FUNdamentals in FUNctional FITness
by Nikki Carrion, MA
FitXpress LLC
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Co-Owner; FitXpress
Nikki Carrion is co-owner of Fit Xpress
Consulting Services in Waterloo, IA.  
She has over 25 years of experience
in the field of health promotion and
says her passion for her work comes
from her desire to practice preventive
health and promote positive lifestyle
changes.  Although she works with a
wide variety of ages, from college
students to older adults, she says her
focus is on empowering older adults
to higher levels of functional fitness.   

Nikki has a graduate degree in
Community Health Education with an
emphasis in Gerontology from the
University of Northern Iowa.  She also
has a number of certifications
including balance training, chronic
disease self- management, exercise
for hip & knee replacements, group
exercise instruction, personal
training, yoga and pilates.


  • MA; Community Health
    Education.  University of
    Northern IA.  Emphasis in


  • Enhance Fitness Master
    Trainer ~ University of
    Washington, WA.
  • Chronic Disease Self-
    management Master Trainer
    ~ Stanford University, CA.
  • Balance Trainer ~ Cal State
    Fullerton, CA.
  • Personal Trainer / Fitness,
    Yoga & Pilates Instruction ~
    Nat'l Exercise Trainers

Nikki Carrion’s primary
passion and mission is to
empower older adults to
higher levels of functional
fitness.  Besides the Relax &
Breathe CEU module,
FitXpress has a series of
chair exercise DVDs as well
as a training module for
activity professionals.  
FitXpress methods are safe
and effective AND
demonstrate how to put the
FUN into FUNction!
For more information go to:
check out the product page.
Empower yourself with
or call 319-404-4219.  
Range-of-Motion Effects Physical Balance

Residents/patients (RPs) who fall, even those who are not injured, are likely to develop
a fear of falling. This fear may cause them to limit their activities, leading to reduced
mobility and physical fitness.  Little do they know…reduced mobility and physical fitness
is shown to increase the risk of falling (Vellas et al. 1997).   Therefore, it is important to
encourage RPs to be physically active with a goal of being stronger, more flexible and
having a better awareness of their surroundings and of their bodies.  

In the past, we discussed determinants of physical balance.  However, one area that I
feel could use additional time-and-attention is that of exactly how range-of-motion
(ROM) of the various joints fit into the equation.  Overall ROM is important, but the ROM
of the shoulder/neck region, the hips and the ankles are particularly important.  So…let’
s take a look at these areas 1-at-a-time and consider options for making improvements:
Neck & shoulder region: The shoulders tend to lose ROM over a period of years due to
the forward patterns of our ADLs (e.g. driving, typing, opening cupboards, picking up
objects, etc.).  When we want something behind us…we turn around and get it in a
forward fashion.  As a result, we eventually lose the ability to take the shoulders through
their full ROM.  Check the archives, and check the ROM of your shoulders by using the
back scratch test mentioned in the Flexibility = Mobility column (one of the 1st few
FitXpress columns).  ROM of this area is particularly important for static balance /
balance when standing still.  This is due to the fact that as this area becomes
increasingly tight…we begin to round the upper back and carry the head forward of the
shoulders.  The average human head weighs in the neighborhood of 10#.  When
considering the idea of holding 10# forward of one’s center of gravity, you can see
where this is an issue.  Activities that serve to increase the ROM of the neck & shoulder
region include daily 1) chin tucks for the purpose of pulling the head back and bringing
the neck into line with the spine 2) reverse shoulder rolls / elbow circles in an effort to
increase shoulder ROM 3) head turns / vertical rotation of the vertebrae of the neck
(precede with chin tucks for safety).

Hip region: As a result of a great deal of sitting in one position, the hip region tends to
stiffen up.  Stiff hips affect physical balance as this stiffness affects gait / walking
patterns.  It is very difficult to walk when the hips are stiff as the movement in the act of
walking comes from the hip joint.  Dynamic balance, or the balance when the RP is
walking, is then impaired.  Indications of a problem include shuffling, walking flat-footed
and walking with the toes pointed out.  Activities that can serve to increase the ROM of
the hip region include daily movement of this area, with the best activity being to do a
slow, exaggerated hula while keeping the head and shoulders stationary.  The hips
move purposefully…forward, side, back, side while the head and shoulders stay put.  If
the shoulders and head move during the hula, this is a definite indication the hips are
tight and need work.

Ankle region: Again, lack of movement forces the ankles to become weak and tight.  The
ankles and feet communicate with the brain in terms of the RP’s exact position in space
and the type of terrain that is underfoot, which is critical in terms of maintaining an
upright position.  Tightness in this area affects both static and dynamic balance, and
activities that can serve to increase the ROM of the ankle region include slow ankle
rotation, pointing and flexing the foot repeatedly and coming up onto the ball of the foot
and stirring around repeatedly with the heel.  Options are performed on one side…and
then on the other and should be done slowly and purposefully.  Massaging the feet is
shown to be effective in stimulating circulation; key in terms of being able to sense the
surface underfoot and stay upright.  

Aging alone does not cause falls, and falls seldom "just happen." Empower your RPs!  
Help them to prevent falls by understanding the determinants of falls, and what they can
do to make a difference; be physically active, get regular eye exams / ear exams /
physicals, take calcium and vitamin D, slow down and avoid rushing, eliminate clutter,
use assistive devices when needed, wear nonskid shoes and practice a high level of
awareness of the self and the surroundings.   

The FitXpress Steps to Better Balance & Falls Prevention training module is soon to be
released, and will have 8 available CEUs.  If you would like more information regarding
this empowerment opportunity, email me ( or give me a call (1-800-
Until next month, be healthy…be happy!  