At Active, we’ve partnered with MyZone to enhance our proprietary heart-rate based training program, The ZONE because we know how important heart-rate training is for our members, and it’s helping our bottom line as well.
Three sets of ten repetitions of pushups.
How long should repetition be?
How much rest should occur between each repetition?
How much rest should occur between each set?
How should the push up be performed?
How would a trainer determine the dose of this exercise was appropriate?
How would a trainer know that the total amount of exercise for a given exercise session was tolerated well by the client?
The dosing of exercise can be an uncertain process with lots of assumptions and guesswork involved. Often the trial and error nature of prescribing a dose of exercise can lead to a client not feeling so good… either during the session, or after. It is definitely no fun to have a client start feeling unwell during a session, or come back following a session only to report a couple days of misery due to soreness and malaise.
An understanding of the relationship between homeostasis and allostasis can inform the exercise prescription dose.
Homeostasis (n.) the tendency toward a stable equilibrium between elements of a system, especially as maintained by physiological processes. The inherent inclination of the body to seek, and maintain, an internal condition of balance, equilibrium, and ease, within its internal environment, even when faced with external changes. Energy conservation and efficiency. Normative. Homeo=same and stasis=not moving.
Allostasis (n.) the intrinsic process by which the body responds to stressors to regain homeostasis. Maintaining stability through change. Adaptive system responses. Coping.
System element excursion in reaction to a stimulus/demand.
It is critical that the exercise professional take a thorough personal health history in order to gather information that directs physical assessment process. Past and current medical conditions, prior injuries and surgeries, life stressors, and activity history can give insights into the overall state of the clients system. This insight may give rise to precautions to physical assessment, and create a conservative frame for asking the client to undergo the physical stress of exercise, both systemically and locally.
A physical assessment can give quantified data points, and qualitative information, that leads to a better understanding of the client’s bodily tolerance potential to mechanical and chemical stressors experienced during and after exercise. This is referred to as the Allostatic Load of the client.
Allostatic Load (n.) the accumulative damage of the body’s cells as an individual is exposed to repeated acute and/or chronic stressors with inefficient regulation of the responses within cells. It represents the physiological consequences/costs of exposure to fluctuating or heightened neural or neuroendocrine responses that result from repeated acute or chronic stressors. This leads to maladaptive system responses. Protective responses that are on too long, not down regulated properly, or cycles of normal hormone change throughout the day, or the response didn’t come on line at all to govern the process of change.
Allostatic Load can accumulate and the overexposure to neural, endocrine, and immune stress mediators can have adverse effects on various organ systems, and their response and return to subsequent stressors, leading to dysfunction and disease. (5)
Greg Mack is a gold-certified ACE Medical Exercise Specialist and an ACE Certified Personal Trainer. He is the founder and CEO of the corporation Fitness Opportunities. Inc. dba as Physicians Fitness and Exercise Professional Education. He is also a founding partner in the Muscle System Consortia. Greg has operated out of chiropractic clinics, outpatient physical therapy clinics, a community hospital, large gyms and health clubs, as well operating private studios. His experience in working in such diverse venues enhanced his awareness of the wide gulf that exists between the medical community and fitness facilities, particularly for those individuals trying to recover from, and manage, a diagnosed disease.
REFERENCES
An exercise management program specifically designed to attack Parkinson’s disease can help you reduce falls, improve energy, and restore function so you can live a normal, independent, and productive life.
Medical exercise and medical fitness professionals can guide you in using exercise to recover a happy, fulfilling, independent life with this condition.
I know this because I have witnessed exercise win. I have seen people claim victory. I have seen them take their life back from the thief called Parkinson’s (keep reading and I will share a story with a great ending)
Just to familiarize you, Parkinson’s is a progressive neurologic disorder that affects 1% of the population over 50. The condition progressively destroys cells in the brain that produce dopamine, a neurotransmitter controlling movement. Parkinson’s is characterized by tremors, postural instability, impaired movement, rigidity, a shuffling walk, difficulty moving the body, and speech impairment.
The Parkinson’s posture is characterized by an excessive forward head drop, rounded shoulders, forward trunk lean, and side to side shuffling. This posture is very taxing on the body and leaves its afflicted depleted of strength, energy, and confidence in their body.
