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The American Journal of Managed Care: What are some specific patient characteristics associated with relapsing-remitting multiple sclerosis (MS)?

Jonathan C. Calkwood, MD: In general, female predominance of the disease, at least in the relapsing forms, and onset in early to mid-adulthood is the well-known demographic of MS. Theprognosis for an individual with MS can be highly variable and can be hard to predict. The disease is characterized by intermittent neurological attacks and recoveries which progress to permanent physical and cognitive disability. The patient characteristics associated with relapsing-remitting MS that interest me most are those characteristics that help me understand where a patient is currently in their disease course as well as those that help me predict a patients risk of disability. To me, the important characteristics are those that are predictive of long-term accumulation of disability. How do I predict where that patient might be? If I have someone with aggressive disease, I want to match that disease aggressiveness with an appropriately efficacious treatment. Now, that might beg the question, If highly officious treatments preserve neurons and prevent more disability, when should we use a less efficacious treatment? The question I often ask other neurologists who might be reluctant to make a treatment change is, How many brain cells is it ok to lose on a lesser efficacious treatment that we might have prevented? Theanswer should be zero and current research strongly supports early intervention with highly efficacious therapies to limit development of disability.

There are three patient characteristics that I am most concerned with: relapses, magnetic resonance imaging (MRI) lesions, and the level of disability based on neurological exams. I focus on those characteristics that are predictive of a more aggressive disease including: race, frequency of exacerbations, incomplete recovery from a relapse, or more severe relapses. The character of the patients neurologic symptoms, be it relapses or their day-to-day symptoms, can help us. Patients who have symptoms or relapses with predominantly involved symptoms that are coming from their brainstem or their spinal cord may have more disabling issues. Its the same for MRI characteristics. If lesions are accumulating in the brainstem and the spinal cord, that patient is at higher risk for physical disability. We also use a patients neurologic exam abnormalities in a similar way. There are many risk factors that may exist in an individual that may influence risk assessment so it is important to form a type of a matrix of what those characteristics are to try to identify a higher-risk patient.

AJMC: What do you see as existing gaps in care for patients with relapsing-remitting MS?

Jonathan C. Calkwood, MD: There are many gaps in our healthcare system that may influence a patients ultimate accumulation of disability. I think there is a huge gap that readers of AJMC could, and should, influence. The healthcare insurance industry attempts to apply utilization management practices that work well in many other disease states but are fundamentally flawed when applied to MS. Individual patient variability in a disease state like diabetes or hypertension is relatively uniform compared to MS. These diseases have easily measured and inexpensive biomarkers that tightly correlate with outcome. In these diseases, you can identify a treatment failure before there is permanent end organ damage. Selectively limiting access to treatments is less likely to have permanent consequence for the patient with diabetes or hypertension when end organ damage can be predicted by biomarkers. Treatment escalation based on efficacy, cost, or treatment risk has little if any long-term consequences for the patient and makes sense in these diseases where treating to those biomarkers prevents end organ damage in the future.

In MS, the measure of treatment failure is end organ damage. We grow all the brain cells we have by the age of 19 to 21 years of age. Neurons, unlike other tissues in our body, do not have the capacity to regenerate. In MS, a new lesion on the MRI, a relapse, worsening on neurological exam, cognitive decline, or other changes indicate that the patient has already lost brain cells.

Even as an expert in MS, it is difficult to predict how an individual patient is going to progress, but I can put them in a higher risk group. As such, we should treat patients proactively to prevent disability accumulation.

I believe the single biggest clinical gap in care is the limited access to classes of therapy or individual medications that may be medically determined by the physician as appropriate for an individual patient. Since more efficacious treatments have demonstrated better outcomes, we want to use the most efficacious treatment early in the course of disease that is appropriate for that individual patient.

Other important gaps in care are access to MRIs and medications because of the financial burden it puts on them. A patient with MS is usually on multiple symptomatic medications, so theyre paying copays on those medications, too.

Another gap in care is the support of insurance companies of nonpharmacological measures, which have been proven to reduce disability. Some structure is needed that encourages patients with disabilities to participate in wellness programs (eg, physical therapy, exercise programs focused for patients with MS and disabilities, etc).

AJMC: If left untreated, what is the course of disease for patients with relapsing-remitting MS?

Jonathan C. Calkwood, MD: If left untreated or undertreated, the data have been very clear that patients do worse and accumulate disability. Our earliest studies on disease-modifying therapies involved a placebo control group. With the very earliest studies on platform therapies, we saw the same thing when there was a placebo-controlled trial. Even if that study is only a year long, we will see on the Kaplan-Meier curve a separation between the 2 groups of patients in terms of their disability, MRI, or relapse rates that shows the difference between a patient whos on treatment versus not on treatment. Typically, in those studies, the patients in the placebo group rolled into a treatment trial or the treatment group for an extension study. When we put the patients taking placebo on treatment, they paralleled the other group, but at a significantly higher rate of disability. Even a delay in treatment of 1 or 2 years makes a difference in the disability progression of a patient with MS.

AJMC: How quickly will symptoms develop in these patients if theyre left untreated?

Jonathan C. Calkwood, MD: Its really unpredictable but virtually every patient will worsen more than they would have to if they werent on a treatment or if incomplete efficacy is not addressed.

