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Weight Loss Myths

Like Cicero coining the phrase “Ipse dixit” (“He, himself, said it”) in reference to the mathematician Pythagoras, we tend to appeal to the pronouncements of the master (in our society, celebrities and the media) rather than to reason or evidence. After all, if Jillian Michaels from TV’s The Biggest Loser or any other celebrity trainer says it’s so, it must be so, right? This has led to the proliferation of many myths in the weight-loss and fitness industry. Why do we think or claim we know things that we actually do not know? There are so many passionate people in the weight-loss and fitness industry, which is great, but oftentimes that passion gets in the way of science. And that can be dangerous. Do you know your weight-loss facts from fiction?

Myth: You have to exercise in your fat-burning zone to burn fat and lose weight.

People often assume that low-intensity exercise is best for burning fat. Cardio equipment manufacturers contribute to this assumption by posting a “fat-burning” workout option on their front panels, which influences people to choose that option because, after all, people want to burn fat. During exercise at a very low intensity, such as walking, fat does account for most of the energy you use. At a moderate intensity, such as running at 80 percent of your maximum heart rate, fat accounts for only about half of the energy you use. While you use both fat and carbohydrate for energy during exercise, these two fuels provide that energy on a sliding scale—as you increase your intensity, the contribution from fat decreases while the contribution from carbohydrate increases. While you use only a minimal amount of fat at higher intensities, the number of calories you use per minute and the total number of calories you expend are much greater than when you exercise at a lower intensity, so the amount of fat you use is also greater. Research has shown that the highest rate of fat use occurs when you exercise at a hard aerobic intensity (Achten et al. 2002; Astorino, 2000; Knechtle et al. 2004). What matters is the rate of energy expenditure rather than simply the percentage of energy expenditure derived from fat. Since you use only carbohydrate when you exercise at a high intensity, does that mean that if you run fast, you won’t get rid of that flabby belly? Of course not.

Despite what most people think, you don’t have to use fat when you exercise to lose fat from your waistline. The little amount of fat that you use in combination with carbohydrate during moderate-intensity exercise is in the form of intramuscular triglycerides—tiny droplets of fat within your muscles. Adipose fat (the fat on your waistline and thighs) is burned during the hours before and after your workouts while you’re sitting at your desk. For fat and weight loss, what matters most is the difference between the number of calories you expend and the number of calories you consume. So don’t worry about exercising in your fat-burning zone, because there’s no such thing.

Myth: Working out first thing in the morning on an empty stomach burns more fat. 

Muscles will indeed use more fat if you exercise when your blood glucose is low, as it can be first thing in the morning after an overnight fast. But burning more fat during your workout doesn’t necessarily mean that you will lose more weight. Exercising when fasted before breakfast doesn’t reduce the total number of calories you consume throughout the day, and doesn’t allow you to cheat the laws of caloric balance; at the end of the day, you still have to have a caloric deficit to lose fat.

When you exercise first thing in the morning before breakfast, your muscles don’t just rely on fat immediately. When exercising at a low or moderate intensity, they’ll use some fat, just like they would when you exercise at any other time of the day. But they’ll also use whatever carbohydrate is available from blood glucose and stored glycogen because carbohydrate is the muscles’ preferred fuel. When you run out of glucose, your muscles will then start to rely more heavily on fat. But exercising on an empty stomach with low blood glucose decreases the intensity at which you can exercise, which results in a lower-quality workout and less total calories burned. For weight loss, it really doesn’t matter if the calories you burn when you exercise come from fat or carbohydrate; how many total calories you burn is what matters.

Myth: Resistance training increases resting metabolic rate.

Perhaps the biggest myth in the fitness industry is the issue of resistance training increasing resting metabolic rate by increasing muscle mass, which leads to greater weight loss. Although it is true that resting metabolic rate is influenced by the amount of muscle you have, you would have to add a lot of muscle to significantly impact your resting metabolic rate. It’s not like you can add 10 pounds of muscle (which is very difficult to do unless you train like a bodybuilder for many months) and all of a sudden your resting metabolic rate is double what it was before. There’s about a 10-calorie increase in metabolic rate for every pound of muscle. So, if your resting metabolic rate is 1,500 calories per day, you would need to add 15 pounds of muscle mass to increase it by 10 percent. Resistance training can make you look better because of the effect it has on your muscles, but it won’t really impact your resting metabolic rate much. As you lose weight, your resting metabolic rate actually decreases, even when you maintain muscle mass by resistance training. Exercise can prevent the decline in resting metabolic rate as you lose weight, but it certainly does not increase as you lose weight.

Humans’ resting metabolic rate—the amount of energy you need to stay alive—is pretty stable, having been set by millions of years of evolution. Lifting dumbbells in a gym or doing burpees in the park is not going to change that. Some studies have shown an increase in resting metabolic rate following many weeks or months of exercise, but the magnitude of change is relatively small (about 30 to 142 calories per day) compared to what is needed for weight loss (Dolezal & Potteiger 1998; Poehlman & Danforth 1991). And some of these studies have been done on seniors, who are more likely to show increases in resting metabolic rate due to the attenuating effect of exercise on age-associated losses in muscle mass. It’s much easier to impact muscle mass and thus resting metabolic rate in an older person than in a younger person.

Myth: Intense workouts contribute to weight loss by burning more calories after the workout is over.

Ever since the fitness industry found research showing that people burn calories after they work out while they recover from their workout, a whole new argument was born. Exercise stopped being about the exercise and became about what came after. “Do this workout,” trainers and gurus say, “because you’ll burn four times as many calories for up to 48 hours afterward.”

After some workouts, specifically those that are intense or long, you continue to use oxygen and burn calories because you must recover from the workout, and recovery is an aerobic, oxygen-using process. This increased oxygen consumption following the workout is called the EPOC (Excess Postexercise Oxygen Consumption).

