Living well with osteoporosis

How to live well with Osteoporosis (OP)

What is Osteoporosis?

In simple terms it means porous bones.  Bones, which are breaking down and rebuilt throughout your life, are less efficient at rebuilding as you get older so they become weaker and lose density.

Are you at risk?

If you are female and over age 45 then probably yes.  If you meet any of the following factors then you will be at higher risk:

A parent had osteoporosis, was hunched, had fractures or shrank considerably with age

You are of Caucasian or Asian descent

You’ve ever had an eating disorder, have been extremely slender or are under weight

You’ve had irregular periods

You smoke (or have ever smoked) or drink alcohol above national guide lines

You’ve been on long term medication ( steroid/laxative/thyroid/antacid)

You don’t exercise or over exercise

You have digestive problems or are coeliac, or have Crohn’s disease.

You’ve never had children

You had an early menopause

You are getting shorter or have already suffered a broken bone

Testing and drug therapy for Osteoporosis.

If you are concerned about osteoporosis then you may have already consulted your GP, had tests and been given medication.  Research in this area is ongoing so it is definitely worth seeking your GP’s advice as to the medical treatment available.  

I am not giving advice in this area, but aim to help you manage your condition, or delay the onset through food and exercise.

Theory’s about the body’s acid/alkaline balance.

Scientists and experts do not agree on what we should eat to reduce our risk of OP. This makes it extremely difficult for the general public to make an informed decision as to the best diet to follow.  There seems to be two main views on limiting the effect of OP.

One is to follow an alkaline diet, the other to follow a balanced diet including all food groups.

Key points from those recommending an alkaline diet: 

·        The acid/alkaline balance of our body plays a large part in much of the media coverage of OP.

·        It is claimed that calcium neutralises the body’s ph so it uses up reserves to counter the acidity caused by eating acidic food.

·        If your diet is acid (more of this later) then your bones will give up calcium to balance the ph.

·        With age our bodies do not excrete acid as efficiently so our bodies become more acidic.

·        We should aim to eat an alkaline diet.

·        Limit intake of acid protein (see list below). Unlimited vegetable protein is fine.

·        Limit dairy as the acid level can cause more loss of calcium than gain

·        Proteins with high acidic levels include red meat, chicken, eggs, cheese, most nuts

·        68g of protein daily is much better than consuming over 95g (Tracking your food intake over a few days and using a nutrition calculator such as MyFitnessPal will give you a good idea as to where your protein intake level is)

This advice is at odds with the recommendations of the UK National OP Society for a balanced diet with all food groups.  They do not reference the body’s acid/alkaline balance at all.  I have not, so far, been able to find any scientific basis for this balance.

For more on the myths about acid/alkaline balance check out:

https://chriskresser.com/the-ph-myth-part-1/

For the UK National OP Society advice check out:

https://nos.org.uk/information/healthy-living-and-risk/healthy-eating-for-strong-bones/

https://nos.org.uk/information/healthy-living-and-risk/healthy-eating-for-strong-bones/further-food-facts-and-bone/

As a sport nutritionist I follow the latest research and have a particular interest in eating for good health.  In my opinion, a healthy eating plan will ensure that your weight is stable and by adding in a few tweaks for specific issues we can address health issues without ever following ‘a diet’.  Find an eating pattern which suits you and which you can follow for life, then you can make changes permanent and, as a result, you will gain the most benefit.

My advice for managing Osteoporosis

Having looked at much material and research I think that a balanced approach is required.  Doctors know much more about the science behind our bodies so rely on them for medication.  They may not be as knowledgeable about diet and exercise so that is where you need to make your own decisions.

My key dietary points:

·        Avoid fizzy drinks, processed food, artificial sweeteners and stress

·        Cut down on caffeine, sugar, salt and alcohol

·        Be aware that spinach and rhubarb contain oxalic acid which prevents absorption of calcium.  I’m not sure how much evidence there is to support this is but there are so many other sources of calcium it seems sensible not to rely on these.

·        Increase your intake of green leafy vegetables (list below) they are seen in all the ‘good lists’ for calcium and other vitamins

·        Increase your intake of chickpeas, kidney beans, lentils, soya beans and tofu

·        Note that many products use soya extract, this is not the same as actual soya beans.

