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Bridging the Gap Between Fitness and Healthcare: Why the Future Needs Medical Fitness Professionals

/7 August 2025/ All MFN blog/

With over half of U.S. adults living with at least one chronic disease or medical condition, there’s a growing demand for professionals who can bridge the gap between healthcare and fitness. The solution? A new wave of educated, specialized fitness professionals trained to work with clinical populations.

A Broken System, By the Numbers

Despite massive healthcare spending, the U.S. continues to struggle with preventable health outcomes:

  • The U.S. spends more on healthcare than any other country, yet ranks 49th in life expectancy.¹
  • Among peer nations, the U.S. has the lowest life expectancy for both men and women.²
  • The U.S. leads in obesity rates, nearly twice the average, and the highest rate of people with multiple chronic conditions.³
  • We also see the highest rates of hospitalizations and deaths from treatable or avoidable conditions.³
  • Overall, the U.S. ranks just 35th out of 169 countries in global citizen health.⁴

These sobering statistics paint a clear picture: Our system focuses heavily on treatment, not prevention.

Exercise is Medicine!

Physical activity is one of the most powerful tools we have to prevent and manage chronic disease. The evidence is overwhelming. An increase in physical activity directly correlates with improved health outcomes, across nearly every domain of health.

A Study by the American Journal of Lifestyle Medicine reveals physical activity-related health benefits for adults, both healthy and with medical conditions/chronic diseases.

ADULTS 
All-cause mortality          Lower risk  
Cardiometabolic conditionsLower cardiovascular incidence and mortality (including heart disease and stroke) Lower incidence of hypertension Lower incidence of type 2 diabetes
CancerLower incidence of bladder, breast, color, endometrium, esophagus, kidney, stomach, and lung cancers
Brain HealthReduced risk of dementia                             Improved cognitive function Improved cognitive function following bouts of aerobic activity Improved quality of life Improved sleep Reduced feelings of anxiety and depression in healthy people and in people with existing clinical syndromes Reduced incidence of depression
Weight StatusReduced risk of excessive weight gain Weight loss and the prevention of weight regain following initial weight loss when a sufficient dose of moderate-to- vigorous physical activity is attained An additive effect on weight loss when combined with moderate dietary restriction
OLDER ADULTS
FallsReduced incidence of falls incidence of fall-related injuries
Physical FunctionImproved physical function in older adults with or without frailty
INDIVIDUALS WITH PREEXISTING MEDICAL CONDITIONS  
Breast CancerReduced risk of all-cause and breast cancer mortality
Colorectal cancer             Reduced risk of all-cause and colorectal cancer mortality
Prostate CancerReduced risk of prostate cancer mortality
OsteoarthritisDecreased pain Improved function and quality of life
HypertensionReduced risk of progression of cardiovascular disease risk of increased blood pressure over time
Type 2 DiabetesReduced risk of cardiovascular mortality Reduced progression of disease indicators: hemoglobin A1c, blood pressure, blood lipids, and body mass index
Multiple SclerosisImproved walking Improved physical fitness
DementiaImproved cognition

Why Education Matters: The Role of Medical Fitness Professionals

To work effectively with clients dealing with chronic diseases, aging-related conditions, or post-rehab needs, you must go beyond a general personal training certification.

Specialized education is critical. You need:

  • A deep understanding of medical conditions you are working with.
  • The ability to design safe, customized programs that account for limitations, medications, and symptoms.
  • Communication skills to collaborate with healthcare professionals.
  • A passion for service, empathy, and whole-person wellness.

Medical fitness professionals are a vital extension of the healthcare team, and their impact can be life-changing.

Take the Next Steps

Whether you’re just starting or already working in the space, the MedFit Global Virtual Conference is the ultimate opportunity to expand your expertise in medical fitness.

📅 October 22–26, 2025, 100% virtual event
✔ Attend from anywhere — 100% virtual event! If you can’t watch live, your registration includes 6 month access to recordings after the live event.
✔ Gain evidence-based strategies from 85+ expert-led sessions across diverse health topics.
✔ Learn how to build a thriving practice in the medical fitness space.
✔ Earn CEUs while expanding your ability to serve clients with chronic conditions.

Use coupon MEDFIT to save 25% off registration for this event!