Many studies have documented the EPOC and compared it and its associated post-workout calorie burn between exercise of different intensities and durations (Laforgia et al. 1997; Treuth et al. 1996; Tucker et al. 2016). However, the post-workout calorie burn caused by the EPOC is a highly overexaggerated issue among fitness trainers. The increase in metabolism is transient, perhaps lasting a few hours, depending on how intense the workout was. The unbridled optimism regarding the EPOC in weight loss is generally unfounded. Studies have shown that the EPOC comprises only 6 to 15 percent of the net total oxygen cost of the exercise, and only when the exercise is very intense (Laforgia et al. 2006). Since unfit individuals recover more slowly than fit individuals, the EPOC will be higher in unfit individuals. However, most unfit individuals simply can’t handle the intensity of exercise that is required to induce a high or prolonged EPOC.

The calories you burn when you exercise have a greater effect on your body weight than the calories you burn afterward. It is the workout itself that creates the demand for change.

Myth: Nutrition (diet) is more important than exercise for losing weight and looking good.

I hear a lot in the fitness industry about the importance of clean eating. Indeed, most fitness professionals quote that physical appearance is 80 percent due to nutrition and 20 percent due to your workouts. I don’t know where those numbers come from, but those percentages are unknowable.

If we are to assign a relative importance to each, it’s presumptuous to think that the specific foods we eat are more important to our health, fitness, and cosmetics than are genetics and training. People like to claim that abs are made in the kitchen, but the truth is that muscles are made by training them. I’m pretty sure I didn’t get my sculpted legs and ass from eating kale salads; I got them from running 6 days per week for 33 years.

This is not to say that a person’s diet doesn’t matter. Of course it does. But to place such a large emphasis on diet over exercise misses an important point—cutting calories and eating a more nutritious diet does not make you fitter. Although your nutrition is undoubtedly important, it doesn’t give your muscles a stimulus to adapt. Only exercise can do that and thus give you all of the fitness and health benefits. The sculpted legs of runners and upper bodies of fitness magazine models didn’t get that way just by eating fruits and vegetables.

Truth is, you need both diet and exercise. Diet gets your weight off, especially initially, and exercise keeps it off. To lose weight, you must consume fewer calories each day. To maintain weight, you must exercise on most, if not all, days of the week. Research has shown that body weight and body mass index are directly proportional to the amount of exercise people do (Williams & Satariano 2005; Williams & Thompson 2006).

If we take two people, and one eats perfectly clean with a nutrient-dense diet and no processed foods but doesn’t exercise much, and the other exercises a lot but has a mediocre diet with the occasional Twinkie or chocolate chip cookie, who is going to look better and be fitter? I hope you said the latter. Truth is, exercise and genetics exert a greater influence on how you look (and on your physical performance) than your diet does.

Join Dr. Karp for his upcoming webinar on this topic:


Jason Karp is the creator of the REVO2LUTION RUNNING certification, 2011 IDEA Personal Trainer of the Year, and recipient of the 2014 President’s Council on Fitness, Sports & Nutrition Community Leadership Award. A PhD in exercise physiology, he has more than 200 publications, mentors fitness professionals, and speaks around the world. His sixth book, “The Inner Runner”, is available in bookstores and Amazon. Visit his website, Run-Fit.com

Article reprinted with permission from Jason Karp. Originally published on Personal Training on the Net (PTontheNet.com). 

 

References

Achten, J., Gleeson, M., and Jeukendrup, A.E. 2002. Determination of the exercise intensity that elicits maximal fat oxidation. Medicine and Science in Sports and Exercise. 34(1), 92-97.

Astorino, T.A. 2000. Is the ventilatory threshold coincident with maximal fat oxidation during submaximal exercise in women? Journal of Sports Medicine and Physical Fitness. 40(3), 209-216.

Dolezal, B.A. and Potteiger, J.A. 1998. Concurrent resistance and endurance training influence basal metabolic rate in nondieting individuals. Journal of Applied Physiology. 85(2), 695-700.

Knechtle, B., Müller, G., Willmann, F., Kotteck, K., Eser, P., and Knecht, H. 2004. Fat oxidation in men and women endurance athletes in running and cycling. International Journal of Sports Medicine. 25(1), 38-44.

Laforgia, J., Withers, R.T., Shipp, N.J., and Gore, C.J. 1997. Comparison of energy expenditure elevations after submaximal and supramaximal running. Journal of Applied Physiology. 82(2), 661-666.

LaForgia, J., Withers, R.T., and Gore, C.J. 2006. Effects of exercise intensity and duration on the excess post-exercise oxygen consumption. Journal of Sports Sciences. 24(12), 1247-1264.

Poehlman, E.T. and Danforth, E. 1991. Endurance training increases metabolic rate and norepinephrine appearance rate in older individuals. American Journal of Physiology Endocrinology and Metabolism. 261: E233-E239.

Treuth, M.S., Hunter, G.R., and Williams, M. 1996. Effects of exercise intensity on 24-h energy expenditure and substrate oxidation. Medicine and Science in Sports and Exercise. 28(9), 1138-1143.

Tucker W.J., Angadi, S.S., and Gaesser, G.A. 2016. Excess postexercise oxygen consumption after high-intensity and sprint interval exercise, and continuous steady-state exercise. Journal of Strength and Conditioning Research. 30(11), 3090-3097.

Williams, P.T. and Satariano, W.A. 2005. Relationships of age and weekly running distance to BMI and circumferences in 41,582 physically active women. Obesity Research. 13(8), 1370-1380.

Williams, P.T. and Thompson, P.D. 2006. Dose-dependent effects of training and detraining on weight in 6406 runners during 7.4 years. Obesity. 14(11), 1975-1984.

caruso1

Why Exercise When You Have Cancer?

Exercise is important for everyone even individuals who have cancer. It is important to understand your body and know what you can do. An Exercise Specialist can help you to figure out an exercise plan that works for you. Everyone is unique and therefore needs an individualized exercise program.

It is important to notify your Exercise Specialist when you have treatments. The exercise program may need to be modified for a few days after treatment. Modification is important to help preserve energy and wellbeing. You may need to do two sets of an exercise instead of three for a training session or two. Exercise can help you to stay strong and relieve stress even if you are only able to do twenty minutes every other day.

