Consistent exercise and physical activity may be the closest thing we have to the “fountain of youth” in our society today. Dr. Michael Roizen, author of “The RealAge Workout”, cites studies on identical twins that show genetic inheritance influences only about 30% of the rate and way one ages – the rest is up to you!
There are more health claims made about vitamin D than perhaps any other vitamin. Media stories touting vitamin D for this ill or that are common, particularly in the age of COVID-19. We’re also frequently told Americans don’t get enough vitamin D, with surveys showing as many of 40% of individuals have below optimal amounts in the blood. So how do we get vitamin D and what claims are true and backed by research? Let’s take a closer look at vitamin D to flesh out what we know for sure and where more research is needed.
Molecularly, vitamin D is a group of fat-soluble compounds with a four ringed cholesterol backbone. What’s most important to know is that it comes in two forms — as vitamin D2 in food and as vitamin D3 in our skin.
Vitamin D3
Our skin is our primary source of vitamin D, but it begins there as an unorganized and inactive form, requiring UV exposure to convert to usable vitamin D3. Conversion via UV light is exceedingly efficient, and it’s estimated brief exposure of the arms and face is equivalent to ingesting 200 international units day. Conversion varies however with skin type (darker skin converts more), latitude, season and time of day. Infants, disabled persons and older adults often have inadequate sun exposure as well, and the skin of those older than 70 also does not convert vitamin D as effectively. Interestingly, vitamin D also requires temperature to be activated, so you may not get as much of a benefit from sunlight in the winter months as you might expect.
Vitamin D2
Because it is fat-soluble, dietary vitamin D2 is best absorbed with fat in the diet and fish is a common source. Uptake can be negatively impacted by disorders associated with fat malabsorption such as celiac disease, Crohn’s disease, pancreatic insufficiency, cystic fibrosis, short gut syndrome and cholestatic liver disease.
Once activated and in the bloodstream — either by UV exposure or absorption through the diet — the liver converts vitamin D to 25-hydroxyvitamin D (25[OH]D), and then the kidneys further convert it to 1,25 hydroxyvitamin D, the most active form of vitamin D in the body. For this reason, kidney and/or liver problems can also negatively impact vitamin D levels.
Interestingly, all cells in our bodies have receptors for vitamin D, and this has in part fueled the varying claims as to how it might impact health. What we know for certain is that it helps with calcium absorption in the gut, regulating calcium levels via the kidneys, and regulating parathyroid hormone. Vitamin D’s role in calcium regulation and absorption means it has a direct impact on healthy bone growth and turnover. For this reason, you often see it in calcium supplements.
Research has also shown a clear correlation between Vitamin D and muscle health, including research showing improved lower body strength. Some research has also shown vitamin D can help prevent falls in the elderly.
Naomi L. Albertson M.D. is Board Certified by the American Academy of Family Physicians and specializes in the non-surgical management of musculoskeletal problems, sports injuries, concussions, and the treatment of osteopenia and osteoporosis.
Cultivate connections and build relationships within your professional field. There are enough clients and work to go around for all of us. Consider how collaborating with other professionals in your area or the periphery of your field may make you better at what you do. We are better when working together, and I believe our clients are better off.
As a Fitness professional working in the collegiate realm, this has been of the utmost importance to me and my career. Collaborating on a team to produce the best product has been a great learning experience. And let’s face it, when we work together, it expounds upon the individual ideas and makes them grander. We also get the opportunity to hear other points of view and fresh ideas.
Being able to draw on the knowledge of others is an immeasurable way to learn and grow in your area of expertise. The benefits of mentoring and being mentored by others are also invaluable. Think back to who has mentored you in your profession. How has that experience shaped your practice today? How can you pour into others to share your knowledge?
As a personal trainer, I try to build relationships with other professionals in my area. There will come a time in your career when a client presents with an issue outside your scope of practice. Having a list of reliable professionals, you can refer for your client is wonderful. This often yields better results for the client than searching the internet for a provider. And yes, I even have relationships with other trainers. Not every trainer is suitable for every person. Here is a list of the health professionals I have built relationships within my area.
