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Male doctor explaining the spine to a senior patient in medical office

3 Curves = Straight: The Importance of Neutral Spine in Exercise

I have been teaching strength training, as well as Pilates based mat and Vinyasa Yoga for over 2 decades. As a former dancer, I know that I was always struggling with having a “flat stomach” or having a “flat back”. Dancers, in trying to achieve that “perfect turnout” and “flatness”, were often taught to “elongate the spine” by “tucking the pelvis” under, which basically leads to a posterior tilt. Unfortunately, this idea is often taught in fitness to the general population. Trainers and teachers alike, some coming from the dance world, will tell students to “protect their back” by tucking the pelvis such as during standing exercises, even bicep curls, or worse, curl their knees into their chest while lying on the ground or bench, and attempting to do a chest press. Students will be so conditioned to this ROUND SPINE and TUCKED PELVIS, that eventually when they stand, this is their posture. Over time, the discs can bulge, and the forward pelvis will eventually lead to lower back pain they were trying to avoid, as well as knee pain and other issues.

I am a reformed pelvic tucker. I advocate neutral spine when teaching, whether it be standing work such as bicep curls, pronated work such as plank and push-ups, or supine work such as leg lowers and overhead triceps.

The spine has 3 curves: the cervical spine (at the neck) has a concave curve, the thoracic spine (back of the rib cage) has a convex curve, and the lumbar spine (lower back) has a concave curve. And if you want to add a 4th, the pelvis/sacrum has a convex curve as well.

Together, this “S” shape is what keeps a body “straight”. Constantly flattening one’s back or pushing one’s vertebra into this position will eventually damage them. Plus you have to learn to CONTAIN YOUR MUSCLES, not force your vertebrae. There is a moment when the base of your ribs and your pelvic bone will feel like they are aligned in the front, like suspenders. Whatever curves are left over should remain.

Sometimes I do my supine abdominal work as well as strength training on a foam roller (pictured at right). This way there is no avoiding working in neutral spine. Plus, the foam roller will target the transverse abdominus as you are struggling to keep the foam roller still while performing exercises such as chest press, chest flies, overhead triceps, single and double leg lowers, etc.

Another bad habit that trainers and teachers tell their clients and students is to “sit on their hands” while performing exercises such as leg lowers. This is BAD for every reason. Your hands have small bones and veins which are easily damaged by sitting on them. Say you are 200+lbs, and you are putting all of your body weight on your hands! This is not good! I often joke and tell my students “I am a guitar player! I am not going to sit on my money makers!” Also, sitting on your hands again causes the pelvis to tuck, and the shoulders to protrude forward. By teaching this, you are telling your clients and students to “slouch”. You have not taught them how to gain strength by maintaining neutral spine. Third, more often than not, the reason the clients are feeling “pain” in their lower back is they are attempting to lower their legs beyond the range where the abdominals are effective. For me, about a 45 degree angle from the top is plenty of work. Attempting to lower one’s legs all the way to the floor and back will usually be out of the range of someone’s abdominal strength. Find a range of motion where the abdominal muscles fell the work, and the lower back is not effected. You can also put your client on the foam roller, or if you do not have a foam roller, place a thin towel under the sacrum to alleviate any pain the floor may be causing, as well as teach neutral spine.

For “plank”, I often joke (as I am a realtor as well) that “if the plank is not straight, I am returning it to aisle 4 in Home Depot”. People tend to hang their heads when something is difficult. I advocate looking a few floor boards ahead while performing plank, as well as push-ups, and to use a side mirror to check that the line of the head, shoulders, ribs and hips are aligned, while keeping the natural lumbar curve. Again, the ribs and hips should feel like suspenders. Push-ups are basically a “plank with an arm bend and straighten”. So it is important not to hang one’s head, especially when the floor is getting close :). (Planks pictured at right)

In closing, remember that you want to teach your students functional exercises that will help them out in the real world. Teaching neutral spine alignment is one of the most important ideas. You would never want to lift a box with a rounded, tucked spine, so why teach clients to “tuck their knees into their chest” while performing chest press? Sometimes it will take some time for a client to undo these bad habits, but in the end, clients will be stronger, and use the transverse abdomens vs poor alignment to perform daily tasks.

Photos courtesy of ANDREW MARK PHOTO.


