Tap Into Inner Greatness

WHAT'S INSIDE Walk the Walk: + GAIT ANALYSIS EXTRA INCOME Sources FOR FITNESS PROS

Earn CEUs: FROM PEAK BONE MASS TO OSTEOPOROSIS

tap into inner greatness

fall 2016 fall 2016

Volume THIRTY-FOUR // Number Four

COVER Photo by Nick Onken

ON THE COVER

36 Lewis Howes: Tap Into Inner Greatness 12 Extra Income for Fitness Pros 20 Walk the Walk: Gait Analysis 23 Earn CEUs: 16 From Peak Bone Mass to Osteoporosis

36 68

TRAINING EDGE FEATURES EXERCISE Nutrition

08 industry News and Highlights 36 Cover: Lewis Howes 46 exercise Update 62 nUtrition Update By Lucia Viti 11 Let’s Get Technical 48 work it Out: Upper 64 tHe Athlete’s Kitchen: 40 Up in the Air Crossed Syndrome For Athletes in 12 Beyond the Fitness Doors By Cherryh Cansler, MA By Kenneth Miller, MS Weight-Sensitive Sports By Lawrence Biscontini, MA By Nancy Clark, MS, RD, CSSD 42 a Bal ncing Your Personal Life 52 mAke Your Fitness Class 16 Fall Prevention With Your Professional Life “The Best Night Out!” 68 tea Time by Kathy Kuenzer, PhD By Janice Jaicks By Susanna Kalnes By Evangeline Yvonne Samples, MS, RD, LD 19 AF Q & A 44 gift Guide By Lucia Viti HEALTH By Matt Brzycki AS ALWAYS 20 wALk This Way By Theresa Miyashita, PhD 54 Health Update 04 CONNECT 23 CEU: From Peak Bone Mass 56 on the Pulse: to Osteoporosis Youth Concussions 05 PRESIDENT'S MESSAGE By Matt Brzycki By Audra Eisz, DPT and 06 Laura Gladwin, MS WHAT'S NEW 60 Hormone RiskS at the Gymnasium By Yusuf M. Saleeby, MD

FALL 2016 / AMERICAN FITNESS 3 Connect

AMERICAN FITNESS

EXECUTIVE TEAM

PRESIDENT AND PUBLISHER Vice President of Operations Andrew Wyant Michelle Warren

EDITORIAL STAFF

CONTENT STRATEGIST Stacey Penney, MS

Managing EditoR Kevin McGuire

Editor Esther Gwynne

Assistant Editor Josh Burns

Contributing Writers Lawrence Biscontini, MA Matt Brzycki Cherryh Cansler, MA Nancy Clark, MS, RD Ray Eldard Audra Eisz, DPT, ATC Laura Gladwin, MS Deborah K. Howe Janice Jaicks Susanna Kalnes Kathy Kuenzer, PhD Kenneth Miller, MS Nancy McCarthy Theresa Miyashita, PhD Stacey Penney, MS Laura Quaglio George Redmond, PhD Yusuf Saleeby, MD Evangeline Yvonne Samples, MS, RDN, LD Lucia Viti

exercise & content consultant Meg Jordan, PhD, RN

DESIGN Barbara Brown, Creative Director (BBM&D Strategic Branding) Arrate Zavala, Art Director Jon Leslie, Associate Art Director Julia Cohoat, Designer Jessica Miranda, Designer

Contributing Photographer Nick Onken

ATHLETICS and Fitness Association of America (AFAA) National Academy of sports medicine (nasm) WEBSITE: www.afaa.com WEBSITE: www.nasm.org EMAIL: [email protected] EMAIL: [email protected] PHONE: 800.446.2322 | 602.383.1200 PHONE: 800.460.6276 | 602.383.1200 MAIL: 1750 E. Northrop Blvd., Ste. 200 MAIL: 1750 E. Northrop Blvd., Ste. 200 Chandler, AZ 85286 Chandler, AZ 85286

SUBMISSION GUIDELINES: Send all editorial queries to [email protected]. Please CAUTION TO READERS: The opinions, information and recommendations contained tell us more about your topic, why it would be relevant to the health and fitness community, within articles, features, columns and advertisements of this magazine are not neces- areas covered, and your qualifications to write the piece. Your query will be reviewed for sarily those of the publisher, AFAA, NASM or their parent corporations or affiliates. The timeliness, relevancy and accuracy. If we feel it will be valuable for our audience, we will publisher and contributors cannot guarantee such materials are safe and proper for follow up with you. every reader or for every reader’s students and clients. Readers are urged to consult a physician before using or relying upon such materials, and to advise their students and CHANGE OF ADDRESS: Please provide old and new address details to AFAA, clients to do so as well. This magazine and its contents are sold without warranties ATTN: Membership, 1750 E. Northrop Blvd., Ste. 200, Chandler, AZ 85286 or or guarantees of any kind, expressed or implied, and the publisher and contributors call 800.446.2322. disclaim any liability, loss or damage caused by the contents.

Copyright ©2016 Assessment Technologies Institute, LLC. All rights reserved. American Fitness ® (ISSN 0893-5238) is published quarterly by the ATHLETICS and Fitness Association of America. Association membership fee is $99 for individuals, includes a subscription to AMERICAN FITNESS magazine. POSTMASTER: Send subscription correspondence/ address change to AFAA at 1750 E. Northrop Blvd., Ste. 200, Chandler, AZ 85286.

4 AMERICAN FITNESS / FALL 2016 President’s Message

From Aerobics to Athletics

We changed our company name from Fitness professionals looking to add extra the Aerobics and Fitness Association of income will want to check out “Beyond the America to the Athletics and Fitness As- Fitness Doors” by one of AFAA’s most popular ANDREW WYANT, PRESIDENT sociation of America! instructors. In this article, Lawrence Biscontini If I were reading this, I might think to my- explores career growth opportunities that ex- self, “So what?” ist in the areas of guest teaching and training, Of course, AFAA is still AFAA. Today’s providing continuing education, and writing AFAA, however, reflects our commitment to articles, blogs and even books. TAKE FIVE deliver the highest level of training, certifica- And if you’re ready to take your career and tion and career development—but in a wider life to the next level, you won’t want to miss our Some of our favorite array of disciplines than ever before. cover story on Lewis Howes, the author of the highlights from Since 1983, AFAA has been the global New York Times bestseller The School of Great- this issue: leader in group fitness certification, issuing ness: A Real-World Guide to Living Bigger, over 350,000 certifications in 73 countries. Loving Deeper, and Leaving a Legacy. Howes is Lewis Howes AFAA began by providing instructors and a former pro athlete who, after being sidelined Finding opportunities trainers with practical skills, science-based by an injury, went from sleeping on his sister’s 01 for greatness (p. 36) training and hands-on experience in a cat- couch to running a seven-figure business in egory that was desperately in need of leader- just a few years. In The School of Greatness, he ship, direction and consistency. provides the framework to help you find and Osteoporosis Now AFAA’s vision for a future in fitness Attaining and follow your life’s passion too. 02 maintaining peak includes so much more than just aerobics It’s a new day for AFAA, and while our heri- bone health (p. 23) classes. It has broadened to encompass a wid- tage remains firmly rooted in aerobics, today’s er array of activities and disciplines–many of AFAA and American Fitness encompass so which can be found on the pages of this issue Gait Analysis much more. What each step tells of American Fitness. Please reach out to me on Facebook and on 03 (p. 20) For example, in “From Peak Bone Mass LinkedIn! I would love to hear from you about to Osteoporosis,” Audra Eisz and Laura your own success story and the topics you’d Gladwin give you tools to help your clients like to see covered in future issues. Beyond achieve their peak bone mass in their youth, the Fit Doors 04 Ways to increase your maintain bone mass as they age, and recog- Regards, fit income (p. 12) nize and mitigate the risk factors for bone loss later in life. In “Upper Crossed Syndrome,” Kenneth Upper Crossed Miller offers a process for establishing a more Syndrome ideal posture and re-educating the body. This 05 Correct clients’ is of particular importance for clients who re- “tech” posture (p. 48) main seated for the majority of their workday, Andrew Wyant whether behind a desk or a steering wheel. President

FALL 2016 / AMERICAN FITNESS 5 WHAT'S NEW

What’s New

Teh New AFAA Is Still Your AFAA Our initials are the same — AFAA — but we begin a new chapter in our 33-year history with a new name: the Athletics and Fitness Association of America. The switch is much more than a word swap from “Aero- bics” to “Athletics,” says Andrew Wyant, president and general manager of the National Academy of Sports Medicine (NASM) and AFAA. “This [name change] demonstrates the vision AFAA has for a future in fitness that includes so many more activities than aerobics classes,” says Wyant. Our commitment? To deliver the highest level of training, certification and career development in a wider array of disciplines. We’re also excited about our logo makeover. Check it out in this magazine and on our website at www.AFAA.com.

Z umba and AFAA – A Strong Combination AFAA has partnered with Zumba® to enhance the training and safety of Zumba instructors around the world! For those who register to become certified in the new STRONG by ZumbaTM progression system, AFAA is providing a special rate on its Group Ex Instructor certification. In addition, 10% of proceeds from this special purchase will be donated to the Zumba Global Research Grant for Breast Cancer Prevention, a medical research grant working toward a preventative solution for breast cancer around the world. For more on STRONG by Zumba, visit www.strongbyzumba.com.

Ironman U and NASM Tri the Distance IRONMAN® and NASM are teaming up to expand the sport of triathlon through IRONMAN UTM. This innovative education and coaching certification platform offers online instruction for coaches and endurance athletes of varying skills and abilities. NASM-CPTs will now have a unique opportunity to introduce their clients to triathlon training, allowing them to expand their fitness programs into sport-specific plans. We’re confident trainers and triathletes will benefit greatly from this exciting new partnership! More information on IRONMAN U can be found at http://university.ironman.com.

NAksSM Knoc It Out with Everlast Discounts Everlast®, the preeminent boxing brand since 1910, and NASM have partnered to bring current NASM- CPTs huge discounts on equipment, apparel, and bags—up to 50% off! To sign up, fill out the short form at www.everlast.com/customer/account/create/ which will take you to the My Dashboard page. There, you’ll select NASM Members and enter your certification number to validate your account. It’s that easy! Everlast has also created Everlast F.I.T., a functionally integrated training program that combines traditional fight sports with functional full-body strength and conditioning, approved for NASM CEUs! Learn more at www.everlast.com/fitcerts.

6 AMERICAN FITNESS / FALL 2016

TRAINING EDGE INDUSTRY NEWS & HIGHLIGHTS what is

training?

ActivMotion Bars contain rolling weights that shift dynamically with every movement, creating the necessity to brace the core and keep stable as the weight shifts.

ActivMotion Bars and ActivMotion Training™ are quickly becoming a staple for trainers and group instructors. According to a recent study at the University of Michigan Human Movement Innovation Lab, ActivMotion Bars activate the core and joint stability muscles nearly twice as much as common static fitness tools.

ActivMotion Training is the education taught in conjunction with ActivMotion Bars. This innovative new training system progresses clients through the Go to www. development of stability strength, integrated strength and reactive core strength through the use of the unique activmotionbar. muscle-activating stimulus of ActivMotion Bars. com for more info.

8 Don’t Call it a Stationary

Bike! By Lucia Viti

Cyclists take note—the design affords fluid mo- simulation occurs as perfectly future has arrived. Real- tion in the sagittal, frontal as the real thing would out- Ryder®, the first unsta- and transverse planes. doors. Proper posture, pedal tionary stationary bike, Compared to a typical stroke, balance, propriocep- is rocking the world of stationary bike, steering tion and reaction time are indoor cycling. Inspired side-to-side or holding also consistently tested and by a passion for cycling straight and stable pro- rewarded. Without question, year-round, international vides a constant balance the innovative instability cap- co-founder Colin Irving, challenge, thus instigat- tures a “real-life” crossover. a semi-pro competitive ing upper body and core According to Irving, the cyclist, conceptualized strength while increas- RealRyder cycling program an indoor stationary bike ing caloric expenditure. is different because the bike that replicated the expe- Riders maintain pedal is different. “No other indoor rience of riding outdoors. cadence while controlling bike has our Ryde,” he says. In 2005, Irving teamed the bike’s rotation. The re- “Reveling in the sensations up with fitness industry sulting three-dimensional and awed by the sheer experts Sean Harrington movement replicates the physics, RealRyders glide, and Rich Hanson to “real” riding experience. lean and flow while playing unveil RealRyder. RealRyders learn how in a virtual, multidimensional RealRyder touts an to sidestep the fear of fall- experience. Riders become articulating bicycle frame ing roadside. Riders steer one with their bike, aware (ABF) that rotates like a straight line or lean into and active literally to their a gyroscope, allowing turns—adjusting speed core. Challenged by its movement to occur while and balance—to define power and speed, riders will securely stationed on a the sweet spot of any never get bored. It’s time to fixed frame base. The “lean-in” angle. The take the training wheels off!” realryder.com

FALL 2016 / AMERICAN FITNESS 9 TRAINING EDGE INDUSTRY NEWS & HIGHLIGHTS Find Your

For many individuals, eating well and realize their health and fitness goals users, the Vennares are expanding moving more is easier said than done, once and for all. their platform to 25 cities over the next so they simply don't do it. The key is connecting individu- year. According to Anthony Vennare, Like other NASM trainers, broth- als with fun and active activities that Fitt uses shareable content and com- ers Anthony and Joe Vennare have are right in their own backyard. That's munity events to showcase the local made reversing this unfortunate trend why they created Fitt, an online city- health and fitness scene. That way, he their life’s work. Having spent years by-city guide that connects individu- says, “the healthy choice becomes fun operating a 12,000-square-foot gym als with the sweat spots, healthy eats and accessible.” before moving their business online, and upcoming races in their commu- to learn more about Fitt‚ visit: the brothers believe they may have nity. After a yearlong pilot in the city www.fitt.co. cracked the code for helping people of Pittsburgh that attracted 2 million

what’s in Your Library New exercises are a great blueprint for progresses to more technique, you’ll find way to prevent trainer achieving them. targeted sculpting and advice on reps, pacing, (and client) boredom, Written by interna- shaping. You’ll find and optimal performance and this book serves up tionally renowned fitness variations, new exercises of each movement. You’ll 117 of the best. Strong educator, author and and workouts while also learn to incorporate & Sculpted is a simple trainer Brad Schoenfeld, progressing through cardiorespiratory training and effective science- PhD, the four-phase advanced and peak and mind-to-muscle and based program that program starts with physique phases. visualization techniques takes into account building an essential In addition to step-by- proven to enhance results. needs and goals and foundation for muscle step exercise instruction Visit HumanKinetics.com then provides the development, then and photos showing proper to preview or order.

Just opening this book approaches and and endurance as you every movement as well as will make you want to exercises into discover performance variations to increase or hit the weights and start a high-octane, levels and a physique decrease difficulty. You’ll squatting, lunging and high-efficiency that you never also find expert advice, pressing! If you’re looking system for building thought possible. equipment tips and safety for the chisel and the muscle and boosting Building Muscle and precautions. Get the re- performance, this read performance. Get Performance includes sults you’ve been looking delivers both! the best exercises for hundreds of exercises and for. Visit HumanKinetics. Nick Tumminello increasing speed, 75 ready-to-use programs. com to preview or order. combines effective explosiveness, athleticism Detailed photos depict

10 AMERICAN FITNESS / FALL 2016 Fusionetics Fitbit® lymber let´s ge t TECHNICAL

L ymber Fitness and Wellness App Fusionetics makes the complex simple and delivers solutions Meet Lymber, a new app that gives you access to signups that optimize results and maximize the value of your services. for a wide range of fitness classes and wellness activities— To learn more, visit www.fusionetics.com. without paying a membership fee. It works like Expedia or Hotels.com, only for exercise and Fitbit Sleep Schedule Fitbit® has released a simple yet powerful set of sleep tools to wellness activities including boxing, cycling, Pilates, yoga, help Fitbit users improve their sleep consistency and overall and Zumba, as well as spa visits and massages. That means health. Sleep plays a critical role in health and well-being, prices can fluctuate up or down depending on real-time from protecting against cardiovascular disease, diabetes and availability—a last-minute deal could be a steal or book in obesity, to boosting neurocognitive functions, mental health advance to ensure a spot with a favorite instructor. Lymber and longevity. Available on the Fitbit app and compatible with gives instructors and personal trainers the power to create all Fitbit devices that track sleep, Fitbit’s new Sleep Schedule their personal brand and build their following. feature helps guide you to get a more consistent pattern of Lymber (www.getlymber.com) is partnering with hundreds sleep with of studios on the West Coast, and plans to be in the top 20 • personalized sleep goals to achieve your optimal amount of sleep each night U.S. markets by year’s end. • customized bedtime and wake-up targets to establish sleep consistency Fusionetics • reminders to stay on schedule, and a sleep schedule Fusionetics is a Performance Healthcare System integrating history to chart your progress cutting-edge technology with sports science and clinical “What’s great about the new Fitbit Sleep Schedule feature application to provide evidence-based assessment and is that it looks at your sleep data from your Fitbit device, programming solutions that optimize performance, enhance analyzes it for patterns and creates a personalized schedule recovery and decrease the risk of injury. just for you,” says Tim Roberts, Executive Vice President, Developed under the leadership of Dr. Micheal Clark— Interactive at Fitbit. “This is an example of how we’re providing

TM guidance using Fitbit data to help people develop healthier creator of NASM’s OPT model—with an elite team of sports habits and routines, and is just the first in a series of new sleep medicine professionals and world-class athletes, Fusionetics is features that we’re working on to help our users improve their used by many of the world’s most prominent professional and health through data and coaching.” collegiate sports teams and athletes. It can be utilized by any level of professional, and is easily accessed on any computer, Source: Fitbit, Inc. Businesswire.com: www.businesswire.com/news/home/ smartphone or tablet. 20160620005271/en/.

FALL 2016 / AMERICAN FITNESS 11 TRAINING EDGE

Exercising Your Talents Into Additional Sources of Income

By Lawrence Biscontini, MA

12 Beyond the FItness doors

For the fitness professional looking to add extra sources of exercise and stress management.” Ultimately, the greater income to this career path, opportunities exist that often- the variety of services you can offer a resort, the more likely times go unexplored. P.L. Travers, famous for how her char- companies will consider having you as a guest instructor or acter Mary Poppins shares educational advice with children, trainer. To explore such possibilities wrote, “It’s amazing what we can accomplish when we learn • be sure your resumé highlights your versatility in Fhow to look beyond our own walls.” These words bring wis- terms of the populations you can train and the classes dom—and financial opportunity—to today’s fitness profess- you can teach ional. The frequently unexplored areas for bothhorizontal and • find a colleague in the spa industry who may be vertical career growth include guest teaching and training, willing to do a trade. (They take your place while providing continuing education, volunteering and writing. you visit theirs.) Horizontal Career Growth occurs when you do exactly • use www.spafinder.com and experienceispa.com as what you currently do, but in a different place, expanding places to begin research for resorts with well-estab- your demographic. Vertical Career Growth happens when lished patterns of trade. you amplify your job description to include additional skills, One final suggestion for expanding your services hori- which can occur within and beyond the demographic you zontally: ally yourself and your services with a charity that currently embrace. speaks to you. When you can create synergy between what Horn izo tal Career Growth you already do while amplifying the message of wellness, making the earth a better place, everyone wins. For example, The first—and usually least daunting—example of how offer a special event that most of your tribe would want to to expand your career is to not alter what you teach or train, attend. You teach for free, but to access this event, partici- only where. Consider continuing what you do with a change pants have to bring canned goods, gently used winter coats, of scenery. Guest teaching at a resort or spa can expose your used shoes or children’s toys. Invite the supported charity to talents to a completely different culture or demographic. In come by at the end of class for the donations. While initially these situations, the most common contractual arrangement it appears that you are you doing your norm with the same involves a “fitness trade” in which you (and possibly a guest) people, a closer look reveals you are thinking beyond self- fly to a destination, offer fitness services for 2 to 3 hours per profit alone. Group pictures, comments, shares and tagging day in exchange for accommodations, meals and spa servic- on social media will spread the message of your community es. You’ll often find additional opportunities and work leads outreach initiatives and, consequently, you will reap more just from meeting people while exposing your talents to a press from a properly executed event than you could gain wider audience beyond your daily grind. from your normal fitness class. Soon your tribe and the com- Suzanne Hosley, Managing Director of Fitness Innova- munity will associate you with your philanthropic outreach. tions Thailand (FIT) Ltd., recommends making additional income during vacations. “If you want to be traveling any- Vic ert al Career Growth way,” she says, “consider working with resorts, spas and ho- The following provide unique, and proven, ways to in- tels in vacation destinations to teach and maybe even devel- crease both your revenue and exposure as you consider op wellness programs and retreats, incorporating nutrition, adapting additional work avenues within the fitness world.