Register at https://www.fbasucceed.com/medfit

References

1. US News and World Report, World Bank Data, 2022

2. Peterson KFF, Health Systems Tracker

3. U.S. Health Care from a Global Perspective, Commonwealth Fund

4. 2019 Bloomberg Healthiest Country Index

trainer-with-2-clients

You Are Not Meant to Do This Alone: Why Coaches Must Advocate With (Not Just For) Their Clients

/7 July 2025/ All MFN blog/

Let’s get one thing straight: you’re not supposed to know everything.

If you’re a wellness professional, a coach, or a trainer who’s ever felt the pressure to have all the answers—pause right there. The most powerful thing you can do for your clients living with chronic conditions, complex needs, or layered life stress isn’t giving them the perfect workout plan. It’s giving them a team.

  • A tribe.
  • A wellness village.
  • A network of practitioners who care as much as you do.

That’s where advocacy meets real results.

Because the more we partner with physicians, physiotherapists, mental health providers, dietitians, chiropractors, pelvic floor specialists—and yes, even energy workers or doulas—the more we can truly offer whole-person care. This is not just good ethics. This is smart, scalable, and sustainable business.

Five Reasons This Approach Works Brilliantly for Clients

Layered Support = Deeper Healing

One coach can’t address every facet of a chronic condition—but a collaborative circle can. From movement to medication, it’s all covered.

Increased Safety and Confidence

Clients feel safer and more motivated when they know their care providers are communicating and aligned—not contradicting each other.

Reduces “Health Overwhelm”

Navigating appointments, jargon, and options alone is exhausting. A coach-led village offers clarity and calm in the chaos.

Personalization Without Pressure

Referring out doesn’t mean you’re stepping back—it means you’re curating a smarter, more personalized, and more powerful plan of action.

Empowerment Instead of Dependency

The goal isn’t to keep clients needing us—it’s to help them thrive. A team model teaches self-advocacy, not dependency.

Top 10 Reasons Referral Networks Build Profit (Yes, Profit!)

  • Increased Referrals Back: Practitioners who trust you, refer to you. Period.
  • Higher Retention Rates: Clients stay longer when they feel supported beyond the gym.
  • Program Expansion: Collaborate on workshops, health talks, or shared services.
  • Reputation Boost: You become known as the connector—a go-to expert with integrity.
  • Cross-Promotion: Shared newsletters, blogs, podcasts, and campaigns reach more eyes.
  • Client Outcomes Improve: Better results = more testimonials, more word-of-mouth.
  • You Can Charge More: You’re offering comprehensive care, not just training.
  • Reduces Burnout: You’re not carrying it all alone. You share the load.
  • Loyalty from Clients and Partners: They remember who helped build their wellness web.
  • Opens Doors: Speaking gigs, funding opportunities, strategic collaborations—they all begin with being trusted and known.

Fyonna Vanderwerf is an award-winning educator, Ironman finisher, and inclusive fitness coach with over 25 years of experience transforming how wellness is delivered. At Bees Knees Wellness Muskoka, she leads a client-centric, compassion-first approach where collaboration is non-negotiable and community is everything. Whether in-person, virtually, or on retreat, Fyonna helps clients and fellow coaches build strength, energy, and self-trust—one empowered step at a time.

Eric Chessen 1

Can’t Vs. Doesn’t Understand; Coaching Towards Learning Style

/10 June 2025/ All MFN blog/

“Okay, now let’s see a squat, I’m gonna go first and then you try.”

The above is a standard sentence during my PAC Profile assessments and it carries with it powerful proactivity. I just also serendipitously learned that “proactivity” is a real, bona-fide word. When we teach movement, it makes sense to demonstrate first. Explaining to anybody a physical activity they’ve never performed, or performed with questionable technique, will skew towards wheels-fall-off territory early. Proactive practices give us and our athletes more opportunity sooner, and reduce the need to backtrack.

The most efficient use of initial instruction time (the first time we are teaching an exercise) looks like this:

  1. Label
  2. Demonstrate
  3. Provide supported performance

For the ASD (Autism Spectrum Disorder) population, labeling in particular can have interim or long-term benefit for language (productive and receptive), memory, and independence. If the athlete is familiar with the word “squat” and can equate it to the movement pattern that constitutes a squat (whatever their current ability level), the coach does not have to repeat and demonstrate and repeat and repeat and repeat. Because the athlete already knows. The word squat and the movement squat have been paired in a way that makes sense, and is memorable, for the athlete.

