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Senior-and-Trainer

Dementia Doesn’t Invalidate Exercise Needs

/8 June 2021/ All MFN blog/

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.

Today’s Geriatric Medicine is a bimonthly trade publication offering news and insights for professionals in elder care.

Get a Free Subscription to Today’s Geriatric Medicine

 

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.

 

References

  1. Hamar B, Coberley CR, Pope JE, Rula EY. Impact of a senior fitness program on measures of physical and emotional health and functioning. Popul Health Manag. 2013;16(6):364-372.
  2. Smith PJ, Blumenthal JA, Hoffman BM, et al. Aerobic exercise and neurocognitive performance: a meta-analytic review of randomized controlled trials. Psychosom Med. 2010;72(3):239-252.
  3. Rizzoli R, Bruyere O, Cannata-Andia JB, et al. Management of osteoporosis in the elderly. Curr Med Res Opin. 2009;25(10):2373-2387.
  4. Lee DC, Artero EG, Sui X, Blair SN. Mortality trends in the general population: the importance of cardiorespiratory fitness. J Psychopharmacol. 2010;24(4 Suppl):27-35.
  5. Conn VS. Depressive symptom outcomes of physical activity interventions: meta-analysis findings. Ann Behav Med. 2010;39(2):128-138.
  6. Dunn AL. Review: exercise programmes reduce anxiety symptoms in sedentary patients with chronic illnesses. Evid Based Ment Health. 2010;13(3):95.
  7. Teri L, Gibbons LE, McCurry SM, et al. Exercise plus behavioral management in patients with Alzheimer disease: a randomized controlled trial. JAMA. 2003;290(15):2015-2022.
  8. Ahlskog JE, Geda YE, Graff-Radford NR, Petersen RC. Physical exercise as a preventive or disease-modifying treatment of dementia and brain aging. Mayo Clin Proc. 2011;86(9):876-884.
  9. Toulotte C, Fabre C, Dangremont B, Lensel G, Thévenon A. Effects of physical training on the physical capacity of frail, demented patients with a history of falling: a randomised controlled trial. Age Aging. 2003;32(1):67-73.
  10. Huusko T, Karppi P, Avikainen V, Kautiainen H, Sulkava R. Randomised, clinically controlled trial of intensive geriatric rehabilitation in patients with hip fracture: subgroup analysis of patients with dementia. BMJ. 2000;321(7269):1107-1111.
  11. Nelson ME, Rejeski WT, Blair SN, et al. Physical activity and public health in older adults: recommendation from the American College of Sports Medicine and the American Heart Association. Circulation. 2007;116(9):1094-1105.
  12. What is dance/movement therapy? American Dance Therapy Association website. https://adta.org/. Retrieved January 7, 2018.
  13. Homann KB. Embodied concepts of neurobiology in dance/movement therapy practice. Am J Dance Ther. 2010;32(2):80-99.
  14. American Dance Therapy Association. Dance/movement therapy & the older adult. https://adta.org/wp-content/uploads/2015/12/DMT-with-the-Elderly.pdf. Accessed January 7, 2018.
  15. Kshytriya S, Barnstaple R, Rabinovich DB, DeSouza JFX. Dance and aging: a critical review of findings in neuroscience. Am J Dance Ther. 2015;37(2):81-112.
  16. Iacoboni M. Mirroring People: The New Science of How We Connect With Others. New York, NY: Farrar, Strauss and Giroux; 2008.
all-age-group-plank-exercise

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

/5 May 2021/ All MFN blog/

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”. 

senior-man-dumbell-punch

Immunity in Question

/30 April 2021/ All MFN blog/

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

 

References

exercise-gym-covid-mask

Safely Returning to Exercise Post-COVID-19 Illness

/28 April 2021/ All MFN blog/

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.

 

References

  • 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/

 

Young woman having knee pain

Rolling to Fight Arthritis!

/13 April 2021/ All MFN blog/

“By the year 2040, an estimated 78.4 million (25.9% of the projected total adult population) adults aged 18 years and older will have doctor-diagnosed arthritis” (Hootman JM, Helmick CG, Barbour KE, Theis KA, Boring MA)

The time is now! Let’s talk about how to prevent the onset and symptoms of various forms of arthritis through myofascial release!

