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🎉Bone Density Scan Victory! 🎉

I can hardly contain my excitement—I want to shout this from the rooftops!

At 67 years old, I just received my new DEXA scan results (the test that measures bone density), and the news is nothing short of incredible:

📈 My spine bone density has increased by 17% over the past 5 years—enough to move me completely out of the osteopenia range and back into normal bone density!

💪 My hip bone density held steady at -1.1. That’s a victory too, because after menopause, women typically lose 1–2% of their bone density per year. Holding steady means I’ve beaten the odds and protected my bone health. Note that this was all done without medication. (I was not prescribed meds as my numbers didn’t cross into osteoporosis)

Also, this was measured on the exact same machine as five years ago, so the results are truly apples-to-apples.

What was different?

This made me pause and reflect: What did I do differently in the last five years?

Looking back, two big turning points stand out.

First, I joined a clinical trial aimed at preventing cognitive decline (Alzheimer’s runs in my family). Part of my trial regimen included adding strength training with weights and HIIT – High Intensity Interval Training. I figured, something good for my brain and body, I’m in!

 

Second, COVID arrived, and like many of us, I had to pivot. Overnight, I shifted from hands-on teaching in my studio to guiding people online over Zoom.

Suddenly , I wasn’t just coaching, providing verbal and tactile cues; I was doing the classes with my students. That meant my own workouts became the very classes I was teaching: about 2.5 hours a week of consistent, bone and muscle-focused training. (I don’t count my restorative or roller classes here—they’re self-care, still important, but they’re not bone-building.)

And here’s the kicker: I think many people imagine that Pilates teachers are “working out all day long, so sure, their bones will get stronger.”

The truth? Outside of Zoom, most of my time is spent creating programs, designing Bursts, editing and publishing videos for my on-demand library, running my business, and doing a lot of admin work.

My actual workouts are the ones I teach live over Zoom, and that bone-building focus and consistency is what has made all the difference here.

What else did I do or not do?

I took a Calcium supplement, just 333 mg a day, as insurance, in case I didn’t get my full 1200 mg through my diet.

As part of the clinical trial for cognitive decline, I was put on bio-identical hormone therapy and am still on that. It helps the brain and bones. And yes, I’m getting regular breast mammograms and ultrasounds to monitor my health.

I did not use a weighted vest or a vibration platform.

I invested in better technology, lights, camera, moved to Vimeo for my library to deliver the highest quality classes over Zoom.

I promise—I wasn’t sneaking off at midnight to do some top-secret bone-building workout. Everything I did to strengthen my bones, I did right alongside YOU, my BoneSmarties, in our virtual classes!

So what have I learned?

✨ What’s good for the brain is also good for the muscles and bones.
✨ Consistency matters more than perfection.
✨ Steady, focused research-based effort over time can yield remarkable results.

✨ Virtual and On-Demand classes have been a game-changer—whether it’s juggling a busy schedule or joining from another time zone, they just fit people’s lives better. That’s why they’re here to stay.

My DEXA scan is living proof that bone-safe, bone-building movement works. Your bones are living tissue, always responding to the signals you send. With the right kind of safe, targeted exercise, you can strengthen them, protect yourself from fractures, and feel more confident in your body, at any age.

My Mission

💗 Through BoneSmart Pilates® classes and my On-Demand Movement Library, my mission is to empower people with osteoporosis, osteopenia, or anyone who simply wants to age strong, to move with confidence while protecting and strengthening their bones. 

Linda B., a BoneSmart On-Demand Movement Library member, shares, “My last DXA showed my bones have improved, and I am back into the osteopenia range again. I attribute it all to the bone-building exercises you teach.” 🥰

And from my primary care physician in response to my bone density results, “Continue your excellent exercise regimen!”

If you’ve ever been told that “bone loss is inevitable,” I’m here to tell you that’s not the full story.

✨ You can make a difference in your bone health at any age.
✨ You can protect yourself from fractures.
✨ You can feel stronger, steadier, and more confident in your body.

Here’s to Aging Strong—inside and out! 💗💪

👉 If you’re ready to take simple, safe, and effective steps for stronger bones, I’d love to support you. Explore my On-Demand Movement Library, pop into a live Zoom class, explore my BoneSmart Bursts, or jump into our upcoming Strong for Longer fall hybrid series, where you can join in person or over Zoom.

No matter how you participate, you’ll discover that it’s never too late to build strength, resilience, and confidence together.

 

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Pilates – Isn’t that like yoga?

 

As a Pilates teacher for almost three decades and a yoga practitioner for eight years, I often get this question. Based on my personal experience, here are some comparison points about the two disciplines.

For the sake of this discussion, I am comparing yoga to Pilates done on the Reformer. This isn’t about determining which is better; they often enhance each other.

Keep in mind that both traditions include movements contraindicated for those with osteoporosis and certain spinal issues such as herniated discs.

I modify my teaching (and practice) to avoid deep flexion and flexion combined with rotation.

ORIGINS

  • Yoga was developed over 5,000 years ago in India with the purpose of connecting individual consciousness to a universal consciousness creating spiritual enlightenment.  Poses or “asanas” combined with breath control and meditation improve the physical, spiritual, mental, and emotional health of the practitioner.
  • Joseph Pilates began the development of his regimen (historically called “Contrology”) approximately 100 years ago.  The underlying theme of Pilates is a systematic and disciplined approach to physical movement through focus and clarity of the mind.  Joseph Pilates created unique equipment that could support the body to correct dysfunction and improve movement.

EQUIPMENT     

  • Yoga utilizes mats and small props like yoga blocks, bolsters, straps, and blankets to aid or support the practitioner.
  • Pilates has an extensive array of machines, or apparatus, designed to assist individuals in improving alignment, strength, and coordination. The Pilates reformer is the most well-known, consisting of a sliding carriage attached to a frame by springs that provide adjustable resistance. Users perform exercises lying down, sitting, kneeling, or standing. The Reformer promotes controlled, precise movements that target core stability, postural alignment, and functional strength, making it effective for fitness, rehabilitation, and injury prevention.

MOVEMENT

  • In my 8+ years of yoga experience, poses are typically held for extended time periods to release muscle tension, increase muscle length and/or build strength. In some styles of yoga, a long series of poses is repeated sequentially, with the purpose of warming the body to allow for an increased range of motion.
  • Pilates movements are guided by the needs of the client and the versatility of the apparatus, which the teacher can configure to provide assistance or resistance for the client. The format of a Pilates session includes often relatively short segments of movement that emphasize control and precision. A movement is focused on and repeated for several repetitions before moving on to the next exercise.

 

MIND BODY CONNECTION

  • In many types of yoga, the session starts with setting an intention for the practice and ends with a guided meditation and relaxation, or “savasana.”  The goals are to clear the mind and surrender to the movement.
  • In Pilates, there is constant attention on posture, alignment and movement mechanics.  The practitioner is encouraged to focus on each movement, staying present and intentional.  The theme of controlling the body with the mind is ever-present.

BREATH

In Yoga, breath is used to:

  • Anchor awareness: Focusing on the breath helps draw attention inward, fostering mindfulness and presence.
  • Coordinate movement: Breath is often synchronized with poses—inhales to expand or open, exhales to fold or release—creating a flowing, meditative rhythm.
  • Support stability and ease: Deep, steady breathing can help relax tension, improve endurance in postures, and maintain focus.
  • Regulate energy: Different breathing techniques can energize, calm, or balance the system, depending on the intention of the practice.

