Training guide
Bone responds to load. Jolts through the skeleton, such as jumping, hopping and jogging, and muscles pulling hard on it, as in strength training, signal it to keep or add bone; walking on its own does little for bone density, and swimming and cycling don't load it. Most bone is built by your 20s, but trials show that strength and impact training can still add a little bone, or slow its loss, at any age, including after the menopause. The gains are a few per cent at most.
This guide covers how bone is built and lost, what the trials show for children, adults, women after the menopause and men, how much impact and strength work to do, calcium, vitamin D, protein, alcohol and smoking, a step-by-step impact routine with moves and workouts, and when to ask a GP about a scan. If you have osteoporosis or have broken a bone in a minor fall, start with our osteoporosis guide.
Impact (jogging, hops, small jumps, stamping) and strength training signal bone to keep or add mineral. Low-intensity exercise wasn't enough in women after the menopause, walking on its own did little for the spine, and swimming and cycling don't load bone, though they're good for your heart.
Most bone is built by your 20s. After that, exercise in trials gave small but consistent gains at the spine and hip, or less loss than doing nothing, including in women after the menopause.
Strength training on 2 to 3 days a week, working towards a weight you can lift 8 to 12 times, up to 3 sets; about 50 moderate impacts on most days if impact suits you, starting with 20 to 30; and back and balance work. That's the UK consensus, as our osteoporosis guide gives it.
Adults need 700 mg of calcium a day, which most people get from food, and the NHS advises everyone to consider 10 micrograms of vitamin D a day in autumn and winter. Extra calcium adds little. Eat enough overall, and the 2024 UK osteoporosis guideline advises keeping alcohol to 2 units a day or less and not smoking.
If you have osteoporosis, or have broken a bone in a minor fall, our osteoporosis guide comes first: it covers impact and lifting with fractures. A broken bone after a minor fall, or sudden back pain with height loss, needs a GP: see the warning signs.
Bone density is how much mineral, mostly calcium, is packed into your bones. A bone density (DXA) scan measures it at the spine and hip and compares it with healthy young adults. Osteopenia means lower than average but not low enough to count as osteoporosis. Density is one part of bone strength: bone size and structure, muscle strength and falls matter too.
Source 15
Bone is gained fastest in the teenage years, at about 12.5 in girls and 14 in boys, and by 4 years after that peak, 95% of adult bone mass is in place. Lifestyle shapes 20 to 40% of the most bone you'll have, with the best evidence for physical activity and calcium.
Source 7
Loss of the spongy inner bone starts in young adulthood: in 553 people, more than a third of a lifetime's loss of it came before 50. Around the menopause, spine density fell about 2.5% a year, and 10.6% over 10 years, in the SWAN study of 862 women.
The Royal Osteoporosis Society calls impact low when one foot stays on the ground, as in walking, marching or stair climbing, and moderate when both feet leave the ground, as in jogging, skipping or dancing. Strength training loads bone by working the big muscles of the hips, legs, back and arms.
Genes set much of your peak bone mass. Women lose bone faster around the menopause, but men get osteoporosis too. Low body weight, eating too little, smoking, heavy drinking, steroid tablets and some medical conditions raise the risk of weak bones.
Most trials are in women after the menopause; gains are a few per cent at most, and few trials counted fractures.
Across 80 studies of 5,581 women after the menopause, exercise gave small but consistent gains at the spine and hip, with or without low bone density and whether or not it was supervised. In a Cochrane review of 43 trials (4,320 women), combined programmes gave about 3 percentage points less spine loss than no exercise. Strength, weight-bearing and mixed exercise worked about equally.
Across 100 trials, low-intensity exercise wasn't an effective signal for bone in women after the menopause, and high-intensity training did more for the spine in a smaller set of studies. But in 11 studies that compared high and low intensity directly, high wasn't clearly better. Work towards weights that feel hard by 8 to 12 reps.
In the LIFTMOR trial, 101 women after the menopause with low bone mass (average age 65) did 8 months of supervised 30-minute sessions twice a week, with heavy lifts and impact: spine density rose 2.9%, against a 1.2% fall in the home group, with one minor back spasm. In LIFTMOR-M, 93 men (average age 67) raised spine density 4.1% against 0.9%, but the groups weren't fully randomised. These are single, closely supervised trials, so heavier lifting comes only after learning the lifts with a coach or physiotherapist.