It has been one of my greatest privileges to work alongside a Physical therapist (PT) to graduate a client from PT to Personal training. I have learned so much about injuries and rehab and have built trusted relationships that I can refer my clients to, AND I have been referred to by those professionals as well.
An important caveat; work within your scope of practice. If the opportunity arrives to work with another health professional, obtain the proper RFI or Request For Information. This document says that the client/patient has permitted the two professionals to share information on that person. Abiding by all HIPA laws and regulations, use this information to help bring the client/patient to better whole health.
I know that what I offer as a personal trainer is not the only thing my clients need in their life for whole-body health. Sometimes possibly combining massage with our workouts is what brings their bodies to better health. Another example is counseling. It may be that the stress in life is making it more difficult for my client to reach their full potential; talk therapy may make the physical workout more productive.
If we keep in mind, as health professionals, that we are working toward the whole-body health of our clients/patients, this style of practice is not complex. If we are honest, it is the same for us. Complete whole-body health has many different facets.
Cultivate, Build, and Grow!
Shannon Briggs is a multi-passionate fitness professional and educator. She brings 30-plus years of experience to a long, fulfilling career in the fitness industry. In the past 13 years at the University of Texas at Austin, Shannon has led continuing education workshops in multiple group fitness formats and topics specific to personal training; she also has written the curriculum and manuals for numerous workshops accredited by the American Council on Exercise (ACE). Shannon is currently a monthly contributor to Campus Rec Magazine for Fitness and Wellness.
Nearly 8 million individuals in the US currently have a diagnosable eating disorder. Though that is a big number, it’s not big enough to guarantee that everyone reading this knows someone who is impacted.
Here’s the thing, that number DOES NOT include those with more subtle disordered eating symptoms. This broadens the scope quite a bit.
What if we looked at diagnosable eating disorders as the far end of a spectrum?
Let’s call the other end, healthy intuitive eating.
What does that mean? Healthy intuitive eating means that you eat when you are hungry. It also means that you eat what you are hungry for, and you stop when you feel satisfied.
There are people that fall on that far end. Truly. I have even met one or two! They are not unicorns- possibly the closest living things though.
Let’s label everything in the middle as “disordered eating”. This would include behaviors like overeating, food restricting, skipping meals, over-exercising, overly rigid eating schedules and so many more.
The majority of people, that I know anyway, lie somewhere in that space. Would you agree? Where do you fall?
The big difference between eating disorders and disordered eating is that the latter is typically not lethal and is not all-encompassing.
The big similarity is that more often than not, individuals impacted have a poor body image.
Body image is how you see yourself when you look in the mirror or when you picture yourself in your mind. It encompasses:
Many of us internalize messages starting at a young age that can lead to either positive or negative body image. Let’s clarify what that means.
Positive body image is a clear, true perception of your shape; seeing the various parts of your body as they really are. Body positivity involves feeling comfortable and confident in your body, accepting your natural body shape and size, and recognizing that physical appearance says very little about one’s character and value as a person.
A negative body image, on the other hand, involves a distorted perception of one’s shape. Negative body image involves feelings of shame, anxiety, and self-consciousness. Those with negative body image are constantly comparing themselves to others without recognizing that they are essentially comparing apples to bananas… oranges aren’t far enough away… In such comparisons, they determine their perceived self-worth or value.
As with disordered eating, body image concerns can affect most of us. Recognizing the positive in our bodies can have a huge impact on both of these things. When you are stuck in a spiral of negative self talk, try thinking about things that your body can do. It is easy to judge your looks by looking through unrealistic lenses, but what if you took a moment to appreciate the amazing machine that you possess.
