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Aug 17

Effect of a dietary and exercise intervention in women with overweight and obesity undergoing fertility treatments: protocol for a randomized…

This is a single-blinded randomized control trial testing the efficacy of a dietary and exercise intervention for women with overweight and obesity undergoing infertility treatment. Ethical approval was obtained from the UAMS Institutional Review Board (UAMS IRB-260113), version 10 of the protocol. This article follows the SPIRIT (Standard Protocol Items: Recommendations for International Trials) guidelines for reporting clinical trial protocols [25]. Table1 and Fig.1 detail the time schedule of enrollment, interventions, and assessments. Findings will be disseminated via peer-reviewed manuscripts and presentations at scientific conferences, at which time protocol amendments will be discussed.

Study Flow Chart. Protocol schematic diagram including informed consent, visits, randomization, intervention and control groups, fertility clinic procedures, and cross over design. AF&GA: Arkansas Fertility and Gynecology Associates, BMI: Body Mass Index

This multi-component intervention will be conducted primarily via telemedicine, thus the location will vary and may include places like the participants homes or a local gym. Participants will be undergoing fertility treatments at Arkansas Fertility and Gynecology Associates (AF&GA), which serves Arkansas and surrounding states. Data collection will take place within AF&GA and the Arkansas Childrens Nutrition Center (ACNC), both of which are located in Little Rock, Arkansas.

Criteria for study inclusion are women with a BMI between 25 and 45kg/m2, age of 21years or over, and planning to undergo in vitro fertility treatment. Participants reporting the following will be excluded from the study: pre-existing conditions (e.g. sexual transmitted diseases) that will affect the outcomes of the study as determined by the principal investigator; current use of recreational drugs, tobacco, nicotine, or alcohol; food allergies, food intolerances, or food preferences which would interfere with compliance to the meal plan; and contraindications to exercise or already meeting the Physical Activity Guidelines for Americans [8] (150min moderate activity/week or 75min of vigorous activity/week with resistance exercise on 2 or more days/week.

Recruitment of participants will be conducted by the AF&GA team using IRB-approved tools. Advertisements and information sheets will be distributed to eligible participants electing to undergo fertility treatments. Women who are interested in participating in the study can inform the AF&GA team, call the ACNC recruitment line, send an e-mail expressing their interest, or express their interest through the ACNC website. To establish eligibility for participation in the study, a standardized questionnaire will be administered by phone.

The informed consent process will educate potential participants about the research study through IRB-approved methods. Eligible participants will be contacted, and a copy of the informed consent will be provided to the participant prior to signing consent documents. A research team member will reach out to potential participants 2days prior to the scheduled visit to perform a COVID-19 screening and answer questions on the intervention components of the study. At the first visit, the research team will review all study procedures and the informed consent documents with the potential participant. Participants will be given sufficient time to review the consent form, ask questions, and receive clarification prior to signing any documents. If eligible and interested in enrollment, informed consent will be obtained from the participants and documented.

Women will be randomized, with computer generated randomization, to a standard of care group (N=60) and an intervention group (N=60). Due to the high incidence of obese women with Polycystic Ovarian Syndrome (1530%) [26], compared with other infertility diagnoses, women will first be classified into one of two strata based on the presence or absence of PCOS. Within each stratum, the proposed study will randomize the enrolled participants into either the intervention group (N=30) or the standard of care group (N=30). Thus, the potential for confounders of infertility, besides PCOS, should be equally distributed between the groups and not affecting the main outcome of interests. The study will have four experimental arms: PCOS-standard of care, PCOS-intervention, no PCOS-standard of care, no PCOS-intervention. Allocation will happen at the second visit (after consent and the collection of baseline measures) by providing the participant with an opaque, sealed envelope containing their allocation.

The intervention, combining an exercise and a dietary component along with the standard practice from AF&GA, will take place during the weeks leading up to oocyte retrieval and continue until 2 weeks after implantation. We expect the intervention to last 812weeks, depending on the participants specific fertility treatment plan.

The intervention will be delivered by trained research team members who will meet with participants twice weekly and serve as their health coach in order to track compliance and support adherence to the meal and exercise plan. This contact will occur via their preferred contact method (e.g., telephone, text messages, email, or using applications such as FaceTime). All interventionists will complete an intensive training on the intervention protocol and motivational interviewing techniques [9, 27]. They will be provided with detailed counselor guides to follow. Prior to conducting a coaching session with a participant, they will be required to be certified by one of the study investigators in providing both initial and subsequent intervention sessions. All sessions will be video or audio recorded; 15% of sessions will be randomly selected, reviewed, and scored on a fidelity rating scale to ensure that the protocol is being implemented as intended. Fidelity ratings will include building and maintaining rapport; discussion of daily meal plan adherence and compliance; discussion of weekly exercise adherence and compliance [28]; use of SMART goal setting techniques [29]; engagement with participant in problem solving as needed; and use of reflective listening, positive reinforcement, and summarizing techniques [30]. Feedback will be provided to the coach on every session reviewed.

The exercise intervention will be based on the Physical Activity Guidelines for Americans for exercise prescription (150min of moderate exercise per week and muscle strengthening exercises on two or more days per week). The exercise program will be customized to the participant and delivered using a web- and mobile-based application. The exercise program will be built for 8 to 12weeks, depending on study length, with increasing intensity of combined aerobic and resistance exercises over the course of the study. The goal is for participants to perform at least 3 routines per week at their desired location. Total session time may vary by participants depending on number of breaks and rest periods. Exercise routines will combine aerobic, resistance and stretching exercises. In addition, participants will be encouraged to walk daily and increase their daily steps by 500 steps per day every week until they reach 10,000 steps per day. They will be able to monitor their steps with provided pedometers (Fitbit, Garmin, Apple Watch, etc.). Participants adherence to their exercise prescription and walking goal will be assessed weekly by the coach.

The dietary intervention is based on the Mediterranean diet. The meal plan was designed by a Registered Dietitian and follows the 2015 Dietary Guidelines for Americans healthy Mediterranean-style eating pattern (Tables2 and 3) [31]. Participants will be provided with all meals (3 meals/day) throughout the 812-week intervention that are in compliance with the Mediterranean diet in the form of refrigerated packaged meals from a company with the capacity to provide made-to-order meals and deliver them to the participants home address. The meals will be heated using conventional equipment found in most households and require no further preparation. Depending on calorie and macronutrient requirements, as assessed by the coach in accordance with participant feedback, snacks that adhere to the Mediterranean meal plan may be added. Snacks will include nutrient dense foods such as whole grains, fruits, nuts, low-fat milk, yogurt, and/or cheese. This nutrition intervention is not designed for participants to lose weight, however with the meal plan that could occur. Participants will be provided with a detailed weekly meal plan and will be asked to keep record of what they eat daily, on paper and/or using RedCap surveys.

Participants in the standard of care group will be provided with dietary and physical activity recommendations from the Dietary Guidelines for Americans at their first study visit and will follow the standard of care practice at AF&GA up to their retrieval procedures. Participants will not be required to wait 8weeks prior to their retrieval procedures since no intervention is needed. If participants in the standard of care group plan to undergo a second oocyte retrieval cycle, they will be offered to join the intervention group at that time as a cross over design.

