Several researchers have established a relationship between our attitude and feelings towards exercise and our physical activity habits. In general, a positive attitude typically equates to being more physically activity. For example, the work of Carol Dweck, a prominent professor of psychology, has shown that having a growth mindset (in contrast to a fixed mindset) may help to alleviate many of the psychological barriers that prevent us from being physically active.

In general, individuals with a growth mindset:

1. Believe that skills can be improved
2. Focus on the process of learning.
3. View effort as useful and can lead to growth and development
4. Embrace challenges and frame them as opportunities
5. Consider mistakes as a vehicle to learn
6. Encourage constructive feedback

In general, individuals with a fixed mindset:

1. Believe that skills are born and can only be marginally improved with practice
2. Focus on performance outcomes and try to avoid looking bad
3. View as unnecessary for growth and development
4. Consider challenges as threats
5. Become frustrated by making mistakes
6. Take constructive feedback personally (they get defensive).

Check out the Mindest Questionnaire at http://performanceredefined.ca/posters/ to see how growth minded you are!

Next time you find your self with limited time and no access to a gym challenge yourself with one of the bodyweight workouts below. Enjoy!

Workout A: 20 Minutes of Fun!
Push-up x 30s, Squat x 30s, Inverted row x 30s , Jumping jack x 30s
Repeat 10 times without resting. Vary your tempo to make the workout more or less challenging.

Workout B: 450 Rep Challenge!
Push-up x 15, Squat x 15, Inverted row x 15
Repeat 10 times, resting as needed. Vary your body angle (push-up and row) or tempo (squat) to make the workout more or less challenging.

Workout C: A Need for Speed!
Push-up x 5-10 as fast as possible (max 10s), Squat x 5-10 as fast as possible (max 10s), Inverted row x 5-10 as fast as possible (max 10s)
Begin every 30s, repeat 10 times. Vary your body angle (push-up and row) to make the workout more or less challenging.

STUDY BACKGROUND

Firefighters are commonly exposed to extreme environments that challenge their ability to perform safely. Over the past several years, tremendous efforts have made to reduce the incidence of fires and fireground injuries; however, there has also been a rise in the number of injuries sustained while attending to non-fire emergencies and engaging in exercise and physical training. To better understand this injury problem so that an appropriate prevention strategy can be developed we need more information about the injuries that are being sustained. At present, it would be challenging to create an intervention to prevent “leg” injuries that occur while “training”, or “trunk” injuries caused by “overexertion”. Linking injury reporting to firefighters’ movement patterns may provide insight into the postures and motions that are contributing to the injury problem, regardless of the occupational activity being performed.

STUDY DESIGN

This study examined the injuries sustained by the Calgary Fire Department (CFD) between 2007 and 2011. In 2011, the CFD consisted of 1363 uniformed personnel operating out of 37 stations. Members responded 100,695 times to 50,520 incidents, the most common being medical emergencies (46%), false alarms (17%), hazardous conditions (16%), investigations (9%), and public service assistance (7%). Only 4% of all dispatches involved fire suppression activities. All included injuries resulted in medical treatment, restricted work duties or lost time. Injuries were described by type (i.e. sprain/strain, cut, etc.), body part affected, job duty, and the general motion pattern employed at the time of injury, which included: 1) bending, lifting and squatting; 2) jumping and landing; 3) lunging and stepping; 4) running; 5) pushing and pulling; and 6) sitting.

KEY FINDINGS

Over the 5-year span, 1311 injuries were reported, of which 64% were sprains and strains. The most common were those affecting the back (32%), knees (17%), ankles (15%) and shoulders (13%). Categorized by job duty, 33-45% of all back, knee, ankle and shoulder injuries occurred at the fire station, while 27% were attributed to exercise and training. Only 15% of all sprains and strains were sustained while attending to fires.

Irrespective of job duty, 70% of all back injuries were related to lifting, bending and squatting, 81% of all knee injuries were associated with lunging and stepping, and 99% of all shoulder injuries were attributed to pushing and pulling.