Karli Taylor is an entrepreneur and leader passionately working to shape the nation’s fitness and wellness industry through innovative programming that can be incorporated into any lifestyle. Karli has been in the industry for over 20 years. Beginning as a group exercise instructor and personal trainer, she worked her way to an executive position at a fitness chain in the northeast where she worked behind the scenes for 5 years, until her love of teaching drove her to leave the corporate office for the gym floor. She is the co-founder and creator of BarreFlow, through which she certifies fitness professionals around the globe.
In America today, 40% of females, including women, children and teens, suffer in silence with either primary or secondary dysmenorrhea every month. Primary dysmenorrhea accompanies the monthly menstrual cycle without any underlying medical conditions. Secondary dysmenorrhea means that there is another medical issue present, such as endometriosis. This condition makes it hard to function, with most women being bedridden for three to five days or longer. Dysmenorrhea is not a weakness, but a real medical issue.
Generally, the female client will have severe throbbing pain from the waist down. They can feel it in their stomach, low back, legs and feet, making it hard to move. Other symptoms include nausea, vomiting, diarrhea, anxiety, stress, depression, lightheadedness, fatigue, headache, fever, and depression, weakness and fainting. Risk factors are smoking, obesity, being underweight, strong family history, high levels of stress, anxiety and/or depression. Women can still have painful stomach cramping well after menopause if they have Endometriosis.
This is a silent stressor for many women because they rarely choose to speak about it. Some have been living with the pain for twenty years or more and think there is nothing they can do. If a client comes to you and mentions that they have a lot of pain, urge them to see their doctor. This conversation is more likely to happen with a female personal trainer. The good news is that fitness professionals can help their clients to feel better during this painful time of the month.
It is important to acknowledge this painful condition because of the physical and mental implications that come along with it. As the trainer you, may be working with a therapist as well as an OB/GYN. You are trying to help your client feel better overall. We recommend scheduling an assessment first to understand the client’s medical history. As a fitness professional, you may want to refer your clients to other professionals as well. Acupuncture, for example, is well known for helping women to ease and reduce anxiety. When you network with other professionals, you form a referral system to obtain more clients for yourself, too.
After completing your assessment, you will develop a wellness program for your client. The program will include: exercise, meditation (specific to this condition), and aromatherapy, as well as other components. Try to have your client establish a regular daily wellness routine. Journaling is also important as it helps to connect your thoughts, feelings and behaviors. Support groups can also help as women share their experiences with others.
Robyn Kade is the President/CEO of The Stress Management Institute for Health and Fitness Professionals™ and the SMI Business Institute™. Robyn received her Bachelor’s Degree from Rowan University in Health Promotion and Fitness Management. She is an American Council on Exercise (ACE) personal trainer and group fitness instructor, received a certificate in PTSD through the Kew Training Academy, and is a Compassion Fatigue Resiliency and Recovery – Educator. Robyn is also certified through the American College of Sports Medicine for Exercise Is Medicine (EIM) Level 1. Robyn is currently pursuing her Master’s Degree in Wellness and Lifestyle Management with a concentration on Wellness Coaching at Rowan University.
References
To minimize injuries and subsequent negligence claims/lawsuits, exercise professionals need to be aware of their many legal duties and risk management responsibilities. When faced with a negligence lawsuit, courts will determine the standard of care (or duty) of an exercise professional. If the court finds that the exercise professional breached a duty and the breach of duty caused harm to the plaintiff (injured party), the exercise professional (and the professional’s employer) may be found negligent and, thus, liable for the plaintiff’s harm and will need to pay monetary damages. The damages can be in the millions of dollars. For example, the jury awarded the plaintiff $14,500,000 in Vaid v. Equinox (1).
Legal scholar, the late Betty van der Smissen, stated: “if one accepts responsibility for giving leadership to an activity or providing a service, one’s performance is measured against the standard of care of a qualified professional for that situation” (2, p. 40).
A “qualified” professional possesses proper credentials and is competent. A competent exercise professional knows how (has the knowledge and practical skills) to design and deliver a “safe” and “effective” exercise program.
