Whether you are a man or woman, and whatever your age or health status, taking part in physical activity is the single most important thing you can do to maintain mobility and independence and enable you to enjoy a happy, healthy life. Barring an injury or disabling disease, most of us have the ability to walk and should aim to stay fit and to keep on walking for many years.
The sooner you begin to lead an active life, the better. From childhood to becoming a young adult, your body was growing bigger and stronger. Your skeleton was developing to support you throughout your life. Bones are particularly important to your health and play a vital role in maintaining your physical independence.
Being active will boost your energy levels, enabling you to keep on being more active for years to come. Activity also helps control your weight and is key to keeping your muscles and bones strong, your joints working properly and your heart healthy. The better your strength and balance, the less likely you are to fall and fracture bones, or to lose the ability to perform basic daily functions like walking, climbing stairs or standing up easily. Performing routine everyday physical activities, such as housework and gardening, all count as exercise. Choose to do hobbies and activities that you enjoy and which you will want to keep on doing, and think about joining a gym or sports club.
If you’re in pain, all this activity may seem impossible, but in many cases, exercise can actually help you feel better. There are five immediate benefits to being active and taking exercise – and they are easy to remember. They all begin with S.
1. Stamina – gives you the energy to keep going
2. Strength – helps build strong muscles to tackle any necessary work
3. Suppleness – encourages flexibility, allowing you to bend and stretch
4. Skill – being active encourages coordination of body and mind
5. Shape – exercise expends energy (burns calories), helping control your weight.
To keep ourselves healthy and help maintain our bone strength, how much exercise should we take, and which exercises should we do? For people over 65, and some at risk of falls, it’s important to include specific exercises designed to help with balance and coordination. But all of us should move around more and sit around less, in order to minimise bone loss and possibly reduce the risk of broken bones. Being physically active has also been proven to improve your cognitive function (brain function) and your sense of well-being, and to make it easier for you to get on with the various activities of everyday life.
Nowadays I prefer to use the expression physical activity rather than the word exercise because I want adult people to realise that any movement, including everyday activities and leisure pursuits, counts as exercise. This may include sport or leisure activities such as ballroom dancing or gardening, as well as the necessary activities such as housework or shopping. It can be as simple as climbing the stairs or taking short regular walks. Research has shown that you are never too old to start reaping the rewards of being more active.
When I think of a planned, structured physical exercise activity it usually has the aim of improving specific physical, mental and social needs (body, mind and spirit). Whatever physical activity or exercise you do it should help to improve those 5 S’s – your stamina, strength, suppleness, skill and shape.
The all-important posture
The pace of life and pressure of work can result in poor posture and tension headaches. We appear to carry the world on our shoulders and many people will experience stiffness in their upper body and neck. Sometimes bad posture is caused by unsuitable chairs and seating positions, or from sitting for too long in front of TV or computer screens. Check that your chair, desk and worktop are at a good height and in sufficient light. Sit with your bottom well back on the seat and if you’ve an arch in your back, support it with a cushion or towel. Have your legs slightly apart, knees bent to an angle of 90°, with your feet flat on the floor. (If you’ve got short legs, a footrest or block solves the problem.)
How much exercise do we need?
To be effective, exercise must be done on a regular basis. For general health, adult men and women should aim to do 30 minutes of moderate-intensity physical activity on at least five days each week, plus some other specific form of physical activity to improve muscle strength on at least two days each week. From the age of 65, exercise to improve balance and coordination is also recommended. We should aim for an active lifestyle. All activity is good for us – and inactivity isn’t! It’s a natural process for both men and women to lose some bone density after about the age of 35 (see here). Research has shown that regular, weight-bearing/impact exercise makes it possible to prevent some bone loss. A 2018 Consensus Statement from the Royal Osteoporosis Society (ROS) recommends that the most effective way to promote bone strength is to combine weight bearing/impact exercise with muscle strengthening exercise. If you are well enough, it is recommended you gradually increase the intensity of these types of activity or exercise. At least 50 moderate impacts (running, low jumps, hops or skips) are recommended on most days, or about 20 minutes of lower-impact exercise such as brisk walking if you have had spinal fractures or a large number of other osteoporotic fractures. Muscle strengthening exercises are also recommended on two to three days of the week, such as heavy gardening, housework or DIY (or sports and leisure exercises that work on the main muscle groups). If you are able to use weights then increasing the intensity of exercises using weights up to 8–12 repetitions is recommended – using the heaviest weight that you are able to lift this number of times (the technical name for this is ‘progressive muscle resistance’). Correct technique and posture is essential and you may need some instruction to make sure you are lifting correctly.
