Transcript
Speaker: So I would say your goal is fall prevention. I wouldn't pick yoga. um And especially yoga is very variable. So telling someone to do yoga is like telling someone to take medication. There's been doses and ways of doing it, right? yeah So I think if you're insisting on using yoga as your method of exercise and you want the most fall prevention benefit, then you better pick one that is incorporating a lot of dynamic stuff, reactive control, those sorts of things.
Speaker: But it wouldn't be my first choice as I have Valpermancheek. I'm Laurel Beaversdorf, strength and conditioning coach. And I'm Dr. Sarah Court, physical therapist. For too long, women have been sidelined in strength training. Oh, you mean handed pink dumbbells and told to sculpt?
Speaker: Whatever that means. We're here to change that with tools, evidence, and ideas that center women's needs and voices. Welcome to the conversation.
Speaker: Welcome to the Movement Logic Podcast. I'm Laurel Beaverstorf, and I'm here with my co-host, Dr. Sarah Court. What's up? What is up? but Things are good, generally speaking.
Speaker: um i i you know This is a completely personal thing, but i don't know if other people struggle with this, but I've i've been working on not being late.
Speaker: Do you ever struggle with that? No, but no never. For example, when I used to work at at the clinic that I used to work at, it's about seven minutes from my house. You would think I would never be late, but because it was so close, I was always coming like screeching in with like 30 seconds to spare. And it would be definitely, the the clinic owner did not appreciate it. um And so I'm, I'm,
Speaker: I'm working on, on like, not the the problem happens in the before where I'm trying to figure out how much time I need to get to where I'm going. And I always underestimate it or I estimate it correctly, but then I just get super involved, fast, faffing around with something unrelated that I shouldn't have started working on that took too much time. And then by the time I actually leave, I'm, I'm know that I'm going to be late. So I'm now trying to not do that and leave like an appropriate amount of time to get somewhere, but I don't know how to gauge it. And so far when I've done it, I've showed up places like half an hour early because I don't know where the actual middle ground is. So that's what I'm working on lately. You're just going to get more and more accurate the more and more attempts you make. So I believe in you. I think you can do it. Thank you. I, in the last year have started setting alarms in my phone.
Speaker: So I'll set alarms. I'll look at my schedule the day before and I'll say or even like a week before and I'll set an alarm in my phone for when that appointment is going to take place. But I'll usually set it like depending on where it's happening, if it's happening in my basement or if it's happening somewhere in town, I'll set the alarm for like five to 20 minutes. before the thing. And um so anyway, that's been very helpful for me, not just missing appointments, which is one my problems. Yeah. My problem also with stuff like that is i'll I'll set the alarm, the alarm will go off, I'll silence it, and then I'll just forget about it completely. I just keep faffing around. Like I don't take the alarm seriously enough. yeah so That happens to my morning alarm, but the faffing is just me going back to sleep. um All right, well, let's let's get into it. So we have ah a very, very amazing guest today. Before we learn about her and hear from her, um we have a free class coming up for anyone who wants to learn more about the course, Lift for Longevity, that we are running for the fifth time. are we Is this the fifth time we're doing it yep This is round five of Live for Longevity. um Our free class is on September 8th, 9 a.m. Pacific, 12 p.m. Eastern. It's one hour. It's going to give you the experience of the first actual workout in the program. and you get to ask questions and learn more about the course. If you would like to hear and be able to sign up for that free class, the best thing that you can do right now is make sure that you are on our interest list. This is a special list of people that we have, ah you know, learned are interested in this course in this free class. So you can go to the link in our show notes and get on the interest list.
Speaker: if you're not If you're on our regular mailing list, you also have to sign up for this separate like subcategory list. like Just being on our main mailing list, you may miss stuff. So you want to make sure if you're interested that you get on this interest list.
Speaker: Awesome. All right, so now let's get into who we are talking to today. Her name is Dr. Laura Gian Gregorio, and she is a professor in the Department of Kinesiology and Health Sciences at the University of Waterloo.
Speaker: She's also a Tier 1 Canada Research Chair in Bone Health and Exercise Science. She earned her PhD from McMaster University and her work spans osteoporosis and bone health, clinical exercise physiology, aging, clinical trials and knowledge translation. And you are going to hear in this interview that she is An exceptionally good science communicator.
Speaker: Dr. Gian Gregorio leads research aimed at reducing the burden of osteoporotic fractures. Her team studies how bone and muscle respond to physical activity, it investigates exercise interventions for people at high risk of fracture, and it works to translate that research into practical recommendations for clinicians exercise professionals and the public. She also has collaborated with Osteoporosis Canada on initiatives including BoneFit and the Too Fit to Fracture exercise and physical activity recommendations. So today we get to talk with her about what exercise can and cannot do for bone, how we should think about resistance and impact training, and why building bone density is only one part of reducing fracture risk.
Speaker: Sarah, we have already spoken with her. we have. Spoiler alert. It's one of those, you know, where time ceases to have meaning kind of situations with podcasting. So anyway, not to give any spoilers, but like this was probably one of our best interviews because it was fully on the sort of seed topic of this entire podcast, right, which is bone density. And we got like like the foremost expert in this area. We got to ask her all of our questions and some questions from Instagram. And I just thought it was like a treasure trove, a very dense delivery, but very clear delivery of a lot of a lot of information that um
Speaker: I don't think we've ever packaged so thoroughly into one single episode. What what do you what do you think? Yeah, no, I mean, she's she's an incredible, as you said, science communicator in the sense that she can take these these topics that are very often dry and dense and hard to parse and understand, like, what do they actually mean? Like, what are these studies actually showing us? She's very good at taking that and explaining it in language that we can all understand. And um we were just joking before how like she she is such a science communicator and such a a researcher that she won't make those sort of like very certain this is the answer statements that you often hear on social media from people who are trying to get you to buy something. And, you know, her language is always filled with sort of like
Speaker: maybes and shoulds and might and cans and this is what we're seeing and it looks like this is happening and I was joking with Laurel before this that like I kind of aspire to that level of accuracy right in my in my sinus communication because there's there's there's never a claim that isn't uh actually evidence-based. And so as a result, there's not a lot of like really strong claims going on. There's a lot of like, this is what the evidence seems to suggest, which is the most accurate way that you can talk about it. It just doesn't make for, it doesn't make for a great reel on Instagram, but like. Like virtual virtually every declarative statement is qualified yeah by several more people.
Speaker: caveat-esque type yeah yeah statements, but that's really what responsible science communication looks like because science is not ah it's not set in stone. It's not black and white. It's not about necessarily even answers or the truth. It's about, as she said in the episode, getting closer to approaching the truth, right? Getting closer to it. We're very excited for you to hear from Dr. Laura Gian Gregorio.
Speaker: Thank you so much for joining us, Dr. Gianne Gregorio. Laura's great. Thank you. again You're welcome. Thank you so much for for coming on the show. We've been big fans of your work.
Speaker: And we actually, yeah, we encountered you several years ago. i think it was several years ago ah because we were getting a lot of questions about...
Speaker: This is OsteoStrong. osteostro yeah and some of the claims that they were making about their machines and their clinics and and people who were asking us about osteostrong and what we thought are like what is this place and i mean when i looked into the claims i was like wow this sounds really impressive and positive Then I dug a little deeper and found... impossible....Bone's Lab, which is your YouTube channel, in which you did just a thorough breakdown of what the claims were and what the evidence were it was for the claims. And i was like, okay, so I just shared your videos with everybody who asked us about osteostralion. I have to actually do an updated one because there have been a few other papers published that certainly support...
Speaker: The idea that the claims are not what they seem. Okay. There was actually, i don't know if you want to get into this. Yes, please. So there was actually a Greek study that was published that the reporting, research reporting didn't meet um typical standards and didn't meet the journal's own standards because they do say you have to meet these standards to be published. Like it's a reporting guideline that you have to meet.
Speaker: And so I went through the reporting guideline and they hadn't reported any of the things in it. And I said, this is really surprising that they would publish this. And, you know, with the methodological, like the reporting, that the quality of the research design and all that. There was a bunch of things that didn't seem right. So we wrote, myself and Rob Daly wrote a letter to the editor, as did a number of other researchers, because everyone was pretty surprised that it got published. Because it's a really high quality journal.
Speaker: And we wrote a letter to the editors. And we actually wrote it to several editors because we wanted to make sure that it didn't get missed. And the reason is because the senior author was on the editorial ward of the journal, so we weren't sure if there was something going on there. So we sent it to several editors and... um They kind of said, we'll look into it. And we didn't hear anything for months. So in the meantime, the paper is there. And the you know there's all this Osterstrong media saying, oh, new paper. Awesome. Shows Osterstrong is great. And it was up for months and months and months. And then all of a sudden, it was quietly removed and replaced with an entirely different article. I guess they gave our letter to the authors and made them rewrite it, which is not typical. When you do a letter to the editor, usually you would publish the letter so that there's transparency.
Speaker: And then the authors are usually allowed to respond. And that's also public. And none of it was public. The new paper is somehow an entirely different study design, which it don't usually change the study design for the fact.
Speaker: So that was really surprising to me that, again, they were allowed to sort of change that. And I think the reason that happened I'm speculating, by the way. I don't know the editors or the authors or anything like that. But one of the points I raised was that they had initially listed it as a clinical trial.
Speaker: And most medical journals require that you register clinical trials and they won't publish them unless the clinical trial is registered. And the reason for that is because of transparency. So...
Speaker: If, let's say I do a clinical trial and I want to know, does jumping up and down increase bone marrow density of the lumbar spine, right? That's my primary outcome. my primary question. and Let's say I don't register my trial or tell anyone my plan and I do my study and I see, oh, well, there was no change in the lumbar spine, but there was a change at this weird...
Speaker: hip, leg, angle, like some other outcome, right? I can actually just write a paper and say, oh, look, it changed the hip and not mention the lumbar spine at all, right? So I can kind of change my focus because the results didn't align with my narrative. So the idea of registering is you kind of say, this is my plan in advance so that you can't change the analysis or change the plan after to align with your hypotheses or your narrative. So they didn't register their trial.
