Aging Gracefully Blog

Archive for the ‘Osteoporosis and Bone Health’ Category

“S.U.S”: Secret Code for Posture

Monday, July 24th, 2017

When I was growing up, my mother and I shared a secret code for posture. S.U.S. meant Joan Pagano - desk stretches"Stand Up Straight" and I seemed to need constant reminders. When my self-image finally "grew" into my height, I straightened up to claim my full 5'10 ½ inches. Now at the age when loss of height can be an issue and posture needs constant vigilance, I look for ways to stand tall and straight.

This series of at-work desk stretches can be done anytime, anywhere – you don’t have to be at work! But because we typically develop a forward posture from doing desk work, it’s the perfect opportunity to create a habit of stretching in the small moments of your day. Do them with me in the video below.

While there is nothing we can do to stop the aging process, there are a number of things we can do to stay tall, including working on posture and alignment, ensuring the health of our skeleton, and of course, stretching out our muscles.

Posture and alignment tips

When sitting, engage your core muscles instead of relying on external support. The torso will passively conform to whatever type of chair you are sitting on, and properly designed chairs are rare. Keep your weight distributed evenly across both hips. Feel the sit bones, not the tailbone, beneath you. Sit up tall, with the spine straight and with a natural curve in the lower back.

When standing, distribute your weight evenly on both feet. Soften the knees so they are not locked or hyperextended. Stack your ribs up over your hips, pelvis in neutral, i.e. not tilted forward or backward. Think of elongating the torso, stretching the space between the ribs and the hips, lengthening the spine.

Healthy skeleton

If you have lost height and/or are developing a permanent slump with rounded back or “sloping” shoulders, check with your doctor to make sure you don’t have a spinal condition like osteoporosis. A simple bone density scan can give you a report.

Spinal fractures are the most common type of fracture to occur with osteoporosis, accounting for 40% of all fractures. Vertebral fractures can cause your spine to curve forward (“kyphosis”) and may cause pain as the other muscles of the back are strained. Once your doctor approves, these simple moves can strengthen and lengthen the spine, improve mobility in the upper and middle back, and reverse the forward slump.

 Stretching muscles in your workout

Stretching is one third of a well-rounded workout (the other two being aerobic exercise and strength training). After you've been contracting the muscles repeatedly in your aerobic workout – walking, running, cycling, swimming, etc. – it's important to lengthen them out by stretching. The same principle applies to strength training: after the muscles have been contracting against resistance, they need to be stretched out to their full length. Short, bunchy muscles will never give you a long, lean line.

It's advisable to stretch every day, even on days you don't exercise. Take a lesson from your pet dog or cat and notice that they stretch periodically throughout the day. You can move your joints to help wake up in the morning and get your circulation going. Or take a few minutes at work or in the evening to relax, to counteract the demands of your day and discharge tension from the muscles.

Video:  At-Work Desk Stretches

Contact Joan for help with your posture:



Stay on Your Feet

Thursday, May 4th, 2017

May is National Osteoporosis Awareness month. The bottom line of exercise for osteoporosis is to prevent falls and hip fractures, the most debilitating and life-altering type of fractures.  A combination of strengthening, stretching, and balance training is the perfect formula for fall prevention, and it can all be done 1-2-3!

Have you noticed that your balance is slipping with age?  Sometimes when I make a lateral move, like side-stepping to avoid something, I go off balance and swerve a bit. I definitely look tipsy and feel embarrassed!

Our ability to balance peaks at around age 20 and normally remains excellent through our early to mid-40s, after which it begins a subtle process of deterioration.  It happens so slowly that it is almost imperceptible, but the fact is that the neurotransmitters that coordinate balance deteriorate with age.

The good news is that balance improves with training, both with strength training and with specific balance training.  The first gains in a strength training program are neuromuscular, creating a new integration between the brain and the body.  As you learn proper form to coordinate the movements, the signals to the brain create growth, first in the pathways to the brain and then to the muscles and joints directly. 

The neuromuscular stimulus results in quicker reaction time, the ability to recover from a stumble or to change direction.  Our balance centers – eyes, ears and feet – work together to sense imbalance and correct the course.  As the muscles get stronger, especially in the lower body, we become more stable and more able to prevent a fall or an injury.

Specific balance training is also very effective.  If you are just starting to work on balance, try this simple stork stance to determine which leg is more stable.  Stand on one leg, fixing your eyes on something in front of you. Engage your core muscles by drawing your belly button in toward your spine.  When you can hold the position for 30 seconds, try closing your eyes (or one eye) to increase the level of difficulty.  When you switch legs, note the difference between the two sides, which can be quite dramatic.

Next, add movement for dynamic balance, such as doing a "tight-rope" walk on the floor.  Walk heel-to-toe in a straight line.  Again, it helps to keep your eyes focused on something in front of you instead of looking down since the eyes are one of your balance centers.  Maintain proper alignment, holding your torso upright, chest lifted, eyes straight ahead. 

