How long to improve bone density

The most advanced studies now are focusing on the use of some noninvasive bone imaging techniques, such as quantitative peripheral computed tomography pQCT , magnetic resonance imaging MRI , and DXA-based hip structural analysis HSA [ 16 , 41 ]. Of these, once eliminated duplicates and papers not primarily focused on exercise and osteoporosis, 18 systematic reviews and meta-analyses were considered with respect to different type of exercise Table 1 and 7 with respect to whole body vibration Table 2.

One of the most common forms of aerobic training is walking, an exercise very well accepted by the older people, because it is harmless, self-managed, and easily practicable. The effects of walking on BMD have been widely considered, although the results are not always consistent in the various studies [ 17 — 19 , 42 ].

The meta-analyses showed the absence of significant effects on the lumbar spine or on the femoral neck attempted by the only walking [ 6 , 43 ]. Likewise, from the studies analysed by Gomez Cabello et al. However, the effectiveness of walking in maintaining the level of BMD and in preventing its loss is already an excellent result of this simple type of exercise.

Actually, there is evidence that an intervention of more than 6 months in duration can provide significant and positive effects on femoral neck BMD in peri- and postmenopausal women [ 18 ]. Some studies show how a brisk walking or jogging can have positive effects on hip and column BMD in women of menopausal age [ 19 ].

Certainly, some low-impact activities, such as jogging combined with stair climbing and walking, favor minor loss of BMD in both the hip and the spine in menopausal women. In comparing different types of physical exercises with controls, Howe [ 15 ] found a significant effect in BMD for bipodalic or monopodalic static exercises and on spine and wrist for dynamic low-impact exercises including walking and Tai Chi.

Regarding Tai Chi, the issue is in increasing debate; recent literature [ 21 , 22 , 44 — 46 ] suggests a positive effect on attenuating BMD loss at the lumbar spine and the proximal femoral neck and on biomarkers of bone metabolism. However, in order to be effective, this activity has to last 12 months as minimum [ 21 ]. Walking, as an isolated intervention, is not able to modify the loss of BMD.

However, in the context of a health maintenance program in general it is advisable to walk for at least 30 minutes a day. Aerobic training and in particular the path with high intensity and speed, interspersed with jogging, climbing scales, and stepping, is able to limit the reduction of BMD. Strength and resistance training are the most studied techniques to increase bone mass in the elderly.

The rationale of these exercises lies in the mechanical stimulus indirectly produced on the bone [ 8 , 9 , 41 ]. Like weight-bearing exercises, the strength exercise determines a joint reaction force and muscle strengthening, producing an important clinical benefit on the BMD, in the lumbar spine and, to a greater extent, in the femoral neck [ 20 ]. Studies have examined the effect of strengthening the muscles of the upper limb and lower limb, rather than specific groups such as iliopsoas and spinal extensors.

From the evidence gathered by Zehnacker et al. In relation to the hip, the exercise is effective on the greater trochanter if it involves the buttocks, on the lesser trochanter if it involves the iliopsoas, and on the Ward's triangle if it involves the adductors and the hip extensors, according to the studies of Kerr et al. Here, the authors concluded that there are several possible explanations for the different effectiveness of site-specific exercises: various muscle insertions, different weight or type of contraction, and duration and nature of the exercise.

Similarly, Sinaki et al. After two years of exercise, there was a significant reduction in the loss of BMD in the subjects being treated. This significant difference, compared to controls, was maintained eight years after, despite the decrement of both BMD and muscle strength. In opposite opinion are Bemben et al. In particular, there was no difference between men and women at the femur level, while in women the effect is greater at the spine.

The peak load exerted seems to be therefore more important than the number of repetitions on the increase in bone mass in menopausal women [ 1 ]. Other considerations that must be taken into account [ 9 ] are that women require a greater intensity of exercise to obtain certain results on bone mass. Hence, it is always important to perform a balanced agonists and antagonists training taking into account that the speed of execution during the movements is pertinent in obtaining greater osteogenic stimulation.

The effectiveness of progressive resistance training is confirmed also in the review of Cheung and Giangregorio [ 41 ] who considered this exercise the best one in postmenopausal women to improve both spine and hip BMD.

This would not be the case of older adults, in which physical activity and exercise only have minimal effects on BMD, while strength training should be suggested. However, in clinical practice, in osteoporotic individuals with high risk of vertebral fracture, the use of resistance machines should be well thought out, since this technique often requires forward bending and twisting of the trunk to perform the exercise or to adjust the equipment and to ensure the proper setting.

They can be utilized only if is used and adjusted with the proper form [ 51 ]. Strength training determines an increase in specific site bone density, in particular at the neck of the femur and at the lumbar spine, which is maintained in the short to medium term. At least 3 sessions a week for a year are recommended.

Progressive resistance training for the lower limbs is the most effective type of exercise intervention on bone mineral density BMD for the neck of femur. The multicomponent training consists of a combination of different exercises aerobics, strengthening, progressive resistance, balancing, and dancing and it is aimed at increasing or preserving bone mass.

