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The Roles of a Medical Fitness Practitioner: Scope of practice, prevention and interprofessional collaboration

Physical activity is any bodily movement produced by voluntarily contracting skeletal muscle that results in energy expenditure above a basal level. Physical activity has been demonstrated to positively affect over 30 chronic conditions and is considered the best deterrent of chronic disease in primary and secondary prevention. The main goal of a Medical Fitness Practitioner (MFP) in the healthcare continuum is to prevent the onset of chronic disease and bridge the gap between clinical intervention and conventional fitness programs. This is achieved by developing exercise programs for those who have, or are at risk for chronic disease or dysfunction, have health conditions that may be mitigated or managed by exercise and activity, are newly diagnosed with disease and need exercise guidance, or have completed a medically supervised rehabilitation program and need to continue to progress. A fitness professional versed in medical fitness protocols, such as an MFP, can work with those who are at risk for chronic disease.

Scope of Practice

Scope of practice refers to boundaries set by knowledge, skills and abilities (KSAs), as well as education, experience and demonstrated competency, such as a program of study, or an exam to measure proficiency. A basic personal training certification suggests the holder can develop exercise programs for apparently heathy clients. Unfortunately, considering the overweight and obesity rate is near 70%, and 50%-60% of the adult U.S. population has at least one chronic disease, adhering to scope of practice becomes increasingly important, yet at the same time many fitness professionals may be providing services outside their scope of practice, and beyond their level of certification. By accepting a client, the trainer is proposing a safe workout will be developed and implemented, and the client will not be at risk of injury. If advice is given that is not within the trainer’s scope of practice, the trainer and the facility may be subjected to a lawsuit.

An MFP who integrates medical fitness into practice has the KSAs, based on education, experience and demonstrated competency to conduct pre-participation interviews, perform fitness assessments and to design and implement health and fitness programs for disease management to avoid future injury and to improve activities of daily living. Unlike an MFP, unless otherwise educated, a fitness trainer who promotes medical fitness is not a licensed healthcare provider and does not possess the KSAs to diagnose an unknown condition, suggest supplements, design meal plans, physically touch a client or provide behavioral counseling.

Prevention

In the United States, medical care tends to focus on treatment rather than prevention. Whereas treatment is given for a diagnosed disease or injury, the goal of prevention is to avoid, improve or slow down the progression of a probable or possible disease or injury. Prevention can be categorized as primary, secondary or tertiary. The goal of primary prevention is to foster a life of wellness and therefore avoid or reduce the chance of disease or dysfunction. Primary prevention includes immunizations, targeted types of exercise, balanced nutrition and wellness and education programs. Secondary prevention is managing a symptomatic disease in the hopes of slowing down or reversing the progression. Examples include treatment for hypertension, asthma and some cancer treatments. Tertiary prevention involves the management and treatment of symptomatic disease with the goal of slowing progression and severity, as well as reducing disease related complications. Tertiary prevention includes treatment for late stage cancer, coronary heart disease and some types of rehabilitation to include orthopedic, cardiac and pulmonary. Physical activity has been demonstrated to effectively treat over 30 chronic conditions, mostly in primary prevention but also in secondary and tertiary, making it the number one intervention against chronic disease.

Interprofessional Collaboration

Due to the growing incidence of obesity and chronic disease, leveraging the skills of various providers who can collaborate to deliver the best possible care, based on clinical needs, is necessary to manage the complex health care demands of a population with an increasing incidence of comorbidities. Due to a worldwide shortage of health workers, in 2010, the World Health Organization (WHO) recognized interprofessional collaboration as means to mitigate the global clinician shortage, strengthen health systems and improve outcomes. Interprofessional collaboration refers to health care teams, made up of trained professionals with various backgrounds, who work alongside patients and their families to provide high-quality care, based on the needs of the patient. Consequently, as medical providers begin to recognize the need to prescribe evidence-based exercise as an intervention in the management of chronic disease, MFPs, who are on the front line of health care, are trained and educated to be part of a clinical team that complements and leverages the strengths of each team member to improve population health. As health-science and technology advance, it is imperative for fitness professionals who work with clients who have one or more chronic disease to remain up-to-date on emerging fitness protocols. An MFP is required to participate in continuing education in areas including cardiopulmonary disease, metabolic disorders and orthopedic dysfunction.

