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.
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.
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]
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.
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
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.
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.
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.
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.
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.
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.
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.
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.
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.
Regardless of how precisely these mechanisms work or interact what we currently believe and have pieced together is a reduction in calories likely:
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
(-) “When and+ accumulates, such as during scarcity of nutrients especially glucose, sirtuins are activated….”
When I was in graduate school I discovered in my readings, the differences between open-loop systems and closed-loop systems approach. I fell in love with the Open-loop systems descriptions in business and how it contrasted with the closed-loop. In this blog, I will explain what these systems are and how you likely operate in both but you need to invite the open-loop systems into your practice and perhaps your own training.
A closed-loop system is as you might think — closed to the influence and energy of outside sources. While this seems efficient, in the long run- it is not. A closed-loop system is similar to the thermostat in your living space. The temperature goes down, it is detected by a thermometer. This is sent to an “integration center” which processes the information and sends a signal to an “effector” which would be a heater or air conditioner to “turn on” or not. In training, this might be where you train someone and they begin to get stronger with weights. Say you have them doing a bench press between 8 and 15 repetitions. Once they can do 15 reps easily, you “raise the weight” and they no longer can do. Job done… or is it?
In an open-loop system, there is “new energy” coming in and adaptations must take place. So when a tree is growing there is a normal system, where leaves go through photosynthesis, they make glucose and oxygen from carbon dioxide and water they provide energy to the plant and everything is “honkey-dory”…or is it?
Actually, the leaves that were getting a high amount of light send a signal to the integrating center, and the leaves that were getting very low light also send a signal to the integrating center. The tree adjusts its growing pattern to maximize the light pattern. It was capable of adaptation. It was capable of pulling in new positive energy and adjusting the system to accommodate it, thus survive.
Our bones must constantly have new incoming stimulus to grow or even “stick around” especially in older age. The natural process of the bones is to “lose mineral density” but by introducing new stimulus and the proper nutrients, you can maintain or even grow bone mass.
To develop a system, you must include all 3 aspects of the homeostasis cycle. You must do an assessment to understand the current state of the client. This is a receptor or detector. If you don’t have a good assessment system that is understood by the integration center, then the system is broken. If you do not understand the scientific background, then you as a trainer, are not a good integration center. Finally the effector. In the case of this analogy, the effector is exercise. Exercise will change the stimulus to the bone, thus it “effects” the result.
In my Osteoporosis Fitness Specialist online course, I provide a comprehensive assessment system using the ABCDEFF. It assesses someone’s agility, balance, coordination, dexterity, endurance, force, and flexibility. Throw in someone’s bone density (T-score) and if they have broken a bone, as well as a nutritional and medical intake and you have a really good picture of your client’s status. From there, a solid education on bone physiology and how exercise influences bone physiology sets up the integration center. Finally, the exercise programs are highly adaptive to not only the location (gym, home, or park) but the level (1-4). Thus, great adaptability exists to allow new energy to flow into the system.
Assessments… most trainers are scared of this word, and many clients don’t want to go through them. A good assessment should not be feared, and actually it should be embraced because it may give critical information to guide your training program. What if you went to the medical doctor and he or she just guessed at what you might have, and then gave you a drug or wanted to do surgery on you! You would think they are crazy! Why should setting up a training program be any different, especially for someone with a medical condition.
This webinar will go through the different tests that are easy to perform, very informative, and well within a trainer’s scope of practice. It will also discuss how to use clinical tests in conjunction with your own to advance your assessment and accurately deliver a program specifically guided to help your client improve their condition and life!
Dr. Mark P. Kelly has been involved with the health and fitness field for more than 30 years. He has been a research scientist for universities and many infomercial projects. He has spoken nationally and internationally on a wide variety of topics and currently speaks on the use of exercise for clinical purposes and exercise’s impact on the brain. Mark is a teacher in colleges and universities in Orange County, CA., where Principle-Centered Health- Corporate Wellness & Safety operates.
Regular exercise has a favorable effect on many of the established risk factors for cardiovascular disease. For example, exercise promotes weight reduction and can help reduce blood pressure. Exercise can reduce “bad” cholesterol levels in the blood (the low-density lipoprotein [LDL] level), as well as total cholesterol, and can raise the “good” cholesterol (the high-density lipoprotein level [HDL]). In diabetic patients, regular activity favorably affects the body’s ability to use insulin to control glucose levels in the blood. Although the effect of an exercise program on any single risk factor may generally be small, the effect of continued, moderate exercise on overall cardiovascular risk, when combined with other lifestyle modifications (such as proper nutrition, smoking cessation, and medication use), can be dramatic.
There are a number of physiological benefits of exercise. Regular aerobic exercise causes improvements in muscular function and strength and improvement in the body’s ability to take in and use oxygen (maximal oxygen consumption or aerobic capacity). As one’s ability to transport and use oxygen improves, regular daily activities can be performed with less fatigue. This is particularly important for patients with cardiovascular disease, whose exercise capacity is typically lower than that of healthy individuals. There is also evidence that exercise training improves the capacity of the blood vessels to dilate in response to exercise or hormones, consistent with better vascular wall function and an improved ability to provide oxygen to the muscles during exercise. Studies measuring muscular strength and flexibility before and after exercise programs suggest that there are improvements in bone health and ability to perform daily activities, as well as a lower likelihood of developing back pain and of disability, particularly in older age groups.
