The rallying cry is, “Let’s change healthcare!” From all corners of the medical universe, there is agreement that change is necessary. The biggest questions are, “What is the change?” and, “Who will make it happen?”
Once upon a time I was engaged. I was 21 years old and more in love than I had ever been, and perhaps more than I have even to this day as I sit here writing this at 6 am on a calm Summer morning. I lived with my fiancé and her children. Although life was a bit nutty at times. We had something. Something good. For a moment there, it was permanent…
In July, I had the opportunity to deliver a webinar for MedFit Network on data analytics and population health for the medical fitness profession. I believe the MFN is spot on in their interest in data, and here’s why….
Year after year, the IHRSA Trend Report continues to state that there will be an increase of trillions of spending cost in healthcare spending, with aging Baby Boomers contributing heavily to the total over the next decade. At least 50% of adults between 50-64 years of age live with at least one chronic condition. More than 44% of US consumers take at least one prescription medication daily, and the 50+ age group accounts for nearly 3/4 of spending on prescription drugs. The most commonly prescribed drugs for 40- to 60-year-old adults are for high cholesterol, gastrointestinal disorders, diabetes and hypertension.
As more individuals who actively participate in the US healthcare system seek solutions, the more we need to do for positioning our programs and facilities to address their non-traditional needs. As with any other business, we must change, modify and refocus our service delivery system as our client profile and the associated service needs change.
In April 2017, I made the decision to solely focus on developing a Medical Fitness Service to champion the Exercise is Medicine® (EIM) initiative through HEALTHEFIT. Despite being created in 2007, EIM remains an untapped service that has not only been ignored by fitness professionals but also by healthcare as well. Exercise is Medicine®, a global health initiative managed by the American College of Sports Medicine (ACSM), encourages primary care physicians and other health care providers to include physical activity when designing treatment plans and to refer patients to evidence-based exercise programs and qualified exercise professionals, especially those with the Exercise is Medicine credential.
In reviewing the multiple areas that we could contribute positive health outcomes, we decided to focus on the following:
1. Orthopedic Pathology
- Acute Low Back Pain, Low Back Pain and Sciatica, Shoulder Impingement Syndrome, Rotator Cuff Pathology, Hip Replacement, Full Knee Replacement, ACL, Meniscus Pathology, Patella-Femoral Syndrome, Osteoporosis
2. Cardiovascular Disease
- Hypertension, Coronary Artery Disease, Peripheral Vascular Disease, Alular Heart Disease
3. Pulmonary Disease
- Chronic Obstructive Pulmonary Disease [COPD], Asthma, Bronchitis, Emphysema
4. Metabolic Disease
- Diabetes Mellitus, Obesity, Blood Lipid Disorders
HEALTHEFIT’s medical fitness services incorporate a Triangle Treatment Protocol® including: EIM, DNA based nutrition, and Behavioral Medicine. Depending on an individual’s employer benefits plans and/or health insurance, either all or part of these medically directed services can potentially be reimbursable. Creditability is very important to the medical industry therefore we had to ensure that we differentiate our staff from the everyday personal trainer.
While credentials are indeed important, the ability to translate this knowledge into patient specific program design and treatment progression processes is the real professional test. Our medical fitness providers are fitness professionals who have a comprehensive knowledge of special populations. I have been able to create a new professional that is gaining the trust of physicians and health insurance. Our recruiting, orientation, and onboarding process has been the difference in separating HEALTHEFIT from other programs and gaining acceptance with Virginia Premier as their exclusive in-network medical fitness provider and out-of-network
status with Anthem and Cigna.
Want to learn more? Join David for his upcoming MedFit webinar on this topic:
David Rachal III is the founder and CEO of HEALTH-E-FIT, a medical fitness based facility in Chester, VA, where he’s created a scalable system that engages, educates, and empowers physicians and medical fitness providers to work together. His facility uses exercise and nutrition as medicine making prevention, treatment, and long-term management accessible for all. David’s contributions to the fitness industry also include training hundreds of private clients to success and educating over 1,000 trainers in the past eight years as a Fitness Presenter and Certification Specialist with nationally recognized organizations. David holds an MBA with a focus in Healthcare Management. He holds many specialty training certifications, including the ACSM ‘Exercise is Medicine’ credential, the FMS Functional Movement Specialist, and NSCA Tactical Strength and Conditioning Facilitator.
