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Healthy-Lifestyle-Nutrition-Exercise-Medicine

Using a Lifestyle Medicine Approach to Support Health

/17 December 2021/ All MFN blog/

The American College of Lifestyle Medicine (ACLM) defines lifestyle medicine as an approach to prevent, treat, and sometimes reverse chronic diseases to promote optimal health. Individuals are encouraged to follow a healthy eating pattern that is predominantly plant-based, engage in regular physical activity, experience restorative sleep, manage stress with success, avoid risky substances, and engage in positive social connections. There are a variety of tools and strategies that medical, health, and fitness professionals can utilize to have a collaborative conversation with clients and/or patients that can evoke change. It is useful to have a structured framework to facilitate the conversation.

Using the 5 A’s Framework to Structure the Conversation

Many medical providers and personal trainers have not been trained to facilitate a conversation surrounding an individual’s desire and readiness to change. This is a useful tool for structuring the conversation and ultimately setting SMART goals if the client or patient is indeed ready to commit to making a change.1

Assess
To begin the conversation, ask if the patient is currently engaging in the healthy behavior that is being contemplated as well as exploring their feelings about this specific health behavior. This dialogue will give you some insight about current beliefs and behaviors as well as identifying any gaps in their knowledge.

Advise
Here you can put on your expert hat and provide the individual with evidence-based information that highlights the benefits of making a health behavior change. If your client or patient is receptive, now is the time to provide them with specific strategies or a prescription.  For example, if they are looking to lose weight, you could prescribe a combination of cardiovascular and muscle strengthening exercises to support that goal.

Agree
As the conversation continues, collaboratively work to identify goals based on where they are showing interest and energy as well as where they have confidence in their ability to successfully make a sustainable change.  In this part of the conversation, you can help your client and/or patient create a SMART goal that is relevant and aligns with their values to promote self-efficacy.  

Assist
It is now time to discuss potential barriers and explore strategies that could be helpful in overcoming these challenges. This is also an opportunity to discuss social and environmental support structures that have the capacity to promote accountability and ultimately lead to self-monitoring.  

Arrange
As the conversation draws to a close, arrange a follow-up visit to monitor progress and convey that you are there to provide motivation, accountability, and support.  This is also an opportunity to refer your client and/or patient to community resources or to other health, fitness, or nutrition professionals that can support the behavior change process.

Redefine Health with Lifestyle Medicine

Using a lifestyle medicine approach highlights the need to promote optimal health by addressing health behaviors across the dimensions of wellness. This approach has the capacity to prioritize mental health as it is integrally related to our physical health and impacts our relationships with others. Lifestyle medicine is an emerging field that prioritizes our conversations with clients and patients creating rapport and trust that ultimately enables them to experiment with behavior change.  Health coaching and lifestyle medicine are a powerful combination used in delivering evidence-based interventions that have the capacity to help others redefine their health.

Suzanne Stringer, Master of Health Science, CHES, CHC, CPT is a health coach and personal trainer. She collaborates with clients to co-create goals that enable them to experience success as they work through the behavior change process. Additionally, Suzanne is an adjunct faculty member in the Health Sciences Department at AACC.


References

  1. American College of Lifestyle Medicine.  (2021).  Foundations of Lifestyle Medicine Board Review Manual.  American College of Lifestyle Medicine.  

 

ocean-hope-positivity

Living With Purpose: A Challenge Fear Can Sabotage

/9 December 2021/ All MFN blog/

I find the holiday season to be challenging mentally, emotionally and physically. I am sure many of you who are reading these words feel a similar pressure of the current year ending – and the uncertainty of the new one to come. During this time of the year I have found myself being repeatedly burdened by entertaining old, worn out, negative thinking which leaves me exhausted and prone to getting sick, frustrated and fearful of the unknown time ahead.


The mind-body connection

This year it has been no different for me as I seem to be facing a past challenge regarding my belief in myself, my self-worth – and my purpose. For the better part of the last week and a half I have been struggling with a bad case of what I believe is the flu. With this latest (rare) bout of illness I have been blessed with a large dose of coughing, sneezing, general weakness and a very substantial lethargy. I believe in the power of the mind to bring us health and well-being but I also believe our thoughts (and beliefs) can – and do – deliver to us the other side of life which includes illness, unease, a genuine lack of self-confidence, and a sense of what I will call “hopelessness” – a feeling of living without purpose.