In 8 trials, regular walking didn't significantly protect spine density in women after the menopause, and in 10 trials any hip benefit appeared only with programmes longer than 6 months. Programmes that mixed jogging with walking and stair climbing did better.
In one trial, 50 jumps on 6 days a week raised hip density by 2.8% in 5 months in women before the menopause, but not in women after it. Across trials, impact-only programmes didn't raise density after the menopause, while mixed programmes did. In women before the menopause, jumping helped the hip more than the spine.
In men, exercise had a small effect on hip density in one review of trials, and on both the spine and hip in another of 12 studies.
Across 27 trials, weight-bearing activity added a little bone in children and teenagers. 10 minutes of jumping twice a week for 8 months improved bone in 99 13-year-olds, and in 205 children, 7 months of jumping left them with 2.3 to 4.4% more bone mineral than other children 3 years later.
Across 20 trials, exercise went with about a third fewer fractures from minor falls, and about twice that benefit with mostly supervised programmes. Few trials were designed to count fractures, which is why our osteoporosis guide grades this emerging too.
In 29 women before the menopause, hip density rose 2.7% with jumping and strength training and drifted back towards where it started within 6 months of stopping. Young ice hockey players who stopped playing lost more hip density over 3 years than those who kept going.
These are the UK consensus doses as our osteoporosis guide gives them, word for word, and our plan for women over 50 builds them in. The consensus was written for people with or at risk of osteoporosis; we use the same doses here for building and keeping bone (our reading).
On 2 to 3 days a week, with at least a day's rest between, for 20 to 30 minutes. Choose a weight you can lift 8 to 12 times with good technique: that is one set. Build up to 3 sets. Go lighter if you cannot do 8 well, heavier if 12 feels easy.
If you have no spinal fractures, build up to about 50 moderate impacts on most days, such as jogs, hops, low jumps or stamping: for example 5 sets of 10, with a walk or rest between. You can spread them across the day.
Moderate means no landing from height. High impact is not specifically recommended, but if you already do it you can usually carry on.
Source 9
3 to 5 repetitions, each held for 3 to 5 seconds, at least twice a week (the 2022 consensus paper). The 2018 quick guide allows up to 10 repetitions on 2 to 3 days a week, so treat 3 to 5 as the start and 10 as the ceiling.
Source 8
Be active every day, spread across the day, and avoid long spells of sitting.
Source 8
Start impact with 20 to 30 heel drops, as our plan for women over 50 does, and build up over a few weeks. For strength, a squat, a hinge (such as a deadlift), a push and a pull each session, stopping 2 to 3 reps short of failure and adding reps, then weight, as our plans' notes say.
Source 8
Trials ran 6 to 12 months or more and measured changes of a few per cent, so judge the habit over months, not the next scan (our reading).
From the UK consensus's impact advice as our osteoporosis guide gives it and the heel drop page; the 2 to 4 weeks is editorial. Leaking during impact? Start with pelvic floor exercises first.
Loading the 3D figure…
The movement on the figure: Heel drop (impact for bone)
If impact suits you, build up to about 50 moderate impacts on most days, for example 5 sets of 10, starting with 20 to 30. With spinal fractures or several broken bones from minor falls, keep to low impact and follow our osteoporosis guide.
On 2 to 3 days a week, working towards a weight you can lift 8 to 12 times, up to 3 sets. Heavier sets of 5, as in the LIFTMOR trial, only after learning the lifts with a coach or physiotherapist.
3D demoDumbbell goblet squatIntermediate · A dumbbell
3D demoTrap bar (hex bar) deadliftIntermediate · Other / check instructions
3D demoStanding overhead pressIntermediate · A barbell + A dumbbell
3D demoSupported single-arm dumbbell rowIntermediate · A dumbbell + A bench or box
3D demoStep-upBeginner · A step
3D demoFarmer's carryIntermediate · A dumbbell + A kettlebellBack extension work for posture and balance work against falls, as the UK consensus recommends.
Active play, sport and jumping build bone while it's growing fastest: short jumping programmes at school added bone that was still there years later. Our plan and strength workout for teenagers cover safe strength training.
Gains in women before the menopause and in men are small, but strength and impact training help keep the bone you have. Mix both.
Bone loss starts about a year before the final period and is fastest until two years after it. In the SWAN study of 862 women, 7.4% of spine bone density was lost in that three-year window, out of 10.6% over ten years. A UK consensus recommends progressive strength training on 2 to 3 days a week and about 50 moderate impacts on most days. Our osteoporosis guide has the detail.
