All MFN blog Archives - Page 2 of 142

GLP-1 Receptor Agonists: The New, Improved, and Not-Fully-Understood Weight Loss Drugs (Part 1)

Dr. Irv Rubenstein/15 March 2025/ All MFN blog/

Super-duper weight loss drugs (originally they were designed to help those with Type 2 diabetes, or T2D) like Ozempic, Wegovy, Mounjaro, et al. have swamped the marketplace because of their unique pharmacologic actions compared to their predecessors. Earlier weight loss drugs and over-the-counter concoctions (like coffee and other caffeine-derivatives, as well as smoking cigarettes, for example) simply sped up metabolism and boost energy. These, then, provided (ab-)users an artificial mechanism by which to burn calories and even avoid consuming calories since energy levels didn’t require them.

What makes these modern drugs so unique is their effects on hunger and appetite hormones. Essentially, they alter or disrupt hormone signaling that tell the gut to stop demanding food and/or the brain to feel satisfied with the food you’ve consumed, presumably before you overeat. That is, those appetite and hunger messages lead people to eat less without – we hope – causing permanent and as-yet-unknown effects on the endocrine system as a whole.

Caveat: while some of these drugs have a relatively long history due to their use in managing diabetes, 5-10 years on the market may not be sufficient to declare with absolute certainty that long-term impacts are not going to crop up.

The past couple of decades have given scientists and pharmaceutical companies greater understanding about the gut-brain connection. Hormones, which are signaling proteins that course throughout the body, often have multiple outlets and receptors that allow one metabolic process to influence or be influenced by another part of the body. One of the most common hormones that most of us have some awareness and understanding of is insulin.

Insulin, cell receptors, and disease

Pumped out by the pancreas, insulin helps manage blood sugar, an essential substrate that feeds all of our organs, especially the brain. The digestive process breaks down carbohydrates into sugars that the blood stream then carries to organs for energy. Ever feel groggy or slower between meals? Well, that’s your brain saying ‘feed me…ideally, with sugars, or carbs’. Ever feel like your energy is waning on a long bike ride or hike? That’s your muscles demanding calories, especially sugar-based calories. The insulin signals drive both the sugar calories from those foods to their respective locales and even help pull stored glucose (a form of sugar) from glycogen stores (sugar formulations the body keeps around in case they’re needed like the liver) between feedings. When insulin is in short supply (as in Type 1 diabetes), sugar can’t enter cells.

However, without receptors on the surface and within the cells to allow insulin to do its job, it is neutered. These dysfunctional receptors are part of the process that leads to T2D: when insulin is unable to unlock the cells that have disabled receptors, the brain, heart, and other organs including muscles are deprived of energy.

A few digestive and appetite hormones have similar roles. Leptin, ghrelin, PYY, and the big kid on the block, glucagon-like peptide 1 (GLP-1) transmit signals of fullness, satiety, and hunger to and from the gut and brain. Without operative receptors, however, some of these signals get disrupted. Obesity itself, regardless of original causality, be it genetics, diet, or lifestyle, is one of those disruptors. With obesity, some of these hormones fail to signal when you are sated or over-signal that you continue to be hungry. GLP-1 works by messaging the digestive system that you are sated. Therefore, for those who cannot get that feeling, GLP-1 receptor agonists – these super-duper drugs – help reduce food intake by reducing appetite…and increasing weight loss.

All drugs have side effects

One of the oldest drugs which originally came from willow tree bark is aspirin. Well-known and long used to reduce fevers, manage headaches, and more recently thin blood for those folks at risk for potentially-fatal blood clots such as after lower-extremity surgery or certain cardiac conditions, can also lead to excessive bleeding in the event a closed-head injury or gastric ulcers due to its effect on the stomach lining.