FALL 2016 / AMERICAN FITNESS 13 TRAINING EDGE

Clients online

Online coaching can be a great way to your success in this arena, he says, lies Getting Started expand our services beyond the four walls in showing your clients the value of what Here are a few steps Chelliah recom- of our facility, reaching customers all you have to offer. First, though, you must mends for trainers and instructors who over the world. “Most of our clients are learn what they value, need and want. are ready to begin online coaching: busy people who could really use some “Take the time to ask, listen, under- 1. Clients apply to join the program. extra help and motivation throughout stand,” says Comana, a faculty instructor Chelliah requires a minimum the day,” says AFAA-certified instructor for National Academy of Sports Medicine. 3-month commitment. He also Noel Chelliah, founder of the DailyMuscle Find out what their barriers to adherence explains clearly how much sup- Transformation Bootcamp, based in are. Learn what they have found helpful port he will provide, to prevent Kuala Lumpur, Malaysia. “The technol- in the past. “Once you fully understand becoming overwhelmed with hourly ogy available to us today makes this [clients’] challenges, their ambivalence or messages, emails and calls. easier. Without having to invest in any resistance, what they desire to do or can 2. after signing up, clients take additional subscription-based software, do—then respond,” says Comana. "before" photos and record their I teach other [trainers] how to success- Another important factor, he adds, is to starting weight and measurements. fully use emails, Skype and Facebook “empower them outside of their exercise This will serve as a baseline to Private Groups to provide daily motivation hour.” The perceived value of your online measure their progress. exclusively for online coaching clients.” coaching is directly related to the amount 3. Each day, clients email you Chelliah adds that social media also of time it impacts clients throughout the an update of their activities serves as the perfect platform for you to day. Comana likens it to owning a smart- and food intake. upload workouts, recipes, articles and phone. If you used it only 10 minutes a 4. Each week, you email each client videos for your clients’ reference. “We day, it would hold little value. But using it specific suggestions. Progress creatively and economically charge for 4 hours a day causes it to hold tremendous and tweak their plan based on the those needed services,” he says. value. The more you can contribute to your client's progress and adherence. Exercise physiologist and fitness clients’ success throughout the day—be- 5. at month’s end, bill your clients. consultant Fabio Comana is also a yond your session in the gym—the greater Chelliah uses PayPal, and he offers proponent of online coaching. The key to your perceived value will become. a money-back guarantee.

14 AMERICAN FITNESS / FALL 2016 (continued from page 13)

Mer nto ing and Coaching 1. Why this subject? 2. Why this author? 3. Why now? Mentoring occurs when one with experience, practical tips The first question ensures that the topic is of interest. The and wisdom shares this information with others. When find- second makes you sell yourself as an expert on the subject. ing a good fit with a mentoree, choose a compensation plan The third establishes that the time when the article comes that provides a win-win situation. Consider these possibilities: out would be ideal for this topic. • a payment plan based on what the mentoree can Pi rov ding Continuing Education afford without selling valuable insider information Vertical expansion can include becoming involved in below its value. continuing education. Taking your message to other profes- • a trade of services for time spent together based on sionals may at first seem a daunting task, but once you find professional career or talents the mentoree has, such a particular talent in the fitness industry, that talent often as massage, tax preparation or even meals. comes with a responsibility to share. Start by teaching your • an internship program in which the mentoree shadows the mentor and assists with work tasks fellow instructors and trainers, honing your message. Once in exchange for the valuable hands-on experience, comfortable, you can apply to spread your educational mes- plus the additional live recognition the mentoree sage by offering professional continuing education credits. receives by being introduced and associated Veteran instructor and multiple award-winner Keli publicly with the mentor. Roberts recommends this approach if it matches your style. Coaching is another vertical growth opportunity. This can Roberts, winner of the 2003 IDEA Group Fitness Instructor involve an individual interaction or interplay with a group of the Year Award, works out of Pasadena, Calif., as a person- or company. Understand that mentoring is relationship- al trainer, group fitness instructor, consultant and presenter. oriented between the parties involved for a long-term com- She says, “To become a master trainer, start by presenting for mitment, while coaching is task oriented and performance one of the many companies that offer opportunities for ap- driven, usually for a shorter term. prenticing to become a continuing education provider, such as BOSU®, Schwinn®, Tabata Bootcamp®, Barre Above™ and Fitssr ne W iting TRX®, just to name a few. Once you make more of a name In addition to mentoring and coaching, providing your for yourself offering their content, you can develop and start opinion can build your tribe and be an extra income source. to offer your own content [with] something special to your Chris Freytag, based in Minneapolis, works as a group fitness unique talents that you bring to the industry. ” instructor and yoga teacher. As part of her vertical career Having an established traditional fitness career can pro- growth, she founded Get Healthy U (gethealthyu.com). She duce satisfactory results. However, for those who wish to recommends making more money in fitness by blogging. “I expand their careers, both vertical and horizontal career started my website as a blog,” she shares, “and turned it into a expansion holds promise. Consider implementing some of content marketing site where I make money on advertising, the shared examples that match your personality, and let us affiliate programs and sponsored content. The key to starting know how they work for you! AF a blog is to be consistent, authentic and responsive to your readers. Create connections and offer value to your commu- Lawrence Biscontini, MA, nity through online content.” is an AFAA and NASM contributing writer Ryan Halvorson works as an editor, freelance writer and who has been exercising his global talents be- group personal trainer in San Diego, and he recommends yond the gym. As an author, mentor, public increasing your income by writing for fitness industry publi- speaker, charity advocate and “edutainer,” his cations. Editors of such publications are always looking for company FG2000 is dedicated to raising the unique ideas, concepts and stories, as well as qualified pro- standards of fitness around the world with a fessionals to write about them. The best way to get started philanthropic mission, “wellness without walls.” He has investigat- is to research digital or hard-copy publications that produce ed—and implemented—successful horizontal and vertical methods content that matches your expertise, and send article queries with your fresh ideas. Make sure you adhere to that publica- for career expansion for over three decades, as a recent 2015 Life- tion’s query process—each will likely have specific require- time Achievement Award from ECA will attest. Find Lawrence at ments—which can usually be found on its website. It’s best www.findLawrence.com. to have some local writing experience under your belt before REFERENCES: submitting a query, so be sure to get plenty of practice with a BISCONTINI, L. “WORKING WITH A MENTOR.” AMERICAN FITNESS, 30, NO. 5, blog or client email newsletters. Research-based articles will (2012): 12-14. meet with more success than blogs when submitted for in- SCHROEDER, J. IDEA COMPENSATION SURVEY REPORT FOR 2015. WWW.IDE- AFIT.COM/FITNESS-LIBRARY/2015-IDEA-FITNESS-INDUSTRY-COMPENSATION- dustry professional magazines. TRENDS-REPORT (ACCESSED MAY 2, 2016). When preparing to write, consider these three questions TRAVERS, P.L. MARY POPPINS: THE COMPLETE COLLECTION. ORLANDO: HARCOURT to determine if your material is newsworthy: BRACE. 1934

15 TRAINING EDGE

Fall Prevention

16 Falls among older adults have become a public health improved balance. Tai chi is excellent for balance be- crisis of near-epidemic proportions. Clearly, falls in cause it uses multiple types of weight shifts as well as aging adults can be life-changing, even life-threaten- standing on one leg for short periods of time. This ing. But things are happening to change that. In 2008 form of exercise helps improve balance because it the National Council on Aging spearheaded the first targets all the physical components needed to stay National Falls Prevention Awareness Day as part of its upright—leg strength, flexibility, range of motion Falls Free® Initiative. The goal: to form a national col- and reflexes.5 Flaborative effort to provide information to prevent falls Another of tai chi’s benefits is emotional. “Any- by older adults. 1 one who’s had a fall or who has instability has what we The Centers for Disease Control (CDC) reports that call a ‘fear of falling,’” says Dr. Peter Wayne from the each year 2.5 million older people are treated in emer- Osher Center for Integrative Medicine at Brigham and gency rooms for fall injuries, at least 250,000 are hospi- Women’s Hospital and Harvard Medical School. talized for hip fractures, and an aging adult dies from a “Ironically, a fear of falling is one of the biggest predic- fall every 20 minutes.1 To put a price tag on it, by 2020 tors of a fall. By making you firmer on your feet, tai chi the annual direct and indirect costs of fall injuries for takes away that fear,” he says. older Americans is expected to exceed $60 billion.2 Pilates The CDC has taken action, too, Preliminary evidence also shows with the STEADI (Stopping Elderly that “core strength training and Pi- Adult Accidents, Deaths & In- EXERCISE STYLES lates exercise training have a positive juries) Initiative. STEADI gives influence on measures of strength, healthcare providers tools to THAT PROTECT balance, functional performance and reduce their patients’ chances of falls in older adults.”6 Simply stated, falling. These materials help SENIORS FROM core strength gives clients a good “identify patients at low, moder- INJURy base for controlling movement and ate and high risk for a fall; identify maintaining balance. modifiable risk factors; and offer By Kathy Kuenzer, PhD “As people get older, they can lose effective interventions.”3 some of their balance and coordina- What are the interventions that tion. Pilates increases strength and fitness professionals, such as physical therapists and flexibility in both the core and the legs, which posi- trainers, can provide aging adults to reduce their chances tively affects balance. This, along with basic fitness ben- of falling? efits, can help them reduce the risk of falls,” according In her practice, Kimberley Bell, DPT and co-chair to Ellie Herman, owner of several Pilates studios, and of the San Diego Fall Prevention Task Force, focuses on a renowned Pilates instructor and author. Although older adults with dizziness, vertigo, imbalance and re- Pilates is great for improving core strength and postural peated, unexplained falls. Her “multifactorial approach” alignment in seniors, many Pilates mat exercises focus can be used by PTs and trainers seeking to improve bal- on spinal flexion. This is problematic because the area ance in their aging clients. Dr. Bell suggests that a client at risk of fracture in seniors is between the scapulae • be checked by a doctor for medicines or physical affected when performing many of the popular abdom- conditions (including vestibular disorders) that inal forward flexion exercises. can contribute to falling • have vision and eyewear checked Yoga • find ways to make their homes safer Although it is not regarded to be as effective as tai • exercise to improve balance and leg strength.4 chi, yoga is another balance-enhancing form of exercise PTs and trainers should begin any exercise intervention that can be done in a class setting. Seniors can prac- with a client by making sure they have completed the tice standing poses using chairs to support themselves. first three of these directives. Appropriate poses include an alternative downward- facing dog for flexibility, the crescent lunge for balance Tai Chi and stability, the chair pose for leg strength, the bridge Studies show that having a strong core and leg pose for core strength and stability, and the tree pose for muscles and practicing weight shifts contribute to balance and alignment.7

FALL 2016 / AMERICAN FITNESS 17 TRAINING EDGE

In the Erlangen fitness intervention, the fitness group experienced 23% fewer falls than the control group.

O ther Exercises Kathy Kuenzer, PhD, is a freelance to Help Reduce Falls writer from Albuquerque, N.M., who is inter- In 2015 the CDC updated its Compendium of Effective Fall ested in physical fitness and wellness in seniors. Interventions. This guide presents “specific interventions for Since retiring from a position as professor of which there is published evidence of the intervention’s ability writing and literature at the University of New 8 to reduce falls among community-dwelling older adults.” Of Mexico, she has walked in seven half-marathons. the 29 interventions covered, 15 use group classes that focus on side-stepping, dancing, leg strengthening, tandem stand- RE FErenceS: ing and walking, endurance training, quick reaction exercises, 1. nATIONAL COUNCIL ON AGING. “FALLS PREVENTION FACTS.” WWW.NCOA. and multitarget stepping. Three of the exercise interventions ORG/NEWS/RESOURCES-FOR-REPORTERS/GET-THE-FACTS/FALLS-PREVENTION- are based on tai chi. The average reduction in numbers of falls FACTS/ (ACCESSED JUN 7, 2016). 2. nATIONAL COUNCIL ON AGING. “FALLS FREE® OVERVIEW.” WWW.NCOA. among the exercise interventions was 42%. In particular, in ORG/RESOURCES/FALLS-FREE-OVERVIEW/ (ACCESSED JUN 7, 2016). the Erlangen fitness intervention, the fitness group experi- 3. centerS FOR DISEASE CONTROL. “STEADI – OLDER ADULT FALL PREVENTION.” enced 23% fewer falls than the control group. Furthermore, WWW.CDC.GOV/STEADI/ (ACCESSED JUN 7, 2016). in the Multitarget Stepping Program, the fall rate was 65% 4. KIMBERLEY BELL PHONE INTERVIEW, FEB 2, 2016. 9 5. AMERICAN COLLEGE OF SPORTS MEDICINE. “IMPROVING YOUR FLEXI- lower among people who took part. BILITY AND BALANCE.” (FEB 2, 2012). WWW.ACSM.ORG/PUBLIC-INFORMATION/ The CDC guide, which is available online, contains the ARTICLES/2012/02/02/IMPROVING-YOUR-FLEXIBILITY-AND-BALANCE type of provider for each intervention, the provider’s neces- (ACCESSED JUN 7, 2016). sary training, and contact information for the principal inves- 6. GRANACHER, U., ET AL. “THE IMPORTANCE OF TRUNK MUSCLE STRENGTH FOR BALANCE, FUNCTIONAL PERFORMANCE, AND FALL PREVENTION IN SENIORS: tigator of each intervention so that fitness professionals can A SYSTEMATIC REVIEW.” SPORTS MEDICINE, 43, NO. 7(JUL 2013): 627-41. DOI: obtain more information. 10.1007/S40279-013-0041-1. One caveat from the American Physical Therapy 7. “5 YOGA BALANCE POSES TO PREVENT FALLS.” MYSILVER-AGE. THEBEGROUP.ORG/HEALTHY-AGING/5-YOGA-BALANCE-POSES- Association is that “[b]alance training should be challeng- TO-PREVENT-FALLS (ACCESSED JUN 13, 2016). ing and progressive in difficulty (such as reducing base of 8. “A CDC COMPENDIUM OF EFFECTIVE FALL INTERVENTIONS: WHAT WORKS FOR support and/or increasing movement in multiple direc- COMMUNITY-DWELLING OLDER ADULTS.” WWW.CDC.GOV/HOMEAND tions).” Another recommendation is that balance training RECREATIONALSAFETY/PDF/FALLS/CDC_FALLS_COMPENDIUM-2015-A. PDF#NAMEDDEST=SINGLE-INTERVENTIONS-EXERCISE (ACCESSED JUN 13, 2016). be done at least three times per week for older adults at 9. “A CDC COMPENDIUM OF EFFECTIVE FALL INTERVENTIONS: WHAT WORKS FOR 10 increased risk for falls.” COMMUNITY-DWELLING OLDER ADULTS, 3RD EDITION.” WWW.CDC.GOV/ It goes without saying that keys to ongoing prevention of HOMEANDRECREATIONALSAFETY/FALLS/COMPENDIUM (ACCESSED falls in seniors are tai chi, Pilates, and other balance-focused JUN 13, 2016). 10. “PROMOTING EXERCISE FOR IMPROVED BALANCE AND FALLS PREVENTION.” and core-strengthening exercise. As Dr. Bell says, “Seniors HEALTH.GOV/PAGUIDELINES/BLOG/POST/PROMOTING-EXERCISE-FOR- 4 should make exercise a focus of retirement.” AF IMPROVED-BALANCE-AND-FALLS-PREVENTION.ASPX (ACCESSED JUN 13, 2016).

18 AMERICAN FITNESS / FALL 2016 AF + Q ByA Matt Brzycki Does endurance training Does grape juice increase Does cold-water immersion have an adverse effect on endurance performance? after exercise improve oral health? Grapes and grape products—such as muscular adaptations? Researchers compared a group of grape juice—contain varying amounts Cold-water immersion is, ironically, 35 triathletes (average age 36.8) who of antioxidants. (Interestingly, red a hot trend in recovery strategies. did endurance training for more than and purple grapes have more antioxi- It’s thought that this treatment—aka 5 hours per week to a control group of dants than green.) It’s reasonable to cryotherapy—can reduce 35 individuals (average age 36.1) who think that the protective properties of muscular fatigue and soreness didn’t do any endurance training. It grapes and derivatives could have an following exercise. was found that endurance athletes had ergogenic effect. In one study, 21 subjects (average a significantly greater risk of dental Researchers randomly assigned age 21.3) did strength training two times a week for 12 weeks. The partici- erosion than non-athletes. There was 28 recreational runners (average pants—who had at least 12 months of no significant difference between the age 39.8) to two groups: One group experience with strength training— two groups in prevalence of decayed, received grape juice and the other were randomly assigned to do received a beverage that had the same missing or filled teeth. Among the 10 minutes of either cryotherapy or amount of calories, carbohydrates endurance athletes, there was a active recovery after each session. and volume as the grape juice. For 28 significant correlation between caries Strength training focused on the lower prevalence and the cumulative weekly days, both groups drank the assigned body and was supervised. training time. beverage, before and immediately The subjects who received It appears as if exercise after training. On the days in which no cryotherapy were immersed up to their decreases saliva flow rate. The training was done, the groups drank waists in water that was maintained researchers speculate that this the assigned beverage during meals. at about 50°F; those who did active results in a compensatory increase Those who consumed grape juice recovery pedaled a stationary bike at in saliva pH, producing an acidic significantly improved their running a self-selected low intensity. time to exhaustion by nearly 13 minutes environment. This may also be Individuals who did active while the performance of the control recovery after strength training exacerbated by the frequent group worsened by about 1 minute. had significantly greater increases consumption of acidic sports drinks. Moreover, those who consumed grape in muscular size and strength than It’s critical for endurance athletes juice significantly improved three of those who did cryotherapy. to replace the carbohydrates that the four markers that were used to they use for energy as well as the assess antioxidant activity. Those who REFERENCE: ROBERTS, L.A., ET AL. “POST-EXERCISE COLD WATER IM- electrolytes that they lose through consumed the control beverage experi- sweat. However, their consumption MERSION ATTENTUATES ACUTE ANABOLIC SIGNALLING enced no change in those variables. AND LONG-TERM ADAPTATIONS IN MUSCLE TO STRENGTH of sports drinks, energy gels and TRAINING.” THE JOURNAL OF PHYSIOLOGY, 593, NO. 18 energy bars may increase their risk REFERENCE: (SEP 2015): 4285-301. of certain types of oral disease. TOSCANO, L.T., ET AL. “POTENTIAL ERGOGENIC ACTIVITY OF GRAPE JUICE IN RUNNERS.” APPLIED PHYSIOLOGY, M att Brzycki REFERENCE: NUTRITION, AND METABOLISM, 40, NO. 9 (2015): FRESE, C., ET AL. “EFFECT OF ENDURANCE TRAINING ON 899-906. is the assistant director DENTAL EROSION, CARIES, AND SALIVA.” SCANDINAVIAN of campus recreational JOURNAL OF MEDICINE & SCIENCE IN SPORTS, 25, NO. 3 fitness at Princeton (JUN 2015): e319-26. University. He has more than 33 years of experience at the collegiate level and has authored, co-authored and edited 17 books.

