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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!


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.


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. 


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

Smiling elderly woman training in a group

It’s time to play!

I had just returned home from an amazing educational conference in Arizona. Some of the most educated and credentialed humans in the fitness world had come together to share and learn the most up-to-date and evidenced-based systems in the fitness world. My thoughts felt like a bag of ping pong balls had been dropped, bouncing in many directions at once.

I was getting out of my car on the way to get groceries. All the lessons, lectures, and workouts swirling in my mind. I was looking for a common thread. What was the connection to all that I have learned?  Then, I hear this clippity clack clippity clack! I look over my shoulder in the parking lot of a Publix. There was this young girl holding her mother’s hand. She had her princess outfit on, crooked crown, fake jewels and plastic shoes. The shoes skipping on the pavement was the clippity clack sound that made me look. I giggled at the difference between mom’s face, stress, deep thought and worry, and the young girl’s free and happy smile. Then I see them in the store. The young princess was leaping from colored tile to colored tile. I could see the imaginary moat she might be trying to cross while being chased by the creatures below.

I flashback to a seminar and one of the drills I just experienced with Master Instructor, Andy Hainey. Bounding in multiple planes of motion to challenge the athlete’s ability to accelerate and decelerate force efficiently. This beautiful happy princess was naturally doing some of the most advanced programming I flew thousands of miles to study.

BOOM! It hit me. PLAY…. she was PLAYING! The sessions and lessons that shone brightest and stayed with me from the workshops, were those that felt like play. They were technical and evidence-based, and they were fun! No one used jargon or spoke of the sagittal plane or the eccentric phase.  They made it fun.

Benefits of Incorporating “Play” into Your Programming for All Ages

The are many studies of the benefits of play and physical relation between activity in youth populations. The evidence shows a positive relation between physically active youth, and seven areas of cognitive performance (perceptual skills, intelligence quotient, achievement, verbal tests, mathematics tests, developmental level/ academic readiness, and other). Sibley et al., 2003

Playing increases enjoyment and adherence at all ages. It creates a positive reaffirming cycle of success. The more you enjoy something, the more time spent doing it. The more time spent doing an activity, the more skilled you become. The greater the skill level you achieve or the higher the achievement, the more you will enjoy doing the activity. 

We forget what it was like to play as we age with all the responsibilities and stresses we have We are told to put childish things aside. As a “fitness professional” we are blessed to keep playing in many senses of the word. I have spent many hours of my life educating myself and gaining certifications. While I believe that time has been well spent, my clients continually tell me their favorite aspect of our time together is the fun factor.  

Many feel as though they haven’t repeated a workout ever. This is not the case. I do follow the NASM OPT model. It is a progressive system that can be applied to every aspect of fitness training. Our body has a miraculous ability to adapt to specific demands placed on it. That is my primary guide to programming for my clients. Once we establish their baseline abilities through comprehensive assessments, and what goals they want. Then we create the program based on the S.A.I.D. principle (Specific Adaptation to Imposed Demands). The assessments many times feel intimidating and clinical and set that as the tone for you and your client.  If we as trainers and coaches make the assessments fun and non-intimidating games (I use the term drills in place of games for my adults many times) or play, we can start creating a positive nurturing environment for our clients.  Don’t just show them where they are deficient. Let them show and celebrate what they are capable of.

Bottom line is, have fun and play! You will enjoy every session. Your clients will look forward to each session. They will give their all and get better results.  Keeping clients training is one of the most challenging parts of what we do.  Embrace your inner child, and theirs. Get them to hop from stone to stone in monster infested waters or bring out the agility ladder. Either way just play!

Coach Pete Guzman is a NASM Master Trainer with CES, PES, YES, CNC, SGPT MMACS and 4th degree Black Belt. Look for his upcoming seminar in June to find out more about youth programming and adding fun to your clients’ journeys.


Taking it Slow. Not Every Fitness Goal Needs to Be Fast and Hard.

Go big or go home? We all want to see fantastic results from our hard work and dedication to any fitness program. If we maintain nutrition, eat well and work as hard as we can, we are going to see results: that is inevitable. But, do we have to train as hard as possible each and every time we workout, each and every day? Sure, we fit in a rest day, but what else can we do to make sure we are restoring our bodies and minds?

Fitness goals are most easily reached when they are part of every aspect of our lifestyle and not compartmentalized into a few hours of the day. We have limited energy sources no matter how healthy we are, so it is important to maintain awareness about how each of our decisions & actions influence our wellness and choose accordingly.

From a physical aspect, we can slow down some of our workouts to build strength. This works in a variety of ways. By increasing resistance, continuing muscle exertion over a period of time and working muscles beyond the support of initial momentum, strength can be gained, even with relatively light weights or by using the weight of the body alone. This can be true of some weight training programs and is something you can discuss adding to your fitness routines with a certified personal trainer. It is also one of the key elements of building strength through yoga practice and asanas (yoga postures). An additional consideration from a holistic health perspective is the effects of the stress hormone cortisol on weight loss. By taking part in calming physical activities such as restorative, gentle, yin and meditative yoga practices, it is possible to reduce stress, allowing the body to shed weight, heal and be at top capacity for more intensive strength and cardio training when you are working with your personal trainer or in other group fitness programs. By taking time to slow down, you can actually optimize performance and fitness results.

