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Fitness-Exercise-Data

The Top Big Data Issues – and How Wellness Can Do Them Better

/21 October 2021/ All MFN blog/

Big data is here to stay within the healthcare profession.  More and more engineers and data programmers are being hired to sift through the myriad of data that consumes the field.  Of concern to executives at the top are certain attributes of healthcare that may need “fixing”.  The aspects of this report are to highlight what are perceived as the biggest concerns in healthcare, and how the wellness industry – if they can stay on track – can supersede all of these types of issues as they transition to the data analytics side of their health offerings.  

#1 – In network utilization.  

This is a very big concern for hospital systems and physician network groups, as patients have a tendency to switch providers if they think they will get better service, better medicine, or better prices.  One of the reasons is that most patient contracts don’t require patients to stay in a network – which puts the responsibility of good care, competitive prices, and follow ups squarely on the doctors.   If patients are unhappy with their doctor or practice for any reason, they can leave.  Now that these organizations are getting bigger and more complex – it’s easier to see why patients may become disgruntled, and try to find a better solution in a private practice, or smaller group or hospital practice. 

From the wellness side – it’s not uncommon for health club members to stay at their club or studio for years.  Prices don’t change that much, and most members have a very personal relationship with their instructors and club owners.  They have group classes, personal exercise programs, child care, plenty of free parking, and clean facilities that provide some of the latest in technology every few years.  So – should healthcare systems look to health clubs to see why people stay in clubs longer?  Perhaps they should be partnering with these health clubs for specific programs for their patients.

#2 – Customer satisfaction.  

This is a priority in most businesses.  Hospitals and physician practices are no exception.  However, most people still associate going to the doctors with being sick.  So there is already an inherent negative connotation to the doctor’s office.  Therefore physicians need more than a lab coat and a prescription to make sure patients are getting what they need.  They need a team-orientated approach that can help with the issue NOW, and use the team to follow up with the patient to make sure the situation and health concerns are taken care of over time.

Again – the health and fitness industry is concerned about customer satisfaction.  With cut-rate gym memberships, and a new club coming into communities almost every month, clubs and owners need to offer clean facilities, professional trainers and instructors, and technologically advanced equipment that doesn’t break down and that is easy for members to take advantage of.  The issue between the two programs – is that although some exercise programs push the body and may be painful – it’s a good pain and the rewards of long term participation should be better health and less risk of using the healthcare system over time.  It’s the old adage of “pay me now, or pay me later” axiom, and more people are willing to put their trust in health clubs – and the risk of injury or illness or death is extremely low compared to even trips to the doctor’s office. 

#3 – Looking at the mounting data to convene the best possible approach to patient care.  

Again – this is a huge concern in healthcare – that doctors can’t read the thousands of new studies that come out in their field each month, so they rely more and more on their clinical experience (which may be a good thing), but they will stick to the tried and true methods they have always been using, and may not prescribe the most effective type of treatment for their patients.  Big data in many instances can do two things – one is look over millions of studies in a particular field, and two – through machine learning, hone in on what may be the best type of treatment plan for a particular patient, based on their age, severity of disease, family history, weight, and other factors.  This is a powerful tool to help doctors prescribe and treat better.

However, it’s still the same paradigm.  They are looking over medical studies, many of which may not be in the best interest of the patient.  One of the most cited studies in medicine came in 2005 when Stanford epidemiologist John Ionnidis reported that the majority of medical research finding are false, because they have inherent bias from their authors, their findings are not statistically significant, they were published by industry officials, and are not relevant, and conclusions may not match the actual results of these very papers.  Ionnidis opened the floodgates for many professionals who have gone after medical research and institutions for publishing false studies.  It is estimated that almost 40% of medical research studies are false, in that their findings do not hold relevance regarding the enhancement of patient care.

In contrast, sports medicine has been methodological in its research for a century – from the basis of treadmill cardiac and performance testing in the 1930s, to the onset of physical activity studies in the 1950s and 60s, to cardiac rehab and exercise safety studies in the 1980s, to the onset of exercise for special population groups in the 1990s.  There are very few reports on sports medicine research fraud, and the foundation of this research usually shows some level of benefit to those who participate.  In almost all cases, no harm is done to subjects while performing these studies.  This has now transitioned into many successful clinical health club programs for persons with cancer (Sunflower Wellness, Cancer Well-fit, Fast Trac Cancer Program), spinal cord injury (Claremont Club), multiple sclerosis, diabetes, hypertension, weight management, bariatric recovery, and medical fitness in general. 

#4 – Cost savings. 

