Exercise and physical activity improve our physical health through cardiovascular workouts and strength training to build and maintain muscle mass. It also improves our immune system function and helps to prevent many chronic diseases, condition, and injuries among other physical benefits. Exercise is also a known mood booster with many mental health benefits. The Mayo Clinic states that depression and anxiety symptoms often improve with exercise and can keep them at bay once they have lessened or gone away. Research hasn’t shown just one clear way that exercise works to help increase our happiness but there are many proven benefits to exercise that help improve both our mental health as well as our physical health.

“When you exercise, it increases endorphins, dopamine, adrenaline and endocannabinoid — these are all brain chemicals associated with feeling happy, feeling confident, feeling capable, feeling less anxiety and stress and even less physical pain.”

Dr. Kelly McGonical

Exercise Gives You Endorphins

Elle Woods, the main character in the Legally Blond movie played by Reese Witherspoon, has a famous line, “Exercise gives you endorphins. Endorphins make you happy.”   While this was part of a speech when the character is proving that a woman didn’t shoot her husband (“Because happy people don’t shoot their husbands. They just don’t.”) you get the idea, it is proven that exercise can release the mood enhancing hormones endorphins that help to relieve pain, reduce stress, and improve your sense of well-being. There are other ways to boost your endorphins as well like meditation, massage and laughing. Endorphins aren’t the only hormone that exercise can produce in the body to help your mental health.

Exercise Can Boost Dopamine and Serotonin Levels

Dopamine and serotonin are two more hormones that make us feel happier and less stressed. The most commonly used antidepressants work by increasing serotonin levels in the brain. One natural way to increase these hormones is by working out. When you exercise, your body releases more tryptophan, the amino acid your brain uses to make serotonin. This boost in serotonin (along with other endorphins and dopamine) is why some people may get that happy feeling known as a “runner’s high” after an intense workout. It is important to note that you might not get an intense euphoric feeling (“runner’s high”) after your workout, but you will still get the increased feel-good hormone levels and an overall mood boost.

“If you are in a bad mood go for a walk. If you are still in a bad mood go for another walk.”

― Hippocrates

Exercise Can Decrease Stress Levels

Physical activity helps to decrease or regulate stress hormones like cortisol. When stressed, our bodies increase our cortisol levels which can cause inflammation and when they remain elevated, can lead to chronic stress and anxiety. Chronic stress can take a toll on you both physically and mentally. According to the American Heart Association, physical signs of stress can be headaches or trouble sleeping and can lead to high blood pressure and heart disease. Emotional signs of stress can be feeling anxious or depressed or both. Stress can also make you feel cranky or forgetful.

Regular physical activity can help to reduce stress which in turn may relieve tension, anxiety, and depression. Any kind of exercise or physical activity can help. Walking, pickleball, a workout class, biking, swimming, yoga, gardening, strength training or dancing are all possible options. Find something (or several things) you enjoy and will do on a regular basis.

“I do have to take care of myself, not only because I’m in the movies, just for mental health reasons. I exercise for me. You know, maybe it would be nice to not have to do that in order to feel good, but I do. I feel like I have to, to feel good. To clear my head and all of that, so.” 

-Annette Bening

Exercise Can Increase Self-Image and Self-Esteem

Exercise can increase your confidence as you try new things, get better at exercises or a sport or reach new goals. For example, someone who works for weeks to build their upper body strength to complete a push up or a pull up will feel great once they achieve that goal. Or crossing the finish line of a 5k after working hard to train to be able to finish that race.   These feelings of self-mastery can boost your self-esteem which in turns reduces stress, anxiety, and depression symptoms.

Exercise not only changes your body, it changes your mind, your attitude and your mood.

-Unknown

Exercise Can Be a Good Distraction

One of the ways that researchers think exercise can help our mental health is the Distraction Hypothesis. Doing some kind of physical activity requires some focus and can help take your mind off any worries you may have. If the activity involves repetitive motions, it will take the focus from your mind and into the rhythm of your movements. This will give you many of the same benefits of meditation, like calmness and clarity. It also reduces the stress hormone, cortisol.

