Key points
- Resistance exercise, jumping, and explosive movements with rapid stopping all help to improve bone health and bone mineral density.
- Combined and aerobic exercise can benefit bone health.
- Few study interventions meet best-practice guidelines for the frequency, duration, intensity, and type of exercise for osteoarthritis.
- Diet-alone is not effective for reducing pain and improving function in osteoarthritis but diet + exercise is.
- Aquatic exercise is as effective as land-based for improving physical function and reducing pain.
Resistance exercise is known to improve bone health, in particular, bone mineral density and there are associations between strength, muscle mass, and bone density.1
Plyometric (jumping-type) exercise has been shown to improve bone mineral content, density, and structure without negative effects in children and adolescents.2 Strength training and exercise that includes impact (like jumping or rapid stopping) also improves bone mineral density in peri- and post-menopausal women,3 and combined aerobic and resistance training improves bone health in people with diabetes.4
While aerobic exercise is beneficial for osteoarthritis, a review of interventions for osteoarthritis of the knee found that only 8% of all studies on exercise for osteoarthritis met best-practice guidelines for frequency, intensity, type, and duration of exercise.5 Despite this, reviews of the evidence show that diet alone does not reduce pain in osteoarthritis, whereas diet + exercise does.6 Both diet and exercise improve physical function in osteoarthritis,6 and this effect is likely to be greater when combined.
In older people (70 years plus) with osteoarthritis, physical exercise improves pain and function. Aquatic exercise for this population is as effective as land-based exercise. However, only diet + exercise had a significant effect on weight loss.7
It is recommended to use loads of 70-90% of 1-repetition maximum for more than 2 sets per exercise, using 1-3 minutes rest intervals over 2-3 sessions per week to improve lean body mass, bone mineral density, and reduce the risk of osteoporosis.1
References
1. Pimenta LD, Massini DA, Santos Dd, Vasconcelos CMT, Simionato AR, Gomes LAT, et al. Bone Health, Muscle Strength and Lean Mass: Relationships and exercise recommendations. Revista Brasileira de Medicina do Esporte. 2019;25:245-51.
2. Gómez-Bruton A, Matute-Llorente Á, González-Agüero A, Casajús JA, Vicente-Rodríguez G. Plyometric exercise and bone health in children and adolescents: a systematic review. World Journal of Pediatrics. 2017;13(2):112-21.
3. Sañudo B, de Hoyo M, del Pozo-Cruz J, Carrasco L, del Pozo-Cruz B, Tejero S, et al. A systematic review of the exercise effect on bone health: the importance of assessing mechanical loading in perimenopausal and postmenopausal women. Menopause. 2017;24(10):1208-16.
4. Viggers R, Al-Mashhadi Z, Fuglsang-Nielsen R, Gregersen S, Starup-Linde J. The Impact of Exercise on Bone Health in Type 2 Diabetes Mellitus—a Systematic Review. Current Osteoporosis Reports. 2020;18(4):357-70.
5. Schulz JM, Birmingham TB, Atkinson HF, Woehrle E, Primeau CA, Lukacs MJ, et al. Are we missing the target? Are we aiming too low? What are the aerobic exercise prescriptions and their effects on markers of cardiovascular health and systemic inflammation in patients with knee osteoarthritis? A systematic review and meta-analysis. British Journal of Sports Medicine. 2020;54(13):771-5.
6. Hall M, Castelein B, Wittoek R, Calders P, Van Ginckel A. Diet-induced weight loss alone or combined with exercise in overweight or obese people with knee osteoarthritis: A systematic review and meta-analysis. Seminars in Arthritis and Rheumatism. 2019;48(5):765-77.
7. Quintrec J-LL, Verlhac B, Cadet C, Bréville P, Vetel JM, Gauvain JB, et al. Physical exercise and weight loss for hip and knee osteoarthritis in very old patients: a systematic review of the literature. Open Rheumatol J. 2014;8:89-95.