Labeling adds to the lexicon. It’s remarkable just how much functional language we can build through fitness programs. Not only exercise names “squat, press, pull-down, push throw, rope swings…” but objects “Sandbell, rope, cones, Dynamax ball, sandbag…” and abstract concepts including prepositions “in, on, under, right, left, up, down…” When our athletes are actively engaged in fitness activities teaching these terms/concepts is easily presented in a natural manner.

Demonstrating is crucial because it circumvents us and our athlete standing there and staring at one another (or off into the distance for those of our less-eye-contact-inclined friends). We always demonstrate a new exercise; this provides context and a framework for both the learning style and that athlete’s interpretation of what we just did. We’ll learn how they follow visual modeling and, often, how motivated they are to perform the thing they just saw.

Do they get right down to squatting? Are they hesitating? Overwhelmed? We will be given really good clues here.

Providing supported performance means that we are starting the athlete at a level of performance that they are sure to master quickly (if we have to progress the exercise immediately this is a good sign). If we wind up progressing an exercise five times during the first session then good. Good! This translates to the athlete having early successes that can be reinforced. We usually prefer to do the exercises that we’re good at, and our athletes with autism are not much of an exception.

We may provide a physical or guided prompt early on with an exercise to ensure safe and effective technical performance. With the squat this may mean having the athlete hold on to a resistance band attached to a secure, stable area and squatting to an elevated surface (we always use Dynamax balls propped up on cardio step risers).

Depending on physical, adaptive, and/or cognitive ability, we may be able to fade this support in the first session or it could take months.  I have some highly motivated athletes who, because of their physical needs, require longer practice with a given level of an exercise before they’ve reached mastery and can progress. The athlete should be held to the expectation of his/her best current level of performance (unless we’re talking about exceptional amounts of strength or power, because then programming changes a bit).

Efficient and effective coaching enables us to determine how best the athlete will learn a particular exercise. While it’s tempting to classify our athletes as “more visual” or “more kinesthetic” learners I’ve found that it is far better to approach this from an exercise-by-exercise basis. Some of my athletes need physical prompting through the end range of an overhead press but can “get” a band row when I demonstrate pulling my arms back while standing parallel to them.

“Don’t know how” is a misinterpretation of breakdown in effective coaching communication. We need to be instructing with less words, more action. More show than tell.

When our athletes, or any of us, don’t understand the direction, the contingency, or the expectation we freeze, get off-task, get frustrated, or a Lucky Charms marshmallow cornucopia concoction of all three.  Being proactive in coaching means giving our athletes the information they require delivered in a way that is useful.

It is easy to take for granted the neurotypical ability to interpret nuance, abstraction, and implied information; the untold stuff between the clearly marked things. Giving our athletes the context and environment to succeed, especially in the first few sessions or when teaching a new exercises becomes our bridge to success in coaching and performance.

Photos provided by Eric Chessen.

Eric Chessen, M.S., is an Exercise Physiologist with an extensive background in Applied Behavior Analysis. Eric provides on-site and distance consulting worldwide. He is the founder of Autism Fitness®, offering courses, tools, resources and a community network to empower support professionals to deliver adaptive fitness programming to anyone with developmental deficits to create powerful daily living outcomes that last a lifetime.

running-bleachers

Kick up the Cardio

/23 May 2025/ All MFN blog/

Currently, health clubs offer a variety of cardio and strength options. They offer a plethora of equipment and classes yet attrition remains high. By combining the science of cardio and strength training with a motivated and energetic instructor new programming combining….

obesity-fitness-pro-personal-trainer

Creating Welcoming, Inclusive Health & Fitness Environments for People with Obesity

/13 May 2025/ All MFN blog/

Each year for the past several decades, the health & fitness industry has served approximately 20% of the population, primarily helping the fit get fitter. Eighty percent of the population joined a health & fitness center but did not stay, or never joined because they decided it was not the right fit for them. A movement is gaining momentum to change that, and to make the health & fitness industry more inclusive and welcoming of people of all different ages, shapes, sizes and abilities. 

Worldwide, rates of obesity have tripled in the past 45 years. More than 42% of Americans have obesity, with the prevalence in the United States rising over 12% in the last 18 years. This presents an untapped opportunity for fitness professionals with specialized knowledge and expertise in working with clients with obesity. 