What is myofascial release?  

It is a type of physical therapy often used to treat myofascial pain syndrome. Myofascial pain syndrome is a chronic pain disorder caused by sensitivity and tightness in your myofascial tissues. These tissues surround and support the muscles throughout your body that are affected by arthritis.

What is fascia tissue? 

This holds the muscle together and keeps them in the correct place. The fascia separates the muscles so they can work independently of each other. The fascia provides a lubricated surface so that the muscles can move smoothly against each other. When fascia is constricted, it prevents blood flow and decreases circulation.

What parts of the body can I roll?

  • Head, Face & Neck
  • Shoulders, Chest Arms, Wrists & Hands
  • Upper & Lower Back, Hips, Glutes, Thighs, Knees, Ankles, Feet

What is the Benefit of Rollga Rolling My Face & Neck? 

Rolling for Youth Preservation: First, let’s discuss regaining a rejuvenated look for our skin. When looking at what causes skin aging, it is a slowing down of circulation of blood. As noted by the NIH, this consists of a slowing in the circulation of nutrient-rich blood and detoxifying lymph and increasingly sluggish skin-cell turnover; the skin becomes more “stagnant.”

Rolling the Face. When “rolling” the face, be sure to apply gentle to medium pressure. The two main points of tension are in the superficial fascia and the other is lymph. Lymph is a highly underrated circulatory system within the body that is responsible for detoxifying waste from the skin on a cellular level, in addition to its many, many other functions. When holding tension in the muscles and fascia, lymph cannot move freely and do its job of clearing out waste from the tissue. The result of poor lymph flow can present as dull skin, an accumulation of blackheads and milia, and/or stubborn hyperpigmentation, and more. Superficial fascia is the layer of connective tissue right under the skin on the face. It acts as the support and infrastructure for your skin and is responsible for giving it “lift and tone.” It can also carry a lot of tension and adhesions that restrict circulation of blood and lymph. If you’ve ever used a foam roller on tight legs, think of how much softer one leg feels after rolling when compared to the unrolled leg. Foam rolling is a form of self-administered myofascial release, and that is EXACTLY what we want to do for the face.

Rolling for Neck Tension. The neck is the superhighway of ALL circulation to and from the face. A tight neck acts like a traffic jam between the body to face and back again. This prevents detoxifying lymph from draining as well as it should, and working the neck alone can be major in bringing flow and vitality back to the complexion as well as reducing puffiness in the face. Many people experience a very high level of neck and jaw tension due to everyday stress. Remember that working hard also means you must self-care harder!

Rolling to Fight Arthritis: To reduce the onset of symptoms from various diseases such as arthritis that affect facial and neck muscles, various myofascial release techniques such as Rollga rolling stimulates muscles, improves blood flow and enhances circulation. Because the jaw is a joint that is commonly affected by arthritis, myofascial release eases tension, improves joint mobility and decreases pain while speaking or chewing.

Learn more about Rollga rolling for the face and neck by contacting info@ContiFit.com

Request a manual, attend a workshop, or take an online course to learn about myofascial release with Let’s FACE it Together™ Facial Exercise & Rehabilitation!

Check out the Arthritis Fitness Specialist Online Course from MedFit Classroom.

Reprinted with permission from Christine Conti. Originally printed on rollga.com.

Christine M. Conti, M.Ed, BA is and international fitness educator and presenter. She currently sits on the MedFit Education Advisory Board and has been nominated to be the 2020 MedFit Network Professional of the Year. She is currently writing the MedFit Network Arthritis Fitness Specialist Course and is the CEO and founder of ContiFit.com and Let’s FACE It Together™ Facial Fitness & Rehabilitation. Christine is also the co-host of Two Fit Crazies & A Microphone Podcast and the co-owner of TFC Podcast Production Co.

DNA-puzzle

The Evolution of Truly Personalized Medicine: Epigenetics, Food, and Fitness

/9 April 2021/ All MFN blog/

Most would not argue that there is an ongoing transition in how our healthcare is being delivered. This article will examine some of these transitions as a result of breakthroughs in technology, as well as how genetic information, exercise, and diet will play an increasingly greater role.

