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Friendly therapist supporting red-haired woman

The What, the How and the Why of Lifestyle Improvement

/30 May 2022/ All MFN blog/

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

/25 May 2022/ All MFN blog/


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 Aging, 8(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. Aging, 9(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 aging, 67, 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 disease, 2, 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. Diabetes, 65(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. Oncotarget, 6(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 letters, 592(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 aging, 12, 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 medicine, 40(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

 

 

 

Trainer-client-clipboard-assessment

What is a Systems Approach? Use It to Train Others and Yourself

/23 May 2022/ All MFN blog/

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.

Webinar with Mark Kelly: Kick Some ‘Ass’essments!

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.

senior-man-and-trainer-treadmill

Exercise and Cardiovascular Disease

/20 May 2022/ All MFN blog/

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.

Benefits of Regular Exercise

  • Increase in aerobic capacity
  • Decrease in blood pressure at rest
  • Decrease in blood pressure while exercising
  • Reduction in weight and body fat
  • Reduction in total cholesterol
  • Reduction in LDL (bad) cholesterol
  • Increase in HDL (good) cholesterol
  • Increased insulin sensitivity (lower blood glucose)
  • Improved self-esteem

Physiological Effects of Exercise

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.

How Much Exercise is Enough?

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.

How Can a Personal Trainer Help?

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:

  • Is exercise safe for me?
  • How long should I exercise?
  • How frequently should I exercise?
  • Do I stretch before or after exercise?
  • Can I do strength training and lift weights?
  • How do I know if I’m exercising at the right intensity?
  •  What if I develop symptoms such as dizziness, light-headedness, or nausea?

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

  • Kochanek KD, Xu JQ, Murphy SL, Miniño AM, Kung HC. Deaths: final data for 2009 [PDF-2M]. National vital statistics reports. 2011;60(3).
  • Roger VL, Go AS, Lloyd-Jones DM, Benjamin EJ, Berry JD, Borden WB, et al. Heart disease and stroke statistics—2012 update: a report from the American Heart Association . Circulation. 2012;125(1):e2–220.
  • Heron M. Deaths: Leading causes for 2008 [PDF-2.7M]. National vital statistics reports. 2012;60(6).
  • Heidenriech PA, Trogdon JG, Khavjou OA, Butler J, Dracup K, Ezekowitz MD, et al. Forecasting the future of cardiovascular disease in the United States: a policy statement from the American Heart Association. Circulation. 2011;123(8):933–44.
  • CDC. Million Hearts™: strategies to reduce the prevalence of leading cardiovascular disease risk factors. United States, 2011. MMWR 2011;60(36):1248–51.
Senior-Fall-Prevention

Minimize the Risk of Falling in Elderly with Simple Balance Exercises

/16 May 2022/ All MFN blog/

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

trainer-clients-in-gym-smiling

Essential Skills for Personal Trainers

/27 April 2022/ All MFN blog/

Agility, Bodybuilding, CrossFit, Dropsets, Energy substrates… etc. There is a program — or ten — for every letter for every letter of the alphabet! Everyday something new comes out that will make all the difference in the world without any work. That is the dilemma for Personal Training. Weeding out the bad and applying the good becomes the more difficult each year. In addition, more is expected of each trainer! 

Industry Skills

With constant growth and industry change, a Personal Trainer’s education doesn’t stop with certification.  In fact, that is only the catalyst for future growth. A degree also doesn’t guarantee adequate knowledge. By the time you finish your program, the information you started with in antiquated. So, what do you need to know, or at least pay attention to?

The basics… Certification, there are more than 500, CPR/AED, knowledge of physiology, anatomy, kinesiology, biomechanics, program design, exercise selection, equipment usage, safety techniques, assessment, current trends, and nutrition to start! Then there is the requirements for keeping current! Thought your read a lot during college…get ready for a whole new level of information. Kind of like getting a drink out of a fire hose!

Interpersonal Skills

You are under the watchful eye of everyone you encounter. Whether you are working, working out, eating at a restaurant, or getting a donut at the bakery, you are on display. Being real and approachable is paramount to a successful career. No one cares about your credentials; they care that you treat them well.

