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woman-walking-dirt-road

Restoring Health: A Lifestyle Rx

America is in bad shape. According to the Centers of Disease Control (CDC), 60% of adults are living with one chronic disease and 40% have two or more.(1)  Astoundingly, 12% of adults are living with 5 or more chronic conditions(2) including cardiovascular disease, diabetes, obesity, coronary obstructive pulmonary disease and hypertension. A concept people need to understand is that these diseases can be prevented, managed and even reversed with lifestyle choices.

The COVID-19 pandemic has shown a bright light on how our level of health can literally be a matter of life or death. A study of thousands of patients hospitalized with the novel coronavirus in the New York City area found that 94% had one chronic disease and 88% had two or more. The most common conditions included hypertension, obesity and diabetes.(3) In May of this year, the CDC reported that people with an underlying chronic illness had six times the risk of being hospitalized and twelve times the risk for dying.(4)

Boost Health & Immunity

Now is the right time to take small steps to improve health and build immune resilience with daily lifestyle choices. While there isn’t one diet, exercise regimen, or stress-relieving technique that is good for everyone, there are principles to follow that can boost health and vitality at any age.

There is a huge misconception that our genes determine our health destiny. This simply isn’t true. The study of epigenetics shows that we have the ability to change the expression of our genes by the way we think, feel, move and eat.(5) Each of our daily decisions and choices can increase or decrease inflammation in the body, moving us towards disease or back to health.

Acute & Chronic Inflammation

Our immune system uses the ancient, biological pathway of inflammation to protect us against injury and infections.(6) When you cut your finger, immune cells are sent to kill invading bacteria and begin the process of wound healing. This is acute inflammation that goes away in days or weeks when the body is healed.

One the other hand, chronic inflammation lasts a long time, from months to years.(2) It’s basically an abnormal immune response that causes damage to cells, tissues and organs. Oxidative stress plays a big role; it occurs when more free radicals are produced within cells than the body can neutralize.(2)  As you can imagine, when more damage occurs than can be repaired, health problems crop up.

It is now widely accepted that chronic inflammation is at the root of most, if not all, chronic conditions like cardiovascular disease, diabetes, obesity, hypertension, cancer, arthritis and joint disease.(2)

Lifestyle Matters

The good news is that deliberate and healthier lifestyle choices can prevent, manage and even reverse chronic inflammatory disease, the most important cause of morbidity and mortality facing people today.(7) It’s empowering to know that if you have, or want to prevent a chronic disease, you can regain your health and vitality by choosing real whole foods, optimizing sleep, reducing stress, being social, and moving more.

You may be thinking, “How the heck can simple lifestyle decisions address the complexities of chronic conditions?”  The body has an innate ability and intelligence to heal itself. You experience it each time you cut your hand; you wash the wound, put a bandage on and don’t have to think about it.

The research also supports it and I have lived it; by utilizing the power of lifestyle medicine I was able to restore my health from the ravages of chronic Lyme disease. You just need to provide the right environment for healing. This is not an easy task, but it can be done with time, effort and a plan.

Taking Action

Changing your lifestyle habits can feel overwhelming. To help you embrace this challenge, think about this analogy, “How do you eat an elephant?  One bite at a time!”   Any healing journey begins with awareness, learning and exploration; then gradually taking action, one small step at a time.

Start today by exploring lifestyle behaviors that decrease inflammation and can put your health back on track so you can live with less pain, more energy, and greater vitality. A lifestyle prescription to restore health includes:

  • Reducing stress with deep breathing.
  • Getting good quality sleep by going to bed and rising at the same time.
  • Eating a plant-based diet rich in a rainbow of vegetables.
  • Hydrating with filtered water in the morning and during the day.
  • Nurturing relationships and engaging with positive people.
  • Moving well with good posture when performing daily activities and exercise.

Be proactive, make one hour a week to learn more by reading books, researching on PubMed.gov, listening to podcasts, attending lectures and webinars so you can find the strategies and practices that work best for you. As you begin to feel better, you will naturally be motivated to continue learning and making better lifestyle choices because healthy feels so good!