I hope to give you some insights to both how the human body works as well as why medically-based fitness is not only valid, but absolutely necessary to reverse, assist, or prevent various chronic and acute disease conditions. Wow, that is a “mouthful” to say the least. I feel so strongly about this perspective that I hope to create the Adaptive Health Model as a major “brand” of fitness. My company (Principle-Centered Health) for the past couple of decades has always had a systems-based approach to health and fitness. This approach ties a lot of different facts into a common theme, usually called a theory in science. Even my dissertation looked at how people adapted to the physical, mental and social issues in their lives using exercise, self-efficacy, and social support, respectively, and levels of strain and burnout. How humans adapt to the stresses put on them is very specific and can go in good or bad directions.
What is the Adaptive Health Paradigm?
Like most theories, paradigms or what people consider “original thought”, this “adaptive” paradigm builds on the “regenerative medicine” framework, and some disease models; thus, is not original at all. What may be new, or unique about the adaptive perspective is taking the old phrase from physicist Isaac Newton and his third law of motion, “for every action there is an equal and opposite reaction.” The body will respond to stresses by reacting in a “defensive” manner. If we break something down, the body builds it up (opposite reaction). If we are too low or too high in some function, the body will try to correct this. This negative feedback loop controls most systems in our bodies. I have often described our bodies as fragile but resilient. It is our fragility that signals the resilience to kick into gear!
Luckily for us, fitness is based on this exact principle. If we do endurance training, we are going into a lower oxygen state and there are many mechanisms or functions that kick in (sympathetic nervous system) when we push or stress our bodies. The body is responding to what is known as an “acute insult” by increasing the ability to transport and use oxygen, so that this “insult” doesn’t hurt us next time. The same “specificity of training principle” occurs with resistance training. We breakdown muscle and the body builds it back stronger to tolerate that “insult” the next time. When multiple acute exercise stresses are added up, the body changes and we call this “training”.
If stresses are really high, either too intense, too long, or too often, the body gets injured due to this overload, or it needs a lot more time to heal back up. This is why overload needs to be done gradually and progressively. Even our brains use this idea as a guiding principle. We push our mental capacities to learn more, but if we stress it too much, it will repress memories or shut down (burnout).
This same principle applies when we give our body bad things, or a lack of good things, it adapts with a dysfunctional state or disease state. Chronic inflammatory diseases, diabetes, metabolic syndrome, coronary artery disease, emphysema and heart disease are just a few of the examples of how the “garbage in and garbage out”, or “use it or lose it” works. If we sit and work at the computer too much we develop dysfunctional postures and upper cross syndrome may develop. If we do not constantly stress some system, it reverses the training changes, and goes into the “default” state, which is untrained and unable to respond to daily stresses. We simply need to obey our bodily blueprints, we need to constantly use our bodies to maintain function, and overload it to improve function. We need to have the right nutrients in place to allow this to happen, and then basically – get out of the way!
Intelligence in the Body – Applications the Adaptive Health Paradigm
The perspective being proposed in this article shares much with the more holistic medical practices. The human body is really good at healing itself when is it given the right factors to do so, and when we “get out of the way” for it to do so. I know many people who strongly believe in using alkaline water to “cure their ills”. They believe that the body does not know how to regulate itself with its own pH. Most of these same people don’t know what pH even stands for! They don’t know that it is actually the inverse log of the hydrogen ion concentration relative to the hydroxide ions, and that the respiratory system and renal system will go into action as soon as blood pH goes 0.05 pH units high or low!
In other words, these people believe their own bodies are naïve or incapable of curing itself, and like a young child or baby, their body needs constant care and guidance. Most people are so stressed about “taking care” of their bodies that they are doing more harm than good via the stress hormones, especially cortisol being constantly secreted and their adrenal gland is getting fatigued. In reality, the body is really good at healing itself, when we keep it strong and in good operating condition (via exercise and movement) and when we give it the right components to do the healing (via nutrition), and we get out of the way of the immune system (by managing our daily stress levels).
The mind works very much like a muscle. It must be trained and kept strong and when injured it will react in dysfunctional ways, and fight to protect itself. I recently heard an expert in human behavior change speak on how to keep a resolution. He said, we can’t keep a resolution without changing the underlying behaviors which caused the bad habit or lack of a good habit in the first place. By changing the way we think, we change the way we act, and changing our actions will change the way we think!
