Fitness Professionals Archives - Page 12 of 64

Body Language, Self-Awareness and The Client Experience

Robyn Kade/4 November 2022/ All MFN blog/

As a trainer, you wear many different hats during a typical work week. In turn, you are pulled in many different directions among family, friends and clients. If you are focusing on too many topics at once you cannot be in the moment, which can lead to a lack of client retention.

Being in the moment.

There is a lot of competition in the studio market and potential members/clients like to belong to a gym – and stay with a gym – where they feel comfortable. That puts the limelight on personal trainers to generate the positive client experience that is so important to retention.

This is why being in the moment is vital to gaining new clients and retaining current ones. If trainers are distracted this may be apparent through body language. Members may perceive being distracted as receiving bad customer service.

Members decipher up to 93% of what is said through body language.

When you think of excellent customer service, which companies come to mind? What makes them stand out from their competition? The employees that work for these companies are mindful and in the moment. They anticipate the needs of the client and help them accordingly. Being in the moment means that your body language and what you say conveys the same message. This is important to note for customer service and member retention.

The importance of not ‘zoning out.’

Members are constantly making decisions on how they want to spend their money. When trainers work with clients they should be mentally and physically present for each session. If a trainer zones out the trainer leaves their client wondering if the session is important to them. Trainers also miss out on potential new clients who may have wanted their services.

Clients will typically get your attention first by asking if there is “something else you need to do”. This should be a clue that they know you are not in the moment. You want to fix this quickly before the client stops training at your facility. Potential clients also watch to see how focused and attentive you are. I once had a member watch my training sessions for 5 months before deciding that he wanted to hire me. He said that he was looking at my training style, personality and attentiveness. He passed up two other trainers because they seemed uninterested.

When you and/or your staff have better self-awareness you are able to anticipate the needs of your members easier. You will also notice that more clients would like to train with you. By being in the moment every day your clients feel like they had an experience that they want to share with friends and family.

Do you know what message you’re conveying?

Nonverbal communication involves facial expressions, gestures, eye contact, posture, voice, and touch -and is actually more important then what is said verbally. Trainers are communicating non–verbally with clients and members all of the time and when mixed signals are sent, clients have to try to figure out how you actually feel. You may be speaking to your client and sound present and in the moment but is your body language communicating otherwise?

Robyn Kade is the Founder of The Stress Management Institute for Health and Fitness Professionals. She has 18 years of experience in medical based fitness.

References

http://www.helpguide.org/articles/relationships/nonverbal-communication.htm

http://www.statisticbrain.com/gym-membership-statistics/

Helping Older Adults Flex their Stress Resilience Muscles

Cate Reade, MS/26 October 2022/ All MFN blog/

We can all agree that stress levels have skyrocketed to an all-time high following the “year of fear.” Older adults with chronic conditions have been the hardest hit since they are most vulnerable to Sars-CoV-2 and severe outcomes. Millions have been struggling with the fear of infection and mortality; inactivity and muscle weakness as well as social distancing and isolation. Helping older adults build stress resilience strategies into daily life is critical to bolster and protect physical, mental and social wellbeing.

Living under chronic stress leads to bad decisions. That’s because the part of the brain called the amygdala is activated when under threat. It is our survival brain with the “fight or flight” response being its signature. This means that blood is flowing to the “reactive” brain and away from the “thinking and planning” part of our brain, the pre-frontal cortex.

This can contribute to poor eating, activity and lifestyle choices. Convenience and processed foods can easily take center stage along with sedentary behaviors and heavier use of drugs and alcohol. This can lead to malnutrition, decreased blood flow and the increased risk and severity of chronic conditions as well as impairing immune function. It is a recipe for dis-ease and higher health risks, particularly in pandemic times.

Chronic stress puts the body into a catabolic state of “breaking down” while also turning down the volume on the body’s anabolic pathways of “building up” (1). The body was designed to live in the parasympathetic state, also known as “rest, digest, heal and repair” mode. Constantly living in the stress response leads to high levels of cortisol, oxidative stress and pro-inflammatory cytokines (immune messengers). This chemical marinade literally shrinks muscle and brain cells (2).