Although the scope of practice of many allied healthcare fields overlap, the role of the MFP is to work with the client’s team of other healthcare providers, while staying within the scope of practice, based on KSAs. Regardless of the collaborative health team, the client’s physician is always the center, and as such should be provided regular updates as to the client’s progress.

An MFP is uniquely qualified to work with individuals within the healthcare continuum. Some KSAs associated with MFPs are:

  • Knowledge of basic chronic disease pathophysiology
  • The use and side effects of common medications taken by someone suffering from a chronic disease
  • The knowledge to perform and analyze basic assessments related to movement and anthropometry
  • The knowledge to design a safe and effective workout based on information received via assessment results, and the clinical recommendations from other healthcare providers
  • FITT protocols, exercise progressions and regressions
  • The implications of exercise and activity for individuals with chronic disease
  • Contraindications of chronic disease, and signs and symptoms of distress related to chronic disease
  • Knowledge of signs and symptoms that require expertise outside of the scope of practice for medical exercise
  • The ability to recognize a medical emergency
  • Current CPR and adult AED are required

This article was featured in the summer 2020 issue of MedFit Professional Magazine. Click to read the latest issue and get your free subscription.


Dan Mikeska has a doctorate degree in Health Science and a master’s degree in Human Movement, as well as certifications from NASM, ACE, the Cancer Exercise Training Institute and the Exercise Is Medicine credential from ACSM. He currently owns NOVA Medical Exercise and Medical Exercise Academy and is adjunct faculty for A.T. Still University’s Master of Kinesiology program. Dan’s mission is to improve population health and to increase the quality of life by connecting education, medicine and fitness. 

Female-Trainer-and-older-male-client

The Commodification of Medicine and Fitness: The Good, the Bad, and the Ugly

The need for medical and fitness services/products continues to grow. In the United States, and around the world. The corporate and industrialized delivery of medical and fitness products/ services continues to grow to meet increasing demand. Innovations in medical diagnostic technologies, surgical procedures, biomaterials, and medicines help individuals live longer, and with a higher quality of life. Technology and scientific research are propelling fitness product/service innovation with digital activity monitoring apps . . .

sun-behind-the-storm

Interesting Times for Interested People

So, we are all shut in our homes and are not supposed to go to work, movies, or restaurants to dine in, and we can’t even watch live sports on TV. Life is so bad, and unfair… or is it?

I have decided to look at the bright side of this event, and see it as an opportunity. While many are not in my particular position, and are actually out of job and income due to this pandemic, I want you to reframe it. Change the paradigm of this being a negative, to this being a time for catching up, reflecting, and perhaps actually changing yourself.

We all have parts of our lives that need attention. In today’s current society, it is basically impossible to be all things to all people, including ourselves. We must try to balance job, family, social contact, social media, our own diet, hobbies, medical attention, our education — professionally or otherwise, our spirituality, and even our environment. Having balance in a variety of areas is true wellness! We are often so busy teaching and preaching the benefits of fitness and wellness to others, we deny it to ourselves. I remember doing a self-survey several decades ago by some program discussing the “wellness wheel”, which many of you have probably heard of. The survey was showing areas that needed attention. (Back then I had a very lop-sided wheel, and it is not much better now.) The wheel consisted of a mnemonic (6 components. It has shifted slightly in past few decades, but the pneumonic still works well: SPICES.

Old Wellness Areas New Wellness Areas
S-ocial Social – all interactions with people outside of ourselves
P-hysical Physical – our physiological status
I-ntellectual Intellectual – includes cognitive and emotional health
C-ognitive Career – includes educational and skill acquisition and financial health
E-motional Environmental (could include emotional) – clean, organized?
S-piritual Spiritual – interactions with entities beyond people

I want to use this as a time to clean up many things that have been neglected — both around my house and inside “my house”, my physical body and mental space. I may even use this opportunity to shift my professional pursuits away from academic teaching to wellness coaching. Maybe I can chat on the phone more, spend time with my daughter, or spend more time cooking or reading. Whatever it is, start doing it now!

