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Pilates and Exercise for Osteoporosis

an Interview with Rebekah Rotstein


Updated June 20, 2014

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

Exercise partners lifting dumb-bells in living room.
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Exercise for osteoporosis is a confusing subject. There are exercises for prevention. There are exercises for rehab. And, when osteoporosis is present, there is always the issue of exercise safety. Pilates, specifically, is a form of exercise that is often mentioned with regard to osteoporosis. But in Pilates there are definite parameters as far as what exercises are appropriate for osteoporosis.

We must have strong bones that can bear our weight and allow us mobility. But with so many dynamics playing into the exercise for osteoporosis scenario, we really need to know what we are doing when we exercise for osteoporosis. In the interview below, Rebekah Rotstein helps us clarify the role of exercise, Pilates, and Pilates equipment with regard to osteoporosis and bone strengthening.

Among a long list of credits, Rebekah Rotstein is an expert in osteoporosis, bone health, and Pilates. She is the founder of Incorporating Movement, a Pilates and Movement education organization, and the designer of the Pilates for Buff Bones® workout. Rebekah is also an educator for the Foundation for Osteoporosis Research and Education.

Rebekah, we have all heard that weight-bearing exercise helps prevent osteoporosis. How does it do that?
Bone is dynamic tissue, like muscle, that strengthens in response to forces it has to resist. Gravity is one such force, and working against gravity is what we refer to when speaking of "weight-bearing exercise." The combination of compression and tension from gravity and from our muscles plays a major role in bone strengthening. But the prevention of osteoporosis also comes from impact like jumping or running where the bone is "loaded" to an extent that it has to accommodate these forces, basically reinforcing itself to sustain future forces. (Note that if someone has extremely low bone density or has already experienced a fracture, high impact could be contraindicated.)

Should we be making a distinction between weight bearing exercises and resistance exercises?
Weight-bearing exercises are technically anything standing, although I include quadruped (on hands and knees) in this since you bear the weight of your trunk through your hands and transmit forces via your wrists. The wrists are a critical site to strengthen because they are the most common site of osteoporotic fractures along with the spine and hip.

Resistance exercises simply involve muscles pulling on the bone to create tension which also fortifies the bone. The resistance can come from weights, elastic bands or springs. But you can also consider your own body weight as resistance in some instances, like a push-up. In this example, you're using gravity and your own body weight to provide resistance and induce muscle pull.

The best formula for bone strengthening, in addition to the high-impact we discussed before, occurs where you combine weight-bearing with resistance training. So weighted squats, or using an elastic band while standing or performing standing lat pulls, would be good additions to a bone workout regimen.

I know there are some limits around Pilates and osteoporosis which we will discuss later, but in terms of prevention, is Pilates enough?
Pilates is a wonderful means for strengthening the body, establishing efficient movement patterns, and aligning the joints and the axial skeleton (among numerous other benefits!). But your bones need additional loading to prevent osteoporosis as well as the general bone loss that naturally occurs with age. This loading comes from weights, squats and high impact exercises like running and jumping. You need to move in new ways and to "surprise" the bone, as some researchers are now saying. Bone tissue gets lazy so we need to keep it on its toes, all pun intended! We need to move in differing directions and at different speeds to encourage the bone to continue to strengthen.

So Pilates is an invaluable tool to complement bone-loading techniques and to prevent injuries and falls. We have to remember that the real danger with osteoporosis is the devastating falls that can induce a fracture. Pilates, with its emphasis on posture, alignment and balance as well as full body integrated movements, offers a fantastic platform when combined with other functional (upright), impact-based and resistance exercise. Furthermore, Pilates establishes good form for weight training so that the forces best transmit through a well-aligned spine and hips. And remember, exercise must be accompanied by other healthy lifestyle habits including proper nutrition to mineralize the bones.

Next, exercises for osteoporosis and preventing bone loss.

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