Exercise Can Provide Social Support

Connection with others is an integral part of our health, physically and mentally. A low level of social interaction was found to be as harmful to one’s lifespan as smoking a pack of cigarettes a day. Having positive relationships with others could influence personal behaviors that influence your health. For example, your spouse or a friend may encourage you to eat healthier and go for walks. Other studies confirm that having social relationships can positively affect our mental health as well. Having gone through the recent pandemic, most of can relate to the fact that less social interaction can contribute to loneliness, feelings of isolation and feeling depressed.

Exercising is a great way to find or create social connections. Joining a gym, a recreational pickleball league, a running group or group exercise class can boost our connectedness with others by talking with others in the group, sharing feedback, using friendly competition, and feeling like you are part of something. Physical activities can create events where you connect with others which increases our feelings of connection and improves our emotional wellbeing.

How Much Exercise Should You Do?

Adults should do at least 150 minutes (2 1/2 hours) a week of moderate-intensity aerobic exercise, according to the Physical Activity Guidelines for Americans. A study found that adults who completed 150 minutes of brisk walking per week had a 25% lower risk of depression when compared with adults who did not exercise. Those who walked for 75 minutes a week had an 18% lower risk of depression. Higher physical activity levels only offered minor additional benefits according to the researchers.

For your overall health, the American Heart Association recommends at least 30 minutes of moderate aerobic activity (think walking or a leisurely bike ride) five days a week PLUS strength training twice a week. Or at least 20 minutes of vigorous aerobic activity (like jogging or a challenging bike ride) three days a week PLUS strength training twice a week. The Centers for Disease Control offers more detailed guidelines.

Don’t let these guidelines intimidate you, even 10-minute exercise sessions a couple times a day have been shown to help you get the effects without it taking over your schedule. Find a way to work movement into your daily routine even in short bursts. Any type of exercise for any length of time done regularly can increase both your physical and mental health.

To start exercising when you are experiencing mental health problems can feel difficult, or even impossible. Start small and start with something that you usually enjoy. Keep reminding yourself that you will feel better from exercise, both long and short term. 

Exercise Isn’t a Replacement for Other Treatments for Mental Health If Needed

If you feel overwhelmed, unable to cope, or that stress is affecting how you function every day, consider connecting with a mental health professional. Whether it’s a social worker, pastoral counselor, marriage and family therapist, psychologist, psychiatrist, or another trained professional, getting connected to a professional can be a first step to feeling better.

If you or someone you know is struggling or in crisis, help is available. Call or text 988 or chat 988lifeline.org.

Maximize your workouts with your nutrition!  What to eat before and after your workout for the best results.   

Exercise has many benefits on its own, but when paired with a healthy balanced diet, the results from your workouts and your overall health will be even better.   By diet, I don’t mean a prescribed way of eating temporarily to lose weight.  Wikipedia sums up the two meanings of the word diet nicely, “In nutrition, diet is the sum of food consumed by a person or other organism. The word diet often implies the use of specific intake of nutrition for health or weight-management reasons.”  In this post, when I use the word diet, I mean the kinds of foods a person usually eats, not the second definition of a restricted or specific diet plan.  Those restrictive and/or temporary diet plans tend to become an unhealthy on and off pattern where you may lose weight but then gain it all back plus some when it is over.  Plus, you are usually miserable while doing it.  (Read our post on nutrition, exercise and weight loss for more information on what to focus on in your diet if you would like to lose weight.)  Learning to always have an overall healthy diet is best for your health and helps to get the most out of your strength training and cardio workouts.   

Overall Diet 

Our bodies need the three macronutrients – carbohydrates (carbs), protein, and fat.  To feel our best, we should ensure that most of the time we are focusing on quality carbs like whole grains and vegetables, lean proteins like chicken, turkey, fish, or soy products and heart-healthy unsaturated fats like those found in olive oil and avocados.  We also need fluids, mostly water, to perform at our best.     

