Exercise Archives - Better Bones

Walking on Earth

April 12, 2018/in Exercise /by Dr. Susan E. Brown

“The foot feels the foot when it feels the ground.” – The Buddha

Now that winter is finally over — after what seems like forever — more and more of us are getting outside and being active. It’s a time that I like to go for walks to watch the world wake up from its long sleep.

Walking is one of the most useful exercises we have because it offers us so many key health benefits, as enumerated by many, many studies:

Even one hour a week walking at the average pace reduce hip fracture risk by 6% in postmenopausal women, while walking for at least four hours a week was associated with a 41% lower risk of fracture (Feskanich et al., 2002)
Walking reduces the tendency to high blood pressure, the risk of blood clots and stroke, and multiple cardiovascular risk factors (Murtagh et al., 2015).
In older adults, walking more correlates to lower risk of depression and greater quality of life (Arrieta et al., 2018).
Brisk walking improves oxygen uptake and cardiovascular fitness as well as muscle tone—while alkalizing the body.

But I would argue that simply hopping on a treadmill for 10–15 minutes every other day, while it gathers all those benefits and more, somewhat misses the point. Walking outdoors gives us a chance to reconnect with the world around us — ideally in a soothing natural environment like a park or trail, or at the very least a tree-lined sidewalk. (Interestingly — and something that resonates with the Earth Day anniversary coming up — research shows that people who walk in parks tend to get more benefits due to less interruptions in walking from traffic or other hazards they must negotiate [Sellers et al., 2012]).

When we walk outside, we can enjoy the breeze, the rain, the sun, the leaves — all that the world has to offer. And it reconnects us to ourselves in a very useful way: Walking upright on two legs is the trait that defines the human lineage. Even though we’ve become used to sitting more than standing nowadays, regular walking on two legs is considered a uniquely human trait. Taking the time to walk — to put our feet on the ground and feel them, as the Buddhist saying goes — can offer us a type of internal realignment that very few other exercise methods provide.

As we approach Earth Day, we have the opportunity to celebrate all the positives that walking offers us. If you can, take that opportunity in a park or garden path; let your feet touch the ground, mindful of all the good things walking in the open air can bring you.

But if you can’t, no worries! No matter how you like to do it—in groups, by yourself, fast or slow, listening to music or meditating—just walk. Do it on a regular basis. Do it 30 minutes a day, and your bones and entire body will thrive.

References

Arrieta H, Rezola-Pardo C, Echevarria I, et al. Physical activity and fitness are associated with verbal memory, quality of life and depression among nursing home residents: preliminary data of a randomized controlled trial. BMC Geriatr. 2018 Mar 27;18(1):80. doi: 10.1186/s12877-018-0770-y.

Feskanich D¹, Willett W, Colditz G. Walking and leisure-time activity and risk of hip fracture in postmenopausal women. JAMA. 2002 Nov 13;288(18):2300-2306.

Murtagh EM, Nichols L, Mohammed MA, et al. The effect of walking on risk factors for cardiovascular disease: an updated systematic review and meta-analysis of randomised control trials. Prev Med. 2015 Mar;72:34-43.

Sellers CE, Grant PM, Ryan CG, et al. Take a walk in the park? A cross-over pilot trial comparing brisk walking in two different environments: park and urban. Prev Med. 2012 Nov;55(5):438-43.

Getting more by doing less with high-intensity, slow-motion weight training

March 14, 2018/in Exercise /by Dr. Susan E. Brown

A few months ago, I spoke with Rick Berman, a certified personal trainer and owner of Studio 2020 Fitness. Rick uses a weight training technique that was originally researched for building bone — a slow-motion, high-intensity training program. While this strength training program might not suit everyone, I like it because you can see benefits working out only once or twice a week for 15 to 20 minutes!

