For many of us, getting older isn’t easy. We persevere through stiffness, aches, and pains.

The good news is we don’t have to accept these “inconveniences” of age as inevitable.

The key, my friends, is lean muscle mass.  According to Dr. Allen Mishra, an orthopedic surgeon at Stanford, “muscles are modifiable until the day you die.” And there’s recent research to back this up.

Orthopedic surgeon Dr. Vonda Wright notes that “we do not have to be the victims of the passage of time; we don’t have to go down a slippery slope from vitality to frailty and do nothing about it.”  She states that the number one thing that can save our lives is our lean muscle mass.

Muscles play a crucial role in aging and longevity due to their impact on overall health, mobility, and metabolic function. Here are several reasons why muscle matters for aging and longevity:


  • Metabolism and Weight Management: Muscle tissue is more metabolically active than fat tissue, which burns more calories even at rest. As people age, they tend to lose muscle mass, which can decrease basal metabolic rate. This makes it easier to gain weight and harder to maintain a healthy weight, which in turn can increase the risk of various health conditions such as obesity, type 2 diabetes, and cardiovascular diseases. Preserving muscle mass through exercise and a balanced diet can help mitigate these risks.


  • Bone Health is a subject I’m passionate about: Muscles are connected to bones through tendons, and when muscles contract, they exert force on bones, which in turn helps to stimulate bone growth. This is crucial, especially for women who are at a higher risk of osteoporosis, a condition where bones become weak and brittle. According to the National Institute of Health (NIH), one in two women over 50 will experience an osteoporosis-related fracture in their lifetime. Engaging in weight-bearing exercises and resistance training can improve bone density and reduce the risk of fractures as people age. And don’t forget impact exercises to “surprise the bones,” which, according to Wolf’s law, stimulates bone growth. If you do have osteopenia or osteoporosis, make sure to find a trainer or physical therapist who has special certification for working with osteoporosis. There are clear guidelines that need to be followed to keep you safe.


  • Leg Power Predicts Brain PowerAccording to a UK study by Steves et al 2015, evidence showed that the stronger the legs were, the less risk of dementia and the greater the gray matter in the brain. For those concerned about cognitive decline, this is an actionable step you can take. Strengthen those legs.


  • Balance and Fall Prevention: Strong muscles, particularly those in the legs and core, are essential for balance and stability. Falls are a significant concern for older adults, as they can lead to serious injuries such as hip fractures. Having good muscle strength and
    balance reduces the risk of falls and enhances the ability to recover from a loss of balance. Also, don’t forget that having strong arm and shoulder muscles and a strong core can help you avoid a fracture by “catching yourself” before your hips or knees hit the ground.


  • Functional Independence: Maintaining muscle mass and strength is directly linked to the ability to perform daily tasks
    independently. This includes activities such as walking, climbing stairs, carrying groceries, and getting up from a chair. As people age, the loss of muscle mass (sarcopenia) can impair these functional abilities, leading to a loss of independence. Regular strength training and exercise can help preserve muscle function and independence.


  • Hormone Regulation: We often perceive muscle as something that helps keep us strong or helps us move.  What we might not realize is that muscle also serves as an endocrine-like organ. When muscles contract, they release these molecules called myokines.  Myokines have positive effects on your Metabolic system, Cardiovascular system, Immune system and your Mental function.  Brain-derived neurotrophic factor (BDNF) protects your brain and supports neuroplasticity essential for learning and memory. A 2023 study by Abou Sawan et al showed evidence that “increasing physical activity can affect cognitive function in older adults.”


  • Inflammatory Response: Chronic low-grade inflammation is a common feature of aging and is associated with various age-related diseases, including heart disease and Alzheimer’s. Regular exercise, especially resistance training, has been shown to have anti-inflammatory effects, which can contribute to better overall health and longevity.


  • Longevity and Quality of Life (QOL): Overall, maintaining muscle mass and strength is associated with a longer, healthier life. Studies have consistently shown that individuals with higher muscle mass tend to live longer and have a lower risk of age-related diseases. Additionally, having good muscle health improves the quality of life in older adults, allowing them to remain active, independent, and engaged in daily activities. If you don’t have the strength to take a walk, get into and out of your chair safely, or play with your grandkids, your quality of life plummets.


