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Can you be Healthy at Every Size?

Can you be Healthy at Every Size?

by Molly Gries, PT, DPT

Have you ever been given this advice? “If you lose 10 pounds, your knees will not hurt as much,” or “Before you begin a running program, you need to lose weight.” Wait, what?? Is this true? Is a number on a scale the sole determinant of your health or a true limiting factor on being active? While science suggests there is no such thing as “healthy obese,”1 think of it this way: It is not that your weight does not matter. It is just that it is not the only thing that matters. The goal of a healthy weight is living a life that balances the amount of energy you input (eating) to the energy you expend (exercise).2

Health at Every Size

What is Health at Every Size?

The Health at Every Size movement (HAES) promotes acceptance and appreciation of one’s body, even if you’re overweight. It encourages overweight people to shift their focus from losing weight to other healthy habits, such as eating healthy foods and getting more physical activity and exercise.

Weight is Just a Number

The number on the scale does not tell the whole story about your health.  Measures of weight are not highly correlated to health.3,4,5  Body mass Index (BMI) measures a ratio between your height and weight. The number on the scale and BMI do not consider body composition. A very muscular person may have a BMI that is considered overweight or obese. On the flip side of the coin, someone with a low BMI may still have a high amount of visceral fat—the so-called “skinny-fat” phenomenon—which increases disease risk. It is worth pointing out that the conventional criteria for healthy body weight are based primarily on Caucasian body types and may not be appropriate for all races and ethnicities.6 In a culture that values thinness and lean bodies, it is easy to think you can only be healthy at a lower weight. This is simply not true. In fact, research shows that being thin is not a safeguard to disease or painful conditions. 4,7

Let’s Focus on Something We Can Change

Being healthy is a choice driven by habit. You can truly be healthy at any size and people are healthy at every size. Your body can still heal, and you can have less pain without losing 10 pounds. You can start a new activity and hobby without being a certain weight. Treating your body with respect and appreciation must come first and optimizing your health habits does just that. 

Your body weight is affected by many variables, including genetics, nutrition, and physical activity.  While we cannot change genetics, we can change our habits. One goal should be to eat enough calories to sustain you while eating a well-rounded diet that is rich in fruits, vegetables, lean proteins, and low in high-processed food. Another goal is to engage in some form of physical activity daily to average at least 150 minutes a week of moderate-intensity aerobic activity. And don’t forget about getting adequate sleep (8 hours a night on average) and staying hydrated (about 8 glasses of water a day).  Optimizing health habits affects your pain experience and ability to function in your daily activities and roles in life far more than a set number on a scale.5

How does your bodyweight affect your pain complaint?

When evaluating injury or persistent pain, it is important to determine underlying root causes.  Often, sedentary activities or doing repetitive activities with little to no variety contributes to sensations of pain more than how much you weigh or what the scale says. Most sensations of pain start to feel better when walking or moving versus sitting still. Though often blamed for the onset or persistence of pain, specifically prescribed exercise and physical activity has been shown to relieve pain.7 Your weight did not change because you walked around the block, but your experience of pain may have lessened. This shows that your bodyweight may not be correlated to your experience of pain.  However, it can be daunting to start a new activity and difficult to figure out the first steps. This is where your Doctor of Physical Therapy can help. Physical therapists educate and guide you in starting an exercise program aimed at reducing pain through education and training in optimal loading and movement patterns and working collaboratively with you to create baseline fitness to achieve your movement and fitness related goals. This can be as simple as a guiding you through a progressive walking program with optimal loading patterns, and progress to a more complex and comprehensive program that includes strength training, aerobic activity, stretching, mindful meditation, and tips on nutrition and sleep hygiene. A Doctor of Physical Therapy specializes in movement and pain science and can help you confidently and safely reach your fitness goals.

Being as healthy as you can be at your current size may also be a bridge to being healthy at a healthier size in the future.

In a society that is biased against being overweight, HAES philosophy offers a valuable and needed perspective. It is not that your weight does not matter. It is just that it is not the only thing that matters—in terms of your health, but also in terms of your value and rights as a human being.

