Effective Motion Strategies

Exercise, Mindfulness, Cognitive, and Lifestyle: Part 1 of 3

In this three-part series, I will discuss certain changes in dosing as well as components to health and performance that otherwise were not considered nearly as crucial just a short time ago. In the first< I want to set a tone, however I will not spend a great deal of time discussing actual implementation of today’s guidelines, as they are quite well established…………..mostly.

When I was in an undergrad exercise physiology course, I remember a class where we discussed a new statement from one of our largest organizations in the industry regarding intensity stimulus level for aerobic activity. Keep in mind, this was a bit before (and likely lead up to) there was a daily physical activity promotion, compared to exercise. The statement was that as low as 37% of HRMax was a threshold for individuals to obtain cardiovascular benefit from exercise. This was a far cry from the “target zone” we had been learning about and was therefore a little confusing……………..I don’t know if that is the best term; it was also almost disappointing to some of us in a way, others seems pleased, “we don’t have to have people work this hard.” I recall asking, “ is this because the individuals that benefit from that level of intensity are so deconditioned?”  Maybe that is NOT a good finding.  

Is it possible that some standards are created or changed to accommodate changes to populations? Yes, as some of this has to do with statistics relative to the subject pool, intervention and measured outcome. I am preaching to the choir here when I ask, “do you think training at 37% of your max (anything) will improve your outcomes?” Of course I’m referring to the appropriate match up of stimulus and desired outcome. Due to the lack of accumulated physical activity, there is now component of this in recommendations. As professionals, it is our responsibility to ensure this information is not received after being skewed by a layperson’s interpretation, even some professionals for that matter. For example, there was an article in the NY Times some years ago discussing a recent published article that stated being obese did not have the same risk as once thought……………….in the study they specifically evaluated active/exercising individuals who measured “obese” or at least “overweight” on the BMI. As a generality, obesity is more “associated” with being sedentary but that is not a rule, likewise being “thin” does not indicate “active” or “healthy.”  The message from the article was that overweight is not as bad as once thought.  Actually, it meant that you can be overweight and still meet other areas of fitness and potentially health, but may not negate the obesity component.  

Being sedentary is associated with so many diseases and disorders, it really is considered a disorder itself.  Even if a classified seentary person does not have other identifiable diseases or disorders, they are not "healthy."  Exercise is above and beyond accumulated physical activity……….people are actually surprised to learn that being sedentary can override the benefits of exercising three days per week. I had a colleague in the past (in my health department nonetheless), at one of my positions in higher education criticize me for “somehow managing to bring in ‘exercise’ into most all of my lectures.” Well, being an enthusiast, professor of exercise and sport science and medicine, and something called academic freedom, consider me guilty. To me, the interplay/interaction of exercise to most everything else is crucial, and beyond just accumulating physical activity minutes, exercise can deliver an extensive amount of interplay, when performed correctly. This same person who criticized me for my promotion of exercise argued that gardening was just as good. First off, exercise does not necessarily mean being in a gym and lifting weights (although, I do like that!). There are several activities that can meet the criteria, even gardening, if you can somehow overload appropriately. But for this person, it was the only method and in description did not meet the criteria including the lack of opportunity during the various seasons in the northeast.  Ironically, this person was also out sick for about an entire during most every semester. No, I'm not implying causal relationship here.................well, actually I am.  

I want to take some time discussing this interplay of exercise with some more recent concepts/areas to include mindfulness and cognitive training. We all know the components of fitness and lifestyle, but how have things changed with technology, sports, occupations, education, etc? If exercise 3 times per week wont offset being sedentary, how have other aspects changed?

I would think the last thing people want to hear is more "things you can do during the pandemic" but I have been inundated by people/organizations I work with on creating messaging. But again, they are also thinking of ways to remain connected so maybe its still not needed. I was having a conversation with one of my high school athletes about the "lack of season." Although this is detrimental to the progress of the sport it is a unique opportunity to add more focus on controlled and appropriate condition, or in the case of an athlete just coming off one season and going to the next, more recovery.

We are not able to have the contact we would like, so we are managing other ways. So what about us? I feel I have been fortunate in my career to travel the world, working and meeting practitioners that enhance and repair dysfunctional human movement. I have also spent a great deal of time treating these very same people. So in our downtime (some of us), be sure to practice self care, learn new techniques, further your knowledge, enhance business knowledge and RECOVER FROM YOUR OWN AILMENTS. I want to comment especially on the latter two.

