How many calories do I need and when should I eat them?

Your calorie intake is based off your sex, age, weight and activity level. The younger you are generally the more calories you need. The less you weigh or want to weigh the fewer calories you need. The more active you are the more calories you need to stay healthy. And males typically need more calories then females. Many calorie calculators can be found on the web. (Go to MercySiouxCity.com, find the Health Information and Tools area and click on Wellness Tools. Select Nutritional Needs Calculator, found here.)


Now that you know how many calories you should be eating each day you want to spread that amount out over the day. General guidelines are as follows:

• Breakfast – 25-30% of your total calories
• Lunch – 30-35% of your total calories
• Dinner – 30-40% of your total calories
• Snacks – the percent left over after accounting for normal meals.

Remember hidden calories: having black coffee has no calories, but if you add cream and sugar there are additional calories that you need to count. For example: A Starbucks Caffe Mocha Venti 2% with cream is 410 calories, if your calorie needs are 2,000 calories that’s just over 20% of your calorie needs for the day. A 12 oz can of pop is 120 to 170 calories per serving compared to 0 calories for water.

Eating the proper portion sizes to get the right amount of calories for you is an important part of maintaining or getting to your healthy weight.  Don't forget that what those calories are is important as well.  Calories from fruits and vegetables are better for you then a processed bag of potato chips.

Your Brain is made for Movement

There is power in movement. While we all move everyday, we often aren’t aware of all the movement that is available to us. We get stuck into our routines and after we pass into our 30’s, 40’s or beyond we start to realize we can’t move like we did when we were younger and find ourselves sitting on the couch or in a chair at work more and moving less. I think most of us marvel at how much a toddler moves on a regular basis. They do this instinctively because their brain and nervous system is exploring and making sense of this world that we live in. This is often times referred to as novel movement. Your brain loves novel movement, it get’s its attention. This is why newer research is showing improvements in brain function in elderly with decreases in Alzheimer’s and dementia with those that exercise regularly.
Add some novelty to your existing exercise program by changing up the routine a little. Add some strength training in if you don’t already do it. Walk up hills or stairs as part of your cardio program as compared the flat treadmill. Try some different strength training exercises outside your normal routine. Make sure you move through the full movement you can and challenge yourself to move with more range of motion. Yoga, Tia Chi and Fledenkrais Awareness Through Movement are great movement based exercises that can help you explore novel movements to improve your exercise routine.
If you aren’t currently exercising start easy as you add new movements to your daily routine. Gradually you will be amazed, in a few months time, the ability to move easier and freer as you progress with a movement based exercise program.
We have to remember without a nervous system and the movement that it is in-charge of, we would be as alive as a tree.   See this great TED Talk by Daniel Wolpert about the real reason for our brains...MOVEMENT!

“Don’t worry, be happy.”

While we maybe have heard that anger and stress can lead to increase cardiovascular risks, whereas laughter and positive thinking can decrease those risks. Did you know science has proven this? An interesting study looked at people’s responses watching a movie for about 15 minutes. They watched either a stressful movie (beginning of Saving Private Ryan) or a humorous movie (There’s Something about Mary). They found that blood vessels constricted by as much as 30% to 50% when watching the stressful movie, whereas vasodilatation (blood vessels opening up) occurred when investigators measured vascular function in subjects watching the comedies.
The effects of this change in blood flow usually lasted about an hour but some research has shown it to last up to 24 hours. This change in the blood vessel dilation is similar to taking statins (drugs for lowering cholesterol) or physical activity. Unfortunately some of us have lots of stress that lasts longer than 15 minutes and can’t be turned off as easy as a stressful movie.

So next time you feel a little angry or stressed out, maybe sit down a watch a good comedy and laugh yourself to a little better health. Maybe we could tell a few more jokes at work so as to improve our heart and overall health a little. And if you need help laughing more to reduce stress and anger don’t forget about Employee Assistance Programs. Programs such as these (in one study) have shown to reduced depression and reduced waist girth, increased HDL cholesterol levels (the good cholesterol) and physical activity (trend toward improvement), and patients were better at managing their anger and anxiety in eight visits. At one year, the reduction in depression was maintained, and there were significant improvements in self-rated health.

“Ask not what your health care can do for you, but what you can do for your health care.”

Yes, this is modification of the famous lines spoke by President Kennedy at his inaugural address. But medical self-care needs to become a larger part of our health care practices to reduce improper use of the health care system. None of us like the continually rising cost of health care insurance that continues to take away from our paychecks.


How prevalent is this improper use?

• According to many national survey’s Americans are guilty of utilizing the health care system unnecessarily. Studies show that up to one-third of all Emergency Room visits and regular physician office visits are unnecessary.

What does this improper use cause?

• It increases wait times for care in the ER or increased days to get into and see a physician.
• Increase health care costs, which leads to increase health insurance premiums.

What can you do?

1. Many illnesses can be managed easily and effectively without medical intervention. Unfortunately everyone can get an illness or injury at times, but your body is built with its own defense and repair system to handle many of these problems. Improve your health care knowledge on what will get better on it’s own in time and simple home treatments you can do on your own.
2. Improve your health to decrease severity and frequency of illnesses and injuries. Through proper diet, exercise and stress reduction you can greatly decrease risk of getting an illness or injury and recover quicker if you do get one.

Is snacking needed or is it bad for me?

Snacking is an optional dietary requirement. While many myths and mix-ups are surrounded around snacking such as:

• You need to eat every two to three hours to keep your metabolism revved up.
• Snacking will help keep your blood sugar levels steady.
• Snacking will lead to increase weight gain.

All of these often heard points are simply not true, but misinterpretation of true facts.


Eating more often does not boost your metabolism. It is stated that by eating more often in the day you prevent your body from going into “starvation mode”. During “starvation mode” your body adjusts its metabolism to slow down to conserve energy and burn fewer calories. While this might have partial truth to it, your body does not go into starvation mode after only a few hours without food.
Your blood sugar naturally rises after a meal and then slowly falls back to baseline as the glucose is taken up by the cells of the body for energy. Having this natural rise and fall of blood sugar is natural and good for you (as long as it does not fall to low). This is why to measure your blood glucose level you are to not eat for 12 hours to see what its baseline is. Going more than 3 or 4 hours without food for a healthy non-diabetic individual is not harmful for you.

Snacking will only lead to increase weight gain if it adds to increase overall calorie intake for the day based on your metabolism needs. If you eat less for your regular meals to compensate for the snacking calories then you will not gain weight.

