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A Pipeline of New Clients Through Physician Exercise Referrals

/2 June 2021/ All MFN blog/

“I want to know how good the [fitness professional] is at their art and science of progressing people through exercise.” 

These words were spoken by a physician who regularly refers his patients to fitness professionals. In 2019 and 2020, I spent ten months surveying and interviewing physicians and fitness professionals at a New England healthcare organization. This healthcare organization has had an exercise referral network in place for over a decade, and averages about thirty-five exercise referrals per week. 

As part of the exercise referral network, physicians were able to refer patients to community-based fitness centers and professionals, as well as a hospital-affiliated facility. The hospital-affiliated facility has four programs: an 8-week exercise program for post-rehab (muskuloskeletal, cardiac, and pulmonary); a 13-week fitness, nutrition, stress management and behavior modification program; a 12-month weight management program; and a 3-month cancer recovery program. Its program staff were registered dietitians, personal trainers, and health coaches.

The purpose of my research was to understand physicians’ and fitness professionals’ perspectives on physician exercise referrals and the impact on patient behavior change. Not enough physicians provide exercise referrals to their patients, and my research revealed a clear opportunity to address barriers to referral. In addition, physicians are less comfortable referring their patients to community-based fitness facilities and professionals than they are to hospital-based fitness facilities and professionals. Raising physician familiarity with, awareness of, and confidence in fitness professionals can help build physician trust in their capabilities. This is especially true for fitness professionals who have expertise and experience working with special populations, including people with different injuries, disabilities and diagnoses.

“Physicians want to know that [their patients] are exercising in a place where, if anything bad or adverse were to happen, they are in good hands.” ​ –Fitness Professional 

Join me for my upcoming webinar with MedFit, where I’ll speak more on this topic as part. I’ll discuss ten steps that fitness professionals can take to become professionals that physicians trust to take good care of their patients. These steps focus on facilitating communication between physicians and fitness professionals about patients’ progress and outcomes, as well as raising physician awareness of the professionals’ capabilities. Join me as I walk through how to develop A Pipeline of New Clients Through Physician Exercise Referrals.

 

Dr. Amy Bantham has 20 years of experience working in consulting, health & fitness, and healthcare. She is the CEO/Founder of Move to Live®More, a research and consulting firm addressing physical inactivity, obesity, chronic disease, and social determinants of health through cross-sector collaboration and innovation. 

Amy holds a Doctor of Public Health from the Harvard T.H. Chan School of Public Health, with concentrations in Health Communication and Obesity Epidemiology & Prevention. Her doctoral research focused on physician exercise prescriptions/referrals and patient exercise behavior change. She is a certified group exercise instructor, personal trainer, and health & wellness coach. She also holds a Master of Science from Northeastern University, a Master in Public Policy from the Harvard Kennedy School, and a Bachelor of Arts from Yale University.

trainer-client-crutches

Closing the Trust Gap: Are personal training certifications failing medical fitness?

/1 June 2021/ All MFN blog/

For over 30 years, the alphabet soup of letter-bearing personal training certification companies like ACE, NASM, NSCA and ISSA have focused on providing education leading to a fitness certification. While the companies have differing audiences and missions, collectively they have failed to truly make the connection between the fitness industry and the healthcare industry.

Personal trainers tend to be health advocates (and sometimes zealots) who show up as the face of the fitness industry. They tend to actually live and practice the life they espouse. Most leave the industry quickly, but even as they leave personal training and continue throughout their careers they tend to retain their core values around fitness.

Listen to almost any group of personal trainers and you’ll hear them speak passionately about the value of fitness and the ability to help control or eliminate diseases like type 2 diabetes, heart diseases and some forms of cancer. For their more affluent customers, personal trainers are frontline soldiers in a battle for healthier living.

So, how is it that well-intentioned organizations that believe that healthier living improves lives and who have over 350,000 personal trainers working in America alone have been unable to connect those trainers to the next higher level of their mission? What has gone so wrong that the average consumer would more likely connect a personal trainer to an Instagram or social media influencer than to their healthcare provider?

In a recent ISSA survey, personal training buyers were asked what education or qualifications were required to become a personal trainer. Nearly 80% of those surveyed did not know. Fortunately, nearly everyone surveyed believed that some form of education or certification was required. Perhaps consumers would have the same answer if the question was asked regarding nursing or other healthcare positions other than that of a doctor.

In this situation and those like it in America, we are accustomed to trusting the person in the job has the knowledge, skills and abilities to do the job. We may not know how or why, but we have given them the magic ingredient — trust.

In our society, we fundamentally trust that by achieving the title of doctor, the holder will do no harm and will have the secret to curing what ails us. Do we trust that our personal trainer will do no harm and will have the secret to help us achieve our fitness goals? Not so much.

In the same ISSA survey, buyers of personal training were asked if personal trainers could help clients lose weight and 90% answered yes. When asked if personal trainers could help cure type 2 diabetes only 10% answered yes. There was an 80% difference when asked the same question in the context of personal training goals versus medical goals!

It would seem logical that if the same question was asked in the context of knee pain or joint pain and heart disease or blood pressure the results would be the same.

