WEBVTT 00:00:00.000 --> 00:00:02.819 Anyone coaching older adults, just make sure 00:00:02.819 --> 00:00:05.879 you're checking their fracture history, you know, 00:00:05.879 --> 00:00:08.619 if they do have any of those fragility fractures 00:00:08.619 --> 00:00:10.759 or things that could indicate that they have 00:00:10.759 --> 00:00:13.240 low bone density. Maybe you can even ask them 00:00:13.240 --> 00:00:15.800 if they have their bone density report and you 00:00:15.800 --> 00:00:17.960 can make sure that you have all the information 00:00:17.960 --> 00:00:20.699 and you know exactly what their baseline bone 00:00:20.699 --> 00:00:25.059 health status is like. Hi, Amy. It's my pleasure 00:00:25.059 --> 00:00:27.320 to have you on Evidence Strong Show. If you could 00:00:27.320 --> 00:00:29.359 briefly introduce yourself. Hi, thanks for having 00:00:29.359 --> 00:00:31.920 me, Alex. Great to talk about another, you know, 00:00:31.920 --> 00:00:34.759 research, study and exercise with someone who's 00:00:34.759 --> 00:00:37.600 pro -exercise. So my name's Amy Harding. I'm 00:00:37.600 --> 00:00:40.439 a research fellow from Griffith University. I'm 00:00:40.439 --> 00:00:42.759 in the School of Allied Health, Sport and Social 00:00:42.759 --> 00:00:45.479 Work. So I've been researching musculoskeletal 00:00:45.479 --> 00:00:48.159 conditions for about 10 years now. I'm currently 00:00:48.159 --> 00:00:51.439 working on an MRFF funded project. So that's 00:00:51.439 --> 00:00:53.539 like an Australian government funded study. study, 00:00:53.600 --> 00:00:56.420 the stop fracture study, and we're implementing 00:00:56.420 --> 00:00:59.859 a referral pathway to exercise and trying to 00:00:59.859 --> 00:01:02.700 embed that into the osteoporosis model of care. 00:01:02.840 --> 00:01:04.760 So from a little bit of a different background 00:01:04.760 --> 00:01:07.200 than maybe some of your people that follow you 00:01:07.200 --> 00:01:09.920 and watch you. Now, the background is very relevant 00:01:09.920 --> 00:01:12.299 because today we're talking strength training 00:01:12.299 --> 00:01:16.099 and aging. So let's try to build some kind of 00:01:16.099 --> 00:01:18.599 background. What would you have to say about 00:01:18.599 --> 00:01:21.700 aging? Well, it's a privilege, obviously, to 00:01:21.700 --> 00:01:25.019 become old. But we know from all of the demographic 00:01:25.019 --> 00:01:27.920 data that's coming out about the population in 00:01:27.920 --> 00:01:30.200 Australia and in a lot of countries that the 00:01:30.200 --> 00:01:33.379 percentage of the population that are older is 00:01:33.379 --> 00:01:36.019 increasing. And we've also got life expectancy 00:01:36.019 --> 00:01:38.579 that's increasing. So we know that people are 00:01:38.579 --> 00:01:40.500 living for longer and we want to try and keep 00:01:40.500 --> 00:01:42.920 them healthier for longer as well. So I guess 00:01:42.920 --> 00:01:46.060 in Australia, the Australian Institute for Health 00:01:46.060 --> 00:01:49.200 and Welfare did a report a couple of years ago 00:01:49.200 --> 00:01:51.739 and they said that one in six Australians were... 00:01:51.760 --> 00:01:55.599 over 65, which is 16 % of the population. That 00:01:55.599 --> 00:01:58.200 might not seem like much in relative terms, but 00:01:58.200 --> 00:02:00.900 when we talk about absolute terms, that's 4 .2 00:02:00.900 --> 00:02:03.780 million older people. So that's a big chunk of 00:02:03.780 --> 00:02:06.439 the population. So aging itself, back to your 00:02:06.439 --> 00:02:08.960 question, what happens when we get older? Well, 00:02:09.080 --> 00:02:11.460 specifically with musculoskeletal conditions, 00:02:11.800 --> 00:02:14.120 we're thinking about things like sarcopenia. 00:02:14.240 --> 00:02:16.560 So that's like loss of muscle mass and muscle 00:02:16.560 --> 00:02:19.259 strength and function. Osteoporosis, which is 00:02:19.259 --> 00:02:22.530 my area of interest. That's reduced bone density 00:02:22.530 --> 00:02:25.909 and an increased propensity to fracture. And 00:02:25.909 --> 00:02:28.210 then we've got other things like osteoarthritis. 00:02:28.210 --> 00:02:30.729 So we see our joints, our cartilage starts to 00:02:30.729 --> 00:02:32.930 get a little bit, you know, worse for wear as 00:02:32.930 --> 00:02:36.270 well. Apart from musculoskeletal conditions with 00:02:36.270 --> 00:02:39.069 aging, we've got metabolic, neurological, cardiovascular 00:02:39.069 --> 00:02:41.590 conditions. So there's lots of things that can 00:02:41.590 --> 00:02:44.009 deteriorate as we get older. But the great thing 00:02:44.009 --> 00:02:46.729 is exercise can ameliorate all of those conditions. 00:02:47.050 --> 00:02:49.389 So keeping active is really important. Probably 00:02:49.389 --> 00:02:51.830 the other thing to remember is that one in four 00:02:51.830 --> 00:02:54.650 older adults have a fall every year. So falling 00:02:54.650 --> 00:02:57.849 is also a really big risk of injury for this 00:02:57.849 --> 00:02:59.669 group. So that's something else that can also 00:02:59.669 --> 00:03:02.490 be improved with exercise. So that's your balance. 00:03:03.469 --> 00:03:06.009 Falling, let's just add a little bit of relevance. 00:03:06.270 --> 00:03:08.789 So the fall is a problem already because it's 00:03:08.789 --> 00:03:11.590 a risky event. But then what happens after the 00:03:11.590 --> 00:03:13.669 fall is risky too. Could we speak a little bit 00:03:13.669 --> 00:03:15.710 about that? Yeah. So when we're thinking about 00:03:15.710 --> 00:03:18.370 older adult that fall, a lot of them will have 00:03:18.370 --> 00:03:21.110 low bone density. So they might have osteopenia 00:03:21.110 --> 00:03:24.310 or osteoporosis. So the fall itself might not 00:03:24.310 --> 00:03:26.430 be that bad. It might be something like a trip 00:03:26.430 --> 00:03:28.909 or a slip. So from standing height hitting the 00:03:28.909 --> 00:03:31.210 ground. So not particularly, you know, a big 00:03:31.210 --> 00:03:33.740 change in height. the fall. But they can have 00:03:33.740 --> 00:03:36.020 things like fractures, you know, fracturing their 00:03:36.020 --> 00:03:38.379 wrist, bones in their hand, their shoulder. But 00:03:38.379 --> 00:03:40.780 the big one is really fracturing a hip. So when 00:03:40.780 --> 00:03:43.740 some people, older people fall, they might fracture 00:03:43.740 --> 