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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 Kade 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!




Why Use Foam Rollers?

We see many claims about fitness tools but they often don’t live up to the hype when reviewed by experts. Numerous claims have been made that foam rolling increases blood flow, is useful in warming up the muscle prior to exercise, and assists in post-exercise recovery. A study reported in the respected Journal of Strength and Conditioning Research determined that foam rolling is worth the effort: areas massaged with the foam roller saw increased arterial blood flow. The foam roller lives up to the claims; it is a useful tool that should be part of your exercise tool belt.

Foam rollers were once used exclusively in a physical therapy setting. Dr. Moshé Feldenkrais is credited with being the first person to use rollers for therapeutic purposes (for instance, improving body alignment, reducing muscle tightness, teaching body awareness) in the late 1950s. Foam rollers have been used by a variety of clients with conditions ranging from multiple sclerosis to common orthopedic concerns. The beauty of the foam roller is that it can be used by almost everyone.

Research has shown that stretching, relaxation, meditation, foam rolling, and biofeedback techniques all ease muscle tension, which contributes to pain and common muscle stiffness. A massage is a favorite method of stretching and relaxing tight muscles. It enhances functional range of motion, aids in the healing process, decreases muscle reflex activity, inhibits motor-neuron excitability, and contributes to relaxation. However, not many people can afford a daily or weekly massage session. A regular foam roller session can provide many of the benefits same benefits as and prolong the benefits of a massage while adding diversity and challenge to your standard exercise program.

Designing a balanced exercise routine that includes flexibility movements with strength training, cardiovascular exercise, and relaxation can reduce chronic discomfort and stress. Since foam rollers break up interwoven muscle fibers and help move oxygenated blood into those muscles, they’re an excellent device with which to release tight spots in the muscles (the technical term is “myofascial release”) and return the muscles to a more optimal state. This can be done prior to exercising to improve range of motion, after a workout, or during a break at work to relax tight muscles and reduce soreness from sitting too long.

From the Foam Roller Workbook, by Karl Knopf. Reprinted with permission from Karl Knopf

Karl Knopf, Ed.D, served as the Director of The Fitness Therapy Program at Foothill College for almost 40 years. He has worked in almost every aspect of the industry from personal trainer and therapist to consultant to major Universities such as Stanford, Univ. of North Carolina, and the Univ. of California well as the State of California and numerous professional organizations. Dr. Knopf was the President and Founder of Fitness Educators Of Older Adults for 15 years. Currently, he is the director of ISSA’s Fitness Therapy and Senior Fitness Programs and writer. Dr. Knopf has authored numerous articles, and written more than 17 books including topics on Water Exercise, Weights for 50 Plus to Fitness Therapy.


Bridging Rehab with Fitness: Become the Trusted Referral for Rehabilitation Therapists

There are special and unique bonds that are made between clinician and patient in a rehabilitation setting. Many times, rehab patients are at a very difficult time in their lives and through months of daily expert guidance, hard work, education, and often even fun, alongside their rehab team, they make considerable gains back towards independence.

Because of this daily interaction, the rehab team develops a vested interest in the continued progress of their patient. Over the course of many months of the blood, sweat and tears of intensive therapy sessions, a friendship has been formed and considerable progress made together. It’s no wonder that rehab professionals are very selective with the fitness referrals they make once their patients are ready for the post-rehab world.

They are selective because they want the absolute best for their patient; they want someone with an understanding of their patient’s diagnosis; someone who understands medical precautions and contraindications; and someone who can safely continue to progress their patient without putting them at risk for a secondary issue. Though they may be selective with referrals, a trusted source for continuing their patients’ goals is needed.

Here are some ways to bridge the gap and gain the trust of your local rehabilitation professionals:

Require a medical or physical therapy release

Having medical releases before beginning ongoing sessions is an excellent way to open dialog with your client’s doctor or physical therapist and further, ensures that you are programming their fitness plan accordingly. Send your assessment with your client to share in their next appointment along with a simple inquiry form about restrictions or suggestions to use in your program design. This will go a long way in establishing a great level of trust and building a rapport with the clinic.

