I am excited to finally bring you the Osteoporosis Fitness Specialist program. It started about 3 years ago as a presentation on the MedFit Tour in Phoenix. It was then developed into a webinar, then short continuing education product, and now a full 10-hour course! It has been nicknamed Project B.O.N.E. for Beating Osteoporosis with Nutrition and Exercise.

It is a unique course in the fitness world because it is a total turn-key format. It starts in the first module with education on bone anatomy and physiology. It then delves into what osteoporosis and osteopenia are and how our bone mass naturally changes across time. It then goes into some of the mechanisms of how bone adapts to the stresses we put on it as well as the interrelationships between joints, bones and movements and how they can improve or decrease with movement or lack of it.

The second module goes into the role nutrients play on bone health. It is interesting that you can approach this from four different perspectives. First, you can attempt to integrate certain foods into your diet that help you obtain calcium, vitamin D, and other bone-building nutrients. Second, you can try to avoid foods that actually decrease calcium absorption and even the stores in your bone. These are termed calcium-robbing foods.

I have developed 13 short video segments that are entitled “EAT this, NOT that” to help guide people with substituting good food for a “bad food”, or one that potentially depletes calcium. Taking in the right nutrients is key because the exercises that strengthen bones are not able to do their “job” if the nutrients that can build bone are not available. Trying to change the way someone eats is one of the more difficult things in life. By making gradual changes and by substituting one food for another, the transitions become easier, and before you know it you are eating well!

The third module is about how exercise can change your bone health and why it works.  One common misconception is that weightlifting is going to stress your bones more than body weight movements that use ground forces. This is simply not true. The target spots and how to work them are combined into the SHoW ME pneumonic — which informs which body parts to focus on (Spine, Hips, and Wrists) and what exercise modalities to use, with Multiplanar activity and Eccentric contractions being the best for bone-building if the client can handle it. Another pneumonic is the SAFE exercises, which represents Strength, Agility, Flexibility and Equilibrium or balance.

The fourth module is on assessments. This is one of the keys to the innovation of this program. Not only does the assessment encompass personal traits, habits, demographic and activities of daily living, but it has a comprehensive physical assessment which is named the ABCEDEFF battery. The agility, balance (both static and dynamic), coordination, dexterity or deftness, endurance, force or strength in both upper and lower regions, and flexibility in both upper and lower regions are part of this assessment program. The tests are simple to perform and the individual will fall into one of four categories, with some having male and female standards separately. The proper way to perform the assessment tests are demonstrated in videos.

The fifth module is putting it all together meaning you’re using: a) the results of your assessment and b) the client’s intake information, which includes their c) needs, limitations and preferences to combine it into a comprehensive, highly-personalized and effective. Clientas will likely not be at the same level for all the variables tested, so you may have a client who is strong but inflexible or a client that is flexible but weak. You address the weak spots and monitor progress easily.

Why is it so effective? Because the assessment will categorize the client one of four levels. Each exercise has four levels for proper progression or regression. The client is getting the right exercise for them depending on their skills, bone density and any limitations. Exercises are similar in each of the three workout venues — a gym, a park, and at home — but vary with the equipment available and surroundings. Each of these venues has pros and cons and in the current age of COVID, it is important to have alternatives to turn to.

The final module addresses some business aspects. Marketing and promoting your skills and knowledge are what keeps you in business. There must be a balance between the training skills and knowledge as well as how to manage the logistics and getting the word out.

I believe this program will set a new standard in training programs and how to carefully train a client with the knowledge gained from an assessment and thorough intake questionnaire. The disease of osteoporosis is only going to get bigger. With 54 million Americans already with low bone density, the numbers are already huge!

Dr. Mark P. Kelly has been involved with the health and fitness field for more than 30 years. He has been a research scientist for universities and many infomercial projects. He has spoken nationally and internationally on a wide variety of topics and currently speaks on the use of exercise for clinical purposes and exercise’s impact on the brain. Mark is a teacher in colleges and universities in Orange County, CA., where Principle-Centered Health- Corporate Wellness & Safety operates.

For those struggling with chronic medical conditions, exercise can be an often under-utilized way to manage some symptoms and improve others. This is especially the case for diseases like osteoporosis. This is a great opportunity for fitness professionals to utilize their training to really help others.

