bone may not adapt to mechanical loads if energy availability is inadequate 1
• Low energy availability suppresses bone formation markers, particularly in female endurance athletes 1
• Weight gain and adequate nutrition are essential for bone response to exercise 1

Fracture Risk Considerations

• High-impact activities in individuals with existing low BMD may increase fracture risk 1
• Balance and fall prevention exercises should be incorporated for those at high fracture risk 1
• Estrogen may be permissive for osteogenic effects—chronically amenorrheic athletes show poor response to mechanical loading 1

Complementary Interventions

Essential Nutritional Support

• Calcium intake: 1,000 mg/day under age 50; 1,200 mg/day over age 50 1
• Vitamin D: 800-1,000 IU/day minimum, higher doses may be necessary for those with risk factors 1, 7
• Combination calcium and vitamin D more effective than monotherapy 1

Lifestyle Modifications

• Avoid tobacco use—negatively affects bone quality and increases fracture risk 1
• Limit alcohol consumption—even moderate intake increases fracture risk 1
• Implement fall prevention strategies including vision correction and home safety modifications 1