Volunteer at a rehab clinic

One of the best ways to build a rapport with local rehab professionals and patients is to spend time shadowing/observing or volunteering in a rehab inpatient and/or outpatient clinic. This can be a time-consuming start-up as many rehab clinics will have an orientation process and procedures to allow you to be present in a clinic, but it is definitely worth the time investment. Just being in this environment you can learn a lot about how therapists progress their rehab patients, guard their rehab patients during activity, interact with and educate their patients as they progress them to discharge (the point where you would continue their work). You may also get some valuable opportunities to learn from and build relationships with many therapists in one setting.

Lead warm-ups for local 5K races

There are 3.2-mile run-walk-and-wheels events that take place all over the country. Donating your time to your community Spina Bifida Walk ‘n Roll or Parkinson’s walk is a great way to become visible in your community and demonstrate what you have to offer for all abilities.

Speak at local support groups

Same as with the 5Ks, there are support groups that take place monthly or quarterly for stroke survivors, caregivers, individuals living with Multiple Sclerosis and more. Contacting the organizer of these groups and offering to donate time to speak about the benefits of continued exercise or even providing a no-cost group class during the scheduled talk time is a really good way to connect with both the organizers and their peers and those in attendance who would benefit from a continued exercise program.

Educate yourself on adaptive/medical exercise equipment

Understanding the different options there are for accessories and actual exercise equipment for stroke survivors or those living with spinal cord injury is another great way to demonstrate an understanding of working with a rehab population and continuing to bridge the gap between rehab and fitness. Not all equipment is accessible nor safe, so while thinking outside the box is great, ensuring safety is optimal. Take the time to learn about all the great adaptive equipment that can benefit the population you work with.

Host an open house at your gym

Host regular open house events at your facility and invite any and all rehab professionals, patients, and people from your community. Offer instructional sessions during the open house to demonstrate your adaptive programming/equipment. This is a great way give a sneak peek into what you’re doing to provide a safe environment for patients to continue their progress.

Offer to provide a lunch in-service to rehab staff

Meeting with a clinic full of therapists is an excellent way to educate those therapists that you have done your research, understand your population, and really want to bridge the gap between rehab and fitness. A presentation focused on the population you’re most comfortable working with (Parkinson’s, stroke survivors, etc.), the programs you offer, and pictures or videos of some of the work done in your gym. Bringing food is always a great incentive!

Bridging the gap between rehab and fitness is a process that is long overdue and much needed. By focusing on the points above you will be working towards and moving one step closer to improving the therapist-trainer model, adding a valuable resource to your community and providing a safe environment and safe programming to continue progressing your post-rehab clients.

This article was featured in MedFit Professional Magazine

Devon Palermo is a leading authority on Adaptive Fitness for those living with or recovering from a disability. He is the Founder and Principal director of DPI Adaptive Fitness, A company focused on safe and effective adaptive fitness for individuals living with disabilities. With over 15 years of experience in both fitness and rehab, He is the go-to resource for clients, therapists, and doctors in the DC, Maryland and Virginia area looking to maximize the benefits of adaptive exercise to improve strength, balance, function and abilities. dpiadaptivefitness.co


Is age truly a number or is it something different entirely?  

Is age truly a number or is it something different entirely?  

Having just turned 50 and totally feeling like I am in my 20s while looking, according to longevity face age technology, like I am in my 30s, I personally had to get to the bottom of this question. 

I have interviewed over 100 different longevity experts, written the best-selling book, the Codes of Longevity, and continue to pore through the research to realize that again and again one key answer keeps popping up. 

What it really means to be an “age” isn’t about good genes, a specific diet, cutting edge therapies, lotions, peptides or supplements, although these all do slow down the aging process.  

Age is experienced, understood, and expressed as a result of our perception. 

A key finding in the largest study to date done by Michigan State University on aging assessed over 1/2 a million people to discover that “our perception of age changes as we age”.     

What you believe and how you perceive yourself, your health and your potential matters! It’s literally the feedback from your brain to your body that plays a key role in either speeding up or slowing down the aging process. 

This is shown again and again in the literature from neuroscience and epigenetics to psychoneuroimmunology that the brain informs, impacts and influences the expression of the cells and your very DNA.  

Have you ever stopped to consider what you perceive about age? 

I remember as a kid seeing the elders in my Italian family at get-togethers as strong, jovial, playful, passionate, and vibrant people. I noticed their beautiful skin, how active they were and decided then and there I was going to age amazingly. 

On the flip side, when I was 35, my mother died of cancer at the young age of 54 and that shifted my belief about what aging might mean for me. 