When medical science was first getting its start, a more holistic philosophy was taken on how to treat illness and maintain health. Hippocrates has often deemed the father of modern medicine, and even today the allopathic physicians (M.D.s) take the Hippocratic Oath – to do no harm to their patients. Hippocrates knew, even in 400 B.C., that the best healer of the body is the body itself. For the most part, the best treatment is to create a strong body and get out of the way. Five guiding principles used in his philosophy for treatment include:

  1. Walking is man’s best medicine.
  2. Know what person the disease has, rather than what disease the person has.
  3. Let food be thy medicine.
  4. Everything in moderation.
  5. To do nothing is also a good remedy.

The second and fifth principles emphasize the power of knowing the individual and getting out of the way! The first and third principles show the power of exercise and food for healthy living. Even the genius, Thomas Edison, realized that a health maintenance organization (HMO) approach was the best method of healthcare both practically and financially. His quote, “The doctor of the future will give no medicine but will interest his patient in the care of the human frame, in diet and in the cause and prevention of disease,” is evidence that a holistic, preventative approach is what he advocated. He is also quoted, “…you can’t improve on nature.”

One size does not fit all

Personalized medicine is now at the forefront and it utilizes the genetic and epigenetic data of a person to guide medicines and treatment plans. Cancer drugs have probably harnessed this advantage to the greatest extent, thus far. Former President Jimmy Carter received Keytruda (pembrolizumab) for his brain cancer and it boosted his immune system and beat cancer. While most of America (71%), still doesn’t even know about personalized medicine, those who were familiar with it did not know it would yield better results with fewer side effects. The different directions of personalized medicine are still being realized, but the field of pharmacogenetics is the first to really jump on the bandwagon of highly effective, precision-based treatment.

The reasons some drugs work for some people and not for others, or why side effects occur in some individuals and not others, is due to individual variability in metabolism. Why are some people lactose tolerant, or some can drink alcohol with no problem, and others have severe issues? It is usually because of enzyme differences, which are under the control of our genes. Interestingly, our enzyme genes can often be turned on or off by “inducible sequences” known as promoters or suppressors of operons, respectively. These “switches” can be repressed or induced depending on our environmental stimuli. Thus, we actually have some control over our gene expression, and this field is known as epigenetics.

Knowing what gene variants someone possesses or not will guide the personalized medicine physician on which drug to use or not. By knowing allergic reactions in advance or which medicines may have side effects will help physicians to not make a bad situation worse. Unfortunately, the cost of personalized medicine drugs is much higher than alternative treatments. There is still a lot of exploration to be done on all the various applications of this technology, but the bottom line is that understanding individual variations and enabling the body to do what it is designed to do is a very good thing! Companies like Toolbox Genomics is one of many companies that use your genetic information to then tell you what foods and supplements to eat or avoid, and which exercises may help you the most, and ones that you may not respond to so well. The reason physicians do an intake on family history or run various tests is to collect information that will guide their treatment. A genetic test on certain gene variants is simply taking this a step further.

How do exercise and diet apply to our epigenetics?

Did you know that exercise is highly beneficial to not only help with fighting cancer once it is already present but also to never getting it? Physical exercise or movement, in general, will shift the epigenetics so that genes that suppress tumors are increased, and genes that cause cancer (oncogenes) are decreased. It does this by changing the number of certain reactions called methylations. Things go wrong when there are too much or too few methylation reactions. Exercise has been shown to reduce or even reverse the epigenetic mutations that often result in tumorigenesis or tumor production. Exercise has also been shown to reduce genetic factors associated with aging like telomere length.

The fields of proteomics and metabolomics as well as pharmacogenomics, are all emerging because of the knowledge on how our genetics affects proteins, metabolism, and reactions to drugs, respectively. The field of nutrigenomics is rapidly expanding, and several companies are capitalizing on studying the relationship of how our genes affect how we process and utilize foods, as well as how food can affect our genes. Vitamins A and D, certain fatty acids, especially medium and short-chain, some sterols (derived from cholesterol), and zinc have been shown to directly influence gene transcription. Indirect effects include how diet affects gut bacteria, which in turn influences gene expression. Soon when nutritional recommendations are given, it will likely be “for this individual.”