If that sounds too good to be true, for once, it’s not — because this workout is not light duty. The whole point, Rick tells me, is that you have to work the muscles to great intensity in order to stimulate the muscle cells to build more muscle (which, as you know if you’ve read my blog, goes hand-in-hand with building bone. That means working the muscles to the point of complete fatigue — that “just can’t do even one more rep” point. This is accomplished by slowing the workout down considerably so that you aren’t using momentum to provide energy for the next rep; it forces your muscles to provide all the force needed to raise the weight. Getting to complete fatigue doesn’t actually take long, when you’re doing that much more work with slow movements (and that’s why the workouts are fairly short).

This program takes advantage of the body’s ability to adapt to the stresses we place on it — the more work we do, the more the muscles and cardiovascular system adjust to meet those strains. And it doesn’t matter how young or old you are: Rick says that “a number of my clients are 60, 70 years old — I have some in their 80s — and I see people that come in the door that can barely lift, sometimes, 20, or 30, or 40 pounds. I’ve had clients that have started at 20 pounds, and within … maybe 8 weeks, they’re doing 40 or 60 pounds. We see very rapid increases in muscular strength.”

It should be no surprise that this method is good for developing bone as well as muscle. As Rick pointed out, the original exercise protocol was developed for an osteoporosis study some 33 years ago at the University of Florida Hospital. The slow speed was initially used because of fears that the research subjects — women 60 and older with osteoporosis — might injure themselves, but the serendipitous finding was that this slower training safely created more muscle mass, even with less-frequent workouts!

For more, watch my full discussion with Rick Berman. You will learn a lot!

Important PS: Always check with your doctor before starting any new form of exercise. There is no “one size fits” all strength training program and this intense slow-motion workout is not for everyone. If you’re new to weight training, I encourage you to work with a professional trainer who can teach you correct technique to avoid injuries and help you get the most out of your workouts. Best would be to find a trainer like Rick who specializes on slow-motion, high intensity training if you chose to give this system a try.

Hey Miranda, am I doing this hip-strengthening exercise correctly?

January 18, 2018/in Exercise /by Dr. Susan E. Brown

Recently, I had the opportunity to spend some time with Miranda Esmonde-White, founder of the world renowned Classical Stretch Exercise Program.

It is always a delight to be in the company of someone who radiates so much warmth and energy — but I was also eager to ask her a question: I had been told by my physical therapist that the muscles in my right hip were weaker than my left, and I was using one of Miranda’s exercises to strengthen my right hip. The movement involved a series of leg lifts, so I showed her what I was doing and asked her if I was performing them correctly.

Her reply was a gentle but firm rebuke: the most effective approach to building any single muscle group is a whole-body approach.

All our muscles are interwoven in a series of elegant chains, all interconnected. Thus, she explained, the strengthening of any particular muscle group should begin with lengthening and strengthening the total body muscular system. In fact, this is what Miranda teaches us to do in each of her 20-minute exercise DVD segments — strengthen and lengthen all the muscle groups.

Only after this whole-body work-out should I go on to focus on my right hip muscle group, if needed.

My response to her pointing out the error of my ways initially was embarrassment — because I immediately recognized my flawed thinking as something I’ve railed against when it comes to bone health!

I’ve always argued that the health of the skeletal system is dependent on the health of the entire body and vice versa. You cannot successfully nourish and promote the health of one single bone, nor can you expect excellent results if you deal with just one factor that is causing bone loss and don’t address the others.

Take a minute for your health in the new year

January 2, 2018/in Exercise /by Dr. Susan E. Brown

I’m a big believer that any step you take to improve your health, no matter how minor it may seem, can have profound effects on all the body’s interconnected systems.

Case in point: a recent study on interval training found that exercising a few times week for 10 minutes — with just 60 seconds of maximal effort per session — was enough to boost insulin sensitivity, cardiorespiratory fitness, and skeletal muscle strength.

In the study, the researchers took an interval training regimen developed some years ago that used 20 to 30 minutes of cycling per session and pared it down to a 10-minute program to see if the benefits could be obtained with even less time commitment. Over the course of 12 weeks, previously sedentary men engaged in interval training 3 times per week for 10 minutes per session. Their workouts consisted of:

2 minutes of low-intensity cycling followed by a maximum-effort burst lasting 20 seconds (performed 3 times)
A 3-minute cool-down to end the session.

