There is an opportunity for wellness and wellness coaching to impact the lives of millions of people in a life-saving way. 79 million Americans are estimated to have a condition called pre-diabetes. Usually symptom free, without intervention they will develop full-fledged Type II diabetes within ten years and possibly endure physical damage to their heart and circulatory system along the way. Yet, according to the American Diabetes Association, if a person is successful at lifestyle improvement they can completely avoid the onset of diabetes 70% of the time.
Fibromyalgia is a condition where there is muscle pain, fatigue, and tender spots on the body. While there is no cure for this condition meditation may help you to cope with the symptoms. There are many benefits of meditation for Fibromyalgia including: decreased stress, feeling more at ease, decreased blood pressure and heart rate, decreased anxiety, increased energy and pain tolerance.
Fibromyalgia is a debilitating condition that affects roughly 1 to 3% of the general population. The syndrome is characterized by widespread muscle aches and pains, stiffness, fatigue and muscle spasms. Most people with fibromyalgia report difficulty doing everyday activities such as carrying objects, walking and competing ADLs (activities of daily living). Pain, fatigue, helplessness, psychological distress and
difficulty coping with stresses plague many people with the condition. The exact causes of fibromyalgia are not well understood, but it is thought to be a combination of increased sensitivity to pain and environmental and psychological factors. Criteria for diagnosis of Fibromyalgia from the American College of Rheumatology include:
- Chronic widespread pain in all four body quadrants
- Pain in 11 of 18 tender points
- Other symptoms: fatigue, weakness, attention and memory disturbances, heat and cold intolerance, and weight fluctuations.
For unknown reasons, a much larger percentage of women suffer from fibromyalgia than men.
Treatment of Fibromyalgia
Long-term effective treatment includes education, pharmacotherapy, behavioral therapy, and exercise. It is important to educate individuals that fibromyalgia is chronic, but it is not progressive and does not cause permanent damage or inflammation. Active participation is the key to improving their condition.
Can Exercise Help?
One would think that individuals with fibromyalgia shouldn’t exercise. And many people limit physical activity out of fear that it will make their symptoms worse. But in reality, if you have fibromyalgia, you can’t afford to not exercise.
If done correctly, exercise interrupts the downhill spiral of muscular and cardiovascular deconditioning and the resulting loss of function. Deconditioning leads to increased muscle soreness after even minimal amounts of physical activity. Additionally, many individuals have postural imbalances, tight muscles and poor range of motion, all of which place more strain on the body and movement.
A program including consistent aerobic exercise improves function, symptoms and well-being. And strength training improves muscle strength and reduces exercise-related pain and exercise-induced muscle fatigue. Overall, an exercise program can help to alleviate many of the physically and emotionally painful symptoms of fibromyalgia.
Exercising Safely With Fibromyalgia
Prior to increasing physical activity, discuss your plans with your physician. Because postural imbalances and tight, inflexible muscles are common in individuals with fibromyalgia, every activity session should begin and end with mobility (flexibility and range-of-motion) activities. You should also include self-myofascial release or foam rolling to help loosen tight muscles and prepare the body for movement. These exercises should be done slowly, emphasizing quality of movement, and never be painful.
Once you are able to perform these basic exercises comfortably, add strength training two to three times a week using light weights. The emphasis is not on quantity, but rather on the ‘quality’ of muscle movement. If you use too much weight, try too many sets or repetitions, you can cause muscular microtrauma, which leads to muscle soreness and can potentially worsen your symptoms.
Aerobic exercise should also be on your exercise plan. Warm water provides an optimal medium for beginning your exercise program. Many communities have facilities that offer warm-water exercise sessions for people with arthritis and these classes are ideal starting points for those with fibromyalgia as well. Walking is also an excellent activity. Other types of exercises, such as cycling, stairstepping and using other popular machines found in fitness facilities, may increase symptoms if you don’t maintain correct posture. Aerobic activities should be undertaken at a moderate intensity a minimum of three times per week. Start with just a few minutes and gradually increase duration to build up to 20 to 40 minutes of activity each day.
The key to exercise success for individuals with fibromyalgia is consistency. When you experience flare-ups, back off or take a day off. Resume your physical-activity program as soon as you feel better.
With appropriate mobility exercises, strength training and aerobic conditioning, you can expect to see improvement in your functional status overall.
How can an exercise professional help someone with Fibromyalgia?
- What type of exercise should I be doing? Aerobics? Weight training? Both?
- How intensely should I be working?
- What if I feel pain or discomfort during exercise?
- Where should my heart rate be?
- What time of day should I exercise?
- Should I change my nutritional habits at all?