Falls are a major concern with Parkinson’s disease as the body loses its ability to “catch” itself if it starts to fall. A person will experience decreased reaction time, and a feeling of “slowness”, making it very easy to fall and sustain serious injury.
If I just described your daily struggle, there is GOOD NEWS!
An exercise management program specifically designed to attack Parkinson’s disease can help you reduce falls, improve energy, and restore function so you can live a normal, independent, and productive life.
Let’s discuss the components of an effective exercise program for Parkinson’s and how it can benefit you or your loved one.
Parkinson’s disease (PD), reduces the tone (or pull) of the extensor muscles (helps you stand upright). Consequently, when walking, the PD client takes shorter steps and his/her posture is stooped with bent arms, bent knees, and a forward falling head. Over time, this flexion posture (leaning forward) results in further weakening of the extensor muscles (helps you stand upright), and it becomes more difficult to fully stand upright. Joint and muscle stiffness discourages movement, and eventually, the tissue around the joint shortens and restricts movement. Flexibility training improves joint function, reduces stiffness, and improves mobility.
I recommend you focus on the following areas for stretching:
Gentle strengthening exercises for your extensor muscles (muscles that hold you upright) are super important because they counteract the flexion (forward lean) tendency seen in PD. Extensor muscles of the body include calf (gastrocnemius), anterior thigh (quadriceps), buttocks (gluteals), back (spinal extensors), back of the upper arm (triceps), mid-back (posterior shoulder girdle) and back of the neck (neck extensors). With this, the muscles included in hip extension, external rotation, and abduction are vitally important to improving balance and gait and preventing falls.
The benefits of improving your muscle strength and endurance include:
Rigidity can reduce your ability to inhale and exhale your breath. Additionally, PD may cause decreased chest expansion, slowed movements, fatigue, and poor endurance during prolonged activity. Aerobic activity has been shown to be extremely beneficial for improving cardiovascular and respiratory fitness, as well as the generalized health of the PD client. You want to perform aerobic (or cardiorespiratory) exercises involving large muscle groups to increase your heart rate, thereby improving cardiorespiratory function. Aerobic exercise is most beneficial when started early in the disease process.
Some great ways to perform CV exercise include:
Incorporating postural and balance training into your exercise program cannot be emphasized enough. Parkinson’s pain, stiffness, and lack of muscle strength disrupts your ability to perform efficient, controlled, and coordinated movements like walking. Awkward movement and postural patterns, like side shuffling, will require more energy and will increase your fatigue, resulting in decreased body stability and increased risk of falling.People with PD may develop new postural problems elicited by the disease, or the disease may exacerbate old postural problems. Poor posture fatigues the body. Injury can occur if proper body mechanics are not utilized. Therefore, it is very important that you learn what healthy posture is and how to maintain it throughout your daily activities and during exercise.
Postural training is highly beneficial as it:
Postural exercises should focus on increasing your awareness of proper posture and teaching you how to achieve and maintain correct body alignment with all exercise. Proper body mechanics should be a component of the total exercise program. Your program should emphasize sitting, standing, and walking tall. Include techniques for bed mobility tasks, getting in and out of chairs, descending and rising from the floor, and exercises involving proper use of the back muscles in tasks of daily living/lifting, etc.
Body awareness is another component of posture training. This means learning how to observe and listen to your body. People who are aware of their bodies are more likely to recognize incorrect positioning and movements that could unnecessarily stress a joint, increase muscle tension, or increase risk of falling. They are also better able to avoid overexertion.
Prior to activity, you should go through an alignment checklist from foot to neck focusing unloading your joints and using the right muscles to stand. You can practice this in front of a mirror to visually learn how to adjust your body.
Check out this great diagram (right) from the Mayo clinic that illustrates some postural checkpoints to focus on during walking.
Activities that enhance postural awareness go a long way toward improving your ability to recognize and correct postural problems.
As you read at the beginning of this article, Parkinson’s attempts to steal freedom people by overwhelming them with frustration, grief, or fear of living as a slave to a disease for the rest of their lives. However, as you can see, exercise can set you free. Exercise can teach your body to move right again, and exercise can teach you the tools you need to fight back and reclaim your freedom.
