Aging, pain, and the fitness industry gap: A convo on the Practice Human Podcast

Listen to my interview on Caitlin Casella’s Practice Human podcast where we discuss pain, strength training, quality of life, and the gap in the fitness industry as it all pertains to older adults and aging.

Automatically Generated Transcript From Practice Human: Ep 047: Alia Bisat | Training for Vitality and Independence Later in Life, May 21, 2024

“And in my interview today, I'm talking with my colleague, Alia Bisat.

And Alia created an online membership called The Mob. I teach classes for The Mob on Mondays. I teach a strength class and a class that we call TLC Toolkit, which is some tools from the PT Clinic just for moving and feeling a little better, improving mobility, desensitizing, achy or painful areas of the body.

And I have to say, through all of the time before and during the pandemic, as I've been teaching online, it's been a struggle at times to find a format that I feel serves the people at home online really well from a learning perspective. And Alia just nailed it with the mob membership. All of the classes in the mob are capped at six people, or most of them, there are a few that are a little bit larger groups, but for the most part, capped at six people exclusively live and with cameras on and with communication back and forth.

So that as a coach for the mob, I can have a really personalized interaction with all of the students in the class and get to know their movement, get to know their practice, get to know all of them personally really, really well so that I can serve them better as a coach. And I'm honored to be working with such an incredible group of coaches in the mob membership. And I just love the small group live 30-minute short class format that you'll find there.

It's been a joy to teach in that space, and I highly recommend it if you are someone who's looking for something that is exclusively live with a much more intimate, personalized touch and a lot of guidance. If you're looking to get strong, work on just basic life skills of function. And if you're somebody who's over the ages of around 40 or 50, one of the things that Alia and I discuss in our interview is how there's really a gap in the fitness world, the fitness market for serving some folks that are a little bit older or need a little bit more specialized or personalized attention.

“After listening to this episode, if you want to learn a little bit more from Alia, she's offering a free 60-minute webinar about osteoarthritis. As many of you know, you've heard me talk about osteoarthritis a lot. It is a subject near and dear to my heart.

She is hosting a free webinar on Thursday, May 30th, so it's coming up soon. You can register through her bio link. I'll put a link in the show notes.”

“Also put a link in our Practice Human bio link on Instagram. And it's gonna review some of the misconceptions about osteoarthritis. It will present some of the well-researched and effective treatments, and some key elements of the physiology of pain, some pain science, and then some effective strategies for you to manage your physical function with osteoarthritis.”

“So I know she's gonna have a lot of great empowering, hope building type of information there. So if you're a person with osteoarthritis, or if you experience other joint pain, or if you know anyone who could benefit from this, it's a free hour long webinar with her on Thursday, May 30th. Again, we'll link this up in the show notes so you can find it through my Instagram bio and Alia's Instagram bio.”

“And then finally, Alia has a special offer for those of you who might be interested in joining the MA membership. If you do a one-on-one consult with her, if you're interested in joining the membership, and this is just standard, she does a one-on-one consult with anyone who might be coming in to join us. If you mentioned the Practice Human Podcast episode, and you do end up getting a membership, she'll throw in two additional 45-minute one-on-one sessions with Alia.”

“And she is just, you'll see. If you listen to this interview, she's a tremendous coach. She is really an empowering person in terms of helping people later in life really take on more robust activity, more robust exercise, and build up a reserve of tolerance for heavier workloads, heavier exercise so that we can really keep doing all the things we wanna do to stay independent in our lives.

And I know you all listening know that that's really important to me. So I love Alia's work. It was really great to have her on the podcast and just hear her take on some of the issues here that we discuss.

And I wanna thank Alia for sharing everything she shares with all of you here listening on the podcast and the students in the mom membership. They're just really lucky to have this space. So if you have any questions for me, you can always reach out to us at hello at practicehuman.com.”

“We respond to all of your emails and I hope you enjoy my interview with Alia. I am really excited today to have on the podcast, my friend Alia Bisat. Alia began teaching yoga in 2015 and quickly became frustrated with the limitations of a single discipline.

It was clear that there was infinite value in helping people become stronger and more mobile beyond the purpose of performing yoga poses, but to improve function in daily life. She developed a passion for helping make inaccessible movements more accessible, especially for those left in the margins of the fitness industry, namely older adults, people with pain, and the average not so flexible Jane and Joe. Alia uses a one-on-one style that allows her to build relationships with individuals and works with various movement disciplines to help people move, feel, and therefore live better.

She operates from a belief system that the body is inherently strong and infinitely adaptable, and so do I. I love that belief system, and I'm really excited to have you here, Alia.

I'm excited to be here. Thank you for having me.”

“Yeah, and we met probably around that time, I would say, sometime between 2015, 2016-ish, I would think, as yoga teachers in New York City. And I believe we met through a group of teachers that came together for some social gatherings and mutual support because we were all going through a bit of a reckoning with yoga, yoga asana, teaching yoga, what to call ourselves when we were straying away from something that, or into something that didn't quite feel like teaching yoga anymore. I think that's the context in which I got to know you.

Yeah, I think so. It was, you know, looking back on it, I sort of forgot about that group until starting to work with you and thinking about when we met. And it was a really, really awesome group to have at the time when all of us were having certain doubts and kind of confusion about how to define our boundaries around what is yoga and what is not.