We trust that personal trainers understand how to improve our fitness, but we don’t connect our fitness to our healthcare. This is a trust gap.

This trust gap is the most fundamental issue preventing all of the subsequent steps which need to happen in order for medical fitness to thrive. There can be no insurance reimbursement or physician prescription of exercise as medicine as long as we don’t first believe our health is in our control and that fitness professionals can help their clients achieve results.

Today, even physicians who believe in exercise as medicine are reluctant to refer clients. Despite some of the most forward-looking physicians and groups bringing exercise and personal training into their medical practice, compliance remains spotty and reimbursement varies widely.

A recent study provided insights around prescribing exercise as medicine in the treatment of 26 different diseases: psychiatric diseases (depression, anxiety, stress, schizophrenia); neurological diseases (dementia, Parkinson’s disease, multiple sclerosis); metabolic diseases (obesity, hyperlipidemia, metabolic syndrome, polycystic ovarian syndrome, type 2 diabetes, type 1 diabetes); cardiovascular diseases (hypertension, coronary heart disease, heart failure, cerebral apoplexy, and claudication intermittent); pulmonary diseases (chronic obstructive pulmonary disease, asthma, cystic fibrosis); musculoskeletal disorders (osteoarthritis, osteoporosis, back pain, rheumatoid arthritis); and cancer.

But, how much of this is studied by medical students and applied by physicians? Why does the majority of our society doubt fitness? Is it because we don’t trust fitness professionals? If so, what is the fitness certification world to do?

If we are to close this trust gap, the industry needs to achieve three milestones:

  1. Personal trainers need to have a common standard of professional knowledge and skill
  2. Required continuing education and training must be in place
  3. We need to have standards of care for fitness programming.

This requires that the industry through leadership such as IHRSA combined with companies like ISSA, NASM, ACSM, ACE and others eliminate the need for individual exams and certifications and move to a common standard of excellence for all.

In the absence of the fitness industry creating an environment where all parties can trust their personal trainer to provide safe and effective training programs, none of us can expect medical schools to teach fitness or doctors to prescribe exercise or insurance companies to reimburse for exercise.

COVID-19 created a broad national awareness of the incredible risks of obesity and underlying medical conditions which largely could be controlled through diet and exercise. Now is the time to take action and help a new generation live healthier lives.

Andrew Wyant serves as the President of the International Sports Sciences Association (ISSA) after having helped successfully build and grow a series of businesses in a wide variety of industries. Since becoming ISSA’s leader in 2018, the ISSA has grown by over 400% and has become the No. 1 rated and reviewed personal training company in the world. Andrew is passionate about the potential personal trainers have to help improve our world by reducing the rates of preventable diseases. He has been deeply involved in the health and fitness industry since 2011.

This article was featured in MedFit Professional Magazine.

Spring into summer salad

The Naturopathic Chef: Spring into Summer Salad

/31 May 2021/ All MFN blog/

Refresh and revitalize with this bright side dish that’s perfect for any summer table.

The dressing doubles as a versatile marinade, too.

Dressing

  • 1 Tbls Shallot, minced
  • 1 Tbls Aged Balsamic Vinegar
  • 2 Tbls Fresh Lime Juice
  • 2 tsps Fresh Orange Juice
  • 2 tsps Honey
  • ½ tsp Dry or Dijon Mustard
  • ½ tsp Salt
  • ¼ tsp Pepper
  • ¼ cup Avocado Oil

Stir all ingredients together except avocado oil. Whisk oil into mixture to emulsify. Chill 

Salad

  • 2 cups Watermelon, cubed in bite-sized pieces
  • 1 cup Strawberries, sliced
  • 2 small Persian Cucumbers, sliced
  • 8 Mint leaves, chopped
  • 2 Basil leaves, chopped 
  • 2 Tbls Toasted Pistachios, chopped
  • 2 Tbls Feta, crumbled
  • pinch of Salt

Toss ingredients with dressing, top with pistachios and feta.

Phyte Facts

Everything in this salad contributes to proper hydration and mineral balance, making it perfect for warm weather. Both Mint and Basil have cooling properties and keep our thermostats operating at peak performance. Love to hike? This is your perfect companion.

Get more great recipes from Tina Martini — her book, Delicious Medicine: The Healing Power of Food is available to purchase on Amazon. More than a cookbook, combining 20+ years of experience, along with her love of coaching, cooking and teaching, Tina offers unexpected insights into the history and healing power of clean eating, along with recipes to help reduce your risk of disease and improve overall wellness so you can enjoy life!

Affectionately referred to as The Walking Encyclopedia of Human Wellness, Fitness Coach, Strength Competitor and Powerlifting pioneer, Tina “The Medicine Chef” Martini is an internationally recognized Naturopathic Chef and star of the cooking show, Tina’s Ageless Kitchen. Tina’s cooking and lifestyle show has reached millions of food and fitness lovers all over the globe. Over the last 30 years, Tina has assisted celebrities, gold-medal athletes and over-scheduled executives naturally achieve radiant health using The Pyramid of Power: balancing Healthy Nutrition and the healing power of food, with Active Fitness and Body Alignment techniques. Working with those who have late-stage cancer, advanced diabetes, cardiovascular and other illnesses, Tina’s clients are astounded at the ease and speed with which they are able to restore their radiant health. Tina believes that maintaining balance in our diet, physical activity, and in our work and spiritual life is the key to our good health, happiness and overall well being. Visit her website, themedicinechef.com

Sweet Letters

Sugar Substitutes: Good, Bad, Ugly?

