What is your exercise action plan?

My simple Exercise Action Plan for Better Bones

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We know consistent exercise builds bone density and strength, which reduces fracture risk.  But we also know that being consistent at exercise can be challenging, especially when there are so many options and so little free time!

“Exercise Action Plan”

That’s why an “Exercise Action Plan” (EAP) is so helpful. A set plan boosts commitment and focus by giving you clear, concrete goals of where you want to go — and let me remind you to celebrate when you get there!

To help you create your own plan, here are what kinds of exercise build Better Bones, as well as my own EAP.

Walking or other aerobic exercise at least 30 minutes each day

Aerobic capacity is directly correlated with bone density and overall health. Any aerobic activity is fine. You may not realize that walking a mile in 15 minutes is aerobic.

My EAP

  • When there is no seasonal sport or outdoor work to be had, I walk. Often I use my weighted vest, stopping a few times to hop a bit. With a weight vest I build more strength, balance, and bone density with less time spent exercising. (See study references below.)
  • My goal is 10,000 steps a day and I reinforce this nightly by texting a friend who shares the same walking goal. I only make my 10,000 steps occasionally, but I’m OK with that.
  • Walk your dog twice a day, even if you don’t have one! Dance, hop, skip — all kinds of lower body impact activities can be aerobic and all fortify the hip.

Strength training, at least 30 minutes every other day

Any exercise that builds muscle builds bone. Even gentle, mindful exercises like yoga, tai chi, or Pilates strengthen muscle and bone.

My EAP

  • Personally, as a “time miser,” I like to use my whole body vibration machine 10 to 15 minutes a day (equivalent to more than 30 minutes in the gym), 3 times a week.
  • On alternate days I love to make time for 25 minutes of “Classical Stretch,” a video workout by Miranda Esmonde White, as seen on PBS for 17 years now. I gain strength, flexibility, and balance from this gentle, yet serious, workout.
  • I always try to include the simple back-extensor exercise proven by Mayo Clinic to build spinal bone and greatly reduce spinal fractures (even in those who have already had a spinal fracture).

Group exercise, at least once a week

There’s both fun and power in numbers. When we make exercise a social event, it’s often reinforced and more enjoyable. And, anything that makes us feel happier builds bone!

My EAP

  • I’ll be taking a yoga class, joining a gym workout, playing a friendly game of tennis, or walking with friends.

Take a moment to sit down, take a few deep breaths, and design your own EAP. I would love to hear about your plan.

 

References:
Cussler, E. C., S. B. Going, L. B. Houtkooper, V. A. Stanford, R. M. Blew, H. G. Flint-Wagner, L. L. Metcalfe, J. E. Choi, and T. G. Lohman. 2005. Exercise frequency and calcium intake predict 4-year bone changes in postmenopausal women. Osteoporosis International 16(12):2129–2141.

Greendale, G. A., S. H. Hirsch, and T. J. Hahn. 1993. The effect of a weighted vest on perceived health status and bone density in older persons. Quality of Life Research 2(2):141–152.

Jessup, J. V., C. Horne, R. K. Vishen, and D. Wheeler. 2003. Effects of exercise on bone density, balance, and self-efficacy in older women. Biological Research for Nursing 4(3):171–180.

Marques, E. A., J. Mota, and J. Carvalho. 2012. Exercise effects on bone mineral density in older adults: A meta-analysis of randomized controlled trials. Age 34(6):1493–1515.

Roghani, T., G. Torkaman, S. Movasseghe, M. Hedayati, B. Goosheh, and N. Bayat. 2013. Effects of short-term aerobic exercise with and without external loading on bone metabolism and balance in postmenopausal women with osteoporosis. Rheumatology International 33(2):291–298.

Snow, C. M., J. M. Shaw, K. M. Winters, and K. A. Witzke. 2000. Long-term exercise using weighted vests prevents hip bone loss in postmenopausal women. The Journals of Gerontology Series A, Biological Sciences and Medical Sciences 55(9):M489–M491.

