Fitness Professionals Archives - Page 3 of 64

Gait and Alignment

Kama Linden/28 March 2024/ All MFN blog/

Many times when I run in Central Park, I see some elite runners. They look like gazelles. However, sometimes, I will see runners who have knees turned in, toes turned the opposite way, or simply just POUNDING on their feet.

When I teach Yoga, or even strength training, I advocate aligning the hip bone (asis joint) with the knee, and the 2nd toe.

i.e., Squats.

Often trainers will tell students to “bring their feet hip width apart” and perhaps, having read too many magazines with models who are super thin, they bring their feet so wide that they are BEYOND the alignment they could possible sit in or walk in. Imagine the MANSPREAD on the subway. Over time, if clients keep doing “squats” with their feet so beyond the width of their hips, it puts undo strain on the ACL, ankles, and causes many muscle imbalances.

In a squat, the goal is NOT to “go lower”.

A member once wrote a nasty comment via the gym website that “I didn’t go low enough” in my squat. What is “low enough”? If you are compromising form, or bending your back over more to make up for the fact that knees can only bend so much, then this is counterproductive.

When squatting, you should “crease” the hip joint (hip flexors) and imagine a chair being pulled out for you. Reach for the chair with your butt while bending your knees. The chest may tilt slightly forward, but the movement is NOT initiated by bending the upper body into forward flexion. Imagine if you were wearing all white, dry clean only clothing, and were carrying a tray of martinis (or red sauce). You would have a mess if you bent forward with your upper body. Therefore, keep your chest high, hold the platter high, and only angle forward as needed. This way all the work goes into the quads and glutes, and not into the back.

Another drill I like to teach is a step-to 1 leg squat. Take a step to your right, balance on the right leg, and perform 1-3 squats. Then repeat by stepping left. To advance this, take a little hop, and then do 1-3 1 legged squats.

1 leg step ups (pictured above): place 1 foot on a bench laterally. The step should have 2 risers on each side if you are between 5’ and 5’4, and maybe 3 risers if you are above 5’6, and 4 risers if above 6’ tall. Press the weight into the foot that is on the bench and full stand up on this 1 leg. Then sit back down into the squat stance with both knees bent (one will be on the floor).

1 leg dead lifts (pictured above): based on warrior 3: 1 leg is very straight without locking. Like a seesaw, pitch forward by lifting the free leg as high as it can go, but do not round the back, or drop the chest. I also look forward and keep my chest slightly lifted. Recover to upright by raising the gaze. Repeat 4-8 reps per leg.

Sit, stand, raise lower…this is a combination 1 leg squat into 1 leg deadlift (warrior 3). Repeat 4-8 reps.

Practicing 1 legged drills will make it so that when you perform drills such as squats on 2 legs, you will remember that if you were to take 1 leg off the ground, your stance/width should be based on this idea.

This will give you better form for running, and even walking.

The hip, knee, and 2nd toe should always REMAIN FRIENDS in every exercise for better alignment, and pain-free workouts.

Kama Linden has been teaching fitness for over 2 decades. She has taught strength, step, pilates, vinyasa yoga, senior fitness, and has worked with clients and students of all ages and fitness levels. She is certified by AFAA Group Exercise and NASM CPT, as well as 200 hour Yoga. She has a BFA in Dance from University of the ARTS. Her new book, “Healthy Things You Can Do In Front of the TV” is now on sale on amazon.com, BN.com, and Kindle. Visit Kama’s website, bodyfriendlyoga.com, and kamalinden.com.

Seniors with trainer in gym at sport lifting barbell

4 Tips to Help Your Clients Reduce Their Risk of Falls

Christian Thompson, PhD/26 March 2024/ All MFN blog/

No matter how fit and healthy your older clients are, there is one thing that can change their lives forever: a bad fall. Every year, almost 1/3 of older adults fall and many cause injuries that will affect them the rest of their lives.

As a fitness professional, you need to be well-prepared to deliver the most effective fall prevention exercise programming to your clients. You can find excellent guidance on assessment and program design at www.mobilitymatters.fit. But you also should be providing advice to your clients on how to reduce their fall risk in other ways.

Have them do these and keep them on their feet!

1. Many falls happen outside where there are lots of potential hazards. Advise your clients to avoid walking on loose gravel, metallic/painted surfaces and cracked sidewalks and avoid being outdoors in bad weather (e.g., rain, sleet, snow). Appointments can always be rescheduled, but a trip to the ER should never be the reason!

