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Exercise for Osteoporosis and Prevention of Bone Loss

An Interview with Rebekah Rotstein

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Updated June 20, 2014

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

What would an adequate Pilates exercise program for prevention of osteoporosis need to include?
A Pilates osteoporosis-prevention program needs to include sufficient back strengthening (spinal extension and scapular stability) as well as hip and wrist strengthening. These elements are the basis of the Pilates for Buff Bones® program. I often see Pilates classes and sessions emphasizing spinal articulation at the expense of the shoulders, back and hips.

I recommend re-evaluating your programming to be sure that the back gets attention - and specifically the upper thoracic. Many of us cheat by relying on our lumbar spine for the extension! That upper back strength has been shown to improve balance and reduce risk of falls too. And of course core control is integral in order to achieve that upper back extension. More standing should occur near the end of the workout too to make the work functional, integrating the feet, and for additional weight-bearing.

What about exercise with the larger Pilates equipment like reformer and Pilates chair? Are they safe for people with osteoporosis?
The Pilates equipment is terrific for those with osteoporosis because the springs provide the resistance needed for bone strengthening and offer limitless movement possibilities, both within the classical repertoire and beyond. The chair is a great machine for weight-bearing, functional exercises in particular.

Which Pilates exercises are best for people with osteoporosis?
I recommend side, front and back splits on the reformer (as appropriate for the client's level) since they're weight-bearing and improve balance, just like the standing leg pumps and mountain climber on the wunda chair. Pulling straps on the reformer is great for the back and shoulders as are the swan on the chair and cadillac.

What kinds of movements should people with osteoporosis avoid?
Those with osteoporosis should avoid spinal flexion (forward bending) - especially when its loaded like in rolling like a ball and short spine (where the back bends forward with mid-upper spine bearing the body weight). They should also avoid motions that incorporate flexion with side bending and rotation. Any side bending should emphasize a lengthening of the spine rather than pure side-bending which many exaggerate and collapse into flexing as well without realizing it. The key is to "off-load" the front, or anterior portion, of the vertebral body [spine].

Thank you, Rebekah!

Below are sample Pilates exercises that fall within the guidelines that Rebekah Rotstein outlines above. Some are weight bearing and some include resistance from the Pilates ring or exercise band. They do not include flexion (forward bending) or side bending with rotation. *Anyone with osteoporosis should do Pilates or any exercise with an instructor trained in exercise appropriate for osteoporosis.

Rebekah teaches a full osteoporosis safe workout on her DVD Pilates for Buff Bones®. You can learn more about Rebekah Rotstein on her website, IncorporatingMovement.com. Rebekah also teaches Pilates for osteoporosis classes online at PilatesAnytime.com

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