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Friendly therapist supporting red-haired woman

The What, the How and the Why of Lifestyle Improvement

Health and wellness folks are sometimes confused about the role each professional might play in helping individuals to live their best life possible. Our clients are seeking to be healthier by losing weight, managing stress, stopping smoking, becoming less isolated, and often, managing a health challenge of some kind. To do so they need excellent wellness information, great treatment (if that is called for) and a way to make lifestyle changes that will ensure lasting success.  So, who is responsible for what?

Fitness trainers, rehabilitation therapists, physical therapists, dietitians, various treatment professionals and health educators can help their clients/patients to know what lifestyle behavioral changes will move them towards improved health and wellbeing. What we often hear from these medical and wellness pros is frustration with a lack of success on their client’s part in making the recommended changes and making them last. The reality is, most people simply don’t know that much about how to change the ingrained habits of a lifetime.  

The physical therapist works with their client in their session and sends them home with exercises that must be done every day. The dietitian creates a fantastic meal plan that their client must put into practice. The fitness professional creates a tailor-made workout plan, but their client needs to exercise on their own, not just in front of their trainer.

Health educators, treatment professionals, etc. provide the
WHAT
Health and Wellness Coaches provide the
HOW
Our Clients find their
WHY

Everyone’s challenge is the how. It takes more than willpower and motivation.  What is often lacking is an actual well-thought-out plan that the client has co-created with the help of someone who can provide support, accountability and a well-developed behavioral change methodology. Translating the lifestyle prescription into action and fitting it into an already busy life is often where, despite good intentions, our clients struggle. This is where having a trusted ally in the cause of one’s wellness pays off.

As the field of health and wellness coaching grows, the challenge coaches sometimes face is clarity about their own role. Sometimes the confusion is all about the what and the how. For coaches to be proficient at “writing” the lifestyle prescription they need additional qualifications. It becomes a question of Scope of Practice.

To guide coaches, the National Board for Health and Wellness Coaches (NBHWC) has developed a Scope of Practice Statement. Here is the part most relevant to our question:

While health and wellness coaches per se do not diagnose conditions, prescribe treatments, or provide psychological therapeutic interventions, they may provide expert guidance in areas in which they hold active, nationally recognized credentials, and may offer resources from nationally recognized authorities such as those referenced in NBHWC’s Content Outline with Resources.”  (NBHWC)

If coaches can “wear two hats” professionally they can combine the what and the how. Otherwise, the key is to coordinate with other wellness professionals or work with the lifestyle prescription that their client already has.

Beyond the what and the how is the why.  The “why” of behavior is all about motivation – initiating and sustaining behavioral change efforts by drawing upon the energy and desire to do so. The key here once again is the question of who is responsible for supplying this. People may initiate behavior based upon external motivation – the urging and cheering on of others, the fear of negative outcomes. In order to sustain that motivation, it has to come from within. The challenge here for all wellness professionals is to help our clients to discover their own unique sources of motivation. Seasoned wellness professionals realize they can’t convince or persuade anyone to be well. However, when we help our clients discover their own important sources of what motivates them, they discover their why.  Motivation is fuel. Now with the aid of a coach our clients can find the vehicle to put in. They know what they need to change. Now they have a way to know how to change and grow, and they know themselves, why.


Michael Arloski, Ph.D., PCC, NBC-HWC is CEO and Founder of Real Balance Global Wellness Services, Inc. Dr. Arloski is a pioneering architect of the field of health and wellness coaching.  He and his company have trained thousands of coaches around the world. 

Trainer-with-senior-client-using-machine

A Pipeline of New Clients Through Physician Exercise Referrals

“I want to know how good the [fitness professional] is at their art and science of progressing people through exercise.” 

These words were spoken by a physician who regularly refers his patients to fitness professionals. In 2019 and 2020, I spent ten months surveying and interviewing physicians and fitness professionals at a New England healthcare organization. This healthcare organization has had an exercise referral network in place for over a decade, and averages about thirty-five exercise referrals per week. 

