Recently, someone I knew was telling me they had osteopenia. They also had a healthcare professional tell them that exercise could not help. This is particularly frustrating to me because there is a fair amount of evidence that exercise can help in osteoporosis. Naturally, a literature review ensued.

First of all, there are basically research studies for almost all diseases and conditions that show how activity or physical therapy has a benefit. This is the case with osteoporosis. Improvements in balance, strength, fall reduction, and quality of life can be seen.¹ Clearly that alone is beneficial for those with decreased bone mass. However, can exercise also increase bone mineral density?

Looking at many of the review articles on Pubmed, the research points to at least some effect on osteoporosis.^1,2 In many of the reviewed studies, bone mineral density improvements were seen.¹ This includes older  individuals with decreased bone mineral density starting an exercise program. Although most of the research is strongly supportive of exercise as an intervention to address bone, there is not a universal consensus. Absolute gains in bone mineral density are very limited and these modest gains may not occur at the hips.3 Personally, I still feel confident regarding the bone mass benefits despite some of these concerns. As we age, bone mass tends to decrease. Any absolute increase or even a reduction in bone mass loss is a win in the fight against osteoporosis. Some methodological concerns such as loss to follow up are mentioned as well.^2,3 This indicates further high quality research in this area is needed, but I still feel the current research is enough for me to promote exercise as an intervention for bone mineral density.

Now if exercise can improve bone health, how can we  best prescribe it to maximize our results? Going through most of research, the trend is for more intense exercises to net the best bone mass results.^1,2. Individuals who have a history of higher impact activities have better bone mass. This trend carries over to older individuals who embark on exercise programs. Generally speaking higher intensity interventions such as resistance training yield greater results than aerobic training. Loaded activities even as low intensity as walking will outperform decreased loading activities such as cycling or swimming. One review article even promoted the use of explosive power exercise to best target osteoporosis for seniors⁴. Although I did not have access to the actual article (only the abstract was available to me), it follows with the trend of higher intensity training being the most beneficial.

I think this all indicates how exercise has a valuable role in the management of osteoporosis and osteopenia. It also highlights how pushing out patients with a higher intensity activities is something we need to strongly consider to really improve their health status. A risk benefit analysis is still warranted. Having your patient with extreme frailty and vertebral compression fractures doing depth jumps is likely not a great idea, but increasing the intensity of a resistance training program for an osteopenic individuals might be something we need to think more about doing. To me this evidence, indicates another way activity and exercise can be a powerful tool to promote health and wellness.

Hope that helps,

Steve

References:

1. Moreira LD, Oliveira ML, Lirani-Galvão AP, Marin-Mio RV, Santos RN, Lazaretti-Castro M. Physical exercise and osteoporosis: effects of different types of exercises on bone and physical function of postmenopausal women. Arq Bras Endocrinol Metabol. 2014; 58(5):514-22.
2. Howe TE, Shea B, Dawson LJ, Downie F, Murray A, Ross C, Harbour RT, Caldwell LM, Creed G. Exercise for preventing and treating osteoporosis in postmenopausal women. Cochrane Database Syst Rev. 2011; 6(7):CD000333.
3. Martyn-St James M, Carroll S. Progressive high-intensity resistance training and bone mineral density changes among premenopausal women: evidence of discordant site-specific skeletal effects. Sports Med. 2006; 36(8):683-704.
4. Donath L, Faude O, Bopp M, Zahner L. Health-related strength and power training in seniors: Purpose and recommendations. Ther Umsch. 2015; 72(5):335-42.