Table of Contents
This strength training guide is for people who want to age well, with a special emphasis on individuals concerned about osteoporosis, osteopenia, or low bone density. Strength training is a critical component of a bone building exercise program. We cover:
- How strength training lessens bone loss and benefits your bone health.
- The difference between strength training and weight bearing.
- How to combine weight-bearing and strength training.
- Resources you can access on this site.
Strength Training and Your Health
Strength training is crucial for good health. A regular strength training routine has been shown to benefit your:
- Cognitive health.
- Bone health.
- Muscle health.
- Independence.
- Quality of life.
- Longevity.
Some people refer to strength training as resistance training or weightlifting. We will use all three terms throughout this guide.
If you do not regularly strength train, you will begin losing as much as 3% of your muscle mass per year. This is commonly referred to as sarcopenia.
Many are surprised to know that muscle loss starts in the mid-’30s. The older we get, the faster the rate of muscle loss. The expression “use it or lose it” applies very well to our muscles and bones.
Strength training is the solution, and it is available to each of us. It improves the strength of our muscles, bones and our retirement options!
Leading health organizations recommend strength training for older adults. Adding resistance training exercise to your weekly routine goes far beyond your muscle and bone health.
Strength Training Lessens Bone Loss
How Strength Training Works at the Cellular Level
When you perform strength training exercises, you’re doing far more than simply stressing your bones, you’re sending powerful signals directly to the stem cells responsible for building bone. Research from the University of North Carolina (1) reveals that mesenchymal stem cells in your bone marrow can differentiate into either bone-building osteoblasts or fat-storing adipocytes. The direction these stem cells take depends significantly on physical loading.
Dynamic, cyclical forces, exactly the type generated during strength training, activate specific signaling pathways that preserve a molecule called β-catenin, which steers stem cells toward becoming osteoblasts rather than fat cells. This explains why studies consistently show that weight-bearing exercise simultaneously increases bone formation while decreasing bone marrow fat.
Why the Right Type of Strength Exercise Lessens Bone Loss
Not all movement is equal when it comes to bone health. The research demonstrates that static loading does not induce bone remodeling. Your skeleton needs dynamic, repetitive force to respond.
The key parameters include magnitude (how heavy the load), frequency (how quickly you move through repetitions), and cyclicity (the repetitive nature of the movement). Walking at a moderate pace, while beneficial for cardiovascular health, doesn’t generate enough intensity to increase bone density in postmenopausal women.
However, high-intensity strength training, as demonstrated in Exercise for Better Bones and Stronger Bones, Stronger Body video series, has been shown to improve bone mineral density and physical function in women with osteopenia and osteoporosis. The researchers note that exercise prescriptions should include both weight bearing and strength training components, with particular attention to strengthening the paraspinal muscles to protect the spine and incorporating balance training to prevent falls.
How Strength Training Benefits Your Bones
Strength training for osteoporosis is critical if you want to age with strong bones. This class of exercise has been shown to protect your bones in the following ways:
- Strength training lessens bone loss by suppressing the osteoclast activity level. (1)
- Improves bone building by stimulating the osteoblast cells and the pre-osteoblast cells. (1)
- Improves bone strength by making the bone more resilient to strains. (1)
- Helps prevent falls. (2,3)
- Protects your spine from degenerative changes, including compression fractures. (4)
- Accelerates healing and recovery after a fracture. (5,6)
- It improves your chances of returning to independence one year after a hip fracture. (7,8)
In the video below, I explain how strength training improves bone health and increases bone density.
Strength Training for Osteoporosis
Strength training can help maintain or increase muscle mass. When you lift a heavy load, more muscle fibres are recruited. Some muscles attach directly to bones, while others attach via tendons. (As illustrated in the image below.) The contracting muscle sends mechanical signals to the bone. This mechanical signalling stimulates osteoblasts (bone-building cells) and calms the osteoclast activity (bone-cutting/cleaning cells). (1)
Strength Training for Muscle and Balance
How Often Should You Strength Train for Osteoporosis?
This is how I designed the exercise schedules in my book, Exercise for Better Bones, and the Stronger Bones, Stronger Body Video streaming series.
Examples of strength training exercises for an active adult include squats, lunges, push-ups, and modified back extensions. Start with a manageable weight. Increasing the weight and intensity over time allows you to build muscle and bone safely.
Strength Training for Osteoporosis, Osteopenia and Low Bone Density
Strength training exercises are beneficial for people with osteoporosis and osteopenia. Several major studies confirm this.
One of the most extensive studies specific to bone health began before the year 2000 in Germany. Dr. Wolfgang Kemmler conducted a 16-year study of the benefits of exercise. His study focused on post-menopausal women with osteoporosis.
Dr. Kemmler found that post-menopausal women strengthened their muscles. The same exercises could stop bone loss. (8)
A 2020 meta-analysis of the effects of high-intensity exercise on postmenopausal women. The study showed high-intensity exercise to be more effective for the spine than the hip. (9)
How Does Strength Training Prevent Osteoporosis and Osteopenia, and Increase Bone Density?
