Search Weight Loss Topics:


Page 767«..1020..766767768769..780790..»


Sep 18

‘A lifesaver’: US seniors turn to Zoom to connect with friends and family – The Guardian

In his 72 years, Brad Veloz has risked his job and overcome health issues to fight for LGBTQ+ and Latino rights. The coronavirus wasnt going to stop his activism.

A year ago, the self-described in-your-face activist had never even used Zoom online video conferencing, but it is now a constant presence in his life in lockdown to connect with fellow activists instead of taking to the streets.

Velozs newfound digital lifestyle reflects the demand on seniors to move their lives online because of the threat of Covid-19. The adults with the least exposure to the internet, people 65 and older, are also at higher risk to the illness from Covid-19, which has still not been controlled in the US.

Velozs virtual routine also includes online bill pay, grocery orders and restaurant deliveries. He is especially excited about being able to use shared Google documents to collaborate on group letters to city officials and other activist matters.

It really took the pandemic, being homebound, to really wake us up to the real world, Veloz told the Guardian in a video call from his home in San Antonio, Texas.

In a lucky coincidence, Veloz took a tech literacy course at the beginning of the year, leaving him more prepared for the pandemic. But roughly a third of internet users over 65 described themselves as only a little, or not at all confident in their ability to use computers, smartphones or other devices to do necessary online activities in a 2015 Pew Research Center survey. Of the group surveyed, just 26% said they were very confident using electronic devices to get online.

But once seniors get online, most make the internet a standard part of their daily routine, according to Pew.

The ability to go online has been a lifesaver, emotionally and socially, said Ronda Russick, 75. Russick is the president of the Academy of Senior Professionals at Eckerd College (Aspec), a group of more than 300 people aged 55 to 95 who attend courses and discussion groups at the St Petersburg, Florida, college.

Aspec successfully moved online after the campus shut in March. Last week, sessions included discussions about medical phone apps, the themes of the Mexican artist Diego Riveras work done in the US and Say Nothing, a non-fiction book on the historical conflict in Northern Ireland.

At the end of the day, I feel like Ive been on campus because were doing so much Zooming and youre able to see people, Russick said.

Before the pandemic, some members would go to campus early to sip coffee and chat on a patio where fans circulated the Gulf coast breeze. Now, that group lives on in a 24/7 video chat channel called the Fan Club.

The weekly social hour has also moved online and separate social groups have sprung up, including a group of 17 women who gather in their own Zoom room to drink wine and talk about their lives.

Aspec had avoided doing online classes before the pandemic, except in special circumstances, but members now see new opportunities. In post-pandemic life, they hope to continue including speakers and members from outside Florida in discussions.

Ashok Kalro, 76, was instrumental in organizing courses to teach Aspec members how to get online and said while getting the group connected didnt happen overnight, it was easier than expected. One of the things we learned is people are scared of technology, but when it comes to something they are very interested in, they pick it up fairly quickly, he said.

Tom Kamber, executive director of Older Adults Technology Services (Oats), said that anecdotal finding was consistent with what researchers know about what motivates seniors to learn new things. While you can tell a child to learn about dinosaurs, and they will learn about dinosaurs, older adults are motivated to learn new things that will help them meet their goals.

That has been a motivation at Oats, an organization which for 15 years has offered in-person tech classes for groups of about 12 to 14 seniors through its Senior Planet program. In the year leading up to the pandemic, the organization had been moving towards making these classes available online.

Now, Senior Planets plentiful free virtual courses include contacting lawmakers online, how to spot fake news and virtual grandparenting.

Kamber said participation had skyrocketed in the pandemic from 30,000 people taking in-person classes to 60,000 people in the virtual programs. This is in part because of the not-for-profits partnerships with groups such as the 38 million-member interest group for people older than 50, AARP.

We went from 12 to 14 people in a classroom where you could literally see if the person had tape on their eyeglasses in the back row to doing a class together with AARP with 14,000 people on a Zoom call, Kamber said.

At Senior Planet, too, social spaces are developing around virtual classes, such as the morning exercise program. People login early, and stay late, to chat with their friends.

Kamber, 53, is pleased to see the flood of support for their programming, but said it was a symptom of ageism that such classes hadnt been backed more strongly before. We are really horrified it took this kind of a tragedy for people to get aware of the priority of getting older people online and to commit the kind of resources they needed to, Kamber said.

Despite seniors increased interest in getting online, the US digital divide has left millions without the services needed. The Federal Communications Commission (FCC) says 21 million Americans lack high-speed internet access but other studies have estimated the number at close to 42 million.

Already underserved populations are the least likely to have internet access, while seniors with a college degree and a household income of $75,000 or more are the most, according to Pew. Seniors who report that they have a disability are also less likely than those who do not to use the internet, smartphones or tablet computers.

Brad Veloz in San Antonio said he didnt know how he and his husband would be getting by without the Senior Planet tech classes they took at the beginning of the year.

The couple decided to enroll in the classes in January when they offered by San Antonios Pride Center. The pair were weeks away from graduation when the pandemic hit and classes were shut down. Luckily, this was after they had their first introduction to Zoom.

Veloz said: I would urge seniors to really look at technology and to learn how to navigate with technology because it can help us, it can connect us to our family, to our friends, conduct business and just connect us to the world.

Continue reading here:
'A lifesaver': US seniors turn to Zoom to connect with friends and family - The Guardian

Read More..

Sep 18

Reducing serious fall-related injuries: an interview with NEJM STRIDE Study author Tom Gill – GeriPal – A Geriatrics and Palliative Care Blog

Every year, about a third of older adults fall. About one in five of those falls result in moderate to severe injury. What can we do to help not only prevent those falls but also the complications of them?

What did it show? Well, the conclusion of the NEJM abstract states that this multifactorial intervention "did not result in a significantly lower rate of a first adjudicated serious fall injury than enhanced usual care." We talk to Tom about whether that is the right take home from this pragmatic study and how should we think about fall prevention in our own clinical practices.

You can also find us onYoutube!

Listen to GeriPal Podcasts on:

TRANSCRIPT

Alex: This is Alex Smith.

Eric: And Alex, we have Mr. Disability on our podcast.

Alex: We have Mr. Disability. We have Tom Gill, who is Professor of Medicine and Geriatrics, and Director of the Program on Aging, and the Director of the Pepper Center at the Yale School of Medicine. This is his second appearance on the GeriPal Podcast. Welcome back to the GeriPal Podcast, Tom.

Tom: Thank you Alex. Thank you Eric. I'm delighted to have a second chance.

Eric: We're going to be talking about your New England Journal of Medicine study, the randomized trial, the multifactorial strategy to prevent serious fall injuries, or the Stride Study. But before we do that, do you have a song request for Alex?

Tom: Right, I had selected Losing My Religion by R.E.M. I know you want a story about that, but I had lots of CD ROM, or CDs, back in the late '80s and early '90s, and I transferred them all onto my MacBook, and that's how I listen to my music is on my MacBook. I have a couple of the R.E.M. albums and I thought, "Oh, that would be a good choice." And then I listened to songs, and gave Alex a few options, and I think we settled on Losing My Religion. I just like the melody, and the lyrics.

Alex: Mm-hmm (affirmative), this is a great one for people to sing along, if you're listening in the car, sing along. It also has maybe a little bit about falls. Consider this, the slip that brought me to my knees failed. Maybe? A tenuous connection?

Tom: I didn't catch that, but I commend you for it.

Alex: Here's a little bit.

Alex: (singing)

Tom: Excellent.

Alex: Love R.E.M., love R.E.M., great choice. Thank you.

Eric: So, let's jump into it. The Stride Study. First of all, congratulations on this study for you and your colleagues. This was huge. How, before we get into the study, how did you get interested in the topic of falls and starting to think about interventions for it?

Tom: Right, well my long-standing mentor, Mary Tinetti is the world's expert on falls, and she'd done most of the seminal epidemiological work, and that led to intervention research in a more traditional efficacy study, and she demonstrated the benefit of a multifactorial approach to preventing falls. It was a relatively small study, the results were published in New England Journal in the '90s, but she didn't have sufficient power to look at injuries. And then she followed that up with a state-based study in which she divided Connecticut into two parts, implemented a similar intervention, more in a real-world settling, and that demonstrated benefit with about a reduction of 8% in serious fall injuries. But it wasn't a randomized trial.

