Fitness Professionals – Page 64

Aerobics pilates women feet with yoga balls

The 9 Principles of Pilates

Naomi Aaronson/6 November 2014/ All MFN blog/

For breast cancer survivors using Pilates, it is extremely important to pay attention to the Pilates principles. Getting physical exercise is essential to recovery, but overdoing it can cause more harm than good. Make sure you review the principles below before beginning Pilates for breast cancer recovery, and ask for help from a certified Pilates instructor if you need it.

The 9 Pilates Principles

These principles guide each Pilates exercise to ensure that they are done correctly and safely. In Pilates, less is more. The emphasis is on a correct starting position with proper execution of the exercises; there is no wasted movement in Pilates. No more than five to eight repetitions are completed (except for the Hundreds), and breathing during each exercise is very important. Concentrate on the correct movement patterns first and then add Pilates breathing.

pilates woman stability ball gym fitness yoga If you’ve never done Pilates before, this may sound like a lot to think about. If possible, we recommend working with someone who is trained in Pilates first to get you on the right track.

Breathing: Breathing oxygenates the blood and connects the mind and body. Breathing during Pilates will enhance your relaxation, improve your focus, and help to activate your muscles. Pilates breathing is called “rib cage breathing” or costal breathing as the rib cage expands as you inhale and knits together as you exhale. Coordinating the breath with the movement is the goal. This may be difficult at first, but please stay with it. If you get confused, don’t hold your breath—keep breathing!
- Inhale through the nose as if to smell the roses. Place your fingers on your rib cage and feel your rib cage expand.
- Exhale through pursed lips as to blow out candles, drawing the belly in towards your spine. This activates the transverse abdominas muscle. The deeper the exhalation, the more this muscle is activated. Activation of this muscle should feel very gentle, as it is more like a subtle tightening of the abdomen. The lower back and pelvis should remain still. Buttocks and thighs should stay relaxed.
Concentration: You must place intentional focus on every movement. You will feel each exercise more if you close your eyes, once you become more familiar with the movements. After breast cancer surgery, you may lose the ability to feel if muscles are working properly. Closing your eyes will help in this process to listen to your body and refocus your mind upon proper body movement.
Control: To be in control means that you maintain the proper form, alignment, and effort during the exercise. You don’t want to throw your body around. If there is jerkiness, shaking, tightness and/or pain you are not in control. You can limit the movement and make it smaller if necessary to regain control.
Centering: In Pilates, all movements come from the “powerhouse,” or core abdominal muscles. Learning to use the powerhouse correctly will improve your posture, stabilize the spine, and improve your quality of movement. Thus, every exercise is an abdominal exercise. Visualizing a corset around the waist will help you to activate these muscles.
Precision: Every exercise should be performed with precision and an emphasis upon proper form. Therefore, proper starting position and posture is crucial as well as performing the exercises slowly without momentum.
Balanced Muscle Development: Everything that is done on one side of the body must also be done on the other side. For example, if you do an exercise with your right arm, you must also do it with your left.
Rhythm/Flow: All movements in Pilates are done with a sense of rhythm. The movements should be graceful and smooth.
Whole Body Movement: The whole body is engaged through breathing, engagement of the core, and use of the arms and legs (even though some exercises will not use the arms at all).
Relaxation: Breathing assists with the relaxation of muscles throughout the body. Unwanted tension should be released prior to beginning the exercises. You may work one body part and relax the others

Written by Naomi Aaronson and Ann Marie Turo. Reprinted with permission from Naomi Aaronson, MA, OTR/L, CHT; Also published on demosHEALTH.

Naomi Aaronson, MA, OTR/L, CHT can be reached at www.recovercisesforwellness.com.

Doctor Examining Male Patient With Knee Pain

The knee complex: understanding the science behind both movement and dysfunction

Chris Gellert/5 November 2014/ All MFN blog/

Introduction

The foot is where movement begins, requiring mobility to perform simple functional movements. The knee however, requires stability with daily movements, but more importantly, dynamic sport movements such as soccer or football. In this article, we will review the anatomy of the knee, common injuries of the knee, functional assessments and training strategies to work with clients with previous injuries.

Basic anatomy of the knee
Let’s look at the anatomy of the knee.. The joint is vulnerable when it comes to injury, because of the mechanical demands placed upon it and the reliance for soft tissue to support the knee. There are two primary joints within the knee, the tibiofemoral joint and the patellofemoral joint.