The next challenge to your equilibrium moves you from a stable surface, the floor, to an unstable one such as a stability ball.  You can sit, lie, or place your feet on top of the ball to create instability.  Just sitting on it requires continual adjustments:  the ball activates the muscles of your feet, legs, hips, and spine to maintain your balance.  Some schools in Europe have replaced chairs with balls in classrooms to improve posture and activity levels in children. I use one myself for a desk chair.

Your balance will improve with practice.  Do strength training exercises to enhance your mind-body connection and to build stability in the large muscles of the legs.  Then do specific exercises to challenge your balance and create symmetry between the two sides of your body. You'll reduce your risk of falling and prevent a possible injury.

Watch this video to see a simple way to strengthen your ankles, stretch your legs and practice balance.

Video: 1-2-3 Calf Raise, Leg Stretches, Balance

Joan Pagano demonstrating calf raise

Joan Pagano is a member of the National Osteoporosis Foundation Ambassador Leadership Council. She is the former trainer to Jacqueline Onassis and Caroline Kennedy, a best-selling author, a speaker on health and fitness topics and the owner of Joan Pagano Fitness in New York City.  For more about Joan and her services, please visit

(c) Copyright - Joan L. Pagano. All Rights Reserved Worldwide.

Strength Training by the Decade

Thursday, November 5th, 2015

Mother and daughter doing push-ups

Strength training sculpts the contours of your body and strengthens the bones within. By building lean body mass,it boosts your metabolism and your energy levels, making you resistant to the slow-down that occurs with age. A well-designed exercise program that includes weight training will impact your weight, health, fitness and well-being for decades to come.

At 20: A 20-year-old woman who does not lift weights will lose about 6 pounds of muscle and gain 5 pounds of fat by age 50. This means that even if you maintain your scale weight perfectly over time, subtle changes are occurring in your body composition that can affect your health and appearance.

At 30:Strengthening the muscles benefits the bones as well. Now is the time to put "bone in the bank" to fortify against the natural loss of bone that occurs gradually with age.  By age 25 to 30 you’ve achieved your peak bone mass, the highest bone content you’ll have in your lifetime. Although bone continues to renew itself, from this time on you will experience a natural decline in bone density that accelerates at the time of menopause before leveling off again.

At 40: Turning 40 is a wake-up call as many women begin to notice changes in their bodies that sound the alarm. You may be perplexed by creeping weight gain and stubborn belly fat. At around age 40, most women start to lose bone and muscle mass causing a decrease in metabolism of about 5% every decade. The slower metabolic rate contributes to mid-life weight gain when you eat the same amount of food but don't burn all the calories consumed. Strength training revs up the metabolism by maintaining muscle.

At 50: What causes midlife belly? The average weight gain during perimenopause is 10 pounds, and there is a natural tendency to store fat in the abdominal area. The combination of age, hormones, and stress all contribute to belly fat. With age, a woman's level of estrogen declines and the male hormone testosterone becomes more prominent. This causes fat to migrate to the gut from other parts of the body. Stress reaction has a similar effect on fat distribution as it releases another hormone, cortisol, which also encourages fat storage in the belly. Women who lift weights gain less abdominal fat than those who don't.

At 60, 70 and beyond: Sarcopenia, the age-related loss of muscle mass and strength, causes a generalized slow-down. Between the ages of 50 and 70, women lose almost 30% of overall strength, with dramatic losses after age 70. The fast twitch muscle fibers shrink in size, causing not only a loss of muscle mass, but also a loss of power and energy levels. With advancing age, it becomes more critical to preserve your  "functional independence" as measured by your ability to perform all your day-to-day activities, which together comprise a lifestyle. 

Strength training is the key factor in an active aging process. Strong people are more able-bodied and self-sufficient. Studies show that lifting weights can improve your quality of life into your 80s and 90s. Steady exercise can help recover lost vitality, reverse physical frailty, and manage chronic health problems like osteoporosis, glucose intolerance and type 2 diabetes, arthritis, and heart disease. You are never too old to begin a weight-training program and the sooner you start, the longer you benefit.

(c) Copyright - Joan L. Pagano. All Rights Reserved Worldwide.

Spring is the Season for Hip Fractures

Wednesday, April 23rd, 2014

New research reveals that most hip fractures occur in the spring in women over the age of 55.  Falls are the leading cause of these fractures in post-menopausal women, emphasizing the need for counseling to reduce the risk of falling both inside and outside the home.

As published In the current issue of the National Osteoporosis Foundation Report (April 2014), a group of researchers examined fracture data from 60,000 post-menopausal women from the US, Canada, Australia and seven European countries.  They found that only hip fractures showed a seasonal variation, with the majority occurring in the spring.  The main cause was falls resulting from slipping or tripping, both inside (52%) and outside (48%) the home.

One contributing factor could be lower levels of Vitamin D due to reduced exposure to sunlight over the winter which manifest in spring, however this was not studied. In addition to adequate Vitamin D, we need enough calcium to mineralize the bones.  Due to conflicting results of several major studies regarding calcium supplementation, experts recommend that the safest and most effective source of calcium is found in food choices, not supplements, and that exercise is key to bone health, specifically weight bearing and strength training exercise.

For more on the calcium controversy and types of exercise beneficial to the bones, please refer to this previous blog post.

Which Exercise is Best for Osteoporosis?

