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Behavioral Bonsai: Effective Fitness Coaching for the Autism Population

“First, which hand?”

“Right hand”

“That’s your left. Which one is your right hand?”

Debbie holds up her right hand.

“That’s your right hand! Alright, cool, walking band pulls with your right hand.”

Coaching fitness programs for the autism population is taking the art of Bonsai to strength and conditioning. We eliminate noise, static, whatever you want to label as extraneous. Successful fitness and adapted PE programs with the autism population require a keen sense of senses.

How is Karl responding to directions for performing a bear walk? Can I fade my hand-over-hand prompt for Jack’s single arm Sandbell press and maintain the integrity of the movement? Is Kelvin going to get over-anxious if introduced to a new variation of the squat? Herein are some of the essential considerations for successful fitness sessions.

We start with three questions: What’s going on physically? What’s going on adaptively? What’s going on cognitively?

The answers provide a flow chart-style of contingency-based decisions? If this; then that. Autism is complicated. The strength and motor planning deficits are complicated. The odd, occasionally near-light speed escalation of anxiety and off-task behavior is complicated. What works is a rational and reliable strategy for each situation to support growth and development in each area of ability (physical, adaptive, cognitive). Taking the guesswork, or most of it, out of programming clears the path to short- and long-term benefits for the athlete.

The two most common coaching errors with respect to the ASD population are over-coaching and exercise selection (typically too progressed). Over-coaching is, by proxy, over-explaining and providing too many verbal directions at once. We often need to simplify verbal instruction for athletes with ASD as short-term recall is an issue of particular deficit. Here’s one set of directions likely to be problematic;

“First hurdle steps, then Sandbell slams, then bear walk from the blue cone to the green cone.”

Many of the athletes I’ve coached will start with bear walks. They’re not being deliberately off-task or defiant, it’s simply a matter of hard-wiring. The verbal directions were too extensive and our athlete was unable, at least for now, to hold them in place.

In the Autism Fitness Level I Certification we teach a strategy called “Label/Demo/Do & Cue” as an efficient way to teach and facilitate learning different exercises with safety, efficiency, and comprehension. Labeling refers to naming the exercise. Demonstrating is our showing the athlete proper form and performance, and Do/Cue gets them into the activity quickly so that we can coach as they learn.

In real life (IRL, LOL!) we would take each one of the aforementioned exercises (hurdle steps, Sandbell slams, and bear walks) and teach/instruct them separately. Consider that physical and adaptive skills can be mutually exclusive. An athlete might have proficiency with all three exercises, yet still require verbal direction at each stage;

“First hurdle steps”

Athlete performs hurdle steps.

“Great hurdle steps and getting your knees up! Now you have eight Sandbell slams.”

Athlete performs 8 Sandbell slams

“Those were some powerful Sandbell slams! Now bear walk from the blue cone to the green cone.”

Athlete completes the bear walk

Using this strategy we avoid overwhelming the athlete and having to back-track. We want to Label/Demo/Do & Cue because it provides the coach with more time to teach the exercise rather than explaining it. Our goal is to maximize “down” time and increase on-task behavior, wherein the athlete is learning and mastering each exercise. Given the strength, stability, and motor planning deficits common to the autism population, it is imperative that as much of a session as possible is dedicated to them being in action.

Labeling the exercise has a secondary benefit. As the athlete becomes more familiar with the name of a movement, he/she can request in or make an informed, motivated decision when an instructor provides options. We use this strategy with consistent success, asking athletes whether they would prefer to do “push throws or overhead throws first” during our medicine ball warm-up.

The structure here is key. Providing choice between exercises sets up a few important contingencies. First, the coach is giving structure. Both medicine ball throws will be performed, however, the athlete gets to choose the order.

The open-ended option “What do you want to do?” could be overwhelming or the athlete may choose something entirely outside the realm of exercise (“bathroom” and “break” are common inserts here). Providing choice within structure enables us to teach what needs teaching and coach what needs coaching while still leading towards autonomy. Over time, many of our athletes wind up “designing” their own sessions with frequent choices being offered, usually with respect to the order of exercises.

Exercise selection is crucial. Focusing on the foundation of movement patterns (locomotion, pushing, pulling, squatting, hinging, and crawling) we are able to address some of the most pervasive physical deficits common to this demographic. It is not about variety, rather building baseline skills that transfer or generalize to novel environments and situations. It can take some time for these movement skills to establish. In multiple cases learning to hinge properly during the scoop throw has taken our athletes a few years to master.

Focusing on a few exercises also gives our athletes the opportunity to learn the name and typical order in which the exercises can be performed. Whereas our warm-up/mobility section nearly always features hurdle steps, overhead resistance band walks, bear walks/crawls, and medicine ball throws (push, overhead, and scoop), our strength/focus section includes squats, presses, pulls, farmers walks, and heavy carries.

Using a “limited” selection of exercises enables our athletes to master the baseline skill (physical), become accustomed to the name and instructions around the exercise (cognitive), and be familiarized enough with each exercise that it can become reinforcing, where the athlete is motivated (adaptive) to engage.

The art of empathetic coaching requires us to ask one overarching question; What is it like for you to be coached by me right now? We acknowledge our athlete’s current abilities and make well-guided plans for their successes.

Photos provided by Eric Chessen.

Eric Chessen, M.S., is an Exercise Physiologist with an extensive background in Applied Behavior Analysis. Eric provides on-site and distance consulting worldwide. He is the founder of Autism Fitness®, offering courses, tools, resources and a community network to empower support professionals to deliver adaptive fitness programming to anyone with developmental deficits to create powerful daily living outcomes that last a lifetime.


