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5 Pilates Exercises to Improve Respiratory Function

CarolAnn, M.S., CPT, CN/8 May 2025/ All MFN blog/

Pilates is a total body exercise method that is highly effective for strengthening and lengthening the entire body. While Pilates is mostly known to improve core strength (the “Powerhouse”), posture, and range of motion, this exercise method can be used to improve respiratory function in those suffering from respiratory diseases. Respiratory diseases include asthma, COPD, chronic bronchitis, emphysema, lung cancer, cystic fibrosis, pneumonia, and now COVID-19. These diseases affect the way one breathes and lowers oxygen saturation that the body needs to function properly. One of the main principles in Pilates is breathing, thus the need to take a closer look at the effects of Pilates on respiratory function.

Benefits of Pilates Related to Respiratory Disease

Improves postural cavity to breathe properly.
Expands breathing capacity with diaphragmatic breathing.
Increases pulmonary ventilation which is needed for better respiratory function.
Improves lung volume.
Develops intercostal muscles (respiratory muscles) to better “squeeze” out impure air.
Improves exhaling all impure air out of the body while inhaling pure air.
Improves thoracoabdominal mobility.
Improves circulation to deliver oxygenated blood more efficiently.
Increased SpO2 (blood oxygen saturation).
- >95% indicates healthy respiratory function.
- <95% indicates taxed respiratory function.

The Pilates Breathing Method

Joseph Pilates, the creator of Contrology, stated in his book Return to Life Through Contrology: “Lazy breathing converts the lungs, literally and figuratively speaking, into a cemetery for the deposition of diseased, dying and dead germs as well as supplying an ideal haven for the multiplication of other harmful germs.”¹

Lateral Breathing: The main goal for Pilates breathing is to breathe deeply expanding the ribcage without raising the abdominal muscles training them to jet out. Therefore, deep lateral breathing through the ribcage is the hub of the breathing technique. Proper breathing is inhaling through the nose and exhaling forcefully through the mouth. When one inhales, the ribcage expands out to the sides using the intercostal muscles, and then when exhaling the ribcage knits together like one is being sinched in a corset. According to Joseph Pilates, one should exhale forcefully getting all impure air out of the lungs like wringing out every drop of water out of a wet cloth.
Set Breathing Pattern: When performing the Pilates exercises, one should inhale to prep for the movement and exhale as one performs the movement.
Rhythmic Breathing Pattern: In some exercises, one breathes in rhythm to the exercise. This breathing consciously activates respiratory muscles to enable the lungs to expand and transport oxygen.

5 Effective Pilates Exercises to Improve Respiratory Function

The Hundred (Rhythmic Breathing)

Begin a tabletop position with the shoulder blades and head lifted off the mat looking forward.
Pump the arms up and down 100 times vigorously so the abdominals respond to and control the movement.
Inhale through the nose 5 times to the rhythm of the arms pumping, then exhale 5 times to the rhythm of the arms pumping.
Keep the lower back imprinted to the mat at all times.

Single Leg Stretch (Rhythmic Breathing)

In a supine position, lift the shoulder blades and head off the mat looking forward.
Bend the right knee towards the chest as the left leg extends straight out hovering over the mat.
Inhale through the nose as you switch the legs 2 times, then exhale as you switch the legs 2 times.
Inhale, inhale, exhale, exhale as you switch, switch, switch, switch.
Keep the lower back imprinted to the mat at all times.
Perform 8 sets.

Dying Bug (Set Breathing Pattern)

In a supine position, position the legs in table-top and arms extend straight up towards the ceiling.
Press the right hand firmly on the right thigh and press the right thigh to the right hand in opposition.
Inhale through the nose as you extend the left arm back overhead and the left leg extends straight out hovering over the mat.
Exhale through the mouth and draw the arm in and the leg back to tabletop. Repeat on same side and switch.
Keep the lower back imprinted to the mat at all times.
Perform 8 reps on each side.

Toe Taps (Set Breathing Pattern)

In a supine position, lift the legs into tabletop keeping the upper body and head down on the mat.
Anker the arms next to the body pulling the shoulders back and down on the mat.
Inhale through the nose as you lower both feet and legs together towards the mat. Keep the knees at 90º and the feet away from the glutes.
Exhale as you pull the legs back up to tabletop.
Keep the lower back imprinted to the mat at all times.
Perform 10 reps.

