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Older couple at the gym

Exercise & Fitness: “Cardio Conditioning & Training”

The real power of being fit is in the ability of the cardiovascular system to perform at high levels throughout the day. The process of becoming fit is inherently tied to the heart’s ability to pump blood and oxygen to the organs, tissues, muscles, and extremities during periods of peak demand. The conditioning process is a daily effort requiring activity and movement. The training process is the planned activity that is designed to stress the system intentionally over time and at a prescribed intensity. They are two sides of the same coin and will be highlighted in this article.

Personal Trainer At The Gym

Personal Trainer and the Healthcare Team

Musculoskeletal issues have become the number one reason for physician visits.(1) Doctors are starting to agree that many surgeries may have been unnecessary.(2) The opioid crisis is a symptom of a larger societal issue to be sure, but it appears that too many people are turning to pain medications to manage their various aches and pains. Certainly pain medication and surgery can help many diseases and symptoms. However, they can also have long-term detrimental effects on human health. Can supervised exercise contribute to helping the problems of too many surgeries and too many pain medications being prescribed?

The modern research on this subject continues to support the notion that properly dosed and executed exercise can have a long-term positive impact on pain and possibly reduce the need for surgery. Who in the health and wellness community conducts supervised exercise? The Personal Fitness Trainer and Exercise Professional.

Personal Trainers are sought out to create fun and challenging workouts, help people lose weight, or help athletes perform better for their sport. We feel that although important, this puts exercise professionals like personal trainers in too narrow of a box.

Can a Personal Trainer be more?

Can an Exercise Professional transcend these service niches and be considered part of one’s healthcare team?

We not only believe so, we think that we must.

Exercise has more power than we, and the exercise consumer, give it credit for. Exercise can stimulate powerful natural medicine to help individuals overcome chronic pain and possibly even avoid surgery.

Our goal is to trumpet this message to exercise professionals and consumers alike and work to support the development of the exercise professional to meet this demand. Our plan is to be one of the pioneers that move exercise to the forefront of healthcare as a powerful, and often overlooked, process to be integrated proactively within a healthcare team for supporting individual health where pain persists and surgery is being considered. Will you join us?


Article co-written by Greg Mack and Charlie Rowe of Physicians Fitness.

Greg Mack is a gold-certified ACE Medical Exercise Specialist and an ACE Certified Personal Trainer. He is the founder and CEO of the corporation Fitness Opportunities. Inc. dba as Physicians Fitness and Exercise Professional Education. Greg has operated out of chiropractic clinics, outpatient physical therapy clinics, a community hospital, large gyms and health clubs, as well operating private studios. His experience in working in such diverse venues enhanced his awareness of the wide gulf that exists between the medical community and fitness facilities, particularly for those individuals trying to recover from, and manage, a diagnosed disease. 

Charlie Rowe has been in the fitness industry for almost 20 years, and currently a Muscle System Specialist at Physicians Fitness. He has also worked within an outpatient Physical Therapy Clinic coordinating care with the Physical Therapist. Charlie hold numerous certifications, including Cooper Clinic’s Certified Personal Trainer, NSCA Certified Strength and Conditioning Specialist, the ACSM Certified Health Fitness Specialist, Resistance Training Specialist Master Level, and ACE Certified Orthopedic Exercise Specialist Certifications. Charlie’s experience and continued pursuit of education make him one of the best in his field.

References

(1) Musculoskeletal Injuries: A Call to Action and Opportunity for Fitness Professionals, ACE Prosource 2013 by Nicholas A. DiNubile, M.D.

(2) Doctors Perform Thousands of Unnecessary Surgeries. Peter Eisler and Barbara Hansen, USA Today. Published 3:25 p.m. ET June 19, 2013. Updated 1:34 a.m. ET June 20, 2013

yoga-lake

Stress Management and Diabetes

Diabetes, is left uncontrolled, can cause a whole host of health complications such as vision impairment and neuropathy. It is important to adhere to any instructions your doctor has given you to keep blood sugars controlled. Your physician may also educate you on exercise, diet and stress management to keep a balanced and healthy lifestyle.

Anyone who suffers from chronic stress may have many health issues later in life. One condition that may arise is diabetes.  Prolonged stress can either cause diabetes or make it tough to obtain normal blood sugars. Blood sugar numbers usually go up and down depending on what you do throughout the day. If you are fasting your numbers should be less than 100 but could be 180 two hours after eating a meal. Most diabetics must monitor their glucose levels on a regular basis.

