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The Seven Stages of Grief for Chronic Disease and Stress

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. 



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.



How Feedback Can Improve Sit to Stand Performance

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 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


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

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.



water bottle

Dehydration Generation – Who is Most Susceptible?

The sensation of thirst declines with age. Even young children who play outdoors in the heat are often reluctant to stop playing and drink water.

In seniors, illness and medications may further reduce thirst or increase urine production. Older adults are at increased risk of experiencing heat stroke or urinary tract infections.

I understand why people may not want to drink water. Besides possibly making extra trips to the bathroom, it is boring, tasteless and fills you up. There are many options to flavoring water from squeezing lemon or limes into a glass or water jar, to adding other assorted fruits such as apples, pears, oranges, etc. It just takes a few minutes to prepare.

Preventing dehydration is important. Whether you are outdoors or inside a cooled room, it can still happen. You lose fluids through perspiration and breathing, even if you are not exercising, your core temperature may rise and result in heatstroke. Early signs of dehydration include dark yellow urine and dry skin. In severe cases, symptoms can progress to dizziness, fainting, and even seizures. Treatment in extreme cases can also affect the heart and kidney function. Limit your prolonged activities if you feel any symptoms mentioned above. Your stamina will prevail.

To reduce your risk, sip water throughout the day rather than wait until you feel thirsty. It’s also smart to drink a full glass of water each time you take medications (if recommended). You can hydrate with foods, too, such as soup, smoothies, and produce with high water content, like celery and watermelon.

In the meantime, keep moving and exercising your body, especially if you have stiff joints from arthritis, sit too long or feel stiff or de-conditioned.

Reprinted with permission from Lori Michiel. 

Lori Michiel, NASM, has been assisting seniors in their homes since 2006 with customized exercise programs including those designed to address Parkinson’s, metabolic disorders, arthritis and diabetes. These adaptive programs are specifically designed to improve balance, circulation, flexibility, mobility and promote independence. Lori Michiel Fitness has over 40 certified trainers who are matched with clients in Los Angeles, Ventura and Orange Counties. Connect with Lori at www.LoriMichielFitness.com.


Want to live longer? Watch your omega-3 levels

A recent study spanning 11 years and more than 2,000 participants yielded a startling finding: When comparing omega-3 index to conventional cardiovascular risk factors in older adults, it showed that having a low blood omega-3 index was as strong a predictor of mortality as smoking.1

The average age of the participants at the beginning of the study was 65, when their blood fatty acids were measured, and they were followed for 11 years. There were 2240 participants and 384 deaths over that time.

Comparing omega-3s and smoking

Omega-3 index is a measurement of DHA and EPA as a percentage of the total fatty acids in red blood cell membranes.  The average omega-3 index in the study was 5.8%, the lowest fifth had omega-3 index less than 4.2%, and the highest fifth had levels greater than 6.8%.

Using mathematical modeling, the researchers estimated that participants who were in the highest fifth of omega-3 index at age 65 gained 4.74 years of life compared to those in the lowest fifth. This was similar to the difference between smokers and non-smokers at age 65; smokers lost 4.73 years of life, according to the model.

Over the 11-year follow-up, of participants in both of the low-risk categories – non-smokers who had a high omega-3 index – 85% survived. This is compared to only 47% of those in the high-risk categories – smokers with a low omega-3 index.1 The loss of life years was similar in low-omega-3 + non-smoking and high-omega-3 + smoking.

More evidence connecting omega-3 levels with longevity 

This research comes a few months after a meta-analysis of 17 prospective cohort studies that linked higher circulating omega-3 fatty acid levels to longevity. In a pooled analysis of the studies, participants in the highest fifth of combined blood DHA and EPA were 15-18% less likely to die from any cause over the follow-up period (median follow-up time was 16 years in these studies). Higher blood omega-3s were also associated with reduced risk for death from cardiovascular disease and cancer.2

The importance of DHA and EPA

DHA and EPA are important structural and functional components of brain and retinal cell membranes. They also have triglyceride-lowering, anti-inflammatory, anti-platelet, and anti-hypertensive properties, plus beneficial effects on cell membranes that may also contribute to better health and a longer life.2

Previous studies have linked low omega-3 index (below approximately 5%) with increased risk of cognitive decline in older adults.3,4  All the above studies corroborate the prior studies linking low omega index to brain shrinkage and cognitive impairment, and they reinforce how critical it is to properly address this issue.