One of the key findings from the Okinawa Japan Blue Zone is that their environment naturally encouraged strengthening. For instance, a typical home has low-lying tables, and people sit on the floor. Centenarians rise up and down from the floor on average 30 times a day and, in the process, strengthen their hips, legs, and core and hone their balance. That’s a lot of squats and a lot of function!  Okinawan centenarians tend to their gardens most days. They weed, pull, dig, and squat for one to two hours a day. In contrast, falls are one of the top ten leading causes of death for older people in the US. They have weak hips and legs and poor balance because so many of them are sedentary, sitting in chairs and Lay Z Boys.


A few Commonsense Thoughts

We are not destined to go from vitality to frailty

Remember, your muscles are modifiable till the day you die.  Commit to continuous improvement to create the best version of yourself every day!  As Dr. Mishra suggests,  “Exercise relentlessly.”  Do resistance training daily.  He proposes you consider resistance training as necessary as brushing your teeth daily.

You don’t have to join a power-lifting club to maintain your muscle.  Just begin today to do some form of resistance training if you’re able. Work with a physical therapist or trainer to help you develop a customized strength training program regardless of your age. Dr. Mishra notes that the higher the weight, the more susceptible you might be to injury, like tearing a tendon. Instead, it’s more important to be consistent.

Here are some simple strength exercises you could begin today.

  • 💪 Biceps curls with hand weights that challenge you without strain. Emphasize slowing down the unfolding (eccentric phase) of the exercise. 8-10 reps



  • Triceps kickbacks with hand weights, emphasize slowing down the bending portion of the exercise. 8-10 reps



  • Resistance bands. 8-10 reps



  • Planks (start with hands and knees-lifting the knees just off the ground, spine straight) Hold 10-15 sec.



  • Chair Squats (sit-to-stand) Emphasize slowing the descent to the chair to build more control and strength. Start with five reps twice a day and build from there.


Muscles are not just about strength and appearance; they are vital for overall health, mobility, and longevity. To get optimal results, be consistent and take responsibility for showing up for yourself, even if you’re working with a trainer or PT.

One tip Dr. Mishra provided was this: even 8 minutes a day of strength training makes a difference!

If you’re short on time, the BoneSmart Burst™ subscription might be the answer. These 5 to 10-minute bone-safe workouts, designed by a physical therapist, are a great way to start your day or break up a day of too much sitting.  Participants say these bone-safe exercise bursts are “bite-sized enough to be doable with a busy schedule” and “the variety is great!”

In conclusion, to promote healthy aging and improve longevity, take agency for your own progress and modify your muscles with consistency and conviction.


Yes, I said it. I believe all this marketing about anti-aging is just a bunch of BS.   If we’re not aging, we’re dead. We’re all aging, so why not embrace it?  The question is, HOW do you want to age?

I believe in Empowered Aging 

Empowered aging is about being:
💥 Bold,
🤩 Audacious,
💃🏻 Adventurous,
💪 Strong,
🙌 Confident,
👄 Sexy at Every Age!

Empowered Aging is for the woman who knows the best is yet to come and the time is now to step into your power.

Empowered Aging is for the woman who isn’t interested in the old paradigm of needing to look, feel, act or speak a certain way to make others more comfortable.

So how do we manifest this?   We take care of the pillars that keep us healthy.

  • Getting enough sleep.
  • Connecting with others and finding your purpose.
  • Getting proper nutrition that supports your body and brain.
  • Learning something new every day
  • And my specialty, incorporating mindful movement into your daily routine.

So, whether you’re 45 or 85 or anywhere in between, I invite you to join me in shifting the paradigm around aging from the Anti-Aging bullsh*t to women embracing the next chapter and feeling powerful in whatever lies ahead.  I created the BoneSmart Pilates® Method with you in mind.   Though what I teach may look and feel like exercise, it’s so much more.



I teach movement skills that enhance your quality of life, injury prevention, and support you in aging strong.    As an example, I teach and reinforce hip hinging technique in all my classes.  This is a spine sparing technique that keeps you safe and strong particularly if you have compromised discs or bones. My goal is to have you own the principles and techniques I teach you in class, so you can apply them during your daily activities.

My classes offer you a solid movement foundation and provide you with connection to other like-minded empowered women. Then you are responsible for applying what you’ve learned as you move through life outside of my class.

I have had many people tell me they heard my voice cueing their shoulders when they were putting dishes in a high shelf, or putting their luggage into the overhead compartment of a plane. They would “hear me” cueing their alignment when they were kayaking or lifting those ubiquitous Amazon boxes.  I love that!  I’m happy to serve as your secret elf voice urging you on with clarity, precision, and breath.