Find a Fitness or Allied Health Pro Near You

Search the free MedFit Network directory to locate a professional near you! MedFit Network maintains a free directory of fitness and allied healthcare professionals who can work with individuals with chronic disease, medical conditions or the senior population.


Cate Reade, MS, RD is a Registered Dietitian, Exercise Physiologist and Functional Medicine Practitioner candidate on a mission to improve functional mobility and health span utilizing the power of lifestyle medicine. She has been teaching, writing and prescribing healthy eating and exercise programs for over 25 years. Today, as CEO of Resistance Dynamics and inventor of the MoveMor™ Mobility Trainer, she develops exercise products and programs that target joint flexibility, strength and balance deficits to help older adults fall less and live more.

 

References

  1. https://www.cdc.gov/chronicdisease/index.htm
  2. https://www.ncbi.nlm.nih.gov/books/NBK493173/
  3. https://www.the-scientist.com/news-opinion/nearly-all-nyc-area-covid-19-hospitalizations-had-comorbidities-67476
  4. https://www.cdc.gov/mmwr/Novel_Coronavirus_Reports.html June 19, 2020
  5. https://www.nature.com/scitable/topicpage/epigenetic-influences-and-disease-895/
  6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6345337/
  7. https://pubmed.ncbi.nlm.nih.gov/23974765/
Elderly woman with alzheimer

The Dark Side of Parkinson’s Disease: The FACE of Parkinson’s Disease, Part 2

Click to read part 1 of this article, covering background on facial masking, swallowing, vocal issues for people with PD.

As a fitness professional, you can help. The key is is knowing how to appropriately apply facial, swallowing and vocal projections drills to private and group sessions.  Below are some tips to utilize with your “fighters”.

Occupational Therapy Tips

Decreased facial expression

  • Practice recognizing emotions in other people and creating appropriate responses. These responses may include facial expressions and verbal communication. Practicing these reactions to others can help support relationships. 
  • The word, “affect” refers to the appearance of emotion through facial expressions, voice tone, and body language or gestures. If you have trouble with facial expressions, try to express yourself more through adding gestures or body language when you communicate.
  • Communicate your situation! Try explaining your trouble with facial expressions and decreased voice volume to people who may not initially understand.
  • Facial exercises: 
    • look in the mirror and practice your facial expressions.
    • hold a smile, raise your eyebrows as high as you can, bring your eyebrows together to frown,  open your mouth as wide to stretch your jaw, close your eyes tightly and open them wide, close your mouth and expand your cheeks, stick your tongue out and stretch it in each direction
    • Try to exaggerate your facial expressions and lip movements when you speak

Drooling

When eating:

  • Try to maintain good posture
  • Focus on keeping your chin up and lips closed when eating
  • Swallow often to limit saliva
  • Avoid sugary foods that create more saliva

Lip closure exercises:

  • Close lips tightly for 5 seconds and release (5 times)
  • Close lips around tongue depressor and hold while trying to pull from mouth for 5 seconds (5x)
  • Fill your cheeks with air and move the air from cheek to cheek (5×5 times)

Dysphagia (Swallowing)

Transferring food from a utensil to the mouth, chewing the food then swallowing and most likely socializing all at the same time without any problems is a task most people take for granted.  According to Dr. Jose Vega MD, PhD, three phases must occur in order to swallow properly.

  1. The Oral Phase: This phase begins when food is placed in the mouth and moistened with saliva. Moistened food is called a food bolus.
  2. The Pharyngeal Phase: As the food bolus reaches the pharynx, special sensory nerves activate the involuntary phase of swallowing.
  3. The Esophageal Phase: As food leaves the pharynx, it enters the esophagus, a tube-like muscular structure that leads food into the stomach due to its powerful coordinated muscular contractions. The passage of food through the esophagus during this phase requires the coordinated action of the vagus nerve, the glossopharyngeal nerve, and nerve fibers from the sympathetic nervous system.

