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depression

I’m Depressed, Not Lazy

/25 August 2017/ All MFN blog/

Every doctor, therapist, psychiatrist and psychologist knows that the best form of natural medication for depression is exercise. The most common phrases a person who says they feel depressed will hear is, “You should go for a walk.” “Try joining a gym.” Or “Just dance around your living room for 10 minutes, you will feel so much better.”

As a personal trainer who has been training clients with exercise and working with them on nutrition for 20 years, I know these are all true statements and true facts. Among my clients of all different ages, levels of fitness, ethnicities, cultures and sizes, I have had an incredible number of clients who have had some type of mental illness. And the most prevalent type has been different levels of depression. Some of these clients had been diagnosed before coming to see me and knew that it was what “the doctor ordered.” And some of these clients had no idea they suffered from depression or anxiety or had food addictions or other addictions until they started working with me and I figured it out by talking with them, discussion, and watching their behavior. I never claim to be a Psychiatrist so I always suggests that they find a licensed Psychiatrist.

But here is what I am finding in my experience with my clients and what I have seen over the years:

I believe there is a link between the chemical imbalances in a person with depression and the inability for that said person to get up off the couch and move. I believe that there is something that is either missing or disconnected and when the person actually THINKS about going on a walk, or going to the gym, something very different happens to them than to someone who does not suffer from a chemical imbalance/depression.

One of my clients who suffers from the most severe form of depression (I have learned that there are different levels of depression) described how she felt to me: “I feel as if I have a 700 lb. heavy, wet blanket on top of me at all times.” She said that sometimes her coping skills are much better than other times but that the 700 lb. heavy, wet blanket is always on top of her… every minute of every day. It broke my heart to hear this, but I was so thankful that she shared it with me because it was the first time that I actually understood what she felt like. I understood why it is such a struggle for her to do basically, anything. I thought about the “average” person. After a full day of work, most of us are pretty tired and the last thing we want to do is go to the gym or on a walk, etc. So, it is a struggle to make that effort and make the right decision and motivate to drive home and change and go to the gym…or to have packed our bags and drive to the gym from work. Now, think about if you had a 700 lb. heavy, wet blanket on top of you after you worked a full day. Think about having to stand up to get to your car with that 700 lb. heavy, wet blanket and then driving home and having to stand up and get out of your car with that 700 lb. heavy, wet blanket and going into your home and once you are inside, the idea of having to go and MOVE with that 700 lb.  heavy, wet blanket has to be the LAST thing in the world that you would want to do. And from what I understand and from what I am seeing and hearing and observing, this is not just after a full day of work. This is ALL THE TIME. The IDEA of moving is so overwhelming and feels like such a massive obstacle/chore/punishment that it just shuts them down. The part of this that makes me so sad and is the main reason I am writing this and trying to get my observation noticed is that what ends up happening is that the person does not understand what is happening. Here is what goes on in their mind:

I am LAZY. I am UNMOTIVATED. I am WORTHLESS. I have NO self control. I have NO self discipline. I am a FAILURE because I have tried so many times and I cannot do it. I am a FAT slob. I have NO will power.

So, then the cycle starts. The one thing that comes easy for someone that is overwhelmed by the idea of moving is to sit on the couch and watch TV or read a book or do a puzzle or knit and usually what goes very well with this is to also eat. I am not saying that any of these things are bad but in the context of this paper we see that  the activities that are chosen by someone suffering with these chemical imbalances are sedentary. And then I wonder about the correlation between obesity and depression because of this inability to move, the uncomfortable nature of moving, the discovery that SITTING and doing an activity is all that can be accomplished. It is not laziness, it is not being unmotivated, it has nothing to do with willpower. There is a missing step in what the doctors/therapist/Psychiatrist are telling their patients…and how they are helping them.

The missing step is FROM THE COUCH TO THE DOOR. Or even better FROM THE COUCH TO STANDING UP. A doctor can tell the patient to exercise. To walk. To go to the gym. But the issue is that this patient CANNOT even make it off the couch. Or out of bed. And this is NOT being lazy. I have to keep saying this because I have had too many clients feel shamed because they have been made to feel so worthless by statements like: “Oh, come on, it is not that hard.” “Just set your alarm an hour earlier.” “Aren’t you worth it?” “Don’t you care about your health?”

Can you imagine hearing this your whole life and BELIEVING it? Believing that you FAILED, again. And AGAIN. And AGAIN. And then finding out years later that there was something chemically in your body,  that you had no control over, contributing to all of this and no one told you. Yes, you could be very angry. Or, you could react like one of my clients. She was 67 when she contacted me to help her get in shape for a scholar walking tour in France. It was a level above the beginner tours that she and her husband had done in the past and she was scared that she would not be able to walk the 4 miles required. She made a pact with her husband that she would get a trainer and get in shape for the trip. When I first sat down with C, she told me she NEVER exercises and does not like to move. Her exact words were, “ I come from a family where, Why stand if you can sit, why sit if you can lay down?” I was cracking up when she told me but was also horrified to realize it was the truth!!! After she told me her whole story of her food addiction and some other aspects of her life, I was deep in thought. I asked her if she suffered from depression. She looked at me, eyes WIDE open and said, “how did you know?” And I told her everything that I just told you in this paper. She was speechless because she has been in therapy her whole life and no one has ever touched on anything like this in regards to seeing a correlation between  her chemical imbalances in depression and her real struggle to just, move. She actually said to me, “I just thought I was lazy.” And when I saw her the following week, I asked her if she had thought about what we talked about. She told me she had thought about it everyday and when I asked her what she was thinking, her response was exactly why I am writing this paper. She said, “ I felt a sense of relief.”