If nothing else, this has opened the world’s eyes to the need to stay healthy. It has shown people the need to be sanitary and practice good old-fashioned health care techniques, like washing hands and not running out of toilet paper! (Sorry, had to throw that one in!)

As an educator in both physical health and medical applications, we are perfectly positioned to show the communities we live in how to harness the power of exercise for both preventative and rehabilitation purposes. I have learned many new applications for teaching online and most people are focused on coming together for the “greater good”, and this is a breath of fresh air.

Good luck and stay healthy as you address the holistic health agenda in our society.


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.

stressed at computer

Stress and the Psychology of Heart Health

Most of us accept stress as a necessary evil that is a part of the American lifestyle. But living under stress day in and day out can lead to heart disease. According to the American Psychological Association, prolonged stress can contribute to high blood pressure and circulatory problems, and if stress makes you angry and irritable, you are more likely to have heart disease or even a heart attack.

trainer-resistance-band-senior-woman-client

You Are The Solution

This article is meant to be a wake-up call to the fitness industry. The health of our population and country are at stake. While advancements have extended our country’s overall lifespan, it has occurred primarily through the use of medications and life-saving procedures rather than through lifestyle changes. The stark reality is that the overall health of Americans is declining as evidenced by the $3.5 trillion spent every year on health care expenditures.

Another alarming statistic is that between 1997 and 2016, there were approximately 4.5 billion prescriptions written per year. 70% of Americans take at least one and 20% take five or more prescription medications (Preidt 2017). The majority of these medications were taken to address lifestyle-related diseases and the subsequent impacts of poor nutrition choices and lack of physical activity. Additionally, many prescription and over-the-counter medications are used to treat osteoarthritis, the most common cause of physical disability in the world. While genetics, weight, and age have been considered as underlying factors, the decrease in quantity, as well as quality, of physical activity have been shown to be much greater factors to the onset and prevalence of osteoarthritis in modern society (Wallace 2017, Osar 2018).

While often attributed to causes outside one’s control (i.e. genetics), the fact is that the diseases contributing to the greatest number of deaths (heart disease, cancer, and Type 2 diabetes) and disability (osteoarthritis) are directly related to controllable factors. While each has a genetic component, lifestyle has a much greater impact on the incidence and prevalence of these diseases. One of most important and underappreciated components in the overall decline in one’s physical, physiological, and cognitive health, is the lack of physical activity. Less than 20% of the population meet the daily physical activity guidelines and less than 5% of the adult population participates in 30 minutes of physical activity. Even more disturbing is that more than 78 million U.S. adults and 12 million children are obese.

Dr. Caldwell Esselstyn has been attributed with the quote, “Genetics loads the gun, lifestyle pulls the trigger.” This suggests that lifestyle is as important as genetics in the expression of many chronic diseases. This sentiment is reiterated in a recent study from Bodai et. al (2018). “Epidemiological, ecologic, and interventional studies have repeatedly indicated that most chronic illness, including cardiovascular disease, cancer, and type 2 diabetes, are the results of lifestyles fueled by poor nutrition and physical inactivity.”

The health of our population and country is at stake. This is a call for fitness professionals to step up and recognize that you are the first line of defense against the deleterious impacts of lifestyle diseases. It is your responsibility to educate your communities that lifestyle changes, incorporating proper nutrition as well as increased physical and cognitive exercise, should be the first step in addressing chronic lifestyle diseases. You can continue to change the health of our nation by implementing evidence-based nutrition, exercise, and cognitive training programs. Be the solution your clients, your community, and our country needs by investing in advanced education in nutrition, exercise, movement, and cognitive training. Create relationships with allied health professionals so that we can collectively educate, collaborate, and coordinate the changing of our nation’s health care system.

This article was featured in MedFit Professional Magazine Winter 2020 issue. Subscribe to MedFit Professional Magazine to read more great content like this!