The future of medicine will be taking our genetic information to a whole new level. Soon “smart” watches, clothes, hats, and other common devices will collect information that can benefit our health in many ways as the way healthcare is delivered continually evolves.

This article was featured in MedFit Professional Magazine

Dr. Mark P. Kelly has been involved with the health and fitness field for more than 30 years. He has been a research scientist for universities and many infomercial projects. He has spoken nationally and internationally on a wide variety of topics and currently speaks on the use of exercise for clinical purposes and exercise’s impact on the brain. Mark is a teacher in colleges and universities in Orange County, CA., where Principle-Centered Health- Corporate Wellness & Safety operates.

walking shoes

Keep Walking: Benefits of Walking as Aerobic Exercise

/18 March 2021/ All MFN blog/

Aerobic exercise (also known as cardio) is physical exercise of low to high intensity that depends primarily on the aerobic energy-generating process. “Aerobic” means “relating to, involving, or requiring free oxygen”, and refers to the use of oxygen to adequately meet energy demands during exercise via aerobic metabolism.

Generally, light-to-moderate intensity activities that are sufficiently supported by aerobic metabolism can be performed for extended periods of time. What is generally called aerobic exercise might be better termed “solely aerobic”, because it is designed to be low-intensity enough so that all carbohydrates are aerobically turned into energy. The bulk of the energy in this type of exercise is due to mitochondria ATP production which relies on oxygen for the metabolism of carbs, proteins and fats for energy.

Health Benefits

Among the recognized health benefits of doing regular aerobic exercise are:

  • Strengthening the muscles involved in respiration, to facilitate the flow of air in and out of the lungs
  • Strengthening and enlarging the heart muscle, to improve its pumping efficiency and reduce the resting heart rate, known as aerobic conditioning
  • Improving circulation efficiency and reducing blood pressure
  • Increasing the total number of red blood cells in the body, facilitating transport of oxygen
  • Improving mental health, including reducing stress and lowering the incidence of depression, as well as increased cognitive capacity
  • Reducing the risk for diabetes (One meta-analysis has shown, from multiple conducted studies, that aerobic exercise does help lower Hb A levels for type 2 diabetics)
  • Reducing the risk of death due to cardiovascular problems

How to Walk Properly and Correctly to Keep Walking

Starting from the foundation of our body, our feet, we need to keep in consideration and balancing our weight through a tripod that includes our heel, big toe and small toe during our gait circle.

Gait is categorized into two phases: stance and swing. The stance phase occurs when the foot is on the ground. In young to middle-aged adults, the stance phase makes up 60% of the gait cycle. The remaining 40% of the cycle is spent in the swing phase where the foot is off the ground and being propelled forward.

The more we keep repeating this cycle in the correct form the more we keep producing the right pattern for our body to keep walking/exercising, planting the benefits for our longevity.

Additionally, we need to consider the alignment of the rest of the body. Thorax and Pelvis should be in the same line allowing breathing to go in a constant rhythm with the heart and lungs. Usage of the diaphragm and full expansion of respiratory muscles will allow extra oxygen intake, leading to better performance and eventually weight loss.

Body Performance Benefits

In addition to the health benefits of aerobic exercise, there are numerous performance benefits:

  • Increasing storage of energy molecules such as fats and carbohydrates within the muscles, allowing for increased endurance
  • Neovascularization of the muscle sarcomeres to increase blood flow through the muscles
  • Increasing speed at which aerobic metabolism is activated within muscles, allowing a greater portion of energy for intense exercise to be generated aerobically
  • Improving the ability of muscles to use fats during exercise, preserving intramuscular glycogen
  • Enhancing the speed at which muscles recover from high-intensity exercise

Neurobiological Effects:

  • Improvement in brain structural connections
  • Increase in gray matter density
  • New neuron growth
  • Improvement in cognitive function (cognitive control and various forms of memory)
  • Improvement or maintenance of mental health

Walking is widely recommended for its health benefits. According to a recent U.S. Surgeon General report on physical activity and health in America, more than half of the U.S. population does not participate regularly in any type of exercise. That physical inactivity can lead to poor health. It is time to start making better choices and better habits. Let’s start walking!

