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Menopause Exercise: The Depression or Well-being Determinant?

Wonder if your menopause exercise prescription makes a difference? It turns out your hormone ride during menopause deems exercise more necessary than ever. Your hormones reveal more than your likelihood to store belly fat or hot flash.

Research published in the Menopause Journal says your likelihood of being depressed or feeling positive lies in your physical activity level. The study addressed menopause, movement, and mental well-being.

One of 7 levels of physical activity was assigned to each subject:

  1. I do not move more than is necessary in my daily routines;
  2. I go for casual walks and engage in light outdoor recreation 1 to 2 times a week;
  3. I go for casual walks and engage in light outdoor recreation several times a week;
  4. Once or twice a week, I engage in brisk physical activity(eg, yard work, walking, cycling) that causes some shortness of breath and sweating;
  5. Several times a week (3-5), I engage in brisk physical activity(eg, yard work, walking, cycling) that causes some shortness of breath and sweating;
  6. I exercise several times a week in a way that causes rather strong shortness of breath and sweating during the activity;
  7. I do competitive sports and maintain my fitness through regular training.

Which level describes you?

Based on that you fall into one of these categories:

  • Low (1 to 3)
  • Medium (4 and 5)
  • High activity (6 to 7)

Subjects in the study with the highest level of activity had the lowest incidence of depression and the greatest sense of well-being.

That’s the bottom line.

What’s most interesting is that researchers measured not only self-reports of depression but hormone levels. So the study was both objective and subjective.

Given we’re in a time when positive mood, attitude, optimism are so important to how we get from day to day, this is just one more message to get moving.

There’s More

Menopause has historically been associated with negative feelings about aging and with greater incidence of depression than in younger women or same age men. The proper menopause exercise prescription, however clearly has the ability to change your well-being.

In fact, many women report that this is a time of great life satisfaction.

Menopause Exercise Rx

The high activity level word descriptions used in this study are exact descriptions of the High Intensity Interval Training and strength training to fatigue that are a necessity for women who want to flip 50 feeling not just well, but outright full of energy and vitality during and beyond COVID19.

Often when I talk about the After 50 Fitness Formula for Women, and a critical part of it — “Less Exercise, More Food” — inevitably an audience member will comment. She may say something like, “I’m so glad you said women over 50 need less exercise.”

I get nervous with that simple statement. Because like a recent podcast I created about “Moderate Exercise,” that is too open to interpretation.

So let me take some real estate in this post to get clear:

  • You are not a flower.
  • You are not delicate.

You absolutely need to push limits in your workouts – for seconds at a time. That’s true when you’re in good times and when you’re in COVID19.

You need moderate amounts of:

  1. High Intensity exercise that gets you breathless
  2. High Intensity strength training that takes you to muscular fatigue
  3. Fill in with low to moderate exercise that you love

It is #1 and #2 above that have the best opportunity to change your hormones for the better, and in doing so changes your mental well-being, your visceral belly fat, your hot flashes and night sweats, and reverses the effects of 179 genes associated with aging.

Careful Clarification

Advice to do less exercise is often interpreted as advice to do “light” exercise or following a doctor’s vague advice to “walk.” It’s not enough. And walking 3 or 4 miles a day as many women do in an effort to overcome weight or fat gains in menopause only makes matters worse. Greater volume of the same ineffective exercise will not get you better results.

Yes, you want less exercise. Less than you think, and of the right type (of intense exercise).

It’s true that if you’re just beginning you start with habits. We get you hooked and regular first. Yet, yes, you can do interval training when you start. COPD patients and asthma sufferers often do best with intervals. If they can you can. We simply apply a progressive plan for you.

Before you start intervals it may be appropriate for you to “restore before more.” If you’re already exhausted, suffering from mood swings, your first step is to restore yourself with rest, sleep, nutrients and movement, NOT exercise.

Menopause exercise is not a generic prescription for all women in menopause. It should be based on your unique condition now, your current hormone status (assessed by a fitness specialist by your signs & symptoms), and your personal preferences and schedule.

Yet, menopause exercise has the power to make this second half better than the first.


Reprinted from flipping50.com with permission from Debra Atkinson.

