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Senior man in a gym talking to personal trainer

Where to Begin When You Are Working Out With a Health Condition

/11 September 2023/ All MFN blog/

The gym can be a confusing place especially for individuals with health concerns. Many times, these clients are trying to navigate their workouts by themselves because they are unsure of the appropriate questions that they need to ask.

First of all, there are two different types of trainers. There are trainers who have a four year degree and certifications. These trainers are sometimes called Fitness Specialists and have had many hours of study related to a wide variety of diseases and injuries. They are used to modifying exercises and programs based on any specific condition you may have. Fitness Specialists are usually found in a medically based fitness facility affiliated with a hospital. Please note that some Fitness Specialists will specialize in a certain area. Some work with individuals with diseases and disabilities and some don’t. You can search the free MedFit Network directory to find a fitness pro in your area. In their MFN profile, you’ll find information about their condition-specific education and services.

When you finally narrow down who you might like to hire you will want to ask some questions. Please don’t be afraid to ask these questions as they will help you to decide which trainer is right for you. It is also recommended that you observe Fitness Specialists training clients.

First you want to make sure that the trainer has had experience with your condition. If not, they should be willing to research it and or speak with your doctor with your permission. There are exercise guidelines that all Fitness Specialists should follow when working with clients who have health conditions.

You will also want to ask about the trainers background. It is alright to ask about education, certifications, and years of experience. You also want to hire someone who is patient with you. This is extremely important as you figure out which exercises work best for your body. I would also like to add that you need to be patient with yourself as well. Try to relax and enjoy your training session.

Asking the questions from above help to keep you feeling confident. Exercise can seem frustrating in the beginning but you have to keep a positive mindset. In the beginning, set small goals and do the best you can during each training session.

Robyn Caruso is the Founder of The Stress Management Institute for Health and Fitness Professionals. She has 15 years of experience in medical based fitness.

new year

Fitness New Year’s Resolution Tips

/2 January 2023/ All MFN blog/

The holidays were here and there was plenty of running around and parties to attend. As we said goodbye to this year, we are ready to take on the new year. Many individuals have decided to make fitness a resolution and made the commitment with themselves to get into better shape.

Many individuals do not plan for this transition and end up stopping within three months. There are some things you can do to be successful if fitness is on your list of resolutions.

The first thing you want to do is to choose a fitness facility where you feel comfortable. By comfortable I mean, do you like the atmosphere? Is the gym to big or small for you? When you look into fitness facilities, make sure they’re not too far from your home. If the gym is too far, you’re less likely to go consistently. Try to plan for when the best time would be to go. Decide if morning, afternoon or evening works better for you and your schedule.

When you find your gym and figure out a time, make an appointment for an assessment and consultation. There are some people who decide to do this after a couple months of joining. Try to see a fitness professional within the first two weeks. We are able to help you figure out a plan for your workout and keep you on track. Some fitness centers call new members after the first week to see how everything is going.

It’s also important to not have an “all or nothing” mentality. If you decide to go to the gym three days a week, but sometimes fall short, it’s OK! Just get back to your schedule the following week. It will take about three months to adapt to your new transition.

Another tip is to have fun! Look at class schedules and try new classes. If you are new to classes, don’t worry about keeping up with everyone else. I always suggest that clients show up to class ten minutes early. This enables you to speak with the instructor about any injuries or concerns you may have. You can also leave class early if you need to. Some new students may only be able to do a warm up and have to leave. Remember that everyone in the class was in the same boat as you at some point.

It may seem tough to add fitness to your life at first, but it will get easier. You will start to feel better overall. Many people are able to sleep much better, bring down their blood pressure and cholesterol, reduce stress, and prevent osteoporosis. The benefits are really endless! The best thing is that you are setting the stage for a healthy lifestyle as you get older. You will be able to do more and live independently longer.

Good luck to everyone this year who has fitness as one of their resolutions. You will be able succeed if you keep positive and plan for success. Have a happy and healthy new year!

Robyn Kade is the Founder of The Stress Management Institute for Health and Fitness Professionals. She has 20 years of experience in medical-based fitness. 

Personal Trainer At The Gym

Body Language, Self-Awareness and The Client Experience

/4 November 2022/ All MFN blog/

As a trainer, you wear many different hats during a typical work week. In turn, you are pulled in many different directions among family, friends and clients.  If you are focusing on too many topics at once you cannot be in the moment, which can lead to a lack of client retention.

