As a personal trainer, you may find it increasingly difficult to compete in an industry that has no licensure and very little in the way of requirements. As an industry, we let anyone willing to take a two-, four-, six- or eight-hour online course become a personal trainer. This may explain the lack of expertise that is witnessed in so many trainers at gyms across the country. You may find yourself watching them from the sidelines, cringing as you notice the client performing deadlifts with an arched-back; squats with their knees caving in; or any other combination or poor supervision, direction and form.

It’s unfortunate, but the average person has no idea what to look for in a trainer. They don’t know the questions to ask, the accredited certifications and whether or not that trainer is able to work with any pre-existing conditions that they may have. As gyms hire underqualified trainers, underselling those of you who are worth your fee, clients continue to get injured. The client goes to a physical or occupational therapist and tells them they’ve been working with a trainer at X gym. The therapist rolls their eyes, having heard the story time and time again, discrediting personal trainers and the fitness industry as a whole.

If you have put your time in — getting your degree, obtaining every accredited certification you could get your hands on and starting at the bottom of the food chain, scraping your way to the top, you may be feeling frustrated and perhaps a little defeated.

Data from the U.S. Census Bureau shows that there are 76.4 million baby boomers. There were actually a total of 76 million births in the United States from 1946 to 1964, the 19 years usually called the “baby boom.” Based on these staggering numbers, many nationally certifying bodies are realizing the need for medical fitness professionals. They are looking to change the industry, set standards for our fitness professionals, and require advanced education in order to work with any special population. In the next few years, we are going to see the pendulum swing in the fitness industry. There is a movement towards medical fitness and you can get in at the ground level, setting yourself apart from the low-level trainers. You will be able to create a niche market that will open doors in the medical community, increase referrals and increase revenue.

Perhaps you or someone you love has been touched by cancer; there were an estimated 18 million cancer cases around the world in 2018!

• One-quarter of new cancer cases are diagnosed in people aged 65 to 74
• Median age at diagnosis is 61 years for breast cancer, 68 years for colorectal cancer, 70 years for lung cancer and 66 years for prostate cancer

In 2018, there were approximately 43.8 million cancer survivors diagnosed within the previous five years. By 2040, the global burden is expected to grow to 27.5 million new cancer cases. During the COVID-19 pandemic we are seeing that cancer patients, as well as others with compromised immune systems, are more alone and isolated than ever. This provides an unprecedented opportunity for you to provide a necessary and life-changing service to those in treatment or recovering from cancer. The Cancer Exercise Training Institute offers an online university fast-track program that also includes business coaching and training to take your business online. In five weeks, you can sit for the exam and, with at least an 80% passing grade, become a Cancer Exercise Specialist.

To some of you, working with what would appear to be an aging or sick population may not be of interest. You need to decide if you want to be like every other trainer, creating beach bodies and six-packs, or if you want to really make a difference in someone’s quality of life, and your success as a trainer. Think outside the box. Beyond the baby boomers, we have athletes and adolescents who have diabetes, who suffer with obesity, have asthma, cancer and so much more. This is a relatively untapped market.

For those of you who are up for a challenge, willing to step outside of your comfort zone and explore a new and exciting avenue in fitness, this offers a tremendous opportunity. There will always be those who want to lose weight, get toned, get ripped and improve sports performance, but after a while you can do that in your sleep. When you have clients that can’t get out of bed, can’t get up and down from a chair or can’t even perform self-care, and you are able to help them to take control of their life and their body in a way they never imagined was possible, it is truly the most meaningful and rewarding part of your career.

As we change the standards in the fitness industry, specialized training will be a requirement and you will be one step ahead of the game. By setting up meetings with nurses, doctors, patient navigators and support groups, you exponentially increase your potential client base. The unqualified trainer will not even be able to get in the door. The medical community will not accept a trainer without appropriate credentials.

As a highly credentialed trainer, you can establish yourself as a blog writer, magazine contributor and speaker. Opportunities may range from speaking to a support group at a local hospital to becoming a keynote speaker at a huge event. You can even conduct local or destination retreats for specific groups (i.e.; breast cancer, diabetes, juvenile diabetes, active aging etc.). The doors will also open up to you at medical fitness facilities and possibly hospitals that are looking for highly credentialed medical fitness professionals.

There are certainly other ways that you can make your mark and create unique marketing opportunities, but many of those will come and go with various trends and fads in fitness. Sadly, we live in a country that believes that “bigger is better” and wants “more for their money.” This has led to an epidemic of cancer, heart disease and diabetes, among other things. People will continue to age and whether it’s through the natural aging process or poor self-care, this is a market that is here to stay.

