Expert Advice On Personal Training Clients With Osteoporosis

Working with older clients can often have its own set of unique challenges and rewards, but it’s equally important to understand how being a personal trainer for osteoporosis differs from more conventional training. 

To cover this niche area of fitness, this article will be broken into three parts:

• What A Personal Trainer Needs To Know About Exercise For Osteoporosis
• 5 Tips On Being An Effective Personal Trainer For Osteoporosis Clients
• 3 Key Exercise Groups For Training Clients With Osteoporosis

But before we get started, our Level 4 Nutrition course provides you with specialist knowledge to help clients with their nutrition. Download our course prospectus to learn more. 

What A Personal Trainer Needs To Know About Exercise For Osteoporosis

Osteoporosis is a common medical condition, causing bones to become: 

• Brittle
• Weak
• More prone to breaking

This is a result of losing bone density, which, while it’s a natural part of the ageing process, means exercise can mean clients risk breaking bones easily, or otherwise injuring themselves.

According to the NHS, osteoporosis affects over 3 million people in the UK. Although both men and women can be affected, older women are at a higher risk due to hormonal changes that occur during menopause, which directly affect bone density.

When personal training older clients, you should always be aware of their limits. AgeUK states around 1 in 2 women and 1 in 5 men over 50 will break a bone because of osteoporosis.

Bones most at risk from those suffering with osteoporosis are those that often bear the most strain, and include the:

• Wrist
• Hip 
• and Spine

This means when training clients with osteoporosis, you should be careful of exercises that engage these bones, such as step-ups or push-ups.

When creating an exercise programme for clients with osteoporosis, you should ask them what bones they’ve broken or fractured in the past to highlight any particularly vulnerable areas.

Unfortunately, most people aren’t aware they have osteoporosis until they break a bone as there aren’t any symptoms. However, if particularly vulnerable clients complain about pain or issues, especially during exercise, ask them to look out for:

• Loss of height
• Curving of the spine
• Severe back pain

If they’re experiencing any of these issues, you should advise them to see a doctor before continuing their training with you. If they’re over 50, it’s likely the client will be given a bone density scan (DEXA scan) to diagnose or assess the risk of osteoporosis.

After the results of this scan, you can then tailor their exercise programme with a greater understanding of what they’re at risk of, and how vulnerable they are in terms of performing certain exercises. 

There are types of exercises to prevent osteoporosis you should be aware of as a personal trainer. Weight-bearing and resistance training are hugely important for the improvement and prevention of osteoporosis. 

When dealing with particularly vulnerable clients, these are the kinds of exercises you should focus on, and what we’ll discuss in more depth later in the article.

5 Tips On Being An Effective Personal Trainer For Osteoporosis Clients

The role of exercise in the treatment of osteoporosis is crucial in helping clients live fulfilling, injury-free lives. It helps conserve bone tissue, reducing the risk of fractures and the rate of bone loss.

While it may seem a difficult task being a personal trainer for those with osteoporosis, our tips will help you provide effective training, as well as explore how you can best support your clients as they deal with the condition.

#1 - Avoid Certain Exercises Altogether When Training Clients With Osteoporosis

When creating an osteoporosis exercise plan, you need to think carefully about what exercises you’re including. While you may not like being too restrictive, it’s important to avoid certain exercises altogether when being a personal trainer for clients with osteoporosis.

Exercises such as sit-ups or crunches should be avoided as these kinds of movements put pressure on the vertebrae, which can be damaging if the spine is particularly brittle, or has suffered breaks before.

Exercises you should avoid using that involve flexing the spine include:

• Bending from the waist (Deadlifts, for example)
• Rapid sideways bending (Kettlebell side bends, or Russian twists)
• Rotation activities (Trunk rotation, twists, etc.)

However, extending the spine isn’t damaging for those with osteoporosis. Yoga poses such as child’s pose or cobra pose are ideal for stretching the spine without putting pressure on it. 

Doing this can help prevent curvature of the spine and improve posture, and ultimately lead to more freedom and options when it comes to planning a session for an osteoporosis client.

Depending on how severe your client's osteoporosis is, something such as a pilates exercise like the standing roll-down can lead to injury. As the movement of this could lead to a fracture or injury, you may be feeling limited in what you can do.

