398 | Exercise to Improve Bone Density for Osteoporosis | Research Proven Strategies

[00:00:05] Welcome to the Optimal Body Podcast. I'm Dr. Jen. And I'm Dr. Dom. And we are doctors of physical therapy, bringing you the body tips and physical therapy pearls of wisdom to help you begin to understand your body, relieve your pains and restrictions, and answer your questions. Along with expert guests, our goal of the Optimal Body Podcast is really to help you discover what optimal means within your own body. Let's dive in. Before hopping into this episode, a quick word from our favorite foot health sponsor,

[00:00:34] that is Vivo Barefoot Shoes. And the thing I'm really excited about in March, this is something I talk about all the time. Vivo has styles for everything, and they are unveiling a bunch of different styles from their women's footwear line. So these are lifestyle shoes. These aren't things you'd be necessarily exercising or running in, but they're things that you can wear out and look good while still getting the benefits from barefoot shoes. I talk about how all the time

[00:00:59] I am only wearing Vivo's dress shoes when I go to weddings. And I end up being the envy of the wedding by the end of it because I'm out there dancing, having an amazing time. My feet still feel great. And all the other guys are, what are those shoes? Because they look comfortable and my feet are absolutely burning right now, or they're getting blisters. And that's why I love Vivo. They have found ways to bring the benefits of barefoot shoes into dress and casual styles. And they're unveiling a

[00:01:27] bunch of new styles for women's casual and lifestyle wear this month. So if you go down to the link in the show notes, you can get 20% off your entire Vivo Barefoot order by using code OPTIMAL20 at checkout. Go check them out, get some lifestyle shoes and continue to treat your feet well today. Okay, today talking about osteoporosis, which we haven't done a podcast on yet, right? And yeah,

[00:01:51] I'm kind of surprised honestly when you brought that up. Because it's so prevalent, especially in women. You know, so many women as they age start to develop reduced bone density. There was something that you looked at that said in the UK this was over one-third of women and one-fifth of men will sustain what they called a fragility fracture in their lifetime, which essentially means a fracture that

[00:02:19] is likely due to lower bone density. You know, if you had had normal levels of bone density, the fall or whatever it was, wouldn't have fractured that bone, which is pretty significant. One-third of women, one-fifth of men. That's hugely significant. 20 to 30% of people. Yeah. Another study kind of looked at like globally about 200 million women have osteoporosis. And so

[00:02:43] this is a huge topic. This is a huge consideration. And even I did a webinar where we kind of talked about this and one person in particular on the webinar had been diagnosed with osteopenia, so not yet to osteoporosis. And her only recommendation from the doctor was to take calcium. And that was it. I was like, and there was nothing else said in that discussion. Which is so, that's so crazy. And to me, the old school, especially like if that was his only

[00:03:11] recommendation and not even saying like, let's see a different professional, like a physical therapist or somebody who like, there's so much research now showing things that can be done to either stop or reverse, you know, developing of osteoporosis. Well, and we also know, I mean, and this is me speaking as physical therapist, this is outside my scope of practice, but just taking calcium is not enough. So this is where working with an RD

[00:03:37] and actually understanding the absorption and how you get more calcium and other nutrients that need to be involved or what you could be lacking is so highly beneficial to also help improve this bone mineral density. But your body's not going to do anything with just excess calcium unless you're stimulating bone growth. Yeah. Like you need to be stimulating bone growth and taking calcium alone doesn't stimulate our

[00:04:03] osteoclasts and osteoblasts to start remodeling of the bone. So it's just like, again, stupid recommendation. Just taking extra calcium doesn't, isn't going to do anything for you unless you're doing some other things along with it. Like you said, nutrition wise and movement wise. Yeah. And I think it's really fascinating to look at, you know, these bone mineral density changes throughout the lifespan. So not just in older women, right? But especially for a female

[00:04:31] when estrogen levels are low and we can be looking at this again throughout the lifespan. So if you are on fertility treatments, you're taking fertility medication, you're taking endometriosis medication that can lower your estrogen levels. If you are postpartum and you are lactating, you are breastfeeding, that can lower your estrogen levels and especially postmenopause. So all of these different changes throughout a woman's life can lower our estrogen, which impacts our bone mineral density. And this is

[00:04:59] where we have to be even more cognizant and aware of what we're doing to aid within our body. Yeah. Those little babies are like little calcium leeches, little bone leeches. Just taking everything. Jeepers. Now I need to pause a minute and just say that today is day one of Strong Healthy Joins. And I'm so excited for this group of people that we have going in. And I just need you to hear this one feedback that we received last year. I need you to hear this. Maybe you'll resonate.

