Hi everyone.

My name is Haley and this is laurav and welcome to the Body Pod.

Welcome back everyone for another episode on the Body Pod.

Today, I have the privilege of introducing you to doctor Lisa Moore.

Doctor Lisa Moore is a twenty eight year veteran physical therapist who supports women who have had a diagnosis of breast cancer and osteoporosis.

She is certified in Cancer Rehabilitation bone Fit trained through the Bone Health and Osteoporosis Foundation.

She's a certified yoga teacher.

She is also certified in functional nutrition for chronic pain via the Integrative Pain Science Institute.

Lisa has developed the Brick House Bones program for evidence based exercises to support bone health for people with low bone mass and osteoporosis.

Her many years of clinical work as a physical therapist have her constantly seeking knowledge about what truly helps women, how to facilitate change, and how to empower women toward their own recovery.

So this conversation is very interesting and very educational, so enjoy this episode with doctor Lisa.

All Right, doctor Lisa Moore, we are so thrilled to have you here today as this massive osteoporosis name and expert in the field.

So thank you for sharing your time with us today.

Oh, thank you, Hailey, Laura.

It's really an honor and a privilege to be here and I'm so grateful you invited me.

Thanks well, our audience is going to love this because I'll have to tell you, Lisa, in the last year, since menopause has kind of had this massive.

Growth the bone.

You know, bone health is a massive topic, and I will say that just getting you know, thousands of women onto my platform, people will you know, women will come in and they're just like, I don't know what to do, or they'll tell me their diagnosis and I'm like, what you know, I'm not diagnosing you?

Where do you know?

But their questions are all like where do I start?

So I want to dive right in to how you like, how did you come upon this?

Obviously you you're a physical therapist, and when did the osteoporosis?

Have you always been interested in that or did that kind of come later on?

Yes, So later in my career I was focusing on oncology rehab.

So in my fifties, I'm working with women who've had breast cancers, who are going through breast cancer treatment and they're at even higher risk for osteoporosis and bone health issues because of the treatment and because of estrogen suppression after this, and they're asking me, how can you help protect my bones?

And I didn't know.

It wasn't part of my training.

And then I get my own bone density because well, I'm curious.

I'm not waiting till I'm sixty five to find this out, and I have low bone density.

So it wasn't part of my traditional PT training.

It wasn't part of my normal skill set.

And I knew enough to tell people to limit activity, but I didn't know enough to really empower them to take control.

So that's when I really took a deep dive in training and bone fit in the Institute of Clinical Excellence and really finding what is up to date research for myself and so I could help my clients.

It was a huge.

Gap because most of the information education was aimed at the most frail and the most vulnerable, and it didn't really fit people like me that wanted to be strong and active but just needed to know how to modify my high intensity strength training, how to incorporate aerobic training or flexibility that was safe from my body.

So that's how I got started.

And how long has this been since this has been your focus?

Probably three four years of education and I've only started really producing content for a year and a half.

But it's been really high demand.

People are asking for more and more about what you exactly said.

How do I do this?

How do I start?

And how do I progress?

Oh, Lisa, we have nine million conversations.

I wish I was your neighbor right now and we could just hash it all out for like an entire day.

So I am super familiar.

We're super familiar with your with your YouTube, which you're crushing, by the way.

I'm blown away that you've only been doing that for such a short a short period of time, so that says a lot.

But you've created brick House Bones.

Tell us the story behind that name and your mission with it.

Well, I just love the sound brick House Bones, you know, it's so empowering.

But it really is about the children's book The Parable, Right, It's about building this body for life.

That isn't about quick fixes, gimmicks, fancy gadgets, or just a drug or pill.

It's about these small action steps that we take over time consistently so that in through our lifespan, including being an older adult, which we all want to achieve.

It isn't about who is the smallest, but who is the strongest that gets to stay independent and active and out of a nursing home and living the life that they want for as long as possible.

I love it.

So through through this YouTube channel, you've had thousands of women come through getting this information.

If we were to start at the very beginning, let's just start with osteopenia and osteoporosis.

So everyone knows the names of those, but where does the where do we differentiate osteopenia and osteoprocess And I'm just curious.

This wasn't even on my notes.

What do you see more?

Do you get more women in the osteopenia realm or do you get more women.

That are osteo or that are already osteoporosis?

Great question.

Well, so it's based on a bone density test switch the gold standard in the world is a DESA scan that measures the density of our bones.

And there was a cutoff line for determining what is a risk factor for osteoporosis.

So that is osteopenia.

Osteopenia is a risk factor for osteoporosis.

It's like pre diabetic.

We're getting warning signs that there's some loss happening, and when we look at scores, it kind of shows up like a thermometer.

So the more negative the score, the lower the score, the colder it gets, the worse the number is in our bone density.

So a score of minus one to minus two point four is that osteopenia or pre osteoporosis stage.

This is really a time where we need to take action.

More people have osteopenia.

There's a much larger number of people that fit this category than osteoporosis, but it is a sign that we need to take action.

