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Stress Management Exercise Programming

Robyn Kade/16 October 2018/ All MFN blog/

As fitness professionals, we know that exercise helps our clients to cope with stress. We are told that any type of exercise will help them to reduce stress levels. The problem with this way of thinking is that we do not look at stress from the same point of view as a chronic illness. In turn, you could be putting your clients at risk of developing illness’s. We know that stress can wreak havoc on the body but what can we do as fitness professionals?

When we have clients diagnosed with diabetes, cancer and heart disease, for example, we follow a certain protocol or guideline. Not everyone is the same so you may have to deviate and think outside the box. Why should there be a difference with stress management exercise programming? There are specific guidelines that you should be following.

Many fitness professionals take into consideration the mental piece of stress but not what is actually going on inside the body as a direct correlation. Or fitness professionals may think that the client is better because they feel less stressed mentally after their session. When we do any type of exercise, endorphins will be released throughout the body. This will make you feel better mentally but it is a quick fix for what is really going on inside.

If a client is highly stressed and you have them do an intense workout they may become physically worse. Exercise is a stressor on the body itself and will increase cortisol levels. This in turn, can make blood sugars and blood pressure higher. If someone does not have either of these conditions it could become their new norm over time. When pushed to hard, a client may develop conditions like Alzheimer’s Disease earlier due to high cortisol levels.

We need to look at stress management from a physiological standpoint when prescribing exercise. Many fitness professionals do not make this important connection during their sessions. We may advise clients to do meditation, yoga and exercise as a “one size fits all approach” Our clients’ bodies are different and therefore need a customized exercise and health education plan. If you have a client who cannot lose weight when exercising and eating properly have them see their doctor. The Physician may want their patient to take a cortisol level test to make sure their body is functioning normally.

Fitness professionals should follow the FITT Principle for stress when working with this population. Knowing the appropriate frequency, intensity, time and type of exercise is very important. You must assess your client and know their stress levels before you can customize a program. It is also important to look at their health history and what medications they are taking.

One way of effectively training clients is by using the Aria Method™. Open and flowing movements are important for training individuals who are stressed. Posture and stress play an integral part of movement and should be taken into consideration. For instance, Stress can make people hunch over or adapt to a kyphotic posture. By opening the chest and strengthening the muscles you are correcting this motion. Take a moment and really look at your clients before deciding how to train them.

Educating clients about stress and healthy coping techniques is also important and can make a big difference. It may be hard for some individuals to make positive lifestyle changes. Remember to praise clients for any changes they make no matter how small.

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

References:

Five Fitness Myths Busted

Maurice D. Williams, MS/15 October 2018/ All MFN blog/

By now you know that certain myths simply aren’t true – weights don’t make you bulky, diets are typically a bad idea, and that fat physiologically can’t be transformed into muscle.

So, I’m going to focus more on five fitness myths busted that won’t be true anymore for you after today! First of all, let’s start with that famous phrase I’m sure you’ve heard before.

1. Eat less and move more to lose fat. While this might work in the short-term, it doesn’t work for the long-term. You can only eat SO MUCH less and move SO MUCH more. The solution is to focus on food quality and portion size first.

2. Cardio is best for fat loss and for re-shaping your body. Actually, to achieve this, you should focus on weight training. Similarly, this applies to body weight training or actual weight training. Adding muscle to your body will not only re-shape it into a more athletic, more defined look, but it will also increase your metabolic efficiency since muscle burns more calories at rest than fat.

3. Fat makes you fat. Sure, fast food, fried, and processed fats are absolutely no good. But naturally occurring fats like avocados and nuts are shown to have tremendous benefits on a desirable body composition. So, eat good fat to lose fat! About 1-2 tablespoons per meal is ideal.

4. Sit-ups and other “ab” exercises give you abs. It’s actually mostly great nutrition that will reveal abdominal muscles. Real core-strengthening exercises like planks, deadlifts, and kettlebell swings can also help with this!

5. Keeping a food journal will help you monitor and control what you eat. Let me caveat this one. Above all, I’m a big believer in food journals! BUT only if you tell the truth. ☺ You can’t forget anything for this to be effective. And you can’t back track and try to remember what you ate the past 3 days and still expect an insightful outcome. Do it right and it works! Do it wrong and it’s not a great use of time.

Originally printed on Move Well Fitness blog. Reprinted with permission.

Maurice D. Williams is a personal trainer and owner of Move Well Fitness in Bethesda, MD. With almost two decades in the industry, he’s worked with a wide range of clients, including those with health challenges like diabetes, osteoporosis, multiple sclerosis, hypertension, coronary artery disease, lower back pain, pulmonary issues, and pregnancy. Maurice is also a fitness educator with Move Well Fit Academy and NASM.

Elder woman training with physiotherapist

Resistance Training: Programming and Execution

Nicholas Prukop/12 October 2018/ All MFN blog/

In my previous article I made a case for a comprehensive resistance training program as a way to “cut the odds” in our favor as we “grow older and not old”. I also strongly believe in developing a strong cardiovascular system since it is responsible for keeping the life giving oxygen and nutrients moving into the body’s tissues and organs in order to sustain our lives. These two beliefs are driven by my desire to keep my body as strong and adaptable (and flexible) as I can in order to “prevent” challenges of all kinds from entering my experience in the future.

