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Interpreting Health History: How Drugs Affect Your Clients’ Training and Performance

As a responsible fitness professional, you understand the importance of conducting a thorough health screening before taking on a new client or participant. That being said, most of us have no formal training in medicine or pharmacology, so interpreting the information provided on a Health History Questionnaire can pose a challenge.

One area in particular that tends to be overlooked is the medications section of the questionnaire. It is easy to assume that since the drugs our clients take have been prescribed by a physician, they are safe and will not affect our programming. However, many common and popular medications have serious side effects that can undermine performance and pose safety risks. In some cases, they may cause weight gain, or make it difficult for your client to lose weight.

Common Drugs that Affect Training

Following is only a partial list of the most popular medications prescribed for metabolic disorders, birth control, depression and other common conditions.

  • Paroxetine (Paxil): Used to treat depression and anxiety disorders, this medication can cause weight gain, or can interfere with your client’s ability to lose weight. 
  • Metoprolol and other beta blockers: Commonly prescribed for high blood pressure and heart disease, beta blockers suppress adrenaline receptors, slowing heart rate and reducing exercise tolerance. Beta blockers can cause weight gain.
  • Clenbuterol and Corticosteroid inhalants: Clenbuterol is a bronchodilator that has properties similar to adrenaline, It revs up basal metabolic rate and increases aerobic capacity, but it can also cause anxiety and insomnia, and may initiate a heart attack. Inhaled corticosteroids for asthma are known to cause weight gain. 
  • Anti-allergens like Zyrtec and Allegra: Used to treat seasonal allergies, they tend to stimulate appetite, and can therefore cause weight gain. Your client may not list these meds because they can be bought without a prescription. If your client can’t lose weight, ask if they are taking allergy meds. 
  • The Depo shot (medroxyprogesterone acetate): A convenient form of birth control, substantial weight gain is a common side effect. 
  • Statins like Lipitor: Statins are often prescribed for high cholesterol. They are known to increase muscle soreness and reduce performance. Recent research reveals that statins can increase the risk of Type 2 diabetes, promote premature aging, and increase muscle pain. Statins have been linked to rhabdomyolysis during intense exercise, a condition where muscle cells break down and release myoglobin into your system, which in turn can cause kidney failure and death. 
  • NSAIDs (Non-Steroidal Anti-Inflammatory Drugs): These over-the-counter analgesics, including ibuprofen and naproxen, are probably the most common meds taken by gym goers. They should not be taken longer that three days in a row, but many people take them daily for months or even years. They can be harmful to the liver, kidneys, and GI tract, and can increase the risk of heart attack. 

The Trainer’s Responsibility

When reviewing your client’s health history, take special note of listed meds. Go online and research their side effects, and take them into consideration when programming. Educate your clients about the risks, and encourage lifestyle changes that address their condition. Never tell your client to stop taking prescription meds; it can make you legally liable for any negative consequences. However, you can encourage your client to discuss concerns about side effects with their health care provider. 

Resources

To build a successful fitness career, increasing your knowledge about health issues is a must. You cannot help your clients if you do not understand their medical conditions, and how drugs affect their performance. As always, W.I.T.S. has valuable resources to help you grow. Consider a certification in Older Adult Fitness, or get continuing education credits with Essentials of Diabetes and Prediabetes, Introduction to Cardiovascular Disease and Exercise, or any of our other MFEF courses.

We are sponsoring the CI track again this year too.

SPECIAL FOR BLOG READERS!  Join us at the Club Industry Business Conference this October 23-25th. Get CEC’s for W.I.T.S. too. As a blog reader and follower, you can use this PROMO CODE: “SAVE25” for $125 OFF the registration! Here is the link so see you in Chicago! . http://www.clubindustryshow.com/National2013/Public/Content.aspx?ID=1044377

 

 

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3 Things To Know When Working With Diabetic Clients

3 Things to Know When Working with Diabetic Clients

By: Fitness Learning Systems

 

  1. Symptoms of Hypoglycemia

Prevention of hypoglycemia is important for a safe exercise program for someone who has diabetes. Anyone taking insulin or an oral medication that may cause hypoglycemia should be aware of symptoms and how to manage this situation especially during exercise. Hypoglycemia occurs when glucose levels are < 70mg/dl.  This condition may become worse if not treated. Prevention is the best intervention.

Symptoms may include: (more…)

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Identifying Special Populations: Carve Out Your Niche to Grow Your Business!