 

 

Tips for keeping bone while losing weight

 

Do you know that as you lose unwanted weight you also lose wanted muscle and bone?

4 simple steps  to preserve both bone and muscle while losing unwanted body fat

  • Maintain an alkaline balance. Most weight loss programs are acid-forming and drain both bone and muscle of alkalinizing mineral compounds. To counter this, increase your intake of low- calorie alkalizing vegetables. Eating two cups of vegetables at each meal is a good start, as is drinking lemon water and using ginger or green tea and spicy foods to alkalize, detoxify and speed-up metabolism. Here are more ideas to alkalize.
  • Consume adequate protein. A higher protein diet can help preserve muscle while you lose weight. Your body needs protein and only excess protein is acid-forming. If you find that your first morning urine pH is below 6.5 then add more alkalizing foods and use alkalizing mineral compounds such as found in my Better Bones Builder multi-vitamin/mineral.
  • Use your muscles more. To lose fat and build muscle we must reduce caloric intake while showing the body we need new, stronger muscles. Increasing exercise signals the body to burn calories and ramp-up energy production to build new muscle. Do at least one half hour of aerobic and one half hour of strength training exercises every day.
  • Steady your intake of all bone building nutrients. Cutting calories reduces the intake of essential bone building nutrients. That’s why supplementation with adequate doses of all the 20 plus key bone nutrients is essential. Both precious bone minerals and living bone protein matrix will be lost right along with the unwanted weight unless the body is provided with full spectrum, adequate dose nutrient supplementation.

Remember, the human body is one y interwoven, indivisible unit and any change made in that unit is felt everywhere. With smart changes, you can lose weight along with have a better body and better bones. Good luck!

Tips for sticking with your summer exercise plan

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During summer’s warmer weather and longer days, it’s easier to get outside and get moving. Yet, how many of you have gotten off to a great start with your summer exercise plan, and then after a few days or weeks, feel frustrated or bored with your routine?

For example, I used to be very active in my vegetable garden in early spring, and then neglect that physical activity as the summer moved on. But over the years, I’ve discovered some ideas that really help me keep exercising part of my daily routine.

Here’s what keeps me moving

Do what you enjoy. No matter what activity you choose to do, make sure it’s something you like doing. If it’s not, you’re less likely to stick with it — and the benefits of exercise only last as long as you continue to do it. Don’t hesitate to try something different for inspiration!

Set reachable goals — both short- and long-term. Nothing keeps you motivated like success! By setting doable goals, you’ll stay motivated as you reach them — and look forward to the next ones. And don’t forget to celebrate when you do. I love to play golf, so I make a game of congratulating myself for good shots or new techniques I have mastered.

Make sure your plan fits your lifestyle. I don’t like to sit at my desk all day, so I jump up to do in-office errands frequently and hop on my whole body vibration machine to break up my work day.

Consider joining an exercise group. I know I need more aerobic exercise, but I am somewhat lazy about getting enough, so I joined a local biking group. Biking with others turn my exercise into a fun, community-building activity.

Plan for a rainy day. No matter how well you plan, there are always days when it’s harder to get going than others. Keep track of your most common obstacles, like weather or last-minute errands. You may spot some patterns and be able to figure out strategies to overcome them. Some of my favorite ways to avoid weather limitations are using a weighted vest around the house and using our Better Bones Exercise DVD. You can find many of my favorite bone-building exercise devices in our shop.

Remember all the different ways you’re supporting your bones, such as maintaining and/or increasing muscle and bone strength, as well as balance, flexibility, stability, and emotional well-being. Every day you exercise, you’re supporting your bones. Congratulations!

Finally, if you have special health concerns, it might be wise to check with your healthcare practitioner before beginning any exercise routine.

For other ways to help you stay motivated with exercise — and for many other opportunities to grow and change — I’ve developed my weekly Transformational Challenge. Here’s my fun challenge to power up your walking to get started.