Any number from minus two point five or below is the diagnosis of osteoporosia.

This is a low bone density.

And that number was kind of randomly assigned by a group of professionals because they had to place some sort of cut off to say where do we start to pay more attention and consider treatment options.

I would say most of my clients that I see are in the osteoporosis range.

The people that reach out to me both virtually and in person, that because often they don't know that this has happened because they've been tested till later or till after they've already had a fragility fracture, and then they're diagnosed with osteoporosis.

I know where I'm sending every person.

I'm just going to link you on my website.

I'm not joking because when those women come in, I see more of the osteopenia that are kind of getting into that, or they might not even know that yet, but that you know, when somebody comes and says, I have you know, minus three and what do I do?

I'm like, I'm not prescribing an for you.

You know, you need to get cleared by a physician and you need to have a physical therapist to guide you through.

Like that needs to be more one on one treatment.

How do you with your with your YouTube?

So if somebody, well, tell us first what the four x four method is, because initially when I love it and I know what it is, but when I first saw that, I was like, oh, everyone's talking about four x four heavy lifting.

That's is that what she means?

But you tell us what that is?

Yeah, So my four x four program is four exercises four rounds working upper body, lower body, core and impact.

So this is moderate to high intensity, depending on how much weight you use and your ability.

I give modifications, but it's it's just a way for people who are busy professionals or busy lives that want to get a targeted exercise program that doesn't have dangerous exercises in it if they have osteoporosis, but gives them a really strong stimulus for strength.

And I have a bigger program called Build, which is more eight exercises, four rounds, includes balance and mobility and more complex moves.

But people wanted a more efficient, compact workout, so that's why I created the four by four.

Is they ask, and so can any age or any like if you're a beginner or advanced, can anyone do that?

Do you feel like?

Would you?

The four by four is definitely more more for an experienced exercise or somebody that's already been doing you know, weightlifting training, maybe a little bit of jumping, although I do provide modifications for people that don't want to jump at all, modifications on styles of push ups or renegade rows or things like that.

I mean, they can use no weight if they want to go through the movements, or they can use heavyher weights.

But I do recommend that it's not a beginner's program.

It's not a place to start if you're newly diagnosed and you're figuring out how to begin safe strength training.

Okay, so let's dive there because you and I you know, we're all aware of the messages out there for the menopausal crowd, and when anything explodes, there's I would say a potentially dangerous side to information because there's the you know, women need to lift heavier, yes, and or, but there are definitely limitations, and let's dive into that because.

You don't want to create I am aware you don't want to hurt yourself.

Well, and it's I mean, it's it's a lot of pressure.

There's a lot of pressure when when you're helping women and they're like, Okay, cool, I need a jump and I need to lift heavy, right, but what's your situation?

So what tell us about what that means to you and how you break that down for someone because I'm sure you get asked some of those same questions as well.

Yes, absolutely, And the thing about YouTube is it's really a general education platform, right, It's not a one size fits all tool.

Yes, there's so much messaging about women need to lift heavy, but when we put this in context of bone health, and we have to put it into context of the individual, and so we have lots of wonderful evidence that supports low, moderate, and high intensity strength training to improve muscle mass and bone density.

It is the effort that is produced.

So if you're doing lower weights and higher repetitions and you have a similar amount of fatigue as somebody with higher weights and lower reps, we're still getting the benefit we want.

We don't have to add extra force on joints if that's not in your comfort zone.

And I think it's.

Really important, and I love your messaging on this and building that base, building that stability, getting this this functional movement patterns correct before we start to add a lot of load.

And for anyone that has other complex medical history rumatoid arthritis or other conditions spondaloliites, different conditions of the spine that they have fear about movement, we can absolutely keep loads small and build movement confident first.

To me, that's one of the most important things in the messaging is for people to be able to tune into their bodies and learn this feels good when I do this, and this feels like too much, So I'm going to redirect my training that feels better in my body in this situation.

And I think there's always a way to adapt and modify.

That includes movement, not eliminates.

It includes not eliminates.

I love that.

So, all right, if we're a beginner and somebody comes and they're not even the beginner, that the the descriptions and the definitions that we give a beginner intermedia advanced are vast and can get swomen into you know, general programming, into a potentially wrong program because they may think that they're advanced, but you know, it all depends on what the trainer.

What the trainer decides is maybe an advanced level.

But if you have someone that just here's they need to start jumping, even if they have they don't have osteopenia, or maybe they do slightly, maybe they've just discovered that.

But either of those camps and they're in their.

Forties, they're decently fit, they're they're exercising most days.

Would you start them with just jumping right away?

No, If they're already exercising, that's great.

I like to go from strength training to power.

So power is still getting more ground reaction forces.

We're building up speed because that's what jumping is, right, we're talking more power exercises.

But we can do that work on that power that speed at bell swings, dumbbell clean snatches.

We can even do squats at a different tempo so that we're building power and speed, maybe working a little bit of agility training to work that loading.

