Focus on eccentric exercise to build leg strength for skiing

Regardless of how you exercise, it helps to understand what "eccentric" means when it comes to muscle movement.  The opposite type is "concentric."  Doing squats or lunges is not as effective if you don't know which direction is an eccentric exercise.

Here is what I found in a Backcounty.com article:

"Think of concentric strength as “positive” strength. This is the strength you use to stand up from the bottom of a squat, or hike up a steep hill. Eccentric strength is “negative” strength. You use eccentric strength to lower yourself into the bottom of the squat, and hike down a steep hill. Eccentric strength absorbs force.

My observation at the fitness center is that some people tend to think that going faster is better when they are using fitness machines.  Meaning to the point that they ignore the speed warning provided by the machine.  They also tend to do relatively heavy weight that they cannot handle slowly.  For ski conditioning, a weight that can be handled slowly for 10-15 reps is more helpful in the long run.

Balance training with BOSU and TRX

Balance training is a critical component for skiers.  The TRX is good for working on core strength.  Pretty effective when the two are combined.  I have done most of the exercises in the video but adding the BOSU would certainly make them more difficult.

A Smart Approach To Balance Training - TRX Training

The exercises are variations on squats, planks, and lunges.

TRX for core strengthening, plank variations and more

While almost any exercise using the TRX is good for strengthening the core, there are many ways to focus on core muscles.

The plank is accepted as a basic exercise for building core strength.  There are many possible variations of a plank.  Not surprisingly, there are TRX plank variations as well.  The seventh variation on the following webpage is not one I'll ever try.  It's a handstand with one foot in the TRX!

7 TRX Plank Variations

TRX rotational ward
TRX plank
TRX side plank
TRX 1-arm plank
TRX forearm plank
TRX single leg plank
http://www.acefitness.org/blog/5693/7-trx-plank-variations-for-a-stronger-core

For those familiar with TRX exercises, this webpage is a nice summary of core exercises.  If you don't know an exercise, finding a video on YouTube is fairly easy when you know the name.

20 TRX Core Exercises

Overhead back extension

Hip drop

Torso rotation

Kneeling roll-out

Kneeling oblique roll-out

Standing roll-out

Overhead squat

Assisted sit-up

Resisted single-leg raise

V-Up - heels in cradles

Suspended plank (elbows or hands)

Crunch (elbows or hands)

Oblique crunch

Mountain climbers

Pike

Pendulum

Body saw (elbows or hands)

Side plank (on elbow, with or without arm assist)

Side plank with hip drops

Side plank with reach-through

http://www.cyberpt.com/documents/CORE%20EXERCISES.pdf

Getting started with knee strengthening exercises

What can you do to strengthen your knees?  What if you aren't up for doing lunges and squats quite yet?  Here is a video to get you started.  The target audience is anyone over 50 who is feeling a little unstable or occasionally experiences knee pain.  I recognized the first exercise from knee rehab.  I learned it during my first physical therapy session.

There are three exercises done on the floor and two standing exercises.  To do all the exercises, you need a foam roller or a mid-size ball, and a stability ball.

Keeping knees happy, importance of strong hamstrings

When it comes to supporting knees, hamstrings are more important than quads.  This video by Dr. Megan Hersh answers the question "What does asking and squatting have to do with knees?"  She holds a doctorate in physical therapy and was a competitive ski racer through college.  At the end of the video, Dr. Megan shows her first ski instructor (in PA) a couple exercises to help his hamstrings.  Her guest is a long time skier and coach.  He was over 75 when they filmed at Vail in 2015.

Below what she says about squats.  Highly recommend reading all her comments posted on YouTube with the video.

"If done properly, squatting can actually have the reverse affect on the knees from its rumored "being bad for the knees". Practicing proper slow and controlled squats can help train and strengthen the muscles used during the squatting nature of skiing. EMG studies show the majority of the prime mover muscles used in skiing actions contract eccentrically, just as they do in the lowering of a squat. Also, since the hip angle generally does not have significant change during a turn in skiing, the rate or speed of contraction during skiing is relatively slow.

This being said, the type of training that you should do to get ready to hit the slopes should involve predominately lower body exercises with a large eccentric bias and a relatively slow rate of contraction. This means that you should do the exercises slowly in a controlled fashion concentrating on technique to maximize the benefits of the exercise and transfer to skiing performance."