So, after this last experience with C, I realized that I wanted to try and use what I have discovered in order to help give relief to so many people in the same situations. How would that look? Here are a few ideas I have thought about:

  1. It should be brought to the attention of doctors/therapists/psychiatrists to suggest to their patients that there are some cases of depression where the chemical imbalances might be part of the issue holding them hostage. Just giving the patients awareness that this is a possibility is so important and could change people’s lives.
  2. As a personal trainer, I will offer services to these patients/clients. I will set up appointments to make house calls for movement. This will not be called a workout or a training session. It will be called, “Stay Put and Move.” Or, some version of that but nothing related to exercise or working out. It is me, showing up at their home and taking their hand and gently helping them off the couch and moving. We will just walk from room to room. Or just stand up and sit down. We can go to the kitchen and get a drink. We can sweep the floor. And when they are ready, we can walk up the stairs or take out the trash. What I am trying to get at it that I will just get them moving and talking and laughing. And hopefully they will see that it is not that bad or hard and it might actually feel good and be fun. There will never be any pressure to do it on their own if they do not want to because I understand that is not in their control. If they end up doing it on their own, it is a huge bonus.
  3. I get a mini bus and make a group house call. This means that I get at least 5 people (or it is a group of 5 friends) and I drive to each home and walk in and actually take their hand and walk with them out to the bus. Once I have all 5 people I will go to a rented space and we will have a group move class. Not a workout, just moving. Fun, laughter, movement with other people who are dealing with the same chemical imbalances and who struggle with the same issues. The key here is that a friendly face comes to YOU and gently takes your hand with a smile so you are not thinking about the fact that you are about to go and do something you do not want to do like move. A friendly face will be walking you to a bus full of people who are going through the same thing but will all be supportive of each other and end up feeling great at the end of the hour. The bus will drop off each person to their home and I will walk them back inside and leave them with a hug and a smile.
  4. I start an online FaceTime/skype 10 minute movement. For 10 minutes I will be on FaceTime/skype with my client and I will have them stand up and sit down. We will walk into the other rooms of their home “together.” I will have them get up and get a glass of water. They will vacuum a room or sweep a floor. But all in the privacy of their own home, in their own clothes, without having to see or face anyone in person and only for 10 minutes. But this 10 minutes will be so important for someone who might be 400-600 lbs. and feels helpless. I will understand what they are feeling and going through and instead of pushing them hard or making them uncomfortable by going too fast, this will be based on them and what they can do in that 10 minutes with me. And when they are finished, they will feel a sense of accomplishment because no one is judging that they only did 10 minutes. THEY know that they picked up the phone and MOVED and did the work and no matter how long or what they did, for them, it is a huge accomplishment.

So, in conclusion, my purpose is to look at depression and the chemical imbalances it creates as it relates to exercise. Does the chemical imbalance in someone suffering from depression cause that person to severely struggle with movement/exercise. Have people who suffer from depression lived long enough with the idea that they are “lazy” and can we change that so there is an understanding of why they are struggling to move/exercise? Are there ways that we can help them by focusing on the missing steps? If the struggle is from the couch to the door, that is where we need to start. I gave C “homework” of the movements and stretches that we did together to do at home until we met again the following week. I did not expect her to have done the movements because most of my clients do not do their “homework” unless they are with me. When I arrived at her house the following week, I asked her what she had done on her own. Expecting to hear “nothing,” I heard, “I did 15 minutes on the bike and the stretches you told me to do and the neck exercises. I did all my homework.” I did not let on that I was shocked but I did let her know I was very proud of her, which I was. It also made me think that because she had this knowledge that she had an extra obstacle (chemical imbalance) it gave her the green light to move. Maybe having the awareness that it is not her being lazy, it is something bigger than her, it took a different meaning to get up and move. Maybe this gave her a freedom from her own label of “lazy” and now that she knows she is not lazy, she is free to get up and move. If this is the case, can we please pass out this awareness and hand out the relief?

Deborah Stern has a degree in psychology/nutrition from DePaul University in Chicago, IL. She has been dedicated to helping women, men and children of all ages and all fitness levels in improving their lives through exercise, nutrition and personal growth.  Deborah started early in life  on this journey for herself and has been taking her clients on the journey for the past 25 years. Visit her website at foodprintforlife.com, and her blog at debapproved.blogspot.com.
Nutritional label

The Skinny on Visceral Fat: Why Are Skinny People Dying from “Obese” Diseases, and What Can We Do About It?

/24 August 2017/ All MFN blog/

Considering the near-consensus that adipose tissue is the culprit behind so many diseases, one must wonder the reason behind some obese people having no metabolic dysfunction.[1]

The real irony comes with the emergence of a new phenomenon that acknowledges and catalogues those within a healthy BMI range that find themselves at greater risk for diseases generally reserved for those considered obese.

People within the acceptable BMI range have found themselves saddled with heart disease, Type 2 Diabetes, and greater instances of certain cancers.[2]  The inquisitive mind must ask why those that are considered low-risk by BMI standards exemplify the results of those considered at high-risk.

These individuals have a pattern of fat storage invisible to the naked eye and hidden deep around the organs and within the liver.  Considered visceral fat, visceral adipose tissue (VAT) or intra-abdominal adipose tissue (IAAT), these skinny people are at an increased risk of metabolic diseases despite not being visibly overweight.[3]  Also referred to as the thin-fat phenotype,[4] this particular population may be at increased danger of these potential diseases because the issue with visceral fat storage is not visible; it cannot be pinched, or jiggle, or seem unsightly, and so these individuals are not only unaware of the problem, but may even be resistant to the possibility since they do not manifest the outward appearances associated with these issues.

Understanding Visceral Fat

Visceral adipose tissue (VAT) is gaining increasing understanding and acceptance as an active hormone gland with dangerous, destructive potential on the endocrine system.[5]  These functions allow it to   partly control nutritional intake, hunger, and appetite through secretions of leptin and angiotensin, control insulin sensitivity and inflammation through tumor necrosis factor alpha (TNF-a), Interleukin-6 (IL-6), resistin, visfatin, adiponectin, and other hormones.[6]  With such an impressive list, and such numerous and varied hormone functions, the vital importance of VAT’s endocrine functions becomes apparent. The ignorance or ignoring of this becomes dangerous.