Participants will be compensated for their time spent at the research facility, their traveling costs and efforts with a monetary value of $50 per visit. Participants randomized to the intervention group will also receive all free meals for a period of 8 to 12weeks depending on their fertility treatment plan. They will also receive training assistance, coaching, and reimbursement for monthly fees to a gym of their choice up to $50/month for the duration of the intervention. As an incentive to keep up with the exercise intervention, participants will be offered $10/week for meeting their step and exercise goal. A bonus of $80 will be provided to participants who completed all weekly exercise sessions prescribed. Participants in the standard of care group will receive a completion bonus with a monetary value of $200 at their last visit. Total compensation for the standard of care group (all paid by checks or gift cards) will be up to $350 dollars.

Participants will attend three research study visits at the ACNC, two at the beginning of their fertility procedures and the last within 5days of their oocyte retrieval procedures. Table 1 and Fig. 1 detail the time schedule of enrollment, participant visits, and the intervention. On average, we anticipate that there will be 812weeks between visit 1 and 3 depending on the participants fertility treatment plan. Questionnaires will be administered on paper or via online platforms such as RedCap.

Women who agree to participate will provide background information including their name, address, date of birth, education, number of people living in their household, marital status, and health history. Participants will be required to obtain an exercise release form from their physician at AF&GA prior to the study visit. They will also be required to sign a consent for release of medical information in order to obtain data relating to the clinical results from the fertility procedures as well as pregnancy and delivery outcomes.

Anthropometric data will include height, weight, and waist and hip circumferences. All measures will be repeated in duplicate or triplicate in order to ensure measures fall within stated tolerance ranges. Height will be measured to the nearest 0.1cm with a wall-mounted stadiometer (tolerance of +/1cm). Weight will be measured to the nearest 0.1kg on a scale that has been tared with clothing the participant is wearing (tolerance of +/0.1kg). Waist and hip circumferences will be measured to the nearest 0.1cm using a tape measure against bare skin or form fitted shorts (tolerance of +/1cm).

Vitals will include blood pressure, pulse, and temperature. Blood pressure and pulse will be measured with a digital blood pressure monitor twice (with 5min in between each measurement); a third measurement will be taken if the two measures have a difference of 6mmHg for systolic or 4mmHg for diastolic blood pressure. Temperature will be taken upon arrival for each visit with an infrared non-contact forehead thermometer in accordance with COVID-19 screening procedures. Participants with a temperature100.4F will be asked to reschedule their visit while those with a temperature below 100.4F will have it taken again orally with a SureTemp Plus thermometer for data collection purposes.

Body composition and bone mineral content will be measured using dual energy X-ray absorptiometry (DXA; Hologic Horizon A, Bedford, MA). This technology involves very small amounts of radiation and yields a very important measure of body composition and bone mineralization [32]. Quality control calibrations will be performed each day and subjects will be positioned according to the manufacturer recommendations for the whole body scan while wearing light clothing without metal.

Resting energy expenditure will be measured using indirect calorimetry (MOXUS, AEI technologies, IL) following an overnight fast while wearing a heart rate monitor (Polar, Finland) [33]. The instrument measures the flow of oxygen consumed and the flow of carbon dioxide produced to calculate energy expenditure. The system will be calibrated daily. Activity energy expenditure will be assessed using the ActiGraph9XLink accelerometer (ActiGraph, Pensacola, FL) worn for 7days and a previously validated physical activity questionnaire (International Physical Activity Questionnaire) [34].

A cardiorespiratory fitness test will be performed on a treadmill following the guidelines for exercise testing from the American College of Sports Medicine. After evaluating the participant at rest and during the 35min warm up, speed and/or incline will be increased in periods until exhaustion. During the entire test, breath composition will be sampled and measured using a metabolic cart (Medgraphics Ultima PFX system, MGC Diagnostics Corporation, St. Paul, MN, USA). Leg strength will be measured by an isokinetic dynamometer (Humac Norm, Computer Sports Medicine Inc., Stoughton, MA). The Humac dynamometer will be used for testing of right and left legs for flexion (hamstrings) and extension (quadriceps) at certain angular velocities.

Blood samples, up to 35ml, will be collected from the participants at visits 1 and 3 by a trained phlebotomist under overnight fasted conditions. During the entire study, we will collect up to 70ml total. Blood samples will be centrifuged to separate plasma, serum, and red blood cells. Blood samples will be used to assess glucose, insulin, HOMA-insulin resistance score, interleukin-6, C-Reactive Protein, tumor necrosis factor, leptin, lipid profiles or any other biomarkers or analytes of interest using ELISA, electrochemiluminescence (ECL), colorimetric assays, metabolomics or any other appropriate methodology. Urine and stool collection will be obtained to evaluate metabolites, hormones or bacteria/microbes. Samples will be obtained using sterile collection cups. All biological samples will be aliquoted and stored at 80C until further analyses.

Maternal depression will be evaluated using the Beck Depression Inventory-II, which has been shown to have high reliability and validity [35]. Participants level of perceived stress will be evaluated through the administration of the Cohens Perceived Stress Scale which is a validated 14-item questionnaire examining the perception of stressful life events and levels of experienced stress over the course of the 4 weeks prior to the completion of the survey [36]. Participants with elevated scores will be provided with mental health resources and referred to their primary care provider.

Baseline dietary intakes will be assessed using 3-day food records. Dietary data will be evaluated by a trained research assistant for completeness and analyzed with the Nutrition Data System for Research (NDSR, Nutrition Coordinating Center, University of Minnesota, MN). Data entry into this software will be randomly audited (10%) by a trained research assistant to ensure quality control.

AF&GA will provide the research team with oocytes (eggs), cumulus cells (cells surrounding the egg), and follicular fluid (liquid surrounding the egg that also contains granulosa cells) that are not needed for the IVF procedures (e.g., too many eggs retrieved). These samples will be collected during the standard oocyte retrieval procedures performed as part of standard care for the participants undergoing fertility treatment. Participants will undergo standard procedures at AF&GA for ovarian stimulation, which include hormonal superovulation and oocyte retrieval 36h after human gonadotropin injection. Any deviations from the standard clinic procedures will be documented and sensitivity analyses will be performed to determine whether deviations to stimulation protocol yielded in significant differences. It is possible that the research team will not obtain samples in the case that the retrieval yields only enough eggs for the IVF procedures. In this case, only follicular fluid will be obtained. The research team will not obtain samples that could have been fertilized or frozen as agreed with the participant prior to the retrieval procedure. The research team will obtain only samples that are unneeded by the clinic. Thus, no additional treatment or clinical procedures will be required for the participants. The embryologist at the clinic will collect the cumulus cells during the processing of the oocytes. Granulosa cells will be isolated from the follicular fluid by centrifugation at 4000rpm for 10min. Follicular fluid samples contaminated with blood will not be used for analysis. Samples will be placed on ice and transported by the research team to the ACNC where they will be stored in messenger RNA lysis buffer and frozen at 70C until processing. Oocytes and cumulus cells will be used to study gene expression while follicular fluid will be used to measure metabolites and hormones that may be influenced by diet and exercise. Both mRNA and genomic DNA will be isolated from individual oocytes as previously described [9]. cDNA libraries will be prepared and fragmented cDNA will be evaluated to determine size distribution of the libraries. Samples will be sequenced using the NextSeq 500 System (Illumina). Individual libraries will be generated and RNA-Seq will be conducted. Sequencing reads from each sample will be trimmed and filtered before being aligned to the human genome (hg19). All data will be analyzed using SeqMonk and R software. Differentially expressed gene expression will be identified using the DESeq2 package which will include multiple testing corrections. Serum and follicular fluid glucose, total cholesterol, and triglyceride levels will be assessed using colorimetric or electrochemiluminescence assays. Serum and follicular fluid insulin, leptin, tumor necrosis factor (TNF)-, C-reactive protein (CRP), and interleukin-6 will be measured using enzyme-linked immunosorbent or electrochemiluminescence assay kits. Serum lipid profilesnon-esterified fatty acids, high-density lipoprotein, and low-density lipoprotein will be analyzed by enzymatic methods on a clinical analyzer. All assays will be performed in accordance with the manufacturers instructions.

