Hard-to-Recognize Heart Attack Symptoms

June Chewning, BS MA

In my 38 year career and 18 years owning a fitness center, I know heart attacks happen.  I have heard about them when members went home, sat up in bed, and dropped dead next to their spouse after a visit to the gym. I have made the ambulance ride to the hospital with them when they thought they just pulled a chest muscle, but their pulse and blood pressure were erratic. When they went back to work after a lunch time work out to look up the symptoms of heat attack on Google and realize it was happening to them right then. When they couldn’t figure out why their calves hurt so bad when they exercised, and when told to stop exercise and consult their physician had triple by-pass surgery the next day.  When my friend’s sister had a massive heart attack at age 40 because they thought she had a bruise instead of a blood clot in her leg.  When a young teacher thought she had the flu from her kids at school and went home early from aerobic class feeling nauseous and dropped dead at the threshold of her apartment.

Health-Fitness professionals, heart disease is the leading cause of death  in the US.  You will encounter it.  Be prepared and get educated. Be aware and vigilant about seeing the tell tale and not so obvious symptoms in your clients.  Save a life…

Healthy Heart, Healthy Life
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This article is from
the American Heart Association
Go Red for Women Program

Well-known heart attack symptoms can include chest pain and radiating discomfort in the left arm. But, as Dr. Suzanne Steinbaum explains, there are several other ways your body may tell you when something isn’t quite right, potentially with your heart.
Read on for details on four silent heart attack symptoms that women should most definitely be aware of.

Shortness of breath
According to Steinbaum, director of The Heart and Vascular Institute at Lenox Hill Hospital in New York City, women often struggle to breathe a few weeks before experiencing a heart attack.
“If you are used to doing a certain amount of activity and then, all of a sudden, you can’t get enough air, that is when I get concerned,” says Steinbaum.

Back pain
Irregular pain in the lower or upper back can indicate stress to the heart muscle, Steinbaum says.

Jaw pain
“I had one patient who would feel her jaw start to hurt every time she got on a treadmill,” Steinbaum says. “But once she stopped, her jaw pain would go away. She went to a dentist, but there wasn’t anything wrong with her teeth.”
This discomfort continued until the woman experienced a heart attack. When she came into Steinbaum’s office after the event, it was evident that the jaw pain was directly linked to what was happening in her heart.
“Sometimes the heart isn’t able to give a good signal and, instead, the pain can radiate to the neck, jaw and back,” she says.

Flu-like symptoms are often reported weeks and days before a heart attack. In fact, as Steinbaum explains, TV personality Rosie O’Donnell reportedly regurgitated a few times before she experienced a heart attack in early 2012.

Advice: Trust Your Gut
If you aren’t feeling normal or are experiencing any of the symptoms above, head to you local emergency room. It is better to take care of yourself and prevent damage to your heart, in the event you are having a heart attack.
“A women’s intuition is a very strong thing; don’t ever discount it,” Steinbaum says.
“Ninety percent of my women patients who’ve just had a heart attack tell me that they knew it was their heart all along. That they just had a feeling.”

Alzheimer’s Disease: Part 1

About Alzheimer’s Disease
Adapted from the Medical Fitness Specialist Certificate Program by Alzheimer’s Research and Prevention Foundation: Alzheimer’s Disease Prevention and Intervention.
(Article 1 in a 3-part series about Alzheimer’s disease.)

dreamstimemedium_32992482Although there are natural physiological changes that occur with age, memory loss is neither normal nor a natural process of aging. It is important to take a proactive role in retaining the strength, resiliency, and vitality of the brain. Research has shown that just as the body needs strength-building exercises to maintain muscle strength, so does the brain.

The brain goes through natural changes with age. However, mental decline may be preventable and even reversible with appropriate and adequate stimulation. Studies have shown that by keeping mentally active, cognitive deterioration may be reduced and even avoided. (The Power of Brain Aerobics: Maximize Your Memory 2016) Rigorous mental activity may also improve the mind and memory in those who are starting to show signs of mental deterioration.

