Hide

Error message here!

Lost your password? Please enter your email address. You will receive a link to create a new password.

Error message here!

Back to log-in

Close
Doctor Examining Male Patient With Knee Pain

Restoring Movement and Mobility: The fitness professional’s role in total joint replacement care

/6 May 2021/ All MFN blog/

According to the American Joint Replacement Registry, there are 860,000 total knee and hip replacements done in the United States per year. This number is projected to double in the next ten years. There are more knees than hips done per year and more females have these joint replacements than males.

According to Mike Carberry of Advanced Medical Integration, “Regenerative medicine is one of the most talked about subject healthcare has ever known; and for good reason. It could hold the solution to the puzzle of America’s failed healthcare system.”

This is wonderful news for the personal training industry. Insurance is paying for less and less, costing more while the number of consumers seeking optimal health is increasing. A perfect storm in the making!

A personal training certificate, however, is not enough to appropriately deal with the typical client with total joint needs. Specialization in anatomy, joint physiology, biomechanics and therapeutic exercise are necessary in order to adequately and appropriately manage total joint conditions. These skills and techniques in conjunction with medical communication skills will give physicians confidence to send these patients to the appropriately skilled personal trainer. Spending time with a physical therapist and surgeon specializing in these areas will go a long way in establishing confidence, trust and credibility in handling the client with total joint conditions.

Most individuals with true joint pain have some level of osteoarthritis. Approximately 27 million Americans suffer from degenerative joint disease (also known as degenerative arthritis or osteoarthritis). Degenerative joint disease is the most common chronic condition of the joints and occurs most often in knees, hips, lower back and neck, small joints of the fingers, and the bases of the thumb and big toe.

Osteoarthritis is the most common form of arthritis that causes a breakdown of joint cartilage, and it affects mostly middle-aged and older adults.

Although there is no cure for osteoarthritis, the good news is that it can be helped, and quality of life maintained by implementing and maintaining some simple changes in daily life. Regardless of the intervention, from routine steroid injections to platelet rich plasma/stem cell treatments to total joint replacement, here are a few areas where the personal trainer can intervene with great success.

Exercise

Exercise is key component of arthritis care, exercise strengthens the muscles, lessens joint pain and stiffness and improves overall health. Types of recommended exercises may include strengthening, aerobic activity (aquatic activity is wonderful), range of motion or stretching activities and balance exercises.

Joint protection

Protect the joints to ease pain and avoid further damage. Make sure to balance rest with activity as well as know when to stop. A good rule of thumb is to adjust down the frequency, intensity and duration by 50% of what a “normal” client can do or what the client thinks they can do. Remember these clients are typically deconditioned relative to strength and cardiovascular fitness. They will not handle the all-too-popular high-intensity interval training (HIIT). This population will succumb to overload and may be injured.

Pain control

Pain control routinely treated with prescription or over-the-counter medications can be replaced or augmented by relaxation techniques (yoga, Tai Chi, meditation and massage) along with application of heat, cold and/or vibration.

Post-procedure care

If the client has had regenerative therapy or a total joint replacement, they will need a specific post-procedure plan to allow for healing/protection, early intervention and return to activity function. Hopefully, they had pre-intervention care inclusive of appropriate exercise, nutritional counseling and insight on what to expect with the procedure and post-procedure care. Appropriate nutrition for optimal health and healing along with hydration techniques and insights are a must during these sessions.

Phase 1: Post-procedure care

Typical post-procedure care is in three to four phases. Phase one is protect/rest, restore and control pain. During this phase the focus is on mediating pain, restoring range of motion, controlling swelling and protecting the joint. This is typically fourteen to twenty-one days in duration. Stitches or staples are usually removed at this time and scar management can commence around the twenty-first day.

Phase 2: Post-procedure care

Phase two is the restore and regenerate phase. The

wound is healing (healed), the joint and soft tissue healing continues, and remodeling of tissue has begun. This phase is typically three to six weeks in duration. Techniques to restore range of motion and other soft tissue techniques to facilitate healing according to tissue physiology and the client’s general health are initiated (conditions such as diabetes, obesity, cardiovascular disease and others will alter the healing and remediation phases). Techniques for ambulation, gait and balance are initiated along with appropriate cardiovascular conditioning.

Phase 3: Post-procedure care

Phase three typically commences when the client has gained full range of motion, has good balance and gait mechanics and is able to tolerate closed-chain activities for both upper and lower extremity movement patterns. This phase is the final phase and progresses to full functional activity and return to sport or recreational activities of choice (these activities may be placed into a fourth phase). During this phase it is incumbent upon the personal trainer to load appropriately and have working knowledge of the mechanics of the sport or recreational activity. There are some tremendous resources available for this purpose.

Complications

Complications to be aware of when working with these patients include but are not limited to infection, blood loss, dislocation, blood clots and fatigue. The personal trainer should also be in contact with the client’s physician and physical therapist if one has been engaged. These are medical conditions requiring communication and conservative care.

Most physicians like to know who is working with their patients and appreciate the communication for optimal outcomes. The insightful and knowledgeable personal trainer with the right training can be an invaluable member of the total joint care team. The future is bright!

This information is provided as an overview and in no way should be interpreted as a protocol for treatment or otherwise. Our goal is to inform the reader on opportunities in the profession and stimulate further investigation.

This article was featured in MedFit Professional Magazine. 

Dr. Stephen A. Black is a sports medicine specialist, author and clinician. His doctoral degree is in sports medicine and he holds degrees in physical therapy, athletic training and certification through the National Strength and Conditioning Association. Dr. Black has over forty years’ experience in patient care and practice management. He lectures frequently on topics in sports medicine, works with professional, Olympic and youth athletes and holds several academic appointments. Visit his website, rockymountainhpc.com

all-age-group-plank-exercise

Walking Off the Plank or Getting to the Core of the Matter

/5 May 2021/ All MFN blog/

The ubiquity of planks in gyms and exercise videos has denigrated it to the level of a ‘fad’.

