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Trainer Challenge of Stroke

A stroke is an obvious turning point in most survivors’ lives. In a best-case scenario, it can be as minor as a mild concussion. At worst, it is a disabling brain injury that leaves the person incapable of caring for themselves—or even breathing on their own. In any case, stroke clients can provide a significant challenge to a trainer wanting to help them, once medical care and primary rehabilitation has plateaued. This is especially true considering the variety of experiences a survivor can have, following a stroke.


Cholesterol and Heart Disease | Fact Sheet from PCRM

Nearly 2,400 Americans die of cardiovascular disease daily, with an average of one death occurring every 37 seconds. In 2018, roughly one out of every 10 Americans over the age of 20 had some type of cardiovascular disease (coronary heart disease, heart failure, and/or stroke), and one out of every seven deaths in the United States was due to coronary heart disease alone.


Sensory Input Drives Motor Output – “You gotta feel it to move it!”

In our previous article, we showed you this picture to help understand neuroplasticity and how neurons that wire together, fire together. In this blog we’ll use the same picture to understand how sensory input to the brain affects motor output.

The sensory area (purple) is on the front “slice” of the parietal lobe. The neurons here will be activated by sensory input such as touch, vibration, threat, pressure, temperature and joint position. Lying just in front of the sensory area is the motor area (blue), which is the back “slice” of the frontal lobe. The neurons here are activated through volitional movement.

In both the sensory and motor areas of the brain, you can see in the illustration that specific areas are dedicated to specific body parts. And those areas are represented in the same areas for sensory and motor (e.g., where the hand is located in the sensory area is in the same place in motor area along the “slice”).

Why sensory input matters for stroke survivors

The bottom line is that for you to move an area well, your brain must be able feel, or “sense”, the area well. This is why issues like peripheral neuropathy in the feet so greatly affect the ability to balance and walk. Having good sensory input from an area of the body is a prerequisite for good motor control when we try to move an area.

One of the most prominent dysfunctions after stroke is a reduced ability to move one side of the body. This can occur at many different levels, from total paralysis to reduced coordination of fine motor skills. Common examples include limb spasticity, usually in flexion (e.g., a clenched fist held close into the chest), or what is termed “drop foot”, an inability to dorsiflex (lift) the foot, which severely interferes with a safe, functional gait pattern. This happens because the stroke damaged areas in the motor cortex associated with the affected body part.

The good news is that by increased sensory input to the affected area, we can begin to improve motor output. You have likely seen this already if you have ever used things like percussion guns or kinesiology tape. The many new “toys” we see in the fitness industry these days are simply sensory input devices, providing the sensory area with more and novel input, which then allows the motor area to “fire” better and provide better movement (i.e., improved range of motion, more strength, etc.).

A 2017 study found that “kinesio tape application to the tibialis anterior has significant effects on motor recovery of the lower extremity, spasticity, ambulation capacity, HRQoL (health-related quality of life) and gait compared to the control group and baseline.” (1)

The concept of sensory input affecting motor output and how to harness it is not only for stroke recovery, but also for general fitness, performance, and pain clients!

Begin learning a neuro-centric approach to medical fitness and how to work with stroke survivors with our Stroke Recovery Fitness Specialist online course, available through the MedFit Classroom.

Pat Marques is a Z-Health Master Trainer and NSCA-CPT specializing in training the nervous system to improve performance and get out of pain.  After retiring from the Active Duty Army, Pat pursued his education and certifications in exercise science, initially working with wounded, ill, and injured soldiers. During this time that Pat discovered the power of using a neurological approach to training to get out of pain and improve fitness and performance. He currently provides exercise therapy, movement reeducation, and strength and conditioning for all levels of clients at NeuroAthlete, from chronic pain sufferers to Olympic-level and professional athletes.


  1. Belma Fusun Koseoglu, Asuman Dogan, Hilmi Umut Tatli, Didem Sezgin Ozcan,Cemile Sevgi Polat (2017). Can kinesio tape be used as an ankle training method in the rehabilitation of the stroke patients? Complimentary Strategies in Clinical Practice, Vol. 27.

