Exercise,  Fitness tips

Can water-based exercise improve Osteporosis?This article is a 3 min read

Aquatic-based exercise programming can be used by varied populations including highly conditioned athletes to persons with chronic illness. It is an ideal modality for many older adults due to the fitness benefits it can provide with the relatively lower risk of negatively impacting current musculoskeletal conditions. It is generally enjoyable and provides a great social benefit for the older adult who partakes in aquatic based classes. In addition, the creative personal trainer can use aquatic based programming to enhance the delivery of a comprehensive fitness program for individual clients.


It is estimated that 24.5 and 5.1% of women and men respectively have osteoporosis (OP) involving the femur neck or lumbar spine over the age of 65 years (Osteoporosis 2016). The three most common fracture site related to OP are the wrist, hip, and spine (Cotton & Andersen, 2007). Fractures in the spine are responsible for significant height loss and/or kyphosis (Cotton & Andersen, 2007) and as a result an increased risk of falling is present. Hip fractures are the most devastating as 50% of all patients do not return to functional walking.

Water-based exercise

The evidence is clear that weight-bearing and resistance exercise can increase bone mineral density and improve OP. However, some individuals based on clinical presentation may be better suited using aquatic exercise as it reduces joint stress and risk for severe falls. Having said that, water-based exercise as a primary intervention for OP is not recommended as the buoyancy of water does not allow for enough overload of the bone (Harvard Health Publishing, 2016).

Having said that, water-based exercise as a primary intervention for OP is not recommended as the buoyancy of water does not allow for enough overload of the bone

(Harvard Health Publishing, 2016)

However it may not be without value, a 2017 meta-analysis by Simas, Hing, Pope, & Climstein looked at water-based exercise and its impact on bone mineral density (2017). The study objective was to evaluate if water-based exercise is effective at preventing bone loss in middle-aged postmenopausal women. The analysis included 11 studies with over 600 participants. The studies compared water-based exercise to control groups and four of the studies included a comparison with land-based exercise. The authors concluded that water-based exercise was beneficial in maintaining or improving bone health in postmenopausal women, however, land-based exercise was superior (Simas, Hing, Pope, & Climstein, 2017).

The take-home message is that if an individual is an appropriate candidate for land-based activity, which most are, then these activities should be considered first-line interventions and aquatic exercise as a secondary activity – primarily for other fitness benefits.

TheNational Osteoporosis Foundation of the United States guidelines for persons with osteoporosis emphasize activities that stress the bone. For individuals who are considered to have bones that are too fragile activities should be light-intensity. Activities such as walking, jogging, and weight training have been found to improve bone density. It is beyond the scope of this article to give specific recommendations for FIIT and it is recommended that the individual seek professional assistance starting with their doctor.

Take care in the pool

Whilst training individuals with OP in a pool area, the facility and staff must provide for safe movement on the pool deck and entry and exit from the water as the population is at high risk for both falling and fall-related fractures that may have high degrees of mortality.


Cotton, R. T., & Andersen, R. (2007). Clinical exercise specialist manual: ACE’s source for training special populations. American Council on Exercise.

Harvard Health Publishing. (2016, January). Exercising in water: Big heart benefits and little downside – Harvard Health. Retrieved September 21, 2018, from https://www.health.harvard.edu/exercise-and-fitness/exercising-in-water-big-heart-benefits-and-little-downside

Osteoporosis. (2016, August 17). Retrieved September 20, 2018, from https://www.cdc.gov/nchs/fastats/osteoporosis.htm

Simas, V., Hing, W., Pope, R., & Climstein, M. (2017). Effects of water-based exercise on bone health of middle-aged and older adults: A systematic review and meta-analysis. Open Access Journal of Sports Medicine, Volume 8, 39-60. doi:10.2147/oajsm.s129182

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