Fitpro Magazine Mar-Apr 2021 Preview

MAR/APR 2021 | FITPRO.COM 

BACK TO 

BAREFOOT 

Becoming barefoot strong 

ALL ABOUT 

THE THYROID 

Nutrition for health 

TAKE YOUR 

CLASSES 

OUTDOORS 

Bring members together again 

+ 

DON’T 

STOP 

MOVING! 

The dangers of 

sitting still

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MAR/APR 2021 | FITPRO.COM 

MAR/APR 2021 

BACK TO 

BAREFOOT 

Becoming barefoot strong 

TAKE YOUR 

CLASSES 

OUTDOORS 

Bring members together again 

ALL ABOUT 

THE THYROID 

Nutrition for health 

DON’T 

STOP 

MOVING! 

The dangers of 

sitting still 

Cover photography: BUA FIT 

Educate • Support • Connect 

Editor in chief/exec director 

Jane Waller 

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. 

+ 

Sub editor and proofing 

Aislinn Kelly 

Content and media assistant 

Dominic Munson 

Senior designer 

Kelly Flood 

kellyflood.co.uk 

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: 

Fitpro magazine, 

First Floor Offices, 

Saxonbury House, High Street 

London, E11 1QQ, UK 

Call: +44 (0)20 8586 0101 

Website: fitpro.com 

Newsletter: If you’re not already receiving it, 

make sure your contact details are up 

to date by emailing info@fitpro.com 

“The crocus of hope is poking through 

the frost and spring is on its way, both 

literally and metaphorically.” 

I have to admit, I had to look up the meaning of crocus: it’s a ‘small 

spring-flowering Eurasian plant’. And it certainly does feel that way at last. 

We are nearly there everyone and will soon be able to hug and share the 

love once more. 

We recognise it’s been a difficult and challenging time, particularly over 

lockdown and winter. With a skeleton staff in the London office to take your 

calls, we have spoken to many of our members and your stories have been 

both heartbreaking and inspiring. While, sadly, some plan to leave or have 

already left the industry because they cannot see a way forward, many have 

used this opportunity to reinvent them selves. Brand-new websites, new 

logos, live streaming classes and upskilling into new areas of expertise have 

been some of the positives from this COVID madness. Interestingly, our 

‘Movement is Medicine’ online course offerings have been hugely popular, 

as we all understand a little more how important it is to provide a service to 

those with underlying health conditions. 

In the first lockdown, a year ago, we also searched for services that would 

support our community with what they needed momentarily and also for the 

future after COVID. As a consequence, we ran our first free webinar on 

‘Helping clients to manage weight during Covid 19’, which may have been as 

much for all of us as it was to educate our clients. The response even caught 

us a little off-guard – it was phenomenal. So, we decided to continue with a 

free webinar each month on topics that are relevant, applicable and full 

of information. 

Right on cue, this month’s free webinar is on ‘Teaching outdoor sessions’, 

so let’s hope Boris doesn’t let us down for 29 March, as the government is 

indicating a relaxation around outdoor gatherings. With the sun peaking 

out, now is the time to plan on bringing your members and clients back to 

face-to-face group exercise. You may have been holding back on this, as you 

have never offered outdoor exercise before, but join us on the free webinar 

(register here) and read our article on page 18, as both are full of practical 

ideas to set you and your peeps up for a safe, invigorating outdoor 

experience. And, of course, your FitPro insurance covers you for outdoor 

training as well – good to know. 

As I opened, I sign off with more words from Boris Johnson: “It’s not the 

end – but the beginning of the end.” 

JANE WALLER, EXECUTIVE DIRECTOR 

Boris Johnson, 

22 February 2021 

Twitter (@fitpro_online) Facebook (facebook.com/fitproltd) Instagram (@fitpro_ltd) FitProLtd 

For references visit fitpro.com/references fitpro.com | 3

CONTENTS 

MARCH/APRIL 2021 

08 

05 CIMSPA industry update 

CEO Tara Dillon brings you the 

latest developments 

06 12 key consequences of 

prolonged sedentary behaviour 

Reasons we need to keep moving 

15 

08 Best foot forward 

How honing your running form 

can improve speed and efficiency 

12 Load it up 

The scientific principles and 

application of loaded 

movement training 

12 

15 The BioMechanics method 

for corrective exercise 

A look at how to meet clients’ 

musculoskeletal restoration 

needs head on 

18 

18 Taking it outside 

The lowdown on running 

outdoor group X classes 

20 Notes from a group X manager 

How to shape the member 

experience and build a great team 

22 ‘SCRIPT’: A football case study 

Part two in our series by the UKSCA 

25 If an exercise hurts, should 

your client stop? 

A physiotherapist answers 

the question 

26 All about the thyroid 

The role nutrition plays in maintaining 

a healthy thyroid 

22 

30 Becoming barefoot strong 

Incorporating foot strengthening 

into client programming 

33 Working with kidney patients 

What to consider when training a 

client with kidney disease 

26 

4 | FITPRO MAR/APR 2021

INDUSTRY UPDATE 

\ CIMSPA 

TARA DILLON KEEPS YOU UP TO DATE WITH THE LATEST AT CIMSPA. 

Insurance 

Welcome 

2021 

It hasn’t been the greatest start, but we 

remain focused on supporting all fitness 

professionals working in the sector. 

You are our primary concern and, as such, we continue to field all of your queries and 

requests that come in on a daily basis, providing advice and guidance as well as a 

variety of resources to help the growing number of CIMSPA members through the 

challenges presented by the pandemic. 

This includes working to secure some financial help for the sector’s self-employed 

and freelance workers. In Wales, the Sport Freelancer Fund has helped freelancers 

working in physical activity and sport to recuperate losses they have experienced as a 

result of COVID-19. The fund is for those who directly deliver activities that get the 

nation moving, including personal trainers, instructors, practitioners and paid coaches, 

and who have lost at least £2,500 of income since the crisis began due to contracts 

being cancelled or restrictions halting their work. We, along with our partners, are 

working hard to see if we can set up a similar scheme 

for self-employed and freelance professionals in 

England and will keep you updated on our progress. 

This global crisis continues to impact on our sector 

and all those working in it on so many different 

levels, not least mental health. That’s why we are 

delighted to support Workplace Mental Wealth’s new 

national survey that aims to litmus test the mental 

health of the fitness and active leisure workforce. 

The survey is the first time, on a sector-wide scale, 

we have asked individuals to tell us how they feel and 

how well they feel supported. We look forward to 

reporting on the outcome of the survey and how we 

can use this information to support you further. 

Before the pandemic, it was widely accepted that 

one in four people experienced mental health issues 

each year. I suspect the pandemic has exacerbated 

this issue but there is no evidence of this. This survey, 

We can work 

together to provide 

the support needed 

to drive happiness, 

health and 

productivity 

which includes both the employed and self-employed, addresses this. Once we 

understand the state of mental health in the workforce, we can work together to provide 

the support needed to drive happiness, health and productivity. 

As we start to see light at the end of the COVID-19 tunnel, we should not lose sight of 

the effect this pandemic has had and continues to have on the workforce. We need to 

collectively keep our attention on the mental wellbeing of our workforce and provide 

relevant support where needed. 

‘When the world 

is changing 

around us, 

FitPro insurance 

is always here to 

protect you’ 

Check out our 

insurance schemes 

Click here 

FitPro Insurance is 

underwritten by Aviva. 

FitPro is a trading name for Fitness Professionals Ltd 

which is authorised and regulated by 

the Financial Conduct Authority - FCA number 705177 

TARA DILLON IS CEO OF CIMSPA 

cimspa.co.uk 

T: +44 (0)20 8586 8635 E: info@fitpro.com 

For references visit fitpro.com/references 

fitpro.com | 5

12 KEY CONSEQUENCES 

OF PROLONGED 

SEDENTARY BEHAVIOUR 

In part four of our Targeting the Sedentary Market series, 

Dr Paul Batman outlines 12 reasons we need to keep moving. 

To control the transmission of the 

COVID-19 virus, multiple lockdowns 

of entire population groups have 

been required. While successful in 

controlling the pandemic, it has 

contributed to public health issues in those 

unable or not motivated to undertake 

physical activity. While the general 

consequences of quarantining have been 

reported, there are unique complications 

caused by prolonged sedentary behaviour 

that are often overlooked. 

Deep vein thrombosis 

1 Deep vein thrombosis (DVT) is caused by 

blood clots in the veins during prolonged 

periods of sedentary behaviour. These blood 

clots can travel to other parts of the body and 

cause serious blockages, leading to heart 

attacks or strokes and other life-threatening 

conditions. Blood clots can travel to the lungs 

and, by obstructing the pulmonary artery, can 

cause a pulmonary embolism¹. 

2 

Insulin sensitivity and 

metabolic syndrome 

Over the past 40 years, there has been a 

dramatic increase in the number of people 

with type 2 diabetes, mainly due to sedentary 

behaviour and poor eating habits. Prior to 

1960, there were fewer than two million 

people in the US with type 2 diabetes, 

swelling now to 26 million, while a further 80 

million have pre-diabetes. The body’s cellular 

mechanisms are not designed for sedentary 

behaviour. Without muscle contractions to 

relocate blood sugar, most will remain in the 

blood until insulin is released to move it into 

the muscle, organs and fat cells. If large 

muscles are contracting, there is an increase 

in the movement of blood sugar into the 

muscles, reducing the blood sugar spike 

without a large increase in insulin release². 

3 Telomeres 

In the nucleus of each cell, genes are 

stacked into DNA molecules, tightly packed 

into thread-like structures called 

chromosomes that are surrounded by specific 

proteins that support its structure. At the 

ends of the chromosomes are sections of 

DNA called telomeres that protect the genetic 

data, make it possible for cells to divide and 

hold the secrets to ageing and chronic 

An active lifestyle and reduction in 

sedentary behaviour can reduce the 

risk of cancer by more than 45% 

diseases. With each cell division, the telomere 

shortens, eventually causing many agerelated 

diseases. The shortening of the 

telomere reflects the number of times the cell 

has divided. When they get too short and the 

cell can no longer divide, the cell becomes 

inactive, ‘old’ or dies. This shortening process 

is accelerated by ageing, sedentary behaviour 

and cancer³. 


SEDENTARY LIFESTYLE \ RESEARCH UPDATE 

4 

Lipoprotein lipase (LPL) 

Lipoprotein lipase (LPL) is an enzyme 

important in fat metabolism. LPL is found in 

the walls of the adipose (fat) cells and is 

responsible for converting triglycerides into 

free fatty acids and glycerol and clearing it 

from the blood into the skeletal muscle. 

Sedentary behaviour reduces LPL activity, 

reducing triglyceride uptake into the skeletal 

muscle, increasing dyslipidaemia, reducing 

HDL (good cholesterol) activity and 

contributing to an increased risk of metabolic 

syndrome. Multiple muscle contractions 

throughout the day are the most effective 

method of increasing LPL activity³. 

5 

Stabiliser muscles 

The stabiliser muscles are important in 

maintaining correct posture in both static and 

dynamic movements and in glucose and free 

fatty acid consumption. Sedentary behaviour 

renders them ineffective and weaker. 

Stabilisers require constant intermittent 

movement, often in an isometric manner, to 

maintain strength and flexibility. A loss in 

strength of the stabiliser muscles affects the 

force production of the mover muscles. The 

mover muscles can no longer pull hard on 

the bone, reducing its force and power. 

6 Cancer 

Cancer is the second main cause of 

death, with smoking, sedentary behaviour 

and poor nutrition increasing its impact 

significantly. An active lifestyle and a 

reduction in sedentary behaviour can reduce 

the risk of cancer by more than 45% by 

stimulating the immune system, decreasing 

body fat, changing participating hormone 

levels and improving the antioxidant 

enzyme’s fighting capabilities. Sedentary 

behaviour promotes inflammation, increasing 

the risk of endometrial cancer, ovarian cancer 

and breast cancer without any significant 

change in BMI, indicating that physical 

activity might be the key variable in cancer 

risk reduction⁴. 

7 

Bone density 

Bones grow due to the stresses and 

strains placed on them. If loading on a 

specific bone increases, the bone will remodel 

itself over time to become stronger. 

Sedentary behaviour reduces bone mineral 

density due to the absence of any significant 

overloading mechanisms. Sedentary 

behaviour can also cause a rapid resorption 

of bone with a decrease in bone development 

and bone mineral density, contributing to 

osteoporosis. 

8 

Brain function 

The brain of sedentary people can form 

a sedentary structure, due to the interaction 

with their sedentary environment. Their 

sedentary brain is less responsive to the 

neurochemicals for movement. They have 

muscles that are trained to sit and not send 

feedback signals back to the brain to get 

them moving, making it difficult to motivate 

them to exercise. Active people are more 

sensitive to moving neurochemicals and have 

a strong feedback loop from the muscles to 

the brain that encourages movement. 