Osteoporosis is a disease of the skeletal system in which bones fail to create new tissue and when existing bone tissue breaks down. This means that bone structures on those with osteoporosis are much more susceptible to injury. As such, you — as a fitness professional — are uniquely suited to help osteoporosis patients who need to be much more careful and might require a little bit more creativity in their regimen.

First of All…

Make sure that the client has cleared their exercise program with their doctor. Nothing can take the place of a qualified medical professional in terms of assessing safety. This also means that you might want to be available to discuss programming with a medical professional if possible. This way, you become an integral part of the individual’s treatment team and can offer valuable insight to both the doctor and the patient as to how they are dealing with one thing or another in relation to their illness.

Structural Considerations

There are quite a few things to take into consideration when programming a client’s regimen. In large part, you can even take an engineer’s approach when thinking about what is most important for them to achieve their goals. For instance, a cable bridge like the Brooklyn bridge in New York City is supported both with pylons and cables. Similarly, the human body has a skeletal and a muscular system which work together to support people.

If the concrete pylons under the bridge started to decay, one could compensate for this a little bit by strengthening the more flexible cables which also work to hold the bridge up. In this same way, if a person’s bones are brittle, their muscles can help compensate for this deficiency to an extent. But that isn’t all.

Bones have also been shown to respond positively to exercise in a similar fashion to muscles. So when you consider the building of muscle as a reaction to contraction and exerted force, bones will react similarly. Just be careful not to do too much.

Injury Prevention is EXTREMELY Important

Whereas most people would agree that injury prevention is important in training, it becomes that much more important to consider when training someone with osteoporosis. When a person with strong bones gets injured, depending on the severity, they might bounce back in a matter of weeks. When someone with osteoporosis gets injured, it can be a matter of months before they can return to training. Psychologically speaking as well, this can lead to a confidence issue which will negatively feed upon itself in the gym.

Staying positive is really critical, both for success in exercise and success in treatment, and injuries which knock you out of commission can completely derail months of work.

Training Approaches

To continue the metaphor about a cable bridge’s support, another way to make those structures more effective is to reduce the amount of weight of the overall structure. Thus, weight loss can be a really helpful goal for the individual. This will alleviate some pressure and will likely lead to less pain.

Furthermore, strengthening the muscles which surround bones and joints can have a very positive impact on the individual fighting the disease. Stronger muscles mean that, even when sitting or standing, the individual uses less of their bone structure to support their body and uses more of their muscular system. This constitutes great progress.

As such, a combination approach is often best. The National Institution of Health notes that load-bearing exercises are best. Although activities like swimming are great for developing muscles and burning fat, there still needs to be a solid land-training component as well. This could be walking, hiking, or — for people who have more advanced experience with exercise — even running.

But cardio alone is insufficient. Resistance exercises will help to build critical muscle mass that will help them to live with less pain and less risk of an accident. This doesn’t mean that they have to start benching 300 pounds. Often times, simple and modified bodyweight exercises are a great way to implementresistance training. For those who are less mobile, resistance bands are incredibly useful.

Circuit Training

Circuit training is a great way to more efficiently train clients. It’s especially the case for those suffering with osteoporosis. As such, you might have a circuit where they perform an individual bodyweight exercise — say modified push-ups, bodyweight squats, and a few balance exercises. Have your clients perform each exercise under your supervision for 30 seconds, then have them walk for 60 seconds, then do the next exercise for 30 seconds, alternating until they get to 20 minutes. Obviously, a program like this can be tweaked to be harder or easier based on the client’s ability level. This is a great way to train outdoors on a track, and is also valuable  because it could be used in someone’s living room on days with bad weather as well.

Educate Them for Success

It’s also important to understand that you are not just guiding the individual through their routine, but you are teaching them how to train when you aren’t around. This means that it’s even more important to explain why you are having them do one exercise instead of another and how it fits into the overall picture. Their ability to exercise independently of you will only garner more trust in your client/trainer relationship and they will see gains more quickly. Just remember to keep them safe and teach what you can. They will thank you for the effort!

Jane Curth is the co-founder and CEO of FitFixNow. Helping people on their wellness journey is her passion; Jane has helped clients and students with their diet and fitness struggles for over 20 years.