What do you believe? How do you feel about age, a number, pick a number and consider if there is a person or experience that you can recall that influenced your perception or created a belief inside of you?

You may, like many, think of “youth” as an expression of mental and physical ability fueled by energy, focus, performance, and the capacity to take on whatever comes your way. What do you consider to be “middle-aged” perhaps you think of the body slowing down, weight increasing, energy decreasing, and a mild loss of desire setting in, because “that’s just what happens when we get older”. While “old age” can bring up thoughts of the inevitable breakdown of the body and mind that may one day confine us to a wheelchair or nursing home.  

While yes, there are plenty of examples of this occurring, it doesn’t have to.  

In a study published in the Frontiers in Aging Neuroscience, it was found that people who felt younger than their age scored higher on memory tests, rated themselves as healthy, had more grey matter in the brain and were less likely to have symptoms of depression.

You can begin to shift your perception, reconnect to the youthful you, and actually support your brain and body to reverse age by feeling younger. 

Here are a few ways to practice living life optimized at any age and any stage:  

Check your perception

What you perceive, you believe. What you believe drives your feelings, emotions, habits, and daily actions. If you really want to express enhanced youthful vitality, begin by checking your perception of age. 

  • Ask yourself, what does age mean to me? Consider how or when you decided that and if it is actually what you want to be true for you today. 
  • Check-in daily and notice what age you perceive yourself to be today. If you want to be “younger” what if anything would you need to believe or feel today to make that possible? 

Set an ageless vision

Super centenarians hold a similar growth mindset in common. They don’t get fixed or rigid on what was or what is, they are open and look forward to what is coming while appreciating what is here in the now.  They feel like they will live forever but aren’t afraid to die today. They are beyond time and age.  

  • Check-in daily and ask yourself, what am I ready to more fully experience today? 
  • What am I  grateful for today? 
  • What can I look forward to in the days, weeks, and years ahead?  

As you look ahead while appreciating the moment you align with the feelings that energize, excite and engage you to more fully experience and enjoy your life at every age and every stage.

Learn, play and connect

If your perception of age changes as you change, then how can you support lifelong vitality?  It’s rooted in novelty and growth.  The brain craves new experiences. Seek out opportunities to learn something new, like a game or hobby that you can play and enjoy with others for enhanced connection.  

Live your purpose

Purpose ignites all of the following steps. It’s the meaning from within that fuels your desire to learn, grow, connect, engage, laugh, play, and a part of your “why” you want to live a long youthful life.  

  • To connect, simply notice the moments, the people, the places, and things that feel life-giving and soul-filling.  Make more time, enjoy and experience those encounters more frequently for that youthful energy that gives you the capacity to enjoy your amazing life every day regardless of your age. 

Over the past year, I have upgraded my perception, I have challenged my beliefs and I know now with certainty that I can and easily will express boundless vitality, gratitude, and joy each day, every day, regardless of age to 120 and beyond. What are you ready to perceive and believe as possible for you as you feel your way young? 

Webinar with Dr. Petersen

Join Dr. Melissa Petersen, Founder of the Human Longevity Institute, for this webinar where as she shares the science of longevity explaining the role of stress on biological aging and how we can implement immediate clinical solutions to slow down the rate of aging, improve healing while enhancing physical and mental resilience allowing us to thrive by design at every age of life.

Dr. Melissa Petersen is the Founder of the Human Longevity Institute and Author of the Codes of Longevity. As a sought-out keynote speaker and expert in thriving, she is redefining what is possible in living a thriving life by design at every age and every stage, to learn more, visit: ww.DocMelissa.com

ahtlete running

RED-S: What’s That?

RED-S stands for Relative Energy Deficiency in Sport. It happens when athletes eat insufficient food relative to the number of calories they burn. Athletes who enjoy the See Food Diet (they see food and they eat it) are less likely to experience RED-S compared to those who eat restrictively because they are fearful of weight gain. Athletes who eat only “healthy” foods can also slide into RED-S when they unknowingly consume too few calories to support optimal physiological functions.

Athletes most at risk for RED-S tend to be in sports that 1) emphasize appearance (figure skating, dancing), 2) have weight categories (wrestling, rowing), and 3) require endurance (running, cycling). But any athlete can suffer from RED-S—even those who have not lost weight. Take note: under-eating is not always accompanied by weight loss! When the body perceives a “famine” (too little fuel), it does an amazing job of preserving itself from wasting away. 