Trevor Wicken has been practicing as a Medical Exercise Practitioner for almost two decades and has a Bachelors degree in Sports Medicine and a Masters Degree in Exercise Science. He is certified as an elite trainer through NASM and has spent his entire career passionately helping people to use exercise and movement to reduce pain, prevent injury, and manage medical conditions.
Did the title of this article capture your attention? It should because surgery, no matter how big or small, is serious business. The type of surgery this article is speaking to is orthopedic surgery. This means surgery due to pain, disease, and dysfunction in your muscles, tendons, ligaments, bones, and joints.
Maybe you, or someone you care about, have been told that surgery is necessary. You have done what the doctor suggested. You tried Physical Therapy. You went beyond that, and tried massage, acupuncture, chiropractic, drugs, and other alternative interventions. Why would avoiding a surgery even come into your mind? You are in pain, the doctor said you need it and that should be the end of the discussion right?
It’s a tough decision with uncertain consequences. Second and third opinions are recommended.
There might be several reasons why you want to avoid it; the thought of someone going in and “cutting you” (surgery is really a controlled injury), the risks associated with being put under anesthesia, the long recovery time and disruption to your life routine post surgery, you know someone that had surgery and months later are still not feeling much better, or they may be suffering complications from the surgery itself.
You have doubts.
Maybe you have read the recent research that concluded that a very common surgical procedure on knees actually showed more long term harm than good. (1)
Have you read the research that shows that there are many individuals with a diagnosable orthopedic disease that don’t report pain? And there is research that shows that some report pain and nothing can be found wrong that directly explains the pain. (2) (3)
Maybe you will need the surgery. But is there one more conservative non-surgical alternative that you haven’t tried yet?
There is… Exercise.
But wait, you already did exercises at the physical therapy clinic. Even the chiropractor gave you some stretches and rubber bands to tug on and that didn’t work.
Here is the problem. All exercise is not created equal. What may work for one person doesn’t work for another. Why is that?
Because every pain situation, just like people, is unique.
Pain is a word. When you choose to use the word pain to describe a sensation in your body you are clearly elevating the level of concern you have for the sensation.
Pain is not a thing like a brick, cat, glove, or car. Pain is the brain’s conclusion about all of the information it is receiving and processing from within the body moment-to-moment.
If you are considering surgery because you are experiencing a sensation that you choose to use the word pain to describe, then in a sense you are having surgery to remove the pain right? Which is weird because pain isn’t a thing to be removed, as it is simply a word chosen to describe a subjective conclusion based on bodily information. So a surgeon doesn’t remove pain with a scalpel, they remove the body part that they think is causing the pain. Sometimes this works great. Sometimes it doesn’t. See previous references.
What the surgeon is doing, what the drugs are doing, what the spinal manipulations are doing, are changing, or at least trying to change, the information that the body is producing to see if changing the information that way will lead to a new conclusion of the brain.
Change the information and possibly change the conclusion.
Back to the exercise thing.
What is exercise? It is stimulation to, and of, the body that changes the information within it. Sometimes those changes are short term and sometimes they can be of a longer term.
But you tried exercise in physical therapy and with the chiropractor and it didn’t help.
As stated earlier not all exercise is equal. Often exercises are just given to work on the area of the body that hurts. This might not be the best way to change the information. Exercise has very specific influences on the body depending on HOW you do it. The old adage “Just Do It” is painfully inaccurate advice. We need to know the quantity but also need to know the quality of your experience with different exercises.
Pain is a subjective experience that, at least right now, does not have an objective measurement like temperature, pressure, and distance. Your pain is totally unique to you and cannot be experienced by anyone else. Pain has a component of quality associated with it. It certainly can have a cause like when you break a bone, cut of your skin, tear a muscle, or sprain a ligament. But sometimes the cause is not so clear-cut.
So what am I proposing? What could be the thing that you haven’t tried yet?
A different approach. A totally different strategy. A more precise HOW.
I am talking about exercise that is highly catered and highly specific to your unique body.
Your body has its own unique history, a unique genetic profile, a unique combination of diseases and dysfunction, all of which confluence towards a unique problem. This requires a completely unique solution. A completely unique HOW.
This unique strategy and HOW is based on some simple concepts.
