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Tania Pacheco-Werner put on her walking shoes. She was halfway through her first pregnancy and had just been diagnosed with gestational diabetes. Her doctors advice? Stay active.

But Pacheco-Werner lives just outside Fresno. It was summer, and well over 100 degrees. The air outside was also thick with wildfire smoke from nearby forest fires an increasingly common occurrence due to climate change.

The expectant mother wanted to do everything right, but was getting conflicting advice. On the one hand, she needed to walk and stay active to prevent complications from gestational diabetes; on the other, public health messaging about wildfires told her to stay inside and reduce her exposure to the smoke. So, what did she do?

Pacheco-Werner went to Walmart. Every day, her husband drove her to the nearby superstore so she could walk around and exercise indoors where the air felt cool and clean thanks to air-conditioning and filtration.

Her doctors hadnt instructed her to come up with this solution. In fact, her doctors never advised her about the potential effects of wildfire smoke on her pregnancy. But Pacheco-Werner holds a PhD in medical sociology, is the co-director of the Central Valley Health Policy Institute, and also serves on the Board of the California Air Resources Board for the San Joaquin Valley. She had been closely following a growing body of scientific literature about the impacts of wildfire smoke on preterm birth and adverse birth outcomes.

Thanks to her own research, Pacheco-Werner knew to buy an air filter to make her home safer for herself and her baby. She knew that finding a safe space to exercise was important for a healthy pregnancy. But looking at the cloud of smoke hanging over Fresno, Pacheco-Werner suspected many other pregnant people were also in danger.

Those most at risk were likely the people living in substandard housing, a problem tied to historically exclusionary policies in the region. As research increasingly shows how wildfire smoke and poor air quality hurt pregnant people and the children they carry, cities across California are working to curb these effects through ventilation centers and weatherization programs. In Fresno, where the air quality is routinely some of the worst in the country, the city and its residents are grappling with how to keep up with the increased risk of severe wildfire smoke.

Since the beginning of the 20th century, the bulk of Fresnos affordable housing and, in turn, its low-income populations and many people of color have been located on the citys west side. Government policies codified housing discrimination in the 1930s with residential safety maps that aimed to help investors decide which areas were safe investments. They marked the least desirable neighborhoods in red, which became the basis for the term redlining. In many instances, Black people living in these redlined neighborhoods were denied home loans altogether. West Fresno was one of these redlined districts, and the homeowners there have been feeling the repercussions ever since.

The idea that present-day health problems can be traced back to redlining is not new, nor is it exclusive to wildfire smoke. In a 2020 study by the UC BerkeleyUC San Francisco Joint Medical Program, researchers found that historically redlined areas of eight cities in California including Fresno have significantly higher rates of emergency department visits due to asthma. The study analyzed several factors that might contribute to health problems in redlined areas, including emissions from highways, which are found more frequently near low-income neighborhoods. The study also briefly noted that, under racially exclusionary housing practices, Black families lacked access to well-constructed housing.

Areas that were redlined have been shown to have houses that are of poor quality, said Rachel Sklar, a post-doctoral researcher at the UC San Franciscos Program on Reproductive Health and the Environment. Sklar is trying to understand the links between redlining and birth complications for pregnant people in California. She explained that, because older houses tend to have older windows, poor-quality insulation and no air conditioning (requiring inhabitants to open windows), these homes likely also harbor more air pollution, including wildfire smoke. That means residents of these homes might face higher rates of pollution exposure.

A 2005 study from the University of California Berkeley analyzed housing characteristics that may lead to leakage of air pollution into the home. The study found that older and smaller houses tended to have more leakage than newer and larger ones, which are more likely to have weather-stripped windows and incorporate modern building techniques. Another study, from 2001, found that there could be a tenfold difference in leakage between the homes with the best air tightness and those with the worst.

Air pollution of all types is a problem for these leaky homes. But as wildfire smoke increases in both severity and intensity in places like Fresno, public health messages are failing to address inequalities in housing standards. According to a report titled Wildfire Smoke: A Guide for Public Health Professionals compiled by the Environmental Protection Agency, the most common advisory during a smoke episode is to stay indoors, where people can better control their environment. However, the authors explained that the effectiveness of staying indoors as a strategy depends on how well the building limits smoke from coming indoors. The authors acknowledged that access to air conditioning is helpful to reduce indoor smoke, but many low-income households dont have access to it.

In very leaky homes, the report said, outdoor particles can easily infiltrate the indoor air, so guidance to stay inside may offer little protection.

In the summer of 2018, when Pacheco-Werner was pregnant, the county of Fresno issued a health advisory about the wildfire smoke and extreme heat. In this advisory, the county advised people with existing respiratory conditions, young children, and the elderly to remove themselves from smoke. The California Department of Public Health (CDPH) has issued similar warnings in summer months, urging people living near wildfires to stay indoors if possible. While the CDPH notices do state that pregnant people like Pacheco-Werner are especially vulnerable, no alternatives are given to account for variations in indoor air quality or access to filtered air.

Exposure to dangerous levels of wildfire smoke has increased significantly over the last decade. This is true for most of California and much of the western United States, but Fresno has been hit particularly hard. According to the air quality tracking website IQAir: Smoke that travels from wildfires throughout the state often reaches the Fresno area and worsens the citys already poor air quality, often increasing air pollution levels significantly.

Researchers are studying the impact of Fresnos poor air quality on children, including those exposed prenatally. The Childrens Health & Air Pollution Study is a collaboration between Stanford University and UC Berkeley that has published numerous studies assessing the effects of various sources of air pollution on childrens health, including a 2020 review of the effects of wildfire smoke. The authors cited a single day in 2018 when over 1 million school children in California had classes canceled due to wildfires. Children are particularly susceptible to smoke, they wrote, because they tend to spend more time outside, breathe more air relative to their body weight, and are still growing and developing. The researchers advised that ventilation and filtration be improved in all buildings in which children spend time. They also noted that childrens risk of health problems due to wildfire smoke doesnt just start when they head off to school: Problems can arise while theyre still in the womb.

Researchers have recently sought to better understand the effects of wildfire smoke on pregnant people. In 2021, Stanford researchers, led by Sam Heft-Neal, published a study that linked wildfire smoke to preterm births across California. Heft-Neal and his team were able to demonstrate that every additional day of smoke exposure was linked to an increased risk of preterm birth, concluding that nearly 7,000 excess preterm births in California could be attributed to wildfire smoke exposure in the studys five-year period.

Preterm birth is typically defined as birth before 37 weeks of pregnancy. According to the Centers for Disease Control and Prevention, babies born prematurely are at risk of a variety of health complications, including breathing problems, feeding difficulties, vision and hearing problems, and developmental delays. Additionally, one-third of infant deaths across the state are related to prematurity.

In the United States, the average rate of preterm births is one in 12. But there is a stark divide along racial lines, especially for pregnant people in Fresno County, home to the highest rate of preterm births in California. At least in part due to societal inequities and institutional racism, Black people in Fresno County are nearly 75 percent more likely to have a preterm birth than white people. This statistic led researchers, health experts, physicians and community members to launch the California Preterm Birth Initiative to conduct and fund research on racial disparities in birth outcomes while centering BIPOC lived experiences. According to the Fresno County Department of Public Health, in 2020, the preterm birth rate for white pregnant people in Fresno County was just under 9 percent, but the rate for Black pregnant people was approximately 13.5 percent. For Hispanic pregnant people, like Tania Pacheco-Werner, it was 10 percent, though Hispanic preterm births make up the highest total number in Fresno County, at 821 reflecting the areas large Hispanic population. Of the total 1,378 preterm births in Fresno County in 2020, 59.5 percent of them were Hispanic.