I get concerned about RED-S when I hear athletes say things like: 

“My friends tell me I eat like a bird…”

“I’m not losing weight, despite all my exercise. Am I eating too much—or too little?”

“I stopped getting my period last year. My doctor said that’s normal for female athletes.”

As mentioned above, RED-S is common in weight-class sports. Case in point: A survey of male and female competitive lightweight rowers (≥18 years old) indicates that many of the rowers had RED-S. They ate an inadequate amount of food relative to what their bodies deserved to be fed. They prioritized weight over health to qualify to row. As a result, the under-eaters experienced excessive fatigue, muscle loss, poor recovery between training sessions, stress fractures, and reoccurring injuries. 

Interviews with the rowers indicates they knew very little about RED-S. Most of the rowers—as well as their health care providersthought RED-S affected only women who had stopped having regular menstrual periods. Wrong. RED-S applies to both male and female athletes!!! 

Because lack of RED-S education can easily contribute to long-term health issues, this article educates all athletes, males and females alike, about the adverse effects of being under-fueled. Please share this with your partners, teammates and others whom you may notice “eating like a bird.” 

  • A tell-tale sign of RED-S in males is loss of libido/sex drive, and in females, irregular or no monthly menstrual period. Other health issues related to RED-S include weight loss (bot not always), reduced bone health that shows up as stress fractures today and osteoporosis in the future, chronic fatigue due to poorly fueled muscles, nagging injuries, moodiness, and depression. Performance issues include inability to gain or build muscle or strength, reduced agility and coordination, poor recovery from hard workouts, impaired judgement, loss of mental sharpness, and reduced ability to focus. An athlete’s plan to lose weight to enhance performance commonly backfires in the long run, if not the short term.
  • As mentioned above, RED-S appears in not only athletes who consciously restrict their food intake, but also in those who unknowingly consume inadequate fuel to support their bodies’ energy needs. This can happen with athletes who juggle school, work, family, friends, and training demands—and have “no time” to eat. RED-S can also happen with others whose “healthy diet” includes a lot of high fiber foods such as beans, nuts, and whole grains that can curb one’s appetite. Or maybe the athletes think they are eating enough because they eat large portions—but the foods are what I call “fluff” (rice cakes, popcorn, lettuce). Regardless of the cause, having low energy availability affects all systems of the body.
  • While restricting food and prioritizing weight over health has become normalized among athletes, you need to know that under-eating is not harmless. Living with an energy deficit affects every system in the body, including the gastro-intestinal system (reduced GI motility, constipation), cardiovascular system (dangerously low heart rate, unusual fatigue), slowed metabolism (energy conservation, cold hands, cold feet). An athlete should never try to maintain a “competitive weight” all year round. 
  • Poor knowledge of RED-S can lead to under-diagnosis, poor management, and poor health outcomes. For example, some health care providers still tell female athletes that amenorrhea is normal in women who train hard. The recommendation to “Just take a birth control pill to get your period” is outdated and does not resolve the underlying problem: an inadequate amount of fuel to support normal functioning of the whole body.

Do you have RED-S? 

Here are a few questions that could help identify if you are under-eating. Do you:

  • Constantly think about your food, weight, or body image? 
  • Severely limit your food intake?        
  • Experience guilt or shame around eating “unhealthy foods”? 
  • Count calories or fat grams whenever you eat or drink? 
  • Feel fat even though others tell you that you are thin?

What’s the solution? 

If you are training hard and eating very little, you could easily be experiencing RED-S. While the obvious answer is— Just eat more and exercise less — doing so can be difficult. Fear of weight gain is a huge barrier. As I repeatedly hear from my doubting clients, “What makes you think I could eat more, exercise less, and not get fat? That just doesn’t make sense.” 

Well, it does make sense because the body does an amazing job of conserving energy (cold hands and feet, low heart rate, loss of menses/libido). When you eat more, your metabolism perks up and you burn off the added calories, as opposed to store them as excess flab. You’ll then be able to train better, recover better, and perform better. If you are under-eating, start by adding 100 to 300 calories to breakfast, then lunch, and then afternoon snack. Notice the benefits: feeling perkier and well-fueled!