Thread the Needle (Set Breathing Pattern)

Start in a side kneeling position with the hips lifted off the mat and one forearm down on the mat with the other arm straight up to the ceiling.
Inhale through the nose as you lean the body back an inch to expand the ribcage.
Exhale through the mouth as you rotate forward and thread the arm under the armpit towards the back. Crunch the obliques and transverse abs.
Inhale through the nose as you un-rotate and return to the start position with the arm lifted towards the ceiling.
Perform 8 reps on each side.

Pilates, respiratory function and research

The literature is scarce and sometimes conflicting about the benefits of Pilates breathing related to the respiratory system. However, there are some existing studies that look at the increase in lung volumes, respiratory motion, SpO2, and the reduction in respiratory rate using Pilates breathing exercises. More research needs to be conducted. Refer to suggested reading at bottom of article.

Education for Fit Pros

Fitness Professionals & Personal Trainers: Become a Respiratory Disease Fitness Specialist!

Some of your clients may suffer from a respiratory disease and you may be an important source of relief. The Respiratory Disease Fitness Specialist online course will equip you with the knowledge to safely and effectively work with these clients to help improve their quality of life.

CarolAnn, M.S. Exercise Science and Health Promotion, is a 30+ year veteran in the fitness industry educating other health/fitness professionals to increase their expertise and brand influence. She is on the MedFit Education Advisory Board and the head health/fitness educator for FiTOUR. She is currently the Head Instructor at Club Pilates in Athens, GA.

Suggested Reading

Cancelliero-Gaiad, K. M., Ike, D., Pantoni, C. B., Borghi-Silva, A., & Costa, D. (2014). Respiratory pattern of diaphragmatic breathing and pilates breathing in COPD subjects. Brazilian journal of physical therapy, 18(4), 291– https://doi.org/10.1590/bjpt-rbf.2014.0042
de Jesus, L.T., Baltieri, L., de Oliveira, L.G., Angeli, L.R., Antonio, S.P., Pazzianotto-Fort, E.M. (2015) Effects of the Pilates method on lung function, thoracoabdominal mobility and respiratory muscle strength: non-randomized placebo-controlled clinical trial. Pesqui. vol.22 no.3. http://www.scielo.br/scielo.php?pid=S1809-29502015000300213&script=sci_arttext&tlng=en
Hagag, A.A., Salem, E.Y. (2019) Pilates Exercises Improve Postural Stability, Ventilatory Functions and Functional Capacity in Patients with Chronic Obstructive Pulmonary Disease. IOSR Journal of Nursing and Health Science (IOSR-JNHS), vol. 8, Issue 4 Ser. VI., PP 86-91 http://iosrjournals.org/iosr-jnhs/papers/vol8-issue4/Series-6/M0804068691.pdf
Baglan Yentur S, Saraç DC, Sarİ F, et al. (2020). Fri0613-hpr the effects of pilates training on respiratory muscle strenght in patients with ankylosing spondylitis. Annals of the Rheumatic Diseases;79:912. http://dx.doi.org/10.1136/annrheumdis-2020-eular.2129

References

Pilates, J., William, J. M., Gallagher, S., Kryzanowska, R. (2000). The Complete Writings of Joseph H. Pilates: Return to Life Through Contrology and Your Health. BainBridge Books, Philadelphia, PA. (Originally written 1945)

Atrial Fibrillation – Living with a different beat

Megan Johnson McCullough/25 April 2025/ All MFN blog/

Our heart is at work literally 24/7 for us and without it doing this constant job for us, well, we know the consequences. An irregular heartbeat (arrhythmia) can pose complications that increase the risk of having a stroke or even heart failure. It can be frightening for someone and can also impact their daily living.

Yoga for Mental Health

Kristy Manuel, MS, Yoga Therapist/8 April 2025/ All MFN blog, Conditions/

Since yoga has been found to help those with diseases and illnesses like Alzheimers, Arthritis, it’s a given that it can help ease mental health issues and disorders. A new review on the health benefits of yoga, published in Frontiers in Psychiatry, with help from researchers at Duke University School of Medicine, found that yoga could be a promising treatment for some mental illnesses.

Weight Loss Principles: The Good, the Bad, and the Ugly

Dr. Irv Rubenstein/3 April 2025/ All MFN blog/

Weight management is a, if not the, Holy Grail of lifestyle change for many, especially for women. Not that men don’t seem as concerned about their weight; it’s just that many men don’t see themselves as overweight when they look in the mirror – they see the same kid who played ball in high school.

Normally, I do not like to focus on weight loss. In taking a health professional’s perspective on weight, it’s just a number…until it’s not.