Saturday, June 22nd, 2013

Over the years, many women have come to me for guidance on the best exercise for their bones. Their questions vary, asking for help in interpreting the results of their bone density test and what those numbers mean in terms of choosing safe and effective exercises. Each individual is unique but there are general guidelines that apply to all. 

One woman saw me working with my regular client in her gym and asked whether I could advise her on her personal situation. She said that in an effort to strengthen her bones she had continually increased her weights, as per the advice of her doctor.  But now she had developed shoulder, lower back and knee issues from lifting too much weight. Although the guidelines for strengthening healthy bones call for high impact, high resistance exercises, it’s counter-productive to overload the joints to the point of injury!

Another woman had been diagnosed with osteoporosis and came to me for a fitness consultation.  She was so stymied by her diagnosis that she had stopped exercising for fear of causing further damage to her fragile bones. There are many safe and effective exercises for osteoporosis, but you need to bone up on the guidelines.

Between these two extremes, there lies a perfect course for your own routine. The National Osteoporosis Foundation classifies exercises in four groups, beginning with those that are most effective for building bone and, in diminishing intensity, those that are safer options if you've been diagnosed with low bone mass, osteoporosis or are frail.

Group 1: Weight-Bearing, High- Impact, Resistance Activities

  • Weight-bearing:  standing exercises where you are resisting the force of gravity
  • High-impact:  activities where both feet are off the ground
  • Resistance:  applying resistance to the muscles using bodyweight, weight lifting tools (like free weights, stretch bands and tubes, weighted balls) and weight machines
  • Examples:  jogging or running; jumping rope; basketball; weight lifting

Group 2: Weight-Bearing, Low-Impact Activities

  • Weight-bearing:  standing exercises where you are resisting the force of gravity
  • Low-Impact:  activities where one foot is always on the ground
  • Examples:  walking and treadmill walking; cross-country skiing and ski machines; elliptical trainers; stair climbers

Group 3: Non-Impact, Balance, Functional Exercises

  • Non-impact:  activities where both feet are on the ground or you are seated
  • Balance:  exercises to reduce your risk of falls and fractures
  • Functional:  exercises similar to everyday activities
  • Examples:  Pilates and yoga (avoid forward bending postures); Tai Chi; bodyweight exercises like chair squats and heel raises

Group 4:  Non-Impact Activities, Non-Weight Bearing

  • Non-impact:  activities where both feet are on the ground or you are seated
  • Non-weight-bearing:  activities where your weight is supported
  • Examples:  bicycling and stationary bike; swimming; water aerobics; deep water walking

All of these activities enhance your health and well-being; however some are less helpful to your bones.  If you love to bike or swim, for example, try to do some cross training by adding in walking or resistance exercises for the lower body, like chair squats.  But always remember: Safety First! And be sure to check with your doctor before beginning an exercise program or becoming much more physically active. This information is not intended as medical advice.

For more about healthy exercise for your bones, please see Joan Pagano’s video program “Beat Belly Fat, Bloating, Bone Loss and the Blues:  Simple Steps to a Better You

If you have any questions about your own exercise program, connect with me here.

(c)  Copyright - Joan L. Pagano. All Rights Reserved Worldwide.


Join the Conversation: Clueless, Confused or Just Plain Concerned about Bone Health?

Tuesday, June 18th, 2013

LISTEN LIVE: Dr. Radio Show

DATE: Wednesday, June 19

TIME: 8:00-9:00 am ET

LOCATION: Sirius XM Radio Channel.81

Call in with questions/comments: 877-NYU-DOCS

Fact! According to the National Osteoporosis Foundation most women over the age of 45 fail to recognize their personal risk for developing osteoporosis, the disease of "porous bones," even though the majority of women have at least two risk factors for the disease by this age.

Fact! Conflicting results of several major studies and recommendations by the US Preventive Services Task Force have put into question the benefits of supplements containing calcium to prevent bone loss.

Fact! What do experts draw from this controversy?

  • First, that better studies are needed to clarify the possible risks and benefits of calcium supplements and to whom they may apply.
  • Secondly, that the safest and most effective source of calcium is found in food choices, not supplements.
  • And finally that exercise is key to bone health, specifically weight bearing and strength training exercises.

Join us live on Sirius XM's Dr. Radio Show this Wednesday, June 19 from 8-9 am. I'll share all the insider tips that I've learned over the past 25 years as a fitness professional and address questions such as:

  • What are the major risk factors for osteoporosis?
  • What is the difference between weight-bearing and weight-training exercise?
  • How can you work these exercises into your lifestyle, no matter what your fitness level?
  • What kind of exercise is safe if you've been diagnosed with osteoporosis?

Call in with your questions and comments to 877-NYU-DOCS

Vivacious host Dr. Marina Kurian sets a lively tone in her show and engages her audience with humor and personal insight. I'm always delighted to appear with her! Catch us live this week:

LISTEN LIVE: Dr. Radio Show

DATE: Wednesday, June 19

TIME: 8:00-9:00 am ET

LOCATION: Sirius XM Radio Channel.81

Call in with questions/comments: 877-NYU-DOCS