Semaglutide and liraglutide, two of the main GLP-1 drugs out there, have been found to reduce food obsessions leading to calorie restriction but, oddly, have been correlated with reducing other addictive obsessions from gambling to sex to alcohol and other drugs. (1) Interestingly, in combination with bimagrumab, semaglutides “led to superior fat mass loss while simultaneously preserving lean mass despite reduced food intake”. (2)

However, a disconcerting unintended consequence of these weight loss meds is that “the potential health benefits of diet-induced weight loss are thought to be compromised by the weight-loss-associated loss of lean body mass, which could increase the risk of sarcopenia (low muscle mass and impaired muscle function)”. (3) Any time you diet, some of the weight you lose, after initial water weight, is lean tissue – muscle mass and, if rapid and extensive weight is lost, bone mass. A meta-analysis of 18 well-controlled studies that included over 1300 subjects confirmed that these kinds of drugs, which were originally designed to help those with T2D, contribute to loss of muscle mass; metformin, another T2D drug, on the other hand, does not. (4)

Some studies show that, “compared with persons with normal weight”, those with obesity have substantial muscle mass to support and transport their bodies, but poor muscle quality, that is more fatty infiltration generally from lack of a training stimuli. Somehow, though, the “diet-induced weight loss” reduction of muscle mass happens “without adversely affecting muscle strength”. This maintenance of muscle mass that accompanies weight loss improves overall physical function, likely due to the loss of fat mass which otherwise is a drag on performance. While it is recommended, and is very vogue, to encourage a high protein intake – of 1.2 – 2.0 grams/kg of body weight vs the RDA recommendation of 0.8 g/kg – to preserve lean body and muscle mass during weight loss, apparently this does not improve muscle strength; and it could have “adverse effects on metabolic function” if kidney problems are an issue or become one.

Finally, while both endurance exercise, if performed at pretty high intensities such as stair climbing or cycling with high resistances, and resistance training (RT) at moderate to heavy loads “help preserve” lean tissue during a weight loss regimen, only intensive and consistent RT improves muscle strength. This is why researchers are so heavily promoting RT as a way to prevent the inevitable loss of muscle and to restore the low-quality muscle that people with obesity have to a more functional variety. (3)

The mechanisms for these drugs’ effects on lean tissue are under investigation. One group of researchers has determined that the combination of these drugs actually protects against muscle atrophy. The biochemistry is irrelevant here. What might be more relevant is the customary fact that rarely are these drugs prescribed together. So, while they might prevent this adverse effect, it will require more study before they are co-prescribed. (5) There is evidence that shows that oral semaglutide, when prescribed for T2D patients, does help with weight loss and, even alone, does not lead to substantial loss of muscle mass. (6)

Weight loss vs Muscle loss: Inevitable or Preventable?

As we discussed above, any significant amount of weight loss is accompanied by muscle and even bone loss, especially if done quickly over a short period of time. This could be diet-related, disease- or medical treatment-related (think: during chemo or radiation for cancer), or even, shockingly, exercise-related. Yes, if someone engages in intensive and long-duration cardio training such as running or biking, and weight loss occurs, so, too, does muscle loss. (Real News, Nov 2024)

Why? It’s pretty simple: unless sufficient calories are consumed to compensate for the excess energy output, the body becomes very efficient by discarding muscles that are not used in the training (REAL News – Dec. 2024) or simply allowing unused muscle fibers, like the bigger, stronger, more powerful fast-twitch fibers, to atrophy since neural stimulation is withheld. Even young athletes on a hypo-caloric diet designed for weight loss lose muscle mass unless they’re on a significantly-elevated protein intake diet. (7) Sadly, too, weight loss of 5% or more is accompanied by bone density loss! (REAL News – December 2018)

With studies showing that GLP-1’s can lead to 15 – 24% weight loss, they can be accompanied by 10%, or ~6 kg, of muscle mass loss. (8) Sergeant et al (2019) found in over half of the studies included in their meta-analysis of the same year, the proportion of muscle loss was somewhere between 20% and an astounding 50% of the total weight lost! (9) A more recent study by Bikou et al. confirmed that, while extremely effective for fat loss, these meds can cause up to 40% of the weight lost being lean mass. (10)

All of these researchers concluded that, with intensive RT, not only can patients reduce the muscle loss, they can maintain muscle mass to reduce weight re-gain should they stop taking the medications.

Takahashi et al (11) demonstrated that vitamin D supplementation, and possibly vitamin B12, but not vitamins A, B6, C, and E, might correlate with with the loss of lean tissue in older adults with T2D. Thus, in addition to a vigorous RT program, getting in extra D could reduce the atrophy that accompanies weight loss.

