If you have been diagnosed with osteoporosis, there are certain exercises that can have a positive impact on your bone health and exercises that can work against your bone health. For this reason, it's important to know which exercises and positions should be avoided to prevent unnecessary fractures. If you're just starting out on your exercise journey, you might not be sure which exercises and movements or positions to avoid. Wellen's workout program takes the guesswork out of the equation for you by incorporating only osteoporosis-safe exercises. But it's still important to know what you should and shouldn't do on your own.
Keeping up with a regular exercise routine is one of the best ways to improve your balance and maintain bone strength with osteoporosis. Even better: It's never too late to start, even if you're a beginner.
But not all exercise is created equal. Certain activities, such as walking and strength training, provide multiple benefits for people with osteoporosis or osteopenia, including:
- Building muscle strength and mass (or bone density)
- Increasing balance and reducing falls
- Reducing risk for bone fractures or breaks
- Improving posture
- Reducing pain
However, certain other exercises can increase the risk of falls, fractures, or breaks.
Exercises to avoid with osteoporosis
It's always important to involve your doctor or physical therapist when starting a new exercise routine. They will guide you in developing a safe and effective workout regimen, but it's also essential to understand why certain exercises are not appropriate for someone with osteoporosis.
As a general rule, if you have osteoporosis, avoid exercises that involve excessive bending, twisting, or jumping to decrease your risk of experiencing osteoporosis related problems.
High-impact exercise
Weight-bearing exercise, or exercise that involves supporting your own body weight, have been shown to increase bone mineral density and improve quality of life in people with osteoporosis (Shanb, 2014).
Weight-bearing exercises can fall into two categories: low impact and high impact.
High-impact exercises such as running and aerobics, involve a lot of movement and jumping, which puts increased pressure on bones and joints. For people who have had a vertebral compression fracture or multiple low-trauma fractures, this type of exercise is not recommended due to an increased risk of bone breaks (fractures) (Brooke-Wavell, 2022).
However, for people who have osteoporosis, have adequate physical preparation and no history of vertebral or low-trauma fractures, moderate impact exercises, like jumping, may be beneficial. This is because these types of exercises have actually been shown to improve bone density (Brooke-Wavell, 2022).
As you can see, high-impact exercise is not for everyone. For both of these groups, a thorough physical exam and proper physical preparation with a fitness expert such as a physical therapist is recommended before starting a moderate-to high-impact exercise program (Brooke-Wavell, 2022; Kistler-Fischbacher, 2021). And if you’re unsure whether high-impact exercises are appropriate for you, stick to low-impact to be safe.
What to do instead: low-impact exercise.
Low-impact exercises such as walking, tai chi, dancing and the elliptical machine, provide a cardiovascular workout much like high-impact exercises do but without putting as much pressure on the body. They require you to move your own body weight, which can benefit your bone density, but without any sudden or jerky movements.
Crunches
Adding core exercises to your routine to work your abdominal muscles can help improve your posture and overall strength, but crunches and sit-ups are exercises that should be avoided by someone with osteoporosis.
The forward flexion – or forward bending of the spine – that occurs with crunches (and sit-ups) causes compression on the vertebrae in the spine, leading to fractures (Sözen, 2017).
In fact, all movements that involve spinal flexion should be avoided if you have low bone density. Spinal flexion is when you bend forward, which is why those with fragile bones should avoid movements like lifting heavy objects, some Pilates poses, and certain yoga poses.
What to do instead: Gentle core exercises.
It's still possible to build core strength and improve posture without putting undue pressure on the upper or lower spine. A few exercises that are safe for osteoporosis include:
- Abdominal drawing in maneuver
- Supine alternate bent knee fall out
- Supine alternate lower extremity march
Outdoor sports
Getting in a round of golf or a game of tennis on a nice day can be a great way to stay active and have fun with friends, but these activities can also cause osteoporosis-related problems by putting extra stress on the joints and bones. The same goes for extreme winter sports such as skiing, snowboarding, and ice skating.
While some preliminary studies showed that golf may improve bone density of the lower spine in people taking hormone replacement therapy (Eser, 2008), the twisting, bending, and reaching common in this sport can put added pressure on the spine and could lead to a spinal fracture or fracture in other bones if proper body mechanics are not utilized.
Fixed-weight machines
Consistent weight training with free weights or resistance bands has been shown to preserve and build bone and muscle mass (Hong, 2018).
Resistance training using fixed-weight machines at the gym can provide bone-building benefits when done properly, but it can also be dangerous when done with poor posture or body mechanics. The reason: many of these machines were made for men, not women, and it may be challenging to use the machine without added bending, twisting, and flexion to adjust to the size of the equipment.
If it is easier to access weight machines than free weights, consult a physical therapist about how you can properly use the equipment without the risk of fracture. They may advise you to invest in resistance bands for your home use, which can make strength training more accessible without requiring as much money or space.
What you shouldn't do is skip strength training, which is critical for building and maintaining bone density. You don't need to be lifting huge weights to benefit your bone health. You can build strength using challenging resistance that still allows you to keep to controlled movements with proper form.
Are yoga and Pilates safe with osteoporosis?
Both yoga and Pilates can provide bone-building benefits when the exercises or poses are weight-bearing, strengthening and/or include resistance. However, not every yoga pose and Pilates exercise is safe for someone with osteoporosis. Certain yoga and Pilates moves that involve excessive rounding (flexion), twisting, or arching (extension) of the spine should be avoided to keep pressure off the spinal bones, which are more prone to compression fractures in a person with weakened bones. For example, if you've been diagnosed with osteoporosis, you should avoid positions in which you are bending forward or deeply stretching the hips (like pigeon pose) if you've been diagnosed with osteoporosis.
But for those with healthy, strong bones, yoga and Pilates can be good for improving bone mineral density. And even for some people with osteoporosis, there have been studies that show yoga and Pilates can be beneficial for women with osteoporosis, as long as the unsafe positions mentioned above are avoided. A small 2016 study found that yoga improved bone mineral density in postmenopausal women with osteoporosis (Motorwala, 2016). Another study found that just 12 minutes of yoga a day improve bone density in the hips, femur, and spine (Lu, 2016). Studies on Pilates workouts also showed that it had bone-building benefits, and the study participants also reported reduced pain (Angın, 2015).
In summary, yoga and Pilates can have positive effects on bone health, but only if done properly and when certain movements that place the bones in a more vulnerable position are avoided.
If you're unsure whether or not an exercise is safe, you can always start with Wellen's personalized fitness program, which has been specifically designed with the health considerations of women with osteopenia and osteoporosis in mind.
Osteoporosis exercises to avoid FAQs
What makes osteoporosis worse?
Osteoporosis may continue to worsen if you don't follow an exercise program that supports bone density and get critical nutrients like calcium and vitamin D. But people with low bone density may also risk compression fractures by doing certain movements that put undue pressure on the spine. People with osteoporosis should generally avoid exercises with a risk of fracture, avoid jerky movements, and choose exercises without bending or twisting.
Are planks good for osteoporosis?
Yes, planks are a good way to strengthen abdominal muscles in people with osteoporosis. They don't require bending the spine forward (like a crunch or sit up does), so they're safe for your thoracic and lumbar spine. Your abdominal muscles aren't the only muscles working, though.
Holding yourself in the plank position can also train the upper back, arm and shoulder muscles, and help you keep your shoulder blades back and down for better posture. Building abdominal strength is important for maintaining good posture; older adults that slouch as they age can suffer vertebral fracture from the increased pressure on their spine.