If number 4 is true then it stands to reason that any part of your body’s information generation and processing can affect any other part’s information. You may good at contraction shortening but are not so good at contraction lengthening.
If number 5 is true then a good way to see if you actually have control and assess the information control is my assessing your ability to do number 3.
Given the fact that your body is completely unique from any other body, this means that any strategy and HOW must be created to explore your unique information control system and any influences between parts. See number 6.
This is what Muscle System Specialists are trained to do. To systematically explore your information control by assessing your muscles’ ability to hold joint positions and change joint positions via lengthening or shortening contractions. This tells us about the quality of you information generation and processing.
The challenge is to find those places and conditions. You have roughly 600+ muscles and are capable of being in a dizzying array of positions and motions.
It’s okay – we have a process to explore your unique body’s abilities and start discovering the solutions it needs in order to change its control, to change the quality of information within it that just might lead to a change a reduction in pain.
Can you avoid surgery? Maybe. You have to decide if it’s worth some time and effort to exhaust conservative non-surgical options. Always speak with your doctors regarding this important decision.
Greg Mack is a gold-certified ACE Medical Exercise Specialist and an ACE Certified Personal Trainer. He is the founder and CEO of the corporation Fitness Opportunities. Inc. dba as Physicians Fitness and Exercise Professional Education. He is also a founding partner in the Muscle System Consortia. Greg has operated out of chiropractic clinics, outpatient physical therapy clinics, a community hospital, large gyms, and health clubs, as well operating private studios. His experience in working in such diverse venues enhanced his awareness of the wide gulf that exists between the medical community and fitness facilities, particularly for those individuals trying to recover from, and manage, a diagnosed disease.
Charlie Rowe, CMSS joined Physicians Fitness in the fall of 2007 after spending 9 years as the Senior Personal Trainer at Oak Hill Country Club in Rochester, New York. He has also worked within an outpatient Physical Therapy Clinic coordinating care with the Physical Therapist since joining Physicians Fitness. Charlie has earned the Cooper Clinic’s Certified Personal Trainer, the NSCA’s Certified Strength and Conditioning Specialist, the American College of Sports Medicine Certified Health Fitness Specialist, Resistance Training Specialist Master Level, and American Council on Exercise Certified Orthopedic Exercise Specialist Certifications.
References
As a kinesiologist who specializes in exercise programming for older adults, I am often asked which exercise is the most important to do regularly.
Well, you might not like my answer! An older adult who wants to live an active and exciting life needs to be a “Jack Of All Trades” when it comes to exercise, making time for many different training techniques. Here’s why:
As we get older, the aging process takes a toll on most physical functions, such as muscle strength and cardiovascular endurance.
A way to illustrate this is through “Aging Curves”. Look at this illustration (below) and see how function improves early in life as we grow and mature, then begins to decline during adulthood. The amount of decline is not set in stone and is modified by our lifestyle choices. Research has demonstrated that function declines more slowly in those who are physically active (red curve) and declines more rapidly in those who are sedentary (blue curve). Without a doubt, staying active is the key to an active and exciting older adulthood!
However, there is no single exercise that benefits all parts of the body. So, in order to keep any of our aging curves from plummeting to the disability threshold, we need to include exercises for cardiovascular fitness, muscular strength/power, flexibility, balance, and agility in our training programs. Or, put it in another way, we need to become a “Jack of All Trades”!
Are you a fitness professional interested in learning more on this topic? Check out Dr. Thompson’s 4 hour course with PTontheNet, Exercise Programming for Active Older Adults.
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.
The biggest question fitness trainers need to ask themselves is “Why do you want to work with the chronic populations?” Is it because:
a) The stats (IDEA, IRHSA) out there say it is the fastest growing population/market?
b) You really want to help people that tend to have multiple issues because it is rewarding?
c) You feel drawn to it because one of your clients now has a condition?
d) You like figuring out puzzles?
e) All of the above.
All of the above factors play a role in working with chronic conditions. It takes a much different approach than working with the general population. For starters, what defines a chronic condition, besides something that is ongoing?
