MedFit Professional Summer 2019

Page 1










! E U






Lisa Dougherty |, publisher

Josh Vogt |

05 08 SPECIALIZE AND THRIVE Working with individuals with osteoarthritis and joint replacements Dr. Evan Osar


The new blue ocean Lisa Dougherty

national sales director

Josh Vogt | editor

Lindsay Vastola | audience development manager

Rachel Spahr | graphic designer

Kelli Cooke | contributing writers

Dr. Evan Osar and Dr. Mark Kelly featured columnists

Lisa Dougherty, Phil Kaplan and Dr. David Kruse


12 THE EVOLUTION OF TRULY PERSONALIZED MEDICINE Epigenetics, food, and fitness Dr. Mark Kelly

07 WHY MEDICAL FITNESS? An integrative Perspective Dr. David Kruse







’m challenged. In this moment, as I attempt to write a “welcome” letter for our premier issue, my emotions and thoughts run so deep, 500 words cannot possibly capture all that I’m feeling. While I’ve always viewed the future as a time where fitness and medicine come together, I was never certain of the path. I simply knew I had to pave it. I’ll share a few introductory thoughts, so you understand the passion upon which this magazine was hatched, and then I’ll share a few suggestions for the pursuit of a noble career committed to finding reward by bettering the lives of others. From there, I’ll leave it to the wonderful authors we’ve compiled to educate and empower you, and in issues to come, “the rest of the story” will unfold. Most of us pursued a career in fitness because we care about bettering the lives of others. I began mine 20 years ago, in 1999 when I was inspired by my father who was battling cancer for the second time, I made a career change to help others restore health through fitness. I started my own personal training company, Whole Body Fitness and called myself a “medical fitness” professional.

Medical fitness is not “training sick people,” rather those moving towards or through the “dis-ease” continuum. They are functional yet compromised. What was once considered “special populations” is now the new norm; the “unwell” – those who have moved away from optimal health. A popular 2004 book “Blue Ocean Strategy” encouraged organizations and individuals to pursue “blue oceans” of uncontested marketing space where they can thrive with little competition in a growing and prosperous field of endeavors. Medical fitness presents such an opportunity. This is the new blue ocean… the greatest opportunity the fitness industry has seen, one in which you have the ability to positively change lives and be financially rewarded. Working with older adults, I saw a huge need, and in 2013 I founded the MedFit Network. It is both a professional membership organization for fitness and allied healthcare professionals, gyms, clubs and studios, it also serves as a free online national resource directory for the community to locate fitness and allied healthcare professionals with a background in prevention, treatment

and rehabilitation for those with medical conditions, chronic disease, disabilities, and women’s health issues. In 2017 I created the MedFit Education Foundation, a nonprofit 501(c)(3) to help facilitate professional education through live conferences via the Medical Fitness Tour, webinars, and online courses through MedFit Classroom and MedFit TV. This magazine was created as a next step - to be a communication tool to all those who want to elevate themselves in the emerging medical fitness space through education, ideas, innovations, trends, products and sharing inspiring stories from those who are in it. Join us and be one of the pioneers who not only prevent, but reverse chronic disease, restore functionality, vitality and hope in people. You have the ability to step into a heightened position as a medical fitness professional to influence and coach those in need with your talents and in exchange, have the opportunity to be rewarded beyond measure. Welcome to what fitness business icon Phil Kaplan calls the new blue ocean, the space between medicine and fitness!


Phil Kaplan



he rallying cry is, “Let’s change healthcare!” From all corners of the medical universe there is agreement that change is necessary. The biggest questions are, “What is the change?” and, “Who will make it happen?” I don’t pretend to have the answers, but I do know this: when there’s a rallying cry for change, there’s an opportunity for a pioneering effort to take hold, and the release of this magazine is evidence of that effort taking shape. We live in a society of understandable impatience. In other arenas, we’ve witnessed near-instantaneous change. Breakthroughs in technology have altered the way we advertise, sell, purchase, and communicate; and innovations often restructure the landscape and the playing field in mere months. Readjustment is vitally important for all entrepreneurs and flexibility has proven the most vital trait in businesses committed to longevity in this age of forced adaptation. While the technological advances in medicine are astounding, and we’ve seen radical innovations in exercise equipment and fitness monitoring, shifts in optimizing healthcare are disturbingly slow to manifest; and that’s for very good reason. When we talk about healthcare, we’re talking about the most sophisticated machine in existence - the human body - and more specifically, we’re talking about a sea of human bodies struggling to maintain the