Nourishing your mind can also come in handy, as a way to promote your health when you are not busy exercising or working. Take time to read, learn, talk with fitness experts, organize your time and plan your meals. A wealth of free information is available online to support you in your fitness goals. Blogs with entries from personal trainers and other fitness experts are a great place to start, like the MedFit Network blog. Many personal trainer certification organizations (like ISSA or ACE) also maintain blogs with a variety of advice for personal trainers and fitness enthusiasts. You may also get inspired and decide to take your fitness goals one step further. Once you get involved learning more about fitness, biomechanics and how amazingly capable your body is, you may even get inspired to become a personal trainer or group fitness instructor yourself!

No matter where you are at in your fitness journey, don’t forget to take some time for yourself. Slow down sometimes to speed up your progress!

John Platero is the founder of National Council of Certified Personal Trainers (NCCPT) which has certified thousands of personal trainers both nationally and internationally.

Article reprinted with permission from John Platero.

Fitness parners in sportswear doing exercises at gym. Fitness sp

The Perils of Taking the Easy Way Out When It Comes to Fitness

We are by nature lazy creatures. We try to get by with as little effort as possible; we love to minimize work but maximize enjoyment. Sadly, this concept applied to exercise can have severe consequences to our bodies. 

Weak links, in essence, are parts of our bodies that are not as strong as the others. Logically, it would make sense for us to strengthen these weak links in order to build our bodies as a whole. 

However, our bodies usually choose to perform a movement with the least amount of effort and resistance. If one of our muscles is weak, instead of activating it, our body will compensate or cheat by making the other muscles around it work harder to complete the movement. 

This results in strong muscles growing stronger, and weak links growing weaker. The only way to overcome our cheating tendency is to consciously activate our weak links and establish proper movements. 

Once fundamental movements are established, only then can you add in other factors such as strength, endurance, speed, agility and athletic skills, which will help play a big role in improving performance and injury prevention.

A chain is only as strong as its weakest link

There’s no point building big muscles if your joints, tendons, and bones can’t stand the strain. Instead, it is wiser to first build your foundation — and for many people, that means revisiting the weakest parts of your body. 

Perhaps it came from a previous injury, or maybe it’s just a muscle you didn’t pay attention to previously. Whatever the case, tending to your weakest link will lay the necessary groundwork for true fitness. Skip this step, and you may end up doing yourself more harm than good. 

It’s not just limited to gym-goers who overload their muscles by lifting too much weight. In fact, women who are supposedly “flexible” and great at yoga can get into trouble too. On one hand, the gym-goers are building strength without flexibility; on the other hand, yoga enthusiasts are pushing the limits of their stretches without increasing their strength. This can result in joint laxity (looseness of joints) that makes them vulnerable to injury. 

Weak links due to injuries

Some of you reading this right now may have suffered injuries before, whether major or minor. And most of you would be able to relate to the fact that you never feel the same after an injury. The weak links caused by injury are often hard to repair and can lie dormant for a long time before resurfacing to cause discomfort and pain. 

That’s why it is important to identify your weak links. Even if you’ve never been injured, there are other factors that may cause weak links: 

  • old injuries that you were unaware of
  • surgery
  • poor movement
  • incomplete rehabilitation
  • alignment issues
  • muscle imbalances
  • aging
  • mindset
  • genetics 

As you may realize, weak links are not always caused by outward injuries, but may also develop due to intangible factors like age, mentality and physical habits. 

Nevertheless, many people suffer because they do not rehabilitate completely from an injury. A lot of people go through physio and recovery program, but stop once they reach 80% wellness. However, it’s at this stage where it’s the easiest to experience re-injury. Instead, it’s always better to achieve 110% fitness before you go back to your usual workout or sports routine. This ensures your weak link has been strengthened and prevents injury from occurring easily. 

Getting fit the right way

Ultimately, your body is unique. Although most of us want to go straight to training like Arnold, or run like Usain Bolt, our body has its own sets of strengths and weak links that need to be addressed individually first. And the best way to do that is through a personally tailored corrective exercise program, measured out specifically for you. 

The shortcut to fitness is doing it right in the first place.

Ke Wynn Lee, author and an international award-winning corrective exercise specialist, currently owns and operates a private Medical Fitness Center in Malaysia. Apart from coaching, he also conducts workshops and actively contributes articles related to corrective exercise, fitness & health to online media and local magazines.


Be Physically Active to Boost Your Immune Response

In these challenging times, if we only could get a medication that would boost our immune system and response to viruses, lower all stress associated with still being in a pandemic, and treat most of the pre-existing health conditions that are associated with a higher risk of dying from COVID-19, we would all be lined up for it! Guess what? We already have something that does all these things already—and that is physical activity.

Let’s consider its impact on how well your immune system works. While physical activity can boost your immune function, here’s what else we know about the immune system and all the lifestyles factors we can manage:

Exercise: A single workout may temporarily suppress your immune system, but chronic training (assuming it is not excessive) boosts immunity to the common cold, other viruses, and a whole host of pathogens (1). Being regularly active generally makes you less likely to get sick.

Stress: Any type of stressor, be it physical or mental, can weaken your immune system, most commonly through increases in levels of the hormone cortisol and other factors (2). Exercise overtraining raises cortisol levels and can make you more likely to catch a cold or the flu.

Sleep: Lack of sleep—particularly deep REM sleep—and short sleep duration cause a rise in cortisol levels that can dampen immune function (3). Many people with type 2 diabetes and overweight/obesity also have sleep apnea that interferes with getting quality sleep, making them more susceptible to getting sick. Better management of all of these conditions helps.

