Which exercises are safe with osteoporosis?

Why exercise with osteoporosis?

Osteoporosis makes bones thinner and more likely to break, often after a minor fall. Many people worry that exercise could cause a fracture and become less active, but inactivity weakens bones and muscles further and increases the risk of falls.

A UK consensus statement on physical activity and exercise for osteoporosis concluded that there is little evidence that physical activity causes significant harm and that, in general, the benefits outweigh the risks 1.

What kinds of exercise strengthen bone?

Bones respond to loads that are greater or different from everyday activity. The consensus recommends resistance exercise, such as lifting weights or using resistance bands, and impact exercise, such as brisk walking, stair climbing, heel drops or jogging where appropriate, to maximise bone strength 1.

Resistance exercise should work the major muscle groups and progress gradually in load. The Royal Osteoporosis Society provides practical guidance on building up strengthening and impact exercise safely 3.

How does exercise reduce fractures from falls?

Most fractures in people with osteoporosis follow a fall. A Cochrane review of 108 randomised trials with 23,407 older people living in the community found that exercise reduced the rate of falls by 23 per cent, based on high-certainty evidence, and may reduce the number of people with fall-related fractures 2.

Balance and functional exercises, such as standing on one leg, heel-to-toe walking and sit-to-stand, together with strength training and activities such as tai chi, help people stay steady on their feet.

Which movements need care?

The consensus recommends avoiding postures that involve a high degree of forward bending of the spine during exercise and daily life, such as repeated sit-ups, toe touches or lifting heavy objects with a rounded back 1. Bending at the hips and knees while keeping the back straight is safer.

People who have had a spinal fracture or multiple low-trauma fractures should usually limit impact to the equivalent of brisk walking, and those at risk of falls should start with targeted strength and balance training before higher-impact activities 1.

Can exercise help posture and spinal fractures?

Spinal extension exercises, which strengthen the back muscles, can improve posture and may reduce the risk of falls and spinal fractures 1. Examples include lying on the front and lifting the head and shoulders slightly, or sitting tall and squeezing the shoulder blades together.

For people with pain from a spinal fracture, exercise can reduce pain and improve mobility and quality of life, ideally with specialist advice to support a return to normal activities 1.

How much exercise is recommended?

Many people aim for strength training on two or three days a week, balance activities on most days and regular weight-bearing activity such as walking 1. Starting at a comfortable level and building up gradually improves confidence and reduces soreness.

Physiotherapists and trained exercise professionals can adapt programmes for people with fractures, pain, other health conditions or low confidence.

How can daily movements be made safer for the spine?

Bending from the hips and knees rather than rounding the back when picking things up, keeping loads close to the body and avoiding twisting while lifting reduce strain on the spine. Getting in and out of bed by rolling to the side first is also helpful.

Household tasks such as vacuuming, gardening and carrying shopping can be adapted by using long-handled tools, splitting loads and taking breaks. A physiotherapist can teach safe movement strategies for daily life.

When should I seek advice before exercising?

Seek medical advice before starting if you have had a recent fracture, have sudden severe back pain, chest pain or dizziness with exertion, or a condition that affects balance.

New, severe back pain after a minor strain or fall may indicate a spinal fracture and should be assessed.

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