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Personal trainer and her client with dumbbells

Metabolic Syndrome: A New Focus for Lifestyle Modification

Tammy Petersen/4 June 2018/ All MFN blog/

Personal trainers have the opportunity to do more than just help people they train become more active. We need to be prepared to also help our clients implement lifestyle behavior changes related to stress, family history of coronary heart disease, obesity, smoking, high blood pressure and high cholesterol.

A look at what is called metabolic syndrome will help you understand why, even though increasing physical activity levels is the overall best thing you can do for any client, there are additional ways to guide them to a healthier lifestyle. Sometimes you may be able to help them make the changes yourself; and, sometimes you will need to refer them to another health professional like a doctor or dietitian for guidance. Either way, knowing how to help them or when to direct them to someone who is more knowledgeable than you is important. So, first let’s become familiar with the syndrome and the clinical criteria that the doctor uses to diagnose it. Your goal is then to help your clients understand and make the necessary changes so that they don’t progress to cardiovascular disease and the almost certain heart attack heart that will be the end result.

Cardiovascular disease is still the number one cause of morbidity and mortality in the United States and much of this burden of disease can be linked to poor nutrition and a dramatic increase in sedentary lifestyles, leading to overweight and obesity. This increase in weight leads to an increase in the incidence of type 2 diabetes, and blood pressure and cholesterol problems, which are all well-established cardiovascular disease risk factors. The National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP) III has updated the recommendations for the evaluation and management of adults dealing with high cholesterol, renewing its emphasis on the importance of lifestyle modifications for improving cardiovascular risk. The NCEP has coined the term “therapeutic lifestyle changes” (TLC) to reinforce both dietary intake and physical activity as crucial components of weight control and cardiovascular risk management.

As well as focusing attention on the LDL cholesterol (also called bad cholesterol) levels, the NCEP also identified metabolic syndrome as a secondary target of therapy. Metabolic syndrome (also called insulin resistance syndrome and syndrome X) is characterized by decreased tissue sensitivity to the action of insulin (pre-diabetes), resulting in a compensatory increase in insulin secretion. This metabolic disorder predisposes individuals to a cluster of abnormalities that can lead to such problems as type 2 diabetes, coronary heart disease and stroke. The prevalence of the syndrome has increased 61% in the last decade. It is crucial for medical professionals to identify patients at risk and follow these patients closely and counsel them about making lifestyle changes to lower the risk of type 2 diabetes and cardiovascular disease.

GUIDELINE: According to the NCEP, the criteria for metabolic syndrome includes at least 3 of the following 5 clinical factors

Risk factor	Defining level
Abdominal obesity Men Women	Waist circumference >40 in (>102 cm) >35 in (>88 cm)
Fasting triglyceride level	>150 mg/dL
HDL cholesterol level Men Women	<40 mg/dL <50 mg/dL
BP	>130/>85 mm Hg or taking antihypertensive medication
Fasting glucose level	>100 mg/dL or diabetes

Source: Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Bethesda, Md: National Institutes of Health; 2001. NIH publication 01-3670.

Millions of Americans at risk for metabolic syndrome can sharply lower their chances of getting this disease by adopting a healthy lifestyle (stop smoking, low-fat diet, weight loss/maintenance and increased physical activity). Without diet and exercise modifications, most patients will eventually fail and progress to type 2 diabetes within a decade and experience a heart attack about 10 years later. Experts recommend a diet reduced in saturated fats (<7%), low in cholesterol (<200 mg/day), high in fiber (20-30gm/day) and reduced in simple sugars. Weight loss of only 5-7% (less than 15 pounds) can make a big difference in health markers like cholesterol and blood pressure. A program that includes daily exercise reaching 85% of heart rate for age is reported to be of benefit too. However, any exercise is better than none, and a target of 30 minutes every other day is a reasonable level for most people.

As a fitness professional reading this, hopefully you are not asking yourself “so what?” but are instead seeing an opportunity to educate and motivate your current clients and to use your knowledge to help attract future clients. The medical community is good at diagnosing this syndrome, but not necessarily equipped to provide patients with the tools to be successful with the lifestyle changes they recommend. There exists a wonderful opportunity to build a partnership with physicians in your area. Most physicians will gladly refer patients to you for help with the all-important exercise and nutrition portion of the treatment program. In many cases, you have more knowledge in this area than the physician who has been trained in tertiary, not preventative, (i.e. most MD’s know very little about diet and exercise since this is not a focus in medical school) medicine. Often times all that you will need to get a referral is for the doctor to be aware of your existence and to give them an easy way to get the patient to you. A short introduction letter outlining your qualifications and showing your desire to help people make lifestyle changes is a good start. A personal visit to your primary care doctor and others in your area is even better. But, be prepared to take up just a few minutes of their time to introduce yourself, your idea, and leave your letter and cards.

Tammy Petersen, MSE, is the Founder and Managing Partner for the American Academy of Health and Fitness (AAHF). She’s written a book on older adult fitness and designed corresponding training programs. SrFit Mature Adult Specialty Certification is used nationwide as the textbook for a college based course for personal trainers who wish to work with mature adults. SrFit is also the basis for a specialty certification home study course that qualifies for up to 22 hours of continuing education credit with the major personal trainer certification organizations.

