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Trainers and Nutrition

It was 1995.  I sat on a panel at the Club Industry conference in Chicago and made a fully convicted argument that “personal trainers MUST talk about nutrition.” I had been told by assorted experts, club owners, and educators that ‘it’s illegal for trainers to talk about nutrition.’ Absurd.

In referencing that event from 20 years ago, I’m realizing how far we’ve come in the field of personal training. I’m also reminded of the Diet Ginger Ale Lady.

I was in the checkout line in Publix supermarket and the woman in front of me had only 3 items. She had 3 cases of diet ginger ale. Period. The cashier eyeballed her purchase and quipped, “you must like diet ginger ale.” The response was surprising.

“No, I don’t like it at all, but it’s a great diet!”

Now the visibly overweight cashier’s ears perked up, “Diet? How does it work?”

“Well, the ginger gives you all the nutrients you need and the carbonation makes you feel full, so for two days you only have diet ginger ale. On the third day you have all the soup and salad you want. You repeat the 2-day 3-day regimen until you’ve lost the weight.”

I was sure somebody was going to show up. Maybe the FBI. At the very least, the local police. After all, if it’s “illegal” for personal trainers to talk about nutrition, this woman had to be committing extreme violation!

No cops came. No SWAT Team or sting operation. The diet ginger ale lady left with her purchase and went on her way.

I share this to make a point. The advice people are receiving related to nutrition runs from relatively sane to outwardly dangerous. If we are going to guide our clients toward health, we have an obligation to help them make better choices.

I understand why some opted to believe that nutritional advice from trainers violated the law. Personal trainers without nutritional credential should NOT be prescribing diets, nor should they be recommending supplements. There are far too many risks, and in that, there have been lawsuits and judgments.

Let’s not, however, go to a full pendulum swing and prevent trainers from speaking truth.

I said earlier we’ve come a long way, and we have, and many trainers have become educated in nutritional practices, have aligned with software programs or continuing education courses, and the stigma is lessened significantly.

That doesn’t mean I believe the entire field of personal trainers should be spewing the nutritional beliefs they most attach to.

While many trainers have become responsibly educated, others haven’t and that presents a challenge.

My anecdotal experience has shown me that many personal trainers with limited education in clinical nutrition, marry themselves to one of two approaches and those approaches become a blanket touching each and every client.

  1. They adhere to the old school teachings of “calories in vs. calories out” and reference mathematical formulas to estimate “ideal” caloric intake.
  2. They profess that a bodybuilding type plan, generous in protein, and ample in both meals and energy substrates, is the way to go, failing to recognize the uniqueness of each client.

Many today scream Paleo, others yell Keto, and there’s very little unity.

Here’s my suggestion. While science will reveal new subtleties in food intake for specific groups, demographics, and performances, and food will continue to change as genetic modification, commercial livestock rearing, and food preservation techniques will challenge nature, the basics of “The Macro” won’t change.

  • Amino acids are the building blocks of tissue and we obtain them from dietary proteins.
  • Essential fats are essential with a host of vital benefits.
  • Starvation is NOT an effective weight loss strategy.
  • Processed foods will disrupt pancreatic hormones and metabolic processes if consumed often over time as staples in a nutrition plan.
  • Sugar intake can lead to a host of chronic and debilitating conditions If it isn’t well managed and kept modest at best.
  • Natural (organic) foods, grass-fed, pasture raised, and wild caught are going to provide more of nature’s “life force” than anything removed from sunlight, anything chemically modified, or anything hybridized for resistance to pests or weeds.

The bullet points are nothing but generalities, and this doesn’t pretend to be a complete list of important points, but a trainer equipped with some consistently valuable guideposts for their clients seeking health and betterment are certainly more powerful than those who avoid nutrition altogether.

Dr. Joel Fuhrman, Physician, Nutritional Scientist New York Times, Best-Selling Author

There are a great many leaders opening new doorways in the field of nutrition. One of them is Dr. Joel Fuhrman. We’re privileged to have him sharing his powerful insights at the MedFit Tour stop in Irvine, CA on February 9. It’s only one of the many reasons you should attend.

Dr. Fuhrman will share eye-opening research about the impact of fruit, specific vegetables, fats, and common foodstuffs on human health. . . and I guarantee two things. One, you’ll be blown away as so much of his study reveals the misinformation that plagues our population. Two, you’ll be far better equipped to deliver thrilling outcomes for your clients, whether you train athletes, regular folks, or the chronically afflicted.

