Showing posts with label bone mineral density. Show all posts
Showing posts with label bone mineral density. Show all posts

Sunday, May 23, 2010

Building & Protecting Bone: Odd Angle Exercise, Resistance, Movement (and shaking) Work

ResearchBlogging.orgA fear for many women is that as we age, we seem to be more vulnerable to the "Help Help, i've fallen and i can't get up" hip fracture and related. Awhile ago, i wrote about bone building, and what's known about strategies to keep it together and enhance it. Quick review: bone builds in response to demand. Woolf's law is "use it or lose it" - our bone is "remodeling" all the time. So while calcium, magnesium, zinc and vitamin d are all important, these nutrients alone don't really go into bone building mode unless there's demand on the bones. That means load. Likewise, even with strong bones, we don't stay upright if our movement is compromised by various aches and pains.

A new research survey on non-invasive approaches to bone building puts these points together in a really nice review called "Physical approach for prevention and treatment of osteoporosis" The nice thing is it's free.

Summary: Here's a summary of the approaches that look good for building up bone mineral density:
BONE BUILDING
Resistance training - that's good but it's also site specific. In other words, lower body work helps the lower body (hip/pelvis); upper body work helps the upper body (including the critical spine).


Impact Training - this is stop and start and "odd angle" activities like soccer or squash (not running so much), but also for the more frail, even dancing and ball games have been proposed as ways to help keep demand up on bones.

Combinations. Meta analysis of research suggests that the best approach, unsurprisingly is a mixed approach of resistance training and impact training. Fortunately such practice can be fun and have bone building effect.

Vibration. the next time someone pooh poohs force plates, you might want to suggest that they've been shown - repeatedly - to help build up bone. It's not a HUGE gain, but it could be an excellent modality for the initially infirm:
A 1-year prospective, randomized, double-blind, and placebo-controlled trial of postmenopausal women demonstrated that 20 minutes of a low-level vibration applied during quiet standing can effectively inhibit bone loss in the spine and femur. Placebo subjects lost 2.13% in the femoral neck over 1 year, whereas treatment was associated with a gain of 0.04%, reflecting a 2.17% relative benefit of treatment. In the spine, the 1.6% decrease observed over 1 year in the placebo group was reduced to a 0.10% loss in the active group, indicating a 1.5% relative benefit of treatment (40).


BALNANCE - Physical and Hormonal
T'ai Chi - does nothing for bone building at all, BUT helps get on with movement and balance and the breathing can help destress, so hormonally very helpful in supporting staying safe.  Research has mainly focused on T'ai Chi for these effects, but it might be interesting to consider that other approaches that emphasize mobility, balance, de-stressing, and the whole sensory motor apparatus might not benefit here too?

BUILDING & REPAIR
New & Approved. The review also considers several other forms of "physical agents" like Low Intensity Pulsed Ultrasound (LIPUS) that has been shown to stimulate bone repair. Electrical stimulation has also now been approved by the FDA for "bone repair."

Experimental.  Pulsed electro magnetic fields (PEMF) is a newer approach, nothing conclusive there yet. Low Level Laser Therapy is also being trialed in animal models, but again nothing yet in human studies.

Role for Movement Practice & Assessment?
Where we seem to be at is that concern about bone mineral density has two components: first is to ensure practices for maintianing and building BMD, but second is the development of practices to help people feel stable and mobile rather than vulnerable to falls - improving range of motion, visual accuity and balance.  It's not just Range of Motion - thought that's important - it's the whole sensory-motor awareness package.

It doesn't matter if we're younger or older - we can have issues with our movement that can compromise our ability to respond with agility to a tricky situation. The entire functional movement screen program is based on the premise that there's no point building strength on top of dysfunction, hence the screen for movement issues.

But likewise, we can have issues with our balance or visual accuity or our brains ability to perceive our selves clearly in motion. Indeed, i've written quite a bit about the benefit of just kicking off our restrictive shoes to get more info to the brain about where we are in space, and how doing so has pretty big benefits for movement and also feel of one's own mobility (as the feet move more and better, it seems so do other joints). 

So it seems pretty basic that as part of our quest for better bone health, a related quest for optimizing our body's ability to move in space is pretty important. I've said before, this awareness development is part of why i like I-Phase so much: it's prepping the body for the Real.

In other words, as we build better bones, there's a real benefit in openning up our body's awareness of itself in space, and simultaneously, it's ability to respond better to what's happening. 