Agreeing with the UK guidelines for health, the ROS Statement says that if you are unsteady, or you are over 65 and not exercising regularly, then balance exercises are recommended in addition to help prevent falls and fractures. These should be incorporated at least two to three times a week.
How can the exercise programme help?
My programme of exercises consists of a variety of easy movements designed to promote well-being and fitness and specifically to promote bone strength in both men and women. They are exercises you can do in your everyday life, around your home, your workplace or in the garden. Aim to do the recommended 30 minutes on five days per week – but build up to this slowly to avoid possible injury or overtiring. Begin by choosing exercises you know you can do comfortably, and then gradually increase the amount and intensity. It is not unusual to experience a little muscle stiffness for a day or two after you exercise: it indicates you are working hard! But pain that is persistent may be a sign of injury, so stop exercising for a few days and, should it continue, consult your GP. The following exercises are intended for both men and women of any age and are especially beneficial for women aged 40-plus, who are approaching the menopause. However, whatever your age or ability, the sooner you start incorporating exercise into your life, the better.
Why is weight-bearing exercise with impact, combined with muscle strengthening exercise, so beneficial?
Weight-bearing/impact exercises (when you are standing up with all your body’s weight pulling on your skeleton) will help preserve and even build bone, but the effect only occurs when the weight is repeatedly exerted, especially with some force behind it. Muscles that are attached to either end of the bone force it to twist and bend in response to the strike action and jarring movements. This stress-strengthening effect on bone is boosted with a well-balanced diet including sufficient calcium and vitamin D (see Chapter 7).
High-impact weight-bearing activities such as basketball or track events with high-level jumps, or moderate-impact activities such as running, jogging and low-level jumping are effective in young adults. In fact, moderate impact will help to promote bone strength at any age as long as you are fit enough. All of these activities involve a hard, vibrating strike action in which the weight of the upper body is borne by the spine, hips, legs and feet. However, simple brisk walking and lower-impact aerobics exercises are useful weight-bearing/impact exercises that are especially suitable in later life to help prevent you losing bone strength as you age.
Muscle strengthening (or resistance) exercise is another way to add load and work muscles and bones harder. Using a weight or weights machine, wearing a weighted vest or using resistance bands would be one way to do this. Alternatively, the body’s weight can provide the resistance as in a press-up or wall press-up.
Any muscle-strengthening exercise may help to prevent loss of bone strength; however, gradually increasing resistance over time – the progressive resistance training described above – is necessary to give your bones the greatest chance of getting stronger. Past middle age, weight training and exercise classes that contain a variety of activities have been shown to influence bone strength.
Some years ago, studies at the University of Nottingham Medical School showed that premenopausal women, who were encouraged to do a series of little jumps for a controlled period of time on a regular basis, significantly increased the bone density of their ankles, knees and femoral head. On the flip side, it has been shown that astronauts who spend very long periods of time in a weightless environment experience considerable bone loss due to the lack of gravity. More recently, students volunteered to remain bedridden for long periods of time (even months) to help scientists separate out the effects of gravity on bone. All were found to have lost bone density, bone strength, and muscle mass, and extensive training was necessary to restore the loss.
Bone is a living tissue that reacts to increases in loads and forces by growing stronger, but not all forms of exercise are effective for improving bone strength. Swimming and cycling are excellent for improving overall strength and suppleness and the function of your heart and lungs, but they are not weight bearing, and consequently do not promote bone strength. Research has shown that it is regular, weight-bearing/impact exercise combined with muscle-strengthening exercise that helps prevent some of the dramatic bone loss which often occurs in women over 50 years of age.
Can we target specific bones?
Introducing additional weights can target specific bones still further. For example, exercising with dumbbells puts extra demand on the arms and wrists. Twisting a tight lid off a jar helps strengthen wrists and forearms, as does carrying heavy bags of shopping (just make sure you keep a straight back and don’t stoop). Lifting household objects, like heavy cooking pots or the vacuum cleaner, has a similar beneficial effect. It is likely that it’s the more intense muscle-strengthening exercise that is going to promote or improve bone strength, although doing any muscle-strengthening exercise will help to maintain bone strength and reduce the loss of bone density. However, take care to avoid falling when carrying awkward and heavy objects because a fall might cause a fracture.
Once you are familiar with this exercise programme, you will be able to adapt everyday objects and activities and turn them into beneficial exercise.