19 TRAINING EDGE

Gait analysis is a dynamic assessment that can be completed through a variety of means: when the client walks into your setting, while they are walking on a treadmill, or while they are walking to their next exercise. This evaluation can supply a plethora of information and provide insight into compensations that could be occurring regularly. While there are a variety of high-tech instruments that can be used to analyze gait (accelerometers, gyro- scopes, force plates, etc.), visual and/or video gait analysis is common in a clinical setting. However, the quality of the assessment is based on the assessor’s experience. The key step is knowing what to look for while conducting the analysis. Remember that the human body is a kinetic chain; issues at one joint may manifest as a compensation at another joint. For example, altered biomechanics occurring at the hip may be noted as a compensation at the knee, ankle or foot. For this reason, it is important not to isolate an evaluation on a specific joint, but to look at the entire body. Gait compensations can occur for a number of What Your Client's Gait different reasons: current/previous injury, neurological/ orthopedic disorders, postural compensations, overac- Says About Their Muscles tive/underactive musculature, footwear, etc. This article will address potential lower extremity compensations in By Theresa Miyashita, PhD, ATC, PES, CES an otherwise healthy, active client.

20 Check Ankle Dorsiflexion A decrease in ankle dorsiflexion (moving the top T o address the decrease in dorsiflexion observed, of the foot toward the shin) can have an impact on the one can incorporate an appropriate corrective exercise entire kinetic chain. A minimum of 10° of dorsiflexion is strategy into the client’s program design. Inhibition of SMR CALVES necessary for proper walking gait mechanics.1 If some- the gastrocnemius complex can be achieved via self- one does not possess the appropriate amount of ankle myofascial release (SMR).6 During this process it is dorsiflexion, the most common compensation noted on important to “hold” over the tender spots (i.e., trigger a gait analysis is an early heel-off.2 This is when an points) until they are released, which may take 30 to 90 individual picks up their heel too soon, leading to an seconds. Following SMR, the next step is incorporating increased amount of time and pressure on the forefoot.3 the appropriate lengthening strategies for the overac- O veractivity of the gastrocnemius and soleus, plus tive musculature: gastrocnemius and soleus. This can tightness of the Achilles tendon are commonly linked be achieved via static or neuro-musclar (NM) stretch- to a decrease in dorsiflexion. The decreased amount of ing.7 It is important to separate stretching strategies necessary movement between the tibia and talus, due to of the gastrocnemius and soleus via position of the the overactivity of the aforementioned musculature, is knee—knee flexed to target the soleus and knee ex- also linked to excessive compensatory pronation during tended to target the gastrocnemius. Following the in- the gait cycle.4,5 W hile in the gait cycle, the subtalar hibition and lengthening phases, strengthening of the joint should pronate during the loading response of the underactive muscles will assist in returning the over/ stance phase to adapt to the ground. The concern with underactive muscles to their proper length-tension a pronated foot is that it is a sloppy foot—and too much relationships. The anterior tibialis and intrinsic foot time spent in a pronated position will predispose one to muscles should be targeted via resisted dorsiflexion calf Stretch a variety of pathologies including, but not limited to, an and inversion, marble pick-ups and towel scrunches assortment of overuse injuries.3 (intrinsic foot muscles).

L ook for knock-knees A common knee compensation observed in a gait generation and osteoarthritis.8 While there are a number analysis is genu valgum—knee adduction. During the of different causes for genu valgum—injury, metabolic stance phase of the gait cycle, we may note the knee(s) or syndromic conditions9—we will focus on potentially moving inward, creating a “knock-knee” posture. This over/underactive musculature. Potentially overactive may become immediately evident as soon as your cli- muscles linked to a genu valgum posture include ad- SMR adductors ent’s foot hits the ground, or it may become more pro- ductor complex, biceps femoris, vastus lateralis and nounced when the body weight is completely over the the lateral gastrocnemius. These muscles should be stance leg (with the body and ground at a 90° angle). targeted via SMR and static/NM stretching. Poten- This type of posture is more evident in the pediatric, tially underactive muscles that should be targeted via female and obese populations.8,9 The long-term compli- strengthening include gluteus medius, gluteus maximus cations linked to genu valgum include joint cartilage de- and the vastus medialis oblique.

O bserve hip rotation T here are many compensations that can occur at Our first step in addressing these muscular imbal- the hip joint leading to altered gait mechanics. These ances through a corrective exercise program is to inhibit adjustments may also be noted lower in the kinetic and then lengthen the overactive muscles, followed by chain as compensations occurring at the knee, ankle or activation/strengthening of the underactive muscles. sMR HIP FLEXORS foot. For example, external rotation at the hip joint may Due to the sedentary lifestyles and occupations be viewed as a toe-out gait; while an internally rotated of many Americans, overactivity of the hip flex- hip may present as a toe-in gait. If these hip rotations ors leading to an anterior pelvic tilt is commonly are due to musculature, and not bony malalignment, viewed. During a gait analysis, we may note an in- we can address the dysfunctions through corrective crease in the lumbar curvature or the trunk leaning exercise. Femoral external rotation may be due to over- slightly forward. Targeting the hip flexors and the activity of the piriformis, gluteus maximus, gluteus erector spinae with SMR and static/NM stretch- medius (posterior fibers), and/or the tensor fascia latae ing will help to decrease the overactivity of these (TFL). The gluteus medius (anterior fibers) and adduc- muscles. Strengthening the gluteus maximus and tor complex are likely underactive; while the opposite hamstring complex will assist in maintaining proper is probably associated with femoral internal rotation. pelvic alignment.10

FALL 2016 / AMERICAN FITNESS 21 TRAINING EDGE

EEvaluatvaluatee eacachh aaspspeecctt of thethe bobodydy sepseparatarately,ely, but ddoo not forgetforget ththatat ccompompensensationsations observeobserved aatt oneone joint mmayay bebe dduuee to ddysfunctionysfunction aatt aanothnotherer joint.

Assessment Tips of altered gait mechanics can allow for the JOURNAL OF ORTHOPAEDIC AND SPORTS PHYSICAL THERAPY, 7, NO. 2 (1985): 69-72. While conducting a gait analysis, it development of an appropriate corrective 5. hintermANN, B. AND NIGG, B.M. “PRONATION IN is important to take your time. Make exercise program. RUNNERS. IMPLICATIONS FOR INJURIES.” SPORTS MEDI- For more details on corrective exercise CINE, 26, NO. 3 (SEP 1998): 169-76. note of deviations occurring and deter- 6. GRIEVE, R., ET AL. “THE IMMEDIATE EFFECT OF TRICEPS mine which muscles may be involved. It programming and gait assessments, check SURAE MYOFASCIAL TRIGGER POINT THERAPY ON RE- is important to take a thorough subjec- out the NASM Corrective Exercise Special- STRICTED ACTIVE ANKLE JOINT DORSIFLEXION IN REC- ization at www.nasm.org/ces. AF REATIONAL RUNNERS: A CROSSOVER RANDOMIZED tive evaluation prior, so you know if any CONTROLLED TRIAL.” 17, NO. 4 (OCT 2013): 453-61. compensations can be linked to other eti- 7. NAKAMURA, M., ET AL. “ACUTE EFFECTS OF STRETCHING ologies; e.g., joint replacement surgeries, Theresa Miyashita, ON PASSIVE PROPERTIES OF HUMAN GASTROCNEMIUS PhD, ATC, PES, CES, MUSCLE-TENDON UNIT: ANALYSIS OF DIFFERENCES osteoarthritis, bony malalignments, etc. If BETWEEN HOLD-RELAX AND STATIC STRETCHING.” the client’s gait compensations are due to received her undergradu- JOURNAL OF SPORT REHABILITATION, 24, NO. 3 (AUG issues beyond over/underactive muscula- ate degree in sports medi- 2015): 286-92. cine from Canisius College, 8. brouwer, G.M., ET AL. “ASSOCIATION BETWEEN VAL- ture, you may not be able to address them GUS AND VARUS ALIGNMENT AND THE DEVELOPMENT through a corrective exercise program. Buffalo, N.Y.; her master's AND PROGRESSION OF RADIOGRAPHIC OSTEOARTHRI- Should this be the case, it is important degree in athletic training TIS OF THE KNEE.” ARTHRITIS AND RHEUMATISM, 56, from University of North Carolina at Chapel NO. 4 (APR 2007): 1204-11. to refer to a licensed healthcare provider. 9. FARR, S., ET AL. “FUNCTIONAL AND RADIOGRAPHIC Hill; and her doctoral degree in education and Con clusion CONSIDERATION OF LOWER LIMB MALALIGNMENT IN biomedical sciences from Colorado State University. CHILDREN AND ADOLESCENTS WITH IDIOPATHIC GENU Appropriate strength ratios between ag- REFERENCES: VALGUM.” JOURNAL OF ORTHOPAEDIC RESEARCH, 32, NO. 10 (OCT 2014): 1362-70. onist and antagonist muscles can help to 1. SAHRMANN, S. MOVEMENT SYSTEM IMPAIRMENT SYN- 10. KANG, S.Y., CHOUNG, S.D. & JEON, H.S. “MODIFYING DROMES OF THE EXTREMITIES, CERVICAL, AND THO- stabilize joints and allow for proper move- THE HIP ABDUCTION ANGLE DURING BRIDGING EXER- RACIC SPINES. ST. LOUIS: MOSBY, 2011. ment patterns. However, when these ratios CISE CAN FACILITATE GLUTEUS MAXIMUS ACTIVITY.” 2. cornwALL, M.W. AND MCPOIL, T.G. “EFFECT OF AN- MANUAL THERAPY, 22 (APR 2016): 211-15. are altered due to over/underactivity of KLE DORSIFLEXION RANGE OF MOTION ON REARFOOT the agonist/antagonist muscles, altered MOTION DURING WALKING.” JOURNAL OF THE AMERI- joint mechanics and gait compensations CAN PODIATRIC MEDICAL ASSOCIATION, 89, NO. 6 (JUN 1999): 272-77. can occur. 3. JOHANSON, M.A., ET AL. “HEEL LIFTS AND THE Dysfunction in walking patterns can lead STANCE PHASE OF GAIT IN SUBJECTS WITH LIMITED to several problems including joint pain, DORSIFLEXION.” JOURNAL OF ATHLETIC TRAINING, 41, NO. 2 (APR 2006): 159-65. injury, decreased force output and long- 4. mcPOIL, T.G. AND KNECHT, H.G. “BIOMECHANICS OF term complications. Proper identification THE FOOT IN WALKING: A FUNCTION APPROACH.” THE

22 AMERICAN FITNESS / FALL 2016 Continuing Education Units in the Convenience of Your Own Home

corner afaa’s CEU Corner™ is one of the best continuing education This issue’s CEU Corner and Quiz Feature is: offers available. By simply reading and studying this com- CEUprehensive article and completing the corresponding online OSTEOPOROSIS quiz, you can earn 2 AFAA/0.2 NASM CEUs for a $35 fee. by Audra Eisz, PT, DPT, OCS, ATC, and Visit AFAA.com today! Laura Gladwin, MS, CPT, CGF, MAFP © 2016 Aerobics and fitness association of America

LEARN & EARN CEUs T TRAININRAININGG ED EDGGEE CE CEUU CORNER CORNER

What You Should Know

By Audra Eisz, PT, DPT, OCS, ATC, and Laura Gladwin, MS, CPT, CGF, MAFP

24 AMERICAN FITNESS / FALL 2016 Many clients view osteoporosis as a This contributes to childhood obesity and concern among seniors. As fitness “By including bone affects bone health. It is important for professionals, though, we know health in our program children to consume foods that supply cal- that building peak bone mass be- cium, vitamin D and protein before they gins early in life and ends before design and nutrition consume foods and drinks that provide Mwe reach middle age. We also know discussions—even for little nutritional value.1 how proper exercise and nutrition Calcium. For children aged 9 to 18, can strengthen clients’ skeletal sys- our healthiest young the Recommended Dietary Allowance tem. Personal trainers work hard to clients—personal (RDA) for calcium is 1,300 mg per day, design programs that help clients which is roughly four servings of dairy.1 achieve their goals. By including trainers can contribute The American Academy of Pediatrics sug- bone health in our program design gests that diet, not supplements, should and nutrition discussions—even to the prevention of be the primary source for calcium. This is for our healthiest young clients— osteoporosis on a both because supplements have a reduced personal trainers can contribute to bioavailability and because this promotes the prevention of osteoporosis on a large scale.” healthy lifelong dietary habits.2 A few large scale. notes about calcium: This article will demonstrate In childhood and adolescence, • Dairy products. Researchers have how to help all clients achieve peak the primary objective for bone stated that dairy is the optimal source bone mass, maintain bone mass and health is to attain the genetic from which to obtain calcium. Milk recognize risk factors of osteoporo- 1 potential of peak bone mass. also provides protein, vitamin D and sis. You will also learn how to keep To do this, we have to ensure other nutrients such as magnesium clients with osteoporosis safe, while proper nutrition and exercise and phosphorus, all of which are helping them with bone-beneficial to build the strongest bones important for bone health.1 exercise and nutrition. possible. It’s the only chance we • Vegetables. Oxalates in spinach, Youth: Building Peak Bone Mass will get. collard greens, rhubarb and beans re- Humans have a limited amount Youth Nutrition duce the bioavailability of the calcium of time to achieve peak bone mass. and Bone Health found in vegetables. Also, it is difficult That window opens in puberty and Three main dietary nutri- to eat a large enough quantity of veg- closes in the mid-20s, or in some etables to meet the RDA for calcium 1, 2 ents contribute to optimal bone 1 cases in the third decade of life. density: calcium, vitamin D with vegetables alone. and protein. In the literature, • Soy milk. A study looking at there is a concern about “milk supplementation in soy milk shows that the calcium might have displacement” among our 3 youth, in which soda, sports reduced bioavailability. drinks and energy drinks are Vitamin. Also called D calciferol, vita- 2,5,6 replacing milk consumption. min D is actually a hormone responsible for the absorption and utilization of calcium.1 The RDA for vitamin D is 600 IU or 15 mcg per day for both males and females aged 1 to 70 years.4 Vitamin D is found in fortified dairy products, egg yolk, fatty fish and fortified orange juice.4 Vitamin D is also synthesized by our skin when it is exposed to sunlight; in fact, that’s our primary source of the nutrient. Because children are spending more time indoors and using sunscreen when outside, vitamin D deficiency in youth can be a problem.1 In a recent commentary in the Journal of the American College of Nutri- tion, researchers state that moderate, un- protected sun exposure (less time than is required to burn) should be “sought rather than avoided.”8

25 TRAINING EDGE CEU CORNER

Protein. This nutrient provides the amino acids to build the bone matrix. It Exercise in the adolescent years also stimulates insulin-like growth factor 1 (IGF-1), which is an important player in bone formation.2 According to the can have a profound effect on the Institute of Medicine (IOM), the protein Dietary Reference Intake (DRI) for achievement of peak bone mass. The males and females aged 9 to 13 years is 0.76 g/kg/d. At ages 14 to 18 years, this type of exercise a young person decreases to 0.73 and 0.71 g/kg/d for males and females, respectively.19 does is very important. Youth Exercise and Bone Health Research has shown that children Calcium. Adult males aged 19 to 70 time. However, if we use this information who participate in high-impact sports years and females aged 19 to 50 years along with our experience and educated (gymnastics, volleyball) and odd-impact should consume 1,000 mg of calcium per reasoning skills, we can infer that adults sports (basketball, soccer) generally have day. Females aged 51 to 70 should con- need to do both impact exercise and re- higher bone mineral density (BMD) and sume 1,200 mg of calcium daily.11 sistance training to maintain and possibly improved bone geometry.7 (See page 27.) Vitamin. D Adult males aged 19 to improve BMD. Some evidence points out One randomized controlled trial, 70 years and females aged 19 to 50 years that exercise may have site-specific (lum- coupled with a summary from the Amer- should consume 600 IU (15 mcg) of vi- bar spine or femoral neck) results. Know- ican Academy of Pediatrics, shows that tamin D per day. It should be restated ing this, we can choose exercises for our healthy children who participated in that the primary source of vitamin D is clients based on their needs. Here, some high-impact, low-frequency exercises its synthesis by our skin when exposed to specific study results: such as jumping, hopping or skipping sunlight. This exposure should be direct Premenopausal women: Resistance for 10 minutes three times per week in- (not blocked by sunscreen) and should training and high-impact, weight-bear- 9,2 creased BMD of the femoral neck. The be moderate (not lasting long enough to ing exercise. One systematic review and a American Academy of Pediatrics goes cause a sunburn). Vitamin D may also be review of the literature from Brazil came 12,15 on to say that weight-bearing activities consumed in food, but sources are lim- to the following similar conclusions. (such as dancing, jogging, jumping and ited to dairy, egg yolk, fatty fish, and forti- With regard to premenopausal women, walking) are preferred over swimming fied orange juice.4 resistance training exercise and high- and cycling for pediatric bone health. Protein. The amino acids in protein impact, weight-bearing exercise—either There does, however, seem to be a are needed to build the bone matrix. Pro- alone or in combination—can increase limit as to how much activity a child’s BMD in the lumbar spine and femur 1 tein also stimulates the production of in- 15 bones can take. In a study of 6,000 high sulin-like growth factor 1 (IGF-1), which to 2%. A randomized controlled trial school girls, those who participated in aids in bone formation.2 According to the with premenopausal subjects found that more than 8 hours of impact sports per Institute of Medicine (IOM), the protein a 12-month, progressive high-impact week (such as basketball, cheerleading, Dietary Reference Intake (DRI) for adults training program (3x/week plus home ex- gymnastics or running) were two times ercises, with more than 66 sessions total) 1,10 aged 19 years and older is 0.66 g/kg/d, as likely to sustain a stress fracture. except during pregnancy and lactation in resulted in enlarged bone circumference and improved bone geometry relating to Adulthood: A Bone women, when it rises to 0.88 g/kg/d and increased bone strength. The same effects Maintenance Plan 1.05 g/kg/d, respectively.19 were not found in participants who were From our 20s to our 60s (for most Adult Exercise and Bone Health less compliant (< 19 sessions).13 adults), our goal is to maintain the bone Research on exercise prescription Postmenopausal women: Resistance density we achieved in childhood and for the prevention and treatment of os- training and low-impact activities. This adolescence.2 Here, nutrition and exer- teoporosis in adults is not as clear as it group has been the focus of most research cise are still key, but so is the awareness is regarding children. To date, studies regarding exercise and osteoporosis. In a and mitigation of risk factors that can have focused mostly on postmenopausal systematic review, Nikander et al. uncov- lead to a reduction in bone mass. women, even though others in the same ered mixed results.15 The general find- Adult Nutrition and Bone Health age group are men and premenopausal ings were that resistance training can As in childhood, the three most im- women. Much of the evidence regarding have a positive effect on BMD (1 to 2%) at portant nutrients for bone health in adult- adult exercise and bone health can seem the lumbar spine, but improvements hood are calcium, vitamin D and protein. contradictory if we review one study at a at the femur were not consistent. They

(continued on page 29)

26 AMERICAN FITNESS / FALL 2016 Build Your Bone Health V ocabulary

As we talk about exercise and bone health, you’ll notice a few different terms being used. Bone mineral density (BMD) describes the amount of calcium and other minerals that are found in an area of bone. This can be measured by dual- energy X-ray absorptiometry (DXA). Bone strength refers to the geometry of the bone, and how it may absorb and withstand various forces. It includes such factors as the shape of the bone, its size, and its microarchi- tecture. Measurement of bone geometry is very complex, and it is usually accomplished with quantitative com- puted tomography or high-resolution magnetic resonance imaging. Conclusion: Both BMD and bone geometry are important for strong, healthy bones. A very dense bone without good geometry will not be able to bend and absorb forces.

Children who participate in high-impact sports such as gymnastics generally have bones that are stronger and better able to withstand various forces.

27 TRAINING EDGE CEU CORNER

E xercise Guidelines for Bone Health

Use this reference to select bone-building activities for clients in with regard to resistance training) as it is for older adults, who may various age groups. In all cases, it is very important for the client have risk factors for cardiovascular disease or other conditions or to obtain a written clearance from their physician prior to partici- medications that need to be considered.23–29 pation. This is as vital for young adults and children (particularly

Population Exercise Modalities Guidelines

Children/Young Adults Weight-bearing aerobic activities • Training loads must be greater than what is experienced (basketball, gymnastics, soccer, during everyday activities. track/field) • Include weight-bearing aerobic activities to improve/maintain work capacity and bone mass. High-intensity resistance training • Emphasize activities that develop muscle strength and power (for young adults only, supervised and with (several bouts at 5–10 minutes/bout depending on activities; physician’s clearance) not one long bout). Motor skills • Aim for 60 minutes/day total with a combination of aerobic (hopping, jumping, running, skipping) and muscle-strengthening activities.