I would like to examine programming and execution in this article in order to enable and empower you to “take up the challenge” of becoming more than you ever thought possible through a well planned resistance training program that enhances your life through an acquired discipline, focus and commitment to your own health and well being. This process – (and it is a process) – continues throughout our lifetimes and rests on the foundation of a desire to consistently learn new things about ourselves. It is a process of expanding not only our own consciousness, skill and knowledge of our potential health and fitness futures – but also includes our developing ability to maintain such a process over time.

TRACKING

I find the key to my success over the past 55 years has been my desire and commitment to retain my program of running and resistance training by tracking all of my workouts – both running and weightlifting – allowing me to know “where I am” at any point in time. These records keep me up to date on the factors influencing my growth and reflect my effort to attain my goals of improving strength. power, endurance, speed, quickness, flexibility and balance.

The reality is that today “tracking devices” are available through technological advances and now can serve us in ways that I never dreamed possible before. I still record my results in logs and journals and appreciate the way in which this form of tracking has enabled and inspired me to keep going and improve my results. The gym where I train is filled with people “wandering” through their time there and never really getting focused while staring at their electronic devices or “smart” phones. NO ONE ever is tracking their work and consequently they will never know when – or how – to improve.

RESISTANCE TRAINING

Resistance training is the progressive stimulation of muscle fibers in order to create a more adaptable and powerful muscle. The “loads” we place on particular muscle “groups” are in alignment with the capability, experience and knowledge of the individual executing the program. There are type I and type II fibers. Each type responds differently to the multiple “stimuli” applied.

Type I fibers handle loads “over time” and respond well to longer periods of stress thereby classifying them more as “endurance” fibers. Type II fibers do not become engaged until the load reaches a high enough level where they get “recruited” to assist in handling the applied load. They are power fibers and help with explosive movements such as sprinting from danger. They normally are not required in the day to day activities most people engage in and only when we need them will they enter the equation. If they never get trained to respond however, the odds of being able to engage them when needed becomes remote.

THE PYRAMID

BASE SET (8-12 reps): This set warms the muscle and allows it to perform under a minimal load preparing it for more work in subsequent sets. A set is a prescribed number of repetitions that puts the muscle through a complete range of motion and allows the muscle to “respond” to the load. This stimulus enhances the neuromuscular system to become more capable and ready to help our bodies move effectively throughout the day or when doing other activities requiring a response such as cycling, swimming or hiking.

STRENGTH SET (4-8 reps): This set increases the load and allows for a greater stimulus and response to the activity of moving a “heavier load” through a full range of motion. This set is a “building set” since its intention is to take the muscle to “fatigue” allowing for growth during recovery and down time. One can induce additional growth in this phase by adding sets and continuing the process – depending on your experience and readiness to train in this more advanced manner.

BASE SET (8-12 reps): The final part of the pyramid is to return to a lighter load – not necessarily the original load – and allow the muscle to “work through” the waste that accumulates in the fibers as a result of the prior stimulation.

SETS: Sets are the “pieces” – the individual components – to the puzzle of resistance training. “Putting it all together” in a cohesive program is very important in determining your success. Generally, it is advisable to seek professional guidance when assembling a resistance training program since determining proper training technique, loads and the types of exercises can become quite daunting if you are inexperienced and lack the proper knowledge to do it yourself.

I think of this issue in the following manner: If I am attempting an activity such as snow skiing that I have limited or no experience or skill in doing, I will hire an instructor to teach me the basics and allow me to LEARN how be safe while I learn and begin to enjoy this new activity SAFELY.

PROGRAMMING EXAMPLES

(Include free weights, machine assisted and body weight exercises in planning)

Chest: Push ups (regular and modified), bench press (free weights), or machine press.

Shoulders: Overhead press (dumbbells), lateral raise (machine), rubber tubing with handles.

Back: Lat pull (cable), seated row – tubing, machine, wall press (body).

Arms: Curl (free weights), tubing, machine curl.

Abdominals: Basic crunch (knees bent, upper body life), resistance balls (destabilized crunch), wall crunches with back flat on wall.

Legs: Squats (wall) and lunges (static or moving), leg press (machine) calf extension (stairs and machine).

IN SUMMARY

Resistance training is the “pay check” and cardio is the “bonus”. My former fitness manager said these words to me over twenty years ago and I cannot disagree with him today. You will not get an argument from me on the benefits and power of a well planned resistance training program – especially after the age of 40! The idea that we can maintain our muscular strength and endurance over time WITHOUT training is ludicrous.

Every day that passes without proper stimulation of our major muscle groups is a day that we will never recover. The outcome could become catastrophic if we break a hip or suffer some other major injury that could eventually end our lives. I schedule my own resistance training sessions on Monday and Thursday so as to maximize my training and recovery times. Each program is varied by the number of sets I do, the resistance I engage and the time I take to execute the program. Each session is designed with this thought in mind: MAINTAIN my current lean muscle mass and strength for the years to come.

Your programming efforts are waiting for your decision to begin this new phase of your life and it is MOST definitely a “life affirming” decision. Take the time today to evaluate your needs and make the decision to begin TODAY! If you need help to get started – as I would with my skiing example – then get it! Don’t be afraid to learn new skills that could possibly save your life “down the road” because you – and your body – will be grateful you took a positive step that will NEVER let you down. I embrace this message myself everyday – and KNOW you will too! Travel well.

