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Dr. Susan E. Brown

Are high-tech gyms the future of strength training for building bone?

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Can you imagine a gym session that begins with you lying down on the massage table? Well, this is exactly how every training session begins at my new high-tech gym/health club and I want to share with you why I think this model is the future for the ideal muscle and bone strength training program.

What is so special about the futuristic, high-tech gym?

Comprehensive baseline testing is a hallmark of the futuristic gym. No longer do you go to the gym just to “pump iron” and run laps as best you can. Rather, at the futuristic gym, you are given the option of a concierge-type service that employs science-based methods to assess and maximize musculoskeletal strength, oxygen utilization, fat burning capacity, body composition, and posture alignment.

Upon signing up for these specialized training services, my new fitness facility conducts the following baseline tests, which are then monitored over time as I implement my personal fitness program:

1. Bone mineral density testing done on the DEXA machine

Your doctor tests the bone density of your spine and hip using the DEXA machine. Here at my high-tech gym they measure bone density of your entire body (head, arms, legs, spine, trunk, ribs, & pelvis) and watch the changes over time as you build muscle strength.



 

2. Testing of your muscles

My new high-tech gym uses a proprietary system for detailed muscle testing known as “Bionetics.” This is a type of kinesiology that assesses the muscles, identifying which ones are strong, which ones are weak, and which ones are inactive.

The fitness specialist then bases your program on your muscle activity profile, and knowing which muscles are strong, weak or even inactive guarantees the safety of your strength training program. Assessment of shoulder and trunk rotation is also a key measurement monitored over time as this program has its roots in optimizing performance for golfers and other athletes.

3. Testing of posture and body alignment with 3D imaging

For example, in my case this imaging revealed a misalignment with my right shoulder being lower than my left, it also showed that I had an imbalanced distribution of weight on my feet leading to posture misalignment.

4. An oxygen uptake assessment

This is much like the VO2 max and is used to define the ideal training heart rate for each individual. If the goal is fat burning, one training heart rate is established, if the goal is endurance, another calculation is made. 

5. Resting metabolic rate testing

This test determines how many calories are used at rest and activity and helps to define the ideal energy sources for the individual.  For example, some individuals are more inclined to use fat for energy, while others are more inclined to use carbohydrates, or many are evenly split on how they process energy. This test helps determine how your metabolic system will function most efficiently.

6. Diet and eating guidelines 

Specific guidelines as to the composition of the diet, the amount of protein, the amount of carbohydrates, and total calories is calculated for each individual given their goals.

Why start each session with time on the massage table?

A central component of this futuristic fitness center is muscle testing. The first focus in each session is to detect which muscles are strong, which muscles are weak, and which muscles are inactivated. An inactivated muscle suggests that the brain-muscle messaging system is impaired — and this neural pathway must be reestablished.

 

 

 

 

 

 

 

 

In my case, bionetics testing found that my chest pectoral muscles and some upper back muscles were inactive.  For movements and strength training that might involve these muscles, I was compensating using my arms and shoulders. This can lead to injury and overuse, and even more, it gave me a tendency to slump my shoulders forward.  Now that I know this slumping is a result of weakened upper back muscles and inactive chest pectoral muscles, with proper corrective strength training and careful activation of the inactive pectoral muscles, I have improved my body alignment and posture. 

This high tech gym in my hometown is known as the Athletic Apex Health Club, with locations in four cities (Orlando, Florida;  Fort Worth, Texas; Syracuse, New York and Rochester, New York). Their approach has a lot in common with the Australian Bone Clinic where older women, under careful supervision, are able to build substantial bone density with strength training. 

Looking into my crystal ball, I see these higher tech, science-based fitness programs becoming more popular and available over time. If you already belong to a gym that you love, why not show them this blog and ask if they could consider adding these much-needed biometrics assessment services?

Watch Dr. Brown in her training session at a “high tech gym”!

swimming builds bone
Dr. Susan E. Brown

Can swimming and water exercise really build bone?

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People frequently ask me if swimming or other water exercise can help build or maintain bone density. I’ve always thought (and so have other researchers) that water exercise wouldn’t be the best possible exercise for bone — after all, swimming is low-impact, and the water supports your body weight. I could see how the full-body muscle movement in water exercise might reduce the “use-it-or-lose-it” peril of sedentary living, but could this form of exercise really stimulate the bones to build new bone?

Well, I have good news for all you swimmers: Studies from all around the world suggest that you not only can maintain bone density with aquatic exercise, you can also build bone.

How water exercise helps after menopause

Several studies over the years that have found that water exercise does indeed offer benefits for bone building in postmenopausal women — but not in terms of bone density increase. Rotstein and colleagues (2008) followed a group of 35 postmenopausal women for seven months as they participated in hour-long water exercise three times a week. They found that the mineral content of the women’s bones improved — meaning, the bones were stronger — but their bone density wasn’t noticeably greater.

