Although stay-at-home restrictions are loosening around the USA and summer is coming, you may still need to get some of your activities indoors at home for a variety of reasons. If you aren’t doing resistance workouts already, you should really consider adding some resistance exercises to your normal regimens. 

In fact, if you do nothing else, doing these 5 key exercises is critical for people with diabetes who may have weak core muscles, altered gait and balance, and central and peripheral nerve damage.  If you lose your core strength, it will affect your ability to do all activities of daily living, including walking and living independently.

Do at least one set of 8-15 reps of each one, but work up to doing 2-3 sets of each one per workout.  For best results, do these exercises at least 2 or 3 nonconsecutive days per week — muscles need a day or two off to fully recover and get stronger — but just don’t do them right before you go do another physical activity (as a fatigued core increases your risk of injury).  

These and many more exercises are available on Diabetes Motion Academy for free download.

• Exercise 1: Crunches with waist worker
• Exercise 2: Chair sit-ups OR Low back strengthener
• Exercise 3: Modified push-ups
• Exercise 4: Squats OR Suitcase lifts
• Exercise 5: Sit-to-Stand exercise

#1: Crunches with waist worker

Crunches:

Directions:

• Lie down on your back with your knees bent. 
• Place your hands on your head right behind your ears. 
• While breathing out, contract your abdominal muscles to lift your head, neck, and shoulders off the floor and curl forward no more than 45 degrees. 
• Hold for a moment before returning to the starting position, then repeat. 

Waist worker:

Directions:

• Lie on your back on the mat with your legs bent, your feet flat on the floor, and your left hand behind your head. 
• Stretch your right hand across your body toward your opposite (left) knee and circle your hand three times around your knee in a counterclockwise direction; your right shoulder blade will lift off the mat. 
• Repeat the circular movement around the right knee using your left arm, but in a clockwise motion. 
• Keep your head in a neutral position and relax your neck to ensure that the contraction is in your abdomen area only. 

#2: Chair sit-ups OR Low back strengthener

Chair sit-ups:

Directions:

• Sit up straight in a chair with your feet on the floor, hands to your sides for support.
• Bend forward, keeping your lower back as straight as possible, moving your chest down toward your thighs.
• Slowly straighten back up, using your lower back muscles to raise your torso.
• For added resistance, put a resistance band under both feet before you start and hold one end in each hand during the movement. 

OR

Low back strengthener (Superman exercise):

Directions:

• Lie on your stomach with your arms straight over your head, your chin resting on the floor between your arms. 
• Keeping your arms and legs straight, simultaneously lift your feet and your hands as high off the floor as you can (aim for at least three inches off the floor).
• Hold that position (sort of a Superman flying position) for 10 seconds if possible, and then relax your arms and legs back onto the floor.
• If this exercise is too difficult to start, try lifting just your legs or arms off the floor separately–or even just one limb at a time. 

#3: Modified push-ups

Directions:

• Get on your hands and knees on the floor or mat. 
• If using a band for extra resistance, position it across your back and hold one end of it in each hand so that it is somewhat tight when your elbows are straight. 
• Place your hands shoulder-width apart on the mat. 
• Tighten your abdominal muscles to straighten your lower back and lower yourself (from your knees, not your feet) down toward the mat as far as you can without touching it. 
• Push yourself back up until your arms are extended, but without locking your elbows. 
• If this exercise is too hard, stand facing a wall and place your arms on it at shoulder height and your feet about a foot away; then, do your push-ups off the wall (with or without a resistance band).

#4: Squats OR Suitcase Lifts

Squats: 

Directions:

• Stand with a dumbbell (or household item, like water bottles) in each hand and your feet shoulder-width apart, with your toes pointing slightly out to the side.
• If you’re using a resistance band, tie both ends of your band onto a straight bar or broom handle, which is placed squarely across your shoulders with the loop of the tied band placed under your feet. 
• Keep your body weight over the back portion of your foot rather than your toes; if needed, lift your arms out in front of you to shoulder height to balance yourself.
• Begin squatting down but stop before your thighs are parallel to the floor (at about a 70-degree bend), keeping your back flat and your abdominal muscles firm at all times. 
• Hold that position for a few seconds before pushing up from your legs until your body is upright in the starting position. 
• Do squats with your back against a smooth wall if needed to maintain your balance.