What about normal adipose tissue?  When examined and compared side-by-side, VAT proves itself far more dangerous.  When compared to total body fat, VAT is significantly better correlated with triglycerides, systolic and diastolic blood pressure, HDL/total cholesterol ratio and its effects on glucose and insulin.[7]

Its intimate control over so many hormonal processes also places VAT in a potential death spiral.  Since it acts as both a hunger controller and as a controller of insulin resistance and blood sugar through its release of leptin, resistan, visfatin, and acylation stimulating protein (ASP), visceral fat, in excess, exacerbates the very conditions that allowed it to expand.  For example, a sedentary lifestyle and poor diet results in excess visceral fat accumulation.  This excess visceral fat then produces excess hormones that signal the body to develop a diseased state such as Type 2 diabetes and insulin resistance.  In turn, these disease states trigger their own lifestyle and dietary shifts that result in further visceral fat accumulation.  And so spins the disease spiral.

VAT also plays a critical role in the secretion of endogenous growth hormone (GH).  As levels of VAT increase, exogenous secretion of GH decreases.[8]  As levels of GH drop, VAT increases due to a decrease in hormone-sensitive lipolysis.[9]  This becomes more apparent when the use of a GH releasing hormone reverses these effects. A full series of articles is necessary to explain the myriad of potential dysfunctions caused by such endocrine disruption.

Fortunately, clinical treatment with a growth hormone releasing hormone is not necessary.  VAT can be safely controlled long-term through intelligent lifestyle alterations and a properly designed training plan.

Fighting Fat With Fat

Unfortunately, there is very little information regarding effective dietary intervention to reduce VAT.  However, understanding how integral VAT accumulation depends on endocrine disruption, especially that of hyperinsulinemia, one can intelligently extrapolate this outwards and hypothesize a sensible and logical dietary approach.

Since VAT accumulation depends on hyperinsulinemia and reduced exogenous GH secretion as two major components, we would want to incorporate a diet that controls blood sugar levels (and thus insulin secretion) as well overall improved endocrine function.  Removing all sugar, with the notable exception of low-sugar fruits, is the first obvious step.  A ketogenic diet has proven itself time and time again, clinically, to controlling hyperinsulinemia, even in those with congenital issues.[10]  The ketogenic diet is also efficient at controlling blood sugar levels,[11],[12] and therefore insulin secretion, an excess of which similarly leads to hyperinsulinemia.

A diet that is the opposite of the Standard American Diet (appropriately abbreviated as SAD) is a good direction to go, regardless of the stance of a ketogenic approach.

Exercise Modalities to Combat Visceral Fat

When it comes to exercising with the sole intent of reducing VAT, there are a couple variables one must take into consideration to ensure maximal positive effect.

Per a meta-analysis in 2012 found that moderate or high intensity aerobic training has the highest potential to reduce VAT.[13]  Note, too, that this was in the absence of caloric restriction.  The type of diet otherwise pursued was not expanded on.  One could wonder the potential improvement in outcomes if this same design was followed in combination with the ketogenic diet.  Not surprisingly, similar results were found with strength training as well in this same meta-analysis.  In this study, “moderate” was defined as >250 min.wk.  Of similar importance is the studies analyzed that included greater volume defined as 45-60 minutes a day, six days a week, did not yield more positive results, suggesting a definite bell curve and potential for decrease in return for higher-volume work, an idea supported throughout this section.

This meta-analysis also implied a threshold for training intensity for VAT to be effected optimally.  Unfortunately, no further evidence is described for this, other than mentioning the synergistic qualities of high-intensity training post-exercise.[14]

One must use caution with the word “aerobic”, however, as the effect of regular aerobic exercise, defined as walking and jogging at a moderate intensity on body fat is negligible.[15],[16]  Perhaps this explains why so many people find themselves on treadmills and elliptical, performing steady-state aerobic exercise with little or no improvement.

High intensity training demands special mention here due to increased GH secretion.[17]  In this same study, GH concentration was still ten times higher than baseline an hour after recovery.  Harkening back to the relationship between VAT and reduced GH secretion, this method of training directly counteracts one of the most damning results of excess VAT and could single-handedly upset one of the mechanisms behind VAT accumulation.

Since Type 1 diabetics are prone to experiencing hypoglycemia after prolonged aerobic expenditure, a single 10-second sprint could help retain healthy sugar levels.[18]  This opens a potential exercise prescription for a population group that otherwise would be at a higher risk.  Obese women with metabolic disorder were studied under a high-intensity exercise training and low-intensity exercise training, with the HIET group showed significantly reduced abdominal fat, abdominal subcutaneous fat, and visceral fat, where no significant changes were found in either a control group or the low-intensity group.[19]  The last thing a medical fitness expert wants to do is waste time with an ineffective approach.

Numerous studies also highlight the effectiveness of HIIE over steady-state aerobic exercise for reduction of adipose tissue and VAT.  Tremblay et al. compared HIIE and aerobic exercise and found that the HIIE group lost more subcutaneous fat after 24 weeks than the aerobic group.[20]

Another study by Trapp et al. once again found that women in the HIIE group lost 2.5kg more subcutaneous fat than those in a steady-state aerobic program.[21]

The Slimmed-down Version

All this information implies that although VAT has numerous mechanisms to harm the body and exacerbate disease states, the appropriate modifications to training and lifestyle can help the body against it without the use of drugs.  The optimal exercise prescription rests with a mixture of moderate and high-intensity training combined with intelligent diet.  Thankfully, despite its horrible potential, managing visceral fat is not so difficult a task.  As fitness professionals, we can utilize this information to ensure that we do not get stuck in an archaic steady-state paradigm and can better serve our clients.

Shane Caraway CHN, CPT, PTSP, uses his education, experience, and credentials as a certified personal trainer and nutritionist to help others recapture the primitive mystique, strength, and beauty that their body is capable of. His greatest pleasure comes from the successes of his clients, no matter how mundane or simple each small victory may be. Always in pursuit of various techniques, compounds, nutrients, herbs, and other means to help support the body against disease, Shane finds the challenge of combating chronic disease to be the pinnacle of his work, especially with diseases and conditions that otherwise cause clients to surrender.