So yeah, that was a cool experience at the time.

“Yeah, and it was helpful for me for sure to talk with people who are going through some of those same things because it can feel super isolating, especially in something that is your career and what you love and kind of an identity, I think, for yoga teachers in a way that can feel scary to step outside of that and move into something else. Yeah, and you moved into a form of strength training, really, or training for life, I would say, that kind of champions functional activity in daily life. Would you agree with that in terms of your focus right now and what you're doing?

Yes, for sure. Functionality is kind of the pillar, the main focus of any of the work that I offer now.”

“eah, and I was wondering if you could share a little bit about how that transition came about or what that felt like for you, going from teaching primarily yoga asana to the type of coaching and training that you're doing today.

Yeah, so the transition from yoga was really a reflection of what was going on in my body. I have never been a particularly flexible, mobile person. I mean, everything is relative, but if you talk about bodies who are teaching yoga, I was never one of those dancers or kind of people who just where yoga really came naturally to them.

So I actually did my yoga training because I had reached a plateau in yoga and I wasn't getting anywhere. And I thought if I did my training, I would just be able to lift my legs over my head. And I realized quickly that that was not the case.”

“The yoga training didn't really offer me that. But I enjoyed teaching and I started teaching and getting into breaking down poses with people. But what really transformed my body and my ability to perform the poses was strength and mobility.

It totally changed what I was able to do in the classes and in my teaching. And so I started incorporating the strength and mobility in my yoga classes in addition to breaking down the poses in such a way that I needed to break them down for myself to be able to learn them. I really needed to feel the different component parts of each pose in my body and understand it in my body and how to work with it within my body, like putting my foot in a different position or really understanding how the pelvis moves from side to side to be able to then put that into a more complicated pose.

“And so my teaching reflected both of those things, the breakdown of the poses and in turn, some strength and mobility practices, and people really responded to it. And yeah, I would say that was the biggest, those were the two biggest elements in the transition, which of course was very slow, happened over time.”

“eah, and I think I remember part of that for both of us was that we had that shared weekend together where we took the functional range conditioning, mobility specialist weekend and the FRC. And I think for me that that started to connect a lot of dots in terms of ways that I can introduce different kinds of stimulus, physical stimulus to the body within a yoga asana type of setting, because it slots in so well with body weight practice, something that you can do with minimal equipment or that you can do really easily with yoga props in a yoga classroom environment. So I felt like we had a little bit of shared transition just in that modality at one point, bringing some of that into the yoga classroom.

I loved that training. And it also created the transition between, okay, getting good at yoga and getting good at life. And it was those trainings and that change in my body where I was like, what am I actually teaching here?”

“What is the point of, and this kind of goes into my frustration with yoga at the time, like what's the point of getting better at warrior two? What's the point of getting better at bird of paradise? What am I actually trying to get someone to do?

I'm trying to get them stronger in their legs. I'm trying to get them more mobile in their hips. I'm trying to get their balance to be better.

So then why am I limited to those positions, those shapes that were chosen randomly by someone hundreds of years ago? Like maybe I can offer a little bit more than that. And so, yeah, at some point, my yoga, as yours did too, you know, started to not really look like yoga anymore.”

“And then it's like, well, okay, maybe it's time to move on.

Yeah. What did your transition into strength training look like? Was that something that you started training on your own or did you work with a coach?

Did you work with a trainer? How did you move into that?

Yeah, it was either 2015 or 2016. I can't remember. I think it was 2016.

My now husband, at the time we had started dating, we first started dating, he convinced me to start working with a personal trainer. I had only ever done in the past group class stuff, and I've always been a runner, but I'm not always strength trained. But I dabbled in group class strength stuff in the past, but he introduced me to his personal trainer and she's still a good friend of mine.”

“nd that was, it was just awesome. I mean, it was the first time that I squatted in deadlift and I played with handstands and I, it was super empowering and immediately felt a difference in my yoga practice. And yeah, that was the beginning of it.

Cool. Yeah, I get questions a lot from people who are yoga teachers and interested in strength training or interested in bringing more strength training to their clients. And I was asking like, how do I get started with that?

And my answer is always, well, like start strength training. Like you start doing it, right? And then you get all, you really kind of get all the, because you already know how to teach.”

“You know, as a yoga teacher, we already have this set of tools from teaching and seeing people moving and giving verbal cues and coaching people through their bodies, talking people through their bodies and through movement. And I think that it's just, for me anyway too, it's just like such a potent experience too, and kind of an aha moment to start strength training myself and be like, oh, okay, this is different. And there's a different set of words and tools and positions and movements that come with it, but teaching is teaching.

And then it's the transition. Yeah.”

“Yes, for sure. But I also will always, I will always push people, anybody of any, doing anything is to get a coach, even for just a couple of sessions. And I understand that's not accessible for a lot of people, but if it is accessible, anytime you're doing something new, hire somebody who knows more than you for just one or two sessions, and you will just, you'll at least know where to go from there and allow your journey to take a particular direction where you have specific questions to ask and specific threads to follow.

Yeah, that's really huge. I think it's important that people who offer one-on-one sessions also are consumers of one-on-one sessions too. Like, because you learn so much from the learning about how another person conducts a one-on-one session.”

