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Health, fitness, wellness

Living Well with Arthritis

Although arthritis today is considered one of the leaders of the pack in the epidemic of chronic illness, millions of those affected are living fulfilling lives and living them well.

According to The Institute of Medicine’s New Report on Living Well With Chronic Illness, 8.6 million Americans are living with disabilities related to arthritis. The Arthritis Foundation reports it as “striking one in every five adults, 300,000 children and as the leading cause of disability in the United States.” Arthritis is a chronic illness that impacts many.

Depositphotos_39763765_xs(1)Those living with arthritis can live well and have a good quality of life by employing lifestyle interventions as medicine, in conjunction with, prevention, joint protection, weight management, physical activity, wise food choices, stress management and a good medical regimen. By combining all these necessary recommendations into a personalized Wellness Strategy and Plan, a coach can assist an arthritis patient in organizing what is important for them to live life well. The Wellness Plan then becomes a map by which to navigate toward managing and maximizing the patient’s best life possible.

A common factor also influencing quality of life for those challenged by arthritis or any chronic illness is what is called “adherence” or “medical compliance”. Lack of adherence to medical and lifestyle improvements is a large piece of the cost of healthcare today and contributes to the epidemic of chronic illness. Average patient adherence rates for prescribed medications are about 50 percent, and for lifestyle changes they are below 10 percent.

The World Health Organization reports “improving adherence also enhances patients’ safety because most of the care needed for chronic conditions is based on patient self-management, use of medical technology for monitoring, and changes in the patient’s lifestyle.” A coach assists in supporting patient compliance and self-accountability and works with the patient to forward the action toward their goals.

The same report goes on to say “patient-tailored interventions are required and must be customized to the particular illness-related demands experienced by the patient. There is no single intervention strategy that has been shown to be effective across all patients.” Therefore, working with individuals one on one is of primary importance for enhancing their quality of life. Coaches work with clients on a one on one basis assisting them in creating a wellness plan that is personalized to them.

Dr. Bennett and team’s article Health Coaching for Patients with Chronic Illness states “it is critical that those with arthritis understand, agree with and participate in the management of their chronic condition. Health coaching is one way to accomplish this function.”

A long-term study done at Stanford University indicates that interactions with a coach can significantly increase the health of people with chronic illness. Stanford’s Chronic Disease Self-Management Program brought patients (including those with arthritis) together with a coach. “Subjects who took the Program, when compared to those who did not, demonstrated significant improvements in exercise, cognitive symptom management, communication with physicians, self-reported general health, health distress, fatigue, disability, and social/role activities limitations. They also spent fewer days in the hospital, and there was also a trend toward fewer outpatient visits and hospitalizations.”

Young Couple Jogging in Park

It was found “This type of self-management, through coaching, is so effective it has been endorsed by the Surgeon General of the United States.”

“Give a man a fish, and he eats for a day. Teach a man to fish, and he eats for a lifetime.” Health & Wellness coaches work with a client to tailor-make a wellness plan that includes self-management, coordinating their medical regimen, and forwarding lasting lifestyle changes. Working together with a coach, a patient can successfully manage their condition and create a strategy to living life well with arthritis.

What Can Health & Wellness Coaches Do for You?

► Work with you to take an inventory of your current wellness status

► Guide and facilitate your personal well-life vision toward the life you would like to live

► Work with you to develop a personalized Wellness Plan that is tailored to your needs. The wellness plan becomes the map that integrates your important areas of focus including: self-management support, the medical regimen, and lifestyle improvements.

  • Self-management support:
    • Promote healthy behaviors
    • Impart problem-solving skills
    • Assist with the emotional impact of chronic illness
    • Provide regular follow-up and accountability
    • Encourage people to be active participants in their care
    • Assist in patient self-advocacy
  • The medical regimen – facilitation of a patient-directed approach
    • Scheduling and attending medical appointments
    • Asking your medical team the right questions
    • Following through on daily prescribed medications
    • Tracking your regimen to support success
  • Lifestyle improvements
    • Physical activity
    • Healthy eating
    • Eliminating risk factors
    • Promoting healthy behaviors

► Bridging the gap between clinician and patient.

  • Health coaches can bridge wellness-coachthese gaps between the medical team and patient by following up with patients and guiding a patient-centered approach, asking about needs and addressing obstacles, addressing health literacy, cultural issues and social-class barriers.
  • Health Coaches help patients become self-directed in navigating the health care system. Coaches can help with patient self-advocacy and coordination of care

► Provide accountability & support for you to be successful

  • Offer emotional support
  • Coping with illness is emotionally challenging. Coaches can offer emotional support and help patients cope with their illnesses. They also assist patients in seeking out additional emotional support that will help them achieve and maintain success.

► Provide ongoing evaluation of progress toward your goals

  • Re-evaluating success
  • Resetting goals & action steps as necessary
  • Provide acknowledgement & support of successes
  • Assist in maintaining forward momentum toward goals

► Serve as a continuity figure

  • Coaches travel with the patient as an ally and assist them with staying the course while implementing their wellness plan.

► Assist in patient-directed achievement of successful lifestyle behavioral change

  • Be your ally and walk shoulder to shoulder with you

Dr. Linda Gogl is a Doctor of Physical Therapy with Board Certification in Orthopaedic’s with over 20 years in healthcare. She currently serves as Director of Development and Team Member for Real Balance Global Wellness Services. Her professional experience includes outpatient Clinical Director, Developer/Director of an APTA Credentialed Orthopaedic Residency Program, Director of Quality Assurance for the largest physical therapy private practice in California, Credentialed Clinical Instructor, Adjunct Professor of Anatomy & Physiology, Research mentor and Clinical Coordinator for University affiliations. More recently she also served as National Director of Training and Implementation for OptimisPT, a physical therapy software system.


