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Knee joint anatomy, 3D model

Musculoskeletal System & Healthy Functioning: Parts that Make Up the Whole

Orthopedics 101: What makes up our musculoskeletal system? In order for our body to move, the joints, ligaments, and tendons must work together. If a person has a disease, injury, or condition, affecting any one of these parts, nerve signals are interrupted and movement is hindered.

When you think of joints, think of two parts of the skeleton being fit together. The bones are connected by joints. Joints are also called articulations. Here’s the lineup….

  1. Bones are lined with cartilage so they don’t grind against each other; it is the covering at the end of the bone.
  2. Bones are joined to bones by ligaments, so where two bones meet that is a joint; ligaments are important for stability.
  3. Muscles are connected to bones by tendons.

Technically, muscles are not part of the joint, but stronger muscles help protect the joints.

You know that cracking sound we sometimes hear with movement?? When you flex or contract a muscle which takes place at the joint, the ligament stretches with that joint. When you straighten out that joint, the ligament helps to pull the joint back to its normal starting position. This means that ligaments are a major part of movement, but over time, they start to lose their elasticity. This loss of stretch makes the joint make that cracking noise from bone on bone.

Tendons are important for our range of motion with movement. They’re found in smaller joints like fingers and wrists. We use tendons a lot, especially at the wrist. A tendon’s job is to make sure you can bend your wrist, but not too far.

After years of constant use, our joints can develop arthritis. This occurs especially in the knee, hip, and shoulder areas. The knee joint has three parts, the hip has two, and the shoulder has the one that seems to be commonly injured.

Tendons and ligaments do wear out. They do not grow or repair themselves. A baseball pitcher who has repetitively used their arm and shoulder to throw the ball as hard as they can over and over again will, after a number of years, most likely experience damage to the rotator cuff. Then it’s surgery.

Long story short, our body sure does do a lot for us to produce movement. As I type and while you read, movement is occurring even in the eyes. We have to appreciate what we have and if we don’t use it, we lose it before that expiration date comes our way.

Your fitness journey is a lifelong commitment to your health, so exercise wisely, fuel your body right, and MOVE!!!!

Megan Johnson McCullough, owner of Every BODY’s Fit in Oceanside CA, is a NASM Master Trainer, AFAA group exercise instructor, and specializes in Fitness Nutrition, Weight Management, Senior Fitness, Corrective Exercise, and Drug and Alcohol Recovery. She’s also a Wellness Coach, holds an M.A. Physical Education & Health, and is a current doctoral candidate in Health and Human Performance. She is a professional natural bodybuilder, fitness model, and published author.




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

Most would not argue that there is 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 is 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 on 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 the 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 possess 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 does 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 amount of certain reactions called methylations. Things go wrong when there is 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. In direct 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. Subscribe to MedFit Professional Magazine to read more great content like this!

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.


A Simple Exercise to Stimulate Your Cerebellum and Boost Your Movement Accuracy, Balance, and Coordination

While every brain structure has the potential to be a valuable training target for a medical fitness professional, the cerebellum should always be a high priority consideration when trying to help clients and patients accomplish their pain and performance goals. The cerebellum, whose name means “little brain,” is located at the back and bottom of the brain, and while it makes up only 10% of the brain’s volume, it houses 80% of the brain’s total neurons


My 3 Favorite Core Exercises

Core Exercises are always in style, right? If I had a $100 for every time I have been asked what is the best core exercise to help me get rid of my belly fat I would be writing this blog from the beach in Punta Cana!

Seriously, core exercises have their place and are important to do. Consider a few of the main reasons why they are important:

  1. They can help stabilize your spine.
  2. They can prevent low back injury or discomfort.
  3. They can help improve sporting activity.
  4. They help improve posture.

As a result of the benefits listed above for doing core exercises, here are my three current (yes, they do change) favorite core exercises:



Exercise preparation

  1. Begin by lying flat on floor in supine position with knees bent, feet flat, toes pointing straight ahead and arms by sides.
  2. Activate core by drawing navel towards the spine and squeezing the glutes.