Nunn et al., in a study of diet-induced mouse obesity, found that blocking a particular muscle cell receptor that is known to interfere with muscle growth – ActRII – while being treated with a semaglutide medication preserves muscle mass. It actually induced an almost 10% increase in lean mass!However, this is what you might call a proof of concept study and has not yet been approved for humans taking a GLP-1 drug. (12)

Some studies have found that muscle mass loss does not deteriorate as much in patients with T2D as one might expect. (6) The Japanese subjects experienced substantial health benefits over the 24 months they used a combination of liraglutide and semaglutide, affirming Klausen et al.’s (1) finding. Too, Gurjar et al. found that “drug repositioning” with liraglutide might be the answer to weight-loss-induced muscle loss, at least in mice. (13)

There is a new kid on the block in Phase 3 studies – a combination drug of Amylin + two GLP-1 drugs – semaglutide and cagrilintide – that offers comparable weight loss while helping to “preserve the reduction in energy expenditure” which could help maintain weight loss in the long run. (14) This could be the game-changer what with all these super-duper drugs that are helping people lose weight, especially for those who are older, more likely to have blood sugar control issues such as T2D, and may already have suffered age-related sarcopenia. However, for all patients who are taking these GLP-1’s, the basic prescription still holds, whether or not it totally reverses years of sedentary living or age-related muscle loss, and that’s RT using loads greater than body weight.

Check out part 2, If You’re Using GLP-1 Meds for Weight Loss, Then You Gotta Do Weight Lifting

Originally printed on STEPS Fitness blog. Reprinted with permission.

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

References

1. Mette Kruse Klausen et al. The role of glucagon‐like peptide 1 (GLP‐1) in addictive disorders. Br J Pharmacol. 2022 Feb; 179(4): 625–641. Published online 2022 Feb 2. doi: 10.1111/bph.15677)

2. Nunn et al. Antibody blockade of activin type II receptors preserves skeletal muscle mass and enhances fat loss during GLP-1 receptor agonism. Mol Metab. 2024 Feb:80:101880. doi: 10.1016/j.molmet.2024.101880. Epub 2024 Jan 11.

3. Cava et al. Preserving Healthy Muscle during Weight Loss. Adv Nutr. 2017 May 15;8(3):511-519. doi: 10.3945/an.116.014506. Print 2017 May.

4. Ida et al. Effects of Antidiabetic Drugs on Muscle Mass in Type 2 Diabetes Mellitus. Curr Diabetes Rev. 2021;17(3):293-303. doi: 10.2174/1573399816666200705210006.

5. Xiang et al. GLP-1RA Liraglutide and Semaglutide Improves Obesity-Induced Muscle Atrophy via SIRT1 Pathway. Diabetes Metab Syndr Obes. 2023 Aug 15:16:2433-2446. doi: 10.2147/DMSO.S425642. eCollection 2023.

6. Uchiyama et al. Oral Semaglutide Induces Loss of Body Fat Mass Without Affecting Muscle Mass in Patients With Type 2 Diabetes. J Clin Med Res. 2023 Jul;15(7):377-383. doi: 10.14740/jocmr4987. Epub 2023 Jul 31.

7. Mettler et al., Increased Protein Intake Reduces Lean Body Mass Loss during Weight Loss in Athletes. Medicine & Science in Sports & Exercise 42(2):p 326-337, February 2010. DOI: 10.1249/MSS.0b013e3181b2ef8e

8. Locatelli et al. Incretin-Based Weight Loss Pharmacotherapy: Can Resistance Exercise Optimize Changes in Body Composition? Diabetes Care. 2024 Apr 30:dci230100. doi: 10.2337/dci23-0100.

9. Sergeant et al. A Review of the Effects of Glucagon-Like Peptide-1 Receptor Agonists and Sodium-Glucose Cotransporter 2 Inhibitors on Lean Body Mass in Humans. Endocrinol Metab (Seoul). 2019 Sep;34(3): 247-262. doi: 10.3803/EnM.2019.34.3.247.

