The Impact of Movement on Your Bone Health in Menopause with Niamh Daly

While there are many parts of midlife to love and look forward to, accelerated bone loss isn’t one of them. It’s part of the aging process that we can’t control, but there are things we can do to slow the process down and protect ourselves from unwanted breaks and fractures. Osteoporosis is known as the “silent disease”, so understanding how to avoid it is crucial after age forty. 

The good news is that there are many paths to increasing our bone health that doesn’t have to include a gym membership. In today’s episode, I am joined by my friend and yogi, Niamh Daly who is sharing why we don’t need to be motivated by fear when it comes to protecting our bones in midlife. When we understand that bone growth is stimulated by the muscle that surrounds the bone, we see why all movement (not just big bursts of exercise) counts!

Niamh is a big believer in how Pilates and Yoga can support our bones in midlife. If this is a practice you love too, you’ll want to listen and learn about some of the common poses and movements that you should be skipping or doing differently if you have osteoporosis all instructors know about these modifications, and so Niamh will share the types of movement that you need to steer clear of, along with suggestions of what to do instead.

 To learn more about Niamh and her work, check out her website at Instinctyoga.com and follow her on Instagram at @yinstinctyoga.

TRANSCRIPT

Jenn Huber  00:02

Hi and welcome to the midlife feast the podcast for women who are hungry for more in this season of life. I'm your host, Dr. Jenn Selena Huber. Come to my table. Listen and learn from me. Trusted guests, experts in women's health and interviews with women just like you. Each episode brings to the table juicy conversations designed to help you feast on midlife. Hi there and welcome to this week's episode of the midlife feast and today we're talking about a very important topic, which is bone health and specifically around movement to help support our bone health in midlife and beyond. The reason that we're talking about this, of course, is that may is osteoporosis Awareness Month. And if you're in midlife, you definitely need to be paying attention to this episode, and also all of the other information that will be coming your way from me and other people this month to help you stay strong as you kind of transition through this period of life when we are more likely to lose bone. So we know from research that about 20% of bone loss will happen during menopause and post menopause. And then about one in 10 women over the age of 60 already have osteoporosis. So my guest today is Nev daily. nev of course, is a returning guest, she's a friend of mine, who's a yoga instructor and a Pilates instructor and more recently has become certified and has done some additional certification to help support people in maintaining their bone health through menopause. So this conversation is very practical, very relevant, we talk about some of the things that you need to be thinking about with movement, especially if strength training and going to the gym has not been part of your regular routine, you'll be happy to know that there are suggestions that don't involve that. And of course inside the midlife peace membership community this month, we're focusing on all things bone health. So if you're looking for some information and support around the nutrition piece, and how we can support our bones and overall health with a gentle nutrition and intuitive eating approach to health, we'd love to have you but for now, let's get on with the episode. Welcome, Neil, welcome back, I should say is your one of a handful of returning guests that we've had on the podcast. So welcome back.

Niamh Daly  02:23

You're welcome. I mean, thank you for welcoming me. I like the idea of being one of a handful. That's kind of nice.

Jenn Huber  02:29

I'm kind of think actually, I think there's only maybe two others, maybe three. So definitely an elite group so far, but really excited to talk to you. Today we will talk a little bit about yoga. So people who know you might be expecting to hear about yoga. But what we're talking about today is bone health and movement for stronger, better bones. So why don't you tell us a little bit about what women in midlife need to know about bone health?

Niamh Daly  03:00

Well, that's the interesting thing. What do we need to know because the world at the moment in menopause is there's a lot of fear mongering. And there are statistics I could share with you about women and bones which you know, my put The Frighteners up everybody. But of course, it's not going to happen to everyone. But absolutely, there is accelerated bone loss in post menopause leading up to full menopause. And then particularly for a number of years just after menopause, then it does kind of get less dramatic, but there is still loss of bone as the years go by. So your chances of having osteoporosis over 80 are way bigger than over 50. But there is one statistic in the US is that 54% of women over 50 will have low bone density, so not osteoporosis, but osteopenia and osteopenia, which means low bone mass, you know lower than what we would want in a woman at that age. So not lower than what it should be in your 20s. but lower than what kind of healthy bone mass is for a woman in her 50s that can also lead to increased fracture risk. 

