Strength training is often discussed in the context of muscle mass and physical performance. Its role in bone health receives far less attention. Yet maintaining bone density is one of the most important aspects of healthy ageing.
Bone health across the lifespan
Bone health starts earlier than many people realise. Bone mass is built during childhood and peaks in early adulthood, but maintaining strong bones remains important throughout life.
Bone density gradually declines with age in both men and women. In women, bone loss accelerates after menopause due to the decline in oestrogen levels. This increases the risk of osteopenia, osteoporosis and fragility fractures.
Bone is living tissue that responds to mechanical load. When muscles generate force against bone during resistance exercise, and when bones absorb appropriate weight-bearing impact, these loads stimulate the body to maintain and strengthen skeletal tissue.
Regular exercise can therefore help slow age-related bone loss. It can also increase muscle strength and improve balance, addressing two important contributors to falls and fractures. The response varies with the type, intensity and consistency of the exercise, as well as a person's age, health and starting bone density.
Three key types of exercise for bone health
1. Weight-bearing exercise
Weight-bearing activities are performed on your feet and require you to support your own body weight against gravity. Examples include walking, stair climbing, jogging, dancing, step-ups, skipping and jumping.
Higher-impact activities generally provide a greater stimulus for bone health where they are appropriate. The suitable level of impact depends on bone strength, previous fractures, joint health, physical capacity and falls risk. For some people, low-impact activities such as walking and stair climbing are the right starting point; others may safely progress to jogging, hopping or jumping.
Weight-bearing activity should be included regularly, often on most days of the week. Walking has broad health benefits, but it may not provide enough stimulus on its own to optimise bone strength. This is why resistance and balance training are also important.
2. Progressive resistance training
Progressive resistance training involves working the muscles against resistance, with gradual increases in the load over time to build bone and muscle strength. Examples include squats, lunges, deadlifts, rows, chest press and shoulder press. Free weights, gym machines and resistance bands can all be used.
The relationship between strength training and bone health is well established. Moderate- to high-intensity progressive resistance exercise generally provides a stronger bone stimulus than very light exercise, particularly when it is combined with appropriate weight-bearing impact.
Strength training should generally be performed at least twice per week. The load, exercises and rate of progression need to match the individual's experience, movement quality and fracture risk. Technique and consistency matter more than rushing to heavier weights.
3. Balance training
Balance training does not necessarily increase bone density directly, but it has an essential role in fracture prevention. Improving balance, mobility and the ability to respond to a loss of stability can reduce the risk of falls.
Balance exercises should progress to a level that safely challenges stability and may include:
- Static balance tasks, such as standing on one leg or in a heel-to-toe position.
- Movement-based tasks, such as heel-to-toe walking or stepping over obstacles.
- Functional tasks, including rising from a chair and negotiating steps.
- Dual tasks, such as maintaining balance while catching a ball.
Balance work should be included several times per week, particularly as we get older or when there are concerns about falls. Exercises need to be challenging enough to improve balance, while still being performed in a safe environment with appropriate support or supervision.
Why stronger bones are only part of the picture
The objective is not simply stronger bones. Preserving bone density and building muscle strength help support mobility, independence, recovery from injury and quality of life as we age.
Exercise also supports metabolic and cardiovascular health. Few interventions benefit bone, muscle, balance, physical function and long-term health simultaneously.
Exercise needs to be matched to fracture risk
If you have osteopenia, osteoporosis, a previous fragility fracture, persistent pain or another relevant health condition, your exercise program may need to be modified. High-impact exercise is not suitable for everyone, and people with vertebral fractures or very low spinal bone density may need particular care with loaded forward bending, twisting and rapid or uncontrolled movements.
This does not mean avoiding exercise. It means choosing the right starting point and progressing safely. A physiotherapist or accredited exercise physiologist can assess your current capacity and develop a program that balances bone loading, muscle strength, balance and injury risk.
Exercise is an important part of osteoporosis prevention and management, but it does not replace medical assessment or prescribed osteoporosis treatment. Bone density, fracture history, medicines, nutrition, vitamin D status and other risk factors may all need to be considered.
The bottom line
Bone responds to the demands placed upon it. A well-designed program combining weight-bearing activity, progressive resistance training and challenging balance work can help maintain bone strength, preserve physical function and reduce falls and fracture risk. The safest and most effective program is one matched to your individual bone health and physical capacity.
How Executive Medicine can help
Executive Medicine's exercise physiologists can translate assessment findings into a practical exercise plan aligned with your health, functional capacity and long-term goals. Where bone health or fracture risk is a concern, exercise advice can be considered alongside the broader medical assessment.
References
- Healthy Bones Australia. Exercise Prescription to Support the Management of Osteoporosis: For Physiotherapists and Exercise Physiologists. View source .
- Healthy Bones Australia. Position Statement on the Management of Osteoporosis. View source .
- International Osteoporosis Foundation. Exercise. View source .