That is, focusing on weight is an excess we in the West – the wealthy, industrialized, relatively-safe from famine and disaster societies – tend to overindulge ourselves with. But, for those same reasons, we also are prone to illnesses and diseases that correlate with our lack of food scarcity. Thus, watching one’s weight is synonymous with watching one’s health unless one goes to extremes such as with eating disorders/disordered eating.

With this in mind, the advent and profusion of interest and usage of anti-obesity medications (AOMs) such as Wegovy, Ozempic, etc. are worth addressing.

As this blog post from the American College of Sports Medicine by Renee Rogers, Ph.D. FACSM (Dec. 18, 2023) discusses, the health and fitness professional (HFP) might feel threatened by a flurry of OAMs that might detract from his/her potential market. People who are trying or need to lose weight can now do so without having to engage the services of the HFP. In her essay, she notes that OAMs do work very well but that permanent weight loss and subsequent health and functionality still depend on maintaining a fit and strong body.

Also, now that we have meds that prove, essentially, that weight loss is not simply a function of willpower – that, because they work by effecting hormone changes that signal the brain and the GI system that they are not hungry, overeating is not necessary (excuse the simplification), people can now attend to engaging in healthful exercise and activity for other purposes: health (obviously), fitness, energy, fun, etc.

Finally, allow me to introduce Sheila Olsen, a freelance author on topics pertinent to health, fitness, and diet. Below is her excellent and well-researched review of weight loss for women. Thank you, Sheila, for reaching out to me and offering to contribute to the STEPS Fitness blog:

Losing Weight the Right Way: Tips for Women

Being healthy and at a healthy weight is important for everyone, but women have different health concerns than men and often lose weight differently.

The Differences

The biggest reason why men and women lose weight differently is hormones. For women, hormonal changes due to menstruation, pregnancy, and menopause can cause them to gain or lose weight. In addition, the hormones that control a woman’s appetite and metabolism are different from those that control a man’s. This means that women often have a harder time losing weight than men.

Another reason why women and men lose weight differently is that they tend to eat differently. Men are more likely to eat high-calorie foods and snacks, while women are more likely to snack on healthier foods like fruits and vegetables. This difference in diet can also lead to different rates of weight loss.

Though there are many reasons why women and men lose weight differently, the most important thing is that both sexes should focus on eating healthy foods and exercising regularly. By doing this, nearly everyone can achieve their goals for healthy weight loss, or at least healthy living.

Personal Training

Personal training services are specifically designed to support women on their weight loss journey, offering tailored fitness programs that cater to individual goals and needs. With a focus on sustainable and healthy weight loss, these services include one-on-one coaching, nutritional guidance, and customized workout plans that are both effective and enjoyable. The experienced trainers at Steps Fitness understand the unique challenges women face in losing weight and are committed to providing the motivation, support, and expertise needed to achieve lasting results.

Working Out at the Gym

Another great strategy for losing weight is to join a gym. Gyms offer a wide variety of machines and classes that can help you lose weight and get in shape. When working out at the gym, include cardio exercises such as running or elliptical training. Strength training is also crucial because it will help you build muscle mass, allowing you to burn off calories throughout the day.

Eating Mindfully

To lose weight, you must be mindful of the foods you eat. This means choosing healthy foods that are low in calories and fat. Diets high in processed foods and sugar can lead to weight gain, so it’s important to avoid these types of foods when trying to lose weight. Instead, focus on eating fresh fruits and vegetables, lean proteins, and whole grains. Additionally, be sure to drink plenty of water as this will help you stay hydrated and full throughout the day.

Consuming Caffeine

Caffeine is often highlighted for its potential effects on weight loss, especially among women, due to its ability to increase metabolism and enhance fat burning in the short term. Moderation is key, as excessive caffeine consumption can lead to unwanted side effects, so understanding and managing intake is crucial for leveraging caffeine’s benefits for weight loss effectively. For women considering caffeine as a part of their weight loss strategy, it’s important to be aware of the caffeine content in their favorite beverages. Online resources can be incredibly helpful for this, offering detailed information on the caffeine levels in various drinks, from coffee and tea to energy drinks and sodas. By consulting these resources, women can make informed decisions about their caffeine intake, ensuring it aligns with their health goals and dietary needs.

Staying Hydrated

As mentioned above, staying hydrated is key to losing weight. Drinking plenty of water throughout the day will help you feel full and satisfied so that you’re less likely to snack on unhealthy foods. In addition to water, green tea is an excellent beverage for weight loss as it contains antioxidants that can boost your metabolism. Aim to drink eight glasses of water or green tea per day.