We have to train.

Then how do you land?

If you're going to begin jumping, you have to be able to land correctly and that impact.

Some people mistake thinking they have to land with a stiff leg or a stiff knee, and that is not the case.

We still want to absorb those forces with some flexibility there.

So I generally start with power and agility strength training power agility, and then progress up to impact.

If they're landing, if we can step off a low box and have a good landing platform, then we can build from there.

Okay, I'm so glad you said that, because that is what I recommend the same whether anyone takes my advice.

Not everyone will, and people will want to just jump right into it, but that is.

Super important that we're.

Building up the ability because I'm like, when's the last time you jumped.

I don't know, when I was a teenager.

Okay, you don't get to just go back into, you know, doing these jumps if we haven't really prepped the body.

So I take a similar approach there as well.

Now, the other thing with that is we're as we're in perimenopause and menopause and the change in our ability to adapt and modulate collagen tissue when we when we rush into ballistic activities like that, that's where plano fasciitis happens.

That's where we get tendon itis issues really quickly.

So we have to build that resilience in our on our tissues and especially in our tend and ligament tissues to be able to do that, especially at this time frame of perimenopause and menopause.

Oh yeah, it's a different game, no question.

So if we talk about the landing, because there was a study that came out that talked about the hard, stiff landing and that's kind of been confusing for for a lot of women too, including myself, When I was like, wait, so we're supposed to land hard or we're supposed to land and actually absorb.

So with that, I'm sure you're familiar with the study that I'm talking about, the one study that had the sharp, you know, stiff stiff landing.

What are your thoughts on that?

As a thirty year veteran physical therapist, I do not like that stiff legged landing when it comes to hips, knees, and feet.

I just don't think the.

Benefits outweigh the risks, and so I don't teach that method.

I don't think the value is there for how to have healthy, happy joints.

I love it.

I love that stance.

Okay, thank you for clarifying, because I know that's kind of a mixed message too.

So if we look at the one the statistics of one one to two women over fifty will suffer an osteoborotic fracture, and then we know that your your chance of refracturing is quite high, or if you've already had a fracture at this age stage.

So someone comes to.

You again, I just like basic and real life advice of someone comes to you, would you how long is the build up before you would have them, say, using some heavier loads, And of course it's individual, but is there kind of like, oh, I see around three, you know, six months post fracture, depending on the ability level.

Or is that just too broad of an answer that question to answer?

Yeah, it is really it is really difficult and it is really individual.

But but what But what I would want to say is I've worked with many, many clients who have had either vertebral fractures or hip fractures, wrist, pelvis.

And of those clients that are able without any other barriers to participate in a strength training program, they do get up to lifting in a very high intensity and a very high quality, you know, up to eighty percent of their one redmax we can do and not all of them do that.

But and the build is based on control.

So as I'm watching somebody and as I'm guiding somebody, I'm really looking for are they able to maintain that spinal extension where their goblet squat because that is protective.

Do they need wedges for their squats because they're getting too much flexion and tipping forward when they're squatting.

How do we modify it to keep them safely?

And if the movements can be done safely, then we progress as normal.

And of course they have to have adequate healing.

They have to have adequate nutrition, they have to be able to have adequate rest.

I worry too much about overtraining, but there isn't necessarily a limit.

When I have someone who has a history of a fracture, I might just go a little more slowly and I'm a lot more critical about the quality of their movement.

Okay, but they can get back up to heav lifting, yes, jumping.

Jump jumping maybe jumping maybe even if they if someone's had a fraction.

I do have folks that get into jumping if they have had a fracture.

But one of the things we do is a fracture risk assessment.

So what is there decks, a score, What are there other fracture risks?

Do they have a family member as fractures like either parent had a hit practice?

So we do a fracture risk assessment too to weigh the pros and cons.

You know, is it beneficial to do this or should we just focus on the strength training?

Okay, So everyone needs a Lisa pt in their life guiding them through.

So when we look at the body parts, where we have these the fracture risks.

So let's start with the rest.

Uh, what do you do in maybe even like your YouTube series to build up that area.

Well, I love it.

And first of all, the bone health exercise should be full body, so we should be treating everything, not just the areas that are measured.

But yes, arms are generally not weight bearing, right.

We don't walk on our hands, so we don't get the same stimulus to our bones.

But we can do weight bearing.

So and anything that involves gripping is working these forearm flexers.

So we can do planks, we can carry weights, farmers, carry suitcase carries.

Any upper extremity strengthening where you're holding weights is working the forearms.

We can hang from a bar and do dead hanks.

That's a great grip strength exercise to help with forearm bone density.

I love to use, you know, blaze pods.

I love blaze pods.

So people are in a plank position and then they've got to tap out stomp out the light, so we're getting a little bit of an impact as well at the same time.

So carry push, pull, lift, if it's in your hands, it's helping your forearms.

And then weight bearing is another thing.

Okay, I'm so glad you asked that question.

