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Episode 71: Inbetweenisode - Can You Really Walk Your Bones Stronger?
1.1k Plays5 months ago
Welcome to Episode 71 of the Movement Logic podcast! In this inbetweenisode, Sarah analyzes a recent NY Times article about exercise and bone density. How much do they get right, and how much do they get wrong? You’ll have to listen to find out!
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Transcript
Introduction to Movement Logic Podcast
00:00:02
Speaker
Welcome to the Movement Logic podcast with yoga teacher and strength coach Laurel Beaversdorf and physical therapist, Dr. Sarah Court. With over 30 years combined experience in the yoga, movement, and physical therapy worlds, we believe in strong opinions loosely held, which means we're not hyping outdated movement concepts. Instead, we're here with up-to-date and cutting-edge tools, evidence, and ideas to help you as a mover and a teacher.
Purpose of Shorter Episode
00:00:35
Speaker
Hello, and welcome to the Movement Logic Podcast. I'm Sarah Court, and I am here solo today for a shorter chat than usual, or what we are calling an in-between episode. In other words, it's between regular episodes.
Correction on Past Episode
00:00:50
Speaker
In this in-betweason, that is the in-between seasons period that we find ourselves in right now, Laurel and I are addressing some smaller topics that arise frequently around the topics we cover on our show. Before we get into it, however, I have a small correction to make from a previous episode.
00:01:09
Speaker
In episode 69, our interview with Adam Meekins, we talk at one point about whether everyone in the medical field should have a quote-unquote patient-facing job, or if some people are better suited to research or other aspects that don't require a constant human interaction. Because, you know, it can feel like a tsunami of humanity sometimes when you're seeing patient after patient. And so I mentioned that our friend Trina Altman's husband, who is a radiologist, that that job really suits him to a T as it requires little to no human interaction at all. But I neglected to mention his name, which was a massive oversight on my part and one that I will now correct. His name is Farzod.
Discussing NY Times Article on Bone Health
00:01:50
Speaker
All right, so in today's In Between a Sode, I am going to discuss a recent New York Times article called How to Strengthen Your Bones with Exercise written by Danielle Friedman.
00:02:00
Speaker
and I'll link, of course, to that article so you can read it as well. I'm going to talk about what the article gets right, what it gets wrong, and what it gets confusing, which you'll see what I mean as we as we go forward. So this article first appeared in the June 5th, 2044 edition of the newspaper, and it talks about why postmenopausal women are at the greatest risk for developing osteoporosis, and thus the potential sequelae of falling, broken bones, and hospitalization. It discusses different forms of exercise that women can do and emphasizes that it's never too late to start. Now, there's a part of me that once that wants to give them credit, honestly, just for writing about menopausal and postmenopausal women at all.
00:02:45
Speaker
This is a very freaking low bar to get credit just for writing about it, but historically this demographic and our needs have been largely ignored or dismissed. So small yay just for that. All right, so the article starts with an inspirational story about a woman who, when she discovered at age 50 that she was at high risk for developing osteoporosis, began training to run marathons. She also worked on her strength and her balance and she has gone on to run marathons for the past 15 years and avoided an osteoporosis diagnosis using exercise. Fantastic. Hooray. I love it. Great opening. That story is a real life example of the main message of the piece, which is that, as I said, postmenopausal women are at the highest risk of osteoporosis.
00:03:33
Speaker
but that it's never too late to start building bone and that you can see meaningful changes at any age. So I am on board with this part of the message just big time. That's absolutely correct. And it's really what we need to be seeing put out there by the medical profession and, you know, movement teachers like us. And it goes on to explain how the reason why women who are postmenopausal are at the greatest risk is that the drop in estrogen that occurs is what causes this potential decrease in bone density because it's a very important hormone that plays a part in bone density generally for women. So awesome, great. So far, so good. I'm happy with this article, no notes, pleasantly surprised.
Strength Training for Older Women
00:04:18
Speaker
And then they go on to have ah Dr. Kate Ackerman, who is an associate professor of medicine at Harvard Medical School. And she admits that for a long time, medical doctors were afraid to push their older patients to strength train
00:04:31
Speaker
for fear of fracture, and that this was a mistake on the doctor's parts. And she is quoted later in the article as saying, quote, we used to be really nervous about older women in particular and having them do too much. We did them a little disservice because they got nervous to move because they thought they would break.