10. Bikou et al. A systematic review of the effect of semaglutide on lean mass: insights from clinical trials. Expert Opin Pharmacother. 2024 Apr;25(5):611-619. doi: 10.1080/14656566.2024.2343092. Epub 2024 Apr 18.

11. Takahashi et al. Vitamin Intake and Loss of Muscle Mass in Older People with Type 2 Diabetes: A Prospective Study of the KAMOGAWA-DM Cohort. Nutrients. 2021 Jul 8;13(7):2335. doi: 10.3390/nu13072335

12. Nunn et al. Antibody blockade of activin type II receptors preserves skeletal muscle mass and enhances fat loss during GLP-1 receptor agonism. Mol Metab. 2024 Feb:80:101880. doi: 10.1016/j.molmet.2024.101880. Epub 2024 Jan 11.

13. Gurjar et al. Long-acting GLP-1 analog liraglutide ameliorates skeletal muscle atrophy in rodents. Metabolism. 2020 Feb:103:154044. doi: 10.1016/j.metabol.2019.154044. Epub 2019 Dec 5.

14. From online lecture on Medscape: https://www.medscape.org/viewarticle/1001688_4

Trainer helping senior woman exercising with a bosu balance

The Balance of Life: Strength and Stability as We Age

Jason Safford/13 March 2025/ All MFN blog/

The sun rises, golden and quiet. A man stands on a Bosu Ball. He wobbles, his ankles working, his knees bending. He holds his arms out, steadying himself like a sailor on rough seas. This is not just balance training. It is life training.

As we age, balance becomes more than grace; it is survival. Falls are common, and they break more than bones. They break confidence. Stability training can change that. A Bosu Ball or a balance board may look simple, but they are tools of transformation.

The Power of the Core

Your core is your body’s anchor. It keeps you upright and controls your movements. When you train with a Bosu Ball, your core muscles engage deeply. They fight to keep you steady. This builds strength from within.

The Foundation: Ankles and Knees

Your ankles and knees are the foundation of your mobility. The Bosu Ball tests them. It makes them stronger. As you balance, your muscles and tendons adapt. They become more responsive. This is how you protect yourself from missteps and falls.

Strength in Hips, Strength in Life

Mobility in the hips is a gift of freedom. A strong hip means a stable stride. It means climbing stairs without fear. The balance board gives your hips the challenge they need. Consistency is key. Train regularly, and you will feel the change.

Balance Is Strength

Balance is not just for gymnasts. It is the heart of strength. Without it, strength falters. A Bosu Ball or balance board teaches your body harmony. It brings your muscles and mind into sync.

The Long Road Ahead

Life is a long walk. The road twists and turns, but with balance and stability, you keep moving. These simple tools—the Bosu Ball, the balance board—are keys to a longer, stronger life. They help you build resilience.

So stand tall. Wobble today so you can stride tomorrow. The strength you build now will carry you far, steady and sure, into the years ahead.

About the Author: Jason Safford, CSCS, CES (Coach J), is the Founder and Chief Performance Coach for Win Your Day Now (www.winyourdaynow.com). With over 30 years of experience in health, fitness, and life coaching, he has worked with clients of all ages, from young athletes to active seniors. He holds more than 10 certifications, specializing in areas such as transformation, nutrition, sports psychology, and corrective exercise. A dedicated husband, father, and author, Jason has published Winning with Exceptionalism and is preparing to release Win Your Day.

Don’t Let Arthritis Stop You: Move On

Dr. Irv Rubenstein/20 February 2025/ All MFN blog/

Arthritis comes in many forms and has many manifestations, affecting almost every joint in the body. We generally speak in terms of the two most-known if not popular forms of arthritis: rheumatoid (RA) and osteo-arthritis (OA.) The essential difference is in the root cause. RA is an auto-immune disease whereby the body, for unknown reasons, attacks itself, particularly in the joints. OA, on the other hand, is often considered the downstream effect of wear and tear, over-use, prior injury, or, as we’re seeing more of as society gets more sedentary, from lack of use. In OA, typically, some insult to the joint disrupts the natural repair processes and further deterioration occurs subsequently.