  • Arthritis Foundation. Arthritistoday.org
  • Bennett et al, Health Coaching for Patients With Chronic Illness. Fam Pract Manag. 2010 Sep-Oct;17(5):24-29.
  • Harris et al. The Institute of Medicines’s New Report on Living Well With Chronic Illness. Centers for Disease Control and Prevention. Volume 9 – September 20, 2012.
  • Lorig et al. Chronic Disease Self-Management Program, 2-year Health Status and Health Care Utilization Outcomes. Medical Care. Volume 39, Number 11, pp 1217-1223.2001
  • National Prevention Strategy, Clinical and Community Preventive Services, National Prevention Council 2010. www.surgeongeneral.gov/initiatives/prevention/strategy/preventive-services.pdf
  • National Prevention Council Action Plan: Implementing the National Prevention Strategy www.surgeongeneral.gov/initiatives/prevention/2012-npc-action-plan.pdf
  • World Health Organization. Adherence to Long-Term Therapies. Evidence for Action. 2003.
Breast Cancer Survivor

Breast Cancer and Exercise

The most common issues that plague post-mastectomy patients are upper-crossed syndrome and range of motion limitations in the affected shoulder. Upper cross syndrome is the combination of protracted (rounded) shoulders, forward head, cervical lordosis, winged-scapula, and thoracic kyphosis. As a result of these postural deviations, mastectomy, lymph node dissection, and/or radiation, the chest muscles may become tight, shortened and spastic. This not only exacerbates the postural deviations, but may limit the ability of the patient to move their arm/shoulder through flexion, extension, abduction, and external rotation. While this is a general statement, the majority of patients will present with these symptoms. This is compounded even more if the woman undergoes reconstructive surgery. Not only with it further exacerbate upper-crossed syndrome, it will create a muscle imbalance in the area of surgery, if either the rectus abdominis or latissimus muscle are used for reconstruction.

a trainer helping a senior woman doing fitnessThe most important factor in the safety and efficacy of the exercise program is the initial assessment. At the very least this should include a comprehensive postural assessment as well as shoulder range of motion measurements taken with a goniometer. The well-trained fitness professional will be able to deduce, from the results, which muscles need to be stretched and which need to be strengthened. By selecting the wrong combinations of exercises, the results may not only be undesirable, they may in fact be detrimental. For example, if a client presents with moderate to severe upper-crossed syndrome, performing any kind of “pushing” exercise that would involve the chest muscles (chest press), could make the syndrome even more pronounced by causing the pectoral muscles to tighten and contract. Instead, the goal need to be on stretching the chest wall and strengthening the opposing muscles in the back; particularly the scapular stabilizers.

Prior to adding a load (resistance) of any kind, the patient should have close to full range of motion through the particular plane of motion. Without correcting the range of motion first, the patient will reinforce the negative movement pattern by performing strength training exercises throughout a limited pattern of movement. Therefore, initially the focus should be on range of motion exercises. These may include very basic exercises that the patient can do on their own; front wall walks, side wall walks, pendulum swings, and corner stretch, or active isolated stretching that can be executed with the assistance of a professional. The combination of both will increase the speed of improvement in most cases.

Once close to full range of motion is achieved, the emphasis can be on strength training. Not only will this help to correct the postural and range of motion deviations, it will help increase bone density and lean muscle mass. Many women will either be of menopausal age, or thrown into menopause from their cancer treatment. With estrogen no longer being produced, the risk of osteoporosis increases. To make things even more complicated, the long-term side-effects of chemotherapy include osteoporosis, diabetes, and damage to the heart and lungs; all of which can be avoided or improved through proper exercise recommendations.

The last part of the equation is the risk of lymphedema of the affected arm/shoulder. Lymphedema is the swelling of the extremity following the removal of, or radiation to the lymph nodes on that side. Even if someone has undergone a sentinel node biopsy, and only had one node removed, they can still get lymphedema. Lymphedema is progressive if untreated and can be very painful and disfiguring. It can happen at ANY time after surgery; one hour or fifty years. The risk doesn’t increase or decrease with time, however a higher percentage of body fat, infection, age, and poor nutrition can all increase the risk once someone is at risk. In my sixteen years of working with cancer patients, I would say this is the number one “overlooked” issue amongst cancer patients. More often than not, they will not even be told about lymphedema. Following lymph node dissection and/or radiation, the lymphatic pathways do not operate with the same efficacy that they did previously. Therefore, we no longer know what the individuals exercise threshold is. It is critical to START and PROGRESS SLOWLY. This allows for a gradual increase in frequency, intensity, and duration of the exercise program. If at any point there is swelling, the patient should be advised to stop exercising and see their doctor immediately to determine if, in fact, they do have the onset of lymphedema. They should come back with a medical clearance form and the exercise instructor should take a step back with the frequency, intensity, and duration to the point prior to the onset of swelling.

Putting all of these pieces together is very much like solving a mathematical equation. If you are missing any of the information, you will never solve the problem. A typical exercise session should begin with cardiovascular exercise. This too should be gradually increased at a rate that the client is comfortable with and their body responds favorably to. They should stay well-hydrated, they should not wear tight-fitting or restrictive clothing on their upper body, and they should not overheat (all of these factors can increase the risk of lymphedema). Following the warm-up they should be instructed to do a series of lymph drainage exercise to open up the lymphatic pathways and prepare the body for exercise. I reference these exercises in CETI’s Cancer Exercise Specialist Handbook and Breast Cancer Recovery with the BOSU® Balance Trainer Book.