Reprinted with permission from Nicholas Prukop.

Nicholas Prukop is an ACE Certified Personal Trainer & a Health Coach, a fitness professional with over 25 years of experience whose 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.

If you need help in designing a fitness plan, you can contact Nicholas Prukop via email at runningnick@sbcglobal.net or read his inspiring book Healthy Aging & YOU.

Managing the Problem: Natural Treatments for Gastrointestinal Disorders

Henry Moore/11 October 2018/ All MFN blog/

Millions of Americans suffer from some form of gastrointestinal disorder. In fact, as many as 45 million Americans have irritable bowel syndrome. There are many different kinds of GI disorders—and different ways to treat them. It can be a painful and disruptive way to live, and people often suffer for years without realizing the real source of the problem is digestive in nature. If you are experiencing chronic heartburn, bowel discomfort, persistent diarrhea, or severe cramping, you may have a serious digestive problem and should consult your doctor.

If you are someone who experiences digestive ailments, know there are plenty of ways to effectively address them through diet, exercise, and other natural methods. Gut health plays a critical role in our overall well-being, so making sure you take the steps to optimize your digestive health is imperative. Here are some common ailments, as well as strategies that can help alleviate the associated symptoms.

Dysbiosis

When harmful bacteria is dominant in the GI tract, the gut is in a state of imbalance, also known as dysbiosis. While the optimal solution is to achieve balance between beneficial and harmful bacteria, it can be a problematic situation for many people. Bloating is one of the more unpleasant symptoms, but this can be treated with probiotics.^[1]

Acid reflux

Acid reflux is a condition in which stomach acid backs up into the esophagus, causing severe discomfort and, over time, damage to the esophagus.^[2] Other symptoms include nausea, chest pain, tooth erosion, bad breath, and trouble breathing or swallowing. There are a number of approaches a patient can implement, including weight loss, not overeating, emphasizing low-carb foods (which inhibits bacterial overgrowth caused by undigested carbs), minimizing carbonated drinks, and limiting alcohol and coffee intake.

Crohn’s disease

Crohn’s Disease is an inflammatory bowel condition thought to be caused by family history and genetics, though the precise causes are unknown. It’s a painful condition with symptoms that may include diarrhea, rectal bleeding, fever, weight loss, and abdominal pain. While anti-inflammatories are typically used to treat Crohn’s, there are several natural approaches that have worked for Crohn’s sufferers. Wild oregano oil is sometimes used to get rid of disease-causing bacteria and viruses, while probiotics can be helpful, taken in amounts high enough to have a therapeutic effect.^[3]

Irritable bowel syndrome

IBS is a common problem among Americans, who may experience diarrhea, painful dry stools, or loose stools. Bloating is another problem commonly associated with IBS which, as mentioned, can be treated with probiotics found in live yogurt. Symptoms are generally treated through diet—with an emphasis on low-fat, high-fiber foods—and by avoiding dairy, alcohol, caffeine, and foods that tend to produce gas.

Diverticulitis

Diverticulitis is caused by small pouches formed in the colon. The condition occurs when these pouches become inflamed, which can cause severe abdominal pain and fever.^[4] Since obesity is considered a major risk factor, exercise is usually indicated as a form of treatment. A severe attack may require treatment with antibiotics and a liquid diet that allows the colon to heal. This can also help prevent the need for surgery to treat or remove the impacted portion of the colon. Dietary modifications include an increase in vegetables, legumes, and whole grains.

Gallstones

Gallstones are hard deposits that form in the gallbladder, an organ involved in digestion. There are about 1 million new cases of gallstones diagnosed each year in the United States, according to the American Gastroenterological Association.^[5] It’s a condition associated with high amounts of cholesterol or excessive waste in the patient’s bile.

Some gallstone patients have success treating gallstones by drinking apple juice or using apple cider vinegar to cleanse the system. Milk thistle, which is available in pill form, may also be effective in treating gallstones naturally. Studies have shown that regular exercise, such as running or walking, can help prevent the development of gallstones.

The millions of Americans who live with some form of intestinal disorder struggle with unpredictable pain and digestive problems. They are manageable conditions that are difficult to cure. However, a combination of natural treatment methods, diet, and exercise can make a significant difference for patients.

Henry Moore is the co-creator of FitWellTraveler. The site blends two of his favorite subjects (travel and health) to provide readers with information about how to get the most out of both.

References:

[1] https://plexusworldwide.com/sunnyshare/trust-your-gut/probiotics-bloating

[2] https://www.medicalnewstoday.com/articles/146619.php

[3] https://www.healthline.com/health/crohns-disease/alternative-treatments

[4] https://www.mayoclinic.org/diseases-conditions/diverticulitis/symptoms-causes/syc-20371758

[5] https://www.gastro.org/practice-guidance/gi-patient-center/conditions

top view of Healthcare costs and fees concept.Hand of smart doct

Looking at the Use of CPT Coding for the Wellness Profession. A Revised Look at Integration of Health Promotion within Healthcare.

