EXERCISE IS MEDICINE

EXERCISE IS MEDICINE

CALLING ALL PHYSICIANS: GET ON BOARD!!!

By Monika Tarkowska-Carter CPT, LWMC, HLC

What do YOU think about exercise? Is it fun and play or pain and suffering? Simple discomfort that needs to be endured or the necessary evil? Something boring you just go through mechanically or something you look forward to? But have you ever thought of exercise as medicine? Well, maybe you should.

Did you know that in 2005 the Centers for Disease Control and Prevention (CDC) estimated that 365,000 deaths in the US occur annually from poor diet and lack of physical activity? Two-thirds of US adults are either overweight or obese. More than half of US adults do not meet the recommended levels of physical activity. Almost one-fourth of US adults have no leisure-time physical activity at all (1). Maybe it’s time to think about prevention.

Studies repeatedly show that exercise and physical activity can help prevent obesity, diabetes, cardiovascular disease, many types of cancer and other chronic conditions. Together, sedentary lifestyle and poor diet contribute to the current obesity epidemic as well as increased morbidity and mortality. However, overweight or obese people are not universally at risk for metabolic or cardiovascular diseases and other associated chronic conditions. Many of these people (about one-third) do not show any clinical or subclinical risk factors for cardiovascular disease (CVD) such as dyslipidemia, hypertension or elevated blood sugar. The strongest predictor of CVD risk is low levels of cardiorespiratory fitness (1).

Earlier this year I attended the American College of Sports Medicine (ACSM) Health and Fitness summit in Austin, TX where Steven N. Blair, Ph.D., FACSM (past President of ACSM) gave a standing ovation lecture to fitness professionals entitled: “Fitness or Fatness: Which is more important to health?” Dr Blair has done a tremendous amount of research on the subject showing that the fitness level of an individual is a much greater predictor of disease and mortality than overweight or obesity alone. Obese individuals who are fit have much lower risk of mortality than lean individuals who are unfit, and low cardiorespiratory fitness in overweight or obese people is as hazardous as other risk factors. He went as far as suggesting that no papers should be published, nor research project funded, on obesity and any health outcome unless physical activity/fitness has been accurately measured and taken into account in the analyses (2).  Dr. Blair published over 450 scientific papers, many of them on the subject of physical activity and its prevention of various diseases. One of them showed that physically fit women were less likely to die from breast cancer (3).

At the same conference, Ted Mitchell, MD, FACSM (President and CEO of the Copper Clinic) showed how many conditions were affected by the lack of fitness. Among them were: joint pain, fatigue, headaches, heartburn, snoring, decreased sex drive and sex problems, stress, anxiety and depression (4).

With all the research available on the subject why isn’t more being done about prevention? We live in a disease driven society. Disease is a lot more profitable than health. Drug companies make huge profits on medications and medical treatments. Don’t get me wrong – they are needed and often life-saving but prescribing medications for every condition that could have been easily prevented in the first place is becoming more and more prevalent. Prevention involves lifestyle changes, not just diagnostics. Everyone can and should practice prevention in the form of a healthy lifestyle. It is free and available to all. Better nutrition and higher levels of physical activity don’t increase cost but bring a huge payoff in terms of lower health-care cost, increased productivity and greater quality of life. The main keys to health, longevity and disease prevention are: getting more active, eating a little healthier and incorporating some kind of movement into your everyday life. In a very real sense, exercise is medicine. At this point, however, little is being done by organized medicine to increase physical activity among patients.

As a member of the American College of Sports Medicine (ACSM) and a professional in the health and fitness community, I am committed to encouraging physical activity for the health benefits it brings to all people. Exercise and physical activity are powerful medicine helping prevent and treat numerous chronic conditions. Significant health benefits can be achieved with at least 30 minutes of moderate physical activity most days of the week.

A recent survey by ACSM reveals that, while 4 out of 10 physicians talk to their patients about the importance of exercise, they don’t always offer suggestions on the best ways to be physically active. According to the same survey, nearly 65% of patients would be more interested in exercising to stay healthy if advised by their doctor and given additional resources.