However, similar to personal training clients with arthritis or a similar condition, there are adaptations you can put into place to ensure your clients don’t feel as though they’re missing out. For example, you can swap a standing roll-down for a variation of standing bird dog.

This simple exercise is performed by having the client:

• Stand opposite a wall
• Slowly lift their right leg behind them
• At the same time, lift their left arm above their shoulder
• Repeat using the opposite movements

The client will still work those same muscle groups, but have a much lower risk of causing injury, or breaking a bone.

Other Movements To Avoid If Clients Have Osteoporosis

Bending & Twisting: While this may seem unavoidable when exercising, clients should avoid performing movements where they twist or bend at the waist. This may include exercises such as Russian twists, or bicycle crunches. Alternatives to these exercises can be side planks or stair climbing, as these target those same muscles without . 

Attempting more straining exercises can increase the risk of compression fractures, especially in the spine. Other activities to watch out for include tennis and certain yoga poses, something to keep in mind if your clients enjoy these sports.

High-Impact Exercises: As a personal trainer specialising in osteoporosis, you should avoid exercise involving rapid movements. Instead, you should opt for slower movements to reduce the risk of injury.

This doesn’t mean you have to limit the number of exercises, just have the clients perform them at a slower pace. To avoid the risk of injury altogether, it’s best to avoid high-impact exercises and focus on sustained low to moderate activity, such as aerobics and long-distance walking.

#2 - As A Personal Trainer For Osteoporosis, Include Aquatic Exercises

As a personal trainer specialising in osteoporosis, it’s likely you’ve considered aquatic exercises as part of your service. Although swimming or water-based activities aren’t proven to improve bone mass in clients with osteoporosis, it’s still great for treatment.

It’s worth mentioning that water exercise such as swimming doesn’t count as a weight-bearing exercise, as the water’s buoyancy counteracts the effects of gravity. However, it’s the resistance of the water and the higher level of safety which makes it an ideal training environment.

Similar to how water exercises are good for those with arthritis, it’s great for people suffering with osteoporosis. The reason for this is because the natural buoyancy makes it easier on the joints as well as helps to improve: 

• Mobility
• Cardiovascular health
• Muscle strength

If clients with osteoporosis complain some exercises aren’t challenging enough in their usual environment, why not try personal training in the pool to give them a greater workout without having to advance to more impactful exercises that may increase the risk of injury.

Some aquatic exercises you can have clients with osteoporosis perform include:

• Water walking
• Lateral arm lifts
• Slow jogging
• Sidestepping 

You may also add resistance weights or foam dumbbells to increase the challenge for clients in the pool. However, always ensure clients feel comfortable when leaving the pool as it can be harder for people to tell how tired they are as opposed to working out at the gym.

#3 - When Training Clients With Osteoporosis, Use Reaction & Balancing Exercises

The role of exercise in the treatment of osteoporosis is absolutely crucial in reducing the risk of falling, one of the biggest causes for fractures and sprains. Using exercises for balance and stability helps keep your muscles stronger and stable, reducing the risk of falling.

Various exercises clients can do to improve balance include:

• Back leg raises
• Heel-to-toe walk
• One-legged stand
• Side steps

Other activities based on movement, such as tai chi, can also help improve stability. This offers the benefits of:

• Muscle strengthening
• Flexibility
• Endurance training

However, as it uses slower, more deliberate movements it doesn’t run the risk of worsening existing chronic problems.

While these activities are simple, it’s a great way to increase their balance in a controlled way.

These balancing exercises should also be combined with reaction exercises to help with their reflexes should they suffer a fall.

The Bone Health & Osteoporosis Foundation (BHOF) estimates that approximately one third of all people over age 65 in the US fall, resulting in broken bones. With this in mind, it’s important to teach clients how to reduce the impact of a fall.

Most of this impact comes from not being able to stop the fall or trying to in a clumsy way which can worsen the extent of injuries. This means teaching clients some exercises to help themselves if this situation arises.

You could have clients with osteoporosis practice wall push-ups. This is where they push themselves away from the wall then slowly fall back towards it with all their weight.