The Naturopathic Chef: Gluten Free Pizza Crust

This is the pizza crust I developed for my gluten free corporate lunch and learns. I needed a crust that was fast and easy to handle. GF recipes are often unstable and difficult for a novice GF baker to execute. The ground flax seeds and chia slurry give this crust structure and stability, while maintaining a light, airy crispness. It also has the much desired “chew factor” that great Napolotano-style pizza has. Your family will say, “pi’u la pizza per favore!” “More pizza, please!”


  • 1-1 1/2  Cup GF Beer, room temp (Just enough liquid to bring the dough together)
  • 1 tsp Dry Yeast
  • 3 cups GF all purpose flour
  • 1 Tbls Ground Flax seeds
  • 2 tsps Salt
  • 2 1/2 tsps Baking Powder
  • 1/4 cup Olive Oil
  • 2 Tbls Chia Seeds, bloomed in 1/2 cup Water

Prepare two rimmed cookie sheets with parchment lightly sprayed with olive oil

In a small mixing bowl, pour 1 cup of beer in and sprinkle yeast over beer. Set aside. When using a stand mixer, the paddle will give the best results; or use a wooden spoon to mix by hand. Stir flour, flax seeds, salt, and baking powder together. With mixer running, slowly stream in beer/yeast mixture. Add olive oil and chia slurry. All GF dough tends to be sticky. Please, do not over mix, this leads to a tough crust. Lightly coat a large mixing bowl with olive oil. Place dough in a bowl, and cover with plastic wrap. Allow to rest in a warm place for 75-90 minutes. When dough is puffed (it doesn’t rise the same way traditional crust does,) divide in half. Place each piece of dough on the prepared cookie sheets. Brush a small amount of olive oil over the top of each. Cover with plastic wrap and press dough into desired thickness and shape. Bake at 325 degrees for 45 minutes. Remove from oven and slide parbaked crusts to a wire cooling rack. From here, crusts can hold at room temperature up to four hours, or when completely cooled, wrap in plastic and then in foil. Freeze up to one month. Remove frozen crusts and top with sauce and other toppings. Bake at 500 degrees for 10-12 minutes using a preheated pizza stone or cookie sheet.

Fresh crust on the day of: One hour before baking, place pizza stone in middle of oven. Heat oven and stone to 500 degrees. Top parbaked crust with sauce and toppings. Slide pizza onto heated stone. Bake as directed above, or until cheese is golden and bubbly.


  • 1 28 oz can San Marzano Tomatoes
  • 2 Tbls Tomato Paste
  • 1 Tbls Basil
  • 1 Tbls Oregano
  • 1 Tbls Thyme
  • 3/4 tsp Red Chili Flakes (Optional, but very traditional)
  • 2 tsps Balsamic Vinegar
  • *This sauce is very herbaceous at this measurement. Decrease to 2 tsps if you don’t want the herbal flavor at the front of the palate

Mix all ingredients in a large saucepan, except vinegar. Cook over medium heat mashing and stirring the tomatoes as the sauce reduces. Cook 30-40 minutes or until moisture is gone and sauce is very thick. Remove from heat and stir in vinegar. Set aside until ready to assemble and bake your masterpiece!

Phyto Facts

Celiacs vs. Coeliac

Most of us have heard of Celiac disease by now with the marked increase in the mainstream population. Most of us, however, have never heard of Coeliac Disease. Coeliac is derived from the Greek word, “koiliakos,” meaning, “to suffer in the bowels.” Grains and other fibrous foods pass through the stomach and upper intestines in their crude form. This causes great pain, acid reflux, and indigestion in general. The inflammation caused from this poor digestion is painful along with the host of other side effects that go along with being Coeliac. But, it is not fatal like Celiac can be. It all comes down to the inability to break down gluten and other plant proteins. Gluten is the general name for the proteins found in grains. The three grains that are highest in gluten are Wheat, Barley and Rye. Other grains such as Kamut, Duram, Spelt, and Farina are cousins of wheat, and can cause irritation and inflammation, particularly in those with Celiac disease. The mass production of wheat has genetic consequences: there is mounting evidence that the genetic modification of our grains is leading to a marked increase in inflammation of the digestive tract and brain, as seen in Autism. Clinical depression, Parkinson’s, ALS, Alzheimer’s/Dementia and the slow output of Leptin (the fat burning hormone) are all being connected to GMO grain in the latest research.


The herbs we’re using are high in Apigenin. I’ve written about the research concerning its powerful effect on ovarian cancer. Apigenin also calms anxiety and is showing promise as a protective agent for strengthening the brain in a fetus. There are many case studies linking a chronically agitated nervous system to clinical depression later in life. Omega-3s and Apigenin are critical to avoiding this in adults and children. Besides our leafy herbs; flowers are very high in this phytonutrient. Specifically, Chamomile tea. Mommies, please check with your OB/GYN to confirm a nightly cup of Chamomile fits with your prescribed regimen. Here’s to babies that sleep through the night!


Lycopene, in the sauce, can slow aging. It is one of the best internal beauty secrets we have. Lycopene also reduces Sun damage by as much as 40%, keeps our hearts healthy and strong, and will someday be the cure for Prostate cancer. Sloan-Kettering is a leader in this technology. It truly is Delicious Medicine.