References

Adipose tissue image: Blausen.com staff (2014). “Medical gallery of Blausen Medical 2014″. WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.010. ISSN 2002-4436

[1] https://www.ncbi.nlm.nih.gov/pubmed/?term=Exercise%2C+abdominal+obesity%2C+skeletal+muscle%2C+and+metabolic+risk%3A+evidence+for+a+dose+response.

[2] http://westminsterresearch.wmin.ac.uk/14274/

[3] http://westminsterresearch.wmin.ac.uk/14274/

[4] https://www.researchgate.net/publication/51618462_The_thin-fat_phenotype_and_global_metabolic_disease_risk

[5] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3648822/

[6] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3648822/

[7] https://www.ncbi.nlm.nih.gov/pubmed/?term=Exercise%2C+abdominal+obesity%2C+skeletal+muscle%2C+and+metabolic+risk%3A+evidence+for+a+dose+response.

[8] http://europepmc.org/articles/PMC4324360

[9] http://europepmc.org/articles/PMC4324360

[10] https://ojrd.biomedcentral.com/articles/10.1186/s13023-015-0342-6

[11] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2716748/

[12] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3506983/

[13] http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0056415

[14] http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0056415

[15] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2991639/?_escaped_fragment_=po=6.25000

[16] https://www.ncbi.nlm.nih.gov/pubmed/19175510

[17] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2991639/?_escaped_fragment_=po=6.25000#B1

[18] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2991639/?_escaped_fragment_=po=6.25000#B1

[19] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2730190/

[20] https://www.ncbi.nlm.nih.gov/pubmed/8028502

[21] https://www.ncbi.nlm.nih.gov/pubmed/18197184

mother-with-stroller

Postnatal Exercises

/23 August 2017/ All MFN blog/

Exercise is recommended to keep the body strong and in proper working order. Exercise also builds and maintains healthy joints, bones and muscles. Postnatal exercises help a woman get back into shape after giving birth, and they also help combat postpartum depression. There are several basic exercises you can do within a few weeks after giving birth. However, if you’ve had a Caesarean section, you may want to wait at least six weeks before doing any abdominal exercises. If you experience pain while exercising, stop immediately and call your doctor for advice.

Walking

Walking is the most basic of exercises, and it’s a good way to begin a new workout regime. Begin by walking at a leisurely pace, and increase your pace and distance over time. Once you’re comfortable in your movements, take advantage of all those great baby registry gifts you’ve received. Put the baby in the baby carrier and push the child in front of you as you walk.

Some women enjoy walking with a friend, as it gives them time to socialize, an activity you may be neglecting while caring for your new baby. If you are a runner, avoid an intense running workout until you have spoken with your physician. Some women are discouraged from exercising strenuously in the first few weeks after giving birth, especially if they are waiting for the wound from a C-section to heal. A doctor can answer questions about your limitations.

Pelvic Tilt Exercise

The tummy is a major problem area for many women after giving birth. Thus, pelvic exercises are often helpful. The pelvic tilt exercise is easy to do and can tighten up your stomach and strengthen your back. Begin on your back on the floor with your knees bent and your feet flat against the floor. Then, flatten your back against the floor as you tighten your abs and lift your pelvis slightly off the floor. Hold this position for 10 seconds. Repeat the exercise by doing three sets of ten seconds each. Pelvic tilt exercises can be done anywhere. After you’ve finished breastfeeding and put the baby down for a nap, take a few minutes to do your exercises.

Kegel Exercises

Some people worry about finding the time to exercise. However, both pelvic tilts and Kegels can be done in a short time frame. The purpose of Kegel exercises is to strengthen the muscles in your pelvic floor. During pregnancy, the muscles of a woman’s pelvis are often weakened. This is why some women experience incontinence after childbirth. If you notice that coughing, sneezing or laughing causes you to leak small amounts of urine, then you could probably benefit from Kegel exercises.

Kegels are simple. First you must identify your pelvic floor muscles. These muscles are the ones you use when you stop yourself from urinating mid-stream. Practice stopping and starting urination while in the bathroom, but only do this once or twice to identify the proper muscles. Do not make a regular habit of contracting your muscles during urination, as this can cause bladder problems.

Once you’ve identified your pelvic floor muscles, you are prepared to do Kegels. Lie on your back and contract your muscles for five seconds, and then relax for five seconds. Do this until you can contract for ten seconds at a time. Do three sets of ten seconds 2-3 times each day. You can even do Kegels while standing up and walking around. Kegels can help those who leak a small amount of urine but probably won’t be helpful to women with a serious incontinence problem.

Forearm Planks

Planks are good exercises that target and tone your abs, thighs and butt. Planks are also a great way to strengthen your abs without straining your back and neck. Begin by lying on your stomach on the floor. Put your forearms on the floor beneath your shoulders and keep your back straight with your legs extended so that your toes touch the floor.

Then, lift your tummy from the floor so that it is parallel to the floor. Using your forearms and toes to hold your body weight, tighten your tummy and hold your abs off the floor for 30-60 seconds. Rest for 30 seconds, and then repeat the exercise 4-5 times. You can also do planks with your palms flat against the floor and your arms straight rather than placing your weight on your forearms.

Finding time to exercise after giving birth can be a challenge. Try to schedule a brisk walk several times weekly at a local park, or simply walk around your neighborhood. Any exercise is better than none at all. Kegels, pelvic tilts and planks can be done inside your home. Take a few minutes several times a day while your baby sleeps to do your exercises. It’s also a good idea to have your doctor recommend stretches and workout routines. Remember to start light, then increase your exercise intensity over time.

