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corrective-exercise-stretching-fitness

Benefits of Being a Corrective Exercise Specialist

/27 September 2021/ All MFN blog/

Research shows that 90% of people report painful and limiting musculoskeletal conditions affecting the success of their workouts. (4) In response to this need corrective exercise is booming with fitness professionals becoming educated about musculoskeletal assessments, movement analysis and corrective exercise to help both themselves and their clients feel and function better. Becoming a specialist in corrective exercise and integrating these strategies into your fitness business has many advantages. 

  • Attract More Clients: Latest research indicates the number one reason people seek the help of a fitness professional is to assist them with muscle/joint pain. (4) If you are qualified to address these problems, you will attract more clients.
  • Increased Revenue: Having a sought-after specialty qualification in corrective exercise has been shown to increase your income by as much as 50%. (1)
  • Utilize Fool-Proof Assessments: When a client comes to you with pain or complains of pain during their workout, you can take a strategic and active approach to assessing and correcting the underlying cause of their problem.
  • Use Proven Methods: The corrective exercise strategies contained in well-recognized corrective exercise certifications like The BioMechanics Method have been tried and tested on real clients and produce unbelievable results. 
  • Design Better Workouts: A better understanding of functional anatomy and movement can not only help you get clients out of pain, but it can also assist you in designing more effective exercises. This enables you to create high-performance programs for both weekend warriors and professional athletes.
  • Accelerate Client Results: Injuries and movement dysfunction limit the types and intensity of workouts clients can perform. Helping clients feel better so they can perform better, both in and out of the gym, lets them realize goals sooner.
  • Keep Clients Coming: When clients get injured, they drop out. Addressing your client’s muscle imbalances and movement dysfunction at the outset of their program decreases the likelihood they will experience pain or injuries and ensures they can continue working with you.
  • Increase Word of Mouth Referrals: The ability to help clients get out of pain and achieve their goals is marketing gold. They will confidently refer friends, family and colleagues to you for help. You will also be able to successfully network with health professionals who need a trusted, qualified corrective exercise specialist to whom they can refer patients.
  • Get Ahead at Work: Latest research indicates that advanced qualifications weigh heavily in an employer’s decision when looking to promote a staff member. (2)
  • Edge out the Competition: Statistics show that 89% of clients are looking for a fitness professional to help them alleviate their aches and pains. Yet only 56% of personal trainers offer corrective exercise services.4 The knowledge and skills you obtain by earning a corrective exercise qualification could provide you with a major competitive edge in the fitness arena.

Helping clients overcome aches and pains can be a profitable and rewarding experience. A sound understanding of biomechanics will allow you to develop and use your practical corrective exercise skills. It also provides an outlet for you to market your unique services and become one of the industry’s most sought-after professionals.

MedFit Network (MFN) members receive 20% off The BioMechanics Method Corrective Exercise Specialist certification. Members can get their discount coupon here.

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.

 

References

  1. NASM. 2015. Annual NASM-CPT Survey. Chandler, AZ: National Academy of Sports Medicine.
  2. National Federation of Personal Trainers, 2012. www.nfpt.com
  3. Price, J. 2018. The Biomechanics Method for Corrective Exercise. Champaign, Illinois: Human Kinetics.
  4. Schroeder, Jan., and Donlin, Ayla. 2013. IDEA Fitness Programs and Equipment Trends Report. IDEA Health & Fitness Association.
female-trainer-senior-client-exercise-ball

Flip the Script: How Fitness Professionals Can Overcome Challenging Clients

/24 September 2021/ All MFN blog/

If you are a fitness or medical fitness professional, there is a good chance you have heard one or more of the following statements at least once in your career. In fact, there is also a good chance you have heard these statements on a daily basis. 

1. I am a little tired and my muscles are a little sore from our last session, so I am going to cancel today and rest. 

2. I don’t want to do “that exercise” because I have never done it before.

3. My doctor told me that I should not be squatting, bending, reaching, twisting, etc… 

Many of you reading this article can relate to at least one of the above and may have even let out a slight sigh of frustration when it comes to overcoming challenging clients. Overwhelming amounts of research show that exercise can help to improve your health and fitness without hurting your joints.(1) With your current treatment program, exercise can: 

  • Strengthen the muscles around your joints 
  • Help you maintain bone strength 
  • Give you more energy to get through the day 
  • Make it easier to get a good night’s sleep 
  • Help you control your weight 
  • Enhance your quality of life 
  • Improve your balance 

However, many of our clients still believe that exercise will aggravate their joint pain and stiffness, but that is not the case. Lack of exercise actually can make your joints even more painful and stiff.(2) If the muscles and surrounding tissue are strong, it helps to maintain support for your bones. Choosing not to exercise weakens those supporting muscles, creating more stress on your joints. 

While fitness and medical fitness professionals understand the importance of exercise, the way we translate this to our clients is key. Oftentimes, clients receive misinformation along with mixed messages from doctors, family members, friends, and of course, social media. However, after decades of both academic and professional research working with special demographics, I have discovered a powerful technique to increase clients’ willingness to improve their health through exercise. The answer lies not only in showing the client how each exercise emulates real-life situations, but also how it affects their independence.