The bottom line

DHA and EPA supplementation is important for anyone who doesn’t eat fatty fish frequently. Omega-3 index is low in vegans – approximately 4% when measured in studies, and the research suggests that adding ALA from flax seeds and walnuts does not significantly raise omega-3 index in most people. Most of the ALA in our diet is burned for energy, not converted to EPA and DHA. Consuming pre-formed DHA and EPA is the most reliable way to increase omega-3 levels in the blood.5-8 I recommend checking the omega-3 index with a blood test and assuring DHA and EPA adequacy using an algae-based supplement (refrigerated if possible) to avoid the pollutants, microplastics, and animal protein in fatty fish, and as a more sustainable option than fish oil.

Originally printed on drfuhrman.com. Reprinted with permission.

Joel Fuhrman, MD is a board-certified family physician specializing in nutritional medicine. He is President of the Nutritional Research Foundation and the author of 7 New York Times bestselling books, including his most recent book, “Eat to Live”. Visit his website, DrFuhrman.com.

👉👉Get $10 off $150 or more on Dr. Fuhrman’s website. Use coupon LS10OFF150.


  1. McBurney MI, Tintle NL, Vasan RS, et al. Using an erythrocyte fatty acid fingerprint to predict risk of all-cause mortality: the Framingham Offspring Cohort. Am J Clin Nutr 2021.
  2. Harris WS, Tintle NL, Imamura F, et al. Blood n-3 fatty acid levels and total and cause-specific mortality from 17 prospective studies. Nature Communications 2021, 12:2329.
  3. Coley N, Raman R, Donohue MC, et al. Defining the Optimal Target Population for Trials of Polyunsaturated Fatty Acid Supplementation Using the Erythrocyte Omega-3 Index: A Step Towards Personalized Prevention of Cognitive Decline? J Nutr Health Aging 2018, 22:982-998.
  4. Lukaschek K, von Schacky C, Kruse J, Ladwig KH. Cognitive Impairment Is Associated with a Low Omega-3 Index in the Elderly: Results from the KORA-Age Study. Dement Geriatr Cogn Disord 2016, 42:236-245.
  5. Craddock JC, Probst YC, Neale EP, Peoples GE. A Cross-Sectional Comparison of the Whole Blood Fatty Acid Profile and Omega-3 Index of Male Vegan and Omnivorous Endurance Athletes. J Am Coll Nutr 2021:1-9.
  6. Sarter B, Kelsey KS, Schwartz TA, Harris WS. Blood docosahexaenoic acid and eicosapentaenoic acid in vegans: Associations with age and gender and effects of an algal-derived omega-3 fatty acid supplement. Clin Nutr 2014.
  7. Office of Dietary Supplements, National Institutes of Health. Omega-3 Fatty Acids. Fact Sheet for Health Professionals [https://ods.od.nih.gov/factsheets/Omega3FattyAcids-HealthProfessional/]
  8. Arterburn LM, Hall EB, Oken H. Distribution, interconversion, and dose response of n-3 fatty acids in humans. Am J Clin Nutr 2006, 83:1467S-1476S.

Can a Pregnant Woman Safely Continue her Pre-Pregnancy Workout Routine?

A regular exercise routine has become a way of life for many women, and many choose to continue their exercise routines when they become pregnant.  Research in the field of maternal fitness has shown that exercise during a non-complicated pregnancy is healthy for both mom and baby and may help prevent or reduce some of the physical problems associated with pregnancy, labor, and delivery.

Although exercise is a positive addition to a healthy pregnancy, there are established guidelines that help ensure that a woman’s exercise program is safe and effective.  First and foremost, it is important for a pregnant woman to consult with her healthcare provider before starting any exercise program.  She should bring a list of questions regarding her exercise program and provide an overview of what type, intensity, frequency, and duration of exercise she would like to do.  This enables her healthcare provider to accurately assess whether the fitness program is appropriate for her pregnancy.