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


Avoiding Burnout: Daily Balance with Bumbles

We have all heard that we should strive for balance in our life.  Balance requires adequate sleep, food, movement, play, and acts of self-care.  Most of us are lucky if we get 3 of those in one day.  Lack of daily balance interferes with thinking, makes ideal weight almost impossible, and leads to anxiety, depression, and frustration. Most importantly, it decreases chances to succeed.  Burnout was very recently made an official medical diagnosis, and it’s caused by a lack of daily balance.  It is a proven result with medical consequences from living an out of balanced life.

My cat, Bumbles, proves that balance works every day.  Bumbles was born in my home, so I’ve really seen him put this into action, which has given me far greater appreciation for the balance in my life that I strive for.

1. Breakfast is first. This is Bumbles’ highest priority until it’s done.  He tickles my face with his whiskers if I try to sleep later with the intent of skipping it.  Eating a healthy breakfast prepares me for my day, prevents that afternoon slump, and tends to make my portion sizes smaller during all my daily meals and snacks.

2. Meditation is Bumbles’ favorite in the morning, and a powerful form of self-care. As soon as he hears me pulling out the headphones to listen to Deepak, Bumbles is in position.  He can So Hum it with the best of them.  His present moment awareness has been achieved.  Taking the time to calm my mind, become aware of the present moment, and allowing my brain to take a break from overthinking is a centering force that follows me through the day.  When I’m working throughout the day, the only moment that matters is this one.  It’s proven to be the best way to get things done quickly and easily.  If I’m thinking about what’s next, I’m not paying attention to what I’m supposed to be focusing on now.

3. Then it’s time for work. He reigns over his kingdom, making sure nothing has changed overnight, and is sure to bap a few of his friends over the head along the way.  He is also an aeronautical enthusiast that watches every bird that flies anywhere near the house with absolute fascination.  I start work each day with enthusiasm and expectation and allow items to flow naturally without a sense of intense pressure or overwhelm.

4. He breaks for lunch and a short nap. There are numerous studies that show taking a short 20 to 30-minute nap in the middle of the day if you are tired can be extremely beneficial.  In our work-obsessed world, we often judge ourselves as being lazy or not doing what we are supposed to be doing if we allow ourselves to rest, but appropriate rest is essential to normal body function. Even taking a short walk outside can be the slight break that makes the rest of the day much more beneficial.

5. Exercise… Bumbles loves to play fetch with super balls. He does about 3-5 high intensity chase and retrieves drills.  He then does rope climbs, ramp runs, and several roll over on his back maneuvers.  This is followed by a healthy dinner.  Exercise does not have to be done in a gym.  It’s convenient if that is the location you prefer, but exercise can be done in your living room, hotel room, in the back yard, through your neighborhood.  Exercise can be done anywhere.  If you need ideas, I am here to provide them.

6. Just chilling…  Bumbles watches tv. He has a couch right next to it, and he especially likes it when Ellen dances.  He limits it to about an hour though, because its treat time.  We all need downtime, where we have left the cares of the day behind to be begun again tomorrow.  It can be sitting and watching a beautiful sunset or meeting with friends.  Having quiet time and play time during our day is essential for mental well-being.

7. Bumbles finishes his busy day spending time with friends, little man face scratches, and cuddling time with me. A normal bedtime routine reduces insomnia, promotes better quality sleep, and sets you up for a great morning.  It’s best to strive to go to bed at the same time every night to even further the benefits of regular sleep.

And then it’s on to tomorrow.

Bumbles is happy, calm, at a normal weight, healthy, and just really happy to be King Bumbles.  He’s achieved success at work, at meals, at present moment awareness, at play, at relaxation, and most definitely at rest.  We could all learn a bit from Bumbles.   I, as his human, have achieved the same results by following his plan.  If your life is currently out of balance, and it’s impacting your life, weight, or health, then try starting with just one of the missing components.  Ease it into your life in an enjoyable way until it becomes routine, and then move on to the next.  Lack of balance didn’t happen overnight.  Burnout and lack of balance are usually due to a lifetime of small habits adding up.  Give yourself the time to regain balance. My recommendation…. just start with awareness.

Reprinted with permission from Heather Clawson, MD.

Dr. Heather Clawson is a nonclinical physician with a strong background in fitness, both before and after her medical training.  She has the unique ability to take medical issues, convert them into fitness terms, and then deliver that information in an easy to understand way for the person in front of her. She’s been involved in fitness for almost her entire life, and she has extensive ICU experience, but she has chosen to use her medical knowledge on the other side of medicine — before a person becomes a chart, labs, and a room number. Visit her blog, heatherclawsonmdblog.com

couple biking

The Role of Exercise in the Treatment of Diabetes

Diabetes Word Cloud Concept

According to the American College of Sports Medicine’s flagship journal, Medicine and Science in Sports and Exercise (1), there are more than 21 million Americans with Type 2 Diabetes as of 2010 with an estimated 7 million undiagnosed. If these numbers don’t mean much, let’s give it some perspective: in 1958 there were only 1.5 million. (Granted, the US population has increased, but only from about 180 million to 310 million, not 15-fold as in the numbers of T2D.) Furthermore, due to the now-defined pre-diabetes – or sub-clinical diabetes where the precursors to diabetes are lurking if lifestyle does not change dramatically – it is estimated that 80 million Americans are at risk. Thus, some public health officials are predicting that 21-33% of Americans will have diabetes by the year 2050. The healthcare burden this portends will bankrupt the nation. To make matters worse, the preponderance of both pre-diabetes and T2D is increasing in children and adolescents as sedentary behavior, poor diet and obesity abounds.