Feasibility and acceptability will be measured primarily through structured qualitative interviews that will take place after intervention completion. These interviews will be conducted by trained team members in-person or virtually through video conferencing and are expected to last approximately 60min. They will be audio recorded and transcribed before being coded and analyzed to identify key factors contributing to feasibility and acceptability of the intervention. Compliance with the intervention provides another measure of feasibility and acceptability. Participants in the intervention group will track their daily dietary intake for the duration of the intervention using paper and/or RedCap surveys. These surveys will be reviewed weekly by the health coach for completeness before being analyzed with NDSR (NDSR, Nutrition Coordinating Center, University of Minnesota, MN). To account for deviations from the meal plan, overall dietary compliance will be evaluated by comparing participants Healthy Eating Index (HEI) score to that of the standard meal plan. Participants will track their adherence to the exercise intervention (150min/wk. exercise) using personal training software (FitSW, FitSW Inc., Colorado Springs, CO) and their steps will be continuously monitored by a pedometer (Fitbit, Garmin, Apple Watch, etc.) provided by the research team. Compliance with the exercise prescription (150min/week) and walking goal (500 extra steps/week) will be assessed weekly by the health coach. Coaches will document the average number of weekly steps and total exercise minutes.

All investigators and research team members will complete and maintain appropriate CITI training. All data will be entered into the ACNC clinical relational database and/or RedCap. The database will be housed on a shared drive that is backed up nightly off-site Monday through Friday. Access to the server is password protected, as is access to the study database. Data and study samples will be labeled with a unique identifier (e.g., MB-101). This identifier will be in no way associated with the participants personal information, such as name or date of birth. The key to the coded information, all identifiers, and biological specimens will be destroyed 7years after the study close date. Data and samples will not be used for future research, either with or without identifiers. Participant names, contact information, and address will be shared with the meal preparation and delivery company. Data and samples will only be accessible by investigators, research assistants, and institutional oversight offices (e.g., IRB).

Prior to inferential analyses, exploratory data methods will be used to check for potential outliers and aberrant observations and measurements. The following will be tested between the PCOS and no PCOS groups to assess potential differences: fertility diagnosis (male factor, ovulatory disorder, tubal factor, endometriosis or unexplained), pregnancy, live birth, age and race using Mann-Whitney U nonparametric tests for each strata. Follicular fluid and serum metabolites will be analyzed using a one factor Analysis of Covariance (ANCOVA) at four levels because of the potential unbalanced data structure. Pair-wise comparisons using Tukey-Kramer post-hoc tests will be used to identify groups whose means differ significantly while retaining the family-wise error rate at 5%. If the distributional assumptions for ANOVA are not met, and if a suitable data transformation is not found, a Kruskal-Wallis equality-of-populations rank test will be used, followed by Dunns test of multiple comparisons. When the design is balanced, two-way ANOVA or non-parametric Friedman test will be used in data analysis. As alternatives, generalized linear models may be also used to test the effects of treatment and presence of PCOS and ANCOVA may also be used to control for additional confounding factors Correlations will be determined using the Pearson Product Moment or the Spearman Rank Order for non-parametric tests. Significance will be set at p<0.05. RNA-seq data will be analyzed using SeqMonk and R software. Gene expression levels will be expressed as raw read counts for differential expression analysis and as log-transformed normalized reads per kilobase per million mapped reads for visualization. Differentially expressed gene expression will be identified using the DESeq2 package and filtered at two-fold change and statistical significance with a p value 0.05. Gene Ontology (GO), transcription factor (TF) target analysis, and pathway analyses will be conducted with DAVID bioinformatics and/or WebGestalt, which include multiple testing corrections. For participants assigned to the standard of care whose fertility treatments were unsuccessful, they will be offered to re-enroll and be directly assigned to the intervention group. The data from these participants will be analyzed separately, using paired t-tests or non-parametric equivalent to evaluate the effect of the intervention (pre and post).

Based upon existing data in the literature, a power of 0.8, and a p-value set at 0.05, with 20 women per group, we will be able to detect a mean difference of at least 0.37 standard deviation units in follicular levels of C-reactive protein and of insulin. In our previous study, we found follicular fluid CRP differences of 3.2g/ml (2.7 vs. 5.9g/ml, respectively) between normal weight and obese women [12]. Thus, we are confident that this sample size will be sufficient to detect clinically meaningful differences. Based on our experience, we expect that we will be unsuccessful in obtaining a good quality oocyte from approximately 33% of women enrolled. Therefore, we will enroll 30 women in each of the 4 groups (PCOS- standard of care, PCOS-intervention, no PCOS- standard of care, no PCOS-intervention) to assure that we will have at least 20 oocytes per group.

A Data and Safety Monitoring Plan is in place for this study. Adverse events, enrollment numbers, lost to follow up counts, and withdrawals will be monitored by the Clinical Coordinator. A continuing review will also be completed annually. Any adverse events and deviations will be reported to the IRB and included in the continuing review. Any adverse effects or unanticipated problems will be reported to the study PI, the IRB, and the study sponsor in accordance with IRB policies. At all times, the IRB will be promptly provided with the information from the Clinical Coordinator as needed.

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Effect of a dietary and exercise intervention in women with overweight and obesity undergoing fertility treatments: protocol for a randomized...

Aug 17

How to quickly build muscle in your first 6 months of strength training, according to a powerlifter – Insider

Lifting weights might seem intimidating, but if you're new to strength training, you can put on muscle and gain strength faster than athletes with decades of experience.

That's the magic of "newbie gains," which refers to the extremely fast progress beginners can make in the first six months to a year of weightlifting or similar workouts. That's because your body isn't used to the new stimulus of working out and is primed to adapt quickly as a result, according to Chris Duffin, a world record-holding powerlifter and co-founder of Kabuki Strength.

With the right planning, you can make the most of "newbie gains" while they last, and set yourself up for long-term success. To optimize your training, Duffin recommends that you prioritize recovery, don't skimp on nutrition, stick to a specific workout routine, and avoid overtraining.

A morning gym session is fine, but not if you're getting less than adequate sleep as a result.One of the biggest mistakes you can make when starting a new workout routine is waking up too early to work out, according to Duffin.

Losing sleep to exercise is a common problem with gym newbies, he said, and can lead to more soreness and risk of injury. It can also defeat the purpose of strength training in the first place, since lack of sleep means you aren't giving your muscles time to grow and adapt, stalling your gains.

"It's like bending over to pick up a dime and missing the $10 bill in front of you. It doesn't make sense," Duffin said.

Most research recommends at least seven hours of sleep for the average adult, and up to nine or even ten hours for some elite athletes.

Another common mistake gym newbies make is what Duffin calls "shiny object syndrome" trying out many different workout programs in a short time, without spending much time on any of them.