With core activated and glutes squeezed, lift hips off ground to form a straight line between knees and shoulders.

Hold and slowly return back to floor, touching floor momentarily then repeat.

If your client feels their hamstring cramping, check their pelvis for correct alignment. Pelvis should be neutral – asis and psis should be even or horizontal. If there is a misalignment correct it. If you aren’t sure then gently stretch the quads and try the exercise again.

Prone Iso Abs (i.e. Planks)


  1. Kneel on the floor on all fours.
  2. Align your hands directly beneath your shoulders.
  3. Align your knees directly beneath your hips.


  1. Lift and extend one leg to the floor behind you.
  2. Place the ball of your foot on the floor as in a push-up position.
  3. Maintain neutral spinal alignment in this semi-supported position.
  4. If you feel comfortable enough, extend both legs into a full plank position.
  5. Make sure to keep your shoulder blades down and wide on your back during all phases of the exercise.

Mecaback Wedge Crunch

Set Up (standard) 

Feet on the floor, Arms crossed at chest 


  1. Maintain a stable pelvis. Tailbone gently pointing down. 
  2. Brace your abdominals and lift straight up. Only lift your torso 2-3 inches from the floor, 
feeling the point at which the abdominals are working hardest, pause.
  3. Slowly lower.
  4. Repeat. 

Maurice D. Williams is the owner of Move Well Fitness in Bethesda, MD, and Assistant Professor of Health & Human Performance at Freed-Hardeman University.  He is a NASM Master Instructor and Master Trainer,  and is also certified with NASM as a Corrective Exercise Specialist, Performance Enhancement Specialist, Senior Fitness Specialist & Weight Loss Specialist, and as a Certified Strength and Conditioning Specialist by NSCA.


Opening a Closed Door: How to Gain Access to the Medical Suite

Your passion is to help people maintain or regain optimal health and fitness. Under current law and standards, you are only permitted to work with clients who are already-fit and healthy or have been released for independent exercise and have passed your health screening questionnaire. But those are not the people you yearn to work with. The clients you seek must have authorization or approval from a medical provider before you can proceed.

How often have you met with a potential new client, asked them to get clearance from their doctor, and then never seen them again? Or, a client develops a new pain or problem and you refer them for consultation and that ends the relationship. Another frequent scenario: Your client has followed through with your request only to be referred by their primary care provider for a cardiac treadmill test, but your concern about their low back pain or shoulder dysfunction was not addressed. Success as a medical fitness specialist is dependent upon working relationships with medical professionals. In order to establish those relationships, the aspiring medical fitness trainer needs a better understanding of the medical system. What follows are a few insights into the medical system that medical fitness specialists need to understand.

Recognize how busy the medical practitioner might be

“Estimates suggest that a primary care physician would spend 21.7 hours per day to provide all recommended acute, chronic, and preventive care for a panel of 2,500 patients.”1[i]. Today, the average primary care provider is responsible for roughly 2,300 patients, so not quite 21.7 hours of work/day, but more than any individual can possibly provide.

In order to cope with the workload, doctors must rely on their support staff to help whenever possible. Do not be alarmed or offended if your inquiries are met by a nurse or medical assistant. Most providers simply do not have the time to meet with you for an introduction or discussion. On the flip side, most doctors would love to have effective, safe, and reliable resources for their patients who need to lose weight, get fit, manage diabetes, recover from surgery or cancer treatment, etc. They need you.

Understand the current reimbursement rules

In most cases, providers cannot bill for services unless the patient is in the room with them. Therefore, time spent talking on the telephone, responding to emails, or filling out forms is usually unreimbursed time. This means that your client will probably need to actually make an appointment to be assessed and cleared for exercising with you. To streamline the process, send a letter with your client introducing yourself and what you do. Include a form stating your concerns and your proposed training plan. Design the form to be easy to read, with a simple agree or disagree that can be checked or circled and space for the provider’s signature. You might also want to leave room for comments and questions. If you have received a response from a provider, you should consider sending intermittent progress reports updating the provider about your mutual client/patient.