People who have diabetes may also feel stressed because of their treatment plan. This is also called, “Diabetic Distress”.  Individuals with diabetes have many things they must do to take care of themselves such as: check glucose levels, exercise, cook and eat healthy meals, maintain a certain diet and take medications as prescribed. This new lifestyle can be very stressful for many people who have diabetes.

Along with Diabetic Distress there are the usual stressors that are a part of life. It is important to find ways to control stress throughout your lifespan. If you are newly diagnosed, the first step to reducing stress is to talk to your physician. Your medical team is on your side and can help you find a Diabetes Educator. These individuals host classes to go over any new information and questions you may have.

When controlling stress, you need to find out what works for you personally. Some individuals like to take a walk in the park, others choose to practice meditation or use a combination of many techniques. When you start to try new practices remember that you may have to try each a few times. The body has to get used to approaches. A qualified stress management consultant can help you to create a stress management plan specifically for you.

A great way to incorporate stress management into your daily routine is through meditation. Choose a certain time of day that you know will work for you. Some individuals find it helpful to meditate before getting out of bed in the morning. Others find it works best at the end of the day when they have finished working. Taking a break at work during lunch can be helpful as well. Once you find the time of day that works best choose your space. You want to find a room in your house that is free from distraction. It will also help to turn off all electronics and the television.

When practicing meditation, remember that there is no right or wrong way to meditate. Some individuals choose to meditate laying on a mat while others sit or stand. Choose a position that is comfortable for you. When sitting for meditation your knees should be lower than your hips to help sustain the position.

Guided meditation is also a great choice for meditation. A trained instructor will guide you through the meditation to help you reduce stress. Please check out this free guided meditation that you can try at home. Our Soothing Garden meditation may be shared with friends and family as well.


Robyn Caruso is the Founder of The Stress Management Institute for Health and Fitness Professionals. She has 15 years of experience in medical based fitness.

pexels-anna-shvets-3962285

The Athlete’s Kitchen

“I used to be skinny when I was a runner in college. Look at me now. My BMI says I am “obese.”

“Despite exercising regularly, I’ve gained weight with menopause … frustrating!!!

“I’ve always been able to manage my weight by eating a little less and exercising a little more. Since I turned 50, that’s not working for me anymore.”   

If any of the above comments sound familiar to you—or your parents or friends, keep reading. I counsel too many mid-life athletes who express frustration about undesired weight gain. Women can younger athletes avoid it?  

STRESS pencil

A Stress Management Plan for an Aging Population

April is National Stress Awareness Month!

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

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

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

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

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

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


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

 

Sources:

https://consumer.healthday.com/encyclopedia/aging-1/age-health-news-7/aging-and-stress-645997.html

https://www.slideshare.net/soniya302/stress-among-elderly

http://www.elderly.gov.hk/english/healthy_ageing/mental_health/stress.html

https://www.stress.org/seniors/

http://www.providencecare.com

http://www.health.harvard.edu/aging

 

heart-stethoscope

Body Fat Promotes Heart Disease

Risk factors for heart disease – elevated LDL cholesterol, hypertension, elevated triglycerides, inflammation, and blood glucose – are all exacerbated by excess body fat, and overweight/obesity itself is considered a risk factor.1-3

Is it beneficial to be a little overweight?

However, there has been controversy about a potential “obesity paradox” in heart disease: the idea that some amount of excess weight either does not pose any risk or is even protective. Unfortunately, the studies that suggest there may be a protective effect of body fat are often the ones that get more news coverage; but this does a disservice to an already overweight and nutritionally misguided public, allowing them to believe that excess body fat won’t harm their health.

Is there really an obesity paradox? Or is it just that BMI is not a good measure of body fat?

Many of these studies have used body mass index (BMI), however BMI, which only takes into account height and weight, is not an accurate indicator of body fatness. BMI does not distinguish between fat mass and lean mass, nor does it take into account fat distribution (visceral fat vs. subcutaneous fat). Many people whose weights are within the “normal” BMI range are still carrying excess fat.

There has been no evidence providing a convincing explanation of how excess fat could possibly provide a cardiovascular advantage.  Plus, there are numerous medical conditions may cause unintentional weight loss, including depression, anxiety, autoimmune diseases, cancers, and digestive disorders. In the elderly especially, a low BMI may be an indicator of muscle loss and frailty rather than an indicator of a healthy low level of body fat. In short, people who are thinner are not necessarily healthier.

Relationship between body fat and heart disease: using better measures than BMI

A new study  is helping to clear this issue up,4 in a cohort of almost 300,000 people in the UK (age 40-69) who were followed for an average of 5 years. Their first analysis puts the optimal range of BMI for heart disease prevention at 22-23 kg/m2. It was a “J-shaped” association, meaning risk rose both above and below the 22-23 range. But the researchers went further. They used multiple measures of body fatness to get a more accurate picture: waist circumference, waist-to-hip ratio, waist-to-height ratio, and percent body fat.

