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Study design and participants

The PREFERABLE-EFFECT study design and methods have been published previously, and the full protocol is provided in the Supplementary information37. In brief, this multinational randomized controlled trial was undertaken at eight hospitals and study centers in Germany, the Netherlands, Poland, Spain, Sweden and Australia.

Eligible patients were 18years of age or older, diagnosed with stage IV breast cancer, had an Eastern Cooperative Oncology Group performance status of 2, and were able and willing to participate in the exercise program and wear an activity tracker. Exclusion criteria were unstable bone metastases as determined by the local treating physician; untreated symptomatic brain metastases; estimated life expectancy of <6months; serious active infection; excessive physical activity (>210min per week of moderate-intensity to vigorous-intensity exercise) or current participation in an exercise training program comparable to the EFFECT exercise program; severe neurologic or cardiac impairment according to the ACSM criteria38; uncontrolled severe respiratory insufficiency or dependency on oxygen supplementation at rest or during exercise; uncontrolled severe pain; any other contraindications for exercise; any circumstances that would impede adherence to study requirements or the ability to give informed consent; or pregnancy. Patients were enrolled regardless of sex, which was collected according to the identity information provided by the patients. Patients were recruited by their clinical care or study teams or through social media (for example, national patient organizations). Medical eligibility criteria were assessed by a physician at the treating hospital.

The study was conducted in accordance with standards of good clinical practice and the Declaration of Helsinki. The study was approved by the institutional review board of the University Medical Center Utrecht, the Netherlands (19-524/M), and by the local ethical review boards of all participating institutions. The study was registered with ClinicalTrials.gov on 9 October 2019 (NCT04120298). All patients provided written informed consent before enrollment.

Patients who met the eligibility criteria and provided informed consent were randomly assigned (1:1), after completion of the baseline measurements, to participate in a 9-month structured and individualized exercise program in addition to usual care (exercise group) or to receive general physical activity advice in addition to usual care, but no structured exercise program (control group). All participants received an activity tracker. Randomization was performed centrally using a blocked computer-generated sequence and was stratified by study center and therapy line (first-line or second-line vs. third-line treatment or a later line of treatment). Owing to the nature of the intervention, participants, local clinicians and study nurses, and investigators were not blinded to group assignment after randomization.

A 9-month structured and individualized exercise program was offered to participants randomized to the exercise group. Details of the exercise program have been published elsewhere37. In brief, the exercise program included supervised, multimodal exercise sessions of 1h, two times per week for the first 6months. For the last 3months, one supervised session was replaced by one unsupervised session. Supervision was performed by qualified exercise professionals (for example, physiotherapists and exercise physiologists) in a community-based or hospital-based fitness center, or a physical therapy practice close to the participants home address. In addition to the in-person supervised exercise sessions, we offered live remote exercise sessions to participants using videoconferencing software (Zoom) if training facilities were closed owing to local COVID-19 regulations or if previously enrolled participants felt unsafe exercising at a local training facility because of the COVID-19 threat.

The multimodal exercise program consisted of resistance, aerobic and balance exercises (Extended Data Table 6). Resistance exercise intensity was individualized using 12-repetition maximum muscle strength testing. For participants with bone metastases, 12-repetition maximum testing was not performed for exercises that loaded the parts of the skeleton with bone metastases (see Extended Data Table 7). During the exercise sessions, resistance exercises that loaded the affected region were either omitted or performed according to the start low (that is, low weight and more repetitions), go slow (that is, gradual increase) principle25, depending on patient characteristics and the experience of the involved exercise professional. Aerobic exercise intensity was tailored to the participants fitness levels using the maximal short exercise capacity (MSEC) and estimated peak power output (Wpeak) with the steep ramp test at baseline. The intensity of both the aerobic and resistance exercises gradually increased during the exercise program; however, the intensity was continuously adjusted, depending on the health status of the participant and the participant's perceived exertion.

In addition to the supervised exercise program, participants were encouraged to be physically active for at least 30min per day on all remaining days of the week. To support this, participants received an activity tracker (that is, Fitbit Inspire HR) and an exercise app specifically designed for the PREFERABLE-EFFECT study. The app included exercises that participants learned during the supervised exercise program and that could be performed at home. All exercises were illustrated with simple animations and contained clear instructions (see Supplementary Fig. 1 for screenshots of the app). The exercise app was also used to support the unsupervised sessions during the last 3months of the intervention period.

Participants randomized to the control group received care as usual, supplemented with written information on the current physical activity guidelines (that is, 150min of aerobic exercise and resistance exercise two to three times per week). They were advised to avoid inactivity and to be as physically active as their health status allowed11. They also received an activity tracker and an explanation of the basic functions of the tracker. The control group did not receive a structured exercise intervention, as this is not yet part of routine care.

All participants visited the study center for measurements at baseline, and at 3 and 6months post baseline. This included the assessment of functional performance and physical fitness. At all visits as well as at 9months post baseline, PROs were assessed using online questionnaires. Participants were asked to complete them without conferring with others. For participants undergoing intravenous chemotherapy, the measurements took place at least 3days after chemotherapy administration. PROs, including HRQOL and fatigue, were assessed using the EORTC QLQ-C30 and the EORTC QLQ-FA12, respectively39,40. The QLQ-C30 is a 30-item questionnaire, including a global HRQOL score, five functional scales (physical, role, emotional, cognitive and social), three symptom scales (fatigue, nausea and vomiting, and pain) and six single items (dyspnea, insomnia, appetite loss, constipation, diarrhea and financial difficulties). A summary HRQOL score can be calculated using 13 subscales, excluding the global QOL and financial difficulties items41. The QLQ-FA12 is a 12-item questionnaire that assesses different dimensions of fatigue (physical, emotional, cognitive and total fatigue). For both EORTC questionnaires, scores range from 0 to 100. For the summary score, global QOL score and functional scales, higher scores indicate a higher HRQOL or a higher function, whereas for symptom scales, higher scores indicate a greater symptom burden. To assess higher levels of physical functioning, four items from the EORTC questionnaire item bank were added to the physical function scale (see Supplementary Table 2). Subsequently, a domain-specific T-score was calculated for physical functioning using EORTC software. This T-score reflects the score of the participant relative to an age-matched and a gender-matched European reference population, with 50 representing average physical functioning.