Tom: So PCORI released an RFA. This made it to their top list in terms of priorities, and I was part of a group that responded to this RFA. I think at that point, Mary had moved on to other research endeavors, so she left us to pursue the opportunity that was presented by PCORI.

Alex: That's great, and we should welcome Ken Covinsky back to the podcast. Ken, how are you doing?

Ken: Hi, good to see you all. Hi Tom.

Tom: Hi Ken. Not a good night last night.

Ken: No it was not, we can't lose to the worst team in baseball.

Alex: What is the Cubs' record right now?

Tom: Something like 18-12, or something like that? Ken may know precisely.

Ken: Yeah, I was keeping track for awhile, but then we went on a losing streak, so I stopped monitoring quite as closely. So we're still number one in the NL Central, but we're not, we don't have an .800 record anymore.

Alex: So here's the analogy. Early returns were incredible, right out of the gate, right? The Cubs were, I don't know, 6-1 or something like that. Looked so promising, right? This was a sure thing, just like Mary Tinetti's early studies were incredibly promising.

Eric: Great job bringing it back to falls, Alex. I think Ken thought we were doing a Cubs podcast. [laughter]

Ken: That's right. [laughter]

Alex: So, back to the study. So falls, why are falls a big deal in older adults? Why should we care?

Tom: They're common. So about 30% of persons over 65 will fall every year, and about 30% of those will lead to significant injury. So that's almost 10% of persons over 65 will have a significant injury from a fall in a year, and those values increase with age. So, it leads, at least in our work, our own epidemiologic work, fall-related injuries are one of the most significant, precipitating events in terms of disability and functional decline.

Eric: What do we know, before the STRIDE Study, what did we know about trying to prevent fall-related injuries? You talked a little bit about Mary Tinetti's work. If you kind of had to sum it up, what we knew before this study, what would it be?

Tom: I think it was fairly well-established that falls are preventable, and there are different approaches. There's a literature about different types of exercise, whether it's physical activity or gait and balance, and gait training, generally have been effective reducing falls. And then the alternative approach has been this multifactorial risk factor reduction approach in which focusing on the totality of factors that make an older person susceptible to falls, including sensory impairments, footwear, the environment, medications, in addition to gait and balance problems. So, well-established literature about the reduction of falls, but not ... even the large meta analyses that have pulled the result from the smaller studies, haven't had sufficient power to establish whether fall-related injuries, particularly serious fall injuries, could be reduced from an intervention.

Tom: ... so that was the genesis of, I think PCORI's call for a proposal.

Alex: Mm-hmm (affirmative).

Eric: So that's where this study kind of fits into this environment. Can you tell us a little bit about kind of what you did in this study? How was it set up?

Tom: Right, well, it was quite large. There were 10 clinical sites across the country, from the east coast to the west coast, and there was the data coordinating center and the recruitment and assessment center were based here at Yale. We didn't have one of the clinical sites, and the administrative coordinating center was in Boston. And most of the recruitment and followup in ascertainment of the outcomes was done centrally at Yale. So it was a different model, and this was even pre-COVID, in which the recruitment for nine of the 10 sites was done centrally, and the followup for all the participants, the 5,600 plus participants, was done centrally at Yale. And, that's on the recruitment and followup front. The interventions were implemented at the clinical sites, but they were implemented kind of in real world practices. There wasn't a budget to implement the interventions at each of these sites. We did have support for a fall care manager at each of the site, and this was kind of the ringleader for doing the risk factor assessment to identify the factors that made the participants susceptible to falls and fall-related injuries, and then developing a plan and partnership with the participant that was done by the fall care manager, and then who would then follow the participant over time.

Tom: It was a much longer intervention than we're accustomed to. For those who enrolled early, it was up to 40 months. So, and the followup went to 44 months. So it was very large in terms of number of participants, the number of sites, the duration of followup and the duration of the intervention.

Eric: So you had multiple different sites, the patients that you were enrolled all had risk factors for falls, right?

Tom: That was part of the screening that was done, it was based on three screening questions that whether they've had a fall-related injury in the past year, whether they've had two or more falls in the past year, or whether they're have had ... or, if they're afraid of falling because of a gait or balance problem. So, one or more of those questions, if they were answered yes, was the primary entry criteria for the study, in addition to age. We started with age 75 and older, and over time we had to reduce that incrementally to 73, and then to 70, in large part because these populations were fixed at each of the 10 sites. We didn't have an opportunity to recruit an 11th site when, not surprisingly there were challenges in implementing a large scale trial such as this in terms of recruitment.

Alex: And let's hear a little bit more about the intervention itself. So you had these nurses who were trained as fall specialists, and can you tell us a little bit more about what they did? I understand it was a multi-component intervention. What were the key components of this intervention?

Tom: Right. Well they're fairly standard factors that had been part of prior multifactorial interventions, and one of them is medications. So they were, and I know that's an area of great interest at UCSF, with the deep prescribing network. We probably, if that had been in place before Stride, we probably could've taken advantage of some of the discoveries that will likely be made there. So medications were a big focus; impairments in gait, balance, and muscle strength; there was osteoporosis, was a third area, because we were interested not just in reducing falls, but fall-related injuries, and up to half of the injuries that are related to falls are fractures, at least serious injuries. Posture of hypotension was a fourth area, a fifth was vision impairment, a sixth was home safety, or home hazards, and in fact ... missing one here. Oh, footwear, primarily footwear.

Alex: Right. So critically important areas that we all think about as major risk factors for falls and injury related to falls, and then what, after they'd assessed these areas, what did they do? So, what did the participants do, or what were they asked to do?

Tom: Right. Well, this was what Dave Ruben, who was in charge of the intervention component of the study, called a chronic care model and so for individual participant would identify if there are, which of those seven areas were flagged as being relevant for them, and then they would negotiate and try to prioritize the risk factors, so not try to do everything at once. Try to prioritize. If there were four risk factors were identified, try to identify which ones the participant was interested in starting with. And then they would work together, there was a plan, a series of interventions that were linked to the identification of the risk factor. And these are all fairly standard practices. We didn't develop new interventions, these are interventions that are already available in clinical care. They may not be implemented routinely, but there are standard approaches for postural hypotension, that's often linked to medications.

Tom: And so we just, the fall care manager will work with the participant, try to implement the intervention for the risk factors that were prioritized. And then they would have followups on a semi regular basis. I believe there was at least quarterly, some of those followups would be over the phone. I think the annual assessments were done in person. The initial assessments were done in person, but a lot of the other activity between the fall care managers and participants were done over the phone.

Alex: Ken, jump in here, you got a question?

Ken: Yeah, no, just I think one thing that just seems to ring through with this, Tom, is just the intricate, massive effort of this study. I mean, I think you could teach a whole course on clinical trial design looking at Stride, and just the way you incorporated the best practices of pragmatic trials but also really, everything we know about preventing falls in real world practices, but really moving beyond the kind of typical experimental setting to the real world. So, I can't ... I wonder if there's anything you think maybe, with the post hoc knowledge of the study you would've added, but I don't think anyone ... it's hard to find anything that you could've done better. But I'm wondering if you think there's anything.

Tom: Right, well thanks for pointing out, I neglected to say this earlier, that this was designed as a pragmatic trial because we already know from efficacy studies that aren't necessarily based in real world practice that falls can be prevented. So this was a trial design to see if similar strategies, more in real world settings, could be equally effective. In terms of what could've been done better, we've had a lot of discussions internally about that, and I ... behavioral interventions are challenging to implement. It's not as straightforward as opening your pill bottle and taking a single pill once or twice a day for some period of time. It's not easy to change behaviors, and particularly in this setting with multiple different providers, because the gait and balance, the physical component of the intervention, was really done in partnership with home care services, and outpatient physical therapy groups, and senior programs, and things like that. There wasn't an intervention that the fall care manager implemented him or herself for that risk factor. This is taking advantages of the resources that were available through that clinical site or that surrounding community.