Meanwhile, a continuous training group did a 2-minute warm up, followed by 45 minutes of cycling at 70% max heart rate, then a 3-minute cool down.

Just 60 seconds is all it takes

The astonishing conclusion was that the sprint interval training regimen — a total time commitment of 30 minutes per week, with just 60 seconds of maximal effort per session — was as effective as 150 minutes per week of moderate-intensity continuous training. And more amazing is that benefits were seen across the board — increasing insulin sensitivity, cardiorespiratory fitness, and skeletal muscle mitochondrial content. (I should note here that although this particular study was done with men, other research suggests interval training has a similar effect among women.)

This is an absolutely incredible finding! It reinforces the idea that even a small commitment of time and effort and can have big benefits. So go all out for a minute to improve your bone health — and total health — this year!

Reference
Gillen JB, Martin BJ, MacInnes MJ, et al. Twelve weeks of sprint interval training improves indices of cardiometabolic health similar to traditional endurance training despite a five-fold lower exercise volume and time commitment. PLoS One. 2016 Apr 26;11(4):e0154075. doi: 10.1371/journal.pone.0154075.

How much exercise is “enough” for bone health?

October 2, 2017/in Exercise /by Dr. Susan E. Brown

When I talk to some of my clients about exercise, I know a lot of them aren’t enthusiastic, thinking I’m going to tell them they need to spend hours lifting heavy weights and sweating in a gym. After all, everyone knows it’s weight-bearing exercise — and lots of it — that builds bone and lowers the risk of fractures, right?

Surprise! Not necessarily. Two new studies show that even small amounts of low-impact exercise have a positive effect on fracture risk.

Twenty minutes of walking does the trick

The first study (Stattin et al., 2017) followed over 65,000 Swedish men and women for 17 years and found that participants who walked or bicycled daily for even short periods of time had a lower fracture rate compared with those who did not. Regardless of sex or age, even relatively sedentary people could lower their fracture risk by exercising just a little bit every day. As long as they got at least an hour of exercise per week, these otherwise inactive people had a 13% lower rate of hip fractures and a 6% lower rate of any fracture compared to people who did none at all.

It’s worth emphasizing that the findings held true whether you looked at any fracture (including common, relatively mild fractures like vertebral or wrist fractures) or the more serious and life-changing hip fractures that everyone fears.

Of course, the more exercise they got, the better the results: those with 20 minutes of walking or cycling every day, which translates to about 2 hours per week — had a 23% lower rate of hip fracture and a 13% lower rate of any fracture. That’s a pretty good return for not a lot of effort — just imagine what you get when you do even more!

Light loads do more than you think

The second study (Hamaguchi et al., 2017) had a small group of 7 postmenopausal women undergo six weeks of training wearing a weighted vest with 380-760 g (roughly from 1.75 pounds) of added weight. With just two workout sessions per week, the participants saw improvements in pelvis BMD (1.6%) and knee extensor strength (15.5%) — which is helpful in maintaining balance and preventing falls. Workouts consisted of squats, front lunges, side lunges, calf raises and toe raises (eight sets of three repetitions with a 15-second rest between each set).

A little bit goes a long way

I know that it can be hard to start exercising if you’re not accustomed to it, and especially if you’re recovering from a muscle strain or a fracture, the get-up-and-go impulse just isn’t there. But you don’t have to do a lot to get benefit from it! Both of these studies show that a little goes a long way.

References

Hamaguchi K, Kurihara T, Fujimoto M, et al. The effects of low-repetition and light-load power training on bone mineral density in postmenopausal women with sarcopenia: a pilot study. BMC Geriatrics 2017;17:102. doi:10.1186/s12877-017-0490-8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5414134/

Stattin K., Michaëlsson K., Larsson S.C., Wolk A., & Byberg L. Leisure-Time Physical Activity and Risk of Fracture: A Cohort Study of 66,940 Men and Women. Journal of Bone and Mineral Research 2017;32(8):1599-1606. doi: 10.1002/jbmr.3161.