Snacking is fine to do as long as it doesn’t lead to increasing your overall calorie needs for a day and is made up of healthier foods. But it is not required either for a healthy diet.

Staying up late may lead to your weight going and staying up as well

Research shows that people who stay up later are at increased risk for weight gain. The night owls (staying up past 2 am) typically consumed about 250 more calories then their morning lark counterparts (getting to bed before midnight). Also those that stayed awake later consumed two times as much processed fast food, more regular soda and half as many fruits and vegetables. This increased calorie intake and poor food choices could lead to weight gain of 2 pounds per month if not balanced with increased physical activity. Those that stayed up later had a higher body mass index (BMI), which is a general measurement of a person’s body fat based on weight and height. Normal BMI is 18.5 to 25, a BMI over 30 is obese and over 40 is morbidly obese.

People who eat unhealthy foods and more calories because they are staying up later may increase their risk of stroke, heart disease and gastrointestinal disorders due to obesity related risks.

Nutrition Facts Label made easier

Gaining improved understanding of the Nutrition Facts Label on packaged and prepared foods will help you know how the food adds (or subtracts) from you nutrition goals for the day.


Serving size:

• Check how many servings the package contains. Often times things packaged in a way that we would think are single serving actually are two or three servings on the Nutrition Facts Label. Missing this crucial fact can easily lead to over consuming far more calories than you intend to.

Calories:

• If your diet intake needs are around 2000 calories a day (This would be for a 40 year old female that weighs 150 pounds and is about 5’ 6” and is lightly active), then look at the total calories, knock off the last digit and divide by 2. This will give you a rough estimate of percent of calories for the day. For example if it is a 300 calorie frozen meal, that would be 15% of your daily calorie needs.

Daily Values (DV):

• While the percentages can vary person to person you want to look at balancing your diet with all three macro nutrients (Carbohydrates, Fat and Protein).
• General guideline percentages: 
• Carbohydrates 45-65% of your calories. 
• Protein: 10-30% of your calories. To find minimum grams needed take you weight and divide by 3, to find maximum take one gram of protein for each pound of weight. For example if you weigh 150 pounds, you should at a maximum get 150 grams of protein and a minimum 50 grams.
• Fat: no more than 30% of your diet should come from fat calories.
• Try to look for food that the % DV of fiber is equal to or greater than % DV of carbohydrates.
• Most people tend to have too much sugar and not enough fiber in their diet. Avoid eating foods that have more sugar grams than fiber grams.
• Sodium content is an ever growing number in many foods. Try to find foods with less then 5% to help keep sodium intake in check. Too little sodium is very rarely a problem for most people’s diet needs in the United States.

Importance of Exercise for Arthritis Patients

Exercise can help ease joint pain and stiffness for arthritis sufferers. Research has shown the old thought process: “rest your arthritic joints”, only makes them worse. But despite this knowledge and plenty of science documenting appropriate exercise benefits for arthritis suffers, many men and women with osteoarthritis do not engage in any meaningful physical activity in a typical week.


Dunlop DD, Song J, Semanik PA, et al. Objective physical activity measurement in the osteoarthritis initiative: Are guidelines being met? Arthritis Rheum. 2011: Jul 26 [Epub ahead of print]

OBJECTIVE: Measured physical activity levels of adults with knee OA and report the prevalence of meeting public health physical activity guidelines.

METHODS: Cross-sectional accelerometer data from 1111 adults with radiographic knee OA aged 49 to 84 years participating in Osteoarthritis Initiative accelerometer monitoring ancillary study were assessed for meeting the aerobic component of the 2008 Physical Activity Guidelines for Americans (≥150 minutes/week in episodes≥10 minutes). RESULTS: Aerobic physical activity guidelines were met by 12.9% of men and 7.7% of women with knee OA. A substantial 40.1% of men and 56.5% of women were inactive, doing no moderate-to-vigorous (MV) activity over 7 days that lasted 10 minutes or more.

CONCLUSION: Despite substantial health benefits from physical activity, adults with knee OA were particularly inactive based on objective accelerometer monitoring. The percentages of men and women who met public health physical activity guidelines were substantially less than previous reports based on self-reported activity in arthritis populations.

Centers for Disease Control and Prevention: Physical Activity and Arthritis
(found at: http://www.cdc.gov/arthritis/pa_overview.htm)

Why is physical activity important for arthritis? Scientific studies have shown that physical activity can reduce pain and improve function, mood, and quality of life for adults with arthritis. Physical activity can also help manage other chronic conditions that are common among adults with arthritis, such as diabetes, heart disease, and obesity.

Tips for S.M.A.R.T. physical activity if you have arthritis

• Start low, and go slow
• Modify activity when arthritis symptoms increase, try to stay active.
• Activities should be “joint friendly.”
• Recognize safe places and ways to be active.
• Talk to a health professional, like a physical therapist, who is specialized in training movement/exercise.

Are all exercises created equal?

With the plethora of exercises, products, and health fads in the news and hitting the market these days, it is confusing to know what the “best” exercises or products are for you. Many products or types of exercise will make claims of “scientifically proven” or “research shows” on why their type of exercise is better than another to lose weight, tone-up, live healthier and get the body you have always wanted. Unfortunately, these exaggerations or misinterpretations of scientific literature (which I like to refer to as exercise babble) are all too common in popular culture. Exercise babble aside, most research currently shows the type of exercise you do is of little importance, however it is very well proven exercising in general will make you healthier! So after sorting through all the misinformation, here is a simple guide for picking the “best” exercises for you:

• Goal Setting: Match your exercises to your health goals. If you want to exercise for athletic competition, you will want to perform exercises that match that specific event. For the average person wanting to exercise to live a healthier life, the specifics of exercise are of less importance. For those that do no exercise, a little more of anything is all you need. Set goals and if you are unable to reach your goals, find a professional that can help you.
• Enjoy it: Find activities that you like. If your brain does not like something, you simply will not do it the rest of your life. One golden rule to live by is: Exercise should never cause pain!
• Stick with the three basics:
1. Cardiovascular (aerobic) exercise that will increase your heart rate for a period of time.
2. Strength training exercises targeting specific activities or general movements.
3. Movement activity that moves your body through full range of motion.
• Appropriate stress: The fine line is stressing the body enough for improvement to meet your goals and still enjoying the exercise. This is where many exercise routines go wrong. You apply too much stress leading to burnout or injury, or not enough stress and are unable to make positive changes to meet your goals.