"People are trying to find the secret sauce. They'll try an approach for a month and then hop to the next thing, but the only way you can learn what works for you is to stick with something," he said.

He recommends being consistent with a program for at least six months for best results.

Duffin said people often start a new fitness routine and a new diet at the same time, trying to change their body composition in the shortest amount of time.

But to build muscle effectively, you need to be in a calorie surplus, which means eating more food than you burn off in the form of exercise and daily activities. Cutting calories too much can slow muscle growth, worsen fatigue, and impair your progress on a new workout program.

To avoid missing out on gains, Duffin recommends changing one major variable in your routine at a time. For instance, if you're adding workout days or training more intensely, give your body time to adjust before making big tweaks to your diet.

Finally, while it can be tempting to go all-out on your fitness goals, Duffin said overtraining is a major barrier to progress.

"More is not better. You want to do the least amount to get the result you want," he said.

For fitness newbies, 45 minute workouts, three times a week is a good start.

Duffin said this slow, steady approach may take patience, but it's the best way to ensure the longevity of your gains.

"The beauty of strength training is that it continues to be progressive over time," he said.

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How to quickly build muscle in your first 6 months of strength training, according to a powerlifter - Insider

Aug 17

Helping Southland Residents with Post-COVID Recovery – Los Angeles Business Journal

Some people who have had COVID-19 are finding their symptoms related to the virus continuing for many months. Shortness of breath, persistent fatigue, cognitive brain fog issues, difficulty eating and drinking, speech and language problems, cardiac issues, plus the anxiety or depression that can often be associated with the lengthy recovery from this new virus that we still have so much to learn about. It can affect almost every aspect of life and make resuming previous activities harder than expected.To combat the complicated, multi-layered process of post-COVID-19 recovery, Pomona Valley Hospital Medical Center (PVHMC) offers a comprehensive Post-COVID Recovery program designed to help those with post-COVID-19 health issues. Pulmonary rehabilitation-certified respiratory therapist, Tammy Magill, RRT, leads a highly skilled multidisciplinary therapy team who carefully evaluates symptoms, tests each patients underlying physiologic impairments, and individualizes a specific treatment plan based on the findings. The goal is to help patients recover from the continuing effects of the disease through specialized therapies and progressive exercise programs designed to improve lingering symptoms and restore functional independence as quickly and safely as possible. Interestingly, many of our Post-COVID Recovery patients were not necessarily the most ill, or those hospitalized the longest, said Magill. They managed their initial symptoms at home and, either never got over them completely, or got over them originally and symptoms returned months later.Alta Loma resident, Denalonor Bustamante, came to PVHMCs Emergency Department on December 9, 2021, where she was diagnosed with COVID-19, pneumonia and a sinus infection. She was admitted to the hospital, placed on high-flow oxygen and began her 22 day-stay in the Telemetry unit. She was discharged on New Years Eve and began the new year continuing her recovery at home.The first couple of weeks at home, I was weak and slept all the time. My head and body ached and I would cough nonstop for periods ranging from 45 minutes to 2 hours, said Denalonor. I had developed pulmonary thrombosis my doctor described it as taking shards of glass and spreading it on my lungs," Denalonor added.Denalonors pulmonologist, Dr. Rakesh Sinha, soon referred her to PVHMCs Post-COVID Recovery where she began twice weekly sessions on February 18, 2021. At her first appointment, they conducted an assessment she could only walk on the treadmill with no resistance for five minutes. She continued this five-minute rehab for the next 23 weeks and would come home so exhausted that she would sleep for 23 hours. A few months later and Denalonor can now walk on the treadmill with some resistance for more than 20 minutes. Im not as exhausted. My stamina is picking up and I am not coughing as much I can have a conversation now without gasping at every other word, said Denalonor. I fought long and hard in the hospital and had some dark days, but with the help of the amazing Post-COVID Recovery Associates, Im working on strengthening my lungs and I am hopeful.Patients who have completed the program say they are happy to be getting back to normal and report positive outcomes such as better breathing, improved oxygen levels, reduced anxiety levels, less fatigue, longer walk times, resuming previous recreational activities and returning to work.

For more information about PVHMCs Post-COVID Recovery Program, call (909) 865-9810 or visit

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Helping Southland Residents with Post-COVID Recovery - Los Angeles Business Journal

Aug 17

US Conducts Maritime Security Exercise in Gulf of Guinea with Allies – The Maritime Executive

Nigeria patrol boats participated in the exercises (US Navy photo)

PublishedAug 15, 2021 3:45 PM by The Maritime Executive

As part of its effort to demonstrate its commitment to maritime security in the Gulf of Guinea, U.S. forces conducted a series of exercises and a planning conference in the region. The efforts were in support of the global initiative and the programs being developed by the Nigerian government to combat the rise in assaults and hijackings of merchant ships in the region.

The Expeditionary Sea Base USS Hershel Woody Williams, which became the first warship permanently assigned to the U.S. Africa Command area of responsibility, lead the maritime security exercise. Also, participating were the Nigerian Navy, the Spanish Navy, and members of Ghanas Special Boat Squadron.

The exercises we conducted this week show our commitment to the mutual goal of countering maritime crimes in the Gulf of Guinea, and how we can work together to achieve it, said Capt. Chad Graham, commanding officer, USS Hershel Woody Williams. These maritime training operations required the collaboration of not one, but three countries navies, all working together simultaneously, said. Collaborative operations like this offer invaluable experience for my crew in the present, but they also allow us to be more efficient and capable in future operations with our partners in the region.

Officers of the Nigerian Navy touring the Williams (US Navy photo)

The three-day at sea training exercise consisted of maritime interdiction operations, visit, board, search, and seizure (VBSS) scenarios, fleet maneuvering, and helicopter insertion and casualty evacuations. Alongside Hershel Woody Williams, participating ships included Nigerian Navy ships NNS Prosperity, NNS Nguru, NNS Ekulu, NNS Osun, NNS Ose, and the Spanish Navy ship SPS Vigia, as well as the Nigerian Navys Regional Maritime Awareness Center at Western Naval Command.

This exercise followed a two-day maritime planning event held with leaders from the Nigerian Navy. Also, during the port visit in Logos, the crew of the Williams participated in a series of community relations activities, and the vessel hosted ship tours.

The program including a 3-day training exercise (U.S. Navy photo)

U.S. commanders noted that America shares a common interest with its African partner nations in ensuring security, safety, and freedom of navigation on the waters surrounding the continent. They noted that these waters are critical for Africas prosperity and access to global markets while recognizing that Gulf of Guinea nations have steadily increased their capability of working together and sharing information.

Nigeria maintains the largest navy in the Gulf of Guinea region. Recently, the government has initiated a concerted effort to increase security in the region. In July, Nigeria launched the Deep Blue Project, which is the first integrated maritime security strategy in West and Central Africa aimed at the ongoing threats of piracy and robbery. Nigeria is committing $195 million worth of new equipment along with a dedicated maritime security unit and training as part of the combined effort on land and at sea.

The U.S. joins with other members of the international community in an increased emphasis in providing greater maritime safety in the region. The Danish government announced plans to deploy a frigate to the area in the winter of 2021-2022 during the time when piracy activity typically increases. Denmark also called on other nations to join in deploying forces to the Gulf of Guinea.

