Movement Signals That Build Bone: Why Exercise Advice Isn’t One-Size-Fits-All

What’s Inside This Episode?

• Why some active clients continue losing bone despite doing “all the right things”
• The overlooked signals that tell bone when to adapt and rebuild
• Why common exercise recommendations may not be enough for bone health
• The difference between movement for general health and movement for bone resilience
• What practitioners need to consider before recommending more challenging exercise
• Why a personalized approach matters more than a generic bone exercise plan
• The connection between strength, confidence, mobility, and fracture prevention
• The clinical questions that reveal whether a client is ready for more challenge
• How to match movement strategies to the individual, not just the diagnosis
• Why the right stimulus matters more than simply doing more exercise

Resources and Links:

• • • Download the full transcript here
    • Download the Beyond Protocols Guide: Learn how to recognize root-cause patterns, connect the dots between labs, genetics, lifestyle, and symptoms, and create personalized strategies for your clients.
    • Join the Next-Level Health Practitioner Facebook group here for free resources and community support
    • Visit INEMethod.com for advanced health practitioner training and tools to elevate your clinical skills and grow your practice by getting life-changing results. 
    • Check out other podcast episodes here

 

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Transcript

 

Dr Ritamarie  

I honestly think that walking is wonderful. It supports circulation and lymph flow and insulin sensitivity, mood, mitochondria, cardiovascular health, and even longevity, but for many of our clients, it's not enough to build bone. That may surprise many people. 

 

For years we've been told to do weight-bearing exercise, so they walk. Many walk every day, and they do this for years, and then they get a DEXA scan, and their bone density has still gone down, and they feel betrayed. They say, but I did what I was told. I walked. I took my calcium. I took my vitamin D. Why am I still losing bone? 

 

The answer is that bone responds to specific signals, not just walking. It responds to load and strain and impact and muscle pull and power and to novelty. Bone responds best when the signal is strong enough, safe enough, and repeated often enough to matter.

 

Today, we're going to talk about movement as a bone-building signal. It's not just “exercise is good for the bones,” but it's what kind of exercise, for whom, how much, and of course when to be cautious, and how we, as practitioners, can think more precisely, because jumping may help lots of people, but it's not for everyone. Weighted vests may help some people, but they're not for everyone, either. Yoga may help some people, but specific yoga movements, and it needs to be repeated with specific modifications for people who have osteoporosis already. 

 

When practitioners understand this, they can stop giving vague advice and start giving safer, smarter, and more personalized movement recommendations. 

 

In the last episode, we talked about bone as an endocrine organ and why bone loss is not just a calcium problem. Today we're moving into the mechanical side of the conversation, how movement tells bones to build, what kind of movement matters most, and why the wrong recommendations can either be too little or create risk.

 

Dr Ritamarie  (00:02:39)

Be sure to subscribe, and if you work with clients dealing with osteopenia, osteoporosis, menopause, sarcopenia, frailty, thyroid issues, chronic stress or insulin resistance, this episode can help you think more clearly about movement prescriptions. 

 

In the previous episode, we talked a lot about bone as an endocrine tissue, and we looked at estrogen and cortisol and thyroid and insulin and inflammation and osteocalcin and LCN2, which may be new to you, and why bones are not inert structures. 

 

Today, we're talking about movement and specifically the kind of movement that tells the bone we're needed, get stronger. Bone isn't just a mineral problem, bone loss is a signal problem, and movement is one of the strongest signals we have to tell the bones to get stronger. 

 

Let's start with a simple concept. Bone adapts to the forces, the loads, that are put on it. We often call this mechanotransduction. It's a big word, but the idea is simple. Mechanical forces get translated into cellular and biochemical signals. 

 

When bone experiences load, strain, or impact, osteocytes sense that force and help coordinate remodeling. That can influence the osteoblasts, the cells that build bone, and osteoclasts, the cells that break bone down. Movement isn't just burning calories. Movement is information, in this particular case, to the bone. A jump is information along with a heavy carry, a squat, a heel drop, a yoga balance pose, and resistance band row. 