We have an older MS disability scale that attempts to predict progressionthe MS severity scale. This is a natural history scale of the disease untreated. It is a tool to gauge the risk of progression by essentially gauging the length of time they had MS against their disability score. If we dont treat those people early, the data have been very clear that they will do worse and accumulate disability. The disability score is the Expanded Disability Status Scale, which is used in most clinical trials and can be used to gauge the risk of the individual patient. I think the best indication would be if Im able to gauge that individuals overall MS risk and disability based on the MS severity scale. It is important to monitor the patients to see how quickly disability is evolving while they are on treatment. These scales can be helpful but have significant limitations to predict an individual patients future disability, and to help determine a treatment approach to match the aggressiveness of the disease.

MS can be more inflammatory in adolescents and young adultstheir symptoms may change very quickly. I have a tendency to use more efficacious therapies in these patient types as I am more concerned about the risk of disease progression. Postpartum mothers are another high-risk group. Then there are those patients who arent necessarily relapsing but theyre neurologically worsening, seemingly relentlessly, despite our most effacious treatments. The progressive patients with MS that are incompletely responsive to our current treatments represent a challenging group of patients to treat. We are sometimes left with supportive care measures alone.

While we commonly talk about physical symptoms, we also have to consider cognitive symptoms which develop from the onset of disease, but may not be visible until later in life. Early and effective treatment is necessary to preserve the brain cells and neurologic function. The brain of a patient with MS can atrophy at a faster rate than non-MS patients and have a greater risk for losing neurologic function sooner. If you have patients on a less efficacious therapy, their disease may not be controlled. Time equals brain cells, and we cant grow those neurons back. While its hard to predict how quickly symptoms will develop when a patient is untreated, it doesnt matter if theyre developing symptoms or not because theyre losing brain cells faster. If theyre not on the appropriate treatment, this results in more brain loss and greater levels of disability.

AJMC: Could you provide a couple of examples of how relapsing-remitting MS affects patients quality of life?

Jonathan C. Calkwood, MD: I think the two most underappreciated areas that affect quality of life of patients with MS are fatigue and cognitive dysfunction.

The most profound, universal impact is fatigue. A symptomatic issue with MS that we really dont understand very well but profoundly affects the ability of many patients to fully participate in work, life and relationships. Fatigue is commonly cited as a reason that a person with MS chooses to leave the work force.

The cognitive decline that I alluded to scares me the most because its silent, and it really creeps up. Weve got very crude tools for assessing cognitive functioning. We dont have a very good clinical metric, and by the time the person with MS has cognitive symptoms, they already lost many brain cells. We may not have good biological markers. Brain atrophy is a trailing indicator of disease severity but is linked with fatigue and cognitive dysfunction. By the time we can measure brain atrophy, were well behind the curve. Thats one of the bigger, more worrisome quality-of-life issues, because cognitive dysfunction is pervasive in patients with MS, as early as clinically isolated syndrome.

A third aspect of MS on quality of life is physical disability. Some people with MS can be cognitively functioning but physically disabled or, on the flip side, they could look fine but be cognitively disabled. I have plenty of patients who have significant gait limitations, yet theyre still fully functioning in the workforce. Theyre cognitively intact and are able to do highly cognitive jobs, yet physically they need to ride a scooter to get from the parking lot to their desks. MS manifests very differently in different people.

AJMC: What utility do biomarkers have for patients with relapsing-remitting MS?

Jonathan C. Calkwood, MD: At this point in time, immune system biomarkers measured by laboratory tests are of limited usefulness in MS because we just dont understand the immune system abnormalities in MS well enough. Thats where MRI, relapse rates, disabilities, and monitoring response to treatment come into place as biomarkers. I think one of the problems in MS is were managing the patient with a reactive approach. From a neurologists perspective, treating a patient with MS is like driving a bus while looking through the rearview mirror. We are always responding to what has already injured the patients brain. We dont have good, predictive biomarkers so were often responding after a patient has developed more disability. Thats why were often left using scales like the MS severity scale, the risk factor assessment, and a patients individual risk factors. If someone had a relapse, the biomarker could be a change on MRI. Thats probably our biggest, most useful biomarker because the brain MRI scans will show us lesions in the absence of new symptoms. The MRI is an effective biomarker, to help us define and identify an inadequate response to treatment, so we can then escalate therapy. But even an asymptomatic lesion can cause permanent loss of precious neurons.

The ideal biomarker would identify an inadequate response to therapy and warn us that a patient was headed for trouble before they lost brain cells. The biomarker of interest recently has been neurofilament light chains, which are proteins normally only found inside of nerve cells. These proteins are increased in the spinal fluid and blood of people with MS. The FDA has recently granted fast track review of a commercial lab test for neurofilament light. There is still a lot to learn, changes in neurofilament light chain correlates with disease activity and may be predictive for an individual or as a biomarker to distinguish relapses. Obviously, the neurofilament lights are going up in the blood or in the spinal fluid because brain cells are dying; those neurofilament light chains belong inside nerve cells. We can at least use that as a general biomarker now, but it is yet another example of a biomarker indicating that the end organ has already been irreversibly damaged.

AJMC: What nonpharmacologic approaches do you think are helpful in your patients?

Jonathan C. Calkwood, MD: It takes a village to care for a person with MS. They require so much support. The care provider and support partners of persons with MS deserve enormous credit. Education, social and psychological support provided by MS nonprofits and MS nurses are an important source of support. A neurologist trying to take care of people with MS cant just be a neurologist. We already talked about how you have to be an immunologist. Sadly, our patients, despite our best efforts, become disabled, and we have to understand physical medicine and rehabilitation. I would say probably one of the single biggest positives coming out of the neurologic literature in the past decade, but especially the last 5 years, has been a broadening of our approach to focus on biological and immunologic systems. Now we postulate, Whats the impact of general health and wellness on persons with MS? As we have learned, the data on smoking have trickled out in MS. Its not just the other health issues associated with combustion products of tobacco. Smoking tobacco makes the immune system more aggressive.