As described by van der Smissen,“for that situation” is determined by reference to the following three factors:
The professional must be aware of the skills and abilities the participant needs to participate “safely” in the activity, e.g., the exercise professional must possess adequate knowledge and skills to lead “reasonably safe” exercise programs.
Example: Exercise professionals that lead exercise programs that are considered “advanced” that can increase the risk of injury (e.g., Olympic lifting, high intensity programs) need to have advanced knowledge and skills necessary to safely lead these types of programs, i.e., they need to be fully informed of precautions that must be taken.
The professional must be aware of individual factors of the participant, e.g., medical conditions that impose increased risks and know how to minimize those risks.
Example: Exercise professionals that design/deliver exercise programs for individuals with medical conditions (e.g., pregnancy, diabetes, back problems) need to possess credentials and competence in clinical exercise by completing clinical academic coursework/education as well as obtaining clinical certifications and experience (3). From a legal liability perspective, it is essential that exercise professionals fully understand any additional or unique risks the medical conditions(s) might impose and how to minimize those risks. In Bartlett v. Push to Walk (4), the court stated:
Programs like Push to Walk “May impose particular duties that an ordinary health club would not have…What would constitute…negligence would differ between an ordinary health club and a facility like Push to Walk” (p. 7).
The professional must be aware of any conditions that may increase risks, e.g., weather conditions such as heat/humidity, floor surfaces, exercise equipment, and know how to minimize those risks.
Example: Exercise professionals need to have the necessary knowledge and skills to properly implement important safety precautions to help prevent heat injuries. Knowing and implementing precautions to minimize risks associated with slippery floor surfaces and improper maintenance of equipment is also important.
A personal trainer had a client, Levy with known osteoporosis, perform a series of jump repetitions on a BOSU ball. After a few reps, she lost her balance and fell fracturing her wrist that required surgery to have a plate and screws inserted into her wrist. She filed a negligence lawsuit against the defendant facility.* The facility filed a motion for summary judgment (request to dismiss the case). Trial court granted the defendant’s motion, and the plaintiff appealed. Upon the appeal, the appellate court reversed the trial court’s ruling. The court stated that the trainer, knowing Levy had osteoporosis, unreasonably increased the risk of harm to her by having her perform an advanced exercise. The appellate court considered the nature of the activity (jumping repetitions on a BOSU ball) and the type of participant (client with osteoporosis) and determined that the exercise professional did not meet the standard of care for that situation.
*In a negligence lawsuit, in addition to the exercise professional, the fitness facility is also named as a defendant through a legal principle called respondeat superior, in which the employer can be vicariously liable for the negligent acts of its employees.
Meeting the standard of care when prescribing exercise for individuals with medical conditions begins by exercise professionals obtaining the necessary credentials and competence. It was obvious that the trainer in the Levy case did not have the necessary knowledge and skills to prescribe a safe and effective program for a client with osteoporosis. The trainer failed to take important precautions to minimize the risk of a fall.
Information provided in this article comes from: Law For Fitness Managers and Exercise — the only comprehensive resource for fitness managers and exercise professional who want to: PROTECT THEMESELVES, THEIR BUSINESS, AND THEIR CLIENTS! For education programs that accompany the text, go to: Educational Courses (fitnesslawacademy.com)
JoAnn M. Eickhoff-Shemek, Ph.D., FACSM, FAWHP, professor emeritus, Exercise Science at the University of South Florida and president of the Fitness Law Academy, LLC, is an internationally known author and speaker. For more than 35 years, her teaching and research have focused on fitness safety, legal liability, and risk management issues. Dr. Eickhoff-Shemek is the lead author of a comprehensive legal/risk management text, Law for Fitness Managers and Exercise Professionals, and is the co-author of another textbook, Rule the Rule of Workplace Wellness Programs, published in 2020 and 2021, respectively.
References
Strength training boosts a key longevity hormone more than aerobic exercise does – so we love ‘em both. No need to have a favorite.