Dr. Fuhrman is only one of a dozen extraordinary speakers slated to share insights in the wide-open and opportune field of Medical Fitness.  It’s the future. It should be a part of yours.

P.S. Here’s a gift, see Dr. Fuhrman live on video for free. Click here to access.


Phil Kaplan has been a fitness leader and Personal Trainer for over 30 years having traveled the world sharing strategies for human betterment.  He has pioneered exercise and eating interventions documented as having consistent and massive impact in battling chronic disease.  His dual passion combines helping those who desire betterment and helping health professionals discover their potential.  Email him at phil@philkaplan.com

lungs

Pulmonary Hypertension and Mind/Body Medicine?

To understand how Pulmonary Hypertension reacts to Mind/Body Medicine, you must understand what is going on biologically. Mind/Body Medicine, such as meditation and exercise, can help to give these clients a better quality of life. As a fitness professional, it is important to know how, when and why you are using certain mind/body modalities.

Pulmonary Hypertension is a very rare disease of the lungs and right side of the heart. Sometimes there is no known cause except a change in the cells that line the pulmonary arteries. There is no cure, so managing the disease is the best most people can do. Some clients may be on multiple medications, which is normal. The changes in the pulmonary cells cause the artery walls to be thick and stiff. Extra tissue may form and the arteries may become tight. Young individuals usually become diagnosed by the age of 36 and women are diagnosed more often then men. Each year, 10 to 15 people per million are diagnosed in the United States. It is important to note that life expectancy is about 3 to 5 years if not diagnosed and treated.

Hypertension, as most people know, is a blood pressure which is 130–139 over 80–89. Individuals with hypertension can usually come off of medications with eating healthy and exercising. There are instances where the client will never stop taking medications,  due to genetics. The client can eat healthy and exercise, but the blood pressure does not come down. A primary doctor may try to get the blood pressure under control, but can’t.

In this situation, the individual would be sent to a Cardiologist who specializes in Pulmonary Hypertension. There are four types of Pulmonary Hypertension and they each have their own symptoms and treatment. It is important to obtain a doctor’s clearance before working with this population.

Types of Pulmonary Hypertension

Group 1: Pulmonary Arterial Hypertension
This group is usually classified as having no known cause. It can be genetic or develop from someone having Lupus, Scleroderma or HIV. Symptoms for this classification can be chest pain, dizziness, fatigue, inability to exercise, low blood pressure, chronic cough, shortness of breath, swelling or swollen legs.

Exercise is very important for this group by strengthening the heart and lungs. Clients will initially go to cardiac rehab for four to twelve weeks. When rehab is over, remember to obtain a clearance prior to working with your client. Start your client out by doing their cardiac rehab program.  The goal is to strengthen the heart and help the client to build cardiovascular endurance.

Group 2: Pulmonary Hypertension due to left lung disease
The heart does not pump blood or relax effectively. Medications are used for this group to help lung functioning. Blood pressure medicine and diuretics may also be prescribed. The physician may also ask their client to lose weight or use a CPAP if they have sleep apnea.

Group 3: Pulmonary Hypertension due to lung disease
This group of individuals may have COPD, Interstitial Lung Disease, Sleep Apnea, chronic high altitude exposure, and pulmonary fibrosis. Treatment consists of improving lung function, proper sleep breathing and staying away from high altitudes.

Group 4: Chronic Thromboembolic Pulmonary Hypertension
In group four, clients have blood clots in the lung. The blood clot restricts blood flow causing hypertension. It is important to work closely with the client’s physician for this type of hypertension.

Overall, exercise is thought to be good for individuals with Pulmonary Hypertension. There are, however, some guidelines to follow. Clients should never over exercise or become overheated. If you are working with someone who presents with symptoms, do not exercise upper and lower extremities at the same time. Exercise in extreme hot or cold environments should be avoided.

Stress management techniques will not help with bring blood pressure or heart rate down. For these clients, it is important to concentrate on the symptoms. Many individuals with Pulmonary Hypertension develop anxiety, depression and chronic stress. Clients may sit in a chair or lie on the floor for mind/body classes. It depends on what is comfortable for each client. It is important that the client knows to not get discouraged because they are not seeing a drop in blood pressure.