There are also some precautions to take. While exercising, you may want to wear gloves. Wearing gloves helps you to keep your hands clean during workouts. This is important because the immune system is already weakened. Wiping equipment before use will also help you to be as clean as possible. It is important to wipe mats and dumbbells as well.

caruso1Start your exercise program slowly and progress when you are ready. Fitness is an individual journey and everyone starts at a different place. It is important to not compare yourself to others and keep focused on your goals. Your exercise prescription will depend on which phase of cancer you are in.

There are many ways that exercise can benefit individuals during treatment such as: maintaining your physical capabilities, lessen nausea, maintaining independence, improve quality of life, control weight, decrease anxiety and depression, and improve self-esteem.

When you are recovering from treatment you may notice that the side effects linger. Your Exercise Specialist will adjust your program according to how you feel. Eventually, you will be able to progress and feel less fatigued. It is important, however, to continue to be active after treatments have been discontinued. Research shows that there is less chance of cancer recurrence in active individuals.


Robyn Caruso is the Founder of The Stress Management Institute for Health and Fitness Professionals. She has 15 years of experience in medical based fitness. Contact Robyn by email at: tsmi.caruso@aol.com

 

References

American Cancer Society (2014). Physical Activity and the Cancer Patient. Retrieved http://www.cancer.org/treatment/survivorshipduringandaftertreatment/stayingactive/physical-activity-and-the-cancer-patient

Web MD (2007). Exercise for Cancer Patients: Fitness After Treatment. Retrieved http://www.webmd.com/cancer/features/exercise-cancer-patients?page=3

 

Walking-Sneakers

A Clearer Vision in Training

As fitness professionals, what we can expect is the unexpected. Often the last person we think may send an inquiry, does. If you’re like me and the majority of your training is in-home, you often get the privilege to work with so many you may not otherwise in a traditional gym or studio setting.

The Unexpected Client

While I was used to receiving various inquiries from those with different chronic conditions or disease, disabilities and other limiting factors, the one I didn’t anticipate was a blind client. The first thing I did before responding was see what trainers in my area may be willing to work with this individual, no response, no one was interested. My first thought was my “scope of practice”. Surely this wasn’t in that category for me. While I took time to reflect on how I could possibly help this person, I did some asking around to a well-respected fitness professional not in my area. I asked him, “How do you train a blind person?” He responded by saying, “I have never had the chance to do that but I would say you train him just like anyone else.” That made complete sense to me in that moment. What I didn’t know I would research. Next, I would fully disclose that I did not have prior experience with training a blind person, but I would be happy to take him on. So, I did.

Learning Curve

In researching training the blind community and speaking with a few people in various agencies, I couldn’t get much beyond the science and statistics. No methods, no accommodations, no modifications, no advice, not much to guide me. I did learn about Orientation and Mobility Specialists and while that was needed in the beginning for my client, it was not needed for him to have at the time for the training to take place.

You adjust everything you know about training. A huge eye opener for me was learning that I had a vision dependency on cueing. My verbal cueing was subpar. Too often I was used to saying, “Watch me first, then you try,” then correcting form as needed. In programming for my client, I needed to better learn to be descriptive so that what he could not see, he could imagine in the mind. It had to make sense.

Tips

What helped me to make progress, not just with my blind client but in general, was to really read the descriptions of exercise, movement and anatomy. Even if I had to read it continuously to better explain, that is what I did. When something didn’t make sense, we just eliminated it and found a better option.

Learning to count steps was another big deal. It was critical to know how to express inches, feet, yards when walking or moving around. For example, we are 2 yards from your driveway, in 2 feet there is a table, it is 35 steps to your mailbox.

Blindfold yourself. Close your eyes when exercising. Have another trainer, family member or friend, tell you some of the exercises that you find hard to describe and learn from those examples. Get a real feel for what your client may experience. Learn how they use their cane and the types of canes (sticks). One wealth of information came to me from a blind athlete. He took time to talk to me and just reinforce how important it is for my client to be independent.

Announce what you’re doing before you do it. It’s the same with asking to touch a client, “Is it okay if I touch your elbow?” Or, “I am going to pick up these dumbbells.”

Challenges

Learning to not be so protective, smothering and motherly, as was my nature as a mother of five. I was scared every moment, what if my client falls, trips, bumps into the wall, anything. I felt I had to always be on guard and with the slightest change in movement or awkward movement, I would have my arm ready to catch if I needed. Too much! It was very helpful that a few times I had another trainer in training (my husband) come along with me and he brought it to my attention. I told him, I know I can do it, but what if something happens? He said, it just will and I can’t spend every minute in protection mode. It’s not good for me or the independence of my client.

Programming always changed. There were days we just walked because that was as much as my client could handle. Cancellations due to various reasons required me to step up and not be taken advantage of as well. Adapting to all of that and being patient in what my client needed took time.

Addictions (substance abuse). While I won’t get into much depth on this topic, there were many other challenges within this area that I was exposed to and needed to refer out and gain help for. Again, it was the unexpected.

Nutrition problems. Making sure my client was eating, what and when. There were many discussions we had regarding proper nutrition. Much of it would lead back to other barriers, such a cigarettes or substance abuse. It required other professional intervention, as I am not a Registered Dietitian, but we did review general eating habits and good vs bad. Occasionally, we got it just right.

Dawn working with her client

The Workouts

While the primary goal was weight loss and increased strength for my client, we tackled everything. We incorporated cardiovascular activities and ones we did often were running together with a rope (tether), jumping jacks, and walking. But every part of the programming goals were to incorporate functional exercises which all required flexibility, balance, core, resistance, strength training, and what my client could focus on doing alone. We used dumbbells, resistance bands, sandbells, medicine balls, jump ropes, tires, picnic table, stairs, Airex pad and simply bodyweight. The most important use of all the exercise was in how it would further benefit my client and the goals we set. Nothing should be useless training.

In closing

While there is so much more to be said on how I trained my blind client, the most important message to relay is to not be afraid of what you can’t do, but do what you can. We should always ask questions, always expand our knowledge and do what we as fitness professionals are here for — to assist in living a healthier, active lifestyle. We can’t promise the moon, but it is our responsibility to do the very best we can within our scope, and what we are hired for. If you’re doing that, than you are probably doing it well.