Speaker: Or at least I couldn't find a clinical trial registration. So I raised that with the editor. I'm like, there's no registration here. Right. It's not listed in the methods. I can't find one anywhere. So I think they changed the design so that they didn't have to list a clinical trial registration. That's the only reason I can think of. Like, why would you change the design otherwise? Right.
Speaker: So and this that's my my my speculation. I don't know. i don't know. I'm not trying to, you know. that like of course I can't figure out why they would go from it's a clinical trial to it's a 160 person series.
Speaker: And it doesn't actually meet the definition, like case series. You're not supposed to do experimental interventions with case series. So its it doesn't really meet the definition. So they change it to a case series. i mean, this is lots of research stuff. So I do need to do a new video because there's that trial. There was a trial in in Australia that showed no effect, um but it was a pilot. So we can't really make conclusive statements from that.
Speaker: And then there was another trial that was done at the Karolinska Institute, and they actually did an exercise intervention and compared it to osteostrom, and neither intervention increased bone marrow density.
Speaker: Now, their exc exercise intervention was probably not super high impact or super high intensity strength training. So that might be why they didn't see a a change in the x exercise group, or maybe the exercise doesn't work as well as Fetal Bank. Who knows? There could be many things, but the... Well, can I say something? Yeah, yeah. It seems like their business model is working great, though, because there are osteo-strong clinics all over the place. In fact, I've seen them in person just randomly traveling around the United States doing whatever I was doing.
Speaker: And so it seems like. murdering Yeah, it seems like they got the marketing really dialed in. But the science behind their claims is pretty unethical, would you go as far to say?
Speaker: So i I will just say, like, I'll speak to the bone outcomes. I don't think that there's evidence to support claim that it increases bone strength.
Speaker: I don't think there's evidence. Whether there's evidence for other outcomes, I haven't done that much of a deep dive. But I also noticed that they've changed the messaging on their website. So it's not as...
Speaker: you can reverse your osteoporosis type of messaging. I think they dialed back the messaging a little bit. I guess what concerns me with this kind of thing, and it's not just them, there's other people who do this, is that you're taking a group that they've been given a diagnosis that creates fear.
Speaker: Right. So people are told you have low bone mass, you're at an increased risk of fracture. And there's that that kind of stereotypical image of, you know, someone bent over with a cane or someone, you know, who's who's had fractures. and And now they're afraid to do things because they're afraid that if they go and and do some activity, that they're going to break something.
Speaker: And so you're you're actively marketing your thing and trying to make money off of this vulnerable group because of fear. So that's why I'm so vocal about it, because I feel like, oh yeah you know, I don't think it's fair to try to take advantage of people.
Speaker: And I'm not suggesting that they're doing that, by the way. I'm just saying that that's the end result. is If you're saying this is going to increase your bone density, this is going to reverse your osteoporosis. to a group that it's it's a very attractive message to a group that has a lot of fear and then they're going to spend their money on it. So it's, to me, a concern because you you then better know that it's actually true if you're going to do that. So that's my opinion. If you you're making that claim, then then you you should have like moderate to high certainty evidence that that's actually true.
Speaker: And there's other companies that are doing that as well. It's not just that are marketing... to that audience. I'm not suggesting like they're intentionally doing unethical behavior. I think they probably believe their intervention works based their perception of the evidence that exists. So I'm not saying they're intentionally trying to be unethical. I just I personally think that you need to have a bit more confidence in the evidence before you try to make those claims.
Speaker: Well, i do know that they are intentionally trying to make a profit. So sometimes... Trying to make a profit. Sometimes, what is the ah the quote from Upton Sinclair? It's difficult to convince a man that he is, you know, wrong or he is being, you know...
Speaker: inaccurate in his claims if his profit margin depends on, you know, the the the things that he's saying being true or something. I mean, I totally butchered that. But like, I think what we're looking at here, if we're charitable, is that they are ah making claims with a high level of certainty that have low to no evidence behind them because they are a for-profit company and certainty sells.
Speaker: I just wanted to say also, You know, we've seen sort of this expansion online, certainly in the in the muscle and bone and, you know, people are interested in exercise of of people, you know, pointing at a study and being like, this is proof. And this is such a classic example of that, where, you know, a typical osteo strong potential customer.
Speaker: is unlikely to have the research wherewithal to be able to go into the studies, actually look at them, actually, you know, ah contradict what osteo strong is claiming that they say and say, actually, no, I don't think this is true.
Speaker: So that's, that's the part that always, that makes me so frustrated with stuff like this, where, you know, because, because people are being encouraged, which is the right thing to do, people are being encouraged to pay attention to evidence, but Evidence is getting thrown around a little bit like, look, here, look, here's some evidence. Here's some other evidence over here. Here's some more evidence. and people people don't understand the difference, I think, sometimes between Based on the the message that the person pointing at the evidence is saying, I think it's very hard to to know without having at least some sort of scientific background whether or not this evidence actually ah says what they're claiming it says.
Speaker: i This is um like all over social media, these types of things. So you see... The problem is there is a large spectrum of quality of evidence, right?
Speaker: And, you know, if you are persistent enough or you have enough money, you can publish research. So it doesn't have to be good. So what is the osteo-strong papers was published in a predatory journal? Or what I think is a predatory journal. I can't say for sure.
Speaker: OK, because there's no formal definition or whatever. But um what I'm pretty sure is a predatory journal where they basically can pay money and have it published with very little peer review. Right.
Speaker: There are other examples. So I was on social media the other day and I saw someone who has very good intentions. And again, these are don't hate to call it out because I think people have good intentions. So they they find a study. It aligns with their pro science narrative.
Speaker: And they go, look at this study. It shows, so there's this one study that looked at bone structure in the spine. And they were engineers who did this study. And they looked at bone structure in the spine, not using a clinical measure that is used for looking at bone.
Speaker: their study showed that they could increase bone structure. So this person was like, it's not just about bone density. You can increase bone structure too. And this study shows it. And this is what it said. And these are the exercises they did. Now, now all of a sudden we're we're going, okay, you should do these exercises from this study because of this evidence. And the problem is this was a study that was published in an engineering journal, not a medical journal.
Speaker: And it didn't therefore probably get the same scrutiny because like people who are peer reviewing for that journal aren't going to understand clinical trial design and and the types of things you need to do.
Speaker: So there was like a over 40 percent attrition rate in this study, like over 40 percent of people dropped out. The sample size was very small. It was not well designed. Like I would not use that study to make imprints as. So I'm not suggesting we shouldn't promote exercise, but like that's not the study you want to use. And you should shouldn't then go, oh by the way, you should do the exact exercises from this study. And oh, by the way, I'm selling a jumping program. You can use, come inside my program that I'm selling. Shouldn't I? So I get it. Like you're trying to promote science communication. I think that the intentions are good, but now you're selling something and you're selling something based on evidence that is not very good.
Speaker: And that, that troubles me. And it seems to me like this is the new thing. There's exercise personal trainers and even exercise physiologists and other people who are positioning themselves as science communicators, but they don't actually understand how to read science.
Speaker: Right on. Right on. All right. We're going to get into it. Okay. Uh, We had to talk about Osteostrom for a bit because that was the way we we learned about you. But here's here's a question for you. can women Can women still build bone during and after menopause?
Speaker: Or are we mostly just trying to prevent bone loss? It's a hard question to answer. So during menopause, people, during the menopause transition, so this is like a little bit before, a little bit after, women or females will lose bone, right?
Speaker: That's a hormonal thing. And I don't think you can entirely prevent that with exercise. So that's number one. So I think that, you know, you can have good intentions and take your calcium and your vitamin D and all that stuff.
Speaker: I don't think you can completely prevent that loss because it's not a lack of loading that's causing that loss, right? It's a hormonal change, right? And, you you know, the the thing, though, is is that the amount of bone people lose is quite variable.
Speaker: And we don't know exactly why some people lose more bone than others, right? Then there's the whole, like, where are you starting? Are you starting with a T-score of zero? Are you starting starting with a T-score of minus one?
Speaker: Because that may also influence how much you... can build and all the different things that influence bone turnover. There's a lot of different things. So every person kind of has a different cocktail of hormones and starting level of bone density and genetics and all these things. And so you're going to have variability in where they start and you're going to have variability in their response during or what happens during menopause. And then probably you're going to have variability in their response to exercise.
Speaker: There's not one answer. Like you I can't say yes, for sure, all women can... you know, have huge increases in bone density or can prevent the loss. I do know that there are studies, mostly either done pre-menopausal or post-menopausal, not that many in the transition phase, that show that you can have small between-group differences. So we compare the control group to the intervention group.
Speaker: There is people who do strength and impact training combined, usually that's the interventions that that they do, will have a um higher and bone density than the people who don't.
Speaker: In some studies, that manifests as a prevention of loss. And in some studies, it manifests as the exercise group increased a little bit and the control group lost a little bit. And so that's your between group difference, right?
Speaker: um So that's what happened in Livermore, right? So the exercise group saw and a small increase in bone mineral density and the control group saw a small decrease in bone density. And the difference between the groups was statistically significant.
Speaker: And I think you see that in other studies as well. And I think that difference also depends on the type of exercise. So I think in some studies, you might see... more of an increase in and other studies, it might be more of a prevention of loss. And then there are studies that show no benefit as well, right? So there's quite a variable response and we need to tease out why that is. i think some of it is based on, you know, baseline variability. So give me a good example.
Speaker: We're doing a strength training study right now. We had a woman in our study who was in the high intensity strength training group. And I know for a fact that she experienced a large drop in bone density. And that's because she had underlying hyperparathyroidism that was not treated.
Speaker: And so you're going to have this variability and this is normal and this is going to happen. And and that's the other reason why i struggle we have these really small trials, because The small trials tend to have the keenest of keen and the healthiest of healthy people.
