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DNA-puzzle

The Evolution of Truly Personalized Medicine: Epigenetics, Food, and Fitness

Most would not argue that there is ongoing transition in how our healthcare is being delivered. This article will examine some of these transitions as a result of breakthroughs in technology, as well as how genetic information, exercise, and diet will play an increasingly greater role.

When medical science was first getting its start, a more holistic philosophy was taken on how to treat illness and maintain health. Hippocrates is often deemed the father of modern medicine, and even today the allopathic physicians (M.D.s) take the Hippocratic Oath – to do no harm to their patients. Hippocrates knew, even in 400 B.C., that the best healer of the body is the body itself. For the most part, the best treatment is to create a strong body and get out of the way. Five guiding principles used in his philosophy for treatment include:

  1. Walking is man’s best medicine.
  2. Know what person the disease has, rather than what disease the person has.
  3. Let food be thy medicine.
  4. Everything in moderation.
  5. To do nothing is also a good remedy.

The second and fifth principles emphasize the power of knowing the individual and getting out of the way! The first and third principles show the power of exercise and food for healthy living. Even the genius, Thomas Edison, realized that a health maintenance organization (HMO) approach was the best method of healthcare both practically and financially. His quote, “The doctor of the future will give no medicine but will interest his patient in the care of the human frame, in diet and in the cause and prevention of disease,” is evidence that a holistic, preventative approach is what he advocated. He is also quoted, “…you can’t improve on nature.”

One size does not fit all

Personalized medicine is now on the forefront and it utilizes the genetic and epigenetic data of a person to guide medicines and treatment plans. Cancer drugs have probably harnessed this advantage to the greatest extent, thus far. Former President Jimmy Carter received Keytruda (pembrolizumab) for his brain cancer and it boosted his immune system and beat the cancer. While most of America (71%), still doesn’t even know about personalized medicine, those who were familiar with it did not know it would yield better results with fewer side effects. The different directions of personalized medicine are still being realized, but the field of pharmacogenetics is the first to really jump on the bandwagon of highly effective, precision-based treatment.

The reasons some drugs work for some people and not for others, or why side effects occur in some individuals and not others, is due to individual variability in metabolism. Why are some people lactose tolerant, or some can drink alcohol with no problem, and others have severe issues? It is usually because of enzyme differences, which are under the control of our genes. Interestingly, our enzyme genes can often be turned on or off by “inducible sequences” known as promoters or suppressors of operons, respectively. These “switches” can be repressed or induced depending on our environmental stimuli. Thus, we actually have some control over our gene expression, and this field is known as epigenetics.

Knowing what gene variants someone possess or not will guide the personalized medicine physician on which drug to use or not. By knowing allergic reactions in advance or which medicines may have side effects will help physicians to not make a bad situation worse. Unfortunately, the cost of personalized medicine drugs is much higher than alternative treatments. There is still a lot of exploration to be done on all the various applications of this technology, but the bottom line is that understanding individual variations and enabling the body to do what it is designed to do is a very good thing! Companies like Toolbox Genomics is one of many companies that use your genetic information to then tell you what foods and supplements to eat or avoid, and which exercises may help you the most, and ones that you may not respond to so well. The reason physicians do an intake on family history, or run various tests is to collect information that will guide their treatment. A genetic test on certain gene variants is simply taking this a step further.

How does exercise and diet apply to our epigenetics?

Did you know that exercise is highly beneficial to not only help with fighting cancer once it is already present, but also to never getting it? Physical exercise or movement in general will shift the epigenetics so that genes that suppress tumors are increased, and genes that cause cancer (oncogenes) are decreased. It does this by changing the amount of certain reactions called methylations. Things go wrong when there is too much or too few methylation reactions. Exercise has been shown to reduce or even reverse the epigenetic mutations that often result in tumorigenesis or tumor production. Exercise has also been shown to reduce genetic factors associated with aging like telomere length.

The fields of proteomics and metabolomics as well as pharmacogenomics, are all emerging because of the knowledge on how our genetics affects proteins, metabolism, and reactions to drugs, respectively. The field of nutrigenomics is rapidly expanding, and several companies are capitalizing on studying the relationship of how our genes affect how we process and utilize foods, as well as how food can affect our genes. Vitamins A and D, certain fatty acids, especially medium and short chain, some sterols (derived from cholesterol) and zinc have been shown to directly influence gene transcription. In direct effects include how diet affects gut bacteria, which in turn influences gene expression. Soon when nutritional recommendations are given, it will likely be “for this individual.”

