What exercises are recommended for a generally healthy adult to strengthen bones, considering a history of osteoporosis or fractures?

Bone Strengthening Exercises for Adults

For generally healthy adults, including those with osteoporosis history, perform multicomponent exercise incorporating dynamic weight-bearing impact activities and progressive resistance training 2-3 days per week for at least 10 weeks, with programs exceeding 1 year showing the greatest bone density improvements. 1

Core Exercise Components

Weight-Bearing Impact Exercise

• High-impact activities (jumping, stair climbing, jogging) are most effective for bone stimulation, generating ground reaction forces that trigger bone formation 2, 3
• Walking alone limits progressive bone loss but does not improve bone mass—higher mechanical intensity is required 2
• Tai Chi provides weight-bearing stimulus while improving balance 2
• Critical caveat: High-impact exercise may not be appropriate for postmenopausal women with established osteoporosis; these patients should focus on resistance training instead 3

Progressive Resistance Training

• Train each major muscle group 2-3 days per week 1
• Intensity prescription by experience level: 1
  • Beginners/older adults starting exercise: 40-50% of one-repetition maximum (1RM)
  • Novice to intermediate exercisers: 60-70% of 1RM (moderate to hard intensity)
  • Experienced strength trainers: ≥80% of 1RM (hard to very hard intensity)
• Perform 8-12 repetitions for most adults, or 10-15 repetitions for middle-aged and older adults 1
• Include exercises targeting all major muscle groups: chest press, shoulder press, leg press, squats, step-ups 1

Balance and Functional Training

• Essential for fall prevention, which directly reduces fracture risk 1
• Incorporate balance exercises into the multicomponent program, particularly for adults over 65 years 1
• Gait and mobility training reduces fall rate in community-dwelling older adults at high risk 1

Optimal Program Structure

Frequency and Duration

• Minimum effective dose: 2-3 days per week for at least 10 weeks 1
• Maximum benefit: Programs lasting >1 year show positive effects on bone mineral density (BMD) 1
• Sessions should be 60+ minutes when combining multiple exercise types 1

Progressive Overload Strategy

• Gradually increase exercise volume by adjusting duration, frequency, and/or intensity 1
• This gradual progression enhances adherence and reduces musculoskeletal injury risk 1
• Site-specific loading is critical—exercises must target the bones you want to strengthen 2, 3

Special Considerations for Osteoporosis History

Exercise Prescription Modifications

• Supervised programs are strongly recommended for those with chemotherapy-induced peripheral neuropathy, balance impairments, or cognitive dysfunction affecting fall risk 1
• Programs should be individually tailored by a clinician who can evaluate fracture and fall risk based on physical and cognitive function 1
• Focus on progressive resistance exercise following hip fracture, which produces small but significant improvements in mobility and physical function 1

What NOT to Do

• Avoid unloaded exercise (swimming, cycling alone) as primary bone-strengthening modality—these have no impact on bone mass 2, 3
• Whole body vibration has controversial evidence for BMD improvement, though it may help with balance and fall prevention 2
• Low-impact exercise alone shows insufficient evidence for bone health outcomes in people with bone fragility 1

Expected Outcomes

Realistic Bone Density Changes

• Younger adults during rapid growth: 2-5% per year gain in BMC and BMD 4
• Older adults and postmenopausal women: 1-3% per year net gain, or attenuation of bone loss 3, 4
• Lumbar spine responds better than femoral neck to exercise interventions 1
• Effects are highly site-specific—bone density increases only in mechanically loaded regions 2, 3

Additional Benefits Beyond Bone Density

• Improved muscle strength and mass 5, 4
• Enhanced balance and reduced fall risk (number needed to treat = 3 to prevent one fall with multicomponent interventions) 1
• Better functional ability and quality of life 4
• Reduced risk of cancer recurrence in cancer survivors 1

Critical Implementation Points

Mechanical Loading Principles

• High forces and high impacts have greatest osteogenic potential 3
• Joint reaction forces must exceed common daily activity levels to stimulate bone formation 2
• Even relatively small amounts of high-impact exercise can be efficient for enhancing bone mass (except in postmenopausal women with osteoporosis) 3

Common Pitfalls to Avoid

• Insufficient intensity: Resistance training must reach moderate to high intensity (≥60% 1RM) to be effective 1
• Inadequate duration: Programs shorter than 10 weeks show minimal bone effects 1
• Single-modality approach: Combining weight-bearing impact with resistance training is superior to either alone 1, 3
• Cessation of activity: Stopping exercise induces rapid metabolic bone changes and loss of gains 6

Safety Considerations

• Perform exercises through full range of motion at moderate to slow controlled speed 1
• Avoid breath-holding and Valsalva maneuver 1
• For those with established osteoporosis, avoid high-impact activities and focus on progressive resistance training 3
• Assess fall risk factors including gait, lower limb strength, medication effects, and environmental hazards before prescribing high-intensity programs 1