Is Ultra-Marathon Running Bad for Your Bones?

Is Ultra-Marathon Running Bad for Your Bones?

As a runner and Exercise Physiologist, I at times feel conflicted. I have trained for and completed Ultra-Marathons myself, and also helped coordinate the training plans for clients undertaking similar and more extreme goals than mine.

As a runner, I love the training, the planning, the dedication, the achievement- all of it. But as an Exercise Physiologist, my role in Allied Health is to prescribe exercise to enrich the health of my clients. Am I actually doing the opposite for the ultra-runners I train? Am I the equivalent of a Dietician helping their client’s to compete in a pie-eating contest?

In recent years researchers in my field have cast their scrutinous eye at the Ultra-running community. Ultra-running has evolved from a beyond-the-fringe subculture of self-flagellating weirdos to a legitimate, world-wide sport that attracts a broad cross-section of society.  New evidence indicates this may not be an entirely great thing.

Ultramarathon Running and Bone Mineral Density

A recent study published in the International Journal of Applied Exercise (Düz, S., & Arik, M. 2020) compared the bone mineral density of middle-aged male ultramarathoners (UM) (aged 44-56y) to active (AM) and sedentary (C) peers. The average weekly running volume for the UM group was 104.29km, compared to the AM group which was 61.5km.

Analysis of bone mineral density (BMD) showed that the UM group had lower BMD at the lumbar spine, femoral neck and hip compared to the AM group. The total bone mineral density of the UM group was even actually lower than that of the sedentary control group. This indicates that the ultramarathon men in this study are at more risk of osteopenia and osteoporosis than men who do nothing! Bear in mind that impact exercise is recommended for maintaining and improving bone mineral density. This study indicates that there may be a threshold in which the overall stress of the training volumes that many ultramarathoners endure may be beyond what is healthy for their bones.

How do I reconcile this?

Firstly, I strongly advocate that all runners regularly undertake resistance training sessions. The main reasons I advocate this are for performance benefits, as well as improving soft-tissue resilience (for injury prevention). But for high-volume runners, I can add attenuation of bone-mineral loss to this list.

Secondly, I would challenge the need for super-high weekly running volumes for all but the absolute elite level ultramarathoners. High mileage is essential for elite performance in Ultramarathoning. But if your aim is to just complete the race, rather than win the race, is the cost of this high mileage really worth it? I have helped many runners achieve great outcomes in 50+km events with weekly training volumes of ‘only’ 50-60km per week. This would put them into the ‘active’ group of the study I referenced, which showed significantly higher BMD scores than the ultramarathoners and sedentary group.

For those aiming for events much longer than 50km, it is prudent to question the overall health impact of such a goal.


Düz, S., & Arik, M. (2020). The Effect of Ultramarathon Running on Bone Mineral Density in Male Athletes. International Journal of Applied Exercise Physiology9(5), 100-108.


7 Myths About PCOS

7 Myths About PCOS

PCOS is a fairly common condition in women (1 in 10), however there are many misconceptions out there about it. Check out these 7 myths about PCOS…


Myth 1:

PCOS = infertility.

Having PCOS does not mean you are infertile. PCOS is a common cause of infertility due to  the hormonal imbalances in the body blocking ovulation. PCOS women are still able to fall pregnant, and may or may not need a little help from their doctor.


Myth 2:

You must have ovarian cysts if you have PCOS.

Wrong! The Rotterdam diagnostic criteria for PCOS requires 2 out of 3 of the following;

  1. Irregular menstrual cycles, AND
  2. Hyperandrogenism (excluding other causes), OR
  3. Polycystic Ovaries on an ultrasound*

*You do not need to have cysts on ovaries to have PCOS and cysts on the ovaries does not mean you have PCOS.


Myth 3:

You have to be overweight to have PCOS.

Incorrect! In fact about 20% or more women present as healthy or underweight and are categorised as having lean PCOS.


