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Munzir Obaid,1 Ayman El-Menyar,2,3 Mohammad Asim,2 Hassan Al-Thani1

1Department of Surgery, Hamad General Hospital (HGH), Doha, Qatar; 2Department of Surgery, Clinical Research, Trauma and Vascular Surgery Section, HGH, Doha, Qatar; 3Department of Clinical Medicine, Weill Cornell Medical School, Doha, Qatar

Correspondence: Ayman El-MenyarWeill Cornell Medical College, Consultant Clinical Research, Trauma Surgery, Hamad General Hospital, Doha, QatarTel +974 44394029Fax +974 44394031Email aymanco65@yahoo.com

Background: We aimed to study theprevalence and outcomes of thrombophilia in acute pulmonary embolism.Methods: A retrospective observational study was conducted to include patients with a radiologically confirmed diagnosis of PE screened for thrombophilia from May 2011 to February 2015. Data included patients demographics; clinical presentation, risk factors, laboratory investigations, management, and outcome were analyzed and compared in patients with and without thrombophilia.Results: A total of 227 cases of PE were included in the study, of which 108 (47.6%) had thrombophilia. The most frequent coagulopathic abnormality included deficiency of protein S, protein C, andantithrombin III and hyperhomocysteinemia. Only seven out of 79 patients werefound to have factor V Leiden. PE patients diagnosed with thrombophilia were 10 years younger in age and peaked in the age range 30 39 years. Prior history of DVT (p=0.001) and PE (p=0.001) were the main significant risk factors in thethrombophilia group. The frequency of different risk categories of clinical probability scores did not differ significantly among those with and without thrombophilia. Pulmonary hypertension was a common complication in thethrombophilia group (P=0.009). Medications used included warfarin (74.7%), enoxaparin (73.9%), and heparin (55.4%). The overall mortality rate was 8.4%, and was non-significantly higher in the non-thrombophilia group.Conclusion: Deficiencies of protein S, protein C, and antithrombin III are the leading causes of thrombophilic defects. Patients with hereditary thrombophilia are at increased risk of acute PE, particularly among young individuals. Therefore, early detection of thrombophilic defects together with other unprovoked risk factors could reduce the risk of recurrent VTE.

Keywords: pulmonary embolism, thrombophilia, risk factors, thromboembolism, outcome

This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License.By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.

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Prevalence and Outcomes of Thrombophilia in Patients with Acute Pulmon | VHRM - Dove Medical Press

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If youre looking to lose weight and keep it off, a new study may help you to reach your goal. Researchers have now found that consistently losing weight in the early days of a new diet plan even small amounts may increase the chances of achieving long-term weight loss.

It is estimated that more than 2 in 3 adults in the United States are overweight or obese. Excess weight can increase the risk of numerous health problems, including type 2 diabetes, heart disease, stroke, and even some types of cancer.

Adopting a healthful, balanced diet is considered one of the best strategies for weight loss, but as many dieters will know it is not as easy as it sounds.

Every year, around 45 million people in the U.S. go on a diet, primarily with the aim of losing weight. However, research has indicated that up to 40 percent of people who lose weight regain more than half of it over the subsequent 2 years.

So, why are some people able to maintain their weight loss while others struggle? Lead study author Emily Feig, Ph.D., of the College of Arts and Sciences at Drexel University in Philadelphia, PA, and colleagues sought to find out.

The teams findings were recently published in the journal Obesity.

The researchers enrolled 183 participants to their study, all of whom were either overweight or obese. For 1 year, each subject participated in a weight loss program. This comprised meal replacements and behavioral goals, such as increasing physical activity and calorie tracking.

Study participants were asked to keep a record of any food-related behaviors they experienced, such as cravings, binge eating, and emotional eating.

Additionally, subjects attended weekly weigh-in sessions. Two years after the weight loss program began, participants were weighed for a final time.

The team found that participants who experienced consistent weight loss in the first 6 and 12 weeks of the program were more likely to have maintained their weight loss at 12 and 24 months, compared with those whose weight fluctuated.

As an example, the team explains that a person who lost 4 pounds one week, regained 2 pounds the next week, and lost 1 pound the following week were less likely to achieve long-term weight loss than those who consistently lost 1 pound over the same 3-week period.

