ME and MY TRAINER

One Woman's Defiant Response to a Diagnosis of Osteoporosis

By Bonnie L. Walker

When I found out that I had osteoporosis at the age of 57 I panicked. It was September 1996. My gynecologist, noticing that I had lost nearly one inch in height, ordered a test, which showed that the bone density in my spine was significantly less than that of an average person of my age. The report also stated that I was in danger of spontaneous fractures.

Memories of my grandmother's curved back flooded into my mind. I had tried to live a healthy life style, but apparently it was not enough. Immediately I began doing everything possible to increase my bone density: estrogen therapy, calcium and more exercise.

My doctor also told me that Tufts University studies indicate that strength training helps to increase bone density in postmenopausal women. He suggested that I give it a try. My concern was that when I attempted strength training before, I had injured myself.

But this time it is different. The threat of osteoporosis has made me determined to succeed. I remember the advice of Carrie Fein, a kinesiologist and fitness director at a local retirement community. "No one would ever think of taking up an activity such as golf, tennis or swimming without some lessons," she told me. "But most people do not realize how important it is to have a personal trainer when learning to lift weights."

She is right. The benefits go far beyond simply avoiding injuries.
1. Getting Started
For me, walking into a commercial gym in Bowie, is overwhelming. I am greeted by the clatter of treadmills, stationary bikes, rowing and step machines. In an adjacent pullover and "thigh combo." Grunts and groans measure the exertion of people pushing and pulling on these stainless steel monsters. Beyond these metal beasts, there is an enormous rack where the "free weights" perch, weighing from two to more than a hundred pounds. Off by themselves, the AB machines sit on latex mats, waiting to test my long unworked stomach muscles.

I have signed up with Martin Evans, a personal trainer certified by the National Sports Performance Association. Marty spots me standing near the door. Guessing correctly that I am thinking about a quick retreat, he walks over quickly to welcome me and immediately gets me started on what will soon become routine, a five-minute warm-up on a stationary bike. I appreciate that Marty adjusts the seat to fit my height, arm length and torso. He also chooses the right level of difficulty.

While he is making notes in my personal workout book, I have a chance to look around at the other women in the gym. They seem so confident, so energetic. Their bodies are slim and toned. I wonder how long it will take me to look like them, or if I will.

According to my workout log, here is what I did during my hour following the five-minute bike warm-up on that first day. For each exercise, I did three sets of 12 repetitions. (The weight in parenthesis is what I was doing eight months later.)
Leg extensions, 5 pounds (35)
Leg curls, 10 pounds (40)
Thigh combo, 20 pounds (80)
Calf raise, 10 pounds (20)
Bent-over row, 5 pounds (20)
Lat pull, 30 pounds (45)
Dumbbell shoulder press, 5 pounds (12)
Triceps kickback, 3 pounds (8)
Triceps press, 20 pounds (30)

2. Working the Equipment
Just about any gym will assign someone to walk a equipment. Some people probably can learn how to work each machine with one explanation, but I find it's more complicated than that. It takes several visits before I feel comfortable even adjusting the bike on my own. I am intimidated by the fancy programming that sets the difficulty level and measures the time spent, the calories burned and the distance traveled.
All of the equipment I use - the leg extensions, the leg curls and the thigh combo - need to be adjusted for the proper weight and seat height. Even the weightlifting benches need to be tilted at 30 or 70 degrees.
Over time I learn to do almost everything on my own, but having Marty adjust the equipment in the beginning gives me the freedom to concentrate on more important tasks such as learning proper techniques. It also keeps the frustration level down.

3. Developing a Program
Just working out is not what I am here for. I have a goal. That's another way that Marty was helpful. During that first hour, he starts putting together a program consisting of a set of exercises that work each of my muscles at the most beneficial level. There is a lot to consider. Marty asks me how much time I have available, what activities I am involved in already, and what I like to do. On each piece of equipment that I use, he learns about my current level of strength, endurance, flexibility and balance. I am relieved that he doesn't expect everything to happen in the gym. It's okay that I find the treadmill boring and like to walk outdoors.
This plan has to be one that I can live with, because what I am doing is something that I need to continue for the rest of my life.

