5 Steps to Restore the Core


5 Steps to Restore the Core!

Chris Kelly CSCS (NSCA), CES, PES (NASM)

This information is from Chris Kelly’s eLearning continuing education course:
Restore the Core: Integrated Core Training for Real World FunctionSee the full course for additional core assessments with video, and several core exercises and progressions with videos.

Part 2 of the Core Series is Core Complete Training: A Systematic Approach for Aesthetic Core Development by Chris Kelly.

Five Step Process for Restoring the Core
Much like a weight belt, the abdominals tighten around the spine to provide support during exercise or daily tasks such as bending over and rotating. Contracting the abs in this fashion is known as an abdominal brace.

While this reaction happens automatically with healthy adults, a lack of conscious control or a poor understanding of how to do it during exercise is often related to a host of issues such as back pain and weakness of core muscles deep inside the body.

While the outer core consists of the visible stomach muscles (rectus abdominis, internal and external obliques), the muscles of the inner core are located close to our joints (multifidus, diaphragm, pelvic floor and transversus abdominis).  Although these muscles are too weak to actually move the limbs, their function is to contract isometrically before movement occurs to stabilize the joints.

The most important thing to understand about this idea is that these muscles must fire before any movement takes place to allow stability to occur. Interestingly, a timing delay in this reaction has been found to exist in clients with chronic back pain illustrating the fact that the presence of chronic or acute pain can throw off the way the inner core fires and stabilizes the body.

By contrast, the muscles of the outer core are responsible for moving or preventing motion of the extremities and trunk after the inner core muscles have fired.  A common error made in training programs for clients who are de-conditioned or returning from injury is an overabundance of outer core training without re-establishing control of the inner core muscles. The first step in a progressive core training program is to establish the status of the muscles of the inner core as well as whether the client possesses conscious abdominal control.

This is accomplished via assessments as well as subjective observation. Once the need for this type of training has been established, the goal of the program becomes bringing these muscles back to function while teaching conscious control of the abdominals.

We use a simple five step process for restoring the core to increase function for abdominal training as well as daily life.

Step 1: Regain Mobility

One of the more important concepts in fitness and/or rehabilitation is mobility before stability. If a joint does not possess the ability to move correctly, it can only stabilize through its limited range of motion.  With this in mind, the first order of business is to get your client to stretch and use the foam roll for the following muscles:

  1. Psoas and Quadriceps
  2. Gluteus Medius and Gluteus Maximus
  3. Latissimus Dorsi
  4. Hip Abductors and Adductors

These muscles directly act upon the pelvis and are often tight and restricted.

In creating the mobility program for a client, consider the following:

  • Identify the basic purpose of myofascial release (foam rolling.)
  • Determine the number of rolls per muscle the client should perform on each area.
  • Determine the primary areas targeted for foam rolling and stretching.
  • Identify the order of foam rolling, stretching and hip mobility in the warm up process.

Sample Video of Mobility

Step 2: Breathe and Brace

After foam rolling and stretching, the session continues with a simple drill to teach the client to re-establish deep breathing. This exercise can be seen as a “bang for your buck” movement because we are training the diaphragm while relieving stress and tension getting the client into the right frame of mind to exercise.

This drill can be performed by asking the client to inhale deeply through the nose while expanding the stomach, hold the breath for a slow three count and release through the mouth. At the same time, watch the position of the chest to ensure it is not rising.

While it will likely take several sessions for the client to gain an understanding of this method of breathing, practicing this drill both in your warm up and as homework will improve conscious control of this breathing pattern until it becomes unconscious habit.

Once the client has gained a working understanding of breathing, the next concept is to re-establish conscious abdominal control. This can be done by teaching them to actively “brace” or contract their abs.  A brace involves tightening the abs as if to avoid being poked in the stomach.

This drill can be practiced by placing one hand on the stomach and one hand slightly above the small of the low back.  Apply pressure by pushing into the stomach while tightening your abs to resist. You will feel your back extensor and abdominal muscles simultaneously tighten. Beginners should hold each brace for 5-10 seconds and then release several times to become familiar with this action. As this becomes easier, the length of each hold increases while the client breathes normally.

The ultimate goal of bracing is to consciously tighten the abs to stabilize the trunk against movement of the extremities. While bracing only requires around a 20% abdominal contraction for daily life activities, these demands are greatly increased during tasks which require increased stability such as resistance training or sports.  The trick is to “tune” the brace by allowing contracting as much as necessary in given situations.

With this in mind, the final bracing progression incorporates leg movement while breathing and bracing normally.

Sample Video of Abdominal Bracing

Step 3: Mobilize the Hips

In looking at the body as an integrated unit, consider that certain joints are built to move while others require stability. While the goal of bracing is to tone the muscles around the spine to decrease or prevent motion of the torso, we want to gain movement at the hips (the joints directly above and below the lumbar spine) and thoracic spine to allow normal movement to occur.   This task can be accomplished through mobility drills for the hips and thoracic spine while maintaining an abdominal brace in various standing positions.

Because new clients often lack knowledge of coordinated movements, the phase one series begins against a wall. Pressing in to the wall allows the client to balance while pressing in to the wall to maintain abdominal bracing and normal breathing.

Exercises in this phase are simple in nature and intended to mobilize the hips and t-spine in multiple planes of motion. As the client gains proficiency in both bracing and movement, move off the wall for phase two progression by engaging in more complex and integrated movements. For each phase, perform each drill back to back once for 10 reps or 20-30 seconds each.

Sample Video of Hip Mobilization

Step 4: Free Standing Strength Training

Though weight lifting is traditionally viewed as an opportunity to strengthen the limbs, the truth is that any free standing exercise can also be seen as core training by simply initiating an abdominal brace during the activity. Certain exercises can be modified to increase the stabilization requirements in specific directions.

These include:

Anti-rotation Exercises:
Exercises which involve pressing, pulling or carrying weight on one side of the body forcing muscles of the core to prevent rotation or lateral flexion of the torso.

Anti-extension Exercises:
Exercises which involve pressing overhead, rowing against gravity or pushing up against gravity forcing the core to prevent excess extension of the torso or arching of the back.

Including these exercises in your training program allows you to mimic situations for your client which increase stability demands such as carrying a briefcase and lifting items overhead.

Sample Video of Standing Strength Training Exercise

Step 5: Progress Your Planks

After the re-establishment of breathing patterns and the ability to actively brace the abdominals in supine position (lying on the back), progress to more advanced exercises such as planks.

The key to a plank is to first find a neutral spine position while remaining on all fours. From there, raise into a plank position while maintaining the brace and neutral spine position.  A dowel rod or broom stick can be placed on the client’s back to teach the back to stay in position while the stomach can be poked at various angles to ensure the client is maintaining the abdominal brace.