New research: Low-weight, high-repetition strength training builds bone

May 31, 2017/in Exercise /by Dr. Susan E. Brown

Here’s good news for those of us who avoid rigorous high load strength training – either due to risk of injury or personal preference. New research shows powerful bone-building benefits can also be obtained with low-load, high-repetition strength training.

To determine this, researchers compared the results of a 24 week strength training program for two groups – one using the Body Pump Program,™ a full body, low-load, high-repetition resistance training program using weights with the other group using a combination of Pilates and yoga exercises without weights.

At the end of the 24 weeks period those doing the low-load, high-repetition strength training increased their bone density (BMD) significantly, while those doing the core strengthening program didn’t increase bone density.

Gains in bone density in the low-load, high-repetition group

4% gain in arm BMD
8% gain in leg BMD
6% gain in pelvis BMD
4% gain in spinal BMD

As for gains in muscle strength, both groups experienced improvements in body mass composition and muscular strength, but the gains were greater in the low-load, high-repetition strength training group.

My take on the study results

Personally, I find a low-load, high-repetition system works well for me. And this approach fit right into the strength training program I was already doing at my local Y.

This well-designed study clearly shows that you can build bone density with a gentler form of strength training, but you must commit yourself to do 3 hours strength training per week and find time for 3 hours of aerobic exercise each week also. I know that this may sound like a lot, but remember, if you don’t change things up to keep challenging your bones and muscles, you won’t get results! Here are some of my favorite ideas to help you get started.

More details about the study’s strength training program

All sessions were one hour
First, participants did a three-week preparation program learning the proper form of each exercise.
During the first 12 weeks of the full study participants did 2 strength training sessions per week and 3 bicycling aerobic sessions per week.
During the second 12 weeks period there were 3 strength training sessions and 3 by bicycling sessions per week.
Each session consisted of 8 loading exercises done with a load of only 20% of the individual’s 1 repetition maximum. (Traditional high-load strength training uses weights of 70-85% an individual’s 1 repetition maximum with only 6-12reps per set).
Each of the low load exercises was done for 100 reps, thus the entire class involved some 800 repetitions with a low-weight load.
Participants were asked to increase the weights in any particular exercise if the exercise did not feel hard enough by the end of the 4 to 5 minutes of repetitions.
8 exercises were done each session including squats, dead lifts, chest press, triceps variation, bicep curl, lunges, pushups and clean and press.

For further specifics on this type of low-load, high-repetition strength training program see the BODYPUMP Program™ info.

Q: Will a weight vest really help me build bone?

A: Several clinical studies demonstrate how the regular use of the weight vest helps to build bone density by adding extra weight and a greater impact to your steps. This is especially critical for thin women, who have less of a weight-bearing effect to their bones when they walk.

As you use the vest over time, you’ll note you are building muscle strength. Remember, studies show you that as you build muscle you also build bone.

Q: How often should I use the vest?

A: It’s best to use the vest daily or at least every other day. The most bone-strengthening benefits are seen with regular, long-term use over the years.

Personally, I’ve worked up to putting 19 pounds in my vest — and I really like to wear the vest when I walk my dog. Each time the dog stops to smell a mail box, I do a few small hops giving additional impact to the hip.

Q: How much time should I wear the vest?

For most healthy individuals the answer is the longer time you have it on the better. Various studies used the vest for at least 1 hour, 3 times a week. Remember, it is important to build up strength and work up slowly on the weights. And, take the vest off when you find yourself getting fatigued.

Q: How much weight do I start with?

A: You should start with 1-2 pounds of weight. The vest itself weighs 1 pound, so a gentle start is to add 1 extra pound (which equals 2 of the flexible weight packets) to get started. You’re working toward a goal of loading the vest with 10% of your body. For example, a woman who weighs 100 pounds would work up to 10 pounds in the vest.

Q: What is the maximum amount of weight I can use in the vest?

A: The vest has pockets to hold 18 pounds of flex-weights, plus the vest itself which weighs 1 pound.

Q: How do I put the weights in the vest?

A: The unique soft flex metal weights are very easy to manipulate in and out of the pockets on the vest. They are even easy to use for anyone with arthritis.

