Why resistance training should be non-negotiable for bone health in 2026
Bone needs load to stay strong. Here’s how resistance training preserves bone density with age.
Bone needs load to stay strong. Here’s how resistance training preserves bone density with age.
We all know the historic objections to weight training:
“I don’t want to get too bulky”
“I’m not strong enough”
And the classic:
“I do lots of running, so I don’t need to train my legs”
Thankfully, greater awareness and education over the last decade or so has meant more people are embracing resistance training and are appreciating the benefits.
Yet there’s one demographic that may still need some convincing.
The narrative for older adults, particularly those new to exercise, is that gentle activity is best. Light cardio, swimming, walking and maybe some Yoga are promoted as the tools to improve longevity and quality of life, whilst being ‘safe’.
These activities are unquestionably beneficial for cardiovascular health in particular and should be done regularly. For a while now though, an increasing body of research has supported the idea that resistance training, and its positive impact on muscle mass and strength, plays a significant role in health and life expectancy. A meta-analysis of resistance training and mortality found that any amount of resistance training was linked to a lower risk of death from all causes, with the greatest benefit when it was combined with aerobic activity.
One of the lesser known but crucial benefits is maintaining or even increasing bone density.
As we get older our bone mineral density (BMD) naturally decreases, leaving us more susceptible to conditions such as osteopenia and osteoporosis.
Osteopenia (early-stage bone loss) and osteoporosis (advanced bone loss) affect hundreds of millions of individuals worldwide. According to the International Osteoporosis Foundation, one in three women and one in five men over the age of 50 will experience osteoporotic fractures. These breaks, often in the hip and spine, can lead to a loss of independence, rapid functional decline, and a higher risk of death.
Our bones are continually being broken down and rebuilt in a process known as remodelling. Cells called osteoclasts resorb old bone tissue, whilst osteoblasts synthesise raw materials, such as proteins and minerals, into new bone.
Due to hormonal changes as we get older, bone resorption starts to outpace formation, leading to reduced BMD. However, a key factor that influences this balance is the demands we place on our bodies.
Our bodies will adapt to whatever stresses they are subjected to regularly, in order to become more resilient to that stress in future. This is the fundamental principle behind the beneficial effects of exercise. Or, why we need to ‘use it or lose it’.
In terms of BMD then, so long as we are giving our skeleton a reason to be structurally strong, it will do what it can to stay so.
‘Wolff’s Law’ states that the bony tissue formed as part of the remodelling process will be laid down in the direction of the stress placed upon it, thereby helping that bone to handle similar loads in future. As an analogy, think of extra pillars automatically growing under a bridge at the points where the most traffic passes over it.
Conversely, if there is no stress (for example if someone is sedentary), bone density will reduce as there’s less stimulus for rebuilding, but the mineral breakdown continues.
That’s where resistance training comes in.
Repeated movements under load enhance and direct the bone remodelling process. A systematic review concluded that ‘progressive resistance training programs concomitantly increase lower-limb muscle strength and femur/hip bone mineral density in older adults’.
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So is there a specific way of training to maintain BMD? In short, any form of ‘resisted movement’ will be beneficial, whether that’s body weight, free weights, machines or even playing certain sports. Indeed any weight-bearing activity will have a positive impact.
Variety is also important, in terms of the exercises performed, using all three planes of movement and including some uneven loads, such as suitcase deadlifts and single-arm presses. This ensures the bones experience stresses (and therefore develop density) in all directions.
And what about clients that still hold onto old beliefs about exercising with weights? Let’s look at a couple and see how we overcome them.
“I don’t want to bulk up”
This is really a topic for another article, but in short, your clients can rest assured that it’s extremely difficult to put on enough muscle to notice a significant visible difference – just ask any aspiring bodybuilder! You can explain that training for maximum lean mass gain (hypertrophy) requires a highly specific approach, vastly different to a health-focused strength programme.
Plus, anything they do gain would have a compounding health benefit in terms of improving metabolic rate and body composition.
“I’m not strong enough” or “I already have fragile bones – shouldn’t I be lifting light weights?”
If we are safely applying the principle of overload, then all we should ever be asking clients to do is slightly more than they can currently manage. That’s good practice as a coach and promotes adaptation whilst minimising the risk of injury.
Ideally we do want to be lifting heavy loads for optimal results (see below), but there’s no point doing so from the very beginning if the client is deconditioned or new to resistance exercise. This could discourage them from participating and adherence is the biggest priority for any exercise programme.
The O’Bryan et al meta-analysis suggested lower volume but higher loads are most effective for increasing BMD. So for optimal results we do need to progress towards what would be considered ‘heavy’ weights, e.g. 5-6RM.
That said, perceptions of ‘heavy’ are subjective. If five bodyweight squats are a challenge, then five bodyweight squats are all the client needs, until they can manage six, then seven, and so on. Then we can add additional load and continue the progression to compound the benefits. A more useful metric may therefore be RPE, aiming for 7-8 on a scale of 0-10.
In summary, relying solely on light cardiovascular exercise to improve health as we age may not be the safest option after all. There’s a huge opportunity to incorporate resistance training into your clients’ routines to maintain and increase bone density while they still have the capacity. The impact could be life-changing (and life-extending).
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