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MS and Circuit Training

I was recently told that a very high percentage of people with Multiple Sclerosis (MS) DO NOT exercise. As a fitness professional with MS, that blew me away. I wish I could find the actual percentage but I don’t think that’s a statistic high on the priority list for any studies! But with all the time I spend in the MS community educating about fitness, I tend to believe that this is a fact, as I hear so many say they don’t exercise because they don’t know how. This is where I have found my niche to fill the gap.

According to Multiple Sclerosis News Today, The first study on the benefits that exercise can provide to people with MS was published by University of Utah researchers in 1996. The participants improved their cardiovascular, bladder and bowel function, increased their strength, experienced less fatigue, developed a more positive attitude, and suffered fewer bouts of depression”.

With information and proof like this, why don’t more people with MS get into the gym, exercise at home or do some form of fitness program? My answer is lack of knowledge and fear. When you don’t know where to start, don’t understand how to find an exercise program that fits you, or you are not educated on the benefits of exercise for MS, you become immobilized and therefore do nothing. I believe this is the main reason why the percentage of MSers who aren’t exercising is so high.

This is where becoming a MS Fitness Specialist makes a ton of sense. Providing a proper workout plan for those with MS is not just a great thing to do, but a much-needed service.

There is a very good selection of workouts that can benefit people with MS, and one of these programs is circuit training. This type of workout gets your heart rate up and strengthens your muscles at the same time. You will never get bored in a circuit training program.

With little rest between each exercise, you rapidly go from one exercise machine to another to work different muscle groups. Depending on the intensity of the workout, you may use 8 or 12 different machines performing a different exercise and muscle group each stop.

I have my clients do 10-12 reps at each machine, using a time under tension (TUT) pace, lasting between 120–144 seconds, before moving on to the next stop.

To keep things exciting and motivating, you can change it up a bit by switching the exercises you do for each body part. A circuit training workout can be done at the gym with equipment, at home with dumbbells and resistance bands, or on an outdoor fitness trail by alternating push-ups and squats with fast-paced walking, jogging or biking.

You will need 20-30 minutes to take a MS client through the workout. The great thing about circuit training is it is easy to adjust the level of intensity by the rest time spent, the pace you perform each movement (TUT), and the speed in which you go through the circuit. A program like this works all areas of your body so you get an effective full-body workout in a short amount of time, as long as you select an exercise for each muscle group: core, arms, chest, back, shoulders and legs. The cardiovascular aspect of the program is taken care of in the time spent at rest. The less rest between sets and exercises, the more your heart rate will be elevated and the more heart-healthy cardio benefits you will receive.

There are many benefits in a circuit training routine as it is aerobic, low-impact and strength training all wrapped up in one program. You get the benefits of muscle building and toning along with a cardio workout. So, if you’re looking for a full-body workout for a MS client that can be don in 30 minutes or less, circuit training checks off all the boxes. The exercise options are endless as well with the variety of machines, resistance bands, free weights and bodyweight movements that can be incorporated into this style of program. Circuit training is an excellent workout choice for MS once you completely understand how to do it at a level that is safe yet challenging for the client you put through this program.

I want to see the percentage of people exercising with MS to overshadow the percentage that do not. You have a tremendous opportunity to be a solution to avoid in the fitness industry by becoming a MS FitnessSpecialist and working with a community that needs you.

David Lyons, BS, CPT, is the founder of the MS Bodybuilding Challenge and co-founder of the MS Fitness Challenge with wife Kendra. He has dedicated his life to helping people with MS understand and be educated on the importance of fitness in their lives. He is an author and sought after motivational speaker, dedicated to helping others by sharing the lessons gained from his life experience.  His most recent book, Everyday Health & Fitness with Multiple Sclerosis was a #1 New Release on Amazon at its release. He is the 2013 recipient of the Health Advocate of the Year Award; in 2015, he received the first ever Health Advocate Lifetime Achievement Award, and the Lifetime Fitness Inspiration Award in Feb 2016. In 2017, David received the Special Recognition Award from the National Fitness Hall of Fame.


