Know your risk

Hey everyone, here’s another short, but great read for all the fitness and non-fitness pros. This month I covered an article relating to risk stratification. It’s published on the National Posture Institute’s website, but I wanted to post it below as well for easy access. Still, check out their resources and Facebook page, they have tons of certifications, CEC/CEU opportunities and educational material to help health/medical and fitness professionals.

Without further ado:

Health Screening: What You Should Do When Starting a New Exercise Program

by Nick A. Titley, M.S., NPI-Certified Posture Specialist

All of my new clients must perform a health screening process. As a personal trainer and NPI-Certified Posture Specialist™ it’s important that I perform some form of assessment and risk stratification to ensure that my clients are able to meet the demands of the new regimen. Sometimes, clients aren’t able to dive into a new routine because they are considered “high risk” due to a health related issue. In this article, you’ll learn more about the health forms and criteria that can determine your risk levels and what you need to do if you’re considered “high risk”.

If this is the first time you’re reading about health screening or assessments then this is the perfect opportunity for you to learn more. Every personal trainer and health/medical professional should take you through an assessment process. The American College of Sports Medicine website states that fitness assessments will help in the development of individualized training programs and can be used to check for heart disease and other chronic diseases.

 Assessments include Medical History forms, a Physical Activities Readiness Questionnaire (PAR-Q), a Cardiovascular Risk Factor form, Informed Consent and a Physician Clearance form. A PAR-Q will determine your readiness to exercise. A medical form will ask for detailed information like blood pressure, obesity, cholesterol levels, heart disease and stroke. It may also ask what medications you’re currently taking.

If you’ve never taken any of these assessments and you’re working with a trainer I suggest you ask them to conduct assessments because they don’t have a solid idea of who you are and run the risk of putting your health in danger.

The American College of Sports Medicine (ACSM) has created a risk stratification form that allows the professional to determine whether you’re low, medium or high risk and in need of modifications or further medical evaluation before beginning your new program.

The ACSM form examines age, family history, cigarette smoking, sedentary lifestyle, obesity, hypertension, diabetes and dyslipidemia (related to cholesterol levels) as criteria for assessing your risk level. In ACSM’s Guidelines for Exercise Testing & Prescription if you have symptoms of cardiovascular disease (CVD), or you’ve been diagnosed with a known cardiovascular, pulmonary or metabolic disease then you’re considered “high risk” and require a physician’s approval before starting an exercise program.

If there are no symptoms of CVD or a diagnosed disease, but you have less than two risk factors then you’re considered “low risk”. If you have two or more risk factors then you’re considered “medium risk”. If you fall into the low or medium risk areas then you don’t require a physician’s approval, but it’s always advised that you still see a health professional if you’re unsure about your wellbeing.

Confused about your risk? Here’s an example: If you’re currently a smoker, obese, live a sedentary lifestyle and may have hypertension and be pre-diabetic, you’re considered “medium risk”. If you have only one symptom—sedentary lifestyle or you’re a cigarette smoker— then you’re considered “low risk”. However, if you have heart disease, chest pain, known heart murmur or other signs or symptoms suggestive of a disease then you’re considered “high risk” and need to see a doctor before committing to a program.

If you’re starting a new exercise program I highly suggest you urge your professional to conduct a health screening process to find out more about your medical, fitness and health information as it will give you both a better sense of how your needs can be met while avoiding a problem. Safety is your best bet and knowing your health status is applying that principle.

Personal trainers and health professionals need to conduct a health screening process before starting a new program. If you have a known disease like CVD, or show signs and symptoms of a major problem then you’re considered “high risk” and need physician clearance. If these symptoms and diseases are absent then you could be low or medium risk. It’s advised that you still consult a doctor if you’re starting a new program or you’re unsure about your medical history.



  • Percia, Matthew, Davis Shala PhD, and Gregory R Dwye. “Getting a Professional Fitness Assessment.” ACSM | Articles. ACSM, 10 Jan. 2012. Web. 12 Mar. 2015. .
  • Thompson, Walter R. ACSM’s Guidelines for Exercise Testing and Prescription. 8th ed. Philadelphia: Lippincott Williams & Wilkins, 2010. Print.