Meta Slider - HTML Overlay - Women wearing pink tops and ribbons for breast cancer on white backgroundFollowing the warm-up and lymph drainage exercises, the exercise specialist should determine what the areas of “need” are for the client. Remember to begin with stretching and range of motion exercises until they have close to “normal” range of motion. At that point the goal becomes strength training and choosing exercises that will strengthen the weaker muscles and stretch the tight and shortened muscles. Weight/resistance should also be very gradually increased and attention paid to any potential swelling of the extremity. Typically I chose exercises that will stretch the chest (chest fly, corner or door stretch, assisted stretching) and will strengthen the back (low/high rows, reverse flies, lat pulldown). They often [present with winged scapula following a node dissection. If this is the case, I will incorporate exercises that will strengthen the serratus anterior. If they have undergone an abdominal TRAM procedure, core work will be of the greatest importance in preventing, or minimizing, low back pain.

Because every muscle in the body works synergistically, an imbalance in the shoulder can lead to a multitude of imbalances from the hips to the knees to the ankles etc… Choose your exercises carefully. Put emphasis on the areas of need. This is not and can never be a cookie-cutter workout. No two breast cancer patients are the same. Not only are you taking into consideration their surgery, reconstruction, and treatment, you have to also factor in the remainder of their health history and any additional orthopedic concerns. I urge anyone who wants to work with cancer patients to undergo specialized training. It is very complex and the untrained professional can end up doing more harm than good.

Andrea Leonard is the Founder and President of the Cancer Exercise Training Institute. She is a certified as a corrective exercise specialist by The National Academy of Sports Medicine (NASM), as a personal trainer by The American College of Sports Medicine (ACSM), the National Academy of Sports Medicine (NASM), the American Council on Exercise (ACE), and as a Special Populations Expert by The Cooper Institute. She is also a continuing education provider for the National Academy of Sports Medicine and The American Council on Exercise.


Physio assisting elderly woman during exercise with power band a

The Importance of Exercise Following A Stroke

According to the American Heart Association, 700,000 people annually in the United States suffer a stroke.(1)  The incidence of stroke is likely to continue to escalate because of an expanding population of elderly Americans; a growing epidemic of diabetes, obesity, and physical inactivity among the general population; and a greater prevalence of heart failure patients.(2)

Following a stroke, survivors will often work with Physical and Occupational Therapists to restore strength and control through exercise programs. However, most insurance companies only pay for a certain number of therapy sessions per calendar year which can leave a gap in the rehabilitation process. It’s important to continue the exercises that a physical therapist has prescribed and progress safely through an exercise program to regain strength and functional movement. This is where a certified personal trainer with experience in rehabilitative exercises can come in. A certified personal trainer can be part of the healthcare team and can design a program which is both safe and functional.  Walking, flexibility exercises, and light strength training can help a stroke survivor continue on the path of rehabilitation. Swimming is also another beneficial form of exercise if a pool is available.

Another benefit of exercise for stroke survivors is prevention of recurrent stroke or heart attack, which occurs frequently in people who have had a stroke.(3)  Reducing risk factors can decrease the incidence of recurrent strokes and coronary events. An aerobic conditioning program can enhance glucose regulation and promote decreases in body weight and fat stores, blood pressure, C-reactive protein, and levels of total blood cholesterol, serum triglycerides, and low-density lipoprotein cholesterol.(4) Exercise also increases high-density lipoprotein cholesterol and improves blood rheology, hemostatic variables, and coronary endothelial function.(5)

It is very important that a personal trainer communicate with healthcare professionals about their client after a stroke, including the physician and physical & occupational therapists to best help the client. Safety should always come first when exercising. Overexertion and pain should always be avoided. Decrease in balance, spasticity(6), memory, and fatigue is common after a stroke. Like everyone else, stroke survivors will have good days and bad days. However, modification of exercises can help after a stroke to get individuals on the path to better physical health.

Kris Pritchett Cameron is the owner of ReNu Your Life Fitness & Neuro Wellness in Cedar Rapids, Iowa and a certified personal trainer through the American Council on Exercise. Kris has dedicated over 20 years to the health and fitness of others. Kris has worked with all ages from children to the elderly, but her specialty is medical fitness and working with older adults. With a background in healthcare and physical rehabilitation, Kris has experience working with clients who have orthopedic injuries, arthritis, Multiple Sclerosis, Parkinson’s Disease, Alzheimer’s, cancer, diabetes, heart disease, osteoporosis, bariatric surgery, mental disorders, and stroke. 


  • American Heart Association. Heart Disease and Stroke Statistics-2003 Update, Dallas TX
  • Gillum RF, Sempos CT. The end of the long-term decline in stroke mortality in the United States? Stroke 1997; 28:1527-1529
  • Mol VJ, Baker CA, Activity intolerance in the geriatric stroke patient, Rehabil Nurs. 1991; 16:337-343
  • Franklin BA, Sanders W. Reducing the risk of heart disease and stroke. Physician Sports Med. 2000; 28: 19-26
  • Hambrecht R, Wolf A, Gielen S, et al. Effect of exercise on coronary endothelial function in patients with coronary artery disease. N Engl J Med. 2000; 342: 454-460
  • Spasticity is a condition where muscles are stiff and resist being stretched. It can be found throughout the body, but is common in the arms, fingers, or legs. Hope: The Stroke Recovery Guide. 2010 National Stroke Association
doctor chart

What I did when I was diagnosed with Multiple Sclerosis

The road to a diagnosis of multiple sclerosis may have come in a whirlwind of a day or at the end of long, agonizing years. The destination is all the same – a mysterious, unpredictable and unseen disease.

