September 22, 2026, 11:54 am | Read time: 9 minutes
The human body typically builds bone mass until about the age of 30. As we age, natural bone loss begins. Additionally, there is the pathological case of widespread osteoporosis, which is associated with increased bone fragility. To counteract this loss as effectively as possible, physical activity is recommended. However, there are still no uniform, concrete guidelines on suitable training forms and recommended doses for bone protection. A new study has addressed this issue; FITBOOK spoke with one of the study’s authors.
Training Can Maintain Bone Stability–But Which?
To be precise, it is the bone mineral density (BMD) that decreases with age. It indicates how much mineral substance is contained in a specific bone volume. This value is an important indicator of skeletal stability, and the relevance of this topic is evident in the fact that osteoporosis and the associated bone fractures are among the leading causes of limitations and premature mortality in older age. This is what the authors of the current study write in their introduction.1
As a personal trainer explains to FITBOOK in this article, targeted strength training is particularly recommended for women in menopause to counteract the advancing bone loss. She especially values whole-body vibration, or working with vibration machines, which can help build bone density and muscles.
But that’s just one of many different opinions. Some professional societies, for example, recommend 30 minutes of daily walking to prevent osteoporosis, the authors of the current study write.2 The World Health Organization (WHO), on the other hand, suggests 150 to 300 minutes of moderate-intensity physical activity or 75 to 150 minutes of high-intensity activity per week for general health benefits.3 Additionally, muscle-strengthening activities should be performed.
Study Highlights Ideal Training Type and Dose for Bones
The team led by lead author Changbo Lu aimed to specifically investigate which training forms and what dose of exercise can help adults over 40 maintain or even improve bone density. They also examined whether regular exercise affects the risk of bone fractures.
The study went beyond the simple question of whether exercise generally has a positive effect on bones. The researchers wanted to find out more precisely which combination of training forms and volume is associated with measurable changes in bone density in the lumbar spine, femoral neck, and hip. They also investigated whether factors such as age, gender, and body mass index (BMI) influence the effect of training.
To compare the different intensities and durations of various training forms, the training load was given in MET-minutes per week. A MET is a unit that describes the energy expenditure of physical activity compared to resting energy expenditure.
Details of the Study
This is a hierarchical Bayesian network meta-analysis of randomized controlled trials (RCTs), supplemented by a multivariable dose-response network meta-analysis. This statistical method allows multiple training forms to be compared simultaneously with each other and with control groups, even if the training forms were not directly compared in the individual studies. The Bayesian method takes into account the probability distributions of the estimated treatment effects.
For the literature search, the researchers accessed the databases PubMed, Embase, the Cochrane Library or CENTRAL, and Web of Science. The search began from the start of each respective database and was updated until January 2026. Randomized controlled trials with adults aged 40 and older were included. The training programs studied had to have been completed for at least four weeks.
A total of 124 studies with 18,429 participants and 480 interventions were included in the analysis. The duration of the individual interventions ranged from 12 to 208 weeks. A uniform study duration or a median follow-up time was not specified for the meta-analysis.
Six Training Categories in Focus
Six different training categories were examined:
- mixed endurance training
- strength training
- a combination of endurance and strength training
- brisk walking or jogging
- “mind-body exercises,” such as Tai Chi or yoga
- whole-body vibration
Control groups included individuals who did not follow a set training program or only performed light stretching or relaxation exercises.
To evaluate the effects of the individual training categories, the researchers examined changes in the bone density of participants in the lumbar spine, femoral neck, and entire hip. They also recorded the number of bone fractures sustained.
Study Author: Brisk Walking or Jogging Shows Greatest Effect
“According to our analyses, brisk walking or jogging, as well as combined endurance and strength exercises, are the most effective and easily implementable training forms for improving bone mineral density.” This is what study leader Xiaojiang Yang explains in response to a FITBOOK inquiry.
In the lumbar spine, both brisk walking or jogging and the combination of endurance and strength training showed an improvement in bone density. Both training forms led to a difference of 0.013 g/cm². In the femoral neck, brisk walking or jogging showed a difference of 0.009 g/cm², while mind-body training, such as Tai Chi or yoga, showed a difference of 0.007 g/cm². In the entire hip, brisk walking or jogging resulted in an improvement of 0.021 g/cm².