Healing is a Skill

One aspect of training and conditioning the human body the right way, that I find particularly fascinating, is the anabolic effect that occurs, and the healing response that it creates. Anabolic, or anabolism, refers to the metabolic process of building up tissue structure in the body. You can easily remember that anabolism refers to building up when you think about anabolic steroids – the performance-enhancing drugs that bodybuilders, baseball players, and others have used to gain bulk. However, we are not talking about artificial anabolism through taking anabolic steroids here; we are talking about the body’s natural and healthy anabolism. Many times, this anabolic effect gets discussed among athletes and strength coaches in terms of getting bigger, faster, and stronger, or amongst fitness enthusiasts in terms of shedding fat, looking lean and ripped, and feeling great. However, when we think about anabolic response from an injury standpoint, one of the best parts of an elevated anabolic effect is the tissue growth and healing response it stimulates.

To further discuss anabolism in the body, we must understand that metabolic processes are controlled by our body’s hormones. Hormones regulate many of the major physiologic processes in our bodies. These processes include metabolism, appetite, strength, lean muscle mass, body fat percentage, body composition, tissue integrity, heart rate, blood pressure, energy and fatigue, mood, sex drive, emotions, and stress. Many factors affect hormone levels, including nutrition, sleep, physical activity, and physical, emotional, and mental stress. We cannot control all of these factors, but we are able to control some of them.

One major factor influencing hormone regulation that we as humans are (for the most part) in control of is physical activity, aka exercise. The type of exercise is important. The intensity and the duration of exercise are the two main factors to consider when thinking about how hormones will be influenced by exercise. This is why I say training the body the “right way” will produce an anabolic effect. We will get back to exactly what the “right way” is in terms of hormone regulation in the next section. For now, let’s finish discussing how these hormones are promoting a healing effect in the body.

Basically, exercise is really a form of trauma to the body. Correct exercise training is a controlled, mild form of trauma done in a very specific way to produce a very specific result. So one main, and very cool, thing that happens when you consistently train your body the right way is that you are actually teaching your body how to recover from damage. You are training your body to recover from trauma. You are literally teaching your body how to heal in a more efficient manner. The way I see it, healing is a skill. You can train yourself to be better at that skill!

Dr. Donnie Richardson, DC, CCSP, DACBSP, CSCS, is a Sports Medicine Specialist and Strength and Conditioning Specialist. Dr. Donnie has worked for the Many United States National Teams since 2008, serving as both a team doctor and sports performance coach, traveling both nationally and traveling internationally all over the world with our countries top athletes. Dr. Donnie also owns and operates his own private practice in Los Angeles, Universal Sports Performance, offering services ranging from sports medicine, injury diagnosis, physical rehabilitation, physiotherapy, injury prevention, sports performance training, personal fitness training, nutrition and diet programming, among other health care services.


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

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

They are getting injured.

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

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

It’s not!

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

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

Exercise is simple, right?

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

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


Apparently not.

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

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


Because the human body is really complicated!

Because exercise places stress on your body.

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

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

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

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

But there is a solution.

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

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

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

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

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

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

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

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

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

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

Co-written by Charlie Rowe and Greg Mack.

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

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


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

Eric Chessen 1

When To Pass “Go”: Criteria for Baseline Mastery and Coaching The Neuroadaptive Population

“So every few weeks you change things up, right?”

A common question asked by parents when I begin working with a new athlete in my program. 

“I change the exercises once we see independent mastery. Variety is just variety without pre-requisite skills being developed. So yes, I’ll add some new exercises…when it makes sense.”

If there’s one thing I can’t do it might be avoiding long-winded sentences. 

For the autism and other neuroadaptive populations, developing strength and enhancing motor skills does not come easily. Pre-existing deficits in motor control and stability can present a challenge for engaging in a variety of physical activities. Many individuals with ASD often find physical activity aversive due to myriad factors. Among these are;

  • New/novel tasks and environments
  • Instructions that may be unclear
  • Elevated anxiety and uncertainty 

The pathology behind movement limitations is a combination, mostly a feedback loop, of muscular and neurological impediments. Differentiation in neuronal firing for those with autism causes a delay in neuromuscular performance, often resulting in movement that can be described as “clunky,” “inhibited,” and compensatory patterns are often observed.

Given the importance of fitness, particularly the development of strength and stability for neuroadaptive populations, it is critical to implement programming that addresses strength deficits and contraindicated movement patterns. An effective approach progresses or regresses exercises based on current level of ability.