Choosing the Right Health Insurance

Health insurance is an important factor to consider when it comes to trying to lose weight. Choosing the right health insurance plan can help you by providing meaningful support and resources that can make a huge difference in achieving your weight loss goals. Insurance plans can provide access to effective nutrition counseling and consultations. If you’re currently self-employed and not covered, you still have options. You can explore health insurance plans through the Freelancers Union or Affordable Care Act, or you can join your spouse’s plan.

Establishing SMART Goals

It can be helpful to establish SMART goals for your weight loss journey. SMART stands for Specific, Measurable, Achievable, Relevant, and Time-based goals. These goals should be realistic and attainable so that you don’t get discouraged along the way.

For example, a SMART goal might be “to lose 10 pounds in three months by eating mindfully and exercising three times per week.” This goal is specific (lose 10 pounds), measurable (three times per week), achievable (exercising three times per week), relevant (lose 10 pounds in three months), and time-based (in three months).

Managing Stress

One common health concern for women is managing stress. Stress can have many negative effects on your health including causing weight gain. When trying to lose weight, it’s crucial to find ways to manage your stress. Getting regular exercise, practicing meditation or deep breathing, journaling, spending time outside, and spending time with friends or family can all help.

How Surgery Can Help

Weight loss surgery, such as gastric bypass or sleeve gastrectomy, can be a beneficial option for individuals struggling with severe obesity and related health issues. These surgeries can lead to significant and sustained weight loss, helping to reduce the risk of obesity-related conditions like diabetes, hypertension, and heart disease. Furthermore, they often lead to improved overall quality of life and increased mobility for those who have struggled with obesity for an extended period, making them a valuable tool in managing long-term health.

Whether you’re working with a personal trainer, walking more often, or finding a better health insurance plan, these tips can help women lose weight in a healthy way. Remember, every woman’s body is different, so what works for one person might not work for another. The most important thing is to find what helps you and stick with it. With consistency and perseverance, you can reach your goal weight and stay healthy!

Originally printed on STEPS Fitness blog. Reprinted with permission.

Dr. Irv Rubenstein graduated Vanderbilt-Peabody in 1988 with a PhD in exercise science, having already co-founded STEPS Fitness, Inc. two years earlier — Tennessee’s first personal fitness training center. One of his goals was to foster the evolution of the then-fledgling field of personal training into a viable and mature profession, and has done so over the past 3 decades, teaching trainers across through country. As a writer and speaker, Dr. Irv has earned a national reputation as one who can answer the hard questions about exercise and fitness – not just the “how” but the “why”.

Personal Trainer and the Healthcare Team

Physicians Fitness/1 April 2025/ All MFN blog/

Musculoskeletal issues have become the number one reason for physician visits.⁽¹⁾ Doctors are starting to agree that many surgeries may have been unnecessary.⁽²⁾ The opioid crisis is a symptom of a larger societal issue to be sure, but it appears that too many people are turning to pain medications to manage their various aches and pains. Certainly pain medication and surgery can help many diseases and symptoms. However, they can also have long-term detrimental effects on human health. Can supervised exercise contribute to helping the problems of too many surgeries and too many pain medications being prescribed?

The modern research on this subject continues to support the notion that properly dosed and executed exercise can have a long-term positive impact on pain and possibly reduce the need for surgery. Who in the health and wellness community conducts supervised exercise? The Personal Fitness Trainer and Exercise Professional.

Personal Trainers are sought out to create fun and challenging workouts, help people lose weight, or help athletes perform better for their sport. We feel that although important, this puts exercise professionals like personal trainers in too narrow of a box.

Can a Personal Trainer be more?

Can an Exercise Professional transcend these service niches and be considered part of one’s healthcare team?

We not only believe so, we think that we must.

Exercise has more power than we, and the exercise consumer, give it credit for. Exercise can stimulate powerful natural medicine to help individuals overcome chronic pain and possibly even avoid surgery.

Our goal is to trumpet this message to exercise professionals and consumers alike and work to support the development of the exercise professional to meet this demand. Our plan is to be one of the pioneers that move exercise to the forefront of healthcare as a powerful, and often overlooked, process to be integrated proactively within a healthcare team for supporting individual health where pain persists and surgery is being considered. Will you join us?

Article co-written by Greg Mack and Charlie Rowe of Physicians Fitness.

