So, pushing for maximum flexibility should be our constant goal, right? Not necessarily. There is a particular period of time when attempting to train our muscle tissue for maximum elongation can be a bad idea. This time generally consists of the first 24 to 72 hours following muscular or tendonous trauma.

Remember when coaches would tell athletes who had twisted an ankle or knee to “Run it off”‘? We now know that was very bad advice. But, by the same token, we are repeating that same detrimental line of thought when we suggest trying to “stretch out” an area of the body where some pinpointed discomfort is occurring.

Regardless of the mechanism of injury, e.g., muscle strain or pull, joint sprain or hyperextension, one thing is common in any tearing of tendonous or muscular tissue, and that is hemorrhaging (bleeding). Whether it is micro or massive tissue trauma, the bleeding that occurs is not unlike when we scrape or cut our skin. As the blood forms over the wound, it produces a protective scab until the healing process can take place, producing new skin.

The bleeding from trauma to a muscle or tendon does not necessarily form a scab like the one we see on top of the skin. However, there is a coagulation of blood and a spasming of tissue as the body attempts to protect itself from further damage until the healing process can take place. When this happens, a passive-or possibly even active-range of motion may be warranted, but stimulating the stretch reflex to maximum endpoint can induce further trauma.

Let’s create a scenario. A firefighter feels a slight discomfort in a hamstring after a drill. He may complain of tightness and feel that if he could just stretch it out a little bit it would improve. So he does, and, for the time being, it does feel better. At this point, he is doing pretty well, or maybe experiencing a minor cramp.

Later, we see him trying to stretch out that hamstring again. However, this time the dull ache or slight burning sensation does not subside. All of this indicates that an injury has occurred and continued stretching is contraindicated. The muscle/tendon is resisting efforts to elongate and is sending a pain message to the brain. Don’t ignore it. Instead, curtail activity, ice the body part and consult your trainer.

With respect to prenatal resistance training, however, the information is limited. Once a woman becomes pregnant it may be difficult for her to find approval for beginning such a program. Therefore this article offers a different perspective on exercise and pregnancy, a philosophical perspective focusing on when a woman should train for this important time of life. It is not within the scope of this perspective to address specific exercise prescription.

I often discuss exercise programs with women who suddenly become motivated to begin exercising when they first learn they are pregnant. Although they’re somewhat apprehensive, I encourage them to feel at ease with an appropriate prenatal program because research supports this idea. Furthermore, it has been established that exercise during pregnancy can result in benefits¹. My position, however, is that women should train for pregnancy before becoming pregnant. Then the prenatal classes could be more appropriately used as part of a maintenance program throughout gestation.

Pregnancy is accompanied by substantial physiological and morphological changes: increased metabolic rate and heat production, as well as decreased cardiac output, A-VO2 difference, and proprioception have been reported ^3,4,6,8,9. Because of this, prudent modifications of the guidelines for designing a general fitness program have been suggested for women who have no complications during pregnancy ². Further modifications should be considered, even to the point of curtailing the program, for women with certain medical or obstetric conditions ¹.

In summary, what we’ve learned from the research is that it is all right, even beneficial, to
exercise during pregnancy. The suggested modifications are simply a way to contend with the natural limitations of the body. The key phrase here is natural limitations of the body. Wouldn’t it be more wise to train prior to conception when a woman would be free of any limitations?

At the risk of arguing semantics, I have substituted “exercise” during pregnancy with “training” prior to conception. The concept of training more clearly defines intent. In terms of pursuing an objective, the elite athlete training to overcome the opponent is similar to the average individual training to overcome the effects of a sedentary lifestyle. It is this establishment of the objective that leads to the development of a prescription of exercise specific to the endeavor or event.

Likewise, a pregnant woman faces continual physiological and morphological opposition throughout her pregnancy. Wouldn’t a training program specific to preparing for these changes seem logical? In addition to the philosophical aspect of “training” versus “exercise” is the even more important issue of intensity.

A specific training program infers work at a greater intensity. Granted, the research now suggests there is no indication that pregnant women need to limit their exercise intensity ¹. However, intensity usually refers only to the cardiovascular consideration. It seems rather imprudent to ignore the question of intensity for resistance training. I would hope that competitive athletes do not assume they can continue their normal resistance training intensity during pregnancy.

Additional support for training prior to conception comes from concern about the thermoregulatory response. Artal and others ³ have presented information that the effects of exercise on core body temperature during pregnancy are limited. What is more clearly understood is that fit individuals are better able to regulate their core body temperature ¹.

Referring once again to the physiological and morphological changes during pregnancy, there are reasons that limit the ability as well as the desire to exercise at an intense level during pregnancy. Non-weight-bearing activities have proven to be successful alternatives for maintaining a high – intensity , moderate – duration regimen of exercise training throughout the third trimester ^5,7. However, pregnancy itself is a weight-bearing activity that increases in intensity for 9 months.

Finally, just what level of conditioning is really necessary? Much of that answer depends on your preexisting level of conditioning. Obviously, the worse condition you are in, the less work you have to do to derive a benefit.

Another way to address this question is in terms of specificity. Can the prenatal exercise program effectively prepare the musculature of the legs, back, and pelvic region to support the additional 20 to 35 lbs, indeed often as much as 40 to 50 additional lbs? Can a woman be prepared to generate the maximal effort required during delivery-repeatedly, often for many hours? Does the prenatal regimen offer her body an opportunity to learn to replace glycogen stores and buffer lactic acid production efficiently?

Just because childbirth is nothing new does not mean we should be remiss in seeking a better way for the sake of women’s wellness.