Chronic Stress Stinks & Shrinks

What happens when muscle and brain cells atrophy? Sarcopenia and cognitive decline arrive on the scene. This in turn leads to the downward spiral of physical and mental pathology that can include disability, dependency, dementia, an increased risk of falls, fractures and hospitalizations.

Resilience is a Process

The American Psychological Association defines resilience as “the process of adapting well in the face of adversity, trauma, tragedy, threats, or significant sources of stress,” or “bouncing back” from difficult experiences (3). It is an adaptive process that can be developed. Being “hardy” or resilient is linked with positive outcomes, including improved functional mobility, health and longevity.

Medical fitness specialists can help older adults build stress resilience by empowering them with education and encouragement. This can be a powerful intervention as it combines education with behavior modification. It includes asking questions while providing clear messaging that reduce fears and clarify health benefits followed by simple actionable steps. The pro-active older adult can choose to practice the strategies that resonate with them. Being accountable to and encouraged by a trainer knowledgeable about geriatrics can support the process of building resilience to weather “stress storms.”

Building Stress Resilience

Like health, resilience is multi-dimensional and includes physical, mental and social components. As fitness professionals, we understand that exercise activity is the most powerful intervention to relieve stress because movement positively impacts the health of every cell in the body and brain. After all, who doesn’t feel better after an appropriate workout or walk in the sunshine?!

5 Simple Strategies

Being mindful of breathing, eating and moving are great ways to build stress resilience. Living in the present moment helps develop awareness, connection and calm. Avoid overwhelm by choosing to practice one small step at a time.

1. Breathe Deeply. Breath connects body and mind. Stress breathing is shallow breathing. By focusing on the depth and pace of breath, the parasympathetic nervous system is engaged. Encourage older adults to become aware of tension and overwhelm; to take “Breathing Breaks” while focusing on breathing in and out through the nose. It can be as simple as starting with 3 deep breaths and working up to 30.

2. Eat Slowly. In order to digest food and absorb nutrients properly, eat seated in a relaxed, calm environment. Encourage older adults to slow down and focus on chewing food 20-30 times. This supports the mechanical breakdown of food for better digestion. While eating, focus on the food’s aroma, flavor, texture, mouth feel and swallowing.

3. Tea Time. Take a few minutes to savor a warm cup of herbal tea like lemon balm, lavender or chamomile. Enjoy the aroma and feeling of warmth in hand and the body. This practice is a wonderful way to wind down at the end of the day or as needed.

4. Gratitude Attitude. Before rising and/or going to bed, think about, say out loud or write down 3 things you are grateful for. Practicing gratitude is linked with boosting happiness, optimism and a sense of greater well-being (3).

5. Move more. Inactivity and sedentary time slows down blood flow, metabolism and immune function. Encourage older adults to break up sedentary time with 5 minutes of movement every hour. Light intensity activity like house cleaning has been shown to reduce the risk of mobility disability by 40%! Simply moving more throughout the day is powerful medicine, especially when paired with a tailored exercise program.

Today, building stress resilience is absolutely critical for older adult’s functional and cognitive health. They will be so grateful for your guidance!

Fit Pros: Guide Older Clients as a Geriatric Fitness and Lifestyle Specialist

Millions of people over age 65 looking for guidance from fitness professionals who are knowledgeable in exercise, nutrition and lifestyle principles that can help them improve functional mobility, while also preventing and managing chronic conditions to live their highest quality of life. The Geriatric Fitness and Lifestyle Specialist online certificate course will give you insights, strategies and tools to be a successful professional in this rapidly growing market. Learn how to be a valued part of clients’ continuum of care, working with the medical team to improve functional outcomes and positively impact people’s lives.

Cate Reade, MS, RD is a Registered Dietitian, Exercise Physiologist and Functional Medicine Practitioner candidate on a mission to improve functional mobility and health span utilizing the power of lifestyle medicine. She has been teaching, writing and prescribing healthy eating and exercise programs for over 25 years. Today, as CEO of Resistance Dynamics and inventor of the MoveMor™ Mobility Trainer, she develops exercise products and programs that target joint flexibility, strength and balance deficits to help older adults fall less and live more.