Being in the moment.

There is a lot of competition in the studio market and potential members/clients like to belong to a gym – and stay with a gym – where they feel comfortable.  That puts the limelight on personal trainers to generate the positive client experience that is so important to retention.

This is why being in the moment is vital to gaining new clients and retaining current ones. If trainers are distracted this may be apparent through body language. Members may perceive being distracted as receiving bad customer service.

Members decipher up to 93% of what is said through body language.

When you think of excellent customer service, which companies come to mind? What makes them stand out from their competition? The employees that work for these companies are mindful and in the moment. They anticipate the needs of the client and help them accordingly.  Being in the moment means that your body language and what you say conveys the same message. This is important to note for customer service and member retention.

The importance of not ‘zoning out.’

Members are constantly making decisions on how they want to spend their money. When trainers work with clients they should be mentally and physically present for each session. If a trainer zones out the trainer leaves their client wondering if the session is important to them. Trainers also miss out on potential new clients who may have wanted their services.

Clients will typically get your attention first by asking if there is “something else you need to do”. This should be a clue that they know you are not in the moment.  You want to fix this quickly before the client stops training at your facility. Potential clients also watch to see how focused and attentive you are.  I once had a member watch my training sessions for 5 months before deciding that he wanted to hire me. He said that he was looking at my training style, personality and attentiveness. He passed up two other trainers because they seemed uninterested.

When you and/or your staff have better self-awareness you are able to anticipate the needs of your members easier.  You will also notice that more clients would like to train with you. By being in the moment every day your clients feel like they had an experience that they want to share with friends and family.

Do you know what message you’re conveying?

Nonverbal communication involves facial expressions, gestures, eye contact, posture, voice, and touch -and is actually more important then what is said verbally. Trainers are communicating non–verbally with clients and members all of the time and when mixed signals are sent, clients have to try to figure out how you actually feel.  You may be speaking to your client and sound present and in the moment but is your body language  communicating otherwise?

Robyn Kade is the Founder of The Stress Management Institute for Health and Fitness Professionals. She has 18 years of experience in medical based fitness.

References

http://www.helpguide.org/articles/relationships/nonverbal-communication.htm

http://www.statisticbrain.com/gym-membership-statistics/

woman heating pad

Why Suffer in Silence?

/15 July 2022/ All MFN blog/

In America today, 40% of females, including women, children and teens, suffer in silence with either primary or secondary dysmenorrhea every month. Primary dysmenorrhea accompanies the monthly menstrual cycle without any underlying medical conditions. Secondary dysmenorrhea means that there is another medical issue present, such as endometriosis. This condition makes it hard to function, with most women being bedridden for three to five days or longer. Dysmenorrhea is not a weakness, but a real medical issue.

Generally, the female client will have severe throbbing pain from the waist down. They can feel it in their stomach, low back, legs and feet, making it hard to move. Other symptoms include nausea, vomiting, diarrhea, anxiety, stress, depression, lightheadedness, fatigue, headache, fever, and depression, weakness and fainting. Risk factors are smoking, obesity, being underweight, strong family history, high levels of stress, anxiety and/or depression. Women can still have painful stomach cramping well after menopause if they have Endometriosis.

This is a silent stressor for many women because they rarely choose to speak about it. Some have been living with the pain for twenty years or more and think there is nothing they can do. If a client comes to you and mentions that they have a lot of pain, urge them to see their doctor. This conversation is more likely to happen with a female personal trainer. The good news is that fitness professionals can help their clients to feel better during this painful time of the month.

It is important to acknowledge this painful condition because of the physical and mental implications that come along with it. As the trainer you, may be working with a therapist as well as an OB/GYN. You are trying to help your client feel better overall. We recommend scheduling an assessment first to understand the client’s medical history. As a fitness professional, you may want to refer your clients to other professionals as well. Acupuncture, for example, is well known for helping women to ease and reduce anxiety. When you network with other professionals, you form a referral system to obtain more clients for yourself, too.

After completing your assessment, you will develop a wellness program for your client. The program will include: exercise, meditation (specific to this condition), and aromatherapy, as well as other components. Try to have your client establish a regular daily wellness routine. Journaling is also important as it helps to connect your thoughts, feelings and behaviors. Support groups can also help as women share their experiences with others.