The Williams is under the command of the U.S. Sixth Fleet, headquartered in Naples, Italy. As part of the ESB ship class, the U.S. Navy noted that she is a highly flexible platform that may be used across a broad range of military operations. Acting as a mobile sea base, the Williams is part of the critical access infrastructure that supports the deployment of forces and supplies to support missions.

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US Conducts Maritime Security Exercise in Gulf of Guinea with Allies - The Maritime Executive

Aug 17

Wellbeats partners with M Health Fairview University of Minnesota Masonic Children’s Hospital to bring virtual wellness classes to patients and their…

ST. LOUIS PARK, Minn., Aug. 16, 2021 /PRNewswire-PRWeb/ --Hospital stays are stressful, and when a child is involved, it can be easy for parents to neglect their own health. Thanks to a new partnership between Wellbeats and M Health Fairview University of Minnesota Masonic Children's Hospital, families will have access to a free and convenient way to tend to their physical and emotional well-being while their children undergo treatment at the hospital.

The agreement, which took effect July 1, gives patients and families access to the more than 800 on-demand, virtual wellness classes in the Wellbeats app. This content is available free of charge to patients and families for the duration of their hospital stay. That means taking yoga or mindfulness classes from the comfort and privacy of a child's hospital room or participating in guided stretching exercises to work out the kinks from a night in a guest bed is all easily accessible to families. Whether an individual is looking for an intense workout to relieve stress or simply a quick break to get their blood flowing, Wellbeats delivers high-quality content for every age, ability level, and personal fitness preference.

"Wellness should be accessible and attainable to everyone, regardless of age, health status, or current life situation," said Jason Von Bank, president and CEO of Wellbeats. "We're proud to partner with Masonic Children's Hospital to enhance the exceptional care they provide with content that supports overall well-being and helps families maintain healthy habits during a time of great stress in their lives."

Wellbeats content isn't just for parents. With a wide range of classes tailored specifically to younger users, Masonic Children's Hospital patients can also access Wellbeats classes, as long as their health allows. All classes can be streamed with an internet-connected computer or on an iPhone or Android device through the Wellbeats app. Classes will also be available on televisions in patient rooms.

"Families may be with us for days or weeks at a time, so it's important to make their stay as comfortable as possible. With Wellbeats' on-demand content, families will have a diverse selection of engaging classes available any time of night or day, making it easy for them to be proactive about their well-being," said Jason Villar, service line strategy director for M Health Fairview University of Minnesota Masonic Children's Hospital. "We've already seen a positive response from patients and families to this offering and we look forward to the influence it will have on their experience with our hospital and their care. "

Wellbeats classes will be available to all families as long as the patient is undergoing inpatient or outpatient treatment at Masonic Children's Hospital.

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Based in St. Louis Park, MN, Wellbeats is the premier provider of on-demand, virtual wellness content and programming for use in corporate well-being initiatives. With more than 800 exercise, nutrition, and mindfulness classes, challenges, and fitness assessments available anytime and anywhere, Wellbeats allows employers to support employees with wellness resources that fit their needs, lifestyle, and schedule. Wellbeats provides best-in-class content that appeals to people of all ages, interests, and fitness levels. Wellbeats content is easily accessible through apps for iOS, Android, Windows, and Apple TV; any modern Web browser, Chromecast, Airplay, and Roku. To learn more, visit, Follow on LinkedIn or check out a sampling of the company's fitness classes during a Facebook Live session.

About M Health Fairview University of Minnesota Masonic Children's Hospital

M Health Fairview University of Minnesota Masonic Children's Hospital provides a broad range of more than 55 pediatric programs and specialties from surgery, imaging and neonatal and pediatric intensive care to cardiac and oncology services and blood and marrow and organ transplantation. Our clinical staff apply innovative approaches to creating medical breakthroughs based on their work with patients and on findings through research at the University of Minnesota. This has led to several firsts, including the first successful pediatric blood marrow transplant, infant heart transplant in Minnesota, and cochlear ear implant surgery for a child. Visit to learn more.

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Wellbeats partners with M Health Fairview University of Minnesota Masonic Children's Hospital to bring virtual wellness classes to patients and their...

Aug 17

The best fitness watch money can buy (updated August 2021) – PhoneArena

Getting in shape is not an easy feat and staying in shape is equally difficult. Hopefully, we now have tiny electronic personal trainers on our wrists, watching our every move (or the lack of it) and giving us a hard time if we slack off too much.

There are fitness bands and trackers, for sure many people use them and find them useful. But some prefer a fitness watch, not only because of its looks but also because a good fitness watch beats most of the bands and trackers by a mile when it comes to features.

Samsung Galaxy Watch 4

Samsung officially announced the Galaxy Watch 4 series and it's still hot from the hardware oven. The Korean tech giant has seriously upped its game with the Galaxy Watch 4. This fitness watch takes body measurements to the next level because it comes with a built-in Bioelectrical Impedance Analysis sensor that can measure body fat, skeletal muscle, body water, estimate your basal metabolic rate, and more.

We've never seen such a sensor baked into a fitness watch before, and it's a serious feat. The Galaxy Watch 4 offers 95 supported workouts, 13 of which are on the watch by default. It can autodetect most of them, and thanks to the aforementioned sensor, coupled with the more traditional heart rate and SpO2 sensors, the watch can give you amazingly detailed statistics.

The good thing is that the Galaxy Watch 4 is no slouch in other areas, unlike other more sports-oriented watches. For starters, it's very stylish and you can wear it in the gym or at a formal dinner with the same success. It has a bright and vivid Super AMOLED display (it's a Samsung watch after all), and it packs the new Exynos W920 LTE equipped chipset. So, lots of power and lots of smart features.

Apple Watch 6

Let's get the mainstream ones out of the way first. Not that the Apple Watch 6 isn't good. Quite on the contrary - it's one of the best fitness watches for iPhone users. This fitness watch offersa range of new fitness options including dance tracking, core training, functional strength training, and cooldown. All these arrive as part of watchOS 7 and sit alongside more traditional options like running and cycling.

The Apple Watch Series 6 has a built-in SpO2 blood oxygen saturation sensor and uses Vo2 max readings to monitor your cardio fitness levels as well. Apple constantly improves the user experience on its wearables with updates and you'll get years and years of support on this fitness watch.

Needless to say, the Apple Watch Series 6 is a full-fledged smartwatch with many amazing features. It's super-fast, it has tons of watch faces, some great apps, and you can get it with a titanium frame for extra durability and to shave off some of the weight, too.

Garmin's flagship smartwatch, its most advanced and most expensive one is made for high-performance athletes. The Fenix 6S Pro is a rugged multisport GPS fitness watch that just begs to be taken outside. There are preloaded tracking profiles for trail and track running, swimming, running, biking, hiking, rowing, skiing, golfing and more. The Fenix 6S Pro comes with onboard maps for 2000+ ski resorts as well!

Granted, it may lack the body composition feature but it comes packed full of sports goodness. You still get the heart rate and blood oxygen saturation sensors, and Garmin has perfected its sports tracking algorithms through the years to the point where the watch doesn't actually need more sensors to do the job.

Get your Garmin Fenix 6 watch here:

Another big plus is the battery life - unlike the Galaxy Watch 4, the Garmin Fenix 6S Pro can last for up to 9 days on a single charge, which is kinda important when you are, you know, in the mountains. You can also customize your Fenix 6S Pro, choose a sapphire option, or the neat Solar variant that charges its battery with the power of the Sun. The only downside is that the Fenix 6S Pro is rather expensive. But if you are the outdoors type, it can be the best fitness watch for you!