The researchers were interested to discover that participants who reported lower preoccupation with food, lower binge eating, and lower emotional eating at study baseline experienced greater weight fluctuation and lower total weight loss.

The team says that these findings indicate that it may not be a persons relationship with food or food-related behaviors that influence long-term weight loss. Rather, it may be down to the consistency of weight loss.

The researchers caution that their study cannot prove cause and effect between weight loss consistency and better long-term weight loss.

However, principal investigator Michael Lowe, Ph.D. who is a professor of psychology at Drexel University believes that they may have identified an effective strategy for shedding the pounds and keeping them off.

Settle on a weight loss plan that you can maintain week in and week out, even if that means consistently losing of a pound each week.

Michael Lowe, Ph.D.

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What is the secret to long-term weight loss? Study sheds light

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THERE is indeed a secret connection between exercise and weight loss. The secret is exercise does not and will not functionally or sustainably help with weight loss.

Over the years I have given rational and calculations explaining the how and why, but this time I will put forward the latest study.

Walking 10,000 steps a day will not help with weight loss

Fit bands, Android and Apple watches everywhere have been ticking off their motion sensors, feeding their pedometer apps with millions of steps all around the world.

Individuals walking and marching on the spot in the belief that each step will bring them closer to that fitness industry stated magical number, convinced that they will be healthier and certainly slimmer for their numerically set target.

A recent study conducted at Brigham Young University found that an increased step count between 10,000 and 15,000 per day, six days per week over the course of 24 weeks, did not prevent the usual average gain of 3.4 pounds by students for that period.

For weight management, the steps were categorically useless.

Why people believe exercise will make them lose weight

In the 1970s, as more people began to gain weight and suffer from dietary-related illnesses, research was placing the cause squarely at the feet of the refined food industry.

In response, that industry helped to promote the idea that it is not what you are eating, but your own laziness that will kill you.

The solution, embrace the bro logic that movement requires energy, therefore more movement means more metabolism, resulting in less fat. Human efficiency and adaptability is not taken into consideration here, ignoring our ability to do more with less energy over time.

They told us to go to the gym and work off those pounds. In our imagination this fiction seems so logical, that even in the face of actual research, people, wrongly, cannot conceive anything else to be true.

This false idea persists in the hearts and minds of nations today and is still foolishly promoted by: Corporate wellness programmes; trainers; merchants; manufacturers; and television shows.

All influencing populations, diminishing the responsibility and focus from nutrition while protecting the processed foods industry and making millions for many in the fitness industry.

How is exercise useful?

Is exercise useless? No, exercise is most definitely useful, and is one of the best things you can do for your well-being.

Exercise can:

Increase healthy muscle mass for long-term, increased metabolism and body weight management.

Lengthen your life span.

Create a mindset and culture to allow you to embrace a healthy diet and lifestyle.

Manage moods and provide emotional benefits.

Strengthen joints.

Reduce pains.

Increase and maintain fitness, mobility, balance, and functionality.

Build heart, pulmonary and vascular health.

Exercise will do all that and much more, but because humans are extremely efficient and adaptive animals, it will not directly make you lose weight. You will never train away a poor diet.

Face the reality, embrace the discipline and get serious once and for all about your nutrition and change your life.

If you truly want to lower your body fat, change your body and health, get the fiction out of your head once and for all, and embrace the real knowledge of a fact-based wellness programme.

Fitz-George Rattray is the director of Intekai Academy, which is focused on helping people live a healthy lifestyle through nutrition and weight management. If you are interested in losing weight or living a healthier lifestyle, give them a call at 876-863- 5923, or visit their website at intekaiacademy.org.

Now you can read the Jamaica Observer ePaper anytime, anywhere. The Jamaica Observer ePaper is available to you at home or at work, and is the same edition as the printed copy available at http://bit.ly/epaperlive

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Could skipping breakfast impact weight loss? (Getty)

Skipping breakfast and snacking late at night could lead to a delay in the bodys ability to lose weight, new research has suggested.

If were trying to shed the pounds, we know we need to watch what we eat, how much we eat and how much we move, but according to a new study our ability to burn dietary calories could also be impacted by the time of day most of our food is consumed.

The study, published in the journalPLOS Biology,monitored the metabolism of middle-aged and older subjects in a whole-room respiratory chamber over two separate 56-hour sessions.