Simple example: better range of motion combined with better practice of movement into multiple positions, and better balance and visual processing means the brain has more knowledge about its being able to Zig rather than having to Zag around that wet spot on the floor, and thus, us not going for a tumble.

Stronger bones PLUS less risk of falling in the first place (and not being able to get up) - that seems to be more a complete package.



Conclusion: Why is osteoperosis such the women's issue?
 One advantage that guys have is the size of their muscles puts more load on their bones so that the bones are under more demand.  More demand on the bones, more continued adapting to load.

Women have not been encouraged to do as much manual labour or high resistance workouts as guys.
Similarly our formal worlds are increasingly desk bound, so less movement is part of our daily lives. As we age, this decrease in multi-plane motion seems to increase. Let us say phooey to this increasingly restricted mode of being.

It will be interesting to see as the culture shifts towards it being ok for gals to work out, and as muscle tissue can be built up at any age, that perhaps hip and related fractures will become a fate of a by-gone age.

Citation:

Lirani-Galvão, A., Lazaretti-Castro, M. (2010). Physical approach for prevention and treatment of osteoporosis Arquivos Brasileiros de Endocrinologia & Metabologia, 54 (2) DOI: 10.1590/S0004-27302010000200013


Related Resources

Thursday, April 29, 2010

Football (er, soccer): best for coach potatoes seeking health, fat loss, muscle?

ResearchBlogging.org
What to do if wanting to move off the coach and into health?
If a guy - especially a guy just starting up a fitness program - wanted to do just one thing that would help drop fat, build muscle (and muscle mass), improve endurance, enhance bone mineral density, improve cholesterol levels and blood pressure, it's football (what north americans call soceer).

Really. Better than HIIT, than running, than resistance training alone, football seems to be the Big Pill solution. The only potential downside is that levels of injury may be higher than hitting the weight room or stationary bike. Overall, the cost/benefit analysis may make football the Healthy Choice. As the authors say in the abstract:
Taken together, recreational football appears to effectively stimulate musculoskeletal, metabolic and cardiovascular adaptations of importance for health and thereby reduces the risk of developing life-style diseases.
Let's take a look at the attributes the authors reviewed. To begin with, they considered studies of men who have been sedentary and then got into some kind of training protocol.


Blood Pressure and Heart Rate
Over 12 weeks, men who trained for an hour, two or three times a week, on the football pitch, comparable to endurance training of same lenght and duration. Football also showed up as better than strength training, to the level thought to have significant health benefits. Risk of death from heart attack goes down with bett blood presure too.

The footballers also have a lowered resting heart rate, and lowered heart rate during submax runs. They also have lower heart rates in intermittent exercise. Compared with groups who did resistance training alone, that didn't happne. This indicated both central and peripheral adaptations. That's great.

Vo2Max
A quality near and dear to the hearts of many people is VO2max. Playing football over 12 weeks had the same effect (13% improvement) as "using continuous training" (eg running) for the same time, or HIIT for less time. BUT what's particularly cool is that the football group continued to have an imporvement after the first four weeks of ball play. Runners did not. It also seems that just playing some extra small sided games had the same effect as additional interval running susseions for experienced players. Playing a game is likely more enjoyable than running repeats, too.

Fat Burning (& other metabolic impacts)
Here's the kicker. How does football do for fat burning? Fat oxidation during low to moderate intensity goes up. muscle enzyme activity up, muscle fiber conversion from IIx to IIA up (good). LDL/HDL ration changed signficantly - for the good.

Now here's an interesting comparison: neither low intensity aerobics for 12 weeks, nor high intensity intermitent running or strength training lead to changes in cholesterol. What does show benefit is higher intensity work. Football vs just running seems to hit the sweet spot. Runners do have similar weight loss - just not these other perks to the same degree.