Exercising should be simple and has too many benefits for healthy living for you not to be doing it. Don’t let advertisements or people confuse you with exercise babble into not wanting to exercise or spending more time and money on gimmicks you don’t need. Remember good health should be inexpensive and easy; injury and illness will be expensive and difficult.

Stress Reducer Tips

While appropriate stress is vital to keep us alive and thriving, excessive stress or what some term “toxic stress” can be detrimental to our health. Keeping stress under control is vital to healthy living. Here are a few tips:

1. Don’t over schedule – it is easy to get our schedule filled up as we add more and more responsibilities to our lives. Learn to say “no” to some things and try to remove things that you maybe don’t need to do off your schedule.
2. Be realistic – be careful when trying to do everything perfect or expecting everyone around you to be perfect. We have to realize we and everyone else is not perfect. Don’t put more stress on yourself or others than needed.
3. Get enough sleep – while it may seem like we can function with less sleep, which is what we often times do when we don’t follow tip #1. Parts of your brain actually shut down when you are lacking sleep. You are functioning, just not at your fullest level, which puts more stress on the parts that are functioning.
4. Treat your body well – regular appropriate exercise is a significant component to reducing stress. Be careful not to go to the opposite side of no exercise, excessive exercise can actually lead to increasing stress. Also a healthy diet is important to decrease the stress to your body trying to function. You wouldn’t expect a car to work very well if you didn’t use good gas for the engine.
5. Watch what you’re thinking – your attitude, outlook and thoughts influence biological functions of your body. People with what is called a “growth mindset” have better control of their stress as compared to “fixed mindset” people. Growth mindset people see that their abilities and situations will grow and change, like a muscle if you work on it. They also accept criticism because they know it will make them better in the long term. Know that with challenges comes some failure but failure is a necessary part of growth and change.

Evaluate your eating habits

If you have tried multiple diets and various practices to lose weight and have been unsuccessful in becoming the healthier you that you want to be, try a food diary:


• Keep a diary of the foods you eat, when you ate them, how you were feeling and what you were doing when you ate them. Review this diary after a few days or weeks to see if there are any patterns in your eating habits that may need changed to be a healthier you.

• Increased calorie intake can often time come from not realizing how much you eat throughout a day. Multiple studies show that 90% of people underestimate their calorie intake for a day. A diary will help you track and be more aware of how many calories you are taking in.

• Eating for our ancient ancestors was for survival purposes. While some people in the world and even here in the US, hunger is still an issue. But for most of us, hunger does not coincide with starvation and famine as those people experience. A diary will help you look at if you were just eating for true hunger reasons or other reasons.

• Some of those other reasons can be because eating is a social event or a psychological coping mechanism that some of us can easily fall trap too. Do you eat every time you turn the TV on? When you are upset or stressed about something do you always open a bag of chips or go for the chocolate? Every time you go to a restaurant do you order an appetizer, main course and dessert and eat it all, even if you’re full after the appetizer? A diary will help you notice if your eating habits are possibly due to these issues as compared to just needing the nutritional intake for health.

• Often times we may think we are eating healthy, only to review a diary of food intake and see 1 or 2 servings of fruits and vegetables and lots of processed foods and snacks with empty calories. A food diary will help you be more aware of the types of foods you are eating on a regular basis.

• After reviewing your eating habits pick one thing to change. It may take some time but with patience and persistence you can make a change toward a healthier you. After making the change stick, pick another habit to change. Eventually you will become the healthier you that you want to become.

Are all dieting plans created equal?

We all have a diet; it is the amount of food we consume. The problem for many of us is in dieting, the deliberate selection of food to control body weight. Should dieting be so complex that it gets over 11 million results when you type it into Google? The simple equation of how much food you take in, known as calories, minus the amount of calories you burn through your day (basal metabolic rate plus activity level) will equal your weight control. Bring in more calories then you burn and you gain weight, burn more calories then you take in and you lose weight.


Dieting plans started in the early 1900’s. Seems like you hear about new dieting plans all the time and everyone of us can name probably at least ten or more, and have tried at least a handful. It seems like they should all work based on what they try to sell us, but if they truly worked how come only about 5% of us will be successful at keeping the weight off according to the Center for Disease Control and Prevention?


Which ones work and which ones fail? Well actually any dieting plans that has you take in fewer calories then you burn will work, remember the simple equation. If your dieting plan has you eating 500 calories of whatever food it is or supplemented with a pill or shot and you are burning 2,000 calories, you will lose weight. Yea dieting plan works! The reason most of these dieting plans fail eventually over time is that we don’t want to eat cabbage soup, take a pill or shot, walk around starving or some other strange idea the rest of our lives. So we eventually go back to our old eating habits: 3,000+ calories in and only 2,000 calories burned. We gain all the weight back plus more, the dieting plan fails! And for many of us it is time to pick a new dieting plan to go through the same cycle all over again.


To find a successful diet plan, eat a balanced diet that you can do the rest of your life. It needs to have the calorie intake needed based on your activity level to meet the weight you want to be. While the thought of losing 20 pounds in 2 weeks sounds great, we should all realize that gaining 20 pounds in 2 weeks would be very unhealthy, so maybe losing 20 pounds in 2 weeks isn’t so healthy either. Eating like the person you want to become will take more time to get you where you want, but it is much healthier and will allow you to be successful for life.

Strength Training 101

Strength training is a very important component of a healthy exercise program, so what are the best training methods to use for a healthy life with strength training.  Here are few basic guidelines:


Use the FITT acronym to help remember the key components of strengthening training program.

Frequency: Research shows that 2 x / week is the best frequency for a strength training program for general health. But 1 x / week is better then none.

Intensity:

• Typically do 8-15 repetitions per exercise, unless training for specific purpose.
• Maintaining good form/posture throughout the exercise.
• Go through a full range of motion throughout exercise.
• Last few repetitions should be challenging but don't lose your good form.
• Breathe out on exertion, do not hold your breath.
• Speed should match normal daily activity (higher speed may increases injury risk).
• Perform 1-2 sets of each exercise.
• Sport specific or high intensity training may require varied sets.

Type: There are lots of types of strength training exercises from body resistance, free weights, elastic bands, machine weights and others. Multi-joint exercises, an exercise that requires you to use more than one joint as you move the resistance, are typically better. You should have exercises that balance pushing and pulling motions along with balance of arm, leg and trunk/core muscle exercises.