00:03:46.080 their hip. They have some really bad health outcomes 00:03:46.080 --> 00:03:48.400 after that. So a lot of them will lose their 00:03:48.400 --> 00:03:50.219 independence. So they need to go and live in 00:03:50.219 --> 00:03:52.719 aged care or even worse, they just remain in 00:03:52.719 --> 00:03:55.259 hospital. Their health deteriorates. Their morbidity 00:03:55.259 --> 00:03:58.199 and mortality is huge with hip fracture. So when 00:03:58.199 --> 00:04:00.180 we're thinking about falling, the kind of big 00:04:00.180 --> 00:04:02.580 one we want to avoid is the hip. fracture. So 00:04:02.580 --> 00:04:06.280 let's talk a little bit about your PhD and two 00:04:06.280 --> 00:04:08.639 other studies associated with it. The goal is 00:04:08.639 --> 00:04:11.560 simple, get people better, but specifically what 00:04:11.560 --> 00:04:14.300 you are aiming for. Yeah, so I guess our research 00:04:14.300 --> 00:04:18.220 group has always been interested in musculoskeletal 00:04:18.220 --> 00:04:21.620 conditions. My supervisor for my PhD, who's now 00:04:21.620 --> 00:04:24.899 my kind of my boss in my research role, she had 00:04:24.899 --> 00:04:27.600 done a study called the Liffmore study with one 00:04:27.600 --> 00:04:30.379 of the other PhDs in our research group. So the 00:04:30.379 --> 00:04:33.240 Liffmore study was looking at a particular kind 00:04:33.240 --> 00:04:36.139 of exercise program. So that was a high intensity 00:04:36.139 --> 00:04:38.800 resistance and high impact training program. 00:04:38.920 --> 00:04:41.399 So we call that HIRED just for the acronym. So 00:04:41.399 --> 00:04:44.500 that training program was in postmenopausal women 00:04:44.500 --> 00:04:47.720 with low bone density. So they had an osteopenia 00:04:47.720 --> 00:04:50.959 or osteoporosis. So that original study, the 00:04:50.959 --> 00:04:53.980 LIFTMORE study was done by Dr. Steve Watson and 00:04:53.980 --> 00:04:56.420 they found some really fantastic results in that 00:04:56.420 --> 00:04:58.980 study. So they had really excellent increases 00:04:58.980 --> 00:05:02.649 in bone density. at the spine, some changes in 00:05:02.649 --> 00:05:05.769 the hip and some geometric changes as well. So 00:05:05.769 --> 00:05:08.110 sometimes we can have changes in the geometry 00:05:08.110 --> 00:05:11.370 of the proximal femur or the femoral neck that 00:05:11.370 --> 00:05:14.009 will make it more resistant to fracture. So you're 00:05:14.009 --> 00:05:16.050 making the bone stronger because it's changing 00:05:16.050 --> 00:05:18.730 its geometry, but it may not necessarily been 00:05:18.730 --> 00:05:21.350 changing the actual density. So there's some 00:05:21.350 --> 00:05:23.389 other kind of factors that come into play there. 00:05:23.490 --> 00:05:26.829 So the LIFTMORE study basically found that it 00:05:26.829 --> 00:05:30.230 was effective at reducing their risk of and reducing 00:05:30.230 --> 00:05:32.509 their risk of fracture. So they had better balance. 00:05:32.610 --> 00:05:35.170 They had better muscle strength, better mobility. 00:05:35.430 --> 00:05:37.569 Therefore, you know, if you're less likely to 00:05:37.569 --> 00:05:39.769 fall, you're less likely to fracture. And the 00:05:39.769 --> 00:05:42.790 bone density was also increased. So their bones 00:05:42.790 --> 00:05:44.910 were stronger and they were less likely to fall. 00:05:44.990 --> 00:05:47.410 So overall, that's a fantastic result. Awesome. 00:05:47.449 --> 00:05:49.610 And then you decided to do your study. So what 00:05:49.610 --> 00:05:52.290 your study was about? Yeah. So then we decided, 00:05:52.410 --> 00:05:55.189 well, we know this exercise program is effective 00:05:55.189 --> 00:05:58.269 in women. Now we need to know if it's equally 00:05:58.269 --> 00:06:00.959 as effective. in men. So we just replicated the 00:06:00.959 --> 00:06:04.180 same exercise protocol in older men. So that 00:06:04.180 --> 00:06:07.740 was 45 and older, and they had a low bone density 00:06:07.740 --> 00:06:10.620 as well. So we use a particular kind of machine 00:06:10.620 --> 00:06:13.720 called a DEXA scanner or a bone density scanner. 00:06:13.860 --> 00:06:16.480 So we should be able to quantify what their bone 00:06:16.480 --> 00:06:19.519 density is like when they join this study. So 00:06:19.519 --> 00:06:21.959 every participant in our study, the LIFMOR for 00:06:21.959 --> 00:06:25.240 men study had osteopenia and osteoporosis. So 00:06:25.240 --> 00:06:27.939 that's just low bone density or low bone mass. 00:06:27.980 --> 00:06:30.439 So then we did the same protocol with the high 00:06:30.439 --> 00:06:33.100 -risk exercise program. And we did that for eight 00:06:33.100 --> 00:06:35.360 months. And we basically did a whole lot of measures 00:06:35.360 --> 00:06:37.500 before and after the eight months. So we could 00:06:37.500 --> 00:06:40.139 look at the fall and fracture risk the same as 00:06:40.139 --> 00:06:42.139 what we did in the LIFTMORE study. All right. 00:06:42.160 --> 00:06:44.519 So I think it's a good time to, because coaches 00:06:44.519 --> 00:06:47.519 will be super interested to hear about what the 00:06:47.519 --> 00:06:49.839 program, the exercise program consisted of. Yeah, 00:06:49.839 --> 00:06:52.060 sure. So the program, the high -risk program 00:06:52.060 --> 00:06:55.360 was high -intensity resistance and high impact. 00:06:55.579 --> 00:06:57.899 So the high -intensity... resistance component 00:06:57.899 --> 00:07:01.860 was some compound movement exercises using barbells. 00:07:01.860 --> 00:07:05.339 And we aimed for 80 to 85 % of one repetition 00:07:05.339 --> 00:07:08.839 maximum or one RM. So that was different exercises 00:07:08.839 --> 00:07:11.860 that are targeting specific muscles around the 00:07:11.860 --> 00:07:14.160 bones that we want to try and increase the density 00:07:14.160 --> 00:07:17.180 of. So that's the spine and the top of the femur, 00:07:17.220 --> 00:07:19.579 the top of the thigh bone. So we did a deadlift 00:07:19.579 --> 00:07:22.480 and squat and then an overhead prep to get some 00:07:22.480 --> 00:07:25.560 axial load as well. So they were the three resistance 00:07:25.560 --> 00:07:27.990 training exercises. exercises. The impact exercise 00:07:27.990 --> 00:07:30.910 was kind of like doing a chin up on a chin up 00:07:30.910 --> 00:07:33.449 bar and then dropping to have a little bit of 00:07:33.449 --> 00:07:36.250 a heavy impact on the ground. So that was, we 00:07:36.250 --> 00:07:38.509 call it like a drop chin. So some people might 00:07:38.509 --> 00:07:40.790 be familiar with like drop jumps and things like 00:07:40.790 --> 00:07:42.829 that. So that's where we're working on getting 00:07:42.829 --> 00:07:45.930 impact through the bones. That's awesome. And 00:07:45.930 --> 00:07:48.709 how was it twice a week, three times? How often 00:07:48.709 --> 00:07:52.350 the participants were? Yeah, they did twice weekly 00:07:52.350 --> 00:07:55.930 exercise. So we think that that's a good achievable 00:07:55.930 --> 00:07:58.389 amount for people. Also, a lot of the recommendations 00:07:58.389 --> 00:08:01.069 for resistance training and older adults out 00:08:01.069 --> 00:08:03.410 there really say twice weekly strengthening. 