/27 May 2021/ All MFN blog/

Today’s athletes are confronted with a plethora of foods and beverages containing low- or no-calorie sweeteners (LNCS): Diet Pepsi, Halo-Top ice cream, Gatorade Zero, Nuun.

Questions arise: 

Are these products a better option than their sugar-containing versions? 

Will they help you lose weight? 

Are they safe? 

Should athletes eat them or avoid them?

The goal of this article is not to recommend for or against LNCS sweeteners such as Equal (aspartame), Sweet ‘n Low (saccharine), and Truvia (stevia), but rather to offer science-based information to help you decide whether or not they are safe to include in your sports diet.

Background Info

The 2020-2025 US Dietary Guidelines for Americans state that we should limit added sugars to less than 10% of our daily calories. The average (i.e., unfit, over-fat) American consumes about 270 calories (17 teaspoons, 13% of total calories) of added sugars a day. Soft drinks, other sweetened beverages, cookies, candy, and desserts are common culprits. For a sedentary person who may require 1,800 calories a day, 10% of calories equates to 180 calories (45 g) of added sugars a day that displace wholesome foods. Given that exercise enhances our ability to metabolize sugar, active people are less likely to end up with health issues (prediabetes, type 2 diabetes) related to sugar consumption. For them, added sugars can be a useful source of muscle fuel. Ideally, the sugar comes surrounded with nutrients, such as a post-exercise recovery chug of chocolate milk.

Today’s competitive athletes often select their foods more wisely than the “average” American. Their hope is to not only enhance performance but also reduce their risk of injury and invest in their longevity. For an athlete eating more than 3,000 calories a day, the guideline of less than 10% of total calories from added sugars equates to 300 calories (75 g) of added sugars a day. That leaves plenty of space for some sugary sports foods and treats, if desired. 

Athletes’ bodies tend to readily use sugars (they appear in the blood as glucose) to replenish depleted muscle glycogen stores. During long, hard workouts, sugar-filled gels and sports drinks can enhance performance. So why would an athlete want to choose a Gatorade-Zero, Nuun, or Propel with LNCS? Well, if weight-conscious, NLCS can help athletes save a few calories (though doing so while exercising can hurt performance). With meals and snacks, swapping a can of sugar-sweetened soda for a diet soda ideally allows the athlete to enjoy 150 more calories of nutrient-dense foods, such as fruits or veggies. (We know what often happens, however. The saved calories go towards cookies. Ha!)

Are foods sweetened with LNCS a way for athletes to have their cake and eat it too? The media has certainly painted a halo of horror on LNCS, leading many to believe they are mysterious chemicals, contribute to obesity, and bolster one’s sweet-tooth. Are they really bad for you? Let’s take a look at what science says. 

Aren’t they nothing but (scary) chemicals?

All foods are made of chemicals: carbon, oxygen, nitrogen. Aspartame (brand names are NutraSweet and Equal) is made of two amino acids that taste 200 times sweeter than table sugar. You need very little of it. The powder in the blue packet is mostly a harmless filler that keeps the few molecules of sweetener from getting lost in the packaging.

Are they safe to consume?

Sugar substitutes are among the most highly studied ingredients out there. The FDA, WHO and other global health organizations have confirmed the safety of these products in doses well above the amounts commonly consumed by humans. Studies that reported a link to cancer were done with animals given absurd amounts of no- or low-cal sweeteners and are not relevant to humans in real-life.

That said, the FDA has established Acceptable Daily Intakes (ADI) for these sweeteners. ADI is the amount of a LNCS a human can consume every day during their life —with a built in 100-fold safety factor below which no adverse effects have been seen. For aspartame, the ADI equates to 107 of those little blue packets a day (19 cans of diet soda every day of your life). So yes, some athletes could overshoot the ADI—but it’s highly unlikely! 

Do low- and no-calorie sweeteners lead to weight loss?

LNCS are one tool in a dieter’s toolbox. They can help dieters lose weight IF they displace calories the dieter does not replace. One athlete told me he lost 30 pounds in a year just by trading in his lunch- and dinner-time can of Pepsi for Diet Pepsi. That one simple change shaved off 300 calories a day that he did not replace. That said, research indicates people can easily compensate for the calories by eating more of other foods

Do low- and no-calorie sweeteners lead to weight gain?

No. People who drink diet soda are more likely to be over-weight, but diet soda did not cause the weight gain. Rather, people who live in large bodies are more likely to use LNCS to save some calories.

Don’t these sweeteners trick the body into thinking it’s getting sugar—and trigger a spike in blood glucose, followed by a crash, and hunger?

Well-controlled, randomized studies indicate the answer is no. Nor do LNCS make people feel hungrier. Some animal studies have shown that LNLCS might increase appetite, but those studies were conducted with large amounts of LNCS that we would never consume. This has not been replicated in humans.