9 

Confined places 

The body is affected by the force of 

gravity at all levels of its organisation (i.e., 

cells, systems, organs – all are responsive to 

changes in gravity). By changing position, the 

body is always working against gravity, 

creating new loads on different body parts. 

When the same position is maintained for 

many hours, cells will react by creating 

unnatural overloads on the specific muscles. 

Sedentary behaviour reduces movement 

patterns, load distributions and cell 

deformations, resulting in cell membrane 

damage. Every movement loads the tissues of 

the body in different ways, increasing the 

daily reliance on gravity, increasing ground 

reaction forces by interacting with the 

environment and supporting bodyweight⁵. 

10 Sarcopenia 

Sarcopenia is the involuntary loss in 

strength, function and muscle mass that 

comes with ageing or sedentary behaviour. As 

a result of ageing, muscle mass decreases by 

3-8% per decade after the age of 30 years, 

with a substantial loss by age 60 years, 

resulting in joint problems and poor posture. 

This can lead to an increased risk of falling and 

disabling injuries. Sedentary behaviour causes 

an initial decrease in neural strength, followed 

by a loss in muscle mass, muscle power and 

mitochondrial dysfunction at any age. 

11 

Mitochondrial distress 

Mitochondria are very small 

organelles found within all cells of the body. 

Initially, it was thought that their role was to 

just produce energy for the remake of ATP, a 

molecule necessary for any type of 

contraction. Mitochondria play a vital role in 

maintaining health over the lifespan. 

Diseases of the mitochondria have a 

profound effect on daily life and longevity, 

as they regulate substrate utilisation, energy 

production and muscle size and function. 

Sedentary behaviour causes a reduction in 

mitochondrial number and size and enzyme 

activity. Sedentary behaviour combined with 

ageing results in an accelerated decrease in 

mitochondrial functioning, contributing to 

insulin resistance and type 2 diabetes, 

muscle breakdown, oxidative stress and 

reduced aerobic fitness⁶. 

12 Inflammation 

Older adults, obese and overweight, 

unhealthy and sedentary groups present 

with a low level of chronic tissue 

inflammation, contributing to cardiovascular 

disease, colorectal cancer, type 2 diabetes, 

chronic obstructive disease and different 

types of dementia. Under normal conditions, 

inflammation is important to fight the 

spread of diseases or infection. Those ‘at 

risk’ of low-grade chronic inflammation 

include the unfit and sedentary, whose 

immune system is in an overactive state, 

resulting in a high-energy demand, a 

decrease in insulin sensitivity, increased 

atherosclerosis and tumor growth, and 

increased oxidative stress. 

The bottom line 

The root of all sedentary problems lies in the 

lack of daily muscle contractile activity. 

Intermittent muscle contractions in any 

domain have the greatest effect on 

variations in metabolic rate than any other 

intervention. The changes in the metabolic 

rate of muscle activity are so dramatic it can 

increase 50-100 times from rest to muscle 

activation. 

To conclude, Dr Marc Hamilton, a pioneer 

researcher in inactivity physiology, said, 

“Public health campaigns should eventually 

provide people with a rich sense of 

‘metabolic awareness’ about the concept 

that the body constantly senses and 

responds to movement vs inactivity, in 

tandem with behavioural strategies 

promoting the ability to take full advantage 

of every opportunity to move more.” 

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 


fitpro.com | 7

Best foot forward 

HOW TO HONE YOUR 

RUNNING FORM 

Dr Thomas Michaud discusses how a few simple changes to your 

running form can improve speed and efficiency – and may even 

reduce your risk of injury. 


RUNNING FORM \ TECHNICAL 

Given the popularity of running, 

it’s surprising how much 

controversy exists over which 

style of running is best for 

improving performance. Some 

coaches advocate that all you need to do to 

achieve the ideal running form is to run with a 

cadence of 180 foot strikes per minute. In 

theory, this ideal cadence not only improves 

your running form but also reduces your 

overall risk of injury. The problem with this 

belief is that a universal cadence is achieved 

by altering stride length. More than 30 years 

ago, the renowned exercise physiologist Tim 

Anderson demonstrated that any adjustment 

in the length of the runner’s self-selected 

running stride produces an immediate 

decrease in running efficiency¹. On top of 

that, the world’s best runners have huge 

fluctuations in cadence, with some runners 

averaging 145 foot strikes per minute and 

others averaging 210. Clearly, if cadence was 

an important factor in running economy, 

there wouldn’t be so much variation in 

cadence among elites. 

Perhaps the most pervasive belief 

regarding options to improve running form is 

whether runners should universally avoid heel 

Simply positioning your leg 

in a near vertical position 

at initial touchdown could 

improve both economy and 

performance 

striking by making initial ground contact with 

the mid or forefoot. Proponents of the more 

forward contact point suggest that a midfoot 

strike pattern is “more natural” because 

experienced lifelong barefoot runners 

immediately switch from heel to midfoot 

strike patterns when transitioning from 

walking to running. The switch to a more 

forward contact point is theorised to improve 

shock absorption (lessening our potential for 

injury) and enhance the storage and return 

of energy in our tendons (making us faster 

and more efficient). Advocates of Chi and 

Pose Running have gone so far as to say that 

runners who continue to strike the ground 

with their heels are reducing running 

efficiency and increasing their potential 

for injury. 

In a recent literature review evaluating the 

pros and cons of the various foot contact 

points, Joe Hamill and Allison Gruber² looked 

at every published paper addressing the 

controversy and came to the adamant 

conclusion that “changing to a mid- or 

forefoot strike pattern does not improve 

running economy, does not eliminate an 

impact at the foot-ground contact, and 

does not reduce the risk of runningrelated 

injuries.” 

In my opinion, the controversy regarding 

ideal running form was finally resolved in 2017 

when researchers from the United Kingdom 

evaluated 97 experienced distance runners 

(47 females) to determine exactly which 

biomechanical factors are associated with 

improved running economy and which 

factors relate to performance³. To evaluate 

economy, the authors analysed a range of 

respiratory gases and the velocity of lactate 

turn point (a marker of fatigue). The 

correlation between running performance 

and running form was determined by 

measuring three-dimensional motion of the 

spine, pelvis and lower extremities during all 

phases of gait and analysing which specific 

movement patterns correlated with each 

runner’s season’s best running time. The 

authors looked at stride length normalised to 

height, cadence, vertical oscillation of the 

pelvis, braking forces, posture and the 

position of the hip, knee and foot during 

different phases of the running cycle. 

Surprisingly, even though all participants 

were experienced distance runners, including 

29 elite runners, there was huge variation in 

all aspects of running form. For example, 

vertical oscillation of the pelvis varied 

two-fold and braking forces differed by 280%. 

Cadence ranged from 144-222 foot strikes per 

minute, while stride length was between 1.04 

and 1.49 times the runner’s height. Runners 

also showed significant differences in the 

positions of their feet, legs and hips at 

touchdown. Some runners made initial 

ground contact with their foot pointing down 

11°, while others hit the ground with their foot 

pointing up 24°. The position of their lower 

legs varied from 1° to 16° relative to vertical, 

and the forward lean of the trunk varied 

by 20°. 

After analysing all the data, the authors 

determined that the most economical runners 

had less up and down motion of the pelvis, 

lower braking force, stiffer knees, shorter 

stride lengths and a more vertical leg during 

initial ground contact. Running performance 

was predicted by lower braking forces, a more 

vertical leg during contact, reduced spinal 

motion and reduced ground contact times. 

The best part of this study was the conclusion 

that simply positioning your leg in a near 

vertical position at initial touchdown could 

improve both economy and performance. In 

fact, having a nearly vertical leg at touchdown 

explained 10% of a runner’s performance and 

it is one of the easiest changes in running 

form you can make. Figure 1 summarises the 

various joint interactions associated with 

improved performance and efficiency. The 

authors point out that their study provides 

“novel and robust evidence” that running 

form strongly influences running economy 

and performance. 

Figure 1: 

Biomechanical measurements 

associated with improved 

performance and efficiency 

Folland et al³ prove the most economical runners presented 

with reduced vertical oscillation of the pelvis (A), lower 

braking forces (B), shorter stride lengths, and a more 

vertical leg during initial ground contact (C). Runners with 

the fastest running times presented with decreased braking 

forces, shorter ground contact times, a more vertical leg 

at initial contact (C) and a reduced range of spinal motion 

(D). Excessive vertical oscillation of the pelvis and a more 

vertical leg at touchdown most strongly correlated with 

both improved economy and faster running times. 


fitpro.com | 9

Figure 2: 

Dynamic stretching drills 

Jump rope training allowed 

the runners to spend less 

time on the ground, as the 

tendons of their legs and 

arches learned to more 

effectively store and 

return energy 

Gluteals 

Hamstrings 

While walking, lift knee toward 

chest, raising the body on the toes of 

the opposite leg. 

Walk while swinging your leg 

forward until a stretch is felt in your 

hamstrings. Keep your toes pointing 

towards your knee. 

The best drills and exercises for 

improved performance 

While you can easily adjust the position of 

your leg and reduce motion of your pelvis 

with minimal practice, the ability to reduce 

ground contact time is a little more 

complicated and can typically only be 

achieved by performing plyometric running 

drills. These drills improve the storage and 

return of energy in your tendons, which in 

turn allows you to spend less time on the 

ground as you more effectively propel 

forward. My favourite plyometric drills are 

illustrated in Figure 2. One study showed a 

5% improvement in VO²max and a 3% 

improvement in 3km race performance after 

just six weeks of training⁴. 

An alternative but more complicated 

method for reducing ground contact times in 

improving efficiency is to perform a series of 

six, 10-second strides while wearing a 

weighted vest (fitted with 20% of the runner’s 

bodyweight). Researchers from New Zealand⁵ 

showed that, compared to a control group, 

runners who performed the drills while 

wearing the weighted vests had huge 

improvements in peak running speed and 

economy. Apparently, the weighted vests 

allowed for faster running times and 

improved efficiency because the vests forced 

the runners to stiffen their knees and hips in 

order to absorb forces associated with 

carrying the added weight, which in turn 

reduced the amount of time they spent on 

the ground. The improved form persisted 

even after the weights were no longer worn. 

I really like this study, as the added weight 

allows your central nervous system to analyse 

impact forces at the point of contact and 

modify limb position and stiffness 

accordingly. For example, if you had excessive 

up and down oscillation of the centre of mass 

and/or were overstriding, you might not 

notice this if you’re strong and healthy but 

the amplified impact force associated with 

wearing the weighted vest would make it 

more obvious. My only concern is that the 

weighted vests used in this study were pretty 

heavy, which could increase the risk of injury. 

Less fit or inexperienced runners should 

Abductors 

Gastrocnemius 

Quadriceps 

Abductors 

While moving forward, raise the trail 

leg by abducting the hip 90 o , while 

keeping the knee flexed. Move as 

though you were stepping over an 

object just below waist height. 

Tip-toe walking. Move forward while 

alternating walking on tiptoes. The 

aim is to raise your body as high as 

possible with each step. 

Rapidly kick heels towards buttocks 

while moving forward. 

Quickly move sidewards alternating 

one leg in front of the other. Go 

15 yards and repeat in opposite 

direction. 

This figure has been modified from Figure 4.5 in Turki O, Chaouachi D, Behm D et al (2012), The effect 

of warm-ups incorporating different volumes of dynamic stretching on 10- and 20m sprint 

performance in highly trained male athletes, J Strength Cond. 26: 63-71. 

definitely start out with lighter weights and 

gradually increase the load based on comfort. 

Runners who don’t want to play around 

with weighted vests can also increase 

efficiency by adding a jump rope routine to 

their weekly workouts. One recent paper 

showed that swapping out a conventional 

warm-up routine with five minutes of jump 

rope training a few times per week resulted in 

significant improvements in 3km time-trial 

performance⁶. The jump rope training more 

than likely allowed the runners to spend less 

time on the ground, as the tendons of their 

legs and arches learned to more effectively 

store and return energy. 

Lastly, because isometric contractions 

performed with muscles maintained in their 

lengthened positions have been proven to 

improve tendon resiliency⁷, I’ve outlined a few 

simple exercises that you can do in five 

minutes or fewer to keep your muscles and 

tendons strong and supple (Figure 3). 

Whether you run a marathon in two or six 

hours, these exercises can help improve 

performance and can also serve to reduce 

your risk of injury. 


Each time your foot hits the ground while running, an impact force averaging three times 

your weight travels through your body at more than 200 miles per hour, causing your bones 

to vibrate and tendons to stretch. When you consider the average runner strikes the ground 

more than 10,000 times per hour, this translates into a remarkable amount of force that needs 

to be absorbed, and explains why nearly 50% of recreational runners are injured each year. 

