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Personal Trainer, Gym, Pull Down Machine, Exercising, Assistance

Training the Older Adult Client – Part IV: Key Corrective Exercise Patterns for the Shoulders

Welcome to the 4th installment of this edition of Integrative Movement Insider™ (IMI) where we’ve been discussing a few of the key concepts and corrective exercise patterns we use when training our older clients.

In the previous video we discussed how to implement the foundational concepts of the Integrative Movement System Corrective Exercise Strategy™ – improve our clients’ awareness, pay attention to the small details, and help your clients earn-the-right – to help our older clients successfully work towards achieving their health and fitness goals.

In Video 1, we discussed one of our go-to corrective exercise patterns for improving glute function and hip mobility. In Video 2 of the series, I shared with you one of the key corrective exercise patterns we use to improve scapular stability and overall head and thorax alignment.

If you missed either video you can access those videos here: Video 1 and Video 2

In the third video of the series, I’ll share another one of our go-to corrective exercise patterns for improving overhead shoulder range of motion.

You can be the specialist your current – as well as potential – clients need, want, and will seek out to help them safely and effectively work towards accomplishing their health and fitness goals.

By helping our older clients become aware of the factors that are within their control and helping them become more aware of their posture and movement we empower them for success.

By paying attention to the simple things like alignment, breathing, and control we can help our older clients address many of the underlying issues that are leading to chronic tension, discomfort, and/or the loss of performance.

By helping our clients ‘earn-the-right’ by appropriately progressing their patterns we empower them to safely and effectively work towards achieving their health and fitness goals.

If you like this information and want to learn more about how to develop your confidence and expertise in working with older clients that have Chronic back tightness, Degenerative joint disease, or Spinal stenosis and other issues related to the trunk and spine, then consider joining us for our one-day events. We share these concepts in our one-day, intensive training – Corrective and Progressive Exercise for the Older Client: The Trunk and Spine-Level I.

You will leave this training with the tools and strategies you need to successfully work with and attract older clients. You won’t think the same about training this population after attending this workshop!


Dr. Evan Osar is the developer of the Integrative Movement Specialist™ certification designed specifically to aid the fitness professional establish themselves as an invaluable part of their client’s health care team. In addition to his chiropractic degree, Dr. Osar has earned national certifications through the American Council on Exercise (ACE), National Academy of Sports Medicine (NASM), National Strength and Conditioning Association (NSCA), and The Soma Institute – National School for Clinical Massage Therapy. He is the founder of Fitness Education Seminars, an education company with the mission of helping trainers and therapist recognize their role as a part of the solution to the health care crisis.

brain-neurons

Health-Related Fitness and Parkinson’s Disease

When people hear the words “Parkinson’s disease”, they don’t often think of health-related fitness as a simultaneous condition. However, many people with Parkinson’s are in fact very physically fit! As a Care Advisor for Neuro Challenge Foundation for Parkinson’s, I have met Parkinson’s sufferers and Parkinson’s fighters. The fighters know very well the benefits of exercise and strive to maintain their health and fitness to the best of their ability despite the challenges they face.

Parkinson’s disease is a neurodegenerative disease that is marked by tremors, slowness of movement, stiffness of muscles, and unsteady balance. Dr. Dean Sutherland, Director of the Southeastern Center for Parkinson Disease states that “exercise is as important as anything you can do for Parkinson’s.” How can you become a Parkinson’s fighter? The first step is to understand the five components of health-related fitness and how they affect functionality.

The first component is maintaining a healthy body composition. What does this mean? Your weight should be appropriate to your height and you should strive to have more lean muscle mass than fat mass in your body. You can find out your body mass index by going to the Center for Disease Control’s website and accessing their BMI calculator. Excessive fat in the body can result in loss of muscle mass, and muscle is something people with Parkinson’s should strive to maintain.

The second aspect of health-related fitness is muscular strength. Having strong muscles improves posture, decreases the risk of musculoskeletal injuries, improves balance and decreases the risk of osteoporosis. Muscular strength helps people with Parkinson’s maintain independence.

The third component important for health-related fitness is muscular endurance; or the ability of a muscle or group of muscles to work repeatedly over a period of time. An example of muscular endurance would be the ability of the leg muscles to ride a stationary bike for 30 minutes. People with Parkinson’s will experience better posture and stability if they are able to sustain muscular endurance. They will also be able to have more fun doing recreational activities!