I’m the woman next door, with all of the problems and joys of everyday life. I know that the more I give, the more I’ll receive–so my blog is intended to help people, and hopefully, it will do good things for me too. As a working mother, I’m often faced with many practical, everyday situations that make life harder, but that shouldn’t be the case. Visit my website at thebabbleout.com

Sources
http://www.mayoclinic.org/healthy-lifestyle/womens-health/in-depth/kegel-exercises/art-20045283
http://www.webmd.com/parenting/baby/6-exercises-for-new-moms#2
http://kemh.health.wa.gov.au/brochures/consumers/postnatal_exercise.pdf

Doctor and patient

A New Code of Ethics For Health And Wellness Coaches: Healthy Boundaries, Part One

/22 August 2017/ All MFN blog/

The old New England expression that “good fences make good neighbors” applies to the world of professions as well as it does to rows of piled rocks in the old fields and forests of places like Vermont and Maine. The concept of professional boundaries seems to expand the more you look into it. In this and a following post we will look at role definition, ethics and scope of practice, boundary crossings and violations, self-disclosure, and other issues from the unique perspective of the health and wellness coach.

Since its inception just over twenty years ago the ICF (International Coaching Federation) has developed a Code of Ethics which it revises on a regular basis. The ICF also maintains an Ethics Community of Practice where you can bring ethics questions and learn from presentations.

Law & Ethics in Coaching: How To Solve And Avoid Difficult Problems In Your Practice (2006) by Patrick Williams and Sharon K. Anderson houses considerably valuable information from the chief authors and other contributors.

With the development and growth of the field of health and wellness coaching, the question of ethics and scope of practice emerged with the realization that such coaches often face unique situations, sometimes interacting with the medical world, that require a fresh look. While the ICF Code of Ethics is to be embraced by all coaches, the need for something more became evident.

As an Executive Team member of The National Consortium for Credentialing Health and Wellness Coaches, I was honored to chair a committee last summer of extraordinary coaches who are part of our NCCHWC Council of Advisors.

Through our efforts “in August 2016, the NCCHWC created the Code of Ethics and Health & Wellness Coach Scope of Practice to serve as a reference for health & wellness coaches and faculty. The NCCHWC expects all credentialed health and wellness coaches (coaches, coach faculty and mentors, and students) to adhere to the elements and Principles and ethical conduct: to be competent and integrate NCCHWC Health and Wellness Coach Competencies effectively in their work.”

Please download the NCCHWC Code of Ethics and Health & Wellness Coach Scope of Practice here: NCCHWC Code of Ethics; NCCHWC Health & Wellness Coach Scope of Practice. You can also find copies of both documents in the Wellness Resources section of the Real Balance website.

Codes of ethics such as these serve as the primary guides to help form professional boundaries that we can adhere to. In Section Three of the NCCHWC Code of Ethics we find most of the references to boundaries. The most obvious boundary here is #23 – to avoid any sexual or romantic relationship with current clients, sponsor(s), students, mentees or supervisees. But, we also see in other items in this section, that much of the issue of boundaries also refers to creating clear agreements with our clients about the nature of coaching, how it works, confidentiality, financial agreements, etc. The client-centered nature of coaching is emphasized along with complete transparency, spelling out the rights, roles and responsibilities for all involved.

The issue of boundaries is more directly addressed in item #22. Hold responsibility for being aware of and setting clear, appropriate and culturally sensitive boundaries that govern interactions, physical or otherwise, I may have with my clients or sponsor(s). Here we are looking at how we create a safe environment for our client where they feel respected, comfortable and safe. While most individuals are at least somewhat sensitive to this in most social interactions, the coach must be especially sensitive about it because of the trusting nature of the coaching relationship. While not on the same level as clinical relationships, coaching clients must feel free to express themselves at a trusting level. The health and wellness coaching client who is attempting to gain insight about how they hold themselves back from being successful at weight loss, for example, needs to feel that they can reveal information about relevant feelings and experiences without feeling vulnerable. This shows up mostly in two areas, the appropriateness of touch, and self-disclosure.

While not inherently wrong, behaviors such as giving/receiving a hug from/with a client after a triumphant moment in coaching, may be misconstrued in its intention. For one client it may, according to some authors, “engender healthier relationships”, while for another it may feel like a boundary crossing, which other authors would argue, might “pave the way to a boundary violation.”  Coaches learn early on in their training to ask permission. Seeking permission first and respecting our client’s wishes can avoid such boundary crossings/violations. We avoid the pitfalls of assumptions and honor our client’s personal and cultural boundaries in this way.

Self-disclosure also has different boundaries in different cultures and with different individuals. We looked closely at this topic in a previous blog post “Self-Disclosure in Coaching – When Sharing Helps and Hinders“. We can remember from that post that coaches who do not self-disclose at all are not trusted, while those who disclose “too much” are thought to be incompetent. Our own self-disclosure, should never put undue pressure on our client to also self-disclose. Differences in culture, social class, family upbringing, etc. all can set very different boundaries around the issue of appropriate self-disclosure.

Originally published on Real Balance blog. Reprinted with permission.

Dr. Michael Arloski is the CEO and Founder of Real Balance Global Wellness Services, Inc. (www.realbalance.com). Real Balance has trained thousands of wellness coaches worldwide. Dr. Arloski is a board member of The National Wellness Institute, and a founding member of the executive team of The National Consortium For Credentialing Health and Wellness Coaches. He is author of the leading book in the field of wellness coaching: Wellness Coaching For Lasting Lifestyle Change, 2nd Ed.

blood-samples

The Rise of Consumer-Based Blood Testing: A Huge Step Forward for the Medical Fitness Profession

/18 August 2017/ All MFN blog/

A recent report in Forbes Magazine by writer Unity Stokes discusses the recent issues concerning the validity of blood tests results from a Silicon Valley lab company called Theranos. Theranos was founded by a 30-something Elizabeth Holmes, who garnered over $5 billion from investors to launch her company that promised blood from finger sticks vs. whole venous blood draws. This year her company was investigated by the Department of Justice for investor fraud. Today Theranos has little investor value, but Ms. Holmes helped launch the consumer based blood lab model – in which patients can order blood labs from online companies when they want – essentially taking away a physician-ordered medical procedure.