·        Include cider vinegar in your diet

·        Include a range of fruit and vegetables

·        Include seeds such as pumpkin, flax and sunflower

·        Include nuts, especially almond, hazelnuts and brazils

My key lifestyle points:

·        Vitamin D from sunlight is essential so spend time outside all year round

·        Walking is great exercise and gets you out in the sunlight

·        Stick to exercise where your weight is on your feet, walking is ideal

·        Work on your balance, it deteriorates with age and a fall can start a downward spiral in your activity level

·        Reduce your stress levels, try mindfulness, relaxation and regular exercise

·        Choose exercise with a social element as it will be easier to maintain

This blog will be added to as I continue my research and any comments are welcome.
This article was first published on the blog 'how to feel good'

The Science behind Yoga (and other exercise programmes)

The Science behind Yoga (and other exercise programmes)

I recently shared an article about science and yoga.  It was interesting as it focused on changes within the brain brought about through yoga practice.  What I found most interesting was that these changes are brought about by the focusing of the mind rather than the performance or achievement of yoga poses.  This means that the benefits can be gained by any mindful exercise programme which encourages you to focus on breath, link your mind to your body and gain relaxation. 

Much of the benefit yoga is proven to provide is associated with the management of stress.  The article claimed that 90% of all the illness we suffer is stress related.  I haven’t been able to verify that figure but stress certainly has a big impact your health and your ability to recover.

Do you suffer any of these basic symptoms of stress:

• High resting heart rate.
• Repeated headaches.
• Stiffness in your neck and/or tight shoulders.
• Back pain.
• Periods of fast shallow breathing.
• Increased perspiration (e.g. sweaty palms)
• Repeated stomach upset, nausea and/or diarrhea.

Or any of these which are more likely to develop over a longer period:

 •             You’re often off sick

•              You have high blood pressure

•              You suffer chronic neck, shoulder, or low back pain

•              You suffer reflux disease or IBS

•              You have low fertility, problems during pregnancy, or painful menstrual periods.

•              Your arthritis, asthma or other chronic conditions worsen

•              You have skin problems such as acne and psoriasis.

If any of these sound familiar then the regular practice Yoga, or a programme with the same benefits, could certainly help you to better health.

The main elements in Yoga that have been found to improve a person’s stress levels are: breath, movement, mindful attention and relaxation.

Breath is a particularly powerful tool and can be used to control the stress response of the body. By filling the lungs, taking fewer breaths, making them deeper and longer you control the breath and lower blood pressure and stress response.  By focusing your mind on each breath, you regulate your thoughts, give yourself space and empty your brain.  In research, focus on breathing has been shown to change the way in which the brain (prefrontal cortex) behaves. Particularly in reducing depression and changing behavior to be more positive.  Neurotransmitters work more effectively and the interbrain links are improved giving a variety of benefits to the body.

By combining breath, movement, mindful attention and relaxation we can change how we feel and in time even change how our bodies behave.

In fact you can get all these benefits from most of our classes at the Studio.

·        In IMF Pilates we spend time training our brains to consciously connect to different muscle groups and to identify and engage specific muscles we want to work.  This connects the mind to the body in a practical way.  By having to concentrate on each position the mind is forced to empty other thoughts.  In this way you can achieve relaxation and stress relief through simple movement.

·        In Yoga For Healthy Backs we use the power of breath and relaxation techniques to reduce specific back pain.

·        In All Woman IMF Pilates we additionally focus on the relaxation of each part of the body. This helps you to connect more fully with your body and to enable complete relaxation.  Brilliant for pregnant clients, particularly useful through labour, and menopausal women suffering from stress and anxiety.

·        In Janey’s Yoga, using classic poses, she has an approach she calls ‘help yourself to find yourself’. She positions herself as a facilitator to help you find yourself rather than a teacher of Yoga,  The article I mentioned earlier used the line ‘Use yoga to find out who you really are’, this is clearly aimed at the type of Yoga Janey practices.

The image of yoga, often shown by the media, and presented by Yogis themselves is of skinny flexible, capable people adopting difficult and complicated positions.  In reality, the benefits can be obtained by almost anybody.  If you are busy, stressed, unfit, overweight, inflexible, not used to exercise or not sure about joining a class, whatever your age, we can still help you.  None of these are a valid excuse for doing nothing.  Movement is vital if you are to improve any of the above conditions.

