Fitness Professionals – Page 37

Exercise for Atrial Fibrillation

Eric Durak/20 April 2020/ All MFN blog/

Here are some things to look for when working with a client with Atrial Fibrillation (A-fib).

FIRST…

What types of medications are they on? Calcium Channel Blockers, blood thinners (Coumadin)? These may have an effect on the intensity and type of exercise performed. You know that people who have A-fib are at increased risk for strokes, and may have hypertension and get dizzy more often. The medications – while they may help with some factors – may preclude a well-designed exercise program just because they may not tolerate some types of exercise.

What are the exercise goals? Are they wanting to tone up? Lose some weight? Get stronger? Train for a tennis match or 5K? This would help in structuring the program. The type / intensity / duration are all dependent on what the client wants. If they are just coming off surgery or a new prescription – this is important to build the foundation (which you know).

SECOND…

Does the doctor have any contraindications for exercise? Usually, it’s not to “overdo”, which means building up a program. I read a good article by Dr. Bill Sekula on a program for A-fib. It’s essentially a “step down, time up” program, where patients go from a few minutes of exercise a few times per day – to building up to an hour of exercise one time per day. However, I am going to recommend more of an ITP (interval training program) that concentrates on moderate strength programs (using the 40-50% rule similar to cancer patients), so they don’t use the Valsalva maneuver while lifting, but still use a progressive resistance approach.

THIRD…

Monitoring with a HR monitor, and having good hydration status are both important. Of course, you probably have them using the smart water bottle. Because of the heart dynamics and possible Coumadin Rx, the hydration is important. I assume you do a HR variability test with your client. This may be a very important test to do, as over time it may be instrumental in reducing A-fib occurrences.

I like the article by Dr. John Mandrola on the amount of exercise. He states that A-fib is completely controllable through specific lifestyle changes. He states that low inflammation exercise (high intensity endurance / triathlon, etc.) training needs to be modified, as do other lifestyle issues. I really like the discussion on inflammation, which may be one of the biggest issues in cardiac care of late. He talks about the “J curve” of exercise and that the more intense actually increases the odds ratio (OR) for sudden cardiac events and other abnormalities related to A-fib.

I think he is on to something, and you should look into some other lifestyle aspects such as meditation and heartbeat regulation through mindful breathing and relaxation. I know that excess stress, lack of sleep and poor diet have effects on the electrical system, including SA node and conductivity. Regular relaxation may do a LOT to improve the normal sinus rhythm and reduce resting HR to a more manageable level.

Dr. Mandrola also recommends regular monitoring of BP, keeping the use of warm exercise clothing due to peripheral circulation issues, and not overheating.

I like the issue of ITP and progression. I also am more of a fan of modified strength training for most clinical conditions. I think it would work for AF because if you think of the strength of contraction during exercise (even moderate) – it will have a strong steady beat during exercise (in most cases).

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

References

Movement and Cognition

Dr. Michael S. Trayford/9 April 2020/ All MFN blog/

How our ability to maintain balance, walk, and move is directly reflective of our higher human functions (A brief overview and case study)

Balance and cognition are inextricably linked. Quantification of improvement in key performance indicators of cognition is directly related to precisely measured improvements in balance and postural stability. A thorough understanding of this relationship is paramount to the understanding of conditions related to cognitive impairment, leaning and behavioral struggles, brain injury, and so much more.

At the time of presentation to APEX Brain Centers, Roger was a 70-year-old male struggling with severe balance problems, clumsiness, fatigue, and a general disinterest in life. He used to enjoy life as a family man, successful entrepreneur and golfer. Just over 10 years prior he had undergone radiation therapy for cancer that damaged his 8^th cranial nerve (the balance and hearing nerve). He had also undergone prism therapies and surgery for eye position abnormalities, which have caused further insult to his ability to maintain good balance and to learn effectively. Although not listed as a primary complaint, he also suffered from significant cognitive decline in several areas as evidenced by very low to low average scores on standardized cognitive testing.

