Pilates for Osteoporosis: Pros & Cons

So you have a diagnosis of Osteoporosis. Why do Pilates ?

It is quite a stressful thing to receive a diagnosis of Osteoporosis. You don’t know how it is going to impact your future, your lifestyle, quality of life or even life expectancy. You don’t know which activities are safe and what are best avoided. I want to explain about all the benefits you would get from doing a regular bone health orientated Pilates class.

In addition, the sad fact is that generally in the UK we tend only tend to receive our diagnosis after breaking a bone. There is no primary prevention strategy that involves routine bone scans to pick up reduced bone density early. In short, we tend to learn the hard way.

I have written this article to outline one (of the many of course), positive things you can do if you have received that diagnosis: Pilates! We can do Pilates to stay bone healthy, remain strong and get stronger.

In addition, and this is super important, a sensitively planned spine-safe class done regularly will help you to feel positive about your body. Knowing that you are doing something positive, be that improving bone health or overall health is tremendously beneficial.  It is a kind of Pilates derived placebo effect.

What is Osteoporosis

This is a brief definition from the NHS website:

Osteoporosis is a health condition that weakens bones, making them fragile and more likely to break. It develops slowly over several years and is often only diagnosed when a fall or sudden impact causes a bone to break (fracture).

Rather than talk here about the disease itself and the various drug treatments I’d suggest taking a look at the brilliant info on the Royal Osteoporosis Society website.

There are various risk factors for Osteoporosis and I have covered those in an earlier article called How Pilates can help Bone Health.

Medication, diet and regular exercise are extremely important to help combat the effects of the disease, prevent it from getting worse, and even reduce its severity.

If you have Osteopenia then your bone density is lower than average but not low enough to be classed as Osteoporosis. It is generally not treated with drugs but the diagnosis needs to be on your watch list and acted upon so that you can aim to prevent Osteopenia progressing to become Osteoporosis.  One of the very best things to help your body if you have Osteopenia is to take regular exercise.

Today I want to talk about why you would choose Pilates as a form of exercise if you have Osteoporosis. or Osteopenia.

Benefits of Pilates for Osteoporosis

Pilates is an exercise system which builds strength in the muscles and mobility in the joints.  It is a full-body system, aiming to work the whole body quite literally from the tips of your toes up to your head.  There is a big emphasis on alignment and form (that is, how well you do the exercise).  It involves optimising the breathing, building a good deep core connection, working gently as well as vigorously.

So far so good,  but why chose it if you have Osteoporosis? Well, there are an awful lot of Pros when it comes to Pilates and most especially if you find a specialised Bone Health orientated Pilates class.

  • The focus on alignment in Pilates is ideal to help prevent stooping and ensuring that the correct muscles and bones move at the correct time. In some ways that sounds obvious but it does matter. Poor alignment can increase the torsion and tension across the spine which then cause stress fractures in the spine bones (vertebrae).
  • Related to alignment: in the Pilates class we teach body aware, spine safe movement strategies.  This is the kind of  valuable exercise tip that you go home and use on a daily basis.  For example, knowing the right way and the less favourable way to pick things up from the floor.
  • Breathwork. Yes, that again!  In the context of Osteoporosis, breathing well is more important than it first appears. Basically breathing well keeps the upper back moving gently and stops it from getting too stiff.  Breathwork is the bedrock of your deep core strength, which in turn is the foundation of your trunk stability.   I discuss the value of breathing in more depth in another blog post, Good Breathing: How and Why we should take it seriously.
  • Pilates always includes spine mobility work . This is absolutely vital – to keep the spine moving in all directions as much as possible and to try and reduce the increased curvature of the upper back head and neck
  • In a specialist Pilates class we work on the balance. This is tremendously important.   Poor balance increases the risk of falls and it is falling that leads to fractured wrists, thigh bones and arm bones.
  • Strength exercises for the legs, hips, bottom,  wrist, shoulder, spine
  • Foot work. This also appears a little leftfield, but keeping the feet mobile and supple reduces the risk of falls

Are there exercise systems better than  Pilates for Osteoporosis ?

Does Pilates Help Bone Density?

The fundamental problem with Osteoporosis is a reduction of bone mass (also known as bone density). To reduce the risk of stress fractures in the spine or wrist and hip fractures following a fall, you need to improve bone density. Medication is crucial to achieve this.  With exercise, for bone density improvement you need to lift heavy weights. All the research evidence points to this.

What precisely is Heavy Lifting?

The kind of thing you’d do in a gym.

Deadlift which is essentially squatting with a weighted barbell, (pictured below).

author doing a deadlift with 10kg barbell

author doing an overhead press exercise with a 10kg barbell

Back Squat
which is squatting with a barbell across the back of your shoulders


Overhead press: standing with straight arms overhead with a barbell, (also pictured below).


Hanging from a bar above your head.


The difficulty here is that for many people this is too extreme, and Pilates is an easier option if exercise is new or daunting.

What about High Impact Exercise?

For pre-menopausal women and for men, sprinting, sports where you have to jump, and high-intensity interval training where you do things like Star Jumps are good for bone building. If you are an older woman then the evidence for this is nowhere near as strong. Lighter impact such as brisk walking is far better.   Traditionally Pilates contains no exercise with any impact.  For a Pilates class to be more effective for your bone health it has to be modified to include hopping, little jumps or heel bounces.

