Exercise for osteoporosis: what helps and what to avoid

Yes, you can and should exercise with osteoporosis. UK expert consensus recommends three things: resistance and impact exercise to strengthen bone, strength and balance training to prevent falls, and back-strengthening exercise for posture. The main thing to avoid is repeated or loaded bending forward of the spine. If you have had a spinal fracture, keep impact to brisk-walking level [1].

Can you exercise with osteoporosis?

Osteoporosis weakens bones so they break more easily; the wrist, hip and spine are the most common sites [5]. That sounds like a reason to sit still. The evidence says the opposite.

The Royal Osteoporosis Society (ROS) puts it simply: "Most people with osteoporosis can exercise safely" [2]. The UK consensus statement found "little evidence that physical activity is associated with significant harm, and the benefits, in general, outweigh the risks" [1]. The question is which kind and how hard, which depends on whether you have already broken a bone and how steady you are.

Does exercise help osteoporosis?

Exercise helps in two separate ways.

First, it acts on bone. A Cochrane review of 43 trials with 4,320 postmenopausal women found a "relatively small statistically significant, but possibly important" effect on bone density. The most effective approach for the hip was progressive resistance training for the legs; for the spine, programmes combining several types of exercise [8].

Second, it acts on falls, which cause most fractures. A Cochrane review of 108 trials with 23,407 older people living at home found exercise reduced the rate of falls by 23% and the number of people falling by 15%. Programmes built around balance and functional training cut the rate of falls by 24% [10].

Can you improve osteoporosis with exercise, or reverse it?

Exercise can slow bone loss and, with the right training, add a little density. It does not cure osteoporosis and does not replace the medicines your doctor may prescribe; the UK consensus treats it as sitting alongside drug treatment [1].

The strongest single trial is LIFTMOR. It randomised 101 postmenopausal women (average age 65) with low bone mass to supervised high-intensity resistance and impact training twice a week for eight months, or a home-based low-intensity programme. Spine density rose 2.9% in the training group and fell 1.2% in the comparison group; at the hip the figures were +0.3% and −1.9%. There was one adverse event, a minor lower-back spasm [9].

Two cautions. LIFTMOR was closely supervised and built up gradually. And the Cochrane review found no effect on the number of fractures, so density gains are a marker, not a guarantee [8].

What type of exercise is best for osteoporosis?

The UK consensus is summarised as "strong, steady and straight" [1]. Each word is one type of exercise.

Strong: resistance and impact exercise for bone. Muscle-strengthening exercise on two or three days a week, using a weight you can lift 8 to 12 times, building up to three sets. Start lighter and learn the technique before adding load. For impact, aim for about 50 impacts a session, for example five sets of ten jogs, hops or jumps [1].

Steady: strength and balance training for falls. If you are unsteady or have fallen, the priority is specific, highly challenging balance and strength exercises, supervised by a trained professional, around three hours a week over at least four months [1]. The ROS recommends balance exercise on at least two days a week, building up to daily: sit-to-stand, heel raises, heel-toe walking, standing on one leg, or tai chi, dance and Pilates [3].

Straight: back-strengthening exercise for posture. Exercises that strengthen the back muscles support the spine. Aim for movements repeated three to five times, held for three to five seconds, at least twice a week [1].

Underneath all this, the UK Chief Medical Officers advise 150 minutes of moderate activity a week and note that "weight-bearing activities which create an impact through the body helps to maintain bone health" [7].

What weight-bearing exercise is good for osteoporosis?

Weight-bearing exercise is "exercise where your feet and legs support your weight". The NHS lists running, skipping, dancing, aerobics and jumping on the spot, and for people over 60, brisk walking, keep-fit classes or tennis. Swimming and cycling are good for your heart but "are not weight-bearing exercise" [6].

Is jogging good for osteoporosis? If you have not broken a bone, jogging and hopping are among the impacts the consensus suggests [1]. If you have had a spinal fracture or several low-trauma fractures, the ROS says to "stay with low-impact exercise", and the consensus caps impact at brisk-walking level [1][2].

Resistance exercise is the other half: "the action of the tendons pulling on the bones boosts bone strength", whether with press-ups, gym weights or bands and dumbbells at home [6].

What exercises should you avoid with osteoporosis?