Really you are an ambassador to health care. That means public speaking, communications skills coaching, counseling (not professional), ability to lead a group, excellent customer service, goal oriented, sales, all while maintaining a positive attitude!

Energy

Getting someone to do something they don’t want to do and eventually enjoy it is the mark of a good trainer.  Everyone wants six pack abs, but if you are a good trainer a year later, they will want to share a six-pack with you!  Passion and motivation are why they hire you! Why are you a trainer? If you can’t answer that question without hesitation, you need to dig deeper into why you want to train!  It must sustain you! Maybe you overcame a health issue, were an ex-athlete, lost weight, or reached some personal goal, that is what people want to buy!

Passion

More than a PhD, passion drives great trainers. Richard Simmons changed generations with his Sweating to the Oldies exercise programs. A household name for sure, he probably had the most direct influence on the fitness industry! Dealing with issues that affect most people, he forged a niche market of the average guy that just want to fit in, get healthy, and look better naked.

Entrepreneurial

Guess what, just because you love helping others and working out, doesn’t mean you’ll be a good trainer. There is that little thing about running a business.Even if you are working for a gym, there are many qualities that differentiate outstanding from average trainers. Why do people hire you? Guess what it’s not because of your body, it’s for what you can do for them!

The list of desired traits is long but distinguished. Whether you like it or not, you are running a business. Therefore, qualities like accountability, time-management, delegation, networking, multi-tasking, planning, leadership, teamwork, flexibility, creativeness, logical thinking, patience, organization, motivation, and most of all tack.

Ready for the challenge?  It will be the hardest thing you will every love.  

Stay healthy.

Reprinted with permission from author.

Mike Rickett MS, CSCS*D, CSPS*D, RCPT*E is a nationally recognized health and fitness trainer of the trainers, fitness motivator, author, certifier, educator, and the 2017 NSCA Personal Trainer of the Year.  He has been a fitness trainer for more than 35 years. With Cheri Lamperes, he co-directs BetterHealthBreathing.com, a conscious breathing educational program focusing on the diaphragmatic technique to enhance overall wellness.  In addition, he also directs the personal training site ApplicationInMotion.com.  

 

woman-walking-dirt-road

Restoring Health: A Lifestyle Rx

/22 April 2022/ All MFN blog/

America is in bad shape. According to the Centers of Disease Control (CDC), 60% of adults are living with one chronic disease and 40% have two or more.(1)  Astoundingly, 12% of adults are living with 5 or more chronic conditions(2) including cardiovascular disease, diabetes, obesity, coronary obstructive pulmonary disease and hypertension. A concept people need to understand is that these diseases can be prevented, managed and even reversed with lifestyle choices.

The COVID-19 pandemic has shown a bright light on how our level of health can literally be a matter of life or death. A study of thousands of patients hospitalized with the novel coronavirus in the New York City area found that 94% had one chronic disease and 88% had two or more. The most common conditions included hypertension, obesity and diabetes.(3) In May of this year, the CDC reported that people with an underlying chronic illness had six times the risk of being hospitalized and twelve times the risk for dying.(4)

Boost Health & Immunity

Now is the right time to take small steps to improve health and build immune resilience with daily lifestyle choices. While there isn’t one diet, exercise regimen, or stress-relieving technique that is good for everyone, there are principles to follow that can boost health and vitality at any age.

There is a huge misconception that our genes determine our health destiny. This simply isn’t true. The study of epigenetics shows that we have the ability to change the expression of our genes by the way we think, feel, move and eat.(5) Each of our daily decisions and choices can increase or decrease inflammation in the body, moving us towards disease or back to health.

Acute & Chronic Inflammation

Our immune system uses the ancient, biological pathway of inflammation to protect us against injury and infections.(6) When you cut your finger, immune cells are sent to kill invading bacteria and begin the process of wound healing. This is acute inflammation that goes away in days or weeks when the body is healed.

One the other hand, chronic inflammation lasts a long time, from months to years.(2) It’s basically an abnormal immune response that causes damage to cells, tissues and organs. Oxidative stress plays a big role; it occurs when more free radicals are produced within cells than the body can neutralize.(2)  As you can imagine, when more damage occurs than can be repaired, health problems crop up.