This has been a fairly constant theme in research of water exercise and bone health: Swimmers’ bone densities are found to be comparable to sedentary control subjects, but their rate of bone turnover is significantly higher (Gómez-Bruton et al., 2013), meaning their bones became more resistant to fracture and able to repair themselves more effectively.

Personally, I’m happy for women to have stronger bones even if they’re not dense — I’ve long maintained that strong bones are the key to avoid debilitating fractures. Brazilian researchers, however, have been getting great results on both fronts by using a high-intensity interval-training method in their water exercise studies.

In 2014, one study (Moreira et al. 2014) found that high-intensity water exercise for 6 months reduced bone resorption markers even though bone density didn’t change — not that different from what earlier research found. More recently, however, Aboarrage and colleagues (2018) trained study participants in a high-intensity aquatic exercise protocol that included a form of interval training using jumping and hopping performed for 20 minutes in warm water that was about chest deep.

This new study offers a different twist: By using exercise that encouraged jumping in water and fairly high exertion, the water exercisers increased bone density throughout the body, and specifically in the spine and femur. As an added bonus, the exercise group also had greater leg strength and agility after the six-month time frame than the controls.

Swimming builds better bones

For those who prefer water exercise, this is great news! You’re not shortchanging your bones by swimming or doing water aerobics. And if, for one reason or another, you can’t perform other types of exercise due to severe joint pain or poor balance — or perhaps you’re recovering from a fracture to an arm or a leg — exercising in water is one way to keep your muscles strong without overloading your joints or risking a fall. So, I for one am going to let go of the mentality that water exercise isn’t useful for promoting bone health. Jump in, the water’s fine — and it’s good for your bones!

References

Aboarrage, AM Jr, La Escala Teixeira CV, Dos Santos RN, et al. A high-intensity jump-based aquatic exercise program improves bone mineral density and functional fitness in postmenopausal women. Rejuvenation Research 2018;21(6). https://doi.org/10.1089/rej.2018.2069

Gómez-Bruton A, Gónzalez-Agüero A, Gómez-Cabello A, et al. Is bone tissue really affected by swimming? A systematic review. PLoS One 2013;8(8):e70119.

Moreira LD, Fronza FC, Dos Santos RN, et al. The benefits of a high-intensity aquatic exercise program (HydrOS) for bone metabolism and bone mass of postmenopausal women. J Bone Miner Metab. 2014;32(4): 411-419.

Rotstein A, Harush M, Vaisman N. The effect of a water exercise program on bone density of postmenopausal women. J Sports Med Phys Fitness 2008;48(3):352-359.

osteoporosis and exercise
Dr. Susan E. Brown

Osteoporosis and Exercise: The Better Bones, Better Body® Exercise Principles

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It’s no secret that exercise helps strengthen thin, weak bones, even in people with osteoporosis. Explaining why it works can be a bit of a challenge — unless you understand the five principles that we at Better Bones use as the basis for our program.

#1 Bones and muscles form interconnected muscle–bone units

The very idea that exercise can help strengthen bones makes no sense at all unless you understand the close relationship between the bones and the muscles. They work together in supporting and moving the body, but can’t do much separately. Remove the bones from an arm or leg, and the muscles have nothing to attach to; eliminate the muscles, and the bones hang uselessly, unable to move or function.

Once you view them as a unit, it makes intuitive sense that lean muscle mass predicts bone mass (rather than total body weight). It also makes sense that chronically strong muscles are associated with strong bones, and by the same token, chronically weak muscles are associated with weaker bones. Both bone mass and muscle mass are lost with aging, but we can do a great deal to limit this loss through modifications of lifestyle (including exercise) and nutrition.

#2 Bone adapts to the load put upon it 

In all her wisdom, Mother Nature is economical. Energy and resources are spent to build the amount of bone and muscle that an individual’s activity patterns shows they need. That is, bone acclimates itself to the load put upon it: More activity tells the body that more muscle and bone are required; less causes muscle and bone to decrease.  Intermittent spurts of higher-impact loading, in particular, stimulate the strengthening of bone.

#3 The loading of bone has a site-specific effect

You don’t, unfortunately, get a full-body effect for a partial-body workout. The muscles pulling on the tendons that in turn pull on the bone sends an important signal to build bone strength, but that signal is localized — meaning, if we exercise in such a way as to work the hip and  leg, such as in jumping or hopping, we will build bone strength in the hip and leg, but not necessarily in the arms, wrists, or upper skeleton. Similarly, a right-handed tennis player will have stronger bone in their right arm, which moves more, than in their left arm. So if overall bone strength is your goal, you need to exercise in ways that work all (or most) of the major muscle groups. 