Beginning as a static hold, the plank is utilized to build isometric endurance while teaching the torso to resist movement. Once this exercise can be held statically for time, it can be progressed by moving the arms and legs while maintaining a stable torso.

Sample Video of Plank Progressions

About the Author
Chris Kelly is an experienced fitness journalist, speaker, and strength coach. With over ten years in the fitness industry, Chris’s experience spans from work in rehabilitation settings to strength and conditioning for athletes.

As a fitness speaker, Chris has authored numerous seminars and workshops focusing on back pain and restorative core training along with a variety of related topics. He holds fitness certifications from the National Academy of Sports Medicine and the National Strength and Conditioning Association. Chris received a bachelor’s degree in communications from St. Johns University in Queens, New York, and a master’s degree in journalism with a specialization in health and science from Columbia University in New York City.

An experienced health writer, Chris has also written extensively on fitness, healthcare, and nutrition. His writing has appeared in numerous publications including Exercise for Men, Prevention, Health, and the Boston Globe

A Brief Look at Exercise and Pregnancy

A Brief Look at Exercise and Pregnancy

Author: Danielle Noblitt Spangler

Working with pregnant clients in a training scenario can be done safely in many cases and throughout much of the pregnancy. The medical recommendations for pregnant women have changed over the years to increase amounts and types of exercise to benefit both the mother and her developing fetus. Awareness and precautions must be taken to create programs for these women as they progress through their pregnancy, and learning about the risk factors associated with pregnancy and your client specifically is a logical step to take when training pregnant clients. 

Historically, prenatal physical activity has been influenced by necessity, race, ethnicity, social status, wealth, and culture. In the 18th century royal mothers-in-waiting may have been confined to bed while their equally pregnant servants catered to their needs. Peasant women were expected to work alongside their husbands, bear their children in the fields, and return immediately to their labors while the high-born women were lavished with care in late 19th century, early 20th century China. 

As recently as the twentieth century, there were varying philosophies regarding the appropriate level of physical activity for prenatal women. In the 1920s and 1930s, a program of prenatal exercise was introduced in the United States with the goal of improving prenatal fitness to facilitate delivery, aid in return to pre-pregnancy weight, reducing labor pain, and improved fetal oxygenation. (Symons Downs 2012) 

However, by 1949, the standard level of physical activity recommended for prenatal women consisted of housework, gardening, occasional swims, and short daily walks totaling one mile. Sports were to be avoided. (Symons Downs 2012)

In 1985, the American College of Gynecologists and Obstetricians (ACOG) issued its first recommendations for prenatal physical activity that endorsed aerobic exercise but cautioned care when engaging in high impact activities. Limits on duration were advised at no more than 15 minutes of strenuous activity, a heart rate of no greater than 140 beats per minute, and a core body temperature of no more than 100.4°F. These very conservative guidelines were developed by a panel of obstetricians, evidently without the input of pre and postnatal women. (Symons Downs 2012).

ACOG has since modified the pre and postnatal exercise recommendations. As of 1994 ACOG has changed their strict stance on maintaining a heart rate range below 140 bpm to accepting the rate of perceived exertion from mild-moderate, and a heart rate guideline of 50 -60% of maximum heart rate (HRmax)

ACOG maintains its stance to avoid exercises where there is a risk of falling or abdominal trauma and recommends 30 minutes or more of daily moderate exercise when no obstetric complications are present.

Benefits of Exercise during Pregnancy

Some benefits of prenatal exercise are obvious, whereas others may not be as initially evident. The benefits of prenatal exercise for weight and body fat control, increasing endurance and strength throughout pregnancy and delivery, and promoting/improving circulation and posture are widely known. But perhaps more importantly, the subtle benefits of prenatal exercise can reduce the incidence of pregnancy-induced hypertension. This lowers risk for pre-eclampsia and toxemia. 

In addition, benefits of prenatal exercise include: (ACSM 2018)

  • prevention of excessive gestational weight gain
  • prevention of gestational diabetes mellitus 
  • helps control gestational diabetes when it occurs
  • decreased risk of preeclampsia
  • decreased incidence/symptoms of low back pain
  • decreased risk of urinary incontinence
  • maintenance of fitness level
  • improves emotional well-being
  • reduces the time needed to recover from delivery and aids in postpartum weight loss
  • speeds time to return to pre-pregnancy state
  • decreases the experience of postpartum depression

The developing fetus also benefits from exercise. According to a breakthrough study, “Mother’s Exercise During Pregnancy Programs Vasomotor Function in Adult Offspring.” (Bahls 2014), women who engage in regular aerobic exercise during pregnancy appear to improve the physical and mental health of their children into adulthood. The authors of the study opined that, based on their study, evidence suggests that aerobic exercise during pregnancy has the potential of programing the arteries of the infant to be more resilient and efficient. This appears to reduce susceptibility to cardiovascular disease across the lifespan. 

They added: “A second important aspect of the findings in our study is that previous research identified the endothelium, which is the single-cell layer lining all blood vessels, to be susceptible to fetal-programming interventions. Contrarily, we show that the vascular smooth muscle was significantly altered in adult offspring from exercise trained mothers.”

Although no studies at this time suggest a risk to the fetus during maternal exercise, the relationship between fetal temperature, low birthweight, and maternal exercise is being investigated. 

Fetal temperature is .5 degrees higher than the mother under normal conditions and most fetal heat is transferred to the mother across the placenta. Fetal heat is also transferred across fetal skin, amniotic fluid, and the uterine wall. 

Exercise increases maternal and fetal internal temperatures taking more than one hour to return to normal. Studies show that exercising more than 5 times a week after the 34th week may result in lower birthweight babies. However, despite its earlier more conservative approach to prenatal physical activity, the American College of Obstetricians and Gynecologists updated its Committee Opinion number 650 (December 2015) to replace Committee Opinion 267 (January 2002) that incorporates a more liberal approach to maternal exercise.

All who are pregnant or those who may be pregnant should see their physician and have physician’s consent before initiating or continuing exercise. The doctor can determine the risk of exercise during pregnancy depending on the mother’s health/pregnancy history and other factors. 

High Risk Pregnancy

Pregnancies are considered high risk if one or more of the following factors are present:

  • The mother is age 35 or over
  • The pregnancy is a multiple gestation (more than one baby)
  • The mother has a history of miscarriages
  • If the mother has diabetes
  • If the mother has thyroid disorders
  • If the mother has anemia
  • The mother is obese
  • The mother has a sedentary lifestyle

There is a lot to learn and understand to safely work with pregnant clients. You want to guide your client through a pregnancy safely with an exercise program that will enhance the health of the mother and child. For more information about pregnancy and exercise see:

A Modern Approach to Exercise During Pregnancy by Danielle Noblitt Spangler. 

An interactive online 4 hour Continuing Education Course with over 55 short instructional videos including exercises to use with your clients. Use code PREGNANCY20 to receive 20% off this course now through April 30, 2022!

