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Autism Spectrum Disorder – Where Fitness Professionals Land on the Spectrum 

According to the CDC (2022), about 1 in 44 children has been identified with autism spectrum disorder (ASD). Autism Spectrum Disorder (ASD) is a neurological disorder marked by deficits in social communication as well as repetitive behaviors and restricted interests (Hodges et al., 2020. This information tells us, that it is likely in the near future or even now as a fitness professional, we may experience having a client with ASD. Being a neurological disorder, there can be faulty lines between mind and body communication that influence body movements and mechanics. Therefore, as a fitness professional, working with an ASD client would require individualized programming tailored to specific needs, but there are common sensory and motor skill deficiencies we as fitness professionals can certainly assist with. 

The Diagnostic and Statistical Manuel of Mental Health Disorders (DSM-5) has now coined the term “spectrum” to include both lower and higher functioning forms of autism. 

The ”spectrum” consists of the following: 

  • autistic disorder
  • Asperger’s disorder
  • childhood disintegrative disorder
  • pervasive developmental disorder not otherwise specified (PDD-NOS)

Furthermore, the DSM-5 requires the following for diagnosis: 

Individuals must meet all the social communication/interaction criteria:

  1. problems reciprocating social or emotional interaction
  2. severe problems maintaining relationships
  3. nonverbal communication problems

Must also meet 2 of the 4 restricted and repetitive behaviors criteria that do cause functional impairment:

  1. stereotyped or repetitive speech
  2. motor movements or use of objects
  3. excessive adherence to routines
  4. ritualized behavior, or excessive resistance to change
  5.  highly restricted interests, abnormal in intensity or focus
  6. hyper or hypo reactivity to sensory input or unusual interest in sensory aspects of environment

There are a number of risk factors for ASD including sex because ASD is 4 times more common in boys than girls. Other risk factors include family history, age of parents when born, and being born early (CDC, 2022). The fitness professional will of course meet the ASD after diagnosis but being aware of certain behaviors and traits is an important component to help better understand and relate to the client’s needs and abilities. The fitness professional can become part of the ASD client’s comprehensive treatment program. There is a need for our help, especially since obesity rates are higher among persons with ASD. Although some of this can be related to diet, lack of physical activity is a key contributor to this phenomenon. We know that P.E. at school alone is not enough time spent moving, and because persons with ASD might need special sensory and motor accommodations, this can be a deterrent for participation. Without the advocacy of parents, activity may not be prioritized. 

Common among persons with ASD, there exist vestibular, proprioception, interoception, low muscle tone, postural instability, and compromised endurance and balance deficiencies (Autism Speaks, 2022). Adding to these, persons with ASD have been found to have differences compared to those without ASD with gait (stride width, velocity, and stride length) (Autism Speaks, 2022). As fitness professionals, we have the knowledge and experience to program design for these fitness and skill related components, so having a specialization to reach this population makes us both more credible and more marketable. Special populations need special people like us to add exercise as medicine and improve quality of life, despite the challenges, stereotypes, and stigmatisms that exist when it comes to persons on the “spectrum”. 

Join Megan for her webinar on this topic, Working With Special Populations: Autism Spectrum Disorder (ASD) Fitness Integration

Dr. 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 a Ph.D in Health and Human Performance. She is a professional natural bodybuilder, fitness model, and published author.


Autism Speaks (2022). Autism diagnosis criteria: DSM-5.

Autism Diagnosis Criteria: DSM-5 | Autism Speaks

Centers for Disease Control and Prevention (2022). Data and Statistics on Autism Spectrum Disorder. Data & Statistics on Autism Spectrum Disorder | CDC 

Hodges, H., Fealko, C., & Soares, N. (2020). Autism spectrum disorder: definition, epidemiology, causes, and clinical evaluation. Translational Pediatrics9(Suppl 1), S55– S65. https://doi.org/10.21037/tp.2019.09.09


Increase Core Strength by Improving Your Breathing

“Core strength” is a popular fitness buzz term, but what’s the big deal all about? Core strength is essential for all our movements. The core is a collection of muscles that stabilizes the central muscles in our torso and spine. As our body’s center, our core has the big task of holding us upright. A strong core makes everyday activities easier to do.

You might think core training is all about lying on a yoga mat doing interminable “crunches.” But there’s way more to core training than aiming for a flat tummy or a “six-pack.”.

Importantly, you use your core when you put on shoes and when turning to look behind you. Likewise, reaching that box on your top kitchen shelf, or sitting in a chair are activities rely on a strong core. In fact, you might not notice a weak core until these activities become difficult or painful. Significantly, a strong core is also how you avoid back pain as you get older.

Breathing Helps Build Core Strength

The key to building core strength is by employing stomach-based, diaphragmatic breaths, so that our torso and ribcage expand forward, back, and to the sides. Breathing in is bodyweight exercise that lengthens the transverse abdominis muscles and obliques, which helps build core strength. Breathing correctly can increase flexibility and lower the risk of exercise-related injury. Also, a strong core helps with things like balance, and, oh yeah… it makes you look thinner.