2. Indoors, advise your clients to make sure that their path from the bedroom to the bathroom is free from obstructions (e.g., pet toys, rumpled rugs) prior to going to bed at night – that way a trip to the bathroom will not include a trip and a fall!

3. Advise your older female clients to never wear high heeled shoes outdoors. Put their heels in a canvas tote bag and walk outside in sneakers or flats instead. Nobody looks good falling, no matter how stylish the shoes!

4. In the bathroom, advise your older clients to line the floor of their shower/tub with textured adhesive strips. These are less likely to cause a slip or a trip than a rubber bath mat that might slip or bunch up. They also give a nice pedicure!

Christian Thompson, PhD is an Associate Professor in the Department of Kinesiology at the University of San Francisco and founder of Mobility Matters, an exercise assessment and program design platform designed to help fitness professionals and clinicians work with older adults. Christian has published scientific articles on exercise programming for older adults in peer-reviewed journals such as Medicine and Science in Sports and Exercise, Journal of Aging and Physical Activity, and Journal of Applied Research.

Specialized Education for Fit Pros

Break It Down – KISS Principle (Keep it Simple for Seniors)

Holly Benson, BS/21 March 2024/ All MFN blog/

Teaching proper and biomechanically safe movement patterns takes a keen understanding of each pattern. What muscles and joints are involved? What skills are required for good execution? What deficiencies does the client have based on your preliminary movement assessments? Begin with the simplest version of each fundamental movement pattern and build on the complexity and intensity slowly.

Adjust accordingly, and encourage the client to give honest and precise feedback as they are learning. Find out if there is discomfort physically and/or psychologically. Adjust again. You want your client to feel successful and excited about their accomplishments during the exercise session and overall. They need to feel confidence in their ability to learn and improve, and enjoy the learning experience while they get stronger and more functional. Learning to exercise properly and safely is hard work for our clients. We must progress them gradually and with well thought out, logical, and achievable progressions. Knowing when they need to rest and reset is essential to building trust with the client, and creating a positive learning experience for them.

Fatigue and the Body/Brain Duo

It is critical that researchers consider the brain as well as the body when examining fatigue development and its impact on the body. By looking at brain and muscle function simultaneously, they will see that when participating in highly cognitive tasks, brain resources are divided which may speed up the development of physical fatigue. Processing and executing detailed and complex exercise instructions can accelerate the onset of body fatigue.

A study conducted by Ranjana Mehta, PhD., assistant professor at the Texas A&M Health and Science Center School of Public Health, evaluated the interaction between physical and mental fatigue and brain behavior. The study showed that when we attempt mental tasks and physical tasks at the same time, we activate the prefrontal cortex of our brain. This can cause our bodies to become fatigued much sooner than if we were only participating in a physical task. (Study published online as: Human Factors: The Journal of the Human Factors and Ergonomics Society This study was co-authored by Raja Parasuraman, Ph.D., professor of psychology at George Mason University in Virginia)

When we are working with geriatric clients, and one of our objectives is educating them, we must be cognizant that the lesson material must be “dosed-out” in absorbable amounts. Keeping the instructions simple and concise for maximum understandability is advised. When combining actual physical movement with the processing and following the instructional cues, the client is working extra hard and fatigue can set in sooner than you had planned. You may notice them starting to lose attentiveness or move slower. They may abruptly stop what you have them doing. They may look a bit frustrated or flustered. They have detached from the workout experience. The brain is full. The body feels tired. They need a break.

Taking pause to re-assess and re-set allows time for the client to recover mentally and physically. It is also a good time for the trainer and client to decide how to adjust and move forward in the session. Switching to less physically demanding, easy-to-do exercises feels like a relief to the client. They experience ease and a sense of control as their body and mind restore.

You can resume the previous exercise if the client wants to. If they are done with that hard thing, they are done. Save it for the next session to practice or learn again, and celebrate the effort and attention that the client gave the exercise that day. Educate them on the facts surrounding fatigue levels after learning and practicing complex physical movement. Tell them the cognitive benefits of combining cognition with physical effort!

Fit Pros: Guide Older Clients as a Geriatric Fitness and Lifestyle Specialist

Millions of people over age 65 looking for guidance from fitness professionals who are knowledgeable in exercise, nutrition and lifestyle principles that can help them improve functional mobility, while also preventing and managing chronic conditions to live their highest quality of life. The Geriatric Fitness and Lifestyle Specialist online certificate course will give you insights, strategies and tools to be a successful professional in this rapidly growing market. Learn how to be a valued part of clients’ continuum of care, working with the medical team to improve functional outcomes and positively impact people’s lives.