Throwing and catching exercises may also be a good activity to try, especially with older clients as having them practice their reflexes can reduce the risk of injury. While it’s unlikely to reduce their risk of falling, it can help decrease broken bones or strains.

#4 - Advise Osteoporosis Clients On How To Further Look After Their Bones

Although the role of exercise in the treatment of osteoporosis is important, there are also things you can advise clients on to help protect their bones from further damage. 

If clients are relatively new to using exercise for osteoporosis alleviation, this is the perfect time to suggest other lifestyle changes. When people begin a new exercise regime, they’re more likely to listen to tips to stay fit & healthy, as well as change their behaviour.

Ensure Clients With Osteoporosis Receive Enough Vitamin D

While we’re told about getting enough vitamin D, few people actually know why this is important. Vitamin D helps your bones absorb calcium, crucial for making them stronger. The less calcium your bones absorb, the weaker they’ll be.

The main source of vitamin D is from exposing the skin to sunlight. A short amount of time in the sun without sunscreen is good for this, but keep this to a minimum where possible, especially without proper sunscreen.

Vitamin D can also be found naturally in foods such as:

• Eggs
• Oily fish
• Certain breakfast cereals

However, it can be difficult to get vitamin D from food alone. If it’s winter or there isn’t much sunlight where your clients live, ensure they speak to a doctor who may supply them with vitamins or advice.

Eat Foods Rich In Calcium

Calcium is what provides bones with their strength and structure, an absolute necessity for clients with osteoporosis. This is especially important for older clients as the body’s ability to absorb calcium reduces as we age.

Consuming calcium-rich foods is the best way to do this. The NHS recommends adults have around 700mg of calcium each day.

Some foods rich in calcium include:

• Cheese
• Yoghurt 
• Milk
• Dried fruit 

These can either be eaten as a snack or included as part of a meal. Eating healthy meals and snacks consisting of fruits and vegetables isn’t just great for getting calcium but also because these are immunity boosting foods.

Advise Clients With Osteoporosis To Reduce Smoking & Drinking

While smoking and heavy drinking come with a range of negative health issues, they can also lead to bone loss and increase the risk of broken bones. 

The NHS-recommended weekly number of alcohol units is 14. This should be spread out across the week to avoid binge drinking. However, smoking should be avoided altogether as any amount of it is bad for the bones.

Aside from causing damage to the bones, other general health issues that come with smoking include:

• Various cancers
• Heart attack
• Diabetes
• Stroke

Drinking and smoking heavily in the past means your bones may have been left weakened, resulting in an increased vulnerability to breaks and fractures.

Cutting out these habits while ensuring you receive enough calcium and vitamin D is important for keeping you healthy.

Ensure Osteoporosis Clients Maintain A Healthy Body Weight

Being a healthy body weight can also help keep your bones healthy too. Smaller clients with osteoporosis may be more at risk of injury if their body weight is lower.

The reason for this is because a lower body weight often means you have smaller bones which are more fragile. Having less body fat and muscle also means there’s less protection for bones if someone suffers a fall, increasing the risk of fractures. 

Healthy foods to help increase bone strength include:

• Green leafy vegetables (okra, broccoli, cabbage)
• Soya beans 
• Tofu
• Nuts 
• Fish (sardines, pilchards)

You need to ensure your personal training clients with osteoporosis are eating plenty of foods for energy so they receive enough vitamins and minerals, crucial for maintaining healthy bones.

- - - - 

Aside from being a personal trainer for osteoporosis, why not explore other areas of fitness and develop a different niche? These articles can help you with this:

• Personal Training Clients With Arthritis: Tips & Exercises
• Advice & Guidance For Personal Training Blind Clients
• Expert Advice On Training Clients With Eating Disorders

#5 - Educate Clients With Osteoporosis About Their Condition

As a personal trainer specialising in osteoporosis, you should not only be training clients in the best way you can, but also educating them about their condition and the best way to train when they aren’t around.

By demonstrating your knowledge of the condition, its role in exercise, and how you can best adapt their training programme, clients are much more likely to be receptive to what you tell them. 

It’s more likely they will also be more open to the advice you impart, especially about their own condition, plus you can tell them exactly why they should avoid certain exercises or use certain ones over others.