As more Personal Trainers are certified every day and gym owners conspire to keep wages low, you may find yourself wondering whether you can survive with a fitness career. But like any other business, when the competition gets tough and the market gets crowded, it is time to think like a Marine:

Improvise, adapt and overcome!

(more…)

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Lose Weight and Improve Your Health with hCG

Being overweight at any stage in life poses physical and emotional health challenges for both men and women. Besides the social stigma of obesity that leads to body shaming and self loathing, there are practical matters that lead to embarrassment, like sitting on an airplane or taking public transportation, finding flattering and comfortable clothing, going through turnstiles or sitting at a school desk. (more…)

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Fabulous Foods that Fight Inflammation

Chronic Inflammation


Chronic inflammation is a common but serious condition that can lead to obesity, diabetes, heart disease and depression. In essence, it is an ongoing state of metabolic turmoil that your immune system identifies as infectious. To fight off the perceived threat, your body produces mononuclear white blood cells to surround and attack the invaders, causing low-grade swelling and inflammation throughout your body. With nowhere to go, and no actual invaders to attack, the white blood cells may eventually start attacking internal organs or other necessary tissues and cells.

Causes

The typical American lifestyle is often busy and stressful. Maintaining high levels of stress over long durations of time has been found to change gene activity in the immune system that triggers an inflammatory response. Chronic overeating, too much sugar, high fructose corn syrup, refined grains, processed foods and excessive alcohol consumption may also trigger chronic inflammation. Inflammation is linked to depression and difficulty sleeping, which can increase stress, creating a vicious cycle. A 2015 study in “JAMA Psychiatry” found that people with depression had 30 percent more brain inflammation than those who were not depressed.

Solutions

Regular physical activity and intermittent fasting have been shown to reduce inflammation. A reduced calorie whole foods diet like the Mediterranean diet, with high vegetable consumption and limited meat and dairy positively effects inflammation reduction. Stress management may be the most beneficial way to reduce inflammation. Stress is often linked to overeating and excess alcohol consumption. Daily meditation, mind-body exercise like yoga, qigong and tai chi, spending time in nature, and lifestyle changes that allow time for rest and recreation will reduce stress and benefit your health over the long run.

Foods that Help


To reduce inflammation, choose whole foods with protective antioxidants and polyphenols like green leafy vegetables, tomatoes, apples, berries, watermelon, pineapple, nuts, fatty fish like salmon and sardines, coffee and red wine. Use organic coconut oil and cold pressed virgin olive oil for cooking. Avoid refined grains, sugar, fruit juice and soft drinks, refined vegetable oils, margarine, shortening, deep fried foods and processed meats. Eat butter, eggs and other animal products from sustainable organic pasture-raised sources.

Resources

Healthy nutrition goes hand-in-hand with physical fitness. As the saying goes, “You can’t out-train a bad diet.” Whether you want to learn the basics or keep up with the latest, W.I.T.S. has course offerings to meet your needs. Bite into the basics with Certified Personal Trainer or Lifestyle Fitness Coaching. Take a stab at Nutrition Concepts or Sport and Exercise Nutrition. Dig into Pregnancy Fitness or Older Adult Fitness Foundations. Feed your brain with continuing education from any of our awesome CEC bundles!

References

Bruun, JM et al. (2006). Diet and exercise reduce low-grade inflammation and macrophage infiltration in adipose tissue but not in skeletal muscle in severely obese subjects. American Journal of Physiology – Endocrinology and Metabolism, 290(5), 961-967.

EurekAlert!: New biological evidence reveals link between brain inflammation and major depression (2015, January 28). Retrieved from: https://www.eurekalert.org/pub_releases/2015-01/cfaa-nbe012615.php.

Foods that fight inflammation (2015, October 26). Harvard Health. Retrieved from http://www.health.harvard.edu/staying-healthy/foods-that-fight-inflammation

Images courtesy of freedigitalphotos.net: marin; marcolm; Surachai.

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Prevention of Cognitive Decline and Alzheimer’s- Part 2

Adapted from the Specialist Certificate Program by Alzheimer’s Research and Prevention Foundation.

(Article 2 in a 3-part series about Alzheimer’s disease.)

 

In the previous article, it was noted that:

  • although there are natural physiological changes that occur with age, memory loss is neither normal nor a natural process of aging.
  • there is no medication at this time that cures fatal Alzheimer’s disease, so prevention is the best line of defense against the disease.
  • exercise plays a very important role in prevention of cognitive decline and brain health.