References

Kirwan R et al (2020). Sarcopenia during COVID-19 lockdown restrictions: long-term health effects of short-term muscle loss. Geroscience. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7528158/
Mohammed A & Kunugi H (2021). Screening for Sarcopenia (Physical Frailty) in the COVID-19 Era. Int J Endocrinol. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8152925/
MacLeod, S et al (2016). The impact of resilience among older adults. https://www.sciencedirect.com/science/article/pii/S0197457216000689

Gym woman pilates stretching sport in reformer bed

The Role of the Pilates Professional in Cancer Treatment and Rehabilitation

Graciela Perez/10 October 2022/ All MFN blog/

I am a 15 year breast cancer survivor, and experienced what cancer patients go through, not just from theory, but from living it. I’m going to talk about the role that Pilates had in my rehab and why I consider essential for cancer patients and survivors.

After surgery and treatment, most cancer patients are left with lack of flexibility and range of motion, and poor posture because of the scar tissue. Most experience fatigue from chemo and radiation or just stress of the circumstances. Many go through hormonal treatment which reduces the muscle mass, increases the risk of osteoporosis and bone fracture, bone pain, fatigue, mood swings and lack of stamina and stress.

Breathing is an essential part of Pilates. It helps with stress and stamina, reduces fatigue, opens the lungs and helps with mood swings. When we are paying attention to our breathing, we clear thoughts and allow the oxygen and energy flow through our bodies.

Awareness is a principle that helps us increase the consciousness of our body and the parts that are in disharmony and need to be repaired, isolating them from other parts to progressively make them stronger and healthier. Mind –Body connection

Control is another principle helps coordinate the body parts and move them with the correct alignment, avoiding jerky movements used in general workouts (especially using the Core which we call the powerhouse) and increasing BALANCE that is so affected in cancer patients.

Flexibility and range of motion are key in the rehabilitation for mobility and functionality of the limbs or part of the body affected so we start testing the patient range of motion without any resistance at first.

Pilates machines have springs that allow switching among different resistance according to the patient’s condition avoiding injuries and pain,

Allowing the patient to get FLEXIBLE then STRONGER and then MANAGE THEIR OWN BODY improving posture, Functionality, mobility, self-image and self-confidence.

Exercise Samples

Graciela Perez is a National Academy of Sports Medicine (NASM) Personal Trainer, Aerobics and Fitness Association of America (AFAA) Aquatic Specialist, and a Cancer Exercise Training Institute Cancer Exercise Specialist. She’s been helping people reaching their health and fitness goals since 2003.

Step up to Better Balance

Karl Knopf/21 September 2022/ All MFN blog/

When we are young we take our balance and coordination for granted. Yet as we progress through the years sometimes our muscles get weaker and joints get tighter and our posture changes all contributing to decreases in balance skills.

Understanding Osteoarthritis

Chris Gellert/7 September 2022/ All MFN blog/

Osteoarthritis (OA), the most common form of arthritis, affects some 27 million adults per year and is on the rise. The Centers for Disease Control and Prevention (CDC) estimates that in 2005, self-reported arthritis or other chronic joint symptoms affected approximately 21.4 million Americans aged 65 years and older. This estimate is expected to reach 41.1 million by 2030. Osteoarthritis makes simple movements and activities of daily life painful and difficult to perform.

Osteoarthritis typically occurs in the hands, knees, spine and hips affecting a multitude of joints. Those affected with OA will typically complain of symptoms of stiffness, low-grade inflammation and pain. This stiffness and pain are most prevalent in the morning which improves with activity and as the day progresses.