Time:

• Only needs to take 10-30 minutes.
• During this time you should perform 8-10 exercises including all major muscle groups: legs, arms, trunk/core.
• Rest period between exercises:
• Short (30-90 seconds) Fitness Range
• Long (3-5 minutes) Strength Enhancement Range

Just a few more thoughts on why you might want to exercise and a tip to help you stick with it.

It is clear that exercise is important, yet people struggle to do it.

Aerobic exercise as an example has been shown to help with: muscle tone, stroke patients, memory, rheumatoid arthritis, inhibit gray matter loss in the brain, panic disorders, stress chemical changes, muscle function, muscle disease, brain function, decreases pain/changes pain perception, improve sleep, improve quality of life, HIV patients, cardiopulmonary fitness, osteoarthritis, aids the immune system, decrease chronic inflammation, migraines, helps heart disease, post-traumatic stress, anxiety, depression, just as good as anti-depressants, low back pain, fibromyalgia, increase brain size, pregnancy, diabetic/insulin, nerve sensitivity, brain injured patients, cystic fibroses, chronic fatigue syndrome, oxygenates the brain, improve mood, etc.  A pretty impressive list, don't you wish you could get all of that in a pill...well you can't, unless that pill is

shaped like physical activity called exercise.

Here's a couple pretty neat studies and some interesting findings:

D. K. McGuire et al., "A Thirty Year Follow-Up of the Dallas Bed Rest and Training Study," Circulation. 104 (2001): 1350-57.

Approximately 30 years ago a very important study on exercise was conducted. The study was called the Dallas Bed Rest and Training Study. Researchers recruited 6 college students to literally spend their summer in bed.

• After just three weeks in bed, the subjects experienced deterioration in cardio-vascular fitness that was equivalent to twenty years of aging.
• Thirty years later, five of the six subjects were retested. 
• Only two had continued to exercise with any regularity, and all had gained weight and body fat. 
• Even so, the declines from thirty years of actually aging were less than those they had suffered during the original three weeks of bed rest. 
• Immediately after being tested, the five men were put on an aerobic exercise pro-gram, which included regular walking, jogging, and cycling. 
• In just six months, the declines they had suffered over the previous thirty years were completely reversed

Heiden, E., M. Testa, et al. (2009). Faster, Better, Stronger, HarperCollins

A group of students were gathered to participate in an exercise study.

• The first group of students was asked to exercise at least once for twenty minutes during the next week. All they had to do was to do a single 20 minute exercise. After the week, it was found that only 29% complied with the instruction. 
• A second group of students was given the same challenge, along with detailed information about the significant role exercise plays in reducing the risk of heart disease, an attempt to further motivate them. Following the week, it was found that 39% of them complied with the instruction. 
• A third and final group were asked to commit to exercising at a specific time, on a specific day, at a designated location. For this group, compliance more than doubled to an extraordinary 91%.

Looks like a little exercise can go a long way to make you healthy and feeling younger.  Setting up a specific time and place seems to help us stick with it.

I send out a monthly newsletter to physicians in the area to highlight some relevant research in regards to Physical Therapy and patients that might benefit from a referral to Physical Therapy for certain conditions, so I thought I would share some of them here as well.


Immediate effects of a high-velocity spine manipulation in paraspinal muscles activity of nonspecific chronic low-back pain subjects. Manual therapy. 2010; 15(5): 469-475.

High-velocity spinal manipulation is commonly adopted for treating chronic low-back pain (CLBP) and has been associated with changes in muscle activity, but the evidence is controversial. The aim of this study was to analyze the immediate effects of high-velocity spine manipulation on paraspinal activity during flexion–extension trunk movements. EMG activity during the static relaxation phase was significantly reduced following intervention for the manipulation group but not for the control group. The extension-phase EMG activity was also reduced after manipulation, but the flexion-phase EMG levels remained unchanged. Accordingly, the percent changes in FRR and ERR were significantly larger for the manipulation group compared to the control.

The results suggest that a high-velocity spinal manipulation is able to acutely reduce abnormal EMG activity during the full-flexion static phase and activation during the extension phase.

Treatment of Chronic Low Back Pain: A Randomized, Clinical Trial Comparing Group-Based Multidisciplinary Biopsychosocial Rehabilitation and Intensive Individual Therapist-Assisted Back Muscle Strengthening Exercises Spine; 1 March 2010 - Volume 35 - Issue 5 - pp 469-476

Both a multidisciplinary biopsychosocial rehabilitation program and an intensive individual therapist-assisted back muscle strengthening exercise program used in Denmark have been reported to be effective for the treatment of CLBP.

Results: Of the 286 patients, 14 patients did not start treatment. Of the remaining patients, 25 (9%) dropped out of therapy. The 2 groups were comparable regarding baseline characteristic. After treatment, significant improvements were observed with regard to pain, disability, and most of the quality of life dimensions. These effects were sustained over the 24-month follow-up period. There were some statistically significant differences between the 2 groups relating to secondary end points, Roland-Morris disability questionnaire, and in the MOS 36-Item Short-Form Health Survey the “physical functioning” dimension and the “physical component summary.”

Conclusion: Both groups showed long-term improvements in pain and disability scores, with only minor statistically significant differences between the 2 groups. The minor outcome difference in favor of the group-based multidisciplinary rehabilitation program is hardly of clinical interest for individual patients.

Trying to get to the simple side of complexity with health.

The body is an amazingly wonderfully complex living organism. As we study and research the body looking for ways to improve the health of it, we can very quickly get confused with the complexity of all the different systems interacting with each other to maximize the efficiency of the body as it lives.

I like that phrase, "Simplicity lies on the far side of complexity." It means you must strive to make your way through the difficult, uncertain and often confusing part before things become clear enough to be considered simple. Let’s apply this thought to a few basic health principles:

• Exercise – We can easily get confused with magazine articles from supposed experts and antidotal information from family or friends on how often, how long, what types of exercises are best for weight loss or muscle production, what pace or exertion, high intensity versus lower intensity and debates can go on and on over many of these. But the simple side for most us is we need move more.

• Nutrition – What percent of each macro-nutrient (fat, carbohydrate, and protein) does each of us need? How many calories should I eat? Are some calories better then other calories? How many times a day do I need to eat? Do I need supplements, if so which ones? And the question list goes on and on. But the simple side is most of us need to control portion sizes and be a more balanced, nutritious eater.

