What Kinds of Exercises REALLY Work to Prevent Bone Loss?

Author: Lily Mazzarella
While doing research on bone health during menopause, I came across a fantastic article titled “Exercise for the Prevention of Osteoporosis in Postmenopausal Women: an Evidence-Based Guide to the Optimal Prescription” from 2019 in the Brazilian Journal of Physical Therapy.

Here is a synopsis of the findings:

Effective Exercises for Preventing Osteoporosis 

Osteoporosis is a global health issue, particularly affecting postmenopausal people, leading to increased risk of fractures. While pharmaceuticals targeting bone mineral density (BMD) are commonly used, they do not improve muscle strength, power, and functional capacity—key factors in preventing falls and fractures. Exercise, on the other hand, addresses these factors and is a crucial strategy for preventing osteoporosis and related fractures. Here is a rundown of the types of exercises that are essential for bone building and those that are less effective.

Less Effective Exercises for Bone Building

While walking and water aerobics may not prevent bone loss, they have many other benefits–especially in the realm of brain health–and should not be discounted!

1. Walking and Low-Impact Aerobics:

• Regular walking, cycling, and swimming have little impact on preventing age-related bone loss in postmenopausal women.
• These activities do not impart sufficient load on bones to stimulate significant skeletal adaptation.

2. Water-Based Exercises:

• While beneficial for overall fitness, water-based exercises are less effective compared to land-based exercises for bone health.
• They may help in reducing age-related bone loss but are not as potent in enhancing bone density.

Essential Exercises for Bone Building

1. Progressive Resistance Training (PRT):

• Frequency: At least 2 days per week.
• Intensity: Moderate to high intensity (70–85% of maximum muscle strength).
• Exercises: Squats, lunges, leg presses, and exercises targeting the hip and spine.
• PRT effectively increases or maintains bone mineral density (BMD) by placing a diverse range of loads on bones via muscle action and gravity.

2. High-Velocity Power Training:

• Frequency: Twice weekly.
• High-velocity training involves rapid muscle contractions that induce high strain rates on bones, beneficial for both bone and muscle strength. Examples include jump squats, kettlebell swings, bench press “throws,” and sprinting.
• This type of training is more effective than traditional PRT for improving functional performance and reducing fall risk.  However, the risk of injury is higher with this type of exercise, so it should be undertaken incrementally and under supervision–in a good small group class, for example. 

3. Weight-Bearing Impact Exercises:

• Frequency: 4–7 times per week.
• Intensity: Moderate to high impact activities (>2–4 times body weight).
• Exercises: Jumping, bounding, skipping, hopping, and multidirectional movements.
• These exercises stimulate bone adaptation through high-magnitude, dynamic loading.

4. Multi-Modal Exercise Training (basically, a combination of the prior 3 forms):

• Incorporates a combination of weight-bearing activities, PRT, power training, and balance/mobility exercises.
• Example Program: A 12-month program with 2–3 sessions per week, including various exercise modalities, has shown improvements in BMD, muscle strength, and balance
• 5. Balance and Mobility Training:

• Frequency: At least 2–3 hours per week.
• Exercises: Dynamic balance activities, stepping exercises, and mobility drills.
• Essential for reducing fall risk, these exercises should be progressively challenging and specific to everyday tasks.

While not all exercises are equally effective for bone building, a combination of progressive resistance training, high-velocity power training, weight-bearing impact exercises, and balance/mobility activities is essential for preventing osteoporosis and related fractures in postmenopause. And obviously, not all of these exercises are physically possible or available to everyone.  These exercise programs should be tailored to individual needs and preferences to optimize effectiveness and decrease risk of injury.