As an exercise physiologist who trains clients within the scheme of periodization, I feel the value of prenatal exercise classes is that of maintenance rather than a building phase. My philosophy is simply to be as physiologically prepared as possible for any endeavor in life. Ideally, an exercise prescription that is tailored to the individual should be designed to account for her exercise history and lifestyle. This preparation specific to the objective is most logically and prudently achieved prior to conception; afterward, a prenatal exercise prescription should focus on maintenance throughout pregnancy.

1. American College of Obstetricians and Gynecologists. Exercise During Pregnancy and the Postpartum Period. ACOG Technical Bulletin #189. Washington, DC: ACOG, 1994.

2. Artal, R. D.I. Masaki, N. Khodiguian, Y. Romem, S.E. Rutherfod, and RA. Wiswell. Exercise prescription in pregnancy: Weightbearing vs. non-weight bearing exercise. Am. J. Obstet. Gynecol 161:1464-1469. 1989.

3. Artal Mittelmark, R. RA. Wiswell, and B.L. Drinkwater, eds. Exercise in Pregnancy (2nd ed.). Baltimore: Williams&Wilkins, 1991.

4. Artal, R. R Wiswell, Y. Romem, and F. Dorey. Pulmonary responses to exercise in pregnancy. Am. J. Obstet. Gynecol 154:378-383. 1986.

5. Clapp, J.F. III, and S. Dickstein. Endurance exercise and pregnancy outcome. Med. Sci. Sports Exerc. 16:556-562. 1984.

6. Clark, S.L, D.B. Cotton, J.M. Pivarnik, W. Lee, G.D.V. Hankins, T.J. Benedetti, et al. Position change and central hemodynamic profile during normal third-trimester pregnancy and post partum. Am. J. Obstet. Gynecol. 164:883-887. 1991.

7. Collings, C.A., L.B. Curet, and J.P. Mullin. Maternal and fetal responses to a maternal aerobic exercise program. Am. J. Obstet. Gynecol 145:702-707. 1983.

8. McMurray, R.G., A. C. Hackney, V.L. Katz, M. Gall, and W.J. Watson. Pregnancy-induced changes in the maximal physiological responses during swimming. J. Appl. Physiol. 71:1454-1459. 1991.

9. Pivarnik, J.M., W. Lee, S.L. Clark, D.B. Cotton, H.T. Spillman, and J.F. Miller. Cardiac output responses of primigravid women during exercise determined by the direct Fick technique. Obstet Gynecol 75:954-959.1990.

Gregory L. Welch is an exercise physiologist and president of SpeciFit, an agency of wellness and competitive performance enhancement in Seal Beach, California.

Because you are working one on one, you can further the wellness of older adults by translating the benefits of general exercise into a program specific to “real-life function.” The more information you can acquire from individuals regarding their specific needs, the better you can customize their exercise programs.

Of course, any older client will require medical clearance. Take careful notice of any training restrictions the physician may indicate, and telephone the physician if you have any questions.

Real-Life Function

One of the more striking characteristics of the aging process is impaired motor performance (Wiswell et al.1990), which is demonstrated in the slowing of movements, the loss of fine coordination and a decrease in maximum strength. Training for real-life function as I’m using the term means helping clients regain or improve their ability to stand up, sit down and maintain general independence. These activities require coordination, synchronization and a certain amount of strength.

Functional tasks can range from the simplest self-care to executive-level occupational responsibilities (Reuben & Solomon 1989). To help clarify the description of these tasks, three categories of function have been defined:

Basic Activities of Daily Living (BADL) include bathing, eating, dressing, using the toilet, transferring from one place to another, and walking.

Intermediate or Instrumental Activities of Daily Living (IADL) include such tasks as cooking, shopping and light housework.

Advanced Activities of Daily Living (AADL) are recreational, occupational or community service functions.

The older client most often seen by the personal trainer will generally range between the IADL and AADL categories.

Evaluating Functional Ability

Analysis of functional ability does not require a lot of statistical normative data. Older adult clients are the least concerned about how they compare to the norm. Instead, they are very concerned with their own progress, which you can record and report.

When designing an exercise program for older adults, you can address functional tasks in the interview phase. You can usually determine clients’ levels of independence by simply asking them about their ability to get out of bed, dress, prepare meals, shop and perform other daily activities.

A lot of information can also be acquired through observation of functional mobility. Does the person need assistance getting up from the floor or from a bench? Make your observations part of your notes.

Even if you are unsure of the individual’s basic functional capabilities, using the typical screening tests considered it standard in our industry, such as the step test or bike ergometer, may actually be putting the cart before the horse. An older adult may not score well on a simple step test due to nonspecific joint pain, an inflamed tendinous attachment or muscle cramping-all of which are common in a deconditioned older adult.

Failing to complete the test makes the client feel worse. He or she may even leave the test facility in pain, which may increase the next day. After going to all this trouble, the trainer still doesn’t have any more information, and may end up with one less client.

Prior to administering any standard test of muscular strength, endurance or flexibility, it is prudent to ascertain total body active range of motion or mobility. Begin with single-joint movements (shoulder flexion, extension, abduction and adduction) and progress through multijoint actions (shoulder flexion simultaneous to internal rotation and scapular elevation). By observing the movement, you can identify discomfort, immobility and perhaps muscle weakness within these ranges of motion.

Next, you can hand the client a very light weight, such as a one-pound dumbbell, and ask her or him to repeat the above movements. Gradually increase the resistance, and observe carefully. You may observe a number of things:

1. If there is a limit to the range of motion, it may indicate joint intolerance (Hyatt 1994). There can be so much intolerance that the muscle can’t overcome it and range of motion will be stopped. If you suspect joint intolerance (possibly due to an arthritic condition), refer the client to an appropriate medical professional for further evaluation.

2. If the client can move through a full range of motion without pain, but has difficulty raising the arm with a specific resistance (indicated by the muscle “quivering”), the problem is more likely muscle weakness. Observation will help you determine what level of resistance to begin with. The weight of the body part alone may be sufficient to begin the training program.