Be familiar with HIPAA

The Health Insurance Portability and Accountability Act (HIPAA) was enacted in 1996 to protect an individual’s medical confidentiality, particularly when changing jobs which at that time meant changing health insurance providers. Unfortunately, the law is complicated and places multiple restrictions on who members of a medical team can talk to about a patient’s medical condition.

As an unlicensed party, the fitness professional is not privy to “protected health information” (PHI) without direct written consent from the patient (your client). Due to these restrictions, the medical providers cannot fill out or respond to your request for information or clearance without your client’s “written” consent. If the client takes the form and returns it to you, this action implies they have agreed to share the information. If you send the form directly to the provider, that permission has not been granted unless the client has signed a HIPAA release form allowing the doctor to share personal health information with you personally.

The aforementioned are a few reasons why you may have perceived a wall or barrier between you and medical providers. One solution is to ask your client if you might accompany him or her to the appointment to obtain medical clearance or guidance. That way the medical provider would have a specified time and be reimbursed for addressing your concerns. You would be communicating directly with the medical provider and not support staff, and it would be easiest for the client/patient. It is also a way to introduce yourself to the medical provider and initiate a working relationship. Although you will probably not be compensated, it may be well worth your time in the long run.

Once you have made it into the office with your client, now what?

Know your details

Because there are so many different avenues to becoming certified as a personal trainer, there can be large differences in the knowledge base and competence of one trainer compared to another. The aspiring medical fitness professional must have a thorough understanding of the pathophysiology of the conditions they will be working with in order to communicate effectively with medical providers. In addition, you need skill and experience in the programs you design and utilize with your clients. Be able to back up your training plans with published research.

Recognize that a medical fitness professional has a fund of knowledge that the medical provider does not have

Exercise science is not covered in medical school curricula. Medical school is about illness and disease, not health and fitness. Generally speaking, the average MD knows very little about exercise science. Most do not know about the effects of eccentric versus concentric loading, how to train for endurance versus strength, what to do to improve stability, balance, and core strength. Fitness professionals are not inferior to medical professionals; you have a different knowledge base. Recognize and believe that you have something to offer. You may not know all of the anatomy and biochemistry that the doctor does, but you have a basic understanding of your client’s condition and you know the potential benefits of your interventions. Share this information with the medical providers.

Stay within your scope of practice

Because personal trainers and medical fitness specialists are not licensed by any governmental or legal agency, and because laws vary from state to state, there is no clear definition of the skills and competencies of a medical fitness specialist. Working outside of your scope of practice can lead to civil and even criminal penalties[ii]. Therefore, for the time being, if you want to work with clients struggling to manage chronic illnesses, recover fully from injuries or surgeries, etc., you need to work under the wing of medical professionals who have prescriptive authority – those professionals in the medical field licensed to diagnose problems and prescribe treatment.

Dr. Robert Butler MD, founder of the National Institute on Aging once said: “If exercise could be packaged in a pill, it would be the single most widely prescribed and beneficial medicine in the nation.” There are pockets here and there in the US where medical providers and fitness professionals work together. In many cases, there is a visionary medical provider at the helm of an interdisciplinary team. In other cases, fitness professionals have worked hard to become part of a medical delivery model.[iii] The more medical fitness specialists that can take the leap and align themselves with medical providers, the more people will be helped.

This article was featured in MedFit Professional Magazine. Get your free subscription to read more great content like this!

Dr. Mary Hoagland-Scher,MD is a board-certified family physician who practiced medicine for 30 years. When she entered medical school, her goal was to help people stay healthy. As the focus of western medicine shifted away from health to disease management with a strong emphasis on pharmaceutical and or surgical intervention, she became uneasy with her role and decided to discard her prescription pad and learn new tools. Now as a NASM Certified Personal Trainer she is working to shrink the gap between fitness and medicine.