So I think we tend to think about osteoporosis as something that only that that's the only danger in terms of fracture. And that image we see of the older person falling breaking a bone even though the fall wasn't big, but it actually those low impact fractures can happen in osteopenia not nearly as regularly as with osteoporosis. And the I mean, there's always so many different research papers. But one interesting one that I read is that it's more likely that if you've low bone mass aka osteopenia, that you'll have a fracture if you're in a smaller body, whereas people with osteopenia in larger bodies may not fracture as readily. And as you know, I'm sure one of the risk factors for developing osteoporosis is having spent your life in a small body so it may be that you're small boned or you've been of low weight for a lot of your life. I don't know Jen, whether you want me to go into the other risk factors because, you know, I don't want people going oh my god, I have that. Oh my god, I have that. Because really, to me, the most important thing is that for every woman, you can assume that there is some increased bone loss, Peri menopausal or postmenopausal. And it is, without doubt, a good idea to look after your bone density, your posture and your strength and your avoidance of false. So your vestibular sense. So, in a way, doesn't matter what your risk factors are, just assume it's got to be done.

Jenn Huber  05:29

Yeah, no. And I think that one of the the take home messages if you're just listening to this, and you're brand new to thinking about your bones in midlife, is that our ability to build bone kind of peaks before we're 40. Yeah, and so everything kind of leading up to that is a little bit more focused on building bone and setting the foundation for healthy bones later in life and strong bones. But everything after that, and maybe even more so important post menopause, it's much more about slowing the rate of loss. Yes. Which, you know, I think a lot of people don't really understand, because the message has always been about building strong bones, you know, in your 50s 60s 70s, whatever it is, but it's really about slowing the loss. And that's what I you know, I'm excited to hear from you about some of the things that we can do, I think the risk factors, you know, we can look them up, they're kind of everywhere, but I think it's the practical take homes of okay, what do I need to know, what can I start doing, and especially when it comes to movement, I think that there's a lot of misinformation or disempowering information, because people sometimes think, well, if I'm not a runner, if I'm not lifting heavy weights at the gym, then I'm not doing my bones any good. So what, what can we talk about in relation to movement that might help to demystify some of that?

Niamh Daly  06:58

Yeah. So why is movement important? Oh, yeah, well, okay, so around your bones, you have a kind of skin called the periosteum. Perry means around as we all know, from perimenopause, and osteo means Ostium means bones. So periosteum is like a skin around your bones. And what we know from the new anatomy world that we're not just about origin and insertion of muscle starts at one end of a bone and finishes at the other end is absolutely connected to the bone intimately all the way along the bone by the skin, which is intimately connected with the muscle, so they're kind of one in the same thing. In fact, there's a guy in it, who's at the forefront of the research into the fashion world and the fact and his theory. Now he's a clinical anatomist, a big nerd says that we're actually just one muscle, he knows, you know, he's absolutely world renowned. We are one muscle, that's all we are. And so everything we do to any muscle stimulates the periosteum. the periosteum, sends signals to the bone to build new bone tissue. So those are our most robust and repeatably significant research is that lifting quite heavy weights, is what's going to help you grow bone, the word is osteogenesis, as in, you know, Genesis in the Bible, the beginning the growth. 

But anything that stimulates and calls on muscle is going to stimulate the periosteum, it's going to stimulate the bones to make those cells kind of go, oh, what's my job here, this is my job to turn into bone tissue. So even something like swimming gets a bad rap. Because it's, it's not weight bearing, we all think that weight bearing is the only way. But if you swim laps, say especially if you use like those paddles that make you give you more resistance, there's resistance against the water, so your muscles are engaging. So there's got to be some stimulus to bone there. But as you say, it may not be about increasing your bone scores, your density scores, it may be about slowing the decline and stabilizing the bones. So you'll find that if you go to a doctor and you get a DEXA scan, which is the the sort of weird, complicated X ray type thing to check bone density, that if you have a diagnosis of low bone density or osteoporosis, any normal physician or any, you know, physician who's doing who's within their protocol will say, Let's rescan you in two years because the rate of your loss is important to know it's not just about what your score is on one moment. It's what's your score over the course of two years. So they won't jump to treatment. Because we do know that we can slow bone loss and the stuff we can do you I'm sure I've talked to your people about dietary interventions, and that is incredibly important because we can't build bone if we don't have the mineral circulating in our system. So as you know, that's one of the things You know, malnourishment will absolutely affect your bones, of course it will. So movement wise, we can assume that anything that really engages muscle is stimulating bone. We can also look at how it's not just about stronger bones. It's not just about building bones, as you say. But neither is it even just about trying to stabilize and stop bone loss. 

