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Female-Trainer-and-older-male-client

Patients Need Personal Trainers: How personal training can impact millions

/18 June 2024/ All MFN blog/

In the United States, 11.2 million people were diagnosed with obesity and/or diabetes over the last year.(1,5) These are primary risk factors leading to stroke and total joint replacements, adding another 8 million people per year.(6,7) This means that the fitness professional in the post-medical and post-rehabilitation space has more potential clients than they could hope to serve. The question is how to reach them and build a business around these problems.

Personal Trainer and marketer Joe Lemon has some advice.  Two primary problems for trainers trying to innovate this post medical/rehabilitation space are trust and visibility. Both these problems are interrelated and so deserve to be tackled for this space to become profitable.

In the United States, less than 50% of physicians suggest patients go to a gym. Even less (20%) recommend a personal trainer.(4) But the question is, why? First, we found a general ignorance of what personal trainers can do for their clients and, secondarily, if personal training was a safe, effective modality. This is partially due to a lack of standardization in personal training education and regulation across the USA. In addition, until recently, there has been a lack of specific training for fitness professionals in the medical fitness space that can be understood and trusted.

Even for those exceptional personal trainers who do provide the training to address specific clients’ post-medical/rehabilitation needs, there is a gap between their skills and clinicians’ knowledge that they exist. Joe has practical advice to close that gap and create a bridge to clinicians.

First, identify who these clinicians are. Sports medicine, orthopedic surgeons, neurologists, bariatric doctors and primary care physicians are all viable referral sources. Network and get to know someone who can make personal introductions for you directly to the doctor or their assistant or office manager, who is often the gatekeeper of the practice. Once you get the opportunity to talk to them, give them tangible, always take a pamphlet explaining your qualifications, education, and process. Providing them with hard copy printouts from the MedFit websites (medfitnetwork.org and medfitclassroom.org) are the most accessible sources of information you could use. And always, leave them with the material they can give their patients that link directly back to you in the form of business cards and pamphlets/brochures.

Lastly, get out and talk about what you do. Remember, communication is 7% what you say where 38% how you speak it, and 55% your body language.(3) Getting in front of people these days is easier now than ever. Schedule talks at gyms and coffeehouses, video it, and post it online. The more you talk passionately about what you love doing, the better. Connect with your potential client recruit them to be your spokesperson to their physician for you.

Dr. Grove Higgins is a chiropractor, rehabilitationist, soft tissue injury expert, researcher, anatomy instructor, biomechanist, human performance expert, speaker, and corporate health consultant. In 2015, Dr. Higgins cofounded Neuroathlete with Coach Patrick Marques (LTC, US Army Ret.) and Peter Hoversten. Neuroathlete’s goal is to more broadly deliver neurological training to a global audience.

References

  1. (CDC), U. D. (2021). 2020, National Diabetes Statistics Report. 
  2. Lemon, J. (2021). Business Development, Market Research, & Strategic Partnerships. (G. Higgins, Interviewer)
  3. Michail, J. (2020, 8 24). Strong Nonverbal Skills Matter Now More Than Ever In The “New Normal”. Retrieved from Forbes: https://www.forbes.com/sites/forbescoachescouncil/2020/08/24/strong-nonverbal-skills-matter-now-more-than-ever-in-this-new-normal
  4. Pojednic, R., Bantham, A., Arnstein, F., Kennedy, M., & Phillips, E. (2018). Bridging the gap between clinicians and fitness professional: a challeng to implimenting exercise as medicine. BMJ Open Sport & Exercise Medicine, 1-5.
  5. CDC f. (2021, 3 1). National Center for Health Statistics. Retrieved from Centers for Disease Control and Prevention: https://www.cdc.gov/nchs/hus/contents2019.htm#Table-021
  6. Springer, B. D. (2021). Highlights of the 2020 American Joint Replacement Registry Annual Report. Arthroplasty Today, 9, 141-142.
  7. Stroke. (2021, 5 25). Retrieved from Center for Disease Control and Prevention: https://www.cdc.gov/stroke/facts.htm
trainer-senior-client-stretch

Health and Disease Spans: Can You Change It?

/13 June 2024/ All MFN blog/

Sam is a 90-year-old client of mine who comes into the clinic every day, walks for 30 minutes on the treadmill, then jumps on the elliptical for 15 minutes following by another 15 minutes on the stationary bike. After he’s done with his cardio, he knocks off 10 pull-ups, unassisted, and then he finishes the rest of his strength program. He feels energetic and enjoys spending time with his family and friends. On the other hand, Bob, a client who came in a few months ago, is 62 years old, sleeps in a recliner most nights because his back pain is too severe to stay in bed. He is an attorney working long hours with high levels of stress. His long hours keep him from exercising on a regular basis, he is a borderline diabetic and has recently started Lisinopril to control his newly diagnosed hypertension.