Once the newcomer to fitness – about 20 years ago – it is now so common as both an exercise of choice for almost all kinds of athletes and people and as a standard of achievement for those with too much time on their hand that it has lost its sheen so far as I’m concerned.

Now don’t get me wrong: the plank, both the front plank and the lateral or side plank, is a valuable tool in the hands of a competent personal trainer or fitness instructor… or therapist. But a little history might put it in perspective as I go on with my thesis here.

For the uninitiated, low back pain vs 6-pack abs has been the main driver of abdominal muscle training. Prior to the early 1950s, most people who did ab work – for it was not yet understood as the ‘core’ – were athletes, particularly boxers and soldiers. The latter group did them both to fulfill some concept of total body strength (in addition to push-ups, pull-ups, and other calisthenics) and to torture recruits. The former did them to protect against the pounding of their opponents in the ring.

But in the early 50s, two docs, Williams and Kraus, came up with an ab routine to help those with what was then and would still be called non-specific back pain (NSBP). They determined that the sedentary world of office workers was the cause of so many new chronic complaints of low back pain (LBP). Thus they developed what came to be called the Williams flexion exercises: sit-ups (crunches had yet to be developed), oblique sit-ups, and knee-to-chest and other hamstring stretches among some other exercises.

As our understanding of LBP improved over the decades, with better diagnostic tools available to physicians, it became more specific rather than non-specific. Thus, disk problems were better understood and new therapies evolved. Hence was born the McKenzie protocol. These exercises were extension-based, with the yoga cobra stretch designed to push the disk forward away from the spinal nerves and supermans, bird dogs, and the elimination of all flexion exercises until further notice becoming the new, vogue protocol.

While these did little for the abs, they worked the back muscles and introduced, although the term had yet to be applied, the core.

In the mid-1990s, some physiotherapists came up with an exercise designed to help those with a very specific LBP, that is, spondylolisthesis, and spondylolysis-related pain. The researchers qua therapists had determined that the small, intrinsic muscles of the mid-section – the transverse abdominis (deep within the abdominal wall), the multifidi (which span 3 vertabrae) and the rotatores (which span 2 vertabrae) – tended to be atrophied in those with spondylo issues. These muscles also did not respond to voluntary movement in a timely fashion. Thus they created what has become known as the navel drawing-in maneuver, a technical procedure that takes time to learn but had proven itself quite useful for patients.

So, while these exercises did little for the larger, external muscles we can see in the mirror, they did what they were supposed to do for those deeper – what are called the local – muscles that stabilize an inherently unstable spine: try to stabilize it.

Why am I going through this history of ‘core’? Because in the late 1990s, Dr. Stuart McGill started touting the planks, front and side, as ways to strengthen the global  – the large external, visible – muscles that lock the spine in position. His research is compelling but, more than that, it’s exciting. Doing the navel drawing in maneuver of spondylo problems is worthwhile for those problems, but you can’t incorporate them as easily into a hard-core group or individual exercise program… and you can’t measure improvement as easily as you can with a timed plank.

Which brings me to the topic at hand: how long do you have to be able to hold a plank to derive benefits?

A Runner’s World article addressed this not so much from a scientific standpoint as from a practical and pragmatic one. Whereas many in the fitness world brag about helping clients get to, or themselves doing, 60 second or longer planks as if that’s a big deal, this article questions such valuations.

First, we should ask, why plank? If it’s for ab strength, cool — but the longer you do it, the more it’s about endurance, not strength. If it’s for ab look, or definition, cool — but then nearly anything would work as well, although one should cut one’s food intake enough to shed fat overall. That way the muscles you have – and you all have them – are more noticeable.

If it’s for core strength and function, cool – but how much of our daily lives occur in a prone position hovering off the floor a few inches? (Caveat: planks are generally non-functional, like crunches, because of their positioning, but it’s possible that a vigorous and healthy sex life is improved with both front and side plank capabilities!)

Nonetheless, for whatever reasons you’ve incorporated planks into your life, or workout styles, the ultimate benefit of the plank is for spinal stability. In other words, they were designed and studied and promoted to help those with LBP issues. They may help in almost any and all types of LBP but they may need modification according to one’s abilities and pain instigators.

Studies have shown a benefit to young athletes at the college level if you can hold a front or side plank for 100-120 seconds. While these are pretty substantial numbers, they alone won’t confer complete security against low back issues. In other words, the data is correlative, not predictive. Planks can be corrective but doing them longer does not mean you are even more secure against LBP.

As the article mentioned above notes, doing shorter planks (10-30 second) but more of them may be sufficient for both pain and injury prevention as well as function even if you operate standing or seated in your sport or daily life. These shorter planks may give you that six-pack and side torso look you seek, assuming you have a lean midsection overall.

And they may even be useful in such injury prevention programs for athletes whose knees and ankles are at risk as well as in the elderly when it comes to fall prevention.

My model for them, as a side note, is to do them briefly but quickly. That is, to ‘pop’ up into the plank position but hold for 5-10 seconds. The idea is to be able to quickly engage these powerful support muscles as they would be needed for real life – in a coordinated and rapid firing to support the spine as it goes through its often large and dangerous positions in life and sport.

This is what I gleaned from a study Dr. McGill reported years ago at an ACSM meeting in Nashville. Comparing the muscles that fired in the hips and torso of a football player and an exercise science Master’s Degree student, he found the former engaged all the correct stabilizing muscles simultaneously and at the right time during a plyometric push-up. The grad student fired off the same muscles but not in a coordinated manner, suggesting that maybe his spine was not quite as rigid during this vigorous endeavor.

So now, after reading all this, I hope you understand that I’m not discouraging planks. I’m simply reinforcing their value by making them effectively, easier.

