Osteoporosis Part III: Exercise For Bone Health

 

Exercise is a crucial part of any healthy and balanced lifestyle. While the idea of putting stress on the body may seem counterintuitive when the bones are weak, in the case of osteoporosis, weight bearing exercise is necessary in its treatment and prevention. 

In general, prevention is the best medicine. We accrue most of our bone mineral density in adolescence, with bone mass peaking in our 20-30s. After 30, bone rebuilding slows down and its loss begins, thereby, exercise in young adulthood is beneficial for countless numbers of reasons and should be a part of any lifestyle. 

Any sort of exercise has great benefits for osteoporosis, including reduction of inflammation and stress, which both contribute to bone loss, as well as improving overall balance and fitness. However, in the case of bone health, the specific bone increasing benefits or weight bearing exercises are important and most beneficial for bone health. Especially in young, healthy populations, the running, dancing and jumping type exercises put stress on the bones and stimulate the growth and strengthening, allowing old bone to be replaced with new bone. Resistance style training can be tailored to any age or fitness level by sticking to body weight or bands and working up to adding weights. This type of exercise improves muscle strength and builds up muscle around the bones that help protect them from fractures. Balancing type of exercise is also helpful and adaptable and accessible to all ages and fitness levels. Things such as tai chi, yoga or even standing on one leg can improve proprioception, balance and reduce the risk of falling. 

If osteoporosis is already present, the recommendations are similar in order to prevent further bone loss, with a few tweaks or adjustments. Strength training, especially for the upper back, flexibility, stability, and balance are all still encouraged. However, weight bearing aerobic activities would need to not be high impact. For example, walking should replace running or using the elliptical machine instead of climbing stairs. Anything imposing sudden or forceful movement, or that increases the risk of falling should be avoided. Other techniques to some consider questionable are excessive or unsupported bending and twisting motions, as well as forward flexion of the spine, such as sit ups and toe touches without modifications. A certified Yoga Therapist or Physical Therapist can provide safe and effective and personalized routines.

 Ayurveda and Yoga are synergistic. Together they balance one’s mind, body, and energy or spirit, for deeper awareness and optimal health. While being remarkable for overall health, yoga as a form of exercise, has been shown to improve bone mineral density. In a study done by Lu et al. in 2016, researchers recruited 741 volunteers and followed them for 10 years comparing pre yoga bone mineral density (BMD) with post yoga BMD changes. The yoga practice was a 12-minute DVD of 12 yoga poses that they believed would stimulate the bones and increase BMD in the lumbar vertebrae, hip, and femoral neck. The 12 poses are included below and each of these were held for a minute every single day.

Poses of the DVD from top left: (1) Vriksasana—tree, (2) Trikonasana—triangle, (3) Virabhadrasana II—warrior II, (4) Parsvakonasana—side-angle pose, (5) Parivrtta Trikonasana—twisted triangle, (6) Salabhasana—Locust, (7) Setu Bandhasana—bridge, (8) Supta Padangusthasana I—supine hand-to-foot I, (9) Supta Padangusthasana II—supine hand-to-foot II, (10) Marichyasana II—straight-legged twist, (11) Matsyendrasana—bent-knee twist, (12) Savasana—corpse pose. 

Using dual-energy x-ray absorptiometric scans radiographs of hips and spine, a bone quality study was taken, resulting in overall bone mineral density improvement of the spines, hips, and femurs of the 227 moderately and fully compliant patients, and a monthly gain in bone mass density, BMD, was significant in the spine (0.0029 g/cm2, P = .005) and femur (0.00022 g/cm2, P = .053). Researchers could then conclude that yoga appears to raise BMD in the spine and the femur safely, but insignificant increase in the hips.

An important point to note, is that while these yoga poses were proven to be effective, the quality of the movement, and not just the movement itself, is important and relevant to the outcome. Proper alignment is necessary in any sort of yoga practice, but the addition of Bandhas may be the missing component to many practitioners’ results. Bandhas literally translates to “lock” or “tighten” and they are intentional muscle contractions with the aim of redirecting energy flow within the body. The purpose is to purify the nadis and chakras which balances the flow of prana. This is done by blocking the descending movement of consciousness and redirect it upwards through the moola bandha. Then keep it centered in the heart through the Jalandara bandha. Lastly, using the uddiyana bandha to help with stability by building and harnessing the energy. The technique behind this is to use the muscles of the legs, pelvic floor and torso to all work together to stabilize, support, and align the bones of the pelvis, sacrum, and spine. To engage the core, one would start at the foundation of the pose, then exhale, and engage mula bandha (root), udiyana bandha (below the navel), and jalandhara bandha (chin/throat). Next, one would inhale and fill the lungs from the top down. After an even ratio or 4-4-4-4, you would then choose a breath ratio to align with your own needs and goals. Lastly, coordinate the movement with bandha and breathing, with focus to the ajna chakra, between the eyebrows at the pineal gland. If done correctly the outcome of the yoga flow will be the optimal use of muscles, alignment, support and stability. Doing this can also literally act as a shock absorber to provide protection from stress and strain to the joints and ligaments. Therefore, proper form and the use of Bandhas and breathing, not only enhances the effects of the treatment and prevention of osteoporotic symptoms by increasing muscle strength and bone density, it also ensures that the yoga poses being performed are done in a safe manner that will not damage already weak bones. 

In summary, the outlined forms of exercise as well as Ayurvedic Yoga Therapy that includes a comprehensive assessment and properly executed movement with bhandas and breathing have been scientifically proven for the prevention and treatment of osteoporosis.

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 Works cited:

https://www.mayoclinic.org/diseases-conditions/osteoporosis/in-depth/osteoporosis/art-20044989

https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/osteoporosis-and-exercise

https://www.niams.nih.gov/health-topics/exercise-your-bone-health#:~:text=Resistance%20training%20 exercises%20

Lu YH, Rosner B, Chang G, Fishman LM. Twelve-Minute Daily Yoga Regimen Reverses Osteoporotic Bone Loss. Top Geriatr Rehabil. 2016 Apr;32(2):81-87. doi: 10.1097/TGR.0000000000000085. Epub 2015 Nov 5. PMID: 27226695; PMCID: PMC4851231.