4 Common Breathing Problems

1.Your neck, chest, and shoulder muscles feel tight. If you carry a lot of tension in the muscles around and under your neck, those muscles may feel painful or tender. Poor diaphragmatic control can cause neck and shoulder muscles to become short and tight. Slouching means you’re not activating your diaphragm when you breathe.

2. You sigh, or yawn frequently. If you must take a deep breath, sigh, or yawn every few minutes, it’s a sign that your body isn’t getting enough oxygen when you breathe.

3. You breathe with your mouth open. Unless you have a sinus infection or congestion that prevents you from breathing through your nose, your mouth should be closed as you breathe.

4. Your resting breath rate is too fast. A normal, resting breath rate should be about 12-20 breaths per minute. If the number of times you breathe each minute is too fast, your breathing is probably shallow. A normal respiratory rate keeps the balance of oxygen and carbon dioxide even in the body.

4 Ways to Practice Correct Breathing

1. Keep your shoulders still. Sit in a chair that has arms on the side. Support your arms and elbows by the arms of the chair. As you inhale through your nose, push down onto the arms of the chair. Exhale while you purse your lips and release any pressure on the arms of the chair. The purpose of this exercise is to keep you from elevating your shoulders as you inhale, which can cause upper chest breathing.

2. Slow your breath. Pursing your lips forces you breathe more slowly. Start by creating as small an opening as possible in your mouth when you breathe. Imagining you’re blowing through a straw or blowing at a candle only hard enough for it to flicker, but not blow it out. Breathe in through your nose for 2-4 seconds, then breathe out for 4-8 seconds, keeping your lips pursed. Repeat this for about 3-5 minutes.

3. Use upper chest resistance. Lie on your back, place a hand on your upper chest, apply slight downward pressure to the hard bone (your sternum) in the middle of your chest and maintain that pressure while you inhale and exhale. This will force you to “bypass” your chest while breathing and start to breathe from deep within your belly.

4. Blow up a balloon. When you blow up a balloon, you activate your abdominal muscles, align your spine and pelvis, and contract your diaphragm. Blowing up a balloon works your deep core muscles. It also requires all your mid-section muscles to work together. Sit on a chair with a straight back, or the floor against a wall, with your knees bent and your feet flat on the ground without leaning against the chair back or wall. Inhale deeply from your nose with your mouth closed, pushing your belly out. Then exhale by blowing slowly into the balloon, exhaling as much air as you can. Your deep abdominal muscles activate as you blow into the balloon.

Jacqueline Gikow, whose holistic, health and wellness practice centers on pain relief through better movement, is the owner of Audacious Living NYC™. She is certified through the National Association of Sports Medicine (NASM), the National Board of Medical Examiners (NBCHWC), the Functional Aging Institute (FAI), Medfit (MFN), and the Arthritis Foundation (AFAP/AFEP). Her fitness practice includes in-home and remote, one-on-one fitness training and coaching in New York City. Visit Jacqueline’s website at audaciouslivingnyc.com, or on Facebook.




To Spoil or Not to Spoil…That is the Question

Personal Trainers, do you SPOIL your clients?

Do you keep your clients reliant on YOU?

I used to think this was a good practice. I even thought of it as Full-Service Personal Training. But in hindsight, I wasn’t teaching my clients to be responsible for their health and fitness.

I enjoy serving my clients, bringing their dumbbells to them, taking their dumbbells, and re-stacking them. I let my clients get comfortable on the bench before giving them the bells or bar to press. I move Bosu balls and re-adjust TRX straps for my clients constantly. I have spent many hours wiping down equipment for my clients before and after use. I have adjusted weight machine bench heights, placed pins in plates, safety hooks on barbells, and the list goes on and on and on.

I thought this action was being kind and a good service provider. I am willing to bet many of you have also done this with your clients.

Flash forward 30 years in the industry. I am about to have hand surgery on my dominant hand. It is a minor surgery, but surgery non the less, and I will not be able to serve my clients in this same way while I am healing.

I have spent the last month teaching my clients how to load and de-load dumbbells safely from a bench press and how to set each weight machine for their height. Many of my clients didn’t even know how much weight they had been lifting; they just did what I said and trusted me to hand them the proper equipment.

I have spent time explaining the lengths of the TRX straps for different exercises and shown them how to adjust the straps by themselves.

This has been a big lesson for me. Doing everything for our clients only creates a client with a considerable amount of dependency on you, the trainer. This, in turn, produces less self-efficacy outside of your sessions, resulting in less progress towards their fitness and health goals.

As Professional Fitness Trainers, our ultimate goal is for our clients to be healthy. We may not always be there for them. What if you move or they move? What if you have surgery or an accident? Make sure your clients can care for their fitness with knowledge and safety.

Don’t get into the habit of full-service training. If you already have been doing it as I was, begin the de-programming process for your clients. That is the best long-term way to serve them and their health goals.

I know what some of you are thinking – if they can do it all independently, they won’t need us anymore. However, I’m afraid I must disagree. Your job is to program well and continually challenge your clients appropriately for their fitness level and health goals. If you continue to do that while educating them on the how and why of what you are doing, the sky is the limit for their success and yours! Happy Training!