What’s the difference between my two clients? Sam has experienced a long and successful health span. At 90, his disease span has barely started to show. Bob, on the other hand, has an early onset disease span. He is losing his function and productivity while experiencing a slow and steady decline into the abyss.

There are several factors that influence the onset of one’s disease span. Factors such as genetic predisposition, lifestyle choices and sleep patterns are just a few examples that will influence the shape of your disease span curve. Often, the interrelatedness of influencing factors dictate our life’s outcome. By understanding our history, recognizing the triggering events that have occurred over time and managing mediators affecting our health, we are in the unique position to have a positive impact on our health/disease span curve.

Regardless of your previous lifestyle choices, you can create a big change. It is amazing how quickly our bodies respond to positive changes. In as little as 30 days, I have seen people decrease their need for medication, increase their energy, improve their sleeping habits and become more engaged in their personal relationships.

Remember Bob, in 45 days he was off his pain medication, sleeping in bed and played 9 holes of golf which is something he hadn’t done in 5 years. It is essential to understand your lifestyle history to take the necessary steps in making a well-rounded change. Success begins when you work with the right professional to re-write your story which will in turn elongate your health span, shorten your disease span and result in dying young at a ripe old age.

Jim Herkimer, DPT, MS, ATC  has been involved in health, fitness and rehabilitation for over 35 years. He is currently the CEO and Executive Director at Sports Conditioning and Rehabilitation (SCAR) in Orange, California. SCAR is a wellness and rehabilitation clinic providing a continuum of care for individuals through the life span. Throughout his career, he has had the opportunity to help a variety of athletes and individuals from all walks of life reach beyond their potential. 

Geriatric-Elderly-Fitness

What does the word “geriatric” mean to you?

/11 June 2024/ All MFN blog/

geriatrics\ ˌjer-​ē-​ˈa-​triks  , ˌjir-​\ : a branch of medicine that deals with the problems and diseases of old age and the medical care and treatment of aging people.

What does the word geriatric mean to you? Oftentimes, it comes with a negative connotation. It’s time to change the perception of this word in the fitness industry.

In the medical fitness space, we seek to align with doctors and health professionals.

Geriatric medicine physicians (Geriatricians) work to promote health by preventing and treating diseases and disabilities. To a great degree, this includes improving functional abilities and independence in their activities of daily living. With the rapid growth of the older population in the US, the demand for geriatric medicine is higher than ever.

Physicians specializing in geriatric medicine work closely with interdisciplinary teams, including physical therapists and fitness professionals, to implement care plans that will improve quality of life. This is where a properly educated fitness professional can enter, collaborate with doctors and make a huge impact in the lives of this population.

Senior Fitness vs. Geriatric Fitness

Senior fitness is popular in the fitness industry and many organizations offer education for working with seniors — but it’s primarily focused on seniors who are “generally healthy”.  Senior fitness is centered on preventative measures to maintain existing health as a person ages.

But not all seniors fall into this category. In fact, most do not. Geriatric fitness is for those who are not healthy,  who need guidance with fitness and lifestyle changes to improve degraded function so they can perform activities of daily living and be independent.

Why Specialize?

Specializing in geriatric fitness allows you to reach a huge market (there are over 70 million baby boomers with 10,000 people reaching age 65 daily!), but you’ll also find it to be a fulfilling part of your career. You’ll find creating programming for this group intellectually stimulating and challenging. You’ll also find it emotionally rewarding — helping geriatric clients make small improvements in their health will have an enormous impact on their quality of life, independence and well-being.

You’ll also offer peace of mind to caregivers — often adult children — as they are frequently the ones seeking an educated fitness professional to help their aging parent.

It’s time to see the word geriatric in a new, positive light. A personal trainer specializing in geriatric fitness is helping a senior maintain independence, prevent life-threatening falls and manage chronic health conditions to live their highest quality of life through their golden years.

Become a Geriatric Fitness and Lifestyle Specialist

Align yourself with the medical community and become a Geriatric Fitness and Lifestyle Specialist! Check out MedFit Classroom’s first of its kind online course for fitness professionals.