 

Through many years of research, the Alzheimer’s Research and Prevention Foundation has determined a four-part program to use in the prevention, delay, and treatment of cognitive decline and Alzheimer’s disease.  This program is called “The 4 Pillars of Alzheimer’s Prevention.”

 

Recent research, some of which was sponsored by ARPF, supports the notion that lifestyle interventions can help decrease chances of developing memory loss and possibly help prevent Alzheimer’s disease. Medical findings support the correlation between positive lifestyle changes and prevention of certain diseases, such as cancer and heart disease. The same relationship is being examined and assumed positive with respect to Alzheimer’s disease. The basic concept behind the ARPF is that it is important to take a proactive, integrative approach to assist in preventing cognitive decline and Alzheimer’s disease.

 

Pillar 1: Diet

 

Diet is critical to the brain’s health. Prevention starts with smart diet and positive lifestyle changes that can influence the health of your cells and your genes.  One of the best ways to feed the brain for better memory is to avoid a diet high in trans-fat and saturated fat. These fats can be found in animal products, such as red meat, and can cause inflammation. This type of diet can also produce free radicals, which are a normal by-product of body metabolism. However, in high quantities, they can damage and even kill valuable, functioning brain cells.

Eating foods that are high in antioxidants, such as those rich in Vitamin C and E, is an effective way to eliminate free radicals from the body. Scientists believe that consuming a vast intake of fruits and vegetables, fish, which is rich in omega-3 oils, and a vegetarian protein substitute, such as soy, can be protective against memory loss.  Supplements prescribed by a healthcare professional can also be beneficial.

 

Pillar 2: Stress Management

 

Stress management has many positive benefits, including improved physical and cognitive performance, lower blood pressure, improved heart function, reduced anxiety, less chronic pain, and even increased longevity.

 

Learning to balance daily stress is a vital part of any Alzheimer’s prevention strategy. Studies have shown a strong correlation between having elevated cholesterol, blood pressure, and/or high cortisol levels and the onset of Alzheimer’s disease. Stress has been found to be a common key factor in all of these conditions.

 

Cortisol, the stress hormone, plays a role in memory. Normal cortisol has no effect on the hippocampus (part of the brain where memories are processed and stored); however, excess cortisol overwhelms the hippocampus and actually causes atrophy in this area of the brain. Elevated stress levels play a role in cognitive impairment and even the development of dementia and Alzheimer’s disease. Stress is therefore not only a direct risk factor for Alzheimer’s, but indirectly affects other Alzheimer’s risk factors, such as diabetes, thyroid dysfunction, and cardiovascular disease.  Stress-management techniques such as meditation, deep breathing, yoga, and many other relaxation techniques have been found very valuable in alleviating stress. A specific type of meditation developed by the ARPF called Kirtan Kriya is a brain aerobic exercise that works to reduce stress responses.  You can learn more about the technique at www.alzheimersprevention.org.

 

Pillar 3: Physical and Mental Exercise

 

Both physical and mental exercise have been found in research to be important in prevention and treatment of AD. Physical exercise is discussed in article 3 of this 3-part series and is covered extensively in the ARPF Specialist Certificate Course: Exercise Prescription for Alzheimer’s Prevention and Intervention. This article will look at mental exercise and prevention.

 

Neurologists report that mental exercise can help reduce the chance of developing Alzheimer’s disease by up to 70%. Brain Aerobics are activities that challenge the brain with tasks that are new and different. These novel tasks challenge the brain and function can be improved. It is recommended to spend at least 20 minutes, three times a week doing mental exercises. Examples of brain aerobics include reading, writing, playing board games, and doing crossword puzzles. Brain aerobics exercises do not have to be complex. They can be done at any time and any place.

 

Pillar 4: Spiritual Fitness

 

Increased consciousness and cognition is the final purpose and frontier of Alzheimer’s prevention. Spiritual Fitness may also contribute to brain health and is a proven defense against Mild Cognitive Impairment (MCI) and even Alzheimer’s. Spiritual fitness contributes directly to your ability to maintain a high level of mental function as you age.

 

Spiritual fitness is the combination of attributes of:

  • psychological well-being (such as contentment, socialization, and having a purpose or mission in life)
  • combined with spiritual well-being (includes service to others and the ongoing search for peace of mind).