This implies that the same interventions are provided to all people, differently from multifactorial training, customized on the individual characteristics [ 52 ].

The association of several types of exercise is advised to the patients affected by osteoporosis with the goal to counter the reduction of bone mass [ 23 — 26 , 43 , 53 — 56 ]. The combination of multiple types of exercise would have a significant effect on BMD at three sites: femoral neck and greater trochanter, but the maximum benefit would be achieved at the spine level [ 15 ].

However, diverse methodological and reporting discrepancies with respect to the proposed mix of exercises, the characteristics of patients with or without fractures, and the outcome measures seem relevant in determining the result of the exercise program. The revision of Gomez-Cabello et al. The meta-analysis conducted by Nikander et al. It is interesting to note from this review how the most challenging high impact exercise programs, such as jumping, are only effective when they are associated with other low-impact exercises.

Bolan at al. Giangregorio et al. In particular, it is stated that such individuals should not engage in aerobic training to the exclusion of resistance or balance training. Xu et al. They suggest that each session should be between 30 and 60 min, 3 or more times per week for at least 10 months.

Also, in the review of studies analyzed by Marquez et al. Combined exercise and group exercise programs, including weight-bearing activities, balance training, jogging, low-impact loading, high magnitude exercise, muscle strength, and simulated functional tasks, are advised to determine BMD increasing or at least to preserve it. However the combination of exercise should be tailored on the patient's clinical features. No agreement exists on the best protocol in terms of duration, frequency, and the type of exercises to be combined.

The most relevant effect was detected at the spine. The vibration of the entire body is a physiotherapy intervention based on the use of a high frequency mechanical stimulus generated by a vibrating platform Whole Body Vibration or WBV that activates the mechanoreceptors of the bone favoring osteogenesis. The results of the studies included in two systematic reviews [ 1 , 61 ] conclude that the treatment with a WBV seems to be more effective than simple walking and of similar efficacy to strength training to improve bone mass at specific sites femoral neck and spine in postmenopausal women.

To obtain these results, Dionello et al. The positive effect of WBV in improving BMD in different sites is supported also by other reviews [ 29 — 31 ] and confirmed by Oliveira et al.

Fratini et al. Thus, it is better if the subject during the treatment assumes static postures, such as full-standing or hack squat. However, many factors e. Conversely, a previous systematic review [ 34 ] showed that while the use of vibration platforms can improve muscle strength in the lower limbs of elderly patients, it does not seem to induce significant changes in bone mineral density in women.

Similarly, while the analysis performed by Cheung and Giangregorio [ 41 ] on 5 systematic reviews shows only a modest clinical improvement of BMD at the hip in postmenopausal women, the review of Jepsen et al. Training with vibrating platforms is reported to have effect on enhancing muscle strength, improving balance, and reducing the risk of fall in osteoporotic patients, while controversial findings on improvement of BMD in different sites were reported.

Although several exercise recommendations for individuals with osteoporosis have been proposed, reviews are often inconclusive, for the methodological variability emerging from the studies. However, results from the Cochrane review [ 15 ] suggest a relatively small, statistically significant, but possibly important effect of exercise on bone density in postmenopausal women compared with control groups.

The exercise types most effective on BMD for the neck of femur, which should be considered in clinical practice, appear to be the progressive resistance strength training for the lower limbs. The most effective intervention for BMD at the spine has been suggested to be the multicomponent training exercise programme. Weight-bearing aerobic exercise and training with vibrating platforms may have also an impact in improving BMD.

These evidences are relevant not only because they support the possibility to increase BMD in postmenopausal women, but also because they confirm the possibility to prevent further bone loss in osteoporotic patients, thus limiting the risk of fractures. Key considerations for future research lines emerge from this review: 1 the need for studies to evaluate the effects of the longer-term exercise; 2 the need for studies on male patients; 3 the need for studies that use evaluation criteria of the outcome that are more sensitive to changes in the bone structure; 4 inclusion of parameters such as diet or drugs as a covariate in the analysis of the effects of the exercise; 5 the need to stratify studies on the effects of exercise on BMD based on age; and 6 the need to understand the effects of deconditioning.

National Center for Biotechnology Information , U. Journal List Biomed Res Int v. Biomed Res Int. Published online Dec Author information Article notes Copyright and License information Disclaimer. Corresponding author.

Maria Grazia Benedetti: ti. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

This article has been cited by other articles in PMC. Abstract Physical exercise is considered an effective means to stimulate bone osteogenesis in osteoporotic patients. Introduction According to the literature, the level of bone loss in a postmenopausal woman increases with age, respectively, with a loss of 0. In general, therapeutic exercises for osteoporosis can be ranked in two types of activities: Weight-bearing aerobic exercises , such as impact activities or any other exercise in which arms, feet, and legs are bearing the weight, i.