Dawn Baker is an Independent Contractor Personal Trainer, founder of One Accord Fitness LLC and has been changing lives in the fitness industry for 6 years.

towel, dumbbells, apples and water bottle isolated on white

Call To Action: May is Global Employee Health and Fitness Month

What is Global Employee Health & Fitness Month?

Global Employee Health and Fitness Month (GEHFM) is an international and national observance of health and fitness in the workplace, created by 501c3 non-profit organization, the National Association for Health and Fitness. The goal of GEHFM is to promote the benefits of a healthy lifestyle to employers and their employees through worksite health promotion activities and environments.

Formerly titled National Employee Health and Fitness Day, GEHFM has been extended to a month-long initiative in an effort to generate sustainability for a healthy lifestyle and initiate healthy activities on an ongoing global basis with a reach into South America, Europe and Asia.

Employers everywhere are invited to participate. The website and toolkit are available to participants, healthandfitnessmonth.org

Employers will challenge their employees to create Healthy Moments, form Healthy Groups and develop a Culminating Project. Participants will be able to log these activities on the website through the month, allowing employer and employees to track, share and promote their individual and group activities. GEHFM is structured very simply for ease of use and primarily targeted on companies with 500 employees or less.

Healthy Moments are occasions of healthy eating, physical activity or personal/environmental health. (e.g., cooking a healthy meal or scheduling a dental/doctor visit.)

Healthy Groups are formed to create a sustainable activity continuing even beyond the month. (e.g., healthy lunch groups; company sports team; walking club.)

Culminating Project is an event that promotes health throughout the whole company or community. (e.g., planting a community garden; company/family fitness event.)

When is GEHFM and how it works?

GEHFM is held during the month of May every year (traditionally physical activity month). Health Moments occur daily, even multiple times a day and are created by individuals and groups. Healthy Groups implement activities to be performed several times throughout the month. Finally, the Culminating Project is developed during GEHFM and is executed at the end of May.

Why should employers/employees participate?  

GEHFM is a great way to kickoff wellness and fitness programs and bring excitement and can complement existing programs. Workforce wellness programs have been shown to benefit the employer through enhanced employee productivity; reduced health care costs; reduced employee absenteeism and decreased rates of illness and injury. These programs benefit employees by lowering stress levels, increasing well-being, self-image and self-esteem, improving physical fitness, increasing stamina, increasing job satisfaction and controlling BMI and blood pressure.

Benefits of GEHFM

  • Free, innovative and proven tool kit provided to help guide activities and events
  • Promotional items advertising GEHFM available for purchase by participants
  • Ability to log and track moments, groups and projects
  • Option to implement friendly competitions and challenges to build teamwork
  • Simple and adaptable to any wellness and fitness program
  • Creates sustainable healthy programs, environments and policies

About the National Association for Health and Fitness (NAHF)

NAHF was founded in 1979 by the President’s Council on Physical Fitness and Sports and has as its vision that America shares in the social economic, health and environmental benefits that come from living an active lifestyle.  Our mission is to improve the quality of life for all individuals in the United States by promoting physical fitness, sports and healthy lifestyles. We also champion environmental and policy support for active living and encourage and share innovation in the States. NAHF values active living (integrating physical activity into daily lives) community involvement and leadership development for all societal sectors; promoting quality physical education in our schools; developing workforce health promotion programs and active-aging programs. With our focus on the States, NAHF “bridges the gap” between federal and local action and unites researcher and community practitioner.

Global Employee Health and Fitness Month website: healthandfitnessmonth.org


Diane Hart, Owner of Hart to Heart Fitness, is a Nationally Certified Fitness Professional, Personal Trainer, Health Educator and is current President of the National Association for Health and Fitness founded in 1979 by the U.S. President’s Council on Sports and Fitness. She is also Chair and one of the original architects of Global Employee Health and Fitness Month, which strives to make healthy the norm in the workplace.

senior-trainer-machine

Exercise Combats Frailty

Exercise is key to maintaining muscle mass that enables performance of the activities of daily living.

US Census projections suggest that the majority of baby boomers will turn 65 between 2010 and 2030, reflecting the impending need for increasing medical care within this demographic.(1-3)

“Baby boomers are now senior boomers, and just as this group has influenced everything in the past, they will impact tomorrow’s health care services as well,” says Patrick Kearns, MD, a geriatrician at El Camino Hospital in Mountain View, California.

The health and function within this group will range from those who are extremely fit and healthy to those who are physically dependent. How an individual ages is, to some extent, determined by the cards (genes) they were dealt and, to a larger extent, how they’ve played those cards. Research confirms the relationship between living a healthful, active lifestyle and both quantity and quality of life. Proactive steps taken throughout a person’s lifetime may prevent or delay the advent of frailty.(3-5)

The medical profession continues to make significant strides in treating conditions that would have caused death years ago. And while the average life expectancy has increased dramatically since the 1900s, this increase in longevity comes with the possibility of living more years with physical limitations and reduced functional ability.(3,5)

Some studies have discovered that a sizable number of adults over the age of 65 cannot lift a 10-lb bag of groceries, walk a mile, or easily get up from a chair. One study suggests a significantly increased risk of falling for individuals who cannot lift themselves out of a chair at least eight times in 30 seconds.1 But how can frailty be prevented or even reversed?

Identifying the Problem

Anyone, young or old, can experience frailty, which is the loss of some physical function and can result from various causes. Among the most common are a chronic medical condition; loss of a sensory system; changes in medical, mental/emotional, or functional fitness status; age-related muscle loss (sarcopenia); falls; or a sedentary lifestyle.(1,3,5)

Many times a combination of these factors results in a person’s inability to function independently, leading to the classification of frailty. The term “frail elder” often refers to the role age plays in the above conditions. Most of us can visually identify a physically frail person, but currently no definitive criteria exist for defining frailty. However, some professionals are attempting to develop a universal objective definition of elder frailty traits.(3,6)

Often family members, in concert with health care professionals, are the first to recognize an elder’s decline in strength and level of independence. Assessment of diminished balance and muscle strength suggest the need to initiate a comprehensive general conditioning program.(1)

Never Too Late

A recent study published in the Journal of Aging and Health showed that a group of octogenarians involved in a 16-week program of walking or resistance training could improve significantly in strength, flexibility, agility, and balance.(1,7) Of course, prevention is cheaper than treatment, so the intervention of a well-rounded fitness program should begin long before frailty concerns emerge. Some older adults admit that if they had known they’d live so long, they would have taken better care of themselves when they were younger.