Speaker: um And so you don't necessarily see some of this more variability that you would see in the general population. Also, some of them will exclude people for various reasons. So they might go oh, well, we shouldn't include that person because they have this parathyroidism issue.
Speaker: And so all of a sudden, if you start picking and choosing who's allowed to be your analyses, it can start to align very much with your pro-science narrative, right? What I'm trying to say, this is is a really long answer, I'm so sorry. It's okay. Is that?
Speaker: I think probably we can increase bone mass by a small amount with exercise and or in some people it might be more of a prevention of loss. And a lot of that depends on your baseline bone density and all the other things that influence your bone health.
Speaker: Cool. It does. It does. I have a follow up. How much of bone loss around midlife would you say is attributable to menopause versus to inactivity?
Speaker: I think you have both and not just inactivity. Like I said, there's a many, many things that influence bone strength, right? And so people who under eat for the amount of calories they burn, who are very thin, tend to have very low bone density, right? So this is, we know this, this is a risk. So that's one factor. And women, you know, there's a lot of imagery and messaging that promotes thinness in women. So, um you know, that's going to be a factor. And that's one that doesn't get talked about enough, I think. People focus on, oh, it's just because you're inactive or you're not lifting the heaviest of heavy weights. And it's like, well, no, actually, there's many factors that contribute to your bone health.
Speaker: So people have celiac disease, people have rheumatoid arthritis, people have, you know, family history. These are all things that influence bone strength. But yes, that period around menopause, many females will lose bone and it's quite variable.
Speaker: Then there's going to be the the layer of age-related bone loss that everybody experiences, right? And so maybe you might be able to prevent some of that. And then there's all the other things, like if you have celiac disease, if you have prolonged periods of immobility, if you have other hormonal issues that influence bone, rheumatoid arthritis is another one because that's a risk factor for fracture. So...
Speaker: um If you have very low body weight, if you have a strong desire for thinness or um um even an inadvertent under eating. So we see that a lot in athletes who burn a lot of calories, right? So pete cyclists, any endurance sport where you're burning a ton of calories, if you don't, um you know, eat enough and you have a very thin physique.
Speaker: you could be actually affecting your bone strength. So many endurance athletes, they can experience relative energy deficiency in sport. And sometimes that's just inadvertent under eating, right? I don't think if there's like, it's only hormones. It's only inactivity. It's all of these things. And the more things you have that cause bone loss, the more likely you will then slip into that range where you are now osteoporotic and in hybrids.
Speaker: think sounds like yeah It sounds like we maybe need to change the way we think about bone density, osteoporosis, osteopenia a little bit where I think, ah or maybe our messaging a little bit where where I think it's gotten very sort of like...
Speaker: um focused mostly on either the exercise you need to do or like take your calcium or whatever. But but then in actuality, it's perhaps more like something like dementia, where it's like there's actually 14 different risk factors that you could be working on.
Speaker: Yeah. Right. and well And it's not all of them you can work on. Right. Exactly. Some of it's genetic. Change your parents. Yeah, exactly. know Yeah. So there are many things that employee you can work on the modifiable ones. right And so that's why I really don't like this whole all you need to do is lift heavy weights and you'll be fine. It's like there are some people who, despite doing that, have other risk factors that are going to cause bone loss. So and, and you know, because then you set people up for like, you know, judginess of like, oh, well, you have osteoporosis. No, it's.
Speaker: There's many, many things that contribute to bone strength. And you can do what you can with the modifiable risk factors. So you can try to do strength training. You can try to get adequate protein, calories, calcium, vitamin D. But like when you look at the research on calcium and vitamin D supplementation, it's not like it moves the dial that much on fracture risk, right? So you need enough calcium and vitamin d to avoid excessive bone loss, but it's not you know going to cause huge increases in bone loss. Unless you are very deficient and now you replace it, you might move the dial a bit because now you've you're you're fixing a modifiable risk.
Speaker: yeah But it's more like you need enough to try to prevent bone loss, but it's not going to cause huge increases in bone loss, especially if you're already close to meeting the RDA or whatever the recommendations are.
Speaker: um Yeah, I have a I have a friend who this is is exactly happened to her. She has osteoporosis. I think there's also there's both a family risk. And then she also went through breast cancer in her early 30s, went through menopause, you know, kind of the medical menopause. So a huge hormone of loss.
Speaker: then got her period back, then what actually actually went through menopause at like the right time. And because of all of that, she did a bunch of heavy lifting, and it didn't move the needle at all. And it was very frustrating for her.
Speaker: Yeah. And that's what I'm saying. So I feel like you can do what you can, but I just i i really dislike this narrative of... Oh, it's not the menopausal aging. and It's not the menopausal loss. It's just because you're inactive. That's not true.
Speaker: There are many things that cause bone loss that are not just inactivity. And some of them are not modifiable. Like you can't if you have cancer and you go on a treatment that causes bone loss, you can't like you're not going to. That's just going to not do it. You're not going to not do it.
Speaker: um and And I don't think strength training is going to counteract because it's a hormonal thing, right? It's not inactivity that's the problem. It's the fact that you are deficient in hormones that affect bone cell activity. And that's also what's happening in ah the menopause transition. So again, like certainly you can do what you can to maintain bone muscle strength and do impact loading and and try to move the dial as much as you can that way. But I don't think that's going to completely counteract the changes that we see. No.
Speaker: yeah I'd love to see more studies in people during the menopause transition to see if we can actually, you know, um prevent some of the loss that occurs. That would be lovely. But we just don't have good studies in that space. Yeah.
Speaker: Well, speaking of studies, we wanted to actually talk a little bit about how
Speaker: We've looked at that Kistler-Fischbacher, the meta... Meta-analysis. Thank you. Meta-analysis systematic. I was like, what comes after meta? Meta-analysis systematic review. And from our understanding, which is, you know, we are amateurs at this, but from our understanding, it does show that but pretty much all loads can contribute to bone building, including light. So like heavy, moderate, and light.
Speaker: At the same time, we have heard... You interviewed speaking more to the efficacy of heavy and moderate and not so much to the light. Can you speak to this a little bit?
Speaker: So one of the problems with a lot of attempts to do meta-analyses and answer questions about intensity, frequency, type of exercise is that they're all reliant on the quality of the studies that are going into the meta-analysis.
Speaker: Right. Right. And so to to really understand differences in the characteristics of the intervention, you need to have enough studies with those characteristics. And you really need to do it using meta regression, not subgroup analysis. So like if I'm trying to look at whether or not low versus moderate versus high is effective. I need enough studies in each of those categories to be able to make conclusions. I can't just have one study in that category. I need a bunch, right? We just don't have enough in each of those categories. So number one. Number two, many of the studies combine conclusions.
Speaker: types of exercise. So a lot of the studies will combine resistance and impact. So really hard to dissociate type of exercise, never mind intensity then of those things, right?
Speaker: So you're kind of throwing studies that used high intensity impact and resistance training with ones that used moderate intensity resistance training and impact and ones that used no impact and some other resistance, mean? So it's really hard to tease out those things. Then there's the other layer of many of the studies are underpowered to answer any question.
Speaker: So if you actually look at the forest plots in that study, the forest plot is basically like the effect estimate from each study and the variability around that effect estimate. And a lot of them cross zero, like they basically show no effect and the the variability or the precision, your ability to actually answer the question is very low because they have 20 people in the study, 10 in the intervention group and 10 in the controller, 30 people.
Speaker: Even 30 in each group is pretty low for a BMD outcome. So if you actually look at the forest plots, a lot of them don't even show an effect of bone density at all. Right. um Never mind your ability to discern which intensity is more effective.
Speaker: So um so they they attempted with that to do the best they could with that meta analysis and put some subgroup analyses and they didn't actually find much of a difference um across the intensity. But that doesn't mean you can conclude that there is no difference.
Speaker: Right. That's that's an entirely different question. Right. yeah um In order to be able to conclude that there truly is no difference, you actually need adequately powered studies to show non-imperiority or show that there is no difference. So we can't make a conclusion that there's no difference between intensity. A lot of people do, you can't do that.
Speaker: um But what I did was i kind of I kind of just look at, and this isn't the best, like it's not a meta regression, but i I kind of look at, okay, when we look at um across the studies, if I look at the ones that are a bit higher quality that have actually adequate sample sizes or that are actually showing an effect, what do those ones say? So I'm kind of trying to say, okay, if I look at the highest quality studies, I'm trying to discern what are they telling me?
Speaker: And on Cambridge, like i I look at them and I say, like, many of the ones that seem to show an effect are either moderate or high intensity. um And they often combine resistance and impact. So that's the best answer I have. But I can't say conclusively, this is the best or this is the only, because I just don't think that we have a body of evidence that is of high enough quality, of high enough precision to start making claims about which intensity is better.
Speaker: Right on, right on. So, sorry, can I just have one little follow-up and then we can we can move on. So, so um because one of the things that what we ran into early on when we started doing this kind of investigation and work is like a lot of kind of Pilates-based interventions or what we would consider sort of low-intensity interventions were being touted as, you know, helpful for bone density.
Speaker: So is your feeling that Between like heavy, moderate and light is the reason why we can't specifically so yet say that light works is in part due to the fact we just don't have enough evidence to show it.
Speaker: So I think there's there's two kind of things. Of the evidence, when you look at the studies that have been done with late intensity, not a lot of them move the dial, right? So the meta-analysis that was available before that one, Belinda Beck's group did that one, was one public, the Cochrane Review on the topic, which was published in 2011. So the that Cochrane Review on the topic has not been updated since 2011. Maybe it's been updated since and I haven't seen it. but um And that one showed, if you looked at light intensity, that there was there was no benefit. Like low weights is what they said. um
Speaker: The other thing we have to think about is when I don't have a good answer, i look indirect questions. So I don't have lots of studies in people with low bone mass. To answer the question, when we did systematic reviews in that population, it seemed to be that it was combined resistance and impact.