Additionally, check out these video clips of exercises for pregnant women:


  • American College of Sports Medicine (ACSM) (2018) ACSM’s Guidelines for Exercise Testing and Prescription. 10th edition. Wolters, Kluwer publisher.
  • Bahls M et al. (2014)  Mother’s exercise during pregnancy programmes vasomotor function in adult offspring. Exp Physiol. 99(1):205-19.
  • Downs, Danielle & Chasan-Taber, Lisa (2012) Physical activity & pregnancy. past & present evidence & future recommendations. Research Quarterly for Exercise and Sport. Dec. 83, 485-502.

Heart Rate Variability

Heart Rate Variability

Heart Rate Variability or HRV is a measure that looks at the changes in the time between successive heart beats. Instead of being a measure of the number of heart beats in a given time (heart rate), HRV looks at the small changes in inter-beat-intervals (IBIs) in a given period of time. The inter-beat-intervals are also referred to as R-R intervals, reflecting the measurement of IBIs on an electrocardiogram (ECG) between the R (QRS) waveforms. HRV is typically measured in milliseconds (ms).

In measuring HRV, the frequency of heart rate signals is analyzed, as opposed to analyzing over time as with HR beats per minute. A mathematical process called “spectral analysis” is used to look at the HR power spectrum to determine the frequency of HR signals. Although heart rate over time (for example a one-minute HR) may be reasonably stable, the time between two heart beats can be considerably different. 

This rhythmic fluctuation occurs between heart beats because of the changes in the sympathetic-parasympathetic balance that controls sinus rhythm in the heart. By looking at HR variability you can “noninvasively evaluate the relative contributions of the sympathetic and parasympathetic nervous system at rest and during exercise. There are many physiological influences on HR variability frequency domains.” (Kenney 2019)

  • When the sympathetic nervous system (stress/fight or flight) is more active, you will see a lower HRV. When the parasympathetic nervous system (rest, digest, repair) is more active, you will see a higher HRV.
  • Influence is exerted in the sympathetic branch through the release of adrenaline which acts on nicotinic acetylcholine (ACh) receptors allowing the body to respond to challenges to survival.
  • In the parasympathetic system, the vagus nerve and vagal tone respond to ACh to help conserve and restore energy by reducing heart rate, blood pressure, and the digestive system. (Singh 2019)

At this time, HR variability is primarily being used to examine physiological parameters in a few different ways:

  • in chronic disease risk, cardiovascular disease risk, and health indications
  • in looking at the impact of exercise training, especially in reference to functional and non-functional over-reaching, over training, and recovery.

HR variability is also considered an interesting marker for resilience and behavioral flexibility with applications for psychological and behavioral health.  “It is well established that low HRV is associated with a broad range of medical and psychological health problems.” (Wheat 2010) 

The goal is to maintain balance between the sympathetic and parasympathetic branches. “If we have persistent instigators such as stress, poor sleep, unhealthy diet, dysfunctional relationships, isolation or solitude, and lack of exercise, this balance may be disrupted, and your fight-or-flight response can shift into overdrive.”  HR variability can give insight into the ANS and be a valuable preventive tool metric.

A reduced HR variability (sympathetic) is associated with: 

  • worsened anxiety and depression
  • increased risk of cardiovascular disease and death
  • myocardial infarction
  • chronic heart failure
  • unstable angina
  • diabetes mellitus

An increased HR variability (parasympathetic) is associated with: 

  • better cardiorespiratory fitness
  • resilience to stress
  • lower risk for many chronic diseases

A heart rate that is variable and responsive to demands is believed to bestow a survival advantage. The ability of the autonomic nervous system and sinoatrial node to respond dynamically to environmental changes results in increased HRV and generally indicates a healthy heart. A reduction in HRV is believed to indicate an inability or attenuation in the autonomic nervous system’s or sinoatrial node’s responsiveness to change. 

HR variability moves to a healthier level with:

  • more mindfulness
  • meditation
  • sleep
  • physical activity (Faye 2010)
  • regular aerobic exercise which increases vagal tone (Singh 2019)

Monitoring the autonomic nervous system (ANS) with HRV has become a useful tool for cardiovascular health and fitness:

  • providing insight to cardiovascular risk evaluation and diagnosis.
  • using HRV to alert athletes of overtraining and to optimize training. (Singh 2019)

A resting ECG for a healthy individual will show obvious high frequency values. HRV can lower with aging, sedentary lifestyle, mental load, and possibly overtraining. (Singh 2019) Cardiorespiratory exercise training increases vagal tone therefore increasing HRV.

HRV is the beat-to-beat alteration of the R-R interval of your heart rate. The gold standard for measuring HR variability is to analyze a strip of an electrocardiogram (ECG) to determine the IBIs. With this method being impractical and unavailable to the general public, HRV can also be tracked with a HR/heartbeat monitor (finger/wrist device or a chest strap) and the purchase of an app to analyze the data. There are other ambulatory methods for measuring HRV, many of which are not practical to use at this time but may become more practical as technology advances.

Common metric measurement devices use the following technology: (Singh 2019)

  1. ECG Devices: measurement of ECG still remains the most accurate way to measure HRV. Single lead ambulatory devices are available to analyze HRV.
  2. Photoplethysmography (PPG): “an optical technique that detects blood volume changes in the microvascular bed of tissue under the skin’s surface.” (Singh 2019) This method can be affected by motion and skin characteristics. It measures lower frequency components (sympathetic) and changes in blood volume with each heartbeat. Interest in PPG for measuring HRV is rising due to accuracy and wear ability, but there has been limited validation of this method for tracking HRV. Ongoing research is in progress to improve the accuracy of this method.


  • Most wrist worn tracking devices depend on PPG. Some now are adding ECG sensors.
  • Chest straps with ECG electrodes that record ECG signals are more accurate. Some will send RR data to a cell phone via wireless technology. (Singh 2019)
  • Wearable technology (PPG and ECG) for individual use, research use, and metric monitoring for health and disease risk continues to advance with HRV being a metric in the spotlight.
  • Validity of wearables must continue to be studied for risk stratification, accuracy, and reproducibility. (Singh 2019)

When and How to Measure HRV (www.AgelessInvesting.com)

  • HRV should be measured while you are sitting or standing upright. Parasympathetic saturation, a phenomenon caused while lying down, makes trends in HRV harder to interpret.
  • HRV is best taken in the morning because your cortisol awakening response will make the reading different at any other time.
  • Therefore, if you can’t take the reading within an hour of your usual time then don’t take it that day. Taking your reading at the wrong time will not accurately represent your awakened state and you may alter your baseline.

