MedFit Professional Fall 2019

Page 1


FALL 2019





Lisa Dougherty |, publisher

Josh Vogt |

05 08 REDEFINING HEALTHCARE A battle cry for medical fitness professionals JR Burgess


A prescription for true healthcare Lisa Dougherty

national sales director

Josh Vogt | editor

Lindsay Vastola | audience development manager

Rachel Spahr | graphic designer

Kelli Cooke | contributing writers

Dr. Stephen A. Black, JR Burgess featured columnists

Lisa Dougherty, Phil Kaplan, Dr. David Kruse



The fitness professional’s role in total joint replacement care Dr. Stephen A. Black








wenty years ago, I left Corporate America, went back to college and continued to take a dozen chronic disease and exercise specialty certificate programs. My dad was battling cancer for the second time and I wanted to help people to have a better quality of life through fitness. I was a pioneer back in 1999 opening a “medical fitness” business. I believed, and still believe, that I can help others restore health after a medical diagnosis, surgery, physical therapy or those who want to improve the quality of their life through lifestyle changes, diet and exercise. Healthcare through fitness is not a new concept. Since ancient Greek times, there has been an undeniable power in the collaboration of the two. The demand for healthcare through fitness – or what we refer to as medical fitness - is rising as we face a national healthcare crisis. By stepping into the space of medical fitness, next-level fitness professionals can coach people on a journey to optimal health. Among many opportunities, medical fitness professionals can specialize in transitioning clients from medical management and/or physical therapy to a regular physical activity program following a surgery, an injury, a medi-

cal diagnosis or exacerbation of a pre-existing condition, or help prevent and restore health through personalized fitness plans.

“pay-per-service” system to a value-based system where patients are empowered to find true health. In this new model, doctors establish far greater value and can establish lucrative cash practices aimed at recovery and disease reversal and medical fitness professionals can see greater success as well. I think many agree that a comprehensive approach across disciplines of medicine and fitness lead to improved outcomes. What if we could collaborate in a meaningful -Robert Butler, National Institute on Aging way, honoring the complementary power of each other? This partUnder our current insurance-based healthnership of bringing fitness professionals into care system, physicians are limited in time to the paradigm of healthcare and promoting help patients restore health and regenerate healthcare through fitness would be a game their bodies. At best, most physicians are changer. managing symptoms. There is no prescripThe true power lies in uniting these two tion drug that cures a chronic disease and we forces, fitness and medicine. Together we are know that over sixty percent of our populapioneers who will reverse chronic disease, tion has been diagnosed with at least one. restore functionality, vitality and hope in Chronic disease costs the U.S. $3.3 trillion in people. Both physicians and medical fitness annual healthcare costs, making “healthcare” professionals pursuing this path together will feel more like “sick care.” truly find the reward they were seeking when The medical field needs to shift from a they entered into their professional.

“If exercise could be packaged in a pill, it would be the single most widely prescribed and beneficial medicine in the nation.”


Phil Kaplan



et’s start with four statements I’m willing to call facts: 1. Chronic disease afflicts the majority of American adults over the age of 45. 2. People with chronic disease choose a visit with an allopathic physician (conventional medicine) as their first course of action. 3. A pharmaceutical prescription is the first course of action after linking symptoms and biomarkers to a commonly diagnosed disease (type 2 diabetes, hypothyroidism, hypertension, hypercholesterolemia, etc.). 4. There isn’t a single medication that can cure a single chronic disease. I’ll give you a minute to re-read those four statements and see what conclusions you can extrapolate. Your list of conclusions most likely includes, “The first course of action for most American adults seeking disease reversal cannot possibly lead to their desired outcome.” If the course leads to medication as a purported solution, and the medication cannot cure the ailment, it should become clear that the sea of disease-plagued adults is being “managed,” not “fixed.” I addressed this in the previous issue of MedFit Professional when I asked that the physician and the trainer see, think, and do differently, but now I’ll go a step further. Allow