Holly H. Benson, BS, is a veteran in the Recreation and Fitness industries with over 35 years of administrative and technical experience. She holds two bachelor’s degrees, Corporate & Community Fitness and Recreation Administration, and numerous fitness certifications. She has developed thriving fitness programs for special populations and has passionately focused her career on the much older adult. She currently owns and operates Moving Strong Medical Exercise, LLC in Lakewood, Colorado and provides in-home and virtual fitness training to older adults and persons with chronic medical and orthopedic conditions.

Why We Lose Balance and How We Fix It

Cate Reade, MS/16 March 2024/ All MFN blog/

It’s no secret that balance tends to decline with age. Your clients may notice they are swaying a bit more while standing and walking, or feeling weaker or less steady. We all want it, but what is balance? We need to understand what it is in order to restore what was lost, safely, effectively and efficiently.

Balance is the ability to maintain the body’s center of mass over its base of support. Your center of mass is a few inches below your belly button or can be thought of as your trunk. Your feet are your base of support (unless you are performing a handstand!)

Balance is the ability to stay upright when standing (static balance) or when moving and performing activities like walking or climbing stairs (dynamic balance). The most common question I hear from older adult clients is, “Why am I losing balance?” Let’s find out why.

What is Balance?

Balance is a sense that lives in the brain. Balance relies on information constantly flowing into the brain from three main sensory systems including our visual, vestibular and proprioceptive systems. Moving properly depends on the ability of the brain to gather and interpret the sensory information provided by eyes, ears and joints. This is essential because the brain then tells the body how to respond to stay upright and balanced.

The quality of the sensory input gathered directly impacts the quality of movement. The stronger the sensory signals sent to the brain, the more accurate the instructions sent to the body will be. On the flip side, as sensory signals become impaired, movement quality dwindles, as reaction time becomes slower.

Making Sense of Balance: The 3 Systems

Let’s explore the sensory systems that make up balance.

Visual System: Your eyes tell your brain about where your body is relative to the environment, whether you are walking inside your home, in a busy airport, or strolling on the beach. With aging eyes, a great many people don eyeglasses to function day to day, and as our eyesight weakens, so too does the quality of the sensory input.

Vestibular System: The ears relay information to the brain about the motion and position of the head to adjust posture to maintain balance. Semicircular canals in the inner ears contain fluid and tiny hair cells. As the head nods up and down, moves left to right, or tilts to the side, the fluid in the inner ear moves and the tiny hair cells sense the speed and direction the head is moving in.

By age 70, it’s typical to have lost 40% of those sensory-detecting hair cells (Zalewski 2015).

Proprioceptive System: Proprioception, literally meaning “sense of self”, is your sense of body awareness and is a prerequisite for balance. It’s how you understand the parts that make up your body, where they are located, how they feel and even what they can do. It’s the way your body communicates with itself so you can walk without looking at your feet.

Proprioceptors are sensory nerves that live in and around joints, in ligaments, joint capsules, tendons, muscles and connective tissues. They sense and send signals to the brain about joint position and motion, as well as the muscle force involved in movement.

As we age, our sense of body awareness is impaired leading to poor joint function, body alignment, control and coordination. The result: poor balance and higher risk of falling.

Losing and Restoring Balance

As our eyes, ears and joints lose their sensory capabilities, this is why balance is gradually lost.

To regain what was lost, we apply the SAID principle (Specific Adaptations to Imposed Demands) to improve function with targeted training. Up to 70% of the sensory input for balance comes from your joints (Peterka 2002), so improving joint function can be a highly efficient way to improve proprioception at any age so clients can enjoy better balance and more confidence to prevent falls.

Most Efficient Balance Training

I start each balance training session using the MoveMor® Mobility Trainer to warm up clients’ lower body, restore ankle mobility and foot stability while increasing proprioception. Clients are thrilled to experience improved functional abilities so they can save themselves in time to prevent falls.

With 12-points of resistance, MoveMor® makes it simple to restore joint flexibility and strength in less time than any other tool, all from a safely seated position! This wakes up proprioceptive sensory nerves essential for balance while stimulating motor nerves for quicker reflexes.

You can get started with training clients on their journey to feeling steadier, stronger and more confident by visiting MoveMor.com/exercise-programs. There are 7 exercise programs to choose from that vary in length from 5-30 minutes. Our Take 10 to MoveMor exercise program is proven to improve balance, ankle flexibility, strength and more in just 10 minutes! An exercise guide makes it simple to identify weaknesses and tailor exercises.

