Fitness Professionals – Page 39

Physio assisting elderly woman during exercise with power band a

The Importance of Exercise Following A Stroke

Kris Cameron/9 July 2019/ All MFN blog/

According to the American Heart Association, 700,000 people annually in the United States suffer a stroke.₍₁₎ The incidence of stroke is likely to continue to escalate because of an expanding population of elderly Americans; a growing epidemic of diabetes, obesity, and physical inactivity among the general population; and a greater prevalence of heart failure patients.₍₂₎

Following a stroke, survivors will often work with Physical and Occupational Therapists to restore strength and control through exercise programs. However, most insurance companies only pay for a certain number of therapy sessions per calendar year which can leave a gap in the rehabilitation process. It’s important to continue the exercises that a physical therapist has prescribed and progress safely through an exercise program to regain strength and functional movement. This is where a certified personal trainer with experience in rehabilitative exercises can come in. A certified personal trainer can be part of the healthcare team and can design a program which is both safe and functional. Walking, flexibility exercises, and light strength training can help a stroke survivor continue on the path of rehabilitation. Swimming is also another beneficial form of exercise if a pool is available.

Another benefit of exercise for stroke survivors is prevention of recurrent stroke or heart attack, which occurs frequently in people who have had a stroke.₍₃₎ Reducing risk factors can decrease the incidence of recurrent strokes and coronary events. An aerobic conditioning program can enhance glucose regulation and promote decreases in body weight and fat stores, blood pressure, C-reactive protein, and levels of total blood cholesterol, serum triglycerides, and low-density lipoprotein cholesterol.₍₄₎Exercise also increases high-density lipoprotein cholesterol and improves blood rheology, hemostatic variables, and coronary endothelial function.₍₅₎

It is very important that a personal trainer communicate with healthcare professionals about their client after a stroke, including the physician and physical & occupational therapists to best help the client. Safety should always come first when exercising. Overexertion and pain should always be avoided. Decrease in balance, spasticity₍₆₎, memory, and fatigue is common after a stroke. Like everyone else, stroke survivors will have good days and bad days. However, modification of exercises can help after a stroke to get individuals on the path to better physical health.

Kris Pritchett Cameron is the owner of ReNu Your Life Fitness & Neuro Wellness in Cedar Rapids, Iowa and a certified personal trainer through the American Council on Exercise. Kris has dedicated over 20 years to the health and fitness of others. Kris has worked with all ages from children to the elderly, but her specialty is medical fitness and working with older adults. With a background in healthcare and physical rehabilitation, Kris has experience working with clients who have orthopedic injuries, arthritis, Multiple Sclerosis, Parkinson’s Disease, Alzheimer’s, cancer, diabetes, heart disease, osteoporosis, bariatric surgery, mental disorders, and stroke.

References

American Heart Association. Heart Disease and Stroke Statistics-2003 Update, Dallas TX
Gillum RF, Sempos CT. The end of the long-term decline in stroke mortality in the United States? Stroke 1997; 28:1527-1529
Mol VJ, Baker CA, Activity intolerance in the geriatric stroke patient, Rehabil Nurs. 1991; 16:337-343
Franklin BA, Sanders W. Reducing the risk of heart disease and stroke. Physician Sports Med. 2000; 28: 19-26
Hambrecht R, Wolf A, Gielen S, et al. Effect of exercise on coronary endothelial function in patients with coronary artery disease. N Engl J Med. 2000; 342: 454-460
Spasticity is a condition where muscles are stiff and resist being stretched. It can be found throughout the body, but is common in the arms, fingers, or legs. Hope: The Stroke Recovery Guide. 2010 National Stroke Association

Behavioral Bonsai: Effective Fitness Coaching for the Autism Population

Eric Chessen, M.S./2 July 2019/ All MFN blog/

“First, which hand?”

“Right hand”

“That’s your left. Which one is your right hand?”

Debbie holds up her right hand.

“That’s your right hand! Alright, cool, walking band pulls with your right hand.”

Coaching fitness programs for the autism population is taking the art of Bonsai to strength and conditioning. We eliminate noise, static, whatever you want to label as extraneous. Successful fitness and adapted PE programs with the autism population require a keen sense of senses.

How is Karl responding to directions for performing a bear walk? Can I fade my hand-over-hand prompt for Jack’s single arm Sandbell press and maintain the integrity of the movement? Is Kelvin going to get over-anxious if introduced to a new variation of the squat? Herein are some of the essential considerations for successful fitness sessions.

We start with three questions: What’s going on physically? What’s going on adaptively? What’s going on cognitively?

The answers provide a flow chart-style of contingency-based decisions? If this; then that. Autism is complicated. The strength and motor planning deficits are complicated. The odd, occasionally near-light speed escalation of anxiety and off-task behavior is complicated. What works is a rational and reliable strategy for each situation to support growth and development in each area of ability (physical, adaptive, cognitive). Taking the guesswork, or most of it, out of programming clears the path to short- and long-term benefits for the athlete.

The two most common coaching errors with respect to the ASD population are over-coaching and exercise selection (typically too progressed). Over-coaching is, by proxy, over-explaining and providing too many verbal directions at once. We often need to simplify verbal instruction for athletes with ASD as short-term recall is an issue of particular deficit. Here’s one set of directions likely to be problematic;

“First hurdle steps, then Sandbell slams, then bear walk from the blue cone to the green cone.”

Many of the athletes I’ve coached will start with bear walks. They’re not being deliberately off-task or defiant, it’s simply a matter of hard-wiring. The verbal directions were too extensive and our athlete was unable, at least for now, to hold them in place.

In the Autism Fitness Level I Certification we teach a strategy called “Label/Demo/Do & Cue” as an efficient way to teach and facilitate learning different exercises with safety, efficiency, and comprehension. Labeling refers to naming the exercise. Demonstrating is our showing the athlete proper form and performance, and Do/Cue gets them into the activity quickly so that we can coach as they learn.

In real life (IRL, LOL!) we would take each one of the aforementioned exercises (hurdle steps, Sandbell slams, and bear walks) and teach/instruct them separately. Consider that physical and adaptive skills can be mutually exclusive. An athlete might have proficiency with all three exercises, yet still require verbal direction at each stage;

“First hurdle steps”

Athlete performs hurdle steps.