Short and sudden planks will give you good tone, good muscle strength and endurance… but also good power and better function, with which to manage and prevent low back pain.

Article originally printed on stepsfitness.com. Reprinted with permission. Images courtesy of STEPS Fitness.

Dr. Irv Rubenstein graduated Vanderbilt-Peabody in 1988 with a PhD in exercise science, having already co-founded STEPS Fitness, Inc. two years earlier — Tennessee’s first personal fitness training center. One of his goals was to foster the evolution of the then-fledgling field of personal training into a viable and mature profession, and has done so over the past 3 decades, teaching trainers across through country. As a writer and speaker, Dr. Irv has earned a national reputation as one who can answer the hard questions about exercise and fitness – not just the “how” but the “why”. 

Aimee-Carlson-Toxin-Terminator

Toxicity & Detox

/4 May 2021/ All MFN blog/

When I first began my own personal health journey, I had no idea what a toxin was. Having worked in the automotive business for better than 30 years, I thought toxins consisted of the various chemicals and products we used in that business. I knew we had to carry MSDS (Material Safety Data Sheets) for every product we had in the facilities. I related toxins to workplace environments, and truly had no idea that they were also hidden in our homes!

The automotive industry was highly regulated. In fact, there are several agencies that oversee the practices within automotive businesses, establish the regulations that must be followed and perform on-site inspections. As a mother and a grandmother, I was enraged to find out there were no such regulations on the products that we purchase off the shelves in the stores. I incorrectly made the assumption that these products were safe for me and my family to use.

This is what led me to become The Toxin Terminator. I knew there needed to be a voice in this field. When it comes to being healthy, many people seek out help with how they eat or look at their physical fitness and how they move each day. But they aren’t paying attention to the number one contributor to the symptoms they are experiencing, toxins! In fact, even if they do, it can be such a confusing path to go down. Marketers have learned the terms they need to use to give the illusion of their products being safe. We call this greenwashing. This is one of the reasons why it is so important for people to have a certified person working with them to help them navigate this complex arena and overcome the root cause of their symptoms.

Learning about toxins, the symptoms of toxin overload and where they are, was the first step in my journey of overcoming chronic disease. The toxins are what flip the switches on, and the detox is how we turn those switches off and truly heal the cells, so the body gets well. Through my journey, I have met with hundreds who have also reversed their chronic disease. Through my podcast and masterminds, I have had the opportunity to meet and discuss this topic with top researchers, doctors, coaches, industry thought leaders and people just looking to feel better. I personally became certified as a Toxicity and Detox Specialist so I would be able to help others walk through their own healing journey.

According to the Centers for Disease Control, 6 out of 10 adults suffer from a chronic disease and 40% have two or more. 90% of healthcare dollars in the United States are spent on chronic disease and 70% of all deaths are caused by a chronic disease. These numbers are out of control. It is my mission to decrease these numbers. Last year taught us all too well the danger of these numbers and the importance of our own personal health and reducing our underlying factors.

People are ready to take control of their health and we can do this together!

Join Aimee for a Webinar on This Topic!

Register for this free webinar, Counting Chemicals: Everyone is busy counting calories, when they should be busy counting chemicals!

Aimee Carlson is a lifetime entrepreneur, owning and operating a multi-location national franchise, to a professional network marketer, best-selling author, podcast host of The Toxin Terminator and certified Toxicity and Detox Specialist.

senior-man-dumbell-punch

Immunity in Question

/30 April 2021/ All MFN blog/

When I was in graduate school, cardiac rehab was THE big issue in exercise science. Most graduates who wanted to work in clinical chose cardiac rehab as their mainstay. However, much of the discussion about the medical benefits of exercise changed in the late 1980s when Dr. David Nieman from Appalachian State University published the first in a series of reports on exercise and the immune system. In my opinion, Dr. Nieman changed the conversation on exercise as his research looked at one of the first biological mechanisms for change in the body due to acute and chronic exercise.

The State of Immunity

Why are we discussing exercise and the immune system? Because thirty years and hundreds of papers on the effects of exercise on immune enhancement, we are still as a nation not educated (let alone convinced) that exercise should be a mainstay of maintaining and improving overall health – especially in persons with infectious disease.

Let’s look at some of Nieman’s work. First, Dave was a marathon runner, who noticed that after long races he and his friends felt “drained” and some came down with colds. He took blood samples pre- and post-marathon race and found on numerous occasions that specific immune cells such as lymphocytes dropped dramatically after races – leaving persons (himself as well) more likely to come down with colds. So, his response was to train accordingly and get plenty of rest in days after races.

His second area of research looked at the chronic effects of exercise on the immune system, such as white cells, natural killer cells, and other specific immune groups. His conclusion after his research is that exercise does stimulate immune cell function, and this may help in persons with cancer (immune damage due to chemotherapy), and other metabolic diseases.

Today’s Immunity

Over this same 30 years the nation has gotten fatter, lazier and sicker. To the point where many people have no idea that their diet and exercise regimens can actually improve their immune function – so they resort to medications.

Today we are faced with a COVID infectious disease, where many people literally fear for their lives. The crux of this report isn’t to cherry-pick statistics, or to point fingers, but the bottom line is that persons who are physically fit suffer much less severe symptoms of COVID, the flu or other infectious diseases than sedentary counterparts.

The immune system is one of the strongest areas of biology that cement the strength of regular exercise. Along with changes in blood chemistry and telomere length, immune changes represent one of the foundations of clinical exercise benefits for young and old. Especially old.

Why Americans Should Start Exercising

Physical fitness has been left out of the discussion relating to COVID. This, along with proper nutrition and supplementation are not only NOT mentioned in the media, but many are disregarding the basics in favor of specific medical therapies.