References

Centers for Disease Control and Prevention. Early release of selected estimates based on data from the January-June 2003 National Health Interview Survey. URL: cdc.gov/nchs/about/major/nhis/released200312.htm.
Summary Health Statistics Tables for the U.S. Population: National Health Interview Survey, 2016 https://www.cdc.gov/nchs/nhis/SHS/tables.htm 16 Apr. 2018.
Centers for Disease Control and Prevention. Prevalence of health care providers asking older adults about their physical activity levels—United States, 1998. Morbidity and Mortality Weekly Report. 51(19):412-4, 2002.
Huang, Paul L. “A Comprehensive Definition for Metabolic Syndrome.” Disease Models & Mechanisms5-6 (2009): 231–237. PMC. Web. 16 Apr. 2018.

3 Keys to Healthy Aging

Nicholas Prukop/1 June 2018/ All MFN blog/

No one really knows why we age other than to acknowledge that as our cells die and don’t get replaced, organs – and ultimately our bodies – do indeed die. The role that disease plays in this process is obvious – especially if there is no successful treatment available that can address the underlying causes of the problem. I believe in the “art of prevention” as a strategy for helping not only extend our lives – but also improving the quality of the time we have to live.

I did not come to this understanding in my early years because when we are young we assume we will “live forever”. It is only as we grow older and have to face the challenges of aging that we begin to appreciate the beauty and mystery of our own bodies – and what we “could” have done better along the way.

I decided that based upon my own experiences over the past 7 plus decades of life that we ARE in control of much of the aging process as we currently know it. I could assign a number to it (i.e. 80, 90%) but I would most likely be wrong. I will therefore ask instead what if we could control the “majority” of the outcomes we might face, then how would WE choose – and act – today to prevent problems in the future? When we REACT rather than RESPOND to life’s “urgings” we are always going to be “behind the curve” and face unintended consequences.

There are people who live to be hundred or more and then there are those of us who “die before their time”. How do we distinguish between being “lucky” and making good choices and does making thoughtful choices always work? I believe it does and this is why I thought I would share with you what I consider to be the three most important keys to healthy aging as I have lived them.

BEING PHYSICALLY ACTIVE

From a purely practical standpoint this key is what I would call a “no-brainer”. I started life on Maui in the mid 1940’s (1946) and was introduced to swimming before I could even walk. I remember a man holding me by the stomach in a half empty pool teaching me to kick my legs and paddle my arms. That man became my future swim coach and his name was Mack Nakano – a former champion himself. He shared his passion and love for swimming that animated his own life and I have carried that love and passion for physical activity within me ever since those wonderful days of my boyhood on Maui.

As I grew and I moved on from swimming to other sports (because of circumstances beyond my control), I found I had formed a love for all forms of physical activity. I discovered other ways to enjoy being active when I was no longer competing and that main form of activity became running. As I adjusted to life on the mainland at Syracuse University in 1964, I began a running campaign that has stayed with me to the present day. I can’t imagine letting even one day go by without stressing my body in some form and even when I was injured as I was last year, I still found ways to train and remain active. This idea is a part of WHO I AM.

I have run over 65,000 miles in the more than half a century I have been a runner. I believe my commitment to being fit has saved my life many times over during my lifetime – even in the darkest of times when I felt lost and without hope. My question to you is: What is your passion when it comes to being physically active and will you honor that passion the way I did with my running program? If you don’t have one – then find one! Being physically fit does NOT guarantee a healthy body but a healthy body does require a FIT body. I am hopeful my “luck” continues into the years ahead. I will do everything in my power to insure that it does!

BECOMING A “CRITICAL THINKER”

This is my second choice for a key to healthy aging because the key to life IS thinking and the corresponding choices that we make leading to the actions that we take as a result. ALL thought is powerful but it is in HOW we CHOOSE to use these “power houses” of life that makes all the difference. With the fast paced changes that are occurring in all facets of life today, it is becoming increasingly difficult to know “what to think”. I say that becoming “aware of our thoughts” is a key to healthy aging because they lead us to our potential choices and it is through our choosing that we can enhance our circumstances – or cause them to do us great harm.

An example of choice gone wrong would be the choice to smoke. We all know the dangers inherent in smoking – or taking drugs for that matter – but many of us do it anyway. My father started smoking during World War II as many service men and women did during that terrible conflict and as a result shortened their lives. My father died in November of 1983 at the age of 64 from cancer which had spread throughout his body but started in his lungs. I saw him the week before he died and it left an indelible impression on me. I was 37 at the time and I vowed to never go out like that. The past 35 years have been healthy ones for me because I cared about my future health and most importantly ACTED on that thought.

Deciding to become thoughtful and critically involved in our thoughts is an important part of the healthy aging process. Don’t “fall into” your choices – make them consciously and with the belief that you are doing what is right for you. People buy pills of all kinds sight unseen, and other potentially dangerous products online all the time “without thinking about the consequences” of their actions. I believe that we MUST “think before we leap”. It is the only sensible way to move forward in life and hopefully “cut the odds” in our favor so my advice is simple: Get in touch with your thoughts and act according to what they are allowing you to see and feel about yourself – and then choose wisely. This is the best any of us can do and it will insure WE are choosing our path in life – and not the other way around!

THE SPIRITUAL LIFE

I am not religious and have never found comfort – or peace for that matter – in any conventional religion but I have found that the spiritual path is available to all of us who seek a different way. I found this path in 1985 through a minister at the Church of Religious Science in Huntington Beach by the name of Peggy Bassett. She introduced me to the principles that would guide my life and choices going forward and that have sustained me to this day 33 years later.