Self-reported physical activity levels were assessed using a modified version of the GodinShephard Leisure-Time Exercise Questionnaire42,43. The Godin questionnaire is a four-item questionnaire that includes questions about the average frequency and duration of mild-, moderate- and vigorous-intensity aerobic exercise and resistance exercise in bouts of at least 10min performed during leisure time in a typical week. In addition, the Fitbit Inspire HR was used to measure daily step count and minutes of physical activity (that is, minutes per day being sedentary or lightly, fairly or very active, as classified by the FitBit software), throughout the study period. For Fitbit data, only data were used for participants who had >4 valid wear days (defined as 10h of activity registration) around the measurement timepoints (that is, baseline and 3, 6 and 9months post baseline).

As a measure of physical fitness, the MSEC was assessed with the steep ramp test using a cycle ergometer44. After 3min of unloaded cycling, the test started at 25W and was increased by 2.5Ws1 or 25W per 10s, depending on the available settings of the cycle ergometer used, until exhaustion. Participants were instructed to cycle between 70 and 90r.p.m. The test ended when the cycling cadence dropped below 60r.p.m. or when the participant experienced pain or discomfort. After termination, the participant was asked to continue cycling at an easy cadence and with minimal load to promote recovery. The outcome was recorded as the highest achieved output in W and is referred to as the MSEC. From the MSEC, peak power output (Wpeak) was estimated using a regression equation45. Before physical fitness testing, resting heart rate and blood pressure were measured for safety reasons.

Body weight and height were measured in light clothing without shoes. Demographic and clinical data were extracted from questionnaires and medical records, respectively. Adherence to the supervised exercise program was recorded by the exercise professional in a case report form. Safety was assessed by the reporting of AEs and SAEs related to exercise or physical fitness testing. Participants in both groups were asked by the study personnel about exercise-related and physical fitness testing-related AEs and SAEs in a standardized manner during all follow-up visits. In addition, for participants allocated to the exercise group, the exercise professionals assessed any potential exercise-related AEs and SAEs that had occurred since the previous exercise session or during the current session and recorded this on standardized training documentation forms.

Adherence to the supervised exercise program was measured in terms of attendance and compliance. Attendance rates were computed as the number of supervised exercise sessions attended divided by the number of sessions offered. Compliance rates were calculated as the number of supervised exercise sessions in which participants performed all prescribed balance, resistance and aerobic exercises, divided by the number of sessions prescribed.

The study had two primary outcomes: HRQOL and cancer-related physical fatigue, which were assessed using the summary score of the QLQ-C30 and the physical fatigue dimension of the QLQ-FA12, respectively. We assessed the primary outcomes at the fully supervised intervention period (that is, at 6months) and defined the period from 6 to 9months as the maintenance period.

Secondary outcomes reported in this paper include the primary outcomes assessed at 3 and 9months, as well as a range of other variables: the QLQ-C30 global QOL score, and all other QLQ-C30 function and symptom scales and single items, all other QLQ-FA12 fatigue dimensions, self-reported and measured physical activity, and the MSEC.

The study included pre-planned modifier analyses for the following covariates: age (<50 vs. 50 years), baseline fatigue levels (QLQ-C30 fatigue scale score of <39 vs. 39)16, baseline depression levels (PHQ-4 depression subscore of <3 vs. 3), history of psychological disorders (any report vs. none), baseline insomnia (PSQI global score of 04, 58 or 9), baseline body mass index (<25 vs. 25 and <30 vs. 30), baseline fitness level (MSEC, continuous), type of therapy (chemotherapy vs. other), type of metastasis at baseline (bone only vs. mixed (visceral and non-visceral) vs. non-visceral only) and primary tumor receptor status (triple-negative vs. human epidermal growth factor receptor 2 (HER2)-positive vs. HER2-negative and hormone receptor-positive). In addition, the following subgroup analyses were prespecified: female patients only, all patients excluding those who never started the exercise program or dropped out within a month, all patients excluding those who did not adhere to the exercise program (that is, attendance of <80% of scheduled exercise sessions), all patients excluding those who began chemotherapy (intravenous or oral) between baseline and 6months post baseline. A subgroup analysis based on baseline pain levels (QLQ-C30 pain scale score of <25 vs. 25)16 was not prespecified but became of interest during the study.

An improvement in either or both primary outcomes in the exercise group from baseline to 6months post baseline relative to the control group was of primary relevance. Based on a pooled analysis of six randomized controlled exercise trials in patients with breast cancer receiving adjuvant treatment, we anticipated an ES of 0.35(ref. 46). With n=139 patients per group (n=278 in total), a mean standardized ES of at least 0.35 could be detected with a power of at least 78% or 82% at a nominal two-sided significance level of 2.5% for each outcome separately using an analysis of covariance adjusted for baseline values of the outcome variable, assuming a correlation between pre-invervention and post-intervention levels of =0.3 or =0.4, respectively47. To account for a potential drop-out rate of approximately 20%, the target sample size was 350 participants (n=175 per study arm).

A statistical analysis plan was written before the analysis was performed and included in the study protocol. Descriptive statistics were used to characterize the study population at baseline. Questionnaire scores were calculated according to published scoring manuals. All primary analyses were performed according to the intention-to-treat principle. For the primary outcomes, linear mixed-effects models were used to assess exercise effects on physical fatigue and HRQOL separately while taking the hierarchical structure of the data into account. Models were adjusted for the baseline value of the outcome and stratification factors (that is, center and therapy line) and included participants for whom the outcome was observed at two or more timepoints. Models with different covariance structures were compared on the basis of Akaikes information criterion. Modeling assumptions were examined and met. The same approach was used for the analysis of secondary outcomes.

Cohens standardized ESs were calculated by dividing the adjusted BGD of the 3-month, 6-month and 9-month post-intervention means by the pooled standard deviation at baseline. For the primary outcome, a two-tailed BonferroniHolm-adjusted P value was calculated to indicate statistical significance. For all secondary outcomes, ESs and 95% CIs are reported without P values. These confidence intervals are intended to express precision of the effect estimate and should not be used to infer statistical significance, as they do not account for multiple comparisons.