As fitness professionals, what we can expect is the unexpected. Often the last person we think may send an inquiry, does. If you’re like me and the majority of your training is in-home, you often get the privilege to work with so many you may not otherwise in a traditional gym or studio setting.
While I was used to receiving various inquiries from those with different chronic conditions or disease, disabilities and other limiting factors, the one I didn’t anticipate was a blind client. The first thing I did before responding was see what trainers in my area may be willing to work with this individual, no response, no one was interested. My first thought was my “scope of practice”. Surely this wasn’t in that category for me. While I took time to reflect on how I could possibly help this person, I did some asking around to a well-respected fitness professional not in my area. I asked him, “How do you train a blind person?” He responded by saying, “I have never had the chance to do that but I would say you train him just like anyone else.” That made complete sense to me in that moment. What I didn’t know I would research. Next, I would fully disclose that I did not have prior experience with training a blind person, but I would be happy to take him on. So, I did.
In researching training the blind community and speaking with a few people in various agencies, I couldn’t get much beyond the science and statistics. No methods, no accommodations, no modifications, no advice, not much to guide me. I did learn about Orientation and Mobility Specialists and while that was needed in the beginning for my client, it was not needed for him to have at the time for the training to take place.
You adjust everything you know about training. A huge eye opener for me was learning that I had a vision dependency on cueing. My verbal cueing was subpar. Too often I was used to saying, “Watch me first, then you try,” then correcting form as needed. In programming for my client, I needed to better learn to be descriptive so that what he could not see, he could imagine in the mind. It had to make sense.
What helped me to make progress, not just with my blind client but in general, was to really read the descriptions of exercise, movement and anatomy. Even if I had to read it continuously to better explain, that is what I did. When something didn’t make sense, we just eliminated it and found a better option.
Learning to count steps was another big deal. It was critical to know how to express inches, feet, yards when walking or moving around. For example, we are 2 yards from your driveway, in 2 feet there is a table, it is 35 steps to your mailbox.
Blindfold yourself. Close your eyes when exercising. Have another trainer, family member or friend, tell you some of the exercises that you find hard to describe and learn from those examples. Get a real feel for what your client may experience. Learn how they use their cane and the types of canes (sticks). One wealth of information came to me from a blind athlete. He took time to talk to me and just reinforce how important it is for my client to be independent.
Announce what you’re doing before you do it. It’s the same with asking to touch a client, “Is it okay if I touch your elbow?” Or, “I am going to pick up these dumbbells.”
Learning to not be so protective, smothering and motherly, as was my nature as a mother of five. I was scared every moment, what if my client falls, trips, bumps into the wall, anything. I felt I had to always be on guard and with the slightest change in movement or awkward movement, I would have my arm ready to catch if I needed. Too much! It was very helpful that a few times I had another trainer in training (my husband) come along with me and he brought it to my attention. I told him, I know I can do it, but what if something happens? He said, it just will and I can’t spend every minute in protection mode. It’s not good for me or the independence of my client.
Programming always changed. There were days we just walked because that was as much as my client could handle. Cancellations due to various reasons required me to step up and not be taken advantage of as well. Adapting to all of that and being patient in what my client needed took time.
Addictions (substance abuse). While I won’t get into much depth on this topic, there were many other challenges within this area that I was exposed to and needed to refer out and gain help for. Again, it was the unexpected.
Nutrition problems. Making sure my client was eating, what and when. There were many discussions we had regarding proper nutrition. Much of it would lead back to other barriers, such a cigarettes or substance abuse. It required other professional intervention, as I am not a Registered Dietitian, but we did review general eating habits and good vs bad. Occasionally, we got it just right.
While the primary goal was weight loss and increased strength for my client, we tackled everything. We incorporated cardiovascular activities and ones we did often were running together with a rope (tether), jumping jacks, and walking. But every part of the programming goals were to incorporate functional exercises which all required flexibility, balance, core, resistance, strength training, and what my client could focus on doing alone. We used dumbbells, resistance bands, sandbells, medicine balls, jump ropes, tires, picnic table, stairs, Airex pad and simply bodyweight. The most important use of all the exercise was in how it would further benefit my client and the goals we set. Nothing should be useless training.