A CALL TO PHYSICIANS

If there was a drug that could so powerfully fight America’s obesity epidemic and the health implications it brings, prevent and treat dozens of diseases would you prescribe it to your patients? Certainly.

This is the impetus behind Exercise is Medicine, an initiative from ACSM. One objective is to encourage YOU, the physician, to “prescribe” exercise during patient visits. Please, talk to your patients about exercise and, as appropriate, refer them to qualified fitness professionals. Counseling patients on the benefits of physical activity in their long-term health and well-being is critical and should be a standard part of your practice.

On November 5, 2007 the American Medical Association (AMA) partnered with ACSM to bring the above initiative into fruition. However, this is just the beginning. A lot more needs to be done and we rely on you for help and active participation. There is a great need to merge the fitness industry with the healthcare industry. Why do these two worlds so seldom interact? All healthcare practitioners “…must insist that the world healthcare systems make as big (or bigger) commitment to getting patients active as they make to getting them to take medications or submit to various procedures that have less scientific evidence supporting their benefit. With a wealth of evidence in hand, it is time for organized medicine to join with fitness professionals to ensure that patients around the world take their exercise pill. There is no better way to improve health and longevity” (5).

You can find additional resources about the initiative at: http://exerciseismedicine.org/physicians.htm. Additional information about the American College of Sports Medicine is available at: http://www.acsm.org/. On May 3, 2010 the National Physical Activity Plan was launched in Washington DC as a result of cooperation between many health organizations. More information about the plan can be found at: http://physicalactivityplan.org/index.htm. To find a qualified fitness professional in your area please go to: http://www.ideafit.com/fitnessconnect?gclid=CMPR2cOpoaUCFQoBbAodJxvlKA. IDEA Health and Fitness Association is the biggest educational body in the fitness industry and has recently published an online listing of certified professionals. Their certifications, insurance status and CPR/AED skills have been verified so you can be assured that they are qualified. You can search either by zip code and a type of professional you are looking for or check a particular professional by their last name.The highest rated ones appear at the top. If you would rather contact the certifying organization directly here are a few most reputable ones:

1. ACSM (American College of Sports Medicine) - http://www.acsm.org/

2. NASM (National Academy of Sports Medicine) - http://www.nasm.org/

3. NSCA (National Strength and Conditioning Association) - http://www.nsca-lift.org/

4. ACE (American Council on Exercise) - http://www.acefitness.org/

A CALL TO PATIENTS

Please, ask a few questions about your health status the next time you visit your doctor. Are you at a healthy weight? Taking your current health status into consideration, what types of exercise are best and safest for you? Is there a certified trainer you should hire to improve your health?

 *For more information on what to look for when hiring a personal trainer, please refer to my article from November 8, 2010: “Personal Trainers – The Good, The Bad and The Ugly”.

A CALL TO PARENTS

Please, give your children the gift of lifelong wellness by being a role model and supporting them in establishing a habit of lifelong physical activity. Have fun being active as a family.

DON’T UNDERESTIMATE EXERCISE – IT’S A POWERFUL DRUG!

References

1. Jan Warren-Findlow, PhD and Steven P. Hooker, PhD. Disentangling the Risks Associated With Weight Status, Diet and Physical Activity. Prev Chronic Dis. 2009 October; 6 (4): A 135

2. Steven N. Blair, MS, PED; Dept of Exercise Science and Epidemiology/Biostatistics, Arnold School of Public Health, Univ. of South Carolina. “Fitness or Fatness: Which is More Important for Health?” – a lecture presented at the ACSM’s 14^th Health and Fitness Summit and Exposition, April 2010, Austin, TX.

3. Peel, J .Brent; Sui, Xuemei; Adams, Swann A.; Herbert, James R.; Hardin, James W.;  Blair, Steven N.  A Prospective Study of Cardiorespiratory Fitness and Breast Cancer Mortality. Medicine and Science in Sports and Exercise. 41(4):742-748, April 2009

4. Ted Mitchell, MD, FACSM; President and CEO, Copper Clinic. “Aging with Attitude: The Impact of Exercise on Quality of Life” – a lecture presented at the ACSM’s 14^th Health and Fitness Summit and Exposition, April 2010, Austin, TX.