The Center for Managing Chronic Disease defines it as such:
“A disease that persists for a long time. A chronic disease is one lasting three months or more, by the definition of the U.S. National Center for Health Statistics. Chronic diseases generally cannot be prevented by vaccines or cured by medication, nor do they just disappear. Eighty-eight percent of Americans over 65 years of age have at least one chronic health condition (as of 1998). Health damaging behaviors – particularly tobacco use, lack of physical activity, and poor eating habits – are major contributors to the leading chronic diseases.”
What I find so fascinating is in the last sentence: “health damaging behaviors”. That is the core of working with chronic conditions; you want to impact a person’s or client’s health damaging behavior. If they are coming to you with a condition, we already know they have one, if not more, behaviors that need to be addressed and changed. This means you not only have to work with the biomechanical/physical implications of their condition, but the emotional/psychological aspects of it as well. Welcome to the world of medical exercise, a very rewarding and extremely challenging area of the fitness industry–a part where you will need to wear several different hats: health coach, sleuth, guide, emotional supporter, cheerleader, and fitness professional. Therefore, you need to be prepared.
Start by deciding which medical conditions you are interested in; a great list can be found at Chronic (Medicine) on Wikipedia. Next, find out if any of these support organizations offer a certification–National MS Society, Arthritis Foundation, and Cancer Training Institute are some out there. Visit websites and request information. Most support organizations have a lot to offer on their websites, or try googling the condition itself. It may take some time, since with search engines today advertisements tend to come up first. Research support groups in your area, and ask to attend a meeting. This will expose you to the emotional side as well as the physical limitations of their condition, and what difficulties they face on a day to day basis. This will aid you in designing an appropriate exercise program for their specific needs. Read, read, and read some more, and then be critical. A lot of information is very general; dig deep, and if an article or website does not have the information you need, ask a professional.
As a certified fitness professional, I did not go to medical school or physical therapy school, nor do I have a degree in nutrition. But I have learned a lot over my 20+ years working with special populations–and as a person who has fibromyalgia–but I don’t come close to knowing enough. As clients with conditions come through my door, many on numerous medications with eating habits that would make most trainers cry, medical questions come up. For example, “Can I eat dairy products if my medication says not to take calcium supplements with it?” Or “I find every time I walk upstairs I get out of breath–does that mean it is my condition or am I just out of shape?” And “Have you heard that Maltitol is bad for you, and what is Maltitol?” At this point, unless I feel there is a huge medical issue that needs addressing (then they get sent to their doctor immediately), I contact the appropriate person on my board and ask them the question. The board also helps with disseminating and understanding clinical test results that clients give me, or any other physiological question that is beyond my knowledge. It also builds your credentials as a professional when dealing with the medical community.
Most fields in the medical community are clearly defined by a scope of practice. From having spoken with more than a few doctors, they are very hesitant to refer to personal trainers, mostly because of injuries as a result of improper exercise programming or what they have observed in the gym. In the medical fitness industry, it is even more imperative to be precise and transparent with what you are doing. When a new client comes to me, I contact their doctor or physical therapist–usually via e-mail or letter–detailing what I have found from my assessment, the condition, and what kind of program I am designing. This gives them the opportunity to comment or change it accordingly. It also opens up lines of communication. The professional knows I am not going to have a spinal fusion client performing kettle bell swings right out of the gate; they will see my progressions and know that if something is off, I will refer back to them.
One of the hottest issues in the fitness industry is licensing; for it, against it, I am not going to argue it here, but as a fitness professional, I need to make sure I do not prescribe or diagnose. Even if I am 99.9% sure a person has impingement syndrome because of all the presenting symptoms, I am not going to say it. I am going to refer them to a medical professional. Especially with this population, there are a lot of cross over issues, and it is not our responsibility to diagnose but to help manage and improve their condition.
Working with chronic conditions requires a lot of empathy and the ability to set boundaries. You need empathy more than sympathy; if you cannot get inside what they are going through pain- and limitation-wise, it will be hard to establish trust. Establishing trust is the biggest tool you can develop–my clients trust I will not hurt them, make them worse, or ask them to do anything they cannot accomplish. If you get the opportunity to attend a support group or speak with people who have chronic conditions, most want to get better, but don’t know how. They are afraid of making things worse; even the avid exercisers who have tried to “fight through the pain” find it doesn’t work, and are at a loss as to how to proceed. You have to understand how life changing their condition is, where they started, and where they are right now. It can help to take courses in health coaching or read up on behavior modification– even better if you can find something geared toward the specific condition you are dealing with.
