Jan-Feb 2020 Fitpro magazine for website

JAN/FEB 2020 | FITPRO.COM
COLD
THERAPY
7 reasons
why it’s good
to be cold
STRONG
WOMEN
The menstrual cycle
and strength training
DEMENTIA
AND EXERCISE
What PTs need to know
SNOW FIT
Pre-slope prep,
mountainside
INTERMITTENT
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Fitpro Jan/Feb 2020
Welcome
Editor in chief/exec director | Jane Waller
Sub editor/editorial consultant | Fiona Bugler
Sub editor and proofing | Aislinn Thompson
Content and media assistant | Dominic Munson
Senior designer | Dawn Turton
Advertising and sales | Fitpro magazine
publish@fitpro.com, +44 (0)20 8586 0101
Imagery | iStockphoto.com | Fitness Professionals
stock.adobe.com | bigstockphoto.com
Executive directors | Brent Hallo and Jane Waller
Contact Fitpro at:
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Often experts in their field will have differing opinions to
each other. FitPro does not consider it our responsibility
to judge or form an opinion; however, we can assure our
readers that all authors for FitPro are reputable and
qualified in their field. It’s your responsibility to decide
what works and what doesn’t work for you and your
business. When choosing to follow any of the
programmes we publish, remember that before trying
any new exercise, nutrition or health plan, you should
consult an appropriate health or fitness professional for
clearance. Opinions expressed by the authors in this
magazine or on our blogs do not necessarily reflect those
of other authors, the publisher or anyone on our team.
No material in this magazine may be reproduced without
written consent from the publisher.
AI, intelligent clothing, working out wherever you want and gamification –
just some of the visions for our future fitness highlighted in a recent article featured in
Forbes put together by key investor in fitness, Richard Kestenbaum. As we start a
new decade, we’re excited to continue to be part of this ever-changing, inspiring and
energy-filled industry!
This year marks the 14th anniversary of The American College of Sports Medicine’s
fitness predictions, published in their annual survey, listing 10 of the trends to watch in
2020. It’s no surprise to us to read that tech and fitness wearables have retained the top
spot for the second year running. Wearable technology – including fitness trackers, smart
watches, heart rate monitors and GPS tracking devices – is now estimated to be a $95
billion industry.
While we’ve become fantastic at gathering data for our ‘quantified’ selves, many of us
still lack the know-how we need to make sense of the information we’re gathering. “The
future will really come down to the analysis of the data and presenting that in a clear,
concise format for the benefit of the user,” says Dave Wright, CEO of MYZONE ® , a physical
activity heart rate monitor system.
What about group training? It was only in 2017 that group exercise training made the
top 20, appearing at number six, followed by second in the 2018 and 2019 surveys. This
year, it’s reached number three and is staying popular. According to Kestenbaum, people
like to be around other people, and he points out that “social experiences at gyms is by far
the highest motivating factor for joining and going.”
Recent research from Exercise Move Dance (EMDUK) found that yoga and Pilates
ranked as number one and two in the UK’s top five most popular group X classes in 2018.
This ties in with findings from Golds Gym in America, which sees a future for ‘restorative
fitness’, as a counter to HIIT classes that may have caused burnout among regular
attendees. They predict an increase in the popularity of classes such as yoga and Pilates
and treatments such as cryotherapy, sauna, compression and percussion therapy.
While HIIT remains at number two in the top trends highlighted by the ACSM survey, this
year potential new trends such as mind/body movement (e.g., tai chi) and lifestyle medicine
have been included. Personal training, exercise is medicine, fitness for older adults and
health/wellness coaching are all in the top 10 and reflect the demand for fitness being
tailored to individuals to help us live longer and live healthier.
At number 18, ‘Worksite health promotion and workplace well-being programmes’ is
one to watch as more employers recognise the importance of well-being and providing
support and services to keep their employees fit and healthy, both in mind and body.
‘Employing certified fitness professionals’ is a new item on the 2019 survey and, as
the survey suggests, “hiring certified health fitness professionals through educational
programmes and certification programmes that are fully accredited is fast becoming
a trend.”
We love hearing about the changes and the new ideas and tech developments in fitness,
and sharing them here, with you. But, as we head into the next decade, we find ourselves
back where we started – valuing and nurturing and providing learning opportunities for our
fitness professionals. To coin a phrase, education, education, education … fp
Jane Waller
Executive Director
Twitter (@fitpro_online) Facebook (facebook.com/fitproltd) Instagram (@fitpro_ltd) FitProLtd
For references visit fitpro.com/references
fitpro.com | 3

Contents
06
05 CIMSPA: Leading by listening
Raising the Bar results
06 Research review
How exercise affects the hormone leptin
08 Snow fit
Keeping clients fit while on the slopes
08
12 Network retention
Focus on keeping existing members
14 Dementia and exercise
What PTs need to know about this
special population
18 Exercises in the third trimester
Swiss ball exercises for mums-to-be
22
22 Cold therapy
7 reasons why it’s good to be cold
24 Intermittent fasting
Is it for me?
26
26 The low-down on cannabidiol
Why are some fit pros taking CBD?
28 The menstrual cycle and
strength training
Strong women (part two of a three-part series)
28
4 | FITPRO JAN/FEB 2020

COMMENT • INDUSTRY INSIDER
Tara Dillon keeps you up to date with the latest at CIMSPA.
Leading by listening
A new approach to the Raising the Bar
research has given unique insight into what
employers want from their fitness, sport and
physical activity professionals and how qualifications must
be shaped to meet their needs.
People are the most important
asset our industry has. Our
gyms, exercise studios and
sports halls only come alive when
we have the right people with
the right skills. The training and
development of our workforce is
therefore critical.
It’s for this reason that CIMSPA
joined forces with Future Fit
Training this year on its Raising the Bar research. Since 2014, this project has sought
the views of employers and training providers on the validity and impact of the sector’s
training and development, and in so doing has provided some valuable data. This year,
we decided to take the research a step further and go behind the statistics and get
key stakeholders around the table to lead the discussion on training, assessment and
standards of deployment.
I can’t emphasise enough how constructive these past few months have been.
Taking place over a series of stakeholder meetings, this consultative approach has
given us unique insight into what employers actually want from fitness, sport and
physical activity professionals and how training providers can develop qualifications
to meet their needs. They’ve told us how they want professionals to be assessed,
what they think of our professional standards and the role of Continuing Professional
Development in setting minimum standards for deployment.
Employers explained what their needs are now and where they see the direction of
travel in the future. By sitting employers and training providers around the same table,
we have been able to move the conversation on and give employers the opportunity to
have a say in one of their key areas of investment – people.
This exercise means that our qualifications are always evolving. It means that our
fitness, sport and physical activity professionals are qualified and competent to serve
our customers. And, above all, it means we can protect our customers and give them
the best possible experience.
I’m delighted to say that the results of the Raising the Bar research will be launched
at the CIMSPA conference in February 2020. For more information about the event, visit
cimspa.co.uk/conferencehome fp
Insurance
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your trainers,
I’d get insured
with FitPro.
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Accidents do happen.
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underwritten by Aviva.
Tara Dillon is CEO of CIMSPA
cimspa.co.uk
FitPro is a trading name for Fitness Professionals Ltd
which is authorised and regulated by the
Financial Conduct Authority – FCA number 705177
T: +44 (0)20 8586 8635 E: info@fitpro.com
5566
For references visit fitpro.com/references
fitpro.com | 5