“I do anyway. Good point. I wanna delve into the area of pain and pain science a little bit, because you have studied quite a lot in pain science in this transition, on this journey.

And one thing that you shared on your website that really stood out to me is you said that you grew up witnessing loved ones suffer from chronic pain. And more than the pain itself, what you found most debilitating was the way they were treated by medical professionals or by the medical community. I'd love for you to share a little bit more about that.

Yeah, you know, my mom has suffered from chronic pain for as long as I can remember, a variety of pain experiences. And I just grew up with hearing her talk about going to doctors. And it's not just doctors.”

“It's been massage therapists. It could have been osteopaths. It could have been chiropractors.

Just across the board professionals that she was going to for help. And her coming back with stories of whether it was being talked down to or whether it was being doubted or whether it was just not being taken seriously or told that it was all in her head. I mean, and then I think having that experience growing up has primed me to have my ear open to those stories without really realizing it.”

“And then when I started my, through yoga, you know, having people come talk to you about injuries after class, but then starting working with one-on-one and working with people who have had injuries and hearing their stories about the way that they've been treated by physical therapists or, you know, doctors anywhere across the board, it's just so disheartening how people have not, they're regularly not heard and treated as whole people. And I think I've always been sensitive to that without even consciously realizing my sensitivity to it. And so there was a point, I have no idea when I first watched Lorimer Mosley.

So Lorimer Mosley is like one of the head science, pain science researchers in the world. And he has this TED talk that's quite old now, I think 10 minutes long. I have no idea how I came across it, but I remember when I came across it, where he breaks down the biopsychosocial model of pain, I kind of lit up and I was like, oh my God, I can't believe this is actually how pain works, that no one knows about this, even though it's been in the research for 20 plus years.

“And no one's talking about this. And then you delve in and you realize that medical schools aren't teaching this, that the doctors that have been in practice for 20, 30 years have not kept up with the research. And this is life changing stuff.

And yeah, I just feel very sensitive to listening to people talk about their pain, validating their pain, and then understanding that we have so many options for how to help them either come out of pain or at least increase their functionality within the pain that they have.

Yeah, for sure. I mean, I've definitely, in my clinical practice, encountered a lot of patients who come to me after having been put through just such a runaround between specialists and with diagnosis and get to a point where they have this really kind of fear-induced belief that whatever's going on is medically serious, because it has been assessed and talked about by medical professionals in all kinds of contexts. And like, one of the terms that gets used from one of my mentors that I've studied, low back pain with, Ben Cormack, is he uses the term over-medicalization.”

“And we talk about how people think that their issues, their symptoms, their concerns are medically serious when they're not necessarily like a serious medical condition. I think one of the things he says is it's seriously painful, but it's not medically serious. I think that description is really helpful.

And yeah, and I think people get a lot of kind of conflicting information when they start to be seen by a lot of different professionals kind of seeking a diagnosis, you know, when an actual diagnosis might not be the most helpful thing, just having somebody really listen to them and learn about their lifestyle and what they're struggling with, it might be the most important thing for them.

Yeah, well, man, there's so much wrapped up into it. I mean, yes, totally over-medicalized, but then how do you tell somebody that what they're going through and what they're feeling isn't actually a medical problem? Right, there's so many belief systems tied up into what they're seeing, what they're hearing from an authority figure, what they're seeing on their MRI screen and what they have been taught to believe MRI screenings are.”

“And there's just a lot to break down there. So, I mean, yes. And I think the number one, I think if there's any myth to break that would at least start the cascade of unraveling what pain is and how it works in the body, it's this idea that, which of course you've talked so much about, is that damage does not equal pain and pain does not equal damage.

It's not physical tissue damage. And so, but that by itself can take months or years to work with somebody about changing their belief system about it, but yes, totally leading to the over-medicalization of things.

Yeah. And then I think it really feeds into the ways we work with people in terms of movement and exercise, because if someone's coming from a place of believing that I don't know if I should do this because I'm gonna make it worse, or if I move in such a such a way, I'm causing more harm. Usually someone kind of perceives that as more mechanical damage or something.”

“It can be a really tough uphill battle as a coach who treats with movement and exercise to get that person moving and exercising in a confident way, in a way that's gonna build them up and make them feel better and function better and be more resilient. But I find it to be kind of a tricky, kind of a little bit of a sticky spot to get past that.

Yes, completely. And if you... I mean, I love working with the older population, which we'll talk about, but one of the barriers to movement and exercise for people who are older is that they have more experiences under their belt of these over-medicalization situations.”

“They have had the chance, literally they've lived more years, so they've had the chance for more energy, they've had more experiences at hospitals, and with doctors, they've had more images done over the course of the years, and so they literally have a racked up experiences under their belt, which just affirms all of the things that they've been told in the past. So it's just a bigger belief system. There's more barriers to break down with that population, which is what I find so rewarding to work with that population specific.

Right, right, well, and there's also just this societal belief that age and age alone means your body's breaking down, which is not necessarily the case. Yes, there are changes in our tissue structures, there are cartilage changes and things like that that happen, but it doesn't mean that your body's just totally falling apart once you turn the corner from like 40 to 50. I've even worked with young patients with chronic low back pain in their late 20s and 30s who think that just because they're 30, their back is gonna hurt for the rest of their lives, “when actually it's quite common for men in their 30s to have low back pain, more common than people actually much later decades to have low back pain.”

