Journal of Osteoporosis and Physical Activity
Open Access

Cardiovascular Exercise and Its Impact on Bone Health: Insights for Osteoporosis Management

Alejandro González^{* *}Correspondence: Alejandro González, Department of Physiotherapy, University of Barcelona, Barcelona, Spain, Email:

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Description

Osteoporosis, a metabolic bone disease characterized by decreased bone mineral density (BMD) and structural deterioration of bone tissue, remains a significant public health concern, particularly among older adults and postmenopausal women. The condition often leads to increased bone fragility and a higher risk of fractures, especially in the spine, hip, and wrist. While pharmacological interventions are widely used for osteoporosis management, non-pharmacological strategies such as exercise have garnered increasing attention for their preventative and therapeutic potential. Among these, cardiovascular (aerobic) exercise plays a notable role in promoting systemic health—but its specific impact on bone health continues to be a subject of research and clinical interest.

Cardiovascular exercise involves activities that increase heart rate and circulation, such as walking, jogging, cycling, swimming, and dancing. These exercises primarily enhance cardiovascular and respiratory function, but when applied correctly, they can also contribute to skeletal health. The relationship between cardiovascular exercise and bone health lies in the mechanical loading that occurs during weight-bearing activities. Mechanical loading is essential for bone remodeling—a dynamic process regulated by the balance between osteoclast (bone-resorbing) and osteoblast (bone-forming) activity.

Weight-bearing aerobic exercises like brisk walking, stair climbing, and low-impact dancing stimulate the bones through ground reaction forces, which help maintain or increase BMD, especially in the lower extremities and hips. Repetitive impact during these exercises creates mechanical stress on the bones, leading to microdamage that stimulates remodeling and strengthening. Studies have shown that regular participation in such activities can modestly increase BMD or at least slow the rate of bone loss in individuals with osteoporosis or osteopenia.

However, not all cardiovascular exercises exert the same osteogenic effect. Non-weight-bearing activities such as swimming and cycling, though excellent for cardiovascular endurance and joint health, provide minimal mechanical loading and therefore have a limited direct impact on bone density. That said, they can still play an indirect role in osteoporosis management by improving overall fitness, muscle strength, and balance—factors that are critical in preventing falls and related fractures.

Incorporating cardiovascular exercise into a broader osteoporosis management plan must take into account the intensity, frequency, and duration of the activity. Moderate-intensity aerobic exercises performed at least 3–5 days a week for 30–60 minutes have been shown to benefit bone health. It's also important to ensure that the exercises are safe for individuals with compromised bone strength. Sudden, high-impact activities or those with a high risk of falls should be avoided unless the individual has adequate musculoskeletal conditioning and balance.

Moreover, combining cardiovascular exercise with other forms of training—such as resistance and flexibility training—can provide comprehensive benefits. Resistance training complements cardiovascular exercise by targeting specific muscle groups and promoting localized stress on bones, especially the spine and upper limbs. Flexibility and balance exercises, such as tai chi and yoga, further reduce fall risk and improve postural alignment.

Beyond its skeletal effects, cardiovascular exercise contributes to other systemic benefits that support bone health. Improved circulation enhances nutrient delivery to bone tissue, while better cardiovascular fitness can delay the onset of frailty. Additionally, aerobic exercise helps in weight management, which is particularly important for postmenopausal women, where both excessive leanness and obesity can negatively influence bone metabolism.

Conclusion

Cardiovascular exercise serves as a valuable component in the multifaceted management of osteoporosis. While its direct impact on increasing bone mineral density may be less pronounced than resistance training, appropriately selected weight-bearing aerobic activities contribute significantly to maintaining bone mass, enhancing muscular support, and reducing the risk of falls. These exercises also promote cardiovascular health, overall physical function, and psychological well-being, making them essential in comprehensive osteoporosis care.

The key to optimizing the benefits of cardiovascular exercise lies in selecting weight-bearing forms of activity, maintaining proper intensity and frequency, and integrating it with resistance, balance, and flexibility training. Clinicians should tailor exercise recommendations based on the individual's fracture risk, physical capabilities, and comorbid conditions. As research evolves, cardiovascular exercise remains a cornerstone of proactive, holistic osteoporosis management—empowering patients to maintain mobility, independence, and quality of life throughout aging.