Each woman’s level of fitness and health is different, as is each pregnancy. There are several points to consider when choosing to continue a fitness program during pregnancy.  Some types of exercise are more easily continued during pregnancy, and common sense, safety, and comfort all play a role in deciding whether an activity should be part of a prenatal fitness program.

Choosing the type of exercise that will be safe and effective during pregnancy can be determined by reviewing the following points:

  • What activities does she enjoy or are skilled at doing?
  • Does the activity pose an increased risk of falls or blunt abdominal injury?
  • Is she able to do the activity without being compromised by balance and center of gravity changes?
  • Can the activity be easily modified as pregnancy progresses?
  • Does common sense conclude that this is a safe activity to continue during pregnancy?

Research on prenatal exercise has suggested that greater benefits are achieved by including sustained, weight-bearing exercises such as walking, running, stationary stepping/elliptical machine, or dance classes in a prenatal fitness program.  However, some women may not tolerate weight-bearing exercise during pregnancy and are more comfortable with non-weight bearing activities such as swimming and stationary biking.

There are several activities, such as scuba diving and water skiing, that are never safe to do during pregnancy.  Other activities, such as downhill skiing, horseback riding, and sports with a chance of abdominal impact may also be too risky for most women to continue during pregnancy.

Here are a few tips for keeping a prenatal exercise routine safe:

  • Pregnant women need to add 300 calories to their daily food intake to meet the needs of pregnancy. If she is physically active, she may need to increase that amount if she’s not gaining weight normally. The number of extra calories needed depends on the intensity and duration and frequency of the exercise program.  It is important to drink 8-10 cups of water each day and increase that amount during hot and humid weather.
  • Exercise in heat and humidity can be dangerous. It is safest to exercise in an air-conditioned facility during the summer months. If she does choose to exercise outdoors during warm weather, she should avoid the high heat times between 11:00 am and 4:00 pm and reduce intensity and duration to prevent overheating.
  • She should frequently monitor herself during exercise for signs of overheating, such as dizziness, faintness, or nausea. Drinking plenty of water before, during, and after exercise to replace the fluids lost will help prevent dehydration and overheating. Hot tubs and saunas may cause core temperature to rise to unsafe levels and should be avoided.

A simple method for monitoring intensity level during prenatal exercise is to assess how hard the exercise feels.  A pregnant woman should feel that her exercise level is moderate to somewhat hard.  If she feels out of breath or is unable to talk (termed the “talk test”), she is working at too high a level and should decrease intensity or stop and rest. Her exercise level should feel challenging but not so difficult that she feels exhausted during and/or afterward.

Self-assessment is one of the best ways for a pregnant woman to monitor her exercise program and assure herself that her activity level is safe. A pregnant woman should review the following questions several times each month and follow up with her healthcare provider if she experiences any problems.

  • Do you and your healthcare provider feel that you are gaining weight normally?
  • Do you feel well physically and mentally?
  • Are you able to comfortably follow your exercise program without pain, exhaustion, or problems following exercise?
  • Do you experience chronic or extreme exhaustion?
  • If you are at the point in pregnancy where you are consistently feeling fetal movement, have you noticed any change in the pattern or amount of your baby’s movements?
  • Does your baby move at least two times within 20-30 minutes following exercise?
  • Was your last abdominal fundal height measurement (a measurement of fetal growth) or ultrasound assessment within normal limits, and is your baby progressing normally at each medical check?
  • Does your healthcare provider have any concern regarding the health of your pregnancy?

Pregnant women who continue a challenging level of exercise need to be aware of signs or symptoms that indicate overwork, such as an elevated resting heart rate, frequent illness, lack of weight gain, depression and chronic exhaustion.   She should decrease or stop her exercise program during illness, when fatigued, under excessive stress or if experiencing any complications with her pregnancy.

Prenatal exercise should enhance pregnancy and help to make a woman’s postpartum recovery smoother.  The best advice for the athletic woman who wants to continue her fitness program during pregnancy is to use common sense, listen to her body, and enjoy all the challenges and changes this incredible experience offers.