The purpose of this book is to show you that impact forces are not necessarily harmful. By 

modifying your running form and doing specific exercises to improve tendon resiliency, not 

only can you effectively absorb these forces, but you can also store and return a significant 

percentage of them in the form of elastic recoil. Besides reducing your risk of injury, efficiently 

storing and returning energy can allow you to run faster with less effort. 

Learn how to: 

Perform an at-home gait analysis to make specific changes in your running form that can 

reduce impact forces and improve performance 

Incorporate new exercises to enhance the storage and return of energy in your tendons 

Select the running shoe that is right for you 

Treat 25 of the most common running-related injuries with the most up-to-date, 

scientifically justified treatment protocols available 

Since graduating from Western States Chiropractic College in 1982, 

Tom Michaud has published numerous book chapters and dozens of journal 

articles on subjects ranging from the treatment of tibial stress fractures in runners 

to the conservative management of shoulder injuries in baseball players. 

In addition to lecturing on clinical biomechanics internationally, Tom Michaud 

has served on the editorial review boards for Chiropractic Sports Medicine and the 

Australasian Journal of Podiatric Medicine. He is also the author of Foot Orthoses 

and Other Forms of Conservative Foot Care, as well as Human Locomotion: The 

Conservative Management of Gait-Related Disorders, both self-published. 

“Tom Michaud’s experience with athletes has been long-running and highly praised. His vast 

knowledge of the human body and understanding of biomechanics will help you achieve your 

peak potential. This book is a great resource for athletes of all ages and abilities.” 

Joan Benoit Samuelson, former world record holder in the marathon and Olympic gold 

medalist. 

Chichester, England 

North Atlantic Books 

Berkeley, California 

www.lotuspublishing.co.uk 

£14.99 

North 

Atlantic 

Books 

RUNNING FORM \ TECHNICAL 

Figure 3: 

n To improve resiliency in your glutes and 

quad tendons, warm up with 25 lateral 

step-ups (A). Next, move into a long-step 

forward lunge position and hold this 

position with your back knee held 

slightly off the ground (B). This exercise 

places less stress on your knee than 

conventional lunges (20) and, in addition 

to placing the glutes and quads in their 

lengthened positions in the forward 

leg, the rectus femoris is isometrically 

tensed in a lengthened position in the 

back leg. Maintain this position for 20 

seconds and repeat four times. A resilient 

rectus femoris tendon is essential for fast 

running, as it snaps the trail leg forward 

to initiate the swing phase. 

n Your Achilles’ and calf tendons 

can be made more resilient with the 

ToePro platform. Warm up by doing 25 

repetitions (C) and then slowly lower your 

heels so they are 1cm from the ground 

The best exercises to improve tendon resiliency 

(D). Hold this position isometrically for 

20 seconds and repeat that routine four 

times. With each set, alternate between 

raising and lowering your arch to isolate 

different tendons: your peroneals are 

lengthened when your weight is on the 

outside of your foot, while your tibialis 

posterior tendon is lengthened when 

your foot is rolled inward. If you don’t 

want to use a ToePro, you can do this 

exercise by leaning forward into a wall 

while standing on an AirEx balance pad. 

With all of these exercises, you need to 

be fatigued when you finish, so stronger 

runners may need to wear a weighted 

backpack or hold a dumbbell. 

n The most effective exercise to improve 

resilience in the glutes and hamstrings 

is the single-leg push down. Before 

performing this exercise, warm up with 

a standing windmill exercise (E). After 

you’ve warmed up, lie face up on the 

floor with your arms out for stability, 

then place your foot on a physio ball 

or workout bench and push down with 

your heel (F) with enough force to 

raise the pelvis off the ground (G). Try 

to duplicate the position your hip is in 

during initial contact, which is typically 

between 20 and 30° of flexion. Hold 

this position for 20 seconds and repeat 

This no-nonsense guide shows you how an understanding of anatomy 

and biomechanics, coupled with the latest strengthening exercises and 

rehab protocols, can keep you running injury free 

four times on each leg. If this exercise 

is too difficult, bring the opposite knee 

towards the chest. Conversely, • if you’re 

• Decrease your risk of injury by identifying problems with strength, flexibility, and/or 

neuromotor coordination using specific functional tests 

not fatigued after 20 seconds, straighten 

• 

the opposite leg so it is closer to the leg 

that is pushing down, which makes the 

exercise significantly more difficult. This 

exercise duplicates the position your foot 

is in just before initial ground contact 

and markedly strengthens the hamstring 

tendons, which are important for both 

shock absorption and storing and 

returning energy. 

Health & Fitness/Sports 

INJURy-FREE RUNNING TOM MICHAUD 

DR MICHAUD 

graduated from 

chiropractic college in 

the early 80s. In 1993, 

his first textbook, Foot 

Orthoses and Other 

Forms of Conservative Foot Care, 

was translated into four languages. 

Human Locomotion was published in 

2012 and is used in physical therapy, 

chiropractic, pedorthic and podiatry 

schools around the world. He recently 

completed a second edition of Injury- 

Free Running: Your Illustrated Guide 

to Biomechanics, Gait Analysis, and 

Injury Prevention. This article was 

reprinted from a portion of this book. 

TOM MICHAUD 

INJURy-FREE 

RUNNING 

Your Illustrated Guide to Biomechanics, 

Gait Analysis, and Injury Prevention 

SECOND EDITION 

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Load it up 

Applying loaded 

movement training 

Over the last 10 years, both research into and the application 

of the scientific principles behind loaded movement training in 

strength, conditioning and performance environments 

have validated its place as a necessary means for enhancing 

life and sport. Paul Edmondson reports. 

The primary principles behind loaded 

movement training (LMT) derive 

from applied functional science¹ – 

the science and application of 

functional and authentic human 

movement. They are as follows: 

n Task-orientated movements (as opposed 

to thinking of just certain muscles). If you 

train movement, muscles will thrive but “train 

thinking only of muscles and movement 

vocabularies will slowly but surely decline.”² 

n Whole-body integration. The body is fully 

connected – joints, muscles, skin, nerves, etc. 

– all of which come together to share the 

responsibility for movement. We are stronger 

as a whole than the sum of our parts.³ 

n Vector variability. Our bodies, joints and 

muscles have the ability to move through 

three planes of motion during functional (life 

and sport) tasks – varied movement ladders 

up to effective/efficient movement and 

minimises wear, tear and repetitive trauma 

through repetitive linear (one-dimensional) 

motion.⁴ 

n Harnessing and using momentum. The 

body seeks to receive energy (via stretch) first 

before producing force for efficient motion 

– muscles are not the only tension regulators 

(things that move us).⁵ 

For many years in the strength and 

conditioning world, the need to ‘inhibit’ 

momentum has been well documented and 

for good reasons, such as to: 

n increase motor unit recruitment (activation 

of more muscles working) 

n enable greater time under tension, which 

elicits the production and secretion of 

anabolic (muscle-building) hormones 

n improve intramuscular co-ordination 

(better neuromuscular patterning within the 

muscle being trained)⁶. 

In the strength arena, this is 100% viable. 

Outside the gym, however, the body always 

seeks to capture momentum through ‘stored 

elastic stretch’ (within skin, fascia, ligaments 

and tendons – all fibrous connective tissues) 

using soft tissues like rubber bands to store 

and release energy with purpose and minimal 

energy cost to the body.⁷ 

The body’s two main survival properties are 

staying alive (first) and ‘efficiency ‘(how do I, 

the body, get work done in the most 

cost-effective manner as far as ‘energy 

conservation’ is concerned).⁸ If I go to throw a 

ball as far as I can, or jump as high as I can, 

my body moves in the exact opposite 

direction first: I recoil back to uncoil and 

release a ball forward, or I go down first to go 

up higher in my jump. Why? Because the 

movement brain understands that if I can first 

stretch all of my tissues (skin, fascia, etc.) like 

rubber bands, they return a huge amount of 

energy back into the directed/intended 

motion (about 92%).⁹ That’s big! 

Now let’s look at the same tasks taking 

momentum away. Now I freeze at the bottom 

of my jump, or pause on my winding up 

‘loading phase’ of throwing the ball (taking 

out momentum) – the returned energy that 

comes only from concentric muscle action is 

about 60% of total energy return put into my 

jump/throw¹⁰, therefore my body has to make 

up the deficit through ATP anaerobic 

metabolism (that’s costing energy and very 

soon you will fatigue; each jump rep gets less 

and less, the ball you’re throwing repeatedly 

is not travelling as far, and your body is 

getting tired too). 

So, to keep performance high and 

minimise the use of energy in real life, the 

body intuitively knows to use momentum for 

the storage and redirection of energy/ 

movement/tasks for efficiency and 

effectiveness in overall motor skill 

development. 

Walking, running, dancing – all of life – 

require movements that ‘ebb and flow’ 

and change direction for extended 

periods of time without breaking 

the system down or costing the 

body unnecessary energy 


LOADED MOVEMENT TRAINING \ PROGRAMMING 

expenditure. Herein lies the true brilliance of 

the body’s fascial system. 

Fascia can not only take away the sole 

responsibility on muscles for movement tasks 

but can up-regulate their input to motion 

(through stored elastic stretch and recoil). 

Fascia is made up of collagen, which is the 

most abundant protein in the body, and 

therefore it makes sense for this tissue to ‘pull 

its weight’ and take the onus off the smaller/ 

less-diverse muscles¹¹. 

These are some of the complex nuances 

that ladder up to an intelligent highperforming 

movement system, where all 

tissues share the responsibility of motion. As 

we say at ViPR, “the whole is greater than the 

sum of its parts”¹². Therefore, don’t just 

consider training muscles – that’s part of the 

conversation of movement – but learn to 

capture, harness and utilise momentum in 

training and see movement improvement 

gains. Then you’ll have a more complete 

understanding of moving better and 

maximising human potential. 

SEE BELOW 

FOUR DRILLS OF 

MOMENTUM-BASED 

TRAINING: 

❯ Video one 

ViPR tick tock – ViPR held in a HAV (hands 

1 around ViPR) grip close to top of tube (grip 

strength). Stand with feet pre-positioned wide 

(near end range, not at end range) then, by 

using a lateral shift and squatting motion of 

the pelvis, ViPR translates laterally in the 

opposite direction (counter shifts) to the pelvis. 

This creates the body’s ability to capture and 

return momentum in the adductors/ 

abductors/glutes/pelvic floor/core. Keep a tall 

spine and initiate motion through the hips. 

❯ Video two 

If I first stretch all my 

tissues like rubber bands, 

they return energy back 

into the motion 

2KB double to single arm cross-body 

lateral swing – standing with feet 

shoulder-width apart, with a dual hand grip, 

allow the kettlebell to load down ACR risk to 

the outside of the left knee, and countershift 

hips opposing lateral vector – this ensures the 

kettlebell can move safely past the knees 

without crashing into them – and, at the point 

of maximal load, drive hips laterally towards 

the kettlebell and dynamically swing arms 

across the body to shoulder height (repeat 

both sides of body). Keep spine tall and 

initiate motion via hips. 


fitpro.com | 13

❯ Video three ❯ Video four 

3ViPR anterior and posterior lateral 

swings – this drill is a tweak on the 

textbook kettlebell swing, with a leverage 

and directional difference. Holding ViPR on 

tube in a HAV grip (closer to the end is 

harder – closer to the centre is easier) load 

ViPR down and back to the left posterior 

corner of the room and, once fully loaded, 

dynamically snap hips forward. Keep spine 

tall and initiate motion via hips. 

4ViPR tick tock with lateral pivot lunges – 

holding ViPR in a HAV grip, simultaneously 

lunge to the same side lateral swinging ViPR 

to the same side lateral (initiate swing from 

hips) then, as ViPR loses its weightlessness at 

the top and descends, controlling its motion 

down, take an opposite-side lateral step 

(curtsey lunge) and repeat in a dynamic 

rhythm for reps/time. 

Move strong! 

PAUL EDMONDSON 

has been a fitness professional for almost 20 years. Paul started with Premier Global as a tutor and has gone 

on to occupy a course development role with the Training Room and become a master trainer for ViPR, Power 

Plate, Core-Tex and, most recently, TRX. For the last three years, Paul has been teaching with the Gray Institute 

(Gary Gray’s US-based education) and has conducted 37 international teachings at conventions, seminars and 

education workshops in Europe, the Middle East and Far East territories. 

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APP

CORRECTIVE EXERCISE \ COACHING 

The BioMechanics 

Method Corrective 

Exercise Specialist 

course, available 

NOW online. 

The BioMechanics 

Method 

for Corrective Exercise 

In this extract from 

The BioMechanics Method 

for Corrective Exercise 

textbook, the author 

Justin Price explains how 

to perform a structural 

assessment and zeroes in on 

how to understand various 

muscles of the body. 