The time is right to revolutionize the culture of sport, so that athletes can focus more on performance and health, and less on weight. To initiate this change, you might want to participate in your sport at a weight that fits your genetic physique and allows you to prioritize health over weight. Excelling as a strong and powerful athlete could easily lead to a more satisfying sports career than starving yourself to be an injury-prone athlete who spends too much time sitting on the sidelines. The thinnest athlete is unlikely the best athlete. The best fueled athlete who is genetically gifted will win the prize!

The bottom line: If you think you have RED-S, talk with a trusted sport dietitian (RD). Poorly managed RED-S can too easily end up as malnutrition, disordered eating, osteoporosis—and a disappointing future for your athletic aspirations.

Nancy Clark MS RD CSSD counsels both fitness exercisers and competitive athletes in the Boston-area (Newton; 617-795-1875). Her best-selling Sports Nutrition Guidebook is a popular resource, as is her online workshop. Visit NancyClarkRD.com for info.





Natural Prescription – An Alternative Approach

One of the best things we can do for our bodies is to “get out of the way”! Believe it or not, our body can actually do a great job of healing itself, or functioning quite optimally when it’s allowed to do so. The body does this by reacting to what “stresses” are put upon it and finding homeostasis through temporary changes or more permanent adaptations. Even the brain will make quick reactions to things in the form of neurotransmitters and neural firing or long term adaptations in adopting new ways of perceiving things or hard-wiring changes.

A statement capturing the above sentiment is from Goodheart (1989) on healing, “People are healed by many different kinds of healers and systems because the real healer is within. The various healing modalities are merely different ways of activating the inner healer.”

Are you of the Mechanist (Rationalist) or Vitalist (Empirical) Approach?

The standard or “orthodox” medical practice in the U.S. follows a mechanist approach, where symptoms are perceived as bad and should be minimized or suppressed through surgical or pharmaceutical means. This seems great at the surface level. If something is causing me pain or discomfort let me do something to relieve or eliminate that pain. If I am having nausea or diarrhea because of something in my gut, let me take something to stop the vomiting or diarrhea. Underlying this “quick fix” of symptom alleviation is THE PROBLEM. The body is trying to rid itself of the “problem” by expelling if forwards or backwards! There are many medical conditions for which it is okay to consider treating symptoms, and for some this is vital. However, it is preferable for this to be done in conjunction with identifying the source of the problem, so a long-term fix can be explored.

A Vitalist approach views symptoms as part of the healing process, not a problem that should be hidden. Many branches of health care use this philosophy including: chiropractors, osteopaths, naturopaths, and practitioners of Chinese or Indian medicine advocate this Vitalist approach. By suppressing the symptoms, the practitioner may actually be extending the illness or exacerbating the problem. Researchers at the University of Maryland found taking aspirin for the flu may prolong the illness up to 3 days. Acetaminophen (Tylenol) or aspirin interferes with the normal fever response that fights the infection (Burke, 2000).

Listening to the Symptoms tell you Where the Problem Lies

Rather than reducing or eliminating the symptoms, what if we tried to increase our sensitivity to it. For example, if we took antibiotics to fight a bacteria, are we enhancing the body’s immune response to this foreign agent or “giving it” something to help, much like a crutch. A quote from unknown origin:

Give a man a fish, and you feed him for a day. Teach a man to fish, and you feed him for a lifetime.

This is at the heart of the Vitalist approach. The body is great at adaptation but we have to let it “learn” to adapt- not “feed” it some drug that forces it to do something. A quote from the Nobel Prize winner, Rene Dubos, Ph.D. remarks, “Good health is a process of continuous adaptation to the myriad of microbes, irritants, pressures and problems which daily challenge man.” This is also at the heart of exercise training. You must “overload” a system in order to get an improvement in function. You literally must stress it, and let it endure that strain in order to get the adaptation. Likewise, by putting your body in destabilized environments, you will gain a better sense of balance, in order to stabilize yourself. Recent evidence has found that anti-inflammatory agents actually weaken the endurance training effect.

Fortunately, medical advances have allowed us to treat many illnesses effectively and safely, and it is always advisable to follow the advice of your doctor. Allowing your body to adapt to certain stresses can be very positive in certain scenarios, but it is important to recognize when this doesn’t come at a risk of increasing morbidity, mortality, or increasing the likelihood of illness complications.