Fourth, health-related fitness is greatly enhanced by good cardiorespiratory functioning. This is the ability of the heart, blood vessels and the lungs to work effectively together to deliver oxygen to all the cells and muscles in the human body. Activities of daily living are more easily performed with strong cardiorespiratory fitness, and cognitive functioning is enhanced as well.

Finally, the fifth component of health related fitness is flexibility, or the ability of joints to move through a full range of motion. People with Parkinson’s who maintain good flexibility experience enhanced postural stability and balance, and are less like to fall. Being flexible also makes it much easier to perform simple tasks like bending over to tie your shoes, pull a shirt on over your head, or swing a golf club.

It’s never too late to begin a program towards improving your health-related fitness. Your body is designed to last a lifetime, and you can help influence how well it performs for you. Always get a physician’s clearance before beginning an exercise program and if you are new to exercise, enlist the supervision of a certified fitness professional.


Carisa Campanella, BA, AS, is an ACE Health Coach and ACSM Personal Trainer. She is the Program Manager at the Neuro Challenge Foundation for Parkinson’s. Neuro Challenge provides ongoing monthly support groups and educational programs, individualized care advising and community resource referrals to help empower people with Parkinson’s and their caregivers.

finger-touch

Success in Life & Business… It’s a Matter of Touch

I am sure you would agree that effective communication plays a significant role in relationships with clients, customers, patients, partners, family members, colleagues, friends, etc. But what about when those individuals are away from you? Do you fill that void effectively and systematically or do you leave it to chance?

Maximizing success in life and in business is dependent upon a complete relationship. To optimize your success you must see your time away from others just as important as the time you spend with them.

Let me explain. Your spheres of relationships are continually changing from both your perspective and from the perspective of others. As a result of these shifting viewpoints, the strengths or weaknesses of these bonds fluctuate and unless you systematically inject yourself into the relationship, you leave success and happiness to chance.

So how do you step-up and make sure you are not rolling the dice when it comes to your success? Simply put, by implementing real, honest, and effective “touches” you can maintain your presence the way that you want it to be. These “touches” are small, short, targeted, and balanced communications that fill the relationship gap that will maintain and even grow trust, loyalty and commitment. Found in various forms, these individualized gems can be phone calls, text messages, video calls, written letters, cards, etc. And the frequency? This depends on each situation but I recommend 14 to 21 days as the sweet spot to offer the best balance.

Remember, to maximize your success, “touch” everyone regularly in a way that will positively inject your influence and not allow chance to control of the outcome.

Reprinted with permission from Dr. Steve Feyrer-Melk.


Steve Feyrer-Melk, MEd, PhD, is a powerful, passionate, and trusted authority in Lifestyle Medicine who is bringing an innovative, refreshing, and successful approach to proactive health care. Dr. Steve co-founded the Optimal Heart Attack & Stroke Prevention Center where he crafts and hones real-world programs for immediate impact. Dr. Steve also serves as the Chief Science Officer of Nudge, LLC, a lifestyle medical technology company.

women-lifting

7 Common Workout Injuries and How to Avoid Them

As my ruthless and merciless coach always says, “No pain, no gain and you have to risk it to get the biscuit.” True as this may be when it comes to making physical progress in your workouts, there are exceptions you need to keep an eye out for.

I mean, you are human after all and there is only so much punishment that your body can take… even machines wear out. So, here are 7 common workout injuries that you should know about and great tips on how to prevent them from happening in the first place.

  1. The Famous Ankle Sprain

This commonly affects runners and joggers. Not only does this hurt like hell, it could also bench you for an entire month. If you’re a fitness fanatic like me, then that is a nightmare of profound proportions. You can easily get this running outside in uneven terrains like a rocky pathway.

Jumping on and off a pavement can also mess you up pretty badly. Even the treadmill doesn’t keep you safe from this: classic causes include jumping off too quickly or mistakenly stepping half on the belt and half off of it while it’s still running – ouch!

Preventive Measures:

The first and most important tip is to get yourself a quality pair of running shoes. The next thing you want to do is pick out a good old ankle brace just to be on the safe side. Once those are in check, you may need to rethink the terrain you run in.

Though running through the forest is a fantastic idea, make sure the path you pick is even with no rocky features or too many roots popping up all over the place.