00:08:03.629 --> 00:08:05.790 So we thought that was something good that people 00:08:05.790 --> 00:08:08.850 could fit into their calendar. So something achievable 00:08:08.850 --> 00:08:11.350 twice weekly. All right. And you'll run the study 00:08:11.350 --> 00:08:13.389 for eight months. Yeah, we did eight months. 00:08:13.529 --> 00:08:15.949 Generally, when we're talking about being able 00:08:15.949 --> 00:08:19.149 to detect changes in bone density, you need at 00:08:19.149 --> 00:08:22.290 least a minimum of six months. Six to 12 months 00:08:22.290 --> 00:08:24.810 is kind of the range that most researchers will. 00:08:24.839 --> 00:08:27.339 work on. Anything less than six months, it's 00:08:27.339 --> 00:08:29.300 a little bit unlikely that you'll be able to 00:08:29.300 --> 00:08:31.920 detect change using the kind of device that we 00:08:31.920 --> 00:08:34.320 scan the bones on. So that's the bone density 00:08:34.320 --> 00:08:36.960 or the DEXA scanner. So we've just added a little 00:08:36.960 --> 00:08:39.299 bit more for the eight months just to make sure 00:08:39.299 --> 00:08:41.759 we were catching everything. So the changes in 00:08:41.759 --> 00:08:44.220 the muscle will be visible even to the naked 00:08:44.220 --> 00:08:46.960 eye will be visible faster probably, but bone 00:08:46.960 --> 00:08:50.379 requires repetitive loading for a long period 00:08:50.379 --> 00:08:54.019 of time. Why do you think it is? So bone density... 00:08:54.059 --> 00:08:56.879 It's just the way that all the little cells work 00:08:56.879 --> 00:08:59.759 in the bone kind of microenvironment where they 00:08:59.759 --> 00:09:02.620 actually need a full kind of remodeling cycle. 00:09:02.840 --> 00:09:05.419 So they lay down little bones, kind of little 00:09:05.419 --> 00:09:08.320 cells chew away at the bone and then some other 00:09:08.320 --> 00:09:10.820 cells move in and lay down new bone density. 00:09:10.980 --> 00:09:14.259 So that's quite a kind of long process in comparison 00:09:14.259 --> 00:09:16.799 to when we're looking at muscle changes like 00:09:16.799 --> 00:09:19.799 hypertrophy or hyperplasia. They happen a lot 00:09:19.799 --> 00:09:22.259 faster. So that's why some of the studies look 00:09:22.259 --> 00:09:24.639 at bone density. take a little bit longer. How 00:09:24.639 --> 00:09:27.340 did you structure the progression? Yeah. So the 00:09:27.340 --> 00:09:31.720 intensity we were aiming for was 80 to 85 % of 00:09:31.720 --> 00:09:35.179 1RM. So we did some 1RM testing and a couple 00:09:35.179 --> 00:09:37.259 of time points in the study as well, just to 00:09:37.259 --> 00:09:40.200 ensure we were at the right intensity. We also 00:09:40.200 --> 00:09:43.720 used a Borg scale. So some coaches might be familiar 00:09:43.720 --> 00:09:45.720 with that. That's a scale where you can kind 00:09:45.720 --> 00:09:49.039 of, I guess, a participant or a client can stand 00:09:49.039 --> 00:09:51.500 there and kind of rate how hard the exercise 00:09:51.500 --> 00:09:55.129 is based. on a scale. So we used a 6 to 20 Borg 00:09:55.129 --> 00:09:57.669 scale and they were aiming for 16 and higher. 00:09:57.789 --> 00:09:59.750 So that was kind of another way of being able 00:09:59.750 --> 00:10:02.690 to ensure we're in the right intensity. I did 00:10:02.690 --> 00:10:05.490 all of the coaching of the classes myself and 00:10:05.490 --> 00:10:08.350 I find people are really responsive, even individuals 00:10:08.350 --> 00:10:10.889 that have never really been in a gym before, 00:10:11.009 --> 00:10:14.149 to being able to quantify their intensity by 00:10:14.149 --> 00:10:16.830 using repetitions in reserve. So that's where 00:10:16.830 --> 00:10:19.210 you're able to kind of train them and teach them 00:10:19.210 --> 00:10:21.809 that how many reps did you feel like you... could 00:10:21.809 --> 00:10:24.509 do after you'd finished your set. If you felt 00:10:24.509 --> 00:10:27.789 like you had two or three more in the tank, we 00:10:27.789 --> 00:10:30.210 can add a little bit more load to the barbell. 00:10:30.389 --> 00:10:33.269 So that's a really easy way of the client also, 00:10:33.350 --> 00:10:35.950 or the participant being able to control what 00:10:35.950 --> 00:10:38.509 their intensity is like as well. Okay. In terms 00:10:38.509 --> 00:10:41.210 of testing, so one repetition maximum with older 00:10:41.210 --> 00:10:43.669 adults, some people may be a little bit reserved. 00:10:44.070 --> 00:10:46.690 What would you say to that? Well, we did it in 00:10:46.690 --> 00:10:50.710 our study at 12 and 24 weeks. So they had a little 00:10:50.710 --> 00:10:52.539 bit. of time. They'd developed their technique. 00:10:52.639 --> 00:10:55.440 They were familiar with the exercises, their 00:10:55.440 --> 00:10:58.500 tissues, and that it had time to adjust to that 00:10:58.500 --> 00:11:01.059 kind of activity, particularly for people where 00:11:01.059 --> 00:11:03.659 they're not familiar with doing the gym and they 00:11:03.659 --> 00:11:06.399 might be a novice, so to speak. I found that 00:11:06.399 --> 00:11:08.899 was quite easy to do. If you've developed a good 00:11:08.899 --> 00:11:11.679 technique with people and they understand why 00:11:11.679 --> 00:11:13.919 they're doing what they're doing, 1RM testing 00:11:13.919 --> 00:11:17.980 is completely fine for me. I understand reservations 00:11:17.980 --> 00:11:21.460 some coaches might have. really easily do like 00:11:21.460 --> 00:11:25.360 a 3RM or a 5RM or even just an AMRAP as well 00:11:25.360 --> 00:11:28.279 is a really great way of checking intensity. 