Emerging Science
Heart Rate Variability is a metric that is growing in interest and understanding. Using HRV as an indicator of heart disease and increased risk of sudden cardiac risk will provide non-invasive evidence that may be a catalyst for change in lifestyle habits for many at risk. HRV and the vagal response are also linking the predisposition and development of chronic disease directly to the importance of adequate sleep, stress reduction, mindfulness, and relaxation. This is a game changer, making the importance of “chilling out” and getting enough quality sleep something that goes from a luxury to a strong necessity that needs to be deeply entrenched in daily life. It is essential to health and quality of life. Our growing understanding of the role physical activity plays in HRV and vagal response will hopefully drive future generations to make physical activity a globally accepted way of daily life.

To Learn more about Heart Rate Variability and Heart Rate Training see the NAFC PowerCert: Heart Rate-Based Training for All Applications to earn .6 CECs. 


  • Kenney WL, Wilmore JH, Costill DL. (2019) Physiology of Sport and Exercise. 7th Human Kinetics.
  • Wheat AL, Larkin KT. (2010) Biofeedback of Heart Rate Variability and Related Physiology: A Critical Review. Appl Psychophysiol Biofeedback (2010) 35:229–242.
  • Singh N, Moneghetti KJ, Christle JW, Hadley D, Plews D, Froelicher (2019) Heart Rate Variability: An Old Metric With New Meaning In The Era Of Using MHealth Technologies For Health And Exercise Training Guidance. Part One: Physiology and Methods. US Cardiology Review VOL13: Issue 1: Spring 2019. https://www.aerjournal.com/articles/Heart-Rate-Variability-MHealth

Understanding the Seven Stages of Grief and Chronic Illness

Understanding The Seven Stages of Grief and Chronic Illness

It is essential to understand the Seven Stages of Grief and chronic disease if you plan to work with clients living with a chronic disease. Many individuals have heard of the five stages of grief created by Elizabeth Kubler-Ross in 1969. This model is used to explain the stages of grief over the loss of a loved one. There has been an updated model called the Seven Stages of Grief for Chronic Pain and Chronic Illness by Dr. Jennifer Martin, PsyD of www.imaginelifetherapy.com

According to imaginelifetherapy.com, there are seven stages of grief for chronic disease: denial, pleading, bargaining and desperation, anger, anxiety and depression, loss of self and confusion, and acceptance. Clients can go from one stage to another until finally reaching acceptance. An individual, for example, can go from denial to anger and back to denial. Everyone will go through the stages in their own way and timing. There is no set time for anyone to reach acceptance of their situation. If your client can see positive changes after working with you, their outlook will be more positive. As they become stronger and learn more skills, clients will become more ambulatory and be able to move more over time.

Many times, clients will be experiencing their symptoms (chronic disease symptom cycle) and the stages of grief simultaneously. We usually think of grief with respect to the loss of a loved one. With chronic disease, your client may be grieving the life they used to live. Knowing that their lives may changed because of an illness is very stressful. In addition, the individual may be thinking about the future and how their health will be ten years from now. As a health fitness professional, you need to help your client to be present and in the moment. Help them understand and focus that the work they do today will influence how mobile they are ten years from now. If they are discouraged by the big picture, it will be harder for them to stay focused.

Each stage of grief has its own parameters and can give you insight as to which stage the client is currently in. Empathy and support are a critical part of helping a client to get through the stages of grief. Tailor exercise programming to what your client can handle each time they train. If they are having a rough day, you can offer the client a meditation session instead of a training session. Having options to meet them where they are each session may improve compliance if they are not mentally or physically ready for an exercise session.

Adapted from: Pratt, Amanda. “7 Stages of Grief for Chronic Pain and Chronic Illness: St. Petersburg Therapist.” Chronic Illness Therapy, 3 Aug. 2018, imaginelifetherapy.com/7-stages-of-grief-for-chronic-pain-and-illness/.

To know which stage of grief a client may be in, you must have an understanding of each stage.

Denial: The individual has just been diagnosed and is in shock. They cannot believe that they have been diagnosed with a chronic disease. They start to wonder how they will make changes and live a good life. Shock can help the person to decide to move on to the next stage and start working through the stages. It may also backfire if the individual chooses to think that the condition will eventually go away or be okay. Sometimes denial presents as pretending the chronic disease is not happening.

Pleading, Bargaining, and Desperation: In this stage the client tries really hard to bargain or plead to not have a chronic illness. The individual also wishes really hard that they could go back to their previous life. They may feel guilty and blame themselves for becoming sick and wondering if they could have done more to prevent their illness. Guilt usually comes with bargaining as the person blames themselves for their situation.

Anger: This is a crucial stage for individuals to begin the healing process. There is no specific timeline for the client to get through the anger stage. Please note that a client may come in angry some days when training. Try to remain empathetic and patient as the individual goes through this stage. Keep in mind that everyone on the healthcare team often sees anger from the newly diagnosed individual. It is normal for the client to be angry at their doctor, caregiver, family, friends, and even you, their trainer. However, they will most likely apologize after showing you that they are visibly angry. Anger typically comes later in the process when the disease progresses, and the individual realizes that life will change.

Anxiety and Depression: These will set in next as life changes are solidified. The feelings of depression can be substantial and seem to the client like they will never go away. If a client starts to withdraw, offer meditation instead of a training session to keep the client on track. Try to also be understanding about their condition and how they are feeling. If they must cancel with you, ask that they do so within a certain amount of time as your time is valuable as well. There may be anxiety about the future and the unknown as the person wonders what will happen to them.

Loss of Self and Confusion: This can be very real for individuals with a chronic illness. In this stage, life has changed so much for this individual that they do not recognize themselves. Some people define and understand themselves by what they can do. Due to the chronic illness, they can no longer do what they used to do in the same way and  they have to figure out how to redefine themselves. This stage may happen at the same time as anxiety and depression or separately.

Re-evaluation of Life, Roles, and Goals: The client will be thinking about how they can move forward as a wife, mother, husband, father, sibling, and friend. They are forced to re-evaluate how they fit into the picture of their new life and what that means in daily life, figuring out how to go about daily activities, and what work will look like for them.

Acceptance: This is the final stage in which the client accepts his or her new reality. The client is not usually happy with it, but they learn how to deal with their new norm. They strive to learn new skills to make life better and discover new things that bring joy into their lives. In this stage, the client will be most accepting of trying new exercises and stress relief modalities in their training sessions.

Adapted from: Pratt, Amanda. “7 Stages of Grief for Chronic Pain and Chronic Illness: St. Petersburg Therapist.” Chronic Illness Therapy, 3 Aug. 2018, imaginelifetherapy.com/7-stages-of-grief-for-chronic-pain-and-illness/.

Robyn Caruso is the Founder of The Stress Management Institute for Health and Fitness Professionals. She has 20 years of experience in medical-based fitness.

