The Show Up Fitness Podcast

How to train a client w/ Osteoporosis | Become a Trainer in Santa Monica / Atlanta

• Chris Hitchko, CEO Show Up Fitness • Season 2 • Episode 217

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Your bones are constantly changing. Beneath the surface, specialized cells called osteoblasts build up bone tissue while osteoclasts break it down. This delicate balance shifts as we age, with breakdown eventually outpacing construction—especially in women after menopause when estrogen production decreases. The result? Weakened bones vulnerable to fractures that can dramatically reduce quality and length of life.

The good news? Osteoporosis is 100% reversible. But not through the gentle exercise most people associate with bone health. True bone remodeling requires significant resistance—at least 75% of your maximum capacity. That means working in the challenging 6-12 repetition range where those last few reps feel difficult. Light workouts might feel tough, but they won't trigger the microscopic bone stress needed to stimulate rebuilding.

The type of loading matters too. Vertical loading—where gravity forces travel through the length of your bones—provides optimal stimulus. Back squats, bench press, and overhead presses create this vertical pressure, while even beneficial exercises like hip thrusts don't provide the same bone-building stimulus. This explains why activities like swimming and yoga offer minimal bone density benefits despite their many other advantages.

Proper progression is essential, especially for beginners or those with existing bone concerns. Start with bodyweight or assisted movements to develop competence before adding load. A thoughtful progression might move from TRX-assisted squats to goblet squats and eventually to barbell back squats, gradually increasing weight over time. With consistent training and proper nutrition (adequate protein and calcium), meaningful improvements in bone density typically emerge after about six months.

Personal trainers have a unique opportunity to address this critical health issue. By understanding bone physiology and designing progressive resistance programs, you can literally

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Speaker 1:

a bench press or an inclined dumbbell, because when my arms are out in front of me, gravity is pulling the weights down. I have to resist the eccentric portion and you're going to have microscopic tears on the bone which will then remodel. Welcome to the Show Up Fitness Podcast, where great personal trainers are made. We are changing the fitness industry. One qualified trainer at a time with our in-person and online personal training certification. If you want to become an elite personal trainer, head on over to showupfitnesscom. Also, make sure to check out my book how to Become a Successful Personal Trainer. Don't forget to subscribe, rate and review. Have a great day and keep showing up. Howdy y'all. Welcome back to the show of fitness podcast. Today we're going to talk about bone mineral density, osteoporosis and osteopenia. But before we talk about that, today's a really awesome day.

Speaker 1:

We got Ms Linnea sitting over here. You can't see her, but she graduated from the university of Utah degree in kinesiology and she's waiting for a client right now. And I said well, do you think we can crank out a quick podcast before your client comes in? Has her degree in kinesiology, but she's gaining that hands-on experience to get her certification, we'll show up. And as she's going through the two-month internship with Megan. I'm looking over here at her program that she has for her clients. So she's actually gaining experience and in juxtaposition to someone who gets their textbook certification, you literally have no idea what the hell to do, how to program. You don't have critical thought in conversations with experts on if your programming is even good. What you hear a lot of is oh, I'm just going to gain some experience. So I'm looking at her program right here here and she had some exercises that maybe weren't the best and she was able to think through it with Megan to design a superior program. And that's why she's going to absolutely crush it as a trainer and turn her passion for fitness into career. Right, yes, yeah, that girl. Nice Because that's right, because she's doing the work, and that's exactly how you gain confidence. And so in these two months she's going to have experience under her belt. Her belt buckle and so when she goes into an interview she's going to crush it.

Speaker 1:

And we just have to give a shout out to Mr Kim. He just got certified with us. I did his CPT earlier, crushed those 17 muscles of the shoulder, 20 of the lower body, got the eight core movement patterns, designed a program and now he has an interview at Lifetime Today and I am absolutely 100% confident that he's going to get hired because he's going to be able to talk through that program confidently. Where most trainers that come in, they're going to be so freaked out because they're on the spot, their confidence isn't there, so that manager's going to be like, ah, they're too green, they're not ready yet. So that's what we're turning out the best trainers in the world and, ironically, the person who we're designing this and talking about today, ms Melissa. She is a trainer here in the greater LA area.

Speaker 1:

She went to the Sacramento seminar. We had a great conversation. Now she's training at Crunch and I asked her before. I said what's the big difference between NASM and show fitness? And she said there's no comparison and I gave the analogy. It's like comparing a driver's test to an Indy 500 race car driver. They're just not the same. Even the DMV test is more challenging because it's a hard test, but you have to gain practice. Most trainers are just going to read that book and go out there and they're lost. So they put their tail between their legs and what do they do? They go find a specialization and they keep on reading more and more and more. Nothing wrong with continuing education, obviously, but you need hands-on learning with proper supervision.