A certified personal trainer or other exercise professional can help to answer all these questions and develop an exercise program that is tailored towards your needs and abilities. Your trainer will do an initial evaluation on you to find out your baseline measures in terms of aerobic capacity, strength, flexibility, bodyfat, and circumference measurements. An evaluation may also look at your posture and how you perform basic movement patterns. Based upon this information, your trainer can determine what muscles may be tight and need to be stretched or foam rolled. The evaluation process will also indicate what muscles are weak and need to be strengthened through resistance training to help improve mobility and improve quality of life. An exercise professional can also formulate a target heart rate zone for you to train in while you perform aerobic exercise.
If you develop any symptoms during exercise, your trainer should recognize the situation and alter the activity accordingly. Individuals with fibromyalgia often have flare-ups of intense pain. Communication between you and your trainer can help to pin point certain exercises or movements that may cause these flare-ups and be avoided or decrease the intensity. Sometimes rest is the best remedy for pain flare-ups. Your trainer will develop a strength training routine customized towards your needs and abilities and shows you ways to modify exercises or movements that may be too intense or demanding, especially at first. The goal of the client-trainer relationship is to create an exercise program that is effective, challenging, yet comfortable and ultimately leads to a better quality of life.
Eric Lemkin is a certified personal trainer, strength & conditioning specialist, corrective exercise specialist and founder of Functionally Active Fitness. Lemkin has been a certified personal trainer for 17 years and has helped people ages 8-80 reach their fitness goals through customized personal training – specializing in exercise for the elderly or handicapped.
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2. Buchwald, D., P. Umali, J. Umali, et al. Chronic fatigue and the chronic fatigue syndrome: prevalence in a Pacific Northwest health care system. Annals of Internal Medicine 123:81–88, 1995.
3. Skinner, J.S. Chronic fatigue syndrome: Matching exercise to symptom fluctuations. The Physician and Sportsmedicine 32:28–32, 2004.
4. Tuck, I., and D. Wallace. Chronic fatigue syndrome: A woman’s dilemma. Health Care of Women International 21:457–466, 2000.
5. Clauw, D.J., and L.J. Crofford. Chronic widespread pain and fibromyalgia: What we know, and what we need to know. Best Practices in Research and Clinical Rheumatology 17:685–701, 2003.
6. Norregaard J., P.M. Bulow, J.J. Lykkegaard, et al. Muscle strength, working capacity and effort in patients with fibromyalgia. Scandinavian Journal of Rehabilitation Medicine 29:97–102, 1997.
7. Simms R.W., S.H. Roy, M. Hrovat, et al. Lack of association between fibromyalgia syndrome and abnormalities in muscle energy metabolism. Arthritis and Rheumatism 37:794–800, 1994.
Do you have type 1 diabetes, type 2 diabetes, or prediabetes? Then you need to know that exercise is a cornerstone in the management of all of these conditions, and it can benefit your health in so many ways.
Sometimes, being active can actually make it more challenging for you to manage your blood glucose (“blood sugar”) levels, unless you learn more about its effects. I have always known at some level that exercise generally did good things for my blood glucose, even before I had my first blood glucose meter (after going 18 years without access to one). How could I tell without a blood glucose meter?
Being active always made me feel better, physically and emotionally, so much so that I earned a PhD in Exercise Physiology to understand why. You don’t need to go that far with your education, but there are some basics about being physically active with diabetes or prediabetes that you really need to know.
Here are some things that I know about exercise now that I wish someone had told me years ago.
#1: Exercise can help erase your blood glucose “mistakes”
- Exercise acts kind of like an extra dose of insulin.
- At rest, insulin is the main mechanism your body has to get glucose into muscle cells.
- During exercise, glucose goes your muscles without needing any insulin (via muscle contractions)
- Being regularly active makes your muscles more sensitive to insulin, so it takes less to have the same effect when you eat during or after exercise.
- What better way to help erase a little overeating of carbs (or some insulin resistance) than a moderate dose of exercise to lower your blood glucose?
#2: Exercise doesn’t always make your blood glucose go down
- It doesn’t always make your blood glucose come down, at least not right away.
- During intense exercise, the excess glucose-raising hormones your body releases can raise your blood glucose.
- Over a longer period of time (2-3 hours), it usually comes back down, but who wants to wait that long?
- If you take insulin, you’ll need to take less than normal to correct a post-workout high or your blood glucose will likely be crashing low a few hours later.
- A cool-down of less intense exercise (like walking) can help bring it back to normal, so do an easy, active cool-down after intense workouts or activities.
#3: Your muscles are critical to managing your blood glucose levels
- Exercise also helps you build and retain your muscle mass.