And if you have to run indoors on your treadmill, then it is highly recommended that you get one with a clip that attaches to your clothes so that it turns off when the clip detaches from the treadmill.

  1. The Excruciation Shin Splints

You will know you have this when you get a sharp pain on the inner side of your shin bone every time you put weight on your leg. This is another common one among runners.

Although other activities that involve a lot jumping, like rope skipping, can also give you these. It is caused by a muscular inflammation and is the result of suddenly bumping up the volume of your current workout regimen.

Working out on hard, paved surfaces or using old, worn out shoes can also give you problems. You may need a doctor’s opinion once you start getting the symptoms. Some painkillers and a few weeks off should get you back up and running.

Preventive Measures:

As with ankle sprains, you will also need a good pair of running shoes for the splints. Next up, make sure that you stretch and warm up properly prior to your workout.

A few light bodyweight exercises and dynamic stretches are always a good idea. Make sure you use static stretches after your workouts to cool you off as well. As for your workouts, take it easy with the intensity increments. Don’t go higher than 10% percent with your frequencies or volumes every time you decide to take things to the next level.

  1. The Agonizing Lower Back Strains

A sudden pain in your lower back accompanied by some tenderness could be a sign that you’ve hit the threshold. This happens when you tear the muscles or ligaments in your lower back, especially the lumbar muscle.

Squatting and dead lifting with improper form or with excessively heavy weight could definitely put you at high risk. Skipping warm ups and stretches and doing side bends can also get you to this unpleasant point. Another reason could be a hunched back that causes you to overcompensate by bending backward by the lower back for upward presses. Worst-case scenarios include developing nerve compressions and herniated disks.

Preventive Measures:

First thing’s first, never skip your pre-workout warmup sets and stretches. These will get the blood flowing down lower back so that it can absorb all the stress from your workout. If you have a hunched back, then you need to start doing wall squats.

It is highly advisable to superset all the exercises in your workouts with this so as to fix your problem. Variety is key here so be sure you keep switching between workouts to improve the endurance of your lower back muscles. Lastly, your form for squatting and deadlifting should be flawless, done with the weight that you are comfortable with.

  1. The Busted Rotator Cuff

This one is common among weight lifters in the gym (or anywhere else for that matter). If you’re having pain in your shoulder every time you raise your arm over your head or reach behind your back, then this is probably the culprit.

It is made up of 3 muscles that attach the edge of the scapula to the top point of the upper arm. The work of these muscles is to rotate your shoulders externally.

The pain we are talking about here occurs because of a strength imbalance between these muscles and the deltoids. This results in an impingement or a tear in one of the muscles of the rotator cuff.

Preventive Measures:

This is a highly neglected muscle for most weightlifters. It is very rare to see anyone do any kind of external rotation exercise in the gym. This is where all the problems start. So, you need to integrate external rotation exercises to balance out strength between the rotator cuff and the deltoids. Exercises such as side-lying external rotation with dumbbells should become a staple among your shoulder workouts.

  1. The Classic Pec Tear

This happens when you tear either your chest muscle or the tendon that attaches it to the upper arm – quite the agonizing ordeal. This also happens among weight lifters within the famous benching community.

Every time you make up your mind to bite more than you can chew by adding too much weight on the bench press or chest flyes, you run the risk of getting this dreadful injury. You will feel the tear immediately when it happens before your upper arm turns color to blue-black.

Preventive Measures:

This has been said so many times, it feels cliché saying it all over again. But I’m going to say it anyway – leave your ego outside the doors of the gym. Just because overload causes muscle growth doesn’t mean you should go all Hercules with the weights.

Choose the weight that’s right for you, especially for the dumbbell bench press and pec flyes. It is also a good idea to have a spotter around so you don’t end up dropping the dumbbells behind you, causing you to overstretch your pec, resulting in the tear.

  1. The Old Rupture of the Bicep Tendon

If you are a curl junky, then you need to pay close attention here. This happens when the tendon attaching your bicep to your forearm tears and curls upwards.

It is extremely painful and it is caused by curling too heavy and uncontrolled movement that causes the arm to drop suddenly with the dumbbell or barbell in hand. If it happens to you, your bicep will become larger than usual with a blue-black coloration.

