Hide

Error message here!

Lost your password? Please enter your email address. You will receive a link to create a new password.

Error message here!

Back to log-in

Close
male-trainer-female-client-gym

Fitness Has Become a Luxury Item. It Doesn’t Have To Be…

/4 January 2022/ All MFN blog/

Something strange is happening to the fitness industry. Or maybe it already happened – years ago – and I’m only just noticing now (having no social media presence can be a mixed blessing). There’s a shift in how fitness is being packaged and sold, a shift that emphasizes an almost slave-like devotion to the self. During my lifetime the act of “working out” was usually presented as democratic in nature, a basic right accessible to all. Now, it’s being rebranded as a sort of mandatory luxury item for this generation of digital nomads.

Hell, even the language has changed. Health is “wellness”; exercising is “training”; getting a massage is “self-care.” Forgive me for coming off as a younger Andy Rooney, but back in my day you’d hit the gym a few times a week, either before or after work, and that was that. Maybe you’d play some ball with buddies on the weekend, maybe run an easy 5K Sunday morning. Food mattered, but it wasn’t something to stress over.

Today the expectation is to be up at 4 a.m. for morning meditation and journaling while riding out the final wave of your 12-hour daily fast. Breakfast – and every morsel that passes your lips thereafter – is posted on Instagram for the approval of the oh-so legitimate dietitians, trainers and food scientists who lurk in the comments section. Your workout is no longer just that, it’s an “experience” to be shared with your tribe/team/pod, one that we must pause and express gratitude for whenever possible (quick, grab your journal!).

By now you’re likely wondering what my point is. Hasn’t the pursuit of physical perfection and ultimate longevity always been just a tad self-indulgent? And what’s wrong with indulging the self anyway? My point – and my problem – is that entry into this cult of wellness comes at a ridiculous cost, in both the literal and metaphorical sense of the word. Forget for a moment the time commitment required; society is being duped into believing you need a Fitbit, compression shorts and a $200 pair of lifting shoes to get in shape, when a notebook, sweatpants and Chuck Taylors will do just fine.

Of course, there’s always been a market that caters to the well-heeled. Peloton presents the most extreme example of this absurdity. Have you seen how much those bikes cost? And then there’s the monthly membership to boot. You could fly first-class to France and tour the countryside on your own damn bike for the same price. The same goes for Equinox – not a gym, but a “temple of well-being” that charges its parishioners thousands of dollars for the privilege of spilling sweat inside its walls.

Pay attention to the way these products are being positioned. Peloton ads feature every day, average folks pedaling away on $3,000 machines in their unspectacular homes. Lululemon ads feature every day, average folks running and bending and lifting in outfits that cost more than most people make in a day. The message is clear, yet entirely incongruent with reality. At least Equinox has the decency to showcase their upper crust offerings in the proper context; in keeping with the tradition of aspirational luxury brands, their ads make no sense at all.

Getting in shape doesn’t require a payment plan or a line of credit. I’ve spent time in posh gyms and I’ve spent time in musty warehouses and I can assure you there is next to no correlation between high fees and quality of service. In Toronto, Hone Fitness offers memberships for as low as $30 a month and you can bring a friend whenever you want. The YMCA has 120 fitness centers across Canada with fully-equipped weight rooms and loads of fitness classes; their membership subsidy program ensures everyone, regardless of income, can cycle their stress away. You may not be able to bathe yourself in eucalyptus-infused steam showers afterwards, but really who needs that anyway?

Paul Landini is a personal trainer, health educator and fitness columnist with The Globe & Mail. He specializes in making fitness fun and accessible to all, regardless of their age, gender or abilities. Paul has been a long-time advocate for plant-based nutrition and loves nothing more than dispelling the many myths surrounding vegan and vegetarian diets.