Robyn Kade is the President/CEO of The Stress Management Institute for Health and Fitness Professionals™ and the SMI Business Institute™. Robyn received her Bachelor’s Degree from Rowan University in Health Promotion and Fitness Management. She is an American Council on Exercise (ACE) personal trainer and group fitness instructor, received a certificate in PTSD through the Kew Training Academy, and is a Compassion Fatigue Resiliency and Recovery – Educator. Robyn is also certified through the American College of Sports Medicine for Exercise Is Medicine (EIM) Level 1. Robyn is currently pursuing her Master’s Degree in Wellness and Lifestyle Management with a concentration on Wellness Coaching at Rowan University.


References

STRESS pencil

A Stress Management Plan for an Aging Population

/4 April 2022/ All MFN blog/

April is National Stress Awareness Month!

Fortunately today, there are many tools to help individuals cope with stress. The first step is to acknowledge that you are stressed and to know what is stressing you. Once you are aware of your stressors, you need to make a stress management plan to follow. The journey may not be perfect but it is a work in progress. Most individuals aren’t going to know how to develop a plan or where to start. A trained individual such as a certified personal trainer can help to formulate the best plan for each client and make changes as the client achieves each milestone in the process.

As many as 20% of people experience depression in their later years

A stress management prescription is also needed for aging adults since the mind and body become slower to adaptations. The stress response lasts longer and seniors experience different symptoms then younger adults. Some key symptoms can be: crying, overeating, wounds taking longer to heal, heart palpitations, anxiety and depression. As a trainer, you will most likely be working with the client’s doctor who is treating them for these symptoms. There is a myriad of modalities that you can use to help your client drastically reduce their stress levels while they heal. As a fitness professional, incorporating meditation, exercise, yoga, Pilates, and many other techniques can help your client’s symptoms improve mentally and physically. The question is can we do more than telling clients to take a class? The answer to this question is an emphatic yes!

The causes of stress for this population are also different and depend on which decade in life they are in. Some examples are: loneliness, being institutionalized, fear of having enough money for retirement, loss of independence and many other causes. The problem is that many people can’t asses their own stress level and don’t know where to turn for answers. Chronic stress is harmful in many ways, but can be minimized once the individual becomes aware of their stress level and knows there are stress management professionals who can help.

Today, 53% of Baby Boomers are using complementary approaches to try and relieve stress and help with other conditions such as: anxiety, depression, chronic pain, stress, and hypertension. Complementary approaches are not limited to but include; exercise, nutrition, yoga, Pilates and Tai-Chi. Research conducted by the National Center for Complementary and Integrative Health shows that meditation can help to relieve symptoms for example chronic pain. As a fitness professional it is important to realize that these modalities must be used in conjunction with conventional medicine.

When training clients, it is important to see them as a whole person through the dimensions of wellness. As people, we have many things going on mentally and physically that are very complex. A stress management plan helps to streamline what can work best for your client and their current needs. The plan can evolve and most likely will depending on what is going on in your client’s life at the time. When you can assess and classify your clients you then know which complimentary approaches will work better for them. This will in turn, will help to keep your client engaged and on track with their goals.

Robyn Kade is the Founder of The Stress Management Institute for Health and Fitness Professionals. She has 18 years of experience in medical based fitness. Become a Stress Management Exercise Specialist today!

 

References

group meditation session

Choosing Appropriate Music for Mind/Body Classes

/26 October 2021/ All MFN blog/

When creating mind/body fitness classes, we are never told which type of music is most useful or how to appropriately choose our music. An instructor will usually choose music for the sound that is pleasing to them. There is nothing wrong with this, and in fact, music is very subjective to everyone. Not everyone will like the same music that is chosen for the class. Some class participants may ask where you purchased your music, but you cannot please everyone with the music selection. You may be wondering how the brain picks up these frequencies and synchronizes them with its brainwaves. The brain can differentiate each sound frequency as it enters the brain through the ear. You may not know, however, that each frequency has it’s own specific purpose. For example, white noise is commonly used for helping individuals to get to sleep as well as calm the sound of Tinnitus (a ringing in the ears). Once you understand how frequencies work you can choose music that will produce a certain outcome. (National Institutes of Health, 2018)