In each session, lunch and dinner were presented at the same times (12.30pm and 17.45pm, respectively), but the timing of the third meal differed between the two halves of the study.

Read more: The best diets for long-term health

In one of the 56-hour sessions, the additional daily meal was presented as breakfast (at 8:00) whereas in the other session, a nutritionally equivalent meal was given to the same subjects as a late-evening snack (22.00pm).

The duration of the overnight fast was the same for both sessions.

While the two sessions did not differ in the amount or type of food eaten, or in participants activity levels, the daily timing of the third meal had an impact on the amount of fat burned.

Researchers found that the late-evening snack session resulted in less fat burned when compared to the breakfast session.

Study authors said the circadian rhythm, or the body clock, is programmed to assist the body to burn fat when asleep.

As a consequence, skipping breakfast and then snacking at night could lead to a delay in the burning of the fat.

Based on their experimental observations, the researchers said the timing of meals during the day/night cycle could impact the extent to which ingested food is used versus stored.

The study team said their research could have wider implications for advising people on their eating habits, suggesting that a daily fast between the evening meal and breakfast could help optimise weight management.

Story continues

Read more:The risks and benefits of veganism

This isnt the first time the health benefits of the overnight fast have been discussed.

Last year research suggested skippingbreakfast and eating a late dinner could lead to more serious outcomes after a heart attack.

Scientists found people who frequently bypassed brekkie and regularly ate dinner less than two hours before going to bed were far less likely to survive if they suffered a heart attack.

But there has also been some contradictory research in terms of whether eating breakfast can aid weight loss.

While eating breakfast has previously been thought to help aid weight loss, a further body of research suggests you may be better off without it.

Past studies have found aprotein-based morning meal or a bowl full ofoatsfirst thing could be the key to maintaining a steady weight and controlling your appetite later in the day.

Read more: Rosie Huntington-Whiteley reveals she doesn't eat after 6pm

But last year scientists from the Monash University in Melbourne found those who eat breakfast were found to have a higher energy consumption during the day (an average of 260 more calories) compared to those who skipped the morning meal.

Breakfast eaters also weighed, on average, almost half a kilogram more (0.44kg) compared to non-breakfast eaters.

Whats more, the scientists concluded skipping breakfast does not reduce appetite during the day, as previously thought.

The scientists werent the first to challenge the supposed link between eating breakfast and weight loss.

Followers of the popularintermittent fastingdiet will often skip breakfast in order to limit their eating window to later in the day.

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Skipping breakfast and eating late could stop you losing weight - Yahoo News

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Dina Farhana | Published: March 07, 2020 14:30:00 | Updated: March 07, 2020 14:32:41

In the world of weight-loss diets, low-carbohydrate, high-protein eating plans often grab attention. The Paleo, South Beach, and Atkins diets all fit into that category. They are sometimes referred to as ketogenic or "keto" diets.

But a true ketogenic diet is different. Unlike other low-carb diets, which focus on protein, a keto plan centres on fat, which supplies as much as 70-90% of daily calories. And it's not the type of diet to try as an experiment. The keto diet is primarily used to help reduce the frequency of epileptic seizures in children. While it also has been tried for weight loss, only short-term results have been studied, and the results have been mixed. The long term impact is not well studied as most of people are not able to continue it over the years.

How does it work?

The keto diet aims to force the body into using a different type of fuel. Instead of relying on sugar (glucose) that comes from carbohydrates (such as grains, legumes, vegetables, and fruits), the keto diet relies on ketone bodies, a type of fuel that the liver produces from stored fat.

Burning fat seems like an ideal way to lose pounds. But getting the liver to make ketone bodies is tricky:

l It requires that we deprive ourselves from carbohydrates, fewer than 20 to 50 grams of carbs per day (keep in mind that a medium-sized banana has about 27 grams of carbs).

l It typically takes a few days to reach a state of ketosis.

l Eating too much protein can interfere with ketosis.

What does someone eat?

Because the keto diet has such a high fat requirement, followers must eat fat at each meal. In a daily 2,000-calorie diet, that might look like 165 grams of fat, 40 grams of carbs, and 75 grams of protein. However, the exact ratio depends on the particular needs.

Some healthy unsaturated fats are allowed on the keto diet - like nuts (almonds, walnuts), seeds, avocados, tofu, and olive oil. But saturated fats from oils (palm, coconut), lard, butter, and cocoa butter are encouraged in high amounts.