 

Aspects of Spiritual Fitness include:

  • Socialization or being with like-minded people
  • Acceptance and forgiveness of yourself and others
  • Patience and allowing yourself to be in the moment
  • Compassion and empathy towards yourself and others
  • Purpose or meaning in life via self-discovery and building your legacy
  • Sense of spirituality, regardless of origin or religion, which makes you happier
  • Volunteering or service without thought of self-reward is a very beneficial, life-affirming act

 

Current research suggests that some of the most striking brain benefits of Spiritual Fitness are:

  • Reversal of amyloid plaque in the brain, which may increase risk of Alzheimer’s
  • Improvement in your genes via healthier telomeres
  • Slowing of Alzheimer’s progression

 

For more information about Prevention of cognitive decline and dementia, visit the ARPF website at www.alzheimersprevention.org.

 

The information in this article is taken from the “Introduction to Alzheimer’s Disease” course, the first course in a two-course 11 hour Medical Fitness Specialist Certificate Program: Alzheimer’s Disease Prevention and Intervention. Stay tuned for additional information about exercise and prevention of Alzheimer’s.

 

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Sugar Cane: Diabetes and Joint Pain

It’s Complicated

knee-joint
When thinking about Type 2 Diabetes, it is important to remember that it is really a symptom and not a disease. Type 2 is directly related to lifestyle behaviors including nutrition, hydration and physical activity. In most people with Type 2, other symptoms coexist, including obesity, high blood pressure, high circulating triglyceride levels and an increased risk for stroke and heart disease. This cluster of symptoms is often referred to as Metabolic Syndrome. Recent research suggests that osteoarthritis is also closely linked to Type 2 Diabetes and Metabolic Syndrome.

Making the Connection

A common markers for Metabolic Syndrome is inflammation. Inflammation is an immune response to harmful substances in the body. Just as a soft tissue injury or a bacterial infection leads to swelling, or inflammation, unwanted substances circulating in your bodily fluids attract anti-inflammatory agents to fight them off. Because your joints, especially your knee joints, are surrounded by synovial fluid, they are a ripe target for inflammation that leads to pain and disability.

Treatment vs Cure

pills

Osteoarthritis is usually treated with either opioid pain killers, nonsteroidal anti-inflammatory drugs, or NSAIDS, like aspirin, ibuprofen, naproxen and celecoxib, or analgesics like acetaminophen. Injections of corticosteroids help reduce joint inflammation, and hyaluronic acid can be injected to supplement that found naturally in synovial fluid, but which appears to be broken down in patients with osteoarthritis. However, pain management does not lead to a cure for osteoarthritis.

Interventions

fruits-and-veggies
The best way to treat joint pain, along with Type 2 diabetes and the other elements of metabolic syndrome is to overhaul your lifestyle behaviors. Becoming physically active on a consistent daily basis will get the ball rolling quickly. The American College of Sports Medicine recommends 30 to 75 minutes daily of moderate to vigorous cardiovascular exercise, along with at least two bouts of total body resistance training weekly. Switching out soft drinks and other beverages for plain filtered water will lower sugar consumption. Modifying your diet by eliminating refined carbohydrates and replacing them with whole fresh vegetables and fruits will help you lose weight and reverse metabolic syndrome.

Resources

Our goal at W.I.T.S. is to provide our fitness professionals with all the resources necessary to meet your clients’ needs. For professional growth, be sure to keep current with Continuing Education. We offer courses ranging from Fitness to Sales and Marketing to Business Management. Consider making yourself more marketable by earning an additional Certification such as Personal Trainer Certification, Older Adult Fitness Specialist, Group Exercise Instructor Certification, Youth Fitness Certification, Lifestyle Fitness Coaching or Fitness Management. To help your diabetic clients, zero in on our numerous Nutrition courses, and courses focused on Special Populations. And remember to get your Digital Badge, so all your friends and contacts on Social Media will know that you are a dedicated fitness professional.

References

Kim, DD (2001). Diabetes and Your Joints. Clinical Diabetes, 19(3),136.

Mayo Clinic Staff. Bone and joint problems associated with diabetes. http://www.mayoclinic.org/diseases-conditions/diabetes/in-depth/diabetes/art-20049314

Rosario, M and Azevedo, I (2010). Chronic inflammation in obesity and the metabolic syndrome. Mediators of Inflammation, 2010.

