Exercises for Strong Bones

Your skeleton is far more responsive than it looks. Each of your 206 bones constantly senses the forces placed on it and adjusts, adding material where it is stressed and quietly losing it where it is not. That makes exercise one of the most powerful tools you have for building bone when you are young and holding on to it as you age. This guide explains which kinds of movement matter most, how much to aim for, and how to stay safe, including if you already have osteoporosis.

Why bones respond to load

In the late 1800s, the German surgeon Julius Wolff described a principle now known as Wolff's law: bone adapts to the loads it carries. In plain terms, bone is a use-it-or-lose-it tissue. When muscles pull on bones and your body weight presses down through them, bone cells detect tiny amounts of bending and strain. They respond by reinforcing the bone, making it denser and better shaped to handle that force.

The opposite is true as well. Astronauts in zero gravity and people on long periods of bed rest lose bone quickly because their skeleton is no longer being challenged. Bone responds best to loads that are a little greater than usual, applied in varied directions, and done regularly. Gentle, repetitive movement that the body is already used to, such as a daily stroll at the same pace, gives a smaller bone-building signal than activities that add a bit of impact or resistance.

Exercise also builds the muscles that protect bones, improves balance and coordination, and makes falls less likely. Since most fractures in older adults happen after a fall, that benefit may be just as important as any change in bone density.

The main types of bone-building exercise

Health organizations, including the Royal Osteoporosis Society and the Bone Health and Osteoporosis Foundation, recommend combining several types of activity. Each one does a different job.

Weight-bearing impact exercise

Any activity done on your feet, where your legs and spine carry your body weight, counts as weight-bearing. The more impact involved each time your feet strike the ground, the stronger the signal to your bones. Higher-impact activities include jogging, jumping and racquet sports. Lower-impact choices include brisk walking and stair climbing. People who are new to exercise, are frail, or have had certain fractures usually start with lower-impact options and progress only if appropriate.

Swimming and cycling are great for fitness and are kind to sore joints, but because water or a saddle supports your weight, they do relatively little to load the skeleton. Keep them in your routine if you enjoy them, and add weight-bearing activity on other days.

Strength and resistance training

When a muscle contracts against resistance, it tugs on the bone where it attaches, and that pull helps stimulate bone. Resistance can come from free weights, machines, elastic bands or your own body weight. The key is progression: gradually increasing the load as you get stronger so that the challenge keeps pace with your ability. Everyday activities such as carrying groceries, digging in the garden or climbing stairs with a backpack add to the total.

Balance, posture and flexibility

Balance training does not build bone directly, but it lowers your chance of falling and breaking one. Posture and back-strengthening work helps keep the spine upright and supports safer bending and lifting. Flexibility work maintains the range of motion you need to move comfortably, though stretching on its own is not a bone-builder.

How much activity to aim for

The World Health Organization's 2020 guidelines on physical activity set out general targets for health, which also support bone and muscle:

• Children and teens aged 5 to 17: an average of at least 60 minutes a day of moderate-to-vigorous activity, mostly aerobic, with vigorous activity and muscle- and bone-strengthening activity on at least three days a week.
• Adults aged 18 to 64: 150 to 300 minutes a week of moderate-intensity aerobic activity, or 75 to 150 minutes of vigorous activity, or a mix, plus muscle-strengthening activity for all major muscle groups on two or more days a week.
• Adults 65 and older: the same as for adults, plus varied multicomponent activity that emphasizes balance and strength at moderate or greater intensity on three or more days a week, to improve function and prevent falls.

The guidelines also stress that some activity is better than none and that cutting down on long periods of sitting has its own benefits. If you are starting from zero, small amounts that build up over weeks are the right approach.

Exercise with osteoporosis: the Strong, Steady, Straight approach

In the UK, the Royal Osteoporosis Society (formerly the National Osteoporosis Society) worked with experts to publish a consensus statement called Strong, Steady and Straight. Its message is encouraging: most people with osteoporosis can and should exercise, and fractures are rarely caused by exercise. Its quick guide groups advice into three themes.