Figure 2. Structures within the knee joint

Knee Joints

a. Tibiofemoral joint: Is a hinge joint that permits some rotation between the distal end of the femur and proximal end of tibia. The joint capsule surrounds the femoral condyles and tibial plateaus and provides stability to the knee by the medial collateral ligament(MCL) and the lateral collateral ligament (LCL).

b. Patellofemoral joint: Is formed by the patella(knee bone) that glides in the trochlear groove of the femur. The height of the lateral femoral condyle helps prevent lateral subluxation, while soft tissue surrounds the joint to increase stability. This is seen in figure 3.

Figure 3. Patellofemoral joint

Primary structures within the knee joint: ligaments and mensici
Several ligaments described below provide stability at the knee joint.

a. Collateral ligaments: The two primary supporting ligaments are the medial collateral ligament (MCL), which is along the inside of the knee. The MCL is a thinner and weaker ligament biomechanically, making it more susceptible to injury more often injured per the research. While the lateral collateral ligament(LCL) is along the outside or lateral aspect of the knee providing lateral knee stability.

b. Anterior cruciate ligament(ACL): is the most commonly injured knee ligament and is taut during knee extension. It originates more proximally on the femoral side than the posterolateral (PL) bundle. It inserts anteromedially(front and to inner side) on the tibia. The ACL limits and controls forward translation of tibia on the femur and limits tibial rotation.

c. Menisci: the menisci are fibro cartilaginous discs located on the articular surface of the tibia along the medial and lateral tibial plateaus. The outer portion of the meniscus(lateral meniscus)is oval shaped (O) and thick. Attaching at the anterior and posterior horns via coronary ligaments.

Vascularity: The middle third and inner third of both menisci are relative avascular. The medial meniscus is more C-shaped, and thinner in structure. Both menisci receive nutrition through synovial diffusion and from blood supply to the horns of the menisci.

Function of the menisci: The menisci provide shock absorption, joint lubrication and stabilization.

Common injuries and causes

There are several common injuries that affect the knee. The most common are patella femoral syndrome(PFS), osteoarthritis(O.A.) and anterior cruciate ligament(ACL) injuries.

In this next section, we will review each condition providing a deeper understanding of each.

a. Patellofemoral syndrome
Pathophysiology/sign and symptoms: PFS is a condition where the patella does not translate biomechanically in the trochlear groove between the femoral condyles. Here the patella is positioned in either a tilt, glide or rotation accompanied by diffuse, achiness in the front of the knee.

Contributing Factors(Evidence Based Research): Several studies have shown that decreased flexibility of quadriceps and hip flexors(Lankhorst et al. 2012 & Meira et al. 2011) contribute to PFS. Decreased hip abductor strength has been shown a significant factor seen in multiple studies as contributing to PFS (Khayambashi, H., et al. 2012, Meira et al, (2011), Bolgla et al. (2008),Cichanowski et al. (2007), and Robinson et al. (2007).

Other factors include prolonged wearing of high heels, muscle imbalances(quadriceps>hamstrings).

b. Osteoarthritis(OA) of the knee

Figure 4. Osteoarthritis of knee

Pathophysiology/sign and symptoms: A degenerative process of varied etiology, which includes mechanical changes within the joint as seen in figure 4.

Risk Factors: Excessive weight born on hip joint, muscle imbalance, repetitive stressors.

Sign and symptoms: Pain in the a.m. described as “achy” that decreases as the day progresses, pain with weight bearing or walking, difficulty squatting, and lateral thigh discomfort.

c. Anterior cruciate ligament injuries
In the last several years, there has been more news about the incidence of ACL injuries. The incidence rate is greatest between the ages of 16 and 18 years. Female athletes are 3-9x more likely to sustain an ACL injury then male athletes. This results in at least 200,000 ACL reconstructions are performed each year in the United States, with estimated direct costs of $3 billion (in U.S. dollars) annually (Frobell, R., et al 2010).

Figure 5. Mechanism of injury for ACL tear

Pathophysiology/Mechanism of Injury: The knee is struck while in hyperextension, forcing tibia anterior(forward)on the femur, as seen in figure 5. The ACL can also be injured with same mechanism of injury with combined with medial rotation of the lower extremity(LE). This creates instability and a direct disconnect the nervous system to the musculoskeletal system because of the “lack of control” within the knee joint.