Recently, we have identified obesity to be an immunological issue for patients with MS. The immune system becomes more aggressive. Managing the patients general medical issues, managing their quality of life, and managing exercise is absolutely one of the most important things. Weve known about that for quite a long time. People with MS will go into a slow downward spiral just from inactivity, so regular exercise is important.

Heres an example. When I joined Randall T. Schapiro, MD, FAAN at the Schapiro Center for MS, we had a program called the Back to Fitness program. That program took patients who had wrapped up physical therapy, but they still werent back to where they were prior to their MS relapse, or, in some cases, they just became deconditioned. Here in Minnesota the winters are long and hard and people with MS may lose function quickly if they are not able to exercise and be active. Every spring, we get calls from our patients. Theyd say, I need steroids. Id say, Well, why do you need steroids? I cant walk to the mailbox anymore, theyd say. Id ask, Well, when was the last time you walked to the mailbox? Last September, theyd answer, and it was April. Thepatient hadnt been active, so we got them into physical therapy. That Back to Fitness program was hugely cost-effective. We had an exercise physiologist who would spend 3days a week for a couple of weeks taking that patient into the gym and showing them how to exercise. Then patients could use a community health club to do their own therapy. The program reduced steroid use and side effects, reduced fall risk, gave patients a transition from physical therapy, and kept me from having to order physical therapy. It was cost-effective and benefitted patient overall well-being.

In addition to access for pharmacological therapies, a comprehensive approach to the disease should include support for health and wellness, access to primary care and internal medicine services for comanagement of medical conditions, smoking cessation, diet, and exercise. These interventions could help these patients more by helping them learn how to do those things that are going to maintain their health better, prevent disability, and lower cost to the healthcare system and society.

AJMC: How do you decide on the appropriate pharmacologic treatment for your patients?

Jonathan C. Calkwood, MD: It starts from having an accurate diagnosis. Once we have made a diagnosis, I try and assess a patients risk of future disability. If the risk is high, we definitely want to use a stronger treatment, even if the treatment comes with some risk. The majority of what I do, day in day out, is risk management for my patients. I cant really predict whats going to happen to them, and I can only put them in a higher or lower risk group based on the factors I mentioned earlier.

When I meet a patient with MS for the first time, the first thought process I go through is, Do they have MS? And then, Are they on the right disease-modifying therapy? By that, I mean the right efficacy. I think selecting the treatment for the patient starts from thatmatching the treatment, the risk of the disease, and the risk of the treatment at some level.

The risk of treatment is not just adverse effects and lab abnormalities. The risk of a less efficacious treatment, may be disability for the patient with MS. If we cant truly predict how an individual is going to do, should we plan and treat for the best or worst potential outcome? If it is my brain we are talking about, I am going to want to err on the side of prophylaxis against the worst possible outcome. If I have a game plan that they have mild disease, and Im wrong, they get more disabled. If I have a game plan for the worst-case scenario, and Im not putting the patient at inordinate risk from the therapy and then it doesnt happen, is the patient any worse off? No, as long as you pay attention to risk, tolerability, adverse effects, and cost.

Based on research data and my experience, I prefer to use the higher-efficacy therapies early in the course of disease. It does not make sense to me to let a patient lose brain cells that we could otherwise prevent. The neurology community is in the process of making a 180-degree turn away from a treatment approach that starts with less efficacious therapies and escalates treatment as disease progresses to starting with higher-efficacy therapies. Among the MS specialists, we are making a change, but its slow going.

Link:
Expert Perspectives on Disease Burden of Relapsing-Remitting Multiple Sclerosis: A Q&A With Jonathan C. Calkwood, MD - AJMC.com Managed Markets...

Patrick Mahomes and Brittany Matthews have been dating each other since their high school days. The couple has spent the majority of their lives together. They have seen each other growing up and have supported each other to pursue their dreams.

Brittany was a good soccer player during his time in college and also played the sport at a professional level. When the Chiefs drafted Mahomes, Brittany Matthews was given an opportunity to play soccer in a league in Iceland.

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She spent about a year there before she came back to Kansas City to live with Patrick Mahomes. She later became a certified fitness trainer. After that, she launched Brittany Lynne Fitness, a website that offers training programs and fitness merchandise designed by Brittany herself.

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On her website, Brittany wrote, I have experience with all levels of fitness and have carried that experience with me to create exercise programs for people at all stages on their fitness journey. With Mahomes busy with football on the field, Brittany Matthews herself is creating another business empire. She is quite active on social media platforms, and that will help to grow her business further.

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Patrick Mahomes and Brittany Matthews have been close to each other since 2011. They finally decided to get married earlier this year in Hawaii. Both of their families and close friends were present to celebrate their special day, which had been a long time coming.

The couple already has a daughter named Sterling. Moreover, they are expecting the birth of a baby boy pretty soon. Mahomes and Brittany were typical high school sweethearts. Despite all the challenges in front of them, they were able to stay together and get married.

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Watch This Story: Tom Brady Reveals His Eldest Son, Who Lives Separate From Gisele Bundchen And His Step-Siblings, Does Not Get Enough Time With His Dad: Lives In New York City And He Wants Time

With Mahomes continuing to climb the ranks of best quarterbacks ever, Brittany has been able to make a name for herself as well. The couple is pretty active in the business world. They are bound to achieve immense success there as well.

