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Osteoporosis and Exercise
by Grace T. DeSimone, B.A., ACSM-CPT, ACSM-GEI
orldwide, more than 200 million people have osteo-
W porosis, according to the National Osteoporosis
Foundation. One in three women over the age of
50 years and one in five men will experience osteoporotic frac-
tures in their lifetime.
WHAT IS OSTEOPOROSIS?
Osteoporosis literally translates as “porous bones.” It occurs
when the holes between bone become bigger, making it
fragile and liable to break easily. Bone is living tissue that
is constantly being broken down and replaced in a process
known as remodeling. Osteoporosis occurs when the growth
of new bone does not keep up with the loss of old bone. As
a result, bones become thin and weak and more prone to
breaks. Osteoporosis fractures typically occur in the hip,
wrist, or spine. Bone mass peaks around 17 to 30 years and
is maintained until around age 50 (menopause for women).
After age 50, there is rapid loss. From teen years to age 30,
aerobic exercise and strength training improve bone mass.
Mature adults (ages 30 to 50 years) need more weight-
bearing exercise.
HOW IS IT MEASURED?
Bone density is a measurement of how dense and strong the
bones are. Bone mineral density (BMD) is related to bone
strength. BMD testing is used to diagnose osteoporosis. BMD
is measured with a test called a DEXA scan. By measuring BMD,
doctors can predict the risk of having a bone fracture. Having low
bone density does not necessarily mean you are losing bone.
Your bone density may still be considered normal for you. Some
people never have normal bone density for a variety of reasons,
including genetics, body size, or certain diseases and conditions.
The older you are, the more likely you are to have low bone
density. Speak with your health-care provider to find out when
you should be tested.
WHAT IS OSTEOPENIA?
Osteopenia refers to bone density that is lower than normal
peak density but not low enough to be classified as osteoporo-
sis. If your bone density is low compared with normal peak
density, you are said to have osteopenia. Having osteopenia
means there is a greater risk that, as time passes, you may
develop osteoporosis.
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CAN IT BE AVOIDED?
It’s never too late to improve the quality of your health. If you
have been diagnosed with osteopenia or osteoporosis, your
health-care provider will offer a recommended strategy, includ-
ing nutrition, calcium supplements, and exercise.
BEAR WEIGHT
As you learn more about bone health and exercise, you will
hear the term “weight-bearing exercise.” This refers to activ-
ities that require you to literally bear your own weight. If you
think about an activity such as swimming, the water is bearing
a portion of your weight. If you are sitting on a bike, the bike
is bearing some of your weight. If you are jogging on a re-
bounder or a mini-trampoline, the springs are absorbing
and propelling some of your weight. Instead, look to activities
that you are solely supporting your own body such as walking
or jogging.
OSTEOPOROSIS PREVENTION/CARDIOVASCULAR
EXERCISE RECOMMENDATIONS
According to the Physical Activity Guidelines, adults should
do at least 150 minutes (2 hours and 30 minutes) to 300 minutes
(5 hours) a week of moderate-intensity, or 75 minutes (1 hour
and 15 minutes) to 150 minutes (2 hours and 30 minutes) a
week of vigorous-intensity, aerobic physical activity or an
equivalent combination of moderate- and vigorous-intensity
aerobic activity. To increase the benefit for bones, try to
make the majority of your exercise weight-bearing if possible.
High-impact activities such as jogging, rope jumping, climbing
stairs, and bench stepping are great choices, but if you have
been diagnosed with osteoporosis, this is often not recom-
mended because the added stress on bones may increase the
risk of fracture based on the severity of bone loss. Always ask
your health-care provider specific questions before engaging in
any exercise program.
What about ankle or wrist weights? Although it seems
like a logical solution to add ankle weights to increase the
load of each step, this is not recommended and can cause
more harm than good because it places undue repetitive
stress on the knee and hip joints. The same can be said of
the addition of wrist or hand weights. If you want to con-
sider loading up, ask your health-care provider about the
use of a weighted vest.
November/December 2019
 Sidebar: Daily Dose of Balance
 Practice balance each day. Stand in a doorway or next to a
counter or sturdy chair that allows you to hold on when
needed.
 Stand tall with one foot in front of the other. Aim to touch
the toes of your back foot with the heel of your front foot.
 Look down bringing your chin toward your chest, then slowly
look straight ahead, then carefully cast your eyes upward
and look at the ceiling or sky. Try this two or three times then
switch feet. When you have mastered this, try to perform the
exercise with your eyes closed. This improves propriocep-
tion, your body’s ability to sense movement.
OSTEOPOROSIS PREVENTION/RESISTANCE
EXERCISE RECOMMENDATIONS
Resistance training may promote BMD improvement and re-
modeling. ACSM recommends 2 sets, 8 to 10 repetitions, 2 to
3 days/week, all major muscle groups. For osteoporosis pre-
vention, focus on improving trunk, hip flexors/extensors, lower
extremity, back, and abdominal muscle strength. Improving
strength in these areas may assist in preventing a fall. Add flex-
ibility activities at least once a week. Balance is a key ingredient
in training and should be practiced daily.
EXERCISE RECOMMENDATIONS IF YOU HAVE BEEN
DIAGNOSED WITH OSTEOPOROSIS
Perform 4 to 5 days of aerobic style exercise at 40% to 70% of
maximum heart rate 3 to 5 days per week 30 to 60 minutes
per session. Focus on duration rather than intensity. Avoid
Volume 23 | Number 6
high-impact exercise. Focus on weight-bearing exercise with
minimal fall risk (walking on a flat surface). Practice balance
exercises for a few minutes each day. Yoga and Pilates also
can improve strength, balance, and flexibility. However, certain
positions may not be safe for people with osteoporosis or those at
increased risk of broken bones. For example, exercises that have
you bend forward may increase the chance of breaking a bone
in the spine.
LEARN THIS
While learning what we should be doing, so many people forget
to ask, “What should I avoid?” This is a critical piece of owning
your health. When you speak to a medical professional, be sure
you walk away with a list of dos and don’ts.
BE CONSISTENT AND SPECIFIC
The professionals in your exercise community are here to help
you. Ideally, you should receive specific information on recom-
mended activities as well as those that are contraindicated. Take
the time to learn about your condition and engage an ACSM
certified professional to assist in creating your program.
Grace T. DeSimone, B.A., ACSM-CPT, ACSM-GEI, is the
national group fitness director for Optum. She and her group fit-
ness teams manage group exercise classes in worksite wellness
programs across the country. She is the editor for ACSM’s Re-
source Manual for Group Exercise Instructors (2011)
and is the 2016 IDEA Health and Fitness Association Pro-
gram Director of the Year. She holds a bachelor’s of arts degree
in Dance from Hunter College, City University of New York, in
New York, NY, and is an ACSM Certified Group Exercise In-
structor® and an ACSM Certified Personal Trainer®.
www.acsm-healthfitness.org 5