Authors: Nick (WTGR) & Dr. Mark Cucuzzella (NRC)
As we age, bone density naturally decreases, leading to weaker bones and an increased risk of fractures. This process happens due to changes in bone remodeling, hormone levels, and lifestyle factors. Bone density peaks in our 20s-30s, then declines gradually (~30s-50s) and accelerates after 50 (especially in postmenopausal women).
By maintaining an active lifestyle, proper nutrition, and strength training, we can slow bone loss and reduce fracture risk as we age (healthy aging).
✅ Weight-Bearing Exercise: Walking, rucking, strength training, stair climbing.
✅ Calcium Intake: ~1,200 mg/day for adults over 50 (dairy, leafy greens, fortified foods).
✅ Vitamin D: Essential for calcium absorption (~800–1,000 IU/day). We suggest you check your level optimal is 50 nmol/l
✅ Protein Intake: Supports bone matrix formation as well as maintaining muscle mass which is necessary for bone density
✅ Strength Training: Resistance exercises help stimulate bone growth and muscle protein synthesis
✅ Avoid Smoking & Excess Alcohol: Both accelerate bone loss.
In this post, we will focus on improving bone density and blood pressure with weight bearing exercises. Based on recent research, the best exercises for improving bone density in older adults include:
✅ Weight-bearing activities: Walking, hiking, stair climbing, jogging, dancing.
✅ Strength training (2–3x per week): Lifting weights, resistance bands, bodyweight exercises (squats, lunges, push-ups).
✅ High-impact activities (if safe): Jumping rope, plyometrics, tennis (stimulates bone remodeling).
✅ Balance & stability exercises: Tai Chi, yoga, and balance drills reduce fall risk. We suggest bare feet or minimal shoes to enhance proprioception and balance.
For optimal bone health benefits, experts recommend:
- Performing weight-bearing and resistance exercises 2-3 times per week
- Focusing on exercises that target the hip and spine
- Gradually increasing intensity and duration
- Combining different types of exercises for comprehensive bone health, maintaining muscle mass, and improved cardiovascular health.
It’s important to note that the effectiveness of these exercises can vary based on individual factors. Older adults should consult with a healthcare professional before starting a new exercise regimen, especially if they have existing bone health concerns or osteoporosis.
Improving Bone Density
The question we all ask is how long It takes to see any improvements in bone density. The period for seeing measurable improvements in bone density from walking depends on several factors, including age, walking intensity, frequency, existing bone health, and overall lifestyle (like nutrition and resistance training). However, research suggests that consistent walking can lead to noticeable improvements in bone density within 6 months to 2 years.[1][2][3]
There are, however, several factors affecting the rate of improvement. These include:
Walking Intensity & Type
- Brisk Walking (~3.5–4.5 mph) is more effective than slow walking.[4]
- Incline or Hill Walking increases impact forces, stimulating greater bone remodeling.
- Weighted Walking (Rucking/Weight Vest) applies extra load, accelerating bone density gains.[5]
Frequency & Duration
- Minimum: 30–45 minutes per session, at least 5 days per week.[6]
- Optimal: 60 minutes daily for greater benefits.
Nutrition
- Calcium & Vitamin D are essential for supporting bone remodeling.
- Protein Intake is crucial for bone matrix formation.
Resistance Training Combination
- Combining walking with strength training (e.g., squats, lunges, resistance bands) speeds up bone gains.
Age & Baseline Bone Density
- Younger individuals (under 50) may see faster gains (~6–12 months).
- Older adults (over 60) or those with osteoporosis may take 1–2 years for significant changes.
Speed up bone remodeling with a brisk, uphill, and weighted walking daily for at least 30 minutes.
While bone remodeling is a slow process, consistent walking—especially brisk, uphill, or weighted walking—can improve bone density within 6 to 24 months. For faster results, pair walking with strength training and a bone-supportive diet.