Ultimately, what the researchers found was that using BMI produces different results than the other indicators. BMI was the only one that showed an increase in risk at the low end (<18.5 kg/m2). When they excluded smokers and participants with pre-existing diseases, the increase in risk associated with low BMI almost disappeared.  The more accurate measures of body fatness – body fat percentage, waist circumference, waist-to-hip-ratio, and waist-to-height ratio – showed a clear trend: more body fat, greater risk.4

More body fat, greater cardiovascular risk

The researchers concluded that the obesity paradox observation mainly occurs due to confounding effects of disease and other factors on BMI, and that the “public misconception of a potential ‘protective’ effect of fat on CVD risk should be challenged.”4

As discussed above, a low BMI is often an indicator of disease, rather than an indicator of a healthy weight resulting from healthful eating. The standard American diet (SAD) is fattening. If someone is eating the SAD and is not overweight, there is likely something wrong.

Lose weight permanently on a Nutritarian diet

The dramatic weight loss-promoting effect of the Nutritarian diet contributes to cardiovascular protection. A 2015 study published in the American Journal of Lifestyle Medicine analyzed and reported weight loss results provided by 75 obese patients who had switched to a Nutritiarian diet. The average weight loss was 55 pounds, and very importantly, they kept the weight off. None of these respondents had gained back the lost weight after three years.5

Reprinted with permission from Dr. Fuhrman.


Dr. Fuhrman is a board-certified family physician specializing in nutritional medicine. He is President of the Nutritional Research Foundation and the author of 6 NY Times bestselling books, including The End of Heart Disease.  Visit him at DrFuhrman.com

References

  1. Coelho M, Oliveira T, Fernandes R. Biochemistry of adipose tissue: an endocrine organ. Arch Med Sci 2013, 9:191-200.
  2. Tchernof A, Despres JP. Pathophysiology of human visceral obesity: an update. Physiol Rev 2013, 93:359-404.
  3. Benjamin EJ, Blaha MJ, Chiuve SE, et al. Heart Disease and Stroke Statistics-2017 Update: A Report From the American Heart Association. Circulation 2017, 135:e146-e603.
  4. Iliodromiti S, Celis-Morales CA, Lyall DM, et al. The impact of confounding on the associations of different adiposity measures with the incidence of cardiovascular disease: a cohort study of 296 535 adults of white European descent. Eur Heart J 2018:ehy057-ehy057.
  5. Fuhrman J, Singer M. Improved Cardiovascular Parameter With a Nutrient-Dense, Plant-Rich Diet-Style: A Patient Survey With Illustrative Cases. Am J Lifestyle Med 2015.
Male doctor explaining the spine to a senior patient in medical office

3 Curves = Straight: The Importance of Neutral Spine in Exercise

I have been teaching strength training, as well as Pilates based mat and Vinyasa Yoga for over 2 decades. As a former dancer, I know that I was always struggling with having a “flat stomach” or having a “flat back”. Dancers, in trying to achieve that “perfect turnout” and “flatness”, were often taught to “elongate the spine” by “tucking the pelvis” under, which basically leads to a posterior tilt. Unfortunately, this idea is often taught in fitness to the general population. Trainers and teachers alike, some coming from the dance world, will tell students to “protect their back” by tucking the pelvis such as during standing exercises, even bicep curls, or worse, curl their knees into their chest while lying on the ground or bench, and attempting to do a chest press. Students will be so conditioned to this ROUND SPINE and TUCKED PELVIS, that eventually when they stand, this is their posture. Over time, the discs can bulge, and the forward pelvis will eventually lead to lower back pain they were trying to avoid, as well as knee pain and other issues.

I am a reformed pelvic tucker. I advocate neutral spine when teaching, whether it be standing work such as bicep curls, pronated work such as plank and push-ups, or supine work such as leg lowers and overhead triceps.

The spine has 3 curves: the cervical spine (at the neck) has a concave curve, the thoracic spine (back of the rib cage) has a convex curve, and the lumbar spine (lower back) has a concave curve. And if you want to add a 4th, the pelvis/sacrum has a convex curve as well.

Together, this “S” shape is what keeps a body “straight”. Constantly flattening one’s back or pushing one’s vertebra into this position will eventually damage them. Plus you have to learn to CONTAIN YOUR MUSCLES, not force your vertebrae. There is a moment when the base of your ribs and your pelvic bone will feel like they are aligned in the front, like suspenders. Whatever curves are left over should remain.