Dr. Evan Osar, an internationally recognized speaker, author, and expert on assessment, corrective exercise, and functional movement. Dr. Osar is committed to educating and empowering fitness professionals while helping them develop relationships with allied health professionals. He is author of the Corrective Exercise Solutions to Common Hip and Shoulder Dysfunction and has developed the industry’s most complete training certification, the Integrative Movement Specialist™. With his wife Jenice Mattek, he created the online educational resource. For more info, visit IIHFE.com

References

Bodai, B. I., Nakata, T. E., Wong, W. T., Clark, D. R., Lawenda, S., Tsou, C., … Campbell, T. M. (2018). Lifestyle Medicine: A Brief Review of Its Dramatic Impact on Health and Survival. The Permanente journal22, 17–025. doi:10.7812/TPP/17-025

Centers for Disease Control and Prevention. Osteoarthritis. Retrieved from https://www.cdc.gov/arthritis/basics/osteoarthritis.htm

Centers for Disease Control and Prevention. Leading Causes of Death. Retrieved from https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm

Centers for Medicare & Medicaid Services. National Health Expenditure Data. Retrieved from https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsHistorical.html

Osar, E. (2018). The Fundamentals for Training the Older Client with Osteoarthritis. Retrieved from https://www.ptonthenet.com/remote-learning

Preidt, R. (2017). Americans Taking More Prescription Drugs Than Ever. https://www.webmd.com/drug-medication/news/20170803/americans-taking-more-prescription-drugs-than-ever-survey

U.S. Department of Health & Human Services. Facts and Statistics. Retrieved from https://www.hhs.gov/fitness/resource-center/facts-and-statistics/index.html

Wallace, IJ., Worthington, S., Felson, DT., Jurmain, RD., Wren, KT., Maijanen, H. Woods, RJ., Lieberman, DE. (2017). PNAS. 114(35): 9332-9336.

med-fit-client-doctor-exercise

Healthcare Through Fitness

A discussion of medical fitness is rooted in an understanding of the health benefits of fitness and exercise. The documented benefits are endless and include management of chronic disease, management and prevention of osteoporosis, improved mood and sleep disorders, stress relief, management and prevention of obesity.

Health agencies across the spectrum of public health and disease-specific organizations recognize and promote exercise and fitness as an integral part of the management of chronic disease; diseases that include diabetes, cardiovascular disease, Parkinson’s, depression, multiple sclerosis, and arthritis, among others.

If fitness and exercise are well accepted as part of the management strategy for multiple diseases, why is it that access to organized exercise plans, and fitness professionals who can help implement those plans, are not a standard part of the medical treatment paradigm? Why is it not a standard benefit covered by common medical insurance policies?

The reasons are multifactorial and a reflection of the overall healthcare conundrum in our country today. Let’s focus, however, on how to make a change. We need to focus on how to integrate fitness professionals into the medical paradigm. A perfect model for this is an integrative medical fitness center.

What is a medical fitness center? It is a fitness facility with a multidisciplinary staffing approach and has the following characteristics:

  • Regular medical oversight by a medical director
  • Practitioners with nationally-recognized certifications and training in the care of chronic disease
  • Comprehensive health assessments and exercise prescription
  • Exercise classes geared toward specific medical conditions

These centers bring together credentialed staff in a collaborative way to provide exercise prescription plans specific to the needs of an individual with chronic disease.

The concept of the medical fitness center is not new; many currently exist in communities throughout the United States. However, an understanding of their importance in the context of the current healthcare environment has grown. The idea of creating “medical homes” that are collaborative across disciplines and provide a comprehensive healthcare approach is now being recognized to provide a high standard of care while simultaneously decreasing overall healthcare costs. This is true specifically for high-risk individuals who suffer from chronic disease.

Further integration of medical fitness centers, and broad access to exercise and fitness resources, will hopefully become standard of care and widely accessible to all individuals, especially those with chronic disease. This integration will inherently bring fitness professionals into the paradigm of healthcare and promote healthcare through fitness.