Common assessments
One great test to assess a client’s movement pattern, is the squat. The squat is a classic fundamental primal movement that someone typically performs almost on a daily basis. With this test, you can observe how the client’s ankle, knee, hip and back moves compared to normal movement patterns. This is seen in the figure below.

Figure 6. Squat in frontal and side view

Figure 7. In place lunge

Another simple assessment is an in place lunge, which examines one’s control through the entire kinematic chain. The lunge is another fundamental primal movement. The lunge is a dynamic movement that is typically performed during daily activities (stooping down to pick something up) or as part of an athletic movement.

This test examines ankle control, knee control and pelvic movement in the sagittal plane. Lastly, a diagonal traveling forward lunge looks at the ability of the client to control ankle, knee, hip, and pelvic movement in both the sagittal and frontal planes. This is not only a functional movement, but very effective for sport specific clients.

Training strategies and programming for knee injuries

Figure 8. Traveling forward lunge

With any injury, the most important thing to remember is the type of injury, healing time and prior level of function of the client.

a. Patellofemoral syndrome
Recommendations for training: Continued stretching of tight hip flexors, ITB, and hamstrings is fundamental. Client should be taught initially static core strengthening exercises, and then progressed to dynamic core strengthening as appropriate. Client would also benefit from education on shoes with respect to type that are most effective for them, and to cross train utilizing, such as hiking, yoga, pilates, and swimming. Lastly, to alter running surfaces(if client runs) and educating the client about changing their shoes every 500 miles or 6 months for maximum stability and control.

b. Osteoarthritis of knee (O.A.)
Recommendations for training: Aqua therapy has been shown in the research to significantly reduce pain, improved physical function, strength, and quality of life (Hinman, Rana S., et al 2007), stretching ITB, hip flexors, quadriceps and hamstrings, strengthening weaker hip abductors(glute medias/minimus). Strengthening specifically hip abductors in various studies when compared to general strengthening resulted in s significant reduction in knee pain, objective change in functional outcome tests, physical function and daily activities (Bennell,K.L., et al. 2010 & Hernández-Molina, G et al. 2008). Core strengthening shoulder also is an integral part of the training program.

Figure 9. Dynamic stabilization Training

c. ACL injury(Anterior cruciate ligament injury)
Recommendations for training: should focus on hamstring strengthening. Strengthening the hamstrings biomechancally transfers the load from the front of the knee to the back, thereby decreasing the stress to the ACL. Neuromuscular training as seen in figure 9, is very effective. It challenges the connection between the nervous and musculoskeletal system requiring the client to stabilize the entire kinematic chain. Research has shown neuromuscular training reduces ACL injuries (HUBSCHER, M. 2010 & Griffin LY, et al., 2006). Core strengthening should be multidirectional in nature as seen in figure 10.

Figure 10. Multidirectional
Training

In the picture on the left, left trunk rotation involves the internal/external obliques, atissimus withdorsi, and right glute medius and minimus muscles to stabilize, as the left glute medius and minimus to stabilize. With the yellow cord applied from the back, this engages the abs primarily to stabilize (from the front) accompanied by the obliques to stabilize, which the low back extensor muscles contract to prevent being pulled backwards. It is important to include dynamic training focusing on hamstrings, glute medius, maximus. Closed chain strengthening (CKC) exercises, such as diagonal forward and diagonal reverse lunges are not only functional, but replicate many common sports as soccer, football and basketball accordingly.

Contrainidications/Precautions: Avoid leg extension exercises completely this causes an anterior translation(shearing) of the tibia on the femur/stressing the graft. Therefore, the exercise is contraindicated. *Biomechanically, shearing stress on the ACL is greatest from 30 degrees of knee flexion to full extension.

Recommendations for training: American Academy of Orthopedic Surgeons (AAOS) Guidelines Post Therapy:
• Continuation of closed kinetic chain exercises(ie. reverse lunges, diagonal lunges,
forward lunge with medicine ball trunk rotation)
• 3 ½ months light jogging begins
• 4 months running begins
• 4 months introduction of plyometrics
• Surgical reconstruction typically sidelines athlete for 6-9 months and once cleared by physician can return to sport activities.

Summary

The knee is a dynamic joint that is comprised of a multitude of ligaments, tendons,
connective tissue, muscles that synergistically initiate and correct movement, and
stabilize when an unstable environment. Understanding the anatomy, biomechanics
and weak links of the knee, common injuries and evidenced based training strategies, should provide you with the insight to better understand and work with clients with these kind of injuries more confidently.