National Posture Institute’s 2015 State of Industry Survey

Hi everyone,

I had the privilege of working on the National Posture Institute’s 2015 State of the Industry survey. For all the fit professionals who want to see the review, I’ve posted the link and the information below.

National Posture Institute (NPI) Survey Report

2015 State of the Industry Survey:  Posture, Health, and Fitness Report

The National Posture Institute (NPI) believes that posture, exercise performance, injury prevention, and education surrounding body alignment and exercise selection are important areas of concern for fitness and allied-health/medical professionals. NPI created its 2015 State of the Industry Survey to determine whether professionals were prepared to work with clients on posture correction/exercises and to review the current state of the industry and upcoming trends. This report will review NPI’s State of the Industry’s 2015 Survey results.

NPI surveyed personal trainers, physical therapists, physiotherapists, group exercise instructors, athletic/sports performance specialists, P.E. teachers, chiropractors and other allied-health, medical and fitness based professionals for this study. The majority of our respondents work as personal trainers/exercise professionals in settings such as health clubs/fitness facilities, home-based training, private practice training, corporate offices/fitness centers and college/universities. An additional group of respondents work as physical therapists, chiropractors, ergonomic specialists, athletic trainers and other allied health/medical professional in hospitals, medically-based fitness sites, sports performance sites and private clinics.

Respondents indicated that they work with a diverse client age group from young children (29%) to (80+) older adults (51%). Respondents stated their client base includes children/adolescents, stay at home moms/dads, corporate executives, office workers, athletes, academics, retirees and health/medical professionals.

As indicated on the survey, clients/patients “sometimes” inquire about posture and body alignment and 78% of professionals are actively educating them on the subject. Professionals also indicated that they generally conduct assessments on their clients. When asked about conducting posture assessments, 75% say they conduct posture assessments on a regular basis. Balance/agility skills, muscular strength and endurance assessments are also predominantly being used by professionals. When asked about corrective exercise programs, 53% say they use them. However, when asked whether corrective exercises for posture related injuries are being administered the responses were almost tied.

The survey shows that 69% of respondents have received training on how to conduct and create programs that focus on posture and body alignment. While some received little training from personal training organizations, others note that they learned some information about posture through books and/or magazine articles. The majority of respondents received educational training from the National Posture Institute (NPI); It was listed as the primary organization to learn about posture education, assessments and exercise movements.

Professionals indicated that they prefer using free weights, suspension and body weight training as opposed to commercial strength training/circuit training equipment when working with their clients/patients. The most popular exercises mentioned were: squats, lunges, step-ups, bicep and triceps curls, back rows, push-up variations, frontal/lateral raises and planks. It should come as no surprise then that exercise tubing, stability balls, body weight exercises and free weights/dumbbells took top spots when asked about the modalities being used while training.

Professionals believe that the most prevalent postural deviations seen in their clients are “forward head posture,” “rounded shoulders,” and “muscular imbalances”. They also indicated that the most common injury sites are the “lower back,” “rotator cuff,” and the “knees”. Respondents believe that the programs that could most likely cause an injury are power lifting, heavy lifting, Olympic style lifting, Crossfit and plyometrics.


The results show that fitness, health and allied-health/medical professionals are becoming more aware of posture, body alignment and exercise selection. They are actively developing programs for their clients/patients with posture and body alignment in mind. Professionals are predominantly working with clients/patients that range from ages as young as 5 (five) to 80+ years old. Respondents stated their client base includes children/adolescents, stay at home moms/dads, corporate executives, office workers, athletes, academics and health/medical professionals.

Professionals are conducting fitness and posture assessments; many of the respondents have learned to perform postural assessments and corrective exercises from the National Posture Institute. Clients/patients “sometimes” inquire about posture, but professionals that responded to this survey are actively educating them on the subject.

Fitness, health and medical professionals must continue to learn about posture and body alignment. As professionals, being aware of these areas allow for greater vigilance when selecting programs, methods and exercises for clients/patients. Professionals must continue taking the initiative and actively discussing the subject of posture with their clients/patients. Though their current responsibilities are great, professionals must not overlook the negative effects of poor posture and body alignment. Lastly, professionals must take an active role in becoming strong role models that can educate the public about proper posture, alignment and exercise performance. (For more information on posture, certifications related to fitness/nutrition/posture and more, check out the rest of their website.)