There is no long banned list. The concern is the spine, specifically bending it forward under load.

• Avoid or modify movements involving "sustained, repeated or end-range flexion" of the spine, and any exercise "that causes the back to curve excessively especially with an added load" [1].
• The ROS names sit-ups, touching your toes and the Pilates "roll-down" and "curl-up" as exercises that "can put pressure on the spine" [2].
• Lifting is fine: "it is how you lift rather than how much you lift that matters". Use a hip hinge, bending from the hips with a straight back [2].
• If you have had spinal fractures or many broken bones, stick to low-impact exercise [2].

Everyone with osteoporosis benefits from guidance on adapting everyday postures and movements, not just gym exercises [1].

Exercise after a spinal fracture

A spinal (vertebral) fracture changes the rules but does not end exercise. The consensus recommends impact "on most days at a level up to brisk walking", aiming for 150 minutes over the week, plus daily back-strengthening exercises, which can "reduce muscle spasm, relieve pain, improve flexibility". It adds that "a referral to a physiotherapist will be helpful" [1].

The ROS agrees gentle exercise can improve pain after spinal fractures. You can start "as soon as you feel ready" without waiting for bones to fully heal; if fractures are painful or you find it hard to move, ask your GP for a physiotherapy referral [4].

Osteopenia and osteoporosis exercises: is there a difference?

Osteopenia means a bone density scan shows lower density than average for your age, but not low enough to be classed as osteoporosis, and it does not inevitably progress [5]. LIFTMOR included women with osteopenia as well as osteoporosis, and the approach is the same: progressive resistance, impact you can tolerate, and balance work as you get older [9].

If you are unsure whether you have either, NICE's 2026 guideline sets out who should be assessed for fracture risk; ask your GP [12]. NICE's falls guideline also recommends asking people about falls in the last year, with an assessment that includes osteoporosis risk alongside gait, balance and strength [11].

Who should you see?

Exercise for osteoporosis is easy to do half-right. Doing it fully right, at a load that stimulates bone without loading a fragile spine, is a prescription task.

	Clinical Exercise Physiologist (CEP)	Level 4 specialist instructor	Physiotherapist
Training	AHCS-accredited MSc; AHCS register (PSA-accredited, voluntary)	Ofqual-regulated Level 4 certificate or CIMSPA-endorsed course, on top of Level 3 exercise referral	Degree; HCPC statutory register, protected title
Best for	Exercise testing and an individually prescribed, progressed programme for complex or higher-risk cases	Supervised exercise for stable, already-assessed people, often in leisure centres and NHS-commissioned schemes	Diagnosis, pain after fracture, hands-on treatment
Cannot	Diagnose, or replace your fracture clinic or GP	Diagnose or act as a regulated clinician	Not applicable

Clinical Exercise Physiologists are the most specialised exercise professionals for this. They hold an AHCS-accredited MSc, sit on the AHCS register (PSA-accredited and voluntary, not statutory), and are trained specifically in exercise testing plus the design, delivery and evaluation of exercise for acute, chronic and complex conditions. That means someone who can set a resistance load, judge how much impact your spine can take, and progress it safely, which is what LIFTMOR relied on [9]. See what a Clinical Exercise Physiologist is.

Level 4 instructors sit underneath CEPs. There is no osteoporosis-specific Level 4 qualification in the UK. The relevant one is Level 4 Exercise for Falls Prevention, delivered as the Postural Stability Instructor (FaME) course by Later Life Training and evidenced for primary and secondary prevention of falls [13]. NICE asks for falls exercise to be "delivered by appropriately trained professionals", "progressive and tailored", and focused on "balance, coordination, strength and power" [11]. A Level 4 falls instructor can deliver that to stable, clinically referred clients at lower cost; they cannot diagnose or act as a regulated clinician.

Physiotherapists are statutorily regulated and the right call for diagnosis, a painful new fracture, or hands-on treatment. Their skills overlap with CEPs and the two complement each other; see the exercise professional tiers guide.

Request a match with a verified clinical exercise physiologist through The Health Nav.