Hey Hero! Check Out June’s story…

Hey Hero! Check Out June’s story…

June Chewning, Director Education for NAFC shares this story with us to help underscore the importance of understanding the basics of body health and chronic disease. This story also gives a real life example that can help us understand how the work we do as fitness professionals can help people develop healthy habits that can have a positive impact on their lives.

In my 41 years working in the fitness industry I have had some interesting experiences. One experience occurred when I came to the fitness center one morning and a man was sitting at a table looking very uncomfortable. He said he pulled a chest muscle, but I found out he had been doing biceps curls. I went and got my blood pressure cuff and quickly discovered he was in trouble. His pulse was thready and his blood pressure was tanking. He refused an ambulance, but I managed to get him to agree to get in the car and go to a small medical center that was close.  They stabilized and transported him to a heart hospital, and he had triple bypass surgery that afternoon. I was a “Blood Pressure Hero” that day.

Many of us as fitness professionals avoid cuing into important vital signs like heart rate and blood pressure. We don’t understand them, don’t know how to take them correctly, or just don’t have time to deal with it.  As fitness continues to connect and merge with medicine, it is becoming necessary for all levels of fitness professionals to learn more about basic body health and chronic disease. Basic vital signs are a window to the basic function of the body that can be very revealing.

High blood pressure is called the silent killer for good reason: there are no symptoms and it often goes undiagnosed or uncontrolled.  High blood pressure or Hypertension is directly related to atherosclerosis and heart disease as well as stroke, the 2 leading causes of death in most developed countries. There are important things fitness professionals should understand about blood pressure and exercise. Here are few facts:

  • High or uncontrolled blood pressure is very dangerous and poses a very serious health threat.
  • Exercise and diet are the most successful ways to control blood pressure.
  • For hypertension, exercise, diet, and 2 classes of blood pressures are used to help lower blood pressure.
  • Exercise should only be initiated after a client with high or uncontrolled BP has seen their health care professional and is under medical supervision and treatment. Systolic blood pressure can increase significantly during exercise, so a client coming to you with known (suspected) high blood pressure should not exercise without medical clearance.
  • Pregnant clients with preeclampsia or chronic high blood pressure should not be exercising during pregnancy and sometimes postpartum as it may exacerbate the condition and can be very serious.
  • Clients with pulmonary hypertension require physician clearance and may require oxygen during exercise or a medically supervised exercise program.

Chronic exercise is confirmed by research to be successful for preventing and managing hypertension. The benefit of exercise is primarily due to Post Exercise Hypotension (PEH). For most people BP is lower than pre-exercise BP after exercise, and chronic exercise can sustain PEH resulting in lower resting blood pressure.  

It is important for all fitness professionals to have a basic understanding of blood pressure. NAFC has a fantastic CEC course that helps our students develop a greater understanding of heart health, and we are running special on that course this month in honor of heart health awareness! Check it out here, and use code HEART2020 for 25% off <3

June Chewning has served the health-fitness industry for many years as a land and aquatic fitness professional, trainer, and teacher.

Healthy Heart for a Healthy Life!

Healthy Heart for a Healthy Life!

February is widely recognized as Heart Month, and in honor of that we are offering up some heart healthy goodness for ya! Read all the way through for a treat for yourself as well <3

This post features an excerpt from our CEC Course, Healthy Heart for a Healthy Life. Trainers work with people from all walks of life, and trainees returning to an exercise program after medical procedures or diagnoses will likely be part of your training experience. Rehabilitation following a cardiac event is a multi-step process, and this piece gives an overview of the progression.

Cardiac Rehabilitation and Return to Unsupervised Exercise

Cardiac Rehabilitation is a medically based, professionally supervised program that assists people in recovering from heart attacks, heart surgeries, and other coronary interventions such as PTCA (angioplasty) and stenting.

Cardiac rehab intervention, most often prescribed by doctor referral, has been shown to reduce rates of re-hospitalization, lower mortality rate, decrease the need for cardiac medications, and increase the rate at which people return to work.

In cardiac rehabilitation, clients are carefully monitored and under the supervision of a cardiac registered nurse and other medical professionals. There is a crash cart present in the facility for if an emergency arises. Clients are taught to self monitor and connect with their body through Rate of Perceived Exertion (RPE) and other means in order to listen to their body, monitor symptoms, and to exercise safely and appropriately.

Special medical training and equipment is required in cardiac rehabilitation. Although clients may want to skip a long drive to go into town to go to cardiac rehab, or it may not be at convenient times, it is important that cardiac rehab be completed and they are cleared to join/participate in a community setting. It is very unwise to allow clients to participate in community programs without proper participation and clearance from cardiac rehabilitation. Physician’s consent for participation in a group fitness certification class, personal training, or small group training is strongly advised and initial (preferably ongoing) communication with the cardiac rehab team is encouraged.

Phases of Cardiac Rehabilitation



Phase I (Inpatient)

  • Provide patient education concerning lifestyle changes (heart healthy food choices, regular exercise and risk factor modification)
  • Provide education on intervention or surgery when hospitalized (signs/symptoms or heart attack, CHF, stent placement, CABG, PAD, etc.)
  • Ambulate patient if possible and provide information on home exercise program.
  • If patient has had open heart surgery, ROM exercises and/or ambulation daily, incentive spirometry, coughing/splinting and home activity guidelines especially for post discharge care.

Phase II (Outpatient)

  • Post-intervention patients
  • Physician referral needed
  • All patients monitored by telemetry units during individualized exercise program.
  • Patients taught how to monitor heart rate, RPE (rate of perceived exertion) and symptoms during exercise
  • Exercise sessions include ~30+ minutes of cardiovascular activity, moderate strength training (approval needed), and cardiovascular risk factor modification education on at least 3 days/week
  • Number of exercise sessions depends on condition and physical response to exercise

Phase III

  • Non-monitored, supervised maintenance program
  • Can be located in hospital or other fitness facility
  • Exercise guidelines provided by progress in Phase II, physician recommendations, and patient’s needs/goals

Phase IV

  • Home exercise guidelines given
  • May exercise at community facility
  • Encouraged to monitor Intensity (HR, RPE, symptoms, etc.)
  • Focus on making positive lifestyle changes
  • Some programs are Phase III/IV combined

Working with clients that have heart disease in a group or individual setting requires fitness professionals to follow safe guidelines and recommendations. It is important to understand these exercise guidelines especially for those who have heart disease and have attended cardiac rehabilitation phase 2. Educate yourself, seek advice, and consider shadowing an experienced professional when creating a client base for those who have been cleared to exercise in cardiac rehabilitation phase 3 and 4 programs.

The information in this course is from the NAFC Continuing education course “Healthy Heart for a Healthy Life” by Tina Schmidt-McNulty.

Alright, now for your treat! We are offering a discount on this course all February. When you purchase it, use discount code HEART2020 for 25% off the list price. This course is worth .3 CECs toward your certification renewal!