Exercise should be touted if not for just ONE area of concern – and that is obesity. As one of the main comorbidities for severe COVID, losing weight would reduce severity in many people. This alone would reduce the burden of the disease from a death, healthcare expense and severity aspect. Of course, there are other complications relating to COVID, but in general, exercise has many positive effects, with few side effects. Its contribution to enhancing immunity is one of the biggest attributes.

Using proper assessment and outcome metrics, trainers and coaches can correlate the effects of their programs with other health and medical scores (such as a change in blood sugar or blood pressure each session, or loss of body fat over a one-month period). These are important because they will correlate to changes in overall blood labs, which will have both an acute effect (reduction in the risk of heart attack, stroke, or asthma attack), or long-term effects, such as reduction in diabetic complications, risks of falls, and peripheral vascular disease. Trainers may not understand just how powerful regular exercise can be for specific medical populations, but since the 1970s, the data is clear that exercise has an effect on almost every type of medical condition – even relatively new conditions to exercise training such as autism and Ehlers-Danlos Syndrome.

If we understand that just a moderate amount of exercise will improve circulation enough to enhance the immune system, then we should be detailing it to new members as they come into the health club setting.

Why Health Clubs Need to Open – and Stay Open

Even mom and pop clubs can play a role in improving health.  The first is to have a member tracking system that can keep people coming to the club, at least twice a week. For health’s sake, perhaps 3-4 days per week would be preferable.  The “essential” label is a bit misleading because there are no true metrics for what an “essential” business may be (outside of trash collection, medical triage, and grocery stores). Clubs can position themselves through medical fitness and in the near future, have the technology and assessments necessary to look at health outcomes as persons who normally would not be in a health club see the benefits of a medically based program that will cater to their needs while improving their health along the way.

Eric Durak is the President of MedHealthFit, and founding partner in the Fitness Is Medicine Initiative. He is a 35- year veteran of the health industry. He has worked for health clubs, medical research centers, and continuing education. He has been at the forefront of the medical fitness movement and appreciates the opportunity to work with MedFit Network to move medical fitness to the forefront of health care.  Email him at edurak@medhealthfit.com

 

References

Cartoon nose breathing in word

Breathing to Enhance Exercise Intensity and Recovery

/27 April 2021/ All MFN blog/

For years the standard measure of resistance training was measured in volumes and loads, usually determined by sets and repetitions. Although an apparent effective way to determine success in a workout program, is it the most effective? Is there another way to determine intensity? Or better yet, a way to enhance recovery during a set? These questions are now being investigated. Some of the research is over fifty years old and more prevalent today than when it was originally hypothesized.

The recent rise of books like Breath by James Nestor, the impressive exploits of the self-proclaimed “Iceman” Wim Hof, or even the Biomimicry thinking of Dr. Robert Friedman has started questioning the traditional thinking of exercise performance, health and the immune system.

Conscious breathing, or diaphragmatic breathing, is not only for yoga and meditation but is a controlling factor in the regulatory governor for resistance training. Instead of counting reps, count breaths. Not any kind of breath, but specific breathing patterns designed for the type of exercise performance desired. For example, if you’re going to perform 12 repetitions of a specific exercise, instead you would do three +patterned breaths that would look something like this: On the first repetition, inhale through your nose (deep into your belly or diaphragmatically), hold your breath on the second repetition, and slowly exhale on the third and fourth repetitions. This allows for more controlled energy in and out!

This breathing style also has its roots in the Golden Ratio and the Fibonacci Sequence.  The book Nature’s Secret Nutrient by Dr. Robert Friedman puts it in specific terms where the goal is to exhale 1.618 times longer than you inhale. This breathing protocol can be used, and has been used with success, for resistance, cardiovascular, power, and even flexibility training.

According to Patrick McKeown, the author of 7 publications, including The Oxygen Advantage, conscious breathing is the optimal way to create energy and recovery into your body. Here’s why. First when you inhale through your nose, turbinate’s filter and increase the NO3, you humidify the air, and move oxygen more slowly to allow more absorption. NO3 is vaso-dilater which increases the capacity of arteries. When you hold and exhale slowly and controlled, you create an increase of CO2 tolerance, another vaso-dilator, and increase O2 hunger so more oxygen is absorbed. This dilation of arteries leads to more energy to the muscles and faster recovery.

Another key point to conscious breathing is slower minute ventilation. This means less “dead” air space — the space in your nose and trachea that are not used in the transition of O2-CO2. For example, if you breathe 12 times a minute and inhale 6 liters of air, you would only get about 4.1 liters of air in the lungs. But, if you breathe at a rate of 6 breaths a minute you would only have 6 dead spaces with the 6 liters of air taken in, and therefore take in about 5 liters of air. Considerably more efficient!

Diaphragmatic breathing also allows for more oxygen uptake. Eighty percent of the oxygen absorption occurs in the lower half of the lungs. Therefore, if you are breathing shallowly you are doing your body a great disservice!  

With diaphragmatic breathing, you engage all abdominal muscles and create a network that not only moves oxygen and CO2 but creates a stronger, more focused core for activity. Whether running, jumping, lifting, or doing back handsprings, conscious breathing creates the foundation of movement. 

Even posture benefits from conscious breathing. Diaphragmatic breathing is greatly hampered if your posture is poor. Allowing an awareness of the most efficient way to breathe increases the likelihood of taking postural corrections and moving in a more anatomically correct manner. Whether exercising, sitting or even sleeping, posture plays a big role in the ability to breathe. Breathe well and you will perform and recover at a whole new level.

These benefits of diaphragmatic breathing not only add to the effectiveness of your workout and make each repetition not only more dynamic but the transition an integral part as well.

Whether it is technology, health concerns, financial issues, relationships, or even weather, we are constantly bombarded by stressors. Individually they are manageable, but together they can become a recipe for disaster.  Exercise is an invaluable way to boost your immune system, energy, and most important overall mental health. Use every technique at your disposal.