Kama Linden has been teaching fitness for over 2 decades. She has taught strength, step, Pilates, Vinyasa Yoga, senior fitness, and has worked with clients and students of all ages and fitness levels. She is certified by AFAA Group Exercise and NASM CPT, as well as 200 hour Yoga. She has a BFA in Dance from University of the ARTS.   You can order her new book, “Healthy Things You Can Do In Front of the TV”  on pre-sale on amazon.com, and it will soon be available on BN.com, and Kindle. Visit her website at bodyfriendlyoga.com

woman-walking-dirt-road

Restoring Health: A Lifestyle Rx

America is in bad shape. According to the Centers of Disease Control (CDC), 60% of adults are living with one chronic disease and 40% have two or more.(1)  Astoundingly, 12% of adults are living with 5 or more chronic conditions(2) including cardiovascular disease, diabetes, obesity, coronary obstructive pulmonary disease and hypertension. A concept people need to understand is that these diseases can be prevented, managed and even reversed with lifestyle choices.

Today, the COVID-19 pandemic has shown a bright light on how our level of health can literally be a matter of life or death. A study of thousands of patients hospitalized with the novel coronavirus in the New York City area found that 94% had one chronic disease and 88% had two or more. The most common conditions included hypertension, obesity and diabetes.(3) In May of this year, the CDC reported that people with an underlying chronic illness had six times the risk of being hospitalized and twelve times the risk for dying.(4)

Boost Health & Immunity

Now is the right time to take small steps to improve health and build immune resilience with daily lifestyle choices. While there isn’t one diet, exercise regimen, or stress-relieving technique that is good for everyone, there are principles to follow that can boost health and vitality at any age.

There is a huge misconception that our genes determine our health destiny. This simply isn’t true. The study of epigenetics shows that we have the ability to change the expression of our genes by the way we think, feel, move and eat.(5) Each of our daily decisions and choices can increase or decrease inflammation in the body, moving us towards disease or back to health.

Acute & Chronic Inflammation

Our immune system uses the ancient, biological pathway of inflammation to protect us against injury and infections.(6) When you cut your finger, immune cells are sent to kill invading bacteria and begin the process of wound healing. This is acute inflammation that goes away in days or weeks when the body is healed.

One the other hand, chronic inflammation lasts a long time, from months to years.(2) It’s basically an abnormal immune response that causes damage to cells, tissues and organs. Oxidative stress plays a big role; it occurs when more free radicals are produced within cells than the body can neutralize.(2)  As you can imagine, when more damage occurs than can be repaired, health problems crop up.

It is now widely accepted that chronic inflammation is at the root of most, if not all, chronic conditions like cardiovascular disease, diabetes, obesity, hypertension, cancer, arthritis and joint disease.(2)

Lifestyle Matters

The good news is that deliberate and healthier lifestyle choices can prevent, manage and even reverse chronic inflammatory disease, the most important cause of morbidity and mortality facing people today.(7) It’s empowering to know that if you have, or want to prevent a chronic disease, you can regain your health and vitality by choosing real whole foods, optimizing sleep, reducing stress, being social, and moving more.

You may be thinking, “How the heck can simple lifestyle decisions address the complexities of chronic conditions?”  The body has an innate ability and intelligence to heal itself. You experience it each time you cut your hand; you wash the wound, put a bandage on and don’t have to think about it.

The research also supports it and I have lived it; by utilizing the power of lifestyle medicine I was able to restore my health from the ravages of chronic Lyme disease. You just need to provide the right environment for healing. This is not an easy task, but it can be done with time, effort and a plan.

Taking Action

Changing your lifestyle habits can feel overwhelming. To help you embrace this challenge, think about this analogy, “How do you eat an elephant?  One bite at a time!”   Any healing journey begins with awareness, learning and exploration; then gradually taking action, one small step at a time.

Start today by exploring lifestyle behaviors that decrease inflammation and can put your health back on track so you can live with less pain, more energy, and greater vitality. A lifestyle prescription to restore health includes:

  • Reducing stress with deep breathing.
  • Getting good quality sleep by going to bed and rising at the same time.
  • Eating a plant-based diet rich in a rainbow of vegetables.
  • Hydrating with filtered water in the morning and during the day.
  • Nurturing relationships and engaging with positive people.
  • Moving well with good posture when performing daily activities and exercise.

Be proactive, make one hour a week to learn more by reading books, researching on PubMed.gov, listening to podcasts, attending lectures and webinars so you can find the strategies and practices that work best for you. As you begin to feel better, you will naturally be motivated to continue learning and making better lifestyle choices because healthy feels so good!

Learn more about restoring health with lifestyle practices!

Register now for Cate Reade’s webinar on this topic. This webinar will give a basic overview of the principles and practices of why and how lifestyle choices can help prevent, manage and reverse chronic conditions.


Cate Reade, MS, RD is a Registered Dietitian, Exercise Physiologist and Functional Medicine Practitioner candidate on a mission to improve functional mobility and health span utilizing the power of lifestyle medicine. She has been teaching, writing and prescribing healthy eating and exercise programs for over 25 years. Today, as CEO of Resistance Dynamics and inventor of the MoveMor™ Mobility Trainer, she develops exercise products and programs that target joint flexibility, strength and balance deficits to help older adults fall less and live more.