Nutrition: Chronic malnutrition lowers the ability of the immune system to function optimally. Low levels of vitamin D (which acts as a prohormone) in the bloodstream has also been tied with lower immunity, and many people with diabetes and older adults have low vitamin D status. Getting adequate vitamins, minerals, and calories in your diet can boost your immunity.

Alcohol: While a moderate intake of alcohol may give you some health benefits, abuse of alcohol suppresses your immune system (4). “Moderate” is one drink per day for females, two for males—and there is no rollover from one day to the next if you miss one!

Smoking: Tobacco smoking increases inflammation and lowers immune function, and it may also lower your immune response to certain vaccines. Quitting smoking can help restore immune function.

We also need to discuss how our bodies react to vaccinations. All of us are facing possible vaccination for COVID-19 once we all can get access to the many safe and effective vaccines that are now slowly being distributed around the US and the world. You may be, like I was previously, assuming that vaccines work the same for everyone. In reality, there is no guarantee of a universal and equally protective response, and a whole host of factors (inside your body and out) can impact how well a vaccine actually works for you (5). Not surprisingly, all of the lifestyle factors listed above can impact the strength of your immunity post-vaccination, and making improvements in any/all of them can help. But your age can also have a negative effect.

COVID-19 is unlikely to be the last threat to our collective health, so it is worth discussing why we are more vulnerable to threats to our immune system as we get older. For starters, older adults have a less robust immune response to everything, including strains of influenza, and they suffer from a more rapid waning of antibodies. Basically, our immune systems are getting less robust and effective as we age—and that potentially impacts our response to vaccines. 

Generally, older adults have a lesser immunity to any virus that they have been vaccinated against, and that will likely include the current global coronavirus once a vaccine is available. However, engaging in regular aerobic training improved flu vaccine responses in a group of older adults who had been previously sedentary (6): participants who did a regular moderate-intensity physical activity like brisk walking were 30 to 100 percent more likely to have an antibody response sufficient to keep them from getting the flu. Although research on this topic remains limited, exercise is likely to help boost the immune systems in people who are currently sedentary and start being active.

Other confounding health issues may make immune responses weaker when you are exposed to a virus or vaccinated. For instance, many seniors with diabetes develop kidney disease requiring dialysis. In these individuals, many fail to have an adequate immune response when given a vaccine for hepatitis B; how well it works depends on their age, how long they have been on dialysis, their diet, and other factors (7). In children (and adults) with type 1 diabetes, certain vaccines have been shown to be less effective, particularly when they also have celiac disease and consume gluten (8).

So, what can you do? Fight back by adopting the healthiest lifestyle that you can—one that includes being regularly moderately active—and stay as healthy as you can for when the next virus comes along. Protect yourself with a daily dose of exercise!

Sheri R. Colberg, PhD, is the author of The Athlete’s Guide to Diabetes: Expert Advice for 165 Sports and Activities (the newest edition of Diabetic Athlete’s Handbook). She is also the author of Diabetes & Keeping Fit for Dummies, co-published by Wiley and the ADA. A professor emerita of exercise science from Old Dominion University and an internationally recognized diabetes motion expert, she is the author of 12 books, 30 book chapters, and over 420 articles. She was honored with the 2016 American Diabetes Association Outstanding Educator in Diabetes Award. Contact her via her websites (SheriColberg.com and DiabetesMotion.com).



  1. Cerqueira É, Marinho DA, Neiva HP, Lourenço O. Inflammatory Effects of High and Moderate Intensity Exercise-A Systematic Review. Front Physiol. 2020 Jan 9;10:1550. doi: 10.3389/fphys.2019.01550. PMID: 31992987.
  2. McEwen BS. Central effects of stress hormones in health and disease: Understanding the protective and damaging effects of stress and stress mediators. Eur J Pharmacol. 2008 Apr 7;583(2-3):174-85. doi: 10.1016/j.ejphar.2007.11.071. PMID: 18282566.
  3. Vgontzas AN, Zoumakis M, Bixler EO, et al. Impaired nighttime sleep in healthy old versus young adults is associated with elevated plasma interleukin-6 and cortisol levels: physiologic and therapeutic implications. J Clin Endocrinol Metab. 2003 May;88(5):2087-95. doi: 10.1210/jc.2002-021176. PMID: 12727959.
  4. Rodríguez-Rabassa M, López P, Sánchez R, et al. Inflammatory Biomarkers, Microbiome, Depression, and Executive Dysfunction in Alcohol Users. Int J Environ Res Public Health. 2020 Jan 21;17(3):689. doi: 10.3390/ijerph17030689. PMID: 31973090.
  5. Zimmermann P, Curtis N. Factors That Influence the Immune Response to Vaccination. Clin Microbiol Rev. 2019 Mar 13;32(2):e00084-18. doi: 10.1128/CMR.00084-18. PMID: 30867162.
  6. Woods JA, Keylock KT, Lowder T, et al. Cardiovascular exercise training extends influenza vaccine seroprotection in sedentary older adults: the immune function intervention trial. J Am Geriatr Soc. 2009 Dec;57(12):2183-91. doi: 10.1111/j.1532-5415.2009.02563.x. PMID: 20121985.
  7. Udomkarnjananun S, Takkavatakarn K, Praditpornsilpa K, et al. Hepatitis B virus vaccine immune response and mortality in dialysis patients: a meta-analysis. J Nephrol. 2020 Apr;33(2):343-354. doi: 10.1007/s40620-019-00668-1. Epub 2019 Nov 7. PMID: 31701375.
  8. Opri R, Veneri D, Mengoli C, Zanoni G. Immune response to Hepatitis B vaccine in patients with celiac disease: A systematic review and meta-analysis. Hum Vaccin Immunother. 2015;11(12):2800-5. doi: 10.1080/21645515.2015.1069448. Epub 2015 Sep 17. PMID: 26378476.