Trials added a little bone, or slowed its loss, in women in their 60s and beyond. Balance work matters more with age, because falls cause most broken bones. If you feel unsteady or have fallen, build strength and balance first:
Build strength and balance before you add other activity, including brisk walking: the UK consensus warns that brisk walking may raise the risk of falls and fractures in people already at risk.
The NHS says adults need 700 mg of calcium a day, which you should be able to get from your diet: milk, cheese and yoghurt, tofu, green leafy vegetables, soya drinks with added calcium, and fish where you eat the bones, such as sardines. In 59 trials in people over 50, extra calcium from food or supplements raised density by only 0.6 to 1.0%, without further gains, and the evidence that supplements prevent fractures is weak.
The NHS advises everyone to consider 10 micrograms of vitamin D a day in autumn and winter, and all year if you're rarely outdoors, usually cover most of your skin outdoors or have dark skin. Oily fish, red meat, egg yolks and fortified foods contain some. In 23 trials (4,082 people), supplements barely changed bone density in people without a deficiency.
Across 16 trials and 20 studies that followed people over time, more protein gave a small benefit at the spine, with no harm to bone.
Source 41
The 2024 UK osteoporosis guideline advises keeping alcohol to 2 units a day or less and stopping smoking. In 16,971 people, drinking more than 2 units a day went with more fractures; in 59,232 people, current smoking went with 25% more fractures.
Training hard on too little food harms health and performance in women and men (relative energy deficiency in sport, or REDs). If you are worried about your energy, your periods or repeated injuries, see a doctor.
Source 44
Where medicine is needed, exercise should be seen as an addition to it rather than an alternative: medicine has much stronger evidence for preventing fractures.
Source 14
NICE asks doctors to assess fracture risk in everyone 50 and over, and women after the menopause, who have broken a bone in a minor fall or take steroid tablets, and to consider it in all women 65 and over, all men 75 and over, and people 50 to 74 with risk factors such as 2 or more falls in a year, a close relative's broken hip, low body weight, smoking or drinking more than 14 units a week. A scan follows if the assessment says it's needed.
Source 16
The UK consensus doesn't adapt exercise for bone density alone: what changes the advice is a spinal fracture or several fractures, not the scan number, as our osteoporosis guide explains.
Source 8
The bone-strengthening workout puts impact, strength, back work and balance into 40 minutes. Do it twice a week, with heel drops or other impact on most other days, as our plan for women over 50 does.
Impact, strength and balance for stronger bones, following UK osteoporosis consensus advice, with options for every level.
40 minBeginner14 movesA kettlebell, Other / check instructionsStrength and balance in one session: squats, Romanian deadlifts, push-ups, rows, step-ups, back extensions, carries and single-leg balance.
45 minBeginner14 movesA wall, A dumbbellA beginner's springy session: calf strength first, then heel drops, calf springs and gentle bounces, building towards skipping and pogo hops.
20 minBeginner11 movesA wall, A stepA first jump rope session in about 20 minutes: a springy warm-up, five short rope rounds with equal rest, calf and shin work, and calf stretches.
20 minBeginner7 movesA jump rope, A wallBalance practice in 10 minutes: tandem stance, single-leg stands, marches, heel walks, tree pose and floor transfers.
10 minBeginner7 movesA wall, A bench or boxA 40-minute first strength workout for teenagers: a warm-up, landing and jump drills, then squats, hinges, push-ups, rows, step-ups and carries, kept light.
40 minBeginner19 movesA wall, A dumbbellA 30-minute yoga class for osteoporosis: standing strength, balance at a wall, back-strengthening holds and hip hinges in place of deep forward folds.
30 minBeginner19 movesA bench or box, A wallA 25-minute Pilates workout for osteoporosis and osteopenia: the Royal Osteoporosis Society's swaps for rounding moves, plus back strength and balance.
25 minBeginner16 movesA wall, A bench or boxA 30-minute routine for a rounded upper back in later life, built from the SHEAF trial: floor back-strengthening, posture practice and gentle mobility.
30 minBeginner13 movesA bench or box, A wallThe plan for women over 50 is built on the UK consensus; the plans for women and men over 40 and 50 and for teenagers build strength and impact in, and the beginner strength programme suits heavier lifting once you've learned the lifts.