Some Pilates exercises are unhelpful

A lot of the exercises in the Classical Pilates repertoire involve far too much spine curling. For example Single Leg Stretch, The Hundred, Roll Down.    This is definitely best avoided if you have Osteoporosis, and far from the exercise ideal if you have Osteopenia.    The same goes for other forms of exercise of course, but if we are simply looking at Pilates, then the class has to be modified from its traditional form to be both safe and effective for people with Osteoporosis or Osteopenia.

Whatever you do requires consistency

With any lifestyle change, be it sleeping, diet or exercise,  you do need to stick at it consistently and be prepared to wait to see results.    Taking ownership over an aspect of your health will enable you to feel more positive straight away.   Standing taller and breathing better can impact you very quickly indeed.    Strength gains from exercise take weeks, so do improvements in balance.    When you do Pilates to help with your Osteoporosis or Osteopenia, be prepared to stick at it week in and week out and ideally, practice at home too

So why chose Pilates for Osteoporosis?

Improving bone density is  vitally important in the treatment of Osteoporosis.  With Osteopenia you are aiming to preserve the bone density that you have.  However, bone density isn’t  the only component to combating the disease. Far from it.  We need to get stronger in the muscles so our bodies are simply more resilient and less frail, less prone to falls.  Another vital component of exercise “therapy” is mobility work so the body moves with more ease, is less stiff.

Pilates will deliver real strength-related benefits but in some ways, it is its relative gentleness that makes Pilates for Osteoporosis an attractive and beneficial exercise choice.  Not only that but most of the exercises can be modified to suit different abilities.  Take the humble squat for example.  You can squat deep or with far less range, you can do Sit to Stand which is gentler, or squat heel raise which is far more demanding.

Is Pilates Safe if you have Osteoporosis?

Yes it is, as long is the exercises are spine safe.   A Pilates for osteoporosis class will avoid too much forward bending, too much twisting in all directions.  Movements  should be slow and controlled.   Balance work will always be performed within reach of a supporting wall or chair.

Is there an ideal exercise regime if you have Osteoporosis?

The evidence is basically all in favour of heavy lifting to increase your bone density. If you can do those things in the gym, do them and, ideally, two to three times per week.

High-impact cardio is good if you are male or a pre-menopausal woman. For older women, the high-impact stuff is less useful.  We can load the bones by jumping or hopping.   Perhaps you’d prefer to be dancing though!

However, another way to consider whether a regime is ideal is to look at safety and adherence. A regime is only really good if you can maintain it. This bone business is for life.  We can’t retire from it like an ageing footballer.  It has to be tolerable, practical, affordable and at last partly enjoyable.

An ideal regime needs to be safe. Many gyms don’t provide a safe environment for lifting if you need to be careful and are at risk of injury. Nowadays in most gyms, there are no instructors on the gym floor and everyone is learning from their phones. I would not recommend weight lifting to any rookie in that environment. Better to start with good tuition in a Pilates class and learn the basics.  Alternatively hire an experienced Personal Trainer who is used to working with older,  less strong clients.

Any regime needs to be consistent and frequent. If you attend a Bone Health Pilates class then also walk, jog, dance and ideally do another class or redo the exercises at home.   Aim for 2 to 3 sessions of exercise per week.

What sort of Exercises are there in a Bone Health Pilates class?

In my Pilates for  Osteoporosis classes, I tend to cover major themes in each class but vary the exercise selection.

Every single class contains:

  • An opportunity to work on breathing, both in isolation and whilst doing exercises in different body positions.
  • Exercises to rotate and side bend the spine and to lengthen it.  The latter is gentler and kinder than trying to do reverse curl-type movements (back bends).
  • Balance work in a variety of different ways.
  • Strength for the thighs and bottom, for example, body weight squat, standing hip hitch.
  • Strength for the shoulders, arms and wrists.  For example, press up from all fours.
  • Some kind of hopping, bouncing or on the spot jogging for those that can manage it.  Foot stamping is a good alternative.
  • Work to achieve length in the body, length in the spine. For example standing tall whilst doing leg raises, or shoulder exercises with exercise bands.

Conclusion & Next Steps

Should that be Jumps though?  No answers on a postcard.

Deciding on lifestyle change following a diagnosis of Osteoporosis or Osteopenia is difficult. Beyond giving up smoking, everything is a bit of a grey area.

Starting or continuing regular exercise is extremely helpful. I’d go so far as to say that it is a necessity. If you can lift heavy and, literally, jump around, do so. If you are not ready for that, chose exercise that will deliver loads of other benefits

Pilates will do that for you. A bone health specialist class will be even better because it intentionally gives you what you need in a spine-safe way.

You will see and experience, improved balance, spine mobility, alignment and breathing mechanics.   You will also gain increased strength overall and feel stronger as you go about your daily activities.

In more real terms, you want to feel you can get up the stairs without aching, easily pick something from the floor, not feel fearful of too much gardening, be confident on uneven ground when out walking. These things are possible and I’ve seen it happen time and time again when people do their Pilates regularly.

There is a secret sauce here binding the class aims altogether: confidence that you are learning to move well and are helping yourself to manage the diagnosis as best you can.

If you live In North Leeds I run a specialist Pilates for Health class every Friday morning.   If you would like more information, do get in contact or visit my website for more info.

Author doing a standing buttock exercise: leaning to the left, lifting the right leg out to the right side

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