Why does weight bearing exercise help osteoporosis

Several critical issues in the evaluation of evidence, limiting in some way the conclusion of this review, were highlighted in the Cochrane reviews [ 3 , 15 ]. Regarding the methods , among the several exercises proposed in the literature there were relevant differences in the type and in the setting where the exercises were carried out, the intensity, the duration, frequency of the sessions, and the total duration of the program.

Furthermore, the sample size, patients' compliance or adherence to the study, the presence of a control group, the number of postmenopausal years, and the follow-ups reported in the studies were very diverse. With regard to the criteria used to evaluate and measure the effectiveness of the exercises, the studies generally referred to the measurement of BMD detected at the femur the whole hip, neck, trochanteric and intertrochanteric region, and the Ward's triangle , lumbar spine, distal radius, forearm, tibia, ankle, and total body.

In addition to BMD, other studies had also considered aspects such as bone quality, fracture risk reduction, BMC, cortical bone density, body mass, and muscle strength.

This discovery highlights the limits of bone densitometry DXA in providing accurate BMD measurements or its ability to provide relevant information about the main determinants of bone strength, such as size, shape, and bone structure. Minor changes in bone mass distribution, cortical and trabecular structure, and bone geometry can lead to large increases in bone strength dependent on changes in BMD [ 15 ]. The most advanced studies now are focusing on the use of some noninvasive bone imaging techniques, such as quantitative peripheral computed tomography pQCT , magnetic resonance imaging MRI , and DXA-based hip structural analysis HSA [ 16 , 41 ].

Of these, once eliminated duplicates and papers not primarily focused on exercise and osteoporosis, 18 systematic reviews and meta-analyses were considered with respect to different type of exercise Table 1 and 7 with respect to whole body vibration Table 2.

One of the most common forms of aerobic training is walking, an exercise very well accepted by the older people, because it is harmless, self-managed, and easily practicable. The effects of walking on BMD have been widely considered, although the results are not always consistent in the various studies [ 17 — 19 , 42 ].

The meta-analyses showed the absence of significant effects on the lumbar spine or on the femoral neck attempted by the only walking [ 6 , 43 ]. Likewise, from the studies analysed by Gomez Cabello et al. However, the effectiveness of walking in maintaining the level of BMD and in preventing its loss is already an excellent result of this simple type of exercise. Actually, there is evidence that an intervention of more than 6 months in duration can provide significant and positive effects on femoral neck BMD in peri- and postmenopausal women [ 18 ].

Some studies show how a brisk walking or jogging can have positive effects on hip and column BMD in women of menopausal age [ 19 ]. Certainly, some low-impact activities, such as jogging combined with stair climbing and walking, favor minor loss of BMD in both the hip and the spine in menopausal women. In comparing different types of physical exercises with controls, Howe [ 15 ] found a significant effect in BMD for bipodalic or monopodalic static exercises and on spine and wrist for dynamic low-impact exercises including walking and Tai Chi.

Regarding Tai Chi, the issue is in increasing debate; recent literature [ 21 , 22 , 44 — 46 ] suggests a positive effect on attenuating BMD loss at the lumbar spine and the proximal femoral neck and on biomarkers of bone metabolism. However, in order to be effective, this activity has to last 12 months as minimum [ 21 ]. Walking, as an isolated intervention, is not able to modify the loss of BMD. However, in the context of a health maintenance program in general it is advisable to walk for at least 30 minutes a day.

Aerobic training and in particular the path with high intensity and speed, interspersed with jogging, climbing scales, and stepping, is able to limit the reduction of BMD. Strength and resistance training are the most studied techniques to increase bone mass in the elderly. The rationale of these exercises lies in the mechanical stimulus indirectly produced on the bone [ 8 , 9 , 41 ]. Like weight-bearing exercises, the strength exercise determines a joint reaction force and muscle strengthening, producing an important clinical benefit on the BMD, in the lumbar spine and, to a greater extent, in the femoral neck [ 20 ].

Studies have examined the effect of strengthening the muscles of the upper limb and lower limb, rather than specific groups such as iliopsoas and spinal extensors.

From the evidence gathered by Zehnacker et al. In relation to the hip, the exercise is effective on the greater trochanter if it involves the buttocks, on the lesser trochanter if it involves the iliopsoas, and on the Ward's triangle if it involves the adductors and the hip extensors, according to the studies of Kerr et al.