Sarcopenia plays a major role in what many believe advances functional loss and contributes to becoming frail. Studies have shown that without the intervention of progressive resistance training, lean muscle tissue loss can begin as early as the age of 30.(1,3,5) These small changes go unnoticed or are even accepted as part of normal aging until a person finds difficulty in completing simple tasks. While the outward circumference of a limb may remain the same, the interior integrity of the muscle mass is decreasing. We can visualize the muscle loss as analogous to a lean steak’s transformation to one with marbled fat. So it is with humans: A muscle biopsy shows intermuscular fat within the muscle.

Why is less muscle detrimental? One reason is that muscle tissue is the furnace that revs the metabolism, thus assisting an individual to better control body weight, which in many cases decreases the risk of type 2 diabetes, hypertension, and other metabolic diseases. An increase of only 7.7% in resting metabolic rate derived from strength training would result in an increase of 50,000 extra calories expended in one year, which could result in a loss of 14 lbs of fat (in a 180-lb person).(1,5,7)

Strong leg muscles lead to improved balance.1 Strong functional muscles enable a more active and independent lifestyle. Being involved in a sensible strength conditioning program can foster improved bone density. Wolf’s Law says the strength of the bones is in direct proportion to the forces applied to them. If a person sits during most of the day, then he or she will have bones made for that kind of lifestyle. “Use it or lose it” applies to muscle strength as well as bone strength.

The hallmark study done by Maria Fiatarone, MD, a researcher at Harvard Medical School, placed 100 frail nursing home residents aged 72 to 98 into several experimental groups.(1,3,5-7) Her research found that those participating in progressive resistance exercises improved their strength significantly vs. those who were given nutritional supplements. The strength-training group increased their overall strength by 113%; gait velocity improved significantly as well stair-climbing ability over the nonexercising groups.

The take-home message was that resistance training is superior to nutritional supplementation and is far more cost-effective.

Exercise Benefits

A review of the literature appears to prove that proper physical activity has broad and positive influences over many of the characteristics associated with normal aging. It could be said that everything that physically declines with age can be positively influenced with proper exercise.(4,8,9)

We’re all familiar with normal aging, but healthful aging often is determined by the activity or lack of activity that precedes old age. An inexpensive strategy to improve the prospects of living long and well includes a regular dose of sensible physical activity. Some commonly acknowledged benefits of a well-rounded exercise program include improved self-efficacy, metabolism, sleep patterns, cardiovascular capacity, balance, muscular strength, endurance, and movement along with reduced fatigue, depression, anxiety, and arthritic and low back pain.(1,8,9)

Designing a Fitness Program

While it’s never too late to feel great, it’s best to start early. While this article attempts to show ways to intervene with a patient experiencing some level of frailty, the best solution is to encourage patients to engage in activities that help prevent it. It’s better to do a little bit of anything than a lot of nothing. Remind patients to start slow and progress cautiously. All of the exercises suggested below can be done simply with a chair. It’s even possible to perform some of the exercises in bed.(4,8,9)

Providing motivation to embark on an exercise regimen and stick with it presents a challenge, though. Suggesting participation in activities patients don’t want to do requires patience and skill. Focus on ways to make the activities appealing while preventing injury. Matching the exercise routine to a person’s personality and physical abilities often is more of an art than a science. A good coach/teacher can motivate a patient to do something he or she doesn’t want to do—and thank the coach for it later.(4,8,9)

It’s wise for health care professionals to provide patients with guidelines of indications and contraindications related to exercise. If possible, try to match patients with suitable options within the community that match their physical abilities, personalities, and social and economic issues. Some long term care facilities offer in-house and/or programs available to local older adults.(4,6,7)

An exercise program for patients at risk of becoming frail should aim to improve functional activities of daily living. An assessment by an occupational therapist, physical therapist, or nurse should provide some direction on the major areas to be addressed. While the aim of the intervention is to improve function, make sure the person leading the session keeps some fun in functional. This may require some socializing and interacting with patients. If patients are unmotivated to perform activities or exercise, even the best program will have low compliance rates and not produce the desired outcomes. All programs should follow some type of evidence-based guidelines.(8,9)

Improving muscular strength and endurance helps enhance patients’ functional muscular endurance and strength to perform daily activities without becoming fatigued. The basic concept of progressive resistance training, commonly called strength training, weight training, or weight lifting, is to begin with a resistance that can be comfortably performed six to eight times and then continue increasing the number of times (reps) until he or she can perform the movement easily between 10 and 15 times.(6)

Once that level is attained, patients can add small amounts of resistance to again challenge the muscles. As an individual advances, another set (a grouping of reps) can be added. The number of reps and sets varies depending on the objective. Matching activities to the functional tasks a person needs to perform can involve lifting a milk jug, opening jars, getting up from the toilet, or walking outside to get the mail, for example. The goal should be to build up a reserve of strength so patients can engage in any necessary activities.(4)

Strength training can include the use of resistance bands that come in varying levels of resistance. Light water bottles, hand weights, or attachable wrist/ankle weights work well. For patients who are particularly weak, simply using the weight of their limbs is a fine starting point.(4)

Cardiovascular Fitness

Aerobic simply means with oxygen. Most exercise physiologists use the example of anything you could do while holding your breath as anaerobic while the opposite characterizes aerobic exercise. Running a 100-yard dash could be called anaerobic and walking a mile aerobic. The goal of aerobic exercise is to improve the ability to move freely without becoming winded or to execute activities that facilitate locomotion, whether it’s propelling a wheelchair farther or safely walking unassisted to the dining room. This addresses breathing function as well as aerobic exercise to assist in reducing cardiovascular diseases and burning calories. Seated aerobics, peddling a stationary bike, and even walking exercise can be suitable options.