A great way to get introduced to my technique is through either my On-Demand BoneSmart Movement Library or my BoneSmart Bursts™.

People love the wide variety of my On-Demand BoneSmart Movement Library which has over three hundred 30 and 60 minute classes plus bonus content. You can move at your own pace at a time of day that fit your schedule.

The BoneSmart Bursts™ are best described as 5-10 minute surprise gift packages of curated movement for the active ager that lands in your inbox 3x/week.  The style of movement and whether you use props or not is always a surprise.  Adaptations are offered so it’s accessible and beginner friendly. Best of all, it’s designed by a licensed PT so the exercises are backed by science.





“Blue Zones” are regions that have more centenarians and fewer cases of chronic disease than anywhere else in the world, a pattern that experts attribute to occupants’ healthy diet and lifestyle habits. There’s now 6 Blue Zones identified but you don’t have to move to them to benefit from the secrets uncovered. I’ve long been intrigued by the health benefits of living in Blue Zones and the secrets behind the quality of the inhabitant’s longevity.

What are they doing that I’m not doing? What can I change?

Here are 4 Habits you should consider to support healthy aging inspired by the blue zones.

  1. Eat Healthy Fats
  2. Move everyday
  3. Prioritize sleep
  4. Make time for community
Let’s look at each one more closely.


Eat healthy fats

One commonality between people living in blue zones worldwide is the amount of healthy fats in their diets. In Okinawa, Japan, they eat fatty fish such as salmon, while people consume plenty of local olive oil in the Mediterranean. One of the reasons they’re associated with longevity is their ability to reduce inflammation, which is at the root of chronic health conditions like heart disease, strokes, depression, and anxiety.

Move Everyday

Instead of setting yourself ambitious, potentially unachievable fitness goals, take your cues from the blue zones and build some movement into your daily routine. It doesn’t necessarily have to be “exercise”. In a study published by Nature Medicine, short “bursts” of activity (like running up the stairs) that were measured using wearable tech devices were found to be beneficial in staving off ill health. The results revealed that those who did short but intense bouts of movement reduced their heart disease mortality risk by 50 percent and their risk of death from cancer by around 40 percent, compared with those who did no vigorous activity. Although it might not feel like you’re doing much, this kind of movement is enough to stress the cardiovascular system, increasing oxygen uptake and preventing cardiac arteries from clogging.

Daily movement of some kind is also important for healthy lymph flow, which is essential for keeping the immune system in shape. Start by making small incremental changes every day. Whether it’s factoring in more stairs to climb, adding counter push-ups while waiting for your coffee to brew, or including a few gentle stretches to your pre-bedtime routine, aim to add more movement a little each day. Going for a 10-minute walk after dinner will help to improve your digestion and lower your stress levels before you
head to bed.


Want some simple guidelines for adding movement to your day? The BoneSmart Bursts™ are 5-10 minute movement snacks created by a PT with variety, creativity, and bone safety in mind.



Prioritize your sleep

People understand the importance of a great night’s sleep in blue zones.  Good quality sleep re-energizes brain cells, repairs skin, and strengthens every major system in the body, including the immune, respiratory, endocrine, and central nervous systems. Naps are also a priority in blue zones. Experts agree that the right kind of nap (around 20 minutes is optimum and never after 3 pm), can not only restore a sleep deficit but also improve concentration, mood and energy. As for healthy nighttime habits, sticking to a regular sleep schedule of set times and getting between seven and nine hours a night all contribute to better overall health.


Blue zone inhabitants all share a common belief in the importance of community and connection. Humans are naturally sociable creatures, so it’s no surprise that social connection is key to a long and healthy life. A recent study found that socially isolated people had a 26 percent higher risk of all-cause death, while prolonged loneliness also resulted in an elevated risk of 14 percent. Being around other people is also key to better brain health. When we interact with others, blood circulates to different parts of the brain to help us listen and formulate responses. Constantly using the brain in this way increases our neuroplasticity, connections between brain cells, and the neural circuits used.

Wrapping it up

In closing, try to include more healthy fats, move more, honor your sleep, and connect with others to promote healthy aging.

Exercise can feel like drudgery when you frame it as something you “have to do” rather than something you “get to do.”

As a movement educator and motivator, I’m always searching for ways to infuse joy into the classes I teach. Why? Because it makes it fun. If movement isn’t fun, why do it?  It should feel good and help change your outlook in some way.

