Osteoporosis LTC Recommendations

3. Exercise

Do you want to have good balance, strong muscles and bones? Muscle strengthening exercises, combined with balance exercises and moderate or vigorous intensity physical activity can help you live longer, reduce the chance of a fall, and keep you fit and independent. 

How Much and What Kind of Exercise Do I Need?

  • 20-30 minutes per day of moderate to vigourous intensity physical activity. Brisk walking, dancing or cycling are example are examples of moderate intensity physical activity. 
  • Exercises to improve muscle strength at least twice a week; exercises where your muscles get tired after~10-12 repetitions.
  • Do things to challenge your balance everyday. 
  • Pay attention to yor posture at intervals throughout the day, and include exercises for your core muscles in your routine.

For some people, it may be hard to achieve the recommendations above. How should I get started?​​​​​​​​

  • Find Your Balance: Pick one balance exercise and make it a habit, or part of your day. Examples include walking on an imaginary tightrope while walking to the kitchen, or standing on one foot while brushing your teeth.
  • Find Your Strength: Choose a few exercises that you can do where you live, like wall or counter push ups, squats or chair stands, or resistance exercises with elastic bands. Or, find exercise class in your community that includes strength exercises. 
  • Motivating Movement: Start with 10-minute bouts of activity that get you breathing a little harder each day, or twice a day. Walk when you can, and move a little more briskly to get where you need to go. Exerise with a friend or in a class to make it a habit and make it fun. 

What are the Recommendations for Exercise for Older Adults?

If you are a health care provider in the care of older adults in LTC facilities: 

High RiskLow Risk
We suggest balance, strength and functional training exercises only when part of a multifactorial intervention to prevent falls.We suggest balance, strength and functional training exercises to prevent falls.
This recommendation places a high value on avoiding the small increase in falls which may occur among individuals at high risk of falls who participate in exercises, such as balance, strength, and functional training.This recommendation places a high value on the probably small reduction in falls that is achieved with exercise, as falls may lead to serious injuries. It also places high value on the other benefits that exercise could provide.

To reduce the risk for fractures, residents should be encouraged to be as active as possible and participate in exercise programs that include balance training, muscle strenghtening, and a focus on good posture. These types of exercises should be practiced at least 2-3 times a week. 

Learn about the use of exercise in long-term care

Did You Know?


Exercise sessions a week are encouraged for indivdials who wish to reduce fracture risk


Of individuals who fall in long-term care hit their head


Of long-term care residents have some hand contact first but are not of sufficient strength to prevent falling

Exercise focusing on balance training and strength training may be beneficial for higher risk individuals


Too Fit to Fracture is an exercise recommendation package designed to reduce falls and fractures for individuals with osteoporosis. It includes strength training, posture, balance training and weight bearing aerobic physical activity.

Key Publications

  • Too Fit To Fracture: exercise recommendations for individuals with osteoporosis or osteoporotic vertebral fracture [Giangregorio LM et al. Osteoporos Int. 2013]
  • Too Fit To Fracture: outcomes of a Delphi consensus process on physical activity and exercise recommendations for adult with osteoporosis with or without vertebral fractures [Giangregorio LM et al. Osteoporos Int. 2015]
  • Once a week not enough, twice a week not feasible? A randomised controlled exercise trial in long-term care facilities [Marijke JM et al. Patient Educ Couns. 2006]
  • Effective Exercise for the Prevention of Falls: A Systematic Review and Meta-Analysis[Sherrington C et al. J Am Geriatr Soc. 2008]
  • A 6-mo home-based exercise program may slow vertebral height loss. [Webber CE et al. J Clin Densitom. 2003]
  • Practical implementation of an exercise-based falls prevention program. How to do it [Gardner MM et al. Age and Ageing. 2001]