“Great hurdle steps and getting your knees up! Now you have eight Sandbell slams.”

Athlete performs 8 Sandbell slams

“Those were some powerful Sandbell slams! Now bear walk from the blue cone to the green cone.”

Athlete completes the bear walk

Using this strategy we avoid overwhelming the athlete and having to back-track. We want to Label/Demo/Do & Cue because it provides the coach with more time to teach the exercise rather than explaining it. Our goal is to maximize “down” time and increase on-task behavior, wherein the athlete is learning and mastering each exercise. Given the strength, stability, and motor planning deficits common to the autism population, it is imperative that as much of a session as possible is dedicated to them being in action.

Labeling the exercise has a secondary benefit. As the athlete becomes more familiar with the name of a movement, he/she can request in or make an informed, motivated decision when an instructor provides options. We use this strategy with consistent success, asking athletes whether they would prefer to do “push throws or overhead throws first” during our medicine ball warm-up.

The structure here is key. Providing choice between exercises sets up a few important contingencies. First, the coach is giving structure. Both medicine ball throws will be performed, however, the athlete gets to choose the order.

The open-ended option “What do you want to do?” could be overwhelming or the athlete may choose something entirely outside the realm of exercise (“bathroom” and “break” are common inserts here). Providing choice within structure enables us to teach what needs teaching and coach what needs coaching while still leading towards autonomy. Over time, many of our athletes wind up “designing” their own sessions with frequent choices being offered, usually with respect to the order of exercises.

Exercise selection is crucial. Focusing on the foundation of movement patterns (locomotion, pushing, pulling, squatting, hinging, and crawling) we are able to address some of the most pervasive physical deficits common to this demographic. It is not about variety, rather building baseline skills that transfer or generalize to novel environments and situations. It can take some time for these movement skills to establish. In multiple cases learning to hinge properly during the scoop throw has taken our athletes a few years to master.

Focusing on a few exercises also gives our athletes the opportunity to learn the name and typical order in which the exercises can be performed. Whereas our warm-up/mobility section nearly always features hurdle steps, overhead resistance band walks, bear walks/crawls, and medicine ball throws (push, overhead, and scoop), our strength/focus section includes squats, presses, pulls, farmers walks, and heavy carries.

Using a “limited” selection of exercises enables our athletes to master the baseline skill (physical), become accustomed to the name and instructions around the exercise (cognitive), and be familiarized enough with each exercise that it can become reinforcing, where the athlete is motivated (adaptive) to engage.

The art of empathetic coaching requires us to ask one overarching question; What is it like for you to be coached by me right now? We acknowledge our athlete’s current abilities and make well-guided plans for their successes.

Photos provided by Eric Chessen.

Eric Chessen, M.S., is an Exercise Physiologist with an extensive background in Applied Behavior Analysis. Eric provides on-site and distance consulting worldwide. He is the founder of Autism Fitness®, offering courses, tools, resources and a community network to empower support professionals to deliver adaptive fitness programming to anyone with developmental deficits to create powerful daily living outcomes that last a lifetime.

The Role of Exercise in the Treatment of Diabetes

Dr. Irv Rubenstein/21 June 2019/ All MFN blog/

Diabetes Word Cloud Concept

According to the American College of Sports Medicine’s flagship journal, Medicine and Science in Sports and Exercise (1), there are more than 21 million Americans with Type 2 Diabetes as of 2010 with an estimated 7 million undiagnosed. If these numbers don’t mean much, let’s give it some perspective: in 1958 there were only 1.5 million. (Granted, the US population has increased, but only from about 180 million to 310 million, not 15-fold as in the numbers of T2D.) Furthermore, due to the now-defined pre-diabetes – or sub-clinical diabetes where the precursors to diabetes are lurking if lifestyle does not change dramatically – it is estimated that 80 million Americans are at risk. Thus, some public health officials are predicting that 21-33% of Americans will have diabetes by the year 2050. The healthcare burden this portends will bankrupt the nation. To make matters worse, the preponderance of both pre-diabetes and T2D is increasing in children and adolescents as sedentary behavior, poor diet and obesity abounds.

While prevention is optimal and much is being done in the way of public health messaging, one of the best means by which to regulate blood sugar in either healthy, pre-diabetes or T2D patients is through physical exercise. Recall above where we discussed how muscles use the sugar in the blood for fuel. The more muscles you have and the more regularly they work at some critical level of effort, the easier it is to control blood sugar. In fact, one’s levels of physical activity (PA) may be a better predictor of risk for diabetes than one’s BMI (body mass index, a ratio of height to weight.)

For the sake of discussion, we should break down physical activity into three main types – activities of daily living (ADL), aerobic exercise (AE) and resistance (or strength) exercise (RE). The MSSE article reviewed the data on all these for their impact on blood sugar, insulin control and T2D risk. Not unremarkably, the evidence strongly suggests that the more active you are, the lower your post-meal and long-term blood sugar is, the better your muscles are able to use the sugar in the blood (glucose tolerance or insulin sensitivity), the lower or lesser your insulin response is to food intake, and the lower your risk for diabetes is. What is remarkable, however, is how little physical activity is required in order to affect many of these changes and benefits.

As far as ADLs is concerned, the general prescription is to ambulate (walk, run, bike, etc) for 30-60 minutes a day or close to 10,000 steps/day, or almost 4 miles/day. This does not mean you have to take walks that last that long; it means you should move around more often throughout the day and sit less often. In fact, some studies show that simply standing up for 2 minute bouts of walking every 20 minutes of sitting lowered post-meal blood sugar and insulin response to eating. (2) While walking is effective, new studies (3) demonstrate that high intensity interval training (HIIT), or sprinting, may be an even better regulator of blood sugar. Comparing training programs in two groups of sedentary women, one doing intervals of moderate intensity, the other at high intensity, the authors found that the HIIT group had slightly greater fat oxidation in the muscles, a roundabout indicator of improved glucose control. HIIT might also be more time efficient.