 

References

  1. https://www.cdc.gov/chronicdisease/index.htm
  2. https://www.ncbi.nlm.nih.gov/books/NBK493173/
  3. https://www.the-scientist.com/news-opinion/nearly-all-nyc-area-covid-19-hospitalizations-had-comorbidities-67476
  4. https://www.cdc.gov/mmwr/Novel_Coronavirus_Reports.html June 19, 2020
  5. https://www.nature.com/scitable/topicpage/epigenetic-influences-and-disease-895/
  6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6345337/
  7. https://pubmed.ncbi.nlm.nih.gov/23974765/
scale

The Habits of Successful Weight Losers

In a national television interview with Barbara Walters in 2014, Oprah Winfrey confessed that not being able to maintain her weight loss was her biggest regret. In that interview, Walters asked Winfrey to finish the sentence, “Before I leave this Earth, I will not be satisfied until I…”

“Until I make peace with the whole weight thing,” Oprah replied.

Losing weight is hard; keeping it off is even harder. What is unique about those who succeed? The answer is buried deep in the archives at the Weight Control and Diabetes Research Center in Providence, Rhode Island: The National Weight Control Registry (NWCR), the largest database ever assembled on individuals successful at long-term maintenance of weight loss. Founded in 1994, the NWCR includes more than 10,000 individuals who complete annual questionnaires about their current weight, diet and exercise habits, and behavioral strategies for weight loss maintenance.

Habit #1: Live with Intention

Living with intention eliminates the random approach to weight loss maintenance in favor of the systematic and methodical one that leads to results. The NWCR has shown that, when intention is behind weight loss maintenance, 21 percent of overweight people are successful weight losers.[1]

The longer people keep their weight off, the fewer strategies they need to continue keeping weight off.[2] In other words, weight maintenance gets easier. The longer your clients persist in their intention and behave in accord with that intention, the easier it is for that behavior to “stick” and turn into a habit.

What makes one individual persist at a specific behavior while another individual doesn’t? For starters, the persistent individual has a conscientious personality. In the most recent NWCR study published in 2020, conscientiousness was compared between successful weight losers from the NWCR and non-NWCR weight regainers.[3] The successful weight losers were found to be more conscientious than the weight regainers and scored higher on measures of order, virtue, responsibility, and industriousness. The scientists suggest that being conscientious may help individuals maintain their weight loss by improving adherence to specific behaviors.

In a review of 56 studies that contained 58 health behaviors, researchers at Université Laval in Quebec, Canada and the University of Limburg in The Netherlands found that intention remained the most important predictor of health behavior, explaining 66 percent of the variance.[4] In half of the reviewed studies, perceived behavioral control (believing that you have control over your behavior) significantly added to the prediction.

Habit #2: Control Yourself

Being a successful weight loser requires a lot of self-control, delaying gratification now (e.g., dessert) for the more desirable reward later (e.g., a slimmer waistline, better health, enhanced self-esteem, and happiness).

Compared to typical unsuccessful dieters, successful weight losers are better able to resist temptation, control themselves, and push back against the environment. They restrict certain foods,[5] weigh themselves regularly,[6],[7] and use digital health technology.[8]

One of the key factors of self-control is disinhibition, which literally means not being inhibited. Some inhibition is good, because it prevents people from not giving into temptation and eating whatever and how much they want. High levels of disinhibition are bad, because it leads to risky behavior. Disinhibited eating is a failure to maintain control over eating. The opposite of disinhibited eating is dietary restraint. Several NWCR studies have found that increased disinhibition leads to regaining lost weight.[9],[10],[11],[12],[13] Other studies have found strong relationships between a lack of self-control—impulsivity—and obesity.[14],[15],[16]

Habit #3: Control Calories

Successful weight losers consume fewer daily calories than the general population. Table 1 shows the number of calories the NWCR members consume per day, from the several studies that have reported it, along with the amount of weight they lost at the time they entered the NWCR.

Table 1 – Caloric Intake of Successful Weight Losers

  Calories Per Day Pounds Lost
1,381([17],[18])

1,297 (women)

1,725 (men)

66

63 (women)

78 (men)

1,306 (women)([19])

1,685 (men)

63 (women)

77 (men)

1,390([20]) 69
1,462([21]) 124
1,400([22]) 62
1,399([23]) 73
Average

Women

Men

1,406

1,302

1,705

79

63

78

Successful weight losers consume a low-calorie diet of about 1,400 calories per day, with women consuming about 1,300 and men consuming about 1,700 calories per day. By comparison, the U.S. adult population consumes an average of 2,120 calories per day (women consume about 1,820 calories per day and men consume about 2,480 calories per day).[24],[25]

Successful weight losers control calories several ways, including limiting how often they eat out at restaurants,[26] rarely eating fast food,[27] and limiting how many calories they drink.[28] They are also more likely than normal-weight individuals to have plans to be extremely strict in maintaining their caloric intake, even during times of the year when it’s easy to consume calories, like during holidays.[29]

Want to learn about more of the habits of successful weight losers? Register for Dr. Karp’s webinar, Lose It: The Habits of Successful Weight Losers from the National Weight Control Registry


Content from this article is adapted from Lose It Forever: The Habits of Successful Weight Losers from the National Weight Control Registry by Jason R. Karp, Ph.D.