While prevention is optimal and much is being done in the way of public health messaging, one of the best means by which to regulate blood sugar in either healthy, pre-diabetes or T2D patients is through physical exercise. Recall above where we discussed how muscles use the sugar in the blood for fuel. The more muscles you have and the more regularly they work at some critical level of effort, the easier it is to control blood sugar. In fact, one’s levels of physical activity (PA) may be a better predictor of risk for diabetes than one’s BMI (body mass index, a ratio of height to weight.)

For the sake of discussion, we should break down physical activity into three main types – activities of daily living (ADL), aerobic exercise (AE) and resistance (or strength) exercise (RE). The MSSE article reviewed the data on all these for their impact on blood sugar, insulin control and T2D risk. Not unremarkably, the evidence strongly suggests that the more active you are, the lower your post-meal and long-term blood sugar is, the better your muscles are able to use the sugar in the blood (glucose tolerance or insulin sensitivity), the lower or lesser your insulin response is to food intake, and the lower your risk for diabetes is. What is remarkable, however, is how little physical activity is required in order to affect many of these changes and benefits.

As far as ADLs is concerned, the general prescription is to ambulate (walk, run, bike, etc) for 30-60 minutes a day or close to 10,000 steps/day, or almost 4 miles/day. This does not mean you have to take walks that last that long; it means you should move around more often throughout the day and sit less often. In fact, some studies show that simply standing up for 2 minute bouts of walking every 20 minutes of sitting lowered post-meal blood sugar and insulin response to eating. (2) While walking is effective, new studies (3) demonstrate that high intensity interval training (HIIT), or sprinting, may be an even better regulator of blood sugar. Comparing training programs in two groups of sedentary women, one doing intervals of moderate intensity, the other at high intensity, the authors found that the HIIT group had slightly greater fat oxidation in the muscles, a roundabout indicator of improved glucose control. HIIT might also be more time efficient.

Between the two studies referenced here, and many more that have looked at HIIT programs compared to traditional long, slower/lower intensity programs, the general belief is that the more muscles that are contracting and the harder they contract, the better the short-term and long-term blood sugar control. The only caveat here is that large muscle groups or bigger body movements are necessary to see these effects; single joint/small muscle contractions will not elicit the disease-modifying effects one might be seeking. For these reasons, RT has been getting more looks when it comes to modifying risk factors for T2D. In fact, the preponderance of evidence shows that RT, at sufficiently high enough intensities to build muscle mass, improves blood sugar control both by using sugar to fuel contractions and by improving the insulin sensitivity of those muscles even after the workouts.

Overall, physical activity has been shown to be an effective, efficient and low-risk/low side-effects treatment and preventive for T2D. A single bout of exercise is sufficient to regulate blood sugar for the next 16-24 hours.

As such, it is recommended that exercise be partaken nearly every day for at least 30 minutes; if obesity is a factor in a patient’s disease, then 60-90 minutes of accumulated physical activity is strongly suggested. Furthermore, a combination exercise prescription of cardiovascular and RT exercise – either same or alternating days – is deemed optimal.

To conclude, physical activity of all sorts has been found to enhance blood sugar uptake by muscles during the session and for several hours thereafter. Thus, it is one of the best, least invasive means by which to prevent, regulate and, for early stage T2D, even reverse diabetes and its downstream effects on the heart, kidneys, nerves (especially of the lower extremities), and eyes. Besides its collateral benefits on the cardiovascular system, it may help reduce weight though it is essential in maintaining weight loss. And PA clearly improves quality of life, not just through its physical benefits but its effects on the brain and psyche, reducing the risk of depression which may be a factor in both the sequence of events leading to weight gain, the challenges of both weight loss and disease management, and the reduction in one’s ability to enjoy various aspects of life due to immobility, neuropathy, visual impairment, and dialysis.

For more information about diabetes, exercise, pharmaceutical management and research, please visit the American Diabetes Association site at diabetes.org

Dr. Irv Rubenstein graduated Vanderbilt-Peabody in 1988 with a PhD in exercise science, having already co-founded STEPS Fitness, Inc. two years earlier — Tennessee’s first personal fitness training center. One of his goals was to foster the evolution of the then-fledgling field of personal training into a viable and mature profession, and has done so over the past 3 decades, teaching trainers across through country. As a writer and speaker, Dr. Irv has earned a national reputation as one who can answer the hard questions about exercise and fitness – not just the “how” but the “why”. 


1. Roberts et al, Modification of Insulin Sensitivity and Glycemic Control by Activity and Exercise. MSSE, Vol. 2013: 45(10):1868-1877
2. Dunstan et al., Breaking up prolonged sitting reduces glucose and insulin responses. Diabetes Care, 2012:35(5): 976-983
3. Astorino et al., Effect of Two Doses of Interval Training on Maximal Fat Oxidation in Sedentary Women. MSSE, Vol. 45(10), pp.1878-1886, 2013



Fibromyalgia signs

Fibromyalgia and Exercise: How to Get Your Nerve Back

According to the National Institute on Health (NIH), fibromyalgia affects over 5 million U.S. adults and an estimated 3-6% of the world population.  While fibromyalgia is most prevalent in women (75-90% of those with fibromyalgia), it also occurs in men and children of all ethnic groups.  People with fibromyalgia experience aches and pain all over the body, fatigue (extreme tiredness that does not get better with sleep or rest), and problems sleeping.  Fibromyalgia may be caused by a problem in the brain with nerves and pain signals. In other words, in people with fibromyalgia, the brain misunderstands everyday pain and other sensory experiences, making the person more sensitive to pressure, temperature (hot or cold), bright lights, and noise compared to people who do not have fibromyalgia.  Fibromyalgia has been compared to arthritis. Like arthritis, fibromyalgia causes pain and fatigue. But, unlike arthritis, fibromyalgia does not cause redness and swelling, or damage to the joints.