LEPTIN LEVELS • RESEARCH EXPLAINED
Appetite and hunger hormones
Research review
This issue, Dr Paul Batman reviews the effect of exercise on levels of the hormone leptin.
Title: The Effect of Chronic Exercise Training on Leptin:
where individuals increase their energy intake and decrease their
A Systematic Review and Meta-Analysis of Randomised
levels of physical activity in the presence of high leptin levels.
Controlled Trials
The research on the effects of exercise on leptin levels is
inconsistent, with some studies reporting increased leptin levels, and
Authors: Michael V Fedewa, Elizabeth D Hathaway,
others reporting lower levels. The difference in the research can be
Christie L Ward-Ritacco, Tyler D Williams, Ward C Dobbs
due to the intensity and the duration of the exercise, the nutritional
Source: Sports Medicine (June 2018), 48(6): 1,437-50
status of the subject, the circadian rhythm of leptin, the time of blood
Introduction
Exercise is used as a main intervention in over 90% of weight-loss
programmes, even though these programmes only lead to modest
reductions in bodyweight. One reason given for this modest decrease
is the interaction between hormonal control and energy expenditure
and energy intake.
Leptin is a major hormone responsible for controlling energy
balance. It is released as a result of fasting, caloric restriction
and overfeeding. During fasting, leptin is released due to feelings
of hunger, a greater desire to eat and a need for increased
energy intake.
Generally, lower leptin levels help the body to restore energy
balance by increasing appetite and decreasing energy expenditure,
while increased leptin levels supress appetite and increase energy
expenditure. Alternatively, obesity can cause a leptin resistance,
sampling and the caloric imbalance caused by the exercise.
This study quantified the effects of exercise training of more than
two weeks on circulating leptin levels.
Methods
The researchers completed a meta-analysis of reviewed articles
that were published before 2016, published in English, were peer
reviewed, involved human subjects, measured leptin levels before,
during and after the exercise session, and had an intervention period
of greater than two weeks.
Results
The researchers reviewed 72 publications that included 3,826
subjects with ages ranging from 8.2 years to 71 years. The evidence
from the studies reviewed indicated that chronic exercise training
was associated with a decrease in leptin levels across all groups,
regardless of age and sex and levels of adiposity. Aerobic exercise,
resistance training and concurrent training all showed decreased
leptin levels with no difference noted between any of the forms
of training.
Conclusion
Dietary interventions have reported even lower leptin levels when
combined with long-term exercise. The reason for this reduction in
leptin levels in the combined exercise and diet intervention is the
body’s way of protecting its fuel source by controlling total daily
energy expenditure during periods of lower energy availability. It
appears that the intensity or duration of the exercise has to be
significant to decrease leptin levels.
Reports suggest that short-term acute exercise of fewer than 60
minutes and exercise that generates fewer than 800 kcals does not
change leptin levels. The decrease in leptin levels in activity greater
than 60 minutes is due to the diurnal rhythm of the leptin and
hormonal changes occurring as a result of the exercise. This can
be seen in ultra-endurance activities that create a need to eat and
store energy.
In overweight people, decreased leptin levels could be responsible
for the increased weight gain when compared to normal weight
people. Some obese groups tend to have high leptin levels, which
have little effect on energy intake causing a leptin resistance leading
to further weight gain.
In the ‘normal weight’ population, the decrease in leptin after
long-term training could be due to an increased sensitivity caused
by the body attempting to establish a new ‘set point’. In this group,
the increased leptin sensitivity could explain the reduced leptin levels
while still enhancing weight loss. This suggests that long-term training
increases leptin sensitivity to receptors, while still potentially causing
reduced leptin levels, paradoxically resulting in weight loss rather than
weight gain.
Training studies of fewer than two weeks report no changes in
leptin levels after a training bout, irrespective of the training variable.
Longer training studies greater than 12 weeks have reported
decreased leptin levels due to changes in body composition, fat
mass, improvements in insulin sensitivity, changes to lipid metabolism
and concentration, possibly all due to improved fitness levels and
long-term training responses. This response, as a consequence of
sustained training, still results in weight loss even though leptin levels
are also low, unlike what happens in the untrained.
Changes in leptin levels due to exercise are very specific to the sub
population being trained as well as the fitness level of the individual,
resulting in little consistency in recommendations. fp
Learn about nutrition and fasting in our CPD
online courses. Click here
BIOGRAPHY
Dr Paul Batman has been involved in health and fitness for more
than 40 years as a university lecturer, vocational educator, author,
researcher, international conference presenter and workshop
facilitator. Over the last 18 years, Paul has built, owned, operated and
sold two leading health and fitness vocational training institutes, and
has received a Lifetime Achievement award for his services to the
Australian fitness industry. Paul originally contributed to our Network
articles back in the 1990s. drpaulbatman.com.au
6 | FITPRO JAN/FEB 2020
For references visit fitpro.com/references
fitpro.com | 7

SNOW FIT • TRAINING
Snow fit: Elevate
your alpine experience
Steve Tongue gives tips on how to keep your
snow-loving clients fit on the slopes this winter.
Ski season is here and millions of recreational skiers will head to the
mountains to thrill seek, learn new skills, drink to excess, show off, socialise,
breathe clean air and generally have a wonderful time. However, many of our
clients fail to physically prepare.
You should really start preparing your clients now – ideally, eight weeks before they head
off. Physical conditioning has the biggest impact on how much enjoyment clients have on the
slopes, the likelihood of injury and how well their bodies recover each day. It’s well worth clients
investing time and money on snow conditioning plans, workout classes and PTs. I’ve certainly never
had a client who regretted that little extra prep. In this article, we’ll look at the advice you can give
clients to implement once they reach their snowy destination, to enhance their performance, reduce
injury risk and up the alpine pleasure.
While on the mountain, dehydration
and fatigue can lead to mistakes
Pre-slope prep
On the first morning of the trip, time should be allocated to
prepare the body. Firstly, it must be fuelled. A breakfast of healthy,
slow-release carbohydrates and healthy fats, such as a warming
bowl of porridge with seeds (e.g., pumpkin), will provide
sustenance. Hydration is also very important and your clients
should try to quench their thirst before they head out. As little as
2% dehydration inhibits physical performance and can negatively
affect cognitive function 1 . Snap decisions and judgements on the
slopes can seriously affect safety.
Once the stomach is smiling, it’s time to physically prepare the
body. A thorough warm-up can reduce risk of injury and help get
the best out of the body. You probably know your clients’ bodies
well and will be aware of the muscles and joints that need TLC.
These ‘sticky spots’ are a great place to start movement prep,
focusing on key muscles and joints for skiing/boarding such as
the quads, glutes and spine.
A great place to start is by using a foam roller to help hydrate
and warm up the soft tissues. (Foam rollers are also available
in a travel size.) The opposite video demonstrates some rolling
techniques that take just five minutes to prepare the hamstrings,
glutes, quads and adductors. (See video 1.)
These foam-rolling techniques, inspired by Stull K (2018),
Complete Guide to Foam Rolling, prepare key muscle groups for
snow sports. Begin scanning the muscle by rolling along it and
searching out the most tender spots. Once you have located any
tender points, remain still on that point for 30-60 seconds until
pain has reduced. Maintain pressure on the muscle and mobilise
the associated joint as shown in the video.
Then it’s time to stretch. A dynamic stretch helps to raise
temperature and heart rate, and helps muscles hit full range of
motion. In the video opposite, I have put together a snow-specific
stretch routine to stretch multiple key muscles, saving time and
stimulating the body’s intermuscular co-ordination. (See video 2.)
These are suggested dynamic stretch routines for snow sports.
The aim is to gradually increase ROM, temperature and heart
rate. Perform six to 10 forward and diagonal arm swings in each
foot position (symmetrical, offset left and offset right). Inspired by
the Gray Institute.
For the final phase of prep, I have some muscle activation
techniques to stimulate stabilising muscles, waking up those
smaller muscle groups that stabilise the knees, hips and back, so
that balance and compelling control can be demonstrated when
hitting those edges. A light mini band is fantastic for this but, if
you don’t have one, these exercises can be performed without.
(See video 3.)
These exercises are designed to activate stabilising muscles
of the hip prior to snow sports. Perform six to 10 reps of each
exercise and be aware the goal is to stimulate, but not fatigue,
the muscle.
Top 5 injuries
According to statista.com,
the top five most common
injuries from 2006-2018
were to knees, head,
shoulder, lower back
and hand.
❯ 1. Snow Prep Foam Roll
❯ 2. The Snow Swing
❯ 3. Snow Stability Exercises
8 | FITPRO JAN/FEB 2020
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fitpro.com | 9