[00:05:28] I just turned 53 and in menopause and getting back into routine weight bearing exercises just hurt after and didn't stay consistent. I thought it was just me getting old and out of shape. And I reluctantly joined your challenge mostly for the aspect of a doctor in knowing the body and didn't think these short sessions would do anything but a refresher for a real workout program. Well, I was completely wrong. Never ever have I been given such specific in-depth instructions with demonstration. I don't even have to look at you and follow your instructions. Also,

[00:05:57] I love that you do the workouts with us. I hate getting programs with only a quick demo and the workout is written out. I didn't think a few rounds in these short workouts would do anything wrong. I feel it the next day, like in a good way that I'm actually working the body part that I worked. I'm very impressed and learning so much and pushing myself, lifting heavier than I have in years, keeping good form. You are amazing. And we aren't even done with the week yet. I'm just still loving it.

[00:06:24] I mean, you guys, is that not incredible to hear? To hear what is possible in your body when you just come and give it a chance and hear potentially something different with how you move. This is why I'm so excited about this program, getting you stronger, getting you mobile, getting you connected to your inner core in a way that you haven't done before and you get to keep the program for life. This is the last opportunity to get in with us, to be guided with a community. There's private

[00:06:51] community chat support where I am active in it and helping you and guiding you along the way. But you also get to keep this for life. So again, this is the last chance that there is a $10 discount. And on top of that, use code optimal as a podcast listener and you get an additional discount. Okay, get in. Okay, so where to go from here? Like, we're obviously going to talk more on the exercise side of things. Again, if this is you, there are definite considerations. If you're in one of those

[00:07:21] stages, like Jen said, where you're going to have low estrogen and that's going to affect our bone density or be leaching calcium from our bone because of deficiencies elsewhere, that's where there could be nutrition considerations that you'd want to talk with someone who knows what the heck they're talking about. But on the exercise thing, what stimulates bone growth? And I want to specifically talk about a more like bone remodeling because we never really just, there are two specific cells,

[00:07:48] are osteoclasts and osteoblasts. Osteoblasts, I always remembered because they blast the old bone away. They're the people who come in and they're like, get rid of that old demineralized bone. And the osteoclasts are the one who create the new bone. And so, it's this remodeling process of taking away the old, putting in the new. And how do we stimulate these is through load, is when our bones

[00:08:15] feel load put through them, they're going to start to remodel in a way that responds to that load. And that's like a basic physiologic principle of bone. Right. And there's something called Wolf's Law, which I like to bring up only because it's, you know, it states that our bones will adapt according to the demands placed on them. And that means the demand of load that we're placing on them and the demand we're not placing on them. So, our bones will- Happens both ways.

[00:08:44] Yes, exactly. So, our bones will change if we're not loading them enough. And I think that's where, you know, where we can see those significant changes and why it's important. You brought this up in the last PT Pro we did on exercises for longevity. Like, if you don't use it, you lose it. And that's what, essentially what Wolf's Law is saying. It says, if you don't use it, you lose it. If you use it a lot- You're going to improve it.

[00:09:09] Yeah, it will improve a lot. And yeah, it's just, again, this how osteoporosis is seen as this age-related thing. I don't completely agree with that. Yes, there are things that happen through our lifespan that definitely have impact on our bone density. However, if something that we consistently see through lifespan is just a reduction in the amount of activity we do, a reduction in the amount of loading we do on our system, both with weights or just with like regular daily activity. And so, again, if you are given the recommendation

[00:09:39] because you have significant osteoporosis by your doctor, like, oh, you shouldn't do lifting, you shouldn't do heavy exercise because you're going to be at risk of fracture. Mm-hmm. Again, there is always that risk. Yes. And we should always be working with a professional if we have significant amounts of osteoporosis. 100%. Because there are definite considerations that could increase or reduce risk of fracture when doing different activities. But to tell you that you're

[00:10:05] not supposed to load your body is almost going to be more detrimental. 100%. Because if the end all goal is to prevent fracture, then we have to prevent fall. Right? And in order to prevent fall... Prevent fall and prevent the bones from losing more density. Right. And so, in order to prevent that, we actually have to do the opposite. We need to strengthen, we need to impact our bones, we need to work on balance, we need to work on all these

[00:10:32] systems of the body to help prevent what ultimately we don't want to happen. And so, that's where clinically the most effective physical exercise for the individual will be the highest intensity that they can tolerate. That is clinically proven within the research right now. So, it's not just, oh, okay, you have osteoporosis, do some low impact exercise or go do some aerobic activity. No,

[00:10:57] it's literally getting you into the highest intensity that you can tolerate is what's actually going to help to improve. And so, there's multiple ways to get this high load through the body. First of all, we want to be axially loading our skeleton, which basically means top to bottom. If you look at the long bone of your arm or your leg, it's essentially loading from hip to foot with a straight leg.