The way I teach is informed by science and research. I’m particularly influenced by the research findings of Kelly McGonigal, a health psychologist and author of “The Joy of Movement: How Exercise Helps Us Find Happiness, Hope, Connection, and Courage.”

Across cultures and ages, there are specific movements that both express and elicit joy. Think about hitting a goal, winning a race, or accomplishing something important to you. The universal physical sign for joy is arms thrown overhead in the air. This is seen with young and old, internationally, and even with blind people who’ve never visually seen that movement. It’s a universal physical manifestation of an emotion.




If we listen to music in a group, we might notice people swaying their arms overhead, often in unison, expressing joy and connection.

The feelings you derive from a class can have lasting positive effects. For instance, if you felt strong and capable during certain exercises when you encounter a challenge later in the day, you are already armed with the sense that you are strong enough to handle it. You’ve altered your outlook even outside of class. That’s a powerful way to use movement to foster a positive mental state.


Celebrate what you CAN Do!

Sometimes we become so focused on our limitations that we forget to celebrate what we CAN do! Maybe it’s just moving to your favorite music in a way that makes you smile. That’s an absolutely legitimate form of exercise, and you should incorporate whatever kind of movement brings you joy. Movement in any form should be viewed as a gift to celebrate.

Try these Incentives

Use one of these three ideas to feel good during movement: music, nature, and/or people.

Add some motivating music. According to McGonigal, music is a “powerful evoker of joy” and can help release endorphins and dopamine. Endorphins and dopamine are both chemicals in your body that make you happy, but they function in different ways. Endorphins relieve pain naturally. When they attach to your brain’s reward centers (opiate receptors), dopamine (a mood-boosting neurotransmitter) is then released. For example, endorphins will naturally help soothe a runner’s achy muscles.



“Green Exercise”, working out in nature has an immediate effect on mood and can help people feel calmer and happier, improving mental health.





Moving Together
As Barbara Streisand so eloquently sang, “People, people who need people, are the luckiest people in the world.”   As a former professional dancer, I felt firsthand the power I experienced dancing, moving, and even breathing as one in a group. The sensations and emotions you experience, whether they be strength, joy, or discovery, are amplified tenfold in a group setting.



I’ll never forget my first time back teaching in-person group classes toward the end of the pandemic. One of the participants came up to me with tears in her eyes after class. She shared how deeply moved she was by being able to exercise in connection with others again, breathing, laughing, and moving together. This revelation both surprised and touched her.

Track Progress In a Novel Way

Give your trackers a break for a bit. Maybe be a little less data-driven; find a word that best describes how you feel after a workout. Track that instead to support a mindset of joy.

During one of my recent Signature BoneSmart Pilates® Standing Strong classes that I teach, I asked the participants to note how they felt before class with just one word. Some of their words included: “discombobulated, vulnerable, stiff, tired, flustered, and exhausted.”

After an hour of moving together with beautiful music and supportive cues, they each shared a word describing how they felt. These descriptions included solid, confident, invigorated, hopeful, and free. The evolution that occurred with each individual is a testament to the transformative power of movement to elicit joy and optimism.

In Conclusion
The process of moving (even over Zoom) with a joyful mindset and perhaps some motivating music can be transformative and set you up to have a fantastic day!

Do you ever notice that your shoulders are tight and creeping upwards towards your ears? Almost like you’re trying to make your shoulders replace your earrings? It’s not a good habit and makes your overall posture very tense.

This kind of neck and shoulder tension is a common problem that can be caused by poor posture, stress, and even sleeping in the wrong position.   If left unchecked, it can lead to headaches, back pain, and other health issues. The good news is that there are several ways to help.


Try these 4 tips to decrease neck and shoulder tension.