As part of the exercise referral network, physicians were able to refer patients to community-based fitness centers and professionals, as well as a hospital-affiliated facility. The hospital-affiliated facility has four programs: an 8-week exercise program for post-rehab (muskuloskeletal, cardiac, and pulmonary); a 13-week fitness, nutrition, stress management and behavior modification program; a 12-month weight management program; and a 3-month cancer recovery program. Its program staff were registered dietitians, personal trainers, and health coaches.

The purpose of my research was to understand physicians’ and fitness professionals’ perspectives on physician exercise referrals and the impact on patient behavior change. Not enough physicians provide exercise referrals to their patients, and my research revealed a clear opportunity to address barriers to referral. In addition, physicians are less comfortable referring their patients to community-based fitness facilities and professionals than they are to hospital-based fitness facilities and professionals. Raising physician familiarity with, awareness of, and confidence in fitness professionals can help build physician trust in their capabilities. This is especially true for fitness professionals who have expertise and experience working with special populations, including people with different injuries, disabilities and diagnoses.

Physicians want to know that [their patients] are exercising in a place where, if anything bad or adverse were to happen, they are in good hands.” ​ –Fitness Professional 

Join me for my upcoming webinar with MedFit, where I’ll speak more on this topic as part. I’ll discuss ten steps that fitness professionals can take to become professionals that physicians trust to take good care of their patients. These steps focus on facilitating communication between physicians and fitness professionals about patients’ progress and outcomes, as well as raising physician awareness of the professionals’ capabilities. Join me as I walk through how to develop A Pipeline of New Clients Through Physician Exercise Referrals.

 


Dr. Amy Bantham has 20 years of experience working in consulting, health & fitness, and healthcare. She is the CEO/Founder of Move to Live®More, a research and consulting firm addressing physical inactivity, obesity, chronic disease, and social determinants of health through cross-sector collaboration and innovation. 

Amy holds a Doctor of Public Health from the Harvard T.H. Chan School of Public Health, with concentrations in Health Communication and Obesity Epidemiology & Prevention. Her doctoral research focused on physician exercise prescriptions/referrals and patient exercise behavior change. She is a certified group exercise instructor, personal trainer, and health & wellness coach. She also holds a Master of Science from Northeastern University, a Master in Public Policy from the Harvard Kennedy School, and a Bachelor of Arts from Yale University.

Trainer-with-senior-client-using-machine

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

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

Scope of Practice

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

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

Prevention

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

Interprofessional Collaboration

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

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

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

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

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

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


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

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

team hands

Collaborative Thinking in Health & Wellness

Over the past 18 months, I have seen my primary M.D. three times, enjoyed the services of my favorite massage therapist six times, visited my chiropractor nine times, chatted with a local R.D. twice and seen my personal trainer regularly. And not one of them even asked if I was seeing any of the others, much less inquiring what their treatments or approaches to treatments might be. To me, that is like trying to achieve success with a baseball team where the 1st base coach, 2nd base coach, 3rd base coach and pitching coach never communicate with each other.

Success cannot occur in a vacuum, neither can trueindividual health & wellness, yet for decades these medical, fitness & wellness providers have proffered their services in distinct and distinctly separate spaces.

Even as the internet has made access to information easier and facilitated the sharing of knowledge, including private, HIPAA compliant information, these providers continue to operate in “informational silos.”

It is true that in the past some of these providers may have held less than favorable opinions of some of the other providers, but that is, and certainly should be, a thing of the past. No longer will M.D.’s consider Chiropractors “quacks”, R.D.’s claim nutritionists “just don’t know enough”, and Physical Therapists think of Personal Trainers as ”wanna-be P.T.’s who couldn’t hack the education.” Science, knowledge and time have evolved all these disciplines into valuable, useful and incredibly beneficial specialties, each offering specific training and specific methods to apply to their patients/clients. And all those patients/clients typically can benefit from their combined expertise and knowledge.