Myth 4:

There’s no cure for PCOS so there’s nothing you can do about it.

So soo wrong! It is true that there is no cure for PCOS, however, there are many ways to manage your PCOS and reduce your symptoms, including exercise, diet and supplements, some medications**, stress management and positive sleep behaviours. 

**This depends on the underlying driver of PCOS. See Finding Your Root Cause of PCOS.


Myth 5:

If you’re not trying to conceive there’s no need to worry about PCOS.

Unfortunately, PCOS can increase the risk of Type 2 Diabetes, high blood pressure, heart disease, and anxiety and depression. If you’ve been diagnosed with PCOS it is important to manage your condition to reduce your risk of developing other chronic health conditions.


Myth 6:

All symptoms of PCOS are the same for every woman.

Not true. There are many symptoms of PCOS and you won’t experience all of them, or even experience them to the same extent that another woman does.

(Symptoms can include: irregular periods, hair loss, unwanted hair growth, acne, bloating, weight gain, mood swings, irritability, fatigue, or even loss of libido.)


Myth 7:

There is a one size fits all way to manage PCOS.

As mentioned before, there are different drivers of PCOS, as well as differing symptoms, and most importantly… different outcome goals. Therefore managing PCOS will be different for each woman. If you’re looking to get pregnant your journey will look very different to if you’re looking to reduce your symptoms, or improve your health outcomes. 

This is why it is so important to work with YOUR body and tailor your management plan to YOUR goals. And if needed working with health professionals who understand you and what you’re going through.


And there you have it! 7 myths about PCOS busted!

So is running actually good for your knees?

So is running actually good for your knees?


But I’ll start by hitting you with three facts.

  1. People who run have a lower incidence of knee osteoarthritis than people who don’t (Timmins et al, 2017; Alentorn-Geli, E. 2017).
  2. The knee is the most common site of injury in runners (Van Gent et al, 2007).
  3. The most common cause for running injury is training error (Damstead et al, 2018).

This is how I reconcile these facts in my head.

Running, when appropriately ‘dosed’ is a good thing for our knees (and muscles, tendons, bones, heart, lungs, brain, gut etc etc). However when the dose is too great either acutely or chronically the most likely point in our body to ‘fail’ is our knees. If this is the case, it is not running that is bad for the knees, it is bad coaching, or no coaching that is actually bad for our knees.

Let me reiterate point 1 in case you glossed over it. People who run are less likely to end up with OA than those who don’t. And it isn’t a small difference. Runners are about 3x less likely than non-runners to develop OA. Check my first reference if you don’t believe me.

For many reasons, running is something that you should do, but you should do it in a quantity and frequency that is appropriate for you.

An an Accredited Exercise Physiologist, it is my absolute bread and butter to assess and prescribe the right ‘dose’ of running for you right now, and help you build upon that at your speed.

Please don’t avoid running because you think it is bad for you. And don’t let poor coaching be the reason that it is.


About The Author


Alentorn-Geli, E., Samuelsson, K., Musahl, V., Green, C. L., Bhandari, M., & Karlsson, J. (2017). The association of recreational and competitive running with hip and knee osteoarthritis: a systematic review and meta-analysis. journal of orthopaedic & sports physical therapy, 47(6), 373-390.

Damsted, C., Glad, S., Nielsen, R. O., Sørensen, H., & Malisoux, L. (2018). Is there evidence for an association between changes in training load and running-related injuries? A systematic review. International journal of sports physical therapy, 13(6), 931.

Timmins, K. A., Leech, R. D., Batt, M. E., & Edwards, K. L. (2017). Running and knee osteoarthritis: a systematic review and meta-analysis. The American journal of sports medicine, 45(6), 1447-1457.

Van Gent, R. N., Siem, D., van Middelkoop, M., Van Os, A. G., Bierma-Zeinstra, S. M. A., & Koes, B. W. (2007). Incidence and determinants of lower extremity running injuries in long distance runners: a systematic review. British journal of sports medicine, 41(8), 469-480.