Eric Durak/11 October 2018/ All MFN blog/

It has been over 24 years since I wrote my first book on Medical Insurance Billing for the Health and Fitness Profession. The book was based on my years as an exercise therapist who used CPT coding for sessions with diabetic patients. Our use of proper billing, follow up letters, and reasonable pricing allowed our physician practice to bill out for some exercise sessions for over two years.

I have been asked recently to discuss the issue of reimbursement in our current system. Over the past 50 years the system has worked for physicians, and some allied health professionals, who have developed procedures that they will get paid for – and they usually perform specific types of services within their practice that allow them maximum reimbursement.

The times are changing, though. As they have since the mid 1990s when managed care tried to curb the amount of fee for service payments for specific services. If you talk with physical therapists, you would see that they have been concerned over a decade that they are unable to bill for the same amounts per service that they once did. A sign of the times? Perhaps – but in the wellness profession we need to dig a bit deeper to see how the system (that is not built for us) can work for us.

Billing for a Fee For Service Method

All healthcare agencies that use CPT coding to some degree. How they use them is a different situation. Some medical practices will submit bills to CMS or health plans and wait for payment. It is based on where they live, and what these agencies pay on an average for the particular service. Medical professionals will “bundle” a number of different procedures together for each payment in hopes of getting a higher payout. However – using CPT codes are also valuable for health promotion professionals to understand the “language” of health care. Let’s look at some examples of how these codes may work well for wellness programs.

Success Stories in Contracting

Perhaps one of the biggest success stories of working with healthcare is the Silver Sneakers program. They don’t bill directly for FFS – they have used specific CPT codes to negotiate for contracts for their wellness programs. Another example is Wellquest – the east coast company that competed in the senior wellness space with Silver Sneakers. They were also successful in negotiating contracts with regional health plan. They didn’t use CPT codes – but specific types of programming to convince health plans to buy into their model. There are a few companies that use versions of coding to help injured athletes come back to work. One is the Industrial Athlete in Detroit, MI. This company has been delivering preventive and therapy services to companies since 1989. Companies look to specific CPT codes to detail the particular type of program they are delivering. Of course – they may want to know what type of reimbursement is being delivered in their area, but many in the health club setting look to costs of personal training, which may range from $30-150 per session depending on the location. Let’s look at the types of codes that have been historically been used for exercise-related services. There are other worker’s compensation programs that are billing directly for personal training with staff that have been to the Occupational Medicine doctors, and now want to get back to work. With chronic exercise, many of them reduce their risk for future back injuries by almost 100%.

What are the Codes?

When I started investigating CPT billing codes, I uncovered what I thought was the Holy Grail for many allied healthcare personnel. They thought that because they studied an allied healthcare curriculum in school, and passed a state board licensure exam – they were entitled to receive reimbursement based on these skills. However – when I spoke with the American Medical Association (the national body that owns the © the CPT codes used by all healthcare professionals), I received a different story. The codes are merely descriptors of services. They are copyright of the AMA, and they are licensed to others to use them directly. For our purposes, we will be discussing CPT codes that have to do with exercise therapy, and some health education procedures.

Exercise therapy falls under the physical medicine section of the CPT coding book. They may be used for exercise prescription if an MD or other licensed professional wishes to incorporate these services in their practice. Specific codes for these services are as follows:

*Physician or therapist is required to have direct patient contact.

97110 – Therapeutic procedure, one or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion, and flexibility. This code is used for limited visits, such as exercise training for rotator cuff therapy, or general use of aerobic machines. This type of training may encompass a one or two-week period, and be billed out ≈ 3-5 times.

97112 – Neuromuscular re-education of movement, balance, coordination, kinesthetic sense, posture, & proprioception. This code is used primarily by Physical Therapists and Massage Therapists for patients with neuromuscular deficits that require movement along with physical manipulation of body parts (along with pressure point work, etc.). This code would not be used for therapeutic exercise procedures, but specific movement programs such as shoulder or hip movement post stroke, or shoulder movements post breast cancer surgery.

97113 – Aquatic therapy with therapeutic exercises is used for any therapeutic activity involving water. Aquatic therapist and inventor of the Hydro-Tone equipment Dan Solloway of Oklahoma used this code for all of his work with patients referred to him for aquatic exercise therapy for over two decades.

97116 – Gait training is again used for persons who have orthopedic limitations with movement. It is used infrequently (or not at all) by most exercise therapists, but could be used in the expanding market of senior gait and balance prevention exercises.

97150 – Therapeutic procedure(s), group (2 or more individuals). This code is used for classroom programs, such as T’ai Chi, yoga, chair aerobics, therapeutic step classes, etc. This is designed for practitioners who teach in the group setting – especially with special population classes. One of the top codes that could be used in wellness.

97530 – Therapeutic activities, direct (1 on 1) patient contact by the provider (use of dynamic activities to improve functional performance), each 15 minutes. It replaces the old Kinetic Activities code that was used primarily for exercise therapy procedures. This code should still be used most by exercise therapists for 2-4 segments of 15 minutes each

97535 – Self care/home management training (e.g., activities for daily living [ADL] and compensatory training, meal preparation, safety procedures, and instruction in use of adaptive equipment) direct 1 on 1 contact by provider, each 15 minutes. This code is used primarily in the PT/OT settings, where patients need to regain day-to-day skills, as opposed to general strength and aerobic capabilities. Community Training (97537) is an extension of the self-care coding used primarily by PT and OT. However – now that more trainers and coaches are training in the home, this code may have a benefit relating to home care fitness and wellness programs.