If you’re overweight, losing weight would probably decrease your risk of various diseases, especially if you go about it in a sane and sustainable way, but following HAES philosophy, the focus should be on optimal health versus weight.  Find activities that bring you joy and that you will follow consistently. Eat food that makes you feel good and that you enjoy. Starting a new exercise or activity does not mean you have to be perfectly pain-free and good at it right away. It is better to start with small steps and ask for help from a trainer, coach, or your physical therapist. Most importantly, being healthy is about feeling good about yourself. You can truly be healthy at every size.8

“Everybody can do amazing things, regardless of the number on a scale.

Take a moment and appreciate all that you can accomplish.”


  1. Kramer CK, Zinman B, Retnakaran R. Are Metabolically Healthy Overweight and Obesity Benign Conditions?: A Systematic Review and Meta-analysis. Ann Intern Med. 2013;159(11):758–769.
  2. Worsfold, K. A., & Sheffield, J. K. (2021). Practitioner eating disorder detection: The influence of health mindset, thin-ideal internalization, orthorexia and gender role. Early intervention in psychiatry15(2), 296–305.
  3. Body Mass Index: Considerations for Practioners. (n.d.).
  4. Dias Neto, D., Mourinho Baptista, T., Marques, C., & Sousa Ferreira, A. (2020). The role of weight perceptions and their impact on health and well-being: A multiple mediation model. Clinical obesity10(4), e12362.
  5. S. Department of Health and Human Services. (n.d.). Maintain a Healthy Weight. National Heart Lung and Blood Institute.
  6. Ethnic Differences in BMI and Disease Risk. Harvard TH Chan School of Public Health, Harvard University.
  7. Louw, A. (2013). Why do I hurt?: a patient book about the neuroscience of pain. Orthopedic Physical Therapy Products.
  8. Penney, T. L., & Kirk, S. F. (2015). The Health at Every Size paradigm and obesity: missing empirical evidence may help push the reframing obesity debate forward. American journal of public health105(5), e38–e42.


Online Fitness Recommendations – Stuck at home? Workout online!

Online Fitness Recommendations

by Terri Sullivan, PT, DPT, Orthopedic Clinical Specialist



You’re at home due to COVID-19.  You’re going stir crazy.  You can’t go to the gym.  You’ve been exercising outside acknowledging the 6 foot social distancing rule, but you want something more.  Something you can do at home when the weather is crummy or it’s dark outside.  Here are several blogs and free apps that are available to help keep yourself active and in shape. 

This was recently recommended to me by a fellow practitioner and they thought the women who created it does a great job with providing several levels and modifying exercises to help those remotely.  Initially, it’s free, but you can pay for more. 


This is also a more female based workout app and you have to pay to sign up, but they have several options depending on your needs. 


7 Minute Workout
I’ve had several patients recommend this app to me.  Granted, you have lots of time right now, but this is a great way to fit exercise while working from home and taking care of family matters.  Oh, and it’s free! 


Are you lonely at home and want to feel a part of an exercise community?  This is another great exercise app that is also free and has options to pay for more services. 


As for yoga, here is one app and one streaming option: 

Down dog
This is a wonderful, free app that I’ve recommended to many patients.   You can choose the level of expertise, the length of time you have, the type and what you want to target.  It’s awesome because you can download it on your phone and do it anywhere! 


Yoga with Adriene
I stream this women’s website often for my own practice and I recommend this all the time.  She is very mindful about cues, she goes slow, and there are a multitude of free videos available online.   Plus, I love her dog Benji! 


Stay healthy and safe out there!   


I Want to Ride My Bicycle – Commuting tips for bike month

I Want to Ride my Bicycle

By Julianne Simpson


Each year as May and Bike Month arrive, I am so excited to see more cyclists out on my morning and evening commutes. I love seeing their new clothing, new bikes and encouraging them to overcome their nervousness on their first bike commutes of the year.