Is Your Brain Really “Plastic”? – The Key to Stroke Recovery

Neuroplasticity is the brain’s ability to reorganize itself by forming new neural connections. This occurs through the changing of neurons, the organization of their networks, and their function via new experiences. Neuroplasticity is also called neural plasticity, brain plasticity, cortical plasticity, or cortical re-mapping.

You are experiencing neuroplasticity every time you learn something new, such as how to use a new computer program, a new line of music, a new app on your phone, or a new exercise in your workouts. Learning is neuroplasticity.

For brain injuries such as stroke, neuroplasticity takes on an even greater importance. Because the injury literally damaged or even destroyed neurons, we must harness neuroplasticity to build new neural connections to do regain or improve upon the resulting dysfunction. The cool thing is that other areas of the brain, those not normally associated with a given action, can assist if the stimulus is strong enough.

Why neuroplasticity matters for all brain injury survivors

The concept of neuroplasticity is very important and if you work with stroke survivors it is a concept you will want to explain at some level. Here are some points of why neuroplasticity is so important:

  • Neuroplasticity provides hope – Despite the fact that the concept of neuroplasticity has been around for several decades, it is still not widely understood in the public arena. When we explain neuroplasticity to our pain and brain injury clients, they often reply that knowing this gives them hope. Hope is especially important for a stroke survivor, in which the loss of a major motor function occurs so swiftly that it can seem to be a very daunting process to recover from.
  • We can target neuroplastic change – The great thing about learning a neuro-centric approach to training and exercise therapy is that the nervous system is very orderly and so we can be very targeted in our training to regain or improve dysfunctions.
  • Neurons that wire together, fire together – Understanding some basic neuroanatomy can go a long way. The bottom line is that areas of the brain that live close to one another can affect one another. Here is an easy example:

    • In the picture above, we see the sensory (purple) and motor (blue) cortices of the brain; if we had an issue with knee articulation, we could stimulate that area by moving the hip and/or ankle, which would “fire” into the knee area just by their proximity.
    • Here is a less obvious example: Also, notice how close the eyes and the hands are in the sensory and motor maps; you can help motor control of the hands by doing eye exercises.
  • You have lots of “backup disks” in the brain – A stroke can damage whole neuronal areas beyond repair. While this sounds daunting, it is still possible to regain function. One aspect of neuroplasticity is that other areas of the brain can actually take over to learn and perform tasks they are not normally associated with, given the right kind and amount of stimulus.

The concept of neuroplasticity and how to harness it is not only for stroke recovery, but also for general fitness, performance, and pain clients! Begin learning a neuro-centric approach to medical fitness and how to work with stroke survivors with our Stroke Recovery Fitness Specialist online course, available through the MedFit Classroom!

Dr. Grove Higgins is a chiropractor, rehabilitationist, soft tissue injury expert, researcher, anatomy instructor, biomechanist, human performance expert, speaker, and corporate health consultant. In 2015, Dr. Higgins cofounded Neuroathlete with Coach Patrick Marques (LTC, US Army Ret.) and Peter Hoversten. Neuroathlete’s goal is to more broadly deliver neurological training to a global audience.

Master Trainer Pat Marques served in the Active Duty Army for 20 years in the Infantry and Special Forces, including combat tours in Iraq. Upon retiring Pat decided to try and combine his two passions – soldiers and fitness. He was able to work with soldiers through adaptive physical training, helping them deal with amputations, chronic pain, PTS, and traumatic brain injury. Pat has completed over 600 hours of neurological training, becoming a Z-Health Master Trainer. He currently provides exercise therapy, movement reeducation, and strength and conditioning for all levels of clients at NeuroAthlete, from chronic pain sufferers to Olympic-level athletes. 

gym training, young man and his father

Exercise for Atrial Fibrillation

Here are some things to look for when working with a client with Atrial Fibrillation (A-fib).


What types of medications are they on? Calcium Channel Blockers, blood thinners (Coumadin)? These may have an effect on the intensity and type of exercise performed. You know that people who have A-fib are at increased risk for strokes, and may have hypertension and get dizzy more often. The medications – while they may help with some factors – may preclude a well-designed exercise program just because they may not tolerate some types of exercise.