TRX knee rehab at any age

I started using the TRX when I was finishing up knee rehab (no surgery).  I was over 55 and missing an ACL.  The goal was to strengthen my legs in order to continue skiing at an advanced level.   I was lucky to find an older personal trainer.  She wasn't a skier but was willing to research and learn what exercises are most useful for skiing.  She liked the TRX so I was willing to give it a try.

As I research the TRX, I found this video of an older man using the TRX for knee rehab.  Later on, it became obvious that the TRX is very useful for full-body workouts that improve core strength, balance, and flexibility, which are all important for skiers of all ages.  For an introduction to basic TRX exercises for ski conditioning: TRX ski conditioning focus .

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These two videos are of a college athlete working towards full recovery after knee surgery.  It's interesting to see how the TRX can be used even in the early non-weight bearing phase immediately after surgery.

TRX for hips

As I improved as an advanced skier, ankles and hips became more important.  I knew about the importance of working hip adductors and abductors, but hadn't thought about hip flexibility.  My PSIA Level 3 instructor at Alta made a point to emphasize hip flexibility.

Each sequence includes three exercises.  They were part of a weekly series by TRX.

Ankle: cossack, bottom up squat, squat jump

Hips: cossack, hip swings, crossing step side lunge

Hips: hip pull, crossing balance lunge, surfer

A few TRX lunges

The lunge is often part a ski conditioning workout to strengthen legs.  One reason is that lunges strengthen hamstrings, which provide important support for knees.  Having strong hamstring is especially important for people who are missing an ACL.

Here are a few TRX lunges.  When I started knee rehab several years ago (not a skiing injury), I was not that good at lunges.  I found that doing them with the TRX provided just enough extra support that I was more comfortable going deeper on a lunge.  Definitely appreciated the TRX when starting side lunges.  When my personal trainer introduced the suspended lunge, I was happy to find that I was strong enough for such a 1-leg exercise.

The link below goes to a webpage with a video of four types of TRX lunges:
TRX Lunges: side, back, balance, crossing balance

TRX crossing balance lunge

TRX suspended lunge

Warm up before a workout or ski day

One of the advantages of working with my personal trainer is that she figures out some warm up exercises before I start doing the real work.  Below are a couple examples of warm up sequences.

Ski Day warm up, 5-10 min, using a resistance band

It happens that these videos were not created by Americans.  The first is from Australia and the second is from a fitness company in London.  I've come across a lot of good ski conditioning videos from Australia.  The first video is from a ski workout webpage that geared more for younger skiers who are hard chargers.

Ski Workout - Fitness for Snow

The tips for preparing for a big ski trip include comments about ski lessons as well as getting enough sleep.  A bit different approach than Americans who give advice how to prepare for a ski vacation.

TIPS TO GET YOU READY FOR YOUR SKI TRIP

1. Start your ski fitness program at least six to eight weeks before your trip.  Target ski-specific muscles. Make sure you get a program that really works the thighs, butt, and core stabilisers. The legs will predominantly be working eccentrically throughout skiing to maintain your squat position and stabilise throughout uneven terrain, so ensure your training incorporates eccentric leg extensor exercises.

1. Keep up the ski lessons on the snow to ensure correct technique.
2. Warm up with some easy runs and stretches before challenging yourself further when out on the slopes.
3. Allow time for rest and refuelling. Schedule in regular drink (high quality water) and food breaks. Watch the quality of food on the mountain. You may want to travel with home-prepared snacks.
4. Keep in mind that although the slopes are enticingly less crowded at the end of the day, fatigue can set in and cause some grief. Monitor your energy levels and focus on maintaining good technique.
5. Aim for 8 hours sleep each night, which is actually hard not to do since you’ll be quite exhausted from a day’s skiing, and avoid late nights of drinking. Becoming intoxicated hammers your neuromuscular system which will not be in the best shape to provide adequate support the following day and your ski trip could turn fairly expensive medically!
6. Find good quality and correctly fitting boots, skis, bindings and consider clothing that breathes, conserves heat or cools by evaporation.
7. Have fun!

FreeMotion machines for strength training

When I changed fitness centers a couple years ago, a bonus was that the new one has FreeMotion machines.  Although the main reason for the change is that the new one is only a mile from my house.  It was completed a year after I first started looking for a place to work out that had machines and fitness classes.