00:11:28.500 --> 00:11:30.980 So you can use some online calculators to work 00:11:30.980 --> 00:11:33.500 out what kind of load they need to be at to get 00:11:33.500 --> 00:11:36.259 a certain intensity. In respect to your question, 00:11:36.360 --> 00:11:39.299 me, myself, I had no issues with the 1RM testing. 00:11:39.480 --> 00:11:41.860 It was fine. Okay. In terms of participants, 00:11:42.059 --> 00:11:45.220 how did they perceive the program? I guess we 00:11:45.220 --> 00:11:48.279 started with a familiarization period where they 00:11:48.279 --> 00:11:50.940 developed a real... good foundation. So they 00:11:50.940 --> 00:11:53.279 had really good movement patterns. And then we 00:11:53.279 --> 00:11:55.500 just gradually, you know, increased the load 00:11:55.500 --> 00:11:58.080 over time. They felt really comfortable. They 00:11:58.080 --> 00:12:00.539 knew that I knew what I was doing and they understood 00:12:00.539 --> 00:12:03.580 what the exercises were targeting and why we 00:12:03.580 --> 00:12:05.799 were doing that kind of program so they could 00:12:05.799 --> 00:12:08.639 improve their bone health and, you know, reduce 00:12:08.639 --> 00:12:11.279 their risk of fallen fracture. Generally, you 00:12:11.279 --> 00:12:13.360 know, older people might be a little bit turned 00:12:13.360 --> 00:12:15.440 off by the gym. It's not some an environment 00:12:15.440 --> 00:12:18.220 that they like. But I think when people know 00:12:18.570 --> 00:12:20.549 that ultimately they're going to be healthier. 00:12:20.789 --> 00:12:22.389 They're going to be happier. They're going to 00:12:22.389 --> 00:12:24.509 have a longer life. They're going to reduce their 00:12:24.509 --> 00:12:27.149 risk of lots of conditions. They might not particularly 00:12:27.149 --> 00:12:30.090 like the exercise, but you know, they know that 00:12:30.090 --> 00:12:32.870 they need to do it. And gradually, once you get 00:12:32.870 --> 00:12:35.509 past that kind of three month mark, you see people 00:12:35.509 --> 00:12:37.610 really going, oh, you know what? I actually really 00:12:37.610 --> 00:12:39.970 like this. This is great. Like, I feel like I'm 00:12:39.970 --> 00:12:43.009 coming in. I'm doing something that people don't 00:12:43.009 --> 00:12:45.409 expect me to be able to do. I feel really like 00:12:45.409 --> 00:12:47.950 empowered. So I don't know that I think. People 00:12:47.950 --> 00:12:50.529 get a switch once they get past that like six 00:12:50.529 --> 00:12:52.669 month mark or that three month mark where they're 00:12:52.669 --> 00:12:55.149 like, oh, wow, this is actually great. So we 00:12:55.149 --> 00:12:57.889 actually did some interviews after the completion 00:12:57.889 --> 00:13:00.629 of the study with all the participants. And a 00:13:00.629 --> 00:13:03.509 lot of them had continued to do resistance training, 00:13:03.750 --> 00:13:06.429 either set up a little gym at home or even gone 00:13:06.429 --> 00:13:09.990 and engaged an exercise physiologist or like 00:13:09.990 --> 00:13:13.250 you, a physio who was continuing to do some exercise 00:13:13.250 --> 00:13:16.129 programming for them. So they'd, you know, completely 00:13:16.129 --> 00:13:18.720 fallen. in love with exercise and resistance 00:13:18.720 --> 00:13:21.419 training. So yeah, I think if people know that 00:13:21.419 --> 00:13:23.399 it is good for them, it will like drive them 00:13:23.399 --> 00:13:25.879 to do it a little bit. I even see that the work 00:13:25.879 --> 00:13:29.220 you guys doing could have some, the clinic could 00:13:29.220 --> 00:13:31.879 have some collaboration with weightlifting gyms 00:13:31.879 --> 00:13:34.440 or powerlifting gyms in the area and just send 00:13:34.440 --> 00:13:37.139 these people to the coaches there and where they 00:13:37.139 --> 00:13:40.019 can keep the group environment, the encouragement 00:13:40.019 --> 00:13:43.919 and the progression so they actually get stronger 00:13:43.919 --> 00:13:46.659 and have opportunity to be involved. in competing 00:13:46.659 --> 00:13:49.080 or, you know, just supporting other people who 00:13:49.080 --> 00:13:51.399 do the same. I think that could be a really good 00:13:51.399 --> 00:13:53.879 collaboration. Our research group, we were really 00:13:53.879 --> 00:13:56.220 lucky in that we have a great head of our research 00:13:56.220 --> 00:13:58.840 group, Professor Belinda Beck, who's been my 00:13:58.840 --> 00:14:02.559 mentor for 10 years now. So we found all of these 00:14:02.559 --> 00:14:04.759 great results from our studies, like the one 00:14:04.759 --> 00:14:07.419 that I did for my PhD, the LIFMO for men and 00:14:07.419 --> 00:14:10.019 the LIFMO for women before that. So then we did 00:14:10.019 --> 00:14:12.960 another study with another PhD after mine called 00:14:12.960 --> 00:14:16.000 the MedEx OP study. So they replicate. the same 00:14:16.000 --> 00:14:18.799 exercise program again. And we found all of these 00:14:18.799 --> 00:14:21.299 results and Professor Belindebeck was like, this 00:14:21.299 --> 00:14:24.080 is too good not to be able to have people out 00:14:24.080 --> 00:14:26.740 there accessing. This is so good for health and, 00:14:26.759 --> 00:14:29.580 you know, reducing fracture, reducing falls. 00:14:29.679 --> 00:14:32.120 We've got to roll it out in the public. So she 00:14:32.120 --> 00:14:34.360 actually started the bone clinic in Brisbane. 00:14:34.500 --> 00:14:37.159 So that's a translational research facility that 00:14:37.159 --> 00:14:40.100 she runs. So people can go there and do the exercise 00:14:40.100 --> 00:14:43.259 program, which is called the Enero exercise program. 00:14:43.440 --> 00:14:46.269 So that's exactly. based on what we did in all 00:14:46.269 --> 00:14:48.509 of our studies. So they can go to the clinic 00:14:48.509 --> 00:14:51.769 in a real world scenario and do the exercise 00:14:51.769 --> 00:14:54.909 program with an exercise physiologist. And they're 00:14:54.909 --> 00:14:57.710 having some fantastic results over a number of 00:14:57.710 --> 00:15:00.250 years now, more than six years in the clinic 00:15:00.250 --> 00:15:02.570 at the bone clinic. And that exercise program 00:15:02.570 --> 00:15:05.809 and Nero is also at allied health clinics all 00:15:05.809 --> 00:15:08.850 around the world and around Australia. So we 00:15:08.850 --> 00:15:12.009 found this fantastic program and now people can 00:15:12.009 --> 00:15:14.710 go and do the evidence -based. program exercise 00:15:14.710 --> 00:15:17.529 professionals. So that's really fantastic. That's 00:15:17.529 --> 00:15:21.350 amazing. You used something called biodensity. 