IMPLICATIONS

1. Firefighter injuries are not just a fireground problem

Only 14% of all injuries were sustained during fireground operations. While differences in the on-duty responsibilities, community demographics, and climate of the participating department may have influenced the findings, they are consistent with those reported in the past few years from fire departments across the United States. Over the 5 years examined, the majority of injuries were sustained while attending to fire station-related responsibilities and participating in exercise or physical training. These findings may reflect the fact that there are fewer fires, and a greater emphasis is being placed on firefighter wellness and fitness (i.e. more time being active); however, it does not diminish the scope of the injury problem. Instead, it highlights the reason why specific information is needed to develop targeted injury prevention strategies for any workplace.

2. Categorizing injuries by movement pattern may improve our prevention efforts

Irrespective of job duty, the general movement pattern used at the time of injury was strongly associated with the type of injury sustained – 70% of all back injuries were lifting-related, 81% of all knee injuries were lunging-related, and 99% of all shoulder injuries were pushing- and pulling-related. This finding also highlights the fact that the associated job duty could not distinguish the types of injuries sustained, perhaps because firefighters lift the same way whether attending to a medical emergency, exercising in the gym or completing a station-related activity. However, it also for this reason that there may be merit in developing prevention strategies that focus on the (re-)training of general movements that are common to a variety of job tasks. In other words, an emphasis could be placed on changing firefighters’ movement habits in an exercise or training environment so that new patterns emerge while performing other relevant job- and life-related activities. All firefighter injuries will never be avoided, but documenting the associated movement patterns will help to reduce the risk of sustaining similar injuries in the future.

STUDY BACKGROUND

There are countless reasons why we move in a particular manner. Factors such as hip mobility, hamstring length, gluteal strength, perception of risk, prior experience, focus of attention, motivation, and simply being aware of the fact that movement matters can influence how we perform any given task. For this reason, assuming that any specific pattern is the product of “movement dysfunction” and in need of “corrective” exercise may be entirely unfounded.

The Functional Movement Screen (FMS) is a seven-task test that was developed as a low-cost means to “red-flag” potential problems that may predispose us to future injury. However, at present, there is no evidence to suggest that a particular FMS score accurately or reliably reflects the presence of movement “dysfunction”. Deficits in joint mobility and/or stability could certainly impact individuals’ FMS scores, but their scores may also be influenced by their awareness and appreciation for the criteria being used to grade performance.

STUDY DESIGN

Twenty-one firefighters (19 men, 2 women) were recruited to participate. All firefighters were free of musculoskeletal injury and pain at the time of testing and on full active duty. The study was designed to examine whether knowledge of the FMS grading criteria influenced FMS scores. Upon arriving for the testing session, the FMS was administered using published verbal instructions. No feedback was given, nor were the objectives of the screen described. Within 3 minutes of completing this initial test, participants were asked to perform the FMS a second time. However, this time they were provided with a verbal description of the criteria used to grade each of the seven screening tasks immediately prior to performing. The instructions provided were standardized across participants and no specific feedback was offered regarding any individual’s original FMS score. A research assistant blinded to the testing procedures graded the pre- and post-screens using video.

KEY FINDINGS

The firefighters’ mean (SD) FMS score increased significantly from 14.1 (1.8) to 16.7 (1.9) when they were provided with knowledge of the grading criteria. Significant improvements were also noted to four of the seven individual task scores (Deep Squat: 1.4 (0.7) to 2.0 (0.6); Hurdle Step: 2.1 (0.4) to 2.4 (0.5); In-line Lunge: 2.1 (0.4) to 2.7 (0.5); and Shoulder Mobility: 1.8 (0.8) to 2.4 (0.7)). With the exception of the Shoulder Mobility screen in which there is only one criterion, participants’ improvements could not be attributed to a single observation.

