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Walking-Sneakers

A Clearer Vision in Training

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.

The Unexpected Client

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.

Learning Curve

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.

Tips

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.”

Challenges

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.

Dawn working with her client

The Workouts

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.

In closing

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.

Autism

Autism Spectrum Disorder – Where Fitness Professionals Land on the Spectrum 

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: 

  • autistic disorder
  • Asperger’s disorder
  • childhood disintegrative disorder
  • pervasive developmental disorder not otherwise specified (PDD-NOS)

Furthermore, the DSM-5 requires the following for diagnosis: 

Individuals must meet all the social communication/interaction criteria:

  1. problems reciprocating social or emotional interaction
  2. severe problems maintaining relationships
  3. nonverbal communication problems

Must also meet 2 of the 4 restricted and repetitive behaviors criteria that do cause functional impairment:

  1. stereotyped or repetitive speech
  2. motor movements or use of objects
  3. excessive adherence to routines
  4. ritualized behavior, or excessive resistance to change
  5.  highly restricted interests, abnormal in intensity or focus
  6. hyper or hypo reactivity to sensory input or unusual interest in sensory aspects of environment

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 Pediatrics9(Suppl 1), S55– S65. https://doi.org/10.21037/tp.2019.09.09

breathing-outside

Increase Core Strength by Improving Your Breathing

“Core strength” is a popular fitness buzz term, but what’s the big deal all about? Core strength is essential for all our movements. The core is a collection of muscles that stabilizes the central muscles in our torso and spine. As our body’s center, our core has the big task of holding us upright. A strong core makes everyday activities easier to do.

You might think core training is all about lying on a yoga mat doing interminable “crunches.” But there’s way more to core training than aiming for a flat tummy or a “six-pack.”.

Importantly, you use your core when you put on shoes and when turning to look behind you. Likewise, reaching that box on your top kitchen shelf, or sitting in a chair are activities rely on a strong core. In fact, you might not notice a weak core until these activities become difficult or painful. Significantly, a strong core is also how you avoid back pain as you get older.

Breathing Helps Build Core Strength

The key to building core strength is by employing stomach-based, diaphragmatic breaths, so that our torso and ribcage expand forward, back, and to the sides. Breathing in is bodyweight exercise that lengthens the transverse abdominis muscles and obliques, which helps build core strength. Breathing correctly can increase flexibility and lower the risk of exercise-related injury. Also, a strong core helps with things like balance, and, oh yeah… it makes you look thinner.

4 Common Breathing Problems

1.Your neck, chest, and shoulder muscles feel tight. If you carry a lot of tension in the muscles around and under your neck, those muscles may feel painful or tender. Poor diaphragmatic control can cause neck and shoulder muscles to become short and tight. Slouching means you’re not activating your diaphragm when you breathe.

2. You sigh, or yawn frequently. If you must take a deep breath, sigh, or yawn every few minutes, it’s a sign that your body isn’t getting enough oxygen when you breathe.

3. You breathe with your mouth open. Unless you have a sinus infection or congestion that prevents you from breathing through your nose, your mouth should be closed as you breathe.

4. Your resting breath rate is too fast. A normal, resting breath rate should be about 12-20 breaths per minute. If the number of times you breathe each minute is too fast, your breathing is probably shallow. A normal respiratory rate keeps the balance of oxygen and carbon dioxide even in the body.

4 Ways to Practice Correct Breathing

1. Keep your shoulders still. Sit in a chair that has arms on the side. Support your arms and elbows by the arms of the chair. As you inhale through your nose, push down onto the arms of the chair. Exhale while you purse your lips and release any pressure on the arms of the chair. The purpose of this exercise is to keep you from elevating your shoulders as you inhale, which can cause upper chest breathing.

2. Slow your breath. Pursing your lips forces you breathe more slowly. Start by creating as small an opening as possible in your mouth when you breathe. Imagining you’re blowing through a straw or blowing at a candle only hard enough for it to flicker, but not blow it out. Breathe in through your nose for 2-4 seconds, then breathe out for 4-8 seconds, keeping your lips pursed. Repeat this for about 3-5 minutes.

3. Use upper chest resistance. Lie on your back, place a hand on your upper chest, apply slight downward pressure to the hard bone (your sternum) in the middle of your chest and maintain that pressure while you inhale and exhale. This will force you to “bypass” your chest while breathing and start to breathe from deep within your belly.