“So some of those things are just like such pervasive sort of myths in the society that freak people out about the changes that they feel in their bodies.

Totally, totally. It is not inevitable.

So that's a perfect segue into our next topic and one that I'm really excited to discuss with you. And this is the fact that your target audience, and I'll just mention right now for those listening, Alia has created this fantastic online membership called The Mob. And I teach a little bit, teach a couple of classes weekly in the membership.”

“And it focuses on small group training with lots of individualized feedback for people age 50 plus. And I would love to hear about why you created this and why it is specifically for ages 50 and up.

Yeah, the 50 and up thing is a little arbitrary. I had to pick a number. It could have been 55, it could have been 65.

I ended up picking 50 just to kind of pick a number, honestly. I wanted to pick something that was below the Medicare age, I think 65, but above. There's something about people in their 40s where they're still able to like, or they tend to, again, making big age generalizations, they tend to just like jump back into fitness classes pretty easily.”

“50s do that too. But anyway, I just had to pick a number. But I created this because I felt like I was, so the real transition here was that I was seeing, most of my work is one-on-one clients, and I was seeing a lot of people who were 50 and up, and they usually came to me because they had some sort of chronic pain issue or mobility issue that kept them from being able to be as functional as they wanted to be in their daily lives.

And after working with them for several months or several years, they were in great shape. And I was honestly kind of running out of room in my schedule to see other people that had acute pain issues. And so I wanted to create something that embodied all of the principles that I use in my teaching and my work with people, but in group form to literally honestly offload my schedule, but know that I was sending them to a place or putting them in a group where they were gonna be taken care of and move within the boundaries of the ethos and the principles that “that I really strongly believe in about pain and movement and aging and resiliency.”

“So there really isn't anything like that, that I can find that is specifically for this age group that is online, that is small, like the classes are small, the teachers like you, whom I love, are very highly qualified. So it's pretty specific, I think.

Yeah, and I think it's specific, too, in that it is online, it's small, and it's live. That all the instruction is delivered live to people who we can see and speak to in the moment and see respond to our verbal cues. And yeah, and for me, that's super rewarding.”

“I mean, I might have mentioned this to you when I came on to start teaching for the mob, but I can't just teach to a camera in an empty room. I don't feel like I'm teaching. I'm not teaching anyone, I'm not teaching.

This isn't teaching. I have to be teaching a person in front of me who I can respond to, because it's a give and take, it's a back and forth. That's teaching to me.

So I also love the live component of it. It's really cool.”

“Actually, yeah, that's a huge component. It's live, all the classes have recordings, but the recordings are available to some people who might have missed a class, but the class is taught to the people who are showing up. And the beauty of it, I mean, I've talked to some people who are potentially interested in joining, and they're like, oh, online classes, I just can't get into it.

I'm so zoomed out from the beginning of the pandemic. And I'm like, these are really different classes in the way. I mean, I taught a few classes at the beginning of the pandemic, yoga classes, and you have 20 people in the class, and half of them have their video off, and you can't really see everybody on the screen because there's 20 boxes.”

“And so there's no more than six or seven people on the screen, and they are live, and their videos are on, and you are really interacting with those people, which is obviously what, like you said, that's what real teaching is.

Yeah, yeah, and it is truly unique to any way that I've taught online, I have to say. And part of it too, I think, that makes it work really well is when there's only six or seven people max in there, they know each other, so they're not strangers on Zoom. And so that creates a little bit of like social atmosphere and some comfort in having video on.”

“I can totally understand people keeping their video off in like a class of 30 people on Zoom. For sure, for sure. In this context, it's like everybody knows each other's name and there is some social aspect to it.

And yeah, it's really nice. It's really nice with that size of a group online live. And the classes are short.

Classes are short, classes are only 30 minutes. And it's kind of amazing how all of us have packed so much into 30 minutes without it feeling none of the classes feel like super fast or overdone, but it's accessible. Hour long classes, I think we all figured out during the pandemic that they're just less accessible for people.”

“For sure, yeah, yeah. So I think all of those format things that we just talked about really speak to how this is unique and breaking down some barriers in the fitness industry for folks 50 and over. I'd like for you to talk a little bit more in depth about this gap that you see in the fitness industry and how the work with the mob is kind of filling that gap or your work that you've done with people over the last several years, one-on-one, like what are you giving them that they can't really get anywhere else in terms of the actual coaching and physical practice?

Some of the barriers are the same to anybody else in terms of starting exercise, which is being self-conscious or not knowing the fundamentals of strength training, not knowing how to start, there's financial barriers. But in particular for this age group, which is where I think the industry is lacking, is addressing, in my mind, kind of two or three things. One being what I think is the biggest component is the injury component.”

“There's fear of injury that I think is more prevalent with an older age group than a younger age group. They either have something that already hurts, they have an injury, they don't want to make it worse, or they don't have an injury, but they don't want it. They're thinking about their bodies a little bit more now that they're aging.

Or they had an injury, they went to PT, they had to deal with that whole thing, and they don't want it to come back. They've had an experience with another personal trainer who maybe wasn't very qualified or whatever. They had an injury and they felt like they weren't paid attention to.”