 One of the biggest attributes of big data and population health is to drive policymakers and physicians to deliver the highest quality care at the most competitive prices.  In many opinions, this is a misnomer of sorts, and medicine is continually advancing technology, which is very expensive, and works through a third party reimbursement system — which is many times more expensive than if they offered the service or procedure or product at market value.  Many hospitals are undergoing facelifts (no pun intended) and look more like five-star hotels than medical centers.  All of these amenities cost the patient and insurance pool more money.  This is why healthcare costs usually rise at more than twice the rate of inflation, and have some of the highest costs of any industrialized business model.

As far as health and fitness, the rate of price changes for the average health club has held steady at just below inflation for years.  The prices for café food, personal training, specialty exercise, or apparel has also held steady.  Even with the rush of new technologies for equipment and personal monitoring devices (such as FitBit), prices have remained constant. 

Big data in the health and fitness setting should be concentrated on health outcomes.  There are many software programs in the industry now that look at finances, front desk management, club administration, and human resources.  They do their functions well.

If big data is going to continue to look at all aspects of healthcare, and continue to miss the boat regarding improved patient health and well-being, then no amount of data can help repair the continual dysfunction that exists between an over-burdened and (in many opinions) under caring system, and the continued increase in poor health in the US.  Prescribing more pain meds, vaccines, or antibiotics will not help improve health – and in many cases is making health worse. 

The health and fitness profession is on the mark moving into the realm of special populations at every level.  As the amount of population health and data analytics becomes a more ingrained part of wellness, we will see at many levels how these types of interventions improve health, reduce costs, and vastly improve patient satisfaction and retention to their favorite health club, exercise program, or personal trainer. 

Eric Durak is President of MedHealthFit – a health care education and consulting company in Santa Barbara, CA. A 25 year veteran of the health and fitness industry, he has worked in health clubs, medical research, continuing education, and business development. Among his programs include The Cancer Fit-CARE Program, Exercise Medicine, The Insurance Reimbursement Guide, and Wellness @ Home Series for home care wellness.

 

References

https://www.optum.com/content/dam/optum3/optum/en/resources/gated/Optum_NYUPN_Topic_Spotlight.pdf

Ionnidis, JPA.  Why most published research findings are false.  2005.  PLoS Medicine.  Aug. 30. Doi: 10.1371/journal.pmed.0020124

 

foot-pain

Why Do My Feet Hurt?

/20 October 2021/ All MFN blog/


Many of you reading this are going to experience a foot problem at some point in your lifetime. Some of you are even going to develop a chronic condition that will introduce your body to a new level of suffering. Ever heard the old saying – “when your feet hurt, you hurt all over”?

The tendency for most of you will be to try to figure out what is wrong, and find a way to alleviate your discomfort. You may self-treat with over the counter products such as insoles, anti-inflammatory or pain medicine. Some of you will seek professional advice from your primary doctor or a specialist. A lot of you will look for answers online, to determine a diagnosis.

After doing this you may think that you’re going to get to the solution you’re after, but in actuality there’s something that should be looked at long before pursuing any of the steps mentioned above. From the 22 years I’ve been taking care of people’s feet, I can tell you that there is a key piece of information many never find. It’s honestly something few know about, but it’s much more likely to be causing your foot troubles.

The fit of your shoes

Yes, the commonly accepted shape of shoes and the method of assigning your feet a number and letter, based upon measurements with the Brannock device, are the most likely reasons for your foot pain. Why? Having your feet measured in this way ignores the natural shape of your feet, and guarantees that you will change this natural shape and inhibit proper function. For many of you this started in infancy, but because of the amazing compensatory abilities of your feet you are likely able to function fairly well in unnatural alignment. For a while, that is.

Picture from CorrectToes

Studies show that about 75% of people in the United States have foot pain at some point in their lives. When that day comes for you to experience your own personal suffering; instead of resorting to the means mentioned above, perform a free and simple in home test to show yourself the most likely reason for your pain.

We perform this test on every patient that comes in to our clinic, and the majority of their feet spread beyond the sock liner. This ensures that their feet are going to be misaligned, because the upper part of the shoe is the same shape as the sock liner.

This goes for you men as well. Even in athletic shoes.

So when your feet begin to hurt – resist the temptation to self-medicate, seek professional advice or try to figure out your diagnosis, until you have checked the fit of your shoes.

Be skeptical of any advice or treatment of your foot pain that does not include aligning your feet naturally. Your feet are designed to be widest at the ends of the toes, so be wary of any professional who ascribes your foot pain to genetics, biomechanics or overuse, but fails to ensure that your feet are aligned as they are naturally designed to be. It is impossible to achieve lifelong foot health and ignore this basic anatomic fact.

Originally printed on the Correct Toes blog. Reprinted with permission.

Dr. Ray McClanahan’s practice, Northwest Foot & Ankle in Portland, Oregon, allows him to care for those who find their highest joy when in motion. In his 18 years as a podiatrist, he has learned that most foot problems can be corrected by restoring natural foot function. He is also the inventor of Correct Toes, silicone toe spacers. His professional goal is to provide quality natural foot health services with an emphasis on sports medicine, preventative and conservative options as well as education on proper footwear.