#4 Rest is required to build bone (and muscle)

Building bone is not all about working the muscles, though. Rest is very important for both the bone and muscle renewal process. We show the bone and muscle we need them to be stronger by the stress we put upon them during our activities, but it is in the recovery period, when we’re at rest, that bone and muscle renewal take place.

#5 The impact of exercise on bone strength follows a direct dose-response relationship 

Even small amounts of exercise benefit bones, but the bone-strengthening benefits of exercise are increased with a higher dose of exercise. The more frequent your exercise sessions are, and greater the intensity per session, the greater the strength you’ll impart to your bones.

#6 Age is no barrier to bone strength

There are plenty of people in their later years who are worried about osteoporosis. They sometimes say, “I wish I’d started exercising when I was still young enough!” But if I were to add a sixth principle to this list, it would be this: It is never too late to build bone strength with exercise. Studies have shown that even wheelchair-bound 90-year-old seniors can build bone with weight bearing exercises, and even a little bit helps a lot. 

 

Hear Dr. Brown talk in her own words about these bone building exercise principles

 

 

Dr. Susan E. Brown

So how did our client Cindi build so much bone?

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Since we first published our blog on building bone density with serious weight lifting, we’ve been bombarded with questions. In particular, everyone wants to know how our client Cindi managed to increase her bone density in the neck of the hip by over 20% and the spine by over 5%. I promised I’d give you the details on her story, so here it is.

Point # 1: Cindi’s Background

  • Cindi was a lifelong exerciser who paid good attention to her diet and lived a very healthy lifestyle.
  • Even before coming to work with us at the Center for Better Bones she had a serious, long term exercise program.
  • For decades, she enjoyed a regular exercise program combining muscle conditioning exercises, cardio, and yoga.
  • Cindi also used low dose hormone replacement therapy since menopause.
  • When she came to see us in April 2016, she had a low vitamin D level at 29ng/ml. Her weight was 116 lbs.
  • With this exercise program, lifestyle, and estrogen, her bone density tests showed generalized stability from ages 55 to 62.
  • Then, between the ages of 62 and 65, she lost a significant amount of bone. She lost 3.2% bone density in the spine, 18% in the neck of the hip, and 14% in the total hip.
  • Not believing that she could have lost this much bone, Cindi herself paid for a second bone density test two months later, to find out that she indeed had lost that much bone density.
  • So at 65, she was diagnosed with osteoporosis of the neck of the hip (T-2.9), osteoporosis of the total hip (T-2.6), and osteoporosis of the spine (T-2.6). After doing the complete Better Bones, Better Body program and doing her serious strength training for 1.5 years, she no longer had osteoporosis, her T scores were all in the osteopenic range.
  • It is also worth mentioning that Cindi had a great deal of support from her family physician who was willing to order all the appropriate tests to look for any hidden causes of this rapid bone loss.

Cindi’s bone density loss between the age of 62 and 65

SpineNeck of HipTotal Hip
-3.2%-18%-14%

Point #2: Cindi’s decision for building bone density

Cindi had regular bone density test and the bone was quite stable but at age 65, she suddenly found that she lost a significant amount of bone.

Being quite attentive to her health, Cindi was alarmed at this accelerated bone loss. She became further concerned when her endocrinologist told her the solution was, “ to gain 10 pounds and go on a bone drug.” Cindi really didn’t see herself either doing a bone drug or gaining 10lbs, so she set out to learn all she could about how to naturally build back her bone density. One of the first things she did was to make an appointment with D. Brown at the Center for Better Bones.

“I went to the Center for Better Bones because they offered a comprehensive program. They evaluated my diet and prescribed a vitamin and mineral regime. My vitamin D and calcium was tested twice a year to ensure I maintained the correct levels. I learned about and adopted an alkaline diet. Dr. Brown offered a well researched plan, education and a helpful and supportive staff.” — Cindi

  • Cindi also discussed her rapid bone loss with her son, a professional CrossFit and Olympic weight trainer, who suggested she began serious weight lifting.
  • While she was intrigued by her son’s suggestion, she was concerned that she might injure herself. Doing online research Cindi discovered the Australian Bone Clinic where older women were gaining significant bone density lifting heavy weights with any injury.
  • Assured that she could develop a safe weightlifting program, she began her “technical weight lifting program” soliciting the supervision of her son and other trainers at her local gym.

A year and a half after beginning her weight lifting program, Cindi spoke with Lisa Weiss, one of the Australian Bone Clinic’s founders. Lisa told Cindi they recommend people only do the such weight lifting programs under their supervision. Cindi had read in their Women’s LIFTMOR Trial Study that they perform 5-7 different tests to assess safety while training their clients. Lisa Weiss said without such supervision and testing she would wonder about the possible development of horizontal fractures. Cindi thought that was referencing the spine. She did not know what that meant and feels it is important to find out about that and the tests. Cindy did her weight training program without thoroughly understanding this information. She feels it is important to know more about this to feel a “technical weight lifting program” is actually safe for women with compromised bone density.