Difficulty swallowing as it pertains to PD, reflects a deficiency of dopamine in the brain and often improves with medication and therapy/exercises. Drooling is also a symptom and is caused by reduced reflexive swallowing not from an overproduction of saliva but tends to improve with dopamine replacement therapy.  I have come to learn over the years that tremors and swallowing problems are usually the reason someone living with PD isolates themself.  It is embarrassing to finally get food on your utensil only to get it to your mouth and realize it has scattered all over the place or fear of aspiration which by the way may not always be heard. Aspiration can be quiet and lead to aspiration pneumonia, the leading cause of death in PD.

Care-partners and Fitness Professionals need to recognize the signs of aspiration as noted below. 

Coughing Before/After Swallowing

  • Trouble chewing 
  • Pocketing food inside the cheek
  • Gagging during a meal
  • Crying or face turning red while eating
  • Drooling especially during meals
  • Clearing the throat before/after and throughout the day
  • Hoarse during and after the meal

For this reason, Coaches at Bridges For Parkinson’s offers popsicles to our “fighters” at the end of class. And they love it! They can have a fun treat without the fear of dropping food and visit with others so it is a win-win! Plus, it allows us to make sure they are hydrated. Sneaky, sneaky!

If a person living with Parkinson’s Disease or their care-partner is not sure whether their loved one has a swallowing issue, the Parkinson’s Foundation provides some great questions to help determine the answer:

  • Have I recently lost weight without trying?
  • Do I tend to avoid drinking liquids?
  • Do I get the sensation of food being stuck in my throat?
  • Do I drool?
  • Is food collecting around my gum line?
  • Do I cough or choke before, during or after eating or drinking?
  • Do I often have heartburn or a sore throat?
  • Do I have trouble keeping food or liquid in my mouth? 

ORAL EXERCISES to help with strengthening and coordinating the LIPS

  1. Pucker up and blow a “oooo” then transition to an “EEEEEE” (SMILE BIG!)
  2. “MMMM” press lips together as much as possible and take a deep breath in and hum..         good for the lungs too.
  3. “Blowfish Hold” and hand isometrically pushes into cheek

TONGUE- ROM, Coordination and strength to help with eating and drinking

  1. Stick tongue out as far as possible and hold it there (add SPOON FOR RESISTANCE)
  2. Stick tongue out and up and hold (ADD SPOON FOR RESISTANCE)
  3. Stick tongue into sides of cheek (helps with food deposits)
  4. Roll tongue back and press against roof of mouth

In addition to swallowing exercises, meal prep aids in reducing issues brought on by dysphagia and may lower the risk of aspiration. The APDA Organization recommends the following nutritional information:

  • Foods that don’t require vigorous chewing. Avoid dry and crumbly foods.
  • Moderately textured wheat breads instead of very coarse, nutty breads or very soft, white breads.
  • Oatmeal, cream of wheat or moistened dry cereals instead of coarse, dry cereals.
  • Well-cooked, tender chicken/turkey, well-cooked fish without bones, chopped and ground meats, instead of stringy, tough meats that require a lot of chewing.
  • Soft casseroles and poached or scrambled eggs
  • Mashed potatoes or rice, moistened with gravy or margarine, instead of wild rice or French-fried potatoes.
  • Soft, cooked pasta elbows, instead of long spaghetti.
  • Soft, well-cooked vegetables, cut up or creamed, instead of raw vegetables or those with a hard texture.
  • Pureed or mashed fruits, fruit juices and fruit sauces, instead of fruits with seeds or hard outer skins. Avoid nuts, seeds or coconut.
  • Custard, yogurt, ice cream or other soft desserts

Speech

The article begins with a story of a grandmother experiencing dysphagia, hypomimia and hypophonia (softness of voice).  But people living with PD are not limited to hypophonia when it comes to speech problems.  Dysarthria and tachyphemia are additional speech issues people living with PD may experience.

Hypophonia or softness of voice is a condition that the Davis Phinney Foundation states 90% of people living with PD will experience. Characteristics of hypophonia include raspy voice, low speech volume, breathy and/or monotone speech.  