Premenopausal Weight-bearing aerobic activities • Training loads must be greater than what is experienced Women/ (basketball, group fitness classes, hiking, during everyday activities. Middle-Aged Men jumping, martial arts, running, soccer, • Emphasize activities that develop strength and power tennis, walking) focusing on hips, thighs, back and arms. • Weight-bearing aerobic activities to improve/maintain work High-intensity resistance training capacity and bone mass (30–60 minutes; 3–5 days/week). (free weights, machines) • High-intensity resistance training to assist in BMD Core/stabilization activities and reduce fall/fracture risk (75–85% of 1RM; 20–40 minutes; 2–3 days/week). • Core/stabilization activities (2–3 days/week). • Flexibility training (30-second hold as tolerated; 3–5 days/week but preferably 7 days/week).

Non-Osteoporotic Weight-bearing aerobic activities • Include exercises that focus on fall prevention Postmenopausal (brisk walking, dancing, hiking, tai chi, and address muscle weakness, postural instability Women/ water fitness, yoga) and poor functional mobility. Older Men • Weight-bearing aerobic activities (40– 70% peak HR; High-intensity resistance training 30–60 minutes; 3–5 days/week). (machines, free weights, elastic bands) • High-intensity resistance training to assist in BMD Balance exercises and reduce fall/fracture risk (75–85% of 1RM; 2 sets of 8–10 reps; 20–40 minutes; 2–3 days/week). Core/stabilization activities • Balance activities (2–3 days/week) Flexibility training • Core/stabilization activities (2–3 days/week). • Flexibility training (30-second hold as tolerated; 3–5 days/week but preferably 7 days/week).

28 AMERICAN FITNESS / FALL 2016 also reported that several studies found Categories. There are two categories no improvement in BMD at the lumbar of osteoporosis: primary and secondary. spine or femur with walking or endur- Primary osteoporosis is bone deteriora- ance training programs. tion due to age and/or decreased gonad A different meta-analysis revealed function. Secondary osteoporosis is a re- that a combination of impact activi- sult of chronic illness that causes acceler- ties was significant for improving BMD ated bone loss.18 at both the lumbar spine and femoral Causes. While primary osteoporosis 16 neck. The study looked at high impact is related to age and hormone levels, sec- (jumping rope, vertical jumps, running ondary osteoporosis has several causes. more than 9 km/hr), odd impact (aero- Some of the most common are: bics and agility activities), low impact • Endocrine and metabolic illness (walking, stair climbing, and jogging at such as anorexia nervosa, athletic less than 9 km/hr or 11 min/mile) and amenorrhea, diabetes mellitus T he Female combined impact (“impact activity mixed (type 1) and hyperparathyroidism. with high-magnitude joint reaction force A thlete Triad 6 • Genetic disorders including Ehlers- loading through resistance training”). Danlos syndrome, Marfan syndrome The female athlete triad is among the causes The authors concluded that low-impact and osteogenesis imperfecta. of secondary osteoporosis, the type of bone activities (jogging, stair climbing, walk- • Medications such as glucocorticoids ing) when combined with resistance loss not related to aging and the hormonal (steroids to reduce inflammation), changes that accompany it. As mentioned in training are the most effective in main- excess thyroid hormone, methotrex- taining BMD. Interestingly, this study this article, the female athlete triad is de- ate (for rheumatoid arthritis) found that high- and odd-impact activi- and the blood thinner heparin scribed as low energy intake (with or without ties did not have an effect on BMD in (with prolonged use). an eating disorder), menstrual dysfunction postmenopausal women. • Nutritional problems such as and low bone mineral density (BMD). Men aged >31: Site-specific exer- alcoholism, chronic liver disease, Low energy intake. This includes a spec- cise. There is little evidence specifically deficiencies of calcium and/or regarding males, exercise and osteopo- trum of people, ranging from athletes who un- vitamin D, gastric operations and rosis. A meta-analysis found that site- 18 intentionally consume too little to those with specific exercise may help improve BMD malabsorption syndromes. an eating disorder (who intentionally reduce 14 • The female athlete triad, which for men older than 31 years. Overall, 1 is described as low energy intake caloric intake). Athletes at risk for low en- more research is necessary to determine ergy intake include those who restrict food in- the most beneficial exercise for men and (with or without an eating disorder), bone health.14,15 menstrual dysfunction and low take or certain types of food, vegetarians, and BMD. (See sidebar.) those who exercise for prolonged periods.22 Understanding Osteoporosis Menstrual dysfunction. When an athlete According to the National Osteopo- Recognizing At-Risk Clients rosis Foundation (NOF), osteoporosis is Dr. Jeannette South-Paul’s article becomes amenorrheic, she loses the bone- 21 a silent condition and the most common in American Family Physician gives a building effects of estrogen. bone disease in humans. Its characteris- comprehensive list of risk factors for os- Low BMD. Amenorrhea and low body tics are low bone mass and a disturbed teoporosis: female gender, petite body weight, as from an eating disorder, result in bone architecture, with deteriorated frame, low body weight, white or Asian a decline in BMD. 21 It can take years for BMD ancestry, sedentary lifestyle or history of bone tissue jeopardizing bone strength to recover, even after a person is in recovery and increasing fracture risk.17 immobilization, null parity, increasing Testing. Osteoporosis is detected age, high caffeine intake, renal disease, from an eating disorder and has achieved a 18 by dual-energy X-ray absorptiometry lifelong low calcium intake, smoking, ex- normal body weight. (DXA). One of the results is reported as cess alcohol use, long-term use of certain Conclusion: In 2007, the American Col- a T-score, which compares the patient’s drugs, impaired calcium absorption, be- lege of Sports Medicine issued a position 18 bone mineral density (BMD) to “young ing postmenopausal. It is important to statement on the female athlete triad.22 They 17 normal” adults of the same gender. A know these risk factors. However, it may recommend that the athlete be treated by a T-score of less than -1.0 results in a diag- be more useful to create clusters and as- nosis of osteopenia (early-stage osteopo- sociations with your clients to effectively team that includes a physician, a registered rosis)2 and a T-score of less than or equal identify people at risk. Let’s look at a few dietitian and, for athletes with an eating dis- to -2.5 indicates osteoporosis.17 examples you may see. order, a mental health practitioner.22

FALL 2016 / AMERICAN FITNESS 29 TRAINING EDGE CEU CORNER

Bone-Building Medications

It’s good to know what drugs your client is taking, and that includes any Hormone therapy or estrogen therapy is FDA-approved for the for the prevention or treatment of osteoporosis. There are five categories prevention of osteoporosis and relief of other symptoms associated with of medications available for the prevention and treatment of osteoporosis: menopause. Vertebral and hip fracture risk can be reduced by 34%, and bisphosphonates, calcitonin, estrogen agonist/antagonist, hormone thera- other osteoporotic fracture risk is reduced by 23%. Since these therapies py and parathyroid hormone. These are typically used in adults, not children may increase the risk of cardiovascular disease, stroke and breast cancer and adolescents, whose first line of treatment is nutrition. 1 in some people, the FDA says that they should not be the first approach to Biphosphonates. These medications, often prescribed for people tak- preventing osteoporosis.17 ing glucocorticoids, include familiar brand names such as Actonel, Boniva, Interestingly, adolescent girls with amenorrhea due to anorexia nervosa Fosamax and Reclast. Results vary, but these generally reduce the inci- or the female athlete triad (see sidebar on page 29) are often prescribed dence of fracture by about 50% over a three-year period. Side effects in- oral contraceptives to improve BMD; however there is no research to sup- clude difficulty swallowing, gastric ulcers and visual disturbances.17 port this. Additionally, this treatment may start a menstrual cycle in fe- Calcitonin is FDA-approved for the treatment of osteoporosis in women males with anorexia, which can be incorrectly interpreted as a sign that who are at least five years postmenopausal. It is administered daily as a they have achieved a healthy body weight.1 nasal spray, with side effects including rhinitis and nosebleeds. Parathyroid hormone, or teriparatide, is used for treating osteoporosis Estrogen agonist/antagonists. Evista (raloxifene) is FDA-approved for in men and women with high fracture risk, as well as men with primary the prevention and treatment of osteoporosis in postmenopausal women. It osteoporosis. This is an anabolic (bone-building) treatment and should not reduces vertebral fractures by 30% in people who have had a fracture, and be used for more than two years. After 18 months of therapy, patients with by 55% in people who have not had a fracture over three years. Raloxifene osteoporosis experienced a 65% decrease in the risk of vertebral fractures also reduces the risk of invasive breast cancer, but it can increase hot and a 53% decrease in non-vertebral fractures.17 flashes and raise the risk of deep vein thrombosis.17

Client 1 is a 15-year-old female who to ask each of them to secure permission tion for two of the recommendations: 1) was recently immobilized for an ankle from their physician and other members “In women age 65 and older and men sprain. She is on the high school cross- of their healthcare team before you be- age 70 and older, recommend bone min- country team and the swim team. Re- gin working with them. As an astute fit- eral density (BMD) testing” and 2) “In cently diagnosed with type 1 diabetes, ness professional, you realize your role postmenopausal women and men age she is managing well. can have a positive impact in both their 50 to 69, recommend BMD testing when Client 2 is a 56-year-old female who fitness and bone health. The following you have concern based on their risk had gastric bypass surgery and is now sections will relate back to these client factor profile.” well enough to start exercising to main- examples and highlight what they may Clients 2 and 3 are thankful for your tain her new weight loss. We’ll assume experience with their doctors, as well as advice and see their doctors. When they 17 she is postmenopausal, and she led a very ways in which you can help them. return with their BMD results, Client 2 sedentary lifestyle prior to her surgery. Understanding the reports she has osteopenia (early-stage Client 3 is a 70-year-old male who Screening Process osteoporosis) and Client 3 has osteopo- is a former competitive cyclist but now First it is important to understand rosis. Client 3 has been prescribed medi- has a diagnosis of atrial fibrillation (AF). what is advised in regard to screening. cation to help improve his bone density. (Hint: People with AF usually take a We’ll look to the NOF for these recom- To learn what he might be taking, read blood thinner, maybe heparin.) He still mendations.17 Remember, Client 2 is “Bone-Building Medications” above. cycles but lately he has noticed that he’s at risk because of her prior sedentary Client 1 is a very different matter. getting weaker and loses his balance lifestyle and her gastric bypass sur- The first line of treatment for adoles- when he’s working in the garden. gery. Client 3 is at risk because of his cents focuses on nutrition, not medica- All of these clients appear healthy, en- age, his background in cycling and his tion. What’s more, your concern for her ergetic and ready for a workout. In rec- decreased balance. will be in helping her achieve peak bone ognizing that these people are at risk for Clients 2 and 3 should have a DXA mass, which is especially important since osteoporosis or osteopenia, you will want scan for BMD, since they fit the descrip- she is at increased risk for osteoporosis.

30 AMERICAN FITNESS / FALL 2016 Designing a Program examples for the lumbar spine include Putting It All Together for Clients with Osteoporosis planks and spinal extension exercises. Let’s get back to our clients. As you The literature has shown that the most recall, Client 1 is a teenage girl, recent- effective exercise for improving BMD ly immobilized by an ankle sprain. Her in adults is a combination of resistance spine extension sports are cross-country and swimming. training and impact or agility training.12 Your role as her personal trainer must in- The question is: What is safe? clude helping her to achieve peak bone Special considerations for clients mass. You are concerned because her with osteoporosis. A team of fitness and cross-country sport, gender, recent im- healthcare providers should develop a mobilization and diagnosis of type 1 progressive exercise program for those Examples for the hip are multidirectional diabetes are all risk factors for having low diagnosed with osteoporosis due to the lunges, double- or single-leg dead lifts, or BMD in the future. 26,29 following: leg press. Nutritional discussions must include • People with osteoporosis have height- calcium, vitamin D and protein intake. ened fear and anxiety of falling. Exercise design for this athlete should • People with severe osteoporosis are involve cross-training that incorporates at a higher risk of fracture in the high-impact and odd-impact activities, wrists, spine, hips, thighs and ankles such as dancing and skipping. Since she if performing more vigorous impact- dead lift is a runner, functional training exercises oriented exercises. that target the hip and core—such as re- • Neuromuscular function, such as bal- sisted or weighted chops in a split stance ance, should be assessed prior position—will be both beneficial and to exercise. meaningful to her. • Assessing mobility-related fitness parameters (strength and flexibility of the upper and lower body, aerobic endurance, agility and balance) in older adults is recommended. Aerobic exercise. Walking can have a positive effect on BMD at the femur, Exercises to avoid. For all degrees but not the spine. High-impact aerobics of osteoporosis, research recommends have the greatest effect on both femur and avoidance of jumping activities and all spine BMD. exercises that involve deep forward trunk Resistance training. It is important flexion or spinal flexion (e.g., full situps, Chop to strengthen the back extensor muscles rowing, toe touches). Biomechanically for both improved spine BMD and re- speaking, spinal flexion exercises and duced fall risk. flexion-based functional movements increase the risk of fracture in the vertebral bird dog on ball 2 body. Along those lines, if your client cannot properly hip-hinge during a squat and shows increased spinal versus hip flexion, they should not be doing a squat until they can maintain a neutral spinal posi- Client 2 wishes to reverse the effects of tion. With any exercise prescription, your her sedentary lifestyle, which has resulted client needs to be safe from a stability in osteopenia. Since she has had gastric standpoint, as most hip fractures happen bypass surgery, you educate her regard- as a result of a fall. ing DRI values for calcium, vitamin D and Site-specific exercises. If your cli- One study describes that postmenopausal protein, and you encourage her to speak ent has had a DXA scan and can tell you women will maintain or improve hip BMD to her GI specialist, since her absorption that his bone density is decreased in a if they participate in resistance training at of these nutrients may be altered. As you specific site (usually the hip or lumbar 70 to 90% of 1RM, three to four sets of 8 evaluate her posture, you notice her head spine), you may design exercises to stimu- to 12 repetitions, two to three times per and shoulders are forward, and she has late site-specific bone formation. Some week over the course of 1 year.20 difficulty balancing on one foot.

FALL 2016 / AMERICAN FITNESS 31 I f your client has decreased bone density in the lumbar spine, design exercises to stimulate site-specific b one formation there. Examples include planks and spinal extension exercises.

32 You start by retraining his squat me- Your exercise design will include back extensor chanics and work on flexibility so he can and scapular exercises to improve her posture, and maintain his posture. After a few weeks hip strengthening exercises with a balance component of this, he tells you that his balance when to them. gardening is steadily improving. You’re able to progress his program by adding planks, single-leg dead lifts and multidirectional lunges, first without resistance and in a few weeks adding a resistance component to ensure increased BMD. Conclusion Developing our bones is a lifelong venture, but the most important building comes at a time in our lives when Squat With Row we tend not to think much about it. As fitness professionals we are in a position to give our clients a remarkable gift— bone health for life. So whether you’re After six weeks of working together, her posture and balance have working with a high school athlete, a improved so much you feel her exercise program can reach its full professional elite, or someone’s dear potential by adding in impact activities such as rapid stair stepping grandmother, consider the needs of their and jump rope. bones. By helping them understand the consequences of their dietary and activity choices, you will impact their strength for life. AF

Audra Eisz, PT, DPT, OCS, ATC, received her BA in kinesiology, emphasis in athletic training from Chapman University, and her doctorate in Rapid Stair Step physical therapy from the University of South- ern California. She is Board Certified as an Orthopedic Clinical Specialist in Physical Therapy, and practices in San Diego. She also joins an aerobics class at your encouragement Laura Gladwin, for more odd-impact activity. MS,, CPT CGF, Client 3 is an accomplished MAFP, received her athlete, but he is a bit depressed BS in physical educa- with his diagnosis of osteopo- tion from Michigan rosis. Luckily, you know that Lunge State University, and high-intensity resistance train- her master’s in physi- ing, balance and proprioceptive cal education, emphasis in exercise physiology exercises, as well as impact ac- and sports medicine, from California State tivities are safe for him as long University, Fullerton. She has over 35 years of as his spine is in neutral and he experience in the fitness industry as an educa- is safe from falling. tor, author and master trainer.

FALL 2016 / AMERICAN FITNESS 33 Developing our bones is a lifelong venture, but the most important building comes at a time in our lives when we tend not to think much about it.

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WITZKE, K.A. “OSTEOPOROSIS AND OSTEOPENIA.” 5. COMMITTEE ON NUTRITION AND THE COUNSEL THROUGHOUT LIFE.” BMC MEDICINE, 8, NO.47 IN ACE ADVANCED HEALTH & FITNESS SPECIALIST ON SPORTS MEDICINE AND FITNESS. “CLINICAL RE- (JUL 2001). (EPUB). WWW.BIOMEDCENTRAL.COM/ MANUAL (C.B. BRYANT & D.J. GREEN, EDS.). SAN PORT—SPORTS DRINKS AND ENERGY DRINKS FOR ARTICLES/10.11861/1741-7015-8-47 (ACCESSED DIEGO: AMERICAN COUNCIL ON EXERCISE, 2008. CHILDREN AND ADOLESCENTS: ARE THEY APPROPRI- MAY 13, 2016). 27. FUCHS, R.K. AND SNOW, C.M. “GAINS IN HIP BONE ATE?” PEDIATRICS, 127, NO. 6 (MAY 2011) (EPUB). 16. MARTYN-ST JAMES, M. AND CARROLL, S. “A META- MASS FROM HIGH-IMPACT TRAINING ARE MAIN- DOI: 10.1542/PEDS.2011-0965. ANALYSIS OF IMPACT EXERCISE ON POSTMENO- TAINED: A RANDOMIZED CONTROLLED TRIAL.” 6. VARTANIAN, L.R., SCHWARTZ, M.B. AND BROWNELL, PAUSAL BONE LOSS: THE CASE FOR MIXED LOADING JOURNAL OF PEDIATRICS, 141, NO. 3 (SEP 2002): K.D. “EFFECTS OF SOFT DRINK CONSUMPTION ON EXERCISE PROGRAMMES” [DATABASE OF ABSTRACTS 357-62. NUTRITION AND HEALTH: A SYSTEMATIC REVIEW OF REVIEWS OF EFFECTS (DARE): QUALITY ASSESSED 28. FAIGENBAUM, A.D., ET AL. “YOUTH RESISTANCE AND META-ANALYSIS.” AMERICAN JOURNAL OF REVIEWS]. BRITISH JOURNAL OF SPORTS MEDICINE, TRAINING: UPDATED POSITION STATEMENT PAPER PUBLIC HEALTH, 97, NO. 4 (APR 2007): 667-75. 43, NO. 12 (DEC 2009): 898-908. DOI: 10.1136/ FROM THE NATIONAL STRENGTH AND CONDITION- 7. TENFORDE, A.S. AND FREDERICSON, M. “INFLUENCE BJSM.2008.0527. ING ASSOCIATION.” JOURNAL OF STRENGTH AND OF SPORTS PARTICIPATION ON BONE HEALTH IN THE 17. NATIONAL OSTEOPOROSIS FOUNDATION. “CLINI- CONDITIONING RESEARCH, 23, NO. 5 (SUPPL) YOUNG ATHLETE: A REVIEW OF THE LITERATURE” CIAN’S GUIDE TO PREVENTION AND TREATMENT OF (AUG 2009): 60-79. [ABSTRACT]. 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34 AMERICAN FITNESS / FALL 2016 Osteoporosis: CEU Quiz

1. Peak bone mass is 6. The female athlete triad falls into the 11. For bone health, the literature generally achieved: ______osteoporosis category. seems to support that exercise may a. in the fourth decade of life. a. primary have ______results. b. at puberty. b. secondary a. site-specific c. from puberty to the mid-20s. c. lower b. minimal d. in adulthood. d. upper c. inferior d. low-adverse 2. Optimal bone density can be 7. Over a three-year period, achieved through the consumption of: ______generally decrease(s) 12. A guideline recommendation for a. a low-carb diet, vitamin E and zinc. the incidence of fracture by 50%. children is to emphasize activities b. minerals such as boron a. bisphosphonates that develop ______and and magnesium. b. hormone therapy ______. c. large amounts of green c. glucocorticoids a. muscle endurance; agility. leafy vegetables. d. calcitonin b. stabilization; balance. d. calcium, vitamin D and protein. c. muscle strength; power. 8. Bone strength refers to the d. flexibility; speed. 3. Bone geometry and BMD are ______of the bone, and two important factors for strong, how it may absorb and withstand vari- 13. Generally, training loads must be healthy bones. ous forces. ______what is experienced a. True a. curve during everyday activities to see results. b. False b. density a. equal to c. dimensions b. greater than 4. A very dense bone without good d. geometry c. less than geometry will not be able to: d. varied to a. produce red blood cells. 9. Children who participate in b. support bodily organs. sports such as ______and 14. For postmenopausal women and c. bend and absorb forces. ______demonstrate older men, it is important to incorporate d. attach ligaments and tendons. higher BMD. exercises that focus on fall prevention. a. swimming; baseball a. True 5. There is a high likelihood b. gymnastics; soccer b. False that adults who perform both c. hiking; golf ______and d. rowing; surfing 15. A client diagnosed with osteoporosis ______exercise(s), should avoid exercises that involve: can maintain and possibly 10. Men aged 19–70 and women a. core stabilization. improve BMD. 19–50 should consume 1,500 mg of b. using elastic tubing. a. high-impact; lap swimming calcium and 800 IU of vitamin D per day c. deep forward trunk flexion. b. impact; resistance training to maintain bone health. d. circuit training techniques. c. tai chi; yoga a. True d. flexibility; core stabilization b. False

To earn 2 AFAA/0.2 NASM CEUs, purchase the CEU quiz ($35) and successfully complete it online at www.afaa.com.

