What are the important things to consider in women’s bone health and how can you make sure you are looking after yours while training for triathlon? How can strength training help?
As athletes, when training for triathlon, the goals are focused on speed, endurance, power output and other such performance-related goals. So much focus is on training for these, that the discussion about bone strength falls by the wayside, without which your body cannot be strong. Although, not necessarily a goal, it is always important to consider health outcomes. The discussion of bone often only surfaces when stress fractures or breaks are incurred, by which time it may be too late.
Furthermore, there are risk factors for compromised bone health that are both gender and sport specific, so lets explore these in more detail before delving into the practical advice of how we can support our bones as part of our training and nutrition protocols.
Gender
Just being a woman puts one at a much higher risk of osteopenia, osteoporosis and stress fractures than our male counterparts.
Age
Respecting our bones is an important consideration from a young age. Bone is in a cycle of remodeling, absorbing old and laying down replacement throughout life. Women hit peak bone mass around the age of 30, after which, this remodeling starts to decline, so having the foundations from a young age is paramount and continuing to preserve this through exercise, nutrition and lifestyle modifications will go a long way to protect it.
Our risk of osteopenia and osteoporosis increases with age, particularly post-menopause as our hormones decline.
Low body mass
Low body mass also increases risk of osteopenia and osteoporosis. There is a general appeal to be lean in the sport and for women, societal pressures also contribute to this mindset.
Female Athlete Triad or Relative Energy Deficiency in Sport (RED-S)
In sport there is also the risk of the female athlete triad, now terms RED-S (relative energy deficiency in sport), whereby low energy availability results in loss of menstrual cycle and low bone mineral density, as a result of too few calories to support the total daily energy expenditure (TDEE) of the athlete.
Nutritional Deficiencies
Not only do athletes require a higher energy intake than the general population, their nutritional density needs additional attention. Dieting in the pursuit of leanness, or neglecting nutritional intake can result in deficiencies of nutrients required to maintain both bone and muscle strength. More on this later.
Lifestyle
Being sedentary, smoking, excessive alcohol and caffeine intake are also risk factors. As triathletes, I’m going to assume these do not apply to you for this article.
What can we do to keep our bones healthy?
So what defines bone health and strength? This comprises of bone size and thickness, content and bone mineral density (BMD).
Exercise choice and selection
When we train, our muscles contract and pull on the attached bones, improving their strength. For optimal bone health forces need to be applied using both impact and strength training.
Impact training includes running (great for triathletes!), skipping, boxing for the upper body and other plyometric movements such as jumping (box jumps, squat jumps, leaps, jumping lunges and so on).
There are many misconceptions for women that strength training will make you bulky or too heavy for your sport. Because the female physiology is so different from a male’s, this isn’t possible. What is more likely is that you get smaller, more toned and stronger and faster and finely tuned in your sport, preventing injury.
Work up to lifting fairly heavy weights to generate enough force through the bones and muscles, but progress to this over time.
Choose full body, compound exercises that utilize more than one muscle group at a time, such as squats, deadlifts and push and pull exercises as well as core strengthening and loaded carries. Work using the larger muscle groups to generate plenty of force and work in differing directions. When designing a programme, include plenty of rest between sets so that in each exercise, enough exertion is possible to generate that force required for our bones. Be sure to include balance and core work to help to prevent falls both when training and in activities of daily living.
Another exercise selection consideration is that the most common sites of fracture are in the legs, hips and spine. Appropriate choices to load these areas are deadlifts, squats, and flexion and extension of the spine (e.g. sit ups and back extensions). Power exercises such as kettlebells swings are a great selection for force generation.
If you have been diagnosed with osteoporosis, you should always seek guidance from a professional because there exercises that you should avoid, but still remain active.
Strength and power training is crucial to both building and maintaining bone and its supporting muscle strength. At Her Spirit we have plenty of classes that you can access, from HIIT to strength training using bodyweight and equipment.
Nutrition
As previously mentioned, endurance exercise expends a large amount of energy. But it also places the body under increased stress and the bones under additional pressure. This in turn increases our requirements for the nutrients calcium, vitamins D and K and magnesium.
Calcium can be easily obtained in the diet from dairy or fortified alternatives. Eating a mix of dark leafy greens, whole grains, nuts and seeds, beans and pulses should cover the micronutrient requirements.
The body’s main source of vitamin D is synthesized from the sun, and although contained in some foods, the NHS recommends supplementation of 400 micrograms throughout the winter months, but there is a large body of evidence to suggest that taking it throughout the year at a higher dose is more effective.
If you have suffered with stress fractures before or you think that you may be at risk, a blood test to check for deficiencies is wise, then you can begin to take appropriate steps be it using diet or supplementation.
If too few calories are consumed and menstrual dysfunction occurs, in the case of RED-S, then bone health will be compromised resulting in stress fractures or, in the long-term, osteoporosis. Calculating your energy expenditure (TDEE) and matching it with sufficient caloric intake is the easiest way to balance this. Online tools such as calorie calculators and food tracking apps are useful to help guide you. Remember that without sufficient fuel, your body cannot operate and you will ultimately pay the price.
Lastly, we mustn’t forget protein, the building blocks of our body. We need protein to repair and support our cells and muscles. Training our muscles to support our bones requires sufficient protein to stimulate muscle protein synthesis, particularly the amino acid leucine. This is predominantly in animal-based proteins but can also be found in vegan sources such as soy and some pulses. Varying your sources of protein and eating a serving (palm-sized or a quarter of your plate) with each meal and snack should ensure that you acquire enough. Post workout shakes that combine protein and carbohydrates are a convenient habit to ensure that you have that safety net in place.
In summary
Prevention is definitely better than cure, when it comes to bone health. The impacts of falling off a bike could be life changing if we don’t address it from a young age.
Fuel your body with enough energy and nutrients and train in a way that finely tunes your amazing body into a powerhouse triathlete with longevity.