How Fitness Instructors Can Use Resistance Training to Support Clients with Osteoporosis and Low Bone Density
How many of your clients should be doing bone-strengthening exercises? The answer, aside from the occasional exception, is all of them. Our bones are constantly in a state of flux. Old bone is broken down, and new bone is created. In our younger years, bone is created faster than it is lost, but around age 30, all that changes.
At this point, we begin to lose more bone than we gain. This negative trend will continue unless changes are made to preserve bone density. This is where fitness pros come in! While we can’t entirely stop bone loss, we can help clients slow it and mitigate its effects. In this article, we’ll talk about the top ways to keep your clients’ bones healthy and strong – resistance training.
What Are Safe and Effective Resistance Exercises for Clients with Osteoporosis?
Clients of any age can, and do, benefit from resistance training for bone health. The building of healthy bones starts in childhood, but unless your client has a time machine, they can’t go back in time to build that initial foundation. People with osteoporosis have already lost some of that foundation and have weakened bones more prone to injury. Their bones are losing mass faster than they can gain it. While we can’t turn back time to regain what’s been lost, we can teach our clients functional and foundational movements to help maintain the bone mass they do have and strengthen surrounding tissues to keep them moving safely and comfortably.
The predominant part of this training is done through resistance exercise.
Resistance training strengthens bones in part by putting them under stress. As in life, there is good stress (eustress) and bad stress (distress). We want to program exercises that focus on this good stress and minimize distress and risk for injury. Activities that involve large muscle groups and joints are beneficial because they can build strength without overtiring any one muscle.
Foundational compound movements are my go-to exercises for bone strength. If your client has difficulty with balance or lacks a solid strength base, consider using closed-chain exercises for support and stability. Great examples of closed-chain exercises include:
- The classic squat, where the feet stay on the ground throughout the movement, is a great way to build stability and bone strength through the lower body. For clients needing extra help balancing or maintaining form, use variations like a wall sit or TRX squat if you have a suspension trainer handy. The leg press machine is another excellent way to perform the same movement from a seated position.
- Pushups target the upper body to promote strength through the spine, core, and arms. There are nearly limitless options for pushup variations you can give clients, from wall pushups (an excellent way to build strength in deconditioned individuals) to pike pushups for individuals wanting to build more strength.
- Planks and side planks, overused by some trainers and not used at all by others, can be a simple yet powerful way to support muscle and bone strength. If you want to take the exercise from closed-chain to open, you can add some dynamic movements, such as leg or arm lifts.
When programming for bone health, be sure to prioritize exercises that load the spine and hips safely. If your client has or is at risk for osteoporosis, avoid high-impact exercises (e.g., box jumps, jumping lunges) and spinal flexion (as this can put clients at risk for spinal fractures).
Pro Tip: Cueing is critical. Helping your clients have good form can reduce and even prevent many skeletal injuries. Practice key cues before working with clients. If you notice that someone continues to struggle to correct their form after you cue them, try changing what or how you cue and see if that helps. If it doesn’t, consider breaking the exercise down further or selecting a different exercise.
What Does a Quality Resistance Training Program for Bone Health Look Like?
A quality program is one that meets people where they are. I like to look to the past and the future when I’m working with someone on bone health. Finding out what their past looks like can tell you part of their bones’ story. If they have eaten a healthy diet and have been doing strength training for an extended period of time, they likely already have stronger bones than someone who has a poor diet and is just starting to exercise. Most clients won’t come to you with results of a bone scan, so you don’t always know what their bones really look like, which is why I like to ask them about their past.
Once I know more about their foundation, we look forward. If they have a family history of osteoporosis or other bone conditions, we can assume that they may inherit one of these conditions later in life. This makes a huge difference in our training. It informs my programming – I know that we need to focus on resistance training as a primary goal and teach it in a way that it becomes a lifelong habit. It also serves as a powerful motivator for clients to keep training, because they know their future self will benefit from it.
Putting together both past and present, we develop a well-rounded strength training program that:
- Engages all major muscle groups, preferably in compound movements
- Builds bone strength in bones most likely to be affected by osteoporosis, including the hips, wrists, and spine
- Promotes muscle building in areas where bones are prone to being weak
- Discourages the use of high-intensity jumping or plyometric-type movements (in most cases)
- Adapts over time based on progressive overload principles and the client’s health status.