FALL 2016 / AMERICAN FITNESS 35 Tap Into Inner Greatness

By Lucia Viti Photos by Nick Onken

36 The Ohio native became a two-sport online marketers. Interviewees include all-American planning a future in pro- sports, business and science aficiona- fessional football…until a wrist injury dos. “Greats who reached the pinnacle decimated his career. Broke and broken, of success by choosing to do so,” he adds. the 24-year-old crashed on his sister’s putting it on paper sofa and sank into a deep depression. Howes quickly capitalized on his Without a formal education, Howes re- podcast to fulfill his dream of writing mained uncertain about his future. a book that would inspire millions and “Everything about my identity was become a New York Times bestseller. tied to football,” he states. “I had little “I was determined to give people the to support my need to survive, let alone tools that my mentors gave me to learn thrive. I lacked the skills, tools, knowl- how to embrace greatness in their ev- edge and expertise to land a job. I lacked eryday lives,” Howes says. “The School a college degree. The economy was in de- of Greatness: A Real-World Guide cline. The timing was tough.” to Living Bigger, Loving Deeper, and Howes didn’t take long to change the Leaving a Legacy was written based trajectory of his future. “I began obsess- on the success of my podcast. People ing about business, marketing and posi- were hungry for powerful, meaningful ewis Howes is a tively influencing others. I reached out to and purposeful.” one-man empire. Cultivated from the mentors who inspired me. I asked them Within a year, his dream come true to coach me. I knew I had to aggressively ground up, the lifestyle entrepreneur, catapulted his podcast into the strato- L change my mindset to develop the nec- sphere. Howes had successfully trans- author, keynote speaker, high-perfor- essary skills to become an entrepreneur.” lated his concept of hustling greatness mance coach, webinar presenter and into a thriving business that helped podcast host crafted a multimillion- Going for It others. “I will do whatever I can to For the next two years Howes hustled dollar online media company by fusing serve people and show them how much “left and right, 12 to 14 hours a day” intellect, tenacity, fortitude, courage and I care.” leaving no stone unturned and no pros- perseverance. Recognized by the White According to Howes, there are a pect untapped. He rehabbed his injury House as one of the top 100 American million ways to be great for those deter- by working out and taking salsa dance entrepreneurs under 30, Howes is con- mined to utilize their gifts and talents classes. Howes didn’t just learn the nu- stant in his pursuit of excellence. Now in achieving their dreams. “Greatness ances of venues such as LinkedIn, he touting his New York Times bestseller, doesn’t come to you, you go to it,” he The School of Greatness: A Real-World became an expert at building a foun- paraphrases from his bestseller. “Great- dation of relationships from it. When Guide to Living Bigger, Loving Deeper, ness moves. You slow down, it moves interning—for free—at an invention and Leaving a Legacy, the online mo- farther away. You stop, and it disap- company, he attended master classes in pears over the horizon.” gul towers among the entrepreneurial business administration. He formulized The School of Greatness encourages giants of today. But that wasn’t always self-promoting webinars, making his everyone on their journey of discov- the case. first “real money” while teaching others how to maximize LinkedIn as an essen- ery, regardless of their present track. chasing a dream “These concepts of mindfulness, joy Howes forged through a turbulent tial resource. The budding entrepreneur childhood—bullied and sidelined as an burst onto the online marketing scene as outcast—by excelling in athletics, in both a lifestyle and business coach, while establishing his name—and ultimately his football and the decathlon. Grit and guts brand—through social media. “I took made up for what the self-described “tall, what worked for me and ran with it. “Greatness skinny, goofy-looking kid” lacked in “I worked for seven years before doesn’t talent. “I wasn’t the fastest, strongest or launching the podcast The School of the most talented athlete,” he says, “but Greatness in 2013”, he says of his suc- come I knew the coaches loved the guys who cessful forum that showcases inspiring hustled. So I hustled; not just to make stories from “some of the most brilliant to you. the team but to start, be great and [be] business minds, world-class athletes and accepted by my peers. I worked to be influential celebrities on the planet.” You go better prepared than anyone else while Howes attributes his expansive pod- to it.” taking advantage of every opportunity cast audience to his ability to connect that came my way.” with people from all walks of life, not just

FALL 2016 / AMERICAN FITNESS 37 and love harness dreams by lifting us from the depths of despair,” continues the social media kingpin. “The School of Greatness is not a bag of tricks or hacks. This isn’t boot camp. The School of Greatness is a way of life, a way of living.” Living Your Dream Those who flourish do so because of their ability to conquer adversity and seize opportunity, notes Howes. “Greatness is the survival of your vision based on your willingness to face adversity while adopting a mindset to seize opportunity,” he reveals. “I took a strategic approach in learning how to leverage my talents to create results. The School of Greatness creates a package for everyone to put the work into their lives and do what they’re meant to do.” His advice for readers of American Fitness: Identify and build on your strengths. “Our best asset is the perception that others have of us,” he points out. “Brand yourself, build an audience, network and give yourself options. Don’t limit yourself to just what’s offered to you; create an opportunity. Be proactive. Build relationships, educate and differentiate yourself.” Do something you love. “People need to get clear on what they want to do and how to make that happen,” he concludes. “Many live a lie—frustrated, struggling, unhappy and unful- filled—by not following their dreams. To achieve the building blocks of greatness, we must strive to do what we love. Success is doing what you love to do. I’m driven to do something great with my life—to be a symbol of inspiration for those who believe they’re champions.” Continue to dream big. “If we lose the ability to dream, we lose the ability to fully live and ex- press ourselves. I dream constantly,” says Howes. “Dream as big as you can, and be on the path toward that dream.” AF

Lu cia Viti is an AFAA certified, 34-year fitness veteran and freelance journalist. Ms. Viti presently teaches at the Bay Club Carmel Valley located in San Diego.

Melding Acrobatics and Dance With Flair

By Cherryh Cansler, MA

If the silk hammocks suspended from the ceiling during AntiGravity® AIRbarre Fitness classes remind you of huge cocoons, then the people twisted up in them may seem like caterpillars emerging as butterflies—if those butterflies were lean, muscular and dedicated to fitness. Participants raise their own body weight into the air to perform flips, lifts and a variety of yoga and dance moves to tone and strengthen their bodies. 40 i AIRBarre’s Roots technique encompasses more than 1,000 moves, it is best for people who Although professional dancer are active. Classes range from 60 to 90 minutes and promote the flow of Christopher Harrison first established endorphins, leaving participants feeling joyful, empowered and uplifted. AntiGravity in 1991 as the Antigrav- “To do all of the exercises, it is easiest for someone who maintains a ity Theater & National Aerial Perfor- consistent fitness regimen and has a strong core,” he points out. “During mance Training Center (in Orlando, the course of the practice, participants conquer basic fears and discover Fla.), the practice is no longer only a new level of self-confidence while benefiting from a solid workout.” for professionals, says Harrison, who Teaching AIRbarre Fitness was “discovered” when he was in high There are five levels of AntiGravity Fitness Instructors, but the most school by Oscar nominee Herbert common is Level One, a four-day training course called AntiGravity Ross. The famous director/producer Fundamentals 1 & 2. Once a trainer passes those, he or she may teach cast him in Footloose as the first per- in a private (noncommercial) space or in an AntiGravity Fitness autho- son you see dancing in the film, and rized and licensed facility. he went on to star in lead roles on The higher level trainings are held primarily at the company’s Broadway, including A Chorus Line, AG Advanced Training Institutes in New York City and in Chiang West Side Story and Cats. Mai, Thailand. AntiGravity was the first con- Although there are no “strict requirements” to become an AG Fitness temporary American acrobatic performance company that seamlessly Instructor, Harrison has five recommendations. integrated acrobatics and dance me- 1. Teaching Experience diums, according to Harrison, who Familiarity with teaching in a group environment is very helpful. It invented a silk hammock in order to doesn’t matter what the discipline is as long as one knows how to take incorporate aerial arts performances. charge of a room and maintain order. Although it is very helpful, During his second year of creative teaching experience does not always need to be related to physicality. exploration using his invention, Har- 2. Positive Outlook rison discovered that if he hung the The philosophy of AG Fitness is based on having fun while getting hammock at the same height as a fit. “Everyone needs to leave class feeling successful and empowered. ballet barre, he could perform his If instructors take themselves too seriously—a typical trap for boot ballet and yoga exercises. “I always camp-style trainers, balletmaster-style dance instructors, etc.—they knew I would expand the technique are not right for this technique. Enthusiasm is key to being an AG to encompass my roots. AntiGravity Fitness Instructor,” he advises. “This is not a typical workout; it is AIRbarre is that expression, which I playful conditioning for body/mind/spirit.” am grateful to share,” says Harrison. 3. Training Background AntiGravity Managing Director Alex Although not required, some experience in preferably two of the Schlempp, a former principal bal- following disciplines helps ensure success: aerial arts, dance, fitness let dancer from the Juilliard School, training, gymnastics, martial arts, skating, yoga or other artistic was also instrumental in developing sports. Qualifications in fitness training, physical therapy, Pilates and the AIRbarre fitness routine, which is yoga are also helpful. now taught at CRUNCH gyms in the 4. Knowledge of Anatomy U.S. as well as other locations you can “Basic understanding of anatomy, kinesiology and body find at antigravityfitness.com. mechanics is very supportive to your learning and teaching “Because of [Schlempp’s] virtuoso jumps and turns, as a choreogra- approach,” says Harrison. pher I would feature him within the 5. Physical Fitness performance company long before AG Fitness requires instructors who maintain a consistent fitness he moved into management. His ex- regimen and have a strong core. “It does not require that one is pertise has been invaluable in the without body fat,” says Harrison. “Rather it requires that they are creation of AIRbarre,” says Harrison. strong enough to lift their own body weight in different planes He also credits Lorainne Major, “a of motion.” AF beautiful ballerina, with brilliantly creating the sequencing within the Cherryh Cansler, MA, is a certified per- class designs.” sonal trainer and group fitness instructor in Kansas City, Mo. She has a master’s degree in journalism and contributes Who’s Up For Some Air? to magazines, newspapers and websites all over the country. Harrison says anyone can do AntiGravity Fitness, but since the

FALL 2016 / AMERICAN FITNESS 41 Balancing Your Personal Life with Your Professional Life Planning. Organization. Strategy.

By Janice Jaicks

There we were, driving down the freeway to visit a ment Guidance from One Busy Mom to Another,” new potential venue for our fitness event. I’m disin which shares how she keeps her sanity and stays cussing the room layout for workshops, and my connected to her husband and 7-year-old daughter. coordinator is pumping. No, not iron…milk! Work. Same with Brett Klika, who has a 3-year-old daugh- TLife. Balance. Figuring out how to fit it all in and do ter and a wife he makes top priority, in addition to it well. A common topic among friends, family and being a strong force in the industry and always on coworkers—finding a true balance between your the go. He says, personal life and your professional life can really Sometimes I find it’s necessary to evaluate time, be a stressful, challenging issue. It is clearly on the because time is what provides the opportunity minds of many leaders in the fitness and health in- for energy. I often have to audit how I’m spend- dustries, as more and more books, videos and working my time and decide if everything I am doing shops try to tackle the question of what makes up a during that time is necessary for my overall mis- well-rounded lifestyle. sion. This may mean turning down some opportunities, it may mean cutting out or “outsourc- Tips From the Pros ing” things that are taking away my ability to Successful national and international speakers apply energy to the things that are important to make a point of trying to create balance in their me. However, if I cut out something it’s so I can lives and happily share what they’ve learned with apply more energy, not just time, to something the rest of us. For example, Shannon Fable, a pow- more connected to my mission. erful businessperson who speaks around the world, has created a group fitness management software For Cody Sipe, PhD, co-founder of the Func- company, consults for several well-known brands tional Aging Institute, this re-evaluation of pri- on education and operation, and writes numerous orities recently led him to alert business associ- articles. Among them are blogs like “Time Manage- ates that he would not be checking email for a bit

42 because he was traveling with his son’s soccer team. And while he managed to 5. Remind yourself why you’re do- reply to important business-related texts, you can bet that he didn’t slack with ing what you’re doing. Options for that soccer team either! “A strong spiritual foundation and making my fam- this might include making a vi- ily the top priority are the keys to my success. It keeps me focused and makes sion board, writing inspirational saying no to the nonessentials easy,” explains Sipe, who has seven children notes to yourself, or committing to with his wife Jenny. His business partner Dan Ritchie, PhD, (husband and fa- daily journaling. ther of five) is the first to say, “Don’t plan anything during Father’s Day. My wife 6. Take time for yourself. Period. AF would shoot me!” Mindy Mylrea, creator of Tabata Bootcamp, is another one who’s got balance in the bag. She has always maintained a powerful bond with Janice Jaicks has her three boys, in spite of frequent travel, and she is launching a new workout been an aquatic fitness program, while also standing by her husband Bruce through his cancer fight. professional for more than 25 years. She founded It ’s More Than Business FitnessFest in 1997 and If you’re aiming for success in the world of fitness, health and wellness, it’s has hosted over 30 con- time to start taking notes on the examples being set by these types of individuals. ferences in the South- Pay attention to the ones who “have it all,” and realize it’s because they’ve figured west, including Phoenix’s largest continuing out how to have it all. Planning. Organization. Strategy. Not to mention a good education conference for fitness professionals. night’s rest. These leaders don’t lead without sleep, because they need the energy Janice has trained hundreds of new and vet- to be the best for their families and the best for their businesses. eran aqua instructors all over the country. She What else is essential if you have a family is their support—that of your spouse is a continuing education provider for ACE, or partner is particularly crucial when it comes to busy careers. It’s important to AFAA, NASM and AEA, and is the former fitness coordinator for Fitness Forum Health Club discuss the things that bother your spouse. These can include working weekends, in Chandler, Ariz. Janice has gained valuable traveling, and attending social functions in which your spouse is not included. experience as a national presenter with IDEA, Communication is your foundation. Often, women struggle more than men with SCW, IAFC and her own FitnessFest and the balancing act. Though we say, “We’ve come a long way, baby,” the reality of AquaCon conferences. it is an independent, successful woman needs a partner who can handle that… which isn’t always the case and which can lead to serious complications with work and at home. If there are challenges and struggles between you and your partner, it is almost impossible to give 100% to your professional life. What’s best for my business is flexibility. The team in our FitnessFest administration office is comprised of a six-woman team that includes a nursing mom of a 9-month-old and a mom of a 1½-year-old. Anyone who has parented knows how challenging it is, and juggling the work week on top of it all is no small ac- complishment. We tend to be more flexible in our office than a more corporate environment might allow, and although we try to be consistent, it’s not the end of the world if we have to alter our Monday morning meetings to accommodate a “situation.” So how can you be more balanced? 1. Plan everything as far out as you can. Know when graduation is next June so you don’t plan a workshop that weekend. Know when special recitals are scheduled. Know your work calendar into the next year (if not farther). 2. Keep a calendar. Maybe you prefer paper, maybe you prefer electronic, but post your calendar somewhere visible for quick access before you commit to something else. It’s all about how you will remember. 3. When you are with your kids, your clients, your spouse, be fully present. Don’t answer the phone, reply to texts, or let your mind wander into the next hour. 4. Maintain the support of your spouse/partner and your family by commu- nicating your goals, your plans to reach those goals, and your schedule. Talk to them about what their goals and plans are, too, and find out what they need from you in order to accomplish them.

FALL 2016 / AMERICAN FITNESS 43 what’s on your wish list? It’s never too early to start your holiday wish list— or invest in some innovative new gear. Check out The Purpose: Recovery these mindful ways to treat yourself, your clients Our Pick: The HyperIce HYPERSPHERE and fit-minded friends and family members.

By Lucia Viti The HyperIce HYPERSPHERE is a soft, travel-size, vibrating massage ball that allows you to target deep The Purpose: Release muscle tissue in difficult-to-reach Our Pick: GRID® STK Foam Roller areas, such as between the shoulder blades or in the hips. It’s a useful tool This innovative handheld foam roller from in recovery sessions to ease muscle TriggerPoint is wrapped in a GRID three-dimensional tension and soreness, expedite surface designed to mobilize tissue and aid in recov- recovery and increase flexibility, but ery, and its AcuGRIP handles are structured to roll, it’s perfect for warm-ups too. The release and relieve. Lightweight and water-resistant, sphere’s speed, frequency and inten- the GRID STK Foam Roller increases circulation sity are all adjustable, and it runs on a and provides acupressure relief. Find out more at rechargeable battery. For details, visit tptherapy.com. ElivateFitness.com.

The Purpose: Relaxation Our Pick: Pranamat ECO

Ready to recharge, sleep better or enhance your yoga sessions? The Pranamat ECO therapeutic massage mat is dotted with plastic lotus flowers whose points stimulate the body’s autonomic nervous system. Its “bed of nails” effect reduces inflammation, muscle soreness and pain, so it’s ideal for recovery after intense exercise. It’s also recommended for practicing asanas to reduce headache, back pain or stress. Each mat is made from all-natural materials, so you can rest easy knowing it’s eco-friendly too. Available at pranamat.com.

44 The Purpose: Comfort Our Pick: Tasc Performance Apparel

In 2006, tasc Performance began using fast-growing, sus- tainably sourced ‘Moso’ timber bamboo to create fabrics for its line of performance apparel. Its unique fabric-finishing process results in a lightweight, silky-soft fabric that wicks moisture and offers a UPF (Ultraviolet Protec- tion Factor) of 50+. Choose from a myriad of colorful, chic, comfortable styles of tasc Performance apparel on tascperformance.com.

The Purpose: Hydration Our Pick: Hydro Flask®

Now is the perfect time to upgrade your water bottle. Hydro Flask is committed to “saving the world from luke- warm.” Its double wall, vacuum-insulated TempShield technology keeps water cold (or tea hot), while preventing the transfer of condensation (or heat) to the outside layer. Inside, a pro-grade stainless steel lining repels flavors, so today’s latte won’t taste like yesterday’s sports drink. Check out the complete product line—available in numerous colors, styles, and sizes—at hydroflask.com.