I would sometimes get strange looks from students when I brought up this topic, not so much from practitioners once in business. You can be the best ____________ (fill in the blank of your area of expertise) but if no one comes to you, what difference does it make? Even non-profit organizations must generate revenue (even in form of stipends, donations, etc) to remain viable. Think of it this way, if you cannot keep the doors of your business open, you cannot help all of those people that motivated you to become who you worked so hard to become.

If you are in physical medicine of some sort (Athletic Training, Chiropractic, Massage Therapy, Physical Therapy, sport performance/conditioning/fitness) you have more than a 50% chance of being injured at any given time. A high percentage of these injuries can turn chronic have permanent change to your livelihood. Some even have to give up something they do. You would not allow your patients or clients to continue, you would decrease the negative stimulus, change mechanics, change volume and even restrict certain activities. We counsel our people as to why this is a necessary condition of progress, so we should do the same for ourselves, we deserve it. Then make sure this is a constant practice, self care.

During the Down Time

This unfortunate situation (to put it lightly) has forced all of us to change the way we do things, and force changes for certain things more permanently. For those of us in the human movement business, we play a crucial role in the prevention, treatment and performance aspect of mobility. Least of which, the first being prevention to linked disorders associated with lack of exercise (not just physical activity) including the immune system. We must remain as active as possible and equally important is to maintain the mobility of the communities we serve.

Hopefully there is minimal activity such as walking from here to there, but for some this may be all they are obtaining and may not even be different than what they were getting in physical activity prior to this event. Although their decline will be less steep, it is a decline nonetheless. Our patients and clients could be much more influenced by this sedentary time and we should do what we can to minimize that. The best part is, they may be influencing other people’s habits and you may actually acquire more clientele by addressing this situation.

Maintain Communication

• Mass communication is a good means of getting global messaging across your demographic

o Used for promoting general mission, eg “staying healthy is important for maintaining and strengthening immunity”

• Provide individual communication to your active clients and patients

o Specific to their condition and compliance

Support Home Compliance

• Create educational content

• Consider live events that cover for group exercise

• Use remote resources to evaluate and coach movement

Supplies

• Guide them on places to access equipment, supplements, etc

• If you carry products, assist people in their needs

o You can ship direct to people

o Increase your supply revenue

o Some distributors will ship direct to your clients/patients and allow you to maintain margin

Prepare

• Help both yourself and your constituents for what is to come

o Use this time to reevaluate your business

 For example, increasing volume or per participant value (overall case or per visit/session)

o Offer additional incentives such as new packages and even offerings, eg if you do not carry products

o Marketing/messaging considerations to counteract what some may foresee as barriers, eg less disposable income

Early on in my clinical career, I remember seeing some repeat patients. I wondered why, especially given that it was not injury related, or at least I did not consider the reoccurring conditions as injuries, but more so something that should have been managed. I know, I know, I was young and naïve. I am referring to reoccurring non specific low back pain in middle aged individuals. I asked one of our patients, “so what happened, why have you returned for the same conditioned we treated you for just less than a year ago?” He sort of just shrugged his shoulders to which I responded, “you know, we are just going to do the same things we did before and if you don’t want to come back for this again, I suggest you continue doing this when you leave.” A that moment, I developed the “once a low back pain patient, always a low back pain patient.” Meaning that, you will probably always have to do something to manage this. That concept sort of narrowed to NSLBP, or and later to really any chronic condition or unmanaged condition/injury (more on this later, see What Happens When we Ignore: Most Acute LBP will reside on its own, so why should we treat?) This was over 25 years ago, but I don’t think I lay claim to this concept but I should investigate �� This was also at a time with little (like $5.00) or no copay, low premiums (if) and reimbursement was open and essentially not contested or capped (remember those days???). A runner with bilateral knee pathology was worth about $300/visit????

I like posing this questions to future practitioners: What would happen if we eliminated all reoccurring conditions and chronic problems? Well first off, we would save global healthcare an obscene amount of money given that chronic conditions consume some of the highest % of healthcare/GDP in both developed and undeveloped countries. We would be without patients? I don’t think this would happen completely, but there might be a shift, in some of the industry in what is keeping people healthier as well as the conditions in which we treat. I was once told be a salesperson I should buy their product because its great for acute injuries or at least the acute phase……………..I said, “that is not where we struggle as practitioners or in healthcare.”