Robyn Caruso is the Founder of The Stress Management Institute for Health and Fitness Professionals. She has 18 years of experience in medical based fitness.

References:

  • http://www.tsmihfp.com
  • https://pulmonaryhypertensionnews.com/pulmonary-hypertension-who-classification/
  • https://phassociation.org/medicalprofessionals/consensusstatements/exercise/
  • http://pulmonaryhypertensionrn.com/types-of-pulmonary-hypertension/
Health Care Collage Words Medicine Background

How Do You Define Health?

Health can be defined in a variety of ways.

  • The absence of disease.
  • The absence of symptoms of a disease.
  • The ability to achieve a specific health goal. (Weight loss or reduced medication)
  • The ability to achieve a specific life goal. (Travel or dance at your granddaughter’s wedding)

There’s no right or wrong definition of health. It’s all what’s of most importance to you. However, unless you take a moment to reflect on and define it for yourself, you may by default be guided by your physician’s goal for your health.

Their goal is well-intended and certainly well researched, however, without the understanding what’s most meaningful to you in terms of your health, you’re likely following a standard protocol. They may get you 90% of the way to your health, not realizing it’s the last 10% beyond the standard protocol that enables you to achieve what is most meaningful to you.

As we’ve entered into a New Year when health goals are more at the forefront of our minds, it can be an inspirational time to determine what health means for us.

A vision helps you determine what you’re aiming towards.

You can then communicate a clearly defined vision with your health care providers, so they can support you in achieving your goal.

So, what does this look like?

As a nutrition coach, I always take new clients through this process.

What goal comes to mind first?

Generally speaking, the most popular answer is weight loss. But nobody wants to lose weight just to have a lower number on the scale. It’s about what they can do when they’re at that lower weight. (Walk up the stairs without being winded, not need a seatbelt extender during a plane ride or feeling comfortable in a bathing suit on your anniversary vacation.)

Because I work primarily with individuals that have autoimmune disease, the motivations are much deeper. The obvious would be less pain, more energy and increased mobility. But when truly getting to understand each person, they share that they want to regain the ability to walk down the driveway to get the mail, have enough energy to do their own grocery shopping, or reduce pain so they can sleep better at night.

The latter goals have such great detail that your care team will want to get onboard in setting you up for success.

From here, you can best determine what providers and services you need most to achieve health in your terms.

This may also prompt them to offer more options for you in achieving your goal. It could be as simple as suggesting a session with a physical therapist to a mediation app that’s been helpful to other patients in managing pain.

Bottom line, you need to first define your vision for health and then clearly communicate that vision with your healthcare team – ideally starting with your primary care physician – so you can be supported with the best path to your health success.

Join Alene for her upcoming webinar with MedFit Classroom:


Alene Brennan has been featured in USA Today, Philadelphia Inquirer, Huffington Post and Mind Body Green. Alene overcame debilitating migraine headaches through diet and lifestyle and is now once again using a “Less Pharm, More Table” approach is managing her diagnosis of Multiple Sclerosis. Alene holds four certifications: Nutrition Coach, Yoga Instructor, Personal Trainer and Natural Food Chef. She also completed specialized training in nutrition for autoimmune disease specifically the Wahls Protocol and the Autoimmune Protocol. Since receiving her MS diagnosis and seeing first-hand the power of using diet and lifestyle to create a healing environment in the body, she dedicated her virtual nutrition coaching practice to helping people with MS and autoimmune dieseases take back control of their health. Visit her website, alenebrennan.com.

High intensity interval training workout

How Much High Intensity Exercise is Too Much?

Are you doing too much high intensity exercise? High Intensity Interval Training (HIIT) has been the holy grail of fitness trends for the past several years. Is it the Holy Grail for YOU? Here’s what a recent study says and how to interpret that if you’re a woman flipping (or wanting to) her second half with flare.

Exercise is stress. High intensity exercise is greater stress. Stress causes cortisol.

Cortisol plays two roles in our lives. It’s both the stress hormone and the energy hormone. The perfect amount of stress makes you feel alive and thrive. Too little or too much cortisol each causes problems.

When you’re exercising with the right amount of “overload” or stress you create a positive, not negative, stress response. That’s not to say (because I hear you saying that’s how you negate stress) that exercise doesn’t relieve stress. It can. But we sometimes don’t give ourselves the right dose, frequency or intensity to optimally relieve stress without having it come back to bite us you-know-where.