Due to their differing causes, there are obviously differing treatments; but the basics of medical management are essentially the same. I am not qualified to address the specifics of the treatments available but, in lay terms, treatment usually entails some version of anti-inflammation and pain-reduction drugs, precautionary movement or positional guidance (don’t do’s, for example), physical therapy to manage pain and inflammation, and therapeutic exercises to support the structures affected as the disease itself causes not just inflammation and pain but damage to the structures that support the joints. Typically we identify arthritis as something that damages cartilage and, in truth, that is often what the standard ‘films’ – X-ray, possibly MRI (magnetic resonance imaging) – show. We now know that the synovial sacs around the joint are also affected and that these and other chemical disturbances affect the muscles and tendons that move and support the joint. In almost all cases of arthritis, pain, inflammation, reduced strength and range of motion (ROM) ensue, diminishing quality of life in many ways and, because some of the drugs used to treat it, potentially reducing quantity of life. (Gastrointestinal bleeding from non-steroidal anti-inflammatories (NSAIDs) or bone loss (osteoporosis) from corticosteroids can lead to fatal outcomes (such as spontaneous fractures leading to falls from osteoporosis) if not treated with other medications.)

When someone is potentially afflicted or actually diagnosed with a form of arthritis, the medical community goes into hyper-drive, encouraging changing one’s habits, be they the types of activities one engages in recreational, competitively, or professionally; or the types of non-activities one currently does, in particular, being inactive.

In some cases, dietary advice is offered as we are learning more about foods that are pro-inflammatory and others that have anti-inflammatory benefits. In the former category, we are learning that excessive sugar or simple carbohydrates, including processed wheat products, may exacerbate inflammation while others, such as salmon, dark, green veggies, and certain oils (e.g., olive oil) are capable of reducing the inflammatory elements circulating throughout our bodies and our joints. Furthermore, in more extreme cases, when arthritis becomes very painful and debilitating, over-the-counter and/or prescription-fitted braces may be offered to defer some of the more end-line procedures such as surgery to fuse the joint or replace it with a prosthetic device.

The most common non-pharmaceutical and non-surgical treatment for arthritis of any sort: exercise.

Note that there are several legitimate ways to integrate exercise through resistance training programs that have proven quite effective in arthritis management. Yoga, Pilates (floor or machine based), Tai Chi, Qigong and water-based, or aqua, exercise are all beneficial to many aspects of the overall arthritis program of strength, ROM, proprioception and ultimately function. Since many of these are quite technical and are often done in class formats, one should ask the instructor(s) as to their experience working with arthritis clients.

As with any form of exercise, by whatever professional instruction, you should be totally aware of your pain levels as going “through” the pain is not recommended; thus, you must assert control over the exercise sessions. There will be some exercises, however, that are not destructive and may be somewhat painful but must be done in order to maintain reasonable levels of function and independence. So long as the pain subsides within a couple of hours – preferably as soon as you stop – and there is no exacerbation of inflammation the next day, you can assume that the exercise was just enough. If symptoms flare up over the next 24 hours, however, assume you did more than you should have and alert your trainer or instructor so that he/she can avoid doing the aggravating exercise(s) as much or as hard next time. For these reasons, along with all the other recommendations so far as exercise interventions are concerned, it is best to seek the counsel and assistance of a fitness professional with a background in medical fitness. This could be someone with a more advanced academic degree, someone with a license to practice rehabilitation exercise (physical therapist, athletic trainer, etc.), or someone who’s taken several educational programs to have a greater understanding of the variety of disorders and diseases that may benefit from exercise interventions.

UPCOMING WEBINAR

Grip Strength for Everyday Function: From Hands to Forearms

Christine Conti/18 February 2025/ All MFN blog/

What is the role of grip strength in daily activities and overall health?

IT Band Syndrome – Injury to Movement

Megan Johnson McCullough/28 January 2025/ All MFN blog/

Iliotibial band syndrome (IT) is a pain many workout enthusiasts, runners, and cyclists can experience.

Training Clients Through Crisis

Shannon Briggs/7 January 2025/ All MFN blog/

*Before we begin, it is essential to look at your accrediting agency’s ‘Scope of Practice.’ Remember, as a Certified Personal Trainers, we DON’T diagnose, prescribe, treat injury or disease, rehabilitate, counsel, or work with patients. We DO perform fitness screenings, design exercise programs, coach, give general health information, refer clients to medical health professionals when needed, and work with clients.