Samsung Galaxy Watch Active 2

If you value your style, you'll love the Galaxy Watch Active 2. It's very sleek and comfortable to wear, and even though there's the "Active" part in its name, the watch can hold its ground on formal occasions too.

The Galaxy Watch Active 2 comes equipped with quite the variety of workouts that you can manually start: arm curls, arm extensions, back extensions, bench press, burpees, circuit training, crunches, deadlifts, ellipticals, exercise bikes, these and other exercises performed at the gym are available. And then you also have activities like hiking, pilates, stretching, swimming, walking, and yoga.

The built-in heart rate monitor is quite accurate and works pretty well, and the automatic workout detection is also great. The Galaxy Watch Active 2 can also track your sleep, manage your calorie intake, and it also comes with smart features on board.

The Fitbit Versa 3 brought even more improvements to the proverbial smartwatch table and rectified some of the complaints people had with the second-gen model. It has the same sleek and lightweight design that Versa fans love, and it can automatically track workouts, too.

Sleep tracking, heart-rate monitoring, SpO2 readings, GPS, NFC are all present on the Versa 3, alongside water-resistance at up to 50 meters (5ATM), and one whole week of battery life.

Health & Fitness Smartwatch - Soft Gold

In order to meet its target price, though, the Fitbit Versa 3 had to cut some corners. You won't get LTE connectivity on this fitness watch, nor wireless charging for that matter. The display is a bit on the small side, and the bezels are... well, definitely there! But these minor drawbacks can't spoil the final user experience - the Fitbit Versa 3 is a solid fitness watch that won't cost you an arm and a leg.

Now, if you're serious about your cardiovascular health, you should be familiar with Polar. The company is well known among fitness experts and enthusiasts. Polar manufactures heart rate sensors, widely recognized as the Gold Standard of heart rate tracking both by regular users and researchers around the globe.

What most people don't know is that Polar also makes fitness Watches. The Polar Ignite 2 takes Polar's expertise in heart rate monitoring and crams it into a stylish and durable everyday gadget. This fitness watch is perfect forgym, group exercise, swimming, running, cycling, walking, yoga, and practically anything that gets your heart racing.

The Polar Ignite 2 comes with some neat smart features as well. You can control your music, receive notifications from your phone, check the weather - all the basic stuff. There's built-in GPS inside, alongside a bunch of training guides and programs, and because the heart rate sensor is so good in this one, you also get top-notch sleep tracking and analysis.

The Polar Ignite 2 comes ina variety of colors and the price is also quite affordable.

Honor MagicWatch 2

The Honor MagicWatch 2 offers a unique blend of classic and modern - it's understated, stylish, and elegant. It's not the best fitness watch but it covers all the basics and with style. You won't need to milk your bank account dry too.

Some people say that Honor/Huawei fitness watches are just fitness bands undercover. There's some truth to this but in our case it doesn't matter much. What you're getting is amazing battery life and a slew of fitness activities and programs. Sleep tracking is present, and you get the usual pack of sensors, namely of the heart rate and blood oxygen saturation variety.

The Honor MagicWatch 2 may be a fitness band undercover but boy, what a cover! It screams premium and has one of the brightest and prettiest OLED displays on the market. And while you'll have to cough up $500-600 for similarly good looking devices from other brands, the Honor MagicWatch 2 will give you style for much less.

Garmin Forerunner 945

Garmin's Forerunner 945 has one goal and one goal only - to make an athlete out of you. The GPS inside this fitness watch is specifically built with runners in mind. You get very detailed data of your running sessions and other workouts, alongside other fitness-oriented features.

From the daily suggested workouts, to the dedicated coach, the Forerunner 945 boasts a sophisticated training app that can measure the effects of your workouts and even suggest a recovery time. There are lots of metrics on board, including a VO2 Max reading that will show your overall fitness level and progress, and there's a cool feature that's exclusive for Garmin fitness watches, called IERCC.

In case of any sort of emergency, the watch will automatically send your name and location to the Garmin IERCC, a 24/7 staffed professional emergency response coordination center. The Forerunner 945 comes in two variants - there's the vanilla version and an LTE model.

The only downside of the Forerunner 945 is its price. If you go for the LTE version, you should expect to part with around $600. There's a trimmed-down version - the Forerunner 55 that you can get for less than a third of that, and it will cover all the basics for you.


The best smartwatch for elite athletes

Tons of useful metrics

LTE option

Garmin IERCC emergency service

Mobile payment

Smart notifications

Good battery life

Navigation with color maps


Our list of best fitness smartwatches may be concluded for now but it is far from complete. There are so many brands out there that devices are getting announced as we type. Expect more entries to appear soon, and fuel your healthy obsessions. Until then, stay fit and stay safe.

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The best fitness watch money can buy (updated August 2021) - PhoneArena

Aug 17

National Guard Bureau chief visits Northern Lightning Exercise at Volk Field – Wisconsin Department of Military Affairs

VOLK FIELD, Wis. Gen. Daniel Hokanson, the chief of the National Guard Bureau and a member of the Joint Chiefs of Staff, visited Wisconsin Aug. 10 to observe the annual Northern Lightning Counterland training exercise involving aircraft and personnel from the National Guard, Air Force, Army, Marine Corps, and Navy.

During his visit, Hokanson met with senior Wisconsin National Guard leadership as well as exercise participants and several of Wisconsins Airmen. He took the time to discuss each Airmans responsibilities at Volk Field while also learning about their family and personal life.

This is the best part of what I get to do, because when I go back I can tell the story of all the great things that you guys do, Hokanson said.

Airmen discussed the logistics behind Northern Lightning and other exercises that occur at Volk Field throughout the year. Before an exercise can take place, equipment and personnel need to be brought in and properly prepared in order for the training to be successful.

Nobody really sees that, Hokanson said. Theyre all focused on the jets and stuff like that, but all the work behind that, the semis coming in, all that stuffs got to be off-loaded. Youve got to bring all those people in. Youve got to get them billeting. Youve got to meet them. Thats the beauty of what the Guard can do.

Col. Leslie Zyzda-Martin, Volk Field Air National Guard Base commander, chimed in that many of the Airmen werent giving themselves the credit they deserve for all that they do.

When these guys are telling you their story, theyre very humble because youre only looking at a bench of a couple behind them, Zyzda-Martin said. Its unbelievable.

Airmen also discussed day-to-day operations and the support they provide to the local communities. The Volk Field Fire Department serves as the only full-time fire department in Juneau County and often works to provide support to surrounding communities through mutual aid agreements.

Volk Field Fire Department Deputy Chief Ross Krizan explained, as an example, that recently they received a call to help an individual who was stuck on a nearby bluff. He said the real-world mission was beneficial to the firemen who responded.

You can train all day, but when you get out there, you get hands on and actually lower somebody from a bluff who is not getting down otherwise, that is training that we just cant provide here, Krizan said.

Hokanson also took the time to discuss some of his priorities and listen to issues affecting Air Guard members in order to better address them.

I appreciate the chance to talk to you about you personally because to me, the beauty of the Guard is in this room, Hokanson said. Its just the people. At the end of the day, the equipment is going to come and go, but the enduring issue is weve got some incredible folks doing just great things to make this all happen.

Simultaneously, the generals wife, Kelly Hokanson,met with support staff and members of the Wisconsin National Guard Service Member Support Division to discuss a range of topics including family readiness, diversity, and health.