When I received my diagnosis Thursday, July 7, 2016, I didn’t know a thing about multiple sclerosis.

I knew about diabetes, cancer and heart disease. Why wasn’t I familiar with MS? Isn’t that the “wheelchair disease?”

The questions ransacked my mind.

  • What’s going to happen to my body?
  • What had already happened to my body?
  • What caused it?
  • Did I do something to bring this on?

Like it or not, MS was now part of my world.

I felt like I just booked a plane ticket for an undisclosed destination. No trip planner. No time for online reviews. No travel agent recommendations. Nada. Just signed, sealed and delivered. I knew, however, I needed to hit the road with the best possible plan to restore and maintain my health.

I wanted MS to know that I was in charge.

MS was not going to determine my health or my future.

So, I had the right mindset, but not a clue where to begin.

According to my neurologist, I needed to start on a disease modifying drug. These drugs are designed to reduce the MS attacks and slow down the damage to the central nervous system (the brain and spinal cord – the place of attack for this autoimmune disease).

Personally, I believe there is an incredibly valuable place in this world for medicine and in my opinion, this was one of those places. However, I also knew from my years of studying nutrition and wellness strategies I needed more than what the medicine cabinet could offer to truly conquer this disease. I needed the best of both worlds – the main medication to address the disease and a highly personalized, research-based nutrition plan.

My gut told me two things:

  1. My body had sustained an immense level of chronic stress over the recent years – I changed careers, completed a triathlon, attended culinary school in NYC, helped to care for my mother during cancer treatments and ultimately grieved her passing. These intense years not only drove me into extreme adrenaline fatigue but likely created a firestorm of other stress-induced damage I was just beginning to discover. Based on my research, stress was actually powerful enough to “turn on” an autoimmune disease like MS. I would never know what actually turned MS on in my body, but I knew I needed to arm myself with as much ammo as possible to stabilize this disease.I was onboard with taking the disease modifying drug based on the recommendation of my neurologist. However, all medications have risks and benefits and sometimes the risks don’t outweigh the benefits. For me, the symptom-management medications were not compelling enough for my current state of health. I didn’t have extreme symptoms, and I didn’t want to start popping pills like movie theatre popcorn. Outside of the main medication, I wanted to begin healing my body through diet and lifestyle first. I knew the research and experienced the body’s healing abilities in the past.
  2. I needed to pursue my own healing plan as if it was my only path to restore my health. The reality is my body didn’t get MS because it was deficient in a disease modifying drug. The medicine would help, but it’s not addressing the root cause. There was something on a much deeper level that allowed this gene to turn on. Through reading and research and discovering the profound work of Dr. Terry Wahls, I learned about a new path to stopping the progression of this disease. Dr. Wahls – a medical doctor diagnosed with MS – had the food prescriptive plan to reversing MS through paleo principles and the science to back it up. Step aside Beyonce, you may slay a dance floor like no other, but Dr. Wahls is my new hero. She’s slayin up some serious healing in the kitchen. I knew if I didn’t get to the root cause of what turned the disease on in my body, the medication would only take me so far. For the best chance of truly stopping the progression of this disease, I needed to get to the root of it.

Here’s what I did when I left my neurologist’s office and invite you to do the same.


Deep healing starts in the kitchen. Hippocrates said it himself, “Let food be thy medicine and medicine be thy food.” Food – real whole food – has the nutrients our cells need to thrive and heal. I needed to ensure that my body was receiving the proper nutrients to stand up to MS; and equally as important I needed to ensure my body was digesting and absorbing the nutrients I was giving it. The latter half is the most overlooked yet essential part of the equation.

Thanks to the clinical research of Dr. Terry Wahls, the science was already done to show not only the nutrients my body needed to heal from MS but also the prescriptive menu to achieve it. And so it began… eliminating gluten, dairy, soy and eggs, and fueling up on my nine cups of veggies a day. Healing my gut. Healing my cells. Healing my life.

Start Now: How many veggies do you eat in a day? When was the last time you had a veggie? (Unlike our school cafeterias French fries and ketchup don’t count!) Add one at your next meal… even at breakfast. Toss some veggies in an omelet or spinach in your smoothie.


The importance of sleep goes far beyond the beauty benefits. When we sleep our body doesn’t have to move, digest food or think critically. That enables our body to use its energy to remove toxins, manufacture hormones and fight infection. Sleep may seem passive, but it’s prime time hours for the body to detox and repair – essential components to anybody, especially those suffering from an autoimmune disease like MS.

At the time of my diagnosis, I had an incredibly demanding schedule. As a personal trainer, I lead a weight loss class that began at 6 am. And some nights I have been at the gym as late as 10 pm, so sleep was a luxury. However, if I was serious about standing up to MS and doing everything in my power to support the healing process, I needed to prioritize sleep. I couldn’t change the time of my morning alarm but I did become more efficient with getting to bed and getting off the electronics an hour prior to snuggling in.

Start Now: Aim for 7-8 hours of sleep a night in a dark, cool room. If you’re completely off the mark for this now, shoot for 30 minutes earlier than your current bedtime. Once that becomes an easy habit, progress with another 30-minute increment until you reach your goal.


Stress is part of life. Work/life balance is a myth. It’s time to get a grip on what’s stressing you out, set realistic expectations in all areas of your life and prioritize a little chill-axation.

This was by far the greatest challenge for me. Veggies – I got them. Earlier bed time – it’s not easy, but I can deal. Chill on the couch? There might as well have been needles poking out of the couch cushions, it was straight up torture. The idea of doing “nothing,” was actually stressful to me. I wasn’t being productive! There were so many other things to do.