commodity we know as optimal health. Doctors and health practitioners ideally work to empower patients to find systemic improvement, while fitness professionals seek to teach their clients to regenerate and recompose. These are anything but rapid processes. When we work to change the way a human body expresses the state of cellular condition, we have to work within the laws of nature, and in that lies part of the challenge. The hunt for curative medications creates revenue, anticipation, and optimism, but we know that chronic disease cannot be “cured” by medication. If a treatment, surgical intervention, or injection could offer a sudden “fix,” healthcare would indeed be revolutionized. If true healthcare is linked to helping people find wellness, escape chronic disease with permanence, the only solutions proven to date are shifts in lifestyle, nutrition, movement, and mindset. While technological advancers seek “the miracle that will change medicine,” we have the ability to access “the miracle” of human healing. If we’re going to truly pioneer entry into a new era, one in which medicine and fitness come together to provide effective interventions for human betterment, let’s recognize the need for human change, shifts initiated by a collective of medical practitioners, and fitness professionals willing to behave differently. Ideally, a simple message will resonate. Here is that message:

To the physician: See what you haven’t seen. See the potential of helping patients return to divine health by connecting them with expertise in the realm of restorative exercise and nutritional interventions. To the fitness professional: Do what you haven’t done. Realize that the medical field, justifiably, does not recognize “the personal trainer” as a peer, a colleague, or a professional. Don’t be offended by that truth but accept it as an opportunity for you to stand above mediocrity. Take the initiative and connect with medical professionals, respecting their skepticism, and prove the virtues of your newly found specialty – Medical Fitness. Do we, the fitness professionals, truly have the power to “heal?” Yes. Here’s what gives us the power. Most chronic diseases are (unintentionally) self-induced; progression along the “disease continuum” is often reversible and by understanding how, together with physicians, we can facilitate adaptation in endocrine balance, cellular integrity, and metabolic processes. We can partner with medicine to reverse the epidemic of chronic disease. Now, it’s up to all of us. Let’s make it happen. Phil Kaplan is a long-time fitness professional committed to helping individuals reverse chronic disease and has developed programs within the medical arena to bridge the gap between fitness and medicine and pave a pathway for change.

Dr. David Kruse


An integrative perspective


t is well recognized that the population of individuals over the age of 65 in the United States is expanding. With age, comes natural and expected physiologic deficits in the musculoskeletal system that affect the pursuit of exercise and fitness. The benefits of exercise and fitness are well documented, with numerous health benefits across age groups. Exercise can be pursued to accommodate for deficits that come with the normal aging process, as well as to compensate for, or improve the status of, underlying chronic disease in all ages. When considering the treatment of chronic diseases or conditions, such as diabetes, hypertension, Parkinson’s, depression, multiple sclerosis, Alzheimer’s, and arthritis, medical science has made great strides and continues to develop novel therapies and medications to combat these diseases. The medical community also recognizes that a comprehensive approach, across medical disciplines, can create improved outcomes. This collaboration should include physicians, massage therapists, acupuncturists, physical therapists, doctors of chiropractic medicine, and fitness professionals, among others. This approach embodies the concept of medical fitness: a comprehensive and holistic approach to maximize the health and quality of life through disease or deficit-specific fitness interventions.

