Osteoporosis is a progressive metabolic bone disease characterised by the loss of bone mineral density (BMD) and compromised bone strength. Osteopenia is considered a halfway point to osteoporosis; the bone density is lower than normal and treating it may slow the progressive bone loss that leads to osteoporosis.
Understanding exercise and bone health begins with understanding how bones are made.
We repeatedly place demands on our bones and these demands cause our bones to constantly re-modelling themselves. Bone re-modelling occurs in two phases. First, special bone cells called osteoclasts break down bone. Then, other bone cells called osteoblasts create new bone. Osteoclasts and osteoblasts can coordinate well for most of your life. Eventually, this coordination can break down, and the osteoclasts begin to remove more bone than the osteoblasts can create leading to osteoporosis.
Why is exercise important for Osteoporosis?
Exercise is a highly modifiable contributor to bone health (osteogenic). Physical activity generates external (ground reaction and inertial) and internal (skeletal muscle) forces on the skeleton. These forces cause very small amounts of deformation in the bone tissue, resulting in mechanical strain. This mechanical strain is sensed by cells (osteocytes) that reside in bone. When unusual strains are sensed, osteocytes initiate an adaptive response that produces new bone tissue (osteoblasts). The more vigorous the strain, the greater the response.
For a given external force, weak bones deform more, resulting in relatively large tissue strains, whereas strong bones experience low strains. This elicits a more robust biological, bone building response in the weaker bone that eventually results in stronger bone.
What types of exercises help?
Types of exercises that ARE osteogenic:
- Resistance training
- Jumping, landing, hopping, Running, jogging, very brisk walking
- Netball, basketball, soccer
- Dancing, impact aerobics
Types of exercise that are NOT osteogenic:
- Leisure walking
- Yoga, tai chi
- Lawn bowls
Structured osteogenic exercises: Where to start?
- Wholistic strength training
- Goal/s: Improve bone strength and ensure injury prevention.
- Frequency: 2 week Prescription: 2-3 sets of 5-8 repetitions (~8 exercises).
- Target major muscle groups attached to the hip and spine.
- Intensity: 8/10 (hard but not maximal)
- Impact exercise
- Goal: To induce relatively high bone strains (rapidly).
- Frequency: 4-7 days per week
- Prescription: Aim to work up to 50 repetitions over time (5 sets of 10 repetitions with 1–2 min rest between sets).
- Vertical and multidirectional jumping, bounding, hopping, skipping and bench stepping.
- Balance training
- Goal: Reduce the risk of falls, which can lead to fractures.
- Frequency: Up to 4 days per week.
- Can be built into a strength program.
- Prescription: <10 seconds per exercise, challenging, a variety of exercises
Tips and tricks:
Begin loading your bones slowly.
- Whilst impact training is encouraged, it is important you have the strength and stability to complete those movements without increasing the risk of injuring yourself. For example, you would never take up sprinting before jogging. Strength training is a good place to start.
Form is more important than anything
- Training with good technique (both strength training and impact exercise) is essential to reduce your risk of injury. Getting support and guidance from a trained individual is useful.
Introduce impact exercises into your daily life.
- Because you only need to do 10 impacts at a time, there is no reason why you can’t do them sporadically throughout your day.
Resistance and impact training should not be painful
- You may need to reduce or eliminate high ground reaction forces if you have joint or muscular pain (such as arthritis or lower back pain). You can slowly build intensity up over time. Managing your osteogenic exercise program can be challenging.
If you would like support, guidance or more information please call, email or visit the iNform Health website.
About The Author
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 Physiology, 9(5), 100-108.
Should I exercise with an injury? In this article we answer this age old question and provide some practical tips that you can implement immediately.
Training is going well.
You are getting in the gym a few times per week, the weights are going up, and you are feeling better.
Then boom, disaster strikes.
Seriously, there is nothing that can derail your progress quite like an injury.
It not only makes it harder to exercise, but depending on the type of injury, it may even make something as simple as getting off the couch seem like climbing mount Everest.