This is how I have started to feel in December – that regardless of what I have done, written or spoken about in terms of my passion for healthy aging, that it matters little and that I am wasting my time. This thought has occurred to me many times before and I am sharing it with you now because I am going through this challenge in this moment in time. ALL of us at some point in our life (and in my case it has been more than once) have felt empty inside and afraid – fearful of the unknown, of not being enough, of having chosen our path in life badly – and much more “baggage” that we carry around with us every day! It is a burden we decide to carry. It is up to each of us to decide to stop carrying this extra weight – or it will remain a “drag” on our life well into the future! We don’t need negative thought patterns ruining our lives, do we?

Fighting negative thoughts

The point is that it takes courage and discipline to “fight” this negative “wave” of feelings and thoughts. The first step that we can take to address this important issue is to become AWARE that it is happening – and to STOP and THINK in order to increase the possibility of changing your mind in order to “reassert” your power over your training – but your life as well. I am grateful for these reminders as they spur me to make the choice again that I AM valuable and worthy of success. Even at 70, I am dealing with this very issue as Christmas approaches – again. I had a terrible Thanksgiving because I could not be with my daughter and grandson and tonight had a harsh exchange of words with her over the phone (frustration, anger, fear – whatever it may be.)

What this matter basically comes down to is a FIRM belief in ourselves – and our own unique purpose – that we are alive for a reason. It is incumbent upon each of us to maintain a vigilant and forceful awareness that CAN prevent negative thoughts from derailing our dreams from becoming fully realized. If we allow these negative thought patterns to remain in our subconscious minds over time they WILL harm us emotionally, mentally and physically. ALL life – and reality – begins with thought, so guard your thoughts well! I am sorry to report that we are never done with these challenges of the mind and they can – and DO repeat (sometimes – not always) for a reason: To REMIND us of who we are – and are becoming. The ego wants to regain control of our thought patterns and return us to an earlier status quo that never worked for us – and never will.

The antidote for this negative “cycle of thought” is an examination of what we are doing and how well we are doing it. Can we improve our behavior? Our discipline? Our planning? Our listening? What is it that we are seeing again – and why? My conversation (argument) with my daughter showed me I am still capable of entertaining past negative thinking with poor results showing up again in my life. What a DRAG! Low self-worth and self-esteem can raise doubt and fear in all of us. What I am experiencing right now is a reminder of the road I have travelled – and the miles I have to go. It is always incumbent upon each of us to be “self aware” and allow this awareness to guide us to take personal responsibility for our behavior – and thoughts – (all that any of us can control  and then, and only then, will we make it successfully to our goal and accomplish our mission.

Our fitness programming follows this same logic and if we believe we cannot make it – we won’t. Our thoughts determine our results and our belief systems determine everything else of importance in our lives. DON’T LET FEAR AND SELF DOUBT control your future destiny. DO NOT entertain thoughts that in and of themselves are self destructive. I don’t know how the distance with my daughter will be bridged before Christmas but it will probably include compromise and some serious mutual listening.

Conflict in itself solves NOTHING but it CAN promote growth and understanding so I am not shy about engaging in a good argument – if it leads to greater mutual understanding – and peace. It is in HOW we disagree that matters. I argue with my feelings leading the way sometimes and that CAN be hurtful, but in this hurting we may get the opportunity to expand our definition of ourselves – and expand our consciousness as well. This is what I would call a “win – win”. This potential outcome CAN help us grow into a new definition of ourselves and create new opportunities with those we love – and with those others we value in our lives. It is about taking some risk and exposing ourselves to being uncomfortable for a while. I feel it is worth the effort – just be smart about how you go about implementing this idea!

I am convinced this time of year is challenging for all of us because there is much we need to learn – not only about ourselves – but about each other as well. After 45 years of being a father I am still learning about what that means and tonight I found out I am still NOT as patient or compassionate as I thought I was and so some “soul searching” will be required to bring me back to my best path of growth and understanding with those I love.


Take time today to reflect not only on your relationship with yourself but also with those you love and care about and see what emerges. You might be in for some amazing surprises and only YOU can do this work. Becoming a thoughtful listener is really the key to effective communication so practice that skill a lot! We have TWO ears and ONE mouth for a reason. I really find the holiday season to be about buying “STUFF” and not about appreciating our many blessings. This thought drives me crazy! However, this is the life we are living today so I either learn to live with it creatively or I will continue to hit the same “brick wall” as I have in the past – and I CHOOSE NOT DO THAT. All of this is to say that becoming unsettled, confused – or even angry – is probably a sign that we ARE ready for positive change to enter our lives and I TRULY BELIEVE that is a VERY good thing! Travel well.