For example, telling a client, “Today we will be working on how to safely and effectively execute a squat,” is a lot different than saying, “Today we will be practicing our sit to stand movements so that you have the lower body strength and flexibility to rise from your favorite chair without assistance.” 

Most importantly, it is important to reiterate to your client that their lack of strength, mobility, and balance leads to a more sedentary lifestyle that will decrease their ability to function independently as time progresses. Additionally, muscle atrophy, joint immobility and poor flexibility are key indicators that functional movements, or movements that are required to perform everyday tasks, will soon be a thing of the past.

If a client is unwilling to perform various exercises, here are some conversation starters:

  1. Did you know that this is not just an exercise, but one of the foundational movements to support strength, balance and flexibility in your everyday life?
  2. Do you know the definition of functional fitness?
  3. Do you know that this isn’t just an exercise, but will help you walk up and down the stairs, get up from a seat, carry your groceries, and pick up a grandchild?
  4. Are you ready to give up your independence? 

Christine M. Conti, BA, M.Ed, is an international fitness educator and presenter. She currently serves as the Director of Membership for MedFit Network, sits on the MedFit Education Advisory Board and is a course author for MedFit Classroom. She is also CEO and founder of ContiFit.com and Let’s FACE It Together™ Facial Fitness & Rehabilitation and co-host of Two Fit Crazies & A Microphone Podcast. 

Check out Christine’s online course with MedFit Classroom, Arthritis Fitness Specialist:

References

  1. CDC: Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion. (2021, April 5). Benefits of Physical Activity. Center for Disease Control and Prevention. Retrieved September 10, 2021, from https://www.cdc.gov/physicalactivity/basics/pa-health/index.htm
  2. Mayo Clinic. (2021). Exercising With Arthritis: Improve Your Joint Pain and Stiffness. Mayo Clinic. Retrieved September 9, 2021, from https://www.mayoclinic.org/diseases-conditions/arthritis/in-depth/arthritis/art-20047971
food-and-vegetable-coop-box

Breast Cancer: How To Reduce Your Risk | Fact Sheet from PCRM

/23 September 2021/ All MFN blog/

A healthy diet and lifestyle can lower your risk of getting breast cancer.

These four simple tips can boost your health in other ways, too!

Choose Plant-Based Foods

Healthy foods from plants (vegetables, fruits, whole grains, and beans) can lower your breast cancer risk in several ways. They are often low in calories and high in fiber. This helps you feel full and lose weight if needed.

High-fiber, low-fat diets can also help reduce estrogen levels. Lower estrogen levels can lower your risk of breast cancer. A recent study showed that eating less fat and more fruits, vegetables, and grains could help protect breast cancer survivors, too. Packed with nutrition, plant-based diets can also reduce the risk of other diseases, like diabetes and heart disease. For the best nutrition, eat a variety of plant foods each day. Be sure to include a good source of vitamin B12, too, such as a supplement. Keep salt intake low, but when you do use salt, choose the iodized kind.

Fill up on veggies.
Not only are they healthy, but some have cancer-fighting nutrients. Try adding broccoli, collard greens, or cabbage to meals.

Eat more soy.
Tofu, soy milk, and edamame may help protect against breast cancer. Studies show that women who eat more soy have a lower risk of breast cancer. Soy foods may help protect women who’ve already had breast cancer, too.

Avoid processed meats.
Hot dogs, bacon, sausage, and lunch meats have been linked to a higher risk of breast cancer. Swap in healthy plant-based proteins like beans, tofu, or nuts instead.

Download the Physicians Committee for Responsible Medicine’s Fact Sheet, Breast Cancer: How To Reduce Your Risk, to read the remaining 3 tips! 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.

seniors-biking-in-gym-group

Exercise’s Impact on Cognition

/22 September 2021/ All MFN blog/

It’s not news that the brain changes with age. Significant changes in regions of the brain occur in healthy adults as they age, based on MRI studies.(1) The caudate, cerebellum, hippocampus, and association cortices shrunk substantially. This shrinkage in the hippocampus and the cerebellum accelerates with age. The hippocampus, the site for new memory formation, is involved with learning and emotion with a rich supply of estrogen and progesterone receptors. The cerebellum coordinates voluntary movements including all conscious muscular activity, balance, coordination, and speech.

