How Fitness Aids in Rehabilitation

by

Bill Sonnemaker, PES, CES, CSCS

2007 IDEA International Personal Trainer of the Year

IDEA Master Trainer, NASM, NSCA, ACE, ACSM

It is overwhelming to experience an injury that disrupts your life, whether you are suddenly sitting on the sidelines or simply unable to function as you previously had on a daily basis.  The road to recovery is long and rough; along the way you may encounter surgery, a regimen of physical therapy, and lingering uncertainty about your ability to return to physical activity.  Many people feel that their physical therapy was discontinued before they were fully recovered.  Unfortunately this is a common problem that can suspend the healing process.  If you completed a thorough course of physical therapy but are still concerned about your level of rehabilitation, a new option exists for pursuing further rehabilitation in a fitness setting through a specialized personal trainer. Fitness professionals with specializations in post-rehabilitation, corrective exercise, and biomechanics are trained to understand the conditions leading to your injury, the surgical techniques involved, post surgical complications and their specific role in the rehabilitation continuum.  These innovative health and fitness professionals have the knowledge and skills to effectively develop and implement corrective exercise strategies for impairments of the foot and ankle, knee, lumbo-pelvic-hip-complex, low-back, shoulder, etc.

Many personal trainers work precisely at picking up where a physical therapist stopped, leading you through appropriate progressions safely to improve strength, mobility and flexibility. This is an invaluable resource for individuals following rehabilitation.  Considering the time and financial investment made in your surgery and recovery, if you do not feel 100 percent recovered it is wise to seek post-rehab training with a specialized personal trainer. Look for trainers who possess advanced degrees and credentials such as a CES (Corrective Exercise Specialist) or PES (Performance Enhancement Specialist) from the National Academy of Sports Medicine (NASM). These individuals have had special training in biomechanics and muscle imbalances.  By taking the extra time to do so, you will reinforce, strengthen, and help prevent reoccurrence of injury.

Qualified fitness professionals join forces with physicians and other health professionals to decrease the number of "couch-potato patients." Your physician may recommend pursuing a fitness program as a pre-operative or post-rehabilitation option rather than simply awaiting surgery or recovery. 

Through the combination of exercise, advice, and support, participation in exercise can replace patients' initial fear with confidence, enabling them to become healthier and modify other risk factors.

Some examples of how a qualified personal trainer can help you recover include: inhibitory techniques such as self myofascial release; lengthening techniques such as static stretching; activation techniques such as positional isometrics; and integration techniques such as integrated dynamic movements.

Supervised exercise programs are highly effective at improving health and rehabilitation outcomes for elderly persons following major joint surgery. 

Tasks demonstrating physical function, performance, and positive health outcomes improve through individual training and group training.

Patients recovering from many injuries actively respond to exercise during dynamic weight bearing, which induces physiologic and neuromuscular responses in individuals and may serve as a preparatory program for more advanced rehabilitation.

Restoration of muscle eccentric strength and coordinated antagonist muscle activity should be key points in postoperative rehabilitation following surgical repair.

Forward-backward weight shifting may be preferable in initial rehabilitation after ACL injury compared to body weight shift from side to side.

Balancing exercises on unstable bases (sensorimotor training [SMT]) are often used in the rehabilitation process of an injured athlete to restore joint function. SMT is able to enhance rate of force development (RFD) in a maximal voluntary muscle contraction. Specific neural adaptations indicate that SMT might be used complementarily to BST, especially in sports that require contractile explosive properties in situations with high postural demands, e.g., during jumps in ball sports.

Performing core and back exercises at home together with rehabilitation treatments might be effective and improve function for patients with chronic low back pain.

Flexibility training improves range of motion significantly in patients.

When combined SMR (Self Myofascial Release) and Static stretching result in a significant decrease of the passive resistive torque.

Functional training can help prevent impairment and disability among elders who practice correct execution of locomotor activities of daily living, (including gait, stepping, and sit to stand) or progressive resistive using elastic bands with varying degrees of intensity. Elders can significantly improve their combined lower-extremity strength (hip extension and abduction, ankle dorsiflexion, knee flexion, ankle plantarflexion, and knee extension). 

Intensive functional training intervention results in strength improvements of comparable magnitude as those attained from strength training and functional training also confers greater improvements in dynamic balance control and coordination while performing daily life tasks.