Greg Mack is a gold-certified ACE Medical Exercise Specialist and an ACE Certified Personal Trainer. He is the founder and CEO of the corporation Fitness Opportunities. Inc. dba as Physicians Fitness and Exercise Professional Education. Greg has operated out of chiropractic clinics, outpatient physical therapy clinics, a community hospital, large gyms and health clubs, as well operating private studios. His experience in working in such diverse venues enhanced his awareness of the wide gulf that exists between the medical community and fitness facilities, particularly for those individuals trying to recover from, and manage, a diagnosed disease.

Charlie Rowe has been in the fitness industry for almost 20 years, and currently a Muscle System Specialist at Physicians Fitness. He has also worked within an outpatient Physical Therapy Clinic coordinating care with the Physical Therapist. Charlie hold numerous certifications, including Cooper Clinic’s Certified Personal Trainer, NSCA Certified Strength and Conditioning Specialist, the ACSM Certified Health Fitness Specialist, Resistance Training Specialist Master Level, and ACE Certified Orthopedic Exercise Specialist Certifications. Charlie’s experience and continued pursuit of education make him one of the best in his field.

References

(1) Musculoskeletal Injuries: A Call to Action and Opportunity for Fitness Professionals, ACE Prosource 2013 by Nicholas A. DiNubile, M.D.

(2) Doctors Perform Thousands of Unnecessary Surgeries. Peter Eisler and Barbara Hansen, USA Today. Published 3:25 p.m. ET June 19, 2013. Updated 1:34 a.m. ET June 20, 2013

Understanding the Pain Experience to Better Assist Your Clients

Anthony Carey, MS/27 March 2025/ All MFN blog/

Pain is a very personal and subjective experience. Modern pain science no longer views pain as a sensation; rather, pain is viewed as an experience that results from an amalgamation of inputs that are physical, psychological, emotional and social. These inputs must be viewed interdependently, because they all directly affect one another and the overall pain experience.

The Bio-psycho-social Model of Pain

Researchers and clinicians have structured the bio-psycho-social (BPS) model of modern pain to better understand and treat chronic pain.

“Bio” represents biology, biomedical and/or biomechanical. This is the historical way chronic pain was treated—seeking disease, dysfunction or damage and then designing interventions that would address it.

“Pyscho” represents the current psychological characteristics of the chronic pain sufferer. This could include the individual’s beliefs about his or her situation, historical references related to past pain experiences, anxiety, depression and expectations about the future. Many of the psychological elements are influenced by family members and/or perceived experts or authorities (e.g., doctors, nurses, physical therapists and personal trainers).

“Social” represents the social implications of the pain experience. Social stressors relate to doubts that those around us don’t believe our pain is real and whether there is a social support structure in place. Additional stressors may be related to missing important social events, traveling or the inability to maintain employment or familial responsibilities.

The International Association for the Study of Pain defines pain “as an unpleasant and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.” The word “potential” is significant in this definition because it describes pain even in the absence of tissue damage.

In a 2018 paper, the Centers for Disease Control and Prevention (CDC) noted that 50 million Americans suffer from chronic pain and 20 million suffer from high-impact chronic pain. High-impact chronic pain is chronic pain that “frequently limits life or work activities,” according to the report.

As a health and exercise professional, the likelihood of working with clients who have chronic and/or recurrent pain is high. These are clients who have been cleared for exercise by their physicians and who have either completed or are currently involved with treatment by a licensed medical provider such as a physical therapist or chiropractor. Understanding evidence-based strategies for exercise and maintaining professional scope of practice provide an important service to this population. Exercise programming to reduce mechanical stress and improve movement confidence and function are well within our professional role. But at no time should a health and exercise professional attempt to treat or diagnose any condition or provide medical advice.

The growing body of evidence around pain is reshaping treatment approaches by medical professionals. As a health and exercise professional who will very likely work with clients experiencing chronic pain, understanding the bio-psycho-social paradigm and what it means in reference to program design, communication and expectations are paramount.

The Importance of Rapport

One of the most effective strategies for introducing physical activity to clients with chronic pain is to establish rapport, which in turn, may help relieve anxiety and fear and set expectations. Here are three strategies to get you started:

First impressions are unavoidable. If your potential clients’ first impressions are that you have no understanding or empathy for their struggles, you are at a disadvantage. Many of these impressions will be nonverbal and immediately communicated by observing your attire, the environment and any observable interactions with other clients, members or staff. Dress professionally for your role. Find a quiet, “safe” environment to sit and speak with your clients/prospective clients to enhance privacy.
Listen. Give your clients the opportunity to express their concerns and fears. Remember that many people with chronic pain have been rushed in and out of appointments and often do not feel as if they are being heard. Giving them this opportunity is significant. For example, one of my favorite and most impactful questions to ask a client before we begin our first session together is, “Is there anything that I haven’t asked that I should have asked?” This gives the client permission to share anything else that might be important or gives me permission to move to the next phase of the appointment.
Validate. When it comes to starting an exercise program, arguably the greatest fear an individual with chronic pain will have is that it is going to make his or her pain worse. To validate your clients is to communicate that you understand that their pain is very real and that their concerns are understood. That is, you have to enter the client’s world. You have to understand a client’s challenges, frustrations and setbacks to be able to truly serve him or her.

