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Senior-Fall-Prevention

Fall Prevention: It’s Not Just Physical!

/6 September 2022/ All MFN blog/
Facts About Falls (cdc.gov)

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

  1. “What is Proprioception?” Your Therapy Source. 22, August 2022. What is proprioception? – Your Therapy Source
  2. Brennan, Dan, MD. “What is Proprioception?” 27, November, 2021. Proprioception: What It Is, Disorder, Symptoms, and More (webmd.com)
  3. “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)
  4.  “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
  5. “Dehydration in Elderly People: Risks, Warming Signs, and Prevention Tips,” Great Senior Living. 7, June, 2021. Dehydration in Elderly People: Risks, Signs & Prevention (greatseniorliving.com)
  6. Buxton, William G., MD. “Fall Prevention & Balance Treatment.” Pacific Brain Health Center. 22 December, 2021. Fall Prevention & Balance Treatment | Pacific Brain Health Center
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Fight Back Stronger! Working with Clients with Parkinson’s Disease

/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.

EXERCISEADL
Seated knee extensionToileting
Wall SquatShowering
SquatDressing
Squat/stand and lift heelsCleaning
Squat-jumpCare-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.

EXERCISEADL
Tap one foot behindVacuuming
Reverse LungeStepping in/out of shower
Step one foot forwardTying shoelaces
Forward lungeWalking 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.

EXERCISEADL
Basic Deadlift with arms crossedGetting in/out of car
Supported Deadlift with one foot behindToileting/Showering
Traditional Deadlift with weightsDressing
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.

EXERCISEADL
Wall Push-upRising from the floor
Push-up on Smith Machine BarHouse cleaning
Push-up on kneesShowering
Push-up on hands/toesPushing 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.

EXERCISEADL
Shoulder retraction onlyOpening refrigerator
Shoulder retraction and holdVacuuming/sweeping
“Row” arms (no weights)Showering
“Row” with tubesPulling up pants
“Row” with one armPicking 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.

EXERCISEADL
WalkingCarrying groceries
Bird dog walkCarrying laundry basket
Farmer’s walk with two weightsChild care
Farmer’s walk with one weightPet Care
Farmer’s walk with one weight overheadHouse 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.

EXERCISEADL
Isometric tube holdEnter/exit tub or shower
Isometric tube hold and step laterallyEnter/exit vehicle
Circles with tubeEmptying dishwasher
Circles with tube/squatLaundry related activities
Torso rotation with tubeAll 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.

All-Ages-Senior-Yoga-Fitness

Turning Back the Clock on Aging

/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!

vitamin-bottle

The (Current) Truth About Vitamin D

/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.

hands-in-circle-connections-teamwork

Cultivate Connections!

/3 August 2022/ All MFN blog/

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.

  • Chiropractors
  • Acupuncturist 
  • Counselors/therapist
  • Group instructors
  • Massage therapist
  • Orthopedic surgeons
  • Personal trainers
  • Physical therapist
  • Registered Dieticians

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.

Unknown food

Body Image and Disordered Eating

/29 July 2022/ All MFN blog/

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:

  • What you believe about your own appearance 
  • How you feel about your body
  • How you sense and control your body as you move.  
  • How you physically experience or feel in your body. 

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.   

Webinar with Karli Taylor and Christine Conti

 

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.

 

 

woman heating pad

Why Suffer in Silence?

/15 July 2022/ All MFN blog/

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

gavel

Exercise Prescription and the Standard of Care

/11 July 2022/ All MFN blog/

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).

Factors Courts Consider When Determining the Standard of Care

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 Nature of the Activity
  • The Type of Participants
  • The Environmental Conditions

Nature of the activity

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.

Type of participants

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).

Environmental conditions

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.

Case Example: Levy v. Town Sports International, Inc. (5)  

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.

Conclusion

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.

Join Joann for her webinar on this topic, Exercise Prescriptions: Linking Safety and Business Success

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

  1. Vaid v. Equinox, CV136019426, 2016 LEXIS 828 (Conn. Super. Ct., 2016).
  2. Van der Smissen van der Smissen B. Elements of Negligence. In: Cotten DJ, Wolohan JT, eds. Law for Recreation and Sport Managers, 4th Ed. Dubuque, IA: Kendall/Hunt Publishing Company,
  3. Warburton DER, Bredin SSD, Charlesworth SA, et al. Evidence-Based Risk Recommendations for Best Practices in the Training of Qualified Exercise Professionals Working with Clinical Populations. Applied Physiology Nutrition and Metabolism 36, S232-S265, 2011.
  4. Bartlett v. Push to Walk, 2018 WL 1726262 (2018 U.S. Dist. Ct., D. N.J.).
  5. Levy v. Town Sports International, Inc., 101 A.D.3d 519 (2012 N.Y. App. Div. LEXIS 8543).