Career Development via CECs and Special Offer!

Career Development via CECs and Special Offer!

Many degrees and certifications require continuing education to remain current. Many holders of these degrees and certifications procrastinate the continuing ed process until the very last minute while dreading it every second, too! We know…we are also fitness professionals 😉

It’s a requirement of the credential and not always what we choose, and that can be difficult to accept…it also requires expenditure of precious resources (time, money, energy, etc) to complete those credits.

While the requirement itself may not always be inspiring, there are many valid reasons for continuing education conditions to remain in the health and fitness industry. Part of the reasoning can be put to valuable use for you by expanding your usable knowledge and credential base…aka career development. Making it work for you can lead to places never envisioned upon completing that first certification! Intentional pursuit of your personal development can be a fantastic side effect of filling the req’s, and that is the intended message in this post 🙂

We are committed to helping health and fitness professionals build meaningful and vibrant careers, and the pursuit of continuing education is a big part of our service offerings to our students and program graduates. June Chewning, our Director of Education shares a bit of her continuing ed story with us here:

Hi Everyone,

My name is June Chewning. I am the president of Fitness Learning Systems and the new Director of Education for NAFC. I just wanted to share that a few days ago I looked in my wallet and found 6 expired CPR cards and one current card. It made me realize that in my 41-year fitness professional career, I think I have renewed my CPR over 25 times. It could be more because there was a long period of time when Red Cross required renewal every year.

That made me start thinking of needing renewal for certifications, and I started thinking about all the conferences and workshops I have attended and all of the courses I have taken. For many years I considered CE for Cert renewals a total pain in the glutes. But then I looked back at all I have learned, and it made me realize after all these years how grateful I am that continuing education is required.  Even coming out of college with a Bachelor’s degree in Physical Education and then pursuing a Master’s degree in Exercise Physiology did not give me all of the knowledge nor experience I needed to be a great fitness professional.  It was all that continuing education that was the icing on the delicious cake.

I am most grateful that for some reason all of these years I have taken my continuing education seriously… it defined me as a professional and led me to numerous job opportunities that allowed me to make a living as a fitness professional.  It allowed me to diversify. It led me from a physical education teacher, to a group fitness instructor and personal trainer, to a Master Trainer position, to an international presenter, to doing research and writing training manuals and courses, to an education consultant and research committee lead, to a gym owner for 18 years, to a college professor and developer of college curriculum, to the president of Fitness Learning Systems and currently to Director of Education for NAFC. I would have to say without doubt that the biggest factor in my ability to diversify was my continuing education. Knowledge IS power.

So, this crusty old health-fitness professional would like to encourage you to invest in quality continuing education and make it count. That, more than anything in your career, pays off consistently with career benefits.  Pay attention and carefully plan your career path, making each CEC count. It will maximize your potential for success in this industry. I have loved being a fitness professional for 41 years. From teaching aerobics bare foot with leg warmers, to teaching and constructing courses for medical exercise, it has been worth the sometimes bumpy ride.

Thanks a bunch for that share, June! We are so honored to have you part of our team, and we don’t think you’re crusty at all (insert smoochy face emoji).

CECs are a great investment in yourself, your career, and those who benefit from your work efforts. If you don’t already know about it, we have an awesome special going right now…all PowerCerts and CECs are 40% off until midnight on 1/5/20 with code CEC40. Click here to check out the offerings. As always, you’ve got 18 months from date of purchase to complete the coursework, so it’s a valuable investment to make now and use as your schedule allows over the remainder of your certification period.

Big, happy New Year to you all!

– Your NAFC team

Hey, Hero! Help Your Clients Pave their Path to Sustaining Gains…BP Version

Hey, Hero! Help Your Clients Pave Their Path to Sustaining Gains…BP Version

Trainers and Fitness Professionals have so much influence with their clients.

Wait, that’s you!!!

As Fitness Professionals, you have a front and center position of authority and influence with the people who hire your services…whether attending your class, joining your gym, or hiring you to create personalized programs for them, these are people looking to you for guidance. As such, you have an enormous opportunity to positively impact each of these people every time you interact with them, especially when they are in your care and they’ve received news from their docs!

When clients receive news from the doc

So many of our clients have received news from their health care practitioners regarding blood pressure (BP) test results, and generalized actions to take with regard to those results. But, many of these clients don’t really know what those actions can look like in a daily activity perspective. The translation between a broad-stroke, indiscriminate set of guidelines given to them by a health care professional and specific, customized instructions on daily practices can fall directly in your purview.

You have the tools to help them create a very detailed and action-oriented plan to generate sustainable results…read on for some info that can help augment your current knowledge level!


The following is compiled by June M. Chewning BS, MA and is from “Blood Pressure, Hypertension, and Exercise,” a continuing education course offered by NAFC.

Did you know as a health-fitness professional you can have a positive affect on a client’s health, longevity, and brain function by simply helping them prevent and manage hypertension? The good news is that it is easy- just get them to exercise regularly! The influence of exercise on blood pressure is significant, and for most clients promoting healthy blood pressure is as easy as learning how to assess BP, prescribe regular exercise, and re-assess BP.  Almost every client with elevated BP will see results with regular exercise…so why not be the BP hero?

To be a BP hero, it is important to be educated in the anatomy of BP, how BP works, how to assess BP, BP disease exercise warning signs, and what has a positive effect on maintaining a good BP or lowering an elevated BP. This article gives you a snapshot insight into the fascinating world of blood pressure and exercise.

The body delivers vital oxygen and nutrients and removes waste and metabolic by-products through the combined effort of the cardiovascular and respiratory systems, referred to in combination as the cardiorespiratory (CR) system. The lungs in the pulmonary system are of particular interest as the closed loop vascular system passes through the lungs to pick up oxygen and dispose of carbon dioxide. The success of this closed-loop system relies heavily on a delicate balance to provide effective distribution of blood to virtually all organs and cells in the body.

The proper function of the cardiorespiratory system, and the ability of blood to continuously loop though the system, depends on maintaining the proper pressure in the vessels and organs of the cardiorespiratory system. The pressure is primarily controlled by the vascular system. The pressure maintained in the CR system is measured and monitored by blood pressure.

Blood Pressure is defined as the pressure/force exerted on the arterial walls with each heart beat. (Cleveland Clinic 2019) Blood pressure can be measured directly by a catheter in the artery, or indirectly with a blood pressure cuff and sphygmomanometer. Two pressures in the arteries are measured to determine blood pressure:

  • Systolic Blood Pressure (SBP): represents the highest pressure (against the artery walls) in the artery occurring during ventricular systole, or ventricular contraction, and ventricular blood ejection.
  • Diastolic Blood Pressure (DBP): represents the lowest pressure (against the artery walls) in the artery occurring during ventricular diastole, or ventricular relaxation, which allows the heart to refill.