What are the exercise goals? Are they wanting to tone up? Lose some weight? Get stronger? Train for a tennis match or 5K? This would help in structuring the program. The type / intensity / duration are all dependent on what the client wants. If they are just coming off surgery or a new prescription – this is important to build the foundation (which you know).


Does the doctor have any contraindications for exercise? Usually, it’s not to “overdo”, which means building up a program. I read a good article by Dr. Bill Sekula on a program for A-fib. It’s essentially a “step down, time up” program, where patients go from a few minutes of exercise a few times per day – to building up to an hour of exercise one time per day.  However, I am going to recommend more of an ITP (interval training program) that concentrates on moderate strength programs (using the 40-50% rule similar to cancer patients), so they don’t use the Valsalva maneuver while lifting, but still use a progressive resistance approach. 


Monitoring with a HR monitor, and having good hydration status are both important. Of course, you probably have them using the smart water bottle. Because of the heart dynamics and possible Coumadin Rx, the hydration is important. I assume you do a HR variability test with your client. This may be a very important test to do, as over time it may be instrumental in reducing A-fib occurrences.

I like the article by Dr. John Mandrola on the amount of exercise. He states that A-fib is completely controllable through specific lifestyle changes. He states that low inflammation exercise (high intensity endurance / triathlon, etc.) training needs to be modified, as do other lifestyle issues. I really like the discussion on inflammation, which may be one of the biggest issues in cardiac care of late. He talks about the “J curve” of exercise and that the more intense actually increases the odds ratio (OR) for sudden cardiac events and other abnormalities related to A-fib. 

I think he is on to something, and you should look into some other lifestyle aspects such as meditation and heartbeat regulation through mindful breathing and relaxation. I know that excess stress, lack of sleep and poor diet have effects on the electrical system, including SA node and conductivity. Regular relaxation may do a LOT to improve the normal sinus rhythm and reduce resting HR to a more manageable level. 

Dr. Mandrola also recommends regular monitoring of BP, keeping the use of warm exercise clothing due to peripheral circulation issues, and not overheating. 

I like the issue of ITP and progression.  I also am more of a fan of modified strength training for most clinical conditions.  I think it would work for AF because if you think of the strength of contraction during exercise (even moderate) – it will have a strong steady beat during exercise (in most cases).  

Eric Durak is President of MedHealthFit – a health care education and consulting company in Santa Barbara, CA. A 25 year veteran of the health and fitness industry, he has worked in health clubs, medical research, continuing education, and business development. Among his programs include The Cancer Fit-CARE Program, Exercise Medicine, The Insurance Reimbursement Guide, and Wellness @ Home Series for home care wellness.



  1. https://www.everydayhealth.com/hs/atrial-fibrillation-and-stroke/afib-exercise-safety-tips/
  2. https://drbillsukala.com/tips-for-safe-exercise-with-atrial-fibrillation-af-or-a-fib/
  3. http://www.drjohnm.org/2014/05/exercise-over-indulgence-and-atrial-fibrillation-seeing-the-obvious/


Trainer helping senior woman exercising with a bosu balance

Stroke Survivors Worldwide Desperately Seeking Great Care. Don’t Be a Deceiving Professional

15 Million People Suffer Stroke Each Year. There is a huge “real” need for stroke survivors to have continued physical therapy after their insurance has covered their (usually very limited) physical therapy sessions.

It’s an important time for fitness professionals to step up and gain stronger knowledge in physical rehabilitation with stroke survivors. This need is worldwide!

I know this because I have helped survivors worldwide and heard their stories of struggle. I’ve personally heard their human desire to get their bodies back to movements for everyday life. This includes things like walking, arm and hand function, balance, cognitive skills, stability, driving and much more!! Hundreds of thousands of survivors are desperately seeking proper care and guidance.

I have been asked by stroke survivors and caregivers worldwide for help. After I published my first book in 2017, The Stroke of an Artist, The Journey of a Stroke Survivor and a Fitness Trainer, I began being contacted from all over the world for help. I wanted so badly to help them all.

I also received calls and messages from personal trainers who had a survivor client. I was surprised at how some reacted. For example, one trainer, after spending an hour sharing knowledge and telling him to seek out more education beyond the one-day certification he had, responded with “So basically…” — he tried to sum up in one sentence how to train a survivor. And he had it all covered. I thought, wow, that survivor’s recovery is determined by this trainer’s ego and lack of listening skills. Most trainers I spoke with wanted a quick answer to full-body stroke recovery. They did not want to take the time needed to extend their knowledge.