00:15:21.409 --> 00:15:24.750 So could we talk a little bit about that? So 00:15:24.750 --> 00:15:26.929 this is a kind of machine that was, I guess, 00:15:26.950 --> 00:15:29.889 a little bit more popular in North America than 00:15:29.889 --> 00:15:32.669 it was here. So we had this biodensity machine 00:15:32.669 --> 00:15:35.309 and there wasn't too much research about the 00:15:35.309 --> 00:15:38.690 effectiveness and the safety of it. So that biodensity 00:15:38.690 --> 00:15:41.610 machine is essentially kind of a multi -station 00:15:41.610 --> 00:15:45.080 machine where you're doing a near maximal isometric 00:15:45.080 --> 00:15:47.980 contraction. So it was kind of like a chest press, 00:15:48.159 --> 00:15:51.139 a leg press, a stimulated kind of deadlift and 00:15:51.139 --> 00:15:53.940 almost like an underhand chin up. So some kind 00:15:53.940 --> 00:15:56.980 of similar movements to what we had in the high 00:15:56.980 --> 00:15:59.659 rate protocol. So that biodensity machine, we 00:15:59.659 --> 00:16:02.259 then thought, well, we can also look at that 00:16:02.259 --> 00:16:04.539 in our study, lift more for men. So they were 00:16:04.539 --> 00:16:07.139 the two groups. One group did the high rate program. 00:16:07.539 --> 00:16:11.019 One group did the biodensity machine. We matched 00:16:11.019 --> 00:16:13.960 the frequency for the two groups as well. That 00:16:13.960 --> 00:16:17.799 biodensity machine now is the OsteoStrong so 00:16:17.799 --> 00:16:20.000 that people might be familiar with that name. 00:16:20.159 --> 00:16:22.399 There's a few centers popping up around Australia 00:16:22.399 --> 00:16:25.279 now. Generally they only recommend or the manufacturers 00:16:25.279 --> 00:16:27.940 recommend once weekly so we just did the twice 00:16:27.940 --> 00:16:30.059 weekly just so it was matching the frequency 00:16:30.059 --> 00:16:32.700 for the two groups in the study. We were looking 00:16:32.700 --> 00:16:36.600 at about 35 in each group so they had really 00:16:36.600 --> 00:16:40.200 good compliance almost 78 percent completed the 00:16:40.200 --> 00:16:42.759 whole eight months which is generally quite good 00:16:42.759 --> 00:16:45.559 in a research study kind of setting. So yeah, 00:16:45.620 --> 00:16:48.200 then we then did the same measures pre and post 00:16:48.200 --> 00:16:51.139 and we compared all of the results between the 00:16:51.139 --> 00:16:54.539 two groups. We did a really quite a big suite 00:16:54.539 --> 00:16:57.220 of measures. I guess kind of the key ones were 00:16:57.220 --> 00:17:00.059 related to bone density. So that was using the 00:17:00.059 --> 00:17:03.059 DEXA. So we looked at lumbar spine, femoral neck 00:17:03.059 --> 00:17:05.319 and total hip bone mineral density. So that's 00:17:05.319 --> 00:17:07.779 just like the massive bone at particular parts 00:17:07.779 --> 00:17:11.049 of your skeleton. We also looked at scan. parts 00:17:11.049 --> 00:17:13.730 of the forearm and the leg. It's something called 00:17:13.730 --> 00:17:16.769 a PQCT or a peripheral quantitative computer 00:17:16.769 --> 00:17:20.130 tomographer. That's basically a 3D scan. So the 00:17:20.130 --> 00:17:22.450 bone density scanner is only two dimensional. 00:17:22.730 --> 00:17:26.450 This PQCT scan is 3D. So we can look at the volume 00:17:26.450 --> 00:17:29.650 and the area of the bone and the muscle as well. 00:17:29.769 --> 00:17:31.769 And then we also did a lot of other measures 00:17:31.769 --> 00:17:34.730 that coaches might be familiar with, like things 00:17:34.730 --> 00:17:39.009 about balance and mobility. So tandem walk, climbed 00:17:39.009 --> 00:17:41.490 up and go five. times sit to stand, functional 00:17:41.490 --> 00:17:43.890 reach tests. So some kind of battery of pretty 00:17:43.890 --> 00:17:47.210 commonly used tests in, I guess, exercise studies. 00:17:47.230 --> 00:17:49.589 So that would facilitate comparison with other 00:17:49.589 --> 00:17:52.069 studies as well. So yeah, a whole lot of measures 00:17:52.069 --> 00:17:54.670 that we looked at, all really indirectly related 00:17:54.670 --> 00:17:57.250 to a fall and fracture risk. Amazing. All right, 00:17:57.269 --> 00:17:59.890 are we ready for the results? Okay. So I guess 00:17:59.890 --> 00:18:02.569 that the kind of the key things were with the 00:18:02.569 --> 00:18:06.509 results that the higher group saw a 4 .1 % increase 00:18:06.509 --> 00:18:09.559 in lumbar spine bone mineral density. which is 00:18:09.559 --> 00:18:12.900 really fantastic because as we age, we tend to 00:18:12.900 --> 00:18:16.000 see a decline in bone density. So even maintaining 00:18:16.000 --> 00:18:18.619 or increasing bone density is something that 00:18:18.619 --> 00:18:21.140 is fantastic. So that was the kind of the main 00:18:21.140 --> 00:18:23.920 key result. They also increased their trochanteric 00:18:23.920 --> 00:18:25.759 bone mineral density. So that's a particular 00:18:25.759 --> 00:18:28.339 part of your femur where a lot of muscles attach. 00:18:28.660 --> 00:18:31.859 And that was 2 .8 % increase there. So some really 00:18:31.859 --> 00:18:34.380 good improvements in the bone density. That was 00:18:34.380 --> 00:18:36.940 also a little bit higher than what was observed 00:18:36.940 --> 00:18:39.779 in the biodensity. group when we did the between 00:18:39.779 --> 00:18:42.880 group comparisons. So yeah, slightly better increases 00:18:42.880 --> 00:18:45.480 in bone density for the high rate group versus 00:18:45.480 --> 00:18:47.740 the higher density group. You mentioned that 00:18:47.740 --> 00:18:50.480 then the natural history is that people lose 00:18:50.480 --> 00:18:54.740 some bone density as we age. Well, how much of 00:18:54.740 --> 00:18:57.259 a loss it is? That varies a little bit depending 00:18:57.259 --> 00:19:00.019 on what ethnicity and what kind of age bracket 00:19:00.019 --> 00:19:02.240 you're looking at. But generally, it's about 00:19:02.240 --> 00:19:06.220 in the realm of 2 .5 % per year for men, slightly 00:19:06.220 --> 00:19:09.490 more for women. after menopause with the withdrawal 00:19:09.490 --> 00:19:12.170 of estrogen, they get a little bit more of a 00:19:12.170 --> 00:19:15.069 rapid and more marked decline in bone density 00:19:15.069 --> 00:19:18.130 than men. So maintenance of bone mass is an excellent 00:19:18.130 --> 00:19:21.450 outcome and then even improving it is even better. 