Tom: I think giving patients the opportunity, the participants the opportunity to prioritize the factors, at least to start with, is probably wise, and this being PCORI, we worked in partnership with patient stakeholders both on a national level and each clinical site had their own patient stakeholders committees, and we learned a lot from them. But I think we perhaps weren't as attentive during, as the intervention was being implemented, in monitoring how the intervention was being implemented, as carefully and as closely as we might have done otherwise, given-

Alex: Meaning that you're worried that you may have recommended somebody go take an exercise program, but they may not have followed through and done the exercise program, particularly since you weren't paying for the exercise program, you were referring them to some community class.

Tom: Or in part, that's part of it. I mean I think the fall care manager would monitor that, and then would encourage them, but yeah, there was some limitations on our part of what we could actually do ourself for that specific risk factor. There are certain things, I think there's a tendency probably for the participants and maybe the fall care managers together to focus on the low-lying fruit, things that aren't as difficult.

Eric: Give them some vitamin D, call it a day.

Tom: Right, and that's one thing, and for the osteoporosis, calcium vitamin D, so you can see that that had pretty good uptake. But when we looked at bisphosphonates, not that they're without risk or harm, but they're much more effective in terms of reducing fall-related fractures. So, I think we probably could've done a better job in retrospect of pressing the participants more aggressively to try to reduce the and focus on the factors that were going to be most potent in terms of reducing the outcomes.

Eric: Well maybe we can talk about what outcomes you actually saw. We can talk about kind of what we've learned from afterwards a little bit more. What did you find?

Tom: Right, well the primary outcome was defined as a serious fall-related injury, and that could either be a fall-related fracture, a laceration, or a joint dislocation. That was one set of outcomes. The other was a fall-related injury that led to hospitalization. But even then, there was a finite number of reasons for that. This was an interesting, I know you have mostly a clinical audience, but if we were designing the trial or the protocol, initially any fall-related injury that led to hospitalization was going to be included as the outcome. But as we worked through the details, we realized that that could lead to some bias in that we're working in partnership with the primary ... fall care manager's working partnership with the physicians, the patients' physicians. So, and the fall care manager's obviously not blind to the treatment group, and the physicians wouldn't be blinded.

Tom: So, if a participant had a fall and some type of injury, they would more likely ... we were concerned that they were more likely to be sent to the emergency department, and once you go to the emergency department, the more likely to be admitted, and that would be a conservative bias. So we thought we had to limit the hospital-related injuries to injuries that no one would dispute warranted being hospitalized. We had to omit the ones that could be discretionary, and that's one of the reasons why our outcome rate was lower than we had originally projected. Now that's kind of the backstory, that's not in any of the manuscripts.

Eric: And early on you said about one out of 10 older adults will have a serious fall, fall-related injury over the course of the year. Is that what you found, or sounds like maybe a lower number.

Tom: Well, it's not just, I mean it's moderate to severe injuries, and it's always a challenge to, how do you define a serious fall injury? And there's a lot of different definitions out there, and in the end, we had to select one that was going to reduce the possibility of biased ascertainment, which is often an issue in the context of a behavioral intervention, in which it's not possible to ... blinding is of concern, to the other clinicians that are part of the equation.

Eric: Yeah, so-

Tom: It's probably less than 10%. We were projecting I believe, and it's per 100 the way that the statisticians worked this out was on a per 100 year basis, and I believe the projections were somewhere along the lines of 20 fall-related injuries per 100 person years. And we ended up with rates probably a third of that. And part of it may have been because we had to modify the primary outcome, but also, and this is almost for any trial, the outcome rates are lower than are projected because the outcome rates were often based on epidemiologic studies, and trials notoriously recruit persons that have a lower risk of the outcome of interest.

Alex: Right.

Tom: That's the nature of the beast.

Alex: Yeah. We'll get to who was in the study and do they look like geriatrics...clinic patients, but before we do, I want to ask what the control condition was.

Tom: Yeah, usual care got some education. We had a brochure, we took advantage of the information that was available through the CDC, there's a well-established program called Steady and there are materials that we pretty much pulled off the CDC and we provided them to participants, but they didn't have access to a fall care manager. We also had training for their primary providers, or primary care providers, but that was-

Alex: And the primary care providers also got the result of the risk assessment?

Tom: That's true, but all ... that was in both treatment groups. Yes.

Alex: So, do these patients look, we asked Jeff Williamson this question when we did a podcast with him about Sprint Mind. We said, "Jeff, we did a journal club on your paper, and we looked around the room, and we said, 'Did anybody see any patients like this in clinic?' And nobody saw any patients like that in clinic." And he responded honestly, like, "Yes, this is really designed for a primary care population, the well older adults. How about your study? Are these patients who you might see in a geriatrics clinic?

Tom: I think these patients more so than in Stride, the one characteristic that I think would perhaps not as generalizable was education. About 50% of the participants were college educated, and that's higher than you're probably accustomed to in most settings. That's often the case in clinical trials. But when you look at other indicators of frailty or physical limitations, I believe a third of our participants were using a mobility aid. They had the whole panoply of chronic conditions. A significant proportion had had a prior fall-related fracture. I'd have to look for the details here, but-

Alex: I think one other piece that stood out to me is it's really laudable that you went after people who had cognitive impairment. You didn't exclude them from the trial, as is often done, and yet even by trying to recruit them, I think it was only like 3% or something.

Tom: Right, yeah, you're right, 3-4%. They weren't excluded. We had, again, all the recruitment was done over the phone, so we used the Callahan Cognitive Screen, and if they had four or more errors on that, we had to identify a proxy who could assist on the intervention side of the equation, and in the ascertainment of the outcome of the every four month followup interviews, because we obviously couldn't rely on the participant to accurately report about falls or injuries that they had had over the prior four months.

Ken: Yeah, so Tom, it seems like the intervention really dealt ... if you were to sort of classify the two big probably in primary care practice with respect to falls, the first is that they're not identified. So we're just not trained much to ask about falls in a review of systems, and I think a lot of primary care physicians who are sensitive to falls will tell you that they don't really know what to do when they identify a fall. So it sounds like really, I mean two central features here are that you had a systematic way of identifying either people who are at risk for falls, so fall risk, which of course included a previous fall. But then you really, you had a structure for what to do.

Tom: And that was the kind of the rationale for the a fall care manager. If the intervention led to more robust findings, and then ultimately was shown to be cost-effective, this is a model that could be implemented in real-world practice. You could have a fall care manager responsible for a panel of 200 at risk older patients, and this could be their job, and that was kind of the frame of reference when we developed the intervention was the selection of these 10 clinical sites, they all had their own healthcare system. So this could be implemented in real-world practices without a lot of additional time and effort.

Eric: I think that, one of the things is, I love that. When we look at the results though, the primary results are really negative. There was no difference between the groups as far as first time to serious injury fall. So when I see the results, and I see the ... how am I supposed to interpret it? Am I just supposed to say that a nurse led multifactorial fall intervention doesn't work, so what do I do now?

Ken: And actually Tom, I'm going to ask Eric's question, because I'm very curious, I'm going to ask this question, the exact same question Eric asked in a different way. So, that momentous day when the three PIs of this study got together and results were unsealed, and you found out the results of the study, what was the mood in, I guess it was a Zoom room, but what was the mood in that room? Was it happiness, sadness, oh my God? What was it like?

Tom: I think we were disappointed that the findings weren't as robust as we had expected. And yes, in the traditional sense, this was a negative trial. And that's, we interpreted the results a little differently because the intervention group had some reduction, a much smaller reduction in fall-related, serious fall injuries, than the usual care, or enhanced usual care group to the effect of about a 8% reduction. We were postulating a 20% reduction, and we didn't have the power to detect an 8% reduction, and it would've taken a trial three times the size to detect a reduction that low. So, when we were trying to put these results in the context of prior literature, this is about the size of the reduction that Mary Tinetti had reported in her earlier New England Journal paper for the Connecticut Collaborative Fall Prevention Network, which is not a randomized trial. I alluded to it earlier, in which she implemented this intervention in the northern part of the state, and then the southern part of the state was the control, and it was not, it was an intervention that was more ecologic. It wasn't on a per participant level, and she reported a reduction of about 8%.