me to throw out two more inferences I’ll boldly call truths. 1. Inflammation is the root cause of virtually every chronic disease. 2. With an enhanced skill set, personal trainers can introduce a series of exercise, nutritional and lifestyle interventions that can reverse inflammation. I know I’m asking you to work a bit, inviting you to consider my thoughts and draw conclusions, but in this case, I believe along with the conclusions comes a true recognition of the opportunity presented for doctors and trainers alike. We know medication will not cure the most prominent ailments, and with my two latest truths, we consider we can battle those ailments at their core. We’d have to, with those considerations on the table, accept the validity of the thought, “Personal trainers, with the right knowledge, skill set, and intervention ability, can better serve most American adults than the current course those adults are ushered onto.” Reversing disease requires strategy beyond the simplicity of “eat right and exercise more.” For most personal trainers, specialization in this area will require a heightened understanding of:  How exercise can be modified to improve parasympathetic recovery

 How accepted and sound shifts in nutrition can work to reduce systemic inflammation  How maladaptation of the endocrine system creates blockages such as insulin resistance and the soon-to-follow condition, weight loss resistance  How specific exercise strategies can initiate movement toward restored endocrine balance  How to mitigate “the chronic stress response” (adrenal overload) Such specialization will also require an elevated understanding of mindset and adherence as well as of the microbiome. If you’re a trainer reading this, I hope it spurs you forward to seek out the skill set that will position you as a leader. If you’re a physician reading this, I hope it puts you on the lookout for your greatest ally, the fitness professional who can partner with you in restoring patients to health. The true magic will lie in the collaboration, the partnership in which each respective player honors the complementary power of his or her partner. 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



n the MedFit Professional inaugural issue, the concept of medical fitness was discussed, and the benefits of an integrative approach were highlighted. A discussion of medical fitness is rooted in an understanding of the health benefits of fitness and exercise. The documented benefits are endless and include management of chronic disease, management and prevention of osteoporosis, improved mood and sleep disorders, stress relief, management and prevention of obesity. Health agencies across the spectrum of public health and disease-specific organizations recognize and promote exercise and fitness as an integral part of the management of chronic disease; diseases that include diabetes, cardiovascular disease, Parkinson’s, depression, multiple sclerosis, and arthritis, among others. If fitness and exercise are well excepted as part of the management strategy for multiple diseases, why is it that access to organized exercise plans, and fitness professionals who can help implement those plans, are not a standard part of the medical treatment paradigm? Why is it not a standard benefit covered by common medical insurance policies? The reasons are multifactorial and a reflection of the overall healthcare conundrum in our country today. Let’s focus, however, on how to make a change. We need to focus on how to integrate fitness professionals into the

medical paradigm. A perfect model for this is an integrative medical fitness center.

ties throughout the United States. However, an understanding of their importance in the context of the current healthcare environment has grown. The idea of creating “medical homes” that are collaborative across disciplines and provide a comprehensive healthcare approach is now being recognized to provide a high standard of care while simultaneously decreasing overall healthcare costs. This is true specifically for high-risk individuals who suffer from chronic disease. Further integration of medical fitness centers, and broad access to exercise and fitness resources, will hopefully become standard of care and widely accessible to all individuals, especially those with chronic disease. This integration will inherently bring fitness professionals into the paradigm of healthcare and promote healthcare through fitness.

The concept of the medical fitness center is not new; many currently exist in communities throughout the United States. What is a medical fitness center? It is a fitness facility with a multidisciplinary staffing approach and has the following characteristics:  Regular m edical oversight by a medical director  Practitioners with nationally-recognized certifications and training in the care of chronic disease  Comprehensive health assessments and exercise prescription  Exercise classes geared toward specific medical conditions These centers bring together credentialed staff in a collaborative way to provide exercise prescription plans specific to the needs of an individual with chronic disease. The concept of the medical fitness center is not new; many currently exist in communi-

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.