Debra Atkinson is the #youstillgotitgirl who is flipping 50 and changing the way thousands of women think about their second half. She’s the host of the Flipping 50 TV Show and the Flipping 50 podcast. As a master personal trainer, strength and wellness coach with over 30 years fitness industry experience, she works with women who are pro-aging with vitality and energy. She is an international fitness presenter, author of hundreds of articles and multiple books. Visit her website, flippingfifty.com

Reference:

https://journals.lww.com/menopausejournal/fulltext/2020/04000/the_role_of_physical_activity_in_the_link_between.6.aspx

joint-replacement-xray

The Role of the SAID Principle in Joint Replacement Fitness

The SAID Principle, Specific Adaptation to Imposed Demand, is a fundamental law of human physiology. The classic definition of this principle is “the body adapts to what it does”.  A more precise, neuro-centric definition would be “the body ALWAYS adapts to EXACTLY what it does”. The takeaway is this: if you want a certain result, you must train with precision.

Joint replacements are an incredible medical innovation, but they are also incredibly traumatic events to the dermal, fascial, musculoskeletal, and nervous systems. Of specific concern for joint replacement clients are the mechanoreceptors that provide input to the brain about the joint and surrounding area through touch, pressure, stretch (skin and muscles/tendons), temperature, vibration, and movement.

Some studies have shown, depending on the type of replacement performed, joint capsule mechanoreceptors are no longer present and do not regenerate. The injuries to tissues or joints, whether acute or chronic, can result in dysfunctional proprioceptive feedback, and that is not automatically regained after joint replacement. So, we will need to train with precision to maximize and improve proprioceptive input and joint position sense.

Building variety into fitness training for joint replacement clients

Training with precision means taking our fitness training beyond “strengthening and stretching”. Our joint replacement clients likely got plenty of that during their physical therapy anyway. Another way to think about the SAID Principle is “use it or lose it”. If we want our joint replacement fitness clients to get the most out of their replacement, we need to program a variety of aspects:

  • Motor Control Drills for individual joints (the replaced joint as well as supporting joints) take the targeted joint through full, active, pain-free range of motion. It can be startling how many folks have poor motor control and joint position sense over some joints when asked to focus movement at only one joint.
  • Open & Closed Chain movements around the affected joint are both important and should be included. Barbells are great, but most human movement (walking, running, reaching, throwing, etc.) is open chain, so we need to train it!
  • Loading variations such as isometrics, free weights, and resistance bands require different firing patterns and levels of motor control. Isometrics specifically are a vastly underutilized form of strength training that is very “low threat” neurologically, allowing muscular force production in a very safe manner.
  • Speed of Movement variety can also improve motor control. Going through a movement in slow motion, or to the beat of a metronome, can be incredibly challenging but beneficial. 
  • Multi-Planar / Multi-Directional Movements are one of the most important variations to implement with joint replacement clients to build a large and detailed proprioceptive map of the new joint and surrounding musculature.

Programming for this type of variety is very important for joint replacement clients but also for general fitness, performance, and pain clients! Begin learning a neuro-centric approach to medical fitness and how to work with joint replacement clients with our Joint Replacement Fitness Specialist online course, available through the MedFit Classroom!


Pat Marques is a Z-Health Master Trainer and NSCA-CPT specializing in training the nervous system to improve performance and get out of pain.  After retiring from the Active Duty Army, Pat pursued his education and certifications in exercise science, initially working with wounded, ill, and injured soldiers. During this time that Pat discovered the power of using a neurological approach to training to get out of pain and improve fitness and performance. He currently provides exercise therapy, movement reeducation, and strength and conditioning for all levels of clients at NeuroAthlete, from chronic pain sufferers to Olympic-level and professional athletes.

 

References

  1. Cobb, E. (2020). R-Phase Certification Manual and Presentation. Z-Health Performance Solutions.
  2. Soulat, N., Alistair, P., and Gey, V. (2014). Assessing Regeneration of Mechanoreceptors in Human Hip Pseudocapsule After Primary Total Hip Arthroplasty. Journal of Orthopedics, Trauma and Rehabilitation (18)
  3.  Domoslavska, D. (2011). Restoring proprioception after sports injuries and pathological states of the shoulder complex. Journal of Combat Sports and Martial Arts (Vol. 2).
Senior-and-Trainer

Are You Asking the Right Questions of Your Geriatric Clients?

In the world of medical and mainstream fitness, assessment methods and tools abound.  We like to pre-test and post-test and record our findings to show positive change toward the betterment of our clients’ general health.  But what about their well-being?  Are we asking them how they are really doing on that day and in general?  Should we probe further or would that be invasive and make our older client feel uncomfortable and possibly interrogated?  

male-trainer-female-client-gym

Fitness Has Become a Luxury Item. It Doesn’t Have To Be…

Something strange is happening to the fitness industry. Or maybe it already happened – years ago – and I’m only just noticing now (having no social media presence can be a mixed blessing). There’s a shift in how fitness is being packaged and sold, a shift that emphasizes an almost slave-like devotion to the self. During my lifetime the act of “working out” was usually presented as democratic in nature, a basic right accessible to all. Now, it’s being rebranded as a sort of mandatory luxury item for this generation of digital nomads.