The respiratory concerns created with the COVID outbreak have raised awareness of the importance of conscious breathing! Any way we can manage stress, improve the immune system and kickstart the recovery process at the same time is golden. Diaphragmatic breathing is that gold.

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

percussion-therapy

Percussion Therapy

/22 April 2021/ All MFN blog/

Percussion therapy involves a revolutionary handheld device that jolts target areas of the body with gentle pulses of pressure. This action softens muscle tissue in areas where there is intense stiffness and build-up. It can be used to accelerate the growth and repair of tissue, increase blood flow, offer pain relief and improve range of motion & function.

trainer-and-senior-woman-gym

Specialize and Thrive: Working with Individuals with Osteoarthritis and Joint Replacements

/19 April 2021/ All MFN blog/

Arthritis is the most common cause of disability in the world.3 Osteoarthritis, the most common form of arthritis, has led to a dramatic increase in the incidence of hip and knee replacements in recent years. The rate of total hip replacements has almost doubled between the years 2000-20101 and approximately 7.2 million Americans are now living with hip and/or knee replacements. 6 While these rates have nearly doubled in recent years, the number of younger individuals (ages 45-54) having these replacement surgeries is increasing.5

The rapid and dramatic increase in individuals living with osteoarthritis and/or joint replacements has created a massive void between the number of people living with these issues and the number of qualified individuals to help them safely and effectively accomplish their functional goals. This void, however, has created an incredible opportunity for fitness professionals to align themselves with allied health professionals to become part of the solution. This article will discuss some recent changes in the thought process about how osteoarthritis develops, how fitness professionals are an important part of the solution, and why this is the most opportune time for fitness professionals to specialize and align themselves with health professionals.

Why do so many individuals experience osteoarthritis and what can be done about it?

While injury, overuse, age, obesity, genetics, and race have been given as possible causes, there has been a lack of solid evidence to explain why the incidence rate of osteoarthritis continues to skyrocket. 2,3,5 However, recently there have been suggestions that osteoarthritis is not as previously suggested, due only to old age or genetics. Dr. Ian Wallace, a postdoctoral researcher who has studied more than 2,000 skeletons, believes the recent dramatic increase in osteoarthritis isn’t an inevitable consequence of living longer. He believes it is more attributable to the modern decline of physical activity and is quoted as follows: “Dr. Wallace thinks the most obvious candidate to explain the increase in knee osteoarthritis is the modern decline in physical activity.” 8

Nevertheless, it is not just about people needing more quantity of activity; it’s also about the quality of the exercise.10,11 If exercise is performed without optimal joint alignment and control, the individual is at risk for developing degenerative joint changes.10,11 Therefore, it’s imperative that fitness professionals specializing in working with individuals that have osteoarthritis or joint replacements are able to properly assess for non-optimal and inefficient posture and movement habits and from these results, develop an appropriate exercise program. Additionally, fitness professions specializing in this niche must also be able to instruct proper exercise form and understand what exercises or activities are contraindicated with these populations. 10,11

A well-designed exercise program that includes flexibility, strength, and cardiovascular exercise is required to appropriately address the postural and movement habits that contributed to the development of osteoarthritis. Likewise, many individuals will have developed compensatory patterns as a result of joint pain or loss of mobility and subsequently developed non-optimal posture and movement habits that need to be addressed.

Several organizations including the Arthritis Foundation, Center for Disease Control, and American College of Sports Medicine have created guidelines for working with individuals that present with arthritis. General recommendations include improving joint mobility/flexibility, aerobic conditioning, resistance training, maintaining a healthy weight, and consulting with a medical doctor.2,3,13

Helping individuals develop a more optimal and efficient posture and movement strategy is one of the most effective strategies for safely working with individuals with osteoarthritis and joint replacements.9,10,11 An approach that includes using the most appropriate soft tissue release, mobilization, stretching, neuromuscular activation strategies, and appropriately progressing the individual through the fundamental movement patterns has been shown to improve joint mobility and strength in individuals with osteoarthritis as well as joint replacements. 9,10,11 Additional strategies that have been shown to be helpful in improving strength and mobility and managing the symptoms of osteoarthritis include three-dimensional breathing7,9,10,11, proper nutrition featuring a whole-foods, plant-based diet4, and meditation.14

The future

The great news is that there is a growing need for qualified fitness professionals to work with the increasing numbers of individuals that have osteoarthritis and/or joint replacements. However, this requires that the fitness professional have both the right education and the appropriate skillset as many of these individuals will require a thorough approach to address their specific needs and to provide them with the best functional outcomes. Organizations such as the MedFit Education Foundation are helping to create the education necessary for health and fitness professionals to develop specializations in working with special populations including the older adult populations experiencing osteoarthritis and joint replacements. Additionally, through their educational platforms and live course work, they provide fitness professionals with strategies for aligning and working with allied health professionals.

For many individuals experiencing pain or loss of function secondary to osteoarthritic changes, seamless integration between medical procedures, rehabilitation, and functional fitness is becoming a viable and necessary alternative to narcotics and surgery. Hence, the birth of the medical fitness space where fitness professionals work either in collaboration with or in the actual physical location of medical doctors, physical therapists, chiropractic physicians, and massage therapists. Clinics such as Rejuv Medical have provided a model for how to improve patient outcomes by combining the benefits of regenerative medicine procedures (Plasma Rich Protein and Stem Cell Therapy), physical therapy, and personal/group training.

Specialization in working with individuals that have osteoarthritis and/or joint replacements and working in the medical fitness space is the future. The fitness professional that acquires the appropriate education and develops a working relationship with allied health professionals will be able to attract more individuals that need, want, and will pay for their expertise. By providing a more integrated and effective approach to helping individuals accomplish their health and fitness goals, these fitness professionals will continue to thrive in the coming years.

This article was featured in MedFit Professional Magazine.