The contents of this book are 

organised in a logical and 

sequential format to ensure that 

professionals trained and 

qualified in The BioMechanics 

Method techniques are able to identify 

both the potential causes and the most 

successful techniques for relieving 

common musculoskeletal imbalances to 

swiftly eliminate pain and improve physical 

function. Readers learn how to use the 

results of individual consultations and 

assessments to pinpoint clients’ exercise 

needs, so they can successfully start or 

return to a regular fitness programme. In 

short, those trained in The BioMechanics 

Method possess the skills to meet clients’ 

musculoskeletal restoration needs head on 

and represent perfectly the fitness 

professionals of the future. 

Beginning with part one, Fundamentals of 

Structural Assessment, you will learn to 

perform a cohesive series of verbal, visual, 

and hands-on assessments for the feet and 

ankles, knees, lumbo-pelvic hip girdle, 

thoracic spine and shoulder girdle, and neck 

and head, as well as how to communicate 

these assessments effectively to clients. 

Understanding your clients' skeletal 

structures from the outset provides the 

necessary framework and background 

information you need to understand the 

detailed functional anatomy and soft tissue 

information in part two. 


fitpro.com | 15

PART 1: FUNDAMENTALS 

OF STRUCTURAL ASSESSMENT 

Evaluate for foot abduction or adduction 

With the client still standing in front of you, check the position of his 

feet. Note whether one or both feet are facing forward, if one or both 

feet are adducted (turned inward ‘like a pigeon’), or if one or both 

feet are abducted (turned outward ‘like a duck’) from the midline of 

the body (see Figure 2.4). An abducted or adducted position of the 

feet may indicate overpronation¹. For example, a client with an 

overpronated foot may also abduct her foot when standing because 

overpronation produces an internal rotation of the lower leg, which 

causes the knee to turn toward the midline of the body. As a result, 

she may turn her foot outward to realign the knee to face forward². 

Figure 2.4 

Example of 

abducted 

foot position 

IN PART TWO of the book, Understanding Muscles 

➜ and Movement, you will be introduced to over 100 

bones, joints, muscles, and other soft tissue structures 

and learn how these parts of the body are affected by the 

musculoskeletal imbalances discussed in part one. The 

anatomical information in this section also sets the stage 

for exercise selection by teaching you what myofascial 

structures may need to be addressed as part of your 

corrective exercise programmes. 

PART 2: UNDERSTANDING 

MUSCLES AND MOVEMENT 

Arches of the feet 

There are three arches in the feet (Figure 8.1) made of a combination 

of bones, muscles, fascia, ligaments, and tendons: 

n The medial longitudinal arch 

n The lateral longitudinal arch 

n The transverse arch 

Figure 8.1 

Arches of the foot 

Most people who overpronate will abduct rather than adduct their 

feet. Occasionally, though, you may come across a client who 

adducts (i.e., turns in) one foot. This problem is usually also caused 

by overpronation. As previously discussed, when a person 

overpronates, the foot and ankle move toward the midline of the 

body. This causes the knee to also move toward the midline. To 

compensate for this change in knee position, the person will turn the 

foot outward so that the knee faces forward. However, in clients who 

are bowlegged or have another congenital condition that affects the 

alignment and position of their legs, their knees may actually be 

oriented toward the outside of the body. These clients may 

overpronate, but they may also turn their feet inward to make their 

knees face forward. 

❯ Assessment for overpronation 

CHECK THE BIG TOES 

Calluses, bunions, and crooked toes may also be evidence of common 

musculoskeletal imbalances in the feet and ankles, so it is important 

to ascertain the condition of the client’s toes³. Look at the big toe of 

each foot to determine if the first joint of that toe is swollen, has a 

bunion, or looks as though it points away from the midline rather than 

straight ahead. If the big toe on one or both feet is not straight, this 

may indicate that the client overpronates. When a person 

overpronates, the foot collapses and weight is transferred toward the 

centreline of the body. This transfer of weight across the foot before it 

can pass over the end of the big toe can cause any of the following: 

irritation on the inside of the big toe (e.g., a callus), inflammation and 

additional bone growth on the first joint of the big toe (a bunion), or a 

shift of the big toe toward the other toes (hallux valgus). 

The two longitudinal arches run along the sides of the foot from the 

heel to the toes. These two arches are intricately designed to help 

displace the weight of the body as it comes forward over the foot and 

to dissipate ground reaction forces as they travel back up to the body. 

The foot is also arched transversely (across the foot) to enable it to 

interact softly with the ground as weight is displaced from side to 

side and to provide additional stability and mobility to the foot so it 

can adapt to the terrain of the contact surface. The arches of the feet 

also lift the structures of the foot up and away from the ground to 

help protect these areas from injury⁴. 

The medial longitudinal arch is the prominent, big arch that runs 

along the inside of the foot from the heel to the base of the big toe. 

It is formed by the bones, ligaments, tendons, muscles, and fascia 

on the medial side of the foot. This arch is an excellent shock 

absorber, and it helps dissipate weight and force forward and toward 

the midline of the body⁵. 

The lateral longitudinal arch lies on the outside of the foot. It is 

made up of the bones, ligaments, tendons, muscles, and fascia on 

the lateral side of the foot. This arch is supported by many muscles 

that wrap under the outside of the foot⁵. Visually, this arch appears 

flatter than the medial longitudinal arch. It is much more solid and is 

capable of less movement than its medial counterpart. The lateral 

longitudinal arch works in conjunction with the medial longitudinal 

arch to support the weight of the body during weight-bearing 

activities⁶. 

The longitudinal arches of the foot are supported and maintained 

by a combination of factors. The tendons of various muscles that run 

below the apex of each arch help to maintain the height of these 

arches. The tendons of other muscles that run lengthwise along the 

foot help provide tension in these arches⁷. The shape and 

sequencing of the bones in the foot and the ligaments that hold 


▼ ▼ 

CORRECTIVE EXERCISE \ COACHING 

Transverse arches help dissipate shock 

from side to side and provide support 

as the foot transfers weight laterally 

them together form an interlocking mechanism that provides 

additional arch stability. The dense fascia that runs along the sole of 

the foot also helps support and maintain the shape of these 

important structures⁵. 

When your foot comes in contact with a surface like the ground 

during gait, tension is created in the structures of the longitudinal 

arches as the muscles that support these arches (e.g., tibialis 

posterior, tibialis anterior, flexor hallucis longus, abductor hallucis, 

peroneals) elongate like bungee cords and become taut. This 

tension helps slow down and distribute the transfer of weight 

forward over the foot. This tension also helps stabilise the bones of 

the foot which, conversely, provide additional structural support for 

the arches⁵. The activated muscles and soft tissue structures further 

help the foot to transfer the dispersed weight forward from the heel 

toward the toes, and this facilitates the transfer of weight to the 

other side of the body as you step forward to land on the other foot⁶. 

As the gait cycle continues and the other foot makes contact with the 

ground, the longitudinal arches in that foot activate to continue the 

shock absorption and weight transfer cycle. 

The transverse arch in the centre of the foot is created by the 

bones (and their supporting ligaments and muscles) in the midfoot 

area⁶. In addition to the main transverse arch, the midfoot also 

contains a series of small, dome-shaped transverse arches that run 

from side to side across the foot just behind the start of the toes. 

These transverse arches help dissipate shock from side to side and 

provide a system of support as the foot transfers weight laterally⁸. 

❯ Arches of the foot 

PART 4: THE COMPLETE 

CORRECTIVE EXERCISE LIBRARY 

Calf massage 

n Area(s) of body: Feet and ankles, knees 

n Imbalance(s) : Lack of dorsiflexion, overpronation, tracking 

problems of the knee 

n Structures addressed: Gastrocnemius and soleus 

n Exercise benefits: Massaging the muscles on the back of the calf 

can help realign and rejuvenate the soft tissue structures of the 

lower leg. Because the gastrocnemius and soleus muscles attach to 

the heel, this exercise will help improve dorsiflexion and 

consequently decrease overpronation. It will also help the knee bend 

more effectively (due to the fact that the ankle and knee bend 

together during many weight-bearing activities such as squatting, 

walking, and lunging). 

How to perform: 

1. Sit down, place the ankle of the side being 

massaged on the knee of the opposite leg 

and grasp the belly of the calf with your 

hands. 

2. Massage across the muscle or up and down. 

3. Target knots or adhesions during the 

massage. 

▼ 

n Duration and repetitions: Massage one 

to two minutes at least once per day. 

n Tip: To increase adherence, encourage 

clients to use this massage technique 

while they are sitting at home watching TV 

or at work. 

Progress: Use a massage device on the 

calf or perform the calf stretch. 

Regress: Use a hard ball (such as a 

baseball or lacrosse ball) placed on a book 

with the calf muscle placed on top of the ball. 

PART FIVE, Corrective Exercise Program Design, 

➜ provides detailed instruction on developing 

corrective exercise programmes and fostering positive 

client relationships so that your consultations, individual 

sessions, and programmes prove successful. Part five also 

contains a valuable case study to help you understand 

how the various components of the process can be 

implemented seamlessly when working with clients. 

IN PART THREE, Fundamentals of Corrective 

➜ Exercise, you will learn about the elements of 

corrective exercise programmes, how to select and adapt 

exercises to meet the needs of each client, and how to 

coach each technique. Non-exercise-related strategies to 

incorporate with corrective exercise programmes are also 

covered in this section. 

Lastly, to help you capitalise on the corrective exercise skills you 

learned in parts one through to five, part six, Business of Corrective 

Exercise, contains information on how to set up a corrective exercise 

business, with specifics about networking and referral systems, tips 

for maintaining your scope of practice, and marketing methods for 

attracting and retaining clients. 

PART FOUR, Complete Corrective Exercise Library, 

➜ contains an array of self-myofascial release, 

stretching, and strengthening exercises. This 

comprehensive collection will guide your selection of 

specific techniques that will constructively address a 

client’s musculoskeletal and physical conditions. 

The above extract has been 

taken from The BioMechanics Method 

For Corrective Exercise textbook by 

Justin Price. RRP £70 but use the 

25% discount code FP25 to receive 

a saving of £17.50; price is £52.50. 

Visit human-kinetics.co.uk 


fitpro.com | 17

Taking it 

outside 

With spring finally in the air, 

Britain’s new passion for 

outdoor fitness is set to 

continue. Whether it’s HIIT 

classes or yoga, people 

have been taking their workouts outside over 

the past year as a result of the COVID-19 

pandemic following the closures of gyms and 

studios, as well as the increased concerns 

over the hygiene of enclosed indoor spaces. 

And it’s not just bootcamps and boxing. 

There is increasing interest in taking part in 

other more traditionally studio-based classes 

outdoors, including Pilates, barre and Zumba. 

According to the ACSM’s Worldwide Survey of 

Fitness Trends, ‘Outdoor Activities’ was already 

on the increase, with the trend rising from 17th 

place for 2019 to 13th place for 2020. However, 

unsurprisingly, ‘Outdoor Activities’ leapt to 

fourth place in the same survey for 2021. 

Sarah Adkin encourages you to step out of 

the studio and into the great outdoors to run 

classes that are powered by nature. 

➤ NOT JUST GOOD FOR SOCIAL DISTANCING 

There are, of course, many benefits to 

outdoor exercise, in addition to the ease of 

social distancing and the lowered risk of 

transmitting viral infections to other 

participants. Here are a few that may be 

helpful to those of you who would like to try 

and convince any reluctant clients to give 

workouts in the great outdoors a spin: 

■ Exercising outdoors can help reduce 

depression, anxiety and anger, due to the 

increased vitamin D intake.1 

■ Physical activity outdoors can reduce 

blood pressure and stress, meaning that 

outdoor exercise feels less strenuous and can 

help you push yourself further than you 

would do in an indoor environment.2 

■ Exercising outdoors may burn more 

calories due to the extra energy your body 

needs to regulate your body temperature.3 

The increased demand for outdoor fitness 

due to the pandemic has, of course, meant 

that many fit pros have felt compelled to add 

outdoor classes to their repertoire. However, 

as some of you may have already discovered 

the hard way, hosting a class outdoors is not 

simply a case of taking your studio class and 

plonking it outside. There are a few 

challenges to take into consideration. 

➤ LOCATION, LOCATION, LOCATION 

Choosing the right location for your class is 

crucial to its success. As with any fitness 

solution, proximity to the clients’ homes is, of 

course, key; however, clients are often 

prepared to travel a little further if the 


OUTDOOR TRAINING 

\ COACHING 

location has a special appeal. Both urban 

and natural features are a big draw and, if 

you can find somewhere with both, you’re 

onto a winner! 

For example, many people love exercising 

near water, so running a session by a lake or 

pond is a great choice. Another natural feature 

that is always a huge crowd pleaser is 

anywhere with a great view. The more 

Instagrammable, the better! 

