In 2018, Australian researchers published groundbreaking results from the LIFTMOR study in the Journal of Bone and Mineral Research. This study revealed something exciting: postmenopausal women who followed the LIFTMOR exercise program showed significantly greater improvements in both lumbar spine and femoral neck bone mineral density (BMD) compared to women following a less intense exercise regimen.
Prior to LIFTMOR, researchers had been hesitant to study high-intensity resistance and impact training for postmenopausal women with osteoporosis. This caution stemmed from legitimate concerns about fracture and injury risks in older adults, considering their varying fitness levels and medical conditions.
The impressive LIFTMOR results have transformed how many of us in the field think about exercise prescriptions for women with osteoporosis. This raises an important question: Should all postmenopausal women with osteoporosis follow the LIFTMOR protocol or incorporate these exercises into their bone health routines?
I’ll help you determine whether LIFTMOR exercises could safely increase your bone density. But first, we need to examine the LIFTMOR study more closely to understand what it actually tells us.
Let’s dive deeper into the study details to help you make an informed decision about your bone health.
The LIFTMOR Study
The Lifting Intervention for Training Muscle and Osteoporosis Rehabilitation (LIFTMOR) trial was designed with a clear purpose: to determine whether a brief, bone-targeted high-intensity resistance and impact training (HiRIT) program could improve bone density in critical areas—specifically the femoral neck and lumbar spine—in postmenopausal women with low to very low bone mass.
In this section, we’ll examine two important aspects of the study. First, I’ll walk you through the specific exercise protocols used in the LIFTMOR trial—what the participants actually did in their workouts. Then, we’ll look at how researchers recruited and selected the women who participated, which will help you understand whether the study participants were similar to you in terms of age, health status, and bone density.
Understanding these details will help you determine if the LIFTMOR approach might be appropriate and beneficial for your unique situation.
The LIFTMOR Protocol: Program Description
The LIFTMOR research team carefully selected 101 participants from a large pool of 568 women. All participants were postmenopausal women over 58 years of age with low bone mass (T-score <–1.0 at the hip and/or spine). These women were randomly divided into two groups:
- High-Intensity Resistance and Impact Training (HiRIT) group: 49 women who followed the LIFTMOR protocol
- Control (CON) group: 52 women who followed a lower-intensity exercise program
LIFTMOR Study Exercises: The HiRIT Group
The HiRIT group participated in an 8-month program that was:
- Twice-weekly
- 30 minutes per session
- Fully supervised
The LIFTMOR program focused on four key exercises:
- Deadlifts
- Overhead presses
- Back squats
- Jumping movements with impact loading
Safety was a priority in this program. The first month served as a transition period, using only body weight and low-load exercise variations. This allowed participants to learn proper movement patterns before progressing to higher intensity. Impressively, all participants mastered the four fundamental exercises within just 2 months.
After the transition period, the full LIFTMOR protocol included:
- Warm-up sets of deadlifts at 50% to 70% of one rep max (1 RM) as needed
- Main resistance exercises (deadlift, overhead press, and back squat) performed as 5 sets of 5 repetitions at high intensity (>80% to 85% of 1 RM)
- Impact loading through jumping chin-ups with drop landings—participants jumped while pulling themselves up with their arms, then dropped to land as heavily as comfortably possible
- Small group sessions with maximum 8 participants per instructor (who was both an exercise scientist and physiotherapist)
The LIFTMOR Control Group (CON) Exercises
The control group followed a different approach designed to improve balance and mobility while providing minimal bone stimulus. The researchers designed this program to maximize participant retention.
The CON group’s program was:
- 8 months long
- Twice-weekly
- 30 minutes per session
- Home-based (in other words, it was not supervised by a health or exercise professional)
- Low-intensity (10 to 15 repetitions at <60% 1 RM)
Their routine included:
- Walking for warm-up (10 minutes) and cool down (5 minutes)
- Low-load resistance training (lunges, calf raises, standing forward raise, and shrugs)
- Stretches (side-to-side neck stretch, static calf stretch, shoulder stretch, and side-to-side lumbar spine stretch)
The resistance exercises gradually progressed from body weight to a maximum of 3 kg hand weights by the final month.
The LIFTMOR Protocol: Candidate Selection Process
The Australian researchers designed the LIFTMOR study specifically for postmenopausal women over 58 years with low bone mass (T-score <–1.0 at the hip and/or spine). They cast a wide net when recruiting participants, using posters, radio, newspaper, television, and word-of-mouth from May 2014 to November 2015. Their efforts resulted in 568 women initially signing up.