Pathology

The cause of OA involves a combination of mechanical, cellular and biochemical changes. The processes involves changes in the composition and mechanical properties of the articular cartilage. Cartilage is comprised of water, collagen and proteoglycans, In healthy cartilage, there is continual remodeling that occurs as chrondocytes (cartilaginous cells) replace macromolecules that are lost through degradation. In Osteoarthritis, this process is disrupted leading to degenerative changes and abnormal repair response. 2

Contributing Factors

Despite increasing awareness of the negative effects of obesity on health and OA in particular, the prevalence of individuals who are overweight or obese is increasing. Data from the National Health and Nutrition Examination Survey (NHANES) collected between 1999 and 2000 show that 64.5% of the US population is overweight, including 30.5% classified as obese. Carrying extra weight places biomechanically places increased stress and force on the weight bearing joints. Other common risk factors include joint injury, mechanical stress, history of immobilization and trauma.

Medical Management

Arthritis treatment first begins with education. Treatment for osteoarthritis can help relieve pain and stiffness, however the condition can progress. Physicians will tend to focus to help those afflicted with OA by helping patients manage their pain. There are several ways to do this. The first commonly used approach is pharmacologic intervention. Traditional non-steroidal anti-inflammatory drugs(NSAIDs) have been shown to be effective for OA pain, and are perceived as second-line drugs for the treatment of mild to moderate OA.

Physical therapy is very effective in helping those suffering with OA. Where the focus is on helping the patient by improving their muscle flexibility, joint mobility and strengthening the weaker hip musculature. Resulting in improved mobility, function, decrease pain and improved quality of life.

Training Recommendations

Because arthritis is a “process,” the most effective training is education and prevention. From a cardiovascular perspective, a cardiovascular program should be tailored to the client. A recumbent or stationary bike is a great starting point to reduce the load to the hips and knee which can be progressed to the elliptical machine. Stretch the tight (postural) hip flexors and quadriceps seen in figure one will reduce the load to the knee joint. Yoga can also be an effective intervention which will improve flexibility, balance, strength and body awareness. Strength training should focus on targeting the weaker phasic muscles; glute maximus, glute medius/minimus as seen in figure two. These muscles are necessary for everyday movements such as arising from a chair, climbing stairs, and negotiating uneven surfaces.

**Figure 1. (left) Anterior muscles of the hip complex**
**Figure 2. (right) Posterior muscles of the hip complex**

Strengthening the core begins with simple exercises such as bridging with the ball (figure three), targeting glute maximus, hamstrings, and the lower back musculature. This can be progressed to having the client hold longer or to perform a single leg bridge. Functional strengthening exercises such as reverse lunges holding a medicine ball that can be progress to either holding overhead or adding trunk rotation will do two things. four and figure five). The use of aqua therapy can also be effective which eliminates gravity resulting in a client’s ability to strengthen their lower body in a relaxed environment.

**Figure 4. (left) Reverse lunge with wood chop**
**Figure 5. (right) Diagonal lunge with trunk rotation with medicine ball**

Summary

Arthritis continues to affect many individuals for various reasons. One thing is certain, knowledge, prevention and early screening is fundamental. Understanding the pathological process and medical approach is the first step in helping your clients with OA. Refreshing yourself on anatomy, biomechanics and understanding proper exercise prescription is fundamental. Any exercise program should be individualized resulting in improved function.

Chris Gellert, PT, MMusc & Sportsphysio, MPT, CSCS, C-IASTM, NASM CPT. Chris is the President of Pinnacle Training & Consulting Systems, LLC. A consulting and education company that is committed to creating and providing evidenced based educational material in the form of home study courses, dynamic live seminars, mini-books, DVD’s on the areas of; human movement, fitness and rehabilitation with unique practical application. Chris has 20 years clinical experience having worked with primarily orthopedic patients, spinal injuries, post-surgical conditions, traumatic and sport specific injuries and 20 years as a personal trainer. For more information, please visit www.pinnacle-tcs.com.