Come into your body and reconnect!

Exercising with arthritis?

Do you suffer from arthritis?

The first thing to remember is that ‘Exercise is beneficial for people with arthritis’. Arthritis is a very general term which covers a multitude of conditions which affect joints and is frequently (but not always) linked to the body’s aging process.

If you have arthritis follow these simple guidelines to get the most benefit from your exercise:

• Make sure your warmup is slow and gentle warm up with movement to mobilise your joints encouraging the release of synovial fluid to lubricate the whole joint more effectively.  It’s a bit like warming oil in a pan so it coats the whole pan surface.
  
• Choose low impact activities to reduce the stress placed on the joint. Pilates, yoga, walking and swimming are all good.
  
• Include strength training as studies have suggested it can decrease pain.  It also works to build bone density which encourages healthy joints. Simple exercises standing up can help build strength so don’t choose classes which are all mat based.
  
• Try to maintain the range of movement and flexibility of a joint.  You may not become more flexible but should be able to maintain the movement range that you currently have.  (Without regular exercise you will gradually have less range of movement.)
  
• Don’t exercise if you have rheumatoid arthritis and your joints feel warm and swollen. This is an indication of flare up and exercise at this time could worsen your condition.
  
• Avoid movements which require extreme flexibility and stretching exercise techniques.
  
• Avoid exercises which require kneeling if your knees are affected.
  
• Avoid exercises which require repetitive stress or high impact activity such as road running.

By following these simple guidelines you’ll be able to gain all the benefits of regular exercise enabling you to keep ‘fit for life for all of your life’.

Fitness Trends for 2016

As the New Year approaches we tend to look back and review the past year and also plan ahead to the next one.
2015 saw The Studio develop extra-small classes, enabling clients to enjoy individual tuition within a group format. This makes it affordable, effective and sociable.
I undertook further training to enhance my skills as a fitness professional and soft tissue therapist. My specialist training with an experienced osteopath this year was in the diagnosis, treatment and prevention of knee pain. A really useful area in which to have more knowledge. My soft tissue work training was in recognising and releasing the tightness which causes poor posture and gives back pain along with some new techniques to offer sport massage without pain.

So, what underlying trends can we expect to see in 2016? (ref ACSM)
1. Wearable Technology
Trackers, heart rate monitors etc… all helping increase activity levels by constant monitoring.
2. Body Weight Workouts
Taking fitness back to basics by using body weight instead of machines and free weights.
3. HIIT
High Intensity Interval Training used with many forms of fitness to improve performance and shorten the time spent exercising.
4. Strength Training
Both in the gym and in classes for general fitness as well as improved bone density.
5. Fitness Professionals with better training
Improved training leads to better results and more choice for the public in looking to improve their fitness.
6. Personal Training
Including group PT - extra small group exercise classes, perfect for affordable individual tuition
7. Functional Fitness
Fitness which helps activities of everyday life, essential for keeping active for longer.
8. Fitness for Older Adults
Older adults have specific requirements which are now recognised and will be better catered for.
9. Exercise for weight loss
Dieting alone cannot achieve sustainable weight loss and this trend backs the theory that exercise is an essential part of weight loss.
10. Yoga
Yoga has many forms and often includes ‘wellness’ which features lower down the list of fitness trends. I see these combined to offer an exercise based way to cope with the stress of today’s busy lifestyles.

Why can't I control my weight?

It’s the magic question to which we all wish we had an answer!

New research from a study conducted at the University of Sheffield has addressed the problem of using a single classification of people who have a weight problem. They are suggesting that this restricts the effectiveness of treatment options. They propose a number of classifications each of which will require a different approach.

Below I have taken their classifications, adapted them to reflect the demographic I see in my work as a physical therapist and then suggest solutions:

1. Young healthy females displaying the most positive health characteristics.
   These are typically called yo-yo dieters, they are interested in health and fitness and follow the latest trends in exercise and popular diets. They are able to lose weight quite quickly but maintaining the weight loss over a long period is harder. They join the gym or a fitness class at the beginning of the year but find it hard to keep attending once ‘life’ gets in the way. It’s not their main priority in a busy life so is easily dropped.
   
   For these people, I would recommend a monthly session with a motivational trainer or nutritionist/exercise professional, booked and paid up well ahead. This will keep interest and motivation levels high by suggesting new exercises, new techniques, and help and encouragement in developing healthy eating habits with recipes and nutritional advice.
   