Protein is part of the keto diet, but it doesn't typically discriminate between lean protein foods and protein sources high in saturated fat such as beef, pork, and bacon.

What about fruits and vegetables? All fruits are rich in carbs, but you can have certain fruits (usually berries) in small portions. Vegetables (also rich in carbs) are restricted to leafy greens (such as kale, Swiss chard, spinach), cauliflower, broccoli, Brussels sprouts, asparagus, bell peppers, onions, garlic, mushrooms, cucumber, celery, and summer squashes. A cup of chopped broccoli has about six carbs.

Keto risks

A ketogenic diet has numerous risks. Top of the list: it's high in saturated fat. Dietary guideline recommends to keep saturated fats to no more than 10% of our daily calories because of the link to heart disease. And indeed, the keto diet is associated with an increase in "bad" LDL cholesterol, which is also linked to heart disease.

Other potential keto risks include these:

Nutrient deficiency. "If someone not eating a wide variety of vegetables, fruits, and grains, we may be at risk for deficiencies in micronutrients, including selenium, magnesium, phosphorus, and vitamins B and C.

Liver problems. With so much fat to metabolize, the diet could make any existing liver conditions worse.

Kidney problems. The kidneys help metabolize protein, and the keto diet may overload them. (The current recommended intake for protein averages 0.8 to 1.2 per kg body weight per day.

Constipation. The keto diet is low in fibrous foods.

Fuzzy thinking and mood swings. The brain needs sugar from healthy carbohydrates to function. Low-carb diets may cause confusion and irritability.

Those risks add up - so make sure that you talk to a registered dietitian before ever attempting a ketogenic diet.

What about the other diets?

The popular low-carb diets (such as Atkins or Paleo) modify a true keto diet. But they come with the same risks if you overdo it on fats and proteins and lay off the carbs. Theories about short-term low-carb diet success include lower appetite because fat burns slower than carbs. "But again, the impacts on long term still unknown. And eating a restrictive diet, no matter what the plan, is difficult to sustain. Once, someone resume to a normal diet, the weight will likely return.

The writer is a nutritionist and working for an NGO.

dinafarhana927@yahoo.com

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Should we try the keto diet? - The Financial Express BD

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March is National Kidney Month. This month Healthy Kingsport would like to raise awareness about the prevention and early detection of kidney disease. High blood pressure, diabetes, cardiovascular disease, and obesity are risk factors for chronic kidney disease. Eating healthy, exercising regularly, and maintaining a healthy weight help prevent chronic kidney disease.

What is kidney disease?

Damaged kidneys are kidneys that cannot filter blood the way they should. Some people have no symptoms at all and are diagnosed by a lab test. Chronic kidney disease is the most common form of kidney disease slow and progressive loss of kidney function over several years. More than 10,000 people in Tennessee have end-stage renal disease, and the number affected grows by 10% annually. Chronic kidney disease, also known as chronic renal failure, chronic renal disease, or chronic kidney failure, is much more widespread than people realize; it often goes undetected and undiagnosed until the disease is well advanced.

According to the National Kidney Foundations, southern states make up the top 10 list of those hardest hit by kidney failure. Alabama, Mississippi, and Tennessee are among the highest in the US. Centers for Disease Control (CDC), more than 8% of the population in each of these states also have diagnosed diabetes, the leading cause of kidney disease.

These states have high rates of obesity and physical inactivity. Multiple chronic diseases are highly prevalent in this geographic area, also known as the stroke belt. Yet healthy diet combined with physical activity to maintain a healthy body weight could change the levels of kidney failure, said Joseph Vassalotti, MD, National Kidney Foundation Chief Medical Officer.

Symptoms

Common symptoms include blood in urine, high blood pressure and fatigue.

There is no cure for chronic kidney disease, which means treatment focused on reducing symptoms. Diagnosis commonly occurs after blood tests, kidney scans, or biopsy. Reduce the risk of complications and slow the progression of the disease. In most cases, kidney damage is the result of chronic diseases, such as diabetes types 1 and 2, and hypertension (high blood pressure).

If chronic kidney disease progresses to kidney failure, the following complications are possible. Anemia, central nervous system damage, fluid retention, hyperkalemia, and possibly resulting in heart damage, these are just a few complications.