REFERENCES

David M Lee et al. Rheumatoid Arthritis. The lancet. Vol. 358. September 2001. pp: 1240-1242.
Hinton et al. Osteoarthritis: Diagnosis and Therapeutic Considerations. Journal of American Family Physician. 65(5) Pgs: 841-849. 2002.
Weinblatt ME, Maier AL, Fraser PA, Coblyn JS. Long-term prospective study of methotrexate in rheumatoid arthritis: conclusion after 132 months of therapy. Journal of Rheumatology. 25: pp: 238–42. 1998.
Kremer JM. Safety, efficacy, and mortality in a long-term cohort of patients withs rheumatoid arthritis taking methotrexate: follow-up after a mean of 13·3 years. Arthritis Rheumatology. 40: pp: 984–85. 1997.
Tugwell P, Wells G, Strand V, et al. Clinical improvement as reflected in measures of function and health-related quality of life following treatment with leflunomide compared with methotrexate in patients with rheumatoid arthritis: sensitivity and relative efficiency to detect a treatment effect in a twelve-month, placebo-controlled trial. Arthritis Rheum. 43: pp: 506–14. 2000.
Schneider, Rayfel. Et al. Rheumatology Disorders Clinics of North America. 28. pp: 503–530. 2002.
Braun, Jurgen et al. Ankylosing Spondylitis. The Lancet. 369, 9570; Research Library. pp. 1379. 2007.
Ding, T., Deighton, C. Management of Rheumatoid Arthritis. Journal of Medicine. Volume 38. Issue 4. 2009. pp: 172-1769.
Calin, A. Ankylosing Spondylitis. Journal of Medicine. Volume 34. Number 10. pp: 396-399. 2006.
Litman, D. Maximizing Success in Osteoarthritic Care: Benefits of a comprehensive Management Approach. Internet Journal of Rheumatology. Volume 5. Issue 2. pp: 1-2. 2008.

Fall Prevention: It’s Not Just Physical!

Christine Conti/6 September 2022/ All MFN blog/

As a fitness professional or caregiver, what are you doing to help reduce the risk for falls? You may be reinforcing the importance of exercises that promote strength, balance, flexibility, and mobility, but are you aware that decreasing fall risk requires a multi-pronged approach? It’s time to reimagine what we know about reducing falls to better serve our clients of all ages and fitness levels.

Are you aware of these crucial fall risks and are you infusing these fall prevention best practices?

1. Proprioception

What is proprioception? Proprioception is the ability of your muscles and joints to determine where they are in space. The proprioceptive nerve endings in the body provide us with the information of where our hands, arms, and legs are in space without having to look at them. ¹

Proprioception results from sensory receptors in your nervous system and body. Most of these receptors are located in your muscles, joints, and tendons, and when you move, the

receptors send detailed messages to your brain about your positions and actions. Your brain processes these messages and works with your vision, nervous system, and vestibular system to create your perception of where your body is and how you’re moving.²

As a fitness professional, it is important to address coordination and balance issues through various modalities when designing a movement session. For example, incorporating proprioception specific movements will not only reduce muscle deterioration, but also reduce risk of injuries from falls.

Have you tried these?

Tai chi or Vinyasa Flow Yoga can boost proprioception in the legs
Seated or Standing Core exercises to increase balance
Pushing & Pulling (compresses & stretches nerve endings) to increase stability
Self-hugging and releasing, squeezing playdough or touching fingers together for body awareness
Stack objects like books and practice carrying them from one place to another
Eyes Closed Prompted Movements: “Touch Left Elbow with Right Pointer Finger”

2. Brain Health

“In older people who had no signs of disease that would make them prone to falls, higher levels of activity in the front of the brain, called the prefrontal cortex, were associated with a higher risk of falls later in life.” ³ The prefrontal cortex, the area of the brain where goal setting and decision-making takes place, is just one part of the brain that has been linked to fall risk.

These exercises help to light up the prefrontal cortex and other parts of the brain responsible for improving reaction time, coordination and balance.

Dual-Tasking
- Add questions or engage in conversation
- Listen to Music with or without words
- Tell stories and ask comprehension questions
- Play “Alphabet” or various memory games
- Number exercises and call out numbers
  - ie. Right punch #1, Left punch #2, Right Kick #3, Left Kick #4

3. Hydration/Nutrition

In a 2015-2018 study by the CDC, “US adults drank an average of 44 ounces” of water, well below the recommended amount of fluid intake for a day. ⁴ As a fitness professional, being aware of the risk for dehydration is the first step to averting it. While dehydration can have serious mental and physical consequences, it is important to know that it is both preventable and treatable.