Tom: So, and then we took, had some solace in the self-reported fall injury outcome, which was a predefined secondary outcome, and that, the reduction was about 8-10%, and that was statistically significant because the outcome rates were much higher than for the adjudicated serious fall-related injury outcome. And the adjudication process was quite rigorous, and I think that led to a lower than anticipated outcome rate of somewhere, as I mentioned earlier, five per 100 year.

Eric: I'm also trying to think about this like if this was a drug, would this be clinically an important difference? When I look at that primary outcome of first adjudicated serious injury fall between the two groups, the intervention group was 4.9, the control group was 5.3, so a difference of .4 for time to first event. Is that a big difference? Again, it's always hard to wrap my head around in 100 years. How am I supposed to think about that?

Tom: Those numbers aren't based on 100 years, but I mean I think that's a small difference, and it depends on what intervention is necessary to get an effect at that level. And I think the intervention is not, would not be cost-effective for an effect that small. So I don't think we would ... if there was a pill that gave that same reduction, and that's all you had to do? It would probably be meaningful, and maybe cost-effective.

Tom: A behavioral intervention can be much more expensive, and it's very, they're time consuming and it required repeated touchpoints between the participant and the intervention, it was not nearly as easy as Jeff Williams Sprint Study, which you take a pill.

Ken: So Tom, could I ... a thought, and I'd be interested in what your reaction to this, is that one of the things that strikes me about Stride is it was this incredibly well-done study, and it makes me wonder if it's time for the field of geriatrics in our field to have a little bit of introspection that everything was really done well and right. And you could point to a few things maybe you would've don differently, but nothing's been as good as Stride in terms of fall reduction, or for that matter, any geriatric syndrome. Yet, we could not prevent fall-related injuries, at least we couldn't prove it, and even if it was there due to lack of power, it's on the order of a very small amount, like 10%.

Ken: So the thought is, does our field need to be a little bit more humble about the ability to really prevent things like fall-related injuries and prevent fall-related syndromes? And at the same time we're trying to move forward there and keep moving the needle there, also say well, irrespective of fall-related injuries, this is a phenotype of patient where there's lots of suffering, that patients who fall, and their families, suffer a lot, and clinical geriatricians deal with this a lot, and should we focus as much on the palliative aspect of that? So in addition to preventing falls, should the next study on fall prevention also say even if we can't prevent fall injuries, can we prevent the life space constriction that people have with falls? Can we prevent the caregiver stress and the levels of depression patients have who fall? Should we really actually be looking beyond falls itself, but looking more to the wide spectrum of suffering that really geriatricians and palliative medicine providers are expert at dealing with, even if we can't change the fall outcome?

Tom: That's an interesting question. Let me, and I think there's two components to that. First, in terms of what clinicians should do with this information, I think there's a distinction here between what might be done at the systems level and what might be done at the level of the patient and physician. I think on a patient level, I would not want to discourage physicians or providers from trying to work with their patients to reduce risk factors for falls, because I think on a per patient basis, falls and fall-related injuries are preventable. But when you take a step back and try to implement that on a systems basis, it doesn't work as well as we would like, and I think that's an important distinction, and this is an intervention that won't be picked up by health systems. But I think there's useful information here for physicians and other providers in terms of working with their older patients who are at risk for falls and trying to reduce those risks and improve their outcomes. So that's part one.

Tom: Part two, I think you're right that you can also address the consequences of fall-related injuries as part of a more expansive intervention, although that's going to be even more challenging to design and implement, because you're broadening the scope, and to do that from a trials perspective, I think would be maybe a challenge that the UCSF Pepper Center might be willing to embrace. Now we did include other outcomes that were secondary, and they're labeled as wellbeing outcomes, and there's a manuscript under review now providing the results of the wellbeing outcomes, and they pretty much mapped the results of the primary outcome. So, there's no evidence that in an expanded array of outcomes that the intervention provided meaningful benefits.

Eric: That was one of my questions, especially to Mr. Disability, is that you have this group of people, vast majority were afraid of falling on trial enrollment. So we give them potentially physical therapy, exercise, you correct vision, you help with orthostasis, you do all of these things, so maybe they're just going out more and when you're exposed to going out more, to a hazardous outdoor environment in those cities, maybe that's why they're falling more because they're actually doing more. Sounds like that may not be a correct assumption.

Tom: I mean it's a fair point, and a trial like this doesn't have an opportunity to account in that level of detail in terms of the opportunities to fall and be injured. Now, Yale was previously a site for the life trial, and which was a physical activity intervention that was, showed that major mobility disability could be reduced by a fairly aggressive physical activity intervention, and we published a followup report I think in BMJ about fall-related injuries, and whether this physical activity intervention could reduce the likelihood of fall-related injuries. And again, it was a mixed picture that overall there was no reduction in serious fall injuries, but for reasons that we could only speculate on, there was a significant reduction in men, but not in women. And we were concerned in the life trial about the possibility that by making folks more physically active, they would be more likely to fall and become injured.

Tom: Now what we did find is that there was a slight increase in the number of falls, but generally, a reduction in fall-related injuries that was significant for men. Women had some reduction in fall-related injuries, but there wasn't a significant finding. So, it's a valid point, but I think that there's probably no evidence that by increasing physical activity alone you're going to increase the likelihood of having a serious fall injury.

Alex: That's great. I just want to point out for our listeners who may be wondering why are we calling Tom Gill Mr. Disability, that Tom Gill Tweets @mrdisability. Time for one more question, Ken, you got a last question?

Ken: Well, yeah, no, I mean I think I like the way you've been thinking about this at system and patient, individual levels, because I think you're right, the effect may well be different. And I think one thing you are implying is that if ... it's basically the your group at Yale who've basically showed that there's unifying risk factors for falls, functional dependence, incontinence, all the geriatric syndromes have similar risk factors, so presumably if you're trying to prevent falls, you're trying to do other things that are going to be good in other ways so that these ... I think that you're right that this type of intervention is likely to be good regardless. Yeah, but I do wonder though at the same time we're trying to offer physical therapy and trying to reduce the number of medicines, we should also have the social worker involved and teach our patients how to use paratransit, so at the same time we're trying to prevent falls, we're also making sure they can do all the things that are important to them, fall or not.

Tom: Again, I can't dispute that. I think those are valid points taking a broader perspective. Just maybe a final comment about the distinction between systems and patients, about 14% of the participants in Stride who are in the randomized intervention group didn't get anything at all. So they didn't even get that first visit by a fall care manager. That's just the reality of clinical trials. So you take those 14% off the equation, and then you have to account for adherence to the recommendations that were provided by the fall care manager, and that's why these trials, behavioral trials, are just so darn complicated. And that's why I maintain hope and expectation that this intervention, if implemented on a case by case basis when an opportunity to optimize adherence in the context of a patient-doctor relationship has a high likelihood of demonstrating benefits.

Eric: This is my last question for you Tom, is did anything in this trial change your clinical practice? Bringing back down to doctor-patient relationship and how you think about it, anything change there?

Tom: My practice is not a primary care practice, so I can't put myself in the shoes of a primary care provider. I think I have a greater appreciation of the challenges of implementing an intervention that has multiple components, and have somewhat envious of our colleagues who are implementing pharmacologic trials. They have their own challenges, but ....

Eric: But it sounds like from a geriatric syndrome perspective, while it doesn't, from a systems based standpoint, didn't seem to work as we'd hoped. From a patient perspective standpoint, when we're in there with our patients, that we shouldn't lose our religion about the importance of fall reduction...

Alex: There we go. [laughter]

Eric: You like that Alex? [laughter]

Alex: All right, let's just do a little bit more of the song to close it out, and then we'll thank our guests and wrap it up. Here's the last couple verses of We Won't Lose Our Religion.