A competitive runner since sixth grade, Dr. Jason Karp pursues his passion every day as a run coach, exercise physiologist, bestselling author of 10 books and 400+ articles, speaker, and educator. He is the 2011 IDEA Personal Trainer of the Year and two-time recipient of the President’s Council on Sports, Fitness & Nutrition Community Leadership award. His REVO₂LUTION RUNNING™ certification has been obtained by fitness professionals and coaches in 23 countries. His new book, “Lose It Forever: The Habits of Successful Weight Losers from the National Weight Control Registry” is available on Amazon.

 

References

[1] Wing, R.R. and Hill, J.O. Successful weight loss maintenance. Annual Review of Nutrition, 21:323-341, 2001.

[2] Klem, M.L., Wing, R.R., Lang, W., McGuire, M.T., and Hill, J.O. Does weight loss maintenance become easier over time? Obesity Research, 8:438-444, 2000.

[3] Gold, J.M., Carr, L.J., Thomas, J.G., Burrus, J., O’Leary, K.C., Wing, R., and Bond, D.S. Conscientiousness in weight loss maintainers and regainers. Health Psychology, 2020.

[4] Godin, G. and Kok, G. The theory of planned behavior: a review of its applications to health-related behaviors. American Journal of Health Promotion, 11(2):87-98, 1996.

[5] Wing, R.R. and Phelan, S. Long-term weight loss maintenance. American Journal of Clinical Nutrition, 82:222S-225S, 2005.

[6] Wing, R.R. and Hill, J.O. Successful weight loss maintenance. Annual Review of Nutrition, 21: 323-341, 2001.

[7] Butryn, M.L., Phelan, S., Hill, J.O., and Wing, R.R. Consistent self-monitoring of weight: A key component of successful weight loss maintenance. Obesity, 15:3091-3096, 2007.

[8] Goldstein, C.M., Thomas, J.G., Wing, R.R., and Bond, D.S. Successful weight loss maintainers use health-tracking smartphone applications more than a nationally representative sample: comparison of the National Weight Control Registry to Pew Tracking for Health. Obesity Science and Practice, 3(2):117-126, 2017.

[9] McGuire, M.T., Wing, R.R., Klem, M.L., Lang, W. and Hill, J.O. What predicts weight regain among a group of successful weight losers? Journal of Consulting and Clinical Psychology, 67:177-185, 1999.

[10] Niemeier, H.M., Phelan, S., Fava, J.L., and Wing, R.R. Internal disinhibition predicts weight regain following weight loss and weight loss maintenance. Obesity, 15:2485-2494, 2007.

[11] Butryn, M.L., Phelan, S., Hill, J.O., and Wing, R.R. Consistent self-monitoring of weight: A key component of successful weight loss maintenance. Obesity, 15:3091-3096, 2007.

[12] Thomas, J.G., Bond, D.S., Phelan, S., Hill, J.O., and Wing, R.R. Weight-loss maintenance for 10 years in the National Weight Control Registry. American Journal of Preventive Medicine, 46(1):17-23, 2014.

[13] Lillis, J., Thomas, J.G., Niemeier, H., and Wing, R.R. Internal disinhibition predicts 5-year weight regain in the National Weight Control Registry (NWCR). Obesity Science and Practice, 2(1):83-87, 2016.

[14] Chamberlain, S.R., Derbyshire, K.L., Leppink, E., and Grant, J.E. Obesity and dissociable forms of impulsivity in young adults. CNS Spectrums, 20(5):500-507, 2015.

[15] Fields, S.A., Sabet, M., and Reynolds, B. Dimensions of impulsive behavior in obese, overweight, and healthy-weight adolescents. Appetite, 70:60-66, 2013.

[16] Amlung, M., Petker, T., Jackson, J., Balodis, I., MacKillop, J. Steep discounting of delayed monetary and food rewards in obesity: a meta-analysis. Psychological Medicine, 46(11):2423-2434, 2016.

[17] Klem, M.L., Wing, R.R., McGuire, M.T., Seagle, H.M., and Hill, J.O.  A descriptive study of individuals successful at long-term maintenance of substantial weight loss. American Journal of Clinical Nutrition, 66:239-246, 1997.