Shannon Briggs is a multi-passionate fitness professional and educator. She brings 30-plus years of experience to a long, fulfilling career in the fitness industry. In the past 13 years at the University of Texas at Austin, Shannon has led continuing education workshops in multiple group fitness formats and topics specific to personal training; she also has written the curriculum and manuals for numerous workshops accredited by the American Council on Exercise (ACE). Shannon is currently a monthly contributor to Campus Rec Magazine for Fitness and Wellness.

creatine (2)

The Benefits of Creatine Supplementation for Active Older Women

Loss of muscle and bone mass is arguably the greatest potential threat to vitality and independence in the aging female population. As ovarian estrogen declines during the menopausal transition, muscle and bone undergo significant changes.

Muscle mass and strength decline and loss of bone density accelerates after the onset of menopause. When these losses become severe, there is an increased risk of disabling falls and fractures and associated higher rates of medical comorbidities including high blood pressure, type 2 diabetes, depression, and cardiopulmonary disease.

Previously, in Athletic Aging, I posted about this very issue. Grip Strength as a Marker of Vitality in Mid-Life Women and Body Composition and Hormone Therapy – Truth and Tales are two articles that discuss the interplay among female reproductive hormones, muscle mass and function, body composition, and metabolism.

But it’s not just about muscles and bones! Mid-life women also struggle with sleep deprivation, brain fog, depression, and mood lability.

Today we continue this important conversation and take a deep dive into the science that explores the potential benefits of creatine supplementation in mid-life women that go beyond our muscles and bones!

How Does Creatine Work?

Creatine is a naturally occurring compound that is synthesized in the Human body by the kidneys and liver from the amino acids glycine and arginine. It is stored as phosphocreatine which supplies the energy that fuels muscle movement. Creatine is also found in animal proteins such as red meat, fish, poultry, and organ meats.

The phospho in phosphocreatine is a critical component for the production of adenosine tri-phosphate (ATP) found in tiny cell components called “mitochondria” that exist in every type of cell throughout the body. Think of the mitochondria as the “batteries” that power the cells within our tissues, and ATP as the “charge”. The “T” stands for tri -or 3 phosphates which is like 3 “bars” on your cell phone. When energy is used, ATP is converted to ADP – the “D” is for di- or 2 bars on your phone. So to recharge your phone to 3 bars (ATP), you need to plug it into the electrical outlet. Creatine serves as the source of energy to fully charge the mitochondria and replenish the stores of ATP.

What the Science Tells Us

Athletes have effectively used creatine supplementation for decades to support performance. Creatine is among the safest and most well-studied supplements in the sports industry.

Most of what we know about creatine was learned through the study of young, male athletes. Creatine has been shown to be effective in enhancing muscle strength, mass, and performance in strength-based activities. Because the aging population is particularly vulnerable to loss of muscle mass and function, attention has been turned toward investigating the potential use of creatine supplementation for preserving muscle mass and function in older individuals – particularly menopausal women.

A review of several randomized control trials and meta-analysis of studies investigating creatine supplementation in older female adults has discovered the following:

  • Women have 70-80% lower creatine stores and consume lower dietary amounts of creatine compared to men.
  • Declining estrogen levels are associated with increased inflammation and oxidative stress and may contribute to the reduction in protein synthesis and response to anabolic stimuli. Creatine supplementation has been proposed as a counter-measure to the inflammatory effects of declining estrogen.
  • Creatine supplementation with a high-dose load and maintenance of 3-5g daily in the absence of resistance training had minimal impact on muscle mass, strength, function, and bone density parameters in menopausal women.
  • Although studies have shown mixed results, the vast majority of research shows improvement of muscle strength, function, and bone density parameters with supplementation of 5g of creatine daily when combined with a consistent, long-term strength-training program of 3 months or more in menopausal women ages 50-65+.
  • There were no significant adverse effects of creatine supplementation in menopausal women across multiple studies.
  • Clinical evidence has reported positive effects of creatine supplementation on mood by restoring brain energy levels and balance. Evidence also suggests that creatine supplementation may favorably impact the dopamine and serotonin systems.
  • Creatine supplementation has consistently demonstrated improved cognitive performance and brain function, particularly in cases of sleep deprivation and mental fatigue. This is important given many mid-life women struggle with vasomotor symptoms (hot flashes) and disrupted sleep.

Summary of Recommendations for Mid-Life Women

  • Engage in a program of consistent (at least 2-3 times weekly) resistance/strength training as a permanent part of your long-term workout program.
  • Daily supplementation of creatine monohydrate may improve muscle strength, mass, function, bone density parameters, and body composition when combined with a consistent resistance/strength training regimen.
  • Dosing: Many experts agree a loading dose is not necessary. A daily dose of 5g/day (ideally in a shake, beverage, or with food) over time will achieve appropriate tissue saturation levels. *Vegetarians may require a dose of 5-10g daily.
  • Check out this podcast featuring Dr. Darren Candow, one of the leading creatine researchers for an incredibly informative review of how creatine works and the potential benefits of supplementation.
  • If you have chronic conditions involving your kidneys or liver, check with your doctor before incorporating creatine into your nutrition plan.

Article reprinted from Athletic Aging with author permission.

