One of the most common challenges I face as a Pilates instructor and physical therapist is osteoporosis. Repeatedly, I find that postmenopausal women arrive to class, or to physical therapy, unaware of their bone density status. Some women don’t understand that a total hysterectomy qualifies as menopausal. There seems to be a large information gap regarding the disease and how to manage fracture risk. In the U.S., 30% of postmenopausal women have osteoporosis , yet many of these women do not understand the risk they are assuming, especially when exercising.
Up until about age 30, roughly, the skeletal system is in a constant state of renewal. The body lays down more bone than it breaks down, maintaining strong bones. After about age 30, that process starts to slow and eventually reverse, when osteogenesis (or bone growth) is outpaced by osteolysis (bone breakdown) resulting in more brittle bones. This process is demonstrated best by the length of time one would spend in a cast with a broken bone. Someone in their 20’s will likely heal a fracture quicker than an elderly person, due to their faster rate of bone renewal.
Estrogen plays a large part in bone density. Simply put, the drop in estrogen that occurs in menopause, can increase the rate of bone breakdown versus growth, leading to porous bones and potentially fractures. Often, the disease will progress unnoticed, until fracture occurs (often in hip or vertebrae) or loss of height is observed at a routine doctor’s visit.
Bone density tests (DEXA scan) are recommended post menopausally to help determine fracture risk, however, this alone, often does not paint the full picture of risk. The FRAX assessment may help add to the overall risk picture. So what are the keys to safe exercise as we age?
Weight bearing is essential
Exercise plays a huge role in maintaining bone density even as we age. However, not all exercise is treated equally. It is common knowledge that weight bearing exercise is beneficial, but not everyone is clear on what qualifies as weight bearing. And how much impact in weight bearing is appropriate? That probably depends on your risk, and a professional (PT) can help create a program that works uniquely for you, monitoring progression until maximum benefit is achieved with the least risk.
Nevertheless, weight bearing exercise is any exercise that occurs with the feet on the ground. Activites can range from walking to playing tennis (these two activities vary considerably in intensity and impact, and as such should be chosen with unique consideration).
Flexion can be frightening
If you have already suffered a fracture from low bone density, or have been diagnosed with osteoporosis, you might have been for instructed to avoid loaded flexion activities. But what does that mean? Well, essentially any flexion against gravity, as in sit-ups, or any activity lying on your back with your head, neck and chest curled up. In most cases, you will be fine with flexion activities such as a standing roll-down warm-up (since you are working with gravity and not using any weight).
Strength training is key
Bone growth occurs as an adaptation to stresses put on it. This is a good thing, and incidentally, the rationale for therapy after injury. It is just pure and simple physiology. Clearly the “stress” has to be of the appropriate intensity to maximize bone growth and not create more problems. This is where a qualified professional can be of great value! I love one-on-one personal trainers, and they should be very familiar with these precautions, but you need to be your own advocate and decline, if a trainer is trying to convince you that sit-ups are an appropriate exercise for someone with osteoporosis. After all, not all personal training certificates are created equal. My advice is to seek the advice of a physical therapist first and get started on a program before transitioning to a personal trainer if you are at risk.
Balance training for moderating fall risk
As a final category of exercise prescription, elderly especially, should consider some form of supervised balance training. The goal behind including this type of exercise is to help prevent falls. Regardless of how strong your bones are, a fall resulting in a broken hip is a game changer for the elderly and prevention is key. An example of a functional balance training activity is Tai Chi; however, any strength exercise can be modified to include a balance challenge that suits your particular needs.
My mantra where exercise is concerned, is that you must find a way to make exercise enjoyable to some degree, or it simply won’t get accomplished. So if you prefer to walk while listening to a podcast on a headset, then so be it. Find a group class if that is more motivating for you. I truly believe that exercise that is not enjoyable is unproductive.
How do I choose to workout? I don’t have low bone density (I am only 42 and not menopausal) but I do know about safe exercise. After years of trial and error, I have finally come to a happy place with my workouts. I now rely on a core set of mixed regimens. I run sometimes – moderately, mostly 3-4 miles maximum. I play tennis in the summer, sometimes racquetball in the winter. I will use the elliptical and glider equipment at the gym 40-60 minutes at a moderate pace. I will do yoga (sometimes at home by myself, sometimes in a class). I enjoy biking, or a TRX and kettle bell class once in a while. The bottom line is, I prefer to mix it up week to week.
My absolute go-to exercise, though, is Reformer Pilates. I discovered it 6 years ago, and it has become a lifetime exercise for me for a few reasons.
- it is adaptable to any level I may be at the moment and is still challenging
- It is infinitely variable, keeping it fresh and exciting every session
- It helps prevent bulky muscles and instead creates lean, strong muscles.
- It incorporates strength, balance and coordination
- It feeds my love of choreography, if I so choose
- It mimics functional movement, helping to strengthen for everyday activities and conversely to prevent ingrained, stubborn patterns
- Lastly, it can be invigorating and mindful all wrapped into one
I walk away from my classes feeling refreshed and clear headed, but also as if I had given my body a gift. I can’t say enough good things about it, as a form of exercise for any level of ability (or disability) and any age or population. I have found the combination of exercise that works for me, which clearly may not work for everyone, which is an important point. No one routine fits all. What are your workout routines and how do you stay safe in doing so?Share This: