How to Build Strength at Any Age: Bone Health, Fitness Myths, and Functional Movement with Dr. Hannah Sadowsky

What if the difference between fragility and resilience as you age came down to learning how to load your body well? In this conversation with Dr. Hannah Sadowsky, physical therapist and strength coach at Old Bull Athletics, we unpack why strength training is one of the most powerful tools for bone density, longevity, and everyday function.

From osteoporosis prevention to the truth about flexibility and the fitness myths still keeping women small, this episode is a practical, empowering guide to building strength at any age.

Key Takeaways

00:14 — Guest introduction: meet Dr. Hannah Sadowsky
00:32 — Hannah's background, gymnastics roots, and clinical journey
00:55 — Personal experience and the benefits of strength training
02:37 — Path to physical therapy and Old Bull Athletics
04:34 — Empowerment through strength training
05:52 — Family influence and an active upbringing
06:54 — Why strength training is essential for women's health
07:50 — Overcoming gym intimidation and where to begin
09:17 — Building strength at home with limited equipment
10:43 — Physical therapy for bone health and osteopenia
11:59 — Bone density, mechanical stress, and progressive overload
14:29 — Flexibility and mobility through loaded movement
19:07 — Reactivity training and easy at-home exercises
21:07 — Debunking fitness myths, including the knee-over-toe rule
22:34 — What good physical therapy should actually look like
24:08 — Starting strength training at home: absolute versus relative strength
26:52 — Patient success stories and meaningful transformations
30:48 — The role of physical therapy in longevity
32:26 — Final thoughts on building a sustainable strength practice
37:46 — Love it or leave it: rapid-fire fitness round
39:28 — Key takeaways to put into practice this week

Guest Bio

Dr. Hannah Sadowsky is a physical therapist and strength coach based in Miami, practicing out of Old Bull Athletics. With a background as a competitive gymnast and over fifteen years of coaching experience, she specializes in helping clients of all levels build functional, resilient strength, whether they're recovering from injury, navigating bone density concerns, or stepping into strength training for the first time.

Follow Dr. Sadowsky on Instagram: @hsadowsky and Old Bull Athletics @oldbullathletics

References

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Full Transcript

Meet Dr. Hannah Sadowsky

I am so excited for today's episode. I have with me my own personal superhero, my physical therapist, Dr. Hannah Sadowsky. She has taught me that doing hard things, like failing while lifting weights, is exactly what makes me stronger.

Hannah is a physical therapist and strength coach. She earned her degree about six years ago and currently practices out of Old Bull Athletics in Miami. She also has a deep background in gymnastics, competing from age six through seventeen and coaching competitively for over fifteen years. Her control, strength, and creativity in her own training is part of what inspired me to bring her on.

From Gymnastics to Physical Therapy

I'm one of ten kids, so I had a nurturing role in my family from early on. Combining that with gymnastics, I knew I wanted a career in health and helping people. As a coach, I saw a clear gap in how athletes were handled when returning from injury, especially in gymnastics. I wanted to fill that gap.

After PT school, I worked at a large hospital in Miami, but my dream was always Cirque du Soleil. I started working with performers on cruise ships at the Port of Miami to build my resume. Then COVID hit, and 99 percent of Cirque lost their jobs. I pivoted, applied to Old Bull, and it's been the perfect fit ever since.

Why I Send Patients to Old Bull

I'll be honest, I never thought of myself as an athlete until I started training with Hannah. She's helped me conquer the push-up, the pull-up, sled pulls, and most importantly, she's helped me stop pulling my back out. After having kids, I was throwing my back out roughly once a month. I once sneezed and pulled it out. I have not pulled my back in nearly two years of training with her.

That's why I send so many of my patients to her and to Old Bull. Strength training is not optional in my practice. It is foundational.

Why Strength Training Matters More Than Cardio Alone

So many of my patients, myself included historically, are cardio queens. Running, kickboxing, Pilates. But strength training, lifting heavy, is often missing from the routine. It's intimidating. People don't know where to begin.

The starting point is education. Cardio isn't bad. It serves a purpose. But strength training does something fundamentally different and equally essential. We meet people exactly where they are. We don't compare them to anyone else. The first session might just be learning how to squat from a box, the same way you'd sit down on a toilet. Once people get going, that's the hardest part. From there, you keep showing up.

Reverse-Engineering the Pull-Up

People often ask how to work toward a pull-up. The answer is to break the skill down into its components.

A pull-up requires core strength and lat strength. So you start with movements that build those qualities, hollow body holds, planks, and band pull-downs. Your lats are the wing-shaped muscles across your back, and they're the primary movers in a pull-up. If you can attach a band high up at home and start doing band pull-downs, you're already training toward the goal. The pull-up is the finish line, not the starting point.

Bone Density: The Window Most Women Miss

This is where I want patients to pay attention. The standard recommendation for osteoporosis screening with a DEXA scan is age 65. By that point, a critical window has often already closed.

When my patients come in around 40 or 45, I'll order a DEXA scan, and frequently I'll find osteopenia. That's when we have real options. Bone mineral density actually starts declining around age 30. Slowly through the thirties and forties, then more drastically as we approach menopause and the hormonal shifts that accelerate the loss.

Strength training stimulates the cells responsible for bone growth. The earlier we intervene, the better the outcome.

Why Mechanical Stress Is the Key

The way you signal your bones to grow stronger is through mechanical stress. That means loading them with something challenging enough to demand adaptation.

This is where the myths come in. People assume yoga, Pilates, or light weights are enough. They aren't, at least not for stimulating bone growth. A 10-pound squat is not enough load to trigger that adaptation. Even running and HIIT, which generate four to five times your bodyweight in impact, plateau once your body adapts to them.

What works is progressive overload. You have to keep challenging the system. In our sessions, we aim for an intensity of about 7.5 to 8 out of 10, meaning you have roughly two reps left before failure. That's where adaptation happens.

The Hip Fracture Statistic Every Woman Should Know

One in four women who sustain a hip fracture will die within the next year. That number is real, and it's the consequence of years of unaddressed bone density loss combined with poor balance and reactivity.

But here's the empowering piece. Strength training, balance work, and reactivity training all reduce your fracture risk. If you trip and catch yourself, you don't fall. If you don't fall, there's no fracture. Bone health is not just about the DEXA number. It's about every layer of resilience you build around it.

We think of healthy bone like a sharp cheddar block, dense and structured. Osteoporotic bone is more like Swiss cheese, porous and prone to break. The goal is cheddar bones.

Loaded Mobility Beats Static Stretching

I'll admit, I hate stretching. Hannah has helped me work on flexibility in a completely different way.

Static stretching has its place, but the changes don't last long. Loading a muscle in a lengthened position, on the other hand, produces faster and more durable improvements in flexibility. A deadlift, for example, stretches your hamstrings under load, which means you're building strength and improving flexibility at the same time. After a heavy set, test your hamstring flexibility. The change is immediate.

This is why loaded mobility work, including weighted movements that take joints through their full range, consistently outperforms passive stretching.

Reactivity Training You Can Do at Home

Reactivity is the body's ability to respond to an unexpected stimulus. It's a key piece of fall prevention that often gets overlooked.

A simple at-home drill: download a color-change app on your phone. Place it in front of you. Lunge to the right when it shows green, to the left when it shows red. You're forcing your nervous system to react and your body to move accordingly. Playing tag or capture the flag with your kids does the same thing. Anything that requires split-second decisions trains reactivity.

The Knee-Over-Toe Myth

For decades, women were taught that knees should never pass the toes during a squat. The truth is, your knees pass your toes every time you walk down the stairs. It's a normal, functional movement pattern.

When we train the body to avoid it, we leave it unprepared for everyday life. The goal is to train these patterns safely and progressively so your body is ready for whatever real life demands of it.

What Good Physical Therapy Actually Looks Like

Traditional physical therapy often looks like a clinic full of tables, with patients spending most of their session lying on them, with ice or heat and minimal active movement. That's not what we do.

A strong PT setting looks more like a gym. There are weights, real ones, and tools to apply appropriate load. Physical therapy should be physical. The therapist's job is to teach, demonstrate, and progressively transition you toward independence.

A red flag in any clinic: no weights heavier than 20 pounds. If a clinic doesn't have meaningful load available, they aren't equipped to help you build the strength your body actually needs.

Absolute Strength Versus Relative Strength

If you're at home with limited equipment, you still have everything you need.

There are two types of strength. Absolute strength is your ability to move an outside load. Relative strength is your ability to move your own bodyweight. Push-ups, pull-ups, glute bridges, leg lifts, hollow body holds, all of these build real, functional strength using nothing but your body. You can progress them by slowing the tempo or increasing reps. When your body starts craving more challenge, that's your signal to introduce external load.

A First Session for a Postmenopausal Patient

Imagine a patient who's postmenopausal, was just diagnosed with osteopenia, and has never strength trained. She used to power walk, maybe ran a few half marathons, but stopped after kids. She's nervous.

We start with a functional movement assessment. Show me a squat. If squatting feels intimidating, I'll ask, how do you sit down on a toilet? We'll put a box there. Show me how you bend over to pick something up. Can you hold a plank? Can you do a push-up?