4. Blow up a balloon. When you blow up a balloon, you activate your abdominal muscles, align your spine and pelvis, and contract your diaphragm. Blowing up a balloon works your deep core muscles. It also requires all your mid-section muscles to work together. Sit on a chair with a straight back, or the floor against a wall, with your knees bent and your feet flat on the ground without leaning against the chair back or wall. Inhale deeply from your nose with your mouth closed, pushing your belly out. Then exhale by blowing slowly into the balloon, exhaling as much air as you can. Your deep abdominal muscles activate as you blow into the balloon.


Jacqueline Gikow, whose holistic, health and wellness practice centers on pain relief through better movement, is the owner of Audacious Living NYC™. She is certified through the National Association of Sports Medicine (NASM), the National Board of Medical Examiners (NBCHWC), the Functional Aging Institute (FAI), Medfit (MFN), and the Arthritis Foundation (AFAP/AFEP). Her fitness practice includes in-home and remote, one-on-one fitness training and coaching in New York City. Visit Jacqueline’s website at audaciouslivingnyc.com, or on Facebook.

 

References

trainer-and-middle-aged-client

To Spoil or Not to Spoil…That is the Question

Personal Trainers, do you SPOIL your clients?

Do you keep your clients reliant on YOU?

I used to think this was a good practice. I even thought of it as Full-Service Personal Training. But in hindsight, I wasn’t teaching my clients to be responsible for their health and fitness.

I enjoy serving my clients, bringing their dumbbells to them, taking their dumbbells, and re-stacking them. I let my clients get comfortable on the bench before giving them the bells or bar to press. I move Bosu balls and re-adjust TRX straps for my clients constantly. I have spent many hours wiping down equipment for my clients before and after use. I have adjusted weight machine bench heights, placed pins in plates, safety hooks on barbells, and the list goes on and on and on.

I thought this action was being kind and a good service provider. I am willing to bet many of you have also done this with your clients.

Flash forward 30 years in the industry. I am about to have hand surgery on my dominant hand. It is a minor surgery, but surgery non the less, and I will not be able to serve my clients in this same way while I am healing.

I have spent the last month teaching my clients how to load and de-load dumbbells safely from a bench press and how to set each weight machine for their height. Many of my clients didn’t even know how much weight they had been lifting; they just did what I said and trusted me to hand them the proper equipment.

I have spent time explaining the lengths of the TRX straps for different exercises and shown them how to adjust the straps by themselves.

This has been a big lesson for me. Doing everything for our clients only creates a client with a considerable amount of dependency on you, the trainer. This, in turn, produces less self-efficacy outside of your sessions, resulting in less progress towards their fitness and health goals.

As Professional Fitness Trainers, our ultimate goal is for our clients to be healthy. We may not always be there for them. What if you move or they move? What if you have surgery or an accident? Make sure your clients can care for their fitness with knowledge and safety.

Don’t get into the habit of full-service training. If you already have been doing it as I was, begin the de-programming process for your clients. That is the best long-term way to serve them and their health goals.

I know what some of you are thinking – if they can do it all independently, they won’t need us anymore. However, I’m afraid I must disagree. Your job is to program well and continually challenge your clients appropriately for their fitness level and health goals. If you continue to do that while educating them on the how and why of what you are doing, the sky is the limit for their success and yours! Happy Training!


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.

woman-walking-trail

Watch Your Step

Because I’m a lifelong advocate of fitness walking and injury-free walking, I’m always trying to come up with the simplest way to get walkers to move along the ground in a way that produces the least amount of impact to the feet, knees, hips and lower back. The answer to this dilemma is different depending on whether you’re walking or running. I’ll begin with you walkers.

Legs

Leg Length Discrepancy: Is it Causing Your Pain and Dysfunction?

In order to design effective corrective exercise programs that both alleviate pain and improve function, fitness professionals must understand their clients’ strengths, limitations, and weaknesses.[1] This includes having an awareness of common structural imbalances such as leg length discrepancies (i.e., when one leg is shorter than the other). While it is not within a fitness professional’s scope of practice to diagnose a leg length discrepancy (LLD), it is extremely important that personal trainers and fitness instructors understand the ramifications of this imbalance and how it can affect a client’s musculoskeletal system.