The other very important consideration 

when choosing your location is the 

practicalities of the space for the style of class 

you are running. Do you need a flat surface? Is 

there sufficient space? Can you make use of 

any structures within the space for your 

workout (think resistance bands around a 

fence or railings as a ballet barre)? Is it 

important to be within easy reach of toilet 

facilities? Is there adequate lighting after dark? 

➤ THE GREAT BRITISH WEATHER 

Unfortunately, the weather is one of the 

biggest causes of anxiety for both clients and 

trainers when participating in outdoor classes. 

You may well have heard the old Scandinavian 

saying, “There’s no such thing as bad weather, 

only bad clothes.” This is something to always 

bear in mind for both yourself and your clients. 

The second very important consideration is 

appropriate programming according to 

the conditions. 

There’s no getting away from it: much of the 

year in the UK is very cold with approximately 

50 days of the year at sub-zero temperatures. 

You may find that some participants are keen 

to embrace the cold – what with the rise in 

interest in the benefits of cold exposure, the 

cold has almost become a fitness trend in 

itself (#snoga anyone?). 

When you are faced with these low 

temperatures, wearing multiple layers is 

essential so that you can strip off as your 

body temperature fluctuates. When 

programming a class for the cold, make sure 

it is as dynamic as possible and keep any 

static stretches to maintenance rather than 

developmental. Avoid any long periods of 

inactivity, for example, when demonstrating a 

circuit give your class a movement to do 

while they are watching. Also be sure to 

include exercises that increase circulation to 

the fingers and toes, such as wrist and ankle 

circles. If you’re practising yoga in the cold, 

toe squats are a good choice. 

When programming a 

class for the cold, make 

sure it’s dynamic and 

keep static stretches to 

maintenance 

What if it rains? Needless to say, waterproof 

clothing is a huge help! When programming 

your class, you will need to put a particular 

focus on safety, as well as the general comfort 

of your participants. Avoid speed-based 

exercises such as sprints due to slippery 

surfaces, and keep the class on their feet, 

avoiding exercises where hands or knees 

need to come to the ground. 

When it comes to classes that are more 

challenging in the rain, such as yoga, you may 

wish to consider choosing a location that has 

a sheltered area such as a bandstand. A final 

consideration is everyone’s personal 

belongings. Your class will love you for 

bringing along a plastic or tarpaulin sheet to 

keep everything dry. 

The other extreme condition to consider is, 

of course, the heat. It’s rare and welcome 

when it arrives but hot weather can potentially 

be more challenging than wintry conditions. 

Ensure you remind class participants to bring 

water and always carry spare, as there is 

always someone who forgets. When it comes 

to programming, it is wise to significantly 

reduce the intensity of the class. It is also 

advisable to switch location to the shade if 

your usual spot is exposed. 

➤ LOCAL LICENSING 

A further issue for fit pros when considering 

setting up an outdoor class is whether or not 

permission or licensing is required. There is 

no one answer to this, as the regulations vary 

wildly from council to council. Some do not 

require you to be licensed at all, some have 

well established and very organised licensing 

procedures, while some require you to pay 

but are far less structured and open about it. 

The best advice I can offer is to make sure 

you find out who owns the outdoor space that 

you are hoping to use and reach out to them. 

Wheedling your way into their good books is 

highly recommended if you can. 

➤ HEALTH AND SAFETY 

For outdoor classes, health and safety 

considerations are very different from those 

within a gym environment. Many councils will 

require you to submit a risk assessment but, 

even if they don’t, it is good practice to do so. 

At the start of every session, you will need to 

check the space for any potential hazards 

such as bits of glass, rubbish and twigs. 

Another area of potential danger lies in 

members of the public (including children 

and dogs) weaving in and out of your space. 

For this reason, be particularly vigilant 

about equipment being left lying around as a 

trip hazard, and make sure you and your 

participants do not significantly obstruct any 

public pathways. Also remember to always 

carry a first aid kit with you at all times when 

teaching outdoors. See you at the pin drop! 

SARAH ADKIN 

is an experienced outdoor group fitness 

instructor and community manager at BUA 

FIT. buafit.co.uk 


fitpro.com | 19

Notes from a 

group X manager 

When it comes to shaping the group exercise member experience, we should 

be creating a space where members feel welcomed, motivated and inspired to 

achieve their goals, says group exercise manager Faye Edwards. 

The responsibility of a group exercise 

manager is to recognise the needs 

of group X members and provide 

them with an exceptional 

experience that encourages them to 

be consistent. It’s also our job to ensure that 

the highest level of class experience is 

consistently delivered. 

So, how do we do this? Initially, we need to 

encourage member feedback and ensure 

action based on that feedback is promptly 

taken. Quality control is also imperative; we 

need to know exactly what is being delivered 

in the studios. Although instructors will be 

qualified and skilled at what they do, it can 

happen that an instructor becomes stagnant; 

the fitness industry is forever evolving and it’s 

the responsibility of the instructor to evolve 

with it. This includes ensuring instructors have 

a professional set-up, are ready and in the 

studio before members arrive, use up-todate 

playlists and devices, are innovative with 

their programming and make positive 

connections with members. 

We can’t just rely on member feedback to 

find out if standards are being kept, as not 

every member will give feedback. If they are 

not happy with a class delivery, they simply 

won’t return to that class. This is something 

that should never happen and, with quality 

control, it can be avoided. 

So, how do we ensure that a high standard 

is held in group X? A group exercise manager 

should make it their priority to get to know 

every instructor on their schedule and to 

attend the classes themselves. At Third Space, 


GROUP X \ MANAGEMENT 

we pride ourselves on feedback and 

development. We regularly access classes to 

ensure our core values are being delivered, 

which are reliability, innovation, passion 

and expertise. 

Encouraging member 

engagement 

To encourage group X member engagement, 

one of the criteria that needs to be met by 

each instructor is to be personable and to 

connect with each member. This is achieved 

through getting to know their names, getting 

to know their needs and goals, and creating a 

positive team environment, giving members 

a sense of belonging in a community. 

At Third Space, we like to make things 

interactive for our members and we are huge 

fans of Myzone, a heartrate-tracking device. 

Members love using the Myzone belt, as it 

makes them accountable and it’s a great way 

to measure fitness progress, along with 

providing a little healthy competition to keep 

them going. We have screens in the studio 

and gym so members can visually see their 

Stats don’t lie, so these 

should be looked at on 

a daily basis and action 

taken 

work input. We also run events and 

competitions as incentives to keep them 

motivated. This has been such a great tool to 

create team spirit and it’s wonderful to see 

members engaging with other members and 

staff outside of the group X department. 

From a business perspective, it’s important 

to very closely monitor and measure all class 

statistics, including class occupancy, 

penetration, most popular disciplines, cost, 

etc. Analysing the year-on-year growth 

enables us to pre-plan and set budgets. 

Getting the timetable right 

Sometimes less is more and simplicity is key. 

There is no point overwhelming members 

with a huge array of different concepts and 

styles; as long as every important training 

component is offered on the timetable, then 

you can meet the needs of every member. At 

Third Space, we keep the different concepts 

to a minimum, as this takes away any 

confusion about what each class entails. 

There is little point having 10 different types 

of a HIIT concept. 

The classes provided should do what they 

say on the tin, so well-thought-out concept 

names are important as these could make or 

break a member’s decision to attend. It is also 

important to have consistency in the timings 

of sessions throughout the week, so that 

members can become familiar with the 

day-to-day schedule. Monitoring the 

analytics of class occupancy also ensures you 

can deliver what is most in demand from the 

members and it’s important to take action 

when something is not working. If occupancy 

is low, something has to change; the stats 

don’t lie, so these should be looked at on a 

daily basis and action taken, as it’s not 

financially feasible to have empty classes. 

Building a winning team 

At Third Space, we pride ourselves on training 

and development. We regularly run education 

days, workshops and refreshers to give each 

instructor the opportunity to continue to up 

their skills, learn and grow. When recruiting 

instructors, it’s so important for them to fully 

understand the brand and expectations. They 

need to receive information on the group X 

team structure, core values and insight into 

the brand’s objectives. Again, feedback is key 

and a fundamental way of making continued 

progress, so they should be given feedback 

throughout the recruitment process and tools 

to support their growth. 

While many clubs are great at showing 

appreciation to both employed and selfemployed 

staff, which keeps everyone highly 

motivated, it’s particularly important to 

remember the freelance instructors and show 

appreciation to them too. It’s the nature of 

their job that they may not always have the 

opportunity to feel part of a team. At Third 

Space, we have instructor of the month, so 

the instructors who have the best 

performance will be praised for their efforts. 

We also have instructor of the year rewards. 

This is based on their performance, which 

includes consistency with teaching, support 

with cover and member feedback. The 

self-employed team is very much made to 

feel included in the business, as we 

appreciate that, with such a high penetration 

of group exercise, this is what supports 

member retention. 

At Third Space, we have what we call our 

signature concepts, which are classes 

designed and curated by master trainers. In 

order for an instructor to teach a signature 

concept, they must attend and pass the 

training workshop, followed by quarterly 

refreshers to keep them up to date on the 

format and class delivery. Training and 

education are monitored by the master 

trainer, who will communicate with the 

instructors and coach them in their 

continued development. 

Adhering to brand standards is a top 

priority to ensure a safe space is provided for 

both members and staff. In the group 

exercise department, we will use our in-house 

systems to log things like instructor insurance 

and log expiration dates, so we can keep on 

top of renewals. We also do regular in-house 

training, which is managed by the operations 

manager. This includes manual handling, fire 

safety, diversity and inclusion, DSE, infection 

prevention control and more. 

Finally, we measure our success in group 

exercise by meeting our set targets. The main 

objective is simply to have a high penetration 

and ensure that operations are carried out at 

an exceptional standard, keeping the 

members happy and, thus, resulting in 

member retention. 

FAYE EDWARDS 

Group exercise manager, celebrity trainer 

and founder of F.I.T Jam Dance Movement, 

Faye Edwards is renowned for her high energy 

and positive influence. Faye started her 

career in the fitness industry over nine years 

ago and has a wide array of expertise, from bodybuilding 

competitions, to concept creating and events, to fitness 

conventions and retreats both in the UK and internationally. 


fitpro.com | 21

‘SCRIPT’: 

A FOOTBALL CASE STUDY 

In the last issue, part one of our new series by the UKSCA outlined the first steps 

in the information-gathering process prior to writing and implementing effective 

strength and conditioning (S&C) programmes. Here, part two focuses on 

providing the S&C trainer with a sport-specific case study of how to capture and 

use this information to develop a thorough understanding of the sport, carry out a 

comparative analysis and set SMART training goals for an individual participant. 

In association with 


NEEDS ANALYSIS 

\ STRENGTH & CONDITIONING 

Imagery supplied by: www.stuartcowperphotography.smugmug.com 

DEBBY SARGENT currently works 

at the University of Gloucestershire 

(UoG) delivering undergraduate 

and postgraduate strength and 

conditioning courses. She has over 

20 years of experience working with 

high-performance athletes and has been a UKSCA 

tutor and assessor since 2008. 

BARRY JONES MSc BSc (Hons) 

ASCC CSCS is a UKSCA accredited 

strength and conditioning coach with 

10 years' experience working in highperformance 

sport. 

CHRIS SIMPSON MSc, ASCC is currently 

a sport & fitness lecturer at Dundee and 

Angus College and also the lead strength 

& conditioning coach at ICE Dundee and 

co-director at Fit 4 Purpose (Angus). 

LUKE BIRMINGHAM is a physical 

preparation coach in Tayside and Fife, 

Scottish Institute of Sport. 

The following case study is based on 

a female footballer, with the 

corresponding needs analysis 

detailing the sporting requirements. 

Football is played over 90 

minutes and divided into two 45-minute 

periods, separated with a 15-minute half-time 

interval. Football is regarded as an aerobic 

intermittent sport, meaning the predominant 

energy source is aerobic glycolysis. The key 

performance-related movements are 

sprinting, high-intensity running, jogging, 

walking, jumping (single and double leg) and 

change of direction manoeuvres, indicating 

that football incorporates multi-directional 

movements at various intensity levels¹. Players 

are reported to cover distances of 9,000- 

13,000 metres per match; this is multifactorial 

dependent on playing level and positional 

differences, plus tactics can alter distances². 

For example, it has been reported that wider 

midfielders and centre midfielders (average > 

11,000 metres) cover more total distance 

during a match compared to centre backs 

and forwards (average < 11,000 metres). 

Furthermore, wide midfielders covered the 

greatest distances at high intensities (speeds 

categorised over 14km/h¹), with centre backs 

producing the least³. Key determinants of 

successful performance are anaerobic-based 

movements/actions such as jumping, 

accelerations, decelerations, sprinting and 

high-intensity running. These actions only 

contribute to less than 30% of a game, yet 

superiority in these attributes is pivotal across 

all successful teams⁴. This is supported 

through the findings of Faude et al⁵, who 

reported that most goals were preceded by a 

powerful action (83%), this predominantly 

being a straight sprint performed by either 

the goal scorer or assisting player. It is further 

reported that high-intensity running was 

repeated on average 125 times per match, 

with the average duration of 2.3 seconds⁴,⁶. 

