Cycling and Osteoporosis

With its low-impact nature and numerous health benefits, cycling, also referred to as bicycling and biking, has become a preferred choice of exercise for many fitness enthusiasts around the world. It is an activity that can be learned when you’re a small child and continued throughout the lifespan. But if you’re a man or woman over 50 with osteoporosis or osteopenia, you’re going to want to know whether or not cycling is good for your bone health. 

Osteoporosis, characterized by a significant loss of bone density, and osteopenia, its precursor, affect millions of individuals worldwide making them more susceptible to fractures. Postmenopausal women can be particularly impacted by low bone density, as a drop in estrogen during menopause can have a huge impact on bone health. Bone health is an important component of overall health for everyone, but for women over 50 incorporating bone-building exercises into a regular fitness routine is essential for active aging. Unfortunately, while cycling has many health benefits, bone health is not one of them. But don’t let that stop you from hopping on your bike if cycling is an exercise you love!

As we dive into the world of cycling, we'll explore this sport’s effect on bone health, its benefits, and its risks. Keep reading to learn more about the relationship between cycling and osteoporosis, and how to incorporate it into a bone-building workout program.

Overall health benefits of cycling

Cycling is a great form of aerobic exercise that provides your body with numerous health benefits. It can be done in the great outdoors, indoors on a stationary bike, alone, or with a group. It is a popular form of aerobic activity for people with arthritis or other conditions that cause pain during walking or standing activities. According to research, it has many physical and mental health benefits (Harvard School of Public Health, 2022). 

The main benefits of cycling include:

• Cardiovascular fitness: Cycling improves heart health by increasing blood flow, strengthening the heart muscle, and enhancing the body's ability to transport oxygen (Chavarrias, 2019).
• Muscle strength and endurance: Regular cycling helps build and maintain muscle strength, particularly in the lower body, promoting better mobility, function and overall strength during daily activities.

Additional benefits of cycling include:

• Reduced stress and anxiety
• Reduced body fat levels and risk of obesity 
• Reduced risk of diabetes, certain cancers and other chronic diseases

Cycling and bone health

While cycling can be great for your heart, lower body strength, and overall health and wellbeing,  it may not be the most effective exercise for improving bone density.

Studies on the relationship between cycling and bone density have shown mixed results. Most research suggests that cycling may not provide significant benefits to bone health, as it is a non-weight-bearing activity (Andersen, 2018; Olmedillas, 2012). However, these studies have primarily focused on professional cyclists. Other studies have found that cycling may lead to modest improvements in bone density when combined with weight-bearing activities for people who do not exercise regularly (Peterson, 2017). But ultimately, this evidence is not conclusive.

Here are the main downsides of cycling for bone health:

1. Non-weight-bearing activity: Cycling is a non-weight-bearing exercise, meaning that you are not bearing your own weight or working against gravity during the exercise. This makes sense, because when you ride a bike, your weight is being supported by the bike itself. In weight-bearing exercises, such as walking, jogging, or dancing, your legs are doing the work against gravity, and creating impact-loading forces that stimulate bone formation and remodeling (Cartledge, 2022). For this reason, these fully weight-bearing activities are more effective at maintaining and increasing bone density than non-weight-bearing exercises such as cycling (Andersen, 2018). 
2. Limited stress on the upper body: Cycling primarily engages the muscles of the lower body, placing minimal stress on the upper body. This means that the bones and muscles in the upper body, such as the wrists, arms, and spine, do not receive the same workout as the lower body. 

While there are limitations to the bone benefits of cycling, don’t hop off your bike just yet! Cycling can be a fulfilling part of any exercise routine. If it is something you enjoy, keep at it. Just make sure that cycling isn’t the only part of your workout; to maintain and improve bone health, it’s important to incorporate several other strategies for an osteoporosis-friendly routine. 

Integrating cycling into an osteoporosis-friendly fitness routine

Pair cycling with weight-bearing exercises

To maximize the benefits of cycling for bone health, it is essential to combine cycling with weight-bearing exercises and resistance training (Daly, 2019). A well-rounded exercise program should include activities that promote bone density, muscle strength, balance, posture, and flexibility. For you, that may mean cycling on some days of the week, and incorporating weight-bearing or resistance training exercises after those workouts or on other days. 

Walking, hiking, and stair climbing are all examples of weight-bearing activities that are safe for people with osteoporosis and work on the bones in your lower body. Other exercises such as planks and push-ups (even with modifications!) or exercises in a quadruped (hands and knees) position put weight through your wrists and arms, helping to build bone in the upper extremities. Resistance exercises use weights or resistance bands and/or bodyweight to challenge your body to work against an additional force, which is also an important component of a bone-building exercise routine. 

Strengthen the areas of the body missed by cycling

As mentioned, not every bone and muscle in the body is addressed while riding a bicycle. For cyclists, it's essential to focus on adding strengthening exercises that target a variety of muscle groups to improve overall performance, prevent imbalances, and reduce the risk of injury. These include:

1. Core muscles (abdominals, obliques, and lower back): A strong core is crucial for maintaining stability and keeping your spine in good alignment while cycling. Strengthening the core can help prevent lower back pain and improve overall riding posture. It can even prevent osteoporotic fractures and falls.
2. Upper body: Since cycling primarily targets the lower body, incorporating weight-bearing and resistance exercises for the upper body can help build and maintain bone density and strength in that area. Working on upper body strength is crucial for activities such as carrying groceries, lifting a heavy laundry basket off the floor, and performing yard work. 