Continue reading here:
Wife Brittany Matthews Is as Involved With Professional Sports as Husband Patrick Mahomes, but as an Owner - EssentiallySports

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The MS in Exercise and Sports Nutrition along with the dietetic internship prepares graduates to take the national Registration Examination for Dietitians and apply for a license to practice through the Texas State Board of Examiners of Dietitians. Licensing of dietitians in Texas is voluntary. If you are a resident of another state, contact our department to determine whether our program fulfills requirements to apply for licensure in your home state.

Findmore informationabout degree options, program requirements, dietetic internships, research and career path opportunities in theMS Exercise and Sports Nutrition (ESN) programs at the Denton and Houston campuses.

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MS Exercise and Sports Nutrition - Texas Woman's University

DUBLIN, July 19, 2022 /PRNewswire/ --The "European Health and Fitness Market: Analysis By Value, By Membership, By Club, By Region Size and Trends with Impact of COVID-19 and Forecast up to 2026" report has been added to ResearchAndMarkets.com's offering.

The European health and fitness market in 2021 was valued at US$22.94 billion. The market is expected to reach US$32.55 billion by 2026. The European health and fitness market growth is to be driven by key structural trends such as urbanization, public health promotion, fitness technology and employee well-being programs. The market is expected to grow at a CAGR of 7.25% during the forecast period of 2022-2026.European Health and Fitness Market Dynamics:

Growth Drivers: One of the most important factors impacting the health and fitness market is the growing fitness club membership penetration rate. People are getting more aware that exercise improves energy levels, decreases medical expenses, and likely increases longevity. In addition to this, people can also expect mental health improvements and more energy on a daily basis. Because of this, fitness has become a trend for millions of people, leading to a rapid increase in the fitness penetration rate. Despite the fact that the vast majority of people now live more sedentary lives, an increasing number of individuals are opting for a more proactive lifestyle. Furthermore, the market has been growing over the past few years, due to factors such as favorable demographic changes, the rise of lifestyle-related illnesses, an increasing number of social media users, growing personal disposable income, increasing obesity, and an increasingly-health conscious audience, etc.

Challenges: However, the market has been confronted with some challenges specifically, lack of skilled and professional trainers, the high cost of setting up a club, etc.

Trends: The market is projected to grow at a fast pace during the forecast period, due to various latest trends such as the increasing adoption of virtual reality in training, growing use of fitness wearables, the evolution of hybrid gym memberships, technological advancements, etc. There is an increase in gyms offering hybrid memberships. Many traditional gyms are noticing that members want to have the option to work out either online or in-person. A hybrid gym offers the best of both worlds and includes a combination of in-person and online workout options. For example, a gym may offer in-person exercise classes that are also live-streamed or available on-demand for members who want to continue with home workouts. On the other hand, hybrid gyms help to reach more people. Therefore, the growing trend of market hybrid gym memberships is expected to propel market growth in the coming years.

The report includes:

Key Topics Covered:

1. Executive Summary

2. Introduction2.1 Health and Fitness: An Overview2.1.1 Introduction to Health and Fitness2.1.2 Benefits of Exercise on Health and Fitness

3. European Market Analysis3.1 An Analysis3.2 Membership Analysis3.3 Club Analysis

4. European Regional Market Analysis

5. Impact of COVID-195.1 Impact of COVID-19 on Health and Fitness Market5.2 Impact of COVID-19 on Fitness Clubs5.3 Post COVID-19 Impact on Health and Fitness Market

6. Market Dynamics6.1 Growth Driver6.1.1 Favorable Demographic Changes6.1.2 Rise of Lifestyle-Related Illness6.1.3 Growing Fitness Club Membership Penetration Rate6.1.4 Increasing Number of Social Media Users6.1.5 Growing Personal Disposable Income6.1.6 Increasing Obesity6.1.7 Increasingly-Health Conscious Audience6.1.8 Increased Importance of Employee Well-being Programs6.2 Challenges6.2.1 Lack of Skilled and Professional Trainers6.2.2 High Cost of Setting up a Club6.3 Market Trends6.3.1 Increasing Adoption of Virtual Reality in Trainings6.3.2 Growing Use of Fitness Wearables6.3.3 Increasing Market Consolidation6.3.4 Evolution of Hybrid Gym Memberships6.3.5 Rapid Digitization6.3.6 Technological Advancements

7. Competitive Landscape7.1 European Health and Fitness Market Players by Clubs7.2 European Health and Fitness Market Players by Membership

8. Company Profiles

For more information about this report visit https://www.researchandmarkets.com/r/bf72q3

About ResearchAndMarkets.comResearchAndMarkets.com is the world's leading source for international market research reports and market data. We provide you with the latest data on international and regional markets, key industries, the top companies, new products and the latest trends.

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European Health and Fitness Market Analysis By Value, Membership, Club and Region 2022-2026: Growing Fitn - Benzinga

Multiple therapies can effectively treat Veterans posttraumatic stress disorder (PTSD). But what works for one person may not work for another, highlighting how a one-size-fits-all approach to PTSD, or mental health in general, is unlikely to be successful.

At the same time, interest is increasing among researchers and clinicians in using complementary and alternative treatments, such as exercise, to enhance traditional mental health care and support a patient-centered approach to care. Veterans with PTSD frequently use these treatments and often rate them as enjoyable.

Thats the word from Dr. Daniel Reis, a clinical psychologist at the VA Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC) for Suicide Prevention. He recently led a literature review to evaluate the results and quality of studies on the benefits of exercise for Veterans with PTSD.

Dr. Daniel Reis (Photo by Rachel Warden)

In the review, the researchers identified six single-arm studies in which all participants took part in an exercise, plus three randomized controlled trials (RCTs) that compared an exercise group against another group. The Veterans in the studies were diagnosed with PTSD or had experienced PTSD symptoms but had not received a PTSD diagnosis.