Dr. Evan Osar is an internationally recognized speaker, author, and expert on assessment, corrective exercise, and functional movement. Dr. Osar is committed to educating and empowering fitness professionals while helping them develop relationships with allied health professionals. He is author of the Corrective Exercise Solutions to Common Hip and Shoulder Dysfunction and has developed the industry’s most complete training certification, the Integrative Movement Specialist™. With his wife Jenice Mattek, he created the on-line educational resource www.IIHFE.com. 

References:

  1. American Association of Hip and Knee Surgeons. NCHS Releases Hip Replacement Data. Retrieved from http://www.aahks.org/nchs-releases-hip-replacement-data/
  2. Arthritis Foundation. Osteoarthritis Treatment. Retrieved from http://www.arthritis.org/about-arthritis/types/osteoarthritis/
  3. Centers for Disease Control and Prevention. Osteoarthritis. Retrieved from https://www.cdc.gov/arthritis/basics/osteoarthritis.htm
  4. Clinton, C., O’Brien, S., Law, J., Reiner, C., Wendt, M.R. (2015). Whole-Foods, Plant-Based Diet Alleviates the Symptoms of Osteoarthritis. Arthritis. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4359818/
  5. Dotinga, R. (2015). Number of Hip Replacements Has Skyrocketed, U.S. Report Shows. Retrieved from https://consumer.healthday.com/senior-citizen-information-31/demographic-arthritis-news-37/number-of-hip-replacements-has-skyrocketed-u-s-report-shows-696419.html
  6. Mayo Clinic. First nationwide prevalence study of hip and knee arthroplasty shows 7.2 million Americans living with implants. Retrieved from http://www.mayoclinic.org/medical-professionals/clinical-updates/orthopedic-surgery/study-hip-knee-arthroplasty-shows-7-2-million-americans-living-with-implants
  7. Mattek, J. and Fisher, S. (2017). What Lies Beneath: The under-realized effects of breast, abdominal, and pelvic surgeries. St. Bernardino, CA: Niche Pressworks.
  8. McDonald, B. (2017). Skeletons say arthritis isn’t about aging – it’s about activity. Retrieved from http://www.cbc.ca/radio/quirks/august-19-2017-1.4252722/skeletons-say-arthritis-isn-t-about-aging-it-s-about-activity-1.4252755
  9. Osar, E. (2012). Corrective Exercise Solutions for Common Hip and Shoulder Dysfunction. Chinchester, UK: Lotus Publishing.
  10. Osar, E. (2017). Integrative Corrective Exercise Instructor Certification Program: Training the Older Client. Chicago, IL: Institute for Integrative Health and Fitness Education course handouts.
  11. Osar, E. (2018). The Fundamentals for Training the Older Client with Osteoarthritis. Retrieved from https://www.ptonthenet.com/remote-learning
  12. Pagnano, M., Wolfort, M., Berovitz, A. 2015. U.S. National Center for Health Statistics. Data brief; National Center for Health Statistics.
  13. Riebe, D., Ehrman, J., Liguori, G., Magal, M. ACSM’s Guidelines for Exercise Testing and Prescription. 10th Philadelphia, PA: Wolters Kluwer.
  14. Selfe, TK., Innes, KE. 2013. Effects of Meditation on Symptoms of Knee Osteoarthritis. Alternative Complementary Therapies; 19(3): 139-146.
puzzle-collaboration

The Power of Collaboration in the Quest for Cure

/15 April 2021/ All MFN blog/

Let’s start with four statements I’m willing to call facts:
1. Chronic disease afflicts the majority of American adults over the age of 45.
2. People with chronic disease choose a visit with an allopathic physician (conventional medicine) as their first course of action.
3. A pharmaceutical prescription is the first course of action after linking symptoms and biomarkers to a commonly diagnosed disease (type 2 diabetes, hypothyroidism, hypertension, hypercholesterolemia, etc.).

fitness-dumbells-exercise

Exercise and Dementia — Does Physical Activity Provide Cognitive Benefits?

/14 April 2021/ All MFN blog/

The World Health Organization recommends regular physical exercise—both aerobic and strength training—for older individuals as a means of reducing cognitive decline.1 However, studies on the effects of exercise on cognitive function in individuals with dementia have produced mixed results. While some research indicates a positive effect, other studies have failed to find clear benefits. Thus, the question remains: Is exercise actually effective at slowing down cognitive decline in individuals with dementia?

Evidence in Favor: Cognitive Benefits in Dementia

Repeated randomized controlled trials have found that various types of exercise programs produce cognitive benefits in dementia over a three- to four-month period. For example, one trial of 40 community-dwelling adults with mild to moderate dementia examined the impact of a four-month home-based exercise intervention consisting of strength and balance training exercises plus daily walking. Those in the exercise group showed improved scores on the Mini-Mental State Examination (MMSE) over baseline as compared with controls. (2) Similarly, a Belgian trial of 25 patients with moderate to severe dementia found that a program of daily physical exercises supported by music produced significant improvements in cognition on both the MMSE and the fluency subtest of the Amsterdam Dementia Screening Test 6 compared with controls. (3) Multiple other trials have produced similar results. (4-7)

A weakness of most randomized controlled trials showing a cognitive benefit of exercise in dementia is that the study populations have been small. One 2016 trial, however, tested a moderate- to high-intensity exercise intervention in a larger sample: 200 community-dwelling patients with mild Alzheimer’s disease (AD). Participants were randomized to either a supervised exercise group (one-hour sessions three times per week for four months) or to a control group. The study found no effect on cognition in the exercise group as a whole; however, in an exploratory analysis, the researchers found a possible beneficial impact on cognition among those who were most consistent in attending exercise sessions and who exercised at the greatest intensity, suggesting a dose-response relationship between exercise and cognition. (8)