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

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


Dr. David Kruse attended medical school at UC San Diego, after graduating from UC Berkeley. He holds board certifications in family and sports medicine. He practices sports medicine with the Orthopaedic Specialty Institute, in Orange, CA. Dr. Kruse is the Chief Medical Officer for the MedFit Network and on the Medical Advisory Board for the MedFit Education Foundation. He is currently a Team Physician for USA Gymnastics, Orange County Soccer Club, and Biola University. Visit his website, krusesportsmd.com

healthy-eating-path

Reducing Calories May Help You Live Longer

Mounting evidence suggests that we may be able to live a longer, healthier life by strategically restricting our energy intake. For many years the scientific community has known that a surplus of energy intake results in the storage of fat, which is linked to chronic disease, and premature death. However, now emerging evidence suggests that restricting calories may be able to slow the rate in which we age. Aging can be categorized as either primary or secondary. Primary aging is considered inevitable at the date of this publishing and is the biological maturing and eventual breakdown that accompanies the years of age beyond 30.  Secondary aging comes from external influences such as obesity and lifestyle factors that cause cellular damage and is not part of the natural aging process. (2)

What is calorie restriction? Calorie restriction describes a process where one limits the amount of food they consume. The term calorie is a shortened term originating from kilocalorie and is used as a measurement of food energy. When the body has an excess of calories beyond what it needs to function it stores those calories in our body as fat. Despite the diet industry’s most sincere efforts and propaganda, studies still do not support the effectiveness of one fad diet over another for weight loss. (13) This means, weight gain, and weight loss are ultimately determined by the number of calories consumed, and the number of calories expended.

Earlier we identified obesity as contributing to secondary aging. The scientific community has established that being overweight, or obese dramatically increases your risk of cancer, heart disease, and type II diabetes, among other chronic disease, thereby reducing life expectancy. In fact, people that are 100 pounds or more overweight can expect a life expectancy that is nearly 14 years less than the national average. This is a shorter life expectancy than that of someone who is of a healthy weight and smokes cigarettes. (3, 12) A calorie reduction below what your body is expending results in weight loss, and for those who have a higher than healthy level of body fat, can expect a reduction in not just their weight but in secondary and primary aging.

There are many misconceptions of what constitutes being overweight or obese.  A person is classified as being overweight if they have a BMI (body mass index) of 25 or higher, and obese if they have a BMI of 30 or higher. BMI is calculated by dividing your weight in kilograms by your squared height in meters. BMI is likely a fair indicator if you are relatively inactive. If you are engaged in a fitness program or are an athlete, an alternative approach to determining healthy weight is by determining percentage of body fat. A healthy body fat is typically considered to be between 8-22% for men and 20-35% for women (aged 18-34).  A classification of obese may be assigned if someone has a body fat percentage of 26% or higher for men and a body fat of 39% or higher for women. (7) As always if you’re not sure where you fit into these metrics see a credentialed fitness professional or consult with your primary care provider.

It is estimated a calorie deficit of 200-500 calories daily is required to achieve healthy weight loss. Two ways to achieve this deficit are to reduce calorie consumption and increase calorie burn (expenditure). Calorie burn can be increased through additional physical activity; however, it should be cautioned that one can consume calories at a far faster rate than physical activity can burn them. As an example, it is estimated that a 180-pound man burns approximately 14 calories per minute jogging (1). As a point of reference, a single Hershey kiss contains 22 calories.  The lesson here is to use physical activity in addition to a nutritious diet, not in place of a nutritious diet.  (For more information on a nutritious diet visit choosemyplate.gov.) Give special attention to the section on vegetables, especially non-starchy vegetables as they are high in vitamins and minerals and low in calories.

For persons of a healthy weight, calorie restriction appears to offer slowed primary aging. The current school of thought is that primary aging is slowed as a result of a protective cellular reaction triggered by the calorie restriction. There is still much we do not know about the mechanisms responsible for this anti-aging phenomenon and some debate among scientists exists. However, the most common consensus among scientists is that this reaction collectively comes from activating sirtuins, increasing AMPK, impacting MTOR, and an improvement in blood sugar. (8,10,15,16,17,18) If you do not know what any of that means here’s a quick break down but don’t fret if you are not familiar with the lingo.