Do no- or low-cal sweeteners have a negative impact on the microbiome?

Questionable research with mice who consumed very large amounts of saccharin suggests it might impact the microbiome of rodents. But no conclusive evidence to date indicates LNCS negatively impact the human gut microbiome. Stay tuned.

The bottom line

We are all born with an innate desire for sweet tastes, starting with breastmilk! We have many options for satisfying that sweet tooth in good health.

Sports Nutritionist Nancy Clark, MS, RD counsels both casual and competitive athletes in the Boston-area (Newton; 617-795-1875). The 6th edition of her Sports Nutrition Guidebook (2020) can help you eat to win. Visit NancyClarkRD.com.

For more information:

Senior-Woman-Deep-Breath

Weight Loss Happens On The Exhale… The Nasal Exhale

/26 May 2021/ All MFN blog/

Every person longing to be slim has heard the same advice forever: Eat less and exercise more. So simple, so logical, so what happened? America is the land of the overweight and the frustrated. For millions of people, every road has led to the same locked door. Until now. I’m going to give you the secret to helping you help your clients reach their weight loss goals in a healthy, lasting and fulfilling way.


For reasons ranging from stress to the influence of advertising, the majority of Americans find it difficult to lose the weight and keep it off. In addition, they are famously sedentary. According to the Centers For Disease Control & Prevention, 70% of adults are overweight or obese, contributing to health risks including heart disease, high cholesterol, high blood pressure, diabetes, stroke, and more (1). Either for health or vanity reasons, many of these overweight men and women try to slim down and usually gain back at least as many pounds as they lost. The secret to effectively losing weight and transforming patterns of behavior happens with breath. 

How Breath Influences Fat Burning

The way we breathe, fast or slow, mouth open or closed, shallow or deep affects our biochemical, physiological, biomechanical and psychological states of being. Nasal diaphragmatic breathing signals our parasympathetic branch of the autonomic nervous system while mouth breathing signals our sympathetic branch.  The difference determines whether you’re fat-burning or sugar-burning. Can you guess which turns you into a fat-burning machine? You guessed, nasal breathing.

Most of our clients are living in a stressed state (or the sympathetic branch of our nervous system). Not only is this the sugar-burning system, it also leads to abnormally high levels of cortisol. High cortisol levels promote weight gain (2).

In addition, nasal breathing increases oxygenation while mouth breathing decreases oxygenation. The speed at which your body burns oxygen or fuel for fat-burning benefits depends on how well your body utilizes oxygen. As we diaphragmatically nasal breathe, we stimulate the vagus nerve. “The vagus nerve regulates metabolic homeostasis by controlling heart rate, gastrointestinal motility and secretion, pancreatic endocrine and exocrine secretion, hepatic glucose production, and other visceral functions.” (4)

How The Fat Leaves On The Exhale

Fats are large molecules made up of oxygen, carbon, and hydrogen. When the oxygen we breathe reaches these fat molecules, it breaks them down into carbon dioxide and water.  The blood then picks up the carbon dioxide – a waste product of our bodies – and returns it to the lungs to be exhaled.  Therefore, the more oxygen our bodies use, the more fat we will burn.  

Nasal breathing is more efficient than mouth breathing in terms of supplying oxygen to the body as well as the transfer of oxygen and carbon dioxide between the lungs and red blood cells. When performing cardiovascular exercise, it is therefore preferable to inhale and exhale through the nose. (3)

Have you ever wondered where the fat goes? If you’re like most of us, you probably think the majority of fat is excreted through bodily fluids. Surprisingly, it’s not. Based on the research from the British Medical Journal, the majority of fat turns into carbon dioxide which is exhaled when we breathe. (5)

See My Interview With Ruben Meerman

Transforming Patterns of Behavior

The person who’s been sedentary for years won’t suddenly be persuaded to run a marathon. Core changes must come first in order to make everything else possible.  Using “breath as medicine” to improve health and the training experience, we cultivate the “choosing mind,” where we can alter lifelong patterns. 

People become sedentary and develop poor lifestyle patterns based on habit, boredom or emotional triggers.  So, there’s more involved than just losing the physical weight. Our issues are in our tissues. We’ve got to transform the emotional and physiological weight which is embedded in our unconscious and subconscious minds.  

Mindful breathing while exercising is being “neurofit” meaning we’re influencing physiological changes in the brain related to behavior. Life is a sensory experience and the body keeps score. Focusing on the breath allows a person to slow down, unwind and look inward. This is crucial for people whose lives are chronically hectic and stressful, who eat without thought, regardless of hunger. With deep, powerful breathing, they can break old patterns while cleansing internal systems. How does this happen?  By stimulating the vagus nerve (which only happens through nasal diaphragmatic breathing), we strengthen the areas of the brain responsible for emotional self-regulation. (6)

The body always lives in the present. It will never crave a Twinkie because of unrequited love, an upcoming review with a cranky boss, or an unhappy childhood. It cares only about what it needs from moment to moment to maintain homeostasis. The typical brain calls for millions of automatic acts in a day – from adjusting endocrine levels to blinking to deploying white cells for battle. As the connection between body and mind is fortified with breath, the choosing mind emerges reconnecting with our body to hear its’ objective voice which discriminates between emotional reactivity and true desire.