If we acknowledge the role of exercise in medical fitness, then it makes logical sense that fitness professionals should be included within this paradigm. Fitness professionals will be essential to the further development of this medical fitness concept and our ability as healthcare professionals to meet the growing need of the aging population. As the healthcare community continues to explore the role of exercise in the care of individuals with chronic disease, the engagement of fitness professionals in exercise prescription and implementation will be essential to accomplish a holistic and comprehensive approach. To enable the success of this integration, fitness professionals should take the initiative and continue to advance their industry in the following ways:  Continue to build upon medical fitness educational resources available to fitness professionals. This can involve further expansion of coursework, webinars, conferences, and web content. It is essential that all this work is done under the guidance of established credentialing organizations.  More exposure should be brought to fitness professionals with education in medical fitness. Medical professionals, and individuals with disease or deficits, should be able to find fitness professionals with this specialty training via established

networks. This will maximize the implementation of exercise prescription, and consequently the benefits received from this intervention.  Fitness professionals who make an effort to advance their knowledge should feel supported through various educational platforms that provide updates in standard of care, additional ways to collaborate, and continued exposure to future advancements in medical fitness. The medical community should work together toward an integrative approach, while providing fitness professionals the platform to become rooted in the medical paradigm. This will go a long way to maximize the many benefits exercise and fitness can provide for our aging population and individuals with chronic disease. Dr. Kruse attended medical school at UC San Diego, after graduating from UC Berkeley. He holds board certifications in family and sports medicine. He practices sports medicine with the Orthopaedic Specialty Institute, in Orange, CA. Dr. Kruse is the Chief Medical Officer for the MedFit Network and on the Medical Advisory Board for the MedFit Education Foundation. He is currently a Team Physician for USA Gymnastics, Orange County Soccer Club, and Biola University.




SPECIALIZE AND THRIVE Working with individuals with osteoarthritis and joint replacements Dr. Evan Osar


rthritis is the most common cause of disability in the world.3 Osteoarthritis, the most common form of arthritis, has led to a dramatic increase in the incidence of hip and knee replacements in recent years. The rate of total hip replacements has almost doubled between the years 2000-20101 and approximately 7.2 million Americans are now living with hip and/or knee replacements.6 While these rates have nearly doubled in recent years, the number of younger individuals (ages 45-54) having these replacement surgeries is increasing.5 The rapid and dramatic increase in individuals living with osteoarthritis and/or joint replacements has created a massive void between the number of people living with these issues and the number of qualified individuals to help them safely and effectively accomplish

sionals are an important part of the solution, and why this is the most opportune time for fitness professionals to specialize and align themselves with health professionals.

their functional goals. This void, however, has created an incredible opportunity for fitness professionals to align themselves with allied health professionals to become part of the solution. This article will discuss some recent changes in the thought process about how osteoarthritis develops, how fitness profes-

to the modern decline of physical activity and is quoted as follows: “Dr. Wallace thinks the most obvious candidate to explain the increase in knee osteoarthritis is the modern decline in physical activity.”8 Nevertheless, it is not just about people needing more quantity of activity; it’s also

Why do so many individuals experience osteoarthritis and what can be done about it? While injury, overuse, age, obesity, genetics, and race have been given as possible causes, there has been a lack of solid evidence to explain why the incidence rate of osteoarthritis continues to skyrocket.2,3,5 However, recently there have been suggestions that osteoarthritis is not as previously suggested, due only to old age or genetics. Dr. Ian Wallace, a postdoctoral researcher who has studied more than 2,000 skeletons, believes the recent dramatic increase in osteoarthritis isn’t an inevitable consequence of living longer. He believes it is more attributable


about the quality of the exercise.10,11 If exercise is performed without optimal joint alignment and control, the individual is at risk for developing degenerative joint changes.10,11 Therefore, it’s imperative that fitness professionals specializing in working with individuals that have osteoarthritis or joint replacements, are able to properly assess for non-optimal and inefficient posture and movement habits and from these results, develop an appropriate exercise program. Additionally, fitness professionals specializing in this niche must also be able to instruct proper exercise form and understand which exercises or activities are contraindicated with these populations.10,11

An approach that includes using the most appropriate soft tissue release, mobilization, stretching, neuromuscular activation strategies, and appropriately progressing the individual through the fundamental movement patterns has been shown to improve joint mobility and strength in individuals with osteoarthritis as well as joint replacements.9,10,11 Additional strategies that have been shown to be helpful in improving strength and mobility and managing the symptoms of osteoarthritis include three-dimensional breathing7,9,10,11, proper nutrition featuring a whole-foods, plant-based diet4, and meditation.14

