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The Roles of a Medical Fitness Practitioner: Scope of practice, prevention and interprofessional collaboration

Physical activity is any bodily movement produced by voluntarily contracting skeletal muscle that results in energy expenditure above a basal level. Physical activity has been demonstrated to positively affect over 30 chronic conditions and is considered the best deterrent of chronic disease in primary and secondary prevention. The main goal of a Medical Fitness Practitioner (MFP) in the healthcare continuum is to prevent the onset of chronic disease and bridge the gap between clinical intervention and conventional fitness programs. This is achieved by developing exercise programs for those who have, or are at risk for chronic disease or dysfunction, have health conditions that may be mitigated or managed by exercise and activity, are newly diagnosed with disease and need exercise guidance, or have completed a medically supervised rehabilitation program and need to continue to progress. A fitness professional versed in medical fitness protocols, such as an MFP, can work with those who are at risk for chronic disease.

Scope of Practice

Scope of practice refers to boundaries set by knowledge, skills and abilities (KSAs), as well as education, experience and demonstrated competency, such as a program of study, or an exam to measure proficiency. A basic personal training certification suggests the holder can develop exercise programs for apparently heathy clients. Unfortunately, considering the overweight and obesity rate is near 70%, and 50%-60% of the adult U.S. population has at least one chronic disease, adhering to scope of practice becomes increasingly important, yet at the same time many fitness professionals may be providing services outside their scope of practice, and beyond their level of certification. By accepting a client, the trainer is proposing a safe workout will be developed and implemented, and the client will not be at risk of injury. If advice is given that is not within the trainer’s scope of practice, the trainer and the facility may be subjected to a lawsuit.

An MFP who integrates medical fitness into practice has the KSAs, based on education, experience and demonstrated competency to conduct pre-participation interviews, perform fitness assessments and to design and implement health and fitness programs for disease management to avoid future injury and to improve activities of daily living. Unlike an MFP, unless otherwise educated, a fitness trainer who promotes medical fitness is not a licensed healthcare provider and does not possess the KSAs to diagnose an unknown condition, suggest supplements, design meal plans, physically touch a client or provide behavioral counseling.

Prevention

In the United States, medical care tends to focus on treatment rather than prevention. Whereas treatment is given for a diagnosed disease or injury, the goal of prevention is to avoid, improve or slow down the progression of a probable or possible disease or injury. Prevention can be categorized as primary, secondary or tertiary. The goal of primary prevention is to foster a life of wellness and therefore avoid or reduce the chance of disease or dysfunction. Primary prevention includes immunizations, targeted types of exercise, balanced nutrition and wellness and education programs. Secondary prevention is managing a symptomatic disease in the hopes of slowing down or reversing the progression. Examples include treatment for hypertension, asthma and some cancer treatments. Tertiary prevention involves the management and treatment of symptomatic disease with the goal of slowing progression and severity, as well as reducing disease related complications. Tertiary prevention includes treatment for late stage cancer, coronary heart disease and some types of rehabilitation to include orthopedic, cardiac and pulmonary. Physical activity has been demonstrated to effectively treat over 30 chronic conditions, mostly in primary prevention but also in secondary and tertiary, making it the number one intervention against chronic disease.

Interprofessional Collaboration

Due to the growing incidence of obesity and chronic disease, leveraging the skills of various providers who can collaborate to deliver the best possible care, based on clinical needs, is necessary to manage the complex health care demands of a population with an increasing incidence of comorbidities. Due to a worldwide shortage of health workers, in 2010, the World Health Organization (WHO) recognized interprofessional collaboration as means to mitigate the global clinician shortage, strengthen health systems and improve outcomes. Interprofessional collaboration refers to health care teams, made up of trained professionals with various backgrounds, who work alongside patients and their families to provide high-quality care, based on the needs of the patient. Consequently, as medical providers begin to recognize the need to prescribe evidence-based exercise as an intervention in the management of chronic disease, MFPs, who are on the front line of health care, are trained and educated to be part of a clinical team that complements and leverages the strengths of each team member to improve population health. As health-science and technology advance, it is imperative for fitness professionals who work with clients who have one or more chronic disease to remain up-to-date on emerging fitness protocols. An MFP is required to participate in continuing education in areas including cardiopulmonary disease, metabolic disorders and orthopedic dysfunction.