Types and Prevalence of LLD

There are two types of leg length discrepancies: functional and anatomical. A functional leg length discrepancy refers to a musculoskeletal imbalance where any number of structures (or muscles) in the body are not working as they should. This results in parts of the skeleton being pulled out of alignment making it appear as though one leg is shorter than the other. Alternatively, an anatomical leg length discrepancy occurs when the bone(s) in one leg are actually shorter/longer than those in the other.[2] As the possible cause(s) of a functional leg length discrepancy are wide and varied, this article will focus on anatomical leg length discrepancies and how they affect your client’s body.

Anatomical, also known as true, leg length discrepancies have been found in as much as 95% of the population.[3] However, significant leg length discrepancies of more than one centimeter are found in about 1 out of 4 people.2 True leg length discrepancies affect the entire musculoskeletal system and play a substantial role in the health, function and experiences of pain for your clients.[4]

How LLDs Affect the Body

The body is designed to be dynamic and can adjust incredibly well to varying movements and positions. However, a true leg length discrepancy (that is left untreated) causes bones and joints to shift out of alignment, soft tissue structures like muscles, tendons, ligaments and fascia to compensate/overwork and can lead to pain and injury over time.[5] Some major areas of the body that are affected by a LLD discrepancy are the lower back, hips, feet and ankles.

LLD and the Lower Back

The pelvis forms the base of support for the spine. Therefore, a level and well-balanced pelvis is critical for spine health and optimal lower back function. In order to comprehend how an LLD can affect the spine and lower back, it is imperative to understand the structural anatomy of this area. Either side of the pelvis is made up of three bones (i.e., the ilium, ischium and pubis) that are fused together.[6] However, independent movement of each side of the pelvis is possible due to two important joints located in the pelvis. One of these joints is called the sacroiliac joint (SI joint). The SI joints are located on either side of the back of the pelvis where the top of the pelvis (i.e., the ilium) meets the base of the spine (i.e., the sacrum). The other joint is located on the front of the pelvis where the pubic bones (i.e., pubis) meet (i.e., the pubic symphysis) (see picture below).[6] Since the base of the spine articulates with each side of the pelvis via the sacroiliac joint, movement of the pelvis affects movement and function of the spine.

In addition to interacting with the spine, each side of the pelvis also articulates with the corresponding leg via the hip socket. From a skeletal point of view, the height of each side of the pelvis is governed, in part, by the length of the leg on that side of the body. If one leg is longer than the other then the pelvis will likely also be higher than that same side (see picture below).[2]

If the left side of the pelvis is higher due to a leg length discrepancy, then the base of the spine (i.e., the sacrum and coccyx) will shift toward that side also causing a compensatory shift in the rest of the spine all of the way up to the neck and head.[2] Therefore, a leg length discrepancy can cause pain and irritation to the joints of the pelvis, the intervertebral discs of the spine and the muscles and other soft tissues that help stabilize and mobilize these areas.

LLD and the Hips

The relative length of each leg also affects the position and function of the hip socket. As one side of the pelvis elevates in compensation for a longer leg, the hip socket shifts laterally toward the longer side.[2] Consequently, the hip of the longer leg will shift to a position outside of the foot/leg (see picture below).

These compensation patterns in the hip/leg can cause various aliments for clients such as greater trochanteric bursitis, iliotibial band syndrome, tracking problems of the knee, and sacroiliac joint dysfunction.

LLD and the Feet/Ankles

Leg length discrepancies can also affect the function of the feet and ankles. Pronation, or a flattening out of the arch of the foot, is a common compensation for clients with an LLD to effectively shorten a longer leg by reducing the height of the arch. Conversely, supination effectively lengthens a shorter leg by increasing the height of the arch. As such, a common compensation pattern for someone who presents with a LLD is to overpronate on the side with the longer leg and over supinate on the shorter side. These imbalances in the feet typically display with compensatory shifts in the ankles as well. Overpronation is usually accompanied by an ankle that rotates in too much, while a supinated foot is accompanied by an ankle that rotates out too much.[5] These misalignment issues in the feet and ankles can lead to ankle sprains, Achilles tendinitis, plantar fasciitis, ankle impingement and a whole host of other painful problems.