Criteria for Baseline Mastery (CfBM) is a protocol borrowed from the practice of Applied Behavior Analysis (ABA). CfBM provides us a clear description of when a skill is mastered and what the requirements are for that goal. Mastery, in this definition, means that the skill can be performed to a particular level independently. 

In our Autism Fitness™ programs, we use CfBM to set goals, track progress, and provide appropriate progressions and regressions for each athlete with every exercise. With squats, we very often reduce range of motion (ROM) by having the athlete squat to a box or similar stable platform. Depending on trunk stability, an upper body support may also be required. Having the athlete hold onto a band (held lengthwise by the coach), provides additional support. What we’re after is the athlete’s best performance of the squat with a complete reduction of compensatory movement.

Establishing a standard for performance enables us to set both general and specific goals for each athlete. For squats, as with most of our strength-focused exercises, we use 3 sets of 10 reps as our goal. Within those sets and repetitions, we are looking for stability and control throughout the entire range of motion (hips below parallel). While 3 x 10 may initially read like a standard-issue hypertrophy protocol (not necessarily bad, either), there is further reason to embrace this scheme. Three sets provides enough stimulus for the athlete and enough observational opportunity for the coach for integrity or technical breakdown of the movement. If and when the athlete is able to maintain technical control of the squat for 3 sets of 10 reps, it will be abundantly clear that they have mastered the skill, at least to the current level of challenge. 

We use 10 repetitions because it takes us far enough away from maximal loading to be safe (especially for detrained athletes) and an excellent range for improving general strength and muscular development. If an athlete can perform 10 consecutive squats below parallel maintaining rooted foot position and spinal integrity, we have valid claim to progressing the exercise.

For those with neurodevelopmental challenges, it may take months to improve on a particular exercise. Strength and stability aside, proprioception (the real-world “mind/body” relationship) often presents as a particular obstacle. Our athlete may confuse squatting with bouncing or sitting, intentionally or unintentionally rushing through the exercise. 

We have to be careful in assessing the underlying reason for the bounce and/or sit squat. When we consider through the lens of the PAC Profile™, we ask whether this is a physical, adaptive, and/or cognitive concern. For each possibility, we can apply particular questions.

Physical: Is the squat progressed beyond the current capability of the athlete and are they compensating as a result?

Adaptive: Is the athlete sufficiently motivated to complete the exercise at their current level of ability?

Cognitive: Does the athlete understand the expectation for performance of the squat? Are we certain it is clear for them? 

Our goal for each athlete, strictly from the physical perspective, is safe and effective performance of each exercise or movement pattern before adding variety. Building a foundation of strength, stability, and motor planning can have restorative and preventative benefits and enhance quality of life at any age.

Eric Chessen, M.S. is the Founder of Autism Fitness. An Exercise Physiologist with an extensive background in Applied Behavior Analysis (ABA), Eric has coached successful fitness and adapted PE programs for the neurodiverse population over 18 years. Eric is the creator of the Autism Fitness™ Certification and PAC Profile™ Method. He is also Director of Neuroadaptive Programming for Inclusive Fitness. He resides in Charlotte, NC. Go to AutismFitness.com for more information. 


Healthy Aging and You: The Power of Strength Training

I recently thought about why we exercise and what we choose to do first – and it isn’t generally strength training. Why is that? I believe it’s because we feel we CAN’T do something about becoming stronger unless we join a gym – and then we always seem to gravitate to cardio exclusively as if that is all we can do. We want to lose weight, feel better about ourselves, burn stored fat or just increase our energy level, but what if there was a better way?

fitness tracker

3 Pros vs. 3 Cons of Wearable Fitness Trackers – Are Any Right for You?

Fitness trackers are some of the hottest tech gadgets on the market. They can measure your daily steps count, monitor your heart rate, log how many calories you’ve eaten, and even analyze your sleep quality. Some models can read your blood oxygen levels and use GPS technology to keep track of your running, walking, or biking route. Many people swear by making this type of “wearable” technology a part of their daily routines.

But is there any merit to all this hype?

Are fitness trackers a passing trend or a worthy addition to your health and exercise routine?

Why wear a fitness tracker?

We all know that it’s important to exercise regularly, especially as we age. Studies have shown that physical activity can extend longevity, prevent cardiovascular disease and stroke, and combat the onset of dementia. Having a regular exercise routine is an important part of keeping your body feeling young and in shape. The trouble is that many people struggle with keeping up a consistent workout routine. This is where fitness trackers come in.

