4 Guaranteed Tips ...to get you bigger, fitter, and stronger! by Chad Waterbury

I could never be a coroner. Nope, I couldn't because it sure as hell doesn't sound like much fun. And I don't think I'm alone with this sentiment. After all, I've never heard little Bobby stand up in his second-grade "What I'd Like to Be One Day" presentation and belt out, "Ms. Johnson, I'd sure like to embalm corpses when I grow up."

Maybe it's the stale, formaldehyde-infested air that irks me? Maybe it's the one-sided conversations that make the job seem so unappealing? Or maybe it's the thought of being caught between two angry siblings who're vying for all of Daddy's gold?

(Yep, the daughter wants all of the inheritance so she can get 700 cc's of silicon stuffed in front of her breastplate. The son, on the other hand, wants it all so he can buy a plethora of guns, whores, and booze — and he might waste some of it, too.)

Nah, I know why I never want to be a coroner: very little job satisfaction. You see, my job is to make people bigger, faster, leaner, and stronger. The cool and challenging part of my job is that my success in this business depends on my clients' results. If they weren't getting results, I wouldn't be here. And helping people reach their goals is what my job satisfaction's all about.

Another part of my job satisfaction comes from passing on what I've learned over the years. So I'm going to outline four key elements that help me achieve those results with my clients. Here goes!

Tip #1: Constantly Rotate Reps and Sets

In order to achieve results for any longer than three weeks at a time, you should constantly rotate your sets and reps. If you rotate those two elements throughout the week, you'll be able to stick with the same movements for a longer period of time before stagnating.

For example, if you perform 5 sets of 5 repetitions with 85% of your 1RM for, say, the bench press, squat, row, and deadlift, you'd get two to three weeks' worth of progress before winding up on an endless plateau. Why? Because your body will adapt to an unchanging rep scheme very quickly. Pair this with a constant number of sets per body part and a relatively constant load, and you're on a fast track to Nowhereville.

If, however, you performed the bench press, squat, row, and deadlift with different parameters for each workout, you could get two to three months worth of progress — and that's without even changing your movement patterns. You must provide your muscles with a constantly changing stimulus. The question I usually get from readers is, "How do I constantly rotate parameters?"

There are many ways, but I like to start out simple. These are the only two steps you need to follow to get started:

1) Use a set/rep volume per body part of 24-36.

2) Choose a rep scheme that's at least 3 reps higher than your last workout (the greater the spread, the better).

So let's say that you're ready to put those two principles into play. If you perform three workouts per week, here's how a sample plan could look.

Day 1: 8 x 3 (8 sets of 3 repetitions per body part)
Day 2: Off
Day 3: 3 x 12
Day 4: Off
Day 5: 4 x 6
Day 6: Off
Day 7: Off
Day 8: Repeat cycle

If you workout four times per week, it could look something like this:

Day 1: 8 x 3
Day 2: 1 x 36
Day 3: Off
Day 4: 5 x 5
Day 5: Off
Day 6: 3 x 12
Day 7: Off
Day 8: Repeat cycle

Obviously, the options are endless. The key is to use rep ranges that you haven't used in the last two months. So if you've been on a 5 x 5 kick, stay at least 2 reps away from 5 reps per set (e.g. 1, 2, 3, 7, 8... 36).

But what about loading? That brings me to point number two.

Tip #2: Calculate Volume

Make no mistake about it: there's a strong, positive correlation between math and muscle. If you don't know how to calculate your training volume, each subsequent workout will be like pissing in the wind. Many people have caught on to the importance of constantly changing reps, but I don't think many have figured out how to properly manipulate the sets, reps, and load.

Let's say your upper back workout is comprised of 4 sets of 6 repetitions with 80% of your 1RM for the bentover row. And let's say your 1RM for the bentover row is 300 pounds. We need to calculate the volume of that movement. Volume is the total number of reps multiplied by the load lifted.

Total Reps x Load = Volume

So with the bentover row example, here's the volume of that movement:

24 (4 x 6) x 240 pounds (300 x 80%) = 5760 pounds

Okay, this is where most people get into trouble. They know it's time to switch up their sets and reps, so they perform, say, 2 sets of 12 during their next workout for the bentover row. And if they don't have any idea what load to use, they might just wing it. So they end up doing 2 sets of 12 reps with something like 70% of their 1RM. Here's how that looks:

24 (2 x 12) x 210 pounds (300 x 70%) = 5040 pounds

What's the problem? They've just performed an upper back workout with 720 pounds less volume than their previous workout! I see this happen so often that it hurts. You must go into each workout knowing how to arrange your parameters in order to beat your last performance! If you don't, you really are pissing in the wind.

In order to make an upper back workout with 12-rep sets beneficial, you should increase the number of total reps. This will up the set-rep volume so you're achieving a higher total volume with each subsequent workout. In other words, if you merely add one set (3 x 12) and use 70% of your 1RM, here's how the volume looks:

36 x 210 pounds = 7560 pounds

Voila! Now you're doing a workout that results in 1800 pounds more volume. And it's accomplished by adding just one set to each movement. Now you're on your way to bigger, stronger muscles instead of spinning your wheels.

Before I leave this topic, let me mention a few important points about calculating volume. First off, nothing in training is perfect and infinite. It's damn near impossible to always go into the gym and beat your last performance. Therefore, it's a good idea to arrange planned periods of unloading in order to avoid burnout.

For advanced lifters, an unloading week every three weeks is a good start. For beginners, an unloading week every five to six weeks is usually sufficient. In either case, I recommend you lower your volume by 25-30% for a few workouts to give your body a break. Then, get back to constantly improving your volume with every new workout for the next three to six weeks.

Second, the time element is also an important factor. What I'm saying is this: the amount of time it takes you to finish 4 x 6, 2 x 12, or 3 x 12 will have a significant effect on your muscles. Obviously, if you take four minutes to complete 2 x 12 with 210 pounds, it's going to overload your muscles differently than if you take six minutes to complete the same 2 x 12 with 210 pounds. In other words, your volume per minute will be much higher if you finish 2 x 12 in four minutes compared to six minutes.

If you want to take the time to figure your volume per minute, feel free, but all I care about is this: at the end of the day, did you expose your muscles to more volume than the previous workout? If you did, you're going to get results.

My friend Charles Staley uses a similar philosophy with his EDT system. The difference is that his system is based on doing more work in the same amount of time, whereas this section is about augmenting volume regardless of the time it takes you to do so.

Third, it's not necessary to beat your previous volume by 1000, 800, or even 400 pounds. As long as you're increasing your volume by at least 2%, you're fine. In fact, if you try to up the volume too fast, you'll set yourself up for burnout. Strive for small, constant increases in volume of 2-3%.

Finally, all workouts are not created equal. What I'm saying is that 6 x 4 with 80% of your 1RM is different than 4 x 10 with 70% of your 1RM, even if you don't consider training volume. The stress to your muscles in terms of total motor unit recruitment, and the rate at which your motor units are recruited, has a bearing on what specific response you'll incur from the workout. But I hesitate to merge into this realm because it's very complex. Let's keep it simple and focus on volume.

So for an advanced person doing bentover rows, here's how it all breaks down for three workouts per week for four weeks:

WEEK 1

Workout 1
24 (6 x 4) x 240 pounds (300 x 80%) = 5760 pounds

Workout 2
28 (4 x 7) x 225 pounds (300 x 75%) = 6300 pounds

Workout 3
40 (4 x 10) x 204 pounds (300 x 68%) = 8160 pounds

WEEK 2

Workout 1
28 (7 x 4) x 240 pounds (300 x 80%) = 6720 pounds

Workout 2
32 (4 x 8) x 225 pounds (300 x 75%) = 7200 pounds

Workout 3
40 (4 x 10) x 210 pounds (300 x 70%) = 8400 pounds

WEEK 3

Workout 1
32 (8 x 4) x 240 pounds (300 x 80%) = 7680 pounds

Workout 2
36 (4 x 9) x 225 pounds (300 x 75%) = 8100 pounds

Workout 3
40 (4 x 10) x 216 pounds (300 x 72%) = 8640 pounds

WEEK 4 (Unloading)

Workout 1
24 (6 x 4) x 240 pounds (300 x 80%) = 5760 pounds

Workout 2
27 (3 x 9) x 225 pounds (300 x 75%) = 6075 pounds

Workout 3
30 (3 x 10) x 216 pounds (300 x 72%) = 6480 pounds

(Week 5 resumes with a progression that must beat your performances from week 3.)

You should really take some time to look over this periodization example of weeks 1-4. You'll see how I typically arrange a progression and unloading periodization plan with advanced trainees. Of course, this isn't written in stone since there are many additional variables that must be addressed, but it gives you a good starting point.

I use this example because it's a conglomerate of progressions, just like my programs. Workout one is a set progression; workout two is a rep progression; and workout three is a loading progression. The point is to show that any progression can result in a higher volume.