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Lack of sleep can have a detrimental
effect on athletic performance, such as
speed, endurance, power and even risk
of injury
While on the mountain
While on the mountain, dehydration and fatigue can lead to mistakes.
Time should be taken to rehydrate at every opportunity and, if
needed, a drink and snack can refresh energy levels and maintain the
quality of performance.
Proactive recovery
Upon return, it’s best to get warm and cleaned up and not rush off
to dinner or the bar, taking time out to boost recovery and prepare
for another fulfilling day. Younger or fitter clients may recover more
quickly but, if prior physical preparation was lacking, a little time
invested in proactive recuperation is worth it. If stiffness sets in early
doors, 10mins doing a few yoga poses can form part of an active
recovery strategy. (See video 4.)
❯ 4. Snow Recovery Yoga
These yoga poses help stretch and relax primary muscles used in
snow sports. Focus should be on breathing, relaxation and gentle
stretching. If you are unsure of any of these techniques, seek support
from a qualified yoga teacher.
For those prone to muscle tightness or spasm, spending five
minutes on foam-roller techniques could aid relaxation and help
loosen off. When rolling, emphasis should be on the muscle groups
that instinctively feel the need for attention. After a day of exertion,
a recovery-based sports massage is the perfect way to set up for a
good night’s sleep.
Nutrition is a big part of your clients’ recovery from physical
exertion. Protein is the key macronutrient we require for growth and
repair. Small protein-rich snacks throughout the day are useful, such
as seed- and nut-based trail mixes or jerky. A large portion of protein
in the evening meal is a key opportunity to hit the protein quota.
Clients should aim to hit a minimum of 0.75g of protein per kg of
bodyweight per day 2 . Accompanying protein sources with a good
helping of vegetables and some good-quality carbs, such as rice or
potatoes, should replace those calories burned off throughout
the day.
The final step for recovery – and arguably the most important – is
sleep. To help recover from a big day of activity, a solid seven to
nine hours’ sleep is required 3 , as the body does most of its repair
work during the night. Lack of sleep can have a detrimental effect on
multiple elements of athletic performance, such as speed, endurance,
power and even risk of injury 4 . To achieve the required amount of
sleep, a 10pm lights out is needed if planning to hit the slopes around
9am or 10am the next morning. Advise your client that consuming
a large amount of alcohol will also likely reduce their amount of
good-quality sleep, making the next morning’s skiing not just toxic
but fatigued. If they do find themselves in this situation, napping can
help – anything from 30mins to two hours. Research has shown that a
short nap following a poor-quality night’s sleep can improve sprint performance
in athletes 5 , so daytime napping after a sleepless night can
be useful. Be warned, however, that napping past 4pm may impact
on the coming night’s sleep pattern and set clients up for a bad night.
In summary, the most important factor remains: clients need to put
in that all-important physical prep before their trip. They should also
plan time to warm up, cool down, fuel and rest the body well every
day while in the mountains. By following this advice, they should have
an exhilarating snow sport experience and hopefully return home fit,
happy and healthy. fp
BIOGRAPHY
Stephen Tongue is a personal trainer based at Original Moment in
Nottingham. Stephen has a special interest in functional movement
and sports therapy, often assisting in building plans for special
populations and injury rehabilitation. Stephen is a fitness industry
educator and has held a variety of master trainer roles for brands such
as ViPR, TRX and PowerPlate.
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RETENTION • BUSINESS
Five minutes to retain
a member, right?
Divided between the five staff, this was 300 members each.
Next, they worked out how this would impact on their already
busy days: 300 members x 5 minutes = 1,500 minutes or 25 hours
every two weeks for each of the fitness staff. So, 12 hours out of a
38-hour week would be used up in order to deliver just one aspect
of what was felt to be an important element of the experience in the
club. Still, they knew this was a valuable and honourable thing to do,
so set about the task with their usual enthusiasm and commitment,
agreeing to review their progress in three months’ time.
Retaining members is far cheaper
than acquiring new ones. By using
member data to highlight low and
non-users, operators can focus on
integrating, motivating and
retaining these individuals, writes
retention specialist Jon Nasta.
Great club operators tell us that they take time each week to walk the
gym floor and see how their staff interacts with their members. The
warm smile and friendly “hello” from reception and the encouraging
comments from the fitness staff as members go through their workouts
are all part of the complete package consistently offered by successful clubs. So,
how do we guarantee that this personal service is delivered, thereby increasing
customer satisfaction?
Five-minute mission
A club owner recently told me about how they had raised the issue of
interacting with members at a meeting with their fitness staff. They run a busy
facility with more than 1,500 members and five fitness staff. Personal service is how
they differentiate from the large multi-site operator that opened down the road and
a new boutique that opened recently. They set themselves the mission of holding
a five-minute conversation with each member, every two weeks. They felt that
five minutes was the least they should deliver for their monthly membership dues.
The cost of acquiring a new
member had doubled over the
last 10 years
You can’t chat to people who aren’t there
Pretty soon, the staff discovered that they were each experiencing
the same issues. Many five-minute conversations were being held
with members, but it became clear that the same members were
being seen over and over. These were committed exercisers who
used the gym many times a week and had no issues with the facility.
Some even expressed a wish to be left alone to get on with their
training. Something was clearly wrong with the five-minute plan.
The staff were committing a third of their time to interacting
personally with members, yet they were still seeing the same rate of
cancellations as prior to the change of strategy.
At the next staff meeting, they went through all the members that
had left in the previous several weeks and it became apparent that
they hadn’t been chatted to before cancelling their memberships.
Why? More than 90% of the leavers had not been seen in the last six
weeks and thus had not experienced the club’s personal interactions.
After a little more digging, the data revealed that most leavers were
those not experiencing the club’s high level of service for the simple
reason that they had stopped visiting in the previous two to four
months, and no one had noticed.
Cost of retention versus acquisition
We know interacting in a positive and constructive manner with
members in our clubs is a prerequisite for a successful and profitable
operation. We invest a lot of money and copious amounts of time in
staff training and systems to ensure these interactions are delivered
to a high standard. Yet, as we become more sophisticated as an
industry, we are learning more facts about the efficacy of our old and
maybe outdated strategies. The IHRSA published figures showing
it can cost up to seven times more to get a new member than to
keep an existing one, and that the cost of acquiring a new member
had doubled over the last 10 years. If the health club industry today
agrees on just one thing, it’s that the market is becoming more and
more competitive. As this continues, it is harder and harder to keep
the cost of winning new members from rising. This places an added
premium on the ‘risk versus reward’ conundrum of retaining
members. If it was possible 10 years ago to outrun attrition by
topping up with great sales figures, the prospect of doing so in
today’s competitive market and challenging economy certainly make
this a far more daunting task.
Use it or lose ... them
Look at the evidence: new members that are encouraged to achieve
a visit frequency of once a week or more during their first four to eight
weeks of membership are 100% less likely to cancel in the next year.
Members that use your club less than once a week are at twice the
risk of leaving, compared with those that visit weekly.
An IHRSA retention report highlighted a study that concluded if
an individual’s club usage drops by more than 50% from their usual
pattern (over an eight-week period), they are at risk of cancelling their
membership. For example, a member that previously visited twice a
week for the last six months who now only visits once a week should
thus be highlighted as a potential cancellation risk.
Better use of your time
Every year, as an industry, we sell hundreds of thousands of
memberships to those people who, although they sincerely want to,
have not yet been able to develop the discipline to make exercise a
regular habit. Behavioural scientists will confirm that to develop such
habits and discipline is not easy to do on your own. As the amount of
data relating to the exercise habits of our members increases and
becomes easier to translate, we are learning that there are many
ways for us to spend our five minutes other than just with the
members who are already doing a great job. For example, clubs
that use AI software services such as Keepme to improve systems,
pinpoint at-risk members, and tailor their service to individual
members, are likely to find opportunities to spend those five minutes
more productively.
By highlighting low or non-users, they are able to focus on more
comprehensive new member integration programmes and motivating
at-risk members to make exercise a habit. While expending time and
effort to better service your customers is never a wasted endeavour
when your goal is to reduce attrition, you also need to ensure you
don’t neglect those members who need your five minutes the
most – the ones who are not regularly walking through your door or
attending the classes they would enjoy the most. As the ever-growing
body of evidence and research suggests, expanding your focus to
include this segment of your membership base is where the true
retention battle is won or lost. fp
BIOGRAPHY
Jon Nasta has a wealth of experience in the health and fitness industry from both a supplier
and operator’s perspective. Noted for his expertise in member engagement and retention,
Jon has held positions such as COO of retention management, sales director of fitness, and
marketing director for Xercise4Less. Jon has recently joined Keepme as its new consulting
partner: keepme.ai/twitter.com/keepme_ai
This feature was originally published by fitnessnetwork.com.au and has been recreated with permission.
12 | FITPRO JAN/FEB 2020
For references visit fitpro.com/references
fitpro.com | 13

DEMENTIA • SPECIAL POPULATION
Dementia and exercise
It is important for anyone with
a diagnosis of dementia to
maintain their independence for
as long as possible – Helen Green
Alzheimer’s
“The most common form of dementia is Alzheimer’s,”
Green continues. “It is caused by the build-up of
‘plaques’ or ‘tangles’ in the brain. The two proteins,
amyloid (plaques) and tau (tangles), prevent brain cells
producing the chemicals required to send messages to
each other. This leads to brain cells dying and shrinkage
of the brain known as atrophy. Alzheimer’s can occur
in all areas of the brain and so affects many of the
person’s functions,” she adds.
Progression of Alzheimer’s disease
Healthy brain
Steps to diagnosis Helen Green
1 GP
The symptoms of
dementia can be present
for many months, even
years before the person
begins to recognise
these. Speak to your GP
who will conduct a full
physical health screen
and basic memory
assessment. There
are many physical and
mental health issues that
can impair an individual’s
short-term memory that can be treated, so these must be ruled out. These can
include infections, depression or nutritional deficiencies. If no health concerns
are found and the memory test has highlighted issues, your GP may then make a
referral to a specialist service for further investigations.
2 The Memory Clinic
This specialist service will take a full history of the person’s symptoms, their
duration and severity, other health issues, family history, and details of their
lifestyle. The service will likely complete more in-depth cognitive functioning tests
that look at the person’s ability to retain and recall information, verbal fluency and
language skills, ability to recreate diagrams and judge distances.
3 CT or MRI scan
The specialist service may also request further tests such as a CT or MRI scan to
assess the structure of the brain and any changes that have occurred.
Cases of dementia are set to rise to more than one million by 2025, and double that by 2051.
Olivia Hubbard speaks to Dementia UK’s Helen Green about the condition, and PT Luke
Hughes, a dementia specialist and business owner, shares practical coaching advice.
According to Alzheimer’s Society statistics, there are 850,000
people with dementia in the UK, with numbers set to rise to more
than one million by 2025, and double that by 2051.
Modern medicine has helped us live longer, but 70% of
people in care homes have dementia or severe memory problems, and
the problem isn’t confined to older people; in the UK, 42,000 people aged
under 65 have dementia. 1
Types of dementia
There are many different types of dementia and it is possible to have more
than one form at the same time, which is referred to as mixed dementia.
The three main variations are Alzheimer’s, Vascular, and Dementia with
Lewy bodies (DLB).
“The main difference between the types of dementia is how they affect
the structure and function of the brain, and their underlying causes.
Therefore, the symptoms we see in the person can differ also,” explains
Helen Green who works on Dementia UK’s Admiral Nurse Dementia
Helpline – the only specialist-led dementia helpline in the country.
Mild Alzheimer’s disease Severe Alzheimer’s disease
Vascular dementia
“Vascular dementia is caused by a disruption of the
blood supply, often through a stroke, TIAs (transient
ischemic attacks) or head injury. The brain cells affected
then stop functioning, and the person will show sudden
and significant changes in their cognition along with high
levels of confusion and distress. Symptoms may ease
after a few days but will not return to the level before
the disruption occurred. How this affects the individual
differs dependent upon where damage has occurred
in the brain. Vascular dementia can affect language,
reading, writing and communication. Memory problems
may not surface at first, particularly if this area of the
brain has not been affected,” says Green.
Dementia with Lewy bodies
“This type of dementia is caused by a build-up of protein
clumps in the brain and can affect the person’s mobility
and co-ordination, similar to symptoms of Parkinson’s.
This form of dementia can also cause hallucinations
and sudden bouts of confusion that fluctuate rapidly,”
Green explains.
4. 4 Diagnosis
As the diagnostic process is based on the fact that dementia is a degenerative
condition (i.e., symptoms worsen over time), this may mean further monitoring
is required for six to 12 months before dementia is confirmed. Therefore,
people can experience symptoms of dementia for a few years before an official
diagnosis is given.
Living with dementia
Green says, “There is the perception that people living with dementia are vulnerable
and unable to be a productive part of society so must stop working. A good
example of this not being the case was shown in Channel 4’s The Restaurant,
which showed that, with some simple adjustments in the workplace to support the
person’s existing skills and abilities, we can enable them to continue working.
“It is important for anyone with a diagnosis of dementia to maintain their
independence for as long as possible. We know this is good for their well-being,
and many people with dementia do in fact continue to work.
“The Equality Act 2010 protects people from discrimination; with a diagnosis
of dementia, people are automatically protected by this Act. Often the person’s
long-term memory remains intact until the dementia becomes advanced, therefore
skills they have used on a daily basis in their workplace are frequently retained.”
Exercise and dementia
The new NICE guidelines have stated that people with dementia should be offered
activities to promote their well-being – exercise can be one of those activities.
14 | FITPRO JAN/FEB 2020
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fitpro.com | 15