A result i find peculiar is a claim that
12 weeks of intense interval training and short-term strength training, no changes were observed in fat mass (Fig. 2b), which may be related to the fact that the total energy expenditure was limited for the interval runners and that the strength training group had no changes in metabolic fitness as indicated by unchanged fat oxidation during exercise, lipid profile, capillarization and enzyme activities (Nybo et al., 2010).
Study design is interesting, isn't it? As i've written about before, in work by Trapp, intervals on bikes were the one thing that showed fat loss - especially in the trunk - where steady state did not - even without tracking diet. So hmm. I'll go for total caloric expenditure did not exceed caloric intake in these runners/lifters, but it did in the football case, but i'm not ready to say "football is better than intervals for fat loss" -with fat loss as the single factor of interest. That said, there's more good stuff for football

Lean Body Mass
12 weeks of football, not only does fat go down, and cholesterol change, lean body mass goes up. The study authors look at related work to say heh, this should be good for glucose tolerance. Indeed, there's one study the authors site that when 12 weeks of football & dietary advice was given to a bunch of 47-49 year olds with type 2 diabetes, glucose tolerance was "markedly improved" (a similar trial without that advice showed no difference. hmm)


Musculo-Skeletal fitness
Soccer is stop and go. I've written before about how such action has been shown to be good for bone mineral density. Seems its good for muscle too. Again, comparing with interval and steady state running where there was no muscle fiber change, football does it all. The cool result is that 12 weeks of football got similar results to "14 weeks of heavy resistance training in young men" These kinds of changes just don't seem to happen in regular endurance training. But they do happen across ages in football.

Bone Mass
I admit i am partial to work on bone mineral density. It's a big deal for gals in particular, and we know that muscle size plays a not inconsiderable role for keeping the bones working. But so does the type of axial loading on the bones.

Here's the latest: go lift or do stop and start sports
[T]he increase in leg bone mass following 12 weeks of recreational football training was of a similar magnitude as the gains observed following strength training of the same duration, whereas neither recreational jogging nor high-intensity interval running induced changes in total or leg bone mass. In accordance, both male and female football players have higher hip and spine BMD than equally fit runners (Fredericson et al., 2007; Mudd et al., 2007). Furthermore, meta-analysis of cross-sectional studies reveals that participation in non-weight-bearing sports or physical activities with monotonous and stereotypic movement pattern appears to have little or no effect on bone mass or BMD, whereas strength-based and high-impact sports are associated with higher BMD (Egan et al.,2006).
In football, small sided games with lots of turns, stops and starts seems to be optimal.

Perceived Exertion
How tired are we after an activity? A lot of this experience is assessed perceptually against physiologic markers. Guess what? footballers repport lower poop'dness, despite work done. Play is good.

Injury
All good things come at a price? After last week's exegisis on ankle injuriers in sport, this question of injury level is not inconsiderable: what happens when someone gets off the coach and wants to get back int the game?

Most of the comparisons about footbal are with other on-your-feet activities like running, or very different work like lifting. Alas, no comparisons have (yet) been done with Kettlebells. The point is, when looking at injury, these are the places of comparison: how does football compare with say running?

[One study ]Parkkari et al. (2004) "have reported an injury incidence of 7.8 injuries per 1000 h of football participation, which ranks football eight in 31 recreational and competitive sports. Running ranks 20 with an injury incidence of 3.6 injuries per 1000 h of participation, but no differentiation between the types of running has been made. ... In another study involving 31 620 inhabitants in a Swedish municipality, injury rates in persons attending a physician for an acute injury sustained during sports participation were reported (de Loes & Goldie, 1988). In this study, ice hockey and handball were found to have the highest risk followed by football. For males aged 15–59 years, the ranking was ice hockey, horseback riding, handball and football. If an injury incidence of 7.8 injuries per 1000 h of football participation is valid in recreation football in general, the implication is that the players would be exposed to one injury every 1.2 years if he carried out two 1-h sessions per week all-year round and one severe injury every ∼13 years as the severity of most injuries in recreational football is mild to moderate with approximately 9% categorized as severe injuries, defined as injuries that result in missing of work or a corresponding activity for at least 1 day (Parkkari et al., 2004).

It should be emphasized that the above-mentioned injury incidences in football are the incidence for training and match play analyzed together. However, it is well known that for elite and amateur football players the injury risk per hour of activity is approximately 5–10 times higher during match-play than training (Poulsen et al., 1991; Hägglund et al., 2003; Arnason et al., 2004) with injury incidence from two to five injuries per 1000 h of participation in training sessions.

Stay away from match play and risk of injury seems to be lower.