Roger sought care at APEX Brain Centers in Asheville, NC in May of 2015 and underwent an intensive course of brain/body rehabilitation. He was admitted into an individualized program directed by extensive diagnostic testing and led by clinicians highly experienced in functional neurology. What follows is a sampling of some of the leading-edge clinical interventions and significant functional gains Roger experienced during his program.

Intervention for balance and cognitive decline

Roger underwent comprehensive brain/body rehabilitation at a frequency of 3 times per day over the course of 15 days (with 2 days off between each for much needed rest and recovery). His brain function was carefully monitored throughout the training process with measurement of EEG, vital signs, eye movements, balance, mental and physical timing, and more to ensure he was receiving the proper amount therapy to be effective, but not too much so as to be counter-productive. Modalities implemented included, but were not limited to: neurofeedback, Interactive Metronome, vestibular rehabilitation, metabolic and nutritional therapies, eye movement and neurological rehabilitation, whole body vibration, electrical stimulation, breathing exercises, and home care recommendations.

Outcomes after Brain Training

Subsequent to his rehabilitative program, Roger reported subjective improvements in the vast majority of his pre-intensive complaints. More profound than that, his wife was quoted as saying, “it’s like I have my old husband back.” She noted that he used to be the life of the party and had been slowly deteriorating over time to the point of sitting in his chair all day and sleeping more and more often. He was finally plugging back into life, putting an end to his isolation and apathy. As is demonstrated by his balance testing, he is also experiencing a renewed ability to maintain balance, allowing him to be safer and more efficient in navigating his physical environment and getting back on the golf course.

Actual, measurable objective improvements recorded with post-intensive diagnostic testing include:

Cognitive Testing: Increase in his Neurocognition Index of 48%. This is a standardized overall score of cognitive performance. Increases in various aspects of memory, attention, processing speed and more as great as 21%.

Interactive Metronome: 56% improvement in task average with motor timing, and normalization of hyper-anticipatory timing tendency with motor tasks (i.e. responding prematurely to a pre-set reference tone).

Computerized Assessment of Postural Stability (CAPS): 20.5% improvement in balance on an unstable surface with eyes closed – bringing him from severe to mild reduction in balance compared to his peers. Elimination of a posterior center of pressure (CoP); significantly reducing his risk of falling backwards.

Video Oculography (VOG): Significant improvements in numerous aspects of oculomotor (eye movement) functionality including: gaze holding, slow and fast eye movements, optokinetic responses, and spontaneous/involuntary eye movements.

Better Movement Equals Better Cognition

With an alarming increase in the number of baby boomers and seniors experiencing balance issues and cognitive decline (that are in fact related and measurable), it is important to recognize the symptoms of these potentially debilitating disorders and, more importantly, that something can be done about them. Early intervention is key, as the longer one waits and the more function is lost, the more difficult it is to recover and have full engagement with life. These same concepts apply to all areas of cognitive and mental health.

Learn more on this topic… join Dr. Trayford for his MedFit webinar, Movement and Cognition.

Dr. Michael S. Trayford is a Board Certified in Chiropractic Neurology and Neurofeedback; and is the Founder and Director of Clinical Operations at APEX Brain Centers in Asheville, NC. His primary areas of focus in clinical practice, associated research, and teaching are learning and behavioral disorders of adulthood (with a focus on addictive and compulsive behaviors), brain injury, and cognitive impairment.

Interesting Times for Interested People

Dr. Mark Kelly/6 April 2020/ All MFN blog/

So, we are all shut in our homes and are not supposed to go to work, movies, or restaurants to dine in, and we can’t even watch live sports on TV. Life is so bad, and unfair… or is it?

I have decided to look at the bright side of this event, and see it as an opportunity. While many are not in my particular position, and are actually out of job and income due to this pandemic, I want you to reframe it. Change the paradigm of this being a negative, to this being a time for catching up, reflecting, and perhaps actually changing yourself.