DEMENTIA • SPECIAL POPULATION
How exercise can help
Anxiety: Regular exercise is effective in reducing some of
the symptoms the person may experience, such as anxiety
and frustration.
Training a client
with dementia
Qualifications
Luke Hughes
Anxiety and dementia
Anxiety is one of the most noticeable symptoms of dementia and this
aspect of my client’s condition was lessened during the programme,
and I believed would continue to decrease with adherence to the
programme. One research study that partially supports my findings is
the Dementia and Physical Activity Trial by The BMJ 2 .
Mobility: Exercise can also help with mobility and reduce the
potential for falls.
Social engagement: Exercise provides social engagement
when part of a group.
Luke Hughes is a personal trainer who works with dementia clients.
He has a Level 3 Award in Awareness of Dementia, which he gained
prior to becoming a PT.
To work with clients with dementia, the minimum requirement is
a Level 3 Personal Trainer qualification; however, further qualifications
While this study found that there is ultimately no link between
regular moderate exercise and the slowing of cognitive impairment in
those suffering from dementia, it did note that their physical fitness
was improved significantly in comparison to those who only received
their usual care (which we would expect to see).
How far can exercise help? There is a lot of evidence
will give you and your client confidence. Good training will help
While there is no proof that exercise does anything else but
that regular physical activity can reduce the risk factors for
you to familiarise yourself with the symptoms of dementia as well as
improve the physical fitness of the participants, exercise is proven
developing vascular dementia; however, there is a lack of
how to establish and maintain a positive trainer-client relationship in
to release endorphins and reduce anxiety, and this has a direct
clear evidence on whether physical activity can prevent any
this situation.
correlation with improved well-being.
further damage to the brain when the condition has been
diagnosed. Some studies suggest that a sudden increase in
After understanding how dementia can alter the client’s
communication, behaviour and physical state (such as balance and
Exercise suggestions
exercise actually exacerbates the problems experienced with
spatial awareness), it’s easier to aid them effectively in their training.
A combination of aerobic exercise and strength training provides a
cognitive function.
As with any client, you should always be aware of their personal needs
well-balanced approach to improved health and fitness. The following
Considerations for PTs
and goals.
For any prospective students or existing PTs looking to expand their
knowledge, Exercise Programming for Clients with Dementia is a good
are my top three exercises to help clients with dementia begin their
exercise journey (after speaking to their GP):
Don’t make assumptions: Trainers should assess each
individual on their own abilities and not assume their diagnosis
makes the person incapable.
Training environment matters: Busy patterns on walls or
breaks in the floor covering, large mirrors, shiny floors and
dimmed lighting can be disorientating and increase difficulties
with spatial awareness. Large groups of people can be
intimidating as can an unfamiliar setting. Smaller class sizes
in a well-lit room where there is clear signage for exits and
toilets can help.
resource, and they may also wish to take the Dementia Awareness
training course that is CPD certified and run by the Alzheimer’s Society.
Anxiety is one of the most noticeable
symptoms of dementia – Luke Hughes
1 Squats (with chair)
If your client has issues with balance, instruct them to perform squats
with a chair:
• Start by standing upright with feet shoulder-width apart
• Engage the abdominal muscles and be sure that your bodyweight
rests on your heels
• Bring your hips towards the ground, keeping your knees behind
your toes
• When you reach the chair, hold the position for a second and then
rise upwards (ending with your chest high)
• Progress: bodyweight squats or kettlebell/dumbbell squats
Be clear with cues and use music: Those living with
dementia may have difficulty following complex verbal
instructions so think about simple, repetitive exercises that
can help them get involved. Consider using non-verbal cues
and, where appropriate, music that will be familiar to them.
Research has shown that dancing in particular can be highly
beneficial to people living with dementia as it not only has
physical benefits in terms of cardiovascular exercise, but also
promotes emotional well-being and encourages the brain to
create new neurological pathways.
BIOGRAPHY
Helen Green works on Dementia UK’s Admiral Nurse Dementia Helpline
– the only nurse-led dementia helpline in the country. Helen has
worked in the area of dementia care for the past 17 years in hospital,
care home and community settings. Her natural curiosity about people
as well as her emotional resilience allows her to support a range of
families who ring the helpline.
Case study
Who: Female in her 60s, in the early to middle stages of dementia.
Approach: I was careful to take an approach that would benefit her
health and well-being.
Type of exercises: Low-to-moderate aerobic exercises mixed with
low-impact strength training.
Frequency: Two sessions per week over a period of two months.
Results: I noticed various improvements in my client’s overall
well-being during our sessions. I first noticed an improvement in her
2 Kettlebell swings
Ensure that the client begins with a light weight, and then slowly
work up to heavier weights within their ability range. If they are
unable to use kettlebells, try some punching bag exercises
instead. Kettlebell swings are great for cardiovascular health,
as well as for strength and conditioning. They are classed as a
full-body exercise:
• Lift the kettlebell carefully, keeping your feet just more than
shoulder-width apart
• Get into a slight squat (knees behind toes)
• Push the kettlebell back between your legs, then propel it forward
(keeping your weight in your heels and your arms and grip loose)
• Ensure your power is in the lower body and momentum of the
kettlebell (it’s a hip hinge movement)
3 Stationary bike
More information
For further information and for resources
on dementia, please visit dementiauk.org
You can also contact the Admiral Nurse
Dementia Helpline on 0800 888 6678 or
email helpline@dementiauk.org
aerobic endurance, which is arguably one of the most important
aspects of improved health and fitness (especially for those focusing
more on cardiovascular fitness rather than muscle mass). My client’s
symptoms of anxiety seemed to lessen significantly over the twomonth
period, particularly towards the end of each session. While
regular exercise has not been proven to improve the symptoms of
dementia directly, it has been credited for a decrease in anxiety.
This is a great piece of equipment as it can be used for either low- or
high-impact workouts:
• Perform long-duration cardio workouts on the stationary bike for a
low-impact workout; 40 minutes as a guideline
• Use the bike for HIIT workouts if you want a high-intensity
workout; opt for bursts of 40 seconds moderate pace,
20 seconds fast pace
BIOGRAPHY
Luke Hughes is the co-founder and managing director of OriGym
Centre of Excellence, a UK leading fitness provider. As well as being a
qualified personal trainer with a master’s in sports science, he holds a
Level 3 Award in Awareness of Dementia and has worked with many
clients who have the condition.
16 | FITPRO JAN/FEB 2020
For references visit fitpro.com/references
fitpro.com | 17

PREGNANCY • PROGRAMMING
Exercise
in the third trimester
Yoga poses and exercises for the third trimester
The following poses are listed to increase your power for pushing during the third trimester, and there
are cues for enjoying each pose throughout your pregnancy. Move slowly, breathe deeply, and enjoy
your yoga practice.
Heart-opening stretch on stability ball ▼
Benefits
This pose stretches the chest and shoulders.
Desi Bartlett looks at the exercises mums-to-be can perform on a Swiss ball during their
third trimester.
Not so long ago, women were told to
relax and put their feet up during the
third trimester. Now that we know
the many benefits of exercise for
mummy and baby, it is important to indicate
which exercises are safe and effective.
We know that pelvic floor training can be
beneficial for expecting mums because it can
help support the extra weight of pregnancy,
shorten the second stage of labour, and
(because of increased circulation) increase
the rate of healing after baby is born. Since
the groundbreaking work of Dr Kegel in the
1940s there have been many advancements
in the field of pelvic floor dysfunction, and
physical therapists have developed new and
varied techniques for strengthening your
pelvic floor.
Many birth professionals recommend the
use of a Swiss ball (or a birthing ball, as a
doula or midwife might call it) to help your
baby get into a good position for labour
and delivery. (You can also use a Swiss ball
during your pregnancy as a prop in many
exercises and stretches.) Bear in mind that
there are benefits to strengthening the pelvic
floor muscles even when you know that you
are going to have a C-section. The pelvic
floor has to hold the weight not just of your
organs but also of your baby throughout the
pregnancy, so strong muscles in the pelvis
offer support.
Also, keeping these muscles strong can
lead to faster recovery. The ball can also be
used after you have had the baby to help you
get back into shape and to gently bounce
with your baby in your arms when they need
soothing.
Here’s some information to help you
understand how best to use a Swiss ball,
and how to choose one that’s right for you.
In choosing a ball, first look for the size of
ball that best fits your height (see table).
It’s also important to look for a label on
the box or website that you are purchasing
from that says anti-burst technology to help
ensure it’s a safe piece of equipment to use
throughout your pregnancy and beyond.
Exercise ball
diameter
45cm
55cm
65cm
75cm
Your height
5' and under
5'1"– 5'8"
5'9"– 6'2"
6'3"– 6'7"
Feeling
Enjoy the feeling of opening your arms wide as if to receive, and
the light and energy of your heart centre shine like the rays of the
sun and expand from the inside outward. You are receiving the
gift of motherhood; it can be sweet to reflect on the magnitude
of this gift. On a purely physical level, this stretch feels very good
after you have been working at the computer or in other positions
where you round forward.
Instruction
• Sit on top of the stability ball with your feet hip-width apart.
• Slowly walk your feet forward until your hips can easily come
down off the ball. The ball will rest just above the waistband
of your pants and will support your middle back, upper back,
neck and head.
• Open your arms wide and let your focus gently rest on the ceiling
as you breathe into a deep yet passive stretch for the chest,
shoulders and arms (see figure below). This stretch is passive in
nature because, even though you are opening your arms wide,
gravity will play a large part in opening the chest as your arms
are gently drawn apart a bit further, as if to give someone a
big embrace.
Adjustments
On those days when you feel as though your balance is a bit off,
place the ball up against a wall or a sofa for an added sense of
stability and support.
a
b
Kneeling hip abduction ▲
Benefits
This exercise strengthens the outer thighs and hips and stabilises
the core with the ball.
Feeling
This exercise can be a bit humbling; it’s surprising how challenging
it can be to simply lift your leg! Be patient with yourself and affirm
that you are a strong and powerful mother and that this movement
is simply another opportunity to overcome a challenge. Prove to
yourself that you have a deep reservoir of strength you can draw
from as needed.
Instruction
• Begin kneeling on the floor with the right side of your torso lying
on the stability ball (see figure a). Place your right knee on the
floor and your right forearm on the ball. Your left hand can rest
on your left hip and your left leg will extend to straight.
• As you exhale, slowly lift your left leg until it is parallel with the
floor (see figure b).
• As you inhale, let the leg come down until it almost touches
the floor.
• Repeat 12 to 15 times, making sure that you are breathing
deeply and comfortably. Then switch sides.
Adjustments
If you would like additional padding under your right knee, place
a folded blanket there for cushion. You can tap the top foot to
the floor any time you feel as though your balance is off. Take a
moment with your foot on the floor to recalibrate and find your
balance. Then continue the exercise when ready.
18 | FITPRO JAN/FEB 2020
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fitpro.com | 19

