COVID really impacted the fitness industry and caused many of us to come up with creative ways to keep earning a living doing what we love by going online with virtual classes, training and coaching. This certainly created an awakening on the importance of health and wellness.
In our previous article, we showed you this picture to help understand neuroplasticity and how neurons that wire together, fire together. In this blog we’ll use the same picture to understand how sensory input to the brain affects motor output.
The sensory area (purple) is on the front “slice” of the parietal lobe. The neurons here will be activated by sensory input such as touch, vibration, threat, pressure, temperature and joint position. Lying just in front of the sensory area is the motor area (blue), which is the back “slice” of the frontal lobe. The neurons here are activated through volitional movement.
In both the sensory and motor areas of the brain, you can see in the illustration that specific areas are dedicated to specific body parts. And those areas are represented in the same areas for sensory and motor (e.g., where the hand is located in the sensory area is in the same place in motor area along the “slice”).
The bottom line is that for you to move an area well, your brain must be able feel, or “sense”, the area well. This is why issues like peripheral neuropathy in the feet so greatly affect the ability to balance and walk. Having good sensory input from an area of the body is a prerequisite for good motor control when we try to move an area.
One of the most prominent dysfunctions after stroke is a reduced ability to move one side of the body. This can occur at many different levels, from total paralysis to reduced coordination of fine motor skills. Common examples include limb spasticity, usually in flexion (e.g., a clenched fist held close into the chest), or what is termed “drop foot”, an inability to dorsiflex (lift) the foot, which severely interferes with a safe, functional gait pattern. This happens because the stroke damaged areas in the motor cortex associated with the affected body part.
The good news is that by increased sensory input to the affected area, we can begin to improve motor output. You have likely seen this already if you have ever used things like percussion guns or kinesiology tape. The many new “toys” we see in the fitness industry these days are simply sensory input devices, providing the sensory area with more and novel input, which then allows the motor area to “fire” better and provide better movement (i.e., improved range of motion, more strength, etc.).
A 2017 study found that “kinesio tape application to the tibialis anterior has significant effects on motor recovery of the lower extremity, spasticity, ambulation capacity, HRQoL (health-related quality of life) and gait compared to the control group and baseline.” (1)
The concept of sensory input affecting motor output and how to harness it is not only for stroke recovery, but also for general fitness, performance, and pain clients!
Begin learning a neuro-centric approach to medical fitness and how to work with stroke survivors with our Stroke Recovery 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
The future will see an increased proportion of elderly people throughout all modern societies. It is estimated by the WHO (World Health Organization) that in the year 2050 there will be equally as many elderly people in the world as there are children (1). Not only will there be more elderly people but the perception of being old will also continue to change. Previously, age was seen as a natural weakness process and reduction in lifestyle options.
Can you accept insurance for medical fitness/exercise therapy? Can your clients use their FSA & HSA (medical savings account) for your services? The answer to both questions is yes, however, it’s not an easy yes. The only way for your clients to do these two things is if you are billing for qualified medical expenses.
What are qualified medical expenses? Qualified medical expenses are expenses that mitigate, treat, or prevent disease per IRS.gov Publication 502. The IRS narrows the expenses that are deductible even more by limiting the qualified expenses to supplies (example: KT Tape) or an action being billed that will alleviate or prevent disability or illness. The catch for medical fitness/exercise therapy is that general health and well-being are not qualified medical expenses.
So, how can your client use their insurance or medical savings accounts for your services? The client needs their doctor to provide them with a prescription that identifies your services as medically necessary. The doctor saying you really need to lose weight is not a prescription.
What expenses or activities are covered per the IRS Publication 502? One example is a weight loss program for a client with a medical need for weight-loss. The weight-loss program becomes medically necessary when the doctor has diagnosed the client with obesity, heart disease, or some other disease and has determined that your weight-loss program or something similar will help the client improve or alleviate the disease or condition. What isn’t covered as a qualified medical expense are the dues for your club, the weight-loss program for a client without the prescription from the doctor, or the sessions to maintain good health after you fixed the problem your client had a prescription. The key is that a doctor or medical professional has diagnosed a disease and given the client a prescription for your services.