All that from a simple breath. 

Continuing Education: Breath as Medicine

Ed Harrold’s Breath AS Medicine breath coach training focuses on breath regulation concepts & strategies by applying the principles and philosophy of yoga breathing (or pranayama) to improve breathing rates and patterns. Breath AS Medicine is a highly effective modality for both the prevention of illness as well as therapy for managing and/or reversing existing chronic illness.

Click here to learn more about Ed Harrold’s Breath AS Medicine e-learning courses. Use coupon MedFit20 for 20% off either the 15 or 25-hour trainings.

A shorter 6-hour course is also available on MedFit Classroom. Click here for details.

Ed Harrold is an author, inspirational leader, public speaker, coach and educator. Ed’s mastery in the science of mindful breathing has guided him to apply conscious breathing practices in corporate performance coaching, fitness & athletic training, healthcare trainings, stress reduction and overall health and well-being.

Today, Ed blends the fields of neuroscience and the wisdom of contemplative traditions into effective strategies to improve well-being in Corporate America, Healthcare, athletic performance and individual health. Ed’s fluency in mindfulness-based strategies combined with the belief in the human potential gives him the depth and understanding to meet individuals and group needs across industries and platforms.

 Ed is the author of  “Life With Breath” and “BodyMindBusiness”; he is a contributing health & wellness editor for Huffingtpost, Thrive Global, MindBodyGreen & PTOnTheNet. Ed’s Breath AS Medicine Training offers CE in the healthcare, wellness coaching, fitness & athletic training sectors. Ed is a Faculty Member of the Medical Wellness Association. Learn more about Ed at www.edharrold.com

 

References

  1. National Center For Health Statistics, Health, United States, 2015.  Table 53.  https://www.cdc.gov/nchs/fastats/obesity-overweight.htm 
  2. Sominsky, L. & Spencer, S. (May 2014). Eating behavior and stress: a pathway to obesity, School of Health Sciences and Health Innovations Research Institute, Retrieved from http://journal.frontiersin.org 
  3. Novotny, S. (2007, February 1). The science of breathing. Ideafit.com. Retrieved from http://www.ideafit.com/ 
  4. Harada, S., Yamazaki, Y., Koda, S., Tokuyama, S. (April 23, 2014). Hepatic Branch Vagus Nerve Plays a Critical Role in the Recovery of Post-Ischemic Glucose Intolerance and Mediates a Neuroprotective Effect by Hypothalamic Orexin-A, Retrieved from http://journals.plos.org/ 
  5. Meerman, A. Brown (December 19, 2014).  When Somebody Loses Weight, Where Does The Fat Go? The BMJ. Retrieved from http://www.bmj.com/content/349/bmj.g7257
  6. Porges SW, Doussard-Roosevelt JA, Maiti AK (1994).  Vagal Tone And The Physiological Regulation of Emotion.  PubMed.  Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/7984159 
team hands

Collaborative Thinking in Health & Wellness

/21 May 2021/ All MFN blog/

Over the past 18 months, I have seen my primary M.D. three times, enjoyed the services of my favorite massage therapist six times, visited my chiropractor nine times, chatted with a local R.D. twice and seen my personal trainer regularly. And not one of them even asked if I was seeing any of the others, much less inquiring what their treatments or approaches to treatments might be. To me, that is like trying to achieve success with a baseball team where the 1st base coach, 2nd base coach, 3rd base coach and pitching coach never communicate with each other.

Success cannot occur in a vacuum, neither can trueindividual health & wellness, yet for decades these medical, fitness & wellness providers have proffered their services in distinct and distinctly separate spaces.

Even as the internet has made access to information easier and facilitated the sharing of knowledge, including private, HIPAA compliant information, these providers continue to operate in “informational silos.”

It is true that in the past some of these providers may have held less than favorable opinions of some of the other providers, but that is, and certainly should be, a thing of the past. No longer will M.D.’s consider Chiropractors “quacks”, R.D.’s claim nutritionists “just don’t know enough”, and Physical Therapists think of Personal Trainers as ”wanna-be P.T.’s who couldn’t hack the education.” Science, knowledge and time have evolved all these disciplines into valuable, useful and incredibly beneficial specialties, each offering specific training and specific methods to apply to their patients/clients. And all those patients/clients typically can benefit from their combined expertise and knowledge.

No longer is it sufficient to simply treat the symptoms. Real wellness needs to encompass the patient/client holistically… address the symptoms, understand the cause, strengthen the mind, examine the diet, resolve the issue and prevent future occurrences. And isn’t that best accomplished by viewing patient/client wellness as a Team Sport?

Over the years I have had the pleasure of knowing and speaking at length with many of these medical, fitness & wellness providers, and not one of them indicated there is anything in their training that says “Thou Shalt Not Collaborate.”