Evidence Against: No Cognitive Benefits in Dementia

Although a range of studies suggest that exercise has a benefit for dementia treatment, other studies have found no such benefit. Such was the case, for example, with a 2017 Swedish trial of nearly 200 individuals with dementia in a nursing home setting. Participants were randomized either to a four-month high-intensity exercise intervention or to a seated attention control activity. The exercise intervention had no benefit for either global cognition or executive function over control, relative to baseline measures. This was true regardless of the sex of the participants, their forms of dementia, and their cognitive levels at baseline. (9)

In the case of the Swedish trial, the researchers hypothesized that the lack of benefit could be due to the fact that the exercise intervention focused on strength training rather than aerobic exercise. But a 2018 randomized control trial from British researchers produced no better results with aerobic exercise. In this large, carefully designed trial of almost 500 participants with mild to moderate dementia, participants were assigned to either an exercise group (which included both aerobic exercise and strength training) or to a usual-care group. Not only did exercise fail to produce cognitive benefits, but those in the exercise group actually demonstrated slightly worse cognition at the end of 12 months than did those in the usual care group. (10)

Mixed Results From Meta-Analyses and Systematic Reviews

The mixed results in individual randomized trials mirror the contradictory findings of several recent meta-analyses and systematic reviews.

Specifically, a 2015 systematic review of 17 randomized controlled trials found only very limited benefits of exercise in dementia—namely, researchers concluded that exercise programs may improve ability to do activities of daily living in dementia, but that exercise provides no benefits for cognition, neuropsychiatric symptoms, or depression. (11)

By contrast, however, two other recent meta-analyses reached the opposite conclusion and have affirmed the benefits of exercise—especially aerobic exercise—for cognition in dementia. The first of these meta-analyses, published in 2016, found that exercise has a positive benefit on cognition in both AD and other dementias and that both high-frequency and low-frequency exercise programs are beneficial. (12)

The second meta-analysis with a positive result, published in 2018, included 19 randomized controlled trials involving patients with AD as well as those at high risk of AD. This meta-analysis found that exercise interventions appear to slow cognitive decline in both groups—in those who have AD as well as in those at risk of the disease. (13)

Resolving the Inconsistencies

To make sense of the inconsistencies, a first point of note is that the research on exercise and its impact on cognition in dementia is still in its infancy. “There are a relatively small amount of studies that examine this relationship and there are still many unknowns due to limitations of the current literature,” says Gregory Panza, MS, an exercise physiologist at Connecticut’s Hartford Hospital and lead author of the 2018 meta-analysis referenced previously that found a positive benefit of aerobic exercise on cognition in dementia.

Not only are there a limited number of studies, but many of those that are available have been small and of relatively poor methodological quality. In fact, the authors of the 2015 systematic review that found no cognitive benefits of exercise in dementia explicitly noted that there was considerable unexplained heterogeneity in the analysis, and that the quality of the evidence was “very low.” (11)

With respect to meta-analyses in particular, Panza, a doctoral candidate in the department of kinesiology and the Human Performance Laboratory at the University of Connecticut, notes a major weakness of several analyses that have found a lack of impact of exercise on cognition: Namely, they have included mixed samples of people with multiple types of dementia (AD, vascular dementia, and other types of dementia) and analyzed them all together as one sample, rather than examining each group separately. “This is an issue because there are several physiological differences among the different types, and as a result, exercise may be affecting each type of dementia differently,” Panza says. Additionally, previous meta-analyses usually have failed to examine moderators such as age and gender. It’s important to examine moderators, he says, “because it gives you valuable information on which variables may be influencing the impact that the exercise is having on cognitive function.”

To address these limitations of previous research, Panza and his coauthors adhered to high-quality methodological reporting standards in their own 2018 meta-analysis, suggesting that their group’s finding of a positive cognitive benefit of exercise in dementia may carry more weight than the negative findings of some previous analyses. In their study, Panza and his colleagues also conducted within-group analyses (in which they compared cognitive changes both before and after the intervention for both the exercise and control groups), rather than merely conducting a between-group analysis as had previous meta-analyses. The within-group analysis allowed the group to take into account the cognitive decline that occurs naturally with untreated disease in the control group, and this analysis revealed the novel finding that exercise could improve cognition among controls. Overall, then, the Panza’s meta-analysis offers important support to the hypothesis that exercise can indeed slow cognitive decline in dementia.

Exercise in Midlife Protects Against Dementia

In addition to the evidence about the effect of exercise on cognition in individuals who already have dementia, there’s also a body of research on the effects of mid- to late-life exercise on future risk of cognitive impairment. (14) For instance, in a longitudinal study of women spanning 44 years, high levels of physical fitness were associated with a significantly reduced risk of dementia several decades later as compared with medium levels of physical fitness; in fact, high levels of physical fitness delayed onset of dementia by 9.5 years compared with medium fitness. (15)

Some research suggests that exercise may have especially significant benefits for individuals at highest genetic risk for dementia. A 2014 study, for instance, examined a group of 97 cognitively normal adults and compared how high vs low levels of physical activity correlated with each group’s hippocampal volume over the following 18 months. Researchers found that exercise had no apparent impact on hippocampal volume in those without genetic risk. But in those at genetic risk (that is, carriers of the APOE-E4 allele), low levels of physical activity were associated with a decline in hippocampal volume. This same group of less-active, higher-risk individuals was also more likely to show both cognitive and functional decline over the study period. (16)

According to Stephen Rao, PhD, Ralph and Luci Schey Endowed Chair at the Cleveland Clinic Lou Ruvo Center for Brain Health, a main mechanism by which exercise is thought to affect dementia risk is by affecting inflammation. “What exercise seems to be doing is reducing the amount of inflammation that ultimately is a very important factor in the progression of the disease. The disease is going on for 10 to 15 years prior to its diagnosis. So anything you can do to alter processes like inflammation can make a big dent in the rate of progression of the disease.”

