Jason Moffatt shares personal trainer marketing with video

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How To Do Lying Leg Curls

Emphasis

This movement is very effective in isolating the muscles in the back of your upper leg (hamstrings).

Starting Position

Lie face-down on the bench with your knees just off the edge of the pad. Position your body so the leg pads are resting up against the Achilles tendon (just above your ankle). Hold on to the handles located on the either side at head level.

Movement

Bending your knees, raise the leg pad up as far as you can (at least 90 degrees). Take two to three seconds to lower the pad until it is in the starting position.

Training Tips

• Keep your hips against the bench throughout the entire movement.
• You can do single leg curls for rehab purposes only. Be very careful, this can hurt the lower back.

Warning Tips

• Do not bring your hips off the pad or twist your hips as you raise the leg pad up. This can cause an injury to your lower back.
• Do not point your toes during this exercise. This will place more stress on your calf muscles.
• Do not lower the weight any faster than two to three seconds. You must be in control at all times during this movement. The faster you perform this movement, the less control you will have which in turn will increase your risk of injury.

Robert Bovee Certified Master PPT, RTS, ETS, FTS

As one of the most successful Professional Personal Trainers and Exercise/Fitness Therapists in the United States, Robert continues to remain at the forefront of the industry by providing his clients with a thorough education and the tools to implement that education. By improving his client’s physical health, strength, endurance, cardiovascular fitness and nutritional habits, he is able to motivate them to lead longer, happier and more productive lives. Find out more about Robert and his personal training career and services, here.

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EPTI PT Deadlifting

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Happy Thanksgiving from NFPT

Thanksgiving is one of our favorite times of year here at NFPT. It is a time for us to enjoy the company of family and friends and to think about all of the things we have to be thankful for in our lives. And believe us, all of us, no matter where we are in life, have a TON to be thankful for!

We are thankful for this wonderful industry and the way that you, as a NFPT certified trainer, can make a difference and stand out as part of the NFPT Family of Trainers. We are so thankful for you, and blessed by your passion for the job, no matter where you are on your path.

So, as you are celebrating with your families and friends this Thanksgiving, take some time away from the food, football, shopping and political arguments with your Uncle Ed and think on all the things you have to be thankful for in your own life. We hope you have a wonderful holiday weekend!

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Those in 50s Largest Group Battling Drug Addiction

Big jump also seen in those aged 60 and older needing treatment for painkiller, heroin abuse

Exercise Affects Human Genome

We know that exercise has the power to change our outward shape. But the findings of a new study offer insight into how it changes the shape of our inner workings at the genome level and how that could lead to improved health and fitness.

The human genome serves as a kind of control panel in which the switches are the genes, constantly turning on or off, dependent on the biochemical signals they receive from the body. When genes are activated, they express proteins that cause physiological responses at some other point in the body.

It’s known that certain genes become active as a result of exercise, while others “pipe down”. Little was known, however, about exactly how those genes are triggered by exercise.

In recent years, science has looked at epigenetics, a process whereby temporary biochemical changes in the genome – though not in the DNA itself – are caused by various kinds of environmental impact. One such type of epigenetic change is methylation, in which a methyl group is added to or removed from a base in the DNA molecule without affecting the original DNA sequence – roughly analogous to the role of changing the software for a given piece of hardware.

A new study from Karolinska Institutet in Sweden shows that long-term endurance training in a stable way alters the epigenetic pattern in the human skeletal muscle. The researchers also found strong links between these altered epigenetic patterns and the activity in genes controlling improved metabolism and inflammation – findings that could have some implications for preventing and treating some diseases as well as insight into how to maintain good muscle function throughout the lifespan.

The study observed 23 young and healthy men and women who performed supervised one-legged cycling, using the untrained leg as a control. The volunteers took part in 45 minute training sessions four times per week during a 12-week period. Muscle performance was measured in both legs before and after training. Measurements also took the form of skeletal muscle biopsies, markers for skeletal muscle metabolism, methylation status of 480,000 sites in the genome, and activity of over 20,000 genes.

Results show that there were strong associations between epigenetic methylation and the change in activity of a total of 4,000 genes. Genes associated to genomic regions in which methylation levels increased, were involved in skeletal muscle adaptation and carbohydrate metabolism, while a decreasing degree of methylation occurred in regions associated to inflammation.

One novel and potentially far-reaching finding of the study was that most of the epigenetic changes occurred in regulatory regions of the human genome. These “enhancer” sequences in the DNA are often located far from the genes they regulate compared to so-called promoter regions, which previously were considered to be in control of most gene activity.

The findings, the researchers say, could lead to a better understanding and treatment of diseases such as diabetes and cardiovascular disease. The team also observed epigenetic differences between male and female skeletal muscle, something that could have bearing on developing gender-specific treatments.

Reference:

1. Lindholm, Maléne E., et al. “An integrative analysis reveals coordinated reprogramming of the epigenome and the transcriptome in human skeletal muscle after training.” Epigenetics just-accepted (2014): 00-00.

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Unilateral Training

Ready or not, here it comes…November 2015, 1 year until the next presidential election. Already we are being inundated with candidates, conventions, and more than enough mud-slinging. Whether you consider yourself a Republican or a Democrat, these are challenging times.

Much like the political parties, each of us possesses strengths and weaknesses in our various muscular body parts. While we may contemplate taking the time to explore our weaknesses, (unlike many politicians, sadly!) and doing the requisite work to strengthen these gifts, the path of least resistance usually wins out. We are left with a dynamic that is often out of alignment, as it were, because this is what feels familiar and comfortable.

The same thought processes often apply in the gym. We are all familiar with our “dominant hand”, the one with which we hold a pencil. This side of the body almost always possesses more strength than its non-dominant counterpart, simply due to consistent use. The result over time may be muscular imbalances and, even worse, weakness that can lead to injury. Engaging periodically in unilateral training, trying to give equal time and attention to both the dominant as well as the weaker muscles, can help alleviate this problem. In the political arena, I’d refer to this as bipartisan training. Yes, there are some aspects on which both sides agree!!

The theory of unilateral strength training is not new, yet it is far from mainstream. Single-limb training offers many advantages over traditional exercises. It promotes greater strength and growth because it takes advantage of exercises that work stabilizing and neutralizing muscles, and not just prime movers, since an unbalanced force is being applied across the body. Moreover, when executing a typical single-limb exercise, bodyweight becomes a more important aspect of the resistance, thereby training the muscle in the way that it is actually used in activities of daily life.

Training one side of the body at a time also allows for greater neural drive to that one limb. This enables the body to recruit more muscle fibers by concentrating all force on one limb rather than splitting the force between two. The end result? A stronger, well-developed muscl that will benefit the entire body! (Ah, if only is was that simple to run a country!!!)

Unilateral training can be applied to most body parts, and simply requires a bit of “outside-the-box” thinking. The most common of these exercises is, of course, the single-arm dumbbell bicep curl with which most individuals are familiar. We can easily apply the same theory to a chest workout. Unilateral incline flyes, for example, require a tremendous amount of core stabilization. Similarly, performing a military press one arm at a time will force the core to remain engaged while supporting the deltoids. One-arm cable rows will help to define both sides of the back muscles more evenly.

This method of training may require an additional set or two on the weaker side; this is generally preferable to trying to use a heavier weight on the less-dominant side of the body. So it is in other realms of daily life. Rather than spend our days only doing that at which we excel, we might choose to do “a few extra sets” to embolden those attributes with which we are not yet comfortable, the tasks that could use some shoring up and empowering. Strong, balanced muscles lead to a more centered being. If that can be accomplished in the gym, imagine what awaits you if you apply this principle to all aspects of your world!

Someone should inform Washington, D.C…….