Music and Stress

According to the University of Nevada, music can be a powerful stress reliever as well as help the mind to be more focused. (4) Choosing the right type of music for each class is critical in helping you to achieve the objective of somatic movement classes. It is known, for example, that faster music can make participants feel upbeat and be better able to concentrate. A slower beat can help you to quiet the mind and your class participant to de-stress. The University of Nevada says that music that is 60 beats per minute can cause the brain to synchronize with the beat, causing alpha brain waves to initiate. This relates to sound frequencies that are 8-14 hertz or cycles per second. Alpha brainwaves are present when we are relaxed and conscious. Delta brainwaves are dominant at 5 hertz. Stanford University found that certain sounds tend to relax us more; they are Native American, Celtic, Indian stringed instruments, drums, and flutes. There is a song called “Weightless” by Marconi Union, which is said to be the most relaxing song in the world. They ask that you not listen to it while driving in the car. The specific purpose of the song is to help lower the heart rate, reduce blood pressure, and reduce levels of the hormone cortisol. You can play the song on YouTube for a thoroughly relaxing experience and then record how you felt in your journal. It is noted that individuals should listen to this type of music for at least 45 minutes to obtain full benefits. 

Psych Central says that nature sounds are very beneficial in decreasing stress levels because of the external focus it provides. When playing nature sounds for somatic movement classes, you want to use real sounds of nature. Artificial sounds draw the participant into themselves and can have the opposite effect. Listening to nature for 30 to 40 minutes three times a week can profoundly decrease stress and cortisol levels. (5) When choosing music for the Mindful Stretch or NeuRoll Calm™ class, we ask that you use primarily natural sounds mixed with soft music. Isochronic tones can be used as well, depending on the goal of the class you are instructing. (3)

Nature sounds help you to focus internally

Nature and soundscapes are widely used for meditation, but the question is which sounds are best for our group exercise class or small group training sessions. As the instructor, you are setting the objective for each class, and you can choose the music accordingly. Both of these types of music have frequencies or noise colors, and each color can be used to elicit specific meditative responses. The colors are white noise, pink noise, blue noise, grey noise, violet noise, red noise, green noise, and black noise. According to audiology.com, the most common noise colors used in meditation are white noise, pink noise, and brown noise. You can tell the difference in the noises by listening to them one at a time. White noise has a higher frequency and is perceived to be louder than it is; think of a water fountain. Pink noise has a more resonant sound than white noise and has more of a balanced sound; an example would be a calm ocean, and brown noise sounds like a soft rumble like thunder or a rough ocean. (2)

White noise is a collective frequency of all noise and can block out or mask other sounds. Some individuals use a fan, for example, to help them fall asleep at night. White noise is the go-to sound for masking sounds that come from within. Tinnitus sufferers use white noise to mask the constant sounds in their ears. Tinnitus can sound like a heartbeat, swooshing noise, or many other sounds within the ear. Other benefits of white noise are improved concentration and sleep promotion. (2)

Pink noise is a popular alternative to white noise, and some individuals prefer it because of the more gentle, relaxing sound it makes. We recommend changing up the music because not everyone will always like the music you choose. Like white noise, pink noise also includes the whole sound spectrum, but it has a less harsh sound. An example of pink noise is rushing water or heavy rain. Pink noise is also used to block out other sounds and help with improved focus, alleviating headaches, and promoting sleep. (2)

Brown noise was actually discovered by Robert Brown, a botanist in the 1800s, who calls this Brownian Motion. Brown takes the low frequency of pink noise lower, so it sounds like a buzz. Brown noise sounds like rushing water with a low roar. Brown noise is used to help with relaxation or meditation, improved focus, and reading comprehension, as well as sleep promotion. This is also known as Brown noise because the change in sound signal is random.(2)

Noise Color Chart

Adapted from:  Gulf Coast Audiology. “White, Pink or Brown: Which Noise Helps You Sleep Better? – Hearing Aids Hearing Loss: Pascagoula: Biloxi, Mississippi: Gulf Coast Audiology.” Hearing Aids Hearing Loss | Pascagoula | Biloxi, Mississippi | Gulf Coast Audiology, 10 Feb. 2016,