I believe in “quiet time” for myself (meditation and affirmative prayer work – a form of prayer that affirms rather than asks for something). Every day presents me with a new opportunity to get “in touch” with my “inner self”, providing me with the opportunity to receive guidance – and even wisdom – that may give me clarity or a new understanding of some aspect of my life that may be causing me pain or any other challenge I need to address in the present. I will respond only when I can “see my way clear” to a solution and only then will I act on this wisdom or guidance.

The role of the spiritual journey is to bring an expanded consciousness – or awareness – into our life experiences and allow us to contact joy, peace, harmony and love in a way that enriches and sustains us while allowing us the opportunity to “let go” of the baggage of our pasts. Regret, guilt, unexpressed anger, hatred and other forms of negative inner turmoil CAN and DO lead us to an early death. The body responds to all forms of emotion and if these emotions – and thoughts – are not directed by US to a “higher consciousness” they will bring sickness and chronic illness in all their terrible manifestations into our lives.

I have never been in a hospital, had surgery, taken drugs or medication, or had any outside medical intervention that I can recall – ever. I believe that through the spiritual path that Peggy me gave all those years ago – coupled with my ongoing efforts to remain healthy and fit – I thrived and DO wake up each day grateful and hopeful. I am “lucky” but this luck came to me because I ACTED on my BEST instincts – and intentions – at the time I was making crucial choices in my life. What will your choice be when it comes to letting go of “preconceived notions” of what you “think” is true so that you can finally live in the REAL truth of who you are – and are becoming?

IN SUMMARY

I believe the world we live in today is “noisy”. There are too many voices and too little silence. I believe in being quiet and thinking and experiencing my life on more than just the superficial levels available in today’s world. I believe listening is becoming a lost art and that we are never going to “hear” anything of value arguing with another. Sometimes I feel as though I was not meant for this world and look back with fondness on the world as it was when I was a boy learning to swim and ultimately getting to know the me that I am today.

The keys to healthy aging are mine and mine alone. Whether others take what I have shared and “think about” them is for others to know. I believe that there is something greater and wiser than me that created me and is helping me to share what I have learned in my own unique way. This is my mission and this mission – or purpose – is always “on my mind”. I want it to be there constantly so that I may choose to support it in any way that I can in order to bring my life full circle from student to teacher – and back to student again.

What will you do with this information and how will your choices today affect your future? Only you will know but I will tell you that in “thoughtful living” we are ALWAYS rewarded by life with the best that it has to offer. Isn’t that worth your time and commitment? It is to me – and it is PRICELESS! Think about that!

Originally published on Healthy New Age. 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.

Member Spotlight: Cheryl McLea, Personal Trainer in Newark, DE

MFN/29 May 2018/ All MFN blog/

Cheryl primarily trains women with autoimmune conditions. I have clients with all types of conditions, such as MS, Lyme disease, Hashimoto’s, Epstein Barr, breast cancer, chronic back pain, fibromyalgia, Polycystic Ovarian Syndrome, amongst others.

Four Sources of Stress & How to Beat Them

Christine Estrada/23 May 2018/ All MFN blog/

Stress is a normal physical response. Everyone feels stress. You may feel stress when you have too many errands to run, when you are given a promotion at work, or in your daily commute through Atlanta traffic!

During stressful times, your body responds physically by producing hormones to speed up your heart, make you breathe faster, and give you a big burst of energy. That physical reaction is called the “fight or flight” response.

Some stress is good and some stress is bad. But when stress happens too often, it can take a toll on your body. So that’s why I want to discuss where stress comes from and how you can effectively manage it.

Take a look around you. The environment in which you live can cause stress. Pollution causes stress and comes in the form of substances or energy — think trash or smog and noise or light pollution. Your environment also includes your family, home, neighbors, community, and geographic location. The people with whom you choose to surround yourself can either be uplifting and positive or upsetting and negative. Being isolated or overcrowded can also cause stress depending upon which situation you prefer.

Your diet may be causing you stress. The food that you eat either nourishes or starves your body. Do you eat mostly processed foods with chemical additives and empty calories? Doing so creates a toxic environment inside your body and allows you to become more susceptible to sickness and disease.

How much physical activity do you get? Science and medicine have proven that exercise negates the effects of bad stress on your body and in most cases it does so better than any prescription medicine. On the other hand, a lack of physical activity can make even small amounts of stress seem monumental.

Take an inventory of what you’re feeling right now. Are you worried, doubtful, fearful? Do you feel happy, confident, or at ease? Your attitude and how you choose to react to stress can either cause you more stress or help you release stress. Oftentimes people manufacture stress in their thoughts that then manifest themselves in their bodies and environment.

The good news is you have choices here. You can choose to take control of all of these factors in your life. Or you can choose to be a victim to stress and succumb to headaches, ulcers, back pain, sickness, disease, obesity, depression, unhealthy relationships…

Take a moment to look at these four areas of your life. Identify the stress points. Then allow yourself to decide whether you will take control of that stress or simply accept it.

Reprinted with permission from Christina Estrada. Originally printed on yourfamilylifestylecoach.com.

Christina Estrada is a lifestyle coach helping people discover their strengths and reset their mindset for a healthier, more fulfilling life. She is a holds multiple certifications with International Sports Sciences Association (ISSA), including Master Personal Trainer, and Specialist in Fitness Nutrition, Youth Fitness, and Senior Fitness.

Eating Junk Food Raises Cancer Risk, Even for Slim Women

Dr. Joel Fuhrman/21 May 2018/ All MFN blog/

Whether you are slim or obese, one thing is clear: calorie-dense processed foods increase cancer risk, regardless of body weight.