Accepting FSA & HSA is as simple as contacting your credit card processor and making sure you are set up correctly in their system. Most of the time this is as easy as answering a few questions about what you do. Making the decision to accept medical insurance at your facility is a much more extensive process, one that will require you to have a NPI (National Provider Identifier) number and a lot of extra time for the processing, filing, and record-keeping that goes along with dealing with medical insurance companies.
In short, if your client has a medical necessity for your services and their doctor has given them a prescription, then your client can use their FSA or HSA for their sessions. They also may be able to submit their receipts back to their insurance company for reimbursement. If your client doesn’t have a medical savings account or an insurance company that will reimburse them for their expenses, they can collect the receipts for the services, that qualify as medically necessary, and submit them with their taxes to their tax preparer. There are minimum limits that clients must reach before they can start using their medical expenses as itemized deductions. Their tax professional can help them with this.
To learn more about exactly what is and isn’t considered a qualified medical expense refer to the IRS Publication 502: irs.gov/pub/irs-pdf/p502.pdf
Heather Nusbaum is a Certified Management Accountant, Exercise Physiologist, Licensed Massage Therapist, MELT Instructor, and Master Trainer with NASM & ISSA. In 2013, Heather created Paws for Fitness a program to incorporate canines in the workout process. Over the years, this program has become a therapeutic modality within the training protocols of her business Nutree Fitness.
How did Heather go from Accounting and Business to Exercise Physiology? At a young age Heather was diagnosed with ‘Dysfunctional Knees’, this was a label that was attached to describe being in pain 24/7. This pain continued for the next 15+ years. After gaining weight due to age and inactivity, she realized that something had to give in her early 30’s. On her own she picked up and modified a box program and within 1 year had completely removed all the knee pain she’d suffered for the last 15+ years. Over the next few years it became apparent that she could help other people do what she had accomplished by accident, improving their quality of life and moving toward a pain free existence.
I was recently told that a very high percentage of people with Multiple Sclerosis (MS) DO NOT exercise. As a fitness professional with MS, that blew me away. I wish I could find the actual percentage but I don’t think that’s a statistic high on the priority list for any studies! But with all the time I spend in the MS community educating about fitness, I tend to believe that this is a fact, as I hear so many say they don’t exercise because they don’t know how. This is where I have found my niche to fill the gap.
According to Multiple Sclerosis News Today, “The first study on the benefits that exercise can provide to people with MS was published by University of Utah researchers in 1996. The participants improved their cardiovascular, bladder and bowel function, increased their strength, experienced less fatigue, developed a more positive attitude, and suffered fewer bouts of depression”.
With information and proof like this, why don’t more people with MS get into the gym, exercise at home or do some form of fitness program? My answer is lack of knowledge and fear. When you don’t know where to start, don’t understand how to find an exercise program that fits you, or you are not educated on the benefits of exercise for MS, you become immobilized and therefore do nothing. I believe this is the main reason why the percentage of MSers who aren’t exercising is so high.
This is where becoming a MS Fitness Specialist makes a ton of sense. Providing a proper workout plan for those with MS is not just a great thing to do, but a much-needed service.
There is a very good selection of workouts that can benefit people with MS, and one of these programs is circuit training. This type of workout gets your heart rate up and strengthens your muscles at the same time. You will never get bored in a circuit training program.
With little rest between each exercise, you rapidly go from one exercise machine to another to work different muscle groups. Depending on the intensity of the workout, you may use 8 or 12 different machines performing a different exercise and muscle group each stop.
I have my clients do 10-12 reps at each machine, using a time under tension (TUT) pace, lasting between 120–144 seconds, before moving on to the next stop.
To keep things exciting and motivating, you can change it up a bit by switching the exercises you do for each body part. A circuit training workout can be done at the gym with equipment, at home with dumbbells and resistance bands, or on an outdoor fitness trail by alternating push-ups and squats with fast-paced walking, jogging or biking.
You will need 20-30 minutes to take a MS client through the workout. The great thing about circuit training is it is easy to adjust the level of intensity by the rest time spent, the pace you perform each movement (TUT), and the speed in which you go through the circuit. A program like this works all areas of your body so you get an effective full-body workout in a short amount of time, as long as you select an exercise for each muscle group: core, arms, chest, back, shoulders and legs. The cardiovascular aspect of the program is taken care of in the time spent at rest. The less rest between sets and exercises, the more your heart rate will be elevated and the more heart-healthy cardio benefits you will receive.