And the key is to beat your volume performance with each workout that uses the same parameters. It's not necessary to beat your volume performance with every subsequent workout throughout the week. In other words, if Monday is your 6 x 4 day, the following Monday you must beat your previous performance by adding more sets, reps, or load in order to augment the volume of that session.

Tip #3: Adhere to Total-body Training

I really thought I had this factor covered when I wrote Total-Body Training a few years ago. But based on the conversations I have with readers, it's evident that I haven't struck a loud enough chord when it comes to this important topic.

Total-body workouts beat any split, any day of the week. If you start training all of your major muscle groups every time you go to the gym, you'll be on the fast track to bigger muscles and higher fitness levels.

You'll build bigger muscles because you'll be training with a higher frequency, and you'll build your fitness levels because total-body workouts are damn tough. In fact, you'll probably have to pace yourself during the first few weeks of total-body training if you've been on a body part split.

Total-body workouts result in a higher work capacity, fitness level, and endocrine response. How do total-body workouts do all those things? Because when you cram compound movements such as squats, deadlifts, pulls, and presses all into the same session, it's very taxing to your body.

If you've never combined four to eight compound movements into one workout, you're in for a big surprise. You soon realize that a properly designed total-body weight training session will not only develop the ATP-PC energy system, but also anaerobic glycolysis and aerobic metabolism. And that's why people can generally get away with doing less cardio when their weight training consists of total-body workouts.

By simply switching from a body part split to total-body workouts, I've seen people drop four pounds of pure fat within the first month of undertaking total-body workouts without changing anything else. The reason is because the energy system and androgen response from total-body workouts is favorable for both fat-burning and muscle growth.

Another advantage of total-body workouts is that they tend to eradicate most of those pussy isolation movements. Once I tell someone that they need to train all of their major muscle groups in one session, they soon become very efficient with their choices of movements.

Why perform pressdowns for triceps, flyes for pectorals, and front raises for deltoids when you can develop all of those muscle groups with the dip? With a compound movement like the dip comes a greater hormonal response. And with a greater hormonal response come bigger muscles and less body fat.

Enough with my sales pitch. If you haven't been performing total-body workouts, you need to start. But ease into it. Start out with four compound movements for each workout and perform three workouts each week. Choose a squat, deadlift, press, and pull variation for each workout. One of the four movements can consist of a variation of the snatch or clean.

Perform a different variation for each of the three workouts each week. Don't forget about tips one and two! (Of course, if you don't want to design your own workouts, you can find mine in the archives. Except for "Anti-Bodybuilding Hypertrophy" and "Big Boy Basics," every program of mine is total-body.)

And if you're one who believes that you can't train all of your major muscle groups with four movements, I invite you to do the following circuit for 8 sets of 3 reps with the heaviest load that you can handle for each set:

A1 Snatch
A2 Dip
A3 Woodchop
A4 Chin-up

Once you're accustomed to four compound movements for three workouts per week, you can start increasing the number of movements. I suggest you add one or two more movements and stick with it for three to four weeks before adding more. I generally recommend no more than eight movements per total-body session, but there's really no limit. Once you start building your work capacity and fitness levels, you can do as many movements as your available time allows.

Speaking of time, that brings me to my last point.

Tip #4: Consume Peri-workout Nutrition

One of the biggest fallacies that I keep hearing is this: resistance-training workouts must last less than one hour. Bullshit!

The putative notion that workouts should last less than an hour is based on old research that demonstrated a shift of anabolic and catabolic hormones in the negative direction after 45 minutes of resistance training. But now that we know how important it is to ingest carbs and protein at the onset and/or during a workout, that research becomes much less relevant.

If you drink Surge or some sort of whey/maltodextrin drink at the onset of your workouts, you can easily train for 90-120 minutes without worrying about cortisol's detrimental influence on your physique.

How important is peri-workout nutrition? I now consider a carb/protein drink at the onset of resistance training workouts to be more important than a post-workout drink. Don't get me wrong, I'm not saying that anyone should stop consuming a post-workout drink, but between the two, peri-workout nutrition is the clear winner in my book.

So if you want to get bigger, leaner, and stronger, strive for longer and more demanding total-body workouts. And be sure to consume liquid carbs and protein at the onset, or during your workouts.

But this issue of peri-workout nutrition stretches beyond controlling catabolism during your workouts; it can also be beneficial during periods of fat loss. You probably know from Drs. Lowery and Berardi that your carb sensitivity is elevated in the morning and after your workouts. So you might be surprised to learn that there are some people who I had drop all morning and post-workout carbs in order to get them shredded. But I had these same people still consume carbs during their workouts.

I believe it's the best time to ingest the majority of your daily carbs if you're on a low-carb diet. You'll keep losing fat because the carbs will be soaked up by the heightened sensitivity of your muscles, and you'll be able to maintain your workout intensity. As a bonus, you'll recover much quicker between workouts.

Many of my clients need to get absolutely shredded for one reason or another, and as I said in the beginning, my clients' results determine my success. If peri-workout carbs slowed their fat loss or didn't improve their recovery, I'd drop them quicker than Anna Nicole Smith drops a blind date once she finds out he's not a billionaire.

To support my position that peri-workout carbs won't stall your fat loss, let me mention a T-Nation reader who hired me this year to prepare her for a figure competition. I had her consume Surge during all six of her workouts each week. And I continued with the peri-workout Surge until the last week before her competition (at that point, I had to drop her water). She got ripped, and she won the competition. Here she is:

If you have a high tolerance to carbs, consume one full serving of Surge at the onset, or during, your workouts. If you have a medium tolerance to carbs, consume half a serving. If the mere thought of bread expands your waistline, consume 20-30 grams of pure whey.

I must mention, however, that in eleven years of transforming bodies, I can count on one hand the number of people whose fat loss stalled when they ingested liquid carbs and protein during their workouts. In fact, when I manipulate my clients' carb intake, the peri-workout carbs are the last carbs to get eliminated from their diets.

So try a full or half serving of Surge (or some whey/maltodextrin drink) before going with only whey protein. If you do, you'll continue to burn fat while enhancing your training intensity and recovery.

Summary

1) Rotate your sets, reps, and load throughout the week.

2) Calculate the volume of each training session.

3) Perform total-body workouts.

4) Consume Surge or a whey/maltodextrin drink at the onset of each workout (afterwards, too).

If you incorporate these four steps into your program, you'll be way ahead of the competition. I guarantee it!

© 1998 — 2006 Testosterone, LLC. All Rights Reserved.

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Total-Body Training The 3-day-per-week, full-body workout plan by Chad Waterbury

Harbinger Hypertrophy

Let’s cut the bullshit and get to the brass tacks. For decades, men built slabs of muscle with simple, three day-per-week training programs. They trained their whole bodies in one brief workout session and they grew big and strong. Scoff all you want, but tens of thousands of trainees can’t be wrong.

Well, it's high time we look into the past, learn from what we see, and build a new future.

We must learn from the successes and just as importantly, the failures. Yes, although this classic hypertrophy plan worked well, it wasn't perfect. And today we know what we can do to fix the drawbacks.

Let's break it down right now. The majority of non-steroid injecting trainees who’ve built respectable physiques have done so with the following, undisputable parameters:

1) They train every major muscle group three times each week.

2) They keep intensity levels sufficient without overindulgence.

3) They choose a training volume that can be maintained along with the stressors of life.

4) They execute compound, multi-joint exercises that have been shown to produce the most hypertrophy.

5) They keep each training session as brief as possible.

6) They allow at least 48 hours of recovery between workouts.

I’ve worked with trainees at every imaginable level of the fitness spectrum, and the aforementioned elements are ubiquitous in their most successful hypertrophy programs. So I often wonder why they ever strayed. Why stop doing what's working?

Usually their reasoning is based along the following statement that I recently heard from a veteran of the iron game: "Hell," he said, "I don’t know why I ever stopped doing it. I just assumed there was a better way." Well buddy, I’m here to tell ya, there ain’t no better way!

I’ve written numerous training programs for T-Nation, and they all work. But, oftentimes, trainees don’t seek what I seek. They want to look good nekkid, period. Not only that, but they don’t give a rat’s ass what strength qualities they’re training. All they care about is the most efficient and effective route to the physique they’ve only seen in pictures.

It’s time for a change. I want each and every one of you to see that physique in the mirror, not just in magazines. But as I said, we must also learn from the failures of past programs. Burnout and training injuries were often a "given" in old-school, total-body programs. The reason for this indiscretion is simple: poor planning.

Therefore, this article is based on the successes of the past along with my own successes as a trainer. I’ve learned to properly plan my clients' programs so results are steadfast and continuous.

Every single time I hit the gym, I perform a total-body workout with most of the following guidelines. I doubt that will ever change. In fact, that’s how I added almost 100 pounds of muscle to my frame. I don’t know why I ever wandered, so I’m here to keep you from running astray.