Incidence of Dementia

The United States is experiencing both a declining birth rate and an increased average life span. This combination will increase the percentage of people over the age of 65 to 19.6%, resulting in a total of 71 million people by the year 2030.(2) The number of people over the age of 80 is also expected to increase to 19.5 million by 2030.(2) These changes will greatly increase the number of people with dementia since 6% to 10% of North American individuals aged 65 or older have dementia; this increases to 30% in those aged 85 or over.(3)

Dementia, or senility, is a difficult-to-define cluster of symptoms that include memory loss, loss of vocabulary, and loss of motor function in the absence of a change in the level of consciousness. Dementia can be measured qualitatively by verbal memory tests such as the Blessed Orientation-Memory-Concentration test, comprising six questions as listed in the following table:

The scores from each of the table’s six items are multiplied to produce a weighted score. Score 1 for each incorrect response; weighted error scores greater than 10 are consistent with dementia.(4)

Exercise Affects the Brain

The incidence of Alzheimer’s dementia can be used as a measurement of brain health.(5) As part of his study “Exercise Is Associated With Reduced Risk for Incident Dementia Among Persons 65 Years of Age and Older,” Eric B. Larson, MD, MPH, et al asked 1,740 mentally healthy men and women over the age of 65 how many days per week over the past year they had exercised for at least 15 minutes. The incidence of Alzheimer’s disease (AD) was significantly higher for individuals who exercised fewer than three times per week (19.7 per 1,000 person-years) compared with those who exercised more than three times per week (13 per 1,000 person-years). These results were not influenced by the E4 alleles on the apolipoprotein gene, which indicates a genetic predisposition for AD.

Laura Podewils et al studied the relationship between physical activity and dementia in 3,375 men and women over the course of 5.4 years.(6) Physical activity in these individuals over the age of 65 was assessed via the Minnesota Leisure Time Questionnaire. The subjects were questioned regarding the frequency and duration of their physical activity over the previous two weeks. Like Larson et al, this study found that increased exercise decreased the incidence of Alzheimer’s dementia.

The Mini-Mental State Exam can be used as a measure of cognitive ability or impairment. The 30-point questionnaire commonly used by health care providers screens for dementia, evaluates cognitive impairment, and follows cognitive change over time, making it an effective way to document an individual’s response to treatment.(7) Kristine Yaffe, MD, et al used the Mini-Mental State Exam to show that cognitive performance increases as the number of blocks walked per week increases.(8) The study involved 5,925 women over the age of 65 over a six- to eight-year period.

The most objective measure of cardiovascular fitness is the measurement of the maximum rate of oxygen consumption as measured during incremental exercise—milliliters of oxygen per kilogram of body mass per minute. A subjective measure of exercise amount or duration is not as accurate as the above direct measure, which is called maximum oxygen consumption or VO2 max. Deborah Barnes, PhD, et al conducted a six-year study of 349 individuals over the age of 55 measuring both VO2 max and subjective measures of fitness. Barnes found only the lower levels of VO2 max correlated with cognitive decline.(9) The four studies mentioned show a positive cognitive benefit from exercise. A meta-analysis performed by Colcombe and Kramer from 1966 to 2001 examined 18 studies of fitness training and cognitive function in nondemented older adults. They concluded that fitness training had a positive influence on cognition.(10)

Prospective controlled human studies provide more robust data than both animal and uncontrolled studies. Stanley J. Colcombe et al were the first to show in a prospective controlled setting that increases in cardiovascular fitness in humans results in increased functioning of the prefrontal and parietal cortices. These data suggest that increased cardiovascular fitness can affect improvements in the plasticity of the aging human brain and may serve to reduce both biological and cognitive senescence in humans.(11) In addition, women tended to exhibit the greater benefit.(12) In a literature review, Kramer et al complemented these data through the use of MRI, which is very accurate in the brain. Through this technique, Kramer and colleagues concluded that older adults who participated in the aerobic training group demonstrated a significant increase in gray matter volume in regions of the frontal and superior temporal lobe when compared with controls. The results suggest that even relatively short exercise interventions can begin to restore some of the losses in brain volume associated with normal aging.(12)

Animal studies offer some insight into how aerobic exercise benefits brain function. Aerobic exercise increases brain function in both young and old animals. Aerobic exercise increases the levels of brain-derived neurogenic factor (BDNF) and insulinlike growth factor 1 (IGF-1). BDNF has been shown to regulate neurotransmitters, including dopaminergic and cholinergic systems and may be playing an important role in the exercise-induced effects on the brain.(13) BDNF may be involved in the postexercise changes seen on a brain MRI. In addition, IGF-1 may be mediating the effects of exercise on BDNF, neurogenesis, and cognitive performance. Animal studies provide information on the effects of exercise that is difficult to obtain in human intervention studies. The sum of these animal studies overlaps with results from human studies and suggests that exercise is an effective enhancer of neurocognitive functioning in both young and old animals.(12)

AD, the most common form of dementia, shares many age-related pathophysiological features of type 2 diabetes, including insulin resistance, disrupted glucose metabolism in nonneural tissues, peripheral oxidative and inflammatory stress, amyloid aggregation, neural atrophy, and cognitive decline. Brain insulin resistance appears to be an early and common feature of AD, a phenomenon accompanied by IGF-1 resistance, promoting cognitive decline independent of classic AD pathology.(14) Such a large set of shared features suggests shared etiologies.