While it may not mean too much for medical fitness professionals today – it should. There are two reasons. Even though Theranos is not the top dog in the blood lab industry now – they have changed the way we think of blood labs in general.

The big picture here, as explained by Stokes in his article, is that whatever the endpoint is for Theranos, consumer based lab testing is here to stay and will be one of the fastest growing areas of healthcare.

Simply put – consumer based blood lab companies allow patients to log onto web sites and essentially become “members” of an online community. Their membership allows them to receive blood labs independent of their physician referral.

Why is this important? For the Medical Fitness Professional – it is the game changer that they have been waiting for. Over the past 25 years they have pushed the terms “post rehab exercise” and “clinical exercise” to allow trainers to move into the health care environment.

While performing duties that may in some cases seem similar to physical therapy (in the eyes of the uneducated observer) they are now able to have a piece of health care that they can use to further their development of the clinical exercise realm.

Blood labs will allow personal trainers, health coaches, health nurses, sports conditioning coaches, and exercise physiologists to refer their clients and athletes to blood lab companies online and directly test the effects of an exercise and sport program on their health.

According to StepOne Health CEO Craig Brandman, MD – over 90% of healthcare decisions are make by the results of blood labs, and in sports medicine – we can only imagine looking at blood labs on an on-going basis to see how our prescribed exercise (or sport) program is doing on blood lab parameters.

Take diabetes for instance – in athletics or health improvement, the basis for medical decision making is in two critical areas – fasting and post blood glucose testing with a home monitor and long term care regarding the glycosylated hemoglobin (A1c). These tests are crucial to seeing how improvements are doing in overall diabetes health. The first test – the home glucose monitor – can be used in any health club and by anyone. The A1c test is a lab test and is usually prescribed by a doctor – until now.

Dr. Brandman and myself have been in communication for some time to bring StepOne Health into the realm of the health and fitness profession. As a former medical researcher – I can’t agree more. With cancer patients, weight management, hormone management, cardiovascular risk patients, and most others, the ability to manage blood labs may be the most important element in showing others in health care the benefits of exercise and sports training at any level.

Sports training programs rely on physical performance markers, injury status, range of motion, and other elements to see the improvement in athletes. Blood testing allows them to not only measure acute markers (blood glucose, lactate, etc.), but to look at markers such as Creatine, Testosterone, and BUN levels and prescribe fitness accordingly.

How will this come to pass? In my conversations with Dr. Brandman – we are working on two fronts. First is to enhance the education of health and wellness professionals as a whole. The Blood Lab Wellness Specialist course was launched in February of 2016, and it allows heath and wellness professionals to have a baseline understanding of the blood lab process. Second – StepOne Health will be creating a referral-based system whereby Medical Fitness Professionals and coaches can directly refer clients to the StepOne Health portal and become part of the referral family. This will include discount rates on blood panels, referral fees for professionals, genomic testing profiles, and online coaching when needed. In my opinion, it is the single most important step in bringing wellness and fitness into today’s health care system as any single faction.

I recently had the opportunity to interview Dr. Brandman about the issues concerning healthcare. In his opinion, health and fitness professionals SHOULD be referring clients to blood work. The more clients know about how their fitness impacts their overall health status, the better. See the interviews with Dr. Brandman on my medhealthfit YouTube Channel here:

https://www.youtube.com/watch?v=NFco-TrQ_hw
https://www.youtube.com/watch?v=O7IFebUXpXU

Lastly – the profession of medically based exercise is steeped in our tradition of sports medicine. Allowing for blood lab data (under HIPPA guidelines of course) to steer the course of exercise programs makes for formidable outcomes measures and research. It will allow practitioners to absolutely have clear cut outcomes on the programs they are teaching and will only strengthen the association with medical practice groups, hospitals, and health plans, who are looking for the best opportunity to work with providers at the best possible pricing. It is a win for all parties – especially patients, who can see how exercise truly affects their health status.

For more information – log onto www.steponehealth.com and look over the web site.

For more information on the Blood Lab Wellness Specialist, visit medhealthfit.com/health-lab.

Eric Durak is a pioneer in the post rehab movement. He has worked in personal training, medical research, environmental health, and is the author of numerous industry certification courses, such as the Cancer Fit-CARE program / coaching program, Fitness Medicine, Wellness @ Home, The Insurance Reimbursement book for wellness professionals, and recently – the Blood Lab Wellness Specialist. See all of his programs at the medhealthfit.com web site.

References

http://www.forbes.com/sites/unitystoakes/2015/11/04/despite-clamor-surrounding-theranos-the-entrepreneurs-vision-of-transforming-diagnostics-is-near/

http://www.inc.com/magazine/201510/kimberly-weisul/the-longest-game.html

http://www.wsj.com/articles/theranos-is-subject-of-criminal-probe-by-u-s-1461019055

Couple biking

Healthy Aging by the Decades: Your 50s

/15 August 2017/ All MFN blog/

The primary question being asked in the majority of sessions for retirement planning is what you will need in terms of financial reserves to carry you through your later years. Unfortunately, this is the only model used in America and worldwide today. However, the question that you should really ponder is: “What will you do if your health fails, and how will your retirement life really be if you will no longer be able take care of myself?” An additional issue revolves around the date at which you start taking your social security benefits, but age is just a number! In reality, what if things don’t go according to plan and you don’t even make it to 70?

What healthy aging should be about rsz_healthy

The concept of healthy aging is something that has appealed to me since I realised that at any point in time I was indeed training for the decades to come. When this dawned on me, I had to re-evaluate my own position on what aging healthfully encompasses. I am convinced that money is only part of the dilemma: if we reach our 50s and 60s with little of the health we desire, what are our realistic prospects? I have concluded that financial planning is not enough: it’s essential to be physically, emotionally, spiritually and professionally fit as well. Recently, I told a friend at the gym that I think that if people go by the common definition of retirement, namely “remaining in a state of leisure”, this will lead to an early death because people literally stop “living”.