• Stress – There are lots of books you can buy to help you reduce your stress, probably enough that trying to decide which one you need stresses you out!!! But the simple side is most of us need to laugh more and worry less. Also take action to walk the delicate line of hoping for the best and let positive thoughts and feelings dominate most of our emotions, but at the same time be realistic and let a small piece of us prepare for the worst.

• Overall health – How do you get healthy? This is the magic question for most of us. With so many different answers to the same question, how do you know what to believe? Everyday there is another guru or fad that we hear works for them or others to get healthier. But the simple side is most of us need to: exercise more, eat better and stress less in a way that works for us and keep working to get better at all of them.

Less TV and just a little exercise for a longer life

Just wanted to pass on a couple of studies done if you want to live a little longer:

One shows watching TV up to 6 hours a day can reduce your life span by about 5 years!!!  See this link for more info: http://www.medicalnewstoday.com/articles/232902.php

The other shows just 15 minutes of exercise a day can increase your life span by about 3 years as compared to sedentary people!!!  See this link for more info: http://www.medicalnewstoday.com/articles/232899.php

Here is a link that sums up both articles: http://www.medicalnewstoday.com/articles/232783.php

Follow the simple rule of 5 to get the day started off right

It’s amazing the different marketing we can fall victim too when we walk down the cereal aisle. More money is spent on marketing breakfest foods than any other food item as stated by research done by USDA/Economic Research Service.  We will find a huge variety of flakes, nugget, clusters, squares, and O’s fortified with various vitamins, minerals and such; all in the name of getting our day off to a healthy start. In the attempt to compete in the very profitable market of breakfast foods they add all sorts of fancy ingredients and health claims – lower cholesterol, promote weight loss, improve health. Don’t be so impressed. Most of these nutrients and benefits can be obtained from less processed and many times less expensive foods. The biggest concern with many of these is the added sugar.

Follow the Simple Rule of Five: Look at the Nutrition Facts label; ideally, it should have less than 5 grams of sugar and 5 grams or more of fiber per serving. This is not an absolute rule; some breakfast foods may fall short in the fiber category but have 0 grams of sugar, so not a bad choice. Also some cereals have dried fruit in them so will be higher in the sugar category. If sugar or corn syrup is one of the first few ingredients pass it on and look for a better choice.

Info taken from Nurtition Diva's: Secrets for a Healthy Diet

Get in the Zone for proper exercise intensity

Finding the right intensity to exercise at is important to maximize the safety and effectiveness of your workout.
One of the best ways to monitor the intensity of your workout is with your heart rate. Find the appropriate “zone” for your exercise to meet your goals, try to keep your heart rate during the workout in this zone. Consult your physician if you have any risk factors for cardiovascular problems or if you are unsure if you might have some. Next calculate your submax heart rate; your physician can help you with this if you have any risk factors. If not, then this can be found by walking or running at a sustainable pace at near maximum effort for 15-20 minutes after warming up and then check your heart rate at the end. This is your submax heart rate.
Healthy Heart Zone (Warm up 60-70% submax rate) --- The easiest zone and probably the best zone for people just starting a fitness program. It can also be used as a warm up for more serious exercisers. This zone has been shown to help decrease body fat, blood pressure and cholesterol. It also decreases the risk of degenerative diseases and has a low risk of injury.
Fitness Zone (Fat Burning 70-80% submax rate) --- This zone provides the same benefits as the healthy heart zone, but is more intense and burns more total calories.
Aerobic Zone (Endurance Training 80-90% submax rate) --- The aerobic zone will improve your cardiovascular and respiratory system AND increase the size and strength of your heart. This is the best zone to progress toward with your exercise program for long term health benefits.
Anaerobic Zone (Performance Training 90-100% submax rate) --- Benefits of this zone include an improved VO2 maximum (the highest amount of oxygen one can consume during exercise) and thus an improved cardiorespiratory system, and a higher lactate tolerance ability which means your endurance will improve and you'll be able to fight fatigue better. If you are training for a competition of some sort you need to get into this zone to improve your performance.
High Intensity Interval Training (Maximum Effort 100-110% submax rate) --- Although this zone burns the highest number of calories, it is very intense. Most people can only stay in this zone for short periods. You should only train in this zone if you are in very good shape and have been cleared by a physician to do so. Implementing short bursts (1-2 minutes, 5-6 times) of this intensity with easy rest periods in between can have significant health and fat burning effects, but care needs to be taken.

More Stress Signs

A few weeks ago I post about some physical signs that may be due to increase stress (see here for reminder).  Here are a few more few signs that may be stress related, anyone recognizing these signs should see a doctor first to rule out serious illness or injury. The irony of stress is that the very things that will make you feel better--exercise, self-care, eating a healthy diet--are usually the last things you want to do.


Stress Sign: Weight Gain

Stress often pushes us into a vicious cycle of choosing unhealthy foods, binge diet and eating, losing energy and gaining weight. This is due to an increase production of glucocorticoid hormones as a reaction to the stress response.

What you can do: You can jump in anytime in the vicious cycle to put a stop to it. Don't skip meals, decreasing calories too significantly can increase your bodies stress response. Actually eating to little is often a cause for stalled weight loss. Undereating almost always leads to eventually overeating and weight gain. Just make sure the added calories you need come from healthy foods.


Stress Sign: Back Pain

Although the causes of back pain are usually physical, emotional stress can play a role in how severe pain is and how long it lasts.

What you can do: Strength training and cardiovascular exercises are important in keeping your back healthy. Maintaining a healthy weight will also reduce strain on your back and decrease coritsol production which increases sensitivity of your nerves.



Stress Sign: Tension Headaches

These headaches occur when your scalp and neck muscles become too tense.

What you can do: See your doctor to make sure you don't have a more serious headache-related disorder. Utilizing meditation and self-care along with a regular exercise program and healthy diet will decrease frequency and intensity of headaches.

What’s Causing the Obesity Epidemic

What’s Causing the Obesity Epidemic

Great post hope everyone gets a chance to read.

Bottom line: Worry less about what types of calories (fat, protein, carbohydrates) and control the amount of calories you take in.  Going out to eat less can help (if you do go out, split your meal with someone or take part of it home for a meal tomorrow), and at home eat smaller portion sizes also (instead of going back for seconds you may find more energy to go out and get some exercise instead).