MoveMor® seamlessly integrates into your balance and fall prevention training to accelerate functional outcomes and satisfaction so your clients can enjoy better balance and an extra spring in their step today!

Cate Reade, MS, RD is a Registered Dietitian, Exercise Physiologist and Functional Medicine Practitioner candidate on a mission to improve functional mobility and health span utilizing the power of lifestyle medicine. She has been teaching, writing and prescribing healthy eating and exercise programs for over 25 years. Today, as CEO of Resistance Dynamics and inventor of the MoveMor™ Mobility Trainer, she develops exercise products and programs that target joint flexibility, strength and balance deficits to help older adults fall less and live more.

The Importance of Exercise for the Disabled or Handicapped

Terrance Hutchinson/14 March 2024/ All MFN blog/

Everyone must remain active. This is only achievable with the help of exercise. Contrary to popular belief, handicapped people also wish to stay fit and healthy. On the other hand, some of handicapped individuals do not realize the importance of it.

Let’s discuss the importance of exercise for handicapped people.

Prevention of Heart Disease

Exercise can help reduce the risk of developing diseases relating to the heart. This includes high blood pressure, heart attack and ischemic heart disease. Furthermore, exercise is essential for preventing various other medical conditions.

Prevention of Comorbidities

Inactivity is a disease in itself. Being inactive makes the body less productive. This makes them more prone to the development of illness, ranging from something as small as flu to as big as cancer. Disabled and inactive individuals have a higher chance of developing colon cancer and diabetes.

Prevention of Anxiety and Depression

Being inactive and indoors can lead to depression and anxiety. You may feel down most of the time. Exercising releases endorphins in our body. These help in regulating mood; those who exercise regularly experience improvement in their moods.

Alleviates pain

Inactivity can cause harm to your bones and muscles as well. The majority of people suffer from pain in joints and other complications. Stiff muscles are also an additional drawback of inactivity.

Handicapped people who exercise more often do not suffer from these symptoms. They report relief of pain. Furthermore, such people also have faster healing of wounds and injury from trauma.

Clears the mind

Exercising not only helps with our physical well-being. It also aids in improving our mental health as well. Brain fog is a real thing; people can be doubtful about the decisions they make. Exercising helps people to think clearly. They can divert their mind from useless jargon to more productive thoughts.

DO NOT LET OTHERS STOP YOU FROM EXERCISING

Being handicapped has a certain societal stigma with it. The perception of people can often stop you from exercising. Always remember that exercising will only benefit you alone. Don’t worry about what others think!

Conclusion

Being disabled can be a hard thing. But, exercise is an activity that will help you to gain self-esteem. You do not need to start with rigorous workouts.

This journey begins with a single step, time will help you get better in the long run. So what are you waiting for? Start looking for an exercise regimen that suits you best.

Here’s to your health!

Terrance Hutchinson is the Owner of Your Best Lifestyles Fitness and Nutrition. He is a Certified Personal trainer specializing in Exercise Therapy, Corrective Exercise, Sports Nutrition, and Corporate Wellness. He an author of 3 books, he has his own podcast, he has contributed articles to major newspapers and magazines, Terrance has spoken at health events, webinars, seminars, hospitals, schools, doctors offices and has been featured nationally syndicated television platforms. Terrance has clients in many states and counties and is looking to help others bridge the gap between the medical and fitness industries. To learn more about Terrance, visit yourbestlifestyles.com

Aquatic Pre-Hab for Joint Replacement

Dr. Rick McAvoy/30 January 2024/ All MFN blog/

By 2030, the demand for primary total hip arthroplasties is estimated to grow by 174% to 572,000. The demand for primary total knee arthroplasties is projected to grow by 673% to 3.48 million procedures.

Pre-surgical or prehabilitation (prehab) programs have been gaining increased popularity and show promising results in getting clients moving quicker after surgery. Prehab can be defined as an individualized physical conditioning program to improve strength, endurance, and range of motion prior to surgery.

I have found in my experience that by incorporating an aquatic program six or more weeks prior to surgery can have significant benefit post-operatively.

A multicenter study performed at New England Baptist Hospital, Beth Israel Deaconess Medical Center and Harvard Medical School found that knee- and hip-replacement surgery patients who had participated in prehab for just six weeks prior to surgeries reduced the need for inpatient rehabilitation by 73 percent. This study involved water-and land-based strength training, plus aerobic and flexibility exercises.

Why Use the Water to Help with Pre-hab?

