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Is exercise good for bone health?


Is exercise good for bone health?
 

We all know exercise is beneficial for our hearts, our lungs, our brains and all other aspects of our health. So it shouldn’t be a surprise to learn that staying physically active is considered essential for keeping our bones healthy too, even if you already have a bone health condition such as osteoporosis. Here’s what the Royal Osteoporosis Society has to say about some of the benefits of exercise (i):
 

  • It helps strengthen your bones and muscles, which means you’re less likely to fracture a bone

  • It boosts your sense of balance so you’re less likely to have a fall

  • It can also help with everyday activities and increase your chances of living independently if you’re older

 
Certain types of exercise are particularly good for your bones, including exercises that increase muscle mass and make your muscles stronger and exercises that improve your balance and co-ordination (these are particularly helpful as you get older as they can reduce your chances of falling and breaking a bone).
 
Activities where your bones and muscles bear the weight of your body, called weight-bearing exercises, can even increase your bone density, making them stronger – especially high-impact activities such as jumping or running (these are sometimes also called weight-bearing exercises with impact). These high-impact exercises involve working against gravity, which increases the weight-bearing effect even further by transmitting extra force or jolts through your skeleton.
 
High-impact weight-bearing exercises, however, may not be suitable if you already have a bone condition such as osteoporosis. They should also be avoided by anyone who has had a joint replacement operation.
 

What does the science say?

 
Numerous studies confirm physical activity may help prevent bone conditions and even treat them too. For example, researchers writing in the medical journal Missouri Medicine claim increasing physical activity at any age positively affects bone health. It also confirms the idea that if you’re active when you’re younger it can increase your bone density throughout your life and reduce your risk of having a fracture when you’re older (ii).
 
Meanwhile a review of 59 trials and observational studies on exercise and bone health concludes that physical activity probably plays a role in the prevention of osteoporosis, with programmes that involve multiple exercises and resistance exercises appearing to be the most effective (iii). Scientists also confirm that inactivity is linked with lower bone density, claiming physical activity is a key component of maintaining bone health in both men and women (iv).
 
Elsewhere experts have investigated what happens to bones when you perform weight-bearing exercise. In a nutshell, they suggest cells called osteocytes can sense when force is applied to bones. When this happens the osteocytes send signals to other bone cells, triggering a process that increases bone turnover and formation (v). Weight training and resistance training work in the same way – muscles and tendons apply extra force to your bones, which stimulates the bone cells to produce more bone tissue.
 
However scientists claim one type of exercise offers the biggest benefit when it comes to bone health – jumping. In their study, the experts discovered jumping just 10 – 20 times a day with 30-second breaks between jumps may improve hip bone mass density in women after just 16 weeks (vi).
 

How to exercise for stronger bones

 
All forms of exercise are good for your general health. Even those that don’t put much or any stress on your bones – swimming, cycling and exercises that you perform while sitting, for example – can be helpful because while they may not improve your bone density directly they can offer other benefits such as improving your flexibility and balance (which can help prevent falls). Non weight-bearing exercises are also good options for people with joint problems such as arthritis.
 
However if you can do weight-bearing exercises, examples include:
 

  • Hiking and brisk walking

  • Running and jogging

  • Dancing

  • Climbing

  • Tennis and badminton

  • Stair climbing

  • Bench stepping

  • Football

  • Basketball and volleyball

  • Heavy gardening

  • Skipping

  • Hopping

  • Weight and resistance training (resistance exercises include push-ups, squats, lunges, dead lifts, bicep curls, tricep presses, chest presses, leg presses and working out with resistance bands)

  • Plyometrics (jump training)

  • Star jumps

  • High-impact aerobics

  • Circuit training

 
You could also try including some jumps in your usual exercise routine. Or if you don’t feel comfortable jumping simply try stamping your feet: stand up straight and stamp one foot on the ground (imagine you’re trying to crush a can with your foot). Do five to 10 stamps on one foot, then repeat on the other foot. If you need a bit of support, hold onto the back of a chair or similar while you do this exercise.
 

How much exercise should you do?