Hayley because I don't know if it's because I knew we were talking to you today, but when I was taking a couple of things out of the stove, I felt like my risks don't feel as strong as they used to, and so it made me a little bit worried.

And those are things you can do at your house during the day, little things like that.

And maybe I'm just nervous because I want to stay strong and not be having any fractures.

But that's a really good tip.

Yes, so, and I love that you say that it's a systemic.

It's a systemic issue, which is why we're not just targeting risk lumbar.

You know, hip femur.

Exactly, that's what was measured, but it affects our bo metabolism is under attack, so we have to make all of us strong and resilient.

Okay, So if we move to the lumbar, how do we strengthen the lumbar?

Yeah, so, and again we're still talking.

There's a couple of strategies here to think about.

So when we're doing compound movements, full body movements at a moderate higher intensity, we have better efficacy for improving lumbar spine bone mineral density.

So we're talking to squats, we're talking deadlifts, we're talking muscles that cross the back and hip.

We're talking working.

Through the core.

But lumbar is the area's measured.

We can't do decks of scan on the thoracic spine because of the ribs, but we know that thoracic area isn't big area at risk for fracture.

Muscles that go along the spine, that work on our posture, that hold us upright, that help us be in better positions.

If we target those muscles along the shoulder girdle, along the upper back and lower back, that is protective against fracture.

I mean, these are simple things we can do.

These are things that we can do prone so laying down like doing W's doing Superwoman's doing swimmers, you know, things with bands where we're working the muscles of the upper back.

These are protective against fracture because they help those muscles engage and protect the spine into extension so we don't get that overflextion that compresses the vertebra.

Okay, so moving down to like hip femur, same, I mean, those same exercises are obviously going to be included in there.

But if somebody were like, well, I want to, you know, talk to exercises that could target those areas.

Love it so hip.

So hip fractures generally occur because of a fall to the side and landing on the side of the hip, So that's like fracture prevention.

But we're talking bone density to impact exercises and yes, squats, deadlifts, But where I like to really focus is on moving in different planes because we so often exercise just working in the sagital plane, but frontel plane movement really benefit the hip, frontel and even transverse plane.

So I think that variety of stimulus stimulus.

When I'm am working with a client that can do impacts and jumps, we're jumping in different directions.

If they can't jump, we are lunging in different directions.

We don't just do a front plank, we do a side plank.

We do a sideplank with a leg race.

We're doing different versions of clams single leg bridges, but we have to change the direction and that novel stimulus is what helps that cortical bone.

It helps that outers hard surface of the bone to want to remodel and grow stronger.

If we're giving it the same stimulus all the time, and it's like, yah, I've got this, I'm fine.

But we start to mix it up by moving in different directions, which is real life, then.

It adapts and grows stronger.

I love moving in different directions.

I love moving in a frontel plane, not just sad to the plane for this for hips especially, Yes, I agree.

So if we're getting the muscle stronger, it's getting the bone stronger.

Yes, So that kind of goes hand in hand.

So when we break down, you know, let's break down the two main ways that we can really work on bone health from outside of medication.

So we we know we can heavy resistance train or resistance train with effort around eighty up to eighty percent of your one rep max.

So with effort, which again is the key, the keyword.

So we're putting a strain or bend on that bone.

But do you recommend jumping some form of jumping and heavy lifting or do they do the same thing and you can get you can choose one or the other.

If you can't jump, if you're lifting heavy er, you know, up to that eighty percent, as we've discussed, does that count as the pliometric as well.

Yeah, for someone who is really concerned about jumping and it isn't safe for them for whatever reason.

Absolutely moderate and high intensity doesn't even have to be high intensity.

Moderate and high intensity strength training and agility and power.

If they can work power without the impact, they are getting great benefit and they're still going to be able to enhance their strength and benefit their bone density.

The big thing to think about is we tend to get really focused on can I increase my bone density?

But what osteopenia or osteoporosis means is you have a risk factor for a fracture.

So to me, the most important thing is to help people prevent ever having a fracture, because if you never have a fracture, your osteopenia or osteproosis doesn't change your life.

And when we look at the effects of medications and we look at the effects of exercise for fracture prevention, exercise is at the top.

Strength training is at the top, so.

Regardless of impact, they don't have to do impact, but strength training and muscle mass is going to be something that can improve your balance, improve your resilience, and prevent you from ever having a fraction.

What about nutrition and bone health.

Outside of calcium and vitamin D, what are other nutrients or dietary habits that play the biggest role.

I love it because this is critical.

We can't build a strong house if we don't have the right building materials.

We can give it the right sea.

We have all the.

Construction workers we want, but if we don't have the right materials, we can't build a stronger body.

So protein is right up there.

You know, when we look at what the volume of our bone mass is, it's fifty percent protein.

So we have to have adequate protein.

And these amino acids are also the building backs to blocks for collagen, and collagen matrix is what the calcium and other minerals attached to to create strong and flexible bone.

So I generally recommend one point two to one point five grams per kilogram of ideal body weight.

I know that's kind of middle of the road.