“And so there's the injury aspect of it. There's the lack of education. They're just not, the education is just not as available for this age group in terms of why strength training is so important in general, but why for this age group and the way that this age group in particular loses muscle at a faster rate.

People don't know that, as I mentioned before, that falls are not inevitable. Losing muscle mass is not inevitable. All of those things, type two fibers, loss of your type two fibers is not inevitable.

There are things we can do about that. And then there's, of course, the whole ageism conversation in our society. And like I mentioned too, the greater number of experiences under their belt of all of these things, just because they lived more years, make this a little bit more difficult.”

“And you've got classes like, so in the industry, things like Orange Theory or F45 or Barry's Bootcamp, it's not, they're geared towards younger people. But it's really, their classes are really fast and they're not individualized. And whether you're young or old, if you're starting something and you're nervous about it, you don't want to go to a class where things are that fast paced and you don't want to go to a class where you don't feel like you're being paid attention to.

So I think that's a really big one. Having classes that are small, where you have someone very qualified in the room that you can ask questions to, and you don't feel nervous about asking those questions. Being underestimated is kind of a general gap in the industry.”

“The industry does not, I think the one of the best, I'm gonna give this example of a client of mine actually. I think she was 75 at the time that she fell. She was ice skating, actually.

She fell and she broke her wrist. And there was some complication in the wrist so that she was gonna have to either get a surgery or she was just gonna have to put it in a cast and wait it out. And they didn't even give her the option of the surgery because of her age.

And the surgery was going to be more likely to get her to be back to her functionality using her wrist. That was gonna be the better option for her. They didn't even give her that option.

They gave her the option of putting her in a cast. And she was like, she's a doctor. She was like, you know, I don't know.”

“She got a second opinion and the second opinion said, no, you really want surgery if you plan on using your wrist heavily. And like the fact that she wasn't even given that option in the beginning just shows the way that this population is treated and underestimated in general. And that by itself to me is a huge gap in the industry.

I have another client too, who they were gonna put him in a boot for some tendonitis. They were gonna put him in a boot for six weeks. He's 79.

You put someone in a boot for six weeks at 79 for a level three out of 10 pain, the cascade of issues you're gonna have for that is huge. And that again, it's just underestimating people just because of their age, their capacity and their interest in being functional in life for another 10, 15 years. They're just very dismissed and it's a huge issue.”

“Yeah, yeah. Well, and I think even within kind of our profession of coaching, strength coaching, training, things like that, there's a lot of people out there who are actually scared to offer more robust exercise to older adults. People want to be challenged and want to be pushed and they want to see progress.

And you have to work at, I mean, you understand exercise science, right, there has to be a certain level of intensity to send a strong enough signal to drive adaptation. And I mean, it's rampant in the PT world too. I mean, the kind of joke is like, oh, yellow theraband PT, which I will say there is a time and a place for yellow theraband.

It's the kind of thing that's like, you just want to bubble wrap people to keep them safe when really it's the giving them exposure to things that promote adaptation. It's what's really going to keep them safe, right?

Right. Even so the CDC has a, the CDC talks about, they have like this, you know, PDF about falling and false prevention. So the good news is the CDC says falling is not inevitable, which I love that”

“And they say it doesn't have to be this way. And one of the things they talk about, they like list, okay, you know, talk to your doctor about the types of medications you're taking, but then they also say exercise. And one of their examples for exercise for better balance and strength is Tai Chi.

That's the only example they give. And I'm like, okay, there's nothing wrong with Tai Chi. Tai Chi can absolutely improve people's balance and stability.

But if we're talking about robust bones and muscular strength and the ability that we're talking about resilience capacity. So if you do fall, that you don't break a bone, Tai Chi is not going to cut it. And that's what they list, you know?

So even at that level, we're not giving the right advice about the importance of intense strength training.”

“Yeah, yeah. And I think it's quite well supported in the research that power and strength, right? Ability to generate force quickly and just being able to move more weight, right?

More resistive training are the things that really help prevent falls and keep people independent for the long term. So that would look like fast movements, maybe a little bit of impact and heavy resistive strength training.

Yeah, yeah. And the ability to jump, which I know you have like a jumping from scratch program. The ability to jump helps you not fall.

You have to be able to pick your feet up off the ground quickly, which is jumping, in order to catch yourself when you're about to fall. So those things are super, super important.”

“Yeah, I mean like quick reaction time is important. And you're not going to train that quality with slow fluid movements, where you're totally shifting weight and in control like yoga or like Tai Chi. And not that there aren't, like you said, great benefits to those practices.

They just don't train those qualities in the way that they're done, in the way that our movement is done.

And I think I just plug in here that, you know, within this conversation, if anyone's listening and they are thinking when we say older adult, you know, you're thinking about 70-year-olds, 80-year-olds, 90-year-olds. I mean, people who are 50 are losing the ability to jump and move quickly. People who are 40 are losing the ability to jump and move quickly.

So this applies to anybody.”

“Yeah, yeah. I mean, one of my clients that I just saw today was, she said that she had shared with her primary care physician that something about getting up off the floor without using her hands or without using, like, furniture to, like, help her get up off the floor. And she said her doctor, like, gave her this look of surprise, like, oh, you can do that.