Of course, that's important. But even more important, arguably, is working on posture and balance. So that we're helping people avoid falls when they become quite severely osteoporotic in later life. And that, you know, I think anyone who has had elderly parents in their lives or has them, they know the impact of a fracture in later life. And really, we have to be aware that when we're talking menopause, average onset is at a time when our body is aging, it leads us into the latter third, third of our lives. So it is a conversation about future proofing. So with regard to movement, we're looking at things that really engage muscle, so something like Pilates would really stimulate muscle activation, it's also really good for balance and for posture, it's really good for interoception because in Pilates, there's a really strong emphasis on noticing which muscle is getting stimulated and where. And when we develop interoception as an awareness of the inner sensations of our body, we're also helping develop our proprioception, which is helping us know where we are in space. So we're avoiding falls, it's helping us know how high we need to lift our foot to put it on the on the step, that kind of thing that can get in the way in later life. If someone is proprioception is not great. So working on proprioception is really important. So you might not think that working on your senses is important for bone care. So staying active in any way, where you're aware of your body moving through space is going to be beneficial. In terms of things, like you said, running, everybody thinks they have to run. Ironically, and you know, delightfully. There is some research to suggest that walking is better for osteogenesis than running. I'm not quite sure why maybe it's because the running maybe increases the cortisol more. And then cortisol is catabolic, and it jumps away at bone tissues. 

So stress is a big thing to be thinking about. Now, if you'd like running run, because that level of cortisol increases positive sometimes, but it's if it's chronically high, I don't know why walking might be more beneficial. But also walking downhill is beneficial. So you could get a helicopter to the top of the mountain, and then walk down to make all that effort. So jumping, skipping that kind of thing. So for instance, I go swimming in the sea, as regularly as I can a few times a week. And part of my routine, when I get out of the sea is I jump 100 times on the stony beach, obviously making sure that I'm jumping on something levels are not turning my ankle. But yeah, jumping hopping. Even if you're too afraid to jump, if you already have balance issues, just lifting your heels and doing, you know banging your heels against the floor, like you're almost jumping, if you like skipping rope, great idea. But also more lovely things that you might enjoy for not a runner, like learning to dance, which is also going to be good for your brain as in learning new dances. But obviously something like salsa, which is really slippy slidey might not be as beneficial to your bones as something like I don't know, swing because you're jumping around the place. But yeah,

Jenn Huber  13:50

well, I think you know, because so many of the listeners to this podcast are people who are trying to redefine their relationship with food and movement. There's often a, it's not a resistance. It's not an obstacle. I don't know exactly what the right word for it is. But it's kind of a holdover of this all or nothing thinking that often exists when we're in this place of, you know, trying to manage micromanage that calorie and calorie equation where the activity is valued for its output and not for what we get from the experience in the moment or for the long term benefits. And so, I'm often talking to people about, you know, redefining this relationship with movement and when it comes to something like bone health, it is a great motivator to try and find ways to move your body in ways that you enjoy as often as you can. And anything counts like that's what I want people to hear from what you're saying thing is that, yes, there is research to say that if we can lift really heavy weights, that it that helps build bone. And that's great, if that's accessible to you, if you enjoy it, if you can do that safely, if you want to do that even right. And I think lifting heavy weights is a great thing. 