Dr. Carla DiGirolamo is a double Board-Certified Obstetrician/Gynecologist and Reproductive Endocrinologist who specializes in the care of reproductive age and mid-life women. Carla completed her residency training in Obstetrics and Gynecology at Brown University Medical School/Women and Infants’ Hospital and her Reproductive Endocrinology training at the Massachusetts General Hospital at Harvard Medical School. She is a North American Menopause Society (NAMS) Certified Menopause Practitioner and has been featured in multiple podcasts and speakerships at various events discussing the physiology of the hormonal changes of menopause, hormone therapy and functional fitness training.



Smith-Ryan, AE et al. Creatine Supplementation in Women’s Health: A Lifespan Perspective; Nutrients 2021, 13, 877. https://doi.org/10.3390/nu13030877Ellem

Pinheiro dos Santos, E et al. Efficacy of Creatine Supplementation Combined with Resistance Training on Muscle Strength and Muscle Mass in Older Females: A Systematic Review and Meta-Analysis; Nutrients 2021, 13, 3757. https://doi.org/10.3390/nu13113757


Watch Your Step

Because I’m a lifelong advocate of fitness walking and injury-free walking, I’m always trying to come up with the simplest way to get walkers to move along the ground in a way that produces the least amount of impact to the feet, knees, hips and lower back. The answer to this dilemma is different depending on whether you’re walking or running. I’ll begin with you walkers.


Taking Fear from Foe to Friend

Step One: Acknowledge and Accept Fear  

Acknowledging and accepting your fear is the first step toward limiting its power over you. Acknowledgement requires you to admit that you have fears, and acceptance requires you to realize their power. Congratulations, you are human! We all have fears, but the ways they affect our lives depends on the relationship we choose to create with them.  

  • Don’t be a Denier. Deniers bury their fears so deeply that the fears often go unrealized, gaining an unknown power over the Denier. The danger is that at any moment, the Denier may be confronted by their formerly hidden fears, which seem to come out of nowhere, overwhelming the person’s thoughts, decisions, and actions. Just because you  deny them doesn’t mean they don’t exist. 
  • Don’t be a Pretender. Pretenders admit their fear, but rely on their ability to vanquish, destroy, eliminate, and ultimately control it. They live under the misguided belief that they can make fears disappear. The problem arises when the fear the Pretender thought was destroyed comes back with a vengeance at an inopportune time. As with the Denier, that re-emerged fear can affect thoughts, decisions, and actions, potentially  placing the person on the pathway to unwittingly forfeit their dreams.  

Once you acknowledge the existence of your fear and learn how to address it productively instead of fighting it, you reclaim some of your power over it.  

Step Two: Find Your Fear’s Origins  

  • Determine where your fear originates and gain a deeper understanding of yourself. Knowing “the why” is a power diffuser. Is your fear based in lack of self-worth, self-love, self-doubt, rejection, or feelings of failure, or trepidation of success? If so, where did  this emotional trigger come from? Examine the negative assumptions you are making  and determine their source. This could be a childhood experience, something someone  said that you internalized, or some other event that created a negative self-assessment, which in turn is creating a fear. Knowledge is power, and it places you on the pathway toward healing.  
  • Take action to heal your fears’ origins. Healing comes through loving yourself and  seeking a deeper and richer understand of your authentic core. In my book, Yes! Commit. Do. Live, I explain, your “passions, loves, talents, gifts, and desires, along with  your character values, all inform and empower you.” These elements form your inner core. So let your fears reveal more of this inner core and show you something important that you may not have recognized. For example, if you have a fear of public speaking, a deep dive into your inner core could unearth your talent for storytelling, listening, and  using empathy to connect with others. Nurturing those talents, which are all  components of a great public speaker, would empower you to meet your public  speaking fear. So, use that inner core power to meet and ultimately tame your fears.

Step Three: Focus on the Positive  

  • First, ask yourself what opportunities and adventures are now presented due to the fear  that has arisen. What possibilities for building new talents and skills are now open that were previously closed to you? Write them down and celebrate them as “what can be,” and then start envisioning them as “what is.” For example, that fear of public speaking could be preventing you from experiencing new opportunities in your career, family,  and friendships that could change your life. By focusing on the positive aspects of what  can be and the emotions that flow from that positive outlook, you shift your mindset away from negative thinking.  
  • Second, remember that negative thinking is often at the core of our fears. Without facts or evidence, we allow negative thoughts to paralyze us and convince us that  defeat/disaster is inevitable. By choosing to focus on the positive outcomes we can gain from facing the challenge, we gain power over negative thinking.  

As a state and federal prosecutor, I was afraid at the beginning of every trial. What if I didn’t succeed? What if I made a mistake? However, none of these fears were based on facts. By focusing on creating a positive outcome for the victim and empowering them through the trial  process, I could move forward through my fear. According to Andrew Newberg, M.D., and Mark  Robert Waldman in Words Can Change Your Brain: 12 Conversations Strategies to Build Trust,  Resolve Conflict, and Increase Intimacy, a single positive or negative word can actually alter our brains. There is neurological power in positive thinking, so the time is now to live in the  positive.  