How to improve your balance

Improve balance to reduce falls and fractures

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If you stop to think about it, maintaining our upright human posture on two legs is pretty tricky! Staying balanced requires instantaneous coordinated efforts from the brain, muscles, nervous system, ears, eyes and even the joints.

Most of us manage good balance effortlessly (for the most part) until we start to age. Then changes to our vision, ear canal issues, muscle loss and medication use can cause decline in our balance. Missteps come more easily, tripping is more common and recovery is more difficult.  You might have noticed that walking on uneven ground is a bit more challenging, or that you are less stable walking in the dark.

All these are signals reminding us to tone up our balance, and the good news is that everyone can improve balance dramatically with just a few simple, mindful exercises. Cultivating good balance should be central to everyone’s bone health program. In fact, studies repeatedly show that balance improvement — through tai chi, yoga, strength training or simple balance exercises — even reduces fracture rates.

In the video below, our fitness expert Gina Galli and I demonstrate a few simple activities that can help you regain excellent balance right now.  We also demonstrate a new Better Bones balance gadget that I really like — the OPTP Pro Balance Pad.  Hope you enjoy our demo!

Is pilates safe for women with osteoporosis?

Making Pilates safe for women with osteoporosis

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I often recommend Pilates to help women build strength, flexibility, balance, alignment and reaction time—all of which help prevent and control osteoporosis and avoid needless fractures. And just a quick glance at the medical literature shows how important the benefits of Pilates can be!

But that said, I’m often asked if Pilates is safe for those with osteoporosis. This is an important question because many classic Pilates movements involve spinal flexion (bending forward) which is not suited for those with weak spinal vertebrae. But this need not stop anyone from enjoying Pilates now that there exists what I call “osteo-modified Pilates,” such as the “Bone Smart Pilates” program by physical therapist Teresa Maldonado Marchok.

Below is a video chat with Teresa that includes her modified “hinge from the hip movement” which avoids the dangers of classic forward bends. You might want to take a few minutes to check out Teresa’s tips for making tips for making Pilates “bone smart”.

References:
Babayigit,  GI, et al., Integrating Pilates exercise into an exercise program for 65+ year – old women to reduce falls.  J Sports Sci Med, 2011, March; 10(1):105-111

Bird, ML, J Fell. Positive long – term effects of Pilates exercise on age – related decline in balance and strength and older, community – dwelling men and women.  J . Aging Phys Act. 2014, July 22(3):342-7.

Kucukcakir, N et al., Effects of Pilates exercises on pain, functional status and quality of life in women with osteoporosis.  J Body Move Ther. 2013, Apr; 17 (2):204-11.

 

Answers to your hopping questions

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One of the reasons this bone health community is so much fun for me is the participation of readers like you!  From adding insight on the topics to sharing your experiences to catching typos, I know I can count on you.  Hearing from you is truly rewarding!

My recent blog on hopping was a great example.  I received so many questions and comments from hoppers — as well as non-hoppers — that I thought I would share them:


Question:  What if I can’t hop?

Answer from Dr. Brown: First, as several readers emphasized, hopping is not for everybody!  If you would like an alternative to hopping, I suggest walking down the stairs. The weight you put on your legs as you step down actually increases bone.  Walk down the stairs consciously and perhaps with a little bit of extra thud.  Oh yes, heel drops are also a nice alternative to hopping. They can be done gently or with more force.

Special note:  See my video at the end of this blog for more about how to hop.


Question: What about a rebounder?

I’ve recently started using a rebounder. I bounce 300 times, and I do shift from leg to leg for part of the time. Hopping is too painful for me because I apparently don’t have much padding in my heels any longer and I have fibroids in my arches. Do you think bouncing on the rebounder will give me the same bone building benefits?  — Heather

Answer from Dr. Brown: A rebounder is a wonderful exercise to increase the circulation of blood and lymph, but it does not provide the impact that is necessary to seriously stimulate bone. In fact, the rebounder is meant to limit the impact and make the contact softer. It still great exercise to do though, so keep it up!