 

In Pilates, breath is a foundational principle used to enhance movement quality, core engagement, and mind-body connection. Key aspects of breath in Pilates:

  • Facilitates Core Activation: Exhaling deeply engages the deep abdominal muscles, particularly the transverse abdominis, supporting the spine and improving core control.
  • Promotes Efficient Movement: Coordinating breath with movement helps reduce tension, improve flow, and maintain precision. In general, practitioners inhale through the nose to prepare and exhale out the mouth during the effort phase of an exercise.
  • Enhances Focus: Conscious breathing keeps the mind present and aligned with the body’s actions, reinforcing Pilates’ emphasis on mindful movement.
  • Improves Oxygenation: Full, lateral (ribcage-expanding) diaphragmatic breathing supports healthy lung function and efficient oxygen exchange during physical effort.
  • Supports Spinal Mobility: Breath can help mobilize the spine, especially in exercises like articulating bridge, where the exhale contributes to segmental articulation of the vertebrae.

 

INTENTION

  • Yoga emphasizes the mind-body and spiritual connection, quieting the mind by focusing on mastery through introspection.  Flexibility and strength are improved through repetition of the asanas.
  • Pilates follows a systematic approach, focusing on individual movements as they integrate with the whole.  The intended outcome of Pilates is improved posture, strength, balance, and vitality.  You’ll develop a strong, stable core from which you can move freely.
Final Thoughts

While the two disciplines have distinct roots and methods, they both offer profound benefits. Personally, I find that my yoga practice enriches my Pilates teaching—and vice versa. Each provides a unique lens through which to explore movement, presence, and personal growth.

Have you practiced both? When switching between the two, what do you notice in your body, mind, and spirit? I’d love to hear your reflections on either discipline or both.

 

Teresa Maldonado Marchok, PT, is a licensed physical therapist, certified Pilates teacher, and founder of BoneSmart Pilates®.

Since 2012, she has served as a volunteer educator for both American Bone Health and the Bone Health and Osteoporosis Foundation, leading community presentations to raise awareness about bone health. She currently serves on the advisory education committee for the Bone Health and Osteoporosis Foundation. 

Teresa offers a comprehensive suite of bone-safe movement resources, including her On-Demand BoneSmart Movement Library, her BoneSmart Burst™ membership, award-winning DVDs, virtual live classes, and in-person studio sessions designed specifically for the person she’s working with.

Her passion for empowering active agers through intelligent movement is grounded in over 30 years of experience in Pilates, physical therapy, and a distinguished performing career as a soloist with the Martha Graham Dance Company.

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Capital Gains for Your Bones: My D.C. Symposium Recap

I just returned from the International Osteoporosis Symposium in D.C., where healthcare providers from around the globe gathered to share the latest research and insights. One fun takeaway? Those of us who specialize in osteoporosis—whether in movement or medicine—are affectionately known as “Bone Heads”! I’m proud to add that to my growing list of quirky titles, right alongside being a “Graham Cracker”.  Yes, that’s what they call dancers who’ve performed with the Martha Graham Dance Company.

The conference kicked off with an energizing keynote by comedian Kay Frances. She had us laughing while delivering a powerful message: take care of yourself, stress less, and embrace life with humor. With wit and wisdom, she reminded us to stay positive, let go of what we can’t control, and not take ourselves too seriously. Her blend of comedy and insight was the perfect reminder that laughter truly is the best stress reliever.

I realize you “BoneSmarties” (yes, that’s what I call you) include people navigating accelerated bone loss as well as physical therapists, health professionals, and movement specialists working with this population. I do my best to address everyone here.

I cover a lot, so to make it easier for you, here are the presentations I highlight:

  • BoneFit™ Training
  • Long-Term Osteoporosis Management
  • Protein for Muscle and Bone Health
  • Trabecular Bone Score- why it’s important
  • The Skeleton as an Endocrine Organ (The Bone is Not Stone)
  • Year in Review
  • Integrating Exercise and Rehabilitation: Enhancing Patient Care

Scroll down to find the topics that interest you and skip those that don’t.

1) BoneFit™ All-Day Training


I recently completed BoneFit™ certification, an evidence-based approach developed in Canada that tailors movement for individuals with low bone density and osteoporosis. What does that mean for you? It means the guidance I provide is grounded in science and designed with safety in mind. You’re in good hands with someone BoneFit™ certified.    (Full disclosure: This is actually my third specialized osteoporosis training for physical therapists—I just wanted to stay current and continue refining my knowledge.)

Key points:

  • 50-70% of fragility fractures occur in people with osteopenia. That’s always a startling statistic for me. It’s a reminder that having osteopenia, (DXA T score between -1.0  to -2.5) doesn’t mean you won’t fracture.
  • A fragility fracture is a broken bone that happens from a low-impact event — something that wouldn’t normally cause a break in healthy bone. Examples are: Falling from a standing height, rolling over in bed, or sneezing or coughing hard (in severe cases)
  • We need to emphasize as movement professionals that our goal is to “prevent fractures” through strength training, balance training, and functional movement education, like hip hinging and the golfer’s lift.
  • As professionals, use verbiage like spine-friendly movement strategies rather than spine-safe, which sounds scary. Many people are already scared by this diagnosis, so we want to empower them to continue to move.
  • Our focus is on preventing the first fracture (or subsequent ones). For example, after a spine fracture, there’s a fivefold risk of having another fracture.
  • For balance training, standing on one leg like a stork is not enough (though it’s a good place to start). We need to mimic real-life situations where we navigate unexpected environmental obstacles and perturbations, such as tripping over a dog toy on the floor or accidentally getting bumped by someone in a crowded store, and be able to maintain our balance.

 

BoneFit™ Updated Movement Guidelines

(The key difference from prior guidelines is avoiding language that states you should “never” do something or that these movements are “contraindicated” because using that vocabulary can be scary and instill a fear of movement.)

Spine movements to Limit:

Repeated/sustained, weighted, end-range, rapid/forceful, or combined:

  • Flexion (crunches or sit-ups, Pilates rollover, yoga plow pose)
  • Rotation (forced twisting of the spine to end range)
  • Side Bending
  • Combinations of above

Hip:

  • Forced, end-range rotations like the yoga pigeon pose
  • Surgeon-dictated post-surgery limitations (need to clarify for how long)

 

Also covered in this BoneFit™ workshop were these two questions that I often hear regarding OsteoStrong and weighted vests.

  • Will OsteoStrong help my bones? The research was poorly done. Here’s a link from a Bones Lab scientist at the University of Waterloo that clarifies the lack of evidence for its efficacy.
  • Are Weighted Vests good for osteoporosis? According to the Bone Health and Osteoporosis Foundation, “The evidence for using a weighted vest to improve bone mineral density or prevent skeletal fractures in women and men is uncertain. Larger studies of older adults with low bone density or osteoporosis over a longer follow-up time are needed to determine whether weighted vest exercise will lead to beneficial outcomes.”

In addition, a weighted vest may not be safe for those who have had a spine fracture, spine surgery, have hyperkyphosis (excessive rounding of the upper back), or are at high risk of breaking a bone.