Between the two studies referenced here, and many more that have looked at HIIT programs compared to traditional long, slower/lower intensity programs, the general belief is that the more muscles that are contracting and the harder they contract, the better the short-term and long-term blood sugar control. The only caveat here is that large muscle groups or bigger body movements are necessary to see these effects; single joint/small muscle contractions will not elicit the disease-modifying effects one might be seeking. For these reasons, RT has been getting more looks when it comes to modifying risk factors for T2D. In fact, the preponderance of evidence shows that RT, at sufficiently high enough intensities to build muscle mass, improves blood sugar control both by using sugar to fuel contractions and by improving the insulin sensitivity of those muscles even after the workouts.

Overall, physical activity has been shown to be an effective, efficient and low-risk/low side-effects treatment and preventive for T2D. A single bout of exercise is sufficient to regulate blood sugar for the next 16-24 hours.

As such, it is recommended that exercise be partaken nearly every day for at least 30 minutes; if obesity is a factor in a patient’s disease, then 60-90 minutes of accumulated physical activity is strongly suggested. Furthermore, a combination exercise prescription of cardiovascular and RT exercise – either same or alternating days – is deemed optimal.

To conclude, physical activity of all sorts has been found to enhance blood sugar uptake by muscles during the session and for several hours thereafter. Thus, it is one of the best, least invasive means by which to prevent, regulate and, for early stage T2D, even reverse diabetes and its downstream effects on the heart, kidneys, nerves (especially of the lower extremities), and eyes. Besides its collateral benefits on the cardiovascular system, it may help reduce weight though it is essential in maintaining weight loss. And PA clearly improves quality of life, not just through its physical benefits but its effects on the brain and psyche, reducing the risk of depression which may be a factor in both the sequence of events leading to weight gain, the challenges of both weight loss and disease management, and the reduction in one’s ability to enjoy various aspects of life due to immobility, neuropathy, visual impairment, and dialysis.

For more information about diabetes, exercise, pharmaceutical management and research, please visit the American Diabetes Association site at diabetes.org

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”.

References

1. Roberts et al, Modification of Insulin Sensitivity and Glycemic Control by Activity and Exercise. MSSE, Vol. 2013: 45(10):1868-1877
2. Dunstan et al., Breaking up prolonged sitting reduces glucose and insulin responses. Diabetes Care, 2012:35(5): 976-983
3. Astorino et al., Effect of Two Doses of Interval Training on Maximal Fat Oxidation in Sedentary Women. MSSE, Vol. 45(10), pp.1878-1886, 2013

Meta Slider - HTML Overlay - Pregnant woman holding fitness dumbbells

Prenatal Exercise: Training for the Main Event

Sheila Watkins/5 June 2019/ All MFN blog/

Say good-bye to the myth of the “delicate” condition and hello to pregnancy in the 21st Century!

Current research continues to show that women can safely exercise and maintain their fitness level during the perinatal period. The mom who laces up her sneakers instead of heading to the couch will be rewarded with a healthier pregnancy and a healthier baby.

Pregnant woman doing yoga with a personal trainer Pregnancy is a time of excitement, uncertainties, fears, and many profound physical and emotional changes. This “season in life” affords mom a wonderful opportunity to adopt a healthier lifestyle. Starting an exercise program during pregnancy is a great way to begin and continue this healthier lifestyle for herself and subsequently for her child. With obesity on the rise in the US, it is important for everyone to increase their current level of physical activity. This is especially important for pregnant women as the results of obesity and excessive weight gain have been shown to be detrimental to both mom and baby long term.

A Historical Perspective on Prenatal Exercise Guidelines

Moms today are inundated with information regarding pregnancy and exercise. Unfortunately, a great deal of this information is outdated. It is important for women to have a working knowledge of the most current guidelines so that they can make intelligent choices regarding their exercise programs. For many years, pregnant women were advised to “take it easy” during pregnancy. Mom was advised to rest and gain weight in order to ensure a healthy pregnancy. In the 1950’s women were “allowed” to walk a mile a day for exercise and this mile was preferably “broken up” into smaller segments. The American Congress of Obstetrics and Gynecology (ACOG) issued the first formal guidelines for perinatal exercise in 1985 (1). These guidelines were highly restrictive as they were not based on extensive research and were designed for the majority of pregnant women without regard to pre-pregnancy fitness levels. Four of the original guidelines are highlighted below:

Mom should exercise at a heart rate <140 bpm.
Strenuous exercise should not exceed 15 minutes
Maternal core temperature should not exceed 38 degrees C
No supine exercise after the first trimester

A great deal of research involving both sedentary and trained subjects was published

after the release of the 1985 guidelines. This prompted ACOG to publish a revision of the original guidelines in 1994 which lifted specific limitations for prenatal exercise (2). ACOG said, “There are no data in humans to indicate that pregnant women should limit exercise intensity and lower target heart rate because of adverse effects.” In this revision, there was no mention of the 140 bpm maximal heart rate or an exercise limit of fifteen minutes. Women were advised to use the “talk test” and “perceived exertion” as ways to measure exercise intensity. We were making progress! Although the 1994 guidelines were a refreshing change in the right direction for ACOG, they still did not address the pregnant athlete. In 2002, ACOG published “Exercise During Pregnancy and the Postpartum Period: ACOG Committee Opinion 267” (3). In this publication, which was reaffirmed in 2009, ACOG recognized that “in the absence of contraindications, pregnant women should be encouraged to engage in regular, moderate intensity physical activity to continue to derive health benefits during their pregnancy as they did prior to pregnancy.” This revision focused more on the athlete as well and was the first formal recommendation by an American physician group to include prenatal exercise. The major points of the 2002 update include:

Previously sedentary women and those with any medical or obstetrical problems should obtain medical clearance before embarking on an exercise program; NO PRENATAL CLEARANCE, NO EXERCISE, NO EXCEPTION.
Thirty minutes or more of moderate exercise daily, or on most days of the week is recommended. This brought the exercise guideline for pregnancy more in line with the ACSM guidelines for the general population.
Competitive and recreational athletes with routine pregnancies can remain active, “listen to their bodies” and modify their exercise routines if medical necessity arises.
Physically active women with a history of or risk for preterm labor or fetal growth restriction should reduce their activity in the second and third trimesters.