Strength training can help prevent osteoporosis and osteopenia. It increases bone density through remodeling.
Bone remodeling involves two major activities:
- Resorption: Removing or resorbing old or damaged bone tissue.
- Formation: Replacing it with new bone tissue.
The balance between bone resorption and formation is vital for maintaining bone health. (11)
Unfortunately, things can get out of balance. After menopause, the resorption cells outnumber the formation cells. This can speed up bone loss and cause osteoporosis.
Strength training helps to inhibit the bone-resorbing cells and stimulate the bone-building cells.
How Does Strength Training Differ from Weight Bearing Exercise?
Strength training involves the progressive loading of muscles. The goal is to fatigue them within 5 to 12 repetitions.
Weight bearing exercises usually involve more repetitions and a longer duration. Activities such as running, brisk walking, basketball, and soccer are weight bearing.
Earlier, I mentioned exercise guidelines from leading organizations. These health organizations also recommend 30 minutes of aerobic activity daily. The aerobic activities can include weight-bearing exercises such as brisk-walking, running, or jumping-rope.
Both weight bearing exercise and strength training stimulate bone building. Whether you bear weight or strength train, your muscles vibrate. This vibration, in turn, pulls on the bone, stimulating bone growth.
Strength Training for Osteoporosis Products
I offer several strength training for osteoporosis products. The first product is my book, Exercise for Better Bones, and the other is a workout series in streaming video format.
Exercise for Better Bones
Exercise for Better Bones is a comprehensive exercise program for individuals who want to improve their bone health. It includes strength training exercise programs for people at different levels of fracture risk and activity level. Exercise for Better Bones is available on Amazon in print and Kindle format.
Stronger Bones, Stronger Body Video Workouts
Stronger Bones, Stronger Body is an online video series designed for people who want to follow me through a structured workout.
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Strength Training and Muscle-Nerve Communications
Our nerves’ ability to send messages to muscles decreases as we age. But it need not be the case. Strength training improves the nerves’ ability to talk to muscles.
In 2021, Dr Walker reviewed evidence from studies of resistance training-induced neural adaptation in older adults. (11)
A 2022 study further supported the positive effect that intense strength training could enhance muscle-nerve communication. The study included 38 healthy men in their late 60s and 70s. After just 16 weeks of heavy resistance exercise, there was evidence that increased nerves could communicate better with muscles. (12)
You’re Always Young Enough to Get Stronger
Researchers conducted a small study with healthy older adults over the age of 85. All individuals were living independently and the age ranged from 86 to 96 years old.
Eight weeks of strength training generated significant results. The residents added almost 10% muscle mass to their thighs and improved their strength by 174%. (13)
This study proved that you’re always young enough to make strength gains. You need not be competing in the Masters.
The Power of Protein When Strength Training
Protein is essential to building muscle and bones. At any age, protein is critical for supplying the amino acids necessary to build bone and muscle.
Around 50 years of age, we need to increase the protein in our diets to maintain muscle mass. Regular exercisers should eat more protein than the recommended daily intake of 1.0 to 1.2 g/kg of body weight. (14)
Most adults can generally meet this intake level through diet alone. But supplement as needed.
Consume protein within an hour of completing your strength training and with each meal throughout the day.
The type of protein matters. In 2022, a study of 1,570 older men and women looked at this issue. It found a positive association between animal protein and bone mineral density scores. (15)
In contrast, plant protein eaters had lower BMD scores.
Free Osteoporosis Exercise Course
How to Start a Strength Training Program
Follow these guidelines for establishing a consistent routine. Our Exercise for Better Bones program is a great one-stop resource for most people.
- General Recommendation: Aim for at least two sessions per week, making sure to target all major muscle groups.
- For Adults Over 50: Many people in this age group find it more manageable to break up their workouts into shorter daily routines or to train three times per week.
Lifting Intensity and Progression
The goal of strength training for bone health is to fatigue your muscles within a specific range.
- The Target: You should aim to lift a weight that challenges you enough to fatigue your muscles within 5 to 12 repetitions.
- The Principle: The key is progressive loading. Start with a weight that is manageable for you and gradually increase the weight and intensity over time. This approach allows you to build muscle and bone safely and effectively.
Key Strength Training Exercises
Here are some examples of effective strength training exercises that target major muscle groups:
- Squats
- Lunges
- Push-ups
- Modified back extensions
These exercises provide the mechanical signals for bone growth, but your body needs the right nutritional building blocks to respond to those signals effectively.
Strength Training Diet
Protein is an essential building block for both muscle and bone tissue. To get the most out of your training, it is critical to supply your body with the amino acids it needs to build and repair these tissues.
Don’t Forget Weight-Bearing Exercise
While strength training is unique, it works best in combination with weight-bearing aerobic exercise. Both stimulate bone growth, but they differ in their approach.