Originally printed on HealthyNewAge.com. Reprinted with permission from Nicholas Prukop.

Nicholas Prukop is an ACE Certified Personal Trainer & a Health Coach, a fitness professional with over 25 years of experience whose 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.

PDFS-Exercise

Bilateral Coordination: The Gateway to Successful Movement | Part 2

/8 December 2021/ All MFN blog/

In Part 1 of this series, we discussed an overview of bilateral coordination, its importance and how it falters in Parkinson’s Disease (PD).

Now, we’ll discuss strengthening the pathways for those with PD with exercise.

Steps To Incorporating Bilateral Coordination Into Your Exercise Program

Clearly, the brain is a work of art when you consider the “architecture”, the “highway” of nerves required to communicate with the rest of the body, to the final outcome of the original thought or idea. ANY kind of “road block” is going to hinder an individual from completing tasks as simple as writing or buttoning a shirt. And for the person living with PD, this includes walking, bathing, driving, communicating, dressing, well, about every Activity of Daily Living (ADL) that you can conceive.

BUT… never fear, the PD Fitness Specialist is prepared to address these matters of the brain with some challenging YET fun activities to promote improved motor control!

I won’t lie, you may see smoke coming out of the “fighters” ears but the incredible sense of accomplishment at the completion of the drill will be worth it.

Always begin with the fundamental question of program design. What are the needs of my private clients and fighters? What are their common issues?  They definitely need to work on:

Strength (7 foundational movements)

  • Lunge
  • Squat
  • Pull
  • Push
  • Carry
  • Hinge
  • Rotate

NOTE: I encourage Fitness Professionals (FP) to start with the most basic form of each Foundational Movement before progressing to a more challenging version. I have learned that repetition and exercise phases are a necessary part of any fitness program, similar to the human development process.

Your program should also include cardiovascular endurance, agility (footwork/hand-eye), cognitive challenges, fine motor drills, balance/gait drills — ALL which incorporate Bilateral Coordination challenges that provoke the brain to enhance:

  1. Neuro-protection to preserve at-risk dopamine neurons.
  2. Neuro-repair to improve damaged “circuitry”  and rewire the brain.
  3. Neuro-Adaptation that trains the brain to move without conscious awareness of each move such as walking .

Yes, this requires the Fitness Professional to sit down and develop a program that is constantly evolving as the abilities and needs of the client change BUT it can be done. For example, to address gait and incorporate an additional Bilateral Coordination drill that will challenge your client(s) mental focus, try the following progressive drill.

NOTE: Step one is a fantastic way to help a person living with Parkinson’s Disease safely transition out of a “freezing of gait” moment.

Criss-Cross Applesauce (Stand in squat stance)-

  1. Cross the right hand to the left shoulder.
  2. Cross the left hand to the right shoulder.
  3. NOW, cross the right hand to the left knee.
  4. Cross the left hand to the right knee

Have your client(s) say “Criss-Cross Applesauce” while performing the drill. This will address hypophonia problems and assist in maintaining a strong beat..

Once they have achieved this version, have them progress to the next level….

Criss-Cross Applesauce with Marching Knees

  1. Cross the right hand to the left shoulder.
  2. Cross the left hand to the right shoulder.
  3. NOW, cross the right hand to the left knee BUT lift the knee to meet the hand as if marching.
  4. Cross the left hand to the right knee and lift knee to meet hand as if marching.

To add complexity to the drill, have your clients tap the marching knee onto a step or bosu.

Once they have achieved this version, have them progress to the next level….

Criss-Cross Applesauce with A Forward Lunge

  1. Cross the right hand to the left shoulder.
  2. Cross the left hand to the right shoulder
  3. NOW, cross the right hand to the left leg AS you lunge forward.
  4. Come back to start position.
  5. Cross left hand to the right leg AS you lunge forward
  6. Return to start and repeat drill

To add complexity to the drill, have your clients perform a diagonal lunge or a lateral step.

This is just one example of how you can incorporate Bilateral Coordination into a movement we do all day every day! Walking! And if you work with people living with Parkinson’s Disease, then expect their learning time to vary but with repetition and encouragement, they will conquer this drill and be excited to try the next.