Researchers studied data from 92,000 postmenopausal women who took part in the Women’s Health Initiative, a 15-year study of health in postmenopausal women. They focused on the energy density of the women’s diets – “high energy” diets are synonymous with “high calorie” diets – and noted the number of calories per gram of the total diet.

The researchers made an unexpected finding: Women in the top fifth of energy density were 10 percent more likely to be diagnosed with an obesity-related cancer compared to the bottom fifth, and this relationship was found in women who were at a normal weight at baseline.² These cancers include colorectal, pancreatic, endometrial, ovarian, liver, kidney, gallbladder, and postmenopausal breast cancers.¹ This increase in risk was associated with the calorie density of the women’s diets.²

The results suggested: If you choose low-nutrient, energy-dense foods, it will affect your health even if it doesn’t affect your waistline. Just because you’re slim doesn’t mean junk food isn’t damaging your health.

Energy density vs. nutrient density

Dietary energy density in this study was defined as the number of calories per gram in a food of the entire diet. For the most part, typical high energy-dense foods, such as baked goods, French fries, burgers, pizza and desserts, are low in nutrient density (micronutrients per gram). High nutrient-dense foods, such as vegetables, fruits, and legumes, tend to be low in energy density.

Following a diet that is high in nutrient density and low in energy density is essential for good health. This is the origin of my health equation H = N/C (Health = Nutrients per Calorie). A high ratio of micronutrients to calories is the basis of a healthful diet.

How energy density might promote cancer

Obesity contributes to cancer in a variety of ways: for example, excess fat tissue causes a state of low-grade inflammation, promotes insulin resistance, and produces estrogen.^1,3-5 ⁶ However, calorie-rich junk food has effects – other than weight gain – that could contribute to cancer development:

Elevated insulin and IGF-1 levels: From high-glycemic processed foods and high animal protein foods, respectively. Excess of these pro-growth hormones is linked to an increased risk of several cancers.⁴
Oxidative stress and inflammation.⁷
Nutrient inadequacies:⁸ Many Americans do not meet recommended intakes of magnesium, calcium, vitamin C, vitamin E, and vitamin K.⁹
Lack of protective phytochemicals from natural plant foods (such as glucosinolates from cruciferous vegetables and lignans from flax and chia seeds).^10,11
Excess folic acid from fortified refined foods: Anyone in the U.S. who eats a typical diet (especially those who also take a conventional multivitamin) is exposed to excessive amounts of folic acid due to mandatory fortification of refined grain products. Although rates of neural tube defects have gone down, there are serious concerns about the potential cancer-promoting effects of exposing the whole population to synthetic folic acid daily in the food supply. ^12-15 (Read more: Folate Position Paper)

When you eat a diet with more micronutrients and fewer calories, you age more slowly, and also improve immune system protection against cancer. When you eat excess calories, especially excess calories that do not contain a significant micronutrient load, you accelerate aging and increase your risk of cancer. You can exercise off those extra calories, but they will still negatively affect your health. It is not enough to be at a healthy weight – you must actually eat healthfully to age more slowly, prevent cancer, and live a long healthy life.

Originally printed on DrFuhrman.com. Reprinted with permission from Dr. Fuhrman.

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

References:

National Cancer Institute: Obesity and Cancer. In 2017 [https://www.cancer.gov/about-cancer/causes-prevention/risk/obesity/obesity-fact-sheet]
Thomson CA, Crane TE, Garcia DO, et al. Association between Dietary Energy Density and Obesity-Associated Cancer: Results from the Women’s Health Initiative. J Acad Nutr Diet 2017.
Coelho M, Oliveira T, Fernandes R. Biochemistry of adipose tissue: an endocrine organ. Arch Med Sci 2013, 9:191-200.
Cohen DH, LeRoith D. Obesity, type 2 diabetes, and cancer: the insulin and IGF connection. Endocr Relat Cancer 2012, 19:F27-45.
Kolb R, Sutterwala FS, Zhang W. Obesity and cancer: inflammation bridges the two. Curr Opin Pharmacol 2016, 29:77-89.
Cleary MP, Grossmann ME. Minireview: Obesity and breast cancer: the estrogen connection. Endocrinology 2009, 150:2537-2542.
Saha SK, Lee SB, Won J, et al. Correlation between Oxidative Stress, Nutrition, and Cancer Initiation. Int J Mol Sci 2017, 18.
Ames BN. Prevention of mutation, cancer, and other age-associated diseases by optimizing micronutrient intake. J Nucleic Acids 2010, 2010.
Fulgoni VL, 3rd, Keast DR, Bailey RL, Dwyer J. Foods, fortificants, and supplements: Where do Americans get their nutrients? J Nutr 2011, 141:1847-1854.
Stefanson AL, Bakovic M. Dietary regulation of Keap1/Nrf2/ARE pathway: focus on plant-derived compounds and trace minerals. Nutrients 2014, 6:3777-3801.
Shukla S, Meeran SM, Katiyar SK. Epigenetic regulation by selected dietary phytochemicals in cancer chemoprevention. Cancer Lett 2014, 355:9-17.
Smith AD, Kim YI, Refsum H. Is folic acid good for everyone? Am J Clin Nutr 2008, 87:517-533.
Figueiredo JC, Grau MV, Haile RW, et al. Folic acid and risk of prostate cancer: results from a randomized clinical trial. J Natl Cancer Inst 2009, 101:432-435.
Kim YI. Will mandatory folic acid fortification prevent or promote cancer? Am J Clin Nutr 2004, 80:1123-1128.
Mason JB. Folate, cancer risk, and the Greek god, Proteus: a tale of two chameleons. Nutr Rev 2009, 67:206-212.