Dr. Rachele Pojednic and I have developed a MedFit Classroom Specialist Course. Presented in 10 modules and requiring 10 hours to complete, the Obesity Fitness Specialist course defines obesity and weight bias and identifies the biological, developmental, environmental and lifestyle factors that contribute to obesity. It explores solutions to obesity using the Socioecological model and empowers fitness professionals to be a part of individual-level, as well as institutional- and community-level, solutions. 

Learners will be able to position themselves as obesity fitness specialists separate and distinct from weight management and weight loss specialists. They will be able to create safe and effective programming for clients with obesity and inclusive environments that can lead to sustained client behavior change and health outcomes. The course culminates in a 10-step roadmap with one end goal—obesity fitness specialists who can help their clients reduce their risk of obesity-related risk factors and associated disease, discover the joy of movement, and reap the many health benefits of physical activity. 

People with obesity who find health & fitness environments where they feel welcome and included are likely to stay. Fitness specialists who are able to lead with empathy and build trust are likely to make their clients feel understood and heard. Obesity Fitness Specialists have an important role to play in helping their clients with obesity achieve their health & fitness goals.

Dr. Amy Bantham, DrPH, MS, MPP, is the CEO/Founder of Move to Live More, a research and consulting firm addressing physical inactivity, chronic disease and social determinants of health through cross-sector collaboration and innovation. A certified health and wellness coach, personal trainer, and group exercise instructor, Amy holds a Doctor of Public Health from the Harvard School of Public Health. She can be reached at movetolivemore.com or @MovetoLiveMore

heart-graphic

Heart Rate Variability, Why It Matters and How Can You Improve it

/12 May 2025/ All MFN blog/

Heart rate variability (HRV) is a measurement of the variation in time between successive heartbeats.

HRV is controlled by the sympathetic and parasympathetic branches of the autonomic nervous system, which work in opposition to regulate our body’s functions. The sympathetic nervous system is responsible for our “fight or flight” response, while the parasympathetic nervous system is responsible for our “rest and digest” response.

A higher HRV indicates that the parasympathetic nervous system is dominant, which means that the body is in a state of relaxation and recovery. A lower HRV indicates that the sympathetic nervous system is dominant, which means that the body is in a state of stress and exertion.

HRV is a valuable tool in assessing overall health and identifying potential health risks. It is affected by various factors, including age, fitness level, stress levels, and sleep quality. As we age, our HRV tends to decrease, and this decrease is associated with an increased risk of developing chronic health conditions.

Research has shown that a low HRV is associated with an increased risk of mortality from various health conditions, including heart disease, diabetes, and cancer. Monitoring HRV regularly can help identify potential health risks and enable us to take steps to address them.

What is a Good HRV?

A “good” HRV varies depending on a person’s age, fitness level, and overall health. Generally, a good HRV falls between 60 and 100 ms. This range varies depending on age:

AGE GROUPAVERAGE HRV
18-2562-85 ms
26-3555-75 ms
36-4550-70 ms
46-5545-65 ms
55-6542-62 ms
66+40-60 ms

Factors Affecting HRV

HRV tends to decrease with age, and this decrease is attributed to a decrease in parasympathetic nervous system activity. This decrease can be more pronounced in individuals with chronic health conditions or who lead sedentary lifestyles.

Chronic health conditions, such as heart disease and diabetes, can negatively impact HRV. Furthermore, lifestyle habits such as smoking, excessive alcohol consumption, and a poor diet can also have a negative impact on HRV.

Stress, whether physical or emotional, can decrease HRV. Poor sleep quality or sleep deprivation can lead to a decrease in HRV, as the body is unable to fully recover and recharge.

Certain medications, including beta-blockers used to treat high blood pressure and heart conditions, can significantly decrease HRV. (If you are taking medication and are concerned about its impact on HRV, we recommend speaking with your healthcare provider.)

How to Improve Your HRV

Regular exercise has been shown to increase HRV, especially high-intensity interval training. Engaging in regular physical activity improves heart health and can positively impact HRV. It is important to note that overtraining can have the opposite effect on HRV, so it is important to find the right balance between exercise and rest.

Regular relaxation and stress management techniques can help counteract the effects of stress and improve HRV. Relaxation techniques such as progressive muscle relaxation and guided imagery can help reduce stress and increase HRV.

Getting enough quality sleep is essential for overall health and can increase HRV. Consistently getting 7-9 hours of quality sleep each night can improve HRV.

Eating a balanced diet rich in whole foods can improve overall health, which can in turn increase HRV. Foods that are high in omega-3 fatty acids, such as fish and nuts, have been shown to increase HRV. Conversely, a diet high in processed foods and sugar can have a negative impact on HRV.

Limited alcohol and caffeine consumption. Caffeine can increase heart rate and activate the sympathetic nervous system, while alcohol can have a depressant effect on the parasympathetic nervous system. Limiting alcohol and caffeine intake can positively impact HRV.

2-Pilates-Resp

5 Pilates Exercises to Improve Respiratory Function

/8 May 2025/ All MFN blog/

Pilates is a total body exercise method that is highly effective for strengthening and lengthening the entire body. While Pilates is mostly known to improve core strength (the “Powerhouse”), posture, and range of motion, this exercise method can be used to improve respiratory function in those suffering from respiratory diseases. Respiratory diseases include asthma, COPD, chronic bronchitis, emphysema, lung cancer, cystic fibrosis, pneumonia, and now COVID-19.  These diseases affect the way one breathes and lowers oxygen saturation that the body needs to function properly. One of the main principles in Pilates is breathing, thus the need to take a closer look at the effects of Pilates on respiratory function.

Benefits of Pilates Related to Respiratory Disease

  • Improves postural cavity to breathe properly.
  • Expands breathing capacity with diaphragmatic breathing.
  • Increases pulmonary ventilation which is needed for better respiratory function.
  • Improves lung volume.
  • Develops intercostal muscles (respiratory muscles) to better “squeeze” out impure air.
  • Improves exhaling all impure air out of the body while inhaling pure air.
  • Improves thoracoabdominal mobility.
  • Improves circulation to deliver oxygenated blood more efficiently.
  • Increased SpO2 (blood oxygen saturation).
    • >95% indicates healthy respiratory function.
    • <95% indicates taxed respiratory function.

The Pilates Breathing Method

Joseph Pilates, the creator of Contrology, stated in his book Return to Life Through Contrology: “Lazy breathing converts the lungs, literally and figuratively speaking, into a cemetery for the deposition of diseased, dying and dead germs as well as supplying an ideal haven for the multiplication of other harmful germs.”1

  • Lateral Breathing: The main goal for Pilates breathing is to breathe deeply expanding the ribcage without raising the abdominal muscles training them to jet out. Therefore, deep lateral breathing through the ribcage is the hub of the breathing technique. Proper breathing is inhaling through the nose and exhaling forcefully through the mouth. When one inhales, the ribcage expands out to the sides using the intercostal muscles, and then when exhaling the ribcage knits together like one is being sinched in a corset. According to Joseph Pilates, one should exhale forcefully getting all impure air out of the lungs like wringing out every drop of water out of a wet cloth.
  • Set Breathing Pattern: When performing the Pilates exercises, one should inhale to prep for the movement and exhale as one performs the movement.
  • Rhythmic Breathing Pattern: In some exercises, one breathes in rhythm to the exercise. This breathing consciously activates respiratory muscles to enable the lungs to expand and transport oxygen.

5 Effective Pilates Exercises to Improve Respiratory Function

The Hundred (Rhythmic Breathing)

  • Begin a tabletop position with the shoulder blades and head lifted off the mat looking forward.
  • Pump the arms up and down 100 times vigorously so the abdominals respond to and control the movement.
  • Inhale through the nose 5 times to the rhythm of the arms pumping, then exhale 5 times to the rhythm of the arms pumping.
  • Keep the lower back imprinted to the mat at all times.

Single Leg Stretch (Rhythmic Breathing)

  • In a supine position, lift the shoulder blades and head off the mat looking forward.
  • Bend the right knee towards the chest as the left leg extends straight out hovering over the mat.
  • Inhale through the nose as you switch the legs 2 times, then exhale as you switch the legs 2 times.
  • Inhale, inhale, exhale, exhale as you switch, switch, switch, switch.
  • Keep the lower back imprinted to the mat at all times.
  • Perform 8 sets.