Many people, especially seniors, resist drinking a lot of water because they worry about falling if they have to take frequent trips to the bathroom. In fact, dehydration may even occur due to the fear of falling if they worry about getting up multiple times at night.. Whatever the

reason, having an ongoing conversation about hydration should be built into your daily programming.⁵ You have the ability to ease their fears about increasing hydration to reduce falls.

Are you asking these questions?

How many glasses of water did you drink today? Are you also drinking electrolytes?
Do you frequently feel thirsty throughout the day? When?
What other foods are you eating that contain mostly water? Fruits? Vegetables?
Are you keeping a water bottle or glass of water near you throughout the day?
What concerns you about adding more water to your daily routine? Falls? Why?
Can you add more fruits and vegetables to your diet so you stay hydrated longer?

4. Environmental

Perhaps one of the most important, and oftentimes overlooked, fall prevention best practice is analyzing one’s physical environment.⁶ Reminding clients about the hidden dangers and fall risks present in and around their home may significantly reduce fall risk and prevent life-threatening injuries. Creating an inventory of common environmental risks is a great start!

Are you constantly asking them about their environment and how to make it more safe?

What kinds of routine activities do you perform every day?
- Do you walk to the bathroom at night or rush to answer a phone call?
Are there obstacles on the ground within the home environment?
- Pets? Small tables? Plants? Boxes? Shoes?
Is their adequate lighting throughout your home?
- Nightlights? Hallways? Stairways? Outdoors?
Are the floors and/or floor coverings slippery or could snag?
- Slick Flooring? Throw rugs? Thresholds?

In summary, knowledge is power and consistency is key when it comes to fall prevention. While it is paramount to create safe and effective cardiovascular, strength, balance and flexibility programs, it is equally important to address factors such as proprioception, brain health, hydration and environment? The time is now to educate yourself to best help “fall proof” your clients!

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

References

“What is Proprioception?” Your Therapy Source. 22, August 2022. What is proprioception? – Your Therapy Source
Brennan, Dan, MD. “What is Proprioception?” 27, November, 2021. Proprioception: What It Is, Disorder, Symptoms, and More (webmd.com)
“Brain Activity May Predict Risk of Falls in Older People.” American Academy of Neurology. 7. December, 2016. 26. August, 2022. Brain Activity May Predict Risk of Falls in Older People (aan.com)
“Get the Facts: Data and Research on Water Consumption.” Center For Disease Control. 7. June, 2022. Get the Facts: Data and Research on Water Consumption | Nutrition | CDC
“Dehydration in Elderly People: Risks, Warming Signs, and Prevention Tips,” Great Senior Living. 7, June, 2021. Dehydration in Elderly People: Risks, S igns & Prevention (greatseniorliving.com)
Buxton, William G., MD. “Fall Prevention & Balance Treatment.” Pacific Brain Health Center. 22 December, 2021. Fall Prevention & Balance Treatment | Pacific Brain Health Center

Fight Back Stronger! Working with Clients with Parkinson’s Disease

Colleen Bridges/29 August 2022/ All MFN blog/

Determined, consistent and tenacious are just a few words I like to use to describe my Parkinson’s Disease “fighters”. I call them “fighters” because instead of lying down and giving up, they have chosen to take charge of their future. They commit to FIGHT BACK against Parkinson’s Disease, and that is a “fight” I want to join!

It is critical that you observe how the “fighter” moves, processes information and responds to challenges. We utilize that information and create fitness programs to address the motor symptoms those living with Parkinson’s Disease (PD) struggle with each and every day.

And the best place to start is with “Foundational Movements” that will broaden a fighter’s Activities of Daily Living (ADL). People living with PD require a unique fitness program to address the impact that PD has on their ADLs.