Fitness trackers are wearable health devices designed to monitor your activity level. They come in all shapes and sizes, from simple models that are little more than glorified pedometers to advanced smartwatches that can track your body’s vital signs in micro detail.

Tracking your fitness activity also can be an important step to taking charge of your health because it makes people more conscious of their health. Having a log of your activity level and vital signs can also be a valuable tool to share with your doctor or personal trainer. Seeing hard data makes it easier to create a sustainable routine you can stick to.

The Pros of Using a Fitness Tracker

Helps build routine

For many people, blindly exercising without any way to track their progress can be frustrating. It can be hard to find the motivation to get moving when you have no way of knowing if your efforts are working. Wearing a fitness tracker allows you to see your progress in real-time and make adjustments. If you track 5,000 steps a day, you can make it a goal to gradually increase to the recommended 10,000 steps per day. It can be motivating to see your numbers improve, which makes it easier to stick to your routine.

Motivates you to move more

Most of us spend far more time than we’d like to on the couch. Sitting too much can be deadly. It’s a good rule of thumb to get up and move for 15 minutes for every hour that you spend sitting down. Many fitness trackers come with built-in reminders for this exact reason, helping you remember to get up and move throughout the day.

Keeps track of your dietary choices

Many fitness trackers offer ways to input your daily food and water intake via the connected apps. Keeping track helps make sure that you’re getting adequate nutrition. Studies have shown that tracking your food intake can lead to weight loss, even without following a specific diet plan. The information can also help a dietitian or a personal trainer get an idea of your daily meal plan. They can use this data to help you formulate a healthy diet, and logging your choices regularly can help you stick to it.

The Cons of Using a Fitness Tracker

Can be overwhelming

Some people may find the amount of data to be overwhelming. Many devices offer far more options than the average person needs, and the high cost of some premium models means they may not be an ideal investment. Those who are less technically savvy may also find the device’s smartphone app frustrating to use, or simply not worth the trouble.

Ask yourself what’s most important to you to keep track of — such as your heart rate, number of steps and estimated number of calories burned — then look for models that only track those features. You’ll save money and save your brain from information overload.

May lead to obsessive behavior

The detailed stats that a fitness tracker provides can be a tremendous motivation for some people. But for others, this may open a gateway to obsessive behavior. Many people can’t help but fixate on obtaining perfect stats, and may push themselves too hard to achieve them. The number on the screen is only a best estimation of your daily activity, not a measure of your self-worth! It’s also worth noting that fitness trackers are not medically accurate with their stats, and there can be vast discrepancies between different models.

Not as useful in the long-run

While a fitness tracker can be a valuable tool to motivate you in the early stages of your fitness journey, they’re not as useful for keeping the weight off in the long-run. Surveys have shown that around ⅓ of people who buy fitness trackers stop wearing their devices after six months. Other studies have found that they’re not as helpful for losing weight as most people would believe. A randomized trial by the Journal of American Medicine found that people who didn’t wear a fitness tracker actually lost around 8 pounds more on average compared to their device-wearing counterparts.

Does that mean that wearing a fitness tracking device will inhibit your progress? Not necessarily. Those in the study who wore the trackers still saw improvements to their body composition and physical fitness thanks to their new diet and exercise routines. That’s because the trick to living a healthy lifestyle is finding a routine that works and sticking to it. If the fitness tracker helps you do this, excellent! If not, another method of motivation might be better for you.

The Best Alternatives to Fitness Trackers

It’s worth noting that shelling out hundreds of dollars for a fitness tracker isn’t the only way to monitor your health. If you want to get an idea of what your heart rate is like while exercising, try this simple experiment: go for a brisk 30-minute walk around your neighborhood. When you get to the halfway point, try singing one of your favorite songs. If you can sing it perfectly without any hesitation, up the pace.

You can also set “stand up and move” reminders on your watch or smartphone. For tracking your food intake, there are a number of apps available to let you log your daily meals. Some people enjoy keeping a physical food journal rather than going with a purely digital route. You can always experiment until you find the right method.