Our muscles rely primarily on carbs for energy and rely on protein to help repair and build our muscles after a workout.   

The Mayo Clinic reminds us, “Not getting enough vitamins, minerals and other nutrients can compromise your health and your performance. 

Yet fueling up for activity is as easy as following the well-established rules of a healthy diet: Eat plenty of fruits and vegetables, consume lean proteins, eat healthy fats, get your whole-grain carbohydrates, and drink plenty of fluids, especially water.” 

Before Your Workout 

Fueling your body properly before a workout will keep your energy levels up and allow you to perform to the best of your ability.  It’s important to think about what you are consuming before your workout, what you shouldn’t eat before you work out and how long before you exercise should you be consuming these foods.   

It may take some trial and error to figure out the right foods and the right timing for eating before you exercise.  If you eat too much right before your workout, you may feel sluggish or even nauseous.  If you eat too little or haven’t eaten in the past 4 to 5 hours (or more), you may not have the energy you need to push through or do your best.  An empty stomach could also cause you to feel lightheaded.   

In general, if you are having a larger meal, make sure it is at least three to four hours before exercising.  If it is closer to your workout time, a small meal or snack is a better idea and could be eaten about one to three hours before you get moving.  When eating something small within an hour or two of your workouts, focus on easily digestible carbohydrates (low in fiber) for energy, to ease hunger pangs and to minimize stomach digestion during exercise.  Something around 200 calories, mostly carbs and some protein usually works best.  Stay away from any new food you haven’t tried before or anything greasy or fried.   

If you exercise early in the morning, before breakfast, usually a short brisk walk is fine on an empty stomach.  Just be sure to drink some water.  For more intense exercise, eat a small amount of easy to digest carbs before you start.   

Some examples of a pre-workout snack: 

• a banana 

• slice of whole grain toast with peanut butter 
• a fruit smoothie 

Stay Hydrated 

It’s best to start your workout hydrated.  Drink plenty of fluids (especially water) with meals and two hours before exercise.  Water is usually enough to keep you hydrated during your workouts.  However, if you're exercising for more than 60 minutes in hot, humid conditions, sports drinks may help. They give you carbs and sodium, as well as fluids. 

After Your Workout 

During your exercise, your body used its stored energy and broke down some muscle fibers.  Restoring those nutrients is important.  Eat a meal that is high in protein and contains some carbs within one to two hours of your exercise session if possible. Consider a smaller snack that includes carbs and protein if your meal is more than two hours away. 

A few post workout meals and snacks examples: 

• chicken breast with brown rice and broccoli 
• sweet potato with seasoned black beans 

• Greek yogurt with fruit (use frozen fruit and blend into a smoothie if preferred) 
• scrambled eggs with chopped veggies 

Protein 

Protein is an important macronutrient that is involved in nearly all bodily functions and processes.  It plays a key role in exercise recovery because it provides essential amino acids that build and repair muscles.  The amount of protein you should consume each day depends on a few factors including your weight, your overall health, and how long and what types of workouts you are doing.  In general, The Academy of Nutrition and Dietetics recommends that the average individual should consume 0.8 grams of protein per kilogram or 0.35 grams per pound of body weight per day for general health. That means a person that weighs 75 kg (165 pounds) should consume an average of 60 grams of protein per day. Someone who is very active would most likely benefit from more protein each day.  You can calculate your minimum protein requirement by multiplying your weight in pounds by 0.36 or use this online protein calculator. 

Ideally, protein requirements should come from whole foods, but supplemental protein, in the form of protein powders, readymade drinks or bars, can be convenient and okay for you if they do not artificial sweeteners, colors or fillers or sugar alcohols.  Check the ingredient list for ingredients you recognize.  There is some debate about negative effects of artificial sweeteners on the gut microbiome, potentially causing some chronic conditions and negatively effecting the hormone that regulates our feeling of fullness.  The results of studies on this are varied, but excessive consumption of artificial sweeteners and sugar alcohols does seem to impact the bacteria within the gut and both sugar alcohols and artificial sweeteners can cause upset stomach symptoms for some individuals.  It isn’t a good practice to rely on protein supplements to meet your daily protein requirements, but they can be quick and convenient when you need them.  For some peace of mind about the quality of protein powders, check that they are NSF Certified for Sport or Informed Choice Certified. These third-party tests confirm that a powder’s label accurately reflects its ingredients, and that it doesn’t contain banned or dangerous substances. 