Hell, even the language has changed. Health is “wellness”; exercising is “training”; getting a massage is “self-care.” Forgive me for coming off as a younger Andy Rooney, but back in my day you’d hit the gym a few times a week, either before or after work, and that was that. Maybe you’d play some ball with buddies on the weekend, maybe run an easy 5K Sunday morning. Food mattered, but it wasn’t something to stress over.

Today the expectation is to be up at 4 a.m. for morning meditation and journaling while riding out the final wave of your 12-hour daily fast. Breakfast – and every morsel that passes your lips thereafter – is posted on Instagram for the approval of the oh-so legitimate dietitians, trainers and food scientists who lurk in the comments section. Your workout is no longer just that, it’s an “experience” to be shared with your tribe/team/pod, one that we must pause and express gratitude for whenever possible (quick, grab your journal!).

By now you’re likely wondering what my point is. Hasn’t the pursuit of physical perfection and ultimate longevity always been just a tad self-indulgent? And what’s wrong with indulging the self anyway? My point – and my problem – is that entry into this cult of wellness comes at a ridiculous cost, in both the literal and metaphorical sense of the word. Forget for a moment the time commitment required; society is being duped into believing you need a Fitbit, compression shorts and a $200 pair of lifting shoes to get in shape, when a notebook, sweatpants and Chuck Taylors will do just fine.

Of course, there’s always been a market that caters to the well-heeled. Peloton presents the most extreme example of this absurdity. Have you seen how much those bikes cost? And then there’s the monthly membership to boot. You could fly first-class to France and tour the countryside on your own damn bike for the same price. The same goes for Equinox – not a gym, but a “temple of well-being” that charges its parishioners thousands of dollars for the privilege of spilling sweat inside its walls.

Pay attention to the way these products are being positioned. Peloton ads feature every day, average folks pedaling away on $3,000 machines in their unspectacular homes. Lululemon ads feature every day, average folks running and bending and lifting in outfits that cost more than most people make in a day. The message is clear, yet entirely incongruent with reality. At least Equinox has the decency to showcase their upper crust offerings in the proper context; in keeping with the tradition of aspirational luxury brands, their ads make no sense at all.

Getting in shape doesn’t require a payment plan or a line of credit. I’ve spent time in posh gyms and I’ve spent time in musty warehouses and I can assure you there is next to no correlation between high fees and quality of service. In Toronto, Hone Fitness offers memberships for as low as $30 a month and you can bring a friend whenever you want. The YMCA has 120 fitness centers across Canada with fully-equipped weight rooms and loads of fitness classes; their membership subsidy program ensures everyone, regardless of income, can cycle their stress away. You may not be able to bathe yourself in eucalyptus-infused steam showers afterwards, but really who needs that anyway?


Paul Landini is a personal trainer, health educator and fitness columnist with The Globe & Mail. He specializes in making fitness fun and accessible to all, regardless of their age, gender or abilities. Paul has been a long-time advocate for plant-based nutrition and loves nothing more than dispelling the many myths surrounding vegan and vegetarian diets.

Healthy-Lifestyle-Nutrition-Exercise-Medicine

Using a Lifestyle Medicine Approach to Support Health

The American College of Lifestyle Medicine (ACLM) defines lifestyle medicine as an approach to prevent, treat, and sometimes reverse chronic diseases to promote optimal health. Individuals are encouraged to follow a healthy eating pattern that is predominantly plant-based, engage in regular physical activity, experience restorative sleep, manage stress with success, avoid risky substances, and engage in positive social connections. There are a variety of tools and strategies that medical, health, and fitness professionals can utilize to have a collaborative conversation with clients and/or patients that can evoke change. It is useful to have a structured framework to facilitate the conversation.

Using the 5 A’s Framework to Structure the Conversation

Many medical providers and personal trainers have not been trained to facilitate a conversation surrounding an individual’s desire and readiness to change. This is a useful tool for structuring the conversation and ultimately setting SMART goals if the client or patient is indeed ready to commit to making a change.1

Assess
To begin the conversation, ask if the patient is currently engaging in the healthy behavior that is being contemplated as well as exploring their feelings about this specific health behavior. This dialogue will give you some insight about current beliefs and behaviors as well as identifying any gaps in their knowledge.