The Bottom Line

When used correctly, a fitness tracker can be a helpful tool that offers detailed feedback on your body’s activity level and other aspects of your health. If you need an extra boost to get moving or want to keep a close eye on your progress, they can be a worthwhile investment. However, if you have a tendency to obsess over small details or don’t need the extensive data that a fitness tracker provides, another option might be better to track your progress. Ultimately, how you choose to track your activity is your choice. Whatever option you choose, the important thing is that you keep moving and stay active at a healthy level.

Originally printed on aviv-clinics.com. Reprinted with permission.

Aviv Clinics delivers a highly effective, science-based treatment protocol to enhance brain performance and improve the cognitive and physical symptoms of conditions such as traumatic brain injuries, fibromyalgia, Lyme, and dementia.

Our intensive treatment protocol uses Hyperbaric Oxygen Therapy and cognitive and physical training as well as nutrition management for better brain health. The medical program closely tracks clients’ progress before, during, and after the treatment protocol, using customized tablets and other technology. Based on over a decade of research and development, the Aviv Medical Program is holistic and customized to your needs.

Aaron Tribby, M.Ed is Head of Physiology for Aviv Clinics where he is responsible for managing a team of physiologists, physical therapists, dietitians, and stress technicians at Aviv Clinics – the first hyperbaric medical treatment center of its kind in North America dedicated to improving brain performance. He also oversees the cardiopulmonary exercise tests and CPET in the clinic, responsible for analyzing each test. Leading to Aviv Clinics, his clinical experience is focused on health and wellness, strength and conditioning and nutrition within both the non-profits and private sectors including Mercy Hospital and MusclePharm, respectively.



  • Aviv Clinics – Brain Performance. Aviv Clinics USA. (2021, July 1). https://aviv-clinics.com/hyperbaric-medical-program/.
  • Gartner Survey Shows Wearable Devices Need to Be More Useful. Gartner. (2016, December 7). https://www.gartner.com/en/newsroom/press-releases/2016-12-07-gartner-survey-shows-wearable-devices-need-to-be-more-useful.
  • Jakicic, J. M., Davis, K. K., Rogers, R. J., King, W. C., Marcus, M. D., Helsel, D., Rickman, A. D., Wahed, A. S., & Belle, S. H. (2016). Effect of Wearable Technology Combined With a Lifestyle Intervention on Long-term Weight Loss. JAMA, 316(11), 1161. https://doi.org/10.1001/jama.2016.12858
  • Langhammer, B., Bergland, A., & Rydwik, E. (2018, December 5). The Importance of Physical Activity Exercise among Older People. BioMed research international. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6304477/.
  • Patel, A. V., Maliniak, M. L., Rees-Punia, E., Matthews, C. E., & Gapstur, S. M. (2018). Prolonged Leisure Time Spent Sitting in Relation to Cause-Specific Mortality in a Large US Cohort. American Journal of Epidemiology, 187(10), 2151–2158. https://doi.org/10.1093/aje/kwy125
  • ScienceDaily. (2019, February 28). Tracking food leads to losing pounds. ScienceDaily. https://www.sciencedaily.com/releases/2019/02/190228154839.htm.
Senior couple on country bike ride

Creating Fit and Functional Older Adults

Beginning in the seventh grade, I became fascinated with age—specifically how our bodies’ functional capacities decrease with the passage of time. When I once shared this perception with my 98-year-old grandmother, she said, “Just wait until you’re 80.” I’m still far from 80, so I can only imagine how difficult it will be then to stand up from a chair or run around the neighborhood.

The biggest factor in the decline in physical capacity with age is level of physical activity. When your clients remain active throughout adulthood, they can retard the aging process and continue to live a life worth living. I know 70-year-olds who are fitter than 30-year-olds.

Physiology of the Older Adult

After age 30, most physiological functions decline at a rate of approximately 0.75 to 1 percent per year. Perhaps the biggest functionally-related physiological change with age is a decrease in muscle mass, called sarcopenia, which is due to a loss of motor units (a motor neuron and all the muscle fibres it connects to) and atrophy of fast-twitch muscle fibres. With the loss of motor units comes denervation of muscle fibres (a lost connection between the motor neuron and the fibres within the motor unit). This denervation causes the muscle fibres to deteriorate, resulting in a decrease in muscle mass, which significantly decreases the older adult’s muscle strength and power, making certain activities of daily living difficult.