I haven't used the FreeMotion machines that often yet, but like the concept.  Appreciate being able to do variations even on the machines that are focused on one muscle group.  Also like being able to do single leg/arm exercises easily.  Some exercises are much more similar to TRX versions than what's available on traditional strength training machines.  The advantage over the TRX is the ability to move beyond body weight when ready.

Using FreeMotion for back muscles

FreeMotion Squat - a training video for personal trainers

Overview of the FreeMotion concept - a marketing video

Ski conditioning 20-min workout with kettle bells, TRX

This is an example of an intense 20 min workout.  Not sure I would ever do the entire workout, which includes 3 reps for each series.  Might do 2 reps though.  More interested in the components selected.  Starts with strength work with kettle bells, then a few TRX exercises, then a leg blaster series of squats and lunges (25, 25, 25, 25).  I remember doing the leg blaster for a few weeks with the TRX with my personal trainer a couple years ago.

Progressive approach to pistol squats

The pistol squat is a single leg exercise that builds leg strength and improves ankle flexibility, which is helpful once someone is past the beginner stage on skis.  This is one of those exercises where it's important to do a progression to build up to the final version.  Below are several progression ideas.

1-min Introduction to Pistol Squat Progression

Progression in a fitness center

Working from the bottom up is another approach that may be good for people who need to work on ankle and hip flexibility.  Click on the link for a detailed explanation and videos.

Pistol Squat Tutorial

The following progression for a modified pistol squat is based on working next to a counter top.

• With a hand on the counter top, go 1/4 of the way down on one leg and hold for 10 seconds.  Use the arm and both legs to return to standing.  As you get stronger, go down lower and hold. 
• Next work on eccentric muscle.  Go as slow as you can to the end of your range and hold.  Stand up using the arm and both legs.
• After mastering a slow descent and the hold, use the bent leg to power up to a standing position.  Use the arm as needed.
• The last step for the modified pistol squat is to take the hand off the counter top.

The TRX can be useful for developing proper form for pistol squats.  In general, the extra support from the TRX makes it easier to do deeper squats of any kind.

TRX for core strength

The TRX makes it easy to build core strength.  The 2-min videos below show a few of the exercises that my personal trainer introduced after about a year.  To start with, I could do about five Atomic Pushups.  Note that at that time I was able to do 10-15 regular pushups.  Worked up to 12 Atomic Pushups during pre-season ski conditioning.

TRX with a ski conditioning focus

When I first started using the TRX, it was fall.  I was most interested in exercises that were directly related to ski conditioning.  There are probably thousands of videos online involving the TRX.  These are a few that helped me get a feel for the advantages of using a TRX.  Ski conditioning should include working on strength, flexibility, balance, power, and cardio.  With the TRX, it's easy to do exercises that cover more than one aspect at the same time.

The first video is how the TRX is usually set up in a gym.  The other two show how the TRX can be used with the door anchor.

Examples of squats, lunges, adding power

Strengthening hamstrings

Learning or improving squats

Basic exercises while wearing a weighted vest

Using a weighted vest for improving bone health does not require doing exercises.  It can help even when only worn during daily living.  However, wearing one while exercising enhances the impact.  Note that the lunges in the video are also great for ski conditioning.  So are the jumps for those who have knees that are ready for that much exercise.

BOSU basics for ski conditioning

The first item I bought to use at home for knee rehab in 2012 was a BOSU®.  The BOSU is a half-dome balance trainer that can be found in many fitness centers.  I was using one for physical therapy pretty early in the process.  The key use then was to improve 1-leg balance for the injured leg.  Later on, I learned that there are lots of exercises using a BOSU that are good for skiing.

The following exercises were put together for a National Ski Patrol meeting several years ago.  As she mentions, a few of them are easy to do when watching TV.  Improving balance doesn't really take that much effort if you spend 5-10 min a day doing something.

Weighted Vest for Better Bone Health

A simple approach to stimulate bone growth is to wear a weighted vest during exercise or daily living on a regular basis.  The study often cited that clearly showed positive results for hips was reported in 1998.  Since then other studies confirm the idea that wearing a weighted vest with no more than 10-15% of body weight is helpful.  As with any exercise that uses weights, need to work up to the max weight gradually.