PREGNANCY • PROGRAMMING
a
b
Wall squat ▲
Benefits
This move strengthens the hips, thighs and core stabilisers.
Feeling
Feel a powerful sense of grounding through your feet as you enjoy
this exercise. In the Eastern traditions, the legs correspond to the
element of earth, so there is a natural sense of being grounded in
the lower body. At the same time, feel the crown of the head rising
toward the sky so that you have a sense of growing tall as a result
of your supported, stable foundation.
Instruction
• Place a stability ball against the wall at the height of your hips,
and turn your body away from the wall so that the ball rests
gently above your tailbone as you step your feet hip-width apart
(see figure a). Your hands can rest on your hips or on top of
your thighs if you prefer; both are correct.
• Standing tall in your torso, inhale and squat down until your
knees are at a 90° angle, making sure your knees are pointed
straight ahead (see figure b). The ball will naturally roll up the
length of your spine until it is just above the shoulder blades.
Focus on the pelvic floor stretching in four directions at the
bottom of the movement. Imagine that your pubic bone is
moving forward, your tailbone is moving back slightly and the
sit bones are moving away from each other.
• As you exhale, straighten your legs and return to standing,
gently engaging your glutes at the top of the movement. As you
straighten your legs to stand up, feel a gentle lift in the pelvic
floor and imagine those same four bony landmarks (tailbone,
pubic bone, sit bones) moving in toward the midline of the body.
At the very top of the movement, you can also add a Kegel so
there is a little extra contraction or lift of the pelvic floor.
• Repeat the exercise 12 to 15 times, remembering to
co-ordinate your breath cycle with the movement.
Adjustments
If you have a tendency to let your knees either knock in or collapse
out, place a yoga block between your inner thighs to maintain
the proper alignment of your knees. If you would like an added
challenge, you can add a Kegel exercise at the top of the squat.
Feel the lift of the pelvic floor as you rise, emphasising it as you
straighten your legs.
Seated side-to-side rock ▼
Benefits
This movement mobilises the muscles of the pelvic floor.
Feeling
Experience the feeling of mobility in the hips as though you were
a child simply enjoying playtime with a beach ball. This is a valid
form of exercise that has distinct benefits for pelvic mobility, but it’s
also fun! Allow yourself to be playful and perhaps take a moment
to think of all of the ways you can start to invite the spirit of play
into your life. Soon you will be the mother of a little one who loves
to play.
Instruction
• Sit on top of the stability ball with your feet a little bit wider than
hip-width apart. Sit up tall through your torso and put your
hands on your hips or reach them directly in front of you at the
height of your shoulders.
• Feel your sit bones gently pressing into the ball. Begin to shift
your bodyweight more onto the left sit bone as you exhale
(see figure). You will also feel a secondary contraction in your
waist muscles (the obliques act as a synergist, an agent that
increases effectiveness).
• Return to centre and then change sides. Enjoy several rounds
of this exercise, and remember to breathe deeply and naturally.
It can also be helpful to use what the yogis call a dristi, or focal
point. Allow your gaze to rest gently on one point; this will help
you keep your equilibrium.
Adjustments
If you feel unstable with this exercise, it’s OK to place your ball
at arm’s length from the wall so you can tap the wall with your
fingertips to re-establish your balance.
Seated thread-the-needle pose ▼
Benefits
This pose stretches the outer thighs and hips and the glutes.
Feeling
The feeling is one of releasing and letting go. The outer hip and
thigh is a large muscle group that can get tense without us even
noticing it until we are in deep stretches. Take your time and
breathe into the feeling of letting go of any tension that no longer
serves you; imagine it releasing and relaxing more and more with
each breath cycle.
Instruction
• Seated on a ball or chair, place your feet hip-width apart.
• Cross your right ankle on top of your left thigh, and place your
left hand against the sole of the right foot, with your right hand
on top of your right thigh. Gently encourage the upward flexion
(dorsiflexion) in your foot by pressing your left hand into your
right foot. Press your right hand down actively onto the right
thigh to encourage external rotation in the right hip.
• Now, elongate your spine and hinge forward at the hips, with
the breastbone reaching forward and slightly down (see figure).
Be aware that you are not rounding in the upper body, and that
your head and neck are an extension of your long spine.
• Hold for 30 to 60 seconds, then switch to the other side.
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Adjustments
If you would like a slightly more intense stretch, try this pose
standing while keeping your hands safely holding onto a bar or the
side of a treadmill. You can sit into the stretch and let your hips go
back a little bit further than they do in the seated variation. If you
don’t have a treadmill or a fixed bar you can
hold onto, you can ask your spouse or
significant other to let you hold onto their
forearms as you sit back into the stretch.
FitPro members can save 25% with code FP25. Visit uk.humankinetics.com. The above extract has been
taken from Your Strong Sexy Pregnancy: A yoga and fitness plan by Desi Bartlett.
20 | FITPRO JAN/FEB 2020
For references visit fitpro.com/references
fitpro.com | 21

