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