Signs of Normal Change vs. Early Alzheimer’s Symptoms
Alzheimer’s Disease: Symptoms, Stages, Diagnosis and Coping 2016
Reprinted with permission from helpguide.org
Normal Early Alzheimher’s Disease
Can’t find your keys Routinely place important items in odd places, such as keys in the fridge, wallet in the dishwasher
Search for casual names and words Forget names of family members and common objects, or substitute words with inappropriate ones
Briefly forget conversation details Frequently forget entire conversations
Feel the cold more Dress regardless of the weather, wear several shirts on a warm day, or shorts in a snow storm
Can’t find a recipe Can’t follow recipe directions
Forget to record a check Can no longer manage checkbook, balance figures, solve problems, or think abstractly
Cancel a date with friends Withdraw from usual interests and activities, sit in front of the TV for hours, sleep far more than usual
Make an occasional wrong turn Get lost in familiar places, don’t remember how you got there or how to get home
Feel occasionally sad Experience rapid mood swings, from tears to rage, for no discernible reason

There are 47.5 million people suffering from dementia worldwide, with 7.7 million new cases each year. The most common cause of dementia, Alzheimer’s disease, makes up 60-70% of cases. (Dementia 2016) Millions of Americans are challenged by Alzheimer’s disease and other forms of dementia. In 2016, an estimated 5.4 million Americans of various ages are diagnosed with Alzheimer’s disease, and approximately 5.2 million of those are ages 65 and older. (Alzheimer’s Disease Facts and Figures 2016)

Although Alzheimer’s is not a new illness, it seems like it has become a household name. The reason for this accelerated trend is that people are living longer now than ever before in history, which is causing the exponential growth of the number of cases of Alzheimer’s disease. Seniors age 85 and older unfortunately have a 50% chance of developing this disease. In addition, women are more prone to have Alzheimer’s, partially because they live longer than men. In addition, Alzheimer’s disease and other dementias are one of the most expensive chronic diseases. Approximately $46 billion (19%) of the cost of the disease is out-of-pocket spending, which creates a considerable personal financial burden for the families of those with the disease. (Alzheimer’s Disease Facts and Figures 2016)

There are a number of risk factors that may lead to cognitive decline. (Adapted from Alzheimer’s Risk Factors 2016 and 2016 Alzheimer’s Disease Facts and Figures 2016)

  • Age. There is a greater incidence of cognitive decline with age. Most experience the disease at 65 years old or older, however, some can also develop the disease at a younger age. Older age is not sufficient enough alone to cause the disease.
  • Family History. A first-degree relative (mother, father, or sibling) with Alzheimer’s increases your risk up to seven times greater that you may develop the disease.
  • Genetic Predisposition. Everyone inherits one of three forms of the APOE gene from each parent. There is an increased risk of developing the disease later in life if a person has two APOe-4 genes. However, this does not guarantee the disease will develop.
  • Stroke. Brain health is closely linked to the overall health of your heart and blood vessels. A healthy heart ensures enough oxygen and nutrient-rich blood is supplied to the brain so that it functions properly. Stroke is typically caused by vascular disease, including blockage in the carotid arteries that supply the brain.
  • Depression. Depression and lack of social involvement, interaction, or connection, as well as loneliness, have been linked to increased risk for Alzheimer’s.
  • Head/Brain Injury. A head/brain injury is defined as a disruption in normal brain function caused by a blow/jolt to the head or penetration by a foreign object to the skull. Moderate and severe traumatic brain injuries (TBI) increase the risk of developing dementias, including Alzheimer’s disease. Those who have had repeated TBIs are at a higher risk of dementia, neurodegenerative disease, and cognitive impairment.
  • Lack of Adequate Sleep. Sleep deprivation leads to increased risk of many chronic diseases including cardiovascular disease. There is an increasing body of research about the implications of inadequate sleep on the brain. It’s believed that while you sleep, the brain clears out harmful toxins, a process that may reduce the risk of Alzheimer’s. A breakthrough study on mice showed that, during sleep, the flow of cerebrospinal fluid in the brain increases dramatically, washing away harmful waste proteins that build up between brain cells during waking hours.
  • Cardiovascular Disease and CVD Risk Factors.
    • Smoking
    • Diabetes
    • Hypertension (high blood pressure)
    • High cholesterol
    • Physical inactivity
    • Obesity