COLD THERAPY • TRAINING
7 reasons
why it’s good to be cold
From boosting immunity to beating depression and helping athletes recover from
exercise, getting cold is hot news! Fiona Bugler examines cold therapy for health and
tries out a chamber where plummeting temperatures promise brilliant health.
1
Improves recovery after exercise
When exposed to the cold, the body will maintain blood in the core region to protect the
vital organs. As soon as the cold is removed, the heart pumps blood back to the
extremities, which helps bring back nutrients and oxygen to repair damaged tissues.
“Application of Whole-Body Cryotherapy (WBC) during the post-exercise recovery
period has now been tested with many sports,” says Christophe Hausswirth PhD in
his paper The Effects Of Whole-Body Cryotherapy Exposure In Sport: Applications
For Recovery And Performance. 1 He points to a German study, published in
January 2015 2 , which showed an improvement in early recovery after
intermittent high-intensity exercises. The study was significant
because it was the first time a placebo effect had been included.
2
Boosts brown fat – the ‘healthy’ fat
When the body is exposed to very cold temperatures it is forced
to work harder to heat and transport the blood around the
body. “You go into fight or flight mode and this increases
metabolism and overall calorie expenditure,” explains
Dr Harpal Baines, a surgeon who has followed a
varied medical career path and now specialises in
functional medicine, and owns the Harpal Clinic
(harpalclinic.co.uk) in Central London, which
houses a CryoAction cryotherapy chamber.
Cold therapy, cold showers and being in cold
temperatures are all believed to boost
the production of brown fat,
which is considered to be ‘healthier’ than white fat (fat stored
round the hips and stomach). “It’s hard to quantify the effect of
cryotherapy over a short period,” explains Dr Baines, but, she adds,
“other treatments such as cryolipolysis show cold therapy works
where body fat is concerned – like liposuction but with fewer
side effects.” 3
3 Improves sleep
In his paper, Christophe Hausswirth points to two studies that show
WBC could help athletes to sleep better, particularly during phases
when the training workload is increased. “During intense training
periods, a deterioration in sleep is commonly reported (with sleep
latency, reduced duration and efficacy of sleep); these effects were
not observed when athletes were exposed to very intense cold on
a daily basis,” he says. “One of the most common things we hear
from our clients after a cryotherapy treatment is that they had a good
night’s sleep,” confirms Gary Read, operations manager at the Harpal
Clinic. “We’ve also found positive effects on people with chronic
fatigue syndrome,” adds Dr Baines. “Someone with chronic fatigue
can’t get rid of toxins and absorb nutrients effectively. In layman’s
terms, cold therapy helps this process by opening the ‘gates’ of the
body’s cells, helping to clear out rubbish and take more energy in.”
4 Beats depression
Studies of cold-water swimming are emerging which are confirming
that it can help beat depression. TV doctor Dr Chris van Tulleken
kicked off further research into the subject when he treated a
24-year-old for depression with cold water swimming, featured in a
TV documentary and published in the British Medical Journal case
studies 4 . Dr Baines says that, although it’s hard to measure levels
of serotonin and other neurotransmitters in the lab, she’s witnessed
how clients respond to being out of their comfort zone. “It’s similar to
suggesting someone does 30 seconds of star jumps – you can’t help
lift your mood when you alter your state dramatically,” she says.
5 Improves your work productivity
Cold showers have long been linked to good health and mixing with
hot and cold has also been seen as an age-old way to boost health
in Scandinavian countries. One study found that switching between
hot and cold showers resulted in improved work attendance. The
study of over 3,000 18–65-year-olds published in 2016 by the
Academic Medical Centre in Amsterdam 5 found taking a ‘hot-to-cold’
shower every day saw a 29% reduction in self-reported sick leave
from work.
6 Boosts your mental strength
Wim Hof is known as the Ice Man and is famous for submerging
himself in freezing cold temperatures for long periods of time to help
promote good health. By stimulating the body, the Wim Hof method
of cold therapy and breathing aims to release your inner power, which
he says is blocked in our artificial world. If you want to add the Wim
Hof method to your skillset, you can train to become an instructor.
Check out wimhofmethod.com/whm-academy-course-information
7
Enhances complexion
Exposure to cold temperatures is said to stimulate the production of
collagen, leading to a return to youthful, glowing skin and a gradual
reduction in fine lines and wrinkles. Stars such as Ruby Wax claim
daily cold showers ward off wrinkles. “In the world of beauty, cold
therapy is used in the same way that micro-needling and ultrasound
frequency treatment is used,” explains Dr Baines, who also runs a
central London beauty clinic. “When the body senses damage is
being done to the skin, it responds by a process of repair that results
in collagen bundling – the skin produces the right type of collagen
and more elastin resulting in better complexion,” she says.
FitPro tries out CryoAction
Fiona Bugler tried out the
CryoAction chamber based at the
Harpal Clinic near St Paul’s,
Central London.
At the end of a long London working day, I was feeling
sluggish and tired when I arrived at the Harpal Clinic.
I hadn’t really known what to expect and was apprehensive
when I saw the temperature gauge showing -120°C.
Dressed in a sports bra, running shorts, long socks, hat,
gloves and a face mask to stop my breath freezing, I
anxiously stepped into the gassy chamber. I had read that
I could walk in circles but must not touch the sides (I assume
I’d get stuck to them). I’d also been told to be sure there was
no moisture on my body – which of course would freeze.
Gary, from the clinic, had explained that it wouldn’t feel as
cold as my daily 60-second cold shower. And he was right.
The three minutes went very quickly. In the last 30 seconds
I felt a little pain in my left arm, radiating from a shoulder
injury, but I was reassured that this meant the treatment was
having the desired effect.
After it, I felt great; I really had been given a reboot to
my sluggish system and my low mood lifted. A few days
after, I ran a season’s best over 5km, exactly one minute
quicker than the week before. Dr Baines suggested that
exposure to cold may have boosted my mitochondria levels
to help me run faster. I’m all for marginal gains and would
definitely try this again. fp
❯ 1. Cryotherapy in action
22 | FITPRO JAN/FEB 2020
For references visit fitpro.com/references
fitpro.com | 23

INTERMITTENT FASTING • NUTRITION
Intermittent
fasting
Is it for me?
What is intermittent fasting and is it right for you?
Linia Patel tells us why we should sit up
and take notice of this growing trend.
Click here
for information on
Intermittent
fasting:
Fad or future?
online course
When did you eat dinner last
night? And breakfast today?
Chances are that you had at
least a seven- to eight-hour fast
between dinner and breakfast. However,
based on the intermittent fasting (IF) diet,
which has gained traction over the last few
years, a 16-hour period is the ideal. Or,
reducing your calories to 25% two days a
week could do your waistline some good.
Or even having a complete fast day twice a
week could be the new anti-ageing tonic.
What is intermittent fasting?
Fasting is not a new concept. For centuries,
people have temporarily restricted their food
intake as a way of life (our hunter-gatherer
ancestors) and for religious reasons.
Devotees of fasting have long claimed it
brings physical and spiritual renewal.
In the past few years, the different
intermittent fasting methods have gained
popularity. Intermittent fasting is the process
of cycling in and out of periods of eating and
not eating. The different methods are:
• Alternate-day fasting: This method
requires you to restrict all food for 24
hours, once or twice a week.
• Whole-day fasting: Commonly also
known as 5:2. This approach to fasting
advocates healthy eating to meet your
caloric intake five days a week, cycled
with a 500-600 calorie diet the other two
days of the week.
• Time-restricted feeding: Typically, with
this one, you eat all your daily calories
within a shortened period (typically six to
eight hours) and fast for the remaining
14-16 hours. You can do this every day or
a few times a week.
The research so far
Physiologically, calorie restriction has been
shown in animals to increase lifespan and
improve various metabolic processes which,
in turn, have a positive effect on many inflammatory
pathways 1 . The studies on animals
show strong evidence that intermittent fasting
not only produces positive metabolic changes
(a reduction in blood pressure, better insulin
control, improved cholesterol profile and
weight loss) but, the research suggests, fasting
also has a positive impact on anti-ageing
and overall longevity 1, 2 . The act of fasting is
believed to cause an immune response that
I have found that IF works best for people who
already have a stable and healthy eating pattern
before 12pm 12pm – 8pm after 8pm
no milk
no sugar
fasting window eating window fasting window
repairs cells and regulates insulin control.
High levels of insulin over time promote
inflammation and fat storage 1,2,3 .
What is disappointing is that the studies in
2, 3,
humans have produced conflicting results
4,5
. Take the impact of fasting on weight loss,
for example. A review of 40 studies found
that intermittent fasting when done correctly
(hold on to the word ‘correctly’ – it’s important!)
was effective for weight loss. Interestingly,
there were no significant differences in
blood pressure, heart rate, fasting glucose
and fasting insulin with the subjects following
IF and those following another general
healthy weight-loss regime 3 . The results also
suggested that it was unclear if fasting was
superior to other weight-loss methods with
regards to decreased appetite and
compliance rates 3 . The different modes of
fasting, as well as the mix of participant
characteristics (lean vs obese), is worth taking
note of when interpreting these results 3,4 .
More high-quality studies including
randomised control trials (the gold standard
in research) with a follow-up of greater than
one year are needed to show a direct effect
and for us to clearly understand who benefits
the most from fasting and how it should be
done for each population group.
One size doesn’t fit all
From my clinical practice, I have found that
IF works best for people who already have a
stable and healthy eating pattern (eating in
balance and eating enough), as in this way it
doesn’t become a fad diet. If you are eating
the right foods in the right proportions on
your non-fast days, then your chances of
losing weight and reaping the positive
benefits of fasting are higher. However, it’s
common to see people following a feast
and famine IF pattern of eating, which does
more harm than good! Even with fasting,
moderation is key. More is not better. It’s
not about trying to do as many fast days
as possible either. This is called disordered
eating. In fact, people with a history of eating
disorders, or those using medications that
require food intake (type 1 diabetics),
those still actively growing (teenagers), and
pregnant or breastfeeding women should not
be fasting intermittently.
So, what does this mean for us?
There is more evidence building up to show
that, for some population groups, there are
many benefits to IF; however, more research
is needed for us to fully understand the
therapeutic benefits. Within my clinical
practice, many clients who correctly follow an
IF pattern reap the benefits in terms of weight
loss and metabolic benefits. The environment
in which we live encourages us to consume
food mindlessly and many clients find that
IF is a good tool that helps many to get in
tune with their hunger and fullness signals. If
you want to dabble in IF, speak to a dietitian
or a registered nutritionist so that they can
recommend a method of fasting that works
specifically for you. fp
BIOGRAPHY
Linia Patel is a leading dietitian and
sports nutritionist. She is currently a PhD
candidate in Public Health. Her passion
is translating nutritional science into
easy-to-digest and practical advice.
24 | FITPRO JAN/FEB 2020
For references visit fitpro.com/references
fitpro.com | 25