In 2006, the “ACSM Roundtable Consensus Statement: Impact of Physical Activity During Pregnancy and Postpartum on Chronic Disease Risk” was published (4). This report, based on an analysis of the most current research by a panel of scientific and clinical experts, supported the safety and long term benefits of prenatal and postpartum exercise for both mom and baby. Some of the benefits highlighted in this report and other studies show that exercise:

Reduces the risk of preeclampsia (a condition marked by high blood pressure, protein in the urine and marked fluid retention in the mom which can lead to serious maternal and fetal complications).
Treats or prevents gestational diabetes, the diabetes of pregnancy. For some women exercise alone may stabilize blood sugar. Moms with gestational diabetes are more prone to Type II diabetes later in life.
Helps manage or alleviate pregnancy related musculoskeletal issues. Exercise may help with low back pain, urinary incontinence, abdominal muscle and joint and muscle issues.
Links breastfeeding and postpartum weight loss. Weight loss can occur with moderate exercise and caloric restriction without affecting the quantity and quality of breast milk or infant growth.
Positively impacts mood and mental health. Exercise is a “mood elevator.” It reduces stress, fatigue, anxiety and improves self-image.
Baby’s health and development: The panel advised that beginning or continuing a prenatal exercise program had both short and long term positive effects.

Beautiful pregnant woman thinking of her baby The most recent guidelines for prenatal exercise were included in the 2008 US Dept. of Health and Human Services Physical Activity Guidelines (5). Women who are not currently active should strive for at least 150 minutes of moderate intensity cardiovascular activity per week. This translates to 30 minutes of exercise 5 days a week, very similar to the ACOG guideline. They recommend that those women who are currently active may continue their normal routine providing there is an open line of communication with their healthcare providers

The latest research continues to showcase the benefits of prenatal exercise. A 2013 review of the international evidence reinforced the fact that women who engage in prenatal exercise have a decreased risk of developing gestational diabetes and other hypertensive disorders during their pregnancies. They are also less likely to deliver big babies (> 9 pounds). Other studies suggest that babies born to active moms are lighter and leaner at 1 and 5 years of age (6). Additional research has supported these findings and has extended the benefits to older children (8-10 year olds) (7). This is quite significant considering the fact that childhood obesity is on the rise. We now have exciting evidence that the in utero environment of exercising mothers may provide long term effects for their offspring with regards to bodyweight and body fat. Prenatal exercise may also boost babies’ brain activity. Canadian research has shown that babies of exercising moms had greater brain activity 8 – 12 days after they were born, as evidenced by an increased ability to process repeated sounds (8). This was the first study to link prenatal exercise with babies’ brain development.

In 2015, ACOG released two new publications, “Obesity in Pregnancy,” Bulletin Number 156 (9) and “Physical Activity and Exercise During Pregnancy and the Postpartum Period,” Committee Opinion Number 650 (10). Both publications emphasize the need for regular exercise to prevent or combat excess weight gain and /or obesity in the perinatal population. Greater than half of the women of childbearing age in the US are overweight or obese. Obesity in pregnancy is associated with significant risks for both mother and baby. Bulletin 156 authors wrote, “Optimal control of obesity begins before conception. Weight loss before pregnancy, achieved by surgical or nonsurgical methods, has been shown to the most effective intervention to improve other health problems.” The updated Bulletin 156 recommendations include:

Behavioral interventions that utilize both diet and exercise can improve postpartum weight loss better than exercise alone
BMI should be calculated at the first prenatal visit and used to counsel women on diet and exercise utilizing the Institute of Medicine Guidelines for prenatal weight gain
Small preconception weight losses in obese patients can improve pregnancy outcome
Losing weight between pregnancies in obese patients may decrease the risk for a large-for-gestational-age baby in a subsequent pregnancy

Pregnant women doing squatting exercise. Pregnancy is an ideal time for maintaining or adopting a healthy lifestyle. Recommendations from ACOG Committee Opinion Number 650, “Physical Activity and Exercise During Pregnancy and the Postpartum Period” include:

Physical activity in pregnancy has minimal risks and has been shown to benefit most women, although some modification to exercise routines may be necessary because of normal anatomic and physiologic changes and fetal requirements.
A thorough clinical evaluation should be conducted before recommending an exercise program to ensure that a patient does not have a medical reason to avoid exercise.
Women with uncomplicated pregnancies should be encouraged to engage in aerobic and strength-conditioning exercises before, during, and after pregnancy.
OB-GYN’s and other obstetric care providers should carefully evaluate women with medical or obstetric complications before making recommendations on physical activity participation during pregnancy. Although frequently prescribed, bed rest is only rarely indicated and, in most cases, allowing ambulation should be considered.
Regular physical activity during pregnancy improves or maintains physical fitness, helps with weight management, reduces the risk of gestational diabetes in obese women, and enhances psychological well-being.
20-30 minutes of moderate intensity exercise per day, on most or all days, is recommended.
Exercise intensity should be monitored by RPE and the “talk test.” Suggested RPE is 13-14 on a 6-20 scale.
Women are encouraged to stay well hydrated, avoid long periods of lying supine and cease exercise if they have any warning signs (see below).
Women who were sedentary before pregnancy should gradually progress their exercise programming
Women who were regular exercisers prior to pregnancy and who have uncomplicated, healthy pregnancies should be able to engage in high-intensity exercise programs, such as jogging and aerobics, with no adverse effects. High-intensity or prolonged exercise in excess of 45 minutes can lead to hypoglycemia; therefore, adequate caloric intake before exercise, or limiting the exercise session, is essential to minimize any risk.\Contact sports, activities with a high risk of falling, scuba diving, sky diving and “hot yoga” are not recommended

Warning Signs and Symptoms to Discontinue Exercise (11)

If a woman experiences any of the following, she should cease exercise and contact her health care provider as soon as possible:

Vaginal bleeding or fluid leakage
Shortness of breath prior to exertion
Pelvic pressure or cramps
Dizziness
Headache or any vision problem
Pain of any kind
Uterine contractions
Muscle weakness
Calf pain or swelling
Preterm labor
Decreased fetal movement
Chest pain
Temperature extremes (hot or cold; clammy)
Nausea / Vomiting

As a result of almost 30 years of research showing the benefits of prenatal exercise, we have seen a substantial increase in the number of motivated personal trainers who are certified to work with this very special population. No two pregnancies are the same and no two prenatal fitness programs should be the same. Trainers certified in perinatal fitness and wellness possess the knowledge and skills to design and implement individualized programs to help mom prepare for the “marathon of labor” and the “tasks of mothering” after the baby is born.