The future of medicine will be taking our genetic information to a whole new level. Soon “smart” watches, clothes, hats, and other common devices will collect information that can benefit our health in many ways as the way healthcare is delivered continually evolves.

This article was featured in MedFit Professional Magazine summer 2019 issue.

Subscribe to MedFit Professional Magazine to read more great content like this!


Dr. Mark P. Kelly has been involved with the health and fitness field for more than 30 years. He has been a research scientist for universities and many infomercial projects. He has spoken nationally and internationally on a wide variety of topics and currently speaks on the use of exercise for clinical purposes and exercise’s impact on the brain. Mark is a teacher in colleges and universities in Orange County, CA., where Principle-Centered Health- Corporate Wellness & Safety operates.

Walk Park

Natural Prescription – An Alternative Approach

One of the best things we can do for our bodies is to “get out of the way”! Believe it or not, our body can actually do a great job of healing itself, or functioning quite optimally when it’s allowed to do so. The body does this by reacting to what “stresses” are put upon it and finding homeostasis through temporary changes or more permanent adaptations. Even the brain will make quick reactions to things in the form of neurotransmitters and neural firing or long term adaptations in adopting new ways of perceiving things or hard-wiring changes.

A statement capturing the above sentiment is from Goodheart (1989) on healing, “People are healed by many different kinds of healers and systems because the real healer is within. The various healing modalities are merely different ways of activating the inner healer.” 1

Are you of the Mechanist (Rationalist) or Vitalist (Empirical) Approach?

The standard or “orthodox” medical practice in the U.S. follows a mechanist approach, where symptoms are perceived as bad and should be minimized or suppressed through surgical or pharmaceutical means. This seems great at the surface level. If something is causing me pain or discomfort let me do something to relieve or eliminate that pain. If I am having nausea or diarrhea because of something in my gut, let me take something to stop the vomiting or diarrhea. Underlying this “quick fix” of symptom alleviation is THE PROBLEM.  The body is trying to rid itself of the “problem” by expelling if forwards or backwards!  There are many medical conditions for which it is okay to consider treating symptoms, and for some this is vital.  However, it is preferable for this to be done in conjunction with identifying the source of the problem, so a long-term fix can be explored.

ChirocopractorA Vitalist approach views symptoms as part of the healing process, not a problem that should be hidden. Many branches of health care use this philosophy including: chiropractors, osteopaths, naturopaths, and practitioners of Chinese or Indian medicine advocate this Vitalist approach. By suppressing the symptoms, the practitioner may actually be extending the illness or exacerbating the problem. Researchers at the University of Maryland found taking aspirin for the flu may prolong the illness up to 3 days. Acetaminophen (Tylenol) or aspirin interferes with the normal fever response that fights the infection (Burke, 2000).

Listening to the Symptoms tell you Where the Problem Lies

Rather than reducing or eliminating the symptoms, what if we tried to increase our sensitivity to it. For example, if we took antibiotics to fight a bacteria, are we enhancing the body’s immune response to this foreign agent or “giving it” something to help, much like a crutch. A quote from unknown origin:

Give a man a fish, and you feed him for a day. Teach a man to fish, and you feed him for a lifetime.

This is at the heart of the Vitalist approach. The body is great at adaptation but we have to let it “learn” to adapt- not “feed” it some drug that forces it to do something. A quote from the Nobel Prize winner, Rene Dubos, Ph.D. remarks, “Good health is a process of continuous adaptation to the myriad of microbes, irritants, pressures and problems which daily challenge man.” This is also at the heart of exercise training. You must “overload” a system in order to get an improvement in function. You literally must stress it, and let it endure that strain in order to get the adaptation. Likewise, by putting your body in destabilized environments, you will gain a better sense of balance, in order to stabilize yourself.  Recent evidence has found that anti-inflammatory agents actually weaken the endurance training effect.

Fortunately, medical advances have allowed us to treat many illnesses effectively and safely, and it is always advisable to follow the advice of your doctor.  Allowing your body to adapt to certain stresses can be very positive in certain scenarios, but it is important to recognize when this doesn’t come at a risk of increasing morbidity, mortality, or increasing the likelihood of illness complications.

