Osteoporosis and Exercise – Activities, Guidelines, Research, and Insights from Physical Therapist and Polestar Pilates Educator Sherri Betz
Many thanks to guest author Sherri Betz of TheraPilates® Physical Therapy Clinic in Santa Cruz, CA for letting me share this great information for Osteoporosis and exercise on my Centerworks.com/blog. Sherri recently published this article in her newsletter, and then added extra insights once the questions started flooding in!
I encourage you to keep reading below and pass this very important information along to your fellow Pilates teachers and friends to better understand what types of exercise are most beneficial for increasing bone density and avoiding the risk and health challenges of osteoporosis.
Osteoporosis and Osteopenia do not have to be debilitating, and can be reversed! But it takes the right types of exercise and activities to facilitate bone growth. Thanks Sherri for sharing your expertise!
Osteoporosis and Exercise
In response to the plethora of questions from the Osteoporosis Update, let’s put bone building into perspective…. Okay, so the question is: To jump or not to jump?
Jumping and Osteoporosis
Jumping stimulates bone the best in the femoral neck. This means loading the long bones of the femur dynamically with 4-8x body weight. Apparently, jumping rope or jumping on a mini-trampoline is not enough to really stimulate bone significantly to increase density. Dynamic sports such as gymnastics, volleyball, soccer, rugby, football seem to do well in the bone category with athletes.
DO NOT JUMP if you have less than a -3.0 T-score in the spine or hip!
You may do faux jumps or “stomping” (I think of Flamenco Dancing….I was just in Spain and am going to investigate this further!) I also wonder about the popular exercise “Zumba” which might be a great bone stimulus. Bring back the 80’s Step Aerobics Classes…great for balance, lower body strength, coordination and bone!
Bareither ML, et al. Habitual Site-Specific Upper Extremity Loading is Associated with Increased Bone Mineral of the Ultradistal Radius in Young Women. J of Women’s Health, Vol. 17, No. 10, 2008.
Swimming and Osteoporosis
Swimming appears to have a negative effect on bone. It appears that the gravity-eliminated environment of the water, EVEN in competitive swimmers and water polo players depletes bone. Kavouras did a study in 2006 on water polo players where they measured BMD in the legs and arms at the beginning of the season and by the end of the season the players showed a DECREASE in BMD of the legs and an increase in the arms. So exercise in the water (even vigorous water exercise) does not build bone and may be having a detrimental effect on the bones of older adults who love their aqua exercise classes! Talk about taking candy away from a baby!
G.Bravo, et al. A weight-bearing, water-based exercise program for osteopenic women: Its impact on bone, functional fitness, and well-being. Archives of Physical Medicine and Rehabilitation, Vol. 78, Issue 12, Pages 1375-1380, 1997.
Kavouras SA, et al. Water Polo is Associated with an Apparent Redistribution of Bone Mass and Density from the Lower to the Upper Limbs. Eur J Appl Physiol(2006) 97:316-321.
Magkos F, et al. The Bone Response to Non-Weight-Bearing Exercise is Sport, Site and Sex-Specific Clin J Sport Med (2007) 17; (2)123-128.
Running, Biking and Osteoporosis
Cycling is next on the list….competitive cyclists have significantly lower BMD than Runners and Weightlifters as shown in studies by Sowers, Drinkwater and several others.
What about Running? Running may initially have a stimulating effect on bone but to continue running for several years would obey the bone law of diminishing returns. This is possibly demonstrated in one study showed that runners who ran more than 20 miles per week showed a decrease in BMD. Novel stimulus or “surprising the bones” is really good for getting bone turnover but the same exercise after a while is not going to have a significant bone response. We really have to vary our activities.
Pilates Exercise and Osteoporosis
A trend I am seeing while following clients for several years at my Pilates Studio is that the first year they might see an increase and the second year they seem to plateau with consistent Pilates Mat and or Apparatus training.
Everyone has asked, what about jumping on the Pilates Reformer?? Well, the jumping that stimulates bone is 4-8x body weight. The Reformer jumping is actually LESS than body weight and is not against gravity (2 strikes against it for building bone) However, it is a fantastic tool to safely introduce someone to jumping with correct form and alignment so that they can eventually jump or “faux jump” against gravity. Jumping on the Reformer might also help to increase leg strength to help clients tolerate the impact on their hip, knee and ankle joints.
Power Marching or Stomping and Osteoporosis
Someone asked about “power-marching” in place…does this build bone? Actually the folks from Oregon State University are just about to publish a study on “stomping” with good results in increased BMD! Now, the folks who can’t or should not jump can SAFELY stimulate bone! I think this will take the Bone world by storm!
The Best Exercises, Activities, and Sports to Improve Bone Density and Reduce Risk of Osteoporosis
Overall, the best exercises to effect bones appear to be: high-impact aerobic exercise (in small doses), gymnastics, squash, volleyball, rugby, soccer, and weight training.
Todd JA and Robinson RJ. Osteoporosis and Exercise (Review) Postgraduate Medical Journal (2003)320-330.
Points to remember:
• If you have below a -3.0 T-Score in the hip or spine DO NOT Jump!!