Diagnosis and Causes of Fibromyalgia

Up until recently, fibromyalgia has been very difficult to diagnose coining the condition as the “invisible disease” believing that the syndrome was “all in the head” of those who suffer from fibromyalgia.  However, currently fibromyalgia can be identified through a questionnaire and the Manual Tender Point Survey test.  There has been a breakthrough recently with a blood test that may identify fibromyalgia making it even more possible to treat fibromyalgia.  However, more testing is needed to be more widely accepted.  Here is a short list of what may cause fibromyalgia:

  • Genes:  Mutation or deficiency in the MTHFR or COMT genes specifically
  • Having other diseases such as arthritis
  • Family history
  • Emotional or physical abuse
  • Posttraumatic stress disorder (PTSD)
  • Gender:  Occurs mostly in women
  • Anxiety and depression
  • Not moving enough

Exercise and Fibromyalgia

Moderate exercise is known to improve use of oxygen, energy levels, anxiety, stress and depression, sleep, self-esteem, cardiovascular fitness, muscle strength, and mobility. While the pain and fatigue associated with fibromyalgia may make exercise and daily activities difficult, it is crucial to be physically active.  Usually, there are no specific exercises to avoid if one has fibromyalgia. Aerobic exercise (running, jogging), weight training, water exercise, and flexibility exercises may all help. Golf, tennis, hiking, and other recreational activities are also healthful. However, exercising hard (overexertion) leads to the problems people experience post-exercise, which are called “post-exertional malaise.”  This occurs because people with fibromyalgia don’t have the energy to condition like others who can handle the increase in exercise and conditioning.  Instead, if the exercise uses more than the limited amount of energy the body can make, their systems crash, and they feel like they were hit by a truck for a few days after.  Because of this, the key is to find an amount of walking or other low-intensity exercises one can do, where he/she feels “good tired” after, and better the next day.  Instead of ramping up in the length or intensity of the workouts, one should stick to the same amount while working to increase energy production.

Benefits of Exercise

Because the main focus of fibromyalgia is neurotransmitters and brain health, one key benefit of exercise is the boosting of endorphins and serotonin in the brain.  Studies show that exercise can help restore the body’s neurochemical balance which in turn triggers a positive emotional state.  Boosting levels of natural endorphins are essentially boosting pain-fighting molecules that help to reduce anxiety, stress, and depression which are symptoms of fibromyalgia.  Elevating serotonin plays a vital role in mediating moods thereby helping relieve symptoms of fibromyalgia.

Other benefits of exercise include:

  • Burning calories and making weight control easier
  • Giving range-of-motion to painful muscles and joints
  • Improving a person’s outlook on life
  • Improving quality of sleep
  • Improving one’s sense of well-being
  • Increasing aerobic capacity
  • Improving cardiovascular health
  • Increasing energy
  • Strengthening bones
  • Strengthening muscles
  • Relieving pain

Quick Exercise Tips

Exercise consistently (aim for daily) for 15 minutes.  Even as little as 5 minutes a day can reduce your pain.  Aim to feel “good tired” after a workout but better the next day.  If exercising increases your pain, go easier and exercise for less time.  Don’t try to ramp up in time or intensity unless you notice an increase in energy.

Learn more on this topic! Join Carol Ann for her upcoming webinar:

CarolAnn (M.S., CPT, CN) is a 25+year fitness industry veteran holding positions such as program director, studio owner, educator, presenter, and author.  She develops health/fitness curriculum for organizations such as FiTOUR, Hydracize, MedFit Network, and PT Global.  Along with producing and starring in several fitness videos, she is an expert contributor for publications such as Livestrong, PFP, and New Tampa Style Magazine. She serves on the Health Advisory Board for MedFit Network.  She is now spreading the gospel of health and fitness targeting churches with Chiseled Faith®.  She has been selected to be a 2019-2021 National Fitness Hall of Fame Fitness Superstar.  You can find her work at CarolAnn.Fitness and ChiseledFaith.com.

healthy middle aged man workout at the beach

Healthy Aging & You: The 7 Keys to Fitness Achievement

What does it mean to be fit or “be in shape”? We set fitness goals for a variety of reasons that are important to us at the time but in the long run is really losing weight a lasting goal? Do we really ever regard the “real” point of becoming fit? Probably not. Getting older means losing “something” in most people’s minds (mobility, independence, freedom to do what we love to do etc.). It however doesn’t have to be that way. If we think in terms of performance based goal setting and being able to do all the things we love to do over time – regardless of age – we will find that getting older doesn’t have to mean “getting old”. I would like to share with you what I consider the seven keys to fitness that if we maintain over time we will be able to be not only functional but vibrant and healthy as well.


I have always maintained that if I remained fit for life that I would be training every day toward becoming an “evolving athlete” – capable of “doing what I want, when I want – without getting hurt”. This is as good a definition of what it means to be fit to me given my track record as a fitness professional. Taking time today to evaluate what you REALLY want from your fitness activities is probably a good idea and worth the effort and time up front so that you can access the benefits that you TRULY want from your training program. Here are the seven keys to fitness that will make your efforts worthwhile:

#1.  Strength

Strength is a cornerstone of any fitness program. How we build strength over time is dependent on our effort and focus at being consistent in all we do. I started a weight training program in college with the help of the varsity football team at Syracuse University in 1965 and learned the basic principles of strength training with their help. I am still using those same methods and training principles today 50 years later and the secret to my success is clearly defined methodology and consistency of effort. I record all my results in a written log and am now in a training mode for my 70’s that will enable me to be able to run well into my 80’s thanks to my resistance training program. What do you want to be able to do as you age? Strength training is THE foundation for healthy aging.