Blood pressure is the amount of force (hydrostatic pressure) that pushes the blood through the vascular system. Pressure drops gradually as the large arterial vessels branch resulting in lower venous pressures (compared to artery pressure) as the blood progresses through the closed loop system. Blood pressure and associated measures are commonly expressed in millimeters of mercury or “mmHg.”

BP is expressed by ventricular systole over ventricular diastole, for example 120/80. Blood pressure does not remain constant and varies throughout the day or over time in the aging process depending on many factors including exercise, stress, body position, medication, cardiovascular condition, respiratory health, proper hydration, and age.


Fun Fact #1

Blood Pressure depends primarily on body size.

So, children and young adolescents have much lower blood pressures than adults. (Kenney 2019)

Current Guidelines for BP Classification and Management – American Heart Association 2019 (www.heart.org)

Systolic     BP

Diastolic BP



<120 and



Healthy lifestyle choices and yearly checks.

120-129 and


Elevated Blood Pressure

Healthy lifestyle changes and reassessed in 3-6 months

130-139 or


High Blood Pressure Stage I

10 year heart disease and stroke risk assessment. If less than 10% risk, lifestyle changes and reassessed in 3-6 months. If higher after reassessment, lifestyle changes and medication with monthly follow-ups until BP is controlled.

≥140 or


High Blood Pressure Stage II

Lifestyle changes and 2 different classes of medicine, with monthly follow-ups until BP is controlled.

*Individual recommendations need to come from health care provider.

Source: American Heart Association’s Journal Hypertension published November 13, 2017.

Hypertension is defined as:

“Having a resting systolic blood pressure (SBP) >140 mmHg and/or a resting diastolic blood pressure (DBP) >90 mmHg, confirmed by a minimum of two measures taken on at least two separate days, or taking antihypertensive medication for the purpose of blood pressure control.” (ACSM 2018)

This chronic medical condition is called the “silent killer” because there are typically no symptoms. Learning how to assess BP for your client can put you forefront in the fight to detect and fight this deadly chronic disease.  Elevated blood pressure can increase the risk for coronary artery disease, stroke, heart attack, kidney disease, peripheral artery disease, and heart failure. There are both genetic and lifestyle factors that can affect the development of hypertension.

A client with hypertension should engage in regular exercise after their blood pressure is effectively controlled. Exercise to control and manage high blood pressure should only be initiated after the client has seen their health care professional and is under medical supervision and treatment.  Systolic blood pressure can increase significantly during exercise, so the client coming to you with high blood pressure should not exercise without medical clearance.


Fun Fact #2

Hypertension causes the heart to work harder than normal at rest and with activity because it must pump blood from the left ventricle against a greater resistance in the arteries. (Kenney 2019)

The American Heart Association updated guidelines recommend treatment options including lifestyle changes and blood pressure lowering medications. The lifestyle modifications for those with hypertension can lower systolic approximately 4 to 11 mmHg with the largest impact from diet and exercise. (Whelton et al., 2017)

It is well documented in research that even light-moderate exercise can help control and lower blood pressure if you have hypertension. The World Health Organization (WHO) recommends a minimum threshold of 150 minutes per week of moderate intensity physical activity for health and quality of life. This threshold of physical activity plays an important role in cardiorespiratory health, longevity, brain health, muscle/bone health, balance and fall prevention, and function to name a few. Maintaining physical activity/exercise is recommended for prevention and control of virtually all chronic diseases.

In most people, hypertension responds very well to using physical activity/exercise as an adjunct therapy. Starting regular exercise typically helps you control hypertension with lower medication doses. As a health-fitness professional, it is very rewarding to see a client reduce or eliminate blood pressure medication through a regular exercise program.

Thanks a bunch, June!

Fit Pros, the info June shared with us here is so relevant for many of the people we have the opportunity to serve. While this news can be tough for a client to hear, we are resourced to help guide them to sustainable, improved results. To learn more, consider taking continuing education courses about blood pressure and exercise. Knowledge is powerful, and will help you to become a BP hero!



  1. Chewning, J and Schmidt-McNulty T. (2019) Blood Pressure, Hypertension, and Exercise.
  2. American College of Sports Medicine (ACSM). (2018) ACSM’ Guidelines for Exercise Testing and Prescription. 10th Wolters Kluwer.
  3. Kenney WL, Wilmore JH, Costill DL. (2015) Physiology of Sport and Exercise. 6th Human Kinetics.
  4. Whelton PK, Carey RM, Aronow WS, Casey DE Jr, Collins KJ, Dennison-Himmelfarb C, DePalma SM, Gidding S, Jamerson KA, Jones DW, MacLaughlin EJ, Muntner P, Ovbiagele B, Smith SC Jr, Spencer CC, Stafford RS, Taler SJ, Thomas RJ, Williams KA Sr, Williamson JD, and Wright JT Jr. (2017) ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. doi: 10.1161/HYP.0000000000000065

Transformation is…

Transformation is…

In honor of Transformation Thursday, we offer ourselves up for a peek behind the curtain.

Change is a constant companion whether we like it, seek it out, or avoid it like crazy. While that fact might seem dissatisfying to some, it is a truth that can serve us deeply when we accept it and learn to use the transformative power that change can bring to our lives.

Those of you reading this post are all part of the fitness industry in some manner…whether you are a seasoned professional leading your own groups or gyms, recently certified as a fitness professional, or considering getting started with your training curriculum…but that hasn’t always been the case. In order to get to your current position, you had to change something!

NAFC is in the same boat, and we want to share our new approach to transformation with you. We are all about moving forward into our mission and goals in a big way, and that means we had to take a hard look at the things we were doing and ask ourselves some tough questions. We didn’t like all the answers…so we had to make some big decisions. Part of that work involved our overall mission, and since that directly impacts each of you, we want to share the process and the outcome with you…as well as our new approach to change that we are implementing into our daily processes.

Here’s our new mission statement:

We are changing the way the world does personal training instruction and delivery. We do this by adhering to a strict set of educational standards, creating and administering curriculum that truly prepares our students to succeed in this industry, and influencing the industry to require a higher level of regulation regarding training adherence and body movement science.

We give our students the education to become certified and to have an advantage that others don’t in the fitness industry. NAFC, with its higher standards and focus on practical application, helps our certifieds to be truly respected and relevant in their newly chosen career. And, we provide several career pathways and training depth for our certified trainers that continue to challenge and create opportunities for them in their chosen career!

When NAFC certifies trainers, we not only teach them how to train, we provide them with the skills needed to succeed in the business of training.

How’s that for some big goals?!

Working through this along with all the other changes we’ve implemented over the past year, helped to remind us all realize that we truly are part of something special. And, what’s most awesome…this is something we each chose, and we each get to create it every day!  