Step Four: Transform the Feelings  

  • You can use your body’s responses to gain more control of your fears. What happens to you when fear arises? According to MedicalNewsToday, for some people, their limbs shake, their breathing becomes shallow, their mouths get dry, and their hearts race. While these reactions may on the surface seem negative, those physical manifestations  are tied to the excitement of the moment.  
  • Once you are aware of your fear responses, redefine them. Remember, there is power in positive-thought realignment. When I left the practice of law to begin a singing career, during my early musical auditions, I was confronted with the physical manifestations of fear. I had a choice. I could allow those manifestations to derail my singing career, or I could retrain my brain and body to create a new understanding of  what those manifestations represented. I chose the latter—and you can, too. Here’s  how: 

Redefine those manifestations and repeat the new definition continuously until they feel real.  Repeatedly tell yourself this new positive understanding:  

  • My body’s shake is the energy surge that fuels my excitement. 
    • My shallow breathing is my body’s signal to slow down and take in rich oxygen.
    • My rapid heart rate is my body’s preparation on a cellular level to ready me to  step into my excellence.

Visualize your success over your fear and allow the positive emotions that flow from that  success to flood your body, head to toe.  

Find your calm and peace the “DDB” way—engage in deep diaphragmatic breathing. At each fearful moment, use the 5-5-5-5 breathing pattern: Inhale for a count of five, hold for five, exhale for five, and repeat for five. This practice allowed me to stay present and focus on the beauty of the moment.  

Reset those feelings further by recording your successes and focusing on each time you were able to feel the fear and do it anyway. I allowed every positive audition to reinforce my new positive understanding of my body’s response to each exciting opportunity. This process of transference turns negative thinking positive.  

Step 5: Look at Fear as Your Friend and Celebrate It!  

Fear is an extension of ourselves. It moves us. It represents a chance for a beautiful life transition. Fear offers an opportunity for immense growth and introduces us to new and wonderful challenges. It can be a gateway to the most beautiful, exciting opportunities, helping  you to unleash talents and unearth new passions.  

By taking the preceding steps, you are able to tame your fears. Remember, fear is not a villain, so there is no need for an epic battle. Instead, fear requires a relationship with yourself. It is a welcomed companion, a catalyst for change to constantly challenge your status quo. So, the next time you feel fear, ask, “What opportunity lies on the other side?” Challenge yourself to live through it. Do what makes you shake! Do what makes you shy away! It may not  be easy, but it’s essential for continued breakthrough as you journey to your highest state of  excellence.  

When you’re willing to feel the fear and move forward anyway, you position yourself to truly  write your story, live your purpose, elevate your thoughts, visualize your success, and live a life  without regret and with passion, laughter, self-determination, and endless optimism.  

Join Lisa for her webinar, How to Take Your Fears from For to Friend

Lisa Charles is a federal prosecutor turned singer/actress, wellness expert, certified health coach/consultant, and an acclaimed speaker. She served as the Fitness/Wellness Research Coordinator for the Rutgers University Aging & Brain Health Alliance, and is the CEO of Embrace Your Fitness, LLC, and the Author of YES! COMMIT. DO. LIVE.

  • Join my email list at yescoachlisa.com
  • lisa@yescoachlisa.com
  • IG: @lisaembracefitness

10 Keys to Planning for Your Health and Fitness Needs

Being proactive beats reacting every time. With our nation’s level of fitness deteriorating with each passing year, I thought it important to highlight these 10 keys. I am evaluating what it is that I may want to change in my own world and by sharing these thoughts with you hopefully move you to such a review as well.

1.  Get a physical

As a nation we are not being proactive when it comes to our health and as a result we are over medicating ourselves and creating other significant health related problems as a result. Being on drugs is not an effective way to maintain our health – making healthy choices instead is a far better strategy for preventing illness and disease in the long run.

2.  Get “real”

Being “real” with yourself starts with an honest evaluation of where you ARE in your physical and mental – and emotional life. Dumping old behaviors – and attitudes – that are no longer serving you is a place to start. Another step we can take is to get moving – doing whatever you can to positively move in the direction of what I call “your highest good”. We all have something we are here to do in life so get going and don’t waste a single day. Writing these articles is part of what I am to do so I am writing them!

3.  Get moving

By way of reminder – we are meant to be active beings – not sitting beings. Find out what it is you enjoy doing and get moving. Your body will thank you every day you do this. I know how I feel after I run and lift weights and it is in one word — happy.

4.  Get a handle on your stress

We are all stressed at some point during our day so why don’t we start working on strategies for dealing with the stresses – and stressors – in our lives BEFORE they happen. Being proactive in stress management means knowing we are going to have to deal with stress in our lives so why don’t we practice before the event or stress occurs? I have passed on some of my strategies in prior articles: Meditation, prayer, visualization work, focused breathing, running, quiet reflection, etc. These and other techniques are readily available and can be learned through classes and other forums.

5.  Get excited

Getting excited about life fuels our imagination and creativity. The more I think about my potential to make a difference in the world the more excited I become about each day of my life. The same experience can happen to you if you are open and receptive to what your subconscious is trying to tell you. The world of technology is taking away our ability to “go into the silence” and discover what life has in store for us. The “noise” we face every day is keeping us from hearing anything that could be of help to us in planning for it is we may want to do – and accomplish. Take a moment and ask yourself “am I living up to my full potential and if not what can I do about it?”

