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What Exercises Are Best For Maintaining Bone Density & Balance?

With gyms and group classes closed due to the current global pandemic, the rise in home workouts has been evident. We know this is important for maintaining fitness and strength, but it is also very important for maintaining the health of our bones along with our balance capabilities.

Those who have been performing a bone loading exercise program with us at Physiotas, don’t despair! If you haven’t been continuing your program, you won’t lose all the benefits of your hard work as bone density loss is very gradual.

However, if you can perform an exercise program at home, the aim is to prevent bone loss, maintain muscle strength and to improve your balance in order to reduce the risk of falls.

As with any program, take care to start and progress slowly with any new exercises to allow your body’s muscles, tendons, ligaments and bones to adapt slowly to the load placed on them.

WHAT EXERCISES ARE BEST FOR MAINTAINING OR IMPROVING MY BONE DENSITY?

  • There is not a simple answer to this question as there are many things to consider such as general health, balance, frailty, and available equipment
  • Only heavy resistance training and impact loading exercises stimulates bone to become stronger. Walking, swimming and cycling will not increase bone mass
  • Ensuring adequate calcium and protein in your diet (minimum 1000mg/day) will maximise the benefits of exercise for bone
  • An exercise program which combines resistance training, impact loading and balance exercises is recommended
General impact loading recommendations:
  • The goal of impact loading is to jolt the skeleton rapidly and firmly
  • Any firm landing type activity with a hard floor surface is ideal
  • Up to 50 repetitions are required during any one exercise session with a maximum of 5 sets of 10 recommended
  • It is vital that impact loading is initiated gently to avoid injury. Over a period of month your body will gradually tolerate more impact
  • Examples of impact loading exercises:
    • Vertical and multidirectional jumping
    • Bounding, hopping, skipping rope, jumps off a step, stamping your fee
    • Step-ups with or without stamping your foot onto the step to increase impact
    • To increase the impact loading, simply increase the height for activities such as bounding and jumping off a step. You could also add weight in a backpack
    • Do these types of exercises 2-3 times weekly

CARE:
Sudden jolts are not recommended for individuals with extremely low
bone mass due to high risk of low trauma fracture

  • If you have advanced arthritis, the associated pain may be a strong disincentive to jump
  • For these people, simply stamping your feet onto a hard surface may be a manageable alternative
  • Pain or increased disability are good guides as to whether your joints are tolerating the impact
  • Please stop any impact exercise that causes increased pain and/or joint inflammation which lasts more than two days
  • Always land on even surfaces to prevent ankle injuries or overbalancing
  • Practice impact loading near a sturdy table or support rail so you can steady yourself when landing if required
General resistance training recommendations:
  • If you have never lifted weights before, you should consult your Physiotherapist or Exercise Physiologist at Physiotas before you begin to learn the correct technique and prevent injury
  • If you have some experience with resistance training, you should start with low to moderate weight (a weight you can lift a maximum of 10 times) and build up over a 3-week period to allow your body to adapt to the increasing load
  • The following are examples of recommended resistance training exercises:

Squats, Lunges or Walking Lunges

Deadlift

Military Press or Shoulder Press

Push-Ups or Kneeling Push-Ups

THE PLAN

  • Complete 3 sets of 10 for each exercise initially, then gradually increase the weight and decrease the number of repetitions per set until you reach 5 sets of 5 repetitions
    • E.g. Start with 3 sets of 10 at 10 kg and progress to 4 sets of 8 at 20 kg, then finally to 5 sets of 5 at 25kg
    • If you don’t have weights at home, you can improvise using things you may have around the house:
      • Milk crates with milk bottle filled with water inside
      • Soft drink or water bottle filled with water or rice
  • Aim to complete 2-3 training sessions per week with a minimum of 1 day off between exercise days is recommended
General balance training recommendations:

You can include either static or dynamic balance exercises to challenge your balance.

Static Balance Challenges:

  • Stand on 1 leg: aim for 30 seconds each leg
  • Stand with feet close together: aim for 30 seconds
  • Tandem Balance: stand with 1 foot right in front of the other with the heel of the front foot touching the toes of the back foot
  • You can make these tasks more difficult by moving your trunk (leaning, reaching, bending), then regaining your balance without using your arms.

Dynamic Balance Challenges:

(This involves moving while maintaining balance)
  • Stepping over obstacles
  • Walking on uneven or soft surface such as a foam mat or folded blankets
  • Walking on your toes or heels
  • Walking backwards and sideways or with your arms above your head

Increase the challenge by dual tasking:

  • Standing on one leg while tossing a ball and catching it
  • Tandem walking while counting backwards or reciting the alphabet backwards
  • Stand on 1 leg in a middle of an imaginary circle; reach out with other foot as far as you can in various directions
  • Use the “Clock Yourself” app which uses lunges into random directions around an imaginary clock to challenge your balance and cognitive function

TIPS

  • Always practice balance where you can safely catch yourself if you overbalance: beside a handrail or sturdy table/couch
  • Balance training must be practiced for around 2 hours a week to have a notable effect. Luckily it doesn’t have to all be done at once
  • Some activities can easily be incorporated into normal daily activities: tandem stance while washing up or cleaning the teeth
  • It is important that activities are truly challenging for you to derive benefit: maintaining balance for a time period not yet mastered
  • Structured activities such as Tai Chi, yoga, and dancing provide excellent dynamic balance training. There are many online video programs of these activities available

 

EXAMPLE HOME BONE LOADING/ BALANCE PROGRAM

2-3 sessions per week
Session 1:

Impact Loading: Jump on spot: 5 sets of 10

Resistance Training: 3 sets of 10 progressing to 5 sets of 5 (with weight) over a period of 3 weeks

  • Squats
  • Push-ups or kneeling push-ups
  • Deadlift with bar or dumbbells
  • Military press with bar or shoulder press with dumbbells

Balance Challenges:

  • Stand on 1 leg 3 x 30s each
  • Walk backward 3 sets of 10 steps
  • Stand on 1 leg and reach to touch 3 witches hats (or stacked Tupperware containers) Do these 5 times on each leg.
Session 2:

Impact Loading: Skipping with rope 3 sets of 30 seconds

Resistance Training: 3 sets of 10 progressing to 5 sets of 5 over a period of 3 weeks.

  • Walking Lunges with dumbbells in hands
  • Push-up off table
  • Deadlift with bar or dumbbells
  • Military press with bar or shoulder press with dumbbells

Balance Challenges:

  • Tandem Balance: Stand with 1 foot immediately in front of the other. Perform 2 times 30 sec on each side
  • Stand on 1 leg in front of a wall. Throw the ball at the wall, then catch it on the rebound. 3 sets of 10 throws
  • Stand on 1 leg and reach to touch your knee, shin, or ankle with the opposite hand. Do this 5-10 times on each leg.

This program of exercises is designed to improve muscle function and balance in order to reduce the risk of falls. While it will not improve your bone density/mass, it will prevent bone loss.