Linking preterm birth rates to wildfire smoke exposure is complicated, Kendalyn Mack-Franklin of the California Preterm Birth Initiative explained. People of color in Fresno have reported a number of variables that contribute to their high rates of preterm birth, from lack of access to prenatal care, to racism within medical facilities. Environmental exposure likely played a role before the significant increase in wildfire smoke too, since redlined neighborhoods in Fresno are closer to freeways and pollution-emitting industrial zones.

Preterm birth has a lot of confounding variables, Mack-Franklin said. Its very difficult to say that its for one particular reason, unless that reason is racism.

In 2019, the California Legislature approved the Wildfire Smoke Clean Air Centers for Vulnerable Populations Incentive Pilot Program. The program, administered by the California Air Resources Board, will build a system of clean air centers by funding ventilation system upgrades in schools, community centers, senior centers, sports centers and libraries. Funding will be divided between Californias three air quality districts (Bay Area Air Quality Management District, San Joaquin Valley Air Pollution Control District and South Coast Air Quality Management District) and the California Air Pollution Control Officers Association which oversees all 35 local air quality agencies across the state. In the San Joaquin Valley District, applications for funding opened on Aug. 17.

Clean air centers are one way to tackle the problem of indoor air quality, but to Rachel Sklar housing is still at the center of smokes disproportionate effects on low-income people of color. The problem is that people have no choice but to live in poorly maintained homes, she said.

Sklar added that while coastal cities like those in the Bay Area might routinely have better air quality than inland regions, low-income residents of those cities are being pushed inward to places like Fresno as their housing costs become untenable. In her most recent paper, published Aug. 28 in the International Journal of Gynecology & Obstetrics, Sklar calls for housing policy reform, writing, The rapid population growth in inland areas with high fire risks, as well as the disproportionate share of low-income black and Hispanic people that are migrating to these areas and experiencing the downstream health effects of living in those areas must be addressed.

While redlining and residential safety maps may technically be relics of the past, Sklar noted that todays housing crisis is pushing low-income people to sub-optimal living situations where their health is going to be affected.

Who would think that urban housing policy would have anything to do with preterm birth rates? said Sklar. Well, you wouldnt, unless you connect the dots.

Air quality districts around the state are starting to realize the importance of healthy air in homes and have piloted a variety of incentives to find solutions, though improvements in air quality are often one of many benefits of energy-focused programs. The Fresno Economic Opportunities Commission has a weatherization program aimed at helping homeowners and renters cut down on energy costs and prepare their homes for extreme weather by weather-stripping doors, caulking windows and gaps, insulating exterior walls, and repairing and replacement ducts. Of the residents served within the past year, 56% lived in homes 50 years or older, said Fresno EOC Energy Manager Matt Contrestano. In addition, almost 23% of the homes assessed were deferred services due to the condition of the home including structural, electrical, plumbing, sewage and water leaks or clutter and pest infestation issues.

In 2021, Fresno EOCs Transform Fresno project, which focuses on downtown, Chinatown, and southwest corners of Fresno, provided energy-efficient upgrades to 12 homes; in 2020, they reached 34 homes. According to Contrestano, these programs help residents by reducing utility bills, maximizing energy efficiency, and allowing each resident to live in a healthier and more comfortable environment.

In 2021, Santa Barbara County Air Pollution Control District launched a program to give hundreds of free air purifiers to residents in the towns of Guadalupe and Casmalia. This year, the San Joaquin Valley District followed suit, approving a similar program to give 1,500 families free in-home air purifiers to mitigate the in-home risks of wildfire smoke exposure.

Despite the grueling summer months, Pacheco-Werner had a healthy pregnancy and carried her baby to full term. But her son, now 4 years old, has developed asthma, which has been difficult for Pachecho-Werners family to manage. Theres no way to know if his asthma is related to the wildfire smoke his mother breathed in when he was growing in her womb.

This past spring, Pacheco-Werner became pregnant again, and she worried that shed have to endure another summer of hot, smoky weather. So far, the pollution has been moderate, but Pacheco-Werner ended up facing another challenge: Her second baby was born preterm, at 36 weeks. Although she and the newborn are recovering well, Pacheco-Werner is concerned he too will develop asthma like his brother.

Even so, Pacheco-Werner is well aware of the privilege that her fluent English and health insurance afford her. But as a Mexican immigrant who spent much of her life in Fresnos most impacted neighborhoods, she continues to use her personal experiences to inform her research on the relationships between neighborhoods and health, fighting for every Californian to have equal access to clean air.

When we dont pay attention to inequality, she said, it affects us all.

This story is published collaboratively with GristandNext City as part of theEquitable Cities Reporting Hub for Environmental Justice.

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Originally posted here:
Wildfire Smoke Is Hurting Pregnant People And Babies. Can California Cities Protect Them? - California Health Report

Parkinsons disease affects the nervous system. It muddles how the brain sends signals that coordinate movement. In Vermont, it's estimated that one out of a thousand people over age 55 have it.

It's a lifelong condition, and there's no cure. But research shows vigorous exercise and even a punch or two can help those with Parkinson's slow the disease.

At the Carter Community Building Association, a nonprofit recreational center in Lebanon, New Hampshire, Ann Harvey, Tom O'Quinn and Suzanne Serat are slipping on brightly-colored padded gloves.

They use them in a special boxing class designed to help people fight Parkinsons.

Nina Keck

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Vermont Public

"Theres this thing in Parkinson's that says if you have a positive attitude, youll be better, and thats true," Serat says. "But, you also need to acknowledge that its really hard, and youre sort of losing your life basically drop by drop, and youre mad about it."

"And," she gestures to the bright blue boxing gloves on her hand, "it feels good to just hit that bag as hard as you can.

The group heads into a small gymnasium where punching bags hang from the ceiling.

Alright guys, were going to get started," calls out instructor Samantha Duford. "So boxing stance, hands up. Were going to throw a jab jab, hook hook, upper upperOkay? Lets go

The dangling bags suddenly come to life, rocked by jabs from either side.

Nina Keck

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Vermont Public

Betsy Warren of West Lebanon smiles behind her mask as she gives her bag a one-two combo.

Warren was diagnosed with Parkinson's in April 2021. Eight months later, she was diagnosed with cancer. She wrapped up chemo this summer, and is in remission. So now, she says, shes back to focusing on her Parkinsons.

This class, called Rock Steady Boxing, is based on a nationally-recognized curriculum, and Warren says its helping.

Oh, its the greatest workout," Warren gushes, breathing hard during a break. "Theres like 23 different things that we do, and its all good for Parkinson's, from yelling, using our voice, to big movements."

She adds: "The thought of hitting something seemed like a good idea, especially early on when youre trying to get used to a diagnosis.

Nina Keck

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Vermont Public

Parkinsons disease affects how people move. It slows them down and can make people stoop and shuffle. Tremors are common. The disorder can also weaken a persons voice, affect eyesight and balance, and can hamper fine motor skills, which can make everyday tasks like buttoning a shirt difficult.

More from Brave Little State: How can older Vermonters 'age in place'?

Physical therapist Samantha Duford is president and cofounder of Upper Valley Programs for Parkinson's. She says her 90-minute Rock Steady Boxing classes target all of those things.

Nina Keck

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Vermont Public

We incorporate balance, coordination and dual-task walking," Duford says. "We really try totarget deficits specific to Parkinson's in everything we do.

Boxing she says is great for big arm movements and getting heart rates up. But the class also includes yoga stretches, core strength training, brain teasers and hand-eye work. For instance, one of this afternoon's activities involves moving lettered clothes pins from one ribbon to another in alphabetical order while balancing on a cushion.

Suzanne Serat and others in the class say the benefits are immediate.

"Absolutely, when I came into class, I was having something called dyskinesia, which is a random movement and side effect from the medication," Serat says. "And because of doing this, it stopped. So this leg is now still.

