Strength Training for Bone Health

Strength training, in my opinion, should be done by anyone & everyone for a multitude of reasons. The reason I want to focus on here is the positive impact of strength training on bone health.

Bone mass responds to mechanical strain, which is primarily a result of muscular contraction - not the forces of gravity as one might expect. Since muscle action contributes to much of the force experienced by bone, muscle strength & size tend to be associated with bone strength.

In situations where someone is put on bedrest or cannot use a limb due to injury, studies have seen a loss of muscle mass before a reduction in bone strength. On the recovery side, once use is resumed, muscle mass comes back before bone strength.

Strength training and other types of activity increase muscle strength & therefore bone mass. How much exercise can enhance bone strength is still not clear, nor is whether or not that increase in bone strength or bone density does in fact reduce the risk for fracture - but I'm hoping that theory someday proves to be true.

 

Bone health is no doubt influenced by a number of other factors as well - nutritional, hormonal, neural, inflammation, to name a few. I won't get into those here, but it's important to note that any or all of these things may impact your individual bone health & it's prudent to consult with a healthcare clinician before initiating a specific exercise program.

When you start a strength training program, you'll be exposed to various combinations of sets, reps and intensity to meet your specific goals - e.g. strength gains, hypertrophy (bigger muscles), muscular endurance, or bone health. The parameters seen to positively impact bone health in the studies that I've read appear to align with either a hypertrophy or strength-focused set/rep/intensity range:

3 x 8-12

70-80% 1RM

3x/week

4 x 3-5

85-90% 1 RM

3x/week

As far as types of exercises, since we know that muscular contraction imparts forces on bone that lead to bone formation, it makes sense to emphasize muscle groups that attach to bones that are more susceptible to stress fracture - e.g. the quadriceps with attachments to the femur & tibia, gluteals with attachments to the sacrum, pelvis & femur, hamstrings with attachments to pelvis & tibia, adductors with attachments to the pelvis & femur, gastrocnemius & soleus with attachments to the tibia, tarsals & metatarsals...etc. Essentially, strengthen all the leg muscles to strengthen the leg bones. 

Shown below is an example to get you started with some heavy, bone-building lower extremity strength exercises. My current routine looks something like this with variations tossed in every once in awhile - emphasizing the heavy lifts first, then working on hypertrophy & endurance later in the session.

In addition to a history of bone stress injuries, I have labral tears in both hips & arthritis in my right knee, so I do a lot of maintenance work to keep those happy. I also do plyometrics routinely to facilitate bone health goals, but that's a post for another day ;-)

Front Squat: 2x8 @ 50% of working weight

4x3-5 @ 85-90% 1RM

Barbell Deadlift: 2x8 @ 50% of working weight

4x3-5 @85-90% 1RM

Standing KB Hip Flexion 3x8 ea @ RPE 7-8

Superset Single Leg RDL 3x8 ea @ RPE 7-8

Single Leg Heel Raise 3x15-20 ea @ RPE 6-7

Adductor Plank 3x30-40s ea

Side Plank + Hip Abduction 3x30-45s ea

If you're looking for help with a specific, individualized strength program to meet your goals of improving bone health & potentially reducing injury risk, let's chat! Schedule a phone consult by clicking the button below!

References:

1. Rosa, N., Simoes, R., Magalhães, F. D., & Marques, A. T. (2015). From mechanical stimulus to bone formation: a review. Medical engineering & physics, 37(8), 719-728.

2. Martyn-St James, M., & Carroll, S. (2010). Effects of different impact exercise modalities on bone mineral density in premenopausal women: a meta-analysis. Journal of bone and mineral metabolism, 28(3), 251-267.

3. Mosti, M. P., Carlsen, T., Aas, E., Hoff, J., Stunes, A. K., & Syversen, U. (2014). Maximal strength training improves bone mineral density and neuromuscular performance in young adult women. The Journal of Strength & Conditioning Research, 28(10), 2935-2945.

4. Lohman, T., Going, S., Hall, M., Ritenbaugh, C., Bare, L., Hill, A., ... & Pamenter, R. (1995). Effects of resistance training on regional and total bone mineral density in premenopausal women: a randomized prospective study. Journal of Bone and Mineral Research, 10(7), 1015-1024.