The metabolic demands can be tracked 

through individual heart rate and VO²max, 

although these metrics do not directly 

correlate to high-intensity work being 

performed. It was found that the average 

game intensity was 70-80% VO²max; 

furthermore, it was reported that 49.6 ± 21.1% 

of matches are spent above the heart-ratemeasured 

anaerobic threshold. This 

highlights the importance of developing a 

high aerobic capacity, allowing for an 

increased level of recovery, removal of the 

anaerobically produced lactate and an 

increased efficiency and capacity at 

performing high-intensity related actions⁷. 

Female football has progressively increased 

in popularity throughout the world of sport, 

with substantial increases in young female 

participation rates over the past decade⁴,⁸, 

with increased physical athleticism 

contributing to the enhancement in playing 

dynamics⁹,¹⁰. Development and enhancement 

in playing dynamics are mostly exhibited by 

improvements in speed, power, strength, 

aerobic and anaerobic capacity⁶. Therefore, it 

is the job of the S&C trainer to prepare and 

develop the participants’ physical capacities 

and robustness to tolerate the competitive 

demands, assisted by the needs 

analysis process. 

Due to the repetitive frequency and 

physical demands of the sport, this exposes 

the particpants to an inherent risk of injury; 

therefore, biomechanical analysis and 

injury management will be covered in 

the next article. 

Individual analysis 

The female footballer is aged 17 and playing 

Academy football (under-18 level) at an elite 

club. The participant’s personal characteristics 

are: height 160cm; mass 50.9kg; body 

composition 13.5% (a lean body composition 

can positively impact on movement efficiency 

and offset fatigue, thereby improving sporting 

performance). The participant’s individual 

circumstances should also be considered. 

Education, work or other commitments may 

impact on the training week and limit the 

participant’s ability to train as desired or 

recover from training sessions. The participant 

is currently at university, studying four or five 

➥ 

Resistance 

training status 

Beginner 

(untrained) 

Intermediate 

(moderately 

resistance 

trained) 

TABLE 1: Classifying resistance training status 

Advanced 

(well resistance 

trained) 

RESISTANCE TRAINING BACKGROUND 

Current 

programme 

Not training or 

has just begun 

training 

Currently 

training 

Currently 

training 

Adapted from Haff & Triplett (2016)¹⁶ 

Training age 

When collecting fitnesstesting 

data, it is important 

to use valid and reliable 

tests that can accurately 

detect changes in 

performance 

days a week, attends training three days per 

week and has a match every Sunday. The 

participant’s training history for the sport is 10 

years and, with regards to resistance training, 

she’s had five months’ exposure to deliberate 

and purposeful strength-based training. 

It is important to determine participant 

training history, as this will impact on other 

factors such as training frequency. As 

illustrated in Table 1, the participant falls 

within the ‘intermediate’ status; therefore, 

resistance training frequency would be two or 

three times per week. Beginner participants 

may require longer between workouts to 

recover compared to advanced participants. 

However, as the training status of the 

participant improves, training frequency 

(number of sessions/week) can increase. 

If all the previously mentioned elements are 

not factored in, the training expectations 

placed on the participant may be unrealistic 

and may lead to sub-optimal performance 

or even injury. 

Creating a testing battery 

A complete understanding of the 

requirements of the sport allows the S&C 

trainer to develop a comprehensive sportsspecific 

testing battery. This can then be 

administered to benchmark players’ physical 

abilities against those required in the sport. 

Fitness testing should ideally take place at the 

beginning of the pre-season training cycle to 

provide accurate baseline data¹¹, with further 

testing being carried out at periodic times 

Frequency 

(per week) 

Training stress 

Technique 

experience 

or skill 

< 2 months < 1-2 None or low None or 

minimal 

2-6 months 2-3 Medium Basic 

> 1 year 3-4+ High High 


fitpro.com | 23

throughout the year. This can help measure 

the effectiveness of the training programme 

and also help to influence future 

programming decisions. 

Considerations 

The testing battery should include tests that 

assess the specific qualities identified in the 

needs analysis. The S&C trainer should also 

consider which resources (time, equipment, 

staff) are available to them to complete the 

testing battery, as this will ultimately decide 

which tests are performed. In addition, 

participant training history and experience 

should also be taken into account. Limited 

skill or technique may prevent the participant 

from performing the test safely and increase 

the chance of injury. In addition, if the 

participant does not have sufficient skill to 

perform the test, it is probably not going to 

provide the S&C trainer with a true and 

accurate measure of the physical quality they 

are trying to assess. In this case a simpler, less 

complex alternative should be found. 

Selecting fitness tests 

When collecting fitness-testing data, it is 

important to be sure you are using valid and 

reliable tests that can accurately detect 

changes in performance. Validity, reliability 

and sensitivity are key concepts the S&C 

trainer should become familiar with¹². The 

validity of a test refers to its ability to measure 

what it is supposed to measure, while a test’s 

reliability refers to how repeatable it is. 

Finally, a test with high sensitivity is capable 

of detecting changes in performance. The 

countermovement jump has been shown to 

be a valid and reliable test of lower-body 

power¹³. Therefore, this test will allow the 

S&C trainer to capture consistent data with a 

low typical error, making it very sensitive to 

change in the presence of training 

adaptations or fatigue. 

➥ 

Capability 

assessed 

Testing battery 

Taking all analysis elements into 

consideration, the following tests (see Table 2) 

were used to assess the participant’s physical 

capabilities based on their high levels of 

validity, reliability and sensitivity¹³,¹⁴,¹⁵ and also 

their high levels of sport specificity. In 

addition, the intermediate training status of 

the participant allows us to examine lowerbody 

strength and power capabilities through 

the repetition maximum (RM) testing of the 

back squat and power clean exercises. RM 

testing assesses the maximum amount of 

weight that a participant can lift for a desired 

number of repetitions – typically one, three or 

five RMs are tested in compound strengthtraining 

exercises. This method of strength 

assessment should only be considered for 

intermediate or advanced strength-training 

participants¹⁶. 

Tests should be performed in order from 

least to most fatiguing, so as to maximise 

recovery between tests and improve 

subsequent test performance¹¹. The order, 

where possible, should be as follows: 

n Anthropometry (e.g., height, weight) 

n Skill and/or speed/power tests (jumps 

and/or sprints) 

n Maximal strength tests (squats, bench 

press, pull-ups) 

n Muscular endurance tests (aerobic or 

anaerobic tests) 

On occasions where the S&C trainer is 

working with large groups or is working under 

specific time constraints, performing the 

tests in this order may not always be possible. 

The S&C trainer should replicate this order 

in future testing sessions¹¹. 

Comparative analysis 

Following the completion of the testing 

battery, a comparative analysis between the 

individual participant’s test results and 

normative fitness testing values found in the 

TABLE 2: Comparative analysis showing individual participant’s 

results vs normative values 

Test 

Individual 

participant's 

result 

Normative 

values of 

comparable 

level 

Body composition Body fat % 13.5 18.5 -27% 

Lower-body power 

Speed 

(acceleration) 

Countermovement 

jump (CMJ) 

28 35 -20% 

Sprint 10m (s) 2.5 2.31 8% 

Speed (top speed) Sprint 30m (s) 5.6 4.86 15% 

Lower-body 

strength 

Aerobic fitness 

Back squat 3RM 

x BW 

Yo-Yo intermittent 

running test level 1 

0.9 1.3 -31% 

1,360 1,379 -1% 

Values highlighted green = on a par with or better than norms; amber = areas of concern; and 

red = improvement is required. Norms taken from Nesser et al (2009)²¹ and Martinez-Lagunas 

(2014)²². 

Difference 

vs normative 

value 

sport is performed. See the participant’s 

comparative analysis in Table 2. 

Here, areas of strength and weakness can 

be identified and this provides the S&C 

trainer with a clear direction with regards to 

setting training goals. If access to normative 

data for elite-level participants is not always 

available, the S&C trainer should use the 

team or squad information collected to 

establish group fitness testing norms¹⁷. 

Goal setting 

The goals of the training programme should 

focus on developing the physical qualities 

that play a dominant role in successful 

performance¹⁸, as described in the needs 

analysis section¹⁶. 

The SMART principle should be used to 

help the S&C trainer set goals for the 

participant to ensure the training goals are 

specific to the needs of the participant, 

measurable, achievable, realistic and 

completed in a realistic timescale. Setting 

unrealistic or unachievable targets can hinder 

the training process, place the participant at 

increased risk of injury and potentially lead to 

overtraining. 

The SMART goals for the participant have 

been identified as developing lower-body 

strength and power. These goals have been 

identified through the large deficits as shown 

in the comparative analysis (see Table 2). 

Development of strength in beginner and 

intermediate resistance training participants 

is very important¹⁹,²⁰. Increasing levels of 

maximal strength sets a good foundation 

from which explosive power and speed can 

be better developed than by employing 

power and speed training strategies alone¹⁹. 

Therefore, the goal for this participant should 

be to aim to improve lower-body strength by 

10% over the pre-season training period 

(eight weeks in length). As the participant is 

still only moderately resistance trained, steady 

progression of approximately 5% over two 

four-week training programmes should be 

achievable in the given timescale. 

The next article in this series will focus on 

the use of movement screens to assess 

movement quality, in order to inform 

programme design to prevent injury. 


EXERCISE PAIN \ COACHING 

If an exercise 

hurts, should 

your client stop? 

Jayden Arnold, head 

of physiotherapy at 

Ten Health & Fitness, 

answers the question. 

It’s a phrase you’ll hear quite often on the 

gym floor. A client is working with their 

trainer and you hear, “My knee hurts, 

should I keep going?” This is often 

answered with a less-than-inspiring, 

“Should be alright.” 

For a client, that’s not helpful for two 

reasons. One, it’s not particularly reassuring, 

and two, it doesn’t fill you with confidence 

that your trainer knows what he or she 

is doing. 

So, let’s look at a simple and safe process 

that will help you reassure your clients that 

pain does not always need to be a barrier to 

exercise – and, equally important, will help 

you to identify the times when it should be. 

If you are ever unsure about 

a client’s pain, the best 

advice is that they get it 

checked out by a physio 

A study in the British Journal of Sports 

Medicine by Smith et al from 2017¹ showed 

that, in some instances, pain during exercise 

could relate to a small short-term benefit. 

But clearly that doesn’t apply to all levels – 

or causes – of pain. And, equally clearly, 

not all pain is good or even advisable 

during exercise. 

If you are ever unsure about a client’s pain, 

or its cause, or if it’s worsening over a couple 

of sessions, then as a responsible fitness 

professional, the best advice you can give is 

that they get it checked out by a physio. That 

way, they – and you – will understand the 

cause and severity, and whether they can 

keep exercising or need a programme of 

rehabilitation before they can get back to 

training at full capacity. 

An approach that’s commonly used in the 

physiotherapy profession, and which can be 

applied in the gym, is the traffic light 

approach to pain: 

n Pain levels from 0-3/10: 

Green light 

In this zone, we are good to go. Get the client 

to give you feedback on their pain as they 

continue but, if pain stays at this level, they 

are OK to continue with the exercise as is 

and, if they stick to the same weight/reps, 

their body should adapt to the load and 

become pain free over time. 


Yellow light 

Be optimistic but cautious. In this zone, we 

look to reduce the load or reps slightly to try 

to get the client within the green zone and 

we monitor closely. If pain levels worsen, we 

stop the exercise. But, in a lot of cases, 

lessening the load slightly will have the 

desired effect. 


Red light 

If your client is hitting this zone, it’s a good 

sign that the body’s tissues are not tolerating 

either the load or the movement and 

something needs to change immediately. 

Pain at red-light levels will inevitably end in 

the pain worsening further and becoming 

more frequent and potentially chronic. 

Firstly, look to reduce the weight – how 

much of an effect does this have? Secondly, 

reduce the range of movement – does this 

lower it into the acceptable zones? If not, try 

breaking the exercise down into parts and see 

if the individual parts of the exercise keep it 

within a comfortable zone. 

Working in these acceptable zones or 

breaking down the parts should begin to 

allow the tissues that are causing a painful 

response to begin adapting and 

accommodating the load. If after a few weeks 

the pain doesn’t reduce or begins to worsen 

at all, feel confident to refer on for further 

assessment. 

Adopt this strategy with your clients – it will 

give you a safe and effective way to give your 

clients confidence that (a) they’re safe with 

you and (b) that pain doesn’t mean a setback 

for their exercise goals. 