Dr. McClanahan is an active runner and athlete. In 1999, he finished 14th in the U.S. National Men’s Cross-Country Championships and had a near Olympic Trials qualifying 5,000 meter mark of 13:56 in 2000. He then qualified for the World Duathlon Championships in 2001.”

senior-couple-walking

Key Exercises and Training for Aging Successfully and Living Your Best Life

/14 October 2021/ All MFN blog/

As the years roll by, nothing has become clearer to me than the fact that aging successfully requires a lot of work. When it comes to our bodies, nothing rings truer than, “If you don’t use it, you lose it.” This is particularly true not only when it comes to preventing declines arising from disuse, but also when trying to slow down the normal impacts of aging. 

The function of our bodily systems peaks at around age 25 and declines over time. As a result, your maximal aerobic capacity decreases, even with constant training, reflective of declines in maximal heart rate. In addition, your balance ability gets worse (particularly after age 40), bones get thinner, muscles atrophy, reflexes get slower, and recovery from workouts takes longer. Aging is not for sissies, but it beats the alternative!

The good news is that it is possible to slow the rapid decline of these systems by changing how you live your life. By including regular physical training, better nutrition, adequate sleep, and stress management, you can delay or prevent a lot of normal aging and reverse decrements caused by inactivity, neglect, disuse, and abuse of our bodies. The only caveat is that we can’t control or reverse neurological decline.

It starts to seem like preventing additional declines from inactivity or inadequate training gets to be a full-time job as you get older and you have to keep adding in additional exercises, stretches, and activities. A fitness instructor recently confirmed that it’s a bit like playing whack-a-mole: fix one weak area or physical problem and another one pops up. Welcome to aging!

So what can you do to live your best life both physically and mentally? I would suggest adding at least these (and many other) critical exercises to your weekly routine:

Cardiorespiratory fitness: Cardio workouts with faster training intervals

In addition to doing regular cardio activities like walking, cycling, and swimming, add in some faster intervals into any workout, such as walking faster for 10 to 60 seconds at a time during your normal walk or doing a hill profile on a cardio training machine. Doing so will increase your fitness more and improve insulin sensitivity for longer. It’s also fine to do high-intensity interval training (HIIT) at least once a week, but start out slowly and progress slowly to prevent injuries and demotivation. Not all your workouts should be equally intense, and varying your aerobic activities also lowers the risk of getting injured.

Muscular strength and endurance: Resistance training exercises

It is easy to work on your muscle strength and muscle endurance by doing a series of resistance exercises targeting your major muscle groups (in the upper body, lower body, and core areas). Pick at least 8 to 10 exercises that cover all these areas and do them at least two to three days per week. It’s fine to use your own body weight, household items (like full water bottles), hand weights, or resistance bands as resistance—you don’t have to have access to a gym or leave home. Adding in these exercises to your weekly routine is critical to aging well and being able to live independently throughout your entire lifespan.

Balance ability: Standing on one leg at a time (and other balance exercises)

This simple exercise involves standing on one leg for a minute, switching to the other leg, and repeating. Have something you can grab onto nearby, such as the back of a chair. You can hold on with both hands, one hand, one finger, or nothing as you get better at balancing. To challenge yourself, move your free leg in different directions (e.g., out front, to the side, behind you) while standing on the other one, or practice standing on uneven surfaces, such as a cushion. If your balance ability is really getting to be an issue, include other balance training activities each week as well.

Joint mobility and cartilage health: Stretches for all your joints

Do a series of flexibility exercises that stretch your joints in all their normal directions to maintain and increase their range of motion. With aging, we are all losing flexibility and diabetes can accelerate this loss when extra glucose sticks to joint surfaces (cartilage) over time and makes them more brittle. Try to stretch at least two to three days per week. The older you get, the longer you should hold each stretch (up to a minute on each one), and you may need to add in specialized stretches (such as for your calves or hips) to really work tighter joints to enhance your mobility and balance ability.

Bone strength: Weight-bearing activities and/or resistance training exercises

Your bones stay stronger when you put normal stress on them regularly, such as carrying your own body weight around when walking or jogging or doing resistance exercises with your upper body or carrying grocery bags. If you stay sedentary, your bones will lose minerals faster and get thinned out more quickly, and non-weight-bearing activities like swimming and cycling just don’t have the ability to build bone as much as weight-bearing ones. Try to adequately stress your bones to stimulate the bone mineral density to stay higher—at least two to three days per week.