 

Onto the next presentation 

2) Long Term Osteoporosis Management

Dr. Michael McClung from the Oregon Osteoporosis Center gave an engaging and informative roadmap for long term treatment.  Key points he made include:

The objective of treatment is to reduce the risk of fracture. Drugs can be catabolic – reducing bone breakdown and resorption and Osteoanabolic drugs which increase bone formation and restore disordered bone microarchitecture. Like other chronic diseases, osteoporosis requires long-term management. There are no treatment “cures” for osteoporosis. Anabolic agents are used only for 1-2 years. The effects of all therapies, including bisphosphonates, dissipate when treatment is stopped.

The decision to start medications is when a patient is at high risk of fracture.

He lays out in very technical terms with lots of evidence, why osteoanabolic drugs should be the initial treatment for high fracture risk patients with osteoporosis.

Why?  Osteoanabolic drugs increase bone mineral density more and more quickly than the anti-reorptive drugs (like alendronate/fosomax)  Clinically they are seeing larger increases in bone mineral density if osteoanabolic drugs are give first vs second.  “If cost were not an issue, all patients with osteoporosis and high fracture risk would be candidates for an osteoanabolic agent as initial therapy to optimize bone mass and strength”.  That benefit can then be maintained with anti-resorptive drugs like bisphosphonates or Denosumab (aka Prolia)

As a reminder Anabolic drugs include Teriparatide (Forteo) and Abaloparatide (Tymlos)

Catabolic/Anti-Resportive drugs include Alendronate (Fosomax), Denosumab (Prolia) and Raloxifene (Evista). Zolendronate (Reclast) infusion is a bisphosphonate derivative used for osteoporosis and cancers that spread to bone.


Onto the next presentation

3) “Protein for Muscle and Bone Health”

(presented by Andrea Josse, Ph.D. from York University, Canada)

This presentation focused on how we prevent bone loss through nutrition, though they pointed out that nutrition and exercise go hand in hand.

In a nutshell, adults older than 65 need more protein than the current RDA. On average, adults 65+ are not obtaining adequate amounts of calcium and vitamin D.

Key Takeaways:

  • Bone and muscle are dynamic tissues that turn over at different rates throughout our lifespan. Nutrition and exercise play key roles in their growth.
  • Older adult females are at greater risk for protein and nutrient deficiency (Calcium and vitamin D). It’s recommended that you get your calcium primarily from your diet.

 

 

  • Protein is beneficial for muscle and bone health across our lifespan. Particularly for the prevention of osteoporosis and sarcopenia (age-related muscle loss). Evidence-based recommendations indicate:
  • Older people should consume an average daily intake of 1.2 g/kg/d
  • If they have a chronic disease (such as osteoporosis) – 1.5 g/kg/d

I look at this and my eyes cross since I work in pounds, not kg. How do we apply this to our pound system?

As an example of how to do this, I calculated the protein needs for “Sara,” a 69-year-old with osteoporosis who weighs 140 lbs. You can use this as a template and just plug in your weight to individualize it for you.

✅ Protein needs for Sara, a 140 lb female with osteoporosis at 1.5 g/kg/day

  1. Convert pounds to kilograms:
  • 140 lbs ÷ 2.2 = 63.6 kg
  1. Multiply by 1.5 g/kg:
  • 63.6 kg × 1.5 g = 95.4 g protein/day

🔹 So her target = about 95 grams of protein per day.

🍽️ Sample Menus to Reach ~95g Protein

You want to spread intake across 3 meals and 1–2 snacks, aiming for 20–30 grams per meal to optimize muscle protein synthesis.

🌞 Breakfast

  • 3 eggs (18g)
  • 1 slice whole grain toast with 2 tablespoons cottage cheese (5g)
  • ½ cup Greek yogurt (plain, 2%) (10g)
  • Breakfast total: 33g

🥗 Lunch

  • 4 oz grilled salmon (28g)
  • 1 cup cooked farro (6g)
  • Mixed greens salad with pumpkin seeds (2 tbsp = 5g) and olive oil
  • Lunch total: 39g

🍲 Dinner

  • ½ cup cooked lentils (9g)
  • ½ cup cooked quinoa (4g)
  • Steamed broccoli (1 cup = 4g)
  • Sprinkle 1 oz feta cheese (4g) over veggies
  • Dinner total: 21g

🥤 Optional Snacks (Choose one or two)

  • Protein shake (1 scoop whey protein powder = ~20g)
  • 1 oz almonds = 6g
  • 1 boiled egg = 6g
  • ½ cup edamame = 8g

And the next presentation

4) Trabecular Bone Score (TBS): How it can help you

Presented by Didier Hans, PhD, Switzerland

This relatively new technology complements bone density (DXA) exams (which measure the quantity of bone) and gives you information about the “quality” of your bone. It could help with clinical decision-making, like whether to start prescription meds.

Let’s look at three examples.

“Susan” has a DXA T score in the osteopenia range, and the doctor wants to put her on meds.  The trabecular bone score would give them further insight into the microarchitecture of the bone, helping to understand the quality and strength of the bone. If it’s good, and her other fracture risks are not of concern, Susan would be better informed to make a decision about starting meds or not.

“Rachel” is actually a friend of mine with osteoporosis. She was diagnosed in her 20s, was a dancer, thin, had a delayed menstrual cycle, and many other factors that put her at risk for OP.  With the proper education, strength training, balance, impact, functional training, dietary supplementation combined with an excellent trabecular bone score, she’s been able to approach this naturally and over 2 decades later, has never fractured.

“Monica” is 71 and has many risk factors for fracture, including being thin with poor balance and having a mother with a hip fracture.  Her DXA T score puts her in the osteopenia range, so she thinks she’s ok. Having a trabecular bone score that is poor could help her see that pharmacological intervention might be the right choice, along with proper nutrition and exercise to help prevent that first fracture.

You might ask, “How do you do a TBS test?”

Good question! A TBS test (Trabecular Bone Score) isn’t a separate scan — it’s an analysis done using images from a DXA scan (the standard bone density scan).

Here’s how someone would get a TBS test:

  1. Get a DXA scan: First, you need a regular DXA scan (usually of the lower spine and hip), which measures bone density (gives you the T-score).
  2. Request a TBS analysis: Not all DXA machines or clinics automatically do TBS. You or your doctor would need to ask if the machine has TBS software and specifically request that your DXA images be analyzed for TBS.
  3. Interpret the results: The TBS gives extra info about the quality of the bone’s internal structure (microarchitecture), not just the density. So even if your T-score is “okay,” a low TBS could still mean your bones are fragile.

Tip: If your doctor doesn’t mention TBS, it’s worth bringing it up, especially if you have risk factors like fractures with only mild trauma or borderline bone density.

I spoke with the reps at the conference. For those who live in northern CA, Stanford is in the process of securing this before the end of 2025. Sinomed in San Francisco currently has it. For those living elsewhere, click here to locate a TBS facility near you.

 

next presentation I’m sharing

5) The Skeleton as an Endocrine Organ

I found this fascinating, and it was very techie, but the main points are that:

  • Bone is not Stone. It’s metabolically alive, remodeling all the time.
  • Bone and muscles have cross-talk with each other through hormones secreted by bone.
  • The interrelationship between bone and muscle is under hormonal control in a two-way street. This brings a whole new face to the parallel development of osteoporosis and sarcopenia (age-related muscle loss) with age.

And the next presentation

6) Year in Review

Dr Lewiecki of New Mexico shared many interesting developments.  Here are just a few.