From there, we map out a plan. We build the foundation, the base of the pyramid, before we worry about progression. Three sessions a week is ideal for someone starting out, but consistency at any frequency beats nothing. Two sessions a week is a meaningful starting point and aligns with CDC guidelines.

Why Sneezing and Pulling Your Back Is Common but Not Normal

When the smallest thing sets your body off, it's usually because everything else is already maxed out. Stress, poor sleep, dehydration, lack of recovery, all of it accumulates. People say "I just took a bad step and tore my meniscus." It usually isn't the step. It's everything that led up to it.

Fat is also part of the picture. Fat tissue is pro-inflammatory and sends signals throughout the body that work against you. Muscle, on the other hand, is anti-inflammatory and metabolically active. Muscle truly is the organ of longevity.

The One Exercise to Do for the Rest of Your Life

If I could only do one movement for the rest of my life, it would be a lunge or a split squat. It's a compound movement that works multiple muscle groups, demands balance, builds stability, and trains reactivity all at once. For longevity, nothing else does this much in a single exercise.

Love It or Leave It

A few quick takes:

Fast workouts: Love them if you know your body. Leave them if you're unsure how you respond to high intensity.
Muscle-ups: Love them.
Hot yoga: Leave it. We live in Miami. Enough heat already.
Interval running: Love it. Stresses the body productively, builds cardiovascular health.
Jumping squats: Leave them.
Pilates: Love it, but don't skip strength training.
Kettlebells: Love them.
Protein shakes: Leave them, personally. Real food preferred.
Creatine: Love it for its benefits, even if I don't currently take it.

Final Takeaways

If you remember nothing else, remember this:

Get moving. Start with compound movements and gradually introduce weights.
Start where you are. If a squat feels intimidating, sit down on the couch and stand up. That's your starting point.
Aim for at least two strength sessions a week, at moderate intensity, for around 60 minutes each. That's the CDC minimum, and it's a solid foundation to build from.

Strength is not just about how you look. It's about how independently and powerfully you live. Start where you are.

Stay consistent. The results will follow.

FAQs

Is strength training safe for women who have never lifted weights before?

Absolutely. Strength training is designed to meet you where you are. Beginners start with bodyweight movements like glute bridges, push-ups, and planks before ever touching a barbell. The key is progressive overload, which simply means gradually increasing the challenge over time. Starting light and building slowly is not just safe, it's the whole strategy.

How is strength training different from cardio when it comes to bone health?

Cardio supports your heart and cardiovascular system, but it doesn't generate the mechanical stress needed to stimulate bone growth. Strength training, especially lifting heavy weights, applies direct load to your bones and signals them to get denser and stronger. This distinction becomes increasingly important as bone density begins to naturally decline around age 30.

How often should women strength train each week?

The CDC recommends a minimum of two days of strength training per week at moderate-to-high intensity, for at least 60 minutes per session. For women navigating perimenopause or early signs of osteopenia, working with a qualified physical therapist or strength coach to build a progressive program beyond that baseline can make a meaningful difference.

Can I build bone density if I've already been diagnosed with osteopenia?

Yes, and this is exactly why starting sooner matters. Osteopenia is an early warning sign, not a final verdict. With the right progressive strength program, meaningful improvements in bone density are still achievable. If you're in your 40s and have received an osteopenia diagnosis, that window is still very much open.

What if I can't afford a gym or don't have any equipment?

You still have everything you need to start. Bodyweight training: push-ups, lunges, glute bridges, planks, hollow body holds, builds real, functional strength and requires zero equipment. Once your body adapts and craves more challenge, that's your natural cue to begin exploring added resistance. The most important step is simply beginning.

Terms used:

1. Sled pulls - a highly effective, full-body functional strength and conditioning exercise targeting the posterior chain (hamstrings, glutes), back, and core, while providing intense cardiovascular benefits

2. Muscle ups - an advanced calisthenics compound exercise combining an explosive pull-up and a straight bar dip to lift the body over a bar or rings

3. Lats - large, wing-shaped muscles on the back that aid in shoulder and arm movement

4, DEXA scan - a quick, painless, and non-invasive imaging test that uses very low-dose X-rays to measure bone mineral density

5. HIIT training - involves short bursts of intense, near-maximal exercise (often 80-90% of max heart rate) alternated with low-intensity recovery periods

6. Deadlift - a strength training exercise in which a weight is lifted off the ground to hip level and then returned to the floor

7. Lunge - a versatile lower-body exercise that strengthens the quads, hamstrings, glutes, and core while improving balance

8. Glute bridges - a highly effective, no-equipment exercise designed to strengthen the glutes, hamstrings, and core while improving hip stability

9. Meniscus - a C-shaped, rubbery cartilage pad in the knee that acts as a shock absorber and stabilizer between the thigh bone (femur) and shinbone (tibia)

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