Basic mobility and self-care: Wall sits and/or sit-to-stand exercise

Until you start to get older, you seldom think about how difficult it can be to get up out of a chair or off the sofa. Many older people get heavier and weaker and start to have trouble doing these basic maneuvers, which are critical to living well independently. To improve your ability, practice doing wall sits, which involves sitting against a wall with your hips and knees at 90 degree angles and your feet straight below your knees for as long as you can. This exercise will also help prevent knee pain and problems. Alternatively, you can do sit-to-stand exercises where you sit on the edge of an armless chair and practice getting up without using your arms. (This is also often called the “getting up from the toilet” exercise.)

Sexual enjoyment (and incontinence): Kegel exercises

Also known as pelvic floor muscle training, Kegel exercises can help with stress incontinence (i.e., urinating a little when sneezing or laughing) and normal incontinence (both urinary or fecal), and they may enhance your sexual pleasure to boot. The easiest way to identify the pelvic floor muscles is to stop your urine flow while urinating or tighten the muscles that keep you from passing gas. To do Kegels, imagine you are sitting on a marble and pretend you’re lifting it up by tightening your pelvic muscles and holding them contracted for as long as you can; do this a few times in a row. When your muscles get stronger, you can do these exercises while sitting, standing, or walking. Both men and women can and should do Kegel exercises regularly.

Sheri R. Colberg, PhD, is the author of The Athlete’s Guide to Diabetes: Expert Advice for 165 Sports and Activities (the newest edition of Diabetic Athlete’s Handbook). She is also the author of Diabetes & Keeping Fit for Dummies, co-published by Wiley and the ADA. A professor emerita of exercise science from Old Dominion University and an internationally recognized diabetes motion expert, she is the author of 12 books, 34 book chapters, and over 420 articles. She was honored with the 2016 American Diabetes Association Outstanding Educator in Diabetes Award. Contact her via her websites (SheriColberg.com and DiabetesMotion.com).

Young woman having knee pain

Women Are More Susceptible To ACL Injuries: 5 Essential Exercises To Minimize The Risk

/7 October 2021/ All MFN blog/

Women have different biomechanics due to a slightly wider pelvis, which means their knees buckle more easily when landing from a jump. Women have looser joints, which is a risk factor for knee problems, and muscular, strength and hormonal issues also play a part.

The ACL provides the knee joint with stability and rotational control during movement. When an ACL tear happens, hearing or feeling a ‘pop’ at the time of injury is common. This is followed by localized swelling at the knee joint.

An ACL injury can occur in several ways:

  • Rapid change of direction
  • Sudden stop
  • Sudden deceleration while running
  • Landing incorrectly after a jump
  • Hyperextension of the knee
  • Direct contact or collision while playing a sport

If you experience any sharp or sudden pain at the knee, especially during sports or from a fall, follow the First Aid RICE protocol immediately — Rest, Ice, Compress, Elevate — and seek medical attention immediately.

There isn’t much you can do once the injury happens, but there are ways to minimize the chance of it happening in the first place. Prevention is better than cure so focus on strengthening the kinetic chain and muscles around the knee. If you do lots of sport with plyometric movements, ensure your technique and form is correct, and include agility drills for neuromuscular control.

Here are 5 essential exercises to help stabilize and strengthen your knees, hips and glutes, which in turn will help prevent an ACL injury.

Single Leg Deadlift

Ensure that your knee doesn’t buckle and aim to keep your hips level. Keep your spine neutral and braced throughout the entire movement while maintaining balance.

Elevated Hip Raise

This exercise targets the hamstrings and calves. Maintain a neutral spine throughout the range of movements.

Walking Leg Lunges with Torso Rotation

Maintain an upright torso with your hips squared. If you feel a sharp pain in your knee at any time during this exercise, stop and seek advice from a qualified trainer.

Lateral Squats

Begin by placing your feet wide apart, then shift your weight from left to right while placing most of your body weight on the heels of your feet. If you feel a sharp pain in your knee at any time during this exercise, stop and seek advice from a qualified trainer.

 

Reprinted with permission from www.purelyb.com

Ke Wynn Lee is an author and an international award-winning corrective exercise specialist who 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.

senior-woman-virtual-exercise

Two Big Fitness Marketing Mistakes Post Pandemic

/28 September 2021/ All MFN blog/

If you make either of these two big fitness marketing mistakes post-pandemic, it will cost you. You’re going to make them totally unintentionally. I mean of course, right? Why would anyone intentionally make a marketing mistake?

Beyond that, though you may think that yes, you’ve got these two bases covered and realize after reading this and listening to my podcast on the topic, no you don’t.

One way you know is you’re attracting the wrong kind of people.

Another way is you’re not getting any engagement on your social or your content marketing. 

If you confuse, you lose.

  • What are you sharing in your social media posts?
  • Do people understand what you do, why you do it?
  • Are you establishing yourself as a go-to authority in the area where you want people to find you for programs, products, and services?