Although the scope of practice of many allied healthcare fields overlap, the role of the MFP is to work with the client’s team of other healthcare providers, while staying within the scope of practice, based on KSAs. Regardless of the collaborative health team, the client’s physician is always the center, and as such should be provided regular updates as to the client’s progress.

An MFP is uniquely qualified to work with individuals within the healthcare continuum. Some KSAs associated with MFPs are:

  • Knowledge of basic chronic disease pathophysiology
  • The use and side effects of common medications taken by someone suffering from a chronic disease
  • The knowledge to perform and analyze basic assessments related to movement and anthropometry
  • The knowledge to design a safe and effective workout based on information received via assessment results, and the clinical recommendations from other healthcare providers
  • FITT protocols, exercise progressions and regressions
  • The implications of exercise and activity for individuals with chronic disease
  • Contraindications of chronic disease, and signs and symptoms of distress related to chronic disease
  • Knowledge of signs and symptoms that require expertise outside of the scope of practice for medical exercise
  • The ability to recognize a medical emergency
  • Current CPR and adult AED are required

This article was featured in the summer 2020 issue of MedFit Professional Magazine. Click to read the latest issue and get your free subscription.


Dan Mikeska has a doctorate degree in Health Science and a master’s degree in Human Movement, as well as certifications from NASM, ACE, the Cancer Exercise Training Institute and the Exercise Is Medicine credential from ACSM. He currently owns NOVA Medical Exercise and Medical Exercise Academy and is adjunct faculty for A.T. Still University’s Master of Kinesiology program. Dan’s mission is to improve population health and to increase the quality of life by connecting education, medicine and fitness. 

Doctor and patient

Health Coaches Don’t “Diagnose or Treat Disease”: Those Words and Others Don’t Belong in Our Vocabulary

It is nothing new that there’s inevitable overlap between the practice of medicine and providing sound health coaching. Ideally, there should be a seamless continuum between the two endeavors, but that could only exist where there is a continuum of cooperation and respect. Health Coaches need to be careful with how we describe and present our work. While health coaching is a vibrant movement, it is still a junior partner to “traditional medicine” and for self-preservation; we should seek to avoid direct “turf wars” with Physicians.

The most balanced approach requires continuous consideration of the distinctions between these complementary fields. While there will always be principled differences, the practical applications change steadily along with knowledge and technology. The most prudent approach is for Health Coaches to simply concede medicine’s proprietary terms. We need to understand them, and can use them, but anytime we do we must draw distinctions that educate our clients about the difference in objectives and procedures of these complementary endeavors. In that sense, there are no “forbidden words”, but there are plenty of places where lack of clarity in purpose and practice can cause problems. Some of the major terms that should be conceded include:

Patient, practice, diagnosis, cause, disease/pathology, prescribing, medicine, treatment, management, effectiveness, intervention and cure.

Health Coaches should strive to embody in our mission what comes from consideration of those terms. We develop relationships with clients, we are not in the practice of seeking responsibility for treating patients. We are helpful guides in exploring the vast, common sense resources of the field of wellness, not prescribing proprietary agents or using medical modalities to treat disease. We act as individual guides on a quest that prioritizes personalized discovery and anecdotal utility, not practitioners who prescribe antidotes approved by impersonal population-based investigations.

Health Coaches are about beings, synergy, elasticity, balance, flourishing and optimization.

We look for associated (natural) influences that can combine to re-establish balance, not for a cause or diagnosis that be controlled by the use of a foreign/artificial agent. Health Coaches are about beings, synergy, elasticity, balance, flourishing and optimization. Medicine predominantly lays claim to systems that don’t display those features.

“The doctor of the future will give no medication but will interest his patients in the care of the human frame, diet and in the cause and prevention of disease.”

Each term, of course, could be expanded upon greatly as time permits. Back in 1903, Thomas Edison said that “The doctor of the future will give no medication but will interest his patients in the care of the human frame, diet and in the cause and prevention of disease.” Edison was simply wrong. Health Coaches should focus on care of the human frame and diet which are the wellsprings of function and flourishing. That’s a big task that requires ever-increasing knowledge and wisdom.

Unfortunately, the human “machine” is inevitably subject to decay of various sorts and severities. Medicine will always have a very important place in providing resources for comfort where nature has been pushed to failure – which is not an uncommon occurrence. The line between those positions shifts over time, but until utopia breaks out, reality will maintain a vast market for both types of emphasis. For now, it is up to the junior partner to hold up their banner while keeping the peace.

