Fitness you feel in your bones

People work out to tone muscles, lower blood pressure or look good in a swimsuit. But there is another - less talked-about - reason: to build bone.

In youth, bones seem so hard that it's difficult to imagine them as living tissue that grows and changes, just like everything else in our bodies.

But they do. And they grow stronger and better with the right nutrition and exercise.

"Any type of weight-bearing endurance exercise such as walking and running helps," says Andrew Wolff, a Washington orthopedic surgeon.

So, if running is not your forte, Wolff suggests you walk or hike and maybe add some resistance exercise such as weights and resistance bands to help keep your bones strong, and, in later years, maybe even prevent osteoporosis.

Anything that "places force across the bones" helps maintain healthy bones, Wolff says.

"It doesn't make a difference as long as you are doing something," he says.

This is because bones - just like muscles - break down and rebuild throughout our lives. This process is particularly active in adolescence and early adulthood, when we rebuild faster than we break down (resulting in "peak bone mass").

"The more active you are when you're young, the better it is," says Jenny DeMarco, a personal trainer in Washington. "You're banking it for later when the bones start deteriorating."

That sounds ominous, but the truth is that even as bones start breaking down faster than they rebuild, particularly after menopause (there is a hormonal component to the breakdown), you still can keep rebuilding and maintain bone density with the right type of exercise, DeMarco says.

"If you are postmenopausal but you don't have osteoporosis, you can do just about any resistance training and weight-bearing exercise anyone else can do," DeMarco says.

And even if you have osteoporosis - or its precursor, osteopenia - you still can do exercises other than bends, twists and heavy weights, she says, which can put the spine and hips at risk.

DeMarco recommends that clients with osteoporosis - once they are cleared by a doctor - work out at least 30 to 60 minutes two to three times a week, with an emphasis on core and balancing (for example, one-legged) exercises.

"Posture is important for everyone, but even more so as we age," DeMarco says, adding that her most frequent instruction is to "bring your shoulders down and back."

In addition to strengthening the bones, the weight-bearing and resistance training also strengthens the muscles, which help give the skeleton stability. (In fact, the muscles we are talking about are called the skeletal muscles.)

Exercises need to be supported by the right nutrition, says Isabel Maples, a local registered dietitian and spokeswoman for the Academy of Nutrition and Dietetics.

"Physical activity can only build stronger bones if the building supplies - calcium, vitamin D, etcetera - are available," Maples says.

Other nutrients - maybe less obvious - are important, too: protein, vitamins K and C, potassium, magnesium and manganese, to name a few.

Where are these found?

"Dairy foods are some of the best bone-building foods," Maples says. Others include dark leafy vegetables, canned sardines or canned salmon with bones, almonds and tofu.

"But as a registered dietitian, in my experience, people who don't regularly drink milk have a hard time getting the recommended amount of calcium," she says, adding that three-quarters of the calcium in the American food supply comes from dairy foods.

Unfortunately, she says, people stay away from dairy because of the calorie content, and this sometimes has the unintended consequence of weakening bones in, for example, young female athletes.

So why not take supplements to make sure we get enough calcium?

"It's better to develop good eating habits rather than just rely on supplements," Maples says, partly because supplements might have only a "leader nutrient" such as calcium and not supply the other important nutrients for bone health such as magnesium and protein.

Or they might give you too much of a good thing; a supplement might have 100 percent of your daily calcium, but depending on what you eat, you could be going way over the recommended amount. Adds Wolf: "Too much calcium intake can cause calcification of people's vascular system," which can lead to heart problems.

So sticking with nutrient-rich food is the better option for the vast majority of people. Let's face it, it's hard to OD on calcium and other nutrients by eating turnip greens.

The right amount of calcium per day is somewhere between 1,000 and 1,200 milligrams, Maples says. The higher number is for adolescents and postmenopausal women.

To get that amount in regular food would take roughly three cups of skim milk or three cups of cooked collard greens.

Other lifestyle choices that improve bone health include avoiding tobacco products and moderating alcohol intake, Wolff says.