4. Deciding Where to Start
As I look around the gym, I see other members walk up to machines and routinely adjust the weight. They casually go over to the rack of dumbbells and pick out the ones they want. Experienced at weight training, they know exactly how much they can lift on each machine or exercise. I have no clue as to how much I can lift.
I soon find that a weight I can lift once with ease is not necessarily a weight I can lift for a whole set. Strength training enlightens me about a law of gravity that no one taught in my high school science classes: A five-pound weight gets heavier upon each repetition.
Marty's standard is to find a weight for each exercise that I can lift between eight and 15 times. When the weight is "just right," I feel the muscle that I am working start to "burn" toward the end of each set. Marty explains that the "burn" is caused by the depletion of glucose. It is a sign that I am stressing the muscle and not damaging it.

My muscles always tell me when to stop by just "refusing" to do the next repetition.
"One more," coaxes Marty. "No!" my muscles scream.
Marty also has rules about resting between sets. Although different trainers have different opinions, he likes me to rest about 15 seconds before starting the next set of my rather light weights. He says that if I were lifting very heavy weights he would recommend a longer rest, up to one minute.

5. Matching Muscles and Weights
Each session, especially in the beginning, turns out to be an anatomy lesson conducted by Marty. I learn that I have more muscles than I thought, in places that I did not know about. Some days they all hurt.
I am surprised to discover that each muscle has a mind of its own, especially when it comes to how much weight it is willing to lift and how many times it will repeat the task. In the beginning, my triceps (muscles toward the back of my upper arms) can barely lift three pounds; others, like my legs, can lift 10.

Some muscles develop more rapidly. After eight months on the leg extension machine I have increased the weight from five pounds to 35 pounds. With the thigh combo machine, I have increased from 20 to 80 pounds. My triceps can now lift eight-pound weights and the backs of my arms are finally becoming toned. Marty explains that some muscles are stronger than others because of previous activities or just genetics.
Even after several months of training, there are differences in the strength of my muscles. I use from three-pound dumbbells for side flys (lateral raises to exercise the shoulders), to 20 pounds for the bent-over row (an exercise for the back). I continue to find all of the exercises for shoulders to be especially hard.

"People don't ordinarily do much exercise involving the shoulders," Marty explains. He encourages me to keep trying. "Shoulder exercises help with posture," he says.

6. Ordering the Exercises
Most people do not understand the effect of "order" on a strength training program, but Marty says it makes a big difference. The exercise I do first determines the subsequent amount of weight I can lift and the number of repetitions I can do. An exercise can tire out a muscle, making it unable to lift as much weight as usual doing some other exercise. Marty refers to this phenomenon as "pre-exhaustion." Another exercise will warm up a muscle, making it able to lift a heavier weight when I do the next exercise.
Variety is good, Marty says. He keeps the routine fresh by changing the order around.
These are the ways a personal trainer makes a workout easier, safer, more beneficial and more fun.
For those occasions when Marty is not available, he makes me a list of exercises with instructions, including the weight to use. I take my list with me when I work out because there is too much to remember even after several months.

7. Learning Technique
As I work with Marty, I find that the most important benefit of having a personal trainer is learning proper technique. Doing an exercise correctly increases the benefit and prevents injury.
Proper lifting techniques do not come naturally to many people. Trying to lift a weight that is too heavy, something many people do, is possible by throwing the weight up, using body mass instead of the individual muscle. The goal in weight training is to isolate individual muscles one at a time. Using a heavier weight than you can lift correctly is not beneficial and can do harm.

Another mistake that people often make is to snap their elbows or knees when lifting weights. The correct method is to press up the weight slowly, stopping before completely extending the arms or legs. Marty tells me that this snapping or jerking motion can cause pain or even damage those joints.

Practicing correct technique is one of the reasons why the walls of gyms are lined with mirrors. Marty frequently stresses the importance of watching myself as I do each exercise to see how it looks as well as how it feels when I am doing it correctly. When I work out on my own, I am able to critique myself.

8. Preventing Injury
Several years ago when I was in a group exercise program at another gym, I did three squats with a light weight.

"That was easy," I thought, ready to do more. I remember the instructor's unheeded warning, "Be careful, you might be overdoing."

Since the squat did not hurt while I was doing it, I just kept going. I could not imagine why she thought that I should stop. I soon learned. For several days afterward, I could barely get in and out of a chair. Going up and down stairs was agony. The pain of sore muscles prevented me from participating in the program for days and discouraged me from trying anything new again.

I consider it Marty's main job to prevent a repetition of that experience. Unfortunately, even under his watchful eye, certain muscles get sore. The soreness may not hit until the third day. And sometimes I experience fatigue on the days that I work out.