Join Sheila for her upcoming webinar:

Sheila Watkins is a perinatal fitness specialist with over 25 years of experience training 2500+ pregnant and new moms, and educating hundreds of fitness instructors, health professionals, and childbirth educators on the rapidly changing field of perinatal fitness. She is the creator of Healthy Moms® Fitness Programs to provide safe and effective group exercise classes and personal training for new and expectant moms, as well as education and training in the field of perinatal exercise for fitness professionals, childbirth educators and other health professionals.

References

ACOG. The ACOG Guidelines for Exercise During Pregnancy and Postpartum; Home Exercise Programs, 1985.
ACOG. Exercise During Pregnancy and the Postpartum Period. ACOG Technical Bulletin, No.189, February 1994.
ACOG. Exercise During Pregnancy and the Postpartum Period, ACOG Committee Opinion, No. 267, Washington, DC: ACOG, January 2002 (reaffirmed in 2009).
Pivarnik, J. et al. American College of Sports Medicine Roundtable Consensus Statement, June 2006.
http://www.cdc.gov/physicalactivity/everyone/guidelines/pregnancy.html
Mudd LM, Owe KM, Mottola MF, Pivarnik JM. Health benefits of physical activity during pregnancy: an International Perspective Med Sci Sports Exerc. 2013 Feb;45(2):268-77.
Pivarnik. J. and Kuffel, E. ACSM Sports Medicine Bulletin; Active Voice: More Maternal Physical Activity May Lead to Leaner Pre-Adolescent Children; June 20, 2010.
http://www.nouvelles.umontreal.ca/udem-news/news/2013-exercise-during-pregnancy-gives-newborn-brain-development-a-head-start.html
ACOG. Obesity in Pregnancy. ACOG Practice Bulletin, No.156, December, 2015.
ACOG. Exercise During Pregnancy and the Postpartum Period, ACOG Committee Opinion, No. 650, December 2015
Watkins, Sheila S. “Healthy Moms@ Perinatal Fitness Instructor Training Manual.” 2013.

Why Exercise When You Have Cancer?

Robyn Kade/22 May 2019/ All MFN blog/

Exercise is important for everyone even individuals who have cancer. It is important to understand your body and know what you can do. An Exercise Specialist can help you to figure out an exercise plan that works for you. Everyone is unique and therefore needs an individualized exercise program.

It is important to notify your Exercise Specialist when you have treatments. The exercise program may need to be modified for a few days after treatment. Modification is important to help preserve energy and wellbeing. You may need to do two sets of an exercise instead of three for a training session or two. Exercise can help you to stay strong and relieve stress even if you are only able to do twenty minutes every other day.

There are also some precautions to take. While exercising, you may want to wear gloves. Wearing gloves helps you to keep your hands clean during workouts. This is important because the immune system is already weakened. Wiping equipment before use will also help you to be as clean as possible. It is important to wipe mats and dumbbells as well.

Start your exercise program slowly and progress when you are ready. Fitness is an individual journey and everyone starts at a different place. It is important to not compare yourself to others and keep focused on your goals. Your exercise prescription will depend on which phase of cancer you are in.

There are many ways that exercise can benefit individuals during treatment such as: maintaining your physical capabilities, lessen nausea, maintaining independence, improve quality of life, control weight, decrease anxiety and depression, and improve self-esteem.

When you are recovering from treatment you may notice that the side effects linger. Your Exercise Specialist will adjust your program according to how you feel. Eventually, you will be able to progress and feel less fatigued. It is important, however, to continue to be active after treatments have been discontinued. Research shows that there is less chance of cancer recurrence in active individuals.

Robyn Caruso is the Founder of The Stress Management Institute for Health and Fitness Professionals. She has 15 years of experience in medical based fitness. Contact Robyn by email at: tsmi.caruso@aol.com

References

American Cancer Society (2014). Physical Activity and the Cancer Patient. Retrieved http://www.cancer.org/treatment/survivorshipduringandaftertreatment/stayingactive/physical-activity-and-the-cancer-patient

Web MD (2007). Exercise for Cancer Patients: Fitness After Treatment. Retrieved http://www.webmd.com/cancer/features/exercise-cancer-patients?page=3

Exercise: A Must for Both MS Patients to Partake In and Healthcare Providers to Promote

Jeff Segal/21 May 2019/ All MFN blog/

Exercise is an essential component of the Multiple Sclerosis patient’s treatment plan. Unfortunately, until the 1990s, exercise was highly regarded as contraindicated to MS patients. In 1993, the first medicine was approved by the FDA for MS and in 1996; the first research showing the benefits of exercise was published by the University of Utah. These were two major breakthroughs which have given hope to a population consisting of the most common disabling neurological disease of young adults (most common onset between ages 20 and 50).

Multiple Sclerosis is a neuroinflammatory autoimmune disease of the central nervous system (CNS), consisting of the brain, spinal cord and optic nerve. The immune system attacks the myelin sheath of the nerves which insulates, protects as well as affects the signal speed from the CNS to the affected body part. Presentation of initial symptom of MS include optic nerve inflammation, poor balance (ataxia), dizziness (vertigo), weakness, double vision (diplopia), bladder/bowel dysfunction, pain, sensory loss, cognitive impairment, fatigue (most common) and a host of others including but not limited to gait impairment, depression, tremors, thermoregulatory dysfunction (autonomic) and spasticity. Because many symptoms are invisible (not outwardly visible), most notably fatigue, pain and cognitive impairment, they can affect confidence, relationships, and discourage patients from seeking treatment or help.

Currently, with more than 16 FDA approved disease modifying treatments, as well as exercise being greatly encouraged by health care providers treating MS, the face of MS is changing for the better. While exercise will not change the course of the disease progression, both aerobic and anaerobic conditioning have greatly helped reduce secondary and tertiary symptoms such as falls, injuries, anxiety/depression, impaired activities of daily living (secondary) and increase self-esteem, and independence while reducing social isolation and family disruption (tertiary).