Official UK recommendations for physical activity don’t mention specific exercises for bone building, but they do advise adults aged 19 to 64 to take part in some type of physical activity every day. They also recommend the following:

  • Muscle strengthening activities that work all the major muscle groups at least twice a week

  • 150 minutes of moderate activity a week, spread out evenly over four or five days, or every day. Alternatively you could do 75 minutes of vigorous activity a week (examples include running, sports such as football, rugby, netball and hockey, stair climbing, aerobics, gymnastics, skipping and martial arts). Meanwhile you could also mix moderate and vigorous activity (or even short sessions of very vigorous activity such as lifting heavy weights, circuit training, interval running and spinning classes) to achieve your weekly target

  • Reducing time spent sitting or lying down, including breaking up long periods of not moving with some activity


Adults aged 65 and older should also try to be active every day, even if they can only take part in light activities such as moving around their home, cleaning and dusting, standing up and making their bed. Other recommendations for this age group include:

  • Muscle strengthening activities that work all the major muscle groups as well as exercises that improve balance and flexibility at least twice a week – these will help you feel more confident on your feet so you’re less likely to have a fall

  • 150 minutes of moderate activity a week such as walking, riding a bike, dancing, playing doubles tennis or hiking (or 75 minutes of vigorous activity a week, or a combination of both)

  • Limiting the time spent sitting or lying down, including breaking up long periods of not moving with some activity


If you’re new to exercise or you haven’t been very active lately, start slowly, and build up your fitness levels gradually, whatever your age. Always speak to your GP before starting any new exercise regime if you have a medical condition.
 

Exercising with osteoporosis

 
If you’re living with osteoporosis, it’s important to stay active – but some types of activities may not be suitable, as they can often put too much stress on your bones and increase your risk of breaking one.
 
The types of exercises your doctor may advise you to avoid include high-impact activities such as those mentioned above – though lower impact activities may be suitable if your doctor agrees, such as brisk walking, stair climbing and marching.
 
It’s also a good idea to avoid exercises that involve bending or twisting at the waist (for example sit-ups, touching your toes, golf, tennis and bowling), as these can put too much pressure on your spine and increase your risk of breaking a spinal bone. It also goes without saying that if you have osteoporosis your doctor may advise you to avoid activities that have a high risk of falling – like skating, horse riding or skiing, for instance.
 
It is, however, usually safe to do most muscle strengthening exercises such as working out with weights or resistance bands, or doing standalone moves such as squats, push-ups and lunges. But always check with your doctor first before starting to do any new type of exercise if you have osteoporosis or any other medical condition.
 

Balance and flexibility

 
Having osteoporosis means your risk of breaking a bone is higher than that of someone with normal bone density – this isn’t good news for anyone who’s not as steady on their feet as they used to be, or for those who have a medical condition that can make them more susceptible to slipping or falling.
 
Activities that may help improve your balance include t’ai chi, yoga, Pilates and dancing (though avoid any poses that include twisting or bending of the spine). Alternatively you could try the exercises to improve balance recommended by the Royal Osteoporosis Society – you can see and download the exercises here.
 
These exercises are easy to perform, including sitting in a chair and then standing up:
 

  • Sit up straight on the front of an armless chair.

  • Keeping your heels on the floor, slide your feet back so that your toes are beneath your knees.

  • Lean forward slightly from your hips and, keeping your spine long push up into a standing position (ideally without using your hands).

  • Once you’re standing, sit back down again: feel the chair against the back of your legs, bend your knees and lower down slowly.

 
Repeat this exercise 10 times.
 
When your balance has improved you could challenge yourself further by trying to stand on one leg – try doing this while you’re in the kitchen doing the washing up, for instance, or while brushing your teeth (stand for a while on one leg, then switch). It may be difficult at first, but as you get better at it try to lengthen the amount of time you spend standing on each leg. And if you get really good at standing on one leg, you may want to try it while throwing and catching a ball.
 
However if you find standing on one leg too difficult, try standing with one foot directly in front of the other – the toes should touch the other foot’s heel – and stay there for up to a minute before swapping your legs around.
 
Yoga, t’ai chi and Pilates are also good for improving your flexibility. Alternatively you could try some simple flexibility moves such as:
 
Leg stretch   Start by sitting on the front of a chair, keeping one leg straight out in front and the other bent at the knee (foot flat on the ground). Try slowly bending forward from your hips (not your waist) until you feel a gentle stretch in the back of your thigh (put your hands on your bent knee for balance if you need to). Hold for 10 - 20 seconds, then repeat on the other leg.
 