Combine that with the fact that an injury can also destroy your motivation, and you have a recipe for disaster.
But does it have to be this way? Does an injury have to derail your progress?
Which begs the question — should I exercise with an injury, or should I rest and wait for it to heal?
Should I Exercise With An Injury?
So, you get injured.
In my personal opinion, stopping exercise is the absolute worst thing you can do.
I mean, as far as I am concerned, this whole ‘fitness’ thing is a simple game of attrition.
You show up, you do the work, and you build momentum. Over time, actually showing up gets easier, and you start to enjoy this whole ‘exercise’ thing.
You begin to push yourself, not because your trainer tells you too, but because you want to see what you are capable of.
And then the results start to come rolling in.
With this in mind, I would argue that even in the face of injury, you should definitely keep exercising.
In fact, it would be silly not too.
Which leads us to our next point quite nicely…
How Should I Exercise With An Injury?
While I am a huge proponent of keeping that exercise momentum going, your exercise routine should change in the face of an injury.
1. Avoid Aggravating Exercises
First and foremost, you need to avoid any exercises that aggravate the injury like the plague.
- This means that if you have a knee injury, squats and lunges might be out of the question
- A shoulder injury may mean that you need to avoid all pressing movements for the time being
- And a lower back injury might mean that you avoid heavy squats and deadlifts for a couple of weeks.
This first step doesn’t have to be hard — hell, I could probably summarize it by simply saying “don’t be stupid“.
While this may be viewed as a negative step, it shouldn’t be.
In fact, this may actually give you an opportunity to get better at some movements you don’t normally spend much time with — which will only benefit you in the long run.
2. Double Down on Exercises That Feel Good
Step number two rolls on quite nicely from step number one, and really, it just makes sense.
Those movements that don’t cause you pain?
Train them hard, train them heavy, and train them often.
Use the opportunity to build strength in different movements and prioritize the growth of certain muscle groups.
In short, have fun with it.
3. Get it Checked Out
And finally, if your injury has been around for more than a couple of days and doesn’t seem to be getting any better, get it checked out by a professional (chiropractor, physio etc.).
There is a genuine possibility that your injury might benefit from:
- Some hands on treatment, possibly a massage
- Some specific rehabilitation exercises
And a health professional can help you with both — which will ultimately get you back to 100% as soon as possible.
Take Home Message
While getting an injury is far from a good thing, it should not derail your progress.
By making some smart adjustments to your training you can keep exercising, and more importantly, keep seeing progress.
About The Author
Did you know that if you start running, there is a 30% chance that within 6 months you will stop.
But evidence from studies such as this one from Fokkema et al (where I pulled that number from) can help people like me understand why, so I can share it with people like you!
So firstly, why do people stop. For the participants of the study linked above, the main reasons were:
- Development of an injury.
- A low perception of physical capability prior to commencement.
- A lack of direction following an initial intro-to-running program.
The good news is that these pitfalls can be avoided if you acknowledge the fact that they exist before you start, and you implement strategies to get over them.
So here is what I recommend before you start running.
- Listen to your body. Running is hard on the body, but this is not a bad thing. Our body responds favorably to loading but if this load crosses a threshold injury can occur. So build gradually. If you start getting sore, walk it off. If you pull up sore the next day, roll your legs over on a bike. Prioritise sleep as that is when our body heals itself. Drink lots of water and eat nutritious food. Basically treat yourself well.
- Get Strong! If you doubt your physical capabilities, improve your physical capabilities. Getting stronger is simplest way to do this. Consult with a trusted Exercise Physiologist or Strength Coach and they can help you get stronger in a safe and appropriate manner.
- Think long-term. Most running programs for beginners aim to get you from 0 to 5km in about six weeks. Plan a six month goal. A 10-12km event is appropriate for that time frame. Search for an event that you would like to do in six months of around that distance and commit to it. Seek out a reputable Coach who can help you plan from week-6 to month-6 and beyond. Running gets easier with increasing experience. And the easier it is, the more enjoyable it is and more beneficial it will be to your long term health.