I always circled back to my “why.” Why does this matter? What’s the risk if I don’t change my habits? What’s the payoff if I do? Remembering my why – standing up to MS – got me through the ick of learning to deal with it. My body needed “active rest,” time outside of my sleeping hours to unwind and relax.

Start Now: What’s one expectation you’ve put on yourself or your life that if you let go of, could free you from guilt? Do it! (Cue Free Your Mind for a little En Vogue action!)

This became my starting point of a very long, very rewarding road to healing. Everyone’s path is as unique, but if given the chance, the body will heal itself.

Let’s give your body that chance, shall we?

This post originally appeared on alenebrennan.com. Reprinted with permission.

Alene Brennan has been featured in USA Today, Philadelphia Inquirer, Huffington Post and Mind Body Green. Alene overcame debilitating migraine headaches through diet and lifestyle and is now once again using a “Less Pharm, More Table” approach is managing her diagnosis of Multiple Sclerosis. Alene holds four certifications: Nutrition Coach, Yoga Instructor, Personal Trainer and Natural Food Chef. She also completed specialized training in nutrition for autoimmune disease specifically the Wahls Protocol and the Autoimmune Protocol. Since receiving her MS diagnosis and seeing first-hand the power of using diet and lifestyle to create a healing environment in the body, she dedicated her virtual nutrition coaching practice to helping people with MS and autoimmune diseases take back control of their health. Visit her website, alenebrennan.com.


Diet and Weight: A Matter of Health, Not Looks

I Hate Talking About Weight!

Honestly, I don’t really enjoy talking and thinking about weight, mine or anybody else’s. Who does?

It’s a bit ironic given the majority of my research is on diet and obesity. Many of my studies look at how what we eat and drink impacts weight gain and its risk to diseases such as type 2 diabetes and heart disease.

This article needs to be on my blog, however, since we live in a world with a pandemic obesity crisis. In the United States alone, approximately two-thirds of adults and one-third of kids are overweight or obese. (Many people who are overweight or obese do not recognize it; I encourage you to calculate your body mass index and discuss your weight with your physician if you are uncertain.) As Westernized lifestyles, behaviors, and food gets exported around the globe, so, too, do our obesity rates: According to the International Obesity Task Force, more than 1 billion adults and 200 million children worldwide are currently overweight while an additional 600 million adults and 40-50 million children are obese.

The reason I don’t enjoy talking about weight is because I actually began my research career thinking about how pervasive and destructive the Westernized perception of beauty is in the US (and some other countries, too). We are bombarded with images of women of unrealistic body sizes and shapes with virtually unattainable weights barring chronic food deprivation. It bothers me greatly that we have such a narrow perception of beauty here in the US, and the last thing I want is for my own research—or this blog!—to fuel this grotesque fire.

That’s why I subtitle many of the lectures I give on this topic “A Matter of Health,” just as I’ve named this blog piece. Because my wish is not that overweight individuals hate their body: the current stigma of fat shaming and weight bias is obscene. Yet, the simple medical fact is that excess body fat carries health risks that are essentially avoidable. Still today, it seems many people do not fully recognize the degree to which extra weight impacts their health. For example, type 2 diabetes is essentially a preventable disease for most people and in some cases can be reversed with weight loss. Many cancers have also been associated with obesity. Yet obesity impacts almost all body organs and systems.

And note that the graphic does not adequately capture the psychological pain and suffering that many overweight individuals face due to diminished self-esteem and prejudice in our body-conscious culture. Especially troubling is the social difficulties and bullying some adults and children face due to weight discrimination.

Environment Matters: Individual Food Choices in Context

In my worldview, which is rooted in public health, an individual does not bear complete personal responsibility for his or her health, weight included. We are a product of genetics and our environment, not just our lifestyle. Most of us live in a society that encourages food consumption at every turn, in every place—and much of it unhealthy, I hasten to add. Food cost and accessibility are additional barriers to eating healthfully for some people as well. Individuals are thus part of a larger system that includes family, community, local, state, national, and global factors that impact our health and weight. (This is known as the social-ecological model of public health, in case you were wondering.) Food policies and production practices also influence what reaches individual plates, and these factors must be considered when working to stem the obesity epidemic on a population basis and help individuals manage their own weight at a personal level. (These topics are the subjects of many of my classes and research projects.)

Even so, when all is said and done the decision of what you choose to put in your mouth must ultimately be made by you. My mission is to help you apply the science to your plate delectably, and that includes cooking and eating in a way that promotes healthy weight. And guess what? Those same meals and habits that will keep you free from excess weight are the same ones that will keep you enjoying good health and living longer, too.

For the Record: My Own Weight

My regular readers know that I’m not just your average nutrition scientist given my life-long love affair with food. And a love of food isn’t always conductive to a healthy waistline.

As a teenager I put on more pounds than was healthy for my size. Like all daughters, I blame my mother. (Just kidding. Kind of.) In other words, the culture of sweets and constant desserts around our house when I was growing up certainly didn’t help matters. But I also began working in restaurants when I was fifteen, and every Saturday night in high school I worked from 5pm to 3am, sometimes 4am. Let’s just say snacking on burgers and fries and fried mozzarella weren’t the best choices. I continued working in restaurants for a decade, so was always surrounded by scrumptious food. Sure, I eventually took off that extra adolescent weight, but I, like many of you, gain weight just by looking at chocolate cake. I practice the strategies I preach to you—like keeping your house free of snacks and sweets and practicing healthy holiday eating tips—because they are based on science, and they work. I’ve altered my behavior and lifestyle and my weight has followed suit.