No longer is it sufficient to simply treat the symptoms. Real wellness needs to encompass the patient/client holistically… address the symptoms, understand the cause, strengthen the mind, examine the diet, resolve the issue and prevent future occurrences. And isn’t that best accomplished by viewing patient/client wellness as a Team Sport?

Over the years I have had the pleasure of knowing and speaking at length with many of these medical, fitness & wellness providers, and not one of them indicated there is anything in their training that says “Thou Shalt Not Collaborate.”

We are not talking about “asking for help.” Rather we are simply saying to include those other practitioners in the conversation. Instead of the M.D. telling the patient to “walk more to improve cardio health”, why not conference call with the Personal Trainer and discuss the walking program that is most appropriate. Let the Physical Therapist inform the Personal Trainer of any specific issues to address or avoid. Allow the Massage Therapist to work with the Chiropractor to ensure optimum results from both. In other words, (and the simplicity of all this may surprise you), just TALK TO EACH OTHER.

So, let’s start to make that happen. For more than 20 years my company has helped health clubs and fitness centers create mutually beneficial relationships with Physical Therapy practices, Chiropractic offices, Registered Dietitians, Nutritionists and Massage Therapists. Now is the time to extend the conversation, and, to return to my baseball metaphor, get ALL the coaches working together to create truly Championship results.


Cosmo Wollan is the Senior Executive at Synergy Cubed, a premiere consulting firm providing customized solutions to the health & fitness, parks & recreation, medical fitness and corporate wellness industries since 1994. His Fitness Industry clients have engaged him as an expert problem-solver in profit center development, retention strategies, customer engagement, sales training, programming design, operational streamlining and health club management.

Aimee-Carlson-Toxin-Terminator

Toxicity & Detox

When I first began my own personal health journey, I had no idea what a toxin was. Having worked in the automotive business for better than 30 years, I thought toxins consisted of the various chemicals and products we used in that business. I knew we had to carry MSDS (Material Safety Data Sheets) for every product we had in the facilities. I related toxins to workplace environments, and truly had no idea that they were also hidden in our homes!

The automotive industry was highly regulated. In fact, there are several agencies that oversee the practices within automotive businesses, establish the regulations that must be followed and perform on-site inspections. As a mother and a grandmother, I was enraged to find out there were no such regulations on the products that we purchase off the shelves in the stores. I incorrectly made the assumption that these products were safe for me and my family to use.

This is what led me to become The Toxin Terminator. I knew there needed to be a voice in this field. When it comes to being healthy, many people seek out help with how they eat or look at their physical fitness and how they move each day. But they aren’t paying attention to the number one contributor to the symptoms they are experiencing, toxins! In fact, even if they do, it can be such a confusing path to go down. Marketers have learned the terms they need to use to give the illusion of their products being safe. We call this greenwashing. This is one of the reasons why it is so important for people to have a certified person working with them to help them navigate this complex arena and overcome the root cause of their symptoms.

Learning about toxins, the symptoms of toxin overload and where they are, was the first step in my journey of overcoming chronic disease. The toxins are what flip the switches on, and the detox is how we turn those switches off and truly heal the cells, so the body gets well. Through my journey, I have met with hundreds who have also reversed their chronic disease. Through my podcast and masterminds, I have had the opportunity to meet and discuss this topic with top researchers, doctors, coaches, industry thought leaders and people just looking to feel better. I personally became certified as a Toxicity and Detox Specialist so I would be able to help others walk through their own healing journey.

According to the Centers for Disease Control, 6 out of 10 adults suffer from a chronic disease and 40% have two or more. 90% of healthcare dollars in the United States are spent on chronic disease and 70% of all deaths are caused by a chronic disease. These numbers are out of control. It is my mission to decrease these numbers. Last year taught us all too well the danger of these numbers and the importance of our own personal health and reducing our underlying factors.

People are ready to take control of their health and we can do this together!

Join Aimee for a Webinar on This Topic!

Register for this free webinar, Counting Chemicals: Everyone is busy counting calories, when they should be busy counting chemicals!