#2.  Endurance

Endurance is being able to do an activity – any activity – over time without tiring and running out of fuel. Endurance is training for the heart and the cardiovascular system and enables us to be able to do more in our lives without tiring. Running is a key activity that I have engaged in since 1964 and has remained a cornerstone of my training program since then. I am doing 7 mile runs at a variety of speeds and currently have accumulated a body of work that has stretched over 70,000 miles. Since 2000 I have run 23,500 miles and I know these results because I have recorded each of my workouts in detail in a runner’s calendar and know where I have been, where I am in my training and where I am going. I want to be able to run a 6 minute mile on my 80th birthday in 2026 and current results say I will be able to do it – barring injury or illness. My book on healthy aging is simple but not easy. Pick what you love to do and keep doing it – and continue to learn more about yourself every day. Be a student of your own life and never stop learning!

#3.  Power

Power comes from being able to retain “explosive” ability over time. Old people lose their power and never regain it because they may have known they had it in the first place. Power is both mental and physical. It resides in the mind as well as the body. Many forms of exercise help us retain our power from yoga to dance (yes dance) to tai chi – and of course weight training. I use several exercises in my own programming for this purpose – from pushups, dips, bench press, leg press, weighted ab work, lunges, squats and other exercises that allow me to retain the power in my body. My “mindfulness” work is embodied in my meditation and visualization (imagination) work that I am committed to doing daily. I also use sprint workouts in order to increase my anaerobic threshold which determines my ability to engage as many of my “fast twitch” muscle fibers as I can. So far I am doing 250 pushups, 1000 crunches, and running sub 6 minute miles while still bench pressing 250 lbs. for my “power set”. If I maintain these results over time I WILL retain my power as I enter my 70’s next year.

#4.  Speed

Most of us lose speed after we leave our 20’s. If we have struggles with health issues we most likely never thought of speed as a part of our lives. Injured joints, soft tissue damage and other debilitating issues will prevent us from ever being fast but it is still worth our time to try and improve our speed of movement. I love to run fast and I will always have this aspect of fitness in the front of my mind as I train my body in the future. I love sprint workouts and will most likely keep the track in my sights going forward. Right now running indoors suits me and I am making real strides in developing leg speed and maintaining a “rhythm” that I positively love. What will you do to address speed in your programming? Seek to rise to a higher level of achievement and see what happens to your confidence!

#5.  Agility

Agility is an elusive quality and many of us never really train for it because it is hard to simulate agility in a training program. Athletes must all have some form of agility or quickness to play their sports at the highest level so they routinely add agility drills to their off season programming. It takes effort and desire but can be a real asset to any training regimen. Seek out new ways of addressing this skill set and see how you might incorporate some agility training into your program and see what happens. Personal trainers and group fitness instructors can – and do – use agility training as a part of their instruction. I am thinking about this aspect of fitness as well and have not yet decided on a course for myself yet so I am still an “evolving athlete” too.

#6.  Balance

Balance is a key to becoming fit and implies not only physical balance but mental and emotional balance as well. Being balanced means that we can more easily respond to life’s challenges and roll with the punches as change enters our lives. Being physically capable of balancing our bodies is a worthy goal. Yoga is a great way to learn to balance the mind and body. The poses help you acquire a “sense of self” in space and time. I use yoga as a part of my stretching routine to “release” tension from my joints and muscles following my training. I find breathing exercises to be useful in calming me and balancing my mind with my heart and is also a soothing way to address stress in my life. Use basic principles of achieving balance in your life and you will go far and be healthy along the way.

#7.  Flexibility

I saved flexibility for last because it captures for me the essence of health and fitness. Being flexible in our thinking and in our physical being is a reward for all our hard work. I am more open to change in my life than I ever thought possible. “Change is the only constant in the natural order” is one of the important lessons I learned from a favorite teacher over 30 years ago and only now am I finally beginning to truly understand this concept as change accelerates in my own life. “Feeling in control” of our lives is important but when we realize that what we love today may change in our lives tomorrow we become more adaptable and willing to change so that we can continue to grow and expand in consciousness. Life is bigger than we can imagine and if we become flexible in body we can save ourselves from injury and if we become flexible in our thinking we can become healthier – and happier – grateful for all that we have been given.


The seven keys to becoming – and staying fit are: Strength, endurance, power, speed, agility (quickness), balance and flexibility. Where do you fall short when it comes to your own fitness? Where do you feel you need to improve your training? What do you REALLY want to accomplish with your training? Looking good is fine but what do you want to DO with your training? I want to travel, water ski, play with my grandson and teach him to be active, empower and inspire audiences to make positive changes in their lives, write more books and articles on healthy aging and live a fulfilling and rewarding (and meaningful life). Time is precious so use it well and gain your freedom to be all you were meant to be!

Reprinted with permission from Nicholas Prukop.

Nicholas Prukop is an ACE Certified Personal Trainer & a Health Coach and fitness professional with over 25 years of experience. His passion for health and fitness comes from his boyhood in Hawaii, where he grew up a swimmer on Maui. He found his calling in writing his first book “Healthy Aging & You: Your Journey to Becoming Happy, Healthy & Fit” and since then he has dedicated himself to empowering, inspiring and enabling people of all ages to reach for the best that is within them and become who they are meant to be – happy, healthy and fit – and be a part of a world where each person can contribute their own unique gifts to life.

active adults walking

Can movement be therapy for emotional stress?

