Frequently Asked Questions

What is osteoporosis?

Osteoporosis is a disease of low bone mass that increases the risk of fracture. Currently, 10 million Americans suffer from osteoporosis.

Who is at risk for osteoporosis?

Osteoporosis is a major public health threat for 28 million Americans, 80 percent of whom are women. One out of every two women, and one in eight men over the age of 50 will have an osteoporosis-related fracture in their lifetime.

What are the risk factors for developing osteoporosis?

Risk factors for osteoporosis fall into two categories – risk factors that cannot be changed, and risk factors that can be changed.

• Risk factors that cannot be changed include:
  • Gender – Women are at higher risk than men. This is because women have less bone tissue and lose bone more rapidly than men because of the changes involved in menopause.
  • Age – The older you are, the greater your risk for osteoporosis. Your bones become less dense and weaker as you age.
  • Body Size – Small, thin-boned women are at the greatest risk.
  • Ethnicity – Caucasian and Asian women are at the highest risk. African American and Latino women have a lower, but significant, risk.
  • Family History – People whose parents have a history of fractures also seem to have reduced bone mass and may be at a higher risk for fractures.
  • Peak Bone Mass – The amount of bone mass you had at the end of growth as you entered adulthood is an important determinant of fracture risk. People who entered adulthood with low peak bone mass are at higher risk for fracture.
• Risk Factors that can be changed include:
  • Hormone Deficiency – This may include low estrogen levels in women due to menopause, or low levels of testosterone in men.
  • Physical Inactivity – An inactive lifestyle or prolonged bed rest increases you risk for osteoporosis.
  • Diet – A lifetime diet low in calcium and vitamin D.
  • Cigarette Smoking
  • Excessive Alcohol Use
  • Medications – This includes corticosteroids and some anticonvulsants.

What can I do to prevent osteoporosis?

Regular participation in weight-bearing activity has been found to strengthen bones and reduce the risk of osteoporosis; while reduced physical activity or prolonged bed rest result in bone loss. In order for physical activity to reduce fracture risk, it must:

• Include weight-bearing activity, and must continue over the lifespan of the person
• Encourage the development of muscle strength and power
• Subject the skeleton to forces that exceed those of regular daily activities (for example, impact activities that have a short duration)
• Promote dynamic balance in order to reduce falls in the older adult

The Better Bones & Balance^® program has been designed specifically to include all of the above. Regular participation in this program has been proven to reduce the risk for osteoporosis and falling.

Do I need a weighted vest to start the program?

No.

We recommend that you begin the program with no weight for the first 2-4 weeks. After that time, a weighted vest will enhance your progress.

Do I need a weighted vest at all to benefit from the program?

No.

You will gain strength and muscle endurance by increasing the number of sets and repetitions as you move from beginner to intermediate and finally to advanced levels. We have included progressions for those who have a weighted vest and those who do not have a weighted vest.

Where do I purchase a weighted vest?

There are many weighted vest vendors. We are not partial to any one brand of vest in particular. A Google search of "Conditioning Vest" or "Weighted Vest" will lead to numerous vendors and types. When selecting the vest that is right for you take the following into consideration: vests come in multiple sizes, have weights that load on the outside rather than the inside, and are washable. Weights should be easy to manage and load 2-3 in each pocket as well as be distributed evenly around the torso with pockets that snap at the top to hold weights in place.

Do I need an exercise step to start the program?

No.

The step will make the stretches easier to perform and also will help "overload" your muscles and bones during the stepping exercise. However, to begin, you can step in place or use a step or stool in your own home, but make sure your stool is very stable as you step up and down. These stepping exercises are important in the program because they are similar to what you do in your daily activities and will improve your ability to climb up and down stairs.

Where do I purchase an exercise step?

Steps can be purchased from a number of vendors online. Some vendors to try include Gaiam, Inc.

Can I exercise along with the program if I have osteoporosis?

Yes, but if you have a recent fracture, you should check with your doctor.

Should I jump if I have osteoporosis in my hips?

Three women who began our program in 1994 had osteoporosis in their hips (as measured from a bone scan). Six years later, two of them have improved BMD (bone mineral density) and no longer have osteoporosis. The other has not lost BMD and thus has halted bone loss at her hip. Jumping, as defined in this program, is a safe activity for women with osteoporosis. However, you should not jump until you have been performing resistance exercises for at least 3 months or if your doctor tells you it is safe.

Why is jumping part of this program?

Jumping is included in this program because there is convincing evidence that it loads the hips in such a way that they respond by building or maintaining bone mineral density. Athletes, such as gymnasts, have BMD values that are over 35% higher than average. This is largely because they land on both feet quickly with very high forces. The jumps in Better Bones & Balance are similar to those from gymnastics in the "style" of landing, but are safe because the forces at the ground are much lower than those experienced by a gymnast.

When should I start jumping?

After at least 3 months of participation in the program. After this time, the strength and stability in your hip, knee and ankle joints should be sufficient to allow jumps without pain or risk of injury.

At what level (beginner, intermediate, or advanced) should I start the program?

We suggest that everyone start this program at the beginner level. In general, beginners are those who are starting a new exercise program. Even if you walk or do aerobics on a regular basis, you should begin at the beginner level since this program is very different from walking or aerobics.