Most experts believe that Alzheimer’s disease, similarly to other common chronic diseases, develops as a result of multiple factors versus a single cause. They also support the idea that some risk factors can be controlled by making smart lifestyle choices.

One thing that permeates the research about cognitive decline is the role that exercise plays in prevention.  Existing drugs at this time treat only symptoms and do not stop the progression of Alzheimer’s disease which is fatal.  Since there are no drugs that cure the disease, prevention becomes critical, and exercise is a very important element in prevention of Alzheimer’s disease.

arpf_seal_of_approval_colorThe information in this article is taken from the “Introduction to Alzheimer’s Disease” course, the first course in a two-course 11 hour Medical Fitness Specialist Certificate Program: Alzheimer’s Disease Prevention and Intervention. Stay tuned for Article 2: Prevention of Cognitive Decline and Alzheimer’s.

Alzheimer’s Disease Prevention and Intervention
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American Breast Cancer Foundation (ABCF) Colaboration

The American Breast Cancer Foundation (ABCF) is collaborating with the Medical Fitness Network (MFN) and Fitness Learning Systems (FLS) to sponsor and promote the Breast Cancer Recovery and Prevention Specialist Certificate Program for fitness industry professionals.

Click here to see Press Release

Chronic Disease and Exercise

Chronic Disease: Unavoidable
By: June Chewning MA, BS

My brother once told me that “if you are born, you have a 100% chance of dying.” The other inevitable fact is that you have to die of something. Although neither of these statements is pleasant to contemplate, the reality is that at one point or another in most people’s lives, chronic disease is unavoidable. Chronic disease infiltrates the aging process, creates quality of life issues, and can in some cases be life altering.
Clients with chronic disease are also unavoidable. They are prevalent in the population in large numbers, and need health-fitness professionals to help them prevent, manage, and live a better life with the disease. With almost every chronic disease, research clearly indicates that exercise plays a role in prevention, recovery, and management of the disease.
One of the best ways to prepare yourself to work with clients with chronic disease is to educate yourself about the etiology, progression, and prevention of the disease so that you can safely and effectively use exercise as a tool to improve function and quality of life. With the need for medical fitness becoming more respected and sought after, proper knowledge becomes essential to safe and effective intervention.

Here are 4 Chronic Disease tips to help you move toward better practice with chronic disease clients.
1. Proper health history and risk factor analysis is critical to the foundation of working with clients with chronic disease. Use it to discover presence of disease and possibly multiple diseases, risk of disease to apply prevention strategies, history of disease progression, and current function and activity levels to establish a starting point. In chapter 10 of the ACSM Guidelines for Exercise Testing and Prescription 9th edition, there is a great section with information and guidelines for working with Individuals with Multiple Chronic Diseases and Health Conditions.
2. Prevention of hypoglycemia (low blood sugar) is important for a safe exercise program for someone who has diabetes. If you work with someone taking insulin or an oral medication that may cause hypoglycemia, you should be aware of symptoms and how to manage this situation especially during exercise. Hypoglycemia occurs when glucose levels are < 70mg/dl. This condition may become worse if not treated. Prevention is the best intervention.
Symptoms may include:
• sweating
• shaking
• dizziness
• headache
• confusion
• irritability
• hunger
• personality change
• weakness
• vision changes
• seizures and/or loss of consciousness.
3. When working with cancer patients and survivors, avoid high intensity resistance training for muscles located under or near a port or a PICC line. (A port is an implanted venous access port or totally implanted port used to insert treatments like chemotherapy into the blood stream and a PICC line is a permanently inserted flexible tube for long term intravenous medicine or treatments.) A PICC line is inserted in the upper arm or the fold in the elbow. The port is normally implanted under the skin in the upper chest (pectoralis area), but can be inserted in the back of the upper arm (triceps area) or in the abdominal area.
4. When working with clients with Respiratory disease, it is important to do a longer warm up and cool down for clients with asthma, COPD, and other respiratory issues. Choose an appropriate, lower demand cardiorespiratory activity for beginner or compromised clients such as cycling or walking. Switch to a lower demand exercise during periods of respiratory condition flare ups. Teach the client proper breathing techniques. There are breathing exercises such as “Pursed Lip Breathing” or “Diaphragmatic Breathing” that help with shortness of breath and the anxiety, fear, and embarrassment that may be present.