In the initial stages of a strength training program, I often focus on building muscle and endurance, with a rep range of 8-12 with moderate intensity and adequate rest time. This allows clients time within each exercise to feel and engage with their movement. I typically start with higher rep ranges than a typical strength-building program, because I want clients to feel good in the movement before weighing them down or increasing intensity to decrease the number of reps.
If your client is deconditioned, you may choose to decrease the resistance and increase the reps at the beginning, to help them build necessary endurance to take on more activity.
Aim for 2-3 training sessions per week per muscle group. This is a safe starting point for most clients and allows them adequate rest in between sessions.
How Does a Personal Trainer Modify Training for Safety & Injury Prevention?
Safe resistance training for bone health can seem like a make-or-break situation, and to some extent, it is. You can make your training both safe and effective, so that your client doesn’t break under your care (or anywhere else).
Start by creating a safe environment for your client to exercise in. This means removing potential fall risks such as loose equipment on the floor, rugs, or clutter. An estimated 1 in 3 adults over age 65 falls each year, and 10% of those falls result in a fracture. Having a safe space in which clients can strengthen their body and their balance can reduce those risks substantially. Have walls, chairs, railings, or other supports to increase stability for your clients.
Once your training space is safe, move on to the client themselves. Be aware of any contraindications they may have from a healthcare provider or from your initial assessments. Be familiar with your clients’ joint ranges of motion and postural alignment. It’s best to avoid heavy loads on the spine and ones that cause the spine to flex forward under a heavy load.
A popular yoga saying goes “I bend so I don’t break,” and this is equally as true in resistance training. Incorporating balance and flexibility training alongside strength work can reduce fall risk and injury. Adjust the range of motion of exercises to match any joint limitations your client may have. Gently increasing a joint’s range of motion can help reduce injury in the event of a fall.
Equally important is the addition of balance training. If a client has a combination of strength and good balance, they are less likely to fall in the first place, and if a fall does occur, it is likely to be less severe.
Why Does Resistance Training Help Strengthen Bones?
Knowing how resistance training helps strengthen bones can play a big role in client adherence. Consistency is the top challenge for most trainers and their clients. A single session is great, but if a client wants to strengthen their bones in a way that will benefit them years down the road, consistency is key. I’ve found that the more educated my clients are about bone loss and strengthening, the more likely they are to stick to their routine.
Start by teaching the basics of Wolff’s Law, that bones become strengthened or weakened in relation to the load that is placed on them. In simple terms, if you place healthy bones under stress, they strengthen. If they are not challenged, they weaken.
Resistance training also promotes osteoblast activity. Osteoblasts are cells that help form bones. When the body senses that stress is being applied to bones, osteoblasts are recruited to build and strengthen bones to meet the needs stress causes over time. Osteoblasts can also be activated by the force generated when muscles pull on bones during exercise.
Varying your client’s exercise routine can also support bone health. Bones respond best to dynamic activity, so rather than doing many repetitions of the same movement, ensure your clients’ programs offer diversity in exercises – have them work through different planes of motion and in a variety of positions. This allows the bones to be positively stressed from multiple angles, increasing strength across the entire bone.
Why Do Fitness Professionals Need Liability Coverage When Training High-Risk Clients?
Having a client fall is the biggest fear of many fitness professionals, but it doesn’t need to be. Clients may sustain injuries from improper form, unmodified exercises, or unsafe exercises, all of which can be modified by a personal trainer.
By being intentional with our programming and actions in each session, the risk of injury decreases. There will always be inherent risks associated with exercise, and when working with those with osteoporosis or compromised bone density, fractures with falls are more likely. This is why liability coverage is key for trainers working with these populations. It allows you to work with high-risk clients with more confidence and helps manage the risk that comes with strength training.
Policies like Insure Fitness Group’s Personal Trainer Insurance provide you with peace of mind and many other benefits, including:
- Coverage for over 500 modalities, including most resistance training styles, such as kettlebell training and weightlifting.
- Protection on- and off-site, so you can be protected whether you’re training your client in-person or online.
- Discounted options for expanding your training so you can train your clients with more knowledge.
Ready to support clients with osteoporosis more confidently?
As a fitness professional, your expertise makes a real difference in your clients’ long-term health, but working with at-risk populations also means taking on more responsibility. Ensure you’re protected with professional liability insurance specifically for fitness instructors.
Speak with our team on 1 (800) 379-7799 about our policy and see how Insure Fitness Group supports your practice across all 50 states.