References:

1. http://www.exercisebiology.com/index.php/site/articles/the_fall_of_the_greatest_theory_of_muscle_growth/

2. https://books.google.com/books?id=KA4iAwAAQBAJ&pg=PT151&lpg=PT151&dq=Theories+of+unilateral+Training&source=bl&ots=_amYNpM4H4&sig=AJT49yDTNp5Zbo4uJFdlYP3T96c&hl=en&sa=X&ved=0CD0Q6AEwBGoVChMIsPLxlpibyQIVyyseCh0uowJH#v=onepage&q=Theories%20of%20unilateral%20Training&f=false

3. http://breakingmuscle.com/strength-conditioning/unilateral-leg-training-part-1-historical-perspectives

4. http://breakingmuscle.com/strength-conditioning/unilateral-leg-training-part-2-challenging-the-overreaction

5. http://www.bettermovement.org/blog/2011/both-sides-now

6. http://www.bodybuilding.com/fun/boost-your-barbell-strength-with-unilateral-training.html

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Personal Training Marketing

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Diabetes: Why It Matters

Diabetes Affects Us All

If you exercise regularly and eat a whole foods diet, you may not think that diabetes is a threat to you. But at its current rate of occurrence, diabetes is projected to affect at least 1/3 of all adults by the year 2050. Even if you yourself do not develop diabetes, there is a good chance your friends and loved ones will develop type 2 diabetes. As a fitness professional working with overweight and out of shape populations, you are almost guaranteed to have clients who are diabetic. As a country, we all bear the financial burdens of diabetes in terms of health care costs.

(Click Image to Enlarge)

Resources

As a fitness professional, the more you understand about your clients’ health, the better qualified you will be to provide appropriate interventions. To learn more about the roles exercise and nutrition play in preventing and reversing disease, consider enrolling in a W.I.T.S. online course. Many of our courses count toward the continuing education requirements for your certifications. Nutritional Concepts, Exercise Program Design for Special Populations, and Certified Personal Trainer are all courses that will enhance your understanding of Diabetes and other metabolic disorders.

References

American Diabetes Association: Fast Facts: Data and Statistics About Diabetes

http://professional.diabetes.org/admin/UserFiles/0%20-%20Sean/14_fast_facts_june2014_final3.pdf

Performance Anxiety

I came across an article in Running Times Magazine (Nov/Dec. 2015), “How Strava is Ruining Your Running,” by Philip Latter. One section in particular mentioned social facilitation and how runners posting performance stats on the Strava app got the sense of being watched and evaluated and, because of that, performed better. It made me think…but about the other end of social facilitation, the part that wasn’t covered in the article.

Social facilitation explains that, in effect, people in the presence of others perform tasks they are confident in with better efforts and results. But, and this is the part that interests me, that same audience can help degrade performance from that same person if they are performing a task they are not confident in.

Though I can’t say with any degree of certainty that I’ve seen social facilitation in action, the concept comes to mind when I witness or think back about clients shrinking away from whatever exercise their trainer asked them to do, giggling, seeming not to take it seriously, or either complaining in dramatic fashion about the hardship.

But what if they are taking it seriously and are just unable to perform at their best? What if the pressure of evaluation is a cause?

An audience can take many forms, and it depends on individual perception—an app can be an audience. Sometimes it’s only the feeling of being watched and evaluated. So it makes sense that even a one-on-one training session, whether it takes place in a gym or a park, can trigger anxiety, because the trainer him or herself is an audience. There is no way to avoid watching the client, but I think that patience and genuine encouragement goes a long way to ease anxiety and perhaps increase effort and success at the same time. 

By emphasizing “genuine encouragement,” I mean that clichés have their place, but “no pain, no gain!” might sound flat to the ears of many. By knowing the client’s triggers, motivations, and real-life goals, in addition to fitness goals, as many trainers do, there is a real opportunity to personalize encouragement to maximize performance and be seen as an ally instead of merely an evaluating audience.

It might also go a long way to remind the client that the session is not a competition. Granted some might thrive in that environment, much like the competitive runners looking to knock their friends off the leader’s board on Strava. But I’m talking right now about those clients we work with who clam up when confronted with developing a new skill and suffer from degraded performance.

Let’s keep the conversation going. How would you go about getting the best from a client who you think suffers from performance anxiety?  

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Members Area Update – Re cap lessons for PT Diploma graduates

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The Link Between Diabetes and Metabolic Syndrome

It’s a Vicious Circle

Ninety to 95 percent of all diagnosed cases of diabetes are Type 2, the form of diabetes that is lifestyle-related. It typically begins as insulin resistance resulting from poor eating habits coupled with a sedentary lifestyle. If insulin resistance persists, the pancreas gradually loses its ability to produce insulin. In many cases, Type 2 diabetes is a factor related to metabolic syndrome, a condition affecting nearly 35 percent of American adults. The disease consists of a cluster of disorders including obesity, hypertension, inflammation and diabetes, all precursors to heart disease. They are all interrelated and feed off one another, causing disease to escalate unless actions are taken to reverse the disorder.

Diabesity

Obesity associated with low levels of physical activity, high levels of mental stress and poor nutritional choices is at the root of metabolic syndrome and diabetes. Abdominal obesity in particular has been pinpointed as a major contributor. Fat in the abdominal area often surrounds and infiltrates the vital organs, undermining their function. Regular daily physical activity coupled with a nutritionally dense high fiber diet are the first steps to managing obesity.

Inflammation and Diabetes

In healthy people, beta cells of the pancreas secrete insulin into the bloodstream in order to regulate blood sugar levels which rise after eating. In the early stages of Type 2 diabetes, the body’s cells become resistant to insulin because they are already storing more sugar than they can use. In that phase, the body produces immune cells called microphages that attack the beta cells in the pancreas to reduce insulin production. Microphages surround the beta cells and cause inflammation.

Hypertension and Diabetes

Chronic mental stress common to our modern lifestyles is frequently associated with hypertension. Stress changes your body chemistry, causing the secretion of hormones related to the “fight or flight” syndrome. Those hormones drive up blood pressure and stimulate your immune system. In earlier times, hormonal stress levels would return to normal once the threat of imminent danger abated. But the demands of modern Western culture keep us in an unhealthy state of perpetual stress. When coupled with poor nutrition and inactivity, prolonged stress causes you to store visceral fat and adds to the inflammation that drives metabolic syndrome and diabetes.

Control and Reversal

The good news is that the conditions that make up the diabetes-metabolic disease complex are highly responsive to physical activity. When you work out, your body uses glucose stored in your muscle cells to provide energy. Reduced glucose stores lower your cells’ resistance to insulin. Exercise also helps reduce stress and inflammation, lowering blood pressure. The responses of blood pressure and insulin sensitivity are acute, meaning that even one workout has an effect. Adding regular exercise into your weekly schedule is the fastest way to begin to turn diabetes and metabolic syndrome around. Eliminating processed foods, grains and sugar and replacing them with a Mediterranean-Style diet will speed up the process.

Resources

As a fitness professional, the more you understand about your clients’ health, the better qualified you will be to provide appropriate interventions. To learn more about the roles exercise and nutrition play in preventing and reversing disease, consider enrolling in a W.I.T.S. online course. Many of our courses count toward the continuing education requirements for your certifications. Nutritional Concepts, Exercise Program Design for Special Populations, and Certified Personal Trainer are all courses that will enhance your understanding of diabetes and other metabolic disorders.

References and Credits

American Heart Association: About Metabolic Syndrome

http://www.heart.org/HEARTORG/Conditions/More/MetabolicSyndrome/About-Metabolic-Syndrome_UCM_301920_Article.jsp#.VkcgeIRGjzI

Current Atherosclerosis Reports: Diabetes and Hypertension: Is There a Common Metabolic Pathway?

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3314178/

Medical News Today: Type 2 Diabetes is an Inflammatory Disease, Say Researchers

http://www.medicalnewstoday.com/articles/270817.php

Obesity Action Coalition: Obesity and Type 2 Diabetes

http://www.obesityaction.org/educational-resources/resource-articles-2/obesity-related-diseases/obesity-and-type-2-diabetes

*Images courtesy of freedigitalphotos.net.

Heat on FFA after Sydney FC players melt

Sydney FC coach Graham Arnold was left fuming after the FFA allowed Saturday's 0-0 draw against Perth Glory to go ahead in 34-degree heat.

Deductibles and your Marketplace health insurance

To find the Marketplace health insurance plan that works best for your family, you should consider many different factors like the premium, the yearly deductible, what services are covered, and other details. While premiums can often be a deciding factor, other considerations could be just as important.

Use Your Step Counter App

Do you have one of those nifty step counter apps? Do you pay attention to it? Do you set a daily goal? If not, maybe you should. 

A group of researchers at the University of Missouri sought to determine whether a major reduction in daily normal activity reduced both insulin-stimulated blood flow and glycemic control and whether a single day’s return to activity would improve those outcomes. The study specifically looked at the number of steps per day. Starting with otherwise healthy individuals who took greater than 10,000 steps per day and then went to less than half that amount over the course of five days before returning to their normal averages of 10,000+ steps per day (which is the daily amount that is recommended by the U.S. Surgeon General). Check out the U.S. Surgeon Generals 5 Step it Up Goals for Promoting Walking and Walkable Communities.