Recommendation

High-intensity interval training (HIIT) is a type of endurance training involving short periods of maximal effort followed by periods of maintenance or recovery effort. What can differ is the timing and type of endurance exercise. A typical cycling HIIT pattern may be four to six maximal 30-second cycling sprints separated by 4.5-minute recovery periods of comfortable cycling. When HIIT is compared with longer steady endurance training, the HIIT patterns show increased mitochondrial density in muscle cells and greater muscle performance improvements.(15,16)

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This article was featured in Today’s Geriatric Medicine.

Today’s Geriatric Medicine is a bimonthly trade publication offering news and insights for professionals in elder care.

Get a Free Subscription to Today’s Geriatric Medicine

 

This article was featured in the Jan/Feb 2016 issue of Today’s Geriatric Medicine (Vol. 9 No. 1 P. 26). Written by Robert Drapkin, MD

Robert Drapkin, MD, a medical oncologist and competitive bodybuilder in Clearwater, Florida, specializes in helping elderly adults achieve a healthful lifestyle to combat illnesses or disease and to extend lifespan.

 

References

1. Raz N, Lindenberger U, Rodrigue KM, et al. Regional brain changes in aging healthy adults: general trends, individual differences and modifiers. Cereb Cortex. 2005;15(11):1676-1689.

2. Chapman DP, Williams SM, Strine TW, Anda RF, Moore MJ. Dementia and its implications for public health. Prev Chronic Dis. 2006;3(2):A34.

3. Hendrie HC. Epidemiology of dementia and Alzheimer’s disease. Am J Geriatr Psychiatry. 1998;6(2 Suppl 1):S3-S18.

4. The Blessed Orientation-Memory-Concentration Test. University of Missouri Geriatric Examination Tool Kit website. http://geriatrictoolkit.missouri.edu/cog/bomc.pdf.

5. Larson EB, Wang L, Bowen JD, et al. Exercise is associated with reduced risk for incident dementia among persons 65 years of age and older. Ann Intern Med. 2006;144(2):73-81.

6. Podewils LJ, Guallar E, Kuller LH, et al. Physical activity, APOE genotype, and dementia risk: findings from the Cardiovascular Health Cognition Study. Am J Epidemiol. 2005;161(7):639-651.

7. Pangman VC, Sloan J, Guse L. An examination of psychometric properties of the mini-mental state examination and the standardized mini-mental state examination: implications for clinical practice. Appl Nurs Res. 2000;13(4):209-213.

8. Yaffe K, Barnes D, Nevitt M, Lui LY, Covinsky K. A prospective study of physical activity and cognitive decline in elderly women: women who walk. Arch Intern Med. 2001;161(14):1703-1708.

9. Barnes DE, Yaffe K, Satariano WA, Tager IB. A longitudinal study of cardiorespiratory fitness and cognitive function in healthy older adults. J Am Geriatr Soc. 2003;51(4):459-465.

10. Colcombe S, Kramer AF. Fitness effects on the cognitive function of older adults: a meta-analytic study. Psychol Sci. 2003;14(2):125-130.

11. Colcombe SJ, Kramer AF, Erickson KI, et al. Cardiovascular fitness, cortical plasticity, and aging. Proc Natl Acad Sci U S A. 2004;101(9):3316-3321.

12. Kramer AF, Erickson KI, Colcombe SJ. Exercise, cognition, and the aging brain. J Appl Physiol (1985). 2006;101(4):1237-1242.

13. Knüsel B, Winslow JW, Rosenthal A, et al. Promotion of central cholinergic and dopaminergic neuron differentiation by brain-derived neurotrophic factor but not neurotrophin 3. Proc Natl Acad Sci U S A. 1991;88(3):961-965.

14. Talbot K, Wang HY, Kazi H, et al. Demonstrated brain insulin resistance in Alzheimer’s disease patients is associated with IGF-1 resistance, IRS-1 dysregulation, and cognitive decline. J Clin Invest. 2012;122(4):1316-1338.

15. Gibala M. Molecular responses to high-intensity interval exercise. Appl Physiol Nutr Metab. 2009;34(3):428-432.

16. Billat VL. Interval training for performance: a scientific and empirical practice. Special recommendations for middle- and long-distance running. Part I: anaerobic interval training. Sports Med. 2001;31(1):13-31.

Physical therapist gesturing thumbs up besides senior woman on yoga ball

Medical Fitness – A Win for Professional and Patient

/21 September 2021/ All MFN blog/

Medical Fitness is a growing trend in health care. Medical Fitness helps extend basic healthcare from the classic and formal model of a person being a patient, receiving treatment and being discharged entirely, to after-care professional services. Medical Fitness is the integration of ongoing fitness, wellness and preventive care under the supervision of health professionals such as physical therapists, exercise physiologists, personal trainers, nutritionists, acupuncturists, chiropractors, massage therapists, mental health practitioners, health and wellness coaches, yoga professionals and more.