3. The client may feel strain or discomfort, which you can identify by her or his facial expression. Or the client may
move the joints through the range of motion without discomfort, but then the following day she or he may feel pain (a classic symptom of people who do too much too soon). To determine if this is the case, you can ask, “After what we did yesterday, do you feel any discomfort?” Be conservative with your progression.

It makes sense to determine what issues of motor performance may actually hinder the desired objective of a given test. The priority should be to train the “weak links of the chain” first-and test later.

Disabilities relating to functional instability can range from multisensory deficits (for example, in vision, touch, spatial awareness or hearing) and decreasing proprioception (balance) to diseases such as arthritis, apraxia and pseudobulbar palsy (Tinetti 1986). Parkinson’s disease can also affect a variety of functions, including rising from a chair and stepping. Cerebellar disease can be responsible for instability when turning. Buchner and Larson (1987) relate functional impairments in patients with Alzheimer-type dementia (ATD). Abnormal gait and balance have also been observed in ambulatory patients with ATD (Visser 1983).

Issues In Program Planning

Because assessing individual function is the primary component of program design for older adults, you should immediately eliminate chronological stereotypes. Discriminatory assumptions-such as those that lump older adults between 60 and 70 years old as recreationally active and those over 80 years old as happy just to be able to get off a bus-put an automatic ceiling on potential ability.

Broad Generalizations.

Evans and Rosenburg (1991) state that the measurement of biological age is a calculation that must be done one person at a time, since chronology offers few clues. It is unduly restrictive to make generalizations regarding the older population. Consider the following generalizations:

Elevated Arms: The broad statement that older adults should not raise their arms above their head against any resistance is illogical. Granted, this maneuver can increase blood pressure, but only if the arms are left in that position for an extended period of time. From a biomechanical standpoint, there can be a risk of impingement with a high number of repetitions. However, for anyone who places household objects in overhead cabinets, a shoulder press exercise can be quite helpful for maintaining the integrity of the shoulder joint and the strength of the associated muscles.

Squats: The same perceptual problem seems to exist with the squat. Many fear the squat is too aggressive for older adults. Yet anyone who sits in a chair and stands up again is performing a squatting motion. The squat is arguably one of the most important exercises for functioning in real life.

Muscular Strength

Very few movements are produced by the musculature of one joint without additional musculature working to stabilize the other joints in the body. With the squatting exercise, for example, there is a great deal of work occurring to stabilize the joints in the upper body so the primary lower-body action can continue successfully.

“When very frail people want to exercise, many doctors recommend walking because they think it’s safe. But people who are weak and have terrible balance are likely to fall. They should get strength training before they start walking,” writes Dr. Maria Fiatarone, assistant professor in the Division on Aging at Harvard Medical School. A walking program is best performed after the body has been prepared to sustain the activity.

Falls and Gait Instability

These are among the most serious problems facing the aging population. Accidents are the fifth leading cause of death in people age 65 and older, and falls constitute two thirds of these accidental deaths (Rubenstein 1988). One study of persons 75 years of age and older suggested that the predisposition to fall may result from the accumulated effect of multiple disabilities. Even the “fear of falling” has been reported as a viable cause of falling (Tinetti et al. 1988).

Measuring a full gait cycle is an excellent way to ascertain information about real-life function. One way to measure stride length is to wet the feet, ask the person to walk and then measure from the point of heel strike of one extremity to the point of heel strike of the same extremity, which constitutes one full gait cycle. (Normal stride length averages 1.5 meters [not quite five feet]. Remember, do not be too concerned about the norms. What matters is the individual’s performance.)

A decreased stride length most likely reflects instability or muscle weakness during support of the opposite leg (Trueblood & Rubenstein 1991). Again, stabilization becomes crucial in the performance of a primary action. Assisted squatting would be highly appropriate, and step-up and balancing exercises would also be helpful.

For example, if your client has difficulty standing on both feet, that’s the base level skill to improve. Progress to swaying right to left, then to holding a small stride and rocking back and forth to work on balance. Then progress to standing on one leg next to a stable object she or he can grab, then practice doing a heel lift.

Another consideration is the speed of the normal gait pattern. According to Visser (1983), the gait pattern slows five to 15 percent due to aging. This is an important consideration in real life when, for example, an older adult needs to cross the street within the time permitted by a stoplight.

As personal trainers, we are at a tremendous advantage working one on one with the older adult. It’s most important for all of us involved with this population to share information. Then and only then can older adults count on real-life fitness programming.

Case Study

The Client:

Billie S. is a 74-year-old with Parkinson’s disease.

During the interview, I ascertained that Billie’s current category of function was between BADL and IADL. Parkinson’s disease obviously furthered her already sedentary lifestyle. She was also contending with mild hypertension and osteoporosis.

However, the most important information I acquired in our initial discussion was that Billie was afraid. She had a fear of walking outside and of climbing stairs. As with many older adults, her real fear was of falling. Plus, the fatigue and muscular rigidly of Parkinson’s decreased her hip and knee flexion and ankle dorsiflexion, making it difficult for her to climb stairs.

The Evaluation:

Physical assessment with Billie began with mobility testing. By giving her various verbal cues, such as, “Reach for the sky” and “Cover up your ears with your arms,” I could begin to identify limitations in voluntary function. Further investigation revealed stiffness in the shoulder girdle, the appearance of a frozen right shoulder, and severe weakness throughout her body.

Billie’s gait pattern indicated severe impairment: Stride length was 25 percent of normal. Step width was greater than normal, which suggested weakness in stabilization of the weight-bearing leg. Step initiation was visibly cautious and resembled a shuffle..

