May is National Osteoporosis Month! How can Pilates help build bone strength? We turn to wellness knowledge website verywell.com for this in-depth examination of Pilates and osteoporosis.

Pilates and Exercise for Osteoporosis: an Interview with Rebekah Rotstein

Exercise for osteoporosis is a confusing subject. There are exercises for prevention. There are exercises for rehab. And, when osteoporosis is present, there is always the issue of exercise safety. Pilates, specifically, is a form of exercise that is often mentioned with regard to osteoporosis. But in Pilates there are definite parameters as far as what exercises are appropriate for osteoporosis.

We must have strong bones that can bear our weight and allow us mobility.

But with so many dynamics playing into the exercise for osteoporosis scenario, we really need to know what we are doing when we exercise for osteoporosis. In the interview below, Rebekah Rotstein helps us clarify the role of exercise, Pilates, and Pilates equipment with regard to osteoporosis and bone strengthening.

Among a long list of credits, Rebekah Rotstein is an expert in osteoporosis, bone health, and Pilates. She is the founder of Incorporating Movement, a Pilates and Movement education organization, and the designer of the Pilates for Buff Bones® workout. Rebekah is also an educator for the Foundation for Osteoporosis Research and Education.

Rebekah, we have all heard that weight-bearing exercise helps prevent osteoporosis. How does it do that?

Bone is dynamic tissue, like muscle, that strengthens in response to forces it has to resist. Gravity is one such force, and working against gravity is what we refer to when speaking of “weight-bearing exercise.” The combination of compression and tension from gravity and from our muscles plays a major role in bone strengthening.

Should we be making a distinction between weight bearing exercises and resistance exercises?

Weight-bearing exercises are technically anything standing, although I include quadruped (on hands and knees) in this since you bear the weight of your trunk through your hands and transmit forces via your wrists. The wrists are a critical site to strengthen because they are the most common site of osteoporotic fractures along with the spine and hip.

Resistance exercises simply involve muscles pulling on the bone to create tension which also fortifies the bone. The resistance can come from weights, elastic bands, or springs. But you can also consider your own body weight as resistance in some instances, like a push-up. In this example, you’re using gravity and your own body weight to provide resistance and induce muscle pull.

The best formula for bone strengthening, in addition to the high-impact we discussed before, occurs where you combine weight-bearing with resistance training. So weighted squats, or using an elastic band while standing or performing standing lat pulls, would be good additions to a bone workout regimen.

I know there are some limits around Pilates and osteoporosis which we will discuss later, but in terms of prevention, is Pilates enough?

Pilates is a wonderful means for strengthening the body, establishing efficient movement patterns, and aligning the joints and the axial skeleton (among numerous other benefits!).

But your bones need additional loading to prevent osteoporosis as well as the general bone loss that naturally occurs with age. This loading comes from weights, squats and high impact exercises like running and jumping. You need to move in new ways and to “surprise” the bone, as some researchers are now saying. Bone tissue gets lazy so we need to keep it on its toes, all pun intended! We need to move in differing directions and at different speeds to encourage the bone to continue to strengthen.

So Pilates is an invaluable tool to complement bone-loading techniques and to prevent injuries and falls.

We have to remember that the real danger with osteoporosis is the devastating falls that can induce a fracture. Pilates, with its emphasis on posture, alignment and balance as well as full body integrated movements, offers a fantastic platform when combined with other functional (upright), impact-based and resistance exercise. Furthermore, Pilates establishes good form for weight training so that the forces best transmit through a well-aligned spine and hips. And remember, exercise must be accompanied by other healthy lifestyle habits including proper nutrition to mineralize the bones.

What would an adequate Pilates exercise program for prevention of osteoporosis need to include?

A Pilates osteoporosis-prevention program needs to include sufficient back strengthening (spinal extension and scapular stability) as well as hip and wrist strengthening. These elements are the basis of the Pilates for Buff Bones® program. I often see Pilates classes and sessions emphasizing spinal articulation at the expense of the shoulders, back and hips.

I recommend re-evaluating your programming to be sure that the back gets attention – and specifically the upper thoracic. Many of us cheat by relying on our lumbar spine for the extension! That upper back strength has been shown to improve balance and reduce risk of falls too. And, of course, core control is integral in order to achieve that upper back extension. More standing should occur near the end of the workout too to make the work functional, integrating the feet, and for additional weight-bearing.

What about exercise with the larger Pilates equipment like reformer and Pilates chair? Are they safe for people with osteoporosis?

The Pilates equipment is terrific for those with osteoporosis because the springs provide the resistance needed for bone strengthening and offer limitless movement possibilities, both within the classical repertoire and beyond. The chair is a great machine for weight-bearing, functional exercises in particular.

Which Pilates exercises are best for people with osteoporosis?

I recommend side, front and back splits on the reformer (as appropriate for the client’s level) since they’re weight-bearing and improve balance, just like the standing leg pumps and mountain climber on the wunda chair. Pulling straps on the reformer is great for the back and shoulders as are the swan on the chair and cadillac.

What kinds of movements should people with osteoporosis avoid?

Those with osteoporosis should avoid spinal flexion (forward bending) – especially when its loaded like in rolling like a ball and short spine (where the back bends forward with mid-upper spine bearing the body weight). They should also avoid motions that incorporate flexion with side bending and rotation. Any side bending should emphasize a lengthening of the spine rather than pure side-bending which many exaggerate and collapse into flexing as well without realizing it. The key is to “off-load” the front, or anterior portion, of the vertebral body [spine].

Thank you, Rebekah!

Below are sample Pilates exercises that fall within the guidelines that Rebekah Rotstein outlines above. Some are weight bearing and some include resistance from the Pilates ring or exercise band. They do not include flexion (forward bending) or side bending with rotation. *Anyone with osteoporosis should do Pilates or any exercise with an instructor trained in exercise appropriate for osteoporosis.

• 5 Back Extension Exercises
• Upper Body Toning with Pilates Ring
• One Leg Circle with Exercise Band
• Leg Bend and Stretch with Exercise Band
• Kick Back with Exercise Band

Rebekah teaches a full osteoporosis safe workout on her DVD Pilates for Buff Bones®. You can learn more about Rebekah Rotstein on her website, IncorporatingMovement.com. Rebekah also teaches Pilates for osteoporosis classes online at PilatesAnytime.com