To Drug or Not to Drug: that is the Question

No one likes being depressed. About one in 10 Americans takes some sort of antidepressant medication. It is the most commonly prescribed drug in the U.S. according to a report published in the Archives of General Psychiatry (2009). While the U.S. may not be a Prozac Nation, as popularized in 1994 by the author Elizabeth Wurtzel, the rates almost doubled from 1996 to 2005 (5.84% to 10.12%). A report in the Journal of the American Medical Association found it to work best in only severe cases of depression and exercise had similar effects in the short term treatment and better effects in long term treatment! The difficulty lies in getting someone to exercise when they are depressed. Thus, an integrated approach is often the best, and this includes psychological counseling as well .

Sometimes Less is More

A take away from this article should not be that standard medical care is bad. Far from it. Many M.D.s are very knowledgeable in areas outside of their standard practice and advocate expressive, rather than suppressive therapies. The take away should be to not rush for a drug to hide or mask your symptoms, but focus on what is the root of the cause, and take action to address this. The term iatrogenic is used for the inadvertent problem caused by a medical treatment. In fact, reports estimate it to be the third leading cause of death in the U.S. with 225,000 to 250,000 dying from iatrogenic diseases annually! While it is hard to say how many of these deaths could have been avoided, it is quite obvious that minimizing invasive treatments until they are necessary is the best plan of action.

Complementary or Integrated Medicine can possibly have the answer to a majority of the health issues presented. The MedFit Network believes those professionals are the future of health care.

Free Webinar with Dr. Mark Kelly

There are a ton of misconceptions surrounding obesity and being overweight. Join Dr. Kelly for this webinar to learn what is actually dangerous about obesity, and how to rethink and reprogram your brain and life toward fun and re-creation, not fitness.

Dr. Mark Kelly Ph.D., CSCS, FAS, CPT has been actively involved in the fitness industry spanning 30 years as a teacher of exercise physiology at academic institutions such as California State University, Fullerton, Louisiana State University, Health Science Center, Tulane University and Biola. He was an exercise physiologist for the American Council on Exercise, a corporate wellness director, boot camp company owner and master fitness trainer.


Why is a Bike So Good for your Knees?

Why is a bike so good for your knees?

When it comes to knee pain, it is hard to know what activities will help them feel better


It is pretty easy to know what makes your knees feel worse:  jumping, running, quick changes in direction, even going up or down stairs.

Why some activities make your knees feel worse

Let’s explore the WHY of knee pain before we get in to how to make your knees feel better.


If you have knee pain, it could be caused by an injury (typically torn ligaments, cartilage, bursitis, dislocation) or maybe you are suffering from something like osteoarthritis where there is inflammation and bony changes inside the joint.

When you are on your feet, your knees are weight-bearing joints.  That means your body weight is going through them.  If you have knee pain and you are overweight, those extra pounds will likely make your knees hurt worse.

Your knee is especially vulnerable because of its wide range of motion.  There are many positions in which your knee can be damaged.  Note: For cardio activity, where you are doing a many-times repeated motion, you may want to exclude weight-bearing exercises.  This, of course, is not the rule for strength training since weight-bearing is actually GOOD to strengthen your bones.


“Impact” refers to the force that goes through the knee joint caused by your foot striking the ground.  As you walk, run, or jump, the forces transmitted are multiplied by your body weight:

  • Walking 2-3 X Body Weight [1]
  • Running 4-14 X body weight [2]
  • Jumping 9+ X body weight

There are also sheer forces through the knee caused by gravity and resistance, like when you slow down, walk down a hill, or come to a sudden stop.

If you have knee pain, you can see why walking, running, or jumping may exacerbate the pain.  Again, if you are carrying extra body weight this creates more force on every step through your knee and is a good reason that doctors want you to be a healthy weight before a knee surgery.


For some people, moving side to side causes pain.  Think basketball shuffle or doing a carioca side line step in your athletic training class (not to be confused with Karaoke which usually involves drunken singing).   Pain here may be caused by collateral ligament issues, meniscus cartilage issues, or joint changes.

I know in my case because of my arthritic changes to the lateral (outsides) of my knees, side to side movement was excruciating.

Is moving your knee actually good for it?

Your knee is the largest joint in the body and it is made to move.  When you stop bending it so much, it may start to feel like a rusty hinge.  That may be due to the joint’s synovial fluid (think lubricant) has gotten thin.  Thin synovial fluid can be caused by many factors, including dehydration, poor diet, or lack of movement, to name a few.