Dysarthria is another speech issue related to PD. It is characterized by poor articulation, respiration and/or phonation according to the National Aphasia Association.  Speech will come across as slurred, effortful and can often be mistaken for inebriated.  Doctors encourage people living with PD who are still driving to wear a bracelet to help law enforcement know they are not drunk.

Tachyphemia or acceleration of speech is also related to speech issues. A person struggling with tachyphemia will sound like all their words are jumbled together and often feel like their tongue is twisted.

While these issues are troublesome and frustrating, there are some easy and even fun ways to combat low volume, slurred and accelerated speech.  

  1. Music Therapy – therapy defined broadly by the American Music Therapy Association as “a treatment including creating, singing, moving to, and/or listening to music [through which] clients’ abilities are strengthened and transferred to other areas of their lives.” All over the country, Parkinson’s Choirs are using singing to help improve respiration, Swallowing and enhanced volume and clarity of voice.
  2. Breathing Drills- Strong lungs reduces risk of pneumonia and allows the person to complete ADL’s with little to no complications.  
  3. LSVT LOUD: an effective speech treatment for people with Parkinson’s disease (PD) and other neurological conditions. A study on hypophonia in PD reviewed the effectiveness of LSVT treatment for those with idiopathic PD and found that voice loudness significantly improved. Goals include: increased voice volume, improved articulation, increased confidence with communication, and changes in neural function related to speech (https://n.neurology.org/content/60/3/432)
  4. Speak Up For Parkinson’s App: Yes, an app with exercises that also provides visual feedback on volume.  

Exercises

  1. Breathe in and exhale on a vowel for 5 seconds.
  2. Hum for 3 seconds making sure to press the lips together then have the “fighter” say….
    Their favorite food or movie or color.
  3. Hum for 3 seconds then say the vowels, sliding the voice from one vowel to the next.
  4. Recite a poem with various emotions.
  5. Partner “fighters” and have them share jokes with each other. Whoever laughs the hardest wins!
  6. Close class or a session with a short song or team phrase . 

Fitness Professionals have the unique opportunity to incorporate exercises for the face, voice and swallowing while also performing strength and/or cardio exercises. You do not have to separate the two. It is a great way to challenge the cognitive aspects and  the physical, all while having fun! The best part is it creates a community moment which deepens their love and trust for you, the fitness professionals.  You are making a difference!’


Co-authored by Colleen Bridges, M. Ed, NSCA-CPT; Renee Rouleau-B.S., PhD student, Jacobs School of Biomedical Sciences, University at Buffalo; Kristi Ramsey, OTD, OTR/L.

 

References

Tattoos Sweat Less Gym

Tattoos & Heat Loss During Exercise

Tattoos are personal permanent images on our body that carry meaning and commemoration. At least 14% of U.S. adults have at least one tattoo and the popularity of getting inked is on the rise. Nearly 36% of millennials have a tattoo and it seems to be a reoccurring trend. The athletic community also has a high incidence of players with tattoos. 

As much color as these skin decorations bring to the body, they may actually affect cause thermoregulatory problems. This is particularly true for people with sleeves, because the arms have a lot of sweat glands. Compared to a person with no tattoos, skin with ink on it sweats about 50% less. The type of sweat released on a tattooed area contains more concentrated amounts of sodium. Dyed skin changes the saltiness of our sweat. When the dye is injected into the skin, its home is same layer where our sweat glands live. Sweat glands excrete liquid onto the surface of the skin, but before it dries or we whip it away, our skin usually reabsorbs quite a bit of the lost sodium and electrolytes. Tattoos block this reabsorption. The age of tattoo does not influence this sweat alteration. New or old, about 50% of sweat is being produced. It is possible that the sweat glands after being inflamed from the 3,000 or more needles puncturing the skin, are now physiologically different. 

This is not a serious condition to sweat about. The body is still able to cool itself down despite tattoos covering perspiration avenues. A person who is covered in tattoos, exercising or working in high heat, or are sensitive to heat, might be at risk. When we exercise we do want to be able to cool down to keep our stamina and performance up. Research has not been adequately performed to determine if the areas of the skin lacking tattoos make up for the sweat not readily perspired by the covered tattoo areas. Don’t worry that if you sweat less you will lose less weight. We all perspire different amounts and quantity of sweat does not equate to quantity of weight loss. As soon as the body become rehydrated, that water loss is replenished. Excessive sweating for weight loss with saunas or body wraps are popular methods among wrestlers and boxers. Maybe they should skip out on marking their bodies. 