Creatine

Creatine: The athlete’s supplement of choice can boost anyone’s fitness plan and health goals

/30 November 2021/ All MFN blog/

Long trusted by athletes and bodybuilders to help improve athletic performance, the muscle strength supplement creatine remains either unknown or shrouded in myth among the wider population.  But increasingly creatine is being recognized by the medical community for the benefits it can bring beyond just athletic performance.  From assisting in injury recovery to helping reduce the risk of falls in the elderly, creatine is a natural, safe, and effective tool all of us can use…

running-bleachers

Kick up the Cardio

/19 November 2021/ All MFN blog/

Currently, health clubs offer a variety of cardio and strength options. They offer a plethora of equipment and classes yet attrition remains high. By combining the science of cardio and strength training with a motivated and energetic instructor new programming combining….

senior fit

The Case for Fitness & Healthy Aging

/11 November 2021/ All MFN blog/

An important principle that has emerged throughout my writing on “healthy aging” has been the issue of fitness and the role being fit plays in preventing illness and injury, yielding a fulfilling and vibrant life – a “life well lived”. The point of healthy aging is to be in a position as we grow older “to do what we want when we want without getting hurt”. I have always believed that my level of fitness would yield positive results as I got older emotionally, physically, mentally and spiritually – and so far I have been proven right in my own life. The “fitness lifestyle” is a consciousness issue just as healthy aging is as well. I make choices everyday that are designed to enhance my ability to live the way I choose. This always includes high intensity, focused training which will (hopefully) prepare me for the challenging years ahead.

Speaking, traveling, teaching, program design, consulting, writing and other activities that I wish to do in my future will require focus, high energy, inspiration, imagination, and physical stamina and endurance. The ability to train the way I am now will translate into the future actions that will yield the result I envision for audiences in the years ahead. Planning for a future that requires me to be prepared to do my work at a high level will also demand that I be as fit as I can be in order to give me the strength to help as many people as I possibly can – while I can. This is my mission – and my purpose.

This article is about something I think about EVERY day. Each of my actions, decisions, and thoughts are applied to the outcome that I seek with every step I take in becoming stronger, faster, quicker, more powerful, balanced, imaginative, flexible and skilled. My purpose is to be able to PERFORM at a high level even as I approach my 70’s and this is the point of my plan – and these articles in this series. How fit are you today for the future you envision for yourself? Does your vision inspire you to reach beyond your grasp? Does it “pull you forward” so that you will take the actions necessary to enable and empower you for the journey ahead? Only you can answer this question! Do it now!

Power, speed, quickness, strength, endurance, balance & flexibility:  the “core” of healthy aging and growing old – not old.

I think of training in terms of performance and so much of fitness today is “gimmicks” – programs designed for the “few” in America who are NOT the obese, overweight, poorly trained, seniors, and youth. The “fatting” of America does NOT include practical programming on TV, the internet – or anywhere for that matter – that appeals to the average, untrained individual struggling just to live a ‘moderately’ happy life. I see this huge “hole” in our society everyday when I go out into the world where the “connection” between being fit and “regular” people is NEVER being made. To most of the world, fitness – or becoming fit – means acquiring a gym membership with all the “hassles” that implies and THAT isn’t healthy or inspiring at ALL!

I worked in the Nautilus and Bally’s systems as a trainer for over ten years and I never once saw the effort being truly made to help people “realistically” ACHIEVE anything. The world outside the gym is a giant “blank” for over two thirds of the population. The only thing I see that is visible today is elementary lifestyle “advice” on Dr. Oz and other related sophomoric network shows that really change nothing. The other major factor in the sales “pitch” to America on fitness comes in the form of “infomercials” that literally “sucker” people into buying USELESS stuff that will never really help them – EVER! The latest gimmick is the “abdominal belt” that will ‘melt” fat away with just 10 minutes a day! This is just the latest in the same old scam – “sell them anything and make a buck in the process!” What a disgrace and a shame that we have resorted to “hucksterism” in this country in order to sell the virtues of being fit! Jack Lalanne’s legacy has almost been completely forgotten today and I want to make sure I play my role in carrying the work he started so long ago forward with me. At least he TAUGHT simple exercises to people of all ages in the 50’s and 60’s with passion AND led them every step of the way during his shows. Those days are long gone!

When we think of helping people to become fit and healthy, we must always remember to train ourselves FIRST so that we can inspire others to do the same. I will not TELL anyone anything because for each of us our understanding and perspectives are different – just as each of us is different. I will always side with “being the example of the change I wish to see in the world” – the theme of my first article in this series. How do I retain my skill level with the “seven keys” of fitness highlighted above? I maintain them – and will elevate myself to higher levels of performance in the future – through my weekly weight training program, running 40 to 50 miles a week, stretching, and meditation. This dedication to fitness will hopefully allow me to do what I want, when I want, without injury and live with joy the active future of service I am envisioning for myself. I believe that with each passing day we are ALL falling ‘behind the fitness curve’ in life – whether we are training or not – and it is imperative that we translate our passion for being fit to others through our example. If we CAN’T DO IT, WE SHOULDN’T BE TEACHING IT!