The Purpose: Resistance Our Pick: The Beast® Battle Rope

Stroops® promises to “bring out the beast in you” (or your clients) with this 20-foot heavy rope. Made with Slastix technology (a fabric sleeve encasing elastic tubing), The Beast Battle Rope “fights back,” engaging the core and forcing the user to work in three planes of motion. Use it in traditional rope drills, as well as in resistance training exercises such as the chest press and standing row. Or hook it to a belt during sprints, broad jumps, lunges and rotational movements. Available for all fitness levels in resistance strengths from 47 to 150 pounds at stroops.com.

FALL 2016 / AMERICAN FITNESS 45 EXERCISE UPDATE

physical activity has far reaching value for cancer prevention. RUNNING from AWAY cancer

Here’s another reason to feel great about your career: Researchers from the Ameri- can Cancer Society and the National Can- cer Institute (part of the National Institutes of Health) say that increasing physical activity can lower the risk of 13 types of cancer. In a new study, these researchers looked at data on 1.44 million adults. “For years, we’ve had substantial evidence supporting a role for physical activity in three leading cancers: colon, breast, and endometrial cancers, which together account for nearly 1 in 4 cancers in the United States,” said Alpa V. Patel, PhD, one of the study’s co-authors from the American Cancer Society. “This study A new venue for linking physical activity to 10 additional cancers shows…that physical activity has street workouts far reaching value for cancer prevention.” The study’s lead author, Steven C. Street workouts are nothing new. tics, martial arts, parkour, pole fitness Moore, PhD, says that these results can The Spartans in ancient Greece per- and yoga. Also notable is the “non- formed outdoor calisthenics to build commitment” policy; clients purchase be generalized to include a diverse group strength and speed. What is new? all-access punch cards rather than of people, including those who are obese This discipline’s recent resurgence in a membership. popularity around the world. By limiting group training to or have a history of smoking. The median One facility with a unique ap- eight participants, Street Workout level of activity in the study was about 150 proach is Street Workout Academy Academy strives to foster team- minutes of moderate- to vigorous-intensity in Santa Monica, Calif. In addition to work, high intensity, and motiva- offering outdoor classes focused on tion for clients at every fitness level. activities per week. calisthenics and functional training, The studio also hosts workshops, this company also brings street work- private sessions and healthy life- SOURCE: outs into a studio setting. Its program style workshops. Learn more at “Increased Physical Activity Associated with Lower Risk features a mix of acrobatics, break streetworkoutacademy.com. of 13 Types of Cancer | National Institutes of Health (NIH).” U.S National Library of Medicine. U.S. National dance, calisthenics, freestyle gymnas- Library of Medicine, n.d. Web. 21 July 2016.

46 AMERICAN FITNESS / FALL 2016 H eartwarming News for Elite Athletes RUNNING R esearch shows that endurance compared the hearts of 33 elite athletes who had been doing long-term intensive exercise for a prolonged time does, to the hearts of men with a similar profile elite-level endurance exercise,” says Philipp in fact, result in structural changes (age, weight and size) but no participation Bohm, MD, co-author of the study. to the heart—in particular the in endurance exercise. The group of athletes enlargement of the right ventricle. included former Olympians, as well as SOURCE: AWAY The general consensus has been previous Ironman participants and “Is Endurance Training Bad for You?” EurekAlert! champions, all of whom have been N.p., n.d. Web. 21 July 2016. that these changes are a healthy training at an elite level for about 30 years adaptation of the heart muscle, but and still continue to train for an average of only recently did a study finally put to about 17 hours a week. The Saarland rest the concerns about possible long- investigators were able to confirm that the term effects. hearts of these athletes were, as expected, significantly larger and stronger than The potential heart hazards of endurance those of members of the control group. exercise have been deliberated by the medi- “But we found no evidence of lasting cal community for over a century—and by damage, pathological enlargement or the media whenever an elite athlete dies of a functional impairment of either the sudden cardiac event. This study, by a team right or left ventricle in the athletes of cardiologists and sports medicine physi- cians from Saarland University in Germany,

Hitting a plateau in strength training? The solution might lie in accentuated eccentric loading (AEL). This method is based on the principle of repetitive muscle contractions applying a greater external load during the muscle’s lengthening (the eccentric phase of the lift) than in the shortening (the concentric phase).

To determine the effects of AEL, “This is no magic pill that will scientists separated 28 strength suddenly create huge differences training experienced males over systematic hard work, smart into three groups. Two were periodization and nutrition,” exposed to supervision, motiva- notes the study’s lead author, tion, greater loading intensities, Simon Walker, PhD, from the immediate post-training protein Department of Biology of consumption and assistance at Physical Activity at University of concentric failure. One of these Jyväskylä, Finland. “But [AEL] beat youR groups used AEL and the other can give a boost or kick-start to used isoinertial training, in which overcoming a plateau in strength the same weight is used in both and muscle mass development.” the eccentric and concentric plateau phase. The third group continued SOURCE: their normal routine. After five “Overcome Strength-training Plateau with weeks, the AEL group displayed with Accentuated Eccentric Loading.” EurekAlert! N.p., n.d. Web. 21 July 2016. a remarkable increase of force production, work capacity, muscle activation and resistance. ael 47 EXERCISE Work It Out

upper crossed syndrome

1 2 Identifying and Step 1 Applying Movement Inhibit/Self-Myofascial Release Overactive Strategies for Muscles

Improved Posture Upper Trapezius, Levator Scapulae, SCM By Kenneth Miller, MS

If you’re like the millions of people who use electronic tools such as a cell phone, tablet, laptop Hold pressure on tender or desk computer, you’ve probably spent hours spots for 30 seconds. upon hours looking at the screen with your head jutted forward. Other situations that might have you holding your head forward of your shoulders Iinclude reading books, significant time behind the steering wheel or watching TV. Whatever the cause, the migration of your head to this forward position can ultimately lead to overactive muscles and a complementing set of underactive muscles. Step 2 1 2 This postural distortion pattern, known as upper lengthen/ crossed syndrome (UCS), can result in imbal- static Stretch ances of muscle tone or timing, often leading to poor movement patterns, and in this tech heavy Upper Trapezius society, increased stress on the head, neck and Tuck chin and slowly shoulder joints. draw left ear to Poor posture at any level may lead to muscle left shoulder. imbalances. This can have a trickle-down effect into the rest of the body, not just in the local areas Levator Scapulae of the neck and shoulders. An associated sequence Continue by rotating chin of muscle imbalances in the hip region, referred downward until a slight to as lower crossed syndrome, can oftentimes be stretch is felt on the observed in conjunction with upper crossed syn- right side. drome. When looking for long-term success in relieving UCS, identifying and addressing pos- SCM tural issues that could exist elsewhere in the body Same as above, except rotate chin upward. will also be needed. This total-body approach will Perform the sequence on both sides, holding each relieve tensions through the entire kinetic chain, stretch position for 20–30 seconds. while also enhancing desired results.

48 Crossed and Countercrossed the underactive muscles, with the deep cer- order to address postural or movement im- The “crossed” in upper crossed syn- vical flexors down toward the mid/lower balances, the less-than-ideal posture has to drome refers to the crossing pattern of the trapezius, rhomboids and serratus anterior. be identified and a corrective exercise strat- overactive muscles with the countercross- As we continually assume the seated, for- egy developed. This corrective program can ing of the underactive muscles. When ward head postures driven by electronic have two applications. First, it can serve as a viewed from the side, an X pattern can be devices or poor exercise selection and tech- stand-alone phase of training that will help drawn for these two sets of muscles. The nique, this X pattern of muscle imbalances the client achieve better postural control overactive muscles form a diagonal pat- will increase. and endurance. Second, it can be applied as tern from the posterior neck with the up- Identify Imbalances the movement preparation for a workout. per trapezius and levators down and across When working with clients or perform- In the first application, the client may be to the anterior neck and shoulder with the ing your own workout routine, attaining in a post-rehabilitation situation and need sternocleidomastoid (SCM) and pectoralis and maintaining ideal posture is para- a program that incorporates flexibility with major. The other side of the X now depicts mount to a safe and effective program. In local and integrated strengthening. The sec-

Step 3 Activate/Strengthen upper crossed

Hold each for 2 seconds. Repeat 10–15 times, 1–2 sets. 1 Assessment results (upper body compensation observations only) Chin Tucks Overhead Squat (OHS) 1. Get on hands and knees with • Head: Forward back straight and head in line • Arms: Elbows fall to side, elbows flex with spine. Extend chin toward Pushing (Standing Cable Chest Press) the floor. • Head: Forward • Shoulders: Elevated Pulling (Standing Cable Row) • Head: forward 2. Scoop chin down toward 2 • Shoulders: Elevated chest as far as possible (like nodding “yes”). Possible Overactive Muscles Keeping chin close to • Sternocleidomastoid (SCM), body, slide back into Levator Scapulae, Upper Trapezius the starting position. Possible Underactive Muscles • Deep Cervical Flexors, Lower Trapezius Floor Cobra 1. Lie on the floor, arms at side of body (or with arms in front of body in a “Superman” position), palms facing toward ground.

2. Pinch shoulder blades together and lift chest off the floor. Hold for 2 seconds. Slowly return body to the ground, keeping chin tucked.

FALL 2016 / AMERICAN FITNESS 49 EXERCISE WORK IT OUT

Step 4 Integrate

Ball Combination 1. Lie with abdomen on a stabil- 1 2 ity ball, keeping feet pointed down and legs straight. Hold a dumbbell in each hand. 2. Lift chest off the ball, keeping back and neck in proper alignment. Extend arms in front of body. Squeeze glutes and lift arms, keeping thumbs up and pinching shoulder blades back and down (scaption). 3 4 3. Move arms straight out to side with thumbs up (abduction). 4. Move arms to the side of the body with thumbs up, retract and depress shoulder Hold briefly at each location, then return arms to extended position in blades (cobra). front of body (position 2). Repeat 10–15 times, for 1–2 sets.

ond application will most likely be for the motions. The movements to note during This four-step process of establishing a client looking to move better and improve an overhead squat assessment for possible more ideal posture is a way of re-educating coordination before applying speed and in- signs of UCS include the body and in this case, the upper body. creased force during their workout session. • Arms falling forward or to side Generally this corrective strategy works to The first step to improving any postural during the descent increase range of motion, to improve local distortion pattern is being able to identify • Head migrating forward strength, and to assist the client in learn- the condition. Upper crossed syndrome • Elevating or elevated shoulder blades ing to better control the newfound range of can be observed from different vantage • Elbows flexed or challenged in motion. Added benefits also include a points with different motions. Some ba- keeping arms straight possible decrease in pain and discomfort, sic assessments that can be implemented Depending on the extent of the distor- stability of the upper torso, and improved to identify distortion patterns are gait ob- tion, someone may exhibit one or more physical performance in training and in servations, overhead squat, pushing and of the listed movement compensations. play. When the head, neck and shoulders pulling motions, and static posture analy- Combining the different assessments can are functioning better, so does the rest of sis. With any postural assessment—static, also confirm findings. This helps in pri- the body. dynamic or transitional—UCS can be ob- oritizing the corrective strategies during For more information on the NASM served by watching head position relative to program design. Corrective Exercise approach, visit the shoulders, and the arms and shoulder www.nasm.org/ces. AF blades relative to the ribs. Corrective Exercise By using the landmarks of the ears, Assessment(s) results can now be ap- Kenneth Miller, shoulders and the glenohumeral (GH) plied to design a program. The four-step MS, is an NASM-CES, joint, a static posture assessment can identi- corrective exercise process for upper PES, and a Pain Free Move- fy UCS by observing if the ears are forward crossed syndrome starts by inhibiting or ment Specialist. As a per- of the shoulder. You might even say that this relaxing the possible overactive muscles, sonal trainer and strength person is slouching. lengthening these same muscles, followed coach in the San Francisco / Observations for the shoulder blade and by strengthening the complementing un- Oakland Bay area, he works the upper arm can be seen from the front deractive muscles, and finally, integrating with athletes and clients to improve and increase and side views with the overhead squat, the involved muscles to reestablish func- their capacity for movement for different sports pushing (pushup) and pulling (cable row) tional synergistic movement patterns. and recreational activities.

50 AMERICAN FITNESS / FALL 2016

EXERCISE

Make Your Fitness Class

The Seven Practical Tips Best By Susanna Kalnes

To some people, there is nothing more to a fitness nighclass than what meets thet eye. There’s an instructor in the room, perhaps some equipment and, of course, a lot of physical activity. Individuals attend classes looking to improve their health, get a nice sweat going and leave feeling accomplished. That’s the gym to them—nothing more, nothing less. “Meh!” But what if I told you that there are little things—simple things—that you can do as an OUT instructor to take your fitness class from “meh” to “marvelous”? What if I told you that, by following these seven steps, you can create an atmosphere that not only draws your students into classes more regularly (growing your numbers), but also makes your class the best night out of the week? The tips I’ve outlined here are effective tactics I’ve learned from fitness celebrities, seasoned instructors, and many of my own students! Perhaps you practice some of them already…but are you doing them all?

52 TIP 1: DRESS TO IMPRESS When you turn on some great music before I remember the first time I met fitness celebrity Chalene Johnson. they arrive, they walk into a lively room that en- I was out in Los Angeles auditioning to be an Area Promotions Di- courages socializing. Think of it this way: If you rector for her company, Powder Blue Productions (she’s now Master were hosting a “night out” with your friends, Trainer for Beachbody®). When she walked into the room to teach you’d turn on the music first…so why not do so a fitness class, I was absolutely blown away by her appearance. Her for your class? outfit was trendy, her hair was curled and sprayed to perfection, and TIP 5: WELCOME YOUR her makeup was impeccable. I remember thinking, “But you are just GUESTS AT THE DOOR going to get sweaty!” This tip is quite simple but also very impor- Over time, I realized just how important that encounter was. tant. At a social gathering in your own home, Johnson explained to me that “fitness instructor” is a profession just would you greet your guests at the door or leave like any other. You’d want to look your very best for any job, and the door open and meet them in the living room? fitness is no exception. Her appearance itself made her class start to My guess is the former. So why not do the same feel like something bigger than just an hour-long workout. It started in your group exercise class? to feel like a party. When you arrive at the gym, after tidying up TIP 2: BE THE FIRST TO ARRIVE and turning on the music, stand by the door and We’ve all heard the expression, “fashionably late,” right? But being wait for your guests so you can welcome them as fashionably late to a celebration is not so fashionable if you are the they arrive. What a great way to make people feel one hosting the party! All too often, I see fitness instructors roll into welcome and comfortable. the gym 2 minutes before their class begins. They show up looking TIP 6: MEET NEW FRIENDS unorganized, frantic and highly unprofessional. You might have all the friends in the world, Don’t be that instructor! When you are teaching a fitness class, be but there’s always room for more, especially at the first person to arrive and the first person to step foot in the room. the gym. When hosting a party, you’d introduce Be prepared, be present, and use the extra time before class to tackle yourself to new guests. It’s no different in your tips three and four. fitness class. Get to know your students sooner TIP 3: TIDY UP rather than later! If you were hosting a party at your house, y ou’d Once you get to know your students, they feel more account- spend some time cleaning and making sure that your able to show up. They plan to be there because they know that home looked as welcoming as possible. The same if they skip a class, you will want to know where they were and thing goes if you are teaching a fitness class. why they missed. So when you get to know your students, you I recently had the opportunity to present at a big end up being a friend and a fitness accountability partner at the fitness conference. When I arrived 30 minutes prior to same time. And to me, those are the best kind of friends! my class, I noticed all sorts of clutter. Towels, old wa- TIP 7: MAKE INTRODUCTIONS ter bottles and flyers were all over the floor. The space This is perhaps the most important of the seven tips you looked messy. So I threw out the trash and eliminated will read today. Once you know your students, start introduc- all of the extra towels. A half-hour later when people ing them to each other. Find common interests, discuss current entered the room, they walked into a very clean and events, or talk about whatever you’d like to get them to connect welcoming space, not a messy one. And that’s exactly with one another. Once your students become friends with each the impression I wanted to give. other, they will view your class as more than just a workout. TIP 4: GET THE TUNES GOING It will become a social hour with their friends. And that, in a There is absolutely nothing worse than walk- nutshell, is how you turn your class into the best night out of ing into a fitness room to the sound of complete the week! AF silence. Am I right? I can almost hear the crickets chirping now… Susanna Kalnes is a freelance writer, Let me be frank. When your students enter a si- TV host, motivational speaker, and AFAA certi- lent room, it’s awkward! It’s awkward for them, it’s fied fitness instructor based in Chicago. For more awkward for you, and it’s even awkward for the crick- information, visit www.susannakalnes.com. ets—ha! When a fitness room is quiet, people tend to keep to themselves, look down at their phones, or sit in the corner being antisocial.

FALL 2016 / AMERICAN FITNESS 53 HEALTH UPDATE

bone growth and remodeling Sources of vitamin K include animal-based foods, broccoli, by osteoblast and osteoclast. Brussels sprouts, cabbage, cauliflower, cereals, eggs, fish, Vitamin K is produced green leaf lettuce, kale, liver and spinach. naturally by gut bacteria or a healthy microflora environment. A fat-soluble nutrient, For years vitamin K (which it requires adequate amounts Getting includes K-1, K-2 and K-3) of dietary fat in the gut in gathered dust on store order to be absorbed. shelves. Primarily known The adequate intake (AI) for helping individuals with for men and women is 120 to Know hemophilia or for prevent- and 90 mcg/day, respectively, ing unnecessary bleeding in according to the National newborns, dose ranges gen- Academy of Sciences. erally focused on its ability They note that no adverse Vitamin K to promote blood clotting. effect has been reported Research concerning the Recent research has turned newfound for individuals consuming attributes of vitamin K’s pos- higher amounts of vitamin attention to vitamin K and its possible sible impact on bone health K, however, a Tolerable impact on bone health. reveals it may be as biologi- Upper Intake Level (UL) cally important as vitamin has not been established. D. While many nutrients Researchers at Linus Pauling have a profound influence Institute at Oregon State sug- on calcium absorption and gest taking a multivitamin/ metabolism, many present- mineral supplement and day researchers contend that eating at least 1 cup of dark vitamin K-2 is as important green leafy vegetables daily as calcium’s comrade vitamin because the dietary intake D-3 to sustain bone health. required for optimal func- Vitamin D-3 (cholecalcif- tion of vitamin K-dependent erol), naturally produced via proteins is unknown. sunlight by the skin, makes sure calcium and phospho- —George L. Redmon, rus are properly absorbed PhD, ND and that blood levels remain stabilized. It’s also needed for

Teach Your Children Well—About Physical Activity and Bone Density

Exercise, particularly high-impact said first author Jonathan A. Mitchell, Density in Childhood Study. That na- had greater levels of physical activ- activity, builds stronger bones in PhD, a pediatric researcher and In- tional study enrolled healthy U.S. ity. This even applied to those with a children, even for those who carry structor of Pediatrics at CHOP. “This children at five sites starting in 2002, higher genetic risk for bone fragility. genetic variants that predispose them study was the first to show that with follow-up visits lasting until Based on their current results, the to bone weakness, according to re- physical activity can counteract the 2009. Participants estimated their researchers advise that pediatricians, search from Children’s Hospital of negative effects of genetic variants amount and type of physical activity schools and child activity programs Philadelphia (CHOP). that associate with bone fragility during childhood. The study team should encourage high-impact phys‑ “While we have known for de- in childhood.” also measured the participants’ bone ical activity for children who are cades that physical activity during The researchers analyzed a co- density and genotyped their DNA for generally healthy. childhood builds up bone and con- hort of 918 children and adolescents, over 60 genetic variants known to be fers lifelong benefits, we did not know from 5 to 19 years of age, all of Eu- associated with bone density. SOURCE: WWW.EUREKALERT.ORG/PUB_RELEASES/ whether the effects of activity depend ropean ancestry, who were part of a Across the board, children had 2016-06/CHOP-PAB061316.PHP (ACCESSED on genetic risks for bone fragility,” larger study group, the Bone Mineral higher bone density scores if they JUN 29, 2016).