 

The question is what message is the movement sending? Walking is super valuable. I don't want anybody to hear this as walking is useless. It’s very good for cardiovascular things and helps to support blood sugar balance, and these things also support bone, but indirectly. 

 

Blood sugar and cardiovascular function, mood even, lymphatic flow, and daily consistency of movement, all of these things are helped by walking. Walking is usually low impact, repetitive, and it's a familiar load. For many people, especially those who already walk regularly, it may not provide enough novel or high magnitude stimulus to significantly increase bone density. 

 

Bone needs a reason to adapt, just like muscles. If the signal is too familiar, too light, or too repetitive, the skeleton may not respond strongly. That's why some lifelong walkers still develop osteoporosis and osteopenia. They were active, but they may not have had enough resistance training, impact, power work, or progressive loading. This is a critical point for us as practitioners to look at. I don't want you to confuse activity with osteogenic stimulus. 

 

A person can still be active, very active, but underloaded. A person can walk daily and still have low muscle mass. A person can do gentle exercise like yoga and stretching and still lack the mechanical signals that maintain hip and spine strength, which is what we're measuring on a DEXA. 

 

Instead of asking, does this client exercise? We need to ask the questions like what kind of exercise? What's the load? What's the intensity? What's the direction of the torques on the bone?

 

What's the speed? What kind of force is that muscle creating on the bone? What's the impact? Progression. We need to know what is the progression? Is it staying mild or varying? What's the risk level of that for that particular person? What's the difference between generic advice and clinical thinking? That's where we need to shine. We need to be giving clinical thought to what we're recommending to people, so that it's personalized, not just a general protocol. 

 

Let's talk about jumping, because it gets a lot of attention. Research on jumping and impact exercise suggests that brief targeted impact can improve or help maintain bone density in the appropriate populations, and that's a critical piece. Some studies have used protocols like 10 to 20 jumps, sometimes once or twice a day with rest between jumps, and have shown improvements in certain bone sites over time.

 

Here's the nuance. The benefits are not magical. The effect size varies. The population matters. The site matters. The progression matters. It's not enough to just tell someone, jump up and down every day. The person's baseline strength and their risk for fracture, their risk for muscle injury, etc., has to matter, has to be looked at. The safety screening matters a lot. 

 

You can't take a jumping study in healthy pre-menopausal women or athletes and automatically apply it to a 72-year-old with osteoporosis and balance problems, poor vertebral compression, so possibly compression fracture, knee pain, and low muscle mass. It doesn't work that way. 

 

That's where we, as practitioners, can get into trouble. Here's how I would say it,  jumping can be osteogenic, because it provides a brief, high impact mechanical signal, but jumping is a tool, not a universal prescription.

 

For appropriate clients, a starting point might be very small. For example, 10 low jumps with good landing mechanics, separated by a few seconds of rest. Or, 10 to 20 heel drops, so not really jumping and leaving the ground, but just up on the toes and then dropping the heels. That makes a difference for some people. Or, small hops, but holding on to something for support. Or, step-down landings or gentle stomps. All of these are ways to get the jumping in. 

 

Dr Ritamarie  (00:08:24)

They need to be tailored for the particular person, and their risk factors, and how their body responds. We can progress based on their tolerance, based on their pain levels, their balance, their strength, even their pelvic floor response. We don't want people jumping up and down and then peeing all over the place.  That's not a good thing,  

 

What is the risk? It's not about doing hundreds of jumps. It's not about getting a high box and jumping off of it. Although, for some people who are in good shape to begin with, that is a good idea. The bone responds to the quality and force, not endless repetition. It's not, “A little bit is good, more is better.” 

 

In many protocols, the rest between impacts matters, because bone cells can become less responsive to repetitive stress without recovery. The goal is not to jump until exhausted. The goal is to send a clear mechanical signal, and this is a section that belongs in every conversation that you're having with a person about impact. 