Here, the authors concluded that there are several possible explanations for the different effectiveness of site-specific exercises: various muscle insertions, different weight or type of contraction, and duration and nature of the exercise.

Similarly, Sinaki et al. After two years of exercise, there was a significant reduction in the loss of BMD in the subjects being treated. This significant difference, compared to controls, was maintained eight years after, despite the decrement of both BMD and muscle strength.

In opposite opinion are Bemben et al. In particular, there was no difference between men and women at the femur level, while in women the effect is greater at the spine. The peak load exerted seems to be therefore more important than the number of repetitions on the increase in bone mass in menopausal women [ 1 ].

Other considerations that must be taken into account [ 9 ] are that women require a greater intensity of exercise to obtain certain results on bone mass. Hence, it is always important to perform a balanced agonists and antagonists training taking into account that the speed of execution during the movements is pertinent in obtaining greater osteogenic stimulation. The effectiveness of progressive resistance training is confirmed also in the review of Cheung and Giangregorio [ 41 ] who considered this exercise the best one in postmenopausal women to improve both spine and hip BMD.

This would not be the case of older adults, in which physical activity and exercise only have minimal effects on BMD, while strength training should be suggested. However, in clinical practice, in osteoporotic individuals with high risk of vertebral fracture, the use of resistance machines should be well thought out, since this technique often requires forward bending and twisting of the trunk to perform the exercise or to adjust the equipment and to ensure the proper setting.

They can be utilized only if is used and adjusted with the proper form [ 51 ]. Strength training determines an increase in specific site bone density, in particular at the neck of the femur and at the lumbar spine, which is maintained in the short to medium term.

At least 3 sessions a week for a year are recommended. Progressive resistance training for the lower limbs is the most effective type of exercise intervention on bone mineral density BMD for the neck of femur.

The multicomponent training consists of a combination of different exercises aerobics, strengthening, progressive resistance, balancing, and dancing and it is aimed at increasing or preserving bone mass. This implies that the same interventions are provided to all people, differently from multifactorial training, customized on the individual characteristics [ 52 ].

The association of several types of exercise is advised to the patients affected by osteoporosis with the goal to counter the reduction of bone mass [ 23 — 26 , 43 , 53 — 56 ]. The combination of multiple types of exercise would have a significant effect on BMD at three sites: femoral neck and greater trochanter, but the maximum benefit would be achieved at the spine level [ 15 ]. However, diverse methodological and reporting discrepancies with respect to the proposed mix of exercises, the characteristics of patients with or without fractures, and the outcome measures seem relevant in determining the result of the exercise program.

The revision of Gomez-Cabello et al. The meta-analysis conducted by Nikander et al. It is interesting to note from this review how the most challenging high impact exercise programs, such as jumping, are only effective when they are associated with other low-impact exercises. Bolan at al. Giangregorio et al. In particular, it is stated that such individuals should not engage in aerobic training to the exclusion of resistance or balance training.

Xu et al. They suggest that each session should be between 30 and 60 min, 3 or more times per week for at least 10 months. Also, in the review of studies analyzed by Marquez et al. Combined exercise and group exercise programs, including weight-bearing activities, balance training, jogging, low-impact loading, high magnitude exercise, muscle strength, and simulated functional tasks, are advised to determine BMD increasing or at least to preserve it.

However the combination of exercise should be tailored on the patient's clinical features. No agreement exists on the best protocol in terms of duration, frequency, and the type of exercises to be combined. The most relevant effect was detected at the spine. The vibration of the entire body is a physiotherapy intervention based on the use of a high frequency mechanical stimulus generated by a vibrating platform Whole Body Vibration or WBV that activates the mechanoreceptors of the bone favoring osteogenesis.

The results of the studies included in two systematic reviews [ 1 , 61 ] conclude that the treatment with a WBV seems to be more effective than simple walking and of similar efficacy to strength training to improve bone mass at specific sites femoral neck and spine in postmenopausal women.

To obtain these results, Dionello et al. The positive effect of WBV in improving BMD in different sites is supported also by other reviews [ 29 — 31 ] and confirmed by Oliveira et al. Fratini et al. Thus, it is better if the subject during the treatment assumes static postures, such as full-standing or hack squat. However, many factors e. Conversely, a previous systematic review [ 34 ] showed that while the use of vibration platforms can improve muscle strength in the lower limbs of elderly patients, it does not seem to induce significant changes in bone mineral density in women.