Medical Fitness is appropriate for many types of conditions such as arthritis, diabetes, orthopedic conditions, pre and post-natal, heart disease, fibromyalgia, stroke, cancer, mental disorders,  and others. When properly implemented, Medical Fitness is a win-win for both patient and health professional.

Physical therapist gesturing thumbs up besides senior woman on yoga ball

Medical Fitness Advantages for the Patient

First, after discharge from the formal healthcare world, the patient can be referred to a variety of health professionals educated in the patient’s condition, providing both a continuum of care and a multi-discipline approach. For example, a person discharged from physical therapy after a total knee replacement might be referred to a certified personal trainer facility educated in post-rehabilitation of a total knee to continue to make further functional gains and improvements. If that person needed help with weight loss, perhaps a referral to a nutritionist would be included. If they also had issues with coping with their diminished function, a consult with a specialist in mental health might be provided as well.

Second, many times the medical facility in which care was provided will have a Medical Fitness component associated with it. Direct referral to this type of facility can provide the patient with security and confidence, being familiar with the facility and with the knowledge that the new health professional is familiar with their condition and diagnosis.

Medical Fitness Advantages for the Health Professional

First, by being part of a Medical Fitness community the health professional can refer a discharged patient for follow up care, secure in the knowledge that their patient will be cared for by an ancillary care professional who is trained and certified to provide a proper continuity of care plan along with the appropriate goals and treatments.

Second, by referring to a Medical Fitness multi-discipline team, the health professional receives security that if their patient has any other issues, those concerns will be addressed. For instance, with the example of the total knee replacement patient needing assistance with weight loss or nutrition consults, (treatments that don’t fall under the umbrella of physical therapy), the physical therapist is assured their patient will be helped to achieve a better transition back into their “non patient” status.

Third, when the health professional refers their patient into a Medical Fitness wellness and preventative care environment, the chance for overall improved outcomes is increased. Patients learn better self-confidence in caring for themselves, taking charge of their own health and lifestyle. If a patient’s condition begins to backslide, the wellness program professionals can help make sure the patient gets referred back to the health professional in a timely manner.

In conclusion, Medical Fitness benefits all involved. Quality of care is improved. Patients receive access to multi- discipline care and can learn to take charge of their life. Health professionals receive security of proper continuity of care and gain improved patient outcomes.

Douglas Feick, PT is a licensed physical therapist in Texas, with emphasis in orthopedics for over 15 years. He is President of BioEx Systems Inc, a software company providing software solutions for physical therapists, athletic trainers, chiropractors, dietitians and personal trainers. His hobbies include scuba diving, raising bees and he is an avid skydiver.

brain-digital-image

The Neuroscience of Mind-Body

/20 September 2021/ All MFN blog/

In an era where neurological disorders and mental illness run rampant, effective and scalable non-pharmacological interventions are desperately needed. Luckily, science continues to demonstrate the efficacy of exercise-based interventions in improving cognitive, neurobiological, and mental health outcomes in a variety of populations. Multiple modalities of exercise, such as aerobic training and resistance training, continue to demonstrate improvements in several measures associated with brain health. While aerobic exercise has received a majority of the spotlight over the past couple of decades, other forms of exercise have also moved to the forefront of the exercise-neuroscience literature.

depression

The Seven Stages of Grief for Chronic Disease and Stress

/16 September 2021/ All MFN blog/

Many individuals have heard of the five stages of grief created by Elizabeth Kubler – Ross in 1969. This model is used to explain the stages of grief over the loss of a loved one.

There has been an updated model called the Seven Stages of Grief for Chronic Pain and Chronic Illness by Dr. Jennifer Martin, PsyD of imaginelifetherapy.com.

According to imaginelifetherapy.com, there are seven stages of grief for chronic disease, which are denial, pleading, bargaining and desperation, anger, anxiety and depression, loss of self and confusion, and finally, acceptance. Clients can go from one stage to another until finally reaching acceptance. An individual, for example, can go from denial to anger and back to denial. Everyone will go through the stages on their own timing. There is no set time for anyone to reach acceptance of their situation. If your client can see positive changes after working with you, their outlook will be more positive. As they become stronger and learn more skills, clients will become more ambulatory and be able to do more over time. (Pratt, 2018)

Many times, clients will be experiencing their symptoms and the stages of grief simultaneously. We usually think of grief in respect to the loss of a loved one. With chronic disease, your client may be grieving the life they used to live. Knowing that their lives may change because of an illness is very stressful. The individual may be thinking about the future and how their health will be ten years from now. As a fitness professional, you need to help your client to be present and in the moment. The work that your client does today will influence how mobile they are ten years from now. If they are discouraged by the big picture, it will be harder for them to stay focused. (Kade, 2020)

Each stage of grief has its own parameters and can give your insight as to which stage your client is currently in. Empathy and support are a critical part of helping your client to get through the stages of grief. Tailor exercise programming to what your client can handle each time they train with you. If someone is having a rough day, you can offer the client a meditation session instead of a training session. This trade-off will make your client feel more open and may even suggest meditation if they are not mentally ready for a training session. (Pratt, 2018).