Alex: (singing)

Ken: Bravo.

Tom: Excellent.

Read the original:
Reducing serious fall-related injuries: an interview with NEJM STRIDE Study author Tom Gill - GeriPal - A Geriatrics and Palliative Care Blog

Read More..

Sep 18

You cant predict anything about 2020, but you can depend on Kansas – Banner Society

Its always advisable to avoid large assumptions after college footballs Week 1. This maxim is rare: Its mostly agreed upon by coaches, analysts, statisticians, and even players. Of course, every September everyone knowingly and willfully ignores this in the name of hype, and it almost always backfires in hilarious fashion.

But most everyone gets it: This is a highly volatile sport in its base setting, with no preseason and a penchant for sudden change. Accordingly, in 2020 [waves at everything], every week is essentially Week 1.

This is not the year to create context. This is not the year to draw sweeping conclusions, at least based on what happens in the football parts of football. One of the best programs currently playing refuses to disclose COVID testing figures. A Navy team that finished 11-2 last year lost its opener to BYU 52-0 after its coaching staff decided against live tackling in practice to help guard against potential transmission. The very first game played in August featured a linebacker trotted out as long snapper because of quarantine restrictions on travel.

Consider Georgia Techs 16-13 spoiling of Mike Norvells Florida State debut, your typical Week 1 exercise in narrative-building: Is Tech back, just one year removed from Paul Johnsons triple option, or is Florida State, who lost four offensive linemen during the game, still in shambles after Jimbo Fisher and Willie Taggart? Remember that the Noles made a lot of people think an eventual 6-7 Virginia Tech team was something special after Taggarts debut.

Now add the additional mitigating circumstances of 2020 to the how good is Tech / bad is FSU exercise: Just like Navys abdication of tackling, Tech head coach Geoff Collins said after the game the team didnt run full kicking drills because of virus concerns. The Yellow Jackets had two field goals and a PAT blocked. Was this game a one-possession upset or a hidden statement win?

This will be a season of bad faith assumptions and terrible context creating messy conclusions if the data points are utilized as anything other than outliers. That of course wont happen one program has already parted ways with its coach based in large part on how his team looked after one game in 2020.

There is a need among fans and professionals to draw inferences, to build conclusions and gather up facts in defense of an idea. To some degree this is a natural behavioral pattern. So if you need to surmise something in 2020, I can offer one certainty free of any pandemic-era qualifier or context:

Kansas football is forever broken.

The Jayhawks lost at home on Saturday night to Coastal Carolina, 38-23, and at one point trailed 28-0 before kicking a field goal as time expired in the first half. This was the second win over KU in as many seasons for the Chanticleers, both over new head coach Les Miles. Miles was brought to Lawrence by his Michigan buddy, A.D. Jeff Long, to resurrect its moribund football program; through 13 games, he now has as many losses to Group of Five programs at home as he does FBS wins as KUs head coach.

This is not a referendum on Miles or Long. This is not a dogpile on the Big 12, which suffered a trio of losses to the Sun Belt on its opening weekend. But those games Kansas State losing at home to Arkansas State and ranked Iowa State getting thumped by upstart Louisiana are subject to interpretation, to 2020 context. Kansas getting dragged is a lighthouse, an anchor, a steady hand to balance oneself in an ever increasing world of uncertainty: The Jayhawks are inexplicably bad. We know this and it has not changed.

Through four head coaches and a variety of on-field systems, Kansas has been so easily attainable a P5 pelt for G5 programs that the excitement of such an upset is wearing off. In eight of the last ten years the Jayhawks have lost to either a G5 or FCS opponent (or both). Kansas is 4-10 against Group of Five since 2011; in the same span the Jayhawks are 2-3 in Power 5 non-conference games.

Thats how bad it is: You could make a convincing argument that its smarter for KU to schedule equally woeful P5s like Rutgers and Boston College, both of whom the Jayhawks beat on the road in recent years, than bringing in a perennially humming mid-tier program like Louisiana Tech or Central Michigan.

But you could even argue its smarter for KU to seek out a fellow P5 doormat than schedule G5 flotsam like Rice or the Chanticleers (who have yet to post a winning season in FBS ball) since both schools have swept KU in the last ten seasons. And despite recent losses to FCS programs Nicholls and South Dakota State, the Jayhawks are 6-2 vs. FCS teams in this timespan. So while their original opener New Hampshire cancelled their season, it wouldve been far more prudent to find any other FCS team to play rather than Coastal Carolina. (That or Rutgers.)

Read this article:
You cant predict anything about 2020, but you can depend on Kansas - Banner Society

Read More..

Sep 18

Olympic Weightlifting Guide and Beginners Program – FitnessVolt.com

Olympic weightlifting is the original strength sport. Before powerlifting and bodybuilding were officially recognized, Olympic lifting was a popular activity.

There are two official Olympic weightlifting disciplines, the clean and jerk, and the snatch. Both of these moves involve lifting a weight from the floor to overhead, albeit with very different techniques.

There used to be a third Olympic lift the clean and press, but this was dropped in the 1960s because of safety concerns. The press was done strictly, with no extra leg drive. To lift more weight, athletes would often lean back and do a sort-of freestanding bench press. Injuries and difficulties in judging meant this lift was dropped from competition and never replaced.

In modern Olympic lifting competitions, athletes get three attempts at each of the two movements. The winner is the weightlifter with the highest total from their best snatch and clean and jerk. The snatch is always done first.

While Olympic lifting is a stand-alone sport, a lot of athletes use the Olympic lifts in their training, even if they dont lift competitively. Thats because both the clean and jerk and the snatch offer so many benefits.

Those benefits are:

Power is force generated at speed. In other words, its your ability to move heavy weights quickly. Its the difference between a slow, heavy squat and a high-speed squat jump. The Olympic lifts are performed explosively, and that will increase muscle power. Power is an integral part of most sports, which is why a large proportion of athletes include Olympic weightlifting exercises in their workouts.

More muscle power will help you run faster, jump higher, and throw, kick, and punch harder.

You should not expect to master the Olympic lifts overnight. The snatch and clean and jerk are complicated, full-body exercises that involve a lot of coordination. But, with practice, youll get better at both of these moves as you get stronger, and your coordination improves. Coordination is your ability to control your limbs and move them accurately.

The Olympic lifts involve large ranges of motion, especially at the knees, hips, and shoulders. Successful Olympic lifters are very flexible, and simply doing these exercises will increase your flexibility and mobility. However, if you are very tight, you may find aspects of the Olympic lifts hard to master until you improve your flexibility.

Both Olympic lifts are full-body movements. They start with a powerful knee and hip extension and also involve the lower back and core, shoulders, and arms. The only muscle group that doesnt do a lot of work in the Olympic lifts is the chest.

If you are short of time but still want to train most of your major muscles, an Olympic weightlifting workout could be the solution.

Because the Olympic lifts are explosive, they target your type 2b fast-twitch muscle fibers. These are the muscle fibers responsible for size and growth. Olympic weightlifters arent usually as big as bodybuilders, but they arent too far behind, and thats in spite of the fact that they dont typically do any traditional bodybuilding exercises.

While the Olympic lifts can definitely be beneficial, there are a few drawbacks to consider too. The main ones are:

The snatch and clean and jerk can be hard to learn. Youll need to develop a decent technique before you think about lifting heavyweights. That means, initially, at least, youll have to settle for easy workouts because lifting too much weight too soon could result in injury.

The good news is that there are simplified versions of the Olympic lifts that are easier to master, such as the power clean.

If you are serious about learning the Olympic lifts, you may need to work with a qualified coach.

A lot of gyms dont have the equipment required for Olympic lifting. Youll need:

Olympic lifting training invariably involves dropping weights from overhead to the floor. Improper equipment will break, and no lifting platform means youll also damage the floor. Because this equipment is specialized (and expensive), you probably wont find it anywhere apart from proper Olympic lifting gyms and some CrossFit boxes.

As well as this equipment, youll also need weightlifting shoes. Weightlifting shoes have a raised, solid heel that allows you to squat deeper. They wont distort under heavy loads, so you should also find it easier to maintain your balance. Most also have metatarsal straps to keep your feet stable and locked in position.