How Much Training Should It Be for the Bones?
More is not always better when it comes to the appropriate amount of training to maintain bone density. The authors consider about 600 MET-minutes per week to be a practical amount. For brisk walking or jogging, this corresponds to approximately 2 to 3 hours per week.
“For a generally healthy adult over 40, the determined value of 600 MET-minutes per week is very encouraging,” Yang finds. Readers should not view it as an intimidating scientific metric but as a very achievable lifestyle goal. And: This is fully in line with general public health guidelines, such as those of the WHO. “This means that to achieve clinically significant benefits for bone health, one does not need to engage in extreme or exhausting training programs–consistent, moderately intense load exercises are sufficient to offset the natural annual decline in bone mass.”
Significant Difference Between Bone Density and Fracture Prevention
The authors also investigated how training affects the risk of bone fractures. However, the certainty of the evidence was rated as low in this regard. In 26 studies with a total of 11,132 participants, mixed endurance training and mind-body training were associated with a lower risk of bone fractures. The results thus provide indications of a possible benefit but do not yet allow a definitive statement about fracture prevention.
Yang emphasizes that bone density and fracture prevention are not the same. While brisk walking and combined exercises can improve bone density, the actual fracture risk is also significantly influenced by the risk of falls.
The analysis showed that mind-body exercises like Tai Chi or yoga, as well as mixed aerobic exercises, had the greatest potential to reduce fracture frequency. Therefore, for the most comprehensive protection against bone fractures, both are important: strong bones and a stable stance. While load-bearing exercises like brisk walking promote bone density, exercises for balance and coordination can help prevent falls. According to Yang, a combination of walking or jogging and balance-enhancing exercises offers a comprehensive approach to fracture prevention.
Significance of the Results
In summary, the study’s findings suggest that brisk walking or jogging for about two to three hours per week represents a practical training dose that can be associated with positive changes in bone density.
At the same time, the study shows that the optimal load does not have to be the same for everyone. “We found that middle-aged adults (40–60 years), men, and individuals with a healthy body weight (BMI 18–25) tend to achieve significant improvements in bone mineral density (BMD) more easily,” explains study author Yang. Older adults over 60 and individuals with overweight or obesity, on the other hand, show reduced skeletal sensitivity to mechanical stimuli.
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Older and Overweight Individuals Should Gradually Increase Load
What does this mean in practice? “That older adults or individuals with higher body weight may need a gradually higher training dose or intensity to achieve the same bone-strengthening effects. However, these are precisely the groups that should interpret the results with caution.” The researcher emphasizes that these individuals should avoid abruptly starting with high-volume training sessions. Instead, they should gradually increase their training volume–he refers to this as “progressive loading.” It is particularly advisable for them to consult a physical therapist or another form of health professional to ensure that the training program is safe and appropriate for their specific fitness level.
According to the authors’ assessment, it can certainly be stated that exercise should be considered a component of a comprehensive osteoporosis treatment. It should not replace necessary medication. Rather, the researchers see brisk walking and jogging as a useful complement to medication, adequate nutrition, and fall prevention measures.
Limitations
The results should be interpreted with some caution despite the high quality of the work. Depending on the area studied, the certainty of the evidence varied. It ranged overall from very low to moderate. A significant reason for this was the risk of bias within the included studies. In 91 out of 124 studies, there were at least some concerns or, according to the authors, a high risk of bias. In 73.4 percent of the studies, bias due to lack of blinding or differences in implementation was particularly relevant. However, this is difficult to completely avoid in exercise studies.
There were also indications that the positive effects may have been partially overestimated. Especially smaller studies on brisk walking or jogging showed unusually large improvements in the lumbar spine and hip. There is also the possibility that studies were more likely to be published if they produced particularly positive results. These factors can lead to the actual effect of the training being potentially less than the results of the meta-analysis suggest.
Furthermore, the use of MET-minutes also entails certain limitations. While the value can capture the duration and intensity of physical activity, it does not directly depict the mechanical load on the bone.
Finally, the composition of the participants partially limits the transferability of the results. Women were significantly more represented in the studies than men. Information on ethnic background and socioeconomic status was also rarely recorded.