The Obstacles

The single biggest mistake trainees have made in their quest for the ultimate physique is in periodization parameters. Simply speaking, they keep executing the same damn parameters in hopes of the body not "catching on" to what they’re doing. Big mistake, my friends. Our bodies are designed for one sole purpose: adaptation. If you forget that, then you can forget about ever creating the physique of a Greek God.

Bill Starr came damn close to pulling off one of the best training programs with his classic text, The Strongest Shall Survive. His initial parameters were excellent. Unfortunately, his program wasn’t willing to adapt, so progress on his "Big Three" program came to a screeching halt for most trainees. You can’t endlessly perform the same exercises with the same parameters and keep experiencing results!

A New Generation is Born

Now the dichotomy arises. We must incorporate the variables that withstood the test of time along with a new plan for continued progress. It’s time to take the past, present and future and blend it into a new hybrid plan!

The How

Exercises per Session: 6

Sets per Muscle Group: 2-4

Reps per Exercise: 5-18

Rest between sets for the same muscle group: 60-120 seconds, and 120-240 seconds (antagonist training)

The Why

The first thing you probably notice with the above parameters is variance. This is the key to your consistent hypertrophy success. A lack of variance is the single biggest reason why trainees aren’t still talking about the continuous progress they received from some of the most popular hypertrophy programs. Without consistent change, results will be anything but consistent.

Exercise Selection

Every session is going to consist of six exercises. Why? Because my empirical evidence has shown that natural trainees can consistently maintain six exercises per session without burning out.

It’s imperative to base your exercise selection around compound, multi-joint exercises. Four out of the six exercises for each session must be compound exercises. Six sissy-assed, single-joint isolation exercises ain’t gonna do the trick. But, you can perform a few of my recommended single-joint exercises for two of the six exercises. Here’s the list you must choose from:

Compound Exercises

Chest: Incline, flat, decline barbell or dumbbell bench presses. Wide-grip dips.

Back: Upright or horizontal rows. Pull-ups or pulldowns with pronated, semi-supinated, and supinated grips.

Deltoids: Standing or seated military presses with a barbell or dumbbells utilizing pronated, semi-supinated or supinated hand positions.

Quads: High-bar full barbell squats, hack squats or front squats.

Lower Back/Hips: Traditional and/or sumo-style deadlifts or Good Mornings. Power cleans or snatches.

Single-Joint Exercises

Biceps: Barbell curls, hammer curls or preacher curls.

Triceps: Lying barbell or dumbbell triceps extensions, and pronated or supinated grip pressdowns.

Deltoids: Front, side or rear dumbbell raises.

Hamstrings: Glute-ham raises or leg curls.

Calves: Standing, seated or donkey calf raises.

Stick to the above list of exercises for optimal results.

The Total-Body Plan

First and foremost, proper periodization planning is imperative. Without sufficient set/rep/load/rest parameters, even the best exercises won’t produce results. Therefore, I’ve devised the following periodization plan for unsurpassable hypertrophy increases:

Week 1

Workout 1

Sets: 3

Reps: 5

Rest: 60 seconds between sets

Load: Choose a weight that forces you to near-failure for the last rep of the last set.*

*This is the recommended load for all workouts.

Workout 2

Sets: 3

Reps: 8

Rest: 90 seconds between sets

Workout 3

Sets: 2

Reps: 15

Rest: 120 seconds between sets

Week 2

Perform with the same parameters as Week 1, but execute antagonist training for all six exercises (more on this later).

Week 3

Workout 1

Sets: 4

Reps: 5

Rest: 60 seconds between sets

Workout 2

Sets: 4

Reps: 8

Rest: 90 seconds between sets

Workout 3

Sets: 3

Reps: 15

Rest: 120 seconds between sets

Week 4

Perform the same parameters as Week 3, but execute antagonist training for all six exercises.

Week 5

Workout 1

Sets: 2

Reps: 18

Rest: 120 seconds between sets

Workout 2

Sets: 2

Reps: 8

Rest: 60 seconds between sets

Workout 3

Sets: 2

Reps: 12

Rest: 90 seconds between sets

Week 6

Perform the same parameters as Week 5, but execute antagonist training for all six exercises.

Week 7

Workout 1

Sets: 3

Reps: 18

Rest: 120 seconds between sets

Workout 2

Sets: 3

Reps: 8

Rest: 60 seconds between sets

Workout 3

Sets: 3

Reps: 12

Rest: 90 seconds between sets

Week 8

Perform the same parameters as Week 7, but execute antagonist training for all six exercises.

Explanation

1) Weeks 1,3,5 and 7 are to be performed with straight sets. In other words, perform one set of the first exercise, rest, perform your second set, and continue for all the recommended sets before moving on to the next exercise.

2) Weeks 2,4,6 and 8 are to be performed as antagonist training. Every session consists of six exercises so antagonist training is simple; all you have to do is perform three antagonist exercise groupings during each workout. For instance, perform quads/hams, chest/back, and biceps/triceps exercise pairings for the recommended sets and reps.

Example: Do one set for chest, then one for back, then another for chest, etc. Then move on to the next pairing, like quads/hams or biceps/triceps.

3) Choose four exercises under the list of compound exercises. Choose two exercises under the single-joint exercise list. Don't leave out any major muscle groups.

4) Constantly rotate exercises from each category. In other words, don’t always start your session with a chest/back pairing. You must keep rotating the body parts and exercises you begin each session with.

5) Don’t perform the same exercise for more than two weeks in a row. For example, if you performed a flat barbell bench press as your chest exercise for Weeks 1 and 2, you must switch to either incline, decline or dumbbell bench presses for another two weeks before switching again.

6) Increase the load 1.25 to 2.5% with each subsequent workout.

7) Perform all three workouts within a seven-day timeframe with 48-72 hours rest between workouts.

8) Be creative! I’m giving you endless options. Just be sure to pick four compound exercises and two single-joint exercises with each session. You can rotate exercises as much as you desire. All you have to do is follow the prescribed parameters.

The future of training is here. Take charge and use these guidelines for lifelong hypertrophy gains!

About the Author

Chad Waterbury is a strength and conditioning coach with Bachelor of Science degrees in Human Biology and Physical Science. Currently, he's studying graduate work in Physiology at the University of Arizona. He operates his company, Chad Waterbury Strength & Conditioning, in Tucson, AZ, where his clientele consists of members of military Special Forces units, athletes, professionals and non-athletes seeking exceptional physical performance and development. Rumor has it the big guy is even writing a book. You can contact him through his website, ChadWaterbury.com.

© 1998 — 2004 Testosterone, LLC. All Rights Reserved.

Wikio

Régime: l'exercice physique aide à ne pas reprendre de gras viscéral

17 novembre 2009 - Faire régulièrement de l’exercice physique après un régime empêcherait le retour du gras viscéral, responsable entre autres du diabète et des maladies cardiovasculaires. Ce sont les conclusions d’une étude américaine menée auprès de 97 femmes.

Selon les résultats, deux séances de 40 minutes d’exercices physiques par semaine suffiraient à ne plus reprendre de gras viscéral. Les exercices aérobiques (marche et jogging) et de résistance (squat, redressements assis, flexion des jambes, exercices avec poids, etc.) sont ceux qui ont donné les meilleurs résultats.

Dans la plupart des cas, les personnes actives physiquement n’ont pas regagné de gras viscéral tandis que celles qui ont arrêté de s’entraîner ou qui n’ont jamais fait d’exercice en ont regagné en moyenne 33 %.

Soulignons que même si les participantes actives n’ont pas regagné de gras viscéral, elles ont toutefois repris du poids (3,5 kilos en moyenne), mais moins que celles qui ne faisaient pas d’activité physique (6 kilos en moyenne).

Les participantes ont été réparties en 3 groupes distincts. Le 1^er groupe respectait un programme d’entraînement physique en aérobie. Le 2^e groupe pratiquait des exercices de résistance tandis que le 3^e groupe ne faisait aucune activité physique.

Au départ, les participantes ont été soumises à une diète stricte jusqu’à ce qu’elles atteignent un indice de masse corporelle plus petit que 25. Au total, la perte de poids moyenne pour l'ensemble des participantes a été de 11 kilos. Elles ont été suivies durant 1 an suivant la perte de poids.

Le gras viscéral est logé dans la cavité abdominale, sous les muscles de l’abdomen. Il est particulièrement insidieux parce qu’il est invisible et encercle les organes vitaux. Plus la graisse viscérale s’accumule, plus grandes sont les probabilités d’être atteints de diabète de type 2 et de maladies cardiovasculaires.

Danny Raymond – PasseportSanté.net

1. Hunter GR, Brock DW, et al.Exercise training prevents regain of visceral fat for 1 year following weight loss, Obesity, 2009 Oct 8.