00:04:52
Speaker
I'm just laughing because, you know yes, she's admitting that they that they did them a disservice, but in her language, it's only a little disservice. I'm like, it's a freaking massive disservice. But anyway, nobody likes to admit they're wrong. So I see so much of this fear of movement with my older female patients. So I'm glad that someone in the medical field is admitting that the messaging needs to change. you know I work in an outpatient orthopedic setting, so I see patients of all ages, but pretty much every single older woman that I treat shows up never having lifted anything heavier than 10 pounds, and they are genuinely concerned that they will hurt themselves if they do. i Sometimes I feel like I'm running a disinformation campaign every day, and
00:05:44
Speaker
As a result, I've started to hold ongoing beginner and intermediate weightlifting classes for patients of the clinic who have graduated from rehab and for whom it would be appropriate. And i get I get a lot of older women in the group, which is promising. And I do think generally the tide is turning on this. I'm hearing more medical doctors promoting exercise over medication in cases where it's indicated. But, you know, anything in the medical field, it's like trying to turn a gigantic ship. It's very awkward and cumbersome and it can be a decades long process. But it is exciting to see someone in a higher education setting, right? This doctor works at Harvard Medical School. It's exciting to see them promoting this message because then
00:06:29
Speaker
At least we're going to see doctors being educated about exercise for osteoporosis. So, so far, totally psyched. Article's doing great. It's accurate. It's inspiring. It's placing a little bit of blame where it's due. So far, so good. But then, of course, everything goes a little sideways.
Critique of NY Times Article on Exercise
00:06:46
Speaker
So here's what happens. Friedman goes on to discuss cardiovascular exercise as a source for bone density building. But at no point mentions that the value for bone density building is going to start to run out if there isn't also external resistance more than body weight. And that the resistance itself will also require variety and progression in order to maintain efficacy for bone building.
00:07:15
Speaker
Okay, so let's break it down. So Friedman states at the beginning that most exercises are good for your bones, which is true-ish, ah but it's not as true as it could be. And I'm gonna tell you why in a second. So she says the best cardio to choose is something that requires you to bear your own weight. So think something like running instead of a stationary bike or walking if you are particularly deconditioned. So what she neglects to mention is that our bones and muscles require progressive overload to continue to respond to any type of load, even just your body weight. So that means that even for the most deconditioned person, the body weight involved in weight-bearing cardio is pretty quickly going to stop being impactful for bone density, maintenance, or increase. And I am very pro-walking. I just want to say I love walking. I think it's great for lots of other reasons.
00:08:11
Speaker
There's even a research research paper that's come out about walking for low back pain, which is great. But the point of this article is about promoting bone density. And there's just no, there's no point where she talks about once this gets too easy, then you need to progress to this. Because here's the thing. If all it took to maintain your bone density, was to be upright and doing exercise with your body weight. The woman in the inspirational story at the beginning of the article would not have been at risk for osteoporosis, as she had reportedly, quote unquote, always been active chasing around after her daughters and the dog. So if body weight movement was enough, the only people who would be at risk for osteoporosis would be the most sedentary people or people who are immobilized for some reason.
00:09:03
Speaker
Those are the people that would be at most risk to develop osteoporosis, but that's not the case because there are plenty of women doing yoga and mat Pilates and even reformer Pilates who are also either diagnosed with or at risk for osteoporosis. So if I was going to rewrite that sentence, most exercises are good for your bones. I think a more accurate statement would be most exercises are good for your bones, at least to begin with. That sentence would have made me much happier and could have led to a more accurate piece overall. all And this is what I just, I hate about pieces like this because they get about like 50, 75% of the way there. And then I don't know what happens. They just like pass out from the effort or they run out of word counts or they don't bother fact checking with any other movement professional besides a Pilates instructor. How about a physical therapist? I'm available in New York times.