Men and women generally attain their highest strength levels between ages 20 and 40, after which the strength of most muscle groups declines, slowly at first and then more rapidly after age 50. Muscle strength decreases approximately eight percent per decade after age 45, with greater strength losses occurring in women compared to men. In both men and women, lower body strength declines more rapidly than upper body strength.

With the loss of muscle mass also comes a loss in mitochondria, which decreases muscular and aerobic endurance. Mitochondria are unique in that they have their own specific DNA, so when older adults lose mitochondria, they also lose mitochondrial DNA. If your clients want healthy functioning muscles as they age, they need lots of healthy mitochondria.

Cardiovascular fitness also declines with age, in part due to a decrease in maximum heart rate and stroke volume (the volume of blood the heart pumps per beat). With a lower maximum heart rate and stroke volume comes a lower maximum cardiac output (the volume of blood the heart pumps per minute), a decreased ability to deliver oxygen to the muscles, and thus a lower VO2max (the maximum volume of oxygen the muscles can consume). VO2max decreases by 8 to 10 percent every 10 years after the age of 30 in healthy, sedentary adults. When maximum cardiovascular functioning declines, so does the workload that can be tolerated at a given percentage of the (lower) maximum. Decreases in VO2max with aging can be variable, particularly if your clients remain active. But if not attended to, a youthful run becomes an aged walk.

Training the Older Adult

Although many physiological factors decline with age, up to 50 percent of this decline is due to deconditioning rather than aging. With proper training, your clients can lessen the physiological effects of aging and remain fit and functional.

Arguably, cardiovascular exercise will always be more important than strength training throughout your client’s life because heart disease is the most common cause of death for both men and women. No one has ever died of a weak biceps muscle. But people die of weak hearts every day. One cannot live very well or very long without a strong heart. Since the risk of heart disease increases as people age, older adults need cardiovascular exercise just as much or even more than do younger adults. Like younger adults, older adults should do at least 30 minutes of cardiovascular exercise on most, if not all, days of the week. The more physically fit one remains, the slower the rate of cardiovascular decline. Maintaining exercise intensity, rather than a higher volume of training, is the key to minimizing the loss of aerobic fitness as your clients age.

Strength training also becomes more important as people age. Given that aging is accompanied by a decrease in muscular endurance, strength, and power, resistance training should take on greater weight (pun intended) when training an older client. I’d even go as far to say that every person over the age of fifty should strength train because that’s about the age at which people start to lose a significant amount of muscle mass. And that loss in muscle mass with age affects your client’s ability to function. If you’ve ever seen a senior citizen try to stand up from sitting in a chair or witnessed how catastrophic a fall can be to a senior, you know how much benefit strength training can have. The positive effects of strength training on bone density, muscular strength and endurance, balance and coordination (which reduces the risk of falling and fractures), functional mobility, physical aesthetics, and self-esteem cannot be denied.

Train older clients with heavier weights and fewer reps per set to target improvements in muscular strength, or with lighter weights lifted quickly to target the fast-twitch muscle fibres and improvements in muscular power. Greater strength gains occur at intensities of 80 to 90 percent of the one-rep max (the maximum weight that can be lifted just once). Although we tend to think of power training as something done to improve athletic performance, it has big implications for older adults, whose muscles lack strength and power. Research has shown power training to be very effective for strength and power development in seniors. Since it takes longer to recover from workouts as people age, give your clients more time between intense resistance and cardio workouts.

If you train older adults with higher intensity, less volume, and more recovery between workouts, not only will they be fitter and stronger, they may even be able to keep up with my 98-year-old grandmother.

From CanFitPro magazine. Sept./Oct. 2017.  Reprinted with permission from Jason R. Karp, PhD

Jason Karp, PhD, is the 2011 IDEA Personal Trainer of the Year, 2014 recipient of the President’s Council on Fitness, Sports & Nutrition Community Leadership award, and creator of the REVO₂LUTION RUNNING™ certification. He has more than 400 published articles in international running, coaching, and fitness magazines, is the author of eight books, including Run Your Fat Off and The Inner Runner, and speaks at fitness conferences and coaching clinics around the world. Get training programs and autographed copies of his books at run-fit.com.