To know which stage of grief your client may be in, you must have a firm understanding of what each stage is. Denial is the first stage in which the individual was just diagnosed and is in shock. They can’t believe that this is happening to them and wonder how they will make changes and live a good life. Shock can help the person to decide to move on to the next stage and start working through the stages. It may also backfire if the individual who has the condition thinks that it will eventually go away, or they will be fine. (Pratt, 2018).

The next stage is pleading, bargaining and desperation, where the client tries really hard to bargain or plead to not have a chronic illness. The individual also wishes they could go back to the life that they had. They may feel guilty and blame themselves for becoming sick and wondering if they could have done more to prevent their illness. Guilt usually comes with bargaining as the person blames themselves for their situation. (Pratt, 2018).

Anger is a crucial stage for individuals to begin the healing process. There is no specific timeline for your client to get through the anger stage. Please note that your client may come in angry some days when training, but they aren’t angry with you. Try to remain empathetic and patient as the individual goes through this stage. Keep in mind that everyone on the healthcare team often sees anger from the individual who is experiencing chronic illness. It is normal for your client to be angry at their doctor, caregiver, family, friends and even you. They will most likely apologize after showing you that they are visibly angry. This stage comes later in the process when the disease progresses, and the individual realizes that life will change. (Pratt, 2018).

Anxiety and depression will set in next as life changes are solidified. The feelings of depression can be substantial and seem to your client like they will never go away. If your client starts to withdraw, offer meditation instead of a training session to keep the client on track. Try to also be understanding about their condition and how they are feeling. If they must cancel with you, ask that they do so within a certain amount of time as your time is valuable too. You may want to also invite the client to a sip, paint and meditate class to help keep their spirits up. The goal is to try and keep these individuals on track using different modalities. There may also be anxiety about the future and the unknown as the person wonders what will happen to them. (Pratt, 2018).

The loss of self and confusion is very real for individuals with a chronic illness. In this stage, life has changed so much for this individual that they do not recognize themselves. They can’t do the things that they used to and have to redefine themselves and decide how to go about doing that. This stage may happen at the same time as anxiety and depression or separately. (Pratt, 2018).

In the stage of re-evaluation of Life, Roles and Goals, your client will be thinking about how they can move forward as a wife, mother, husband, father, sibling and friend. They are forced to re-evaluate how they fit into the picture and what that means in daily life figuring out how to go about daily activities and what work will look like for them. (Pratt, 2018).

The final stage is acceptance in which the client accepts his or her new reality. The client is not usually ok with it and happy, but they learn how to deal with their new norm. They strive to learn new skills to make life better and discover new things that bring joy into their lives. This is the stage that your client will be most accepting of trying new exercises and tools in your training sessions. (Pratt, 2018).

Robyn Kade is the Founder of The Stress Management Institute for Health and Fitness Professionals. She has 20 years of experience in medical-based fitness. 

 

References

Adapted from: Pratt, Amanda. “7 Stages of Grief for Chronic Pain and Chronic Illness: St. Petersburg Therapist.” Chronic Illness Therapy, 3 Aug. 2018, imaginelifetherapy.com/7-stages-of-grief-for-chronic-pain-and-illness/

Kade, Robyn. Mind/Body Medicine Specialist Manual. 4th ed. / USA, Stress Management Institute for Health and Fitness Professionals, 2020.

 

Senior-and-Trainer

How Feedback Can Improve Sit to Stand Performance

/15 September 2021/ All MFN blog/

Sit -to -stand transfers are important movements that physical therapists, occupational therapists, trainers, and coaches use every day with their clients. With professional guidance clients can successfully learn the symmetry of weight distribution and other mechanics required to correctly perform sit-to-stand. Without such guidance clients may not learn the safe and correct way to get up from a seated position or to use the movement as exercise. The result can be pain, falls and other injuries.

Feedback

Feedback regarding proper motor patterns is an important tool that can lead to greater movement efficiency, increased activity, and lower risk of injury. After analyzing the different phases of sit to stand (preparatory/ starting alignment, transitional movements, and the final standing posture), clinicians can use feedback to address both the spatial and temporal parameters of movement that is needed to improve overall performance.

Why We Need Feedback

A natural part of performing a skill is to use intrinsic feedback, the sensory perceptual information caused by-the movement. Vision, proprioception, touch, pressure, and audition help formulate a person’s internal representation of a movement goal.

When performing sit- to- stand, proprioceptors indicate the muscle length and tension of the position of the ankles and feet, as well as the amount of pressure through the limbs; visual information orients the individual to the environment; and vestibular inputs, contribute to sense of verticality. If your clients are not receiving the proper intrinsic feedback, they may not be aware of their movements. For example, an individual with impaired ankle proprioception may need extrinsic or augmented feedback to increase the weight and symmetry through their legs.

Augmented feedback enriches/enhances intrinsic feedback. It provides information to clients who are unaware of their body position. Augmented feedback can help engage the patient during all phases of sit -to- stand and with different modalities: visual, auditory or tactile.

