Moderate intensity three times a week for bone — except total body, where high intensity twice won

That resistance training helps bone is settled. This study asked something more specific: at what intensity, how many times a week, and for which site. It pooled 34 randomised controlled trials with 1,746 participants and ranked combinations of intensity and frequency.

The answer differed by site

Ranked by surface under the cumulative ranking curve, moderate-intensity resistance training three times per week came first at five sites.

• Lumbar spine — 80.3%
• Femoral neck — 75.2%
• Total hip — 68.2%
• Trochanter — 86.0%
• Ward's triangle — 80.5%

For total body bone mineral density, a different combination led: high-intensity resistance exercise twice weekly, at 88.9%. Site-specific and whole-body bone density pointed to different prescriptions.

Where were the significant gains?

Ranking and statistical significance are separate matters. Only four comparisons produced significant increases over control.

• Moderate intensity ×3/week → femoral neck (SMD 0.26, 95% CI 0.06–0.46)
• Moderate intensity ×3/week → trochanter (0.34, 0.10–0.58)
• High intensity ×2/week → total body (0.49, 0.07–0.91)
• Moderate intensity ×3/week → total body (0.30, 0.01–0.59)

And the authors flag the limit themselves: no statistically significant differences were observed between interventions at the lumbar spine, total hip or Ward's triangle. The rankings at those sites should be read cautiously.

Subgroup analyses showed that exercise frequency, intensity, duration, session length, sex, bone health status and age all significantly influenced bone density at different sites. One prescription does not produce the same outcome for everyone.

What it means in practice

It is worth noticing that the two winning combinations carry similar total weekly load. Moderate three times and high twice arrive at a comparable place by different routes, so in practice the choice usually comes down to recovery capacity and schedule.

If hip fracture is the concern that matters most, the sites with confirmed significant gains — femoral neck and trochanter — point to moderate intensity three times a week. If total body density is the goal, high intensity twice weekly led on both ranking and effect size.

How this relates to your strength score

The good news is that either option does not conflict with what you already do. A typical Big 3 schedule of two or three sessions a week already lands on one of these combinations. There is no separate bone programme to build.

A strength score does not measure bone density, so this is a benefit that accrues outside the number. Why bone matters after menopause is covered in strength training and bone density, and the blood pressure side of the same period in resistance training and the postmenopausal heart.