We are not talking about “asking for help.” Rather we are simply saying to include those other practitioners in the conversation. Instead of the M.D. telling the patient to “walk more to improve cardio health”, why not conference call with the Personal Trainer and discuss the walking program that is most appropriate. Let the Physical Therapist inform the Personal Trainer of any specific issues to address or avoid. Allow the Massage Therapist to work with the Chiropractor to ensure optimum results from both. In other words, (and the simplicity of all this may surprise you), just TALK TO EACH OTHER.

So, let’s start to make that happen. For more than 20 years my company has helped health clubs and fitness centers create mutually beneficial relationships with Physical Therapy practices, Chiropractic offices, Registered Dietitians, Nutritionists and Massage Therapists. Now is the time to extend the conversation, and, to return to my baseball metaphor, get ALL the coaches working together to create truly Championship results.

Cosmo Wollan is the Senior Executive at Synergy Cubed, a premiere consulting firm providing customized solutions to the health & fitness, parks & recreation, medical fitness and corporate wellness industries since 1994. His Fitness Industry clients have engaged him as an expert problem-solver in profit center development, retention strategies, customer engagement, sales training, programming design, operational streamlining and health club management.

trainer-resistance-band-senior-woman-client

You Are The Solution

/19 May 2021/ All MFN blog/

This article is meant to be a wake-up call to the fitness industry. The health of our population and country are at stake. While advancements have extended our country’s overall lifespan, it has occurred primarily through the use of medications and life-saving procedures rather than through lifestyle changes. The stark reality is that the overall health of Americans is declining as evidenced by the $3.5 trillion spent every year on health care expenditures.

Another alarming statistic is that between 1997 and 2016, there were approximately 4.5 billion prescriptions written per year. 70% of Americans take at least one and 20% take five or more prescription medications (Preidt 2017). The majority of these medications were taken to address lifestyle-related diseases and the subsequent impacts of poor nutrition choices and lack of physical activity. Additionally, many prescription and over-the-counter medications are used to treat osteoarthritis, the most common cause of physical disability in the world. While genetics, weight, and age have been considered as underlying factors, the decrease in quantity, as well as quality, of physical activity have been shown to be much greater factors to the onset and prevalence of osteoarthritis in modern society (Wallace 2017, Osar 2018).

While often attributed to causes outside one’s control (i.e. genetics), the fact is that the diseases contributing to the greatest number of deaths (heart disease, cancer, and Type 2 diabetes) and disability (osteoarthritis) are directly related to controllable factors. While each has a genetic component, lifestyle has a much greater impact on the incidence and prevalence of these diseases. One of most important and underappreciated components in the overall decline in one’s physical, physiological, and cognitive health, is the lack of physical activity. Less than 20% of the population meet the daily physical activity guidelines and less than 5% of the adult population participates in 30 minutes of physical activity. Even more disturbing is that more than 78 million U.S. adults and 12 million children are obese.

Dr. Caldwell Esselstyn has been attributed with the quote, “Genetics loads the gun, lifestyle pulls the trigger.” This suggests that lifestyle is as important as genetics in the expression of many chronic diseases. This sentiment is reiterated in a recent study from Bodai et. al (2018). “Epidemiological, ecologic, and interventional studies have repeatedly indicated that most chronic illness, including cardiovascular disease, cancer, and type 2 diabetes, are the results of lifestyles fueled by poor nutrition and physical inactivity.”

The health of our population and country is at stake. This is a call for fitness professionals to step up and recognize that you are the first line of defense against the deleterious impacts of lifestyle diseases. It is your responsibility to educate your communities that lifestyle changes, incorporating proper nutrition as well as increased physical and cognitive exercise, should be the first step in addressing chronic lifestyle diseases. You can continue to change the health of our nation by implementing evidence-based nutrition, exercise, and cognitive training programs. Be the solution your clients, your community, and our country needs by investing in advanced education in nutrition, exercise, movement, and cognitive training. Create relationships with allied health professionals so that we can collectively educate, collaborate, and coordinate the changing of our nation’s health care system.

This article was featured in MedFit Professional Magazine.

Dr. Evan Osar, an internationally recognized speaker, author, and expert on assessment, corrective exercise, and functional movement. Dr. Osar is committed to educating and empowering fitness professionals while helping them develop relationships with allied health professionals. He is author of the Corrective Exercise Solutions to Common Hip and Shoulder Dysfunction and has developed the industry’s most complete training certification, the Integrative Movement Specialist™. With his wife Jenice Mattek, he created the online educational resource. For more info, visit IIHFE.com.

References

Bodai, B. I., Nakata, T. E., Wong, W. T., Clark, D. R., Lawenda, S., Tsou, C., … Campbell, T. M. (2018). Lifestyle Medicine: A Brief Review of Its Dramatic Impact on Health and Survival. The Permanente journal, 22, 17–025. doi:10.7812/TPP/17-025

Centers for Disease Control and Prevention. Osteoarthritis. Retrieved from https://www.cdc.gov/arthritis/basics/osteoarthritis.htm

Centers for Disease Control and Prevention. Leading Causes of Death. Retrieved from https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm

Centers for Medicare & Medicaid Services. National Health Expenditure Data. Retrieved from https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsHistorical.html

Osar, E. (2018). The Fundamentals for Training the Older Client with Osteoarthritis. Retrieved from https://www.ptonthenet.com/remote-learning

Preidt, R. (2017). Americans Taking More Prescription Drugs Than Ever. https://www.webmd.com/drug-medication/news/20170803/americans-taking-more-prescription-drugs-than-ever-survey

U.S. Department of Health & Human Services. Facts and Statistics. Retrieved from https://www.hhs.gov/fitness/resource-center/facts-and-statistics/index.html

Wallace, IJ., Worthington, S., Felson, DT., Jurmain, RD., Wren, KT., Maijanen, H. Woods, RJ., Lieberman, DE. (2017). PNAS. 114(35): 9332-9336.