  • Trabecular Bone Score (TBS) is useful to understand fracture risk. The Frax (fracture risk calculator) now has a place to enter your TBS score to better understand your true fracture risk.
  • Medical Coverage of Telehealth is scheduled to expire 03/31/2025. Extended through 09/30/2025 with temporary government funding bill. After that…?
  • Mitigating bone loss for astronauts. Long duration space flights are associated with high bone turnover. An advanced resistive exercise device (ARED) does not totally prevent bone loss. However, ARED in combination with bisphosphonates is more effective.
  • Path of treatment (BMD = bone mineral density from a DEXA scan)

 

  • Here’s a slide of interesting recommended articles

 

 

And the final presentation

7) Integrating Exercise and Rehabilitation: Enhancing Patient Care

This well-crafted, evidence-based presentation by Rebecca Rotstein, NCPT, and Kavita Patel, DPT, approached this subject through the lens of the doctor or health care practitioner. They encouraged practitioners to promote frequent movement and joyful activities. We are reminded to use our words wisely, minimizing terms like “don’t” or “never.”

A movement-based approach for those with compromised bone density should include multiple factors: resistance, balance, functional training, impact, posture, and spine-safe movements in daily activities.

Interprofessional collaboration in bone health was highlighted to improve outcomes. This collaboration encompasses Medical, Physical Therapy, Exercise/Physical Activity, Nutrition, and Pharmacology. Talking with each other as a team is optimal for patient success.

The presenters encouraged doctors to refer their patients for spine-friendly exercise; however, not all physical therapists or movement professionals are knowledgeable about the latest osteoporosis guidelines. The presenters provided sample questions to assist medical professionals in finding a reputable physical therapist or exercise professional who is current with movement-based guidelines. A few sample questions included: “Have you completed advanced training in osteoporosis?”  “Do you know what motions and exercises to avoid and when?” “Are you aware of key elements and exercises to include?”  “Do you work with any bone health associations?”

 

FINAL REFLECTIONS

 

Attending the International Osteoporosis Symposium left me both inspired and energized. The breadth of information—from cutting-edge medical interventions and pharmacological advances to the vital role of targeted movement—reinforced how multifaceted and hopeful osteoporosis care has become. As a teacher and physical therapist, I’m grateful to be at the intersection of science and movement, translating research into practical strategies that help people thrive.

I return to my work with renewed clarity and commitment, knowing that when we blend evidence-based medicine with empowering movement, we not only build stronger bones—we support a life of confidence, vitality, and resilience at every age.

 

 

 

 

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Can Pilates Reformer Training Reduce Fall Risk in Older Adults?

The #1 Cause of Injury-Related Deaths in Seniors: Can Pilates Help?

Did you know that falls are the leading cause of injury-related deaths for adults over 65?   This often results in loss of independence and decreased quality of life. A landmark study published in the Journal of Bodywork and Movement Therapies explores how Pilates Reformer exercises can help reduce fall risk by improving strength, balance, and coordination.   Read the entire study here.

Research Study: How Pilates Reformer Improves Balance & Strength

Researchers conducted a randomized controlled trial to assess the impact of Pilates Reformer training on fall risk in older adults. Participants engaged in a structured Pilates program, focusing on core stability, lower-body strength, and postural control—all key elements in preventing falls.

What Was Tested in the Study?

Over 10 weeks, older adults attended just one Pilates Reformer class per week, while researchers measured:

  • Balance & equilibrium
  • Range of motion in ankles and hips
  • Fear of falling (psychosocial assessment)

Key Findings: How Pilates Reformer Reduces Fall Risk

The study revealed profound benefits:

✅ Improved Balance & Stability – Participants showed significant gains in dynamic balance, helping them better react to potential falls.
✅ Increased Strength – Strengthening the legs and core provided better support and control during movement.
✅ Enhanced Coordination – Mindful movement patterns in Pilates improved neuromuscular function, a crucial factor in fall prevention.
✅ Greater Confidence – Many participants reported feeling more secure in daily activities, reducing fear of falling. Participants felt better about moving. They regained trust in their bodies, shifting their mindset around aging and mobility.

 

Why Is Pilates So Effective for Fall Prevention?

Pilates Reformer training works because it fosters:

  • A shift from fear of falling to confidence in movement
  • Strength, balance, and mobility improvements through controlled, full-body exercises
  • A social component that enhances motivation and engagement

And the social aspect of Pilates plays a huge role!

Whether it’s a special connection with your teacher who has your back or the mid-class giggles or post-class chat after a semi-private session, you create shared wins. They help rewrite a narrative of fear into one of success and resilience.

 

 

 

Traditional Fall Prevention vs. Pilates: What’s the Difference?

Traditional fall prevention programs often focus on static balance exercises, but Pilates introduces fluid, multi-directional movements that mirror real-life challenges. The use of the Reformer adds an extra layer of resistance and support, making the exercises fun, challenging, and adaptable for various fitness levels.

 

Take Action: Improve Stability with Pilates Reformer Training

If you’re working with older adults or looking to improve your own balance and strength, consider incorporating Pilates Reformer exercises into your routine. Concentrate on combined strength and mobility exercises such as footwork, hip work with feet in straps, scooter, reverse scooter, and Eve’s lunge, among others included in the study. I would also include weight-bearing and dynamic balance exercises. Maintain controlled movements, strength with proper alignment, and breathwork—all of which contribute to enhanced stability and fall prevention.

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Fall Prevention 101: A Guide for Healthy Aging and Osteoporosis

When we were young, and we’d fall, we’d pop back up and continue on without much thought.

As we age, falls become a major concern. In fact, falls are a leading cause of injury and death among people ages 65 and older.

Falling is one of the most significant risks for individuals with osteoporosis, as weakened bones are more susceptible to fractures.

The good news is that falls are largely preventable with awareness, preparation, and intentional movement. In this blog, we’ll explore practical strategies for reducing fall risk and empowering you to move confidently through life.

 

Why Fall Prevention Matters

For those with osteoporosis, even a minor fall can result in fractures, commonly in the hip, spine, or wrist. Beyond the physical impact, falls can lead to fear of movement, limiting mobility and quality of life. Prevention is not just about avoiding accidents; it’s about fostering confidence, independence, and resilience.

Seven Things You Can Do to Avoid Falls:

Each is explained below.

  1. Build & Practice Your Balance.
  2. Strengthen Key Muscles
  3. Optimize Your Environment
  4. Wear the Right Footwear
  5. Practice Mindful Movement
  6. Stay Active with Bone-Safe Movement
  7. Know how to Fall Safely.

 

Build Your Balance

Balance is a skill that can be improved with practice. Regular balance training strengthens stabilizing muscles and enhances coordination, reducing your risk of tripping or losing your footing.

Simple Exercises to Try to Build Your Balance:

 

  • Single-leg stance: Stand near a sturdy surface for support and try lifting one foot off the ground. Hold for 10–30 seconds, then switch sides.
  • Heel-to-toe walk: Imagine walking on a tightrope. Place one foot directly in front of the other, with the heel touching the toes of the opposite foot. Keep your head from tipping down, as that will throw off your balance. Be close to something you can hold onto if needed.

 

 

Strengthen Key Muscles

Strong muscles, particularly in your legs, glutes, and core, provide a solid foundation for stability. Functional exercises can help you move with control and reduce fall risk.

Bone-Safe Exercises for Strength:

 

 

Sit-to-stand: Practice getting up from a chair safely without using your hands. This builds leg and glute strength. If you’re deconditioned, you may need a little help from your hands at first.  Keep your shoulders down and spine straight.