For a list of related studies that includes a 5-year study from 2000 and others reported in 2006-2008: http://www.wasatchweightvest.com/Research.html

Most weight vests are designed for general fitness or to enhance training for sports.  A few vests were designed for the purpose of stimulating bone growth.  In general, they are sold with 10-12 pounds of small weights that are easy to add or subtract.  As of 2016, the following are available for $125-210, not including shipping or extra weights.

1) http://weightvest4osteoporosis.com

This vest was designed for women by a woman who was diagnosed with osteoporosis around age 60.  Her product was included in a Wall Street Journal article in 2013.  The vest comes 1/2 pound flex weights to allow up to 10 pounds.  It's adjustable and zips up in front like a regular jacket/vest.  She recommends starting at min weight for an hour a day, 5 days a week.

2) http://www.drfuhrman.com/shop/weightvest.aspx

Joel Fuhrman, M.D., is a family physician, author of Eat to Live (2003), as well as several other nutrition health books.  This vest comes in Long or Short and uses 1/2 pound flex weights, with a   unisex design.  Dr. Fuhrman recommends working up to 3 hours per day, 5 days per week.

3) http://www.wasatchweightvest.com

The Wasatch Weight Vest is the most stylish and was designed by women.  One of the designers is a physical therapist at the Univ. of Utah Orthopedic Center.  This vest comes in a range of sizes from XS to XL.  The color choices are red or light blue, with black planned.  The 1 lb weights are canvas with recycled metal pellets.

4) Iron Wear Fitness Cool Vest
5) Iron Wear Fitness Women's Speed Vest

Iron Wear Fitness sells a variety of weighted vests.  The Cool Vest is similar to the vest sold on Furhman's website, #2 above.  The Women's Speed Vest is similar to the vest sold in #1.

6) Better Bones Women's Zipper Front Exercise Vest

Better Bones is a website by Susan Brown, Ph.D. that is all about bone health.  The vest is similar to the #1 and #5.

IOF Exercise Recommendations for Bone Health and Fall Prevention

Osteoporosis is a global issue.  The International Osteoporosis Foundation is an NGO based in Switzerland that works to pull together foundations from all continents.  The IOF is interested in prevention, diagnosis and treatment of osteoporosis, as well as other bone, muscle, and joint disorders.  Education with the goal of raising public awareness about bone health is an important IOF function.

IOF has exercise recommendations based on recent studies from around the world, including a long-term study on women who were followed for 16 years.  The recommendations depend on the population.  What makes sense for children and adolescents is not what is recommended for post-menopausal women or older men.

Exercise Recommendations - International Osteoporosis Foundation

High Load Low Rep study in older women lasting 4 years

The idea of that progressive strength training with high load and low repetitions is behind a number of studies of longer duration.  A study by Cussler et. al. was reported in 2005 that looked looked at "exercise frequency and calcium intake" over four years in 167 older women postmenopause who were randomized into two groups: exercise or control.  The exercise was two sets of 6-8 reps at 70-80% of max, three times per week.  Although the control group was not asked to exercise initially, they were allowed to start the exercise program after a year and many did.  The final numbers were 23 controls, 55 3-year exercisers, and 89 4-year exercisers.  BMD was measured at baseline and annually.  The study results support the idea that long term strength training is useful to prevent osteoporosis in older women.

Exercise frequency and calcium intake predict 4-year bone changes in postmenopausal women
Osteoporos International, 2005 Dec;16(12):2129-41. Epub 2005 Nov 10.
Cussler EC, Going SB, Houtkooper LB, Stanford VA, Blew RM, Flint-Wagner HG, Metcalfe LL, Choi JE, Lohman TG.  Department of Physiology, University of Arizona, Tucson, AZ, USA.