I decided to begin a Stroke Recovery support group via private Facebook group page. There are almost 3000 members. It breaks my heart, but it keeps me constantly motivated to do what I can to help them and try my best to educate fitness professionals.

It is wonderful to have such a gathering from all over the world in this stroke recovery support group. It is serial and fascinating.  Everyone is so kind and supportive in the group to one another. They encourage and try to help each other so much.

Look at all the different countries our members have gathered together from: Israel, Europe, Switzerland, Australia, Canada, UK, Africa, Great Britain, Vietnam, New Zealand, Scotland, Philippines, Fiji, Ireland, Indonesia, Micronesia, Mumbai, Maharashtra, Turkey, and many States in the United States.

I know how real the urgent need is for fitness professionals to gain knowledge to help survivors get their lives back.

I decided to help get the survivors and caregivers educated since finding the professionals to help them sucked.

I then wrote my book, Stroke Recovery, What Now? When Physical Therapy Ends But Your Recovery Continues

Around this time Lisa Dougherty with the MedFit Education Foundation contacted me to be on the Education Advisory Board and write a Stroke Recovery and Exercise CEC course. I was very excited to have a platform to reach professionals to educate them to bring needed care to stroke survivors.

Fitness professionals and physical therapists must continue their education way beyond the basics of getting their original certification, license and credentials.

Hundreds of survivors have shared with me their struggles to find great care. The stories blow my mind and frustrated me tremendously.

Here is one recent story.

A 54-year-old female survivor, who lives 3 hours away from me, was so excited and filled with hope again after we met in my support group and reading my books and watching my videos. She began to get hand movement back and decided to go find a physical therapist again. She searched, asked questions and found someone who appeared and sounded like they had the knowledge and expertise to help her. She was excited, she sent me a private message and told me what the therapist said. It sounded good. This therapist spoke the neuro words.

This survivor shared in the support group how excited she was and tagged me, thanking me for helping her feel hope again. Everyone was proud of her and encouraging her. I was thrilled.

A few days ago, she sent me a message that after her 5th session with this therapist, the therapist told her that she’d never worked with a stroke survivor before and can’t help her.  She said she had gained more knowledge and recovery from me than 5 sessions with this therapist.

This upsets me so much. She deserves great care and real help. All stroke survivors do. Now she has wasted 5 insurance paid PT session and 5 co-pays. That is not okay!

I have hundreds of stories like this and some are worse.

So, to all fitness professionals and therapists…

Please don’t fake your knowledge and experience to gain a client. Don’t just talk the talk. Put the time and effort into continuing your education. Have integrity, a heart of passion and honesty in your work.

This can mean someone may walk or not walk again.

This can mean someone can hold a fork in their hand again or not.

This may mean someone can go back to work or never again.

And so much more!

In the case of the Survivor who was an artist in my first book, it meant he would paint again or not. He did paint again.

Survivors are encouraged and try to believe, never give up and don’t quit. But they need to have educated professionals they can trust to join their personal stroke recovery team.

And the fabulous 54-year-old stroke Survivor refers to me as “God’s Stroke Angel”. That makes my heart feel warm and fuzzy. ❤

Fitness Specialist and Educator Tracy Markley is the Founder of Tracy’s Personal Training, Pilates & Yoga in Florence, OR. Tracy has over 2 decades experience in the fitness industry; she holds numerous specialty certifications, including many for those with medical conditions & chronic disease. She’s also studied the Brain and the neurological system, and has had great success working with seniors and special populations in stroke recovery, neurological challenges and fall prevention. Tracy also serves on the MedFit Education Foundation Advisory Board

She’s authored 3 books: “The Stroke of An Artist, The Journey of A Fitness Trainer and A Stroke Survivor” and “Tipping Toward Balance, A Fitness Trainer’s Guide to Stability and Walking” and “Stroke Recovery, What Now? When Physical Therapy Ends, But Your Recovery Continues”. Her books bring hope, knowledge and exercises to those in need, as well as sharing her knowledge and experience with other fitness professionals.