  1. Adjust your posture
    If your head is forward of your shoulders, that’s the weight of a bowling ball pulling on your neck structures.   It starts with the alignment of your pelvis. Ensure your sitz bones point down, and everything else above will easily fall into place. Forward head is often a by-product of faulty posture at the computer or while texting. Check your alignment often.
  2. Shoulder Shrugs
    Slowly draw your shoulders toward your ears (preferably on an inhale), then let them melt away from your ears (on the exhale.)  This is an excellent way to re-educate the placement of your shoulders on your shoulder girdle in a relaxed manner.
  3. Shoulder Circles
    Circle your shoulders forward, up to your ears, behind you, then let them relax. Repeat that, adding the inhale on the forward and up movement and the exhale on the back and down movement.    Move slowly.
  4. Breathe!
    When we unknowingly hold our breath, the neck and shoulders are often the first places to accumulate tension. Make breathing a priority. Many of us are shallow chest breathers. We fail to fully expand the lungs and ribs, allowing optimal air passage.  With extra muscle tension in our backs and chests typically brought on by poor posture, it is difficult for the lungs to expand fully. Start simple with a 4-count inhale and a 4-count exhale out your mouth as if you’re making bubbles in a class of water through a straw.  If that’s challenging, make it a 3-count process instead of 4 counts.  Make sure you’re in optimal posture. Over time you can increase the challenge to a 4-count inhale and a 6-count exhale. This will improve your lung capacity and breath awareness, positively affecting your neck and shoulders.


If you do your shoulder shrugs, circles, and breathe, all with attention to excellent posture and alignment, you’ll be on your way to a tension-free neck and shoulders!

Let your earrings live on your ears and allow your shoulders to relax.


Depending on where you live the summer heat may be approaching or is already at its height. Staying active becomes a challenge, especially for people over 50. Exercising in hot weather requires additional precautions to ensure your safety.

My aim is to provide a comprehensive guide for my BoneSmarties over 50, offering tips and strategies for staying fit while minimizing the risk of heat-related illnesses.







  1. Stay Hydrated:     Hydration is crucial when exercising in hot weather, as your body loses water through perspiration. Older adults are more susceptible to dehydration due to decreased thirst sensation. To combat this, it’s essential to drink water before, during, and after physical activity. Avoid alcohol and caffeinated beverages, as they can contribute to dehydration. Carry a water bottle with you and sip regularly to maintain proper hydration levels.  Consider infusing your  water with electrolytes or swap out for a sports drink.  Electrolytes help you replenish minerals  lost through sweat. That’s why water alone is not enough if you’re exercising outdoors in the heat.

  2. Time Your Workouts:    When the sun is at its peak, typically between 10 a.m. and 4 p.m., the heat is most intense. It’s advisable to plan your workouts during the cooler parts of the day, such as early morning or late evening. This reduces exposure to extreme heat and minimizes the risk of heat exhaustion or heatstroke.
  3. Dress Appropriately:    Wearing the right clothing can make a significant difference in staying cool during exercise. Opt for lightweight, breathable fabrics that allow air circulation and aid in moisture-wicking. Loose-fitting clothing in light colors reflects sunlight and helps in maintaining a comfortable body temperature. Additionally, wearing a wide-brimmed hat and sunglasses protects against the sun’s harmful rays and reduces heat-related discomfort.
  4. Protect Your Skin:   Exercising outdoors increases exposure to harmful UV radiation. Individuals over 50 are particularly vulnerable to sunburn and skin damage. Choose a sunscreen with SPF 30 or higher with broad spectrum protection against UVA and UVB. Reapply sunscreen every two hours, or more frequently if sweating excessively. Seeking shade when possible or exercising under tree cover can provide additional protection from direct sunlight.

    You should always wear sunscreen when you go outside, but you should be even more diligent about it if you plan on being out during peak hours.


  5. Check the thermostat and your ceiling fans:  Most gyms/health clubs set their thermostats so the air conditioner runs often and keeps the humidity (and sweat) out of the air!    If you have your home A/C set to an economical setting, and you’re doing a high intensity class like HIIT – you may want to make sure your ceiling fans are on and lower your AC for the time it takes you to do a class.

When our dog Chip was just a young pup, something in his DNA told him to hide the bone we gave him in the backyard. He coveted, cherished, and protected that bone.

He was instinctively BoneSmart.

Perhaps the difference between dogs and people is that the bones they protect and cherish are something they see, touch, and chew.

The bones we need to protect are out of sight. Often other potential health risks receive the spotlight like heart disease and cancer but our bones are important too.

Bones are the very foundation of our bodies that allow us to stand, walk, dance, work, hug, lift, climb, and more.

They are not on the priority list for many people when it comes to overall health awareness or monitoring.

Maybe it’s because people can’t see their bones.  Out of sight, out of mind.
Maybe because people think that bone loss and osteoporosis only happen to elderly, white women. Not true!

What if we cared for our bones like our dogs care for theirs?  Nurturing, protecting, (but perhaps not chewing!)

Sometimes we just need a gentle nudge to step up and take charge.