Conclusion

My primary commitment to myself each day is to NEVER GIVE UP. If I am not sick or injured, I am training – training for my life to come and the role I have chosen for myself as “an agent of change in the world”. Each of us MUST decide what it is WE STAND FOR so that others can be inspired by our example. Jack LaLanne taught me through his example – as John Wooden did – that it is WHO WE ARE on the inside that will be the ‘key’ to inspiring and encouraging others to reach beyond their current grasp and strive for more than they ever dreamed possible. I am convinced every day by what I see in the world that what we have to offer the ‘many’ is desperately needed now more than ever. If we do not take up this challenge, who will? When will the REAL change come? It will only come when we change ourselves (on the inside – healthy aging is an inside job, remember?) and that is the greatest challenge that we will ALL face in life. It is worth fighting for this principle every day of our lives. Will you take it upon yourself TODAY and join me in this “journey of change” – and touch millions of lives in the process? I hope your answer is a resounding YES!

Article reprinted with permission from Nicholas Prukop. 

Nicholas Prukop is an ACE Certified Personal Trainer & a Health Coach, a fitness professional with over 25 years of experience whose passion for health and fitness comes from his boyhood in Hawaii where he grew up a swimmer on Maui. He found his calling in writing his first book “Healthy Aging & You: Your Journey to Becoming Happy, Healthy & Fit” and since then he has dedicated himself to empowering, inspiring and enabling people of all ages to reach for the best that is within them and become who they are meant to be – happy, healthy and fit – and be a part of a world where each person can contribute their own unique gifts to life.

seniors-biking-in-gym-group

Exercise’s Impact on Cognition

/22 September 2021/ All MFN blog/

It’s not news that the brain changes with age. Significant changes in regions of the brain occur in healthy adults as they age, based on MRI studies.(1) The caudate, cerebellum, hippocampus, and association cortices shrunk substantially. This shrinkage in the hippocampus and the cerebellum accelerates with age. The hippocampus, the site for new memory formation, is involved with learning and emotion with a rich supply of estrogen and progesterone receptors. The cerebellum coordinates voluntary movements including all conscious muscular activity, balance, coordination, and speech.

Incidence of Dementia

The United States is experiencing both a declining birth rate and an increased average life span. This combination will increase the percentage of people over the age of 65 to 19.6%, resulting in a total of 71 million people by the year 2030.(2) The number of people over the age of 80 is also expected to increase to 19.5 million by 2030.(2) These changes will greatly increase the number of people with dementia since 6% to 10% of North American individuals aged 65 or older have dementia; this increases to 30% in those aged 85 or over.(3)

Dementia, or senility, is a difficult-to-define cluster of symptoms that include memory loss, loss of vocabulary, and loss of motor function in the absence of a change in the level of consciousness. Dementia can be measured qualitatively by verbal memory tests such as the Blessed Orientation-Memory-Concentration test, comprising six questions as listed in the following table:

The scores from each of the table’s six items are multiplied to produce a weighted score. Score 1 for each incorrect response; weighted error scores greater than 10 are consistent with dementia.(4)

Exercise Affects the Brain

The incidence of Alzheimer’s dementia can be used as a measurement of brain health.(5) As part of his study “Exercise Is Associated With Reduced Risk for Incident Dementia Among Persons 65 Years of Age and Older,” Eric B. Larson, MD, MPH, et al asked 1,740 mentally healthy men and women over the age of 65 how many days per week over the past year they had exercised for at least 15 minutes. The incidence of Alzheimer’s disease (AD) was significantly higher for individuals who exercised fewer than three times per week (19.7 per 1,000 person-years) compared with those who exercised more than three times per week (13 per 1,000 person-years). These results were not influenced by the E4 alleles on the apolipoprotein gene, which indicates a genetic predisposition for AD.

Laura Podewils et al studied the relationship between physical activity and dementia in 3,375 men and women over the course of 5.4 years.(6) Physical activity in these individuals over the age of 65 was assessed via the Minnesota Leisure Time Questionnaire. The subjects were questioned regarding the frequency and duration of their physical activity over the previous two weeks. Like Larson et al, this study found that increased exercise decreased the incidence of Alzheimer’s dementia.