Pain is a complex issue and it is neither helpful nor accurate to approach client communication and programming from an outdated paradigm. The current bio-psycho-social model contains elements of biology, psychology and sociology, of which all must be taken into account for lasting, pain-free movement.

Article reprinted with permission from Anthony Carey.

Anthony Carey holds a Master’s degree in biomechanics and athletic training and is the inventor of the Core-Tex™. Anthony is recognized internationally as a leading expert in biomechanics, corrective exercise, functional anatomy and motor control. He was named Personal Fitness Professional Magazine’s 2009 Personal Trainer of the Year and has received recognition for his work in the national media, including the New York Times, Time Magazine and Oprah’s “O” Magazine.

Anthony has authored two best-selling books: The Pain-Free Program: A Proven Method to Relieve Back, Neck, Shoulders and Joint Pain and Relationship and Referrals: A Personal Trainer’s Guide to Doing Business with the Medical Community, and consults for the San Diego Chargers as well as some of the largest equipment manufacturers and health clubs in the world.

Body Mass Index – Accuracy Called in to Question

Megan Johnson McCullough/25 March 2025/ All MFN blog/

More people are starting to question the accuracy of the BMI (body mass index) measurement. Essentially, this is a measure of your weight to height ratio. Maybe this formula is outdated going back to Lambert Adolphe Jacques Quetelet’s 1832 development (your weight in kilograms divided by your height in meters squared). Popularity didn’t strike until the 20th century when insurance was being evaluated for risk potential and among specific populations.

The (Current) Truth About Vitamin D

Dr. Naomi Alberston/20 March 2025/ All MFN blog/

There are more health claims made about vitamin D than perhaps any other vitamin. Media stories touting vitamin D for this ill or that are common, particularly in the age of COVID-19. We’re also frequently told Americans don’t get enough vitamin D, with surveys showing as many of 40% of individuals have below optimal amounts in the blood. So how do we get vitamin D and what claims are true and backed by research? Let’s take a closer look at vitamin D to flesh out what we know for sure and where more research is needed.

What is Vitamin D and How Do We Get It?

Molecularly, vitamin D is a group of fat-soluble compounds with a four ringed cholesterol backbone. What’s most important to know is that it comes in two forms — as vitamin D2 in food and as vitamin D3 in our skin.

Vitamin D3
Our skin is our primary source of vitamin D, but it begins there as an unorganized and inactive form, requiring UV exposure to convert to usable vitamin D3. Conversion via UV light is exceedingly efficient, and it’s estimated brief exposure of the arms and face is equivalent to ingesting 200 international units day. Conversion varies however with skin type (darker skin converts more), latitude, season and time of day. Infants, disabled persons and older adults often have inadequate sun exposure as well, and the skin of those older than 70 also does not convert vitamin D as effectively. Interestingly, vitamin D also requires temperature to be activated, so you may not get as much of a benefit from sunlight in the winter months as you might expect.

Vitamin D2
Because it is fat-soluble, dietary vitamin D2 is best absorbed with fat in the diet and fish is a common source. Uptake can be negatively impacted by disorders associated with fat malabsorption such as celiac disease, Crohn’s disease, pancreatic insufficiency, cystic fibrosis, short gut syndrome and cholestatic liver disease.

Vitamin D in the Body: What We Know It Does

Once activated and in the bloodstream — either by UV exposure or absorption through the diet — the liver converts vitamin D to 25-hydroxyvitamin D (25[OH]D), and then the kidneys further convert it to 1,25 hydroxyvitamin D, the most active form of vitamin D in the body. For this reason, kidney and/or liver problems can also negatively impact vitamin D levels.

Interestingly, all cells in our bodies have receptors for vitamin D, and this has in part fueled the varying claims as to how it might impact health. What we know for certain is that it helps with calcium absorption in the gut, regulating calcium levels via the kidneys, and regulating parathyroid hormone. Vitamin D’s role in calcium regulation and absorption means it has a direct impact on healthy bone growth and turnover. For this reason, you often see it in calcium supplements.