Advise
Here you can put on your expert hat and provide the individual with evidence-based information that highlights the benefits of making a health behavior change. If your client or patient is receptive, now is the time to provide them with specific strategies or a prescription.  For example, if they are looking to lose weight, you could prescribe a combination of cardiovascular and muscle strengthening exercises to support that goal.

Agree
As the conversation continues, collaboratively work to identify goals based on where they are showing interest and energy as well as where they have confidence in their ability to successfully make a sustainable change.  In this part of the conversation, you can help your client and/or patient create a SMART goal that is relevant and aligns with their values to promote self-efficacy.  

Assist
It is now time to discuss potential barriers and explore strategies that could be helpful in overcoming these challenges. This is also an opportunity to discuss social and environmental support structures that have the capacity to promote accountability and ultimately lead to self-monitoring.  

Arrange
As the conversation draws to a close, arrange a follow-up visit to monitor progress and convey that you are there to provide motivation, accountability, and support.  This is also an opportunity to refer your client and/or patient to community resources or to other health, fitness, or nutrition professionals that can support the behavior change process.

Redefine Health with Lifestyle Medicine

Using a lifestyle medicine approach highlights the need to promote optimal health by addressing health behaviors across the dimensions of wellness. This approach has the capacity to prioritize mental health as it is integrally related to our physical health and impacts our relationships with others. Lifestyle medicine is an emerging field that prioritizes our conversations with clients and patients creating rapport and trust that ultimately enables them to experiment with behavior change.  Health coaching and lifestyle medicine are a powerful combination used in delivering evidence-based interventions that have the capacity to help others redefine their health.


Suzanne Stringer, Master of Health Science, CHES, CHC, CPT is a health coach and personal trainer. She collaborates with clients to co-create goals that enable them to experience success as they work through the behavior change process. Additionally, Suzanne is an adjunct faculty member in the Health Sciences Department at AACC.


References

  1. American College of Lifestyle Medicine.  (2021).  Foundations of Lifestyle Medicine Board Review Manual.  American College of Lifestyle Medicine.  

 

PDFS-Exercise

Bilateral Coordination: The Gateway to Successful Movement | Part 2

In Part 1 of this series, we discussed an overview of bilateral coordination, its importance and how it falters in Parkinson’s Disease (PD).

Now, we’ll discuss strengthening the pathways for those with PD with exercise.

Steps To Incorporating Bilateral Coordination Into Your Exercise Program

Clearly, the brain is a work of art when you consider the “architecture”, the “highway” of nerves required to communicate with the rest of the body, to the final outcome of the original thought or idea. ANY kind of “road block” is going to hinder an individual from completing tasks as simple as writing or buttoning a shirt. And for the person living with PD, this includes walking, bathing, driving, communicating, dressing, well, about every Activity of Daily Living (ADL) that you can conceive.

BUT… never fear, the PD Fitness Specialist is prepared to address these matters of the brain with some challenging YET fun activities to promote improved motor control!

I won’t lie, you may see smoke coming out of the “fighters” ears but the incredible sense of accomplishment at the completion of the drill will be worth it.

Always begin with the fundamental question of program design. What are the needs of my private clients and fighters? What are their common issues?  They definitely need to work on:

Strength (7 foundational movements)

  • Lunge
  • Squat
  • Pull
  • Push
  • Carry
  • Hinge
  • Rotate

NOTE: I encourage Fitness Professionals (FP) to start with the most basic form of each Foundational Movement before progressing to a more challenging version. I have learned that repetition and exercise phases are a necessary part of any fitness program, similar to the human development process.

Your program should also include cardiovascular endurance, agility (footwork/hand-eye), cognitive challenges, fine motor drills, balance/gait drills — ALL which incorporate Bilateral Coordination challenges that provoke the brain to enhance:

  1. Neuro-protection to preserve at-risk dopamine neurons.
  2. Neuro-repair to improve damaged “circuitry”  and rewire the brain.
  3. Neuro-Adaptation that trains the brain to move without conscious awareness of each move such as walking .

Yes, this requires the Fitness Professional to sit down and develop a program that is constantly evolving as the abilities and needs of the client change BUT it can be done. For example, to address gait and incorporate an additional Bilateral Coordination drill that will challenge your client(s) mental focus, try the following progressive drill.

