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If you've been diagnosed with low bone density or osteoporosis, an important part of your treatment plan will involve regular physical activity and exercise. Being strong and fit is an essential component in reducing the risk of falls and fractures.

Activity vs Exercise

Activity refers to the functional movements of everyday life such as gardening, housework, going up and down stairs, walking the dog, or carrying home food on foot from the grocery store. While it's important to keep active in these ways, exercise relates to purposeful fitness regimens. These consist of movements designed specifically to raise the heart rate and improve cardiovascular health, as well as increase strength, flexibility, and endurance. This type of exercise includes fast or power walking, workouts on elliptical machines, weight and resistance-band training, sports, and aerobics.

Engaging in physical activity and various types of exercise benefits osteoporosis patients in many ways. First, weight-bearing exercise such as walking and aerobics stimulates bone growth by working the lower skeleton against the force of gravity.

Exercise also increases muscle mass, and the pressure exerted by strong muscles on the bones stimulates bone growth and density. Ample muscle mass can help protect bone from fracturing in the event of a fall.

Exercise also stabilizes the body's core and improves posture, balance, and walking gait -- all of which help to reduce the risk of falls and fractures.

Maybe best of all, exercise increases energy and boosts mental health and psychological well-being for overall improved quality of life.

Pushing Through Reluctance

Although you may be fearful of exercising after a diagnosis of osteoporosis or, worse, a fragility fracture, the riskiest thing you can do for your bone health is to remain sedentary. Your doctor can assess your exercise capacity or refer you to a fitness professional or physiotherapist to devise a safe exercise plan for you.

A person with osteoporosis who is generally fit and strong and is used to exercising, can likely attempt more than a frail person who has not worked out regularly. Someone unaccustomed to exercise or suffering from other medical conditions such as chronic pain, heart disease, a previous stoke, lung problems, or osteoarthritis will likely need to limit their exercise regimen.

Working Out Safely

Whatever you choose to do, it is advisable to start your regimen slowly, doing a few manageable repetitions per day at first and progressing in a controlled way. You will want to warm up for 10 minutes before you begin each session by swinging your arms, marching in place, side-stepping, or climbing stairs. Stop if exercise becomes painful.

It is also advisable to avoid high-impact activities such as jogging on cement, intense aerobics, and contact sports. If you've had a spine fracture, avoid sit-ups and exercise that involves lifting heavy objects, since that puts stress on the spine. Also stay away from movements that involve twisting the spine or bending forward more than 45º, such as reaching down to touch the toes.

An illustrated series of types is available on the website of the Bone Health and Osteoporosis Foundation. The site also shows of the exercises.

Types of Exercise

For the best results, it's advisable to use a combination of exercises:

• Weight-bearing exercise includes walking, jogging, tai chi, stair climbing, dancing, gardening, and badminton. Aerobics are also beneficial, but for osteoporosis patients they should be the low-impact variety. These activities strengthen the bones in the legs, hips, and lower spine.

• Muscle-strengthening exercises range from weight and resistance-band training to other resistive exercise such as yoga, Pilates, calisthenics, and swimming. Strength training conditions the muscles of the upper back and supports good posture and bone density.

• Flexibility exercises move joints through their full range of motion and help keep muscles working efficiently. These exercises include stretches, which should be done gently and slowly, without jerky bouncing.

• Stability and balance exercises help muscles cooperate to reduce the likelihood of falls. Stability and balance can be improved by moves involving standing on one leg and controlled movement such as that of tai chi and yoga.

Some activities provide more than one benefit at a time. Swimming, for instance, delivers a cardiovascular workout as well as resistance training with muscle pushing against the force of water. Aerobics are good for the heart and lungs and also provide bone-building weight-bearing.

Your healthcare provider can help you design an exercise program that is safe for you. A fitness professional experienced in working with older individuals can also help. The main thing is to get started and keep at it. Serious exercise should be an integral part of your regular routines.

Read previous installments in this series:

For Your Patients: Osteoporosis -- the 'Silent Thief'

For Your Patients: What to Know About Osteoporosis Diagnosis and Treatment

For Your Patients: Osteoporosis and Fractures

For Your Patients: Men Get Osteoporosis, Too

For Your Patients: Medical Conditions That Raise Your Risk of Osteoporosis

For Your Patients: Talking to Your Doctor About Osteoporosis

For Your Patients: What to Know About Osteoporosis and Oral/Dental Health

"Medical Journeys" is a set of clinical resources reviewed by physicians, meant for the medical team as well as the patients they serve. Each episode of this journey through a disease state contains both a physician guide and a downloadable/printable patient resource. "Medical Journeys" chart a path each step of the way for physicians and patients and provide continual resources and support, as the caregiver team navigates the course of a disease.