How to Help a Client with a Suspected LLD

Being aware of the signs and symptoms of a suspected LLD will help you know when to make appropriate referrals to a licensed medical professional who can diagnose a client’s condition with the help of advanced imaging techniques (i.e., x-rays and CT scans). Developing a professional referral network that you can turn to for help with issues that fall out of your scope of practice allows you to provide a more comprehensive service for your clients. It also enables you to create long-lasting relationships with like-minded professionals who will act as a referral stream for your business.[7]

Once the appropriate referral and LLD diagnosis has been made, your allied medical professional will develop a treatment plan that may include a shoe lift. Your role, as an expert in muscles and movement, is to design corrective exercise strategies that help your client adapt to the shoe lift and the resultant new position of their head, neck, pelvis, spine, hips, feet and ankles. The golden rule of any exercise program – gradual progression – should govern every aspect of your client’s LLD treatment. Encourage clients to introduce their lift gradually when acclimatizing to their new leg length and follow the underlying doctrines of corrective exercise program design: utilize self-myofascial release strategies in the initial stages of adapting to the lift; progress to stretching and only conservatively add strengthening exercises after the client has had at least six months to a year to get used to their new leg length.


Justin Price is one of the world’s foremost experts in musculoskeletal assessment and corrective exercise and creator of The BioMechanics Method Corrective Exercise Specialist certification (TBMM-CES).  The BioMechanics Method is the fitness industry’s highest-rated CES credential with trained professionals in over 70 countries. Justin is also the author of several books including The BioMechanics Method for Corrective Exercise academic textbook, a former IDEA Personal Trainer of the Year, and a subject matter expert for The American Council on Exercise, Human Kinetics, PTA Global, PTontheNET, TRX, BOSU, Arthritis Today, BBC, Discovery Health, Los Angeles Times, Men’s Health, MSNBC, New York Times, Newsweek, Time, Wall Street Journal, WebMD and Tennis Magazine. 

References

  1. Bryant, C. X., & Green, D. J. (2010). ACE Personal trainer manual: The ultimate resource for fitness professionals (4th ed.). San Diego, CA: American Council on Exercise.
  2. Knutson, G. A. (2005, July 20). Anatomic and functional leg-length inequality: A review and recommendation for clinical decision-making. Part I, anatomic leg-length inequality: Prevalence, magnitude, effects and clinical significance. Chiropractic & Osteopathy, 13(11). doi:10.1186/1746-1340-13-11
  3. Pappas, A. M., & Nehme, A. E. (1979). Leg Length Discrepancy Associated with Hypertrophy. Clinical Orthopaedics and Related Research, &NA;(144). doi:10.1097/00003086-197910000-00034
  4. McCarthy, J. J., MD, & MacEwen, G. D., MD. (2001). Management of Leg Length Inequality. Journal of the Southern Orthopaedic Association, 10(2). Retrieved July 01, 2016, from http://www.medscape.com/viewarticle/423194
  5. Price, J. (2020). The BioMechanics Method Advanced Corrective Exercise Mentorship. The Biomechanics.
  6. Gray, H., Williams, P. L., & Bannister, L. H. (1995). Gray’s anatomy: The anatomical basis of medicine and surgery. New York: Churchill Livingstone.
  7. Price, J. (2018). The BioMechanics Method for Corrective Exercise. Champaign, IL: Human Kinetics.
Trainer-and-Client-1

5 Steps to Boosting Your Referrals

Marketing is tough, there’s no question about that. Even all the amazing tools of keywords, Google and Facebook algorithms marketing is still like trying to hit a moving target. What worked once, may not work again. Many don’t do marketing because of the costs of acquiring a new client are viewed as too steep.

Is there a way to market effectively, without spending loads of money, and have the leads be highly qualified and likely to buy from you? Yes.

You need to not only build, but to boost your referral network. A referral network is simply people, companies, practices that you can refer your clients to and visa versa. Building an active referral network is a relatively cheap form of marketing that pays huge dividends because even though these leads are from businesses, and other professionals they are essentially still word of mouth referrals. The only difference is that the lead/new client can be traced back to a specific person/company. After all, I think we all know that word of mouth is king when it comes to marketing and advertising. I’m also sure we all wish we didn’t have to work so hard to get more clients/patients.

Wouldn’t it be nice if we could have a steady stream of referrals coming through your door?

Referrals are some of the best leads you can get because they come in already knowing about you, and you have a built-in credibility because of the referring person’s relationship with that lead. If the lead knows, and trusts the person who did the referring, all you need to do is not mess it up and chances are very high that lead will turn into a client. The trust can’t get much higher than if your referrals come from a medical professional.