We all have parts of our lives that need attention. In today’s current society, it is basically impossible to be all things to all people, including ourselves. We must try to balance job, family, social contact, social media, our own diet, hobbies, medical attention, our education — professionally or otherwise, our spirituality, and even our environment. Having balance in a variety of areas is true wellness! We are often so busy teaching and preaching the benefits of fitness and wellness to others, we deny it to ourselves. I remember doing a self-survey several decades ago by some program discussing the “wellness wheel”, which many of you have probably heard of. The survey was showing areas that needed attention. (Back then I had a very lop-sided wheel, and it is not much better now.) The wheel consisted of a mnemonic (6 components. It has shifted slightly in past few decades, but the pneumonic still works well: SPICES.

Old Wellness Areas	New Wellness Areas
S-ocial	Social – all interactions with people outside of ourselves
P-hysical	Physical – our physiological status
I-ntellectual	Intellectual – includes cognitive and emotional health
C-ognitive	Career – includes educational and skill acquisition and financial health
E-motional	Environmental (could include emotional) – clean, organized?
S-piritual	Spiritual – interactions with entities beyond people

I want to use this as a time to clean up many things that have been neglected — both around my house and inside “my house”, my physical body and mental space. I may even use this opportunity to shift my professional pursuits away from academic teaching to wellness coaching. Maybe I can chat on the phone more, spend time with my daughter, or spend more time cooking or reading. Whatever it is, start doing it now!

If nothing else, this has opened the world’s eyes to the need to stay healthy. It has shown people the need to be sanitary and practice good old-fashioned health care techniques, like washing hands and not running out of toilet paper! (Sorry, had to throw that one in!)

As an educator in both physical health and medical applications, we are perfectly positioned to show the communities we live in how to harness the power of exercise for both preventative and rehabilitation purposes. I have learned many new applications for teaching online and most people are focused on coming together for the “greater good”, and this is a breath of fresh air.

Good luck and stay healthy as you address the holistic health agenda in our society.

Dr. Mark P. Kelly has been involved with the health and fitness field for more than 30 years. He has been a research scientist for universities and many infomercial projects. He has spoken nationally and internationally on a wide variety of topics and currently speaks on the use of exercise for clinical purposes and exercise’s impact on the brain. Mark is a teacher in colleges and universities in Orange County, CA., where Principle-Centered Health- Corporate Wellness & Safety operates.

Times Change, So Must You To Some Degree

Dr. Mark Kelly/19 March 2020/ All MFN blog/

By the time this article is released, things will have changed in society, for better or for worse. I seriously doubt anyone predicted what is going on in society worldwide. I have been on planet Earth over a half a century and have never seen anything like this! The COVID-19 restrictions on gatherings, the emotions, and literally the panic that people are experiencing is unprecedented. While everyone has their opinion on the seriousness of the issue to them or to their health, the impact on their current lifestyle is undeniable.

For Better or For Worse – Your Perspective

The old analogy “Is your glass half empty or half full?” is good for this issue. Interestingly, people will vary in their opinions on this, depending on the issue and circumstances surrounding the issue. Sure, some people will see the bright side of life in most circumstances, and others seem to be the Darth Vader of life, and go to dark side. Given enough time and bad or good circumstances, or given the proper intervention, most people can shift perspectives.

The Human Side and Technology

I am currently a teacher in colleges and universities. My various schools have shifted their level of isolation from one to three times! It started off as a delayed move to the online environment, then to lab classes (which I teach) meeting but not lectures, to then all classes are online. Things shifted because circumstances did. I enjoy teaching face to face or “on ground” as it is labelled. This is the human side of me. I like seeing faces, making people laugh, making people think and answer my questions. I like finding out about them and then letting them know something about me. Could this be done in an “online” environment? Yes and no.

By using the conference applications, I can see my student’s faces and they can see mine. They hear my voice and I can have them ask questions and so forth. But their presence, their energy is not in front me, and their separate environment creates a gap that can’t be erased. As fitness professionals, be it with groups or individuals, I know you understand what I speak of. The ability to “tap into” another’s psyche and see them interact to you and you to them is golden, it’s magical, it’s what our humanity is all about!

I have learned new skills, worked with colleagues during this time of desperation on a common solution, and had time with my family I would not have had. Interestingly, I have enjoyed what this horrific event has presented in my life. I am a Hurricane Katrina evacuee. I lived in New Orleans during it and it flipped my life 180 degrees, to say the least. I now live in Southern California, got married and started a family and many, many other things presented themselves because of this event.