Sweat is the body’s air conditioning system. Tattoos might alter the desired temperature. 50% of NBA players have multiple tattoos and there hasn’t been a report yet of tattoo related injuries. Your skin will still get shiny with perspiration, but maybe not the same amount or with added salt. Be sure to hydrate, be sure to exercise, and be sure to get a tattoo you want to keep. 


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.

 

References

bone-health-question-osteoporosis

Osteopenia: Beating Brittle Bones

I recall watching an advertisement on TV that was promoting a brand of milk that is enriched with calcium and vitamin D. The advertisement had a provoking animation of a woman, stooping gradually, as she gets visibly older. The message was that aging adults need higher intake of calcium and vitamin D to maintain strong and healthy bones – and their milk was the solution. Or is it? We know that our bones tend to become more fragile as we age. A proper name for this condition is called osteoporosis. But many of us are probably not aware that women are at a higher risk of developing osteoporosis, compared to men.

STRESS pencil

A Stress Management Plan for an Aging Population

April is National Stress Awareness Month!

Fortunately today, there are many tools to help individuals cope with stress. The first step is to acknowledge that you are stressed and to know what is stressing you. Once you are aware of your stressors, you need to make a stress management plan to follow. The journey may not be perfect but it is a work in progress. Most individuals aren’t going to know how to develop a plan or where to start. A trained individual such as a certified personal trainer can help to formulate the best plan for each client and make changes as the client achieves each milestone in the process.

As many as 20% of people experience depression in their later years

A stress management prescription is also needed for aging adults since the mind and body become slower to adaptations. The stress response lasts longer and seniors experience different symptoms then younger adults. Some key symptoms can be: crying, overeating, wounds taking longer to heal, heart palpitations, anxiety and depression. As a trainer, you will most likely be working with the client’s doctor who is treating them for these symptoms. There is a myriad of modalities that you can use to help your client drastically reduce their stress levels while they heal. As a fitness professional, incorporating meditation, exercise, yoga, Pilates, and many other techniques can help your client’s symptoms improve mentally and physically. The question is can we do more than telling clients to take a class? The answer to this question is an emphatic yes!

The causes of stress for this population are also different and depend on which decade in life they are in. Some examples are: loneliness, being institutionalized, fear of having enough money for retirement, loss of independence and many other causes. The problem is that many people can’t asses their own stress level and don’t know where to turn for answers. Chronic stress is harmful in many ways, but can be minimized once the individual becomes aware of their stress level and knows there are stress management professionals who can help.

Today, 53% of Baby Boomers are using complementary approaches to try and relieve stress and help with other conditions such as: anxiety, depression, chronic pain, stress, and hypertension. Complementary approaches are not limited to but include; exercise, nutrition, yoga, Pilates and Tai-Chi. Research conducted by the National Center for Complementary and Integrative Health shows that meditation can help to relieve symptoms for example chronic pain. As a fitness professional it is important to realize that these modalities must be used in conjunction with conventional medicine.

When training clients, it is important to see them as a whole person through the dimensions of wellness. As people, we have many things going on mentally and physically that are very complex. A stress management plan helps to streamline what can work best for your client and their current needs. The plan can evolve and most likely will depending on what is going on in your client’s life at the time. When you can assess and classify your clients you then know which complimentary approaches will work better for them. This will in turn, will help to keep your client engaged and on track with their goals.


Robyn Kade is the Founder of The Stress Management Institute for Health and Fitness Professionals. She has 18 years of experience in medical based fitness. Become a Stress Management Exercise Specialist today!

 

References

foam-rolling-at-gym

Why Use Foam Rollers?