There are probably more tips and tricks to boost your referrals from your network. Here are the principles I’ve personally used to over double the amount of referrals coming into our facility. Because these are principles or steps, they can be replicated, regardless of whether or not you have the same business model or niche as I do.

Identify

First, you need to identify who you need to talk to. When it comes to professional referrals I would start with your existing clients and who do they see, or visit. Find out the names of the companies, doctors, practices, etc. where they go.

Another way to boost your network is to identify which clients or situations you will most likely come across in your business/practice that you’ll need to refer out to someone else. If you’ve got someone, that’s great. A good goal to shoot for is at least 3 vetted sources for each referring need. For example, if you need to refer to a rheumatologist, you should strive to get 3 different rheumatologists that you’ve talked to, met, and feel like they would take good care of your patients/clients.

Connect

The second step is to connect with these people/companies. It’s easiest to connect with other professionals with whom you share a client/patient. A great phrase to use if it is a medical provider is that you want to ‘collaborate on care’. Keep in mind you shouldn’t disclose the name of your client/patient without a HIPPA release/disclosure. But you can say that you share a patient with xyz and would like to collaborate on care. Once you start having a dialogue you can get your HIPPA release – that’s not the focus here though. The primary objective is to make a connection and talk.

You can email, call, or drop by their office/facility. You may have to do all of them, and more than once. Remember the squeaky wheel gets the oil.

If after repeated efforts to connect you still haven’t made a connect. Drop it and move to someone else. Not every doctor, therapist, facility will be willing to talk or connect. That’s ok. You want to find ones that care as much about your clients/patients as you do.

Tracking

This is a really important step. I hope it goes without saying that you need to track your results you get with your patients/clients. Objective and subjective measures are important. This is a primary reason we do assessments, right? Get usable data. As you retest, what do you do with that information. You need a place where you can find, see, and have visible the progress your people are making.

We use a software that we can customize all our specific tests/measures. Each time we enter a value it lets us know the percentage improvement from baseline to current, or from the previous measurement to the current. Having hard numbers and percentages look awesome. We also make it a point of writing down all the ‘weekly wins’ our clients have. We write it up on a whiteboard. This lets our prospects that come in see our latest amazing results. It also reinforces a sense of community and connection among our members as they see their achievement and others’ up on the board. It also makes it SUPER easy to know who and what to highlight when it comes to the next step.

The other thing you must be able to track is where your leads, prospects, and clients come from or visit. Most CRM softwares have the ability to track a lead source. If you don’t have one, you can use a simple excel spreadsheet.

Communicate Frequently

Step four is to now communicate frequently with your network. What should you say? Show them the results you are getting with you clients, and specifically the people they’ve referred over to you.

Highlight their progress, and why that’s important to them and to the client. You can let them know what’s going on with your business (new products, recent media coverage, awards, new hours, etc.).

We started sending out a monthly newsletter just to our referral network. I’ve found it keeps us top of mind and tip of tongue. The newsletter is great because there may be people in your network who don’t refer many people to you, but seeing your successes will help them feel like they can, and seeing a specific client story may jog their memory about a specific person they see who they can refer to you.

I also directly email the referral source with an update monthly on all the people they’ve sent or whom we see conjunctively.

Both of these options are designed to build your credibility that they can trust you, and you know what you are talking about. It also opens the door for more communication. I would recommend trying to always make the newsletter and email feel conversational by asking a question. It could be as simple as asking, “is there anything we can do to help you?”. Or if you are communicating directly with one person/facility, ask them about a situation (no personal details) that you’ve just seen or have a question about. Give them your thoughts and ask for theirs.

Think of communication with your referral network like a bridge. The first contact is like a piece of rope spanning a river. With each contact you strengthen that bridge. Soon it becomes a log that can be used to walk across the river. That’s good, it’s a solid way to cross, but only one person can cross at a time. We want to help you get multiple referrals at the same time, or at least more frequently. That comes with more communication and contacts. You want to convert this metaphorical bridge from a log into the Brooklyn bridge. It all happens with the trust and results you communicate frequently to your network.

Repeat

This will be the biggest step that gets glossed over and forgotten. Consistency is key. It’s key in fitness and it’s key with your network. You can’t reach out just once, or send just 2 newsletters. You’ve got to do it consistently. Once your network knows that this is a consistent habit for you, it’s just one more reason to trust you because you are consistent and you follow-up.