Prespecified intervention effect modifiers were individually added to the model as a covariate main effect and interaction effect with group allocation. Covariates that appeared to be intervention effect modifiers (Pinteraction0.10) gave rise to subgroup analyses. Prespecified subgroup analyses were performed, irrespective of interaction effects, to assess whether the intervention effect was consistent across subgroups. All modifier and subgroup analyses were treated as exploratory.

Missing values of the primary outcome variables as well as all other PROs were considered as missing at random and dealt with using linear mixed-effects models. A sensitivity analysis, using multiple imputation (m=100, R package MICE)48, was carried out to explore potential bias and demonstrate the robustness of our results.

All statistical analyses were performed using R v4.2.2.

Further information on research design is available in the Nature Portfolio Reporting Summary linked to this article.

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Supervised, structured and individualized exercise in metastatic breast cancer: a randomized controlled trial - Nature.com

Ready to revamp your workout routine? Meet the Women's Health 30-Day Workout Challenge. This exercise plan alternates between 20-minute strength training sessions and cross-training days, so you'll never get bored. Plus, by choosing between bodyweight or dumbbell workouts on the strength training days, you can customize this challenge to your exact fitness level.

Wherever you are on your fitness journey, the key is to be consistent with your practice, says Charlee Atkins, CSCS, creator of at-home workout app

At the end of the Women's Health 30-day Workout Challenge, you can expect to see some pretty awesome results. First, you should be able to do more reps over the course of the month, which is a sign your fitness level is increasing, according to Atkins. Plus, it's great motivation when you can see that you're able to do more reps in weeks two, three, and four than you could in week one, she says. You also likely notice some increased muscle definition and higher energy levels.

And the benefits don't just end there. By committing to a daily exercise routine for a four to five-week period, you're teaching your body a new groove and creating a new habit. Science says so. When you consistently hit your sessions, the activity is more likely to become a lasting habit, per an NIH study. So, set a time, pick the place, and stick to your routine. Atkins recommends exercising in the morning, especially for people who struggle to find the time to work out.

The calendar below will help you to keep track of your workout schedule, as well as the mini goals to target each week. Every strength training day focuses on a different muscle group, so you can maintain a consistent schedule with built-in time for muscle recovery.

After two days of strength training workouts, you'll have one day to do a cross-training exercise of your choice. Cross-training can include cardio or mobility workoutsbasically anything that keeps you moving except strength workouts (since that's what the challenge focuses on), says Atkins.

Time: 20 minutes per day

Equipment: Bodyweight, 6-pound dumbbells, 10-pound dumbbells

On each of the strength-training days, choose one of the two workout routines provided beloweither a bodyweight or dumbbell option. For the dumbbell workout routines, Atkins uses 6-pound and 10-pound weights, but that might not be the right weight for you. When in doubt, go lighter, she says. Make sure you can do the moves with correct form before increasing your weight.

To access follow-along videos of each workout routine, download the All/Out Studio fitness app. Get your first month free with code FREE30 at checkout, or become a Women's Health+ member for 60 days free!

Atkins recommends incorporating cross-training into this workout plan via cardio or mobility workouts, whether that means running, cycling, or doing a HIIT workout. And if you're looking for a build-your-own 20-minute cross-training workout you can do at home, check out this list of effective cardio exercises.

But you can opt for a more low-impact option too, like walking, swimming, or using an elliptical machine, especially if you're a beginner. Cross-training has been a very loosely used term for randomized training modalitiesboth high and low intensityfor decades, Heidi Powell, personal trainer and co-creator of the Transform app, previously told Women's Health. It will help you increase strength, power, speed, endurance, agility, and balance, all of which translates across all sports and your everyday life.

Think of it as supplementing your strength sessions with another form of movement that nourishes both your brain and bod.

Your cross-training activity of choice can change between Wednesday and today! Maybe you took a spin class, and now you're looking for something a bit slower-paced, like a yoga class. When it comes to cross-training, it's best to alternate between two activities at a time, Mike Donavanik, CSCS, founder of Sweat Factor, previously told Women's Health. Dont try to do lifting, SoulCycle, yoga, Pilates, barre all in one week. The goal is to mix it up, so you continue to challenge your body, just not too much.

Rest days are as crucial a part of your fitness routine as any workout! Simply put, a rest day is a day when you take a break from your typical exercise programming to allow time for your body to recover, Natalya Vasquez, CPT, a certified personal trainer, health coach, and founder of Bridal Bootcamp San Diego, previously told Women's Health. Theyre intended to reset your body and mind and allow you time to recuperate.

With this workout plan, you're scheduled to take one rest day per week. However, you can always take more if, after the first week, you feel like you need additional breaks during this 30-day program. (No shame in knowingand respectingyour limits!) Your unique circumstances, including your body and abilities, time constraints, lifestyle, goals, and natural gravitation to exercise will dictate how many days you exercise versus how many days you take off, advises Vasquez. Be open to a less rigid model of days on and off because there will be some weeks where you may be hesitant to take off even one day to rest, and others where youll either feel burnt out, sick, or have life circumstances that prevent you from sticking to your plan.

Just do the best you can and listen to your body each day, and you'll be sure to crush the Women's Health 30-Day Workout Challenge!

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Beginners Say This 30-Day Workout Challenge Actually Gets Results - Women's Health

WRIGHT-PATTERSON AIR FORCE BASE, Ohio --

Many start the year with fitness goals and make health and wellness resolutions. However, by the middle of summer, it is not uncommon to lose motivation. Summer heat and repetitive exercise routines can dampen anyones enthusiasm.

The Civilian Health Promotion Services program has added new and innovative updates to their wellness web portal to help spur civilian exercisers into higher gear. And, like the rest of the CHPS programs, its all free.

AFMC civilians can access high-caliber, engaging online fitness and mindfulness classes with Les Mills International on the Air Force Wellness portal.