CT scan of the patient's brain and the hand of a doctor.

82-year-old Stroke Survivor & Wife Travel From New Jersey to Oregon To Train with Tracy L. Markley

Last year, I received an email from a wonderful woman who lives on the New Jersey Coast. She had read my books and wanted to know if she could fly herself and her 82-year-old stroke survivor husband to Florence Oregon, to train with me. She shard some stories of trainers refusing to work with him and those who did not have the knowledge needed. She also shared a couple stories about physical therapist not wanting to bother with using specific equipment that was needed for him. This is so disappointing. He is now almost 4 years post-stroke and she has still searched out some guidance toward a better recovery for him. It saddens me with all that she has gone through, but I am grateful that I could help, the best I know how. I made some great life time friends.

I am honored that she reached out to me.  I am still in “ahh”, by the whole experience. Often stroke survivors and their caregivers do not find the help needed to further their recovery after physical therapy ends. Unfortunately, some survivors do not even get good physical therapy in the crucial, early stages in recovery, when it is essentially needed. She shared with me some not so good experiences she and her husband had faced, like many others I have spoken with.

They arrived the last week of September 2018, and we met to train almost every day for 4 weeks. It was a productive training month for him. He made some important gains, but has much more hard work to do. I am helping them find a professional near them with the neuro and biomechanics knowledge, needed to bring him further in recovery.

She shared with me that what sold her to come see me was a handwritten note I sent to her inside of the book order she had. She ordered “The Stroke of An Artist, The Journey of A Fitness Trainer and a Stroke Survivor.”  I knew she would get more out of help with that book if I sent her my second book “Tipping Toward Balance, A Fitness Trainer’s Guide to Stability and Balance.” I included it with the other book as a gift.  I had no idea that that would lead to her and her husband taking a journey from the Jersey coast to the Oregon coast to train with me in person.  It is very special.

I have surveyed 100s of stroke survivors in the challenges they have faced finding good guidance in further recovery. Even though there are good stories, there were a much higher amount of disappointing experiences many survivors and their caregivers have faced. Some keep pushing forward and some gave up.

Article reprinted with permission from Tracy Markley. 

Fitness Specialist and Educator Tracy Markley is the Founder of Tracy’s Personal Training, Pilates & Yoga in Florence, OR. Tracy has over 2 decades experience in the fitness industry; she holds numerous specialty certifications, including many for those with medical conditions & chronic disease. She’s also studied the Brain and the neurological system, and has had great success working with seniors and special populations in stroke recovery, neurological challenges and fall prevention. Tracy also serves on the MedFit Education Foundation Advisory Board

She’s authored 3 books: “The Stroke of An Artist, The Journey of A Fitness Trainer and A Stroke Survivor” and “Tipping Toward Balance, A Fitness Trainer’s Guide to Stability and Walking” and “Stroke Recovery, What Now? When Physical Therapy Ends, But Your Recovery Continues”. Her books bring hope, knowledge and exercises to those in need, as well as sharing her knowledge and experience with other fitness professionals.

Physio assisting elderly woman during exercise with power band a

The Importance of Exercise Following A Stroke

According to the American Heart Association, 700,000 people annually in the United States suffer a stroke.(1)  The incidence of stroke is likely to continue to escalate because of an expanding population of elderly Americans; a growing epidemic of diabetes, obesity, and physical inactivity among the general population; and a greater prevalence of heart failure patients.(2)

Following a stroke, survivors will often work with Physical and Occupational Therapists to restore strength and control through exercise programs. However, most insurance companies only pay for a certain number of therapy sessions per calendar year which can leave a gap in the rehabilitation process. It’s important to continue the exercises that a physical therapist has prescribed and progress safely through an exercise program to regain strength and functional movement. This is where a certified personal trainer with experience in rehabilitative exercises can come in. A certified personal trainer can be part of the healthcare team and can design a program which is both safe and functional.  Walking, flexibility exercises, and light strength training can help a stroke survivor continue on the path of rehabilitation. Swimming is also another beneficial form of exercise if a pool is available.