Not every activity requires a special snack before or meal high in protein right after.  An overall healthy diet where you are getting enough healthy carbs and protein, will support most activities like a walk around the block or leisurely bike ride in the neighborhood for example.   Fueling for exercise will look different for a marathon runner, a bodybuilder, and an average gym goer.  Have more questions about your nutrition?  Consider asking a registered dietitian or your doctor.   

There is no perfect meal to eat before and after exercise that works for everyone. Pay attention to how you feel during your workout and to your overall performance. Consider keeping a journal to monitor how your body reacts to meals and snacks so that you can adjust your diet for optimal performance.  Follow the general guidelines given here and experiment to find what foods and what timing works best for you. 

What and when you eat can affect your performance and how you feel while you're exercising. Learning how to fuel your body properly can help you make the most of your exercise routine. 

Exercises and Stretches For Back Pain 

Does your back hurt?  Probably many of you are shaking your heads yes right now because a 2019 survey from the CDC found that 39% of adults had experienced back pain in the past three months when surveyed.  Back pain can range from general muscle aches to a stabbing pain.  It is one of the most common complaints I hear as a trainer, and it is one of the most common reasons people seek medical treatment or miss work.  Luckily, maintaining a strong and healthy body (especially a strong core) can help prevent or relieve most back pain.  If you do suffer from a sore back, it’s important to identify the reason your back is hurting and to know if it is simply a pain like a muscle ache or strain, or if it is a structural issue with the spine or disk problems with the disks that cushion the vertebrae (the small spinal bones).  Some pain or achiness can be the result of being sedentary too long or from arthritis.  Other times it may be a result of an event like an accident or illness.  The Mayo Clinic recommends seeing your doctor about your back pain if it: 

• Lasts longer than a few weeks. 
• Is severe and doesn’t improve with rest. 
• Spreads down one or both legs, especially if the pain goes below the knee. 
• Causes weakness, numbness, or tingling in one or both legs. 
• Is paired with unexplained weight loss. 

Exercise will help to strengthen the muscles that support the spine which removes pressure from the spinal discs and reduces the risk of injury.  Movement will also improve mobility, flexibility, and stiffness.  All of which can reduce pain.  A balanced workout plan is best and should include both stretching and strengthening as well as aerobic exercise that elevates the heart rate. 

In many cases, exercise and stretching most likely will help reduce your back pain and will help to prevent back pain from occurring.  However, some injuries require up to a few weeks of rest to heal the issue, so it’s important to identify the cause of your discomfort before launching into the exercises and stretches below.  Please consult with your doctor if you aren’t sure.   

Exercises for Back Pain 

Start with your breath.  When performing exercises or stretches, be mindful of your breathing.  Focus on taking nice long inhales and exhales and relaxing the muscles in your back.   

Walking is a great exercise anytime and that includes when your back is hurting.  How far and how often you go is a matter of how your body tolerates it and can be different for everyone.  Start by going a short distance and slowly add more time to your walk as the weeks go by.    With this and any exercise, stop if the activity is causing pain.   

The Superman Exercise is a great way to build strength and stability in your lower back and core muscles. 

• Lie on your stomach with your arms stretched out in front of you. Engage your abdominal muscles by drawing your navel in toward your spine. 
• Lift your arms, head, and legs off the ground about five inches. 
• Hold the position for 3-5 seconds and then relax. Repeat this several times, building up to more reps or holds if desired. 

Birddogs are another move that works many muscles of the core and builds strength and stability in the back as well as other parts of the core.   