Pain The iNform Way

Pain The iNform Way

Although pain is advantageous for protection and survival. Persistent pain carries no real biological purpose – yet is sadly highly prevalent in the population. I’m not going to dwell on epidemiology. I want to tie in nicely the importance of clinician collaboration as an excellent prophylaxis for acute (and persistent) pain, whilst also discussing a Cochrane review on the lack of evidence of NSAIDs (nonsteroidal antiinflammatory drugs) for the acute management of low back pain.


What are Cochrane reviews?

Cochrane reviews are excellent resources for clinicians (and the general public) to access high quality evidence with iNformed recommendations. Cochrane reviews (or collaborations) involve clinicians/researchers who have excellent experience and knowledge in a specific field. They gather all the relevant research papers on the topic of research (low back back and NSAIDs in this case). They extract all the relevant papers that meet a specific criteria  and make recommendations based on the overall evidence.

The reason why I spent a good paragraph on the aforementioned is that the Cochrane library can be accessed by anyone! Therefore, anyone can seek and critically evaluate a medication (like a NSAID) for example. You can also look at the evidence (for the acute use of low back pain) and come to an evidence based conclusion. As a clinician, providing evidence based care is important for your health and well-being. We call this evidence based care the Science-Practitioner model.


Ok! I’ll provide you a quick synopsis of the paper.


Van Der Gagg and colleagues found: When using a qualitative (self reported) scale for reports in pain reduction, the authors found no statistically meaningful benefits for the use of an NSAID in acute low back pain. A previous Cochrane review in 2014 by the same group came to the same conclusions for the analgesic paracetamol for acute low back pain. These are important implications, as medication may be one’s first choice approach to decrease symptoms. However, with what’s been written and known empirically, what is the best approach to improve symptoms of acute low back pain?


The current evidence suggests that empirical pain education along with graded specific exercise correctives are the current gold standard for the management of acute low back pain. Pain education allows the individual who has pain to better understand it, whilst the clinician being thorough in their examination providing reassurance, and safety to move. We clinicians call this the biopsychosocial model. As the schematic below shows, this is an intricate interplay between tissue, one’s thoughts and feelings, and the environment (potential threats and safety’s).

My premise in this blog is to not overwhelm you with information. More so that there’s evidence out there for you to access. Along with clinicians whose duty of care is to iNform you on the aforementioned publications, and devise an appropriate treatment plan to improve your symptoms. The team at Move For Better Health can guide you safely through your acute pain, whilst collaborating together (Physio, Exercise Physiology, Psychology, Podiatry, Nutrition/Dietetics) in our disciplines with great communication and decades of combined experience.


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Why You Should Concentrate On Your Breath

Why You Should Concentrate On Your Breath

Stop! Now check you are breathing… or, are you holding onto your breath?

Breathing, which I’ll define as diaphragmatic breathing is incredibly important for many areas such as the management of blood pressure, reducing muscle tone and most noteworthy (and a collaborative of the two aforementioned), activating your parasympathetic nervous system. Now you all know that I’m a huge neuro-nerd! However, for the practicality of this blog I will only touch the surface of the parasympathetic and sympathetic nervous system.

So what is your parasympathetic and sympathetic nervous system?

Crash course in endocrinology!


Your parasympathetic nervous system is what’s known as your ‘rest and digest’ system. A relaxation system let’s say. Your sympathetic nervous system is your ‘fight, flee and freeze’ system. And although a neat sounding alliteration. The sympathetic nervous system should only be called for during short bursts of stress (such as physical activity, complex problem solving). However, when called upon more-so and on a regular basis the sympathetic nervous system can have a downstream effect in compromising the immune system (sickness), all the way down to-your genome (RNA damage).

So you can see that being more parasympathetic over sympathetic is important! And what is an excellent prophylaxis for the parasympathetic nervous system? Diaphragmatic breathing! That’s right! I don’t have to go all spiritual on you’ll here. Just your breath!