2. Males who are unable to control their weight despite having high levels of physical exercise.
   Lifestyle factors are likely to include high levels of food and alcohol consumption. This group can cover a huge age range from mid-30s to retirement. They may be gym members enjoying a weights based training programme on a regular basis, they may get exercise from dog walking or be golfers. The excess weight comes from the excessive intake of food and/or alcohol and the lack of enough cardiovascular exercise.
   
   I would recommend completing a food diary to capture exactly what is consumed over a month long period. Alongside this find a nutritionist/personal trainer to review the amount and type of exercise. They can then ensure there is enough cardio work to encourage fat burning rather than developing further muscle mass. A tracker to follow activity and monitor heart rate will check actual activity levels. Looking at portion control, meal content and reducing alcohol intake will ensure the best chance of success.
   
3. Middle aged females interested in exercise and weight management, although suffering from anxiety, insomnia, depression and fatigue maybe also with low self-esteem.
   This is another big group, many of whom are somewhere along the menopausal curve. Along with the symptoms listed above, weight gain is common as hormones fluctuate. Previously successful weight and exercise regimes no longer work.
   
   Support during this time is essential, recognizing that many others feel the same way. Exercise classes with a social element offer enjoyable exercise which is more likely to be continued as the people in the class become as important as the exercise content. Community venues or small private centres, rather than big leisure complexes, are more likely to offer this type of class. Look for pilates, yoga and general exercise to music with instructors specializing in this age group.
   
4. The affluent healthy elderly, many of whom have high blood pressure.
   Age was not specified so I’ll assume that they mean 65+ although that’s hardly old these days. I think this group is struggling with their weight as a result of changes in life style and in their body as it ages. Food choices have developed enormously during this group’s lifetime and their affluence can lead to indulgent choices with foods high in fat and sugar. This group of people are at risk, if they do not address their weight issues they will soon find themselves in the next category, ie with chronic health conditions.
   
   This group needs exercise which takes account of their age and high blood pressure as well as a carefully structured eating plan. They also need encouragement and support in keeping to the life style changes required. Exercise combined with a social element is a good solution in this case. Also look for an instructor specializing and qualified in exercise for older adults.
   
5. The physically sick but happy elderly with chronic health conditions such as arthritis, diabetes and high blood pressure but low levels of anxiety.
   This group of people are probably in a vicious circle, the chronic health condition has limited their ability to exercise and this has resulted in weight gain, which in turn adds more chronic health issues.
   
   It is very difficult for these people to keep doing exercise since they have to endure levels of pain to stay active. Unfortunately, without undertaking some exercise, the situation will get worse faster. Basic mobility exercises will get this group into better health, together with dietary advice to cut calories and look at foods which ease the inflammation of arthritis. Small classes designed for people with painful conditions can be helpful, providing support and encouragement from a position of empathy and understanding. Look for an instructor with a GP referral qualification, and ask for a one to one session first.
   
6. The elderly deprived who do not have healthy behaviours and have the highest BMI readings.
   These people are likely to have been overweight with unhealthy diets for their whole life. Exercise will not have featured in their lifestyle, and they may have no desire to change. Any cost of treatment is probably an issue, limiting their choices.
   
   This group are the hardest to help. Approaching GP surgeries to see what they offer is the best way forward. For example they might hold exercise sessions funded by the NHS, they should at least offer dietary advice.

Are you still doing sit ups in the hope of achieving a strong core?

Sit ups are often performed as a core muscle exercise. However research continually shows that they are not effective at building core strength. Old habits die hard and in the fitness industry sit ups, crunches, roll ups, roll downs etc… have been around for as long as people have been exercising. But, this doesn’t mean that they are good or effective!

Core muscles are those which hold your body together, giving it strength by binding around your trunk. They support your spine and strengthening them can significantly reduce back pain. I would include in core muscles those around the shoulder girdle. They have a big impact on posture which, if poor, can cause the shoulders to slump forward and eventually result in pain. Recent research has also added new muscles as essential for core stability, known as gluteals. This complex muscle group lies across your butt and holds your pelvis stable.

So back to sit ups, what happens to your body during the exercise?

