Nolan Alexander (Host): Welcome to the Live Greater podcast series, Information For a Healthier You from the University of Maryland Medical System. I'm Nolan Alexander. And today, I'm here with Dr. Jennifer Baima from the University of Maryland Medical System. In today's episode, we'll explore the important topic of exercising safely with osteoporosis. Dr. Baima, thank you so much for joining us. How are you today?

Jennifer Baima, MD: Great. It's my pleasure to be here.

Host: Well, I want to make sure that we understand exactly what we're talking about. So, let's start at the foundation. What is osteoporosis and how is it different from osteoarthritis?

Jennifer Baima, MD: I get that question a lot from patients asking how osteoarthritis is different than osteoporosis. Osteoarthritis deals with the joints and has to do with thinning of the cartilage. Osteoporosis deals with the bones and has to do with thinning of the bones.

Another big difference is osteoporosis really centers around prevention, preventing fractures. So, you might not be feeling any pain. And the way we treat osteoporosis is to prevent something to prevent fractures. Whereas with osteoarthritis, frequently, the patients are already in pain and they're coming to me to reduce their pain from their diagnosed osteoarthritis, or maybe I'm the one making that diagnosis for them.

Host: So, why is exercise so important for people with osteoporosis?

Jennifer Baima, MD: Well, exercise is so important for people with osteoporosis because it doesn't have risks. When we look at medications for osteoporosis versus exercise, if we do a head-to-head comparison, those medications are going to win every single time. However, exercise not only potentiates the effect of osteoporosis medications, but also helps to prevent the breakdown of the bone. Certainly not as strong as medications, but they have such a great synergy. That's what makes it important in the treatment of osteoporosis.

Host: So, what types of exercise are most beneficial for bone health?

Jennifer Baima, MD: Really, osteoporosis exercise is anything outside the pool. So, weight-bearing exercise just means you're not in space and you're not in the water, you're on land. So if we look at physics, right, work is force times distance. So, you can cover more work running than you can walking, but walking counts as osteoporosis exercise. And you might be getting more exercise because you're walking longer than you're running. So, what I try to focus on is what the patient likes the best.

Host: So, it's as simple as that. Anything that's not in the pool.

Jennifer Baima, MD: It is really that simple. And I think the hardest part is motivation, right? So you're not going to do something you don't enjoy. Frequently, I joke sometimes I'm a coach and sometimes I'm a maître d’, right? So, I try to find out, does a patient like exercise? And I love when patients are frank and tell me, "No, actually I don't like exercise." So then, we talk about, well, what hobbies do you have? And is there any way we can dovetail those with exercise or what treats do you like? Is buying new workout clothes exciting for you? Maybe if you do this exercise, that'll get you into some new workout clothes. So, we do try to connect it with ways that are favorable to the individual patient.

Host: I really like that line of thinking. And honestly, when you mentioned physics, I got a little scared at first. But you spoke physics at my level. So, I'm comfortable with that, Dr. Baima.

Jennifer Baima, MD: Physics was my least favorite subject as well. But unfortunately, it finds its way into my life in too many ways.

Host: Well, in different conversations, we know a lot of benefits with exercise, but in relation to osteoporosis, how can exercise also benefit with balance, with posture and something that's very important, fall prevention?

Jennifer Baima, MD: Common exercises that can be helpful for balance, for posture, and for fall prevention would be things like yoga. Even dance counts in that manner. I have patients who are not interested in yoga or dance. Maybe that's too slow for them. Well, walking on the golf course if it's uneven could be considered a balance exercise. If you don't like exercise at all, then one way to incorporate that into your day is I'll have patients hold on and stand on one foot. Maybe they're watching their favorite television program and watching television is something they enjoy. So, they could hold onto their counter and try to stand on one foot and stand on the other foot. And that would be a way to incorporate a short break of balance exercises into your normal day.

Host: Wow. You really thought about everything that's not in the pool. There seems to be a litany of different examples here.

Jennifer Baima, MD: This is why I'm the exercise doctor.

