All MFN blog Archives - Page 12 of 140

Healthy Aging: How Beginner’s Yoga Can Help You Live an All Around Healthier Life

Kaitlin Krull/3 May 2023/ All MFN blog, Conditions/

While most of us know that regular exercise is an important part of overall health, it can be difficult to make our bodies perform in the ways we think are necessary in order to feel the physical benefits. This is especially true as we age, when muscles and organs begin to work differently and we lose flexibility and mobility. Beginner’s yoga is the perfect remedy for addressing these limitations as we age. With both physical and mental benefits, the regular practice of yoga, at any level, can help you to live an all around healthier life. Here are just a few of the best reasons to take up yoga now, regardless of the number on your birthday card.

Physical Benefits

Many people begin practicing yoga in order to reap the physical benefits of the exercise. These are some of the ways yoga improves your physical health:

Increases stamina, flexibility, and mobility
The regular practice of yoga strengthens muscles and joints, allowing you to achieve more with your body, which is especially important as you age. It increases stamina, flexibility, and mobility, together with balance and coordination, which provides an effective yet gentle total body workout.

Helps encourage weight loss
We all know that increased physical exercise, when coupled with a healthy diet, can help you to achieve weight loss success when repeated regularly. This is also true for yoga. Once you begin to strengthen some of those forgotten muscles and joints, you will be able to practice yoga at a higher calorie burning level.

Alleviates physical ailments
Yoga practitioners around the world sing the praises of the exercise’s ability to remedy a number of physical ailments, some of which are particularly prevalent as you age. Regular yoga, even at the beginner’s level, can help to alleviate symptoms of heart conditions, blood flow and circulation issues, and muscle, bone, and joint problems. This kind of physical exercise also lowers cholesterol and blood sugar, thereby lowering your risk for other related health issues like diabetes and stroke.

Mental Benefits

If you weren’t convinced to begin practicing yoga by the physical benefits alone, check out the ways in which yoga can increase mental health as well.

Relaxes mind as well as body
The repetitive and meditative style of yoga is called upon time and again to help relax both the body and the mind. Poses performed at the beginning and end of yoga routines in particular are focused at calming the mind and relaxing the muscles in your body. This relaxation cannot be underestimated when it comes to the state of your mental health and well being.

Gives focus and awareness
Repeated exercises like those found in beginner’s yoga classes are designed to focus and sharpen your mind, increasing both your awareness of the world around you as well as your concentration levels. This can be especially beneficial for very busy people, older adults, and even energetic children, who find that yoga helps them to focus their train of thought and remain calm even in the most stressful of situations.

Relieves stress
Calming thoughts and repeated poses that are common to yoga have the ability to release tension in the body, giving focus to the practitioner. This focus allows positive thought, which logically relieves stress. Lowered stress levels are good for everyone, but best of all they have positive knock-on effects with regards to your physical health too, making yoga an all around positive practice for a healthier life

Kaitlin Krull is a writer and mom of two girls living the expat life in the UK. Her writing is featured on Modernize.com and a number of fitness, health, and home decor sites around the web. She’s a yoga enthusiast of 5 years and loves anything that promotes a healthy mental state and positive lifestyle.

Using the SOAP Note Format for Medical Fitness Clients

Joshua Slone/1 May 2023/ All MFN blog/

The SOAP note format, the acronym of which stands for Subjective, Objective, Assessment, and Plan, is one of the standard document formats that healthcare providers use to document patient information and treatment progress. This article will take you through the format and teach you how to use it with your medical fitness clients.

The Subjective section will include the Chief Complaint of the client/patient, which is the reason they are working with you. This can be an official diagnosis from a licensed healthcare provider, such as Type 2 Diabetes Mellitus, or a symptom of a condition that is causing quality-of-life reduction, disability, or pain. You are not diagnosing any disease, injury, or health condition. You are merely stating the reason for the visit. You can include a brief patient medical history in this section, though you should strive to be succinct in your summary. The healthcare provider for your patient already knows their conditions and struggles and does not need a full page on the topic.