A few words on hormone replacement for women
Hormone replacement therapy (HRT) can help maintain and improve bone density in females, particularly postmenopausal women who experience a decline in estrogen levels. Estrogen plays a crucial role in bone remodeling by reducing bone resorption and slowing bone loss. HRT has been shown to lower the risk of osteoporosis and fractures, especially in the spine and hips. While it is an effective option for bone health, it should be considered carefully with a healthcare provider to weigh the benefits against potential risks. In the authors opinion in most healthy females hormone replacement is a net benefit, not just for the structural benefits of the bone but also for the perimenopause and menopausal symptoms. [7][8][9]
How is Bone Density Measured?
Bone density is typically measured using bone mineral density tests, which assess the strength and health of bones. There are several methods to measure bone density, with the most common and accurate being dual-energy x-ray absorptiometry (DEXA or DXA).
Central DEXA Scan is the gold standard for bone density measurement:
- Uses low-dose x-rays to measure bone density in the spine, hip, and forearm
- Highly accurate and widely used
- Typically performed in hospitals or medical offices
- Patient lies on a padded table while a scanning arm passes over the body
Your doctor will determine the most appropriate test based on your individual needs.
Improving Blood Pressure
Walking with a weighted vest or weighted backpack increases the cardiovascular and muscular demands on the body, which can have both short-term and long-term effects on blood pressure (BP).
Short-Term Effects (During Exercise)
Initially, blood pressure increases temporarily due to the added resistance. The heart works harder to pump blood to muscles under increased load and systolic BP (top number) can rise by 10-20 mmHg, depending on weight and intensity. The diastolic BP (bottom number) usually remains unchanged or slightly elevated. More weight = higher BP response, so it’s important to progress gradually.
Individuals with hypertension should avoid excessive weight and monitor BP. If dizziness or unusual shortness of breath occurs, reduce weight or stop.
Long-Term Effects (Regular Training)
Consistent weighted walking can help lower resting blood pressure over time by strengthening the heart, making it more efficient at pumping blood. It also helps improve vascular function, reducing arterial stiffness. Additional benefits include helping with weight loss (a key factor in lowering high BP) and enhancing insulin sensitivity (which supports healthy BP regulation).
Studies suggest that combining aerobic and strength training which would include moderate-intensity rucking (walking with a weighted backpack) improves cardiovascular fitness[10] and can lower BP by 5-10 mmHg after consistent training (8-12 weeks).[11] [12]Regular weight-bearing exercise like brisk walking with a weighted vest reduces hypertension risk by 25-30%.[13]
Additionally, a review published in the Canadian Medical Association Journal in January 2025 highlighted that maintaining a regular exercise routine may enhance longevity. The findings suggest that engaging in moderate exercise for up to 150 minutes per week—approximately two and a half hours—is associated with a 31% reduction in the risk of death from any cause among older adults.[14]
Key Takeaways
✅ Short-term: BP rises temporarily due to added load.
✅ Long-term: Improves heart efficiency, lowers resting BP, and reduces hypertension risk.
✅ Best for: Strengthening bones & muscles without excessive BP stress when done progressively.
✅ Precaution: Those with hypertension should start light, monitor BP, and consult a doctor if unsure.
Walking with added weight can lower systolic and diastolic blood pressure and improve blood circulation.
Walking with a Weighted Vest versus Weighted Backpack
Both weighted vests and weighted backpacks or rucksacks (used for rucking) can be effective for improving bone density and blood pressure, but they have different advantages.
Weighted Vests
- Targeted load bearing: They evenly distribute weight across the torso, directly increasing the load on the skeletal system, particularly the spine and hips.
- Customizable weight: The weight can be adjusted to match individual fitness levels and gradually increased over time.
- Proven effectiveness: Studies have shown that exercise with weighted vests can prevent hip bone density loss and maintain bone mineral density in postmenopausal women.
Weighted Backpacks (Rucking)
- Natural feel: Rucking engages a broader range of muscles and provides a more natural feel compared to weighted vests.
- Practical application: Rucksacks are widely available and can be easily adjusted for the best fit.
- Comprehensive workout: Rucking engages the entire body, particularly the upper back, shoulders, and hips, offering a more comprehensive workout.
Effectiveness Comparison
The effectiveness of each method may depend on individual factors and specific use:
- Weight distribution: Weighted vests may be more effective for targeting specific areas like the spine and hips due to their even weight distribution.