Speaker 1:

So let's talk about bone mineral density. If you were to go to the doc and you were to get a test, they'll take an x-ray they typically do it of your femur, which is your largest lower body bone, and they're going to look right around the neck of the femur in the head and they're able to measure the density of bone. So when you look at that x-ray you'll see a very white part, but then you'll see kind of like the spectrum into light, gray, into black, and so the spongy part of the bone. There's not a lot of mass. Or they're looking at the outside of the bone and they're measuring the standard deviation and normal bone for someone in their 30s, 40s, 50s and so forth, and then they compare it to an unhealthy bone. So let's compare this to like overweight and obesity, normal BMI 18.5 to 24.9. And then we have overweight, which is 25 to 29.9, obese is 30 plus.

Speaker 1:

Compare that to osteoporosis and osteopenia. Osteopenia is the precursor to osteoporosis. So when you have a standard deviation of negative 1.5 to roughly three, that's osteopenia, and then greater than three with standard deviation, that's going to be called osteoporosis. The cool thing about osteoporosis it's 100% reversible. But you need to have vertical loading. That's the most important part. So if you were to be doing a hip thrust or an RDL, that's fine, that's better than nothing. Hip thrust or an RDL, that's fine, that's better than nothing. But what we need is to have a bar or a weight on our back, because we need a minimum of 75% to damage the bone so it regrows and it's going to become stronger.

Speaker 1:

So the basic unit of bone is called the osteon and we have these cool specialized cells called osteoblasts which build up and then osteoclasts which break down. So in the beginning of life our blasts are more active and as we age, those nasty claws that I call them, the osteoclasts, become more active. And the best thing that we can do is resistance train. But notice what I said 75%. You could have someone who's doing a 10-pound goblet for 10 reps, but not too fatigued, and they could say, wow, that was challenging. But that's not enough to stimulate bone remodeling. You need to have a load where that 10th rep is almost to fatigue. Now don't interpret that as you have to take that beginning client and crush them their first workout Over time, about six months is when you're going to see a change in bone mineral density and there's a lot of factors that go into the remodeling and health of bone.

Speaker 1:

Just as if you were to consume a bunch of protein and not exercise, you're not going to build a ton of muscle. So consuming a ton of calcium and not remodeling your bone via resistance, it's not going to be optimal. So the most important thing we can be doing is strength training. But you have to look at the individual. If we have someone who's older and hasn't lifted weights before, just like we do with our programming, you start with the basics. So instead of doing a lunge or a loaded Bulgarian, you start with a step up. Own the pattern. Instead of doing a back squat for five reps, obviously you regress it back and you do a goblet squat. Instead of doing a hip thrust for 225 or 10, you're going to do a bridge. And then we progress with the low hanging fruit and the appropriate exercises for that individual and we make sure that we are consistently overloading.

Speaker 1:

And remember overload. There's a lot of components to it. We don't have to go up and wait every single time. We just need to make sure we're becoming more efficient. So let's say your client comes in and they're 80 years old and their bones are frail. As we age, we are more prone to breaking a hip. The likelihood of living one year after it's like 50%. So we have to prevent that. We have a ton of medical costs today due to falls and broken hips. So we want to make sure to choose the appropriate exercise, strengthen their hips, which are going to in turn strengthen the bone.

Speaker 1:

But let's say we start out with a body weight squat for 10. You add a kettlebell for five for round two for 10. And then we move up to 10 pounds for round three for 10 reps. But they could do two or three extra because we're just owning the competency of the squat pattern driving through the heels, making sure the big toe and little toe are on the ground. Squat pattern driving through the heels, making sure the big toe and little toe are on the ground. The knee is driving through the toes. We are optimizing the movement or, as I say, the Miyagi-isms wax on, wax off, because in two to three months we will get down to six reps, eight reps.

Speaker 1:

I was training my client today and she's in her 60s, she's a lawyer and we got up to 95 pounds of the bar, with 25 on each side, and we did three sets of six. She normally in the beginning could do 30 to 40 pounds with a goblet, but now we're almost 2.5 times that amount of weight. That's what's needed to stimulate bone remodeling, and now we have to make sure we're consuming enough protein and calcium, because those are the nutrients that are needed for the remodeling process. As we look at the difference between hunks and hunkettes, women are more prone to osteoporosis due to the hormonal profile, and as we age and we go through menopause, we are not going to be producing enough estrogen. Men always produce estrogen. Females always produce testosterone. It's just the amount, and so as we age and we go through menopause, women will stop producing estrogen, and so the body will begin to leach calcium out of the bones. Men will have estrogen, and we don't experience that to the same degree. So that's why it's even more important for ladies to be lifting weights.