Nina Keck

/

Vermont Public

That's not uncommon. Dr. Jim Boyd is director of the Binter Center for Parkinson's Disease and Movement Disorders at the University of Vermont. He says that while intense activity wont stop symptoms, it can slow them down and make them go away temporarily. Its why he says classes like this are so important.

"As a practicing neurologist for nearly 20 years now, you do see a distinct difference between those who become engaged in physical activity early in their course, and develop good habits of exercise, to those that do not," he says.

If boxings not your thing, Boyd says there are dance classes, Tai chi and other workouts specifically designed for people with movement disorders that can help. And since COVID, many are now offered virtually.

Gary Martin lives in Jonesville, Vermont, and was diagnosed with a movement disorder similar to Parkinsons 10 years ago. Martin takes a regular dance class for people with Parkinsons taught by his wife Sara McMahon. He also does a specialized workout called Push Back several times a week.

While hes now using a walker and wheelchair more often, he says the weekly classes have helped his balance, strength and outlook.

"The tendency for most people with Parkinson's [is] to just hang back and not become involved in life," Martin says. "And this has really been helpful in that regard.

Nina Keck

/

Vermont Public

Back at the Rock Steady Boxing class, the group wraps up its weekly workout in a circle.

Earnest Schori says he was diagnosed with Parkinson's in 2018, and besides boxing, he does Tai chi and core strength training. The physical outlet helps, he says, but so does the camaraderie.

"To know that I'm not alone," Schori says, is important.

Suzanne Serat nods. The workouts feel great, but she says the teasing and support that are part of every class the catching up with each other, the understanding and honesty may be even more important.

"You dont have to explain anything. There's none of you that needs to be embarrassed," Serat says."I dont know why, but theres a shame that comes from having a chronic illness, one that shows, and theres none of that when were all together."

Pointing to the clusters of others in the group who are chatting and laughing after class, she says: "You can just sort of sit there and say, 'Its not a good day,' and theyll go 'Yeah.' They get it.

Have questions, comments or tips?Send us a messageor get in touch with reporter Nina Keck:

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In the Upper Valley, fighting back against Parkinson's with a one-two punch - Maine Public

The history of medical education has attracted substantial interest over the past few years, and medical education has moved toward outcome-based education (OBE) [1-10]. This paradigm has been necessitated by increasing concerns about accountability, cost-effectiveness, and rising expectations of the community regarding what future physicians can do to meet their needs[1,3,5,11-14]. Enthusiasm for competency-based medical education (CBME) has translated into the establishment of competency-based frameworks for medical graduates in many countries, for example, the Can Meds (Competency framework approved by the Royal College of Physicians and Surgeons of Canada); Tomorrows Doctor; the Scottish Doctor; and the Accreditation Council for Graduate Medical Education (ACGME)[4,8,15-17]. Moreover, many medical schools are adopting these frameworks in their curricula[6,18]. In contrast to the traditional time-based model, CBME de-emphasizes time and concentrates on how the student can actually perform at the end of their course of study[2,4,10,11,18]. Despite the wide reputation and implementation of this educational strategy, some challenges remain to be addressed, which include the definition of competencies and the development of authentic methods of assessment of these competencies[5]. In addition, the lack of shared discourse and terminology is another reported limitation that currently compromises the full promise of CBME[4,12,13,17,19].

Saudi Arabia was not uncompetitive and has made recognizable efforts recently to establish national competency frameworks for medical graduates[10,16,20-22]. Such national frameworks aimto provide a common platform on which the curricula of medical schools in the kingdom can be grounded and against which all Saudi medical graduates can be compared in terms of skills and knowledge[10,21,23]. This approach has been deemed necessary, particularly in view of the unprecedented expansion in the establishment of medical colleges in the kingdom within the past decade[15,21,23]. In addition, the development of such national frameworks would bring medical education in line with the values, traditions, and cultural background relevant to Saudi Arabia[6,15,16,24]. These efforts have been supported by the birth of the National Commission for Academic Accreditation and Assessment (NCAAA) and the Saudi Medical Education Directives (SaudiMEDs) competency frameworks[22]. The NCAAA, founded in 2004 and responsible for the accreditation and quality assurance of postsecondary training programs, drafted the Learning Outcomes for bachelor's degree programs in Medicine in 2010, which comprises five knowledge and skill domains[10,16,22]. Later, and with regard to medical education, an initiative led by a committee of deans of medical colleges in Saudi Arabia, produced an initial draft of the SaudiMEDs in 2010, which was later updated in 2015. The NCAAA and the SaudiMEDs frameworks were cross-referenced to ensure congruence and consistency between the two national frameworks. All medical schools in Saudi Arabia are now required, as part of their accreditation process, to demonstrate that their curricula include the competenciesand domains of knowledge and skills that are in accordance with these national frameworks[22].

Harden defines curriculum mapping as the process of indexing elements and linking them, as well as incorporating other phenomena such as people and timetable [7]. A curriculum map can be assembled by examining a curriculum through different perspectives, including learning outcomes, subject areas, teaching and learning opportunities, and assessment strategies[25,26]. It has been asserted that the functional linkages between the different objects in a map provide more information than would otherwise be the case with a linear representation of these objects[19,25]. Such a graphical representation of the contents of a curriculum depicts what is taught and elucidates how and where topics are covered, thus making the curriculum more transparent and easily accessible to all concerned parties in the learning process[19]. Curriculum mapping is therefore considered to be a powerful tool for curriculum development because it can highlight gaps as well as redundancies in the formal curriculum[5,9,12,19,27,28]. Lately, several medical training programs and institutions in Saudi Arabia have attempted to map their curricula to certain international and national competency frameworks in response to the growing concerns over improving the quality of their programs and graduates and to meet the requirements of accreditation and quality assurance processes[2,6,14,26].

To establish the background for this study, this section provides more details regarding the national competency frameworkfor medical graduates in Saudi Arabia: the SaudiMEDs. The project was launched in 2009 and was planned to be carried out in three phases. The first and second phases have been concluded, while the third phase is still ongoing[16,22]. Phase 3 aims to provide detailed specifications of the competencies expected at the end of the internship year, which, in this initiative, is considered to be an integral part of the basic medical curriculum. The SaudiMEDs comprises six main domains, 17 essential competencies, and 80 learning outcomes that should be fulfilled by all undergraduate medical programs in the kingdom[21,22]. The framework also consists of 178 clinical presentations, classified according to body systems, and 123 essential skillsrelated to six categories, which all medical graduates should learn by the time of their graduation[29]. The SaudiMEDs framework aims to specify the core abilities of the future Saudi doctor and serves as a mechanism to ensure the comparability and equivalence of the outcomes of undergraduate medical education all over the country. The framework is meant to inform undergraduate medical curricula in Saudi Arabia and not to replace them, thereby preserving medical schools autonomy in the delivery of high-quality medical education that is still based on the schools particular contexts and individual needs[16,21,22].

The Faculty of Medicine at the University of Tabuk implements an outcome-based, community-oriented curriculum designed as a modular system and has three phases that are delivered over six years. The internship period, the seventh year, is not yet a part of our undergraduate curriculum. Initially, the curriculum was adopted from the medical college at King Abdul-Aziz University as a mother college, and it embraces a multilayered, longitudinally, horizontally integrated, and interdisciplinary approach [4,17]. Each module is organized based on a set of learning outcomes and appropriate teaching, learning, and assessment strategies to help students achieve those outcomes. Phase 1 is the preparatory year, which involves general science subjects and the scientific English language. Phase 2 represents the second and third years and comprises system-based, integrated moduleswhich deliver basic sciences and applied clinical knowledge. In the third and final phase, students receive comprehensive discipline-based clinical studies and rotations. Successful performance in each phase is mandatory for the student to advance to the next phase.