To Drug or Not to Drug: that is the Question

Prescription drugsNo one likes being depressed. About one in 10 Americans takes some sort of antidepressant medication. It is the most commonly prescribed drug in the U.S. according to a report published in the Archives of General Psychiatry (2009).  While the U.S. may not be a Prozac Nation, as popularized in 1994 by the author Elizabeth Wurtzel, the rates almost doubled from 1996 to 2005 (5.84% to 10.12%). A report in the Journal of the American Medical Association found it to work best in only severe cases of depression and exercise had similar effects in the short term treatment and better effects in long term treatment! The difficulty lies in getting someone to exercise when they are depressed. Thus, an integrated approach is often the best, and this includes psychological counseling as well.

Sometimes Less is More

A take away from this article should not be that standard medical care is bad. Far from it. Many M.D.s are very knowledgeable in areas outside of their standard practice and advocate expressive, rather than suppressive therapies. The take away should be to not rush for a drug to hide or mask your symptoms, but focus on what is the root of the cause, and take action to address this. The term iatrogenic is used for the inadvertent problem caused by a medical treatment. In fact, reports estimate it to be the third leading cause of death in the U.S. with 225,000 to 250,000 dying from iatrogenic diseases annually! While it is hard to say how many of these deaths could have been avoided, it is quite obvious that minimizing invasive treatments until they are necessary is the best plan of action.

Complementary or Integrated medicine can possibly have the answer to a majority of the health issues presented. The Medical Fitness Network believes those professionals are the future of health care.


Dr. Mark Kelly Ph.D., CSCS, FAS, CPT has been actively involved in the fitness industry spanning 30 years as a teacher of exercise physiology at academic institutions such as California State University, Fullerton, Louisiana State University, Health Science Center, Tulane University and Biola. He was an exercise physiologist for the American Council on Exercise, a corporate wellness director, boot camp company owner and master fitness trainer.

doctor-health

Adaptive Health Paradigm: A Principle-Centered Perspective for Medical Fitness

I hope to give you some insights to both how the human body works as well as why medically-based fitness is not only valid, but absolutely necessary to reverse, assist, or prevent various chronic and acute disease conditions.  Wow, that is a “mouthful” to say the least. I feel so strongly about this perspective that I hope to create the Adaptive Health Model as a major “brand” of fitness. My company (Principle-Centered Health) for the past couple of decades has always had a systems-based approach to health and fitness. This approach ties a lot of different facts into a common theme, usually called a theory in science. Even my dissertation looked at how people adapted to the physical, mental and social issues in their lives using exercise, self-efficacy, and social support, respectively, and levels of strain and burnout. How humans adapt to the stresses put on them is very specific and can go in good or bad directions.

What is the Adaptive Health Paradigm?

Like most theories, paradigms or what people consider “original thought”, this “adaptive” paradigm builds on the “regenerative medicine” framework, and some disease models; thus, is not original at all. What may be new, or unique about the adaptive perspective is taking the old phrase from physicist Isaac Newton and his third law of motion, “for every action there is an equal and opposite reaction.” The body will respond to stresses by reacting in a “defensive” manner. If we break something down, the body builds it up (opposite reaction). If we are too low or too high in some function, the body will try to correct this. This negative feedback loop controls most systems in our bodies. I have often described our bodies as fragile but resilient. It is our fragility that signals the resilience to kick into gear!

Luckily for us, fitness is based on this exact principle. If we do endurance training, we are going into a lower oxygen state and there are many mechanisms or functions that kick in (sympathetic nervous system) when we push or stress our bodies. The body is responding to what is known as an “acute insult” by increasing the ability to transport and use oxygen, so that this “insult” doesn’t hurt us next time. The same “specificity of training principle” occurs with resistance training. We breakdown muscle and the body builds it back stronger to tolerate that “insult” the next time. When multiple acute exercise stresses are added up, the body changes and we call this “training”.

If stresses are really high, either too intense, too long, or too often, the body gets injured due to this overload, or it needs a lot more time to heal back up. This is why overload needs to be done gradually and progressively. Even our brains use this idea as a guiding principle. We push our mental capacities to learn more, but if we stress it too much, it will repress memories or shut down (burnout).