Just to put the icing on the cake, it seems the study authors would like it to be known that runners are sucks:
In the reviewed studies dealing with the fitness and health effects of recreational football and running, around 150 subjects have been followed over 3–4 months of training performed two to three times a week. During these studies, 5% of the footballers (n=3) and distance runners (n=3) contacted the in-house medical doctor regarding injuries, whereas 33% of the interval runners did (n=5) [note the small sample size -mc]. However, further studies are required to obtain more information about injury risk, types of injury, injury severity, etc. for various age groups playing recreational football organized as small-sided games among friends.
Ok, just go play ball, already. Getting into some frienly 4 a side games, a couple times a week, seems to have so many pluses going for it's hard to imagine the down side - if everyone is rather at the same level (So great, where does one find these games?)


Field Note - General recommendation before Getting Back in the Game: get one's doctor's ok first to start a new prorgam of action, then consider getting a movement assessment to check how you're moving to reduce the risk of injury. It's also immediately beneficial to  practice some sensory-motor drills to help field awareness so as to reduce likelihood of falling on self or colleague, and so actually getting more out of the game. Such drills can start with proprioceptvie awareness work. I like z-health's r-phase and especially i phase for this (overviews).

After R- and I- phase, the drills for fast turning, fast getting up off the ground, and just moving fast in the S-Phase Complete Athlete Vol 1 dvd are awesome - as are the drills for field awareness and quickness (review here). A colleague is using a lot of the z-drills to help the kids baseball team he coaches, from proprioception to visual acuity. Injury down, performance up, much?? oh ya.



Citation:
Krustrup, P., Aagaard, P., Nybo, L., Petersen, J., Mohr, M., & Bangsbo, J. (2010). Recreational football as a health promoting activity: a topical review Scandinavian Journal of Medicine & Science in Sports DOI: 10.1111/j.1600-0838.2010.01108.x

Tuesday, February 24, 2009

Bones and Pistols: a start at B2D responses to readers' queries

This post provides a summary of what research suggests about what we can do to enhance bone strength - and especially when we can do it. It also includes a preliminary review of Steve Cotter's Mastering the Pistol DVD. All because of what b2d readers want to know :)

A little while ago, i asked b2d readers if there were any topics of particular interest to them they might like to know more about. Ron asked about Why Hardstyle (implicitly perhaps as opposed to GS?) - a part of a reply to that is in a recent post on early impressions of GS training which may or may not help Ron's quest.

One of the other queries was from supercat strongman Adam Glass on bone strength:
A few weeks back i posted a question relating to the subject of bone adaptation to stress- a law was recited back to me by several members. I would like to see some more information on bone growth-specifically how i can increase the resulting thickess and researched methods of enhancing bone strength.
I've been fascinated by bones ever since i had to study about bone formation for the CSCS certification. It's a topic i find rather overwhelming because SO MUCH is going on in bone. So rather than try to get into the intriguing complexities of bone development and growth, i've restricted myself to Adam's question.

A more detailed discussion of his question is over at geekfit. That seemed a more appropriate place for the article as it has finally given me something i've been looking for: an unequivocal imperative for desk jockeys in their 20's to get working out. Working out now for future ease from pain and disability may be about as exciting to think about as pension planning , but the results are in: bone loss is inevitable, and the best cure is prevention rather than treatment.

If you're interested in the topic, there's lots of detail and referenced research over at the article on geekfit, but let me quote the summary here:
While studies have mainly focussed on post-menopausal women, bone health - in particular bone mineral density - is a concern for both men and women. The best cure for bone loss is prevention rather than treatment, and the best approach for this prevention of inevitable bone loss is to bank it up with extra BMD work in childhood, youth and young adulthood. The best approach to do this loading is with resistive force work: power training, stop and start sports.

Nutrition is critical for bone building, but will not cause bone building any more than simply eating protein will cause hypertrophy. While we still don’t know what the optimal prescriptions are for optimal bone mineral density building, all the studies looking at this effect show that doing nothing is the worst approach; better to do some fast load bearing activities - but not over doing it, or one may have the opposite than desired effect with microfracturing the bones beyond repair.

Because of the critical effect of bone loss post our alas early peeking in life, it’s great to know that we can bank up bone for future benefit by using it regularly and vigerously - at least a few times a week. If you’re reading this, you’re not too young to start the deposit, no matter what gender. Use it or lose it seems to be increasingly a way of describing our entire physiological system, and that is certainly the case with our locomotive, protective, rather magnificent living skeletal system.
The Butt
Another topic posed by Jason was to write the next phase of the Bum as the Path to Sveltness . In that geekfit article i argued that since the butt hosts the largest muscle in the body, working it will have a big bang for the buck.