Dementia Doesn’t Invalidate Exercise Needs

With careful capability assessment and appropriate program design, exercise regimens can improve walking, balance, and flexibility and reduce falls in patients with dementia.

“Ruth, sit down! Don’t get up on your own.”
Who is that? Why is she yelling at me? I need to get up. My legs are stiff and I want to go for a walk.

“Ruth, stop getting up. You’re going to fall.”
Stop yelling at me. Who are these people? I feel so anxious. All I want to do is go for a walk. Why can’t I just go for a walk? I have walked by myself my whole life.

In working with older adults, many of us have witnessed circumstances similar to this. Often staff wish to maintain the safety and security of individuals living with dementia by limiting their independent mobility and ambulation. But are we truly protecting these individuals who are at risk? What are the ramifications of our actions? Movement and mobility are important foundations to maintaining strength, balance, flexibility, and continence; reducing anxiety and depression; and maintaining social relationships.

To this point, the positive impact of exercise in older adults is well documented in the literature. Exercise programs have been found to result in more favorable physical, social, and emotional health status and fewer activities of daily living impairments in the elderly.(1) These optimistic results provide support for older adults’ exercise groups to improve quality of life and reduce the burden of care for at-risk populations, including those with dementia.

While many focus on the cognitive effects of dementia, the physical aspects are also pronounced. Frequently noted are gait changes including a decrease in step length, step height, and reduction in cadence. These are compounded by balance deficits associated with a reduction in coordination, proprioception, and vision. To further aggravate the situation, the physical effects also can result in expressive and receptive communication deficits. As a result, patients living with dementia can have difficulty communicating these issues, as well as pain.

Effects of Exercise on Individuals With Dementia

Randomized controlled trials of patients with dementia or mild cognitive impairment have indicated improved cognitive scores after six to 12 months of aerobic exercise when compared with a sedentary population.(2) Other benefits associated with aerobic activity include the reduction of osteoporosis and fracture risk,(3) as well as a reduction in mortality risk.(4) Aerobic activity has also been noted to have other beneficial effects on secondary diagnoses associated with dementia including depression,5 anxiety,6 and behavior management.(7)

While the exact causative reasons for these beneficial outcomes are not fully understood, many studies favor the view that the cerebrovascular benefits exercise has on other body systems can be applied to the neurodegenerative process of dementia. Furthermore, evidence exists that aerobic exercise reduces the progression of the neurodegenerative process through facilitation of neuroprotective factors and neuroplasticity.(8)

The positive effects of exercise have also been found in individuals living with dementia who are already experiencing negative physical outcomes. Toulotte et al studied the effects of physical training on frail patients with dementia with a history of falls.(9) The training group was noted to have improved walking, flexibility, and balance, and a reduction in falls. Furthermore, Huusko et al evaluated the impact with hip fracture patients who also had mild/moderate dementia. Those who received intensive rehab were found to have shorter lengths of hospital stay and greater ability to return to the community than those in the control group.(10)

Developing an Exercise Prescription

Regardless of the reasons behind the beneficial effects of exercise on individuals with dementia, it’s necessary to evaluate each patient individually before initiating an exercise program. This includes an interdisciplinary review of an individual’s age, prior exercise involvement, and comorbid medical conditions. Based on the findings, an appropriate exercise program can then be initiated using the American Heart Association’s recommendation of 150 minutes per week of moderately strenuous physical activity.(11) These minutes of exercise can be divided over any number of days per week and with any number of sessions per day. For patient tolerance purposes, these sessions are often kept to between 15 and 30 minutes.

What type of exercise is appropriate for a patient to perform? For individuals with dementia, similar to those without, it is important to focus on their interests. Understanding these interest levels requires investigation. For some patients, this investigation may be complicated by apathy, aggressive behaviors, pain, and communication difficulties.

Depending on the severity of the disease, a focused understanding of a patient’s short- and long-term memory recall is necessary. While older adults without dementia may have a strong recall of their short- and long-term interests, this may not be true of an individual with dementia. Therefore, for those with intact long-term memory, we need to obtain the relevant information. Maybe interests include running, ballroom dancing, bowling, bicycling, gardening, or swimming. If patients can’t physically perform these activities, should we just give up? Of course not. We need to improvise. For example, ballroom dancing may now require walkers, or bicycling may need to be on stationary recumbent bikes with scenery posted around the bicycle.

Case Study

Ms. T is a 53-year-old female who presented to the Hebrew Home at Riverdale skilled nursing facility with a diagnosis including vascular dementia. Prior to initiating a therapy-based warm water program, Ms. T required intermittent assistance walking with a rollator. Her cognition was limited to the point that she could not participate in interviews on the Minimum Data Set (MDS). Despite significant staff efforts to minimize any emotional or environmental disturbances, she experienced periods of agitation. She completed a standardized assessment of her mobility, utilizing the Timed Up and Go (TUG) assessment, completing it in 32 seconds.