Written by Chris Gellert, PT, MMusc & Sportsphysio, MPT, CSCS, AMS.

Chris is the CEO of Pinnacle Training & Consulting Systems (PTCS). A continuing education company, that provides educational material in the forms of home study courses, live seminars, DVDs, webinars, articles and min books teaching in-depth, the foundation science, functional assessments and practical application behind Human Movement, that is evidenced based. Chris is both a dynamic physical therapist with 14 years experience, and a personal trainer with 17 years experience, with advanced training, has created over 10 courses, is an experienced international fitness presenter, writes for various websites and international publications, consults and teaches seminars on human movement. For more information, please visit www.pinnacle-tcs.com.

REFERENCES
Bennell, K.L., et al., 2010, ‘Hip strengthening reduces symptoms but not knee load in people with medial knee osteoarthritis and varus malalignment: a randomized controlled trial,’ Journal of Osteoarthritis and Cartilage, vol. 18, issue 5, pp. 621-628.

Bolgla, L, et al., 2008, ‘Hip Strength and hip and knee kinematics during stair descent in females with and without patellofemoral pain syndrome,’ JOSPT, vol. 38, pp. 12-18.

Cicanowski, H et al., 2007, ‘Hip strength in collegiate female athletes with patellofemoral pain,’ Medicine Science Sports Exercise, vol. 39, pp. 1227-1232.

Frobell, R., et al 2010, ‘A Randomized Trial of Treatment for Acute Anterior Cruciate Ligament Tears,’ New England Journal of Medicine, vol. 363, issue 4, pp. 331-341.

Griffin LY, et al., 2006, ‘Understanding and preventing noncontact anterior cruciate ligament injuries: a review of the Hunt Valley II Meeting, January 2005, American Journal Sports Medicine, vol. 234, pp. 1512-1532.

Hernández-Molina, G., et al., 2008, ‘Effect of therapeutic exercise for hip osteoarthritis pain: Results of a meta-analysis,’ Journal of Arthritis Care & Research, vol. 59, issue 9, pp. 1221–1228.

Hinman, Rana S., et al 2007, ‘ Aquatic Physical Therapy for Hip and Knee Osteoarthritis: Results of a Single-Blind Randomized Controlled Trial,’ Journal of Physical Therapy, vol. 87, no. 1, pp. 32-43.

HU ̈ BSCHER, M., et al., 2010, ‘Neuromuscular Training for Sports Injury Prevention: A Systematic Review,’ American College of Sports Medicine, pp. 413-421.

Khayambashi, H., et al., 2012, ‘The Effects of Isolated Hip Abductor and External Rotator Muscle Strengthening on Pain, Health Status, and Hip Strength in Females With Patellofemoral Pain: A Randomized Controlled Trial, ‘Journal of Orthopedic Physical Therapy, vol. 42, no. 1, pp. 22-29.

Landry SC, et al., 2007, ‘Neuromuscular and lower limb biomechanical differences exist between male and female elite adolescent soccer players during an unanticipated side-cut maneuver,’ American Journal of Sports Medicine, vol. 3, pp. 1888–1900.

Lankhorst, N, et al, 2012, ‘Risk Factors for Patellofemoral Syndrome: A Systematic Review,’ JOSPT, vol. 42, No. 2, pp. 81-90.

Meira, E., et al., 2011, ‘Influence of the Hip on Patients With Patellofemoral Pain Syndrome,’ Sports Health, vol. 3, issue 5, pp. 455–465.

Prins, 2009,’ Females with patellofemoral pain syndrome have weak hip muscles: a systematic review, Australian Journal of Physiotherapy, vol. 55, issue 1, pp. 9-15.

Robinsion, R et al., 2007, ‘Analysis of hip strength in females seeking physical therapy treatment for unilateral patellofemoral pain syndrome,’ JOSPT, vol. 37, pp. 232-238

Fitness Professionals: November is Diabetes Awareness Month

Dr. Carla-Dyann Brown/2 November 2014/ All MFN blog, Conditions/

Did you know in 1980, according to the Center for Disease Control (CDC), 5.6 million Americans had been diagnosed with diabetes? This had more than doubled by 2000, with 12 million reported cases of diabetes. If this trend were to continue, by 2020 there would be an estimated 24 million diabetics in the United States alone. However, in 2012 the American Diabetes Association (ADA) estimated that 9.3% of the population, or 29.1 million Americans, have diabetes.