Better Stress

The key is to find your personal optimal exercise. I’m an advocate for the right exercise for you right now. Women in midlife are more susceptible to the negative effects of stress as they go through other major hormone changes. What worked once – even as recently as months ago or last week – may not be your ideal exercise this week.

That doesn’t mean you’re going to suffer, gain weight, get moody or any of the above. If you adjust your exercise according to what’s going on, respond to it even if you can’t predict what changes will be, you’ll sail through those years from peri-menopause to beyond menopause better. That sets you up for a full Flipping 50 (49-99) feeling as young as your habits will allow you. It’s habits that determine how your genetics express or suppress (epigenetics).

What’s the best exercise?  The answer is not the same for you and for every other woman over 50. We’ve got common denominators but your details are unique to you. If you’re deconditioned, conditioned, or an athlete it changes your exercise prescription. If you’re in adrenal fatigue, you’re estrogen dominant, or have low testosterone will change what I suggest you do. If you have osteoporosis, are trying to prevent it, or you have 20 or more pounds to lose, each of these (and more) will change the exercise plan that’s best for you.

A recent study of weight training performed as high intensity interval training (HIIT) was created to determine if HIIT weight training was better than traditional weight training. Researchers asked, is heavy weight training better than the moderate-to-light weight training recommended for decades?

A side note here: the fear of “bulk” from strength training is legit. The three sets of 10-to-12 repetitions taught for decades, as some kind of gold standard actually IS a bulk-building protocol. Ten or fewer repetitions is the optimal strength, bone building, and fat reducing/lean increasing protocol while higher repetition ranges are best for performance enhancement and influencing smaller muscle activation.

Your personal exercise protocol is also influenced by whether you’re a mesomorph, endomorph, or ectomorph. Each body type can respond differently to a protocol.

ACE Research

According to the study performed by the American Council on Exercise, a leading authority in fitness, moderate or average exercise should occur between 70 to 80 percent heart rate intensity, HIIT training requires at least 85 percent heart rate intensity, the study says. Les Mills’ researchers (creators of Body Pump) wanted to determine how to best achieve a healthy balance between one’s HIIT volume (minutes of HIIT per week) and one’s positive stress response. Their hypothesis was that more than 30 or 40 minutes of weekly HIIT volume would prompt a reduced positive stress response.

“A positive stress response to exercise is a critical part of creating the bio-chemical changes in the body that help build new muscle and improve fitness,” the study says. “The stress response can be measured effectively by examining cortisol and testosterone concentrations in saliva.”

Not to repeat myself but as mentioned earlier, this is really what we refer to as the principle of overload in fitness. The stimulus of exercise must be adequate to provide overload such that the body responds after (when between sessions fitness occurs IF you have adequate rest, food, and sleep).

Remember Your Hormones

It’s key for YOU to remember, Flipping 50 friend, that you have another thing to consider. The status of your hormones, not just of your mind’s desire to lose fat, or get in shape needs to be considered when designing your exercise program. Pushing through … following lame social media memes suggesting that “sweat is fat crying” can backfire on you and increase fat storage when stress goes the wrong way. When you read “move more” interpret it as walking down the hall to deliver a message as opposed to going to boot camp 6 days a week or doing two-a-days.

Let me take a step back here and describe what it feels like to lift at a level defined as HIIT. There’s a lot of confusion about HIIT. Anything that gets you breathing slightly harder is NOT HIIT. Lifting with a weight that causes fatigue at 10 repetitions correlates with 80% intensity. So in order to lift and a HIIT level of 90% as per the study, you’d be lifting a weight closer to 5 repetitions.

Don’t panic. You definitely progress to this point. You also can reduce the weight slightly and use power, increasing speed on the lift but always controlling the lowering (eccentric) phase of exercise to achieve this overload without a heavy weight. You do this in daily life… the wind grabs the car door, the door to a store is heavy, or you heft the garbage bag out to the curb… so if you’re worried about injury (valid) do consider whether your daily activity warrants the work so you’re prepared.

Fatigue vs Tired

Moving fast to get breathless is not necessarily overloading the muscles in a way that muscle changes and creates lean muscle tissue that assists in fat burning.