There are many benefits in a circuit training routine as it is aerobic, low-impact and strength training all wrapped up in one program. You get the benefits of muscle building and toning along with a cardio workout. So, if you’re looking for a full-body workout for a MS client that can be don in 30 minutes or less, circuit training checks off all the boxes. The exercise options are endless as well with the variety of machines, resistance bands, free weights and bodyweight movements that can be incorporated into this style of program. Circuit training is an excellent workout choice for MS once you completely understand how to do it at a level that is safe yet challenging for the client you put through this program.
I want to see the percentage of people exercising with MS to overshadow the percentage that do not. You have a tremendous opportunity to be a solution to avoid in the fitness industry by becoming a MS FitnessSpecialist and working with a community that needs you.
David Lyons, BS, CPT, is the founder of the MS Bodybuilding Challenge and co-founder of the MS Fitness Challenge with wife Kendra. He has dedicated his life to helping people with MS understand and be educated on the importance of fitness in their lives. He is an author and sought after motivational speaker, dedicated to helping others by sharing the lessons gained from his life experience. His most recent book, Everyday Health & Fitness with Multiple Sclerosis was a #1 New Release on Amazon at its release. He is the 2013 recipient of the Health Advocate of the Year Award; in 2015, he received the first ever Health Advocate Lifetime Achievement Award, and the Lifetime Fitness Inspiration Award in Feb 2016. In 2017, David received the Special Recognition Award from the National Fitness Hall of Fame.
One aspect of training and conditioning the human body the right way, that I find particularly fascinating, is the anabolic effect that occurs, and the healing response that it creates. Anabolic, or anabolism, refers to the metabolic process of building up tissue structure in the body. You can easily remember that anabolism refers to building up when you think about anabolic steroids – the performance-enhancing drugs that bodybuilders, baseball players, and others have used to gain bulk. However, we are not talking about artificial anabolism through taking anabolic steroids here; we are talking about the body’s natural and healthy anabolism. Many times, this anabolic effect gets discussed among athletes and strength coaches in terms of getting bigger, faster, and stronger, or amongst fitness enthusiasts in terms of shedding fat, looking lean and ripped, and feeling great. However, when we think about anabolic response from an injury standpoint, one of the best parts of an elevated anabolic effect is the tissue growth and healing response it stimulates.
To further discuss anabolism in the body, we must understand that metabolic processes are controlled by our body’s hormones. Hormones regulate many of the major physiologic processes in our bodies. These processes include metabolism, appetite, strength, lean muscle mass, body fat percentage, body composition, tissue integrity, heart rate, blood pressure, energy and fatigue, mood, sex drive, emotions, and stress. Many factors affect hormone levels, including nutrition, sleep, physical activity, and physical, emotional, and mental stress. We cannot control all of these factors, but we are able to control some of them.
One major factor influencing hormone regulation that we as humans are (for the most part) in control of is physical activity, aka exercise. The type of exercise is important. The intensity and the duration of exercise are the two main factors to consider when thinking about how hormones will be influenced by exercise. This is why I say training the body the “right way” will produce an anabolic effect. We will get back to exactly what the “right way” is in terms of hormone regulation in the next section. For now, let’s finish discussing how these hormones are promoting a healing effect in the body.
Basically, exercise is really a form of trauma to the body. Correct exercise training is a controlled, mild form of trauma done in a very specific way to produce a very specific result. So one main, and very cool, thing that happens when you consistently train your body the right way is that you are actually teaching your body how to recover from damage. You are training your body to recover from trauma. You are literally teaching your body how to heal in a more efficient manner. The way I see it, healing is a skill. You can train yourself to be better at that skill!
Dr. Donnie Richardson, DC, CCSP, DACBSP, CSCS, is a Sports Medicine Specialist and Strength and Conditioning Specialist. Dr. Donnie has worked for the Many United States National Teams since 2008, serving as both a team doctor and sports performance coach, traveling both nationally and traveling internationally all over the world with our countries top athletes. Dr. Donnie also owns and operates his own private practice in Los Angeles, Universal Sports Performance, offering services ranging from sports medicine, injury diagnosis, physical rehabilitation, physiotherapy, injury prevention, sports performance training, personal fitness training, nutrition and diet programming, among other health care services.