Preventive Measures:

As we said with the Pec tear, keep your ego in check and lift what you can handle. You will also want to control the weights on the way down – very important. In fact, it is this portion of the exercise, the eccentric, which comes with the most gains. So don’t neglect it. It will give you great gains and keep your bicep tendons rupture free.

  1. The Dreadful Hernia

Whether this is grosser than it is scary, I’m not very sure. It involves swelling, mostly around the belly, caused by protruding organs that tore through their encasings (ie, fascia). This is common among lifters and calisthenics enthusiasts. It happens when you hold your breath as you lift heavy objects.

This results in increased pressure that causes organs, like intestines, to pop through their encasings resulting in the bulge. Rotating your torso during one-arm dumbbell rows can also get you here. You most definitely want to dial 911 if this happens.

Preventive Measures:

Again, keep your ego in check and only lift what you can handle. The next thing you want to do is learn to breathe out through the concentric part of any exercise and breathe in during the eccentric. Also, keep your body from rotating every time you do those one-armed dumbbell rows.

For the long term, it is a good idea to strengthen your abdominal muscles so that your core is strong enough to even out imbalances that could lead you to get a hernia.


Tony John is a blogger and main Co-founder/ Editor at the BoostBodyFit.com. He loves fitness and bodybuilding. Follow BoostBodyFit on Twitter @boostbodyfit.

Two women doing yoga workout at gym

Exercising with Arthritis

Although it comes in many forms throughout the body, in general arthritis is an inflammation. There are various reasons that this condition occurs, but one thing is for sure — it can affect a person of any age and in many different situations.

Pregnant woman holding fitness dumbbells

Prenatal Exercise Program Design: Exercise Intensity

When designing a prenatal fitness program the key components of intensity, duration, frequency, and mode are used, but specific modifications in the level of progression, supervision, and monitoring are needed in order to keep the exercise safe for mother and fetus. The goal of a prenatal exercise routine is to maintain or improve overall fitness, strength, and flexibility. Keep in mind that each woman’s fitness level and ability will vary, and as pregnancy progresses changes in her body will affect her ability to exercise comfortably.

bladder-cancer-ribbon

Exercise and Bladder, Thyroid and Prostate Cancers: The Impact of Staying Active

Part I: Bladder Cancer

There are many reasons why a cancer patient should stay as active as possible through cancer treatment and recovery. I will begin by pointing out a few studies that show how exercise can benefit cancer patients. These studies demonstrate how exercise can reduce certain side effects from treatment, increase energy, decrease stress, and improve quality of life. In the last article of this series, I will suggest ways to develop an exercise program that based on the individual’s needs and is safe and effective.

Introduction

Research has shown that exercise can reduce the risk of getting some types of cancers. There are numerous published studies on the benefits of exercise for those with colon cancer, breast cancer, and endometrial cancer. An American Cancer Society’s newsletter stated: “Among breast cancer survivors, a recent analysis shows that getting exercise after diagnosis was associated with a 34% lowered risk of breast cancer death, a 41% lower risk of dying from all causes, and a 24% lowered risk of breast cancer recurrence. Among colon cancer, studies suggest exercise cuts death from colon cancer and all causes, and cuts the risk of the cancer coming back by up to 50%.”

The Journal of the American Medical Association reported that exercise lowers the risk of 13 types of cancers. Since there is limited research on exercise and bladder cancer, it is important to note that the results of the study showed that those who exercised the most had a 13 percent lower risk of bladder cancer. The JAMA study is empowering because it provides further ammunition as to the importance of exercise for additional types of cancers.

Studies suggest that exercise is safe and helpful for many people who are suffering from cancer and may lower the risk of some cancers. Other health benefits of exercise are weight control, cardiovascular health, increased bone density, and decreased fatigue, stress, anxiety and depression. Exercise can improve range of motion, improve endurance, and decrease the risk of lymphedema.

Exercise helps to control obesity, which is positively correlated with several cancers. Studies have shown that weight gain increases the risk of cancer and the risk of recurrence during and after treatment. Since exercise is a crucial component of weight control which effects cancer risk, exercise needs to be considered as part of the treatment plan.

How does exercise play a role in cancer prevention, control, and cancer outcomes?

  • During exercise, epinephrine is released which helps natural killer cell infiltration.
  • Exercise may restore normal gene function and may influence tumor-suppressing genes. There is a relationship between hypomethylation and hypermethylation and cancer cells.
  • Exercise can affect hormone levels
  • Exercise reduces insulin, increases IGF-1, and decreases leptin and may have an anti-inflammatory effect.