What they found was that cutting back on their normal daily physical activity, for even just a five days, led to decreases in the function of the inner lining of blood vessels in the legs of young, healthy study participants, causing vascular dysfunction that can have long-term effects. In short, while it’s known that the negative effects of not exercising can be reversed, the researchers found that the vascular dysfunction resulting from five days of inactivity would require more than a single day of returning to physical activity in order to improve the situation. Think about this exponentially. If 5 days of little to no activity meant that about 3 days of moderate to vigorous activity would be necessary for the body to return to its respective normal state, in the healthy individual, then what is the implication for those who have not walked 10,000 steps in 5 years!!?? A reason to stress to your clients that what they’ve done to their body in years can’t be solved in days, or weeks. 

These researchers looked at the early effects on the body’s blood vessels when a person goes from high daily physical activity, (which for the study was defined as 10,000 or more steps taken) to low daily physical activity (or less than the nationwide average of about 5,000 steps each day). They found that, although shifting activity amounts downward for just five days did not seem to affect blood flow responses to glucose ingestion, there was a significant reduction in the function of the inner lining of the blood vessels in the legs.

The research is based on what amounts to 30 minutes of moderate activity per day in the form of counting steps and daily physical activity. And though it’s different than defined exercise, such as workouts at the gym, the results point to the importance of staying active on a regular basis – use that step counter as a guide to reaching your daily step goal!

Reference:

1. Reynolds, Leryn J., et al. “Acute Inactivity Impairs Glycemic Control but Not Blood Flow to Glucose Ingestion.” Medicine and science in sports and exercise (2014).

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Narrowing the Gap Between Expectations and Results

Whether it’s staff or members, how do you close the gap between what is actually happening and the optimal situation?

Do you ever wonder why some task, procedure or something that seems so basic is not happening at your club? What is the optimal result that you are looking for compared to what is actually happening? This difference is known as the gap, and performing a gap analysis is one of your first steps to shrinking this difference.

Think about your club and things that you believe should be done better. More new members signing up and using automatic payment? Less members canceling their membership? A higher close rate on personal training packages? Staff maintaining their CPR/AED and fitness certifications? Trainers keeping their tattoos covered when on duty? Members putting away equipment, especially weights? Wiping equipment down after use? Returning towels? Members achieving their fitness goals?

These are all common situations club owners run into, but how do you fix these gaps and change behaviors? You’ll need to discover what the causes for the gaps are. Here are four key causes to initially explore and consider for many situations:

• Knowledge and Skills: Do they know how?
• Motivation: Do they know why, are they confident to do it, and do they care?
• Environment: Do they have the right resources to do it (this can also include equipment, time, space, and policies)?
• Incentive: Are they asked to do it, and are there consequences, positive or negative, for doing or not doing it?

Before you take on every gap, also consider how important it is to close. Of course, safety issues are highly important, but other items may require an ROI evaluation, or you may discover it really isn’t an issue but a personal pet peeve.

Let’s take a closer look at a few of these examples to give you an idea of how to look for performance solutions. We’ll start with club and staff related challenges first, but then move onto some interesting issues with members.

Signing up new members with automatic payment

Your expectation is to increase the number of new members signing up each month by 5% over the previous year, and use a new credit card automatic payment system. You are only attaining 65% of this goal, not even meeting last year’s numbers! What is the cause of this gap? Your staff has had very little turn over, so they have the skills and knowledge on how to sign up a new member along with training on the automatic payment system. The system is easy to use, so they are confident and motivated to use it, especially since they won’t have to manually run charges each month. They are incentivized to sign up new members with a generous bonus plan. So what’s left? Environment! The new system only takes two of the major credit cards, and some of the potential new members don’t have these cards. By upgrading the automatic payment credit card options you can close this this gap. This quick fix is probably worth the upgrade cost for the increase in new members.

Cover those tattoos?

You expect your staff to maintain a professional and clean-cut appearance.

Every time you look at your training staff and see their tattoos showing, do you sense you are losing potential training sales and new business? Before you answer that, you’ll have to consider the demographics of your club. If you cater to a younger, hipper crowd, tattoos in the workplace are more accepted, but the older you get, the more objectionable they become, at least according to a recent survey by Salary.com. If you have a more mature member base, keeping tattoos covered may be better for business. So are tattoos hurting your business or is it a personal pet peeve? Realize you’re not alone in your speculations that it could be hurting your bottom line. From that same Salary.com survey, 39% believed that employees with tattoos and piercing reflected poorly on their employer.

Let’s explore the four key causes to discover what may be causing this perceived gap. Does the staff have the knowledge about the policy on covering tattoos? If you have a policy regarding covering tattoos, this is an opportunity to offer feedback. If you don’t have a policy, maybe you’ll need to consider an update. (This can be a touchy topic, and one that may need direction from your HR team!) Perhaps they are unaware of why they should cover their tattoos. If their clients are younger, there may not be much motivation, but if they are trying to reach older clients for personal training services, they may be more motivated to cover up. Environment is not really a factor (unless temperature and becoming overheated is an issue for covering full sleeve and leg tattoos). If there is not a policy in place regarding covering tattoos, and you haven’t asked them to cover their tattoos, then there is not an incentive or direct consequence in place. This gap looks like one that you’ll need to decide if it is really worth pursuing or accepting it since the “younger generation” is leading the charge in getting inked.

Put the weights away and wipe it off!

Have you solved this one? Everyday I see this at local gyms- members not putting away weights, equipment, or even wiping their sweat off of the equipment. Do they have the skills and knowledge of how to do it? Realistically, if they took the weights off the rack, they can put them back. Wiping up sweat is a rather easy task, too. Are they motivated to do it? This one requires a little more exploration. Do they know why it’s important to put the weights away or wipe the equipment down? Posting professional looking posters near equipment or in the locker room highlighting how MRSA or ringworm can spread, or the trip and fall potential of equipment strewn about might increase personal responsibility.

The environment is also a key factor for this gap. Having cleaning spray and paper towels in multiple and convenient locations can encourage an equipment wipe down. Sometimes there’s not enough room to maneuver around the weight racks to return your weights, or it can be a little intimidating to walk around someone with ear buds blaring doing non-stop bicep curls with 90 pound dumbbells in front of the mirrored weight rack wall. Having a “no lifting zone” marked off near equipment storage racks could be a quick fix. Do members have an incentive to put the equipment away or wipe it down or are there any consequences for not doing it? Punishing members isn’t typically a good business practice. Instead try recognizing and encouraging their efforts. Try a “Caught in the Act” drawing by having staff “ticket” members putting away weights or wiping down equipment. Members enter their tickets into weekly or monthly drawings for prizes. Even handing out branded club merchandise to members doing good deeds is a great incentive!

Member Achievement

Helping members achieve their goals can also be a form of gap analysis. When a member develops discrepancy of where they are today and where they want to be, it is an opportunity to explore the consequences of their actions. This is a key principal in motivational interviewing. Motivational interviewing is about discovering the reasons why a member wants to change a behavior and strengthening their intrinsic motivations to achieve these changes. Unless someone perceives there is a good reason to change a health behavior, they probably won’t do it. Just informing someone of the reasons why it would be good to change an unhealthy behavior doesn’t mean they’ll take action. NASM has just launched a new Behavior Change Specialization that will educate your staff on how to help members achieve healthy behavior changes. (The program even has CEUs to keep your staff up-to-date on their certification requirements!) Visit nasm.org/fitness-specializations for more details.

Conclusion

This two-step performance analysis, discovering the gap and the causes, is just one of many approaches to improve what is, or is not, happening at your club. There are many different ways to analyze performance. The goal here was to get you thinking about what may be holding your club back from performing at a higher level and finding simple, first-step solutions to some of the dilemmas you may be facing.

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How to prevent rotator cuff injuries through corrective exercise programming (Part 1)

Shoulder pain and shoulder injuries are among the most common conditions within the general population and among athletes. Approximately 75 to 80% of these are caused by conditions related to the rotator cuff (1). The rotator cuff consists of four muscles, including the supraspinatus, infraspinatus, subscapularis and teres minor. These act to provide dynamic stability and control the position of the humeral head relative to the glenoid fossa during motions ranging from throwing to performing a push-up (2). There are many factors that can lead to shoulder pain and dysfunction, one being a muscular imbalance between the rotator cuff muscles and its relationship to the scapula and clavicle.