Curriculum development in our college was a major concern for successive administration leaders[16,23,27]. In 2011, in collaboration with the University of Queensland in Australia, an initial evaluation of the curriculum was conducted with regard to its comparability with the Liaison Committee on Medical Education (LCME) and the United States Medical Licensing Examination (USMLE) standards. Recently, with the release of the NCAAA and SaudiMEDs competency specification reports, it became mandatory for all Saudi medical colleges to demonstrate the alignment of their curricula with these national frameworks as part of accreditation and recognition of their programs in the kingdom[9,16,21].

This study aims to assess the degree of congruence between our curriculum and the SaudiMEDs, and hence the NCAAA systembecause the two were cross-referenced successfully, as mentioned in the foregoing[9,16,17,27,28]. We aim to map our curriculum to determine the extent to which it is aligned with the SaudiMEDs and to identify any gaps in respect of accreditation of our program and its future development[9,12,19,27].

We believe that this exercise has fundamental advantages and implications for our college. In addition to fulfilling the requirements of the accreditation process [6,19,27], which has already been launched, it may delineate areas of deficiency and redundancy in our curriculum and enable curriculum planners to tailor these in a more efficient manner[6,19,22,26-28]. This is particularly vital in view of the tight schedules that characterize modular systems such as the one our college employs[28]. Moreover, the curriculum map may improve transparency and access for all stakeholders, for example, students, teachers, module coordinators, and program leaders, to the curriculum and help them better plan their learning, teaching, and development actions, with all working toward a common goal[5-9,11,15,20,26,27]. This study may provide evidence of curriculum evaluation and development approaches in our college, which are essential for internal quality assurance processes, and reassure different stakeholders regarding the feasibility and outcomes of our program[2,6,14,26]. Finally, yet importantly, it may encourage other medical schools to perform the same exercise, which could eventually provide crucial feedback to the steering committee of the SaudiMEDs initiative.

This study was approved and funded by the Deanship of Scientific Research at the University of Tabuk (UT-127-21-2020). This is a descriptive-analytical study that aims to map the curriculum of the Medical College of the University of Tabuk against the SaudiMEDs specification framework. We developed a checklist to collect data from all modules based on the list of clinical presentations and skills that are deemed essential to be covered and mastered by students upon graduation as outlined in the SaudiMEDs framework[29]. The checklist consisted of the 178 clinical presentations and the 123 essential skills listed in the SaudiMEDs specification document. The checklist specifies where each clinical presentation or skill is taught in our modules, how much time is spent on that task [6,19], and how is it assessed, postulating that the coverage of these clinical topics and skills would indicate that our curriculum is congruent with the SaudiMEDs framework because competency is considered to be an aggregation of knowledge and ability[5,6,8,15,18,19,26]. The aim was to develop a content or expertise map that breaks down the subjects taught in our modules and reallocates them to form clusters of expertise around the main subject areas contained in the SaudiMEDs[6,14,19,26-28]. We invited four module coordinators randomly to the pilot phase and asked them to complete the checklist and make comments regarding the process and the number of instructions provided. A message was disseminated to the faculty regarding the project aims and its advantages to our college in a formal meeting led by the dean, and the timeframe for the completion of the project was also discussed. Then, each module coordinator, with the help of other instructors who teach the course, was asked to fill out the checklist based on the modules study guideunder supervision and with the assistance of the researchers[8,20].

Following the completion of the checklist by all module coordinators, the researchers revised all the data and checked for deficiencies and/or inconsistencies, and wherever necessary, module coordinators were contacted again to clarify and verify their entries. Researchers also checked to ensure that the entries in the checklist were based on what is documented in the study guide of the relevant module so as to reflect the situation in reality[14,26]. In the final stage, we gathered the information from all the checklists and combined it all into a final, single checklist of the same kind. Data analysis was first done manually. In the final checklist we calculated the percentages of the essential clinical presentations and skills not covered in the program. Then we used the Excel software (Microsoft Inc, USA, 2010) to draw graphical representations of where those topics and skills are addressed in our taught modules and academic years. The aim was to draw a content map of the curriculum oriented around the main knowledge and skill domains of the SaudiMEDs competency framework. Also, we mapped the clinical presentations and essential skills contained in the SaudiMEDs against the taught modules in our program using Excel (Microsoft Inc, USA, 2010) to provide further evidence of how and where the formers are addressed in our curriculum.

Twenty-seven module coordinators completed the checklist for each module reporting in total the 34 modules taught in the College. The clinical presentationmap shows the contribution of each academic year to the main subject areas of the SaudiMEDs (Figure 1). The coverage of these clinical presentations in our curriculum is approximately 96.1%. Figure 2 shows the skills map, which highlights the contribution of each academic year to the achievement of the main skill domains as indicated in the SaudiMEDs framework. It was found that our curriculum-excluding the preparatory and internship years-currently contains around 76.1% of the skills deemed to be necessary by the SaudiMEDs. The color mix in each column of the academic years reflects horizontal integration, whereas the continuity of each color through all academic years represents vertical integration. Plotting the taught modules against the main skill and knowledge domains of the SaudiMEDs specification matrix in Excel (Microsoft Inc, USA, 2010) produced a characteristic shape of barcode, which identifies our program in comparison to the national competency framework, as shown in Figure 3. Also, we drew visual maps which show the taught modules clustered around the main knowledge and skill domains of the SaudiMEDs framework to demonstrate the contribution of the formers to the achievement of the latter(Figures 4, 5), respectively.

Curriculum mapping is a process wherein the curriculum is analyzed based on its basic units, and links are made to show how these units are related to each other[6]. This study aims to create a map in which the contents of our curriculum that is taught are clustered around the main subject and skill domains of the SaudiMEDs competency framework.

The clinical presentations and skills mapproduced by our study provide a picture of where all of these areas of knowledge and skills are taught and yield a graphical orientation of the different academic years of our program through plotting the SaudiMEDs domains. This visual representation of the relationship between the modules in each academic year and their contribution to the SaudiMEDs areas of expertise may provide students and faculty with a picture of the overall organization of the curriculum and help them to prepare for their teaching, learning, and assessment activities[19,25]. The map may also set the stage for legitimate curricular management decisions to reorganize the distribution of subjects and skills across the modules and redefine the assessment strategies more appropriately. We have identified several clinical presentations and essential skills that our curriculum is deficient in, in relation to the SaudiMEDs, and therefore need to be addressed. However, and understandably, most of the uncovered essential skills are hospital-based and hence would more likely be taught and mastered in the internship period. This emphasizes the importance of setting a structured program for the internship period as part of the undergraduate training, which is already proposed in the third phase of the SaudiMEDs project. Also, some redundancies have emerged and may require attention in the future plans for curriculum development. For example, dermatology and otolaryngology topics appeared to be dealt with in a relatively large number of modules, and if necessary, revision of these subjects may result in some additional space to bridge the gap with regard to the deficiencies. The ability to delineate such gaps and redundancies in the curriculum is one of the prime advantages of curriculum maps, as indicated in the literature[6,19,22,26-28].

Furthermore, the map provides insights into the degree of integration in our program, which is another one of its advantages because the curriculum involves a horizontal and vertical integration approach, particularly in the preclinical phase. Thus, at a glance, the map demonstrates the level and the modules that contribute to each subject or skill area. Thereafter, decisions regarding the appropriateness of the stage and the courses in which each subject or skill is taught could be effected. While this exercise may provide a model to the growing community of medical schools in Saudi Arabia wishingto cross-reference their curricula against the SaudiMEDs framework, it may also demonstrate to the wider community of medical educators that curriculum mapping remains an essential tool for curriculum development.