JAYDEN ARNOLD 

Brisbane-born Jayden has a particular 

interest in knee and ankle injuries and in 

post-operative rehabilitation. He believes 

in a hands-on approach, using a variety of 

treatment options including trigger point 

release, joint mobilisation, taping and 

exercise-based rehabilitation. He works closely with Ten’s 

performance coaches, Pilates 

instructors and personal trainers to 

allow clients’ training to continue 

during the treatment stages 

whenever feasible. Jayden joined 

Ten in 2016 and was promoted to 

head of physio in 2020. 


fitpro.com | 25

All about the 

thyroid 

Dietitian Dr Linia Patel provides an overview 

of thyroid disease and the role nutrition plays in 

maintaining a healthy thyroid.

THYROID DISEASE \ NUTRITION 

I have a tough time losing 

weight because of my 

thyroid.” You’ve probably 

heard this complaint time and 

time again from clients who 

have thyroid disease – and with good reason 

too. The thyroid is a small, butterfly-shaped 

gland that regulates metabolism, but it does 

more than that. Every cell in the body has 

receptors for thyroid hormones. So, although 

tiny, it is a mighty gland. 

Thyroid physiology 

The thyroid is one of the master controllers 

that regulates nearly every major metabolic 

function in the body. It regulates fat and 

carbohydrate metabolism, respiration, body 

temperature, cholesterol levels, menstrual 

cycles, skin integrity, blood calcium levels, 

functioning of the heart and nervous system 

and more¹. 

The thyroid gland secretes a number of 

hormones. The hormone that is secreted the 

most (90%) is called thyroxine or T4. T4 has 

minimal metabolic effects on the body and is 

therefore considered a prohormone. 

Triiodothyronine (T3) is the active thyroid 

hormone but only 7% is produced by the 

thyroid gland. The rest has to be converted 

from T4. When produced, T4 is bound to a 

protein (thyroid-binding hormone) allowing it 

to be transported around the body. When the 

T4 reaches the kidney and liver, it is converted 

to T3. Free T3 then gets into the cells to exert 

its metabolic effect¹. It’s also important to 

note that about 20% of the thyroid hormone 

must be converted to active T3 in the gut 

using an enzyme called intestinal sulfatase, 

which comes from your beneficial microbes! 

This means that, if your gut health is out of 

whack (clinically known as dysbiosis), this may 

reduce the conversion of the inactive T4 to 

the active T32. 

What happens when the 

thyroid doesn’t work so well? 

Occasionally, the thyroid gland doesn’t 

release thyroid hormones. This is called 

primary hypothyroidism or underactive 

thyroid and is the most common type of 

hypothyroidism. Approximately 90% of 

primary hypothyroidism is caused by 

Hashimoto’s disease, which is an 

autoimmune disease. An underactive thyroid 

can slow down metabolism, causing weight 

gain as well as any of the symptoms in the 

box below¹,³. 

HYPOTHYROIDISM 

Weight gain 

Fatigue 

Feeling cold constantly 

Constipation 

Joint pain 

Depression, ‘brain fog’, memory loss 

Coarse, dry hair and skin 

Puffy face 

Infertility, irregular periods 

On the other end of the spectrum, 

hyperthyroidism or an overactive thyroid 

gland is another common thyroid condition. 

The most prevalent form is Grave’s disease, in 

which the body’s autoimmune response 

causes the thyroid gland to produce too 

much T4 and T3. Symptoms of an overactive 

thyroid can include weight loss and high 

blood pressure, as well as the symptoms in 

the box below¹,³. 

Women are five to eight times more likely 

to be diagnosed with hypothyroidism than 

men, possibly because oral contraceptives, 

hormone replacement therapy and the 

hormonal shifts that take place during and 

after pregnancy, as well as during 

perimenopause, can all boost risk¹. All thyroid 

issues also have a strong genetic link with 

other autoimmune disorders such as type 1 

diabetes, rheumatoid arthritis, lupus and 

celiac disease¹,²,³. 

Studies have shown that 

about 30% of people 

taking thyroid medications 

experience a vitamin B12 

deficiency 

Diagnosis of thyroid issues 

As well as taking into consideration the 

symptoms in the below box, there are various 

tests that can be done to screen for different 

thyroid conditions, including blood tests, 

scans and fine needle aspirations. Once a 

diagnosis is made, the treatment plan is a 

spectrum, as not all people need treatment¹,³. 

Depending on the type of thyroid issue and 

severity, treatments can include medication, 

surgery or oral radioactive iodine¹. While 

medical input may be necessary to manage 

healthy thyroid levels, there are also some 

lifestyle changes and things you can do to 

support healthy thyroid function and to 

reduce the intensity of your symptoms. 

HYPERTHYROIDISM 

Weight loss 

Fatigue 

Sweating and trouble tolerating the heat 

An overactive digestive system – diarrhoea 

Muscle weakness 

Anxiety, difficulty concentrating 

Hair loss 

Bulging eyes (exophthalmos) 

Infertility, irregular periods 

Thyroid diet – things to 

consider 

Many nutritional factors play a role in 

optimising thyroid function. Micronutrient 

deficiencies and excesses can trigger or 

exacerbate symptoms⁶. Food alone won’t cure 

thyroid issues; however, a combination of the 

right medication and right nutrients can help 

restore thyroid function and minimise your 

symptoms if diagnosed¹. 

n IODINE 

For people with a properly functioning 

thyroid, iodine is essential as it is required for 

the production of thyroxine (T4)⁶,⁷. It is a 

particularly important nutrient in pregnancy, 

helping with brain development. While in 

western societies autoimmune disease is the 

primary cause of thyroid dysfunction, iodine 

deficiency is the main cause worldwide. The 

recommended daily intake for iodine in the 

UK is 150mg per day. Diets that do not include 

fish, seaweed or iodised salt very often are 

found to be deficient in iodine. 

In the UK, iodine deficiency is considered 

rare, largely due to the widespread use of 

iodised salt in the food system. However, the 

latest National and Dietary Nutrition Survey in 

the UK shows that iodine intake in women of 

childbearing age (16 to 49 years) falls short 

when compared against the World Health 

Organization criteria⁸. Both iodine deficiency 

and excess have consequences and, 

therefore, supplementation should be 

approached with caution. Extra iodine, for 

example, can counteract the benefits of 

thyroid drugs¹,⁶. In the UK, eating a balanced 

diet usually makes taking supplemental 

iodine unnecessary. Speaking to a medical 

professional is recommended before 

supplementation. 

n VITAMIN D 

Some studies have shown that people with 

low levels of vitamin D may have thyroid 

disorders, but the link is yet to be truly 

established⁷. However, that said, the 

suggested correlation and the vast role of 

vitamin D in general health is a reminder to 

ensure that vitamin D levels are kept optimal. 

Since most people in the UK are deficient, the 

guidelines advise that adults and children 

over the age of five take a supplement of 

10mcg each day. If you have dark skin or are 

house bound, then you should consider 

supplementing with vitamin D throughout 

the year⁹. 

n SELENIUM 

The highest concentration of selenium in the 

body is found in the thyroid gland. It’s also 

been shown to be an essential component of 

the enzymes that are integral to thyroid 

function. A number of high-quality studies 

(i.e., randomised controlled studies) have 

shown benefits of selenium supplementation 

in patients with underactive thyroids; 

however, this effect seems to be more 

impactful in people with selenium deficiency 

from the outset¹⁰,¹¹. Incorporating 


fitpro.com | 27

influenced by total energy intake, sleep cycles 

and levels of stress, meaning that these 

factors must also be regulated. Low thyroid is 

often a sign of the body under stress. When 

you are stressed, the body produces more 

cortisol (the stress hormone), which may also 

reduce the amount of T3 in the body. In 

addition, not sleeping enough may cause 

inflammation in your gut, which will affect the 

balance of good bacteria needed to convert 

the inactive T4 to active T3¹,⁴,⁵. Sleep is also 

vital in helping to restore many physiological 

processes in the body, so a lack of it causes 

the release of cortisol. 

Depending on the type of thyroid issue and 

severity, treatments can include medication, 

surgery or oral radioactive iodine 

selenium-rich foods such as brazil nuts, 

seafood and dairy products in your daily diet 

is key. Before supplementation, have blood 

levels assessed. 

n VITAMIN B12 

Studies have shown that about 30% of 

people taking thyroid medications experience 

a vitamin B12 deficiency. This suggests that it 

is important for people on medication to 

include foods rich in vitamin B12 such as 

seafood, dairy, nutritional yeast and fortified 

cereals in their diets¹,¹³. 

n CALCIUM 

If you have hypothyroidism and have been 

prescribed thyroid medication (i.e., 

levothyroxine) to treat hypothyroidism, it is 

worth noting that some calcium-rich foods 

(such as dairy) and supplements can interfere 

with absorption of the drug. Ensure that you 

leave a gap of four hours between taking the 

medication and having a calcium-rich meal 

to ensure there is no significant impact on 

the thyroid hormone levels¹, ¹³. 

n IRON 

Iron supplements can also interfere with the 

absorption of medication (i.e., thyroxine). If 

you are taking this medication, it is advised to 

leave a two-hour gap between taking 

thyroxine and the iron supplements. Ensure 

that you check your multivitamin too, as 

these very often contain some iron¹, ¹³. 

n GOITROGENS 

Known as goitrogens, there are some foods 

that block the uptake of iodine from the 

blood into the thyroid. These foods include 

cruciferous veggies like broccoli, cauliflower 

and kale, as well as sweetcorn, peanuts, 

turnips and cassava. It’s important to note 

that people with hypothyroidism don’t need 

to avoid goitrogenic foods. They’re not a 

problem for everyone. And when they are a 

problem, the fix is pretty simple. All they need 

to do is cook these foods, as heating and 

cooking deactivates most of the goitrogens. 

In addition, generally, they are not of clinical 

importance unless they are consumed in 

large amounts¹,¹³. 

There is still a debate over whether soya is a 

goitrogen or not. Some evidence shows no 

effect and some shows that it interferes with 

the absorption of the thyroid medications. 

Current recommendation if you do eat soya is 

to ensure there is a gap of at least four hours 

between taking thyroxine and when you eat 

your soy-based food¹,¹²,¹³. Kelp (seaweed), 

which is naturally high in iodine, is another 

food that needs to be limited. Although 

iodine is needed to make thyroxine (T4), if 

you take more than you need it can cause the 

thyroid to be overactive. Coffee and 

high-fibre foods can also affect the 

absorption of thyroid medications, so it is 

important to have these foods away from the 

time of taking thyroid medications¹,¹³. It is 

important to speak to your doctor or dietitian 

to get more tailored advice. 

n LIFESTYLE FACTORS 

The regulation and metabolism of several 

hormones, including thyroid hormones, is 

Summary and 

recommendations 

Although there are claims about thyroid diets, 

there is no scientific evidence to back up a 

single eating pattern. It simply isn’t that 

simple, as there are so many factors that play 

a part. However, the following steps are a 

good place to begin: 

✔Stay away from fads. Don’t drastically 

restrict calories, especially if you are a woman. 

Thyroid hormones are very sensitive to your 

energy intake. 

✔ Consume enough iodine. Iodine is 

fundamental for a healthy and functioning 

thyroid gland. Foods rich in iodine include 

seaweed, fish and seafood, dairy products 

and eggs. Speak to a health professional 

before supplementation. 

✔ Eat a balanced diet, which includes 

high-fibre carbohydrates. It may not sound 

as sexy as the latest fad; however, it is 

fundamental for maintaining a healthy and 

balanced microbiota and a healthy thyroid. 

Thyroid and gut disease often co-exist. 

✔ Sleep enough. Get seven to eight hours of 

sleep each night. Sleep is when our body is 

able to reset. It also helps us manage our 

stress much better. 

✔ Get support from health professionals. If 

you are experiencing any of the symptoms in 

the box, request more tests from your GP. In 

addition, if you are living with a thyroid 

problem, being aware of what you are eating 

and how it affects your health is key. A 

dietitian can work with you to tailor a diet that 

supports thyroid health. 

CONGRATULATIONS! 

FitPro would like to congratulate 

Linia for achieving her PhD in Public 

Health. Her topic was: Dietary 

Inequality and Chronic Disease 

Outcomes, specifically looking at 

the mediating effect of income and 

education on dietary inequality 

within the UK. 

DR LINIA PATEL 

is a leading dietitian and sports 

nutritionist. She has a PhD in Public Health. 

Her passion is translating nutritional science 

into easy-to-digest and practical advice. 


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BAREFOOT STRENGTH \ TECHNICAL 

Becoming 

barefoot strong 

Incorporating foot strengthening 

into client programming 

Look out for 

EBFA online 

courses coming 

to the FitPro 

platform soon 

Dr Emily Splichal, author of Barefoot Strong and creator of the 

Barefoot Training Specialist Certification, encourages you to 

understand and experience the power of training barefoot. 