Abstract

The aim of this study was to examine the association of exercise frequency and calcium intake (CI) with change in regional and total bone mineral density (BMD) in a group of postmenopausal women completing 4 years of progressive strength training. One hundred sixty-seven calcium-supplemented (800 mg/day) sedentary women (56.1+/-4.5 years) randomized to a progressive strength training exercise program or to control were followed for 4 years. Fifty-four percent of the women were using hormone therapy (HT) at baseline. At 1 year, controls were permitted to begin the exercise program (crossovers). The final sample included 23 controls, 55 crossovers, and 89 randomized exercisers. Exercisers were instructed to complete two sets of six to eight repetitions of exercises at 70-80% of one repetition maximum, three times weekly. BMD was measured at baseline and thereafter annually using dual-energy X-ray absorptiometry. Four-year percentage exercise frequency (ExFreq) averaged 26.8%+/-20.1% for crossovers (including the first year at 0%), and 50.4%+/-26.7% for exercisers. Four-year total CI averaged 1,635+/-367 mg/day and supplemental calcium intake, 711+/-174 mg/day. In adjusted multiple linear regression models, ExFreq was positively and significantly related to changes in femur trochanter (FT) and neck (FN), lumbar spine (LS), and total body (TB) BMD. Among HT users, FT BMD increased 1.5%, and FN and LS BMD, 1.2% (p<0.01) for each standard deviation (SD) of percentage ExFreq (29.5% or 0.9 days/week). HT non-users gained 1.9% and 2.3% BMD at FT and FN, respectively, (p<0.05) for every SD of CI. The significant, positive, association between BMD change and ExFreq supports the long-term usefulness of strength training exercise for the prevention of osteoporosis in postmenopausal women, especially HT users. The positive relationship of CI to change in BMD among postmenopausal women not using HT has clinical implications in light of recent evidence of an increased health risk associated with HT.

Osteoporosis International in an international multi-discinplinary journal which is a joint initiative between the International Osteoporosis Foundation and the National Osteoporosis Foundation of the U.S.A.

To combat bone loss, not all types of exercise help . . . jumping works, walking too

It's fair to say that even though men also should be thinking about bone health, it's a much bigger topic for women.  Found a good webpage on A Women's Heath.  The basic premise is that it's important to pick appropriate types of exercise if the goal is to build stronger bones.  The article includes references from 2006 to 2014 to support the recommendations.  Jumping, walking, and weight lifting can all be useful, especially for reducing the likelihood of hip fractures.  Walking may not build bone, but has been shown to reduce the risk of fractures.

Build Bone Density with the Right Exercise

One of the studies referenced involved pre-menopausal women in 20 cities in the "Mountain West."  The objects was to look at the impact of jumping as the primary exercise. Sixty women ages 25-50 were randomized into three groups: a control group, or one of two exercise groups who jumped either 10 or 20 times twice daily for 16 weeks. The jumps were high-impact, meaning as high as possible while throwing hands up, landing with feet together or apart, with a 30-sec rest between jumps. Positive differences in BMD in the exercise groups were found at 8 weeks and after the study was completed.

Effect of two jumping programs on hip bone mineral density in premenopausal women: a randomized controlled trial, American Journal of Health Promotion, 2015, Tucker L.A., Ph.D., et. al., mostly at Department of Exercise Sciences, Brigham Young University, Utah.

High load or high impact exercises for good bone health

One of the few hits that proved useful when I search on "osteopenia" is a 2-page article from a physical therapy group in Washington state.

Exercise Guidelines for Healthy Women Who Have Osteopenia

The key point made was that based on research findings, "exercise programs should be site-specific, high load and/or high impact, and progressive."  For weight lifting, being progressive means that as someone becomes stronger, they should use a heavier weight.  A list of suggested exercises for women with osteopenia was included.

For the suggested exercises, the idea is to build up to 70-80% of the maximum weight for a single lift.  At that weight, even 5-8 reps is sufficient to stimulate bone growth.  That's assuming exercises are done on a regular basis, meaning 2-3 times/week.

Gym Routine - using machines

• leg press
• leg curl
• knee extension
• military press
• chest press
• lat. pulldown
• row machine
• back extension
• abdominal strengthening

Home Program - with free weights

• lunges
• bridging with weight
• sit back squat
• dumbbell overhead press
• bench press
• push-ups
• mid-row
• active trunk extension
• abdominal strengthening

Note that it's best to start any exercise program after consulting with your physician.  If bone mineral density is a concern, doing a baseline bone mineral density test before age 50 is worth considering.  Working with a personal trainer or physical therapist initially to learn proper form is worth the investment of time and money.

Bone Health Overview

When I started looking for information about bone density, the amount of information available about osteoporosis was a bit overwhelming.  Especially since I was interested in learning how to avoid osteoporosis, not what to do after being diagnosed with osteoporosis.  Below are a couple overviews that were helpful.

A Visual Guide to Osteoporosis - A WebMD slideshow that provides a quick introduction to bone health and osteoporosis.