This two part series will describe the function of the rotator cuff and its synergistic relationship to the scapula and clavicle, while also providing exercises to strengthen the muscles of the shoulder complex. Correcting dysfunctional movement patterns of the shoulder complex typically requires a multifaceted approach including inhibiting, lengthening, and activating muscles whether the goal is preventative or rehabilitative. This part of the series will focus on corrective exercise strategies that inhibit and lengthen muscles by self-myofascial release in combination with static stretching. Part 2 of the series will provide you with corrective exercise protocols to stabilize and strengthen the rotator cuff muscles.

To understand how to implement corrective strategies we must first look at the anatomy and kinematics of the shoulder. The shoulder complex can be broken down into three distinct regions, the upper arm or humerus, scapula, and clavicle, which are working together providing movement in all three planes. These three regions create a mechanical linkage that is dependent upon one another for proper shoulder motion that is controlled by the upper trapezius, lower trapezius and serratus anterior.

Dysfunctional movement patterns are in part based on the concept of relative flexibility that suggests movement occurs through the pathway of least effort. For example, if hip movement is relatively stiff compared to that of the low back, then the movement is more likely to happen in the back (3). In the case of the shoulder, if the trapezius muscles are limiting proper scapula thoracic motion, the rotator cuff muscles will then compensate for this and become the “pathway of least effort” leading to compensation patterns. Therefore, inhibited or tight trapezius and serratus muscles will alter proper scapula motion. This results in improper clavicle movement due to these muscular imbalances ultimately affecting the rotator cuff.

In order to have properly working rotator cuff muscles, proper scapula thoracic motion must be established in order to maintain the correct length-tension ratio of the rotator cuff muscles. The motion of the scapula and upper arm is defined as a 2:1 movement ratio, meaning for every 2 degrees of upward humeral motion there is 1 degree of upward scapular motion. Muscles involved in creating this movement are the upper and lower trapezius and the serratus anterior. A change in scapula position or motion may cause an internal rotation of the humerus resulting in a shortened internal rotator muscle (subscapularis) and a stretched or weakened external rotator muscle (teres minor). Any dysfunction of these muscles will require opposing muscles acting on the shoulder complex to be affected due to their relationship with one another.

Proper shoulder motion and rotator cuff function are also dependent on clavicle movements that include protraction, retraction, elevation, depression and posterior rotation. As the scapula rotates upward the clavicle elevates up to 30 degrees at the acromioclavicular (AC) joint (4). Then as the arm elevates further the clavicle begins to rotate posteriorly along its axis allowing the scapula to further elevate upward.

This posterior clavicle rotation has been described in numerous studies including one by Ludewig and colleagues who performed a three dimensional analysis (5). Their findings indicate that as the arm elevates, 8 degrees of posterior rotation occurs when the arm is elevated to 110 degrees. Any loss of normal scapula motion will alter the clavicle motion and ultimately restrict the range of motion of the upper extremity. Therefore, prior to initiating any specific rotator cuff exercises it is imperative to restore the muscular function of the scapulothoracic, AC, and sternoclavicular (SC) joint regions.

In order to inhibit and lengthen these muscles a self-myofascial release (SMR) approach with either a foam roll or a tennis ball can be utilized. SMR using a foam roll has been shown to be effective for increasing flexibility when combined with static stretching. Mohr and colleagues demonstrated this when they compared foam rolling and static stretching of the hamstring muscles (6). Their study findings indicate using the foam roll for SMR in addition to static stretching is superior to either SMR or static stretching alone. Therefore, in order to maximize range of motion it is recommended to foam roll prior to static stretching.

The following protocol is based on the above-described findings and can be performed daily or at least 3 times per week. The SMR exercises are performed on the floor applying as much body weight pressure as can be comfortably tolerated for up to 1 minute at time.

1. Trapezius and Rhomboid SMR

Begin seated on floor. Lie back placing foam roll across upper back. Cross arms in front, placing hands on shoulders. Lift hips off floor. Slowly massage upper back, rolling up and down as tolerated, for duration of 1 to 2 minutes. Maintain consistent pressure with foam roll. If a painful area is found, stop rolling and REST on the area for 30 seconds as tolerated, then continue.

2. Posterior Shoulder Tennis Ball SMR

Begin lying on floor facing up. Place a tennis ball behind shoulder. Raise arm so elbow is at shoulder level and bent to 90°. Lift opposite shoulder slightly so that pressure is felt against tennis ball. Grasp wrist with opposite hand and move arm upward and downward massaging shoulder muscles. Perform massage for 1 to 2 minutes. Maintain consistent pressure with tennis ball. If a painful area is found, stop rolling and REST on the area for 30 seconds as tolerated, then continue.

3. Pectoralis Major and Minor SMR with Tennis Ball

Begin lying face down with a yoga or tennis ball situated between the floor and below the clavicle with forearm flat on the ground. Applying constant pressure on the ball, slowly move forearm upwards, pause momentarily, and then slowly return to starting position.

Static stretching to compliment the SMR exercises can be performed daily or at least 3 times per week. It is recommended that each stretch is held for 30-60 seconds and repeated three times resting 30 seconds in between stretches. When stretching the posterior shoulder a cross body stretch is recommended as this was found to be more effective than the side lying sleeper stretch by McClure and colleagues (7).

1. Cross Body Stretch

Begin seated or standing (ideally this is best done with the back against a wall to help stabilize the scapula and emphasize the stretch on the posterior shoulder). Extend one arm in front, and across body, at shoulder level. With opposite arm grasp arm above elbow and gently pull towards chest until a stretch is felt in the back of the shoulder. Hold for 20-30 seconds and repeat on opposite side.

2. Static Foam Roll Chest Stretch

Begin by positioning yourself lying on foam roll with feet flat on floor. Foam roll should support the head and run along the spine down to pelvis. Place arms to sides. Bend both elbows to 90º at shoulder level with palm facing up. Relax as chest and shoulders stretch for 30-60 seconds. Do not try to force arms to floor.

All of the above displayed exercises are easy to execute and include minimal risks if performed as described. To achieve satisfying results it is important do them on a regular basis and for a minimum of 4 weeks.

References

(1) Clark, M.A., Lucett, S.C. (2014). NASM Essentials of Corrective Exercise Training. Burlington, MA. Jones & Bartlett Learning.

(2) Arnheim, D.D., Prentice, W.E. (2000). Principles of Athletic Training. Boston, MA. McGraw Hill.

(3) Lehtola et al. BMC Musculoskeletal Disorders 2012.

(4) Kisner, C., Colby, L.A. (2002). Therapeutic Exercise Foundations and Techniques. Philadelphia, PA. F.A. David Company.

(5) Ludewig, P., et al. (2004). Three-Dimensional Clavicular Motion Durning Arm Elevation: Reliability and Descriptive Data. Journal of Orthopaedic & Sports Physical Therapy, 34(3), 141-150.

(6) Mohr, A., et al. (2014) Effect of foam rolling and static stretching on passive hip-flexion range of motion. Journal of Sport Rehabilitation.

(7) McClure P, et al. (2007). A randomized controlled comparison of stretching procedures for 
posterior shoulder tightness. Journal of Orthopaedic & Sports Physical Therapy 37:108-14.

The post How to prevent rotator cuff injuries through corrective exercise programming (Part 1) appeared first on NASM Blog.

Walk America: the Surgeon General Says So!

Okay, so it’s not just the Surgeon General who says walking is good for you…everyone says so! Walking ranks up there with the best form of exercise there is! And it doesn’t cost a thing – bonus!

NFPT supports the Surgeon General’s call to action to ‘Promote Walking and Walkable Communities‘. Specifically, the Surgeon General’s Call to Action includes 5 Goals¹. We have listed them here with some of our ideas to further promote and reinforce these valuable efforts.

GOAL 1. Make Walking a National Priority. Through initiatives which demonstrate the already popular notion of ‘walking for exercise’ we can bring more attention to how many people already use walking as their primary means of exercise. For example, the more people who use social media to say that they walked today, then the more that others will be encouraged to do the same. Friends and family will think “hey, that’s easy, I can do that too!” – hopefully they will feel the urge to get out and walk the block.