The more you repeat the first four steps, the more referrals you will get. It might take a month or three, but you will see an increase in your referrals and an increase in your network as those other companies don’t just talk about you to their patients/clients, but they start talking about you to their network. And before you know it, you are changing the world. Get after it!


Ryan Carver is the owner of Leverage Fitness Solutions where they specialize in helping older adults defy the status quo around aging. Ryan has been training the older adult since 2006. Ryan has published numerous articles on senior fitness and serves on multiple professional boards. He and his wife have 4 kids.

Friendly therapist supporting red-haired woman

The What, the How and the Why of Lifestyle Improvement

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

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

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

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

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

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

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

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

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

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

Webinar with Dr. Arloski

Join Dr. Arloski for The Behavioral Side of Health: Bringing Coaching Skills Into Your Wellness Work.

All wellness professionals want their clients to succeed at becoming as healthy and well as possible. For them to do so requires the expertise your bring from your profession as a fitness trainer, dietician, therapist, etc., and a way for your clients to follow through on your recommendations and live a wellness lifestyle. That’s where the skills of coaching come in.


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

healthy-eating-path

Reducing Calories May Help You Live Longer


Mounting evidence suggests that we may be able to live a longer, healthier life by strategically restricting our energy intake. For many years the scientific community has known that a surplus of energy intake results in the storage of fat, which is linked to chronic disease, and premature death. However, now emerging evidence suggests that restricting calories may be able to slow the rate in which we age. Aging can be categorized as either primary or secondary. Primary aging is considered inevitable at the date of this publishing and is the biological maturing and eventual breakdown that accompanies the years of age beyond 30.  Secondary aging comes from external influences such as obesity and lifestyle factors that cause cellular damage and is not part of the natural aging process. (2)

What is calorie restriction? Calorie restriction describes a process where one limits the amount of food they consume. The term calorie is a shortened term originating from kilocalorie and is used as a measurement of food energy. When the body has an excess of calories beyond what it needs to function it stores those calories in our body as fat. Despite the diet industry’s most sincere efforts and propaganda, studies still do not support the effectiveness of one fad diet over another for weight loss. (13) This means, weight gain, and weight loss are ultimately determined by the number of calories consumed, and the number of calories expended.

Earlier we identified obesity as contributing to secondary aging. The scientific community has established that being overweight, or obese dramatically increases your risk of cancer, heart disease, and type II diabetes, among other chronic disease, thereby reducing life expectancy. In fact, people that are 100 pounds or more overweight can expect a life expectancy that is nearly 14 years less than the national average. This is a shorter life expectancy than that of someone who is of a healthy weight and smokes cigarettes. (3, 12) A calorie reduction below what your body is expending results in weight loss, and for those who have a higher than healthy level of body fat, can expect a reduction in not just their weight but in secondary and primary aging.

There are many misconceptions of what constitutes being overweight or obese.  A person is classified as being overweight if they have a BMI (body mass index) of 25 or higher, and obese if they have a BMI of 30 or higher. BMI is calculated by dividing your weight in kilograms by your squared height in meters. BMI is likely a fair indicator if you are relatively inactive. If you are engaged in a fitness program or are an athlete, an alternative approach to determining healthy weight is by determining percentage of body fat. A healthy body fat is typically considered to be between 8-22% for men and 20-35% for women (aged 18-34).  A classification of obese may be assigned if someone has a body fat percentage of 26% or higher for men and a body fat of 39% or higher for women. (7) As always if you’re not sure where you fit into these metrics see a credentialed fitness professional or consult with your primary care provider.

It is estimated a calorie deficit of 200-500 calories daily is required to achieve healthy weight loss. Two ways to achieve this deficit are to reduce calorie consumption and increase calorie burn (expenditure). Calorie burn can be increased through additional physical activity; however, it should be cautioned that one can consume calories at a far faster rate than physical activity can burn them. As an example, it is estimated that a 180-pound man burns approximately 14 calories per minute jogging (1). As a point of reference, a single Hershey kiss contains 22 calories.  The lesson here is to use physical activity in addition to a nutritious diet, not in place of a nutritious diet.  (For more information on a nutritious diet visit choosemyplate.gov.) Give special attention to the section on vegetables, especially non-starchy vegetables as they are high in vitamins and minerals and low in calories.