 

 

 

 

 

 

 

Counter push-ups: This strengthens your arms, shoulders, and core to catch yourself if you stumble.

 

 

 

 

 

 

Knees off: From hands and knees, flex your feet and lift your knees just off the floor, maintaining a straight spine from your head to your tailbone. This is a great core, arm, shoulder, and hip strengthener.

 

 

 

 

 

 

 

 

How to Optimize Your Environment

Create a safe home environment by removing common tripping hazards and enhancing visibility.

Home Safety Checklist:

  • Remove loose rugs or secure them with non-slip backing.
  • Ensure all areas are well-lit, especially staircases.
  • Install grab bars in the bathroom and railings on stairs.
  • Clear clutter that you could trip on, like pet toys
  • Keep frequently used items within easy reach to avoid climbing or overstretching.

Wear the Right Footwear

Supportive, non-slip shoes can make a world of difference in preventing slips and falls. Avoid shoes with slippery soles, high heels, or worn treads.  My friend’s mom recently fell wearing shoes with no traction.

 

Practice Mindful Movement

  • Be conscious of your posture and how you move through space. Adopting strategies like “think before you move” can prevent sudden missteps.
  • Always hold the handrail when going up or down stairs.
  • Don’t text and walk.
  • Give your body a moment to adjust when you get out of bed. Sit up first, get your bearings, then stand up and wait a few seconds before taking a step. I apply this guidance on the Pilates reformer when a client has finished a series of exercises on their back, and the next exercise requires them to stand. Giving your circulation and vestibular system a moment to adapt when changing body positions can reduce the incidence of dizziness and falling.

Posture Tips:

  • Stand tall and sit tall, keeping your head aligned over your shoulders and your weight evenly distributed.
  • Avoid bending forward at the waist (rounding your back), which can compromise balance and increase fracture risk.

Stay Active with Bone-Safe Workouts

Exercise isn’t just about building strength—it also improves flexibility, coordination, and bone density, and it should be fun!  Activities like modified Pilates, resistance training, dance, and even high-intensity interval training (HIIT), can be adapted to support your needs while keeping your bones safe.

 

Know How to Fall Safely

While the goal is to avoid falls altogether, learning how to fall can minimize injury. If you find yourself losing balance:

  • when falling forward, try to minimize the impact by grabbing onto something.
  • If you’re strong enough, you can catch yourself with your hands and the strength of your shoulders and core (like the knees off exercise mentioned above). This could spare your knees and hips.

Conclusion

Fall prevention is an ongoing process that combines physical training, environmental awareness, and mindful living. By implementing these strategies, you can reduce your risk of falls and live with greater ease and confidence.

Looking for expert guidance? My BoneSmart Pilates On-Demand subscription offers bone-safe classes designed to strengthen your body and boost your balance. Together, we can create a fall-proof foundation for your future.

Are you ready to take control of your movement and fall-proof your life? Join our online community of active agers today on our free private Aging Strong Forum.  Receive expert bone-safe guidance at our BoneSmart Virtual Movement Library and our bite-size BoneSmart Burst membership

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Avoid Injuries when Lifting or Bending

Why should you Hip Hinge for a Happy Back?

I was moved to write this article after a few of my clients recently injured themselves while lifting or bending. They expressed a lapse in mindfulness at the moment of injury. My goal is to help you avoid the common pitfalls that can occur when bending or lifting improperly.

 

Five reasons that hip hinging is the preferred technique for bending and lifting, especially for individuals with osteoporosis, active agers, or anyone seeking to protect their back.

  1. Hip Hinging Protects the Spine from Flexion Forces

  • Avoids Spinal Flexion: Osteoporosis increases the risk of vertebral fractures, especially from movements that involve rounding the back (spinal flexion), which compresses the front of the vertebrae. Hip hinging keeps the spine neutral, reducing this risk.
  • Preserves Disc Health: Flexing the spine under load can increase the risk of herniating spinal discs. A neutral spine during a hip hinge spares the intervertebral discs from undue pressure.

  1. Hip Hinging Strengthens Posterior Chain Muscles

  • Engages the Glutes and Hamstrings: The hip hinge relies on the large, strong muscles in the back of the body, particularly the glutes and hamstrings, to handle the load instead of the spine.
  • Promotes Functional Strength: These muscles are crucial for daily activities like getting in and out of a chair, climbing stairs, and crouching down to reach your pet, making hip hinging a functional and safe movement.

 

  1. Hip Hinging Enhances Core Engagement

  • A proper hip hinge requires the core muscles to stabilize the spine, improving abdominal and back strength, which further supports spinal health and posture.

  1. Hip Hinging Maintains Balance and Reduces Fall Risk

  • Hip hinging shifts the center of gravity backward, keeping the body balanced over the feet. This decreases the chance of losing balance and falling forward, which could lead to fractures.

  1. Hip Hinging Encourages Proper Movement Patterns

  • Develops Good Habits: This is an important one. Through practice and a lot of repetition, proper hip hinging retrains faulty movement patterns.  This makes bending and lifting safer and more efficient during activities of daily living, like moving from sit to stand or when you’re picking up something off the floor.  The key is to ingrain this movement pattern, through repetition, into your muscle memory.  Once it’s ingrained, it will be your unconscious go-to pattern anytime you need to bend down.
  • Reduces Cumulative Stress: Repeated improper bending (spinal flexion) can lead to wear and tear over time. A hip hinge avoids this cumulative stress.

 

Practical Tips for Hip Hinging

  • Hinge at the Hips, Not the Waist: Push the hips back while keeping the chest lifted and the spine neutral.
  • Be sure to bend your knees. This helps maintain balance and allows the legs to assist in lifting.

  • Use a dowel at first for feedback: You want to ideally feel the dowel in contact with 3 points: the back of your head, between your shoulder blades, and behind your buttocks to promote optimal posture. Practicing with the dowel imprints better alignment.

 

  • Use Your Legs and Hips to Lift: Engage your leg and hip muscles to stand up, avoiding strain on the back.

 

  • Brace your Core and Exhale on the Lift:  Bracing involves engaging your abdominal muscles as though preparing to absorb a light punch. This creates intra-abdominal pressure, which acts like a natural corset, protecting your lumbar spine from injury. Exhaling during exertion naturally engages your deep core muscles.  Abdominal bracing with exhalation results in reduced risk of back injuries and better transfer of force through the body.

 

  • Keep the Load Close to the Body: When lifting, hold objects close to your core to minimize strain.

 

 

In Summary

Adopting the hip hinge for bending and lifting promotes long-term back health, helps prevent fractures in those with osteoporosis, and supports overall functional strength.

 

 

 

Written by Teresa Maldonado Marchok, licensed PT and Nationally Certified Pilates Teacher

Creator of the BoneSmart Pilates® Method and DVD Series

and the BoneSmart On-Demand Movement Library

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Osteoporosis Safe Exercise: 3 Essential Steps to Prevent Fractures

Prevent fractures, avoid falls, and build bone with the BoneSmart ABCs

When people are first diagnosed with osteoporosis, many react with movement paralysis.  Fear takes over, and they want to cover themselves in metaphorical bubble wrap, protecting themselves from breaking a bone should they fall.

There’s a better way.

BoneSmart Pilates® created a simple-to-remember BoneSmart ABC approach to guide you (or your clients if you’re a movement teacher) to prevent fractures, avoid falls, and build bone.

“A” represents Alignment.  “B” stands for Balance.  “C” represents Contraction.