-Kneel on the floor, knees hip-width apart, with your hands firmly placed on the ground about shoulder-width apart. Engage your abdominal muscles by drawing your navel in toward your spine. 

- First, practice lifting one hand and the opposite knee just an inch or two off the floor while balancing on the other hand and knee and keeping your weight centered. 

-When you feel steady and ready to move on to full range of motion, point the arm out straight in front and extend the opposite leg behind you. You should form one straight line from your hand to your foot, hips squared to the ground. However, if your low back begins to sag, raise your leg only as high as you can while keeping your back straight. 

-Return to the starting position and complete 3-4 sets of 10 reps on each side. You can add a light weight in your hand when you become comfortable with this exercise. 

A rack pull is a type of deadlift that is great for anyone with limited hamstring flexibility.  Rack pulls are good for both glute strength and lower back strength.  Start with a light weight as you perfect your form with this exercise. 

• Place a barbell on a rack or boxes, with the bar high enough that it’s just below the knees.  Stand with feet hip-width apart and keep your feet flat on the floor with the weight balanced in both feet throughout the entire move.  Knees should be soft.   

• Keeping your back straight, hinge at your hips shifting them back.  Grab the bar with both hands, about shoulder-width apart. 
• Push your feet evenly into the floor as you stand up keeping the bar close to the body.   
• Lower the bar back down toward the rack or blocks, hitting that hip hinge position again.  
• Repeat 3 sets of 5 reps. 

The Lat Pulldown targets the latissimus dorsi, more commonly referred to as the "lats," which is the muscle just under the armpits and spreading across and down the back. 

-Sit at the Lat Pulldown station and grab the bar with an overhand grip that’s just beyond shoulder width. Your arms should be completely straight and your torso upright. 

-Pull your shoulder blades down and back and bring the bar to your chest. Pause, then slowly return to the starting position. 

-Complete 3-4 sets of 10-12 repetitions on each side. 

Stretches for Back Pain 

When stretching, listen to your body and only push to the point of feeling a stretch.  Stop any movements that feel painful.   

Side Bend 

• Stand with your arms stretched up straight over your head. 
• Plant your feet firmly to the ground, about hip-width apart. 

• Place your right hand around your left wrist and lean your body over to the right side.  Try to keep your hips straight as you stretch. 
• Hold for 5-10 seconds. 
• Return to center. 
• Repeat on the other side. 

Cat-Cow 

• Start on all fours on the floor or place both hands flat on a counter, desk, or tabletop, keeping your arms straight.  Make sure your hands are directly underneath your shoulders and if on the floor, your knees are directly below your hips.   
• Gently round your back, bringing your chin down toward your chest and breathing in. 
• Exhale and arch your back and lift your head to look up. 
• Slowly flow between each move, three to five times.   

Child’s Pose  

• Start on all fours on the floor or on a bed. 
• Move your hips back toward your heels. 
• Your arms and hands should be outstretched on either side of your head, reaching forward. 

• Rest your forehead on the floor or other surface.   
• Hold the pose for 10-30 seconds. 

When your back is hurting, gentle movement can help lessen the pain in many cases.  Consult your doctor prior to starting any new exercise routine and to identify the cause of your pain if you are unsure.  General back aches and stiffness can be helped by light exercise and stretching – moving your body!  Keep your back healthy and strong by building muscle strength, increasing flexibility and performing regular aerobic activity.   

Have you heard of Dormant Butt Syndrome?  Some news articles and magazines have tried to make it sound even more catchy to get you to click on the headline – calling it “Dead Butt Syndrome” or “gluteal amnesia”.   It may sound strange or even silly, but it is a real condition, and it can cause real problems!   

Dormant Butt Syndrome (DBS) refers to when the gluteal muscles are weak, and the hip flexors are tight.  If your glutes are too weak, they may stay that way and forget to, or lose their ability to, fully contract and do the work they should.  This may cause other muscles around them to take on too much during movement or exercise which then could imbalances and result in injuries or pain in other parts of your body, predominantly the back, hamstrings, hip, or knee.  DBS can also cause balance issues and contribute to conditions like sciatic nerve compression and subsequent pain. 

