Your Lovely Bones: Stay Strong with Exercise

In our last post you met author, fitness expert and Cleveland native Joan Pagano. This is the first in a regular series Joan will contribute the Judson Smart Living blog called “Aging Gracefully Takes Muscle.” Since May is National Osteoporosis Awareness Month, we’ve invited her to share strategies for safe exercises that can help prevent and treat Osteoporosis.

A woman who had been diagnosed with osteoporosis came to me for a fitness consultation.  She was so stymied by her diagnosis that she had stopped exercising for fear of causing further damage to her fragile bones.  The truth is that exercise is both a preventative and a treatment strategy for this condition, but the strategies are completely different.  There are many safe and effective exercises for osteoporosis, but you need to bone up on the guidelines.

Osteoporosis is the disease of “porous bones,” in which a lack of bone mineral, primarily calcium, causes the bones to deteriorate.  It is a silent disease that progresses slowly and painlessly over time without symptoms. As the bone gradually diminishes in strength and structure, it becomes increasingly fragile.  In fact, the first sign that you have it may be a bone fracture.

Bone loss is a natural part of aging, and while it’s true that osteoporosis becomes more common with age, it is not true that every older person gets it.  One half of women and two in five men will develop osteoporosis during their lifetime. According to the National Osteoporosis Foundation, 54 million Americans over the age of 50 are affected by osteoporosis or low bone mass (osteopenia) and at greater risk for fracture.

The ultimate goal of exercise for osteoporosis is to reduce the risk of falls and hip fractures.  Most fractures occur in the spine (about 40 percent) and can cause height loss, deformity and pain. A hip fracture has the most debilitating and life-altering effect.  About 25 percent of fractures occur in the hip, most often in the upper part of the thighbone (the femur), and in about half of these cases, the individuals are not able to walk unassisted again.  Fifteen percent of fractures occur at the wrist, often the result of an outstretched hand to break a fall.

Resistance is the key factor in both types of exercise that build bone: weight-bearing aerobic exercise and weight lifting.  In weight-bearing aerobic exercise, your muscles resist the force of gravity to keep you in an upright position.  In weight lifting, you apply resistance to the muscle to stimulate growth (hypertrophy) of the muscle fibers.  In both cases, the pull of the muscle on the bone causes a parallel hypertrophy to the bone.

Your exercise routine begins with knowing your own bone density score, as this determines whether you are in a prevention or treatment phase, and will inform your choice of exercises.

Your physician, medical professional or informed fitness trainer can explain this to you.

Lift, Stretch, Balance: Exercise to Prevent Osteoporosis

If your bones are strong (as determined by the bone density test), the goals of exercise are to maintain bone mass, offset or reduce bone loss, and improve balance and coordination to prevent falls.  Assuming your joints are also in good physical shape, exercise should maximize the load to the bones with a progressive (i.e. gradual intensification) program of weight bearing aerobic exercise and weight lifting, as well as stretching and balance training.  Aim for:

1) Weight-bearing aerobic exercise:

  • Include high-impact activities in which both feet are off the ground at the same time, as in running, jumping rope, and aerobic dance.

Simply jumping up and down is very effective, since for bone formation you need to maximize the ground reaction forces, the force with which your body hits the ground.

2) Strength training:

  • Do high intensity weight lifting, using the heaviest weight you can lift in good form for 8-12 repetitions, with the last few reps being challenging.
  • Perform 1-3 sets of each exercise.
  • To target bones throughout the body, do exercises for all the major muscle groups: Hips and thighs, back, chest, shoulders, arms and abdomen.
  • Remember: To protect your joints from injury, use good judgment regarding high impact aerobic exercise and high intensity weight lifting.  Be sure to increase the workload gradually.

3)  Stretching:

  • Stretch all major muscle groups several times a week.
  • Focus on stretches to open the chest and front of the shoulders, and elongate the spine.
  • Stretch the large muscles of the legs every day since tight muscles can affect your walking gait and increase your risk of falling.

4)  Balance, stability and coordination:

  • Become aware of which side of your body is stronger and more stable. Usually one leg is more dominant, either same side or opposite side of your dominant arm.
  • Perform exercises like stork stance, tandem stance, “tight rope walk” to balance both sides of the body.
  • Use tools like balance pads, disks, foam rollers and stability balls to improve core stability.

Lighten the Load: Exercise to Treat Osteoporosis

If you have been diagnosed with osteoporosis, modify the same types of prevention exercise as above using a lighter intensity to stimulate the bones without overloading them.

A well-rounded fitness training program includes exercises to protect and strengthen the weakened bones, improve posture and core stability, and prevent falls.

1)  Weight-bearing aerobic exercise:

  • Protect the spine: avoid impact exercise and any jarring or twisting movements.
  • Perform low-impact exercise, like walking, at a brisk pace.
  • Add intervals of faster walking, if appropriate.
  • Incorporate hills, steps, and inclines into your route to increase intensity.

2)  Strength training:

  • Reinforce vulnerable fracture sites: the hip, spine, and wrist.
  • Start with lighter weights and higher repetitions and progress to more challenging weights with lower repetitions.
  • Strengthen the large muscles of the upper legs (the glutes, quads and hamstrings) as well as the small muscles of the lower legs (calves and ankles) for stability.

3)  Stretching:

  • Avoid spinal flexion (forward bending) in all positions (e.g. standing or seated toe touches, the plough) which places additional forces on the weakened vertebrae.
  • Restore normal spinal curves, especially in the upper body. Vertebral fractures and poor posture can cause excessive rounding of the mid-back.
  • Lengthen the spine and stretch the torso to maintain height.
  • Avoid stretching or strengthening areas prone to fracture when pain is present.

4)  Balance, stability and coordination:

  • Always work in a safe area with something to hold onto.
  • Static Balance: Practice stork stance, tandem stance, etc.
  • Dynamic Balance: Do “tight rope walk” and practice weight shift, start/stop, change of direction.
  • Stability: use tools like balance pads, disks, foam rollers and stability balls to improve core stabilization.

Whether you are in a prevention or treatment phase, this variety of exercises offers a wide range of choices to keep your program motivating.  Of course, this information should not take the place of guidance from your own physician or other medical professional.  Always consult with your doctor before beginning an exercise program or becoming much more physically active.

Joan Pagano is the author of best-selling fitness books, an informational speaker on health and fitness topics, and the owner of Joan Pagano Fitness in New York City. Former trainer to Jacqueline Onassis and Caroline Kennedy, Joan has provided professional guidance to people at all levels of fitness since 1988, creating hundreds of training programs for individuals, groups, businesses, fitness facilities, schools, hospitals and retirement communities. Her mom Irene Pekoc was a long-time resident at Judson Manor.

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