Hydrating-food

Guide On How To Be Hydrated: EAT Nature’s Water

/18 May 2021/ All MFN blog/

Water is not just blue, it’s green! Eat Nature’s Water.

We think of water as being blue liquid, functional, moistening, and wet, but not nutritious. Original government guidelines on hydration were based on total ounces, and here is the surprise… 45% of those ounces came from food. Over the years, urban legend morphed it into ounces from liquid and finally from water only.  But getting hydration from water AND food is the absolute smartest strategy on the planet, one designed by nature.

Water from fresh food can be up to 2/3 more hydrating than water from a glass.

The gel water in fruits and vegetables is structured by nature, more nutritious, and guess what, more hydrating than liquids because it is packed with fibers to help water absorb not just flash flood through, and also full of nutrients.

Ranging between 80 to 98% gel water by volume, plants are nature’s perfect biological packaging of nutrients and hydration.  The next time you eat a fruit or a vegetable, it is a form of water. Water-rich foods are nutrient-rich, packed with antioxidants, proteins with their amino acids, and vitamins.  They also carry minerals like calcium, magnesium, potassium, and sodium, which when activated by the electrical charge in water are then known as electrolytes that we need for energy.. We need this fuel not only for biological nutrition but also for cognition, judgment, and mood.  And get this, because of the fiber in plants, the water stays in our system longer because we absorb it more slowly. It’s a triple play of hydrating health: pure nature’s water, absorbent fiber, and not only needed nutrients but electrolytes!

Top 12 Hydrating Fruits (% H3O2)

  1. Starfruit – 91.4%
  2. Watermelon – 91.4%
  3. Strawberries – 91%
  4. Grapefruit – 90.5%
  5. Cantaloupe – 90.2%
  6. Pineapple – 87%
  7. Raspberries – 87%
  8. Blueberries – 85%
  9. Kiwi – 84.2%
  10. Apples 84%
  11. Pears – 84%
  12. Grapes – 81.5%

Top 12 Hydrating Veggies (% H3O2)

  1. Cucumbers – 96.7%
  2. Romaine Lettuce – 95.6%
  3. Celery – 95.4%
  4. Radishes – 95.3%
  5. Zucchini – 95%
  6. Tomatoes – 94.5%
  7. Peppers – 93.9%
  8. Cauliflower – 92.1%
  9. Spinach – 91.4%
  10. Broccoli – 90.7%
  11. Carrots – 90%
  12. Sprouts – 86.5%

The Benefits of Fresh Juices and Smoothies

Besides eating lots of fruits and veggies, fresh juices and smoothies are easy to make and are highly hydrating.  While fresh juices with their gel water is still more nutritious and hydrating than a glass of water, they can be expensive to make and juicing filters out the pulp and discards it.

This is why we recommend smoothies as the path to optimal hydration.  Smoothies blend in the whole fruit or vegetable, retaining the plant fibers. In addition to helping us stay hydrated longer, these precious plant fibers, or cellulose, also sweep clean micro-sized toxins, cellular waste, and debris that are constantly coming into our bodies from our industrial environments.  Plant compounds can even buffer us from electromagnetic assaults, which create mineral imbalances. With smoothies, there is no tossing out the pulp!

In Hydration Foundation’s Recipe Section, we have created recipes and tips for making smoothies and other drinks.

Salt is a Hydrating Solution  

Yes, salt can help you stay hydrated. Natural (unrefined) and processed salts are not the same.  Unlike processed salts, natural salts contain sodium, potassium, and many other trace minerals. Sodium provides positively charged ions while potassium provides negatively charged ions. This combination generates electrical charges in our cell membranes and keeps cells functioning. If you don’t have enough salt in your system, your body’s internal charge is not balanced and cells can’t receive and transmit impulses the way they should.  To learn more about salt and its critical role in hydration, click here. A small amount of natural salt is absolutely essential for hydration.

Free Webinar!

Join Hydration Foundation founder Gina Bria for a free webinar on this topic, Guzzling 8 Glasses a Day Is Not the Way… and 5 Other Ways to Get Hydrated You Don’t Hear About

Originally printed on the Hydration Foundation. Reprinted with permission

As founder of The Hydration Foundation, anthropologist Gina Bria spreads the science of how plants transform liquid water into gel water, or H3O2. She shares how we can adapt and use these ideas now in our water-challenged world for better hydration and better water protection worldwide. As a thought leader on the topics of hydration, energy, and water purity, she has shared the TEDx stage with leading water researchers, Dr. Gerald Pollack of the Pollack Water Lab, Dr. Stephanie Seneff of MIT, and Algonquin Grandmother Elder, Nan Andry. She has presented her work in rejuvenation and longevity at worksites in industries as diverse as IT companies, museums, sports conventions, schools, hospitals, and health and wellness gatherings. Her forthcoming book, “QUENCH: Reclaim your Energy and Health with the New Science of Hydration, including A Five Day Plan to Get You Hydrated”, is co-authored with Dr. Dana Cohen, MD, an innovative integrated physician in New York City.