The Mini-Mental State Exam can be used as a measure of cognitive ability or impairment. The 30-point questionnaire commonly used by health care providers screens for dementia, evaluates cognitive impairment, and follows cognitive change over time, making it an effective way to document an individual’s response to treatment.(7) Kristine Yaffe, MD, et al used the Mini-Mental State Exam to show that cognitive performance increases as the number of blocks walked per week increases.(8) The study involved 5,925 women over the age of 65 over a six- to eight-year period.

The most objective measure of cardiovascular fitness is the measurement of the maximum rate of oxygen consumption as measured during incremental exercise—milliliters of oxygen per kilogram of body mass per minute. A subjective measure of exercise amount or duration is not as accurate as the above direct measure, which is called maximum oxygen consumption or VO2 max. Deborah Barnes, PhD, et al conducted a six-year study of 349 individuals over the age of 55 measuring both VO2 max and subjective measures of fitness. Barnes found only the lower levels of VO2 max correlated with cognitive decline.(9) The four studies mentioned show a positive cognitive benefit from exercise. A meta-analysis performed by Colcombe and Kramer from 1966 to 2001 examined 18 studies of fitness training and cognitive function in nondemented older adults. They concluded that fitness training had a positive influence on cognition.(10)

Prospective controlled human studies provide more robust data than both animal and uncontrolled studies. Stanley J. Colcombe et al were the first to show in a prospective controlled setting that increases in cardiovascular fitness in humans results in increased functioning of the prefrontal and parietal cortices. These data suggest that increased cardiovascular fitness can affect improvements in the plasticity of the aging human brain and may serve to reduce both biological and cognitive senescence in humans.(11) In addition, women tended to exhibit the greater benefit.(12) In a literature review, Kramer et al complemented these data through the use of MRI, which is very accurate in the brain. Through this technique, Kramer and colleagues concluded that older adults who participated in the aerobic training group demonstrated a significant increase in gray matter volume in regions of the frontal and superior temporal lobe when compared with controls. The results suggest that even relatively short exercise interventions can begin to restore some of the losses in brain volume associated with normal aging.(12)

Animal studies offer some insight into how aerobic exercise benefits brain function. Aerobic exercise increases brain function in both young and old animals. Aerobic exercise increases the levels of brain-derived neurogenic factor (BDNF) and insulinlike growth factor 1 (IGF-1). BDNF has been shown to regulate neurotransmitters, including dopaminergic and cholinergic systems and may be playing an important role in the exercise-induced effects on the brain.(13) BDNF may be involved in the postexercise changes seen on a brain MRI. In addition, IGF-1 may be mediating the effects of exercise on BDNF, neurogenesis, and cognitive performance. Animal studies provide information on the effects of exercise that is difficult to obtain in human intervention studies. The sum of these animal studies overlaps with results from human studies and suggests that exercise is an effective enhancer of neurocognitive functioning in both young and old animals.(12)

AD, the most common form of dementia, shares many age-related pathophysiological features of type 2 diabetes, including insulin resistance, disrupted glucose metabolism in nonneural tissues, peripheral oxidative and inflammatory stress, amyloid aggregation, neural atrophy, and cognitive decline. Brain insulin resistance appears to be an early and common feature of AD, a phenomenon accompanied by IGF-1 resistance, promoting cognitive decline independent of classic AD pathology.(14) Such a large set of shared features suggests shared etiologies.

Recommendation

High-intensity interval training (HIIT) is a type of endurance training involving short periods of maximal effort followed by periods of maintenance or recovery effort. What can differ is the timing and type of endurance exercise. A typical cycling HIIT pattern may be four to six maximal 30-second cycling sprints separated by 4.5-minute recovery periods of comfortable cycling. When HIIT is compared with longer steady endurance training, the HIIT patterns show increased mitochondrial density in muscle cells and greater muscle performance improvements.(15,16)

Get a Free Subscription to Today’s Geriatric Medicine

This article was featured in Today’s Geriatric Medicine.

Today’s Geriatric Medicine is a bimonthly trade publication offering news and insights for professionals in elder care.

Get a Free Subscription to Today’s Geriatric Medicine

 

This article was featured in the Jan/Feb 2016 issue of Today’s Geriatric Medicine (Vol. 9 No. 1 P. 26). Written by Robert Drapkin, MD

Robert Drapkin, MD, a medical oncologist and competitive bodybuilder in Clearwater, Florida, specializes in helping elderly adults achieve a healthful lifestyle to combat illnesses or disease and to extend lifespan.

