Request Appointment  

High Intensity Resistance Training for Osteoporosis: Are we playing it too safe?

High Intensity Resistance Training for Osteoporosis:

Are we playing it too safe?

By Carrie Hall PT, MHS


The CDC and Surgeon General, along with many researchers1 have proposed that exercise plays a role in prevention and treatment of osteoporosis, but the effect has been perceived to be moderate at best. Debunking this myth, a preliminary study in Australia has shown that high-intensity resistance and impact training (HiRIT) may improve bone and muscle strength in healthy postmenopausal women with osteoporosis.2

Maybe we have been playing it too safe?

It is known that bones respond preferentially to high magnitude weightbearing loads, but most physical therapists prescribing exercise are hesitant to apply high loads to persons with osteopenia (thinning bones) or osteoporosis (low bone density) for fear of risk of injury or fracture. This study aimed to demonstrate that high intensity resistance and impact loading is both safe and effective in improving bone mass and overall physical function.

What did this study do differently?

Researchers analyzed data from the larger Lifting Intervention for Training Muscle and Osteoporosis Rehabilitation (LIFTMOR) Trial on 101 postmenopausal women age 58 or older. For eight months, half of the women did twice-weekly 30-minute sessions of supervised HiRIT that included deadlifts, overhead presses, squats and jumping chin ups with drop landings. The other half formed a comparison group, and for eight months they did unsupervised, twice-weekly 30-minute low-intensity exercise at home.

The graduated loading, close ongoing supervision, and focus on correct technique were key to safety and overall adherence to the program (low drop-out rate). The 2 time per week dosage was also very appealing to this demographic leading to high compliance (participating with expected dosage).

All the participants had bone mineral density testing with a special type of X-ray called a DXA scan before and after the eight-month training program to assess changes in their bone mineral density (BMD), or bone health, at the spine and the femoral neck at the very top of the thigh bone that connects the long bone to the head of the femur.

By the end of the study, the HiRIT participants increased BMD in their spines by an average of about 3 percent and increased hip BMD by 2.2 percent. In the comparison group, women lost an average 1.2 percent of spinal BMD and lost more than 2 percent at the hip, researchers report in the Journal of Bone and Mineral Research.

The benefits of bone density improvements at the femoral neck and spine translate into stronger hips and backs. Women in the resistance group also had a 40 percent improvement in back and leg extensor strength, which helped improve their posture and reduce their risk of falls.

Close ongoing supervision is key!

The researcher of this study felt this demographic has traditionally been held back from high intensity resistance training for fear of fracturing fragile bone with heavy loading, but that this overly conservative approach has led to stagnation in the field. This study demonstrates preliminary evidence for safety and effectiveness of a HiRIT program for otherwise healthy postmenopausal women with low to very low bone mass.

Key to the success of this program is that HiRIT training should be supervised by adequately trained and educated professionals such as a physical therapist, to ensure correct technique and appropriate progressions, as well as to minimize injuries.

WE DO NOT RECOMMEND INDIVIDUALS WITH LOW BONE MASS TO UNDERTAKE THIS PROTOCOL IN AN UNSUPERVISED ENVIRONMENT, even after notable training, because it is not possible to self-monitor technique or self-prescribe dosage.

Despite misconception to the contrary, high intensity resistance training can be safe and has proven to be effective in improving bone mass.

Consult your PT if you are interested in beginning a program such as this.

Happy lifting!


  1. Howe TE, Shea B, Dawson LJ, et al. Exercise for preventing and treating osteoporosis in postmenopausal women. Cochrane Database Syst Rev. 2011(7):CD000333.
  2. Warson SL, Weeks BJ, Weis LJ, et al. High-intensity resistance and impact training improves bone mineral density and physical function in postmenopausal women with osteopenia and osteoporosis: The LIFTMOR Randomized Controlled Trial. JBMR. 2017.


Carrie Hall PT, MHS – President

Mental Hurdles for New Runners

Mental Hurdles for New Runners
by Erik Bies, DPT, MS

1) Creating the habit. The first big hurdle is the mental and behavioral aspect of starting something new and sticking to it. Let’s face it, running is an absurd activity. But so is anything that is challenging. Like anything though, the more you practice the activity, the easier it gets. Creating the habit requires mental toughness and a plan. There are no shortcuts, but you can make a new habit stick by cueing yourself through a variety of strategies: 1) sleep in your running clothes 2) leave running shoes in front of your bedroom door 3) buy yourself a running gadget, so you are committed to using it 4) reward yourself if you must 5) set a goal(s) 6) Train with a buddy to create accountability.

Continue reading “Mental Hurdles for New Runners”

Manual Therapy


By Robin Angus, PT, MS, Cert. MDT


Manual therapy, also known as orthopedic manual therapy, is a clinical approach used by physical therapists that incorporates skilled hands-on techniques to evaluate and treat spinal and extremity joints, muscles, tendons, and ligaments. During the first visit, a patient’s history is thoroughly reviewed and a comprehensive physical exam is completed. A treatment plan of care is then designed and commenced that incorporates specific techniques to help modulate and reduce pain, decrease inflammation, facilitate tissue repair, and increase mobility. The ultimate goal is to improve function via improved pain free mobility.

How is manual therapy used in treatment?

Patients generally have better functional outcomes when their physical therapy treatment includes a combination of procedures such as therapeutic exercise, neuromuscular control and movement training, and manual therapy as compared to those receiving manual therapy techniques as their only form of treatment.

Continue reading “Manual Therapy”

The McKenzie Method Keeps You Pain Free, Saves Money

The McKenzie Method Keeps You Pain Free, Saves Money

By Robin Angus PT, MS, Cert. MDT

No one likes to be in pain, especially during the beautiful summer days that we are enjoying in Seattle this year.

The McKenzie Method® of Mechanical Diagnosis and Therapy® (MDT) is one of the world’s most effective physical therapy approaches to help people with musculoskeletal disorders become pain-free. As an alternative to medical interventions such as MRIs, spinal injections, and in some cases, surgery, MDT can save more than enough money to cover that special summer weekend get away. Continue reading “The McKenzie Method Keeps You Pain Free, Saves Money”



By Jill McVey DPT, ATC

Here in the Pacific Northwest, we are lucky to have easy access to hiking, swimming, paddle boarding, running, and more. As the weather continues to improve, more of us will spend our free time outdoors. Don’t let the usually temperate weather here fool you—heat illness is a very real consequence of exercise in even a slightly warm environment. Prolonged exercise with consistent sweat loss leads to progressive dehydration, which can impair physical performance. Without adequate fluid replacement, the core body temperature will continue to rise, and dehydration can induce failure of the body’s temperature regulation systems. Various heat related illnesses can result as the core body temperature rises, which can lead to a medical emergency. Continue reading “Hydration”

The Therapy of Breathing

The Therapy of Breathing

By Jill McVey, DPT, ATC

As any softball or baseball player can tell you, one does not need to be highly conditioned to play the sport. Highly skilled and strong, yes, but not aerobically conditioned the way a soccer player needs to be. As a former softball player, I assumed I would experience some growing pains when I decided at the age of 30 to try out for the Rat City Rollergirls. Continue reading “The Therapy of Breathing”