While not fully understanding the reference to “horizontal fractures”, Cindi took from the conversation an appreciation of  the  importance of  knowing how and what to test for safety as one develops their weight lifting program. Cindi did her weight training program without benefits of specific testing for safety and looking back she sees the importance of such individualized testing so women can be assured their “technical weight lifting program” is safe given their compromised bone density.

Point # 3: Cindi’s whole body approach

  • First let’s be clear, Cindi did not only do the serious weight lifting, but Cindi carried out every part of the Better Bones Program in a very disciplined fashion.
  • For example, she followed our nutritional supplement suggestions, alkalized her body chemistry, reduced stress, meditated, and she was committed to maintaining a positive perspective on her challenge.
  • While undertaking her new technical weight lifting program she also continued her former exercise program.
  • The characteristics her technical weightlifting program were that it was progressive, meaning she started with low weights and worked up over time to higher weights.
  • Another characteristic was that she spent a great deal of time and effort learning the proper form of each lift so she would not get injured. All in all, she was very disciplined, and consistent with her program, and she had proper supervision with her weightlifting program. 

So what exactly was Cindi’s serious weightlifting program which she did diligently for 1.5 years before the follow up bone density?

ExerciseFrequencyReps/ SetsStarting WeightWeight worked up to
Romanian Deadlift1x/ week10 reps, 3 sets45lbs110lbs- 5 reps/5 sets

135lbs-1 rep maximum

Conventional Deadlift1x/week10 reps, 3 sets- working up in weight each set45 lbs110lbs, 5 reps/5 sets

135lbs, 1 rep maximum

Back Squat1x/week10 reps, 3 sets45lbs95lbs- 5 reps/5 sets

 

Farmer Carry2-3x/ week0.1-0.2 mile20lbs in each hand30lbs in each hand
Suitcase Carry2-3x/week0.1-0.2 mile20lbs30lbs
Back Extension3x/week15 reps0lbs15lbs/15 reps/1 set

It is important to note that this is Cindi’s weight training program, designed for her particular needs. Each client should develop their own program with a trainer that is specific to them.

Romanian Deadlift:

 

Conventional Deadlift:

Back Squat:

Farmer Carry:

Suitcase Carry:

Back Extension:

Want to know more about these exercises? Join our Better Bones Exercise Evolution and see these described in detail! (Available Thursday 2/14)

What do you think? Interested in adding serious weight lifting to your program for building bone density? The first step is to talk to your health care practitioner to understand what kind of exercise and the amount is right for you. When choosing an exercise program or exercise class, find one the caters to women with bone density issues taught by a qualified trainer.

I want to know how you do so please let me know your progress with weight lifting.  Let us know what you are doing to build strong bones in the gym in the comments below!

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Dr. Susan E. Brown

Better Bones Exercise for Osteoporosis Program

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Get ready to get your heart rate up and experience a energetic and high impact yoga workout.  Gina will guide your through an interval yoga program using the HIIT concepts.  You will experience strength training with cardio efforts intertwined with stretch and rest. You can do this workout in less than 30 minutes and all you will need is a yoga mat.  In this video you will be conditioning the large muscle groups like the legs, glutes, core, and so much more. Even if yoga is not your thing, give this workout a try and I assure you, your heart will be pumping and you will feel invigorated and ready to take on your day. 


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Exercise Builds Bone


Our time-tested Better Bones, Better Body Program® works!  It works because we provide the body with everything it needs to build and maintain bone strength.  The Alkaline for Life Diet® giving pH balance, targeted nutritional supplementation, endocrine balancing and stress reduction, and digestion enhancements are all important building blocks of our successful program.

But no part or program is more important than exercise.

The health and strength of our skeleton is directly related to our level and type of physical activity.  Each bone grows stronger or weaker depending on the load put upon.  Even low-intensity regular physical activity promotes bone strength and reduces fracture risk.  At the other end of the scale, intense strength training builds bone density more than any drug therapy ever did.  Everyone can enjoy the bone building benefits of exercise and everyone can develop a personal bone-building exercise program suited to their body type, personal needs and desires.  With our new Exercise Evolution I have set out to bring you safe bone-building exercises that are accessible, fun, motivating and best of all…able to be done from the luxury of your own home!

Exercise indeed builds better bones and a better body and there is no better time than right now to take charge of your own personal life-supporting exercise.

Dr. Susan Brown, PhDDirector of the Center for Better Bones

What’s Included in Your Exercise Evolution Membership?


  • Bone-Building Exercise Videos

    Gain unlimited access to our growing Exercise Evolution archive of videos available on demand.  A new exercise video with Gina Galli RYT is available every Month for you to workout at your convenience.