THIS is a key distinction most program creators and attendees fail to make. Going to a boot camp where you’re moving fast from a strength exercise to a cardio exercise to a core exercise will likely tire you. Tired is not muscle fatigue. Muscle fatigue must be reached so your body changes.

Will it burn calories right now? Yes. Will it change your body, your body composition, and set you up for years of a stronger leaner body? No.

The study used strength training as the mode of high intensity exercise. Researchers compared one set of 5 repetitions for each of 10 exercises to 1 or 2 sets of 10 repetitions for 10-12 exercises. The subjects were both male and female and ages up to 59.

The results showed body fat decreased significantly for both groups. Blood pressure and LDL (bad) cholesterol decreased only for the HIIT group.

“When it comes to HIIT, adding volume doesn’t deliver better results,” the report says.

“It actually hinders. To get the full benefits of HIIT and prevent overreaching, our recommendation is to…

Do a maximum weekly HIIT sessions that are above 90 percent maximum heart rate for 30-40 minutes…

…and balance them with other less demanding workouts.”

“It’s also imperative that you let your body recover properly after a HIIT session. This way, you’re likely to perform better when you do your HIIT workouts and benefit from the positive results,” researchers added.

The key exercise flips:

  1. More is not better when it comes to High Intensity exercise
  2. An understanding of what constitutes high intensity interval training is key if you’re to reap benefits
  3. The more health markers (blood pressure and cholesterol) you’re trying to target with your exercise, the more HIIT could benefit you done with adequate progression
  4. low volume of HIIT (no more than 40 minutes a week) is far better for results (and reduction of injury) than more volume (frequency, or duration)
  5. If you’re doing high intensity exercise that is also high impact cardio or high intensity strength training every day you may be inhibiting your recovery and results.

This distinction of when to work hard and when to recovery is so important. It’s not intuitive for a generation that witnessed the work harder, get better results discipline of our parents.

Article reprinted with permission from Debra Atkinson. Originally printed on flippingfifty.com.


Debra Atkinson is the #youstillgotitgirl who is flipping 50 and changing the way thousands of women think about their second half. She’s the host of the Flipping 50 TV Show and the Flipping 50 podcast. As a master personal trainer, strength and wellness coach with over 30 years fitness industry experience, she works with women who are pro-aging with vitality and energy. She is an international fitness presenter, author of hundreds of articles and multiple books. Visit her website, flippingfifty.com

computer elearning

How Sharp is Your Saw: Using eLearning to Get More Coaching Clients

One of the most powerful tools in any coach’s arsenal is his or her knowledge of which coaching techniques to apply to a given situation and how to apply them to best meet clients’ needs. “Sharpening the saw,” or continually honing one’s skills, ensures coaches are on top of the most effective practices.

Learning new skills and coaching techniques is easier than ever through eLearning–educational programs delivered online. Online courses are more accessible, less expensive and faster to master than traditional educational programs. And best of all, they can be taken at the learner’s convenience, 24/7/365.

So how does eLearning help coaches sharpen their saw? In his mega-bestseller The 7 Habits of Highly Effective People, author Franklin Covey describes “sharpening the saw” as a way of “preserving and enhancing the greatest asset you have–you. It means having a balanced program for self-renewal in the four areas of your life: physical, social/emotional, mental, and spiritual.”

By engaging in eLearning to expand their knowledge of proven, effective practices, coaches can treat clients with a wider variety of issues. These same practices also work on the coach! Taking online training gives coaches the opportunity to see their own issues, in each of the four areas mentioned by Covey, from a fresh perspective, making them better practitioners and better people in general.

Approaching eLearning not only as a tool to gain skills as a coach, but also as a way to live to one’s full potential provides extra motivation when taking online courses and makes “sharpening the saw” more fun!

Reprinted with permission from the SoleLife Blog.


Nichole Lowe is a board certified Health Coach, Educator and Presenter. She is the Founder and CEO of SOLELIFE™. SOLELIFE™ is an online training platform that offers proven advanced training for coaches and health practitioners in Dialectical Behavioural Therapy (DBT) to improve its customers’ client results and grow their referral business. It’s an all-in-one solution for professional coaches where they can learn new skills, connect with peers, and gain valuable industry knowledge in a first-ever fully social eLearning platform.

If you’re interested in learning more about DBT, SOLELIFE offers a free course, Understanding DBT.