It is now widely accepted that chronic inflammation is at the root of most, if not all, chronic conditions like cardiovascular disease, diabetes, obesity, hypertension, cancer, arthritis and joint disease.(2)

Lifestyle Matters

The good news is that deliberate and healthier lifestyle choices can prevent, manage and even reverse chronic inflammatory disease, the most important cause of morbidity and mortality facing people today.(7) It’s empowering to know that if you have, or want to prevent a chronic disease, you can regain your health and vitality by choosing real whole foods, optimizing sleep, reducing stress, being social, and moving more.

You may be thinking, “How the heck can simple lifestyle decisions address the complexities of chronic conditions?”  The body has an innate ability and intelligence to heal itself. You experience it each time you cut your hand; you wash the wound, put a bandage on and don’t have to think about it.

The research also supports it and I have lived it; by utilizing the power of lifestyle medicine I was able to restore my health from the ravages of chronic Lyme disease. You just need to provide the right environment for healing. This is not an easy task, but it can be done with time, effort and a plan.

Taking Action

Changing your lifestyle habits can feel overwhelming. To help you embrace this challenge, think about this analogy, “How do you eat an elephant?  One bite at a time!”   Any healing journey begins with awareness, learning and exploration; then gradually taking action, one small step at a time.

Start today by exploring lifestyle behaviors that decrease inflammation and can put your health back on track so you can live with less pain, more energy, and greater vitality. A lifestyle prescription to restore health includes:

  • Reducing stress with deep breathing.
  • Getting good quality sleep by going to bed and rising at the same time.
  • Eating a plant-based diet rich in a rainbow of vegetables.
  • Hydrating with filtered water in the morning and during the day.
  • Nurturing relationships and engaging with positive people.
  • Moving well with good posture when performing daily activities and exercise.

Be proactive, make one hour a week to learn more by reading books, researching on PubMed.gov, listening to podcasts, attending lectures and webinars so you can find the strategies and practices that work best for you. As you begin to feel better, you will naturally be motivated to continue learning and making better lifestyle choices because healthy feels so good!

Find a Fitness or Allied Health Pro Near You

Search the free MedFit Network directory to locate a professional near you! MedFit Network maintains a free directory of fitness and allied healthcare professionals who can work with individuals with chronic disease, medical conditions or the senior population.

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

 

References

  1. https://www.cdc.gov/chronicdisease/index.htm
  2. https://www.ncbi.nlm.nih.gov/books/NBK493173/
  3. https://www.the-scientist.com/news-opinion/nearly-all-nyc-area-covid-19-hospitalizations-had-comorbidities-67476
  4. https://www.cdc.gov/mmwr/Novel_Coronavirus_Reports.html June 19, 2020
  5. https://www.nature.com/scitable/topicpage/epigenetic-influences-and-disease-895/
  6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6345337/
  7. https://pubmed.ncbi.nlm.nih.gov/23974765/
Elderly woman with alzheimer

The Dark Side of Parkinson’s Disease: The FACE of Parkinson’s Disease, Part 2

/20 April 2022/ All MFN blog/

Click to read part 1 of this article, covering background on facial masking, swallowing, vocal issues for people with PD.

As a fitness professional, you can help. The key is is knowing how to appropriately apply facial, swallowing and vocal projections drills to private and group sessions.  Below are some tips to utilize with your “fighters”.

Occupational Therapy Tips

Decreased facial expression

  • Practice recognizing emotions in other people and creating appropriate responses. These responses may include facial expressions and verbal communication. Practicing these reactions to others can help support relationships. 
  • The word, “affect” refers to the appearance of emotion through facial expressions, voice tone, and body language or gestures. If you have trouble with facial expressions, try to express yourself more through adding gestures or body language when you communicate.
  • Communicate your situation! Try explaining your trouble with facial expressions and decreased voice volume to people who may not initially understand.
  • Facial exercises: 
    • look in the mirror and practice your facial expressions.
    • hold a smile, raise your eyebrows as high as you can, bring your eyebrows together to frown,  open your mouth as wide to stretch your jaw, close your eyes tightly and open them wide, close your mouth and expand your cheeks, stick your tongue out and stretch it in each direction
    • Try to exaggerate your facial expressions and lip movements when you speak