As mentioned earlier, only 101 of these women were ultimately selected to participate in the actual trial. Understanding this selection process is crucial for determining whether the LIFTMOR exercises would be suitable for your specific situation.
Step One: The LIFTMOR Study Details
The research team began by thoroughly explaining the study requirements and participant commitments to all 568 applicants. After learning what their involvement would entail, 162 women decided not to continue, leaving 406 potential participants.
Step Two: Candidate Screening
This critical screening phase was designed to:
- Filter out candidates who might struggle with the LIFTMOR exercises
- Exclude those at higher risk of injury due to physical limitations
- Ensure the study could isolate the effects of the exercises on bone health by excluding participants taking medications that affect bone health
The 406 remaining candidates were screened against strict eligibility criteria and excluded if they had any of the following:
- Contraindications for heavy physical activity
- Lower limb joint injury or surgery
- Recent fracture (within the last 12 months) or localized back pain
- Less than 5 years postmenopause
- Malignancy
- Uncontrolled cardiovascular disease
- Cognitive impairment
- Recent X-ray or radiation treatment
- Conditions known to influence bone health (such as diabetes or immobility)
- Use of medications (other than osteoporosis medications) known to affect bone health
- Inability to attend supervised training sessions if assigned to that group
These were significant hurdles for this population of postmenopausal women over 58 with low bone mass. As a result, the LIFTMOR study findings are based on a select group of relatively healthy volunteers. Anyone with underlying musculoskeletal issues or serious cardiovascular conditions was excluded from the trial.
This rigorous screening process eliminated 305 of the 406 potential candidates, leaving just 101 very healthy participants—less than 18% of the original applicant pool.
Step Three: Candidate Allocation
The final 101 participants were then randomly divided between the two trial groups described earlier.
So how did these carefully selected participants fare in the LIFTMOR trial, and what were the results? We’ll explore that in the next section.
Exercise and Osteoporosis
Exercise is an essential ingredient to bone health. If you have osteoporosis, therapeutic exercise needs to be part of your osteoporosis treatment program.
But what exercises should you do and which ones should you avoid? What exercises build bone and which ones reduce your chance of a fracture? Is Yoga good for your bones? Who should you trust when it comes to exercises for osteoporosis?
A great resource on exercise and osteoporosis is my free, seven day email course called Exercise Recommendations for Osteoporosis. After you provide your email address, you will receive seven consecutive online educational videos on bone health — one lesson each day. You can look at the videos at anytime and as often as you like.
I cover important topics related to osteoporosis exercise including:
- Can exercise reverse osteoporosis?
- Stop the stoop — how to avoid kyphosis and rounded shoulders.
- Key components of an osteoporosis exercise program.
- Key principles of bone building.
- Exercises you should avoid if you have osteoporosis.
- Yoga and osteoporosis — should you practice yoga if you have osteoporosis?
- Core strength and osteoporosis — why is core strength important if you have osteoporosis?
Enter your email address and I will start you on this free course. I do not SPAM or share your email address (or any information) with third parties. You can unsubscribe from my mail list at any time.
The LIFTMOR Results
Exercise might be the most potent intervention for preventing osteoporotic fractures in older adults. However, developing an optimal exercise protocol is far from simple. The LIFTMOR trial produced significant results but also highlighted the challenges in designing osteoporosis exercises that are both effective and safe.
The LIFTMOR investigators reported impressive improvements between the HiRIT and control groups:
- ~4% better lumbar spine bone mineral density (BMD)
- ~2% better femoral neck bone mineral density (BMD)
These results are particularly impressive considering that the 8-month study duration might have been too short to capture the full extent of exercise-induced bone adaptations.
The LIFTMOR study demonstrated the clinical significance of consistently supervised, high-intensity and high-impact exercise for fracture prevention in older women at risk.
However, it’s important to note that only a minority of older adults are able or qualified to participate in such frequent and intense exercise programs. Secondly, the Control Group (CON) exercise program was not particularly demanding in terms of high intensity resistive training.
The LIFTMOR Results: Success Factors
Three key factors contributed to the successful outcomes of the LIFTMOR program:
- Selection
- Preparation
- Supervision
Selection
The LIFTMOR study participants were carefully screened and selected based on their health status and ability to perform the exercises. From nearly 600 applicants, only about 100 participants (less than 20%) qualified for the program after rigorous screening.