97537 – Community/work reintegration training (i.e.: shopping, transportation, money management, vocational activities and/or work environment/modification analysis, work task analysis), direct 1 on 1 contact by provider, each 15 minutes.

97545 – Work hardening/conditioning; initial 2 hours. It is used for applying exercise to rehabilitate a person after an injury or accident, allowing return to competitive employment. The role of the exercise specialist would be to provide specific work-related exercises, and education principles to patients in these rehab settings (low back, carpel tunnel syndrome, lifting techniques, etc.).

97546 – Work hardening/conditioning; each additional 1-hour

97750 – Physical performance test or measurement (e.g., musculoskeletal, functional capacity), with written report, each 15 minutes. It is used to measure strength and aerobic performance, and should be used for all testing procedures that do not require physician supervision or monitoring equipment (such as ECG). This is a good code to use for pre and post testing.

90900 – Biofeedback training; by electromyogram application (e.g., in tension headache, muscle spasm) is used by persons applying low intensity exercise and breathing techniques (Ayurvedic medicine, Hatha yoga, etc.) using EMG applications in the clinical setting. It is used by some exercise physiologists who perform relaxation exercises with patients.

90904 – Blood pressure regulation (e.g., essential hypertension) may be used for programs that offer stress reduction for hypertensive patients. Does not have to include monitoring equipment, but would necessitate improvements in BP control over time independent of pharmacological agents.

93015 – Cardiovascular stress test using maximal or sub-maximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; with physician supervision, with interpretation and report. It is used for cardiac and pulmonary testing, using ECG and monitoring equipment, physician supervised. This code should be used in the clinical exercise setting when performing testing services on patients who are involved in cardiopulmonary rehab services.

96150 – Health behavior assessment (e.g. – health focused clinical interview, behavioral observations, health-orientated questionnaires), each 15 minutes, face-to-face – initial assessment. Mostly for counselors, but could be used with health coaching programs.

Where is the Future?

Since reimbursement is harder to obtain for most licensed health care practitioners – it certainly won’t be something that anyone in the exercise community will be able to obtain simply by becoming licensed or accredited. The system is in a transformation mode. Most of the methods for obtaining reimbursement or contracting dollars will come from outcomes-based programming. Companies such as Optum are moving into this realm by their executive summaries relating to data analytics, outcomes, and ROI. Health and fitness professionals should do well to read the recent report by Marshall et. al. on outcomes in the health club setting. It has set the stage relating to the opportunities to work with clinical populations, and sets the stage for developing relationships with third party payors through a contract mechanism that will satisfy the needs of both parties.

CPT codes are the language of health care procedures, and they were made for physicians. However – that language can help health and wellness professionals to negotiate contracts that will help pay for memberships, personal or group training, nutrition, and mind/body health programs through the health club industry. After 25 years – I think that the disruption in the health care industry is big enough that smart health club companies and training programs will be able to offer comprehensive wellness services that will be reimbursed at some level. We see it as the next logical step in the progression of the industry.

Reprinted with permission from Eric Durak.

Eric Durak is President of Medical Health and Fitness, and has been involved with exercise and health care since the 1980s. He has worked with the insurance billing system with both physicians and physical therapists. He is the author of over 20 books on health and wellness, one being the Fitness and Healthcare Reimbursement Guide.

References

http://karenallenhomeopathy.com/wp-content/uploads/2013/06/c_abc-coding-structure1.pdf
Durak, EP, Shapiro, AA. The Fitness and Healthcare Reimbursement Guide. 7^th edition, 2016. Medical Health and Fitness Publishers, Santa Barbara, CA
Towards Better Outcomes. Optum Executive Summary Report. Optum.com/frostreport. 2016.
Marshall, TF, Groves, JR, Holan, GP, Lacamera, J, Coudhary, S, Pietrucha, RJ, and Tjokro, M. Feasibility of Community-based Supervised Exercise Programs to Engage and Monitor Patients in a Post-Rehabilitation Setting. 2018. Am. J. Lifestyle Med. 13(1):DOI: 10.1177/1559827617750385
Nieves, PN. How a synchronized approach addresses key drivers of change in the industry. Optum.com report, 2016.

Disclaimer: Medical Health and Fitness and the American Medical Association are not responsible for any claims filed by individuals or group practices using the five-digit numeric Physician’s Current Procedural Terminology, 6^th Edition codes, service descriptions, instructions and/or guidelines are copyright as part of the publications of CPT as defined in the Federal Copyright Law, American Medical Association. All rights reserved. CPT (current procedural terminology) is a listing of descriptive terms and five-digit numeric identifying codes and modifiers or reporting medical services performed by and for physicians.

This representation includes only CPT descriptive terms, identifying modifiers for reporting medical services and procedures selected by Medical Health and Fitness for inclusion in this publication. The most current edition is available from the American Medical Association. No fee schedules, conversion factors, or scales or components are therefore found in CPT.

Medical Health and Fitness has selected certain CPT codes and service procedures descriptions and assigned them to various specialty groups of a CPT service or procedure descriptions and its code number in this publication not restrict its use to a particular specialty group.