Friendly therapist supporting red-haired woman

The What, the How and the Why of Lifestyle Improvement

Health and wellness folks are sometimes confused about the role each professional might play in helping individuals to live their best life possible. Our clients are seeking to be healthier by losing weight, managing stress, stopping smoking, becoming less isolated, and often, managing a health challenge of some kind. To do so they need excellent wellness information, great treatment (if that is called for) and a way to make lifestyle changes that will ensure lasting success.  So, who is responsible for what?

Fitness trainers, rehabilitation therapists, physical therapists, dietitians, various treatment professionals and health educators can help their clients/patients to know what lifestyle behavioral changes will move them towards improved health and wellbeing. What we often hear from these medical and wellness pros is frustration with a lack of success on their client’s part in making the recommended changes and making them last. The reality is, most people simply don’t know that much about how to change the ingrained habits of a lifetime.  

The physical therapist works with their client in their session and sends them home with exercises that must be done every day. The dietitian creates a fantastic meal plan that their client must put into practice. The fitness professional creates a tailor-made workout plan, but their client needs to exercise on their own, not just in front of their trainer.

Health educators, treatment professionals, etc. provide the
Health and Wellness Coaches provide the
Our Clients find their

Everyone’s challenge is the how. It takes more than willpower and motivation.  What is often lacking is an actual well-thought-out plan that the client has co-created with the help of someone who can provide support, accountability and a well-developed behavioral change methodology. Translating the lifestyle prescription into action and fitting it into an already busy life is often where, despite good intentions, our clients struggle. This is where having a trusted ally in the cause of one’s wellness pays off.

As the field of health and wellness coaching grows, the challenge coaches sometimes face is clarity about their own role. Sometimes the confusion is all about the what and the how. For coaches to be proficient at “writing” the lifestyle prescription they need additional qualifications. It becomes a question of Scope of Practice.

To guide coaches, the National Board for Health and Wellness Coaches (NBHWC) has developed a Scope of Practice Statement. Here is the part most relevant to our question:

While health and wellness coaches per se do not diagnose conditions, prescribe treatments, or provide psychological therapeutic interventions, they may provide expert guidance in areas in which they hold active, nationally recognized credentials, and may offer resources from nationally recognized authorities such as those referenced in NBHWC’s Content Outline with Resources.”  (NBHWC)

If coaches can “wear two hats” professionally they can combine the what and the how. Otherwise, the key is to coordinate with other wellness professionals or work with the lifestyle prescription that their client already has.

Beyond the what and the how is the why.  The “why” of behavior is all about motivation – initiating and sustaining behavioral change efforts by drawing upon the energy and desire to do so. The key here once again is the question of who is responsible for supplying this. People may initiate behavior based upon external motivation – the urging and cheering on of others, the fear of negative outcomes. In order to sustain that motivation, it has to come from within. The challenge here for all wellness professionals is to help our clients to discover their own unique sources of motivation. Seasoned wellness professionals realize they can’t convince or persuade anyone to be well. However, when we help our clients discover their own important sources of what motivates them, they discover their why.  Motivation is fuel. Now with the aid of a coach our clients can find the vehicle to put in. They know what they need to change. Now they have a way to know how to change and grow, and they know themselves, why.

Michael Arloski, Ph.D., PCC, NBC-HWC is CEO and Founder of Real Balance Global Wellness Services, Inc. Dr. Arloski is a pioneering architect of the field of health and wellness coaching.  He and his company have trained thousands of coaches around the world. 


Mountain Grit: Meet Jim

For all you medical fitness professionals out there, meet Jim, 75. Jim exemplifies the mindset towards aging that we all can emulate.

From urban to suburban, rural to remote, the glass is half-full – so lets fill-it-up’. SPIRIT truly can change the way and the pace at which we age.

[Excerpted from The Training Corner column in the Lone Peak Lookout]   

Q: Hi Pat!  I am sick and tired of my family members and friends telling me to slow down.   

I am 75 and in pretty darn good health. I was blessed with some good genes. Both of my very active parents lived well into their 90s. I’ve never gotten fat, and I quit smoking and heavy drinking back in my 20s. I drive my wife crazy because I am one of those ants-in-pants guys who just can’t sit still until the day is done. OK, I have some aches and pains, wear a hearing aid and need glasses just for reading. No big deal!   