Based on preliminary evidence, the researchers determined that exercise has promise for reducing the severity of PTSD symptoms in Veterans. Reis and his team saw reductions in the four primary symptom domains: re-experience, avoidance, thoughts and arousal. The paper also highlighted the need for more high-quality RCTs to confirm the benefits of exercise for PTSD symptom reduction in Veterans. The review appeared in the Federal Practitioner in April 2022.

The physical health benefits of exercise are well known, and there is a growing body of research showing how exercise can also support mental health, making it an ideal candidate for further investigation as a complementary treatment, Reis says. If exercise does help Veterans with PTSD, it could make a big difference in how we treat the disorder by giving Veterans and their providers another option to use, either by itself or in combination with other treatments.

Finally, he adds, Veterans with PTSD are more likely to have hypertension, which is a leading risk factor for cardiovascular diseasethe number one cause of death in the U.S.and is responsive to exercise. As such, exercise has the potential to protect the health and well-being of Veterans by simultaneously enhancing physical and mental health.

Understanding the complex nature of PTSD is one of VAs most pressing challenges. The department says many Veterans who fought in Vietnam, the Gulf War, and the post-9/11 conflicts in Iraq and Afghanistan have had that mental health condition sometime in their lives.

PTSD symptoms are well documented: re-experiencing trauma through flashbacks and nightmares; avoidance of reminders of a traumatic event; changes in thoughts and feelings, such as guilt and emotional numbing; and hyperarousal.

Reis and his colleagues embarked on the literature review to determine if exercise can successfully treat PTSD in Veterans. No previous research has synthesized the literature on the effects of exercise on PTSD in the Veteran population. The research team also evaluated the risk of bias in the studies, which is often referred to as a quality assessment.

The review showed that yoga was the top exercise treatment used in the studies. The yoga classes involved breathing, movement and relaxation. Also, many studies took a holistic or trauma-informed approach, modifying their yoga programs in ways that were considerate of Veterans needs and past experiences, Reis says. Integrated exercise programs that combine aerobic and strength-based activities, some of which included yoga, are also promising treatment candidates.

Click here to read the full story.

Click here to learn more about VA research.

Link:
Exercise may be useful treatment option for Veterans with PTSD - VAntage Point - VAntage Point Blog

Exercise can be an effective way to manage life with ankylosing spondylitis (AS). Regular movement has a number of physical benefits such as increasing strength and reducing pain. Over time, AS can lead to limited mobility of the spine.

If you use a wheelchair, there are many adaptive exercises you can use to stay active.

Exercise can help keep a range of motion, lengthen muscles, and decrease pain and stiffness if you have AS. Maintaining fitness can help you to manage your AS symptoms and flares.

A 2019 review of randomized clinical trials of exercise programs for people with AS found there was evidence exercise helped reduce pain and increase spinal mobility.

Exercise is good for your:

Participating in a fitness program can also help improve sleep, which contributes to better overall well-being.

Fitness activities can take many forms, including modified forms of yoga, tai chi, and gentle stretching.

A physiotherapist can help you to decide what kind of exercise is right for your body and health. Here are some possibilities from the Spondylitis Association of America that may work for people with AS who use a wheelchair.

This can help stretch your spine and upper back.

This can help your shoulders and upper back. It can also help to strengthen lung capacity.

This can help stretch your chest muscles. Talk with a physiotherapist for a modification of this activity if the back of the wheelchair you use is higher than your shoulders.

These can help to strengthen muscles in your shoulders and upper arms.

These raises can also help your chest and shoulder muscles.

Exercise is an important part of managing ankylosing spondylitis. People who use wheelchairs have the opportunity to choose and modify activities that help to improve strength, flexibility, and spinal mobility. Working with a physiotherapist, you can find the right exercise program that supports your long-term health and well-being.

Read more here:
Seated Workouts to Improve Your Fitness With AS - Healthline

If youre even a little bit interested in getting stronger, youve probably heard or read about the 55 workout program. One of the earliest iterations of this workout was popularized by Bill Starr and it has since had a lasting impact on the strength scene.

The programs hallmark is a lack of flash, focusing instead on raw effort. You prioritize compound movements for five sets of five reps (hence the programs name) and vary the intensity to incite a different training stimulus. Its consistent ability to produce results over the years has reinforced that your effort can trump nearly all other programming bells and whistles. If youre dead set on getting strong really strong heres what you need to know about the 55 program.

There have been numerous iterations of Bill Starrs original 55 program. Its initial format was designed primarily to improve the strength and power of athletes such as football players, Olympic weightlifters, and even combat athletes. You can also find variations with more broad applications, such as his beginner 55 or more specialized versions spawned to suit the needs of other populations.

Any version of the program centers around five sets of five reps for multiple compound (multi-joint) exercises. Another hallmark of the program is slow-and-steady progression with the user increasing the weight on the bar by as little as 2.5 pounds each week.

A study published in Biology of Sport compared two groups of lifters following a bench press protocol. One group performed five sets of five reps (at 80% of their one-rep max), while the other performed six sets of two reps (using 87.5% of their 1RM). Both groups increased their bench press. (1)

Whats more, the researchers assert that these results tend to support the common practical recommendation to start with a lighter load when employing a progressive wave loading strategy, as such a strategy yields similar improvements in performance with a lower level of exertion in training. (1)

The original 55 splits your training routine into three days a heavy day on Monday, light day on Wednesday, and medium day on Friday. Youll focus on the squat, various presses, and the power clean (or barbell row) with negligible additional exercises beyond the core lifts.

Directions: Each workout will be based on a percentage of your 1RM, so its a good idea to know your max for each of the main lifts (see below). The program calls for you to perform a top set at a prescribed percentage of your 1RM for each exercise using the previous four sets to ramp your way up slowly.

Progressing Starrs 55 is as simple as increasing the load of your estimated 1RM by 2.5 percent each week. If (or when) you experience a missed repetition on a single lift or find that the program itself has become too difficult deload by scaling back the load by approximately 10% and carrying on.

More than anything, the 55 is a set/rep scheme and mode of progression that encourages slow and steady strength gains. By staying true to the core principals of this method, you can create a 55 workout of your own that will ensure gains for months to come.

If Starrs original program isnt quite to your liking, you can apply the basic formula to your own workouts. Heres the 411:

If youre interested in MacGyvering your own 55 workouts, use the menu of exercises below to fill in the above categories. You should stick with the same movements for four weeks before subbing them out.

You must know your 1RM to complete the 55 program accurately. If you havent maxed out in a while, or have never maxed out, give this handy calculator a try.

[Related: Jim Wendlers 5/3/1 Strength Training Program Explained]

Like any strength program, the core lifts will be centered on compound exercises that challenge your full body. Your progress is controlled with structured increases in load over time and there will be a cap on how much work you do per day.

The cornerstone of the 55 program is an emphasis on multi-joint, compound exercises. In any variation you find barbell squats, deadlifts, cleans, rows, and various presses will serve as your main lifts.

These exercises force a tremendous amount of full-body coordination and thus strengthen many muscle groups at once. With the lack of machines or isolation-style exercise, your entire body will be forced to get stronger by controlling these barbells entirely by your own means.

The weekly increases in prescribed load are typically going to be as small as you have access to; for example, as low as 2.5-pound increases if possible.

The idea is to slowly and methodically increase the load and let your time and effort with each exercise culminate in increased strength. Slow and steady wins this race.

There is a decided limit on the number of exercises per workout within 55 programming. This is by design, as strength requires a specific measure of focus. Your ability to recover is paramount to your success. With too many additional exercises, you will likely get crushed under a wave of fatigue from such high-frequency barbell work.

55 programs account for this by significantly limiting the additional exercises beyond the main 55, often only employing zero to two additional lifts per workout beyond the compound work for the day.

Strength isnt just about your muscles. Your nervous system made up of your central nervous system (CNS) and the peripheral nervous system (PNS) controls many of your bodies major functions. Your ability to move, your senses, temperature control, sleep, and vital functions are all regulated by your nervous system.

When it comes to strength training, all movement starts in the brain. From gripping a barbell, to retracting your shoulders blades, to pressing a barbell over your chest your brain fires off all of the signals to make those physical steps possible.

If youre new to lifting or havent lifted in a while your nervous system will need time to acclimate to a new series of movement. However, practice makes perfect. The more you perform a movement, the more coordinated and efficient youll become at doing the exercise.

A study in theJournal of Neurosciencestudied how weight training affected the nerves of two monkeys. Each monkey performed one-arm pulls with a single arm. After three months, the researchers concluded that strength training is associated with neural adaptions.It was the monkeys nerves and their muscle-brain connection that was strengthened before their muscles. (2)

So why does this matter in regards to the 55 method? Because performing five sets of moderately heavy weight for two different compound movements grants you, the lifter, plenty of practice for your nervous system. This program forces you to focus on more sets and reps with fewer movements. Youll become a better lifter, and if youre a powerlifter or strength-hungry gymgoer, how you lift is as important as how much you lift.

Generally, strength training can be accomplished with a (somewhat) bare-bones set-up. However, a handful of things to account for before embarking on your strength journey such as equipment, time commitment, and recovery strategies.

Like many strength-centered routines, the main equipment list youll need is the barbell, a squat rack, and plates to load the bar. Many commonly recommended additional exercises fall into the calisthenic category (chin-ups and dips), making them easy enough to do almost anywhere. With that in mind, having a good back extension or glute-ham developer couldnt hurt, depending on how you specifically program your 55.

Access to a deadlift platform is also helpful, ensuring you can best go after your heavy deadlift sets without fear of damaging bars, plates, or the floor from high-intensity pulls.

A dedicated bench press or adjustable mobile bench will also work allowing you to set up in your squat rack to pull double duty.

A few odds and ends for quality of life are to consider a pair of squat or deadlift shoes, chalk, and a good weightlifting belt to prolong your strength training progressions.

Should you dive more into the DIY 55 formatting, ensure you have all the necessary implements (such as kettlebellsor dumbbells) at your disposal before getting started!

While nearly every variation of a 55 program is suited to three days per week, you should allow for a fair amount of time in the gym. Up to three different exercises performed for five sets of five to 10 repetitions in a strength format call for a ton of rest. Allowing yourself the grace for adequate warm-ups and accessory time can also elongate your day, so give yourself a few dedicated hours of training to accomplish a quality session without rushing.

Recovery is one of the most important and overlooked aspects of getting strong. While training for muscle can have some clear signs of fatigue (delayed onset muscle soreness is pretty easy to spot), strength can be slightly less obvious.

Sometimes you wont be sore, but youll still be under-recovered. Allow yourself adequate days off between sessions, following the split as best you can. Eat, sleep, and hydrate like your gains depend on it (because they do) especially as you get deeper into the program.

The 55 method is fantastic for establishing a solid foundational strength base for nearly anyone, but it can be particularly beneficial for powerlifters and field sport athletes.