Binaural Beats

Binaural beats are another type of music that can be used by clients at home or whenever they feel stressed. The sound produced is relaxing as long as the hertz or cycles per second are within the right cycle per sound. Individuals usually listen to binaural beats through earphones to achieve the best outcome. Each ear typically has a different frequency than the brain is listening to. The frequency should be no more than 30 hertz apart for the brain to synchronize the soundwave. The only known side effect of binaural beats, when listened to through headphones, is seizures. If anyone chooses to listen to binaural beats on their own with headphones, it is recommended to consult with their physician first. If you are using binaural beats in class, it does not have the same effect. It is relaxing, but the brain can only synchronize the sound and pick up brainwaves through earphones. For now, we know that binaural beats can help with anxiety, memory, mood, creativity, and attention. The different brain waves are Delta, Theta, Alpha, Beta, and Gamma. Delta brainwaves are synchronized with a hertz of 0.1 to 4, Theta brainwaves are noticed at 4 to 8 hertz, Alpha is 8 to 13 hertz, Beta is 13 to 30 hertz, and Gamma is 30 hertz and higher. (1)

Psychology Today says that individuals have decreased cortisol, increases in melatonin, and decreases in DHEA when listening to binaural beats. This therapy is also being looked into as a possible treatment for anxiety and pain reduction. It is essential to stay within the hertz ranges that are provided below. If you go higher than the recommended Herz range, the individual could end up with the opposite effect of what the goal for the class originally was. For example, someone who is looking for stress relief could become anxious instead. Music that pre-mixed already follows these guidelines. (1)

Isochronic Tones 

Isochronic tones are single notes of tones that are spaced evenly to create a rhythmic beat type of sound. You do not need to wear earphones for Isochronic tones to be useful as they are a singular beat, and the brainwaves produced can be measured by an EEG test. Many Isochronic tones are mixed with soft music or nature sounds. According to Healthline, Isochronic tones may promote better quality sleep, focus, and attention, decrease pain, help with declining memory, meditation, and a more positive mood. Isochronic tones follow the same brainwaves as Binaural Beats. It is recommended to use isochronic tones when instructing mind/body classes. (1)

Binaural Beats and Isochronic Tone Brain Waves Chart

Adapted from: Booth, Stephanie. “Brain Health With Binaural Beats”. Healthline, Healthline Media, 14 May 2019.

The music for class should be either natural soundscapes with soothing music blended with it or Isochronic Tones-based, which you can find online. Isochronic tones can be sold as a full album or a single song. We suggest starting the music before class to help calm class participants and prepare them for Mindful Stretch™.  The instructor should also use a natural voice and no microphone. A natural voice helps to elicit the relaxation response and enables participants to connect with you. Keep in mind that breathing from the diaphragm helps instructors not to strain their vocal cords. The volume of the music being played is essential as well. It should be just loud enough that everyone can hear but soft enough that you can safely talk over the music. If you feel that you are straining your voice, lower the music to a level that is comfortable for you. (3)

Robyn Kade is the Founder of The Stress Management Institute for Health and Fitness Professionals. She has 20 years of experience in medical-based fitness. 

 

References

  1. Booth, Stephanie. “Brain Health With Binaural Beats.” Healthline, Healthline Media, 14 May 2019,
  2. Gulf Coast Audiology. “White, Pink or Brown: Which Noise Helps You Sleep Better? – Hearing Aids Hearing Loss: Pascagoula: Biloxi, Mississippi: Gulf Coast Audiology.” Hearing Aids Hearing Loss | Pascagoula | Biloxi, Mississippi | Gulf Coast Audiology, 10 Feb. 2016.
  3. Kade, Robyn. Mind/Body Medicine Specialist Manual. 4th ed. / USA, Stress Management Institute for Health and Fitness Professionals, 2020.
  4. University of Nevada Reno. Releasing Stress through the Power of Music, 2020.
  5. Collingwood, J. “The Power of Music To Reduce Stress”. Psych Central, 2020.

 

depression

The Seven Stages of Grief for Chronic Disease and Stress

/16 September 2021/ All MFN blog/

Many individuals have heard of the five stages of grief created by Elizabeth Kubler – Ross in 1969. This model is used to explain the stages of grief over the loss of a loved one.

There has been an updated model called the Seven Stages of Grief for Chronic Pain and Chronic Illness by Dr. Jennifer Martin, PsyD of imaginelifetherapy.com.