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L'exercice physique est bon pour les os!

Ostéoporose

Qu’est-ce que c’est? Symptômes Personnes à risque Facteurs de risque Prévention Traitements médicaux L’opinion de notre médecin Approches complémentaires Sites d’intérêt Références

Ostéoporose : qu’est-ce que c’est?

haut

L’ostéoporose est caractérisée par une perte de la résistance des os qui prédispose aux fractures. Dans la plupart des cas, les os se fragilisent en raison d’un manque de calcium, de phosphore et d’autres minéraux.

Lorsque les os sont plus poreux, ils sont plus susceptibles de se fracturer lors d’une chute banale qui, en temps normal, aurait été sans conséquence.

L’ostéoporose apparaît progressivement, avec l’âge. On estime qu’au Canada, une femme sur quatre et un homme sur huit en sont atteints. Entre l’âge de 50 ans et la fin de leur vie, quatre femmes caucasiennes sur 10 subiront une fracture en raison de l'ostéoporose.

Les os de la hanche, des poignets et de la colonne vertébrale sont ceux qui subissent le plus souvent une fracture attribuable à l’ostéoporose.

Diagnostic

Pour poser un diagnostic, le médecin évalue d’abord l’ensemble des facteurs de risque : l’âge, le sexe, les antécédents familiaux, la survenue d’une fracture liée à une fragilité osseuse après l’âge de 40 ans, les habitudes de vie, etc.

S’il le juge nécessaire, le médecin propose un test d’ostéodensitométrie. Ce test permet de connaître le contenu en minéral des os, ce qu’on appelle la densité minérale osseuse (DMO). La solidité de l’os ne dépend pas seulement de sa densité, mais aussi de la qualité de sa structure. La technique la plus couramment utilisée pour évaluer la qualité de l’os est l’absorptiométrie biphotonique par rayons X. Cet examen indolore expose à très peu de radiations. Le résultat de ce test (le score T) est comparé à la densité minérale osseuse moyenne des jeunes adultes.

Il est aussi possible d’évaluer le risque de fracture au cours des 10 prochaines années à l’aide du test FRAX (« fracture risk assessment tool »). Élaboré par des experts de l’Organisation mondiale de la Santé, ce test tient compte de l’ensemble des facteurs de risque.

Une personne atteinte d’ostéoporose a un risque de fracture « élevé ». Lorsque le risque de fracture est « moyen », il est plutôt question d’ostéopénie.

Évolution de la masse osseuse avec l’âge

Les os sont en perpétuel renouvellement : il y a constamment construction de nouveaux tissus et destruction de vieux tissus (« remodelage »). Les os prennent de deux à trois mois pour se renouveler entièrement. Durant toute la période de croissance, la construction l’emporte sur la destruction. Le pic maximal de masse osseuse est atteint vers l’âge de 35 ans. Celui-ci se maintient généralement jusqu’à 40 ans. Par la suite, la masse osseuse tend à décliner de 1 % à 2 % par année.

Durant les 10 années qui suivent l’apparition de la ménopause, la perte osseuse s’accélère de 2 % à 3 % par année, en raison du déclin de la production d’oestrogènes. La perte se stabilise ensuite à environ 1 % par année.

Dans le cas des hommes, la perte est plus graduelle. À compter de 65 ans, cependant, leur risque de souffrir d’ostéoporose augmente et ils sont plus susceptibles d’avoir des fractures.

Le graphique suivant donne une idée de l’évolution de la masse osseuse avec l’âge. Il s’agit d’une courbe moyenne. Ainsi, la courbe relative à un individu en particulier peut être différente, car elle dépend de son hérédité et de son mode de vie. Pour connaître les facteurs qui contribuent à l’apparition de l’ostéoporose, voir les sections Personnes à risque et Facteurs de risque.

Complications possibles

En tentant de limiter ou de prévenir l’ostéoporose, on souhaite essentiellement éviter les conséquences d’une fracture osseuse : douleurs, perte d’autonomie, réduction de la qualité de vie (surtout pour la fracture de la hanche), etc. Par ailleurs, la chirurgie de la hanche pose un risque de décès.

Les conséquences sont souvent plus graves pour l’homme qui, à âge égal, est généralement en moins bonne santé que la femme.

Lorsque l’ostéoporose est diagnostiquée et traitée, il est possible de stabiliser ou d’améliorer l’état des os au point de réduire de 50 % les risques de subir une fracture.

Symptômes de l’ostéoporose

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• L’ostéoporose n’engendre généralement aucun symptôme, d’où ses surnoms de « voleur silencieux » ou de « mal silencieux ». Souvent, la perte osseuse n’est constatée qu’à la suite d’une fracture survenue au cours d’une chute.
• L’un de ses premiers symptômes est parfois une réduction de la taille (de 4 cm ou plus). Cette diminution est liée à une courbature du dos causée par un affaissement des vertèbres. Cet affaissement peut entraîner des douleurs intenses au dos.

Personnes à risque

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Cette section regroupe les principaux facteurs qui mènent à l’ostéoporose.

• Les personnes âgées de plus de 65 ans.
• Les personnes ayant déjà subi un écrasement des vertèbres.
• Les personnes ayant des antécédents familiaux de fractures causées par l’ostéoporose.
• Les femmes ayant eu une ménopause précoce (avant l’âge de 45 ans), pour des raisons naturelles ou après l’ablation de leurs ovaires. Plus le temps d’exposition du corps aux oestrogènes est long, plus le risque d’ostéoporose diminue. Les oestrogènes contribuent au maintien de la masse osseuse.
• Les personnes atteintes d’une maladie qui interfère avec l’absorption du calcium dans l’intestin (par exemple, la maladie de Crohn).
• Les femmes qui ont eu des périodes d’aménorrhée de plus de six mois (hormis la grossesse).
• Les personnes atteintes d’hypogonadisme.
• Les personnes qui ont déjà suivi un traitement aux corticostéroïdes par voie orale durant plus de trois mois.
• Dans une moindre mesure, les personnes atteintes d’arthrite rhumatoïde ou ayant déjà fait de l’hyperthyroïdie. Ces deux facteurs sont considérés comme mineurs.

Facteurs de risque

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Les facteurs suivants accroissent le risque d’ostéoporose. Leur influence est cependant moins importante que celle des facteurs décrits dans la section Personnes à risque.

• Le manque d’exercice physique.
• Une alimentation pauvre en calcium tout au long de la vie.
• Un manque de vitamine D causé par une exposition limitée à la lumière du soleil ou par une alimentation pauvre en vitamine D. Cette vitamine est essentielle au métabolisme du calcium.
• Le tabagisme.
• Avoir pris ou prendre des médicaments anticonvulsivants ou de l’héparine.
• Une perte de poids importante durant la vingtaine.
• Un poids inférieur à 57 kg (125 livres).
• La consommation excessive d’alcool.
• Une grande consommation de caféine (café, chocolat, colas, boissons énergisantes). La caféine augmenterait les pertes de calcium en augmentant le débit urinaire. Les experts recommandent habituellement aux personnes âgées, en plus de s’assurer d’un apport adéquat en calcium et en vitamine D, de ne pas boire plus de trois tasses de café par jour¹.

Prévention de l’ostéoporose

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L’objectif principal est d’empêcher les fractures. La prévention permet de réduire de moitié le risque de fractures associées à l’ostéoporose. Il faudrait se préoccuper de prévenir l’ostéoporose dès le plus jeune âge. Tel que le mentionne l’Organisation mondiale de la Santé (OMS), plus tôt on adopte un mode de vie sain, meilleurs seront les gains.

Mesures de dépistage

Les recommandations ne sont pas uniformes2,3. La majorité des groupes d’experts, y compris la Société canadienne d’ostéoporose, recommandent aux personnes suivantes de subir un test d’ostéodensitométrie : Les femmes et les hommes de 65 ans et plus. Les femmes ménopausées à risque (selon l’évaluation du médecin). Les hommes de 50 ans et plus à risque (selon l’évaluation du médecin).