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Sugar Lumps: Diabetes and Obesity

Hand in Hand

chubby-woman
The link between obesity and Type 2 Diabetes is irrefutable, and as Americans continue to gain weight, the incidence of diabetes is rising. Recent statistics suggest that normal weight people have become a minority in the United States, with 30 percent of us being overweight, and another 34 percent being obese. Diabetes has risen along with the increase in body weight, affecting roughly 11 percent of all adults over age 20.

High Risk

According to the Harvard School of Public Health, 85 percent of all diabetics are overweight or obese. Researchers point out that diabetes is a symptom, rather than a disease, noting several factors that play a role. Genetically, humans are efficient at storing energy as fat. This harkens back to times of feast or famine, where our ancestors went for long spells with little or no food. When food was available, they made up for the hungry season, feasting and storing excess food as fat.

The Stress Connection

stressed
Stress is another cause of Type 2 Diabetes. Chronic stress puts us in a perpetual “fight or flight” stage that elevates circulating blood sugar. Stress is often accompanied by poor sleep, overeating and drinking excessive alcohol, all of which contribute to diabetes symptoms. Even very thin individuals can exhibit signs of diabetes when living in a constant state of stress.

Taking Action

The great news is that Type 2 diabetes is reversible, and the condition is immediately responsive to lifestyle interventions. Regular moderate to vigorous exercise performed for at least 30 minutes daily is a good place to start. Find something you enjoy, like walking on the beach or in a park. Replace soft drinks and juices with plain filtered water, or add a slice of lemon, lime or cucumber for flavor. Avoid refined carbohydrates like flour, rice and other refined grains. Stick to fresh produce and organic sources of protein for your daily meals.

Resources

Our goal at W.I.T.S. is to provide our fitness professionals with all the resources necessary to meet your clients’ needs. For professional growth, be sure to keep current with Continuing Education. We offer courses ranging from Fitness to Sales and Marketing to Business Management. Consider making yourself more marketable by earning an additional Certification such as Personal Trainer Certification, Older Adult Fitness Specialist, Group Exercise Instructor Certification, Youth Fitness Certification, Lifestyle Fitness Coaching or Fitness Management. To help your diabetic clients, zero in on our numerous Nutrition courses, and courses focused on Special Populations. And remember to get your Digital Badge, so all your friends and contacts on Social Media will know that you are a dedicated fitness professional.

References

American Diabetes Association: How Stress Affects Diabetes
http://www.diabetes.org/living-with-diabetes/complications/mental-health/stress.html

Harvard Gazette: Obesity? Diabetes? We’ve been set up.
http://news.harvard.edu/gazette/story/2012/03/the-big-setup/

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Sugar Blues: The Link Between Diabetes and Depression

The Sad Truth

hot-sad-guy
Type 2 Diabetes Mellitus is a lifestyle related disorder involving many factors. Low physical activity, poor dietary choices, stress and poor sleep habits can all contribute. Depression is considered a co-morbidity of diabetes, meaning they often occur simultaneously. Without intervention, the combination can become a relentless downward spiral, with depression plunging you further into negative behaviors, and they in turn contributing to more severe diabetes symptoms.

Chicken or Egg?

Researchers still do not fully understand which comes first, depression or diabetes. But they do know that people with diabetes are twice as likely to suffer from depression, and that people with depression are more likely to develop diabetes. What’s more, a 2011 study suggests that people with diabetes and depression are 82% more likely to suffer a heart attack. It is thought that changes in brain chemistry associated with high blood sugar may lead to depression.

Signs of Depression

There are many signs and symptoms experienced by people with depression. Insomnia or sleeping too much, no longer finding pleasure in things you once enjoyed, difficulty concentrating, overeating, anxiety, sadness, self-loathing and lethargy are just a few. If you think you may be depressed, counseling and pharmaceutical interventions are common treatments. However, drugs address the symptoms without rooting out the cause.

Fixer-Upper

beach-couples
Because depression and diabetes are both responsive to lifestyle behaviors, you can take steps today to improve both conditions. Exposure to natural sunlight increases the production of serotonin, a mood-boosting hormone that can help you feel calm and focused. Serotonin also improves sleep. According to the American Diabetes Association, sunlight also helps fight diabetes and obesity by boosting Vitamin D stores. Changing your diet to include more fresh whole foods and reducing refined carbohydrates can improve insulin sensitivity and lower blood sugar. Regular daily moderate to vigorous exercise can reduce depression and reverse Type 2 diabetes.