  • Exercise & Diet Tracking Portal

    You will have access to this desktop and smartphone application which connects with your FitBit to log your exercise. You can also track and monitor your diet and pH readings to ensure you are getting the results you want!

  • Dr. Susan Brown’s Learning Library

    Access to supplemental educational videos on bone health & overall well-being from the Director of the Center for Better Bones, Dr. Susan Brown, PhD.

  • Community Sharing Page

    Get answers to your specific exercise and diet questions and support of our exercise experts as well as other Exercise Evolution members through our community sharing page. 

  • Exercise Evolution Digital Manual

    Get instant access to the Exercise Evolution Basics Digital Manual with videos: Your “how-to” series to get you started exercising safely for strong bones.

ayurveda for osteoporosis
Dr. Susan E. Brown

Ayurveda for osteoporosis — harnessing the body’s ancient wisdom

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Exercise for building bone is a major focus for us in 2019, and one piece of information I would like to share with you is why it’s so beneficial to bone when you exercise according to your mind-body constitution — something the ancient Indian science Ayurveda describes as your dosha.  Continue reading to learn more about Ayurveda for osteoporosis.

While this ancient science is extremely complex and reveals subtleties about the human body that modern science has yet to imagine, it’s clear that each of us is born with a unique body-mind-spirit constitution. We all have certain strengths and weaknesses, which can be seen as distinct patterns of energy within us. Ayurveda proposes that we can maximize our strengths and minimize our weaknesses. Ayurveda also appreciates that certain constitutions or body types are more likely to be challenged by disorders such as osteoporosis.

Understanding our elemental forces

Many ancient traditions regard four or five basic elemental forces—fire, water, earth, and air, and in some traditions, wood—as essential building blocks of all existence. Ayurveda includes “ether” (space) and combines all the elements into three different doshas: vata, pitta, and kapha dosha. 

In simplistic terms, vata dosha (the energies of “ether” or space and air) is a cold, dry energy that governs body actions such as the beating of the heart and muscle movements. Pitta dosha (the energies of fire and water) is a hot energy governing metabolism, digestion, absorption, assimilation and body temperature. Kapha dosha (the energy of earth and water) is an energy which forms the solid structure of the body. Kapha is the source for lubricating the body, keeping the joints flexible and the skin moist, and maintaining immunity. 

Ayurveda holds that we each have a certain combination at birth, and maintaining this combination brings good health; however, the dosha energetic forces can change quickly and are prone to moving out of balance as we respond to life stressors. Accumulated dosha imbalance leads to the development of illness and certain disorders are linked with certain types of imbalance. 

Ayurveda for osteoporosis

Here’s where osteoporosis enters the picture. With stress, and with age itself, the vata element increases leading to coldness, dryness, frailty, and weak bones and teeth.  Osteoporosis, from the Ayurvedic perspective, is associated with excesses and imbalances in the vata dosha, just as acid reflux or skin rashes are found with excessive pitta energy, or mucus congestion linked to excessive kapha.

My top Ayurvedic tips for regaining bone health

The Ayurvedic approach to preventing and treating osteoporosis involves restoring balance to all three doshas, and most particularly pacifying vata energy. Due to the stressful and fast pace of our modern life, everyone has some degree of vata imbalance and can benefit from these simple lifestyle modifications aimed at reducing excessive vata while balancing all three doshas.

1. Develop regularity in your life.
– Get to bed by 10 and rise at 6.
– Establish regular eating times.
– Make the midday meal your largest (when pitta is strong) and eat a light dinner.
– Adhere to a daily routine; the body likes regularity.

2. Meditate on a regular schedule.
– The best meditation time is upon rising and before the evening meal.
– 15 to 20 minutes in the morning and in the evening is sufficient.

3. Consume nourishing and easy-to-digest hot and cooked food.
– Avoid cold foods for the most part, particularly when the weather is cold.
– Avoid excesses of sugar, caffeine, and alcohol.
– Use high-quality fats such as ghee, coconut and olive oil, and butters or spreads made from nuts or seeds.
– Consume more nuts and seeds (particularly sesame seeds). Other beneficial foods include basmati rice, avocados, fermented dairy, and small amounts of raw sugar and honey.

4. Reduce stress and seek peace of mind.
– Avoid comparing yourself to others.
– Develop an optimistic attitude; see the glass as half-full.
– Become aware of your thought patterns and focus on how you want to look and feel rather than focusing on what you do not want.

Exercise according to your dosha body type

Putting all this information together, here are some ways to harness Ayurveda for osteoporosis in how you exercise for bone health.