Originally printed on the FDN blog. Reprinted with permission.


Reed Davis is a Nutritional Therapist and has been the Health Director and Case Manager at a wellness clinic San Diego for over 15 years. Reed is the Founder of the Functional Diagnostic Nutrition® Certification Course, offering functional lab training, data-driven protocols, tools and leadership you need so professionals confidently solve your client’s health issues and grow your career.

sun-behind-the-storm

Interesting Times for Interested People

So, we are all shut in our homes and are not supposed to go to work, movies, or restaurants to dine in, and we can’t even watch live sports on TV. Life is so bad, and unfair… or is it?

I have decided to look at the bright side of this event, and see it as an opportunity. While many are not in my particular position, and are actually out of job and income due to this pandemic, I want you to reframe it. Change the paradigm of this being a negative, to this being a time for catching up, reflecting, and perhaps actually changing yourself.

We all have parts of our lives that need attention. In today’s current society, it is basically impossible to be all things to all people, including ourselves. We must try to balance job, family, social contact, social media, our own diet, hobbies, medical attention, our education — professionally or otherwise, our spirituality, and even our environment. Having balance in a variety of areas is true wellness! We are often so busy teaching and preaching the benefits of fitness and wellness to others, we deny it to ourselves. I remember doing a self-survey several decades ago by some program discussing the “wellness wheel”, which many of you have probably heard of. The survey was showing areas that needed attention. (Back then I had a very lop-sided wheel, and it is not much better now.) The wheel consisted of a mnemonic (6 components. It has shifted slightly in past few decades, but the pneumonic still works well: SPICES.

Old Wellness Areas New Wellness Areas
S-ocial Social – all interactions with people outside of ourselves
P-hysical Physical – our physiological status
I-ntellectual Intellectual – includes cognitive and emotional health
C-ognitive Career – includes educational and skill acquisition and financial health
E-motional Environmental (could include emotional) – clean, organized?
S-piritual Spiritual – interactions with entities beyond people

I want to use this as a time to clean up many things that have been neglected — both around my house and inside “my house”, my physical body and mental space. I may even use this opportunity to shift my professional pursuits away from academic teaching to wellness coaching. Maybe I can chat on the phone more, spend time with my daughter, or spend more time cooking or reading. Whatever it is, start doing it now!

If nothing else, this has opened the world’s eyes to the need to stay healthy. It has shown people the need to be sanitary and practice good old-fashioned health care techniques, like washing hands and not running out of toilet paper! (Sorry, had to throw that one in!)

As an educator in both physical health and medical applications, we are perfectly positioned to show the communities we live in how to harness the power of exercise for both preventative and rehabilitation purposes. I have learned many new applications for teaching online and most people are focused on coming together for the “greater good”, and this is a breath of fresh air.

Good luck and stay healthy as you address the holistic health agenda in our society.


Dr. Mark P. Kelly has been involved with the health and fitness field for more than 30 years. He has been a research scientist for universities and many infomercial projects. He has spoken nationally and internationally on a wide variety of topics and currently speaks on the use of exercise for clinical purposes and exercise’s impact on the brain. Mark is a teacher in colleges and universities in Orange County, CA., where Principle-Centered Health- Corporate Wellness & Safety operates.

woman-video-chatting

Social Distancing – Not Social Isolation: Coaching for Connectedness

We all still need each other. Even in the age of COVID-19, our health continues to depend upon healthy supportive relationships. Our coach training company, Real Balance 1 has always stressed what we call Coaching for Connectedness.  We‘ve seen lifestyle improvement occur and last more often when people receive support for the changes they are making to live healthier lives.  When a coaching client sets up an action step we ask “Who/what else can help support you in this?”. Research on what makes health behavior last points primarily to two factors: a shift in self-concept and community support. (2)   It’s also a well-established fact that people who are more socially isolated have significantly higher rates of all major chronic illnesses. (3)

Our challenge in the midst of a pandemic situation is how we distance from each other while remaining connected to each other. Yes, follow the CDC guidelines for social distancing. We can still greet each other with elbow bumps, and then go for a walk, a bike ride, a cruise in kayaks, etc., and continue to avoid the proximity that puts us at any risk. We can connect via phone and receive the nourishment of live, interactive conversation that texting and e-mail don’t quite match. We can climb on board a web-based platform such as Zoom and Skype where we are face-to-face for our conversation. We also have all sorts of apps such as Facetime, WeChat, and many more that allow us to have face-to-face interaction for live conversations.