Resources

Our goal at W.I.T.S. is to provide our fitness professionals with all the resources necessary to meet your clients’ needs. For professional growth, be sure to keep current with Continuing Education. We offer courses ranging from Fitness to Sales and Marketing to Business Management. Consider making yourself more marketable by earning an additional Certification such as Personal Trainer Certification, Older Adult Fitness Specialist, Group Exercise Instructor Certification, Youth Fitness Certification, Lifestyle Fitness Coaching or Fitness Management. And remember to get your Digital Badge, so all your friends and contacts on Social Media will know that you are a dedicated fitness professional.

References

American Diabetes Association: Soak Up the Sun: Catching Rays May Work Better Than Taking Vitamin D to Prevent Obesity
http://www.diabetes.org/research-and-practice/patient-access-to-research/soak-up-the-sun-catching-rays-may-work-better.html

Healthline: Is There a Link Between Diabetes and Depression? Know the Facts.
http://www.healthline.com/health/type-2-diabetes/depression#Overview1

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Sugar Rush: How a High-Carb Diet Leads to Diabetes

The Curse of Carbs

baked-goods
When you think of carbs, you probably think of bread, cookies and cakes. But carbohydrate foods include fruits, vegetables, and whole grains as well. When broken down in your digestive tract, glucose is extracted from carbohydrate foods and enters your bloodstream, to be carried to your cells for energy. The difference between a piece of bread, for example, and a sprig of broccoli, is the degree to which the food has been broken down before entering your digestive system. Processed and refined foods yield up their glucose quickly because they are already partially broken down, while whole foods take longer to digest and glucose is released more gradually.

Insulin Resistance

When a large amount of sugar enters your bloodstream, a message is sent to your pancreas to produce more insulin. Insulin works like a key to open the doors of your cells to allow glucose to enter. When there is no immediate energy demand, the cells can store glucose in the form of glycogen. However, the cells’ capacity for glycogen storage is limited. Excessive carbohydrate consumption coupled with a sedentary lifestyle maxes out your cells’ storage capacity. Even when adequate insulin is available, the cells cannot store any more sugar, and elevated sugar levels continue to circulate until they can be eliminated via the kidneys. Eventually, cells become insulin resistant, the early stages of Type II diabetes, and the kidneys are taxed by the excess sugar load.

Acute Response

fit-asian-girl-w-apple
As dismal as the situation may seem, the scenario is easily reversed in its early stages. In fact, during your very first workout, as cells become depleted of stored glycogen, they immediately become more sensitive to insulin, since there is now room to store more glucose. Regular frequent workouts, coupled with reduced carbohydrate consumption, can help normalize cellular insulin sensitivity and reduce circulating blood sugar to normal levels. Regular workouts also promote fat metabolism and reduce inflammation associated with metabolic syndrome.

Change for Life

veggies
The best way to reverse and prevent Type 2 Diabetes is to stay active and eat clean. According to the American College of Sports Medicine, or ACSM, you should perform a minimum of 150 minutes a week of moderate-to-vigorous aerobic exercise, coupled with challenging resistance training at least twice per week. In fact, there is some evidence that resistance training may be more beneficial than aerobic exercise, since it relies almost exclusively on glucose for energy production. A whole foods diet centered on fresh vegetables, along with fruits in moderation, will minimize simple carbohydrates and promote normal blood sugar. Use whole grains sparingly, and use moderate amounts of nuts and seeds as alternatives to chips and other snack foods. Foods like sardines, avocados and coconuts give you healthy fats for energy and suppress carbohydrate cravings.

Resources

Our goal at W.I.T.S. is to provide our fitness professionals with all the resources necessary to meet your clients’ needs. For professional growth, be sure to keep current with Continuing Education. We offer courses ranging from Health and Fitness to Sales and Marketing to Business Management. Consider making yourself more marketable by earning an additional Certification such as Personal Trainer Certification, Older Adult Fitness Specialist, Group Exercise Instructor Certification, Youth Fitness Certification, Lifestyle Fitness Coaching or Fitness Management. And remember to get your Digital Badge, so all your friends and contacts on Social Media will know that you are a dedicated fitness professional.

References

American College of Sports Medicine: Exercise Can Help Tame Type 2 Diabetes, Say New Guidelines.
http://www.acsm.org/about-acsm/media-room/acsm-in-the-news/2011/08/01/exercise-can-help-tame-type-2-diabetes-say-new-guidelines