Exercise

"If we could give every individual the right amount of nourishment and exercise, not too little and not too much, we would have found the safest way to health."


Whether you already have osteoporosis or you're trying to prevent it, physical activity can help. Exercise can slow bone mineral loss, help maintain posture and improve your overall fitness to reduce your risk of falls. The key is to know which exercises to do and how to do them properly - and safely.


Getting started

If you already have osteoporosis, consult your chartered physiotherapist or doctor before starting an exercise programme. Depending on the status of your condition, your physiotherapist may or may not recommend certain movements. Your doctor may also wish to measure your bone density or assess your fitness level.


Choosing the right exercises

Weight-bearing activities:
These include activities you do on your feet with your bones supporting your weight. Walking, jogging and stair climbing are examples. They work directly on the bones in your legs, hips and lower spine to slow mineral loss. Activities that use many muscle groups and both upper and lower limbs are particularly recommended. Exercise will result in site specific bone gains. Running, whilst good for the lower limbs and spine won’t help develop strong bones for the upper limb. If you have osteoporosis, walking – preferably at least a mile a day – is generally the best weight-bearing exercise because it minimizes impact stress on your bones.


Strength Training:
Strength training uses resistance such as free weights, weight machines, resistance bands and water activities. It can also work directly on your bones to slow mineral loss and also strengthen your muscle loss. It is a good idea to alternate between upper and lower limb exercises. If you have osteoporosis, you’ll need the assistance of a chartered physiotherapist to design a strength training programme that includes proper techniques and is appropriate for your degree of bone loss.

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Posture Advice
The stooped posture caused by osteoporotic compression fractures may increase pressure along your spine, which can lead to even more compression fractures. It is therefore important to maintain a good posture. Pilates may be beneficial but make sure that your instructor is suitably qualified to understand your bone health needs.

• Standing. Stand up tall as if being pulled up through the head by a piece of string. Gently draw your shoulder blades back. Pull your stomach in but make sure that you are still breathing normally. Take your weight evenly on both feet.
• Sitting. Sit well back into the chair. Make sure that the chair supports your lower back. Make sure your feet are flat on the floor, otherwise use a foot rest or adjust the height of the chair. Don’t sit for long periods.

Balance Exercises and Falls Prevention
Maintaining good muscle strength and balance will reduce your likelihood of falling. If you don’t fall then you are less likely to fracture. Tai Chi may be good exercise to promote balance. If you are elderly or have a history of falls you may find the following advice useful:

• Footwear. Wear good fitting shoes with low heels and non-slippy soles.
• Eyesight. Have your eyesight checked regularly.
• Environment. When out and about be aware of steps and uneven and rough ground. Be especially careful during icy weather and around wet leaves and grass. At home make sure that you have adequate lighting. Avoid having loose rugs, electrical wires, trailing bed clothes on the floor that may cause you to trip. Have grab rails and rubber bath mats in bathrooms and use stair rails.
• Medication. Some medications may affect balance and co-ordination. Talk to your medical practitioner regarding any medication that may increase your risk of falls.

You should do weight-bearing activities every day. If you’re strength training, aim for at least two, but no more than four, exercise sessions a week to gain the most benefit.

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Safety Tips When Exercising

If you have low bone density or already have osteoporosis, a few precautions are necessary when you exercise. Certain movements may be dangerous because of the stress they put on the spine.

• Forward bending. Avoid activities and exercises that involve bending forward excessively at your waist because they increase the risk of compression fractures of your vertebrae – the small bones in your spinal column.
• Heavy lifting. Avoid heavy lifting, especially when bending forward at the waist. This can include lifting heavy shopping bags, weights, loads of laundry.
• Twisting. Twisting movements can place unusual force on your spine. Golfing and bowling are two common sports that involve twisting and may be harmful. Talk to your doctor or physiotherapist about whether you can safely participate in these sports.
• High-impact activities. Activities that involve higher impact movements, sudden stops and starts, and abrupt weight shifts put too much stress on your spine and can lead to falls and knee injuries. Such activities include running, soccer, squash and basketball.

Sometimes you can’t avoid certain movements, but you can use caution and practice good posture to decrease your risk of injury.

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Osteoporosis Prevention Exercises

The following sample exercises are very practical, as the only prop required is a household kitchen chair. It is best to exercise in a room with plenty of space and natural lighting if possible.

Exercise Tips

• Warm up first with some gentle movement
• Perform each exercise slowly
• Breathe regularly during exercise
• Stay within a range of movement that doesn’t cause you pain
• Gently stretch your muscles at the end of your exercise session
• Allow a days rest between weight-training exercise to allow your muscles to recover
• Talk to your chartered physiotherapist or doctor in advance to ensure your exercise programme is right for you

Sample Resistance Exercises:

1. Calf raises.
Wear ankle weights for this exercise. Rest both hands on the back of your chair for balance. Lift your heels and rise up on the toes of both feet, hold, then slowly lower your heels. As you become stronger, you can rise up on one foot at a time, while you hold your other foot slightly off the ground.

2. Knee flexion.
Wear ankle weights for this exercise. Rest both hands on the back of your chair for balance. Bend one knee and slowly lift this foot backwards, off the ground, while keeping the thigh of this leg still. Try to reach your foot towards the back of your thigh, hold, then slowly lower your foot to the ground. Repeat for the other leg.

3. Hip extensions.
Wear ankle weights for this exercise. Rest both hands on the back of your chair for balance. Bend forward at the hips so that your torso is leaning towards your chair at about 45 degrees. Tighten your tummy muscles and keep your back straight. Slowly lift one leg backwards while keeping your knee straight. Lift as high as you can without losing balance and without bending further forward. Hold, then slowly lower your leg. Repeat for the other leg.

4. Biceps curl.
Wear wrist weights for this exercise. Sit on your chair with good upright posture, your bottom against the back of the seat and your feet flat on the floor. Rest your hands on either side of the seat. Bend the elbow of one arm to raise your hand towards your shoulder. Hold, then slowly lower your hand. Repeat for the other arm.

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