Foundational Movements

Squats
Lunges
Hinge
Push
Pull
Carry
Rotation

I encourage Fitness Professionals to start with the most basic form of each Foundational Movement before progressing to a more challenging version. Neurologically, progressive and regressive movements make an impact on people living with PD. I have learned that repetition and exercise phases are a necessary part of any fitness program, similar to the human development process.

Consider how humans learn how to move from birth to 3 years of age. First, we learn a skill such as rolling over and we repeat it until we succeed. Then, we move on to unsupported sitting, followed by crawling until one day we are up and running!

And just in case you are wondering, the best place to start with foundational movements is in the warm-up. The repetition of the drills enables the fighters to improve their form, prepare for the work phase and create new neural patterns that will improve their functionality.

Let’s briefly discuss the movement patterns and how each movement can improve ADLs.

Squat

This movement pattern is used daily and assists in maintaining the ability to use synergistic muscular tension, stability and mobility through the torso, hips, knees and ankles. However, every fighter is different which means they will need to start at different levels.

EXERCISE	ADL
Seated knee extension	Toileting
Wall Squat	Showering
Squat	Dressing
Squat/stand and lift heels	Cleaning
Squat-jump	Care-giving

Lunge

Falling or the fear of falling is a significant issue for people living with Parkinson’s Disease. The ability to stand on one leg, shift weight back and forth, maintain an asymmetrical split stance, bend down or get up off the floor is crucial for fall prevention. Lunging, in its various stages, provides Fitness Professionals a way to identify weak links.

NOTE: Some overlap will occur with the lunge and hinge movement.

EXERCISE	ADL
Tap one foot behind	Vacuuming
Reverse Lunge	Stepping in/out of shower
Step one foot forward	Tying shoelaces
Forward lunge	Walking up/down stairs

Hinge

We ALL need to strengthen our posterior chain but it seems to be the one area many Fitness Professionals shy away from including in their program. When you consider how many times a day someone bends over, they must have the strength and basic knowledge of how to hinge so they don’t fall or hurt themselves.

This is even more important for people living with Parkinson’s Disease. If they fall, it could take months for them to recover and by that time, the disease has progressed. Make it a goal to include a hinge movement in every routine.

EXERCISE	ADL
Basic Deadlift with arms crossed	Getting in/out of car
Supported Deadlift with one foot behind	Toileting/Showering
Traditional Deadlift with weights	Dressing
Single Leg Deadlift Cross-over Deadlift	House and Pet Management

Push

The push-up is one the most popular exercises of all time! Mastering the “push” is a different challenge. The “push” (not always push-ups) requires core stability, upper back and shoulder strength. Once mastered, people living with PD will notice an increase in power and strength.

Word of caution: Parkinson’s Disease typically affects a person’s posture. Please remember that anything overhead will alter the center of gravity which means some fighters need to perform a “push” exercise that keeps the arms closer to the body.

EXERCISE	ADL
Wall Push-up	Rising from the floor
Push-up on Smith Machine Bar	House cleaning
Push-up on knees	Showering
Push-up on hands/toes	Pushing large door open

Pull

With so many postural issues due to weak muscles, developing a stronger “pull” will help people living with PD strengthen their back muscles which will decrease falls, improve posture and relieve back pain.

EXERCISE	ADL
Shoulder retraction only	Opening refrigerator
Shoulder retraction and hold	Vacuuming/sweeping
“Row” arms (no weights)	Showering
“Row” with tubes	Pulling up pants
“Row” with one arm	Picking a child or pet up

Carry

People living with PD want the ability to carry a grocery bag, walk and pull out keys all at the same time. But if they do not know how to use their body correctly, multitasking can be scary. Carry exercises focus on leverage and load. The good thing is we can always make adjustments depending on other variables. For example, bad shoulders mitigate against the overhead version of the carry while weak hands prevent one from carrying heavy loads. Carry exercises don’t necessarily help prevent falling other than the benefits they provide by strengthening the core. However, Fitness Professionals need to remember that carry exercises will serve your fighters in the early pre-kyphosis stage as a posture exercise. Carry exercises also provide a challenging asymmetrical exercise if performed unilaterally.