According to imaginelifetherapy.com, there are seven stages of grief for chronic disease, which are denial, pleading, bargaining and desperation, anger, anxiety and depression, loss of self and confusion, and finally, acceptance. Clients can go from one stage to another until finally reaching acceptance. An individual, for example, can go from denial to anger and back to denial. Everyone will go through the stages on their own timing. There is no set time for anyone to reach acceptance of their situation. If your client can see positive changes after working with you, their outlook will be more positive. As they become stronger and learn more skills, clients will become more ambulatory and be able to do more over time. (Pratt, 2018)

Many times, clients will be experiencing their symptoms and the stages of grief simultaneously. We usually think of grief in respect to the loss of a loved one. With chronic disease, your client may be grieving the life they used to live. Knowing that their lives may change because of an illness is very stressful. The individual may be thinking about the future and how their health will be ten years from now. As a fitness professional, you need to help your client to be present and in the moment. The work that your client does today will influence how mobile they are ten years from now. If they are discouraged by the big picture, it will be harder for them to stay focused. (Kade, 2020)

Each stage of grief has its own parameters and can give your insight as to which stage your client is currently in. Empathy and support are a critical part of helping your client to get through the stages of grief. Tailor exercise programming to what your client can handle each time they train with you. If someone is having a rough day, you can offer the client a meditation session instead of a training session. This trade-off will make your client feel more open and may even suggest meditation if they are not mentally ready for a training session. (Pratt, 2018).

To know which stage of grief your client may be in, you must have a firm understanding of what each stage is. Denial is the first stage in which the individual was just diagnosed and is in shock. They can’t believe that this is happening to them and wonder how they will make changes and live a good life. Shock can help the person to decide to move on to the next stage and start working through the stages. It may also backfire if the individual who has the condition thinks that it will eventually go away, or they will be fine. (Pratt, 2018).

The next stage is pleading, bargaining and desperation, where the client tries really hard to bargain or plead to not have a chronic illness. The individual also wishes they could go back to the life that they had. They may feel guilty and blame themselves for becoming sick and wondering if they could have done more to prevent their illness. Guilt usually comes with bargaining as the person blames themselves for their situation. (Pratt, 2018).

Anger is a crucial stage for individuals to begin the healing process. There is no specific timeline for your client to get through the anger stage. Please note that your client may come in angry some days when training, but they aren’t angry with you. Try to remain empathetic and patient as the individual goes through this stage. Keep in mind that everyone on the healthcare team often sees anger from the individual who is experiencing chronic illness. It is normal for your client to be angry at their doctor, caregiver, family, friends and even you. They will most likely apologize after showing you that they are visibly angry. This stage comes later in the process when the disease progresses, and the individual realizes that life will change. (Pratt, 2018).

Anxiety and depression will set in next as life changes are solidified. The feelings of depression can be substantial and seem to your client like they will never go away. If your client starts to withdraw, offer meditation instead of a training session to keep the client on track. Try to also be understanding about their condition and how they are feeling. If they must cancel with you, ask that they do so within a certain amount of time as your time is valuable too. You may want to also invite the client to a sip, paint and meditate class to help keep their spirits up. The goal is to try and keep these individuals on track using different modalities. There may also be anxiety about the future and the unknown as the person wonders what will happen to them. (Pratt, 2018).

The loss of self and confusion is very real for individuals with a chronic illness. In this stage, life has changed so much for this individual that they do not recognize themselves. They can’t do the things that they used to and have to redefine themselves and decide how to go about doing that. This stage may happen at the same time as anxiety and depression or separately. (Pratt, 2018).

In the stage of re-evaluation of Life, Roles and Goals, your client will be thinking about how they can move forward as a wife, mother, husband, father, sibling and friend. They are forced to re-evaluate how they fit into the picture and what that means in daily life figuring out how to go about daily activities and what work will look like for them. (Pratt, 2018).

The final stage is acceptance in which the client accepts his or her new reality. The client is not usually ok with it and happy, but they learn how to deal with their new norm. They strive to learn new skills to make life better and discover new things that bring joy into their lives. This is the stage that your client will be most accepting of trying new exercises and tools in your training sessions. (Pratt, 2018).

Robyn Kade is the Founder of The Stress Management Institute for Health and Fitness Professionals. She has 20 years of experience in medical-based fitness. 

 

References

Adapted from: Pratt, Amanda. “7 Stages of Grief for Chronic Pain and Chronic Illness: St. Petersburg Therapist.” Chronic Illness Therapy, 3 Aug. 2018, imaginelifetherapy.com/7-stages-of-grief-for-chronic-pain-and-illness/

Kade, Robyn. Mind/Body Medicine Specialist Manual. 4th ed. / USA, Stress Management Institute for Health and Fitness Professionals, 2020.