[18] Wing, R.R. and Hill, J.O. Successful weight loss maintenance. Annual Review of Nutrition, 21:323-341, 2001.

[19] Shick, S.M., Wing, R.R., Klem, M.L., McGuire, M.T., Hill, J.O., and Seagle, H.M. Persons successful at long-term weight loss and maintenance continue to consume a low calorie, low fat diet. Journal of the American Dietetic Association, 98:408-413, 1998.

[20] McGuire, M.T., Wing, R.R., Klem, M.L., Seagle, H.M., and Hill, J.O. Long-term maintenance of weight loss: Do people who lose weight through various weight loss methods use different behaviors to maintain their weight? International Journal of Obesity, 22:572-577, 1998.

[21] Klem, M.L., Wing, R.R., Chang, C.H., Lang, W., McGuire, M.T., Sugerman, H.J., Hutchison, S.L., Makovich, A.L., and Hill, J.O. A case-control study of successful maintenance of a substantial weight loss: Individuals who lost weight through surgery versus those who lost weight through non-surgical means. International Journal of Obesity, 24:573-579, 2000.

[22] Klem, M.L., Wing, R.R., Lang, W., McGuire, M.T., and Hill, J.O. Does weight loss maintenance become easier over time? Obesity Research, 8:438-444, 2000.

[23] Ogden, L.G., Stroebele, N., Wyatt, H.R., Catenacci, V.A., Peters, J.C., Stuht, J., Wing, R.R., and Hill, J.O. Cluster analysis of the National Weight Control Registry to identify distinct subgroups maintaining successful weight loss. Obesity, 20(10):2039-2047, 2012.

[24] Wright J.D., Wang, C.Y., Kennedy-Stephenson, J., Ervin, R.B. Dietary intake of ten key nutrients for public health, United States: 1999-2000. Advance Data From Vital and Health Statistics, 334:1-4, 2003.

[25] U.S. Department of Agriculture, Agricultural Research Service. Energy intakes: percentages of energy from protein, carbohydrate, fat, and alcohol, by gender and age. What We Eat in America, NHANES 2015-2016, 2018.

[26] Wing, R.R. and Hill, J.O. Successful weight loss maintenance. Annual Review of Nutrition, 21:323-341, 2001.

[27] Thomas, J.G. and Wing, R.R. Maintenance of long-term weight loss. Medicine & Health Rhode Island, 92(2):56-57, 2009.

[28] Catenacci, V.A., Pan, Z., Thomas, J.G., Ogden, L.G., Roberts, S.A., Wyatt, H.R., Wing, R.R., and Hill, J.O. Low/no calorie sweetened beverage consumption in the National Weight Control Registry. Obesity, 22(10):2244-2251, 2014.

[29] Phelan, S., Wing, R.R., Raynor, H.A., Dibello, J., Nedeau, K., and Peng, W. Holiday weight management by successful weight losers and normal weight individuals. Journal of Consulting and Clinical Psychology, 76(3):442-448, 2008.

adaptive-fitness-wheelchair-fitness

The Importance of Exercise for the Disabled or Handicapped

Everyone must remain active. This is only achievable with the help of exercise. Contrary to popular belief, handicapped people also wish to stay fit and healthy. On the other hand, some of handicapped individuals do not realize the importance of it.

Let’s discuss the importance of exercise for handicapped people.

Prevention of Heart Disease

Exercise can help reduce the risk of developing diseases relating to the heart. This includes high blood pressure, heart attack and ischemic heart disease. Furthermore, exercise is essential for preventing various other medical conditions.

Prevention of Comorbidities

Inactivity is a disease in itself. Being inactive makes the body less productive. This makes them more prone to the development of illness, ranging from something as small as flu to as big as cancer. Disabled and inactive individuals have a higher chance of developing colon cancer and diabetes.

Prevention of Anxiety and Depression

Being inactive and indoors can lead to depression and anxiety. You may feel down most of the time. Exercising releases endorphins in our body. These help in regulating mood; those who exercise regularly experience improvement in their moods.

Alleviates pain

Inactivity can cause harm to your bones and muscles as well. The majority of people suffer from pain in joints and other complications. Stiff muscles are also an additional drawback of inactivity.

Handicapped people who exercise more often do not suffer from these symptoms. They report relief of pain. Furthermore, such people also have faster healing of wounds and injury from trauma.

Clears the mind

Exercising not only helps with our physical well-being. It also aids in improving our mental health as well. Brain fog is a real thing; people can be doubtful about the decisions they make. Exercising helps people to think clearly. They can divert their mind from useless jargon to more productive thoughts.