Mesures préventives de base

Les trois mesures suivantes sont les plus importantes. Il est bon, aussi, d’éviter le plus possible les facteurs de risque décrits plus haut. Faire de l’exercice physique. Les études montrent que l’exercice physique est bon pour les os, tout au long de la vie4-6. Être actif durant l’enfance et l’adolescence est particulièrement important, car cela permet de se constituer un squelette plus résistant, donc de faire des réserves de masse osseuse qui serviront à l’âge adulte. Les personnes en forme physiquement développent un meilleur équilibre et une meilleure coordination, ce qui réduit leur risque de chute. Il est recommandé de pratiquer un minimum de 30 minutes d’activité physique au moins trois fois par semaine. Ce qui importe le plus n’est pas la durée des séances, mais leur fréquence7. Les exercices qui agissent le plus sur la densité osseuse sont les exercices des articulations portantes et les exercices contre résistance : - Les exercices des articulations portantes - ou de mise en charge - ont un effet de gravité sur le squelette. Ils forcent le corps à soutenir le poids de l’ensemble de tout le corps. Entrent dans cette catégorie : la course à pied, des sauts, le tennis et les sports d’équipe, tels que le soccer. Ainsi, les activités au cours desquelles le poids corporel est supporté (vélo, kayak, natation), bien qu’excellentes pour la santé cardiorespiratoire et le maintien de la masse musculaire, n’ont pas d’effet réel sur la masse osseuse. - Les exercices contre résistance consistent à déplacer des objets ou son propre corps de sorte à produire une résistance. Ils s’effectuent avec des poids et haltères ou avec les appareils de musculation qu’on trouve dans les centres de conditionnement physique. On obtient, cependant, les mêmes résultats en exécutant certains travaux quotidiens qui exigent de manipuler ou de pousser des charges lourdes. Par exemple, pratiquer le jardinage au moins une heure par semaine serait le deuxième meilleur exercice, après les poids et haltères8. Manger des aliments riches en calcium. Presque toutes les cellules du corps ont besoin de calcium pour bien fonctionner. Avoir une alimentation qui contient suffisamment de calcium permet de combler les besoins du corps sans qu’il ait à puiser dans ses réserves, c’est-à-dire les os. On peut obtenir un apport suffisant en calcium en mangeant régulièrement des produits laitiers, du saumon (avec les os), de la sardine, des légumes vert foncé (brocoli, etc.), des produits à base de soya (tofu, lait de soya enrichi de calcium). Pour savoir si vous consommez suffisamment de calcium, utilisez notre calculatrice interactive. La prise de suppléments de calcium (combinés à de la vitamine D) peut être nécessaire dans le cas de personnes qui ne comblent pas leurs besoins quotidiens en ce minéral. Pour en savoir plus, consulter notre fiche Calcium. Avoir un apport suffisant en vitamine D. Cette vitamine est vitale pour la santé des os et des dents. Elle améliore l’absorption du calcium dans l’intestin et participe à la fixation de ce minéral dans les os. Sa forme active est synthétisée dans la peau lorsque celle-ci est exposée aux rayons ultraviolets du soleil. On trouve peu de vitamine D dans les aliments sous sa forme active, hormis dans les poissons (sardine, maquereau, hareng, saumon, etc.). C’est pourquoi, en Amérique du Nord, le lait et la margarine sont enrichis en vitamine D. Certaines céréales et certaines boissons de riz ou de soya le sont aussi. Consulter la fiche Vitamine D pour en savoir plus.

Autres mesures préventives

Suppléments de calcium et de vitamine D. À titre préventif, la Société canadienne d’ostéoporose recommande à toutes les personnes âgées de 50 ans et plus de prendre 1 000 mg de calcium et 800 UI (20 µg) de vitamine D par jour sous forme de suppléments.

Traitements médicaux de l’ostéoporose

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Le traitement de base combine la prise de suppléments et une médication adéquate avec un programme d’exercice adapté. Par contre, la perte osseuse peut réapparaître lorsqu’on cesse le traitement.

Si l’ostéoporose découle de l’usage prolongé d’un médicament (thérapie aux corticostéroïdes, etc.), il faut voir à éliminer rapidement sa cause.

Médicaments

Il existe plusieurs médicaments capables de freiner la dégénérescence osseuse et de préserver ou d’augmenter la masse ou la densité minérale osseuse, tout en réduisant de manière significative les risques de fractures. Ils sont indiqués lorsque le risque de fracture est jugé élevé.

Voici les principaux :

• Les bisphosphonates. Ces médicaments ralentissent la perte de masse osseuse. Les plus employés sont l’alendronate (Fosamax®) et le risédronate (Actonel®), en doses hebdomadaires ou quotidiennes sous forme de comprimés. Une nouvelle formulation d’Actonel® permet de prendre ce médicament une seule fois par mois. On utilise aussi l’étidronate (Didrocal®) en doses quotidiennes ainsi que l’acide zolédronique administré par injection intraveineuse une fois par année.
• La calcitonine (Miacalcin®). Cette hormone produite par la glande thyroïde ralentit la perte osseuse. Elle procure aussi un effet analgésique. Elle s’utilise par voie nasale ou sous forme d’injection.
• Le raloxifène (Evista®). Ce médicament mime les effets des oestrogènes en agissant sur les récepteurs de ces hormones (mais sans accroître les risques de souffrir d’un cancer hormonodépendant).
• Le tamoxifène. Cette hormone synthétique, employée pour traiter le cancer du sein, a également un effet semblable à celui des oestrogènes sur les os.
• La parathormone synthétique (PTH). Cette hormone sécrétée par les glandes parathyroïdes est réservée aux cas d’ostéoporose importante. Elle s’administre sous forme d’injection. Elle joue un rôle dans les échanges corporels de calcium et de phosphore, et ralentit la perte osseuse.

Dans le cas des hommes dont l’ostéoporose découle d’une déficience en testostérone (hypogonadisme), on recourt à une hormonothérapie aux androgènes.

En cas de douleurs aiguës ou chroniques, on utilisera des analgésiques. Le port d’un corset peut s’imposer si la douleur s’intensifie.

Remarque. L'hormonothérapie substitutive à la ménopause peut contribuer à ralentir la perte de masse osseuse et ainsi réduire le risque de fracture. Par contre, elle est rarement employée dans ce but unique étant donné les risques qu’elle comporte. Notons que, au moment de l’arrêt du traitement hormonal, une phase accélérée de perte de masse osseuse s’amorce, telle qu’on l’observe naturellement chez les femmes au cours des années qui précèdent la ménopause. Pour en savoir plus, consulter notre fiche Ménopause.

Chirurgie

En cas de fracture de la hanche, une intervention chirurgicale est souvent nécessaire pour reconstruire la hanche.

En cas d’hyperparathyroïdie, l’ablation des glandes parathyroïdes permet d’améliorer la densité minérale des os.

Suppléments

La prise de suppléments de calcium (1 000 mg par jour) et de vitamine D (800 UI ou 20 µg par jour) est toujours proposée en complément aux traitements pharmacologiques. À eux seuls, ils ne suffisent pas à traiter l’ostéoporose.

Alimentation

Tel que décrit en prévention, il est bon d’augmenter son apport en aliments riches en calcium et en vitamine D. Il faut aussi veiller à avoir un apport adéquat en protéines, et privilégier une diète alcaline (riche en fruits et légumes).

Pour des conseils pratiques, consulter notre diète spéciale: Ostéoporose.

Exercice physique

Les bienfaits de l’exercice physique sont nombreux :

• préserver la mobilité et l’équilibre;
• prévenir les chutes;
• ralentir la perte de masse osseuse;
• réduire les douleurs causées par une fracture.

Si l’on souffre d’ostéoporose, on doit consulter un médecin ou un kinésiologue avant de pratiquer toute forme d’activité physique. Le programme d’activité physique doit être progressif et bien adapté aux capacités. Les exercices des articulations portantes et les exercices contre résistance sont les plus bénéfiques. Pour plus de détails, voir la section Prévention.

Prévention des chutes

Divers facteurs augmentent le risque de chute chez les personnes âgées : la perte de force musculaire, les problèmes d’équilibre, les troubles visuels, la prise de certains médicaments, etc. La consultation d’un ergothérapeute permet d’aménager le lieu de vie de façon à réduire ce risque.

À appliquer au quotidien - Avoir une bonne posture : redresser la tête et garder le haut du dos bien droit, tout en maintenant les épaules en arrière et le bas du dos cambré. - Soutenir le cou à l’aide d’un petit coussin lorsqu’on est assis dans un fauteuil ou qu’on conduit. - Manipuler correctement les charges lourdes : éviter de pencher le haut du corps pour saisir et soulever une charge; plier plutôt les genoux et garder le dos droit pendant qu’on la déplace. - Pour éviter les chutes, mettre un tapis antidérapant dans la baignoire; porter des souliers à talons plats et à semelles antidérapantes; se méfier des carpettes, des surfaces glissantes et des fils électriques qui traînent, etc. - Faire attention aux chiens et aux chats, car leur comportement parfois imprévisible peut occasionner des chutes.