REDEFINING HEALTHCARE A battle cry for medical fitness professionals

By JR Burgess




or years, fitness and medical professionals have advocated the need for bridging the gap that exists between preventative care and chronic pain and disease. Medicine today does the heavy lifting of disease management, acute trauma and injury. We are an advanced nation in regard to communicable disease, traumatic and emergency medicine. However, the system is imploding with high costs of care coupled with an epidemic of unresolved chronic disease and pain within traditional insurance-covered care. Inside the healthcare system, the financial and political power lands at the top of the chain - pharmaceutical producers, government, insurance companies, the food industry, hospitals, and

time to listen, evaluate, diagnose, empathize, connect, provide options, coach and empower patients towards optimal health. The third leading cause of death right now in the United States is medical negligence, according to the Journal of the American Medical Association. This is an alarming fact because many medical errors are entirely preventable. Functional medicine physician and pioneer, Joseph Mercola recently stated at the healthcare event, Mindshare, that, “Those in control are building the largest tribe and protecting advertisers. It’s a threat, PR firms are doing all they can to discredit those that want to heal the world.” We have the science and evidence to not let a diagnosis be the reason for a life of decline. However, we are all fighting Goliath on steroids. Those in the position of profits-over-people are doing their best to keep education, research, innovation, and successful outcomes from progressing to be an option for all. Alternative healthcare providers attempting to educate the public are seeing censorship through Google and social media on topics such as vaccinations, lifestyle medicine, plant medicine, and functional medicine. In response, many health leaders are looking to create an alternative search engine specifically designed for uncensored health-related information.

By JR Burgess

surgeons - yet we are failing at producing successful and sustainable care. A new measure for quality of care At a recent nationally recognized orthopedic conference I was part of a roundtable of practice executives reviewing key elements on running a profitable practice. Each group was discussing how many patients their top producing physicians were able to see per day. One group was cheering that their top physician is able to see 80 patients a day. Another said 70, and another 60 as if that was a badge of honor. I spoke up and said, “Let’s assume that doctor only uses the bathroom once, walks to the next room between each patient, washes their hands after each patient

and somehow spends no time in his medical charts. At best he or she has three to four minutes to spend with each patient. I would not want that care for you, a family member or anyone I would refer. We should be ashamed of seeing this as quality care.” As a result, over the last decade we have seen a rising trend of medical providers experiencing burnout, dissatisfaction and moral confliction. Many have decided to go against the grain of the standard care in medicine and open functional, lifestyle, regenerative and direct primary care clinical models that have been formed in effort to provide restorative, root cause and preventative medicine that can reverse the rise of chronic disease. It’s a model where medical providers have the proper

Think differently and independently To begin to redefine healthcare, it requires us to think differently and independently about how to slow the rise of chronic disease. Here are four frameworks from which to begin to explore new solutions in healthcare: 1. See to believe Keep an open mind and realize that most exercise and nutrition plans have their place for the right person. Visit alternative offices and practitioners to see the outcomes they are having with patients. See if the service or treatment has a history of successful outcomes that can be consistently repeated. 2. Look at evidence Practitioners often state that the research shows there is no evidence. Ask them about the last paper or research article they have read on the subject matter. For instance, there are several new research studies showing the effectiveness of regenerative treatments such as platelet rich plasma (PRP) and stem cells that have new data FALL 2019 MEDFIT PROFESSIONAL | 9

to support effectiveness compared to other standard of care treatments. 3. Experience it The only thing better than seeing it, is having had it work for you. If it worked for others, it may work for (you) others. 4. Know the research and the outcomes Just because the FDA approves a drug, or that surgery is your only option, you have no guarantee it’s going to heal you or help you without affecting another part of your system or worse.

field of study has the answer to deliver the best health to the world. This all-encompassing effort can include surgeons, researchers, regenerative medicine specialists, functional medicine providers, behavioral therapists, chiropractors, acupuncturists, nutritionists, personal trainers, massage therapists, physical therapists, energy healers, naturopaths and coaches; not one alone has had all the answers. It will take a combination of the right internal, physical, emotional, nutritional and spiritual support to take a person on the journey towards optimal health.