Let’s explore each one.

Alignment encompasses posture. We promote a neutral spine posture, with ear, shoulder, and hip in line when viewed from the side. Our mantra is Sit Tall and Walk Tall. I coach my clients to find their ideal posture when seated in their car and then set the height of the rearview mirror. After 20 minutes of driving, if you don’t see well in the mirror, don’t readjust it – readjust your posture! It just means you’re slouching and need a reset.

Flexion (rounding) of the spine is contraindicated when you have osteoporosis. The rounded spinal forces predispose you to a fracture. Adding weight while in that posture, like picking up the ubiquitous Amazon box, creates a risky situation.

A landmark study conducted by the Mayo Clinic in 1984 changed how we approach exercise for osteoporosis. In this study, the researchers discovered that flexion exercises led to increased vertebral fractures in women with osteoporosis. The findings were so startling that replicating this study today would be unethical. Given this knowledge, it is crucial for individuals with osteoporosis to avoid flexion-based movements such as sitting slouched, rounding over to tie your shoes, or doing abdominal crunches.

Low bone density necessitates safe bending. We emphasize hip hinging by bending from the hips, not the spine. A handy tool is a dowel or broomstick held behind your back. Aim for the dowel to touch your head, upper back, and sacrum. Now, hinge from the hips, maintaining those three points of contact. The result is better posture and stronger legs and glutes!

 

 

 

Twisting to end range should be avoided. (Imagine rotating your spine and then using leverage to get more range, common in some yoga poses) Also, refrain from twisting combined with flexion, such as twisting and rounding the spine while getting a heavy casserole dish out of the oven, or rounding over as you twist to tie one shoe.

 

However, you can still twist safely! Ensure a lengthened, straight spine without any rounding. Imagine sitting in your car seat. You’re a DNA molecule spiraling upward as you twist from the waist up to see behind you, shoulders remaining level.

 

Balance

Ninety percent of hip fractures and one-third of vertebral fractures are caused by a fall. Balance is crucial for preventing falls. A 2008 study by Sakamoto showed that standing on one leg for just one minute, 3x/day, actually improved hip bone density. An easy way to start fitting balance into your day is to brush your top teeth for a minute while standing on one leg and the bottom teeth while balancing on the other leg. Do that twice a day, and you’re already at 4 minutes!

Contraction

 

 

 

 

 

 

Exercises for osteoporosis involve applying mechanical stressors to the bone to stimulate growth.
Think planks, squats, and lunges. Include resistance exercises using free weights, weight machines, or resistance bands. The tendons of the contracting muscles pull on bone, eliciting a growth response. Finally, surprise your bones with impact exercises such as aerobics, stomping, and jumping. Bones respond to impact by stimulating growth.

 

When your hip and leg muscles are strong, you are steadier on your feet, and if you do hit an incongruency in the ground, you have the strength to prevent a fall.

Summing it Up 

According to the Bone Health and Osteoporosis Foundation, 1 in 2 women over 50 will have an osteoporotic fracture in their lifetime. Know not only your DEXA score (which tells you the density of your bones) but also your fracture risk. (Access the FRAX online tool, a quick 11-question survey to learn your personal risk).  If you’re a movement teacher, half of your class over 50 could be at risk of a fracture. Err on the side of caution. Remember, osteoporosis is a silent disease. Two-thirds of spinal fractures go undiagnosed; people don’t even know they have them!

Pilates is rich in exercises you can do safely. Omit all the flexion-based exercises you know (like Rolling like a ball, or Long spine on the Reformer) and modify exercises to make them safe, like keeping the head on the floor during the Hundred, Single leg stretch, and Double leg stretch. Emphasize neutral spine and extension exercises, which are bone-protective. Once you understand the BoneSmart ABCs, you can apply them to any movement system and enjoy a rich and challenging experience.

 

 

Teresa Maldonado Marchok, licensed physical therapist, NCPT (nationally certified Pilates teacher), former soloist with the Martha Graham Dance Company, and current advisory committee member for the Bone Health and Osteoporosis Foundation. Founder of the BoneSmart Pilates® Method and DVD series, Teresa established the first Pilates Program at Stanford University in 1996 where she taught for two decades. She teaches in-person private and small group sessions at her studio in Mountain View, CA as well as offering weekly live virtual classes and an On Demand Virtual library. Incorporating the art and science of movement, Teresa meets you where you and supports you in reaching your goals.

Enjoy live virtual classes and the robust BoneSmart Pilates® OnDemand Movement Library.  If you’re busy and prefer smaller exercise doses, try the BoneSmart Burst™ membership.  Each day you’ll have access to two curated video Bursts of bone-safe movement; everyone has 5-12 minutes to move,  which will leave you feeling strong, energized, and confident!

 

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Why Exercise? Unlocking the Power of Movement for Mind and Memory

Is keeping your memory important to you?

With a strong family history of Alzheimer’s disease, it is critical to me. This is the reason I joined a clinical trial at the start of the pandemic to prevent or reverse Alzheimer’s disease. It’s also why I’m passionate about researching the benefits of movement on our mind and memory.
While many turn to meditation, brain games, and healthy diets for brain health, the often underappreciated role of movement can enhance both mind and memory!

Authors that I follow closely, like Kelly McGonigal and Jim Kwik, have explored the profound impact of physical activity on the brain, offering insights that can help us lead more vibrant and resilient lives.

The Connection Between Movement and the Mind

Kelly McGonigal, a health psychologist and author of The Joy of Movement, has dedicated much of her work to exploring how physical activity can improve our mental and emotional health. McGonigal emphasizes that movement isn’t just about physical fitness—it’s also a vital component of mental well-being. In her book, she describes how exercise can reduce stress, anxiety, and depression by altering brain chemistry. Through the release of neurotransmitters like dopamine and serotonin, physical activity helps elevate mood and create a sense of well-being.

Jim Kwik, a brain coach and author of Limitless, further explores the relationship between movement and cognitive performance. Kwik argues that the brain and body are deeply interconnected, and regular physical activity is crucial for optimal brain function. In his book, he discusses how exercise increases blood flow to the brain, enhancing focus, learning, and memory. Kwik often cites the phrase “as your body moves, your brain grooves,” highlighting the direct impact of physical activity on neural pathways.

How Movement Enhances Memory

Memory, one of the most crucial cognitive functions, can be significantly improved through regular physical activity. Both McGonigal and Kwik agree that movement plays a key role in enhancing memory retention and cognitive longevity.

McGonigal points to studies showing that aerobic exercises, such as walking, running, and swimming, can increase the size of the hippocampus, the brain region responsible for memory and learning. This growth leads to better memory recall and a decreased risk of age-related cognitive decline.

Jim Kwik provides practical examples of how movement can be integrated into learning routines to boost memory. He suggests techniques like “brain breaks,” where short bursts of physical activity are used to refresh the mind during study sessions or work. This practice not only keeps the brain engaged but also helps consolidate new information, making it easier to remember.

He also has a wonderful “Body List technique” for remembering a list of items.

By associating each item with a part of your body and creating a vivid, exaggerated image, you’re making it easier to remember the list. The more unusual and sensory-rich the association, the more likely it is to stick in your memory. When you need to recall the list, you simply “walk” through your body from head to toe, triggering each item as you go.  If you take my upcoming Aging Strong – Movement. Mind. Memory. Series, I’ll walk you through this technique as you quickly memorize a list of 10 brain foods.