For more information on this topic check out these blogs:
Running is NOT bad for your knees
My 5 favourite types of running
Don’t run anymore? Who do you think you are?
About The Author
If you are like me, you need to be told NOT to exercise, instead of TO exercise. Do you feel guilty, or perhaps even grumpy if you haven’t exercised in a couple of days? are you the one who on a holiday needs to exercise first thing in the morning so you can “tick that box” – and then dive into the breakfast buffet?! Is exercise one of those behaviours you have now just built into your life, like brushing your teeth, because it is good for you? yes, it makes you feel good, it helps to de-stress you, and its part of your health insurance, right?! But what if sometimes it works against you??
Some background to stress and recovery
This is a very practical blog, but a bit of background is important. Exercise works because it is a form of ‘stress’ for the body, that we need to physiologically adapt to. In the right doses, and with the right recovery, exercise makes us fitter, stronger, healthier and more resilient. But you know this. You feel it. intuitively.
Interestingly, the body doesn’t know where stress comes from. And it comes in many forms: yes, physical stress; but also in the form of the more commonly known emotional, or psychological stress; but also, toxic stress; inflammatory stress, etc. And these from many sources, such as the foods we eat; physical pain and injury; lack of sleep; toxic relationships; deadlines; financial pressures; public speaking; sick parents; our kids in trouble, etc, etc…. you know: life!
In the right doses, we can adapt to all those stresses. We can get more resilient, and develop a capacity to deal with all of them better, to lift the threshold line. As long as we actually adapt. And we do that by having the right balance between ‘stress’ (or strain) and recovery.
The balance between strain and recovery
Now, the word stress stresses me out. I much prefer, in this case, the word strain. Strain speaks to me of an overall tension; and overall load; that is useful. It achieves things.
Ok, one last bit of back ground, just to make sure we are on the same page. All that stress (strain!) can be positive if we actually benefit from it. If we get something out of it. If it leads to a positive outcome. And the crux of the argument here, is that we only adapt to strain when we recover. That’s right, you don’t get fitter while you exercise. You don’t get stronger while you lift weights. Those exercise bouts are the triggers for adaptation. but your body will only adapt while it recovers. And recovery comes in the form of the right nutrition, active recovery strategies such as massages and meditation, rest (knowing when NOT to exercise), and the all important SLEEP!
My new recovery coach
So let’s go back to your and my personality: the “I have to exercise today…”. We feel this way because we are convinced that today’s exercise bout will be good for us… but what if it’s not? what if our bodies (and minds) would actually do better having an easier day? can we bring ourselves to having an extra day off? or perhaps to just do some light stretching and foam rolling?
Since exercise is actually another form of stress, could that extra session actually tip us towards illness or injury, rather than away from it?? Well, there’s a plethora of evidence to suggest that the answer is unfortunately a resounding YES!
So what would it take to convince you to have an easier day? In my experience, hard objective data is typically what convinces me to change my mind… and sometimes someone to hold that data right in front of my eyes and force me to stare right at it!! does that resonate? I know that we have a LOT of clients at iNform like you and I. So over the last few months we have been doing some in depth research into existing tools that can measure how much strain our bodies are under and how well they recover, particularly while we sleep. We have looked at almost every activity tracker, exercise watch and smart watch in the market, and we feel we have found a winner.
Yep, my new recovery coach (with a little bit of accountability from my exercise physiology colleagues) is my new Whoop band. Funny name, but an incredibly powerful and smart tool to make sure we optimise our exercise, strain and recovery to get the most out of every day.
In a nutshell, it calculates the overall ‘physiological load’, or strain’ that your body underwent during the day. It then recommends how much one should sleep to recover from that strain. Based on how you actually slept, it rates your recovery and recommends the amount of strain you can get away with the following day. Very simple concept, supported by very smart technology! and it has helped me make some good decisions (against my initial intuitions) with the help of quality objective data displayed in easily understood displays.
