Bone Strength and Conditioning Programme
Why Strength Training Helps Improve Bone Health?
Mechanical loading through resistance training is one of the most effective non-pharmacological interventions for improving bone health. At our clinic, we implement a structured and progressive resistance training programme specifically designed to stimulate osteogenesis – the biological process of new bone formation.
Our physio-led protocol emphasises on compound strength exercises such as squats, deadlifts, overhead presses, and jump-landing techniques. These exercises generate ground reaction forces and muscle contractions that place targeted mechanical stress on the skeletal system. This stress is essential in triggering mechanotransduction, the process by which bone cells convert mechanical signals into biochemical responses, leading to increased bone density.
We adopt a progressive overload model, carefully increasing load and complexity over time to continually challenge both musculoskeletal and neuromuscular systems. Proper technique is prioritised to optimise loading of key skeletal sites (e.g., lumbar spine, hips, and femoral neck) while minimising injury risk.
Is It Safe to Strength Train with Osteoporosis?
Yes. While strength training was once considered risky for people with osteoporosis or low bone density, groundbreaking research has proven it is both safe and effective when supervised by trained clinicians.
In fact, the LIFTMOR Trial (Watson et al., 2017) showed that supervised, high-intensity resistance training in women with osteoporosis led to no fractures or serious injuries. This confirms what we see in practice – with expert guidance, strength training is not only safe but is, in fact, one of the most effective ways to reverse bone loss and reduce fracture risk.
What Does the Evidence Say?
The LIFTMOR Trial (Watson et al., 2017) is a landmark study demonstrating that postmenopausal women who participated in supervised resistance and impact training twice per week for 9 months had marked improvements in the following parameters:
Significant increases in bone density at the lumbar spine and femoral neck
Improvements in functional strength, balance, and mobility
No serious adverse events, even in participants with low bone mass
This evidence supports our recommendation at Mayfair Health of bi-weekly supervised resistance training as a clinically effective strategy to stimulate osteogenesis, avoid osteoporosis, reduce fracture risk and improve long-term skeletal integrity.
What To Expect
Our trained physiotherapists help offer more than routine recipe based gym programs. We begin with a detailed assessment, analysing your lifestyle and medical history and performing objective testing of body mechanics and then develop a tailored and targeted treatment protocol that helps to address your unique needs and capacity.
We aim to empower your understanding of your health, teaching you the tools to manage this independently. With us, you will develop the ability to thrive and live with confidence, rather than being fearful of movement and activities.
Bone Strengthening Class
Classes run twice a week, on Mondays and Thursdays from 3–4pm, at our South Kensington clinic.
This is an evidence-based strength programme, based on the LIFTMOR trial. This research studied over 100 post-menopausal women with low bone mass and showed that twice-weekly training led to significant improvements in bone mineral density at the hip and spine, muscle strength, and overall physical function.
Classes are led by an experienced physiotherapist and are kept small, with a maximum of 5 participants, to ensure close supervision. Each participant receives a personalised programme, which is progressed safely under physio guidance. The class is suitable for all abilities.
Exercises include squats, deadlifts, shoulder presses, and jumping.
How to Join
If you feel confident in a class setting, you can then book into the class via reception. If you don’t feel ready after your initial assessment, you can continue with 1:1 sessions and join the class when you feel comfortable.
I Don’t Live In London, What Can I Do?
If you are unable to visit our South Kensington clinic, we offer virtual one-hour consultations with a physiotherapist to discuss your bone health and provide tangible actions to take away. During your session, we will:
Provide a bespoke home-based exercise program
Offer guidance on lifestyle changes to support bone strength
Make referrals where necessary for scans or specialist input
Can I Still Train If I’m injured?
Stopping exercise completely when injured can accelerate muscle and bone deconditioning, increasing the risk of further weakness and injury. At Mayfair Health, our physiotherapists are experts in both osteoporosis management and injury rehabilitation. We will run through an assessment of your injury and discuss future management plans. We will modify your program to maintain the progress you have made, as well as protect and allow for optimal recovery from your injury.
How Can We Help?
INTERESTED IN OUR BONE HEALTH CLINIC?
SEND US A MESSAGE USING THE FORM BELOW AND ONE OF OUR TEAM WILL BE IN TOUCH ASAP!
FAQs:
DEXA vs. EchoLight: What’s the difference?
Both a DEXA and Echolight scan measure what is called bone mineral density and this is depicted as a T-score. A T-score of less than –2.5 is used to diagnose osteoporosis.
A DEXA scan measures the thickness and strength of bones by passing low- and high-energy X-rays through the body. This is what has traditionally been used to measure bone health however can be subject to lower accuracy as the scans are interpreted by a person meaning there can be differences in scoring between radiologists.
An Echolight is a more recent advancement in the measurement of bone health and uses ultrasound waves instead of radiation. Using the ultrasound, the machine gives a computer-generated reading of not only bone mineral density but additionally a “fragility score”. This is a measurement of the quality of the bone’s microarchitecture and has been shown in research to be more reliable in determining someone’s fracture risk.
Is it safe to exercise with low bone density or osteoporosis? How much exercise is needed?
Not only has research shown that it is SAFE to exercise with low bone density or osteoporosis, but that it is NECESSARY. The formation of new bone is stimulated when placed under mechanical load and this is the cornerstone of our bone health program. As physiotherapists, we are trained to safely and gradually load the skeleton through exercise using machines and weights to increase the adaptive response of bone to increase bone mineral density.
A landmark trial in Australia (2018) showed that those who partook in supervised strength training 2x week for 9 months, as well as
those who participated in a 15-minute weekly BioDensity session saw improvements in their bone mineral density
compared to those who did bodyweight exercise, balance training and stretching over the same duration.