Muscle atrophy is clearly related to a loss of muscle torque, but the reduction in muscle size cannot entirely account for the decrease in muscle torque. Reduced neural input to muscle has been proposed to account for much of the remaining torque deficits after disuse or immobilization. Voluntary muscle activation failure and muscle atrophy contribute to loss of muscle torque after immobilization. Both increases in voluntary muscle activation and muscle hypertrophy contribute to recovery in muscle strength following immobilization, with large gains in activation during the first 5 weeks of rehabilitation. In contrast, muscle CSA (cross-sectional area) showed fairly comparable gains throughout both the early and later phase of rehabilitation.

Muscle atrophy is a major impairment that occurs early after reconstruction of the Anterior Cruciate Ligament and can persist for several years. Eccentric resistance training has the potential to induce considerable gains in muscle size and strength that could prove beneficial during postoperative rehabilitation. Eccentric resistance training can induce structural changes in the quadriceps and gluteus maximus that greatly exceed those achieved with a standard rehabilitation protocol. The success of this intervention can be attributed to the gradual and progressive exposure to negative work through eccentric exercise, ultimately leading to production of high muscle force.

If you are searching for a qualified fitness professional in the Atlanta area visit Catalyst Fitness at www.fitnesscatalyst.com or call (770) 499-9143.  Catalyst Fitness is Atlanta's only fully-accredited and medically-recognized personal training facility, designing scientifically-based fitness programs for individuals and corporate wellness programs.

Goals for the New Year--Resolutions for a Lifetime

By Bill Sonnemaker, CSCS, CES

IDEA Master Trainer, NASM, NSCA, ACSM, ACE

The New Year is a great time to begin improving your level of health and fitness.  Deciding to begin is easy, actually beginning is challenging, but avoiding the trap door that appears some time in February is the greatest challenge of all.  That trap door many people fall into come February is constructed from false expectations about attaining ideal health and fitness.  The trap door appears when they realize that getting and staying in good physical shape is a long-term goal and not something that can be accomplished in a month. If you really want to be successful at getting in shape, you will have to be ready for hard-work and change.

Firstly, if you have a negative attitude about fitness, your results and your adherence may be disappointing. Modify your perspective on exercise before beginning your new exercise program.  Instead of viewing exercise as a painful and boring obligation begin thinking of exercise as a time to reward yourself, an opportunity to participate in activities you enjoy, and a way to improve your life.

Long-term success requires planning, discipline, and finding ways to motivate yourself every day.  Motivation will not magically happen. As motivators change daily (you won't initially feel inspired to exercise every day), you have to recommit to your goals each day, fit them into your lifestyle, and focus on intrinsic motivators throughout life.

Adopt a reasonable model of nutrition. Abandon diets that are ineffective and risky to your health and start following the food guide pyramid. You can also calculate your daily caloric requirement and adjust it to your activity level (www.fitnesscatalyst.com/calculations) - then you will know that you are providing the exact fuel on which your body was designed to function.  

Next, you will need some lifestyle modifications. Instead of dwelling on your weight, be proactive and take control of your lifestyle. Maintaining your ideal fitness and weight is a lifetime project, which you must work at daily. So, before you start your exercise program, determine how you will stick to it every day.  Unless you permanently change some of your habits, your weight-loss will only be temporary.  First, figure out your bad habits. Keep a food and exercise journal to determine what could be hindering your goals. Begin replacing your bad habits with healthier ones. For example, instead of unwinding in front of the television for one hour every evening, replace half of that hour with a brisk walk or stretching and core exercises.  To keep you away from the vending machines and fast-food lines, make sure you plan ahead and pack healthful foods and snacks daily to have in your car and in your desk drawer.  When you shop for groceries, steer clear of the inside aisles where you find processed foods, preserved snacks, and everything unhealthy.  Treat yourself with as much fresh fruit and green vegetables as you want. Create an environment in your home, in you car, and at work that is free of bad habits.

In addition to adjusting your attitude and lifestyle, you need to create a plan that contains SMART goals (specific, measurable, attainable, realistic/relevant, and time-anchored).  Write down specific and measurable goals. Decide how much weight you want to lose, making sure the amount is reasonable for your height and frame. Determine a loose deadline to reach your goals, making sure you've given yourself adequate time to reach that goal; keep in mind that one pound per week is considered safe. Establish why you want to lose this weight; do you want to look your best for an upcoming event or just improve your overall health and well-being. Also think about how your life will change when you reach your goal and how you will maintain your ideal weight.  Stay focused on your goals and your plan throughout the journey. 

A successful program must involve stretching (15-30 minutes daily), resistance training (30-60 minutes 2-4 times per week), and cardio (30-60 minutes daily). Choose total-body resistance training exercises that involve multi-planar movement patterns.  Choose cardio activities that moderately elevate your heart rate (60%-85% of predicted max heart rate, see website above) without overly stressing your joints.  Remember the first rule of exercise is “if something hurts, stop doing it.” You can search for resources on each of these components at on the following websites www.acefitness.org and www.exrx.net or speak to a certified personal trainer (ACSM, NASM, NSCA, ACE) who has experience training individuals with goals similar to yours.