The CHPS program has a wide variety of health-related content, but we realized that fitness and nutrition were untapped areas, said Sonya Meier, Department of the Air Force CHPS Program Manager. This expansion of virtual services gives locations that do not currently have an in-person CHPS staff more options.

We chose Les Mills because the programs are science-based, she said, The programs have been researched in depth as being able to help users meet their fitness and health goals.

The Les Mills courses run from 15 minutes to an hour for all skill levels and are available any day or night. Dance, stretch, or tune into a high-energy fitness class.

I use the programs myself and especially love the yoga instruction, she added. There are over 20 programs to choose from, so you can change things up and never get bored.

Another new addition to the portal is Diet ID, which offers personalized nutrition assessment and diet management. Diet ID uses a visual approach to optimizing health instead of food tracking. The program helps participants to learn their unique diet patterns and then offers personalized health management based on the users own fitness goals.

By choosing from a series of pictures and answering simple questions, Diet ID analyses current eating habits and helps users plan. Participants can set milestones and track progress with motivating personalized messages and reminders from the application.

Whether you want to reduce salt intake, start eating cleaner or need to find a healthy diet that takes into consideration cultural or medical food restrictions, Diet ID offers tips for success including menu planning and recipes, said Meier.

These new additions add to the variety of health-related programs available on the Air Force Wellness portal. Users can take a health risk assessment, use tracking logs for exercise and steps, view a local calendar of events, learn to manage stress, improve sleep hygiene, and much more.

Locate and download the Motivation Alliance app on the Apple App Store or Google Play. Enter http://www.USAFwellness.com as your platform.

For more information, contact the CHPS program officer at CHPSsupport@us.af.mil.

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Civilian Health Promotions adds more free virtual fitness, health options - Minuteman

THE SPICIEST PART of the summer is here, and that means there's no time like right now to get into the best shape of your life, and craft the abs you've always wanted.

That's where our Summer Shred Challenge comes in. Consider these 5 workout programs from ACE-certified trainer

Rowe's system will have you training 4 times a week, with an optional fifth workout on Fridays. (You'll then have weekends off to enjoy the summer!) Rowe pushes you using a blend of bodyweight exercises and classic strength movements, then helps you loosen your body with mobility and flexibility concepts. The end result will leave you stronger and more durable than you've ever been, and set you on a path to sculpted abs and strength.

This program is exclusively available to Men's Health MVP Premium members, so if you're not already a member, be sure to sign up now.

Core

Mobility

HIIT

Strength / Mobility

KOREY ROWE, ACE, is a veteran fitness trainer who specializes in well-rounded workout programs that build muscle and strength while enhancing flexibility. The result: You wind up looking and feeling great. Rowe fell in love with fitness at age 17. At the time, he was struggling to do pushups. But after months of work, he was able to master the move. "The thing I have always loved about fitness," Rowe says, "is that there is a direct correlation between the work you put in and the outcome you receive." Translation: If you go hard during Korey's program, you're going to see results.

MEN'S HEALTH MVP is a community of guys who are passionate about building their physical, mental, and emotional fitness, just as you are. And our MH MVP program is about giving you as many tools as possible to make that possible. Our Summer Shred program is just the start of a vast array of features that'll help you become your best self.

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Get in Your Best Summer Shape With This Training Program - Men's Health

Richard Simmons, the frizzy-haired fitness guru who championed positivity, exercise and healthy eating, and helped people lose millions of pounds through an idiosyncratic blend of earnestness and camp, died July 13 at his home in Los Angeles, a day after his 76th birthday.

His publicist, Tom Estey, confirmed the death but gave no other details.

Mr. Simmons, who retired to his Los Angeles home and abruptly left the public eye in 2014, revealed on social media in March that he had been successfully treated for skin cancer. The announcement came days after he published a startling post in which he declared that every day we live we are getting closer to our death and urged readers to enjoy your life to the fullest.

For more than 40 years, Mr. Simmons was a zany, irrepressible advocate for physical fitness and weight loss, wearing sparkling tank tops and striped Dolphin short shorts while exhorting Americans to get off the couch and get moving. If your underwear isnt wet, he would shout, youre not working hard enough!

Adopting playful titles like The Pied Piper of Pounds and The Clown Prince of Fitness, he led classes at his Beverly Hills exercise studio, Slimmons; published best-selling fitness guides, including the Never-Say-Diet Book (1980); promoted portion-control kits like Deal-a-Meal; and released hit workout videos including Sweatin to the Oldies (1988), in which he led aerobics routines to songs such as Dancing in the Street and Great Balls of Fire, backed by a live band in a gym setting meant to evoke a high school reunion.

A self-described former fatty, the 5-foot-7 Mr. Simmons represented a much more accessible physical ideal than svelte or muscle-bound peers like Jane Fonda and Jack LaLanne, said Natalia Mehlman Petrzela, a history professor at the New School in Manhattan and the author of Fit Nation: The Gains and Pains of Americas Exercise Obsession.

Recounting his story in books and exercise classes, Mr. Simmons said he had struggled with compulsive eating ever since he was a boy in New Orleans, entranced by opulent French Quarter restaurants and his parents home cooking. He went directly from pablum to crpes suzette, weighed 268 pounds by the time he graduated from high school and became a plus-size model while studying in Italy as an exchange student, playing a dancing meatball, a bunch of grapes and an earthbound Peter Pan in commercials for food and underwear.

Mr. Simmons said he decided to transform his body after finding an anonymous note left under the windshield wiper of his car, which he had parked outside an Italian supermarket where he was autographing packages of gnocchi. Fat people die young, it read. Please dont die.

Overcome with fear and anxiety, he turned to pills, shots, massages, hypnosis, anything and everything while trying to slim down in a hurry. For a time, he simply stopped eating. He lost 112 pounds in two and a half months, devastating his mind and body, before he checked himself into a hospital.

Mr. Simmons underwent plastic surgeries for his chin, eyes, nose and hair. After moving to Los Angeles, he started his exercise studio in 1974, complete with an adjoining restaurant, Ruffage, that included one of the first free-standing salad bars independent of a steakhouse.