  • [i] Estimating a Reasonable Patient Panel Size for Primary Care Physicians With Team-Based Task Delegation Justin Altschuler, MD, David Margolius, MD, Thomas Bodenheimer, MD and Kevin Grumbach, MD Ann Fam Med September/October 2012 vol. 10 no. 5 39
  • [ii] For an excellent discussion of this issue, see: Abbott, Anthony Ed.D, FACSM, FNSCA. Scope of Practice, ASCM Health and Fitness Journal ,Sept/Oct 2018, Vol 22 Issue 5 pp 51-55
  • [iii] Watch MedFit TV webinar by David Rachal III, “Exercise Prescription: Integrating Services with Medical Professionals and Insurance Providers”

Fitness: Programming Your Body to Become Strong & Resilient

In the early 90s I worked with a colleague who had a track background as a pole vaulter. Doug subsequently became a fitness professional and athletic coach. He had a philosophy about fitness that was characterized by a simple notion: “Weight training is the paycheck and cardio is the bonus”. I have thought about this issue continuously since I met Doug and as I have grown older, I believe he was right.

I am now training as hard – or harder – than I ever have before to ensure I enter my 70s with as little loss of lean muscle mass, and as much strength and power, as I can create. This article will highlight the importance of resistance training, give you some valuable ideas on how you might implement a program, and finally share ideas with you that can protect and preserve your body for the “long haul”.   

The Issue

Resistance training is characterized by working a muscle group to fatigue or failure under a prescribed “load”. This load can be an actual weight or body weight. Any “load-bearing” movement that includes multiple muscle groups is called a compound movement, such as a walking lunge with an overhead press with dumbbells, for example. Because we are sitting for the greatest portion of our days and not stressing our bones we are losing bone mass as well leading to osteopenia (the forerunner of osteoporosis) and then of course osteoporosis – serious bone density decline. The issue of frailty and imbalance is becoming more and more pronounced in our population and will only accelerate if we don’t change our sedentary behaviors.

Identifying the issues related to loss of muscle mass and bone mass is relatively simple and can be done through clinical testing. Women have the highest potential to start this chronic loss because they have different hormonal issues with aging – less testosterone and smaller bones for example – that creates an earlier onset of disease. Fractures and other related problems can happen in an instant if the loss is not addressed in a timely manner and medication can help along with changes in lifestyle and diet. However, the real solution lies in weight-bearing exercise where stresses are applied to the muscles and skeletal structure intentionally and safely. Men are not immune from developing these conditions – they just start later in life due to larger and heavier frames and greater weight.

Beginning a weight training program earlier in life is the best way to prevent the decline and decay of tissues and the easiest form of that training is in the form of weight training – free weights, machines, and other load-bearing exercises, such as bodyweight exercises. I will highlight my program for you as an example of types of exercises that help the most in preserving and protecting our muscles and bones from further loss or damage and injury.


The idea is to do a multiple set (8-12 repetitions/ 2-3 sets to start) program that targets all the major muscle groups: Back, chest, shoulders, arms, abdominals, and legs (calf, quad, hamstring) while “loading” the muscle and joint appropriately to stimulate fiber growth. Fiber growth occurs over time when a muscle is exposed to a load that forces a larger than normal contraction. One contraction is the shortening of the muscle (positive or concentric) and the other is the opposite force of lengthening the muscle (negative or eccentric). This movement is accomplished across a joint and creates the change we seek in terms of strength and size.

Each movement is done in a rhythmic and controlled manner that gives the muscle an opportunity to move through a “complete range of motion”. This constitutes “one rep” and applies the stimulus necessary for a muscle to be stimulated to grow following the session during what is called the “recovery phase”.  Each time we increase the load, we enable the muscle to grow and become stronger because the stimulus changes the nature of contractions making the movement more difficult but insuring that it becomes stronger in the process. 

We are not really sure about why this works the way it does but the theory is that by “tearing the muscle” microscopically we create a muscle that is stronger, more adaptable, and able to withstand greater loads going forward. This is referred to as “progressive resistance training” because it is designed as a controlled process with its defined purpose of increasing lean mass.