DO NOT LET OTHERS STOP YOU FROM EXERCISING

Being handicapped has a certain societal stigma with it. The perception of people can often stop you from exercising. Always remember that exercising will only benefit you alone. Don’t worry about what others think!

Conclusion

Being disabled can be a hard thing. But, exercise is an activity that will help you to gain self-esteem. You do not need to start with rigorous workouts.

This journey begins with a single step, time will help you get better in the long run. So what are you waiting for?  Start looking for an exercise regimen that suits you best.

Here’s to your health!


Terrance Hutchinson is the Owner of Your Best Lifestyles Fitness and Nutrition. He is a Certified Personal trainer specializing in Exercise Therapy, Corrective Exercise, Sports Nutrition, and Corporate Wellness. He an author of 3 books, he has his own podcast, he has contributed articles to major newspapers and magazines, Terrance has spoken at health events, webinars, seminars, hospitals, schools, doctors offices and has been featured nationally syndicated television platforms. Terrance has clients in many states and counties and is looking to help others bridge the gap between the medical and fitness industries. To learn more about Terrance, visit yourbestlifestyles.com

diabetes-exercise-feature

How Exercise May Be the Only Way to Curb the Diabetes Epidemic

The incidence rate of type 2 diabetes has been increasing in the United States for the past 40 years.  In fact, the American Diabetes Association estimates that at least half of all US adults (over 65 million people) have pre-diabetes or full-blown diabetes.  It is often underreported on death certificates, and is probably the third leading cause of premature death in the US.

So why is there such an increase in diabetes in this country?  The biggest reason is diet.

From a young age, children are eating processed food. When they enter school – lunchrooms in many school districts are sponsored with food from McDonald’s, Pizza Hut, and Coca Cola.  In college – most dorm food is also like fast food, and they can eat as much as they want. That and their foray into alcohol, and we have the beginnings of obesity, insulin resistance, and pancreatic damage. The very concept of type 2 diabetes used to be called “adult diabetes”.  Since many teenagers are now diagnosed, it’s now time to change the name.

One would say that if diabetes is a disease of the foods that you eat, then simply change the foods you eat. Not that simple. Once you’re diagnosed with diabetes, you become a ward of the medical system. Doctors will perform a lot of tests, take blood, and prescribe both insulin and drugs to mimic the glucose-lowering effects of the body, and many spend a minimal amount of time counseling on the right type of diet for your needs.

There are, in fact, many good diets to lower blood sugar, like the well-known Keto diet, which emphasizes higher fats and low carbohydrates. This is something that doctors have been prescribing in one form or another since the Atkins diet in the 1960s. What about vegetarian and vegan diets?  If you ask Dr. John McDougall, one of the nation’s leading plant-based doctors, he would advocate that a diet higher in plant-based carbohydrates is better for the body than high amounts of meat and cooking oils.

Both may have a point, but if you look at the food choices that most Americans have, they walk into a grocery store, and if they’re not savvy enough to shop on the outside isles (fruits, vegetables, meats, cheeses), they are trapped in an endless cycle of boxed cereals, candy bars, frozen foods, soft drinks and alcohol. It is almost impossible to go to a store and not pick up about 50-75% of food from a box, bucket or bottle.  Many still haven’t put two and two together — that the foods they eat now will have an effect on their physiology and medical status in 5-20 years.

So what’s missing? I have been in an interesting position of working in diabetes research in the 1980s, and watching from the sidelines the work, research, and policy in this area of medical care for the past 30 years. Here are my thoughts.  

First, although exercise is touted as part of the trilogy of treatment for diabetes (along with diet and insulin), it is the first to be discarded for another type of treatment that is expedient and profitable.  

Second, there are little, if any, referrals to the health club sector in order to work on basic exercise programs for persons with diabetes. Even moderate types of programming will results in dramatic drops in body weight (and fat), daily blood sugars, and A1c levels. It simply is not being done. Many in allied health scream that personal trainers and fitness instructors are not qualified to teach exercise programs for diabetes. With the advent of medical fitness over the past 20 years, this simply isn’t the case today. I would think that having a mechanism to get patients into health clubs through their health plan, or Medicare, or a revolving door policy with their physician group, would be an outstanding way to get more patients into the exercise routine.  

Third, people who work in the fitness industry should be looking very carefully in getting diabetic persons into their facilities in their communities. This takes an effort with health club trainers, club managers and company owners to reach out to the medical community through health programs, lectures, fairs and membership discounts in order to get patients in the door.  It may even entail home exercise visits, or online coaching where patients are taught programs, and keep their exercise routines times and exercise notes. 