At that time, a land- and water-based exercise program with a three-days-per-week frequency was initiated with a physical therapist and dance movement therapist. The hypothesis behind this program was that through the use of multiple therapeutic modalities, gains in strength, balance, cognition, emotional support, and socialization would be achieved. Strength, balance, and functional tasks including ambulation with buoyancy in multiple planes, rotational activities, plyometrics, and resistive activities were implemented. For cognition, behavioral management, and emotional support purposes, music, singing, mental imagery, and floatation were incorporated into individual sessions.

After two months of participating in this innovative program, Ms. T was walking independently without an assistive device. She had also demonstrated an improvement in TUG assessment, completing the test in 10 fewer seconds. Additionally, Ms. T was noted to have experienced an improvement in her cognition, as she was now able to participate in interviews for the MDS. Most meaningful was that Ms. T rediscovered her smile. Tenaya Cowsill, MS, R-DMT, LCAT-P, reported that “this program has been an incredibly meaningful source of joy, autonomy, and pride” for Ms. T.

The Power of Dance

Dance/movement therapy (DMT) is an evidence-based movement approach to psychosocial health and well-being. The American Dance Therapy Association defines DMT as “the psychotherapeutic use of movement to further the emotional, cognitive, physical, and social integration of the individual.”(12) Therapists are board-certified licensed mental health professionals who use movement as a tool to explore, support, and strengthen clients’ emotional needs and coping mechanisms.

DMT can result in both positive physical and emotional outcomes, including a “sense of community, decreasing the experience of emotional isolation, and enriched relational interaction.”(13) Because this modality comprises both verbal and nonverbal interventions, it is especially appropriate for older adults with memory loss who are affected by the expressive and receptive communication difficulties.

The American Dance Therapy Association describes the emotional benefits and processes in treatment for older adults. “Individuals’ capacities and incapacities are explored, and accompanying feelings are expressed. Mourning, frustration, joy, and laughter can be ritualized in group movement, allowing for emotional release and group bonding.”(14)

The physical benefits of exercise and movement have been detailed in previous sections of this article. DMT, which places a focus on mental and emotional health, provides additional benefits as its holistic process includes “physical activity or exercise [and also] … learning, attention, memory, emotion, rhythmic motor coordination, balance, gait, visuospatial ability, acoustic stimulation, imagination, improvisation, and social interaction.”(15)

Older adults, especially those living with memory loss, may struggle with coordinated movement due to changes in brain functioning. Dance therapy welcomes all levels of functioning, encouraging engagement from an individual’s baseline, wherever that may be.

The creative, fluid, psychodynamic process allows for relatedness and engagement with multiple levels of functioning. A primary practice of a dance/movement therapist is one of embodied mirroring defined as the “somatic attunement of the therapist in face-to-face engaged interaction,”(13) which physically communicates to individuals living with memory loss that they are seen and understood. In a time when communication is often impaired, embodied mirroring provides an important tool for validating a patient’s experience.(15) As clinician Kalila B. Homann, MA, LPC-S, BC-DMT, wrote, “Mirroring is practiced by the therapist in DMT as a way to enhance emotional resonance between a therapist and patient … when a therapist mirrors the client’s emotional movements, the therapist is communicating this understanding and acceptance nonverbally.”

On a neurological level this intervention activates the brain’s mirror neuron system. From the neuroscience lens, mirror neurons are thought to be the determining factor in our capacity for empathy and interrelatedness.(13,16) This neurophysiological process “coordinates auditory and visual perception of nonverbal communication by tracking movement and expression in others—replicating the patterns of activation in the brain of the observer.” A resident with memory loss thus experiences validation on a neurobiological level. In dementia, because of the changes in communication that often occur due to brain deterioration, the benefits of emotional attunement from a therapist cannot be overstated. This need for witnessing and validation is a basic human need that does not change with dementia.

Case Study

Ms. M was a 92-year-old woman living in a skilled nursing neighborhood at the Hebrew Home at Riverdale. She carried a diagnosis of mild memory impairment and was a vibrant and active member of the community. She expressed and demonstrated a love for music. She would ambulate throughout the home with her walker, attending a wide variety of programs and actively socializing.

After suffering a stroke, her life shifted. She became reliant on a wheelchair for mobility, and her speech, gait, balance, and cognition were all impaired. This medical event also triggered an exacerbation of major depression, something she had lived with throughout her life. Through working with the rehabilitation team, she demonstrated improvements in functioning; however, major depression remained an impediment to treatment. As her therapy was reaching completion, she was transitioned via a warm handoff to DMT twice weekly from her wheelchair.

During group sessions, she presented with bright affect and eye contact, which was supported and validated by the therapist facilitating the group. In the therapeutic group space, Ms. M was able to both verbally and nonverbally express her grief and frustration with her condition. She spoke about her depression and was able to verbally and physically process her feelings through creative expression within the therapeutic alliance. Ms. M was able to “engage physiological processes related to emotion and make them more available to the conscious mind,” as Homann’s writings suggest. Through increased awareness Ms. M was able to more fully process and express her depressive symptoms, enabling her to further her treatment.

As dance therapy progressed, Ms. M began to increase her interpersonal relatedness, making eye contact with peers, sharing memories and physical gestures of connection. Ali Schechter, LCAT, R-DMT, her dance/movement therapist, states: “[Ms. M’s] movement generates vitality which results in expression.” Through the therapeutic alliance, this expression was validated, supporting Ms. M’s improved mood state.