I find so many clients struggle sometimes just to get that, and they struggle to get more.

So as I look at like, you know, the best gains for helping somebody to achieve that goal, that one point five mark is what I'm shooting for.

So protein being right up there.

Boron.

So I like people to get things through food.

First.

We have great studies that support prunes and eating five to six prunes per day is shown to increase bone mineral density.

And I think it's the boron, but really it's not just the boron, but how it's packaged with the fiber and other micro nutrients in the prunes and how it affects our gut microbiome to help create the right environment for increasing bone density.

Oh, that's a two for one because then you can get the fiber too.

It's fantastic.

Yeah, absolutely, all right, I'm revisiting now me too.

Yes, Yes, it's great.

Yeah, and the fiber makes a huge diffcause I know lots of people that take the five out in the morning and that's just kind of their snack throughout their day as they're kind of running around their house.

And that's a simple thing to do that has great benefit.

Yeah.

You mentioned vitamin D, and vitamin D really needs to be in the sweet spot.

Too low is associated with low bone density, and too high a vitamin D also can affect our ability to utilize calcium.

So we want to keep that in the sweet spot.

Vitamin K two can be helpful, and it comes in two forms.

We have Mk seven and MK four, and vitamin K two helps direct that calcium more into the bones than into the vessels.

This is kind of of a gatekeeper where the calcium gets utilized.

Can everybody take calcium?

I'm not saying that you should talk to your physician and see and your nutrition is if vitamin K two is right for you, but it can be beneficial.

We have nice studies that support vitamin K two four for bone health.

Another one that I often talk about is magnesium, and magnesium is another component of the minerals that helps form that matrix good bone density, and we often very depleted in magnesium as our food supply doesn't often have a good source of it.

So that's one of the easier ones to supplement.

Different forms take different effects, So depending on your GI system, sometimes magnesium glycinate will be a little bit easier tolerated versus magnesium citrate that can have a little bit of a laxative effect.

Right, Okay, So those are the supplements to pay attention to.

What are the myths that you hear about osteopenia osteoporosis that you'd like to clear up.

Oh gosh, well, yeah, there's a whole bunch.

Yes, yes, we could cover a lot here.

You know.

One is that you can never lift heavy.

You know, you can't lift anything again.

You should never bend, never twist, never lift.

And we do have movement precautions that we follow, but I think we've gone we were at one too far out of extreme where we scared people so much about movement that they stopped moving all together.

And scaring people to death is not a strategy, but empowering and educating them is.

And so that's the difference that we have to make there.

What are the strategies and myths?

Gosh, that it's that it's all about that you can't do anything about it.

I think that's one.

That you think that you're that you're stuck in this situation and that you're and that you're fragile.

And what I think people need to realize is we can take action steps again to combat that and to be stronger and more resilient and prevent prevent it from changing our life.

So you talk about minimalist shoes and who should wear them and who shouldn't, So with that, I guess I'm my first question is do you do you start women that are healthy enough and ready enough to jump?

Do you start them wearing a shoe or would you have them start barefoot?

I do start with shoes on, and that is a bit of my own personal bias because I don't do barefoot well because I have an aroma, So part.

That's my own.

I don't want them to have what I have.

But I do training in Impact and balance shoes on and shoes off, because I think we need to train for real life because in real life we're times in barefoot and we're times we're in shoes, and we're in different types of shoes all the time.

But to answer your question, if I'm starting impact, I usually start with with shoes on.

Yeah, okay, And then when do you recommend the minimalist shoe?

Minimalist shoes for people that are working and are having that are doing well with the strength training program, that don't have a bunion, that don't have an aroma, that have that are comfortable, they already say they're comfortable walking barefoot, then they can transition to that minimalist to shoe style.

It is great for improving foot strength and toet strength and just that pro perception that feeling the ground.

Underneath your feet.

There's a lot of benefit to minimalist shoes for people who can wear them for fall prevention and foot strength.

For people that don't know what minimalist shoe is, Can you explain what a minimalist shoe is?

Sure?

Sure?

So, Like a normal tennis shoe will have a nice bit of cushioning, you know, between the toe and the heel, you've got that pad like a running shoe.

Some of them will have a drop, so from the heel to the forefoot there might be a four milimeter drop or a ten milimeter drop, so it's like you have a little bit of a heel.

A minimalist shoe has none of that padding.

So it's kind of like wearing a sock like the Vibrum five Fingers or some of there's many, many varieties out there, but it's very thin, light weight, almost like putting on a sock with a rubber coating on the outside.

That's just one layer between your foot and the ground.

It can fold in half.

You could probably roll it up like a taco.

Because it is so flexible that it doesn't restrict your foot movement.

It gives you a good feel of the ground, but it's not going to have padding and cushion.

It's gonna be laced or it's gonna it's gonna be a hatched your foot really well, but no padding or cushion.

So it's you change your gate speed.

When you have a minimalist shoe, you change how you walk.