The Objective section is for vitals, how the client/patient presents at the visit physically and psychologically (attitude) and any recent lab or imagery results that are pertinent to your scope of practice and the patient’s Chief Complaints. When documenting the results of lab tests, only record what was tested and whether the result (such as fasting blood glucose levels) falls within normative values for the client/patient population. When documenting imagery results, record the type of imagery and the reviewing technician’s assessment (such as an MRI that shows posterior rotator cuff tears). The vitals you can and should take are heart rate, blood pressure, weight, and today’s pain rating on a 1-10 scale if applicable.

The Assessment section is typically used by healthcare providers for differential diagnosis, which is outside your scope of practice. The Assessment section will consist of your statement on the client/patient’s conditions and how they currently influence their fitness and general health. This can include notes on nutrition and physical activity levels. If the client/patient is presenting with an issue that session, such as restriction in shoulder flexion past 80 degrees, you will document that as well. If joint ROM is a focus of the client/patient’s training plan you should assess this at the beginning of the session and document the current ROM state relative to the previous session or baseline evaluation.

The Plan section is where you record the client/patient training for the day. This is also where you will annotate future training/care plans, such as periodization and progression. This section tells the healthcare provider exactly what you are doing with their patient and enables them to provide you with objective feedback on your training plan if necessary. Your training plan should reflect all guidelines and restrictions the patient’s healthcare provider has given you.

The following is an example of a completed SOAP note:

Date: 5/1/2023
Patient Name: John Q. Public
Provider/Trainer Name: Slone, J.

Subjective:
Chief Complaint: pain secondary to posterior rotator cuff partial thickness tear, restriction in ROM due to said injury, weakness of posterior RC due to injury. Pt is alert, attentive, and appears in good spirits and motivated.

Objective:
HR: 85
BP: 120/90
WT: 241lbs
PAIN: 2/10 at rest

Assessment:
Horiz. Shldr abd. restricted to 70/90 degrees, dull, achy pain during concentric posterior RC movement that improves during warmup. No active shldr flex today. Shldr ext does not provoke pain. Ext. rot. does not provoke pain.

Plan:
Today’s Care:
Warmup: arm bike 5min @ RPE 3-4
2×12-15 low face pull w/medium-light band within pain-free ROM
2×12-15 horiz. Abd. w/light band within pain-free ROM
2×8-10 ext. rot. w/light band within PF-ROM
2×8-10 scap retrac. w/medium band
2×3-5 overhead eccentric weight bearing, 3lbs, no pain

2x30s cross-body posterior RC stretch
2×10/12 finger ladder steps within PF-ROM

Future Care:
Continue with periodized RT to build function and strength within PF-ROM. Improve joint restriction through flexibility plan. Adhere to PCP guidelines.

This not unlike what a completed SOAP note in a physical therapy clinic would look like. Objective measures that a PT would use are measured joint ROMs with a goniometer (visual estimation is nearly as accurate in most cases and is acceptable for you to use). In a PT clinic, the Plan would also include treatment modalities, which are outside the trainer’s scope of practice (massage, manual therapy, e-stim, heat, cold, etc).

While you are not required to use this format with your clients/patients, it is of great benefit to use a standardized format that ensures you capture all pertinent information and are able to relay that to allied healthcare providers.

Here is a Word document template for the SOAP note format that you may download and use with your patients: SOAP Note Template.

Reprinted with permission from the Move Well, Live Well blog.

Joshua Slone is an Exercise Physiologist and Pain Therapist. He serves as Rehab Team Lead/Physiologist at the Center for Health in Yucca Valley, CA. His clinical expertise includes chronic pain management, joint replacements, sport and orthopedic injuries, complex medical condition management, geriatrics, degenerative neurological conditions, and psychiatric disorders. Visit his website, movewelllivewell.org

References

Instructor Showing Health Results On Clipboard To Senior Couple

Respiratory Disease and Exercise

CarolAnn, M.S., CPT, CN/28 April 2023/ All MFN blog/

According to the World Health Organization (WHO), hundreds of millions of people suffer every day from chronic respiratory diseases (CRD). Currently in the United States, 24.6 million people have asthma¹, 15.7 million people have chronic obstructive pulmonary disease (COPD)² while greater than 50 million people have allergic rhinitis³ and other often-underdiagnosed chronic respiratory diseases. Respiratory diseases do not discriminate and affect people of every race, sex, and age. While most chronic respiratory diseases are manageable and some even preventable, this is what is known about the nature of chronic respiratory diseases⁴:

Chronic disease epidemics take decades to become fully established.
Chronic diseases often begin in childhood.
Because of their slow evolution and chronic nature, chronic diseases present opportunities for prevention.
Many different chronic diseases may occur in the same patient (e.g. chronic respiratory diseases, cardiovascular disease and cancer).
The treatment of chronic diseases demands a long-term and systematic approach.
Care for patients with chronic diseases should be an integral part of the activities of health services, alongside care for patients with acute and infectious diseases.

Exercise and CRD

If you are a health and fitness professional, some of your clients may be suffering from a chronic respiratory disease and you may be an important source for relief. Moderate exercise is known to improve use of oxygen, energy levels, anxiety, stress and depression, sleep, self-esteem, cardiovascular fitness, muscle strength, and shortness of breath. While it might seem odd that exercise improves breathing when one is short of breath, exercising really does help one with respiratory disease. Exercise helps the blood circulate and helps the heart send oxygen to the rest of the body. Exercise also strengthens the respiratory muscles which can make it easier to breathe.

Beneficial Types of Exercise

There are several challenges to exercise prescription and physical activity participation in this population, but a large body of evidence demonstrates important health benefits from aerobic exercise. Resistance training has also been shown to increase muscle mass and strength, enhancing individuals’ ability to perform tasks of daily living and improving health-related quality of life.⁵

Aerobic exercise is good for the heart and lungs and allows one to use oxygen more efficiently. Walking, biking, and swimming are great examples of aerobic exercise. The guidelines are approximately the same as generally healthy individuals. One should attempt to train the cardiorespiratory system 3-5 days a week for 30 minutes per session. One should exercise at an intensity level of 3-4 on the Rating of Perceived Exertion Scale (Scale Rating from 0 Nothing at All-10 Very, Very, Heavy).

Resistance exercise increases muscular strength including the respiratory muscles that assist in breathing. Resistance training usually involves weights or resistance bands but using one’s own body weight works just as well depending on the severity of the symptoms. It is recommended that one should perform high repetitions with low weight to fatigue the muscles. This type of resistance training also improves muscular endurance important for those with CRD. Resistance training should be performed 2-3 days a week working all major muscle groups.

Stretching exercises relax and improve one’s flexibility. When stretching, one should practice slow and controlled breathing. Not only does proper breathing help to deepen the stretch, but it also helps one to increase lung capacity. One should gently stretch all major muscles to the point of mild discomfort while holding the stretch for 15 to 30 seconds, slowly breathing in and out. Repeat each stretch 2-3 times. Stretching is an effective method to warming up and cooling down before and after workout sessions.

When exercising, it is important to remember to inhale in preparation of the movement and exhale on the exertion phase of the movement. An individual should take slow deep breaths and pace him/herself. It is recommended to purse the lips while exhaling.

Use of Medication

If an individual uses medication for the treatment of respiratory disease, he/she should continue to take the medication based on his/her doctor’s advice. His/her doctor may adjust the dosage according to the physical activity demands. For example, the doctor may adjust the flow rate of oxygen during exercise if one is using an oxygen tank. In addition, one should have his/her inhaler on hand in case of a need due to the increase of oxygen demand during exercise.

Fitness professionals can effectively work with those who have a chronic respiratory disease providing them with a better quality of life through movement. You as their health and fitness coach can provide a positive experience to facilitate an effective path to better health and wellness.

Continued 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.