Reduced Pain & Swelling

Clients awaiting joint replacement surgery are usually in a significant amount of pain. They may experience pain not only at the specific joint but also in corresponding joints that have compensated for improper biomechanics. Using the water’s unloading properties to reduce pain, as well as the hydrostatic pressure to help with swelling reduction, are tremendous benefits.

Restore Range of Motion (ROM)/Muscle Balance

I always tell my clients, “Motion is Lotion.” This means that the more you move correctly, the better you will feel. Gaining as much ROM prior to joint replacement is very important. I also share, “The doctor will be replacing your joint, not your ligaments, tendons or muscles. The more muscle balance we can get the better you will do post operatively.” I give the example of a worn out tire on a car. Over time the cars suspension adapts to that worn tire and pulls out of alignment. The replaced joint represents the new tire; now we have to realign the suspension so everything rides correctly.

In the water using flotation equipment on the lower extremities allows the client to gain much more ROM.

Buoyancy unloads the joint and assists the motion, but more importantly the client has control over the movement. If try to manually stretch a client, he/she is automatically guarded, no matter how much I remind them to “relax”. Moving freely in the water, the client is more likely to push their ROM than if I stretch him/her manually.

Improve Strength

Pain causes muscle inhibition and hence muscle weakening. Neuromuscular control needs to be restored prior to surgery in order to facilitate muscle recovery post-operatively. The stronger the muscles are, the faster the recovery. Strengthening exercises to help balance all muscle groups are much easier and comfortably performed in the water. Water provides an accommodating three-dimensional resistance which allows multiple muscle groups to be strengthened simultaneously.

Improve Proprioceptive Awareness & Normal Movement Patterns

Any functional movement depends on the coordination and fine tuning of the neuromuscular system. Joint degeneration affects the soft tissues that contain proprioceptors, which will cause significant reduction in the awareness of joint movement.

Proprioceptive exercises can be be started prior to surgery to stimulate the neuromuscular mechanisms and make them more responsive after surgery. The water provides a surrounding proprioceptive enriched environment to help restore neuromuscular function, including balance and proprioception.

Improve Gait

Degeneration of lower extremity joint will commonly result in a compensated gait pattern. This pattern is often continued, even after surgery, because of abnormal motor patterns. Use the water to correct gait patterns prior to surgery, which will assist with alignment, weight shift and proprioceptive input, and therefore facilitate a normal post-op gait pattern.

Client Education

Surgeons often do not tell the client what they will experience post operatively. Thus, another benefit of prehab is the opportunity to educate the client on the post-op process. Clients often compare themselves to other people who have had a similar surgery, which can lead to frustration. By educating the client and with the understanding that everyone progresses at a different rate.

In my experience, by utilizing the water for prehabilitation prior to a total joint replacement is one of the best ways to get clients moving and feeling better faster!

If you’re interested in sponsoring a Medically Based Aquatics (MBA) course at your facility, please contact Rick McAvoy at rick@rickmcavoyaquatics.com

Dr. Rick McAvoy has specialized in Aquatic Physical Therapy and Sports Performance for over 30 years and promotes aquatic fitness, rehab and training. He is the Owner of Rick McAvoy Aquatics, an Aquatic Fitness and Sports Performance Training and Consulting Company. Rick is also a published author and researcher in the field of Aquatic Therapy and Fitness as well as Sports Performance.

Coaching Hardiness of Heart: Buffers vs. Band-Aids

Pat VanGalen/26 January 2024/ All MFN blog/

Like a leaky roof, do we just patch the hole, and hope for the best? Or do we replace and restore it, and do the maintenance to optimize it, despite extreme weather conditions? In ski-speak, we joke about variable conditions, never predictable. In life, it’s the same thing. Are we prepped and ready for the curveballs and Murphy-strikes that WILL come our way? Do we have an ample buffer, a reserve capacity to pull from? Can we bounce back, repeatedly, take hits and remain solid? Hardy folks can and do! Think of a hardy person you know. What keeps them surviving, and thriving?

Today, it is well-accepted that cardiovascular disease (CVD), the leading cause of death in the U.S., is rooted in inflammation, insulin-resistance, oxidative stress (rusting), hormonal imbalances and exposure to toxins. We also know that a lousy diet, long-term micro-nutrient deficiencies, physical INactivity, chronic DIStress, and various toxins, raise cholesterol and blood pressure exacerbating an inflammatory response in our arterial endothelium. Remember that half of the people who experience heart attacks do NOT suffer from hypercholesterolemia. To quote Mark Hyman, M.D., Founder, Cleveland Clinic Center for Functional Medicine, “CVD is not about cholesterol; it is about inflammation in a cholesterol environment.”

