Transcription:
Preventing and Managing Osteoporosis

Scott Webb (Host): Osteoporosis affects roughly 10 million people in the us. And though there's no cure for it. Programs like Emerson's strong bones, strong life program can certainly help women and men to manage it. And joining me today to tell us more about osteoporosis and how she and others at Emerson's wellness center work to help folks is Katie wildland.

She's an osteo instructor and physical therapist. Who's an instructor with Emerson's wellness center.

This is the Health Works Here podcast from Emerson Hospital. I'm Scott Webb. So Katie, thanks so much for your time today. We're going to talk about osteoporosis and you being somebody who would have the answers to these questions, I've certainly got plenty for you. So as we get rolling here, what is osteoporosis and how do we manage it?

Katie Wadland, PT, DPT, GCS (Guest): Sure. So osteoporosis is really a disease of the bone. So the way you have to understand osteoporosis is understanding how bone grows and how it breaks down. So bone is actually living, right. You're always creating new cells and you're always having degradation of the old kind of used cells. So osteoblasts make more bone and osteoclasts destroy and resorb bone. So generally when you're growing up, there's more blasts than clasts. So your bones get nice and strong. And then around age 35 or so, the actual rate of the osteoclasts overtakes the rate of the osteoblasts and we get eventual bone breakdown. And of course this change is based on many factors, like your stress level, your lifestyle, behavior modifications, that sort of thing, and also your estrogen level.

So we typically see more osteoporosis in females after menopause, of course, we kind of know it as a post-menopausal disease and it's why it's so much more common in women than men. But the issue really is that not that the bones become weak, but the issue of your posture changes. So when the bones become weaker, we typically come more forward.

We kind of round at the spine and you end up in this forward bent posture. So this creates increased risk of fracture in your spine, and it also changes your balance. Right? So if you can imagine, you're standing up nice and tall one day, the next day, you're more forward. It moves your center of mass forward and it makes it more likely to fall.

And then on top of that, if you have osteoporosis in your hips or your femurs, if you fall, you're more likely to break a hip, which is the big concern, you know, with osteoporosis is hip fractures. And in terms of management, I really look at it in two different components, right? How do we make bone and how do we preserve bone? So of course you need proper nutrition to make more bone. We need our calcium and our vitamin D. And we also need force on bone. So the way bone creates new bone is when there's a load put on the bone that the bone doesn't know how to handle. So if you can imagine lifting a very small weight, your body's not going to change unless you lift a weight that's heavier and your body actually identifies the fact that they need be stronger to lift the same amount of weight.

So your bones are the same way. It's not going to create new bone until a force is applied, that lets the bone know it's not quite strong enough to handle. So that force can either be through weight bearing. So putting load through your bone, like from standing or from jumping or from having a weight on your back, that kind of thing, or it can be from your muscles.

So when your muscles contract, when you lift something that pulls on the bone and that also creates some force in the bone. So in terms of the management, from an exercise perspective, we're trying to encourage our folks to do things that increase the load to the bone, whether that's through aerobic exercise or strengthening, and I can get more into that as well if you'd like.

Host: Yeah, we will. For sure. And you mentioned fractures and broken hips. What else? I, those are the, it seems like to be this sort of the greatest hits, if you will, when it comes to osteoporosis, but what are the common issues that people deal with?

Katie: Yeah. You know, think about too this space that when you come forward, right. Everything inside your body becomes more compressed. So the first thing that gets compressed is really your lungs. So if you round forward, it's harder to get a nice, big inhale and a nice full exhale. So we're more likely to get things like pneumonia, more likely to be short of breath. And then also when you work your way down, all your intestines and your viscera get more compressed. So we tend to see more issues with belly pain, constipation, fluctuations in your bowel kind of patterns that way and pain. I didn't even mentioned pain, you know, you can get back pain just from the differences in your posture.

Host: So let's talk about some of the best exercises to improve bone health and prevent or manage osteoporosis.

Katie: Absolutely. Now you're speaking my language. I love talking about exercise. So when I started teaching the Strong Bones Program for Steinberg, they asked me to create an evidence-based program for osteoporosis prevention and management. So evidence-based refers to, you know, exactly that, what are the best exercises? Not just the most common ones, or the easiest. But based on the research, what is the most effective way to improve bone density and also prevent falls? Because we look at two different parts of a exercise program for osteoporosis. One is bone health, and the other is fall prevention because we don't want the sequelae of the osteoporosis.

So when you look at the evidence, one thing stands out, progressive resistance strength training. So in every study that. The end of it really is that the most effective way to improve bone health is through progressive resistance strengthening. They also, of course, want people doing weight-bearing aerobic activity for that up and downloading, like we talked about, but really the gold standard is good functional strength training.

So I know in my class I teach Mondays and Thursdays the Strong Bones Program. We really do a big component of functional strength training. So strength training, not just individual muscles, but muscles in big groups. So if you're doing say, getting out of a chair, that really utilizes your muscles in a functional pattern, right?

It uses your quads and your glutes and your hamstrings and your calf muscles all at the same time to complete a task, which is the getting up part. So when I do strength training in these classes, I really focus on things like lunges and squats and hinge patterns. And pushups, things that really use your body in really functional ways.

So that's a big part of the class. We also work on balance and we also work on core strength and postural control because at the same time we're trying to improve bone health, we're also trying to counteract some of that forward posture that happens. So we do an awful lot of extending, you know, working on standing up straight, sitting up straight, strengthening all the scapular muscles and then lastly, really on balance and mobility so that if we do have a loss of balance, we're able to catch it more effectively and not end up on the floor.