His workouts were part performance art, part burlesque show and part therapy session, in which he comforted students as they burst into tears. He donned wings, a tutu and other outrageous costumes, and maintained an almost theatrical intensity, shouting out compliments about pupils thighs and butts or chanting, Fat, fat, go away, give it all to Doris Day!

Forget exercising: just speaking with him can raise your heart rate, New York Times reporter Brooks Barnes wrote in 2013 after a visit to Slimmons. He likes to stand about three inches from your face and stare at you. One minute hes laughing maniacally. The next he is teetering on the verge of tears and what appears to be genuine sadness.

Discussing the perils of junk food, Mr. Simmons could be solemn and grave, walking around his studio showing pictures of internal organs that belonged, he said, to the morbidly obese: Do you see this heart? This heart is covered with cookies and pies and grease, and your heart may look like this, and you never know when its going to stop beating.

But he also leavened his message with humor, including on episodes of The Richard Simmons Show, a syndicated series that ran for four years in the early 1980s. The show featured interviews and exercise lessons along with comedy sketches in which Mr. Simmons played characters like the Rev. Pounds, declaring, Though I waddle through the valley of linguine and clams, I shall fear no evil.

Mr. Simmons welcomed celebrities to his classes and salad bar Dustin Hoffman, Diana Ross, Barbra Streisand and Joanne Woodward were all early customers but catered more to ordinary people, mainly women, who said they had never felt comfortable at a gym before walking in to Slimmons.

In a 2024 interview for this obituary, Petrzela said that Mr. Simmons was unique among his contemporaries in welcoming and highlighting people who were not thin, including by featuring them in his exercise videos.

She added that while he never discussed his sexuality, Mr. Simmons brought a new, gender-bending aesthetic into mainstream America, embodying a kind of gender-line crossing flamboyance that was more common to gay nightclubs than gyms. Cultural critic Rhonda Garelick, among others, described Mr. Simmons as unmistakably camp, writing in a 1995 article that his elaborately constructed persona is part cheerleader, part father confessor, and part Broadway chorus boy.

Outlasting fitness stars including Fonda, Mr. Simmons continued to preside over the studios classes into his mid-60s, and said he traveled 200 days a year while promoting exercise programs and meeting with fans whom he considered members of his extended family.

But in 2014, he made what Robert Thompson, a Syracuse University professor who studies television and popular culture, called an almost J.D. Salinger-like, Thomas Pynchon-esque pivot into seclusion, disappearing from view and then closing his gym in 2016.

His withdrawal spawned rumors and conspiracy theories that were amplified by a popular 2017 podcast, Missing Richard Simmons, which investigated tabloid speculation that the exercise guru might be held hostage in his home or transitioning from male to female.

Mr. Simmons rebuffed those reports in social media posts and phone interviews, insisting that he was simply living a more private life in the aftermath of a very difficult knee replacement. He had decided to make a new beginning for myself, he said, one that seemed to fulfill an earlier promise he made about doing what he loved.

I work real hard to make people laugh and to make them think, he told People magazine in 1981. The day I dont love any of this, Ill walk away.

The younger of two sons, Milton Teagle Simmons was born into a show-business family in New Orleans on July 12, 1948. His mother, the daughter of Russian Jewish immigrants, supported the family while working as a fan dancer; his father, who looked after the children, had once performed in a vaudeville act and emceed for big bands in Chicago.

To bring in extra money, Mr. Simmons sold pralines on street corners in the French Quarter work he credited with teaching him how to work a crowd.

He sang and put on a smile, he said, but the joy was mostly an act at a time when he was oscillating between binge-eating and extreme weight-loss techniques, feeling isolated as the only member of his family who was heavyset. He told NPR that he began taking laxatives at age 11 and was eventually consuming 30 a day. By age 13, he was throwing up after meals.

Mr. Simmons went to Catholic schools and contemplated becoming a priest or a monk, writing in a 1999 memoir, Still Hungry After All These Years, that he interviewed with a recruiter for the Dominican Order, believing that the monastery would be a refuge from jokes about his weight.

He ultimately changed his mind (the black cape worn by friars was not my color, he said) and studied art at what is now the University of Louisiana at Lafayette. After two years, he transferred to Florida State University, later explaining that the school offered a two-year exchange program that gave him a chance to study in Italy, where he said he was cast in bit parts in the Federico Fellini movies Satyricon (1969) and The Clowns (1970).

Mr. Simmons received a bachelors degree in 1970. After settling in Los Angeles a few years later, he worked as a matre d at an Italian restaurant and began searching for exercise classes. He tried yoga and Pilates but found it too self-serious no one cracked a single joke and was disappointed by a visit to Vinces Gym on Ventura Boulevard, where an agonizing weightlifting workout left him bedridden for days.

Then he discovered a class taught by Gilda Marx, a high-energy instructor who played music and danced. He was the only man in the course, and recalled that after one class, Marx told him the other students were uncomfortable with his presence. Mr. Simmons speculated that the real issue was that he was just too much of a cutup, cracking jokes and singing along to the music. The encounter inspired him to start his own exercise studio.

By the early 1980s, Mr. Simmons was appearing regularly on the ABC soap opera General Hospital he played himself, leading exercise classes at the fictional Campus Disco and appearing on late-night television shows hosted by Johnny Carson and David Letterman.

Looking to emulate the success of Fondas workout videos, he began releasing his own exercise tapes in 1983, with titles including Dance Your Pants Off, Party Off the Pounds and No Ifs, Ands or Butts. His first VHS tape, Everyday With Richard Simmons, opened with shots of diners enjoying pizza, fried chicken and a corn dog; Mr. Simmons made a dramatic entry while bursting out of a banana split, outfitting everyone in yellow jogging suits and transporting them into his studio, where the sweating commenced.

His exercise videos collectively sold more than 20 million copies, according to his website. Their success helped him accrue a fortune that enabled him to settle into a mansion in the Hollywood Hills, where he lived alone with his housekeepers and pet Dalmatians; maintained a collection of more than 400 dolls; and parked a Mercedes luxury sedan with the license plate YRUFATT.

Survivors include a brother.