Drooling

When eating:

  • Try to maintain good posture
  • Focus on keeping your chin up and lips closed when eating
  • Swallow often to limit saliva
  • Avoid sugary foods that create more saliva

Lip closure exercises:

  • Close lips tightly for 5 seconds and release (5 times)
  • Close lips around tongue depressor and hold while trying to pull from mouth for 5 seconds (5x)
  • Fill your cheeks with air and move the air from cheek to cheek (5×5 times)

Dysphagia (Swallowing)

Transferring food from a utensil to the mouth, chewing the food then swallowing and most likely socializing all at the same time without any problems is a task most people take for granted.  According to Dr. Jose Vega MD, PhD, three phases must occur in order to swallow properly.

  1. The Oral Phase: This phase begins when food is placed in the mouth and moistened with saliva. Moistened food is called a food bolus.
  2. The Pharyngeal Phase: As the food bolus reaches the pharynx, special sensory nerves activate the involuntary phase of swallowing.
  3. The Esophageal Phase: As food leaves the pharynx, it enters the esophagus, a tube-like muscular structure that leads food into the stomach due to its powerful coordinated muscular contractions. The passage of food through the esophagus during this phase requires the coordinated action of the vagus nerve, the glossopharyngeal nerve, and nerve fibers from the sympathetic nervous system.

Difficulty swallowing as it pertains to PD, reflects a deficiency of dopamine in the brain and often improves with medication and therapy/exercises. Drooling is also a symptom and is caused by reduced reflexive swallowing not from an overproduction of saliva but tends to improve with dopamine replacement therapy.  I have come to learn over the years that tremors and swallowing problems are usually the reason someone living with PD isolates themself.  It is embarrassing to finally get food on your utensil only to get it to your mouth and realize it has scattered all over the place or fear of aspiration which by the way may not always be heard. Aspiration can be quiet and lead to aspiration pneumonia, the leading cause of death in PD.

Care-partners and Fitness Professionals need to recognize the signs of aspiration as noted below. 

Coughing Before/After Swallowing

  • Trouble chewing 
  • Pocketing food inside the cheek
  • Gagging during a meal
  • Crying or face turning red while eating
  • Drooling especially during meals
  • Clearing the throat before/after and throughout the day
  • Hoarse during and after the meal

For this reason, Coaches at Bridges For Parkinson’s offers popsicles to our “fighters” at the end of class. And they love it! They can have a fun treat without the fear of dropping food and visit with others so it is a win-win! Plus, it allows us to make sure they are hydrated. Sneaky, sneaky!

If a person living with Parkinson’s Disease or their care-partner is not sure whether their loved one has a swallowing issue, the Parkinson’s Foundation provides some great questions to help determine the answer:

  • Have I recently lost weight without trying?
  • Do I tend to avoid drinking liquids?
  • Do I get the sensation of food being stuck in my throat?
  • Do I drool?
  • Is food collecting around my gum line?
  • Do I cough or choke before, during or after eating or drinking?
  • Do I often have heartburn or a sore throat?
  • Do I have trouble keeping food or liquid in my mouth? 

ORAL EXERCISES to help with strengthening and coordinating the LIPS

  1. Pucker up and blow a “oooo” then transition to an “EEEEEE” (SMILE BIG!)
  2. “MMMM” press lips together as much as possible and take a deep breath in and hum..         good for the lungs too.
  3. “Blowfish Hold” and hand isometrically pushes into cheek

TONGUE- ROM, Coordination and strength to help with eating and drinking

  1. Stick tongue out as far as possible and hold it there (add SPOON FOR RESISTANCE)
  2. Stick tongue out and up and hold (ADD SPOON FOR RESISTANCE)
  3. Stick tongue into sides of cheek (helps with food deposits)
  4. Roll tongue back and press against roof of mouth