The gluteal muscles (glutes) are a grouping of muscles that make up the buttock area.  These muscles include the gluteus maximus, gluteus medius and the gluteus minimus.  The gluteus maximus is the largest muscle in the body.  It’s one of the primary muscles used in many of our day-to-day activities like standing upright, squatting, bending over, walking, and running.  The gluteus medius and minimus muscles work together and are responsible for rotating the hip, moving your leg out to the side and for stabilizing the hip and pelvis during weight bearing activities.   

The hip flexors are the muscles that run from the front part of your lower vertebrae in your lower back, to the pelvis and then connect to your femur (thigh bone).  They are important in this situation because they are the muscles that help to move your legs along with your glutes.  When your glute muscles aren’t working properly, the work of the hip flexors is doubled.  Plus, they are probably already in a tight and shortened position because your glute muscles are lengthened and relaxed.    

If your gluteus medius is underactive or weak, it can alter hip, knee and lower back function and can result in low-back pain (Cooper et al., 2016; (Philippon et al., 2011).  A clinical commentary published in the International Journal of Sports Physical Therapy cites multiple studies that show that weakness of the gluteus maximus has been implicated in injuries like knee pain, low back pain, hamstring strains, ankle injuries and more (Buckthrope et al., 2019).  (I love that this article refers to DBS as ‘sleepy glutes’.) 

What causes DBS?   

An inactive lifestyle is thought to be the main cause of DBS and underactive or weak gluteal muscles.  Too much sitting or laying down for long periods of time, can cause your glute muscles to relax and lengthen too much and in turn cause your hip flexors to tighten.   

DBS can also be due to the glutes not working when they should.  Even if you have an active lifestyle, your glute muscles could be not engaging when they should.  This could be because of a muscle imbalance or alignment being off or an underlying nerve issue.   

Symptoms of DBS 

DBS can be the cause of discomfort or pain in many parts of the lower body.  The pain is usually in one or more of the body parts that form a chain when we walk or run or bend like the back, hip, knee, or foot.  It can sometimes cause feelings of tightness or a dull ache in the glutes or the tendons around the hip joint.  Of course, pain or discomfort in any of these areas could also be caused by other issues so it would be best to speak with your doctor to be sure DBS is the cause.   

Treatment for DBS 

The best way to prevent or treat DBS is to activate your glutes and keep them strong.   Talk with your doctor about if you may have DBS.  With your doctor’s okay, you may be referred to physical therapy or a personal trainer for exercises to fire up your glute muscles.  Here are a few ideas on how to prevent DBS and keep your glute muscles active and firing!   

1. Don’t just sit there! – stand up and walk around at least once every hour.  If you have an Apple Watch, it probably reminds you to stand if you haven’t enough in the last hour.  Don’t ignore it.  Even standing for as little as 2 minutes each hour can make a difference. 

1. Mix up your position throughout the day.  Some examples include sit on a stability ball instead of a chair for part of your day, stand while reading instead of sitting, go for a walk while meeting with a coworker, or walk around your office while on the phone. 

1. Perform lower-body and glute-focused exercises two to three times a week as part of an overall full body strength training program.  Some glute focused exercises are included below.  Please note this is not an all-inclusive list of ways to strengthen the glutes.   

Glute Exercises 

Banded Lateral Walk  

Place a mini resistance band a few inches above ankles but below the calf muscle, and stand with feet hip-width apart, knees slightly bent. Maintaining a tight core, step left foot out to the side, followed by right. That’s one rep. Do 3 sets with 10-15 reps per side.  This exercise can also be done without the mini resistance band if you don’t have access to one. 

Romanian Deadlift 

Start standing with feet hip-width apart, knees slightly bent, holding a pair of weights in front of thighs, palms facing body. Keeping knees slightly bent, press hips back as you hinge at the hips and lower the weights toward the floor.  Don’t go lower than when your back is parallel to the floor.   Keep back flat.  Squeeze glutes to return to standing. That's one rep. Do 3 sets with 8-12 reps. 