IMPLICATIONS

1. FMS scores may not reflect the absence/presence of movement “dysfunction”

Deficits in joint mobility and/or stability could certainly impact FMS scores; however, so too could performers’ perception of risk, prior experience, understanding of the task, focus of attention, motivation, and awareness of the grading criteria. The firefighters in this study improved their FMS scores within minutes of being told what movement patterns were required to achieve a perfect FMS score. Therefore, it would be inappropriate to assume that someone’s movement patterns are the direct result of a specific “dysfunction” or “impairment” that could be rectified via “corrective” exercise. Furthermore, a movement screen such as the FMS may lose its utility to evaluate the transfer of training or predict one’s risk of injury if the performers have knowledge of the tasks’ grading criteria. Whether or not the FMS becomes a viable means to predict future injury, the results of this study suggest that future efforts should not be directed to improve individuals’ performance on the test itself given that this objective could be accomplished artificially without actually impacting injury risk or athletic/occupational performance.

2. Our movement patterns are influenced by load, speed, etc.

Movement is context dependent, which implies that attempts to predict how someone performs a high-demand (e.g. load, speed) sport-, occupation- or life-related activity with a low-demand screen could be prob lematic. This notion is illustrated in the figure. In addition to performing the FMS, the firefighters in this study were asked to perform two simulated job tasks. Despite receiving FMS scores of 16 and 20 on his pre- and post-feedback screens, respectively, the individual shown exhibited substantial frontal plane knee motion and a large frontal plane knee moment while advancing hose. Both of these measures are risk factors for ACL injury. The inclusion of higher demand tasks may not tell us exactly why the particular movement pattern was adopted, but they could help to establish more appropriate recommendations for training.

Commonly cited barriers to regular physical activity include:

1. Not enough time. But…every little bit counts. Whether 5 minutes, 20 minutes or 2 hours, physical activity of any kind and any length can provide health benefits. There is also evidence that just 3 minutes of high intensity exercise can elicit health benefits.
2. Too tired or no energy. But…exercise can help. Being active in the morning or taking small physical activity breaks throughout the day can boost energy levels and combat the effects of a busy work/life schedule.
3. Too lazy or no motivation. But…schedule an appointment. If lacking the motivation to be active or consistently putting things off “until tomorrow” scheduling time for yourself can help to change an existing behavior. The support and encouragement provided by a peer group can also be a powerful motivator in both the short- and long-term. Challenge your friends to something fun!
4. No support or encouragement. But…join an exercise community. Whether a group exercise class, running group or sport and social league, there are several options available to meet new friends, try something new and build a sense of community.
5. No money. But…it can be cheap. Go for a walk, a run or swim at the beach. Climb the stairs or ride your bike to work. Perform a bodyweight circuit in your living room. There are many options that don’t cost anything.

Practical tips to be active every day in as many ways as you can

But, to make exercise matter – to ensure its impact extends beyond the training environment – we must always remember the reasons why we are exercising in the first place. For most of us, exercise is a means to improve safety or performance at work, maintain a fitness level so that recreational activities such as golf or hiking can be enjoyed, or support a healthy lifestyle long into retirement.  Regardless of our motivation to be physically active, adherence in the long-term will be likely be tied to the extent to which we see a direct benefit to our quality of life. In other words, we must perceive benefit from the exercise!

Building on theoretical foundations of exercise science, biomechanics, ergonomics, motor learning, physiology, psychology and coaching, several researchers have started to explore the utility of exercise to change behaviors. For example, performing a particular exercise or group of exercises repeatedly in a semi-controlled environment has shown to elicit changes in the way that performers move while completing a range of unrehearsed tasks of varying loads and speeds. However, the direction of change (whether they get better or worse) appears to be influenced by the instructions and feedback provided while exercising, and the attention that is given to how each exercise is performed.

When an emphasis was placed on select key movement patterns that have been associated with a higher injury risk and poor performance (e.g. control of spine flexion and frontal plane knee motion), firefighters’ movement patterns improved post-training. In comparison, when an emphasis was placed on fitness alone, the firefighters exhibited less control of their low backs and knees following the exercise intervention in comparison to before they started. Frost et al. J Strength Cond Res 29(9): 2441–2459, 2015.