References

Stroke-Brain-MRI

Trainer Challenge of Stroke

/23 May 2024/ All MFN blog/

A stroke is an obvious turning point in most survivors’ lives. In a best-case scenario, it can be as minor as a mild concussion. At worst, it is a disabling brain injury that leaves the person incapable of caring for themselves—or even breathing on their own. In any case, stroke clients can provide a significant challenge to a trainer wanting to help them, once medical care and primary rehabilitation has plateaued. This is especially true considering the variety of experiences a survivor can have, following a stroke.

Female-Trainer-and-older-male-client

Training Clients with Arthritis

/14 May 2024/ All MFN blog/

According to the CDC, during 2019-2021, 1 in 5 adults in the United States experienced doctor-diagnosed arthritis. Since then, the number has consistently increased! The latest statistics from Health.Gov estimate the number of reported arthritis diagnoses is now 1 in 4, which is not only a leading cause of disability, but also a significant driver of economic costs.

eating-for-arthritis-SOS

Eating for Arthritis and S.O.S. — Sugar, Oil & Salt… Oh My! 

/10 May 2024/ All MFN blog/

Is there such a thing as an anti-inflammatory diet? While there is no specific “diet” that people with arthritis or rheumatoid arthritis (RA) should follow, researchers have identified certain foods that can help control inflammation. Many of them are found in the so-called Mediterranean diet, which emphasizes fish, vegetables, olive oil, whole grains, nuts and seeds, among other staples.

Pisa Word Cloud

Pisa Syndrome and Parkinson’s Disease

/26 April 2024/ All MFN blog/

If you work with people living with Parkinson’s disease then you’ve learned that every PD “fighter” experiences their own unique combinations of symptoms. Someone might have a tremor, hypophonia, and cognitive issues, while another struggles with rigidity, balance, vestibular issues and Pisa Syndrome. Wait. What is Pisa Syndrome?

Pisa Syndrome, also known as Pleurothotonus, affects the spine and is defined as a lateral bending of the trunk with a tendency to lean to one side.  Pisa causes changes in the spine such as narrowing of the central spinal canal through which the spinal cord travels leading to stenosis, poor posture and instability.

It is common for Pisa and Scoliosis to be considered the same problem. However, they are not. A person  living with Pisa will “list” to one side, while a person living with Scoliosis will have an S or C curvature to their spine and rotation but not necessarily a lateral bend.

This image has an empty alt attribute; its file name is PISA1.png
PISA SYNDROME
SCOLOSIS

What Causes Pisa Syndrome?

It is likely that Pisa is multifactorial, meaning many factors may influence the development of and severity of Pisa Syndrome. We think there is a central (brain and spinal cord) component to Pisa Syndrome involving basal ganglia dysfunction (dystonia and rigidity), abnormal sensory integration, and/or cognitive dysfunctions affecting perception and postural control. Additionally, there is dysfunction with the Peripheral mechanisms consisting of alterations of the musculoskeletal system (myopathy, soft tissue changes).

There is some conjecture that due to medication changes or the increase of the dose of dopaminergic medications, the likelihood of Pisa onset becomes higher. Do not make medication changes without discussing with your care team. Other scientists think that as basal ganglia dysfunction increases, so do the chances of Pisa (Tinazzi et al., 2019; Artusi et al., 2019).

Is Pisa Syndrome Neurological AND Bone-related?       

Yes! Because Pisa is associated with basal ganglia and sensorimotor dysfunction, there is a high likelihood of the onset of Pisa with various movement disorders, such as idiopathic Parkinson’s (80% of the Parkinson’s population) and atypical Parkinson’s syndromes (20% of the Parkinson’s population), such as Multiple Systems Atrophy, dementia with Lewy Bodies, Progressive Supranuclear Palsy (Castrioto et al, 2014; Barone et al., 2016).

Although Pisa syndrome is usually classified as a neuromuscular disorder, the spine is greatly affected due to favoring one side, leading to postural abnormalities. This can affect not only muscular health and movement, but also bone health. Bad posture, overcompensation for balance to one side, issues such as falling, and increased risk for osteoporosis may be more likely to occur in those individuals with Pisa, resulting in the likelihood of bone fractures and overall decreased bone health (Barone et al., 2016). 

Medication Awareness

Moving on, let’s investigate how medication may affect Pisa Syndrome. Although there are studies correlating the use of dopaminergic drugs, there is no longitudinal or concrete evidence stating that medication causes Pisa syndrome (Castrioto et al., 2014; Barone et al., 2016; Tinazzi et al., 2016). However, it is known that incorrect dosages, either too high OR too low, can affect the onset of this disorder (Castrioto et al., 2014; Tinazzi et al., 2016). Therefore, it is imperative that providers assess the correct dosage, and that medication is taken consistently  to lessen chances of this syndrome.

