There are three different exercise programs to consider in connection with osteoporosis: (1) Preventive Exercise Program (2) Exercise Program for Early Stage Osteoporosis (3) Exercise Program for Advanced Stage Osteoporosis. It is important to know if you already have the disease as exercises in the preventive program may cause a fracture in weak-brittle bones.

Preventive Exercise Program
A moderate exercise program emphasizing weight-bearing activities and resistive or strength training is recommended. Weight-bearing exercises simply means your bones and muscles are working against gravity. This is any activity in which your feet and legs are bearing your body weight including: walking, jogging, hiking, dancing, low-impact aerobics, stair climbing and racquet sports. Swimming and biking, although great aerobic exercise, are not weight-bearing. Resistive or strength training works your muscles to improve muscle mass and strength. Bones are strengthened in the process. Such exercise includes: hand-held weights, exercise bands/tubes, and variable-resistance machines (i.e. plate or pneumatic-air machines). Be sure to check with your doctor if you have been sedentary most of your adult life before beginning an exercise program.

Exercise Program for Early Stage Osteoporosis
Weight-bearing exercise may be appropriate, if symptoms are minor and must be prescribed as tolerated. Potential for overuse is greater and a combination of weight-bearing and seated activity is best. For example, one may walk for 15 minutes than bike or do seated aerobic exercise for an additional 15 minutes. Resistive exercises should be limited to light hand-held weights or exercise machines on low settings. Both should be well tolerated and not result in any increase of symptoms (such as pain or reduction of function). If symptoms arise, lighter forms of resistance should be implemented.

Avoid exercises or activities that flex the spine (i.e. bending forward at the waist). A recumbent exercise bicycle is better than an upright one to ensure proper posture. If one uses an upright bicycle make sure the hands are placed next to the body and not out front on the handlebars, which may flex the spine. Gentle back extension (arching the back), not hyperextension, chest stretches, and upper back strengthening exercises are desirable. These will help promote flexibility and strengthen the muscles of the back protecting it from fractures. Postural and balance exercises can reduce pain, help restore confidence, and decrease one's risk for falling.

Exercise Program for Advanced Stage Osteoporosis
Weight-bearing exercises should be avoided due to the risk of falling and because body-weight alone can be enough force to lead to a fracture of the spine. Gentle seated aerobic exercise is better (i.e. chair aerobics or non-resistive cycling). Water aerobics/exercises and swimming are ideal since the water reduces risk for falling, promotes flexibility, and provides non-impact resistance exercise. In the most advanced stages, only bed exercises should be attempted. As above, postural education and exercises should be prescribed. A good fall prevention program and gentle exercises to strengthen the upper and lower back are desirable.

by Carol Glasscock, MS,PT