The benefits of a safe, progressive/adaptive exercise program are improved overall fitness, ability to perform activities of daily living, moods, sense of well-being, strength while decreasing spasticity, fatigue and may prevent a host of co-morbidities. Because MS patients may be less mobile and underweight/overweight, coupled with the possibility of side effects from the use of corticosteroids, it increases the likelihood of developing conditions such as osteoporosis and diabetes mellitus. This is an even a greater reason those affected with MS should work with professionals who understand the disease.

Although many patients are still hesitant to begin an exercise program because of fear of exacerbating their condition, lack of confidence or inability to find professionals skilled to work with them, now is the best time in the history of MS treatment for both patients and professionals to be on the same page. Exercise no longer has to be an activity of an MS patient’s past. It is simply a must of the present and future.

Jeffrey Segal, owner and chief operator of Balanced Personal Training, Inc., since 2004 is a personal trainer, motivational speaker and educator who has been working in the fitness industry for over 20 years.

At the age of 25, Jeff was diagnosed with Multiple Sclerosis. He was told fitness was not going to be part of his future as an activity. Within a couple of years, Jeff was unable to walk, was visually impaired and barely able to speak. Rather than succumb to his prognosis, he fought for the life he once knew while burying his head in research. Within a year, not only could he walk, see and speak but he used his knowledge, skills and abilities to physically train others in both sickness and in health with an emphasis on Multiple Sclerosis patients.

An Intro to Chronic Conditions for the Fitness Professional

Karl Knopf/15 May 2019/ All MFN blog/

With the future of health being unknown, one thing is known — that Americans are living longer and with age often comes a chronic condition. Living with a chronic disease/condition is often an exhausting and frustrating ordeal. Too often the person may feel burdened and burned out! When the stress of pain and fatigue, coupled with normal life stresses, the client may feel overwhelmed. When the client is overwhelmed, they often don’t take care of themselves and that only contributes to more fatigue and pain. Just a few weeks of neglecting themselves can contribute to further disability. What is the goal of the fitness professional – be positive and supportive and don’t contribute to making they condition worst.

The 3 E’s of Fitness Therapy

Your job as a fitness therapist is the 3 E’s: Educate, Empower and Encourage.

Educate yourself and client about their condition and effects their medications may have on exercise performance. Stay abreast of corrective exercise research. Knowledge is power!

Empower clients to be their own best advocate and to take control of their life not become a victim of their condition. Empower them to take the “dis” out of disability.

Encourage clients about ways to be the best they can be. Think of all methods to foster healthy lifestyles, provide hope and set realistic attainable goals

The purpose of this article is that knowledge is power, and the more you know about a condition, the more you will be an equal partner on your client’s health care team. Not every application is perfect for every client. Always stay alert that what is accepted as a “norm” today can change tomorrow with new research. That is why it is strongly encouraged that your client discuss their fitness plan with their medical professionals. You are not expected to know everything, but you are expected to know when to seek advice!

The Fitness Therapist is first and foremost an educator of the psychomotor domain.

Do NO Harm!

Sometimes clients with a chronic condition will be afraid to embark on an exercise program in fear that it will cause them injury or more pain. They may know intellectually that they should, but the apprehension about what might occur can be paralyzing. They might tell you I know how I feel now and if I feel worst I might not be able to work or take care of my family. Your first and foremost job as a fitness therapist is to DO NO harm and NOT make matters worse. This is why having the client get prior approval and recommendations from their health professional can go a long way in motivating the client. In order to overcome a chronic condition, ask your clients to re-define their paradigm and focus on what they can do rather than what they cannot do! Ask them to think about the benefits of your successes.

Unfortunately, many people with a chronic condition are fearful that exercise may aggravate their condition, so they play it safe and do nothing. Too many people give up on an exercise program long before they experience the benefits of what regular exercise can provide. Be sensitive to your client’s concerns. Never minimize their condition, by saying, “You do not have it so bad I have a friend with ______ and she is doing fine.” What might be a small issue to one person could be a major issue to another. Always start the person where they are at and progress with care from there.

Very often improved fitness empowers the person with a chronic condition to live a richer and fuller life. Ask the client to decide what they want as an end goal of their exercise program and then design the program with small attainable steps to match their goals and abilities. Too often when a person with a chronic condition has lost control of their lives, everybody is telling them what medications to take, what to do and not do. Remind the client that they are the Captain of their wellness ship. You, their doctor and their family can be cheerleaders but they are the Captain.

As their personal trainer, do your best to make their body the best it can be. Never make promises that your program will cure them. Stay alert that many chronic conditions will ebb and flow with periods of exacerbations and remissions. While study after study supports that exercise, when done properly and prudently, produces good outcomes, exercise is never a replacement for medical care.

Regular exercise is therapy for the mind and body.

Some experts project that soon the integration of health care, fitness and wellness will intersect. The anticipated model of wellness and healthcare foresee the role of medicine will be to heal and fitness/wellness to restore health and vitality to those who participate in pro-active lifestyle.

Working definition of Wellness includes attention to the mind, body and spirit.

Today, doctors understand the importance of both passive therapies and rehabilitative exercise. While medical science continues to make great advances in surgical and pharmacologic treatments, exercise physiologists are also proving that simple interventions, such as proper body mechanics and corrective exercise, can play a significant role in decreasing the incidence and severity of orthopedic conditions and other chronic conditions. One of the goals of fitness therapy is to maximize the potential for full function and minimize the chance of re-injury.

Keep in mind that not every exercise is correct for every person or every condition. Depending upon diagnosis, certain movements will not be best for your client. Every program for a person with a chronic condition should be individualized and adapted as needed.

One size does NOT fit all in Fitness Therapy. The cookie cutter approach has no place in fitness therapy! Make the corrective exercise session a positive experience so the client will want to continue to make fitness an important aspect of their treatment plan.

It is important to stay mindful that “Recovery” of a condition may take weeks or even months depending upon the diagnosis or severity of the problem. Also, in the case of some chronic conditions, maintaining is all that can be hoped for. Slow and steady is the best approach. Progressing too quickly will only set the person up for re-injury. As the client embarks on the recovery process, you need to encourage clients to be their own health advocate and wellness trainer.

Exercise: The Miracle Cure All?