Another benefit of exercise for stroke survivors is prevention of recurrent stroke or heart attack, which occurs frequently in people who have had a stroke.(3)  Reducing risk factors can decrease the incidence of recurrent strokes and coronary events. An aerobic conditioning program can enhance glucose regulation and promote decreases in body weight and fat stores, blood pressure, C-reactive protein, and levels of total blood cholesterol, serum triglycerides, and low-density lipoprotein cholesterol.(4) Exercise also increases high-density lipoprotein cholesterol and improves blood rheology, hemostatic variables, and coronary endothelial function.(5)

It is very important that a personal trainer communicate with healthcare professionals about their client after a stroke, including the physician and physical & occupational therapists to best help the client. Safety should always come first when exercising. Overexertion and pain should always be avoided. Decrease in balance, spasticity(6), memory, and fatigue is common after a stroke. Like everyone else, stroke survivors will have good days and bad days. However, modification of exercises can help after a stroke to get individuals on the path to better physical health.

Kris Pritchett Cameron is the owner of ReNu Your Life Fitness & Neuro Wellness in Cedar Rapids, Iowa and a certified personal trainer through the American Council on Exercise. Kris has dedicated over 20 years to the health and fitness of others. Kris has worked with all ages from children to the elderly, but her specialty is medical fitness and working with older adults. With a background in healthcare and physical rehabilitation, Kris has experience working with clients who have orthopedic injuries, arthritis, Multiple Sclerosis, Parkinson’s Disease, Alzheimer’s, cancer, diabetes, heart disease, osteoporosis, bariatric surgery, mental disorders, and stroke. 


  • American Heart Association. Heart Disease and Stroke Statistics-2003 Update, Dallas TX
  • Gillum RF, Sempos CT. The end of the long-term decline in stroke mortality in the United States? Stroke 1997; 28:1527-1529
  • Mol VJ, Baker CA, Activity intolerance in the geriatric stroke patient, Rehabil Nurs. 1991; 16:337-343
  • Franklin BA, Sanders W. Reducing the risk of heart disease and stroke. Physician Sports Med. 2000; 28: 19-26
  • Hambrecht R, Wolf A, Gielen S, et al. Effect of exercise on coronary endothelial function in patients with coronary artery disease. N Engl J Med. 2000; 342: 454-460
  • Spasticity is a condition where muscles are stiff and resist being stretched. It can be found throughout the body, but is common in the arms, fingers, or legs. Hope: The Stroke Recovery Guide. 2010 National Stroke Association
Personal trainer and her client with dumbbells

Metabolic Syndrome: A New Focus for Lifestyle Modification

Personal trainers have the opportunity to do more than just help people they train become more active. We need to be prepared to also help our clients implement lifestyle behavior changes related to stress, family history of coronary heart disease, obesity, smoking, high blood pressure and high cholesterol.

A look at what is called metabolic syndrome will help you understand why, even though increasing physical activity levels is the overall best thing you can do for any client, there are additional ways to guide them to a healthier lifestyle. Sometimes you may be able to help them make the changes yourself; and, sometimes you will need to refer them to another health professional like a doctor or dietitian for guidance. Either way, knowing how to help them or when to direct them to someone who is more knowledgeable than you is important. So, first let’s become familiar with the syndrome and the clinical criteria that the doctor uses to diagnose it. Your goal is then to help your clients understand and make the necessary changes so that they don’t progress to cardiovascular disease and the almost certain heart attack heart that will be the end result.

Cardiovascular disease is still the number one cause of morbidity and mortality in the United States and much of this burden of disease can be linked to poor nutrition and a dramatic increase in sedentary lifestyles, leading to overweight and obesity. This increase in weight leads to an increase in the incidence of type 2 diabetes, and blood pressure and cholesterol problems, which are all well-established cardiovascular disease risk factors. The National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP) III has updated the recommendations for the evaluation and management of adults dealing with high cholesterol, renewing its emphasis on the importance of lifestyle modifications for improving cardiovascular risk. The NCEP has coined the term “therapeutic lifestyle changes” (TLC) to reinforce both dietary intake and physical activity as crucial components of weight control and cardiovascular risk management.