Fitness Learning Systems offers a Specialist Certificate Program for the 4 most prevalent Chronic Diseases. The Chronic Disease and Exercise Specialist Certificate Program contains 5 interactive online courses: Health Appraisal and Risk Assessment (3 hours); Healthy Heart for a Healthy Life (3 hours); Essential Exercise for Cancer Patients and Survivors (2 hours); Exercise, Diabetes, and Metabolic Syndrome (3 hours); and Respiratory Rescue-Understanding the Pulmonary Dysfunctional Client. (3 hours). Join the Medical Fitness profession and market yourself as a specialist by continuing your education with this 14 hour Specialist Certificate. All courses carry IACET CEUs.  Go to Course Chronic Disease and Exercise Specialist Certificate Program

About June Chewning
June has lead in many aspects of the fitness industry since 1978 including teaching physical education and aerobic classes, personal training, employee wellness, facility owner, college professor, and aquatic fitness professional training specialist. Currently she is president of Fitness Learning Systems and enjoys working with authors and organizations to format and develop accredited interactive continuing education eLearning courses.

Restore the Core – Step 1 Regain Mobility

By:  Chris Kelly CSCS (NSCA), CES, PES (NASM)

This information is from Chris Kelly’s eLearning continuing education course:
Restore the Core: Integrated Core Training for Real World Function.  See the full course for additional core assessments with video, and several core exercises and progressions with videos.
Part 2 of the Core Series is Core Complete Training: A Systematic Approach for Aesthetic Core Development by Chris Kelly.


Five Step Process for Restoring the Core
Much like a weight belt, the abdominals tighten around the spine to provide support during exercise or daily tasks such as bending over and rotating. Contracting the abs in this fashion is known as an abdominal brace.

While this reaction happens automatically with healthy adults, a lack of conscious control or a poor understanding of how to do it during exercise is often related to a host of issues such as back pain and weakness of core muscles deep inside the body.

While the outer core consists of the visible stomach muscles (rectus abdominis, internal and external obliques), the muscles of the inner core are located close to our joints (multifidus, diaphragm, pelvic floor and transversus abdominis).  Although these muscles are too weak to actually move the limbs, their function is to contract isometrically before movement occurs to stabilize the joints.

The most important thing to understand about this idea is that these muscles must fire before any movement takes place to allow stability to occur. Interestingly, a timing delay in this reaction has been found to exist in clients with chronic back pain illustrating the fact that the presence of chronic or acute pain can throw off the way the inner core fires and stabilizes the body.

By contrast, the muscles of the outer core are responsible for moving or preventing motion of the extremities and trunk after the inner core muscles have fired.  A common error made in training programs for clients who are de-conditioned or returning from injury is an over abundance of outer core training without re-establishing control of the inner core muscles. The first step in a progressive core training program is to establish the status of the muscles of the inner core as well as whether the client possesses conscious abdominal control.