One of the most important factors to elevating our capacity is the realization that the way we move every single day can have a dramatic impact on our lives. If exercise is viewed as a way to establish desirable movement behaviors, there is evidence to suggest that an emphasis should be placed on engraining select key movement features (e.g. spine and frontal plane knee motion control) that have been shown to be or cited as possible injury mechanisms, or performance-limiting factors. Against this backdrop, exercise can and perhaps should be used strategically to stabilize or engrain these desirable patterns using a variety of frequencies, intensities, times and types of activities such that they emerge and persist in relevant activities beyond the exercise environment.

Using a range of loads, speeds, activities, etc. to improve a performer’s control and coordination of these key features is critical to the transfer of exercise since it would not be possible to practice every possible activity they may encounter in life. Instead, introducing gradual changes to the demands, complexity of the activity, and training environment could alter the habitual patterns used to perform several life-related activities without having to replicate these exact tasks. In fact, there is evidence to suggest that there may be attributes, or “key features”, of an individual’s movement behaviour that are common to a range of activities. The hope is that a desirable behavior emerges as a new habit.

Although exercise provides an excellent opportunity to engrain desirable behaviors such as spine and frontal plane knee motion control, rehearsing an undesirable movement pattern could lead to undesirable consequences. Attention must be given to how we exercise to maximize the potential benefits. Having great strength, endurance and aerobic capacity will have little influence on our safety, performance and quality of life if we move in an undesirable manner. It is often stated that practice makes perfect; however, the truth is that practice makes permanent. Only perfect (deliberate) practice makes perfect. Bad practice leads to bad habits.

While intrinsically motivated (e.g. active for enjoyment, excitement and challenge) people are more likely to maintain a physically active lifestyle in the long-term (i.e. adherence), extrinsic motives can (and perhaps should) be used along the way to engage, excite and empower. Extrinsic factors can motivate us to start something new, persevere, and redefine performance. However, one of the potential limitations to being motivated in this way is becoming complacent when the incentive disappears. This is why knowing what factors regulate our motivation to exercise can help to create a physically active lifestyle – one in which small steps are made every day to cultivate a growth mindset, develop physical literacy, and maximize quality of life.

Central to this integrated approach is an evidence-informed framework that can be easily adopted and understood by all parties involved – every employee needs the capacity to meet the demands of their life. This model provides an excellent foundation to establish recommendations or to create resources by emphasizing the application to employees’ lives. Streamlining the continuum of care and delivering a consistent message (this is for you!) will provide every employee with the opportunity (and motivation) to reduce their risk of injury and disease, improve their health and wellness, and enhance the overall quality of their life.

The Case for Wellness

It is commonly stated that focusing on treatment instead of prevention has created a “sick care” system (not “health care”) in which much of the available funding for health and wellness is spent in reaction to people getting hurt or sick. In this model, most professionals (e.g. physicians, chiropractors, physical therapists, occupational therapists, exercise specialists) treat clients in response to developing or existing problems. Unhealthy, unsafe and stressful work environments can cost employers billions of dollars annually because funding is allocated to these short-term and reactionary initiatives.

However, recent initiatives are helping to create a “proactive” health care system by encouraging the development of wellness and prevention strategies. Placing an emphasis on workplace wellness has consistently shown a return on investment of $2 to $8, which for a large organization amounts to millions of dollars saved annually by investing in employee health. In general, a workplace should only be considered healthy if it addresses the physical environment, personal health resources and the organizational culture.

A Practical Example from the Fire Service

In 1996, the International Association of Fire Chiefs (IAFC) and Fire Fighters (IAFF) launched a Wellness and Fitness Initiative (WFI) to improve the health, fitness and overall quality of life of firefighters across North America. Fire departments who implement the WFI must develop a program that is agreed upon by both labor and management, mandatory, non-punitive and confidential, and specific to firefighters’ physical and psychological needs.

Although the WFI is structured to ensure that firefighters are fit, healthy, and able to handle the unpredictable, physically demanding nature of the job, it is well know that each individual is not just a firefighter. They are are also a father, mother, brother, sister or friend who happens to have a demanding occupation. For this reason, the WFI is as much about preparing firefighters for the job as it is preparing for life, both while working and long into retirement.