By programming more than one set we set up the muscle to have to deal with “variable loads” and have to adapt to these increased loads thereby making it able to withstand more of life’s rigors. The theory of doing 2-3 sets initially is that regardless of the weight used – light and smaller to heavier and larger – is that ALL muscles react in the same way to each stimulus – they grow in strength – but NOT necessarily in size. You don’t have to fear getting “muscle-bound” by lifting weights. That takes a concentrated and persistent effort, with a significant caloric intake to help repair the body, as all bodybuilders know. Most of us will never be in that category – and I am certainly not! 

Program Design: The Schedule

Designing a program that addresses the needs of the body as it ages is relatively simple and yet very challenging to implement. The reason is that you will experience some muscle soreness initially that you might find uncomfortable, but this is just the body’s way of recovering from the session (you should never experience pain as that is not normal – don’t believe in “the no pain, no gain” theory – that is just wrong!). 48-72 hours of recovery time is generally advised so that you can allow the muscle to heal itself. In between, you can then initiate a cardio program of swimming, cycling, walking or some other form of movement that allows you the opportunity to encourage this process to become more of a habit – and train your heart to support your effort (my favorite organ, other than the brain of course). 

I believe in a 3-5 day opening schedule of activity that encompasses some cardio and some weight training. Each session can be anywhere from 30 minutes to an hour depending upon your willingness to include a warm-up and cool-down phase, which I highly recommend. Cardio activities include an extended activity (continuous movement) over time and include a warm-up, training and then cool-down phase. You can include an abbreviated walk on the treadmill or outside and then engage your weight training program with a brief cool down to finish the session. 

Exercises & Muscle Groups

  1. Chest – (examples) chest press with dumbbells, barbell, wall pushups, modified floor pushups (knees on the floor) or wall pushups at an angle. 
  2. Back – (examples) seated row, pulldown – bar, low back extension, rubber tube chest extension, dumbbell reverse butterfly – standing with weights at chest level and extend backward.
  3. Arms – dumbbell curls, triceps extension with dumbbell, reverse pushup off bench.
  4. Legs – Wall slide, traditional standing squat, standing from seated position, leg press, calf extension (stairs), and standing lunges.
  5. Abdominal – crunches – lying on your back, knees bent – raise shoulders off the floor and repeat. Exhale on shortening and inhale on lengthening.
  6. Shoulders – shoulder press with dumbbells, front and side raise with dumbbells

I do 16 main exercises twice a week: Bench press (barbell), incline upright row (back), shoulder press, incline/decline press (chest), incline-lateral low row (back), seated triceps extension, arm curl, latissimus pull (back), pullover – chair (shoulder/back), seated leg press and calf extension, lateral raise (shoulder), low back extension, seated abdominal crunch with 65 pounds, hanging dips – upper body, and seated cable row.

Each of these exercises is performed in multiple sets with many repetitions and a variety of loads and at varying speeds to not only encourage growth of my muscles but also to help me maintain my speed and quickness as well. Each muscle group consists of type 1 and type 2 muscle fibers. Type 1 fibers are used for longer endurance activities while the type 2 fibers are for quick explosive movements such as sprinting and power activity (jumping out of the way of a car for instance). 

The reason I train my muscles against variable loads – climbing (the ladder) and descending – is to insure I give each fiber a chance to be engaged and give them the opportunity to become stronger. As I said earlier, I do my program twice a week – on Monday and Thursday – to ensure I recover sufficiently and allow the muscles time to repair themselves.

I am also cognizant of the reality that regardless of how hard – or well – I train, the odds are not in my favor for remaining this way due to the aging process. I am, however, “cutting the odds in my favor” by doing what I am to stay fast and strong.  I am convinced that weight training is the key to my future and that my potential for running fast will be able to be maintained through my continued commitment to remaining strong. It is as Doug said more than two decades ago – “weight training is the paycheck and cardio is the bonus” – but I am so glad I ran all these years as well! 