I asked for weights for Christmas, so that I can have these adjustable weights, you know, so that I could do more weights, I love lifting weights. But I also want to do things that are pleasurable and enjoyable in other ways, like walking, or like yoga, or, and all of those things are contributing, they're contributors. And so we want to have this, you know, maybe a different perspective around bone health, that we want different activities that are supporting bone health, and not just the best do that all the time and do it as much as you can. Because that's where I think sometimes people get lost in that conversation. So I love what you're saying about, you know, all the different ways that we can activate bone and muscle and, and I love actually, this idea to that building muscle isn't isn't just good for us, you know, metabolically and all those reasons. But it also helps to protect our bone, the stronger your muscles are around the bone, the more protected they are. And so you know, there are many different paths to bone health, by focusing on strength, I think is kind of what I hear from you and from others as well.

Niamh Daly  16:30

Yes, and also, when you're talking about that protective nature of muscle, one of the most lovely pieces of research I read was about how, when you have a fracture, the bone repair is better when there is more muscle tissue nearby, like I don't, there must be some metabolic connection between the muscle and the bone that's different to just you know, it's almost like is the is the muscle just stroking the bones, it's okay, you're gonna be fine. But basically, in different sites, if you've got less muscle, you're, you're less, you're speedy, you're the speed of your bone repairs any age is is is less than if you have good muscles. So there's a definite, intimate relationship between bonds that is more than just my tendon, inserts in my bone here. And then I have to pull my arm here to make my limb move, blah, blah. So with regard to what you were saying about those achievable, fun things, I think just like with eating, where, as my own colleague in the nutrition world says you've got to cast your nutrition net wide, in order to maintain or to ensure you have enough of those all the minerals that are necessary for the bones and indeed the stuff that other stuff, the DS in the season, etc, a bit of a DS and C's. But that, again, that needs to be spread over the day as well. It's not the wisest thing to have loads and loads of minerals at one meal, we need to pepper it through the day. 

And that's the same with our movement when we aren't evolved. To do exercise in one burst. We evolved to be moving bits and bobs all day and not to any kind of ridiculous level of strenuousness. So you may have heard of neat non exercise Activity Thermogenesis which is basically the stuff we do during the day, it's you know, might be digging the potatoes, but it might also be a bit of gardening or cleaning the house or walking the dog. And people who engage in neat exercise are nice not because it's not exercise, nice activity. During the day, do better when they do go to the gym, if they go to the gym, there's more there's better results in their bloods. So we know that we know for sure that that kind of normal daily activity is really good for our body. And if we can add in movements likes like jumping 100 jumps, while the kettle is boiling, you know, that's much more achievable than then having to the gym.

Jenn Huber  18:55

I love that that you brought that up because anybody who works with me will recognize these suggestions are often say like if you're standing at the stove, do some squats, some stove squats, right? You know, uh, you know, walking lunges up and down your hallway, do an extra set of stairs, like these are all little things and it's body weight movement, you are increasing the weight that your body needs to move there for strengthening your bones. By doing these, you know, deep squats, not even deep squats, you don't even it doesn't have to be like a you know, a Goddess Pose or anything just squats at the stove are these walking lunges are going downhill.

 And so I think that this, this idea of strength, movement for bone health is so much more accessible than many people believe. Because when you just read the recommendations, and it's like do strength training a minimum of 20 minutes three times a week. If you've never done strength training, if you've never picked up a set of weights, that can feel really intimidating. So we've talked about a few things and you also mentioned like doing heel drops, let's say Somebody has a regular yoga practice. What are some of the things that they could add into that, that would help to support their bones?

Niamh Daly  20:10

Yeah, so that's a very important, I'm glad you brought that up the yoga piece because the research is quite different around yoga for osteogenesis, as in for growth of bone tissue. And some research has shown that where you would expect bone loss, that yoga has stabilized bone which you could translate into meaning it has probably built bone if if it's a time when bone is supposed to be or is expected to be decreasing. But then there are other studies that have shown no results, no positive results. And then there's there's one study into 12 specific postures that showed that it created osteogenesis. But there's people scrutinizing that, that research at the moment, and I have to say that I kind of smell a rat in that because for me, it can't be about just a specific pose, this pose helps with osteogenesis. What it what matters to me is how you perform anything that you're performing. So you could stand in Warrior pose, which would be something that would be familiar to most people who don't even do yoga, it's like when you're, you've got a you're in a high lunge and your knees bent, and your arms are up overhead, and you're looking straight, straight ahead. 