You're absorbing force a little bit differently, and it absolutely can help with increasing foot strength, which if you live a lifetime in shoes, we we lose that if we don't train it specifically.

Right, Okay, this is going to go down a rabbit hole.

But for for clients that I mean, because this is something that I see, uh not online obviously because I'm not in person training anyone, but in you know, in the women that I do want on one train.

So there's the pronating pronating and collapsing arch and then like Hallas Valgas, how do you like if somebody can't balance without a shoe and then they're jumping or they're loading really heavy and they're collapsing that arch, say down in a squat, where would you have them wear like an an insert a insult in their in their shoes so that they can have some of that protection if they're choosing to jump on their own or to you know, be moving.

Load great, great question.

Yes, absolutely to me having better joint alignment.

So if, like you say, that pronation where that inside of the ankle, that arch is flattening out, the big toe is really pushing over, I do recommend toast spacers to help with that.

But an insert And I'm not a fan of artificial support in general, but in specific cases like this, if we can help someone's ankle and foot alignment to be more optimal so that as they're doing a squat, then the position of their knee, hip and spine over their leg is better, This.

Is more protective.

We don't want to be moving in such a way that we're increasing that direction of failure in that joint.

So absolutely an insert and that a supportive shoe is going to be helpful in that case.

And I always want to put them in the most protected position possible.

Okay, what about someone that's used an insert in their shoe for years and has never tried to work out barefoot or how Hayley does in our socks sometimes what how do you go from always being massively protected and in a cushion, shoe to working towards getting there.

Oh, I love that.

That's a great question too.

You know, I think it's all small bites and snacks, and like in the clinic or working in an exercise session, there may be a time where I say, okay, for these three exercises or these three balanced things, we're going to work barefoot and you can start in these small bites of building that strength.

And then I would ask people to try to really slowly ramp up time barefoot.

And when I've worked with clients that have had plantar fasci itis, they're often shocked when I'm telling them you need to spend time barefoot, and I'll say thirty two minutes, thirty to sixty minutes in a day.

I want you walking around your home without your shoes on.

I want your feet to start to adapt.

But we're not going to do it at an accelerated rate.

So I'll introduce it during exercise, but it doesn't have to be the whole program.

And then I'll have them introduce it on it on a daily basis, but in small doses, and then how it progresses is based on feedback.

How does it feel, Is there pain?

Is there dysfunction, and so we have to get that movement confidence.

But I think it's a wonderful thing to practice and train.

We have to pay attention to the symptoms and the response and that's how we progress it from there.

Okay, I'm motivated to try.

So let's break down some studies because there's a lot of the studies can be cherry picked or even you know, somebody can misunderstand what the study was, or it could be biased.

So there's a lot of studies out there.

Let's focus on the one that everyone knows, which is the Lift More.

The Lift More study, what were what do you what do you think about that study?

And you know it's the one that always gets like thrown around, is the lift More studies.

So yes, I'm curious your thoughts.

Great.

Uh.

I think the Lift More trial was groundbreaking.

I think it was groundbreaking to change our mindset around how we could work with postmenopausal women with osteoporosis because prior to that, we did not believe that high intensity strength training was safe and reasonable.

So just to change the mindset of knowing that this type of exercise can make a difference was huge.

I think it feels it can feel unapproachable to some women to think about barbelle back squats and dead lifts and so.

And also the structure of the program doesn't have periodization.

There isn't that variety that I think if we're looking at a year long program needs to be part of our you know, building phase and growth phase and recovery phase, deloading phase.

I think those are important and that's that's not a part.

But you know you can't make that part of a randomized control trial.

So that's no fault to the study.

The study was wonderful and how it empowered me to work with my clients.

I think the context that it can be taken out of is that's the only answer.

And we know we have research that says it doesn't have to be at that level to be effective.

And we also know we can modify a back squad to be approachable for almost anyone.

They can be doing a sit to stand at body weight to start if they need to.

We can modify a dead lift, the range of motion, the load, all of it to make it approachable so somebody can learn a proper hip hinge.

You know, So all of those exercises within the lift more, trial can be modified and then graded.

You know, this is a lifetime program we do, right we're doing this for life, so we don't have to have that that that one REP max eighty percent thing right away.

We can take years to build on that or even never get there and stay within our saves.

Okay, So the periodization that you said, if you're programming for your clients, you're you're choosing periodization as the overlying You know, that's the template for a year.

You wouldn't just say only stay in low reps all the time, year round.

No, I don't think.

I don't think we should stay at that level for every workout.

No, and for what reasons.

I think we need that change in tempo and load for joint protection, for ligament and tended.

I think it allows for recovery.

That also, adaptation likes the variability, and I think when we're doing the same exact thing over and over, it keeps us stuck in a pattern where maybe we're losing a little bit of the endurance side of that muscle performance, or maybe we're losing a little bit of that power side of that muscle informance.

So I way prefer variety than just a one recipe over and over and over.

Yes, agreed.

All right, So.