OR

Suitcase lift:

Directions:

• After placing dumbbells (or household items) slightly forward and between your feet on the floor, stand in an upright position with your back straight. 
• Keep your arms straight, with your hands in front of your abdomen.
• With your back straight, bend only your knees and reach down to pick up the dumbbells. 
• Pick up the dumbbells or items in both hands, then push up with your legs and stand upright, keeping your back straight.

#5: Sit-to-Stand exercise     

Directions:

• Sit toward the front of a sturdy chair and fold your arms across your chest.
• Keep your back and shoulders straight while you lean forward slightly and practice using only your legs to stand up slowly and to sit back down.
• To assist you initially, place pillows on the chair behind your low back.

From Diabetes Motion Academy Resources, “Basic Core Exercises,” Sheri R. Colberg © 2017.

Sheri R. Colberg, PhD, FACSM, is the author of The Athlete’s Guide to Diabetes: Expert Advice for 165 Sports and Activities (the newest edition of Diabetic Athlete’s Handbook), available through Human Kinetics, Amazon, Barnes & Noble, and elsewhere. She is also the author of Diabetes & Keeping Fit for Dummies. A professor emerita of exercise science from Old Dominion University and an internationally recognized diabetes motion expert, she is the author of 12 books, 30 book chapters, and over 420  articles. She was honored with the 2016 American Diabetes Association Outstanding Educator in Diabetes Award. Contact her via her websites, SheriColberg.com and DiabetesMotion.com.

Everyone has had flat feet, and probably will again – and that’s normal!

While working in a biomechanics lab, part of my job was to read nearly 500 papers on childhood foot development. In doing so, I learned something extraordinary: we all had flat feet at one time and as we get older, we likely will again. This makes so much sense if you see the foot as a sensory organ and not just a mechanical part of the human machine.

Fat Flat Feet

Most babies have cute, pudgy, fat, flat feet!  As the child grows, the foot develops and an arch becomes more and more evident, keeping pace with the child’s physical abilities. Evolutionarily this makes sense.  Before birth we are water dwellers and do not need a well-developed vestibular system.

Only a few months after birth babies begin learning to roll, then crawl, eventually sit upright, and then “find their feet”. They begin to stand and squat and the vestibular system starts to adapt to gravity. Babies’ fat flat feet give them a broad surface to sense the effects of gravity, which allows the vestibular system to orient and develop.

As balance improves, the foot becomes stronger and the arch develops.  The effect is a decrease in the amount of sensory surface area dedicated to gravity, making baby less structurally stable but providing a biomechanical environment for increased speed and agility.  However, now the individual must rely on a very well developed and active vestibular system, supported by the mobile proprioceptive system of the foot joints.

The twilight of the arch

Understanding how and why the arch develops should then clarify the changes we experience as we grow older. The vestibular system slowly becomes less active and balance becomes more difficult. This leads to a natural decline of arch height as an attempt to increase proprioceptive input, like we needed when we were babies.

Gait tells us so much

The reality is, gait assessment is a window into your clients’ nervous system and, utilized properly, it informs how we help our clients improve, at every stage. Now that you know how the arches and vestibular system relate, help your clients rediscover their feet!

Coach Pat Marques & I will host a live webinar, focusing on gait assessment, for MedFit practitioners and trainers.

Dr. Grove Higgins is a chiropractor, rehabilitationist, soft tissue injury expert, researcher, anatomy instructor, biomechanist, human performance expert, speaker, and corporate health consultant. In 2015, Dr. Higgins cofounded Neuroathlete with Coach Patrick Marques (LTC, US Army Ret.) and Peter Hoversten. Neuroathlete’s goal is to more broadly deliver neurological training to a global audience.

Interesting studies and articles:

Does My Kid Need Arch Support: March 2020: Blog. (n.d.). Retrieved from https://www.vivobarefoot.com/nz/blog/march-2020/does-my-kid-need-arch-support

Gray, H., Carter, H. V., Pick, P. T., Holden, L., & Keen, W. W. (1887). Anatomy, descriptive and surgical / the drawings by H.V. Carter with additional drawings in later editions edited by T. Pickering Pick ; to which is added Landmarks, medical and surgical by Luther Holden with additions by William W. Keen. Philadelphia: Lea Brothers &.