6.  Get clear on your purpose

Purpose driven people are happy people and they are self-actualized – meaning they don’t need someone to tell them what to do, think, feel, say, or do. They approach life from a position of “real power” and at the same time are able to acknowledge the uniqueness of each one of us. I got an email today from a reader telling me I would go to hell if I didn’t believe what he did and my response is – “it’s a free country and we get to live our lives the way we choose”.  I am empowered and energized by this thought. I am free – as are you – to live a purpose driven life or stay on the path you are on. We are ALWAYS “at choice” so CHOOSE YOURSELF TODAY!

7.  Get close to “real” people

This key is important in today’s world. “Friends” are NOT on the internet – they are in our REAL lives. Be aware that we need each other. Make it a point to be kind to others – smile, acknowledge them when you can, call people by their names and look them in the eyes when you speak to them. People are what make life worth living – not the cyber world of “fake” experiences and relationships.

8.  Get close to your family

My daughter is going through a difficult time in her life right now. She is facing challenges that are most uncommon and have her living “on edge” every day. She has a 7 year old son who needs her and a career in business to re-establish and beyond. I spoke with her last night and told her “I am here for you – whatever you need”.  As a father I sometimes feel helpless because she is a grown woman but she is still my daughter and I love her. It is my job now to just be her father and love her – tough as that may be for me. Take this step in your own life in the coming year and see what happens – you might surprise yourself at how your family responds to you.

9.  Get serious about your own health and fitness

Time has a way of marching on and to the degree that you acknowledge the passage of time you begin to appreciate what you have been given – and have in life. I am grateful everyday for my passion for training and running because I know it can be taken from me at any time. I live in the present when I am running or lifting weights and it is a practice I hope to continue until the end. I am serious about my fitness program because it gives me the energy and strength to do my work – teaching, speaking and writing on matters of healthy aging, fitness and exercise. Are your energy levels low? Get moving!

10.  Get to know yourself

This is perhaps the best thing we could do to prepare for the year ahead. Get to know yourself and start appreciating the magnificence that is you. Getting to know your self is a lifelong pursuit. The journey never ends.  I have learned during the course of my 66 years that I DID NOT appreciate myself at all – I had to learn the hard way through difficult and painful experiences that until I could love myself – and appreciate what it is I am here to do – that no one would ever appreciate – or love – me either. I spend time (each day) thinking about my life – and my contribution to life itself – and ask myself “is there more that I can learn or do today?” You should do this too – it will help immeasurably improve the quality of your life now and in the years ahead.

Final Thoughts

Why not take the time between now and the end of the year to see what you might want to work on in the year ahead and see how you can live more fully and completely.  Can you make a more expansive contribution to your own life and the lives of others as well? Of course you can! Isn’t this what the fitness lifestyle enables us to do in the first place? So get moving, be willing, be open, and appreciate who you ARE right now because you have only scratched the surface of your potential!

Reprinted with permission from Nicholas Prukop.

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


Are You At Risk? The Link Between Autoimmune Disease & Heart Health

Severe RA Doubles the Risk of Heart Disease1

In the last few decades, researchers discovered that the burden autoimmune diseases like rheumatoid arthritis (RA) puts on the joints during the first year of diagnosis is a strong predictor of heart disease.2 In fact, it is recommended that doctors who diagnose patients with RA should also be addressing potential heart risks.

There have been several new studies from the Mayo Clinic that show a strong connection between inflammation and heart health. Therefore, it is important to address both conditions at the same time.

Dr. Eric Matteson, chair of rheumatology at the Mayo Clinic, says that people with rheumatoid arthritis and other chronic inflammatory conditions are at a much higher risk of heart disease. In fact, people with severe RA are twice as likely to develop heart disease. Matteson believes that the inflammatory process of arthritis plays a key role in maintaining a healthy heart.

Therefore, if you have been diagnosed with an autoimmune disease such as rheumatoid arthritis, it is imperative that you meet with a cardiologist. Autoimmune diseases are known to not only affect the joints in your body by causing painful stiffness and inflammation, but also negatively affect major organs such as the heart.

One symptom that can develop from an autoimmune disease diagnosis such as RA is vasculitis, or inflammation of the blood vessels that move blood throughout the body. “As the blood vessels become inflamed, their walls thicken, limiting how much blood can pass through them. As a result, if blood flow is restricted, this could cause significant damage to tissues and organs.” 3

Because rheumatoid vasculitis (RV) is a non-joint-related inflammatory complication of RA, it can affect anyone.4 If you or a loved one have been suffering with RA for many years and developed severe joint damage and deformity, it is important to make an appointment to get your heart checked.

What causes vasculitis?

Researchers are not sure exactly what causes rheumatoid vasculitis. Like RA itself, most cases of RV can be considered autoimmune diseases. An autoimmune disorder occurs when the body’s immune system mistakenly attacks healthy tissues.

