The bone building workout

As the population ages, osteoporosis, or brittle bone disease, is a growing concern. Though osteoporosis is not just a condition that affects older women, they are one of the groups most at risk for it. Predisposing factors for osteoporosis, and the related condition of osteopenia (essentially a lesser degree of osteoporosis) include:

• genetics: if mom has osteoporosis, you are also at risk
• age: risk increases with age
• menopausal status: menopause initiates changes in hormone levels which eventually can decrease bone density (by the way, improving bone density post-menopause is one useful application of testosterone supplementation)
• smoking: you all know you shouldn’t smoke, so I don’t have to tell you
• history of drastic dieting: this takes its toll on your bones
• high caffeine intake
• corticosteroid use (e.g. Prednisone)
• thyroid disorders
• body composition: if you are too thin, especially if you have been amenorrheic (your periods have stopped) for lengths of time, this increases your risk

Osteoporosis and osteopenia are distinguished by the degree of bone density present. Healthy bone looks like havarti cheese: mostly solid with a few little pores here and there. Bone that has lost its density resembles Swiss cheese that’s been left in the sun: giant holes predominate and it seems that only a few strands of solid matter are holding it all together.

We tend to think of bone as inert, sort of like a Tinkertoy construction that holds our bodies together. In fact, bone is a responsive tissue that reacts constantly to the demands imposed on it. It is always breaking down and remodelling itself. Astronauts exposed to zero-G rapidly lose muscle tone and bone density, while weight training improves bone density. Much of the bone loss associated with “normal” aging is simply a result of poor nutrition, inappropriate lifestyle choices, and lack of proper activity.

A fitness/diet strategy aimed at bone density health and osteoporosis must incorporate the following things:

• Weight bearing exercise (to improve functional strength and bone density)
• Balance and stability training (to prevent falls)
• Adequate vitamins and minerals, particularly calcium, but also magnesium and vitamin D (to provide the building materials for bone, and to help calcium be absorbed)
• A diet that is not hypocaloric (taking in fewer calories than the body needs) for long periods of time, and a bodyweight that is healthy, not underweight

The rest of this article will deal with the first and second components, and discuss how to put together a fitness program that will give you bones of titanium!

weight bearing exercise

Well, duh, we should know by now that that’s weight training. But what kind of weight training is best? Ideally, your workout should include movements that load the bone along its length. That means a squat is better than a leg extension, for example. The weight in a squat is transmitted down along the spine, through the hip, and down along the bones of the leg. The weight in a leg extension is transmitted across the shinbone, and mostly just puts pressure on the knee joint. Most types of presses, such as bench presses, pushups, and overhead presses, are another good choice for bone loading.

A second type of weight bearing exercise is impact exercise. This can be walking, running, jumping, skipping rope, hitting a heavy bag, or any other type of plyometric exercise like clapping pushups. This is also good to incorporate into a workout.

One study found that even a single bout of high-impact exercise can increase bone turnover. Study participants jumped up and down until they were exhausted. Afterwards, markers of bone formation (procollagen type I amino terminal propeptide [P1NP] and bone resorption (carboxyterminal crosslinked telopeptide [CTx]) were both elevated, signifying that the body was busily fixing the damage and rebuilding the bones to be stronger.

Rantalainen, Timo, et al. Short-term bone biochemical response to a single bout of high-impact exercise. Journal of Sports Science and Medicine (2009) 8, 553 – 559.

While other forms of exercise like swimming, yoga, and tai chi are also good for you in general, fun to do, and can help train balance (see below), they don’t provide the same kind of loading that weight training and impact activities do. Indeed, a recent study found that cyclists had surprisingly reduced bone density despite plenty of exercise, because cycling doesn’t really load the bones along their length — the combo of training plus lack of bone loading led to significant problems. So, feel free to do these types of activities, but just make sure to do the bone-loading stuff at least twice a week.

what’s right for me?

Your existing level of fitness and bone density will determine your exercise choice. If you’re a bit older, a bit less fit, and/or already showing signs of degeneration, don’t start right off with two-metre plyometric depth jumps or pounding a cement wall. Start with lighter versions of the recommended types of exercises. Avoid excessive rounding of the spine, especially under load.

Level 3 would be done by someone who is already fit, and interested in prevention. You may find that you can’t progress past Level 1, or Level 2, but that’s okay. The main thing is that you do at least something. I’ve suggested some ideas below. These aren’t the only exercises you should do, of course, but you should include at least a few of them.

There are many ways to integrate these into a workout. You can do a conditioning-type workout where you do them all at once, in a circuit (e.g. jump rope 1 min, 10 pushups, jump rope 1 min, 10 squat jumps, jump rope 1 min, 10 walking lunges, repeat). Or you can just make sure to put one or more movements into your workouts, 2-4 times weekly.

Level 1	Level 2	Level 3
Unweighted squatting Unweighted step-ups on to a low step Unweighted walking lunges	Squatting with a hip belt from Ironmind Squat jumps	Squatting with a bar on your back
Plank or modified plank Counter pushups Light overhead press and/or bench press	Pushups Moderate overhead press and/or bench press	Clapping pushups Heavy overhead press and/or bench press, other presses, jerks
	Hitting a heavy bag at low to moderate intensity, wearing padded boxing gloves	Hitting a heavy bag with open palm style, or wearing less padded bag gloves or hand wraps only, or hitting with all the power you can muster Sledgehammer GPP: swinging a sledgehammer into a mat, sandbox, rubber tire, or some other shock absorbing material
Walking	Brisk walking	Running
Short sets of low jumps	Jumping rope, intervals of up to 1 min Squat jumps with rebound	Jumping rope, intervals up to 2 min, jumping in patterns, jumping on one leg Depth jump from a box with rebound

balance training

As we age, if we do not train it, we lose our balance. Falls are one of the chief dangers for people with osteoporosis, and loss of bone density combined with loss of balance presents a very risky situation. However, balance, like other physical qualities, can be trained. Regular free weight exercises such as squats, deadlifts, Olympic lifts and their variations, and performing exercises standing (e.g. standing press) are all a big help. But there are lots of other ways to train for balance. One of the best ways I know is martial arts. If you are a Level 1 – Level 2 person, something like tai chi, yoga, or even dancing might be better. Below I’ve listed some ideas for training your balance, again sorted into levels of difficulty.

There are exercises here called “perturbation stimulus”. This means putting yourself into a position which is a bit unbalanced, then having someone else supply further instability by pushing you. You are then forced to respond. Make sure your partner is gentle initially and doesn’t shove you. Gentle pushing and pulling will be fine. All you need the partner to do is unbalance you enough so that you have to respond.

Level 1	Level 2	Level 3
Walking along an imaginary straight line Walking lunges	Walking a path with obstacles in it	Overhead squat Single-leg squat with one leg held straight out in front
Standing with eyes closed Mountain pose Powerful pose	Standing on one leg Warrior pose 1 and Warrior pose 2	Standing on one leg with eyes closed Tree pose Half moon pose
Perturbation stimulus administered to person sitting on swiss ball	Perturbation stimulus administered to person standing with eyes closed	Perturbation stimulus administered to person standing with light barbell held overhead