This same principle applies when we give our body bad things, or a lack of good things, it adapts with a dysfunctional state or disease state. Chronic inflammatory diseases, diabetes, metabolic syndrome, coronary artery disease, emphysema and heart disease are just a few of the examples of how the “garbage in and garbage out”, or “use it or lose it” works. If we sit and work at the computer too much we develop dysfunctional postures and upper cross syndrome may develop. If we do not constantly stress some system, it reverses the training changes, and goes into the “default” state, which is untrained and unable to respond to daily stresses. We simply need to obey our bodily blueprints, we need to constantly use our bodies to maintain function, and overload it to improve function. We need to have the right nutrients in place to allow this to happen, and then basically – get out of the way!

Intelligence in the Body – Applications the Adaptive Health Paradigm

The perspective being proposed in this article shares much with the more holistic medical practices. The human body is really good at healing itself when is it given the right factors to do so, and when we “get out of the way” for it to do so. I know many people who strongly believe in using alkaline water to “cure their ills”. They believe that the body does not know how to regulate itself with its own pH.  Most of these same people don’t know what pH even stands for! They don’t know that it is actually the inverse log of the hydrogen ion concentration relative to the hydroxide ions, and that the respiratory system and renal system will go into action as soon as blood pH goes 0.05 pH units high or low!

In other words, these people believe their own bodies are naïve or incapable of curing itself, and like a young child or baby, their body needs constant care and guidance. Most people are so stressed about “taking care” of their bodies that they are doing more harm than good via the stress hormones, especially cortisol being constantly secreted and their adrenal gland is getting fatigued. In reality, the body is really good at healing itself, when we keep it strong and in good operating condition (via exercise and movement) and when we give it the right components to do the healing (via nutrition), and we get out of the way of the immune system (by managing our daily stress levels).

The mind works very much like a muscle. It must be trained and kept strong and when injured it will react in dysfunctional ways, and fight to protect itself. I recently heard an expert in human behavior change speak on how to keep a resolution. He said, we can’t keep a resolution without changing the underlying behaviors which caused the bad habit or lack of a good habit in the first place. By changing the way we think, we change the way we act, and changing our actions will change the way we think!

“What goes Around, Comes Around”

The quote often stated by Thomas Edison in 1903, which was to give rise to the HMO concept, “The doctor of the future will give no medicine, but will interest his patient in the care of the human frame, in diet and in the cause and prevention of disease.” Medical doctors (M.D.s) upon completing medical school and prior to practicing take the Hippocratic Oath, which is to do no harm. Even back in Ancient Rome, Hippocrates understood the importance of individualized medicine and the power to “get out of the way” (#5) and give the body what it needs to take care of itself. He had five rules that are still relevant in today’s medical practices.

  1. Walking Is Man’s Best Medicine.
  2. Know What Person the Disease Has Rather Than What Disease the Person Has.
  3. Let Food Be Thy Medicine.
  4. Everything in Moderation.
  5. To Do Nothing Is Also a Good Remedy.

Integrative and Functional Medicine – Highly Inclusive and Holistic Perspectives

A philosophy of practice using these practices is integrative medicine. A brand of medicine created or at least popularized by Andrew Weil. The University of Arizona has this “brand” of medical school. Again, the academic requirements are similar to the M.D. and D.O. but expands its scope to other areas. From the website, Integrative Medicine (IM) is defined as a “healing-oriented medicine that takes account of the whole person, including all aspects of lifestyle. It emphasizes the therapeutic relationship between practitioner and patient, is informed by evidence, and makes use of all appropriate therapies. many different ways in the patient.
A new type of medicine is emerging from this Functional perspective which is called personalized medicine. Again, the two are basically two sides of the same coin.

Figure 1: A diagram above showing the greater scope of each medical perspective- Integrative and Functional medicines are close in their holistic perspectives, with differing points of emphasis


What is going on within the individual to cause the disease or prolong its existence?

Sometimes disease hits simply because we were genetically predisposed to get it. However, very often if our system is strong and in good operating condition, we resist it from every occurring or overcome it quite quickly. Cancer is a prime example of this. We all have cancers in our bodies all the time. It is the strong immune system that fights it off. This is amongst the reasons that many, many chronic diseases hit us when we are old. The various system have lost their capacity to fight the dysfunction off, or recover from its destruction. Soon cell death (necrosis or apoptosis) or neoplastic (cancer) growth kicks in.