Analyze:

  • The name of your social media profile
  • The posts you create (one by one because that’s how they see them)
  • The way you’ve positioned yourself

And then apply this to the following to avoid the two biggest fitness marketing mistakes

Big Fitness Marketing Mistake #1: No Specific Audience

The other day I reviewed a business website and social media platforms as part of a social media audit. It was hard to know who the ideal customer was and if I couldn’t tell as a fitness marketer looking for it, how could anyone?

Just because you’re focused on a certain age and gender (demographic), it doesn’t mean that everyone in that demographic wants the same thing.

First, there’s your niche. Are you about food, exercise, mindset, hormones, weight loss? What is your specific niche?

But that’s not even enough.

Here’s an example

Take women in menopause. Many are married, but an almost equal number are single. Are you talking about dating? About traveling alone? Or about family vacations? About drinking wines and trips to Napa? Some (I’m one) wouldn’t enjoy that at all because they rarely, and then barely, drink.

Some women have a conservative view of menopause, what’s happening and possible, while others are thinking about doing triathlons after retirement. Who are you talking to?

Women in perimenopause are more likely to have kids at home full-time jobs, and a unique set of problems, compared to women just post-menopause. There’s a subset of women in post-menopause who did have children later… so who are you talking to? Define it very specifically. And realize, they need to feel “like you.” If your images, videos and copy doesn’t resonate with who they are or want to be, you miss the opportunity to help women looking for you.

Find out the #2 biggest fitness marketing mistake and listen to Debra’s podcast on this topic… visit Debra’s blog, Fitness Marketing Mastery

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 serves on the MedFit Education Foundation Advisory Board, is an international fitness presenter, and author of hundreds of articles and multiple books. Visit her website, flippingfifty.com

corrective-exercise-stretching-fitness

Benefits of Being a Corrective Exercise Specialist

/27 September 2021/ All MFN blog/

Research shows that 90% of people report painful and limiting musculoskeletal conditions affecting the success of their workouts. (4) In response to this need corrective exercise is booming with fitness professionals becoming educated about musculoskeletal assessments, movement analysis and corrective exercise to help both themselves and their clients feel and function better. Becoming a specialist in corrective exercise and integrating these strategies into your fitness business has many advantages. 

  • Attract More Clients: Latest research indicates the number one reason people seek the help of a fitness professional is to assist them with muscle/joint pain. (4) If you are qualified to address these problems, you will attract more clients.
  • Increased Revenue: Having a sought-after specialty qualification in corrective exercise has been shown to increase your income by as much as 50%. (1)
  • Utilize Fool-Proof Assessments: When a client comes to you with pain or complains of pain during their workout, you can take a strategic and active approach to assessing and correcting the underlying cause of their problem.
  • Use Proven Methods: The corrective exercise strategies contained in well-recognized corrective exercise certifications like The BioMechanics Method have been tried and tested on real clients and produce unbelievable results. 
  • Design Better Workouts: A better understanding of functional anatomy and movement can not only help you get clients out of pain, but it can also assist you in designing more effective exercises. This enables you to create high-performance programs for both weekend warriors and professional athletes.
  • Accelerate Client Results: Injuries and movement dysfunction limit the types and intensity of workouts clients can perform. Helping clients feel better so they can perform better, both in and out of the gym, lets them realize goals sooner.
  • Keep Clients Coming: When clients get injured, they drop out. Addressing your client’s muscle imbalances and movement dysfunction at the outset of their program decreases the likelihood they will experience pain or injuries and ensures they can continue working with you.
  • Increase Word of Mouth Referrals: The ability to help clients get out of pain and achieve their goals is marketing gold. They will confidently refer friends, family and colleagues to you for help. You will also be able to successfully network with health professionals who need a trusted, qualified corrective exercise specialist to whom they can refer patients.
  • Get Ahead at Work: Latest research indicates that advanced qualifications weigh heavily in an employer’s decision when looking to promote a staff member. (2)
  • Edge out the Competition: Statistics show that 89% of clients are looking for a fitness professional to help them alleviate their aches and pains. Yet only 56% of personal trainers offer corrective exercise services.4 The knowledge and skills you obtain by earning a corrective exercise qualification could provide you with a major competitive edge in the fitness arena.

Helping clients overcome aches and pains can be a profitable and rewarding experience. A sound understanding of biomechanics will allow you to develop and use your practical corrective exercise skills. It also provides an outlet for you to market your unique services and become one of the industry’s most sought-after professionals.

MedFit Network (MFN) members receive 20% off The BioMechanics Method Corrective Exercise Specialist certification. Members can get their discount coupon here.