I’ll tell you more about it in my next blog, unless you want more info earlier, in which case flick me a question in the comments below! I would encourage you to check it out at the link above, and keep an ear to the ground, as there’s a little offering coming up to iNform clients very soon!!
Click here for more information on our Whoop health coaching service.
About The Author
The deadlift is one hell of an exercise — but does that mean you should deadlift from the floor?
Lets find out.
In my opinion, the deadlift is one of the best exercises on the planet.
I mean, when it comes to whole body strength, it is king:
- It works every single muscle in the body (with a heavy emphasis on your legs and upper back)
- Has great carryover to athletic performance tasks (think jumping and sprinting)
- Improves your ability to perform various tasks of daily living
- Builds a sweet set of buns
Seriously, what more could you want?
However, with these amazing positives, there is one big fat caveat that we need to consider.
It needs to be performed with damn good technique.
See, the deadlift is pretty complex movement.
Moreover, the way in which the bar is positioned during a deadlift (in front of your body) means that it naturally places a lot of shear stress on your spine.
Now, to be clear, this is not a bad thing.
When the deadlift is performed correctly, this shear stress strengthens the muscles of your back and trunk. And the result? Over time your back becomes more stable, and less injury prone.
But, if your deadlift technique is poor, then this shear stress is not going to be a good thing.
In fact, it may even result in injury.
What we could only consider ‘not so good’ (AKA my eyes are bleeding) deadlift technique
Good Deadlift Technique (AKA How to Deadlift)
What does good deadlift technique look like?
While there may be some slight variances in deadlift technique between individuals (things like stance width and hand position, for example), there a few general rules that must be adhered to at all times.
- Your whole foot making even contact with the ground
- Armpits positioned over the bar
- Back in a neutral position
- Head in line with spine (so not looking too far up or down)
- Bar positioned over your shoe laces
- Hips back, feeling a whole lot of tension in your hamstrings
If you tick these six boxes, then you are in the prime position to perform a safe and efficient deadlift.
And it should look a little something like this (performed by yours truly):
But (there is always a but…), it does need to be said that not everyone will have the mobility required to get into the bottom position of a deadlift safely.
Which begs the question…
Do I Need To Deadlift From the Floor?
In short, no — you do not.
While I am a firm believer that everyone should deadlift in some way, shape, or form, I also believe that you need to tailor an individuals exercise prescription to their current capabilities.
This means that very few people will actually be able to perform a barbell deadlift from the floor.
Or at least in the initial stages of their training journey anyway.
Which is fine.
See, we have a myriad of deadlift variations available to us that offer the same benefits. Importantly, most of them are easier to perform than a traditional barbell deadlift, as they don’t require quite as much mobility.
In short, they are harder to stuff up.
Then over time (as you become more competent at the movement), you can gradually transition into performing a deadlift from the floor.
The Best Deadlift Variations
With this in mind, I thought I would outline my favourite deadlift variations.
I normally prescribe each of these in the order listed for 4-6 weeks each (before moving onto the next one), for 3 sets of 8-12 repetitions, twice per week.
By the end of the process, you will be in a very good position to start deadlifting from the floor
- Elevated Kettlebell Deadlift
- Sumo Kettlebell Deadlift
- Trap Bar Deadlift
- Romanian Deadlift
- Conventional Deadlift from Blocks
- Sumo Deadlift
As I am sure you can see, these exercises become gradually more challenging.
In this manner, each progressive variation requires a little more mobility, and becomes a little more complex.
However, once you have spent a good 4-6 weeks training each of them you will have your deadlift pattern down pat.
As a result, you will be primed to start deadlifting from the floor!
Take Home Message
The deadlift is an incredible exercise, however, there is no need to perform it from the floor if it sits outside your current capabilities. In fact, you can perform a number of deadlift variations and get exactly the same benefits.
So give some of the variations listed in this article a go, and make sure to let us know what you think!
About The Author