• A sedentary individual who begins ANY (safe) exercise program will likely see results.
• Doing the same exercise program or type for years and years will likely not produce good results.
• Swimming and cycling should not be considered bone building exercise.
• Start where you are…if you are in poor condition, DO NOT begin a jumping program, progress slowly, building your lower body and core strength, preparing your joints for higher impact activities.
• Pilates Reformer work is a good preparation for vertical jumping.
• Pilates Wunda Chair work, Trapeze Table Standing Arm Work and Assisted Squats as well Ped-o-Pul exercises are excellent alignment, weight-bearing and control exercises to prepare for progression to more dynamic exercise.
An article just came out in the NY Times on “The Best Exercises for Healthy Bones”. It was interesting to say the least. The writer suggested that hopping was the best exercise to build bone but gave no context or guidelines to incorporate hopping or jumping safely into an exercise program! I decided to pull together the best information from the top researchers in the field of bone and exercise. I like to look at the groups who have been doing this kind of research for a long time. I was at a bone symposium last week and was able to ask Beth Lambright, the Oregon State University exercise teacher of all the main studies during the past 15 years if jumping rope or mini-trampolines build bone. The answer was “No, you need 4-8x body weight impact to stimulate bone. For children this means jumping off a 24″ box and for adults this means jumping off an 8″ step. They progress from 4″ to 6″ to 8” very slowly and prepare the knees and hips with step-ups, heel raises, squats, lunges and faux jumps before jumping off the steps. So what else will give us healthy bones?
1. Walking does not build bone and should not be considered an osteoporosis exercise. (However, walking is great for your heart if you keep up a good pace.)
Palombaro KM. “Effects of walking-only interventions on bone mineral density at various skeletal sites: a metaanalysis.” J Geriatr Phys Ther. 2005;28(3):102-7.
2. Weighted vests with lunges, squats, step ups, side lunges and small jumps 3 x per week builds bone in the hip according to Christine Snow’s bone research lab at Oregon State University.
(Long-term Exercise Using Weighted Vests Prevents Hip Bone Loss in Postmenopausal Women by Christine M. Snow, Janet M. Shaw, Kerri M. Winters, and Kara A. Witzke Journal of Gerontology: 2000, Vol. 55A, No. 9, M489-M491) They are continuing their long-term studies and the latest one should be published next month!
3. Sinaki has the best long-term research on exercise for building bone and fracture prevention in the spine (vertebral bodies).
(Sinaki, M., et al. 1986.”Relationship between bone mineral density of spine and strength of back extensors in healthy postmenopausal women.” Mayo Clinic Proceedings, 61 (2), 116-22.)
(Sinaki, M., et al. 1996. “Can strong back extensors prevent vertebral fractures in women with osteoporosis?” Mayo Clinic Proceedings, 71 (10), 951-56.)
(Sinaki, M, et al. 2002. “Stronger back muscles reduce the incidence of vertebral fractures: A prospective 10 year follow-up of postmenopausal women.” Bone, 30 (6), 836-41.)
(Sinaki, M,“The role of physical activity in bone health: a new hypothesis to reduce risk of vertebral fracture.” Phys Med Rehabil Clin N Am. 2007 Aug;18(3):593- 608)
4. Loren Fishman has some ongoing research on Yoga for osteoporosis and is getting some increases in BMD with his program.
(Yoga for Osteoporosis: A Pilot Study by Loren M. Fishman, MD. Topics in Geriatric Rehabilitation. Vol. 25, No. 3, pp. 244-250: 2009)
Main Points for Exercising Your Bones:
Hip Bone Building
Jumping is best. (If your T- score is below a -3.0 do not jump!) Prepare for jumping by doing forward and side lunges, squats, step ups, heel raises and standing balance exercises.
Consider using a weighted vest up to 10% of your body weight. Mini-trampolines are a good warm-up or for cardiovascular work but they do not build bone.
Spine Bone Building
Prone (face down) Back Extension Exercises are best.
Walking briskly on uneven terrain up and down hills is great for your heart but should not be considered a bone building exercise.
Yoga and Pilates in general are not considered bone building exercises YET! They may be effective programs to increase variety and pleasure with exercise and are a good body awareness fracture prevention and preparation for the bone loading exercises necessary to stimulate bone formation!
Guest Author Bio:
Sherri Betz, PT has been a licensed Physical Therapist since 1991, international presenter, Polestar Principal Educator/Examiner, Gyrotonic®/GyrokinesisTM Instructor, nominated for APTA Geriatric Clinical Specialist Award 2004, author of The Osteoporosis Exercise Book, 2nd Edition, creator of modified Pilates videos for special populations & is pioneering development in Pilates for Osteoporosis and Geriatrics. Sherri is dedicated to increasing awareness about bone health and serves on the Professional Education Committee of the Foundation for Osteoporosis Research and Education (FORE). Sherri owns TheraPilates® Physical Therapy Clinic, in Santa Cruz, CA. She has served as the Vice-President of the Pilates Method Alliance Board of Directors since 2003. Visit Sherri at: http://therapilates.com/
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