Fitness Gurus and Self-Proclaimed Experts: Why You Should Avoid Them

Fitness Gurus and Self-Proclaimed Experts: Why You Should Avoid Them

by Nick A. Titley, M.S., NPI-Certified Posture Specialist

After having a conversation with a client I couldn’t believe what someone told her about nutrition and fitness. After speaking with a self-proclaimed fitness expert she felt more drained than enlightened. The conversation stuck with me; the last straw came when I saw an “expert” incorrectly instructing someone on how to perform an exercise. After reading this article I hope you’ll understand why you need to avoid these kinds of people.

 Fitness gurus and self-proclaimed experts are everywhere. Many believe that whatever works for them will work for you and they are often the first to offer advice. They flex muscles, revealing what’s under their shirts, eagerly showcasing what they’ve attained as the proof that their advice is legitimate. You’ll be so convinced that they are experts after an interaction that you might be open toward the diet plans and exercise programs they’re willing to prescribe you even when they lack the qualifications or research to substantiate their claims.

I sat down with Akilah to discuss her experience with one of these experts. Akilah explained that she’s been on a weight loss journey and in a recent conversation she was offered nutritional counseling when she never asked for any. She explained to the guru that she added plums to her diet and he told her that she shouldn’t eat them. “He told me at my weight, my body won’t break down the sugar.” He also told her to completely cut fruits from her diet.

Akilah wasn’t satisfied with the response so she questioned it. She mentioned the difference between natural and processed sugars and reasoned that a single plum, with low sugar but full of vitamins, wouldn’t have adverse effects on her body. After her response, the expert told her to eat whatever she wanted because she “knows it all.”

If you’re a fitness guru or self-proclaimed expert that’s offering advice without any real background or training, please stop it. If you’ve encountered people like this, be careful and have no fear in challenging them. If you receive a negative rebuttal or the answers seem far-fetched then do your own research. Always ask a trained professional; it won’t hurt and most times they will confirm, or deny, the information you’re receiving.

It doesn’t stop here; unprofessional behavior also exists in the fitness industry and unqualified fitness gurus are rampant. I interviewed Thomas Johnson, Certified Trainer and owner of GetupNGetFit, and Certified Strength and Conditioning Specialist, Brett Willmott, about the subject. Thomas explained that he’d seen his fair share of these “experts” and, like Brett, voiced traits that he felt make for “bad trainers.”

Lack of attentiveness, disregard for safety, improper technique, and a lack of qualifications, knowledge and experience were on the “bad trainer” lists for both Brett and Thomas. These problems are also seen in gurus and self-proclaimed fitness experts, but the main problem with these people is the advice they’re offering. The information, while sometimes correct, might not work for you and could be detrimental to your overall goals.

While the idea of this might make you cringe, Brett ended by offering some direction. He suggested that anyone seeking help from a fitness expert should research them first. Ensure they’re qualified in the area of their instruction and always be prepared to ask questions. “With a well thought out plan, you will be on your way to an educational encounter,” he said.

For qualified fitness trainers and self-proclaimed experts, this is a wake-up call for some and a reminder for others. Even if you don’t fit the category it’s always good to think twice about what you’re discussing with someone. For anyone else, this isn’t a call to dump your trainer or question every detail, but ask yourself if you at least feel comfortable discussing questions with them. They don’t know everything, but they should at least be professional in putting that point across.

Be careful when taking advice from people who aren’t qualified in the area they’re discussing. Self-proclaimed fitness experts are easy to find, but can impart misinformation. Seek a professional and ensure that you’re comfortable asking questions.


  • Johnson, Thomas. Personal interview. 7 November 2014.
  • Willmott, Brett. Personal interview. 7 November 2014
  • Akilah. Personal interview. 4 November 2014

AL Ligament in Knee

Hey folks,

Have you seen this?! It’s a new ligament in the knee called the Anteriolateral ligament. It’s all over the news. One can only imagine how many text books and other courses need to be updated as a result now.

According to the article, despite successful ACL repair surgery and rehabilitation, some patients with ACL-repaired knees continue to experience a so-called ‘pivot shift’, or episodes where the knee ‘gives way’ during activity. Check it out here: Study on Knee