How to exercise safely with osteoporosis

The Royal Osteoporosis Society has issued guidance on the advice nurses should give about physical activity

I worked for many years on the specialist nurse helpline at the Royal Osteoporosis Society (ROS). Two of the questions I was asked most often were: ‘Will exercise help to strengthen my bones?’ and: ‘Is exercise safe now I have osteoporosis?’

I found that people diagnosed with osteoporosis – some with fractures – were giving up exercise and leisure activities, often because of ‘something they had been told’.

The main reason for reducing activity was fear that exercise could cause fractures, especially in the spine.

The ROS recently published an expert consensus statement, backed up by detailed information for patients, which makes specific recommendations on physical activity for healthcare professionals who advise patients with osteoporosis, increased fracture risk or fragility fractures. The statement has three themes:

• Strong: exercise to promote bone strength.
• Steady: exercise to reduce falls risk.
• Straight: moving, lifting safely and developing strong back muscles to help with pain and posture problems after spinal fractures.

It also sets out some important principles. One is that exercise is generally safe and most people with osteoporosis are not going to snap or break if they stay active and exercise – the benefits outweigh the risks.

Another principle is that a positive, encouraging approach is important – professionals should advise on ‘how to do it’, rather than say ‘don’t do’ it.

Impact and muscle strengthening

Advice such as: ‘Do some weight-bearing exercise, but be careful with impact exercise’ and: ‘Don’t bend over too far’ is unhelpful.

The statement recommends two types of exercise to promote bone strength:

• Weight-bearing with impact. This could involve 50 moderate impact exercises, such as low-level jumps, jogging or hopping. For people with spinal fractures or multiple other fragility fractures, it would involve lower impact activities, such as brisk walking. It should be undertaken on most days.
• Muscle strengthening. For maximum benefit build up to progressive resistance exercise, this could involve 8-12 repetitions of lifting the maximum weight that can be lifted. It should be undertaken two to three times per week.

In undertaking these exercises it is important to build up gradually and develop a good technique, especially when using equipment.

Advice on the exercises should be tailored to individual needs, fitness levels and preferences. As a minimum for older people who are frail, advise them to avoid long periods of sitting.

The ROS statement emphasises that balance and muscle-strengthening exercises to reduce falls risk are essential, especially for those with balance problems or who are about to start a brisk walk.

'Hip hinge' position

Most of these exercises, like Pilates, yoga and moving or lifting exercises to care for the back, will not cause spinal fracture in most people.

However, if movements are awkward, especially with sustained or repetitive forward bending which pushes the spine out of its comfort zone, modify by adopting a ‘hip hinge’ position when bending or lifting, and avoiding ‘sit up’-type exercises that can strain the spine.

Building up back muscle strength also helps with pain and posture problems associated with spinal fracture.

Being active and undertaking exercise cannot replace bone-strengthening drug treatments for those who need them. But, if used in combination with such treatments and appropriately, they can at least reduce falls, vertebral fracture pain, risk of fractures and loss of bone strength.    

Further information

Royal Osteoporosis Society (2019) Strong, Steady and Straight. An Expert Consensus Statement on Physical Activity and Exercise for Osteoporosis

Royal Osteoporosis Society – Patient Resources: Exercise and Physical Activity for Osteoporosis and Bone Health

Sarah Leyland is an osteoporosis nurse consultant, Royal Osteoporosis Society