High-Intensity Exercise for Osteoporosis: A Breakthrough Study

Childhood development places a strong importance on supporting healthy bones and posture.  But it’s not the end of the story.  As we age, factors like health habits, genetics, and environment can influence bone health. Osteoporosis, a condition characterized by decreased bone density, is a common concern, especially for postmenopausal women and older men.

The National Institute of Arthritis and Musculoskeletal and Skin Diseases describes osteoporosis as “a bone disease that develops when bone mineral density and bone mass decreases, or when the structure and strength of bone changes. This can lead to a decrease in bone strength that can increase the risk of fractures (broken bones).”

It is often called a “silent” disease because it progresses without symptoms until a fracture occurs. It’s more common than you might think.

WHAT ARE THE RISK FACTORS FOR OSTEOPOROSIS?

Consider these statistics from the Bone Health & Osteoporosis Foundation (BHOF):

• Of the estimated 10 million Americans with osteoporosis, about eight million or 80% are women.
• Approximately one in two women over age 50 will break a bone because of osteoporosis.
• A woman’s risk of breaking a hip is equal to her combined risk of breast, uterine and ovarian cancer.

Menopause-related estrogen loss can lead to significant bone loss in women, increasing fracture risk.  In some cases, a woman can lose up to 20% of her bone density in the initial 5-7 years after menopause.  While estrogen therapy can help, it’s not suitable for everyone due to its risks.

Contrary to popular thought, osteoporosis affects men too.  The Bone Health & Osteoporosis Foundation reports:

• Up to one in four men over age 50 will break a bone due to osteoporosis.
• Approximately two million American men already have osteoporosis. About 12 million more are at risk.
• Men older than 50 are more likely to break a bone due to osteoporosis than they are to get prostate cancer.
• Men are more likely than women to die within a year after breaking a hip. This is due to problems related to the break.

WHAT CAN BE DONE TO HELP PREVENT OSTEOPOROSIS?

Preventing osteoporosis involves a balanced diet rich in calcium and vitamin D, regular exercise, and avoiding unhealthy habits like smoking and excessive alcohol consumption. Exercise has been shown to have a positive effect on bone density, even in postmenopausal women.  These are steps that can be taken even in youth and young adulthood that can lay a foundation for stronger bones later in life.

A systematic review and meta-analysis reviewed 80 research studies investigating exercise effects on bone mineral density.  The exercise programs involved in these studies tended to be low intensity and included activities such as: walking, aquatic exercise, cycling, aerobic dance, Tai Chi and dynamic resistance training among others.  Resistance training was done at an intensity of 70-80% of 1 repetition maximum.  Some prescribed as low as 50%.

After analysis, researchers noted a “favorable effect of exercise on bone mineral density (BMD) at Lumbar Spine (LS – low back region), femoral neck (FN – the part of the upper leg bone that is prone to fractures due to osteoporosis) , and total hip in postmenopausal women.”  However, the effect was “significant but ‘small’.”  They also noted that the exercise programs that were supervised had greater effects on balance, strength, and power – all risk factors for falls.

CAN EXERCISE INTENSITY EFFECT BONE MASS?

Furthermore, a 2019 study examined whether those with osteoporosis should limit exercise intensity.   As the above meta-analysis shows, most osteoporosis guidelines for exercise are limited to moderate intensity (70% to 80% 1 repetition maximum, for 8-15 repetitions) exercises that target individual muscle groups.  This study’s researchers suggested that this was “unlikely” to be sufficient to stimulate a response that would have a significant impact on bone mass.

By contrast, high-intensity resistance and impact training (HiRIT) exercises involve weight-bearing positions and numerous muscle groups and can target the specific areas (spine and hip) that are known for becoming weak with osteoporosis.  The Lifting Intervention for Training Muscle and Osteoporosis Rehabilitation (LIFTMOR) trial tested high-intensity resistance and impact training (HiRIT) against low-intensity exercises in postmenopausal women with low bone mass.