As her mood state improved through DMT, Ms. M expressed the desire to begin standing and walking again. In addition to mood state support, DMT focused on movement of the spine, core, and hips, aiding in body strengthening for standing. The interdisciplinary team referred her for further physical therapy, and she began standing and, at times, walking with her walker for short periods. She continues to be an active participant in DMT sessions.

Blending Therapy Modalities

Maintaining and improving fitness and well-being remains an important evidence-based practice in our society. This is further magnified for older adults, especially those living with dementia. While the benefits of fitness programs remain the same for this population, the prescription for achievement may require a blended approach. Therapies, inclusive of physical and dance/movement, share many common strengths and goals. Therefore, the ability of these modalities to partner provides opportunities for improved mental, physical, and emotional health. The goal in all treatment is the well-being of residents, and care teams should use interdisciplinary tools and modalities toward that goal.

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This article was featured in Today’s Geriatric Medicine.

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This article was featured in the March/April 2018 issue of Today’s Geriatric Medicine (Vol. 11 No. 2 P. 14). Written by David Siegelman and Mary Farkas.

 David Siegelman, PT, RAC-CT, is the vice president of rehabilitation at the Hebrew Home at Riverdale in Bronx, New York. In this role he oversees the operation of the short-term rehabilitation units, clinical documentation and reimbursement department, and rehabilitation department. Having entered the field as a physical therapist, he has demonstrated expertise in clinical and systems management in acute care hospitals and skilled nursing facilities over the past 20 years.

Mary Farkas, RDT, LCAT, CDP, is the director of therapeutic arts and enrichment programs at the Hebrew Home at Riverdale. She is a licensed creative arts therapist who specializes in the intersection of dementia, end-of-life care, and mental health.



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Walking Off the Plank or Getting to the Core of the Matter

The ubiquity of planks in gyms and exercise videos has denigrated it to the level of a ‘fad’.

Once the newcomer to fitness – about 20 years ago – it is now so common as both an exercise of choice for almost all kinds of athletes and people and as a standard of achievement for those with too much time on their hand that it has lost its sheen so far as I’m concerned.

Now don’t get me wrong: the plank, both the front plank and the lateral or side plank, is a valuable tool in the hands of a competent personal trainer or fitness instructor… or therapist. But a little history might put it in perspective as I go on with my thesis here.

For the uninitiated, low back pain vs 6-pack abs has been the main driver of abdominal muscle training. Prior to the early 1950s, most people who did ab work – for it was not yet understood as the ‘core’ – were athletes, particularly boxers and soldiers. The latter group did them both to fulfill some concept of total body strength (in addition to push-ups, pull-ups, and other calisthenics) and to torture recruits. The former did them to protect against the pounding of their opponents in the ring.

But in the early 50s, two docs, Williams and Kraus, came up with an ab routine to help those with what was then and would still be called non-specific back pain (NSBP). They determined that the sedentary world of office workers was the cause of so many new chronic complaints of low back pain (LBP). Thus they developed what came to be called the Williams flexion exercises: sit-ups (crunches had yet to be developed), oblique sit-ups, and knee-to-chest and other hamstring stretches among some other exercises.

As our understanding of LBP improved over the decades, with better diagnostic tools available to physicians, it became more specific rather than non-specific. Thus, disk problems were better understood and new therapies evolved. Hence was born the McKenzie protocol. These exercises were extension-based, with the yoga cobra stretch designed to push the disk forward away from the spinal nerves and supermans, bird dogs, and the elimination of all flexion exercises until further notice becoming the new, vogue protocol.

While these did little for the abs, they worked the back muscles and introduced, although the term had yet to be applied, the core.

In the mid-1990s, some physiotherapists came up with an exercise designed to help those with a very specific LBP, that is, spondylolisthesis, and spondylolysis-related pain. The researchers qua therapists had determined that the small, intrinsic muscles of the mid-section – the transverse abdominis (deep within the abdominal wall), the multifidi (which span 3 vertabrae) and the rotatores (which span 2 vertabrae) – tended to be atrophied in those with spondylo issues. These muscles also did not respond to voluntary movement in a timely fashion. Thus they created what has become known as the navel drawing-in maneuver, a technical procedure that takes time to learn but had proven itself quite useful for patients.

So, while these exercises did little for the larger, external muscles we can see in the mirror, they did what they were supposed to do for those deeper – what are called the local – muscles that stabilize an inherently unstable spine: try to stabilize it.

Why am I going through this history of ‘core’? Because in the late 1990s, Dr. Stuart McGill started touting the planks, front and side, as ways to strengthen the global  – the large external, visible – muscles that lock the spine in position. His research is compelling but, more than that, it’s exciting. Doing the navel drawing in maneuver of spondylo problems is worthwhile for those problems, but you can’t incorporate them as easily into a hard-core group or individual exercise program… and you can’t measure improvement as easily as you can with a timed plank.

Which brings me to the topic at hand: how long do you have to be able to hold a plank to derive benefits?

A Runner’s World article addressed this not so much from a scientific standpoint as from a practical and pragmatic one. Whereas many in the fitness world brag about helping clients get to, or themselves doing, 60 second or longer planks as if that’s a big deal, this article questions such valuations.