Women in our research were very active, but not strong, and this program is designed to increase strength, power, and bone density. If you have been active in the past, but have not been involved in any regular exercise in the past month, you should start as a beginner.

Intermediates are those who have been engaged in a regular program of weight training (3 times per week) that includes lower body exercise, using weight machines, for at least 6 months.

Advanced are those who have been engaged in a regular program of "high intensity" weight training that includes lower body exercises, using free weights and weight machines, for at least 6 months. High intensity is defined as lifting weight at 85% of your maximum.

Can I exercise in this program if I have osteoarthritis in my knees?

Yes.

Women in our research program had arthritis, one of them an advanced case. They found that the strength and muscle mass they gained in their hips, legs, and ankles helped stabilize and support their joints, their arthritis pain actually decreased and they were able to participate in more activities. If you have arthritis, you should check with your doctor first and not jump if it causes you significant pain.

What if I experience knee pain?

If you experience knee pain while performing the exercises, take a few days off, and then start again with less weight in the vest. Also, for the squats and lunges, bending less will reduce knee pain. If you experience knee pain while jumping, perform the "faux", or false, jumps instead.

Is this program for men, too?

Yes.

Men get osteoporosis, too, and its prevalence in men is increasing. Have your husband or partner exercise along with you. It's a great way to keep motivated and stick with the program.

What should I do if I go on vacation?

You can take a break or continue your program by doing the exercises wherever you are.

What if I only have time for exercise one or two times per week?

Exercising one time a week is better than none. There is evidence-based research that weight training once a week provides benefits. However, for maximum gains, you should try to perform the program 2-3 times per week and cut back after you achieved noticeable gains. Cutting back will maintain the gains you've achieved. If you stop the program, you will lose your hard work!

Can I exercise along with the program if I have osteoporosis?

We have had many individuals diagnosed with osteoporosis participate in the program fully and safely. However, we recommend that you check with your physician before jumping, especially if you have a diagnosis of osteoporosis or have had a recent hip or spine fracture.

Should I jump if I have osteoporosis in my hips?

Three women who began our program in 1994 had osteoporosis in their hips (as measured from a bone scan). Six years later, two of them had improved BMD (bone mineral density) and no longer have osteoporosis. The other has not lost BMD and thus has halted bone loss at her hip. Jumping, as defined in this program, is a safe activity for women with osteoporosis.

You should not jump until you have been performing the resistance exercises for at least 3 months or if your doctor tells you it is not safe.

Why is jumping a part of this program?

Jumping is included in this program because there is convincing evidence that it loads the hips in such a way that they respond by building or maintaining BMD.

Athletes, such as gymnasts, have BMD values that are over 35% higher than average. This is largely because they land on both feet quickly with very high forces.

The jumps in Better Bones & Balance® are similar to those from gymnastics in the “style” of landing, but are safe because the forces at the ground are much lower than those experienced by a gymnast.

When should I start jumping?

After at least 3 months of participation in the program (Program Exercises 1-5b). After this time, the strength and stability in your hip, knee and ankle joints should be sufficient to allow jumps without pain or risk of injury.

Do I need a weighted vest to start the program?

No. You will gain strength and muscle endurance by increasing the number of sets and repetitions as you move from beginner to intermediate and finally to advanced levels. We do not advocate for using a weighted vest while jumping. 

How do I become a BBB instructor?

A fairly simple process actually! To become a certified Better Bones & Balance^® you will need to attend the Instructor Training that is held once a year in Corvallis, Oregon.

The Instructor Training is a two-day training that includes a team of scientists, administrators, and fitness professionals from OSU and beyond. We share the latest research about bone health and provide information about exercise programming and marketing to help you begin teaching or developing Better Bones & Balance^® in your community.

What type of person makes a great BBB instructor?

Being a Better Bones & Balance^® certified instructor is fun and rewarding. If you have:

• a passion for fitness and health
• a dedication to teaching and sharing with others
• an outgoing personality

...becoming an instructor is right for you!

How often do I need re-certify my license to teach? How do I do that?

Instructors need to re-certify every 3 years to keep their license for Better Bones and Balance actively viable. The name of our program is copyrighted and protected under trademark law.

There are two ways to recertify your license to teach.

The first is by following the steps on the BB&B Licensing Re-Certification Application and attaching the relevant documentation.

Note: You will need to show documentation for 8 continuing education opportunities (6 general fitness and 2 skeletal health and/or fall/fracture prevention courses).

The second is by attending the Instructor Training program-- but taking the short course.

Where do I find Continuing Education Opportunities?

There are several ways to earn CEUs and we encourage our instructors to share those opportunities with us. Here is one way that you can earn CEUs through ACSM Online.

Earning CECs through ACSM online is affordable, flexible, and convenient. ACSM's online self-tests cover a wide variety of topics, including the featured articles from ACSM's Health and Fitness Journal and ACSM's Certified News. Courses are self-paced and available for immediate completion. ACSM ceOnline is the go-to site for providing high-quality, relevant continuing education opportunities, available 24/7/365 to ANY certified health and fitness professional. Log on to earn CECs today!

Complete a course & have instant access to:

• Notifications
• Course materials
• Tests
• Certificates
• Receipts