Balance and posture exercises should aim to improve the muscles that influence posture, such as the core muscles and muscles that retract the scapula as well as muscles that promote proper neck alignment. There is evidence that improved posture translates into standing erect and improved balance.

Balance activities should include both static and dynamic movements. Physical therapists can offer recommendations on exercises to enhance balance. Experts suggest patients can begin balance work in a chair, similar to activities for spinal cord-injured and post-stroke patients, as a safe exercise method.

Comprehensive Program Design

Attempting to include all of the aspects listed above would be ideal; no one element supersedes another. However, it’s often advisable to establish a baseline of patient stamina. A comprehensive exercise class can easily include each element. An example of such a class could include five to 10 minutes of warm-up moves, five to 10 minutes of upper and lower body strength training, and five to 15 minutes of light aerobic exercise followed by some light flexibility moves. All of these can be done safely if the activities match a patient’s ability. Individualization is the key even for a group exercise class.(4)

Ideally, providers can perform individual patient assessment. Utilizing a group assessment method such as the Senior Fitness Test also can provide information on fitness levels and achievable goals.

The bottom line is that exercises and activities should be adapted to a patient’s abilities and should never exacerbate an existing condition, as patient safety is more important than any exercise. If an instructor cannot appropriately adapt the movements, then he or she is not qualified to be teaching this segment of the population.

Basic Activities

A sample exercise program to prevent and improve the status of frailty should include the following:

• Range of motion/flexibility: Motion is lotion to stiff joints. A warm-up that addresses the major joints and helps prepare the body for physical activity should last between five and 15 minutes. Include gentle range-of-motion/flexibility activities that foster functional movements, such as putting on socks and shoes or getting dressed. In the early stages, this may be the limit of a patient’s capability, so stopping here is fine.

• Muscular strength and endurance: The focus is to improve functional muscular endurance and strength to enable a patient to perform daily activities without becoming fatigued. The activities should be matched to the tasks an individual needs to perform, such as lifting, dressing, and walking.

Plan of Action

There are not enough physical and occupational therapists nor insurance dollars available to provide all the functional fitness needs of this burgeoning group of older adults. We need to have a stable of well-trained fitness professionals prepared to serve the fitness requirements of today’s elders. The medical community needs to have confidence that when they refer someone to a fitness class, the instructor will do no harm. The fitness trainers of the future should understand the diversity within this group and understand how to assess and train older adults with varying degrees of ability and fitness. It’s essential to adapt fitness methods to a patient’s abilities and conditions and focus goals on improving functional wellness.

Ideally, this article will serve as a wake-up call, not only to the fitness industry but also to health care professionals to work toward establishing national standards for trainers who work with older adults. A great opportunity will be lost if there are not enough trained fitness professionals available to serve this burgeoning demographic.

The field of gerontology promotes aging in place as a viable option. If early and comprehensive frailty prevention programs can be conducted in senior centers, hospital settings, or assisted-living communities, it could possibly delay the onset of frailty along with the associated costs.

In Conclusion

The evidence is convincing that elders’ chronic illness is a powerful driver of medical costs. Research shows that a proactive lifestyle can lessen the challenges often seen in old age. Think of prevention as wholesale and treatment as retail in helping patients understand physical maintenance of their bodies. The goal is to inspire patients to be internally motivated to take positive steps toward becoming the best they can be, no matter what their age or disability.

Originally published in Today’s Geriatric Medicine. Reprinted with permission from Karl Knopf.


Karl Knopf, Ed.D, was the Director of The Fitness Therapy Program at Foothill College for almost 40 years. He has worked in almost every aspect of the industry from personal trainer and therapist to consultant to major Universities such as Stanford, Univ. of North Carolina, and the Univ. of California well as the State of California and numerous professional organizations. Dr. Knopf was the President and Founder of Fitness Educators Of Older Adults for 15 years. Currently, he is the director of ISSA’s Fitness Therapy and Senior Fitness Programs and writer. Dr. Knopf has authored numerous articles, and written more than 17 books including topics on Water Exercise, Weights for 50 Plus to Fitness Therapy.

 

References

1. Rose DJ. Fallproof! A Comprehensive Balance and Mobility Training Program. 1st ed. Champaign, IL: Human Kinetics; 2003.

2. Durstine JL, Moore G, Painter P, Roberts S. ACSM’s Exercise Management for Persons With Chronic Diseases and Disabilities. 3rd ed. Champaign, IL: Human Kinetics; 2009.

3. National Institute on Aging. Exercise & Physical Activity. Bethesda, MD: National Institutes of Health; 2009. NIH Publication No. 09-4258.

4. Knopf K. Total Sports Conditioning for Athletes 50+: Workouts for Staying at the Top of Your Game. Berkeley, CA: Ulysses Press; 2008.

5. National Institute on Aging. In Search of the Secrets of Aging. 2nd ed. Bethesda, MD: National Institutes of Health; 1996. NIH Publication No. 93-2756.

6. Brody LT, Hall CM. Therapeutic Exercise: Moving Toward Function. 3rd ed. Baltimore, MD: Lippincott Williams & Wilkins; 2010:1-49.

7. Ehrman JK, Gordon PM, Visich PS, Keteyian SJ. Clinical Exercise Physiology. 2nd ed. Champaign, IL: Human Kinetics; 2009:135-146.

8. Knopf K. Creating wellness. Paper presented at: Wellness Conference at the Palo Alto Medical Foundation Annual Meeting; October 2012; Palo Alto, CA.

9. Knopf K. Grow well, not old. Paper presented at: El Camino Hospital Aging In-Service; May 2013; Mountain View, CA.

Full page photo

Save the Date: Global Employee Health and Fitness Month, May 1-31

Employers and Employees everywhere can show their support for healthy living by participating in Global Employee Health and Fitness Month (GEHFM) sponsored by the National Association for Health and Fitness (NAHF) and MedFit Network. This outstanding worksite initiative is held from May 1 through 31 each year to celebrate National Employee Health and Wellness Month. The new and improved website for a healthy, active workplace can now be accessed 12 months a year and a company can choose not only the month of May, but any other month in the year to improve well-being and to increase human movement.

