Joanne Baird, MD
Regular exercise has been part of my life since college. As part of a nationally ranked soccer team at William & Mary, we ran drills every afternoon. And on weekends, I hit the trails around Williamsburg as a great stress release from class. My routine over the last 20 years has grown from roads to reps – with circuit training, yoga, and paddle boarding thanks to life here on the Gulf Coast.
We all know the benefits of exercise, like improving muscle strength and endurance, reducing risk of stroke or heart disease, and preventing unhealthy weight gain. But exercise isn’t just a value-add to life. For women, exercise and bone health are inseparable. Regular physical activity is essential to building and maintaining healthy bones. In fact, we’re losing bone strength every day if we’re inactive. Sedentary isn’t an option.
Our bones are naturally growing weaker over time if we’re not doing something to maintain bone density. Osteoporosis is a condition that leads to fragility and the potential for fracture, most prevalent in women after menopause. This bone-thinning disease creates risk of broken bones, which can seriously limit mobility and independence. We also tend to lose muscle as we age – a conditioned called sarcopenia. Those who develop osteoporosis or sarcopenia are considered frail: more likely to fall and more likely to break a bone.
BONE HEALTH – USE IT OR LOSE IT
Our bones benefit from exercise just as muscles do – it makes them stronger. Young girls and teens should begin exercising and eating well to build strong bones. As we age, we focus on maintaining bone strength. Because a bone is a living tissue, it changes over time in response to the forces placed on it. How does bone density grow? As muscles move over bones when you exercise, they get the signal to produce more bone mass. Consider it a healthy nudge! Bones build and become denser – a benefit that increases as you add good nutrition, including adequate calcium and Vitamin D.
Yet another benefit of exercise is better balance and coordination. As we age, balance helps to prevent falls and the broken bones that may result. Studies find one fracture (not caused by trauma like a car accident or blow) often leads to another. The “fragility cycle” is the downward slide we all want to prevent.
WHAT’S THE BEST EXERCISE FOR STRONG BONES?
Most all exercise offers positive health benefits. Yoga and Pilates lengthen muscles and boost mental health and focus. Swimming, kayaking, hiking, or anything outdoors soaks up healthy Vitamin D while toning muscles, too.
The two types of exercise we recommend most for building strong bones are weight-bearing exercise and strength-training exercise. Improving bone strength is site-specific. For instance, walking boosts bone strength in arms and spine but not the wrist. For stronger hands, wrists and arms, resistance bands are a better option.
Have you ever had a Pilates instructor remind you to “keep your shoulders in your back pockets”? Women tend to slump as we age, yet good posture is essential to the health of our entire musculoskeletal system. Postural stretching and strengthening not only prevents slumping, but the spine fractures some older people may suffer from simply bending over to tie shoes or pick up something off the floor.
Weight-bearing doesn’t mean lifting weights, but any activity you do on your feet that works your bones and muscles against gravity. When your feet and legs carry your body weight, more stress is placed on your bones, making your bones work harder. Pushups and plank position are easy (equipment free!) options with great results.
Examples of weight-bearing exercise include:
- Brisk walking and hiking
- Jumping rope
- Tennis, pickleball, and ping pong
- Team sports, such as basketball, soccer, and volleyball
- Stair climbing
The more weight you place on bones, the greater the bone-strengthening benefits. Jogging and jumping rope would top the list. However, if you’ve been diagnosed with thinning bones or qualify as frail speak to your doctor about what type of physical activity is best for you.
During strength-training activities, resistance is added to movement to make muscles work harder and, over time, become stronger. Even though muscle mass is the primary focus of resistance exercises, the stress on bones results in bone-building capacity.
Common types of strength training include weight machines, free weights, and exercises (such as push-ups) that use your own body weight. Elastic bands are inexpensive, travel easily, and can also be used to add resistance to exercises.
A general guideline for strength training is to exercise each major muscle group at least twice a week. Be sure to rest for a full day between strength sessions.
OTHER FORMS OF EXERCISE
I encourage my patients to add non-impact exercise to the mix not only for strength but balance training benefits. Did you know the top complaint that sends a patient to their doctor is dizziness? Followed quickly by… lack of energy. Menopause again is a primary culprit. A body in motion stays in motion, and a body at rest stays at rest. That old physics lesson applies to our lives today, and the need for healthy movement to fuel the energy to… keep moving! Building flexibility and balance not only feels good, but strengthens muscles, heart, and lungs. If you have a musculoskeletal condition, such as arthritis, that limits your weight-bearing activities, swimming, cycling, and chair exercise are great alternatives.