The answer is to face the reality that we are all going to age and start preparing as carefully as we can NOW. It is much more appealing to get on with the business of training NOW rather than later when it may be too late. This thought reminds me of the oil filter ad that said: “Pay me now or pay me later” – meaning that you can replace your engine later (at a much higher cost) – or the oil filter today. Which choice would you prefer for your body? Train now or knee replacement later?

What I learned from my 50s

The decade of our 50s is when we start to “show our age”. This is the time when all our bad choices and lifestyle habits catch up with us. The truth is that playing catch up with our health is never a good option and if we prepare now rather than later we can be way ahead of the curve.

When I was in my early 50s, I realized my goal of running a combined 3000 plus miles (3675 to be exact in 1998 and 1999). That record stood until looking back on those two years I made the decision to break 4000 miles in a combined two year span so in 2011, at the age of almost 65, I started my “run” to a new two year record and finished 2011 with a total of 1955 miles. 2012 was in my sights now as a potential record breaker, so as I worked hard toward my new goal, I remained positive that I could make it past 2000 miles. I ended up with an all time record of 2145 miles and a grand total of 4150 miles. I was elated and found courage in setting a goal that had pushed me beyond previous boundaries and out of long held comfort zones.

This was possible because of my record keeping discipline over the years and the fact that I decided to break a record that had been set 12 years before. I share this example with you as a way of demonstrating that we are never old until we decide we are – and to illustrate how the succeeding decade can be influenced by something we did in the preceding one. I am planning for my 70s now based upon the foundation I laid in the previous decades of my life. I am approaching this new decade with the same thought and care that went into my 50s and 60s. Now, I feel a strong desire to maintain what I have achieved in terms of fitness, instead of going backwards and lose what I have gained.

Being driven to accomplish something meaningful is important to living a healthy and fit life. I found my work with my clients rewarding in my 50s. I believe I shared with them the best that was truly me. My 50s were a decade of growth for me. Some of my clients encouraged me to write about my training philosophy. They supported me because they believed in me and what I had been doing to serve and guide them to achieving their goals. They were responsive to my coaching and I in turn loved being with them and seeing them grow and evolve mentally and phsically. My view of life expanded greatly during my 50s. I found my stride – and witnessed becoming happier and more fulfilled than I had been in years.

In my 50s, my world was far from being perfect, but it was filled with love and support from those I cared about and served. My daughter and I grew closer during this decade while she was living a life of adventure and success. The foundation for who I wanted to be – and become – in my 50s had been laid in the previous two decades. I am grateful for my 50s because I fulfilled part of the promise I had shown as a child on Maui: I had become a good man with a kind heart and most importantly open minded. I loved learning and exploring again – just as I had done all those years before in Hawaii. This sense of progression and continuation at the same time, gave me a feeling I was being true to myself, which is the only key to happiness and wellbeing.

Some suggestions for your 50s

  • Continue to refine your plan for fitness activities and stick to it. Make changes sparingly and take one step at a time.
  • Be patient and loving toward yourself.
  • Eat well, sleep well, manage your stress levels and meditate (think consciously) every day.
  • Make choices that FEEL right to you. Don’t live for others, but find your own “center”.
  • Be attached to learning about yourself and accepting yourself just as you are – and as you are not.
  • Practice being grateful and have an attitude of acceptance and forgiveness. These two traits will carry you far.
  • Make an effort to reach out for help.
  • Don’t rely on the internet for your answers.
  • Stay current on issues that are of importance to you and be willing to say to yourself “I don’t know but I am willing to learn.” No one is an expert on everything – especially when it comes to life. Don’t hold yourself to that standard. Become an authority on yourself and the rest will take care of itself.
  • Be a student of your own life and an expert on becoming who you want to be – and let the rest go!

I will cover the 60’s and beyond in the final part of this series being fully aware that I have only “scratched the surface” of this examination and exploration of “training for the decades ahead”!

Originally printed on HealthyNewAge.com. Reprinted with permission from Nicholas Prukop.

Nicholas Prukop is an ACE Certified Personal Trainer & a Health Coach, a fitness professional with over 25 years of experience whose passion for health and fitness comes from his boyhood in Hawaii where he grew up a swimmer on Maui. He found his calling in writing his first book “Healthy Aging & You: Your Journey to Becoming Happy, Healthy & Fit” and since then he has dedicated himself to empowering, inspiring and enabling people of all ages to reach for the best that is within them and become who they are meant to be – happy, healthy and fit – and be a part of a world where each person can contribute their own unique gifts to life.

Electronic bathroom scale and glucometer with result of measurem

Going Beyond Diabetes Treatment: Exercise!

/10 August 2017/ All MFN blog/

There are many treatments for Type II Diabetes (which will be referred to simply as diabetes in this article) but none come with the level of benefits seen by the implementation of a proper exercise program. This is a tall order but exercise is effective for the treatment of insulin resistance and diabetes in three areas. These areas are inflammation, the cell mitochondria (where the cell generates power), and hyperinsulinemia (high blood insulin).2 Treating these areas with exercise goes beyond the benefits of treating just diabetes. In turn, you will be helping prevent other health issues associated with diabetes such as heart disease, stroke, and circulation issues. The questions is how does exercise do this and what kind of exercise is necessary?1

To understand how exercise treats diabetes, it is important to understand that diabetes is the end result of insulin resistance. Insulin resistance can be illustrated in that: when we eat something with carbohydrates or sugar, our body breaks it down into blood sugar known as glucose. This glucose triggers a response from our pancreas to produce the hormone insulin. Insulin in turn shuttles the blood sugar into the cells to be used as energy. However, when someone becomes insulin resistant the cells do not respond to the insulin’s attempt to shuttle the blood sugar into the cell, so the pancreas produces more insulin to get the same job done. In essence, the cells are developing a tolerance to the insulin and in order to get the blood sugar absorbed the cells begin to require more and more insulin to do the same job. This leads to the blood retaining the blood sugar for prolonged periods of time as well as an elevated presence of insulin. When someone has prolonged high blood sugar, we call this hyperglycemia and the person is said to be diabetic. Having high blood sugar is dangerous due to the stress it places on cells. It can cause many problems up to and including death.