Materials and Methods 2. Methodological Problems Emerging from the Studies Several critical issues in the evaluation of evidence, limiting in some way the conclusion of this review, were highlighted in the Cochrane reviews [ 3 , 15 ]. Table 1 Systematic reviews and meta-analyses on Exercise and Osteoporosis.

Effects of training on bone mass in older adults: a systematic review. Sports Med. Strength exercise seems to be a powerful stimulus to improve and maintain bone mass during the ageing process. Targeted exercise against osteoporosis: A systematic review and meta-analysis for optimising bone strength throughout life. BMC Med. The findings from these studies also suggest that exercise regimens that include moderate- to high-magnitude impacts from varying loading directions may represent the optimal mode to enhance bone structure and strength.

Effect of weighted exercises on bone mineral density in post-menopausal women. A systematic review. J Geriatr Phys Ther. The exercise program must be incorporated into a lifestyle change and be lifelong due to the chronic nature of bone loss in older women. McMahon M. What impact does aquatic therapy have on bone density in postmenopausal women? If it has a positive or maintenance effect, what are the programme parameters that facilitate these outcomes?

Aqualines ;29 1 Exercise for preventing and treating osteoporosis in postmenopausal women. Cochrane Database Syst Rev. The most effective intervention for BMD at the spine was combination exercise programmes compared with control groups. Our results suggest a relatively small statistically significant, but possibly important, effect of exercise on bone density compared with control groups. The effect of exercise on pQCT parameters of bone structure and strength in postmenopausal women -- a systematic review and meta-analysis of randomized controlled trials.

Osteoporos Int. Meta-analysis of walking for preservation of bone mineral density in postmenopausal women. Plos one. However, diverse methodological and reporting discrepancies are apparent in the published trials on which these conclusions are based.

Other forms of exercise that provide greater targeted skeletal loading may be required to preserve bone mineral density in this population. Effects of walking on the preservation of bone mineral density in perimenopausal and postmenopausal women: a systematic review and meta-analysis.

The effect of physical exercise on bone density in middle-aged and older men: a systematic review. Osteop Int. Effects of ground and joint reaction force exercise on lumbar spine and femoral neck bone mineral density in postmenopausal women: a meta-analysis of randomized controlled trials. BMC Musculoskelet Disord.

J Orthop Translat. This beneficial effect is better observed in long-term TCC practice. Effects of tai chi exercise on bone health in perimenopausal and postmenopausal women: a systematic review and meta-analysis. If we combine this information with your PHI, we will treat all of that information as PHI, and will only use or disclose that information as set forth in our notice of privacy practices.

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Show references Bone health for life: Health information basics for you and your family. Accessed Jan. Exercise and bone health. American Academy of Orthopaedic Surgeons.

Golden NH, et al. Throughout childhood, adolescence, and early adulthood, the bones absorb nutrients and minerals, gaining strength. However, as a person enters their late 20s , they have reached their peak bone mass, which means that they will no longer gain bone density.

The bones may lose density as a person continues to age. After menopause , in particular, a person becomes susceptible to osteoporosis , a disease that can weaken the bones so much that they can break easily. However, there are many ways to help boost and maintain bone density. Keep reading for tips on increasing bone density naturally. Studies have shown that both weightlifting and strength training help promote new bone growth and maintain the existing bone structure.

For example, a study on bone density in children with type 1 diabetes showed that participating in weight bearing physical activity during peak bone-growth years improves bone density.

Another study in children showed similar results. Vegetables are low in calories and provide vitamins , minerals, and fiber. One study showed that vitamin C may help protect bones from damage. Eating yellow and green vegetables can benefit most people. In children, these vegetables help promote bone growth; in adults, they help maintain bone density and strength. One study showed that children who ate green and yellow vegetables and few fried foods saw an increase in healthful fat and bone density.

In another study , postmenopausal participants who ate 9 servings of cabbage , broccoli , and other vegetables and herbs for 3 months saw reduced bone turnover and calcium loss. The researchers attributed the results to the boost in polyphenols and potassium that the vegetables provided. Calcium is the primary nutrient for bone health. As the bones break down and grow each day, it is essential that people get enough calcium in their diets. The best way to absorb calcium is to consume small amounts throughout the day, rather than eating one high-calcium meal per day.

It is best to get calcium through the diet, unless a doctor advises otherwise. Foods rich in calcium include:. Vitamin K-2 plays an essential role in bone health by reducing calcium loss and helping minerals bind to the bones. Vitamin D helps the body absorb calcium. People with vitamin D deficiencies have a higher risk of losing bone mass. A person can absorb vitamin D through moderate sun exposure.

Without sufficient vitamin D, a person has a higher risk of developing bone disease, such as osteoporosis or osteopenia.

A healthy weight is essential for bone density — people who are underweight have a higher risk of developing bone disease, while excess body weight puts additional stress on the bones. People should avoid rapid weight loss and cycling between gaining and losing weight. As a person loses weight they can lose bone density, but the density is not restored when a person gains back the weight. This reduction in density can lead to weaker bones.