Q: What activities can I do in this vest?

A: Most all activities! It is great to wear the vest while doing a wide range of activities — from walking to housework to strength training, Pilates and yoga. Wearing the vest is a great way to accomplish more during your exercise time.

Q: Can I jog while wearing this vest?

A: Yes, if you like to jog and jogging with the vest is comfortable this is a great way to get extra bone-building impact with each step. This particularly strengthens the hip.

Q: Does the vest adjust to fit my size?

A: This vest is fully adjustable and fits most everyone from very petite women to larger-boned women. It adjusts on the shoulder for women who are short in the torso or for those who are tall (from under 24 inches to over 50 inches). In addition this vest adjusts around the waist for a snug fit. This high quality Women’s Zipper Front Vest™ can quickly be adjusted to fit women from below 5 feet to over 6 feet tall.

Q: What is the vest made of?

A: The outer shell is nylon with a knitted nylon stretch neoprene chest. The vest has soft double stitched bound edges with Lycra and neoprene stretch pockets for the weights. There is comfortable padding in shoulders with the back and waist shoulder adjustments.

Q: Is the vest washable?

A: The Women’s Zipper Front Vest™ can be hand washed with the weights inside or machine washed with the weights removed.

Q: Where can I get additional weights?

A: Extra flex-weights are available here.

Q: Will the extra flex-metal weights from my existing vest also work with this vest?

A: Yes, you can add other weights you have as long as they fit into the pockets.

Q: I have pain issues. Can I use this vest?

A: This really depends on the sort of pain you have. You should always check with your physician or physical therapist before beginning any exercise regimen if you have pain. Take special care to seek professional advice before using the vest if you have any sort of back pain.

Q: What if I don’t like, or can’t use, this vest after I buy it?

A: You can try the vest for two weeks from that date of delivery. If in that time you decide it is not for you we will refund you for the cost of the vest.

Q: Do I need my doctor’s permission to use this vest?

A: The vest is very safe because you totally control the amount of weight you put in it. By itself, or with say one weight in it, it is like wearing a jacket. If course, if you have a special health concern, or a back issue, it is wise to discuss the use of this vest with your doctor.

You can learn more about my weight vest here.

References:

Jessup, J et al., 2003, Effects of exercise on bone density, balance, and self-efficacy in older women, Biol Res Nurs 2003, 4:171-180.

Snow, C et al., “Long Term Exercise Using Weighted Vests Prevents Hip Bone Loss in Postmenopausal Women”, Jr of Gerontology: Medical Sciences 2000, Vol. 55A, No. 9, M489-M491.

Snow, C, Marcus, R et al., 1991. “Exercise, Bone Mineral Density, and Osteoporosis”, Jr of Exercise and Sport Sciences 1991, Vol. 19:351-388.

How to reduce the risks of too much sitting

February 17, 2017/in Exercise /by Dr. Susan E. Brown

If you’re looking for extra motivation to get up and get moving, there’s a powerful new study documenting how sitting for 8 hours a day can take years off your life.

The increased risk of early death adds to what we know about the harm of inactivity — which also includes increased risk of diabetes, cancer, heart disease, and obesity.

What’s your risk?

Researchers analyzed data from 16 different studies world-wide involving more than 1,000,000 people, most of whom were over 45. Study subjects were classified into activity levels of less than 5 minutes a day for the least active to 60 to 75 minutes for the most active.

The greatest risk was for people who both sat for long periods of time and were physically inactive. One interesting point was that people who sat for 4 hours and got no exercise each day were worse off than people who sat for 8 hours but got an hour or more of exercise daily.

And watching TV makes it worse. Sitting watching TV for more than 3 hours per day was associated with increased risk of death in all activity groups except the most active. And at more than 5 hours per day of TV, it didn’t matter how much you exercised, risk of death was increased.

What can you do to reduce your risk?