Ayurveda recognizes vata types as being smaller-boned, thinner, prone to indigestion and tiring easily, and possibly having a physically weaker constitution. These are the very people I often see in my practice with concerns about bone loss. For vata types, Ayurveda recommends exercises that bring a calming energy into the body — like yoga, tai chi and qi gong. It’s no coincidence that these exercises are also very beneficial for osteoporosis, along with moderate strength and aerobic training as tolerated.

Ayurveda sees kapha types as larger in bone and body size. Kaphas are sturdy, but can be lethargic, and thus need intense, rigorous exercise to energize and invigorate themselves. 

Fiery pitta types, on the other hand, have average body and bone size and are natural athletes with strong stamina. They enjoy and benefit from intense, challenging exercises, but also should cool down their fire with yoga and mindful exercises. 

Think about your own exercise goals — how will do they match your dosha?

Join me on a journey to rediscover the body’s ancient wisdom

I personally find it fascinating to see how other cultures perceive the world and what they understand about the nature of human health. If you’re a student of Ayurveda, and have used Ayurveda for osteoporosis, please share your experiences. If this ancient health science intrigues you, think about joining us at our next Love Your Bones, Love Your Life Retreat to be held at an Ayurvedic retreat center in northern Pennsylvania, May 2-5, 2019.

Exercise for Your Dosha

 

 

Sarcopenia Risk
Dr. Susan E. Brown

Muscle loss with aging — are you at risk for sarcopenia?

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Have you noticed jars are harder to open, walking upstairs is more tiring and you can’t throw a baseball as far as you used to? These are signs of normal age-related muscle loss.

After age 30, most people lose as much as 3–8% muscle mass per decade, and this loss accelerates around age 50 for both men and women. By age 80, most women have lost, on average, 50% of the strength in their back muscles, while men have lost 64%. This normal rate of aging muscle loss is strikingly similar to normal aging bone loss, which can cost up to half of the peak bone mass.

And just as with bone, excessive loss of muscle mass and strength is not a normal aspect of aging. Excessive muscle wasting is a pathological disorder known as sarcopenia, a condition that leads to physical disability, poor quality of life, and even death.

The muscle loss cascade of sarcopenia

One 84-year-old woman came to me with substantial kyphosis (bending of the upper spine) and height loss. Yet when we looked at her bone density, she didn’t have any spinal fractures, which is the usual cause of kyphosis. Instead, she had extreme sarcopenia and it was her lack of muscle strength — not bone weakness — that disabled her to the extent that she could no longer rise from a bed or even a chair unaided. The flowchart below shows how this can happen.

The risk of disability is 1.5 to 4.6 times higher in older persons with sarcopenia than in older persons with normal muscle; declining muscle mass is also associated with metabolic abnormalities, obesity, diabetes, hormone decline, reduced cognitive functioning, and cardiovascular disease.

Are you at risk for sarcopenia?

Many factors contribute to the eventual development of sarcopenia manifested as an excessive loss of muscles mass, muscle strength and muscle function, as the illustration below shows. As you might expect given the bone–muscle connection, it doubles the risk of osteoporotic fracture.

Some authorities estimate that up to 30% of the US population over 60, and 50% of those over 80, could be classified as sarcopenic due to an excessive loss of muscle mass, strength and function. To identify sarcopenia, doctors often use a simple screening questionnaire.

How to maintain — and build — muscle as you age

While sarcopenia indicates an extreme of muscle loss, I bet most of us have experienced a lesser degree of declining muscle strength and wondered what to do about it. Indeed, just as with bone, there’s a great deal you can do to maintain and rebuild muscle as you age — and doing so is a great way to support your bone health too!

Depicted on the illustration below are steps you can take to preserve muscle mass and strength as you age — steps that are very similar to the Better Bones, Better Body® Program for maintaining and building bone strength.  Think about what lifestyle, physical activity and nutritional modifications you could make to build muscle mass. Just like bone, our muscles were designed to last a lifetime, but we need to do our part.

Depicted on the illustration below are steps you can take to preserve muscle mass and strength as you age, including steps such as getting all 20 key bone-building nutrients. Take heart — and take action. My Better Bones, Better Body Program and new “Exercise Evolution” channel are two great places to start. 

Let us know in the comments below how you maintain and build muscle in your daily life!

 

strengthen your wrists
Dr. Susan E. Brown

Why you should strengthen your wrists

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Wrist fractures are “sentinels” of bone fracture risk; in fact, having a low-trauma wrist fracture may be more important than a diagnosis of osteoporosis in determining risk for subsequent hip fracture.

It makes perfect sense — when we fall, the reflex to throw out our hands and take the impact on the wrists protects our hips from being injured far more seriously. As we get older, that reflex isn’t as quick, and thus we have greater frequency of hip rather than wrist fractures.

So how do you know if your wrists are strong enough to stop your fall? And if they’re not — what do you do about it?