Our experimentation with curriculum mapping has yielded a unique barcode-like shape that depicts the relationship between the formal curriculum at our college and the SaudiMEDs framework. The barcode exhibits the alignmentof our taught modules in relation to the main knowledge and skill domains of the national framework. This approach has sparked in our minds the notion of curriculum barcoding. Thinking loudly, we asked ourselves,is it possible to barcode the curriculum in view of a national standard? Would it be a legitimate mechanism to define the curriculum in relation to the minimum training requirements stipulated by the SaudiMEDs? Would it help the wider community of medical schools in the kingdom to define their curricula in view of the national specifications and requirements? Obviously, it might be too early to answer those questions. However, the idea might be appealing given the increased aptitude for standardization and homogenization of medical education and training in the present era of globalization[30]. In addition, the notion of barcoding might be conducive to the growing enthusiasm for the adoption of national and international competency frameworks currently noted in different jurisdictions. It might be possible to translate the basic medical program into a barcode in terms of where the essential matrix of knowledge, skills, and competenciesdescribed by the SaudiMEDs are addressed in the curriculum. Once that is done, the SaudiMEDs barcode might be used to codify and test the alignment of the basic medical curriculum to the requirements of the national framework similarto how barcode machines in the market translate an aggregation of columns into the price. The such process might also be endeared in a world dominated by computerization and digital technologies. Of course, the SaudiMEDs are not intended as a formal curriculum;it preserves the autonomy of medical schools to meet the requirements of their local communities. As such, standardization of basic medical programs is not required to allow for barcoding their curricula to the SaudiMEDs. Instead, the process is more likely codifying the curriculum against the minimum requirements set by the national standard, and can therefore be done regardless of the curriculum design and structure.

Once created, the unique shape of the SaudiMEDs barcode of a given basic medical curriculum in the kingdom might serve as a novel method to display its identity in view of the SaudiMEDs and to demonstrate the congruence between that curriculum and the national standard. Besides, we believe that the barcode might constitute a platform or common language to facilitate communication of curriculum content and characteristics in relation to achievement of the national requirements among the community of medical education in Saudi Arabia. We believe that the SaudiMEDs barcode of a given college might help the responsible authorities to figure out the degree of alignment between the college's curriculum and the national specification requirements. As such, the process might also have implications to the overseeing and accreditation projects of basic medical programs in the country. The above-mentioned advantages might be few examples of others if the SaudiMEDs barcode turned to be applicable. However, and understandably, this quantitative approach alone might not be enough for curriculum assessment and qualitative and other evaluative methods in this concern might be essential. We are aware that this novel idea is still in its infancy and therefore requires further elaboration and testing to endorse its applicability and usefulness in our setting and perhaps other medical schools in the kingdom. This should be the subject of future studies. Lastly, we call for initiation of immense discussion among the community of medical schools in the kingdom to explore the utility and the pros and cons of the SaudiMEDs barcode as a promising method of curriculum description and evaluation with regard to the set of national requirements.

Curriculum mapping is a powerful tool for curriculum development and improvement. The curriculum in our medical college is comparable to and includes most of the skills and knowledge domains of the SaudiMEDs competency framework; however, some gaps need to be addressed. The curriculum map provided a tool for the recognition of unnecessary overlaps in the program and an insight into the appropriateness of the integrated teaching approaches employed in the college. We hypothesized a novel method to test the alignment of our curriculum, and perhaps other corresponding programs in the kingdom, to the SaudiMEDs framework. We described the former as the SaudiMEDs barcode, which we hope to have implications to fulfillment of all the desired competenciesby the future Saudi doctors and to promote overseeing and accreditation of basic medical programs in the kingdom. Data generated from this exercise are useful for informing the decisions and actions that might be taken to improve the curriculum. In addition, it emphasizes the need for a structured training system in the internship period as part of the undergraduate medical program. Further studies in this field are recommended in our college to help in providing continuous assessment and optimization of our curriculum. At the national level, we recommend further studies on curriculum mapping with established guidelines to promote transparency, accessibility to, and improvement of basic medical curricula in the kingdom. Besides, we anticipate further work to test the utility of the SaudiMEDs barcodeas a promising tool to ensure comparability and alignment of the basic medical programs in Saudi Arabia to the national training standards.

Continued here:
Curriculum Mapping for Curriculum Development: The Notion of Curriculum Barcoding in View of the Saudi Medical Education Directives Framework...

Adults with HIV have a greater risk for developing type 2 diabetes (T2D) compared with someone never diagnosed with HIV, Amanda Willig, PhD, notes. However, medications used to treat diabetes dont always control blood sugar as well for someone with HIV. Identifying factors associated with diabetes risk that are similar to the general population, as well as those that are unique to HIV, can help clinicians provide the best preventive care for patients.

For a study published in AIDS, Dr. Willig and colleagues sought to examine the incidence of T2D among people with HIV and related risk factors. They conducted a retrospective cohort study at an academic HIV clinic in the Southeastern United States, obtaining EMR data on demographics and clinical characteristics.

We studied over 4,000 eligible patients with available EMR data who received care at our HIV treatment clinic, she explains. To understand the role that various risk factors play in the current treatment era, we limited our investigation to a 10-year period from 2008-2018.

The researchers defined diabetes using three categories: A1C values equal to or greater than 6.5% and/or two glucose results greater than 200 mg/dL at least 30 days apart; a diabetes diagnosis in the EMR; or exposure to diabetes medication.

Patient Characteristics & HIV-Associated Factors Influence Diabetes Risk

We were surprised to see such a rapid increase in diabetes incidence and prevalence in just 10 years (Figure), Dr. Willig says. The continued increasing trajectory of diabetes burden in people with HIV highlights the critical need for access to diabetes prevention care in this population.

The researchers identified 252 incident cases of diabetes among 4,113 people with HIV. Diabetes incidence increased from 1.04 per 1,000 person-years in 2008 to 1.55 per 1,000 person-years in 2018. Factors related to incident diabetes included BMI (HR, 10.5), liver disease (HR, 1.9), steroid exposure (HR, 1.5), and use of integrase inhibitors (HR, 1.5). Other related factors included lower CD4+ cell counts, duration of HIV infection, exposure to non-statin lipid-lowering therapy, and dyslipidemia.

The strong association of both low and high body weights with diabetes risk indicate that weight management programs for people with HIV can play a crucial role in diabetes prevention, she says. Integrase inhibitors may also impact body weight, and the potential association of this medication class with diabetes incidence highlights the need for preventive lifestyle counseling to minimize the potential impact of these medications, along with consideration of appropriate ART regimens in populations at highest risk for diabetes. Caution in prescribing and utilizing steroids in people with HIV is warranted, with close monitoring for potential side effects.

Modifiable Risk Factors, Social Determinants of Health, & COVID-19

As patients with HIV live longer, clinicians and researchers need to focus care not just on improving longevity but on maintaining good QOL, Dr. Willig notes.

Modifiable risk factors, such as body weight, certainly play a role in diabetes risk, and greater emphasis on lifestyle modification for diabetes prevention is needed to slow the trajectory of increasing diabetes prevalence, she says. However, the impact of HIV infection and certain ART regimens on diabetes risk indicates that these programs should be tailored to address the unique risk factors of those with HIV, including identifying food-insecure patients who may need assistance in meeting nutritional needs and providing medical nutrition therapy.

Dr. Willig pointed to multiple areas for future research highlighted by the current study.

Other research teams have shown that pharmaceutical treatment for diabetes control may take longer to have equivalent impact for someone with HIV, she notes. However, we do not know if lifestyle interventions such as nutrition and exercise also need to be provided for longer intervals or precisely how nutrition and exercise should be tailored for this population. A greater understanding of social determinants of health that are associated with the risk factors identified here is key to effectively tailoring diabetes prevention efforts.