Catherine Cram started her company, Prenatal and Postpartum Fitness Consulting, in order to provide current, evidence- based guidelines maternal fitness guidelines to health and fitness professionals. She was a contributing author for the textbook, Women’s Health in Physical Therapy and co-authored the revision of Exercising Through Your Pregnancy with Dr. James Clapp.  Her company offers the certification course, “Prenatal and Postpartum Exercise Design” which provides continuing education credits for over 30 health and fitness organization, including ACSM, ACE, ICEA, and Lamaze.


Branched Chain Amino Acids: Protein’s Helper

Branched chain amino acids (BCAAs) are an essential nutrient in our body that consists of the chain of chemicals obtained from protein. We have 20 different amino acids in our body, 8 of which are considered essential, and 3 are the branch chain aminos that BCAAs are composed of. This chemical chain includes leucine, isoleucine, and valine. We get this protein source from our food, particularly meat, dairy, and legumes. They stimulate protein’s role of building muscle. They also help prevent muscle breakdown.  

BCAA’s are a popular fitness supplement. For athletes or even the common gym-goer, these chemicals can improve performance by preventing fatigue, improving concentration, and reducing muscle breakdown. They have been shown to improve muscle soreness post-exercise. They can help reduce DOMS (delayed onset muscle soreness) which typically occurs within the initial 24 to 72 hours post-workout. Leucine aids in the muscle-making process. BCAAs have been shown to increase protein synthesis by up to 22%. Many protein powders contain branched chain amino acids, but they can also be found as a supplement all their own. Most protein powders have about 5 grams of BCAAs per 25 grams of protein.  

They are also used medicinally. They are given to people with liver disease. They help the brain translate messages and impede upon faulty signaling related to liver disease, anorexia, mania, and tardive dyskinesia (involuntary repetitive body movements). When cirrhosis occurs in the liver, the brain does not signal correctly to help remove waste products and toxins from the blood. BCAA’s improve appetite to help people with these diseases to have better nutrition.  

Bodybuilders like to take BCAAs as a result of the dieting process leading up to a competition. Dieting is part of stage preparation to look your best, but in this process, the body is at a caloric deficit to get the lean, cut look. However, the competitor doesn’t want to lose muscle mass. BCAAs work their magic with protein synthesis trying to build new muscle while fighting the deficit and then work to decrease breakdown.  

The best food sources that contain BCAAs are meat and dairy:

  • Beef: 100 grams = 6.8 grams BCAAs 
  • Chicken: 100 grams = 5.8 grams BCAAs 
  • Whey protein powder: 1 scoop = 5.5 grams BCAAs 
  • Soy protein powder: 1 scoop = 5.5 grams BCAAs 
  • Canned tuna: 100 grams = 5.2 grams BCAAs 
  • Salmon: 100 grams = 4.9 grams BCAAs 
  • Turkey: 100 grams = 4.6 grams BCAAs 
  • Eggs: 2 = 3.28 grams BCAAs 
  • 1% milk: 1 cup = 2.2 grams BCAAs 
  • Greek yogurt: ½ cup = 2 grams 

Food is always the best source of nutrition. Add supplementation when your body needs extra support. BCAAs are essential in our body. Anything essential needs to be had, so make sure you get the right amount of amino acids to help meet your body’s needs.  

Join Megan for her webinar on this topic, Supplements: The Physiology Behind Trying to “Out Supplement” Nutrition


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 &amp; Health, and is a current doctoral candidate in Health and Human Performance. She is a professional natural bodybuilder, fitness model, and published author.




Six Steps To Inspire Excellence with Your Clients

As a personal trainer, you have a unique opportunity to connect with your clients in a personal way. Not only can you help them with their body and health challenges, you can incorporate positive techniques that will make their time with you even more fulfilling.

Set the Energy and the Mood of the Environment

This is the moment. How can you show the best version of yourself? It’s time to bring all the energy you have and set the mood for success. You need to believe in yourself, trust yourself, and believe in the services and products you represent. Its all in your hands! You control the moment, make it magic, and make it special.