Delivering The Behavioral Side Of Lifestyle Medicine Through Wellness Coaching

Dr. Michael Arloski/18 May 2018/ All MFN blog/

If we could give every individual the right amount of nourishment and exercise, not too little and not too much, we would have found the safest way to health.” –Hippocrates 420 B.C – 370 B.C.

Healthcare providers have been prescribing lifestyle improvement for thousands of years. The evidence has been built from the observations of Hippocrates all the way to the neuroscience of today. We know, from mountainous reams of data, that lifestyle affects the course of an illness or health challenge. The challenge for the healthcare provider of today is to see the “lifestyle prescription” translated into lasting lifestyle change. Many well-intentioned healthcare professionals have attempted to educate and admonish their patients into losing weight, ceasing the use of tobacco, managing their stress better, getting more sleep, being medically compliant/adherent, etc. Seeing actual success in behavioral change happening far too seldom, many have abandoned such efforts and just reach for the pharmaceutical prescription pad.

In recent years, however, there has been an exciting movement in the field of medicine that looks at how to use “lifestyle interventions” as first-line treatment.

“Recent clinical research provides a strong evidential basis for the preferential use of lifestyle interventions as first-line therapy. This research is moving lifestyle from prevention only to include treatment–from an intervention used to prevent disease to an intervention used to treat disease.” –The American College Of Lifestyle Medicine

The Lifestyle Medicine Movement has done much to establish an evidence base and it continues to examine research that distinguishes what appears to work for lifestyle improvement. Much of its attention has focused on nutrition, but more and more the field is realizing the importance of health and lifestyle behavior.

Wellness and health coaching has become the delivery mechanism for wellness programs, and its potential for the same vital role is being seen in Lifestyle Medicine. The reality is that the vast majority of clients that most wellness/health coaches see are already health-challenged in some way. They may already have a chronic lifestyle-related illness, or multiple risk factors that set them up for needing serious preventative help. Wellness/health coaches that work for disease management companies, insurance companies and many corporate wellness programs are already working with caseloads populated primarily by lifestyle medicine patients.

At past Lifestyle Medicine conferences, I’ve presented on “Wellness Coaching And Lifestyle Medicine: Covering The Whole Continuum”. and “Delivering The Behavioral Side Of Lifestyle Medicine: Wellness Coaching Skills & Concepts”. Together with other presenters on wellness coaching we have experienced a strong positive response from an audience made up primarily of physicians.

One of the key concepts of my talks that was especially well received was the idea of how the Treatment Plan needs to be integrated with the Wellness Plan.

Co-creating a Wellness Plan with our clients is one of the primary tasks for the wellness coach. Together we work with a structure that insures the client’s plan for lifestyle improvement will lead to success. A key part of that Wellness Plan will always be the “Lifestyle Prescription” that the client’s treatment team is recommending. What is key is that the Wellness Plan supports The Treatment Plan.

I will be talking further about this concept in my forthcoming book on the more advanced skills and methods of wellness coaching, but here is a sketch of the two plans and the way they overlap.

Treatment Plan

Diagnostically Derived
Treatment Provider Devised
Prescriptive
Responsibility on Provider to administer, responsibility on client to follow
Usually does not accommodate patient’s circumstances or abilities, may accommodate patient’s capacities.
Problem solving, solution finding oriented
Purposed for resolution of illness and disease, reduction of symptoms, healing
“Lifestyle Prescription” focuses on recommended behavioral changes leading to Lifestyle Medicine outcomes
Dependent greatly upon medical compliance/adherence

Wellness Plan

Derived through exploration and self-assessment combined with treatment recommendations.
Co-created by “client” and “coach”
Non-prescriptive – client centered
Responsibility on client to follow with coach’s accountability and support
Not only accommodates, but is derived from client’s circumstances, abilities and capacities.
Designed to eliminate barriers and develop additional support
Possibility, growth and self-actualization oriented.
Purposed for behavioral change and lifestyle improvement
Includes assisting client with medical compliance/adherence

Overlap Of Treatment And Wellness Plans

The Wellness Plan (WP) supports the Treatment Plan (TP)
TP identifies critical areas for recommended lifestyle improvement
Through “client-centered communication” WP aligns with the goals of the TP
Client engages, with coaching support, in lifestyle improvement behaviors that positively affect treatment outcomes
WP helps client with organization, accountability, etc., improving attendance for medical appointments and management of medications, self-testing/self-care
WP helps client make best us of medical appointments (self-advocacy)
WP helps client report more accurately to treatment team about changes in lifestyle behavior (providing more data for treatment decisions)

When clients are operating on a Wellness Plan that they have truly helped co-create with their own buy-in, the opportunity for weaving in Areas of Focus, Goals and Action Steps that support what their treatment team wants to see becomes obvious. Clients then have the structure and support they need to carry out the goals of the Lifestyle Prescription.

Physicians and other healthcare providers can already start making use of wellness and health coaching as a delivery mechanism for the behavioral change they would love to see. Many of their patients already have wellness coaching as an employee benefit. Their company’s wellness program may already provide it, or they may contract with a wellness coaching provider company. More and more employees have wellness/health coaching available through their insurance provider.

Wise medical organizations and practices are hiring wellness coaches to become part of their staff or are outsourcing to them. Healthcare providers are sometime “wearing two hats” and combining their treatment work with coaching. Others are becoming more “coach-like” in their interactions and are then handing the patient off to the wellness coach for the longer process of lifestyle improvement.