5. Sallis, Robert J, MD. Exercise is medicine and physicians need to prescribe it! Br. J. Sports. Med; 2009; 43; 3-4.

THE CURE IS IN THE KITCHEN

“LET NOTHING WHICH CAN BE TREATED BY DIET BE TREATED BY ANY OTHER MEANS”

                                                                   (Maimonides)

By Monika Tarkowska-Carter CPT, LWMC, HLC                                                          

We often forget that clean water and healthy food are not only the foundation of health but have more power than medicines to keep us healthy. But the quality of what we put into our bodies is also of prime importance. If you build a healthy foundation with simple things like nutrition and exercise, your body will thrive.

HEALTHY NUTRITION TIPS:

 1. The most important yet cheapest thing you can do for your body every day is drink good quality pure water, ideally with a ph of at least 7.0.

2.  Drink a minimum of half of your body weight in ounces per day; more if you exercise or if you live in a hot climate.

3. Eat organic foods as much as possible – they have more nutrients, more antioxidants and more disease-fighting phytochemicals and are free of dangerous pesticides, herbicides and fungicides.

4. Eat 4-9 servings of fruits and vegetables daily; choose produce in different colors to get the biggest variety of vitamins and minerals possible.

5. Try to eat more raw vegetables than cooked – they have more much needed enzymes.

6. If you do eat meat, buy only organic meat from grass-fed animals – it is not only free of antibiotics and hormones but is a lot leaner and has a different nutritional profile than commercially raised meat. It is high in anti-inflammatory Omega 3 fatty acids and lower in pro-inflammatory Omega 6. It also contains a higher amount of healthy CLA (conjugated linoleic acid). CLA is an antioxidant with strong anti-cancer properties and can reduce the risk of cardiovascular disease and help fight inflammation. It also reduces body fat and increases lean muscle mass. Meat and dairy products from grass-fed animals can contain 300%-500% more CLA than those from cattle fed the usual diet of grain and hay.

7. Try other healthy lean meats like buffalo and ostrich.

8.  Eat only organic free-range poultry and eggs.

9.  If you do eat dairy make sure it is organic and ideally raw – that means not pasteurized or homogenized. It is devoid of antibiotics and hRGH (recombinant human growth hormone), has more vitamins and the enzymes have not been destroyed by the above processes. It is also well tolerated by people who are lactose intolerant. In California you can get organic raw milk, cream, kefir, immune-building colostrum, butter and cheddar cheese from Organic Pastures (www.organicpastures.com)

10. Include organic nuts and seeds in your diet. Try to eat them raw as roasting at high temperatures oxidizes them, makes them rancid and destroys precious antioxidants. Nuts are a rich source of protein, fiber, B vitamins, folic acid, calcium, iron, zinc and antioxidants selenium and Vitamin E.

11. Make a variety of beans a staple in your diet – they are high in fiber, protein and antioxidants.

12. Eat only whole grains, not ground, processed, bleached, fortified with synthetic vitamins and minerals, etc. Whenever foods have been fortified you know all their original nutritional value has been stripped off in the refining process.

13. Don’t rely entirely on wheat as your main grain source. Wheat has the highest glycemic index of all grains and many people are intolerant to it. Try other grains like buckwheat, oats, quinoa, barley, brown rice, rye, spelt, teff, amaranth, triticale and millet.

14. Limit your caffeine intake. It causes exhaustion of the adrenal glands so your body has a harder and harder time producing enough cortisol necessary to wake you up in the morning and keep you awake when you need to feel alert. It disturbs your normal cortisol cycle.

15. If you must drink coffee for its flavor and aroma, switch to coffee decaffeinated by the Swiss Water Process – the only process that leaves 0.01% of caffeine left.

16. Drink only organic coffee. Non-organic coffee is the heaviest chemically treated food product in the world.

17. Avoid trans fats at any cost. (This includes fried foods produced commercially or in restaurants). They decrease HDL (high density lipoprotein – the good guy) and increase LDL (low density lipoprotein – the bad guy) and have been shown to contribute to heart disease.