The more rhythmic and intense the movement, the greater this effect, since it elicits focus.

Emotional stress makes life overwhelming. Sometimes, we experience an extremely stressful or disturbing event, while at other times we accumulate the stress of upsetting interactions over time. In either case we are left feeling emotionally out of control and helpless. Our minds feel like a hamster spinning away on a wheel, leaving us drained, heavy, disconnected and incapable of making rational inferences and decisions. Our bodies feel like logs being lugged around, making daily chores onerous.

Irrespective of how it’s triggered, emotional and/or psychological disharmony has wide-ranging physical reactions and symptoms. While most of us know of the emotional impact (feelings of sadness, anger, fear, guilt, self-doubt and many more) the physical impact is not widely spoken about. This could include muscular tension, aches and pains, difficulty sleeping or insomnia, breathlessness among others.

Everyone’s triggers and responses are unique. Healing from emotional stress, hence, cannot be a one-size-fits-all solution. If symptoms persist for long or are severe, do seek professional help. That said, there are a few practices that can aid in self-healing.


Movement can be therapeutic for a number of reasons. As we know, stress impacts mental and physical equilibrium, turning the body into a repository of unpleasant side effects. A prolonged state of negative emotions like anger, fear and hyper responsiveness in daily life, adversely impacts the muscular and nervous system. Movement and exercise can help address this at a dual level. At a physical level, it helps by releasing endorphins (aka happy hormones) and calming adrenaline. The more rhythmic and intense the movement, the greater this effect, since it elicits focus. Target at least 30 minutes of exercise/movement on most days. It could be any activity that interests and engages you, be it dancing, yoga, sport, running, swimming, cycling. It might feel better to do it in company, to help break any self-imposed isolation. You could split it up over intervals during the day (though half an hour is not much of an ask to reset yourself and get your mind, body and life on track!).


Try to pay full attention to the activity and how you perform it. Stay with the process. The mind will eventually tune into the rhythm of the body, making you more ‘mindful’ of the activity and yield a positive sensory outcome, including from deep within. For some, this may be attained with gentler workouts, and for some more intense activities could derive the response, depending on one’s personality as well as physical capacity. Remember, there is no ‘right’ or ‘wrong’ way here. The beauty of movement is that it serves all, and it can be scaled up and down dynamically to make you feel most connected and generate positive inner vibes.

Deep breathing

Focus on the act of breathing and on how the breath goes in and out of the body (‘mindful’ breathing). It acts as another powerful therapeutic tool. This is true even during movement. Movement becomes more mindful when you focus on the breath while executing it, maximizing positive benefits physically (more oxygen, less physical stress) and mentally (greater connection with self, less mental stress). It aids in giving the mind a much-needed break while energizing the body.

Good sleep

Try maintaining sleeping and waking up time and hours even though it may seem silly or impossible. For those with sleeping difficulties or insomnia, the body clock needs resetting, requiring some repetitive reinforcements to break the negative cycle. It’s essential to retrain the body and mind to rejuvenate, rest and recuperate.

Changes won’t happen overnight, but all these practices together can go a long way to impart a greater sense of control, which propels us towards a happier state. It’s about reclaiming peace, being kind to ourselves and catalyzing inner healing.

Vani Pahwa is a Functional Fitness specialist with over fifteen years of experience, and cutting-edge certifications from leading internationally-accredited and globally recognized fitness institutes. She is also a Cancer Exercise Specialist (perhaps one of the first in the country). Sought after for her multi-disciplinary fitness modules and expertise, Vani has conducted fitness workshops for leading corporate houses, conditioning and training camps for various sports communities, training programs for coaches, personal training programs for CEOs of multi-nationals, athletes, junior and senior sports professionals among others. Her combination of specialties, client profile and range, and extensive work experience makes her unique in the country. She is the founder of Body in Motion.

Original article published in a leading national daily:  https://www.thehindu.com/life-and-style/movement-as-a-therapy-for-emotional-stress/article26566357.ece

Elder sporty female doing sport

What Exactly is Exercise?

What is Exercise?

It’s obvious isn’t it?

Seems like a dumb question right?

Professionals such as Personal Trainers, Physical Therapists, and Chiropractors prescribe it to their clients and patients for a wide variety of reasons; to heal from an injury, to increase your endurance, or make your muscles stronger.

But what is it – exactly – that is being prescribed?

Exercise (n.) A physical or mental exertion, or the removal thereof, most often for the purpose of physical training, to improve health and/or performance. A stimulus/stimuli applied, or removed, over some duration, and/or created from within, a neuromotor control system, resulting in a neuromotor solution/response, with the purpose of eliciting an intended and specific physiological change/state
Dunn K., Mack G, McMillin C., Motor Control; pathology, assessment and improvement philosophical basis, research, and methodology, Muscle System Consortia, 2018 pg. 9.

Now there are some ten-dollar words!

The key phrase in this definition is “with the purpose of eliciting an intended and specific physiological change/state”.

Exercise in our world is an intention to make a physiological change. We are trying to change the body in a certain direction. In other words, exercise is something that we do to intentionally change something about our bodies.

This differentiates exercise from activities of daily living.

Is taking your dog for a walk exercise? No

Is gardening exercise? No

How about playing a sport? No

What about an activity like skiing? No

This does not mean that doing these activities does not contribute to your health in some way. They are just not exercise.

Why is it important to make this distinction?

In order to improve your health and fitness in meaningful ways it must be done with intention. If we are not working toward intentional change then we probably won’t get the changes we want.