Participants were randomly assigned to one of two study groups.  The intervention group began the study with body weight and low-load exercises aimed to progressively learn the movement patterns of the HiRIT.  They then progressed up to 80-85% of 1 repetition maximum.  The sessions were supervised throughout the workout by an instructor which allowed for proper monitoring of safety and form.  Meanwhile, the control group received unsupervised low-intensity home-based exercise which was designed to remain at less than 60% of 1 repetition maximum.

The results of the LIFTMOR trial challenge the notion that those with osteoporosis should be limited to low intensity exercise.  The HiRIT group showed superior bone density improvement and functional performance.  Therefore, researchers “suggest HiRIT may not only reduce the risk of fracture by enhancing parameters of bone strength but also by preventing falls in postmenopausal women with low bone mass.”  Additionally, while not an intended primary outcome measure, it was observed that participants in the HiRIT group experienced improved stature.  They suggest this is due to increased core strength which allows the participants to stand with improved posture.  This is also associated with decreased risk of vertebral fracture, making it a very significant finding.

There was only 1 adverse event during this study, a participant experienced a mild low-back muscle strain.  However, she was able to return and complete the study with no additional issues.  This led the researchers to suggest: “HiRIT may be safe for postmenopausal women with low to very low bone mass, despite previous safety concerns.”

This study opens new possibilities for managing osteoporosis and preserving bone strength.  They note: “The graduated introduction of loading, close ongoing supervision, and focus on correct technique were key to the evident safety of the protocol and the ability of the LIFTMOR participants to tolerate the program. We do not recommend individuals with low bone mass undertake the LIFTMOR protocol in an unsupervised environment, even after notable training, because it is not possible to self-monitor technique.”

OTHER CONSIDERATIONS FOR OSTEOPOROSIS PREVENTION

Because this was the first study of its kind utilizing high intensity exercise for patients with low or very low bone mass, they advise caution: “HiRIT should be supervised, and proper screening is necessary before starting any high-intensity program.”  Additionally, they suggest future studies be conducted to confirm their findings and further identify best practices and recommendations for maximizing the benefits while ensuring safety of the patients.

The best way to combat osteoporosis is a healthy lifestyle beginning in youth to build strong bones and healthy habits.  However, this study reveals that even for those who are already losing bone mass, there are ways to strengthen your current levels and minimize risk of fractures.  Talk to your Doctor of Chiropractic about your risk factors.   By adopting healthy habits and staying informed, you can preserve your bone strength and continue to enjoy an active lifestyle.

 

Sources:

National Institute of Arthritis and Musculoskeletal and Skin Diseases “Overview of Osteoporosis”  https://www.niams.nih.gov/health-topics/osteoporosis  Accessed 3/28/24

Bone Health & Osteoporosis Foundation (BHOF) “What Women Need to Know”  https://www.bonehealthandosteoporosis.org/preventing-fractures/general-facts/what-women-need-to-know/  Accessed 3/28/24

Bone Health & Osteoporosis Foundation (BHOF) “Just For Men”  https://www.bonehealthandosteoporosis.org/preventing-fractures/general-facts/just-for-men/  Accessed 3/28/24

Mohebbi R, Shojaa M, Kohl M, von Stengel S, Jakob F, Kerschan-Schindl K, Lange U, Peters S, Thomasius F, Uder M, Kemmler W. Exercise training and bone mineral density in postmenopausal women: an updated systematic review and meta-analysis of intervention studies with emphasis on potential moderators. Osteoporos Int. 2023 Jul;34(7):1145-1178. doi: 10.1007/s00198-023-06682-1. Epub 2023 Feb 7. PMID: 36749350; PMCID: PMC10282053.

Watson, S., Weeks, B., Weis, L., Harding, A., Horan, S. and Beck, B. (2019), 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, 34: 572-572 e3659. https://doi.org/10.1002/jbmr.3659