Let’s get practical!

1. Sit in a comfortable chair, or lie supine (on your back).

2. Make sure you’re not distracted!

3. Rest your hands gently on-to the side of your ribs.

4. Inhale for a count of two seconds through the nose by breathing into your hands (notice how your ribs expand).

5. Hold the end of the two second inhale for a further two seconds (deliberate breath-hold)

6. Exhale through the mouth for the count of four. (You should notice that your ribs draw back inwards somewhat.

7. Repeat five more times.

8. Note how you feel?

Fingers crossed you’re feeling perhaps a sense of ease? Slightly calm and relaxed? A bit more mental clarity? Even a wry smile?

So there you go peeps! I didn’t use the word meditation once (this time). I simply guided you through how to breath diaphragmatically, inducing a parasympathetic response. A neat tool to use throughout ones day! Recommended when there’s an accumulation of unease.

About The Author

*Disclaimer: if you are prone to orthostatic hypotension, or vertigo (BPPV). Please be mindful when standing or arising from a lying position following diaphragmatic breathing. Or consult with your GP or EP if you need-so.




7 Surprising Benefits of Exercise for Menopause

7 Surprising Benefits of Exercise for Menopause



Every single woman on the planet will experience it during their 45 – 55’s. If you asked two different women, they’d tell you two different versions of what menopause was like. That’s because although the symptoms are common, not everyone experiences menopause in the same way….


Symptoms of Menopause


Not to worry though, there is something you can do to help manage your symptoms and help you through this change in your life.


The 7 Benefits of Exercise for Menopause!


Exercise has been shown to provide several health benefits whilst you are going through menopause. Exercise can…


1. Help Manage Symptoms! (Woohoo!)


Exercise can actually help to manage and reduce some of the symptoms of menopause such as; aches and pains, loss of libido, and fatigue. Increasing physical activity will result in a positive cycle of feeling better, which will increase motivation to exercise, making you feel better, and so on. You’ll end up feeling better on the inside and out!


2. Boost your Mood!


Women going through menopause commonly struggle with mood changes, anxiety, depression, and stress due to the hormonal changes within their bodies. However, exercise can increase positive mood and also protect against anxiety and depression.



3. Prevent Weight Gain!


Due to changes in hormone levels during menopause women may find they gain weight more easily than before (especially around the belly). Exercise and healthy eating is a great way to reduce weight and prevent any extra kilo’s creeping on.


4. Reduce Risk of Cardiovascular Disease!


Oestrogen plays a protective mechanism against cardiovascular disease. During menopause, oestrogen is reduced which increases the risk of cardiovascular disease. Incorporating exercise into your daily routine can strengthen your heart and reduce risk of heart disease


5. Reduce Risk of Osteoporosis!


Oestrogen also plays an important role in maintaining bone density. The reduced oestrogen production during menopause can lead to decreased bone density, and thus increase the risk of osteoporosis. Exercise can strengthen bones and muscles, and improve balance reducing the risk of fractures due to falls.


Bone Health


6. Reduce Risk of Diabetes!


Changes in hormone levels during menopause can also affect the way your body reacts to insulin, potentially leading to diabetes. Exercise helps the body respond to insulin and remove excess blood sugars reducing the risk of developing diabetes.


7. Help Maintain Physical Function!


As our bodies age they start to decline in physical function (loss of muscle, loss of bone, decrease in balance, etc). Exercise is the perfect way to keep up your function and ability to continue to live the life you love. (And run around after your energetic little grandchildren!)


Awesome right?! You don’t have to just deal with this change you’re going through… There is something YOU can do to help yourself through it! 


General Exercise Guidelines 

150 mins of moderate exercise a week (or 30 mins a day over 5 days)


75 mins of vigorous activity a week


2-3x strength training days a week (non-consecutive days)


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