Question: Do you know if shoes can be worn while hopping?  — Jan-Marie

Grace, a reader, shares her experience: I have been doing some hopping and jumping and appreciate this regimen.  From my experience, I would suggest shoes SHOULD be worn for this.  When I started, I was having some heel issues, but eventually that went away.  I couldn’t overdo it at first, so my advice is start slowly and yes to shoes.

Answer from Dr. Brown:  Jan-Marie: yes, wearing sneakers can be helpful when hopping, especially when hopping on hard surfaces. As Grace shared, it may be essential for those with knee issues. Listen to your body.  Personally I always wear shoes when hopping.


Question: Would jumping rope 100 times each day have the same benefit? — Gail

Answer from Dr. Brown:  Jumping rope is a nice high impact exercise. While it is possible jump rope with just one leg, I don’t think it would be a safe option for most people due to the tripping hazard. If you enjoy jumping rope anyway you do it, continue to do so. As a high impact exercise, it too can provide benefits for bone health similar to hopping,

Thank you for all of your wonderful questions.  As you can see, we have a lot to learn from each other.  Other great places to take part in the conversation are my Better Bones Facebook and Twitter pages.  Please join us!

Watch Dr. Brown hop to strengthen bones

Bone strengthening options for seniors — power hopping

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Hopping 100 times a day isn’t for everyone, but I make it part of my routine and have recommended it for years for those who are able. So imagine how enthusiastic I was that British researchers have “powered-up” simple hopping for remarkable hip-building benefits — and this was among seniors with the average age of 70.

While modest gains were noted by the standard bone density tests, special 3D bone strength mapping revealed remarkable gains:

hopOnleg

These impressive results were obtained by 70-year-old men who would normally experience aging bone loss each year. The gains were from the impact with each hop delivering 2.7 to 3 times body weight ground resistance force (this indicates a significant enough hop to produce an impact of 2-3 times one’s body weight). While the study was done with men, I seen no reason why women would not achieve the same gains from brief single-legged daily hopping. Furthermore, I suspect one would obtain substantial benefits from one legged hopping even if they did not reach the high impact level used in this study.

Here’s their simple hopping program

• Over the course of several weeks, participants worked up to 50 single-legged hops a day

• They hopped on the same leg each day

• As they gained strength, the hops became multidirectional (10 up and down vertical, 10 to the front, 10 back, 10 each to right and left sides)

• At the year’s end hip cortical mass and trabecular density had increase substantially in both legs with greatest gains accrued in the hopping leg.

Granted, these powered-up hops are not for everyone, but if you are feeling fit and decide to dial up your daily hopping routine, keep in mind these guidelines from the study:

• Warm up before each session

• Begin with very low hops and jump higher as you can over the weeks

• Start with just a few one-legged hops a day and work up to 5 sets of 10 hops at a time

• Resting between sets at least 15 seconds, walking in place a bit

• Hold a chair for balance if necessary

• As you get stronger make the hops multidirectional. This multi-directionality loads and strengthens different parts of the hip

• As you gain strength, hop as high and as fast as you can

Let me know your thoughts and your plan to keep hopping one way or another.

 

References:

Alison, Sarah. The influence the Hip-Hop of exercise on 3D distribution of cortical and a trabecular bone across the proximal femur: The Hip-Hop Study. ASBMR Abstract 1013, 2014 Annual Meeting, Houston, Tx Sept. 12, 2104.

Allison, Sarah. High impact exercise increased femoral neck bone mineral density in older men: A randomized unilateral intervention. Bone, 53 (2013):321-328.