Field sports athletes such as football or rugby players serve as some of the most commonly prescribed populations for 55 programs. Given that many of the most popular variations were written with these athletes in mind, it makes sense that the exercise selection, volume, and results would benefit them the most. Its lower frequency and emphasis on strength weaves perfectly into the offseason or can be scaled to maintain in-season performance.

Barbell athletes such as powerlifters will especially benefit from utilizing a 55, which employs many of their competition lifts. The programming style, progressions, and emphasis on recovery also play perfectly into what a powerlifter needs to get brutally strong.

Depending on your strength level, it can serve as apotent beginner to intermediate powerlifting program.

Anyone looking to develop a strong foundation of strength would benefit from utilizing a 55 program. The program focuses on skill development on the effective barbell strength exercises by applying them multiple times per week.

Repeated exposure to these lifts helps develop rapid strength-skill increases, while slow progressions allow muscle tissue to adapt on the back end. Athletes far away from competition or new lifters looking to establish a strong base this program is for you.

While most people benefit from strength training, you might find yourself in a unique position where a 55 is outside your preferred programming style.

Athletes who have already established a high degree of skill or strength might find many 55 programs too unforgiving to see continued progress.

The repeated exposures to barbell lifts are great for beginner, and intermediary strength development since a considerable degree of improvement will come from improved skill. Once your strength reaches a specific level, the linear increases in bar weight between each workout might be a bit overwhelming to be of benefit. Your strength has already reached a level where more time is needed at each weight to squeak out more progress than the program might allow.

While there are many variations of the original 55, they are all rooted in the development of generalized strength. More customizable programs might be a better option if you have specific exercise or strength goals that fall outside the prescribed exercises or their potential carryover.

The lifter with no specific strength goal is the most obvious person who shouldnt be using a 55. Strength is a dedicated pursuit; if youre interested in maximizing muscle gain, endurance, or a wide range of other goals, a 55 might not allow for such variability. Like many programs, if you find yourself chasing dreams outside of what it specifically promises, there is little use for you here.

For some, Bill Starr may be a bit of a throwback, but his influence is widespread. Starr was an Olympic weightlifter in the 1960s, becoming a prolific strength coach, author of several successful programs, and writer for numerous publications.

One of his most recognizable contributions is The Strongest Shall Survive which holds up to this day. Starr also served as a strength and conditioning coach for many collegiate programs and professional football teams, actively contributing to the field well into the 2000s before his death in 2015.

Bill Starr is a legend in the strength scene, inspiring many other coaches and programs through his contributions.

His 55 program(s) highlight the beautiful, straightforward nature of strength training with effort trumping nearly all else in the pursuit of massive progress. For your beginner and intermediate programming needs, look no further than Bill Starrs 55. Sometimes the best thing for you is abrief but brutal stint with simplicity.

Featured Image: Dusan Petkovic/Shutterstock

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Get Freakishly Strong With the 5x5 Workout Program - BarBend

The event encourages students and their families to exercise and read this summer.

NEW HAVEN, Conn. Thursday marked the start of the 2022 Summer of Fun Fitness Challenge in New Haven, where students met at East Shore Park to exercise and had a chance to win some prizes.

The event works to promote learning and exercise over the summer months, with the message "healthy bodies healthy minds."

"Learning doesnt take a vacation," said Gemma Joseph Lumpkin, the organizer of the event and the Chief of Youth, Family, and Community with New Haven Public Schools. "We want our students and their families to come out, enjoy this beautiful weather, enjoy this beautiful East Shore Park."

Students and families of the New Haven Public School District warmed up for a walk in the park, and students that completed the walk received a free book and a chance to win an iPad.

"We came here to get some books," said student, Christian Agapantecato.

The books were for all students big and small.

"I got ocean creatures," said Aiden Scott.

"The Big Dipper" was the book 4-year-old Abigail Moody said she received.

This is an event that parents in the community are thankful for.

"From four all the way up to high school, freshmen and sophomores and juniors are here so I think its a fabulous opportunity for our kids," said Abigail's father, Aaron Moody.

The walk was a fun way to tour the city parks and meet new friends.

"Being a school employee and a parent that lives in New Haven its awesome to have events like this throughout the summer," said Scott. "To kind of break that physical sweat but be sure kids are engaging in academics and breaking that mental sweat as well."

"This is about summer of fun were coming off of COVID, masks are off in New Haven, were saying get out here enjoy the weather, each other, and all New Haven has to offer for the students," said Lumpkin.

There are plenty of opportunities to join this program this summer. The details can be found here.

Lindsey Kane is a reporter at FOX61 News. She can be reached atLkane@fox61.com.Follow her onFacebook,Twitter, andInstagram.

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Summer of Fun 2022 kicks off in New Haven; Students walk and earn free books - FOX61 Hartford

A wellness community empowering your body, mind and soul is forming in Brentwood.

BRENTWOOD, Mo. Staying in shape should be something on the top of all of our minds but for some even starting a workout can be scary. Monica in the Metro traveled to Brentwood to explore a community that is coming together and taking away the fear in and out of the gym.

The alarm goes off at 3 a.m. and there are no grunts or sighs, instead, it's up and at em' with a smile and an eagerness to get to work and change the world! At 4 a.m. the lights flip on by Force Performance owners Brock and Brittany Wilson as they come together to truly make an impact in the region. They always wanted to open a gym but not just an open model, more of a concept of small group classes and custom-designed athlete programs so an entire community could bond.