For persons of a healthy weight, calorie restriction appears to offer slowed primary aging. The current school of thought is that primary aging is slowed as a result of a protective cellular reaction triggered by the calorie restriction. There is still much we do not know about the mechanisms responsible for this anti-aging phenomenon and some debate among scientists exists. However, the most common consensus among scientists is that this reaction collectively comes from activating sirtuins, increasing AMPK, impacting MTOR, and an improvement in blood sugar. (8,10,15,16,17,18) If you do not know what any of that means here’s a quick break down but don’t fret if you are not familiar with the lingo.

  • Sirtuins are responsible for DNA expression and control acetyl groups, as well as activate the mitochondrial antioxidant function. (8,16,17) Oxidative damage is believed to play a role in primary aging. Acetyl groups are important because they control the energy that proteins use during cell replication.
  • AMPK (Adenosine Monophosphate Protein-activated Kinase) detects the presence of nutrients or prolonged absence of nutrients, which then triggers the fragmentation/breakdown of damaged mitochondrial components (mitochondria are the powerhouse of the cell) that need to be rebuilt, increasing mitochondrial health and efficiency. (4,16,17)
  • MTOR (mammalian target of rapamycin), specifically TORC1 regulates protein building and cell growth. It is theorized a reduction in TORC1 and in turn a reduction of cellular division results in reduced DNA damage, and less inflammation. (11,17)
  • In terms of handling blood sugar, there are two important molecules at work. These proteins are Thioredoxin-interacting protein (TXNIP), and Thioredoxin-1. When TXNIP is stimulated by insulin (which results when we eat) cell stress resistance is reduced resulting in increased oxidative damage to DNA. It is theorized that during calorie restriction, Thioredoxin-1 increases which increases oxidative stress resistance, increases nonoxidative glucose disposal, and increases insulin sensitivity (improves use of insulin and absorption of sugar) as well as reduces damage to DNA (and thus slowed DNA aging) (10,15).

Regardless of how precisely these mechanisms work or interact what we currently believe and have pieced together is a reduction in calories likely:

  • Triggers a protective response in the body that helps:
    • Protect mitochondria from free radical damage (mitochondria are the energy makers of the cells)
    • Increases cell sensitivity to insulin and in turn increases absorption of blood sugar into the muscle
    • Induces cellular stress resistance and cell cleansing, which shuts off cell replication. Think of cell replication like a copy machine, if you do not use the original for each copy, but instead use a copy to make a copy, each time the copy gets blurrier. This is thought to also occur in our cells, therefore the less copies we make or the slower we make them the slower the aging process occurs.
  • Appears to reduce risk of age-related diseases such as heart disease, cancer, and diabetes.
  • Begins at 10%-40% reduction in calories per day (from normal)
  • Starvation is too far! You still need to get the vitamins, minerals, and nutrients required to aid your body in recovery, and immune function otherwise your efforts will be counterproductive, which can be done by increasing your consumption of non-starchy vegetables.
  • Calorie restriction can be accomplished by all types of fasting schemes. For example, fasting can take place daily for 12-16 hours, every other day, or over the weekends only. The important thing is achieving that 10%-40% reduction while still getting the proper nutrition necessary. (5)

The takeaway here is achieving and maintaining a healthy weight is the first step to a healthy lifespan and the incorporation of strategically fasting, may bring additional health and longevity. Fasting has been embedded in our culture in many ways from traditional religious observances as well in the fitness industry, but the question is what scheme and plan will work best for you. Most would agree it’s the health span (length of superior quality of life attributed to good health) more than the lifespan that’s important, and while there is currently no fountain of youth this appears to be a good place to start.

Remember, of course, to consult with your primary care provider before undergoing dietary changes.