If you prefer, you can perform that with the soggy chest muscles, and you know, really half baked, which is a lovely feeling sometimes to go soft. But you can then also choose to push against the floor to imagine you're pushing against an elephant trying to push it away with your knee, you can try and imagine you're ripping the mat apart, you could even imagining you're holding a weight above your head will make a difference in how your bones react to how your muscles react. In fact, whenever you think about any muscle contracting, it contracts in a tangible way that is measurable. So imagination is a really important part of how we can increase the benefit for whatever benefit we're choosing. So if we want to imagine that we're relaxed, we all know that we can imagine being relaxed, and that really helps. Imagine being on a sandy beach, you're lying in the sun, we all know that. It's the same with muscle. Imagine your rectus abdominus contracting before you do a sit up if you're doing a setup. And you'll notice that eight contracts and be that the setup might even be easier. Not that I'm advising setups, they're so boring. And also would be contraindicated for osteoporosis, by the way, we should talk about contraindications. So to be more clear about your question, how can a yoga practitioner enhance what they're doing? I personally in my teacher training and in my practice, and in my classes, some of my classes, resistance bands, and I add light weights. 

So you know, dumbbells about two, maybe three kilo and use them within postures, resistance bonds do have some good research around them as being comparable to weights in terms of their the stress that they put the body under the positive stress. But do be aware that again, just I have to I have to speak from what we know that it may not be what enough of what you're looking for. So what can be great with yoga, or Pilates, or this other bone training thing that I've done is that it can prepare you. If you do eventually decide to go and lift weights, it helps you work on what they call your form, ie lifting weights safely so that your whole body is involved in the in the moment. And that you're you're aligned in your bones, you're knowing how to engage your core your pelvic floor, because if you're going lifting heavy weights, you're creating intra abdominal pressure, and women who may be subject to prolapse. So if I'm asking people or suggesting to people who are my yoga students and want a bit more robust bone density, and they want to go to the gym, I'm saying interview your personal trainer. Ask them Do they understand the Peri and postmenopausal body before you go there. So,

Jenn Huber  24:13

so important, so so important, because it is different, right? It is not. It's not the same as training a 20 year old, you have to be aware of what these limitations are. So let's talk a bit about the contraindications. Because I think you're right, that is really important. So what are some of the things that people should have on their radar as press pause before moving ahead?

Niamh Daly  24:36

Yeah, so if you've had a diagnosis of osteopenia or osteoporosis, you need to be a little more considered in the way that you move. Now I'm a big one for improvised movement and allowing your body to just flow the way it wants to flow. But I've you know, I know that when you get a diagnosis of osteoporosis, there's going to be a little bit area of adjustment just like perimenopause, where you're like, Oh my God, I don't know how to move my body anymore. So what you want to avoid is forward bending of the spine, aka flexion of the spine where your front body gets shorter your back body rounds, you want to avoid twisting the spine. But of course, you also need to be able to turn around look over your shoulder in the car, you need to be able to move freely in your body, walking is a twist, you know, there's a slight rotation in the spine when you walk. So we're not saying your spine is never going to twist again. And then if you're a yogi, this would be only really for Yogi's to avoid really, really deep back bends. But be aware as an extension of the spine where the front body gets longer, and you're leaning backwards. 

For those of you who don't know what a back bend is. Be aware though, that osteoporosis tends to be present in parts of the body and less likely to be present in other parts. So it's most common in the femur, that the thigh bone and the hip. And it's most common in the spine all the way up through the whole spine, and most common in the wrists. So those are the places to mind in terms of yoga and stuff you might want to think about when you're in plank, for instance, going on to your elbows instead of on your hands. But at the same time, trying to find some work to start the new wrists for your spine. It's the front of the vertebrae that are more prone to osteoporosis, whereas the sticky bits at the back of the spine is processes that you can feel the knobbly bits in the back of your spine are made of a different kind of bone. And so they're less prone to osteoporosis. So back bends are probably not as much of a risk as forward bends. in particular. And this will be common in some yoga practices and not others. Do not do a forward bend, holding your toes and pulling yourself towards the forward bend towards your legs. Do not do a forward bend, pulling yourself with a strap, do not let your yoga teacher push you into a forward bend. Disastrous anyway, to my mind. But for osteoporosis, even like if you're not going to let go of your forward bends, just make sure they're not done with force forward bending with gravity is worse than if you're sitting and forward bending. 