Speaker: So then you start looking at other populations, right? So you can look at like the types of sports where there seem to be higher bone densities and they tend to be ones that are high impact, high forces, multidirectional movements.
Speaker: Right. So these are basketball players, volleyball players, gymnasts, soccer players. Right. These are, you know, high forces, rapid movements, multidirectional movements, um impact. Those are the types of sports that seem to be associated with much higher than average bone density.
Speaker: Then you look at animal researches, high magnitude forces, short duration bouts, dynamic activity. So again, you're seeing a similar theme here, right? And so again, if you pull out the higher quality, larger sample size studies in meta-analyses, they tend to be combined resistance and impact ah on the moderate high intensity. So I kind of look at the spectrum of evidence that we have because we don't have a clinical trial or a meta-analysis that can answer the question.
Speaker: So going back to Pilates, I don't think, Of the studies that I've seen, like I don't think it aligns with the idea of the strong forces. Like I wouldn't promote Pilates as a strategy because I don't think that the evidence that we do have or the body of evidence would suggest that it would be as osteogenic as some other types of exercise.
Speaker: Sarah, in our course, Lift for Longevity, why do we offer two live one-hour classes every single week led by you and led by me? and That's a great question. And it's for a few reasons.
Speaker: First of all, I'm not aware of any programs available online that offered live classes really at all. Typically it's like a PDF document of the program and some pre-recorded content, maybe some tutorials on how to do certain exercises. And then it's just really up to you to kind of put the whole thing together.
Speaker: And I think for a lot of people, that's where it all falls apart because it's sort of like bringing the building materials to the building site, but then not actually building the building.
Speaker: Right. And so I think That's really good. I think that's what happens. And so we're trying to address any sort of possible limiters for people. The great thing with the live classes is that you get this incredible camaraderie. It's where we start to see that community. of women who are for the most part, forties, fifties, sixties, seventies, just regular folks who understand that getting stronger is important and who understand that a big part of getting stronger is actually developing consistency. And so I think that having these two live classes a week acts as a reminder of I do my workout twice a week. You also get the recordings. So if the times of those classes don't work for you, you can still follow along.
Speaker: But probably the most important that women are getting out of this, which I haven't even mentioned yet, is the live coaching. Either Laurel or myself is teaching the class. And so we're looking at what you're doing and we're giving you feedback on your form in real time. Yeah, you can see us and we can see you and you can also see all the other students who have their cameras on. So it feels like you're in a group with people because you are. i want to add there's something really powerful about a container of time when it comes to behavior change. Knowing that you are scheduled to show up to a class twice a week. influences your behavior because it is making it possibly more likely that you will actually do the thing because it's scheduled, because it's happening. And then there's the container of six months, which is that this is a process that begins and ends with us over the course of six months. And so you know starting out that you're in the beginning of a process in which you will be guided over the course of six months and you will end very differently than you began. You will end with much more knowledge, much more strength, much more skill, many more friends, right? And that power of the container of time drives those behaviors that ultimately lead to those changes. But I think the time element of this, the live class component of it, the fact that it creates a time in which you're supposed to be somewhere twice a week, doing something with a group of people is hugely, hugely important. And if you don't make every live class, that's okay. You still have of that draw, that reminder, that thing that's going to keep you on track, as opposed to courses that are DIY, where, like you said, you bring the materials, but you don't actually build the building. It's just sitting in your computer, right waiting for you to do something with it. you know I used to work at a clinic in Santa Monica, and there was a Pilates studio that I really liked that was sort of on my way home.
Speaker: And so I would purposefully... book and pay for a class at the end of the day so that on my way home, I would go to that class. It's yeah the same thing, right? It's the same idea. When you sign up for LFL, you are essentially booking yourself into 48 live classes over the course of six months. If you'd like to learn more about Live for Longevity and experience a free class in its entirety, it's actually the first class of the course, we're offering a free class experience with us on September 8th and also receive the recording. So if you want to attend a free class, go to the link in our show notes and sign up for that.
Speaker: Cool. um How do we know impact training is beneficial to Build Bone? I've heard you say already that the highest quality trials include both strength training and impact training, but how much of that is impact? How much of it is strength? And then I've heard you say that athletes...
Speaker: who engage in higher impact sports have or tend to have higher bone density. i often wonder about survival bias there, which is that were they athletes in these high impact sports because they already had pretty strong bones and fractures did not take them out of the sport? So how how do we actually know that impact training is beneficial for building bone given these questions?
Speaker: Yeah, so it's really hard to separate out, like, is it the impact training or is it the resistance training? Because I said, a lot of the studies that have looked at bone combine them, right? So there's not as many that just look at one or just look at the other.
Speaker: So it is really hard to say, you know, can you just do impact training or can you just do resistance training? But again, when we look at animal research, it's higher magnitude forces. And so even in the athletes, so gymnasts, but ah like soccer players are not super high impact in the sense that they're not like jumping up and down, but they had multi-directional movements and really rapid movements. And so um I would imagine the forces are quite high and it's dynamic and in multiple directions. So...
Speaker: I can't say for sure, like, only impact or only resistance based on on what we have. so that's why we tend to promote both of them. Do you think it's a good bet to try to cover both bases if you're able to? Okay.
Speaker: Well, also, like, I think also, like, impact exercise, um because inevitably when you're doing impact, you're you're often doing quick movements, right? Because you're jumping up and jumping down and jumping in different directions or whatever.
Speaker: that's also good for agility, right? And it's good for, like, if I need to make a quick movement, right? I want to preserve my ability to do that. Right. I want to preserve my ability to jump off of something if I need to escape or. yes for me like So, you know, or or make a quick movement. So I think there's there's many reasons why that type of training is beneficial. And it's not just for increasing your bone density. So right I think a bit more like.
Speaker: what are the abilities I want to preserve? Like I'm 50 years old, right? So I'm thinking, okay, I'm on this now end of the spectrum. What the abilities do I want to preserve as I move into, you know, the later stages of middle, midlife and older age?
Speaker: I want to still be able to jump. I so want to still be able to, you know, sprint for the bus or whatever it is, right? Like I want to preserve those abilities. And so I think Doing um training that involves multidirectional movements, higher impact, um high forces is important for living. So I i i'd like to kind of get people off the focus of must do everything to preserve bone density. yeah I'm a bone health researcher. I want to preserve bone density, but also want to think about holistically, what am I training for? What do I want in this life?
Speaker: And design a program for those things as well. Cool. We polled our audience on Instagram in and asked them for questions they would have for you. and And someone asked, do we know what training frequency is best for bones? So how many times per week should we be strength training? How many times per week should we be engaging in impact training?
Speaker: Yeah, so there's no magic answer. Like I can't point to a study and says this study says that this frequency is best. I will say that um in research studies, the choice of frequency is often based on feasibility rather than on like, um you know, what people think is actually effective. Like we just ran a trial and we wanted to do it three times a week and we realized it wouldn't be feasible. Both from a cost perspective, it's really expensive to do supervised exercise three times a week in 300 people or many ever we had.
Speaker: And then the other thing is when you take people who have never strength trained before. Yeah. Trying to drag and drop a four times a week strength training program is going to be a challenge. Right. So um I would rather um people start strength training than not do it at all.
Speaker: So I think that the choice in resistance training trials is often twice a week because it's feasible to do. Some of them will do three times a week. Or they'll do like two in person and one at home or whatever it is, right?
Speaker: I don't think there's an ideal frequency. I think that you have to also think about what your goals are. So, you know, if you really are trying to build strength or build muscle size, whatever it is, you know, it's sometimes easier to hit a higher volume of exercise if you split your workouts, for example. So like if you do, instead of doing twice a week full body To do that well and actually be at the right intensity, you can't do a lot of exercises, right? Like, so um you might get five, six, maybe eight exercises in an hour, hour and a half if you're training your whole body once a week. And then you're going to end up having to compromise. like You're not going to be able to do the impact and the whatever. You know what I mean? So if I'm straight training twice a week and i'm doing a full body program...
Speaker: If I'm working hard, I don't have the energy to do more than like six. you know If I'm doing, say, three sets of each one, like six exercises, that's going to take you the better part of an hour. That doesn't count any posture exercises or shoulder mobility or, um you know, ab exercises or all these other things that people want to do. And it doesn't include your impact exercises.
Speaker: So I think the ideal frequency is dependent on what you think is realistic for your lifestyle is what is aligned with your goals. So, for example, you want to run a marathon, you're going to train more than twice a week.
Speaker: Right. So if your goal is that, then you have to figure that out. And similarly, if you really want to build muscle strength in order to have the like energy and not be super fatigued, you may need to exercise more than twice a week and split your workout so that you can target certain exercises on certain days. Right. So.
Speaker: You know, like i I tend to do a two day split just because that works for my lifestyle. Upper body in one day and lower body in another day. And then I can do more exercises for lower body. And I throw in impact exercises as well on that day. Right.
Speaker: um But then there are weeks where I'm really busy. So I also have a a full body routine in my back pocket. So if I can only get in two days a week and I do the full body one instead, or i might do the split routine at the beginning of the week and then the full body at the end because I can't quite fit in two days. So I think the flexibility, the frequency that you exercise has to align with your goals. It has to align with what you can do. I do think that you should hit each muscle for at least twice a week.
Speaker: So that's an ideal scenario. Certainly you can do more. um And um I would say if you're trying to build certain muscles, you might need a bit of higher volume.
Speaker: Yeah. Cool. Thank you. So um this actually kind of segues nicely into like the broader piece of the conversation where we want to talk not just about building bone density, but also preventing fractures because people aren't building bone density just for the fun of it. They're doing it because they don't want to fracture, it right? And that's that's the fear.
Speaker: So somebody might get like a DEXA that says they have osteoporosis or osteopenia. They start working on their bone density because they don't want fracture. fracture anything, but what do you, in your opinion, what's the difference between something like focusing on improving bone density versus focusing on preventing fractures? And is one more valuable than the other?