Host: Yeah, that's the dream, Right. Don't end up on the floor right?

Katie: Yes, unless you want to be on the floor, which I actually strongly encourage. If you can get on the floor, keep getting on the floor. It's a really healthy behavior to be able to get up and down and actually part of my class, we always go to the ground just on principle. Every single class we practice getting on the ground. We do some exercises we get back up because I really think it's critical for people as they age, to be able to continue with that activity, being able to get up and get down just for safety sake.

Host: Yeah. You're so right there, there's this things, as we get older where we're like, yeah, I can't do that anymore. Right. And you got to maybe force yourself out of your comfort zone and get down on the floor and work on getting back up.

Katie: Exactly.

Host: Yeah. And you mentioned your class. I want you to tell folks about that Strong Bones, Strong Life. Tell us about the program and how it differs from other exercise programs.

Um,

Katie: Yeah. So like I mentioned, you know, Steinberg really approached me and asked me to create an evidence-based program. I'm a physical therapist. I know you mentioned that and I'm a Board Certified Geriatric Specialist. So I really pride myself in keeping up to date with the best research. And I'm constantly reading whatever journals come my way. So it's based on a lot of research I've done and I tried to create a really well-rounded program and I think what may be different and people really seem to be getting out of this class is that I have a good eye for modifications. You know, I can see through the Zoom, if someone's struggling with their squat technique or their lunge, or if they're compensating.

So I'm always trying to keep an eye on my classmates and make sure they're performing things in the safest way possible. And I think that, you know, I really try to modify activities. I typically say, okay, here's the exercise. I show it to people first. But then I say here's level one, level two, level three, and a way to modify if you're having an issue.

So I think that's probably one of the biggest differences is I really focus on scaling up and scaling back as needed for everyone in the class. So everyone can feel like they're not only able to do the exercise, but that they're adequately challenged. And that's another part that I think I bring to the table. Is that it's really important to be working hard. Like I mentioned, the bones are not going to change if we're not working harder than our body currently has the capacity to do. So we have to find ways to challenge ourselves during these classes and not just feel like we're going through the motions or we're doing class because my doctor said it's time to go to a fitness class. But really finding ways to challenge each of us individually throughout the class.

Host: Yeah. It sounds like it's both challenging and doable. Right? I think that's probably what most people would want is like, okay, I want you to push me. Sure. And get outside of my comfort zone, but I also need it to be doable. So maybe you can explain how you do that. How do you make it challenging for folks on the different levels and wherever they're at, but also kind of doable for everybody?

Katie: You know, so there's ways to change exercises. Right? We can do things in a full weight bearing position. So say I'm doing the pushup, right? A traditional pushup looks like you're on the ground. Your toes are on the ground. Your hands are in the ground and you're doing a pushup. We can do the same exact activity from different positions that are easier on the body.

So we can try that from a countertop or from a chair or from a wall. So just by changing where we start, that changes the complexity and the challenge of the activity. We also work a lot with resistance bands. I have a set that I love and I recommend every time I start the class. So I want people to pick the band that they think they can do.

And then we kind of reassess, you know, we say, okay, was that challenging? Or do we need a stronger band or pull it tighter? Or change the weight. So we're sort of always playing with the resistance level of the activity in particular, to make sure that we're working hard enough during our strength training.

Host: That's awesome. Just to be able to customize for everybody and make it challenging and doable. And I'm sure lots of fun. You know this has been really educational and fun today. And I really enjoyed hearing about all this, especially the Strong Bones Strong Life Program. I want to know as we wrap up, what do you love most about being a community educator and fitness instructor?

Katie: You know, it's an interesting question. So I've been a treating therapist for about 15 years and so much of what I do is one-to-one right. I go in to see a patient. I do the skilled therapy they need for whatever injury they have or whatever diagnosis they have, but there's so much more, I want to teach people and it's always difficult to get all the education out there during the one-to-one sessions when there's a lot of other things to focus on. So I've been basically creating these classes to teach my patients and the people in the community, all the things I wish I could have told them before they got injured or before they ended up on my caseload.

Like I'd love to not be a therapist. I love to be able to keep everybody healthy and, you know, without having to need me. So it gives me a chance to really be proactive and help people better manage their chronic conditions. And so much of what we deal with when we age can be prevented and manage just through quality fitness, you know, participation in activities and healthy lifestyles.

And I really enjoy teaching that. And the other thing is I'm also getting older, you know, for me, it's my exercise too. So I'm doing the class with everybody. And I'm making sure that my bones stay strong because like I mentioned, your bones are as strong as they're going to be at 35 and they get weaker throughout time.

So I am in the same boat as everybody else hoping to prevent osteoporosis and fractures down the road. So I'm taking care of my body as well, while I'm teaching all my classmates.

Host: Well, I can certainly hear your enthusiasm today. And, you know, as you say, like, you'd like to be able to prevent everybody from getting injured beforehand, but I've come to learn that physical therapists do so much, you know, in prevention and treatment and these classes. So it's just so awesome and really appreciate your time. Thanks so much. And you stay well.

Katie: Oh, I appreciate it. Thanks so much.

Host: For more information, visit Emersonwellness.org, or call Emerson's Wellness Center at (978) 287-3777.

And thanks for listening to Emerson's Health Works Here podcast. I'm Scott Webb and make sure to catch the next episode by subscribing to the Health Works Here podcast on Apple, Google, Spotify, or wherever podcasts can be heard.