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THIS ISSUE:
Personal
Training
Swedish Institute on-line newsletter for our students, faculty and community.
Recent research recommends increased exercise for people who are diagnosed with diabetes, however, these
are people who usually will need guidance when starting a fitness regimen. Denise Lowe, a faculty member
in the Personal Training Program, emphasizes the care that must be taken with special populations. “When
working with adult onset diabetes,” she said, “we’re usually looking at people who have a sedentary
lifestyle, a poor diet and are overweight. Exercise will help them to lose weight and get all of their
systems to work more efficiently, but the key is to begin safely.
“The basic definition of exercise is ‘repetitive motion that keeps you moving constantly for 20 minutes.’
When working with a seriously deconditioned person, we can begin by asking, what can this person do for
20 minutes? Someone who is seriously out of condition, whether they have diabetes or not, might begin by
just walking slowly.”
Part of the curriculum in the Personal Training Program involves using a rate of perceived exertion scale
(RPE scale) to monitor a client’s experience. This means getting constant feedback based on body
awareness. “We ask the client to assess his condition while exercising,” said Denise. “We want to know
if he is comfortable, moderately uncomfortable, or very uncomfortable. We don’t want him to feel wrecked
after the exercise session, because that won’t help and it may discourage the client from continuing.”
Repetition and commitment are the key to seeing positive results.
“The level of exertion needs to be maintained if people want to see change,” Denise pointed out. “That
means weight bearing exercises at least three to five times a week and walking every day. People will
know that they’re getting benefits because the exercises will be easier and they will be able to
increase intensity or weight without being sore the next day.”
Weight training might begin with simple range of motion exercises to see what movements are comfortable,
or even possible, for the client. “We build gradually from there,” said Denise, “slowly adding weights to
different positions, or adding resistance in the form of exercise tubes and bands.” The overall workout
will tone muscles and make everyday movements, such as bending down to pick up an object and place it
on a shelf, easier and less prone to injury.
Once people get walking, Denise likes to see them continue on their own for up to 40 minutes a day. “Once
they are at that level,” she says, “then the personal trainer can get them started on something that
may be unfamiliar and need supervision. For instance, the next step might be working out on low impact
cardiovascular equipment like an ellipse machine or recumbent bike. While most of the exercises will be
aimed at increasing cardiovascular capacity, weights and flexibility training round out the workout.”
Denise has been teaching people how to exercise for 21 years. She started by teaching aerobic dance and
weight training, then learned therapeutic stretch techniques and ISHTA yoga. She teaches the hands-on
classes in the Personal Training Program. She has been on the faculty of the Massage Therapy Program
for seven years, teaching Tools of Assessment, Advanced Western techniques and other related classes.
Aerobics and Weight Training Combined Increase Benefits for People with Type 2 Diabetes
According to the Sept. 18, 2007 issue of Annals of Internal Medicine, people with type 2 diabetes who combined aerobic and resistance regimens doubled the benefit that using only one form of exercise would create. Exercise has been well established as important to diabetes treatment, but many issues remain around the best “dose” and type of physical activity.
In this study 251 sedentary, type 2 diabetes patients ages 39 to 70 were randomized to one of three exercise groups or a waiting list which served as a control. Participants in the experimental groups were assigned to one of three kinds of trainer-supervised exercise:
In all cases sessions were 45 minutes.
After six months aerobic exercise reduced glycosylated hemoglobin A1c (HbA1c) levels by 0.43 percentage
points. Resistance training reduced levels by 0.30 percentage points. Although both of these groups
improved significantly compared with the sedentary controls, participants who combined aerobic and
resistance regimens doubled the benefit with a drop in HbA1c of 0.9 percentage points.
Reducing HbA1c levels translates to reduced major cardiovascular events and microvascular complications
associated with diabetes.
Researchers concluded that a combined regimen of resistance and aerobic exercise is likely to be safe
and practical for this population and that in light of the growing incidence of obesity and diabetes,
“failing to prescribe exercise to patients with diabetes is simply an unacceptable practice.”
Source: Kraus WE, Levine BD, "Exercise Training for Diabetes: The ‘Strength’ of the Evidence”
Annals of
Internal Medicine 2007; 147:423-424.
The Rewards of Post-rehabilitation Therapy
Christina Ricciardi ('03), L.M.T., C.P.T.
When Christina Ricciardi guides her clients through their fitness routines, the space
they are working in feels like a luxurious private work-out room. The gym, part of H&D Physical
Therapy on 46th and Madison, was recently renovated and expanded. A state-of-the-art facility, graced
by floor to ceiling windows that let in energetic cityscape light, it now feels even more spacious.
Instead of crowds on treadmills, there may be only one or two private sessions going on. Though the
mood is more meditative than pumped up, the overall impression is one of thoroughness and quiet
success.
“I’ve been here since April,” Christina explained, “and find it a very exciting place to work.” It’s not
just the great space; it’s also the unique mix of physical therapists who work with the group of
personal trainers collectively known as Your BodyWorks. The group, all Swedish Institute alumni, offer
both personal training and massage therapy services. People undergoing physical therapy may benefit
from the addition of massage therapy, and when finished with physical therapy, they are often referred
to the Your BodyWorks group for personal training.