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

 

References

  1. NASM. 2015. Annual NASM-CPT Survey. Chandler, AZ: National Academy of Sports Medicine.
  2. National Federation of Personal Trainers, 2012. www.nfpt.com
  3. Price, J. 2018. The Biomechanics Method for Corrective Exercise. Champaign, Illinois: Human Kinetics.
  4. Schroeder, Jan., and Donlin, Ayla. 2013. IDEA Fitness Programs and Equipment Trends Report. IDEA Health & Fitness Association.
female-trainer-senior-client-exercise-ball

Flip the Script: How Fitness Professionals Can Overcome Challenging Clients

/24 September 2021/ All MFN blog/

If you are a fitness or medical fitness professional, there is a good chance you have heard one or more of the following statements at least once in your career. In fact, there is also a good chance you have heard these statements on a daily basis. 

1. I am a little tired and my muscles are a little sore from our last session, so I am going to cancel today and rest. 

2. I don’t want to do “that exercise” because I have never done it before.

3. My doctor told me that I should not be squatting, bending, reaching, twisting, etc… 

Many of you reading this article can relate to at least one of the above and may have even let out a slight sigh of frustration when it comes to overcoming challenging clients. Overwhelming amounts of research show that exercise can help to improve your health and fitness without hurting your joints.(1) With your current treatment program, exercise can: 

  • Strengthen the muscles around your joints 
  • Help you maintain bone strength 
  • Give you more energy to get through the day 
  • Make it easier to get a good night’s sleep 
  • Help you control your weight 
  • Enhance your quality of life 
  • Improve your balance 

However, many of our clients still believe that exercise will aggravate their joint pain and stiffness, but that is not the case. Lack of exercise actually can make your joints even more painful and stiff.(2) If the muscles and surrounding tissue are strong, it helps to maintain support for your bones. Choosing not to exercise weakens those supporting muscles, creating more stress on your joints. 

While fitness and medical fitness professionals understand the importance of exercise, the way we translate this to our clients is key. Oftentimes, clients receive misinformation along with mixed messages from doctors, family members, friends, and of course, social media. However, after decades of both academic and professional research working with special demographics, I have discovered a powerful technique to increase clients’ willingness to improve their health through exercise. The answer lies not only in showing the client how each exercise emulates real-life situations, but also how it affects their independence.

For example, telling a client, “Today we will be working on how to safely and effectively execute a squat,” is a lot different than saying, “Today we will be practicing our sit to stand movements so that you have the lower body strength and flexibility to rise from your favorite chair without assistance.” 

Most importantly, it is important to reiterate to your client that their lack of strength, mobility, and balance leads to a more sedentary lifestyle that will decrease their ability to function independently as time progresses. Additionally, muscle atrophy, joint immobility and poor flexibility are key indicators that functional movements, or movements that are required to perform everyday tasks, will soon be a thing of the past.

If a client is unwilling to perform various exercises, here are some conversation starters:

  1. Did you know that this is not just an exercise, but one of the foundational movements to support strength, balance and flexibility in your everyday life?
  2. Do you know the definition of functional fitness?
  3. Do you know that this isn’t just an exercise, but will help you walk up and down the stairs, get up from a seat, carry your groceries, and pick up a grandchild?
  4. Are you ready to give up your independence? 

Christine M. Conti, BA, M.Ed, is an international fitness educator and presenter. She currently serves as the Director of Membership for MedFit Network, sits on the MedFit Education Advisory Board and is a course author for MedFit Classroom. She is also CEO and founder of ContiFit.com and Let’s FACE It Together™ Facial Fitness & Rehabilitation and co-host of Two Fit Crazies & A Microphone Podcast. 

Check out Christine’s online course with MedFit Classroom, Arthritis Fitness Specialist:

References

  1. CDC: Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion. (2021, April 5). Benefits of Physical Activity. Center for Disease Control and Prevention. Retrieved September 10, 2021, from https://www.cdc.gov/physicalactivity/basics/pa-health/index.htm
  2. Mayo Clinic. (2021). Exercising With Arthritis: Improve Your Joint Pain and Stiffness. Mayo Clinic. Retrieved September 9, 2021, from https://www.mayoclinic.org/diseases-conditions/arthritis/in-depth/arthritis/art-20047971
seniors-biking-in-gym-group

Exercise’s Impact on Cognition

/22 September 2021/ All MFN blog/

It’s not news that the brain changes with age. Significant changes in regions of the brain occur in healthy adults as they age, based on MRI studies.(1) The caudate, cerebellum, hippocampus, and association cortices shrunk substantially. This shrinkage in the hippocampus and the cerebellum accelerates with age. The hippocampus, the site for new memory formation, is involved with learning and emotion with a rich supply of estrogen and progesterone receptors. The cerebellum coordinates voluntary movements including all conscious muscular activity, balance, coordination, and speech.

