How do the Bone Builder classes differ from the LIFTMOR protocol?

The LIFTMOR study has been a very important influence on how we think about strength training for osteoporosis.

But Bone Builder is not simply “LIFTMOR copied and pasted into a gym class”.

That distinction matters.

LIFTMOR was a research protocol. Bone Builder is a clinical, real-world class environment built for people with different bodies, different histories, different fears, different injuries and different starting points.

The two are connected by the same core idea:

People with low bone density often need more than light exercise. They need structured, progressive, well-coached loading.

But how that idea is delivered must be adapted to the person in front of us.

First, what was LIFTMOR?

LIFTMOR stands for Lifting Intervention For Training Muscle and Osteoporosis Rehabilitation.

It was an Australian research trial that investigated whether supervised high-intensity resistance and impact training could improve bone mineral density and physical function in postmenopausal women with low bone mass.

The training programme was short, structured and supervised. It used heavy resistance exercises and impact loading, performed twice per week. The high-intensity group improved bone mineral density and physical function more than the lower-intensity home exercise group.

That is why LIFTMOR has become so important.

It helped challenge the idea that people with osteopenia or osteoporosis should only do gentle, low-load exercise.

But the key word is supervised.

LIFTMOR was not a casual gym programme. It was not random lifting. It was a controlled, coached and progressive intervention.

So, is Bone Builder based on LIFTMOR?

Yes and no.

Bone Builder is informed by LIFTMOR, but it is not an exact replication of the LIFTMOR protocol.

That is deliberate.

The LIFTMOR study gives us a powerful evidence base for the use of heavy resistance and impact training in appropriately screened and supervised people with low bone mass. But in the real world, the people walking into Bone Health Studio are not identical to the participants in a research trial.

Some will have osteoporosis.
Some will have osteopenia.
Some will have osteoarthritis as well.
Some will have previous fractures.
Some will have spinal concerns.
Some will be very fearful.
Some will be strong but inexperienced.
Some will have never touched a barbell.
Some will have balance issues.
Some will have shoulder, hip, knee or back pain.

That means the class needs a framework, not a rigid script.

The biggest difference: Bone Builder starts with screening

In LIFTMOR, participants were selected and supervised within a research environment.

In Bone Builder, we use a pre-screening process before people enter the class.

That pre-screen is not just a formality. It helps us understand:

Your diagnosis.
Your fracture history.
Your injury history.
Your current strength.
Your movement confidence.
Your balance.
Your lifting experience.
Your concerns.
Your goals.
Your medical considerations.

This is important because osteoporosis exercise is not just about giving everyone the same four exercises.

The “Too Fit To Fracture” recommendations strongly support resistance and balance training for people with osteoporosis, but they also emphasise the need to adapt exercise to the individual, particularly in the presence of vertebral fracture, pain or hyperkyphosis.

That is exactly how Bone Builder is designed.

LIFTMOR used a tighter protocol. Bone Builder uses principles.

The LIFTMOR programme is often discussed around several key exercises: squat, deadlift, overhead press and a jumping chin-up/drop landing variation.

Those exercises were chosen for a specific research protocol.

Bone Builder uses the same broad principles, but not necessarily the same exact prescription for every person.

The principles are:

Progressive overload.
Heavy-enough loading, when appropriate.
Strong technique first.
Hip and spine control.
Strength through the legs and trunk.
Balance and falls-risk reduction.
Confidence under load.
Individual modification where needed.

For one client, the deadlift pattern may be a barbell deadlift.

For another, it may be a kettlebell deadlift from a raised box.

For another, it may be learning the hip hinge with no external load before we add resistance.

The principle is the same.

The entry point is different.

Bone Builder is built for the real person, not the average participant

Research trials need standardisation. That is how studies work.

A clinical class needs individualisation.

That is the biggest difference.

In Bone Builder, two people may be in the same class but doing slightly different versions of the same movement.

One person might squat to a box.
Another might goblet squat.
Another might use a barbell.
Another might reduce depth because of hip osteoarthritis.
Another might avoid a particular movement temporarily because of symptoms.

That does not dilute the programme.

It improves it.

Because the goal is not to make everyone look identical. The goal is to create the right training stimulus for each person.

Impact loading is handled carefully

The LIFTMOR protocol included impact loading.

That does not mean every Bone Builder participant starts jumping.

Impact can be useful for bone, but it must be earned.

Before impact training, we need to consider:

Bone density.
Fracture history.
Balance.
Joint pain.
Landing mechanics.
Foot and ankle strength.
Pelvic floor symptoms.
Confidence.
Medical advice where needed.

Some people may progress to impact work.

Others may spend more time building strength, balance and landing preparation first.

For some clients, the “impact” pathway may initially look like step-ups, calf raises, controlled marching, heel drops, faster sit-to-stands, low-level landing preparation or other scaled options.

