Table 4.

Summary of exercise of physical activity recommendations for individuals with osteoporosis¹

Type	How often per week?	Osteoporosis	Osteoporosis and history of vertebral fracture	Examples and comments
Balance training	Daily for ≥15–20 min	Progress from “standing still” exercises” to dynamic Fig. 1.		Can do during daily walks or activities: Standing still: ↓ base of support e.g., Semi-tandem stance, one-leg stand; shift weight between heels & toes while standing Dynamic movements: Tai Chi; tandem walk, dancing
Strength Training	≥2 days a week	8–12 repetitions per exercise. Intensity at 8–12 repetitions maximum2	8–12 repetitions per exercise. Aim for 8–12 repetitions maximum2, but form and alignment more important than intensity	Min. 1 exercise each for: legs; arms; chest; shoulders; back. Use: exercise bands; weights, or body weight against gravity. 1–3 sets/exercise. Train at ↓ intensity initially if: sedentary; conditions affecting activity; high fracture risk; strength training novice
Aerobic Exercise	≥5 days per week, ≥30 min/day	Moderate- to vigorous-intensity	Moderate intensity	Do bouts of 10 min or more – accumulate 30 min/day. On a 0–10 scale where 0=rest, and 10=maximum effort, aim for intensity of 5–8. Moderate: You are breathing heavier than usual. You can have a conversation, but you couldn’t sing. Vigorous: You are breathing much heavier than usual. You would not be able to converse or sing.
Spine Sparing	During daily activities	Spine loads supine < standing < seated. Alignment more important than intensity.		Modify activities that flex (bending forward) or twist the spine; most risky when rapid, repetitive, weighted, bending all the way forward, or twisting to the side. Avoid lifting to or lowering from the floor.
Spinal Extensor Training	Daily for 5–10 min	Emphasis on endurance for back extensors. Perform “holds” 3–5 seconds.		Lie face up on firm surface, knees bent, feet flat. Use pillow only if head doesn’t reach floor. Gently press shoulders into floor, as if they are becoming “heavy” into the ground - hold. Repeat 3–5 times
Activity Recommendations	Apply to ADLs, activities of leisure and exercise	May be able to continue most activities with attention to activity considerations. Avoid high fall risk or contact sports.	The risks of exercise machines, many classes and some ADLs may outweigh benefits. Consult with physical/occupational therapist on safe ADL and activity performance.	Activity considerations: Modify or avoid activities that require repeated, rapid, repetitive, weighted or end-range twisting or flexion of the spine, avoid high fall risk or contact sports. Use hip hinge instead of spinal flexion to bend, and step-to-turn instead of twisting.

ADL activities of daily living, RM repetitions maximum²

¹The table summarizes some of the broader recommendations that came out of the consensus process, but was not a product of the consensus process. The table does not thoroughly summarize all recommendations. How the exercise recommendations or physical activity recommendations should be tailored based on case presentation requires clinical judgment. Please refer to the text for a better appreciation of the differences in recommendations between case presentations.

²Repetitions maximum (RM) refers to the maximum level of resistance or difficulty for a given exercise that can be performed for the stated number of repetitions, e.g., 1RM squat is the maximum amount of weight you can lift with good form in a squat one time, 8RM bicep curl is the maximum amount of weight you can lift in a bicep curl eight times