You can get off the ground without using the furniture. And she's in her 50s, right? So, yeah, so I know when I heard that, I was like, oh, okay.

That is my number one assessment that I do with anybody who walks in the door for the first time, the assessment, one of the first assessment is, how do you get down and up off the floor?

Right, yeah, and we shouldn't be, I, it's really kind of, it freaked me out that there are people who are in a place of being surprised that someone in their 50s can get up on, up off the floor without using like a ottoman or something to get yourself up, right?”

“A medical authority figure at that.

Right, yeah, yeah, exactly. I think we should have a little more trust that like, like maybe we should strive for people in their 80s being able to do that, no problem, and not be surprised when that happens, right? That would be great.

Yeah, let's, let's set the bar a little higher, shall we?

Just a little. Again, and that goes back to the topic of ageism. It's just the way that we, the way that we as a society, the structural, the structural way we think about older people and the way that we've seen older people move in Western society and the United States in general, because it's not the same wherever you go.

Totally.

Those assumptions are, they're strong. They're strong assumptions and they show up, you know.

Yeah, yeah. And well, and now, yeah, and that you point that out too, living in our society of sitting on chairs. Yeah, we, at a certain point in life, we don't have need to get down on the ground and up again.”

“And so we stop and then we just find one day that we can't do that anymore. Whereas in places where people do commonly get down on to the ground for their meals and other things, like it's a totally different situation.

Yeah. Yeah, for sure. And the way that they think about the way that other cultures think about aging in general, like, you know, in a lot of Asian cultures, older people are regarded as wise.

And as soon as you have someone feeling with their older age that that's a benefit, that they're gaining wisdom, you've got confidence, and that will translate into your physical ability to do things, right? Right away, just believing that you are in a place that is not deteriorating, and that is a place of reverence in society, that will translate to how you move your body 100%. One of the things that I really like about what I was trying to include in the mob by having really qualified coaches and physical therapists is that the first point of entry for somebody who is starting to have pain somewhere, musculoskeletally, will be one of those coaches.”

“And so one of the industry gaps, and this ties into the idea of over-medicalization, is that, let's say your ankle starts to hurt you, and maybe you ignore it for a little bit and it starts to hurt some more. So then you go to the doctor, you go to your primary care physician. Your primary care physician needs to refer you out to somebody else to get x-ray or MRI.

That can take a couple of weeks. So then you go get an x-ray or you get an MRI, and then you see that there might be a little bit of a tear or maybe a small stress fracture, but maybe there's a tear going on or something. That whole process, so now you've gotten an image that is telling you a story about your pain.

There's maybe been a month or two months that's passed. During that time, you haven't known what to do or how to handle it. So one of the things that I think is really shifting is this idea that physical therapists and even some chiropractors can be the first line of care for people experiencing musculoskeletal discomfort.”

“So the first person you go to is not your primary care physician, but as a physical therapist. So then you have someone who's intervening with non-invasive treatment, which is physical therapy. And strength training.

And so you're kind of cutting short this cycle and you are doing it more quickly. I actually saw an email come through a couple of weeks ago that the military is going to start allowing physical therapists to be the first line of care for military personnel because it's much more cost effective and it's much more effective in terms of the treatment time. And so the mob, what I really hope will happen over the course of some time, because it's only a few months old, is that these members who are developing these really close relationships with the coaches and the physical therapists, when they start to have some pain, for whatever reason, they already have these relationships with these coaches, they can just ask them a question or they can book a one on one session or they can literally ask them in class.”

“And most likely, it's not going to be a medical issue, right? And it's something that you can just deal with in the moment within the strength training class, you increase their confidence and the whole treatment time is like cut in, you know, cut in half.

Yeah, absolutely. Yeah, and that's just for a little bit of further education because I feel like this is so important in my profession with physical therapy. The reason that physical therapists in the United States now receive a doctorate of physical therapy, a DPT, is because it went from being a two years master's degree program to being a three year clinical doctorate so that people have direct access.

And what that means is that they are able to go see a physical therapist without a referral from a physician. What that also means in terms of the level of education that brings the PT profession to a DPT is that we are trained more thoroughly in the medical side of things to be able to recognize and screen for and rule out red flags that might be a disease process that seems like some kind of musculoskeletal pain or issue, “but something that we identify as a reason to refer someone then onto a physician to say, this is not actually something to be treated with physical therapy. I don't have anything to treat here.”

“You're getting the kind of symptoms that tell me you need to go see a physician. So there is also kind of that extra layer built into the PT profession now, so that people can confidently come and see us as kind of a first care provider, when they have something that they think might be musculoskeletal symptoms.

I didn't know that that was the difference. Thank you for that. That's huge.

That's a really important piece of information. I don't yet I didn't know that.

Yeah, and it just kind of transitioned when more and more states in the United States started allowing direct access is that then the physical therapy degree was heightened to that level. So that, yeah, so that if I encounter someone that is presenting with a kind of kind of red flag symptoms that I want them to get seen by another provider, a specialist, or just go back to their primary care physician, then I can send them in that direction.”

“Yeah, very cool. That's great.

It is, yeah, and I completely agree with you that there are a lot of things that can be resolved and improved really quickly if people get the right treatment soon enough before being kind of, yeah, put through the whole ring or the medical profession. Let's talk about a term that you used with me recently, Alia, and I actually had not heard this before. It was a new one for me, but when you explained it to me, I was like, oh, I get it.

And that's a really awesome way to think about life. You mentioned one rep max living. And I'd love for you to talk about what that means and how you help your clients with that.

Yeah. One rep max living, which stands for one repetition max, is a term coined by Dustin Jones, who is a physical therapist out of Kentucky, who is part of the Institute for Clinical Excellence. This is a really great organization with a lot of forward and progressive thinking physical therapists that stay on top of the research and offer a bunch of courses, a couple of which I've taken.”

“So he coined the term one rep max living. So for anyone listening that doesn't know what one rep max is in strength training, one rep max is the load at which you can do one repetition of a movement or exercise. And so one rep max living refers to living your life in such a way that you can only do one time, one repetition of a daily task.

So for example, if you want to think of picking a box up off of the floor, let's say the box is 20 pounds. If you can pick up the box 20 pounds, and it's really difficult for you to do, it's really heavy, you're nervous about it, you're worried about straining your back, maybe you do strain your back or it's complicated, maybe you can't even do it. That would be your one repetition maximum, you might be able to do it one time.”

“So what you would want to do is not live to your one rep max, you want to live beyond it, you want your capacity to be greater. So what you would want to do is train at the gym, picking up something up off the floor, something like a deadlift, you want to be able to do 20 pounds multiple times with different positions, maybe even heavier than 20 pounds in different ways and maybe different speeds. So it's about increasing your capacity beyond what is required of you to mitigate injury.

And I think there's two important ways to look at it. So one would be to mitigate injury, to make injury less likely to happen. But also that you have the capacity or the reserves if something does happen.

So for instance, and it can be one, looking at picking up a box is very specific, but you can look at one rep max as broadly applicable to the idea of fitness meeting that absolute minimum requirement to function. So let's say you are 80 years old and walking for you is fine, but maybe you can't really walk more than half a mile at a time “and you're pretty slow at walking, but you can do it. Let's say you turn your ankle or strain your ankle.”

“ou now probably don't have the reserves to continue to be able to walk while your foot is healing. You may not be able to use, so anytime if you strain your foot, you're going to be compensating by putting more weight on the other leg. You probably don't have the strength in your other leg to deal with the compensation.

You may have to actually be off of your feet for six weeks, which is really debilitating at that age. So you don't have the reserves. So what you want to do ideally to train for that is to walk faster, walk at different speeds, walk with weights in your hands, leg strength, so that walking becomes walking half a mile because it becomes something that is more accessible for you to do.

So that when something happens, you have the capacity to deal with the injury in such a way that doesn't leave you completely incapacitated. Does that make sense?”

“Yeah. Yeah. Absolutely.

So yeah, I think there's two ways of looking at it. So the way that we deal, I mean, I work with my clients and in the mob in two big ways. One is that everybody has a degree of being able to do, we get them to be able to do fundamental movements, like getting down and up off the floor and pushing and pulling and falls prevention stuff and quick, like we were talking about quick movements.

And then we add weight to everything, like how really getting people to be comfortable with weight and comfortable with getting heavy weights. I know that you recently talked to someone about getting a heavier weight and she did and she got a weight that I think she got 30 pound kettlebell, which I think is a lot. And that's super exciting to get people more comfortable with the idea of picking things up that are heavy and doing things multiple times so that when it comes down to it in their daily life, it's really easy for them to do.”

“And even just educating people about that gets them to be more motivated about it and think about the kinds of movements they do in their daily lives.

Yeah. And then I think too, it's kind of a self-amplifying cycle because when someone builds the capacity to do more in their daily life, they do more in their daily life. And then all those hours of the day are bringing them to higher levels of capacity.

I mean, I talk about this a little bit in rehab, how I'll get somebody over the hump of the initial stages of pain and sensitivity and acute early stages of an injury. And then we talk about doing more robust exercises, progressing their exercises they're doing with me in the clinic and that they're doing at home. But I always end up reminding people, it's more than just these exercises becoming harder and more so that you're building more capacity.”

“You just starting to feel comfortable walking longer distances, more walking volume, take the subway instead of the bus and go up and down the subway stairs. As you start to get more comfortable doing the things that were previously a little bit hard to do, you are doing more of the hard things all day every day. And that's huge, too.

I mean, it's like you only do so much in a class or in a training session, but like, what are you doing all those other 12 to 15 hours of the day when you're out and about? And all of that, it's like all of it rises. It's really awesome.

Yes. It is so awesome. And I think that's a really great way of putting it.”

“And it works in reverse, which is, and this is, I think, sometimes the... This is usually the state at which people are coming to me for the first time, is when they realize that, okay, so I can't get down up off, I can't get down onto the floor and back up again, which means that I'm not doing anything on the floor, which means there's a whole kind of world of hip mobility that is avoided when you actually don't spend any time on the floor. And so it's a vicious cycle, it's a cycle in both directions.

And, yeah, how do we get people to cycle up instead of cycle down?

Yeah, yeah, I had a whole talk with this with my friend Elizabeth Whipp, who teaches, she's a strength coaching here at my studio. And we got into a conversation about chair exercise classes. And while there's a time and a place for that, and yes, it creates accessibility, and it's important for some people to be able to sit and exercise.”