Movement Toward Healing: Breast cancer rehabilitation using a Pilates-based approach

Naomi Aaronson/29 October 2014/ All MFN blog/

Ann Marie Turo, occupational therapist, yoga and Pilates instructor and Reiki master, owns a thriving Pilates-based studio. When Turo was diagnosed with a breast cancer reoccurrence in 2002, she was devastated. Despite having limited range of motion, strength and endurance, as well as decreased ADL function, it was not recommended that she have any rehabilitation. This situation is not unusual.

After undergoing a self-described “meltdown,” she decided to take matters into her own hands. Turo designed her own rehabilitation program, which included visualization, Pilates, yoga and Reiki, along with traditional occupational therapy modalities.

Turo believes that an “integrated” approach is the best way to heal physically and psychologically from breast cancer. That is why she created Integrated Mind and Body in Boston.

Pilates is enjoying wide popularity throughout the United States as a form of exercise. It focuses on the whole person, uniting mind and body through a series of flowing movements that require both flexibility and strength. Recently, therapists have began incorporating Pilates as part of their general rehabilitation program for athletes, back injuries, hip/knee replacements and even autism.

Breast cancer survivors are starting to benefit from Pilates as well. A recent pilot study (Keays, 2007) found a modest effect in improving shoulder abduction and external rotation. However, further research is necessary to determine both the safety and efficacy of Pilates, as well as optimal exercise guidelines.

Gym woman pilates stretching sport in reformer bed There are eight principles of Pilates: relaxation, concentration, control, centering, fluidity, precision, stamina and breathing. Joseph Pilates, who developed this movement method, believed that one must pay attention to each exercise and perform it with the utmost control to avoid injury. He believed that it is not the quantity that counts, but the quality of each repetition.

Pilates exercises initiate from the “powerhouse,” or core musculature. Therefore, every exercise is an abdominal exercise that initiates at the center and flows outward. This is in tune with developmental principles and ensures a proper base from which to perform more distal work.

Proper breathing is another cornerstone of this technique. Deep breathing is essential to activate the transverse abdominal muscles, which is why the exercises are coordinated with both inhalation and exhalation. Inhalation facilitates spinal extension and trunk stability while exhalation facilitates spinal flexion and scapular depression.

During upper extremity work there should be a sense of gliding the scapulae down the back to promote shoulder stability. Pilates can incorporate more than 500 exercises, which can be performed either on a mat or on special equipment, such as the Cadillac, Reformer and barrels. These exercises can be modified to meet the needs of patients through the use of springs to assist and mobilize the muscles, and provide resistance when patients are stronger.

Women who are diagnosed with breast cancer will have surgery, which can be followed by systemic treatment such as chemotherapy and/or hormone therapy and then, possibly, radiation. After undergoing breast cancer surgery and treatment, the body seems lost and out of control. Breast cancer survivors are faced with many issues including fatigue, loss of range of motion and strength in the affected arm, lymphedema risk, weight gain and poor posture.

Furthermore, there are psychological implications to being diagnosed with a life-threatening disease and breast removal. Pilates is one tool that can help one regain a sense of mastery and control over a body that seems foreign and lost.

How Does the Rehab Work?
Loss of range of motion and tightness in the axillary and pectoralis regions is common after breast cancer surgery, especially after axillary lymph node dissection and mastectomies. The more extensive the surgery, the greater the limitations secondary to greater tissue loss, pain and scar formation. Because many of the Pilates exercises are performed in the supine position, the neck and back can be comfortably supported. Active assisted exercises with a towel or band are used to improve mobility of the shoulder girdle while the spine is in a neutral position.

Aerobic Pilates personal trainer instructor women Pilates focuses on the scapula stabilizers including the rhomboids, latissmus dorsi, middle/lower trapezius and serratus anterior while performing active range of motion, which is different than a traditional rehabilitative approach. The use of imagery is often used to coordinate the mind and body, so one may be told to “place those wing bones in your back pocket.” Even some of the exercises can be done in side lying, which eliminates gravity, making the shoulder exercises easier to perform.

Pilates emphasizes proper alignment and posture which improves movement efficiency, opens up all the lymphatic channels and facilitates good breathing.

The risk of lymphedema, the buildup of protein-rich fluid in the chest, trunk and arms, is another concern for anyone who has received lymph node dissection and/or radiation. This is due to scarring of the lymphatic vessels that disrupts lymphatic flow, along with the loss of mobility. This can interfere with normal lymphatic or venous drainage from the arm.