54 AMERICAN FITNESS / FALL 2016 athletes: you, too, can sleep better Now, a new Finnish study clearly shows for the first regular basis during the playing season. Those ath- time that systematic examination, counseling and letes who, on the basis of the survey, suffered the individual treatment planning can improve the qual- most serious sleeping disorders were referred to a ity of athletes’ sleep. sleep specialist for examination and an individual- The study, carried out by the University of East- ized treatment plan. ern Finland and Oivauni Sleep Clinic, analyzed The study showed that general sleeping-related the sleep of 107 professional athletes through a guidance, further examinations when necessary survey. All participants were provided with gen- and a personalized treatment plan significantly eral guidance on how to sleep better. The study improved athletes’ sleep, potentially improving found that 1 in 4 athletes suffered from significant athletic performance. sleeping disorders such as trouble falling asleep, snoring or sleep-disordered breathing. In addition, SOURCE: WWW.EUREKALERT.ORG/PUB_RELEASES/2016-05/UOEF- most slept too little and 1 in 6 used sleeping pills SDC051916.PHP (ACCESSED JUN 30, 2016). that helped them to fall asleep or stay asleep on a

Sleeping disorders are so widespread that they are considered a common chronic disease, and professional athletes suffer from sleep disorders more frequently than generally thought.

55 HEALTH on the pulse

A Primer for Fitness Professionals

By Matt Brzycki

Youth Concussions 56 Public awareness of sport-related concussions is on the rise, largely double vision, sensitivity to light/noise, nausea/vomiting, drowsi- due to high-profile injuries. Often overlooked is the enormous po- ness, insomnia, depression, and irritability. Additional signs in- tential children and adolescents have for sustaining a concussion. clude balance or coordination problems, trouble walking in a HOW PREVALENT IS IT? straight line, slurred or incoherent speech, a vacant stare, numb- ness or tingling in the extremities, tinnitus, neck pain, seizures, A systematic review and meta-analysis examined concussion P sluggishness or grogginess, as well as general fatigue and weakness. incidences in 12 youth sports. Researchers found the sports with It’s important to note concussion symptoms can be immediate the highest frequency rates per 1,000 “athlete exposures” were foot- or develop over time. A majority of sport-related concussions resolve ball, ice hockey and rugby; the lowest were baseball, cheerleading within 7 to 10 days. However, symptoms can last several months or and volleyball. (“Athlete exposure” is one practice session or com- more. This is especially true for younger athletes whose brains may petition.) And the occurrence of youth concussions may be rising. need longer to heal. The best concussion treatment is rest. According to the National High School Sports-Related Injury Surveillance Study, an estimated 1.5 million injuries occurred at the WHAT CAN YOU DO? scholastic level in nine sports during the 2005–06 academic year, There are four areas in which fitness professionals can contrib- including about 133,000 concussions, representing 9% of all inju- ute: education, evaluation, preparation and rehabilitation. ries. Compare this with the 2014–15 academic year in which about Education 1.2 million injuries were reported in those sports, including more Fitness professionals can be an excellent resource for educating than 292,000 concussions, representing 24.5% of all injuries. Even athletes, parents and coaches. Teachers and other school personnel if greater recognition and better reporting contributed to the rising should also be “in the know.” Concussed athletes may require aca- numbers, youth sports concussions are a major concern. demic accommodations including shortened school days, periodic WHAT IS A CONCUSSION? rest breaks and excused assignments/exams. A concussion is a traumatic injury of the brain that temporarily At a minimum, educational programs should provide informa- disrupts its normal function. Concussions happen when the brain tion on the signs and symptoms of a concussion, potential short- is moved violently inside the skull as a result of a direct blow or and long-term risks, and the latest research. jolt to the head, face or neck, or to another part of the body where Evaluation the impulsive force is transmitted to the head. The movement can Administer baseline testing so comparisons can be made be- stretch and damage brain cells. Because the brains of younger ath- tween an athlete’s pre- and post-concussive health. Especially letes are still developing, they are more susceptible to concussions meaningful are balance, coordination and reaction time tests. Any than older athletes. history of concussions should also be documented, noting symp- Concussion SYMPTOMS tom details and duration. An athlete needn’t be “knocked out” to have been concussed. Pr eparation One study reported this was a symptom in only 4.6% of concus- The best preventive measure to safeguard athletes against con- sions. Nevertheless, loss of consciousness—however briefly—is cussions is to encourage them to strengthen their necks. In the considered a life-threatening condition that requires immediate event of an impact involving another athlete or the ground, hav- medical attention. ing added neck strength and stability can reduce impulsive forces Headache and dizziness are the most frequently reported transmitted to the head. This may decrease brain movement inside Youth concussion symptoms. Others include inability to focus, blurry or the skull. Concussions FALL 2016 / AMERICAN FITNESS 57 HEALTH on the pulse

I m p o r ta n t: While recovering from a concussion, the brain is vulnerable to repeat injury. Returning to play before the brain is fully healed can put an athlete at risk for another concussion from a second impact. Though rare, this “second impact syndrome” could have dire consequences, including death or disability. This is one reason that it is crucial that parents gain an understanding of concussions, possible signs and symptoms, and what to do if they suspect one has occurred.

In one study, athletic trainers at 51 high schools measured the Athletes can proceed to the next step as long as they continue head and neck circumference, neck length and neck strength of to be without symptoms. Duration of the steps varies. In general, 6,704 athletes who played basketball, lacrosse and soccer during each step should take about 24 hours, but younger athletes may take two different academic years. The study revealed that concussed more time to progress than older ones. athletes had a smaller neck circumference, a small neck coupled BOTTOM LINE with a larger head (ratio), and less neck strength than uninjured Nothing can be done to prevent all youth concussions. But athletes. In sum, neck strength was a significant predictor of fitness professionals can be an integral part of reducing the risk concussion. And consider this: For every 1 pound increase in through education, evaluation, preparation and rehabilitation. AF neck strength, there was a 5% decrease in the odds of sustaining a concussion. This is compelling evidence for performing neck-strengthening M att Brzycki is the Assistant Director exercises, including neck flexion and neck extension. Both can be of Campus Recreation, Fitness at Princeton performed with manual (partner) resistance. If a neck machine is University. He has more than 33 years of ex- available, neck lateral flexion should also be done for both sides. perience in strength and fitness at the collegiate level and has authored, co-authored and edited Rehabilitation 17 books. Across the U.S. laws have been enacted addressing concussions. Most states require that before returning to action, an athlete must REFERENCES: be examined and cleared by a licensed healthcare professional. COLLINS, C.L., ET AL. “NECK STRENGTH: A PROTECTIVE FACTOR REDUCING RISK FOR Nonetheless, fitness professionals can also be involved in the reha- CONCUSSION IN HIGH SCHOOL SPORTS.” THE JOURNAL OF PRIMARY PREVENTION, 35, bilitative process. NO. 5 (OCT 2014): 309-19. COMSTOCK, R.D., CURRIE, D.W. AND PIERPOINT, L.A. SUMMARY REPORT: “NATIONAL HIGH Getting an athlete ready to “return to play” should be a multistep SCHOOL SPORTS-RELATED INJURY SURVEILLANCE STUDY, 2014–2015 SCHOOL YEAR.” protocol with activities gradually progressing to greater levels of in- COLORADO SCHOOL OF PUBLIC HEALTH; AURORA, COLO. WWW.UCDENVER.EDU/ tensity and exertion. Once an athlete is symptom-free, they should ACADEMICS/COLLEGES/PUBLICHEALTH/RESEARCH/RESEARCHPROJECTS/PIPER/ PROJECTS/RIO/PAGES/STUDY-REPORTS.ASPX (ACCESSED APR 18, 2016). follow these five steps (adapted from the 2012 Consensus Statement COMSTOCK, R.D., ET AL. HIGH SCHOOL RIO: SUMMARY REPORT: “INTERNET-BASED SUR- on Concussion in Sport): VEILLANCE OF INJURIES SUSTAINED BY U.S. HIGH SCHOOL ATHLETES, 2005–2006.” 1. Do low-intensity aerobic training (walking, swimming or NATIONWIDE CHILDREN’S HOSPITAL; COLUMBUS, OHIO. WWW.UCDENVER.EDU/ ACADEMICS/COLLEGES/ PUBLICHEALTH/RESEARCH/RESEARCHPROJECTS/PIPER/ stationary bike). PROJECTS/RIO/PAGES/STUDY-REPORTS.ASPX. 2. Increase the intensity and duration of aerobic training. Do HARMON, K.G., ET AL. “AMERICAN MEDICAL SOCIETY FOR SPORTS MEDICINE POSITION simple sport-specific, noncontact drills. STATEMENT: CONCUSSION IN SPORT.” BRITISH JOURNAL OF SPORTS MEDICINE, 47, NO. 1 (JAN 2013): 15-26. 3. Progress to more complex, sport-specific, noncontact drills. McCRORY, P., ET AL. “CONSENSUS STATEMENT ON CONCUSSION IN SPORT: THE 4TH IN- Do low-intensity strength training (light weight, stopping TERNATIONAL CONFERENCE ON CONCUSSION IN SPORT HELD IN ZURICH, NOVEMBER short of muscular fatigue). 2012.” JOURNAL OF ATHLETIC TRAINING, 48, NO. 4 (JUL–AUG 2013): 554-75. PFISTER, T., ET AL. “THE INCIDENCE OF CONCUSSION IN YOUTH SPORTS: A SYSTEMATIC 4. Participate in regular practices and activities. REVIEW AND META- ANALYSIS.” BRITISH JOURNAL OF SPORTS MEDICINE, 50, NO. 5 5. Return to play. (MAR 2016): 292-97.

58 AMERICAN FITNESS / FALL 2016

HEALTH

at the gymnasium

Unintentional Secondhand Exposure May Be Harmful.

By Yusuf M. Saleeby, MD

The use of testosterone replacement therapy (TRT) is a hot topic right now. Just observe the myriad of commercials on TV for topical testosterone gel. In the past half-decade the FDA approval of several forms of topically applied testosterone hormone for men facing andro- pause has escalated, and its use has tripled in the last 10 years. There was a small hiccup in the upward trend of prescribing due to an unfavorable article in a peer-reviewed journal a couple of years ago. The negative press about the harms of TRT was redacted by numerous follow-up Tpublications attesting to the general safety of low-dose testosterone therapy. Again, a steady rise in prescriptions for TRT followed. In the Gym The popularity of TRT has led to a not-so-obvious concern: exposure at the gymnasium. Some trainers encourage “dosing up” before a workout. The result, Topical TRT does not have the time needed for appropriate absorption and will leave remnants on equipment by direct contact and perspiration. Topical gels and creams require up to 6 hours for adequate absorption. If there are remnants on hands that touch exercise equipment, then what remains (even

60 AMERICAN FITNESS / FALL 2016 after wiping down) is present to expose whomever fol- and other bodily secretions that raise the potential risk. lows and uses the equipment. Sweat can also “wash off” Remember to wipe down equipment and wear protec- the topical hormones and leave significant residue on tive clothing at the gym. It has not been determined equipment. This is not limited to men using testosterone. if the use of cleaning agents is beneficial in removal of Women using topical estrogens and progesterone are also residues, but certainly avoid skin contact with clean- placing gym-goers at risk for exposure. ing agents. These measures will lower exposure risk. Safety Suggestions For those on an HRT regimen, being considerate and There are several considerations for use of topical hor- careful with applications will help reduce exposure mones. Apply only in areas that limit exposure or contact for others. AF or “wipe off.” These could be areas covered by clothing or skin less likely to be uncovered at the gym. Places such as Yusuf M. Saleeby, MD, is the inner thigh or upper inner arm ought to be utilized. medical director of Priority Health and There should be adequate time for proper absorption— practices preventive medicine. He has pre- 6 hours is the best estimate for most gels and creams— scribed natural bioidentical hormone ther- before exercising in public. The whole notion of apply- apy for both men and women for almost ing testosterone just before a workout has no bearing on two decades. Dr. Saleeby can be reached for performance other than providing a bit of a dopamine comment at [email protected] or via rush with larger doses. www.PHC365.com. When you are using gym equipment, lightly wiping REFERENCES: it off might just spread residue around. It may be wise to Al-Marrawi, M.Y., et al. “Effect of topical vaginal androgens in a woman on the testosterone levels of her sexual partner with clean before you work out on a piece of equipment as well prostate cancer.” Journal of ClinICAL Oncology, 33, NO. 5 as after. This will cover you in case the previous gym-goer (FEB 2015): 521-22. did not do a good enough job. The use of solvents/disin- Canup, R., et al. “Trends in Androgen Prescriptions from Military Treatment Facilities: 2007 to 2011.” Military Medicine, 180, NO. 7 fectant sprays and such may actually increase the absorp- (JUL 2015): 728-31. tion of residues into the skin. Gross-Sorokin, M.Y., Roast, S.D. AND BRIGHTY, G.C. “Assessment of Wearing workout gloves is a very good idea as they feminization of male fish in English rivers by the Environmental Agency of England and Wales.” Environmental Health Perspec- will provide a barrier for the skin of the hands (those tives, 114, SUPPL. 1 (APR 2006): 147-51. parts of us most likely to come into contact with gym Hackett, G.I. “Testosterone Replacement Therapy and Mortality in equipment). Shirts that cover the shoulders are also a Older Men.” Drug Safety (Oct 2015). PubMed PMID: 26482385. Handelsman, D.J. “Global Trends in Testosterone Prescribing, 2000– smart choice. Also take a change of clothes in case yours 2011: EXPANDING THE SPECTRUM OF PRESCRIPTION DRUG MISUSE.” THE get too wet with perspiration. Wet cloth may be a better Medical Journal of Australia, 199, NO. 8 (OCT 2013): 548-51. conduit for transfer of hormone residue from equipment. Heustess, A., et al. “In vitro skin penetration and skin content of progesterone from various topical formulations.” IntERNA- Secondhand Hormone Risks TIONAL Journal OF PharmACEUTICAL Compounding, 18, NO. 6 (NOV– DEC 2014): 512-15. Those women who have a high possibility for breast Horman, A.M., et al. “Holding thermal receipt paper and eating food cancer may be at an increased risk with environmental after using hand sanitizer results in higher serum bioactive and urine total levels of bisphenol A (BPA).” PLoS One, 9, NO. 10 estrogen exposures. Men with enlarged prostates or (OCT 2014): E110509. testicular cancer could see a more rapid progression of Lau, E. “Accidental hormone exposures prompt proposed drug those diseases with unintentional testosterone expo- label changes.” (oCT 11, 2010). NEWS.VIN.COM/VINNEWS.ASPX? ARTICLEID=16733 (ACCESSED MAY 3, 2016). sures. Women subjected to higher than physiological Lau, E. “Researcher promotes awareness of accidental hor- doses of testosterone could suffer masculinization, while mone exposure in pets.” (JUN 8, 2011). NEWS.VIN.COM/VINNEWS. men exposed to female hormones might face femini- ASPX?ARTICLEID=18762 (ACCESSED MAY 3, 2016). Lau, E. “Scrutiny of secondary topical hormone exposure deep- zation. The reality is that the gym can be a dangerous ens.” (Sp e 9, 2010). NEWS.VIN.COM/VINNEWS.ASPX?ARTICLEID=16512 place when it comes to hormone exposure. When we (ACCESSED MAY 3, 2016). wipe down gym equipment, we are providing a sani- Leet, J.K., et al. “Environmental hormones and their impacts on sex differentiation in fathead minnows.” Aquatic Toxicology, 158 tary process to limit exposure to infections of the skin (JAN 2015): 98-107. and transmission of infectious diseases. Now we should Maganty, A., Osterberg, E.C. AND RAMASAMY, R. “Hypogonadism and also focus on cleaning equipment to prevent the spread Testosterone Therapy: Associations with Cardiovascular Risk.” American Journal of Men’s Health, 9, NO. 4 (JUL 2015): 340-44. of hormones applied as part of prescriptive hormone Mhillaj, E., et al. “Effects of anabolic-androgens on brain reward replacement therapy. function.” FrontIERS IN Neuroscience, 26, NO. 9 (AUG 2015): 295. Parker-Pope, T., “When Hormone Creams Expose Others to Risks.” Conclusion THE NEW YORK Times Well blog. (Oct 25, 2010). well.blogs.nytimes. Prevention is key in limiting exposure to unwanted com/2010/10/25/when-hormone-creams-expose-others-to- risks/?_r=0 (ACCESSED MAY 3, 2016). sex hormones from those using prescription HRT. Be smart and avoid direct contact with equipment, sweat

FALL 2016 / AMERICAN FITNESS 61 NUTRITION UPDATE

Eating a meal of seafood-containing omega-3 fatty acids at least once a week may protect against age-related memory loss and thinking problems in older people, “This study helps show according to a team of that while cognitive abilities researchers at Rush University naturally decline as Medical Center and part of the normal aging Wageningen University in process, there is something the Netherlands. that we can do to mitigate this process,” says Martha Clare Morris, ScD, a Rush nutritional epidemiolo- gist and senior author of the paper.

The study followed 915 people (mean age 81.4 years) for an average of 5 years. Each subject received annual standardized testing for cognitive ability. Participants also completed annual food frequency questionnaires that included four seafood types: tuna sandwiches; fish sticks, fish cakes and fish sandwiches; fresh fish as a main dish; and shrimp, lobster and crab. People who ate more seafood had reduced rates of decline in the semantic memory, (verbal information). They also demonstrated slower rates of decline in a test of perceptual speed, or the ability to quickly compare letters, objects and patterns.

SOURCE: WWW.EUREKALERT.ORG/PUB_RELEASES/2016-05/RUMC-SOC051016.PHP(ACCESSED JUN 3, 2016).

62 Simply Delicious Simple Mills is a leading manufacturer of natural baking mixes that combine whole-food goodness with great taste and texture.

Ingredients such as almond fillers. Baking mixes include flour and coconut sugar Artisan Bread, Banana lower the carbohydrate count Muffin, Pancake & Waffle, and glycemic index to help Pizza Dough and Pumpkin Check out support digestive health and Muffin (a staff favorite!). their complete minimize blood sugar impact. Find Simple Mills products product offerings plus All products are non-GMO, (including the new cracker recipes at certified gluten-free, paleo- line) at Albertsons, Safeway, simplemills.com. friendly and free of grain, Hy-Vee, Mariano’s, Raley’s, soy, and artificial flavors and Wegmans and Whole Foods.

Figs are an ancient food and naturally part of the healthy Mediterranean diet. Research has shown that the Mediterranean diet (one of the eating patterns recommended in the Dietary Guidelines for Americans 2015–2020) is associated with improved health and decreased risk of chronic disease.

Further evidence indicates that consumption of Figs provide more fiber (both soluble and about 2 cups of fruit per day is associated with insoluble) than any other common fruit or veg- a reduced risk of cardiovascular disease, includ- etable. Both fiber types are important for good ing heart attack and stroke. However, the 2015 health. This fruit can be a good choice for those Guidelines point out that nearly 80% of the watching their weight, since high-fiber foods pro- population does not eat this amount of fruit. vide feelings of fullness and can reduce hunger Why not include figs as part of your healthy and cravings. Figs also contain prebiotics, which diet? They’re rich in antioxidants, calcium help support the pre-existing good bacteria in the (¼ C dried = 53 mg; ½ C fresh = 53 mg) and gut, improving digestive wellness. potassium (¼ C dried = 244 mg; ½ C fresh = 354 mg). One quarter-cup serving also pro- Snack on tasty fresh or dried figs, and try vides 6% of the recommended Daily Value of a few recipes from the California Fig Advisory iron. A diet rich in fruits and vegetables, in- Board website (www.californiafigs.com), including fresh or dried figs, naturally increases cluding California Figgy Energy Bites found on fall for potassium and helps lower blood pressure. page 67. SOURCES: CALIFORNIA FIG ADVISORY BOARD. CALIFORNIAFIGS.COM (ACCESSED JUN 3, 2016). BBC. “HEALTH BENEFITS OF FIGS.” WWW.BBCGOODFOOD.COM/HOWTO/GUIDE/HEALTH-BENEFITS-FIGS(ACCESSED JUN 3, 2016). Figs DIETARY GUIDELINES FOR AMERICANS 2015-2020. HEALTH.GOV/DIETARYGUIDELINES/2015/GUIDELINES(ACCESSED JUN 3, 2016). FALL 2016 / AMERICAN FITNESS 63 NUTRITION The Athlete’s Kitchen

Up to 94% of elite athletes who participate in weight- sensitive sports report dieting and using extreme weight- control measures to achieve their desired weight.”