NOTE: Step one is a fantastic way to help a person living with Parkinson’s Disease safely transition out of a “freezing of gait” moment.

Criss-Cross Applesauce (Stand in squat stance)-

  1. Cross the right hand to the left shoulder.
  2. Cross the left hand to the right shoulder.
  3. NOW, cross the right hand to the left knee.
  4. Cross the left hand to the right knee

Have your client(s) say “Criss-Cross Applesauce” while performing the drill. This will address hypophonia problems and assist in maintaining a strong beat..

Once they have achieved this version, have them progress to the next level….

Criss-Cross Applesauce with Marching Knees

  1. Cross the right hand to the left shoulder.
  2. Cross the left hand to the right shoulder.
  3. NOW, cross the right hand to the left knee BUT lift the knee to meet the hand as if marching.
  4. Cross the left hand to the right knee and lift knee to meet hand as if marching.

To add complexity to the drill, have your clients tap the marching knee onto a step or bosu.

Once they have achieved this version, have them progress to the next level….

Criss-Cross Applesauce with A Forward Lunge

  1. Cross the right hand to the left shoulder.
  2. Cross the left hand to the right shoulder
  3. NOW, cross the right hand to the left leg AS you lunge forward.
  4. Come back to start position.
  5. Cross left hand to the right leg AS you lunge forward
  6. Return to start and repeat drill

To add complexity to the drill, have your clients perform a diagonal lunge or a lateral step.

This is just one example of how you can incorporate Bilateral Coordination into a movement we do all day every day! Walking! And if you work with people living with Parkinson’s Disease, then expect their learning time to vary but with repetition and encouragement, they will conquer this drill and be excited to try the next.

Which leads me to share with you the results I have experienced in my Parkinson’s Disease Wellness Center in Nashville and Franklin, Tennessee.

CASE STUDY – RESULTS!

“Susan” is 62 years old and was diagnosed 17 years ago which classifies her as Young Onset Parkinson’s Disease.  Susan had the DBS surgery 10 years ago and although the DBS initially provided relief of tremors and dyskinesia, over time fine motor skills, drooling, hypophonia, balance/poor posture — leading to numerous falls — has become an issue. She is also blind in one eye which limits her spatial awareness, decreases balance and mobility, all of which makes living independently even more challenging. Additionally, the hypophonia had led her to become 80% non-verbal. To answer questions she either nodded yes/no or shrugged her shoulders if she didn’t know the answer.

When we began working 1:1 together, my first priority was to address her posture/gait, as she was stooped forward and shuffling, leading to multiple falls each week. So, in addition to a dynamic warm-up with large ROM drills to properly prepare her body from head to toe, strength training, boxing and cycling, obstacle courses and more, I taught her the “Criss-Cross Applesauce” drill. The first several sessions, Susan had to complete the drill 5x between other warm-up exercises AND march while tapping her hand to the opposite knee when we moved to a new station or machine. She also had to speak the words “Criss-Cross Applesauce” when performing the drill to address her hypophonia.

The first session, Susan could not make the connection that her hand was to tap the opposite shoulder or knee. I had to manually move her hands and say the words with her. By the end of the first session, she was only able to complete the drill at a slow tempo, but that was ok, she did it! She left the gym that day with homework to practice the “Criss-Cross Applesauce” drill three times a day for 5 repetitions. I also assigned marching in place while tapping the hand to the opposite knee 60x twice a day.

The second session, I noticed a significant difference in her timing and coordination. For the first set, I still needed to “mirror” her while she did the “Criss-Cross Applesauce” drill, but overall, Susan was able to complete the drill 3 out of 5x correctly. When Susan would move to a different location, I had her march and tap her hand to the opposite knee. We counted how many steps it took to make it to the next station with the goal of trimming 10-15 steps off the next round. To do so, I had her focus on making precise connections between her hand and opposite knee as well as stomping her foot when stepping. By the end of the session she was able to trim 5-10 steps off between stations.  She completed the session with the same homework as before.

The third session is when I started to notice some fantastic improvements. Susan walked into the gym marching and tapping the hand to the opposite knee. She was able to cover more ground with fewer steps and the best part was that stomping her foot was helping her step with increased assurance. That equates to fewer falls! Additionally, transitioning station to station took less time and she was able to lift her knee higher than the previous sessions.

The “Criss-Cross Applesauce” drill still required me to “mirror” her but she did all 5 reps correctly and her hand/shoulder and/or hand/knee connection was more actively engaged. We continued to perform the drill between each exercise or cardio drill and by the end of the session, she spoke with clarity and increased volume, her stride length had increased, posture was more vertical and her confidence soaring. She even told me a joke!