Since diaphragmatic breathing is used in Pilates both to stabilize and mobilize the spine, this enhances trunk organization. Lymphatic fluid can be propelled through the body with this type of breathing, along with proximal to distal exercise. As one inhales and exhales, the pressure changes, stimulating lymphatic return. In addition, diaphragmatic breathing lowers heart rate and blood pressure, creating a relaxation response conducive to emotional healing.

Use of the deep stabilizer muscles, including the transverse rectus abdominas and multifidus, encourages pumping to the thoracic duct, the main area for lymphatic return. This in effect clears the trunk for fluid from the axillary region and pectoralis area where lymph flow may be impaired.

Once the trunk is cleared, one can exercise the arm at risk. Compression garments or bandages should be worn while exercising if at risk. Exercises should be progressed slowly and gradually to allow the lymphatic system to adjust to an increased lymphatic load.

There are usually few repetitions for each Pilates exercise, which is a natural fit for women at lymphedema risk.

Dealing with Fatigue
Fatigue both during and after cancer treatment is the most common side effect of the treatment. Many women feel unable to function and perform daily activities while undergoing chemotherapy or radiation treatments, and this fatigue can become overwhelming as treatments accumulate. However, many research studies have confirmed the advantages of both strength and aerobic conditioning even during treatment. Pilates offers a gentle introduction or re-introduction to regular exercise that can slowly help restore strength and endurance. One can gradually build up by performing the exercises at least twice a week. This should be combined with an aerobic conditioning program, such as walking, when able.

It is time to think about alternative approaches to meeting the needs of this population, along with individuals suffering from other chronic conditions. As one can readily see, Pilates offers many benefits to women recovering from cancer, especially since occupational therapists are well trained in the modification of such activities and exercises.

At Integrated Mind and Body, Turo works with breast cancer survivors as well as individuals who have had depression, total knee replacements and total hip replacements. She requires a signed physician’s release form, and does a full intake on clients that includes medical history, pain, postural analysis and ADL evaluation, as well as the standard occupational therapy assessments.

Clients pay out of pocket to receive Pilates and Reiki in conjunction with traditional therapy services. Turo demonstrates that therapists can balance an occupational therapy frame of reference along with other healing modalities to be successful.

Reprinted with permission from Naomi Aaronson, MA, OTR/L, CHT; Also published on Advance Healthcare Network.

Naomi Aaronson, MA, OTR/L, CHT can be reached at www.recovercisesforwellness.com.

Breast Cancer and Exercise

Today's Dietitian/5 October 2014/ All MFN blog, Conditions/

October is National Breast Cancer Awareness Month, when pink ribbons remind women to schedule their mammograms and honor those who have died from or survived breast cancer. According to the National Cancer Institute, one in eight American women (12.3%) will develop invasive breast cancer during her lifetime.

When I Learn, I Teach: My Success Story

Kaleb Hill/5 October 2014/ All MFN blog/

After being unemployed for over two years and receiving several reject letters from jobs I applied for, I decided to add volunteer service to my resume. This was some of the most rewarding work I’d done in a long time.

Fit and Strong! Improves Arthritis Symptoms

Today's Geriatric Medicine/8 September 2014/ All MFN blog, business partners, Conditions/

The specialized program, combining structured physical activity with health education to build self-efficacy and effect behavior change, helps to reduce lower extremity joint pain.

ADHD, Athletes & Appetite Issues

Nancy Clark, RD/9 August 2014/ All MFN blog/

Many teens and adults with attention deficit hyperactivity disorder (ADHD) are great athletes. In elementary school, they may not have been good at sitting quietly, but they certainly could excel at sports. Many found exercise had a calming, centering effect. With maturation, exercise still helps them get through their school/workday.

Athletes with ADHD often have trouble organizing an effective fueling protocol, including the basic tasks of shopping for and preparing food, as well as having the right foods available at the right times. This can create problems with low blood sugar (hypoglycemia) and hunger that gets disguised as inability to concentrate, stay focused on a task, edginess, hot temper, and reduced athletic performance. Athletes with ADHD often disregard these symptoms, thinking they relate to their ADHD diagnosis, not hunger and poor diet.