TIP: The carry movement is a great way to challenge the core without doing crunches!

However, before beginning a gait/carry movement with your fighters, make sure they have been thoroughly assessed.

EXERCISE	ADL
Walking	Carrying groceries
Bird dog walk	Carrying laundry basket
Farmer’s walk with two weights	Child care
Farmer’s walk with one weight	Pet Care
Farmer’s walk with one weight overhead	House Management

Rotation

The core maintains the stability and strength of the torso and acts as a conduit for energy. The movement patterns listed above encourage core strength which means rotational exercises are not so much a movement pattern as a powerful supplement to the above foundational movements.

Rotational exercises for people living with PD help improve gait and posture, reduce falls, improve coordination and mobility, increase overall strength and, most importantly, enable them to independently perform ADLs.

Rotation Reminders for Fitness Professionals:

Torso stabilizes the spine and allows movement by coordinating with the pelvic muscles.
Flex, extend, bend and rotate
Anti-Rotational Exercises best for beginners. People living with Parkinson’s DIsease often deal with Processing Information issues. Begin with basic exercises in order for fighters to learn proper form and technique.
Muscles – Rectus Abdominis, obliques, rhomboids, deltoids, glutes, abductors, quads and adductors

Caution! Be sure to include the hips and the lower portion of the spine when rotating.

EXERCISE	ADL
Isometric tube hold	Enter/exit tub or shower
Isometric tube hold and step laterally	Enter/exit vehicle
Circles with tube	Emptying dishwasher
Circles with tube/squat	Laundry related activities
Torso rotation with tube	All ADL categories

In closing, when Fitness Professionals learn the art of organizing movement patterns and creating a program that uses these foundational movements, their fighters living with Parkinson’s Disease experience physical gains such as standing without support, joint mobility, active core stabilization, integrated joint action, cognitive improvement and most importantly the ability to handle a challenging moment with confidence.

Having acquired these foundational skills with the help of you, their Fitness Professional, build trust and credibility for supporting a fighter’s long-term commitment to HOPE. As noted at the beginning of this article, our fighters are determined, consistent and tenacious. They have chosen to take charge of their future and FIGHT BACK against Parkinson’s Disease — a “fight” I hope you, as a Fitness Professional, join!

Become a Parkinson’s Fitness Specialist

You can acquire the tools and resources necessary to integrate foundational movements with ADLs within the Parkinson’s community. Sign up for Colleen’s 12.5-hour online course on MedFit Classroom, Parkinson’s Disease Fitness Specialist.

Colleen Bridges has worked for nearly 17 years as an NSCA Certified personal trainer, group exercise instructor and fitness consultant and as an independent contractor for Nashville’s first personal training center, STEPS Fitness. Her passion for understanding the body in sickness and in health, and how it moves, as fed her interest in and enhanced her talent for working with senior adults, especially those living with a neurological disorder such as Parkinson’s Disease.

Turning Back the Clock on Aging

Diane H. Hart/26 August 2022/ All MFN blog/

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!

The (Current) Truth About Vitamin D

Dr. Naomi Alberston/8 August 2022/ All MFN blog/

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.

What is Vitamin D and How Do We Get It?

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.

Vitamin D in the Body: What We Know It Does

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.

Notable Areas Where the Jury is Still Out

Vitamin D has been thought to lower the risk of cancer, but currently, there is insufficient evidence to support this, though there are many ongoing studies.
There is also insufficient evidence showing that vitamin D helps improve autoimmune conditions and respiratory conditions such as asthma, COPD and acute viral respiratory diseases. In a large study from the UK, no association was found between vitamin D levels and risk of mortality from COVID-19.
Although low vitamin D levels have been associated with an increased risk of cardiovascular disease in some studies, there is no evidence that vitamin D supplementation improves cardiovascular outcomes.
Similarly, a growing number of trials examining the effects of vitamin D supplementation on pregnancy and birth outcomes show conflicting results, with some showing reduction in risk of low birth weight, but more data is needed.

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.