00:19:21.589 --> 00:19:23.750 So we know from some of the research out there 00:19:23.750 --> 00:19:26.329 that, you know, even a one to two percent increase 00:19:26.329 --> 00:19:29.609 in bone mineral density can translate to a five 00:19:29.609 --> 00:19:32.190 to ten percent reduction in fracture risk. Are 00:19:32.190 --> 00:19:35.609 there any tools to predict or without sending 00:19:35.609 --> 00:19:39.329 participants? clients for DEXA scans, are there 00:19:39.329 --> 00:19:42.329 any way to assess bone health in older adults? 00:19:42.450 --> 00:19:44.849 I guess when you're thinking about risk factors 00:19:44.849 --> 00:19:48.109 for fracture, you can really ask some very easy 00:19:48.109 --> 00:19:50.829 questions to determine that, like a history of 00:19:50.829 --> 00:19:53.170 fragility fracture. So that means a fracture 00:19:53.170 --> 00:19:55.809 from a trip or a slip or even something as simple 00:19:55.809 --> 00:19:58.809 as coughing or twisting. So if you have a fracture 00:19:58.809 --> 00:20:01.589 in the past, that automatically increases your 00:20:01.589 --> 00:20:03.990 risk of having subsequent fractures. So that's 00:20:03.990 --> 00:20:06.710 a really easy question to ask. If you're a coach, 00:20:06.769 --> 00:20:08.730 when you're doing your, you know, pre -screening 00:20:08.730 --> 00:20:10.470 with someone, you know, have you had a fracture? 00:20:10.609 --> 00:20:13.250 What kind of denarii around are those fractures? 00:20:13.450 --> 00:20:15.509 And then you can work out if maybe it wasn't, 00:20:15.509 --> 00:20:18.049 you know, a low trauma or a minimal trauma fracture. 00:20:18.289 --> 00:20:20.970 Age, obviously, the older we get, the kind of 00:20:20.970 --> 00:20:23.269 most likely the lower your bone density. So you 00:20:23.269 --> 00:20:25.130 can ask them, you know, what the age might be. 00:20:25.230 --> 00:20:27.769 If they're drinking alcohol or smoking cigarettes, 00:20:28.069 --> 00:20:30.730 that's some other kind of key risk factors for 00:20:30.730 --> 00:20:33.329 fracture and poor bone health. So you can ask 00:20:33.329 --> 00:20:35.740 some of those questions independently. of having 00:20:35.740 --> 00:20:38.180 the bone density scan. That's something really 00:20:38.180 --> 00:20:40.819 easy for coaches to do. But generally, I think 00:20:40.819 --> 00:20:43.980 most women over 50 probably most likely would 00:20:43.980 --> 00:20:47.119 have had a DEXA scan done or a bone density scan 00:20:47.119 --> 00:20:49.559 done. So there's heaps of great resources out 00:20:49.559 --> 00:20:52.019 there. Healthy Bones Australia, if any coach 00:20:52.019 --> 00:20:54.140 is interested in learning a bit more about bone 00:20:54.140 --> 00:20:56.640 health, pop Healthy Bones Australia into your 00:20:56.640 --> 00:20:59.119 search engine and they've got fact sheets on 00:20:59.119 --> 00:21:01.700 there. You can learn a lot more about osteopenia 00:21:01.700 --> 00:21:03.759 and osteoporosis. So I think that's a really 00:21:03.759 --> 00:21:05.559 good starting point. point if you're a coach 00:21:05.559 --> 00:21:07.619 out there and you don't know too much about this 00:21:07.619 --> 00:21:09.759 this world yeah start with that that's a really 00:21:09.759 --> 00:21:12.539 good resource as well all right so in terms of 00:21:12.539 --> 00:21:16.579 bone density you found improvement how the participants 00:21:16.579 --> 00:21:18.740 how did they do in other manner yeah so they 00:21:18.740 --> 00:21:21.460 um increase their muscle cross -sectional area 00:21:21.460 --> 00:21:24.319 in their forearm which is um which was great 00:21:24.319 --> 00:21:27.420 as well and some of the geometry of the bone 00:21:27.420 --> 00:21:30.799 at the forearm and the leg improved for the higher 00:21:30.799 --> 00:21:34.200 group not too many changes in in the those kinds 00:21:34.200 --> 00:21:37.759 of things for the biodensity group. So yeah, 00:21:37.819 --> 00:21:40.400 HIRA was definitely superior with some of those 00:21:40.400 --> 00:21:43.339 geometric changes and the muscle cross -sectional 00:21:43.339 --> 00:21:45.380 area. Some of the other things that improved 00:21:45.380 --> 00:21:48.339 were the five -time sit -to -stand and the timed 00:21:48.339 --> 00:21:51.079 up -and -go. So the HIRA group saw some improvements 00:21:51.079 --> 00:21:54.079 in their, just their general mobility and physical 00:21:54.079 --> 00:21:56.279 function as well. Yeah, their five -time sit 00:21:56.279 --> 00:21:58.819 -to -stand for the HIRA group improved. We also 00:21:58.819 --> 00:22:01.500 did some handheld dynamometer. So that's like 00:22:01.500 --> 00:22:03.809 a little device you can measure. muscle force 00:22:03.809 --> 00:22:06.930 with. They also improved their back muscle and 00:22:06.930 --> 00:22:09.930 leg muscle strength as well. So, you know, as 00:22:09.930 --> 00:22:12.170 you would expect with any kind of compound movement, 00:22:12.349 --> 00:22:15.589 barbell by 80 to 85 % of 1RM, we saw strength 00:22:15.589 --> 00:22:17.730 improvement. So that was great. And that was 00:22:17.730 --> 00:22:20.289 actually more in the higher group than what we 00:22:20.289 --> 00:22:22.730 saw in the biodensity group, which I guess would 00:22:22.730 --> 00:22:25.470 somewhat be related to it being an, you know, 00:22:25.490 --> 00:22:29.009 isometric or a near isometric contraction. They're 00:22:29.009 --> 00:22:30.589 not really going through a lot of, you know, 00:22:30.630 --> 00:22:33.069 eccentric, concentric. movements there. Awesome. 