I have been a personal trainer for over 30 years and have had clients with me for decades. You cannot work that closely for that long with human beings and NOT come across a crisis.

How do we define “Crisis”? The dictionary defines crisis as a time of intense difficulty, trouble, or danger. It includes but is not limited to death, divorce, health scares and medical diagnoses, job loss, financial struggles, family struggles, mental health journeys, injuries and illness, surgeries, car accidents, and so on.

The research is solid.

Exercise is proven to release positive endorphins and happy hormones. Exercise can be a tremendous stress and anxiety release. Exercise will not FIX the crisis but is an excellent way to cope with the problem, clear the mind, and settle the body to be in a better place to navigate the situation.

The good news is as personal trainers, we have a unique opportunity to be in the room where it happens. Physical exercise can be very cathartic for clients going through difficult situations. I cannot count the times I have had a client break down and cry in our sessions. In my own experience, numerous doctors and friends recommended I start yoga classes when dealing with high anxiety. I walked into a class taught by one of my dearest friends and almost had to leave because I was sobbing so audibly I was afraid to disrupt others’ experience. Something unlocked in me during that class. Yoga did not fix my situation or my anxiety, but it did help me navigate my situation better and soothe it for the time being.

I count it a privilege to walk alongside my clients when they are going through a crisis. But it is essential to do so professionally and avoid getting tangled in their situation yourself.

There is a visual picture that many supporting agencies or groups use when training to work with people in crisis that can also be helpful to personal trainers. The image is a large pit or hole in the ground, and the person in crisis is at the bottom of the pit and cannot get out on their own.

The dilemma is how to help that person without getting pulled down in the hole with them, but instead giving them the assistance and support to get themselves out of the hole.

Initially, we should provide a safe place for our clients to share what life is offering them at that time. It is crucial to their physical health and can affect their performance during the training sessions.

Avoid judging the story and offering advice, but rather asking questions. “What do you think is the next step to solve this issue?” Often our clients want to be heard and seen. Giving them the space to share can often lead them to the solution or the next step or provide them with the freedom to move through the grieving process, whatever the situation may be. Of course, direct your client to professional help if you feel they are in danger or experiencing extreme levels of depression, anxiety, or hopelessness. You should have referrals on hand for anything a client needs outside of your Scope of Practice! It takes a village to keep our health in check.

How do we do this and still train our clients? I certainly do not intend for you to have an hour-long listening session instead of training them. Quite the contrary; the training will help them through the crisis.

Here are some of my tricks:

Keep them moving. I use timed exercises instead of counting reps so they can speak, be quiet in their thoughts, or listen to music.
Allow them to have their feelings. Try to avoid telling them to feel differently than they do.
I keep my movements simple and familiar to them to avoid overcomplicating things.
I will pause their story, give the instruction, set the timer, and ask them to continue where they left off.
This is also a great time to ask what music they want to hear while working out. Music has been proven to add to the enjoyment of physical exercise.
Another trick is the slam ball. If I sense anger or frustration my client is experiencing, I offer them to take 60 seconds to repeatedly throw the slam ball as hard as they can against the floor. Depending on the privacy you have, I also allow them to vocalize their frustrations while doing it: excellent cardio work AND a massive release of stress. This is however, inappropriate in a crowded gym, but it works well if you have your own private space.
I make them sweat! This can be helpful to clean toxins out of our system and aid in those happy hormones and endorphins.

You can be the missing puzzle piece that helps get them through.

It is a fine line between ushering your client through crisis and getting involved in their situation, but it can be done, and one size doesn’t fit all. Find the things that work for you and your client. But see them, hear them, and continue to point them to the positive benefits of working out during a difficult season of life. Their physical and mental health will benefit dramatically. It may not be the time to set huge fitness goals, but maintaining their fitness, assisting their immune system under intense stress, and helping with sleep during these times are critical to success.

In closing, I said earlier that I am privileged to walk with my clients through a crisis. And my favorite part of my job is seeing the light at the end of the tunnel. Then celebrate with them when the situation is over, or the grieving is complete. Don’t forget to point out how strong they are, how resilient they are, and not only where they were but how far they have come!