CBD THERAPY • WELL-BEING
C 3
H
C 3
H
CH 3
OH
HO
CH 3
Have you ever run a marathon? According to professor of
clinical exercise physiology Niall Moyna, writing for RTE 1 , as
you wait at the starting line the adrenaline increases your
breathing. The race begins and your heart has to pump four
times the amount of blood than when you are at rest. Over the entire
course, you will lose around five litres of sweat and you will strike the
ground approximately 40,000 times; each time, a large impact force
is creating extra stress on your muscles and joints.
Ultra-athlete Shane Finn ran his first marathon at the age of 18
and, just seven years later, was running 24 marathons in 24 days,
crossing Ireland from coast to coast. “What’s your secret?” I ask him
with curiosity. He hesitates, perhaps because he doesn’t want to
divulge it or perhaps because he simply doesn’t have one. He ran
his first marathon for charity and he’s still running to help others.
“I realised I was given the gift that I could help through fitness and
I wanted to use that gift trying to help other people that weren’t as
lucky as I was,” Finn reveals.
Why are
some fit pros
taking CBD?
Stefania Dall’Armi explores the current debate around cannabidiol (CBD) in sport and what
benefits it may bring to fitness professionals.
Of course, motivation plays a fundamental role, but your body’s
capability has equal – if not more – importance, especially when
talking about endurance sports. “When I train hard (like I did last
spring [when] I cycled and ran across America from San Francisco
to New York) my whole body is in pain basically all the time,” Finn
says. And, at this point, CBD comes into play. “I was kind of intrigued
when I heard about it, so I started doing a bit of reading but I never
really tried it on myself as I am quite conscious of what I eat and put
in my body. But then I found out that CBD gel capsules could help
me to push my body more. I was thinking I needed to try this in my
preparation for America and I did it.”
What actually is CBD?
CBD – or cannabidiol – is one of the hundreds of chemicals found
within the cannabis plant. The easiest compounds to extract and the
best known are CBD and tetrahydrocannabinol (THC). But, unlike
THC, CBD does not possess psychoactive effects.
CBD is considered to be one of the biggest wellness
products of our time. It is broadly sold in health stores
and touted for a wide variety of health issues, which
go from anxiety and insomnia to treating chronic pain
and, especially, some of the cruellest childhood epilepsy
syndromes. But is CBD safe? According to a report from
the World Health Organisation, 2 “In humans, CBD exhibits
no effects indicative of any abuse or dependence potential
[…]. To date, there is no evidence of public health-related
problems associated with the use of pure CBD.”
However, some doctors remain reluctant. Dr Peter
Grinspoon, medicine professor at Harvard Medical School
(Boston) 3 , argues, “A significant safety concern is that it is
primarily marketed and sold as a supplement, not a
medication.” The main issue with CBD is that it is relatively
new and there are very small bodies of evidence without
long-term data. Dr Aisling Pigott, registered dietitian at
British Dietetics Association, says, “I always discourage
people from getting too excited about the latest health fad,
but to take a pragmatic approach when considering using
a product. There are over 100 active compounds within
the [CBD] oil and the exact mechanism of action [is] not
fully understood. Whilst there are some links with potential
benefits and symptom relief in illness – and there are not
any known or reported adverse effects – the evidence is
still quite mixed.”
CBD is completely legal in the UK and has always been
permitted in all its forms (oil, capsules, vapours, creams,
chocolates and energy drinks). There has never been a
specific law to forbid its use but it has only become so
popular in the last few years. However, there are two general
rules that all companies producing CBD have to follow:
they have to keep away from making any medical claim
and their product has to contain less than 0.2% of THC 4 .
CBD was not originally available to athletes, as it was
forbidden by the World Anti-Doping Agency (WADA).
However, at the end of 2017, the WADA released an
updated list with major changes. The document writes,
“Starting in 2018, cannabidiol (i.e., CBD oil) is no longer
prohibited under the S8 Cannabinoids category. Synthetic
cannabidiol is not a cannabimimetic; however, cannabidiol
extracted from cannabis plants may contain varying
concentrations of THC, which remains a prohibited
substance.” 5
So, are you thinking of pushing your body to the next
level? Running a marathon is a great accomplishment and
crossing the line is a surreal feeling. Perhaps, thanks to
new scientific discoveries such as CBD, enhancing your
performance or quickly recovering from an injury are
becoming much easier. Or perhaps, as Dr Pigott is
suggesting, “Diet, lifestyle and friendships still remain some
of the best components of health that can be improved
and will definitely make you feel better.” But, one thing
is for sure, always speak to your doctor before trying
the latest health product, as they can point you towards
the higher quality options. You can also check out CBD
Experts (thecbdexperts.com) to keep track of new
discoveries and updates within the market.
CBD benefits for sports professionals
Here, some fit pros talk about CBD and the benefits they
have experienced.
Shane Finn (ultra-athlete): “When I train hard, I absorb quite a lot
of stress in my joints; especially in winter, it would take ages to get into
a session. But, after taking CBD capsules, I notice some reduction in
joints aching and inflammation. It helps my recovery and usually allows
me to carry on and train a bit more the next day and so on.”
Austin Keen (world champion skimboarder): “I have been
skimming a ton lately and have been using this cream [CBD freeze
roll-on 6 ]. It freezes very generously on my knees, thighs, quads and
legs for recovery. I literally watched the inflammation disappear from a
board to my shin.”
Diana Aguilar (CrossFit PT): “Before training, it helps me to be
more focused, gives me energy and keeps my mind concentrating
without anxiety or stress. After training, CBD gives me sleep quality
and muscle recovery.”
What you should know when choosing CBD
The CBD industry is starting to regulate itself and getting
more controls, but poor testing standards and lax regulation
remain a problem. The Centre for Medicinal Cannabis (CMC)
found from lab tests that 62% of the UK high street products
studied didn’t contain the CBD content promised on the label.
Jonathan Hartshorn has a background in pharmacology and
is CEO at Satipharm 7 . Here’s his advice when researching
which characteristics a high-quality CBD product requires:
Good manufacturing practice (GMP): Unfortunately, there are a
lot of uncertified non-GMP products; they may have impurities such as
toxins and microbes or they have not been properly tested.
So, the most important thing is to find the GMP-certified products.
Reliable dosage: When you start taking CBD you should really try
it for a couple of weeks as a steady dose, to see and assess the effects
it has on you as a consumer. After, if necessary, increase that dose.
Sometimes people feel more safe taking capsules with a consistent
fixed dose. However, CBD is a safe product; it is not addictive and there
is no risk of overdose when following the recommended dosage.
Bioavailability: [This is how much of the drug is absorbed by your
body after taking it; this depends on the form but also whether a full
spectrum of CBD is extracted from the plant.] In this case, the
comparison between oil and capsules is very useful from a health
industry perspective because the capsules are usually more powerful
and better absorbed in your bloodstream than the equivalent dose
of oil. fp
BIOGRAPHY
Stefania Dall’Armi is a journalism and English literature student at Kingston
University of London. While she is passionate about outdoor sports she is
always ready to try new disciplines. Stef recently worked as PA for
76-year-old triathlon athlete and Silverfit charity founder, Edwina Brocklesby.
26 | FITPRO JAN/FEB 2020
For references visit fitpro.com/references
fitpro.com | 27

STRONG WOMEN • THREE-PART SERIES (PART TWO)
Although the underlying causes of PMS
Table 1: DSM-5 Premenstrual Dysphoric Disorder 2
and PMDD need further investigation,
several theories have suggested an increased
sensitivity to the usual hormonal fluctuations
evident across the menstrual cycle (refer to
article one in the series) and neurotransmitter
(i.e., chemical messengers) abnormalities 2 .
Currently, the most efficacious pharmacological
treatments for PMS and PMDD include
combined oral contraceptives and
A
1
In most menstrual cycles, the following symptoms must be present in the final week
before the onset of menses, start to improve within a few days after the onset of
menses, and become minimal or absent in the week post-menses. At least one of the
symptoms must be either (1), (2), (3) or (4) and the individual must experience at least
five total symptoms.
Marked affective lability (e.g., mood swings, feeling suddenly sad or tearful, or increased
sensitivity to rejection)
2 Marked irritability or anger or increased interpersonal conflicts
serotonergic antidepressants 2 . However, nonpharmacological
methods are also available,
3 Marked depressed mood, feelings of hopelessness or self-deprecating thoughts
which may reduce the need for medication.
For example, exercise has previously been
4 Marked anxiety, tension, feelings of being ‘keyed up’ or ‘on edge’
shown to both improve depressed mood 6
and help alleviate the physical symptoms of
5 Decreased interest in usual activities (e.g., work, school, friends, hobbies)
period pains or cramps 7 . Additional release of
endorphins as a result of exercise may also
6 Subjective difficulty in concentration
be beneficial, as these reduce the perception
7 Lethargy, easy fatigability or marked lack of energy
of pain 8 . Menstrual cramps experienced as
part of PMS and PMDD are painful sensa-
8 Marked change in appetite, overeating or specific food cravings
tions that can be extremely severe in some
people. Management of these symptoms is
9 Hyper-insomnia or insomnia
The
menstrual
cycle
and strength
training
This article is the second in a three-part series in
association with the United Kingdom Strength and
Conditioning Association (UKSCA) on women and
strength training. The effectiveness of a training
programme is not solely determined by appropriate and
individualised content, but also by an athlete’s psychology
(i.e., motivation and readiness to train). This second article will
focus on the negative side-effects of premenstrual syndrome
(PMS) and premenstrual dysphoric disorder (PMDD) and how
these conditions might affect the quality of an athlete’s training.
The importance of understanding each athlete’s unique
menstrual experience highlights the need for strength and
conditioning (S&C) trainers to monitor their athletes’ menstrual
cycles, including both psychological and physiological effects.
What constitutes PMS?
PMS encompasses a range of physical, psychological and
behavioural symptoms that are experienced during the late
important for all females but, for athletes in
training or competition, the ability to reduce
pain severity can have a significant positive
influence on training and performance.
How do symptoms affect athletes?
While there is an abundance of literature
exploring the prevalence and impact of PMS
and PMDD in general female populations,
information relating to elite athletic populations
is limited. In a recent cross-sectional
study involving 232 female Japanese
collegiate athletes, all with a regular
menstrual cycle (22-35 days), the authors
reported a prevalence of moderate to
severe PMS and PMDD of 8.6% and
2.9%, respectively 9 . More than 50% of the
population reported symptoms of ‘Depressed
mood’, ‘Anxiety’ or ‘Difficulty concentrating’,
10 A sense of being overwhelmed or out of control
11
B
C
D
E
Physical symptoms such as breast tenderness or swelling, joint or muscle pain, a
sensation of ‘bloating’, weight gain
The symptoms are associated with clinically significant distress or interference from
work, school, usual social activities or relationships.
The disturbance is not merely an exacerbation of the symptoms of another disorder.
Criterion A should be confirmed by prospective daily ratings during at least two
symptomatic cycles. (The diagnosis may be made provisionally prior to this
confirmation.)
The symptoms are not due to the direct physiological effects of a substance
(e.g., a drug of abuse, a medication or other treatment) or another medical condition
(e.g., hyperthyroidism).
American Psychiatric Association (2013), Diagnostic and Statistical Manual of Mental
Disorders, 5th edition, Washington DC: American Psychiatric Association.
luteal phase of the menstrual cycle and which lessen or become
‘Insomnia or hypersomnia’ and more than
mood and well-being can have serious
the symptoms 10,11,12 . Elite athletes train and
absent with menstruation 1,2,3 . PMDD is the most extreme form
70% reported ‘Anxiety or tension’, ‘Anger
implications for the S&C trainer, from both
perform in high-pressure environments for
of PMS and has been defined in the American Psychiatric
or irritability’, ‘Fatigue or lack of energy’ and
a coaching and programming perspective.
extended periods of time (>35-week com-
In part two of this series, Debby Sargent
looks at the effect of the menstrual
cycle on mood and outlines what we need
to know to fully individualise training
prescription for our female athletes.
Association’s Diagnostic and Statistical Manual of Mental
Disorders (DSM) 2 as being present when a cluster of at least
five (out of 11 that are listed) emotional and behavioural signs
and symptoms are evident, in association with functional
impairment. Some of the typical symptoms of PMS and PMDD
include altered mood, anxiety, increased sensitivity to rejection,
sadness, insomnia and difficulty concentrating (see Table 1
opposite) 2 . Many females of reproductive age only experience
‘Overeating or food cravings’ (see Table 2).
Further, the presence of PMS and PMDD
symptoms had a significant detrimental
impact on other aspects of the athletes’ life,
namely difficulties in their ability to work,
socialise and have functional relationships.
Moreover, a notable high prevalence of
adverse ‘physical symptoms’ (e.g., bloating,
From an athlete’s point of view, it is clear
that at certain points of the menstrual cycle,
training and competition performance is likely
to be compromised for some, albeit to varying
degrees. This can impede physiological
adaptation and achievement of performance
goals, but can also impact on psychological
well-being and levels of athlete motivation.
petitive season typical of many intermittent
team sports). Persistent strenuous training
regimens and continued exposure to high
levels of competition anxiety can lead to high
physiological and psychological stress 13,14 .
Therefore, the symptoms of PMS and PMDD
are likely to be heightened at certain points
of the training year. In a population that
mild symptoms of PMS, but prevalence estimates indicate that
headaches and muscle pain, 71.3%) in
Previous literature has shown that in-
typically displays high levels of both ‘Anxiety
those reporting moderate to severe PMS symptoms can be as
addition to 44.3% of the group reporting a
tra-individual variability of PMS symptoms in
or tension’ and ‘Anger or irritability’ (Table 2) 9 ,
high as 30-40% and that the proportion of females meeting the
negative impact on athletic performance in
females fluctuates over time and that severe
this means the athlete’s well-being may be
strict DSM PMDD criteria can range from 3-8% 4,5 .
training or competition, clearly demonstrates
stress (potentially caused by training load or
severely compromised at certain points in
that the menstrual cycle and its effect on
lifestyle factors) appears to worsen
the training year.
28 | FITPRO JAN/FEB 2020
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fitpro.com | 29