So simple, yet so hard

The problem with all crash diets and not enough strength training exercise

Many diets promise fast weight loss, and with enough calorie reduction every diet is 100% successful to lose weight. But unfortunately we can’t live this way forever and eventually the weight comes back 100% of the time (usually with in 6 months to 1 year), so long term every one of these diets nets to 100% failure. But the failure goes deeper than most of us realize. Our weight that we can change is made up of fat and muscle. So when we lose weight we lose both fat and muscle, not just fat. Strength training, which combats the muscle loss, is often the forgotten exercise component to healthy weight loss. Other then aspiring athletes most of us do not spend the time and energy toward strength training programs. Strength training is often times the missing ingredient to help us achieve the weight control we would like long term.


Many of us have gone on multiple different diets in our life only to end up back where we started. These “yo-yo” diets can have a significant impact on our metabolism and our chance to successfully get weight off and keep it off to be healthy. In our attempt to lose weight we lose fat and muscle as we stated. It is biologically very difficult to lose weight and not lose some muscle. Our goal needs to be losing as much fat as possible and not muscle. The best way to accomplish this is to go slow (1-2 pounds per week) and make sure we are strength training. The faster our weight loss the larger percentage of it will be muscle. When we gain weight back it will be fat weight not muscle, unless we are doing lots of strength training.

Here is an example of the problem. If you lose 30 pounds, 20 pounds of fat and 10 pounds of muscle, but then regain the 30 pounds it will now be 30 pounds of fat if you aren’t doing strength training exercises. You know have to eat about 300-500 calories less then before your “yo-yo” diet even though you weigh exactly the same to maintain that weight. Why? Realize the more fat percentage you have, the slower your metabolism. Your metabolism is the amount of calories you need to keep your body alive and maintain your weight. A pound of muscle burns about 30-50 calories per day, whereas, a pound of fat burns about 5 calories per day. This is why some very heavy people can eat very little and still not lose weight or even continue to slowly gain weight, they don’t have enough muscle and their metabolism has slowed down dramatically. The only way to speed up our metabolism is to increase our muscle mass percentage to body weight through strength training exercises.

Can your breathing actually decrease your stress?

After taking in a breath slowly exhale. You probably don’t realize it, but your heart has just slowed down a bit. Don’t worry; it will speed up again when you inhale. This regular-irregular beat is a sign of a healthy interaction between heart and brain. Each time you exhale, your brain sends a signal down the vagus nerve to slow the cardiac muscle. With each inhale, the signal gets weaker and your heart revs up. Inhale, beat faster. Exhale, beat slower.


As your stress and anxiety levels increase you typically will take shorter and faster breaths. This is a useful mechanism to protect you in dangerous situations that may last a few minutes; the problem arises when you have chronic long-term stress that lasts days, months or even years for some people. Normally you should be breathing an inhale/exhale cycle about 8-10 times per minute in a quiet, relaxed state. Many people are in an increased stress response state and will breathe more cycles per minute. Also when stressed these short breaths are often mostly performed by the chest and neck muscles and not as much with the diaphragm. When you work on taking bigger, slower breaths you get the diaphragm to work more, as it should.

Increase stress can lead to increases in depression, anxiety and increase your susceptibility to disease (you are more likely to catch a cold when over stressed). It will also increase the sensitivity of the nervous system, so your pain will often times be greater when you are stressed. Your brain uses two different nervous systems to control your body. You have complete control over one of them, which tells you to move your arms, legs, mouth, etc. to do things. The other is automatic (that’s why it’s called the autonomic nervous system) it speeds up your heart rate, alters your digestion and other things that happen without your full conscious control. This autonomic system has a part to it that increases activity to tolerate stressful activity and another that slows things down to allow you to keep some balance and not have your heart race out of control along with other functions. The interesting part is that through conscious control of working to slow down and use diaphragm breathing, you can actually affect the autonomic system and promote increase relaxation. So yes by working slow diaphragm breathing you can decrease your stress!

Why are Fruits and Vegetables so expensive?

Obviously we all know that fruits and vegetables are an extremely valuable part of a healthy diet, especially since this is often times one of the items we fail to get enough of. Considering we should be having 5-9 servings a day, many of us fall short of this recommendation. But it is easy to justify cutting them short when we look at the cost of them. Is that extra cost really worth the added health benefit? At least they seem expensive, but are they as costly as we think? I think many of us have a double standard sometimes when it comes to these food items. While it is hard to drop $1.50 for a red bell pepper, yet $3.00 for a bag of potato chips (that we can sometimes eat in one setting) seems like a bargain. The cost per serving isn’t that much different, and the nutritional value is vastly different. And of course we all know that disease can be very costly, so realize the cost of those veggies is an investment into your healthy future!


Tips for getting produce:

1. Fruits and veggies should take up at least a third of your meal plates. So they need to take up at least a third of your shopping cart, so it is okay if they take up a third of your bill.
2. The more colors of the rainbow in your cart the better selections you have made. The better the variety the better your overall nutrition.
3. Look for produce that is in-season and grown close to home, this helps keep price down. 
4. Think shelf-life. Some produce keeps better than others, so plan your meals accordingly.

Stress Signs and How to Reduce Them

Scientific evidence suggests that to much stress lowers immunity, which can lead to many physical symptoms as well as emotional problems. Here is a list of a few sign that may be stress related, anyone recognizing these signs should see a doctor first to rule out organic causes like viruses or serious illness. The irony of stress is that the very things that will make you feel better--exercise, self-care, eating a healthy diet--are usually the last things you want to do.

Stress Sign: Irritable Bowel Syndrome

The colon and how it responds is connected to and controlled by the brain through nerves. That's why when we're worried or anxious; we can experience anything from nervous butterflies to cramps or diarrhea.

What you can do: Exercise, even something simple as going for an easy 20 minute walk, can help you burn off stressful energy while also helping to keep bowel movements and sleep patterns more regular. Increasing foods higher fiber to your diet can also help improve how your intestines work.

Stress Sign: Frequent Colds

Stress will lower our immunity, so we are less able to defend off viruses and bacteria. Research shows that subjects who reported higher levels of stress were twice as likely to catch a cold as their less-stressed counterparts.

What you can do: Build a routine of social stress management techniques (an after-dinner walk, weekly coffee with friends, etc.), and remember to stick to it whether you "feel" like it or not, particularly during times of stress.

Stress Sign: Heart Palpitations

Stress can give you heart palpitations that may feel like your heart is racing or skipping beats. Check with your physician to make sure it is not a heart problem.