Host: Well, Dr. Baima, I can also imagine, right, that there's probably some exercises or movements that maybe people should avoid that have osteoporosis. Am I right in thinking that?

Jennifer Baima, MD: Absolutely. And that depends on their other comorbidities. So, that's a big, scary word, but it just means your other stuff, right? So, sometimes patients come to us before they have a fracture and osteoporosis. But unfortunately, I work at the orthopedic center and we see a lot of fractures. So, a lot of our osteoporosis patients have already had a fracture. So, we want to make sure that fracture is healed before we recommend exercise, unless they're under the direction of a physical therapist.

Other things that can interfere would be osteoarthritis, like we talked about. Osteoarthritis can cause pain. And although it is typically not dangerous to exercise with osteoarthritis, it can be painful and certainly I'm not trying to make anyone's life worse. So, for example, if they have knee osteoarthritis, I might recommend switching the squats and lunges to cycling or rowing, because that will help mobilize some of that swelling from the knee osteoarthritis and also prevent osteoporosis.

Host: So speaking of pain, I'm trying to imagine a patient that has some pain and maybe they're worried about an injury, right, or further pain, or maybe somebody's just new to exercise in their life. How can they get started safely?

Jennifer Baima, MD: Generally low impact exercise is well-tolerated by most patients. So if you're we're just saying a blanket prescription, you could look online for low impact exercise. I worry about suggesting anything online. As many doctors joke, please don't confuse your Google search with my medical degree, I think is a common refrain among a lot of us.

However, usually for low-impact exercise, we're thinking about your cardiologist, your primary care doctor. Do you have any heart or lung problems? If you do, you should ask them, is it safe for me to exercise before you have at it. If it's more of an orthopedic problem, we're very happy to help you at the orthopedic center. And what I'm looking for is this a cartilage injury? Is this a bone injury? And that helps me determine the recommendations for exercise and where is it located? Is it in a weight bearing joint such as your hip or in a non-weight non-weightbearing area such as your tailbone? Very different exercise recommendations for those two parts of our bodies that live so close together in our bottom.

Host: I am curious about that. Maybe provide some examples here, Dr. Baima. How should exercise be adjusted for people who have that, who have joint pain or osteoarthritis?

Jennifer Baima, MD: Well, it depends on the location of the osteoarthritis. I often joke that we walk on our feet, no, on our hands. So for patients with shoulder arthritis. Generally, lower body exercises are safer. However, if they need to use a cane or a walker or need to hold on for balance, we want to think about which arm are they using to hold on. Maybe they could use the one without shoulder arthritis. We want to give them some exercises for shoulder arthritis to help modify that.

The hip and the knee, we're a lot more concerned about the typical recommendations of aerobic exercise for those patients. We want to check them out, make sure they don't have a hip fracture. Generally, it's pretty safe to walk with a sacral fracture, a fracture in the tailbone. It is very unsafe to walk with a hip fracture. So, we need to determine that and sort that out before we can give patients a go ahead with the walking and we are happy to do that for them.

Host: Dr. Baima, I feel so much more confident in just my knowledge of exercising safely with osteoporosis based on everything that you've said today. But if I had to walk away with just one thing right here, what is one thing you want me and other listeners to know about staying active with osteoporosis?

Jennifer Baima, MD: In general, it's very safe to exercise with osteoporosis, and you're doing yourself a favor if you do something that you enjoy. It's more consistency than the amount of exercise that you're doing.

Host: Well, I'm sure there's a listener out there that's going to feel a lot better about shagging those loose golf balls that have found their way over in the rough. I'm getting some osteoporosis-safe exercise.

Jennifer Baima, MD: I will be glad to see them out there.

Host: Dr. Baima, thank you so much for your time and insight today.

Jennifer Baima, MD: Thanks for hosting. Take care.

Host: Listen to more at umms.org/podcast, YouTube, or your favorite podcast platform. Thank you for listening to Live Greater, a Health and Wellness podcast brought to you by the University of Maryland Medical System. We look forward to you joining us again. And please share this on your social media.