Your shoulders round into a position very similar to that seen in the office chair slump, the slouched driving position or the collapse on the sofa rounding. In other words, good posture across the shoulder girdle is completely lost. When this was first performed I don’t suppose we were living a life of sitting and slouching so possibly the postural issues we see today were not as prevalent.

Your spine is curled forward. For some this may feel good and indeed be beneficial but for many the compressional force on the intervertebral discs will aggravate previous injuries such as herniations (slipped disc) or prolapsed discs. Measuring this compressional force is something we’ve only been able to do in recent years, and it is huge when performing a sit up. When I first taught these exercises the fitness industry was oblivious to these potential dangers.

Once you get almost half way up, your hip flexors become the main workers to stabilise and complete the movement, to bring you up to sitting. These are also shortened by a sedentary lifestyle and if not specifically stretched they pull the pelvis out of alignment causing back pain.

This brings us onto the new core muscles, the gluteals. Generally weak (despite years of tums and bums classes!) and difficult to activate, yet essential for good posture and a strong core. In those who perform lots of crunches the hip flexors, hamstrings and rectus femoris (thighs) tend to be strong but these muscles work in a vertical plane. In these people the gluteals are likely not to work at all, yet they provide all the essential diagonal support for the pelvis.

If you are looking for a strong core, the exercises you need are those which use the gluteals and the stabilizing abdominals, not the sit up muscles.

If you’re tempted to go for a ‘6 pack’, remember that it can only be achieved by over developing the muscles so they push out through the fascia, which is there to hold them together. For a female to develop a 6 pack, as well as the muscle development she also needs a BMI well below that recommended for good health.

For effective exercise advice look for an instructor with a good understanding of spinal load during exercise, preferably with a specific low back qualification and an interest in functional fitness and posture.

Pain is not as simple as you might think!

Almost everyone will have felt pain at some time in their life. Here at the studio we see a lot of people suffering from pain, mainly associated with movement or a persistent ache. We can usually help to alleviate this either by reducing it or by offering techniques to manage it. What you may not realise is that there may not be a physical reason for the pain.

To get a better insight into what is going on when you hurt, we need to understand how you feel pain.

The ability to feel pain is very important to our wellbeing. It stops us doing things that are damaging to our bodies, and makes us rest to allow our bodies to recover from injury. So you really should not ignore pain, or simply "work through it".
Firstly you should make sure that there is not physical damage causing the pain.

The expected mechanism of pain starts with some physical damage which causes receptors within the nervous system to fire. This action creates minute electrical currents which are passed from nerve cell to nerve cell up to the pain perception center in the brain. It is here that these signals are actually converted into what we know as pain. All along this pathway it is possible for your body to mistakenly trigger, sometimes from a sort of nerve memory. Hence, for example, the site of an old injury can often be painful even though there is no damage or reason for that pain.

The brain itself is quite capable of "making up" pain. If you injure your ankle your brain will avoid movements that cause pain in the damaged area. This is good. However once the damage is repaired, the brain continues to avoid movements that were painful. The fear of pain can cause actual pain. The brain has to be retrained to understand that the pain is no longer there by specific repeated movement patterns.

Often in avoiding pain the body will stress another area and cause a pain there. It doesn't always make the right decisions as to the best way of helping your body.
We see this type of issue often at the studio. A client may have had a small injury to a back muscle lifting something heavy out of a car (shopping or a child are frequent culprits here). The body's defense mechanism leaps into action and activates a range of alternate muscle actions to protect the damaged area. Unfortunately this will usually cause a misalignment, or imbalance in the body, often resulting in the stressing of and possible damage to a whole set of different muscles ranging from shoulders to knees and ankles.

Clients come to us with a problem in their knee. However, when we have taken a holistic review of their gait and completed a range of movement tests we can see that the problem is not in fact in the knee at all, rather it is a bodily imbalance brought about by a completely different issue.

So, if you have pain, my advice is:
Firstly, check with your GP to rule out a structural or other cause which needs medical treatment.
Then, come to The Studio for a half hour one to one consultation so we can assess the best ongoing solution.
Alternately, or in addition, if you have access to a physio ask them for muscle testing and exercises.

Frequently the solution from me (or a physio) will be regular exercise combined with soft tissue treatment and exercises to include in your existing fitness regime or to do at home.

Don't put up with pain, call us, we may well be able to help.