So, when 45 year old 2-stent Charlie, husband, father of three, small business owner, with a passion for hunting and fishing comes to me, I need Whole-Charlie coaching. A Hardiness model fills the bill.

Hardiness Coaching is designed to fortify FIVE structural pillars: 1) Movement, 2) Diet, 3) Rest-Recovery-Regeneration, 4) Stress Resistance and, 5) Purpose-Relevance-Meaning. The Pillars are grounded in a foundation of DAILY habits, patterns and practices, not programs with a start and end date. They are interconnected, and the robustness of one supports the others; if one crumbles, the others bear the brunt. By repairing cracks and leaks within a given pillar, we boost overall resilience, durability, and robustness, not just the CV issue at heart (no pun intended). Hey, what’s good for the heart, is good for the brain is good for the gut is good for the immune system is…

Our clients come to us with the desire to move better, feel better and get back to living life, even surpassing it, despite their issues. Their current health does NOT define them, nor does their age. It’s our responsibility to meet them where they’re at, know where they have been [for decades], and get them where they want to go. Keeping their hopes and dreams alive is paramount.

As Hippocrates so eloquently stated, “Know the person who has the disease, not just the disease that has the person.”

So, when we hear ‘cardiac or cardiovascular’, think beyond the heart and vasculature for transport and waste removal. Think integration with the lymph and respiratory systems, and their role in running a well-oiled machine, one where the other six systems [gut microbiome, immune/inflammatory, energy production (mitochondria), waste disposal – detoxification, communication (neurotransmitters, hormones), structural (cells, tissues, organs) synergistically thrive. This is a Functional Medicine model. Check it out.

Clinical psychologists, physical therapists or medical doctors, we are not. But, we impact lives in a multitude of ways, some measured by hard data, and others, by those intangibles like confidence and joy. Yes, we work within the physical realm, but when we take the integrated pillar approach to coaching Hardiness, we sync and link the pillars, buttressing them to exponentially resist and adapt better to the stresses and strains of life. Buttresses, NOT band-aids!

Coaching MUST transfer to performing and feeling better, at home, in labor, care-giving, recreation and even competition. For example, with regards to the movement pillar, there are three realms: 1) physical activity, as in walking, stairs, labor and chores, 2) recreation, as in sport, dance, all-seasons GO on snow, ice, sand or water, and 3) TRAINING, exercising with purpose. ALL contribute to the robustness of our movement pillar. Training is only one piece of the movement pie, so yes to targeted training, AND to more movement in labor, hobbies and play.

When training any adult, there are 7S Buckets that may need to be restored and refilled. The 7th Bucket is Specificity and Specifics. Specificity refers to “we get what we train for; we keep what we do!” Specifics are those things unique to our client; in this case, those CV conditions that propelled the client in our direction in the first place. It may have been a primary care Doc, a referral from cardiac rehab or simply the client’s grit to BE better. Whatever, we are here to fortify all their pillars of hardiness.

Don’t get me wrong. We must know CVD pathologies, physiology, metrics and measurement, and network with relevant healthcare professionals. But more importantly, we must customize and personalize coaching to provide the springboard for Charlie to thrive, as a husband, father, business owner and outdoorsman, to optimize his health-span, and his zest for living life to his fullest.

So, from pacemakers, stents, meds and more, to risk factors, co-morbidities, MSK challenges and all else in store, we practitioners are here to reboot, rebuild, coach, train and restore.

Specialization for Fit Pros

Join Pat VanGalen in the online course, Cardiac REHAB Fitness Specialist. Learn the nuts and bolts of coaching hardiness within the cardiovascular system. Evidence-based facts, figures, updates AND case studies will tweak your coaching. Integrate, don’t isolate!

Patricia ‘Pat’ VanGalen, M.S. brings a unique blend of education, practical experience, common sense application, science and research to her lecturing, teaching, training and coaching. She launched her professional career 40+ years ago in physical education and coaching, then spent the next 10 years in corporate-industrial fitness, health promotion, cardiac rehab and injury risk reduction programming design, implementation and management. Visit her website, activeandagile.com

Healthy-Lifestyle-Nutrition-Exercise-Medicine

The Power of Why: Motivation for Better Health

Trevor Wicken/15 January 2024/ All MFN blog, Conditions/

As a movement practitioner, I love it when my clients become my teachers. One conversation with someone going through the process of changing their life and fighting challenges may prompt, lead, or sometimes shove me into examining my practice, my approach, and my connection with the people I serve. Just recently Mary, one of my clients, wanted to meet with me to discuss her progress and our conversation inspired this article.