Harnessing the Power of Exercise and Diet to Fight Chronic Disease

Many, many chronic conditions that the MedFit Education Foundation/MedFit Network addresses are helped by exercise and diet because the ability of body to adapt and regenerate itself is enhanced. Most systems in our body fall under the “use it or lose it” scenario. High sugar, alcohol, smoking, and lack of movement are culprits in our health. Our body is not designed for an overload of these factors and across time, many different symptoms will develop because our body can no longer compensate or regenerate.

It is important for the medical fitness professional to understand the power of exercise and nutrition, and the proper application of these tools given the client’s or patient’s current condition. The field of physical therapy developed because many musculoskeletal conditions are helped by movement therapy or exercise. Many chiropractors believe that proper spinal alignment delivers proper neural signals throughout the body, which allows the body to optimize its regenerative capacity.  Thus, an expert in medical uses of exercise to combat disease is critical to a healthcare team.

Join Dr. Mark Kelly at the Medical Fitness Tour in Irvine, CA! Dr. Kelly will be a presenter for the Aging Stronger pre-conference workshop on Friday, February 8, and the session Using Exercise and Diet to Fight Alzheimer’s during the main conference on Sunday, February 10. Click for Event Details


Dr. Mark Kelly Ph.D., CSCS, FAS, CPT has been actively involved in the fitness industry spanning 30 years as a teacher of exercise physiology at academic institutions such as California State University, Fullerton, Louisiana State University, Health Science Center, Tulane University and Biola. He was an exercise physiologist for the American Council on Exercise, a corporate wellness director, boot camp company owner and master fitness trainer.

References

Center for Integrative Medicine, Univ. of Arizona (n.d.). What is IM/IH? Retrieved from: https://integrativemedicine.arizona.edu/about/definition.html

Science Daily (n.d.). Personalized medicine. Retrieved from: https://www.sciencedaily.com/terms/personalized_medicine.htm

Good Reads (n.d.). Retreived from: https://www.goodreads.com/quotes/13639-the-doctor-of-the-future-will-give-no-medication-but

Kalish, N. (2018). Hippocrates’ Diet and Health Rules Everyone Should Follow. Reader’s Digest. Retrieved from: https://www.rd.com/health/wellness/hippocrates-diet/

senior-exercise-trainer

Exercise and Dementia: Thinking Differently about Thinking

Many people are aware of the devastating effects dementia and Alzheimer’s disease (AD) has on families. I know this devastation personally, as my mother suffers from advanced stages of AD. It is very sad to have only the body present of someone you have known and loved your whole life! This article will discuss some of the newer developments in understanding and possibly reducing the disease, as well as the positive role exercise may have in slowing the onset and development of symptoms, and disabilities for any form of dementia.

The impact on family units and caretakers is even greater and can’t be measured by financial impact. Dementia is a group of symptoms that affect mental tasks like memory and reasoning. Dementia can be caused by a variety of conditions, the most common of which is Alzheimer’s disease. Alzheimer’s disease accounts for 60 to 80 percent of dementia cases (http://www.alz.org). Much of the recent attention to professional football players and the repeated brain trauma is due to the increased incidence of dementia, not Alzheimer’s. Dementia is characterized by loss of memory, intellectual capabilities and executive functions.

Alzheimer Concept.According to the Alzheimer’s Association, in 2015, 5.3 million Americans are believed to have this incurable disease. The cost of Alzheimer’s to the U.S. is $226 billion, and this figure is estimated to more than quadruple to $1.1 trillion by 2050 unless some major discoveries are made. It is the 6th leading cause of death behind heart disease, strokes, and cancer but it is the only one that cannot be prevented. One in three seniors will die with some form of dementia. Alzheimer’s is far more prevalent in women, with about 3.2 of the 5.1 million people, or 2/3rds, being women. The Baby boomer generation should cause the number of those affected to swell to 7 million, which may double by 2050. (http://www.alz.org/facts/overview.asp).

Factors Associated with Alzheimer’s Disease

While no one really knows exactly what causes Alzheimer’s disease (AD), there are several factors that are highly associated with it, and even some treatments that seem to slow its progression and onset. The two most prominent factors associated with AD are age and family history.

After age 65, the risk of Alzheimer’s doubles every five years. After age 85, the risk reaches nearly 50 percent. A type of AD is known as early onset or younger onset. This term actually is used for two types, a risk and deterministic form. Both may start in someone’s 30s or 40s and if someone has the gene it is 100%. This “determined” form is rare, accounting for only 5% of the total cases. Research has shown that those who have a parent, brother, sister or child with Alzheimer’s are more likely to develop the disease. The risk increases if more than one family member has the illness.