Incidence of Dementia

The United States is experiencing both a declining birth rate and an increased average life span. This combination will increase the percentage of people over the age of 65 to 19.6%, resulting in a total of 71 million people by the year 2030.(2) The number of people over the age of 80 is also expected to increase to 19.5 million by 2030.(2) These changes will greatly increase the number of people with dementia since 6% to 10% of North American individuals aged 65 or older have dementia; this increases to 30% in those aged 85 or over.(3)

Dementia, or senility, is a difficult-to-define cluster of symptoms that include memory loss, loss of vocabulary, and loss of motor function in the absence of a change in the level of consciousness. Dementia can be measured qualitatively by verbal memory tests such as the Blessed Orientation-Memory-Concentration test, comprising six questions as listed in the following table:

The scores from each of the table’s six items are multiplied to produce a weighted score. Score 1 for each incorrect response; weighted error scores greater than 10 are consistent with dementia.(4)

Exercise Affects the Brain

The incidence of Alzheimer’s dementia can be used as a measurement of brain health.(5) As part of his study “Exercise Is Associated With Reduced Risk for Incident Dementia Among Persons 65 Years of Age and Older,” Eric B. Larson, MD, MPH, et al asked 1,740 mentally healthy men and women over the age of 65 how many days per week over the past year they had exercised for at least 15 minutes. The incidence of Alzheimer’s disease (AD) was significantly higher for individuals who exercised fewer than three times per week (19.7 per 1,000 person-years) compared with those who exercised more than three times per week (13 per 1,000 person-years). These results were not influenced by the E4 alleles on the apolipoprotein gene, which indicates a genetic predisposition for AD.

Laura Podewils et al studied the relationship between physical activity and dementia in 3,375 men and women over the course of 5.4 years.(6) Physical activity in these individuals over the age of 65 was assessed via the Minnesota Leisure Time Questionnaire. The subjects were questioned regarding the frequency and duration of their physical activity over the previous two weeks. Like Larson et al, this study found that increased exercise decreased the incidence of Alzheimer’s dementia.

The Mini-Mental State Exam can be used as a measure of cognitive ability or impairment. The 30-point questionnaire commonly used by health care providers screens for dementia, evaluates cognitive impairment, and follows cognitive change over time, making it an effective way to document an individual’s response to treatment.(7) Kristine Yaffe, MD, et al used the Mini-Mental State Exam to show that cognitive performance increases as the number of blocks walked per week increases.(8) The study involved 5,925 women over the age of 65 over a six- to eight-year period.

The most objective measure of cardiovascular fitness is the measurement of the maximum rate of oxygen consumption as measured during incremental exercise—milliliters of oxygen per kilogram of body mass per minute. A subjective measure of exercise amount or duration is not as accurate as the above direct measure, which is called maximum oxygen consumption or VO2 max. Deborah Barnes, PhD, et al conducted a six-year study of 349 individuals over the age of 55 measuring both VO2 max and subjective measures of fitness. Barnes found only the lower levels of VO2 max correlated with cognitive decline.(9) The four studies mentioned show a positive cognitive benefit from exercise. A meta-analysis performed by Colcombe and Kramer from 1966 to 2001 examined 18 studies of fitness training and cognitive function in nondemented older adults. They concluded that fitness training had a positive influence on cognition.(10)

Prospective controlled human studies provide more robust data than both animal and uncontrolled studies. Stanley J. Colcombe et al were the first to show in a prospective controlled setting that increases in cardiovascular fitness in humans results in increased functioning of the prefrontal and parietal cortices. These data suggest that increased cardiovascular fitness can affect improvements in the plasticity of the aging human brain and may serve to reduce both biological and cognitive senescence in humans.(11) In addition, women tended to exhibit the greater benefit.(12) In a literature review, Kramer et al complemented these data through the use of MRI, which is very accurate in the brain. Through this technique, Kramer and colleagues concluded that older adults who participated in the aerobic training group demonstrated a significant increase in gray matter volume in regions of the frontal and superior temporal lobe when compared with controls. The results suggest that even relatively short exercise interventions can begin to restore some of the losses in brain volume associated with normal aging.(12)

Animal studies offer some insight into how aerobic exercise benefits brain function. Aerobic exercise increases brain function in both young and old animals. Aerobic exercise increases the levels of brain-derived neurogenic factor (BDNF) and insulinlike growth factor 1 (IGF-1). BDNF has been shown to regulate neurotransmitters, including dopaminergic and cholinergic systems and may be playing an important role in the exercise-induced effects on the brain.(13) BDNF may be involved in the postexercise changes seen on a brain MRI. In addition, IGF-1 may be mediating the effects of exercise on BDNF, neurogenesis, and cognitive performance. Animal studies provide information on the effects of exercise that is difficult to obtain in human intervention studies. The sum of these animal studies overlaps with results from human studies and suggests that exercise is an effective enhancer of neurocognitive functioning in both young and old animals.(12)

AD, the most common form of dementia, shares many age-related pathophysiological features of type 2 diabetes, including insulin resistance, disrupted glucose metabolism in nonneural tissues, peripheral oxidative and inflammatory stress, amyloid aggregation, neural atrophy, and cognitive decline. Brain insulin resistance appears to be an early and common feature of AD, a phenomenon accompanied by IGF-1 resistance, promoting cognitive decline independent of classic AD pathology.(14) Such a large set of shared features suggests shared etiologies.