While Olympic lifting is not the most dangerous sport, lifting and balancing heavy weights overhead can cause injury. If you lose your balance while squatting or standing under a heavy bar, you could be seriously hurt. Unlike powerlifters, Olympic lifters do not use power cages, so a missed lift could be catastrophic.

Most established lifters are very good at dumping the bar if they are unable to complete a lift. This means dropping the bar as they jump out from beneath it. Such a maneuver requires a lot of mobility, good timing, speed, and even bravery!

While its beyond the scope of this article to teach you how to snatch and clean and jerk with perfect form, well provide you with the basics to get you started. Entire books have been written about these movements, so we cant do justice to them within the confines of an article.

That said, if you are serious about learning and mastering the Olympic lifts, you should seek out an International Weightlifting Federation coach or join a weightlifting club.

The snatch is arguably the hardest of the two lifts to learn. It involves lifting the bar from the floor to overhead in one movement, often catching the weight overhead while in a deep squat. Its such an athletic movement that the snatch is sometimes referred to as gymnastics with weights.

Things to remember that will improve your snatch include:

The clean and jerk is a two-part lift. The clean involves lifting the weight from the floor to shoulder-height, while the jerk is a sort-of push press during which the bar goes from shoulder-height to overhead. Its a little easier to learn than the snatch, but still a challenging lift to master.

Note: The split jerk is the most efficient way to get the weight up and overhead, but some lifters prefer a push-jerk. This requires less flexibility and balance, although it may ultimately limit the amount of weight you can lift.

Things to remember that will improve your clean and jerk include:

The best way to get better at the Olympic lifts is to a) practice those lifts, and b) do accessory exercises that will positively impact your strength/technique.

With those factors in mind, here are two Olympic lifting programs designed for beginners, one for snatches and one for clean and jerks. They both include the specific Olympic lift as well as more common strength training exercises to boost your performance.

A lot of Olympic lifting programs specify how much weight you should lift based on your current one repetition maximum or 1RM for short. Thats fine for experienced lifters who know their 1RM, but impractical for novices who dont know how much they can lift.

For this program, with the Olympic lifts, increase weight set by set until you notice your speed starting to slow down as you near the specified number of reps. If you feel like you are grinding out the reps, the weight is too heavy.

Its better to lift a lightweight quickly than a heavyweight slowly. Initially, at least, you should focus more on your technique than the amount of weight you are lifting.

Youre only going to do sets of three reps in the Olympic lifts, but six sets in total. This means you wont have to worry about fatigue affecting your technique, but will still get plenty of practice at each lift. Repetition is the best way to master a new exercise something a lot of coaches call greasing the groove.

For the other lifts, choose a weight that takes you close to failure within the specified rep range.

Do each workout once per week, e.g., Monday and Thursday, or, if you want to train more frequently, hit the gym three times per week, alternating workouts each time you train, i.e.,

Before each workout, spend a few minutes warming up. Do some light cardio, followed by dynamic stretches and mobility exercises for all your major muscles and joints. Also, practice the Olympic lift day using an empty barbell or just a wooden pole.

*AMRAP = As Many Reps As Possible

Whether you are looking to improve your performance for sports, build muscle in a new way, or take up and compete in weightlifting, this article should help. The Olympic lifts arent easy to master, but they are very rewarding. Like heavy deadlifts and squats, theyll help build a body you can be proud of. Including them in your workouts will add a lot to your overall development and athleticism.

As with any new lift, the Olympic weightlifting exercises take time to learn. In fact, the snatch, and clean and jerk could be two of the most technically challenging exercises you can do. But, with practice and perseverance, you should be able to do them with at least passable form and impressive weights.

But, when learning these lifts, light and fast is always better than heavy and slow. Leave the grinders for big squats and bench presses. If you cant lift the bar explosively, its too heavy for you. Build your speed and power first the heavyweights come later!

Subscribe to our mailing list and get interesting stuff and updates to your email inbox.

Thank you for subscribing.

Something went wrong.

More here:
Olympic Weightlifting Guide and Beginners Program - FitnessVolt.com

Read More..

Sep 18

Lose weight to beat Covid-19, follow healthy lifestyle, say experts – The New Indian Express

Express News Service

THIRUVANANTHAPURAM:The unhealthy food habits coupled with the sedentary lifestyle of Keralites could prove fatal as the state braces for the Covid-19 case peak. Citing global studies that being obese doubles the risk of hospitalisation and increases the risk of dying due to Covid-19, the state health department has stressed the need for adhering to a healthy lifestyle.

The department also says that the young population should exercise extra caution as obesity is prevalent among them. To corroborate the same, it points out that of the young Covid patients admitted in ICUs, obesity has found to be the villain.

Intensive Care Unit and ventilator admissions are increasing in the state. It is obvious that the elderly and those with comorbidities might need ICU or ventilator care. But now, young patients also need ICU admission and of them, a majority are found to be obese, said an officer of the health department.

When asked about this, Dr Bipin Gopal, state nodal officer for non-communicable diseases, said, Obesity is a problem and it is prevalent among the young generation. It is one of the triggering factors that could worsen the Covid-19 condition.

An intensive care specialist at a government medical college hospital said, Excess weight might result in other diseases such as diabetes, high blood pressure and a weakened immune system. This can make these individuals more vulnerable to Covid-19.

Earlier, the Public Health England, an executive agency of the Department of Health and Social Care in the United Kingdom, had stated that people with excess weight were at greater risk of needing hospital admission or intensive care. It was also found that people with obesity and Covid-19 were twice as likely to end up in the hospital and 74 per cent more likely to be admitted to intensive care. They were also more at risk of dying of Covid-19.

In the light of the study, the UK government released a new national strategy for tackling obesity. A similar strategy should be followed by the state. We have this eat right campaign. But it will have to be strengthened. People should be made aware of the need to stick to a healthy and nutritious diet, said the specialist.

At the same time, a section of the health officials said the state government should immediately roll out a campaign with the message lose weight to beat Covid-19.

Recently, Finance Minister T M Thomas Isaac in a social media post said ICU/ventilator admissions are on the rise in the state. Citing the condition at Government Medical College Hospital, Thiruvananthapuram, the minister said there are two categories of admissions at the ICU -- the elderly and youngsters who are obese. The minister who tested positive for Covid-19 and was treated at the MCH was discharged on Tuesday.

Read this article:
Lose weight to beat Covid-19, follow healthy lifestyle, say experts - The New Indian Express

Read More..

Sep 18

Fish vs chicken: What helps you lose weight faster and why? – Times of India

Following a disciplined diet and lifestyle is one of the sure shot ways to lose weight as well as maintain it in the long run. However, there are special dietary additions and tweaks which are said to accelerate weight loss. Two such examples are fish and chicken. That's why you will always see people choose grilled chicken or grilled fish over other variants. Why are grilled variants good for weight loss?Grilled options instead of fried options make you east less fat than usual since the excess fat tends to drip off the grill. It also requires lesser oil or butter to be prepared and most nutrient profiles remain intact. They are also generally lower in calorie content than other fried meats.Grilled fish and chicken also make sure you get enough protein, omega-3 and other healthy nutrients. Since both these sources contain significantly less cholesterol and saturated fat, they are considered to be 'leaner meats' as compared to other heavier animal products.But, out of these two options- which is the healthier version to choose? What helps aid weight loss faster- grilled fish or chicken?

Grilled fish vs chicken: What's better?Most diet experts and studies suggest that including seafood or poultry in your diet if you are non-vegetarian offers a lot of goodness and are necessary for a balanced diet. However, both these food options have a few advantages over each other.

Is eating fish better to stay in shape?A recent study done by Journal Nutrition, Metabolism, and Cardiovascular Diseases found out that eating fish can be a healthier alternative to other meat sources to stay lean. In fact, eating fish can also promote faster weight loss. Researchers found that people who solely ate fish (and not other types of meats) in an eight week period recorded better weight loss than the ones who didn't.