The Wilson's wanted to start a new wellness movement in Brentwood and it is happening fast! "We talked about a gym for so long and it was supposed to be a ten-year plan and then we said why are we waiting and so we built Force," says Brittany Wilson.

Why the name Force; it truly came to them as just that a powerful force of "This is it, it's gotta be Force." They looked through a thesaurus and were throwing around a lot of names and kept coming back to Force.

A powerful word and a powerful movement are underway. As a gym and as a couple, truly a force to be reckoned with.

"People can go train anywhere but where you really get them is that community, the relationships you build which Brittany's done immensely with all the people that come in member-wise; it's a family to them," says Brock Wilson. "We wanted to create a space where people could make friends and get to know each other and feel like they're welcome".

This community doesn't just come in for their physical training but bonds on weekends and after work. They take walking trips together to a local coffee shop after a workout, go "brunching" and the social outings are growing. Those walks create conversation and a sense of healing and a bevy of emotions. Education is taught as well as the members learn the importance of eating and knowing food is fuel.

"I've been the girl that only ate 800 calories a day, did tons of cardio and tried to be as thin as I could and then once I found weightlifting and not only the strength it gave me physically but how much stronger I felt inside, my confidence got so much stronger," Brittany said.

Brittany has struggled in her own life, finding herself a single mom at a young age and raising her son Lucas. She turned more to the fitness world to find a sense of belonging and solace. It is in this community that spiritual growth was shared and an awakening of the kind of coach she always wanted to be to truly make an impact. A confidence her husband has watched and helped mentor. Brock self admits he is her biggest fan and greatest supporter.

"I regularly find myself watching from the side, just watching her work ethic pretty much every day and what she brings to the table makes me so proud", Brock adds.

Your best can only be done when your mental health is also a focus. Force Performance opened their doors not only to the fitness world but knowing they wanted to hold monthly sessions outside of the sweat left on the floor from an exhausting workout. They wanted the community to feel a sense of trust and belonging to truly open up about their lives and what may be holding them back.

The girls and especially guys afternoons and nights have been incredibly successful. Brock has shared his mental health struggles and a dangerous road he was following after losing his greatest mentor, his father; the late St Louis Blue Rick Wilson. It was a devastating hurt that led him to substance abuse and even thoughts of suicide. He shares this in his talks and has spoken about it numerous times in his social media posts.

"Especially with men, the mental health aspect is key, even just getting together as guys in a different atmosphere and feeling a sense of belonging", outside of just hanging for drinks or hunting. It is a powerful force that continues to grow. Brock says "it's just one of those things guys are telling him they really look forward to now".

You know the line from the movie Field of Dreams "If you build it, they will come', well this dream became a reality. A gym that aesthetically will wow you and look like nothing you have ever seen in St. Louis for all walks of life. A healthy place of education, camaraderie and where the accomplishments can physically be seen in the sweat left on the floor.

"A lot of the unique tools that we have are awesome like the run rockets and a 3D camera system that measures velocity based training", says Brock Wilson. "Brittany's been able to utilize this in her group training classes which is the first one in the country to do so".

He thinks of his dad often and when asked what he would be thinking as he looked down on his son from heaven, the tears began to well up in his eyes as he confidently said "he would be proud, he'd be very proud". He turned to look at his stepson Lucas and said Grandpa Rick would be proud wouldn't he?

They have created a community that the whole family can come together. The members love seeing their son with them and they even bring their fur baby, Echo, to work to visit from time to time and he's a big member favorite too.

They are inspiring athletes from beginners to advanced and their son Lucas has a message for YOU, "One day come in to Force and have a good workout".

Force Performance has only been open for 6 months and has already garnered 150 members and growing. To learn more about their programs and the monthly series exploring your mental health for both men and women you can check them out on Instagram, Facebook and online at https://stlforceperformance.com/

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The 'FORCE' is strong with these two! - KSDK.com

Patrick Balfour has taken part in an eight-week exercise programme run by The Royal Wolverhampton NHS Trust (RWT) at The Bilston Peoples Centre.

The programme has been designed to help those suffering from Chronic Obstructive Pulmonary Disease (COPD).

Patrick, from Bilston, has regular check-ups with the nurse including breathing tests and he was told in January he may benefit from joining the group.

The 75-year-old said: "It has been a mixture of one to one and group sessions. Some of the exercises included walking on the spot, stepping from side to side, weights and leg lifts.

"They help you to manage your breathing and I have noticed a big difference as I used to need to use an inhaler, even when walking up the stairs, but now I dont and I am not as breathless.

"It has really made a change and, not only is it having a benefit on my physical health, but mentally too as I really enjoy the sessions and the staff have been amazing I would recommend it to anyone."

COPD is the name for a group of lung conditions that cause breathing difficulties which tend to get gradually worse over time and can limit normal activities.

James Fryer, exercise physiologist from the pulmonary rehabilitation (PR) team at RWT, who has been monitoring Patricks progress over the last eight weeks, said: "Patrick has been an absolute pleasure to work with.

"He has turned up to every exercise session and has put in so much effort and has rightly reaped the rewards.

"He deserves every success he has achieved due to his hard work and consistency.

"I hope from the exercise and education he has received, he now feels more confident and able to manage his condition.

"We always carry out a pre-rehab and a post-rehab assessment and Patrick improved by 75 metres on his exercise test, which shows physical improvement from pulmonary rehabilitation we are very proud."

Anyone struggling to complete daily tasks due to shortness of breath can speak to a GP and ask to be referred to the service.

More about the different conditions and resources to help can be found at blf.org.uk.

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Breathing improvements for retired ambulance driver thanks to eight-week exercise programme - Express & Star

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