We see many claims about fitness tools but they often don’t live up to the hype when reviewed by experts. Numerous claims have been made that foam rolling increases blood flow, is useful in warming up the muscle prior to exercise, and assists in post-exercise recovery. A study reported in the respected Journal of Strength and Conditioning Research determined that foam rolling is worth the effort: areas massaged with the foam roller saw increased arterial blood flow. The foam roller lives up to the claims; it is a useful tool that should be part of your exercise tool belt.

Foam rollers were once used exclusively in a physical therapy setting. Dr. Moshé Feldenkrais is credited with being the first person to use rollers for therapeutic purposes (for instance, improving body alignment, reducing muscle tightness, teaching body awareness) in the late 1950s. Foam rollers have been used by a variety of clients with conditions ranging from multiple sclerosis to common orthopedic concerns. The beauty of the foam roller is that it can be used by almost everyone.

Research has shown that stretching, relaxation, meditation, foam rolling, and biofeedback techniques all ease muscle tension, which contributes to pain and common muscle stiffness. A massage is a favorite method of stretching and relaxing tight muscles. It enhances functional range of motion, aids in the healing process, decreases muscle reflex activity, inhibits motor-neuron excitability, and contributes to relaxation. However, not many people can afford a daily or weekly massage session. A regular foam roller session can provide many of the benefits same benefits as and prolong the benefits of a massage while adding diversity and challenge to your standard exercise program.

Designing a balanced exercise routine that includes flexibility movements with strength training, cardiovascular exercise, and relaxation can reduce chronic discomfort and stress. Since foam rollers break up interwoven muscle fibers and help move oxygenated blood into those muscles, they’re an excellent device with which to release tight spots in the muscles (the technical term is “myofascial release”) and return the muscles to a more optimal state. This can be done prior to exercising to improve range of motion, after a workout, or during a break at work to relax tight muscles and reduce soreness from sitting too long.


From the Foam Roller Workbook, by Karl Knopf. Reprinted with permission from Karl Knopf

Karl Knopf, Ed.D, served as the Director of The Fitness Therapy Program at Foothill College for almost 40 years. He has worked in almost every aspect of the industry from personal trainer and therapist to consultant to major Universities such as Stanford, Univ. of North Carolina, and the Univ. of California well as the State of California and numerous professional organizations. Dr. Knopf was the President and Founder of Fitness Educators Of Older Adults for 15 years. Currently, he is the director of ISSA’s Fitness Therapy and Senior Fitness Programs and writer. Dr. Knopf has authored numerous articles, and written more than 17 books including topics on Water Exercise, Weights for 50 Plus to Fitness Therapy.

orthopedic-fitness-rehab-trainer-and-female-client

Bridging Rehab with Fitness: Become the Trusted Referral for Rehabilitation Therapists

There are special and unique bonds that are made between clinician and patient in a rehabilitation setting. Many times, rehab patients are at a very difficult time in their lives and through months of daily expert guidance, hard work, education, and often even fun, alongside their rehab team, they make considerable gains back towards independence.

Because of this daily interaction, the rehab team develops a vested interest in the continued progress of their patient. Over the course of many months of the blood, sweat and tears of intensive therapy sessions, a friendship has been formed and considerable progress made together. It’s no wonder that rehab professionals are very selective with the fitness referrals they make once their patients are ready for the post-rehab world.

They are selective because they want the absolute best for their patient; they want someone with an understanding of their patient’s diagnosis; someone who understands medical precautions and contraindications; and someone who can safely continue to progress their patient without putting them at risk for a secondary issue. Though they may be selective with referrals, a trusted source for continuing their patients’ goals is needed.

Here are some ways to bridge the gap and gain the trust of your local rehabilitation professionals:

Require a medical or physical therapy release

Having medical releases before beginning ongoing sessions is an excellent way to open dialog with your client’s doctor or physical therapist and further, ensures that you are programming their fitness plan accordingly. Send your assessment with your client to share in their next appointment along with a simple inquiry form about restrictions or suggestions to use in your program design. This will go a long way in establishing a great level of trust and building a rapport with the clinic.