ADHD medications

Athletes with ADHD often take appetite-killing meds that easily disrupt normal fueling cycles and contribute to fluctuations in energy. Athletes need steady energy to be able to concentrate and perform at their best. Hence, athletes with ADHD need to vigilantly monitor their bodies for early signs of hunger, including feeling fatigued or moody. Some may seek an energy drink such as Red Bull or some coffee, but the solution is not caffeine. They need fuel!

When athletes with ADHD miss meals due to lack of planning, they often end up craving sweets—a sign the body is too hungry and wants a sugar-fix. They can then easily succumb to overindulging in cookies, candy, and other so-called “junk foods.” This may happen at 10:00 pm, after their appetite-suppressing meds have worn off, and this can disrupt normal sleep patterns, as well as kill their appetite for their breakfast and that perpetuates a bad eating cycle.

What’s an athlete with ADHD to do?

The information below is helpful for any athlete – not just those with ADHD…

Take mealtimes seriously. If you can find the time to train and compete, you can also find the time to fuel right. In fact, all competitive athletes who don’t show up for meals might as well not show up for events. Everyone loses his or her competitive edge with hit-or-miss fueling.
Fuel your body on a regular schedule by eating even-sized meals at least every four hours. If meds curb your appetite, plan to eat by the clock, and not by (non-existent) hunger. If necessary, set the alarm on your watch or cell phone. If the sight or small of food makes you nauseous, try cold beverages such as a fruit smoothie with additional protein powder.
Organize your eating into four “food buckets.” Consume the contents of a bucket every four hours, either as a meal (Breakfast, Early Lunch, Late Lunch, and Dinner) or as smaller mini-meals based on wholesome foods, not sweets.

For most athletes, each meal/food bucket should be the caloric equivalent of two or three slices of pizza. That’s about 500 to 800 calories per bucket (or 2,000 to 3,200 calories per day), depending on your body size, sport, and energy needs. For athletes on appetite-curbing ADHD meds, the breakfast bucket should be the biggest bucket and incorporates some of the lunch calories that will otherwise get left uneaten.

The following sample menu has 4 food buckets that offer a steady supply of energy for an ADHD high school athlete:

Time	Bucket	Sample meal
7:00	Breakfast	Bagel + peanut butter + tall glass milk + banana OR 3-egg omelet (lowfat cheese,veg) + toast + fruit Better bet if unable to stomach all of lunch: Bagel & peanut butter + omelet + milk + banana
11:00*	Lunch #1	Tuna sandwich/whole wheat bread + string cheese + milk
3:00*	Lunch #2	Pre-exercise: Energy bar + apple Recovery: Dried fruit & nuts + pretzels
7:00	Dinner	Chicken + brown rice + veggies + milk

* Remember: If you take ADHD meds, you may not feel hungry but your body still needs fuel. Figure out what you can eat, regardless!

• Eat BEFORE your appetite-killing meds kick in. Again, figure out how to front-load your calories. For example, one athlete with ADHD started eating a hearty sandwich for breakfast. Another enjoyed “planned overs” from dinner the night before. By front-loading, they felt calmer during the day, had better workouts in the afternoon, and were better able to focus on the task at hand.

• Plan to fill your food buckets with foods in their natural state, and limit your intake of highly processed foods. Some health professionals believe additives and food coloring in processed foods can trigger hyperactivity in certain people. Plus, highly processed foods often offer less nutritional value and fewer health benefits. Shop for fresh foods along the outside aisles of the grocery store: fresh fruit, vegetables, lean meats, low fat dairy, and whole grain breads.

• Include a protein-rich food in each food bucket, such as eggs, cottage cheese, peanut butter, lowfat cheese, Greek yogurt, turkey/cheese roll-ups. Again, nothing is wrong with having dinner for breakfast; enjoy that cheeseburger and oven-baked “French fries” and then roll the scrambled eggs and cheese into a wrap for lunch. Protein is satiating and helps stabilize blood sugar. A trail mix made with nuts and dried fruit is another option with compact calories for easy nibbling.

• Make a shopping list before you go to the grocery store, and shop after having eaten a meal. That enhances your chances of choosing more of the best sports foods, and less of the rest. Examples include: orange juice rather than sports drink; oranges instead of orange juice; oatmeal (served with a little honey) instead of frosted flakes (with a lot of sugar); whole-wheat bread rather than white bread; scrambled eggs instead of Eggo waffles; baked potatoes in place of French fries; plain yogurt sweetened with maple syrup instead of pre-sweetened yogurt; trail mix rather than M&Ms; protein bars rather than candy bars.