Glute Bridge 

Start by lying on your back, arms by sides and knees bent.  Heels close to the body.  Engage core and glutes, then press into heels to raise hips toward the ceiling until body forms straight line from shoulders to knees. Hold for two seconds before lowering back to start position. That's 1 rep. Do 3 sets with 10-15 reps. 

Sumo Squat 

Start standing with feet wider than shoulder-distance apart, toes turned out slightly, holding a dumbbell or Kettlebell with both hands. Bend knees and push hips back to lower down into a squat. That’s 1 rep. Do 3 sets with 10-15 reps. 

Ultimately, having strong and active glutes will help reduce the risk of pain and injuries in the back and lower body.  There are many different exercises that can strengthen the glutes.  Ask a LivRite personal trainer if you have any questions and for assistance with any of these exercises. 

References 

Cooper, N.A. et al. (2016). Prevalence of gluteus medius weakness in people with chronic low back pain compared to healthy controls. European Spine Journal, 25, 4, 1258–1265. 

Buckthorpe, M., Stride, M., & Villa, F. D. (2019). ASSESSING AND TREATING GLUTEUS MAXIMUS WEAKNESS – A CLINICAL COMMENTARY. International Journal of Sports Physical Therapy, 14(4), 655-669.  

According to The Mayo Clinic, “Osteoporosis occurs when the creation of new bone doesn't keep up with the loss of old bone.”  Osteoporosis is a bone disease where bone mineral density is reduced.  It most commonly occurs in women over the age of 50, but it can affect anyone.  It causes bones to become brittle which increases the risk of fractures.  Our bones not only support our body’s structure, but they also protect vital organs, play a role in blood cell production, our immune system, the storage of calcium, the release of essential hormones, among other functions.   

Our bones are made of living tissue and mainly contain bone marrow, cartilage, membranes, nerves, blood vessels and three different types of cells.  Like other cells in our body, the cells in our bones are constantly being broken down and subsequently replaced.  This process in our bones is called bone remodeling or bone-rebuilding.  The bone remodeling process allows the body to repair broken bones, reshape the bones as we grow, and regulate calcium levels.  Many factors contribute to bone remodeling.  Some of these factors are the parathyroid hormone, vitamin D, estrogen, and testosterone.  This bone remodeling process of breaking down old bone and increasing our bone mass when new bone is made, slows down as we age.  The process starts to slow as early as our 30’s and as we continue to age it’s possible that bone mass is lost faster than new mass can be created.   

Risk Factors for Osteoporosis Can Include: 

• Low calcium levels 
• Vitamin D deficiency 
• Smoking tobacco 
• Using corticosteroids 
• Estrogen deficiencies (common during menopause) 
• Family history of osteoporosis/Genetic factors 
• Age (risk increases after 50) 
• Having an inactive lifestyle 
• Body frame size (men and women who have small body frames tend to have less bone mass to draw from as they age) 

This is not a complete list of the potential causes of osteoporosis, but it can help us identify ways to help maintain or increase our bone mineral density and let us know who might be most at risk.   

How do you know if you have osteoporosis? 

There are no typical symptoms in the early stages of bone mineral density loss.  Once you have osteoporosis, you might experience signs like; back pain (caused by a fractured or collapsed vertebra), loss of height over time, a stooped posture or a bone that breaks easily.   

A bone density test is the only way for doctors to determine if you have osteoporosis or osteopenia.  Osteopenia is a loss of bone mineral density, which means your bones are weaker but not yet to the point of osteoporosis which is a more severe loss of bone mineral density (bones are brittle or almost brittle).  There are not usually any symptoms of osteopenia.  It may be helpful to know if your bones have weakened to this point so you can work with your doctor to determine a treatment plan to prevent it from worsening to osteoporosis.   

How to prevent osteoporosis? 