Nick’s Tips

  1. Do find the resolve to begin – and continue – a weight training program. Schedule at least three days a week for a concentrated effort at building and maintaining your lean muscle mass – and joint integrity. Remember, we start losing 2-5% of our lean muscle mass starting in our 20s – and bone mass as well – unless we do the work to prevent and slow the loss.
  2. Take time to build your cardio capacity through a commitment to your heart. I am able to do my weight training in just over an hour due to my overall cardiovascular fitness.
  3. Take your body seriously and examine how you feel about it. Getting mentally strong through accomplishing your goals is one very important way to stay on track and feel good about yourself. 
  4. Getting lean and being able to burn more calories every day requires only two things: Commitment and discipline founded on purposeful activity.
  5. Take your fitness needs very seriously and yet find ways to make them fun. “Every act we take is its own reward” – Earl Nightingale
  6. Finally, when you see how fast your body will change with weight training (within 30 days, you will see results) it will excite and encourage you to do more and finally realize the dream of a healthy, lean, strong, and fit body.

Nicholas Prukop is an ACE Certified Personal Trainer & a Health Coach and fitness professional with over 25 years of experience. His passion for health and fitness comes from his boyhood in Hawaii, where he grew up a swimmer on Maui. He found his calling in writing his first book “Healthy Aging & You: Your Journey to Becoming Happy, Healthy & Fit” and since then he has dedicated himself to empowering, inspiring and enabling people of all ages to reach for the best that is within them and become who they are meant to be – happy, healthy and fit – and be a part of a world where each person can contribute their own unique gifts to life.


13 Reasons the Right Exercise Matters More in Menopause

During menopause, you’re more susceptible to negative effects of stress. Avoid the wrong exercise (that will worsen stress) and do the right exercise and you can reduce or eliminate symptoms of menopause. There are at least 84 symptoms associated with menopause. This short list of 13 pesky symptoms can be supported by the right exercise.

Hot Flashes (and Night Sweats)

Hot Flashes are potentially the most well-known and most-associated signs of menopause, affecting approximately 50% of menopausal women. They are a sudden sensation of feverish heat that spreads through your body.

Why they occur for some women and not for others, or why they may happen occasionally or for a time and then be gone, is not clearly understood. Vasomotor control is the reason behind why you might experience them when a girlfriend doesn’t when both your hormones may fluctuate.

Night Sweats are excessive sweat that occur during the night. They can contribute to sleep disruption and daytime fatigue or anxiety. That of course, is not the jackpot you want. Both hot flashes and night sweats are believed in part due to fluctuating or low estrogen levels.

Exercise can help this menopause symptom if it’s the right exercise. 

Women who are more fit, with better body composition, and who exercise with adequate intensity experience up to 62% less frequent and or intense hot flashes. What you need to beware of is your tendency to jump to conclusions about how to reach higher fitness levels. Longer and “more” exercise is not the answer. Due to this fast-paced life and your midlife status, the rules have changed.

In midlife, in 2021 and beyond, if you’re still playing the exercise game according to 1980 rules, you will lose.

Will You?

The variability of progesterone related to amount of estradiol had the greatest correlation with hot flash occurrence in more than one study. Increased progesterone variability was associated with decreased hot flashes. Though there’s not much that can be done to influence the variability in your progesterone levels. However, you can exercise to optimize your natural progesterone. Namely, keep stress (cortisol) in check.

Simply start with a smart plan according to your status right now. (More tips below). Ultimately,  include high-intensity intervals at the duration, frequency, and time of day that supports you instead of throwing you under the bus.

Did you know that if the only time you can exercise is late day and you push through high intensity, instead of losing weight you could set off a cascade of events that cause you to gain? The right exercise at the right time of day is a must.


Fatigue is that sluggish, always-tired feeling doesn’t go away with a good night’s sleep. You feel unproductive, moody and this fatigue can cause what’s known as wired-and-tired feeling. You desperately want to get a good night’s sleep and shake it but can’t. For some women, this is like period week fatigue only it doesn’t go away.