18.  Choose only good fats: cold-pressed olive oil, nut oils, seed oils, high-oleic canola oil, avocado oil, organic coconut oil.  (Coconut oil has been greatly misrepresented as a bad fat and although it is saturated it does not contain cholesterol since it is not of animal origin. It has very strong anti-bacterial, anti-viral and anti-microbial properties because of its high content of lauric acid. The only other rich source of it is breast milk. Organic virgin coconut oil is now slowly being recognized by the medical community as a powerful tool against immune diseases and is often used for its medicinal purposes by many hospitals. Two excellent books on the subject were written by one of the top lipid researchers in the world, Dr. Mary Enig: “Know Your Fats: The Complete Primer for Understanding the Nutrition of Fats, Oils and Cholesterol” (Bethesda Press, May 2000) and “Eat Fat Lose Fat” (Hudson Street Press, January 2005). If you use saturated fat like butter use only organic butter from grass-fed cows – it is NOT as unhealthy as once thought. 

19. If you cook with fats at high temperatures use only fats that are stable and do not cause formation of free radicals. Saturated fats are actually best for high temperature cooking as they are very stable. Vegetable oils are NOT a healthy option for this purpose. The best fats for cooking at high temperatures are butter, ghee, duck fat, coconut oil, palm oil and avocado oil.

20.  Minimize intake of sugar in your diet. That includes anything with sugar added to it (sodas, fruit yogurt, crackers, cereals, commercially prepared tomato sauces, ketchup, etc.). 1 teaspoon of sugar has been shown to suppress your immune system for up to 4 hours!

21.  Eat more alkaline foods (fruits and vegetables) to balance out the acidity in your diet especially if you eat a SAD diet (Standard American Diet) that is highly processed and full of acidifying foods like meat, dairy and grains.

22.  Avoid any soda drinks and carbonated beverages as they are all acidic.

23.  Limit alcohol as much as possible – it is not only very high in calories but it also interferes with your body’s ability to burn fat as the liver has to process it and detoxify it first. Alcohol is also one of the strongest causes of inflammation in the gut.

24.  Try to eat 1-2 servings of fish high in Omega 3 per week BUT be extremely careful in choosing fish since most of it these days is high in mercury. The safest fish that is highest in Omega 3 is wild Alaskan salmon, herring, sardines and anchovies. For low-mercury tuna go to http://www.tunatuna.com.  Farmed fish does not have much Omega 3 and is usually high in PCB and other toxins. (You can find out about the amounts of mercury in seafood by going to http://www.gotmercury.org/article.php?id=1034).

25.  Eat all foods as they appear in nature – WHOLE FOODS or at least minimally processed. They are much more nutritious.

26.   Plant foods should make a big part of your diet. They contain not only much needed nutrients but most of them are full of fiber. Aim for at least 25-30 grams of fiber a day.

27. Use only high quality unprocessed sea salt like Celtic Sea Salt (in reasonable amounts). It is high in important minerals and vital to your diet.  

28.  Avoid artificial sweeteners at all cost – they are neurotoxins that can damage the brain and the nervous system. Your brain does not register them as calories and will send you a message to keep eating. Good alternative is a natural sweetener like Stevia.

29.  Avoid microwaved foods (even water) at any cost. Microwaves damage the cell wall of foods and change their molecular structure into something your gut receptors are not likely to recognize as food. Many people who use microwave ovens suffer from various digestive problems.

30.  Avoid genetically modified foods – they are not the same.

31.  Eat well at least 80% of the time. If you do, your body may be able to withstand the 20% of abuse you put it through.

32.  Cheat a little – no super healthy diet is healthy if it offers no enjoyment.

33.  And please……………………..don’t forget the WATER!!!

Always remember:  YOU ARE WHAT YOU EAT

PERSONAL TRAINERS – THE GOOD, THE BAD AND THE UGLY

HOW TO FIND A GOOD ONE, SPOT A BAD ONE AND AVOID THE UGLY

By Monika Tarkowska-Carter CPT, LWMC, HLC

After almost 19 years in the health and fitness industry I have seen them all: from the most professional and qualified ones to those that are a downright disgrace to the training profession, and then everybody in-between.  And what I see doesn’t really surprise me anymore but what does is people’s inability to tell the difference. So here are some helpful hints that will not only tell you what to look for if you are thinking of hiring one but maybe make you think twice about the one you already have. And please, don’t tell me that you’ve had them for a while, you are used to them, you don’t like changes,  they are your buddies, etc., etc. and that’s why you continue training with them because, trust me, that’s not a good enough reason.