Additionally, investigators need to determine which medical and behavioral treatments are most effective to offer in tandem with integrase inhibitor use to minimize undesirable metabolic effects, Dr. Willig continues.

A separate but related issue is the COVID-19 pandemic. We need to explore whether COVID-19 infection or the associated stressors of life during a pandemic have impacted diabetes incidence, and, if that is shown to be the case, whether that changes medical management for diabetes in people with HIV, she says.

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Prevention Strategies 'Critical' as Diabetes Rates Rise in Patients With HIV - Physician's Weekly

LEARN HOW YOUR PLANNED GIFT CAN HELP THE AMERICAN LEGION

After taking a fall last month, my doctor suggested I start doing balance exercises. Do you have any tips for balance?

Most people do not think about practicing their balance, but it is a good idea to start doing so. In the same way that you walk to strengthen your heart, lungs and overall health, you should practice maintaining your balance.

As we age, our ability to maintain balance declines, which can increase your risk of falling. More than one in three individuals 65 or older falls each year, and the risk only increases with age. A simple fall can cause a serious fracture of the hip, pelvis, spine, arm, hand or ankle, which can lead to hospitalization, disability, loss of independence and potential fatalities.

How Balance Works

Balance is the physical ability to distribute your weight in a way that enables you to hold a steady position or move at will without falling. Balance is controlled by a complex combination of muscle strength, visual inputs, inner ear workings and specialized receptors in the nerves of your joints, muscles, ligaments and tendons, which help with orientation. These factors are sorted out in the sensory cortex of your brain, which takes this information and gives you balance. Over time, these neurological pathways dull and causes individuals to gradually lose their balance.

Poor balance can lead to a vicious cycle of inactivity. Individuals who feel unsteady end up curtailing certain activities, which can lead to inactivity. If they are continuously inactive, they no longer challenge their balance systems or their muscles. As a result, both balance and strength decline and simple acts like strolling through a grocery store or getting up from a chair become trickier for these individuals. This can shake their confidence and cause them to become even less active.

Balance Exercises

If you have a balance problem that is not tied to illness, medication or some other cause, simple exercises may help preserve and improve your balance. Some basic exercises you can do include:

One-legged stands: Stand on one foot for 30 seconds or longer, then switch to the other foot. You can do this while brushing your teeth or even while waiting in line somewhere. In the beginning, you might want to have a wall or chair to hold on to in case you lose your balance. Heel rises: While standing, rise up on your toes, lifting your heel as high as you can. Drop back to the starting position and repeat the process 10 to 20 times. You can make this more difficult by holding light hand weights. Heel-toe walk: Take 20 steps and with every step, touch your heel to your toe on your opposite foot. Keep your focus straight ahead instead of looking down at your feet. Sit-to-stand: Without using your hands, get up from a straight-backed chair and sit back down 10 to 20 times. This improves balance and leg strength.

Additional balance exercises are part of a resource created by the National Institute on Aging that offers free booklets that provide illustrated examples of many appropriate exercises. You can order your free copy online or by calling 1-800-222-2225.

Savvy Living is written by Jim Miller, a regular contributor to NBCs Today Show. The column, and others like it, is available to read via The American Legions Planned Giving program, a way of establishing your legacy of support for the organization while providing for your current financial needs.

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How to improve your balance | The American Legion - The American Legion

JOINT BASE LEWIS-MCCHORD, Wash. This month, the Cold Steel Brigade conducted its third Command Post Exercise with California National Guards 40th Infantry Division partners to prepare the division for operational readiness at the Battle Simulation Center at Marine Corps Base Camp Pendleton, California.

What I love about these exercises is we get to train ourselves as OC/Ts, said U.S. Army Maj. Gen. Mark Landes, the First Army Division East commander and exercise director. Anytime we get feedback from a unit like the 40th Infantry Division, which is reacting so quickly, its a lot of fun.

The Sunburst Division Soldiers progress since their first CPX earlier this year was evident to the observer, coach, trainers of the 189th Infantry Brigade.

The 40th Infantry Division has significantly improved in conducting rear command post operations, said Lt. Col. Amanda Stambach, the lead sustainment OC/T for CPX III and commander of 1-357th Brigade Support Battalion, 189th Infantry Brigade. With each exercise, the team has made gains in refining their battle rhythm, assigning roles and responsibilities within command posts, and tailoring working groups to fit their needs.

The training program was designed to have participants work as a team during realistic training scenarios.

This training path has put this diverse group of National Guardsmen and women through a vigorous regimen focused on simulating a first combat experience, said Maj. Lance Brender, a movement and maneuver deputy and executive officer of 2-357th Infantry Battalion, 189th Infantry Brigade. Shared understanding is knowing your own business, then telling everyone else who needs to know, too. It sounds simple, but the execution of it in combat is nuanced and difficult. It means distilling a great deal of raw data into pertinent information and, ultimately, a wise decision.

Each warfighting function team had a distinct role in contributing to the success of the exercise.

The 40th Infantry Division sustainment team was focused on building a common operating picture and integrating with the division plans cell in order to better anticipate sustainment requirements in support of future operations, said Stambach. The Forge team [Soldiers of 1-357th Brigade Support Battalion] conducted analysis to determine the best OC/T support package for the exercise, ensuring we had the right balance of experienced personnel to cover logistics, personnel and medical functions, but not have an overwhelming presence in 40th Infantry Divisions command posts.

The Cold Steel Brigade prides itself on being a learning community, providing OC/Ts who are experts in doctrine with interpersonal skills.

The partnership between the active-duty federal force, in our case the 189th Infantry Brigade, and the state Guards is a vital bond of camaraderie trust, Brender said. We approach our training days with the 40th Infantry Division as precious opportunities to make them the most ready, most lethal force they possibly can be as they contribute to the security of the free world.

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'Cold Steel' Builds on Partnership with 40th Infantry Division - National Guard Bureau

Dr. Shawna Charles, who received a PhD in Psychology from Walden University, put her love of psychology into action by opening a Los Angeles boxing gymto provide people with the help they need, including fitness, an ear to listen to their problems, and a connection to vital social services. Dr. Charles, like many others in her field, understands the connection between good physical and mental health.

Most of us know the many physical benefits of exercise: weight control, lower blood pressure, reduced risk of diabetes, and increased energy, just to name a few. But what about the psychological benefits of exercise? From easing symptoms of depression and anxiety to keeping your memory sharp, theres no shortage of mental benefits of exercise. Whether you need motivation to get to the gym or to just take a brisk walk, the five psychological benefits of physical activity below will have you tying up your shoe laces and heading out the door.

Fascinated by the mental benefits of exercise? Or how exercise can improve depression or anxiety? A bachelors in psychology will give you the knowledge you need to help others by making meaningful contributions in the field of psychology.

Even if you work full time, a bachelors in psychology is something you can achieve. Featuring a flexible, socially conscious learning environment, Walden University makes higher education possible in an online format that fits your busy life. Learn how you can help others with an online BS in Psychology from Walden.

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5 Mental Benefits of Exercise | Walden University

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Judo training program improves brain and muscle function and elevates the peripheral BDNF concentration among the elderly | Scientific Reports -...

Exercise. You know you probably should do it more. But who's got the time?

Sometimes I could be at work 16, 18 hours, sometimes a full 24 hours. It all depends on what was on the agenda for that day," Flagumy Valcourt, officer with the NYPDs intelligence bureau, says. "So that really made it hard to eat correct and dedicate time to work out.

A new study suggests that not to most people not work out enough they should be exercising twice as much as previously recommended. And how are we going to achieve that?

For people that are getting started, the more pragmatic things are, incorporate it into your day wherever you can," Dr. Eddie Phillipssays. Its sort of a get on a bike desk in my office because I have one; meet friends for a walk rather than just sitting down for coffee.