Here’s what you need to know


  •  Do your weight-bearing exercise

(dance, tennis, weight-bearing Pilates, hiking, jump rope, high-intensity interval training “HIIT”- for its bone-building impact…)





  • Strengthen your muscles

Adults naturally lose 1% of their leg strength per year over age 50. Working on spinal extension and leg muscle strength are two of the best activities to prevent falls and age-related changes in posture.  (think hand weights, resistance bands, gym machines)  Joan here is demonstrating hip and leg strength, spine extension strength, and arm strength, all with excellent alignment during our Superpowers 30min. bone-safe strength training class.


  • Practice static and dynamic balance


    • Lift a leg – can you be still and steady? That’s static balance.
    • Dynamic balance involves standing on one leg while moving something else like your arms, your lifted leg, your head, or bending and straightening your supporting leg. When you’re confident with static balance this is the next functional step.


  • Get outside in the sunshine. Make your phone call a walking chat and get your Vitamin D at the same time. Chip’s favorite Tip –

    “Walk Me and get your D!”


  • Get as many bone-healthy nutrients through your food (salmon, sardines, dairy if you tolerate it, almonds…)


  • Take any necessary supplements for bone health


    • Vit D is essential for bone health and we typically don’t get enough just from outdoors especially if we live in certain regions that don’t get a lot of sun. It plays a key role in calcium absorption and helps regulate bone turnover.
    • We all know the importance of calcium for bone health. Supplements can help if your diet isn’t providing enough.
    • Vit C helps form protein collagen essential for bone mineralization.
    • Vit K helps deliver calcium to the bone. If you’re deficient it can lead to low bone density and increase  your risk of fracture.
    • Consult with your doctor regarding the right supplements and dosage specific to your biochemistry.


Author (with help from Chip) – Teresa Maldonado Marchok, PT, NCPT
Founder and Creator of the BoneSmart Pilates® Method and DVD Series

Ambassador for the national organization “American Bone Health”


Maybe you’ve been diagnosed with osteopenia or osteoporosis, and you’re seeking answers?

Your doctors may have told you that you have the bones of a 90 y/o, not to lift more than 30 pounds, or you must take prescription medications or your bones will crumble.

That’s enough to strike fear in anyone.

I’ve shared a Home Exercise Program for bone health and summarized 3 different studies looking at exercise and osteoporosis. Feel free to read the full studies in the links provided at the end.

So we’re on the same page, let’s define osteoporosis. It’s a disease characterized by low bone mass and deterioration of bone tissue, which can lead to increased risk of broken bones. Known as the “silent thief”, bone deterioration can occur over a number of years without presenting any symptoms.
Unfortunately, if detected at the time of a break, the disease is already fairly advanced. The most common fractures we see with osteoporosis are located in the hip, spine, and wrist.

Before we dive into the studies, here are a few select Home Exercises that are great for your bones.

  1. Heel Raise (add hand weights when ready)
  2. Hip Hinge (great to practice with a dowel to cue good alignment, improves posture and is a spine sparing technique to prevent spine fractures)
  3. Lunge (when strong enough with proper form, add hand weights if able)
  4. Back extensor strengthening
  5. Upper back extension mobility (draping over a round surface like a ball or roller)


Study #1

Dr. Lora Giangregorio conducted studies through the University of Waterloo in Canada and these are her findings from her paper
Too Fit to Fracture” for Osteoporosis Canada.

  • There is strong evidence that exercise can reduce falls in older adults. (This is important for those with osteoporosis as your risk of breaking a bone with a fall is greater.)
  • For individuals with osteoporosis:
    • They strongly recommend that people with osteoporosis engage in a multicomponent exercise program (so not just one type of exercise).
    • It should include resistance training (think bands and free weights) in combination with balance training.

  • For people with fractures in their spine, the above two recommendations are the same however the exercise program should be supervised by a physical therapist.


Exercise Recommendations from Lora Giangregorio from Osteoporosis Canada

  • Train your muscles for strength (weights or bands) 2x week
  • Challenge your balance daily (tai chi, single leg balance, dynamic balance)
  • Add aerobic physical activity (preferably walking, hiking, jogging, dancing)
  • Walking is not enough
  • Practice spine sparing strategies (like hip hinging)
  • Pay attention to posture, train back extensor muscles daily









Here’s Dr. Giangregorio’s Too Fit to Fall or Fracture exercise handout free to download. It has some easy to understand exercises and visuals.