Reprinted with permission from Dr. P.K. Newby. Originally printed on pknewby.com

P.K. Newby, ScD, MPH, MS (“The Nutrition Doctor”), is a scientist, author, and adjunct associate professor at Harvard whose newest book is “Food & Nutrition: What Everyone Needs to Know.”


Behavioral Bonsai: Effective Fitness Coaching for the Autism Population

“First, which hand?”

“Right hand”

“That’s your left. Which one is your right hand?”

Debbie holds up her right hand.

“That’s your right hand! Alright, cool, walking band pulls with your right hand.”

Coaching fitness programs for the autism population is taking the art of Bonsai to strength and conditioning. We eliminate noise, static, whatever you want to label as extraneous. Successful fitness and adapted PE programs with the autism population require a keen sense of senses.

How is Karl responding to directions for performing a bear walk? Can I fade my hand-over-hand prompt for Jack’s single arm Sandbell press and maintain the integrity of the movement? Is Kelvin going to get over-anxious if introduced to a new variation of the squat? Herein are some of the essential considerations for successful fitness sessions.

We start with three questions: What’s going on physically? What’s going on adaptively? What’s going on cognitively?

The answers provide a flow chart-style of contingency-based decisions? If this; then that. Autism is complicated. The strength and motor planning deficits are complicated. The odd, occasionally near-light speed escalation of anxiety and off-task behavior is complicated. What works is a rational and reliable strategy for each situation to support growth and development in each area of ability (physical, adaptive, cognitive). Taking the guesswork, or most of it, out of programming clears the path to short- and long-term benefits for the athlete.

The two most common coaching errors with respect to the ASD population are over-coaching and exercise selection (typically too progressed). Over-coaching is, by proxy, over-explaining and providing too many verbal directions at once. We often need to simplify verbal instruction for athletes with ASD as short-term recall is an issue of particular deficit. Here’s one set of directions likely to be problematic;

“First hurdle steps, then Sandbell slams, then bear walk from the blue cone to the green cone.”

Many of the athletes I’ve coached will start with bear walks. They’re not being deliberately off-task or defiant, it’s simply a matter of hard-wiring. The verbal directions were too extensive and our athlete was unable, at least for now, to hold them in place.

In the Autism Fitness Level I Certification we teach a strategy called “Label/Demo/Do & Cue” as an efficient way to teach and facilitate learning different exercises with safety, efficiency, and comprehension. Labeling refers to naming the exercise. Demonstrating is our showing the athlete proper form and performance, and Do/Cue gets them into the activity quickly so that we can coach as they learn.

In real life (IRL, LOL!) we would take each one of the aforementioned exercises (hurdle steps, Sandbell slams, and bear walks) and teach/instruct them separately. Consider that physical and adaptive skills can be mutually exclusive. An athlete might have proficiency with all three exercises, yet still require verbal direction at each stage;

“First hurdle steps”

Athlete performs hurdle steps.

“Great hurdle steps and getting your knees up! Now you have eight Sandbell slams.”

Athlete performs 8 Sandbell slams

“Those were some powerful Sandbell slams! Now bear walk from the blue cone to the green cone.”

Athlete completes the bear walk

Using this strategy we avoid overwhelming the athlete and having to back-track. We want to Label/Demo/Do & Cue because it provides the coach with more time to teach the exercise rather than explaining it. Our goal is to maximize “down” time and increase on-task behavior, wherein the athlete is learning and mastering each exercise. Given the strength, stability, and motor planning deficits common to the autism population, it is imperative that as much of a session as possible is dedicated to them being in action.

Labeling the exercise has a secondary benefit. As the athlete becomes more familiar with the name of a movement, he/she can request in or make an informed, motivated decision when an instructor provides options. We use this strategy with consistent success, asking athletes whether they would prefer to do “push throws or overhead throws first” during our medicine ball warm-up.

The structure here is key. Providing choice between exercises sets up a few important contingencies. First, the coach is giving structure. Both medicine ball throws will be performed, however, the athlete gets to choose the order.

The open-ended option “What do you want to do?” could be overwhelming or the athlete may choose something entirely outside the realm of exercise (“bathroom” and “break” are common inserts here). Providing choice within structure enables us to teach what needs teaching and coach what needs coaching while still leading towards autonomy. Over time, many of our athletes wind up “designing” their own sessions with frequent choices being offered, usually with respect to the order of exercises.

Exercise selection is crucial. Focusing on the foundation of movement patterns (locomotion, pushing, pulling, squatting, hinging, and crawling) we are able to address some of the most pervasive physical deficits common to this demographic. It is not about variety, rather building baseline skills that transfer or generalize to novel environments and situations. It can take some time for these movement skills to establish. In multiple cases learning to hinge properly during the scoop throw has taken our athletes a few years to master.

Focusing on a few exercises also gives our athletes the opportunity to learn the name and typical order in which the exercises can be performed. Whereas our warm-up/mobility section nearly always features hurdle steps, overhead resistance band walks, bear walks/crawls, and medicine ball throws (push, overhead, and scoop), our strength/focus section includes squats, presses, pulls, farmers walks, and heavy carries.

Using a “limited” selection of exercises enables our athletes to master the baseline skill (physical), become accustomed to the name and instructions around the exercise (cognitive), and be familiarized enough with each exercise that it can become reinforcing, where the athlete is motivated (adaptive) to engage.

The art of empathetic coaching requires us to ask one overarching question; What is it like for you to be coached by me right now? We acknowledge our athlete’s current abilities and make well-guided plans for their successes.