L’opinion de notre médecin

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Rappelons-nous que ce n’est pas l’ostéoporose en tant que telle qui est préoccupante, mais plutôt les conséquences qu’elle peut entraîner : les fractures. Il nous faut avant tout les prévenir! Une personne sur deux, victime d’une fracture de la hanche, dépendra d’une tierce personne pour fonctionner normalement dans sa vie courante. Une personne sur cinq décédera des complications de ce type de fracture dans l’année qui suit. Pour agir en prévention, vous devez avoir et maintenir un bon capital osseux. Un peu comme notre capital « retraite », nous n’avons pas tous le même capital osseux. Les trois quarts de celui-ci sont déterminés par notre bagage héréditaire. Vous pouvez le faire fructifier par de bonnes habitudes de vie, dès l’adolescence. Mettez aussi toutes les chances de votre côté pour éviter les chutes : maintenez une bonne force musculaire et améliorez votre souplesse et votre équilibre. Assurément, il s’agit des meilleurs ingrédients d’une recette « antichutes ». Dre Sylvie Dodin, gynécologue

Révision médicale (mai 2009) : Dre Sylvie Dodin, gynécologue, M.Sc., titulaire de la Chaire en approche intégrée en santé (Université Laval). Révision médicale (mars 2005) : Dr Paul Lépine, M.D., D.O.

Approches complémentaires

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En prévention
	Ipriflavone
	Soya (isoflavones), vitamine K
	Bore, collagène, DHEA, graines de lin, magnésium, tai-chi, trèfle rouge
	Prêle des champs

Ipriflavone. Des données provenant de très nombreux essais cliniques montrent que l’ipriflavone, prise avec unsupplément de calcium de 1 000 mg, peut prévenir l’ostéoporose chez les femmes ménopausées^10-12. Il semble également qu’elle puisse ralentir ou contrer la perte osseuse des personnes atteintes d’ostéoporose, y compris lorsque celle-ci est causée par certaines maladies.
Dosage
Prendre 600 mg par jour, en deux ou trois prises, en association avec un supplément de 1 000 mg de calcium.
Mise en garde
Bien que l’ipriflavone soit en vente libre en Amérique du Nord, son usage nécessite le suivi d’un professionnel de la santé en raison de ses effets possiblement immunodépresseurs chez certaines personnes. Voir la fiche Ipriflavone.

Soya (isoflavones). Des données épidémiologiques ainsi que des essais cliniques indiquent qu’un apport alimentaire régulier en isoflavones prévient la perte osseuse. Cet effet bénéfique a principalement été observé chez les femmes, au cours des quelques années qui précèdent et qui suivent la ménopause. L’ensemble des données est suffisamment encourageant pour que les recherches se poursuivent : plusieurs études cliniques sont en cours au sujet des effets des isoflavones du soya sur la santé osseuse¹³.
Dosage
Consommer chaque jour l’équivalent de 80 mg d’isoflavones de soya, de préférence sous forme alimentaire plutôt qu’en suppléments. Les haricots de soya, le tempeh, la farine de soya, le tofu et les boissons au soya sont les principales sources d’isoflavones.

Vitamine K. Des études épidémiologiques ont permis d’observer un lien entre un faible apport alimentaire en vitamine K et une densité osseuse réduite, ainsi qu’un risque plus élevé de fractures^14-16. La plupart de ces études ont été réalisées au Japon. Les résultats sont prometteurs, mais doivent être confirmés par des essais effectués auprès des Occidentales. La vitamine K joue un rôle important dans la coagulation du sang.
Dosage
Les données sont insuffisantes pour suggérer un dosage thérapeutique. Au cours de quelques études menées auprès de sujets occidentaux, on a utilisé de 200 µg à 1 000 ug (1 mg) de vitamine K1 par jour. Au cours d’essais menés au Japon, on a fréquemment employé 45 mg de vitamine K2 par jour (une dose très élevée).

Bore. Les résultats de trois études préliminaires menées auprès de femmes ménopausées (30 sujets en tout) indiquent que la prise de suppléments de bore peut améliorer l’absorption du calcium et ainsi réduire la perte de densité osseuse^17-19.

Collagène. La prise de collagène pourrait augmenter et prolonger l’effet bénéfique sur la masse osseuse de la calcitonine, une hormone couramment prescrite pour contrer la perte osseuse²⁰. Cette hypothèse se base sur un essai clinique mené auprès de 108 femmes ménopausées souffrant d’ostéoporose.

DHEA. La déhydroépiandrostérone (DHEA) est une hormone stéroïdienne anabolisante que les glandes surrénales des humains et de quelques primates supérieurs synthétisent à partir du cholestérol. Avec l’âge, le corps en produit de moins en moins. Les quelques études réalisées jusqu’à présent laissent croire que la prise de DHEA sous forme de supplément peut contribuer à conserver la masse osseuse. Voir la fiche DHEA.

Graines de lin. On s’est intéressé à l’utilité des graines de lin pour contrer la perte osseuse qui survient à la ménopause, mais les résultats ne sont, dans l’ensemble, pas concluants^21-24.

Magnésium. Des recherches ont établi une association entre l’apport en magnésium (aliments et suppléments) et la densité osseuse²⁵. Elles suggèrent que la carence en magnésium contribue à l’ostéoporose²⁶. Les études cliniques portant sur les effets de la prise de suppléments sont toutefois rares.

Tai-chi. Les résultats d’une revue systématique publiée en 2008 laissent penser que le tai-chi, un art martial incorporé dans la Médecine traditionnelle chinoise, pourrait contribuer à réduire la douleur associée à l’arthrose du genou²⁷. Cependant, les résultats sont moins probants pour d’autres types d’arthrose, que ce soit en ce qui concerne la douleur ou l’amélioration des capacités physiques.

Trèfle rouge (Trifolium pratense). Il semble que les isoflavones du trèfle rouge soient capables de réduire la perte de densité minérale osseuse des femmes en périménopause ou en postménopause^28-30. Ces résultats prometteurs devront être confirmés par d’autres études.

Prêle des champs (Equisetum arvense). Traditionnellement, les parties aériennes de cette plante étaient utilisées pour prévenir la perte osseuse, ou aider à la guérison des foulures ou des fractures. La teneur en silice de la plante expliquerait ses propriétés thérapeutiques : cet oligoélément joue un rôle important dans le maintien et le renouvellement des tissus conjonctifs, et il faciliterait la fixation du calcium dans les os. En Italie, le supplément Osteosil® Calcium, qui contient du calcium et de la prêle des champs, est utilisé pour traiter l’ostéoporose et les fractures.
Dosage
Consulter la fiche Prêle des champs.

Selon l’expert des médecines alternatives Edzard Ernst, la chiropratique serait contre-indiquée aux personnes atteintes d’ostéoporose31.

Sites d’intérêt

Canada

Femmes en santé
www.femmesensante.ca

Ostéoporose Canada
Pour en savoir plus sur l’ostéoporose ou obtenir du soutien.
www.osteoporosecanada.ca
Section du Québec : www.osteoporosecanada.ca

Guide Santé du gouvernement du Québec
Pour en savoir plus sur les médicaments : comment les prendre, quelles sont les contre-indications et les interactions possibles, etc.
www.guidesante.gouv.qc.ca

France

Groupe de Recherche et d’Informations sur les Ostéoporoses - GRIO
www.grio.org

États-Unis

National Osteoporosis Foundation
www.nof.org

International

Organisation mondiale de la Santé
Le test FRAX permet d’évaluer, à l’aide de 12 questions, le risque de fracture au cours des dix prochaines années. Il en se base sur des facteurs de risque (âge, sexe, tabagisme, etc.) et sur le résultat au test de densité minérale osseuse (score T). Il a été conçu à partir de cohortes d’Europe, d’Amérique du Nord, d’Asie et d’Australie.
www.shef.ac.uk/FRAX