Study #2

Another study that’s really exciting is the LIFTMOR Trial by Belinda Beck from Australia.

This trial predominantly looks at the effects of free weight training on bone and function.

Her team looked at the effects of high lifting loads (heavier weights than what we might normally see for people with osteoporosis or osteopenia) and impact (think landing from a height of 8 inches onto your feet after doing a chin up exercise on a bar)

Optimal bone loading and bone building requires higher weights and this is not traditionally recommended for people with osteoporosis because of a perceived high risk of fracture.
The purpose of the LIFTMOR trial was to determine the effectiveness of these techniques and to monitor for any fracture in postmenopausal women with low bone mass.

The intervention group consisted of 49 postmenopausal women over 8 months.

After 2 months of training proper posture and lifting techniques with no resistance, they progressed to doing:

Warm up deadlifts (lifting lower amount of weights from the floor with spine straight, knees bent)

Next they did 3 different lifting exercises at 80-85% of 1 repetition max.
That’s determined by how much weight you can lift 5x with good form and breathing and get to fatigue.
They did Deadlifts, Back Squats (with a barbell behind their head, hips and knees bending and straightening) and Overhead Press (pushing weights or a bar up above you as you stand tall. They did 5 sets of 5 repetitions for each of these.

The 4th exercise they did was impact loading, 5×5 sets of jumping chin ups with drop landings to their feet for bone building stimulus to the hips.

Pre- and post-intervention testing included X-rays of the low back and hip bone and measures of different functional performance physical therapy tests that measure walking speed, leg strength and balance.

Improvement in Bone Density and height in the intervention group

  • Improved bone density at the hip of 2.9%
  • Improved lumbar spine bone density of 0.3%
  • Improved height of + 0.2% (yes their stronger back muscles and focus posture actually improved their height!)


Functional improvements in the intervention group

  • Increased leg extensor strength by 37.1%
  • Increased Back extensor strength by 36.3%
  • Faster Gait speed by 4.3%
  • Increased leg strength (stronger hip and leg muscles) by 11.6%
  • Improved Balance by 5.5%

Contrary to current opinion, high intensity training with impact was effective and caused no injuries for postmenopausal women that were highly supervised.

This short video clip includes participants in this trial.  The results are impressive but I shudder at the posture of the woman in the purple tank top and the woman in yellow at the end as they lift. We can do better with our posture and alignment.


Study #3

Physical Therapist Management of Patients With Suspected or Confirmed Osteoporosis: A Clinical Practice Guideline From the Academy of Geriatric Physical Therapy

This paper published in 2022 is actually geared for physical therapists treating patients with osteoporosis. The team assembled clinical practice guidelines for the management of patients with suspected or confirmed osteoporosis. They examined 55 high quality randomized controlled trials of exercise for osteoporosis.

Key takeaway without too much detail for non PT’s include:

Do a combination of any two or more of the following exercise types below. Combining activities slows the decline of bone in the spine and hip.
Doing just one type of exercise won’t have the same effect on your bones.

An example of a combination for bone health would be Pilates and weight training or walking/jogging combined with Tai Chi.

Exercise Types as they defined them:
Static weight bearing exercise (Single leg balance to slow decline at femoral neck.)

 Dynamic weight bearing low force (dynamic balance exercises, Tai Chi, walking, slow stair climbing as exercise to slow bone decline at the lumbar spine)

 Dynamic weight bearing high force (jumping, dancing, jogging, basically if one or both feet leave the ground)

Non weight bearing exercise low force (Pilates mat, yoga)

 Non weight bearing exercise high force (such as a circuit at a gym)

If you’re hungry for more, I encourage you to explore the full studies listed below.

Too Fit To Fracture: exercise recommendations for individuals with osteoporosis or osteoporotic vertebral fracture

L M Giangregorio 1, A Papaioannou, N J Macintyre, M C Ashe, A Heinonen, K Shipp, J Wark, S McGill, H Keller, R Jain, J Laprade, A M Cheung

High-Intensity Resistance and Impact Training Improves Bone Mineral Density and Physical Function in Postmenopausal Women With Osteopenia and Osteoporosis: The LIFTMOR Randomized Controlled Trial.
Watson S, Weeks B, Weis L, Harding A, Horan S, Beck B.J Bone Miner Res. 2019 Mar;34(3):572. doi: 10.1002/jbmr.3659. Epub 2019 Feb 25.PMID: 30861219

Physical Therapist Management of Patients With Suspected or Confirmed Osteoporosis: A Clinical Practice Guideline From the Academy of Geriatric Physical Therapy
Hartley, Gregory W.; Roach, Kathryn E.; Nithman, Robert W.; Betz, Sherri R.; Lindsey, Carleen; Fuchs, Robyn K.; Avin, Keith G. 
Journal of Geriatric Physical Therapy. 45(2):80, April/June 2022.