 

References

1. Raz N, Lindenberger U, Rodrigue KM, et al. Regional brain changes in aging healthy adults: general trends, individual differences and modifiers. Cereb Cortex. 2005;15(11):1676-1689.

2. Chapman DP, Williams SM, Strine TW, Anda RF, Moore MJ. Dementia and its implications for public health. Prev Chronic Dis. 2006;3(2):A34.

3. Hendrie HC. Epidemiology of dementia and Alzheimer’s disease. Am J Geriatr Psychiatry. 1998;6(2 Suppl 1):S3-S18.

4. The Blessed Orientation-Memory-Concentration Test. University of Missouri Geriatric Examination Tool Kit website. http://geriatrictoolkit.missouri.edu/cog/bomc.pdf.

5. Larson EB, Wang L, Bowen JD, et al. Exercise is associated with reduced risk for incident dementia among persons 65 years of age and older. Ann Intern Med. 2006;144(2):73-81.

6. Podewils LJ, Guallar E, Kuller LH, et al. Physical activity, APOE genotype, and dementia risk: findings from the Cardiovascular Health Cognition Study. Am J Epidemiol. 2005;161(7):639-651.

7. Pangman VC, Sloan J, Guse L. An examination of psychometric properties of the mini-mental state examination and the standardized mini-mental state examination: implications for clinical practice. Appl Nurs Res. 2000;13(4):209-213.

8. Yaffe K, Barnes D, Nevitt M, Lui LY, Covinsky K. A prospective study of physical activity and cognitive decline in elderly women: women who walk. Arch Intern Med. 2001;161(14):1703-1708.

9. Barnes DE, Yaffe K, Satariano WA, Tager IB. A longitudinal study of cardiorespiratory fitness and cognitive function in healthy older adults. J Am Geriatr Soc. 2003;51(4):459-465.

10. Colcombe S, Kramer AF. Fitness effects on the cognitive function of older adults: a meta-analytic study. Psychol Sci. 2003;14(2):125-130.

11. Colcombe SJ, Kramer AF, Erickson KI, et al. Cardiovascular fitness, cortical plasticity, and aging. Proc Natl Acad Sci U S A. 2004;101(9):3316-3321.

12. Kramer AF, Erickson KI, Colcombe SJ. Exercise, cognition, and the aging brain. J Appl Physiol (1985). 2006;101(4):1237-1242.

13. Knüsel B, Winslow JW, Rosenthal A, et al. Promotion of central cholinergic and dopaminergic neuron differentiation by brain-derived neurotrophic factor but not neurotrophin 3. Proc Natl Acad Sci U S A. 1991;88(3):961-965.

14. Talbot K, Wang HY, Kazi H, et al. Demonstrated brain insulin resistance in Alzheimer’s disease patients is associated with IGF-1 resistance, IRS-1 dysregulation, and cognitive decline. J Clin Invest. 2012;122(4):1316-1338.

15. Gibala M. Molecular responses to high-intensity interval exercise. Appl Physiol Nutr Metab. 2009;34(3):428-432.

16. Billat VL. Interval training for performance: a scientific and empirical practice. Special recommendations for middle- and long-distance running. Part I: anaerobic interval training. Sports Med. 2001;31(1):13-31.

pregnancy-fitness-1

Can a Pregnant Woman Safely Continue her Pre-Pregnancy Workout Routine?

/9 September 2021/ All MFN blog/

A regular exercise routine has become a way of life for many women, and many choose to continue their exercise routines when they become pregnant.  Research in the field of maternal fitness has shown that exercise during a non-complicated pregnancy is healthy for both mom and baby and may help prevent or reduce some of the physical problems associated with pregnancy, labor, and delivery.

Although exercise is a positive addition to a healthy pregnancy, there are established guidelines that help ensure that a woman’s exercise program is safe and effective.  First and foremost, it is important for a pregnant woman to consult with her healthcare provider before starting any exercise program.  She should bring a list of questions regarding her exercise program and provide an overview of what type, intensity, frequency, and duration of exercise she would like to do.  This enables her healthcare provider to accurately assess whether the fitness program is appropriate for her pregnancy.

Each woman’s level of fitness and health is different, as is each pregnancy. There are several points to consider when choosing to continue a fitness program during pregnancy.  Some types of exercise are more easily continued during pregnancy, and common sense, safety, and comfort all play a role in deciding whether an activity should be part of a prenatal fitness program.