Leg stretch 2   Stand and hold onto the back of a chair or similar. Bend one knee and raise the foot behind you, and try to hold onto your foot or ankle with the hand on the same side. While keeping your knees together, gently pull the raised foot towards your bottom with your hand until you feel a bit of a stretch at the front of your thigh. Hold for 10 - 20 seconds, then repeat on the other leg.
 
Shoulder stretch   Stand facing a wall and get as close to the wall as you can. Put both hands on the wall and slide them upwards until you feel a gentle stretch in your shoulders. Hold for five to 10 seconds, then repeat a couple more times.
 

Nutrition for healthy bones

 
Exercise is just one aspect of keeping your bones healthy – you need to feed your bones the right nutrients too. These include some you may already know about such as calcium and vitamin D, but other nutrients are also important including vitamin K, vitamin C, zinc, magnesium and protein.
 
Calcium   Most of us realise we need calcium for healthy bones (in fact, its the calcium in your bones that give them their strength). However many of us may not be getting enough of it in our diets. You need at least 700mg of calcium a day if youre an adult, which for some people may not be that easy to achieve through food alone (good sources of calcium include milk and other dairy foods, foods fortified with calcium, fish that includes edible bones and some green leafy vegetables such as kale). Thankfully calcium supplements are widely available, including single supplements, multivitamin and mineral formulas and multi-nutrient products designed for bone health.
 
Vitamin D   This is also important because it helps your body to absorb calcium from your food or supplements, with studies confirming taking vitamin D with calcium can help prevent bone loss (vii).
 
The problem, however, is that many people living in the UK and other northern hemisphere countries are at risk of vitamin D deficiencies during certain times of the year, since skin exposure to sunlight is our main source. This is why the Department of Health and Social Care advises everyone in the UK to consider taking a daily supplement containing 10 micrograms of vitamin D during the autumn and winter months (those who are at high risk of not getting enough vitamin D during the spring and summer are advised to take a supplement all year round) (viii).
 
The recommended form of vitamin D is vitamin D3 or cholecalciferol, as its the natural form of vitamin D the body makes when its exposed to sunlight. Vitamin D3 supplements are available in tablet form, plus you can now get them in veggie-friendly drops too. Most vitamin D3 supplements, however, are made from the fat of lambs wool, which means theyre unsuitable for vegans. The good news is vegan vitamin D3 supplements sourced from lichen are becoming more widely available.
 
Vitamin K   This is another important bone health nutrient as its needed for making important bone proteins. Vitamin K works alongside calcium and vitamin D to keep your bones strong: while vitamin D helps your body absorb calcium, vitamin K helps that calcium to get into your bones and teeth instead of into soft tissues where it can cause problems. Indeed, studies have linked poor bone health with low vitamin K levels (ix), while others have found the amount of vitamin K in peoples diet and their bone mineral density are related (x).
 
Another study that has analysed some of the data from the large-scale NursesHealth Study suggests women who consume at least 110 micrograms of vitamin K each day are 30 per cent less likely to break their hip than those who eat less (xi). The researchers claim low intakes of vitamin K may increase the risk of hip fracture in women. Meanwhile scientists analysing information from the Framingham Heart Study have also found a link between vitamin K intake and the risk of hip fracture, not just in women but in men too (xii).
 
Vitamin K is found in plant foods such as leafy greens as well as in animal-sourced foods and fermented foods. Find out more about vitamin K and the foods that contain it in Bone health: the importance of vitamin K. You can also get vitamin K in supplement form singly or as part of a good multivitamin and mineral supplement or a multi-nutrient bone health supplement.
 
Magnesium   Another important bone health mineral, magnesium helps keep bones hard and rigid. Indeed, 70 per cent of the bodys magnesium is stored in the bones and teeth. Magnesium also helps convert vitamin D into the form that boosts calcium absorption in the body. Many people, however, may not be getting enough magnesium in their diet (sources include nuts, seeds, green leafy veg, whole grains, beans and lentils).
 
If youre looking for a magnesium supplement, try to choose a form thats absorbed more readily than others, such as magnesium citrate.
 
Zinc   Researchers believe the mineral zinc plays an essential role in bone metabolism and mineralisation (xiii). Indeed, some scientists claim zinc is an essential mineral required for normal skeletal growth, and that it may also be able to promote bone regeneration (xiv). Like magnesium, the citrate form of zinc is thought to be better absorbed by the body than other forms. You can also try getting more zinc-rich foods in your diet such as dairy foods, shellfish, meat, bread and wheatgerm.
 