Aimee Carlson is a lifetime entrepreneur, owning and operating a multi-location national franchise, to a professional network marketer, best-selling author, podcast host of The Toxin Terminator and certified Toxicity and Detox Specialist.

doctor-and-senior-woman-patient

Opening a Closed Door: How to Gain Access to the Medical Suite

Your passion is to help people maintain or regain optimal health and fitness. Under current law and standards, you are only permitted to work with clients who are already-fit and healthy or have been released for independent exercise and have passed your health screening questionnaire. But those are not the people you yearn to work with. The clients you seek must have authorization or approval from a medical provider before you can proceed.

How often have you met with a potential new client, asked them to get clearance from their doctor, and then never seen them again? Or, a client develops a new pain or problem and you refer them for consultation and that ends the relationship. Another frequent scenario: Your client has followed through with your request only to be referred by their primary care provider for a cardiac treadmill test, but your concern about their low back pain or shoulder dysfunction was not addressed. Success as a medical fitness specialist is dependent upon working relationships with medical professionals. In order to establish those relationships, the aspiring medical fitness trainer needs a better understanding of the medical system. What follows are a few insights into the medical system that medical fitness specialists need to understand.

Recognize how busy the medical practitioner might be

“Estimates suggest that a primary care physician would spend 21.7 hours per day to provide all recommended acute, chronic, and preventive care for a panel of 2,500 patients.”1[i]. Today, the average primary care provider is responsible for roughly 2,300 patients, so not quite 21.7 hours of work/day, but more than any individual can possibly provide.

In order to cope with the workload, doctors must rely on their support staff to help whenever possible. Do not be alarmed or offended if your inquiries are met by a nurse or medical assistant. Most providers simply do not have the time to meet with you for an introduction or discussion. On the flip side, most doctors would love to have effective, safe, and reliable resources for their patients who need to lose weight, get fit, manage diabetes, recover from surgery or cancer treatment, etc. They need you.

Understand the current reimbursement rules

In most cases, providers cannot bill for services unless the patient is in the room with them. Therefore, time spent talking on the telephone, responding to emails, or filling out forms is usually unreimbursed time. This means that your client will probably need to actually make an appointment to be assessed and cleared for exercising with you. To streamline the process, send a letter with your client introducing yourself and what you do. Include a form stating your concerns and your proposed training plan. Design the form to be easy to read, with a simple agree or disagree that can be checked or circled and space for the provider’s signature. You might also want to leave room for comments and questions. If you have received a response from a provider, you should consider sending intermittent progress reports updating the provider about your mutual client/patient.

Be familiar with HIPAA

The Health Insurance Portability and Accountability Act (HIPAA) was enacted in 1996 to protect an individual’s medical confidentiality, particularly when changing jobs which at that time meant changing health insurance providers. Unfortunately, the law is complicated and places multiple restrictions on who members of a medical team can talk to about a patient’s medical condition.

As an unlicensed party, the fitness professional is not privy to “protected health information” (PHI) without direct written consent from the patient (your client). Due to these restrictions, the medical providers cannot fill out or respond to your request for information or clearance without your client’s “written” consent. If the client takes the form and returns it to you, this action implies they have agreed to share the information. If you send the form directly to the provider, that permission has not been granted unless the client has signed a HIPAA release form allowing the doctor to share personal health information with you personally.

The aforementioned are a few reasons why you may have perceived a wall or barrier between you and medical providers. One solution is to ask your client if you might accompany him or her to the appointment to obtain medical clearance or guidance. That way the medical provider would have a specified time and be reimbursed for addressing your concerns. You would be communicating directly with the medical provider and not support staff, and it would be easiest for the client/patient. It is also a way to introduce yourself to the medical provider and initiate a working relationship. Although you will probably not be compensated, it may be well worth your time in the long run.

Once you have made it into the office with your client, now what?

Know your details

Because there are so many different avenues to becoming certified as a personal trainer, there can be large differences in the knowledge base and competence of one trainer compared to another. The aspiring medical fitness professional must have a thorough understanding of the pathophysiology of the conditions they will be working with in order to communicate effectively with medical providers. In addition, you need skill and experience in the programs you design and utilize with your clients. Be able to back up your training plans with published research.