Billie exhibited virtually no arm swing at the shoulder joint, and her elbows remained at approximately 90 degrees of flexion, with her arms drawn close to her torso. Verbal reminders were not sufficient to elicit a correction in arm swing.

Designing the Program:

Billie began a circuit weight training program. The variety of activities in circuit training is very specific to real life. In addition to accommodating a large volume of work in a short period of time, circuit training often allows muscular and metabolic fatigue to occur simultaneously.

Our first goal was strength training to build up Billie’s conditioning level so she could perform cardiovascular training. A secondary goal was to improve her confidence in her ability to move safely.

Billie exercised twice a week for approximately 30 minutes per session.

The circuit program was modified to exclude prone or supine positioning from the floor-or even from a bench- because of her fear of falling when getting up and down. Legs were the predominant focus. Upper-body work was generally performed from a seated position.

We placed a great deal of emphasis on stabilization. Body weight and dumbbells were chosen for this purpose. Balance training was used, progressing to balancing on one leg, and eventually to using the proprioception board. Multi-hip maneuvers (abduction, adduction, flexion and extension) led to a variety of gait patterning.

Billie wore a Polar heart monitor at all times during her workout. (I find the “at-a-glance” reading of the heart rate helpful to track progress as fitness level improves.)

Six-Month Evaluation:

Billie is able to climb three flights of stairs without stopping. This was a primary goal because the walking track is on the third floor. The walking track offers an environment free of obstacles and weather, so she can increase the aerobics component of her program. Her confidence has increased, and she now takes regular strolls outside in the evening with her husband.

There was only a slight improvement in Billie’s stride length. However, heel striking was more definite due to strengthened tibialis anterior muscles (trained by heel walking). Step initiation was also improved due to a strengthened gastrocnemius (trained with heel lifts). The greatest improvement, however, was in step width. Billie’s newfound strength in the hip and pelvis region allowed her to decrease her step width and her upper
body sway.

When reminded, Billie will now let her arms swing. Her cadence is improving, and her shoulders are relaxing. The right shoulder is still limited in active range of motion, but is pain free. She also has pain-free full range of motion with passive movement. The best news is that Billie’s motivation is increasing because her confidence in real-life functioning is increasing.

Circuit Weight Training

The order of the exercise circuit is changed frequently. Billie began with one set of five to seven repetions and either no weight or minimal weight. For example, she initially performed five leg extensions with 10 rounds.

This list shows her current training program. Weight load and repetitions have been gradually increased to this level. While this number of repetitions provides challenge, it is not an intensity that causes muscle failure. Since the training goal is function, muscle failure is not appropriate at this point in the program. Billie uses a combination of free weights and Keiser machines.

Gait Training

2 sets, 20 yds each set:

Initially Billie held onto to me for support. As function improved, she became self-supporting while I walked alongside.

• Toe walking-walking on the balls of the feet with the heels lifted.
  
• Heel walking-contacting just the heels without rolling onto the balls of the feet.
  
• Side walking-stepping to the side, then bringing the feet together.
  
• Carioca walking-crossing one foot over the other while moving to the side.
  
• Back walking-walking backwards.
  
• Line walking-walking along a line on the floor
  
• Foot patterning (square or diagonal, upon command)-stepping to different portions of a quadrant defined by an X drawn on the floor.
  

Gregory L. Welch, MS, is an exercise physiologist and the president of SpeciFit An Agency of Wellness, located in Seal Beach, California. Greg lectures nationally, is on the board of advisors of the Lifespan Wellness Center at California State University at Fullerton, and is a member of the faculty of the American Academy of Fitness Professionals.

The answers to these questions could very possibly alter the thinking as to the use of a weightlifting belt or back brace. Likewise, the following information could lead to a decision not to use a weight belt or back brace at all.

The Function and Benefits of Lumbar Support


Back braces differ from weightlifting belts in the overall objective to support the back. In normal populations back braces are successfully used to offer support in conditions where low back pain reduction is the primary
goal. (1,2) Physical support as well as psychological comfort have been noted with these devices. (3) Even people that have not injured their back often use these corset style braces to assist them in carrying out their everyday lifestyles. It is the rigidity of the brace itself that serves to immobilize the area in a splint-like fashion thus lending support to the lower back. (4,5,6,7)

The weightlifting belt, contrary to popular belief, supports the back in a different manner. While there can be some support due to the rigidity of a weight belt, the benefit is minimal compared to the support offered by the increase in the intra-abdominal pressure (IAP). (8,9,10)

During a normal lifting maneuver such as the squat; the diaphragmatic muscles along with muscles of the torso contract generating pressure on the abdominal cavity. The abdominal cavity together with its predominantly fluid contents, known as the “fluid ball”, are kept under pressure by the surrounding musculature. It is this natural intra-abdominal tension that supports the spinal column. (11) Several studies have shown that weight belts increase intra-abdominal pressure and therefore assist in this natural stabilization mechanism. (3,8,12,13,14) Other studies have shown that increased IAP by use of the weight belt not only relieves the load of the musculature of the lower back, but also reduce the compressive forces on the spinal discs. (15,16,17) Furthermore, it has been reported that the reduction in these compressive forces can be reduced by as much as 50% when utilizing a weight belt. (16,18,19)

Additional benefits exist with the use of the weight belts due to IAP. Subjects demonstrated faster lifting movement (12,13,20) , greater emphasis on hip extension relative to knee extension (12) , as well as greater comfort and sense of support. (12,13,17,20,21)

Potential Hazards of Improper Usage


The use of both weightlifting belts and immobilizing lumbar braces must be observed in terms of their appropriateness. The fact that there are benefits to wearing these devices tends to create the perception that they should be worn at all times, during any lifting activity. This is a myth that will only lead to decreased performance and potential injury.

For instance, the significant increase in IAP and thus the resulting benefit, has been shown to be with heavier lifts of the 90% maximum (1RM) condition. (12) Although during a set of higher repetitions (10 RM) it is reported that while only 61% of the 1 RM is utilized (22) , a possible significant effect of increasing IAP may be considered a cumulative benefit if the last few repetitions are close to failure. (13,17) It would be easy to surmise from this information that wearing the weight belt at all times would be the best insurance policy.

However, electromyographic activity of the stabilizing musculature is reduced when a weight belt is worn which could lead to atrophy of the postural muscle groups. (12,16,23) Injury potential is obviously higher in muscle tissue that is devoid of the optimal training stimulus.

Furthermore, lumbar support devices that increase IAP must be tightened to be effective. High IAP, however, may impede blood flow back to the heart (12) as well as significantly raise blood pressure. (24) Wearing a weight belt at all times would certainly appear contraindicated when all the criteria are examined.

Recomendations


There has been a great deal of information cited above regarding lumbar support devices. From these references the appropriate use of a weight belt or back brace should first be determined based on the person’s objective. The corset-style back brace is commonly used for immobilization due to an injury. These are not directly associated with the concept of stabilization by increasing IAP and therefore could possibly be worn for an extended period. Anyone wishing, however, to use a brace of this type should consult their physician for specific direction. Individuals who are free from acute or chronic lower back pain may choose a lumbar support device in order to prevent injury as well as assist their own musculature for maximal strength enhancement. In the gym environment the weightlifting belt should not be worn at all times. The belt should only be utilized for exercises that involve the spinal erectors against high resistance i.e. squat and deadlift. (21) The belt should be loosened after every set and the individual should breathe between every repetition.

With proper training progression a person should eventually wean themselves off of the weight belt (21) and utilize the support device when intensities reach 80% of the person’s 1 RM unless a set of multiple repetitions is performed to failure. (12) It is imperative, however, that training at lower intensities continue without the weightbelt. This will help ensure the natural stabilization and production of IAP (11).

In the industrial setting, the use of lumbar devices is controversial.
Requiring a lumbar support device to be worn while on the job can actually be
more of a hindrance than a help unless a training program be included. The training program should include proper technique as well as an exercise prescription for conditioning the body’s natural stabilization mechanism.

For occupations such as fire fighting, the back brace would not be logistically convenient or biomechanically efficient simply by the nature of the unpredictable work environment. The most prudent idea to truly protect this special population would be a comprehensive hips and trunk stabilization and conditioning program. Many programs are targeted toward a healthy back when the coordination of the hips and trunk should be the ultimate focus. This is not to say that a weight belt should never be used, but rather considered more of a last resort where the appropriateness is carefully scrutinized.

1. Perry, I, The use of external support in the treatment of low back pain.
J. Bone Joint Surg. 52A: 1440-1442, 1070

2. Axelsson P, Johnson R, Stromqvist B, Effect of lumbar orthosis on
intervertebral mobility. Spine, 17: 678-681; 1992

3. Grew N, Intra-abdominal pressure response to loads applied to the torso
in normal subjects. Spine, 5: 149-154, 1980

4. Lantz S, Schultz A, Lumbar spine orthosis wearing: I Restriction of
gross body motion. Spine; 11: 834-837, 1986

5. Lantz S, Schultz A, Lumbar spine orthosis wearing: II Effect on trunk
muscle myoelectric activity. Spine; 11: 838-842, 1986

6. Norton P, Brown T, The immobilizing efficiency of back braces. J. Bone
Surg; 39: 111-139, 1957

7. Reyna, JR, et. al., The effect of lumbar belts on isolated lumbar muscle.
Spine; 20, 1: 68-73, 1995

8. Harmen E, Rosenstein R, Frykman P, Nigro G, Effects of a belt on
intra-abdominal pressure during weight lifting. Med Sci Sports Exerc;
21: 186-190, 1989

9. Andersson G, Ortengren R, Nachemson A. Intradiskal pressure,
intra-abdominal pressure, and myoelectric back muscle activity related
to posture and loading. Clin Orthop; 129: 156-164, 1977

10. Davis P, The use of intra-abdominal pressure in evaluating stresses on
the lumbar spine. Spine; 6: 90-91, 1981

11. Harman E, Weight training safety: a biomechanical perspective.
Strength and Conditioning; 16: 5: 55-60, 1994

12.Lander J, Simonton L, Giscoble J, The effectiveness of weight-belts
during the squat exercise. Med Sci Sports Exerc; 22: 117-126, 1990

13. Lander J, Hundley J, Simonton R, The effectiveness of weight belts
during multiple repetitions of the squat exercise. Med Sci Sports
Exerc; 24: 603-609, 1992

14. McGill S, Norman R, Sharrat M, The effect of an abdominal belt on
trunk muscle activity and intra-abdominal pressure during squat lifts.
Ergonomics; 33: 147-160, 1990

15. Bartelink DL, The role of abdominal pressure in relieving the pressure
on the lumbar intervertebral discs. J. Bone Joint Surg; 39B: 718-725,
1957

16. Morris JM, Lucas DB, Bresler B, Role of the trunk in stability of the
spine. J. Bone Joint Surg; 43A: 327-351, 1961

17. Bourne ND, Reilly T, Effect of a weightlifting belt on spinal shrinkage.
Br. J. Sp. Med; 25 (4): 1991

18. Eie N, Load capacity of the low back. J. Oslo City Hosp.; 16: 73-98, 1966

19. Lander JE, Bates B, DeVita P, Biomechanics of the squat exercise using s
modified center of mass bar. Med Sci Sports Exerc; 18: 469-478, 1986

20. Cappozzo A, Felici F, Figura F, Gazzani F, Lumbar spine loading during
half-squat exercises. Med Sci Sports Exerc; 17: 613-620, 1985

21. Fagenbaum AD, Liatos NS, The use and abuse of weightlifting belts.
Strength and Conditioning; 16; 4: 60-62, 1994

22. McDonagh MJN, Davies CTM, Adaptive response of mammalian skeletal
muscle to exercise with high loads. Eur J Appl Physiol; 52: 139-155,
1984

23. Waters R, Morris J, Effect of spinal supports on the electrical activity of
muscles of the trunk. J Bone Joint Surg {AM}; 52: 51-60, 1970

24. Hunter G, McQuirk J, Pearman P, Mitrano N, Thomas B, Arrington R,
The effects of a weight training belt on blood pressure during exercise.
J. Appl. Sports Sci. Res.; 3: 13-18, 1989

Greg Welch, M.S., is an exercise physiologist and president of SpeciFit, An Agency of Wellness and Competitive Performance Enhancement, located in Seal Beach, California. Mr. Welch has published several articles in a wide spectrum of national journals. He travels extensively, lecturing to personal trainers across the country, and serves on the board of advisors of the Lifespan Wellness Center at California State University, Fullerton. He is the consulting physiologist to the Heartwise Fitness Institute in Whittier, California, and is a senior instructor for the American Academy of Fitness Professionals. Mr. Welch also serves as a consultant to the American Senior Fitness Association.

Slowly but surely America is awakening to the realization that resistance training is a necessary component of Wellness. For the older adult, weight lifting — a term often used interchangeably with resistance training — is more than just necessary; it is crucial. Independent living cannot be continued if the body’s lean muscle tissue is not maintained. While there are many benefits directly associated with resistance training, the intention of this article is to focus on the importance of stabilization as it relates to functioning within the scenario of “real life.”

This “real life” scenario pertains to the lifestyle of any individual and literally involves putting one foot in front of the other in order to carry out daily functions. Although diversity and intensity of lifestyle activities varies greatly among individuals, the common denominator to all physical activity is lean muscle tissue. In other words, muscle is the key to locomotion. Problems faced by the older adult include not only the general effects of aging, but also the outright neglect of physical exercise specific to maintaining lean muscle tissue.

Yet another issue of concern involves the widespread lack of understanding (and, indeed, a pervasive disbelief) that older adults should engage in muscle building exercise. Weight lifting is commonly thought to be only for the young. Older adults often fear sustaining injury or aggravating joints and muscles wherein discomfort is already a part of daily existence. This mentality fuels the fire for even further physical inactivity. The research clearly shows that reduced muscle mass is a primary factor responsible for the age-associated loss of strength that reflects a decline in total muscle protein brought about by inactivity, aging, or both.

By taking a closer look at human locomotion, one can begin to appreciate the fact that muscle tissue throughout the body works within patterns of synchronization. There is never a time when the body is performing a simple function of daily living that one muscle acts alone. Moving through the kitchen, preparing a meal, tending to the garden, or just opening a window requires a concerted effort by a variety of muscles. Some muscles initiate a movement while others are necessary to curtail the action. Most importantly for the older adult, however, are the muscles that sustain and stabilize the body in order for the primary movement to occur in the first place.

By observing the walking gait pattern, one can identify many aspects of stabilization. Upon every strike of the heel, musculature from the ankle to the knee, through the hip and back, to the shoulders and neck must engage to stabilize the body, thus allowing the primary movement to continue. This collective effort, referred to as proprioception, is more commonly known as balance.

In proprioception, the brain is communicating with the muscles as to the specific level of involvement required to achieve the movement objective. The importance of this neuromuscular relationship becomes most obvious as the deterioration of the muscle tissue occurs. Older adults will adapt their movements to compensate for their muscular weaknesses. While single joint action or muscle isolation exercises are helpful, they cannot match the total neuromuscular involvement of a multi-joint or gross motor movement. Walking is an example of a gross motor movement which is vital to the older adult.

There are two phases of a normal walking gait cycle. Stance is the interval in which the foot of the reference extremity is in contact with the ground. Swing is that portion in which the reference extremity does not contact the ground. The normal gait cycle is 60% stance and 40% swing. Two additional components of the cycle are double limb support and stride length. Double limb support refers to the two intervals in the gait cycle during which body weight transfers from one foot to the other while both feet are in contact with the ground. Stride length is the distance of a full gait cycle from the point of heel strike of one extremity to the point of heel strike of the same extremity. Normal stride length is approximately 1.5 meters.

Weakness in different muscle groups will affect the gait in different ways. Decreased stride length reflects instability during single limb support of the opposite leg. Lack of stabilization will also lead to increased step width and to increased double limb support time, because less muscle tissue is available for balance control. The older adult then further compromises the gait pattern with side to side swaying and with shuffling of the feet. He or she typically fears that any wrong move may lead to a fall.

As the sedentary lifestyle continues, an inverse relationship is created: as caution regarding normal movement increases, the ambition for any movement decreases. Thus, lean muscle tissue proceeds down a spiral of progressive decline, ultimately leading to the requirement of a walker, motorized chair, or even nursing care because the individual is simply too weak to get out of bed and function in “real life.”

Although this is a painfully common scenario in our society, the good news is that it is definitely not inevitable. Stabilization techniques to build functional muscle strength and ensure a continued lifestyle of autonomy are easy to perform.

First, it is important to understand that an exercise program must be established based on some prerequisite information. The current level of function should be identified after medical clearance to exercise is given by a physician. This functional assessment is not to be confused with the typical tests for strength commonly used in the fitness industry. Regarding the older adult, much can be learned about his or her present lifestyle through a verbal interview process and through observation of selected gross motor movements. For example, have the individual sit in a chair, stand up, and sit down again. After performing the activity two or three times, does the individual need assistance? Does he or she manipulate other body parts to be successful at the maneuver? Can the individual perform the movement without swaying or needing to take a step for correction of balance when rising to the standing position? The answers to these and similar questions can provide definitive information as to which muscles need to be conditioned to perform the task properly.

Assessment of gait can also provide valuable information. Measuring stride length and width, in addition to observing the overall pattern, can help in determining whether there is a diminished capacity to support the entire body. Poor posture, torso sway, shuffling of the feet, and overall apprehension by the individual can all be related to weakness in muscle tissue.

Exercises specific to the development of gait stability focus primarily on the pelvic area. Closed-chain movements such as step-ups, squats and lunges, with proper progression, are the most specific to “real Life” function. Equipment such as the multi-hip machine is very beneficial for strengthening adductors, abductors, flexors and extensors. Although this machine is intended to isolate certain muscles, there is actually a two-fold benefit. While the active leg is performing work, the opposite leg must also work isometrically to facilitate the exercise.

Exercises that offer additional stabilization include a variety of agility patterns and trunk development methods. Toe walking (actually walking on the balls of the feet with heels raised), heel walking, cross-over forward patterning, and the grapevine maneuver, as well as torso work with stretch bands, tubing and large rubber balls, all stimulate neural recruitment that will help develop stabilization.

Remember that the older adult population varies tremendously with respect to individual differences and capabilities. Therefore, the exercise specialist must consider the appropriateness of each activity. However, regardless of the current functional level of the individual, a prudent exercise prescription can always be established and, likewise, “real life” function can always be enhanced.

Any industry thrives if the public decides in favor of the industry’s product. Buying decisions are based on perceptions of the product’s value as well as of the industry as a whole.

The key word is perception. A perceptive person is one who can discern the truth of a particular matter. However, a person’s “perception” of an entity or object does not necessarily have anything to do with truth. Information need not be factual or pertinent to create or change a person’s perception. For example, a common perception is that personal training is a fad for the rich and famous. The fact is that training can be a significant facilitator of wellness.

When an industry (like personal training) is based primarily on service, every word, action and deed of every individual within the industry affects the perception of prospective buyers. If the perception is that the industry is unethical, the industry will not prosper. For example, look at the negative impact on the health club industry of clubs that presold memberships and then folded–or that oversubscribed in the hope members wouldn’t show up. Reliable, service-oriented clubs are still fighting to differentiate themselves from the negative perception created by those clubs.

Obviously, we don’t want that to happen to personal training. However, trainers are in a vulnerable position. We are the “new kids on the block” in the fitness industry, and we are being watched closely. We should be very concerned about how the public perceives us and how other health care professions view our contributions to wellness.

Professional ethics in business-or the standard of right and wrong-might appear to be a rather simple concept. We can generally count on adults’ abilities to differentiate between right and wrong. However, not every decision is black and white. Circumstances commonly occur that place many choices in a “gray” area. In business, the gray area of professional ethics is ever increasing due to the complexities and sensitivities of the marketplace. The advertising industry is well aware of this point as it continues to connect cigarette smoking with a positive lifestyle.

How then do we shelter our profession from the negative connotations that could harm it? From my observation of the industry, I feel that trainers’ behaviors in the following areas will dictate the public’s response to our industry.

Misrepresenting Results

Although misrepresentation is almost commonplace in our society, we don’t have to do it. Don’t you think misrepresentation is simply a watered-down term for fraud? Personal trainers, like people in any business, run the risk of misrepresenting themselves in three major areas: (1) results, (2) knowledge and (3) products.

1. Claims of What We as Personal Fitness Trainers, Can Do for a Client. Slogans on fitness business cards and advertisements often say something like. “Get the body you’ve always wanted.” While pursuing the perfect body is certainly the client’s prerogative, prudent disclosure by the trainer about possible limiting factors, such as genetics, is warranted. “Let me help you reach your optimal potential” would be a more appropriate slogan. Let’s not fall into the ”don’t forget to read the fine print” category of business. Clients who have been fooled by a personal trainer will certainly spread the word about their bad experience.

2. Misrepresentation of Ability and Knowledge. At this point in our profession, anyone who has a business card printed can be a personal trainer. While this mentality is difficult to eliminate, personal ethics should motivate us to further our education. Continually advancing our knowledge through certifications, specialty courses and academic degrees will increase our confidence in what we know and our understanding of what we don’t.

Here’s a case in point. On a television talk show, I saw a panel of “fitness experts” consisting of several trendy and well-publicized trainers and an exercise physiologist, Nicki Rippee, Ph.D. In response to a woman who skated professionally and who asked a question about limiting the size of her thighs, one panelist suggested if the woman stretched more, she could elongate her thigh muscles and reduce their thickness.

Fortunately, Rippee explained to the woman that her ability to develop muscle tissue to that extent was in part hormonal, due to genetics, and was also the very reason she was of the caliber to be a professional skater.

All the commercial success in the world cannot replace correct information. As professionals, we must hold ourselves accountable for what we say if we are to be perceived as credible.

3. Making False Claims About Products. Personal trainers must be careful not to misrepresent products. The “infomercial” mentality is alive and well and certain to continue fooling the public for only $29.95. Endorsing a product by saying it “helps strengthen the abdominal muscles” is long way from stating that the revolutionary gadget will burn fat and reduce inches.

Likewise, selling products available through multilevel marketing may be damaging to a personal trainer’s credibility. The driving force behind this very successful marketing approach is financial reward for the sellers, regardless of the quality of the product. In the health care business, this could be perceived as a conflict of interest. After all, how valuable can the advice of the trainer be when the client can attain the same information from a plumber, an accountant or a cashier at the local grocery store?

IDEA Code of Ethics

As a member in good standing of IDEA, the international association of fitness professionals, I will do my utmost to:

1. Provide qualified instruction to all participants.


a. Screen health and exercise history of all participants and establish individual fitness goals. (At least have participants fill out a basic health history form.)
b. Offer modified exercise options for students with different fitness levels or special needs (i.e., demonstrate low-impact or beginner options).
c. Incorporate new research in exercise science into programs.
d. Be knowledgeable in first aid and emergency procedures. (Maintain CPR certification.)
e. Accurately represent my qualifications and make every effort to recommend other professionals in areas outside my expertise.





2. Provide a safe exercise environment.



a. Maintain a clean, well-lit and ventilated facility that meets all governmental regulations and insurance guidelines. (IDEA recommends 34 square feet per participant in fitness classes.)
b. Maintain all equipment according to manufacturers’ instructions.
c. Establish emergency systems for all staff.



3. Stay educated on the latest research and exercise techniques.



a. Pursue continuing education.
b. Facilitate continuing education of staff.
c. Meet the national standards for instructor knowledge.
d. Obtain specialized training for teaching special populations.



4. Foster commitment to fitness and health as a life long goal.



a. Encourage participants to follow regular exercise programs.
b. Track the progress of participants.
c. Educate participants about the benefits of exercise and healthful lifestyles.



5. Show respect for participants and fellow professionals.
a. Promote the exchange of knowledge and experience with other professionals for the benefit of all participants.
b. Never publicly discredit or lower the dignity of individuals, organizations or facilities through conduct or comment.
c. Never discriminate based on race, creed, color, sex, age, physical handicap or nationality.



6. Promote honesty in all business practices.
a. Maintain fair pricing.
b. Do not employ misleading advertising.
c. Maintain sufficient insurance coverage.
d. Use clear, simple language in all contracts.
e. Abide by contracts with clients and other professionals.



7. Uphold a professional image through conduct and appearance.



a. Refrain from unhealthy practices, such as smoking and substance abuse.

Behaving Appropriately

Nothing is perceived as more unethical than inappropriate behavior in a professional setting. While the term inappropriate behavior can cover a wide range of problems, two areas are frequently encountered in training situations.

The first area involves the powerful impression we trainers create by how we dress when working with clients. A professional and modest appearance sends the right message. When working with clients, we should change or cover our own workout clothes to show we’ve changed our role in the gym. This message will help clients see that our focus is-as it should be-on them and not ourselves. We can also instill a more positive body image in our clients when we eliminate the comparison issue.

The second area addresses interpersonal relationships. The relationship between trainer and client often travels a healthy course of friendship and mutual respect when both people maintain ethical standards. However, if the relationship becomes too relaxed and professionalism is compromised, the trainer can send mixed signals that make the client feel confused and uneasy and eventually part company with the trainer. We must take steps to instill confidence and respect in our clients at the onset of the working relationship.

We should eliminate all conversation of a sexual nature from our dialogue with clients. A flirtatious comment here and there can be harmless-and is sometimes even returned by the client. However, we have to control the atmosphere and keep this type of banter from escalating. In fact, it’s best not to initiate it in the first place.

While concerns exist regardless of the trainer’s gender, I’d like to take a minute to speak to male trainers who work with female clients.

Many men may not realize the subtle impact of their words and actions. A female client may read messages into a trainer’s comments. These unintentional messages may make the client feel defensive. Her ability to be comfortable may diminish, and she may feel forced to choose her own words more carefully. Ultimately, she may project her negative perception from one trainer to all male trainers. Women are relative newcomers to the strength gym, and we need to be extremely professional to encourage them along their way instead of standing in their way.

Body contact spotting can be another danger zone for personal trainers. Touching the client is at times necessary and even beneficial. Manual resistance, certain spotting techniques and even an occasional therapeutic hug can be safe and appropriate as long as the trainer’s intent does not exceed professional boundaries.

Inappropriate behavior is more often subtle than blatant. A client of the opposite sex may never mention a problem, yet may still be formulating a perception based on how she or he feels about the circumstances.

One question we can ask ourselves before touching or spotting is: “Would I touch a person of the same sex this way?” We should not treat a member of the opposite sex any differently than we would treat a member of our own sex. This type of subtlety tends to lead to trouble.

A relatively new and interesting technique called Systematic T.O.U.C.H. Training (STT) was developed by Beth and Oscar Rothenberg to help stimulate muscular contraction. One of the benefits of the STT course curriculum is that Oscar Rothenberg, an attorney, has done a tremendous job of covering the legal ramifications of body contact between genders.

The personal trainer’s level of integrity must be above reproach-for the perception of the client and of all others in the gym who may be observing the behavior.

Good Ethics Equals Good Business

The goal of the committee that wrote IDEA’s Code of Ethics was to pursue a specific course of objectives while incorporating a degree of latitude for individual differences and discretion. l would like to suggest all personal trainers regularly review the code so we can continue to build our industry on a foundation we can be proud at.

I believe personal fitness trainers are knowledgeable health care professionals who are uniquely qualified to design and implement specific educational exercise programs, one person at a time. Being perceived as such will ensure the advancement of our profession to the status of a bona fide industry-an industry that can truly facilitate health care; an industry that should not be dismissed by the public for being full of hype, insincerity and questionable moral behavior.

Gregory L. Welch. MS, is an exercise physiologist and the president of SpeciFit, An Agency of Wellness, located in Seal Beach, California. He lectures nationally, is on the board of advisors of the Lifespan Wellness Center at California State University at Fullerton and is a member of the faculty of the American Academy of Fitness Professionals. Welch sat on the committee that originally developed IDEA s Code of Ethics.

©1995 by IDEA. All rights reserved Reproduction without permission is strictly prohibited.

IDEA Members:

Please send us your opinion. What are the ethical issues you face in your work? Does IDEA’s Code of Ethics represent all the issues you face? What would you add to or delete from the code?

Attn: Ethics, IDEA Personal Trainer

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