Pilates Exercises for Osteoporosis

Pilates is an exercise technique that conditions the entire body and can help build bone and muscle strength. You can learn Pilates by taking classes or on your own.

You’ve probably heard that “weight-bearing exercises” — like walking — can help reduce the risk of osteoporosis, a disease in which bones become weak and brittle over time. But don’t overlook Pilates as a potential skeleton-saving workout.

Not only can these core-strengthening workouts strengthen bones and help prevent future injury, they may also help melt belly fat, which may further help protect against osteoporosis. Last year, a Harvard study found that women with more visceral belly fat had decreased bone density levels.

"The fundamentals of Pilates offer a terrific platform for strengthening bones and preventing fractures if done properly," says Rebekah Rotstein, a New York City Pilates instructor and a faculty member at the Kane School of Core Integration, where she trains Pilates teachers. Rotstein has also put together a set of Pilates exercises for osteoporosis called "Pilates for Buff Bones."

But not just any Pilates routine will do — in fact, many basic Pilates exercises aren’t safe for people with osteoporosis because of the strain they put on your spine. Here’s what you need to know before you hit the mat or machines:

How Pilates Works for Someone With Osteoporosis

Pilates involves a set of exercises designed to condition your entire body by strengthening the muscles of the stomach and back, referred to as your “core.” People often think that Pilates is associated with yoga because participants flow through a series of precise positions while paying attention to their breathing. However, the focus of Pilates is more on strengthening exercises than anything else. 

Pilates exercises for osteoporosis can help people with weakened bones by: 

• Increasing bone density, a proven effect of exercise
• Increasing strength and muscle mass, allowing the body to better support bones made brittle by osteoporosis
• Improving balance, which can help prevent falls that might result in a fractured bone, especially if you have osteoporosis
• Improving flexibility and posture, which can help keep the bones in alignment and prevent painful pinched nerves and muscle spasms in the back

Pilates exercises for osteoporosis are safe for people living with the condition. However, not all Pilates classes cater to people with osteoporosis. "Three-quarters of the exercises in traditional Pilates need to be modified for someone with osteoporosis," Rotstein says. "The traditional Pilates mat class is not advisable." But modified classes, which omit the mat exercises listed below and are under the direction of a well trained instructor, can be safe. 

Which Pilates Exercises Are Safe for a Person With Osteoporosis?

People interested in pursuing Pilates exercises for osteoporosis should keep in mind that many Pilates postures can be helpful, but some should be avoided. 

Exercises that work the back, shoulders, legs, and hips are the most beneficial for people with osteoporosis. "The most damaging type of injury one can incur is a fracture of the hip," Rotstein says. "Strengthening the hips should be a big goal." 

However, people with osteoporosis should avoid Pilates exercises that involve bending forward or rolling on your back, and be very cautious when performing exercises that involve twisting through your spine. "Pilates has a large proportion of motions that involve bending forward through the spine," Rotstein warns. "That is the most dangerous motion for someone who has bone loss. It could lead to a fracture of the spine." 

Some Pilates exercises involve the use of equipment such as the Reformer, which resembles a rowing machine and provides resistance for the person exercising. Equipment-based Pilates can be just as safe as mat exercises, Rotstein says, and perhaps more effective because they add an element of strength training to your workout. 

Safe Pilates mat exercises for someone with osteoporosis include:

• Single and double leg kicks
• Side-line series
• Leg pulls and circles
• Push-ups
• Chest expansion

Unsafe mat exercises include:

• Roll-up
• Roll over
• Jack knife
• Spine twist
• Saw

Safe Pilates machine exercises for people with osteoporosis include:

• Foot work (using the Reformer)
• Leg and arm circles (Reformer)
• Pulling straps (Reformer)
• Side splits (Reformer)
• Leg-spring series (Trap Table)
• Chest expansion (Trap Table)

Unsafe machine exercises include:

• Short spines
• Tower
• Overhead
• Mermaid

Questions to Ask a Pilates Instructor if You Have Osteoporosis 

Before you start exercising, here are some questions to ask to make sure the Pilates instructor is well trained and capable of adapting the practice to someone who has osteoporosis: 

• Is the instructor certified through the Pilates Method Alliance?
• Can the instructor understand a bone density mineral report?
• Will the workout include any of the exercises listed above as unsafe?
• Will exercises aimed at balance and fall prevention be included in the workout routine?

With its rise in popularity, it's easier than ever to find Pilates classes, but people with osteoporosis need to look for classes that are specifically geared to their condition.