  • Sirtuins are responsible for DNA expression and control acetyl groups, as well as activate the mitochondrial antioxidant function. (8,16,17) Oxidative damage is believed to play a role in primary aging. Acetyl groups are important because they control the energy that proteins use during cell replication.
  • AMPK (Adenosine Monophosphate Protein-activated Kinase) detects the presence of nutrients or prolonged absence of nutrients, which then triggers the fragmentation/breakdown of damaged mitochondrial components (mitochondria are the powerhouse of the cell) that need to be rebuilt, increasing mitochondrial health and efficiency. (4,16,17)
  • MTOR (mammalian target of rapamycin), specifically TORC1 regulates protein building and cell growth. It is theorized a reduction in TORC1 and in turn a reduction of cellular division results in reduced DNA damage, and less inflammation. (11,17)
  • In terms of handling blood sugar, there are two important molecules at work. These proteins are Thioredoxin-interacting protein (TXNIP), and Thioredoxin-1. When TXNIP is stimulated by insulin (which results when we eat) cell stress resistance is reduced resulting in increased oxidative damage to DNA. It is theorized that during calorie restriction, Thioredoxin-1 increases which increases oxidative stress resistance, increases nonoxidative glucose disposal, and increases insulin sensitivity (improves use of insulin and absorption of sugar) as well as reduces damage to DNA (and thus slowed DNA aging) (10,15).

Regardless of how precisely these mechanisms work or interact what we currently believe and have pieced together is a reduction in calories likely:

  • Triggers a protective response in the body that helps:
    • Protect mitochondria from free radical damage (mitochondria are the energy makers of the cells)
    • Increases cell sensitivity to insulin and in turn increases absorption of blood sugar into the muscle
    • Induces cellular stress resistance and cell cleansing, which shuts off cell replication. Think of cell replication like a copy machine, if you do not use the original for each copy, but instead use a copy to make a copy, each time the copy gets blurrier. This is thought to also occur in our cells, therefore the less copies we make or the slower we make them the slower the aging process occurs.
  • Appears to reduce risk of age-related diseases such as heart disease, cancer, and diabetes.
  • Begins at 10%-40% reduction in calories per day (from normal)
  • Starvation is too far! You still need to get the vitamins, minerals, and nutrients required to aid your body in recovery, and immune function otherwise your efforts will be counterproductive, which can be done by increasing your consumption of non-starchy vegetables.
  • Calorie restriction can be accomplished by all types of fasting schemes. For example, fasting can take place daily for 12-16 hours, every other day, or over the weekends only. The important thing is achieving that 10%-40% reduction while still getting the proper nutrition necessary. (5)

The takeaway here is achieving and maintaining a healthy weight is the first step to a healthy lifespan and the incorporation of strategically fasting, may bring additional health and longevity. Fasting has been embedded in our culture in many ways from traditional religious observances as well in the fitness industry, but the question is what scheme and plan will work best for you. Most would agree it’s the health span (length of superior quality of life attributed to good health) more than the lifespan that’s important, and while there is currently no fountain of youth this appears to be a good place to start.

Remember, of course, to consult with your primary care provider before undergoing dietary changes.


Jeremy Kring, holds a Master’s degree in Exercise Science from the California University of Pennsylvania, and a Bachelor’s degree from Duquesne University. He is a college instructor where he teaches the science of exercise and personal training. He is a certified and practicing personal/fitness trainer, and got his start in the field of fitness training in the United States Marine Corps in 1998. You can visit his website at jumping-jacs.com