The equipped health and fitness professional will have no shortage of opportunity. Requirements for redefining healthcare If the entire medical system turned around today and added preventative and less invasive options like nutrition, fitness, health coaching and energy medicine, we would not be prepared to fill the immediate demand. Consumers seeking optimal health are now aware and seeking expert health professionals who can listen, empower, hold them accountable, and help deliver successful outcomes. Private clinics offering cash procedures and preventative care need to charge more to be able to spend more time with patients. This would allow providers to dig deeper with root cause lab analysis and would offer a greater probability to help lead patients toward successful outcomes. Healthcare in general will perform significantly better when providers are paid based on successful outcomes as opposed to time and service fulfillment. True healthcare is in demand for personal trainers, health coaches, and those with exercise physiology and kinesiology backgrounds to help deliver provider-recommended, outcome-based treatment programs. Most medical providers do not have the training, education or time to provide the nutrition, exercise or individualized care for patients that health and fitness professionals are trained to provide. Therefore, this article is a battle cry to the next-level fitness professional. Not one doctor, trainer, diet or even single



The only way for primary care and transformative clinical models to succeed are with patient behavior change. Clinics need certified personal trainers and health coaches who have expertise in the more specific needs to help patients follow through on the recommended treatment plans. The medical fitness professionals of the future can fill the gap by becoming fluent in any of the following niches:  General biometric lab analysis (serum, gut, nutrient, saliva, heavy metals, etc.)  Genetics and epigenetics  Bio-hacking technology and equipment such as near and far infrared light, PEMF, vibration therapy, cryotherapy, hyperbaric chambers and many more  Energy work  Functional movement evaluation and corrective exercising programming  Artificial Intelligence

 Bracing, foam rolling, taping  Safe and progressive exercise for all conditions  Health coaching centered around: purpose, hydration, nreathing, oxygen, nature, mindfulness, stress management, communication, preparation, sleep, nutrition, and movement.  Food sensitivities  Mental health  Disease management  Hormones  Detoxification  Group health education  In-home fitness products  Tele-health  Medical compliance  Corporate wellness The demand is rising and will explode in the coming decade. Private practices are on the rise. Self-insured companies are seeking savings from healthcare costs. The equipped health and fitness professional will have no shortage of opportunity. If you have a solid knowledge base in any of these areas, there is significant opportunity to work for, partner, refer to, or carve out your own fitness and health business of the future. To change the entire healthcare system over the next few years, we need everyone to collaborate to create universal consensus where all these areas are necessary to comprehensively treat patients. This will require leading experts in all areas of health to come together. Groups such as the MedFit Network are collaborating with medical leaders and are dedicated to raising the bar for personal trainers by defining how the medical fitness professional of the future can support the necessary shift. Those who are filled with passion and purpose for the medical fitness model of the future will see the monetary rewards of their exceptional work as the demand will outnumber the caregivers.

JR Burgess found his purpose for helping people be free from pain at a young age. JR has played an integral role in replicating a proven integrated model of care in more than 80 clinics worldwide. He is driven to make the greatest contribution by changing the way healthcare can be delivered by integrating profitable, regenerative, functional and lifestyle medicine into clinics world-wide. He is a husband, father, two-time #1 bestselling author and international speaker.




The fitness professional’s role in total joint replacement care


ccording to the American Joint Replacement Registry, there are 860,000 total knee and hip replacements done in the United States per year. This number is projected to double in the next ten years. There are more knees than hips done per year and more females have these joint replacements than males. According to Mike Carberry of Advanced Medical Integration, “Regenerative medicine is one of the most talked about subject healthcare has ever known; and for good reason. It could hold the solution to the puzzle of America’s failed healthcare system.” This is wonderful news for the personal training industry. Insurance is paying for less and less, costing more while the number of consumers seeking optimal health is increasing. A perfect storm in the making! A personal training certificate, however, is not enough to appropriately deal with the typical client with total joint needs. Specialization in anatomy, joint physiology, biomechanics and therapeutic exercise are necessary in order to adequately and appropriately manage total joint conditions. These skills and techniques in conjunction with medical communication skills will give physicians confidence to send these patients to the appropriately skilled personal trainer. Spending time with a physical therapist and surgeon specializing in these areas will go a long way in establishing confidence, trust and credibility in handling the client with total joint conditions. Osteoarthritis is the most common form of arthritis that causes a breakdown of joint cartilage, and it affects mostly middle-aged and older adults. Although there is no cure for osteoarthritis, the good news is that it can be helped, and quality of life maintained by implementing and maintaining some simple changes in daily life. Regardless of the intervention, from routine steroid injections to platelet rich plasma/stem