It can:

reduce cardiac mortality by 30%
improve self-image
reduce prostate cancer progression by 50%
assist in decreasing hypertension
reduce the risk of type-2 diabetes by greater than 50 %
reduce bowel cancer by 45%.

For more information see aomrc.org.uk/publications/reports.

Some General Guidelines for Working with Clients with Chronic Conditions

The world of health and fitness is a complex one. Lack of exercise contributes to diabetes, high blood pressure and other assorted sedentary health concerns, but too much exercise causes overstress and injury to joints and muscles. While exercise can make us feel good, too much can bring on pain and soreness. The answer is to train smart. If a client is hurting, let them know it is OK to back off.

Consider asking the client to consult their health professional for suggestions regarding exercise and their condition. The information given by their health professional supersedes the information in any textbook, because the health professional is familiar with their unique situation.
Perform their exercise program when they are having the least amount of pain/discomfort. Teach the client to listen to your body and heed what it says. Keep in mind the 2-hour rule; if the client hurts more 2 hours post-exercise, back off until they are pain-free, but don’t quit. Avoid any activity that aggravates your client’s condition. If they say, “I am fatigued”, don’t force one more repetition. If they say, after a workout, “I hurt!” Back off!
Never allow the client to mask pain with pills or lotions. Pain is the body’s way of informing them that something is going on inside. To prevent a re-injury or unnecessary pain, execute motions in a pain-free range of motion with proper form. If you suspect a re-injury, ask them to schedule an appointment with their doctor. If you suspect the person is abusing pain medications, seek advice. The client is more important than any exercise program!
Encourage them to carry ID and medical information with them to sessions.
Always teach and ideal proper posture and proper body mechanics in all movements when possible given their health status.

Exercise Do’s And Don’ts for Your Clients

DO carry identification when you exercise.
DO check heart rate before, during, and after exercise.
DO listen to your body, if it hurts, STOP!
Do prepare the body for movement and stretch and relax after a session.
DO drink plenty of water before, during, and after each exercise session.
DO consider solitary versus social aspects of your chosen program.
Do teach mindfulness when exercising.
DON’T bounce when stretching, and stop a stretch if it hurts.
DONT squeeze a week’s worth of exercise into one day.
DON’T overestimate your client’s capacity to exercise. However, DON’T underestimate it either. Remind the client that the body is designed for movement, but let it adapt slowly and gradually.
DON’T allow the person to hold their breath during exercise.
DON’T allow the person to go directly into a sauna, hot whirlpool (Jacuzzi), or steam bath after exercising.
DON’T use perspiration (sweating) as an indication of how good (or bad) your workout is: we all perspire at different rates and in different amounts.

Reprinted with permission from Karl Knopf.

Karl Knopf, Ed.D, was the Director of The Fitness Therapy Program at Foothill College for almost 40 years. He has worked in almost every aspect of the industry from personal trainer and therapist to consultant to major Universities such as Stanford, Univ. of North Carolina, and the Univ. of California well as the State of California and numerous professional organizations. Dr. Knopf was the President and Founder of Fitness Educators Of Older Adults for 15 years. Currently, he is the director of ISSA’s Fitness Therapy and Senior Fitness Programs and writer. Dr. Knopf has authored numerous articles, and written more than 17 books including topics on Water Exercise, Weights for 50 Plus to Fitness Therapy.

Reference:

Arthritis Today Sept/Oct 2015

Chronic Pain – Healing with Release

Dr. Maria Sykorova Pritz Ed.D/3 May 2019/ All MFN blog/

Healing with release is based on the fundamental idea, backed by research, that stress, tension and trauma are both psychological and physical. Twentieth-century science is moving forward to a better understanding of the body’s deterioration. Hans Selye recognized that physiological disease could arise from psychological causes, such as stress (Somatic viewpoint). The pathology of chronic pain is associated with numerous losses such as a decline in physical fitness, disturbance of sleep, strained relationships, loss of energy and fatigue. Social isolation, loneliness and anger are often evident in people suffering from chronic pain. These negative emotions exacerbate pain and increase suffering. An estimated 33 to 35 million U.S. adults are likely to experience depression at some point during their lives.

In 2011, in the USA alone, a hundred million Americans suffer with chronic pain and the cost of lost wages translated to $ 600 billion due to employees with chronic pain calling in sick because of a pain–related condition such as:

Headache—$14 billion, only $1 billion of which consists of health care costs (Hu et al., 1999), partly because most people with migraine stop seeking medical care for the condition (Silberstein, 2010)
Arthritis—$189 billion, less than half ($81 billion) of which is for health care costs (Yelin et al., 2007)
Spine problems—$2,500 average in incremental medical costs (Martin et al., 2008); and low back problems—$30 billion (Soni, 2010) Opioid pain medication use presents serious risks, including overdose and opioid use disorder
Between 1999 and 2015, more than 183,000 people in USA died from overdoses related to opioids.

By having a flexible spine with strong hips and thighs, the human body is ideally designed for movement such as walking, running, squatting, and claiming- throwing objects and swimming. Unfortunately, during the course of a person’s life, the sensory-motor nervous system continually responds to daily stresses and traumas with specific muscular reflexes. These reflexes, triggered repeatedly, create habitual muscular contractions which cannot be relaxed–at least not voluntarily.

If stressed, traumatized, overused and repetitively used muscles are required to continue to work, the muscle begins to tighten. Once this happens the contraction of the muscle constricts the blood vessels. This reduction of blood flow reduces the oxygen to the tissue. Once a tissue is oxygen deprived, it will shut down and tighten more. This creates a negative pattern of tension, oxygen deprivation, and more tension that ultimately results in rigid muscle tone. This results in one’s postural misalignment and muscular asymmetry with symptoms such as:

Chronically hard, tight muscles
Chronic tightness or chronic inflammation of a tendon(tendinosis)
Chronic joint tension or chronic inflammation
Limited range of motion in a joint
Impingement of a nerve resulting in numbness or a tingling sensation
Compression of a disc resulting in neck or back pain
Muscle weakness in one area especially if the muscle feels tight
Consistent muscle cramping
Joint instability while performing daily tasks
Recurring muscle strain or injury to the same muscles

Muscles needed to perform regular, daily tasks (such as sitting and standing) are what we call “functional muscles”. It is more important in daily life to have functional muscles than it is to have big, hard muscles. Functional muscles require more endurance than pure strength. The focus of restoring to maintain a healthy body is to increase the endurance of those muscles which are needed to function throughout the day.