We need to be able to learn from these “life-changing events”, grow and see the benefits of them. We need to learn new skillsets to be able to adapt and remember to embrace humanity in the midst of the trauma. People need us and we need people. Be a trainer who engages people with technology and with humanity.

Stress and the Psychology of Heart Health

Jay Del Vecchio/9 March 2020/ All MFN blog/

Most of us accept stress as a necessary evil that is a part of the American lifestyle. But living under stress day in and day out can lead to heart disease. According to the American Psychological Association, prolonged stress can contribute to high blood pressure and circulatory problems, and if stress makes you angry and irritable, you are more likely to have heart disease or even a heart attack.

Understanding Changes in Balance

Dr. Katharine Forth/28 February 2020/ All MFN blog/

How do you assess your clients’ balance? How can you adapt your training plan to deal with natural fluctuations in their balance?

Physical balance is complex and can change daily. Many clients will refer to how long they can stand on one leg when asked about balance issues, but how useful is this as a measure of their postural control or their risk of falling?

Many people who’ve had any kind of formal balance assessment have only done so after having a fall. New statistics show that falls are the leading cause of trauma room visits, across all age groups, and in the case of those over 65, 1 in 4 falls each year. Indeed, the number of deaths by falling is increasing, and yet there are many proven interventions to improve balance and avoid falls.

Many older adults are reluctant to discuss falls or balance issues with their doctors, some wrongly believing that falling is an inevitable part of aging and marks the beginning of the end for them.

Fitness trainers have a significant opportunity to help educate their clients in both the measurement and management of balance and balance issues.

Good balance is the result of the somatosensory, proprioceptive and neuromuscular systems working together. Each system is complex and can be affected by factors such as stress, quality of sleep, medications and exercise habits so understanding where your client is on any given day is helpful for optimizing their health goals.

Regular balance measurement can also be a powerful motivational tool, especially for older adults who want to remain independent and age on their own terms.

Dr. Katharine Forth is an expert in motor control, and conducted post-doctoral research at NASA, where she became the co-founder of Zibrio technology. The Zibrio SmartScale is a bathroom scale that uses artificial intelligence to measure balance and fall risk in a simple 60-second test. The product won an innovation award from the Consumer Technology Association in 2020, and was named by AARP as the winning technology to help ‘older adults stay in the game’ at their pitch competition at CES 2020, judged by Joe Montana. More information can be found at www.zibrio.com

The Lumbar Spine: Understanding the Science Behind Both Movement and Dysfunction

Chris Gellert/11 February 2020/ All MFN blog/

The spine is a complex structure, comprised of nerves, connective tissue, bones, discs, muscles and other essential integrative components. Whether it getting out of a chair or car, lifting or carrying items, some 29 muscles around the pelvic girdle and lumbar spine, provide stability. In this article, we will review the anatomy of the spine, common injuries to the lumbar spine, functional assessments and training strategies to work with clients with previous injuries.

Fit to Travel: Training Tips and Exercise to Prepare Seniors for Active Vacations

Kymberly Williams-Evans. PhD (ABD)/30 January 2020/ All MFN blog/

Get your older adult clients ready for the rigors of tourism and active vacations with these training tips and pre-travel exercises.

Do your over-55 clients or class members want to travel for pleasure but need more strength, stamina and mobility? Do they worry they’ll miss seeing the world because they lack physical ability?

Alzheimer’s Disease, Fitness and Exercise

Dr. Irv Rubenstein/23 January 2020/ All MFN blog/

Alzheimer’s Disease (AD) is a neurodegenerative disease that strikes fear and terror into those who are getting on in years and family members who are in line to care for them. According to the Alzheimer’s Disease Foundation, in 2015 it is estimated that 5.3 million Americans have the disease. It is the 6th leading cause of death behind heart disease, strokes, and cancer but it is the only one that cannot be prevented (1) although some experts now estimate that it may be the third highest (2).