Strong Women, Strong Bones: my book report

Sorry about the length.  I was debating trimming out more, but I
decided that if there was much discussion I would need to track
down the edited portions and restore them in what would be a
disjointed manner.

My book report on Strong Women Strong Bones by
Miriam E. Nelson, Ph.D.

By and large, it was better than I expected.  It is a little dated
(Actonel hadn't been approved yet, and the problems with
HRT were minimized), but that is to be expected of any book
due to publishing lead times.

I do, however, take exception to the information on exercising.
The major faults that I noticed are as follows:

 I. Aerobics:
    A.  The book isn't clear on how to get most benefit for
        your bones. This, in turn, makes it more difficult
        to choose and aerobic activity that also stimulates an
        increase in bone density.
    B.  She doesn't explain the interrelationship of several
        factors:
        1. Changes in bone density are usually small. Results
           of a change may not show up for two or more years.
        2. The standard error in DEXAs can obscure small changes
           (she notes that the standard error is 1%.  Actual
           test have shown it to be closer to 3%)
        3. Most of the time an exercise routine is tested, it
           is for a short time, so factors (1) and (2) above
           will tend to hide the results.  [I suspect this is
           what happened when she tested walking for changes in
           bone density]
    C.  She doesn't seem to realize that the body will adapt to
        a given set of requirements and stop adapting until the
        stimulus is changed. [which may be another reason she
        didn't see any benefit from walking.]
    D.  The "maximum heart rate" and "target heart rate" are not
        explained well, so they are not likely to be used properly.
        (basically, the "maximum heart rate" [220 - age] is the
        result of studying a bunch of people, and doing some
        statistics on the results. The equation [220 - age] is
        good for a large percentage of the population, but will
        be high (dangerous) for some people, and low for others
        (resulting in a lower level of exertion than the person
        could do safely).
    E.  She doesn't do a good job of explaining how to take your
        pulse.  Basically, she suggests counting for 15 seconds
        and multiplying by four.  The better shape your cardio-
        vascular system is in, the faster your heart rate will
        drop after exercise. A fit person can't use a 15-second
        count because the pulse rate will drop quickly enough to
        make it inaccurate.  The shorter the count, though, the
        less accurate it will be because of the pulse that was
        just missed (so in an unfit person, a 15 second-count
        will be more accurate than a six-second count).
    F.  Because of (D) and (E), the exercise intensity scale she
        mentions is a far better way of controlling the level of
        effort.

II. Strength training program
    A.  Major flaw:  the exercise routine is oriented towards
        someone who is in poor condition and will gain muscle
        sloooooowwwwllllllyyyy, if at all (think at least in their
        70's, more likely 80's to 90's), but doesn't state this.
        If someone who doesn't have the limitation tries to make
        use of her routine, they will be severely limiting how
        much they can advance.
        1.  The wide leg squat goal for a 20 - 49 year old male to
            work towards squatting without touching a chair while
            holding 8 to 12 lb dumbbells.  I'm a below average male
            (as far as physical strength goes), but when I started
            squatting it took me less than five weeks to squat with
            135 lbs on my back.  And I was going four to five inches
            lower than I would if I was using a chair as they suggest
            (the lower you go, the harder it is).  Note that I was in
            my 40's when I started this.
        2.  The goal for a 20 to 49 year old woman doing a front lunge
            is to use 5 - 10 lb dumbbells.  This is what I see women
            starting at when they are doing it in the gym.
        3.  She says to limit the ankle weight to 20 lbs and the dumbbells
            to 25 lbs.  This may be true for someone who has severe
            osteoporosis or has joint problems (it is not my area of
            expertise), but it is pure crap for someone who is young and
            healthy.  And she is acting as though her advice applies to
            men and women in their 20's.
    B.  She doesn't explain how to progress to a heavier weight.
        (She says do eight reps.  When it is easy, increase the weight).
        Initially, most of the increase in the weight that a person
        can lift comes from neurological gains (basically, your body
        learns what you are trying to do and gets more efficient at
        it), letting you increase weight easily.  Once you have gotten
        past this point, it won't ever become "easy" to do eight reps
        with a weight unless you progress by doing more reps and then
        increasing the weight and cutting back reps (in other words,
        start with eight reps and work your way to 12 reps.  When you
        can do 12 reps in good form, increase the weight and drop back
        the reps.  Or, start with five reps and work your way up to
        eight.  Once you can do eight, increase the weight and drop the
        reps).
    C.  She seems to think that the mere presence of muscle will
        increase bone density.  If so (and it sounds reasonable to me),
        then limiting weights to 25 lb dumbbells virtually eliminates
        gains to the larger muscles (for younger and middle-aged people)
        as they will adapt to 25 lbs fairly quickly.  And, after that,
        there wouldn't be any stimulus to increased bone density.  She
        ignores the stresses from lifting the weights themselves when
        determining which exercises to recommend, reducing the potential
        benefits of the program.
    D.  Rough judgment of exercises (note that the following ignores her
        maximum weight recommendations):
        1.  wide leg squat:  good exercise for increased bone density.
        2.  step-up: good for legs.  I don't know if it is as good for
            the spine as a squat (you can hold far more weight with a
            squat, but there isn't any impact like there is with the
            step-down portion of a step up.  On the other hand, proper
            lunge technique minimizes the impact on the step down).
        3.  seated overhead press:  adequate for the spine.
        4.  forward fly: poor.  The movement is not against gravity.
            Instead, there is a static hold (which does resist the pull
            of gravity) combined with a movement that is essentially
            perpendicular to the pull of gravity.  The static portion of
            the exercise limits how much weight can be lifted and the
            resulting amount of muscle that is grown.
        5.  wrist curl:  OK for it's purpose.
        6.  back extension:  OK for a beginner.
        7.  Abdominal exercises:  OK for a beginner.
        8.  side leg raise:  poor.  Due to the leverage involved,
            relatively little weight is involved, minimizing stress to
            the skeleton.  In addition, it isn't balance by developing
            the inner muscles (adductors) (lifting the leg on the floor).
            Note that if a wide legged squat is done, both adductors and
            abductors are exercised because they must hold the knees
            steady.  Also note that the main reason for the popularity
            of both hip abduction and hip adduction exercises is the
            mistaken belief that it is possible to burn fat from the hips
            and inner thighs (aka spot reduction).
        9.  standing calf and toe raise:  could be good if weight is
            involved.  As presented, she starts with a calf exercise and
            tibialis anterior (front of the shin) and, when they aren't
            challenging anymore, switches to just a tibialis anterior
            exercise (push and pull toes) while calling it a calf
            exercise.  Instead, she should discuss adding weight to the
            movement.
       10.  chest press:  could be good if there was discussion of how
            to get the weights into position if you aren't strong enough
            to do a biceps curl to get the weight into position (which is
            common)
       11.  biceps curl with rotation:  could be good.
       12.  front lunge:  could be good, with discussion of how to do
            heavier weights.  Some impact from taking steps, although
            probably not much.
    E.  She states that one of the pluses of using machines is
        that it will hold you in the proper position.  While this
        is true if the machine is designed for someone of your height
        (and torso length and leg length, etc), it is not true if the
        machine can't be adjusted to your body.  And many (I think
        the vast majority, but I don't have any numbers) machines are
        designed to fit a male in his 20's because, until relatively
        recently, he was the primary weight lifter in the gym.  Women
        did aerobics, etc. but rarely touched a weight.  A machine
        that can't be adjusted to your body can cause long-term joint
        damage.

Art