Late in his career, Mr. Simmons often noted that he found it difficult to talk with fans and students who told him about their struggles with weight loss and depression. He took their setbacks personally, he said, and cried more than he laughed. Prayer helped, as did keeping busy.

People need the court jester, so I keep that smile on and keep going out there to do what I do, he told Mens Health magazine in 2012. He added, Im the clown you take out of the box and wind up when you need a good laugh. And then, when youre done with me, I go back in my box.

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Richard Simmons, self-proclaimed pied piper of pounds, dies at 76 - The Washington Post

Im Dani Blum, a reporter on the Well desk, filling in for Jancee Dunn today. Part of my job is making sense of the endless array of wellness trends that take over the internet. Some days, that means chasing down the answers to age-old questions; other days, Im investigating new products.

As we slip into summer, and the second half of the year, lets look back at the health trends that have defined 2024 so far.

The water wars are here, and they are vicious thanks, #Watertok. Theres a fierce online community extolling the benefits of hydration and igniting debates over just how much water people need to drink each day and whether plain old H2O is enough.

So how and how often should you refill your water bottle? Theres no one right answer for everyone, and most people can stay hydrated by just reaching for water when they feel thirsty. But watch out for the black gunk that can collect at the bottom of your water bottle if youre wondering if thats mold, the answer (sorry) is yes.

Products that claim to heal and hack your gut have become a staple of wellness culture. In 2024, the gut has gotten a glow up: Pastel cans of prebiotic sodas have popped up on store shelves; the microbiome has gone mainstream; and people are adding apple cider vinegar into their drinks, hoping to cure acid reflux.

Amid all the hype, gastroenterologists want to clarify a few things: namely, that there are ways to help the gut, but few are trendy. Eat plenty of fiber, limit processed foods and lower stress to keep your belly happy and healthy.

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Hurkle-Durkling, Prebiotic Sodas and Other Health Trends Defining 2024 - The New York Times

According to Shawn Williams, who has worked at the center for three years, the resource fair is a popular activity for members, and it will be Sept. 17 this year. The event includes access to vendors, and senior resources and connections that go beyond insurance. One example is the food pantry.

The fair will be from 10 a.m. to 1 p.m. and feature information about health insurance, legal issues, healthy eating, fitness trainers, self care and more.

The center offers a variety of programs and activities, with an emphasis on age-specific exercise programs, social skills, cognitive skills, as well as a safe place to build community.

We have a theater onsite and sometimes we show movies during our Primetime program, Williams said.

The center has nearly 600 members, and the cost is $60 per year for Primetime membership or $15 per quarter.

People dont recognize that the Salvation Army works as a church and a lot of the programs and services are with the intent of meeting human needs, Williams said. We seek to give seniors a safe place to build community with others.

More from Williams:

How are you especially tuned in to the 60+ age group?

We have specific age-related fitness classes that include Zumba Gold, Prime Time Yoga, Chair One Fitness, Gentle Stretch, and Senior Strength. Our program focuses on building skills that can be lost with age, such as social and cognitive skills. We also provide information on topics that are of particular interest to seniors. For example, we have had lectures on cyber security, maintenance of balance, and computer literacy.

Why is this important?

Fitness is important because everyone will get older, we just want to help you get stronger by doing functional activities that you do day to day. Our program focuses on building skills that can be lost with age, such as social and cognitive skills. It also provides information on topics that are of particular interest to seniors. For example, we have had lectures on cyber security, maintenance of balance, and computer literacy.

Tips for staying healthy and active

Have fun, and turn exercise into something you enjoy doing. Do the little things that can help in the long run, like stand on one foot when your brushing your teeth to work on your balance. Eat more fruits and vegetables. For physical health and activity, do what you know you can reliably do often. This might mean joining a pickleball league or a yoga class, or it could mean taking an afternoon walk every day. For cognitive health, never stop learning new things and challenging yourself.

Best advice for individuals 60 years and older

Be the example you want your grandkids to look up to. Never tell yourself that you cant do something because of your age. While you should listen to your body and be safe, youd be surprised what you can do and learn. You have a purpose, and The Salvation Army Dayton Kroc Center welcomes you to join our community.

What need do you see in the area for senior citizens?

More social events, gatherings, and/or programs that create connections with seniors daily.

Impact your business has had in the community?

To allow seniors to meet through our daily programs for activities that include enhancing their mind, body, and spirit. Creating a space for seniors where they feel they have a place to belong. We can see the seniors challenging themselves to learn and stay positive in their lives. Our current seniors have expressed appreciation and gratitude toward staff and program offerings.

Where: 1000 N. Keowee St., Dayton

Hours: 6 a.m. to 8 p.m. Monday through Friday, 8 a.m. to 2 p.m. Saturdays, 10:30 a.m. Sunday worship, Kroc Caf: 11:30 a.m. to 1:30 p.m. Monday through Friday

Services offered:

Seniors with Silver Sneakers, Silver Fit, Renew Active, and Prime Fitness insurance receive free fitness memberships, which includes 22 fitness classes.

Pickleball (8 a.m. to noon Monday through Friday), personal trainers on-site to help with fitness needs and a walking track.

Sewing club Tuesdays (12:30 to 2:30 p.m.) is a social opportunity to talk and share stories while you learn sewing or do a project.

Primetime Tuesdays (11 a.m. to noon) is a weekly program for seniors ages 55 & up. Weekly events include activities, free coffee, & free lunch!

Golden Hour Thursdays (11 a.m. to noon) includes activities and lectures. After the program, attendants are provided a free meal.

People of all ages are welcome to join our Worship Service at 10:30 a.m. on Sundays.

Phone: 937-528-5100

Website: https://easternusa.salvationarmy.org/dayton-kroc

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Salvation Army Dayton Kroc Center offers senior programs and resources - Dayton Daily News

In addition to health coaching, Ive been a personal trainer for over 20 years, and one accessible way Ive seen clients get those bursts of physical activity is set aside 30 minutes after dinner for a walk, bike ride or quick workout using a variety of fitness apps.

If possible, think of it as leisure time or a way to clear your head. Bring a family member or meet up with a friend, or listen to a favorite podcast, music or audiobook.