What you can do: Multiple studies suggest exercise or meditation in which you progressively and systematically tense and then relax every muscle group in your body or, practicing yoga or tai chi type movements on a regular basis can reduce the frequency of your palpitations.

Stress Sign: Chest Pains

It is not uncommon for women--even young women--to have stress-induced chest pain.

What you can do: Talk to your doctor about whether this is a sign of something more serious. Additionally, don't underestimate the power of just being somewhere quiet or listening to music. Self-care is not selfish care.

Get Regular Health Check Ups

So what benefits are there of keeping regular visits with your primary care physician for routine check ups? If you feel healthy, why waste the time and money to go to your yearly check up?


Lets look at a few reasons:

• Many disease processes can be found early with a gradual decline or change in simple tests. While obviously most of us are fearful that by going in to the doctor they will find one of these problems. But we have to be honest and realize by not knowing does not make the problem go away. Plus most often the sooner the problem is found the more treatable it is and can often not cause us any long term damage to our health as compared to if we wait.
• For some of us knowing that a doctor is going to ask us about our health habits can be a motivating factor to make sure we are trying to maintain a healthier life style. Just as most of us probably would not think of showing up at the Dentist for our 6 month check up and not having brushed our teeth in that time.
• Studies suggest that maintaining a relationship with your physician may reduce non-urgent use of emergency department. Which shows when we keep a good and regular relationship with our physician we become more knowledgeable about our health.

Keeping regular physician check-ups has lots of potential advantages to our health.

Another new concept to consider is to add to your yearly physician physical with a yearly physical from your Physical Therapist.  Understanding the amazing importance proper exercise and movement have to health it seems almost common sense that you would add a yearly check up with the health care provider that specializes in exercise and movement - a Physical Therapist. 

• They can assess gait speed and balance if you are elderly and starting to be at risk for falls.  These tests can determine your risk of falling. If you show to be at increased risk, the Physical
  Therapist will show you balance and strengthening exercises to minimize that risk.
• They can assess functional movement and assess general fitness and give you exercises and mobility tips to enhance your current health and fitness.

Keeping regular scheduled visits with health care providers to make sure you are maintaining and enhancing your health is key to living a healthy and vibrant.

Nutritional Note on Breakfast

We’ve all heard that breakfast is the most important meal of the day. Often times those who are trying to lose weight are told never to skip breakfast. Some newer research has found that eating a big breakfast can just add calories to your day and that actually skipping breakfast can be a way to reduce calorie intake for the day. So let’s take a closer look at what we really know about breakfast habits and how they impact nutrition and weight loss.
We know that people who eat breakfast are less likely to be overweight. We also know from data collected by the National Weight Control Registry (NWCR) that over 90% of successful dieters usually eat breakfast (Successful means that they have lost a significant amount of weight and kept it off for a long period of time – not a crash diet and then yo-yo back again). Successful weight management is a lot more then just eating breakfast. The NWCR shows those that eat breakfast regularly (the successful dieters) also exercise more regularly. So eating breakfast is more likely a common trait among those that maintain a healthy weight. So saying no to extra portion sizes and desert has as much to do weight management as also saying yes to breakfast. But just eating breakfast does not instantly make you a regular exerciser and a healthy, disciplined eater.
So as long as your total intake over the course of the day is balanced, nutritious and allows you to maintain a healthy weight, you can be flexible on the first meal of the day. But if you are struggling with your weight or find it difficult to control the quantity or quality of your food choices, thing about changing your breakfast habit to see if it makes a difference. Healthy quick breakfast choices can be: hard-boiled egg, whole grain toast with peanut butter, fruit, yogurt, oatmeal or whole grain breakfast bar. In the end it doesn’t matter what the latest guru or fad that has worked for others. What counts is what works for you.

Seven steps to go from 0 to 30

Most of us know that the recommended amount of cardiovascular exercise should be 30 minutes, 5-6 times per week. We know it has benefits in helping maintain a healthy weight, reducing stress and giving us a better-looking midsection. Some of us also know it can boost the body’s immune system, by increasing the circulation of natural killer cells that fight off viruses and bacteria, so we are less likely to catch the flu or a cold. Not to mention it reduces risk for stroke by 27%, diabetes by 50%, high blood pressure by 40%, mortality from breast cancer by 50%, colon cancer by 60%, Alzheimer’s disease by 40%, and decrease depression as well if not better then the best medications on the market.


Unfortunately though, for some of us finding five extra minutes a day may seem impossible. Or walking five minutes at a moderate pace seems like more work then worth it. So how does one go from nothing to 30 minutes?

Here are 7 steps to make it happen in a healthy way:

1. Set Goals – Decide what you want to accomplish with your exercise program and find a program that will help you meet your goals.

2. Get Ready – Assess your current level of fitness and understand how to exercise safely by meeting with your physician and physical therapist if needed.

3. Do what you enjoy and do it with others. You need to find activities that you enjoy and doing it with others will help you stick with it.

4. Make it a Priority – You need to hold yourself accountable to your goals and make a commitment that the time spent exercising is non-negotiable. Self-care needs to come before you can properly care for others.

5. Start Slow – Variety & Keep it simple. Many of us want to get our fitness back quickly, but realize we probably did not get out of shape quickly. Also trying to get fit faster often will lead to injury. Gradually add appropriate increase to activities as fitness improves over time. Going from 0 to 30 minutes probably needs to start with 5 minutes.

6. Log activity – This is an important step to make sure you are reaching your goals from step #1. Also it holds you accountable to make sure you are doing step #4. Lastly it helps measure that you are doing it correctly by slowly adding challenge as your fitness increases in step #5.

7. Celebrate progress – As you achieve your goals from step #1 reward your hard work and then set new goals to work toward.

Making up your mind to be Happy

“Most folks are about as happy as they make up their minds to be,” Abraham Lincoln once said.

Current research in neuroscience and psychology shows this statement to be more scientific medical fact then just a witty comment. You are more in control of our emotions and anxiety levels than you think. The negative biological effects from stress come from how you think and react to outside stimulus. People with increased anxious tendencies react in a more fearful way then a person who is able to cope in a calmer fashion.


So here are a few tips to reduce stress:

1. Research has shown that spending time with friends is good for mental health. Schedule regular time, at least one time per month, with friends to ward off chronic stress. Laughter is a key activity that has been shown to decrease cortisol, the primary stress hormone in people.