Lastly, the fitness industry needs to move into the technology realm and look at the effects of exercise on patients both over 3-4 weeks, but also 3-4 years. This will be done through outcomes-based software programs that can be detailed to physicians, health plans, and sports medicine journals. Once the majority of medical fitness centers and health clubs are on board, we will see a changing of the guard in terms of what Americans think is the best type of treatment program to reduce diabetes symptoms, and look at the data of how people exercise, and how many of their health risks are being reduced by a challenging and consistent exercise program. This can be done at any age, and at almost every state of diabetes — whether they are newly diagnosed, or have basic complications that they are dealing with regarding long-standing diabetes. 

It is time to embrace exercise as part of a diabetes prevention and reduction strategy.  If not, in 20 years we will probably see the epidemic at such a high level, that a good portion of Americans will not be able to work due to their complications.  The costs to society will be even higher than they are now. It’s a risk we don’t need to take, because of the untapped market of over 31,000 health clubs in the US, there is virtually no reason not to engage in exercise. It would seem that our nation’s health depends on our next steps – literally. 


Eric Durak is President of MedHealthFit – a health care education and consulting company in Santa Barbara, CA. A 25 year veteran of the health and fitness industry, he has worked in health clubs, medical research, continuing education, and business development. Among his programs include The Cancer Fit-CARE Program, Exercise Medicine, The Insurance Reimbursement Guide, and Wellness @ Home Series for home care wellness.

brain-neurons

Parkinson’s Disease and Exercise

Parkinson’s disease is the second most common neurodegenerative disorder after Alzheimer’s disease.  Unfortunately, the incidence of Parkinson’s disease has not declined, and its impact is seen in all races.  This is due in part to the fact that the population of the world is greater than ever before and increasing. In addition, people are living longer than in previous generations, and the baby boomer generation, one of the largest generations in history, has reached old age.

Risk factors for Parkinson’s disease include:

Age: Risk of Parkinson’s disease increases with age.  The average age of onset for this disease is 55 years and the rate of incidence increases steadily until the age of 90.

Gender: Men have a higher risk for Parkinson’s disease than women.

Family history: Individuals with a family history of Parkinson’s disease are at a higher risk for Parkinson’s disease. Moreover, it is said that those with affected first-degree relatives double their risk of Parkinson’s disease.

Agricultural work: Individuals exposed to pesticides and herbicides have a greater risk of developing Parkinson’s disease symptoms. Drinking well-water and living in rural areas have also been associated with an increased incidence of Parkinson’s disease.

Head Trauma: Head trauma can be a risk factor for Parkinson’s disease as is seen in the case of boxers. One study showed that trauma to the upper cervical region, head, and neck was a risk factor for Parkinson’s disease. However, in some cases it took years for these symptoms to appear.

The exact cause of Parkinson’s disease is unknown.  Regarding the molecular events that lead to the development of this disease, there is still some uncertainty in terms of what causes the neurodegeneration seen in Parkinson’s disease. The current hypothesis is that Parkinson’s disease may result from the interaction between environmental factors and genetic susceptibility.

The primary symptoms for PD are deficiencies in motor performance due to the loss of the dopamine pathways in the brain. Decreased dopamine production in the substantia nigra in the brain causes the 4 primary motor symptoms:

  • Bradykinesia: described as slowness in the execution of movements while performing daily activities.
  • Rigidity or Stiffness: caused by an involuntary increase in tone of the limbs and axial musculature.
  • Resting Tremor: Found primarily in the arms and hands and can be socially bothersome. Resting tremors are less disabling since they often vanish with the initiation of activity (especially in the early stages of Parkinson’s disease).
  • Postural Instability: manifested in a slow speed of walking, shortened stride length, narrowing of base of support, and leaning towards one side.

Exercise should be targeted for the primary motor symptoms with exercise and occupational therapy to improve quality of life. Recommended program components include:

  • Posture, gait, mobility
  • Fall risk reduction
  • Cardiorespiratory health
  • Strength and function
  • Depression and Anxiety
  • Joint health

Exercise prescription for clients with PD includes: (ACSM)

  • An individualized program
  • Cardiorespiratory: use guidelines for healthy adults
  • Muscular Fitness: use guidelines for healthy adults
  • Flexibility: slow, static exercises for all major and minor joints in the body including the upper torso, spine, and neck.
  • Neuromotor Exercises: help with balance, gait, and postural instability. Clinicians use a gait belt or parallel bars to ensure safety depending on the severity of the symptoms.  Include functional exercises to improve ADLs and quality of life.

PD exercise therapy includes intervention with many kinds of exercise modes. Both personal training and group fitness have been successful in helping to manage the disease and reduce the symptoms. There is not strong evidence at this point to show that exercise prevents PD, but it is believed that exercise may play a role.  Exercise is however the mainstay for symptom management and slowing disease development.