The exercises which safely activate a natural reflex mechanism calming down the nervous system which releases muscular tension are based on restoring blood flow and oxygen to tissue.

Muscular tension release can be done by manual pressure that is applied to the most superficial layer of tissue where dysfunction appears (pain, tension or rigidity). Once the tight tissue is stimulated, blood flow to the area increases and the tight tissue will become suppler. This allows the therapist to access the next layer of tissue without applying excessive pressure. This pattern is repeated until all layers of dysfunctional tissue are restored and the tight, rigid tissue is replaced with supple and mobile tissue. Supple and mobile tissue will be free of pain and have a greater range of motion.

The ability to release muscular tension independently one must learn how to align their body and mind while experiencing an alert but relax state of awareness. The SykorovaSynchro Method℠ is a phenomenal educational tool with positive impacts to patients mentally, physically and emotionally and has three stages/ progressive levels:

To balance function of sensory-motor cortex via sensory stimulation mental imagery (sometimes called visualization, guided imagery), progressive muscular relaxation and control breathing. Result is relaxed but alert state of awareness.
To enhance sensory integration/ awareness of somatic movement (movement regulated by feeling, mental imagery, sensation). Result is ability to perform somatic/ intuitive movement.
Ability to perform conscious exercises – via mental imagery, sensation. Positive result is in neuro muscular conditioning/ function – postural improvement, balance, coordination, flexibility and agility.

Research has shown that when we imagine an experience, we often have similar mental and physical responses to those we have when the event actually happens. For example, if one recalls an upsetting or frightening experience, she/he may feel their heart beating faster, may begin to sweat, and hands may become cold and clammy.

In life it is very important to minimize the negative effects and maximize the healthy, healing aspects of the mind–body connection. Each person has a unique capacity for getting better, healthier, achieving peak performance and recovering from injury.

The mind-body connection means that one can learn to use his/her thoughts to positively influence the body’s physical responses, to create abilities to be aware of their own thoughts and actions in the present, without judging them self.

Physical activity has the potential to be not just an activity of the body, but a whole body-mind-spirit system. Exercise can create a unique, beneficial mental state; and the positive mental state can enhance the benefit of exercise as a part of muscular release tension plan, which reinforces the perception that exercise is just an out of body experience. We have to remember, that our bodies are made to feel good and has abilities to heal.

A unique water exercise program based and structured on those principles will teach you to release tension, increase mobility and build endurance in muscles, tendons and joints. Those physical exercises are performed with an intense focus to utilize four principles such as breathing, proper form, control and concentration.

Exercise is performed with controlled breathing that utilizes full inhalations and full exhalations that follow a specific number of counts or rhythm. The goal is to learn how to breathe at a pace of 6 breaths a minute, about 3 or 4 seconds inhaling and 6 or 7 seconds exhaling. Once we have the slow, deep breathing accomplished, we don’t have to worry about counting and imagine breathing out any tension in the body or thoughts that get in the way of comfort and relaxation. The benefit of the water environment is tremendous. Hydraulic pressure increases human vital capacity in shoulder depth immersion 7x more than air, which promotes deep breathing and natural relaxation.
Exercise is performed with proper form or in precision. Quality of movement counts more than quantity in a mind-body exercise. Precision requires mental control. The mind has to be wholly focused on the purpose of the exercises as you perform them. The sensation of water on the skin is enhancing biofeedback’s, which helps with proper form greatly.
Neuromuscular exercise always involves the control and balance of your own body-weight. In water exercise we have interplay between gravity and buoyancy, weight and weightlessness. Control of the body can become challenging and at the same time very beneficial for overall success. By implementing movement patterns in a variety of directions, we stimulate and enhance balance, coordination, and flexibility, and inspire the neuromuscular system to become more expansive and creative. Moving in different speeds is an aspect of our physical capabilities that must be practiced in order to maintain a sense of health and well-being.
Releasing Movement is performed with intense concentration on yourself, in the present moment. The mind-body exerciser is focusing on his/her body rather than on the instructor, or on other participants. One should never be day dreaming about other things. The point-of-focus in a self- sensing exercise will differ from most other forms of physical exercise. One should be thinking about stabilizing, or anchoring, the area of the body that is NOT in motion. This is contrary to the usual Western method of trying to isolate the muscles that we perceive to be performing the movement.

Working as a health-fitness professional for the past 30 years, I am sensitive to the overall health of students/clients, and I continue to put research developments into practice. The focus in fitness these days for “Active Aging”, “Athletic Recovery”, “Chronic Pain Management”, “Healing with Release” are functional exercises – exercises that simultaneously use multiple muscles and joints to improve muscular endurance, overall strength, coordination, balance, posture and agility – to get a challenging, effective and fun full-body functional workout as well as prepare the body for every day, real world activities.

Reprinted with permission from Dr. Maria Sykorova Pritz and the Aquatic Exercise Association (AEA). The AEA is the leading educational agency in water fitness and is reaching health-fitness professionals in aquatic field. This article first appeared in the August/September 2018 issue of their AKWA magazine.

Dr. Maria Sykorova Pritz Ed.D earned her doctorate in education (specialty in Physical Education and Sports) from University Comenius in Bratislava, Slovakia. Maria is an ATRI faculty member, member of AEA Research Council, author of health fitness articles and FLS CE class, presenter for national and international fitness conferences. In her 32 years of professional career Maria is combining academic knowledge with hands on experience in functional fitness, pain management via land based and aquatic fitness. Maria’s unique training method (SykorovaSynchro Method℠) involves integration of multidisplinery techniques to achieve overall health and optimized performance. Maria is an ATRI faculty member, member of the AEA Research Committee, FLS continuing education developer, author and presenter.

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Why For Boomers and Seniors, Price Is Not An Issue

Dan Ritchie/26 April 2019/ All MFN blog/

Watch as Dan Ritchie, co-founder and president of the Functional Aging Institute, discusses why price is less of a concern for boomers and seniors and what is of more value to them than the price itself.