Recognize that a medical fitness professional has a fund of knowledge that the medical provider does not have

Exercise science is not covered in medical school curricula. Medical school is about illness and disease, not health and fitness. Generally speaking, the average MD knows very little about exercise science. Most do not know about the effects of eccentric versus concentric loading, how to train for endurance versus strength, what to do to improve stability, balance, and core strength. Fitness professionals are not inferior to medical professionals; you have a different knowledge base. Recognize and believe that you have something to offer. You may not know all of the anatomy and biochemistry that the doctor does, but you have a basic understanding of your client’s condition and you know the potential benefits of your interventions. Share this information with the medical providers.

Stay within your scope of practice

Because personal trainers and medical fitness specialists are not licensed by any governmental or legal agency, and because laws vary from state to state, there is no clear definition of the skills and competencies of a medical fitness specialist. Working outside of your scope of practice can lead to civil and even criminal penalties[ii]. Therefore, for the time being, if you want to work with clients struggling to manage chronic illnesses, recover fully from injuries or surgeries, etc., you need to work under the wing of medical professionals who have prescriptive authority – those professionals in the medical field licensed to diagnose problems and prescribe treatment.

Dr. Robert Butler MD, founder of the National Institute on Aging once said: “If exercise could be packaged in a pill, it would be the single most widely prescribed and beneficial medicine in the nation.” There are pockets here and there in the US where medical providers and fitness professionals work together. In many cases, there is a visionary medical provider at the helm of an interdisciplinary team. In other cases, fitness professionals have worked hard to become part of a medical delivery model.[iii] The more medical fitness specialists that can take the leap and align themselves with medical providers, the more people will be helped.

This article was featured in MedFit Professional Magazine. Get your free subscription to read more great content like this!


Dr. Mary Hoagland-Scher,MD is a board-certified family physician who practiced medicine for 30 years. When she entered medical school, her goal was to help people stay healthy. As the focus of western medicine shifted away from health to disease management with a strong emphasis on pharmaceutical and or surgical intervention, she became uneasy with her role and decided to discard her prescription pad and learn new tools. Now as a NASM Certified Personal Trainer she is working to shrink the gap between fitness and medicine.

References

  • [i] Estimating a Reasonable Patient Panel Size for Primary Care Physicians With Team-Based Task Delegation Justin Altschuler, MD, David Margolius, MD, Thomas Bodenheimer, MD and Kevin Grumbach, MD Ann Fam Med September/October 2012 vol. 10 no. 5 39
  • [ii] For an excellent discussion of this issue, see: Abbott, Anthony Ed.D, FACSM, FNSCA. Scope of Practice, ASCM Health and Fitness Journal ,Sept/Oct 2018, Vol 22 Issue 5 pp 51-55
  • [iii] Watch MedFit TV webinar by David Rachal III, “Exercise Prescription: Integrating Services with Medical Professionals and Insurance Providers”
pexels-marcus-aurelius-6787542

The Essential Ingredient to Sticking With It…

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

Physical therapist gesturing thumbs up besides senior woman on yoga ball

Medical Fitness – A Win for Professional and Patient

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. Medical Fitness is the integration of ongoing fitness, wellness and preventive care under the supervision of health professionals such as, physical therapists, exercise physiologists, personal trainers, nutritionists, acupuncturists, chiropractors, massage therapists, mental health practitioners, health and wellness coaches, yoga professionals and more.

Physical therapist gesturing thumbs up besides senior woman on yoga ballMedical Fitness is appropriate for many types of conditions such as arthritis, diabetes, orthopedic conditions, pre and post natal, heart disease, fibromyalgia, stroke, cancer, mental disorders,  and others. When properly implemented, Medical Fitness is a win-win for both patient and health professional.