 


June M. Chewning BS, MA has been in the fitness industry since 1978 serving as a physical education teacher, group fitness instructor, personal trainer, gym owner, master trainer, adjunct college professor, curriculum formatter and developer, and education consultant. She is the education specialist at Fitness Learning Systems, a continuing education company.

References and Resources:

fitness-exercise-at-home

Exercise is great, but it shouldn’t injure you!

“Many people trying online routines during the coronavirus pandemic are finding it’s not so easy to do them right.” A recent article in the Wall Street Journal, titled “New Home Workouts Come With New Aches and Pains”, has pointed out an unfortunate side effect of folks exercising at home during the pandemic shelter-in-place order.

They are getting injured.

Social media has been saturated with home-based exercise programs as the fitness industry works hard to get, and keep, individuals exercising during this intense, but temporary, period of partial social isolation and staying at home.

We wish we could tell you that under any and all conditions you should always be pursuing exercise because it is always good for you…

It’s not!

“This is chess, not checkers” —Alonzo Harris: Denzel Washington’s Character in the movie, Training Day

Of course, we commend everyone who has made the wise choice to begin and sustain a regular routine of physical exercise.

Exercise is simple, right?

It looks so easy when the trainer and therapists are doing it on the video.

There is a name for the exercise, there is a way it is supposed to be done, you do it, and it helps you!

Right?

Apparently not.

Physical exercise is certainly presented like checkers: a relatively simple and easy game that doesn’t require a lot of skill and deep thinking… some quick fun for the family.

But physical exercise is really more like chess. Chess is a complex game that requires deeper thinking, patience, and skill. So is physical exercise.

Why?

Because the human body is really complicated!

Because exercise places stress on your body.

There are hundreds of muscles, joints, tendons, ligaments, nerves, bones, and on and on.

These structures and tissues have varying properties and tolerances for handling stress.

Some are better at it than others. If you haven’t exposed some of them to the demands of the physical stress of exercise in awhile, or you have had surgeries, previous injuries, or diseases that negatively affect some of your body’s tissues then they just might not be ready.

Instead of being a great thing to do to promote health and wellness, physical exercise becomes a process that degrades it.

But there is a solution.

1 Take honest stock of your own body. Ask yourself some questions:

  • How long has it been since I really exercised and moved the way that an exercise is “supposed” to be done?
  • Have I had injuries or surgeries that could have compromised parts of my system

2. Put the ego aside. Expediency is the wrong mindset for exercise. Physical exercise is a long game.

3. Start slowly and do not assume that because an exercise looks easy it will be.

4. Pay attention to body signals. You’re the expert on your bodily experience. Trust that. If it doesn’t feel right to you stop or modify.

5. Take on the perspective of what is the least amount of exercise I need to do to reach my goal, not the most. Overdosing exercise is the problem.

6. Seek professional guidance and support from a qualified healthcare professional and trainer.

  • Get a thorough pre-exercise assessment to identify any areas of your body that need to be shored up prior to engaging in unrestricted physical exercise.

7. Take Dr. Nicholas DiNubile’s Advice: “The managed dose of exercise that will do the most for you – without harming you – needs to be measured out for you alone.” (1)

If you have been injured while exercising, see your physician to make sure nothing really serious has happened that will require medical attention. When the doctor gets done, and there is no serious problem, seek out an Exercise Professional from the MedFit Network to discuss how we can help measure out the right dose of exercise – just for you – so you can exercise safely and effectively for life.


Co-written by Charlie Rowe and Greg Mack.

Charlie Rowe, CMSS joined Physicians Fitness in the fall of 2007 after spending 9 years as the Senior Personal Trainer at Oak Hill Country Club in Rochester, New York. He has also worked within an outpatient Physical Therapy Clinic coordinating care with the Physical Therapist since joining Physicians Fitness. Charlie has earned the Cooper Clinic’s Certified Personal Trainer, the NSCA’s Certified Strength and Conditioning Specialist, the American College of Sports Medicine Certified Health Fitness Specialist, Resistance Training Specialist Master Level, and American Council on Exercise Certified Orthopedic Exercise Specialist Certifications. 

Greg Mack is a gold-certified ACE Medical Exercise Specialist and an ACE Certified Personal Trainer. He is the founder and CEO of the corporation Fitness Opportunities. Inc. dba as Physicians Fitness and Exercise Professional Education. He is also a founding partner in the Muscle System Consortia. Greg has operated out of chiropractic clinics, outpatient physical therapy clinics, a community hospital, large gyms, and health clubs, as well operating private studios. His experience in working in such diverse venues enhanced his awareness of the wide gulf that exists between the medical community and fitness facilities, particularly for those individuals trying to recover from, and manage, a diagnosed disease. 

References

(1) DiNubile, MD, Nicholas A. Framework: Your 7-Step program for healthy muscles, bones, and joints, 2005, Page xix.