To be clear, not all research shows a protective benefit of exercise against dementia: One 2018 systematic review and meta-analysis found that randomized controlled trials on exercise for dementia prevention are limited, but that the existing evidence does not show any significant effect of exercise in terms of reducing dementia risk. (17)

However, several other meta-analyses have come to the opposite conclusion. A 2011 meta-analysis of 15 prospective studies that included a total of more than 33,000 subjects without dementia concluded that all levels of physical exercise, from low to high, offer a significant and consistent protective effect (-35% or greater) against cognitive decline. (18) Similarly, a 2016 meta-analysis of 10 high-quality prospective observational cohort studies found that those who were more active had a 35% to 40% lower chance of developing AD than did those who were less active. (19)

Implications for Providers

According to Panza, there are still significant gaps in the research on exercise and dementia, and there’s a need for considerably more research using neuroimaging and molecular markers to examine the neuropsychological, electrophysiological, and pathophysiological effects that exercise has on dementia. Still, he recommends exercise—especially aerobic exercise—as a valuable treatment option for those who have dementia or are at risk. “Not only is there evidence that exercise can delay the onset of Alzheimer’s disease but the physical benefits of exercise may also help their patients keep their independence longer.”

Rao likewise acknowledges the unknowns, but he too affirms that exercise appears to be an important means of reducing dementia risk. “Exercise is key. It’s never too late. Providers should really encourage their patients to exercise, within reason, within their level of fitness.”

Get a Free Subscription to Today’s Geriatric Medicine

This article was featured in Today’s Geriatric Medicine.

Today’s Geriatric Medicine is a bimonthly trade publication offering news and insights for professionals in elder care.

Get a Free Subscription to Today’s Geriatric Medicine

 

This article was featured in the May/June 2019 issue of Today’s Geriatric Medicine (Vol. 12 No. 3 P. 6). Written by Jamie Santa Cruz, a health and medical writer in the greater Denver area. Reprinted with permission from Today’s Geriatric Medicine.


References

1. Physical activity and older adults. World Health Organization website. http://www.who.int/dietphysicalactivity/factsheet_olderadults/en. Accessed October 30, 2018.

2. Vreugdenhil A, Cannell J, Davies A, Razay G. A community-based exercise programme to improve functional ability in people with Alzheimer’s disease: a randomized controlled trial. Scand J Caring Sci. 2012;26(1):12-19.

3. Van de Winckel A, Feys H, De Weerdt W, Dom R. Cognitive and behavioural effects of music-based exercises in patients with dementia. Clin Rehabil. 2004;18(3):253-260.

4. Kemoun G, Thibaud M, Roumagne N, et al. Effects of a physical training programme on cognitive function and walking efficiency in elderly persons with dementia. Dement Geriatr Cogn Disord. 2010;29(2):109-114.

5. Arcoverde C, Deslandes A, Moraes H, et al. Treadmill training as an augmentation treatment for Alzheimer’s disease: a pilot randomized controlled study. Arq Neuropsiquiatr. 2014;72(3):190-196.

6. Öhman H, Savikko N, Strandberg TE, et al. Effects of exercise on cognition: The Finnish Alzheimer Disease Exercise Trial: a randomized, controlled trial. J Am Geriatr Soc. 2016;64(4):731-738.

7. Cancela JM, Ayán C, Varela S, Seijo M. Effects of a long-term aerobic exercise intervention on institutionalized patients with dementia. J Sci Med Sport. 2016;19(4):293-298.

8. Hoffmann K, Sobol NA, Frederiksen KS, et al. Moderate-to-high intensity physical exercise in patients with Alzheimer’s disease: a randomized controlled trial. J Alzheimers Dis. 2016;50(2):443-453.

9. Toots A, Littbrand H, Boström G, et al. Effects of exercise on cognitive function in older people with dementia: a randomized controlled trial. J Alzheimers Dis. 2017;60(1):323-332.

10. Lamb SE, Sheehan B, Atherton N, et al. Dementia And Physical Activity (DAPA) trial of moderate to high intensity exercise training for people with dementia: randomised controlled trial. BMJ. 2018;361:k1675.

11. Forbes D, Forbes SC, Blake CM, Thiessen EJ, Forbes S. Exercise programs for people with dementia. Cochrane Database Syst Rev. 2015;(4):CD006489.

12. Groot C, Hooghiemstra AM, Raijmakers PG, et al. The effect of physical activity on cognitive function in patients with dementia: a meta-analysis of randomized control trials. Ageing Res Rev. 2016;25:13-23.

13. Panza GA, Taylor BA, MacDonald HV, et al. Can exercise improve cognitive symptoms of Alzheimer’s disease? J Am Geriatr Soc. 2018;66(3):487-495.

14. Defina LF, Willis BL, Radford NB, et al. The association between midlife cardiorespiratory fitness levels and later-life dementia: a cohort study. Ann Intern Med. 2013;158(3):162-168.

15. Hörder H, Johansson L, Guo X, et al. Midlife cardiovascular fitness and dementia: a 44-year longitudinal population study in women. Neurology. 2018;90(15):e1298-e1305.

16. Smith JC, Nielson KA, Woodard JL, et al. Physical activity reduces hippocampal atrophy in elders at genetic risk for Alzheimer’s disease. Front Aging Neurosci. 2014;6:61.

17. de Souto Barreto P, Demougeot L, Vellas B, Rolland Y. Exercise training for preventing dementia, mild cognitive impairment, and clinically meaningful cognitive decline: a systematic review and meta-analysis. J Gerontol A Biol Sci Med Sci. 2018;73(11):1504-1511.

18. Sofi F, Valecchi D, Bacci D, et al. Physical activity and risk of cognitive decline: a meta-analysis of prospective studies. J Intern Med. 2011;269(1):107-117.

19. Santos-Lozano A, Pareja-Galeano H, Sanchis-Gomar F, et al. Physical activity and Alzheimer disease: a protective association. Mayo Clin Proc. 2016;91(8):999-1020.