Part 2

Motivating our patients, clients and athletes is good for “business.” Yes, business. Let’s first look at the complete philanthropic perspective, a free clinic or service. To really have an impact, you want as much resolution in individual progress as possible. It would not be a good use of resources to keep treating the same people for the same thing over and over because they were non-compliant (doing their part, which is always more than we can ever do with the time we get), as that would limit the overall amount of people you can treat. And in the hybrid (which I think is most of us perform) where you have a clinic or facility that generates revenue enough to cover your overhead and life, you can then afford to give back to your community, you must be somewhat successful in your business. This is not withstanding to those who dedicate their life to giving and ministry.

What exactly are we motivating? I already hinted at it, compliance. At least that is part of it, and a large portion of what we have influence over. Compliance is the amount of commitment our patients/clients have to what we have prescribed to achieve their goals, yes, their goals. I share in the goals, as that is good for my goal as well, success (more on that). This is especially challenging (and quite important) in the world of insurance reimbursement as not only is their dictation in what we will get reimbursed for as far as procedures, but also the number of times we may conduct these procedures. Those outcomes (goal achievement) can also influence on how those payors may treat us in the future. I don’t want to get into a discussion on this too deeply, but there are already tier structures for certain payors on their providers…………….but lets just say that if you can save them money, you will likely make up for it in volume, if that is feasible and of interest.

Aside from the third party payor model, consider the more recent (for some, more recent than others if you are a licensed clinician) approach of out of pocket payor. This is actually what non licensed exercise/fitness/performance leaders experience, whether in a fee for service model or institutional (you work in a facility such as a club, team, institution, in this case you could also be a licensed clinician). Motivating for compliance results in progress, success in the goals set forth. This is proof that what you are doing is working. In today’s health and wellness industry, individuals have been forced to become better consumers of health. This has actually opened up some door for us, maybe closed a few too. The doors closing is that whomever is/was paying, no longer simply just sends the cash over for whatever has been done. Everyone wants to know what they are paying for………..well most.

Motivation

Part I

How do you get your clients or patients to do what is necessary? For those who began working with people more than a decade ago, have you determined any changes in the populations in which you serve? In other words, is what motivated people ten years ago still the same for today? That’s both the population at large and the individuals. For example, I used to provide a profile comparison for my students in my nutrition course, me in my 20s when I was in college and another of me in late 30s. They included biographic data such as body mass and percent fat/fat-free mass, nutrient intake, time spent in physical activity, time spent sedentary (both leisure and occupation). Student did not know this was me, as I wanted them to be candid. To summarize, when I was in undergrad, I was in a health fitness major, worked at a fitness center as a personal trainer and group exercise leader and trained for body building. In other words, my life was fitness and exercise. I trained hours per day, very strict diets, etc. Fast forward about 15 years and now in a career(s) working to make a name for myself in education and in clinical practice…………..you may have looked at my profile by now and figured I no longer train for body building. I recall after class one day, two students, Gerome and Josh, hanging out with me discussing this assignment on the profile comparisons. “How could this guy just let himself go like that?” I revealed my secret of who this person was, and there was a little backtracking but lead to a great conversation of goals and motivation. In another section and lecture for the course, I would flash this picture up and ask folks if they could identify this infamous body builder……………….to this day, no one.

It makes no difference whether it’s about prevention, care, or enhanced performance (well, that’s not total true, but for the sake of argument), it’s about motivation. We know that both sympathy and empathy can be valuable connections to our clients and patients, but we don’t always have first-hand experience with their conditions. However, we do share something for sure, motivation. So what motivates you do to what you do? I do think its also important to understand that we are also likely promoting, seeing as how this website is more so dedicated to non-invasive (non-surgical non pharma, not against, but not in the wheelhouse) approaches to health, wellness and performance. Of course, we must also keep in mind that not everyone is motivated by the same reasons or uses the same construct. We do however identify some key elements/approaches to motivation, such as intrinsic and extrinsic “reward” mechanisms. These will also be affected by the state of the individual and their control over that state. What I mean is, the psychological profile AND the “moment in time.” We can simplify this moment in time as emotion, and how well a person can use that emotion or how it uses them. A great deal of this in sport psychology in preparing athletes for both competition AND training. What about a non athlete or patient? Its actually quite similar.