Osteoporosis - In-Depth Report, in NY Times Health Guide

The NY Times overview covers everything but it's pretty dense reading.  There are references from 2007-2009 and links for assorted websites, including National Osteoporosis Foundation.

A key point made is that testing is important.  The recommendations (below) are standard.  However, getting a baseline sooner is worth considering.  Meaning for women, can be useful to have a bone density test well before menopause.  For all humans, bone loss begins at some point after age 40.  Better to know earlier which areas (hips, spine, arms, legs) are weak.  My family physician suggested that I get tested when I was over 55 but not yet 60.  We learned that while my hip bones are strong, the bone mineral density of my spine is low enough to be considered osteopenia.

Because osteoporosis can occur with few symptoms, testing is important. Bone density testing is recommended for:

• All women over age 65
• Postmenopausal women under age 65 with one or more risk factors for osteoporosis
• All men over age 70
• Men ages 50 - 70 with one or more risk factors for osteoporosis
• Any man or woman over age 50 who has suffered a fracture

EFOPS, 16 year study concludes exercise helpful for bones of older women

One of the most interesting studies to finish in the last couple years is the Erlangen Fitness and Osteoporosis Prevention Study (EFOPS), which ended in 2014 after 16 years.  The study was based in Erlangen-Nuremberg, Germany and run by Wolfgang Kemmler, Ph.D., and his colleagues at the Institute of Medical Physics, University of Erlangen.  Before EFOPS, very few studies followed subjects for more than two years.  The study design was set up to allow post-menopausal women who met the study criteria to choose whether to be in the exercise group (EG) or the control group (CG).  The goal was to have enough women at the end of 16 years to allow for valid statistical comparisons between the groups.  BMD and other assessments were made every four years (4-, 8-, 12-, and 16-year follow-up).  The key measurements were bone mineral density (BMD) for the lumbar spine (LS) and femoral neck (FN).  It was clear by the first interim report after 4 years that exercise was associated with increased BMD, while the CG BMD decreased.  The exercises evolved as the study progressed.  By 2014, there were 105 women remaining in the study (EG: n = 59 vs. CG: n = 46).  The overall conclusion based on the 16-year analysis was that older adults would benefit from doing exercises regularly that could stimulate bone growth as well as help prevent fractures due to falls.

If you are interested in learning more about EFOPS, read on.  The most complete report online is #3.

1) The Erlangen Fitness Osteoporosis Prevention Study: a controlled exercise trial in early postmenopausal women with low bone density-first-year results

INTERVENTION: Fourteen months of exercise training, with 2 joint sessions and 2 additional home training sessions. Exercise and control groups were supplemented individually with calcium and cholecalciferol up to 1500mg of calcium and 500IU of vitamin D per day.

RESULTS: Bone density increased significantly at the lumbar spine for the exercise group (1.3%, P<.001) and decreased in the control group (-1.2%, P<.01). Differences at the total hip (-0.3%, not significant vs -0.8%, P<.05) and the femoral neck (-0.8%, P<.05 vs -1.8%, P<.001) were nonsignificant. Changes in isometric maximum strength were significant for each region (grip strength, trunk flexors and extensors, hip flexors, leg adductors and abductors, arm flexors and extensors) in the exercise group (11%-39%) compared with nonrelevant changes (-1.1% to 3.9%) in the control group. Between-group differences were significant (P<.01-.001) for all strength parameters. VO2max increased significantly by 11% (P<.001) in the exercise group but decreased in the control group by 4% (P<.05) while showing significant between-group differences.

Arch Phys Med Rehabil. 2003 May; 84(5):673-82
http://www.ncbi.nlm.nih.gov/pubmed/12736880

2) Exercise and fractures in postmenopausal women. Final results of the controlled Erlangen Fitness and Osteoporosis Prevention Study (EFOPS)

ABSTRACT: The EFOPS trial clearly established the positive effect of long-term exercise on clinical low-trauma fractures in postmenopausal women at risk. Bearing in mind that the complex anti-fracture exercise protocols also affect a large variety of diseases of increased age, we strongly encourage older adults to perform multipurpose exercise programs.