Shannon Briggs is a multi-passionate fitness professional and educator. She brings 30-plus years of experience in the dance and fitness industry. Shannon is the Personal Trainer to the Kilgore Rangerettes and helps Collegiate Fitness and Wellness Directors fill in the gaps. She leads continuing education workshops in multiple group fitness formats and topics specific to personal training.

Functional Movement Patterns in Exercise For MS

David Lyons/2 January 2025/ All MFN blog/

You’ve heard the terms functional exercise, functional movement or functional movement patterns… but what do these terms actually mean?

The term “functional movement patterns” is confusing because it is really not a specific term. Trainers, especially those putting MSers on exercise programs, will usually take them through a program of upper and lower body exercises incorporating compound movements that ask your body to do several things at once. They tell you this is a functional exercise routine and that it’s the best way to help you with your MS limitations. Every exercise is NOT considered a functional one. So what’s the difference?

Functional, by definition, means, “of or having a special activity, purpose, or task; relating to the way in which something works or operates”. In this case, the task is being a functional MSer with the ability to use your body to do what you’d like it to do like you did before your MS diagnosis.

And even though being “functional” is different from one person to the next—for instance, a triathlete needs to be able to run, bike, and swim without limitation or pain, while a homemaker (male or female) needs to be able to do household chores such as lifting groceries out of a car, moving a vacuum cleaner and loading and unloading a dishwasher without limitation or pain—the actual movement patterns required for these activities aren’t really that different.

When you think of functional movement patterns, you should see them as movements that engage your whole body in a variety of different active ways that involve coordinating your upper and lower body with areas that alternate from being steady to moving, and back again.

So where exercises like squats are considered functional because they require full-body coordination, strength, and stability exercises like biceps curls aren’t considered functional because they lack the full-body mental and physical engagement that comes into play with basic motion.

The main difference between functional training and other exercises that work each muscle is that exercises such as biceps curls or leg extensions attempt to isolate that muscle. When doing these movements we’re working individual body parts as separate from the others creating stimulus within those parts. Functional movements put the emphasis on using your whole body at once.

The focus on functional movement patterns, in theory, is to train your body to move effectively as a fully connected single unit so it is able to sit, stand, bend or change direction effectively when you need it to. Some of the functional exercises I use are squats, lunges, and pushups. These movements effectively engage the whole body in the exercise although they emphasize specific muscles as the main force of action.

I believe in functional movement patterns and agree there is a place for them in MS training BUT without the individual muscle-specific training it would be impossible to do a functional movement. If your legs are so weak from MS limitations how are you going to perform a proper squat that uses all the muscles in your legs?! You won’t be able to. This is why specific muscle training is so important. And the only way to get muscle-specific strength is through resistance training. But it doesn’t end there…

You must strength train each major muscle group, individually and specifically to gain the ability to “function”. I know you keep hearing about functional exercise for MS and how important it is. You are told that you MUST be in a program using functional movement patterns to help your MS limitations. I HAVE MS and I have been a fitness expert for more than 40 years. The real FACT is that functional movement patterns are secondary to strength training. They are important but more important to your physical abilities are training methods that incorporate resistance exercises with principles that cause “thought-based training” ™ which create muscle fiber activation, neuroplasticity, and brain to muscle reconnection.

So where am I going with all this?

Please be careful with who and what you take in as being the right fitness information for MS, especially coming from fitness “experts” who do not understand MS. There is much more to proper exercise for MS than jumping into the next repetitive functional program. And any trainer who says he/she is teaching you how to place mental attention on your workouts but only tells you to concentrate on what you are doing does not understand the significance of proper focus. It is not just a simple matter of paying attention to your exercises and form. It is the training methods you use that force that focus and concentration that is of key importance in your MS exercise program. Exercise programs pushing functional pattern movements with no focus driven process or training method behind them other than the standard and cookie-cutter, “do 10 reps of 3 sets”, are of little value in bringing results to our MS bodies.

Continued Education for Fit Pros

Learn what you need to help MSers… check out the Multiple Sclerosis Fitness Specialist online course for fitness and health professionals!