- Muscles are the main place you store carbs after you eat them—like a gas tank.
- Exercising helps use up stored carbs, but can also increase the size of the tank.
- When you eat carbs post-exercise, they can easily go into storage with a little insulin.
- Being sedentary keeps the tank full and makes you resistant to insulin.
- Aging alone can cause you to lose muscle mass over time, but you can combat it to a certain extent by recruiting all of your muscle fibers regularly.
- Resistance training and/or high-intensity intervals build muscle more because they recruit the faster fibers that you don’t use when walking or doing easier activities.
#4: Exercise is the best medicine there is
- Use exercise to control stress and to stave off depression—with no bad side-effects!
- It’s a natural antioxidant—more effective and better than supplements!
- Being regularly active prevents all sorts of cancers.
- If you’re active, you’ll likely feel better and look younger than you are (as long as you don’t exercise too much).
- You’ll be even less likely to catch a cold if you exercise moderately and regularly.
- Standing more, taking extra steps, and fidgeting even help—be active all day long, and don’t forget your daily dose of the best medicine there is!
For other tips on exercise and more, visit www.diabetesmotion.com or www.shericolberg.com. You can also find some exercise programs geared towards people with diabetes by visiting Diabetes Motion Academy (www.DMAcademy.com).
Sheri R. Colberg, PhD, FACSM, is a Professor Emerita of Exercise Science at Old Dominion University and a former Adjunct Professor of Internal Medicine at Eastern Virginia Medical School. She is an internationally recognized authority on diabetes and exercise.
Managing Diabetes can be very complex. How can the diabetes patient be successful at creating a solid lifestyle plan involving healthy nutrition, increased activity and effective medical management? A study published by American Diabetes Association, Clinical Diabetes, state’s “Controlling diabetes to reduce the incidence of its complications rests largely on individual patients and requires vigorous self-management of the disease. Unfortunately, without sustained support, few people achieve their goals or master the tasks that will allow them to live healthfully and reduce their risk of costly complications.”
According to the New England Journal of Medicine, “Type 2 diabetes is increasingly common, primarily because of increases in the prevalence of a sedentary lifestyle and obesity. It was concluded that the reduction in the incidence of diabetes was directly associated with changes in lifestyle and that Type 2 diabetes can be prevented by changes in the lifestyles of high-risk subjects.”
Diabetes self-management can be very overwhelming for the diabetic patient often leading to a sense of failure but there is help. A Health & Wellness Plan created together with a coach has proven to increase success in achieving healthier lifestyle behaviors and a greater quality of life.
While diabetes management can be overwhelming the Clinical Diabetes study results “revealed broad agreement among participants that their coach helped them figure out what to do to better control diabetes, that their coach’s encouragement was important in controlling diabetes, and that coaching was an important part of the overall program.”
Studies performed by Duke University, published by the New England Journal of Medicine, and the American Journal of Lifestyle Medicine suggest that working with a Health Coach improves medical management, patient engagement, social support, physical activity, diet, decreases stress, and reduces A1C scores. In addition, patient perception indicated positive improvements in overall personal health status, as well as, accomplishment of their goals when working with a health coach.
The Affordable Care Act recognizes that focusing on wellness and prevention is key to improving the health of Americans. The National Prevention Strategy is moving us from a system of sick care to one based on wellness and prevention. Many of the programs and initiatives now being funded include coaching. An example is the YMCA Diabetes Prevention Program that now includes Health Coaches within their team. We are now also finding coaches within insurance companies, such as UnitedHealth Group, Optima Health and Aetna due to success in improving diabetes control for the patient.
What Can Health & Wellness Coaches Do for You?
Coaches work with diabetes patients in a variety of ways. In one example of coaching in a healthcare setting Dr. Heather Bennett and her team (in an American Academy of Family Physicians publication) described Health Coaching for patients as encompassing five principal roles:
- Providing self-management support
- Bridging the gap between clinician and patient
- Helping patients navigate the health care system
- Offering emotional support and support resources
- Serving as a continuity figure.
In Bennett’s model the role of health educator and the role of health and wellness coach was combined.
Providing self-management support
Self-management support is essential for patients to extend their health care outside the clinic walls and into their real lives. Coaches assist patients in seven domains of self-management support: providing information, teaching disease-specific skills, promoting healthy behaviors, imparting problem-solving skills, assisting with the emotional impact of chronic illness, providing regular follow-up and encouraging people to be active participants in their care. Patients have better health outcomes when provided with disease-specific knowledge and skills.