I’ve been communing to and from work on a bicycle year-round for the last 15 years or so and people often ask me about what you might need to start commuting. I used to say that you really just need a bike and a helmet, but now thanks to bike share services like Lime and Jump, you don’t even need a bike!

If you have your own bike, having a proper fit is critical to keeping your knees, back, neck, etc happy and healthy. Terri Sullivan, PT, DPT, OCS offers bike fittings at our Seattle location. Give us a call to schedule one!

For the basics beyond a bike and helmet, keeping the water off you and off your stuff is an important consideration. For keeping water off my stuff, I love waterproof panniers, bags that you attach to a rack on your bike. A waterproof messenger bag or backpack is also great but they will give you a sweaty back. As to keeping yourself dry, there are two ways to go. One is with rain gear that goes over your clothes, the other is with warm clothes that can get wet and dry clothes to change into at work.

Being visible to other road users is also critical. I have always loved to have double lights, that way if one light loses power, you’ve got another to cover you. That means I have two front lights and two back lights. A lot of cyclists wear safety vests, some of them even flash.

Even if you are not participating on a bike month team through Cascade Bike Club, it’s fun to get out and explore Seattle’s bike trails and growing collection of Neighborhood Greenways and Protected Bike Lanes (City of Seattle Bike Map). Venturing out of Seattle is also fun. King County has maps of their trails. Washington Bikes has a large collection of maps as well.

City biking skills are also critical to learn and practice to stay safe on city streets. Classes are available for both adults and kids through Cascade Bike club. If you are feeling unsure about how to ride safely in an urban setting, Cascade Bike Club even offers an Urban Commuting Class for adults. Pedalheads and Cascade both offer classes and camps for kids.

Bike Month is great time to get (back) on a bike. Come say hi today, May 17, 2019 at our Bike Day station in front of our new location, 1200 Westlake from 4p-6p. We will have snacks, tunes and fun stuff!


Julianne Simpson, DPT, holds a BA from Oberlin College and a Doctorate of Physical Therapy from Eastern Washington University. A general orthopedic and pelvic health therapist, she is passionate about helping people move more and empowering her patients to live healthier lives. She dreams of raising kind children, cycling over the Alps and surfing in Alaska.

Texts4Mom – Happy Mother’s Day!

Texts4Mom – Happy Mother’s Day!

by Bridget Dwyer

Happy Mother’s Day! This week, we invited our friend from Fit4Mom Seattle, Bridget Dwyer, to write a guest blog post about motherhood, community and being active. Movement Systems physical therapists are here to support you in your active life. Our PTs can help you with incontinence, pelvic pain, diastasis rectus abdominis and a whole host of other issues. Enjoy her post!

One of my favorite texts every Mother’s Day is the group text from my mom friends.  Every year, we take a moment to wish each other a Happy Mother’s Day.  And every year, we get a chance to think about how lucky we are to have found our little village.  Motherhood isn’t meant to be done alone.  It’s not a solo sport, it’s a team.  Behind those key players of partners and family, your Village is your backup.  Your 6th man on the bench. The women you text when you are Just. Going. To. Lose. It. Today.  The ones who you ask what the hell to do about hemorrhoids because everything you Google looks scary and you’re too embarrassed to ask anyone else.  The ladies who have seen you at your most hormonal and pregnant and are STILL your friends.

To me, the absolute best part about Motherhood (aside from my actual children) is the people that it’s brought into my life.  I found my Village in a Stroller Strides class and in a Run Club. On those early morning stretches of concrete, with no phones to distract us, and no kids to chase after, we had the chance to just be ourselves, and to connect with each other.  Other friends found their Villages in their Co-Op preschool, as they worked together.  We know that Motherhood can feel isolating, to be stuck at the mercy of a baby’s schedule and needs.  It’s a time in our lives when it can feel extra hard to put ourselves on the priority list, behind all of those things we *should* be doing.  And it’s okay.  Friendship happens when we are accepted for who we truly are.  When we open up and let someone in.  Motherhood, which was so lonely at first, became my doorway into a Village of women that I cherish.  Find your people.  And send them a text on Mother’s Day to say “Thanks for being my Village”.

