Exercise Prescription for People with Osteoporosis

Exercise prescription for osteoporosis should prioritize fall and fracture prevention while still supporting general physical activity. The main recommendation is to follow national activity guidelines, but place special emphasis on balance training and progressive resistance training at least twice per week. Walking, yoga, and impact exercise can still be included for enjoyment or other health benefits if they are safe and appropriately modified, especially for people at higher fracture risk. Key exercise targets include improving balance, muscle strength, bone strength, and posture. Balance work should challenge anticipatory control, dynamic control, functional stability limits, and reactive balance, using activities such as tandem standing, one-leg stance, directional walking, step reactions, and ball tasks. Resistance training should focus on functional movement patterns such as pushing, pulling, squatting, hinging, carrying, pressing, and step-ups, with progression toward higher effort. Special attention is also given to posture and hyperkyphosis, with strengthening for back extensors, abdominal muscles, and shoulder stabilizers. Spinal flexion, twisting, and high spinal loads may need modification, particularly in those at high risk of fracture.