But Marty's training helps me avoid overdoing. It reduces the risk of excessive pain and provides a reasonable amount of security that I will not acquire an injury that will end my program. He reassures me that soreness is to be expected when working a muscle that has not been used in a long time.

Marty warns me that having a personal trainer doesn't replace common sense. "If it is too heavy, just tell me," he says. "You are the best judge of what you can do or can't do, not me."

I know he's right. Even one repetition with a weight that is too heavy could result in an injury, so I remain alert to what my body tells me. There are many benefits from growing stronger "gradually."

9. Achieving Your Goals
As Marty and I develop my program, we continue to discuss my goals. Some people focus on increasing their strength and others seek to improve their endurance. People who want to increase their strength need to lift heavier weights for fewer repetitions. For endurance training, they lift a lighter weight for more repetitions.

Some people want to build muscles that will improve their golf swing or, like me, to improve my tennis serve. Each exercise works a different part of the body in a different bones in my spine, where the osteoporosis is the worst. Marty selects those he thinks will help, but he is also interested in any information I can provide him.

Based on their studies involving older women, Tufts University researchers recommend strength training at the appropriate level for an hour twice a week (which is what I am doing). To improve bone density, researchers also stress weight-bearing exercise such as walking and say that lifting weights while standing may be the most beneficial. Marty includes the military press in my routine. This exercise requires me to stand at attention while I lift the dumbbells from my shoulders over my head, instead of doing them seated as I had on the first day.
I also like to work on exercises like the triceps kickback that will firm up my upper arms so that I can wear a sleeveless dress.
These goals can be achieved over time with the right exercise, weight, number of repetitions and technique.

10. Motivation, the Trainer's Extra Benefit
Helping me with motivation is one of the most important ways that Marty earns his money. Especially at the start of a session, when I am tired, out of sorts or bored, Marty encourages me to warm up properly, to go for "one more" repetition, to lift a slightly heavier weight, or to try a new piece of equipment. While I am warming up on the bike, he chats with me about my exercise regimen and encourages me to add extra aerobic exercise.

He tries to keep the strength training program interesting. One day when I arrive, he meets me at the gym door. "It's too nice to stay inside today. We are going outside for the warm-up." I struggle to keep up with his long strides as we walk briskly around a nearby neighborhood.
This kind of personal attention does a lot for someone undertaking an exercise program. Like me, many people begin a strength training program to help them recover from a physical problem at a time when they are somewhat out of shape. The attention is good for one's ego as well as for one's physical condition.

Just having an appointment with Marty is motivating. Many times, getting to the gym is the hardest part. Lots of times in the beginning I might have skipped the session altogether had I not known he was waiting.
After only a few weeks, there are visible changes in the muscles in my arms and my posture has improved. These changes provide motivation that I will need to continue strength training on my own.

11. Getting Your Money's Worth
Many people probably think that having a personal trainer is a luxury. Not true. Having a trainer to get me off to a good start will save me money if it improves my health and lowers my risk of future injury from osteoporosis. Preventing a fractured hip, the most common serious injury related to the disease, or a curved spine, is well worth the cost.
People who join a gym often start out with good intentions. But they quickly drop out because of sore muscles, injuries and loss of motivation. Adding the cost of a trainer (about $25 an hour) to my dues ($50 a month for our family membership) greatly increases my chance for success and helps me get my money's worth from my investment.

I am finding it easy to go through my strength training routine by myself. I have a program that I can live with and that I enjoy.
When I returned for my annual gynecological exam and a second bone density test, a year later, the results were encouraging. Instead of additional loss, the bone density in my lumbar spine actually increased. My doctor is pleased and encourages me to stay with the program.
Perhaps of equal importance is how I feel about myself. I love the firmness in my upper arms and the feel of my biceps straining against the sleeve of my T-shirts. For the first time in several years I have the courage to buy a sleeveless dress! I know that the strength training gets the credit for my new improved serve. My tennis friends have even commented with amazement on an increased quickness on the court. And it's especially nice that my mother, who has spent 50-some years telling me to stand up straight, loves my new and improved posture.
Thanks, Marty!

Bonnie L. Walker is a gerontologist who develops training materials for long-term care facility staff. She has just completed a grant sponsored by the National Institute on Aging titled "Injury Prevention for the Elderly." She is the author of two books published by Greenwood Press: "Sexuality and the Elderly" (1997) and "Injury Prevention for the Elderly" (1996).