Choosing the type of exercise that will be safe and effective during pregnancy can be determined by reviewing the following points:

  • What activities does she enjoy or are skilled at doing?
  • Does the activity pose an increased risk of falls or blunt abdominal injury?
  • Is she able to do the activity without being compromised by balance and center of gravity changes?
  • Can the activity be easily modified as pregnancy progresses?
  • Does common sense conclude that this is a safe activity to continue during pregnancy?

Research on prenatal exercise has suggested that greater benefits are achieved by including sustained, weight-bearing exercises such as walking, running, stationary stepping/elliptical machine, or dance classes in a prenatal fitness program.  However, some women may not tolerate weight-bearing exercise during pregnancy and are more comfortable with non-weight bearing activities such as swimming and stationary biking.

There are several activities, such as scuba diving and water skiing, that are never safe to do during pregnancy.  Other activities, such as downhill skiing, horseback riding, and sports with a chance of abdominal impact may also be too risky for most women to continue during pregnancy.

Here are a few tips for keeping a prenatal exercise routine safe:

  • Pregnant women need to add 300 calories to their daily food intake to meet the needs of pregnancy. If she is physically active, she may need to increase that amount if she’s not gaining weight normally. The number of extra calories needed depends on the intensity and duration and frequency of the exercise program.  It is important to drink 8-10 cups of water each day and increase that amount during hot and humid weather.
  • Exercise in heat and humidity can be dangerous. It is safest to exercise in an air-conditioned facility during the summer months. If she does choose to exercise outdoors during warm weather, she should avoid the high heat times between 11:00 am and 4:00 pm and reduce intensity and duration to prevent overheating.
  • She should frequently monitor herself during exercise for signs of overheating, such as dizziness, faintness, or nausea. Drinking plenty of water before, during, and after exercise to replace the fluids lost will help prevent dehydration and overheating. Hot tubs and saunas may cause core temperature to rise to unsafe levels and should be avoided.

A simple method for monitoring intensity level during prenatal exercise is to assess how hard the exercise feels.  A pregnant woman should feel that her exercise level is moderate to somewhat hard.  If she feels out of breath or is unable to talk (termed the “talk test”), she is working at too high a level and should decrease intensity or stop and rest. Her exercise level should feel challenging but not so difficult that she feels exhausted during and/or afterward.

Self-assessment is one of the best ways for a pregnant woman to monitor her exercise program and assure herself that her activity level is safe. A pregnant woman should review the following questions several times each month and follow up with her healthcare provider if she experiences any problems.

  • Do you and your healthcare provider feel that you are gaining weight normally?
  • Do you feel well physically and mentally?
  • Are you able to comfortably follow your exercise program without pain, exhaustion, or problems following exercise?
  • Do you experience chronic or extreme exhaustion?
  • If you are at the point in pregnancy where you are consistently feeling fetal movement, have you noticed any change in the pattern or amount of your baby’s movements?
  • Does your baby move at least two times within 20-30 minutes following exercise?
  • Was your last abdominal fundal height measurement (a measurement of fetal growth) or ultrasound assessment within normal limits, and is your baby progressing normally at each medical check?
  • Does your healthcare provider have any concern regarding the health of your pregnancy?

Pregnant women who continue a challenging level of exercise need to be aware of signs or symptoms that indicate overwork, such as an elevated resting heart rate, frequent illness, lack of weight gain, depression and chronic exhaustion.   She should decrease or stop her exercise program during illness, when fatigued, under excessive stress or if experiencing any complications with her pregnancy.

Prenatal exercise should enhance pregnancy and help to make a woman’s postpartum recovery smoother.  The best advice for the athletic woman who wants to continue her fitness program during pregnancy is to use common sense, listen to her body, and enjoy all the challenges and changes this incredible experience offers.

Catherine Cram started her company, Prenatal and Postpartum Fitness Consulting, in order to provide current, evidence- based guidelines maternal fitness guidelines to health and fitness professionals. She was a contributing author for the textbook, Women’s Health in Physical Therapy and co-authored the revision of Exercising Through Your Pregnancy with Dr. James Clapp.  Her company offers the certification course, “Prenatal and Postpartum Exercise Design” which provides continuing education credits for over 30 health and fitness organization, including ACSM, ACE, ICEA, and Lamaze.