This technique leverages the brain’s natural ability to remember spatial and sensory information, making it a powerful tool for memorization.

A study published in Psychological Science found that participants who engaged in regular physical activity showed better memory performance and an increase in brain-derived neurotrophic factor (BDNF), a protein that supports the survival and growth of neurons. BDNF is often referred to as “Miracle-Gro for the brain,” as it nourishes brain cells and facilitates neurogenesis, the process of creating new neurons.

Real-Life Examples of Movement’s Impact

Jim Kwik often recounts his own experiences with movement and learning. Growing up with learning challenges, Kwik struggled with reading and memory retention. It wasn’t until he discovered the power of physical activity that he began to unlock his full cognitive potential. By incorporating regular exercise into his routine, Kwik was able to enhance his focus, accelerate his learning, and eventually become a sought-after brain coach.

Practical Tips for Incorporating Movement into Your Life

To harness the cognitive benefits of movement, consider the following strategies inspired by McGonigal and Kwik:

  1. Combine Learning with Movement: As Jim Kwik suggests, try incorporating physical activity into your study or work routine. Take short “brain breaks” every 30 minutes to stretch, walk, or do a quick set of exercises. This will help keep your mind sharp and your memory strong.Also incorporate visual, auditory, and kinesthetic cues with things you want to remember.
  2. Find Joy in Group Activities: Kelly McGonigal emphasizes the power of social connection in physical activity. Join a group exercise class, even a virtual live group class, or simply go for walks with friends. The social aspect enhances the mental benefits and makes it easier to stay consistent.
  3. Start a Daily Movement Routine: Whether it’s a morning walk, a yoga session, or a dance or Pilates class, make movement a non-negotiable part of your daily routine. As both authors highlight, consistency is key to reaping the cognitive benefits.
  4. Challenge Your Brain and Body: Engage in activities that require both mental and physical effort, such as dancing, martial arts, Pilates, or even learning a new sport. This dual challenge can boost brain plasticity (the ability of the brain to create new neural connections) and enhance memory.

 

To Sum it Up

Movement is a powerful tool for enhancing both mind and memory. As Kelly McGonigal and Jim Kwik have shown, regular physical activity improves mental health and emotional well-being and sharpens cognitive functions like memory and learning. By integrating movement into our daily lives, we can unlock the full potential of our minds and lead richer, more fulfilling lives.

References:

  • Kwik, J. (2020). Limitless: Upgrade Your Brain, Learn Anything Faster, and Unlock Your Exceptional Life. Hay House Inc.
  • McGonigal, K. (2019). The Joy of Movement: How Exercise Helps Us Find Happiness, Hope, Connection, and Courage. Avery.
  • Psychological Science: Regular Physical Activity and Memory Improvement Study.
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Former Dancer’s Exercises for Osteoporosis

Originally posted in Prime Women magazine on 9/16/2014

 

Interview with Teresa Maldonado Marchok:

We’ve all heard about the dangers of osteoporosis but did you know you should be doing different exercises for osteoporosis? It is known as a silent disease, so, unless you’ve had a bone density test done lately, you may not even know you’ve slipped into that precarious area of low bone mass (aka osteopenia) or even full on osteoporosis.

Teresa discovered Pilates while dancing professionally with the Martha Graham Dance Company. The rigors of rehearsing and touring worldwide take a toll on a dancer’s body. She credits Pilates’ emphasis on length, strength, breath, and precision with keeping her relatively injury free throughout her dance career.

After leaving the MG Dance Company, she became a physical therapist. It was while she was a PT that she used many of the Pilates mat exercises with her patients and saw profound results. With a herniated disc in her own lower back, Teresa learned that the principles of alignment, recommended for osteoporosis, applied to her condition, as well, and have helped her to control her symptoms. To keep herself healthy, she incorporates these alignment modifications during her daily activities as well as during the dance, yoga, and Pilates classes that she takes and teaches. In a recent interview, I had a chance to ask Teresa about what she believes PRiME women need to know about protecting their bones and how exercises for osteoporosis need to be altered.

Why are we hearing so much about the dangers of osteoporosis lately?

TM: With the rise in aging boomers, we are seeing increasing rates in osteoporosis. The young are not immune either. I got a call this week from a 30 year old woman with osteoporosis that fractured her rib from just a sneeze.

It’s easy to miss osteoporosis, as it’s a silent disease. You might notice your height is no longer what it displays on your driver’s license or your ribs may be sitting on your pelvis, causing pain. You might notice an increased kyphosis (rounding) of the upper back as a result of broken bones there because fractures in the upper back often occur without any symptoms or can be mistaken for a pulled muscle. According to the national organization American Bone Health, 70% of people with osteoporosis have never been screened and don’t know they have it.

A recent report from the U.S. Surgeon General warned that by 2020, 1 in 2 Americans over the age of 50 will be at risk for fractures from osteoporosis and low bone mass. It’s important to be screened and if you have risk factors for the disease. Request a DXA scan, which is the gold standard for measuring bone density and diagnosing osteoporosis.

The good news is that there are proactive steps that you can take to prevent or reduce the effects of osteoporosis. Choosing the right kind of exercise is my area of focus.

Isn’t there medication to take care of osteoporosis?

TM: Controversy exists around different bone medications, but the one undisputed method of addressing this condition is exercise. The strength you develop in your legs, arms, and core, as well as the balance and improved reflexes you cultivate, will decrease your risk of falling and help you recover if you do lose your balance.  Should you hit the ground, you’ll have the upper body strength to decelerate, minimize impact, and avoid a possible hip fracture.

Recently a woman in her prime and Pilates student of mine tripped and lost her balance at a wedding reception. She went into automatic and landed like Spiderwoman, crediting her core strength and quick responses for not injuring herself or ruining her expensive outfit!

What are some examples of types of exercise that build bone?

TM: Some good choices include backpacking, tennis, dance (particularly Zumba and Flamenco), weight training, and high impact aerobics. Activities like walking and low-impact aerobics may not build bone, but they are protective against further bone loss. Biking and swimming are great aerobic choices but have no benefit for building bone due to their lack of impact. In fact, a study showed that endurance cyclists risk hipbone loss because so much of the exercise they do is non-weight bearing.

 

 

Why do women with osteoporosis need a different exercise program than a woman without any bone issue?

TM: Osteoporosis literally means “porous bones.” Their bones are fragile and at risk of fracture. Exercises for osteoporosis require that you put mechanical stressors on the bone to help stimulate growth. Examples include: weight bearing exercise, resistance exercise where the tendons of the muscles that are contracting pull on the bone, stimulating a growth response, and impact exercise such as aerobics, stomping, and jumping.

I saw a presentation recently with results from the Bone Research Lab at the University of Oregon showing that stomping 100 times for 3 times a week improved bone mineral density in the hip. The stomping was done with a force about equal to popping bubble wrap.

Of the sites that fracture, the spine, hip, and wrist are the most susceptible. With that in mind, if someone has been diagnosed with osteoporosis of the hip, but has normal bone density scores everywhere else, then their exercise program should specifically target standing exercises that provide impact translated to the hip bones, strengthening exercises for the muscles surrounding the hip joint, and balance exercises to prevent falling.

On the other hand, if you have low bone density in your upper back (thoracic region), target prone exercises like cobra in yoga or swan in Pilates to strengthen the upper back muscles, which in turn will strengthen those bones. Sinaki has done several informative studies on the link between strong back muscles and the reduction of vertebral fractures.