To secure your success keep a good network of support. Try to get your entire family on board with exercise and healthy nutrition to improve their health and to remove the temptations from the cupboards. Become an advocate to those around you and your enthusiasm will multiply. Find partners for your exercise routines to keep yourself accountable. If you can hire a personal trainer, even for a short time, it is a great investment to jump-start your program or to ensure your long-term success.  Keep your running shoes and workout gear in your car so that you can exercise whenever the mood strikes you.  Modify your program and review your goals every four to six weeks to avoid plateaus and to check your progress. At all stages of your program, be proud of yourself for making your health and fitness a priority.  Remember the importance of a good attitude, healthy habits, and a plan.  You can achieve your goal for the New Years - the best way to start is to make a resolution for a lifetime.

How to Lose 10, 25, and 50 lbs

Bill Sonnemaker, CSCS, CES

IDEA Master Trainer, NASM, NSCA, ACSM, ACE

Where to begin

Speak with a *personal trainer. Working with a personal trainer will help you design a safe, efficient, and progressive exercise program.  Additionally, he or she will help you in determining SMART goals (Specific, Measurable, Attainable, Realistic/Relevant, and Time-anchored). One reason personal training is so effective is because it provides a built-in structure of accountability, support, encouragement, knowledge, and education so that you can eventually take the reins. In addition, working with a professional ensures you are making the best use of your time.

*When looking for a personal trainer make sure he or she meets the following criteria:

•       Maintains certification by one or more of the following accredited and medically recognized organizations: NASM (National Academy of Sports Medicine), ACSM (American College of Sports Medicine), NSCA (National Strength and Conditioning Association), ACE (American Council on Exercise).
•         Possesses current professional liability insurance and CPR certification.
•       Has experience and success working with individuals who have goals and circumstances similar to your own.  Ask for a list of client references.

*Prior to beginning an exercise or nutrition program you should be cleared by your physician.

2 Ways to Create the Desired Weight-Loss

1) Decrease caloric intake, i.e. create a caloric deficit (assuming you are consuming more calories than your body needs). However, decreasing calories drastically (below your Basal Metabolic Rate, BMR) will cause your body to activate its defense mechanism against dieting and starvation.  Sensing starvation from decreased caloric intake, the body slows down its metabolism and hoards fat for survival; it then learns to function on fewer calories. Realizing you are not getting enough calories, your body begins to look for an alternative source of fuel for energy, burning muscle for fuel, which in turn lowers your metabolic rate. Prevent this from happening by consuming enough calories, calories equal to your basal metabolic rate.

2) Increase physical activity, i.e. burn calories. Your goal is to burn ~500 calories per day by increasing your physical activity.

Things to know:

1 pound of fat = 3,500 calories

When exercising if something hurts, stop doing it!

A weight loss of 1-2 lbs per week is generally considered safe and healthy.

To determine your specific values for BMR and other equations discussed below, visit www.fitnesscatalyst.com/calculations.html and use the appropriate calculator.

What motivates you?

Recognize and focus on your intrinsic motivators - they will help you remain accountable and on track even when it is most challenging.  Include a support system to help you stay accountable to your goals; include your personal trainer, family and friends, physician, and nutritionist in what you are doing.

The scale is not always the best indicator of progress. You can also monitor your progress using before and after pictures, body composition (skin-fold measurements), circumference measurements, and observing your clothing becoming roomier.

Nutrition Advice

Eat the right amount of calories; use the Caloric Requirement Calculator to calculate the number of calories you need. Once you have determined the amount of calories you need, multiply the amount by the following ratios: Carbs 40-70%, Protein 15-30%, Fat 10-30%. Then divide by 4 for carbohydrates and protein and 9 for fat to determine the number of grams of each you need to eat.

Keep an exercise and nutrition journal every day. Keeping a journal religiously should be like balancing your checkbook.  Keep tally of all calories you consume and what calories you expend so that you stay on track, not in debt or excess but in control. It will help you manage your eating behaviors by giving you a visual tool, rather than keeping estimated calculations in your head.

Eat 5-9 servings of fresh fruits and green vegetables per day. When fresh is unavailable use frozen. There is some magic in this guideline; you will be challenged to meet this lofty quota, requiring that you eat fruit and vegetables instead of processed snacks, and inadvertently meeting most of your daily requirements of vitamins and nutrients in the process.