Avoid the “over-empathy” trap, because people with chronic conditions can use it as a crutch, too. Balance in sessions is important; include activities they really like to do in with the exercises they hate.
I guarantee the exercises they hate are the exact ones they need to do the most! Offer rewards, if they do their homework exercises, or it could be just to get through a session. It can be difficult to manage both their emotions and their physical selves; if you don’t feel prepared, refer to an outside professional. Yes, you may lose your client, but in the long run, it gains you credibility and more trust.
Recharging and recovering are the new buzz words in the health and fitness industry. It is even more important in the chronic condition realm, for both clients and professionals. More than in any other population, chronic conditions will sap your energy, your strength and sometimes your emotions. Most of this community will not see huge improvements like general exercisers; in some instances you will observe regression. They will have good days and bad days; they have challenges every day of their lives–just getting out of bed and getting ready for the day can seem like climbing a mountain. Then we come through the door and want them to do exactly the last thing on earth they want, which is to move more. They may be cranky, and in the case of depression or mental illness, downright nasty, leaving you to pull all your happy tools out just to make it through the session. In this case, what do you do to recharge your batteries? Funny as it seems, pay attention to the advice you are giving your clients–often times it can go both ways. I tell my clients to meditate, get a massage, plan a fun outing, or simply review their happy journal. These are the exact activities that recharge me!
It is easy to work, work, work, and this clientele is more demanding of our time and attention. Don’t ignore yourself; make sure you work in time to rebalance. Put it on your calendar as faithfully as you do your workouts or doctor’s appointments. All work and no play will bring on the exact condition in yourself that you are working hard to alleviate. If you really want to serve the chronic condition population, lead by example, and make time to recharge.
Sharon Bourke is an MFN member and the owner of Life Energy Fitness. At Life Energy Fitness, her goal is to identify where the compensations are and to help your body relearn proper movement patterns. The results are more energy, less chronic pain, an ability to participate in activities you love, and to prevent other problems from forming.
A number of years ago, I applied for a job as a personal trainer in a gym. During my interview with the manager, he called me “book smart.” It wasn’t a compliment, since he was suggesting that I only knew the information in books, and that what really mattered was a person’s experience. “We really want someone who has been doing this for a while,” he said, before sending me on my way. Ouch. I left the interview frustrated, because it seemed as if my education precluded the gym manager from seeing what I could do. Or perhaps I hadn’t shown him. I had not yet proved to him that I was more than just book smart, that I could actually use my education to train someone to get fit and lose weight.
Knowledge alone is not power. One must be able to apply the knowledge one has. This is where a formal education fails us. I have met many brilliant scientists who have no idea how to train someone. (I once spoke to the scientist who studied cyclist Lance Armstrong for years in his laboratory at the University of Texas, and when I asked him about Lance’s training, he acted like a deer caught in headlights.) Universities do a great job of supplying us with knowledge, but a poor job of showing how to apply that knowledge. That part is up to us to learn on our own.
Too much of the knowledge gained from the great research done by my academic colleagues remains in academic circles, never reaching the fitness professional or the general public. Academic conferences are nothing more than scientists communicating their research to other scientists. Scientists need to do a better job at communicating the results of their research to the people who can benefit from it and showing them how to use it, and fitness professionals need to do a better job at acquiring and applying the education. It is not enough to know how muscles contract; we need to know how to design and administer resistance workouts to help our clients’ muscles get stronger and look better. It is not enough to know how the heart works; we need to know how to design and coach workouts to help our clients’ improve their cardiovascular systems.
Wouldn’t it be great if all fitness professionals were required to have an education that consists of book knowledge and practical knowledge? The latter can be obtained from “rotations” akin to those in medical school. We would all spend a couple of years taking the science courses and then do rotations in health clubs like medical students do in hospitals, to learn how to work with different populations and conditions. Upon graduation, we either become a fitness general practitioner or choose a specialty. I choose running. But you already knew that.
Reprinted with permission from Jason Karp.
