What Exercise Should I Do if I Have Osteoporosis After 50?
Being diagnosed with osteoporosis or osteopenia can raise a lot of questions about exercise.
Should you keep walking? Can you lift weights? Is it safe to exercise at the gym? Should you avoid certain movements? And perhaps most importantly — what type of exercise actually helps your bones?
One of the most important things to understand is that having osteoporosis does not mean you should stop exercising.
In fact, appropriately prescribed exercise is an important part of the overall management of osteoporosis. Australian guidelines recommend a combination of progressive resistance training, weight-bearing impact exercise and challenging balance exercise, with programs modified according to the individual's circumstances and fracture risk.
The challenge is making sure you're doing the right type and level of exercise for you.
Why exercise becomes particularly important after 50
As we get older, maintaining bone health is only one part of the picture.
We also want to maintain:
muscle strength
balance
mobility
cardiovascular fitness
confidence with movement
the physical capacity to remain active and independent.
This is why we shouldn't think about osteoporosis exercise simply as a list of exercises for your bones.
A good program considers the whole person.
For someone in their 50s who is already strong and regularly exercises, an appropriate program may look very different from that of someone in their 70s who has experienced a previous fracture, has reduced balance and hasn't undertaken strength training for many years.
Is walking enough if you have osteoporosis?
Walking is excellent physical activity.
It can help maintain cardiovascular fitness, keep you active and provide many other health benefits.
But walking alone is generally not a complete osteoporosis exercise program.
Healthy Bones Australia explains that bones benefit particularly from controlled impact and muscle loading and recommends combining weight-bearing impact exercise, resistance training and balance exercise.
That doesn't mean you should stop walking.
Instead, think about what may need to be added to your walking.
For many people, one of the missing pieces is progressive strength training.
Why strength training matters
Resistance training places muscles and the skeleton under load.
Australian osteoporosis guidelines recommend regular, progressive muscle resistance training at least twice per week as part of exercise aimed at reducing fracture risk.
Importantly, progressive is a key word.
If an exercise remains very easy indefinitely, it may not continue providing the stimulus required to improve physical capacity.
That doesn't mean everybody with osteoporosis should immediately start lifting heavy weights.
Your starting point needs to reflect your current ability, previous exercise experience, medical history and fracture risk. From there, resistance can be progressively increased when appropriate.
Examples might include exercises such as squats, step-ups, lunges, pulling and pushing movements and other loaded exercises targeting major muscle groups.
The exact exercises matter less than developing an appropriate program that can be safely progressed over time.
What about impact exercise?
Impact exercise can also provide an important stimulus to bone.
Depending on the individual, this might range from relatively low-level weight-bearing activities through to more challenging jumping, hopping or multidirectional movements.
However, this is an area where individualisation becomes particularly important.
Healthy Bones Australia recommends that people diagnosed with osteoporosis work with an appropriately qualified physiotherapist or exercise physiologist when commencing an exercise program so that factors such as skeletal fragility, previous fractures and other medical or physical limitations can be considered.
Someone with a history of vertebral fracture, significant balance impairment or other health conditions should not simply copy a generic high-impact program they find online.
Don't forget balance
When we talk about osteoporosis, it's easy to focus entirely on bone density.
But fracture risk isn't determined by bone health alone.
Falls matter too.
For this reason, challenging balance training is another component recommended in Australian osteoporosis guidelines.
Balance exercises can be progressively modified by changing factors such as the base of support, visual input, surface, movement demands and additional tasks.
Again, the goal isn't simply to perform the same easy balance exercise forever. The exercise needs to provide an appropriate challenge while remaining suitable for the person's falls risk and physical capacity.
Are there exercises you should avoid with osteoporosis?
This isn't as simple as providing everyone with the same list of prohibited exercises.
Exercise recommendations should take into account factors including:
severity of osteoporosis
previous fractures
vertebral fracture history
balance and falls risk
current strength
other musculoskeletal conditions
exercise experience
technique and movement control.
For people at higher risk of vertebral fracture, Australian guidelines specifically recommend that exercise be supervised, modified and tailored to minimise the risk of falls, injury and vertebral fracture.
This is another reason we prefer an individual assessment over simply handing someone a generic sheet of “osteoporosis exercises”.
What is the best exercise for osteoporosis after 50?
There isn't one single best exercise.
Instead, think about developing a well-rounded and progressive exercise program.
For many people this will involve:
Progressive resistance training - To improve muscle strength and appropriately load the skeleton.
Weight-bearing and appropriate impact exercise - To provide additional mechanical stimulus to bone where appropriate.
Balance training - To improve stability and address factors contributing to falls risk.
General physical activity - To maintain cardiovascular fitness, mobility and overall health.
The most appropriate combination and intensity will differ between individuals.
Starting exercise after an osteoporosis diagnosis
If you've recently been diagnosed with osteoporosis or osteopenia, the diagnosis shouldn't automatically make you afraid of exercise.
But it is a good opportunity to reconsider how you exercise.
At Body Fit Physiotherapy in North Adelaide, we assess factors such as strength, balance, current exercise capacity, health history and previous injuries before developing an individual program.
The aim isn't simply to give you five exercises and send you away.
We want you to understand:
What should I be doing? How hard should I be working? How should my exercises progress? And how can I continue exercising over the long term?
For more information about how we approach osteoporosis and osteopenia exercise, visit our dedicated Osteoporosis Exercise & Physiotherapy Adelaide page.
References
Healthy Bones Australia — Exercise & Bone Health and Exercise Prescription to Support the Management of Osteoporosis.
Royal Australian College of General Practitioners & Healthy Bones Australia — 2024 guideline for osteoporosis management and fracture prevention in postmenopausal women and men over 50 years of age.
This article provides general information only and does not replace individual medical or physiotherapy advice. Exercise recommendations may need to be modified according to bone health, fracture history, medical conditions and individual circumstances.
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