Osteoporosis Exercise: Why Walking Alone Isn’t Enough for Your Bones

If you’ve been diagnosed with osteoporosis or osteopenia, there’s a pretty good chance someone has told you to keep active and do plenty of walking. And to be clear, walking is great. It’s accessible, it’s good for cardiovascular health, it keeps you moving and there are plenty of reasons I want people to continue doing it. But if we’re talking specifically about improving or maintaining bone strength, walking alone generally isn’t enough.

This is something I find a lot of people are never really told when they’re diagnosed with osteoporosis. They might be started on medication, told to take calcium or vitamin D where appropriate, encouraged to walk more and then essentially sent on their way. What’s often missing from that conversation is an explanation of what actually stimulates bone to adapt and why the type of exercise we choose matters.

Bone isn’t a static structure. It’s living tissue that continually responds to the demands placed upon it. When we expose bone to an appropriate mechanical stimulus, we’re effectively giving it a reason to adapt to those demands. This is one of the reasons exercise can play such an important role in the management of osteoporosis and osteopenia.

The important word there, though, is appropriate.

Our bodies are incredibly good at adapting to things we do regularly. If you’ve been walking the same route at roughly the same pace several times per week for the last five or ten years, your body is already very accustomed to that activity. It can still be excellent exercise for your heart, lungs, general fitness and mental health, but that doesn’t necessarily mean it is providing enough of a stimulus to the skeleton to achieve what we’re trying to achieve from a bone health perspective.

That doesn’t make walking useless for someone with osteoporosis. Far from it. It just means we need to stop treating all exercise as though it has the same effect.

When we’re prescribing exercise specifically for bone health, we’re interested in appropriately loading the skeleton. Resistance training is an important part of this because when our muscles produce force against resistance, those forces are also transmitted to the bones they attach to. Appropriate weight-bearing and impact activities can provide another stimulus through forces transmitted through the skeleton.

This is usually the point where people become understandably nervous.

I regularly meet people who have been diagnosed with osteoporosis and have subsequently become frightened of lifting anything remotely heavy. Sometimes they’ve been given very broad advice about avoiding lifting, bending, twisting or strenuous exercise and have understandably interpreted that as meaning their skeleton is fragile and needs to be protected.

Nobody wants to cause a fracture, and exercise prescription absolutely needs to take fracture risk into account. But avoiding physical loading altogether comes with its own problems.

If we stop challenging our muscles, we lose strength. If we avoid difficult movements, our physical capacity can decline. If we become less active because we’re frightened of falling or hurting ourselves, balance and confidence can deteriorate as well. Everyday things like getting out of a chair, carrying shopping, climbing stairs or getting up from the floor can gradually become harder.

The answer isn’t to avoid loading. The answer is to load appropriately.

What appropriate looks like will be different for everybody. Someone who has been strength training consistently for twenty years is in a very different position to someone who has never stepped foot inside a gym. A person with a history of vertebral fractures needs different considerations to someone with low bone density and no fracture history. Balance, strength, previous injuries, other medical conditions, medications, confidence and current exercise capacity all influence where we start and how exercise is progressed.

This is also why osteoporosis exercise is about much more than simply looking at a bone density number.

Ultimately, one of the major things we’re trying to prevent is fracture, and fractures often occur as a result of falls. That means strength, balance, coordination and general physical capacity are important pieces of the puzzle as well. Being stronger can make everyday tasks easier. Better balance and physical capacity can help you navigate the world around you more confidently. If you do lose your balance, having the strength and ability to react matters.

So when I’m thinking about exercise for someone with osteoporosis, I’m not only thinking, “How can we appropriately load their bones?” I’m also thinking about how we can make that person stronger, more capable and more confident in what their body can do.

People also often ask whether activities such as swimming, cycling or Pilates are good for osteoporosis. They can all be excellent forms of exercise, but again, we need to distinguish between exercise that is good for your general health and exercise that provides the specific stimulus we’re looking for when targeting bone.

Swimming and cycling are fantastic cardiovascular exercise, but because they are relatively low-loading activities, they don’t provide the same skeletal stimulus as appropriately prescribed resistance and weight-bearing exercise. Pilates can be useful for strength, movement and balance depending on how it is performed, but it shouldn’t automatically be assumed to cover everything we’re trying to achieve in osteoporosis management either.

That doesn’t mean you need to stop doing any of them. If you love swimming, keep swimming. If you love riding your bike, keep riding your bike. If you enjoy Pilates, there may be plenty of good reasons to continue. We may simply need to add another form of exercise alongside it.

It’s equally important to recognise that exercise is only one part of osteoporosis management. Depending on the individual, management may also involve medication, nutrition, adequate calcium and protein intake, vitamin D, management of other health conditions and ongoing review with a GP or specialist. Exercise doesn’t replace appropriate medical care, and I don’t think the two should be viewed as competing approaches. Ideally, they work together.

If you’ve already been diagnosed with osteoporosis or osteopenia and you’re wondering what you should actually be doing, the diagnosis itself doesn’t mean you’re too fragile to exercise. It does mean that exercise deserves a little more thought than downloading a generic osteoporosis workout from the internet and hoping for the best.

At SurfEdge Sports Physiotherapy in Maroochydore, we provide physiotherapist-led osteoporosis exercise through the ONERO® program, an evidence-based exercise program specifically designed for people with low bone mass. Everyone starts with an individual assessment so we can understand their medical and fracture history, current physical capacity, balance, strength and previous exercise experience before they commence supervised exercise.

For me, the goal isn’t to make people with osteoporosis frightened of exercise. It’s almost the opposite. I want people to understand that their bodies are still capable of being challenged, getting stronger and adapting. We just need to make sure the challenge is appropriate for the person standing in front of us.

So if you’ve been diagnosed with osteoporosis and the only exercise advice you’ve received is to go for more walks, keep walking. There are plenty of reasons to.

But when it comes to building stronger bones, walking shouldn’t be the end of the conversation.

If you’ve recently been diagnosed with osteoporosis or osteopenia, or you’ve been told you need to start doing more for your bone health but aren’t really sure what that should look like, we can help. At SurfEdge Sports Physiotherapy in Maroochydore, we offer individual bone health assessments and physiotherapist-led ONERO® exercise classes, with exercise tailored to your starting point, experience and individual risk factors.

The aim isn’t simply to exercise more. It’s to make sure the exercise you’re doing is actually appropriate for what you’re trying to achieve.

If you’d like to get started, you can book an initial ONERO® assessment online, or call us on (07) 5444 0563 to get in touch with the clinic to find out more about our osteoporosis exercise program in Maroochydore.