Eighteen of those 30 minutes can be low intensity, but if you include three to four moderate- to high-intensity intervals lasting at least three minutes each, this research indicates your efforts will go a long way toward taking excellent care of your heart health.

Imagine the nutrients you ate at dinner fueling your body as you goprotein, healthy fat and carbohydrates. Put them to use to strengthen your body before winding down for the night.

Morning or midday exercise is wonderful for your health as well. Find what works for you, and if you want to step your fitness up a notch, consider adding a few quick bouts of exercise in the afternoon or evening. The most important questions to guide your decisions are:

What does your schedule allow? And when are you most likely to lace up your sneakers and get moving?

Your answers are the best bet to take care of both your heart and your spirit.

Hey, Health Coach is for informational purposes only and should not substitute for professional psychological or medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health provider with any questions about your personal situation, health or medical condition.

By submitting your letter to heyhealthcoach@forbesadvisor.com, you agree to let Forbes Health use it in part or in whole, and we may edit the letter for length and clarity. All submissions remain anonymous.

Transform Your Fitness With Science-Based Training

Download the free Caliber app and discover how the average member achieves at least a 20% improvement to their body composition within 3 months.

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What Time Of Day Is Best To Exercise For Heart Health? - Forbes

With the enormous number of workout log apps in the Apple App Store and the Google Play store, it's hard to know which one is right for you, especially if you're just getting started on your fitness journey. These are our picks for the best workout log apps to help you plan, organize, and track your gym sessions so that you get the most out of your fitness time this year.

Simple, functional design.

Calendar with rules for highlighting.

FitNotes, which is free for Android, isa workout tracker focusing on simplicity and a clean design. Its workout log lets you view daily workouts quickly by swiping between them using the built-in calendar. Add an exercise to the workout log and start recording weight and reps or distance and time.

You can create a routine to provide quick access to your commonly used exercises and assign exercises to a particular day within the routine. FitNotes is an excellent app if you're just getting started with workout logging due to its user-friendly interface and ease of use.

Apple

Solid, customizable workout planning.

Adaptable to equipment, workout style, and time.

Easy to log sessions.

Fitbod aims to be a coach and trainer more than a mere log book. Fitbod's training algorithm evaluates your strength-training ability, studies your past workouts, and adapts to your available gym equipment. Then it builds your custom workout.

Fitbod will suggest a workout of the day, with suggested sets, rep counts, and weights based on A. S. Prilepin's famous powerlifting chart. Swapping exercises that target the same muscles is easy, and you can customize each workout freely. Fitbod comes with an extensive library of exercises that includes descriptions and videos with proper form.

Fitbod isn't technically free. New users get a free trial to use the app for a specified time and automatically roll over into a Fitbod Elite premium subscription once the free trial expires. Fitbod Elite offers the ability to generate and log unlimited workouts.

Download For:

Well-designed logging screen.

Includes plate racking calculator.

Bigger Leaner Stronger series routines.

Stacked, free for iOS only, helps you build muscle, get strong, and lose weight faster. Stacked lets you define exercises, combine them to form sequences, and schedule workouts to make routines. The app comes with all the basic exercises and a handful of routines from the Mike Matthews Bigger Leaner Stronger and Thinner Leaner Stronger series.

At the heart of Stacked are logging sets. You get a rest timer, the previous workout's data, personal records, a calculator for 1RM, proper keyboards for entering numbers, and a handy plate picker. Stacked also lets you pre-set playlists for workouts and control playback from the logging screen.

In addition to training, you can track body measurements, define goals, and get graphs to visualize them.

Runloop

When you open HeavySet, which is available only for iOS devices, you'll find an excellent, well-thought-out fitness tracker app. Data entry is easy, with well-placed buttons that are big enough not to miss, even with shaking legs or hands. Typically, you'll have to tap only once to log a set, and HeavySet's smart predictions do the heavy lifting.

HeavySet's smarts don't mean you give up control over setting up routines. You can specify rep ranges, pick your weights based on intensity, or define custom supersets.

S2: Strength Log, which is free for iOS, is a simple, helpful workout log that comes with a long list of exercises (to which you can add), and turning them into workout routines is easy. The app uses your first routine as a baseline for adding on difficulty as you progress in your training.

Log unlimited workouts, create unlimited workout routines and custom exercises, track total mass moved per exercise, history over time, and more with S2.

Logging workouts is easy.

Includes a warm-up calculator.

Fills in your previous weights and reps.

Keeps track of your personal bests.

No way to schedule workouts.

No exercise descriptions, images, or videos.

Strong, free for iOS, Android, and Apple Watch, is an excellent app for planning and logging workouts. It comes with all the tools you'll need to track activities effectively, including an extensive library of exercises and a practical way to enter data.

Adding sets and exercises is fast, as are removing and rearranging them. The app fills in previous data and offers a complete history, charts, and records. Choosing activities as you go is easy, and Strong lets you combine them into routines.

The free version of Strong can save unlimited workouts, but it's limited to three custom routines. Upgrade to a Strong PRO subscription for an unlimited number of routines and additional features.

Download For:

Huge list of exercises with descriptions and images.

Functional logging screen.

Share progress with friends on social media.

Jefit lets you manage and track workouts from one place. Choose from more than 1,400 exercises, add your own, and combine them to form a plan. Jefit offers personalized workout routines tailored to your needs. Easily record your training logs, start the rest time, track your workout, and analyze your data.

Jefit is more social and connected than most workout logs. Share routines with friends or download others' plans, participate in contests, brag about workout stats, and synchronize your data with other platforms and devices.

Jefit's basic plan is free, but you can unlock more features with an Elite Yearly or Elite Monthly plan.

Download For:

GymBook, free for iOS, offers unlimited workouts, exercises, log notes, detailed workout analysis, and more. You can unlock extra features for a fee.

It comes with over 50 exercises (over 300 with a membership upgrade) and a few sample workouts. Adding and adapting is simple, and heat maps show you which parts of the body will be the sorest afterward. It includes helpful graphs for exercises and body measurements.

Clean, simple exercise log.

Option to enter/review data from computer.

