Bone Health Part 7: The Best Core Stability Exercises for Osteoporosis

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Why is core stability important?

Core stability exercises are fundamental to a well-rounded osteoporosis prevention program. Core stability refers to your ability to control the alignment of your trunk (spine and pelvis) as you move your arms and legs. Along with strength, posture and balance, core stability creates a strong foundation to prevent falls and fractures.

The best core stability exercises for osteoporosis work the abdominal and spinal muscles without rounding the upper back (as in a crunch or sit-up) and without twisting or flexing the spine (as in a side crunch or lateral bend).  These movements can overload the fragile vertebrae of the spine and cause spinal fractures.

The TVA muscle is key

The key is to target the transverse abdominis (TVA) muscle, the deepest abdominal muscle that plays a significant role in core strength.  The compressive nature of this muscle makes it a natural corset, keeping the lower back stable and supporting the abdomen. It often functions with the internal and external obliques, muscles running along both sides of your abdomen. The exercises that target the TVA are performed with the trunk in neutral spine alignment.

To get in touch with your TVA, do this simple exercise:  Without moving your pelvis, draw your belly button toward your spine as if you were zipping up a tight pair of jeans or “making your pants loose”. Whenever you hold your stomach in, you are working the TVA.  You often work this muscle without realizing it, for example to keep your back straight when doing a push-up.

Work the TVA in three easy steps

  • Belly breathing

  • Neutral spine alignment

  • Leg slide exercise

Belly breathing

Belly breathing is key here, because the TVA functions (along with the obliques) to compress the abdomen when you exhale.  Practice a belly breath:  Inhale, fill the belly with air, then exhale forcefully by pulling the abdominals tight (think “belly button to spine”) and push the air out.  Place your hands on your belly to feel the action of the abdominals as they expand and contract.

Neutral spine alignment (NSA)

Next, find neutral spine alignment (NSA), the place where your spine rests while preserving all its natural curves.  You should have a slight curve in the lower back, with just enough space to slip your hand in if you are standing straight with your back against a wall.  The correct alignment of the lower back, neither flattened nor arched, will allow you to recruit your core muscles most effectively.

Leg slide

Lie on your back with your knees bent, feet on the floor. Using abdominal compression to maintain NSA, slide one leg out straight and then return to the original position. Work your TVA to keep your lower back from arching and your hips from tilting side to side. To advance, raise your knees to 90/90, right angles at hips and knees (legs in the air, knees over hips, calves parallel to the floor).

The best core stability exercises for osteoporosis

  • Forearm plank

  • Ball transfer

  • Opposite arm & leg lift

Forearm plank

The forearm plank is an isometric core stabilization exercise in which you hold your trunk in perfect neutral spinal alignment. You can perform a standing plank with your forearms  planted against a wall, a half plank from your knees on the floor, or a full plank with the entire length of your body from your toes to your forearms hovering above the floor. For the full plank:

  • Begin lying on your stomach, arms bent with elbows directly beneath the shoulders, forearms on the floor.

  • Come up onto your toes and lift your body off the floor, creating a straight line from shoulder to knee to ankle.

  • Pull your abs tight and anchor your shoulder blades.

  • Hold for 30-60 seconds, breathing normally.

Forearm plank: Core stability – Video 1


Ball transfer

The ball transfer targets the TVA along with the obliques, holding the pelvis in neutral while the moving limbs provide resistance.

  • Lie on your back with your knees bent, feet on the floor.

  • Hold a beach ball or pillow overhead with your arms extended, in line with your ears.

  • Keeping your head and shoulders on the floor, raise your arms and bring your knees up over your hips.

  • Place the ball between your knees, then lower your arms and legs to the floor without arching your back.

  • Tap down lightly and then lift your arms and knees up again to take the ball in your hands and return to the start position.

  • Keep transferring the ball from arms to legs.

  • Repeat 10 times.

Ball transfer: Core stability – Video 2


Opposite arm & leg lift

The opposite arm & leg lift targets the deep muscles along the spine, the erector spinae, as well as the glutes in the buttocks and the deltoid in the shoulder, while challenging your balance and core stabilization. It is weight-bearing through the wrists and forearms.

  • Kneel on all fours, wrists beneath shoulders, knees under hips.

  • Lift one leg behind you to hip height, keeping the knee straight.

  • When you have your balance, reach the opposite arm forward to shoulder height.

  • Hold for one second, then slowly lower both your arm and leg to the start position.

  • Switch sides and repeat five times (one repetition = both sides).

Opposite arm & leg lift: Core stability – Video 3

A strong, stable core enhances your balance by bracing and sustaining posture to steady the body against disturbances, like tripping or being jostled. For more about how to improve balance, see Balance Exercises for Seniors.

RELATED: The Best Bodyweight Exercises for Osteoporosis

Disclaimer: The information presented in this article should not be construed as medical advice. It is not intended to replace consultation with your physician or healthcare provider.


  • Joan Pagano

    Joan Pagano has specialized in strength training for women since 1988 – training, teaching, and writing books on the subject, including Strength Training Exercises for Women (DK, 2014). When the health benefits of strength training started making headlines in the 1990s, and in particular how weight training could protect the bones and prevent osteoporosis, it was a natural segue for her. At that time, Joan was developing and delivering fitness training guidelines for osteoporosis to national audiences of exercise professionals. Currently Joan is recognized by the industry as a leading authority on exercise program design for osteoporosis. She is certified as an Exercise Physiologist by the American College of Sports Medicine (ACSM) and is on the Ambassadors Leadership Council for the National Osteoporosis Foundation. Visit Joan at:

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