Since the founding of Employee Health and Wellness Month in May of 1989, there have been significant strides in documenting the evidence of the value of investing in employee health. Employee health is a powerful strategic  component of an organization’s human capital management. Progressive employers understand that their greatest asset is their workforce and an investment in their employee’s health is essential to managing health costs, improving organizational productivity and employee morale.

The amazing strategic partnership between GEHFM, NAHF and MFN resulting in the new and improved Global Employee Health and Fitness Month website is truly historic in the arena of workforce wellness.  Business and industry can encourage positive behavior change in the supportive context of workplace policies and culture and provide support that assists today’s workforce with their daily struggles. Through GEHFM we will achieve the optimum result of a more physically active, healthier population – one healthy moment and one healthy group at a time.

All you have to do is create and share “Moments, Groups and Projects for Health” such as preparing a healthy meal, organizing a recurring walk or bike ride with colleagues or participate in a clean-up day with your community.

It’s time to make “healthy the norm” in American and this game-changing initiative is a powerful effort toward the realization of this goal.

Visit the website, healthandfitnessmonth.org

Instructor Showing Health Results On Clipboard To Senior Couple

Respiratory Disease and Exercise: How to help your clients not suck at exercise!

According to the World Health Organization (WHO), hundreds of millions of people suffer every day from chronic respiratory diseases (CRD).  Currently in the United States, 24.6 million people have asthma1, 15.7 million people have chronic obstructive pulmonary disease (COPD)2 while greater than 50 million people have allergic rhinitis3 and other often-underdiagnosed chronic respiratory diseases.  Respiratory diseases do not discriminate and affect people of every race, sex, and age.  While most chronic respiratory diseases are manageable and some even preventable, this is what is known about the nature of chronic respiratory diseases4:

  • Chronic disease epidemics take decades to become fully established.
  • Chronic diseases often begin in childhood.
  • Because of their slow evolution and chronic nature, chronic diseases present opportunities for prevention.
  • Many different chronic diseases may occur in the same patient (e.g. chronic respiratory diseases, cardiovascular disease and cancer).
  • The treatment of chronic diseases demands a long-term and systematic approach.
  • Care for patients with chronic diseases should be an integral part of the activities of health services, alongside care for patients with acute and infectious diseases.

Exercise and CRD

If you are a health and fitness professional, some of your clients may be suffering from a chronic respiratory disease and you may be an important source for relief.  Moderate exercise is known to improve use of oxygen, energy levels, anxiety, stress and depression, sleep, self-esteem, cardiovascular fitness, muscle strength, and shortness of breath. While it might seem odd that exercise improves breathing when one is short of breath, exercising really does help one with respiratory disease.  Exercise helps the blood circulate and helps the heart send oxygen to the rest of the body.  Exercise also strengthens the respiratory muscles which can make it easier to breathe.

Beneficial Types of Exercise

There are several challenges to exercise prescription and physical activity participation in this population, but a large body of evidence demonstrates important health benefits from aerobic exercise.  Resistance training has also been shown to increase muscle mass and strength, enhancing individuals’ ability to perform tasks of daily living and improving health-related quality of life.5

Aerobic exercise is good for the heart and lungs and allows one to use oxygen more efficiently. Walking, biking, and swimming are great examples of aerobic exercise. The guidelines are approximately the same as generally healthy individuals.  One should attempt to train the cardiorespiratory system 3-5 days a week for 30 minutes per session.  One should exercise at an intensity level of 3-4 on the Rating of Perceived Exertion Scale (Scale Rating from 0 Nothing at All-10 Very, Very, Heavy).

Resistance exercise increases muscular strength including the respiratory muscles that assist in breathing.  Resistance training usually involves weights or resistance bands but using one’s own body weight works just as well depending on the severity of the symptoms.  It is recommended that one should perform high repetitions with low weight to fatigue the muscles.  This type of resistance training also improves muscular endurance important for those with CRD.  Resistance training should be performed 2-3 days a week working all major muscle groups.

Stretching exercises relax and improve one’s flexibility.  When stretching, one should practice slow and controlled breathing.  Not only does proper breathing help to deepen the stretch, but it also helps one to increase lung capacity.  One should gently stretch all major muscles to the point of mild discomfort while holding the stretch for 15 to 30 seconds, slowly breathing in and out. Repeat each stretch 2-3 times.  Stretching is an effective method to warming up and cooling down before and after workout sessions.

When exercising, it is important to remember to inhale in preparation of the movement and exhale on the exertion phase of the movement.  An individual should take slow deep breaths and pace him/herself.  It is recommended to purse the lips while exhaling.

Use of Medication

If an individual uses medication for the treatment of respiratory disease, he/she should continue to take the medication based on his/her doctor’s advice.  His/her doctor may adjust the dosage according to the physical activity demands.  For example, the doctor may adjust the flow rate of oxygen during exercise if one is using an oxygen tank.  In addition, one should have his/her inhaler on hand in case of a need due to the increase of oxygen demand during exercise.

Fitness professionals can effectively work with those who have a chronic respiratory disease providing them with a better quality of life through movement.  You as their health and fitness coach can provide a positive experience to facilitate an effective path to better health and wellness.

Expand your Education to Work More Effectively with these Clients!

Check out CarolAnn’s 4 hour course with PTontheNet, Respiratory Disease and ExerciseThe goal of this course is to educate health and fitness professionals on how to effectively implement exercise training techniques and work with clients that suffer from various respiratory diseases to help develop strength, flexibility, balance, breathing, and improve their quality of life.  Click here to learn more about the course.