Sometimes I do my supine abdominal work as well as strength training on a foam roller (pictured at right). This way there is no avoiding working in neutral spine. Plus, the foam roller will target the transverse abdominus as you are struggling to keep the foam roller still while performing exercises such as chest press, chest flies, overhead triceps, single and double leg lowers, etc.

Another bad habit that trainers and teachers tell their clients and students is to “sit on their hands” while performing exercises such as leg lowers. This is BAD for every reason. Your hands have small bones and veins which are easily damaged by sitting on them. Say you are 200+lbs, and you are putting all of your body weight on your hands! This is not good! I often joke and tell my students “I am a guitar player! I am not going to sit on my money makers!” Also, sitting on your hands again causes the pelvis to tuck, and the shoulders to protrude forward. By teaching this, you are telling your clients and students to “slouch”. You have not taught them how to gain strength by maintaining neutral spine. Third, more often than not, the reason the clients are feeling “pain” in their lower back is they are attempting to lower their legs beyond the range where the abdominals are effective. For me, about a 45 degree angle from the top is plenty of work. Attempting to lower one’s legs all the way to the floor and back will usually be out of the range of someone’s abdominal strength. Find a range of motion where the abdominal muscles fell the work, and the lower back is not effected. You can also put your client on the foam roller, or if you do not have a foam roller, place a thin towel under the sacrum to alleviate any pain the floor may be causing, as well as teach neutral spine.

For “plank”, I often joke (as I am a realtor as well) that “if the plank is not straight, I am returning it to aisle 4 in Home Depot”. People tend to hang their heads when something is difficult. I advocate looking a few floor boards ahead while performing plank, as well as push-ups, and to use a side mirror to check that the line of the head, shoulders, ribs and hips are aligned, while keeping the natural lumbar curve. Again, the ribs and hips should feel like suspenders. Push-ups are basically a “plank with an arm bend and straighten”. So it is important not to hang one’s head, especially when the floor is getting close :). (Planks pictured at right)

In closing, remember that you want to teach your students functional exercises that will help them out in the real world. Teaching neutral spine alignment is one of the most important ideas. You would never want to lift a box with a rounded, tucked spine, so why teach clients to “tuck their knees into their chest” while performing chest press? Sometimes it will take some time for a client to undo these bad habits, but in the end, clients will be stronger, and use the transverse abdomens vs poor alignment to perform daily tasks.

Photos courtesy of ANDREW MARK PHOTO.


Kama Linden has been teaching fitness for over 2 decades. She has taught strength, step, Pilates, Vinyasa Yoga, senior fitness, and has worked with clients and students of all ages and fitness levels. She is certified by AFAA Group Exercise and NASM CPT, as well as 200 hour Yoga. She has a BFA in Dance from University of the ARTS.   You can order her new book, “Healthy Things You Can Do In Front of the TV”  on pre-sale on amazon.com, and it will soon be available on BN.com, and Kindle. Visit her website at bodyfriendlyoga.com

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The Increasing Need For Trained Maternal Fitness Instructors

The need for trained maternal fitness professionals has greatly increased as a result of the number of fit women who desire to continue with their exercise routine once they become pregnant. The past several decades has provided a large body of evidence that supports the benefit and safety of prenatal exercise in uncomplicated pregnancies, and ACOG and other fitness and medical health organizations recognize the importance of fitness in a healthy pregnancy. Studies have shown that women who continue or even start an exercise program during pregnancy gain less fat weight, have fewer complications during labor and delivery, and return to their pre-pregnancy weight faster than women who didn’t exercise while pregnant.

Knowing what the current evidence based guidelines are for pregnant and postpartum women and being able to work with this population will open up opportunities to create a specialized program that fits their unique needs. Fitness professionals who have training in this field offer skilled support and guidance to pregnant and postpartum women and help them confidently include exercise as part of their lifestyle. Pregnant women are unsure of what exercises and activities they can continue throughout pregnancy and need guidance on how to monitor their routine for safety. As pregnancy progresses, women need strategies for modifying their exercise program as their body changes to maintain a comfortable and safe routine.

For more information on prenatal and postpartum exercise and our CE correspondence course, “Prenatal and Postpartum Exercise Design” please visit, www.ppfconsulting.com

Article reprinted from Catherine’s Maternal Fitness blog with permission.


Catherine Cram, MS, is the owner of Comprehensive Fitness Consulting, a company that provides pre- and postnatal fitness certifications and information to hospitals, health & wellness organizations and the military.