Photos provided by Eric Chessen.

Eric Chessen, M.S., is an Exercise Physiologist with an extensive background in Applied Behavior Analysis. Eric provides on-site and distance consulting worldwide. He is the founder of Autism Fitness®, offering courses, tools, resources and a community network to empower support professionals to deliver adaptive fitness programming to anyone with developmental deficits to create powerful daily living outcomes that last a lifetime.


The Naturopathic Chef: Gluten Free Pizza Crust

This is the pizza crust I developed for my gluten free corporate lunch and learns. I needed a crust that was fast and easy to handle. GF recipes are often unstable and difficult for a novice GF baker to execute. The ground flax seeds and chia slurry give this crust structure and stability, while maintaining a light, airy crispness. It also has the much desired “chew factor” that great Napolotano-style pizza has. Your family will say, “pi’u la pizza per favore!” “More pizza, please!”


  • 1-1 1/2  Cup GF Beer, room temp (Just enough liquid to bring the dough together)
  • 1 tsp Dry Yeast
  • 3 cups GF all purpose flour
  • 1 Tbls Ground Flax seeds
  • 2 tsps Salt
  • 2 1/2 tsps Baking Powder
  • 1/4 cup Olive Oil
  • 2 Tbls Chia Seeds, bloomed in 1/2 cup Water

Prepare two rimmed cookie sheets with parchment lightly sprayed with olive oil

In a small mixing bowl, pour 1 cup of beer in and sprinkle yeast over beer. Set aside. When using a stand mixer, the paddle will give the best results; or use a wooden spoon to mix by hand. Stir flour, flax seeds, salt, and baking powder together. With mixer running, slowly stream in beer/yeast mixture. Add olive oil and chia slurry. All GF dough tends to be sticky. Please, do not over mix, this leads to a tough crust. Lightly coat a large mixing bowl with olive oil. Place dough in a bowl, and cover with plastic wrap. Allow to rest in a warm place for 75-90 minutes. When dough is puffed (it doesn’t rise the same way traditional crust does,) divide in half. Place each piece of dough on the prepared cookie sheets. Brush a small amount of olive oil over the top of each. Cover with plastic wrap and press dough into desired thickness and shape. Bake at 325 degrees for 45 minutes. Remove from oven and slide parbaked crusts to a wire cooling rack. From here, crusts can hold at room temperature up to four hours, or when completely cooled, wrap in plastic and then in foil. Freeze up to one month. Remove frozen crusts and top with sauce and other toppings. Bake at 500 degrees for 10-12 minutes using a preheated pizza stone or cookie sheet.

Fresh crust on the day of: One hour before baking, place pizza stone in middle of oven. Heat oven and stone to 500 degrees. Top parbaked crust with sauce and toppings. Slide pizza onto heated stone. Bake as directed above, or until cheese is golden and bubbly.


  • 1 28 oz can San Marzano Tomatoes
  • 2 Tbls Tomato Paste
  • 1 Tbls Basil
  • 1 Tbls Oregano
  • 1 Tbls Thyme
  • 3/4 tsp Red Chili Flakes (Optional, but very traditional)
  • 2 tsps Balsamic Vinegar
  • *This sauce is very herbaceous at this measurement. Decrease to 2 tsps if you don’t want the herbal flavor at the front of the palate

Mix all ingredients in a large saucepan, except vinegar. Cook over medium heat mashing and stirring the tomatoes as the sauce reduces. Cook 30-40 minutes or until moisture is gone and sauce is very thick. Remove from heat and stir in vinegar. Set aside until ready to assemble and bake your masterpiece!

Phyto Facts

Celiacs vs. Coeliac

Most of us have heard of Celiac disease by now with the marked increase in the mainstream population. Most of us, however, have never heard of Coeliac Disease. Coeliac is derived from the Greek word, “koiliakos,” meaning, “to suffer in the bowels.” Grains and other fibrous foods pass through the stomach and upper intestines in their crude form. This causes great pain, acid reflux, and indigestion in general. The inflammation caused from this poor digestion is painful along with the host of other side effects that go along with being Coeliac. But, it is not fatal like Celiac can be. It all comes down to the inability to break down gluten and other plant proteins. Gluten is the general name for the proteins found in grains. The three grains that are highest in gluten are Wheat, Barley and Rye. Other grains such as Kamut, Duram, Spelt, and Farina are cousins of wheat, and can cause irritation and inflammation, particularly in those with Celiac disease. The mass production of wheat has genetic consequences: there is mounting evidence that the genetic modification of our grains is leading to a marked increase in inflammation of the digestive tract and brain, as seen in Autism. Clinical depression, Parkinson’s, ALS, Alzheimer’s/Dementia and the slow output of Leptin (the fat burning hormone) are all being connected to GMO grain in the latest research.


The herbs we’re using are high in Apigenin. I’ve written about the research concerning its powerful effect on ovarian cancer. Apigenin also calms anxiety and is showing promise as a protective agent for strengthening the brain in a fetus. There are many case studies linking a chronically agitated nervous system to clinical depression later in life. Omega-3s and Apigenin are critical to avoiding this in adults and children. Besides our leafy herbs; flowers are very high in this phytonutrient. Specifically, Chamomile tea. Mommies, please check with your OB/GYN to confirm a nightly cup of Chamomile fits with your prescribed regimen. Here’s to babies that sleep through the night!


Lycopene, in the sauce, can slow aging. It is one of the best internal beauty secrets we have. Lycopene also reduces Sun damage by as much as 40%, keeps our hearts healthy and strong, and will someday be the cure for Prostate cancer. Sloan-Kettering is a leader in this technology. It truly is Delicious Medicine.