Bridget Dwyer: Boy mom, FitPro, runner.  Forever chasing down my wild and crazy dudes.  Come join me on the trail or in a FIT4MOM workout.

5 Reasons Why You Should Try Pilates

5 Reasons Why You Should Try Pilates 

Guest Blog by Allison Moss

Before I share Allison’s awesome blog post, I want to thank her and Club Pilates on Mercer Island for opening up their doors to us.  As a physical therapist, I am always trying to find ways for patients to either become more active or to diversify how they move to maintain a healthy movement system. Pilates is a great option, and Allison does a great job of explaining more…

Take it away, Allison.

Pilates has blown up in the U.S. these last few years and it has everyone wondering what it is about this system that has people flocking into the studios. Pilates is a progressive approach to modern-day fitness that helps people from all walks of life come into the studio with confidence that their instructor will know how to safely and effectively give them the best workout for their body. Whether you are dealing with an injury, recovering from a surgery or just wanting to add in another form of exercise; Pilates has you covered! So, let’s take a look at a few reasons you should consider trying Pilates.

  1. Pilates focuses on the powerhouse, which is the core and back muscles or the midsection of your body. These muscles initiate and support our every movement and also help to protect our spine by strengthening the muscles that surround it. The Pilates Method develops a significantly strengthened core through specifically targeted exercises using fun and integrated techniques to challenge you with every class.
  2. Pilates is a gentle workout that isn’t going to harm the body which is mainly done on an apparatus called a Reformer. The Reformer is a bed like structure and has a carriage that is on wheels and uses resistance via springs connected underneath. Laying down and being able to work out horizontally allows you to use a resistance that is lighter than your body which is very useful for anyone going thru physical therapy or with any medical conditions.
  3. Pilates provides a full-body workout, making sure that you leave every class feeling balanced, energized and focused. Paying attention to all planes of the body, Pilates offers a whole-body commitment in every class. Connecting your mind and body to each exercise helps you understand how and why you benefit from Pilates exercises and keeps you coming back for the same good feeling every time you leave.
  4. Pilates instructors really know their stuff. A major requirement for instructors is that they know anatomy and have knowledge of injuries and medical conditions and how Pilates can help with each one. They look at the why behind each exercise and provide safe progressions for those who are ready by layering on their exercises, this means by starting with the basic foundations of the movements and adding on progressions so that everyone gets the work out they are looking for.
  5. Every class is a new experience. Pilates instructors strive to bring new innovative techniques to keep the classes fun, engaging and challenging while still keeping all the original concepts and principles. Awareness, breath, control and efficiency play a huge part in every exercise and while they keep things fun and new these are always the upmost focus of each class.



Hamstring tightness? Should you be stretching or strengthening?

Hamstring tightness? Should you be stretching or strengthening?

Corley McBeth, DPT

Many people struggle with hamstring ‘tightness’ despite regular, sometimes daily, stretching. The tightness never seems to go away. Let’s talk about why this is happening and what you can do about it.

The hamstrings are comprised of three muscles: the semimembranosus, semitendinosus and biceps femoris. They are the primary bulk of muscle on the back of the thigh – originating on your ischial tuberosity (or “sits bone”) and running down behind the knee, where they attach on the bones of the lower leg (the tibia and fibula). This means that the hamstrings cross two joints, the hip and the knee. They are the primary flexors of the knee joint (meaning they bend the knee), as well as secondary hip extensors (meaning they help straighten the hip). The hamstrings also assist in providing rotational control at the knee, in addition to pelvic stability due to their anchoring role at the ischial tuberosities. They also play a role in deceleration when they contract eccentrically (meaning they are contracting while lengthening). This serves to slow the rate of knee extension, such as when you are trying to slow down from running to walking.

When we are focusing on stretching a muscle, it is important to differentiate muscle ‘shortness’ from ‘tightness.’ True muscle shortness is a structural issue related to a decrease in the length of the muscle fibers. Muscles become shortened due to immobilization or disuse, most often associated with casts/braces or non-weight bearing status following an injury and/or surgery. When muscles have shortened in this manner, it is called a contracture.