Today, On Point: How to double your workout time.

NiCole Keith, physical activity researcher and kinesiology professor at Indiana UniversityPurdue University Indianapolis. (@nicolekeithphd)

Dr. Eddie Phillips, associate professor of physical medicine and rehabilitation at Harvard Medical School. Co-host of the Food, We Need to Talk podcast.

Flagumy Valcourt, officer with the NYPDs intelligence bureau.

MEGHNA CHAKRABARTI: New Years 2020. New York Police Officer Flagumy Valcourt was like, No, finally, this is it. This year is going to be different.

FLAGUMY VALCOURT: I was tired of being sluggish. Not happy with my overall physique and health. So I figured I need to make a change. And what's the best way to do it is by, you know, changing up your diet and getting into a nice exercise routine.

CHAKRABARTI: Officer Valcourt was five foot ten, 225 pounds, and sure, he wanted to trim that weight, but what he really wanted was to get his energy back. So Valcourt had the goal, he had the motivation. But there was one thing he did not have. Any extra time.

VALCOURT: At the time, my schedule was really hectic. I was part of a fuel intelligence unit where it required me to do a lot of search warrants, and stuff and that matter. So the time really fluctuated. So sometimes I could be at work 16, 18 hours, sometimes a full 24 hours. So that really made it hard to eat correct and dedicate time to work out.

And that's a struggle that many officers probably struggle with. I know the ones that are dedicated, they will find the time. And the facilities and our precincts, they have gyms. So you can, if you're lucky, and you have time and you can take an hour break ... instead of eating, you can choose to use the gym or the facilities.

CHAKRABARTI: By the way, this was before the pandemic. And at the time, like Officer Valcourt said, there was a gym at the precinct. Except you also heard him say something else. All that's good, but:

VALCOURT: So you could choose to either eat or if you wanted to work out, they'll use their meal time. ... I'll take on the gym for like 45 minutes and maybe last 15 minutes, eat something if they could, or probably take a quick shake on the go. Something had to give.

CHAKRABARTI: Okay. So working out at the precinct gym wasn't going to work out for Officer Valcourt if he also wanted to have a healthy diet. So maybe he could hit the gym when he was off duty. But another roadblock there. At the time, Valcourt lived in Coney Island and there weren't a lot of gyms he could get to quickly.

VALCOURT: You have to take in count for actually going to the location and working out. I'm going to the gym, it's going to take me an hour to work out. Plus I have to schedule at least 15 to 20 minutes to actually travel to the gym. And then the next 15 minutes, after you're done working out, to travel back. And then get ready to go, whether if you're going to work, or go about your day.

CHAKRABARTI: Now, Officer Valcourt, though, he's not a guy who's about to give up that easily. He was also checking out a kickboxing gym at the time. It's something he enjoyed more. But that gym was an hour long round trip for him. And those different gyms that Valcourt was trying, they led to another barrier. Because as much as he enjoyed his kickboxing workouts:

VALCOURT: Between that and the gym, they can get pricey. And each of them require a monthly dedication. And sometimes I felt like I was paying these monthly dedications and I wasn't even going.

CHAKRABARTI: I mean, that is salt in the wound, isn't it? Paying the money, but being unable to go to the gym. This particular story, though, has a happy ending. Because Officer Valcourt eventually found a workout program that helped him meet his goals. He lost weight, he eats better and he feels healthier. All improvements, at course, back into his life at home and at work in the NYPD Intelligence Bureau. But obviously, it was a struggle. And a familiar struggle, I guess.

If you have an affordable gym nearby, the problem might be time. If you don't have a safe, convenient place to exercise, the issue is both time, money and safety. All the while, Americans, though, have been told that they really, really, really need to be exercising at least half an hour a day, five days a week for good health. Well, times change and research advances. So now those recommendations also could be changing.

And I'm sorry to say you're not going to be getting a break here. Because there's evidence that you might need to double the typically recommended 150 minutes per week, meaning instead of half an hour a day, you might need to be exercising at moderate intensity for an hour a day, five days a week to maximize longevity.

When we say moderate intensity exercise, what do we mean?

Dr. Eddie Phillips: "Let me take on moderate, vigorous and even light. And give you the simplest test in the world, which is called the talk test. So if you and I go for a walk and we're able to talk to each other, but we can't sing. Or in terms of holding a note, we're working moderately, relative to our fitness. If we push the pace and we get to the, Meghna ... I have that ... We're now working, by definition, vigorously. If we're able to walk and talk and sing to each other, we're working at a light intensity. So the moderate intensity is just where you can't hold a note."

How does that map to an actual sort of biological measure? Is there a certain heart rate that we're trying to meet?

Dr. Eddie Phillips: "We could certainly measure heart rates. We could get into heart rate reserve, which is from your lowest heart rate at sleep to your highest at exercise. What percentage you're doing. We could measure Mets, metabolic equivalence. And as you sit here quietly or you're lying in bed with no activity, you're at one met.

"When you get up to six multiples of that, that's considered vigorous activity. So there's lots of ways in the lab or with a fancy watch or some sort of app on your phone, to measure other otherwise. But the talk test sort of wins out. Because it's just so simple. And you know where you are relative to other people, and to your level of fitness.

We've defined moderate intensity. Now, give me the definition, as you understand it, of what kind of exercise we need to maximize longevity.

Dr. Eddie Phillips: "So when we look at your total activity, and I'm going to start to veer into discussions of physical activity, which is any kind of movement where you burn energy. Exercise is actually defined as repetitive and planned and it already sounds boring, kind of like a chore.

"So any sort of physical activity, as soon as you get off of the couch, and we start adding up the minutes at moderate intensity, then we already start to see a plummeting of all cause mortality. So all steps count. Some steps count more than others, the first few. In other words, going from 0 minutes per week towards 150, you don't have to get to 150. You already start to see a dramatic decrease in all cause mortality."

Any sort of physical activity, as soon as you get off of the couch, and we start adding up the minutes at moderate intensity, then we already start to see a plummeting of all cause mortality.

On the implications of the fitness study

NiCole Keith: "They make sense in a way. And, you know, Circulation is an excellent scientific journal, and the methodology of the research was wonderful. What struck me is that much of the data that were collected were self-report data. And people don't do great with self-report data.

"It's really important to collect surveys from people. But when people are asked about how tall they are, they tend to report they're taller. When they're asked how much they weigh, they tend to report they weigh less. And when they're asked to report how much physical activity they do, especially at the moderate level, they tend to report more than they actually do. And part of that is because there's a little bit of a lack of understanding of the difference between light, moderate and vigorous physical activity.

"And part of it is because people don't typically keep track of how long it takes for them to walk from their parking space to their office or from the bus stop to the grocery store. And so that gets overreported. And when that is compared to their health outcomes, that overreporting can sometimes be misinterpreted to say you need more."

Have we been thinking about exercise all wrong?

NiCole Keith:"The fitness industry has conditioned us to think about what the ideal human looks like and does. First of all, there's no such thing as a perfect human, and we don't have to have this ideal body weight or this minimum body composition to be healthy. And 2 pounds of weight loss equals positive outcomes in diabetes, for example. You don't have to lose half of yourself if you weigh 240 pounds, in order to be healthy. You have to lose 2 pounds, and that can be done.

"Reducing sedentary behavior is what Dr. Phillips was talking about, and that our lifestyles have been engineered to be sedentary. Don't be. Stand up when you're doing your radio show. Raise your microphone and stand up. Walk around between shows when you're having your meetings, stand up and walk around. And so Dr. Phillips and I are frequently not together, but I imagine he's in meetings.

"I'm in meetings. I stand up when my back starts hurting or my legs start hurting because I've been sitting too long. I stand up and it's socially acceptable. I teach students and I tell them it is unfair that I get to stand before you for the duration of this class and walk around in lecture and you sit there and listen. So you can walk around too, because I want you to be healthy.