The study also suggested that people consuming three weekly servings of fish could also be good to lose weight and deliver better results.

Eating fish can also serve a lot of benefits. One of the biggest benefits being Omega-3 fatty acids, which our body cannot produce naturally. Omega-3 is known to reduce inflammation and stress levels in the body, which can contribute to weight gain.

While protein helps promote satiety, researches also claim that eating fish can help people stay fuller for a longer duration, as compared to other forms of protein. It is a good kind of lean meat which is also good to boost athletic performance, build muscles and sustain energy levels in the body.

However, do remember that fish has a lower source of protein in comparison to other meats and animal products. Some varieties of fish can also have high-fat content, so you should be careful about the type of fish you are consuming.

There's also the danger of contamination and safety of eating seafood. Traces of mercury, usually found in fish can be potentially harmful to those who have sensitive stomachs. Raw fish should be especially avoided by pregnant women and children.

Are there benefits of eating grilled chicken?Chicken, again, is flavourful and one of the favourites for weight watchers. It's also affordable, compared to other meats, making it easier to include in your diet.

Chicken, as a food source, contains a lot of healthy nutrients in it. From high protein (one serving of chicken serves 27 grams), low-fat content and vitamins and minerals (such as Vit. B6, selenium, niacin and phosphorus), all of these help in weight loss and building a healthier, fitter body. Regular consumption of chicken can strengthen your bones, reduce appetite and build muscle mass. Chicken breast, of all parts, is the healthiest of all.

As healthy as that sounds, the possible downside remains the type of chicken you are eating. A lot of chicken available in the market can emerge from scrupulous sources, containing traces of chemicals and other added ingredients used for preservation. This most commonly happens with frozen food. Make sure what you eat is purely organic and natural.

See more here:
Fish vs chicken: What helps you lose weight faster and why? - Times of India

Read More..

Sep 18

Carbs Or Calories: What Should You Focus On For Weight Loss? Experts Reveal – NDTV

Weight loss expert tips: Eat all food groups in moderation for healthy, sustainable weight loss

Which number is a better indicator for weight loss- calories or carbs? Calories in and calories out is a simple way to decide how much you should eat. For weight loss, the number of calories you take in must be lesser than the number of calories you burn in a day. When it comes to carbs, you need to count the number of net carbs, which is obtained by subtracting fibre from total carbs per serving. Now to say which one of these is better, we would say neither.

Nutritionists like Rujuta Diwekar and Nmami Agarwal believe that neither count calories nor count carbs are an effective way to lose weight. According to them, you must focus on practicing portion control and eating in moderation at all times.

Also read:Keto Diet For Weight Loss: 5 Side Effects That Signal You Need To Quit This Diet Instantly

For weight loss, Diwekar advocates eating local, seasonal and cultural, in time-tested proportions. Your diet should include a variety of fresh fruits and vegetables that are in season, pulses, lentils and legumes, nuts and seeds. Also what is important is to eat good fats like ghee, coconut oil, groundnut oil, mustard oil, etc, to provide your body with essential fatty acids. All of this, when combined with regular exercise (including both cardio and weight training) can help you lose weight effectively and sustainably.

We speak to nutritionist Nmami Agarwal, about which of the two approaches are better for weight loss, calorie counting or carb counting. She says, "While counting calories does help in managing your weight because you take care of the whole algorithm of calories in versus calories out.But the shortcoming with only counting calories is that you are just focusing on the number of calories, and not on the nutrients."

Counting calories may shift your focus from taking care of nutrient intakePhoto Credit: iStock

Also read:Weight Loss: Nutritionist Explains Why A Good Night's Sleep Is Important For Shedding Calories

One can also count carbs for losing weight, however, the problem with this approach would be that it focuses on just one macronutrient. Along with carbs, the other two macros: proteins and fats, also need to be tracked. "Carbohydrate counting is usually a scientific approach used for diabetic patients, under the supervision of an exper. It helps in regulating insulin doses," Agarwal informs.

Thus, when it comes to losing weight, the best approach is to be mindful of your proportions and keep a note of where your calories are coming from in terms of nutrient profile.

For both approaches, eating complex carbs that come from whole grains, proteins from lean meat or pulses and legumes, and fats from healthy sources like nuts, seeds, eggs and ghee, are the best choices, says Agarwal.

She further recommends that one should avoid refraining any major food groups for the purpose of weight loss. All three macros need to be consumed in a balanced and correct proportions for achieving weight loss that is sustainable in nature.

Also read:Weight Loss Tips: Can Heavy Breakfast Help You Burn Double The Calories? Here's The Answer

(Nmami Agarwal is nutritionist at Nmami Life)

(Rujuta Diwekar is a nutritionist based in Mumbai)

Disclaimer: This content including advice provides generic information only. It is in no way a substitute for qualified medical opinion. Always consult a specialist or your own doctor for more information. NDTV does not claim responsibility for this information.

Read the rest here:
Carbs Or Calories: What Should You Focus On For Weight Loss? Experts Reveal - NDTV

Read More..

Sep 18

Talking About Weight Loss Is Not Fat Shaming: Here’s Why – Plant Based News

If weight loss stories are viewed as fat shaming, it makes it more of a challenge to raise the issues that are related to being overweight(Photo: Adobe. Do not use without permission)

A few months ago, Plant Based News covered the story that Adele had lost 100lbs.

This was rumoured to have been attributed to her following a mainly plant-based diet. More recently her friend comedian Alan Carr lost weight after being inspired by Adele.

Many comments on the article about Adele said the story itself was fat shaming.

I disagree.

But why are weight loss stories considered fat shaming by some and how can we look at these differently and in a more positive light?

How we interpret what someone says to us or what we read can be down to many things. A weight loss story may understandably trigger certain emotions in someone if this is something theyve struggled with.

But if weight loss stories are viewed as fat shaming, it makes it more of a challenge to raise the issues that are related to being overweight.

Instead, if we can have helpful, open, and constructive discussions about weight issues we can then talk about the healthy, sustainable changes that can have a positive impact on someones life.

I know when my doctor told me I needed to lose weight I took this as advice. I saw it as him trying to help me, and I decided to do something about it. But the reverse could be true for many and they will see it as an attack.

This means many doctors are fearful of raising the issue of a patient's weight in case their comments are taken as fat shaming. Its not just doctors either many of us will have felt too scared to say anything when weve been concerned about a close friend or family members increasing weight.

Fat shaming is about disrespecting a person and can come in many guises. However, covering a story about a persons weight loss in a neutral way (and provided the weight loss is not a result of an illness ) is not disrespectful; neither is it bullying or shaming.

Talking about someone's weight loss is not implying that they were unattractive, lazy, or lacking self-control beforehand either.

A persons weight issues can often be tied to low self-esteem, poor confidence and quite often negative or upsetting events from the past. This is why comfort eating, or emotional eating is very common in people who are overweight. Its something I see a lot in my health coaching practice

Feeling judged because of their weight, on top of what else they may have going on, is not going to help someone to feel empowered to make changes.

Many doctors are fearful of raising the issue of a patient's weight in case their comments are taken as fat shaming (Photo: Adobe. Do not use without permission)

Being bombarded with images of super-skinny women and men with six-packs sends the message that if you dont look like that, theres something wrong with you. Comparing yourself to people like this can trigger all sorts of negative thoughts and behaviour.

The issue is perpetuated by entertainment magazines, highlighting any perceived imperfections in a celebritys body, which reinforces the notion that you are somehow flawed if you dont have a perfect body.

Its not just celebrities of course; people who are overweight are often portrayed negatively and this is what needs to stop.

If we didnt have this culture of judgement and shaming people who are overweight, then there wouldnt be the reaction weve seen when someone loses weight.

Being kind and compassionate towards yourself and others is a much more positive place to start.

By being in a place of acceptance and valuing yourself youre in a much stronger position to want to give your body what it needs the nutrients and healthy lifestyle to thrive.

When you do this, youre less likely to spiral into self-loathing, eating crappy foods, berating yourself, and then eating more crappy foods because you feel crappy, and it goes on

Being kind and compassionate towards yourself and others is a positive place to start(Photo: Adobe. Do not use without permission)

Being a healthy weight can bring so many positives mentally, emotionally and physically.