The dust has settled. Gone are the 

days of viral debates and forums 

on the benefits vs risks of minimal 

shoes and barefoot running. 

Newspapers such as the New York 

Times have shifted their focus away from 

the controversy around minimal footwear 

and Vibram’s lawsuit is “old news”.¹ 

With no more talk about barefoot 

running, does this mean that the benefits 

of barefoot cease to exist? And that 

barefoot was just a trend? 

Far from it! It is finally time to shift away 

from the association made between the 

words ‘barefoot’, ‘barefoot running’ and the 

connotation that ‘barefoot’ is just a fad. Like 

foam rolling, or self-myofascial release, 

what started as a trend in the fitness 

industry is now a well-accepted, evidencebased 

practice that is an integral part of 

almost every trainer’s and client’s 

programme. 

It is time to expand our minds, set aside 

any preconceptions about barefoot and 

take a moment to truly understand and 

experience the power of training – from the 

ground up. 

As we think about the concept of 

barefoot training, I want you to go beyond 

the literal meaning of these words. This is not 

an argument of which shoes to wear or 

whether you should even be wearing shoes. 

Instead, what I want to focus on is the power 

of the human foot from a fascial and sensory 

perspective – and how training the foot can 

dramatically impact on the stability, strength 

and movement of our clients. 

➤ THE SENSORY SIDE OF FOOT FUNCTION 

The human foot is a fascinating structure of 

26 bones, 33 joints and more than 100 

muscles, tendons and ligaments. Often 

appreciated for its biomechanical or 

kinematic role in human movement, there’s 

an aspect to foot function that is often 

under-appreciated and may arguably be 

more influential. This is the sensory aspect of 

the human foot. 

The skin on the bottom of the foot is 

packed with special nerve endings called 

mechanoceptors, or tactile nerves. These 

nerves are sensitive to various stimuli, 

including pressure, texture, vibration and skin 

stretch, which is then used to anticipate the 

ground, perceive impact forces and sense 

shifts in our centre of gravity. Once 

stimulated, these sensory nerves of the feet 

communicate with the brain via the 

somatosensory cortex to paint a picture of 

foot and body awareness. 

To optimise this interaction between the 

feet, ground and brain, we need to make sure 

we are actually feeling or ‘tuning in’ to this 

sensory input. One of the most common 

causes or reasons for the inability to sense or 

‘tune in’ to the sensory input of human 

movement is footwear. 

Thick, cushioned, supportive footwear with 

smooth insoles completely ‘tunes out’ the 

foot during dynamic movement. The 

excessive cushion in shoes absorbs the 

vibrational stimulus of impact forces, as well 

as other critical input that occurs at foot strike. 

Absorption of sensory input by shoes has 

demonstrated a delay in foot muscle 

contractions, weakening of foot muscles and 

delayed stability all the way up into the core 

and glutes.² This can result in foot, knee or 

back injury, as well as a decreased 

performance due to delayed stabilisation. 

Conversely, the stiffer, non-cushioned 

environment of minimal footwear and 

training barefoot have both been correlated 

with enhanced sensory stimulation, leading 

to hypertrophy of foot intrinsic muscles³, 

increased foot arch⁴ and more efficient 

co-ordination between the feet and core. 


fitpro.com | 31

The human foot is a 

fascinating structure of 

26 bones, 33 joints and more 

than 100 muscles, tendons 

and ligaments 

➤ FROM SHOES TO SURFACES 

We can take this concept of cushion, stiffness 

and sensory stimulation from shoes and 

apply it to training surfaces. The surface we 

train our clients on is just as important as the 

footwear we may recommend to them. 

Interestingly, when it comes to surfaces, 

stiffness wins again! 

All surfaces are designed to vibrate and 

deform upon contact, with the degree of 

vibration being dependent on surface 

stiffness. A review article by Marinsek et al 

found that the ideal mat for optimal landing 

techniques in elite gymnasts was actually a 

stiffer mat that allowed the transmission of 

impact forces.⁵ 

Excessive cushion in training surfaces, such 

as in the case of soft mats, restricts the 

sensory stimulation of the foot, potentially 

leading to delayed stabilisation and 

inefficient movement patterns. When 

thinking about the ideal surface for your 

clients, you want to think that natural surfaces 

(wood, grass) vibrate and provide sensory 

stimulation more effectively than artificial 

surfaces (concrete, marble). 

I often say that we want to think about our 

relationship with surfaces as symbiotic. This 

means that, as our foot strikes the surface, we 

need to vibrate but so does the surface. If, for 

some reason, the surface does not vibrate, 

there is either poor transfer of energy or 

excess vibration entering our foot. Both of 

these can lead to risk of injury. 

➤ INTEGRATION OF FOOT STIMULATION IN 

PROGRAMMING 

The benefits of enhanced foot awareness can 

be applied to many aspects of fitness 

programming, including balance training, 

Olympic lifting, Pilates and conditioning. One 

of the most effective areas to integrate foot 

sensory stimulation is in the client warm-up 

or movement prep. 

If it is conducive, you want to integrate 

barefoot movement on a surface that is hard 

and made of natural material, such as a 

hardwood floor. Various textures, surface 

densities and stimuli can be added to provide 

sensory variety and to train the nervous 

system. Textured mats such as Naboso 

Technology, or vibration platforms like 

Power Plate, both provide additional sensory 

stimulation to the client’s movement. 

To take the power of the foot beyond just 

sensory stimulation, we can also incorporate 

specific training of foot-to-core fascial 

connections. 

➤ FOOT-TO-CORE FASCIAL CONNECTIONS 

The sensory side of the human foot is critical 

to dynamic movement; however, the power 

of the foot doesn’t end there. There is 

another often overlooked aspect to foot 

function that can be limited in footwear – 

foot-to-core fascial connections. 

There is a powerful interconnection 

between the deep foot stabilisers (intrinsic 

muscles) and the deep core stabilisers 

(pelvic floor, deep rotators, etc.). This 

connection is via a fascial line called the 

deep front line, which runs from the bottom 

of the foot, up the lower leg and into the 

pelvic floor and diaphragm. 

Muscles that are connected through 

fascial lines are designed to have coordinated 

stabilisation pathways that are 

fast and efficient. This speed of fascial 

connections is directly related to the 

number of sensory nerves found in fascial 

tissue. According to Robert Schleip, there 

are over 100 million sensory nerves in our 

myofascial web.⁶ 

During dynamic movement such as 

walking, the only contact point between the 

body and the ground is our foot; therefore, 

foot stability and strength is crucial to 

proper transfer of impact forces. When it 

comes to quickly and efficiently transferring 

these impact forces, the faster our feet and 

core can ‘talk’ to each other, the better our 

movement, the lower the risk of injury and 

the more efficient our gait pattern. 

The way to activate and train this 

foot-to-core connection or the deep front 

line is through an exercise called short foot. 

Originally introduced by Dr Janda, short foot 

exercise has been demonstrated to 

effectively strengthen the foot intrinsics 

while activating the foot-to-core connection. 

The following video demonstrates the 

proper execution of short foot exercise. 

Remember that the goal of this exercise is not 

just contracting the foot muscles but more so 

co-ordinating the foot contraction with the 

deep core and breath. I suggest incorporating 

this at the start of a client’s session during 

their barefoot sensory movement. 

❯ Short foot exercise 

➤ WANT TO TAKE YOUR FOOT STRENGTHENING 

TO THE NEXT LEVEL? 

As the client gets stronger in their connection 

to the sensory and fascial side of the foot, 

these concepts can be integrated into all 

aspects of their workout. From squats to 

kettlebell swings, every exercise in which the 

foot is in contact with the ground is an 

opportunity to integrate sensory and fascial 

connections. 

If being barefoot is not feasible due to the 

facility or client preference, then it is 

suggested to optimise the footwear 

environment. Can footwear with less cushion 

be used? Or can you possibly integrate a 

sensory insole by Naboso Technology? 

The more a client can connect to their 

foundation, the better their overall balance, 

posture and gait. To learn more about the 

science of barefoot training, foot-to-core 

sequencing and fascial lines, visit 

ebfaglobal.com. 

DR EMILY SPLICHAL 

a functional podiatrist and human movement 

specialist, is the founder of EBFA Global, 

creator of the Barefoot Training Specialist® 

Certification, author of Barefoot Strong and 

CEO/founder of Naboso Technology. With over 

20 years in the fitness industry, Dr Splichal has dedicated 

her medical career towards studying postural alignment and 

human movement as it relates to barefoot science, foot-tocore 

integration and sensory integration. 


KIDNEY DISEASE 

\ COACHING 

WORKING 

WITH KIDNEY 

PATIENTS 

Tim Webster outlines some 

things to consider when training 

a client who has kidney disease. 

The kidneys process the entire blood 

supply every five minutes, filtering 

out waste products and facilitating 

the passage of essential nutrients. 

The two primary threats to kidney 

health are diabetes and hypertension. 

When damage to the kidneys becomes 

permanent, it’s called chronic kidney disease 

(CKD). There are five stages of CKD. Stages 

1-3 are relatively mild to moderate. Symptoms 

like poor appetite, muscle cramps, puffiness 

and itchy skin begin to appear in Stage 4. 

And, referred to as end stage renal disease, 

Stage 5 represents almost total kidney failure, 

necessitating dialysis – a process by which the 

blood is artificially filtered and purified – 

or a transplant. 

There are two types of dialysis. Peritoneal 

dialysis can be performed relatively easily by 

the patient at home. Haemodialysis can also 

be performed at home but it involves being 

hooked up to a dialysis machine for four to six 

hours a day or eight hours at night. A 

transplant is generally considered to be the 

best treatment for kidney failure, but this 

usually involves joining a waiting list and it 

may not be suitable for everyone. 

What to consider when 

working with kidney patients 

The good news is that you already possess 

the requisite skills to work with kidney 

patients – you just need to learn about the 

constraints the disease may pose and work 

within them. Here are a few things you should 

take into consideration. 

The need to be part of a multi-disciplinary 

team (MDT) is arguably greater with renal 

patients than with most long-term health 

conditions. A good example of a situation in 

which you may require the input of a renal 

specialist is fluid imbalance. Too much fluid 

(overload) puts pressure on the heart and 

lungs, which can cause breathlessness over 

and above what the client may normally 

Things get a bit more 

complicated if the client is 

on dialysis – but nothing 

you can’t handle 

experience during exercise. The flip side of 

this is dehydration, which can affect blood 

pressure causing dizziness and fatigue. Either 

way, if you suspect that a fluid imbalance is 

becoming an issue, the renal team is your first 

port of call. 

If the client is in the pre-dialysis phase, the 

goal is to delay the need for dialysis for as 

long as possible with a combination of 

medication, nutrition and exercise. Providing 

you take symptoms like very low energy, poor 

memory, loss of strength and blood pressure 

variations into account, there’s no reason why 

you shouldn’t give pre-dialysis clients a 

simple, low-impact programme starting 

slowly and progressing as appropriate. 

Things get a bit more complicated if the 

client is on dialysis – but nothing you can’t 

handle. For example, a client on peritoneal 

dialysis is carrying several litres of fluid in the 

peritoneal cavity, which is accessed by a 

catheter. This puts pressure on the core 

muscles and increases the risk of both 

herniation and infection at the exit site. Avoid 

direct abdominal work and prone exercises 

like planks or press-ups. Swimming is also 

out unless it’s cleared by the medical team. 

And, not surprisingly, lifting heavy weights is 

off the menu. 

Haemodialysis requires direct access to the 

blood stream, which is facilitated by a fistula 

in the arm, a tunnel line in the chest, or a 

femoral line in the upper thigh. With this in 

mind, focus on light upper-body weights and 

encourage a relaxed grip. No press-ups, dips 

or planks. Swimming is OK for those with a 

fistula but not for tunnel or femoral lines. 

A kidney transplant involves a donor kidney 

being implanted in the lower abdomen with 

very little protection. Having an MDT at your 

disposal is advisable for working with all 

kidney patients but full medical clearance and 

support is particularly important after a 

transplant. Assuming that is forthcoming, and 

you ease the client into exercise, there’s no 

reason why you shouldn’t develop a relatively 

normal programme for transplantees. 

If you conduct a thorough pre-screen, start 

easy, use your common sense and make sure 

you have a productive relationship with the 

appropriate renal team, you should have no 

problem working with someone who has 

kidney disease. 

TIM WEBSTER 

A physical education graduate of 

Loughborough University, Tim Webster is 

based in Christchurch, New Zealand where 

he specialises in working with neurological 

conditions. He is a founding director 

of Exercise as Medicine NZ, which is a 

charitable trust focused on delivering condition-specific 

exercise to people living with long-term health conditions 

and teaching exercise professionals to do the same. 

Movement is 

Medicine 

Click here 

TO VIEW ONLINE 

COURSES AND 

GET STARTED 


fitpro.com | 33

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