David Lyons, BS, CPT, is the founder of OptimalBody, which touches the lives of fitness enthusiasts of all kinds. OptimalBody has been named The Most Comprehensive MS Fitness Program worldwide since its release. His book, Everyday Health & Fitness with Multiple Sclerosis, was a #1 New Release on Amazon at its release. He is the 2013 recipient of the Health Advocate of the Year Award; in 2015, he received the first ever Health Advocate Lifetime Achievement Award, and the Lifetime Fitness Inspiration Award in Feb 2016. In 2017, David received the Special Recognition Award from the National Fitness Hall of Fame.

Plantar Fasciitis: Heel to Toe Pain

Megan Johnson McCullough/26 November 2024/ All MFN blog/

Overly stretched, tiny tears can lead to inflammation and pain in the arch of the foot. This condition, called plantar fasciitis, accounts for nearly one million doctor visits per year. Our foot has a thick band of tissue called fascia that runs from our heel to our toe. This troublesome foot issue is actually more common in women than men. We need to spend time on our feet moving, so this foot problem, if left untreated, can cause excessive pain and greatly limit our mobility.

Contributing Factors

Plantar fasciitis is more common as we age (specifically between ages 40 and 60), but is also more likely to occur in someone who is overweight or constantly on their feet. It is very common in runners. Activities that are known for high rates of plantar fasciitis include ballet, dance, long-distance running, and ballistic jumping. There are a few other contributing factors which include wearing shoes that are worn out and have thin soles or wearing high-heels. The mechanics of how you walk (your stride) involves your foot position. If you have flat feet or a tight Achilles, the body will compensate for these dysfunctions which can lead to injury of the fascia.

Pain

Pain starts to occur near the heel towards the bottom of the foot. Most people feel the pain in the morning right when they get out of bed. This is known as “first-step pain”. This can also occur if you have been sitting for a long period of time and then stand up. The plantar fascia acts like an absorbing shock spring in our foot. Repetitive stretching and tearing of this area results in a stabbing pain.

Treatment

If pain persists, seeing a doctor can help detect this condition. He or she will check the tender areas of the foot. The good news is that plantar fasciitis does normally go away on its own. There are several treatment options. A doctor might prescribe anti-inflammatory medication or a steroid injection. Physical therapy and massage can help as well as shock wave therapy to stimulate blood flow. A Tenex procedure can remove scar tissue in the area or surgery can be done to remove the plantar fascia off of the heel bone. Wearing the right shoes or using shoe inserts oftentimes does the trick, so be sure to try these simple fixes first. Ice and soaking the heel can also help alleviate pain .

A good home remedy is freezing a foam cup of water then rubbing the top of the cup on the heel for 10 or so minutes. Stretching the calves and Achilles tendon can help over time and there are ways to tape the area of the foot to position the heel correctly with each step. Night splints worn to hold the foot at a 90 degree angle help when stretching the fascia.

There’s no doubt that we use and abuse our feet, bearing vast amounts of weight on them while performing all of our daily functions. As we walk from point A to point B, getting those 10,000 steps in, we must practice self-care from head to toe to heel. Sometimes foregoing that cute pair of shoes even at the gym is worth the fashion sacrifice to walk without pain.

Megan Johnson McCullough, owner of Every BODY’s Fit in Oceanside CA, is a NASM Master Trainer, AFAA group exercise instructor, and specializes in Fitness Nutrition, Weight Management, Senior Fitness, Corrective Exercise, and Drug and Alcohol Recovery. She’s also a Wellness Coach, holds an M.A. Physical Education & Health, and is a current doctoral candidate in Health and Human Performance. She is a professional natural bodybuilder, fitness model, and published author.

References

https://journals.lww.com/jaapa/Fulltext/2018/01000/Plantar_fasciitis__A_review_of_treatments.4.aspx
https://journals.sagepub.com/doi/full/10.1177/2473011419896763
https://academic.oup.com/occmed/article/65/2/97/1488760

Narcissism: What Fitness Professionals Need to Know

Lori Ann Roland/22 November 2024/ All MFN blog/

Let’s discuss the relationship between narcissism and the fitness world and examine why those working in this demographic need to identify and be aware of narcissistic behaviors, not only in themselves but others.