What exercises should women avoid who have osteoporosis?

TM: There was a landmark study done by the Mayo clinic in 1984 that changed the landscape of the way we address exercise for osteoporosis. In this study, the researchers found that flexion exercises resulted in increased vertebral fractures for women with osteoporosis. The results were so startling that to replicate this study today would be unethical. With this understanding, it is imperative that those with osteoporosis avoid flexion-based moves such as sitting slumped at the computer, rounding over to tie your shoes, touching your toes, or doing abdominal crunches. Those with osteoporosis are also encouraged to avoid extreme end of range side bending and rotation as those movements can put excessive compressive forces on the spine.

Tell us about your BoneSmart Pilates® method?

TM: My BoneSmart Pilates® method, in a nutshell, hones down the bone safe principles of exercise into a simple ABC format.

A stands for Alignment. When you have osteoporosis, you need to be aware of keeping your spine in optimal alignment, avoiding flexion. With exercises for osteoporosis, you must be able to bend safely so we incorporate hip hinging, where you bend forward from your hips rather than rounding your spine. I often use a dowel to teach this principle, where the dowel is used as an alignment tool, held vertically behind your back. You try and maintain 3 points of contact with the dowel at your head, upper back, and your sacrum as you hip hinge. Using the dowel to practice hinging or getting up and down from a chair is a great exercise. It reinforces good posture and strengthens your legs and gluteal muscles.

B stands for Balance. 90% of hip fractures and 1/3 of vertebral fractures are caused by a fall. Balance is critical for preventing falls that can be devastating if you have fragile bones. A 2008 study by Sakamoto showed that standing on one leg for just one minute, 3x/day actually improved bone density. An easy way to start fitting balance into your day is to brush your top teeth for a minute while standing on one leg, and the bottom teeth while balancing on the other leg. Do that twice a day and you’re already at 4 minutes!

C represents Contraction of muscle while doing the following 3 kinds of exercise: weight-bearing exercise, resistance exercise, and impact exercise. This gives your bones the signals to grow and rebuild.

For more information and to see a short preview of her award-winning DVD, please visit Teresa Maldonado Marchok’s website at www.BoneSmartPilates.com.

Additional Information for Blog Readers — from Teresa added 7/27/2024.

Since this article published in 2014,  we’ve seen the rapid aging of the population worldwide and changes in lifestyle habits – think sedentary, computer slumped, texting cashew posture.  The incidence of osteoporosis and related fractures has significantly increased and will continue to increase markedly in the future. According to the National Institute of Health, osteoporosis is considered a serious public health concern due to its prevalence worldwide.  Personally I’ve held osteopenia at bay and have successfully controlled my herniated discs by following my program of bone-safe, spine-safe movement. The BoneSmart Pilates® ABCs still hold hold their weight.

In addition to these record rates of osteoporosis, we’re experiencing booming technology to deliver bone-safe exercise sessions live and on-demand.

I now offer a robust On-Demand platform so you can access bone-safe exercises on your schedule anytime regardless of where you live.

Benefit from the BoneSmart  On-Demand Movement Library with over 350 classes of various styles and lengths and the BoneSmart Burst™ Subscription which includes “exercise snacks,”  bite-sized movement gems delivered right to your inbox. 

Learn more about them here.

Do you thrive on live feedback?  In addition, I offer live virtual classes in 30 minute and 60 minute formats.  Gain from the expertise of a licensed physical therapist and nationally certified Pilates teacher (NCPT).

Do you still prefer physical DVDs?  Exclusive to my blog readers a 25% discount at BoneSmartPilates.com on all my DVDs when you enter code STRONG25 at check out.

 

 

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Teresa’s Top 2 Pilates Travel Props

Practicing what I preach, I never leave home without my long resistance band and BoneSmart inflatable core ball, which is a must for any trip I take.  Is a full workout part of my travel routine?  No, but it makes a huge difference to how I feel if I fit in even 10 minutes of a combined core and strengthening regimen.  Both props are travel-friendly, lightweight, and small enough to slip into a zip lock bag with the ball deflated.

 

The video I’m sharing here is just that – short, to the point, and effective.

 

Why care about flexibility and core training while traveling?

Maintaining core strength and flexibility when traveling is important for several reasons:

  • Injury Prevention: A strong core and good flexibility help prevent injuries, which can be particularly important when you’re on the go and might be engaging in unfamiliar physical activities or spending long hours in transit.
  • Posture and Back Health: Traveling often involves prolonged sitting, whether on planes, trains, or cars. Maintaining core strength and flexibility can help counteract the negative effects of prolonged sitting, such as poor posture and back pain. 
  • Adaptability: Core strength and flexibility improve your overall physical fitness, making it easier to adapt to different activities and environments you might encounter while traveling.

 

 

The BoneSmart Inflatable Core Ball has multiple uses.

  1. When deflated with just a puff of air, this ball instantly provides lumbar support for plane seats not designed for comfort or alignment. The beauty of the ball is that you can customize the amount of air to match your unique anatomy. With just the right amount of inflation, you’ll experience immediate support and relief.
  2. Lying on your back with knees bent, place the ball between your thighs and squeeze to activate your inner thigh and pelvic floor muscles. Progress that to bridging, lifting your hips to strengthen your glutes and mobilize your spine.
  3. It’s wonderful behind your upper back, spine draped back, hands supporting your head, knees bent, feet flat on the mat. This opens your chest and reverses the effects of slumping.
  4. You can lift and lower your chest from this position for a bone-safe sit-up variation called “Chest Lift,” which activates your core muscles. Watch the video demonstration to learn to do this correctly.
  5. I also enjoy placing the ball under my bottom for delicious hip releases.

 

The Long Resistance Band also has Multiple Uses 

Band Exercises Designed for Upper Body

The long resistance band offers numerous exercises to increase arm and shoulder strength and flexibility, which can counteract the negative effects of prolonged sitting, especially during travel. In this instructional video, you will learn upper back strengthening, rotator cuff, and mobility exercises to free your chest and shoulders. 

Band Exercises Designed for Lower Body

Extended periods of sitting can lead to shortened muscles in the front of your hips (hip flexors) and back of your legs (hamstrings.)  By doing these exercises, you can experience significant relief in your hips and legs, resulting in increased flexibility and resilience. 

Do you want more exercise options?

 

These exercises I’ve shared are just a small sample of the many ways I incorporate these props into tools to promote better posture, improve strength, and feel great.  Do you enjoy live feedback and cueing? Join one of my ongoing Live Virtual Group Classes.  You only need a little space and a computer or mobile device to jump on Zoom.

 

Prefer exercising without an audience? Unable to attend live BoneSmart classes due to your schedule? Check out the extensive BoneSmart On-Demand Movement Library. With over 300 videos, you can enjoy a variety of 30-minute and hour-long classes designed by a physical therapist to be challenging and fun. These sessions are tailored to be safe for individuals with osteopenia or osteoporosis.

 

Are you tight on time and want something more bite-sized? If so, the BoneSmart Burst™ subscription is the ideal solution. Three times a week, short, expertly crafted bursts of movement land in your inbox to encourage you to follow along and move at your convenience. These Bursts in 5-10 minutes episodes are perfect when traveling or when you have limited time for a workout. Remember, even a little movement can make a big difference.

 

Discover the endless possibilities with our On-Demand options. Visit www.BoneSmartPilates.com to find out more!

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