GOAL 2: Design Communities that Make it Safe and Easy to Walk for People of All Ages and Abilities. Safety and ease of access is a concern for people living in areas where they do not feel comfortable walking at night or in areas where there are limited sidewalks, lighting and places to take long walks. Safety and ease of access includes those rolling wheelchairs who want to enjoy getting physically active within their neighborhood, the pathways and lighting must be offered to do so. If you find that these things are hard to find in your neighborhood, write to your local mayor’s office! Jump on your city’s website and find an email address, it’s easy to do, and it all starts with a simple request. The more people who care, the more that the decision makers will care. Also consider taking a self-defense class; because, whether or not there is a real element of danger or just perceived danger, a self-defense class will help you to trade in your concern for confidence, and enjoy a walk in your neighborhood! I took a self defense class, called RAD (Rape and Aggression Defense), not only because I wanted to feel better about walking at night but because I wanted to take control of the unknown (as much as that is possible) and learn some basic self defense tactics. Personally, I walk with my big dog, no one wants to approach me when I have 100 extra pounds of muscle walking at my side! Now of course that doesn’t work for my mom and her Pomeranian, but the mace in her pocket is a good back up plan.

GOAL 3. Promote Programs and Policies to Support Walking Where People Live, Learn, Work and Play. It is recommended that adults get at least 150 minutes of moderate-intensity aerobic activity (or 75 minutes of high-intensity activity) each week; with children and adolescents it is 60 minutes of activity in some form each day.² So the easy math on that is 30 minutes of walking a day, 5 days a week; or 21-ish minutes a day spent walking 7 days a week, for adults (with the kiddos, it should be more). Think first about what you’re getting already, by default. For example, are you walking to work? Walking your kids to the school bus stop? (a double bonus there, both you and the kids get some daily walking time). Where and how much do you walk already? Simply add to it. The math flushes out whether you purposefully take a long walk before dinner every night, or you take the long way around the office building every day – both are purposeful efforts and one may fit better into your day to day life. Are you on lunch break for an hour?? Walk the first 30 minutes and then eat your sandwich. A lot of businesses now encourage their employees to walk by providing walking tracks or areas, and some even incentivize walks by giving extra break times for those who use their break time to walk or exercise. If it’s not encouraged by employers, it should be. Walking, healthier employees make for productive, happier employees – it just makes sense. Oh, and get your kids away from the TV and their i-DooDads, walk with them to play in the park, walk around the neighborhood and catch up on their lives. A nice long walk with your tween or teen will yield much information that maybe you didn’t know before – another double bonus!

GOAL 4. Provide Information to Encourage Walking and Improve Walkability. This fits the ‘more you know’ mantra, quite effective, as always. Because, with respect to walking, who would get out there and purposefully walk more every day if they didn’t know how good it was for them?? Only the people who really really want to walk and enjoy walking. You might, I might, but the person who is already at great risk because they don’t take care of themselves would probably not get out and about on the walking track, so they need to know why it matters…and that it does matter. I watched this great video, ’23 and 1/2 hours’, he does a great job of putting it all into perspective. Maybe you’ve seen it. Maybe someone you know, who could really benefit from the information, should see it. Share because you care:

GOAL 5. Fill Surveillance, Research and Evaluation Gaps Related to Walking and Walkability. This goal crosses the border of ‘the more you know’ and moves toward confirming the things that we think we know…making sure that stats are maintained, reliable and relevant. In my view, this means more record keeping, tracking and evaluation of the number of people who walk regularly. This data should be correlated directly to their progressive physical fitness levels and specific factors like frequency and duration. But how in the world do you keep track of all of that?? Well, that data collection could be emphasized and organized by state and local run initiatives which rely on the data of doctors, health care providers and of course…PERSONAL TRAINERS. Now, don’t misconstrue. I am not calling for more regulation, that is something that the people and industries of our highly regulated country need no more of. What I am suggesting is that, with enough health care professionals who are educated on the subject and who care about a walking initiative, data as the result of polling and alternative collections can be a valuable piece to the evaluation puzzle. This first starts with education of the initiative.

We applaud the Surgeon General and all of those individuals and companies who support the literal strides that this initiative is taking…come on America, walk with your family, walk with your friend, walk with your dog – let’s Step it Up!

Go here for specific Walking Advice for your Personal Training Clients.

^{1 Surgeon General’s Step It Up Call to Action to Promote Walking and Walkable Communities. Executive Summary. Retrieved from http://www.surgeongeneral.gov/library/calls/walking-and-walkable-communities/exec-summary.html}

^{2 U.S. Department of Health and Human Services. 2008 Physical Activity Guidelines for Americans. Washington, DC: U.S. Dept of Health and Human Services; 2008.}

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Narrowing Attention May Benefit Some Forms of Exercise

There may be something to the advice to keep one’s “eyes on the prize.” The results of a new study suggests that by remaining focused on a specific target ahead, participants perceived the distance to be shorter and walked faster. The study compared this technique to walking while observing the environment naturally, and its findings have implications that could improve the quality of exercise.

The researchers noted that people’s motivation to exercise over a course such as when running or walking often diminishes when faced with a distance to finish that appears daunting.

The study focused on “attentional narrowing,” which affects a person’s perceptions of space. The researchers hypothesized that narrowing attention on a finish line, for instance, would lead it to appear closer, increase walking speed, and reduce feelings of physical exertion.

To test their hypothesis, the researchers designed a pair of experiments. In one, the study’s subjects – 66 adults who visited a park in the summer, were asked to stand 12 feet away from an open cooler that contained cold beverages and ice. The participants were told they would be estimating the distance to the cooler.

From there, the participants were assigned to separate conditions. One group was randomly assigned to a narrowed attention condition in which they were asked to imagine that a spotlight was focused on the cooler. They learned that to be effective at estimating distance, they should direct and focus their attention on the cooler and avoid looking around the environment. The second group was assigned to a natural attention condition: Participants were allowed to let their attention move naturally and in whatever way they found to be most helpful for estimating distance.

The researchers found that those who focused their attention on the cooler perceived the cooler as closer than did those in the natural attention group.

In the other experiment, the researchers used this same intervention (narrowed attention condition) to change perceptions of distance and also improve the quality of exercise. In this experiment, 73 participants walked 20 feet in a gymnasium while they wore ankle weights that added 15 percent to their body weight, thereby making the task more challenging than being in an unladen state.

The researchers found that those participants who used a narrow focus of attention, compared to those who looked around the environment as they would naturally, perceived their targets (in this case, traffic cones) as physically closer – about 28 percent closer than did those in the natural condition group. The narrowed attention on the whole also walked 23 percent faster than did those in the natural attention group. In addition, those in the narrowed attention group reported that the walk seemed to require less physical exertion than did those in the natural condition group, which suggests the technique might be used to incentivize exercise.

Use this knowledge to your advantage when training your clients. Give them obtainable goals that they can “see” and focus on to make the road seem shorter for them. Encourage them and narrow their attention, not just with goals but with each individual exercise you take them through. Keep them focused on the goals and workouts at hand and they should go far!

Reference

1. Cole, Shana, Matthew Riccio, and Emily Balcetis. “Focused and fired up: Narrowed attention produces perceived proximity and increases goal-relevant action.” Motivation and Emotion (2014): 1-8.

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Diabetes – Safe and Effective Exercise Programming

Diabetes is a metabolic disorder that impairs the body’s ability to either produce or effectively use insulin, a key hormone for moving glucose from the bloodstream to the working muscles. Diabetes is currently ranked as the seventh leading cause of death in the United States, with type 2 diabetes accounting for 90 to 95% of currently diagnosed cases. See how exercise can improve insulin efficiency along with exercise program recommendations for diabetic clients.

Diabetes Mellitus (DM) represents a group of metabolic diseases that are collectively characterized by hyperglycemia, a condition defining elevated blood glucose levels attributed to some defect in insulin production or in insulin recognition by cells. Although most diagnosed cases are either type 1 or type 2, four types of diabetes exist based upon their etiologic causes (1).