Jeremy Kring holds a Master’s degree in Exercise Science from the California University of Pennsylvania and a Bachelor’s degree from Duquesne University. He is a college instructor where he teaches the science of exercise and personal training. He is a certified and practicing personal/fitness trainer, and got his start in the field of fitness training in the United States Marine Corps in 1998. You can visit his website at jumping-jacs.com

References

  • American Council on Exercise. (2009). Retrieved from https://acewebcontent.azureedge.net/assets/education-resources/lifestyle/fitfacts/pdfs/fitfacts/itemid_2666.pdf
  • Anstey, K., Stankov, L., & Lord, S. (1993). Primary aging, secondary aging, and intelligence. Psychology and Aging8(4), 562–570. doi: 10.1037//0882-7974.8.4.562
  • Tobacco-Related Mortality. (2018, January 17). Retrieved from https://www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/tobacco_related_mortality/index.htm.
  • Cantó, C., & Auwerx, J. (2011). Calorie Restriction: Is AMPK a Key Sensor and Effector?Physiology, 26(4), 214–224. doi: 10.1152/physiol.00010.2011
  • Derous, D., Mitchell, S. E., Wang, L., Green, C. L., Wang, Y., Chen, L., … Speakman, J. R. (2017). The effects of graded levels of calorie restriction: XI. Evaluation of the main hypotheses underpinning the life extension effects of CR using the hepatic transcriptome. Aging9(7), 1770–1824. doi:10.18632/aging.101269
  • Hadad, N., Unnikrishnan, A., Jackson, J. A., Masser, D. R., Otalora, L., Stanford, D. R., … Freeman, W. M. (2018). Caloric restriction mitigates age-associated hippocampal differential CG and non-CG methylation. Neurobiology of aging67, 53–66. doi:10.1016/j.neurobiolaging.2018.03.009
  • Howley, Edward T., and Dixie L. Thompson. Fitness Professionals Handbook. Human Kinetics, 2017.
  • Imai, S. I., & Guarente, L. (2016). It takes two to tango: NAD+and sirtuins in aging/longevity control. NPJ aging and mechanisms of disease2, 16017. doi:10.1038/npjamd.2016.17
  • Jacobs, Patrick L. NSCAs Essentials of Training Special Populations. Human Kinetics, 2018.
  • Johnson, M. L., Distelmaier, K., Lanza, I. R., Irving, B. A., Robinson, M. M., Konopka, A. R., … Nair, K. S. (2016). Mechanism by Which Caloric Restriction Improves Insulin Sensitivity in Sedentary Obese Adults. Diabetes65(1), 74–84. doi:10.2337/db15-0675
  • Jossé, L., Xie, J., Proud, C. G., & Smales, C. M. (2016). mTORC1 signalling and eIF4E/4E-BP1 translation initiation factor stoichiometry influence recombinant protein productivity from GS-CHOK1 cells. Biochemical Journal, 473(24), 4651–4664. doi: 10.1042/bcj20160845
  • Kitahara CM, et al. Association between Class III Obesity (BMI of 40–59 kg/m) and Mortality: A Pooled Analysis of 20 Prospective Studies. PLOS Medicine. July 8, 2014. DOI: 10.1371/journal.pmed.1001673.
  • Kuchkuntla, A.R., Limketkai, B., Nanda, S. et al. (2018). Fad Diets Hype or Hope?. Current Nutrition Reports 7: 310. doi.org/10.1007/s13668-018-0242-1
  • Mitchell, S. E., Delville, C., Konstantopedos, P., Hurst, J., Derous, D., Green, C., … Speakman, J. R. (2015). The effects of graded levels of calorie restriction: II. Impact of short term calorie and protein restriction on circulating hormone levels, glucose homeostasis and oxidative stress in male C57BL/6 mice. Oncotarget6(27). doi: 10.18632/oncotarget.4003
  • Oberacker, T., Bajorat, J., Ziola, S., Schroeder, A., Röth, D., Kastl, L., … Krammer, P. H. (2018). Enhanced expression of thioredoxin-interacting-protein regulates oxidative DNA damage and aging. FEBS letters592(13), 2297–2307. doi:10.1002/1873-3468.13156
  • Picca, A., Pesce, V., & Lezza, A. (2017). Does eating less make you live longer and better? An update on calorie restriction. Clinical interventions in aging12, 1887–1902. doi:10.2147/CIA.S126458

(-) “When and+ accumulates, such as during scarcity of nutrients especially glucose, sirtuins are activated….”

  • Son, D. H., Park, W. J., & Lee, Y. J. (2019). Recent Advances in Anti-Aging Medicine. Korean journal of family medicine40(5), 289–296. doi:10.4082/kjfm.19.0087
  • Speakman, J.R. & Mitchell, S.E. (2011) Calorie Restriction. Molecular Aspects of Medicine, Jun:32(3):159-221. doi: 10.1016/j.mam2011.07.001