RESULTS: In 2014, 105 subjects (EG: n = 59 vs. CG: n = 46) representing 1680 participant-years were included in the 16-year follow-up analysis. Risk ratio in the EG for overall low-trauma fractures was 0.51 (95 % confidence interval (95 % CI) 0.23 to 0.97, p = .046), rate ratio was 0.42 (95 % CI 0.20 to 0.86, p = .018). Based on comparable baseline values, lumbar spine (MV -1.5 %, 95 % CI -0.1 to -2.8 vs. -5.8 %, -3.3 to -7.2 %) and femoral neck (-6.5 %, -5.2 to -7.7 vs. -9.6 %, -8.2 to 11.1 %) BMD decreased in both groups; however, the reduction was more pronounced in the CG (p ≤ .001).

Osteoporos Int. 2015 Oct;26(10):2491-9. doi: 10.1007/s00198-015-3165-3. Epub 2015 May 12.
http://www.ncbi.nlm.nih.gov/pubmed/25963237

3) Long-Term Exercise and Bone Mineral Density Changes in Postmenopausal Women—Are There Periods of Reduced Effectiveness?

ABSTRACT
The exercise protocol initially focused on a high-intensity strategy that addressed bone but increasingly shifted to a more comprehensive intervention. LS-BMD differences between the EG and CG continuously increased (year 4: 2.4% (95%- Confidence Interval 1.0% to 3.8%), year 8: 3.1% (1.6% to 4.7%), year 12: 3.9% (1.9% to 5.8), year 16: 4.5% (2.5% to 6.6%). Correspondingly, rising differences for FN-BMD (0.9% (–0.2% to 2.1%) versus 1.9% (0.4% to 3.3%) versus 2.0% (0.5% to 3.8%) versus 3.0% (1.0% to 5.0%)) were observed. However, in contrast to our hypothesis, group differences within the four 4-year periods were not consistently significant (LS, p = 0.001 to 0.097; FN, p = 0.026 to 0.673); further, BMD kinetics among the groups varied between LS and FN. Of particular importance, significant differences (p ≤ 0.030) for both regions were still found in the final period. We conclude that exercise—even when adapted for subjects' decreasing bone, health, and fitness status—is consistently effective in favorably affecting BMD in (initially) early-postmenopausal osteopenic women without any leveling-off effect after 16 years of exercise.

Journal of Bone and Mineral Research, Vol. 1, No. 1, Jan 2016
http://onlinelibrary.wiley.com/doi/10.1002/jbmr.2608/full - online Sept 2015

Research on effectiveness of weight and resistance training for building bone

Research related to bone density is being done not only by physicians, but also people working in the nutrition and fitness fields.  The study populations are usually restricted to one of three groups: pre-menopausal women, post-menopausal women, and men.  Many studies support the idea that weight and resistance training (high load, low reps) can make a difference in as little as six months.  Even if there is not clear improvement, the treatment group is more likely to hold steady instead of losing bone density during the study period.  Most studies last less than two years.  Below are a few examples.

Effects or high-intensity resistance and bone mineral density and muscle strength or 40-50-year-old women
Journal of Sports Medicine and Physical Fitness, 1997, Vol. 37, Num. 4, pp. 246-251.  Authors at UNC-Chapel Hill in the Dept. of Physical Education, Radiology, and Nutrition

Systematic strength training as a model of therapeutic intervention. A controlled trial in postmenopausal women with osteopenia
Am J Phys Med Rehabil., 1996, Jan-Feb;75(1):21-8.  Authors at the Department of Sports and Performance Medicine/Internal Medicine IV, University of Vienna, Austria.

Effectiveness of resistance training or jumping-exercise to increase bone mineral density in men with low bone mass: A 12-month randomized, clinical trial
The Bone Journal, Oct 2015, Vol. 79, pp. 203-212.  Authors at Univ. of Missouri in the Dept. of Nutrition and Exercise Physiology.

Bone building for the spine using weight exercises

Strengthening the spine using weight exercises is not that difficult.  However, it's important to use the correct form as well as the correct weight.  The idea is to develop form using a lighter weight but need to work up to a heavy weight in order to encourage bone growth.  The general guideline is to work up to a weight that allows 5-8 reps.  Doing heavy weight exercises 2-3 times a week has been shown to be enough to encourage bone growth over 6-12 months.

1) Weight lifting to prevent osteoporosis, 6 min
Importance of stacking the skeleton

2) Osteoporosis Exercises for Spine Strength and Posture - Australia, 9 min

Working on the middle of the back