Known as the trainers’ trainer, CarolAnn has become one of the country’s leading fitness educators, authors, and national presenters. Combining a Master’s degree in Exercise Science/Health Promotion with several fitness certifications/memberships such as FiTOUR, ACSM, ACE, AFAA, and LMI, she has been actively involved in the fitness industry for over 25 years. She is currently the Founder and Director of Education for Chiseled Faith, a Faith Based Health and Fitness Program for churches. Visit her website, www.CarolAnn.Fitness

References

2015. NHIS Data; Table 3-1. www.cdc.gov/asthma/nhis/2015/table3-1.htm
Mannino DM, Gagnon RC, Petty TL, Lydick E. Obstructive lung disease and low lung function in adults in the United States: data from the National Health and Nutrition Examination Survey 1988-1994. Arch Intern Med. 2000;160:1683–1689.
CDC, Gateway to Health Communication and Social Marketing Practice. Allergies. https://www.cdc.gov/healthcommunication/toolstemplates/entertainmented/tips/Allergies.html
World Health Organization http://www.who.int/gard/publications/chronic_respiratory_diseases.pdf
Eves ND, Davidson WJ. Evidence-based risk assessment and recommendations for physical activity clearance: respiratory disease. Applied Physiology Nutrition and Metabolism. 2011;36(Suppl 1):S80–100. [PubMed]

Want to Feel Better? Then Move Better

Jay Weitzner, MS/26 April 2023/ All MFN blog/

Even after many years of working with clients, I’m still continually astounded by what the body can do. People come in to see me not feeling very good. Some of them actually feel pretty bad and have been feeling that way for years. They’ve usually tried everything out there to feel better. They medicate, get shots, use therapy, ice, tape, or surgery. They stretch, foam roll, try to loosen their fascia, undue an adhesion they were told about, find trigger points or maybe get something adjusted. And their last resort is surgery.

While some things may have valid application, there is something else going on that is not being considered. This one fact sheds some light on it: about 70% of motor neurons lie within the cerebellum. That’s right, the part of the brain that plays a huge roll in behavior, emotions, social interaction, and coordinating attention is loaded with neurons that control movement. The point here is that movement is such a high priority to the human body that any compromise to the quality of that movement can have profound effects anywhere throughout the system. That means that things may be working well in one place and you don’t feel so good in another.

Motor neurons are nerves that connect to muscle. That muscle is part of a muscle system including the brain, spine, nerves and sensor organs. The muscle system is the only thing in your entire body that can move you. When your muscle system quality isn’t what it should be you don’t move well. Not moving well, simply stated, means something’s wrong. When you don’t move well, some part of your body generally doesn’t feel well. When the system isn’t functioning right, it sends signs and signals out in many forms like pain, tightness, stiffness and/or causes delayed healing. This means we might want to be focusing on how you move instead of what you feel.

When we look at things this way we have an entirely new way to deal with bodes when they don’t feel good. We need to identify aspects of the muscle system that function at a lower quality and then RESTORE that functionality. Once we find the positions and movements that the body cannot function in, we can then restore that function. With the muscle system working again you can move better. When you move better you can feel better. You know that leg pain? Maybe it’s time to look at how that knee or hip or ankle moves instead of focusing on what hurts. Back stiff? Instead of stretching tight stuff, maybe it’s time to look at the things that are responsible for moving your back. Move better to feel better and you’ll be better.

Jay Weitzner, MS is a Certified Medical Exercise Specialist through the American Academy on Exercise (ACE); he holds a Bachelor’s and a Master’s in Exercise Science/Human Performance with an emphasis on exercise physiology. Jay specializes in working with clients with musculoskeletal issues — his clients have problems or concerns about their quality of movement and their physical health.

Conquering Stress and Managing Your Time Wisely

Connie Stoltz-McDonald/24 April 2023/ All MFN blog/

We all know stress takes a toll on our family, friends, work, and don’t forget the internal breakdown within your body and health, but it’s something that we can take control of and find ways to cope.

Introduction to Biomimicry and Exercise

Mike Rickett/21 April 2023/ All MFN blog/

Biomimicry, the practice of looking to nature for inspiration and solutions to human problems, can be a valuable tool and designing exercise programs. By studying the movements and behaviors of animals, we can learn how to move more efficiently, effectively and with less injury.

Here are a few examples of how mimicry can be applied to exercise programming:

Mimicking the movements of animals: Many animals have unique ways of moving that can be emulated in exercise programs. For example, the frog jump is a plyometric exercise that mimics explosive jumping of a frog, while the crab walk works lateral movement of the hips and shoulders in a way similar to how crabs move.

Utilizing natural resistance: Resistance training is a common component of exercise programs and bio mimicry can offer new ways to approach it. For example, using a slosh pipe, which is a PVC pipe partially filled with water or some other solution, can stimulate the resistance of carrying something like a baby car seat which is very practical.

Incorporating balance instability exercises: Animals have evolved to a move in environments that require balance and stability, and we can learn from them in designing exercises that challenge our own balance and stability. For example, the bird dog exercise, which involves extending the opposite arms and legs while balancing enough force, mimics the stabilizing movement of a hunting dog.

Emphasizing functional movements: Many exercises in the gym isolate individual muscle groups, but biomimicry can remind us to focus on functional movements that are more relevant to real life activities. For example, the farmers walk, which involves walking while holding heavy weights in each hand, mimics the practical movements of carrying groceries or moving furniture.

By incorporating biomimicry into exercise programming, we can create workouts that are not only effective, but also enjoyable and engaging. Additionally, by working with our bodies instead of against them, we can reduce the risk of injury and improve overall physical health.

Reprinted with permission from author.

Mike Rickett MS, CSCS*D, CSPS*D, RCPT*E is a nationally recognized health and fitness trainer of the trainers, fitness motivator, author, certifier, educator, and the 2017 NSCA Personal Trainer of the Year. He has been a fitness trainer for more than 35 years. He directs the personal training site, ApplicationInMotion.com. In addition, he also directs BetterHealthBreathing.com, a conscious breathing educational program focusing on the diaphragmatic technique to enhance overall wellness.

Massage for Parkinson’s

Kathy Flippin/19 April 2023/ All MFN blog/

The incidence of Parkinson’s disease in the United States is estimated at 1 million, with an additional 50,000 patients being diagnosed every year.

The most common signs of Parkinson’s disease are tremors, muscle rigidity, akinesia (temporary inability to move), dyskinesia (inability to execute specific voluntary movements at will) and loss of postural reflexes. The back posture becomes stooped, and the walk gradually turns to a shuffle as the arms stop swinging.

Can Massage Help?

According to a 2002 study conducted by the Touch Research Institute, massage therapy can improve many PD symptoms and function, from the reduction of rigidity and improvement of sleep, to the reduction of tremor and increase of daily activity stamina symptoms.

The underlying reduction in the neurotransmitter, dopamine, is the cause of many of the PD symptoms. Massage has been shown to have positive effect on the release of neurotransmitters, enhancing their calming influence.

Other benefits of massage are:

Improved Sleep and digestion
Reduced Stress, Depression and Moodiness
Relief for Cramping and Rigidity
Less Fatigue and Anxiety
Reduced Perception of Pain

Precautions

Give a full medical history, including other injuries and conditions besides Parkinson’s.
Use caution in areas with loss of sensation, light touch is best.
Be careful getting on and off the massage table, balance issues may cause risk of falling.

What to Expect

Your therapist should take a complete health history, including a thorough list of treatments and side effects such as neuropathy, rigidity and skin problems.

But your therapist should also ask about other conditions or injuries you may have. You and your therapist should agree on goals for the session, and you should have a chance to explain your preferences for pressure, and the massage environment such as temperature, music, lighting, etc.

Disrobing: Massage can be done over your clothing (without oil) if your balance is an issue, and it’s too much trouble to dress and undress. If you decide to disrobe and you are concerned about falling, you can bring an aide with you, or ask your therapist for help.

During the massage, you will always be kept covered, observing your modesty and keeping you warm. Don’t hesitate to request that your therapist, or someone else help you on and off the massage table.

Position and Turning over: Some people have trouble turning over due to rigid or weak muscles. If you feel like a fish out of water lying on your stomach, just ask your therapist to work with you lying on your side instead. In this position your therapist still has good access to massage your back muscles, and you won’t feel helpless or confined.

How to Find a Practitioner

Check with your city or state to find out what the basic requirements are for massage therapists.

Get a few names and numbers and start calling. Your interview should include questions about training and experience in general practice, and also experience with clients like you. Ask about office environment and policies.

Choose a practitioner that has extra training and experience working with cancer patients. A more complicated health history indicates that the therapist’s expertise is more important. Also, in some cases it is best to get your doctor’s approval.

Most of all, massage should never hurt, and if it does, you should say something. A conscientious massage therapist will constantly seek your feedback during the massage to make sure that the treatment is within your comfort zone the entire time. If you don’t feel that your feedback or concerns are (or will be) addressed, you’re not in the right place.

You can search the MedFit Network for a massage therapist in your area, or search the American Massage Therapy Association’s Massage Therapist search.

Kathy Flippin’s passion is to offer excellent therapeutic massage, and educate her clients on how they can take the best care possible of themselves. Kathy is the owner of Dynamic Touch Massage and has been a Sports Massage Therapist since 1997. Her clients include everyone from professional athletes to active grandmothers.

Colorectal Cancer Development and Nutritional Deficits Management

Abimbola Farinde, PhD/17 April 2023/ All MFN blog/

On an annual basis, a number of Americans are diagnosed with some form of cancer. One of the most commonly occurring cancers that is recognized as the third deadliest cancer in America and the world is colon cancer, or colorectal cancer (CRC).¹ CRC is first known to present as cancer of the colon and rectum which generally affects older adults. The incidence and mortality rate of CRC can increase with age with the median age of diagnosis at 70 years within developed countries.² However, there is the potential for the cancer to impact individuals of all ages.

There are also potential risk factors for development which can include male sex, excessive alcohol intake, smoking, and lack of physical activity to name a few.² Given the current and increasing rate of CRC diagnosis, there has been ongoing promotion of preventative measures and treatment interventions once formal diagnosis has been made.³

There are a number of recommendations for dietary measures to prevent colorectal but once diagnosed, nutritional support is also needed. For any person who is suspected of having CRC, there are both signs and symptoms to be aware of. Many patients can be symptomatic for several months before presentation. Some of the more common findings include rectal bleeding, changes in bowel habit, or loss of appetite and fatigue.⁴ The loss of appetite that can be associated with CRC can present with nutritional deficits. Given that the primary function of the colon is to aid with the absorption of electrolytes and fluids, the diagnosis of CRC and the treatment interventions that can be applied can impact nutritional absorption. The treatment of colorectal cancer can increase the demand for nutrients so during treatment it is important for patients to adhere to a healthy diet to nourish their bodies.

The mainstays for nourishment can be obtained from proteins, consumption of healthier fats, consumption of whole grain goods, fruits and vegetables, and intake of adequate amount of water given the potential for dehydration to occur.⁵ Additionally, according to the American Cancer Society, the following foods are recommended for those who are undergoing colon cancer treatments: plant based foods, fruits and vegetables that contain essential vitamins and antioxidants, and healthy snacks (like Greek yogurt or lean chicken).⁶ If there are instances in which tolerability issues arise with the consumption of these types of foods, it is important for a patient to immediately discuss this matter with their provider.

A diagnosis of CRC can impact a person’s health and life in a significant way. During the course of the condition and the timeframe for therapeutic interventions, it is important to monitor the nutritional needs of the person. The potential for nutritional deficits to occur can be significant with CRC, so a clear, focused plan should be developed with the best course of action in mind to minimize any negative impact. While the goal is always for primary, secondary, and tertiary preventive strategies, it is also important to know how to appropriately address issues such as nutrimental deficits that can arise with the given diagnosis.⁷ The recognition of nutrition as a key element to improved treatment outcomes should also be addressed with its comes to comprehensive CRC management.

Abimbola Farinde, PhD is a healthcare professional and professor who has gained experience in the field and practice of mental health, geriatrics, and pharmacy. She has worked with active duty soldiers with dual diagnoses of a traumatic brain injury and a psychiatric disorder providing medication therapy management and disease state management. Dr. Farinde has also worked with mentally impaired and developmentally disabled individuals at a state supported living center. Her different practice experiences have allowed her to develop and enhance her clinical and medical writing skills over the years. Dr. Farinde always strives to maintain a commitment towards achieving professional growth as she transitions from one phase of her career to the next.

References

Marley AR, Nan H. Epidemiology of colorectal cancer. Int J MolEpidemiol Genet. 2016;7(3):105-114. Published 2016 Sep 30.
Brenner H, Chen C. The colorectal cancer epidemic: challenges and opportunities for primary, secondary and tertiary prevention. Br J Cancer 119, 785–792 (2018). https://doi.org/10.1038/s41416-018-0264-x
Holowaty EJ, Marrett LD, Parkes R, Fehringer G, editors. Colorectal Cancer in Ontario 1971-1996 [Internet] Cancer Care Ontario; 1998 [14 June 2016] Available from: https://www.cancercare.on.ca/common/pages/UserFile.aspx?fileId=13718.
Thanikachalam K, Khan G. Colorectal Cancer and Nutrition. Nutrients. 2019;11(1):164. Published 2019 Jan 14. doi:10.3390/nu11010164
Claghorn K. Colon,rectal, and anal cancer: Frequently asked nutrition questions. OncoLink.February 9, 2021. Accessed January 20, 2022.
Kubala J. A diet plan for before and after colon cancer treatment. Healthline.June 7, 2021. Accessed January 20, 2022.
Brenner, H., Altenhofen, L., Stock, C. &Hoffmeister, M. Prevention, early detection, and overdiagnosis of colorectal cancer within 10 years of screening colonoscopy in Germany. Clin. Gastroenterol. Hepatol.13, 717–723 (2015).

Opening a Closed Door: How to Gain Access to the Medical Suite

Dr. Mary Hoagland Scher/14 April 2023/ All MFN blog/

Your passion is to help people maintain or regain optimal health and fitness. Under current law and standards, you are only permitted to work with clients who are already-fit and healthy or have been released for independent exercise and have passed your health screening questionnaire. But those are not the people you yearn to work with. The clients you seek must have authorization or approval from a medical provider before you can proceed.

How often have you met with a potential new client, asked them to get clearance from their doctor, and then never seen them again? Or, a client develops a new pain or problem and you refer them for consultation and that ends the relationship. Another frequent scenario: Your client has followed through with your request only to be referred by their primary care provider for a cardiac treadmill test, but your concern about their low back pain or shoulder dysfunction was not addressed. Success as a medical fitness specialist is dependent upon working relationships with medical professionals. In order to establish those relationships, the aspiring medical fitness trainer needs a better understanding of the medical system. What follows are a few insights into the medical system that medical fitness specialists need to understand.

Recognize how busy the medical practitioner might be

“Estimates suggest that a primary care physician would spend 21.7 hours per day to provide all recommended acute, chronic, and preventive care for a panel of 2,500 patients.”¹ [i]. Today, the average primary care provider is responsible for roughly 2,300 patients, so not quite 21.7 hours of work/day, but more than any individual can possibly provide.

In order to cope with the workload, doctors must rely on their support staff to help whenever possible. Do not be alarmed or offended if your inquiries are met by a nurse or medical assistant. Most providers simply do not have the time to meet with you for an introduction or discussion. On the flip side, most doctors would love to have effective, safe, and reliable resources for their patients who need to lose weight, get fit, manage diabetes, recover from surgery or cancer treatment, etc. They need you.

Understand the current reimbursement rules

In most cases, providers cannot bill for services unless the patient is in the room with them. Therefore, time spent talking on the telephone, responding to emails, or filling out forms is usually unreimbursed time. This means that your client will probably need to actually make an appointment to be assessed and cleared for exercising with you. To streamline the process, send a letter with your client introducing yourself and what you do. Include a form stating your concerns and your proposed training plan. Design the form to be easy to read, with a simple agree or disagree that can be checked or circled and space for the provider’s signature. You might also want to leave room for comments and questions. If you have received a response from a provider, you should consider sending intermittent progress reports updating the provider about your mutual client/patient.

Be familiar with HIPAA

The Health Insurance Portability and Accountability Act (HIPAA) was enacted in 1996 to protect an individual’s medical confidentiality, particularly when changing jobs which at that time meant changing health insurance providers. Unfortunately, the law is complicated and places multiple restrictions on who members of a medical team can talk to about a patient’s medical condition.