00:10:02
Speaker
So if you're reading this piece and you don't know much about what impacts bone, you're likely going to come away with the impression that if you're not especially fit, you can just walk. If you're fitter, running will be enough. Some people can do weightlifting and strength, but not everyone. And definitely not people with osteoporosis already because they could fracture themselves. Also, by the way, you should also work on your balance to avoid falls and PS don't twist or flex your spine. If you have osteoporosis ever, which very much feels like a tacked on cover your ass from the lawyers at the New York Times. So this is just another example of the kind of mixed message that leaves people relying on types of exercise that will not give their bones what they need long-term, right? Just another day of decoding incorrect information in bone health advice. And I think part of what makes this article go haywire, from my opinion,
00:10:55
Speaker
is that the author starts by discussing cardiovascular exercise. And she probably starts there because there is still a lot of messaging in the medical field that body weight is enough to build bone. And as we've said, it can be for a while, but it's not going to be enough for long. And that message is completely missing from this piece. If she had started with discussing resistance work and saying, you know, try to lift weights. If you can't lift a weight, try resistance bands. And then added, you know, if that's too hard, you can start with body weight exercise.
00:11:29
Speaker
And then you can also, you know, add some weights to that, right? If she had started by discussing the strength aspect for it, it would have been a much clearer story. But the problem is that this piece ends up being inaccurate by omission, right? It would be fixable with just a few extra sentences tacked on or some referral to all of the research on women with osteoporosis successfully lifting weights and either stopping or regressing the progression of it, you know, hello, lift more trial and the requirements of progressive overload. Right? Generally speaking, one of the biggest problems that I see around the issues of osteoporosis and building bone currently is that the messaging from the medical field, from yoga and from Pilates and from media sources like this one is that body weight or weight bearing exercise will suffice forever and ever. Amen. And not only do you not need to progress to external load, but it might be dangerous.
00:12:28
Speaker
Meanwhile, we have the LIFTMORE trial and many others that show again and again that not only is it not dangerous to lift, if you have osteoporosis, but that when it's correctly programmed and progressed, it is the only thing that provides meaningful change over time to bone density. And it is perfectly safe for the vast majority of people. So the more accurate message would say something like this, While most exercises are beneficial for bones initially, your bones need progression and variety in the types of force they are under, which is going to require more than just body weight work. Weightlifting has been proven by research again and again to be perfectly safe for everyone, including those who have osteoporosis already. Progressive overload and impact training, which is completely missing from this piece, are required to continue to improve bone density
00:13:26
Speaker
yoga, all kinds of Pilates, and whatever your cardio preferences are, will not be enough to benefit your bones long term. And that's it.
Frustrations with Exercise Misconceptions
00:13:36
Speaker
So that's the article that I wish had been written, ah but you should definitely still check it out. And, you know, it's sort of that, it's that hard situation where you're like, well, at least they're talking about it sort of, but does that outweigh the fact that the information is not super correct. And you know sometimes people but end up defaulting to, but at least people are exercising, which is better than nothing because there's some horrible statistic like 75, 80% of people in this country do not exercise at all. And that's true. But if we're focusing specifically on bone density, which is the gist of this piece,
00:14:17
Speaker
it's not accurate to say any exercise will do. It's just not. So the article really needed a lot more nuance. And I think honestly, three or four more sentences would have would have made it much more accurate. so And I say this with love. The New York Times always writes health and medical articles that are about 10 years behind what everyone's talking about. Like very recently they were like, have you guys heard of fascia? You know, so, you know, points for points for attempting to address the subject, points off for not using the research that has been shown time again to be what actually makes a change. All right. Well, that's it for me. Thank you so much for tuning into this in-between episode of the Movement Legend podcast. If you like what you hear generally, please leave us a rating or a review.
00:15:10
Speaker
and even subscribe. That would be fantastic. We love reviews. Laurel in particular loves reviews. She checks them a lot. So listen, make Laurel happy. Just write us a little review. You love us. You want us to know it. You want other people to find our podcast. So do we. Let's help them
Conclusion and Call to Action
00:15:28
Speaker
do it. In addition, please make sure you get on the wait list for the Bone Density Course 2024. which we are launching in October. The waitlist is the only place where you're going to hear about the only discount available for enrollment. And everyone on the waitlist is getting every month just a fun little tidbit from us. Sometimes it's a PDF. Sometimes it's a podcast interview. Thank you all so much. We have, I believe, one or two more in-between episodes between now and season five. And then season five starts with a bang on July 17th.