A while ago I watched a fitness instructor taking a client through their first programme review.  On the initial programme the client was doing a seated chest press, the instructor decided to change this to a bench press with a fixed weight barbell.  Now surely there’s nothing wrong with the good old bench press is there?  The bench press can be a great exercise; however the instructor in this case picked the weight up from the rack and held it above the client as they lay down on the bench to perform the exercise, they did a set and then moved onto the next exercise. This was only the clients second ever gym programme, notice any problems yet….

Bear in mind that the instructor gave the client this new exercise to do on their own until their next program review in 6 weeks, a pretty standard procedure in clubs around the country.  When the client repeats the programme on their own they’ll have to find the correct barbell from the rack, perform a type of deadlift (complex) movement to get the weight onto their lap as they sit down, and then find a way to get the weight up to the start point.  Not only will that be tough (and dangerous) but what will happen as they try to progress the exercise by adding weight? 

Do you see the problem now?  Sure there’s nothing wrong with the bench press but in this scenario it was a bad choice of exercise because the client was not capable of completing it safely and effectively on their own.  There’s also a strong chance the client will forget the correct technique, worry about injuring themselves or looking stupid by doing it incorrectly in front of others and simply avoid doing it.  How’s that going to help them achieve great results?

Was it necessary to change the exercise at all? I talked to the instructor afterwards and he said he wanted to give the client more variety. Ultimately he wrote a completely new program with completely new exercises.  This raises a common issue in the fitness world, namely how the variety principle is misunderstood in relation to exercise selection. It seems common place in gyms around the country that every 6 weeks or so client’s programmes are discarded and instructors spend hours designing new ones made up of completely new exercises.  Is this the best use of instructor’s time? Does the client always benefit from this?

The variety principle simply suggests that to avoid plateaus and boredom the FITT variables (frequency, intensity, time, type) should be altered regularly. Why not alter intensity by increasing the load, changing the tempo or reducing rest times between sets?  There are so many options other than simply changing the exercise every few weeks.

A trainer pointed out to me a few years ago that at best he only has an hour or two every week with his clients so he can’t afford to waste time teaching lots of new exercises, if clients are going to get the results, they need to be doing the exercises frequently enough to progress.  What is happening to a client’s heart rate and metabolism when they are spending their time trying to learn new exercises all the time? Not much really! 

So of the thousands of different exercises out there and the multitude of balls, bands, discs and other gadgets that you can incorporate, how do you actually choose an arsenal of great exercises that work?  Initially it helps to eliminate the mass of useless exercises that tend to get in the way. After all, how many clients have actually come to you with the goal of learning lots of new exercises?

The vast majority of clients join gyms to lose weight, ‘tone’, improve health or gain muscle strength and/or size.  The exercises we select for them must achieve these goals.  A way to separate the effective from the ‘why bother’ exercises is to rate them.  Use the table on the following page and enter in any common exercises you use or are thinking of using, and after filling in the boxes give each exercise a rating.  There are plenty of examples to help you.  At the end of the exercise I’d hope that you have a selection of no more than 10-15 exercises that you can use time and again with clients and can alter the FITT variables on to provide variety and keep clients progressing

You might find that some exercises don’t fit easily into one of the movement patterns, e.g. where would you put the famous thigh adductors and abductors or what about wrist curls?  This will probably be the first cull of the useless! Why perform exercises that aren’t big movement patterns?  There may be some calling for such exercises (rehab possibly) but we’re talking about exercises that will achieve the goals of the vast majority of gym users here, not the occasional chap with a sprained wrist!  If it’s not a big movement pattern then it probably won’t use lots of muscle, burn lots of calories, stimulate lots of nerves and low and behold, actually work!

When you have a reliable arsenal of exercises in your ‘tool-kit’ you can focus on selecting the ones that best suit your client. There is a saying we use with trainers and instructors ‘screen the client well and the programme writes itself’.  This simply means that a well performed screening provides you with all the necessary information and makes it obvious what exercises to select for your client.

When you screen a client well you’ll decipher their goals (what they want to achieve, why and when they want it), their exercise history and capabilities (are they a beginner or advanced, what have they tried before), the available time they have to train, their exercise preferences (will they train on their own or in a group, indoor, outdoor, hard, easy, what do they like/not like) etc. You should also gain an insight into any concerns they may have with exercise such as doing free weights in the busiest part of the gym as a nervous beginner. 

One final point here; your ability to think critically and remain focused on the needs of your client at all times is imperative.  It is easy to fall into the trap of thinking your value is in learning more fancy new exercises to dazzle your clients with, exercises that you hope may separate you from other trainers.  But ask yourself; “are these exercises what my clients want and need? How will these exercises help my clients achieve their goals quicker? Will my clients perform them and feel comfortable doing so?”  If the answer is no to any of those questions then you probably shouldn’t add them to your repertoire.  Your client will thank you for it by enjoying exercise, sticking to it and getting results!

Glycaemic Index or Glycaemic load – What’s the difference?

As the debate over carbohydrates (are they good or bad, what do they do, when can you not eat them) intensifies, the glycaemic index (GI), and glycaemic load (GL) have gained credibility as tools to help explain the effect carbohydrate foods have on the body, and thus which to avoid, and which to eat. 

The glycaemic index is a ranking of carbohydrate foods based on the effect they have on blood glucose levels after consumption.  After an overnight fast subjects are fed foods that contain 50grams of carbohydrate and their subsequent blood glucose levels are measured.  Foods that are deemed high GI are rapidly digested and absorbed, resulting in a greater rise in blood sugar levels, while foods deemed low GI are slowly digested and absorbed resulting in a lower rise in blood sugar levels.

It is generally recommended that we eat more low GI foods as due to a slower digestion they will provide energy over a longer period than high GI foods which give a short burst of energy.  Eating low GI helps weight control as theoretically we eat less low GI foods due to the sustained nature of their breakdown.  As there is a lower response on blood glucose levels with low GI foods people with diabetes are advised to eat low GI to help control their blood sugar levels.  The table below shows the GI ratings of some common foods;

While the GI is useful it does have a major limitation as it doesn’t take into account the quantity of food consumed for testing in order to provide 50 grams of carbohydrate. Confused? Lets’ explain it basically. Carbohydrate is not a food per se, it is a nutrient found in lots of different foods, and it is found in these different foods in different concentrations. 

For example sugar (or sucrose) is pure carbohydrate, i.e. 50 grams of it provides 50 grams of carbohydrate, and in comparison it requires 800 grams of carrots to provide 50 grams of carbohydrate. Watermelon is another example, like carrots it is considered high GI, but only has 5 grams of carbohydrate per 100 grams, so we’d have to eat about 1 kg of it to provide 50 grams of carbohydrate (the rest is really just water and fibre). 

This is where the glycaemic load (GL) comes into play, as it takes into account how much carbohydrate a typical serving of food contains as well as its GI.  Glycaemic load is defined as the amount of carbohydrate in a portion of food multiplied by the GI value for the food, divided by 100.  Consequently some foods that we may have avoided due to being high GI are shown to actually be not that bad when we consider typical serving sizes.  For example, how often does anyone really sit down and eat 800 grams of carrots in one go, or 1 kg of watermelon-as that is what is required for those foods to cause the ‘high GI’ effect on blood sugar levels 

The table below shows the GL of some common foods including many of those from above, note how some have changed as the amount of food is considered;  

A comprehensive listing of the GI & GL of many foods

Neither the GI nor the GL take into account the effect of fibre.  Dietary fibre is found in fruit, vegetables, legumes and many cereals, it adds bulk to meals without calories, making us feel full, as well as slowing the process of digestion.  Many low GI & low GL foods are also high fibre foods, so there is an argument to suggest that the actual benefit of eating low GI and low GL is due to the effect of fibre and not the glycaemic effect on blood sugar levels.

While the GI and GL certainly have credibility and interest value, in many ways they actually add to the confusion in regard to what ‘healthy eating’ is. It would seem that supporting the general message from the New Zealand Ministry of Health in regard to eating more fresh fruit and vegetables, wholegrain foods and legumes such as beans, lentils and peas, is not only credible but much easier for the general population to understand, and therefore much more useful. 

With 79% of adults participating in sport and recreation activities every week and 34.9% of adults currently signed up to a club or center, it’s fair to say that physical activity plays a large role in peoples lives in New Zealand. Whether people take part in activity for enjoyment or because they’re aiming to achieve a specific goal, exercise will place stress on our bodies. Understanding exercise principles allows trainers to monitor the stress (exercise load) placed upon their client in order to make the training safe and effective, helping the client to achieve their goals.

This article looks at what the exercise principles are. The next article ‘Exercise Principles in action’ will look at examples of how these principles apply to different clients.

Individualisation

Exercise should be specific to the individual completing the training

People respond differently to exercise so in order to maximise the benefits, training programs should be built around the person’s needs and capabilities.

Specificity

Exercise should be specific to the client’s goals, needs and capabilities.

Our bodies response to training is based on the specific stimulus (training) applied. So to increase adaptation (results) exercise should be specific to an individual’s goals, tasks, movements and capabilities.

Overload

Exercise should overload the body in order for a positive adaptation to occur

For the body to adapt it needs to be overloaded. This means it needs to be placed under greater stress than it is accustomed to. This is accomplished by using the F.I.T.T principle to make the body do more than it has done before.

F = Frequency of training

I = Intensity of training

T = Type of training

T = Time of training (duration)

Progressive overload

Exercise needs to continually overload the body if positive adaptations (change) are to continue to take place.

For the body to keep adapting to exercise the stress it is placed under should progressively increase (i.e. the intensity / loads should continually increase). Similar to overload, stress can be gradually increased using the F.I.T.T principle.

Variety

Exercise needs to be varied for optimal adaptation to occur, avoiding boredom, overuse, injury or hitting a plateau.

For optimal change to occur and to decrease the risk of an individual getting bored, overtraining, getting injured or reaching a plateau, the training must constantly be varied.

Rest and recovery

Rest and recovery are required to allow the body time to adapt to exercise.

Optimal adaptation requires recovery time. It is only during the recovery phase (days between workouts) that the body is able to change and adapt to the stress of the workout. Recovery can be improved in a variety of ways, such as effective nutrition and hydration, light aerobic exercise and stretching sessions. It is believed that 90%⁺ of an individuals time is spent recovering from exercise. If we get this wrong positive adaptations will not occur as quickly.

Reversibility

If you don’t use it you lose it

Adaptations which occur through exercise are reversible, so when training is stopped for prolonged periods the adaptations from previous exercise will be lost.

Maintenance

Fitness can be maintained by altering the F.I.T.T principle.

By maintaining the intensity of training and decreasing the volume or frequency of training by 1/3 – 2/3 the current fitness levels of an individual can be maintained.

Ceiling

Room for positive development decreases the fitter you become

As we get fitter, the amount of improvement possible decreases based on the client getting closer to their genetic potential (ceiling).

Interference

Training contrasting fitness components at the same time can reduce adaptation (results) in both.

Training certain components of fitness at the same time can lead to the interference effect. For example training to increase muscle size and increase aerobic endurance at the same time will lead to the client making slower progress to both goals, even though there will be increases in both of the components being trained.

 So we know exercise principles, now what?

What ever a clients reason for taking part in exercise, it is imperative that every fitness professional understands the exercise principles and how to use them.

Abiding by the principles will help trainers create a safe, injury free, exciting and effective programme, allowing clients to achieve their goals.

Read Exercise Principles in action to see examples of the principles used for both general population and athletes.

Everyone usually loves me – so what’s wrong with that guy?

Even the most successful Personal Trainers will have one or two prickly potential clients that they just can’t seem to win over. So why is this? While you can never please everyone, there is a simple tool called DISC that can help you as a trainer improve your communication and rapport building skills. This in turn will help your conversion rate (leads into clients) and help your current clients work towards their goals in the way that they feel most comfortable with.

DISC suggests people are made up of four quite different behavioural styles, which each have certain traits.  Individuals will generally have a strongest behavioural style; however it is the combination of all four behaviour types that makes up who we are and how we react.

The four behavioural styles are briefly described below:

D- Dominance:

The D behavioural style centres around control, power and assertiveness. D’s are very direct, goal orientated and driven. They like to be the leader, straight to the point, no messing about. This can sometimes make them seem a little insensitive - which they don’t mean to be.  They are just very task focused, and like to do things quickly and efficiently. A good example of a D would be a person in an authoritative position, like Helen Clark.

I - Influence:

The I style is more about social situations and communication. I’s are chatty, they are social creatures who’s main aim in life is to be liked by all around them. They talk a lot, usually very quickly and often about themselves.  They tend to have a short attention span and are impulsive, liking spontaneity.  They are expressive, like to be the centre of attention and are very people focused. Many entertainers would be high I – like Dame Edna!

S – Steadiness:

The S style is characterised by patience, persistence, and thoughtfulness.  They are very steady, calm and loyal. They are a team player, they like consistency and making sure everyone around them is ok.  S’s are very caring, people focused individuals, who are usually a bit quieter and like to do things slowly.  S’s are resistant to change and can be a little over-sensitive.  A person in a very caring role is likely to have quite a high S, perhaps a nurse or a guidance counsellor.

C - Conscientiousness:

The C style is all about structure and organisation. They are cautious, curious, logical and methodical. They like numbers and graphs, are analytical and like to be precise. They ask the ‘why’ questions and often do things slowly as they make sure they are getting it right. C’s can be perfectionists at times, and are very detail and task orientated.  Anyone particular about numbers is likely to be quite high C – maybe your accountant!

So why is DISC important to me as a Personal Trainer?

 DISC was developed to help us understand behaviour, both in ourselves and others.  Once you can identify your own DISC, you will become more aware of your own strengths and weaknesses, and how this affects your interactions with those around you. 

DISC also enables you to quickly identify other people’s strongest style, and adjust your own behaviour to suit them.  This allows you to tailor your services to provide support and information in the way that will be most appreciated by your client.

As a young trainer starting out, one of my first clients was an extremely high ‘D’. Because I was new and very nervous, it would have been easy for me to let him take charge of the session, as my natural approach to personal training was soft and supportive. Luckily we had just learnt about DISC, and I could adjust my behaviour to be more direct, confident and assertive. Subsequently my new client had much more respect for me, and trained with me for the next five years!

While you need knowledge and skill to train people safely and effectively, the bottom line is that people train with you if they LIKE you. If you can interact with clients in a way that immediately puts them at ease and endears you to them, hey presto – your business is booming!

• Using the chart below, try and identify your own DISC
  
• Over the next few days, see you who can identify as the strongest ‘D’, ‘I’, ‘S’ and ‘C’ that you know
• The following articles in this series will look more closely at what each behavioural style really wants, and how you can adapt to give it to them:
• Cut to the Chase – The D client in action
• It’s all about me – The I client explained
• We did it as a team – The S client story
• Why why why – Keeping the C client happy
• The final article ‘ Ok now I know their DISC what do I do?’ will help you apply what you’ve learned in a Personal Training setting

You can also complete your DISC profile online

About Pippa…

I had been Personal Training for almost a year when Pippa was referred to me by her friend. I stood in the reception area waiting as I usually did when I had a new client. I waited, and waited. After fifteen minutes I had given up all hope, when a flurry of blonde hair, designer heels and a rather nice handbag flew through the door.

“I’m here!” the blonde bundle, who I presumed must be Pippa, announced as she threw her gear down, grabbed me in an enthusiastic hug and planted a noisy kiss on one of my cheeks. “Uh, hi” I stammered as I untangled myself from her embrace and tried to remove my clipboard from my ribcage where it had been lodged during the vigorous greeting.

“You must be..” I tried to regain some of the formality I was used to when greeting new clients.

“Pippa, yes hi. Lucy has told me so much about you. Where are we heading… over there? I’m sooo sorry I’m late, you will never believe what happened on my way here…” Linking my arm through hers Pippa began to lead me through to the consultation room as she regaled me with a story of her eventful and very social trip to the gym that morning.

Pippa was most definitely an 'I'. After a screening session that lasted an hour and a half, had me crying with laughter, and left me with no notes on the screening form, I knew the names of all her past boyfriends, family members, and her favourite colour.  I noticed after she had left that I had very little information that was actually relevant to writing a potential exercise program for her (had we mentioned exercise? I really wasn’t sure), however something told me that it wouldn’t really be an issue!

Pippa’s Strengths

Pippa was fun. She was entertaining, spontaneous and loved to be the centre of attention. Sometimes I think we both forgot that we were at the gym and that she was supposed to be exercising.  Instead we focused on the scandal and gossip that seemed to follow Pippa wherever she went. Pippa LOVED to talk; she did things quickly, and loved variety.  She was happy to do whatever I wanted in her gym sessions - as long as it wasn’t boring and she could tell me about her weekend while she was doing it! She was very social, she knew everyone at the gym, and knew all about what was going on in their lives. She went out of her way to always be nice to everybody, and was greatly concerned (and a little indignant) if she thought that somebody didn’t like her. Our sessions flew by, and Pippa wasn’t too concerned with achieving goals and sticking to time frames as long as we were having fun (which we usually were!).  She was definitely an ‘easy’ client to train.

Pippa’s Weaknesses

While I loved Pippa dearly, I had got into Personal Training with a goal of forming close relationships with my clients AND helping them to achieve their fitness goals. Pippa and I had the close relationship down pat – sometimes I thought it was a little too close as she revealed every detail of her personal life to me – including things that I definitely didn’t want to know!  However what I found frustrating was the fact that she had no set fitness goals, an extremely short attention span and very little follow through, meaning that we made limited progress on the gym floor! While she kept training with me because she liked me, her technique was awful - as instead of listening to my cues, she was waiting for her turn to talk again.  She had to have a Personal Trainer because ‘everyone else was doing it’, however I couldn’t help but feel that she used our sessions primarily for socialising and ‘being seen’ at the gym.  

Training Pippa

Pippa and I had a tremendous friendship and a lot of fun on the gym floor. However to get anything done I was forced to develop a few underhand tactics to keep her on task.  I had to remember that what made Pippa tick was having a good time, so the challenge was to try and get her working hard in the gym, while at the same time creating something of a party atmosphere!  I tried to structure our training sessions in a way that would keep us both relatively happy (see programme below). 

 Pippa's programme 

Moral of the story  

I loved training Pippa - the drama, the gossip, the entertainment!  However when talking to other trainers I could sympathise with those who wanted to train their clients hard, and felt frustrated when their client just wanted to talk about themselves.  What I tried to do was set some ground rules early on (in a light and entertaining manner..?!) and realise that a high 'I' usually values social interaction above all else, including, shock horror, their fitness. A good idea is to schedule times throughout their session where you both know that it is their time to talk.  It’s usually all about compromise, when Personal Training an 'I', it really is all about them!

About Sophie…

The first time I met my new client Mandy, her mum Sophie came along for moral support. Mandy was only fourteen, and was pretty nervous about starting at the gym, but nowhere near as nervous as her mum seemed to be!  After a gentle and reassuring screening session (reassuring Sophie that is!), I began training Mandy twice per week.

Every time Mandy came in to train, Sophie would sit patiently down in the reception area reading her book for the duration of the session. I would make sure that I spent some time chatting with her at the start and end of Mandy’s session, as she seemed very uncomfortable in a gym environment.  She would sit in the corner with closed body language, shoulders hunched and head down. She was very softly spoken, quite timid, and seemed to be trying to make herself invisible as she sat there.

A couple of times I gently asked Sophie if she had ever considered joining the gym herself. Her reaction was one of horror, and she would immediately dismiss the idea.

You may have already guessed that Sophie was a very high S - she was caring, patient, and always considerate towards others. She soon became almost a surrogate mother to me, fussing over me, wanting to know how I was and if there was anything she could do to look after me.  Fortunately this began to include baking for me every other week!

Over the course of the first year I could see that both Mandy and Sophie began to trust me, and feel safe in the gym.  Safety is hugely important to an S, and I knew it was imperative not to try and rush Sophie into starting any kind of exercise herself, even though I was itching to get her going! I found the fact that she sat in the reception area for almost two hours every week hugely frustrating - it seemed like such a waste of a perfectly good opportunity to work out!

After a year (a whole year!) of sitting quietly in the café, the day finally came when Sophie tentatively broached the subject of beginning her own exercise program.

“I have a question for you” she practically whispered. “You can say no if you want, it’s probably a stupid idea, but I’ve been thinking…. Do you think that maybe I could have a go at exercising? Would you be willing to take me on as one of your clients? Please feel free to say no, I know it’s a silly idea…”

I sat down with her and smiled warmly. “I think it’s a brilliant idea. If you feel ready, I would love the opportunity to train you”

Inside I was jumping up and down and screaming with elation, but I calmly retrieved my diary, made a time for our initial consultation, and outlined with Sophie exactly what would happen in our first few sessions.

Sophie’s Strengths

Once we got started, Sophie was very consistent, well prepared and early for every session. As long as she was comfortable with what we were doing she would follow her program diligently, and was genuinely excited when she could increase the level on any of the machines. She loved structure and routine, and liked to know what was coming up in our sessions. She was very even tempered, always in a caring, cheerful mood, and I very rarely heard her complain - unless she was joking about how mean I was to her! 

Sophie’s Weaknesses:

S’s can be very resistant to change, so anything new that I wanted to add into our program had to be proposed about four weeks in advance!  I then had to constantly reassure her that I would make the exercise as easy as possible, that we would try it in a discreet corner of the gym where no one could see, and that she could just let me know if she didn’t like it and wanted to stop. However, once we started something, as S’s don’t like to rock the boat or offend people, there was always the chance that Sophie wouldn’t say if she didn’t actually like what we were doing!

S’s can also be over-sensitive, and any ‘constructive criticism’ offered would always be over-analysed and then taken in the most negative way possible. When giving Sophie feedback I had to focus on the ‘commend, recommend, commend’, making sure it was genuine, and it always helped to point out that ‘everybody’ had trouble with this one.

For example:

“That’s great technique Sophie – your tempo and your breathing rate is excellent (commend). In our next set, let’s just try and relax our shoulders (we’re a team – they are ‘our shoulders’) – most people find this exercise a bit tough to get right the first time through (reassure). You actually lifted a bit more than most beginners would, so well done!” (commend)

S’s make fantastic clients, they are steady, loyal and consistent.  After leaving the gym, I kept in touch with Sophie, and, as we are a team, I felt it’s only fair that she gets the final word in this article. Below is Sophie’s description of how she felt starting out at the gym.

Sophie’s Side of the Story:

“When I started at the gym at the age of 50, I was so nervous because it was a totally alien environment. I pictured it being full of tooth-pick thin people in bright pink lycra, who would despise and sneer at me, and I just knew that all those strange pieces of equipment were waiting to make me look stupid and probably to hurt me.

Fortunately, I had the most fantastic personal trainer, who gave me constant reassurance and took everything in very small steps. She started with the least threatening equipment and told me repeatedly how well I was doing - I really needed the positive reinforcement.

I really valued the friendliness of all the gym staff, which made me feel as if I did actually belong.

It was quite astonishing how quickly I realised that the other members were preoccupied with their own activities and were not watching me. Although even now I stress to all my trainers that I do not do anything with an LSF - a "Looking Silly Factor!”

“Hi there, sorry to keep you waiting. I’m Amanda – your personal trainer. You must be John? You’re nice and early!” I smiled warmly.

“Hi, the girl I spoke to last time said to get here 5 minutes before our session, so I didn’t think I was early?” John replied, returning my handshake.

“Oh well, nice and organised then!” I said, wondering who in their right mind would be early for a 6am session. I led John through to the consultation room.

We got down to business right away. John didn’t seem to be into general chit chat and getting to know each other. Instead he focused intently on the form, and as we worked our way through it, I could see it was very precisely filled out, with quite a bit of detail.

All John’s medical and injury history was catalogued and time lined, including how many months of treatment he had for past injuries, the name and dosage of any medications he was on, and his latest blood pressure and cholesterol readings from the doctor.  He seemed intent on following the format of the form exactly, and tried to bring me back on track if I started talking about a topic out of order (who was conducting this screening?!).

John asked a lot of questions regarding the process we were going to follow. He wanted to know what fitness testing we were going to do, what those results would mean and what kind of program I was going to write.  He also wanted to know all the options regarding price – no chance for an emotional sales pitch here!  When I did question John on how often he would like to train with me, he asked why he would need to see me regularly, as once I had shown him the program and taken him through it thoroughly, he would know exactly what to do until it was time for our re-test and a new program.

Upon finishing the session, I gave John my client information sheet on how to prepare for each session, what to bring each time he came in, my cancellation and payment policies and a training agreement to sign. As I anxiously glanced at the clock – our time was almost up, he settled back into his chair and began to read through them all.  After a few more questions regarding some of the fine print, we had a plan. John knew exactly when, and for how long his next session was going to be, what he needed to bring and what we were going to do.  

As I waved him goodbye, I felt drained.  It was a lot of questions for 6am. As I headed to the coffee machine, I contemplated how I was going to program most effectively for John – who was obviously a high ‘C’ DISC style.

John’s Strengths

John was all about structure and organisation. He was very logical, and had an amazing head for facts and figures. After our fitness testing session, he poured over the numbers, and when I produced a graph of his heart rates, I swear he almost squealed with delight.  C’s love following procedure exactly, so I made sure John’s program was as detailed as it could be. He could follow it exactly for 6 weeks, it had specific notes about when and how to progress the exercises, and it even had a section where he could record all the stats from each session.

When I showed John through all of his exercises, I made sure I took my time, so that John had time to process what we were doing and then ask me any questions about technique or the science behind what we were doing. I’m sure by the time we were through his program, he knew almost as much as I did about anatomy and physiology!

Once John felt confident that he knew exactly what to do, he headed off to do the program on his own for 6 weeks (he didn’t feel that 4 weeks was long enough for him to really get it right), and then we would meet up again to re-test and make any necessary changes. 

John’s Weaknesses

John liked to get things exactly right, which meant he was a bit of a perfectionist. Whilst usually I would have loved this in a client – perfect technique is a goal we all have as trainers, it did mean our sessions had the tendency to take longer than expected.  I was constantly stressed by the end of each session as we had spent so long on the earlier exercises that we had limited time for the final few. John didn’t like this as he needed time to understand each one, so I learnt to make our programs a little shorter than I did with other clients.

John also wanted a lot of detail, but only on the task at hand.  Being more an I-S myself, I found this slightly tedious at times, and even a little insensitive. I mean – didn’t he want to talk about his feelings, hear about my weekend, or just generally get to know each other? Apparently not!  Also, his constant questioning of my programming (“why would we do this exercise?” why is it important to work at this heart rate?”) could seem a little critical, and I constantly had to remind myself that he wasn’t questioning my ability as a trainer, he just genuinely wanted to know why!

To have all the answers…

Personal Trainers need to understand what makes their client tick. With John, a DISC style quite different to my own, I found I had to change my behaviour quite dramatically in our sessions. I had to slow down everything I said and did, and really focus on the details of the task at hand.  I found that I was really well prepared for all of our sessions (along with being ready 5 minutes early), and I developed some great fitness testing systems and graphs.  Without John I probably never would have seen the beauty of numbers, or the motivational effect they can have on people who are ‘that way inclined’.  Learning to win over the ‘C’ style client was my biggest DISC challenge – but now I can talk just as enthusiastically about heart rate data as I can about my weekend.

This article looks at how the principles could be applied to two very different people: A typical gym goer; Mark Jones, and an elite athlete Valerie Villi.

Mark Jones:

Mark has never been in a gym before however has been told by his Doctor that it’s important to get active to lose weight and decrease his risk of obesity related diseases. Mark weighs 120kg and his aim is to lose 20kg and to be able to jog non-stop for 20 minutes at the end of 6 months. Currently he is walking his dog twice a week and gets a sore back when walking for longer than 20min.

Valerie Villi:

After winning the Olympic gold in shot put last year, Valerie is back into training and is preparing for the world champs in November. Her objective is to increase her max strength, her absolute power and to perfect her technique. She is currently training twice a day, once in the gym focusing on weights and the second training focusing on technique work.

Although the exercise principles are the same for both individuals they are applied differently to the training programs for optimal adaptations to occur.

Individualisation

Exercise should be specific to the individual completing the training

Mark: Training should take into consideration that he has never trained in a gym before, that he battles obesity and that he gets a sore back after prolonged walking.

Valerie: Training should be built around her strengths and weaknesses as determined by her coaching staff.

Specificity

Exercise should be specific to the client’s goals, needs and capabilities.

Mark: Training should be specific to Mark’s current exercise capabilities and should focus on weight loss, decreasing back pain during exercise and reaching his goal of jogging for 20 minutes.

Valerie: Training should focus on perfecting Valerie’s technique and increasing performance (eg: all body power), in line with her weaknesses. Her overall goal is to win at the world champs so that’s when she needs to peak.

Overload

Exercise should overload the body in order for adaptation to occur

Mark: Overload for Mark may be as simple as increasing the duration of his walks by 2-3 minutes or increasing the number of walks he completes per week.

Valerie: Overload may include adding another set to her power lifting sessions or increasing the load being lifted per exercise.

Progressive overload

Exercise needs to continually overload the body if  adaptations are to continue to take place.

Mark: Progressively overloading Mark can be done by increasing his rate of perceived exertion (RPE) incrementally week by week or introducing resistance training exercises to his program each week over the following 10 weeks.

Valerie: Progressively overloading Valerie can be achieved by increasing her lifting load by 5 kg each week during her max strength training sessions or by increasing the tempo of her repetitions during strength training on a weekly basis.

Variety

Exercise needs to be varied for optimal adaptation to occur, avoiding stagnation, overuse and injury.

Mark: Variety can include offering Mark other aerobic exercises (eg: swimming or golf) to keep him interested in exercise and to keep him progressing towards his goal of losing weight.

Valerie: Variety can include offering various options to continually develop power such as outdoor medicine ball throwing sessions or upper body plyometrics at the beach.

Rest and recovery

Rest and recovery are required to allow the body to take on adaptations to exercise.

Mark: Recovery will focus more on time away from exercise; Mark will require a good 48-72hours to recover from any resistance training as it is a new exercise stress for him.

Valerie: Rest and recovery will be spent eating and hydrating in order to prepare for her next training session that day. She may even complete some aerobic exercise to clear lactic acid and relax the mind.

Reversibility

If you don’t use it you lose it

Mark: If Mark stops training the hard work he has put in to his jogging goal will be lost. Eventually he will return to his original level of fitness (eg: having to start walking again to increase fitness instead of increasing his jogging time).

Valerie: The smallest possible break Valerie takes from training the better in order to keep making adaptations. Reversibility of fitness occurs at the rate of about 1/3 of the time of it took to improve so halting training will only be a backward step to her goal of winning the world champs.

Maintenance

Fitness can be maintained by altering the F.I.T.T principle.

Mark: Instead of Mark walking 5 days a week at a rate of perceived exertion (RPE) of 6, he could decrease his number of walks to 3 but maintain the intensity of an RPE of 6 to maintain his current fitness level. This may free up time for other types of training like resistance sessions.

Valerie: Closer to the competition Valerie will decrease the number of sessions and /or the duration of her training, but keep the intensity of the sessions high in order to maintain her performance level without continually stressing her body.

Ceiling

The room for improvement decreases the fitter you become

Mark: Mark’s adaptations to training will typically occur very quickly and his gains in performance whether it's aerobic capacity, muscle endurance or strength will be large initially. These gains will slow as he gets fitter.

Valerie: Positive increases in Valerie’s performance will occur in small increments and will generally take a lot of training as her body is already conditioned with years of training experience.

Interference

Fitness components can interfere with each other when trained together

Mark: Later on in Mark’s training we may decide to train strength and aerobic capacity together at similar intensities and frequencies. This would lead to a smaller improvement to both Mark’s aerobic capacity and his strength, compared to if one component was being worked on.

Valerie: Training Valerie’s aerobic endurance to allow for more efficient and effective recovery at the same time as focusing on max power development would cause an interference effect. This would lead to a smaller gain in both components.

To avoid the interference effect you would use periodisation, placing emphasis on different training components at different stages of training.

Exercise principles in action shows us that the same principle can be applied differently for each client. The key to using the principles well is having a thorough understanding of them and their relationships along with having a really good understanding of your client and their needs before prescribing any exercise programme.

About Tom…

Tom strode into reception. He sat at a table in the gym café, straight posture, business suit, and took in his surroundings. I approached him and introduced myself. He had a firm handshake, an assertive tone of voice, and maintained direct eye contact. ‘He’s a D’ my brain was shrieking. Being an ‘S’ I was trembling inside, but I knew what I had to do.  I straightened my posture, shook his hand firmly in return, and put on my most efficient and confident voice.

“Thanks for coming in Tom. Let’s head into the consultation room and have a look at why you’re here”.

Tom was 50, a high powered business man – a partner in his firm. He radiated authority, and as he stated his reasons for being here, he slapped his hand on the table to accentuate each point.

“I’ve hurt my back; I want you to fix it. I want to lose some weight, and increase my fitness. I want to cycle around Lake Taupo in November. I want to personal train with you 3 times per week if you think that’s enough, and I expect to see results”.

While my knees shook under the table, I matched his tone of voice, and slapped my hand on the table – accentuating my own points in reply.

“Great Tom. We’ll train 3 times per week at this time, for one hour per session. You will need to do 2 sessions per week on your bike to compliment this to achieve your cycling goals. You’ll also need to do some stretching at home, and we will incorporate some rehabilitation exercises in your sessions to help your back. The cost will be $180 per week, and we will start with a fitness test to see where you are at, and how much work there is to do”.

After a brief and no nonsense screening, Tom was out the door, preparing to dominate the cycling and back rehabilitation world.  I was in the foetal position under the table, but I knew I had achieved a small victory.  Over the following 5 years – Tom would prove to be an educational goldmine for how to train a high ‘D’ client.

Tom’s strengths

Tom was a very determined, motivated and competitive client.  He was extremely goal orientated, and the prospect of cycling around Lake Taupo kept him firmly on track, especially as a few of the blokes in the office were doing the race (he wanted to beat them, of course).  He responded well to direct and concise instructions, and, as D’s are task focused, concentrated intently on the training session at hand. Being a hard worker, he never missed a session, and if he had to reschedule he always made it up. Tom was fun to train in that he loved being pushed hard.  His adherence to his program was excellent, especially the intensity of sessions and the completion of his stretches as he directly related those two factors to the achievement of his goals.

Tom's Weaknesses:

Tom wanted things done quickly; he was not so interested in the finer details of training. This caused a few minor stand offs when selecting what weight to lift, as Tom often found the weights I selected were ‘too easy’.  Being a stickler for technique – I had to hold my ground and keep the weight at a level where he could learn the correct posture and movement – before we upped the intensity.  Early on I learnt to include a couple of machines in Toms programs that he could lift reasonably heavy weights without compromising his back, and I snuck the stability and core exercises in around these. Another helpful hint I found was to stroke Toms ego when I could – “Tom, you can obviously lift more than this, I just want to check your technique on the first set before we put the weight up”. 

D’s can at times come across as domineering and insensitive, especially if working with an ‘S’ type who is much more sensitive (that’s me!).  As a D is very task focused, Tom often did not consider how anything he said or did would affect my feelings. He also liked to be in charge of whatever he was doing, which created a challenge for me in our sessions. When training Tom I had to be very mindful to 1) not take anything he said personally, and 2) be assertive and take control of the session when required.  When doing this I had to remember that D’s want their point of view validated, and to feel listened to and important.

An example of this could be:

Tom: “Interval training is the only way to improve my fitness”

Me: “That’s a great idea (validate point). While starting out, lets focus on building up endurance – 160km is a long way around Lake Taupo (me being assertive). Then we will move into more of a speed phase like you’ve suggested (make Tom feel listened to and important – it was his idea!)”.

The moral of the story

Tom and I had a great training relationship, but if I had not understood DISC we may not have made it past day one!  At times during our training, I could have felt insulted and submissive had I not understood what makes the D style tick, and how to adjust my own behaviour to suit his. However, as I matched Tom’s style from the start and responded to him in a way that he understood and respected, we made a great team.  Most importantly, the great training relationship ultimately led to great results!  Tom went on to rehabilitate his back, cycle around Lake Taupo in a time that he was happy with, and most importantly - beat the boys from work!  

Type 1 Diabetes represents about 10% of cases diagnosed worldwide. A lack of knowledge about the different types of Diabetes means that Type 1 Diabetes has become a disease incorrectly associated by many with poor nutrition, physical inactivity and excess body fat.  In fact, Type 1 Diabetes develops due to none of these things - however the incidence of Type 2 Diabetes has grown to epidemic proportions due to our over-indulgent and sedentary western lifestyle!

What is Type 1 Diabetes?

Type 1 Diabetes usually develops during childhood - although it can develop at any age.  A person generally has a genetic predisposition for the disease (a family history), and some kind of environmental factor must occur that ‘triggers’ it’s development. Scientists are still working to discover what that trigger is, but it could be something as simple as a virus like the common cold, or related to diet early in life. Once this trigger occurs, the individual’s own immune system begins to attack their pancreas, eventually leaving it unable to produce and release insulin. Remember that Insulin is the hormone responsible for moving glucose from our blood into our body’s cells (muscle, liver and fat cells). When no insulin is available, no glucose can get into our cells meaning glucose levels in the blood keep climbing, and the symptoms of Diabetes will appear.

What are the symptoms?

Type 1 Diabetes symptoms tend to have a rapid onset, and include excessive urination, excessive thirst, fatigue, and unexplained weight loss.  Once Type 1 Diabetes has been diagnosed, an individual will require multiple insulin injections throughout the day to keep their blood glucose at a safe level.

Does this have an effect on their ability to exercise?

In non-diabetic people the hormones insulin and glucagon work together to ensure there is always enough glucose available in the blood for our brain, as glucose is its primary fuel. This natural balancing act is essentially lost in the person with Type 1 Diabetes, as all insulin is administered externally, and can’t be reduced internally if needed.  The biggest challenge during exercise is that a pre-exercise insulin injection will keep moving your client’s glucose out of their blood and into their cells, even if the levels in the blood are getting too low.  If glucose levels fall below 4mmol/L (four is the floor), hypoglycaemia - low blood glucose levels - occurs, which can potentially lead to a coma, or even death.  

How can I stop this happening?!

Fitness professionals need to work together with their client and their client’s doctor to adjust their medication regime when starting an exercise program. There could be a need to reduce the amount of insulin injected pre-exercise, or to increase the amount of carbohydrate eaten before a session.  Extreme care needs to be taken to ensure that a client does not drop to dangerously low blood glucose levels when participating in physical activity, and trainers need to be able to recognise the signs of hypoglycaemia immediately.

Some of the signs of hypoglycaemia are:

• Pale skin

• Dizziness

• Shaking

• Fatigue

• Anxiety

What should I do if hypoglycaemia does occur?

You should always carry some high GI foods (e.g. lollies) on you when training a Diabetic client, and they should always carry their own blood glucose monitor on them. If hypoglycaemia does develop, stop the exercise session, give your client high GI foods and water, and once they feel better and their glucose levels have come back up, they can head home – don’t let them carry on with the session. Remember to monitor them in the club until they leave, and call them later to make sure they are ok!

Initial aims when training a Type 1 Diabetic client

Your client must have good control over their glucose levels before they even think about beginning an exercise program, and while it may take a bit of trial and error while getting started, they should eventually be able to participate in any kind of exercise program they would like to.

High intensity exercise tends to prove more of a challenge for controlling glucose levels – it can even cause hyperglycaemia (high glucose levels) due to the extra glucose being released from the liver into the bloodstream. There may not be enough insulin in the body to cope with the extra glucose, and levels begin to rise.

Until you and your client have sussed out the best approach in terms of carbohydrate intake, insulin injections and how they respond to different training sessions, low to moderate intensity exercise may be the safer option.

Will exercise help control Type 1 Diabetes?

Type 1 Diabetics will always require insulin injections to control their Diabetes, however many Diabetics who exercise find that they require less insulin overall as long as they exercise regularly. 

People with Diabetes are more susceptible to high blood pressure, stroke and cardiovascular disease along with damage to their eyes, kidneys and feet if they frequently experience hyperglycaemia.  This is due to the thick blood causing damage to the smaller blood vessels in their body. 

An active lifestyle combined with a healthy balanced diet will help keep their glucose levels in the normal ‘safe’ range, lower their blood pressure and reduce cardiovascular risk factors. All which should help prevent the development of many complications. Plus – regular exercise promotes feelings of health and well being, provides many physical and psychological benefits, and may give a person with Type 1 Diabetes a sense of control over their disease, and subsequently, their life.

This article will look at the concept of TUT (time under tension) to explain how to choose the correct number of reps and tempo for your clients. A good understanding of TUT will help you to write better programmes for your clients. It will also help you to clearly explain why you have written your programme the way you have.

What is TUT (time under tension)

How many of us learnt that 4-6 reps builds strength, 8-12 reps is for hypertrophy and 15+ will build endurance. What no one ever told me…and what I never understood…was why?

Understanding TUT made the whole rep number thing make sense to me. See how it works for you.

TUT is the amount of time a muscle is held under tension for during one set of an exercise. Here is an example of how a typical 10 reps might work for a beginner:

Tempo: 2 seconds on the eccentric phase, a 1 second pause at the bottom and 2 seconds on the concentric phase.

You may see this on a programme as 2:1:2, this = 5 seconds per rep.

TUT:                 5 seconds x 10 reps = 50 seconds TUT

Often we will see programmes written and they will say Bench Press, 3 sets of 10 reps.

Let’s look at how different the same number of reps could be:

            TUT:                 Tempo 3:1:3 = 7 seconds per rep x 10 reps = 70 seconds

            TUT:                 Tempo 1:0:1 = 2 seconds per rep x 10 reps = 20 seconds

We can see that the same programme could be carried out very differently and as a result have a totally different effect on our client.

How do I know what TUT to use with my clients?

When we look at choosing a TUT for our clients the first step is to decide what the aim of the training is. We need to decide, do we want to build muscle, increase strength, improve endurance. Looking at the energy systems graph below you can see some of the main components of fitness that you may train with your clients. What we are going to do is look at the same exercise and how we can alter the tempo and the TUT to change what effect that exercise will have on our client.

The energy systems and fitness components

Let’s look at an example of power training. Power is the ability to be explosive. Being powerful requires lots of energy very quickly and therefore we use our ATP-PC system. The TUT for Power training would be 5-10 seconds.

            Bench Press:

            TUT:                 Tempo 2:0:X (explosive) = 3 seconds per rep x 3 reps = 9 seconds

Strength training also demands high levels of energy output. We are lifting the heaviest loads we can so we will need to work at a high intensity for a short period of time. Strength will use both the ATP-PC system and the early part of our anaerobic system. TUT for strength training is in the 10-30 seconds.

            Bench Press:

TUT:                 Tempo 2:0:2 = 4 seconds per rep x 5 reps = 20 seconds

Hypertrophy training requires us to work the muscles for longer. We still want to work at a reasonably high intensity, using the anaerobic system. We want to fatigue the muscles and cause muscle damage. This will cause a hormone response (testosterone and growth hormone) that will increase our muscle size. The TUT for hypertrophy training is 30-60 seconds.

            Bench Press:

TUT:                 Tempo 3:1:2 = 6 seconds per rep x 8 reps = 48 seconds

Muscle endurance training requires lifting a weight for more than 60 seconds. Therefore the weight can’t be very heavy to begin with (40-60% of their max lifting weight). As the weight is lower, the body doesn’t have to provide energy at such a quick rate. Muscular endurance tends to use the aerobic energy system more (with some anaerobic contribution).    

            Bench Press:

TUT:                 Tempo 2:1:2 = 5 seconds per rep x 15 reps = 75 seconds

How do I use this with my client?

Now that you understand what TUT is, how do you use it?

First, what are you trying to achieve with this client? Really think about this. Did my 40 year old female client say she wants to ‘tone’?  As a Personal Trainer I might decide that for my client to ‘tone’ I want to build some muscle and do a separate cardiovascular programme to help her metabolise fat?  Hypertrophy it is! Hypertrophy doesn’t mean I turn my client into Arnie (or Mrs Arnie). Hypertrophy for this client, means rebuilding the muscle she has lost since her 20^th birthday.

Now how experienced is my client? New to training? Slow controlled tempo it is. 2:1:2.

Therefore 5 secs/rep x 8-10 reps = 40-50 seconds, putting me nicely in hypertrophy.

What intensity do they want to work at? 6/10

My sets will look pretty standard. Start with 2. After 4 weeks I might progress it to 3. I will set the load so that the intensity for my client will be at a 6/10.

An exercise in my client’s programme now looks like this:

            Seated row        2 sets     Tempo 2:1:2      Reps: 8-10    Intensity 6/10    

The exercise is not complicated for my client to follow, but I can clearly explain why the programme is written the way it is. For me as a trainer, understanding TUT increased my confidence with programme writing. It also gave me more options on how to change a programme. Instead of changing every exercise each month I could keep the client's favourites and change the TUT instead to give them a new challenge.

Why is Type 2 Diabetes such a problem?

Type 2 Diabetes is one of the biggest international health challenges in the world. The number of people in New Zealand with Type 2 Diabetes has doubled in the last 10 years, although the true extent of the disease remains unknown.  It is estimated that for as many individuals that are diagnosed with Type 2 Diabetes, there is the same amount of people living with the disease who don’t even realise that they have it! The complications associated with Diabetes – for example hypertension, heart disease, and kidney problems – cost countries billions each year in health care, and can shorten a person’s life expectancy by up to 12 years.

How does someone get Type 2 Diabetes?

Previously it was believed that Type 1 Diabetes was more of a ‘genetic’ disease, and Type 2 Diabetes developed because of unhealthy lifestyle factors – poor nutrition, inactivity and excess body fat (especially abdominal fat). However studies on identical twins have shown that there is a stronger genetic link in Type 2 Diabetes than Type 1. The unhealthy lifestyle factors act more like a ‘trigger’.  

A combination of a genetic pre-disposition and lifestyle risk factors can lead to Type 2 Diabetes developing.

                             

What is the physiology of Type 2 Diabetes?

The physiology of Type 2 Diabetes is not 100% understood and is constantly being researched.  There are many possible factors that could contribute to problems with glucose control in our bodies.  What we do know about the physiology of Type 2 Diabetes is that it is caused by a combination of the following:

1.       The body’s cells (especially skeletal muscle) may be resistant to the action of insulin. This is called peripheral insulin resistance. Remember insulin acts like a ‘key’ to ‘unlock’ the cell and let the glucose in. With insulin resistance it’s almost like somebody has changed the locks to our cells –the key no longer works!

2.       Insulin may not be produced or released quickly enough when we eat.  This is called impaired glucose tolerance (IGT), and happens when there is a problem with the function of the insulin-producing cells (the beta cells) on the pancreas.

3.       The body may not be making enough insulin – again due to some kind of problem with or damage to the beta cells.

The pancreas does initially produce insulin with Type 2 Diabetes, but as insulin resistance develops and blood glucose levels rise, the pancreas steps up its production to try to lower those glucose levels. The pancreas doesn’t know that the cells are resistant to the insulin, it just knows it needs to get those glucose levels down!  Eventually the pancreas appears to ‘wear itself out’, and insulin production begins to decline. If glucose levels remain uncontrolled over a period of time, Type 2 Diabetics may find that they require insulin injections to bring their glucose levels down.

Some of the latest research suggests that by the time insulin resistance is diagnosed, there will already be some problem with insulin production and/or release. This means that many Type 2 Diabetics will end up needing insulin injections.

What are the symptoms of Type 2 Diabetes?

The most common symptoms are similar to Type 1 Diabetes - excessive urination, excessive thirst and fatigue.  When fasting glucose levels (i.e. not eating overnight before a blood test) reach over 7mmol/L, and the symptoms of Diabetes are present, Diabetes is diagnosed. If the cause of the high glucose levels is insulin resistance, the insulin levels in the blood will also be high.

Can you cure Type 2 Diabetes?

There is no ‘cure’ for Type 2 Diabetes, so treatment focuses on managing the disease to prevent longer term complications.  This generally involves encouraging the individual to make healthy lifestyle changes.  Excess body fat is closely linked with Type 2 Diabetes – 90% of individuals diagnosed are overweight or obese.  Weight loss is a common management goal, achieved through decreasing calorie intake (especially fatty and sugary foods) and increasing physical activity levels. 

Exercise is particularly important in the management of Type 2 Diabetes, as it has been shown to increase the transport of glucose into skeletal muscle cells, and increase insulin sensitivity. This makes it a valuable tool in helping maintain glucose levels in a safe range – which is critical in preventing those long term complications. Remember high glucose levels can damage the blood vessels in the body, leading to many different complications e.g. hypertension, and kidney, eye and foot problems.

Are there any risks with exercise?

Upon diagnosis of Type 2 Diabetes, glucose lowering medication is often prescribed. Some but not all of the different medications for Type 2 Diabetes pose a risk of hypoglycaemia when exercising. As fitness professionals we must find out the name of all the medications our client is taking – and with Type 2 Diabetes there may be a few!  It is a good idea to talk to your client and their doctor and see whether adjustments in medication or carbohydrate intake need to be made before or after an exercise session.  

There may be other risk factors present in your client with Type 2 Diabetes – including high blood pressure, high cholesterol, or any other illnesses associated with an unhealthy lifestyle.

Initial aims when training a type 2 Diabetic client

The biggest challenge in training a client with Type 2 Diabetes is often helping them to change their behaviour. They may have many barriers to exercise and healthy eating, and their physical capabilities – especially if complications or other health conditions are present – may be limited.  Medical clearance from the doctor is mandatory before your client begins their exercise program, and you may find that you need to prescribe short duration, low intensity exercise when starting out. We may know that our client needs to work harder and longer to achieve their weight loss and fitness goals, but our initial focus should be on safety promotion and program adherence.

Do you ever discuss incontinence with your clients?

If your client asked you about pelvic floor problems would you feel comfortable or knowledgeable enough to give advice?

 The truth is that many women experience problems with their pelvic floor. 

Statistics from the UK presented by Dr Chris Steele from The Family GP.com and the “This Morning” show a staggering percentage of women live with pelvic floor problems:

• 42% of women in the UK are sufferers

• 40% of women are too embarrassed to consult their doctor
• 33% of women suffer problems 5 years after childbirth

• On average women wait 5 years before consulting their doctor

You may be wondering what are the symptoms of pelvic floor problems, or how would I know if my clients had a problem?

 Common symptoms are not being able to fully control the bladder or sometimes the rectum resulting in partial leakage of their contents.  The following questions provide a guide to determining pelvic floor problems.

Do you ever have embarrassing incidents when you laugh, cough or sneeze?

• Are impact aerobics or trampolining a thing of the past?

• Do you find yourself desperately crossing your legs on the way to the bathroom?
• Do you always look for bathrooms wherever you go?
• Does a long journey fill you with dread?

If your clients answer ‘Yes’ to these questions, they may have pelvic floor problems.  As you can understand, many women are too embarrassed to talk about it and many think it is something they have to live with as a normal consequence of having kids and getting older. 

 Men can also have pelvic floor problems.  They are often associated with prostate problems but can be caused by weak pelvic floor muscles. 

 As fitness professionals you often have the opportunity to discuss health issues with clients.  If you know about pelvic floor issues you are in a valuable position to improve your client’s quality of life by letting them know that they don’t have to put up with it.

 By understanding what and where the pelvic floor is and how it supports your internal organs you will be able to assist them in finding the most appropriate solution. In some cases you will need to refer out to get specialist advice, but at least you will have helped them with the 1^st step, awareness of the problem and that it can be fixed. In other cases you will be able to help with prescription and explanations of pelvic floor exercises and you will know which exercises to avoid to prevent making the condition worse.

 Let’s take a look now at where these muscles are.  For both males and females the pelvic floor runs from the pubic bone to the tail bone forming a hammock shaped layer of muscle. It creates a floor at the base of the pelvis that supports the internal organs.  In women it allows for three openings, the vagina, urethra and rectum while in men it allows for the urethra and rectum.

FEMALE

 MALE

You can see that in women the uterus is supported by the pelvic floor whereas in men the prostate gland is supported.

 When the pelvic floor is strong it supports the bladder and bowel. It helps to close them off to prevent leakage and relaxes to let them empty when we go to the toilet.

 If pelvic floor muscles are weakened the ability to hold a full bladder or hold wind is decreased, especially during exercise. When urine is leaked involuntarily in this way it is called Stress Incontinence.

 In severe cases the ability to support the internal organs is decreased resulting in organs dropping down.  This is known as a Prolapse.  The prostate or uterus, vagina, bladder, and intestines can actually fall out.  Not pretty and definitely not comfortable for anyone who has this condition.

PELVIC PROLAPSE

Exercises can help to prevent pelvic floor problems and in most cases exercises can be performed to correct weaknesses. It is also important to realise which exercises should be avoided as things like sit ups will be detrimental to anyone with pelvic floor weakness.

 Now that we know why the Pelvic Floor is important, the next article will look at exercises to safely strengthen the pelvic floor and how you will know if you can help or if your client needs to see a specialist.

 To further your understanding of the muscles that make up the pelvic floor check out the following tutorial on you tube. 

 http://www.youtube.com/watch?v=K7w0R4O3ctg&feature=email

If you know your macro-nutrients you’ll know that carbohydrates are the body’s preferred source of energy. One of the best sources of good carbohydrate is fruit and vegetables and the average kiwi isn’t getting enough.  So being ‘tired’ and run down’ is more likely to be due to poor intakes of fresh fruit, vegetables and other good sources of carbohydrates such as wholegrain breads and cereals than vitamin deficiency.

As the name suggests ‘micro’-nutrients are nutrients the body needs in very small amounts.  Vitamins and minerals are micronutrients and just like carbohydrates, fats and proteins they are not food groups, rather they are nutrients that are found in the various food groups.  Food groups are; fruits and vegetables, breads and cereals, milk and milk products and lean meats, poultry, seafood, eggs, nuts, seeds and legumes.

Vitamins are divided into two groups; the water soluble vitamins (B-Complex & C) and the fat soluble vitamins (A, D, E & K). The fat soluble vitamins are absorbed with fats and well stored in fatty tissue. Reserves of these vitamins can last a long time and daily intake is not essential.  The water soluble vitamins cannot be stored and are easily excreted, making deficiency more likely and daily intake more important.  The following table summarises the functions of the major vitamins and the food groups that provide these

If followed, the Ministry of Health (MoH) guidelines for daily consumption of the major food groups should ensure that micro-nutrient requirements are easily met. Their information suggests that vitamin deficiency in the NZ diet is actually very rare.

Vitamins however can be ‘temperamental’!  Some, such as vitamin c can be easily destroyed by cooking.  The MoH estimates that boiling vegetables can destroy 50-80% of vitamin c content.  It recommends cooking with minimal water (steaming) or using the microwave.  And where possible fresh is best and raw is great.

Minerals are absorbed from the soil by plants.  They come into our diet through the plants we eat and/or the animals we eat that have eaten the plants.  New Zealand soils do tend to be deficient in iodine and selenium but the MoH has not determined that these soil deficiencies have actually resulted in deficiencies in our diet.  They recommend the use of iodised table salt if possible but advise people to be wary of adding salt to the diet as our intake of sodium is actually considered excessive and excessive sodium levels are linked to high blood pressure. 

There has been an increase in the use of supplemental selenium in animal feeds and the importation of wheat and other products from Australia where selenium in the soil is higher, to counter the low selenium levels in NZ soils. 

In both cases the MoH does not recommend the use of supplements unless under the supervision of a doctor.  The table below highlights some of the major minerals, their functions and common food sources.  

Probably the most controversial mineral is calcium. There is confusion over what the optimal intake is to achieve and maintain peak bone mass, protect from osteoporosis (brittle bones) and the subsequent risk of bone breakages. The MoH estimates that 20% of the population have an inadequate intake of calcium. Rather than encouraging supplementation, the MoH advises people to consume the recommended low fat intakes of milk & dairy products and other foods containing calcium. MoH also recommends preventing losses by minimising alcohol intake and smoking, and including regular exercise which aids calcium retention.

A mineral we in the fitness world are often interested in is iron, due to its importance in the transportation of oxygen to the body, and therefore to performance in endurance events that are largely dependant on an optimal supply of oxygenated blood to working muscles. 

According to its source, iron can be classified as ‘haem’, from meat, poultry and fish, or ‘non-haem’, from plant based foods, iron supplements and iron fortificants in food.  Approximately 20-30% of haem iron is absorbed by the body whereas only about 5% or less of non-haem iron is absorbed.  Because of this it has often been thought that vegetarians especially would be vulnerable to deficiency.  However iron deficiency is actually very low according to the MoH. 

To optimise the absorption of iron the MoH advises people to include foods high in vitamin c at mealtimes, and minimise the consumption of tea and coffee at mealtimes which hinders iron absorption.  Again the MoH only advises supplementation under medical supervision.

Supplements (as their name suggests) are only required to supplement a diet when a deficiency has been established.  As with vitamins, if the MoH’s recommendations for daily intakes of the food groups are met then so will the requirements for daily mineral intakes. 

When you read through the MoH guidelines it is very clear that supplementation (and indeed diagnosing the need for supplementation) is the domain of medical professionals and not fitness professionals. 

So what is our role in regard to micro-nutrient intakes and the use of supplements?  We should:

• Answer our client’s questions concerning micro-nutrient intakes with sound knowledge based on MoH guidelines for healthy eating
• Understand the MoH guidelines for daily intakes of the major food groups and help our clients to meet these guidelines
• Where necessary work with medical professionals to ensure the nutritional needs of all our clients can be met.

I remember a prominent NZ sports doctor referring to the urine at the Olympic Games as the ‘most expensive pee in the world’; because the athletes would take every supplement available on the chance it might offer them a split second advantage.  The reality is that the body only uses what it needs and excretes the rest, hence very expensive pee!  There are probably better things to spend ones money on than unnecessary supplements, such as fresh fruit and vegetables! 

For more information on micro-nutrients, their intakes and the MoH recommendations for healthy eating follow the hyperlink to this article

http://www.moh.govt.nz/moh.nsf/0/07BC6DBE764FDABBCC256DDB006D9AB4/$File/foodandnutritionguidelines-adults.pdf

What are sprains and strains?

At some stage over the years we have all damaged what’s known as our soft tissues; (muscles, tendons or ligaments). We’ve probably all been told someone it’s a sprain or a strain – but how do we know which is which?

A sprain is an overstretching or tearing of a ligament (the tough white tissue which attaches bone to bone and generally found around joints)

A strain is an overstretching or tearing of muscle or tendon (the connective tissue which connects muscle to bone). Other common names for a strain are such things as a torn or pulled muscle or a ruptured tendon.

What causes sprains and strains?

Sprains occur many ways. The most common causes are falls (like rolling your ankle on rough ground), excessive twisting or being hit by an object (such as tackle in soccer). These incidents will cause a joint to move out of its normal range of motion resulting in the overstretching or tearing of a ligament.

Strains can occur over time or suddenly. Strains that occur over time are also referred to overuse injuries. They occur due to the continual stressing of a muscle fibres and its tendon (like overusing the tendons in the wrist with too much typing).

Strains that occur suddenly (acute) are due to a stretching, twisting or overloading of a muscle and its tendon.  A strain occurring suddenly is generally caused by over stressing/overloading a muscle (such as lifting heavy objects with poor technique and straining a muscle in your back) or stressing a previously injured area (such as sprinting and straining a hamstring that was not fully recovered).

How do you know whether it’s a sprain of strain?   

A sprain occurs suddenly around a joint and leads to symptoms such as:

• Direct pain
• Swelling
• Bruising
• Inability to use or move the joint.

A sprain can be categorized according to the severity:

            1^st Degree (mild)             – Very few fibres are torn

            2^nd Degree (moderate)     – A large number of fibres are torn

            3^rd Degree (severe)         – A complete rupture of the muscle or tendon

A strain can occur over time or suddenly and shows the following symptoms:

• Localised pain/ tenderness
• Muscle weakness
• Swelling
• Muscle spasms / cramping
• Limited movement

Similar to sprains, strains are categorized according to the severity:

            1^st Degree (mild)             – Very few fibres are torn

            2^nd Degree (moderate)     – A large number of fibres are torn

            3^rd Degree (severe)         – A complete rupture of the muscle or tendon

Acute Treatment

Acute (immediate) treatment of sprains and strains is the same initially. Firstly you need to decide whether further medical advice is needed or not. If there are any deformities (something looks out of shape), changes in skin colour or large amounts of swelling about the injury site then it’s recommended that the injured site be immobilised and that further help be sought.

If medical assistance is not required immediately then the following should take place:

            P = Protect from further injury (splints, pads or crutches)

            R = Restrict activity, rest (first 48-72 hours)

            I  = Apply Ice (every 20mins per hour)

            C = Apply Compression (elastic bandage)

            E = Elevate injured area (elevate injured area above heart, if possible)

            D = Send person for diagnosis (if pain has not subsided after 24 hours)

During this phase stay away from HARMS which increase damage to the injury:

            H = Heat (Sauna, spa, hot showers etc all increase bleeding)

            A = Alcohol (Increases swelling)

            R = Running (Exercising too soon increases bleeding and swelling)

            M = Massage (Massage or heat rubs increase swelling and bleeding)

            S = Stretching (Stretching further tears damaged muscle fibres, ligaments or tendons)

Rehabilitation

Although acute injury treatment is similar for sprains and strains, their time to heal is different. Sprains take longer to heal as they are the result of damage to ligaments. Ligaments are made up of bundles of dense fibrous connective tissue, and are avascular (without blood vessels) which is why they appear white and take such a long time to heal (e.g.: Achilles tendon rupture).

This is different to a strain, which is muscle and tendon based injury. As muscles have rich supply of blood and nutrients from capillaries, they can heal much faster. Tendons also have blood supplied (although in small amounts) via the musculotendinous (between muscle and tendon) and osseotendinous (between bone and tendon) junctions, so tendons also heal quicker than ligaments.

The timeline for rehabilitation also varies depending on the severity of the injury, but as a general guideline the following three stages should be completed as soon as possible, injury permitting. If you or your clients are unsure at any stage, seek medical advice.

1^st stage =         First 48-72 hours post injury

                        PRICE and No HARMS

2^nd stage =        Post first 48-72 hours

                        Gentle muscle / joint movement

                        Muscle / joint stability exercises

                        Mild resistance exercises followed by icing

3rd stage =        Once movement is pain free

                        Gradually return to more strenuous strengthening activities

Pain should remain low; if it increases, stress is too much on injured area

How to avoid future sprains and strains

To decrease the likelihood of future injuries the following are recommended

• Always perform a gradual warm-up before exercise and a gradual cool down after exercise
• Stop any exercise if you feel pain!
• Improve general strength and fitness to protect muscles and joints
• Improve specific sports skills and techniques, preparing muscles and joints for the stresses they will be placed under during activity
• Correct any muscle strength imbalances

Understanding the differences between strains and sprains allows us to better understand how these injuries occur as well as how to treat and rehabilitate from them. It also allows us to write better programs, whether for recovery and rehabilitation from a sprain or strain, or manipulating current training around these injuries.