Speaker: So fractures happen because the force applied is greater than the bone strength. So When you're trying to prevent fractures, you can work on both sides of the equation. You can try to either increase your bone mass or prevent loss, depending on what's feasible for you.
Speaker: And you can also try to reduce the forces that are applied. And so reducing the forces that are applied, there's many ways to do that. So one is to prevent falls. So the vast majority of fractures happen because of falls. So if you can prevent falls with balance training, agility training, being careful, getting rid of trip hazards in your home, those sorts of things, addressing risk factors for falls.
Speaker: That's one way to reduce the force applied. There's also, um so spine fractures also happen due to falls. This is something actually somebody else, and I saw a social media person said, oh all spine fractures happen because you're bending over. That's actually not true.
Speaker: So we have data to show that I think 40% of the spine fractures in this population-based study were due to falls. Wow. oh Right? You fall on your butt and you can fracture. So this is a common misconception that spine fractures happen because you're bending and lifting things. They do happen for that reason, but it's not the most common reason.
Speaker: It is a reason. And so so certainly preventing falls is going to be really helpful in for fracture prevention. And then matching your... tasks to your body's capacity.
Speaker: So if you have really, really low bone density, you're going to have a lower capacity for forces on the spine. So the problem is it's hard to know exactly what your capacity is.
Speaker: So it's kind of like thinking about the continuum of rich. So the lower the bone density in your spine, the lower your capacity for compressive torsional forces on the spine. So you have to think about that when you're choosing to shovel snow, if you live in Canada, or if you are choosing to lift boxes or lift furniture, or, you know, I've heard of someone fracturing, making a bed because they were lifting the mattress. Right. So thinking about your body position,
Speaker: And the external load, whether the mattress is an external load, right, the shovel of full of snow is external load, but it's also body position. so it's not just the weight of the mattress, it's the body position while you're lifting the mattress because you're bent over, right?
Speaker: So the lower your bone density in the spine, the lower your capacity to do some of those things. If you are at a person who's at risk, then you have to think about how you do things and and what you're doing to reduce your fracture risk. So it's really hard. that You don't want to say, don't do this anymore or don't lift or don't bend. It's really hard to get through the day without bending. You can't put socks on right without bending, right?
Speaker: But it's thinking about like matching the activities to your capacity and doing what you can to reduce the risk. So maybe you're shumbling later loads or you're putting more bags of groceries so that each grocery bag is not as heavy. Or if you have to move furniture, maybe getting movers to do it.
Speaker: Right. And then part of that, too, is. Your body positioning and, you know, like how strong your muscles are and, and you know, because if your if your muscles are not very strong, then they can't stabilize you. And then that's where, you know, your spine, you become unstable and you you run into problems, right? and Where you drop things and drop something on your foot and then fracture a toe, right? So um I think it's not just your bones capacity, but your overall capacity or neuromuscular function in your um fatigue ability of your muscles, your muscular strength and the ability to to support loads. There's lots of factors. You need a train to be able to do those things, right? Someone who's concerned about their body position and moving furniture or carrying grocery bags in their everyday life, who's then having to be pretty vigilant about a lot of decisions that they're usually making spontaneously in the moment every single day now for the rest of their life, um,
Speaker: That sounds like living in ah in a state of fear, but I guess it's ah since the risks are real, right, that then becomes like just the habit of thought that they now need to engage in daily are these candidates for strength training are these candidates for doing something then proactive and deliberate and planned to be able to not have to be constantly worried yeah like so this is where like you know you you do what you can to move the dial so if you are identified as having low bone mass you know do what you can to increase that bone mass and for some people it's
Speaker: addressing, you know, nutritional inadequacy and starting strength training. For some people, they benefit from medication. And, and you know, um i so i I feel like people are really judgy about medication. thatsal You know, don't push the drugs. There are some people who really, bet like some of those medications, especially the anabolics, can have substantial increases in bone mass and can move people out of that risk range.
Speaker: And maybe those people are not ones that are going to increase their bone density that much with exercise. And so... I feel like there's a lot of judgment and and there are people who will benefit. um And so it's an individual decision. You don't want to be born on medication. and you're not You don't want to.
Speaker: You have a thing with Big Pharma. That's your decision. But there are many people who would benefit. So, i you know, if if I had two vertebral fractures and i had really, really low bone density,
Speaker: And I was, you know, worried about future fractures. I might consider an anabolic because why wouldn't I, right? or consider a medication to to prevent those fractures. with you Until you've had fracture, until you've experienced a spine fracture and know what it feels like to be in pain and not be able to do your dishes, it's it's really hard to understand that that, oh, wow, I could have prevented this, right?
Speaker: So I think that we we need to not be so judgy about medications. Like they have a role. But there's there's discussions online about like menopausal hormone therapy, right? And, and you know, there is a lot of people used to use it for bone health. And when health initiative happened and people stopped using it, now there's this resurgence of interest in and in deciding who should use it and who shouldn't. And, you know, I was at a meeting and there was a really interesting presentation where they, you know, this ah Dr. McClung was saying, you know, what we should be doing is identifying people who are high high risk of developing osteoporosis. So these are the people who at menopause have a T-score already of minus one or lower. They are thin. They have a family history, all these things.
Speaker: Those are the people that I might target with menopausal hormone therapy for a few years and then put them on a bisphosphonate to keep that bone just for a few years and then put them on a drug holiday. So that's his approach.
Speaker: I But, you know, and I posted this approach online on socials and someone was like, oh, you're pushing Big Pharma. And I'm like, I'm not. Actually, what I'm pushing is options, right? People should have, if someone is very fearful, their grandmother had a hip fracture, their mother had a hip fracture and they don't want that and they're at menopause, they should be able to make that decision that they want to do.
Speaker: Yeah. um I'm now all going on a crazy tangent. I'm probably not answering your question. but No, you did. It's good. But so I guess what I'm saying is like, I think that people should have options and I think people should consider um all of the factors that can influence their bone strength and make the decisions that feel right for them. Yeah.
Speaker: yeahp I don't know if that that makes any sense. but Yeah, totally. Okay. So so you you mentioned that bone mineral density is like one factor that we take into account when we're looking to prevent fractures, which is kind of the, I'm understanding it as like the bigger umbrella goal of like, let's not break a bone.
Speaker: and We consider bone mineral density and we also consider ah fall prevention. So a question for you is, I think in our audience for a long time and probably still, people think of fall prevention as being synonymous with balance training.
Speaker: And I was wondering if you could speak to the difference possibly between exercises that improve balance, as the lay public tends to understand it, and then exercise that is actually shown to reduce falls.
Speaker: Yeah, I will. And but i I'm going I want to also address one thing that maybe isn't coming out. And that is there's there's also addressing like the modifiable risk factors. Right. And this is something that doesn't get talked about as much in these discussions and that like if someone's not getting adequate calcium, but a vitamin D, but also like if they have like diabetes increases the risk of fracture. So managing diabetes is important.
Speaker: right? You know, celiac disease increases the risk of fracture, especially if you're not managing it well. So managing that well. If you have certain hormones like high parathyroidism, you know, high parathyroid hormone can cause bone loss. Smoking is a risk factor for fracture. High alcohol intake is a risk factor for fracture. So addressing those things as well, I think maybe doesn't get talked about. So that's the Yes. Absolutely. Exercise and not just calcium and not just drugs. Thank you. We have to think about all of the things that influence fracture risk and do our best to address the monophile. Thank you. Thank you. Yes. Very important. So you were talking about balance exercise. Yes.
Speaker: When we're trying to prevent falls, one of the most consistently effective interventions is exercise. And within that, if we look at the types of exercise that have, and there actually is enough evidence there to do metaggression because there's so many studies.
Speaker: um And they tend to, meta-regression tends to suggest that the types of exercise that are effective are ones that challenge flexibility of affected joints. So like ankles, for example, as well as anticipatory control, dynamic control, functional stability limits, reactive control. So these are, you know, those types of aspects of balance. I did a full summary on this on Instagram for people who are interested, but...
Speaker: um Those are the ones that seem to be effective based on the meta regression, but it's a bit tricky because we're at the mercy of what has been studied, right?
Speaker: So, for example, the studies that look at strength training alone, there's less certainty around whether strength training alone can prevent fractures. Right. But a lot of that might be also because it's studied less often. So you think if you're a person who's designing a study to look at whether exercise prevents falls, you're like, OK, if I was trying to prevent falls, what would I do? and I'm going to challenge balance. So I need to do a balance training intervention. So there's less studies, I think, looking at strength training alone as an intervention. And also, you know, you can do strength training exercises that challenge dynamic stability, you know, anticipatory control, all these things. So in theory, you could design an intervention that does both.
Speaker: I think where you run into problems is is competing demands. So I'll give you a good example. If I wanted to have someone do lunges as a strength training exercise, if their balance isn't very good, their balance is going to be the limiting factor. And they're not going to be able to lift heavy or do like full range or do it with good form.
Speaker: And so it's still it's a great balance challenge for them, but it's not going to get them to fatigue or challenge their muscular strength that much. So they may not build a strength with that exercise. So a lot of people are like, oh, pick vex ah this exercise because it challenges both. But the problem is, is then you might compromise on your ability to achieve one goal versus the other. Right. hu So I think that's an important distinction. And that's why I think it is important to have exercises in your program that specifically challenge the aspects of balance. And that's the focus.
Speaker: But then you should also have exercises that specifically challenge muscular strength. And that's the focus. Right. So that's why I think you should do them separately, because that way you're not compromising. Right on.
Speaker: think a lot of people in our in our audience are yoga teachers or former yoga teachers. And there is this message in the yoga world specifically from a certain yoga educational program, very predominantly that.
