Benefits of Exercise on Your Bone Health

Exercise has many benefits! There is much discussion on how regular exercise can improve cardiovascular endurance, increase strength and maintain a healthy weight, and prevent many diseases such as diabetes and high blood pressure.

However, we cannot forget about our bones! How many people think about exercising to strengthen bones or prevent fractures? There are many reasons why it is essential to have strong bones. Bones not only serve as a framework for our body but also have crucial roles such as protecting vital organs, making blood cells, and storing minerals. Unhealthy bones can lead to fractures, resulting in significant morbidity and limitations in daily activities.

Yes, nutrition, including the appropriate amount of Calcium and Vitamin D intake, are critical components of good bone health. Additionally, exercise is an essential factor in building and maintaining strong bones!

Bones go through a remodeling process where old bone is removed and replaced by new bone throughout our lives. Cells within the bone called osteoclasts work to break down bone, and cells called osteoblasts build bone. This remodeling process is essential for maintaining calcium homeostasis, shaping the skeleton during growth, and repairing damage caused by daily stress. Under an appropriate amount of force, the bones thicken at the point of maximum pressure resulting in stronger bones. The balance is offset toward bone breakdown with aging, nutrient depletion, certain medications, and disease processes. It is imperative to manage modifiable factors for weak bones to optimize bone development and minimize bone breakdown.

So when to start thinking about our bone health?

Well, the highest rate of bone development is seen in young children and early teen years, with more than 90% of peak bone mass achieved by age 18. Peak bone mass refers to the maximal density of the bone that will be attained during our lifetime. This is determined by genetic factors and nutrition, hormones, and physical activity. Thus, the bone density that we have at age 18 and into our early 20s is the highest in our lifetime! As we advance into adulthood, bone formation decreases, and bone breakdown increases. In adults, the bone mass equals the peak bone mass at age 18-25 minus the amount of bone subsequently lost. Therefore, it is critical to emphasize healthy eating and exercise habits in children and adolescents to ensure the development of maximal peak bone mass.

It becomes essential for pre-menopausal women to maintain bone density that was achieved in their younger years. Estrogen plays a crucial role in bone health in women and plays in our favor. Estrogen is protective of bones because it inhibits osteoclasts which break down bone and keeps the bone turnover process balanced. In addition, regular weight-bearing exercises help maintain bone strength and minimize bone loss in adulthood.

During menopause, estrogen levels drop, and the balance of bone turnover is altered, leading to an increased rate of bone removal concerning bone formation. This transition results in weakened architecture and low bone mass and can lead to osteoporosis. Osteoporosis is the most common issue of the bone that affects both women and men. It is characterized by low bone mass with disruption of standard bone architecture, making the bones more susceptible to fracture. This is concerning, as the elderly patient may already be at an increased fall risk due to other medical conditions or deconditioning.

Although osteoporosis does have a genetic component, it is preventable and treatable, especially when diagnosed early. The first-line approach to prevention and treatment includes eliminating risk factors that lead to poor bone health, such as inactivity, smoking, alcohol, caffeine, and low Vitamin D and Calcium levels.

Regular weight-bearing and muscle strengthening exercises to reduce bone breakdown risk of fractures and falls. Weight-bearing activities are where muscles contract against gravity with the feet and legs supporting the body's weight. Examples include walking, jogging, jumping, and dancing. Muscle strengthening exercises include weight training or other resistance training methods. Examples include weight lifting, weight machines or resistance bands, yoga, and Pilates. One study evaluating the relationship between bone mineral density and exercise showed that Senior Olympic runners over 65 had significantly greater bone mineral density than non-athletes of similar age. This is encouraging and supports the notion that certain activities can potentially counteract the typical age-related bone loss in adults and improve strength, posture, and balance.

The Best Exercises for your Bones

We know that exercise is good for our overall health, including our bones. But, what are the best exercises, and how often should they be performed? This question will vary depending on the individuals' age, cardiovascular fitness, and associated comorbidities. There are general guidelines with recommendations for exercise in children and adults. For example, the Center for Disease Control recommends that children and adolescents incorporate impact activities such as running and jumping into their daily exercise to build strong bones.

The general recommendation of weight-bearing exercises and resistance training for maintaining bone health applies to pre-premenopausal women. However, regular physical activity may not be enough to improve bone mineral density in this population. Instead, as demonstrated by several studies, higher impact exercises such as jumping, jump rope, and plyometric exercises may be necessary as these correlate with more significant bone mineral mass improvements when performed regularly.

The positive effect of exercise on bone growth is diminished in post-menopausal women due to an increased rate of bone breakdown. Evidence suggests that combining resistance and weight-bearing training in post-menopausal women can improve bone density and prevent falls. The type, intensity, and frequency of exercise, especially for the elderly, need to be catered to each individual based on their age, fitness level, and medical history. A physician's evaluation and clearance are recommended before starting a vigorous exercise program.

It is critical to achieve a high maximal peak bone mass in children and young adults and maintain healthy bones throughout adulthood. This can be accomplished by eliminating factors that cause bone breakdown and incorporating regular exercises that include weight-bearing and resistance training.