What type of Feedback to Use? Auditory, Tactile, or Visual?

When training sit<>stand, what type of feedback and verbal cues would you provide to achieve forward weight shift, symmetry of weight distribution versus increasing speed of transfer?

Think about your clients who have trouble getting up from sitting and are not sure why they cannot rise on their first attempt. Often patients think the problem is lack of strength.

Sometimes using the cue “nose over toes” works for these patients. Other times, it is the size and timing of their forward weight shift that needs to be cued?

Auditory feedback provides an engaging solution in this situation. For example, the Step and Connect’s Balance Matters System features auditory feedback about the timing and amount of weight the client shifts forward. The system’s innovative foot pads make a clicking sound when the move is done correctly. The click is nonjudgmental and motivating. The client learns a new way to move without verbal instruction.  With practice the correct move becomes automatic.

During sit to stand transfers auditory feedback can improve: 

  • Starting alignment
  • Forward weight shift
  • Timing of weight shift
  • Symmetry of weight distribution
  • Postural control (decrease sway at the ankles)

Example using the Balance Matters system:

Sit to stand: Activate back clicker, activate front clicker while you stand, keep all clickers quiet during standing.

Stand to sit: Keep all clickers quiet until bottom is on the seat.

Progressions and Intervention Ideas

Part Practice (only one phase of the transfer).

  • Preparatory phase: Work on good starting posture, activating back clicker to promote anterior pelvic tilt and increased weight bearing through the legs.
  • Transitional phase: Reach forward with arms and activate front clicker to promote anterior weight shift.
  • Transitional phase for stand to sit: partial squats to sit down keeping clickers quiet to improve the timing of weight shift and decrease a “plop”.

Symmetry of movement and weight-bearing

  • Does one side activate sooner than another or do you not activate one clicker on one side since you are weight bearing more on the opposite side.
  • Verbal cue: Hear the clicker go off at the same time standing up and sitting down.

Activate the vestibular system standing on foam footpads

  • Add head turns with sit to stand on foam

Changing the Stance Position

  • Staggered stance and step to work on step initiation.

Eyes closed to improve balance in dimly lit environments.

  • This is important when standing up from bed to walk in order to go to the bathroom at night. An article “Effect of Sitting Pause Times on Balance After Supine to Standing Transfer in Dim Light” mentions that the risk of falling for older adults increases in dimly lit environments.
  • The results of the study suggest that longer sitting pause times may improve adaptability to dimly lit environments, contributing to improved postural stability and reduced risk of fall in older adult women when getting out of bed at night.
  • This is an important topic on how the speed or timing to adapt in different environments (dim lit or uneven surfaces) can change our overall balance and postural control and should be integrated into balance exercises and goals.

Using multi-sensory feedback with the Balance Matters system will:

  • Improve an individual’s awareness of their starting posture and transitional postures.
  • The auditory feedback in the footpads helps promote improved timing, sequence of the task, weight distribution for symmetry and weight shift.

Remember, there are influential factors when designing programs using feedback. Fading the feedback for retention is highly recommended. In the Balance Matters courses, we review more in-depth these influential factors and clinical applications.

Originally printed on stepandconnect.com. Reprinted with permission.

Balance Matters is a unique balance training sensory tool developed by recognized Physical Therapist Erica Demarch, intended initially for Parkinson’s patients and others suffering from balance issues. Now has become a popular sensory balance training tool for people looking to “train their brain” for improved balance. The Balance Matters system is the foundation of Erica’s company, Step and Connect, stepandconnect.com. 

sleep2

Sweet Dreams: 5 Tips for Sound Sleep and a Healthy Brain 

/14 September 2021/ All MFN blog/

It doesn’t matter what age you are, getting a good night’s rest is essential for your physical and mental health. Taking the time to recharge every night is especially vital because sleep and brain health are closely related. However, as we age, sleep doesn’t always come as easily as it used to. 

In a 2003 poll, the National Sleep Foundation found that over 48% of older adults experience symptoms of insomnia more than twice a week, and the National Institute on Aging reported that insomnia is one of the most common problems experienced by adults aged 60 and over.

Insomnia and sleep disruptions have been known to worsen health conditions like Alzheimer’s disease and increase your risk factors for developing other health problems, including heart disease, Type-2 diabetes, and hypertension. Let’s dig into the science behind sleep and what are our five best tips for a good night’s rest!

Why sleep is so important to our bodies

Sleep gives your body some much-needed rest, but it’s also vital for maintaining your cognitive health. When you lie down to sleep at night, your body takes this time to cleanse your brain of toxins and waste. The space between your brain cells actually enlarges during sleep, allowing your body to wash out harmful substances like beta-amyloid proteins, which researchers have linked to the formation of Alzheimer’s disease. It follows, then, getting enough sleep can help ward off Alzheimer’s disease.