This article was featured in MedFit Professional Magazine. 

Andrea Leonard is the Founder and President of the Cancer Exercise Training Institute. She is a certified as a corrective exercise specialist by The National Academy of Sports Medicine (NASM), as a personal trainer by The American College of Sports Medicine (ACSM), the National Academy of Sports Medicine (NASM), the American Council on Exercise (ACE), and as a Special Populations Expert by The Cooper Institute. She is also a continuing education provider for the National Academy of Sports Medicine and The American Council on Exercise.

Cancer surgery and treatment often results in survivors suffering debilitating physical impairments. These can often be ameliorated by a good exercise program that has the added benefit of helping survivors to engage in those activities in which they participated prior to their diagnosis. This article addresses some of the physical side effects cancer survivors may face, including lymphedema and a series of safe and effective techniques to restore functional fitness for those with or at risk for lymphedema.

Surgery, chemotherapy, radiation, and hormonal therapy have side effects, which exacerbate the problems faced by cancer patients. Surgery can create adhesions that can limit range of motion, and cause pain, numbness and tightness. Removal of lymph nodes creates scars and may decrease range of motion. Radiation can cause fatigue, tightness and stiffness. It also can increase the risk of developing lymphedema. Chemotherapy may affect balance, a patient’s immune system, and cause neuropathy, fatigue, sarcopenia, and anemia. Hormonal therapy can cause joint pain and early menopause and the side effects associated with menopause.

Before beginning a cancer exercise program, a patient must receive medical clearance. A medical history, base line range of motion and girth measurements, and a general fitness assessment are taken. It is important to note that many exercises and movements may be contraindicated based on a person’s fitness assessment, medical conditions, and particular surgery. There are different exercises necessary for each type of reconstruction. For those who were active prior to surgery it is imperative to slowly work back up to the previous level of activity. It is not wise to go back to a gym and immediately continue with a pre-cancer exercise routine.

Research has shown that exercise is safe for cancer survivors, even those with or who are at risk for lymphedema. Dr. Schmitz stresses the importance of starting slowly and using proper form with a well trained certified professional. Her study demonstrates the importance of exercise after cancer with slow progressive improvement in order to decrease risk of lymphedema. The research shows that breast cancer survivors no longer have to give up activities that they enjoy doing and avoid activities of daily living. Aerobic exercise is essential to good health and we advise a patient to walk as much as possible. Initially, one might start by walking around their house or up and down their block and then slowly increasing the distance walked. Many physicians recommend that their patients try to walk during chemotherapy. This may decrease fatigue. If using aerobic equipment, make sure not to grip on the railing.

Unfortunately, there is no way to know which patients with lymph node dissection will get lymphedema. This makes it imperative to follow the established guidelines and take a prudent approach to exercise. Patients who have lymphedema need to progress slowly and use a properly fitted garment. Our goal is to promote physical activity without exacerbating lymphedema. Severe range of motion issues and cording problems are referred to lymphedema specialists. Moreover, measurement of the limbs that are at risk for lymphedema are performed frequently to make sure they have not changed in size. Symptoms can be managed easier if they are addressed promptly. Progress is monitored in order to make appropriate modifications to a patient’s program. It is important to learn the right exercises for a patient’s particular situation and how to do them properly and with good form. The patient should learn which exercises to perform, the sequencing, and quantity of repetitions. Exercise smartly and under professional guidance!

Lymphedema can be debilitating and painful and can affect the emotional health of the patient. Our bodies work better if engaged in regular physical activity, but it must be done in a safe manner if lymph nodes have been removed or radiated. A cancer fitness program for someone with lymphedema should begin as an individualized program. The patient must be supervised to make sure there are no subtle volume changes to the limb. Ultimately, we want a patient to be able to exercise on his or her own.

The starting point is a low impact exercise program, performing range of motion stretches and techniques to improve venous drainage. First, we elevate the affected area above heart level. Over time, stretches are incorporated until a patient can achieve 80% of range of motion. At that point, we start adding strength training. A stretching program for those with upper body lymphedema begins with moving or stretching the neck and shoulder areas. If a patient is still healing from breast cancer surgery, begin with pendulum arm swings. The arm is then moved and stretched in all directions, going across the chest and behind the head and back. Stretches that move the arms in shoulder flexion, extension, abduction, and adduction are added. Finally internal and external rotations are addressed. Patients suffering from fatigue can perform many of the stretches while in bed. An easy-to-follow DVD is Recovery Fitness Simple Stretching, which can be found on www.recoveryfitness.net.