The great news is that there is a growing need for qualified fitness professionals to work with the increasing numbers of individuals that have osteoarthritis and/or joint replacements. A well-designed exercise program that includes flexibility, strength, and cardiovascular exercise is required to appropriately address the postural and movement habits that contributed to the development of osteoarthritis. Likewise, many individuals will have developed compensatory patterns as a result of joint pain or loss of mobility and subsequently developed non-optimal posture and movement habits that need to be addressed. Several organizations including the Arthritis Foundation, Center for Disease Control, and American College of Sports Medicine have created guidelines for working with individuals that present with arthritis. General recommendations include improving joint mobility/ flexibility, aerobic conditioning, resistance training, maintaining a healthy weight, and consulting with a medical doctor.2,3,13 Helping individuals develop a more optimal and efficient posture and movement pattern is one of the most effective strategies for safely working with individuals with osteoarthritis and joint replacements.9,10,11



The future The great news is that there is a growing need for qualified fitness professionals to work with the increasing numbers of individuals that have osteoarthritis and/or joint replacements. However, this requires that the fitness professional have both the right education and the appropriate skillset as many of these individuals will require a thorough approach to address their specific needs and to provide them with the best functional outcomes. Organizations such as the MedFit Network (https://medfitnetwork. org), The Institute for Integrative Health and

Fitness Education (, and the Functional Aging Institute ( are helping to create the education necessary for health and fitness professionals to develop specializations in working with special populations including the older adult populations experiencing osteoarthritis and joint replacements. Additionally, through their educational platforms and live course work, they provide fitness professionals with strategies for aligning and working with allied health professionals. For many individuals experiencing pain or loss of function secondary to osteoarthritic changes, seamless integration between medical procedures, rehabilitation, and functional fitness is becoming a viable and necessary alternative to narcotics and surgery. Hence, the birth of the medical fitness space where fitness professionals work either in collaboration with or in the actual physical location of medical doctors, physical therapists, chiropractic physicians, and massage therapists. Clinics such as Rejuv Medical ( have provided a model for how to improve patient outcomes by combining the benefits of regenerative medicine procedures (Plasma Rich Protein and Stem Cell Therapy), physical therapy, and personal/group training. Specialization in working with individuals that have osteoarthritis and/or joint replacements and working in the medical fitness space is the future. The fitness professional that acquires the appropriate education and develops a working relationship with allied health professionals will be able to attract more individuals that need, want, and will pay for their expertise. By providing a more integrated and effective approach to helping individuals accomplish their health and fitness goals, these fitness professionals will continue to thrive in the coming years.

Dr. Evan Osar is an internationally recognized speaker, author, and expert on assessment, corrective exercise, and functional movement. Dr. Osar is committed to educating and empowering fitness professionals while helping them develop relationships with allied health professionals. He is author of the Corrective Exercise Solutions to Common Hip and Shoulder Dysfunction and has developed the industry’s most complete training certification, the Integrative Movement Specialist™. With his wife Jenice Mattek, he created the on-line educational resource


Toolbox Genomics - Revolutionizing Fitness


oolbox Genomics is revolutionizing the fitness industry by enabling fitness professionals to personalize training

protocols for their clients using a simple and effective DNA-based report. This Health Action Plan will help you cut down on trial and error, target recommendations, and get your clients better results in a shorter amount of time. Each personalized Health Action Plan provides extensive insight into your client’s genetic predispositions that affect traits like muscle fiber type, best diet type, weight loss success, and endurance potential, as well as customized recommendations to help you optimize the health of your client. In addition to significant improvements in your clients’ health, Toolbox Genomics also helps you increase revenue in an honest and effective way without feeling like you’re selling. Increased revenue from DNAbased individual protocols can come from: 1. Increased referrals and sessions. Clients today are frustrated with the one-size-fits-all model of fitness and health and are longing for more personalized and individualized care. 2. Increased sales of supplements and further testing. Each report comes with customized supplement and testing recommendations made specifically for your client based on their unique genetic makeup. When you couple this science-based approach with your own recommendations, clients feel empowered, leading to increased sales. 3. Significant margins on all products sold. As a fitness professional, you have the ability to make revenue on every test that is sold to one of your clients.