STRONG WOMEN • THREE-PART ARTICLE SERIES • (PART CATEGORY TWO)
Table 2: Prevalence of premenstrual symptoms and interference with work, usual activities or relationships
Premenstrual symptoms
Symptom Not at all (%) Mild (%) Moderate (%) Severe (%)
Total of
population
affected* (%)
Depressed mood 46.6 29.3 21.3 2.9 53.5
Anxiety or tension 20.1 36.8 34.5 8.6 79.9
Tearful 51.7 25.9 16.1 6.3 48.3
Anger or irritability 26.4 40.2 25.3 8.0 73.5
Decreased interest in work, home or social
activities
52.3 34.5 10.3 2.9 47.7
Difficulty concentrating 39.7 40.2 18.4 1.7 60.3
Fatigue or lack of energy 28.2 43.1 22.4 6.3 71.8
Overeating or food cravings 27.6 33.9 26.4 12.1 72.4
Insomnia or hyper-insomnia 45.4 29.9 17.2 7.5 54.6
Feeling overwhelmed 68.4 20.7 5.7 5.2 31.6
Physical symptoms 28.7 38.5 25.3 7.5 71.3
Interference with work, usual activities or relationships
Work efficiency or productivity, home
responsibilities
51.7 34.5 12.6 1.1 48.2
Social activities 81.0 12.6 4.0 2.3 18.9
Relationships with co-workers or family 71.3 23.0 4.6 1.1 28.7
Athletic performance in training or competition 55.7 31.6 8.0 4.6 44.2
*Percentage of athletes suffering from the symptom (mild + moderate + severe group) Adapted from: Takeda T et al (2015) 9
3. Refer the athlete to a medical
professional where appropriate
Data gathered on the menstrual cycle over
long periods of time may highlight actual or
suspected menstrual dysfunction (Table 3).
If this is the case, the trainer should refer
the athlete to a medical practitioner. The
menstrual cycle is a normal phenomenon and
a sign of a healthy female body if not using
contraception, so this should be investigated
further. Equally, if someone is displaying
extreme PMS symptoms regularly, such that
it severely disrupts their daily well-being and
functionality, then the trainer may recommend
the athlete seeks medical guidance
to explore options to help manage symptoms.
An athlete who suffers from severe
PMS symptoms and has a relatively short
menstrual cycle (e.g., 21 days) will potentially
be the most compromised with regards to
her ability to perform strenuous training and
be successful in competition. You may have
others for whom training and competition
do not appear to be affected at any stage
because the number and severity of PMS is
small or non-existent. As a coach, you will
need to plan differently for these athletes.
Table 3: Common categories of
menstrual dysfunction
Category
Definition
Athlete wellness monitoring
What is clear for the S&C trainer is that, in
order to preserve the well-being of female
athletes and optimise training, knowledge of
their menstrual cycle and their unique cluster
of PMS symptoms would be useful in the
planning and training prescription process.
Athlete monitoring is essential for confirming
whether the athlete is responding to the
training programme in the right way and
for adequate management of fatigue to
last day of menses (i.e., bleeding). This will
not only tell you how long the menses phase
lasts (a normal value is three to seven days)
but will also define the length of the whole
cycle – the number of days between two
consecutive day ones.
In addition, it would be useful for the
athlete to identify what PMS/PMDD
symptoms she is experiencing, when they
appear and to grade their severity. It may
also be worthwhile asking the athlete to
The following patterns could emerge 2 :
• Symptoms that began in the premenstrual
phase and offset at the beginning of
menses or shortly thereafter – these are
likely directly related to PMS or PMDD
• Current symptoms that worsen during the
premenstrual phase – there is probably
an underlying condition that should be
explored if unknown
Eumenorrhea
Primary
amenorrhea
Secondary
amenorrhea
Regular cycles at
intervals of between
21 and 35 days
(adolescents range
from 21-45 days)
No menarche by aged
15 years
Absence of three
consecutive cycles
post-menarche, >90
days between cycles
decisions made using the menstrual cycle
data – both trainer and athlete will benefit
beneficial to help manage symptoms.
Part three of this series will focus on
prevent overtraining and minimise injury
risk 15,16 . Subjective daily wellness typically
forms part of the monitoring process 17,18,19
and this would seem the ideal vehicle to
make brief notes on how she thinks her
ability to train and compete is affected by her
menstrual cycle.
• Continuous or sporadic symptoms not
related to the phase of the menstrual
cycle (neither PMS or PMDD)
Oligomenorrhea
Cycle length of 36-90
days
from becoming more aware of the menstrual
cycle and its effects on training outcomes.
Summary
how S&C trainers can establish a training
environment that gets the most out of their
female athletes. fp
enable the S&C trainer to gather information
2. Look for patterns of symptoms and
It is important that the athlete and trainer
4. Reflect on your programming and
The menstrual cycle and associated
on an athlete’s menstrual cycle and PMS
history. Some practical guidelines on what
information to collect and how to use it are
provided below:
1. Incorporating the right questions
within your daily wellness monitoring
Identifying the length of the menses phase
and the menstrual cycle as a whole is key. To
do this, the athlete should note the first and
behaviour across the menstrual cycle
There is large intra-individual variability in the
menstrual cycle 20 and it can be affected by
stress. Chronic monitoring of the menstrual
cycle across the training year is warranted
to understand how manipulation of training
and competition stress can affect elements
of the cycle. Monitoring consecutive cycles
will help identify patterns of symptoms and
ascertain the regularity of the cycle.
know which symptoms are directly related
to the menstrual cycle. Back ache is an
example of physical pain which could just
be part of her PMS symptoms 12 . If this is
not known to the athlete and trainer, it is
likely the athlete would be referred to other
medical staff for assessment and diagnosis.
In reality, this is not required and the injury
will likely be labelled as ‘undiagnosed’, which
will only add unnecessary stress.
use the menstrual cycle data to inform
planning
If there are no ‘red flags’ highlighted from
collecting the menstrual cycle data, the
trainer can now start using the information
gathered to better individualise training
prescription for the athlete. The monitoring
process should continue, as the menstrual
cycle could change at any point. It is also
essential to engage the athlete in any
symptoms of PMS and PMDD can vary in
severity across individuals. Those athletes
with relatively short menstrual cycles who
suffer from more extreme PMS symptoms
will be the most affected; for the S&C trainer,
an ability to identify which athletes these are
and offer them an alternative programme is
likely to lead to greater success in training
and competition. Appropriate referrals (e.g.,
medical, lifestyle adviser) would also be
BIOGRAPHY
Debby Sargent MSc, ASCC has 20
years of coaching experience, working
with individual and team-sport athletes.
Currently, Debby is a lecturer in strength
and conditioning at the University of
Gloucestershire. She is also the author
of Strength and Conditioning for Female
Athletes (The Crowood Press), providing guidance on
how to adapt training to be specific for women and their
unique needs.
30 | FITPRO JAN/FEB 2020
For references visit fitpro.com/references
fitpro.com | 31

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