As coaches we can continue to work remotely with our clients, as the majority of coaching is already done. As we do, explore the feelings that the changes brought about by social distancing are bringing out in your clients. Empathize. Explore. When people talk about their fears, the intensity of those fears almost always lessens. As people become less afraid, their thinking improves. They aren’t so quick to jump into dismissive all-or-none thinking. They are then able to engage in strategic thinking with their coach to find unique solutions to staying healthy.

  • The fitness center is shut down. How can you shift to working out at home? Use stretch bands. Modify a spare room into a place to do Yoga, floor exercises, etc. Spring brings better weather allowing more cardio outdoors.
  • Do more outdoor exercise/activity with other people – just keep your proper distance.
  • Encourage clients to find new ways to electronically visit their friends, grandchildren, and others. Play online games together.
  • Check in with your clients to make sure they have CDC information/WHO information about how to stay safe during the COVID-19 pandemic. (5,6)

Take heart at how people are showing concern for each other during this time. Younger people who are at somewhat less risk are engaging in social distancing, handwashing, etc. not only for themselves, but for the older and more vulnerable people who could be affected by the contact they are having. People in neighborhood chatlines are volunteering to go pick up groceries and prescriptions for older or more sickly neighbors. Hopefully what will come out of all of this is a greater sense of how we are all in this together. Distancing does not mean isolating. The truism of wellness pioneer Jack Travis is still valid: Connection is the Currency of Wellness.

Be well and stay well!


Michael Arloski, Ph.D., PCC, NBW-HWC – A psychologist with over twenty-five years of clinical work, and more than 23 years as a professional wellness coach, Dr. Arloski is one of the key developers of the field of health & wellness coaching. He is the author of Wellness Coaching For Lasting Lifestyle Change, 2nd Ed., and Masterful Health & Wellness Coaching: Deepening Your Craft.  His company, Real Balance Global Wellness Services, Inc., has trained over 9,000 health & wellness coaches worldwide www.realbalance.com.

References

  1. https://realbalance.com
  2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3753403/  
  3. https://www.apa.org/monitor/2019/05/ce-corner-isolation
  4. https://www.cdc.gov/coronavirus/2019-ncov/index.html
  5. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public

This article was published on Dr. Arloski’s blog. Reprinted with permission.

trainer-resistance-band-senior-woman-client

You Are The Solution

This article is meant to be a wake-up call to the fitness industry. The health of our population and country are at stake. While advancements have extended our country’s overall lifespan, it has occurred primarily through the use of medications and life-saving procedures rather than through lifestyle changes. The stark reality is that the overall health of Americans is declining as evidenced by the $3.5 trillion spent every year on health care expenditures.

Another alarming statistic is that between 1997 and 2016, there were approximately 4.5 billion prescriptions written per year. 70% of Americans take at least one and 20% take five or more prescription medications (Preidt 2017). The majority of these medications were taken to address lifestyle-related diseases and the subsequent impacts of poor nutrition choices and lack of physical activity. Additionally, many prescription and over-the-counter medications are used to treat osteoarthritis, the most common cause of physical disability in the world. While genetics, weight, and age have been considered as underlying factors, the decrease in quantity, as well as quality, of physical activity have been shown to be much greater factors to the onset and prevalence of osteoarthritis in modern society (Wallace 2017, Osar 2018).

While often attributed to causes outside one’s control (i.e. genetics), the fact is that the diseases contributing to the greatest number of deaths (heart disease, cancer, and Type 2 diabetes) and disability (osteoarthritis) are directly related to controllable factors. While each has a genetic component, lifestyle has a much greater impact on the incidence and prevalence of these diseases. One of most important and underappreciated components in the overall decline in one’s physical, physiological, and cognitive health, is the lack of physical activity. Less than 20% of the population meet the daily physical activity guidelines and less than 5% of the adult population participates in 30 minutes of physical activity. Even more disturbing is that more than 78 million U.S. adults and 12 million children are obese.