What does the research show for bladder cancer?

It has been observed that exercise can improve outcomes for those with bladder cancer. Research conducted by J. Vallance suggests that strength training and aerobic exercise can improve psychological and physical issues for those with bladder cancer and increases the chance of survival.

In May of 2007, “Associations between Exercise and Quality of Life in Bladder Cancer Survivors: A Population-Based Study” by Kristina H. Karvinen et al was published in Cancer Epidemiology and Biomarkers. The authors examined the association between exercise and quality of life in a sample of 525 bladder cancer survivors. They found exercise to be negatively associated with several aspects of fatigue. The study also suggested that active bladder cancer survivors have improved mood and energy and quality of life.

In 2016, “Lifestyle factors and health-related quality of life in bladder cancer survivors: a systematic review” by Gopalakrishna, reviewed the literature on the associations between lifestyle factors and quality of life in bladder cancer survivors. Their conclusion was that there is some evidence for a positive association between quality of life and physical activity.

Kellogg Parsons, MD, an associate professor of Surgery at the University of California, San Diego, discusses modifiable lifestyle factors associated with bladder cancer on onclive.com. Parsons and his team found that participants who had any amount of physical activity had improved survivorship compared to those with no physical activity.

A recent study in by Cannioto et al in Cancer Epidemiology reports an association between living a life with little to no recreational physical activity and an increased risk for bladder cancer. The study suggests a connection between being inactive and increased risk of cancer.

In summary, we know that physical activity reduces the risk of numerous diseases. Now we have additional evidence, that it may also reduce the risk of bladder cancer.

Physical Activity in Bladder Cancer Patients

The sooner the patient starts to exercise the better. Starting before surgery and treatments and continuing during treatment can lead to a better recovery with less complications and medications.

Survivorship can serve as a strong motivator to make positive lifestyle changes. Everyone’s situation is unique. Accordingly, exercise needs to be tailored to individual people, taking into account their overall fitness, diagnosis, and other factors that could affect safety.

Regular physical activity can help rebuild a patient’s strength and energy level and help manage other health related issues. Health issues like diabetes, and cardiovascular diseases are a leading cause of death in cancer survivors and those without cancer. Managing health related issues through exercise could increase survival.

Some cancers and cancer treatments may result in incontinence. A side effect of biologic treatment may include irritation of the bladder, an urgent need to urinate, frequent urination, or incontinence.

Incontinence can occur in men or women with bladder cancer and last for a short time or longer. There are different types of incontinence, ranging from mild to severe. Some examples are: stress incontinence can cause a person to leak urine during activities such as coughing, laughing, sneezing, or exercising, urge incontinence is a sudden, urgent need to urinate and continuous incontinence is not being able to control the bladder at all.

Kegel exercises strengthen your pelvic floor muscles to control urine flow. The pelvic floor muscles are comprised of the bladder, sphincter and the pubococcyges muscle. These muscles are used to stop the flow of urine. You can find your pelvic floor muscles by squeezing your sphincter and contracting the urethra to stop the flow of urine when using the bathroom.

Exercise can help control incontinence without medication or surgery. It is wise to start Kegel exercises before surgery and treatments and to work with a pelvic floor specialist.

Kegel Exercise

Perform the Kegel 10 times holding for 5 seconds each. Try to do this four times per day. Take a 5-second break between each repetition. It may take several weeks or months to be able to contract your muscles for 5 seconds at a time, or to repeat it 10 times. If you perform the Kegel several times per day, your pelvic floor strength should improve.

Tips

  • Try not to use the surrounding muscle groups in the buttocks, legs and abdomen.
  • Try to lift the pelvic floor upward.
  • You can perform this exercise in any position: standing, sitting, or lying in bed.
  • Kegels can be done at any time, such as while watching TV, waiting in line or driving.

Part 2 will focus on thyroid cancer. Contact me at caroljmichaels@gmail or go to www.CarolMichaelsFitness.com or https://www.nfpt.com/product/cancer-recovery-specialist to find out about cancer exercise programs in New Jersey and cancer continuing education courses.