Jason Karp is the creator of the REVO2LUTION RUNNING certification, 2011 IDEA Personal Trainer of the Year, and recipient of the 2014 President’s Council on Fitness, Sports & Nutrition Community Leadership Award. A PhD in exercise physiology, he has more than 200 publications, mentors fitness professionals, and speaks around the world. His sixth book, “The Inner Runner”, is available in bookstores and Amazon. Visit his website, Run-Fit.com
Parkinson’s Disease is a brain disorder that causes individuals to have difficulty with balance, coordination and walking. They can also become shaky or stiff and some people even develop tremors. It is a common disease that can….
I hope to give you some insights to both how the human body works as well as why medically-based fitness is not only valid, but absolutely necessary to reverse, assist, or prevent various chronic and acute disease conditions. Wow, that is a “mouthful” to say the least. I feel so strongly about this perspective that I hope to create the Adaptive Health Model as a major “brand” of fitness. My company (Principle-Centered Health) for the past couple of decades has always had a systems-based approach to health and fitness. This approach ties a lot of different facts into a common theme, usually called a theory in science. Even my dissertation looked at how people adapted to the physical, mental and social issues in their lives using exercise, self-efficacy, and social support, respectively, and levels of strain and burnout. How humans adapt to the stresses put on them is very specific and can go in good or bad directions.
Like most theories, paradigms or what people consider “original thought”, this “adaptive” paradigm builds on the “regenerative medicine” framework, and some disease models; thus, is not original at all. What may be new, or unique about the adaptive perspective is taking the old phrase from physicist Isaac Newton and his third law of motion, “for every action there is an equal and opposite reaction.” The body will respond to stresses by reacting in a “defensive” manner. If we break something down, the body builds it up (opposite reaction). If we are too low or too high in some function, the body will try to correct this. This negative feedback loop controls most systems in our bodies. I have often described our bodies as fragile but resilient. It is our fragility that signals the resilience to kick into gear!
Luckily for us, fitness is based on this exact principle. If we do endurance training, we are going into a lower oxygen state and there are many mechanisms or functions that kick in (sympathetic nervous system) when we push or stress our bodies. The body is responding to what is known as an “acute insult” by increasing the ability to transport and use oxygen, so that this “insult” doesn’t hurt us next time. The same “specificity of training principle” occurs with resistance training. We breakdown muscle and the body builds it back stronger to tolerate that “insult” the next time. When multiple acute exercise stresses are added up, the body changes and we call this “training”.
If stresses are really high, either too intense, too long, or too often, the body gets injured due to this overload, or it needs a lot more time to heal back up. This is why overload needs to be done gradually and progressively. Even our brains use this idea as a guiding principle. We push our mental capacities to learn more, but if we stress it too much, it will repress memories or shut down (burnout).
This same principle applies when we give our body bad things, or a lack of good things, it adapts with a dysfunctional state or disease state. Chronic inflammatory diseases, diabetes, metabolic syndrome, coronary artery disease, emphysema and heart disease are just a few of the examples of how the “garbage in and garbage out”, or “use it or lose it” works. If we sit and work at the computer too much we develop dysfunctional postures and upper cross syndrome may develop. If we do not constantly stress some system, it reverses the training changes, and goes into the “default” state, which is untrained and unable to respond to daily stresses. We simply need to obey our bodily blueprints, we need to constantly use our bodies to maintain function, and overload it to improve function. We need to have the right nutrients in place to allow this to happen, and then basically – get out of the way!
The perspective being proposed in this article shares much with the more holistic medical practices. The human body is really good at healing itself when is it given the right factors to do so, and when we “get out of the way” for it to do so. I know many people who strongly believe in using alkaline water to “cure their ills”. They believe that the body does not know how to regulate itself with its own pH. Most of these same people don’t know what pH even stands for! They don’t know that it is actually the inverse log of the hydrogen ion concentration relative to the hydroxide ions, and that the respiratory system and renal system will go into action as soon as blood pH goes 0.05 pH units high or low!
In other words, these people believe their own bodies are naïve or incapable of curing itself, and like a young child or baby, their body needs constant care and guidance. Most people are so stressed about “taking care” of their bodies that they are doing more harm than good via the stress hormones, especially cortisol being constantly secreted and their adrenal gland is getting fatigued. In reality, the body is really good at healing itself, when we keep it strong and in good operating condition (via exercise and movement) and when we give it the right components to do the healing (via nutrition), and we get out of the way of the immune system (by managing our daily stress levels).