Dr. Caldwell Esselstyn has been attributed with the quote, “Genetics loads the gun, lifestyle pulls the trigger.” This suggests that lifestyle is as important as genetics in the expression of many chronic diseases. This sentiment is reiterated in a recent study from Bodai et. al (2018). “Epidemiological, ecologic, and interventional studies have repeatedly indicated that most chronic illness, including cardiovascular disease, cancer, and type 2 diabetes, are the results of lifestyles fueled by poor nutrition and physical inactivity.”

The health of our population and country is at stake. This is a call for fitness professionals to step up and recognize that you are the first line of defense against the deleterious impacts of lifestyle diseases. It is your responsibility to educate your communities that lifestyle changes, incorporating proper nutrition as well as increased physical and cognitive exercise, should be the first step in addressing chronic lifestyle diseases. You can continue to change the health of our nation by implementing evidence-based nutrition, exercise, and cognitive training programs. Be the solution your clients, your community, and our country needs by investing in advanced education in nutrition, exercise, movement, and cognitive training. Create relationships with allied health professionals so that we can collectively educate, collaborate, and coordinate the changing of our nation’s health care system.

This article was featured in MedFit Professional Magazine Winter 2020 issue. Subscribe to MedFit Professional Magazine to read more great content like this!


Dr. Evan Osar, an internationally recognized speaker, author, and expert on assessment, corrective exercise, and functional movement. Dr. Osar is committed to educating and empowering fitness professionals while helping them develop relationships with allied health professionals. He is author of the Corrective Exercise Solutions to Common Hip and Shoulder Dysfunction and has developed the industry’s most complete training certification, the Integrative Movement Specialist™. With his wife Jenice Mattek, he created the online educational resource. For more info, visit IIHFE.com

References

Bodai, B. I., Nakata, T. E., Wong, W. T., Clark, D. R., Lawenda, S., Tsou, C., … Campbell, T. M. (2018). Lifestyle Medicine: A Brief Review of Its Dramatic Impact on Health and Survival. The Permanente journal22, 17–025. doi:10.7812/TPP/17-025

Centers for Disease Control and Prevention. Osteoarthritis. Retrieved from https://www.cdc.gov/arthritis/basics/osteoarthritis.htm

Centers for Disease Control and Prevention. Leading Causes of Death. Retrieved from https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm

Centers for Medicare & Medicaid Services. National Health Expenditure Data. Retrieved from https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsHistorical.html

Osar, E. (2018). The Fundamentals for Training the Older Client with Osteoarthritis. Retrieved from https://www.ptonthenet.com/remote-learning

Preidt, R. (2017). Americans Taking More Prescription Drugs Than Ever. https://www.webmd.com/drug-medication/news/20170803/americans-taking-more-prescription-drugs-than-ever-survey

U.S. Department of Health & Human Services. Facts and Statistics. Retrieved from https://www.hhs.gov/fitness/resource-center/facts-and-statistics/index.html

Wallace, IJ., Worthington, S., Felson, DT., Jurmain, RD., Wren, KT., Maijanen, H. Woods, RJ., Lieberman, DE. (2017). PNAS. 114(35): 9332-9336.

med-fit-client-doctor-exercise

Healthcare Through Fitness

A discussion of medical fitness is rooted in an understanding of the health benefits of fitness and exercise. The documented benefits are endless and include management of chronic disease, management and prevention of osteoporosis, improved mood and sleep disorders, stress relief, management and prevention of obesity.

Health agencies across the spectrum of public health and disease-specific organizations recognize and promote exercise and fitness as an integral part of the management of chronic disease; diseases that include diabetes, cardiovascular disease, Parkinson’s, depression, multiple sclerosis, and arthritis, among others.

If fitness and exercise are well accepted as part of the management strategy for multiple diseases, why is it that access to organized exercise plans, and fitness professionals who can help implement those plans, are not a standard part of the medical treatment paradigm? Why is it not a standard benefit covered by common medical insurance policies?

The reasons are multifactorial and a reflection of the overall healthcare conundrum in our country today. Let’s focus, however, on how to make a change. We need to focus on how to integrate fitness professionals into the medical paradigm. A perfect model for this is an integrative medical fitness center.

What is a medical fitness center? It is a fitness facility with a multidisciplinary staffing approach and has the following characteristics:

  • Regular medical oversight by a medical director
  • Practitioners with nationally-recognized certifications and training in the care of chronic disease
  • Comprehensive health assessments and exercise prescription
  • Exercise classes geared toward specific medical conditions

These centers bring together credentialed staff in a collaborative way to provide exercise prescription plans specific to the needs of an individual with chronic disease.