Speaker 1:

There's nothing wrong with a swim class or yoga, but that's not going to stimulate bone remodeling. So some of the best exercises we can be doing are what are appropriate for the individual. If it's a back squat, great, but you probably need to start with a goblet or maybe even regress to a TRX. We need to look at upper body as well. Doing a pushup is great. Maybe we need to do it on the bar, but we have to load up the bones vertically. So that's going to be doing a bench press or an inclined dumbbell, because when my arms are out in front of me, gravity is pulling the weights down. I have to resist the eccentric portion and you're going to have microscopic tears on the bone which will then remodel.

Speaker 1:

The example I will give in class is when we're teaching the fundamentals of movement. It's like if you take a pencil or a pen and you apply pressure on the ends, you can hear slight little cracking in the middle. Obviously we're not doing it so hard where we break it, but that cracking is going to, via osteoblast formation and proper nutrition, is going to get stronger. So it's like now we're putting a layer of surround wrap around the pencil and then two days later we do it again and then a month later we do it again and via progressive overload, we get up to those 95 pounds. For sets of six that is roughly 85%. So that's more than the requisite 75. That's roughly 10 reps. Remember one to five reps, roughly 85 to a hundred percent of your one rep. Max to fatigue. Six to 12 is about 75 to 85%, and then 12 plus will be 72, as low as 50%. So we want to make sure that we are loading up the body, overcoming the resistance and gravity, throwing in some variations.

Speaker 1:

I think it's great to do some RDLs and some trap bar deadlifts and some conventional deadlifts. Great for the low back. Contrary to what people on social media say, don't deadlift, you're going to hurt your back. Well, let's look at the body like that example. With the overload, let's make it more resilient by getting stronger with proper form. You don't have to do a conventional, you can do sumo or a variation. That is great for your clients so they feel accomplished when they're setting their PRs. If you like hip thrust, great. If you like landmine RDLs, awesome. If you like hip thrust great. If you like landmine RDLs awesome.

Speaker 1:

But we need to progress appropriately. That first month we typically don't like to get less than 10 reps because we just want to strengthen that connective tissue. So then you go back to the doc, you get that second report and they say oh my gosh, your bone mineral density went from osteoporosis to osteopenia. What the hell have you been doing? That's amazing. Or maybe it was even osteoporosis and now you don't have osteoporosis or osteopenia. You are doing some amazing stuff. That's why you, as the qualified trainer, should go to that appointment with your client and network with that doc and you say doc, I'm that great, I helped Mrs Jones go from osteoporosis to having healthy bones.

Speaker 1:

The likelihood of her falling and hurting herself is significantly lower, because not only do I train bilaterally with back squats, but we also do unilateral stuff, because that's when falls typically happen. You're walking down the stairs, you can't stabilize in the frontal plane and, bam, you break a hip and granny dies. We don't want that, so you need to practice specifically. That's the said principle specific adaptation to impose demands. Doc, who's your trainer? Oh, I don't have one, I'm so busy right now. Here's what I'm willing to do, doc. My rates are 150 per hour. I'm going to comp an entire month. 150 times three, that's 450. 450 times four, that's going to be $1,800 of free training that I'm going to give you Because I want you to have a really good idea of what a month of training looks like with me.

Speaker 1:

What are your goals, doc, and then they come in. You train them and now you have an amazing funnel from this physician, funneling clients to you because you're a qualified medical professional. You are taking stress off their plate. You're making their workload easier because, instead of saying the generic, just lift some weights and do some cardio and you probably need to get on some blood pressure medication. We can now have a larger impact and you have weekly, monthly meetings with your medical team because you are a medical professional as well. We have to level up our thinking and there's a huge opportunity to get in front of all the Medicare costs today by being proactive, networking with medical professionals, having these conversations, sending this to your clients, having them posted into your story.

Speaker 1:

Leave that five-star review client. Your trainer's awesome, but we need more exposure and we depend on you because you are getting trained by a qualified trainer and, unfortunately, 90% of textbook trainers quit within the first year. It's because they don't have the competency, they don't have the confidence when they're not doing exactly like Linnea is doing. She's stretching over here with her show up socks on getting ready for her client First one that she's going to be training and they're paying, oh, and I love it because guess what she just whispered to me they just canceled.

Speaker 1:

Welcome to the world of a personal trainer, because that's what happens she can't charge them because it's their first session. They are paying for that first session, but that is part of the growing pains that you're going to experience. So you see why it's so important to charge for your sessions, to review a cancellation policy, because your clients are going to cancel last minute, because your clients will cancel last minute. But guess what? If it's a new one, you can't pay for it. But you're going to look back about a year from now, maybe two Linnea, because you can charge your clients for that initial assessment and that's what we do at Show Up. So before you even get that first session, you have to pay $150 to reserve that spot. So if they do cancel, you're getting paid for it. Great learning opportunities, anything you want to say, linnea, keep showing up everyone. There we go.