So, why is this important to me, and hopefully you? I have also said to my students and clients, “you can be the best scientifically minded clinician, trainer, coach, etc, but if no one is there to train, treat or educate, what good are you to the cause? Or when I get to a point in the lecture about reimbursement, billing, coding etc it would sometimes surprise students and I would even get the response, “but why do we need to discuss this, we got into this to help people.” Well, even a free clinic costs money!

We are entering the competitive season for youth sports in the school systems, as well as other organized events (although some never stopped), so I thought this would be a good opportunity to make some comments. I have been involved in and created several youth programs revolving around conditioning for youth sport performance. Here is a page I began several years ago when we started Blackbird Strength and Conditioning: https://www.facebook.com/Youth-Sport-Performance-and-Fitness-142965999113444/" target="_blank">http://https://www.facebook.com/Youth-Sport-Performance-and-Fitness-142965999113444/

This was a short video spot on the local television show and good friend Acea Theroux: https://www.facebook.com/acea.theroux/videos/1545640034794/UzpfSTcwNzYxMDA1NToxMDE1Njk4OTYwNzk5NTA1Ng/?comment_id=10157196118915056&notif_id=1566951253437782&notif_t=feed_comment" target="_blank">http://https://www.facebook.com/acea.theroux/videos/1545640034794/UzpfSTcwNzYxMDA1NToxMDE1Njk4OTYwNzk5NTA1Ng/?comment_id=10157196118915056¬if_id=1566951253437782¬if_t=feed_comment

Why did I do this? Well, several reasons, one of which is to add some expertise in the community surrounding a important topic, health. Of course strength and conditioning has a premise of improving sport performance, however a reduction in injury may influence ones future as injury may be involved in adult joint degeneration. There is a great review by Punzi et al 2016 that describes the overview of the concept, but the statistics are 20-50% of people experience post traumatic osteoarthritis and this is 12% of OA patients. That translates to $36B/yr spent on this group alone, based on the CDC estimate of overall $300B/yr spent on OA.

Sports themselves have benefits in life long choices of being active, however that may not influence the here and now. What I mean is that not all sports have a great deal of activity that stress the important systems to developing health promoting effects, especially if the child is a one sport season athlete (as opposed to the one sport athlete who plays the same sport year round, out of season). When instilling the notion that conditioning is a year round event to not only support the sport in which the young athlete plays, it also promotes further health benefits. Due to the decline in physical activity of youth, preseason conditioning has taken on a different effect on preseason preparation, ie they are not entering preseason at a level of preseason, and may be sedentary.

Youth community programs can be an excellent opportunity for many. First and most obvious, the youth will benefit from having qualified conditioning to enhance the various aspects of sport, performance. Certainly related to both performance and maybe later on in life is injury prevention. It also instills a new found area of physical activity. We have gone back and forth on promoting “exercise” in place of skill and imagination based physical activity, such as playgrounds, “going outside to play,” etc but for some, it may a great opportunity. In fact, given the extremely low risk of organized condition programs, its also one of the safest. We also approach things a little differently nowadays and even have some competitive “exercise” type opportunities that may improve motivation, eg Crossfit, Spartan Races, etc. I personally have also experienced the performance conditioning programs for youths as sort of hub. Where otherwise some kids may drop out of a program as they realize their skill abilities will not get them to the next level, eg freshmen football to JV, I have identified opportunities for you athletes in other areas. For example, I worked with football player with exceptional performance stats (power, speed, strength) who was a running back, however was just not that great on the field from a player ability perspective. However, this kid made one heck of a 100m/200m sprinter. Ive also seen many young people gain confidence through success in training, attaining various performance goals such as vertical jump height or non goal related effects such as weight loss.

These programs are not done on their own, so the community centers/schools who may host them can utilize what may not be otherwise used space such as a field or multipurpose room in the offseason. It may even generate some revenue to support the programs and facilities. We were able to purchase new equipment. In my case, it created a connection between the college and the community, including a place where students could perform internships to enhance their learning and experience. Also, it may even be a revenue generating opportunity for a local professional, while doing something good for their community!

P.S. I will be reviving the Youth Sports Conditioning page, so stay tuned and Like!

 

 

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