A weekly plan for women over 50: strength, bone-loading and balance on 3 days plus walking, built on UK osteoporosis consensus advice.
3 training days45 minBeginner3 days a weekA 12-week plan for women over 40: three strength days, impact for bone, cardio and recovery through the perimenopause, in a gym or at home, with a 4-day option.
3 training days45 minBeginner3 days a weekA 12-week workout plan for men over 50: three strength days with power and balance work, cardio and recovery, at the gym or at home, with a 4-day option.
3 training days45 minBeginner3 days a weekA 3-day strength plan for men over 40 with power and bone work, two cardio days and mobility, built on research on ageing muscle.
3 training days45 minBeginner3 days a weekA 12-week workout plan for 13 to 17 year olds: technique first, then light weights, 2 or 3 sessions a week around sport and school, at home or in a gym.
3 training days40 minBeginner3 days a weekA 12-week beginner barbell program: squat every session, alternate bench and row with press and deadlift, and add weight each time until it stalls.
3 training days50 minBeginnerIf you have osteoporosis or have broken a bone in a minor fall, start with our osteoporosis guide: it covers exercise with fractures, what to avoid and heavy lifting. Osteopenia gets the same doses as on this page.
With osteoporosis or a past spinal fracture, avoid repeated or loaded deep rounding of the back, and bend from the hips. The osteoporosis guide covers impact and lifting.
Keep impact low, up to brisk walking, and build to 20 minutes on most days (150 minutes a week). This is a precaution, because of theoretical, unproved risks of another spinal fracture.
Source 8
Modify or avoid exercises that round your back deeply or repeatedly, especially with a weight: sit-ups, toe touches, Pilates roll-downs and curl-ups, and extreme yoga forward folds. Bend from the hips instead. You do not need to avoid bending, twisting or lifting altogether: move smoothly and keep your upper back straight.
Twisting should be safe if you do it smoothly and comfortably. Slow down and shorten fast or forceful twists, and leave out the added weight.
Bone loss starts soon after steroid tablets are started. The 2024 UK osteoporosis guideline recommends starting bone-protecting medicine at the same time as steroid tablets, without waiting for a bone scan, for anyone who has already broken a bone easily, women aged 70 or over, and women after the menopause and men aged 50 or over prescribed 7.5 mg or more of prednisolone a day over 3 months. It also recommends regular weight-bearing and muscle-strengthening exercise. Our guides to exercise with Crohn's and colitis, lupus, polymyalgia rheumatica, myasthenia gravis and muscular dystrophy cover bones and steroids in those conditions.
Source 14
Myeloma bone disease is different: Myeloma UK says high-impact exercise is usually not recommended and advises avoiding heavy lifting, so the impact work here isn't for it. Our blood cancer guide covers exercise with myeloma.
WHO notes that people without contraindications generally do not need medical clearance before light or moderate activity. If you have a heart, lung or metabolic condition, are pregnant, or have osteoporosis with fractures, ask your clinician first.
If you get chest pain or pressure, feel faint or dizzy, are unusually breathless, or your heart races or beats irregularly during exercise, as our plans advise.
For chest pain that comes on suddenly and doesn't go away, feels tight or like squeezing, spreads to your arms, neck, jaw, stomach or back, or comes with sweating, feeling sick, light-headedness or breathlessness; severe difficulty breathing; someone who faints while exercising; palpitations that don't go away, or come with chest pain, shortness of breath or feeling faint; or a headache that starts suddenly and is extremely painful, especially while lifting or straining, or comes with numbness or weakness, difficulty speaking or loss of vision. The NHS says a bleed on the brain may be more likely when lifting something heavy. Don't drive yourself to A&E.
Unexplained back pain with muscle spasms, loss of height, or a curved spine or change in posture: a possible osteoporotic spinal fracture, more likely with older age or long-term steroid tablets.
You're over 50 and have broken your wrist: ask about a fracture liaison service to check your bone health.
Pain in one spot on a bone that builds with jumping or running and is there at rest or at night needs checking by a GP before more impact (our suggestion, in line with our osteoporosis guide's line on bone pain at rest).
Ask for an urgent GP appointment or get help from NHS 111 for a headache that's triggered or made worse by coughing, sneezing, bending down or exercising. In the US, contact your doctor or urgent care.