Volunteer at a rehab clinic

One of the best ways to build a rapport with local rehab professionals and patients is to spend time shadowing/observing or volunteering in a rehab inpatient and/or outpatient clinic. This can be a time-consuming start-up as many rehab clinics will have an orientation process and procedures to allow you to be present in a clinic, but it is definitely worth the time investment. Just being in this environment you can learn a lot about how therapists progress their rehab patients, guard their rehab patients during activity, interact with and educate their patients as they progress them to discharge (the point where you would continue their work). You may also get some valuable opportunities to learn from and build relationships with many therapists in one setting.

Lead warm-ups for local 5K races

There are 3.2-mile run-walk-and-wheels events that take place all over the country. Donating your time to your community Spina Bifida Walk ‘n Roll or Parkinson’s walk is a great way to become visible in your community and demonstrate what you have to offer for all abilities.

Speak at local support groups

Same as with the 5Ks, there are support groups that take place monthly or quarterly for stroke survivors, caregivers, individuals living with Multiple Sclerosis and more. Contacting the organizer of these groups and offering to donate time to speak about the benefits of continued exercise or even providing a no-cost group class during the scheduled talk time is a really good way to connect with both the organizers and their peers and those in attendance who would benefit from a continued exercise program.

Educate yourself on adaptive/medical exercise equipment

Understanding the different options there are for accessories and actual exercise equipment for stroke survivors or those living with spinal cord injury is another great way to demonstrate an understanding of working with a rehab population and continuing to bridge the gap between rehab and fitness. Not all equipment is accessible nor safe, so while thinking outside the box is great, ensuring safety is optimal. Take the time to learn about all the great adaptive equipment that can benefit the population you work with.

Host an open house at your gym

Host regular open house events at your facility and invite any and all rehab professionals, patients, and people from your community. Offer instructional sessions during the open house to demonstrate your adaptive programming/equipment. This is a great way give a sneak peek into what you’re doing to provide a safe environment for patients to continue their progress.

Offer to provide a lunch in-service to rehab staff

Meeting with a clinic full of therapists is an excellent way to educate those therapists that you have done your research, understand your population, and really want to bridge the gap between rehab and fitness. A presentation focused on the population you’re most comfortable working with (Parkinson’s, stroke survivors, etc.), the programs you offer, and pictures or videos of some of the work done in your gym. Bringing food is always a great incentive!

Bridging the gap between rehab and fitness is a process that is long overdue and much needed. By focusing on the points above you will be working towards and moving one step closer to improving the therapist-trainer model, adding a valuable resource to your community and providing a safe environment and safe programming to continue progressing your post-rehab clients.


This article was featured in MedFit Professional Magazine. 

Devon Palermo is a leading authority on Adaptive Fitness for those living with or recovering from a disability. He is the Founder and Principal director of DPI Adaptive Fitness, A company focused on safe and effective adaptive fitness for individuals living with disabilities. With over 15 years of experience in both fitness and rehab, He is the go-to resource for clients, therapists, and doctors in the DC, Maryland and Virginia area looking to maximize the benefits of adaptive exercise to improve strength, balance, function and abilities. dpiadaptivefitness.co

All-age-group-in-park

Is age truly a number or is it something different entirely?  

Is age truly a number or is it something different entirely?  

Having just turned 50 and totally feeling like I am in my 20s while looking, according to longevity face age technology, like I am in my 30s, I personally had to get to the bottom of this question. 

I have interviewed over 100 different longevity experts, written the best-selling book, the Codes of Longevity, and continue to pore through the research to realize that again and again one key answer keeps popping up. 

What it really means to be an “age” isn’t about good genes, a specific diet, cutting edge therapies, lotions, peptides or supplements, although these all do slow down the aging process.  

Age is experienced, understood, and expressed as a result of our perception. 

A key finding in the largest study to date done by Michigan State University on aging assessed over 1/2 a million people to discover that “our perception of age changes as we age”.     

What you believe and how you perceive yourself, your health and your potential matters! It’s literally the feedback from your brain to your body that plays a key role in either speeding up or slowing down the aging process. 