Speaker: yoga can prevent falls because it improves your balance. So when I ask about the difference between improving balance and reducing falls, I'm speaking specifically from the perspective of this claim that yoga, because you do a lot of balancing poses in yoga, it ah presumably, i would hope, makes people better at doing those poses. Therefore, they must have improved their balance, which now means that they're not going to fall or they're less likely to fall because they have better balance. Can you speak to that yeah difference between improving balance and then preventing falls?
Speaker: Yeah, so there's many ways to measure balance and there's a learning effect, right? So if your way of measuring balance is standing on one foot and you do yoga balance postures where you stand on one foot, you're going to get better because you're practicing and then you're going to get better at that test.
Speaker: But I guarantee you that, well, I don't guarantee you, but I imagine that the improvement in reactive control may not necessarily be the same because you're not challenging reactive control.
Speaker: So it all depends on how you measure balance, right? First of all. So yes, I do think certain types of yoga where you actually challenge balance could probably improve balance. I think where we don't know as much is whether or not it actually improves or reduces fall rates.
Speaker: So when we look at study, there's not that many studies that look at yoga and its effects on falls. And the ones that do exist do not provide strong evidence that it is effective.
Speaker: And in fact, there was a study that was published where they did virtual Iyengar yoga training, which is primarily static balance postures. um Sorry, I'm not saying Iyengar is static balance. This particular intervention had a Iyengar focus, but they also did a lot of standing postures.
Speaker: um Yeah, you were going to get in big trouble for that claim. So I'm glad you corrected it. I'm not claiming a Yangar static. I'm saying it had a Yangar kind of, what's the word, philosophy? Focus. yeah yeah a Focus. that was there That's what it says in the paper. I don't i don't actually, i didn't I didn't do the intervention. I don't know. But it says it had a Yangar focus. But when you actually read it, it says...
Speaker: It was a lot of more static postures, balanced postures. So I know a little about yoga, so I do know that they're not the same. Okay, so they did, and they actually were what like one of the few adequately powered studies. So they had 700 people in the study.
Speaker: They randomized 700 people, so 350 in the yoga group, 350 in the control group, and they did it virtually because I think it spanned COVID, right? And they found that the people improved their... confidence, improve their physical activity performance.
Speaker: But the exercise group actually had an increased risk of falls, not decreased, that they were higher than the control group. Yeah, that's not what you would expect, right? number What what so want to maybe thats something we happened there? but i thought There's a couple things.
Speaker: and And by the way, the group that did this is in an amazing group of researchers. Like if you want high quality research, like Benchmark gold standard, right? This is me, probably some of the best falls researchers around. Like there's a lot of really great, you know, I don't want to say one is better than the other, but there's, ah if I'm going to name the top five people, they're close to the top of that top five.
Speaker: OK, so just FYI, this is not bad quality research. And they like, what trial is 700 people in it? Right. And so there are some of the thoughts where one is that you have an intervention that maybe is not as tailored and progressive.
Speaker: um but But that's how yoga classes are. It's not like every balance pose is tailored to a person. So it's kind of real world. Like a lot of people are consuming their yoga through virtual YouTube videos or or they go to a class where there's group of people and everyone's kind of doing the same thing. Right. There's maybe a little bit of tailoring, but not too much.
Speaker: And they did primarily, you know, more static, not dynamic stuff. And so I think the thought there was that people felt better. They were more confident. They became more physically active.
Speaker: And because of that, the exposure to risk is higher, right? um And they maybe didn't improve the aspects of balance that you need to recover from instability, like reactive control, dynamic stability, those sorts of things. So...
Speaker: We don't know for sure why they saw an increase. It also could have just been by chance that they saw an increase in the intervention group. So that's another thing is that we often don't pay enough attention to the fact that sometimes things happen by chance. And sometimes even if an intervention is effective in one trial, it happens to be not effective because that happens by chance sometimes, especially in small trials, you get a lot of variability in what the effects are in the Negative trials are less likely to get published.
Speaker: Right. Yeah. right so So there's a bunch of things that contribute to why sometimes you see a benefit for something and not others. So it was a really great trial and and really just shows the need to really think carefully about the types of interventions and doing the the study rigorously to to really help us understand what we're what we know.
Speaker: So I would say your goal is fall prevention. I wouldn't pick yoga. um And especially yoga is very variable. So telling someone to do yoga is like telling someone to take medication. There's been doses and ways of doing it, right? yeah So I think if you're insisting on using yoga as your method of exercise and you want the most fall prevention benefit, then you better pick one that is incorporating a lot of dynamic stuff, reactive control, those sorts of things.
Speaker: But it wouldn't be my first choice as a fall prevention. I'm trying to think of a yoga class where we've worked on reactive control. I know. I was like, I don't think that happens in yoga. yeah Well, it's like the teacher walking around and pushing students. separate But maybe maybe they're put in positions where they're very unstable and they have to react, right? yeah yeah So that's that's the best you could probably do.
Speaker: We're seeing also more, um I'm seeing lots of of it online as well, but on social media, where they're training seniors now in these kind of like fall prevention classes, I think, but where the focus is on practicing falling. So you'll see people like falling backwards onto a mat or you'll see people push themselves up on the ground and then lift their hands and put their hands down back again as quickly as they can.
Speaker: Do we, and this is, it seems it seems to me from from what little I know about it, that this is relatively new. um And so do we have any evidence yet about the efficacy of this as a way to, you know, it's it's not so much fall.
Speaker: Well, it's it's it's it's a way to like prevent the fall from turning into a fracture more than it's like fall prevention itself, right? um it it Is this, what are your thoughts on this? Like in an ideal world, like let's say if for a senior who maybe has balance issues and has some bone density concerns and is also not as strong as they need to be, like, is this something that you think is an effective,
Speaker: intervention to include? Do we have any evidence on its efficacy? What are your thoughts on that? So i will I will say that I haven't done a deep dive to know all of the research in that area. There's only so much like i can read in a day, and I did that. That's not one that I've read extensively in. Sure. So...
Speaker: Put that on there. So I guess the question is, what is the goal of that treatment? So if you're saying, I think if I train these people and then when they fall, they're going to land in such a way that they're less likely to break something, that's a really hard study to design. because You're going to need a huge number of people to show reduction in fractures. So that's probably never going to happen. So then we're never going to be able to answer that question.
Speaker: Yeah. Where I think it might be beneficial is if you have someone who's really fearful of falling. um And you basically put them in this environment and where they're falling and they can do it in a way that is makes them more comfortable. And they also feel like they can get themselves off the ground because a lot people are fearful of getting down and then they can't get back up.
Speaker: So, you know, teaching people to be a little bit more comfortable with themselves in and the reaction, their ability to react. and not being fearful of of being physically active or um teaching people to get up and down off the ground if they struggle with that ability, I think that can be quite useful.
Speaker: Can I point to evidence that say it is useful? No. But it to me is logical, right? should die That would make sense. yeah where we drunk We know that been so sorry right fear fear of falling is is a contributor to falls. I mean, can I can i safely say that like people who are fearful of falling...
Speaker: might engage in less physical activity, which then prepares their body less for the life that they lead that might contribute to them falling or help them, you know, not fracture when they fall.
Speaker: Like fear of falling is ah is a thing that has been studied. Yeah. Fear falling has been studied. Fear of falling is correlated with falls. Correlated. The mechanism by which it contributes is not, I don't think, I don't think we can conclusively say this is why fear of falling is bad.
Speaker: um Like, I think people who fall a lot are in crisis of falls and then they also become fearful. So um I think... There's a correlation. Whether there's causation is is harder. But i do I do think that it could contribute because you're going to if you're fearful, you're going to do less and then you're less prepared for life. So that makes sense, right?
Speaker: I get to get that. um Where was I going again with the, oh yeah. So the one other variable is time. So it is really hard to get people who don't exercise to exercise or even to persist with certain types of exercise, especially when it's hard, right? People don't like doing hard exercise. Yeah.
Speaker: So if you're telling me i'm going to now have to have a full new type of training for people, right? Like if i if I have someone who's willing to 30 minutes twice a week, I am not spending that 30 minutes on having them practice falls.
Speaker: right So that's my... you know If you have someone who's willing to do absolutely everything to try to prevent falls and they're willing to dedicate you know an hour a week, twice a week to strength training and half an hour a week, twice a week to balance training or everyday balance training, and then they're also willing to add on this fall training, fine.
Speaker: But i just I would do it in addition to not instead of. Wow. So that's my personal opinion. Like I think bang for your buck. You want to strength training to prevent sarcopenia, to keep your strong so that you can do the things you want to do possibly maintain your bone density of if strength training alone would be effective.
Speaker: So I like an idea of an it a combined agility and impact program to work on bone density, but also to to keep you agile and and and help prevent falls. And so I would prioritize those things over that.
Speaker: yeah But if someone wants add on a few practice falls at the end of a workout. Sure. Yeah, I'm just thinking not all exercise does everything, but lots of types of exercise do multiple things.
Speaker: And so finding the exercise that deliver the biggest bang for your time buck, where you are not just building strength, you are not just working on your balance, you are not just working on your reaction time or your agility, um but you might have found some exercises that do a lot of those things all wrapped up into one. So cool. um We're going to switch gears now. yeah for seeing all So that's the other reason why I tend to promote moderate to high intensity over low intensity. Because it's really easy to underdose if you're doing low intensity because you get bored or you get fatigued, but you're not actually hitting muscular fatigued. Do you know what I mean? I think that from an efficiency standpoint and from a potential to reach your goal standpoint, the modern and high intensity ranges, you're probably more likely to see gains. I just think about like if I'm going to do, know, squats and I'm doing aiming for like 20 reps, like I'm going to get bored real fast and I might confuse boredom with fatigue. Right. Or it might be able to push out more than that. So you really need to be very vigilant to do low intensity exercise and still see gains. Like I think it's possible, but it's really easy to underdose. And I just don't know necessarily that it's enough of a stimulus. When you want to influence bone or promote muscle growth, you have to challenge your body to do things that it's not used to doing or that are a lot harder.
