Conditions / Musculoskeletal

Osteoporosis or low bone density

Reduced bone mineral density with elevated fracture risk. Exercise is protective, but loaded spinal flexion and rotation are the movements associated with vertebral fracture.

Prescribe

Progressive resistance training for all major muscle groups at least twice weekly
Two sets at 8-12 repetitions maximum for those who tolerate it
Daily balance training, accumulating roughly 2 hours per week
Include back extensor and abdominal bracing work for posture
Teach the hip hinge as the spine-sparing pattern for daily life

Avoid, and why

Loaded spinal flexion such as sit-ups and toe touches - associated with vertebral fracture
Loaded spinal rotation and end-range twisting
Dropping weights, and fast supine-to-prone transitions - fractures were reported in exactly these situations
Breath-holding under load, because of the blood pressure response
Prescribing aerobic work instead of resistance and balance training

How the generator handles this

Max exercise complexity	3
Patterns excluded	None
Balance work added	Yes
Clearance required first	No

Exercises automatically excluded: Overhead carry Ab wheel rollout Romanian deadlift Barbell deadlift Barbell bent-over row Front squat Barbell back squat Dumbbell shoulder press

Sources

Osteoporosis Canada (Morin et al., CMAJ) (2023). Clinical practice guideline for management of osteoporosis and fracture prevention in Canada: 2023 update. Source
Balance and functional training at least twice weekly (strong recommendation); progressive resistance training at least twice weekly including back extensor and abdominal work (conditional).
Giangregorio et al., Osteoporosis International (2014). Too Fit To Fracture: exercise recommendations for individuals with osteoporosis or osteoporotic vertebral fracture. Source
Progressive resistance training for all major muscle groups at least twice weekly, 2 sets at 8-12 RM, plus DAILY balance training accumulating about 2 hours per week. Avoid loaded spinal flexion and rotation, dropped weights, and fast supine-to-prone turns.