Human Brain Health with ECG

Getting Fit Expands Your Mind

Getting fit expands your mind.

When you start a program to develop better habits, get out of pain, or whatever the case may be, one thing you probably don’t expect is how your mind transforms.

Health and fitness are elusive, multi-failure and hard to reach topics for the majority of people. You may have even thought at one point that it’s just not possible for YOU to achieve your goals right?

My first piece of advice is just take the first step. Then the next step and then the next. If you keep taking a step forward, you eventually arrive at your destination. It’s simple when you look at it like that, isn’t it?

It comes down to making the right choices at each meal, to exercise daily, to go to sleep on time, to drink water is how getting fit expands your mind.

When you start to build your confidence and see results around something you may have previously believed to be impossible, it’s incredible what areas of your life open up.

People grow courageous and start businesses because of their fitness results. From the confidence they build through fitness, women choose to do certain fitness adventures or events. Even previously un-athletic seniors pursue fitness careers because of their results and desires to pass that on to others.

So, whether you’re deep into your fitness journey or just thinking about getting started, know that if you keep your mind open, success in fitness shows you that anything is possible.

Fitness is empowerment to the core. you’ll see the possibilities by believing getting fit expands your mind.

Originally printed on Move Well Fitness blog. Reprinted with permission.


Maurice D. Williams is a personal trainer and owner of Move Well Fitness in Bethesda, MD. With almost two decades in the industry, he’s worked with a wide range of clients, including those with health challenges like diabetes, osteoporosis, multiple sclerosis, hypertension, coronary artery disease, lower back pain, pulmonary issues, and pregnancy. Maurice is also a fitness educator with Move Well Fit Academy and NASM.  

Stress Management Exercise Programming

As fitness professionals, we know that exercise helps our clients to cope with stress. We are told that any type of exercise will help them to reduce stress levels. The problem with this way of thinking is that we do not look at stress from the same point of view as a chronic illness. In turn, you could be putting your clients at risk of developing illness’s. We know that stress can wreak havoc on the body but what can we do as fitness professionals?

When we have clients diagnosed with diabetes, cancer and heart disease, for example, we follow a certain protocol or guideline. Not everyone is the same so you may have to deviate and think outside the box. Why should there be a difference with stress management exercise programming? There are specific guidelines that you should be following.

Many fitness professionals take into consideration the mental piece of stress but not what is actually going on inside the body as a direct correlation. Or fitness professionals may think that the client is better because they feel less stressed mentally after their session. When we do any type of exercise, endorphins will be released throughout the body. This will make you feel better mentally but it is a quick fix for what is really going on inside.

If a client is highly stressed and you have them do an intense workout they may become physically worse. Exercise is a stressor on the body itself and will increase cortisol levels. This  in turn, can make blood sugars and blood pressure higher. If someone does not have either of these conditions it could become their new norm over time. When pushed to hard, a client may develop conditions like Alzheimer’s Disease earlier due to high cortisol levels.

We need to look at stress management from a physiological standpoint when prescribing exercise. Many fitness professionals do not make this important connection during their sessions. We may advise clients to do meditation, yoga and exercise as a “one size fits all approach” Our clients’ bodies are different and therefore need a customized exercise and health education plan. If you have a client who cannot lose weight when exercising and eating properly have them see their doctor. The Physician may want their patient to take a cortisol level test to make sure their body is functioning normally.

Fitness professionals should follow the FITT Principle for stress when working with this population. Knowing the appropriate frequency, intensity, time and type of exercise is very important. You must assess your client and know their stress levels before you can customize a program. It is also important to look at their health history and what medications they are taking.

One way of effectively training clients is by using the Aria Method™. Open and flowing movements are important for training individuals who are stressed. Posture and stress play an integral part of movement and should be taken into consideration. For instance, Stress can make people hunch over or adapt to a kyphotic posture. By opening the chest and strengthening the muscles you are correcting this motion. Take a moment and really look at your clients before deciding how to train them.

Educating clients about stress and healthy coping techniques is also important and can make a big difference. It may be hard for some individuals to make positive lifestyle changes. Remember to praise clients for any changes they make no matter how small.


Robyn Caruso is the Founder of The Stress Management Institute for Health and Fitness Professionals. She has 18 years of experience in medical based fitness.

References: