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Weight Loss and Body Fat Reduction

Toning, Bodybuilding, Body Shaping, Gaining Strength

Flexibility and Balance

Cardiovascular Conditioning for Heart Health and Endurance

Sports Injury Rehabilitation

Work with Special Populations
Weight Loss and Body Fat Reduction
Toning, Bodybuilding, Body Shaping, Gaining Strength
Flexibility and Balance
Cardiovascular Conditioning for Heart Health and Endurance

Sports Injury Rehabilitation
Work with Special Populations
Seniors

Pre-Natal and Post-Partum Women

People with HIV/AIDS and Cancer

Cardiac Patients

Renal Patients

Diabetics

People with High Blood Pressure and Elevated Cholesterol

Note: Clients with injuries or in special population groups are required to supply their fitness trainer with a written physician's clearance. Personal fitness trainers are not doctors and (in most cases) are not physical therapists. Therefore it is necessary for your trainer to coordinate your fitness training and nutritional program with your doctor, physiatrist, physical therapist, occupational therapist, chiropractor, special nutritional counselor, and/or alternative medicine healthcare provider(s).
Weight Loss and Body Fat Reduction
We prefer you to think in terms of "fat loss" instead of "weight loss." The aim of getting in shape is how you look and how healthy you are. The goal should be to get leaner. This means changing your body composition so that you have less fat and more muscle. Since muscle weighs more than fat per cubic measurement, absolute weight loss should not be the sole measure of your success. The important results should be how your body looks, how your clothes fit and how you feel. A visible six pack of abs is only accomplished by both building the abdominal muscles and shedding the fat that covers them up.

Calories
The basis for losing body fat is using more calories (an energy value of food), in daily metabolism, activity and exercise than you take in through eating and drinking. It takes about 3500 calories above those utilized to gain one pound of fat. The reverse is also the case. Using up 3500 calories above those taken into your body will cause a reduction of one pound of fat. Therefore, to effectively lose fat, the bottom line is to restrict your calorie intake and increase your calorie output.

High Protein - Low Carbohydrate Diet
Our personal fitness trainers will work with you on a diet and nutritional plan that will give you just the right amount of calories to accomplish this. The diet will consist of foods that deliver you the proper nutrients so that you will get healthier and more energetic and be able to shape your body effectively through muscle toning or building while losing fat. High protein, low carbohydrate, moderate-low fat diets with plenty of vegetables taken in several frequent meals throughout the day are generally recommended to accomplish this.

Burning Fat Through Aerobic Exercise
The diet itself helps to increase your calorie burning by boosting your metabolism, a process further enhanced as you gain more lean muscle. In addition our fitness trainers work with you on an aerobic exercise program to burn fat and increase your metabolic rate. This is done either on equipment such as stairmaster, stationary bicycle, treadmill or elliptical machine or by jogging outdoors. The aim is to sustain the aerobic activity for a minimum of 40 minutes at a time at a moderate intensity of 50 percent to 70 percent of your max heart rate. A personal fitness trainer will help you establish this intensity level and a program of working toward your goal in increments suitable to your current fitness level.

Your diet and aerobic programs will be the cornerstones of your fat loss plan. They are created by your fitness trainer only with you in mind and based on your current condition, goals, your schedule, lifestyle and simply, what will work FOR YOU.

Spot Reduction of Fat
You must remember when embarking upon a fat loss campaign that spot reduction of fat is not possible. Your body gains and loses fat by way of its unique genetic programming. Unfortunately experience and research shows that the first-acquired, and usually largest, fat deposit areas are the last places that our bodies loose fat. So if your holding a lot of fat in your mid-section or in your thighs, that will likely be the last place you loose it. But don't despair, you WILL lose it. Sticking with it is the ticket. To help you do this, your personal fitness trainer also provides motivation and creates a structured program that helps anchor you through a sustained effort.

Obesity
The number of Americans who are profoundly over-fat, or obese, is on the rise. This affliction/disease, affects about 50 million people in this country. Health risks arising from obesity include, heart disease, stroke, high blood pressure, gallbladder disease, and prostate, colon and breast cancer. Obese individuals often suffer both social isolation and institutional discrimination. The market is flooded with weight loss pills and products aimed at this population. Some of these items work, often negligibly, but most do not.

The fight against fat is not an easy one, especially for chronically affected people. It is a long, tough battle. There is no question that the development of a new healthy eating and fitness lifestyle is immensely helpful in winning this fight. Our personal fitness trainers have a great deal of experience working with people in this group. If necessary we interface with a client's physician and/or therapist to construct a program centered around restructuring lifestyle while helping to provide the necessary impetus for its success.

Additional Reading and Resources:
The Physiology of Weight Change
Why Carbohydrates Make You Fat
Weight Loss by ExRx
Fat Loss and Weight Training Myths by ExRx
Weight Loss Abstracts-Resources from ExRx
Study on Protein vs Carbohydrate in Fat Reduced Diet for the Treatment of Obesity
Body Composition: For Health, Fitness and Sport
Fish Oils and Diet/Weight Control
Weight Loss Nutrition and Exercise
Women and Fat Loss Issues

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Toning, Bodybuilding, Body Shaping, Gaining Strength
Toning and Building Muscle
A client will often specify to a fitness trainer whether he or she wants to "tone" or to "build" muscle. Usually, but not always, women want to "tone," while men want to "build." Each person seems to have a pretty good idea of what kind of physique she or he wants.

Toning and building muscle, however, are basically the same physiologic process differing mainly in degree.

In the context of the body's normal functioning, "muscle tone" simply means that the muscle fibers are being stimulated by the central nervous system. But in common use, the designation "toned" pertains to the appearance of a musculature that is hard, as opposed to flaccid , and noticeable, but not overly so. In this respect a toned body implies a lean body, one low in body fat and showing some muscle definition and shape. By "building" muscle it is usually meant, getting as much muscle as possible up to and including the bodybuilder's look.

As we stated earlier, however, the same basic physical process is necessary whether you want to tone or build muscle or whether you want to shape particular body parts or increase strength. To achieve any of these goals involves progressive resistance training.

Progressive Resistance Training
This type of training employs short duration exercises using resistance (free weights, machines, cables, bands, bodyweight) until the muscle or muscle group is fatigued. In each subsequent workout session, the intensity is increased slightly either by trying to sustain the exercise longer, by decreasing the rest time between sets, or by increasing the resistance. Gradually your muscles grow and become stronger as they adapt to increased challenges. This process continues throughout your workout program.

The progressive resistance training method has been successfully used and developed over decades by bodybuilders, weightlifters, and athletes generally. It produces a steady gain in muscle size and strength while lowering the risk of injury. Our personal fitness trainers all employ this training method. They will start you off with resistance commensurate with your current level of fitness and know just how much to intensify the workouts with each session, based upon your progress.

Weight Training
Since most resistance training involves weights, it is also called weight training. (This type of training fits into the general category of anaerobic exercise because the muscle movement doesn't rely on the utilization of oxygen for fuel.) Weight training is used not only for toning and bodybuilding, but also for sport-specific training (most obviously for the sports of weightlifting and powerlifting), and for injury rehabilitation. Each of these endeavors applies weight training in a different way.

Overload, Stress Adaptation and Hypertrophy
To change the physique, weight training is used to effectuate a specific result in the "look" of the body through muscular development. The process of muscle growth , also referred to as hypertrophy, occurs when the muscle is forced to move a resistance (or weight) that is greater than the muscle is accustomed to moving. This is called "overloading" the muscle. When this occurs, the muscle adapts by getting bigger and stronger. This is called "stress adaptation" or adapting to a stress caused by the overload.

This overload causes muscle fibers to wear down one by one through the occurrence of tiny micro-tears and the build up of lactic acid, a fuel by-product. When all or most of the muscle fibers are worn out, the muscle is unable to continue moving the resistance. This is called muscle fatigue or muscular failure. Good personal trainers make sure that clients at intermediate and advanced levels try to achieve muscle fatigue (and even work beyond muscular failure) when training.

In the period following the muscular fatigue workout, when the muscle is resting, the fibers repair. It is through this reparation that the muscle fibers actually grow larger and thereby, stronger. In addition to requiring rest, this process necessitates the presence of adequate protein and other nutrients essential to the repair process.

Body Part Split Routines
Toning, bodybuilding, and body shaping are accomplished using the progressive resistance training method and applying it to working particular muscles or body parts in rotational workouts. For example: if you are weight training four days a week, you may work your legs on day one, back and chest on day two, shoulders and arms on day three and a full body workout on day four.

This is called body part split routines or split routines. Split routine workouts are accomplished by applying different exercises or movements to each body part. For example: to work your biceps you might do barbell curls, pulley curls and one arm dumbbell concentration curls. There are an infinite variety of ways to organize split routines and a wide variety of exercises that can be done for each body part. Your fitness trainer will help you develop a routine and select exercises most suited to your needs.

Reps and Sets
All exercises or movements (such as barbell curls) are done in a series of repetitions, or "reps." Each time a movement is performed and completed once is a rep. In most cases, one rep consists of a positive (or concentric) movement which occurs when you contract and move a muscle, overcoming the resistance and a negative or (eccentric) movement which occurs when you move with the resistence. A number of repetitions done in continual succession without resting is called a "set." You might do four sets of ten reps each for barbell curls to improve your biceps.

Types of Muscle Contractions
In addition to concentric (positive) and eccentric (negative) movements mentioned above, there are also other types of muscle contractions that you can, and probably will, use while doing resistance training. They include isometric, isotonic, and isokinetic.

Isometric is a static contraction. (Example: if you flex your arm at a 90 degree angle while holding a barbell and don't move your arm for 10 seconds.)

Isotonic is a muscle contraction that occurs when your resistence is constant, but the speed that you are moving at varies during different parts of the movement. (Example: while doing a barbell curl with a 40 lb. weight, you might go faster at one point and slower at another point.)

Isokinetic is a movement with speed as a constant and changing resistance. (Example: a leg curl machine with a cam. The cam mechanism changes the resistance at certain points of the movement.)

Genetics
We should point out that each of us is born with a set of genetics that determine our uniqueness. This includes our body's skeletal-muscular structure and our propensity for retaining bodyfat. Some folks don't gain much bodyfat no matter how much they eat or how little they exercise. Others are on the treadmill four days a week, just to keep fat levels constant. Some people gain muscle very easily or are able to develop particular body parts with ease. Others struggle hard to add a centimeter to their biceps.

None of us can change our basic genetic makeup. But you can work hard to take your body to its full potential and see dramatic changes regardless of genetic propensity. This is up to you and how willing you are to do the work and make the sacrifices necessary. You will get out of a training program what you put into it. Your personal fitness trainer is there to point you in the right direction and to help you give 110 percent.

Benefits of Weight Training
In addition to the aesthetic changes to your physique and building strength, weight training has many other benefits including increased bone density, improved endurance and motor performance, strengthening of soft connective tissues (ligaments and tendons), elevated metabolism, lowered risk of sports injury and better functional ability generally.

Additional Reading and Resources:
Muscle Tutorial
Muscles: Anatomy & Physiology Tutoring Links
Muscle Physiology Primer
Biochemistry of Muscle Contraction
Muscle Energy Supply
Adaptation to Exercise: Progressive Resistance Exercise
Weight Training
The Benefits of Weight Training
Strength Trainng Benefits
Strength Training for Women: Debunking the Myths
Skeletal Muscle Cramps During Exercise
Conquering Muscle Cramps
Why women should Train with Weights


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Flexibility and Balance
Flexibility
Flexibility is the range of motion (ROM) available in a joint or group of joints. It can be measured either in linear or angular units. There are two types of flexibility: Static flexibility is range of movement in a joint with no emphasis on speed of the movement. Dynamic flexibility is the ability to use a range of joint movement in the performance of physical activity.

Stretching and Types of Flexibility Programs
Flexibility is improved by stretching the muscle or muscles that move a particular joint. Stretching can be done to warm up or cool down from a workout or other physical activity or during the performance of that activity (for example: stretching between weight training sets). You can also embark on a whole flexibility training program where you concentrate on range of motion movements as your primary goals. Dancers, gymnasts and other performers or athletes requiring ease and capacious movement would benefit from such a program. A program of this sort would also be helpful for someone recovering from injury or who suffers from muscle contracture, an abnormal state of perpetual muscle contraction (commonly known as a "musclebound" condition).

Benefits of Stretching
The benefits of stretching are many. They include promotion of relaxation, diminishing of muscle contracture, lowering of blood pressure, improvement of symmetry and the correction of muscular imbalance which is caused by the lack of flexibility in certain muscle groups, and correction of postural misalignment also due to a disparity of flexibility of opposing muscle groups. Other benefits include better coordination, balance and joint stability. Stretching can also help or avert low back pain by increasing the mobility of the trunk and flexibility of the lumbar spine. Generally, by increasing the biomechanical parameters, stretching and increased flexibility can enhance velocities, energies and momenta involved in all physical activity.

Injury Prevention and Alleviating Muscular Soreness
Since muscle and connective tissue injuries are often caused by limited joint mobility, stretching can help to prevent such injuries by increasing ROM in the joints. In addition, static stretching can relieve muscular soreness due to weight training workouts or other athletic/physical activity. It is thought that this occurs because stretching helps to break down and disburse the build up of lactic acid and to decrease electrical activity in the muscle.

Types of Stretching and How to Stretch
Your fitness trainer will help you to determine whether an overall flexibility program is necessary for you or whether you just need to incorporate stretching before, during and after your weight training or athletic training workout. There are basic and specific stretches which focus on different muscles (or muscle groups) and joints. You can employ these stretches in accordance with your current flexibility levels and your overall program goals.

There are three basic varieties of stretching: static, ballistic and PNF (proprioceptive neuromuscular facilitation).

Static stretching involves holding a position at the maximum range of motion for a short period of time (15 - 60 seconds). Static stretching exercises can be carried out passively (you are moved entirely by an assistant) or actively (you move without the assistance of someone else). There are also variations of both passive and active static stretching. Regardless of whether you are assisted or not, the aim should be to statically hold the stretch while at the maximum point of ROM for about 20 seconds in a relaxed state. This is the safest way to stretch.

Ballistic stretching uses the momentum of a moving body part and bouncing in and out of the fully stretched position. This type of stretching creates a high risk of soft tissue or joint injury and is not generally recommended. We suggest that you not bounce or try to force a stretch.

Proprioceptive Neuromuscular Facilitation (PNF) is a method used to promote the nerve-muscle connection mechanism through stimulation of the proprioceptors (receptors located in subcutaneous tissues [muscles, tendons, and joints] that respond to stimuli produced within the body). PNF stretching utilizes alternating periods of relaxation and maximal isometric muscular contraction while an assistant alternates pushing a stretch and applying resistance.

Balance
As discussed above, both traditional weight training and stretching are instrumental in promoting balance and symmetry on neuromuscular, aesthetic and functional levels. In recent years, however, a host of new exercises and programs have arisen focusing on core and joint stabilization/balance. These exercises usually employ equipment such as Swiss balls, wobble boards and balance cushions meant to de-stabilize you enough so that your body must enlist, train and strengthen its intrinsic balance mechanisms. Programs utilizing these exercises are helpful for everyone, but particularly so for athletes and entertainers in fields relying on finely-tuned balance, seniors, and those recovering from injury. Most of our fitness trainers are proficient in these techniques.

Additional Reading and Resources:
Stretching - The Mobility Program Fitness
The Science of Stretching
Flexibility for Fitness
Flexibility for Strength
Static Stretching Exercises
Warm Up Stretches
Cool Down Stretches
Myths and Truths of Stretching-Individualized Recommendations for Healthy Muscles
Flexibility Training - For the Full Benefits of Exercise, Don't Neglect Flexibility
Stretching and Strengthening
Flexibility Training and Rehabilitation


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Cardiovascular Conditioning for Heart Health and Endurance
Earlier we addressed aerobic exercise as a foundation of a fat loss program. Aerobic activity is also called cardiovascular exercise. During this sustained activity the body uses oxygen from the blood as the primary fuel for the muscles. The utilization of oxygen, requires that the body adapt itself to more efficiently store and deliver oxygen to the muscles where they are converted to fuel. Therefore both lung capacity and oxygen carriage and storage are increased when cardiovascular activity is performed on a regular basis.

In addition, the heart as a muscle is strengthened and its ability to pump blood which carried oxygen is greater. Cardiovascular conditioning, therefore, lowers resting heart rate and blood pressure. Also the "good" cholesterol, HDL, is elevated through aerobic exercise and LDL or "bad" cholesterol is lowered. As a result overall heart and circulatory system health is improved and stamina and endurance increased.

Today cardiovascular disease is the number one killer in the United States, taking more than 900,000 lives each year. Almost one in four Americans are affected by some form of cardiovascular disease.

We encourage all clients over 40 years of age and any at risk for coronary or circulatory disease to engage in systematic monitored cardiovascular training programs. Today cardiologists all recommend and facilitate some form of cardiovascular training for recovering heart patients. Our personal fitness trainers will supervise the intensity and duration progress of these programs, making sure that clients are working within target heart-rate zones suitable to there age, weight and fitness condition. The goal for this training is generally to work in a range of 60-80 percent of max heart-rate for 20-30 minutes three times a week.

Additional Reading and Resources:
Heart News: Road to Fitness: Aerobic Exercise Improves Cardiovascular Fitness
Target Heart Rate Training
Maximum Oxygen Consumption
Preventing Coronary Heart Disease
Exercise and Heart Health
Exercising with Cardiac Disease
The Exercise Prescription
Can Lifestyle Reverse Artery Disease?
Cardiovascular Disease: Facts, Disease Prevention and Treatment Strategies


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Sports Injury Rehabilitation
Introduction
Clients with injuries are required to supply their trainer with a written physician's clearance. Personal fitness trainers are not doctors and (in most cases) are not physical therapists. As part of a team with other professionals, however, certified personal fitness trainers can contribute significantly and uniquely to your recovery and rehabilitation effort. It is necessary, however, for your fitness trainer to coordinate your training and nutritional program with your doctor, physiatrist, physical therapist, occupational therapist, chiropractor, special nutritional counselor, and/or alternative medicine healthcare provider(s).

Outlined below are some of the more common injuries that can result from sports, training, accidents or even daily activities. It is by no means a complete list of all injuries nor do we attempt a full scientific description or medical remedies. If you are injured or symptomatic of an injury or chronic condition, see a doctor. When an injury occurs, use common sense - the adage "no pain, no gain" does not apply here. Stop your activity immediately and initiate the four basic steps known as R.I.C.E. (Rest, Ice, Compression and Elevation) of the injured body part. If these measures are not sufficient, see a doctor.

Of course, focus should always be on injury prevention which can be advanced by careful attention to exercise form, a balanced whole body approach to strengthening and building opposing muscles, gradual (rather than abrupt) increases in workout intensity, stretching, cross training, focus on what you are doing and a healthy nutritional program.

Additional Reading and Resources:
R.I.C.E.
Injury: R.I.C.E.
Virtual Sports Injury Clinic
Glossary of Sports Medicine Terminology
Basic Sports Injury Management
First 100 Hour Rehabilitation Course - Topics and Operational Definitions

Shoulder
Of all joints in the body, the shoulder is the most vulnerable to injury and the one that suffers the greatest number of injuries among people engaged in fitness and weight training activities. This is because the shoulder is constructed in a way to allow it a very wide range of motion. To enable this movement, the shoulder is held loosely together by a capsule arrangement made up entirely of soft tissue.

The best way to prevent and rehabilitate most shoulder injuries is to strengthen, not only the deltoids, or shoulder muscles, but also the supportive stabilizer muscles of the shoulder including the lats, pecs, traps, rhomboids and serratus muscles.

It is extremely important to engage in rotator cuff exercises, not only for the rehabilitation of rotator cuff injury, but for prevention as well. Rotator cuff exercises should be a standard part of any shoulder workout routine. Some shoulder exercises such as behind-the-neck presses, barbell upright rows, stiff-arm pullovers and lateral raises should be attempted with care. These exercises are on the top of the list for causing shoulder injury and are not for everyone.

Some shoulder injuries include:

Rotator cuff injuries -- The most common shoulder problems are rotator cuff related. These include tendinitis (inflamation of the tendon), myofascitis (inflamation of the tendon sheath), tears, calcium deposits (bone spurs), impingement and chronic degeneration. The rotator cuff is made up of the tendons of four muscles in the shoulder joint. These muscles are the supraspinatus, infraspinatus, teres minor and subscapularis. The rotator cuff tendons attach these muscles to the humerus (arm) and scapula (shoulder blade) bones and connect these two bones together.

Bursitis -- Including gleno-humeral, subacromial and scapula. Bursitis is the inflamation of one of these bursas in the shoulder. The bursas are the soft sacs filled with lubricating fluid that facilitate motion in the shoulder.

Shoulder dislocation -- This involves the entire shoulder joint and the humerus (upper-arm bone). Also effected is the soft tissue surrounding the dislocation including muscles, tendons, ligaments, nerves, and blood vessels. The humerus becomes displaced from its sockets in the shoulder joint.

Shoulder sprain -- Including acromio-clavicular and gleno-humeral ligaments. A severe overstretching of the ligaments in the shoulder joint. Ligaments attach bone to bone, in this case the clavical, acromion process and the gleno-humeral joint. If a ligaments becomes stretched or torn the shoulder joint become destabilized and can lead to rotator cuff tears, dislocation and can even result in pieces of bone being pulled loose. Severe cases require surgical repair. Post-ligament surgery requires complete stabilization of the joint and a long rehab process.

Additional Reading and Resources:
Anatomy of the Shoulder
Rotator Cuff Problems
Rotator Cuff Disease/Impingement
Rotator Cuff Injury:Addressing Overhead Overuse
Four Exercises to Strengthen the Rotator Cuff
Management of Shoulder Impingement Syndrome and Rotator Cuff Tears
Frozen Shoulder and Rotator Cuff Injury-A Guide for Treatment
The 7 Minute Rotator Cuff Solution - A Book
Rehab Immediately Following Shoulder Surgery
Superior Labral Tear
Shoulder Separation
Shoulder Dislocation
Evaluation of the Unstable Shoulder
Protecting the Shoulders During Bench Press


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Back
Connecting our upper body to our lower body and enabling us to walk upright is our back. Our backbone is our pillar (and protector) and its braces are the surrounding muscles. The back is complex, made up of bones, discs, ligaments, the spinal cord, muscles and tendons. Back injury can involve any or even all of these components.

Strengthening the back muscles and connective tissue can go a long way toward preventing and treating some back injuries. It was once felt that working out the lumbar or lower back at all would lead to injury. Fortunately, most sports medicine doctors today encourage weight training protocols for lower back and see their muscular-skeletal benefits for back stabilization and strengthening.

Back distress is often exacerbated by weak abdominal muscle support or inordinate fat accumulation around the belly. Strengthening abs and losing the fat can make a big difference in back fitness.

Back injuries include: ruptured disk (herniated disk, slipped disk, herniated nucleus pulposus); back sprains (ligament injury) or strains (muscle injury) of the lumbo-dorsal, sacroliac, thoracic-spine, lumbar-spine regions; and sciatica. Although not injuries, the conditions scoliosis and lordosis, abnormal curvatures of the spine, can cause back problems if they are pronounced, especially when exercising. It is important for your fitness trainer to know if you have extreme cases of either of these conditions.

Additional Reading and Resources:
Anatomy of the Spine
Protecting Your Back
Low Back Pain and Lumbar Stabilization Exercises
Lumbar Injuries Require Sport-Specific Treatment
Sciatica
Diagnosis and Treatment of Piriformis Syndrome
Scoliosis


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Knee
Second only to the shoulder, most sports injuries affect the knee. The patella (knee cap) is basically a free-floating bone resting over the joint where the femur (thigh bone) meets the tibia (shin bone). Cartilage and bursa cushion (or meniscus)the bones and knee cap from each other. An impressive array of ligaments connect the joint together and hold the knee cap in place.

In the course of daily use and especially during heavy fitness training, the knee joint withstands enormous pressure and is subject to a variety of injuries. To prevent these injuries attention should be paid to developing the quadriceps and hamstring muscles and to proper knee alignment when performing any exercise involving leg flexion, especially squats.

Knee injuries include bursitis (inflamation of the bursa sac), cartilage (meniscus) tear or rupture, dislocation (patella, tibia-femur and tibia-fibula), sprain (ligament pull), and ligament tear (most particularly of the anterior cruciate ligament or ACL).

ACL Injury -- The anterior cruciate ligament is the most commonly injured ligament in the knee. Ligament injuries of the knee have increased by 172% in the last 15 years The anterior cruciate ligament originates from the back of the femur and inserts on the top of the tibia . The ligament guides the tibia in a normal path along the end of the femur and maintains joint stability. Once torn, the knee usually becomes unstable. As instability increases, the shear forces across the top of the tibia increase, the meniscal cartilages tear, and the articular cartilage erodes.

Surgical procedures are required to repair and reconstruct a torn cruciate ligament. Protection against ligament injury and a speeding recovery after surgery can best be achieved by strengthening the muscles around the knee that act as shock absorbers and joint stabilizers. Specifically, hamstring strength protects the tibia from the anterior translocation that can rupture the cruciate.

Additional Reading and Resources:
Anatomy of the Knee
Anterior Cruciate Ligament Injuries
Rehab Immediately Following ACL Surgery
Anterior Cruciate Ligament Injuries in Female Athlete: Why Women Are More Suseptible
Torn Meniscus
Posterior Cruciate Ligament Injuries
Patello-Femoral Pain Syndrome:A Review and Guidelines
Knee Bursitis


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Elbow
Movement at the elbow joint is essential in practically all upper body exercises and activities. Composed of the radius, ulna (forearm bones) and humerus (upper-arm bone), the elbow is involved in a variety of motions including flexion, extension, pronation and supination. This complexity of functions makes it susceptible to bone and soft tissue injuries. Improper form during upper body exercises is most often the culprit in causing elbow problems. Straight bar curling or use of machines can also cause elbow problems because the radius and ulna are forced into a certain angle of rotation that may not be compatible with your body's own biomechanics.

Elbow injuries include bursitis of the radio-humeral joint, dislocation, sprain and tendinitis or epicondylitis (tennis elbow).

Elbow tendinitis (tennis elbow) is a very common injury in athletes and those involved in fitness activities. It can often be chronic. This condition involves an inflammation of muscles, tendons, bursa or covering to bones in the elbow joint. It can be caused by a partial tear of the tendon, chronic stress on the tissues that attach the forearm muscles to the elbow joint, sudden stress on the forearm.

Additional Reading and Resources:
Anatomy of the Elbow
An Easy Fix for Tennis Elbow
Tennis Elbow Information
Tennis Elbow
Bursitis of the Elbow
Inflammation of the Biceps Tendon
Inflammation of Rupture of the Triceps Tendon
Assessment and Treatment Guidelines for Elbow Injuries


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Wrist
Because the hand is directly involved in holding, grasping, pushing and pulling resistance devices and weights in practically all fitness and athletic activities, the wrists becomes the weakest link and very prone to injury. It is important before starting a workout program involving weight training to assess wrist strength and mobility. The wrist should then be prepared in advance of other activities by isolated strengthening and flexibility exercises.

Wrist injuries include dislocation of the lunate bone, radius or ulna; sprain of the ligaments of the wrist; tenosynovitis (inflamation of the lining of a tendon sheath in the wrist); carpal tunnel syndrome.

Carpal tunnel syndrome is probably the most common wrist malady affecting not only athletes and those who fitness train, but anyone in the population involved in repetitive wrist movement actions on a daily basis (computer use, etc.). Carpal tunnel syndrome results from the compression of the median nerve at the wrist. The carpal tunnel is comprised of the wrist bones, radius, ulna and a very strong ligament called the transverse carpal ligament. Tendons that control finger movements also run through the tunnel. The compression of the nerve causes irritation and swelling resulting in numbness, loss of strength and dexterity. It is suggested that rest is the most fruitful therapy for this condition.

Additional Reading and Resources:
The Hand, Wrist: Anatomy, Injuries and Carpal Tunnel Syndrome
Bursitis in the Wrist
Carpal Tunnel Syndrome
Basal thumb problems
Trigger finger Tendon release
Excellent New York City hand doctor


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Work with Special Populations
Introduction
Clients in special population groups are required to supply their trainer with a written physician's clearance. Personal fitness trainers are not doctors and (in most cases) are not physical therapists. As part of a team with other professionals, however, certified personal trainers can contribute significantly and uniquely to helping you improve your health and life through a monitored and challenging fitness program. While it is necessary to take your condition or position into account, we will not to treat you as a "sick person," a "patient" or an "older person." You will be pushed and you will be motivated. It is essential, however, for your fitness trainer to coordinate your training and nutritional program and with your doctor, physiatrist, physical therapist, occupational therapist, chiropractor, special nutritional counselor, and/or alternative medicine healthcare provider(s). It's particularly important for your trainer to know if you have any conditions for which exercise, or a particular type of exercise, is contraindicated.

Additional Reading and Resources:
Exercise for Better Health
Exercise is Medicine


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Seniors
As we age, the changes in our levels of hormones, enzymes, cellular function, and other important biochemical functions, lead to a variety of physiological changes. These include: decline in lean muscle mass, bone density, flexibility, oxygen consumption, metabolism, cognitive function, proprioception, balance, agility, and response mechanism. At the same time body fat and free radical levels increase. Of course, we know that we also develop diminished eyesight and hearing, our hair turns grey or white and our skin wrinkles. Eyeglasses, contacts lenses and now laser surgery helps to correct vision and hearing aids amplify sounds for us.

As recently as a decade ago the broad population had no idea that we could slow down and in some cases reverse some of the other physical conditions associated with aging. Clinical studies, most particularly the landmark one carried out by Tufts University, as well as anecdotal evidence all prove that resistance training, coupled with aerobic activity and high protein healthy diets were able to add muscle, lower fat, speed up metabolism and increase bone density, oxygen consumption, flexibility, cognitive function, balance and agility. Many of our personal fitness trainers have a good deal of experience working with older populations.

Additional Reading and Resources:
Research on Resistance Training and Aging
The Importance of Strength Training For Older Adults
Its Never Too Late to Get Moving
Physical Activity Associated with Healthier Aging
Aerobic Exercise Improves Cognitive Functioning Of Older Men And Women
Exercise Benefits for Wid-life Women
High Protein Diet Along with Calcium Increases Bone Density
High-Protein Diet Could Repair Bone Loss


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Pre-Natal and Post-Partum Women
Fitness, proper nutrition and clean living (no alcohol, smoking, drugs, etc.) are essential for a healthy pregnancy and hardy baby. Unless instructed otherwise by her physician, a woman can exercise up to the eighth month. After the birth of the baby, an exercise program can commence almost immediately.

Additional Reading and Resources:
Contraindications to Exercise During Pregnancy
Postpartum Fitness and Exercise
Postpartum Fitness
Postpartum Exercise Routine
Pre Natal and Post Partum Exercise Videos


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People with HIV/AIDS and Cancer
People with HIV experience a wasting of lean muscle mass, a commensurate loss of bone density and reduced strength, endurance and aerobic capacity. A balanced resistance, cardiovascular and nutritional program can retard, and in some cases prevent, these deteriorating processes. While there exists no evidence that a fitness program will boost the immune system in people with HIV or AIDS, the enrichment in quality of life is extensive -- physically, emotionally and psychologically.

The same is the case relative to people living with and fighting cancer. The physical problems encountered depend upon the type of cancer, how advanced it may be, the relative fitness level of the person and whether he or she is undergoing chemotherapy or radiation treatments. Some people with cancer use hard training in their pain management protocols. This is not to suggest that fitness training has been proven to ameliorate pain in cancer sufferers. Most of this evidence is anecdotal and is most likely stems from psychological as much as physiological inducements.

Additional Reading and Resources:
Progressive resistive exercise interventions for adults living with HIV/AIDS (Cochrane Review)
Aerobic exercise interventions for adults living with HIV/AIDS (Cochrane Review)
The Body: The Complete HIV/AIDS Resouce
Nutrition and Exercise When You Have HIV
Exercise and HIV: GMHC'S Nutrition & Wellness Program
How to Exercise With HIV
HIV/AIDS Nutrition & Exercise
HIV virus slowed by exercise
Nutrition and Exercise When You Have HIV
Food and Nutrition Information Center: HIV/Aids Nutrition and Exercise
Exercise a Boon for Those With HIV
Warming Up to HIV and Exercise
Aerobic exercise interventions for adults living with HIV/AIDS (Cochrane Review)
Fighting Cancer With Exercise: One Woman's Story
Study: Cut Your Cancer Risk With Exercise


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Cardiac Patients
Heart attacks are the major cause of death in the United States. Many years ago a cardiac patient was confined to bed and doctor's insisted on complete inactivity. Now cardiologists are getting post heart trauma patients onto a stationary bike or treadmill as soon as they can stand. All cardiac rehab programs include exercises designed strengthen the heart muscle and increase oxygen consumption and beneficial HDL cholesterol. These protocols have been clinically studied and shown to reduce the occurrence of a second heart attack.

Additional Reading and Resources:
Exercise and Heart Disease
Cardiac Rehabilitation: Building a Better Life
Cardiovascular Disease: Facts, Disease Prevention and Treatment Strategies


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Renal Patients
Among a complexity of health problems brought about by kidney disease or renal failure are the inability of sufferers to metabolize protein and the affliction osteodystrophy, a condition similar to osteoporosis. Protein is essential for the body to repair tissue, particularly muscle. Renal patients are put on extremely low protein diets and suffer a wasting effect as well as other health and fitness deficits. Osteodystrophy is the result of the parathyroid glad becoming overactive in the face of renal failure and calcium is leached out of the bones. This condition affects dialysis patients most profoundly.

When a dialysis patient embarks upon a weight training regimen, he or she is able to consume greater quantities of protein because the muscle tissue is utilizing it and it does not have to be processed through the kidney. Furthermore resistance training causes an increase in bone density in the same way it does for osteoporosis sufferers. Renal and dialysis patients who fitness train are able to live healthier and more normal lives. It is very important for renal patients to proceed very slowly when starting and increasing workout intensities.

Additional Reading and Resources:
Keeping Fit on Dialysis
Benefits and Protective Effect of Exercise
Resistance training improves strength and functional measures in patients with end-stage renal disease
A randomized trial of exercise training after renal transplantation
Exercise during hemodialysis decreases the use of antihypertensive medications
Improvement in quality of life of dialysis patients during six months of exercise


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Diabetics
Exercise is essential for people with diabetes. A regular program of cardiovascular training and light-moderate weight training can improve the body's response to insulin, help control glucose levels in the blood, reduce the risk of heart disease, lower bodyfat, cholesterol levels, blood pressure. It is important that diabetics sustain a regular program in order to get the benefits listed.

Additional Reading and Resources:
Exercising With Diabetes: Tips, Strategies, and Precautions
Exercise and Diabetes
The Added Benefit of Exercise in People with Diabetes
Glucose Control - Exercise
Adjusting Insulin Dose for Exercise


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High Blood Pressure and Cholesterol
High blood pressure forces the heart to work abnormally hard. This makes the heart and circulatory system vulnerable to damage, resulting from the heart's need to pump harder to deliver adequate blood and oxygen to the body. As a result, heart enlarges and weakens. Often high blood pressure is the result of plaque having built up in the arteries which comes from high LDL and triglycerides in the circulatory system. The ensuing elevated blood pressure in turn wreck havoc on the arteries which become scarred, hard and lose elasticity. The risk of heart attack is increased, as is the possibility of stroke, congestive heart failure, renal failure, and atherosclerosis. Studies find that most obese people suffer from hypertension. This population is particularly as risk for heart attack and CVA (stroke).

Exercise, particularly cardiovascular performance can greatly reduce high blood pressure especially by increasing the body's natural oxygen consumption, elevated HDLs (the good cholesterol) which helps keep the arteries clean of plaque. Regular, sustained aerobic conditioning lowers heart rate and blood pressure in most people.

Additional Reading and Resources:
High Blood Pressure (Hypertension)
Aerobic Fitness Information
Can Exercise Lower Your Blood Cholesterol?
High Blood Cholesterol in Women and Exercise
Fitness Helps Men Avoid Stroke


See our Links section for more websites providing information and resources on the above subjects

Disclaimer: Personal Trainers New York City is not responsible for the content of the websites listed for additional reading and resources.

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© 2002 Personal Trainers New York City