Any procedure in this publication may be used by designated the services by a qualified health professional. “The American Medical Association assumes no responsibility for the consequences attributable to or related to an use of or the interpretation of any information contained or not contained in this publication”.

The “M” Word – Let’s Talk Menopause

Dr. Maria Luque/10 October 2018/ All MFN blog/

We’ve all heard about menopause, but what really is it? When does it start? How long does it last? How will I know if I’m in menopause? What are the symptoms? Does everyone have the same symptoms? These are just a few of the many common questions that I’m asked on a regular basis. This natural phase in every woman’s life is still a big mystery surrounded by misinformation, confusion, and yes, quite a bit of secrecy. In the next few installments of this series, I will address hormone replacement therapy, alternative therapies, the role of nutrition & physical activity, and any questions you may have. Let’s blow the top off this taboo topic – let’s talk menopause!

Menopause has morphed from an experience that only a small percentage of women lived through to a natural part of every woman’s life today. At the turn of the 20th century, women were not expected to live past 50. Now life expectancy for women is 78 years of age. If you’re a woman in your 20’s or 30’s, you might ask yourself: why should I care? I’m way to young for this. Well, I hate to be the bearer of truth but the reality is that you will eventually go through it; so you might as well be educated.

The fact is that 75% of all women will experience hot flashes, night sweats, insomnia, weight gain, and irritability. Menopause symptoms can be debilitating for many women, often appearing before they realize hormonal changes have begun to take place. Women don’t expect to experience these symptoms in their mid-thirties, but it happens all the time. Yet an alarming number of women still think they don’t have to “worry” about menopause until their 50s. Don’t wait! Educate yourself early on. So let’s start with the basics: what is menopause?

The Menopausal Transition Defined

Menopause is not a singular event but rather a transition lasting on average 3.8 years. It is often described in three phases: premenopause, which is the time when menstruation is normal, to perimenopause, which is the time when menstruation becomes more infrequent and also includes the one year after the final period, after which postmenopause begins, which is defined as the time in a women’s life when the ovaries stop functioning and menstruation has ceased for at least 12 consecutive months. You’re also considered postmenopausal if the ovaries were surgically removed or were damaged during chemotherapy. (Note: a hysterectomy, where only your uterus is removed, does not affect your ovaries or menopause). For a more detailed breakdown of the adult female reproductive life, the most recent Stages of Reproductive Ages Workshop (STRAW) is a great resource (Harlow, et al., 2012). It provides guidance on the different stages, their lengths, characteristics, and signs. Although there is no exact test to determine perimenopause, STRAW also provides guidelines for hormone levels that play a role in determining the stages in the menopausal transition. The most common hormone used for determination of perimenopause is the Follicle Stimulating Hormone (FSH), with levels greater than 25 IU/L indicating decline in ovarian function and beginning of perimenopause. As estrogen drops, FSH climbs to kickstart the follicle cycle and make up for the lack in estrogen.

Symptoms – oh no!

Menopausal symptoms are often summed up to hot flashes and night sweats although that couldn’t be further from the truth. Both hot flashes and night sweats are symptoms of menopause but there are many more, often subtle symptoms, that are not commonly attributed to the menopausal transition but are indeed symptoms linked to declines in ovarian function.

Menopausal symptoms fall into four categories to include vasomotor, psychosocial, physical, and sexual.

Vasomotor symptoms (VMS)

About 75% of women experience VMS
Hot flushes, night sweats, sweating

Psychosocial

Anxiety, impatience, poor memory, depression (prior depression is the highest risk factor for subsequent depression)

Physical

Body aches, fatigue, insomnia, weight gain, changes in skin appearance, migraines

Sexual

Vaginal dryness, painful intercourse, avoiding intimacy, lack of sexual desire

In addition, reduced levels of neurotransmitters (serotonin, dopamine, oxytocin) can cause changes in brain function and behavior, and declines in cognitive function, mood, and memory.

I know, I know, this all sounds very scary and depressing but this article is not designed to scare you into expecting the worst. Its purpose is to inform you of changes that will happen and that can come in all forms and intensities. Every woman is different; some women experience all symptoms to the extreme but there are also women that don’t experience any symptoms at all. It is impossible to predict what your experience will be. My goal is to equip you with the knowledge to be able to identify changes that are attributable to the menopausal transition and how to successfully and hopefully happily transition through this time in your life. Let’s start this conversation.

Have a comment or question? Tweet me @doctorluque

Republished with permission from doctorluque.com

Dr. Maria Luque is a health educator and fitness expert that specializes in helping women take charge of their own wellness. A native of Germany, she pursued a career driven by a passion for health and fitness. Dr. Luque currently teaches at the College of Health Sciences at Trident University International, in addition to conducting workshops, group/personal training, and writing. She’s an IDEA Fitness Expert and has been published in the IDEA Fitness Journal as well as appeared as a guest at local news channel to talk about quality of life and menopause. Visit her website, doctorluque.com

A Doctor, a Lawyer, and a Quitter Walk into a Bar…

Lynn Marie Morski, MD, Esq./8 October 2018/ All MFN blog/

No, it’s not the beginning of a joke. It’s just what happens every time I go into a bar. I have a medical degree and a law degree…and if there were a professional certification for quitting, I’d not only have it, but I’d display it in my office as proudly as I do the other two.