Protect Yourself

Controlling the condition can significantly reduce the chances of developing kidney failure.

Physical activity is excellent! Sit less and stand more. Recent research has linked sitting for 8 hours or more a day with developing kidney disease. Exercise and lose weight. Diabetes is responsible for 44% of all new cases of kidney failure. Obesity and type 2 diabetes are on the rise and can often be treated and reversed with physical activity and weight loss. Try to avoid long term use of kidney-toxic drugs such as over the counter (OTC) pain medications, NSAIDS, such as ibuprofen. Get tested! Ask your healthcare provider for an annual urine test to check for protein in the urine, one of the earliest signs of kidney disease, and a blood test for creatinine to calculate your estimated glomerular filtration rate (eGFR). GFR tells how well your kidneys are working to remove wastes from your blood. Individuals should follow their doctors instructions, advice, and recommendations.

Other healthy choices are eating a healthy diet. Fruits and vegetables, whole grains, and lean meats or fish will help keep blood pressure down. Regular physical exercise is ideal for maintaining healthy blood pressure levels; it also helps control chronic conditions such as diabetes and heart disease.

Many other higher risk factors develop kidney disease, such as;

A family history of kidney disease

Age, common among people over 60,

Overexposure to some toxins and some medications.

Early detection can significantly help prevent severe kidney damage. People who are at high risk of developing kidney disease must have their kidney functions regularly checked. Be you are on advocate, take care of your kidneys so they can take care of you.

Healthy Kingsports mission is to create a sustainable community culture of healthy living by promoting awareness, influencing policy, and enhancing infrastructure. The organizations vision is a community where healthy living is the norm.

For more information, visit the following websites.

http://www.healthykingsport.organdhttps://www.kidney.org

Aiesha Banks is the Executive Director of Healthy Kingsport. She can be reached at [emailprotected]

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What can you do to keep your kidneys healthy? - Kingsport Times News

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Ideally, your overall portfolio should beat the market average. But in any portfolio, there will be mixed results between individual stocks. At this point some shareholders may be questioning their investment in Want Want China Holdings Limited (HKG:151), since the last five years saw the share price fall 23%. Furthermore, it's down 13% in about a quarter. That's not much fun for holders.

View our latest analysis for Want Want China Holdings

While markets are a powerful pricing mechanism, share prices reflect investor sentiment, not just underlying business performance. One way to examine how market sentiment has changed over time is to look at the interaction between a company's share price and its earnings per share (EPS).

Looking back five years, both Want Want China Holdings's share price and EPS declined; the latter at a rate of 0.4% per year. This reduction in EPS is less than the 5.2% annual reduction in the share price. This implies that the market was previously too optimistic about the stock.

The image below shows how EPS has tracked over time (if you click on the image you can see greater detail).

SEHK:151 Past and Future Earnings, March 9th 2020

It's probably worth noting we've seen significant insider buying in the last quarter, which we consider a positive. That said, we think earnings and revenue growth trends are even more important factors to consider. Before buying or selling a stock, we always recommend a close examination of historic growth trends, available here..

When looking at investment returns, it is important to consider the difference between total shareholder return (TSR) and share price return. Whereas the share price return only reflects the change in the share price, the TSR includes the value of dividends (assuming they were reinvested) and the benefit of any discounted capital raising or spin-off. So for companies that pay a generous dividend, the TSR is often a lot higher than the share price return. As it happens, Want Want China Holdings's TSR for the last 5 years was -11%, which exceeds the share price return mentioned earlier. The dividends paid by the company have thusly boosted the total shareholder return.

It's good to see that Want Want China Holdings has rewarded shareholders with a total shareholder return of 5.4% in the last twelve months. That's including the dividend. That certainly beats the loss of about 2.2% per year over the last half decade. We generally put more weight on the long term performance over the short term, but the recent improvement could hint at a (positive) inflection point within the business. While it is well worth considering the different impacts that market conditions can have on the share price, there are other factors that are even more important. Consider for instance, the ever-present spectre of investment risk. We've identified 2 warning signs with Want Want China Holdings , and understanding them should be part of your investment process.

If you like to buy stocks alongside management, then you might just love this free list of companies. (Hint: insiders have been buying them).

Please note, the market returns quoted in this article reflect the market weighted average returns of stocks that currently trade on HK exchanges.