Extended periods of fatigue can be signs you’ve just been pushing through, using caffeine or sugar or both to serve you short term. If you rely on external substances too long, that false energy you borrow is going to catch up to you in the end and you will pay back that debt.

If you rely on external substances too long, that false energy you borrow is going to catch up to you in the end and you will pay back that debt.

So, what do you do when menopause fatigue hits and your calendar says HIIT? Or Long run? You rest. You can’t build fitness on a false foundation. Fake it till you make it doesn’t work with your midlife fitness. Plan the work. Work the plan. Override the calendar and rest if your workouts or your sleep, appetite, mood, or digestion is suffering.

An entire chapter in You Still Got It, Girl! Is dedicated to Rest & Recovery. Oh, there are chapters on exercise and on sleep too but Rest & Recovery is something few of us learned to do well. Now? We have to pay attention.

The right exercise when you’re fatigued could be no exercise. We need to remember what it’s like to just move more and rest well.

Low Libido

Libido is your overall sexual drive or desire for sexual activity. It’s influenced by biological, psychological, and social factors. It’s not just that you may feel dry and a lack of interest thanks to hormone shifts. If you’re experiencing fatigue and other menopause symptoms like weight gain and belly fat, you don’t feel sexy or want to be seen or touched.

One of my first Flipping 50 TV episodes was dedicated to low libido and what you can do about it. It’s partially due to changing hormones. But a lot of midlife women don’t realize that the exercise they’re doing (or not doing) is also destroying libido.

The right exercise will boost your testosterone. The wrong exercise kills it and the mood, girlfriend. Simply said, from the boardroom to bedroom this hormone is important. Last, exercise that gets your hips moving increases blood flow there and so it’s not all intense. Whether it’s dancing for you or it’s Pilates or Yoga is up to you.

Make this flip: Stop the endurance exercise and get on the short, intense train. Plus? If your partner snores? You may need to just have play dates together and sleep separately or the libido will keep being a problem. Sleep deprived and sexy don’t belong in the same sentence.

Sleep Disorders & Insomnia

Sleep disorders & Insomnia are often brought on by night sweats. Anxiety & Depression (below) can also be to blame. If your mind just won’t shut down and quiet when your body is crying for relief from fatigue, there are things you can do. If you think of your symptoms as little messengers something isn’t quite right, it may not just be hormones. Or it may be that your hormones will be helped by some gentle shifts.

It may be a micronutrient deficiency showing up. After all, at midlife, several things may be catching up to you. Have you had a less-than-5-star diet? Are you pretty passionate about your coffee and your wine both? Have you neglected your exercise? Just review your last month and get honest. If “busy” got in the way of you exercising and your regular routine is now a random one, get back on it if only for sleep. Truth is just 10 minutes of exercise can boost sleep by 33% according to a poll by National Sleep Foundation.

It could also be exposure to EMFs (too many screens, electronics) in your lifetime or at least right now. Our bodies weren’t made to handle all of this.

There are about 20 different things you can do (and stop doing) to support sleep. Try them sequentially, not randomly and adjusting until you’ve eliminated each one or find it works is something most of us struggle to do on our own. “I’ve tried everything,” too often means I’ve randomly tried this and that for a while.

The right exercise to help with sleep depends on how you’re currently sleeping.

The Short List

Menopause Symptoms Lessened or Eliminated by (Proper) Exercise

  • Hot flashes
  • Fatigue
  • Night Sweats
  • Libido
  • Sleep Disorders
  • Weight Gain
  • Incontinence
  • Muscle Tension
  • Osteoporosis
  • Insomnia
  • Anxiety
  • Depression
  • Belly fat

Weight Gain

If you’ve experienced weight gain, I have good and bad news for you. First, you can do something about it. Second, menopause is not to blame. Hormone fluctuation may have caused sudden weight gain. But often at a deeper level there is some behavior change that either did or needs to happen.

