Thread by @l_giangregorio

"What exercises should I recommend for my patient with osteoporosis?" If this is you, or if you are a person with osteoporosis, here is a 🧵that presents a simple approach to implementing exercise evidence for fall and fracture prevention.

Start strength training, ≥1 exercise from each category, 2-3 days/wk:
-push (e.g., push up on wall/counter)
-pull (1 arm supported dumbbell row, TRX row, elastic band pulldown)
-squat or sit to stand
-press (overhead press, pike pushup)
-hinge (deadlift, band pull through)

Practice good form first, then find a version of the exercise that takes high effort to complete between 6-12 repetitions. Start w 2 sets of each. Take 3-4 seconds to lower weight/body, & 2 seconds to lift it. Progress # reps to 12, then #sets to 3-5, then make exercise harder.

Do a few things to challenge your balance every day.

2-3 days a week, add a few exercises for trunk muscles, like planks, side planks, and bird-dogs (depicted below). Do 3-5 sets of each and hold for 3-20 seconds (depending on ability)

Some believe you need impact exercise. IMHO, low-impact aerobic physical activity (e.g., short bouts of brisk walking, dancing) is a good start, to condition muscles, and for other health benefits (strength training can do this too). But....

There is evidence that higher impact combined with strength training may improve bone strength in relatively healthy older adults low bone mass e.g., jumps or hops with soft landings. ESSA guidelines recommend 3-5 sets, 10-20 reps, 1-2 min rest.

That said, for a beginner approach to fall and fracture prevention, I would prioritize the strength and balance training - can mean as few as 5-6 strength exercises, done with high effort, 3x per week, and a few daily balance challenges.

The exercises that are best and safest for each person are different, and vary based on fracture and fall risk, health conditions, fitness, strength and balance. In an ideal world, one seeks out help from an exercise physiologist to select exercises, and progress them over time.

When bone mass is very low, fracture risk is high, or there is a history of fractures or other health conditions, an exercise physiologist or physio with strength and conditioning and osteoporosis-related expertise and can tailor exercise selection to minimize risk of fractures.

It IS possible for fractures to happen w exercise, often due to falls, or forces on spine too high. select exercises appropriate for your ability & fracture risk. reports of fracture during exercise are rare. They can also happen during daily activities. So get strong for life!

To be clear, this thread is not health advice for any individual person. It is an outline for how to simplify exercise programs and what to prioritize. You should consult a doctor or exercise physiologist or physical therapist about what is best for you.