The right kind of movement will stimulate your joint to produce thick and healthy synovial fluid that can do its job of reducing friction and nourishing cartilage.  Healthy synovial fluid may reduce your pain – and that is good.

If impact movement, like running, causes you pain, it’s time to find a way to reduce impact. Try these options:

  • Elliptical Machine
  • Swimming
  • Rowing
  • Biking

If weight-bearing movement, (when you are standing up) like using an elliptical machine bothers your knees, try one of these:

  • Swimming
  • Rowing
  • Biking

If Lateral movement also bothers you, you may have to eliminate swimming because if your knee joint is “loose” (like mine was), kicking during swimming may not feel so good.

So that leaves us with

  • Rowing
  • Biking

While I row on an indoor ergometer, my tool of choice is a BIKE.  You can do it indoors on your own or in a class. You can ride a bike outside for exercise, commuting, for adventure touring.  Riding a bike is simply fun.

Article originally printed on HealthyKneesCoach.com. Reprinted with permission.

Robin Robertson is the international best selling author of “Healthy Knees Cycling”, “Healthy Knees Strength”, and “Healthy Knees Total Knee Replacement”. She has owned and operated the Bellingham Training & Tennis Club since 2000. Robin is accomplished in a variety of training methods including Functional Aging Specialist, ACE-certified personal trainer, USA Cycling Coach, and founder of Healthy Knees Coach.



[1] PMC US National Library of Medicine, National Institutes of Health. (2013). Knee Joint Forces:  Prediction, Measurement, and Significance.  Retrieved on 12/6/19 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3324308

[2] Medscape.com (2015) Joint Loading in Runners Does Not Initiate Knee Osteoarthritis.  Retrieved on 12/6/19 from: http://www.azisks.com/wp-content/uploads/2017/04/Joint-Loading-in-Runners-Does-Not-Initiate-Knee-Osteoarthritis.pdf


The Essential Ingredient to Sticking With It…

If you’ve got this “special sauce,” you’ll overcome any obstacles placed in your way to perform your best…anytime!  Regardless of whether it’s sticking with lifestyle change to improve your health, a nutrition plan, cutting back on smoking or drinking, adhering to a medication regimen, following through with physical therapy appointments, or adhering to an exercise program, this essential ingredient will make all of the difference.


The Roles of a Medical Fitness Specialist: Scope of practice, prevention and interprofessional collaboration

Physical activity has been demonstrated to positively affect over 30 chronic conditions and is considered the best deterrent of chronic disease in primary and secondary prevention. The main goal of a Medical Fitness Specialist (MFS) in the healthcare continuum is to prevent the onset of chronic disease and bridge the gap between clinical intervention and conventional fitness programs. This is achieved by developing exercise programs for those who have or are at risk for chronic disease or dysfunction, have health conditions that may be mitigated or managed by exercise and activity, are newly diagnosed with a disease and need exercise guidance, or have completed a medically supervised rehabilitation program and need to continue to progress. A fitness professional versed in medical fitness protocols, such as an MFS, can work with those who are at risk for chronic disease.

Scope of Practice

Scope of practice refers to boundaries set by knowledge, skills, and abilities (KSAs), as well as education, experience, and demonstrated competency, such as a program of study, or an exam to measure proficiency. A basic personal training certification suggests the holder can develop exercise programs for apparently healthy clients. Unfortunately, considering the overweight and obesity rate is near 70%, and 50%-60% of the adult U.S. population has at least one chronic disease, adhering to scope of practice becomes increasingly important, yet at the same time many fitness professionals may be providing services outside their scope of practice, and beyond their level of certification. By accepting a client, the trainer is proposing a safe workout will be developed and implemented, and the client will not be at risk of injury. If advice is given that is not within the trainer’s scope of practice, the trainer and the facility may be subjected to a lawsuit.

An MFS who integrates medical fitness into practice has the KSAs, based on education, experience, and demonstrated competency to conduct pre-participation interviews, perform fitness assessments, and design and implement health and fitness programs for disease management to avoid future injury and to improve activities of daily living. Unlike an MFS, unless otherwise educated, a fitness trainer who promotes medical fitness is not a licensed healthcare provider and does not possess the KSAs to diagnose an unknown condition, suggest supplements, design meal plans, physically touch a client or provide behavioral counseling.