Carol J. Michaels is the founder and creator of Recovery Fitness® LLC, located in Short Hills, New Jersey. Her programs are designed to help cancer survivors in recovery through exercise programs. Carol, an award winning fitness and exercise specialist, has over 17 years of experience as a fitness professional and as a cancer exercise specialist.

References  

Steven C. Moore PhD, et al, Association of Leisure-Time Physical Activity With Risk of 26 Types of Cancer in 1.44 Million Adults JAMA Intern Med2016; 176(6): 816-825.

Lynch B.M., Dunstan D.W., Vallance J.K., Owen N. Don’t take cancer sitting down: A new survivorship research agenda. Cancer. 2013, Jun 1; 119(11): 1928-35 Medicine

Kristina H. Karvinen, Kerry S. Courneya, Scott North and PeterVenner, Associations between Exercise and Quality of Life in Bladder Cancer Survivors: A Population-Based Study, Cancer Epidemiology and Biomarkers Prevention May 2007, 10.1158/1055-9965

Gopalakrishna et al, Lifestyle factors and health-related quality of life in bladder cancer survivors: a systematic review. Journal of Cancer Survivorship, 2016 (5): 874-82

Vallance, J., Spark, L., & Eakin, E.. Exercise behavior, motivation, and maintenance among cancer survivors. In Exercise, Energy Balance, and Cancer (2013) (pp. 215-231). Springer

Cannioto et al. The association of lifetime physical inactivity with bladder and renal cancer risk: A hospital-based case-control analysis, Cancer Epidemiology, Volume 49 August 2017

Cramp F, Byron-Daniel J. Exercise for the management of cancer-related fatigue in adults. Cochrane Database Syst Rev. 2012; 14(11): CD006145.

Booth FW, et al., Lack of exercise is a major cause of chronic diseases. Compr Physiol. 2012 Apr; 2(2): 1143-211.

Stephanie Cash et al, Recreational physical activity and risk of papillary thyroid cancer among women in the California Teachers Study. Cancer Epidemiology, Feb 2013,37(1): 46-53

Hwang, Yunji MS; Lee, Kyu Eun MD, PhD; Park, Young Joo

MD, PhD; et al, Annual Average Changes in Adult Obesity as a Risk Factor for Papillary Thyroid Cancer: A Large-Scale Case-Control Study, Medicine, March 2016, Mar; 95(9): e2893

Cao Y, Ma J. Body mass index, prostate cancer-specific mortality, and biochemical recurrence: a systematic review and meta-analysis. Cancer Prev Res (Phila). 2011; 4: 486-501.

Galvao, et al. Combined resistance and aerobic exercise program reverses muscle loss in men undergoing androgen suppression therapy for prostate cancer without bone metastases: a randomized controlled trial. J Clin Oncol. 2010 Jan 10; 28(2): 340-7.

Galvao, et al. Exercise can prevent and even reverse adverse effects of androgen suppression treatment in men with prostate cancer. Prostate Cancer Prostatic Dis. 2007; 10(4):340-6.

Winters-Stone KM, et al. Resistance training reduces disability in prostate cancer survivors on androgen deprivation therapy: evidence from a randomized controlled trial. Arch Phys Med Rehabil. 2015 Jan; 96(1): 7-14.

Giovannucci EL, Liu Y, Leitzmann MF, Stampfer MJ, Willett WC. A prospective study of physical activity and incident and fatal prostate cancer. Arch Intern Med. 2005; 165: 1005-1010.

Storer TW, Miciek R, Travison TG. Muscle function, physical performance and body composition changes in men with prostate cancer undergoing androgen deprivation therapy. Asian J Androl. 2012, Mar; 14(2): 204-21.

Focht, Brian C.; Lucas, Alexander R.; Grainger, Elizabeth; Simpson, Christina; Fairman, Ciaran M.; Thomas-Ahner, Jennifer; Clinton, Steven K., Effects of a Combined Exercise and Dietary Intervention on Mobility Performance in Prostate Cancer, Medicine & Science in Sports & Exercise. May 2016:48(5S): 51

 

pilates  workout with personal trainer at gym

What Insurance Coverage Do Independent Fitness Professionals Need?

A self-employed fitness professional may be working inside someone else’s studio or at full service health club or they may own their own studio or they may train in their clients’ homes or in public places, such as, parks or a combination of these. Independent trainers are entrepreneurial and have different exposures than fitness professionals employed by fitness facilities.