Li, F., Harmer, P., Wilson, N. L., & Fisher, K. J. (2003). Health Benefits of Cobblestone-Mat Walking: Preliminary Findings. Journal of Aging and Physical Activity, 11(4), 487-501. doi:10.1123/japa.11.4.487

Rock Walking for Healthful & Graceful Aging. (2018, December 13). Retrieved from https://www.integrativehealthcare.org/mt/walking-on-rocks-benefits/

Tubbs, R. S., Mortazavi, M. M., Loukas, M., Dantoni, A. V., Shoja, M. M., & Cohen-Gadol, A. A. (2011). Cruveilhier plexus: An anatomical study and a potential cause of failed treatments for occipital neuralgia and muscular and facet denervation procedures. Journal of Neurosurgery, 115(5), 929-933. doi:10.3171/2011.5.jns102058

My biggest concern as a personal trainer was always the safety of my clients – both physically and medically. Over the years a common theme emerged with each new client relationship that I developed and that was how unprepared people were to really engage in a significant training program and what skills and knowledge they would be required to develop for success. Physicians were often unprepared to advise their patients on what to do, how to proceed, or what limitations and issues needed to be acknowledged by their patients before engaging a trainer to help them “get to the next level”.

A potential client nervously sits down before a very handsome LA plastic surgeon at the beginning of each episode of this extremely popular television show in the early 2000s. The surgeon asks the same question to each patient he meets.,“Tell me what you don’t like about yourself?” The potential client, slightly taken back by the magnitude and depth of this question, details what it is he or she wishes the doctor to change about them.

As a MedFit fitness professional and educator, this particular scenario really resonated with me. In fact, I have spent multiple decades trying to figure out the “WHY” behind the behaviors and mindsets adopted by my clients. What external or internal factors are positively or negatively affecting their ability to make healthy decisions, their ability to feel confident, or their ability to love themselves or others. This is exactly why we all must keep asking, why?

While designing fitness programs to support physical well-being is extremely important, are we providing enough positive reinforcement to encourage clients that “they are enough”? Are we building their confidence and self-worth? Are we empowering their mind and believing in them so hard until they start believing in themselves?

These are the questions we should be asking ourselves when we design fitness programs for the “whole person.”

The Why

Why do people feel the need to drastically change their appearance?

Where do these ideas come from and how will it have a positive effect on their future?

Why is outer appearance still considered more important than overall health when considering recent research to support longevity?

These are just a few questions to consider as a fitness or medical fitness professional as you begin to assess clients and “peel back the onion” to fully understand how you can best support their goals.

The How

If your client suffers from what I refer to as “negative self-talk,” those incessant self-deprecating statements act as a personal bully and obstacle to achieve true happiness — ask them why they feel this way?

Then, continue those “Why” questions until you find out the answers. This may take one whole session, or it may take months of shorter conversations. However, a medical fitness professional has the power to change lives, not only through physical fitness, but mental fitness. Mindset matters!

Consider

1. Is this negative thinking a result of a negative experience or is it being projected on them by others?

2. Ask questions and listen. Only when the fitness professional has developed a trusting, supportive, comfortable, and communicative relationship with their client can the fitness professional begin to understand their “why.”

3. “The way you make your muscles grow is through resistance training, where you work them until your muscle fibers are fatigued and break apart. With proper rest, recovery, and nutrition, those same muscle fibers grow back stronger than they were before. And you grow. The mind and your mindset work the same way.” –Dr. Bryan Price

Christine M. Conti, M.Ed, BA is and international fitness educator and presenter. She currently sits on the MedFit Education Advisory Board and has been nominated to be the 2020 MedFit Network Professional of the Year. She is currently writing the MedFit Network Arthritis Fitness Specialist Course and is the CEO and founder of ContiFit.com and Let’s FACE It Together™ Facial Fitness & Rehabilitation. Christine is also the co-host of Two Fit Crazies & A Microphone Podcast and the co-owner of TFC Podcast Production Co.