Which leads me to share with you the results I have experienced in my Parkinson’s Disease Wellness Center in Nashville and Franklin, Tennessee.

CASE STUDY – RESULTS!

“Susan” is 62 years old and was diagnosed 17 years ago which classifies her as Young Onset Parkinson’s Disease.  Susan had the DBS surgery 10 years ago and although the DBS initially provided relief of tremors and dyskinesia, over time fine motor skills, drooling, hypophonia, balance/poor posture — leading to numerous falls — has become an issue. She is also blind in one eye which limits her spatial awareness, decreases balance and mobility, all of which makes living independently even more challenging. Additionally, the hypophonia had led her to become 80% non-verbal. To answer questions she either nodded yes/no or shrugged her shoulders if she didn’t know the answer.

When we began working 1:1 together, my first priority was to address her posture/gait, as she was stooped forward and shuffling, leading to multiple falls each week. So, in addition to a dynamic warm-up with large ROM drills to properly prepare her body from head to toe, strength training, boxing and cycling, obstacle courses and more, I taught her the “Criss-Cross Applesauce” drill. The first several sessions, Susan had to complete the drill 5x between other warm-up exercises AND march while tapping her hand to the opposite knee when we moved to a new station or machine. She also had to speak the words “Criss-Cross Applesauce” when performing the drill to address her hypophonia.

The first session, Susan could not make the connection that her hand was to tap the opposite shoulder or knee. I had to manually move her hands and say the words with her. By the end of the first session, she was only able to complete the drill at a slow tempo, but that was ok, she did it! She left the gym that day with homework to practice the “Criss-Cross Applesauce” drill three times a day for 5 repetitions. I also assigned marching in place while tapping the hand to the opposite knee 60x twice a day.

The second session, I noticed a significant difference in her timing and coordination. For the first set, I still needed to “mirror” her while she did the “Criss-Cross Applesauce” drill, but overall, Susan was able to complete the drill 3 out of 5x correctly. When Susan would move to a different location, I had her march and tap her hand to the opposite knee. We counted how many steps it took to make it to the next station with the goal of trimming 10-15 steps off the next round. To do so, I had her focus on making precise connections between her hand and opposite knee as well as stomping her foot when stepping. By the end of the session she was able to trim 5-10 steps off between stations.  She completed the session with the same homework as before.

The third session is when I started to notice some fantastic improvements. Susan walked into the gym marching and tapping the hand to the opposite knee. She was able to cover more ground with fewer steps and the best part was that stomping her foot was helping her step with increased assurance. That equates to fewer falls! Additionally, transitioning station to station took less time and she was able to lift her knee higher than the previous sessions.

The “Criss-Cross Applesauce” drill still required me to “mirror” her but she did all 5 reps correctly and her hand/shoulder and/or hand/knee connection was more actively engaged. We continued to perform the drill between each exercise or cardio drill and by the end of the session, she spoke with clarity and increased volume, her stride length had increased, posture was more vertical and her confidence soaring. She even told me a joke!

The exciting results I experienced with Susan have also been experienced in my group exercise classes for Parkinson’s Disease. “Fighters” report that their forward/lateral movements, executive functioning skills, and balance have improved since incorporating Bilateral Coordination drills into our program.

Closing

The brain, in all its complexity, is a beautiful work of architecture. You, the Fitness Professional, have the “blue-prints” at your fingertips and together we can weave together bilateral movements to enhance the lives of those with Parkinson’s strengthening their bodies, mind and spirit and above all giving hope.

To assist you in learning how to create exercises that incorporate Bilateral Coordination into your program, I have included additional videos below demonstrating examples of exercises. (I would like to give credit to Dr. Irv Rubenstein, MedFit author & advisory board for the use of two of his drills in the video.)

This video comes from Dr. Jacob Weiss of handeyebody.com

Become a Parkinson’s Disease Fitness Specialist!

Check out Colleen’s online course on MedFit Classroom….

Co-Written by Colleen Bridges, M.Ed, NSCA-CPT and Renee Rouleau.

Colleen Bridges is the author of MedFit Classroom’s Parkinson’s Disease Fitness Specialist course. Renee Rouleau is a PhD student at the Jacobs School of Biomedical Sciences, University at Buffalo.