In the area of inflammation, it is known that not all inflammation is the same. Inflammation can be acute — meaning it is brought on for a short period of time — which happens with activities such as exercise or when tissue undergoes some sort of trauma. Inflammation can also be chronic, meaning it is persistent and recurrent.

Acute inflammation is necessary, and healthy, because it begins the healing and repair process by bringing in white blood cells, and ridding the tissue of damaged cells. Inflammation is required otherwise the body would be unable to heal.

Chronic inflammation can be found in many conditions, such as autoimmune diseases, prolonged injury/infection, obesity, diabetes and other chronic diseases. When inflammation remains present, even at a low level, it begins to damage the body’s cells. Science now knows that:2

  • Obesity creates a level of chronic inflammation.
  • Inflammation is the precursor to every chronic disease including heart disease, arthritis, and cancer.
  • Inflammation suppresses the insulin signaling pathway (how insulin and your cells communicate) which is believed to be related to a reduction of a heat shock protein, this protein however, can be increased through exercise.
    • Increases of the protein begin after the first session of exercise.3

You may remember from science class the power generator of the cell is the mitochondria. This is where the energy is created from fatty acids and glucose. It is now believed that when the mitochondria of the cell becomes dysfunctional, less fatty acids are taken in, elevating fat (lipids) in the blood, and increasing fat storage. It is also believed that the cell becomes dysfunctional as a result of insulin resistance. This relationship may then further feed into the increased body fat and increased inflammation. Further scientific studies in this area have determined that:

  • Proper exercise increases mitochondrial efficiency, proper exercise being summarized as:
    • No less than 150 minutes of moderate activity per week but ideally more than 250 (start light and increase intensity).
    • Incorporate a combination of resistance exercise (i.e. calisthenics and weights) and cardiovascular exercise.
    • Supervision by a registered clinical exercise physiologist if two or more chronic conditions are present is recommended.4
    • Exercising following an interval training protocol ranging from 70-90% of maximal heart rate may provide superior results if tolerable by participant.5
  • It is well known that aerobic training increases the number of mitochondria in muscle fibers in order to increase the delivery of oxygen to the muscle. More mitochondria means more energy that can be generated within the cell.

Hyperinsulinemia is best described as an elevated level of insulin relative to the amount of glucose (blood sugar) present in the blood. This may be the truest indicator of someone who is insulin resistant and about to become diabetic.6 In the beginning, it was illustrated how insulin resistance develops, and it being characterized as requiring more insulin to do the same job. This additional insulin is the definition of hyperinsulinemia. When someone has hyperinsulinemia it can be expected that in a matter of time, even higher levels of insulin will be required as the cell increases its tolerance to the insulin. Eventually the pancreas will not be able to produce the level of insulin required to lower blood sugar and the person will be said to have hyperglycemia, and will be classified as diabetic. When someone is experiencing hyperinsulinemia, they are already experiencing inflammation, and a weakening of the insulin signaling pathway (ways the cells communication for glucose uptake), and likely a dysfunction of the mitochondria, which in turn may magnify the issue further.

What is known is:

  • Exercise lowers glucose in the presence of insulin, and thus exercise will lower both glucose and insulin levels.
  • If you’re currently diabetic and taking insulin, the amount may likely need reduced prior to exercise.
  • Consistent proper exercise may lead to the need to have a physician re-evaluate dosage or usage of insulin and/or pills (i.e. metformin). Never discontinue use of a medicine without consulting with your physician.

Proper exercise not only goes beyond the treatment of diabetes to the treatment of the cause (insulin resistance), it helps prevent other health issues that stem from diabetes. Health issues such as cardiovascular disease, stroke, and issues with circulation dramatically decrease with exercise. Also, remember diabetes aside exercise reduces risk of nearly every chronic disease.1

Jeremy Kring holds a Master’s degree in Exercise Science from the California University of Pennsylvania, and a Bachelor’s degree from Duquesne University. He is a college instructor where he teaches the science of exercise and personal training. He is a certified and practicing personal/fitness trainer, and got his start in the field of fitness training in the United States Marine Corps in 1998. You can visit his website at jumping-jacs.com

References

  1. Booth, F. W., Roberts, C. K., & Laye, M. J. (2012). Lack of exercise is a major cause of chronic diseases. Comprehensive Physiology, 2(2), 1143–1211. http://doi.org/10.1002/cphy.c110025
  2. Ye, J. (2013). Mechanisms of insulin resistance in obesity. Frontiers of Medicine, 7(1), 14–24. http://doi.org/10.1007/s11684-013-0262-6
  3. Matos, M. A. de, Ottone, V. de O., Duarte, T. C., Sampaio, P. F. da M., Costa, K. B., Fonseca, C. A., … Amorim, F. T. (2014). Exercise reduces cellular stress related to skeletal muscle insulin resistance. Cell Stress & Chaperones, 19(2), 263–270. http://doi.org/10.1007/s12192-013-0453-8
  4. Moore, G. E., Durstine, J.L., & Painter, P. (2016). ACSM’s exercise management for personals with chronic diseases and disabilities. Champaign, IL: Human Kinetics.
  5. Roberts, C. K., Hevener, A. L., & Barnard, R. J. (2013). Metabolic Syndrome and Insulin Resistance: Underlying Causes and Modification by Exercise Training. Comprehensive Physiology, 3(1), 1–58. http://doi.org/10.1002/cphy.c110062
  6. Paniagua, J. A. (2016). Nutrition, insulin resistance and dysfunctional adipose tissue determine the different components of metabolic syndrome. World Journal of Diabetes, 7(19), 483–514. http://doi.org/10.4239/wjd.v7.i19.483