Muscle ‘tightness’ on the other hand, is neurologically driven and is a sensation associated with a muscle remaining in a contracted or tense state. Often the muscle is receiving input telling it to contract because the body is trying to generate stability. The nervous system may be increasing tone in the muscle as a protective response. The sensation of tightness might lead us to believe we need to stretch that muscle; however, providing input that stabilizes rather than stretches will likely be more effective in these situations.

“Muscle ‘tightness,’ on the other hand, is neurologically driven and is a sensation associated with a muscle remaining in a contracted or tense state.”


In many individuals experiencing ‘tight’ hamstrings, the hamstrings may actually be relatively overlengthened for optimal performance of a specific task. To improve postural control at the pelvis and/or knee, the nervous system will send excitatory input telling hamstrings to contract.  Without sufficient tension in the hamstrings (force production), the movement strategy for a particular task will be achieved through compensatory strategies impacting the performance of other muscles such as the abdominals, back extensors, hip flexors, etc. For example, consider lifting a heavy object from the floor using a hip bending strategy (i.e. deadlifting).  Without sufficient tension from the hamstrings, back extensors will create more compression on the spine.  One can debate whether this is good or bad for the back.

“Tight” muscles, despite the fact they are remaining in a relatively contracted state, are not necessarily strong muscles.  It may mean strengthening is the best course.

If you experience chronic hamstring ‘tightness,’ or have a history of hamstring strain and/or low back pain it is recommended to seek out a physical therapist for a formal evaluation. Expert advice based upon your specific experience and goals is very effective. An individualized assessment will help to address your mobility, stability, and overall movement patterns, which will increase the effectiveness of your stretching and strengthening routine.

Corley McBeth, DPT

Benefits of Aerobic Exercise

 Aerobic Exercise and Benefits of Walking

By Kendall Wisehart DPT, ATC

What is aerobic exercise?

  • Simply put aerobic exercise or “cardio” is activity that requires increased activity of the heart to pump oxygen rich blood the muscles.
  • Examples include walking, running, hiking, and swimming
  • Aerobic refers to “with oxygen” whereas anaerobic refers to “without oxygen”


  • Mental benefits include increased confidence, emotional stability, memory and brain function
  • Physical benefits include strengthened heart and lungs, lower cholesterol, improved immune function, and lower blood pressure – among many others!
  • Fitness benefits include improved muscle tone, stamina, and energy levels for both work and play

Disease Prevention (via ACSM)

  • Seniors who walk 6-9 miles/week are less likely to suffer from mental decline as they age, including dementia
  • Walking 30 minutes/day, 5 days/week, along with diet changes, can halve the risk of Type II Diabetes
  • Walking 30 minutes/day, 5 days/week can halve the risk of heart disease and reduce stress, cholesterol, and blood pressure
  • Walking can reduce pain and improve function, mobility, mood, and quality of life without worsening symptoms for those with arthritis
  • Walking triggers endorphins, promotes relaxation, and can help prevent anxiety and depression

Walking 30 minutes/day, 5 days/week can halve the risk of heart disease and reduce stress, cholesterol, and blood pressure

Other benefits of walking (via ACSM)

  • Walking 45 minutes/day halves your odds of catching a cold
  • Walking 1 minute can extend life by 1.5 to 2 minutes
  • Walking 20-25 minutes/week can extend life by several years!

How do I get started?

  • If you have health issues – talk to your doctor and ask to see a physical therapist
  • Choose an activity that you enjoy. It can be as easy as walking or gardening or as intense as hiking or running
  • Find a friend! Having the support of a friend of family member will help keep you going

How much should I do?

  • For most healthy individuals: 30 minutes, 5 days a week of moderate intensity aerobic exercise OR 20 minutes of high intensity aerobic exercise
  • A quick way to gauge intensity is Target Heart Rate. To calculate: 220 – (your age) x 70%. Example: 220 – 45 years old x .70 = 122.5 beats per minute (bpm)
  • You should be able to carry on a conversation with your walking partner without shortness of breath

Can I over-do it?