This is accomplished via assessments as well as subjective observation. Once the need for this type of training has been established, the goal of the program becomes bringing these muscles back to function while teaching conscious control of the abdominals.

We use a simple five step process for restoring the core to increase function for abdominal training as well as daily life.

Step 1: Regain Mobility

One of the more important concepts in fitness and/or rehabilitation is mobility before stability. If a joint does not possess the ability to move correctly, it can only stabilize through its limited range of motion.  With this in mind, the first order of business is to get your client to stretch and use the foam roll for the following muscles:

  1. Psoas and Quadriceps
  2. Gluteus Medius and Gluteus Maximus
  3. Latissimus Dorsi
  4. Hip Abductors and Adductors

These muscles directly act upon the pelvis and are often tight and restricted.

In creating the mobility program for a client, consider the following:

  • Identify the basic purpose of myofascial release (foam rolling.)
  • Determine the number of rolls per muscle the client should perform on each area.
  • Determine the primary areas targeted for foam rolling and stretching.
  • Identify the order of foam rolling, stretching and hip mobility in the warm up process.


About the Author
Chris Kelly is an experienced fitness journalist, speaker, and strength coach. With over ten years in the fitness industry, Chris’s experience spans from work in rehabilitation settings to strength and conditioning for athletes.



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Restore the Core – Step 2 Breathe and Brace

By:  Chris Kelly CSCS (NSCA), CES, PES (NASM)

This information is from Chris Kelly’s eLearning continuing education course:  Restore the Core: Integrated Core Training for Real World Function.  See the full course for additional core assessments with video, and several core exercises and progressions with videos.
Part 2 of the Core Series is Core Complete Training: A Systematic Approach for Aesthetic Core Development by Chris Kelly.

Five Step Process for Restoring the Core
Much like a weight belt, the abdominals tighten around the spine to provide support during exercise or daily tasks such as bending over and rotating. Contracting the abs in this fashion is known as an abdominal brace. We use a simple five step process for restoring the core to increase function for abdominal training as well as daily life.

Step 2: Breathe and Brace

After foam rolling and stretching, the session continues with a simple drill to teach the client to re-establish deep breathing. This exercise can be seen as a “bang for your buck” movement because we are training the diaphragm while relieving stress and tension getting the client into the right frame of mind to exercise.

This drill can be performed by asking the client to inhale deeply through the nose while expanding the stomach, hold the breath for a slow three count and release through the mouth. At the same time, watch the position of the chest to ensure it is not rising.

While it will likely take several sessions for the client to gain an understanding of this method of breathing, practicing this drill both in your warm up and as homework will improve conscious control of this breathing pattern until it becomes unconscious habit.

Once the client has gained a working understanding of breathing, the next concept is to re-establish conscious abdominal control. This can be done by teaching them to actively “brace” or contract their abs.  A brace involves tightening the abs as if to avoid being poked in the stomach.

This drill can be practiced by placing one hand on the stomach and one hand slightly above the small of the low back.  Apply pressure by pushing into the stomach while tightening your abs to resist. You will feel your back extensor and abdominal muscles simultaneously tighten. Beginners should hold each brace for 5-10 seconds and then release several times to become familiar with this action. As this becomes easier, the length of each hold increases while the client breathes normally.

The ultimate goal of bracing is to consciously tighten the abs to stabilize the trunk against movement of the extremities. While bracing only requires around a 20% abdominal contraction for daily life activities, these demands are greatly increased during tasks which require increased stability such as resistance training or sports.  The trick is to “tune” the brace by allowing contracting as much as necessary in given situations.

With this in mind, the final bracing progression incorporates leg movement while breathing and bracing normally.

About the Author
Chris Kelly is an experienced fitness journalist, speaker, and strength coach. With over ten years in the fitness industry, Chris’s experience spans from work in rehabilitation settings to strength and conditioning for athletes.

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