As an unlicensed party, the fitness professional is not privy to “protected health information” (PHI) without direct written consent from the patient (your client). Due to these restrictions, the medical providers cannot fill out or respond to your request for information or clearance without your client’s “written” consent. If the client takes the form and returns it to you, this action implies they have agreed to share the information. If you send the form directly to the provider, that permission has not been granted unless the client has signed a HIPAA release form allowing the doctor to share personal health information with you personally.

The aforementioned are a few reasons why you may have perceived a wall or barrier between you and medical providers. One solution is to ask your client if you might accompany him or her to the appointment to obtain medical clearance or guidance. That way the medical provider would have a specified time and be reimbursed for addressing your concerns. You would be communicating directly with the medical provider and not support staff, and it would be easiest for the client/patient. It is also a way to introduce yourself to the medical provider and initiate a working relationship. Although you will probably not be compensated, it may be well worth your time in the long run.

Once you have made it into the office with your client, now what?

Know your details

Because there are so many different avenues to becoming certified as a personal trainer, there can be large differences in the knowledge base and competence of one trainer compared to another. The aspiring medical fitness professional must have a thorough understanding of the pathophysiology of the conditions they will be working with in order to communicate effectively with medical providers. In addition, you need skill and experience in the programs you design and utilize with your clients. Be able to back up your training plans with published research.

Recognize that a medical fitness professional has a fund of knowledge that the medical provider does not have

Exercise science is not covered in medical school curricula. Medical school is about illness and disease, not health and fitness. Generally speaking, the average MD knows very little about exercise science. Most do not know about the effects of eccentric versus concentric loading, how to train for endurance versus strength, what to do to improve stability, balance, and core strength. Fitness professionals are not inferior to medical professionals; you have a different knowledge base. Recognize and believe that you have something to offer. You may not know all of the anatomy and biochemistry that the doctor does, but you have a basic understanding of your client’s condition and you know the potential benefits of your interventions. Share this information with the medical providers.

Stay within your scope of practice

Because personal trainers and medical fitness specialists are not licensed by any governmental or legal agency, and because laws vary from state to state, there is no clear definition of the skills and competencies of a medical fitness specialist. Working outside of your scope of practice can lead to civil and even criminal penalties[ii]. Therefore, for the time being, if you want to work with clients struggling to manage chronic illnesses, recover fully from injuries or surgeries, etc., you need to work under the wing of medical professionals who have prescriptive authority – those professionals in the medical field licensed to diagnose problems and prescribe treatment.

Dr. Robert Butler MD, founder of the National Institute on Aging once said: “If exercise could be packaged in a pill, it would be the single most widely prescribed and beneficial medicine in the nation.” There are pockets here and there in the US where medical providers and fitness professionals work together. In many cases, there is a visionary medical provider at the helm of an interdisciplinary team. In other cases, fitness professionals have worked hard to become part of a medical delivery model. The more medical fitness specialists that can take the leap and align themselves with medical providers, the more people will be helped.

This article was featured in MedFit Professional Magazine.

Dr. Mary Hoagland-Scher,MD is a board-certified family physician who practiced medicine for 30 years. When she entered medical school, her goal was to help people stay healthy. As the focus of western medicine shifted away from health to disease management with a strong emphasis on pharmaceutical and or surgical intervention, she became uneasy with her role and decided to discard her prescription pad and learn new tools. Now as a NASM Certified Personal Trainer she is working to shrink the gap between fitness and medicine.

References

[i] Estimating a Reasonable Patient Panel Size for Primary Care Physicians With Team-Based Task Delegation Justin Altschuler, MD, David Margolius, MD, Thomas Bodenheimer, MD⇓ and Kevin Grumbach, MD Ann Fam Med September/October 2012 vol. 10 no. 5 39
[ii] For an excellent discussion of this issue, see: Abbott, Anthony Ed.D, FACSM, FNSCA. Scope of Practice, ASCM Health and Fitness Journal ,Sept/Oct 2018, Vol 22 Issue 5 pp 51-55