Many programs unique to the Wisconsin National Guard were explained and discussed including Wisconsin GI Bill tuition benefits, the Comprehensive Health and Wellness Program, and a new domestic violence reporting policy mirroring a policy already established in active duty.

Mrs. Hokanson expressed her interest in many of the benefits Wisconsin offers its Guardsmen and veterans as well as the many changes being made toward improvement.

We have come so far, Kelly Hokanson said. I love the direction that the military is going in recognizing the holistic health of an individual, because the younger generation is not like older generation. I see our senior leaders embrace positive change like this and they say, I wish that was a thing when I was young. I know my husband often says, how much better would we have been had this been available to us.

Mrs. Hokanson also spent time listening to current issues that support staff and Guard members and their dependents are struggling with. As a Transition Assistance Program ambassador, Hokanson shared specific details of the TAP program that would be useful for family readiness staff to utilize and share with Guardsmen. She offered support and resources to a military spouse whose husband was recently deployed, directing her to the Military Kids Grant and the Military Child Education Coalition. She also took extreme interest in an Airman struggling with having consistent access to the Exceptional Family Member Programs and Tricare Extended Care Health Option programs while serving on different statuses and deployments.

These are issues that National Guard and Active Duty service members across the nation are also facing.

Mrs. Hokanson said shes impressed with the National Guard in states like Wisconsin which offer so many resources and are actively creating improvements. She spoke of her appreciation and admiration of the Guard and its tightly knit community.

I want Guard people to realize that active duty is not pie in the sky, Hokanson said. I have a foot in both worlds and there are great things about each, but what you miss on active duty is this sense of community. Active duty creates that feeling of community very quickly and its awesome, but then they leave. You have to reestablish that again at the next phase and you either do or you dont whether or not its important to you.

The beauty about the Guard is that youre here and you remain here. You have those deep ties and you get to know your community members, and they become your extended tribe.

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National Guard Bureau chief visits Northern Lightning Exercise at Volk Field - Wisconsin Department of Military Affairs

Aug 5

What Makes Someone an Expert in Fitness and Exercise? – Everyday Health

Hop on your favorite social media platform and youll find a seemingly endless stream of exercise and workout content from certified personal trainers, exercise enthusiasts, and everyday users pumped to share their personal hot takes.

While these communities can be great resources for surfacing exercise inspiration, motivation, and know-how, its important to know who youre turning to for what info.

Anyone can create a social media profile and start sharing information, says Frances Neric, national director of certification for the American College of Sports Medicine (ACSM) in Indianapolis. But what theyre saying doesnt have to be scientifically sound.

Seeking advice from the wrong person can lead you to workouts that are poorly designed, ineffective, or potentially dangerous. So, how can you differentiate whos legitimate and whos not? Who should you be turning to for what type of advice?

Heres what you should know:

Unlike some professions (like medicine or dentistry), theres no one professional society or board that oversees fitness training. Multiple professional societies offer programs to train fitness professionals.

And those seeking training can choose from a fairly wide variety of certificates and credentials from several professional organizations. When vetting an expert youll turn to for advice about exercise and working out, Neric suggests checking which organization has certified the personal trainer.

You can check the U.S. Registry of Exercise Professionals (USREPS) to see if a personal trainer is certified by a National Commission for Certifying Agencies (NCCA)accredited program, which shows that the fitness professionals certification has met standards set by the industry and comes from a proven safe and effective program, says Neric. (NCCA accredits a range of professions, including nurses and counselors.)

A common fitness certification is "certified personal trainer," or CPT. Reputable organizations that certify personal trainers include the American Council on Exercise (ACE), the American College of Sports Medicine (ACSM), the National Council on Strength and Fitness (NCSF), and the National Strength and Conditioning Association (NSCA), according to USREPS.

Other NCCA-accredited fitness certifications include:

While this registry is extensive and easily searchable (in that there are a number of member organizations that are represented here), its not comprehensive.

There are other NCCA-accredited organizations that certify personal trainers and group fitness instructors, such as the National Academy of Sports Medicine (NASM) and the National Federation of Professional Trainers (NFTP), that arent members of the USREPS.

To verify that an individual has been certified by an authoritative fitness training organization, check that the certifying body is NCCA-accredited, Neric says.

RELATED: Should You Get a Personal Trainer?

According to the NFPT, a certified personal trainer (or someone with any of the other advanced NCCA-accredited fitness credentials) will be able to:

While a certified personal trainer can talk about basic nutrition, they cannot give you specific nutrition information. If an exercise professional is giving direct advice about what and what not to eat, be on alert, says Neric. This person can share generic information, like what a calorie is, but they should not prescribe a specific diet or eating plan.

For information about what to eat and how to exercise, a registered dietitian-nutritionist (RDN) can offer diet advice and recommendations for eating and exercise, according to the American Academy of Nutrition and Dietetics.

RELATED: What to Eat Before and After You Work Out

If you want more specific nutrition advice to optimize training or athletic performance, you may want to look for someone with additional certification, ideally someone who is a board-certified specialist in sports dietetics (CSSD), a credential from the Academy of Nutrition and Dietetics.

Some accredited exercise certification programs also offer additional specialty programs in nutrition. Individuals with these certifications have additional training in nutrition, but they do not necessarily have the same breadth of education as an RDN.

If youre looking for someone who can provide both tailored training and nutrition advice, Neric suggests finding someone who is both an RDN and a certified exercise professional. They are harder to find, but they are out there.

When it comes to specialized workouts, like Zumba, CrossFit, Pilates, and others, what makes someone an expert varies:

RELATED: Everything You Need to Know About Yoga

If you have a chronic illness or disability, if youre pregnant, or you have other special health concerns, you may want to get exercise advice from someone with more expertise about your condition.

If you have a clinical condition, such as obesity, diabetes, or hypertension, its important that your trainer has advanced training beyond a certified personal trainer certification ideally as an exercise physiologist so he or she is able to tailor fitness recommendations for your condition, says Lee Stoner, PhD, MPH, assistant professor in exercise physiology at the University of North Carolina at Chapel Hill. (Dr. Stoner is a fellow of the ACSM and is the director of the Exercise is Medicine program at UNC.)

As an example, the ACSM offers itscertified clinical exercise physiologist program (ACSM-EP), which requires advanced education and hands-on training. Individuals pursuing this certification must have a masters degree in clinical exercise physiology and complete 600 hours of hands-on training, or have a bachelors degree in exercise science and complete 1,200 hours of hands-on training.

For this requirement, hands-on training can include developing exercise programs, using electrocardiography (a test that measure the hearts electrical activity), or working with people who have heart, lung, or neuromuscular disease.

Acccording to Stoner, people with this certification need to have a lot of education. You need to know the pathways of physiology of these various conditions, how to interpret an electrocardiogram, and how to communicate with the clients physician, he says.

If you are on a medication, like insulin to treat diabetes or a beta-blocker for high blood pressure, an exercise physiologist will understand what effect those have on exercise so they can train you in a safe way, Stoner says.

RELATED: Why Being Fit Helps You Manage Chronic Diseases

If you are looking for information about working out while pregnant, ideally look for a CPT who has taken continuing education courses in prenatal and postnatal fitness, from ACE or another accredited fitness organization. (Some prenatal fitness programs do not require experience to be certified, so make sure the person youre taking instruction from has their CPT.)