HOW DO I START A BONE HEALTH EXERCISE PLAN?
Thirty minutes of weight-bearing activity, four or more days a week, is an effective gameplan for bone health. Choose something you enjoy! You won’t stick with it otherwise. Those 30 minutes of exercise can be done in one stretch or broken up into shorter intervals. A 10-minute brisk walk three times a day (if that fits your scheduled) is a smart way to get started. Have a dog? She’ll love it!
If walking outdoors isn’t an option, climbing stairs indoors or even walking in place qualifies, too.
To really reap the benefits of exercise, flexibility and balance training should be in the mix. Just as I’ve added strength training and yoga to my passion for running, you should commit to plenty of time for stretching and balance-building moves to the end of your workout. Not only will you reduce the risk of injury but taking time to stretch thoroughly clears the mind before you hit the rest of your day.
Don’t let your aspirations get ahead of your capabilities. Before choosing any activity, consider your risk of falling. Talk to your doctor or physical therapist before developing an exercise program, especially if you’ve been diagnosed with severe osteoporosis. Spine compression can happen with upright weightlifting, and you should avoid any exercise that bends or twists the back. Stationary bikes and rowing machines are not the best options. Opt for chair and corner wall exercises instead.
AGE AND BONE HEALTH FITNESS
Adolescents and Young Adults
Healthy bones start in the lunchbox. Childhood is the age when bones are building, and it’s critical we fuel our children’s bone density during these years of rapid growth. A diet rich in Vitamin D and C from leafy greens, veggies and dairy is key. The skeleton that lasts our lifetime is essentially developed between the ages of 10 and 18 years old! In fact, our peak bone mass in maximum strength and density is reached in our late 20’s.
Weight-bearing exercise during the teen years is essential to reach maximum bone strength. A teen’s physical activity should include 20 to 30 minutes of weight-bearing exercise at least 3 to 4 days each week.
By our mid-20’s, physical activity alone can no longer increase overall bone mass dramatically. Exercise now is all about preventing or slowing bone loss, maintaining muscle mass to preserve and strengthen surrounding bone, and reducing the risk of falling. Both men and women also need good nutrition, calcium, and Vitamin D to preserve their bone mass.
Women and some men in middle age may require hormonal supplementation (estrogens or androgens) to improve or maintain bone mass as they age. For older people, however, these hormones are generally not recommended. Typically, bone-building medications are better options for those with significantly weakened bones.
Fractures in elderly adults are most common in the wrist, spine, and hip. All can have long-term consequences that may include permanent disability. The statistics are troubling. Six months after a hip fracture, only 15% of those over 50 can cross the room without assistance. And of that same age group, one in four of those who fracture a hip will die within the following year. *
BODY WEIGHT AND BONE HEALTH
When people lose weight, they also lose bone. Low body weight at any age is associated with a greater risk for bone problems and fractures.
Very low body weight has serious red flags for women. While sports and exercise are healthy activities for girls and women of all ages, too much of a good thing can quickly become health-threatening. Is your daughter too focused on being thin? Consumed with exercise? Have a friend who fits this description? Long-term health problems and bone damage could be at risk without intervention.
If young women exercise excessively, they can lose enough weight to cause hormonal changes that stop menstrual periods (amenorrhea). This loss of estrogen — the hormone that is necessary for maintaining bone mass — can cause bone loss at just the age when young women should be adding to their peak strength.
A woman who misses several menstrual periods, sustains a stress fracture in sports, continuously focuses on her weight, or has a distorted body image should see her doctor right away.
Exercise and healthy bones are a winning combination at every age. While bone-building for children and adolescents and bone-preserving for adults, exercise is just one element of a program to prevent bone loss and reduce the risk of fracture. Make sure you understand your individual risk for osteoporosis (Bone Density Scans should start by age 50), know your genetic factors and family history, and feed your body what it needs. A balanced, calcium-rich diet, adequate Vitamin D, and a healthy overall lifestyle (limited alcohol or nicotine) are key ingredients in bone health for a lifetime.