“The physical therapist usually works with a specific condition—maybe it’s an injury or accident, a
stroke or a hip replacement,” Christina explained. “But as personal trainers we take a whole body
approach to fitness. We may continue with some of the specific exercises the physical therapist did, but
we usually expand on that. We have a goal of overall fitness for the client, yet we keep the injury in
mind and design a regimen around that. If I have questions about the limits of any individual, I have
access to that person’s chart, and I can always talk to the physical therapist on staff. I really
appreciate that aspect of working here.”
The space is uplifting, the level of therapist expertise high; does she see people getting better? “Oh,
definitely,” she replied. “Progress is often remarkable during physical therapy. But post-rehabilitation
will always vary with the individual. Healing will depend on the degree of the injury, a person’s
commitment to fitness, and what shape he or she may have been in before. Some may have been elite
athletes. But others may have never done a single biceps curl! That’s why it’s important to help
guide people, especially when they start out, because not all fitness routines can be the same.”
Personal training has also honed Christina’s ability to target in on problem areas of massage therapy
clients. “A client may come in telling me her neck hurts,” she explained. “And I can provide a massage
which will help her feel better temporarily. But knowing how to work with muscles makes me sensitive to
the fact that perhaps her neck hurts because her chest muscles are too tight. Or someone with low back
pain may benefit from corrective exercises so he won’t get that pain anymore.” When asked if she was
worried about putting herself out of business by helping people resolve their pain, Christina just
laughed. Her level of income is about the same as when she was working in a corporate job as a real
estate appraiser. But she’s much happier now. “There is a lot less stress,” she admitted. “And I’m
really happy doing work that makes a difference in people’s lives. These people need us. I think there
will always be people who need this kind of help, even if it’s just for a little while. That’s what we
try to do—help people move to new levels of fitness as quickly, yet as safely, as they can. It’s a really
rewarding work.”
Contact Christina Ricciardi at H&D
Physical Therapy or 212.557.9642.
Returning to the Joy of Movement
Barbara Goldschmidt, Sinews editor
When I sit at the computer all day, I feel like I’m moving, honest. I can go to the mountains, the
ocean, view sunsets and rain forests. The faster I work, the faster the day goes by. Like most of my
office mates, it’s hard for me to get up and away from my desk.
Fantasy aside, the creaky feeling in my low back tells me it is time to start really moving. But how
would I begin to work out? As I told my daughter, I want to do enough to make a difference in my
body, but I don’t want to hurt myself. Since I’d been sitting around for so long, I figured I’d
better get a fitness evaluation first. That’s where Christina Ricciardi came in.
I went to see Christina to get some idea of what kind of shape I was in and some suggestions for
what I should and shouldn’t do. I used to exercise fairly regularly, but just haven’t made time
for the past 10 years or so. Did I mention I was middle-aged?
Christina reviewed my health history, took blood pressure and pulse readings, measured my body fat
and fat distribution. I did a step test for 3 minutes to determine how well my cardiovascular
system recovers, followed by tests for flexibility of all sorts. What did I learn? After an hour
of measurement taking and fitness testing I found out that I’m in pretty average shape for someone
my age; a good starting point for boosting well being.
I am going to begin to work on improving the flexibility of my hamstring muscles, the aerobic
capacity of my cardiovascular system, and my upper body strength. Christina recommended 20 minutes
a day to begin with, alternating days for weight training. When training with weights, she says I
should start with exercises that go across two joints (e.g. an arm press) instead of exercises
that focus on one joint (like a biceps curl). In other words, do general workouts before I get
more specific. That was something I’d never thought about before.
After the last few years of resisting “exercise”, I now welcome a return to movement. Things changed
when I opened my mind to the idea that I don’t have to rush somewhere to “work out.” I can approach
fitness in the ancient Roman way, using my time to exercise, unwind, have a massage, rest. Health
as a simple pleasure. I’m inspired enough to think about being more careful about how I spend my
time. The first thing I have to do is limit the hours I spend on the computer, even if it means
stopping in the mid
A 2005 review of evidence published in the Journal Medicine and Science in Sports and Exercise found that even a little exercise in a day, such as 15 minutes on a stationary bike, was enough to boost energy and reduce fatigue in people with type 2 diabetes, heart failure, hypertension and depression.
(1)
However, Vincent Metzo, Dean of the Personal Training Program, is quick to point out that people should not mistake the meaning of this research. “There is a big difference between reducing risk of disease and actually enhancing fitness,” said Vincent. “For people who are relatively normal, getting fit requires more of a commitment than the minimum it will take for someone who is sedentary to create a change. Personal trainers can work with both populations, but will have very different strategies and goals for each group.”
An important part of the Personal Training Program is the evaluation of current research and how it applies to developing fitness regimens that will be safe and effective for a variety of populations.
(1)Consumer Reports on Health, Vol. 19, No. 6, June 2007, page 9