 

Yoga: Building bone mindfully

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iStock_000002038361XSmallIn yoga, you don’t lift weights or do high impact movements, but research is clear that yoga can help build and maintain bone strength. In a two-year study by Loren Fishman, MD, women with an average age of 68 who did yoga classes gained bone density while those who didn’t lost bone. I’ve seen the power of yoga in my clinical practice too! In many years of clinical practice, my only patient who didn’t lose any bone during her menopause transition was a yoga instructor who taught classes every day.

Why does yoga work so well for bone health?

Yoga directly strengthens the muscles of the core, back and around the hips. Whenever you strengthen muscle, you strengthen the bone attached to it.

Yoga stretches the muscles and also the bones. Stretching and bending of bone stimulates the signal for new bone formation, while reducing bone breakdown.

• Even though it might not appear so, yoga is weight-bearing. For example, standing on one leg puts all the weight of the body on one single leg, strengthening foot, leg and hip muscles.

Yoga increases circulation, bringing nutrient-rich blood and oxygen to all tissues of the body.

• The focus on deep gentle breathing in yoga helps alkalize the body and rids bone-eating acids from the body.

• Yoga is a “mindful” exercise which helps balance the neuro-endocrine system, reducing bone-depleting cortisol.

• Two-thirds of women doing yoga reported positive postural changes in some research and several studies suggest improvement even in established kyphosis.

Most exciting to me, when yoga involves even a short period of meditation you can expect altered gene expression within the body. With meditation, health-promoting beneficial genes are “turned-on” while clusters of “bad genes” that lead to disease are turned off. Exercise should be fun and many of us find yoga is. So if you haven’t done it already, why not give it a try?

 

References:

Bhasin, M. K., J. A. Dusek, B. H. Chang, M. G. Joseph, J. W. Denninger, G. L. Fricchione, H. Benson, and T. A. Libermann. 2013. Relaxation response induces temporal transcriptome changes in energy metabolism, insulin secretion and inflammatory pathways. PLoS One 8(5):e62817.

Fishman, L. M. 2009. Yoga for osteoporosis: A pilot study. Topics in Geriatric Rehabilitation 25(3):244–250.

Fishman, L. M. and E. Saltonstall. 2010. Yoga for osteoporosis: The complete guide. New York: Norton.

Greendale, G. A., A. McDivit, A. Carpenter, L. Seeger, and M. H. Huang. 2002. Yoga for women with hyperkyphosis: Results of a pilot study. American Journal of Public Health 92(10):1611–1614.

Kamei, T., Y. Toriumi, H. Kimura, S. Ohno, H. Kumano, and K. Kimura. 2000. Decrease in serum cortisol during yoga exercise is correlated with alpha wave activation. Perceptual and Motor Skills 90:1027–1032.

Phoosuwan, M., T. Kritpet, and P. Yuktanandana. 2009. The effects of weight bearing yoga training on the bone resorption markers of the postmenopausal women. Journal of the Medical Association of Thailand 92(Supplement 5):S102–S108.

West, J., C. Otte, K. Geher, J. Johnson, and D. C. Mohr. 2004. Effects of Hatha yoga and African dance on perceived stress, affect, and salivary cortisol. Annals of Behavioral Medicine 28(2):114-118.

Yu, H. C., Wu, T. C., Chen, M. R., Liu, S. W., Chen, J. H., and Lin, K. M. C. 2010. Mechanical stretching induces osteoprotegerin in differentiating C2C12 precursor cells through noncanonical Wnt pathways. Journal of Bone and Mineral Research 25(5):1128-1137.

 

Is sitting the new smoking? Dr. Brown adds to the conversation

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“Is sitting the new smoking?” This thought-provoking question has made the news a lot, thanks to the work done by Dr. James Levine of the Mayo Clinic.  He’s compared the negative health effects of sitting to those of smoking — including higher risks of cancers and heart disease — and described our modern lifestyle of desk jobs and too much screen time as “lethal.”