The Real Balance Wellness & Health Coach Certification curriculum (http://www.realbalance.com) has included how coaches fit into the Lifestyle Medicine approach for over a decade. Our students come to us as a resource for learning how they can help deliver the lifestyle improvement that their Lifestyle Medicine clients seek.

Wellness Coaching to support Lifestyle Medicine is not just an idea whose time has come, it has already arrived!

Originally published on Real Balance blog. Reprinted with permission.

Dr. Michael Arloski is the CEO and Founder of Real Balance Global Wellness Services, Inc. (www.realbalance.com). Real Balance has trained thousands of wellness coaches worldwide. Dr. Arloski is a board member of The National Wellness Institute, and a founding member of the executive team of The National Consortium For Credentialing Health and Wellness Coaches. He is author of the leading book in the field of wellness coaching: Wellness Coaching For Lasting Lifestyle Change, 2nd Ed.

Sports Nutrition: #ScienceNotOpinion

Nancy Clark, RD/15 May 2018/ All MFN blog/

Performance starts with fueling, not training! The best way to fuel for top performance seems to be a debatable topic these days. To keep on top of the science regarding food, exercise & performance, I look to SCAN, the Sports & Cardiovascular Nutrition practice group of the Academy of Nutrition and Dietetics (AND). Here are some tidbits of information from this year’s 35th annual meeting in Keystone CO, May 2018.

In your search for sports nutrition information, Leslie Bonci RD CSSD wants you to find #ScienceNotOpinionand #FactsOverFallacy. Here’s some of what science supports:

—Exercising in a fasted stated leads to muscle breakdown. Think twice before eating nothing before morning exercise.

—The keto diet does not enhance performance, but rather leads to a down-regulation of the enzymes needed by carbohydrates to fuel a surge or a winning sprint at an event.

—Whole30 and Intermittent Fasting are just two more fads to add to the list of unsuccessful diets. You never want to embark upon a diet you won’t maintain for the reset of your life. Otherwise, diet backlash (binge eating, weight gain) takes it toll. Learn how to eat smarter, not diet harder!

—Carb-phobia refuses to go away, despite the plethora of research supporting the performance benefits of a carb-based sports diet. #Don’tDreadTheBread.

Omega-3 fats (DHA, EPA) found in oily fish (salmon, tuna, mackerel) are related to brain health. Animal research (rats, mice) suggests giving intravenous DHA within an hour after brain or spinal cord injury contributes to better outcomes regarding recovery. Would the same help athletes? Could DHA help with reducing the damage done by brain injuries? According to Michael Lewis MD, athletes, war fighters and others at high risk for getting concussed should consider taking 3,000 mg. EPA + DHA per day as a protective strategy.Omega-3s can also help treat depression, and that might help reduce suicides. Among soldiers with adequate levels of omega-3, the suicide-rate was 62% lower than soldiers with low blood levels of DHA.

Should athletes take anti-oxidant supplements? Likely not, according to exercise physiologist Scott Powers PhD of the University of Florida in Gainesville. The body has a natural balance of pro-oxidants and anti-oxidants. An imbalance can lead to muscular fatigue and molecular damage. Anti-oxidant supplements can down-regulate the body’s natural production of anti-oxidants, and that can blunt the training response. Athletes can ingest a performance enhancing balance of anti-oxidants (including vitamins C & E, zinc, carotenoids, and polyphenols) via all sorts of colorful fruits and vegetable: blueberries, strawberries, tart cherry juice, grape juice, broccoli, spinach, carrots….

The Academy of Nutrition and Dietetics, along with the American College of Sports Medicine and Dietitians of Canada, have created guidelines on nutrition for athletes. But what about nutrition for fitness exercisers and weekend warriors? If that’s you, exercise physiologist Asker Jeukendrup, PhD, of www.mysportscience.com suggests you match your nutritional guidelines to your athletic goals. That is, are you exercising to lose weight? build muscle? finish an Ironman Triathlon? or just to invest in better health?

When it comes to fueling during extended exercise, Jeukendrup stated the recommendations are similar for both athletes and less fit people: For exercise that lasts from 60 to 90 minutes, you want to maintain high energy by consuming from 30 to 60 grams of carbohydrate (120 to 240 calories) per hour of exercise. If you are a weekend warrior who exercises hard for more than two hours, you want to target 60 to 90 grams carh (240 to 360 calories) per hour. You might have to start at the low end of the calorie range while you train your gut to tolerate that much fuel. (The gut is trainable!). You’ll discover that exercise is much more fun when you have high energy!

An estimated 35 million Americans are older than 65. By 2030, 70 million Americans will exceed the age of 85. Unfortunately, as we age, we lose muscle strength. That loss is associated with frailty and falls. Because the daily diet of an estimated 25% to 40% of older people lacks adequate protein, muscle loss gets exacerbated.

Research suggests that older people, including athletes, should increase their protein intake to 1.4 g to 1.6 g/kg per day, and up to 40 grams after hard exercise. Exercise physiologist Robert Murray, PhD,(www.sportsscienceinsights.com) reports this could help boost the muscle-building response to exercise. If you are an older athlete who weighs 150 pounds (68 kg), this means. 95 to 110 gram protein per day. That’s about 25 grams, four times a day—much more than in a bowl of oatmeal or a handful of nuts!

The health risks of yoyo dieting are more harmful than the (short-lived) benefits of weight loss. Julie Duffy Dillon RD (host of the Love Food podcast) reminds us that weight cycling (yoyo dieting) contributes to malnutrition, muscle loss, reduced metabolic rate, and feelings of deprivation. The binge-eating that occurs upon “blowing the diet” is linked to fat gain, inflammation, elevated blood pressure, and insulin resistance—to say nothing about disordered eating. Dieting is the #1 predictor of who will develop an eating disorder.