As a first step, the WFI highlights the importance of inspiring change. One of the first and most important factors of the initiative is gathering information regarding the attitudes of the members and organization as a whole. The WFI exists to inspire each and every firefighter, whether they are new to the department or nearing retirement. This is arguably the most important step in developing a wellness initiative – to implement any large-scale change requires that employees be open-minded and willing to participate (i.e. buy-in is critical!).

The WFI also provides evidence-based information to help shift firefighters’ perceptions of wellness, fitness and exercise. Knowing that there are simple things that every firefighter can do regardless of age, interests or experience to dramatically improve the quality of their lives today could be the spark needed to achieve success. Only after members have expressed an interest in wellness can measures to be taken to develop education and resources that change their perceptions of health, wellness and the overall workplace initiative.

Ultimately, to establish a positive and productive workplace culture may require a change in employee behaviors. Once the firefighters have embraced the notion of wellness (changed their attitudes) and learned about the potential benefits of the initiative both on and off the job (changed their perceptions), strategies can be developed to change behaviors. The WFI prioritizes member buy-in prior to implementing any intervention that will improve performance, reduce risk or enhance overall quality of life. This is largely accomplished by relying on a network of Peer Leaders (e.g. Peer Fitness Trainers) who have the knowledge and skills to provide guidance within a department.

Lastly, the WFI is built on a framework that every firefighter can use to make exercise and training matter beyond the gym environment. Having embraced an approach that focuses on members’ attitudes, perceptions of wellness and fitness, and positive behavioral change, the WFI truly can impact the quality of firefighters’ lives. Ultimately, an emphasis is placed on enhancing firefighters’ capacity with respect to the demands of their lives so that they can continue to perform any activity they need or want to do today, tomorrow and long into retirement.

Because there is no magic exercise and no single “best” way to achieve any particular goal – there are many ways that exercise can be used to improve health, fitness and performance – exceptional professionals must integrate new evidence, use varying approaches and make every attempt to understand why “it depends” and what “it depends” on.

4 reasons why it depends…

1. Most clients have different interests and ambitions. Influence what they love! Running can be a great way to build cardiovascular endurance…for clients that enjoy running. If your clients don’t like running, choose a different activity.
2. Our clients’ abilities, awareness, motivation, etc. influence how they move. Movement is a learned behavior! Improving a client’s front plank time could be important…if it influences how they control their low back while performing a life-relevant activity. Make your clients’ exercise matter.
3. Exercises are simply tools. Movement matters! Kettlebell swings and snatches can be excellent exercises to improve hip power…for clients that perform by hinging at the hips while controlling flexion and extension of the low back. Each exercise can also be the gateway to chronic low back pain.
4. Nothing ever works out exactly as planned on paper. Focus on implementation! High intensity whole-body circuits can be empowering…in a supportive and enthusiastic environment. Do not overlook the role and importance of effective communication.

1. Performance = fitness and movement

Being physically fit, in the traditional sense (e.g. strong) does not equate to being physically prepared for a particular job, sport, or activity of daily living. Fitness is essential, particularly for physical active populations, but alone it is not sufficient to ensure peak performance and long-term durability; it simply reflects an individual’s potential.

For example, poor torso extensor endurance has been cited as a marker for future low back troubles (Beiring-Sorensen, 1984), although it is not one of the commonly described mechanisms of low back injury (as is spine curvature (Callaghan and McGill, 2001)). A possible explanation is that superior endurance provides the opportunity to maintain spine-sparing postures for extended periods of time by delaying the onset of fatigue. But, if individuals cannot adopt these postures for any number of reasons (e.g. perhaps they are unaware of the importance), muscular endurance becomes secondary and will have little bearing on the risk of injury.

2. Use movement to guide the progression of fitness

An individual’s movement patterns should be used to guide the progression of their exercise program. Only after they have displayed the capacity to perform (i.e. ability, awareness) should an activity’s frequency, intensity and time be modified to make it more challenging. Advancing too quickly may compromise the individual’s safety and limit the potential benefits of the program.