You may, as I did, find yourself in a perfect storm. Everything that happened for me in 2019 put me in a place of toxin exposure (hormone disruption), physical and emotional stress (hormone imbalance x 2), and related time and financial stress (hormone disruption). By the end of the year I’d gained 10 lbs. Now, at first glance, it’s possibly reasonable. However, I was training for an Ironman (that’s 140.2 miles of swimming, biking, and running in a day).

Endurance activity has the potential to throw women in midlife (and others) under the bus with adrenal fatigue and it certainly did me. I’d successfully trained for 7 prior to it, with excellent health (albeit, I modified my protocol intentionally for optimum training as opposed to volume).

During menopause, what you’ve been able to get away with until then, you may not.

Depression & Anxiety

Depression & anxiety are mood disorders more common among women than men. Dropping estrogen can negatively influence production of neurotransmitters (brain hormones) like dopamine and serotonin that regulate mood. Combined declining levels of progesterone and estrogen make it hard to restore happiness after incidence of sadness or anxiety.

During the pandemic if you’ve had a little more struggle with this, though perfectly natural and normal with a decrease in our social connections, as a woman in midlife you may struggle a bit more than you would have going through this say 10 years ago.

What can you do? Mood boosting exercise is a big part. Get outdoors and move and lift weights. Both are associated with increase in serotonin, and reductions in anxiety & depression.

Belly Fat

Belly fat didn’t make many “common symptom lists.” For over 90% of the women I’ve worked with belly fat is a big complaint, whether or not they’ve gained weight. Fat deposits tend to favor the belly.

There are two types of belly fat, visceral fat and muffin top or the pinch-an-inch type.

Visceral belly fat is internal around your organs. Muffin top is that spare tire, often in front and back for women.

The two types of fat respond to exercise differently. The right exercise for targeting menopausal visceral belly fat is high intensity interval training. Altering exercise to include high intensity intervals a few times a week can be enough. However, the muffin top requires more. You’ve got to do intervals and cut out your extra-curricular carb intake.


Osteoporosis and osteopenia (less than optimal but not quite to the 2.5 Standard Deviations from optimal bone that is osteoporosis) are both growing concerns for midlife and older women.

For good reason. Bone loss on average can be between 1-3% of total bone density per year if you’re not doing something about it.[Resistance weight training has the greatest positive influence on bone density. High impact weight-bearing exercise is second. The emergence of vibration therapy also contributes to bone density. However, vibrational therapy has to be combined with function stability movement for optimal prevention of falls and fractures.]

During the 3-5 years around a woman’s menopause bone losses can accelerate to 3-5% loss annually.

What’s the answer, or rather, what’s the answer while you’re at home, opting not to go to the gym during the pandemic? At the gym using the leg press, chest press, and seated row for strength will help most to load your hips, wrists, and spine. At home focus on squats, lunges, bent over row and chest press.

You’ve been conditioned to believe any exercise is better than no exercise. During menopause the right exercise for each woman is unique.

For Fitness Professionals: Offer Your Female Clients a “Hormone Balancing Exercise Prescription”

Gain the information, tools, and resources needed to coach and train this steadily growing population with Debra’s 8-hour online course with MedFit Classroom, Stages of Menopause and Exercise Intervention.

Given the number of women who have not exercised previously, and the current void in proper hormone balancing exercise prescription, there exists numerous, lucrative opportunities for fitness professionals to positively impact the lives and health spans of a great many women still seeking answers.

Reprinted from flipping50.com with permission from Debra Atkinson.

Debra Atkinson is the #youstillgotitgirl who is flipping 50 and changing the way thousands of women think about their second half. She’s the host of the Flipping 50 TV Show and the Flipping 50 podcast. As a master personal trainer, strength and wellness coach with over 30 years fitness industry experience, she works with women who are pro-aging with vitality and energy. She is an international fitness presenter, author of hundreds of articles and multiple books. Visit her website, flippingfifty.com