“We were both just questioning whether a lot of the people who sit to do exercise really need to be sitting to exercise, and how it might be super valuable for a lot of those folks to be up on their feet and moving around and getting down on the ground and getting up and not being sitting in a chair for all of their day and all of their exercise.

Yep. Yep. And I mean, I think it's a great tool.

Totally. There's a time and a place, and there's a lot of people who can't get out of the chair, but for those who can, at least spend a portion of their time moving. I have a client.

She's amazing. She's my oldest client. She's 96, turning 97 this year, and she is mostly chair bound, but she's pretty debilitating arthritis in her hip.”

“But every session, we get up off the floor, up off the chair and back down with her walker, but she's experienced and she is so open to it and so excited about it, but just giving her a few moments of the day where she's standing up on her feet, walking around and sitting back down. So, yeah.

Totally. Yeah. And, you know, with the understanding that that will be hard for some folks and a lot of folks will need one-on-one support for that and all of those things and, yeah, but I think getting people to like kind of seeing people and getting them to work at really their true edge of their capacity is so important rather than just assuming that a bunch of people would just be better off staying in a chair, you know?”

“Yep, yep. This is where we put in our assumptions in terms of what people are capable of doing and can we raise those up a little bit, expect a little more?

Yes, that is the underestimating of people who also then underestimate themselves. I mean, there's a, we not only have the role of not making assumptions, but we also have the role of really helping someone find what their capacity is when they're nervous and when they're underestimating themselves, doing so in a way that's safe and comfortable. And the people's capacity always, mine included, working with a coach, I know that my capacity is greater than what I think it is.

Our capacity is always greater than what we think it is. And so if we work with someone who can bring that out in us, we are going to be infinitely stronger and more capable and more functional in the long run in everyday life.”

“Yeah.

I love this stuff.

I love that. I love it. Thanks, Alia.

Yeah.

I could talk to you about this all day, but I think we should wrap it up, at least for now, but maybe we can do a part two or maybe if folks listening have any questions on any of these talks, you can always reach out to me at hello at practicehuman.com. I'm always happy to jump back on and do follow up talks with people if there's anything else we want to delve into because there's so much here. I like to end these talks with a question about what lights you up or what you're into, what you're driving on besides your coaching work because I know as clinicians and teachers and coaches, we devote so much of our time and energy to learning and absorbing ourselves in these topics.”

“I always like to hear a little tidbit of like outside of all of this, what are you into?

Yeah, you can usually find me in the kitchen. I love to cook. I love, love to cook.

I grew up in a household where cooking and shopping for food and trying new things in the kitchen was a huge part of my growing up. So I love to cook. I love to be outdoors, hiking.

Being active outdoors is probably one of my favorite things. So whether it's tennis or hiking, going upstate, to the Catskills, running, anything outside in nature. Yeah, I'm also learning Spanish.

I've been doing that for a few years and it's really fun to learn something, to actively learn something that has nothing to do with my everyday work is great.”

“Yeah, yeah. But I'm sure a lot of times would really be handy. I really need to learn Spanish one day.

My husband speaks Spanish and his family does, but I was like, gonna learn while I was in PT school. And then I was like, no, what am I thinking? I'm in PT school.

But I really think that, well, one of my professors in school who I really admire from Hunter always said that she advocated for having a couple of semesters in our curriculum that was Spanish for health care providers. And I think any program should have that. And I loved that idea.

Yeah, that's amazing.

Yeah, it's definitely an ambition of mine at some point to learn Spanish. So Alia, how can people reach you? How can people find out more information about joining the mob?

I'm going to put some links in the show notes, but if people are interested in reaching you, working with you, what's the best point of contact?”

“The best point of contact is my email address, which is alia at aliabisat.com. I have two websites. aliabisat.com is my personal website with, well, my personal one-on-one coaching, chronic pain, strength and mobility for chronic pain site.

And then join themob.com is jointhemob.com, unfortunately, because jointhemob.com is going to cost me a lot of money. So that's the website that I have. And that you can find more information on that.

But the way that joining the mob works is there's a consultation required, which I think is a really nice point of entry for people, especially if you're nervous about it or you're just not sure if it's the right fit. So everybody has to have a consult with me. So you just reach out to me.”

“I think the website says that you have to download the app first, but you don't. You can just reach out to me. We set up a consult, we chat, and then go from there.

And I just want to say real quickly too that the membership is, there's financial assistance and sliding scale options for anyone that feels like that is a really, that that's a barrier for them to join. So I just want to put that out there.

Great. Thank you for that. Yeah.

And I also love that point that the joining the membership always starts with a one-on-one consult. So you're already gathering kind of information about a person's goals and what they're looking for and getting a one-on-one assessment. And I think that's really great for kind of bringing somebody in to feel more confident, more comfortable in the classes.

Yes.”

“And they get monthly check-ins are a regular part of the mob. So everyone is you're being someone's keeping tabs on you and helping support you through the membership. So that that's always there.

Yeah.

That's so great. Well, I'll link both your websites in the show notes. I'll also link your Instagram and the mob's Instagram.

And and during the time of me publishing this episode, I'll put I'll put links in my bio links on Instagram to my practice human Instagram page. Thanks, Alia. This was great.

It was lovely.

Thank you so much. Lovely talking to you too.”