The mind works very much like a muscle. It must be trained and kept strong and when injured it will react in dysfunctional ways, and fight to protect itself. I recently heard an expert in human behavior change speak on how to keep a resolution. He said, we can’t keep a resolution without changing the underlying behaviors which caused the bad habit or lack of a good habit in the first place. By changing the way we think, we change the way we act, and changing our actions will change the way we think!
The quote often stated by Thomas Edison in 1903, which was to give rise to the HMO concept, “The doctor of the future will give no medicine, but will interest his patient in the care of the human frame, in diet and in the cause and prevention of disease.” Medical doctors (M.D.s) upon completing medical school and prior to practicing take the Hippocratic Oath, which is to do no harm. Even back in Ancient Rome, Hippocrates understood the importance of individualized medicine and the power to “get out of the way” (#5) and give the body what it needs to take care of itself. He had five rules that are still relevant in today’s medical practices.
A philosophy of practice using these practices is integrative medicine. A brand of medicine created or at least popularized by Andrew Weil. The University of Arizona has this “brand” of medical school. Again, the academic requirements are similar to the M.D. and D.O. but expands its scope to other areas. From the website, Integrative Medicine (IM) is defined as a “healing-oriented medicine that takes account of the whole person, including all aspects of lifestyle. It emphasizes the therapeutic relationship between practitioner and patient, is informed by evidence, and makes use of all appropriate therapies. many different ways in the patient.
A new type of medicine is emerging from this functional perspective which is called personalized medicine. Again, the two are basically two sides of the same coin.
Figure 1: A diagram above showing the greater scope of each medical perspective- Integrative and Functional medicines are close in their holistic perspectives, with differing points of emphasis
Sometimes disease hits simply because we were genetically predisposed to get it. However, very often if our system is strong and in good operating condition, we resist it from every occurring or overcome it quite quickly. Cancer is a prime example of this. We all have cancers in our bodies all the time. It is the strong immune system that fights it off. This is amongst the reasons that many, many chronic diseases hit us when we are old. The various system have lost their capacity to fight the dysfunction off, or recover from its destruction. Soon cell death (necrosis or apoptosis) or neoplastic (cancer) growth kicks in.
Many, many chronic conditions that the MedFit Network and MedFit Classroom address are helped by exercise and diet because the ability of body to adapt and regenerate itself is enhanced. Most systems in our body fall under the “use it or lose it” scenario. High sugar, alcohol, smoking, and lack of movement are culprits in our health. Our body is not designed for an overload of these factors and across time, many different symptoms will develop because our body can no longer compensate or regenerate.
It is important for the medical fitness professional to understand the power of exercise and nutrition, and the proper application of these tools given the client’s or patient’s current condition. The field of physical therapy developed because many musculoskeletal conditions are helped by movement therapy or exercise. Many chiropractors believe that proper spinal alignment delivers proper neural signals throughout the body, which allows the body to optimize its regenerative capacity. Thus, an expert in medical uses of exercise to combat disease is critical to a healthcare team.
Dr. Mark Kelly Ph.D., CSCS, FAS, CPT has been actively involved in the fitness industry spanning 30 years as a teacher of exercise physiology at academic institutions such as California State University, Fullerton, Louisiana State University, Health Science Center, Tulane University and Biola. He was an exercise physiologist for the American Council on Exercise, a corporate wellness director, boot camp company owner and master fitness trainer.
References
Center for Integrative Medicine, Univ. of Arizona (n.d.). What is IM/IH? Retrieved from: https://integrativemedicine.arizona.edu/about/definition.html
Science Daily (n.d.). Personalized medicine. Retrieved from: https://www.sciencedaily.com/terms/personalized_medicine.htm
Good Reads (n.d.). Retreived from: https://www.goodreads.com/quotes/13639-the-doctor-of-the-future-will-give-no-medication-but
Kalish, N. (2018). Hippocrates’ Diet and Health Rules Everyone Should Follow. Reader’s Digest. Retrieved from: https://www.rd.com/health/wellness/hippocrates-diet/