Recherche et rédaction : Marie-Michèle Mantha, M.Sc. Mise à jour : octobre 2009

Références Note : les liens hypertextes menant vers d’autres sites ne sont pas mis à jour de façon continue. Il est possible qu’un lien devienne introuvable. Veuillez alors utiliser les outils de recherche pour retrouver l’information désirée. Bibliographie American College of Rheumatology. Patient Education - Osteoporosis, American College of Rheumatology. [Consulté le 27 février 2009]. www.rheumatology.org Comité scientifique de Kino-Québec (2008). Activité physique et santé osseuse, Ministère de l’Éducation, du Loisir et du Sport, Gouvernement du Québec. [Consulté le 2 mars 2009]. www.kino-quebec.qc.ca/publications/santeosseuse.pdf Côté J. Comment ne pas nuire à l’absorption du calcium, La Presse, 28 octobre 2007. InteliHealth (Ed). Diseases and Conditions - Osteoporosis, Aetna Intelihealth. [Consulté le 27 février 2009]. www.intelihealth.com Jacques P. Brown and Robert G. Josse, pour le Comité consultatif scientifique de la Société de l’Ostéoporose du Canada. Lignes directrices de pratique clinique 2002 pour le diagnostic et le traitement de l’ostéoporose au Canada. CMAJ, March 18, 2003; 168. Mayo Foundation for Medical Education and Research (Ed). Diseases & Conditions - Osteoporosis, MayoClinic.com. [Consulté le 2 mars 2009]. www.mayoclinic.com National Library of Medecine (Ed). PubMed, NCBI. [Consulté le 2 mars 2009]. www.ncbi.nlm.nih.gov Natural Standard (Ed). Condition Center - Osteoporosis. [Consulté le 2 mars 2009]. www.naturalstandard.com Pizzorno JE Jr, Murray Michael T (Ed). Textbook of Natural Medicine, Churchill Livingstone, États-Unis, 2006. Ostéoporose Canada. [Consulté le 2 mars 2009]. www.osteoporosecanada.ca Société des obstétriciens et gynécologues du Canada. Menopause and osteoporosis Uptodate 2009. Journal d’obstétrique et gynécologie du Canada, vol. 31, no 1, janvier 2009. The Natural Pharmacist (Ed). Natural Products Encyclopedia, Conditions - Osteoporosis, ConsumerLab.com. [Consulté le 2 mars 2009]. www.consumerlab.com UpToDate. [Consulté le 2 mars 2009]. www.uptodate.com Notes 1. Magkos F, Kavouras SA. Caffeine use in sports, pharmacokinetics in man, and cellular mechanisms of action. Crit Rev Food Sci Nutr. 2005;45(7-8):535-62. 2. Cheung AM, Feig DS, et al. Canadian Task Force on Preventive Health Care. Prevention of osteoporosis and osteoporotic fractures in postmenopausal women: recommendation statement from the Canadian Task Force on Preventive Health Care. CMAJ. 2004 May 25;170(11):1665-7. 3. Ostéoporose Canada. Briser les obstacles sans briser les os : bilan national 2008 sur les soins de santé en ostéoporose. [Consulté le 2 mars 2009]. www.osteoporosis.ca 4. Jacques P. Brown and Robert G. Josse, pour le Comité consultatif scientifique de la Société de l’Ostéoporose du Canada. Lignes directrices de pratique clinique 2002 pour le diagnostic et le traitement de l’ostéoporose au Canada. CMAJ, March 18, 2003; 168. 5. Bonaiuti D, Shea B, et al. Exercise for preventing and treating osteoporosis in postmenopausal women (Cochrane Review). Cochrane Database Syst Rev. 2002;(3):CD000333. 6. Todd JA, Robinson RJ. Osteoporosis and Exercise. Review. Postgrad Med J. 2003 Jun;79(932):320-3. 7. Comité scientifique de Kino-Québec (2008). Activité physique et santé osseuse, Ministère de l’Éducation, du Loisir et du Sport, Gouvernement du Québec. [Consulté le 2 mars 2009]. www.kino-quebec.qc.ca/publications/santeosseuse.pdf 8. Le jardinage et la marche pour prévenir l’ostéoporose. www.passeportsante.net 9. MayoClinic.com. Exercise with osteoporosis: stay active the safe way. [Consulté le 2 mars 2009]. www.mayoclinic.com 10. Gennari C, Adami S, et al. Effect of chronic treatment with ipriflavone in postmenopausal women with low bone mass. Calcif Tissue Int. 1997;61 Suppl 1:S19-22. 11. Adami S, Bufalino L, et al. Ipriflavone prevents radial bone loss in postmenopausal women with low bone mass over 2 years. Osteoporos Int. 1997;7(2):119-25. 12. Agnusdei D, Crepaldi G, et al. A double blind, placebo-controlled trial of ipriflavone for prevention of postmenopausal spinal bone loss. Calcif Tissue Int. 1997 Aug;61(2):142-7. 13. US National Institutes of Health. ClinicalTrials.gov [Consulté le 2 mars 2009] http://clinicaltrials.gov 14. Feskanich D, Weber P, et al. Vitamin K intake and hip fractures in women: a prospective study.Am J Clin Nutr 1999 Jan;69(1):74-9. 15. Booth SL, Tucker KL, et al. Dietary vitamin K intakes are associated with hip fracture but not with bone mineral density in elderly men and women. Am J Clin Nutr. 2000 May;71(5):1201-8. 16. Olson RE. Osteoporosis and vitamin K intake. Am J Clin Nutr 2000;71:1031-2. Texte complet : www.ajcn.org 17. Nielsen FH, Hunt CD, et al. Effect of dietary boron on mineral, estrogen, and testosterone metabolism in postmenopausal women. FASEB J 1987 Nov;1(5):394-7 18. Beattie JH, Peace HS. The influence of a low-boron diet and boron supplementation on bone, major mineral and sex steroid metabolism in postmenopausal women.Br J Nutr 1993 May;69(3):871-84. 19. Hunt CD, Herbel JL, Nielsen FH. Metabolic responses of postmenopausal women to supplemental dietary boron and aluminum during usual and low magnesium intake: boron, calcium, and magnesium absorption and retention and blood mineral concentrations. Am J Clin Nutr. 1997 Mar;65(3):803-13. 20. Adam M, Spacek P, et al. [Postmenopausal osteoporosis. Treatment with calcitonin and a diet rich in collagen proteins] [Article en tchèque, résumé en anglais]. Cas Lek Cesk. 1996 Jan 31;135(3):74-8. 21. Arjmandi BH, Juma S, et al. Flaxseed supplementation positively influences bone metabolism in postmenopausal women. JAMA 1998 1:27–32. Étude citée et résumée dans : Dodin S, Lemay A, et al. The effects of flaxseed dietary supplement on lipid profile, bone mineral density, and symptoms in menopausal women: a randomized, double-blind, wheat germ placebo-controlled clinical trial. J Clin Endocrinol Metab. 2005 Mar;90(3):1390-7. 22. Lucas EA, Wild RD, et al. Flaxseed improves lipid profile without altering biomarkers of bone metabolism in postmenopausal women.J Clin Endocrinol Metab 2002 Apr;87(4):1527-32. 23. Brooks JD, Ward WE, et al. Supplementation with flaxseed alters estrogen metabolism in postmenopausal women to a greater extent than does supplementation with an equal amount of soy. Am J Clin Nutr. 2004 Feb;79(2):318-9. 24. Dodin S, Lemay A, et al. The effects of flaxseed dietary supplement on lipid profile, bone mineral density, and symptoms in menopausal women: a randomized, double-blind, wheat germ placebo-controlled clinical trial. J Clin Endocrinol Metab. 2005 Mar;90(3):1390-7. 25. Ryder KM, Shorr RI, et al. Magnesium intake from food and supplements is associated with bone mineral density in healthy older white subjects. J Am Geriatr Soc. 2005 Nov;53(11):1875-80. 26. Sahota O, Mundey MK, et al. Vitamin D insufficiency and the blunted PTH response in established osteoporosis: the role of magnesium deficiency. Osteoporos Int. 2006 Apr 5. 27. Lee MS, Pittler MH, Ernst E. Tai chi for osteoarthritis: a systematic review. Clin Rheumatol. 2008;27(2):211-8. 28. Baber R, Clifton Bligh P, Fulcher G, et al. The effect of an isoflavone extract (PO81) on serum lipids, forearm bone density and endometrial thickness in postmenopausal women. Proceedings of the North American Menopause Society (New York, 1999). Étude citée et résumée dans : Natural Standard (Ed). Herbs & Supplements – Red Clover, Nature Medicine Quality Standard. [Consulté le 2 mars 2009www.naturalstandard.com 29. Clifton-Bligh PB, Baber RJ, et al. The effect of isoflavones extracted from red clover (Rimostil) on lipid and bone metabolism.Menopause. 2001 Jul-Aug;8(4):259-65. 30. Atkinson C, Compston JE, et al. The effects of phytoestrogen isoflavones on bone density in women: a double-blind, randomized, placebo-controlled trial. Am J Clin Nutr. 2004 Feb;79(2):326-33. Texte intégral : www.ajcn.org 31. Ernst E. Chiropractic spinal manipulation for back pain. Br J Sports Med. 2003;37(3):195-6; discussion 196. 32. Screening for osteoporosis in men: a systematic review for an American College of Physicians guideline. Liu H, Paige NM, et al. Ann Intern Med. 2008 May 6;148(9):685-701. Review.

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Specialized Training — One Bodypart at a Time

by John Romaniello

Specialization is My Specialty

Over the course of my career, I've worked with athletes who want to perform better, cougars re-investing in their assets, and more fat-loss clients than I can count.

However, I've recently found myself designing more programs for guys who want to bring up lagging body parts.

Perhaps it's because I take an approach to training that's based primarily on improving aesthetics and symmetry, or maybe it's because I've always been outspoken in my opinion that goals are intensely personal and the idea that people "shouldn't" want big arms over big legs is laughable.

Whatever the case, I've always been an ardent proponent of specialization programs, and have encouraged people to use them in their training.

Because full-body muscle growth slows dramatically for advanced trainees, I firmly believe that specialization programs are superior to programs aimed at increasing overall size.

Here are a few reasons why I prefer specialization programs.

Significant muscle growth happens in spurts.

