I sat there in my 200-hour yoga training unable to keep quiet as the instructor told the group how one of the benefits of yoga was improved bone density.
“Wait just a minute,” I piped up and proceeded to describe why this was wrong. I’d been lecturing on osteoporosis as a medical exercise specialist for more than a decade. At this point, there wasn’t much conclusive evidence of the positive effects of yoga on bone density.
But it turns out my yoga instructor was right, or she was predicting a study that would be published years later. A 10-year study of the effects of practicing 12 yoga poses for 30 seconds each found that daily yoga reverses bone loss in the femur (thigh) and spine.1
About these results, lead researcher Dr Loren Fishman said, “We don’t yet know if certain poses led to the bone density improvements or it was all of them combined. We’re currently testing that.”
One advantage of the 12 poses is they can be performed without transitional movement. This reduces the risks of bending and twisting often required during “flow yoga” sessions. Dr Fishman added that even performing one or two of these poses is likely beneficial.
But what else can you do you boost bone health? Here’s an up-to-date look at the exercise and lifestyle changes that work.
Low-impact exercise continuum (low to high)
High-impact exercise continuum (low to high)
Weight resistance exercises
The two main categories of exercise for bone health are weight bearing and weight resistance. In each category is a continuum of intensity and a risk-reward ratio.
Weight-bearing exercises These exercises include any activity that requires movement against gravity to remain upright. That includes a wide variety of exercises in a continuum from low to higher impact with greater ground forces. Even yoga, though minimal in ground forces, involves obvious resistance against forces of gravity from a variety of angles.
Though yoga and Pilates can also increase muscle strength or endurance, they fail to reach the optimal load volume for improvement compared to other physical activity options.
Similarly, some of the exercises included here don’t improve bone density. They may simply support muscle and bone health, which prevents further losses. For instance, walking alone does not improve bone density. It doesn’t have the important ground reactive force, otherwise known as minimum effective stress (MES).2
Weight-resistance exercises Intensity of weight resistance exercise comes directly from the load.3 A light weight lifted 20 times does not have an equal bone-stimulating load of a heavy weight lifted 10 times. Though the muscle can benefit from reaching temporary fatigue with a variety of loads, the bone does not respond the same way.
For prevention of bone loss and reversal of existing osteoporosis, high-impact and high-intensity exercises, when safe, are more beneficial.
Experts have traditionally recommended that those with a known high risk of fracture do lower-impact and lower-intensity exercise. Until very recently, few studies of postmenopausal women (those most susceptible to bone loss) with osteoporosis have explored high-impact and high-intensity resistance training.
The findings of several trials are that high-intensity exercise is safe and does more good than harm.4 Still, make sure to discuss your status with a medical exercise specialist who is experienced in safe exercise for bone health and can provide technique and progression strategies appropriate for you.
Since 1993, when the World Health Organization (WHO) first recognized osteoporosis, exercise guidelines and the science surrounding the populations believed to be most at risk have changed.
A diagnosis of osteoporosis alone no longer means you can’t participate in high-intensity or high-impact exercise. In fact, high-intensity, high-impact exercise may be exactly what you need to reverse bone loss and improve your strength to avoid falls.
However, each individual has to be considered uniquely. If high-impact or even high-intensity resistance training has to be eliminated due to bone status or other conditions, other activities can more safely provide resistance.
For instance, you can try aquatic exercises. Exercises in water that produce strong muscular effort can be effective for those unable to do more. You might also try whole-body vibration. Mechanical vibrations from a whole-body vibration plate provide an alternative to movement-based exercise.
In the majority of studies, the first conducted on astronauts who lost significant bone density while in space for 12 weeks, the exercise is merely maintaining a static position on the plate. The vibration stimulates production of hormones related to bone and muscle growth.5 The vibration is a method of supporting bone density rather than a substitute for other physical activity, lifestyle or treatment methods.
There are many causes and risk factors for bone loss, including certain medications, alcohol consumption and genetics, but lifestyle factors play the biggest role. The earlier bone loss prevention begins, the better.
Optimal bone health requires a comprehensive plan of exercise, diet and lifestyle choices that affect gut and overall health. The evidence is clear that even after menopause, women can still reverse bone loss and increase bone density with the proper interventions.
One key factor to consider is the absorption of nutrients from the diet. A diet rich in calcium and vitamin D is considered a healthy diet for bone, but you may not be benefiting from it. It’s not just what you’re consuming, it’s what you’re absorbing. Taking care of the gut microbiome has been shown to improve bone health by improving absorption of calcium and vitamin D as well as reducing inflammation that leads to bone loss.1
Consider addressing any signs and symptoms of gut disturbances. You don’t have to have a diagnosis like celiac, Crohn’s or IBS. If you suffer from constipation, diarrhea, gas or bloating, these too are reasons to improve your gut health.
A young male US marine diagnosed with osteoporosis recently revealed in an interview that his undetected celiac disease played a significant part in his bone loss because he couldn’t absorb the bone-related micronutrients he was consuming. Similarly, changes in a woman’s gut biome related to hormonal changes that show up as bloating, gas, constipation or diarrhea can hint at malabsorption issues.
Up to 73 percent of women experience gastric issues, including diarrhea and abdominal pain, during their menstrual cycles.2 If you’ve been passing that off as “normal for you” for years, your bones may have suffered.
Improving the gut with probiotics and lifestyle and dietary changes can help boost absorption of nutrients that are key to bone strength. Reducing stress and prioritizing sleep always top the list when it comes to gut health. Dietary changes include increasing dietary fiber and resistant starches and upping the diversity in your daily food choices.
There are currently no contraindicated exercises for osteoporosis, but it should be addressed on an individual basis. A prior client, who had downhill skied for decades, planned to retire to a mountain home and ski daily. Her osteoporosis diagnosis, at a time when women with osteoporosis were treated as if they needed to be bubble-wrapped, felt like the rug had been pulled out from under her.
Yet, the advice was that the risk involved in skiing was not great enough to be a reason not to do it. Would it have been a great time for someone newly diagnosed to take up downhill skiing? Potentially not. It is a higher-risk activity.
The point is, no single exercise is “bad” for everyone. What’s clear is that certain exercises are more beneficial than others. The goal for each individual is to assess the risk-reward benefit of an exercise in light of their current bone health status and to monitor it together with healthcare experts.
Following these guidelines will provide a decision-making basis for selecting the best exercise for bone health.
Debra Atkinson, MS, CSCS, is CEO of Flipping 50 and creator of the Flipping50 Menopause Fitness Specialist course for trainers and health coaches. She is a medical exercise specialist with nearly four decades of experience. Her career has included teaching kinesiology at Iowa State University, giving international presentations to fitness professionals for major fitness associations, and serving as a subject matter expert for the American Council on Exercise.
She’s a sought-after speaker for reframing aging and teaching how to do it, and her TEDx talk is “Everything Women in Menopause Learned about Exercise May Be a Lie.” She’s also the host of What, When and Why to Exercise for 40+ Women, an online event scheduled for May 2023.
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Top Geriatr Rehabil, 2016; 32(2): 81–87 |
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Prz Menopauzalny, 2015; 14(1): 41–47 |
The hidden bone density leak
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Curr Opin Endocr Metab Res, 2021; 20: 100285; Aging Dis, 2020; 11(2): 438–47 |
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BMC Women’s Health, 204; doi: 10.1186/1472-6874-14-14 |
