Tuesday, February 11, 2014

“It Works For Me” – Defining ‘It’.,, 
(Learn the underlying philosophies people)
A personal trainer is, technically, a health professional. Their aim is to improve a client’s health by facilitating better movement, increased strength, increased aerobic fitness, and by educating them about the importance of well-balanced nutrition.

A doctor also aims to improve a patient’s health. The patients they deal with tend to have slightly more serious health issues, and so require different methods of treatment (I am of the personal belief that exercise should be prescribed to most, if not all individuals, but that’s a different matter and irrelevant to the analogy that I’m about to draw, so bear with me).

The fundamental approach of the doctor is based on all the available evidence. They spend years learning how the various systems in the human body work and interact with each other, so they can understand what a particular pathology (an illness or disease) affects, how it affects it, how best to treat it and what NOT to do under any circumstance. They call on basic principles of anatomy, physiology, ethics, pathology, pharmacology and other topics in the medical curriculum, along with the latest advances in clinical research, and lastly their own experiences with similar situations to formulate the best action plan for their patient.

WHY SHOULD the fundamental approach of a personal trainer, coach or nutritionist be anything less?????????????????????

A personal trainer will spend roughly 6 weeks learning the basics of their craft, before being ejected into the real world to start a career as a personal trainer.

In medicine, it’s 4-5 (maybe more) years.

A doctor would very rarely turn around and say “I’m doing this because it works for me.”

He might turn around and say “I’m doing this because it works” and be able to justify:

Why this particular protocol is effective
Why he hasn’t chosen another equally effective protocol (contraindication is a key word here)

If you are a client, looking for a personal trainer, you would expect the same degree of justification – wouldn’t you?

If you are a personal trainer… can you answer those questions?

If not, it might be time to get your head back in the books, or book on to a CPD course. Because you have a responsibility to your client to provide the best possible solution to their problem –exactly the same as a doctor.

Now, I get that sports science/nutrition research often has many flaws, and often uses very small, very specific populations for its research. This makes it hard to generalise an approach that is based purely on the research!

Evidence-based practice, which brings basic scientific principles, the body of research and human experience under one umbrella, is the name of the game here.

[Note that when I say basic scientific principles, I’m not only talking about the concepts of reliability, validity, and experimental control, but also the fundamental principles of anatomy, physiology and endocrinology that underpin our basic function as human beans.]

So often people focus entirely on one aspect of the triumvirate of evidence-based practice and ignore the others. This context is where the phrase “It works for me” starts to, in my eyes, becomes at best ill-informed and at worst downright dangerous – especially if the person relies too heavily on human experience.

For example…

Low-carbohydrate diets are often recommended for weight loss. They tend to back it up with some variation on the theme of “It’s worked for me, look!”. When asked to justify further, they generally will turn around and spout something to do with chronically lowering insulin levels, which leads to less fat storage because insulin is a ‘storage’ hormone and other such hypotheses.

For rapid weight loss, cutting carbohydrate does work. As we know, it will reduce glycogen stores in the muscle and liver (and the associated water that it is stored with), and you are also eliminating a food group that is pretty calorie-dense, and often makes up a significant portion of someone’s diet. By simultaneously increasing protein and fibre intakes, feelings of satiety are increased which makes the diet potentially sustainable. Ta da! Magic.

Or… not. Hey presto, it reverts back to the fact that you’ve slashed someone’s calorie intake, so they lose weight.

What we can see here is confusion as to exactly what “it” is that has worked for an individual. Whilst people claim “it” is the magical insulin that has caused them to lose fat, “it” is not. Contributing factors are:

The fact that their caloric intake has been reduced and that they’re initially shedding a lot of stored water which has contributed to their weight loss.
Also, if they’re working with a trainer, it’s likely that their activity level will have changed, which alters their caloric expenditure.
They may also be less stressed because they’re finally seeing some changes within their body that they’ve been unhappy with for years, and so maybe they’re sleeping better.
They may be responding very well to the increased protein, fibre and fat intakes, so their energy levels aren’t horrendously low.
They really enjoy eating the foods that they’re currently eating so that they can adhere to the diet.
So, in the case of a low-carbohydrate diet, “it” is defined by the correct application of the basic scientific principles and thorough analysis of the client’s circumstances. This is why blanket prescriptions of various training or nutritional interventions are missing the bigger picture – everyone has different circumstances, and so will require a slightly different approach.

Knowing which approach to take requires evidence-based practice. You need to be able to recall the basic principles of how the body works, whilst simultaneously analysing the relevant scientific literature and also the circumstances in which certain training or nutrition interventions have either succeeded or failed. Only then can you truly be confident that the approach that you decide on for a particular client is appropriate, and should help them achieve what they came to you for.

A personal trainer is NOT a doctor. However, I believe that the fundamental approach to dealing with a client should be no less rigorous than that of a trained medical professional.



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