When to be cautious or talk to your doctor first

The ROS advises talking to your doctor or physiotherapist before starting exercise if you [2]:

• have a history of many broken bones or spinal fractures
• are recovering from a broken bone
• have any questions or concerns about your own situation

Also see your GP if you have had two or more falls, or broken a bone in a fall, in the past year; they can refer you to a falls service for assessment and a specialist exercise programme [3]. If newly diagnosed, check with your GP or specialist before starting a new programme [6]. Put the weight down if you feel strain in your back when lifting [2].

Getting matched with a specialist

If you are unsteady, have had fractures, or have other conditions alongside osteoporosis, a Clinical Exercise Physiologist can test where you are and write a programme that progresses safely. If you have been assessed and are stable, a Level 4 falls-prevention instructor can supervise your strength and balance work; your GP or local falls service can point you to one. The Health Nav matches you with a verified clinical exercise physiologist. Related guides: exercise referral schemes, cardiac rehab and diabetes and exercise.

Request a match with a verified osteoporosis exercise specialist through The Health Nav.

This article is general information and does not replace advice from your own healthcare team.

References

1. Brooke-Wavell K, Skelton DA, Barker KL, Clark EM, De Biase S, Arnold S, Paskins Z, Robinson KR, Lewis RM, Tobias JH, Ward KA, Whitney J, Leyland S. Strong, steady and straight: UK consensus statement on physical activity and exercise for osteoporosis. British Journal of Sports Medicine. 2022;56(15):837-846. https://doi.org/10.1136/bjsports-2021-104634
2. Royal Osteoporosis Society. How to exercise safely for bones. https://theros.org.uk/information-and-support/exercise/how-to-exercise-safely-for-bones/ (accessed 15 Sep 2026).
3. Royal Osteoporosis Society. Exercise to help your balance. https://theros.org.uk/information-and-support/exercise/exercise-to-help-your-balance/ (accessed 15 Sep 2026).
4. Royal Osteoporosis Society. Exercises to help with back pain (exercise for symptoms of spinal fractures). https://theros.org.uk/information-and-support/exercise/exercise-for-symptoms-of-spinal-fractures/exercises-to-help-with-back-pain/ (accessed 15 Sep 2026).
5. NHS. Osteoporosis. https://www.nhs.uk/conditions/osteoporosis/ (accessed 15 Sep 2026).
6. NHS. Osteoporosis: prevention. https://www.nhs.uk/conditions/osteoporosis/prevention/ (accessed 15 Sep 2026).
7. UK Chief Medical Officers. UK Chief Medical Officers' physical activity guidelines. 2019. https://www.gov.uk/government/publications/physical-activity-guidelines-uk-chief-medical-officers-report/uk-chief-medical-officers-physical-activity-guidelines (accessed 15 Sep 2026).
8. Howe TE, Shea B, Dawson LJ, Downie F, Murray A, Ross C, Harbour RT, Caldwell LM, Creed G. Exercise for preventing and treating osteoporosis in postmenopausal women. Cochrane Database of Systematic Reviews. 2011;(7):CD000333. https://doi.org/10.1002/14651858.CD000333.pub2
9. Watson SL, Weeks BK, Weis LJ, Harding AT, Horan SA, Beck BR. High-Intensity Resistance and Impact Training Improves Bone Mineral Density and Physical Function in Postmenopausal Women With Osteopenia and Osteoporosis: The LIFTMOR Randomized Controlled Trial. Journal of Bone and Mineral Research. 2018;33(2):211-220. https://doi.org/10.1002/jbmr.3284
10. Sherrington C, Fairhall NJ, Wallbank GK, Tiedemann A, Michaleff ZA, Howard K, Clemson L, Hopewell S, Lamb SE. Exercise for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews. 2019;1:CD012424. https://doi.org/10.1002/14651858.CD012424.pub2
11. National Institute for Health and Care Excellence. Falls: assessment and prevention in older people and in people 50 and over at higher risk. NICE guideline NG249. 29 April 2025 (updates and replaces CG161). https://www.nice.org.uk/guidance/ng249 (accessed 15 Sep 2026).
12. National Institute for Health and Care Excellence. Osteoporosis: risk assessment. NICE guideline NG259. July 2026 (updates and replaces CG146). https://www.nice.org.uk/guidance/ng259 (accessed 15 Sep 2026).
13. Later Life Training. Postural Stability Instructor (FaME). https://laterlifetraining.co.uk/courses/postural-stability-instructor/ (accessed 15 Sep 2026).