2. Positive thinking does not add to your already stressful to-do-list. It creates instant good thoughts and helps shift away from negative thinking. Negative thinking enhances anxious tendencies. It’s not as simple as “mind over matter”, but what your mind thinks of does matter. So as hard as it seems with some circumstances, make yourself look at positive things about a situation and focus more attention to them over the negatives.

Should exercise be work or play?

After a long days work coming home and thinking of doing more work with an exercise program is not very appealing to many of us. Coming home and playing may sound a little more fun and enjoyable. So should your exercise program be work or play? Actually a little of both, lets look at the definition of both and see why and how to get a little of both to make our exercise program enjoyable and effective for us.


Play can be defined as any exercise or activity for amusement or recreation through brisk, light or changing movements or actions. Play has no inherent survival needs and is pleasurable and fun. Work, on the other hand, is an exertion or effort directed to produce or accomplish something. Work is often done under the stress of need, has clear goals or purposes, and is usually not much fun. Play is by definition more exploratory and open ended than work. Work is more defined and goal directed.

So lets look at why our exercise probably needs to be a little of both. If you approach your exercise with an overly serious mindset that can create inappropriate stress. You then activate a brain pattern that is not conductive to long term use as your brain and subsequent behavior will work to avoid this activity. If your exercise is fun, you have a better chance of making it productive and continuing long term. Play actual stimulates many different parts of the brain and actually enhances brain activity and growth. If your exercise is only playful and does not stress the body at all it will not physiologically, from a muscular and cardiovascular system, see as much improvement for improved health. Your body will adapt to stresses placed upon it. So small gradual stresses will allow your body to slowly and appropriately adapt and improve in its muscular and cardiovascular systems. By applying a little work with your exercise program it will help you achieve your health goals and allow you a method to measure your progress.

So if your exercise has some component of play you will more likely stick with it and create an environment that your brain will more likely allow you to continue long term. And if you apply a little work with it you can slowly challenge your muscular and cardiovascular systems to improve your overall health.

Does your expectation of recovery following an injury help predict your actual outcome?

Actually they might! Myers(1) and colleagues in 2007 did an interesting study looking at this and found, that what you think your recovery will be is a good predictor of what it actually will be. Why and how does this happen? We do not actually know, yet different theories are possible:


1. You are a very good predictor of your actual injury and your outcome.

2. Your own bias. Whatever you reported initially you will want to be self-consistent later when asked on your improvement, even if you have not improved that much.

3. If you have a higher expectation, you might be more likely to follow through with the prescribed treatment and return to regular activities.

4. The expectation itself being therapeutic, akin the placebo effects.

The last possibility is often in popular culture thought to be just “crazy fake psychological stuff”. But current neuroscience research shows this phenomenon is a normal neurobiological function of the brain and not fake at all. Our brains have an amazing ability to either up or down regulate everything we experience and do. That is why we hear of stories of wartime soldiers being significantly harmed and feel no pain. His or her brain can down regulate the pain info coming in up to 40 times more powerful than any medication we can give them. While this is an extreme example, realize your brain is always doing this to some degree. Your brain has the neurobiological ability to control information coming in and it’s response to that info. This is very real and at work with many conditions and treatments even though you don’t realize it. There is also an opposite phenomenon, if your expectation is for a negative outcome it may lead to worse symptoms.

So just expecting to get better means you will get better faster, not exactly. If you have doubts, or there are significant biological deficits, you cannot fool yourself or pretend that your expectations will get you better. So if you have doubts about your predicted outcome, seek medical advice. Research at this time cannot fully clarify if changing these expectations based on sound clinical advice leads to better outcomes, but some early research suggests this might help. So isn’t this the popular belief held by some that all you need is “mind over matter”, no. But the biological matter in your brain does matter. Bottom line, if your expectation is to get better, it probably will help. If you do not have a positive expectation, you want to seek the advice of a medical professional to help give advice to clarify expectations of your injury.



1. Myers SS, et al. Patient Expectations as Predictors of Outcome In Patients with Acute Low Back Pain. J Gen Intern Med. 2007; 23(2): 148–53.

Starting off a new year

Well it has been awhile since I have been posting.  Over the last 6 months I have been working on completing my post-professional Doctorate in Physical Therapy through Des Moines University.  In December I finally completed all the course work and my final capstone project.  Around 800 hours of study and work over the last 3 years with this endevor, but it has been well worth it.  Since I have been spending most of my nights working on completing this I haven't had much extra time to post.  I'm hoping to find some time in the coming year to getting back to writing and posting on various topics.

I thought I would include an article I recently did for the local newspaper:

Are all exercises created equal? With the plethora of exercises, products, and health fads in the news and hitting the market these days, it is confusing to know what the “best” exercises or products are for you. Many products or types of exercise will make claims of “scientifically proven” or “research shows” on why their type of exercise is better than another to lose weight, tone-up, live healthier and get the body you have always wanted.  Unfortunately, these exaggerations or misinterpretations of scientific literature (which I like to refer to as exercise babble) are all too common in popular culture. Exercise babble aside, most research currently shows the type of exercise you do is of little importance, however it is very well proven exercising in general will make you healthier!

So after sorting through all the misinformation, here is a simple guide for picking the “best” exercises for you:

• Goal Setting: Match your exercises to your health goals.  If you want to exercise for athletic competition, you will want to perform exercises that match that specific event. For the average person wanting to exercise to live a healthier life, the specifics of exercise are of less importance. For those that do no exercise, a little more of anything is all you need.  Set goals and if you are unable to reach your goals, find a professional that can help you.

• Enjoy it: Find activities that you like. If your brain does not like something, you simply will not do it the rest of your life. One golden rule to live by is: Exercise should never cause pain!

• Stick with the three basics:
1. Cardiovascular (aerobic) exercise that will increase your heart rate for a period of time.

2. Strength training exercises targeting specific activities or general movements.

3. Movement activity that moves your body through full range of motion.

• Appropriate stress: The fine line is stressing the body enough for improvement to meet your goals and still enjoying the exercise. This is where many exercise routines go wrong. You apply too much stress leading to burnout or injury, or not enough stress and are unable to make positive changes to meet your goals.

Exercising should be simple and has too many benefits for healthy living not to be done. Don’t let advertisements or people confuse you with exercise babble into not wanting to exercise or spending more time or money on gimmicks you don’t need. Remember good health should be inexpensive and easy; injury and illness will be expensive and difficult.