Similarly, while the analysis performed by Cheung and Giangregorio [ 41 ] on 5 systematic reviews shows only a modest clinical improvement of BMD at the hip in postmenopausal women, the review of Jepsen et al. Training with vibrating platforms is reported to have effect on enhancing muscle strength, improving balance, and reducing the risk of fall in osteoporotic patients, while controversial findings on improvement of BMD in different sites were reported.

Although several exercise recommendations for individuals with osteoporosis have been proposed, reviews are often inconclusive, for the methodological variability emerging from the studies. However, results from the Cochrane review [ 15 ] suggest a relatively small, statistically significant, but possibly important effect of exercise on bone density in postmenopausal women compared with control groups.

The exercise types most effective on BMD for the neck of femur, which should be considered in clinical practice, appear to be the progressive resistance strength training for the lower limbs. The most effective intervention for BMD at the spine has been suggested to be the multicomponent training exercise programme. Weight-bearing aerobic exercise and training with vibrating platforms may have also an impact in improving BMD.

These evidences are relevant not only because they support the possibility to increase BMD in postmenopausal women, but also because they confirm the possibility to prevent further bone loss in osteoporotic patients, thus limiting the risk of fractures.

Key considerations for future research lines emerge from this review: 1 the need for studies to evaluate the effects of the longer-term exercise; 2 the need for studies on male patients; 3 the need for studies that use evaluation criteria of the outcome that are more sensitive to changes in the bone structure; 4 inclusion of parameters such as diet or drugs as a covariate in the analysis of the effects of the exercise; 5 the need to stratify studies on the effects of exercise on BMD based on age; and 6 the need to understand the effects of deconditioning.

National Center for Biotechnology Information , U. Journal List Biomed Res Int v. Biomed Res Int. Published online Dec Author information Article notes Copyright and License information Disclaimer. Corresponding author. Maria Grazia Benedetti: ti. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

This article has been cited by other articles in PMC. Abstract Physical exercise is considered an effective means to stimulate bone osteogenesis in osteoporotic patients. Remember, exercise is only one part of an osteoporosis prevention or treatment program.

Like a diet rich in calcium and vitamin D, exercise helps strengthen bones at any age. But proper exercise and diet may not be enough to stop bone loss caused by medical conditions, menopause, or lifestyle choices such as tobacco use and excessive alcohol consumption. It is important to speak with your doctor about your bone health. Discuss whether you might be a candidate for a bone mineral density test. If you are diagnosed with low bone mass, ask what medications might help keep your bones strong.

Would you like to order publications on bone disorders to be mailed to you? Visit our online order form. Exercise for Your Bone Health. Why exercise? Wear wrist weights for this exercise if you can comfortably support the weight. Sit on your chair with good upright posture, your bottom against the back of the seat and your feet flat on the floor. Hold, then slowly lower your hands to your sides by retracing the same large circle. Raise both arms either side of your head, with elbows slightly bent.

Bend one elbow so that your wrist moves down behind your head to the base of your neck avoid bending your head forwards. Hold, then slowly raise your wrist to be level with your opposite wrist. Repeat for the other arm. 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. Author: myDr. Osteoporosis Australia. Updated April Therapeutic Guidelines.

Osteoporosis and minimal-trauma fracture. Amended Dec Therapeutic Guidelines eTG March edition. Effects of Resistance Exercise on Bone Health. Endocrinol Metab Seoul. BMJ Best Practice. Skip to content. What is osteoporosis? How can exercise help? Previous article Nuts that reduce high blood pressure. Next article Getting back to fresh fruit. We use cookies on our website to give you the most relevant experience by remembering your preferences and repeat visits.

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By Mayo Clinic Staff. For most people, one set of 12 to 15 repetitions is adequate. When doing the bent-over row, do not allow your shoulder to roll forward. Thank you for Subscribing Our Housecall e-newsletter will keep you up-to-date on the latest health information.

Please try again. Something went wrong on our side, please try again. Show references Bone health: Exercise is a key component. The North American Menopause Society. Accessed Feb. Rosen HN, et al. Overview of the management of osteoporosis in postmenopausal women. Ask Mayo Expert. Osteoporosis: Exercise.

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