Stop straight away if you feel any pain or become unwell, the NHS says, and contact 111 if your symptoms worry you or don't go away.
A dull ache in your muscles for a day or two after something new is normal. Joint pain that's sharp, gets worse during a set or lingers into the next day means switching to the easier option, and seeing a GP or physiotherapist if it carries on (our plans' rule). Our muscle soreness guide has more.
Speak to a GP first if you haven't exercised for some time, or if you have a medical condition or concerns. Get advice first, too, if you have a health problem, an injury or symptoms, have recently had a heart attack or an operation, or are pregnant or have recently given birth.
Source 48
If you have a heart condition, follow your cardiac team's advice on how hard to work, and stop for the warning signs above. People with long-term conditions may wish to ask their specialist before starting. With uncontrolled high blood pressure, avoid straining against a held breath; the high blood pressure guide has more.
Walking didn't significantly protect spine density in trials, and helped the hip only in programmes longer than 6 months. Keep walking for your heart, and add strength and impact.
Most bone is built by your 20s, but trials added a little bone at any age, including in women and men in their 60s.
If you already get enough, extra calcium raised density by only 0.6 to 1.0%, and vitamin D supplements barely changed it. Get what you need (700 mg of calcium, 10 micrograms of vitamin D), not more.
Walking and non-weight-bearing exercise such as cycling and swimming do not improve bone density. They are still good for your heart and general health.
Moderate impact is recommended unless you have spinal fractures or several broken bones from minor falls, and people who exercised had fewer fractures than those who didn't in trials.
Low-intensity exercise wasn't an effective signal for bone in a large review, though trials comparing high and low intensity directly were inconclusive. Work towards weights you can lift only 8 to 12 times.
Gains drifted back within months to a few years of stopping, in small studies. Keep training.
Combine strength training on 2 to 3 days a week with about 50 moderate impacts on most days, such as heel drops, jogging or small jumps, if impact suits you. Eat enough, get 700 mg of calcium from food and consider 10 micrograms of vitamin D a day in autumn and winter, keep alcohol low and don't smoke. With osteoporosis or a past broken bone from a minor fall, start with our osteoporosis guide.
A mix of strength training and impact did best in trials. Work towards weights you can lift only 8 to 12 times, include squats, deadlifts, presses and rows, and add jolts such as heel drops, jogging or small jumps.
Not much on its own: walking didn't significantly protect spine density in trials, and helped the hip only in programmes longer than 6 months. Keep walking for your heart, and add strength and impact.
Yes, a little. In trials of women after the menopause, exercise gave small gains at the spine and hip, or less loss than doing nothing, and supervised heavy lifting raised spine density by a few per cent in women and men in their 60s.
Strength training on 2 to 3 days a week, impact on most days and balance work, as the UK consensus recommends. Bone loss is fastest from about a year before the last period to two years after it, so starting in the perimenopause helps.
Trials ran 6 months to a year or more, and the changes were a few per cent at most. Keep the habit going over months and years rather than chasing the next scan result.
Calcium-rich foods such as milk, cheese and yoghurt, tofu, green leafy vegetables, soya drinks with added calcium and fish where you eat the bones, plus oily fish and egg yolks for some vitamin D. Extra calcium beyond what you need adds little, and eating enough overall matters.
The NHS advises everyone to consider 10 micrograms of vitamin D a day in autumn and winter, and most people get enough calcium from food. With osteoporosis, follow your doctor's advice.
Active play, sport and jumping: short jumping programmes at school added bone that was still there years later. Most adult bone is laid down by the early 20s.
Yes: men get osteoporosis too, and exercise raised bone density a little in trials of men. The same mix of strength and impact applies.
Ask your GP about a fracture risk assessment if you're 50 or over and have broken a bone in a minor fall, take steroid tablets, or have risk factors such as 2 or more falls in a year, low body weight, smoking or a close relative who broke a hip. NICE asks doctors to consider it in all women 65 and over and men 75 and over.
For most people, yes, built up gradually: the UK consensus recommends strength and impact, and trials found fewer fractures in people who exercised. With osteoporosis, a spinal fracture or a past broken bone from a minor fall, our osteoporosis guide and a physiotherapist come first.
Exercise education, not a personal prescription, and clinical review of these guides is pending. Check with a GP before starting hard training if you have a heart condition, chest pain, dizziness or breathlessness when active, and stop for sharp or increasing pain. Health disclaimer.