While there is so much more to be said on how I trained my blind client, the most important message to relay is to not be afraid of what you can’t do, but do what you can. We should always ask questions, always expand our knowledge and do what we as fitness professionals are here for — to assist in living a healthier, active lifestyle. We can’t promise the moon, but it is our responsibility to do the very best we can within our scope, and what we are hired for. If you’re doing that, than you are probably doing it well.
Dawn Baker is an Independent Contractor Personal Trainer, founder of One Accord Fitness LLC and has been changing lives in the fitness industry for 6 years.
According to the CDC (2022), about 1 in 44 children has been identified with autism spectrum disorder (ASD). Autism Spectrum Disorder (ASD) is a neurological disorder marked by deficits in social communication as well as repetitive behaviors and restricted interests (Hodges et al., 2020. This information tells us, that it is likely in the near future or even now as a fitness professional, we may experience having a client with ASD. Being a neurological disorder, there can be faulty lines between mind and body communication that influence body movements and mechanics. Therefore, as a fitness professional, working with an ASD client would require individualized programming tailored to specific needs, but there are common sensory and motor skill deficiencies we as fitness professionals can certainly assist with.
The Diagnostic and Statistical Manuel of Mental Health Disorders (DSM-5) has now coined the term “spectrum” to include both lower and higher functioning forms of autism.
The ”spectrum” consists of the following:
Furthermore, the DSM-5 requires the following for diagnosis:
Individuals must meet all the social communication/interaction criteria:
Must also meet 2 of the 4 restricted and repetitive behaviors criteria that do cause functional impairment:
There are a number of risk factors for ASD including sex because ASD is 4 times more common in boys than girls. Other risk factors include family history, age of parents when born, and being born early (CDC, 2022). The fitness professional will of course meet the ASD after diagnosis but being aware of certain behaviors and traits is an important component to help better understand and relate to the client’s needs and abilities. The fitness professional can become part of the ASD client’s comprehensive treatment program. There is a need for our help, especially since obesity rates are higher among persons with ASD. Although some of this can be related to diet, lack of physical activity is a key contributor to this phenomenon. We know that P.E. at school alone is not enough time spent moving, and because persons with ASD might need special sensory and motor accommodations, this can be a deterrent for participation. Without the advocacy of parents, activity may not be prioritized.
Common among persons with ASD, there exist vestibular, proprioception, interoception, low muscle tone, postural instability, and compromised endurance and balance deficiencies (Autism Speaks, 2022). Adding to these, persons with ASD have been found to have differences compared to those without ASD with gait (stride width, velocity, and stride length) (Autism Speaks, 2022). As fitness professionals, we have the knowledge and experience to program design for these fitness and skill related components, so having a specialization to reach this population makes us both more credible and more marketable. Special populations need special people like us to add exercise as medicine and improve quality of life, despite the challenges, stereotypes, and stigmatisms that exist when it comes to persons on the “spectrum”.
Join Megan for her webinar on this topic, Working With Special Populations: Autism Spectrum Disorder (ASD) Fitness Integration
Dr. 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 a Ph.D in Health and Human Performance. She is a professional natural bodybuilder, fitness model, and published author.
References
Autism Speaks (2022). Autism diagnosis criteria: DSM-5.
Autism Diagnosis Criteria: DSM-5 | Autism Speaks
Centers for Disease Control and Prevention (2022). Data and Statistics on Autism Spectrum Disorder. Data & Statistics on Autism Spectrum Disorder | CDC
Hodges, H., Fealko, C., & Soares, N. (2020). Autism spectrum disorder: definition, epidemiology, causes, and clinical evaluation. Translational Pediatrics, 9(Suppl 1), S55– S65. https://doi.org/10.21037/tp.2019.09.09