• Type 1 Diabetes is caused by factors that include our own autoimmune destruction of the insulin-producing (beta-) cells within the pancreas, or due to some genetic variant or inherited gene, and accounts for approximately 5 – 10% of all diagnosed cases (2). These individuals with type 1 diabetes rely upon exogenous insulin (i.e., pumps, injections) and are more prone to ketoacidosis, a potentially life-threatening condition. Ketoacidosis is a metabolic state associated with inadequate ketone regulation (i.e., excessive accumulation) in the blood that lowers blood pH substantially – it reflects a build-up of incompletely metabolized fatty acids or amino acids due to a lack of available carbohydrates in the cell which are generally needed to metabolize these substrates as fuel.
• Type 2 Diabetes is attributed to an increase in insulin-resistance at the cellular level or due to a gradual secretory deficit from the pancreas, and accounts for approximately 90 – 95% of all diagnosed cases. The causes are varied and sometimes unknown, but dietary choices (e.g., sugar), inactivity and obesity, especially excessive abdominal fat, have all been verified as triggers. Some type 2 diabetics may need exogenous insulin.
• Gestational Diabetes is a condition that approximately 9 – 10% of pregnant women develop around the 24^th week of pregnancy due to changing hormonal levels needed to support fetal growth that impairs insulin function. The mother is unable to produce adequate levels of insulin needed to promote normal glucose uptake in the cells and therefore relies upon exogenous insulin (3). For most, this condition corrects itself post-partum.
• Diabetes due to other specific origin (e.g., drug induced, environmental toxins) – given the idiopathic (unknown) nature of some diabetes cases, some causes of diabetes remain unexplained and attributed to a possibility of events.

An estimated 29.1 million Americans have diabetes, representing 9.3% of our population, but recent emphasis on screening, early detection and preventative measures have decreased the number of new cases each year from 1.9 million (2010) to under 1.7 million cases (2012) (4). Unfortunately, the prevalence of this disease in seniors aged 65 and older remains very high at 25.9% of that age group (11.8 million people), and with this age group (i.e., Baby Boomers) continuing to expand, this is becoming a growing concern.

Diagnosed cases of diabetes however, do not include individuals identified with prediabetes, a condition characterized by blood glucose levels that are higher than normal, but not high enough for a diagnosis of diabetes. This also explains those individuals who may have little-to-no capacity to produce/secrete insulin, yet do not have any genetic variant, or the autoimmune antibodies to the beta-cells in the pancreas. People with prediabetes (aka impaired glucose tolerance, impaired fasting glucose) demonstrate an increased risk for developing diabetes as well as many forms of heart disease. It is estimated that 86 million Americans age 20 and older currently have this condition, and regrettably this number has increased from the 79 million in 2010 (3).

Health Risk Screening:

For any individual contemplating starting an exercise program, a thorough health risk assessment (HRA) that includes a screening for diabetes and pre-diabetes is essential to safeguard against potential harm. Any person with a previous diagnosis of diabetes is automatically classified as a high risk individual according to the American College of Sports Medicine (ACSM) disease risk stratification criteria (high risk = individual with a known or medically-diagnosed cardiac, pulmonary, metabolic or renal disease). This risk categorization does not apply to a person with prediabetes who might only be classified as a moderate risk. High risk individuals require a medical exam and medical clearance prior to initiating any moderate- or vigorous-intensity exercise program:

• Moderate-intensity = 40 – 59% VO₂R* or 3 – 5.9 METs**
• Vigorous-intensity = ≥ 60% VO₂R or ≥ 6 METs

* VO₂R or %VO₂ Reserve is defined as the difference between resting and maximal VO₂, and correlates better to % Heart Rate Reserve (%HRR) which is considered a more accurate and appropriated predictor of exercise intensity than % Maximal Heart Rate (%MHR) (5)

** 1 MET is defined as the amount of oxygen consumed while sitting at true rest and is equal to 3.5 ml O₂ per kg body weight per minute (3.5 mL/Kg/min) (6).

High risk individuals also require supervised exercise testing before beginning any moderate- or vigorous-intensity exercise program. The term ‘supervised’ includes administration of testing by a non-physician health care professional trained in clinical exercise testing and working under the supervision of a licensed practitioner (e.g., doctor). In 2014, ACSM also released additional recommendations that any individual with diabetes, regardless of how well their condition is managed, who qualifies with at least one of the following should also undergo exercise testing before initiating any physical activity (1):

• Over 35 year of age, or
• Diagnosis of type 2 diabetes for over 10 years, or
• Diagnosis of type 1 diabetes for over 15 years, or
• Elevated total cholesterol score > 240 mg/L (6.62 mmol/L), or
• Elevated systolic blood pressure > 140 mm Hg or diastolic blood pressure > 90 mm Hg, or
• Current smoking, or
• Family history of coronary artery disease within a first degree relative (father, mother, brother, sister, son, daughter), or
• Presence of microvascular disease, or
• Autonomic neuropathy.

An individual with prediabetes is not a high risk, but may qualify as a moderate risk pending other compounding risk factors (e.g., blood pressure, lipid profile). This person is able to initiate a moderate-intensity exercise program without a prior medical exam and can also do so without any exercise testing. However, before initiating any vigorous-intensity exercise programming, they must undergo a medical exam beforehand.

Diagnosis:

Various criteria are used to detect the presence of diabetes or prediabetes and are presented in Table 1-1 below. While fasting blood glucose continues to remain the most popular diagnostic tool, it is limited by the fact that it only represents one timestamp of an individual’s day, albeit it an important timestamp reflecting levels after an overnight fast when they should be very normal. Glycosylated hemoglobin (HbA1C) is a newer measure which is a form of hemoglobin that reflects the average blood glucose concentration over a prolonged period of time (i.e., 2 – 3 months). Sustained periods of elevated blood glucose results in greater amounts binding with hemoglobin molecules, which can become a cause of many negative health events like inflammation, diabetes, cardiovascular and kidney disease (nephropathy), and retinal eye damage (retinopathy). HbA1c scores under 5.7% are considered healthy; scores between 5.7 and 6.4% are associated with higher risks for developing diabetes; while scores at 6.5% or higher indicate diabetes (1). An initial goal for diabetics is to maintain HbA1C levels below 7%. Some health experts believe HbA1C is a more appropriate diagnostic tool given how it examines sustained blood sugar levels.

Table 1-1: Diagnostic Blood Glucose Levels for Prediabetes and Diabetes

Status	Fasting (8-hour) Blood Glucose
Healthy Scores	Less than 100 mg/dL (less than 5.55 mmol/L)
Prediabetes *	100 – 125 mg dL (5.55 – 6.94 mmol/L)
Diabetes **	Greater than 125 mg/dL (greater than 6.94 mmol/L)

* Also diagnosed using an oral glucose tolerance test (OGTT) where 2-hour impaired glucose tolerance score ranges between 140 and 199 mg/ dL.

** Also diagnosed using an oral glucose tolerance test (OGTT) where 2-hour impaired glucose tolerance score is equal or greater than 200 mg/ dL.

Exercise Programming:

Managing diabetes effectively requires a structured lifestyle program that includes education, dietary modification and regular physical activity to improve overall health (prevent and/or treat diabetes complications, dyslipidemia, cardiovascular disease, hypertension, and nephropathies). For type 2 diabetics, it should also aim to target an initial weight loss of 5 to 7%.

For type 2 diabetics and individuals with prediabetes, regular physical activity improves insulin sensitivity; glucose tolerance and uptake; and reduced HbA1C levels. For type 1 diabetics or any type 2 diabetics requiring insulin, regular physical activity and the subsequent improvement to insulin sensitivity does not positively impact pancreatic function, but it does reduce the quantities of exogenous insulin required.

When programming for diabetics or even individuals with prediabetes, health and fitness professionals should adhere to the following basic FITT guidelines (1, 2):