- Weight-Bearing Exercise: The goal is muscle fatigue within 5 to 12 reps. Usually involves more repetitions and a longer duration.
- Examples: Brisk walking, running, basketball, soccer.
Health organizations recommend adding 30 minutes of daily aerobic activity to your routine. This can include effective weight-bearing exercises like a brisk walk or run.
It’s Never Too Late to Start
If you think you’ve missed the window to get stronger, think again. A remarkable study focused on healthy, independently living adults, with participants ranging from 86 to 96 years old, demonstrates the incredible adaptability of the human body.
After just eight weeks of strength training, these participants achieved significant results. They gained almost 10% muscle mass in their thighs and improved their strength by an astounding 174%. This research powerfully proves that it is never too late to start.
Conclusion
The objective of this guide was to discuss the importance of strength training for osteoporosis. It covered how strength training lessens bone loss and the role it plays in improving your bone health, reducing your risk of a fall and fracture, and helping you manage your osteoporosis, osteopenia, and low bone density.
Margaret Martin
Recommended Posts on Strength Training for Osteoporosis
References
- Rubin J, Styner M. The skeleton in a physical world. Exp Biol Med (Maywood). 2022 Dec;247(24):2213-2222.
- Wong RMY, Chong KC, Law SW, Ho WT, Li J, Chui CS, Chow SKH, Cheung WH. The effectiveness of exercises on fall and fracture prevention amongst community elderlies: A systematic review and meta-analysis. J Orthop Translat. 2020 Jun 1;24:58-65.
- Adjetey C, Karnon B, Falck RS, Balasubramaniam H, Buschert K, Davis JC. Cost-effectiveness of exercise versus multimodal interventions that include exercise to prevent falls among community-dwelling older adults: A systematic review and meta-analysis. Maturitas. 2023 Mar;169:16-31.
- Kang S, Chang MC, Kim H, Kim J, Jang Y, Park D, Hwang JM. The effects of paraspinal muscle volume on physiological load on the lumbar vertebral column: a finite-element study. Spine 2021;46:E1015–21
- Ikchan Jeon, Sang Woo Kim, Dongwoo Yu. Paraspinal muscle fatty degeneration as a predictor of progressive vertebral collapse in osteoporotic vertebral compression fractures. The Spine Journal Volume 22, Issue 2, February 2022, Pages 313-320
- Eastlack M, Miller RR, Hicks GE, Gruber-Baldini A, Orwig DL, Magaziner J, Ryan AS. Thigh Muscle Composition and Its Relationship to Functional Recovery Post Hip Fracture Over Time and Between Sexes. J Gerontol A Biol Sci Med Sci. 2022 Dec 29;77(12):2445-2452
- Chen YP, Kuo YJ, Hung SW, Wen TW, Chien PC, Chiang MH, Maffulli N, Lin CY. Loss of skeletal muscle mass can be predicted by sarcopenia and reflects poor functional recovery at one year after surgery for geriatric hip fractures. Injury. 2021 Nov;52(11):3446-3452
- Kemmler W., Bebenek M, Kohl M, von Stengel S. Exercise and fractures in post-menopausal women. Final results of the controlled Erlangen Fitness and Osteoporosis Prevention Study (EFOPS). Osteoporos Int 2015 Oct;26(10):2491-9.
- Kistler-Fischbacher, M. et al. The effect of exercise intensity on bone in post-menopausal women (part 2): A meta-analysis. J.bone.2020.115697. Epub 2020 Dec 24.
- Kenkre JS, Bassett J. The bone remodelling cycle. Ann Clin Biochem. 2018 May;55(3):308-327.
- Walker, S. Evidence of resistance training-induced neural adaptation in older adults. Experimental Gerontology. Volume 151, August 2021, 111408
- Soendenbroe C, et al. Human skeletal muscle acetylcholine receptor gene expression in elderly males performing heavy resistance exercise. American Journal of Physiology-Cell PhysiologyVol. 323, No. 1
- Gabriel Nasri Marzuca-Nassr, Andrea Alegría-Molina, Yuri SanMartín-Calísto, Macarena Artigas-Arias, Nolberto Huard, Jorge Sapunar, Luis A. Salazar, Lex B. Verdijk, and Luc J.C. van Loon. Muscle Mass and Strength Gains Following Resistance Exercise Training in Older Adults 65–75 Years and Older Adults Above 85 Years. International Journal of Sport Nutrition and Exercise Metabolism. Volume 34: Issue 1. 24 Oct 2023
- Doyeon Kim ,Yongsoon Park. Amount of Protein Required to Improve Muscle Mass in Older Adults. Nutrients. 2020 Jun; 12(6): 1700.
- Groenendijk I, et al.Protein intake and bone mineral density: Cross-sectional relationship and longitudinal effects in older adults. J Cachexia Sarcopenia Muscle. 2023 Feb;14(1):116-125.
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