Gain Trust. Feeling = Trust.

Gaining trust starts by trying to associate yourself with the person you are having the conversation with. Notice their moves, practice trying to repeat what they said with different words, creating the flow that leads to your purpose in helping them. Gaining their trust is more than communication; it’s a continuous exchange of information that is contagious and leads the person to keep coming back in order to regenerate those moments. Use your body-language, make big round shapes with your hands, and make it as a complete circle. The circle of Trust.

Set the Plan. Find logic behind the steps you have to take. Plan = Logic.

Setting the plan is when you start inserting the logic into what you say. Use numbers, use examples, use proof of results, and make them realize what they really need and why they havent arrived there yet. Here is when you need to sound like the professional you are. Start practicing on yourself, then friends and family, and then the rest of the world. Ask people who really know you what their opinion is about you. Realize who you are, and who you want to be. Then, subtract the difference of who you are now, and you have your starting point.

Energy + Feeling + Logic = Plan + Trust + Result

This is the equation of success. It is the sum of Energy, Feeling, and Logic that will give you the right Plan, Trust and Result you want to achieve. Once you arrive there, you only have to innovate, progress, and communicate the right messages to new / renew / refill and regenerate the system you have already set up for your clients.

Start with the Essentialsand add the Windows of Opportunity

When you need to improvesomeone, you need to start with what is missing, what is keeping them back, realize the friction level. Updating means cut the dead weight first. Realizing incorrect exercise patterns and nutritional bad habits is the way to start eliminating what holds clients back from your results.

Second most important are the missing parts you need to arrive at the result you want. Attract more interest by filling in the nutritional gaps using the “Essentials” and the Windows of Opportunity

  • Essentials are the micronutrients missing from everyone’s diet plan. We keep eating the same food repeatedly, missing a variety of all the essentials to our body. The needs are increasing during exercise periods. Consider also the fact that the food nowadays is genetically modified for mass production, lacking essential micronutrients. A formula with Vitamins, Minerals and Antioxidants will refill anything that is missing.  
  • Windows of Opportunity is the best timing to introduce Amino Acids (building blocks) and Glutamine and/or Creatine, when the body is like a “sponge”, ready to absorb everything right away. First thing in the morning with plenty of water and always during workout. Investing in recovery will accelerate efforts to a healthier lifestyle.   

Everybody needs to feel safe and updated. Like your PC or Smartphone. You do that every day with those devices. So why not use this for yourself and everyone else around you?  If you want to change the world, start from yourself first. It is time for better choices and now you know how to start!

Close with, Hope to see you soon!

The follow-up is what truly matters. You give clients the right knowledge, but you also need to make sure that they spin the wheel in the right direction and with the right speed. Mother Nature knows best and the change will not happen overnight. It is a process that requires time, up to 6-8 weeks to see results. Like the trees, you need to plant the right seeds and keep giving them the right amount of water and nutrients to grow. This is why its important to set a follow-up program in order to re-explain and reproduce the idea that you planted in the beginning.

Dimitrios Triantafillopoulos is a Master Personal Trainer, supporting people, athletes and other trainers to make them feel better with their body and themselves. He holds a Bachelor’s degree in Kinesiology and Sports Science, a Master’s Degree in Nutrition and Sport Fitness, as well as a Medical Fitness Specialty. Dimitrios has attended numerous seminars in Performance Training and Specialized Nutrition, and is also a Certified Instructor in Vibration (Power Plate) Acceleration Training and Electro – Stimulation Training. He is currently a Fitness Manager at Crunch Fitness in New York City.


Creatine: The athlete’s supplement of choice can boost anyone’s fitness plan and health goals

Long trusted by athletes and bodybuilders to help improve athletic performance, the muscle strength supplement creatine remains either unknown or shrouded in myth among the wider population.  But increasingly creatine is being recognized by the medical community for the benefits it can bring beyond just athletic performance.  From assisting in injury recovery to helping reduce the risk of falls in the elderly, creatine is a natural, safe, and effective tool all of us can use…