• Frequency: As exercise frequency is critical to improving insulin sensitivity, these individuals should aim to perform some activity between 3 to 7 days a week (1). The American Diabetes Association (ADA) recommends aerobic activity a minimum of 5 days a week. As the effects of improved insulin sensitivity may only last 24 – 48 hours between sessions, this helps explain the need for greater frequencies (i.e., frequency equals improved insulin sensitivity). Program with no more than 48 hours between each activity bout. As many type 2 diabetics are often deconditioned and overweight, they may struggle to complete exercise 5 to 7 times a week. Fitness practitioners therefore, should implement a manageable and systematic plan that considers, and fits the abilities and lifestyle of their clients first.
• Intensity: Moderate-intensity exercise is probably more appropriate for these individuals, especially for overweight or obese individuals. ACSM recommends initially maintaining intensities between 40 – 59% VO₂R (40 – 59% HRR) or an RPE between 11 and 13 (Borg 6 – 20 scale) which constitutes moderate-intensity (1). Gradually, they recommend greater emphasis on more vigorous-intensity activity, especially if weight loss is a goal. The ADA recommends moderate-to-vigorous intensities and defines moderate as levels where you can talk, but not sing, whereas intense activity is defined as a level where you can only speak in short phrases before needing a pause to take a breath (2). Newer research utilizing lower-volume, higher-intensity exercise like HIIT training however, also demonstrates improvements in diabetic patients (7). In their study, Gibala and colleagues had subjects perform 10 sprints, each lasting 60 seconds at 90% of their measured maximal heart rate, alternating with 60s of recovery between each interval. This protocol was performed three time a week for a total of 2 weeks and showed positive results. Professionals should always remember however, that this form of exercise with high-risk individuals should only be performed under proper medical supervision.
• Duration (Time): Considering how most individuals will participate in moderate-intensity activity, ACSM recommends a minimum of 150 minutes of accumulated activity every week, with each bout lasting no less than 10 minutes in duration (1). ADA also recommends a total of 150 minutes a week, but suggests it should be spread over a minimum of 3 days each week (2). Benefits are considered to be dose-related, implying that a greater accumulation of time provides additional health benefits. This is certainly more relevant to the type 2 diabetic than the type 1 diabetic who needs to improve insulin sensitivity. However, as illustrated in the study by Gibala and colleagues, lower-volume, higher-intensity (i.e., 30-minutes of intervals a week) is also effective.
• Type: Conventional wisdom suggests rhythmic and continuous activity like cardio that emphasizes the larger muscle groups as this supports improved insulin sensitivity, but newer research also supports interval-type activities as well (e.g., sprint intervals, resistance training). Resistance training should only be recommended in the absence of any contraindications that might be exacerbated by this modality (e.g. neuropathies). Resistance training should be performed at least 2 times a week and any formats that can simultaneously provide some cardiorespiratory overload is preferred (e.g., circuit-style format). However a combination of both cardio and resistance training is also recommended for diabetic patients. For example, the individual could perform 10-muinutes of moderate-intensity cardio, followed by a 5-10 minute resistance training circuit, then repeat this cycle throughout their training session. The resistance training program should emphasize 8-10 major muscle groups in circuit format if training fewer than 3 times a week, or become more regionalized (i.e., grouping muscles or body segments) when training more frequently.

Special Considerations:

Hypoglycemia during exercise is a significant concern, especially with those taking insulin or oral hypoglycemic agents that increases insulin secretion and pushes excessive amounts of glucose to enter the cell. Hypoglycemia is defined as a blood glucose level below 70 mg/dL (< 3.80 mmol/L). Symptoms of hypoglycemia include shakiness, dizziness, sweating, headache, sudden mood or behavior changes, tingling of mouth and fingers, clumsiness, mental confusion, and hunger. These individuals should follow a practice of monitoring blood glucose before and for several hours following exercise. Exercise timing, exercising under proper supervision or with a partner, reducing insulin dosages, or even temporarily disconnecting insulin pumps should all be considered as advised by the individual’s doctor. Furthermore, increasing carbohydrate consumption before exercise to prevent hypoglycemia during and following exercise, and also keeping a small supply of high-glycemic load foods nearby is suggested (8). When blood glucose needs to be quickly raised, recommend the consumption of 15 – 20 grams of a high-glycemic sugar or carbohydrate food (e.g., energy drink, sweets).

Conversely, hyperglycemia can become a concern for individuals who are not in glycemic control with their diet and medication. This rarely occurs in healthy individuals because of hormonally-mediated responses, but this response is essentially lost in diabetics – subsequently the symptoms associated with hyperglycemia should be monitored at all times. These symptoms include polyuria (increased urine output), fatigue, weakness, excessive dry mouth, increased thirst and the presence of acetone breath due to ketone accumulation in the blood. As mentioned previously in this article, if insufficient glucose is available to the cells (i.e., indicated by elevated glucose levels in this case), incompletely metabolized fatty acids and amino acids accumulate that elevate ketone body levels. These ultimately convert to acetone if not metabolized and acetone in blood passes to sweat, breath and urine, producing a fruity-sweet smell. Monitoring ketone levels through urine can be completed using a simple urine strip test provided by a healthcare provider. Although exercise generally lowers blood glucose levels, if pre-exercise glucose levels exist above 240 mg/dl, urine ketone levels should be checked, and if present the individual should contact their healthcare provider immediately.

Dehydration resulting from polyuria can occur frequently with hyperglycemia. These individuals should always be regarded as a high risk for dehydration and for developing heat-related illnesses during exercise – always monitor symptoms for any heat-related illness. Hydration before, during and following exercise (rehydration) is an important consideration for hyperglycemic individuals.

Diabetics with retinopathy are also at risk for retinal detachments and vitreous hemorrhaging if participating in vigorous exercise where systolic and mean arterial pressures increase significantly (1). This risk can be reduced by implementing exercise programs that produce smaller elevations in blood pressure (i.e., moderate-intensity exercise and avoiding heavy resistance training or excessive upper body resistance training).

For those individuals with peripheral neuropathies, certain types of exercise (e.g., running, walking and standing) can exacerbate foot issues like blisters and ulcers. Proper foot care is an essential preventative strategy and includes ideas such as:

• Using softer shoe inserts.
• Keeping feet dry at all times with polyester or blended socks, or using silica gel or ventilated midsoles – change socks during a workout as needed.
• Incorporating more non-weight bearing activities.

Closing Comments:

Although diabetes is a serious metabolic disease best monitored by medical professionals, the growing prevalence of this disease has dictated a need for fitness professionals to become part of this healthcare continuum. Although the benefits of exercise in managing diabetes has been clearly established, the fitness professional needs to develop and implement programs with careful consideration as many complications exist that have serious consequences. Understand the specific nature of your client’s disease, then follow all recognized guidelines and instructions prescribed by their doctor to ensure the delivery of safe and appropriate programs that will improve their overall condition.

References:

1. American College of Sports Medicine (2014). ACSM’s Guidelines for Exercise Testing and Prescription (9^th). Philadelphia: Lippincott, Williams & Wilkins.
2. American Diabetes Association (2012).Standards of medical care in diabetes – 2012. Diabetes Care, 35(suppl 1):S11-S63.
3. American Diabetes Association (2015). 2014 National Diabetes Fact Sheet. Retrieved 10/24.
4. DeSisto CL, Kim SY, and Sharma AJ (2014). Prevalence Estimates of Gestational Diabetes Mellitus in the United States, Pregnancy Risk Assessment Monitoring System (PRAMS), 2007–2010. Preventing Chronic Disease, 11:130415. http://dx.doi.org/10.5888/pcd11.130415.
5. Swain DP, and Leutholtz BC, (1997). Heart rate reserve is equivalent to %VO2 reserve, not to %VO2max. Medicine and Science in Sports and Exercise, 29(3):410-414.
6. Jetté M, Sidney K, and Blümchen G, (1990). Metabolic equivalents (METS) in exercise testing, exercise prescription, and evaluation of functional capacity. Clinical Cardiology, 13(8): 555-565.
7. Little JP, Gillen JB, Percival ME, Safdar A, Tarnopolsky MA, Punthakee Z, Jung ME, and Gibala MJ, (2011). Low-volume high-intensity interval training reduces hyperglycemia and increases muscle mitochondrial capacity in patients with type 2 diabetes. Journal of Applied Physiology, 111(6):1554-1160.
8. Sigal RJ, Kenny GP, Wasserman DH, Castenada-Sceppa C, and White RD, (2008). Physical activity/exercise and type 2 diabetes: a consensus statement from the American Diabetes Association. Diabetes Care, 29(6):1433-1438.

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Francis Cabrera Testimonial Sept 15

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What’s New About The Zone Diet After 20 Years?

In recent radio interviews, I am often asked, “Has anything changed about the Zone Diet over the past 20 years?” The answer is both no and yes. The no answer is that the basic outline of the Zone Diet has not changed at all in the past 20 years. Furthermore, in every carefully controlled clinical... Read more »

10 Things Your Personal Trainer Would Like You To Know

Ever wished you could be a fly-on-the-wall in your personal trainer’s office?  Some personal trainers keep certain things to themselves, so not to rock the boat.

Being a personal trainer is hard work.  Early mornings, full days, being a motivator, staying in shape and not always the best pay.  This career is a choice, stemming from a passion to help people.

Enhance your relationship with your personal trainer and make a huge difference in the type of service they give you, by understanding them a little better.

#1 Complaining when it’s time to pay is upsetting.
Most personal trainers are not in the business just for money and it makes them feel bad to hear people complaining and groaning about paying.  It also makes them feel under-valued.  It’s discouraging.