"And so it's about reconditioning ourselves for it to be acceptable, for us to get off at a bus stop early and walk the rest of the way. To condition ourselves to save fuel and to save the environment by burning fewer fossil fuels, by doing destination walking, if we can. And even if we can't, when we pull into the parking lot, take the first space you see, and then walk to the building. There are ways to get steps in.

"And unfortunately, the fitness industry is this billion dollar industry ... selling this idea that you have to have certain clothes, that you have to have certain shoes, that you need certain equipment, that you have to go to these places to become this ideal person. And that is not necessary to be fit. You just have to move more."

The fitness industry is this billion dollar industry ... selling this idea that you have to have certain clothes, that you have to have certain shoes, that you need certain equipment.

On incorporating more exercise into daily life

NiCole Keith:"A colleague and I have coined these as physical activity deserts, and you've talked about some of them. So transportation walking is hard because the sidewalks go nowhere, and there aren't traffic coning measures. And many of our urban areas and our rural areas were built for vehicles and not human transportation in the form of walking or cycling.

"The time issue. And so I get really frustrated when I hear that message that anybody can put on a pair of tennis shoes and go for a walk after dinner, when not everybody owns a pair of tennis shoes and not everybody gets to eat dinner at a time when they can go walking afterward. Because they work the third shift or because they don't get dinner. You know, there's food insecurity. And the cost of physical activity. While you can go to the playground and play with your kids, there has to be a playground. There has to be greenspace.

"People have to feel safe in their environments. And it's not just about traffic, and it's not just about crime, but it's the perception of, do you belong in my neighborhood? Why are you here? Are you a safe person? Are you a criminal? And then we know also that issues related to social justice and physical activity. And so that's a barrier. And I tell many people who are caregivers, that in order for you to be a strong caregiver, you have to be healthy and physically fit. But these caregiving responsibilities frequently get in the way of physical activity.

"So to find a way to be physically active with your loved ones is really important. I know Dr. Phillips and I know each other. He's got a wonderful wife who jogs with him. And so if that's part of your relationship, it's really strong to do things with your spouse, or with your kids. And I know he said sometimes you have to do it to get away from them, but sometimes you can do it with them. And it really builds a strong bond and sets a great example for your children, that even us older folks can still be physically active. Enjoy it."

" ... But the point is, there are several barriers, but also opportunities to overcome those barriers. And I tell people things as simply as, if you have a desk job in your responsibility, like you're a receptionist. And you have to be at that desk. On your break, go to the furthest restroom available and then come back.

"... You don't have to change your clothes. You don't have to get all sweaty. Moderate physical activity is an outdoor walk. You can go outside. You can walk for 30 minutes, come back in, eat your lunch. You can reverse that if you're super hungry, but you can do that all well within an hour and and still get back in time to do your job."

You don't have to get all sweaty. Moderate physical activity is an outdoor walk.

On pursuing health equity in America

NiCole Keith:"Physical activity to achieve health equity is the low hanging fruit. Most people can be physically active. It doesn't cost anything, except for time and energy that we need to spend. It's available to everyone, and that is where the focus should be. Medicine is expensive. Health care is expensive. Physical activity is free. It is the most sensical way to achieve health equity."

Medicine is expensive. Health care is expensive. Physical activity is free. It is the most sensical way to achieve health equity.

Circulation: "Long-Term Leisure-Time Physical Activity Intensity and All-Cause and Cause-Specific Mortality: A Prospective Cohort of U.S. Adults" "The 2018 physical activity guidelines for Americans recommend a minimum of 150 to 300 min/wk of moderate physical activity (MPA), 75 to 150 min/wk of vigorous physical activity (VPA), or an equivalent combination of both."

Read more from the original source:
A new study says you might need to exercise twice as much. But who's got the time? - WBUR News

Coming on the heels of a third round of layoffs, Peloton is now considering redesigning its bikes so that users can assemble them independently. CEO Barry McCarthy is also considering a plan that would let Peloton app subscribers potentially view workouts on third-party workout machines. McCarthy told Bloomberg that Peloton has been working on a bike redesign for a while and, to top it all off, said he hopes Pelotons long-awaited rower might debut sometime this holiday season. He also confirmed the company hasnt fully given up on the Tread Plus.

All of this tracks with comments McCarthy made in May during the companys Q3 2022 earnings. At the time, he floated the idea of potentially changing hardware designs so that in the future Peloton equipment would be designed to arrive at a customers home in one piece. Right now, Pelotons treadmills and bikes require white-glove delivery in separate pieces, with a crew that comes to your home and builds yours for you. The service used to be free, but Peloton began charging an additional $250$350 fee at the end of January.

The move is part of Pelotons ongoing restructuring plan, which aims to reduce the companys costs and improve cash flow. On Friday, Peloton announced it was cutting more than 500 jobs related to last-mile deliveries and product distribution. The company also noted it was raising the cost of its Bike Plus and Tread while shuttering retail locations in 2023. Making it so that customers can assemble their own equipment would mean the company can simply ship devices via FedEx which is a move that rowing rival Hydrow recently implemented with its slimmer, smaller Hydrow Wave rower.

Since taking over in February, McCarthy hasnt shied away from sharing novel ideas on how to turn around Pelotons flailing financial fortunes. Money saved from Fridays cost-cutting measures will purportedly be funneled back into Pelotons R&D as well as marketing efforts. That includes marketing Pelotons standalone app, which McCarthy identified as historically receiving little to no promotion. That dovetails with other plans the CEO divulged to Bloomberg, including potentially allowing Peloton users to stream classes on third-party workout machines. McCarthy also noted the company may tweak the apps subscription strategy toward a freemium model where some features arent locked behind a paywall.

That strategy is similar to what Apple currently does for its Fitness Plus service, which doesnt require the use of an Apple-branded exercise machine. Instead, people can use their own devices to stream Fitness Plus classes while using rowers, treadmills, and bikes at their local gym. The main difference is that Apple still requires users to own a minimum of an Apple Watch and iPhone to access Fitness Plus.

But while McCarthy seems keen to pivot toward services, it seems like hardware still has a role to play in Pelotons business. For instance, the company is gearing up to launch a rower, potentially this holiday season. The rower was perhaps the worst-kept secret in connected fitness until it was confirmed earlier this year at Pelotons annual Homecoming event for subscribers.

More surprisingly, McCarthy hinted that the company was hoping to relaunch the Tread Plus, which was recalled last year after causing several injuries and the death of a small child. While both its Tread and Tread Plus machines were recalled, the Tread was later approved for sale toward the end of 2021. The Tread Plus, however, remains out of circulation. In Q3, the company also noted that returns of the high-end treadmill were higher than anticipated, costing the company $18 million. According to McCarthy, relaunching the Tread Plus is entirely dependent on the government clearing it for sale. Its possible that while Peloton hasnt given up hope on the Tread Plus, its not something that its banking on either. On Friday, part of the rationale for hiking up the price of the affordable Tread by $800 was to position it as a superior device and boost Pelotons premium image.

Another interesting tidbit is that Peloton may be preparing to expand its One Peloton Club leasing pilot. The program bundles together the cost of the bike and classes into a single $89 monthly fee. The pilot has thus far been successful for the company, with McCarthy saying in May that the program had mass market appeal as 53 percent of signups came from households with incomes under $100,000.

Peloton is expected to hold its Q4 2022 earnings call later this month on August 25th, and well likely find out more about which plans will stick then. So far, Pelotons restructuring efforts have been off to a slow start, and Wall Street investors have seemed skeptical overall.

See the article here:
Peloton CEO wants to redesign bikes so you can assemble them at home - The Verge

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