Get a grip on your grip strength

To start, figure out how strong your grip is. Grip strength is a marker of overall muscle strength. As studies have shown, muscle weakness as measured by grip strength is a predictor of unhealthy outcomes including cardiovascular and metabolic diseases, disability and even early mortality (Correia Martins et al., 2018).

One sign that your grip may be getting weaker is if you notice that opening jars is getting a bit harder. My favorite tool for measuring grip strength is a simple hand held-dynamometer. Simply squeeze the handle of this device as strongly as you can to measure your grip strength. Grip strength norms by age have been well established, so it is easy to see how yours compare (Massey-Westropp et al., 2011).

Exercise to strengthen your wrists

If your wrists aren’t as strong as you’d like, there’s certainly much you can do to change that. But first, understand that dominance has a profound effect on strength of the wrist and the bone mineral density of the wrist and forearm.

You might want to jot down the grip strength difference between your dominant and non-dominant arm and then exercise and non-dominant arm specifically to bring it up to the same strength level as a dominant arm. After all, we might have to stop a fall with either wrist, so we want to have both wrists as strong as possible.

Here are some basic exercise principles to strengthen your wrists:

  • The impact of exercise is “site-specific” — that is, if you strengthen the muscles around the wrist, you will strengthen the wrist. That means that you need to load, and thus strengthen, all the muscles around the wrist and arm.
  • Simply doing one type of exercise, such as a wrist curl, isn’t going to cut it. It only exercises one set of muscles, so you need to include wrist exercises that involve a full range of motion of the hand and wrist. See our exercise graphic below for ideas!
  • As with all exercises, start slow and build up. You do not want to overdo it.

Maintain a healthy skeleton

Of course, your wrists don’t exist by themselves, floating in midair — and anything you do to support your overall bone and body health will certainly help your wrists too. So in addition to wrist-strengthening exercises, you can also do full-body workouts to strengthen your muscles and bones as well as focus on getting the full suite of bone-building nutrients and alkaline diet that support better bones and a better body.

Your wrists are the first line of defense against a fall, so why not give them a helping hand?

References

Correia Martins A, Moreira J, Silva C, et al. Multifactorial Screening Tool for Determining Fall Risk in Community-Dwelling Adults Aged 50 Years or Over (FallSensing): Protocol for a Prospective Study. JMIR Res Protoc. 2018 Aug; 7(8): e10304. Published online 2018 Aug 2. doi:  10.2196/10304

Massy-Westropp NM, Gill TK, Taylor AW, Bohannon RW, Hill CL. Hand Grip Strength: age and gender stratified normative data in a population-based study. BMC Res Notes. 2011; 4: 127. Published online 2011 Apr 14. doi:  10.1186/1756-0500-4-127

 

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easy ways to start osteogenic loading
Dr. Susan E. Brown

Osteogenic loading — a key to reversing osteoporosis

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Bone responds to certain levels of physical strain in a really interesting way — it gets stronger.

Any type of strain on bone that applies enough impact or compressive pressure to stimulate new bone growth is called “osteogenic loading.” Our wise body constantly monitors strain, and in the brief moment of impact, when strain is enough to slightly stretch, bend or compress the bone matrix, this impact sends a warning message: high loads are coming, and the bones should grow stronger to carry them.  This signal tells the bone-building osteoblast cells to increase their minerals uptake and build bone —which is why we emphasize the importance of having those minerals in your diet or using a well-constructed multivitamin like our Better Bones Builder.

Osteogenic loading basics

Even when just standing upright, the simple act of resisting gravity puts a load on bone, but this is a one that our body is well adapted to. To build stronger bones, a much higher load — that is, greater compression and bending — is needed to encourage our bodies to spend the necessary energy and resources.

The load put on bone can be measured in terms of multiples of body weight. The higher the load, the better able the activity is to stimulate bone growth. Calculations of multiples of body weight look like this for common physical activities:

Osteogenic Loading

Learn which activities load your bones the most.

Swimming: 0 (Your load is actually lessened in water.)
Standing: 1
Brisk walking : 1–2
Running/jogging:  3–4
Power jumping: 4+
Resistance, strength training:  4 to 10 (Depending on impact.)

Safe impact training programs for osteogenic loading

Most physical activity loads bone to a degree, but for strong osteogenic stimulation, the load needs to reach around 4 times body weight.

At these higher multiples of body weight, however, safety becomes an issue.  Any bone will succumb to fracture under loads that exceed its capacity. When training with high multiples of body weight, professional guidance is mandatory.

Nonetheless, many safe impact training programs have been shown to build bone, including those used at the Australian Bone Clinic and in hopping programs.