3. Train movement not muscles

Since we cannot see muscles it makes much more sense to simply focus on movement. Every movement is the result of the muscular system acting on the skeletal system. Muscles produce force through concentric (shortening), eccentric (lengthening) and isometric (no length change) actions and provide us with an opportunity to perform the physical activities that we need and want to do. If sufficient force cannot be produced to perform a particular activity today, muscles have the unique ability to grow and become stronger in response to applied stimuli, or demands imposed on the muscular system.

However, accurately describing the muscles that are responsible for a given action, let alone the forces that are being produced relative to a muscle’s maximum ability is not possible without sophisticated equipment. And while the scientific literature does offer insight into select relationships between various stimuli and their corresponding muscular adaptations, numerous assumptions would be needed to develop an appropriate course of action for training if the primary objective was to enhance muscle function.

Further, enhancing muscular strength or endurance in the absence of a global objective will likely have little influence on an individual’s risk for injury or their performance. Exercise professionals should appreciate the complexity of muscle mechanics and muscle physiology, but ultimately their decisions to use a particular exercise or make a session more demanding should be based largely on observations made during training.

4. It’s not about the exercise

There are many exercises that can be used to achieve every training objective. An individual’s capacity can be improved with several modalities, exercises, and exercise programs; there are countless options that will provide an effective training stimulus. Exercises are simply tools at our disposal to help achieve a particular objective. There is also no reason why any specific exercise needs to be included in every training program given that almost every individual will perform differently, have a different background and varying personal interests/objectives.

5. Building capacity is a process – Focus on getting better, not making yourself tired

Enhancing capacity is a process. Most of us have a desire to be physically active today, tomorrow and five years from now. There is no date after which time our capacity to perform becomes more or less important, nor is there opportunity to take advantage of an “off-season”.

Much consideration should be given to the design of any exercise program so that it serves to enhance capacity in a manner that is relevant and sustainable over an extended period of time. Short- and long-term objectives are needed to effect sustainable change. It would be very disappointing to quit after only a few months because you were unable to maintain a particular intensity; or worse yet, you got hurt. Our exercise programs can be challenging but not simply for the sake of being hard when the goal is being active for life!

6. Train with a purpose, revisit life’s demands.

Exercise can be used to prevent injuries, improve performance and enhance the quality of our lives. But each of us is different, both with regards to our demands and our capacity to perform. Without acknowledging these differences and establishing a purpose for training, any exercise-related initiatives to become better prepared may be misdirected.

Building capacity is a process that requires simple, yet sustainable strategies that keep us motivated and engaged. It is often the small seemingly insignificant steps that are the most beneficial to effecting long-term permanent change.

7. Coaching is both an art and a science.

Coaching is a science. There are fundamental principles of exercise physiology, biomechanics, motor learning and behavioral change that should be considered in the design process so that performers are challenged in a manner that is appropriate to effect positive change.

Coaching is an art. There is no single “best” approach that should be used with everyone in every situation. Trial and error is necessary because every individual will not respond to a given stimulus in the same manner, nor will they always respond as expected.

Although some structure can help (focus on learning), every exercise program must also be easily adapted to suit the progress being made. We need to understand the science to ensure that we are providing an opportunity to succeed, but creativity is needed to make adjustments and deviate from the plan when things do not progress as expected.

The “best” program in the world will prove to be ineffective if an emphasis is not placed on the coach-client relationship.

8. Improve transfer by emphasizing key movement features

Improving our performance in life does not require that a specific task be replicated in the gym. Many factors can influence the way we move (e.g. perception of risk, awareness, strength), and thus a range of physiological, mechanical and behavioural adaptations could, theoretically, be exhibited in response to subtle task differences. Simply altering the load, modality or instructions, for example, might elicit a different movement strategy than was used to perform the original activity.

However, if “key features” (e.g. control of spine motion) of an activity are emphasized while training it is possible to alter the habitual patterns of a complex skill without having to replicate the exact task. There is evidence to suggest that there may be attributes, or “key features”, of a performer’s movement behaviours that are common to a range of activities (Frost et al. 2015).