Preparation
The research team dedicated a full month to preparing participants for the LIFTMOR exercises. This gradual build-up gave participants time to learn proper technique under the guidance of skilled exercise professionals before advancing to higher intensities.
Supervision
Participants were carefully monitored and supervised by accredited health and exercise professionals during every session. They worked in small groups (maximum 8 per instructor) and were closely tracked to ensure proper form and safety throughout the program.
The key question for most people I work with is whether the LIFTMOR exercises are safe and effective for them. For the majority of patients I encounter in my physical therapy practice, the answer is no. I’ll explain why in the next section.
The LIFTMOR Osteoporosis Exercise Program: 3 Important Considerations
I am deeply concerned about the number of people who follow the LIFTMOR protocol, particularly those who do so with inadequate supervision or independently. I see groups on Facebook promoting the LIFTMOR exercises to people with limited exercise experience. That is misguided and dangerous.
The LIFTMOR trial reduced injury risk by actively managing the selection, preparation and supervision of candidates. I see many cases where people actively use the LIFTMOR exercises after hearing about it on a Facebook group where there is no selection, preparation or supervision.
There are three variables you need to consider before you start the LIFTMOR program:
- Selection
- Injury risk
- Body awareness
First Consideration: Selection
As I mentioned earlier in this post, the group of women finally chosen to follow the LIFTMOR protocol went through a thorough selection process. Almost 600 women applied and the final candidates were whittled down to just over 100.
Many were excluded because they were not fit enough to withstand the training. Even the study authors acknowledge that their sample was relatively healthy, as volunteers with underlying musculoskeletal or serious cardiovascular co-morbidities were excluded.
The researchers recommend circumspection when applying our findings beyond the sample demographic and appropriate screening for contraindications to high-intensity resistance and impact training.
Before you start the LIFTMOR exercises, make sure you go through a similar rigorous screening process to make sure you can do the program without harming yourself.
Second Consideration: Injury Risk
There have been cases where individuals sustained vertebral compression fractures following the LIFTMOR protocol. One case occurred after the reporting period and was never presented in the LIFTMOR study data.
Recently, a reader contacted us with her story. She asked that we share it since it had a devastating effect on her health. In her words:
I was sent to a physical therapy specialist for osteoporosis, and she had me doing the LIFTMOR program, which after only three visits, gave me a compressed spine and fractured my first lumbar vertebrae. So now I’m fearful after five months of rest with pain and inflammation.
This is an example of someone who thought that they were doing everything correctly and with the best of intentions, but experienced a significant set back that could have been avoided.
Third Consideration: Body Awareness
If you don’t have a strong background lifting, your body awareness is not where it needs to be, and you haven’t built up a strong lifting foundation, I don’t think it’s a wise thing to follow the LIFTMOR protocol. You can protect your bones without doing heavy squats and dead lifts.
I reached out to Dr. Stuart McGill, a world renowned expert in back care and the author of several books on low back pain and rehabilitation. He studied the effects of heavy squats and deadlifts on very high level athletes around the world.
Even in that population where they have executed under guidance and professionally, if they even just slipped out of alignment, he could hear a pop and that pop was the end plate fracturing.
If that can happen with a very high elite athlete, I think that the risks outweigh the gains of doing exercises like those in the LIFTMOR protocol.
The LIFTMOR Deadlift Exercise
One of the LIFTMOR exercises that causes me great concern is the LIFTMOR deadlift. This is a very complex exercise and requires perfect execution, something typically outside the reach of amateur athletes.
I think I have very good body awareness and movement. Here is a video of me working with an Athletic Trainer for the Varsity athletic teams at the University of Toronto. I encourage you to take a look and see the amount of attention needed to get the LIFTMOR deadlift exercise in good form.
Exercise and Osteoporosis
Exercise is an essential ingredient to bone health. If you have osteoporosis, therapeutic exercise needs to be part of your osteoporosis treatment program.
But what exercises should you do and which ones should you avoid? What exercises build bone and which ones reduce your chance of a fracture? Is Yoga good for your bones? Who should you trust when it comes to exercises for osteoporosis?
A great resource on exercise and osteoporosis is my free, seven day email course called Exercise Recommendations for Osteoporosis. After you provide your email address, you will receive seven consecutive online educational videos on bone health — one lesson each day. You can look at the videos at anytime and as often as you like.