He also suggests that you talk to your doctor before taking any supplements. That also goes for any exercise program that you start after menopause. If you are at risk for osteoporosis (Caucasian and Asian postmenopausal women in particular), a doctor might recommend a scan to check bone density before you start doing any high-risk exercise, such as overhead squats.

That's because, unlike many other musculoskeletal conditions, osteoporosis is not associated with any particular pain. The only indication - if any - might be a rounding of the back.

"It doesn't hurt until you have a fracture," Wolff says.

Exercises

Not all exercises are suitable for people with osteoporosis. If you think you may have bone-density problems, check with a doctor before trying a new workout routine.

Hip rotation

Hip rotation is geared toward special populations such as seniors, people with osteoporosis, joint problems or general deconditioning, but it can be performed by anyone.

1. Lift one leg into a 90-degree angle while maintaining alignment in your knee, hip and shoulder.

2. Rotate the hip out slowly and controlled while keeping your hips in neutral position. Hold each position for three to five seconds and work up to a specific number of repetitions. Then switch legs.

Incline push-up

The incline pushup exercise is geared toward special populations such as seniors, people with osteoporosis, joint problems or general deconditioning, but it can be performed by anyone. It can be performed on anything that provides incline assistance, such as a bench, stairs or a chair.

1. Hands should be about shoulder-width apart. Keep the chest out, shoulders down and back, and the body in a straight line.

2. Engage the glutes and abs, and lower the chest down as far as possible without putting too much stress on the joints. At the bottom, fire up the chest and triceps, flex your back and push yourself back into the starting position. The body should stay in a straight line. If you need to start at a higher incline, try a wall. Then as you get stronger, move your starting position lower.

Drinking bird

The drinking bird exercise is designed for the general population. Holding a weight is optional; make sure you can do the exercise properly without weight before adding it.

1. With your chest out, shoulders down and back and neck in line with the spine, balance on one slightly bent leg.

2. With the standing leg slightly bent, start to swing the other leg under your body.

3. As you tip the torso forward, keep your rear back to ensure tension is on the hamstrings and glutes, not the lower back. Keep the chest out and shoulders down for the entire exercise; do not round your back. Keep your hips parallel to the ground to engage the core.

Chair squat

The chair squat exercise is geared toward special populations such as seniors, people with osteoporosis, joint problems or general deconditioning, but it can be performed by anyone. It can be performed with or without weights.

1. Begin with your feet a little wider than shoulder-width apart, with your chest out, shoulders down and back, core tight and hips in neutral position.

2. Pushing the butt back and bending at the knees, descend into a seated position. Engage the glutes and quads on the way down. Keep muscles engaged once in the seated position. Do not sit all the way back or bounce or rock to get back up from the seated position. If a chair is too difficult, begin on something higher and work your way down.

Balance reach

The single-leg balance reach exercise is geared toward special populations such as seniors, people with osteoporosis, joint problems or general deconditioning, but it can be performed by anyone.

1. Begin with your feet shoulder-width apart, and lift one leg in front of your body, pointing the toe of that foot. Maintain alignment in your knee, hip and shoulder. Make sure your hips stay level and facing forward.

2. Move the lifted leg slowly to the side of the body, holding at least one to two seconds.

3. Then move the lifted leg behind the body, holding that position for at least one to two seconds. Repeat until a specific number of reps or alternate sides.

Plank row

The plank row exercise is designed for the general population.

1. Begin in plank position with hands on dumbbells or the floor, depending on wrist strength.

2. Keeping hips as parallel to the floor as possible, use your back and bicep to pull one dumbbell off the floor. Keep the dumbbell close to the body and pull your elbow back as far as possible. Either alternate sides or do a specific number of reps on one side before switching to the opposite side.

3. A pushup between each dumbbell row is optional and can also be performed from the knees.

Pop squat

The pop squat exercise is designed for the general population. It's a bone-strengthening plyometric movement that should be done repeatedly without rest for a specific amount of time. Plyometrics are "jump drills" intended to create maximum power and speed. They require quick transitions between extending and contracting muscles.

1. Start in a standing position.

2. Jump out to a squatted position, then immediately pop back to standing. Make sure to land with your knees "soft" (bent), sit back in your heels with your knees behind your toes and land on the balls of your feet when you return to standing position.