  • Absolutely! Just like a sedentary lifestyle, overactivity can have its own negative consequences like injury and reduced immune function
  • Developing a consistent exercise routine is key in preventing over-training, this includes rest days
  • A workout or training session is only as effective as how much you can recover from it

What’s considered “in-shape”?

  • Everyone will have their own unique definition of fitness, related to their fitness goal
  • A lower resting heart rate is just one indicator of fitness, normal RHR is 60-100 bpm

Other biomarkers like blood pressure and cholesterol may be used to determine fitness


Kendall Wisehart DPT, ATC Bio

Mood Disorders and Exercise

 Mood disorders: Does exercise matter?

By Kendall Wisehart DPT, ATC

In physical therapy, it’s easy to get caught up in the physicality of it all – muscles, bones, joints, biomechanics, and our favorite, physics. Unfortunately, what doesn’t get this well-deserved attention are the non-physical benefits, the mental and emotional benefits. Specifically, when examining mood disorders such as depression and bipolar disorder studies found that exercise impacts both physical and mental health outcomes. Exercise also positively affects conditions frequently associated with mood disorders such as anxiety, pain, and insomnia or other sleep disturbances.

Several mechanisms have been proposed for the anti-depressive effects of exercise, which can be divided into two categories – psychological and biological. Psychological variables include increased feelings of control (autonomy), physical wellness, quality of life, improved self-esteem / mood. Biological variables include several growth factors, oxidative stress, and genetics and their role in exercise-induced neurogenesis and anti-depressive effects.

“Studies have shown that after several weeks of moderate intensity exercise, oxidative stress and pro-inflammatory markers are decreased.”

Most of the recent work related to the anti-depressive effect of exercise and biological makers has focused on the role of BDNF or Brain Derived Neurotrophic Factor. By definition, BDNF supports neurogenesis or the growth of neurons. In fact, antidepressant medications up-regulate BDNF and patients with mood disorders exhibit lower levels of BDNF compared to their healthy counterparts. Simply put, BDNF may be the primary mechanism of the anti-depressive effects of exercise. While BDNF is important enough to have it’s own dedicated blog post, what’s important to know is that BDNF is essential in nerve survival, growth, and pathological levels of BDNF may contribute to psychological disorders and chronic pain sensitization.

Exercise may also impact oxidative stress. We’ve all heard the term anti-oxidant and generally accepted it as a good thing. Without going into the specifics of cellular (mitochondrial) energy production, it’s important to understand that oxidation is a normal part of the energy production system of the cell. In the absence of anti-oxidant defense, oxidative stress and cellular damage can occur. Fortunately, exercise can impact oxidative stress. This is especially important for those with mood disorders in which there are increases in inflammation and oxidative stress. Studies have shown that after several weeks of moderate intensity exercise, oxidative stress and pro-inflammatory markers are decreased. On the flip side, high intensity exercise increased oxidative stress. The summary here is simple, a balance of exercise intensity is key when achieving both physical and psychological benefits of exercise.

Finally, based on recent research, exercise has been associated with epigenetic changes that are beneficial for those with mood disorders. Epigenetic changes refer to changes in gene expression without an actual change in DNA sequence. For example, BDNF can be upregulated through these types of exercise induced changes. It has also been suggested that exercise promotes epigenetic changes that promote homeostasis, neuroplasticity, circadian rhythms, and endocrine and immune regulations.

Others have suggested that exercise induced epigenetic changes can reduce the aging process and have beneficial effects on the musculoskeletal system across the lifespan.

Exercise may be an acceptable alternative or adjunctive therapy to enhance mood, functioning, and co-morbid conditions for individuals with mood disorders. Overall, there is promising evidence to support the use of exercise in the treatment of mood disorders. Future research will focus on specific frequencies, durations and types of exercise for specific mood disorders.