If you spot an error that warrants correction, please contact the editor at editorial-team@simplywallst.com. This article by Simply Wall St is general in nature. It does not constitute a recommendation to buy or sell any stock, and does not take account of your objectives, or your financial situation. Simply Wall St has no position in the stocks mentioned.

We aim to bring you long-term focused research analysis driven by fundamental data. Note that our analysis may not factor in the latest price-sensitive company announcements or qualitative material. Thank you for reading.

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Introducing Want Want China Holdings (HKG:151), The Stock That Dropped 23% In The Last Five Years - Yahoo Finance

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At the37thAnnualMiami Breast Cancer Conference Dr. Jean-Bernard Durand discussed data that showed how prescribed and personalized exercise programs can improve outcomes for patients with cancer who already face a high risk of cardiovascular disease.

The mortality for breast cancer continues to go down, but what women are going to be faced with if they do not have a recurrence (is that) their number one cause of death is cardiovascular disease, said Durand. We have to do a much better job of managing their modifiable risk factors and comorbid conditions.

In a presentation at the37thAnnualMiami Breast Cancer Conference Durand described how physical activity and avoidance of weight gain are two important factors in reducing recurrence and mortality in patients with breast cancer. At the time of diagnosis, patients with early breast cancer may already be at a heightened risk of developing cardiovascular disease and further treatment for breast cancer will have side effects on a patients cardiovascular health.

Durand, medical director of Cardiomyopathy Services, and director of cardiovascular genetics research and the Cardiology Fellowship Program at The University of Texas MD Anderson Cancer Center, explained how by looking at a patients cardiorespiratory fitness physicians could craft a personalized fitness program for patients to curb side effects from their diseae and treatment.

Cardiorespiratory fitness is an index of functional capacity of the heart and lungs and reflects the efficiency of oxygen uptake, transport and utilization in the muscles. It is an excellent surrogate of exercise dose and a reproducible measurement, said Durand.

In a study of 248 patients with breast cancer, the prognostic significance of cardiopulmonary function was assessed and measured by peak oxygen consumption. Patients with breast cancer represented 4 cross-sectional cohorts: before, during, after adjuvant therapy for nonmetastatic disease and during therapy in metastatic disease.

Despite normal cardiac function, women with breast cancer demonstrated marked impairments in cardiopulmonary function. Peak oxygen consumption was, on average, 27% less than that of age-matched sedentary in otherwise healthy women without a history of breast cancer. The impairment in peak oxygen consumption during primary adjuvant chemotherapy was 31% less than that of healthy sedentary women and 33% in those patients with metastatic disease.

Improved cardiopulmonary function is also possible with the introduction of exercise training for patients with breast cancer. An analysis of 6 studies involving 571 adult patients with cancer examined the effects of supervised exercise training versus non-exercise on the measurement of peak oxygen consumption.

Intervention lengths were in the range of 8-24 weeks. In all studies, exercise was prescribed 3 times per week and session duration ranged 14 to 45 minutes. Exercise training was associated with a statistically significant increase in peak oxygen consumption, translating to an improvement from baseline to postintervention of 15% favoring exercise.

Durand noted that the MD Anderson Healthy Heart Program takes a multidisciplinary approach to improve patient outcomes. The team includes physicians, exercise physiologists, health educators, dietitians and nurses. The patient undergoes a preliminary evaluation that includes a screening exam and a treadmill test to determine their maximal oxygen consumption.

This will allow us to assess cardiopulmonary safety and determine the exercise dose, as well as compare their fitness level relative to their age and sex, he explained. Standard of care assessment is also conducted and includes assessing the impact of prior cancer treatment on heart health, cholesterol levels, risk of hypertension or high blood pressure, risk of diabetes, body weight and waist measurements, family history on heart health and, if needed, smoking cessation.

One difficulty is trying to explain the metabolic equivalent task [METs] to patients, Durand noted. The Harvard School of Public Health does a great job of breaking this down into light, moderate, and vigorous activity. We like to shoot for the [moderate] area of 3 to 6 METs, he noted.

METs indicates metabolic equivalents and is typically defined as the ratio a person expends energy relative to their mass.

In a separate study highlighted in Durands presentation, patients whose exercise program consisted of nine or more MET hours per week was associated with a 23% reduction in the risk of cardiovascular events regardless of age, cardiovascular disease risk factors at diagnosis, menopausal status and type of anticancer therapy.