This is shown again and again in the literature from neuroscience and epigenetics to psychoneuroimmunology that the brain informs, impacts and influences the expression of the cells and your very DNA.  

Have you ever stopped to consider what you perceive about age? 

I remember as a kid seeing the elders in my Italian family at get-togethers as strong, jovial, playful, passionate, and vibrant people. I noticed their beautiful skin, how active they were and decided then and there I was going to age amazingly. 

On the flip side, when I was 35, my mother died of cancer at the young age of 54 and that shifted my belief about what aging might mean for me. 

What do you believe? How do you feel about age, a number, pick a number and consider if there is a person or experience that you can recall that influenced your perception or created a belief inside of you?

You may, like many, think of “youth” as an expression of mental and physical ability fueled by energy, focus, performance, and the capacity to take on whatever comes your way. What do you consider to be “middle-aged” perhaps you think of the body slowing down, weight increasing, energy decreasing, and a mild loss of desire setting in, because “that’s just what happens when we get older”. While “old age” can bring up thoughts of the inevitable breakdown of the body and mind that may one day confine us to a wheelchair or nursing home.  

While yes, there are plenty of examples of this occurring, it doesn’t have to.  

In a study published in the Frontiers in Aging Neuroscience, it was found that people who felt younger than their age scored higher on memory tests, rated themselves as healthy, had more grey matter in the brain and were less likely to have symptoms of depression.

You can begin to shift your perception, reconnect to the youthful you, and actually support your brain and body to reverse age by feeling younger. 

Here are a few ways to practice living life optimized at any age and any stage:  

Check your perception

What you perceive, you believe. What you believe drives your feelings, emotions, habits, and daily actions. If you really want to express enhanced youthful vitality, begin by checking your perception of age. 

  • Ask yourself, what does age mean to me? Consider how or when you decided that and if it is actually what you want to be true for you today. 
  • Check-in daily and notice what age you perceive yourself to be today. If you want to be “younger” what if anything would you need to believe or feel today to make that possible? 

Set an ageless vision

Super centenarians hold a similar growth mindset in common. They don’t get fixed or rigid on what was or what is, they are open and look forward to what is coming while appreciating what is here in the now.  They feel like they will live forever but aren’t afraid to die today. They are beyond time and age.  

  • Check-in daily and ask yourself, what am I ready to more fully experience today? 
  • What am I  grateful for today? 
  • What can I look forward to in the days, weeks, and years ahead?  

As you look ahead while appreciating the moment you align with the feelings that energize, excite and engage you to more fully experience and enjoy your life at every age and every stage.

Learn, play and connect

If your perception of age changes as you change, then how can you support lifelong vitality?  It’s rooted in novelty and growth.  The brain craves new experiences. Seek out opportunities to learn something new, like a game or hobby that you can play and enjoy with others for enhanced connection.  

Live your purpose

Purpose ignites all of the following steps. It’s the meaning from within that fuels your desire to learn, grow, connect, engage, laugh, play, and a part of your “why” you want to live a long youthful life.  

  • To connect, simply notice the moments, the people, the places, and things that feel life-giving and soul-filling.  Make more time, enjoy and experience those encounters more frequently for that youthful energy that gives you the capacity to enjoy your amazing life every day regardless of your age. 

Over the past year, I have upgraded my perception, I have challenged my beliefs and I know now with certainty that I can and easily will express boundless vitality, gratitude, and joy each day, every day, regardless of age to 120 and beyond. What are you ready to perceive and believe as possible for you as you feel your way young? 

Webinar with Dr. Petersen

Join Dr. Melissa Petersen, Founder of the Human Longevity Institute, for this webinar where as she shares the science of longevity explaining the role of stress on biological aging and how we can implement immediate clinical solutions to slow down the rate of aging, improve healing while enhancing physical and mental resilience allowing us to thrive by design at every age of life.


Dr. Melissa Petersen is the Founder of the Human Longevity Institute and Author of the Codes of Longevity. As a sought-out keynote speaker and expert in thriving, she is redefining what is possible in living a thriving life by design at every age and every stage, to learn more, visit: ww.DocMelissa.com