To improve overall cycling performance and reduce the risk of injury, it's important to incorporate a well-rounded strength training program that targets these key muscle groups. Exercises such as squats, lunges, deadlifts, planks, and heel raises can be beneficial for cyclists. Additionally, incorporating flexibility and mobility exercises can help maintain a proper range of motion and prevent muscle imbalances.

Tips for safe and effective cycling

Now that we have covered the pros and cons of cycling as an exercise form for people with osteoporosis, it's up to you to choose which activities you incorporate in your regular exercise routine. Make sure that you find the balance between doing what you love, and doing what the evidence shows will benefit your bones. 

Regardless of what you choose, here are some final tips for how to stay safe and make cycling an effective part of your fitness routine: 

1. Select the right bike

When choosing a bike, consider factors such as comfort, ease of use, and adjustability. A recumbent bike may be more comfortable for those with back pain or balance issues. Ensure that the bike is properly adjusted to your body to prevent strain and injury. Wearing a helmet and using appropriate safety gear is also essential for outdoor cycling.

2. Proper posture and technique

Maintaining good posture while cycling is essential for preventing injury and maximizing the benefits of the exercise. To ensure correct posture and reduce your risk of spinal compression fractures, start by adjusting the bike to fit your body. Have a healthcare professional help if needed. 

• The seat height should be set so that your leg is almost fully extended when the pedal is at its lowest point. 
• The handlebars should be high, not low like a professional cyclist, to help encourage an upright posture while seated. 
• When gripping the handlebars, your elbows should be slightly bent, allowing for a more relaxed and comfortable position. 
• Keep your back straight with a natural arch and avoid hunching your shoulders. 
• Engage your core muscles to support your lower back and maintain stability. 
• While pedaling, focus on pushing through the balls of your feet and avoid pointing your toes downward, as this can place extra stress on your knees and ankles. 
• Remember to periodically shift your position and take breaks as needed to alleviate pressure on your spine and promote overall comfort. 
• By paying close attention to your cycling posture, you can enjoy a safer and more efficient ride, while protecting your spine and promoting better bone health.

3. Gradually increase intensity

If you are just starting out or have taken a long break from cycling, start with shorter, less intense sessions. Gradually, as your body gets used to cycling, you can increase the duration and intensity. Taking these steps will help prevent overexertion and injury.

4. Choose a safe route

If you’re cycling outside, stay away from dirt, sand and gravel, which can be hard to navigate on a bicycle, and make sure you wear a helmet! A safe, well-lit path can help reduce your risk of accidents and lower your risk of injury. 

5. Listening to your body

Pay attention to any discomfort or pain while cycling, and make adjustments to your bike or exercise routine as needed. Consult with a healthcare professional if you experience persistent pain or have concerns about your bone health and exercise.

Safety tips for getting on a bike

1. Choose the right bike: Ensure that the bike you're using is the appropriate size and type for your needs. A step-through or low-step frame may be easier to mount than a traditional diamond frame.
2. Find a suitable location: Look for a flat and level surface with ample space around you. Ideally, choose a quiet area away from traffic to reduce distractions.
3. Prepare the bike: Make sure the bike is in good working condition. Check the tires for proper inflation, ensure the brakes are functioning correctly, and confirm that the seat height is adjusted to a comfortable level.
4. Wear appropriate gear: Always wear a well-fitted helmet to protect your head in case of a fall. Additionally, you may want to consider wearing knee and elbow pads for added protection.
5. Stand next to the bike: Stand to the side of the bike with your dominant leg (the leg you naturally use to kick a ball) closest to the bike.
6. Adjust the seat height: Ensure that the seat is at a comfortable height where your feet can touch the ground when you're seated.
7. Hold the handlebars: Place your hands firmly on the handlebars to provide stability.
8. Mount the bicycle: While keeping one foot planted on the ground, reach the leg closest to the bicycle across it so that it is on the ground on the opposite side. 
9. Position your feet: Place the toes of your dominant leg on the pedal, keeping the other foot on the ground and ready to push off.
10. Push off and pedal: Push off with your dominant foot while simultaneously pushing down on the handlebars to maintain balance. Once you gain momentum, place your other foot on the pedal and start pedaling.

Safety tips for getting off a bike

1. Find a suitable stopping location: Look for a flat area with sufficient space to come to a complete stop. Avoid stopping on uneven or slippery surfaces.
2. Reduce speed: Gradually reduce your pedaling speed, and slowly apply the brakes to slow down.
3. Position your feet: When approaching a complete stop, slide your dominant foot off the pedal and position it firmly on the ground.
4. Swing your leg over: While maintaining a strong grip with the handlebars, swing your other leg over the seat and carefully dismount the bike. Aim to land with both feet on the ground.
5. Steady yourself: Take a moment to regain your balance before walking away from the bike.

Cycling can be a valuable component of an osteoporosis and osteopenia management plan, providing numerous health benefits. While cycling alone may not significantly improve bone density, incorporating it into a well-rounded exercise program such as Wellen’s exercise program, which includes weight-bearing exercises and resistance training, can support overall bone health. As you take control of your bone health and enjoy the benefits of cycling, remember that the best exercise is the kind you love to do – so if cycling is something you love, keep it up.