Here are more ideas to get moving

Determine your daily sitting time and set your daily exercise requirement.
Establish a routine for getting in those necessary minutes of physical activity: take a 15-minute walk before work, or park your car 10 minutes’ walk from your office. Then take a 20-minute brisk walk at lunchtime and another after work — and just like that, you’ll have negated most of the day’s sitting.
Consider using an activity monitor like a Fitbit that can be set to track your minutes of active exercise. I set mine for 60 minutes a day to ensure I get up and out daily.

If you want to learn more about the risks of sitting, check out my blog Is sitting the new smoking?

So let’s make 2017 our year to get out and moving — I’d love to hear about your exercise plan for 2017!

References:

Ding, Ding, et. al. 2016. The economic burden of physical inactivity: A global analysis of major non-communicable diseases. The Lancet, 388(10051):1311–1324. http://dx.doi.org/10.1016/S0140-6736(16)30383-X

Ekelund, U., et al. 2016. Does physical activity attenuate, or even eliminate, the detrimental association of sitting time with mortality? A harmonised meta-analysis of data from more than 1 million men and women. The Lancet, 388(10051):1302–1310. http://dx.doi.org/10.1016/S0140-6736(16)30370-1

2 hours of strength training a week improves bone density

October 24, 2016/0 Comments/in Exercise /by Dr. Susan E. Brown

We’ve heard over and over that one of the best ways to build bone is exercise. I can’t tell you how many studies I’ve seen to confirm that. But the question a lot of people ask is, “How much do I need to do?”

And there’s great news for people with limited time: New research from the German scientist Wolfgang Kemmler shows that 2 hours per week of high-impact strength-training exercises done over the years on a regular basis is enough to favorably impact bone density, significantly reducing the rate of aging bone loss.

What a powerful argument for the importance of getting regular exercise – especially when you consider that I have seen research suggesting that, without taking any preventive measures, the average women will lose 45% of her bone and muscle mass as she moves from 35 to 85.

Latest study cuts exercise time needed for bone benefits

I first became aware of Dr. Kemmler’s studies in 2003 when his group published research showing that early postmenopausal women with osteopenia could get actually gain bone mass doing 4 hour-long strength training sessions per week. In this 14 month study the exercise program involved a variety of strength-building activities, including included warm-up/endurance, jumping, strength and flexibility training.

Remember, early postmenopause is a time when women lose 5% or even 10% of their bone mass. These exercising women actually gained bone density as a result of their serious strength training done 4 times a week.

Since I don’t think I could add 4 hour-long workouts into my week at that point without a lot of juggling, I was excited to see Dr. Kemmler’s latest report that bone benefits could be seen with a minimum of 2 hours per week of high-impact strength-training exercises.

Mindful exercise options for building bone

If strength training isn’t your thing when it comes to exercise, remember what we’ve seen about the effect on bone from different types of exercise at different exercise frequencies:

My friend, Miranda Esmonde-White, also reports that her Classical Stretch exercise program done on a regular basis has also led to increase in bone density. The same thing has been suggested for tai chi and other more mindful exercise modalities.
Studies now document that the regular practice of yoga could halt bone loss and begin to build new bone.
For those who love to walk, using a weighted vest is one of my favorite muscle and bone-building exercise options.

For me, it boils down to this: your exercise program will be good for bones if it’s sufficiently strenuous to maintain and even build body strength, and if you do it on a regular basis over the years.

References:
Kemmler, Wolfgang et al., The Erlangen fitness osteoporosis prevention study: a controlled exercise trial in early postmenopausal women with low bone density—first-year results. Archives of Physical Medicine and Rehabilitation , Volume 84 , Issue 5 , 673 – 682,2003

Kemmler, Wolfgang et al. Exercise frequency and bone mineral density development in exercising postmenopausal osteopenic women. Is there a critical dose of exercise for affecting bone? Results of the Erlangen Fitness and Osteoporosis Prevention Study. Bone , Volume 89 , 1 – 6 (https://secure.jbs.elsevierhealth.com/action/showCitFormats?pii=S8756-3282%2816%2930106-5&doi=10.1016%2Fj.bone.2016.04.019&code=bon-site)

Bone health risks of too much TV watching

August 25, 2016/0 Comments/in Exercise /by Dr. Susan E. Brown