00:22:33.130 --> 00:22:35.589 I have a question about the biodensity. So you 00:22:35.589 --> 00:22:38.509 said that it was effective in improving bone 00:22:38.509 --> 00:22:42.529 density in the axial, so kind of, you know, this 00:22:42.529 --> 00:22:47.029 direction. So the bones like spine and hip bones, 00:22:47.250 --> 00:22:49.990 thigh bones, these would be the ones that are 00:22:49.990 --> 00:22:53.029 influenced, not so effective in influencing the 00:22:53.029 --> 00:22:56.130 upper body bone density, would you say? Yeah, 00:22:56.170 --> 00:22:59.089 it didn't have too much effect at the radius 00:22:59.089 --> 00:23:03.819 in the forearm. we did those PQCT scans or those 00:23:03.819 --> 00:23:07.079 3D scans. Why do you think it happened? I think 00:23:07.079 --> 00:23:10.140 with the, I guess the population that we're looking 00:23:10.140 --> 00:23:13.299 at, they were, you know, relatively untrained, 00:23:13.299 --> 00:23:15.400 I guess you could say, like not many of them 00:23:15.400 --> 00:23:17.779 had any background doing resistance training 00:23:17.779 --> 00:23:20.720 or any kind of strengthening exercise. They were 00:23:20.720 --> 00:23:23.200 generally doing a lot of just weight bearing, 00:23:23.460 --> 00:23:26.960 cardio based walking, you know, stair climbing, 00:23:27.140 --> 00:23:29.940 jog, little bit of jogging, cycling, so non -weight 00:23:29.940 --> 00:23:32.599 bearing. activity. So really, I guess they did 00:23:32.599 --> 00:23:35.740 have enough stimulus to get a little tiny increase 00:23:35.740 --> 00:23:38.920 in bone density, but nothing too significant. 00:23:39.059 --> 00:23:41.079 Definitely the higher rate group was superior 00:23:41.079 --> 00:23:44.279 with the bone density changes. Okay. And the 00:23:44.279 --> 00:23:47.259 exercise also gave participants that increases 00:23:47.259 --> 00:23:51.859 in the functional tasks. So they opened better 00:23:51.859 --> 00:23:55.319 movers and bigger muscles. Yeah. All that good 00:23:55.319 --> 00:23:57.759 stuff that we love about resistance training. 00:23:58.000 --> 00:24:01.339 It seems like not all... not only the intervention 00:24:01.339 --> 00:24:05.359 was effective, but it was life changing. So these 00:24:05.359 --> 00:24:08.400 people changed their lifestyle after having the 00:24:08.400 --> 00:24:11.480 support for eight months. No doubt that that 00:24:11.480 --> 00:24:14.119 was very smooth introduction to strength training, 00:24:14.440 --> 00:24:17.940 very structured, monitored, safe. And after that, 00:24:18.059 --> 00:24:20.200 they decided this is good for me. I will continue. 00:24:20.420 --> 00:24:23.200 Yeah, definitely. I think I'd really instilled 00:24:23.200 --> 00:24:25.980 in them how important it was for them to focus 00:24:25.980 --> 00:24:28.140 on their health and if they wanted to age well 00:24:28.140 --> 00:24:30.849 to continue. to be active you know you try and 00:24:30.849 --> 00:24:33.970 reduce your time being sedentary make sure you're 00:24:33.970 --> 00:24:36.950 doing weight bearing exercise like still do your 00:24:36.950 --> 00:24:39.089 walking still do your cycling your swimming all 00:24:39.089 --> 00:24:41.329 the things you love but make sure you keep doing 00:24:41.329 --> 00:24:44.089 your resistance training and your impact and 00:24:44.089 --> 00:24:46.910 those additional kind of balance exercises so 00:24:46.910 --> 00:24:48.849 we don't want you to fall we want you to stay 00:24:48.849 --> 00:24:51.549 upright we want you to stay strong so yeah they've 00:24:51.549 --> 00:24:54.029 continued I really instilled in them how important 00:24:54.029 --> 00:24:57.450 it was I think I gave them a good kind of foundation 00:24:57.450 --> 00:25:00.369 like I said earlier to exercise and resistance 00:25:00.369 --> 00:25:02.430 training and they've just continued on, which 00:25:02.430 --> 00:25:05.490 is really nice to see. Some of them had, you 00:25:05.490 --> 00:25:07.730 know, aside from all the measures we took, they 00:25:07.730 --> 00:25:10.230 just reported how much better they felt, how 00:25:10.230 --> 00:25:12.990 much more energy they had, how better, how much 00:25:12.990 --> 00:25:15.509 more their joints and their function were better. 00:25:15.630 --> 00:25:17.970 They had, you know, their knees that would be 00:25:17.970 --> 00:25:20.069 like, oh, I've got a bit of a niggle in my knee. 00:25:20.130 --> 00:25:22.390 The knees felt better. The hips felt better. 00:25:22.529 --> 00:25:24.289 Their back felt better. And I was like, yeah, 00:25:24.309 --> 00:25:26.869 this is what happens when you do resistance training 00:25:26.869 --> 00:25:28.839 and you... doing it properly and you're doing 00:25:28.839 --> 00:25:31.539 the right exercises and the right weight. So 00:25:31.539 --> 00:25:33.740 I think coaches out there, it's really important 00:25:33.740 --> 00:25:36.180 that they're there supervising, making sure people 00:25:36.180 --> 00:25:38.039 have the right technique, making sure they've 00:25:38.039 --> 00:25:40.220 got the right load progression. Yeah, all of 00:25:40.220 --> 00:25:43.119 that good stuff that exercise scientists, you 00:25:43.119 --> 00:25:45.299 know, exercise physiologists and physios can 00:25:45.299 --> 00:25:48.380 do to help people keep living healthy long lives 00:25:48.380 --> 00:25:50.759 and keep them out of hospital. So let's bring 00:25:50.759 --> 00:25:53.279 it all together. What would be your advice for 00:25:53.279 --> 00:25:57.299 coaches who want or will work with? older adults? 00:25:57.599 --> 00:26:00.619 Yeah, so I think anyone coaching older adults, 00:26:00.720 --> 00:26:03.460 just make sure you're checking their fracture 00:26:03.460 --> 00:26:05.920 history, you know, if they do have any of those 00:26:05.920 --> 00:26:08.619 fragility fractures or things that could indicate 00:26:08.619 --> 00:26:11.259 that they have low bone density. Maybe you can 00:26:11.259 --> 00:26:13.400 even ask them if they have their bone density 00:26:13.400 --> 00:26:15.980 report and you can make sure that you have all 00:26:15.980 --> 00:26:18.420 the information and you know exactly what their 00:26:18.420 --> 00:26:20.980 baseline bone health status is like. There's 00:26:20.980 --> 00:26:23.539 also some other really good resources out there 00:26:23.539 --> 00:26:25.720 like Healthy Bones Australia, so you can make 00:26:25.720 --> 00:26:27.920 sure. sure you increase your knowledge in that 00:26:27.920 --> 00:26:31.359 area. Also the Exercise and Sport Science Australia 00:26:31.359 --> 00:26:34.740 position statement on exercise prescription for 00:26:34.740 --> 00:26:37.559 the prevention and management of osteoporosis. 