Speaker: To get your body to adapt, you need to challenge it to do things that are are on the limits of what you're capable of, right? Adapt and build capacity to do more to the next time. So if you're doing really low intensity, it's probably much more akin to what you do in any life. That's just my philosophy. Yeah. Yeah, that was excellently clarifying. Thank you so much. We're going to switch gears now. We want to talk about how to recognize questionable bone building claims and what evidence people should look for before investing their time, their money, their energy to whatever advice is being given. So what are some ways people can spot suspicious bone building papers, claims, influencers? What are they looking for?
Speaker: Yeah, so I really think that if you're looking for someone to interpret research, it should be someone who has a really strong research background. So they have a PhD, they are, you know, a scientist, because there's there's doctors out there who interpret research and they're not necessarily always interpreting, especially if they're going outside of their lane, right?
Speaker: So like... i We just deal with them all day long. That's to make sure we're very familiar with these doctors. Right. And so it's no shame. You know I was talking to endocrinologists at the meeting I was at last week.
Speaker: They're like, yeah, we don't know the exercise evidence. Right. So like they know all about, you know, bone medications and all these different conditions of the endocrine system. And like you don't see me talking about how to manage diabetes like online with medication because it's on my lane, right? So you want to make sure that there are person who is a scientist or former scientist if they're interpreting evidence. Anyone can go on PubMed and read an abstract and then use that for an Instagram reel, right?
Speaker: Like it doesn't mean they actually understand how to evaluate whether or not that's good science, right? So that's number one. If you're looking for someone to interpret science, it has to be someone who knows how to do that.
Speaker: So that's number one. And the number two is the algorithm loves polarizing statements or this is the best or the only way to do. Right. And so people will use that to get.
Speaker: clicks and views and follows, right? So that there's a formula for this. So they will use that. And so if they're always using that, just be cautious because scientists tend to use more nuanced language, right? They tend to be like, this may work. Science suggests science suggests I'm thinking back to when you said, I can guarantee you. And then in the same breath, you were like, woaa wait, I didn't. Let hear me go back. Like this interview. Yeah. so So scientists tend to use more nuanced language because the reality is that.
Speaker: And we can get all philosophical, but like sometimes there isn't just one truth, right? Or there's um we can try to ah approach the truth or understand what we think is the truth.
Speaker: But it's really hard to know the truth because in any given study... aspects of variability can skew the truth a little bit. And that's when we look for replication. We look for having multiple studies showing the same thing, even when they study it slightly differently or it's in a different population or whatever.
Speaker: That gives us more confidence. So what gives us confidence is when you see multiple studies in an area, when you see that there's been high quality studies in an area and they still say the same thing, you know, those sorts of things. That's what gives us confidence. So inevitably,
Speaker: A scientist will tend to be a little bit less polarizing, a little bit less certain when they say things because they know that the next study could change their mind.
Speaker: Right. the next study might be better, more rigorous or better power or designed in such a way that it gives us a closer approximation to the answer. So we we tend to be a bit more nuanced in the way we but that's not doesn't get views on Instagram.
Speaker: If people are starting to make claims like that, then, you know, you can take it with a grain of salt. Look for people who have experience interpreting science. um Yeah, I don't know. And and that they they try to have a bit more of a balance in their in their perspective. um And then also, are they selling something?
Speaker: So that would be the other thing. Right. And so inevitably, you know, people who are using socials to promote messages or to to convince you of claims. Is it because they're selling something and that aligns with their pro-product narrative, right? So that's the case that I would look for independent verification that that that's actually true.
Speaker: And sometimes they pay influencers to say things. So, you know, Tony Robbins is on the Osteostrom advisory company, it used to be, right? So like, um you know, you have people who are advocating for products, but they're not scientists, so they don't know, they can't interpret the science. So...
Speaker: I just kind of look at who the voices are and what the message is. It's unfortunate because there's so much misinformation. Like every single day when I scroll, I'm like, yeah, that's not right or whatever, right? Like, or...
Speaker: quite right maybe like it's not and and so it's in it's not often with good intentions I'm trying to say like everybody is evil and trying to do things I think they just maybe don't realize what they don't know and I'm the same there are lots of times where I might post something and it's not quite accurate and someone might say oh you didn't quite get that right and then I'll try to correct it but like everybody you know has a certain amount of knowledge and no one knows everything okay Do you want to move to the rapid fire? Yeah. So we um rapid fire maybe is a little strong of a term, but we we have some sort of like shorter questions that we want to get your sort of like brief but concise take on.
Speaker: Well, concise is hard for me. Come on, let's do it. Good luck. ah It's your strength training. That's right. Does the video be ever in my favor? That's right. and There we go.
Speaker: um ah Weighted vests for bone health. No. Vibration plates for bone health.
Speaker: That yoga is all you need for bone health. No. the The idea that Pilates is all you need for bone health. The idea that calcium is all you need for bone health.
Speaker: You need to get enough calcium. Right? you eat If you're deficient in calcium, that can cause problems. So you need to get enough. Yes.
Speaker: The idea that all you need is calcium and you can get it. And you can it from food. What about algae? what about What if you get it from algae? Oh, no.
Speaker: think he...
Speaker: If you can, because not everyone can, if you can get calcium from food, because there are risks of taking too much calcium, but the risks are often where they've done supplementation, right So you can develop kidney stones, erotic calcification, a bunch of stuff. So ah but those risks tend to be more likely when you're getting your calcium through supplements than when you're getting it through food.
Speaker: So it's ideal to get your calcium through food. So you use a calcium calculator like we went on the SuperSys Canada website yeah to figure out how much calcium you're getting. And if you're getting enough on a regular basis, you want to do something about that.
Speaker: But just getting enough calcium is not enough to prevent bone loss or current fractures. patient Should postmenopausal women engage in sprint interval training for their bones?
Speaker: I don't know if sprinting maintains or increases bone mass in postmenopausal women because there's not a study that looks at that. But i I think that if they enjoy sprint interval training, that they should do it if they enjoy it and that it's safe for them and they've trained so that its body is conditioned to do that safely. Right? Because if you just start sprint training without ever training for it, you can hurt yourself.
Speaker: But I wouldn't rely on only that for maintaining bone density. Yeah. Some of this. Yeah, we have ah these are some questions also from Instagram. and And there were a couple that were getting a little bit into the detail around around jumping. So impact and like wanting to know, are there most effective jumps for bone density?
Speaker: Should I be doing box jump if yeah I can do them? ah Do we know enough about impact to be able to say this type of impact is better than that type of impact? So I think that if you ask me my opinion of what people should do, I can't like point to a specific study since this is the best.
Speaker: I think people need to start where they're at with impact training, first of all. So if they're not doing it, they shouldn't just start doing drop jumps, right? So on Instagram, I posted a four-step approach. And on our website, to have like a blog that describes it in more detail, but...
Speaker: The idea is like you want to first condition your muscles and joints and more like muscles and tendons, probably even joints per se, but um to that type of loading. Because it often, when you're doing impact, it's often like plyometrics where you're generating forces really quickly or you're absorbing forces really quickly and you don't want to hurt yourself. So people, you know, will start doing heel stops because they saw some menopause influencer doing heel stops on and then they develop plantar fasciitis or fractures on their feet because their body is not ready for that, right? So I would start foundation with build muscle strength, do exercises that target your calf muscles that require stability in your feet and absorbing heavier loads like squats and calf raises lunges. Build the foundation first, then add higher force activities. whether you do the movement more quickly or you add load to your resistance training, more loads, you're lifting a little heavier or you're moving in different directions, then maybe progress to hops and jumps and those sorts of things and make sure you're doing it in multiple directions and getting used to it. It's really easy to roll an ankle or hurt yourself if you're not doing that, right?
Speaker: And that's, again, learning to react and stabilize, right? So you want to build that foundation. And then you can start to progress the level of impact. So then you're jumping higher or landing from a further distance. So so you need to kind of progress through a continuum of impact.
Speaker: And so you have to start where you're at, but it's thought that the height, like, so I know in some of the impact studies, they did have them, you know, dropping from a height with a soft landing, right? um So if that's in the cards for you, if you have the fitness to do that and, you know, you value the potential,
Speaker: of increasing bone density. But there's going to be some people who have, say, really low bone mass where there's a risk associated with that, where they could actually fracture during those loads if their bone density is really low. Or if they have arthritis, it can be quite painful if they have disc issues or if they have a history of Achilles tendonitis or these other things. So some people may not be able to move all the way along that continue, right? They have to start with that and move to where they can.
Speaker: So they might need to limit it to doing, you know, really fast movements or high forces because they can't do the impact. and know if that answers your question. Absolutely does. i I'm going to ask you for the link to that four step approach that you made so that we can put it into the show notes.
Speaker: Yeah, sure. Awesome. So we have one more question to wrap up this fabulously informative conversation. And it's pertaining to your work and the fact that you actually both do the research And you are involved in the practical side of delivering the exercise to the people or you're leading the team that's delivering the exercise to the people. So you're actually working with people like real people in in our in our research not in a research setting. Yeah. So so not exactly what we're doing, but but, you know, I think this is a really unique thing.
Speaker: thing about you actually as a researcher, which is that you're actually working with with people too. So we want to ask you, first of all, obviously you're working with these people to to answer the question your research questions through through research, right? But what are some of the biggest things like kind of on the side as like, you know, Laura ah watching these people, like what are some of the biggest things you notice these people as they undergo this process, discover by by actually engaging in the exercise like resistance training, I imagine, or if you want to say more about the type of exercise you're also having them engage in, what do you notice them discover as they go through this process of consistently engaging in in this exercise as as human beings?
Speaker: Yeah, I mean, one of the things I noticed was like people underestimate what they're capable of right? Like, so an an example being we we were training people in small groups, um but they would have like a two one-on-one sessions first to to kind of figure out where they're at and figure out where to start them, right?
Speaker: And so like, I remember one of our exercise physiologists saying, yeah, brought someone in and there happened to be... small group training session going on and that they saw people doing deadlifts like with barbells and they were like, oh, like that's not going be me. Like I can't do that. Right.