In addition to swallowing exercises, meal prep aids in reducing issues brought on by dysphagia and may lower the risk of aspiration. The APDA Organization recommends the following nutritional information:

  • Foods that don’t require vigorous chewing. Avoid dry and crumbly foods.
  • Moderately textured wheat breads instead of very coarse, nutty breads or very soft, white breads.
  • Oatmeal, cream of wheat or moistened dry cereals instead of coarse, dry cereals.
  • Well-cooked, tender chicken/turkey, well-cooked fish without bones, chopped and ground meats, instead of stringy, tough meats that require a lot of chewing.
  • Soft casseroles and poached or scrambled eggs
  • Mashed potatoes or rice, moistened with gravy or margarine, instead of wild rice or French-fried potatoes.
  • Soft, cooked pasta elbows, instead of long spaghetti.
  • Soft, well-cooked vegetables, cut up or creamed, instead of raw vegetables or those with a hard texture.
  • Pureed or mashed fruits, fruit juices and fruit sauces, instead of fruits with seeds or hard outer skins. Avoid nuts, seeds or coconut.
  • Custard, yogurt, ice cream or other soft desserts

Speech

The article begins with a story of a grandmother experiencing dysphagia, hypomimia and hypophonia (softness of voice).  But people living with PD are not limited to hypophonia when it comes to speech problems.  Dysarthria and tachyphemia are additional speech issues people living with PD may experience.

Hypophonia or softness of voice is a condition that the Davis Phinney Foundation states 90% of people living with PD will experience. Characteristics of hypophonia include raspy voice, low speech volume, breathy and/or monotone speech.  

Dysarthria is another speech issue related to PD. It is characterized by poor articulation, respiration and/or phonation according to the National Aphasia Association.  Speech will come across as slurred, effortful and can often be mistaken for inebriated.  Doctors encourage people living with PD who are still driving to wear a bracelet to help law enforcement know they are not drunk.

Tachyphemia or acceleration of speech is also related to speech issues. A person struggling with tachyphemia will sound like all their words are jumbled together and often feel like their tongue is twisted.

While these issues are troublesome and frustrating, there are some easy and even fun ways to combat low volume, slurred and accelerated speech.  

  1. Music Therapy – therapy defined broadly by the American Music Therapy Association as “a treatment including creating, singing, moving to, and/or listening to music [through which] clients’ abilities are strengthened and transferred to other areas of their lives.” All over the country, Parkinson’s Choirs are using singing to help improve respiration, Swallowing and enhanced volume and clarity of voice.
  2. Breathing Drills- Strong lungs reduces risk of pneumonia and allows the person to complete ADL’s with little to no complications.  
  3. LSVT LOUD: an effective speech treatment for people with Parkinson’s disease (PD) and other neurological conditions. A study on hypophonia in PD reviewed the effectiveness of LSVT treatment for those with idiopathic PD and found that voice loudness significantly improved. Goals include: increased voice volume, improved articulation, increased confidence with communication, and changes in neural function related to speech (https://n.neurology.org/content/60/3/432)
  4. Speak Up For Parkinson’s App: Yes, an app with exercises that also provides visual feedback on volume.  

Exercises

  1. Breathe in and exhale on a vowel for 5 seconds.
  2. Hum for 3 seconds making sure to press the lips together then have the “fighter” say….
    Their favorite food or movie or color.
  3. Hum for 3 seconds then say the vowels, sliding the voice from one vowel to the next.
  4. Recite a poem with various emotions.
  5. Partner “fighters” and have them share jokes with each other. Whoever laughs the hardest wins!
  6. Close class or a session with a short song or team phrase . 

Fitness Professionals have the unique opportunity to incorporate exercises for the face, voice and swallowing while also performing strength and/or cardio exercises. You do not have to separate the two. It is a great way to challenge the cognitive aspects and  the physical, all while having fun! The best part is it creates a community moment which deepens their love and trust for you, the fitness professionals.  You are making a difference!’

Co-authored by Colleen Bridges, M. Ed, NSCA-CPT; Renee Rouleau-B.S., PhD student, Jacobs School of Biomedical Sciences, University at Buffalo; Kristi Ramsey, OTD, OTR/L.

 

References