All of the exercises incorporate abdominal breathing, which can stimulate lymphatic drainage. This intra-abdominal pressure may help move sluggish lymph fluid, stimulate lymph flow, and act as a lymphatic system pump. This type of breathing enables oxygen to get to the tissues. Abdominal breathing and relaxation breathing, along with the proper exercises can also reduce stress, a common cancer side effect. If weak, it may be best just to stretch and breathe deeply.

Strength training may help pump the lymph fluid away from the affected limb. Exercise helps the lymphatic fluid to April / June 2013 ~ NATIONAL LYMPHEDEMA NETWORK 13 move. Muscles pump and push the lymph fluid and can help move the lymph from the affected area. Strength training may also strengthen the arm so that it can handle those activities that may have otherwise led to swelling with a greater level of ease. Always wear a sleeve and stop if there is swelling or pain. Start with light weights and slowly increase repetitions and eventually weight.

Cancer survivors should follow a systematic and progressive plan. Exercise starts with a warm-up and cool down. Begin with deep breathing. Keeping a strong core should be emphasized. It is important to remember that following treatment the body may have become weaker. Even if a patient had exercised using 10 pound weights before surgery, if one is at risk for lymphedema they must start with a light weight. We teach patients to always listen to their bodies and to stop if they feel tired or if their limb aches or feels heavy. Patients must be aware of any changes in their body.

Progression of exercise should be gradual. A deconditioned person should start without using any weight and concentrate on proper technique. If 8-10 repetitions can not be executed, repetitions should be decreased or the weight lowered or resistance band used changed to less resistance. The exercise routines have to be adapted for the day-to-day changes that that can affect the ability to work out. Our program will start using a very light weight, with few repetitions, typically 10. In subsequent sessions, patients can add repetitions. After performing 2 sets of 10 repetitions with no problem then a small amount of weight may be added in 1 pound increments. We also alternate between a strength training exercises with a stretch for each muscle group and to alternate an upper body and lower body exercises. Pilates exercises are great way to incorporate deep breathing with strengthening the core. The deep breathing helps to pump lymphatic fluid and will also help reduce stress.

Every patient is unique. Many patients have pre-existing medical issues. The exercise program should be modified to accommodate all body types and needs. Some might need pillows for comport or postural problems. Also if osteoporosis is an issue, a cancer therapist should have experience working with this population. Always monitor the affected limb. Look for feelings of fullness or aching. We do not want to overwhelm the lymphatic system. Drink plenty of water and stop immediately if any pain. Lymphedema patients should elevate their limbs after a session.

Learn which aerobic exercises are considered safe. Walking, biking, and swimming are considered very safe. Hot tubs, pools, and warm lakes may increase risk of infection. In choosing an activity, consider the risk of injury, prior medical condition, and fitness level. Injuries can create further complications for those with lymphedema. It is still unclear whether certain sports can be safe. For example, tennis can put a lot of stress or repetitive activity on one’s limbs. It is important to know if the activity was something performed prior to lymphedema. If the patient wants to resume the activity in order to exercise, have fun, and to have good quality of life, a sports fitness program can be instituted. This should be performed under medical guidance. In a sports fitness program, the muscles used in the sport are progressively strengthened so that the sport can be resumed. Patients must use caution as they return to a sport.

One of the most important things that can be done to decrease the risk of lymphedema is to keep weight at a good level. Those individuals with whom I have worked who have had lymphedema typically see a marked reduction of swelling in conjunction with weight loss. My students who are successful in losing weight have the most success in lymphedema control. Proper nutrition is important and decrease salt intake. Evidence suggests numerous benefits of exercise: improved fitness level, physical performance, quality of life, and less depression and fatigue. Exercise is part of a healthy lifestyle and will help in weight control and emotional health. There are exercise programs that are targeted at cancer survivors but not all of them will meet the needs of someone at risk for lymphedema.

My goal is for cancer survivors to participate in individually structured and group exercise programs at all cancer centers or facilities close to their homes.

Article reprinted with permission from Carole J. Michaels.

Carol J. Michaels is the founder and creator of Recovery Fitness® LLC, located in Short Hills, New Jersey. Her programs are designed to help cancer survivors in recovery through exercise programs. Carol, an award winning fitness and exercise specialist, has over 17 years of experience as a fitness professional and as a cancer exercise specialist.