I couldn’t agree with Dr. Levine more about the human body’s need to move. And as an anthropologist and a bone researcher, I’m fascinated by new findings that show for millions of years our human ancestors had much high bone density than we do today.

AMNH_bbAnthropologists discovered this when comparing the bones joints modern humans and chimpanzees and from fossils of extinct humans.

It seems that our modern, lighter, human skeletons evolved only 12,000 years ago — a very short time ago, anthropologically speaking! Specifically, what anthropologists see happening is a thinning of the weight-bearing, inner spongy trabecular bone and a subsequent weakening of bone architecture. This has occurred with the advent of a more sedentary agrarian lifestyle.  What I say is that while we will never be as active as our foraging ancestors, there’s a lot we can do get in motion.

Here are some ideas for sitting less, moving more

  • Stand while you are on the phone
  • Use a desk you can stand at or even better — a treadmill desk
  • Take the stairs – at home, at the mall, everywhere
  • Set a timer to remind you to get up and move every hour
  • Walk over to a colleague’s desk, rather than emailing.  I do this, even though the office is very small!
  • Think of where you can shift your own patterns to include less sitting. For example, if you enjoy watching TV, can you watch it standing up? Or at least stand during commercials?
  • Commit yourself to walking at least 15 minutes twice a day and use weighted vest as appropriate
  • And my favorite — a golfing walk, skip the cart

For more ideas, read my article Exercise and bone health — use them or lose them or take a look in SHOP for helpful DVDs and exercise equipment to help get you started.

 

References:

Chirchir, H et al. Recent origin of low trabecular bone density in modern humans.   PNAS, early edition, 2015.  www.pnas.org/cgi/doi/10.1073/pnas.1411696112

Ryan, T and C.  Shaw. Gracility of modern Homo sapiens skeletons is a result of decreased bio mechanical loading.  edition, 2015.  www.pnas.org/cgi/doi/10.1073/pnas.1411696112

American Museum of Natural History blog:  http://www.amnh.org/explore/news-blogs/research-posts/new-research-lightweight-skeletons-of-modern-humans-evolved-recently

American Museum of Natural History press release: http://www.eurekalert.org/pub_releases/2014-12/amon-lso121914.php

Image copyright American Museum of Natural History

New Information About Strong Women and Strong Bones

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Young woman fooling around doing high kick ontop of the Kite Hill, San Francisco, California, USA.

Here’s an exciting twist to one of my favorite topics — how being a stronger woman makes for stronger bones.  As I’ve reported many times before, strong muscles make for strong bones.  But recently, Australian researchers took it one step further.

New study findings show that the strength of just one group of muscles was associated with an increase in bone mineral density body-wide

In this new study researchers looked at the relationship between hip flexor muscle strength and bone mineral density in 865 women who were between the ages of 27-97. Sure enough — the results were very clear about the connection between muscles and bone:

•    The stronger the hip flexor muscles, the greater the bone mineral density at all sites
•    For each increase in muscle strength there was an associated increase in bone mineral density
•    The spine, forearm and the hip were all positively associated with hip muscle strength

Further, researchers also found that the amount of lean body mass (that is, the quantity of muscle mass) was important — perhaps even more so than the quality of muscle mass. Those women with greater lean body mass had greater hip flexor muscle strength and denser bones.

What This Means for You

This study reminds us again that muscles and bones form a single, tightly correlated unit.  Muscle mass is directly related to bone density.

With age, we tend to lose both muscle mass and bone density. While this loss is a natural part of the lifecycle, our chosen lifestyle is a powerful player. That’s why I recommend that we all act to maintain our muscle mass with strength-building enjoyable exercises, and food-wise remember, the Alkaline For Life Eating Program which by its own action reduces loss of both muscle and bone. All of these elements are found in my Better Bones Programs.

 

Reference:
Pasco, Julie et al, (September 2014) Do Strong Women Have Strong Bones?  ASBMR 2014 Annual Meeting, abstract SU0442, Houston, Texas