First, we should ask, why plank? If it’s for ab strength, cool — but the longer you do it, the more it’s about endurance, not strength. If it’s for ab look, or definition, cool — but then nearly anything would work as well, although one should cut one’s food intake enough to shed fat overall. That way the muscles you have – and you all have them – are more noticeable.

If it’s for core strength and function, cool – but how much of our daily lives occur in a prone position hovering off the floor a few inches? (Caveat: planks are generally non-functional, like crunches, because of their positioning, but it’s possible that a vigorous and healthy sex life is improved with both front and side plank capabilities!)

Nonetheless, for whatever reasons you’ve incorporated planks into your life, or workout styles, the ultimate benefit of the plank is for spinal stability. In other words, they were designed and studied and promoted to help those with LBP issues. They may help in almost any and all types of LBP but they may need modification according to one’s abilities and pain instigators.

Studies have shown a benefit to young athletes at the college level if you can hold a front or side plank for 100-120 seconds. While these are pretty substantial numbers, they alone won’t confer complete security against low back issues. In other words, the data is correlative, not predictive. Planks can be corrective but doing them longer does not mean you are even more secure against LBP.

As the article mentioned above notes, doing shorter planks (10-30 second) but more of them may be sufficient for both pain and injury prevention as well as function even if you operate standing or seated in your sport or daily life. These shorter planks may give you that six-pack and side torso look you seek, assuming you have a lean midsection overall.

And they may even be useful in such injury prevention programs for athletes whose knees and ankles are at risk as well as in the elderly when it comes to fall prevention.

My model for them, as a side note, is to do them briefly but quickly. That is, to ‘pop’ up into the plank position but hold for 5-10 seconds. The idea is to be able to quickly engage these powerful support muscles as they would be needed for real life – in a coordinated and rapid firing to support the spine as it goes through its often large and dangerous positions in life and sport.

This is what I gleaned from a study Dr. McGill reported years ago at an ACSM meeting in Nashville. Comparing the muscles that fired in the hips and torso of a football player and an exercise science Master’s Degree student, he found the former engaged all the correct stabilizing muscles simultaneously and at the right time during a plyometric push-up. The grad student fired off the same muscles but not in a coordinated manner, suggesting that maybe his spine was not quite as rigid during this vigorous endeavor.

So now, after reading all this, I hope you understand that I’m not discouraging planks. I’m simply reinforcing their value by making them effectively, easier.

Short and sudden planks will give you good tone, good muscle strength and endurance… but also good power and better function, with which to manage and prevent low back pain.

Article originally printed on stepsfitness.com. Reprinted with permission. Images courtesy of STEPS Fitness.

Dr. Irv Rubenstein graduated Vanderbilt-Peabody in 1988 with a PhD in exercise science, having already co-founded STEPS Fitness, Inc. two years earlier — Tennessee’s first personal fitness training center. One of his goals was to foster the evolution of the then-fledgling field of personal training into a viable and mature profession, and has done so over the past 3 decades, teaching trainers across through country. As a writer and speaker, Dr. Irv has earned a national reputation as one who can answer the hard questions about exercise and fitness – not just the “how” but the “why”. 


Immunity in Question

When I was in graduate school, cardiac rehab was THE big issue in exercise science. Most graduates who wanted to work in clinical chose cardiac rehab as their mainstay. However, much of the discussion about the medical benefits of exercise changed in the late 1980s when Dr. David Nieman from Appalachian State University published the first in a series of reports on exercise and the immune system. In my opinion, Dr. Nieman changed the conversation on exercise as his research looked at one of the first biological mechanisms for change in the body due to acute and chronic exercise.

The State of Immunity

Why are we discussing exercise and the immune system? Because thirty years and hundreds of papers on the effects of exercise on immune enhancement, we are still as a nation not educated (let alone convinced) that exercise should be a mainstay of maintaining and improving overall health – especially in persons with infectious disease.

Let’s look at some of Nieman’s work. First, Dave was a marathon runner, who noticed that after long races he and his friends felt “drained” and some came down with colds. He took blood samples pre- and post-marathon race and found on numerous occasions that specific immune cells such as lymphocytes dropped dramatically after races – leaving persons (himself as well) more likely to come down with colds. So, his response was to train accordingly and get plenty of rest in days after races.

His second area of research looked at the chronic effects of exercise on the immune system, such as white cells, natural killer cells, and other specific immune groups. His conclusion after his research is that exercise does stimulate immune cell function, and this may help in persons with cancer (immune damage due to chemotherapy), and other metabolic diseases.

Today’s Immunity

Over this same 30 years the nation has gotten fatter, lazier and sicker. To the point where many people have no idea that their diet and exercise regimens can actually improve their immune function – so they resort to medications.

Today we are faced with a COVID infectious disease, where many people literally fear for their lives. The crux of this report isn’t to cherry-pick statistics, or to point fingers, but the bottom line is that persons who are physically fit suffer much less severe symptoms of COVID, the flu or other infectious diseases than sedentary counterparts.

The immune system is one of the strongest areas of biology that cement the strength of regular exercise. Along with changes in blood chemistry and telomere length, immune changes represent one of the foundations of clinical exercise benefits for young and old. Especially old.

Why Americans Should Start Exercising

Physical fitness has been left out of the discussion relating to COVID. This, along with proper nutrition and supplementation are not only NOT mentioned in the media, but many are disregarding the basics in favor of specific medical therapies.