According to sports dietitian Nanna Meyer PhD RD of the University of Colorado in Colorado Springs, climate change is here. It’s time for athletes to think more about how we can be good Food Citizens and take better care of the earth that we enjoy. This could be by eating locally grown foods, choosing more plant foods, buying sustainably farmed fish, using fewer plastic water bottles, eating less food in wrappers, and buying from local farmers. Eat with integrity and with respect for the planet!

Nancy Clark, MS, RD 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 www.NutritionSportsExerciseCEUs.com.

The Power of Plank

Kama Linden/10 May 2018/ All MFN blog/

Many people will go to the gym in hopes of “looking” better. Although we all want to be our best selves, working out for a “look” vs. overall strength and well-being can lead to imbalanced muscles, as well as other injuries. This can be especially true for those looking for a “flat stomach” or “washboard abs”. However, the true importance of abdominals is to strengthen and contain the organs in our central region, as well as support the spine, especially the lumbar region.

In Pilates, as well as in Yoga, our main focus is the Transverse Abdominus. A way to think of this: the saran wrap, or casing of a vegan sausage, that wraps all the way around, and holds everything together.

For this reason, many exercises are done in neutral spine, vs. merely moving one’s head up and down. In fact, many people injure their necks because they “pull on their heads”, and don’t even come up high enough to achieve enough forward flexion to have the desired result of abdominal contraction.

I have also encountered students who have had neck and spinal injuries that prevent them from curling up. Does that mean that abdominal strengthening is off the table? The answer is quite the opposite.

Plank is such a wonderful and functional exercise. Learning how to maintain one’s body in neutral spine plays into everything that a person does in daily life activities: from simple sitting and walking, to running and spinning. And you would NEVER want to lift a box in a rounded spine, so it is important to learn to TRAIN the body for real life.

When working with beginners, I will often use a raised box or platform to take the edge off, as having the chest inclined upward will help a new person ease into the idea of eventually having a horizontal line. However, remember that this is not a FLAT line by any means! The spine has 3 curves: the cervical spine (at the neck) has a concave curve, the thoracic spine (back of the rib cage) has a convex curve, and the lumbar spine (lower back) has a concave curve. And if you want to add a 4th, the pelvis/sacrum has a convex curve as well. Together, this “S” shape is what keeps a body “straight”.

To get started: Find and all fours position where you can feel “the suspender” action: when the base of your ribs and your pelvic bone will feel like they are aligned in the front. All your curves in your spine will be present. Your arms will be directly under the line of your shoulders.

At this point I will cue, “Elbow, elbow, leg, leg”. Place one elbow on the mat or on the bench (if modifying), then the other, then walk one leg back straight, followed by the second. The elbows will still be right under the line of the shoulders. The Head will remain elongated (never hung, and DEFINITELY not hanging into one’s hands, hoping for it to be over). The chest is expanded, not rounded, as if you have a great necklace or t-shirt you want everyone to see. The feet are parallel, not spread apart. And although a strong plank will lead to a strong downdog, the BUTT is NOT above the chest. The opposite can be true, especially for a beginner on a box, or when doing the plank on straight arms, but sticking the butt up in the air takes away from the abdominals, and will eventually hurt one’s back and shoulders. Same is true for pelvic tucking/back rounding. The trick is to find and enjoy the neutral spine alignment.

As you progress, some fun variations on plank are:

Gently lifting one foot off the floor a few inches, and placing back down. Doing 8-16 reps alternating legs.
On straight arms (if on the mat), or on bent elbows (on a platform that is 2-4 risers high), gently bend one knee to 90 degrees, hold for a second, place back to parallel on the floor, and switch sides. Doing 8-16 reps alternating legs. This is NOT to be done as a run, as many people will lift their butt/hang their head/round their back. This is meant to be done in a slow and controlled manner for the most pain, I mean FUN!
More advanced, you will see me do a plant on straight arms with my feet on a foam roller. Without changing out of neutral spine, I will gently roll the roller with my feet toward my midline, (about a 90 degree angle), and then extend back to the original plank, without letting my center sag. I do not do this on a ball as that would lift my butt. Again, it is better to have the chest higher than the hips, rather than the reverse.

Of course, plank does involve a bit of strength. Therefore, new students could simply go to an all fours and practice finding neutral spine. Or, to modify further, sit at the edge of a hard backed chair, and practice aligning one’s ribs and hips, and then containing the abdominals. Hold for a count of 5, and release.

In closing, abdominal strength is so much more than flat stomachs and washboard abs. Using the power of the plank, one can achieve true abdominal strength that will help with all sports and daily life activities.

Kama Linden has been teaching fitness for over 2 decades. She has taught strength, step, pilates, vinyasa yoga, senior fitness, and has worked with clients and students of all ages and fitness levels. She is certified by AFAA Group Exercise and NASM CPT, as well as 200 hour Yoga. She has a BFA in Dance from University of the ARTS. Her newest book is titled, “Healthy Things You Can Do In Front of the TV”. Visit her website, bodyfriendlyoga.com

Healthy Aging and You: Change Your Thinking, Change Your Life

Nicholas Prukop/9 May 2018/ All MFN blog/

I am one who believes that REAL change occurs from within ourselves first and that once we decide to accept this principle, our lives – and minds (and hearts) – can become clear of all the “baggage” we have been dragging around with us over the course of our lives. Self esteem issues, guilt, regret, resentment, and so much more can be released so that we can finally live the lives we always wanted. I know from personal experience how difficult it has been for me to arrive “at clarity” on this point and now that I have I can report that my life is beginning to finally “take off”! It only took me 38 years to get to this point of consciousness but can you do better? Absolutely! What I would like to propose to you is that it does NOT have to take this long for us to finally “take control” of our lives because we CAN take control of HOW WE THINK today!

