Should I be doing Fit Sit® if I have osteoporosis?
If you have had a diagnosis of osteoporosis or osteopenia you may be wondering if you should be engaging in the Fit Sit® lessons.
It’s a question that was asked by way of an email this week by a student who had bought my book and is a subject close to my heart as many of my students here in Rutland have osteoporosis as do a number of members of my family including my Mum.
In fact, the Fit Sit® program really came into being many years ago when I first started to work with the mother of a regular student of mine.
This wonderful lady, Deidre, who was already in her late 80s when I begin to work with her, had suffered from polio in her early years, had numerous vertebral fractures, and was at a very high risk of falls because of the shape of her spine. It was impossible for Deidre to get down onto the floor or even onto my Feldenkrais table comfortably but she was determined to do what she could do to improve her movement and balance and so we began to work in sitting with some work in standing. I still think of Deidre every Monday morning which was when we used to meet in her home. She was such a joy to talk to with a delicious sense of humor. Fit Sit would not have happened without her.
"I've been told not to do twists or bend the spine".
One of the issues that concern many people who have osteoporosis or osteopenia is that they have been told, sometimes by an exercise professional, that they should not engage in movements of the spine that involve flexion of the spine or twists as this may cause vertebral fractures.
Not surprisingly, therefore, they become very fearful of any activity that includes these two movements and because they often get contradictory and confusing advice, they begin to avoid exercise and certain types of movement.
If you think about it for a moment, you cannot lead your daily lives without some kind of flexion and twists occurring: looking up, looking down, walking, reaching, getting in and out of a car, dressing and undressing, going to the toilet. Even side-bending of the spine involves some rotation of the spine because of the shape and structure of some of the vertebrae.
It's precisely because of this confusion that here in the UK the National Osteoporosis Society published a document in 2018 called ‘Strong, Steady and Straight: An Expert Consensus Statement on Physical Activity and Exercise for Osteoporosis’.
This 35-page document is an extremely well-written and informative guide that I would respectfully suggest to anyone who has osteoporosis or works with people who have had this diagnosis should take the time to read.
You can download the consensus statement by clicking on this link:
The expert authors of the statement point out that the previous guidance to avoid certain types of movements such as forward bending, which was “based upon a theoretically increased risk of vertebral fracture due to increased force through the bones by high-intensity resistance or impact exercise or increased load on the spine”, was originally developed for those people who already had vertebral fractures.
This advice though, which was meant for a certain at-risk group, was given to anyone with osteoporosis.
Without good information the authors state “people significantly reduce activity levels, limiting both function and enjoyment. This has adverse implications for their bone health, falls and future fracture risk.” (page 4 of the statement).
5 Principals to follow:
The executive summary of the statement set out 5 principles that underpin the guidance given (page 7).
• Physical activity and exercise have an important role in the management of osteoporosis, promoting bone strength, reducing fall risk, and the management of vertebral fracture symptoms.
• People with osteoporosis should be encouraged to do more rather than less. This requires professionals to adopt a positive and encouraging approach, focusing on ‘how to’ messages rather than ‘don’t do’.
• The evidence indicates that physical activity and exercise are not associated with significant harm, including vertebral fracture; in general, the benefits of physical activity and exercise outweigh the potential risks.
• Professionals should avoid restricting physical activity and exercise unnecessarily according to Bone Mineral Density or fracture risk thresholds, as this is often unhelpful and may discourage exercise or activities that promote bone as well as other health benefits.
• People with painful vertebral fractures need clear and prompt guidance on how to adapt movements involved in day-to-day living, including how exercises can help with posture and pain.
Strong, Steady, and Straight
The statement contains guidance on how to promote safe exercise using their Strong, Steady, and Straight approach.
Strong to promote bone density through type, intensity, or amount of physical activity and exercise.
Steady describes the importance of physical activity and exercise to reduce falls and reducing fractures.
Straight focuses on spine care – keeping the back straight – in a positive approach to bending, lifting, and moving safely in order to reduce the risk of vertebral fractures associated with day-to-day activities. It is this section that is most relevant to those who are worried about how to adapt movements to reduce vertebral fracture risk and people who already have symptomatic vertebral fractures.
The key recommendations under the Straight category are that:
For all people with osteoporosis:
• Safe techniques for day-to-day moving and lifting are recommended.
• Movements or exercises that involved sustained, repeated or end-range flexion should be amended or avoided unless someone is already practiced with very good muscle tone.
• Exercises to strengthen back muscles are recommended to promote the best possible posture and to support the spine.
For people with a vertebral fracture causing pain and posture problems
• Daily exercises to strengthen back muscles (focusing initially on endurance by exercising at low intensity) are recommended to reduce muscle spasms, relieve pain, and improve flexibility and posture, with a referral to a physiotherapist for tailored advice.
How does Fit Sit® come into all this?
The Fit Sit® program as many of you know by now is not just about exercising using a chair but is a program based upon the Feldenkrais Method® designed to improve the way that you move and find support from your skeleton.
It is a low-impact form of activity designed to improve your ability to weight transfer effectively so that gravity becomes your friend rather than your enemy. When our spine doesn’t move in the way that it could we become vulnerable to falls and our balance and joints become compromised.
It teaches you how to side-bend, rotate, twist, flex and extend the spine in a way that distributes the effort throughout the whole of the spine so as to reduce the force of gravity going through just one particular part of it. Once you can do this then you are able to balance and move through weight transference rather than muscular lift. None of the flexion (bending) activities are loaded.
Applying the principle set out in the statement cited above the Fit Sit®program can be an excellent way to exercise and improve your movement, posture, balance, and walking.
However, if you are a person who has had vertebral fractures before undertaking the Fit Sit® program, or any movement or exercise program, you should only do so under the guidance of a physiotherapist or other suitably qualified medical professional who can tailor the program to your individual circumstances. Such a person will be familiar with your medical history, the impact of the fractures, and your current level of fitness
Here are some other useful web-based resources that you may find helpful:
If you have any other questions, please do let me know.