I cover important topics related to osteoporosis exercise including:
- Can exercise reverse osteoporosis?
- Stop the stoop — how to avoid kyphosis and rounded shoulders.
- Key components of an osteoporosis exercise program.
- Key principles of bone building.
- Exercises you should avoid if you have osteoporosis.
- Yoga and osteoporosis — should you practice yoga if you have osteoporosis?
- Core strength and osteoporosis — why is core strength important if you have osteoporosis?
Enter your email address and I will start you on this free course. I do not SPAM or share your email address (or any information) with third parties. You can unsubscribe from my mail list at any time.
The LIFTMOR Protocol Alternatives
There are safer ways to increase bone density through exercise without taking the risks associated with the LIFTMOR protocol.
A 16-year long study done by Kemmler established the positive effect of long-term exercise on clinical low-trauma fractures in postmenopausal women at risk. The authors encourage older adults to perform multipurpose exercise programs that incorporate high intensity resistance training, weight bearing and other exercises.
The HiRIT exercises in the Kemmler study were not as demanding or complex as the LIFTMOR trial and still delivered significant outcomes for bone health. A more graduated approach was taken to increasing high intensity resistance training.
In the video below I described a graduated approach to strength training and explained how to optimize your sets and reps to safely build muscle and bone.
You should look for an osteoporosis exercise program that balances your current fitness level and fracture risk so that you safely and sustainably build bone density and strength. My Exercise for Better Bones program is designed to meet that goal.
The program should be multi-dimensional and include strength training, weight bearing, balance, and flexibility exercises. You should try to exercise three or more times a week to see results (3) and gradually progress to a low frequency, high intensity strength training program. (4) In this post, I describe how much weight you need to increase your bone density.
Conclusion
The LIFTMOR study demonstrated that postmenopausal women who followed a high-intensity resistance and impact training (HiRIT) program could improve bone density in critical areas—specifically the femoral neck and lumbar spine.
Does that mean that every postmenopausal woman perform the LIFTMOR exercises? This post argues that most women likely do not meet the requirements to do this program safely.
In fact, the risk of a compression fracture is likely very high when doing one of the exercises in the program, the LIFTMOR deadlift exercise.
An injury or worse, a compression fracture, brought on by an inappropriate exercise can be a significant set back.
A safer and more effective approach is to follow a multi-dimensional osteoporosis exercise program suited to your fracture risk and activity level.
Further Reading
Margaret Martin
References
- Watson SL, Weeks BK, Weis LJ, Harding AT, Horan SA, Beck BR. High-Intensity Resistance and Impact Training Improves Bone Mineral Density and Physical Function in Postmenopausal Women With Osteopenia and Osteoporosis: The LIFTMOR Randomized Controlled Trial. J Bone Miner Res. 2018 Feb;33(2):211-220. doi: 10.1002/jbmr.3284. Epub 2017 Oct 4. Erratum in: J Bone Miner Res. 2019 Mar;34(3):572. doi: 10.1002/jbmr.3659. PMID: 28975661.
- Kemmler W, Bebenek M, Kohl M, von Stengel S. Exercise and fractures in postmenopausal women. Final results of the controlled Erlangen Fitness and Osteoporosis Prevention Study (EFOPS). Osteoporos Int. 2015 Oct;26(10):2491-9. doi: 10.1007/s00198-015-3165-3. Epub 2015 May 12. PMID: 25963237.
- Zitzmann AL, Shojaa M, Kast S, Kohl M, von Stengel S, Borucki D, Gosch M, Jakob F, Kerschan-Schindl K, Kladny B, Lange U, Middeldorf S, Peters S, Schoene D, Sieber C, Thomasius F, Uder M, Kemmler W. The effect of different training frequency on bone mineral density in older adults. A comparative systematic review and meta-analysis. Bone. 2022 Jan;154:116230. doi: 10.1016/j.bone.2021.116230. Epub 2021 Oct 5. PMID: 34624560.
- Engelke K, Kemmler W, Lauber D, Beeskow C, Pintag R, Kalender WA. Exercise maintains bone density at spine and hip EFOPS: a 3-year longitudinal study in early postmenopausal women. Osteoporos Int. 2006 Jan;17(1):133-42. doi: 10.1007/s00198-005-1938-9. Epub 2005 Aug 12. PMID: 16096715
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