Known as the trainers’ trainer, CarolAnn has become one of the country’s leading fitness educators, authors, and national presenters. Combining a Master’s degree in Exercise Science/Health Promotion with several fitness certifications/memberships such as FiTOUR, ACSM, ACE, AFAA, and LMI, she has been actively involved in the fitness industry for over 25 years. She is currently the Founder and Director of Education for Chiseled Faith, a Faith Based Health and Fitness Program for churches. Visit her website, www.CarolAnn.Fitness

References

  1. 2015. NHIS Data; Table 3-1. www.cdc.gov/asthma/nhis/2015/table3-1.htm
  2. Mannino DM, Gagnon RC, Petty TL, Lydick E. Obstructive lung disease and low lung function in adults in the United States: data from the National Health and Nutrition Examination Survey 1988-1994. Arch Intern Med. 2000;160:1683–1689.
  3. CDC, Gateway to Health Communication and Social Marketing Practice. Allergies. https://www.cdc.gov/healthcommunication/toolstemplates/entertainmented/tips/Allergies.html
  4. World Health Organization http://www.who.int/gard/publications/chronic_respiratory_diseases.pdf
  5. Eves ND, Davidson WJ. Evidence-based risk assessment and recommendations for physical activity clearance: respiratory disease. Applied Physiology Nutrition and Metabolism. 2011;36(Suppl 1):S80–100. [PubMed]
Back pain

Exercise Not Helping Your Back Pain? It’s Not you, It’s Your Strategy! | Part 2

This is part 2 in a series. Click here to read part 1.

In Part 1 of this series, we discussed the dilemma of back pain that persists despite your persistent efforts to solve the problem.  You’ve been prescribed medication, exercise, and a myriad of methods to “stretch” and “loosen” your muscles, but no avail. You must be a lost cause . . . right?

Maybe not.

It’s not your effort that’s lacking; perhaps it’s your strategy of solving the problem that’s in need of some tweaking.

In Part 1 we established that the body operates as a system:  an interconnected, interactinginterdependent set of parts designed to achieve a goal– and in the case of the human body, the goal is production of high-quality movement for the sake of survival.  Part of its genius, in my opinion, is in its sophisticated setup for communication within itself: the body is one continuous, cohesive system with a built-in mechanism that allows for every part to be aware of, and work with, the other parts to achieve the goal of operating efficiently.  The human body is a truly amazing system!

Every body movement is a whole-body task that requires an internal, whole-body solution.  Your muscles are an interconnected, interacting, interdependent system, constantly communicating back and forth, working together to create and control movement. All of your muscles are involved in one way or another in any bodily event.

Conversely, an issue with low-quality muscle function in any area of your system has the inherent potential to affect the performance quality—and your brain’s conclusion about how you feel–  in any other area of your system.

 Let’s apply this Systems Approach to form a new strategy to address your back pain.

Solving Your Body’s Problems Using the Systems Approach

The fact that your back is where you feel muscle pain and tightness doesn’t necessarily mean your back itself is the problem.  The standard Western medicine approach subscribes to the philosophy of “Local pain means a local problem, which requires a local solution”, but this isn’t always the case.

Imagine you start your car in the morning, and the “check engine” light pops up.  What’s wrong with your car?  Is the “check engine” light itself the problem?  No– the “check engine” light is an indicator, a safety mechanism built into your car’s system to alert you of a problem somewhere in the car’s system that needs to be addressed.

Likewise, pain you experience with movement is simply an indicator that there’s low-quality function somewhere in your muscle system . . . but not necessarily at the specific location you feel the pain.  The pain is just symptom, the downstream result of poor quality.  The pain itself is not the problem to be solved; the low-quality control is the problem!  Instead of focusing directly on the part where you feel pain, my work focus is on the quality of your position control.  Any area of the body with low-quality muscular control can contribute to a problem with movement, pain, tightness, or discomfort you are experiencing in any other area of their body.

While the work of a Certified Muscle System Specialist™ and the work of a physical therapist may look similar, the philosophy and thought process differ greatly.  Physical therapy generally focuses on a patient’s complaint of pain or tightness, and as a result the therapy is almost always performed on or around the area of the patient’s pain. The physical therapy approach often subscribes to the philosophy of “local problem, local solution” we discussed earlier.

The same goes for massage therapy, stretching, chiropractic, pain medication, and other traditional options for treatment of muscle pain and tightness.  The “local problem, local solution” approach focuses on the pain instead of on the quality of your muscle function as a cohesive, dynamic system.  Chasing “the pain” is rarely an effective problem-solving method. This is the reason why using generic protocols and pre-packaged plans to “treat back pain” are not effective.  This is also why “strengthen your core” isn’t always the panacea for back pain we’re led to believe.

So . . . you’ve completed physical therapy, diligently taken your medication, foam rolled the “tight” area every day . . . but your “check engine” light is still on.  So, how can you understand what your system needs to turn it off?

Find a “systems mechanic” for your muscle system.

Work with a practitioner who is able to look under the hood, run a battery of diagnostics, find areas of low-quality function throughout your muscle system, and prescribe a system-wide plan to remedy the problem and put into place an ongoing maintenance process (like getting regular oil changes and maintenance on your car) so you can keep your system running at its optimal operating potential.

This is the role of a Certified Muscle System Specialist™– we’re muscle system mechanics!  As we help you improve control throughout your system, we can elicit a significant, positive effect on how your entire body feels and moves. Our clients are often surprised that improving muscle control in an area can lessen pain they were experiencing at a different location of their body!

So the next time you’re feeling muscle pain and tightness—or any change in the quality of how your muscles move and feel– remember that the whole is greater than the sum of its parts.  The strategy you’re using to take care of your system matters!

About the Certified Muscle System Specialist™

If you’re interested in learning more about how a Certified Muscle System Specialist™ can help you move better, feel better, and live better, click here.

To find a Certified Muscle System Specialist™ near you, see our list of practitioners throughout the U.S. and Canada.

If you’re a fitness practitioner who is interested in learning more about how to become a Certified Muscle System Specialist™, visit us at www.exerciseproed.com.

Originally published on Physicians Fitness. Republished with permission.


Jessica Cahen, M.S., CMSS, ACE-CMES, RTS is a Course Facilitator for Exercise Professional Education, a rapidly-growing Continuing Education company for exercise professionals, offering the Certified Muscle System Specialist™ course as well as custom-tailored CEC courses for groups upon request.

Jessica holds a Masters Degree in Clinical Exercise Physiology and the Certified Muscle System Specialist™ designation.  She has also earned the distinction of being one of only a handful of ACE Certified Medical Exercise Specialists in the Midwest.  She practices as a Certified Muscle System Specialist™ at Physicians Fitness in Columbus, OH.