We offer a number of wellness products that can be used depending on the needs of your specific client. Weight Management - Help your clients maintain a healthy weight by highlighting how the body may process different macronutrients, as well as identifying potential predispositions for obesity and eating behaviors. Endurance Performance - Help your fitness enthusiasts improve their competitive edge by understanding their muscle fiber type, nutrient deficiencies, recovery ability and injury susceptibility. Nutrition Optimization - Help your clients learn how their genetics they may influence nutrient deficiencies, alcohol and caffeine metabolism, and potential food intolerances. Health Enrichment - Introduce a client who is new to genetic testing with a sample of everything: workout suggestions, nutrient deficiencies, sleep behaviors, injury susceptibility, and alcohol and caffeine metabolism. Genetic testing is becoming increasingly popular, but Toolbox Genomics brings a cutting-edge, unique, and personalized experience to the table. We want to help you experience this revolutionary product. For a limited time, PFP readers can order 4 or fewer panels for only $159 (valued at up to $317). Go to to order and enter the code PFP2019 at checkout.

Toolbox Genomics is the premier onboarding test for your clients. It takes the guesswork out of developing plans and protocols and gives quicker results with targeted recommendations that lead to more referrals and better outcomes. Customized recommendations are made in five key domains of health and wellness: diet, supplements, lifestyle, exercise, and further testing. This comprehensive report allows you to gain a holistic view of your client’s needs to help them get optimal results in the quickest amount of time.




ost would not argue that there is ongoing transition in how our healthcare is being delivered. This article will examine some of these transitions as a result of breakthroughs in technology, as well as how genetic information, exercise, and diet will play an increasingly greater role. When medical science was first getting its start, a more holistic philosophy was taken on



how to treat illness and maintain health. Hippocrates is often deemed the father of modern medicine, and even today the allopathic physicians (M.D.s) take the Hippocratic Oath - to do no harm to their patients. Hippocrates knew, even in 400 B.C., that the best healer of the body is the body itself. For the most part, the best treatment is to create a strong body and get out of the way. Five guiding principles used in his philosophy for treatment include:

1. Walking is man’s best medicine. 2. Know what person the disease has, rather than what disease the person has. 3. Let food be thy medicine. 4. Everything in moderation. 5. To do nothing is also a good remedy. The second and fifth principles emphasize the power of knowing the individual and getting out of the way! The first and third principles

Dr. Mark Kelly

show the power of exercise and food for healthy living. Even the genius, Thomas Edison, realized that a health maintenance organization (HMO) approach was the best method of healthcare both practically and financially. His quote, “The doctor of the future will give no medicine but will interest his patient in the care of the human frame, in diet and in the cause and prevention of disease,” is evidence that a holistic, preventative approach is what he advocated. He is also quoted, “…you can’t improve on nature.” One size does not fit all Personalized medicine is now on the forefront and it utilizes the genetic and epigenetic data of a person to guide medicines and treatment plans. Cancer drugs have probably harnessed this advantage to the greatest extent, thus far. Former President Jimmy Carter received Keytruda (pembrolizumab) for his brain cancer and it boosted his immune system and beat the cancer. While most of America (71%), still doesn’t even know about personalized medicine, those who were familiar with it did not

know it would yield better results with fewer side effects. The different directions of personalized medicine are still being realized, but the field of pharmacogenetics is the first to really jump on the bandwagon of highly effective, precision-based treatment. The reasons some drugs work for some people and not for others, or why side effects occur in some individuals and not others, is due to individual variability in metabolism. Why are some people lactose tolerant, or some can drink alcohol with no problem, and others have severe issues? It is usually because of enzyme differences, which are under the control of our genes. Interestingly, our enzyme genes can often be turned on or off by “inducible sequences” known as promoters or suppressors of operons, respectively. These “switches” can be repressed or induced depending on our environmental stimuli. Thus, we actually have some control over our gene expression, and this field is known as epigenetics. Knowing what gene variants someone possess or not will guide the personalized medicine physician on which drug to use or not. By knowing allergic reactions in advance or which medicines may have side effects will help physicians to not make a bad situation worse. Unfortunately, the cost of personalized medicine drugs is much higher than alternative treatments. There is still a lot of exploration to be done on all the various applications of this technology, but the bottom line is that understanding individual variations and enabling the body to do what it is designed to do is a very good thing! Toolbox Genomics is one of many companies that uses your genetic information to then tell you what foods and supplements to eat or avoid, and which exercises may help you the most, and ones that you may not respond to so well. The reason physicians do an intake on family history, or run various tests is to collect information that will guide their treatment. A