Right now, I am in the throes of remodeling my daughter’s kitchen. I thrive on projects. They are a challenge, so I am always looking for something to fix. I am also the go-to guy when my neighbors need a helping hand. My true passion is calf-roping, so I mentor and teach the younger dudes. Yeah, I can still do it, but I lost my favorite horse last year, so I coach instead. My wife and I love the outdoors, and enjoy hiking, fly fishing, skate skiing and snow shoeing 1-2X/week.

We do all of our own outdoor maintenance, too. If for some reason, my day is void of physical work or play, I walk for 30 minutes, just to keep the pump pumping.  

I did construction all my life, and my back and shoulders act up on occasion. But over the years, I have collected a bag of maintenance tricks from various physical therapists. I have a morning routine of breath-work with tai-chi like moves, and some core preservation exercises. I use that foam roller with the bumps, too, my best friend for about 10 years, now. This regimen seems to work.  

Pat, am I just plain oblivious to this aging thing? Isn’t the body in motion the best brain and overall health potion? I am confident in my skills and abilities, so why would I slow down?  Any suggestions on telling the naysayers to put a sock in it?

Jim, 75

Pat’s Answer:  Hi Jim!  No, you are not oblivious. Yes, a body in motion is the best path to aging younger. Continue to get up and get after it every day. You have purpose, passion, meaning and relevance in your life. There is no need to slow down. You are thriving at 75, and are inspiring others. Keep up the pace, unless something rocks your competence and confidence. We CAN continue to learn, grow and discover throughout our lifespan, if we avoid ruts, complacency and stagnation.

Here is some ammunition for you:

  • Traditional retirement is dead. We reWIRE!  60+ is the time to wind up, not wind down. Act III is ripe with opportunity, adventures, vocations, projects, dreams and sharing the wisdom. You chart your journey.
  • The way and the pace at which we age is malleable. It is deeply rooted in Hardiness and GRIT, not talent. When we invest in our 5 Pillars of Hardiness (Purpose, Movement, Diet, Rest-Recovery-Regen, and Stress Ops), through DAILY habits, patterns and practices, we fortify our resilience, durability and robustness for the long haul. Aging is NOT a disease. It is an accumulation of how we react and respond to the ‘ups and downs’ of life, how we adapt to and bolster our reserve capacity.
  • Aging is living life to the fullest, a journey. 35 is seasoned, that is we have reached our peak biological development. This does not mean that we cannot continue to learn, grow and discover, nor set personal bests in physical endeavors. Check out the Senior and Master Games.   
  • We are individuals. We age at different rates. We are unique in personality, upbringing, physical work-play experiences, life lessons, and ‘what makes us tick’. “If I choose to climb a ladder and clear snow off the roof, quit barking at me. I know my limits, after doing it for 40 consecutive years. And by the way, I take no MEDS, so my balance is pretty darn good.”  
  • “We don’t live life to be safe and healthy; we live safely and healthfully to live life to the fullest!”

From Albert Einstein, and so relevant today, “A ship is always safe at shore, but that’s now what it was built for.” Reasonable risk is the springboard into learning, growth and discovery. Push out of the comfort zone, or slide backwards. A fool-proof safe, static and secure mentality can lead to stagnation, apathy, and even depression. 

In summary, Jim, keep moving, working and playing ‘til you can’t. Vintage vehicles need DAILY maintenance to run well, so continue your morning regimen. If you notice that you are losing strength, you may need to tweak your training for strength and power gains. Mentor and lead by example. No need to preach to the naysayers. Just ask them, “What makes YOU tick? Ok, I’m not YOU.” 

In the soon to be released, Cardiac Rehab Fitness Specialist course, be prepared to rethink your approach to coaching people up to living life to their fullest. In my Pillars and 7S Buckets approach to reclaiming, restoring and rebuilding Hardiness for the long haul, you will be inspired to change the way and the pace at which you age. Jim has the Spirit, and Hippocrates had it right…

“Know the person who has the disease; not just the disease who has the person.”  —Hippocrates

Patricia ‘Pat’ VanGalen, M.S. brings a unique blend of education, practical experience, common sense application, science and research to her lecturing, teaching, training and coaching. She launched her professional career 40+ years ago in physical education and coaching, then spent the next 10 years in corporate-industrial fitness, health promotion, cardiac rehab and injury risk reduction programming design, implementation and management. Visit her website, activeandagile.com.