If we look at daily habits for women that can help with their say someone that's I mean, there's a wide range that listens to this podcast, but I think the numbers Laura are like mid thirties probably to mid sixties.

That might be the same group that you're working with somewhere in that as well.

But just like good habits and routines that women over forty can adopt now to prevent potentially prevent any bone issues later in life.

Great, great question.

Well, you know, I think.

Posture exercise is a great protective mechanism.

So paying attention to posture, but not just attention to it, but building the muscles in the upper back that help us have We have to lengthen the front body and strengthen the back body, and that will pay big dividends for years to come.

Balance training, we can start to begin to see declines and balance in our thirties and forties, and when you still have the ability, if you can start early at dynamic balance training, reactive balance training, things that really challenge you, that's going to be protective for a long time.

If you don't train it you lose it.

Right, So balance and posture training I think are critical.

Fuel your body for the activity you need to do.

Okay, I'm not in the business that helping people be smaller.

I want to help them be stronger.

Fuel your body.

It's not a daily habits.

So fuel your body well and then strength training three times a week.

I think that's a great balance.

You can work in your cardio on other days.

And mobility mobility training so that you have the mobility and your hips, the mobility and your knees and ankles that keep you moving really well.

And that's another you know, that's a lifespan thing that helps us feel good.

And if you can move your hips and knees and ankles well, it protects your spine.

Right when we see people with stiff hips and stiff ankles, where do we compensate.

We compensate by bending back right, see this in the moves.

You can see this in a squad.

So that mobility is really really critical.

Rest.

Sleep.

Optimizing your sleep is an important part of decreasing inflammation.

There's a connection to poor sleep and poor bone health.

So optimizing our sleep is something that we can do every day to help improve how we feel.

Now, you mentioned something that I want to touch on.

So you said, I'm not in the business of making women smaller.

I'm in the business of making them stronger.

And I love that that message is kind of echoing in the space.

With that being said, you know, the second, maybe most common question that I get asked all the time is well, but I have you know, forty pounds to lose.

That's a different conversation.

But if what I want to ask you is is not fueling your body and not you know, always kind of being trying to become smaller on fewer calories, is that good.

For bone health, especially postmenopausal.

No, being underfed is not good for bone health.

It makes it more difficult to reach our goals.

And we know that.

And sometimes it's just your genet, your makeup of being really petite and smaller, but smaller women have lower bone density, being underfueled and constantly in a calorie deficit.

If I mean, if you're not at your ideal weight and you're trying to get to a healthy weight and you're exercising and strength training and maintaining muscle mass.

To me, that's the most important feature.

You know, some of the physicians that are doing the medications to help with weight loss, and they're focusing on muscle mass, And to me, that's the critical piece.

If you are losing weight in a healthy way, but you're maintaining your muscle mass, and it's probably not as big of an effect.

Because we know muscle loss and bone loss go together.

Osteosycopa, they go together.

So if you're losing weight at a.

Rate that's affecting your muscle mass, yes, you're affecting your bone.

That is the microtaph right there that I think that most women don't think about because they think about, Okay, I need to you know, I need to exercise for bone health.

I can jump for bone health.

I can take vitamin C, vitamin D, blah blah blah, calcium, you know, go on some of these medications.

But if you're losing muscle, the bone is along with that.

Yes, And you know it's months and months for women that to regain muscle in the gym setting.

We know that, but bone is even longer.

So if somebody, if you know, if somebody were coming in and they wanted to see a change in bone health and they were doing all the right things and controlling the controllables of what they can.

What is the minimum amount of time.

That you would go back for a DEXA that you would recommend to go back for a DEXA because some women are you know, I in here, I'm going to go back in three months, You're not going to find much.

Yeah, it can really take a long time.

The earliest I would have someone check is in a year, and insurance covers it every two years, and it may or may not show a difference, but it may show up a slight change.

One of the important things I understand about DEXA because there's lots of mobiles by running around doing these tests.

But a true DEXA scan and to get true accuracy, should be done on the same machine, same location, every time.

If you really wanted apples to apples comparison, if you're going to one dex of device and then you're going to a mobile device the next time, you're not getting an accurate representation of that change.

So go to the same location each time.

A year would be the soonest I would have somebody recheck, you know, with optimizing everything, nutrition, maybe hormone therapy which we call pet therapy.

Now that's exercise, nutrition, eight months, you know, eight months to twelve months to see a detectable change, and two years it can be even longer.

For that.

But we want to stop the loss.

No change.

When normal loss is two percent a year for a postmenopausal female, zero loss is a win, that is it.

And I say the same about muscle, maintaining your muscle or even going up you know, a pound or two a year, and.

Somebody might think that they're that's pointless.

Why why did I even do all of that work for well, you didn't lose any that's the goal at this age, you know, especially postmenopauseal.

Are you a fan of hormone therapy?

Yes, absolutely, I have personally been on hormone therapy for multiple years.

I don't ever plan to stop it.

We know hormone therapy is protective for bone density because as we lose estrogen, the osteoclasts, these are the cells that break down bone.