Patients with newly diagnosed heart disease who participate in an exercise program report an earlier return to work and improvements in other measures of quality of life, such as more self-confidence, lower stress, and less anxiety. Importantly, by combining controlled studies, researchers have found that for heart attack patients who participated in a formal exercise program, the death rate is reduced by 20% to 25%. This is strong evidence in support of physical activity for patients with heart disease.
Unfortunately, most Americans do not meet the minimum recommended guidelines for daily exercise. In 1996, the release of the Surgeon General’s Report on Physical Activity and Health provided a springboard for the largest government effort to date to promote physical activity among Americans. This redefined exercise as a key component to health promotion and disease prevention, and on the basis of this report, the Federal government mounted a multi-year educational campaign. The Surgeon General’s Report, a joint CDC/ACSM consensus statement, and a National Institutes of Health report agreed that the benefits mentioned above will generally occur by engaging in at least 30 minutes of modest activity on most, if not all, days of the week. Modest activity is defined as any activity that is similar in intensity to brisk walking at a rate of about 3 to 4 miles per hour.
These activities can include any other form of occupational or recreational activity that is dynamic in nature and of similar intensity, such as cycling, yard work, and swimming. This amount of exercise equates to approximately five to seven 30-minute sessions per week at an intensity equivalent to 3 to 6 METs (multiples of the resting metabolic rate*), or approximately 600 to 1200 calories expended per week.
If you have cardiovascular disease or are at risk for developing disease, you may be apprehensive at starting an exercise program. You may have questions such as:
A personal trainer or exercise professional can answer all of these questions for you and establish a well-rounded exercise program that is safe and effective.
A personal trainer will tell you what types of aerobic exercise are most appropriate for you and devise an exercise program tailored towards your needs. This will include guidelines for frequency (how many times per week), intensity (how hard you should exercise), and duration (how long each exercise session should last). A well-designed exercise routine will start with a warm-up that includes dynamic movements designed to raise the heart rate, increase core temperature, mobilize the major joints in the body, and prepare the body for more intense exercise. Warm-up can be followed by either aerobic exercise or weight training. Your trainer can monitor your heart rate and blood pressure during both activities to make sure you are exercising at the proper intensity. If heart rate and blood pressure get too high, your trainer will have you decrease the intensity of exercise or stop. If you develop any symptoms while exercising, your trainer will be right there to advise you and check your vital signs. Weight training is very safe as long as it is performed with proper supervision. Your trainer will recommend the most appropriate exercises for you to do and emphasize proper breathing and technique. Under the guidance of an exercise professional, you can help to improve aerobic capacity, decrease blood pressure and cholesterol, improve good cholesterol, lower blood glucose, improve muscular strength, increase joint range of motion, and lower weight and body fat. All of these will result in a lower risk for developing cardiovascular disease or if you already have disease, it will decrease the chances of subsequent cardiovascular events. Most importantly, working with an exercise professional will extend your lifespan and greatly improve the quality of your life.
Eric Lemkin is a certified personal trainer, strength & conditioning specialist, corrective exercise specialist and founder of Functionally Active Fitness. Lemkin has been a certified personal trainer for 17 years and has helped people ages 8-80 reach their fitness goals through customized personal training – specializing in exercise for the elderly or handicapped.
References
The mortality rate of seniors after an unintentional fall increases significantly. 38-47% of the elderly who fall will eventually have a fatal outcome [3]. Furthermore, one-half of those who fall are likely to fall again [4]. To minimize falls, exercise and staying physically active is extremely important to ensure that the mind and body is constantly optimized. Unfortunately, not all exercises are created equally for fall prevention. Here are some simple but effective balance exercises that you, or an elder under your care, can do at home.
Before you begin, here are some important considerations:
1. Ensure that you do not have illness or on any medication that interferes with your balance.
2. You have a secure and steady support aid (table, bar, etc.) to hold on to, and there is no dangerous object surrounding you if you fall.
3. There is someone nearby who is able to help you.
4. Start easy and progress as you get better.
5. Try focusing on a non-moving object in front of you to help with your balance.
SHARPENED ROMBERG TEST
Hold on to a support aid (barre, table, etc.). Begin by placing one foot in front of the other in tandem, or semi-tandem. When you feel confident, let go of the support and try to balance for at least 30 seconds. Switch sides. To progress, cross your arms across your chest and hold the position. Aim to achieve at least 60 seconds on both feet.
FALLING STAR POSE
Stand on one foot and make a star pose by shifting your weight to the side. Progress by extending both arms and legs. Hold the position for at least 30 seconds and switch sides.
SINGLE LEG DEAD LIFT (2)
Hold on to a support aid and stand on one foot. Once confident, slowly lower your chest towards the floor (like you’re bowing down) with a firm and braced back (don’t hunch), and push the other leg backwards. Stand tall and repeat this movement 6-10 times on each leg, and switch after.
There are many modifications you can include to make it more challenging, such as shifting your point of focus, shutting your eyes, introducing distractions and using different surfaces. When it comes to maintaining balance, frequency is key. It is recommended that you perform these exercises often enough until you see improvement. Take note of the duration you can stay balanced to measure your progress.
Ke Wynn Lee is an author and an international award-winning corrective exercise specialist currently owns and operates a private Medical Fitness Center in Penang. Apart from coaching, he also conducts workshops and actively contributes articles related to corrective exercise, fitness & health to online media and local magazines.
Reprinted with permission from kewynnpt.com