Bridging the gap between clinician and patient
Throughout the care process, there are plenty of opportunities for disconnects between the clinician and the patient. Prescribing medications is one example. It is a two-part endeavor: 1) writing prescriptions and 2) making sure patients obtain, understand and actually take the medications as prescribed. Physicians perform part one but lack time to address the critical second part. Health coaches can bridge these gaps by following up with patients, asking about needs and obstacles, and addressing health literacy, cultural issues and social-class barriers. Health Coaches help patients navigate the health care system. Many patients, particularly the elderly, disabled and marginalized, need a navigator to help locate, negotiate and engage in services. Coaches can help coordinate care and advocate with patients when their voices are not heard.
Offering emotional support
Coping with illness is emotionally challenging. Well-intentioned but rushed clinicians may fail to address patients’ emotional needs. As trust and familiarity grow, coaches can offer emotional support and help patients cope with their illnesses. They also assist patients in seeking out additional emotional support that will help them achieve and maintain success.
Serving as a continuity figure
Coaches connect with patients not only for office visits but also between visits, creating familiarity and continuity. This is particularly helpful in practices where clinicians work part-time or see one another’s patient. Coaches travel with the patient as an ally and assist them with staying the course while implementing their wellness plan.
Health & Wellness Coaches Can Help
Coaches facilitate a patient-directed process of evaluation and assessment, exploration, tracking and accountability to and assist in co-creating a plan that is tailored to the patient Health & Wellness Coaches work with a patient individually or in small groups. They help create a whole-life integrated wellness plan toward managing diabetes and bringing about the lifestyle changes needed for a healthier life. Coaches serve as an ally to help those challenged with diabetes follow through with their health & wellness plan so they can achieve their goals toward their best life possible.
Affordable Care Act – Department of Health & Human Services: www.hhs.gov
Bennett et al, Health Coaching for Patients With Chronic Illness. Fam Pract Manag. 2010 Sep-Oct;17(5):24-29.
MacLean et al, Telephone Coaching to Improve Diabetes Self-Management for Rural Residents. Clinical Diabetes. January 2012 vol. 30 no. 1 13-16.
Melko et al, American Journal of Lifestyle Medicine, March/April 2010; vol. 4, 2: pp. 187-194.
National Prevention Strategy, Clinical and Community Preventive Services, National Prevention Council 2010. www.surgeongeneral.gov/initiatives/prevention/strategy/preventive-services.pdf
National Prevention Council Action Plan: Implementing the National Prevention Strategy
National Prevention Council, National Prevention, Health promotion, and Public Health Council, 2013 Annual Status Report. June 25, 2012. http://www.cdc.gov/features/PreventionCouncil
Sacco et al, Effect of a brief, regular telephone intervention by paraprofessionals for type 2 diabetes. Journal of Behavorial Medicine. August 2009, Volume 32, Issue 4, 349-359.
Tuomilehto et al, Prevention of Type 2 Diabetes Mellitus by Changes in Lifestyle among Subjects with Impaired Glucose Tolerance .N Engl J Med 2001; 344:1343-1350.
Wolever et al, Integrative Health Coaching for Patients With Type 2 Diabetes A Randomized Clinical Trial. The Diabetes Educator July/August 2010 vol. 36 no. 4 629-639.
Medical Fitness is a growing trend in health care. Medical Fitness helps extend basic healthcare from the classic and formal model of a person being a patient, receiving treatment and being discharged entirely, to after care professional services.
Once upon a time, exercising used to have a uniform and a regiment specific for men and women. Men would suit up in short shorts, beach themed tank tops, white headbands, wrist-bands, calf high knee socks, and white New Balance shoes. Women would shimmy into their sleek leotards, heads decorated with colorful braided headbands, legs adorned with scrunchie leg warmers, and feet comforted by puffy, linen white high-tops.
Psychological stress has been shown to increase activation of the sympathetic nervous system and the hypothalamic pituitary adrenal axis. This increased activation releases adrenaline, noradrenaline, and cortisol, which lead to faster heart rate, increased cardiac output, and narrower arteries. These changes, in turn, create increased blood pressure. Activation of these systems also accelerates the progress of atherosclerosis and can lead to acute plaque rupture, which results in ischemia of the heart (angina) and coronary heart disease and stroke.
Multiple sclerosis (MS) is a chronic disease that damages the nerves in the brain and spinal cord. Sclerosis means scarring; MS sufferers develop scar tissue in response to the nerve damage. Symptoms can include failure of muscle control, balance, vision, and even speech, depending on where the “flare ups” occur. Early MS symptoms include weakness, tingling, numbness, and blurred vision. Muscle stiffness and urinary problems are other signs as well. Treatment can relieve MS symptoms and delay progression, but there is no cure as of yet for MS.