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What Happened During the Pandemic

/17 May 2021/ All MFN blog/

The Perfect Pandemic Storm? 

The average weight gain during the pandemic was 1.5 pounds per month, according to a recent study in the Journal of the American Medical Association. As of May 2021, that’s 20 lbs. The results were gathered by monitoring smart scale users with Bluetooth technology. Subjects were male and female smart scale owners with a mean age of 51.

What Happened? 

Shelter in place (SIP) orders combined with stockpiles of pantry items, ample take-out and door-to-door delivery. Additionally, many found themselves with either a household of varied food wants and needs, serving up a daily meal dilemma, or in isolation lending to depression and anxiety. Neither scenario made it easy to adopt or stick to routine healthy dietary habits.

Researcher Suggestions

From the results, researchers suggest a need to mitigate our present post-pandemic conditions with dietary interventions and physical activity.

As aforementioned, the study included both men and women. Women at age 51, however, have another challenge. Women reach menopause at the average age of 51.3. During the latter stages of perimenopause and early postmenopause, there is an accelerated rate of loss of both muscle and bone. The loss is experienced when there is a sharp decline of estrogen and a corresponding increase of cortisol.

Show Me the Muscle

While average weight gain was the reported data in this study, changes in body composition weren’t included. This author suggests we may safely assume this was fat weight and not muscle. There is a need for both exercise and nutrition interventions.

There is also a potential need to identify solutions to sleep disruption and stress (as cortisol can have a negative impact on fat storage and muscle breakdown). Sleep disruption is common for women in menopause and often accompanies stress or anxiety, of which the pandemic provided an abundance.

Hormonal Contributing Factors

Testosterone and growth hormone also decline with age and levels will suffer more in women who experience unresolved insomnia during menopause. These two hormones are produced in the greatest amounts during deep sleep cycles, which menopausal women may reach with less frequency or for shorter durations. 

Women who were in late-stage perimenopause, early-stage post menopause window during the pandemic have the greatest potential for devastating disability. This is especially true if they weren’t strength training with adequate intensity. We may see these effects in a decade if losses of muscle and bone are not mitigated. 

Sarcopenia, a significant loss of muscle and strength, is experienced by 42% of women by the time they reach 65. This is true in normal times, without a 14+ month decrease in adequate exercise stimulus. Sarcopenia results in frailty, greater risk of falls, and with bone loss also occurring at accelerated rates during menopause, fracture risk is higher. 

Compounding Problems

Pre-existing obesity or that stemming from weight gain during the pandemic coupled with sarcopenia provides an even more severe condition known as sarcopenic obesity. Both obesity and sarcopenia are independent risks for disability. In adults diagnosed with both, there is a 2.5-fold increased risk of disability. 

Inadequate Stimulus

When hormone levels offered a stimulus for muscle decline, there must be some other stimulus to replace it. 

Remember the shortage of dumbbells early in the pandemic? While Peleton sales skyrocketed and walking increased for many, access to the type of anaerobic strength training that has the biggest pro-aging benefits for women in midlife required creativity. For those not familiar with strength training, or not online due to connectivity or comfort, muscle and bone loss awareness and solutions are warranted.

The Perfect Storm for Fitness Professionals

For personal trainers and fitness pros, this truly is a perfect storm. It’s an opportunity for a legacy of impact on a female demographic that touches three generations. Her young adult children, friends and life partners, and parents & in-laws. Household decisions and health habits are influenced most by her. No one else has as much influence on health as she does. 

The unnecessary devastating disability that could result for those who’ve gained and sustained significant weight during the pandemic can be avoided. Fitness pros who take proactive measures to educate, publicize, and offer positive solutions for behavior change can be a part of reversing this significant health risk.

Debra Atkinson is the #youstillgotitgirl who is flipping 50 and changing the way thousands of women think about their second half. She’s the host of the Flipping 50 TV Show and the Flipping 50 podcast. As a master personal trainer, strength and wellness coach with over 30 years fitness industry experience, she works with women who are pro-aging with vitality and energy. She serves on the MedFit Education Foundation Advisory Board, is an international fitness presenter, and author of hundreds of articles and multiple books. Visit her website, flippingfifty.com

References

  • Lin AL, Vittinghoff E, Olgin JE, Pletcher MJ, Marcus GM. Body Weight Changes During Pandemic-Related Shelter-in-Place in a Longitudinal Cohort Study. JAMA Netw Open. 2021;4(3):e212536. doi:10.1001/jamanetworkopen.2021.2536
  • Front. Endocrinol., 21 May 2020 | https://doi.org/10.3389/fendo.2020.00332