Exercises that are good for your bone health | Columnists

One of the many benefits of exercise is that exercise is good for your bones. But are all types of exercise beneficial?

Many factors determine bone health, including (but not limited to) genetics, nutritional status, physical activity (with bone loading), macro- and micronutrient intake, hormonal status, chronic inflammation, and medication use.

It is generally accepted that bone-loading activities (weight-bearing) increase bone formation by activating certain cells in bone called osteocytes, which serve as mechanosensors and sense bone loading. Osteocytes produce a hormone called sclerostin that normally inhibits bone formation. When osteocytes sense bone-loading activities, sclerostin secretion decreases, allowing increased bone formation.

Researchers in Canada have shown greater increases in bone density and strength in students who engage in moderate-to-vigorous physical activity, especially bone-loading exercise, during the school day compared to those who do not.

In women, normal estrogen levels appear to be required by osteocytes to produce these effects after bone-loading activities. This is probably one of several reasons why female athletes lose their periods (an indication of low estrogen levels) and develop low bone density with an increased risk of fractures, even when they are still at a normal weight.

One concern about prescribing activity or bone-loading exercises for people with osteoporosis is that it would increase the risk of fractures from the impact on fragile bones. Safe bone loading levels for fragile bones can be difficult to determine.

Additionally, excessive exercise can impair bone health, causing weight loss or loss of periods in women. Very careful monitoring may be necessary to ensure that energy burned is balanced against nutrition consumed. Therefore, the nature and volume of exercise should ideally be discussed with a health care provider or physical therapist, as well as a nutritionist.

High impact activities such as jumping or repetitive impact activities such as running or jogging or even bending and twisting activities such as toe touching, golf, tennis and bowling may not be recommended for patients with osteoporosis as they increase the risk of fractures.

Even yoga poses should be discussed because some can increase the risk of vertebral compression fractures in the spine.

Strength and resistance training is generally thought to be good for bones. Strength training involves activities that build muscle strength and mass. Resistance training builds muscle strength, mass and endurance by making the muscles work against some form of resistance. Such activities include weight training with free weights or weight machines, using resistance bands, and using your own body to strengthen major muscle groups, such as through push-ups, squats, lunges, and planks.

Some amount of aerobic weight training is also recommended, including walking, low-impact aerobics, elliptical training, and stair climbing. But non-weight-bearing activities, such as swimming and cycling, generally do not improve bone density.

In older people with osteoporosis, agility exercises are especially helpful in reducing the risk of falling. They can be structured to improve eye-hand coordination, eye-foot coordination, static and dynamic balance and reaction time. Agility exercises with resistance training may help improve bone density in older women.

An optimal exercise regimen includes a combination of strength and resistance training, aerobic weight training, and exercises that build flexibility, stability, and balance. You should consult with a physical therapist or trainer experienced in the correct combination of exercises to ensure optimal effects on bones and general health.

In those who are at risk of excessive exercise to the point that they begin to lose weight or lose their periods, and certainly in all women with disordered eating habits, a dietitian should be part of the decision-making team to to ensure the maintenance of energy balance. In this group, especially in very low-weight women with eating disorders, physical activity is often restricted until they reach a healthier weight and ideally after menses resumes in premenopausal women.

Bone density can be assessed at intervals using dual-energy X-ray absorptiometry when there is concern for osteopenia or osteoporosis.

With proper counseling and follow-up, it is likely that any person at risk of bone loss can benefit from an appropriate exercise program.

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