“Many people trying online routines during the coronavirus pandemic are finding it’s not so easy to do them right.” A recent article in the Wall Street Journal, titled “New Home Workouts Come With New Aches and Pains”, has pointed out an unfortunate side effect of folks exercising at home during the pandemic shelter-in-place order.
They are getting injured.
Social media has been saturated with home-based exercise programs as the fitness industry works hard to get, and keep, individuals exercising during this intense, but temporary, period of partial social isolation and staying at home.
We wish we could tell you that under any and all conditions you should always be pursuing exercise because it is always good for you…
It’s not!
“This is chess, not checkers” —Alonzo Harris: Denzel Washington’s Character in the movie, Training Day
Of course, we commend everyone who has made the wise choice to begin and sustain a regular routine of physical exercise.
Exercise is simple, right?
It looks so easy when the trainer and therapists are doing it on the video.
There is a name for the exercise, there is a way it is supposed to be done, you do it, and it helps you!
Right?
Apparently not.
Physical exercise is certainly presented like checkers: a relatively simple and easy game that doesn’t require a lot of skill and deep thinking… some quick fun for the family.
But physical exercise is really more like chess. Chess is a complex game that requires deeper thinking, patience, and skill. So is physical exercise.
Why?
Because the human body is really complicated!
Because exercise places stress on your body.
There are hundreds of muscles, joints, tendons, ligaments, nerves, bones, and on and on.
These structures and tissues have varying properties and tolerances for handling stress.
Some are better at it than others. If you haven’t exposed some of them to the demands of the physical stress of exercise in awhile, or you have had surgeries, previous injuries, or diseases that negatively affect some of your body’s tissues then they just might not be ready.
Instead of being a great thing to do to promote health and wellness, physical exercise becomes a process that degrades it.
But there is a solution.
1 Take honest stock of your own body. Ask yourself some questions:
2. Put the ego aside. Expediency is the wrong mindset for exercise. Physical exercise is a long game.
3. Start slowly and do not assume that because an exercise looks easy it will be.
4. Pay attention to body signals. You’re the expert on your bodily experience. Trust that. If it doesn’t feel right to you stop or modify.
5. Take on the perspective of what is the least amount of exercise I need to do to reach my goal, not the most. Overdosing exercise is the problem.
6. Seek professional guidance and support from a qualified healthcare professional and trainer.
7. Take Dr. Nicholas DiNubile’s Advice: “The managed dose of exercise that will do the most for you – without harming you – needs to be measured out for you alone.” (1)
If you have been injured while exercising, see your physician to make sure nothing really serious has happened that will require medical attention. When the doctor gets done, and there is no serious problem, seek out an Exercise Professional from the MedFit Network to discuss how we can help measure out the right dose of exercise – just for you – so you can exercise safely and effectively for life.
Co-written by Charlie Rowe and Greg Mack.
Charlie Rowe, CMSS joined Physicians Fitness in the fall of 2007 after spending 9 years as the Senior Personal Trainer at Oak Hill Country Club in Rochester, New York. He has also worked within an outpatient Physical Therapy Clinic coordinating care with the Physical Therapist since joining Physicians Fitness. Charlie has earned the Cooper Clinic’s Certified Personal Trainer, the NSCA’s Certified Strength and Conditioning Specialist, the American College of Sports Medicine Certified Health Fitness Specialist, Resistance Training Specialist Master Level, and American Council on Exercise Certified Orthopedic Exercise Specialist Certifications.
Greg Mack is a gold-certified ACE Medical Exercise Specialist and an ACE Certified Personal Trainer. He is the founder and CEO of the corporation Fitness Opportunities. Inc. dba as Physicians Fitness and Exercise Professional Education. He is also a founding partner in the Muscle System Consortia. Greg has operated out of chiropractic clinics, outpatient physical therapy clinics, a community hospital, large gyms, and health clubs, as well operating private studios. His experience in working in such diverse venues enhanced his awareness of the wide gulf that exists between the medical community and fitness facilities, particularly for those individuals trying to recover from, and manage, a diagnosed disease.
References
(1) DiNubile, MD, Nicholas A. Framework: Your 7-Step program for healthy muscles, bones, and joints, 2005, Page xix.
“So every few weeks you change things up, right?”
A common question asked by parents when I begin working with a new athlete in my program.
“I change the exercises once we see independent mastery. Variety is just variety without pre-requisite skills being developed. So yes, I’ll add some new exercises…when it makes sense.”