 

Some people shouldn't jump, or they shouldn't jump, yet, until they build up to it. Use caution with clients who have known osteoporosis with high fracture risk. That's always measured and given on a DEXA scan. A history of a prior vertebral compression fracture. Care has to be taken. 

 

For a recent fracture, they shouldn't be jumping. Severe osteoarthritis, which might impact the way the joints move. Not a good idea. Significant hip, knee, ankle, or foot pain. You've got to be careful. Poor balance is a high fall risk. If they're jumping, they may tip over and fall. Peripheral neuropathy, where they can't feel their sensations and where they don't really notice when they're landing or when they're having pain. 

 

Dizziness, that's not a good thing for jumping,  dizziness, vestibular issues in the inner ear,  severe pelvic floor prolapse, which is going to cause stress incontinence. Very low muscle mass or frailty. Be careful with jumping and when they have unexplained bone pain. 

 

If they're in the middle of an active inflammatory flare, say they have an autoimmune condition, or they've had surgery recently, or they have a history of eating disorders and current underfueling, jumping may not be the best choice. Very low body weight with low protein intake might predispose them to not be a good candidate for jumping. 

 

Anyone who can't land softly with good alignment, and all those other things I just talked about, are predisposing them to that. It doesn't mean they can't progress. It means that the entry point has to match the person. 

 

I like getting up on the toes and coming down on the heels, but for people with bad balance, that might not be appropriate. We need to earn impact. The person we're working with needs to earn the right to do it safely. They need to be building strength and balance and alignment and confidence first. If this is outside your area of expertise, work congruently with a practitioner, a physical therapist, a personal trainer, someone who has the strength, the yoga instruction, who trained in yoga for bone health, all of these people can help and be part of our care team, our coordinated care team. 

 

This means building strength and balance and alignment and confidence, before we get people jumping every day. A client who can't do a controlled sit to stand may not be ready to jump, and that's something you can try. That can be a good quad exercise for people who can't yet do squats, but you just have them sit down in a chair, stand up, sit down in the chair, stand up.

 

Dr Ritamarie  (00:12:03)

When a client can't safely balance on one leg, they're not ready to hop. They have to be able to stand on one leg. A client with active back pain and osteoporosis may need spinal precautions, before they add that load of jumping. The practitioner's job is not to make everyone jump just because we're trying to build bone strength. The job is to find the right osteogenic signal for that person. 

 

What do we do when jumping isn't appropriate? There's still a lot of tools,  Start with resistance training. That may include some squats, partial squats, squats against the wall, or squats, or sit to stand, get in a chair, stand up, and have something to hold on to, if they're out of balance,  Hip hinges, things that hip hinge the hips, and deadlift patterns, but not lifting down and picking up 60 pounds,  Small rows, and rows can be done with bands, not just weights, 

 

Presses. Step ups. You can get a small step stool and have them have it by a wall, and step up, step down, step up, step down. Great for building the musculature in the legs and the hips or the muscles that are around the hips,  Loaded carries. There's something called farmer's carry where you carry weight. Now a very fit person can get up to 50, 60, 70, even 80 pounds. I've done as much as 85 pounds, and I'm not a large person, 

 

Those carries can be helpful. You can just have them carry a bag of potatoes in their hands, or a five-pound weight, a two-pound weight, whatever works, and just walk around for as far as they can go, or as long as they can go in a minute or so. If they can carry it longer than a minute, then you can slowly increase the weight. These are awesome for building resistance and building muscle strength.

 

The resistance bands are one of my favorites. There's all kinds. There's the little short ones, there's the long ones. Those are really helpful, because they can move and upgrade as their strength improves. They're very easy, portable, inexpensive, but also you can adjust to their ability at any point in time. It's not like lifting a 30-pound dumbbell up overhead. No, you can adjust the load.  

Those are great. I think everybody should have a set of those.