I consider myself an expert-level quitter, and it’s a distinction to which I firmly believe more people should aspire.

Why? Because quitting is the most underrated tool for achieving success not only in business, but in relationships, personal happiness and well-being. In fact, it’s one of the most underrated self-care tools out there.

The walls of Amazon’s virtual bookstore are overflowing with self-help books telling us to live our best lives. But rarely do they address one of the main reasons that people get stuck in something less than their best life: no one tells them how to get through the necessary quits to leave whatever isn’t working. They just tell you to transform your life and strive to make progress…until one day you’ve suddenly arrived at said ideal life.

And quitting ain’t easy.

It’s a process fraught with unwarranted stigma -partially thanks to unhelpful sayings like “quitters never win and winners never quit.” And if you can get past the stigma, you’re then smacked in the face with many of the fears associated with quitting, like wondering if another opportunity will arise to replace whatever you’re leaving, or wondering what people will think about your quitting, or fear that the new scenario you find post-quit won’t truly be more fulfilling than the original one.

It’s enough to make someone just stay put. Stuck in the less-than-ideal.

But it doesn’t have to be. Quitting can be your best friend. But not just regular old quitting. Strategic quitting.

Now I could tell you theoretically about why strategic quitting is the greatest thing since avocado toast, but I think it will be slightly more effective if I show you what it looks like in the real world. Because at this point you may be (understandably) wondering how someone with both medical and law degrees has ever quit anything.

I quit all the time.

Because what does it take to get through that much school and training? Time, money, and energy. How was I able to make sure I had enough of all three to get through? By quitting things that were draining my time/money/energy and focusing only on the things that served me.

So what does it look like in action? Before medical school, I was a multimedia designer, but the sinking feeling I got while sitting in coding classes learning new programming languages told me this was not the field for me — so I quit. I started completely fresh and decided to try to get into medical school.

And after I finished medical school and residency in family medicine, I finally got to my sports medicine fellowship, as I had decided I wanted to be a sports doc. However, I got that same feeling when I was doing sports medicine — like something just wasn’t right. Mostly I didn’t like that the hours were somehow both 9 to 5 and nights and weekends, leaving little time for myself.

So I quit. Again.

At this point you may be thinking, “whoa…but what about all of that time and money you wasted on medical school?” Well that’s where strategic quitting comes in. With regular quitting, I would have walked away from medicine altogether and tried some other career that may have had all the same attributes I disliked about medicine.

But with strategic quitting, you take stock of exactly what parts of a job or relationship, etc. aren’t working for you, and quit only those…and you stay vigilant not to get in new situations that have features that didn’t work for you previously. And as long as you learned something from a past situation, it wasn’t a waste.

So I quit the long hours of sports medicine, and took a job where I make my own schedule. And in the future, you can bet that I won’t be taking any new jobs that have night or weekend hours, because I learned from my previous experience. And as for the money and time I spent? Well having spent a lot of time or money on something that isn’t working for you is a terrible reason to spend more time or money on it. Sticking it out doesn’t get you back your investment, it just gets you further from where you want to be.

Now you may be plenty happy in your job or relationship, but what about some smaller things that may be stressing you out?

Here’s another real-life example. I finished yoga teacher training last year, and during my training I had an unlimited membership to the yoga studio. However, shortly after receiving my instructor certification, I started volunteering with a political campaign and didn’t have time to go often enough to make the membership worth the money, which started to stress me out. Yes, you heard that right, yoga was stressing me out.

So what did I do? Did I quit yoga? Obviously not! I just quit the unlimited membership and switched to a class card, thereby taking away all the guilt and stress I felt over not being able to make it to class as much as I needed to.

Now look at your own life…is there something that brings you stress or causes a sinking feeling in your stomach? Is your body subtly trying to tell you to make a change by giving you heartburn or keeping you awake at night? As a doctor, I can tell you the effects of staying in something that is wrong for you are not minimal. Stress is a leading health risk these days, and a major cause of stress is doing something that’s not in line with your own personal good.

So if your job doesn’t light you up, or your relationship brings you anxiety, or your city just isn’t working for you anymore, I urge you to make close friends with strategic quitting before your body stops whispering to you and starts yelling in the form of chronic pain, depression, anxiety, insomnia, and more.

Strategic quitting is the self-care tool you never knew you needed, but that you’ll never give up once you’ve got it down.

Dr. Lynn Marie Morski is a Quitting Evangelist. She helps people to and through their quits through her book “Quitting by Design” and her podcast Quit Happens, along with speaking and coaching. She is also a board-certified physician in family medicine and sports medicine, currently working at the Veterans Administration. In addition, she is an attorney and former adjunct law professor at Thomas Jefferson School of Law. Visit her website, lynnmariemorski.com

How To Keep Your Employees Healthy

Active Wellness/4 October 2018/ All MFN blog/

Health care costs are higher than ever, leaving some businesses struggling to provide coverage for their employees. For many companies…

Testing Your Almond Knowledge: Can you pass this quiz?

Nancy Clark, RD/2 October 2018/ All MFN blog/

Almonds are a popular snack not just because they are nutrient-rich, but primarily because they are crunchy and taste yummy. In this day and age when snacks are replacing meals, you want to reach for good tasting, health-promoting snacks. Almonds can fit that bill!