- Muscle activation: Rucking engages a broader range of muscles, which can indirectly support bone health through increased muscle strength and stability.
- Comfort and breathability: Some individuals may find backpacks more comfortable and allow for better breathability compared to weighted vests.
- Exercise intensity: Both methods can be effective when used consistently and with proper form. The key is to gradually increase weight and maintain a regular exercise routine.
The choice between the two may depend on personal preference, comfort, and specific fitness goals. It’s important to start with lighter weights and gradually increase the load to minimize the risk of injury. As always, it’s advisable to consult with a healthcare professional before starting any new exercise regimen, especially for individuals with existing bone health concerns.
What weight load should you start with?
To balance bone and cardiovascular benefits without excessive BP spikes:
✅ Begin with 5-10% of body weight (e.g., 10-15 lbs. for a 150-lb person).
✅ Gradually increase weight over 4-6 weeks if tolerated.
✅ Maintain good posture (chest up, core engaged) to avoid strain.
✅ Limit duration to 30-45 minutes per session, 3-5 times per week.
Conclusion
Walking with a weighted vest or backpack is an excellent way to improve cardiovascular health and bone density simultaneously, as long as it’s done safely and progressively. Protect your bones for life with these proven strategies:
✅ Move Daily: Walk, lift weights, and challenge your balance.
✅ Eat for Bone Health: Prioritize calcium, vitamin D, and protein.
✅ Avoid Bone Loss Triggers: No smoking, limit alcohol, and reduce excess salt.
✅ Monitor Progress: Get regular bone density scans.
Personal Experiences from Dr. Mark & Nick
Dr. Mark Cucuzzella
Dr. Mark is a mentor, coach, and business partner and we co-founded the Natural Running Center (NRC) with the late Bill Katovsky (two-time Hawaii Ironman finisher, founder of Tri-Athlete magazine, and author & editor of several health & fitness books).
Dr. Mark is an Air Force Reserve Lieutenant Colonel (ret), practices at the Veterans Administration Hospital in Martinsburg, West Virginia. He is a Professor at West Virginia University School of Medicine and developed the US Air Force Efficient Running Program. Mark has run competitively for four decades, with more than one hundred marathon and ultramarathon finishes, and he continues to compete as a master’s runner with thirty straight years under a 3-hour marathon. Mark owns the first minimalist running and walking shoe store, Two Rivers Treads.
He lives in Shepherdstown, West Virginia. His book “Run For Your Life” summarizes the science and the soul of running, nutrition, and physical activity to help you maintain a vigorous life. Visit Mark’s site at www.DrMarksdesk.com
After having knee surgery, a year and a half ago Mark incorporated an alternate day weight vest walking with running. This allows him to add more strength training and modify the loads to his joints. He uses a 40-pound Runmax vest. You can progressively add load with this vest.
Nick
After rucking for a little over 2 months (backpack, 11 pounds based on my weight of 150 pounds), I saw the following changes in blood pressure.
Blood Pressure Improvements
- Lower Systolic BP (top number) by 5-18 mmHg.
- Lower Diastolic BP (bottom number) by 2-5 mmHg.
Taking Blood Pressure Measurements
I did see large variations in BP measurements initially (at home with my Omron BP7450) so after more research (American Heart Association and American College of Cardiology), here are a few things to keep in mind to get correct BP readings.
- Have an empty bladder.
- Rest quietly in a seated position for at least 5 min.
- Do not talk or text.
- Sit back on a chair and keep both feet flat on the floor. Don’t cross your legs.
- Do not drink caffeine.
- Place BP cuff on your bare arm (not over clothes) and directly above the antecubital fossa (bend of the arm).
- Place the center of the bladder of the cuff (commonly marked on the cuff by the manufacturer) over the arterial pulsation of the patient’s bare upper arm.
- Support the arm with the cuff on a flat surface such as a table.
- Take 2 readings at least 1 min apart.
I don’t have a DEXA scan to measure my BMD but will consider it soon after I consult with my physician in my next annual physical appointment.
References
[1] Lan YS, Feng YJ. The volume of brisk walking is the key determinant of BMD improvement in premenopausal women. PLoS One. 2022 Mar 16;17(3):e0265250. doi: 10.1371/journal.pone.0265250. PMID: 35294490; PMCID: PMC8926180.