Affectionately referred to as The Walking Encyclopedia of Human Wellness, Fitness Coach, Strength Competitor and Powerlifting pioneer, Tina “The Medicine Chef” Martini is an internationally recognized Naturopathic Chef and star of the cooking show, Tina’s Ageless Kitchen. Tina’s cooking and lifestyle show has reached millions of food and fitness lovers all over the globe. Over the last 30 years, Tina has assisted celebrities, gold-medal athletes and over-scheduled executives naturally achieve radiant health using The Pyramid of Power: balancing Healthy Nutrition and the healing power of food, with Active Fitness and Body Alignment techniques. Working with those who have late-stage cancer, advanced diabetes, cardiovascular and other illnesses, Tina’s clients are astounded at the ease and speed with which they are able to restore their radiant health. Tina believes that maintaining balance in our diet, physical activity, and in our work and spiritual life is the key to our good health, happiness and overall well being. Visit her website, themedicinechef.com


Avoiding Burnout: Daily Balance with Bumbles

We have all heard that we should strive for balance in our life.  Balance requires adequate sleep, food, movement, play, and acts of self-care.  Most of us are lucky if we get 3 of those in one day.  Lack of daily balance interferes with thinking, makes ideal weight almost impossible, and leads to anxiety, depression, and frustration. Most importantly, it decreases chances to succeed.  Burnout was very recently made an official medical diagnosis, and it’s caused by a lack of daily balance.  It is a proven result with medical consequences from living an out of balanced life.

My cat, Bumbles, proves that balance works every day.  Bumbles was born in my home, so I’ve really seen him put this into action, which has given me far greater appreciation for the balance in my life that I strive for.

1. Breakfast is first. This is Bumbles’ highest priority until it’s done.  He tickles my face with his whiskers if I try to sleep later with the intent of skipping it.  Eating a healthy breakfast prepares me for my day, prevents that afternoon slump, and tends to make my portion sizes smaller during all my daily meals and snacks.

2. Meditation is Bumbles’ favorite in the morning, and a powerful form of self-care. As soon as he hears me pulling out the headphones to listen to Deepak, Bumbles is in position.  He can So Hum it with the best of them.  His present moment awareness has been achieved.  Taking the time to calm my mind, become aware of the present moment, and allowing my brain to take a break from overthinking is a centering force that follows me through the day.  When I’m working throughout the day, the only moment that matters is this one.  It’s proven to be the best way to get things done quickly and easily.  If I’m thinking about what’s next, I’m not paying attention to what I’m supposed to be focusing on now.

3. Then it’s time for work. He reigns over his kingdom, making sure nothing has changed overnight, and is sure to bap a few of his friends over the head along the way.  He is also an aeronautical enthusiast that watches every bird that flies anywhere near the house with absolute fascination.  I start work each day with enthusiasm and expectation and allow items to flow naturally without a sense of intense pressure or overwhelm.

4. He breaks for lunch and a short nap. There are numerous studies that show taking a short 20 to 30-minute nap in the middle of the day if you are tired can be extremely beneficial.  In our work-obsessed world, we often judge ourselves as being lazy or not doing what we are supposed to be doing if we allow ourselves to rest, but appropriate rest is essential to normal body function. Even taking a short walk outside can be the slight break that makes the rest of the day much more beneficial.

5. Exercise… Bumbles loves to play fetch with super balls. He does about 3-5 high intensity chase and retrieves drills.  He then does rope climbs, ramp runs, and several roll over on his back maneuvers.  This is followed by a healthy dinner.  Exercise does not have to be done in a gym.  It’s convenient if that is the location you prefer, but exercise can be done in your living room, hotel room, in the back yard, through your neighborhood.  Exercise can be done anywhere.  If you need ideas, I am here to provide them.

6. Just chilling…  Bumbles watches tv. He has a couch right next to it, and he especially likes it when Ellen dances.  He limits it to about an hour though, because its treat time.  We all need downtime, where we have left the cares of the day behind to be begun again tomorrow.  It can be sitting and watching a beautiful sunset or meeting with friends.  Having quiet time and play time during our day is essential for mental well-being.

7. Bumbles finishes his busy day spending time with friends, little man face scratches, and cuddling time with me. A normal bedtime routine reduces insomnia, promotes better quality sleep, and sets you up for a great morning.  It’s best to strive to go to bed at the same time every night to even further the benefits of regular sleep.

And then it’s on to tomorrow.

Bumbles is happy, calm, at a normal weight, healthy, and just really happy to be King Bumbles.  He’s achieved success at work, at meals, at present moment awareness, at play, at relaxation, and most definitely at rest.  We could all learn a bit from Bumbles.   I, as his human, have achieved the same results by following his plan.  If your life is currently out of balance, and it’s impacting your life, weight, or health, then try starting with just one of the missing components.  Ease it into your life in an enjoyable way until it becomes routine, and then move on to the next.  Lack of balance didn’t happen overnight.  Burnout and lack of balance are usually due to a lifetime of small habits adding up.  Give yourself the time to regain balance. My recommendation…. just start with awareness.

Reprinted with permission from Heather Clawson, MD.

Dr. Heather Clawson is a nonclinical physician with a strong background in fitness, both before and after her medical training.  She has the unique ability to take medical issues, convert them into fitness terms, and then deliver that information in an easy to understand way for the person in front of her. She’s been involved in fitness for almost her entire life, and she has extensive ICU experience, but she has chosen to use her medical knowledge on the other side of medicine — before a person becomes a chart, labs, and a room number. Visit her blog, heatherclawsonmdblog.com