Speaker: And, you know, months later they're doing it. and and And we did qualitative interviews with people after the study and I did many of the interviews and i they would say like I didn't really realize that I could do that.
Speaker: Right. So I think it addresses that fear, but it's like kind of slowly building capacity and and working on it and then realizing what you're actually capable of and then challenging yourself. i think that was really fun to watch. The other thing that I observed is that.
Speaker: There's not a one-size-fits-all approach to resistance training and balance training and impact training. So people will say, oh, this set of exercises was shown to improve bone density if you do it this way. The problem is there's some people who can't do it that way. So then you have to modify it, right?
Speaker: And so, you know, then the question becomes, is it still effective if you modify? it So we had lots of people, for example, in our study who arthritis. We didn't exclude people. a lot of studies do that, right? They'll exclude people who have disc issues or ah prolapse or shoulder problems, right?
Speaker: For example, overhead presses are often recommended in different interventions. But the problem that overhead press, if you want to do it properly, you need to be able to have the range of motion so that your arm is next to your ear, right, essentially.
Speaker: Otherwise, you're pressing like way out here. Right. and So we actually didn't use overhead presses for that reason, because the vast majority of the people in our sample could not do overhead press with good porn. They were doing it out here.
Speaker: Some people think that's okay. I don't. I'm not comfortable with that. So we did landmine presses primarily because that allows people to press in the range that they're able to do. It's not exact overhead axial loading.
Speaker: So maybe it won't be as effective. We'll find out. But, you know, the same is true. a lot of people couldn't do barbell squats because they didn't have the range of motion to put their arms in this position. Right. So we got a safety bar.
Speaker: which is a bar that has padding here and the handles are here so that they can squat and hold the handles here. Safety bar is heavy, right? Like it's heavier than Olympic bar. You actually have to train people to be able to get the safety bar on their back first, right?
Speaker: So we had a lot of those issues where people had range of motion issues that affected what exercise they could do. We had to adapt them. And I think that... you know Rather than just opting out because I can't do this exercise program that everyone says is best for me for bone density, there are other approaches. And so I think that was really encouraging for people that we could tailor that exercise to their ability. We had a woman who fractured her tibial plateau playing pickleball halfway through the study, right? And she was so disappointed because she wanted to be able to continue exercising and she couldn't. So we brought her in and I completely redesigned her exercise program. She had no lower body stuff, obviously. could walk.
Speaker: But we gave her an upper body program that she was able to do. Now it was primarily using machines because she didn't have the stability to stand and do things. But we were able to adapt it and keep her in the study and also allow her to, you know, continue with the exercise. So I think...
Speaker: We have studies that are done in the lab and they're done in a standardized way because it's easier to do and it allows us to reduce variability so we can answer a question. But we also need to test approaches that are real world, that address the issues that people face. So like, you you know, I'm not going to exclude this person who has hip and knee arthritis and spinal stenosis. I'm just going to give them purple squats instead of full ones.
Speaker: And, you know, we'll get them there. And they're just doing it differently. And then hopefully... they'll still see that better. Amazing. Very cool. Sarah, do you have any last questions want to? No, I don't have any last questions. I just have a sort of like a new thought from this conversation, which is always exciting, which is like, you know, we see so much advice that is very sort of like one dimensional for want of a better phrasing. Like, you know, you must strength train, you must do impact training, you must this.
Speaker: Where in reality, like with everything, there's so many more variations on ways you could improve bone density, improve your balance, reduce your falls risk. And it's really so much more about adapting the the training and the skill acquisition to the person in front of you. Mm-hmm.
Speaker: Yeah, um for sure. And I think it's asking what's most important to them because for some people, it may be feeling stronger or feeling more confident or, you know, being more agile. And so if someone is, you know, multiple falls, has vertebral fractures, you know, I'm not going to focus on heavy strength training, right? I'm going to focus on addressing their concerns, their fears, working on balance and agility. Yes, I'm going to incorporate strength training, but we're not, you know, doing five-hour deadlifts on day one. Right, right. Maybe they'll get there eventually, but that's not the goal because that's not what they came in with as the goal.
Speaker: Right. And I think it's again, i i I really dislike the idea of saying this is the most effective programmer. You must do these exercises because that then if people can't do them, they feel disillusioned. Right. But we do need more studies that are pragmatic or that replicate findings. We can understand you know what works and what doesn't.
Speaker: I think it's easy to, you know, be scrolling through Instagram and be in this aspirational mindset of like, oh, yeah, five by fives or sprints. I mean, that sounds amazing. And if you're a person who is physically capable or well trained, you might go, yeah, I mean, it would be great if the whole world was doing that. But if you want to actually feel empathy for the vast majority of people, it's Think of someone, if you are, you know, a physically active person who's well-trained, think of someone in your family. We all have many people in our family who have spent most of their life, if not their entire life, not exercising, who are now at a place where they could...
Speaker: really benefit from either having exercised or start exercising. And imagine that person hearing this message that the best way and kind of, you know, tacitly implied the only way to build bone is to do this extremely difficult, very specific, equipment-heavy type of exercise and ask yourself, is that helpful to my mother-in-law? Is that helpful to my Uncle Joe? Is that helpful?
Speaker: it No, it's it's the opposite of helpful because it just reinforces in that person's mind. And we're all thinking of that person in our family. just reinforces in that person's mind that exercise is not for them.
Speaker: yeah and even if they in any if if they tried to do something like that, they would probably just get hurt or not be able to do it, right? so I completely agree with youhan you. Well, I think there's also like... So there's the people who are struggling or they're bit more apprehensive about starting a program. For those people, I'm a very start where you're at message and let's just get you on the journey of starting an exercise program and and finding something that you know you feel confident doing. Because if they feel confident starting it, they're more likely to continue it. There are those people, though, that...
Speaker: Yeah.
Speaker: how can i make this efficient and still achieve my goals and you want messaging that reaches those people too so i don't necessarily think it's bad to say you know this is ideal um and this is how would design it or this is shins but you you also have to have the messaging for these feet one i think it's just about being well-rounded in the way you approach things and the way you message things. So like, if you you know, if you ask me, like if you have someone who has never stretched me before, again, lots of fear, did I'm like, let's get started. That's my message. Let's start here. let's What do you think is yeah where, you know, what would make you feel a bit more confident with starting? Like, how do we start? Like I've had that happen where we had a person who had knee osteoarthritis and had one knee replaced and the other one was a lot of pain, she was on the wait list.
Speaker: And I was like, you know, I'm going to start with squats. she's like, I can't do that. That's going hurt my knees. And so we had a conversation. So what are you concerned about? data-da and then um' who Some people have found if they do it from a chair and they have a band around their thighs, it doesn't hurt as much.
Speaker: How do you feel about that? Well, maybe I'll will be willing to try it. Within... Eight weeks, she was goblet squatting 30 pounds. I'm not going to say you must goblet squat. right I'm going to say you must start here. never hurt right Whereas if someone is asking me, like, I'm doing all these things, I really want to optimize my training. I'm like, all right, well, do a split routine. You get a bit more volume in there and then you can actually target more More muscle groups, more specific ones. You can, you know, like add some impact on this day and did it up. But I can, you can optimize. But again, it's who's your audience. And if your audience is all of those people, then you have to have messages for all of those people. So this absolutely, there are ways to optimize or achieve more efficiency or work a little harder or do whatever. But you also then have to have messages for the people who are at entry level.
Speaker: Those messages don't do as well on Instagram. But if we're still in the process to get started, but, you know, there is, you know, there is this end of the spectrum where you could move towards. It's almost like a good, better, best kind of situation. This is good. Strength training, at any type of strength training is good. Any type of impact exercise is good.
Speaker: Some trips are better and some like combining different, like if, you know, everybody should do aerobic physical activity, strength training, moderate to high intensity where they're actually working hard and it feels like effort.
Speaker: Right. And then some sort of agility training and yeah throw some impact and jumping in there as well. Like that's an ideal scenario. But like if you've approached the person who's not exercising and say do all of that. Right.
Speaker: Thank you so much. This has been wonderful. Where can people find you? Yeah, and just recently in the past few months created a website and part of that was just so that I could put stuff in one place because I was always giving talks and going, well, can find this over here and you can find this over because worked with different organizations on different things. So boneslab.ca the website and you can find links to some of our socials there. We have little blog and I have like a newsletter we can sign up for. We don't send out a ton of emails like before six year.
Speaker: but mainly to let people know about studies we're doing or reporting on. And then we have some resources as well. We're starting to post it you get a bunch for people after spine fracture that are there and well be posting more later.
Speaker: And then I'm on Instagram. So that'd be Jean Bergogorio Laura. um And we have a Bones Lab Facebook group for people who like Facebook. So it's UW Bones Lab. we have a YouTube channel, Bones Lab.ca. Bones Lab is the thing, so you can find us there. but if they go to the web website, they can usually find the links to all of those things.
Speaker: Awesome. but All right. Well, thank you. Thank you so much. Thank you for having me. It was so great talking to you. It's been great conversation.
Speaker: That was amazing. Amazing. Yeah. She's amazing. I love her. i I'm like, can we or interview you every week? Can you be a third co-host on this podcast? Right. Exactly. I'm sure you have tons of time. Yeah. I'm sure you have so much time for that.
Speaker: yeah all right well um thank you everyone for joining us on this episode of the movement logic podcast we will remind you that you can make sure that you hear about a free class coming up on september 8th by going to the link in our show notes and signing up for the interest list you must get on that list to be ensured you know that you will that you will receive the link to the class and that you will hear more about Lift for Longevity, which we are starting up on September. Our first class is on September 28th. So that is that is coming up very, very soon. um Also, we appreciate it if you could leave a rating and a review. We got some some great new positive reviews. Thank you so much to those of you who took the time to to leave those. And um that's it. That's all we have for you today. We will be back in your ear in two weeks.
