Tag Archive for: osteopenia

The Thought Behind a BoneSmart Burst

A year ago, a Burst subscriber sent me an email that struck a chord.   She said, “That was a great Burst! Such a simple little workout.”

I laughed because what she experienced as a simple eight-minute Burst actually took quite a bit of time and thought to create.  Choosing the right movements, putting them in the right order, making sure they’re bone-safe, effective, and accessible – all of that happens before the camera ever turns on.

Which is why I’ve always loved this quote from Joseph Pilates:

“A few well-designed movements, properly performed in a balanced sequence, are worth hours of sloppy calisthenics or forced contortion.”

He understood something that is still true today: good movement doesn’t happen by accident.

 

How I create a BoneSmart Burst

I spend time thinking about how to create sequences that are safe, effective, and meaningful for the bodies we live in today.   And yes—those bodies are aging. Every single one of us.     As a physical therapist, I approach each Burst with an evidence-based mindset.    I think about what areas of the body need attention and how to create a balanced sequence that supports strength, mobility, posture, and balance.

Some days, a Burst may focus on strength work with hand weights to help stimulate bone and build muscle.
Another day might draw inspiration from Tai Chi or Yoga, cultivating balance and coordination.
Other days, we might explore mobility work, resistance band stretching and strengthening, or posture-focused movement.

But no matter the theme, certain elements are always woven into the experience:

  • Breath
  • Posture
  • Alignment
  • Bone-safe movement strategies

These are the foundation of every BoneSmart Burst.

 

A Little “Behind the Scenes”

Here’s an example of how a Burst might come together.

Let’s say I’m designing a Burst focused on hip strength and balance, both essential for maintaining bone health and preventing falls.

I might start with a simple posture reset to bring awareness to alignment. From there, I might add a standing leg exercise with a resistance band to strengthen the hip stabilizers. Next, we might include a balance challenge that asks the body to react and stabilize.

Just a few movements. That’s it.

But they’re chosen intentionally so they build on each other and create a balanced sequence – exactly the kind of thoughtful design Joseph Pilates was talking about.

Why Mini-Workouts Actually Work

We live in an era of endless notifications, back-to-back meetings, and long stretches of sitting. Finding 45 minutes for a traditional workout isn’t always realistic.

That’s one of the reasons I started creating these Bursts.   Short bouts of movement—sometimes called exercise “snacks”—typically last just 5–15 minutes, but research shows they can still provide meaningful benefits.    These short bursts can lift your mood, boost energy, and help shake off that heavy, sluggish feeling that creeps in after sitting too long.

Research published by the BMJ Group suggests that brief bouts of physical activity can improve cardiorespiratory fitness. Studies in the journal Diabetes Care also show that breaking up long periods of sitting with short movement breaks can help lower blood sugar and insulin levels after meals.

In other words, these small movement breaks aren’t just “checking a box.” They act as a quick reset for your body – and your brain.

Why I Created BoneSmart Bursts

As a physical therapist, I’ve spent decades helping people move better and protect their bones as they age.    One thing I’ve learned is that consistency matters far more than perfection.    Many people think exercise only “counts” if it’s long, intense, or done at the gym. But that mindset can actually become a barrier.

BoneSmart Bursts grew out of the idea that movement should be approachable, doable, and sustainable—something you can weave into everyday life.   A few thoughtful minutes here and there can truly add up.

Small, Smart, and Intentional

That’s the philosophy behind BoneSmart Bursts.   They’re short by design – but they’re never random.   Each Burst is thoughtfully created to help you maintain bone strength, support healthy muscles, improve balance, and move with more confidence.   Just as Joseph Pilates believed, a few well-designed movements can go a long way.

Want to Give it a Try?

If you’re new to BoneSmart Bursts, start with a simple month-to-month subscription.    You can get a whole month for about the same price as a cup of coffee and a bagel.   No long commitment required—you can cancel anytime.

Just 5–12 minutes.
A little movement.
A big reset for your body.

You might be surprised how powerful those few minutes can be.

Not quite ready to subscribe?     Try one first.

Here’s a typical Burst, “Chair Break Reset,” as my gift to you.

Don’t have a core ball? Not a problem. Just use a towel rolled up like a sausage, secured with rubber bands, instead!

 

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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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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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Muscle Matters

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.

 

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Invite Joy into Exercise

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!

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Aging with Grace!

We are bombarded through media, with anti-aging approaches like botox, plastic surgery, facial creams, and expensive supplements.  I personally think the concept of anti-aging is BS.  We are all aging every day.  If you actually stop aging, you are …dead.   I prefer to age, embracing every wrinkle as a testament to the privilege of still being here and with it, hopefully, some added wisdom on top.  Now how we age is a choice.  Everyone makes the choices that feel right for them but I want to share with you an additional approach you can add, that works from the “inside out”.