Biomarkers of Alzheimer’s Disease

  1. APOE genes
  2. Neuro-tangles associated with the Tau protein
  3. Beta amyloid plaques- a protein clump found in the brain- disrupting communication
  4. Inflammation
  5. Decreased brain size

(http://www.alz.org/research/science/alzheimers_research.asp)

When diseases tend to run in families, either heredity (genetics) or environmental factors, or both, may play a role. There are two categories of genes influencing a person developing a disease: risk genes and deterministic genes, both of which are present in Alzheimer’s disease.

Risk genes increase the likelihood of developing a disease, but do not guarantee it will happen. Researchers have found several genes that increase the risk of Alzheimer’s.  Apolipoprotein (APOE)-e4 is the first risk gene identified, and has the strongest impact on disease risk. APOE-e4 is one of three common forms of the APOE gene; the others are APOE-e2 and APOE-e3.

Those who inherit one copy of APOE-e4 have an increased risk of developing Alzheimer’s and those with two copies have an even higher risk, but still not a certainty. In addition to raising risk, APOE-e4 may tend to make symptoms appear at a younger age than usual (early onset). Scientists estimate that APOE-e4 is implicated in about 20 to 25% of Alzheimer’s cases.

Brain Size and Function

We often associate brain size with cognitive capacities and for the most part this relationship holds true. While it is very difficult to measure any increase in mass due to neuroplasticity, we can measure increase activity in the brain due to exercise, or decreased activity from AD and other dementias.

How can Exercise and Diet Help

senior-exercise-trainerIt is important to understand some of the limitations of exercise and diet in helping either dementia or AD. First of all, one must separate non-Alzheimer’s dementia from Alzheimer’s, and then must understand what stage of AD the individual is in. Finally, one must realize if the symptoms have already manifested (onset), and then monitoring the progression.

Exercise has a more pronounced effect on helping decrease progression and even reversing some symptoms with non-Alzheimer’s dementia.  In addition, the earlier someone is able to perform preventative actions, the greater the effect those therapeutic actions will have. Exercises that really activate the brain such as dance, yoga, and new sports or techniques are the best for prevention.

By exercising regularly throughout your life you will lower your incidence of getting Alzheimer’s by 50% and by doing mental exercises with the physical exercises may lower your chances by 70%! This reduction would not apply to those with deterministic genes but it would for others.  Some researchers believe exercise can both delay onset and reduce symptom severity no matter what the cause.

Aerobic exercise in particular causes a release of brain derived neurotropic factor, which has been labeled as “Miracle Gro for the Brain” by the author of SPARK, John Ratey, M.D. In addition, aerobic exercise causes some angiogenesis or the development of additional circulation to the brain. When the brain cells receive more blood, they get more oxygen, and thus function better.

Other side benefits of exercise are the muscle strengthening and enhanced balance and activation of postural muscles. Many Alzheimer’s patients will be at risk for falls and disturbed gait patterns. A consistent exercise program can delay and slow these issues even in somewhat advanced stages.

The dosage is the same as that for the general public or 150 minutes of moderate activity a week. It is important not to push an Alzheimer’s patient into exercise. Many AD victims can become agitated quite quickly and the stress is unwarranted. Simply walking is the best exercise. Make sure the walking path is smooth and not filled with obstructions or difficult terrain.

In an article from Science News, “Walking slows progression of Alzheimer’s”, Cyrus Raji, Ph.D., from the Department of Radiology at the University of Pittsburgh in Pennsylvania, mentions, “We found that walking five miles per week protects the brain structure over 10 years in people with Alzheimer’s and MCI, especially in areas of the brain’s key memory and learning centers. We also found that these people had a slower decline in memory loss over five years. 

The type and magnitude of exercise needs to be carefully monitored with advancing Alzheimer’s or dementia but in those with mild cognitive impairment, a “healthy dose” of both resistance and aerobic exercise is advocated.

Register for Dr. Kelly’s upcoming webinar:


Dr. Mark Kelly Ph.D., CSCS, FAS, CPT has been actively involved in the fitness industry spanning 30 years as a teacher of exercise physiology at academic institutions such as California State University, Fullerton, Louisiana State University, Health Science Center, Tulane University and Biola. He was an exercise physiologist for the American Council on Exercise, a corporate wellness director, boot camp company owner and master fitness trainer.