Recommendation

High-intensity interval training (HIIT) is a type of endurance training involving short periods of maximal effort followed by periods of maintenance or recovery effort. What can differ is the timing and type of endurance exercise. A typical cycling HIIT pattern may be four to six maximal 30-second cycling sprints separated by 4.5-minute recovery periods of comfortable cycling. When HIIT is compared with longer steady endurance training, the HIIT patterns show increased mitochondrial density in muscle cells and greater muscle performance improvements.(15,16)

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This article was featured in Today’s Geriatric Medicine.

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This article was featured in the Jan/Feb 2016 issue of Today’s Geriatric Medicine (Vol. 9 No. 1 P. 26). Written by Robert Drapkin, MD

Robert Drapkin, MD, a medical oncologist and competitive bodybuilder in Clearwater, Florida, specializes in helping elderly adults achieve a healthful lifestyle to combat illnesses or disease and to extend lifespan.

 

References

1. Raz N, Lindenberger U, Rodrigue KM, et al. Regional brain changes in aging healthy adults: general trends, individual differences and modifiers. Cereb Cortex. 2005;15(11):1676-1689.

2. Chapman DP, Williams SM, Strine TW, Anda RF, Moore MJ. Dementia and its implications for public health. Prev Chronic Dis. 2006;3(2):A34.

3. Hendrie HC. Epidemiology of dementia and Alzheimer’s disease. Am J Geriatr Psychiatry. 1998;6(2 Suppl 1):S3-S18.

4. The Blessed Orientation-Memory-Concentration Test. University of Missouri Geriatric Examination Tool Kit website. http://geriatrictoolkit.missouri.edu/cog/bomc.pdf.

5. Larson EB, Wang L, Bowen JD, et al. Exercise is associated with reduced risk for incident dementia among persons 65 years of age and older. Ann Intern Med. 2006;144(2):73-81.

6. Podewils LJ, Guallar E, Kuller LH, et al. Physical activity, APOE genotype, and dementia risk: findings from the Cardiovascular Health Cognition Study. Am J Epidemiol. 2005;161(7):639-651.

7. Pangman VC, Sloan J, Guse L. An examination of psychometric properties of the mini-mental state examination and the standardized mini-mental state examination: implications for clinical practice. Appl Nurs Res. 2000;13(4):209-213.

8. Yaffe K, Barnes D, Nevitt M, Lui LY, Covinsky K. A prospective study of physical activity and cognitive decline in elderly women: women who walk. Arch Intern Med. 2001;161(14):1703-1708.

9. Barnes DE, Yaffe K, Satariano WA, Tager IB. A longitudinal study of cardiorespiratory fitness and cognitive function in healthy older adults. J Am Geriatr Soc. 2003;51(4):459-465.

10. Colcombe S, Kramer AF. Fitness effects on the cognitive function of older adults: a meta-analytic study. Psychol Sci. 2003;14(2):125-130.

11. Colcombe SJ, Kramer AF, Erickson KI, et al. Cardiovascular fitness, cortical plasticity, and aging. Proc Natl Acad Sci U S A. 2004;101(9):3316-3321.

12. Kramer AF, Erickson KI, Colcombe SJ. Exercise, cognition, and the aging brain. J Appl Physiol (1985). 2006;101(4):1237-1242.

13. Knüsel B, Winslow JW, Rosenthal A, et al. Promotion of central cholinergic and dopaminergic neuron differentiation by brain-derived neurotrophic factor but not neurotrophin 3. Proc Natl Acad Sci U S A. 1991;88(3):961-965.

14. Talbot K, Wang HY, Kazi H, et al. Demonstrated brain insulin resistance in Alzheimer’s disease patients is associated with IGF-1 resistance, IRS-1 dysregulation, and cognitive decline. J Clin Invest. 2012;122(4):1316-1338.

15. Gibala M. Molecular responses to high-intensity interval exercise. Appl Physiol Nutr Metab. 2009;34(3):428-432.

16. Billat VL. Interval training for performance: a scientific and empirical practice. Special recommendations for middle- and long-distance running. Part I: anaerobic interval training. Sports Med. 2001;31(1):13-31.