Patient biases also play into difficulties for prescribing patients to exercise programs. We have biases and the patient has biases. The patient bias is that you are expecting them to get to a gym, get a personal trainer and do exercise every single day and that could not be farther from the truth, Durand said. I like to recommend the buddy program, finding a neighbor or friend who will walk with you at a brisk pace, and set up a schedule that you will do this as a team.

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Frustrated by his difficulty in being understood, Lakeland resident Doug Fulton began isolating himself as he dealt with Parkinsons disease. Carole Shamblin of Dover had the same problem. Their solution came through the Speak Out! speech therapy program developed by the non-profit Parkinson Voice Project.

Frustrated by his difficulty in being understood, Lakeland resident Doug Fulton began isolating himself as he dealt with Parkinsons disease.

Carole Shamblin of Dover had the same problem.

"I didnt realize how low my voice was," Shamblin said. "People would constantly say What did you say? "

Her daughter noticed changes in her walking and movement, which led to the Parkinsons diagnosis, but the vocal change was more subtle.

She and Fulton tried speaking louder, but came to realize that wasnt enough on its own.

Their solution came through the Speak Out! speech therapy program developed by the non-profit Parkinson Voice Project, http://www.parkinsonvoiceproject.org.

At its heart is training people with Parkinsons to convert speaking to being an intentional act instead of an automatic function. It combines education, individual therapy and group sessions.

"The hardest part is making it a habit to speak with intent," said Jennifer Ackett, speech-language pathologist with South Florida Baptist Hospital in Plant City.

A grant let SFBH add that speech therapy program last fall.

Shamblin was finishing Speak Out! there in February and looking forward to its follow-up group component, Loud Crowd.

"This helps everything, especially your breathing," said Shamblin, 76. "I tend not to use my mouth but, with this, I use my mouth more."

Speaking with intent involves more facial expressions and motor movements, Ackett said, which helps fight the mask-like expression thats a typical characteristic as Parkinsons advances.

Nine in 10 people with Parkinsons are at risk of developing a weak voice, according to Parkinson Voice Project. That can lead to speech and swallowing problems.

Mike Schwartz, who with his wife, Kathy, comes to a support group in Lakeland, said hes "always asking her to repeat herself."

South Florida Baptist and a few speech language pathologists in Polk County began offering Speak Out! within the past few months as an alternative to other speech therapy they provide.

Fulton, 70, completed Speak Out! with Julie Barrientes, a speech-language pathologist, at her Grow the Vine Speech and Wellness Gym in Lakeland. He gets follow-up therapy there.

"It makes me more relaxed," he said. "I will join into a conversation. I used to isolate myself."

He said he had been very articulate, but that he has a hard time making sentences.

"It was frustrating," he said. "I thought I was losing my mind."

Speak Out! is a way of living, said Barrientes, who also treats patients part time at Watson Clinic.

"Its not just speech exercises, not just voice," she said. "Its also cognitive actions."

Speech-language pathologists Allyson Waters and Emily Thomas, at Astoria Health and Rehab/Villages at Vienna in Winter Haven, had one patient on Speak Out! who drove from Avon Park.

"Its a great program," Waters said, adding that scheduling for Speak Out! is more flexible than another program she uses.

Each person who completes the program gets a workbook and therapy kit to continue practice at home.

All three speech therapists interviewed like the cognitive aspects of the training, which works participants memory and thinking abilities as well as their speech.

All want to increase awareness to be able to have enough Speak Out! graduates for the Loud Crowd component, which is free voice maintenance in a group setting.

"You can do things like ask each other questions or play games," Ackett said."

"We may do singing," Shamblin said.

It offers socialization, reducing the isolation people with Parkinsons may have, along with reinforcement for speaking with intent.

Without a Loud Crowd established, therapists and patients look for creative ways to provide continuing interaction.

Those include continuing to see their patients for follow up, recommending support groups and physical activity like Rock Steady Boxing or other tailored exercise programs. Rock Steady Boxing is in Lakeland at Florida Presbyterian Homes.

Barrientes, also a Parkinsons Wellness Recovery instructor, has Fulton exercise with patients who have other disorders in Functional Fitness, whose foundation is Parkinsons recovery.