As well as focusing attention on the LDL cholesterol (also called bad cholesterol) levels, the NCEP also identified metabolic syndrome as a secondary target of therapy. Metabolic syndrome (also called insulin resistance syndrome and syndrome X) is characterized by decreased tissue sensitivity to the action of insulin (pre-diabetes), resulting in a compensatory increase in insulin secretion. This metabolic disorder predisposes individuals to a cluster of abnormalities that can lead to such problems as type 2 diabetes, coronary heart disease and stroke. The prevalence of the syndrome has increased 61% in the last decade. It is crucial for medical professionals to identify patients at risk and follow these patients closely and counsel them about making lifestyle changes to lower the risk of type 2 diabetes and cardiovascular disease.

GUIDELINE: According to the NCEP, the criteria for metabolic syndrome includes at least 3 of the following 5 clinical factors

Risk factor Defining level
Abdominal obesity
Waist circumference
>40 in (>102 cm)
>35 in (>88 cm)
Fasting triglyceride level >150 mg/dL
HDL cholesterol level
<40 mg/dL
<50 mg/dL
BP >130/>85 mm Hg
or taking antihypertensive medication
Fasting glucose level >100 mg/dL or diabetes

Source: Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Bethesda, Md: National Institutes of Health; 2001. NIH publication 01-3670.

Millions of Americans at risk for metabolic syndrome can sharply lower their chances of getting this disease by adopting a healthy lifestyle (stop smoking, low-fat diet, weight loss/maintenance and increased physical activity). Without diet and exercise modifications, most patients will eventually fail and progress to type 2 diabetes within a decade and experience a heart attack about 10 years later. Experts recommend a diet reduced in saturated fats (<7%), low in cholesterol (<200 mg/day), high in fiber (20-30gm/day) and reduced in simple sugars. Weight loss of only 5-7% (less than 15 pounds) can make a big difference in health markers like cholesterol and blood pressure. A program that includes daily exercise reaching 85% of heart rate for age is reported to be of benefit too. However, any exercise is better than none, and a target of 30 minutes every other day is a reasonable level for most people.

As a fitness professional reading this, hopefully you are not asking yourself “so what?” but are instead seeing an opportunity to educate and motivate your current clients and to use your knowledge to help attract future clients. The medical community is good at diagnosing this syndrome, but not necessarily equipped to provide patients with the tools to be successful with the lifestyle changes they recommend. There exists a wonderful opportunity to build a partnership with physicians in your area. Most physicians will gladly refer patients to you for help with the all-important exercise and nutrition portion of the treatment program. In many cases, you have more knowledge in this area than the physician who has been trained in tertiary, not preventative, (i.e. most MD’s know very little about diet and exercise since this is not a focus in medical school) medicine.  Often times all that you will need to get a referral is for the doctor to be aware of your existence and to give them an easy way to get the patient to you. A short introduction letter outlining your qualifications and showing your desire to help people make lifestyle changes is a good start. A personal visit to your primary care doctor and others in your area is even better. But, be prepared to take up just a few minutes of their time to introduce yourself, your idea, and leave your letter and cards.

Tammy Petersen, MSE, is the Founder and Managing Partner for the American Academy of Health and Fitness (AAHF). She’s written a book on older adult fitness and designed corresponding training programs. SrFit Mature Adult Specialty Certification is used nationwide as the textbook for a college based course for personal trainers who wish to work with mature adults. SrFit is also the basis for a specialty certification home study course that qualifies for up to 22 hours of continuing education credit with the major personal trainer certification organizations.


  1. Centers for Disease Control and Prevention. Early release of selected estimates based on data from the January-June 2003 National Health Interview Survey. URL: cdc.gov/nchs/about/major/nhis/released200312.htm.
  2. Summary Health Statistics Tables for the U.S. Population: National Health Interview Survey, 2016 https://www.cdc.gov/nchs/nhis/SHS/tables.htm 16 Apr. 2018.
  3. Centers for Disease Control and Prevention. Prevalence of health care providers asking older adults about their physical activity levels—United States, 1998. Morbidity and Mortality Weekly Report. 51(19):412-4, 2002.
  4. Huang, Paul L. “A Comprehensive Definition for Metabolic Syndrome.” Disease Models & Mechanisms5-6 (2009): 231–237. PMC. Web. 16 Apr. 2018.