Understanding and Conquering the Relative Insulin Resistance of Midlife – Beyond the Blood Tests

Carla DiGirolamo, MD, CF-L1, PN-1/3 January 2024/ All MFN blog/

One of the most common things my midlife clients struggle with is weight gain. “The things that worked before just don’t work anymore” is the mantra of so many during this phase of life. They visit their healthcare provider with concerns about “waking up in someone else’s body”. The doc runs some tests – thyroid levels, blood sugar studies, and insulin – and all the results come back in the normal range. “Great news!” says their doc. “There’s no problem. You’re just getting older”. End of story.

Many of you who have heard me on various podcasts know that I’m not a fan of the notion that hormone testing reflects the entirety of the Human experience as many “practitioners” would have you believe. The relative insulin resistance of midlife is a perfect example. One does not have to meet the criteria for “pre-diabetes” or metabolic syndrome for there to be real changes for which there are interventions. Isn’t the goal of medical care to prevent these things in the first place rather than just send you away until you actually become diabetic?

One does not need to meet the criteria for “pre-diabetes” or “metabolic syndrome” for there to be changes for which there are interventions. Isn’t the goal of medical care to prevent these things in the first place rather than just send you away until you actually become diabetic?

This is where understanding what’s happening inside your body during the various phases of hormonal life keeps you one step ahead of mainstream medicine. Today we will discuss the phenomenon of relative insulin resistance – the physiologic changes to energy utilization occurring in your body as a result of the normal hormonal changes of midlife – and how to mitigate the effects of these changes so that you can be your healthiest self.

Your Body on Carbs

In a nutshell, carbohydrate is consumed in the diet, digested and absorbed as glucose (among other simple carbohydrates), and utilized as fuel by the tissues in the body. Excess glucose that is not used is stored as glycogen in the liver and muscles, but also as fat. The hormone, “insulin”, is secreted by the pancreas in response to glucose entry into the bloodstream. Insulin drives glucose into the cells so that the cells can use the glucose as fuel to carry out their functions. The “efficiency” of insulin function is impacted by cycling estrogen and estrogen receptors on the surface of cells.

The two bodily systems that use the greatest amount of blood glucose are the brain and skeletal muscle – the voluntary muscles that move our bodies. During midlife, there is a decrease in cycling estrogen and estrogen receptor presence on the surface of skeletal muscle cells. As the ovarian hormonal cycles change and become irregular, there is less circulating estrogen. As a result, muscle mass, strength, and power decline along with the efficiency of the muscle’s ability to utilize blood glucose through insulin-mediated pathways.

A prominent player in cellular and insulin efficiency is an intracellular organelle called the mitochondria: the “batteries” that supply energy to cells. Below is an excerpt from my course Menopause Health and Fitness Specialist Course through MedFit Classroom that explains the science behind how skeletal muscle function is impacted by changes in estrogen and its receptors.

As we just mentioned, when blood glucose is not used as fuel, the excess is stored as fat. When the hormonal changes of midlife reduce the efficiency of glucose utilization by skeletal muscle, the result is a greater excess of unused glucose and increased storage of fat which results in changes in body composition.

Your End-Run Around Relative Insulin Resistance

There are three basic approaches to mitigating the impact of the hormonally-driven changes in how our bodies manage glucose. Resistance training (particularly weight training), nutrition, and neuroendocrine activation.

Resistance Training

If you want your muscles to use more glucose, then you need to increase the activity of those muscles. This looks different for different individuals. If you are sedentary, then starting with walking for 30 minutes 4-5 times per week is a great start! From there, add a weighted backpack, then maybe add some hills or even hiking trails. Simultaneously, engage a personal trainer for 6 weeks and become familiar with weight training. If you are an endurance athlete, make friends with the barbell. If you are a powerlifter, explore different ways to stimulate the muscles that add cardiovascular stimulation like combining running segments with heavy deadlifts. The point is, no matter what your fitness level or expertise, there are new and exciting ways to increase the functional capacity of your skeletal muscle.

