Table 2

Level and grade of evidence for physical activity recommendations for patients with osteoporosis

Patients with osteoporosis at high risk of fracture should not perform trunk flexion exercises, as these increase the risk of spine fracture. Trunk extension exercises and abdominal stabilization exercises can be done safelyIIA
Patients recovering from hip fracture should not perform physical therapy exercises for more than 15–30 min per session early in the rehabilitation process, as longer sessions increase the risk of orthopedic complications. Weight-bearing exercise can be started after 18 d, and higher-intensity exercises such as resistance training can be progressively implemented 1 mo after inpatient rehabilitationIIA
Patients with osteoporosis can safely perform a variety of aerobic physical activities or resistance training. Intensity of the exercise sessions should initially be light to moderate and progressively increase based on the individual’s capabilityIIA
Individuals with osteoporosis should avoid powerful twisting movements of the trunkIIIC
Individuals with spinal cord injury and osteoporosis of the lower limbs should avoid maximum-intensity physical activity (eg, maximal strength testing) via electrical stimulation of the lower limbsIIIC
Progressive lower-limb resistance training, cycling, and walking (all assisted by electrical stimulation) or body weight–supported treadmill training are safe forms of physical activity for individuals with spinal cord injury who do not have recent fragility fracturesIIA
  • * Level I evidence includes randomized controlled trials; level II evidence includes randomized controlled trials with important limitations or observational trials with overwhelming evidence; level III evidence includes observational trials; and level IV evidence includes anecdotal evidence or expert opinion.

  • Grade A recommendations are strong; grade B recommendations are intermediate; and grade C recommendations are weak.

  • Those with previous fragility fractures or those taking systemic corticosteroids for a cumulative period of 3 mo or longer during the preceding year at a prednisone equivalent dose of ≥ 7.5 mg/d.