If there’s one thing I can’t do it might be avoiding long-winded sentences.
For the autism and other neuroadaptive populations, developing strength and enhancing motor skills does not come easily. Pre-existing deficits in motor control and stability can present a challenge for engaging in a variety of physical activities. Many individuals with ASD often find physical activity aversive due to myriad factors. Among these are;
The pathology behind movement limitations is a combination, mostly a feedback loop, of muscular and neurological impediments. Differentiation in neuronal firing for those with autism causes a delay in neuromuscular performance, often resulting in movement that can be described as “clunky,” “inhibited,” and compensatory patterns are often observed.
Given the importance of fitness, particularly the development of strength and stability for neuroadaptive populations, it is critical to implement programming that addresses strength deficits and contraindicated movement patterns. An effective approach progresses or regresses exercises based on current level of ability.
Criteria for Baseline Mastery (CfBM) is a protocol borrowed from the practice of Applied Behavior Analysis (ABA). CfBM provides us a clear description of when a skill is mastered and what the requirements are for that goal. Mastery, in this definition, means that the skill can be performed to a particular level independently.
In our Autism Fitness™ programs, we use CfBM to set goals, track progress, and provide appropriate progressions and regressions for each athlete with every exercise. With squats, we very often reduce range of motion (ROM) by having the athlete squat to a box or similar stable platform. Depending on trunk stability, an upper body support may also be required. Having the athlete hold onto a band (held lengthwise by the coach), provides additional support. What we’re after is the athlete’s best performance of the squat with a complete reduction of compensatory movement.
Establishing a standard for performance enables us to set both general and specific goals for each athlete. For squats, as with most of our strength-focused exercises, we use 3 sets of 10 reps as our goal. Within those sets and repetitions, we are looking for stability and control throughout the entire range of motion (hips below parallel). While 3 x 10 may initially read like a standard-issue hypertrophy protocol (not necessarily bad, either), there is further reason to embrace this scheme. Three sets provides enough stimulus for the athlete and enough observational opportunity for the coach for integrity or technical breakdown of the movement. If and when the athlete is able to maintain technical control of the squat for 3 sets of 10 reps, it will be abundantly clear that they have mastered the skill, at least to the current level of challenge.
We use 10 repetitions because it takes us far enough away from maximal loading to be safe (especially for detrained athletes) and an excellent range for improving general strength and muscular development. If an athlete can perform 10 consecutive squats below parallel maintaining rooted foot position and spinal integrity, we have valid claim to progressing the exercise.
For those with neurodevelopmental challenges, it may take months to improve on a particular exercise. Strength and stability aside, proprioception (the real-world “mind/body” relationship) often presents as a particular obstacle. Our athlete may confuse squatting with bouncing or sitting, intentionally or unintentionally rushing through the exercise.
We have to be careful in assessing the underlying reason for the bounce and/or sit squat. When we consider through the lens of the PAC Profile™, we ask whether this is a physical, adaptive, and/or cognitive concern. For each possibility, we can apply particular questions.
Physical: Is the squat progressed beyond the current capability of the athlete and are they compensating as a result?
Adaptive: Is the athlete sufficiently motivated to complete the exercise at their current level of ability?
Cognitive: Does the athlete understand the expectation for performance of the squat? Are we certain it is clear for them?
Our goal for each athlete, strictly from the physical perspective, is safe and effective performance of each exercise or movement pattern before adding variety. Building a foundation of strength, stability, and motor planning can have restorative and preventative benefits and enhance quality of life at any age.
Eric Chessen, M.S. is the Founder of Autism Fitness. An Exercise Physiologist with an extensive background in Applied Behavior Analysis (ABA), Eric has coached successful fitness and adapted PE programs for the neurodiverse population over 18 years. Eric is the creator of the Autism Fitness™ Certification and PAC Profile™ Method. He is also Director of Neuroadaptive Programming for Inclusive Fitness. He resides in Charlotte, NC. Go to AutismFitness.com for more information.
I recently thought about why we exercise and what we choose to do first – and it isn’t generally strength training. Why is that? I believe it’s because we feel we CAN’T do something about becoming stronger unless we join a gym – and then we always seem to gravitate to cardio exclusively as if that is all we can do. We want to lose weight, feel better about ourselves, burn stored fat or just increase our energy level, but what if there was a better way?