So let’s start with the basics.

THE MOST IMPORTANT THING – EDUCATION and CREDENTIALS

1. Although our industry is not regulated just yet (there is no licensing system) there are many educational bodies that insure proper training of personal trainers. Make sure they have a nationally recognized certification from a reputable organization. The best ones in the industry at the moment are:

-American College of Sports Medicine (ACSM)

-National Academy of Sports Medicine (NASM)

-National Strength and Conditioning Association (NSCA)

-American Council on Exercise (ACE)

-Cooper Institute

The above organizations have operated for many years and provide the highest standards in training fitness professionals. There a few others, less known ones but the bottom line is: make sure they are accredited by NCCA (National Commission for Certifying Agencies). You can find the list of accredited organizations on their website: http://www.credentialingexcellence.org/NCCAAccreditation/AccreditedCertificationPrograms/tabid/120/Default.aspx

2.  A degree in a related field is helpful though not absolutely necessary. I have seen many excellent trainers without degrees and terrible ones with degrees. A degree of B.Sc. or M.Sc. in the field of exercise physiology, kinesiology, biomechanics etc., gives a lot of valuable background knowledge that can be used to successfully train clients but it does NOT prepare one for a training position all by itself as the knowledge gained is mostly theoretical and not practical.  Certification from one of the above mentioned organizations is still absolutely necessary.

3. Many universities now offer special certificate programs in personal training*. These are advanced, college level courses that give not only theoretical but also practical knowledge of the exercise field. Many of them count towards Master of Science degree should a trainer wish to pursue one. (One such example is UCLA Extension which for many years has been considered one of the best programs of its kind).  Some require a certification as a prerequisite to enrollment.

*Note that the Certificate is not the same as Certification but after completion of a university level certificate program most students are able to successfully pass certification exams as their level of knowledge is a lot more advanced.

4.  Is the trainer’s certification current?

Each organization requires a certain number of continuing education units per year. Many trainers take the exam and never renew their certifications when the time comes. Make sure their certification is current. Just go to the website of an organization your trainer is certified from and do your homework. How credible do you think a person is if they took an exam 10 years ago and their certification is long expired?

5.  Continuing education – how often do they take classes, attend lectures, symposia and conferences? How much continuing education do they do per year: the bare minimum or more?

They should be able to show you their certificates of completion if requested.

6.  Do they have additional certifications or training in other complementary fields like nutrition or lifestyle coaching? These are always a huge plus not only because they show a trainer’s commitment to education in many related fields but also because they will assure your needs are better addressed.

HOW TO FIND A REPUTABLE TRAINER IN YOUR AREA?

You can go to the websites of the above listed organizations and enter your zip code or a trainer’s name if you have someone in mind and want to check their credentials.

A better way, however, is a new website by IDEA Health and Fitness Association (the biggest educational body in the fitness industry). Its great advantage is the fact that IDEA has done all the work for you: all current certifications of trainers are listed and verified for accuracy as well as their insurance and CPR training so you can be assured that the information is true. Trainers listed have their own page where you can learn more about them, their areas of expertise, training philosophy, etc. You can read reviews posted by clients, go to the trainers’ websites, blogs, newsletter, Face book and Twitter accounts and see videos if there are any. In addition, the website allows you to find gyms and different classes in your area. Just go to: www.ideafit.com/fitnessconnect , choose a type of professional you are looking for and your zip code and you will get a list of names to choose from. Those that appear on top of the list are the highest rated. 

EXPERIENCE

1. The best certification on the market is just a start. If you are young, healthy, want to get a little fitter and just need a little push to exercise this may be enough but in most cases it is NOT. There is nothing like years of practical experience to make a trainer truly good. This is especially important if you have health concerns or problems, are a lot more serious about fitness than most people or have very specific goals in mind. These can be related to weight loss, fat loss, muscle gain, your particular health condition or sport you participate in. It is hard to suggest a specific amount of years here but look for someone with at least 5 years of experience or more.