Several factors are thought to play a role in whether a person with RA will go on to develop RV, including whether you have:

  • Severe, long-standing RA for 10 or more years
  • Seropositive RA (a high concentration of rheumatoid factor antibodies and certain proteins in the blood)
  • A history of smoking cigarettes, which can damage the blood vessels’ lining
  • Felty syndrome, a complication of rheumatoid arthritis that results in low white blood cell levels and an enlarged spleen
  • Rheumatoid nodules, firm lumps under the skin that form around the joints

The Facts

According to the CDC:

  • One out of every four people in the United States dies from heart disease.
  • Heart disease is the leading cause of death for men, women and people of most racial and ethnic.
  • One person dies every 36 seconds in the United States from cardiovascular disease.
  • People with autoimmune diseases are at a much greater risk for heart disease.
  • Making lifestyle changes to your diet, exercise, sleep and stress greatly reduces risk.
  • In some cases, medicine reduces risk.5

Therefore, if you or a loved one suffer from an autoimmune disease, be sure to schedule an appointment with a trusted cardiologist for a check-up. The most important step you can take to reduce your risk for developing heart disease is taking action.

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


  1. Krans, B. (2013, October 27). Mayo Clinic: Ra can drastically impact heart health. Healthline. Retrieved June 6, 2022, from https://www.healthline.com/health-news/arthritis-ra-raises-your-risk-of-heart-disease-102713
  2. Krans, B. (2013, October 27). Mayo Clinic: Ra can drastically impact heart health. Healthline. Retrieved June 6, 2022, from https://www.healthline.com/health-news/arthritis-ra-raises-your-risk-of-heart-disease-102713
  3. Menard, V., & Teitel, A. D. (2021, May 6). Vasculitis: The risks of ra inflammation. myRAteam. Retrieved June 6, 2022, from https://www.myrateam.com/resources/vasculitis-the-risks-of-ra-inflammation
  4. Menard, V., & Teitel, A. D. (2021, May 6). Vasculitis: The risks of ra inflammation. myRAteam. Retrieved June 6, 2022, from https://www.myrateam.com/resources/vasculitis-the-risks-of-ra-inflammation
  5. Centers for Disease Control and Prevention. (2022, February 7). Heart disease facts. Centers for Disease Control and Prevention. Retrieved June 6, 2022, from https://www.cdc.gov/heartdisease/facts.htm

Leg Length Discrepancy: Is it Causing Your Pain and Dysfunction?

In order to design effective corrective exercise programs that both alleviate pain and improve function, fitness professionals must understand their clients’ strengths, limitations, and weaknesses.[1] This includes having an awareness of common structural imbalances such as leg length discrepancies (i.e., when one leg is shorter than the other). While it is not within a fitness professional’s scope of practice to diagnose a leg length discrepancy (LLD), it is extremely important that personal trainers and fitness instructors understand the ramifications of this imbalance and how it can affect a client’s musculoskeletal system.

Types and Prevalence of LLD

There are two types of leg length discrepancies: functional and anatomical. A functional leg length discrepancy refers to a musculoskeletal imbalance where any number of structures (or muscles) in the body are not working as they should. This results in parts of the skeleton being pulled out of alignment making it appear as though one leg is shorter than the other. Alternatively, an anatomical leg length discrepancy occurs when the bone(s) in one leg are actually shorter/longer than those in the other.[2] As the possible cause(s) of a functional leg length discrepancy are wide and varied, this article will focus on anatomical leg length discrepancies and how they affect your client’s body.

Anatomical, also known as true, leg length discrepancies have been found in as much as 95% of the population.[3] However, significant leg length discrepancies of more than one centimeter are found in about 1 out of 4 people.2 True leg length discrepancies affect the entire musculoskeletal system and play a substantial role in the health, function and experiences of pain for your clients.[4]

How LLDs Affect the Body

The body is designed to be dynamic and can adjust incredibly well to varying movements and positions. However, a true leg length discrepancy (that is left untreated) causes bones and joints to shift out of alignment, soft tissue structures like muscles, tendons, ligaments and fascia to compensate/overwork and can lead to pain and injury over time.[5] Some major areas of the body that are affected by a LLD discrepancy are the lower back, hips, feet and ankles.

LLD and the Lower Back

The pelvis forms the base of support for the spine. Therefore, a level and well-balanced pelvis is critical for spine health and optimal lower back function. In order to comprehend how an LLD can affect the spine and lower back, it is imperative to understand the structural anatomy of this area. Either side of the pelvis is made up of three bones (i.e., the ilium, ischium and pubis) that are fused together.[6] However, independent movement of each side of the pelvis is possible due to two important joints located in the pelvis. One of these joints is called the sacroiliac joint (SI joint). The SI joints are located on either side of the back of the pelvis where the top of the pelvis (i.e., the ilium) meets the base of the spine (i.e., the sacrum). The other joint is located on the front of the pelvis where the pubic bones (i.e., pubis) meet (i.e., the pubic symphysis) (see picture below).[6] Since the base of the spine articulates with each side of the pelvis via the sacroiliac joint, movement of the pelvis affects movement and function of the spine.