MOVEMENT HELPS

Did you know that Pilates can make you look and feel younger?  This is all without expensive creams, needles, or surgery.  The only side effects? Improved flexibility, balance, strength, and posture! Exercise also improves your skin and complexion. By increasing blood flow, exercise helps nourish skin cells and keep them vital. We lose about 1% of our leg strength and about ½ a percent of our bone density yearly after we hit 50.  Pilates slows down the muscle and bone loss that occurs with aging.

3 WAYS TO CONNECT and AGE STRONG

Do you prefer to be guided in your movement practice with skill and a keen eye toward the active ager?

The local Aging Strong Pilates® class that I teach in Los Altos, CA,  my DVD series AGING STRONG Pilates® and my Zoom Virtual Classes all focus on those areas at risk of decline as we age. Those areas include the hips and legs (to keep us strong, mobile, and doing what we love), the spine (to prevent slouching/hyperkyphosis), and balance (to prevent falls).

TIPS TO FINDING A TRAINED PILATES TEACHER

If you want to find a Pilates teacher local to you, search for one that is certified through the Pilates Method Alliance  (is an NCPT-Nationally Certified Pilates Teacher) and who has the skills to customize a program to your abilities. If you have certain challenges like osteopenia, osteoporosis, herniated discs, stenosis, joint replacements (the list goes on) your instructor should be aware of the movement contraindications for each diagnosis and be able to create a program that keeps you challenged yet safe.

CONSISTENCY IS KEY

Remember- 1x a week is helpful but consistency is key in the Aging Strong formula. Improvement is dose-responsive. The more classes you take, the stronger, more balanced, and agile you’ll be. If you can’t get to more than one class, make sure your instructor gives you an individualized home exercise program designed specifically for you. (and try my DVDs if you haven’t already)

I believe in interspersing Pilates with the other movement activities in your life that bring you joy. For example,  I love dancing, hiking, and walking my dog Chip.

Please share in the comments section below, what movement activities raise your spirits and your core temperature!

 

 

 

Written by Teresa Maldonado Marchok, Licensed PT and NCPT (Nationally Certified Pilates Teacher

Creator of the BoneSmart Pilates® Method and acclaimed DVD series

Pilates Studio owner since 1998 melding PT and Pilates in her Mountain View, CA private practice.

Ambassador for American Bone Health

Learn more at www.BoneSmartPilates.com

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Booking Virtual Classes 101

Have you found navigating my online booking system challenging?
I created these short video tutorials to make everything easy peasy, crystal clear!
  1. First view the “Overview for All” before clicking the video for the category of class that interests you.
  2. Bookmark my scheduling home page BoneSmartPilates.as.me for easy access
  3. If you prefer using mobile devices, download the free app “Acuity Scheduling Client” from the App store. My sisters find it easy to navigate.
  4. Always Log In whenever you’re on the site. If  you haven’t created an account you can Create an Account Here

 

 

 

 

 

 

 

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Benefits of working your Bootie in the last and best third of your life

Do you find your butt slowly disappearing or migrating south? Are your jeans sliding off your butt?

Age-related muscle loss, known as sarcopenia, is a real thing. The good news is you can do targeted workouts to minimize the loss that people experience from increasing age and all the excessive sitting that’s been happening recently.

It’s not too late to literally perk things up.

Round perky butts play a role in aesthetics but there’s even more that’s important!

Having strong gluteal muscles gives you the power to stand up, sit down, squat, and perform all your life activities with power and grace.

Strong glutes are important for proper pelvic alignment, propulsion during walking and running, and single-leg balance support.  They also help to support the lower back during lifting motions.

 

6 Benefits of taking the Active Aging Bootie Barre class

Strong glutes help your posture and lessen back and neck pain.

Increased sitting can result in slumped posture and “dead butt syndrome”. This is when your butt muscles become inhibited and literally forget how to fire.

How does this happen?  It’s actually a common problem today.  People are spending inordinate amounts of time sitting behind their computers, zooming, etc.  Picture it, your butt is tucked under, your back is in a C curve (I call it cashew posture) and your head is shifted forward in front of your shoulders. Feeling the back and neck pain yet? With all this faulty sitting, the muscles in the front of your hip joints become short and tight and the opposite muscles, the butt muscles, become neurologically inhibited, overstretched, weak, and inactive.  Strengthening the butt muscles, back muscles and stretching the muscles in front of the hip, exercises that are included in the active aging bootie barre class, address these common issues.

 

Strong Glutes help Prevent Injuries.

Building strong gluteal muscles (the focus of “bootie barre”) can help you avoid injury as well as recover from injury to your low back, hips, knees, and ankles by creating better alignment and stability.  As an example, when squatting sometimes people will cave one knee in towards midline instead of tracking the knee over the foot. That’s often a result of weak gluteal muscles on that side. This is a common dysfunctional pattern known as “dynamic valgus” and it can be prevented with strong gluteal and hip muscles. Proper hip, knee, foot alignment is cued regularly during our bootie barre class.