Vitamin C   Vitamin C contributes to the normal formation of collagen, a protein that makes up a large part of our bones. Some researchers have discovered vitamin C has other functions that may help keep bones strong too, suggesting the ways in which vitamin C affect how our genes work are central to bone formation, and that it may help prevent common bone-degenerating conditions (xv). Vitamin C is found in a wide variety of fruit and vegetables, but a good-quality supplement can help make sure youre getting your fair share.
 
Protein   Experts at the International Osteoporosis Foundation claim adequate dietary protein is essential for optimal bone mass gain during growth and also for preserving bone and muscle mass with ageing (xvi). In older people, for instance, bone mineral density appears to be positively linked with protein intake, with those who eat less protein having a higher risk of falling.
 
Foods high in protein include animal foods such as meat, dairy foods, eggs and fish. Meanwhile vegetable sources include soya products, nuts, seeds, grains, beans and lentils. You can also boost your protein intake by drinking protein shakes or adding protein powders to your meals – these can be convenient for those who struggle to get enough protein through food alone.
 
Find out more about protein’s role in keeping bones strong by reading our article Bone health: the importance of protein
 

Need more information?

 
There’s lots more information on bone health in the bone health section of our pharmacy health library, including a guide to the most common health condition, osteoporosis.
 

References:

  1. About Exercise. Available online: https://strwebstgmedia.blob.core.windows.net

  2. . Physical Activity and Bone Health. Mo Med 2014 Jan-Feb; 111(1):59-64. Available online: https://www.ncbi.nlm.nih.gov

  3. . Evidence on physical activity and osteoporosis prevention for people aged 65+ years: a systematic review to inform the WHO guidelines on physical activity and sedentary behaviour. Int J Behav Nutr Phys Act 2020 Nov 26;17(1):150. Available online: https://ijbnpa.biomedcentral.com

  4. . Correlation between sedentary activity, physical activity and bone mineral density and fat in America: National Health and Nutrition Examination Survey, 2011–2018. Scientific Reports 13, 10054 (2023) Available online: https://www.nature.com

  5. . Regulation of bone health through physical exercise: Mechanisms and types. Front Endocrinol (Lausanne) 2022; 13:1029475. Available online: https://www.frontiersin.org

  6. . Effect of two jumping programs on hip bone mineral density in premenopausal women: a randomized controllled trial. Am J Health Promot 2015; 29(3):158-64. Available online: https://journals.sagepub.com

  7. . Calcium plus vitamin D supplementation and risk of fractures: an updated meta-analysis from the National Osteoporosis Foundation. Osteoporos Int. 2016 Jan;27(1):367-76. Available online: https://www.ncbi.nlm.nih.gov

  8. Vitamin D. Available online: https://www.nhs.uk

  9. . Vitamin K, circulating cytokines, and bone mineral density in older men and women. Am J Clin Nutr. 2008;88(2):356–63. Available online: https://www.ncbi.nlm.nih.gov

    . Associations between vitamin K biochemical measures and bone mineral density in men and women. J Clin Endocrinol Metab. 2004;89(10):4904–9. Available online: https://academic.oup.com
  10. . Dietary vitamin K intake is associated with bone quantitative ultrasound measurements but not with bone peripheral biochemical markers in elderly men and women. Bone. 2011;48(6):1313–8. Available online: https://www.sciencedirect.com

  11. . Vitamin K intake and hip fractures in women: a prospective study. Am J Clin Nutr. 1999;69:74–9. Available online: https://academic.oup.com

  12. . Dietary vitamin K intakes are associated with hip fracture but not with bone mineral density in elderly men and women. Am J Clin Nutr. 2000;71:1201–8. Available online: https://academic.oup.com

  13. . Zinc supplements and bone health: The role of the RANKL-RANK axis as a therapeutic target. J Trace Elem Med Biol

 

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Disclaimer: The information presented by Nature's Best is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications.

 
 
Our Author - Christine Morgan

Christine

Christine Morgan has been a freelance health and wellbeing journalist for almost 20 years, having written for numerous publications including the Daily Mirror, S Magazine, Top Sante, Healthy, Woman & Home, Zest, Allergy, Healthy Times and Pregnancy & Birth; she has also edited several titles such as Women’ Health, Shine’s Real Health & Beauty and All About Health.

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