References

  • American Council on Exercise. (2009). Retrieved from https://acewebcontent.azureedge.net/assets/education-resources/lifestyle/fitfacts/pdfs/fitfacts/itemid_2666.pdf
  • Anstey, K., Stankov, L., & Lord, S. (1993). Primary aging, secondary aging, and intelligence. Psychology and Aging8(4), 562–570. doi: 10.1037//0882-7974.8.4.562
  • Tobacco-Related Mortality. (2018, January 17). Retrieved from https://www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/tobacco_related_mortality/index.htm.
  • Cantó, C., & Auwerx, J. (2011). Calorie Restriction: Is AMPK a Key Sensor and Effector?Physiology, 26(4), 214–224. doi: 10.1152/physiol.00010.2011
  • Derous, D., Mitchell, S. E., Wang, L., Green, C. L., Wang, Y., Chen, L., … Speakman, J. R. (2017). The effects of graded levels of calorie restriction: XI. Evaluation of the main hypotheses underpinning the life extension effects of CR using the hepatic transcriptome. Aging9(7), 1770–1824. doi:10.18632/aging.101269
  • Hadad, N., Unnikrishnan, A., Jackson, J. A., Masser, D. R., Otalora, L., Stanford, D. R., … Freeman, W. M. (2018). Caloric restriction mitigates age-associated hippocampal differential CG and non-CG methylation. Neurobiology of aging67, 53–66. doi:10.1016/j.neurobiolaging.2018.03.009
  • Howley, Edward T., and Dixie L. Thompson. Fitness Professionals Handbook. Human Kinetics, 2017.
  • Imai, S. I., & Guarente, L. (2016). It takes two to tango: NAD+and sirtuins in aging/longevity control. NPJ aging and mechanisms of disease2, 16017. doi:10.1038/npjamd.2016.17
  • Jacobs, Patrick L. NSCAs Essentials of Training Special Populations. Human Kinetics, 2018.
  • Johnson, M. L., Distelmaier, K., Lanza, I. R., Irving, B. A., Robinson, M. M., Konopka, A. R., … Nair, K. S. (2016). Mechanism by Which Caloric Restriction Improves Insulin Sensitivity in Sedentary Obese Adults. Diabetes65(1), 74–84. doi:10.2337/db15-0675
  • Jossé, L., Xie, J., Proud, C. G., & Smales, C. M. (2016). mTORC1 signalling and eIF4E/4E-BP1 translation initiation factor stoichiometry influence recombinant protein productivity from GS-CHOK1 cells. Biochemical Journal, 473(24), 4651–4664. doi: 10.1042/bcj20160845
  • Kitahara CM, et al. Association between Class III Obesity (BMI of 40–59 kg/m) and Mortality: A Pooled Analysis of 20 Prospective Studies. PLOS Medicine. July 8, 2014. DOI: 10.1371/journal.pmed.1001673.
  • Kuchkuntla, A.R., Limketkai, B., Nanda, S. et al. (2018). Fad Diets Hype or Hope?. Current Nutrition Reports 7: 310. doi.org/10.1007/s13668-018-0242-1
  • Mitchell, S. E., Delville, C., Konstantopedos, P., Hurst, J., Derous, D., Green, C., … Speakman, J. R. (2015). The effects of graded levels of calorie restriction: II. Impact of short term calorie and protein restriction on circulating hormone levels, glucose homeostasis and oxidative stress in male C57BL/6 mice. Oncotarget6(27). doi: 10.18632/oncotarget.4003
  • Oberacker, T., Bajorat, J., Ziola, S., Schroeder, A., Röth, D., Kastl, L., … Krammer, P. H. (2018). Enhanced expression of thioredoxin-interacting-protein regulates oxidative DNA damage and aging. FEBS letters592(13), 2297–2307. doi:10.1002/1873-3468.13156
  • Picca, A., Pesce, V., & Lezza, A. (2017). Does eating less make you live longer and better? An update on calorie restriction. Clinical interventions in aging12, 1887–1902. doi:10.2147/CIA.S126458

(-) “When and+ accumulates, such as during scarcity of nutrients especially glucose, sirtuins are activated….”

  • Son, D. H., Park, W. J., & Lee, Y. J. (2019). Recent Advances in Anti-Aging Medicine. Korean journal of family medicine40(5), 289–296. doi:10.4082/kjfm.19.0087
  • Speakman, J.R. & Mitchell, S.E. (2011) Calorie Restriction. Molecular Aspects of Medicine, Jun:32(3):159-221. doi: 10.1016/j.mam2011.07.001

 

 

 

Prescription for good health diet and exercise flat lay overhead with copyspace.

A New Era Begins

The rallying cry is, “Let’s change healthcare!” From all corners of the medical universe, there is agreement that change is necessary. The biggest questions are, “What is the change?” and, “Who will make it happen?”