 

Dr Ritamarie  (00:14:24)

Cables and machine work. I have this thing called the Max Pro. It has cables, and you can adjust the strength of that, and just pulls and pushes, and back and push, and there's so many things you can do with those. At the gym, there's various ones, although sometimes at the gym they are not as adjustable as we may need them to be for somebody who's just starting out. Even body weight progressions.  

 

I have one client, she's now in her eighties, and she decided she wanted to build her upper body strength, and she was going to do push-ups. She couldn't do a single push-up. She went and did push-ups against the wall. She just kept increasing until she got to some larger number of push-ups against the wall, doing that easily, then she did push-ups against the counter, and once she was able to get up to a certain number, I don't remember the exact number, but she was able to do that, she progressed down to the bathtub. 

 

What she would do, she'd do as many as she could at the more challenging position and then finish with the position that she could do more. I think her goal was 60 a day or 80 a day, but she would move from okay, I can only get five at this level, the counter level, so now I'm going to go up to the wall, or I can only get a certain number at the bathtub level or bench or whatever.

 

The key is progression. Then, she finally tried getting down on the floor and did a push-up, and she only did one the first time. Then, she went back and did the rest of the routine. She didn't give up on that. She kept going until she got to the point of 60 full out, full body push-ups in a day. Now they weren't necessarily all together, but she did them across a day. This woman was in her 80s. 

 

It's really important to learn that it's a progression. The key is that it's a progression and a gradual increase. Every little bit counts, not to get them to stop when they get to a certain point. Move to the easier way to do it, and keep increasing the strength. Somebody who's deconditioned, which is a lot of people, a lot of people just don't have the exercise conditioning, doing a chair to sit to stand. It may be a really legitimate strength training exercise. Sit in the chair, stand up.

 

Starting, holding on to a tray or something, or doing it next to a wall, so that there's the balance. We always have to make sure that we're not putting people at risk that they're going to fall. 

 

Dr Ritamarie  (00:16:51)

For a stronger client, that same movement may be good, but you add some resistance. Start with light weights and increase that up. There's a lot of other  impact alternatives that we can work with that are leading up to jumping, if ever they get to it. 

 

Then. we talked a little earlier about heel drops. Get up on the toes and drop down. Now, for some people with balance problems, you can grab onto a table. You can grab onto a wall, but make sure they stay safe. 

 

Stomping, just stomping the feet, like marching in place. Marching with movement, but with intent. Step downs, step up, step down, step up, step down. Stair climbing, that's one of my favorites. I go up and down the stairs as many times as I can. I get out of breath,  Low step-ups into high step-ups. 

 

We talked about carries. It's called farmer’s carry, carrying the buckets, or weighted carries.  I've gotten up to, like I said, 85 pounds, gentle power work with the bands, but the bands can adapt as they're getting well. 

 

The medicine ball. That's a little bit harder, but the medicine ball can be helpful, even just holding a medicine ball and tossing it from hand to hand, or doing a squat with the medicine ball. There are lots of things that they can do. 

 

If they can't jump, because their knees, or the pelvic floor are weak, then the weighted carry might be better, and it's putting a signal on these bones. 

 

For somebody with spinal osteoporosis, spinal extension, strength training, and posture training can be more important than forward flexion. That can put them at risk.

 

For somebody with poor balance, balance training itself becomes bone protective, because fracture prevention is not just about density, it's about preventing falls. If somebody is very out of balance, you can just start them by holding on to something, lifting one leg, and balancing on the other,  then switching and not putting them at risk. If they can't do that at all, then holding on and little by little by little progressing.

 

Dr Ritamarie  (00:18:56)

A really smart bone program includes all of this stuff. Strength, and balance, and posture, and power, and mobility are really, really important. As we age, collagen gets stiffer. Working on impact as it's appropriate. We always have to build in recovery time. 

 

In our next video, we're going to go deeper into resistance training and how that can be super helpful for helping somebody with bone, because muscle pull on the bone is one of the key ways to stimulate bone. When they contract against resistance, they create a force at the bone attachment sites, and that is information, and that stimulates the matrix of the bone and the osteoclast.  