Simple Workout Log, free for Android, is simple in appearance, utility, and organization. It's easy to log sets with your history, exercise performance graph, and plate calculator at hand. You can also turn exercises into routines and see your performance displayed in graphical form.

Unique features include a summary page with stats from your previous workout, powerful graphing of strength and cardio exercises, the ability to log supersets, cloud backup, export to Excel, and more.

A web version of Simple Workout Log is available for reviewing data and setting up routines, and a Pro version is available if you want to eliminate ads.

Effective logging screen.

Includes a plate calculator.

Popular workouts as ready-made exercise programs.

Can't define target intensity based on 1RM.

Doesn't automatically back up your data.

You could lose everything if you switch devices.

Workit, free for iOS and Android, offers easy ways to enter data, create routines, log workouts, and visualize your progress. There are hundreds of exercises included with descriptions, animations, and YouTube video links. A useful plate-racking calculator lets you load with confidence.

Get started with popular programs (Stronglifts, Starting Strength, PPL, and more) or make your own. Progress is easily visualized by exercise and body part trained, and Workit helps you keep track of cardio sessions.

The Pro version removes ads, keeps body stats, and more.

Download For:

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The 10 Best Workout Log Apps of 2024 - Lifewire

(CNN) Low back pain affects at least 619 million people worldwide, and that number is expected to increase to 843 million people by 2050, according to research estimates.

Unfortunately, nearly 70% of people who recover from an episode of low back pain have a recurrence within a year, experts say. In addition to acute physical discomfort and lost time at work, treatment often requires education, physical therapy and exercises such as Pilates that may require fees or specialized equipment.

Yet there is an easy, free way to prevent low back pain, at least for a while, according to a new randomized clinical trial.

People in the study who walked regularly after having at least one episode of low back pain were pain free nearly twice as long as those who did not.

The intervention group had fewer occurrences of activity-limiting pain compared to the control group, and a longer average period before they had a recurrence, with a median of 208 days compared to 112 days, said senior author Mark Hancock, a professor of physiotherapy at Macquarie University in Sydney.

Walking is a low-cost, widely accessible and simple exercise that almost anyone can engage in, regardless of geographic location, age or socio-economic status, Hancock said in a statement.

The study, published Wednesday in The Lancet journal, followed 701 Australian adults, mostly women in their 50s, who had recently recovered from an episode of low back pain that derailed their ability to perform daily activities. Each person was randomly assigned to a control group with no intervention or an individualized walking and educational program.

Those in the intervention group were asked to build up to 30 minutes of walking five times a week over a six-month period at speeds adjusted for age, physical capacity and individual preferences. Jogging was also allowed.

After three months, most of the people who took part were walking three to five days a week for an average of 130 minutes in total, Hancock told CNN via email.

Participants were asked to wear pedometers to track their daily steps and keep a walking diary. At three months into the program, they also wore an accelerometer that objectively measured daily step count and the amount of brisk walking or other physical activity.

The program also provided six physiotherapist-guided education sessions over six months, a more cost-effective model than typical treatment, Hancock said.

We included 3 standard sessions with a physiotherapist and 3 brief phone catch ups, he said in an email. In the few previous studies of prevention exercise programs for back pain the intervention included approximately 20 group classes.

We also discussed simple strategies to reduce the risk of a recurrence of low back pain and instructions on how to self-manage any minor recurrences. The education was embedded in the same sessions as the walking prescription.

In addition to providing participants with longer pain-free periods, the walking program reduced the amount of time taken off work and medical visits by half, said lead study authorNatasha Pocovi, a postdoctoral fellow at Macquarie.

The exercise-based interventions to prevent back pain that have been explored previously are typically group-based and need close clinical supervision and expensive equipment, so they are much less accessible to the majority of patients, Pocovi said in a statement.

Our study has shown that this effective and accessible means of exercise has the potential to be successfully implemented at a much larger scale than other forms of exercise.

Due to the structure of the study, it was not possible to determine how much of the benefit was due to walking or the educational program provided by physiotherapists, Hancock said.

We believe it is likely the two components complement each other, with education helping to overcome avoidance and fear of movement, while the health coaching and walking program resulted in behavior change, he said.

However, because the intervention appeared to be behavioral coaching, and not actual physical therapy, the act of walking may indeed have been the key reason for improvement, said A. Lynn Millar, a retired physical therapistand former professor at Winston-Salem State University in Winston-Salem, North Carolina. She was not involved in the study.

This is important, as many studies have shown that pain response is partially a behavioral response, Millar said in an email. The coaching was limited in duration, thus they can suggest that the primary intervention of walking was the major contributor to the long term response.

What is it about walking that is so helpful for lower back pain? For one, exercise is good for every part of the body.

First, the person is sitting less, and sitting is not the best posture for the back, Millar said. Second, walking will improve general circulation,and will improve blood circulation to themuscles of the back thatareactively supporting the individual during the motion. Movement of a joint also helps circulate thejoint fluids,thus thejoints of thespine may be benefiting from the motion.

Walking improves metabolism and the amount of calories burned, experts say. Lower weight can ease the load on the back and legs, ensuring better spinal health. Taking a brisk stroll also improves the strength of core muscles around the spine and in the legs, all of which can improve posture and provide better support to the spine.

Walking also increases muscle endurance, assuring muscles are less susceptible to fatigue and injury. Weight-bearing exercises such as walking increase bone density, protecting against injury while stimulating the release of endorphins, the bodys natural feel-good hormones that reduce pain and stress.

When starting a walking program, good shoes and arch supports are necessary,and potential problems may be offset by exercise programs such as resistance training and stretching, Millar said.

I also think it is important to have varied paces and distances throughout the week. Some problems are caused by progressing too rapidly, and not paying attention to initialaches, she said.

I also used to see people that were walking in shoes that did not have good support, or they had become so worn, the support was gone, she added.

If your back goes out during walking, activity modification such as cycling or swimming may be necessary, Millar said. Taking a day or two off from walking and doing some back exercises and stretching can also help.

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Prevent low back pain with this simple lifestyle change - WSVN 7News | Miami News, Weather, Sports | Fort Lauderdale

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