A smile and simple “Thanks for all that you do” is much nicer.

#2 The amount you pay them is not what they take home.
You pay a lot of money for this personal service, but some trainers only see 25% of it. Gym owners take up to 50% of what the client pays for a session.  Then, the trainer pays about 20% in taxes.

After they pay bills and for their own health insurance, they hope to have enough left for a retirement fund and vacation time.

#3 Personal trainers need to snack, pee and take a mental break between sessions.
It’s industry standard to be scheduled every hour, back to back, and in fact – clients demand it.  Give your trainer five minutes to breathe before they start your session, you’ll get more of your moneys worth.

55 minutes is plenty of time to get the job done.  Hop on the treadmill while you wait.  You’ll become your trainer’s favorite client, and ultimately get better service.  (chronic excessive tardiness is a different issue)

#4 Your worries and complaints can be exhausting.
Personal trainers care a lot about your happiness and health, so they listen politely as you vent about your life. Remember, they see many other people like you each day, who also share their personal worries.

Keep it light when working out.  Talk about the task at hand, your goals, accomplishments, health and fitness while you’re with them.  Save your dumping session for your psychologist.

#5 Positive reinforcement and gratitude are the best reward.
“That was a great session.”  “You’re a wonderful leader.”  “Thanks for helping me.”

These are things that some clients say regularly (and others never do) and it makes trainers feel happy about their career choice.  It keeps them going.

While it’s their job to motivate and inspire you, they appreciate a pat on the back too. They’re in it to please you and to make a difference in your life.

#6 When you talk a lot it distracts them from their job.
Most people want to be distracted from their workout.  The truth is, they enjoy talking with you.  But, it makes it harder to get you the results you’re looking for.

Focus on your breathing, your form, what you’re feeling.  Ask them questions about what muscles are being worked or what the goal of the exercise is if you feel the need to talk.

If it’s too boring and awkward not to talk a lot for an hour, consider a 30 or 45 minute session.

#7 Your workout will be the best if you trust your personal trainer.
Personal trainers want your workout to be fun, safe and effective too.  They don’t mind you sharing an occasional magazine article or exercise idea, but it’s frustrating when you try to control every last detail of the session/program.

Personal trainers are certified, qualified and spend a lot of time contemplating what is best for you.  Isn’t that why you hired them?

#8 Personal Trainers aren’t responsible for what you do the other 166 hours a week.
They get the opportunity to influence you for one, maybe two, hours a week.  Don’t blame them if you make bad decisions on the other days.  Ask for suggestions and support instead.  Be responsible.

#9 They love it when you ask them health related questions.
Personal Trainers like to guide people and give advice.  When you ask questions, it makes them feel good to find you the answers.  They feel valuable.  They love discussing health and fitness.

#10 Referrals are the best acknowledgement.
If you like what your trainer does for you, tell your friends.  Host an event at your house
and have your trainer speak or demonstrate.

Personal trainers struggle to do it all.  Helping them market is one of the best and easiest things you can do to show your gratitude.  Word of mouth brings in the best new clients.

Here’s to keeping the many inspirational personal trainers in our world happy and healthy!

*This information is from opinion and experience, it does not mean every personal trainer thinks this way!

The post 10 Things Your Personal Trainer Would Like You To Know appeared first on The NFPT Blog.

Holiday Eating: Alcohol, Appetizers, and Desserts! Oh My!

Plan ahead to avoid holiday overeating and weight gain.

The holiday eating frenzy has started! Halloween brought a sugar-packed caloric jump start.to the holiday celebrations, and with all that candy still around and more seasonal treats to come, it’s not easy to eat healthy during the holiday seasons. With a little pre-planning and creativity, those traditional and often calorie-dense, fattening, foods will not lead to a hefty holiday weight gain. Here are some tips to help you eat healthy during the holiday seasons.

1. Prepare ahead of time. Avoid eating a lot of high-calorie items at holiday celebrations, such as processed meats, fried foods, cream-based soups, heavy casseroles, and rich desserts. Fill up on lighter foods like lean meats, grains, fruits, and vegetables. When attending potluck events, bring a healthy dish so that you and other guests will have an alternative if the other dishes served are high in fat and calories.
2. Do not arrive hungry! Arriving hungry is a quick gateway to overeating along with choosing foods you normally wouldn’t select. Never avoid eating during the day to “save” your calories for a large dinner later; it will most likely cause you to eat more overall. Have a healthy snack before heading to the party. You will still be hungry enough to enjoy your favorite holiday foods, but not so hungry that you overeat and choose too many unhealthy options.
3. Holiday favorites. One of my favorite approaches to holiday eating is to focus on the foods I only get to enjoy on that special day. For me, these include my grandma’s Italian green beans (dripping in oil, onion, and garlic), or my mom’s pecan, macadamia, and chocolate pie, candied sweet potatoes, and salted caramel cheesecake. I skip the bread roll, corn, mashed potatoes. I can get these foods any day of the year. Choose your favorites that you truly only get to have on that holiday.
4. Fill-up with fiber. Vegetables are naturally low in fat and calories and contain an abundance of nutrients. Vegetables help you feel satisfied for a longer period of time than most other foods do. Fiber causes your stomach to feel fuller, along with having a better sense of satiety. Eating raw vegetables as snacks, appetizers, and in salads and side dishes is a smart way to fill-up on healthy foods to satisfy your hunger. Try filling half your plate with vegetables at meals.
5. Healthy swaps. Substitute skim milk to decrease (saturated) fat and calorie intake. Consider substituting recipes with lower fat dairy products whenever possible. Replace sour cream with plain Greek yogurt, swap skim, 1% or 2% milk instead of whole milk in recipes. Other swaps include using rolled oats for bread crumbs, cauliflower as substitute for mashed potatoes, spaghetti squash for pasta, pureed low-fat cottage cheese for cream cheese, and even pureed fruit for sugar.
6. Turkey = lean protein! Turkey is one of the leanest types of meat. Broil, stew, bake, or even grill your meats instead of frying them. Use a rack when cooking the turkey to allow the fat to drip away from the meat. When selecting other meats to prepare, choose leaner cuts when possible, such as loin or round cuts.
7. Do not try to DIET! The holiday season is one of the most difficult times to try to diet for weight loss. Trying to follow a strict diet when you are not completely committed can cause you to relapse and binge on foods you have eliminated, and thus cause weight gain. Focus more on maintaining your weight over the holidays. You can do this by controlling your portions, getting regular physical exercise, and making healthy food choices.
8. Alcohol. A cocktail is like a cupcake. Everything in moderation is an even more difficult mantra to follow during the holidays at parties, gatherings, and events. One standard drink serving is 12 ounces of light beer, 8 ounces of regular beer, 4 ounces of wine, or 1.5 ounces of liquor or spirits. Savor indulgent drinks (e.g., eggnog) as if they are a dessert. ALWAYS drink water between alcoholic beverages to prevent dehydration. This may also help to curb your appetite, helping to prevent overeating. Also, be choosy with your drink mixes. That is where the calories can add up quickly.
9. Get active. A busy holiday schedule can easily derail your normal exercise routine. Try to workout early in the morning to avoid schedule conflicts in your day and/or have a backup plan. If you cannot make your normal fitness class or training session always know you can get a great body weight workout at home in just 15 minutes. Try a circuit of push-ups, squats, plank, tricep dips, and lunges. Do each exercise for 30 seconds with 30 seconds rest for 3 rounds. Remember to include fitness in your holiday traditions: play flag football, go sledding, take a walk to view the holiday lights or go caroling. (More Holiday Workouts)
10. Out of sight. Keeping holiday snacks and treats out of sight drastically improves your odds of not mindlessly consuming them. Keep treats put away in the pantry in opaque containers and on a higher shelf. Freezing treats in individual servings can also improve portion control. You may also want to send to-go containers home with guests after the party packed with leftover treats.
11. Be realistic. Holidays are centered around family, food, and fun! If you happen to splurge don’t feel guilty. One day will not make or break your nutrition and fitness routine. Stay mindful and aware of making sure that one day doesn’t turn into several. Even if it does, you can always start fresh. Not one day, one weekend, or even one week will completely ruin everything. You can always get back on track. The average holiday season weight gain has been logged at just under two pounds. The goal is to not gain those extra pounds at all, but if you do gain, don’t let those extra pounds stick around year after year.

Here’s to healthy holidays with food and fitness along with family, friends, and fun.

Sources:

www.eatright.org

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