Some medications that may contribute to the onset of Pisa syndrome include dopaminergic medications such as carbidopa-levodopa (Sinemet or generic), dopamine agonists such as ropinirole, or anticholinesterases such as donepezil. This may sound scary, but it is important to note that Pisa can be treated by adjusting PD medications, so make sure to advise fighters to check in with their  doctor if they are experiencing Pisa symptoms.

The Effect of Pisa Syndrome On Parkinson’s Disease

Now that we’ve looked at Pisa from a scientific perspective, let’s address how Pisa Syndrome affects activities of daily living and Parkinson’s Disease.

As mentioned earlier, Pisa Syndrome essentially causes changes in the spine which leads to poor posture and instability and causes the following:

  • The head may droop.
  • The neck moves forward rather than remaining in alignment with the spine.
  • The shoulders round causing a forward slump that affects the amount of space for your internal organs.
  • Breathing becomes shallow and/or more labored.
  • Movement through the hips and spine decreases which affects gait length and increases risk of falls.

The above postural changes can impact one in the following ways: 

  • Neck/Jaw pain and headaches due to muscle tightness
  • Loss of sleep
  • Digestion disruption due to organs being compressed
  • Depression
  • Poor circulation
  • Constricted nerves
  • Foot pain due to misalignment
  • High blood pressure

Sensory Components of Pisa

Here we see how the three balance systems are impaired:

  • Vision: Impaired perception of vertical (vertical can deviate either towards or away from the side the body tilts).
  • Proprioceptive: Unbalanced proprioceptive feedback (body awareness in relation to space and time).
  • Vestibular: Unilateral or possible bilateral vestibular hypofunction.

Treatment for Pisa Syndrome

Let’s consider some of the activities a person does during the day-to-day – walking, bathing, dressing, cleaning, laundry, caring for children/spouse/pets, cooking, driving, social events.

We don’t have any concrete data on if/how Pisa affects Parkinson’s severity, but we can see from the above how it may affect Parkinson’s symptoms. So, how can we treat Pisa?  Let’s have a look. 

1. Medication – Advise fighters/care partners to speak to their physician. Encourage them to review their medications with their physician to see if changes in dosage or type of drug may be initiating or aggravating the syndrome.

2. Reducing Fall Risk – Pisa Syndrome can increase the risk of falls secondary to a lateral trunk lean which results in a change in the center of gravity and inadequate trunk control. As such, one should seek  a comprehensive evaluation aimed at eliminating risk factors for falls, improving postural awareness, strength/mobility training, and/or offering effective preventive measures to reduce fall risk. This can be performed by a multidisciplinary team consisting of a physician, personal trainer, and physical therapist.

Additionally, and importantly, a major goal of physical therapy is improving midline awareness and making sure that their curvature does not worsen.

3. Exercise – Addressing your fighters core through exercises that involve vertical and lateral challenges provide the most benefit.  While we cannot change the shape of the spine, we can strengthen the muscles that support the core!

  • Rows
  • T’s
  • Front Lateral Pulldown
  • Shrugs (standing upright)
  • Modified Cobra (hands on the kitchen counter or ballet barre to protect those
  • with Osteoporosis and Osteopenia)
  • Tube rotation exercises
  • Isometric tube exercises
  • Stretching to maintain spinal mobility
  • Trunk alignment and midline orientation exercises
  • Physical Therapist to assess for somatosensory integration deficits which include:
    • Vision
    • Vestibular
    • Proprioceptive

*Below, you’ll find a video demonstration to learn how to properly perform these exercises. Bridges For Parkinson’s includes these exercises in the warm-up and strength portion of our routines each week.

Note: Some may need individualized physical therapy to provide postural exercises, reduce lumbar pain, and provide preventative exercises.

In closing, Pisa Syndrome is unique in that it develops over time in conjunction with a movement disorder. The strength of a person’s physical structure depends on having the knowledge to identify possible bone issues such as Pisa Syndrome, properly addressing the issue with corrective exercises and a team that provides support and encouragement.

Bridges For Parkinson’s is focused on helping Parkinson’s fighters, care partners and fitness professionals develop a sense of awareness and provide corrective exercise therapy for those dealing with Pisa Syndrome along with preventative exercises to support a strong, vertical spine!