I will share with you some key ideas that will enable and empower you to do this in your own lives and free yourself from the bondage of old, outdated beliefs and ideas about yourself that no longer serve you but inhibit your growth – and expansion. It is my belief that the current state of affairs with regards to the high drug use in this country, the obesity epidemic, and the onset of chronic diseases such as diabetes are due in part to “how we think” about ourselves and that medicine alone CANNOT “cure” these challenges. This is why I am a proponent of positive change “from within” first so that we can address the underlying “causes” of these potentially life ending challenges.

The Subconscious Mind

The subconscious mind is the “controller” of our experiences and actions. We behave from its instructions and the result is that we create the world as “others” wanted for us when we were children and young adults. Programming of our subconscious occurs very early in our lives and continues unabated throughout our early adult years. It is not until we reach a “crisis point” later in our lives that we begin to realize that control of our thinking created by our parents, teachers and “the others who cared about us” began long before we became “conscious” of their effect on us. I reached this point in 1982 when my wife left me at the age of 35 and I did not find a path to healing until 3 years later in 1985 at the Church of Religious Science in Huntington Beach, California. This spiritual path was critical to uncovering “the real me” and I am still evolving to this very day.

I bring this idea forward now so that I can state that we will ALL arrive at a “crisis point” in our lives whether it be earlier like me or later like my daughter who is facing significant health issues in her mid 40’s, but arrive at it we WILL. Changing my mind about myself was difficult and for many years seemed an impossible task but I welcomed the challenge and through my own spiritual journey have found the “essential me”. This is what I want for you – to find your “essential self” – and free yourself from past guilt, pain, and regret. I never want to carry these burdens again and I know I won’t because I take time each day to “check in with my thoughts” and mostly find them to be encouraging, loving – and most of all hopeful and grateful (the starting point of my day).

Keys to Changing Our Thinking

AFFIRMATION

The struggle to changing our thinking is embedded in the previous programming of our subconscious minds earlier in our lives. “Replacing” this programming is worth the effort and one of the keys to doing this is the practice of affirmation. I will say that eventually with time and a new belief in yourself that you will see results that will amaze you. I will share two affirmations I use every day in my meditation and prayer work. They are only examples and come from my experience with religious science (you can develop your own) but remember an affirmation can be as simple as “I am loved and loving”.

“Today I am standing on the threshold of new experience. Possibilities extend before me and I accept their magnificence. Through my spoken and accepted word, I co-create with divine intelligence the plan for my life. Here and now I am open to the greatness yet to come and I am ready for a miracle”.

“Today I accept that the light of God’s love is in, through and around me. I feel its presence in everything that I do. I experience clarity in all things as this light guides my way into the unknown”.

There is REAL power in our words and thoughts CAN be changed through repetition. I am living proof that all of this works and is possible because I have practiced this discipline since 1985 and I have continued this practice every day since. It is the most important part of my day. Meditation (“going within my mind”) and prayer are the tools I use to stay “centered” throughout my day. You CAN do this too if you make up your mind to do so!

VISUALIZATION

I visualize my future and what I want to accomplish in that future so that I can DEFINE what I want to do – and be. I AM a speaker and a writer and I want to make a difference using these gifts so I am diligently preparing for my contribution to life through writing – and eventually speaking. I use visualization as the powerful tool that it can be by “experiencing” my future work NOW. I speak to audiences with clarity because I have already written about the issues that are important to me to share with people going forward in my life. I know WHO I am, WHY I am here, WHAT my message is, and the change I WILL bring to people of all ages in this future that I now love so much.

I have described in my book “Healthy Aging & You” a PATH forward for anyone who wishes to make significant changes in their lives and finally free themselves from the “shackles of the past” where most of us live our lives – or in trepidation over a future that has not yet occurred. I believe in the power of change and embracing change NOW – not later! I will NEVER go back to my old way of being. It is a waste of energy and more importantly a waste of precious time – time that is fast diminishing. VISUALIZE yourself as you want to be and with affirmative ACTION you too WILL become who you want to be! Finally, as Satchel Paige (the great African- American pitcher) once said: “Don’t look back, something might be gaining on you”!

IN SUMMARY

The power of thinking is undisputed by any expert worth their reputation. My intention is to serve as an example to people that positive thinking CAN and WILL change the course of people’s lives – especially for those that desire it with all their hearts. Meditation, affirmation, and visualization are three keys to “changing our thinking and changing our lives”. Facing crisis in life is a part of living and dealing with crises intelligently and thoughtfully can provide the necessary steps to creating REAL change in our lives that WILL make a REAL difference!

I see a world changing rapidly and with great change comes the potential for great progress if we will only THINK about our lives from the perspective of what we EACH can do to insure that the change we are experiencing is helpful and constructive – and not destructive. This is my mission: To be a participant in change in order to help secure a positive result for the many who desire it. We ALL play a role in life. What will your role be? You can start today to determine the answer to this question and I wish you the best on your new journey! Travel well.

Originally published on Healthy New Age. Reprinted with permission from Nicholas Prukop.

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.