Again, the principle matters more than the exercise label.

Bone Builder includes more balance and movement education

LIFTMOR was highly effective as a bone-loading and strength intervention.

Bone Builder has to solve a broader real-world problem.

Many people with osteoporosis are not only worried about BMD. They are worried about falling, bending, lifting, gardening, walking downhill, getting out of chairs, carrying groceries, and whether their body is safe.

So Bone Builder includes more than loading.

It also includes:

Balance work.
Posture awareness.
Movement education.
Safe bending and lifting strategies.
Strength confidence.
Technique practice.
Functional capacity.

This aligns well with broader osteoporosis exercise recommendations, which strongly support multicomponent programmes including resistance and balance training.

For Bone Health Studio, this is essential.

We are not just training the scan.

We are training the person.

Bone Builder respects joint health

This is another major difference.

Many people with osteoporosis also have osteoarthritis, tendinopathy, previous surgery, back pain, shoulder pain, knee pain or hip stiffness.

A pure research protocol may not account for all of that in the same way a clinical class must.

Bone Builder needs to make good decisions around joint tolerance.

That might mean adjusting:

Range of motion.
Exercise selection.
Tempo.
Load.
Stance.
Grip.
Depth.
Volume.
Rest time.
Session intensity.

For example, someone may need bone-loading work but also have knee osteoarthritis. That person may not initially tolerate deep loaded squats. So we might use a modified squat, hip hinge, step-up, machine option, or more hip-dominant loading to build capacity.

That is not backing away from the evidence.

That is applying it properly.

Bone Builder has a class environment, not a lab environment

The LIFTMOR study was conducted under research conditions.

Bone Builder is delivered in a small-group studio environment.

That means the programme must be clear, repeatable and structured, but also flexible enough to manage the people in the room.

This is why class size matters.

Bone Builder is designed around coaching, not crowd control. Small class numbers allow for proper supervision, technique correction and individual modification.

That is important because loading is only useful when it is delivered well.

A poorly coached heavy lift is not evidence-based just because it looks like LIFTMOR.

The coaching is part of the intervention.

Bone Builder progresses people towards heavier loading

The goal of Bone Builder is not to keep people light forever.

That would miss the point.

Bone needs a meaningful signal.

But heavier loading must be earned.

So the progression is usually:

Learn the movement.
Build confidence.
Control the range.
Add external load.
Increase intensity gradually.
Monitor response.
Progress when appropriate.

Some people will progress quickly. Others will need more time.

That is not a problem.

The goal is not to force everyone to the same destination at the same speed. The goal is to keep moving the person forward safely.

What Bone Builder is not

Bone Builder is not a gentle stretching class.

It is not random circuit training.

It is not a “light weights for older adults” class.

It is not a powerlifting class.

It is not a direct clone of LIFTMOR.

And it is not a class where everyone does the same thing regardless of history.

Bone Builder is a structured, evidence-informed strength class for people who need intelligent loading for bone health.

That means we respect both sides of the equation:

The body needs load.
The person needs the right starting point.

The bottom line

The LIFTMOR protocol showed that supervised, high-intensity resistance and impact training can improve bone mineral density and physical function in postmenopausal women with low bone mass.

Bone Builder takes the most important lesson from that research and brings it into a real-world clinical studio environment:

People with osteoporosis are not too fragile to train. They are too important to train randomly.

So yes, Bone Builder is inspired by LIFTMOR.

But it is adapted for real people.

It includes screening, coaching, movement education, balance, individual modifications, joint-health considerations, and progressive loading.

The aim is not simply to copy a study.

The aim is to help people become stronger, safer, more confident, and more capable in daily life.

That is the real purpose of Bone Builder.

References

Watson SL, Weeks BK, Weis LJ, Harding AT, Horan SA, Beck BR. High-Intensity Resistance and Impact Training Improves Bone Mineral Density and Physical Function in Postmenopausal Women With Osteopenia and Osteoporosis: The LIFTMOR Randomized Controlled Trial. Journal of Bone and Mineral Research, 2018.
https://pubmed.ncbi.nlm.nih.gov/28975661/

Watson SL et al. The LIFTMOR Randomized Controlled Trial. PubMed record.
https://pubmed.ncbi.nlm.nih.gov/30861219/

Giangregorio LM et al. Too Fit To Fracture: exercise recommendations for individuals with osteoporosis or osteoporotic vertebral fracture. Osteoporosis International, 2014.
https://pubmed.ncbi.nlm.nih.gov/24281053/

Giangregorio LM et al. Too Fit To Fracture: exercise recommendations for individuals with osteoporosis or osteoporotic vertebral fracture. Full text.
https://pmc.ncbi.nlm.nih.gov/articles/PMC5112023/