Not only for athletes with ADHD

If you find yourself edgy and unable to focus in the afternoon, experiment with reorganizing your meals and snacks into four (calorically-equal) food buckets and notice the benefits: better focus, fewer cravings for “sweets”—and better performance.

For more information about management of ADHD in kids and adults: http://www.additudemag.com

Reprinted from The Athlete’s Kitchen, August 2014
Copyright: Nancy Clark MS RD CSSD

Boston-area sports nutritionist Nancy Clark, MS, RD counsels both casual and competitive athletes. Her private practice is in Newton, MA; 617-795-1875). For information about her new Sports Nutrition Guidebook, 5th edition, see nancyclarkrd.com. For online education, also see sportsnutritionworkshop.com.

Copy of Mixed_Cut_Fruit_iStock_000003017352Small

7 Simple Steps to Becoming ‘The Biggest Winner’

Jaclyn Chadbourne/10 July 2014/ All MFN blog/

You may have read Jaclyn’s recent post outlining her thoughts on the television show The Biggest Loser. Here, she follows up and outlines simple steps you can take to become the ‘biggest winner’ the healthy way, not relying on short term rapid weight loss to reach your goals.

Research demonstrates that rapid weight loss programs are not recommended nor do they support any correlation to long-term success. Follow some of these simple steps to maximize your chances for success in achieving your “healthy lifestyle goals.”

STEP 1: Assess your Readiness for Change

Embarking on something that you are not ready to do could be harmful because an unsuccessful program could impair your self-esteem and dampen future efforts to achieve your healthy lifestyle goals. Before setting any short or long-term goals, it is recommended to take some time to reflect on your reasons for wanting to set these goals and initiate this journey.

STEP 2: Realize you are an individual

Just as with success, we define what “healthy” means to us. This is an individual aspiration and although our loved one’s can help to motivate us to want to make changes, we ultimately need to aspire to our own picture of “healthy” in order for us to stick with new lifestyle changes. Define what healthy means to you!

STEP 3: Eat real food

Evaluate where you can make minor changes in your dietary intake. Increase fruits, vegetables and water and decrease your intake of sugar and processed food. Eat close to the earth and prepare as much food as possible on your own. But be realistic – don’t expect perfection! You can start by making small nutritional changes that have a big impact on your health! And remember….FIBER is your FRIEND!

STEP 4: Don’t “DIET”

Always remember that a calorie is not just a calorie. Contrary to what we were taught in school many years ago, it is not just as simple as calories in, calories out. Many different factors make up the quality of the calories you take in (or expend). To determine what the best foods are for YOU, it is best to contact a Registered Dietitian or qualified healthcare professional.

STEP 5: Exercise

Choose an activity you enjoy and get some professional advice on the right activities for you and how to do them safely. It should challenge your muscles so you get stronger, but exercise should not hurt. No Pain No Gain does NOT pertain to YOU if exercise is done properly.

STEP 6: Focus on progress

Rid yourself of the All IN or All OUT mentality. Rather than telling yourself “I need to lose X pounds” set small goals toward better health and be proud of your accomplishments in the process. Many times if we set a goal and don’t achieve it, we can give up all together thinking that if we don’t make it to the summit of the mountain, than what’s the point. You still made progress – reward yourself for that and get up tomorrow and do it again. If you fall into old habits, don’t beat yourself up – tomorrow is another day.

STEP 7: Simple Strategies

Switch from drinking soda to seltzer water. Keep raw nuts, carrots and high fiber foods readily available for snacking. Take a therapeutic walk every day. When you’re stronger and ready for something new, challenge yourself a little more with things like roller skating, indoor rock climbing, or setting a goal for a summer hike. If you fall into old habits, don’t beat yourself up – tomorrow is another day.

Everyone has different health goals, and the way we approach them is not a one-size-fits-all process. It’s about more than just numbers on a scale. It’s also about your energy, how you feel, and so many other factors. Health is a journey, and we are all on it together, but in different places. When we understand that, and support ourselves and each other, we all win. And THAT is the message I want my son, and all of America, to hear.

Jaclyn Chadbourne, MA is a Clinical Exercise Physiologist and Co-Owner of the Medically Oriented Gym (M.O.G.) in South Portland, Maine. With a passion for sustainable healthy living and desire to advocate for patient-centered care, Jaclyn works to help the M.O.G. support community resources for all special populations and to implement and oversee clinical protocols. Read more from the MOG on their website, themoggroup.com/blog