“What goes Around, Comes Around”
The quote often stated by Thomas Edison in 1903, which was to give rise to the HMO concept, “The doctor of the future will give no medicine, but will interest his patient in the care of the human frame, in diet and in the cause and prevention of disease.” Medical doctors (M.D.s) upon completing medical school and prior to practicing take the Hippocratic Oath, which is to do no harm. Even back in Ancient Rome, Hippocrates understood the importance of individualized medicine and the power to “get out of the way” (#5) and give the body what it needs to take care of itself. He had five rules that are still relevant in today’s medical practices.
- Walking Is Man’s Best Medicine.
- Know What Person the Disease Has Rather Than What Disease the Person Has.
- Let Food Be Thy Medicine.
- Everything in Moderation.
- To Do Nothing Is Also a Good Remedy.
Integrative and Functional Medicine – Highly Inclusive and Holistic Perspectives
A philosophy of practice using these practices is integrative medicine. A brand of medicine created or at least popularized by Andrew Weil. The University of Arizona has this “brand” of medical school. Again, the academic requirements are similar to the M.D. and D.O. but expands its scope to other areas. From the website, Integrative Medicine (IM) is defined as a “healing-oriented medicine that takes account of the whole person, including all aspects of lifestyle. It emphasizes the therapeutic relationship between practitioner and patient, is informed by evidence, and makes use of all appropriate therapies. many different ways in the patient.
A new type of medicine is emerging from this Functional perspective which is called personalized medicine. Again, the two are basically two sides of the same coin.
What is going on within the individual to cause the disease or prolong its existence?
Sometimes disease hits simply because we were genetically predisposed to get it. However, very often if our system is strong and in good operating condition, we resist it from every occurring or overcome it quite quickly. Cancer is a prime example of this. We all have cancers in our bodies all the time. It is the strong immune system that fights it off. This is amongst the reasons that many, many chronic diseases hit us when we are old. The various system have lost their capacity to fight the dysfunction off, or recover from its destruction. Soon cell death (necrosis or apoptosis) or neoplastic (cancer) growth kicks in.
Harnessing the Power of Exercise and Diet to Fight Chronic Disease
Many, many chronic conditions that the MedFit Education Foundation/MedFit Network addresses are helped by exercise and diet because the ability of body to adapt and regenerate itself is enhanced. Most systems in our body fall under the “use it or lose it” scenario. High sugar, alcohol, smoking, and lack of movement are culprits in our health. Our body is not designed for an overload of these factors and across time, many different symptoms will develop because our body can no longer compensate or regenerate.
It is important for the medical fitness professional to understand the power of exercise and nutrition, and the proper application of these tools given the client’s or patient’s current condition. The field of physical therapy developed because many musculoskeletal conditions are helped by movement therapy or exercise. Many chiropractors believe that proper spinal alignment delivers proper neural signals throughout the body, which allows the body to optimize its regenerative capacity. Thus, an expert in medical uses of exercise to combat disease is critical to a healthcare team.
Join Dr. Mark Kelly at the Medical Fitness Tour in Irvine, CA! Dr. Kelly will be a presenter for the Aging Stronger pre-conference workshop on Friday, February 8, and the session Using Exercise and Diet to Fight Alzheimer’s during the main conference on Sunday, February 10. Click for Event Details
Dr. Mark Kelly Ph.D., CSCS, FAS, CPT has been actively involved in the fitness industry spanning 30 years as a teacher of exercise physiology at academic institutions such as California State University, Fullerton, Louisiana State University, Health Science Center, Tulane University and Biola. He was an exercise physiologist for the American Council on Exercise, a corporate wellness director, boot camp company owner and master fitness trainer.
Center for Integrative Medicine, Univ. of Arizona (n.d.). What is IM/IH? Retrieved from: https://integrativemedicine.arizona.edu/about/definition.html
Science Daily (n.d.). Personalized medicine. Retrieved from: https://www.sciencedaily.com/terms/personalized_medicine.htm
Good Reads (n.d.). Retreived from: https://www.goodreads.com/quotes/13639-the-doctor-of-the-future-will-give-no-medication-but
Kalish, N. (2018). Hippocrates’ Diet and Health Rules Everyone Should Follow. Reader’s Digest. Retrieved from: https://www.rd.com/health/wellness/hippocrates-diet/