Of course, this doesn't mean youll automatically be happier because you are a healthy weight and it doesnt mean youre unhappy if youre overweight. But maintaining a healthy weight by adopting a healthy lifestyle can help with things such as obsessing about your diet and your body.

You reduce your risk of obesity-related issues such as high blood pressure, high cholesterol, cancer, diabetes, heart disease and complications relating to Covid-19. And there are the other bonuses like not getting out of breath, reduced pain and having more energy. Who doesnt want more of that?

By wanting weight loss stories to be seen in a more positive light I am in no way dismissing the fact that many people are struggling with eating disorders and disordered eating.

But this should not stop us talking about the very real health issues related to being overweight.

And of course, a healthy weight will mean something different for everyone we come in all shapes and sizes.

Genetics and certain conditions play a part of course, as well as your lifestyle. Your genes may be the reason you put on weight easily while your friend seems to be able to eat exactly what they want without putting on an ounce!

That doesnt mean that theres nothing you can do; it might be that you just have to do things differently.

With over 60 percent of the UK population now overweight or obese, according to UK Parliament statistics, its become the norm. This means people often dont realise theyre at a higher risk of weight related illnesses and conditions.

Health isnt just about your body weight of course. Other aspects of your life all have an impact, so we shouldnt equate being a healthy weight with necessarily being a healthy person.

Your mental health, how active you are, whether you smoke, what youre eating and drinking and if you are managing stress all determine how healthy you are.

Weight loss stories where someone has focused on eating healthily as Adeles personal trainer has acknowledged was the case for her should be a cause for celebration and the person should be acknowledged for their hard work and tenacity.

Ultimately how people respond and how they feel about what they read and hear is their choice. I hope that most people who want to lose weight will be inspired by stories like these and feel that they too can achieve a healthy weight with a healthy plant-based lifestyle.

Celebrities are of course influential, but whether youre a celebrity or not, by taking control of your health and what you eat, you never know who you may positively influence too.

See the original post here:
Talking About Weight Loss Is Not Fat Shaming: Here's Why - Plant Based News

Read More..

Sep 18

Lose weight and cut your risks from COVID – Gary Skentelbery

The global pandemic caused by the new coronavirus looks likely to be entering a second wave worldwide. The North West of England has already been particularly hard hit.

As the list of Government advice and instructions grows ever longer and more confusing, it can be hard to know exactly what you need to do to make sure that you, your family and your community stay safe.

Sticking to the general rules about wearing masks and maintaining social distancing are the very basics, and by now everyone should be used to keeping up a strict regime of personal hygiene when it comes to washing and sanitising their hands.

However, with the number of infections rising and likely to hit even higher numbers, everybody must know what extra steps they can take to minimise the risks to themselves if they do end up catching COVID-19.

Eating well

Everyone knows that eating a healthy balanced diet improves the condition of your mind and body. One of the ways it does that is to boost the power of your immune system. That gives you a better chance of fighting off any infection or virus in the early stages before it can develop into something more serious.

Ditching the junk food and too many sweets and treats and replacing them with fresh fruit and vegetables sounds simple and straightforward, but often it isnt that easy. That can be especially relevant when giving yourself the odd treat helps deal with stressful situations. The start of a global pandemic of a brand new disease is about as stress-inducing as problems come!

However, another critical factor to take into account is that being overweight does seem to increase the risks of having a bad reaction to a COVID-19 infection. People with a high BMI have been clinically shown to have worse outcomes in many cases. Even Prime Minister Boris Johnson blamed his weight for ending up in intensive care during the first wave of infections last Easter.

Losing weight to cut the risk

So it would seem that for anyone who has been thinking about losing weight, now is the right time to take action and to start to mean business.

Even the NHS has begun to get behind meal replacement diets to combat various conditions that would positively benefit from weight loss. It stands to reason that this approach would be a good idea for anyone looking to protect themselves from a worse-case scenario of the pandemic.

The Cambridge diet was the original name for the 1:1 Diet by Cambridge Weight Plan, which is both a meal replacement regime as well as a one-to-one relationship between clients and medical Consultants.

Scientifically proven to encourage weight loss as shown by research published by the NHS and the British Medical Journal, a range of nutritionally balanced meal replacements offer tasty and enjoyable ways to shed the pounds.

By taking advantage of this type of modern approach to weight loss, you can take back control of your body and give yourself the best chance of fighting off the worst of any infection, including a virus such as Covid-19.

Vitamins

Another way that your overall diet affects the way that your body fights off a virus is by making sure that you have all the essential vitamins and minerals needed for your immune system to function at its best.

When you eat a healthy balanced diet, you should automatically be getting all you need in this regard. However, some things are not all sourced from food. In fact, Vitamin D, which specifically helps to guard against respiratory infections, comes from exposure to sunlight and is created by a natural process in the skin.

Some people become lacking in this vital bodily health aid for various reasons, and the main one is not getting enough sunlight. Most of the summer was spent in lockdown with restrictions on being outside. Hence, its little wonder that many people are entering the time of year when the sunlight is less intense with a lower amount of Vitamin D in their bodies than usual.

Thankfully, you can top up your levels of this readily available and cheap vitamin very easily with a daily tablet. If you think you might need any type of supplements when it comes to vitamins or minerals, its always best to first check with your GP.

Go here to see the original:
Lose weight and cut your risks from COVID - Gary Skentelbery

Read More..

Sep 18

Struggling with portion control? Try these tips and tricks to eat sensibly and speed up your weight loss – Times Now

Struggling with portion control? Try these tips and tricks to eat sensibly and speed up your weight loss  |  Photo Credit: iStock Images

New Delhi: Its important to keep a track on your diet if youre trying to get rid of that stubborn belly fat or shed those extra pounds. Perhaps, you know the drill - eat less, move more. Thats because, to lose weight, you need to burn more calories than you eat. A calorie deficit is, in fact, the basis of most weight loss equations. Maintaining a healthy diet alongside regular exercise can help you lose or control weight. But there are several factors that can hamper your weight loss goals besides diet and exercise - and one such is portion control.

Research has shown that you tend to consistently eat more food when offered larger portions. This indicates that portion sizes are important when trying to lose weight or keep it off. Practicing portion control isnt just lip service or helpful for fat loss. Proper portion sizes or eating the right amount of the right food can also help regulate blood sugar and boost digestion. But, not sure how to control portion sizes or measure the amount of food in a serving? Read on!

Studies show that increased portion sizes can contribute to overeating and unwanted weight gain. So, controlling portion sizes can speed up your fat-burning efforts. Here are a few tips suggested by Nisha, nutritionist, Cloudnine Group of Hospitals, Gurgaon, to help manage portions at home:

To satisfy our palate, we all try to eat out, try different cuisines or at times on a lazy node we try to eat out but controlling and managing portion is also key on those days as well, added Nisha. Try these tips to keep your food portions in check when you are away from home:

The foremost tip for this thing would be to go slow, start minimising the portions you have been having. Here are some more portion control tips to help you eat smaller portions and still feel satisfied:

Also, consider these additional healthy tips for optimal results:

The bottom line is, we need to understand that managing portion is not any diet, its lifestyle modification and for sure initially, it seems tougher but gradually it will streamline. We hope these weight loss tips will be helpful as you try to get fitter and healthier.

Disclaimer: Tips and suggestions mentioned in the article are for general information purpose only and should not be construed as professional medical advice. Always consult your doctor or a dietician before starting any fitness programme or making any changes to your diet.

Read the rest here:
Struggling with portion control? Try these tips and tricks to eat sensibly and speed up your weight loss - Times Now

Read More..

Contact Us Today


    Your Full Name

    Your Email

    Your Phone Number

    Select your age (30+ only)

    Select Your US State

    Program Choice

    Confirm over 30 years old

    Yes

    Confirm that you resident in USA

    Yes

    This is a Serious Inquiry

    Yes

    Message:


    Page 767«..1020..766767768769..780790..»

    matomo tracker