Whereas if you're standing and falling upside down, that's going to be worse. We've got the extra weight of gravity that you were talking about with regard to exercise. And then with twisting, there's these things in yoga called taking this thing called taking the bind or a bind, where you twist and then you hold your two hands behind your back, which helps you stay in the twist and pull yourself more into the twist. It's I mean, it damaged my lower back, you know, years ago, it's something that I find very questionable anyway. But you see people striving for it. And yoga again and again. So forcing yourself into a twist. Get away from that. Even just using your hand on your knee to pull yourself around, twist naturally, the way your body naturally twist to look over your shoulder to check what's there behind you. That's okay, if you're working with your muscles slowly and gently. But it's leverage twists. Yeah, forward bends with gravity extreme back back bends and pulling yourself into forward bends would be the big contract indications. That is

Jenn Huber  28:17

so so important. And I some of them were obvious to me like the back bends and things but I actually didn't even realize about the forward bend. So that's really important. And for me, yeah, the forward

Niamh Daly  28:29

bends even more so than the back bends. And if you're into Pilates things like you'll know what the C curl is not a good idea. So where you sitting and then you roll down vertebra by vertebra onto your back, sit ups with your head and your hands and lifting up not good because you're using quite a lot of force there. So your core strengthening needs to be more about maybe lying on your back. And how do you use your legs in the air to just putting your legs into the air or maybe putting straps around your feet resistance bonds around your feet and moving your legs away from your trunk. That's a great way of strengthening your core. So as plank, but curls like sit ups that kind of thing to be avoided as well. And you know, when you kind of imagine, okay, that's for the the 80 year old with a really delicate frame. But it's not just at that age that that fractures can kind of occur. And other other signs, you know, you don't want your listeners may not be aware of I get this a lot. 

How do I know if I've got osteoporosis? It's called the silent disease, as I'm sure you know, Jen, because there are no symptoms really, unless you have what they call a low impact fracture. AKA you fall from standing or you brush your hand against a wall in a way that we wouldn't expect to fracture. You have a fracture, they check for osteoporosis. And that's what what's going on or loss of heights but that that would happen quite later on in life, the loss of height and loss of height of more than have I think it's more than an inch and a half or is it more within a centimeter and a half, they would think might be indicative. There's me really good with my statistical memory. But yeah, some loss of height is normally without a centimeter and a half. There you go. Thank you. Yeah. So but

Jenn Huber  30:13

yeah, I think I think what the listeners will get from this episode is that there's, there's more than just, you know, needing more exercise to this conversation around movement. You have done some additional training and certification recently. So if people want to learn more about how you work with people in midlife and beyond, for stronger bones, what what's the best way for them to learn about how to work with you and how you can help them?

Niamh Daly  30:43

Yeah, they can go on my currently quite messy websites, which I'm working on with a certain fabulous person helping me kind of see the wood for the trees. But they can go on my website, which is instinct yoga.com, they can find me on Instagram, which is instinct at instinct, yoga, that's instinct with a wire at the front. They can email me I'm very happy for them to do that. You can put that my email in the show notes. Can you Yep. All will be in the show notes. Great. But just to reiterate what you said that I don't want the takeaway to be, oh my God, all those things I have to avoid. There are ways to start finding joyful movement. Again, there may be a transition period where if you had a diagnosis, you're like, oh, never move again. But you will absolutely find your way. And also that for those of you who are trying to look after your bones, there was such a such a multifaceted approach, avoiding stress, working on muscle strength. And then if you do have osteoporosis, you don't have to assume that you're going to fall and break a bone. You can work on your balance or coordination, your posture, yeah, all of that.

Jenn Huber  31:48

That's wonderful. Thank you so much for joining us once again on the midlife feast. And I'm sure we'll have you back again at some point talking about something else.

Niamh Daly  31:58

Why not? Next Gen.