To help prevent osteoporosis, Johns Hopkins Medicine suggests; limiting alcohol consumption, stopping smoking if you smoke, consuming adequate amounts of calcium and Vitamin D as well as having an adequate protein and vegetable intake.  They also mention that weight bearing exercise can help build strong bones and slow bone loss.   

Just like our muscles break down under stress (like resistance training) and then repair themselves to become stronger, our bones have a similar process.  If a bone comes under increased stress over time, for example during weight bearing exercise, the parts of the bone under the most pressure will become thicker over time.  Exercise helps maintain or increase bone density no matter when you start, but if you start exercising regularly when you are young and continue throughout your life you will reap the most benefits. 

Exercising with Osteoporosis 

If you have osteoporosis or osteopenia, ask your doctor or physical therapist before starting a new exercise routine about what exercises are right for you.   

In general, with osteoporosis, it is recommended to avoid excessive bending or twisting of the spine and to be careful of high impact activities like running or jumping.   

In 2022, the British Journal of Sports Medicine (2022; 56 [15]) published exercise guidelines for people with osteoporosis.  A multidisciplinary group of experts met in 2017 to create these guidelines based on their review of research and expert opinions.  They wanted to clear up any uncertainty about what types of exercise and how much physical activity are safe and effective in individuals with osteoporosis.  We know that physical activity and exercise can optimize bone strength, reduce fall, and fracture risk but they wanted to create these guidelines to be more specific on the type and duration of exercise as well as how to minimize any potential risks of exercise.   

They concluded the following recommendations for all people with osteoporosis: 

1. Those at risk of falls should start with targeted strength and balance training. 

1. Perform resistance training 2-3 days a week to maintain bone strength.  Start at 8-12 reps of each exercise, building up to three sets.  Begin with lower intensity exercises to ensure good technique before increasing intensity. 

1. Target all muscle groups but especially focus on the back to promote a healthy spine. 

1. Spread physical activity throughout the day to avoid prolonged sitting. 

1. Include impact exercise 4-7 days a week (like jumping 3-5 sets of 10-20 jumps with 1-2 minutes of rest between sets). 

1. Avoid movements involving a high degree of spinal flexion (in both exercising and in daily life). 

They also found that “There is little evidence that physical activity is associated with significant harm, and the benefits, in general, outweigh the risks.” 

Activities that can help prevent bone loss, maintain bone density and are safe for those with osteoporosis: 

• Weight bearing aerobic activities – activities on your feet with your bones supporting your weight.  Examples include walking, dancing, low impact aerobics, elliptical machines, and stair climbing. 

• Strength training – including using dumbbells, resistance bands or your own body weight to strengthen all major muscle groups.   

An example of a full body strength training routine that’s great for beginners: 

Complete 10-12 repetitions of each exercise before moving to the next.  Then repeat each exercise three more times, resting in between each set. 

1. Squat – Start with your feet shoulder width apart.  Bend your knees as you shift your hips back, keeping your back straight and leaning partly forward.  Squeeze your glute muscles and return to a standing position. 

1. Push Up – Put your hands slightly more than shoulder width apart on the floor (or if a beginner, on a countertop or wall).  Bend your elbows and bring your chest toward the floor (or other surface) keeping your body in a straight line and all moving together. 

1. Standing on One Leg – Have a sturdy piece of furniture nearby in case you need to grab something for balance.  Stand on one leg for as long as possible – up to a minute.  Repeat with the other leg.   

1. Side Leg Lifts – Start with your feet hip-width apart.  Shift your weight to your left foot.  Flex your right foot and keep your right leg straight as you lift it to the side.  Bring the right leg down then repeat the lift on the right leg 10-12 times then switch to the other side. 

Good nutrition and regular exercise are essential for keeping your bones healthy throughout your life.  Regardless of age or osteoporosis risk or osteoporosis status, exercise has a positive impact on strength, mobility, and bone density in addition to improving overall health. It’s never too late to start.  Regular exercise can help to prevent and even reverse some bone loss.  It also can improve balance and flexibility which is key for preventing falls which are the most common reason for bone fractures.