Research has also shown a clear correlation between Vitamin D and muscle health, including research showing improved lower body strength. Some research has also shown vitamin D can help prevent falls in the elderly.

Notable Areas Where the Jury is Still Out

Vitamin D has been thought to lower the risk of cancer, but currently, there is insufficient evidence to support this, though there are many ongoing studies.
There is also insufficient evidence showing that vitamin D helps improve autoimmune conditions and respiratory conditions such as asthma, COPD and acute viral respiratory diseases. In a large study from the UK, no association was found between vitamin D levels and risk of mortality from COVID-19.
Although low vitamin D levels have been associated with an increased risk of cardiovascular disease in some studies, there is no evidence that vitamin D supplementation improves cardiovascular outcomes.
Similarly, a growing number of trials examining the effects of vitamin D supplementation on pregnancy and birth outcomes show conflicting results, with some showing reduction in risk of low birth weight, but more data is needed.

Naomi L. Albertson M.D. is Board Certified by the American Academy of Family Physicians and specializes in the non-surgical management of musculoskeletal problems, sports injuries, concussions, and the treatment of osteopenia and osteoporosis.

Fight Back Stronger! Working with Clients with Parkinson’s Disease

Colleen Bridges/18 March 2025/ All MFN blog/

Determined, consistent and tenacious are just a few words I like to use to describe my Parkinson’s Disease “fighters”. I call them “fighters” because instead of lying down and giving up, they have chosen to take charge of their future. They commit to FIGHT BACK against Parkinson’s Disease, and that is a “fight” I want to join!

It is critical that you observe how the “fighter” moves, processes information and responds to challenges. We utilize that information and create fitness programs to address the motor symptoms those living with Parkinson’s Disease (PD) struggle with each and every day.

And the best place to start is with “Foundational Movements” that will broaden a fighter’s Activities of Daily Living (ADL). People living with PD require a unique fitness program to address the impact that PD has on their ADLs.

Foundational Movements

Squats
Lunges
Hinge
Push
Pull
Carry
Rotation

I encourage Fitness Professionals to start with the most basic form of each Foundational Movement before progressing to a more challenging version. Neurologically, progressive and regressive movements make an impact on people living with PD. I have learned that repetition and exercise phases are a necessary part of any fitness program, similar to the human development process.

Consider how humans learn how to move from birth to 3 years of age. First, we learn a skill such as rolling over and we repeat it until we succeed. Then, we move on to unsupported sitting, followed by crawling until one day we are up and running!

And just in case you are wondering, the best place to start with foundational movements is in the warm-up. The repetition of the drills enables the fighters to improve their form, prepare for the work phase and create new neural patterns that will improve their functionality.

Let’s briefly discuss the movement patterns and how each movement can improve ADLs.

Squat

This movement pattern is used daily and assists in maintaining the ability to use synergistic muscular tension, stability and mobility through the torso, hips, knees and ankles. However, every fighter is different which means they will need to start at different levels.

EXERCISE	ADL
Seated knee extension	Toileting
Wall Squat	Showering
Squat	Dressing
Squat/stand and lift heels	Cleaning
Squat-jump	Care-giving

Lunge

Falling or the fear of falling is a significant issue for people living with Parkinson’s Disease. The ability to stand on one leg, shift weight back and forth, maintain an asymmetrical split stance, bend down or get up off the floor is crucial for fall prevention. Lunging, in its various stages, provides Fitness Professionals a way to identify weak links.

NOTE: Some overlap will occur with the lunge and hinge movement.

EXERCISE	ADL
Tap one foot behind	Vacuuming
Reverse Lunge	Stepping in/out of shower
Step one foot forward	Tying shoelaces
Forward lunge	Walking up/down stairs

Hinge

We ALL need to strengthen our posterior chain but it seems to be the one area many Fitness Professionals shy away from including in their program. When you consider how many times a day someone bends over, they must have the strength and basic knowledge of how to hinge so they don’t fall or hurt themselves.

This is even more important for people living with Parkinson’s Disease. If they fall, it could take months for them to recover and by that time, the disease has progressed. Make it a goal to include a hinge movement in every routine.

EXERCISE	ADL
Basic Deadlift with arms crossed	Getting in/out of car
Supported Deadlift with one foot behind	Toileting/Showering
Traditional Deadlift with weights	Dressing
Single Leg Deadlift Cross-over Deadlift	House and Pet Management

Push

The push-up is one the most popular exercises of all time! Mastering the “push” is a different challenge. The “push” (not always push-ups) requires core stability, upper back and shoulder strength. Once mastered, people living with PD will notice an increase in power and strength.