cell treatments to total joint replacement, here are a few areas where the personal trainer can intervene with great success. Exercise Exercise is key component of arthritis care, exercise strengthens the muscles, lessens joint pain and stiffness and improves overall health. Types of recommended exercises may include strengthening, aerobic activity (aquatic activity is wonderful), range of motion or stretching activities and balance exercises. Joint protection Protect the joints to ease pain and avoid further damage. Make sure to balance rest with activity as well as know when to stop. A good rule of thumb is to adjust down the frequency, intensity and duration by 50% of what a “normal” client can do or what the client thinks they can do. Remember these clients are typically deconditioned relative to strength and cardiovascular fitness. They will not handle the all-too-popular high-intensity interval training (HIIT). This population will succumb to overload and may be injured. Pain control Pain control routinely treated with prescription or over-the-counter medications can be replaced or augmented by relaxation techniques (yoga, Tai Chi, meditation and massage) along with application of heat, cold and/or vibration. Post-procedure care If the client has had regenerative therapy or a total joint replacement, they will need a specific post-procedure plan to allow for healing/ protection, early intervention and return to activity function. Hopefully,

they had pre-intervention care inclusive of appropriate exercise, nutritional counseling and insight on what to expect with the procedure and post-procedure care. Appropriate nutrition for optimal health and healing along with hydration techniques and insights are a must during these sessions. [ Phase 1: Post-procedure care ] Typical post-procedure care is in three to four phases. Phase one is protect/rest, restore and control pain. During this phase the focus is on mediating pain, restoring range of motion, controlling swelling and protecting the joint. This is typically fourteen to twenty-one days in duration. Stitches or staples are usually removed at this time and scar management can commence around the twenty-first day. [ Phase 2: Post-procedure care ] Phase two is the restore and regenerate phase. The wound is healing (healed), the joint and soft tissue healing continues, and remodeling of tissue has begun. This phase is typically three to six weeks in duration. Techniques to restore range of motion and other soft tissue techniques to facilitate healing according to tissue physiology and the client’s general health are initiated (conditions such as diabetes, obesity, cardiovascular disease and others will alter the healing and remediation phases). Techniques for ambulation, gait and balance are initiated along with appropriate cardiovascular conditioning. [ Phase 3: Post-procedure care ] Phase three typically commences when the client has gained full range of motion, has good balance and gait mechanics and is able to tolerate closed-chain activities for both upper and lower extremity movement patterns. This phase is the final phase and progresses to full functional activity and return to sport or recreational activities of choice (these activities may be placed into a fourth phase). During this phase it is incumbent upon the personal trainer to load appropriately and have working knowledge of the mechanics of the sport or recreational activity. There are some tremendous resources available for this purpose. Complications Complications to be aware of when working with these patients include but are not limited to infection, blood loss, dislocation, blood clots and fatigue. The personal trainer should also be in contact with the client’s physician and physical therapist if one has been engaged. These are medical conditions requiring communication and conservative care. Most physicians like to know who is working with their patients and appreciate the communication for optimal outcomes. The insightful and knowledgeable personal trainer with the right training can be an invaluable member of the total joint care team. The future is bright!

Dr. Stephen A. Black is a sports medicine specialist, author and clinician. His doctoral degree is in sports medicine and he holds degrees in physical therapy, athletic training and certification through the National Strength and Conditioning Association. Dr. Black has over forty years’ experience in patient care and practice management. He lectures frequently on topics in sports medicine, works with professional, Olympic and youth athletes and holds several academic appointments.

This information is provided as an overview and in no way should be interpreted as a protocol for treatment or otherwise. Our goal is to inform the reader on opportunities in the profession and stimulate further investigation.




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Correct Toes

Dunwoody Labs

MedFit Classroom

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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.