The Pistol and the Butt
As a preview to more descriptions of butt oriented effort, allow me to come back to the Issue i've been having with the Pistol. The pistol must be one of THE ULTIMATE butt working body weight moves, but i've been focusing on the weighted pistol. Adam gave me some great advice for slingshotting with a kb which i have tried with great pleasure and fried my legs too boot, and Irontamer David Whitely has volunteered to look at a video of my (pathetic attempt at) weighted performance. Rannoch suggested i look at Steve Cotter's Pistol DVD, and i owned a skepticism of any more sets of instructions. But then two things happened.

  1. after cold reflection i thought, my body weight pistols just suck too much: i don't "own" as the expression goes - the body weight pistol. So how get even heavier and do a weighted pistol. To me a weighted pistol is the bell is in the rack - not being used as a counter weight. Maybe no one else cares about that, but it's where i'd like to be. So i decided to get back to basics and focus on just getting more reps. back to the drawing board.
  2. i was at a recent event where the very rannoch recommended dvd was just sitting there, on sale. So dear reader, i bought one.
Another Pistol DVD?
Mastering the PistolWhat i am looking forward to doing is a detailed review of the dvd once i've had a chance to work through it to "master the pistol" - which by Steve Cotter's definition is 10 body weight pistols on each leg.

One may ask (as i did ) why one would need another Pistol DVD since there is already Pavel's most excellent Naked Warrior which teaches both the one arm push up and the pistol, and includes variants of each.

One may ask the same question about why would anyone do another kb instructional dvd after the excellent book/dvd "Enter the Kettlebell"? And this is rather the same question as why are there a dozen textbooks all teaching stats? Part of the answer may be that different teachers/writers/coaches convey the same topics in different ways, and at different times, different approaches may connect more effectively than at others.

Alternative Approaches
Right now, after working through some of the Cotter DVD, there is a certain appeal to the approach. Rather than working pistols by working the same move on progressively lower boxes, there are a series of supporting drills and levels in the DVD.

The DVD provides:
  • flexibility exercises
  • balance work
  • strength prep work
  • three levels of actual pistol practice prep
  • doing those 10/10 pistols
  • variations of pistols (including weighted)

Again, i'm not saying that one approach is better than the other. For my mental state right now, the Mastering the Pistol DVD seems a closer fit.

And here is where there may be a kind of philosophical difference between the two approaches. Cotter's focuses on drills and routines to build up the strength ultimately to execute the pistol as effortlessly as one might get up from a chair. In other words, the progression on the DVD implies that if you do all the preliminary levels, the end result will be the 10/side pistol.

Pavel's approach seems to be more about learning how to generate tension to succeed with movement. He does not quantify number of pistols done to master the move; rather he demos the types of moves that should be possible once the particular strength technique is mastered. The same technique is to be applied starting with the highest box necessary to do the move down to finally the fully in the hole bottomed out posture to do the move.

Naturally there is overlap between the two: Cotter uses progressively lower boxes as parts of his series, too, but again, there seems a philosophical difference especially with regard to the role of tension. That's not a bad thing; it's just different, and i think in a good way for me as a pistol trainee. I like more information.

To Boldly Go...
What i don't know is how Cotter developed his program, any more than i know how Pavel developed and tested his: did each of them test their approach out with 10 newbies to see what worked? Or did they just draw on their experience to say "this seems like a reasonable program to help build up the muscle skill necessary for this move." Dunno.

What i do know, is that, like having a couple texts on say statistics (and i have more than two because it's a topic that drives me crazy so the more insights i can get into ANOVA calculations the easier i breath) to get different material AND to get different perspectives on the same material, it seems there is much to learn from both.

So i'm flagging Cotter's program up as something that looks like an interesting plan to follow to build into the pistol - it even uses Adam's sling shot in level one (thought without the kettlebell :) ).

What it also confirms for me as i work through Level 2 is that, regardless of approach taken, it has been the right decision to get back to basics: to master the bodyweight pistol first - with perfect form for perfect reps (a focus in these moves) - before getting into the weighted variety. It may put off my Bete challenge, but c'est le gare.

This stepping back to perfect the bodyweight variant seems necessary. And as Pavel claims in the Naked warrior, doing the Pistol is a testament to strength, movement and agility, so why not get it right? Right now, it feels like Cotter's circling around and up to it program may be right for where i'm at.

I'll look foward to a more complete review when i'm done the progressions and see where that lands me relative to "mastery."


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