What about painful joints?
My programme of exercises particularly targets the hips, wrists, and spine because these are most vulnerable to the painful, crippling and sometimes life-changing fractures caused as a result of osteoporosis. It’s essential to maintain muscle strength, particularly in the legs and to maintain a good sense of balance and coordination. We will target the ankles, spine, thighs and back, as well as keeping the core muscles strong and flexible in order to avoid falls. So get up off your chair, enjoy the exercise sessions, strengthen your bones and make these exercises part of your life.
If your joints are the problem, don’t try to ‘pace’ your joints – let your joints pace you! For example, walk more, especially out in the fresh air to give yourself a boost.
If you are currently doing no exercise, then you will need to build up exercises slowly with professional input. Don’t take yourself off jogging or do moderate-impact aerobics if you haven’t exercised in a while. Instead, pick lower-impact activities or consider a good exercise class alternative such as dancing or a beginners’ Pilates, yoga or tai chi class and gradually build up as you become practised. Swimming or water aerobics are beneficial for painful joints, or try cycling on a stationary bike at the gym, but don’t forget to include some weight-bearing/impact exercise as well. The secret is to find an activity that suits you and to establish a regular activity routine, possibly in the company of friends to give you encouragement. Even a gentle brisk walking programme that increases in intensity and length will be beneficial – and, if part of a group, sociable! But remember that you must begin with some balance exercises for a few weeks first if you are at all unsteady.
Check this out
If you are in any doubt, I recommend talking to the specialist nurses on the Royal Osteoporosis Society Helpline (ROS). It’s a free number and the nurses are very well qualified to provide personalised and relevant guidance. The number is 0808 800 0035 (free from all UK landlines, mobiles and call boxes).
I would recommend you talk to your doctor and/or physiotherapist about whether it’s safe for you to exercise if you have:
• pain in your hip, knees or back
• heart disease, a respiratory ailment, high blood pressure or diabetes
• previous hip or knee surgery.
If you find doing exercises difficult, or you have painful spinal fractures because of osteoporosis, ask your doctor for a referral to a physiotherapist.
What if I have been diagnosed with osteopenia or osteoporosis on a bone density scan?
If your bone density is significantly below the average range for an adult, you are diagnosed as having osteoporosis. If your result is between the lower end of the normal range and the osteoporosis range, this is called osteopenia. If, like myself, you have been diagnosed with osteopenia, you may worry about breaking bones. You may decide to cut down on exercising and stop participating in some of your former sporting activities, for fear of an increased risk of breaking bones. This is quite understandable, but for the most part is unfounded. For many of you – and myself included – being physical and taking part in exercise classes or playing sport is an important part of our lives. The good news is that regular appropriate exercise can help strengthen our bones and muscles and help reduce our incidence of falls and fractures in the future. Specific stability and balance exercises have been shown to help keep us more stable and less likely to fall.
I want some specific exercises to help promote stronger bones and keep me steady
For those of you, male or female, who have fragile bones, and have been diagnosed with osteoporosis or an increased fracture risk, I have designed special exercises (see Chapter 13). These Osteo Relief exercises are also appropriate for those who have previously broken bones as a result of osteoporosis and who would like to prevent further fractures and reduce pain through exercise. It’s imperative that you think carefully before doing any exercises or movements that may increase the chance of you falling, and that you pay attention to your posture, particularly your upright posture. Avoid movements that involve sustained, repeated forward curving of the spine, such as touching your toes, if it is difficult or uncomfortable. This is particularly important for those of you who have experienced a compression fracture of the spine. Try to incorporate ‘hip hinging’, where you bend from the hip (rather than curving your spine) and slightly bend your knees, particularly when you are lifting anything. You can find more information about hip hinging on the ROS website www.theros.org.uk or by calling the ROS Helpline, as above.
A word of caution
If you are currently doing no exercise, you will need to build up exercises slowly with professional input.
Before starting this or any exercise programme, please check with your doctor if you suffer from heart disease; have high blood pressure, joint problems or back problems; are very overweight, have any serious illness, or are convalescing.
How to use this exercise plan
The exercises in this book are designed for everyone to use, no matter your current level of activity.
The exercise plan starts with a warm-up (see here), and is then divided into workouts for the upper body (see here) and lower body (see here), as well as specific exercises suitable for those already diagnosed with osteoporosis (see here) and exercises that can help to prevent falls (see here). Some exercises appear in more than one section – you can choose to work through the exercise plan as a whole, or to focus on one area of the body at a time.