You shouldn’t be vague about whether clients should do particular exercises, either. If more vulnerable clients could potentially injure themselves by performing them, and they incorporate these into a home workout routine and do break a bone, this will reflect badly on you.

As you’re the trainer, you need to ensure you’re well educated in the subject and can accurately break down their workout, explaining your reasons for tailoring their plan and why they should follow the exercises you’ve suggested.

Some online resources you can suggest to help clients better understand their condition may include:

• Royal Osteoporosis Society
• International Osteoporosis Foundation
• Bone Health & Osteoporosis Foundation

This is a way for them to do their own research to ensure they know how to manage their condition outside of sessions too. However, it’s also important for your own professional development to educate yourself around these resources before passing them onto clients.

3 Key Exercise Groups For Training Clients With Osteoporosis

While there isn’t a single exercise plan that works on every client with osteoporosis, the workouts you plan for clients should be based on:

• Muscle strength
• Risk of fracture
• Motion range
• Physical activity level

With this in mind, you should adapt each client's sessions to reflect the levels above. However, there are some key exercises you can suggest when training clients with osteoporosis.

These include:

• Weight-bearing exercises with impact
• Muscle-strengthening exercises
• Flexibility exercises

Let’s break these types of exercises down!

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#1 - Weight-Bearing Exercises For Clients With Osteoporosis

These activities involve performing exercises on your feet by using your body weight and allowing the bones in your legs to take this weight. The client will be working against gravity while still staying upright.

Examples of these exercises include:

• Low-Impact Aerobics
• Walking
• Elliptical Training Machines
• Stair Climbing

While it’s unlikely these types of exercises prevent osteoporosis, they can slow down the rate of bone loss.

However, if a client with osteoporosis is prone to breaking bones, you may want to avoid more high-impact weight-bearing exercises such as:

• Jumping rope
• Hiking or walking uphill
• Dancing
• Bending or twisting the body

#2 - Osteoporosis Exercises For Strengthening Muscles

These kinds of exercises involve adding weight to the workout for a client with osteoporosis. This is important for maintaining bone density and improving muscles as well as bone strength.

These exercises may include using:

• Free weights
• Resistance bands
• Your own body weight

When training clients with osteoporosis, weights are a great way to strengthen major muscle groups as well as improve posture by focusing on spinal muscles.

Examples of strength training exercises for clients with osteoporosis include:

• Squats
• Standing on one leg
• Bicep curls
• Shoulder lifts

However, you should warn clients to be careful not to twist their spine too much while performing these exercises or adjusting machines. As mentioned earlier, this can be a particularly vulnerable area for clients with osteoporosis.

Performing muscle-strengthening exercises underwater is also a great way to increase the challenge of your sessions when using exercise in the treatment of osteoporosis. 

Holding sessions in water means clients can build resistance and add a level of difficulty without having to worry about further impacting or damaging already weakened bones.

#3 - Flexibility Exercises For Training Clients With Osteoporosis

While flexibility is important for anyone, it’s especially important to include when training clients with osteoporosis. 

Flexibility is great for keeping active and can be done without overexertion, such as through:

• Dynamic stretches 
• Yoga 
• Pilates

Gentle stretches for the neck, shoulders, and upper back will help improve your clients posture. While it may be too late to prevent a client’s osteoporosis, it can still help ease pain and work their muscles.

However, before starting any exercises to improve flexibility, you should begin with gentle warmups to ease clients into the slightly tougher stretches, minimising the risk of injury.

You should also combine balancing exercises with stretches. Improving balance is important for reducing the risk of them falling which could lead to serious breaking or fractures.

Simple ways to improve balance other than the exercises mentioned earlier may include:

• Light dancing 
• Exercise to music 
• Tai Chi

However, you should remind clients as with any exercise, this takes time to improve and will get better with practice.

Before You Go!

As a personal trainer specialising in osteoporosis treatment, you will not only be improving their quality of life but also your skills as a personal trainer.

And with OriGym's Level 4 Nutriton course, you'll develop a suite of specialised skills to help you better provide nutritiona advice for your clients.

Download our complete course prospectus to see how else you can expand your skills or simply leave your details below.