[00:11:24] Right? And so, a lot of ways to do this, like most people will think initially of like, oh, loading, like weightlifting. Yes, that's one way. That's definitely one way to put weight through our body. But almost more effective is things that put impact through our body or impulse. Something that is like the lowest level of this is doing heel drops or what we call a heel drop,

[00:11:50] where you kind of go up on your toes. I like this because you can even hold onto a counter, go up on your toes and kind of just drop down on your heels and you'll feel kind of that impulse up through the body. And doing that five or ten times, that's like a really base level way to start putting that impulse through the body. Mm-hmm. And then, you know, obviously this is where it comes into play of like why we don't want to lose impact as we continue to age is because we need this in order to help improve our bone mass,

[00:12:19] so, or bone density. And so, this is where any kind of jumping that you can tolerate. And the more stiff-legged we actually land, the more we put that axial compression through our bones and the more benefit that we get. So, especially when we're younger and we can still do and tolerate, you know, landing and loading our body at high intensities, do that right now. So, it's not just the box jump, right? But it's actually getting off of the box and landing, not stiff-legged,

[00:12:48] we don't want to injure ourselves, but almost, right? And getting that really high load through the body. And that's like what you progress to. Yes. So, it's like the heel drop is the very bottom of the spectrum. Yeah. The very top is jumping off a box and trying to land more stiff-legged. Right. Or hanging from a bar and letting go and trying to land with more stiff legs. Because again, that's a very high level of impact where in between is jumping off the box and landing with a deep squat. Right.

[00:13:16] And then like progressively going towards a more stiff-legged landing. Honestly, this is stuff that like is a principle of plyometric training too. That's really good for our ligaments, our joints. You know, you do this with everyone as they go through ACL rehab, like learning to decelerate your body quicker, which is that more stiff-legged method. But that's where you're going to get the highest levels of impact and stimulate those osteoclasts and osteoblasts to do their bone remodeling.

[00:13:45] Yeah. And then when it comes to lifting and strength, you know, from the research, we see that osteoporosis only improves by safely increasing load. And so, this first happens when we improve our technique in lifting and then slowly and with supervision, improve load over time. And this means that we're getting up to think of like your one rep max. So, like as much load as you can lift

[00:14:11] one time, you're getting up to about 85% of that one rep max, which is pretty dang heavy. And again, heavy is all relative to everyone. Heavy can be your body weight. Heavy could be a resistance band. It doesn't have to mean a barbell loading, but it means that you're getting yourself to a pretty high intense load within a rep. And if you're going to go a little bit lighter with the load in general,

[00:14:40] say that doesn't get you to your 85%, then you're doing higher volume. That gets you closer to like failure at the end of the set, right? So, maybe instead of doing six to eight reps of a really heavy load, I'm doing a lighter load, but I'm doing 15 plus reps and that's getting me to close to failure by the end. That is what's going to help to ultimately start to improve that strength. And I want to go back to that point one more time, technique. If we can improve our form,

[00:15:09] if we can improve our technique, we reduce the risk and fear of injury. And that's what most people fear when it comes to lifting or heavier or doing more strength training, right? Is that fear of injury. Yeah. And there's like, there's this one specific product. I think of it because my auntie Lorinda always talks about it. Lorinda is someone who's dealt with lower bone density and has been

[00:15:33] trying to work on that and went through all sorts of different solutions. And then she found an OsteoStrong gym, which is essentially they're machines that were designed to do this axial loading on you in a safe way that gets multiples and multiples of your body weight. The founder of OsteoStrong said you need 4.2 multiples of your body weight at the hip joint specifically, you know, to see

[00:15:59] improvements in bone density. Do we specifically agree with that? I don't know that it needs to be 4.2 times. Like I'm sure you'll see some improvements in density, even if you don't hit 4.2, but you're doing different, you know, like, um, but these machines have shown pretty incredible results. My auntie Lorinda swears by them, um, because they do, they, they take advantage of the body's physiology. The body can't ignore when you load it like that. Wolf's law.