2.  Do they have experience training different populations and age groups?  Have they trained clients with your health condition? Are they well informed to do that? Don’t be afraid to ask these questions – a good trainer will not feel defensive when asked. They will probably appreciate that they are dealing with an informed consumer.

3. Do they ask about your medical history and medications taken?

4. Do they do some kind of an assessment or evaluation of your initial condition that would tell them what your fitness level is and help them evaluate your progress in the future?

ADDITIONAL REQUIREMENTS

1. Do they have valid professional insurance?

2. Are they CPR and AED trained? This is an especially important consideration if you are elderly, on medications or have serious health problems. 

It never ceases to amaze me how few people ask me about my credentials or are even interested in them. Yes, I know that I have built a reputation in the fitness industry over many years and that your friends’ referral is what matters to you, but your friend may not be the best judge after all. Know why you are making the choice. Do your research.

PROFESSIONALISM

              

- Is the trainer professional in every way?

- Are they on time?

- Do they treat you and refer to you with respect?

- Are they focused on the client at all times?

- Are they constantly engaging in a conversation with others while training you?

- Are they on their cell phone during the training time?

- Are they always watching television screens in the gym instead of paying attention to you?

- Do they dress appropriately?

- Are they trying to do their own workout while they are training you?

- Is their language appropriate?

-Are they listening to you or do they follow their own agenda?

-Are they good listeners in general?

- Are they sensitive to your concerns?

- Do they treat you like a buddy? (Even if they are your body they should not treat you like one in a professional environment in front of others.)

I am not talking about complete perfection here. All of us are guilty of small “misdemeanors” from time to time, like saying “Hi” to a colleague or club member passing by, having to answer a cell phone call because of some emergency, getting distracted by a piece of braking news on TV, etc., etc. but doing so on a constant basis is not acceptable.

COMMUNICATION

Have they explained their policies to you in a manner that is satisfactory to you? Are you happy with the way they communicate with you? Are they easy to reach? Do they respond to your phone calls or emails in a timely manner?  Do you feel you are being heard?  Is the training about YOU or about them? Do they constantly talk about themselves, their own issues or problems? Are they willing to cooperate with your doctors and be a part of your health team?

PERSONALITY

 

Does your trainer’s personality fit well with yours? Do you want a trainer who is nurturing and soft or energetic and exuberant or a boot camp drill sergeant?

GYM ETIQUETTE

   

 Is the trainer courteous to other members of the club? Do they respect other members’ space or behave as if the gym is their own? Do they treat their colleagues with respect? Do they gossip about other trainers or members? Are they always judging other trainers’ work or other people’s workouts?

Remember that it is OK for your trainer to answer your questions about the exercises others are doing or point to exercises that are downright dangerous as a way of educating you but criticizing others constantly is not OK.

FEES

Unfortunately, as in most industries, the better and more experienced the professional the higher their fees will be. In the US the prices run from as low as $30 a session for beginning trainers in big health club chains to $300 and even $400 an hour for top rated trainers in Hollywood and New York. The average at the moment, depending on where you live, is somewhere in the ballpark of $70- $150 per session. You have to take your budget into account but don’t make your decision based on the price itself. Our industry has many highly qualified professionals whose training and experience justifies their fees and is worth every penny. Remember that continuing education is expensive. If you expect your trainer to stay on top of the latest research you have to be prepared to pay for it.

All the above considered you should, however, keep certain things in mind. Many of us work from early morning hours sometimes until late at night. We are often on our feet all day. We constantly listen to people’s problems and complaints about their various aches and pains. Many clients treat us as their therapists and an emotional outlet for their frustrations. This can be very tiring and draining at times. Please, be understanding if occasionally we need to sit down or our focus dwindles for a few seconds.

CONCLUSION

          Hiring a personal trainer is an important decision in your life and if you have a specific health condition it may just turn out to be one of the most important ones you’ll ever make. Don’t be afraid to do your research, ask the right questions and interview possible candidates. You wouldn’t go to any doctor, would you?

     All of the above qualities are important when choosing a personal trainer. Don’t make this decision lightly. It is your money. It is your HEALTH. And what could be more important than that?