They call out the number of exercises theyve done and she quizzed Fulton during a recent session.

"This includes cognitive so the cognitive aspect is in both programs (he gets)," Barrientes said.

Robin Williams Adams is at robinwadams99@yahoo.com .

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The perfect program doesn't exist, but we can always work toward putting together the most optimal program for our athlete in their given situation.

I always say that when I look at programs I wrote five years ago, they make me cringe. The amount of growth and knowledge in that time can really change our opinions on certain topics and change our programming as a result.

Over the last few years, we've developed a great programming system at PACE Fitness Academy, and there are some common denominators in our most successful programs. They aren't mandatory by any means; no exercise is. BUT, they do yield great results, safe results and most of all, high adherence levels from our athletes. Below are four exercises probably missing from your programming and why you may want to consider them!

The name "Yoga Push-Up" does probably not sit well with a true Yogi, but this is what us meatheads call them. It's essentially a Push-Up into the Downward Dog yoga position. This is a great exercise for building upper-body strength, but also enhancing mobility of the T-Spine and shoulders in a functional and dynamic way.

I've seen the Yoga Push-Up coached up in several ways, but my preference is that you push from the bottom of the Push-Up immediately into the Downward Dog position. The alternative method here is to complete a full Push-Up and then shift into the Downward Dog, but I don't feel that this execution gives athletes the full benefits of the exercise.

Below is an example of the two options.

In terms of programming, you have a great deal of flexibility here. You can use it as a strength accessory movement and even load it up by elevating the feet. You can incorporate it into a dynamic warm-up for stronger and more advanced athletes. Or you can use it as an active recovery tool or a mobility-based practice for athletes lacking in the T-Spine area.

Bottom line: This is a really great addition to a training program and can be beneficial for all athletes. Plus, it adds a little variety to the standard Push-Up and does so in an effective way that isn't just for likes on Instagram.

The Copenhagen Plank is another hidden gem in our programming that supplies a huge bang for your buck in a low intensity environment. This exercise addresses groin strength and core stability, which are two things that all athletes can benefit from.

Cutting, changing directions and moving laterally all place demands on the adductors and torso (core) regions. If athletes are weak in these areas or just generally unprepared, it can contribute to strains, sprains, tweaks or even worse injuries under the unfortunate circumstances that an athlete finds themself in a position that they can't support.

This exercise addresses strength in those areas, which can help with performance, but more importantly, it can help with day-to-day movement quality. Aches and pains in the knees or lower back can often be alleviated by addressing hip and core strength.

The Copenhagen Plank is simple, but brutal. You can program these for time, breathing reps, load it up and change the lever position to get the perfect amount of stimulation for your athlete.

We began implementing the Archer Row into our programs after getting our Reflexive Performance Reset (RPR) certifications. Long story, short: The "archer" position is a position and motion embedded into our physiology and movement since birth.

Look at any picture of a baby between 3-5 months old and you'll probably see this archer pose. This is how babies roll over from their backs to their stomach, which is a big deal for all you non-parents out there!

Our nervous system loves this position. It makes us feel strong and safe, just how we felt when we discovered that there is more to this new world than lying on our backs for 12 hours a day.

This position, in RPR, can enhance the wake-up drills you do or even reverse some of the corrosive movements that tarnish the effects of the wake-up drills. So, I turned it into an exercise.

If you don't have the RPR concepts down or don't care to, the bottom line is this: This exercise is low neural stress, high muscular stress and extremely vital for healthy shoulders.

Lastly, the Jefferson Squat,something I've written about at length for STACK in the past. We're still going strong with this unique and effective lift.

This is one of those old-school bodybuilding lifts that guys like Kai Greene would use to pump the living hell out of their lower body. It was only recently that we discovered the strength and power results it could deliver in lower rep ranges and at their respective spots on the force-velocity curve.

You can literally program this like you would any Squat or Deadlift. Load it the same. Add bands, add chains, do it for speed, do it for 1RM this can be your athlete's main lift. And, it's unilateral, so you get the benefit of increasing single-leg output and performance.

Using the Jefferson Squat has been amazing for our hockey, basketball and baseball players especially. It toes the line of "sport-specific" in the weight room, without losing its merit. Definitely give this a try and get creative with your programming.

Photo Credit:SrdjanPav/iStock

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