[00:16:27] A hundred percent. And what I looked at too, when I was looking deeper into OsteoStrong is that they recommend doing it for at least six to six months to 12 months. So you're doing it for an extended period of time. Again, this only takes 10 to 12 minutes. So it's not a long process, um, that you're going in and doing. Um, but it always should be combined with strength training. And they say that like, because just because you're doing axial load at a really high force on your body, doesn't mean that you're gaining strength. So they also at OsteoStrong recommend

[00:16:56] a strength training program alongside, um, this axial loading, which I think is, is a great recommendation and something that's so highly needed because again, we're trying to prevent the fall. We're trying to get you stronger. We're trying to make sure that you're, you're increasing your overall, body support. And I think it's important to note that going into an OsteoStrong is, is a privilege because I don't think insurance covers it and it does cost money. So if that is not what you're able

[00:17:23] to do, we're going to go over a study that has actually been researched in some exercises that can actually be beneficial. So this, uh, exercise that they called lift more, which I think is appropriate. Um, essentially it was this training for muscle and osteoporosis rehabilitation. Um, and it was an eight month supervised high intensity and progressive resistance and impact training program.

[00:17:49] So it combined hit and strength training, which as we've said, are two components that can get that impulse and the multiple, you know, multiple multiples of your body weight going through your bones, um, to help to stimulate that, that bone density growth. Yeah. And they saw improvements in femoral neck and lumbar spine bone mass density, which I think

[00:18:14] are the main places that people are concerned. Um, plus muscle strength, physical function in specifically postmenopausal women, um, with low to very low bone mass density, which I think is, is really cool. And I think the study was out of, um, Australia, which of course. And this was eight months, but just two times a week, 30 minute sessions. Um, the, again, intensity,

[00:18:38] they use RPE scale, which is the rate of perceived exertion, um, which is the best scale to use because even over heart rate, cause not a lot of people like just measuring your heart rate as you're doing workouts isn't great. But if you use an RPE scale, and again, they have confusing RPE scales. There's one from six to 20, which doesn't make sense to me as much as just using one to 10. If you're going to add a one to 10 scale, you should be at about an eight, be like, this is one of the

[00:19:06] harder workouts that I could do. Um, but 10 is like, I'm going to pass out. And so, yeah, two times a week, 30 minutes. And they saw all these improvements over eight months. So yes, it's a long time, but again, we're trying to combat changes that have either been happening for decades of our life or combat the changes that otherwise might happen decades down the road. Yeah. And some of the exercises

[00:19:30] they focused on, which are, we all need throughout life is the deadlift squat overhead press and impact loading. So they did like jumping chin ups and when they would kind of jump and pull up on the bar and and let go. Right. And eventually they're working their way toward more of that stiff legged, um, landing. Now I do believe that this protocol was also combined with machine based, um, axial loading.

[00:19:55] So they did use axial loading to help with this entire rehabilitation process. So again, if you have, if you can or get access to it or your insurance pays a little bit, like see what you can do, you know, to help to, to gain that because that has been proven to be helpful. But also if you can't, just at least your strength training, at least you're working more toward those stiff legged,

[00:20:18] um, landings and impact, and you're doing what you can while also working on balance training to help reduce the risk of falls and to continue to age well within your body. And wanting to do that with a group today, we are starting our strong healthy joints program, which is a strength based program that works on top end strength. So doing, you know, the 80 to 85%

[00:20:45] of your one rep max for multiple reps, you know, that's going to be a part of this program. And we're starting today with a large group that's in our gen health community and the early bird discount is over. But as our podcast guests, we always want you to be treated well. So you can use code optimal 20 and you'd actually get the program still at the early bird price. It'll give you an extra 20 bucks off and you can start, come start with us today. It includes high, you know, top end strength

[00:21:10] training as well as the high intensity workouts. Jen gives variations for everyone. No matter what level that you're at. So check that out. Links down in the show notes. It's Jen dot health backslash strong backslash strong use code optimal 20 at checkout and come join us. Thanks so much for joining us on another episode. Again, I hope you get into that strong,

[00:21:36] healthy joints program. It is such a fun one. And it really, the empowerment that I saw from people like, oh my gosh, I don't have pain with my deadlifts. And oh my gosh, my squat feels so much better. It is incredible. The strength gains that we're able to happen within 30 days. Plus we go over some really deep core understanding mobility. Of course, we can't skip that. So it's all within this program. And I'm so excited for you to try it again. That's just Jen dot health backslash strong

[00:22:03] and use code optimal 20 as our podcast listener.