If you’re a PT – I wrote a version of this blog, especially for PT’s!    Download it here.

Some people are either or people. I believe both have benefits for improving bone health.

When you add resistance to your routine, your muscles release calcium, magnesium, and other minerals that strengthen your bones. Your muscles don’t know whether the resistance comes from bands or weights.  Whatever you are more prone actually to do, that is the mode of choice. If you dislike weights, go for bands.
I personally like mixing things up.

Here’s the thing, though, you need to really challenge yourself for change to occur.

With resistance training, it’s too light if you can breeze through 20 reps of an overhead press. You’re building endurance, not strength. You should feel “worked” after 10-12 reps at a given resistance (whether it be weights or bands) with excellent alignment and good breathing technique.

I tell Pilates teachers to load up the springs on the Reformer for leg work for their clients with osteoporosis. If the springs aren’t heavy enough, they won’t gain strength or bone. (of course, ensuring proper form)

The other thing to remember is that your bone health is not only a reflection of your exercise. It’s also a function of your nutrition, supplementation, daily activities, or lack of…it’s difficult to tease out.

I believe your best shot at optimal bone health is doing weight-bearing resistance and impact exercises, dancing, walking/hiking, sports you enjoy AND also addressing other factors in your life that support bone health. When appropriate, medications may be the right choice.

Most people want a multifactorial approach to their bone health. I get that. In many ways, we are our own laboratory.

I want to share this interesting study from researchers at the U. of Oregon demonstrating how training with resistance bands increases bone mineral density.

“It is sometimes difficult for sedentary people to change their habits, and going to a gym would be more difficult. But elastic bands offer an interesting alternative since they allow enough intensity to stimulate bone mass, and a multitude of exercises are possible. Regular practice of 2 weekly sessions involving work on the main muscle groups of the body will increase bone mineral density.”  Here’s the research study



Amy SmileyAmy Smiley, Age 62


I spent most of my life in California, with a short stint in Sweden in the 1970s. My degrees are in Chemical Engineering and I worked in the biotech industry once I got out of graduate school. I loved working in such a new field at the time. As the family grew, I decided to quit my paid job and stay home with the children. As time went on I realized I needed a creative outlet and took up Plein air painting (with the same fantastic friend who introduced me to Teresa’s classes!). After my family and friends, I love the outdoors, science, gardening, and art.


I started classes with Teresa in 2012 and have continued with them ever since. Teresa’s Pilates classes are a priority for me because of the physical and mental benefits they provide. I have celiac disease, which causes any number of inflammatory problems and Teresa’s classes are essential to my ability to manage those issues. When something has to fall off my plate it won’t be Teresa’s class!



I’d like to choose just one movement or body dynamic principle that I learned from Teresa that has helped me but there are too many!  From ribs down to soup bowl to lifting your toes…I am always learning something new, even ten years later.  I think, for myself, as I continue to become more body aware, I continue to learn in each class.  And, as new issues develop as the years march on, I discover new fixes for them.  Everything that I have learned from Teresa applies not only in class but in other activities and my daily movement.  Not to mention that Teresa is so gracious with her time whenever anyone has a question about alignment or movement difficulties.  She always takes time to answer any questions and I learn from my questions and those of others.  What a fantastic tool!


Amy Smiley Testimonial for Aging Strong Pilates


At the beginning of the pandemic, I dropped the gym and in-person classes.  Although we stayed active, I really missed the benefit and connection of group exercise classes.  I worried about how well I would maintain mobility and strength without the motivation and guidance that Teresa provides.  When Teresa opened her remote classes I jumped right in and was so grateful! Now that some degree of normalcy is returning, having the option of in-person and virtual classes is even better than before.

I absolutely love the energy and camaraderie in the in-person classes.  They are a tonic for the soul.  I can’t think of a single class where I haven’t had a good laugh for one reason or another.  I missed that tremendously until in-person became available again.  But it’s also great to have access to the class online if I can’t make it in person and to have the videos afterward.