Parkinson’s Disease is a journey and Bridges For Parkinson’s – Rock Steady Boxing Music City and Franklin wants to support you and your Parkinson’s “fighters” on the journey. As a MedFit author and Parkinson’s Fitness Professional, I am here to help.

Together, we fight back stronger!

Fit Pros: You Can Improve the Lives of Those Living with Parkinson’s

Enroll in Colleen’s 12-hour online course, Parkinson’s Disease Fitness Specialist. The course brings the research, medical and fitness fields together so that fitness professionals gain a comprehensive understanding of Parkinson’s disease, and learn how to work with those who have it.

Written by

  • Colleen Bridges, M. Ed., NSCA-CPT, Parkinson’s Disease Fitness Specialist, Founder of Bridges For Parkinson’s
  • Renee Rouleau- PhD candidate, Jacobs School of Biomedical Sciences, University at Buffalo
  • Betsy Lerner, MA English &  African American Lit., ISSA-CPT, Parkinson’s Disease Specialist and Rock Steady Boxing Certified
  • Megan Kelly, PT, DPT, LSVT Big and Parkinson’s Wellness Recovery Certified
  • Cindy Nyquist, LPTA, ATC, Rock Steady Boxing Certified

References

  • Huh, Y. E., Kim, K., Chung, W.-H., Youn, J., Kim, S., & Cho, J. W. (2018). Pisa syndrome in parkinson’s disease: Pathogenic roles of verticality perception deficits. Scientific Reports, 8(1). https://doi.org/10.1038/s41598-018-20129-2
  • Huh, Y. E., Seo, D.-W., Kim, K., Chung, W.-H., Kim, S., & Cho, J. W. (2022). Factors contributing to the severity and laterality of Pisa syndrome in parkinson’s disease. Frontiers in Aging Neuroscience, 13. https://doi.org/10.3389/fnagi.2021.716990
  • Di Lazzaro, G., Schirinzi, T., Giambrone, M. P., Di Mauro, R., Palmieri, M. G., Rocchi, C., Tinazzi, M., Mercuri, N. B., Di Girolamo, S., & Pisani, A. (2018). Pisa syndrome in parkinson’s disease: Evidence for bilateral vestibulospinal dysfunction. Parkinson’s Disease, 2018, 1–6. https://doi.org/10.1155/2018/8673486
  • Artusi CA, Montanaro E, Tuttobene S, Romagnolo A, Zibetti M and Lopiano L (2019) Pisa Syndrome in Parkinson’s Disease Is Associated With Specific Cognitive Alterations. Front. Neurol. 10:577. doi: 10.3389/fneur.2019.00577
  • Barone P, Santangelo G, Amboni M, Pellecchia MT, Vitale C. Pisa syndrome in Parkinson’s disease and parkinsonism: clinical features, pathophysiology, and treatment. Lancet Neurol. 2016 Sep;15(10):1063-74. doi: 10.1016/S1474-4422(16)30173-9. Epub 2016 Aug 8. PMID: 27571158
  • Castrioto, A., Piscicelli, C., Pérennou, D., Krack, P. and Debû, B. (2014), The pathogenesis of Pisa syndrome in Parkinson’s disease. Mov Disord., 29: 1100-1107. https://doi.org/10.1002/mds.25925
  • Huh YE, Seo D-W, Kim K, Chung W-H, Kim S and Cho JW (2022) Factors Contributing to the Severity and Laterality of Pisa Syndrome in Parkinson’s Disease. Front. Aging Neurosci. 13:716990. doi: 10.3389/fnagi.2021.716990
  • Tinazzi, M., Geroin, C., Gandolfi, M., Smania, N., Tamburin, S., Morgante, F. and Fasano, A. (2016), Pisa syndrome in Parkinson’s disease: An integrated approach from pathophysiology to management. Mov Disord., 31: 1785-1795. https://doi.org/10.1002/mds.26829
  • Tinazzi, M., Gandolfi, M., Ceravolo, R., Capecci, M., Andrenelli, E., Ceravolo, M.G., Bonanni, L., Onofrj, M., Vitale, M., Catalan, M., Polverino, P., Bertolotti, C., Mazzucchi, S., Giannoni, S., Smania, N., Tamburin, S., Vacca, L., Stocchi, F., Radicati, F.G., Artusi, C.A., Zibetti, M., Lopiano, L., Fasano, A. and Geroin, C. (2019), Postural Abnormalities in Parkinson’s Disease: An Epidemiological and Clinical Multicenter Study. Mov Disord Clin Pract, 6: 576-585. https://doi.org/10.1002/mdc3.12810