Strong Glutes Improve Balance

Who remembers those old commercials “Help I’ve fallen and I can’t get up!”  Though people joked about it, those commercials depicted a real and serious situation.  Maybe it’s not an issue for you currently but having strong glutes now means you’ll have a strong foundation to propel yourself when walking, have the stability in your pelvis to balance on one leg, get in and out of your vehicle, or shower with ease and if you fall, “you Will be able to get up”!  This all translates to better long-term quality of life.

 

Strong Glutes Enhance Bone Density in the Hips and Pelvis

Strength training is the best way to improve localized bone density. This happens when muscle tissue tugs on your bones during strength training. By building up the muscles around your pelvis (your glutes) as we do in class, you are improving your muscle and bone strength as well as the stability of your entire pelvis and hips.

 

 

Strong Gluts are Aesthetically Appealing

Though not the most important reason, this is often the primary reason people start working on their glutes. It’s a valid goal to have to keep our pants from sliding down and if chasing a perky butt is your goal, I say go for it!

This class is targeted for you, in the last and best third of your life, to get strong safely and efficiently.

As a physical therapist, I ensure that you’re not using your low back to lift your leg behind you (a common error).  I design exercises that work all ranges of motion of the hip and stimulate both slow-twitch and fast-twitch fibers found in your glutes.  And, we get it all done in just 30 time-efficient minutes!  Allow me to be your guide to lift your tush and safely challenge your limits.

Sign up for the Active Aging Bootie Barre Class every Wednesday at 11:30 PM PST. Can’t make that time? Not a problem. You can purchase the class and I can send you a recording to do at your convenience!

Click here for a preview of some Active Aging Bootie Barre Moves!

 

 

 

Written by Teresa Maldonado Marchok, MPT

Physical Therapist,  Pilates Teacher, Aging Strong Activist, Educator, and lifelong learner.   www.BoneSmartPilates.com

 

 

References

BoneSmart Pilates Youtube channel Gluteal Amnesia aka Dead Butt Syndrome  https://youtu.be/YevqgbmS4K8

Buckthorpe M, Stride M, Villa FD. ASSESSING AND TREATING GLUTEUS MAXIMUS WEAKNESS — A CLINICAL COMMENTARY. Int J Sports Phys Ther. 2019;14(4):655–669.

Dunsky A. The Effect of Balance and Coordination Exercises on Quality of Life in Older Adults: A Mini-Review. Front Aging Neurosci. 2019;11:318. Published 2019 Nov 15. doi:10.3389/fnagi.2019.00318

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The Do’s and Don’ts of Movement with Bone Loss

This workshop is for you if you’ve been diagnosed with osteopenia or osteoporosis or if you have healthy bones and want to keep them that way! In this 90 minute session you will discover how to move safely with bone loss.   You’ll learn to find your ideal posture, how to lift safely, what exercises help with hip and spine bone strength, and how to avoid fractures.

I’ll share my easy to remember BoneSmart ABC’s for bone health, which will be the foundation for you to live a  bone healthy life.

Bonus:

Along with the workshop, you’ll get free access to my Private Forum on the BoneSmart Pilates website.  You can ask any exercise-related questions that you have on the forum. Your password will be emailed to you when you register.

This workshop is presented by Teresa Maldonado Marchok, licensed PT, nationally certified Pilates teacher, former professional dancer, ambassador for the national organization American Bone Health and creator of the award winning DVD series BoneSmart Pilates®

This workshop is a great balance of research and information, along with exercise and practice. I highly recommend this workshop if you are 50+ whether you have osteoporosis or not. Brilliant!

– Linda A.

Purchase the workshop here!

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Extend Yourself! Spine Tuning Virtual Workshop

 

Do you ever wonder how the hunchback of Notre Dame got his hump? And do you worry that you are heading toward the same fate?  If you spend too much of your time sitting, driving, doing computer work and/or texting, you just might be. Or, if you’re a breast cancer survivor experiencing surgical tissue tightness across the front of your shoulders, you might collapse your chest in subconscious protective posturing.

These activities all promote a forward flexed spine which can restrict our mobility, impair our balance and breathing, and cause all kinds of problems we don’t want to deal with—including the dreaded hump!

How often do you extend (bend backward)? Unless you change lightbulbs for a profession, I bet not very often. Extension is especially crucial for those with osteopenia or osteopososis-a silent disease of low bone density.  Decreased bone density can lead to a forward flexed spine due to common undiagnosed spine compression fractures.

Extension exercises will help to decrease that forward curve inclination. Those with decreased bone density are more susceptible to fractures, especially from falls. Upright posture is associated with decreased falls and studies show extension exercises build stronger bones in the spine. Added bonus, extending the spine just feels great!

In this workshop, discover the secrets of spine extension exercises to

  • Improve your posture and prevent falls
  • Build bone in your spine
  • Promote healthy aging to continue to do what you love

Learn how to do spine extension correctly, avoiding common pitfalls.  Experience simple extension exercises in multiple body positions, to unleash your optimal posture and bone health throughout the day.

You’ll receive a printable follow-along guide that you can also reference afterward to remind yourself of all the things you’ll learn in the workshop.

Extend Yourself!

PURCHASE HERE

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