Simple ways to enhance your osteogenic loading

  • If you have a desk job, stand frequently and walk, or stomp/skip around every hour.
  • Walk more, walk faster, jog if you can.
  • Practice stepping down stairs with a thud, or walk downhill.
  • Do 100 heel drops.
  • Turn up the music and kick up your heels in dance.
  • Practice jump rope or 1- or 2-legged hopping or jumping, if your knees permit.
  • Begin a strength training program, even in a moderate one. Many studies report a gain of both bone and muscle mass with regular resistance training done just twice a week.

I have seen uncounted clients gain significant bone density doing our full Better Bones, Better Program while amplifying our exercise component with serious strength training.  We are now documenting a variety of successful exercise programs and will be detailing them to you in this weekly blog and on our new Exercise Evolution Channel. Not everyone is suited to lifting heavy weights, but everyone can and should work to increase muscle mass and bone strength.

Become a Patron!

References

Bone Health and Osteoporosis: A Report of the Surgeon General.  Rockville, MD: U.S. Department of Health and Human Services, 2004.

Jaquish J, Singh R, Hynote E, Conviser J. Osteogenic Loading: A New Modality to Facilitate Bone density Development. A: Jaquish Industrial Research, LLC, 2017.

Westcott W. Resistance training is medicine: effects of strength training on health. Current Sports Medicine Reports July/August 2012;11:4P209216.

high-intensity exercise for bone
Dr. Susan E. Brown

High-intensity resistance training for bone offers amazing results

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One thing we know about bone is that it responds to increased weight load by getting stronger. So the recent findings of an Australian bone clinic that studied women doing high-intensity weight lifting really shouldn’t surprise us. But just look at these results!

What happens when older women weight lift?

The clinic studied 101 postmenopausal women with a T score below –1; 44 were classified as having osteoporosis and the remaining 57 were considered to have osteopenia. A bit more than one-fourth of them had already had a fracture.

The women were divided into two groups, experimental and control; they exercised twice a week for at least 8 and up to 12 months, but the kinds of exercise they did were different. For the control group, a low-intensity, home-based exercise regimen that emphasized balance and mobility, but not heavy weight loading, was used. They did lunges, calf raises, and stretches with no more than 3-kg weights in their hands — common types of exercises recommended for older women seeking to maintain fitness and bone strength.

The experimental group, on the other hand, underwent supervised, 30-minute sessions of high-intensity resistance training at 80–85% of the “1 rep max” weight — that being the weight they could only lift only once with maximum effort. The exercises included deadlift, overhead press, and back squat along with jumping chin-ups with drop landings. These types of exercises are not usually recommended for older women, and prior studies of weight-bearing exercise for bone mass improvement used moderate loads rather than high loads, as in this study.

The bigger the load, the stronger the bone

The study’s results were striking:

• The high-intensity group gained an average of 2.9% BMD in the lumbar spine, while the control group lost an average of 1.2%.
• The high-intensity group gained on average 0.3% BMD in the femoral neck, while the control group lost on average 1.9%.
• The high-intensity group gained 13.6% femoral neck cortical thickness, while the control group lost 6.3%.

Some of the individual outcomes were truly amazing. One 59-year-old-woman who trained for a total of 12 months saw an increase of 10.5% in the hip and 8.8% in the lumbar spine!

I just heard about even more record-breaking gains from “C.F.” — one of our clients.  Motivated to find a way to reverse her ongoing bone loss, C.F. — a 67-year-old woman — combined our Better Bones, Better Body Program with supervised high-intensity strength training.  In just 1.5 years she gained a whopping 21.5% in the neck of the hip, 10% the total hip and 5.6% in spine — moving her totally out of the osteoporosis category! Her doctor was so astonished she called me to ask what we were doing. This is a bone density gain that is unprecedented and we will soon be make available to you the details of our client’s full program.

The benefits of high-load weight lifting for older women

Given that we’ve known for years that bone responds to the load placed on it, why hasn’t high-load weight lifting ever been looked at before in women?

As the authors of this study point out, it’s a common misconception that women with low bone mass risk developing spinal fractures if they use heavy weights or free-weight exercises — but this study shows that isn’t true. Only one woman in the study had any sort of injury — a mild muscle strain in her lower back that probably occurred from an error in technique (which is very important in free-weight lifting) rather than the amount of weight she used. Keep in mind, these women were carefully taught the proper form for lifting and highly supervised. Should you try a high-intensity resistance program yourself, be sure to work with a qualified training.

What all this tells us is that even in women who are actively losing bone, high-intensity weight-bearing exercise offers more benefits in reversing the trend than low- or moderate-load weight-bearing exercise.

At the Center for Better Bones, we view exercise as an important part of a natural approach to building and strengthening bone. Learn about our  Better Bones, Better Body Program to find out how you can start building serious bone naturally.

Reference

Watson SL, Weeks BK, Weis LJ, et al. 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; 33(2): 211–220. DOI: 10.1002/jbmr.3284