Word of caution: Parkinson’s Disease typically affects a person’s posture. Please remember that anything overhead will alter the center of gravity which means some fighters need to perform a “push” exercise that keeps the arms closer to the body.

EXERCISE	ADL
Wall Push-up	Rising from the floor
Push-up on Smith Machine Bar	House cleaning
Push-up on knees	Showering
Push-up on hands/toes	Pushing large door open

Pull

With so many postural issues due to weak muscles, developing a stronger “pull” will help people living with PD strengthen their back muscles which will decrease falls, improve posture and relieve back pain.

EXERCISE	ADL
Shoulder retraction only	Opening refrigerator
Shoulder retraction and hold	Vacuuming/sweeping
“Row” arms (no weights)	Showering
“Row” with tubes	Pulling up pants
“Row” with one arm	Picking a child or pet up

Carry

People living with PD want the ability to carry a grocery bag, walk and pull out keys all at the same time. But if they do not know how to use their body correctly, multitasking can be scary. Carry exercises focus on leverage and load. The good thing is we can always make adjustments depending on other variables. For example, bad shoulders mitigate against the overhead version of the carry while weak hands prevent one from carrying heavy loads. Carry exercises don’t necessarily help prevent falling other than the benefits they provide by strengthening the core. However, Fitness Professionals need to remember that carry exercises will serve your fighters in the early pre-kyphosis stage as a posture exercise. Carry exercises also provide a challenging asymmetrical exercise if performed unilaterally.

TIP: The carry movement is a great way to challenge the core without doing crunches!

However, before beginning a gait/carry movement with your fighters, make sure they have been thoroughly assessed.

EXERCISE	ADL
Walking	Carrying groceries
Bird dog walk	Carrying laundry basket
Farmer’s walk with two weights	Child care
Farmer’s walk with one weight	Pet Care
Farmer’s walk with one weight overhead	House Management

Rotation

The core maintains the stability and strength of the torso and acts as a conduit for energy. The movement patterns listed above encourage core strength which means rotational exercises are not so much a movement pattern as a powerful supplement to the above foundational movements.

Rotational exercises for people living with PD help improve gait and posture, reduce falls, improve coordination and mobility, increase overall strength and, most importantly, enable them to independently perform ADLs.

Rotation Reminders for Fitness Professionals:

Torso stabilizes the spine and allows movement by coordinating with the pelvic muscles.
Flex, extend, bend and rotate
Anti-Rotational Exercises best for beginners. People living with Parkinson’s DIsease often deal with Processing Information issues. Begin with basic exercises in order for fighters to learn proper form and technique.
Muscles – Rectus Abdominis, obliques, rhomboids, deltoids, glutes, abductors, quads and adductors

Caution! Be sure to include the hips and the lower portion of the spine when rotating.

EXERCISE	ADL
Isometric tube hold	Enter/exit tub or shower
Isometric tube hold and step laterally	Enter/exit vehicle
Circles with tube	Emptying dishwasher
Circles with tube/squat	Laundry related activities
Torso rotation with tube	All ADL categories

In closing, when Fitness Professionals learn the art of organizing movement patterns and creating a program that uses these foundational movements, their fighters living with Parkinson’s Disease experience physical gains such as standing without support, joint mobility, active core stabilization, integrated joint action, cognitive improvement and most importantly the ability to handle a challenging moment with confidence.

Having acquired these foundational skills with the help of you, their Fitness Professional, build trust and credibility for supporting a fighter’s long-term commitment to HOPE. As noted at the beginning of this article, our fighters are determined, consistent and tenacious. They have chosen to take charge of their future and FIGHT BACK against Parkinson’s Disease — a “fight” I hope you, as a Fitness Professional, join!

Become a Parkinson’s Fitness Specialist

You can acquire the tools and resources necessary to integrate foundational movements with ADLs within the Parkinson’s community. Sign up for Colleen’s 12.5-hour online course on MedFit Classroom, Parkinson’s Disease Fitness Specialist.

Colleen Bridges has worked for nearly 17 years as an NSCA Certified personal trainer, group exercise instructor and fitness consultant and as an independent contractor for Nashville’s first personal training center, STEPS Fitness. Her passion for understanding the body in sickness and in health, and how it moves, as fed her interest in and enhanced her talent for working with senior adults, especially those living with a neurological disorder such as Parkinson’s Disease.