Estrogen is a gatekeeper for these bone breakdown cells and estrogen leaves and we start to see a rapid loss of bone density.

So estrogen is absolutely protective when it comes to bone density and fracture prevention.

Okay, so two percent of bone a year postmenopausal.

Yes, we can lose twe twenty percent of our total bone in that perimenopause menopause transition is a lot.

Yes, Yes, And the unfortunate thing is they don't recommend testing until age sixty five, So at that point you already mean osteoporosis and you've never had an opportunity to really address it if it wasn't tested sooner.

I do recommend if people talk to their position about any risk factors, they may have to get an earlier test.

We should know in our forties, we should know in perimenopause what our baseline bone density is.

This needs to change in America that I don't know about other countries.

I know that it's easy to get a Dexa in Australia, but here it seems like, okay, there's the mobile carts.

But as you said, I'm guessing that you test on the same machine because it's calibrated differently.

But also I'm sure that there's different versions, just like anything, there's like a cheaper version of the Dexa, an older model versus something that's hospital grade.

Is that a fair assumption it is?

But also training, training of the technician and certification of the people reading the data makes a huge difference.

And we don't have consistency in the United States on that certified people that do the DEXA and as well as the trainer, the training and the you know, the data you put in is the data you get out.

If you get bad data in, you're going to get bad data out.

So the training of the technician, the accuracy of the test, and then the training of the person that interprets that data makes a big.

So how do you know you're going to a well trained, certified place.

That's difficult.

That's really difficult.

Doctor Lonnie Simpson is one of the prominent teachers in osteporosis and bone health and she's a certified dosometrist and has been doing this for years and years and years, And she talks about how asking if they ask if they're certified, that's one, and then whenever possible, you know, just checking in with your technicians, because it's a technician, like an X ray technician that does the test.

You know, what, what's your training on doing these DEXA scans and do you do it the same way every time?

And what is the positioning that I need to make sure I do, because a position of the joint is really what matters for them to get the correct view.

You know, what's the proper position to make sure that the radiologists can read this correctly?

And is the radiologists are they trained and certified to read DEXA scans?

Many times they're not going to be.

Well, I'm going to tell you that the first one I ever had, like twelve years ago and the JC Penny parking lot in Utah with the eighteen.

Year old, I'm positive that was not a hospital great machine or that was certified.

So that's hard though, because if you're if you can't, I mean, money is the other issue.

Yes, you know, it's easy to say, okay, well everyone should be getting one every year, especially if you're but for a lot of women, it's like, great, one more thing that I have to pay for that my insurance isn't going to cover, right, I'm angry about this.

Yeah, it is.

Unfortunately, it really does need to change, and I think the more that we talk about this, the more likely that is to happen, because we can like preemptively help protect women from fractures down the line by having this test done much earlier, because if you don't know that you need to address it, you may not create the change that needs to happen until you're sixty five and then you wish someone had told you earlier.

Yeah, we should be having it at thirty five or forty minimum.

Yes, absolutely, absolutely, because if you didn't build peak bone mass when you were a teen in early twenties, then you maybe didn't start from the highest point possible.

So yeah, we do need to know before we go through perimenopause.

In that pause, okay, if we're wrapping this up, and you could share one message with every female over forty who wants to age well and stay independent, what's your message.

HM, Be kind to your body, move it, move it in ways that feel good, move it in ways that bring you joy.

Work on your strength.

It doesn't have to look like somebody else.

And don't compare your strength and your program to anybody else.

This is not a competition.

You know, we're not here comparing whose weights.

It's doing what we're here to build our best body.

This is what's going to give you joy for the rest of your life, so that you stay active, you stay independent, and you continue to do the things you love.

With the people you love.

Strength training is the elixir for positive aging.

Oh my gosh, Lisa, I don't even want to wrap this up.

I'm so mad.

So where can women find you and find your brick House Bones program?

Oh?

Thank you?

So uh, Doctor Lisa Moore, DPT dot com.

Dr Lisa Moore, DPT dot com.

That's where all my collections and programs are and my workshop that really goes into a deep dive on this information.

I am in University Place, Washington.

I'm in Washington State near Seattle, so my clinic is strongbonesptstrongbonespt dot com if they want to email me or reach me there, and then it's at doctor Lisa more DPT on YouTube where I have hundreds of free videos and collections from the Foundation series, which is for beginners.

Just hit play and I hold your hand through it, as well as like the four my four and moderate intensity workouts too.

Well.

Thank you Lisa for sharing your time and everyone should be following you.

Do you know I didn't even know about you.

I found out about you and one of my Facebook groups somebody threw you out and I'm so glad because now I can't I can't get enough of your message and everything that you're sharing on your YouTube and Instagram platforms.

So thank you for joining us today and sharing your time and your wisdom.

This is going to be a fantastic stick episode for our audience.

I'm really grateful you invited me and give me the opportunity to meet with you.

Honestly, thank you so much for having me.

Thanks for listening everyone.

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