Exercise should be touted if not for just ONE area of concern – and that is obesity. As one of the main comorbidities for severe COVID, losing weight would reduce severity in many people. This alone would reduce the burden of the disease from a death, healthcare expense and severity aspect. Of course, there are other complications relating to COVID, but in general, exercise has many positive effects, with few side effects. Its contribution to enhancing immunity is one of the biggest attributes.

Using proper assessment and outcome metrics, trainers and coaches can correlate the effects of their programs with other health and medical scores (such as a change in blood sugar or blood pressure each session, or loss of body fat over a one-month period). These are important because they will correlate to changes in overall blood labs, which will have both an acute effect (reduction in the risk of heart attack, stroke, or asthma attack), or long-term effects, such as reduction in diabetic complications, risks of falls, and peripheral vascular disease. Trainers may not understand just how powerful regular exercise can be for specific medical populations, but since the 1970s, the data is clear that exercise has an effect on almost every type of medical condition – even relatively new conditions to exercise training such as autism and Ehlers-Danlos Syndrome.

If we understand that just a moderate amount of exercise will improve circulation enough to enhance the immune system, then we should be detailing it to new members as they come into the health club setting.

Why Health Clubs Need to Open – and Stay Open

Even mom and pop clubs can play a role in improving health.  The first is to have a member tracking system that can keep people coming to the club, at least twice a week. For health’s sake, perhaps 3-4 days per week would be preferable.  The “essential” label is a bit misleading because there are no true metrics for what an “essential” business may be (outside of trash collection, medical triage, and grocery stores). Clubs can position themselves through medical fitness and in the near future, have the technology and assessments necessary to look at health outcomes as persons who normally would not be in a health club see the benefits of a medically based program that will cater to their needs while improving their health along the way.

Eric Durak is the President of MedHealthFit, and founding partner in the Fitness Is Medicine Initiative. He is a 35- year veteran of the health industry. He has worked for health clubs, medical research centers, and continuing education. He has been at the forefront of the medical fitness movement and appreciates the opportunity to work with MedFit Network to move medical fitness to the forefront of health care.  Email him at edurak@medhealthfit.com




Safely Returning to Exercise Post-COVID-19 Illness

The world of exercise and fitness was struck hard by the COVID-19 pandemic, taking access to gyms and fitness centers away for a period of time. With these facilities returning to their open availability, many individuals who personally experienced having COVID-19 have been posed with the question of when is it safe and okay for them to return to exercising again. Factors to consider include, of course, not wanting to spread the virus. But from a medical perspective, when is the body ready to safely return to exercising?

Internally, the immune system has just been through warfare depending on the strain and severity of the contracted virus, so the first consideration is feeling confident that symptoms have been eradicated during normal daily living activities, before venturing on to performing more strenuous or even mild/moderate forms of physical activity. COVID-19 affects the lungs (respiratory system), causing severe inflammation. Normal functioning of taking in oxygen and releasing carbon dioxide becomes impaired when the virus impedes by increasing fluid in the lungs and inflammation. Therefore, breathing becomes the common exercise inhibitor when first getting back into movement patterns. In fact, the CDC estimates that 3-17% of COVID-19 patients develop a complication known as Acute Respiratory Distress Syndrome (ARDS). A simple test for readiness is trying to walk quickly for 500 meters without feeling breathless or fatigue. From this self-assessment, endurance and intensity can progressively improve.

Returning to strength training can be challenging when considering cardiac output and fatigue depending upon resistance training goals and modalities. Therefore, it is best to work in the endurance phase for 2-4 weeks prior to strength or power training. This will help prepare the body for more intense training as well as let the body adjust to feelings of fatigue and breathlessness that might occur. A negative COVID test does not equate to the body returning to its normal workload capacity right away. Patience is key and although this can be a frustrating feat for athletes and avid gym-goers alike — movement is medicine but overtraining in sub-optimal conditions only prolongs the perceived setback.

There is no exact timeline upon returning to exercise post-COVID, but one way fitness professionals and individuals can gradually and safely do so is to utilize the “Rate of Perceived Exertion” to modify and accommodate for any potential risks. An example of this is the Borg Rating of Perceived Exertion (RPE), using a scale of 6-20 with 6 being no exertion and 20 being maximal exertion. Realistically working between 6 and 11 to start and pacing oneself to 12-15 and above is a good road map. Wearing a heart rate monitor can also be helpful with the understanding that if you are working at a higher level than what your lungs currently want to or can even do, taking resting breaks before returning the exercise is recommended. Exercising over time will help repair the body’s systems to again function as efficiently as before.

Megan Johnson McCullough is the owner of Every BODY’s Fit in Oceanside CA. She is a NASM Master trainer, holds an MA in Physical Education & Health Science, and is a current candidate for her Doctorate in Health and Human Performance. Megan also holds specializations in Corrective Exercise, Senior Fitness, Fitness Nutrition, Drug and Alcohol Recovery, and is an AFAA Group Exercise Instructor. She’s also a fitness model, professional natural bodybuilder, and published author.



  • Salman, D., Vishnubala, D., Le Feuvre, P., Beaney, T., Korgaonkar, J., Majeed. A. et al. (2021). Returning to physical activity after covid-19. BMJ, 372:m4721. doi:10.1136/bmj.m4721
  • Yale School of Medicine (2021). Challenge 5: How does covid-19 affect the respiratory system? https://medicine.yale.edu/coved/modules/virus/respiratory/