That’s truly what transformation is…a conscious choice in our daily practices toward a defined outcome with a close look at how those actions line up with our goals. It’s true for organizational development, and it’s true for each one of you reading this post. The process laid out below has worked successfully for individuals, families, groups, and organizations from all industries. When approached in this systematic manner, it’s awesome how seemingly huge decisions and tasks can be divided up into manageable chunks and tackled quickly!

Here’s the process we followed:

  • Define the desired outcome
  • Assess the current condition
  • Define the reasons for achieving the desired outcome
  • Make the decision to achieve the desired outcome
  • Communicate the decision to all appropriate stakeholders
  • Measure available resources to appropriate toward the effort
  • Define the timeline and milestones (basically map the path from current condition to desired state)
  • Begin

Pretty simple. And yet, as you know, simple doesn’t necessarily equate with easy! It’s a new approach to goal achievement for us. And it’s based in change management science…behavioral change is a science after all, though it isn’t rocket science! It’s been our experience that every goal can be broken down into a project and stepped through in this methodical manner. If we can do it at the organizational level and achieve massively positive transformation, how much simpler is this process when applied to personal goals for yourself or those with whom you work?

We’ve adopted this approach into our organization and we are looking forward to measuring our progress as we move into 2020. We’ve got big work to do, and we are committed to achieving the goals we’ve lined out for the next many months! You’ve likely got big goals too, and we would love to know if you choose to use the process outlined here to get after them. Let us know in the comments or shoot us an email…we are all in this together, after all!

Risk Factors and Stages of Alzheimer’s Disease

Risk Factors and Stages of Alzheimer’s Disease

The information in this post is from the Alzheimer’s Prevention and Intervention Specialist Certificate Program: Course 1: Exercise Prescription for Alzheimer’s Prevention and Intervention.
Authored by Dharma Singh Khalsa M.D., Founding President/Medical Director of Alzheimer’s Research and Prevention Foundation.

There is a growing body of research on modifiable risk factors for dementia. However, modern medicine still hasn’t discovered all the answers in this field. Therefore, prevention supports available evidence targeting risk factors for vascular disease such as diabetes, hypertension, obesity, smoking, hyperlipidemia, and physical inactivity. (Dementia: A World Health Priority 2016) Many of these risk factors can be controlled effectively by making healthy lifestyle choices to aid in the prevention of Alzheimer’s disease.

Most experts believe that Alzheimer’s disease, similar to other common chronic diseases, develops as a result of multiple factors instead of a single cause. They also support the idea that some risk factors can be controlled by making smart lifestyle choices.

Physical exercise on a regular basis is a valuable habit to help decrease the risk of Alzheimer’s and vascular dementia. Exercise may benefit the brain cells directly by improving both oxygen and blood flow to the brain. An evidence-based and medically approved exercise program is recommended as part of an overall wellness plan. (Prevention and Risk of Alzheimer’s and Dementia 2016)

There are a number of risk factors that may lead to cognitive decline.
(Adapted from Alzheimer’s Risk Factors 2016 and 2016 Alzheimer’s Disease Facts and Figures 2016)

  • Age
  • Family History
  • Genetic Predisposition
  • Stroke
  • Depression
  • Head/Brain Injury
  • Lack of Adequate Sleep
  • Cardiovascular Disease and Risk Factors.
    • Smoking
    • Diabetes
    • Hypertension (high blood pressure)
    • High cholesterol
    • Physical inactivity
    • Obesity

Exercise is an important part of treatment. Research shows that it may help slow the progression of disease. Be patient and creative when working with clients who have Alzheimer’s disease. Have an understanding of the disease progression, be vigilant in identifying physical decline, and overall, adjust their exercise program to maintain safety. The seven stage model that is commonly accepted and used to stage the progression of Alzheimer’s is provided below. 

When working with clients, it is helpful to understand the stage of progression (often identified by disease symptoms) they are experiencing. This will give you ideas and guidelines for how to most effectively communicate and motivate the client in order to produce results. Different strategies may be required for communication, programming, and expectations during different stages of disease progression.

For more information on risk factors, risk factor reduction, stages of progression, and The 4 Pillars of Alzheimer’s Prevention™, see the FLS course Introduction to Alzheimer’s Disease. Or visit the Alzheimer’s Research and Prevention Foundation Website at www.alzheimersprevention.org.

Seven Stage Alzheimer’s Disease Progression Model for Help with Expectations during Disease Progression.
(Alzheimer’s Disease: Symptoms, Stages, Diagnosis and Coping 2016) 
(Reprinted with permission from HelpGuide.org)

Stage 1:
Subjective Cognitive Decline (SCD). No impairment. Memory and cognitive abilities appear normal, but individual complains of memory difficulties.

Stage 2: 
Minimal Impairment/Normal Forgetfulness. Memory lapses and changes in thinking are rarely detected by friends, family, or medical personnel, especially as about half of all people over 65 begin noticing problems in concentration and word recall.

Stage 3: 
Early Confusional/Mild Cognitive Impairment. While subtle difficulties begin to impact function, the person may consciously or subconsciously try to cover up his or her problems. Difficulty with retrieving words, planning, organization, misplacing objects, and forgetting recent learning, which can affect life at home and work. Depression and other changes in mood can also occur. Duration: 2 to 7 years.

Stage 4: 
Late Confusional/Mild Alzheimer’s. Problems handling finances result from mathematical challenges. Recent events and conversations are increasingly forgotten, although most people in this stage still know themselves and their family. Problems carrying out sequential tasks, including cooking, driving, ordering food at restaurants, and shopping. Often withdraw from social situations, become defensive, and deny problems. Accurate diagnosis of Alzheimer’s disease is possible at this stage. Lasts roughly 2 years.

Stage 5: 
Early Dementia/Moderate Alzheimer’s disease. Decline is more severe and requires assistance. No longer able to manage independently or recall personal history details and contact information. Frequently disoriented regarding place and or time. People in this stage experience a severe decline in numerical abilities and judgment skills, which can leave them vulnerable to scams and at risk from safety issues. Basic daily living tasks like eating and dressing require increased supervision. Duration: an average of 1.5 years.

Stage 6: 
Middle Dementia/Moderately Severe Alzheimer’s disease. Total lack of awareness of present events and inability to accurately remember the past. People in this stage progressively lose the ability to take care of daily living activities like dressing, toileting, and eating but are still able to respond to nonverbal stimuli, and communicate pleasure and pain via behavior. Agitation and hallucinations often show up in the late afternoon or evening. Dramatic personality changes such as wandering or suspicion of family members are common. Many can’t remember close family members, but know they are familiar. Lasts approximately 2.5 years.

Stage 7: 
Late or Severe Dementia and Failure to Thrive. In this final stage, speech becomes severely limited, as well as the ability to walk or sit. Total support around the clock is needed for all functions of daily living and care. Duration is impacted by quality of care and average length is 1 to 2.5 years.