For now, balance is key and something is always better than nothing – even a short walk can have it’s benefits (see upcoming post).


Kendall Wisehart DPT, ATC Bio


High Intensity Resistance Training for Osteoporosis: Are we playing it too safe?

High Intensity Resistance Training for Osteoporosis:

Are we playing it too safe?

By Carrie Hall PT, MHS


The CDC and Surgeon General, along with many researchers1 have proposed that exercise plays a role in prevention and treatment of osteoporosis, but the effect has been perceived to be moderate at best. Debunking this myth, a preliminary study in Australia has shown that high-intensity resistance and impact training (HiRIT) may improve bone and muscle strength in healthy postmenopausal women with osteoporosis.2

Maybe we have been playing it too safe?

It is known that bones respond preferentially to high magnitude weightbearing loads, but most physical therapists prescribing exercise are hesitant to apply high loads to persons with osteopenia (thinning bones) or osteoporosis (low bone density) for fear of risk of injury or fracture. This study aimed to demonstrate that high intensity resistance and impact loading is both safe and effective in improving bone mass and overall physical function.

What did this study do differently?

Researchers analyzed data from the larger Lifting Intervention for Training Muscle and Osteoporosis Rehabilitation (LIFTMOR) Trial on 101 postmenopausal women age 58 or older. For eight months, half of the women did twice-weekly 30-minute sessions of supervised HiRIT that included deadlifts, overhead presses, squats and jumping chin ups with drop landings. The other half formed a comparison group, and for eight months they did unsupervised, twice-weekly 30-minute low-intensity exercise at home.

The graduated loading, close ongoing supervision, and focus on correct technique were key to safety and overall adherence to the program (low drop-out rate). The 2 time per week dosage was also very appealing to this demographic leading to high compliance (participating with expected dosage).

All the participants had bone mineral density testing with a special type of X-ray called a DXA scan before and after the eight-month training program to assess changes in their bone mineral density (BMD), or bone health, at the spine and the femoral neck at the very top of the thigh bone that connects the long bone to the head of the femur.

By the end of the study, the HiRIT participants increased BMD in their spines by an average of about 3 percent and increased hip BMD by 2.2 percent. In the comparison group, women lost an average 1.2 percent of spinal BMD and lost more than 2 percent at the hip, researchers report in the Journal of Bone and Mineral Research.

The benefits of bone density improvements at the femoral neck and spine translate into stronger hips and backs. Women in the resistance group also had a 40 percent improvement in back and leg extensor strength, which helped improve their posture and reduce their risk of falls.

Close ongoing supervision is key!

The researcher of this study felt this demographic has traditionally been held back from high intensity resistance training for fear of fracturing fragile bone with heavy loading, but that this overly conservative approach has led to stagnation in the field. This study demonstrates preliminary evidence for safety and effectiveness of a HiRIT program for otherwise healthy postmenopausal women with low to very low bone mass.

Key to the success of this program is that HiRIT training should be supervised by adequately trained and educated professionals such as a physical therapist, to ensure correct technique and appropriate progressions, as well as to minimize injuries.

WE DO NOT RECOMMEND INDIVIDUALS WITH LOW BONE MASS TO UNDERTAKE THIS PROTOCOL IN AN UNSUPERVISED ENVIRONMENT, even after notable training, because it is not possible to self-monitor technique or self-prescribe dosage.

Despite misconception to the contrary, high intensity resistance training can be safe and has proven to be effective in improving bone mass.

Consult your PT if you are interested in beginning a program such as this.

Happy lifting!


  1. Howe TE, Shea B, Dawson LJ, et al. Exercise for preventing and treating osteoporosis in postmenopausal women. Cochrane Database Syst Rev. 2011(7):CD000333.
  2. Warson SL, Weeks BJ, Weis LJ, et al. High-intensity resistance and impact training improves bone mineral density and physical function in postmenopausal women with osteopenia and osteoporosis: The LIFTMOR Randomized Controlled Trial. JBMR. 2017.


Carrie Hall PT, MHS – President