64 FOR Athletes Food for Thought

By Nancy Clark, MS, RD, CSSD in WeighT They commonly experience constipation, dizzy spells, headaches, needless fatigue and poor sleep. Symptoms of long-term undereating include ane- mia, constipation, electrolyte imbalance, hair loss, inability to concentrate well, insomnia, dangerously low heart Sensitive rate (fewer than 40 beats per minute), mood swings, social withdrawal and stress fractures—to say nothing of poor performance. After all, you can only perform at your best if you can train at your best. You can only train at your best if you are doing a good job of Sports fueling up before training and refuel- hile many athletes yearn to be leaner and lighter, some athletes ing well afterward. have to be leaner and lighter. If you compete in a sport with Long-term food restriction easily weight classes (i.e., wrestling, lightweight rowing) or in a sport leads to medical complications that that is sensitive to weight (bike racing, running), you likely put involve not just bones, but also the pressure on yourself to achieve a weight that might defy your ge- whole body: brain, heart, hormones, netic physique. Some athletes can achieve the demanded light- intestines, kidneys and reproductive ness healthfully; others struggle with poor energy, lethargy and system. It creates psychological stress depressed mood. and depression. Hence, athletes who It’s no secret that disordered eating practices are common among weight- need to make weight should take the conscious athletes. An estimated 30 to 60% of active women and up to 19% of job seriously—not simply resort to 1 active men struggle with finding the right balance of food and body-fatness. starving and dehydrating their bodies Their quest to be light easily leads to restrictive food intake, overexercising, and pre-event. too little fuel to support normal body functions. In women, strict diets trigger amenorrhea (loss of regular menstrual periods). While some women seem con- So what’s a weight- tent to get rid of that monthly hassle, they lack knowledge that amenorrhea leads conscious athlete to do? to weaker bones, higher risk of stress fractures (today) and early osteoporosis (in The best time to lose weight is dur- the future). It’s difficult to be a lifelong athlete when your skeleton won’t support ing the off-season. But athletes, being your goals. human, often procrastinate until the last While the combination of amenorrhea, disordered eating and stress fractures minute to complete this task. Here are has been dubbed the female athlete triad, today’s sports medicine professionals tips to help you make weight healthfully: acknowledge that weight-conscious men also experience medical issues. For ex- • Avoid losing more than 2% of ample, a study of competitive male cyclists suggests as many as 25% had osteo- your body weight via dehydra- penia (the early stage of osteoporosis) and 9% had full-blown osteoporosis (low tion. That’s a loss of 3 pounds of bone density). The exact cause of the poor bone health is yet to be determined.2 sweat for a 150-pound athlete. Up to 94% of elite athletes who participate in weight-sensitive sports report di- • Find a health professional who eting and using extreme weight control measures to achieve their desired weight.1 can monitor your body fat. If

FALL 2016 / AMERICAN FITNESS 65 NUTRITION The Athlete’s Kitchen

Despite the demands of your sport, try to keep your life in balance.”

you are a man, do not drop below 5% • Include carbohydrates to fuel your muscles. Target at least 1.5 g carb per pound of body fat. Women shouldn’t go below body weight (3 g carb/kg). For a 150-pound athlete, that means 225 grams of carbs 12% fat. (900 calories), preferably more. Divided into meals and snacks, that’s about 60 g • Do not eat less than your resting carb/meal and 30 g each for a morning and midafternoon snack. Translated into metabolic rate (RMR), the energy food, this means enjoy oatmeal with the eggs, rice with the chicken, etc. needed for your brain, heart and • Include a little fat in each meal to add satiety and keep you feeling fed. You also need organs to function. You can roughly fat to absorb vitamins A, D, E and K. Choose nutrient-dense fats, such as almonds, estimate your RMR by multiplying avocado, peanut butter and salmon. your body weight times 10 calo- • Surround your workout with fuel. That is, eat part or all of your breakfast before ries per pound. For example, if you you train so that you have the energy to exercise meaningfully. Include both carbs weigh 150 pounds, you need about (to fuel the workout) and protein (to minimize muscle breakdown). This could be 1,500 calories to simply breathe and yogurt and a banana before you work out, and eggs with toast afterward. be alive. That’s the equivalent of • Plan to eat recovery foods soon after you train. To avoid extra calories, simply back three 500-calorie meals. your training into a meal. That is, if you train from 3:00 to 5:00 in the afternoon, • Add at least 50% more calories than eat dinner right away at 5:30 (as opposed to having recovery food and then dinner that for daily activities and sports. at 7:00). To take the guesswork out of calcu- Dieting gone awry… lating your personal calorie budget Despite the demands of your sport, try to keep your life in balance. Your whole identity and creating an effective food plan, should not be based on being an athlete, but rather on being a person who is athletic and has you want to partner with a sports other interests. After all, if you identify yourself as a marathoner, who will you be if you get nutritionist who is a registered di- badly injured and cannot run? etitian (RD). To find your local To determine if you have crossed the line and have an eating disorder, take this sports RD, use the referral network SCOFF quiz (an acronym for Sick, Control, Over, Fat, Food): at scandpg.org. 1. Do you make yourself Sick because you feel uncomfortably full? • More simply (but less personal- 2. Do you worry you have lost Control over how much you eat? ized), knock off 300 to 600 calories 3. Have you recently lost Over 14 pounds in a three-month period? from your typical (non-dieting) day’s intake. Deleting two beers 4. Do you believe yourself to be Fat when others say you are too thin? (300 calories) and four Oreos (200 5. Would you say that Food dominates your life? calories) could be an easy start to If you answer yes to 2 of the 5 questions, seek help from a sports dietitian. weight loss. The bottom line: You will not be able to be a great athlete unless you take care of your body • To minimize loss of muscle, try to and fuel it appropriately. Here’s to healthful weight management! AF consume 20 to 30 grams of protein every 3 to 4 hours during the active Nn a cy Clark, MS, RD, CSSD, is a sports nutritionist with a private part of your day. That means, three practice in the Boston area (Newton; 617.795.1875), where she helps both fit- eggs for breakfast, two 6-ounce ness exercisers and competitive athletes win with good nutrition. Her best-selling tubs of Greek yogurt midmorn- Sports Nutrition Guidebook, and food guides for runners, cyclists and soccer ing, a can of tuna for lunch, 1 cup players, as well as her teaching materials, are available at www.nancyclarkrd.com. cottage cheese midafternoon, and For information about online workshops: NutritionSportsExerciseCEUs.com. a chicken breast for dinner. The portion actually depends on your REFERENCES: 1. SUNDGOT-BORGEN, J., ET AL. “HOW TO MINIMIZE THE HEALTH RISKS TO ATHLETES WHO COMPETE IN WEIGHT-SENSITIVE body size. The target is about 0.7 SPORTS. REVIEW AND POSITION STATEMENT ON BEHALF OF THE AD HOC RESEARCH WORKING GROUP ON BODY COM- to 1g protein per pound of body POSITION, HEALTH AND PERFORMANCE, UNDER THE AUSPICES OF THE IOC MEDICAL COMMISSION.” BRITISH JOURNAL weight (1.5 to 2.0 g pro/kg) when OF SPORTS MEDICINE, 47 (2013): 1012-32. 2. SMATHERS, A.M., BEMBEN, M.G. AND BEMBEN, D.A. “BONE DENSITY COMPARISONS IN MALE COMPETITIVE ROAD CY- you are cutting calories and are in CLISTS AND UNTRAINED CONTROLS.” MEDICINE & SCIENCE IN SPORTS & EXERCISE, 41, NO. 2 (FEB 2009): 290-96. energy deficit.

66 AMERICAN FITNESS / FALL 2016 INSTRUCTIONS In a medium bowl, stir all ingredients together or combine Despite the demands of your sport, thoroughly using a stand (not try to keep your life in balance.” hand) mixer. Cover and refrigerate for 30 minutes to chill. Remove and roll into 1-inch balls. Store in an airtight container in the refrigerator for up to 1 week.

Variation: If desired, roll in sesame seeds as shown.

NUTRITION FACTS (Per Serving): Cal 220, Total Fat 12g, Sat Fat 3.5g, Trans Fat 0g, Chol 0mg, Sod 45mg, Carb 23g, Sugar 10g, Dietary Fiber 6g, Prot 6g

Recipe & Photo courtesy of California Fig Advisory Board

CALIFORNIA FIGGY energy bites (no bake)

By Chef John Csukor, KOR Food Innovations, Richmond, Va.

INGREDIENTS Yield: 20 balls (2 per serving)

1 1 cup (dry) oatmeal /3 cup pureed fig (prepare in 2 advance using your processor) /3 cup toasted coconut flakes ½ cup peanut butter 1 Tbsp chia seeds ½ cup ground golden flaxseed 1 tsp vanilla extract 1 ¼ cup dried /8 cup water California figs, diced 1 pinch kosher salt

FALL 2016 / AMERICAN FITNESS 67 NUTRITION

The HealthTea Benefits Time of Black and Green Tea

By Evangeline Yvonne Samples, MS, RD, LD

Cultivated in more than 30 countries, tea is one of the most popular beverages in the world. Of the total amount of tea produced and consumed throughout the world, 78% is black, 20% is green, and 2% is oolong, according to Chan and colleagues. China, Japan and Taiwan consume mostly green and oolong teas, while black tea is favored in Western countries and South Asia countries, such as India. Antioxidant and Antimicrobial Activities Although black, green and oolong teas all come from the Camellia sinesis plant, different methods of processing yield different properties. Since green tea under-

68 goes processing to prevent oxida- The Cancer Connection tion and fermentation, it has higher Several recent studies suggest Drinking tea levels of compounds called poly- that tea consumption may de- phenols, which possess significant crease the risk of breast cancer. on a regular antioxidant activity, according to Epigallocatechin-3-gallate (EGCG) basis has been Shrubsole and colleagues. Although is type of polyphenol that may pos- various types of polyphenols exist, sess anti-cancer properties. A 2001 associated a 2000 study published in The study by Kavanagh and colleagues American Journal of Clinical Nutri- suggested that green tea signifi- with a lower tion explains that catechins are one cantly increased mean latency to type of polyphenol that is present first tumor, and reduced the size risk for breast, in tea. In addition, Wang and col- and number of tumors per ani- prostate, and leagues state that different degrees mal, also known as tumor burden. of fermentation yield different In addition, EGCG inhibited hu- endometrial amounts and types of flavonoids. In man breast cancer cells in culture. green tea, catechins make up 80 to Theaflavins, compounds present in cancers. 90% of the total flavonoid content. black tea, and discussed by Man- However, catechins make up only ach, may also aid in prevention. A A meta-analysis published in the 20 to 30% of black tea’s flavonoids, 2007 investigation by Kaur and col- December 2009 American Journal and most of the flavonoids in black leagues discovered that mice who of Obstetrics and Gynecology exam- tea are theaflavins and thearubigins. had either black tea theaflavins or ined the relationship between the Additionally, a 2008 study pub- green tea catechins added to their consumption of tea and risk of en- lished in the Journal of Agricultural drinking water survived longer dometrial cancer. An increase in tea and Food Chemistry examined the than controls. Smaller tumor size intake of 2 cups per day is associ- antioxidant potency of beverages was also reported; the size of the commonly consumed in the United ated with a 25% decreased risk of largest tumor per mouse was de- endometrial cancer. Green tea con- States. Bottled iced black, green and creased by 40 to 42%. sumption was significantly associ- white tea beverages all possessed An association between green ated with a decreased risk; however, Tea Time some antioxidant strength. On av- tea consumption and decreased no association was observed for erage, green tea was the most robust breast cancer risk has also been black tea. It is hypothesized that of the iced tea beverages; its anti- noted in humans. In the Shanghai tea’s protective effects come from oxidant potency composite index Breast Cancer Study, Shrubsole phytoestrogens, which possess anti- was 24.2. In comparison, the anti- observed that drinking green tea oxidant potency composite index on a regular basis was associated estrogenic properties. Antioxidants of orange juice was 19.1; apple juice with a 12% lower breast cancer such as catechins, present in tea, was 14.6. risk than was seen in nondrinkers. may also be protective. In addition, A study published in Pharma- A dose-response relationship was the large amounts of caffeine in tea cognosy Research compared anti- also discovered in premenopausal have been found to mediate chang- oxidant and antibacterial proper- women. Further, in the Singapore es in hormone levels. ties of black, green and herbal teas Chinese Health Study, Inoue found A 2012 study published in The extracted with hot water. Chan and that daily or weekly green tea in- Journal of Nutritional Biochemistry colleagues ranked green tea as hav- take was inversely associated with by Henning and colleagues dis- ing the most antioxidant properties, breast cancer risk, as compared to covered that in mice with prostate black tea as having an intermediate less frequent intake. Interestingly, cancer, tumor volume was signifi- amount, and herbal tea as having this effect was observed even more cantly decreased in those consum- the fewest. Moreover, green tea strongly among women who had ing green tea. Henning concludes inhibited three gram-positive bac- lower intakes of folate. No associa- that the inhibition of tumor growth teria: Micrococcus luteus, Staphylo- tion between green tea consump- was due to green tea polyphenols coccus aureus, and Bacillus cereus; tion and risk of breast cancer was mediating oxidative stress and however, S. aureus was found to be noted among women with high angiogenesis (the growth of new the least susceptible. intakes of folate. blood vessels).

FALL 2016 / AMERICAN FITNESS 69 NUTRITION

SINESIS.” PHARMACOGNOSY RESEARCH, 3, NO. 4 (OCT– Cardiovascular Benef its Healthy Aging DEC 2011): 266-72. DOI: 10.4103/0974-8490.89748. Research on drinking tea and cardio- The Ohsaki Cohort 2006 Study exam- HENNING, S.M., ET AL. “POLYPHENOLS IN BREWED GREEN TEA INHIBIT PROSTATE TUMOR XENOGRAFT GROWTH BY LOCAL- vascular benefits has yielded conflicting ined intakes of black, green and oolong IZING TO THE TUMOR AND DECREASING OXIDATIVE STRESS results. A 2011 meta-analysis of 18 stud- teas and coffee in relation to the risk of AND ANGIOGENESIS.” THE JOURNAL OF NUTRITIONAL BIO- ies examined black and green tea con- incident functional disability in 13,988 CHEMISTRY, 23, 11 (NOV 2012): 1537-42. INOUE, M., ET AL. “GREEN TEA INTAKE, MTHFR/TYMS GENO- sumption and the risk of coronary artery Japanese subjects aged 65 or over. Green TYPE AND BREAST CANCER RISK: THE SINGAPORE CHINESE disease (CAD). Thirteen reviewed black tea consumption was inversely associ- HEALTH STUDY.” CARCINOGENESIS, 29, NO. 10 (OCT 2008): 1967-72. DOI: 10.1093/CARCIN/BGN177. tea, and found no association between ated with incident functional disabil- KAUR, S., ET AL. “BREAST CANCER PREVENTION BY GREEN TEA its consumption and risk of coronary ity. Tomata and colleagues observed no CATECHINS AND BLACK TEA THEAFLAVINS IN THE C3(1) artery disease. The five studies that dealt association between black tea, oolong SV40, T, T ANTIGEN TRANSGENIC MOUSE MODEL IS AC- COMPANIED BY INCREASED APOPTOSIS AND A DECREASE with green tea found a significant as- or coffee consumption and this type of IN OXIDATIVE DNA ADDUCTS.” JOURNAL OF AGRICULTURAL sociation between intake and a re- disability. Causes of incident functional AND FOOD CHEMISTRY, 55, NO. 9 (MAY 2007): 3378-85. KAVANAGH, K., ET AL. “GREEN TEA EXTRACTS DECREASE CAR- duced risk of CAD. Moreover, disability are physical conditions such CINOGEN-INDUCED MAMMARY TUMOR BURDEN IN RATS an increased green tea intake as stroke, myocardial infarction, hyper- AND RATE OF BREAST CANCER CELL PROLIFERATION IN of 1 cup per day was associ- tension or “frailty,” which is associated CULTURE.” JOURNAL OF CELLULAR BIOCHEMISTRY, 82, NO. 3 (2001): 387-98. ated with a 10% decrease with lower muscle strength. Tomata be- MANACH, C., ET AL. “POLYPHENOLS: FOOD SOURCES AND in the risk of developing lieves that green tea’s healthful effects BIOAVAILABILITY.” THE AMERICAN JOURNAL OF CLINICAL NUTRITION, 79, NO. 5 (MAY 2004): 727-47. CAD.e Th researchers are due to the large amount of polyphe- SEERAM, N.P., ET AL. “COMPARISON OF ANTIOXIDANT POTEN- suggest there may be nols it contains. The polyphenols, such CY OF COMMONLY CONSUMED POLYPHENOL-RICH BEVER- AGES IN THE UNITED STATES.” JOURNAL OF AGRICULTURAL several explanations for as EGCG, reduce oxidative damage to AND FOOD CHEMISTRY, 56, NO. 4 (FEB 2008): 1415-22. DOI: these findings. First, DNA and lipid concentrations. 10.1021/JF073035S. the English prefer to SCALBERT, A. AND WILLIAMSON, G. “DIETARY INTAKE AND BIO- AVAILABILITY OF POLYPHENOLS.” THE JOURNAL OF NUTRI- drink black tea with Conclusion Tea is a very healthful beverage. You TION, 130, 8S (SUPPL) (AUG 2008): 2073S-85S. milk, which may reduce SHRUBSOLE, M.J., ET AL. “DRINKING GREEN TEA MODEST- may wish to encourage clients to substi- LY REDUCES BREAST CANCER RISK.” THE JOURNAL OF the bioavailability of fla- tute tea (especially green tea) for less- NUTRITION, 139, NO. 2 (FEB 2009): 310-16. DOI: 10.3945/ vonoids. Second, different JN.108.098699. healthful beverages, such as soda. AF methods of processing yield TANG, N.P., ET AL. “TEA CONSUMPTION AND RISK OF ENDO- METRIAL CANCER: A META-ANALYSIS.” AMERICAN JOUR- different amounts and types of NAL OF OBSTETRICS AND GYNECOLOGY, 201, NO. 6 (DEC Evangeline flavonoids. In addition, a 2012 study 2009): 605.E1-E8. DOI: 10.1016/J.AJOG.2009.07.030. published in Food & Function asserts that Yvonne Samples, TOMATA, Y., ET AL. “GREEN TEA CONSUMPTION AND THE RISK MS, RD, LD, holds OF INCIDENT FUNCTIONAL DISABILITY IN ELDERLY JAPA- in epidemiological studies, black and NESE: THE OHSAKI COHORT 2006 STUDY.” THE AMERICAN green tea may reduce the risk of both a Master of Science in JOURNAL OF CLINICAL NUTRITION, 95, NO. 3 (MAR 2012): Dietetics from Marshall 732-39. DOI: 10.3945/AJCN.111.023200. stroke and coronary heart disease by 10 VENES, D. (ED.). TABER’S CYCLOPEDIC MEDICAL DICTIONARY. University. She is a to 20%, while experimental and clinical PHILADELPHIA: F.A. DAVIS COMPANY, 2009. trial data indicate either neutral or ben- regular contributer for WANG, Z.M., ET AL. “BLACK AND GREEN TEA CONSUMPTION American Fitness. AND THE RISK OF CORONARY ARTERY DISEASE: A META- eficial effects. Potential mechanisms by ANALYSIS.” THE AMERICAN JOURNAL OF CLINICAL NU- REFERENCES: TRITION, 93, NO. 3 (MAR 2011): 506-15. DOI: 10.3945/ which tea can be protective include the BØHN, S., ET AL. “EFFECTS OF TEA AND COFFEE ON CARDIO- AJCN.110.005363. regulation of vascular tone, improved VASCULAR DISEASE RISK.” FOOD & FUNCTION, 3, NO. 6 (JUN 2012): 575-91. glucose metabolism, and inhibition of CHAN, E., ET AL. “ANTIOXIDANT AND ANTIBACTERIAL PROPER- oxidative stress. TIES OF GREEN, BLACK, AND HERBAL TEAS OF CAMELLIA CLASSIFIEDS

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