 

This and the next few episodes are about movement, but because this is a hormone-focused bone series, and we are the Institute of Nutritional Endocrinology, we need to connect movement back to endocrine physiology.  

 

Movement influences insulin sensitivity. Movement supports muscle glucose uptake. Movement can improve inflammatory tone, and it can support sleep. It can support reducing stress and help preserve things like testosterone and growth supportive signals through muscle maintenance. 

 

Movement can also influence myokines, which are signaling molecules released by the muscles. Those myokines communicate with the bone, which is what we're here to talk about. When we recommend movement for bone, we're not just prescribing mechanical load, we're influencing the endocrine terrain.

 

Strength training may help preserve muscle and improve insulin sensitivity, and it may signal bone remodeling. Balance helps to reduce falls. Yoga reduces sympathetic overdrive and improves body awareness. We're going to have another episode all about yoga with bone health. Walking can support glucose regulation and circulation. All of these are important to bring together, but I started saying walking is not enough on its own, but as part of a pool, a pool of exercise is. 

 

Each tool has a role, and the art is matching the tool to the pattern that this person is exemplifying. It's way beyond protocols. A protocol says everyone with bone loss should walk and lift weights, or everyone with bone loss should jump, or everyone with bone loss needs to wear a weighted vest. That's a protocol. We're looking for pattern recognition. What's the person's fracture risk? What's their strength? What's their balance? How safe are they with balance? And what's their hormone status? 

 

All of these are important questions. We have to look at their nutrition status, as well. After all, this is nutritional endocrinology. What's their nutrition status, which leads to what's their gut doing and all that? How confident are they? What's their pain? We don't want to put them into pain patterns, and if they have a history of falls, we need to know that. We should know what their DEXA or REMS are showing.

 

We'll have a whole section on the scanning, and the labs. What does their lab work suggest? Are they remodeling, or are they breaking down primarily? We need to know this, and what movement signal is missing. 

 

That's how we create personalized care. That's also what we teach inside the Beyond Protocols. It's not just what to do, it's how to think through what this person needs first. Go in and download that from the link in the show notes.

 

As practitioners, it's important for us to find the path that works for this particular person, taking into account their scans, their previous fall history, any fracture risk, pains in various parts, and then we can help them to put together a clear a clear plan that's customized to them.

 

Let's bring together what we've been talking about here. Bone responds to movement, but not all movement sends the same signal. Walking is helpful, but usually not enough. Jumping can be powerful but not for everyone. Resistance training is foundational, because the muscle tells the bone we need more strength. It stimulates those osteocytes. 

 

A weighted vest can be useful but not when there's other things that are out of balance, like posture, strength, and balance, and yoga can be very important. We'll have that in another episode. 

 

Your job as a practitioner is not to give every client the same movement plan. Our job is to match the movement signal to the person's risk, capacity, hormones, nutrition, confidence, and goals. That's how we move from generic advice to root cause bone care. 

 

In the next episode, we'll talk more about resistance training and tie in a little bit about yoga and then help you to put together a progression for each individual, a personalized progression for the perfect plan. Well, not perfect, nothing's perfect,  but the plan that's going to help them to balance their endocrine system, get their bones actually stimulated to produce and often reverse, at least to not worsen osteoporosis or osteopenia. It's way more complex than just vitamin D and calcium and walking.

 

If you're a practitioner who wants to think this way clinically, keep listening for the rest of this series. We'll go into resistance training, yoga, labs, imaging, and nutrition, specifically food. This is the kind of work we all need in healthcare. This has to be the future of healthcare. We’re tired of generic protocols, and the this-for-that approach. Precise pattern recognition is what we need.  

 

If you want to be part of this, check out our resources, because this is how I train practitioners to think. This is the future of healthcare. If you want to be part of that, go check out our resources. Check us out. Keep subscribing to this podcast and YouTube series. And until next time, shine on.