In the United States, medical care tends to focus on treatment rather than prevention. Whereas treatment is given for a diagnosed disease or injury, the goal of prevention is to avoid, improve or slow down the progression of a probable or possible disease or injury. Prevention can be categorized as primary, secondary, or tertiary. The goal of primary prevention is to foster a life of wellness and therefore avoid or reduce the chance of disease or dysfunction. Primary prevention includes immunizations, targeted types of exercise, balanced nutrition and wellness, and education programs. Secondary prevention is managing a symptomatic disease in the hopes of slowing down or reversing the progression. Examples include treatment for hypertension, asthma, and some cancer treatments. Tertiary prevention involves the management and treatment of symptomatic disease with the goal of slowing progression and severity, as well as reducing disease-related complications. Tertiary prevention includes treatment for late-stage cancer, coronary heart disease, and some types of rehabilitation to include orthopedic, cardiac, and pulmonary. Physical activity has been demonstrated to effectively treat over 30 chronic conditions, mostly in primary prevention but also in secondary and tertiary, making it the number one intervention against chronic disease.


Interprofessional Collaboration

Due to the growing incidence of obesity and chronic disease, leveraging the skills of various providers who can collaborate to deliver the best possible care, based on clinical needs, is necessary to manage the complex health care demands of a population with an increasing incidence of comorbidities. Due to a worldwide shortage of health workers, in 2010, the World Health Organization (WHO) recognized interprofessional collaboration as means to mitigate the global clinician shortage, strengthen health systems and improve outcomes. Interprofessional collaboration refers to health care teams, made up of trained professionals with various backgrounds, who work alongside patients and their families to provide high-quality care, based on the needs of the patient. Consequently, as medical providers begin to recognize the need to prescribe evidence-based exercise as an intervention in the management of chronic disease, MFSs, who are on the front line of health care, are trained and educated to be part of a clinical team that complements and leverages the strengths of each team member to improve population health. As health science and technology advance, it is imperative for fitness professionals who work with clients who have one or more chronic diseases to remain up-to-date on emerging fitness protocols. An MFS is required to participate in continuing education in areas including cardiopulmonary disease, metabolic disorders, and orthopedic dysfunction.

Although the scope of practice of many allied healthcare fields overlaps, the role of the MFS is to work with the client’s team of other healthcare providers, while staying within the scope of practice, based on KSAs. Regardless of the collaborative health team, the client’s physician is always the center, and as such should be provided regular updates as to the client’s progress.

An MFS is uniquely qualified to work with individuals within the healthcare continuum. Some KSAs associated with MFSs are:

  • Knowledge of basic chronic disease pathophysiology
  • The use and side effects of common medications taken by someone suffering from a chronic disease
  • The knowledge to perform and analyze basic assessments related to movement and anthropometry
  • The knowledge to design a safe and effective workout based on information received via assessment results, and the clinical recommendations from other healthcare providers
  • FITT protocols, exercise progressions, and regressions
  • The implications of exercise and activity for individuals with chronic disease
  • Contraindications of chronic disease, and signs and symptoms of distress related to chronic disease
  • Knowledge of signs and symptoms that require expertise outside of the scope of practice for medical exercise
  • The ability to recognize a medical emergency
  • Current CPR and adult AED are required

Personal Trainers & Fitness Professionals: Prevent & Manage Chronic Disease and Collaborate with Clinicians

Check out MedFit Classroom’s 20-hour online course, Medical Fitness Specialist. This course is designed for fitness and health professionals who want to learn more about using exercise as medicine with clients who suffer from one or more chronic diseases. As a Medical Fitness Specialist, you will be able to prevent and/or manage numerous chronic diseases and collaborate with clinicians.

For a limited time, save 40% on this course by entering coupon code MFNBLOG40 at checkout.

This article was featured in MedFit Professional Magazine. Access past issues or subscribe to read more great content like this!

Dan Mikeska has a doctorate degree in Health Science and a master’s degree in Human Movement, as well as certifications from NASM, ACE, the Cancer Exercise Training Institute and the Exercise Is Medicine credential from ACSM. He currently owns NOVA Medical Exercise and Medical Exercise Academy and is adjunct faculty for A.T. Still University’s Master of Kinesiology program.