Why does this work? The Human body is an amazing machine designed for survival. Mother Nature has programmed redundancies within our physiologic systems to promote longevity. We discussed the impact of our cycling reproductive hormones on how our muscles utilize blood glucose. Fortunately, other physiologic pathways facilitate glucose entry into the muscle cells that depend less on cycling hormones, most notably, the GLUT4 pathway. GLUT4 is a glucose transporter protein that works with muscle contraction to transport glucose into the cells. So when we stimulate muscle contraction through resistance training, this activates the GLUT4 pathway to facilitate the entry of glucose into the cells to be used as fuel, leaving less excess to be stored as fat.

GLUT4 is a glucose transporter protein that works with muscle contraction to transport glucose into the cells. So when we stimulate muscle contraction through resistance training, this activates the GLUT4 pathway to facilitate the entry of glucose into the cells to be used as fuel, leaving less excess to be stored as fat.

Nutrition

We have discussed how glucose enters the cells of our tissues through pathways involving insulin and GLUT4 and how unused, excess glucose is stored as fat. In this section, we will discuss the other important part of this equation, which is the load of glucose that enters the bloodstream by way of the foods we eat.

Glycemic Index – The glycemic index is a measure of how much a carbohydrate source will increase blood sugar over 2 hours from the time of consumption. There are low, medium, and high glycemic index foods with a great description in this resource from Healthline. A lower glycemic index reflects lower blood sugar following consumption and a higher index reflects greater increases in blood sugar. This is important because the glycemic index reflects the glucose “load” on the systems (such as insulin and GLUT4) that need to shuttle the glucose into the cells. When the glucose load is greater, the systems can become overloaded, leaving more excess to be stored as fat. When the load is less, insulin and GLUT4 can better “keep up” with transporting glucose into the cells for use as fuel leaving LESS excess to be stored as fat.

By focusing on carbohydrate sources with a lower glycemic index and minimizing those with a higher glycemic index, you can effectively decrease the glucose load that insulin and other glucose transport pathways see and thus more efficiently use carbohydrates as fuel and minimize the excess that is stored as fat.

Neuroendocrine Adaptation

Adaptation is the ability of the body to adjust or “make familiar” movements or tasks that we undertake. This is a coordinated effort by the muscles, joints, metabolic, and endocrine processes all driven by the master puppeteer we know as the Nervous System!

Because Mother Nature designed Humans for survival, our ability to adapt to physical stimuli and physical tasks is powerful! When we stimulate the muscles repetitively in the same way for an extended period of time, the body doesn’t need to work as hard to manage the load or task and effectively switches into “Auto-pilot”. This is great for elite athletes where the tasks that their sports require become second nature through adaptation.

However, from the standpoint of muscle physiology, they crave something more! This is why we train differently in the off-season: to keep the muscles guessing and thus contantly adapting to become fitter, faster and stronger so that we can crush it on game day! To learn more about this incredible phenomenon, check out Neuroendocrine Adaptation: Your End-Run Around the Menopause Transition.

Key Points for Combatting Midlife Relative Insulin Resistance

Get moving! The first step to using more glucose as fuel and storing less as fat is to move those muscles. For the sedentary, walking, backpacking, and hiking are great ways to start.
If you have never trained with weights, another great place to start is a group “boot camp” style fitness class. Find one at your local gym and sign up with a friend! My favorite group class for getting started with weights is Les Mills BodyPump.
Any level of athlete can benefit from a 4-6 week training program with a trainer or strength coach to gain some basic skills and techniques from basic to more advanced movements depending on your fitness level/familiarity.
Incorporate resistance/weight training at least 2-3x per week.
No equipment, no problem! Push-ups and their many variations are fantastic for anyone of any fitness level to add mass, strength, and power to the muscles of the upper body.
Take an inventory of your carbohydrate intake and using the resources in this LINK, identify carbohydrate sources and potential substitutions that can move the needle toward lower glycemic index choices.
Nutrient timing is a strategy where carbohydrate intake is timed within an hour before training and within an hour after when the muscles are “looking” to fuel movement during the workout and then looking to replenish glycogen stores in the liver following a training session.
Most importantly, be consistent, but be patient! It’s about progress, not perfection. Every little bit you can do has benefits.

Fit Pros: Offer menopausal and perimenopausal women an individualized approach to training, nutrition and wellness as a Menopause Health and Fitness Specialist.

Dr. Carla DiGirolamo is a double Board-Certified Obstetrician/Gynecologist and Reproductive Endocrinologist who specializes in the care of reproductive age and mid-life women. Carla completed her residency training in Obstetrics and Gynecology at Brown University Medical School/Women and Infants’ Hospital and her Reproductive Endocrinology training at the Massachusetts General Hospital at Harvard Medical School.