Medical Fitness Advantages for the Patient

First, after discharge from the formal healthcare world, the patient can be referred to a variety of health professionals educated in the patient’s condition, providing both a continuum of care and a multi-discipline approach. For example, a person discharged from physical therapy after a total knee replacement might be referred to a certified personal trainer facility educated in post-rehabilitation of a total knee to continue to make further functional gains and improvements. If that person needed help with weight loss, perhaps a referral to a nutritionist would be included. If they also had issues with coping with their diminished function, a consult with a specialist in mental health might be provided as well.

Second, many times the medical facility in which care was provided will have a Medical Fitness component associated with it. Direct referral to this type of facility can provide the patient with security and confidence, being familiar with the facility and with the knowledge that the new health professional is familiar with their condition and diagnosis.

Medical Fitness Advantages for the Health Professional

First, by being part of a Medical Fitness community the health professional can refer a discharged patient for follow up care, secure in the knowledge that their patient will be cared for by an ancillary care professional who is trained and certified to provide a proper continuity of care plan along with the appropriate goals and treatments.

senior man with trainerSecond, by referring to a Medical Fitness multi-discipline team, the health professional receives security that if their patient has any other issues, those concerns will be addressed. For instance with the example of the total knee replacement patient needing assistance with weight loss or nutrition consults, (treatments that don’t fall under the umbrella of physical therapy), the physical therapist is assured their patient will be helped to achieve a better transition back into their “non patient” status.

Third, when the health professional refers their patient into a Medical Fitness wellness and preventative care environment, the chance for overall improved outcomes is increased. Patients learn better self-confidence in caring for themselves, taking charge of their own health and lifestyle. If a patient’s condition begins to backslide, the wellness program professionals can help make sure the patient gets referred back to the health professional in a timely manner.

In conclusion, Medical Fitness benefits all involved. Quality of care is improved. Patients receive access to multi- discipline care and can learn to take charge of their life. Health professionals receive security of proper continuity of care and gain improved patient outcomes.


Douglas Feick, PT is a licensed physical therapist in Texas, with emphasis in orthopedics for over 15 years. He is President of BioEx Systems Inc, a software company providing software solutions for physical therapists, athletic trainers, chiropractors, dietitians and personal trainers. His hobbies include scuba diving, raising bees and he is an avid skydiver.

BORRELIA-bacteria

Another MAJOR Mental Health Hidden Stressor…. BORRELIA!

Lyme disease is caused by the spirochete bacteria, borrelia (strains vary by region). The borrelia bacteria has the crazy capability of altering its genome in order to change its exterior shell antigens in order to avoid being detected by the host’s immune system. These modified surface proteins can trigger autoimmunity in the host.

Borrelia infection in the blood

16 proteins on the borrelia bacteria have been shown to cross-react with thyroid tissue, thereby triggering thyroid autoimmunity, such as Grave’s or Hashimoto’s thyroiditis. Lyme can also trigger chronic inflammatory response syndrome, or CIRS.

The bacteria also produce protein “cocoons” called biofilms that protect the bacteria from antibiotic treatment and immune system defense mechanisms. The bacteria will secrete enzymes to digest and steal nutrients from the host. These little bastards will burrow into tissues across the body, such as the joint tissue (joint pain?), or even central nervous system (can mimic neurological conditions). Lyme often comes with co-infections like babesia and bartonella.

Testing for Lyme can be tricky and antibiotics are not always effective by themselves. Therefore using a functional approach (in conjunction with antibiotics, only when absolutely necessary) yields superior outcomes.

Learn more about this topic… join Brendan for his upcoming webinar, Integrative Therapeutics for Lyme and Coinfections.


Brendan Vermeire is an Integrative Clinician and Functional Diagnostic Nutrition Practitioner specializing in complex chronic illness. He began his career as a personal trainer and nutrition coach at the age of 19. After being exposed to the power of functional lab testing in the start of his career, he began intensely pursuing that as a career path which has lead him to being the current Director of the Association of Functional Diagnostic Nutrition Practitioners, the owner/founder of the Premier Virtual Integrative Health Clinic, Metabolic Solutions, and a Clinical Educator for Bio-Botanical Research.