We fool ourselves into thinking that gardening, walking the dog, carrying the groceries, or shopping in the mall are enough to change or maintain our physical health. This justifies avoiding the regular and committed discipline of intentional activity to stimulate the body at levels high enough to drive the changes we need to enjoy a healthy and robust physical life.

Not too long ago I was on vacation in Florida with my parents and an uncle. We needed to go to the grocery store to get food. Being in a foreign store we did not know our way around. We had a long list. Since we had no idea where the items were, my uncle walked all around the store searching for the numerous things on the list. When he came back my mom jokingly apologized for having him cover practically the whole store to find what we were looking for.

His reply, “It’s ok! I can use the exercise!”

About a month after that I was with the same uncle at the Corning Glass Museum of Art. It had stadium-like seating in an area where they do demos of the glass making. This type of seating is very steep. Climbing up the steep stairs to exit the demonstration room was quite the effort for one woman.

“Well I got my exercise for the day!” was her statement as she made it to the top.

This past winter I snowboarded more than I had the past couple of years. But I didn’t consider it exercising. I went because I enjoy it. It helps winter go by easier. I didn’t do it with a goal in mind. I am not thinking about my heart rate, or what my legs are doing. I strictly go to have fun. My enjoyment of that activity is the byproduct of the work that I put in with intentional exercise to support my physical ability to snowboard.

I do strength training to try and improve – or at least maintain – my strength and muscle mass. I do the elliptical or ride the bike to challenge my cardiovascular system. All these things I do are so that I can maintain my ability to be active. One of those things of being able to be active is snowboarding.

What are some activities or things that are important to you?

Is it being active like running, skiing, or hiking?

Regular exercise, (given the previous definition) in order to stimulate your muscle system to improve and/or maintain itself, will directly contribute to your physical health and capabilities.

Exercise equals healthy muscles, which equals healthy life!

Co-Written by Greg Mack and Charlie Rowe.

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. He is also a founding partner in the Muscle System Consortia. 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, CMSS joined Physicians Fitness in the fall of 2007 after spending 9 years as the Senior Personal Trainer at Oak Hill Country Club in Rochester, New York. He has also worked within an outpatient Physical Therapy Clinic coordinating care with the Physical Therapist since joining Physicians Fitness. Charlie has earned the Cooper Clinic’s Certified Personal Trainer, the NSCA’s Certified Strength and Conditioning Specialist, the American College of Sports Medicine Certified Health Fitness Specialist, Resistance Training Specialist Master Level, and American Council on Exercise Certified Orthopedic Exercise Specialist Certifications. 


Tailoring Nutrition to Help Fight Parkinson’s Disease

Good nutritional practices are the groundwork for a healthy and productive life. People with Parkinson’s and their Care Partners have extra challenges to face as they navigate life with this progressive disease that causes tremors, slowness of movement, muscle stiffness and impaired balance. For people with Parkinson’s, healthy eating is another strategy to fight the effects of Parkinson’s.

Like all of us, people with Parkinson’s should strive to eat a balanced diet of carbohydrates, fats, and protein. Carbohydrates are the body’s preferred energy source. Fats – especially healthy unsaturated fats – are also used for energy. Protein contributes to cell growth, repair and maintenance. It is also important to get necessary vitamins and minerals from fruits and vegetables to truly feel your best. Drinking water throughout the day keeps us from becoming dehydrated and helps the entire body to function optimally.

Because People with Parkinson’s already have a progressive disease to manage – it is important to try to keep other chronic diseases at bay. Vitamin E and C are antioxidants that combat free radicals (compounds that injure healthy cells) in the body. It is important that people with Parkinson’s eat plenty of antioxidant containing foods such as blueberries and spinach.

People with Parkinson’s are at a greater risk for osteoporosis and falls – which is why adequate amounts of Vitamin D and Calcium are essential to keep bones strong. The body can create its own Vitamin D from 15 minutes a day of sunlight exposure – or it can be found in foods such as salmon, pork and eggs. Vitamin D is essential for helping calcium be absorbed in the body – calcium being the primary component of bones. Good sources of calcium include yogurt, cheese, kale and spinach.

Protein serves many vital functions in the body, and it is important for People with Parkinson’s to get adequate amounts. Protein rich foods can diminish the effects of some Parkinson’s medications when they are taken together, so taking medications an hour prior to eating can help them to work most efficiently.

Fiber is the bulky, indigestible part of plants that passes through the digestive tract. Fiber absorbs water in the body and helps with regularity. People with Parkinson’s have higher instances of constipation – so eating high fiber foods such as bran cereals, whole wheat bread, beans and broccoli can help relieve this condition.

Sometimes diseases of the eye can occur in People with Parkinson’s. Beta-Carotene is a type of Vitamin A that helps maintain retina function and is found in carrots and sweet potatoes. Leafy green vegetables and egg yolks contain lutein and antioxidants that may lower the risk of cataracts and macular degeneration.

Finally, People with Parkinson’s should always be sure to drink enough water. Adequate water consumption helps relieve constipation, prevents dehydration, aids in vitamin absorption in the body, and rids the body of waste.

Always consult your physician if you notice any undesired weight loss, and before you make any changes to your regular eating habits.

Carisa Campanella, BA, AS, is an ACE Health Coach and ACSM Personal Trainer. She is the Program Manager at the Neuro Challenge Foundation for Parkinson’s. Neuro Challenge provides ongoing monthly support groups and educational programs, individualized care advising and community resource referrals to help empower people with Parkinson’s and their caregivers.