For intermediate and advanced trainees, significant growth happens in bursts. Whatever theory of training you subscribe to and whatever program is your "go-to" for mass gain, if you've been training for a few years chances are you've gotten to where you don't add a pound of muscle at a time. Instead you grow in five to ten pound growth spurts.

This is true for the vast majority of my clients and athletes, and it has certainly been true for me.

At higher levels of development, full-body growth becomes increasingly difficult to achieve.

The more muscle you have, the harder it is to gain muscle. Although in a broad sense this is because you're getting closer to your genetic ceiling, one of the more specific reasons is that your body simply cannot continue to grow under the same conditions.

More advanced trainees are (hopefully) stronger. Lifting heavier weight for a comparable number of reps is more taxing on the nervous system and the general metabolic processes involved in recovery.

In almost all cases, as you progress your ability to train for full-body growth will be far greater than your ability to recover from such training.

On an already developed body, training your ass off for eight weeks to gain three pounds of muscle—which probably makes a minimal visible difference—is lame.

When you put on some muscle in a given time period it's generally distributed over your entire frame.

Gaining a few pounds of lean body mass is always nice, and I would never say it isn't a goal worthy of effort or achievement. It just sucks when you achieve it and you can't see it. And when you're already pretty well developed, that's often what happens.

Recently, I was working with a college lacrosse player who wanted to put on some size in his off-season. At 6'2'' and 180 pounds, I didn't blame him for wanting to get bigger. We packed 15 pounds on him during the summer, and when he walked through the door on the first day of pratice the coach looked at him and said, "I thought I told you to gain some weight."

This kid went from 180 to 195 pounds, with only three pounds being fat, and his own coach didn't pick up on it until he got on the scale.

Granted, it's partially a height issue; if a guy who's 5'8" put on fifteen pounds it would be a lot more obvious. But my point is most people aren't putting on fifteen pounds over a summer; they're adding five to ten, tops. And since it's spread over their entire body, no one really notices.

Everyone notices when you put an inch on your arms, or add significant chest size.

Training with the goal of increasing the size of a single muscle or muscle group has a lot of benefits, but the main one is visibility. People notice. More than that, you notice. Nothing is as satisfying as actually seeing the results in the mirror or in your clothes, instead of having to account for infinitesimal changes on a measuring tape.

So if you can only have the occasional growth spurt, why not dedicate a spurt to something that will be visibly noticeable, intensely satisfying, and realistically achievable over a short duration?

The Bottom Line

I believe in short, single-minded bursts of training for three to six weeks, and no more. I prefer to spend those weeks getting as much out of a training program as possible, putting on some noticeable size and keeping fat gain to a minimum.

(Did I mention that specialization programs don't require extreme "bulking" diets that usually lead to excess fat gain? Unless you're specializing legs, in which case you need to eat a lot. But honestly, who trains legs? Everyone knows you're just going to use this information to get bigger arms. There's no point lying about it.)

Principles of Specialization Programs

When writing a specialization program, the first things to consider are volume and frequency. It should go without saying that when prioritizing a muscle, you need to train it more. Not only with more sets and reps, but a much greater frequency, too.

For a specialization program to be optimally effective, it must meet the following criteria:

High Overall Frequency — In a perfect world, I'd have people training once every 36 hours. When that isn't possible, every other day is the next best option. At the minimum, you should be able to figure out how to squeeze in three workouts per week.

High Weekly Volume, Moderate Workout Volume — Your total weekly volume is going to be pretty high. Between three and four training sessions per week, you're getting a lot of total work for the selected muscle group. I recommend that you generally aim for 40 to 50 sets per week, broken into as many sessions as possible.

Of course, that recommendation doesn't account for reps or load, so here are some more specifics.

50 Sets Per Week:
15 Sets of High Reps — 12-15
15 Sets of Moderate Reps — 8-12
15 Sets of Low Reps — 6 or below
5 Sets of Very High Reps — 18-25 Reps

Moderately High Intensity — Given that you'll be training with both high volume and high frequency, finding the right intensity is important. As a starting point, I recommend using roughly 90% of your max in a given rep range.

So if your 10RM on the bench press is 225 pounds, use roughly 200 pounds for sets of 10.

This recommendation stands regardless of the rep range.

Exercise Selection

One of the best things about specializing a body part is you get to shy away from the basics and really get into some fun exercises. While it'd be impossible to list all the combinations of all the exercises, I'd say that each workout would need to consist of the following:

Compound Exercises — I hope I don't need to define this for you. Just know that big movements are always at the core of any program. Examples include squats, deadlifts, overhead press, pull-ups, close grip bench press, dips, lunges, bent-over rows and floor presses.

Each workout should have at least two compound exercises.

Explosive Exercises — Movements requiring explosiveness are great because they increase strength, power, coordination, and recruit muscle fibers that other exercises leave behind. Examples of explosive exercises would be: jump squats, kipping pull-ups, push presses, cleans, explosive push-ups, jump lunges and cheat curls.

I recommend including one explosive movement per workout.

Isolation Exercises — Stop pretending you don't like biceps curls. Sure, you can probably get big arms without them, but how sweet is that pump? Other examples include lateral raises, leg extensions, leg curls, cable flys, triceps extensions and calf raises.

For the purposes of specialization, I recommend adding two isolation movements per workout.

Unilateral Exercises — Specific to specialization programs, unilateral movements are effective because they recruit a greater number of High Threshold Motor Units. I normally recommend that your unilateral movements correspond with your heavier workouts for the purposes of maximally recruiting HTMUs. Examples of great unilateral exercises are: single leg pistol squats, single arm over-head presses, single arm dumbbell chest presses, Bulgarian split squats and dumbbell rows.

You should include at least one unilateral exercise per specialization workout.

Wacky Exercises — These are the exercises you aren't really sure how to classify. Oftentimes, it's stuff that crazy strength coaches like me come up with just to fuck with you. While they tend to be really bizarre things that make people look at you funny, they are often also radically effective and innovative movements that can help bring your training to the next level. Included in this category are: Siff lunges, fly-aways, javelin presses, drag curls, Bulgarian jump squats, lumberjack presses, renegade rows, side-to-side pull-ups and pike push-ups.

At least one exercise per training session should be new, innovative, and wacky. As a reference, check out the articles series "Exercises You've Never Tried" here on TMUSCLE.

It should go without saying that a lot of these may overlap: a wacky exercise may also be explosive, or a compound exercise might be somewhat wacky. Use your best judgment to figure out which exercises are going to make the program the most fun and effective for you.

A Note on Maintenance

One of the things I notice about most specialization programs in other magazines is that almost no one mentions how to train the rest of the body. You'd think increasing the size of a single muscle was as simple as adding in a few extra sets and whatever they decide the Chest Exercise of the Month is.

At best, you'll see something along the lines of "put all other body parts on maintenance."

It's not that simple.

Correct manipulation of volume is tricky, and honestly, I like to err on the side of caution. I'd much rather have people do a bit too much for the prioritized body part and a bit too little for everything else. To that end, I really tone down the volume for other body parts.

When people make broad recommendations like "put everything else on maintenance" it leaves trainees with a lot of room to screw things up by doing too much and inhibiting results.

After all, what does "maintenance" really mean? You need to define it. For me, it means you need to accept that your focus is your focus, and everything else takes a back seat.

So when I tell someone to put something on maintenance, I mean they should train it as little as necessary. That means not losing strength or mass. In most cases, this is a lot less than you think.

The majority of people can hold onto muscle mass by doing a full body circuit once per week, which is is a pretty decent starting point.

I do understand the concern and fear of losing mass, and I'm not discounting the validity of it. I just take a more pragmatic approach to things. If all you care about is having big legs, who cares if it feels "wrong" to only train chest once every 10 days, or even less?

If at the end of the program you have bigger legs, you accomplished your goal and you and your big legs can go back to training chest again.

Final Thoughts

I'm certainly willing to agree that you can gain muscle—even as an advanced trainee—on programs focused on whole body growth, but the result is usually not impressive. I know there are a lot of great programs from a lot of great coaches that can lead to significant growth over a considerable length of time.

For me, that's not good enough.

I believe in acceleratory, single-minded bursts of focused training, intentioned to produce dramatic results in a relatively short timeframe.

Given that mindset, specialization programs are great for someone like me. They're quick, fun, and the visibility of the results are intensely satisfying.

Bigger arms in four weeks? Sign me up.

A shoulder specialization program is the perfect way to use the "bodybuilder illusion" to your advantage: get bigger shoulders and make your waist look smaller.

Specialization: results you can actually see.

About John Romaniello

Author, coach, and self-professed pretty-boy John Romaniello is the owner of Roman Fitness Systems, LLC, a personal training and online coaching business servicing the greater New York area. When not training professional athletes and aspiring cougars, Roman can be found playing D&D and starting fashion trends. Email him at: Roman@RomanFitnessSystems.com

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