Strong: impact and muscle strengthening

• Do weight-bearing impact exercise on most days, building up toward around 50 moderate impacts per session, such as jogging, low-level jumping or brisk dancing, if this is suitable for you.
• If you are frail, have limited mobility, or have had vertebral or multiple low-trauma fractures, choose lower-impact activity such as walking, building up to around 20 minutes. Moderate impact may be considered later after an individual discussion with a professional.
• Do progressive resistance training two to three days a week, working up to three sets of eight to twelve repetitions with the heaviest weight you can lift safely. Mild muscle soreness the next day is normal.

Steady: balance and fall prevention

• If you feel unsteady, or are over 65 and not already exercising regularly, add challenging balance activities two to three days a week, such as tai chi, dance or a dedicated balance class.
• People who fall repeatedly should be referred to a falls service or physiotherapist.

Straight: spine care and posture

• Learn to bend using a hip hinge, keeping the back straight and bending from the hips, rather than rounding the spine.
• Do gentle back-strengthening exercises two to three days a week, holding each position for a few seconds.
• Be cautious with extreme or loaded forward bending and with sustained or repeated bending to the end of your range.

Movements to be careful with

If you have osteoporosis, and especially if you have had a vertebral (spinal) fracture, the main concern is movement that combines heavy load with a rounded spine. Guidance from the Royal Osteoporosis Society suggests adapting exercises that repeatedly curl the spine forward under load, such as sit-ups, toe touches, and roll-down or curl-up moves in some Pilates classes. Many clinicians also advise care with forceful or loaded twisting of the trunk, and the Bone Health and Osteoporosis Foundation notes that high-impact activities may not be right for people who have had an osteoporotic fracture or are at high fracture risk.

This does not mean you must stop moving. It means choosing safer versions: a hip hinge instead of a rounded bend, a supported squat instead of a toe touch, back-extension exercises instead of crunches. For lifting, technique matters more than the weight. Start light, and put the load down if you feel strain in your back. A physiotherapist can show you how to adapt exercises you enjoy.

Fall prevention and tai chi

A 2019 Cochrane review of exercise in older people living in the community found that exercise programs reduced the rate of falls by about 23%, and those built around balance and functional movements reduced it by about 24%, both supported by high-certainty evidence. Tai chi may reduce the rate of falls by about 19%, although the evidence for tai chi specifically was rated low certainty.

Tai chi combines slow, controlled weight shifts, single-leg stances and gentle turns, all of which challenge balance in a low-impact way. Dance, yoga adapted for bone health, and community strength-and-balance classes are other good options. At home, you can practice standing on one leg near a kitchen counter, walking heel to toe, and rising from a chair without using your hands.

Sample weekly plans

These are examples for generally healthy adults. Adjust them to your ability and any advice from your clinician. Our bone exercise planner can build a version tailored to you.

Leave at least a day between strength sessions that work the same muscles, and increase only one thing at a time: duration, load or impact.

Kids and teens: building peak bone mass

Childhood and adolescence are the best window for building bone. According to NIAMS, bone tissue in most people peaks by their mid-to-late twenties, and how much bone you build by then affects your risk of osteoporosis decades later. Active play that involves running, jumping and changing direction is ideal. Basketball, soccer, gymnastics, jumping rope, dancing and tag all count, and the WHO target of an average of 60 minutes a day with bone-strengthening activity at least three days a week is a good benchmark. Pair activity with enough calcium and vitamin D; our calcium and vitamin D guide explains how much growing children need.

Safety and when to see a physiotherapist

Start slowly, warm up, and build gradually. Choose supportive footwear and a safe, clutter-free space. Talk to a doctor or physiotherapist before you start if you have had spinal fractures or many broken bones, are recovering from a recent fracture, fall often, have another condition that makes exercise difficult, or are simply unsure what is safe. A physiotherapist can assess your strength, balance and posture, teach safer lifting, and design a program that progresses at the right pace. After a fracture, they can advise when it is safe to reload the area.

Remember that exercise supports, but does not replace, medical treatment. If you have been prescribed medicine for osteoporosis, keep taking it as directed. To understand your own risk, try our bone health risk check or read our osteoporosis guide.

The takeaway is simple: stay on your feet, add some impact if it is right for you, lift something challenging a few times a week, and practice your balance. Done consistently, that combination gives your skeleton the signals it needs to stay strong.