In the trial, participants were required to lift heavy weight relative to their baseline strength and there were no reported injuries besides 2 participants missing one session due to some lower back tightness. This shows that exercise is safe, with the Royal Osteoporosis Foundation recommending strength training as the first line of treatment.
How frequent are the sessions, and do I need to continue them indefinitely?
This can be tailored to the individual. The research recommends for the BioDensity program 1x weekly is needed, and for the strength training protocol 2x weekly is needed. This is undertaken over the course of 9 months. The research group who conducted the initial study are still in the process of collecting the data to analyse how long this benefit remain, for individuals who stop completely compared to those who continue.
Our recommendation is that strength training +/- the BioDensity should become part of an active lifestyle long term post the 9-month program, as it is so important and necessary for maintaining a healthy body. When you see your physiotherapist, it is important to discuss this with them to construct a realistic plan together that can ensure you are able to maintain the gains you make in the best possible way.
At what age should I start paying attention to bone health?
At the risk of sounding like a cliche, it is never to early OR too late to start thinking about bone health. For kids and teens, engaging in sports and multi-directional activity helps to develop your PEAK bone mass. This occurs in your mid-twenties where you ideally have strong and healthy bones so that as it gradually declines over time with age, it takes longer for it to develop into osteopenia or osteoporosis.
For those between the age of 18-35 this is where it is essential to start developing good habits and making strength training a part of your lifestyle, as we know this can help build strong muscles and bones. This makes it easier to maintain as you get older, and being proactive, rather than waiting for a diagnosis of osteoporosis to trigger a change in lifestyle.
For adults at any age who have been diagnosed with lower bone mineral density, or simply those who want to prevent the risk of developing osteoporosis, the time is now to start making steps in the right direction. This can involve getting an Echolight scan to get a baseline measurement of what the bone mineral density AND bone quality is like. It can mean starting to pay more attention to things such as nutrition, stress and sleep which we know have a huge impact on bone health as well as almost all the diseases of modern life.
Can exercise reverse low bone density?
YES is the short answer. A landmark trial in Australia (2018) showed that that those who partook in supervised strength training 2x week for 9 months, as well as those who underwent a 1x weekly 15-minute BioDensity session improved their bone mineral density compared to those who did bodyweight exercise, balance training and stretching over the same duration.
In the trial, participants were required to lift heavy weight relative to their baseline strength and there were no reported injuries besides 2 participants missing one session due to some lower back tightness. This shows that exercise is safe, with the Royal Osteoporosis Foundation recommending strength training as the first line of treatment.
Should all high-impact activities be avoided?
The short answer is no. This is dependent on a number of different factors. High impact activity is great for bones and is a necessary component of a program to address weaker bones as the high forces can help stimulate new bone adaptation. One way to assess if someone is eligible for this is by looking at their fragility score (acheived with an Echolight) that can measure their bone quality and dynamic strength. This can mean that someone with osteoporosis who has a good fragility score means they are safer to engage in high impact activities (within reason) compared to someone with a poor fragility score.
When we are younger, high impact activity that is done safely is fantastic and should be encouraged as this helps build our peak bone mass and strengthen our bones by exposing it to stimuli that generates an osteogenic response. This means that the bones increase their bone mineral density over time to better tolerate these forces which leads to stronger bones as we get older.
Is it safe to lift weights with low bone density?
YES! Not only is it safer but it is necessary and the foundation of building stronger bones, especially if you have osteoporosis. The only danger with lifting weights is when it is done with poor technique or without adequate supervision (for those who are new to the gym). This is where injuries can occur as it can place strain on other structures.
The formation of new bone is stimulated when placed under mechanical load and this is the cornerstone of our bone health program. As physiotherapists, we are trained to safely and gradually load the skeleton through exercise using machines and weights to increase the adaptive response of bone to increase bone mineral density.
Why are women more at risk for osteoporosis?
Women are more at risk for osteoporosis due to their hormones. Oestrogen is the key hormone that controls bone formation and during menopause the hormone levels drop, slowing the rate of bone formation. This loss is then outweighed by an increase in bone resorption which leads to a net loss of bone mineral density that over time will gradually cause their bone strength to decline and can lead to osteoporosis.
If you experience menopause before the age of 45, irregular periods at any time point or had gynaecological surgery, this impacts your oestrogen and can lead to an earlier onset of osteoporosis and it is recommended to be assessed by a doctor and had either a DEXA or Echolight scan to check the bone mineral density
What are the signs of low bone density?
Osteoporosis and low bone mineral density is known as a silent disease. This is because there are no signs or symptoms. The only way to assess bone mineral density is through a DEXA or Echolight scan. Unfortunately a lot of people don’t know that they have osteoporosis because they have never had a scan. Therefore it is only when they have a fracture that they realise they are osteoporotic and this is when it becomes much harder to improve.
The best way to prevent osteoporosis is to act like you have it. That means being proactive in the ways we know can help improve your bone health before it even becomes an issue. Taking good care of your diet, sleep and stress levels, as well as strength training and engaging in multidirectional sport all have proven benefits for your bone health.
What results have been achieved with the BioDensity machine?
The research shows that this works. A landmark trial in Australia (2018) showed that those who partook in supervised strength training twice a week for 9 months, as well as those who underwent a 1x weekly 15-minute BioDensity session improved their bone mineral density compared to those who did bodyweight exercise, balance training and stretching over the same duration.
We have been running our bone health service since early August 2024 and therefore are excited to see how our initial clients go after their 9-month Echolight scan to see if their results match that of the research and improve their bone density.
Other clinics that have used a BioDensity machine
for longer have shown similar results to that of the research, showing improvements in their T-Scores of between 5-10%.
