Exercise for Osteoporosis

Warren A. Katz, MD, with Carl Sherman

Series Editor: Nicholas A. DiNubile, MD

THE PHYSICIAN AND SPORTSMEDICINE - VOL 26 - NO. 2 - FEBRUARY 98

For patients who have osteoporosis, exercise is an essential part of treatment. Just as regular workouts build muscle, they also maintain and may even increase bone strength. By strengthening your muscles and bones and improving your balance, exercise can reduce the risk of falls and resulting fractures. Exercise works well with estrogen or other medications that increase bone density and strength. Exercise, medication, and proper diet combat osteoporosis more effectively together than any one treatment alone could do. Remember that you're never too old to exercise.

Here are some tips on how to start a program of weight-bearing exercise and resistance training that will benefit your bones and muscles and also help your general health.

Weight-Bearing Exercise

For most people who have osteoporosis, brisk walking is ideal. It can be done anywhere, requires no special equipment, and carries minimal risk of injury. If walking is too difficult or painful for you, workouts on a stationary exercise cycle are a good alternative.

The full benefits of walking come from a regular schedule—at least 15 to 20 minutes 3 to 4 days per week. But if you haven't been active for years, you may need to start modestly. Start at whatever level is comfortable for you. Five-minute walks are fine at first, but try increasing their length by 1 minute every other time until you reach the optimal exercise level.

Walk briskly enough to become slightly short of breath. A little puffing shows that you're working your body hard enough to improve your fitness. If you have certain lung, heart, or other medical conditions, you should consult your doctor about a safe level of activity.

Resistance Training

Lifting weights or using strength-training machines strengthens bones all over your body, especially if you exercise all of the major muscle groups in your legs, arms, and trunk. Following a program designed by your doctor or a physical therapist is important. Joining a gym or fitness facility is a good way to begin because there you may have access to trainers who can advise you on proper technique.

Strength training is a slow process, so start at a low level and build up gradually over several months. For each exercise, select weights or set the machine so the muscle being trained becomes fatigued after 10 to 15 repetitions. As muscles strengthen, gradually add more weight. But don't increase the weight more than 10% per week, since larger increases can raise your risk of injury. Remember to lift with good form, and don't sacrifice good form to lift more weight.

Tips for Trouble-Free Exercise

Lift and lower weights slowly to maximize muscle strength and minimize the risk of injury.
It's best to perform your resistance workout every third day. This gives your body a chance to recover.
Avoid exercise that puts excessive stress on your bones, such as running or high-impact aerobics. Avoid rowing machines—they require deep forward bending that may lead to a vertebral fracture.
Stiffness the morning after exercise is normal. But if you're in pain most of the following day, your joints are swollen, or you're limping, stop the program until you are again comfortable, and cut your weights and repetitions by 25% to 50%. If bone, joint, or muscle pain is severe, call your doctor.
If a particular area of your body feels sore right after exercise, apply ice for 10 to 15 minutes. Wrap ice in a towel or baggie, or just hold a cold can of soda to the spot.
Vary your routine to make it more interesting. For example, if your strength-building program involves 12 separate exercises, do six in one session and the other six in the next.

Remember: This information is not intended as a substitute for medical treatment. Before starting an exercise program, consult a physician.

Dr Katz is chief of rheumatology at the University of Pennsylvania Health System Presbyterian Medicine Center and the director of Physician Strategic Planning and Development and a professor of medicine at the University of Pennsylvania School of Medicine in Philadelphia. He codirects the Philadephia Osteoporosis Center and the Osteoporosis Center at Main Line Health and Fitness, and is board director of the National Osteoporosis Institute and president of Medical Consultant Services. Mr Sherman is a New York City freelance writer. Dr DiNubile is an orthopedic surgeon in private practice in Havertown, Pennsylvania, specializing in sports medicine and arthroscopy. He is the director of Sports Medicine and Wellness at the Crozer-Keystone Healthplex in Springfield, Pennsylvania; a clinical assistant professor in the department of orthopedic surgery at the University of Pennsylvania in Philadelphia; the orthopedic consultant to the Philadelphia 76ers basketball team and the Pennsylvania Ballet; and a member of the editorial board of The Physician and Sportsmedicine.

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