Eat 3 balanced meals with 2-3 snacks in between your meals. A balanced meal consists of carbohydrates, protein, fat and fiber.

Eat 20-40 grams of fiber per day to aid digestion and cleansing, increase fullness, and promote heart-health.

Limit and remove empty calories such as sodas, sweet tea, desserts, creamers, etc. One 12 oz. can of Coke contains 150 calories.  Over the course of one month you would consume 4,650 empty calories.  If you were to stop drinking sodas you would reduce your caloric intake and could lose 1.33 pounds of fat per month.  The yearly outcome of 1 can of soda per day is nearly 16 pounds of fat added to your body.

Eat breakfast every day - eating a hearty and healthy breakfast provides sustained energy and the satiation you will need to get through the day. Breakfast should include simple and complex carbohydrates, protein, unsaturated fat and fiber.  An example of an ideal breakfast is oatmeal with fresh or frozen fruit on top, 3-5 cooked egg whites, and a small handful of nuts or seeds.

Consume your last meal or snack 2-3 hours before bed.

Refer to the food guide pyramid www.mypyramid.gov for guidelines for a balanced diet, food choices, and servings.  If nutritional planning is just too complicated, this tried-and-true strategy makes it simple. 

Choose low glycemic carbohydrates such as oatmeal, brown rice, and sweet potato versus grits, white rice and white potatoes to reduce insulin surges.

Cut out all candy, soda, chips, and all processed snacks. When you have a craving for one of these, remind yourself that nothing tastes as good as looking great feels.  Keeping your junk food habits will prevent you from achieving your goals.

Eat organic whenever possible; fresh organic produce contains on average 50% more vitamins, minerals, enzymes and other micro-nutrients than intensively farmed produce.

Drink a minimum of 96 ounces of water per day. Drinking enough water helps your metabolism run efficiently and keeps all cellular processes occurring optimally.

Recommendations for Physical Activity

Flexibility (15-30 minutes daily)

Resistance (30-60 minutes, 2-4 times per week)

Cardio (30-60 minutes daily, at 60-85% of predicted max heart rate (220-age))

In addition to focusing on weight-loss goals, you should also focus on changes in body composition, behavioral goals, and feeling better through proper nutrition and regular exercise.

Case Study

The following model can be applied to both males and females. To find your specific values visit www.fitnesscatalyst.com/calculations.html and use the designated calculators.

Determining caloric needs using the Caloric Requirement Calculator: A sedentary 5'10" 40 year old 225 lb male has a daily caloric requirement of 2,833 calories. This value consists of his BMR requirement of 2,092 calories plus 741 extra calories needed based on his level of activity (very light-17 hours, sleep-7 hours).

Determining BMI (Body Mass Index) using the BMI Calculator:  He has a BMI of 32.4 (grade 1 obesity). Also using this calculator, to reach a BMI of 25 he would need to weigh 176 lbs.

His goal is to lose 50 lbs of body fat (175,000 calories). We have broken his goal into 3 stages; 10, 25, and 50 lbs. In order for him to reach the first stage he will need to create a 35,000 calorie deficit. Stage 2 requires an additional 52,500 calories and Stage 3 requires an additional 87,500 calories. He will accomplish his goal by decreasing the amount of calories he takes in and increasing his level of physical activity.

Using the Calories Expended Calculator: a 225 lb. man would expend the following amount of calories as a result of the below exercise program. Note that with each successive table the values were recalculated to take into account the previous weight loss.

10 Pound Weight-Loss (4.76 Weeks)

Cardio=45 _{min. walking at 4.0 mph} on M, W, F and 60 _min. on T, Th, and 30_min. on Su

Resistance=60_{min. normal intensity} on M, W, F

225-216 lbs.	Monday	Tuesday	Wednesday	Thursday	Friday	Saturday	Sunday	Weekly Total
Cardio	350	466	350	466	350	466	232	2680
Resistance	394	n/a	394	n/a	39460	n/a	n/a	1182
Caloric Reduction	500	500	500	500	500	500	500	3500
Total	1244	966	1244	966	1244	966	732	7362

Total caloric loss per week 7,362.  This equates to 2.1 lbs of fat per week.  Time to reach goal 4.76 weeks

25 Pound Weight-Loss (11.56 Weeks)

Cardio=45 _{min. walking at 4.5 mph} on M, W, F and 60 _min. on T, Th, and 30_min. on Su

Resistance=60_{min. normal intensity} on M, W, F

215-201 lbs.	Monday	Tuesday	Wednesday	Thursday	Friday	Saturday	Sunday	Weekly Total
Cardio	403	538	403	538	403