A poor night’s sleep has also been tied to forgetfulness and lapses in memory. Because sleep is the vital period when our brains take time to consolidate our memories, not getting adequate sleep makes you more likely to forget things during the day. A good night’s rest is one of the most powerful weapons in your arsenal in the fight against mental aging. 

Why getting enough rest is more difficult as we age

Production of the “sleep hormone” melatonin naturally decreases with age, making it harder for older adults to fall asleep and stay asleep. The aging process also causes changes to the body’s natural circadian rhythm, which can make you get tired earlier than usual. Because of this, older adults are also more likely to experience restless sleep and waking up throughout the night. 

Environmental factors can also be to blame, such as stress or a lack of structure in your life. Recent retirees sometimes have a hard time adjusting to changes in their schedule, which can lead to fitful sleep. 

How to get a good night’s sleep: build healthier sleep habits

Now that you know why a good night’s sleep is so vital, you’re probably wondering how you can improve the quality of your own rest. If you struggle with tossing and turning or restless nights, don’t worry. The good news is that healthy sleep habits are universal and can be practiced by anyone of any age. 

It’s never too late to establish a healthy nighttime routine! Here are our 5 best tips to help you combat insomnia, in no particular order.

Work up a sweat

Exercise helps to keep you in good shape, but did you know that exercising can also improve your sleep? The Sleep Foundation has demonstrated a clear link between exercise and improved sleep quality in adults. Try using a fitness tracker, which can be useful to show your progress and motivate you. To rest easier at night, try going for a brisk walk or bike ride outside. Exposing yourself to sunshine and fresh air can improve circadian rhythm, so you can stay active with your favorite outdoor hobbies like gardening and fishing. Just be careful not to exercise too late in the day–getting worked up too close to bedtime may actually keep you awake!

Don’t nap during the day

Napping is common among older adults and retirees, with research showing that around 25% of older adults take naps daily. But did you know that your daily power nap may actually be doing more harm than good?

It’s true. While a brief nap can be beneficial for a boost of energy, excessive napping can disrupt your circadian rhythm and make it harder to fall asleep at night. If you absolutely must have a nap, try to take it earlier in the day and make sure to sleep for no more than 30 minutes.

Establish a bedtime routine

Human beings are creatures of habit, so practicing good habits before bed can help improve your rest. If you don’t already have one in place, try establishing a nightly routine before drifting off to sleep. 

You can engage in soothing activities like taking a bath, reading a book or meditating to relax before bed. Sleep comes easier in a cold room, so make sure that your bedroom is cool before you lie down. Always try to fall asleep at roughly the same time every night to establish routine, and make sure that you fall asleep while lying in bed–not in a recliner or on the couch. 

Turn off the TV

Although many of us like to fall asleep with the glow of the TV to keep us company, staring at screens before bed can actually disrupt your sleep. The blue lights found in common electronic devices like smartphones, tablets, TVs and computers can disrupt your natural circadian rhythm. That’s why experts recommend cutting out all screens and electronic devices before going to bed. 

A few hours before your usual bedtime, turn off all your TVs and power down your tablets, phones and laptops. You can replace time in front of the TV with screen-free activities like doing a jigsaw puzzle, playing cards or drawing in an adult coloring book. Instead of sleeping with your phone on your bedside table, try plugging it up to charge in another room. You’ll be less likely to check for texts or emails in the middle of the night and can rest more peacefully. 

Cut back on caffeine and other foods

Eating or drinking certain things too close to bed can cause sleep problems. Foods high in caffeine like coffee and chocolate have been shown to disrupt sleep patterns and interfere with melatonin production. Drinking alcohol late at night also could lead to restless sleep because it can cause decreased REM sleep. Never use alcohol as a sleep aid. 

If you can’t do without your morning coffee, that’s perfectly all right. Just make sure that it stays a morning cup. Avoid consuming coffee in the afternoon and eating large meals too close to bedtime. Don’t drink too much water before bed, either, if waking to go to the bathroom is a problem for you. If you must eat before bed, try having something to boost your melatonin, like a handful of almonds or a cup of tart cherry juice. 

The bottom line

Along with diet and exercise, getting a good night’s sleep is one of the most important things you can do to maintain a healthy mind and body. 

If you’ve tried all these tips and nothing works, check with your doctor to see if one of your medications or an underlying health problem may be to blame. Insomnia can sometimes be a symptom of a more serious issue. 

Sleep is just one of many tools on your belt you can use to live your best life possible, so try to rest well every night!

Originally printed on aviv-clinics.com. Reprinted with permission.

Aaron Tribby, M.Ed is Head of Physiology for Aviv Clinics where he is responsible for managing a team of physiologists, physical therapists, dietitians, and stress technicians at Aviv Clinics – the first hyperbaric medical treatment center of its kind in North America dedicated to improving brain performance. He also oversees the cardiopulmonary exercise tests and CPET in the clinic, responsible for analyzing each test. Leading to Aviv Clinics, his clinical experience is focused on health and wellness, strength and conditioning and nutrition within both the non-profits and private sectors including Mercy Hospital and MusclePharm, respectively.

 

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