In addition to interacting with the spine, each side of the pelvis also articulates with the corresponding leg via the hip socket. From a skeletal point of view, the height of each side of the pelvis is governed, in part, by the length of the leg on that side of the body. If one leg is longer than the other then the pelvis will likely also be higher than that same side (see picture below).[2]

If the left side of the pelvis is higher due to a leg length discrepancy, then the base of the spine (i.e., the sacrum and coccyx) will shift toward that side also causing a compensatory shift in the rest of the spine all of the way up to the neck and head.[2] Therefore, a leg length discrepancy can cause pain and irritation to the joints of the pelvis, the intervertebral discs of the spine and the muscles and other soft tissues that help stabilize and mobilize these areas.

LLD and the Hips

The relative length of each leg also affects the position and function of the hip socket. As one side of the pelvis elevates in compensation for a longer leg, the hip socket shifts laterally toward the longer side.[2] Consequently, the hip of the longer leg will shift to a position outside of the foot/leg (see picture below).

These compensation patterns in the hip/leg can cause various aliments for clients such as greater trochanteric bursitis, iliotibial band syndrome, tracking problems of the knee, and sacroiliac joint dysfunction.

LLD and the Feet/Ankles

Leg length discrepancies can also affect the function of the feet and ankles. Pronation, or a flattening out of the arch of the foot, is a common compensation for clients with an LLD to effectively shorten a longer leg by reducing the height of the arch. Conversely, supination effectively lengthens a shorter leg by increasing the height of the arch. As such, a common compensation pattern for someone who presents with a LLD is to overpronate on the side with the longer leg and over supinate on the shorter side. These imbalances in the feet typically display with compensatory shifts in the ankles as well. Overpronation is usually accompanied by an ankle that rotates in too much, while a supinated foot is accompanied by an ankle that rotates out too much.[5] These misalignment issues in the feet and ankles can lead to ankle sprains, Achilles tendinitis, plantar fasciitis, ankle impingement and a whole host of other painful problems.

How to Help a Client with a Suspected LLD

Being aware of the signs and symptoms of a suspected LLD will help you know when to make appropriate referrals to a licensed medical professional who can diagnose a client’s condition with the help of advanced imaging techniques (i.e., x-rays and CT scans). Developing a professional referral network that you can turn to for help with issues that fall out of your scope of practice allows you to provide a more comprehensive service for your clients. It also enables you to create long-lasting relationships with like-minded professionals who will act as a referral stream for your business.[7]

Once the appropriate referral and LLD diagnosis has been made, your allied medical professional will develop a treatment plan that may include a shoe lift. Your role, as an expert in muscles and movement, is to design corrective exercise strategies that help your client adapt to the shoe lift and the resultant new position of their head, neck, pelvis, spine, hips, feet and ankles. The golden rule of any exercise program – gradual progression – should govern every aspect of your client’s LLD treatment. Encourage clients to introduce their lift gradually when acclimatizing to their new leg length and follow the underlying doctrines of corrective exercise program design: utilize self-myofascial release strategies in the initial stages of adapting to the lift; progress to stretching and only conservatively add strengthening exercises after the client has had at least six months to a year to get used to their new leg length.

Justin Price is one of the world’s foremost experts in musculoskeletal assessment and corrective exercise and creator of The BioMechanics Method Corrective Exercise Specialist certification (TBMM-CES).  The BioMechanics Method is the fitness industry’s highest-rated CES credential with trained professionals in over 70 countries. Justin is also the author of several books including The BioMechanics Method for Corrective Exercise academic textbook, a former IDEA Personal Trainer of the Year, and a subject matter expert for The American Council on Exercise, Human Kinetics, PTA Global, PTontheNET, TRX, BOSU, Arthritis Today, BBC, Discovery Health, Los Angeles Times, Men’s Health, MSNBC, New York Times, Newsweek, Time, Wall Street Journal, WebMD and Tennis Magazine. 


  1. Bryant, C. X., & Green, D. J. (2010). ACE Personal trainer manual: The ultimate resource for fitness professionals (4th ed.). San Diego, CA: American Council on Exercise.
  2. Knutson, G. A. (2005, July 20). Anatomic and functional leg-length inequality: A review and recommendation for clinical decision-making. Part I, anatomic leg-length inequality: Prevalence, magnitude, effects and clinical significance. Chiropractic & Osteopathy, 13(11). doi:10.1186/1746-1340-13-11
  3. Pappas, A. M., & Nehme, A. E. (1979). Leg Length Discrepancy Associated with Hypertrophy. Clinical Orthopaedics and Related Research, &NA;(144). doi:10.1097/00003086-197910000-00034
  4. McCarthy, J. J., MD, & MacEwen, G. D., MD. (2001). Management of Leg Length Inequality. Journal of the Southern Orthopaedic Association, 10(2). Retrieved July 01, 2016, from http://www.medscape.com/viewarticle/423194
  5. Price, J. (2020). The BioMechanics Method Advanced Corrective Exercise Mentorship. The Biomechanics.
  6. Gray, H., Williams, P. L., & Bannister, L. H. (1995). Gray’s anatomy: The anatomical basis of medicine and surgery. New York: Churchill Livingstone.
  7. Price, J. (2018). The BioMechanics Method for Corrective Exercise. Champaign, IL: Human Kinetics.