I learned a lot of almond information while on a tour sponsored by the California Almond Board. Here’s a quiz to share what I learned—and for you to see how much you know about this popular sports snack.

True or False: Eighty-percent of worldwide almonds are grown in California?

True. The Mediterranean climate and rich soil in California’s Central Valley is one of only 5 places in the world that is ideal for growing almonds. The majority of these almonds stay in the US, with exports going primarily to Spain, India, China/Hong Kong, and Germany.

True or False: Growing almonds requires a lot of water?

True. Almonds, like all nuts, need more water per serving than fruits and vegetables do. That’s because making the protein and fat in nuts requires more energy and water than does making the carbohydrate in fruits and veggies. The amount of water required by almonds is similar to other nut trees. Because water is limited and expensive, the almond industry has created innovative ways to improve water usage. For example, the vast majority of almond growers have installed new drip irrigation systems that water the roots of the tree instead of the whole grove. By using automated moisture sensors, the trees do not get over-watered. These better irrigation practices have led to almond growers being 33% more efficient with water usage than 20 years ago. Plus, the water actually grows four products: the edible almond, shells for livestock bedding, hulls for cattle feed, and skins for beer. Nothing gets wasted!

True or False: The average American eats about a quarter of their calories from snacks?

True. People are eating more snacks and fewer sit-down meals. The typical American consumes about 24% of daily calories from snacks. Most snacks eaten before lunch tend to be selected mindfully, with an eye to nutritional value. Evening snacks, however, tend to be more about reward and comfort (think fewer fruits and vegetables; more sweets, salty snacks, and baked goods). Obviously, making smart snack choices are key to having a good sports diet.

True or false: An ounce of roasted almonds (23 almonds) contains 160 calories, but the body can use only 130 of those calories?

True. The official portion size for almonds is 1 ounce (28 grams). That equates to about 23 almonds, one large handful. Count them out to learn how many fit into your palm! A one-ounce portion offers 160 calories, but due to digestibility, one-ounce of roasted almonds actually contributes only 130 calories of good nutrition to your daily intake. Almond butter, however, is more digestible and contributes the full 160 calories.

True or False: Almonds are fattening

False. Almonds are not inherently fattening. That is, almond eaters are not fatter than almond abstainers. A study with overweight and obese adults who ate about 1 to 1.5 servings of almonds daily for 12 weeks reports they lost more body fat (and more belly fat) than those who did not eat almonds as a part of the reducing diet. (1) Because almonds are satisfying, they can actually help you save calories. That is, a handful of almonds will curb hunger for a lot longer than a handful of Skittles.

True or False: Almonds are an excellent source of protein.

False. While a one-ounce handful of almonds offers 6 grams of protein, I rate that a good source of protein—but not an excellent source. You could get three times that protein from 160 calories of chicken.

If you are a vegetarian, the protein in an ounce of almonds is the same amount you’d get in a half-cup of pinto beans. Along with the protein in the almonds comes other important nutrients: fiber, health-protective monounsaturated fats, vitamin E, potassium, and yes, even a little calcium (25-percent of what you’d get in a glass of dairy-milk).

True or False: For vegetarians or people who are lactose intolerant, almond milk is an equal swap for dairy milk.

False. While almond milk is a vegan alternative to dairy milk, it is nowhere near as nutritious as dairy milk, or for that matter, soymilk. I consider almond milk as really being “almond juice” with minimal nutritional value (other than the calcium the producer adds to the product). An 8-ounce glass of almond milk offers only 1 gram of protein, as compared to 8 grams in the same amount of dairy milk. (Read labels to compare brands of almond milk; some might have added pea protein or other nutrients.) Young children, in particular, do not get the protein they need from almond milk. If you choose to avoid dairy, the smarter choice, nutritionally speaking, is soymilk.

True or False: Almonds contain monounsaturated fats that reduce your risk of heart disease.

True. Almonds are a heart-healthy snack. By trading traditional snacks (chips, cookies, candy) for almonds, you can not only reduce your intake of salt, sugar, and saturated fats, and also boost your intake of healthy fats, fiber, protein, magnesium, vitamin E and many other vitamins and minerals. Research suggests almonds help people lower their bad LDL cholesterol when they swap their “junk snacks” for almonds.

True or False: Almonds appeal to today’s health-seeking consumers.

True. If you are looking for a satisfying snack that is vegan, gluten-free, preservative-free, GMO-free, lactose-free, and health promoting, look no further than a packet of almonds. Crunch away!

Nancy Clark, MS, RD, CSSD (Board Certified Specialist in Sports Dietetics) counsels both casual and competitive athletes at her office in Newton, MA (617-795-1875). Her best selling Sports Nutrition Guidebook and food guides for marathoners, cyclists and soccer players offer additional information. They are available at www.NancyClarkRD.com. For her popular online workshop, see NutritionSportsExerciseCEUs.com.

Disclaimer: While the California Almond Board sponsored the trip to observe the almond harvest and processing of the almonds, the opinions are my own.

Reference:

1. Dhillon J, Tan SY, Mattes RD. 2016 Almond consumption during energy restriction lowers truncal fat and blood pressure in compliant overweight and obese adults. Journal of Nutrition 146(12):2513-2519.