The exciting results I experienced with Susan have also been experienced in my group exercise classes for Parkinson’s Disease. “Fighters” report that their forward/lateral movements, executive functioning skills, and balance have improved since incorporating Bilateral Coordination drills into our program.

Closing

The brain, in all its complexity, is a beautiful work of architecture. You, the Fitness Professional, have the “blue-prints” at your fingertips and together we can weave together bilateral movements to enhance the lives of those with Parkinson’s strengthening their bodies, mind and spirit and above all giving hope.

To assist you in learning how to create exercises that incorporate Bilateral Coordination into your program, I have included additional videos below demonstrating examples of exercises. (I would like to give credit to Dr. Irv Rubenstein, MedFit author & advisory board for the use of two of his drills in the video.)

This video comes from Dr. Jacob Weiss of handeyebody.com

Become a Parkinson’s Disease Fitness Specialist!

Check out Colleen’s online course on MedFit Classroom….


Co-Written by Colleen Bridges, M.Ed, NSCA-CPT and Renee Rouleau.

Colleen Bridges is the author of MedFit Classroom’s Parkinson’s Disease Fitness Specialist course. Renee Rouleau is a PhD student at the Jacobs School of Biomedical Sciences, University at Buffalo.


References

  1. van der Hoorn, A., Bartels, A. L., Leenders, K. L., & de Jong, B. M. (2011). Handedness and dominant side of symptoms in Parkinson’s disease. Parkinsonism & Related Disorders, 17(1), 58-60. https://doi.org/https://doi.org/10.1016/j.parkreldis.2010.10.002
  2. Plotnik, M., & Hausdorff, J. M.. (2008). The role of gait rhythmicity and bilateral coordination of stepping in the pathophysiology of freezing of gait in Parkinson’s disease. Movement Disorders, 23(S2), S444–S450. https://doi.org/10.1002/mds.21984
  3. Rutz, D. G., & Benninger, D. H.. (2020). Physical Therapy for Freezing of Gait and Gait Impairments in Parkinson Disease: A Systematic Review. PM&R, 12(11), 1140–1156. https://doi.org/10.1002/pmrj.12337
  4. Son, M., Han, S. H., Lyoo, C. H., Lim, J. A., Jeon, J., Hong, K.-B., & Park, H.. (2021). The effect of levodopa on bilateral coordination and gait asymmetry in Parkinson’s disease using inertial sensor. Npj Parkinson’s Disease, 7(1). https://doi.org/10.1038/s41531-021-00186-7
  5. Kramer P., & Hinojosa, J., (2010). Frames of Reference for Pediatric Occupational Therapy: 3rd Edition. Baltimore, Maryland: Lippincott Williams & Wilkins
  6. Magalhães, L.C., Koomar, J.A., Cermal, S.A. (1989, July) Bilateral Motor Coordination in 5- to 9-year old children: a pilot study. The American Journal of Occupational Therapy. Volume 43 Number 7.
  7. Piek, J.P., Dyck, M.J., Nieman, A., Anderson, M., Hay, D., Smith, L.M., McCoy, M., Hallmayer, J., (2003) The relationship between motor coordination, executive functioning and attention in school-aged children. Archives of clinical neuropsychology. Elsevier’s Ltd. doi:10.1016/j.acn.2003.12.007
  8. Roeber, B.J., Gunnar, M.R. and Pollak, S.D. (2014), Early deprivation impairs the development of balance and bilateral coordination. Dev Psychobiol, 56: 1110-1118. https://doi.org/10.1002/dev.21159
  9. Rutkowska, I., Lieberman, L. J., Bednarczuk, G., Molik, B., Kaźmierska-Kowalewska, K., Marszałek, J., & Gómez-Ruano, M.-Á. (2016). Bilateral Coordination of Children who are Blind. Perceptual and Motor Skills, 122(2), 595–609. https://doi.org/10.1177/0031512516636527
  10. Schmidt, M., Egger, F., & Conzelmann, A. (2015). Delayed Positive Effects of an Acute Bout of Coordinative Exercise on Children’s Attention. Perceptual and Motor Skills, 121(2), 431–446. https://doi.org/10.2466/22.06.PMS.121c22x1
  11. Tseng, Y., & Scholz, J. P. (2005). Unilateral vs. bilateral coordination of circle-drawing tasks. Acta Psychologica, 120(2), 172-198.