[2] Ma D, et al. Effects of walking on the preservation of bone mineral density in perimenopausal and postmenopausal women: a systematic review and meta-analysis. Menopause. 2013 Nov;20(11):1216-26. doi: 10.1097/GME.0000000000000100.
[3] Kemmler W, Lauber D, Weineck J, Hensen J, Kalender W, Engelke K. Benefits of 2 Years of Intense Exercise on Bone Density, Physical Fitness, and Blood Lipids in Early Postmenopausal Osteopenic Women: Results of the Erlangen Fitness Osteoporosis Prevention Study (EFOPS). Arch Intern Med. 2004;164(10):1084–1091. doi:10.1001/archinte.164.10.1084
[4] Pellikaan P, et al. Ranking of osteogenic potential of physical exercises in postmenopausal women based on femoral neck strains. PLoS One. 2018; 13(4): e0195463.
[5] Snow CM, Shaw JM, Winters KM, Witzke KA. Long-term exercise using weighted vests prevents hip bone loss in postmenopausal women. J Gerontol A Biol Sci Med Sci. 2000 Sep;55(9):M489-91. doi: 10.1093/gerona/55.9.m489. PMID: 10995045.
[6] American College of Sports Medicine. June 14, 2019. https://www.acsm.org/all-blog-posts/certification-blog/acsm-certified-blog/2019/06/14/walking-10000-steps-a-day-physical-activity-guidelines
[7] Kiel DP, Felson DT, Anderson JJ, Wilson PW, Moskowitz MA. Hip fracture and the use of estrogens in postmenopausal women. The Framingham Study. N Engl J Med. 1987 Nov 5;317(19):1169-74. doi: 10.1056/NEJM198711053171901. PMID: 3657888.
[8] Weiss NS, Ure CL, Ballard JH, Williams AR, Daling JR. Decreased risk of fractures of the hip and lower forearm with postmenopausal use of estrogen. N Engl J Med. 1980 Nov 20;303(21):1195-8. doi: 10.1056/NEJM198011203032102. PMID: 7421945.
[9] Zhao R, Xu Z, Zhao M. Effects of Oestrogen Treatment on Skeletal Response to Exercise in the Hips and Spine in Postmenopausal Women: A Meta-Analysis. Sports Med. 2015 Aug;45(8):1163-73. doi: 10.1007/s40279-015-0338-3. PMID: 26003475.
[10] Kim J, Kim E, Kim D, Yoon S. Weighted vest intervention during whole-body circuit training improves serum resistin, insulin resistance, and cardiometabolic risk factors in normal-weight obese women. J Exerc Sci Fit. 2024 Oct;22(4):463-473. doi: 10.1016/j.jesf.2024.10.002. Epub 2024 Oct 22. PMID: 39525516; PMCID: PMC11550068.
[11] Schneider VM, Domingues LB, Umpierre D, Tanaka H, Ferrari R. Exercise characteristics and blood pressure reduction after combined aerobic and resistance training: a systematic review with meta-analysis and meta-regression. J Hypertens. 2023 Jul 1;41(7):1068-1076. doi: 10.1097/HJH.0000000000003455. Epub 2023 Apr 27. PMID: 37115856.
[12] Lopes S, Mesquita-Bastos J, Alves AJ, Ribeiro F. Exercise as a tool for hypertension and resistant hypertension management: current insights. Integr Blood Press Control. 2018 Sep 20;11:65-71. doi: 10.2147/IBPC.S136028. PMID: 30288097; PMCID: PMC6159802.
[13] Gerage AM, Alberton CL, Cucato GG, Delevatti RS and Ritti-Dias RM (2023) Editorial: Exercise intervention for prevention and management of hypertension. Front. Physiol. 14:1244715. doi: 10.3389/fphys.2023.1244715.
[14] Jane S. Thornton, William N. Morley, Samir K. Sinha Move more, age well: prescribing physical activity for older adults. CMAJ Jan 2025, 197 (3) E59-E67; DOI: 10.1503/cmaj.231336.