References

  1. van der Hoorn, A., Bartels, A. L., Leenders, K. L., & de Jong, B. M. (2011). Handedness and dominant side of symptoms in Parkinson’s disease. Parkinsonism & Related Disorders, 17(1), 58-60. https://doi.org/https://doi.org/10.1016/j.parkreldis.2010.10.002
  2. Plotnik, M., & Hausdorff, J. M.. (2008). The role of gait rhythmicity and bilateral coordination of stepping in the pathophysiology of freezing of gait in Parkinson’s disease. Movement Disorders, 23(S2), S444–S450. https://doi.org/10.1002/mds.21984
  3. Rutz, D. G., & Benninger, D. H.. (2020). Physical Therapy for Freezing of Gait and Gait Impairments in Parkinson Disease: A Systematic Review. PM&R, 12(11), 1140–1156. https://doi.org/10.1002/pmrj.12337
  4. Son, M., Han, S. H., Lyoo, C. H., Lim, J. A., Jeon, J., Hong, K.-B., & Park, H.. (2021). The effect of levodopa on bilateral coordination and gait asymmetry in Parkinson’s disease using inertial sensor. Npj Parkinson’s Disease, 7(1). https://doi.org/10.1038/s41531-021-00186-7
  5. Kramer P., & Hinojosa, J., (2010). Frames of Reference for Pediatric Occupational Therapy: 3rd Edition. Baltimore, Maryland: Lippincott Williams & Wilkins
  6. Magalhães, L.C., Koomar, J.A., Cermal, S.A. (1989, July) Bilateral Motor Coordination in 5- to 9-year old children: a pilot study. The American Journal of Occupational Therapy. Volume 43 Number 7.
  7. Piek, J.P., Dyck, M.J., Nieman, A., Anderson, M., Hay, D., Smith, L.M., McCoy, M., Hallmayer, J., (2003) The relationship between motor coordination, executive functioning and attention in school-aged children. Archives of clinical neuropsychology. Elsevier’s Ltd. doi:10.1016/j.acn.2003.12.007
  8. Roeber, B.J., Gunnar, M.R. and Pollak, S.D. (2014), Early deprivation impairs the development of balance and bilateral coordination. Dev Psychobiol, 56: 1110-1118. https://doi.org/10.1002/dev.21159
  9. Rutkowska, I., Lieberman, L. J., Bednarczuk, G., Molik, B., Kaźmierska-Kowalewska, K., Marszałek, J., & Gómez-Ruano, M.-Á. (2016). Bilateral Coordination of Children who are Blind. Perceptual and Motor Skills, 122(2), 595–609. https://doi.org/10.1177/0031512516636527
  10. Schmidt, M., Egger, F., & Conzelmann, A. (2015). Delayed Positive Effects of an Acute Bout of Coordinative Exercise on Children’s Attention. Perceptual and Motor Skills, 121(2), 431–446. https://doi.org/10.2466/22.06.PMS.121c22x1
  11. Tseng, Y., & Scholz, J. P. (2005). Unilateral vs. bilateral coordination of circle-drawing tasks. Acta Psychologica, 120(2), 172-198.

 

food-and-vegetable-coop-box

Foods for Cancer Prevention

/7 December 2021/ All MFN blog/

Despite a wealth of scientific data, most people remain unaware of how they can reduce their risk of developing cancer. According to a study released in 2008, only 5-10 percent of cancer cases are linked to genetics; the remaining 90-95 percent stem from environment and lifestyle factors and are potentially preventable. Twenty-five to 30 percent of cancer cases are due to tobacco use, and about 1 in 3 cases are due to food choices. These numbers continue to rise.

In 2014, the Centers for Disease Control and Prevention and the National Cancer Institute compared cancer rates and deaths linked to risk factors such as red and processed meat intake, overweight, and low intake of fruits, vegetables, and dietary fiber. During that year in the United States, 42 percent of cancer cases and 45 percent of cancer deaths were linked to avoidable risk factors such as excess body weight. Factors within our control, like diet and exercise, are largely accountable for cancer outcomes.

Download the Physicians Committee for Responsible Medicine’s Fact Sheet, Foods for Cancer Prevention, to read the rest of this article. Feel free to download and share this free resource.

The Physicians Committee for Responsible Medicine is a 501(c)(3) nonprofit organization, headquartered in Washington, DC. Our efforts are dramatically changing the way doctors treat chronic diseases such as diabetes, heart disease, obesity, and cancer. By putting prevention over pills, doctors are empowering their patients to take control of their own health.

Fact sheet shared with permission from PCRM. Click here to view other PCRM Fact Sheets.