If youre looking for advice about senior fitness, look for a CPT who is also trained in senior fitness. One example is the NASM Senior Fitness Specialization, which is a continuing education program.

If you are injured, your exercise program should be modified. Ideally, this would be done through input from a physical or occupational therapists, notes ACSM.

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What Makes Someone an Expert in Fitness and Exercise? - Everyday Health

Aug 5

Mayo Clinic Q and A: Benefits of pulmonary rehabilitation for COPD and other lung conditions – Union Democrat

DEAR MAYO CLINIC: My father has had COPD for years, but he was hospitalized for worsening symptoms related to his condition. His health care provider advised that he should begin a pulmonary rehabilitation program. He is hesitant and unsure of what to expect. What are the benefits of pulmonary rehabilitation in people with COPD? Do you recommend it for people with other lung conditions?

ANSWER: Pulmonary rehabilitation is a medically supervised program that includes structured exercise training, health education, behavior modification, nutritional counseling and the learning of breathing techniques for people who have certain chronic respiratory diseases or lung problems due to other conditions. Pulmonary rehabilitation seeks to improve the physical and psychological condition of people with chronic respiratory disease, and educate these people on how to establish and maintain behaviors that will benefit their health for years to come.

Pulmonary rehabilitation is beneficial for people with chronic obstructive pulmonary disease, or COPD. It has been shown to reduce symptoms of breathlessness, improve physical function and enhance overall quality of life. Research has shown that people who start pulmonary rehabilitation within three months of hospitalization for COPD-related issues are at significantly lower risk of death after one year, compared to those who start pulmonary rehabilitation later or those who do not take part in pulmonary rehabilitation. More evidence is emerging that pulmonary rehabilitation improves symptoms, exercise capacity and quality of life in people with conditions such as interstitial lung disease, asthma, pulmonary hypertension and cystic fibrosis, as well as in people before and after surgery for lung cancer, lung volume reduction or a lung transplant.

Care related to pulmonary rehabilitation is provided by a team of health care professionals from a range of specialty areas and backgrounds, including pulmonologists, respiratory therapists and exercise physiologists. The pulmonary rehabilitation team also may include experts from nursing, physical medicine and rehabilitation, nutrition, psychology and psychiatry, and sleep medicine, depending on a person's needs.

Typically, pulmonary rehabilitation is provided in an outpatient clinic or in a hospital rehabilitation center, and it normally involves one to three supervised sessions per week for six to 10 weeks.

Before starting pulmonary rehabilitation with patients, the health care team will:

Measure exercise capacity and lung function.

Review medical history and current treatments.

Ask about current levels of physical activity, mental health and diet.

Establish specific goals to be achieved in each person undergoing the program.

Using this information, a specialized care plan is designed to best suit the needs of every person.

Although pulmonary rehabilitation is traditionally performed in a clinic or hospital setting under direct medical supervision, increasing evidence suggests that home-based pulmonary rehabilitation, particularly home-based exercise training, is safe and possibly just as effective. Such home-based rehabilitation may be more convenient for participants. In addition, home-based rehabilitation may be a good alternative for people who are unable to regularly attend a rehabilitation center due to factors such as work commitments and travel restrictions. Many pulmonary rehabilitation centers are working to establish home-based programs.

Exercise training is central to pulmonary rehabilitation. An individualized exercise training plan, or exercise prescription, often is based on the information gathered from exercise tests performed before starting the program, and such a plan is developed for each participant. Exercise training, which combines aerobic exercise, such as treadmill walking or riding a bike; strength training; and exercises that improve balance and flexibility, is designed to improve strength and stamina, and reduce breathlessness, fatigue and tiredness in people who take part in pulmonary rehabilitation. The rehabilitation team may recommend using medication to open up the airways before exercise or teach people how to adjust their regular oxygen therapy during exercise to maximize the benefits gained. As pulmonary rehabilitation participants become more familiar with their exercise program and confident in performing regular exercise, they are encouraged to exercise independently at home or in another setting, such as a fitness center, in addition to the supervised sessions.

Participants also may learn specific breathing techniques such as diaphragmatic breathing, pursed lip breathing or yoga breathing. These techniques can help people with lung conditions better control their breathing, and help them better cope with stressful situations and avoid feeling out of breath, especially during exercise. In some situations, the rehabilitation team also may have a participant take part in specific training of their breathing muscles. This training is designed to increase the strength of the breathing muscles. And when done in combination with exercise training, it has been shown to reduce breathlessness and improve exercise capacity, compared to exercise training alone in some people with respiratory disease.

Education and counseling are also key parts of pulmonary rehabilitation. Participants may receive education on how to more effectively take their medicines and manage their disease; develop a plan to quit smoking, if applicable; and discuss how routine daily tasks can be modified to minimize breathlessness or avoid becoming breathless. In addition, many pulmonary rehabilitation programs offer individual or group-based support on how to best manage and alleviate depression and anxiety, and how to alter diet and prepare meals for long-term health benefits.

Overall, participation in pulmonary rehabilitation is a critical component in managing COPD. I encourage you to talk with your father and his health care provider about the value of pulmonary rehabilitation. I believe it is effective in helping people with lung conditions better manage their symptoms, improve their fitness and ability to perform routine daily tasks, and enhance their overall health and well-being as much as possible.

Dr. Bryan Taylor, Cardiovascular Disease, Mayo Clinic, Jacksonville, Florida


2021 Mayo Clinic News Network. Visit Distributed by Tribune Content Agency, LLC.

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Mayo Clinic Q and A: Benefits of pulmonary rehabilitation for COPD and other lung conditions - Union Democrat

Aug 5

Om Demand: Fitness Brand Adds Digital Meditation Program – GearJunkie

July 30, 2021|By Ilana Newman

Life Time is moving into yet another realm of lifestyle and wellness classes with its digital meditation programs.

If you spend time outdoors, you probably know the flow state that comes from the combination of focus and movement. With a new digital meditation collection, fitness and lifestyle brand Life Time teaches users to access that place of flow.

The on-demand meditation programs build on Life Times current selection of wellness programming. (It currently includes virtual training, on-demand and live streaming exercise classes, health and wellness content, and access to Apple Fitness+.)

The digital meditation programs consist of visual and auditory stimulation, like soothing videos of nature and soft voices. Five categories are offered and include stress management, mental power, daily gratitude, mindful movement, and sleep improvement. Sessions range from 2 to 15 minutes designed to fit a busy schedule.

More than 80% of Americans experienced stress symptoms in January 2021, reported the American Psychological Association. Stress causes cortisol to flood the brain. Practicing meditation releases hormones like serotonin and oxytocin, which reduce inflammation, promote healing and rest, and improve your mood, according to Life Time.

The digital meditation programs allow users to practice both mindfulness and meditation.

According to Life Times meditation preview video, the difference between the two is that mindfulness increases the ability to concentrate and focus (left brain). On the other hand, meditation is the art of letting go. It works the right side of your brain while also strengthening the corpus callosum the part of your brain that connects the right and left hemispheres.

Best of all? Life Times program organizers will release new meditations each day, so there will be a pretty good variety of options.

Interested? You can access Life Times meditation programming through its Digital and Access membership options. First-time members can get their first month of a digital subscription for free. From there, pricing begins at $15/month.

We've all had a tough year. Being able to enjoy the outdoors makes it better. Inhale, exhale, repeat. Read more

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Om Demand: Fitness Brand Adds Digital Meditation Program - GearJunkie

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