genetic test on certain gene variants is simply taking this a step further. Applying exercise and diet to our epigenetics Did you know that exercise is highly beneficial to not only help with fighting cancer once it is already present, but also to never getting it? Physical exercise or movement in general will shift the epigenetics so that genes that suppress tumors are increased, and genes that cause cancer (oncogenes) are decreased. It does this by changing the amount of certain reactions called methylations. Things go wrong when there is too much or too few methylation reactions. Exercise has been shown to reduce or even reverse the epigenetic mutations that often result in tumorigenesis or tumor production. Exercise has also been shown to reduce genetic factors associated with aging like telomere length. The fields of proteomics and metabolomics as well as pharmacogenomics, are all emerging because of the knowledge on how our genetics affects proteins, metabolism, and reactions to drugs, respectively. The field of nutrigenomics is rapidly expanding, and several companies are capitalizing on studying the relationship of how our genes affect how we process and utilize foods, as well as how food can affect our genes. Vitamins A and D, certain fatty acids, especially medium and short chain, some sterols (derived from cholesterol) and zinc have been shown to directly influence gene transcription. In direct effects include how diet affects gut bacteria, which in turn influences gene expression. Soon when nutritional recommendations are given, it will likely be “for this individual.” The future of medicine will be taking our genetic information to a whole new level. Soon “smart” watches, clothes, hats, and other common devices will collect information that can benefit our health in many ways as the way healthcare is delivered continually evolves.

Dr. Mark P. Kelly has been involved with the health and fitness field for more than 30 years. He has been a research scientist for universities and many infomercial projects. He has spoken nationally and internationally on a wide variety of topics and currently speaks on the use of exercise for clinical purposes and exercise’s impact on the brain. Mark is a teacher in colleges and universities in Orange County, CA., where Principle-Centered Health- Corporate Wellness & Safety operates.



Toolbox Genomics Escalante 1.5 The Escalante 1.5 version features an updated knit, internal midfoot strap and sleeker heel cup for a more secure fit, as well as increased breathability in the upper. This new upper coupled with the Altra EGO™ midsole creates the perfect combo of high performance and comfort. With 360° reflectivity, more breathable mesh and updated tongue stay it is best used road running, walking and full gym use.

ISSA Senior fitness certification ISSA’s Senior Fitness Certification is designed for health and fitness professionals who want to gain a comprehensive understanding of how the physical, emotional and social aspects of movement can help people over 50 improve their life as they age. With a focus on assessments and programming, you’ll learn how to safely build strength and flexibility in your clients, while being able to share objective results with them about their progress. This 20-CEU course is all online and at your pace.



Toolbox Genomics is revolutionizing the fitness industry. They offer simple and effective DNA-based reports allowing fitness professionals to customize training protocols for their clients. Their endto-end DNA testing solution for the fitness professional includes a DNA test and Health Action Plan, which provides extensive insight into the individual's genetic predispositions that affect traits like muscle fiber type, best diet type, and endurance potential, as well as customized recommendations to help you drive additional supplement and testing sales and increase referrals.

MedFit Classroom Fitness professionals working with medical conditions, chronic disease and seniors must maintain a higher level of knowledge and skill. MedFit Classroom offers online learning for fitness professionals. You’ll find weekly professional education webinars presented by top educators in the field. In addition, find education to stay current on prevention, treatment and rehabilitation to work with seniors, chronic diseases, medical conditions, women’s health and more with their partner course directory and specialty certificate programs.

Profit, Power and Permission Profit, Power and Permission: A Course in Escalation for the Fitness Professional is the quintessential course for the 21st Century personal trainer. The days of struggling for “session pay” are replaced by the most explosive opportunity our industry has ever seen. If you’re ready to step into a realm of mastery, a world where fitness-meets-medicine for extraordinary outcomes and reward, immerse yourself in this 8-hour career-changing odyssey with personal training pioneer, Phil Kaplan.