The concept of the medical fitness center is not new; many currently exist in communities throughout the United States. However, an understanding of their importance in the context of the current healthcare environment has grown. The idea of creating “medical homes” that are collaborative across disciplines and provide a comprehensive healthcare approach is now being recognized to provide a high standard of care while simultaneously decreasing overall healthcare costs. This is true specifically for high-risk individuals who suffer from chronic disease.

Further integration of medical fitness centers, and broad access to exercise and fitness resources, will hopefully become standard of care and widely accessible to all individuals, especially those with chronic disease. This integration will inherently bring fitness professionals into the paradigm of healthcare and promote healthcare through fitness.

This article was featured in MedFit Professional Magazine fall 2019 issue.

Subscribe to MedFit Professional Magazine to read more great content like this!


Dr. David Kruse attended medical school at UC San Diego, after graduating from UC Berkeley. He holds board certifications in family and sports medicine. He practices sports medicine with the Orthopaedic Specialty Institute, in Orange, CA. Dr. Kruse is the Chief Medical Officer for the MedFit Network and on the Medical Advisory Board for the MedFit Education Foundation. He is currently a Team Physician for USA Gymnastics, Orange County Soccer Club, and Biola University. Visit his website, krusesportsmd.com

Mirabai New Year Article

Health Coaching: A New Way To Keep Those New Year’s Resolutions

So you go to your annual check-up and your doc says “whoops your blood pressure is up and you’re 15 pounds heavier than last year. I’ll give you some meds, but you’ll have to lose weight and get into shape, OK?

You say OK, you walk out and then what?

Join a gym, hire a personal trainer, go on a diet, take a walk? You might do one or several of these because, after all, it’s a new year and a new you.

Right? Right, and you try something. But how long is it till you throw up your hands and say, “ugh, I got started and now I’m off the track just like last year.”

What went wrong? Maybe nothing, except you might not have been psychologically ready to take those steps.

For any change there is a process. One of the models that are used is the transtheoretical model of behavior change (TTM) developed by James O. Prochaska , Ph.D

There are 5 stages:

Precontemplation – going along not aware of a need for, or not wanting a change.

Contemplation – recognizing a need to do something to improve your situation and considering making some sort of change.

Preparation – doing some research, making small changes, or at least thinking about what you’re going to do to help yourself.

Action – Actively making lifestyle changes,

Maintenance – Having made changes, keeping the healthy lifestyle going.

All too often we jump from contemplation to action without being ready for the change. It can feel like getting off a plane in Antarctica wearing shorts and a T-shirt. You wanted to be there but you weren’t ready for what that change would be like, and what you’d need to do to stay there comfortably.

But there is help, a new kind of help.

The health and fitness industry is rising to the challenge of our increased involvement with our own health care.

Many of us still think of fitness professionals as muscle heads with great bodies and not much else. Those types will always exist, but more educational opportunities including degrees and certifications are spawning a new breed of health & fitness professional, one that’s part of the health as well as the fitness industry.

Enter the Health & Wellness Coach

Not to be confused with a personal trainer, the Health & Wellness Coach is a consultant who helps you go, through, preparation, to action and on to maintenance. The coach helps you determine your health and wellness goals and needs. Once you have a path to your goals the coach continues to work with you to help you find the behavior modifications, activities, facilities and allied health professionals (MDs, Ph.Ds, Nurse Practitioners RDs, PTs, Personal Trainers, Exercise Instructors, etc.) to support your healthy lifestyle. You can do this on your own, but having someone with health industry knowledge who has your back, who is nonjudgmental, who just wants to help you focus and succeed can make all the difference.


Mirabai Holland MFA, EP-C, CHC is one of the foremost authorities is the health and fitness industry. Her customer top rated exercise videos for Age-Onset health issues like Osteoporosis, Arthritis, Heart Disease, Diabetes & more are available at www.mirabaiholland.com. Mirabai also offers one-on-on Health Coaching on Skype or Phone. Contact her at askmirabai@movingfree.com.

Prescription for good health diet and exercise flat lay overhead with copyspace.

A New Era Begins

The rallying cry is, “Let’s change healthcare!” From all corners of the medical universe, there is agreement that change is necessary. The biggest questions are, “What is the change?” and, “Who will make it happen?”