  • Walking can help you attain that trim figure you’ve been “dieting” to have. It allows you to burn off fat without losing muscle and without depriving your body of the essential nutrients it needs. And it can help tone your muscles and shape up your legs.
  • Before you begin walking for fitness with freestyle walking programs, you need to consider a few preliminaries, including your age and your overall health. It’s pretty easy to figure out that walking doesn’t require much in the way of equipment. One of the only, and by far the most important items that you’ll need, is a pair of comfortable walk­ing shoes. If you don’t take time and care in selecting your walking shoes, you may be in for some serious discomfort.
  • You also need to learn how to measure your heart rate and listen to your body, so you’ll know where to begin and how hard you need to work to increase your fitness and health. You may have heard similar claims made for other aerobic exercises, but consider this: The only exercise that will do you any good is the exercise you do, and walking is easy, as easy as putting one foot in front of the other.

Dimitrios Triantafillopoulos is a Master Personal Trainer, supporting people, athletes and other trainers to make them feel better with their body and themselves. He holds a Bachelor’s degree in Kinesiology and Sports Science, a Master’s Degree in Nutrition and Sport Fitness, as well as a Medical Fitness Specialty. Dimitrios has attended numerous seminars in Performance Training and Specialized Nutrition, and is also a Certified Instructor in Vibration (Power Plate) Acceleration Training and Electro – Stimulation Training. He is currently a Fitness Manager at Crunch Fitness in New York City.

back-pain

Three Steps to Ease Back into Exercise After a Back Injury

/5 November 2020/ All MFN blog/

According to studies, low back pain affects nearly 80% of all adults.  Most low back injuries come from the following: wearing high heels (women), performing manual labor and people who sit for long periods of time (greater than 3 hrs.). Although these statistics are alarming, there are some simple steps one can take to make sure that they avoid current and future back pain or injury. These steps all involve simple exercises that can be performed from anywhere, including one’s office.

Step 1: Stretching

In order to prevent further injury or a relapse, the first thing to do is stretch common muscles that are tight and may have caused the lower back pain in the first place. Tight muscles are known to overwork and when this occurs, they become overactive and let us know through pain. These muscles include erector spinae, hip flexors, calves and the lats (the big back muscles).

For each stretch, you want to hold the stretch for 30-120 seconds and perform the movement for 1-2 repetitions 3-5x/week. (Watch Five Back Pain Stretches from WebMD.)

Step 2: Strengthening

After you have stretched the tight muscles, now it is time to focus on strengthening the muscles that are weak or underactive. Typically, muscles become weak or underactive from lack of use or overuse by the muscles that assist or oppose the weak muscles. For example, if your hip flexor is tight, it could cause your glutes (butt) muscles to become weak. The muscles that tend to weaken with a lower back injury include certain core muscles, the butt and hamstrings.

For each strengthening exercise, you want to perform 1-2 sets of 10-15 repetitions 3-5x/week. (Watch Core Strength for Back Pain View and Good and Bad Exercises for Low Back Pain from WebMD).

Step 3: Integration

Now that you have isolated the lower back with stretching and strengthening exercises, it’s time to focus on integrating your entire body back into exercising. Integrated exercises involve using as many muscles as possible in one given exercise. By performing integrated exercises, you will ensure that the your hip joint (which can be misaligned with low back injuries) starts and remains in the right position and the proper muscles are working as they should be.

For each integrated exercise, you want to perform 1-2 sets of 10-15 repetitions 3x/week. (View integrated exercises: http://www.allthingshealing.com/Chiropractic/Corrective-Exercise-for-Back-Pain/8558#.VIoTN74zf8E)

If you follow these three simple steps, you can avoid low back pain setbacks and ensure that your back is strong enough to handle your daily activities of life.

Maurice D. Williams is a personal trainer and owner of Move Well Fitness, as well as a fitness educator for Move Well Fit Academy With almost two decades in the industry, he’s worked with a wide range of clients, including those with health challenges like diabetes, osteoporosis, multiple sclerosis, hypertension, coronary artery disease, lower back pain, pulmonary issues, and pregnancy. Maurice is also an Assistant Professor of Health & Human Performance at Freed-Hardeman University.