00:26:37.759 --> 00:26:39.740 God that's a mouthful but that was a paper that 00:26:39.740 --> 00:26:43.220 was published back in 2017 in the Journal of 00:26:43.220 --> 00:26:45.579 Science and Medicine in Sport. It's a really 00:26:45.579 --> 00:26:48.920 excellent summary of osteoporosis and fracture 00:26:48.920 --> 00:26:51.779 risk and then it goes through exercise kind of 00:26:51.779 --> 00:26:54.420 programming and prescription for these older 00:26:54.420 --> 00:26:56.750 adults. that might have low bone mass. And you 00:26:56.750 --> 00:26:59.710 can kind of risk stratify them to determine what 00:26:59.710 --> 00:27:02.609 kinds of activities and what kind of repetition 00:27:02.609 --> 00:27:05.450 range, intensity range, and what kind of impact 00:27:05.450 --> 00:27:08.089 you can do, depending on some of those easy questions 00:27:08.089 --> 00:27:10.869 to ask, like fracture history and their bone 00:27:10.869 --> 00:27:12.950 density results. So yeah, if you're interested, 00:27:13.029 --> 00:27:15.069 make sure you check that one out. That could 00:27:15.069 --> 00:27:17.869 be a good place to start. Also the Nero program, 00:27:18.390 --> 00:27:20.589 you know, that's the licensed program where you 00:27:20.589 --> 00:27:23.130 get a lot of additional training in the bone 00:27:23.130 --> 00:27:26.569 health area. coaches like exercise physiologists 00:27:26.569 --> 00:27:29.029 or physios were interested, you can also find 00:27:29.029 --> 00:27:31.970 out more about the Nero exercise program. You 00:27:31.970 --> 00:27:34.069 can access that online. They've got the Nero 00:27:34.069 --> 00:27:36.930 Academy website, so you can check that out online. 00:27:37.130 --> 00:27:39.569 I guess the important thing to remember is that 00:27:39.569 --> 00:27:41.950 when we're thinking about older adults, improving 00:27:41.950 --> 00:27:45.589 muscle strength, reducing their falls risk is 00:27:45.589 --> 00:27:48.150 key. We know that most fractures happen when 00:27:48.150 --> 00:27:50.970 people fall. So if you can prevent even the first 00:27:50.970 --> 00:27:53.230 fall, you can hopefully prevent, you know... 00:27:53.480 --> 00:27:56.960 90 % or nearly all of their fractures. And make 00:27:56.960 --> 00:28:00.359 sure we keep the messaging positive as well about 00:28:00.359 --> 00:28:03.500 what you can do. Supervision, you know, exercising 00:28:03.500 --> 00:28:06.039 with the coach, watching you, making sure you've 00:28:06.039 --> 00:28:08.940 got the correct technique, correct load progression 00:28:08.940 --> 00:28:12.240 and intensity. That's really important as well. 00:28:12.400 --> 00:28:14.579 So yeah, I guess just keep doing what you're 00:28:14.579 --> 00:28:16.940 doing. Coaches always try and keep learning more, 00:28:17.019 --> 00:28:19.500 particularly if it's an area that you might not 00:28:19.500 --> 00:28:21.859 know a lot about. And there's heaps of good resources 00:28:21.859 --> 00:28:24.859 out there. well. Anything special coaches should 00:28:24.859 --> 00:28:27.660 be aware with postmenopausal women? I guess also 00:28:27.660 --> 00:28:30.960 maybe check what other kind of medical conditions 00:28:30.960 --> 00:28:33.500 and medications they might be on, particularly 00:28:33.500 --> 00:28:36.740 if they are on any of the anti -osteoporosis 00:28:36.740 --> 00:28:38.819 medicines. That's probably something important 00:28:38.819 --> 00:28:41.680 to keep in mind, particularly if they decide 00:28:41.680 --> 00:28:44.480 to discontinue any of those, just to keep a check 00:28:44.480 --> 00:28:47.859 on everything and make sure they don't have any 00:28:47.859 --> 00:28:50.500 change in their symptoms or any other pain or 00:28:50.500 --> 00:28:52.619 niggles that are kind of on. going that might 00:28:52.619 --> 00:28:55.200 need some further investigation, but generally 00:28:55.200 --> 00:28:57.880 I think everyone should be doing resistance training 00:28:57.880 --> 00:29:00.480 and strengthening their bones and muscles. People 00:29:00.480 --> 00:29:03.380 might not realize that exercise can improve your 00:29:03.380 --> 00:29:06.039 bone density. There's still a lot of people in 00:29:06.039 --> 00:29:09.160 the clinical space and a lot of patients that 00:29:09.160 --> 00:29:11.799 think that their bone density will never be improved 00:29:11.799 --> 00:29:14.440 with anything but medication. So it's important 00:29:14.440 --> 00:29:17.160 for coaches to know that exercise can improve 00:29:17.160 --> 00:29:19.759 your bone density, which is key. Awesome. Thank 00:29:19.759 --> 00:29:21.809 you. Two short questions. To finish, the first 00:29:21.809 --> 00:29:24.930 one is what is your favorite exercise, like specific 00:29:24.930 --> 00:29:27.990 exercise in the gym for you? What do you like? 00:29:28.150 --> 00:29:32.410 I really like a deadlift. I really love any row, 00:29:32.609 --> 00:29:35.269 anything row related. I used to love training 00:29:35.269 --> 00:29:38.410 back in the gym. So I love the bent over row 00:29:38.410 --> 00:29:40.650 that's just with a barbell. It feels so good. 00:29:40.789 --> 00:29:43.109 I haven't been in the gym as much lately, but 00:29:43.109 --> 00:29:45.309 I'm hoping I'll get back in there and I'll be 00:29:45.309 --> 00:29:47.670 deadlifting and rowing. Awesome. Where people 00:29:47.670 --> 00:29:50.450 can find you online if they want to follow? We 00:29:50.450 --> 00:29:53.509 will ask a question. Where should they go? Yeah, 00:29:53.549 --> 00:29:56.650 I'm on Twitter. I'm not particularly active, 00:29:56.789 --> 00:29:59.789 but if you shoot a question or you follow me 00:29:59.789 --> 00:30:03.710 there, so Amy underscore T underscore Harding. 00:30:04.069 --> 00:30:06.190 I've got my photo there too, so you'll be able 00:30:06.190 --> 00:30:08.869 to see the bright red hair in the picture. It 00:30:08.869 --> 00:30:11.410 should be easy to find. Generally, if you wanted 00:30:11.410 --> 00:30:14.150 to find me, you can just search Griffith University. 00:30:14.509 --> 00:30:16.829 And if you pop my name in, it should take you. 00:30:16.869 --> 00:30:18.670 We have like a little kind of staff research 00:30:18.670 --> 00:30:21.200 page. And that should have my email address on 00:30:21.200 --> 00:30:23.720 there too. Yeah. So you just feel free to reach 00:30:23.720 --> 00:30:25.900 out. That's pretty much it. Twitter and emails. 00:30:26.079 --> 00:30:28.119 That's where you'll find me. Awesome. That's 00:30:28.119 --> 00:30:29.859 enough. Thank you so much, Amy. It was a pleasure. 00:30:30.000 --> 00:30:33.279 Thanks, Alex. Great to have a chat and everyone 00:30:33.279 --> 00:30:35.119 keep exercising. Yes.