Dying Bug (Set Breathing Pattern)

  • In a supine position, position the legs in table-top and arms extend straight up towards the ceiling.
  • Press the right hand firmly on the right thigh and press the right thigh to the right hand in opposition.
  • Inhale through the nose as you extend the left arm back overhead and the left leg extends straight out hovering over the mat.
  • Exhale through the mouth and draw the arm in and the leg back to tabletop. Repeat on same side and switch.
  • Keep the lower back imprinted to the mat at all times.
  • Perform 8 reps on each side.

Toe Taps (Set Breathing Pattern)

  • In a supine position, lift the legs into tabletop keeping the upper body and head down on the mat.
  • Anker the arms next to the body pulling the shoulders back and down on the mat.
  • Inhale through the nose as you lower both feet and legs together towards the mat. Keep the knees at 90º and the feet away from the glutes.
  • Exhale as you pull the legs back up to tabletop.
  • Keep the lower back imprinted to the mat at all times.
  • Perform 10 reps.

Thread the Needle (Set Breathing Pattern)

  • Start in a side kneeling position with the hips lifted off the mat and one forearm down on the mat with the other arm straight up to the ceiling.
  • Inhale through the nose as you lean the body back an inch to expand the ribcage.
  • Exhale through the mouth as you rotate forward and thread the arm under the armpit towards the back. Crunch the obliques and transverse abs.
  • Inhale through the nose as you un-rotate and return to the start position with the arm lifted towards the ceiling.
  • Perform 8 reps on each side.

Pilates, respiratory function and research

The literature is scarce and sometimes conflicting about the benefits of Pilates breathing related to the respiratory system. However, there are some existing studies that look at the increase in lung volumes, respiratory motion, SpO2, and the reduction in respiratory rate using Pilates breathing exercises. More research needs to be conducted. Refer to suggested reading at bottom of article.

Education for Fit Pros

Fitness Professionals & Personal Trainers: Become a Respiratory Disease Fitness Specialist!

Some of your clients may suffer from a respiratory disease and you may be an important source of relief. The Respiratory Disease Fitness Specialist online course will equip you with the knowledge to safely and effectively work with these clients to help improve their quality of life.

CarolAnn, M.S. Exercise Science and Health Promotion, is a 30+ year veteran in the fitness industry educating other health/fitness professionals to increase their expertise and brand influence.  She is on the MedFit Education Advisory Board and the head health/fitness educator for FiTOUR.  She is currently the Head Instructor at Club Pilates in Athens, GA.

Suggested Reading

  1. Cancelliero-Gaiad, K. M., Ike, D., Pantoni, C. B., Borghi-Silva, A., & Costa, D. (2014). Respiratory pattern of diaphragmatic breathing and pilates breathing in COPD subjects. Brazilian journal of physical therapy, 18(4), 291– https://doi.org/10.1590/bjpt-rbf.2014.0042
  2. de Jesus, L.T., Baltieri, L., de Oliveira, L.G., Angeli, L.R., Antonio, S.P., Pazzianotto-Fort, E.M. (2015) Effects of the Pilates method on lung function, thoracoabdominal mobility and respiratory muscle strength: non-randomized placebo-controlled clinical trial. Pesqui. vol.22 no.3. http://www.scielo.br/scielo.php?pid=S1809-29502015000300213&script=sci_arttext&tlng=en
  3. Hagag, A.A., Salem, E.Y. (2019) Pilates Exercises Improve Postural Stability, Ventilatory Functions and Functional Capacity in Patients with Chronic Obstructive Pulmonary Disease. IOSR Journal of Nursing and Health Science (IOSR-JNHS), vol. 8, Issue 4 Ser. VI., PP 86-91 http://iosrjournals.org/iosr-jnhs/papers/vol8-issue4/Series-6/M0804068691.pdf
  4. Baglan Yentur S, Saraç DC, Sarİ F, et al. (2020). Fri0613-hpr the effects of pilates training on respiratory muscle strenght in patients with ankylosing spondylitis. Annals of the Rheumatic Diseases;79:912. http://dx.doi.org/10.1136/annrheumdis-2020-eular.2129

References

  1. Pilates, J., William, J. M., Gallagher, S., Kryzanowska, R. (2000). The Complete Writings of Joseph H. Pilates: Return to Life Through Contrology and Your Health. BainBridge Books, Philadelphia, PA. (Originally written 1945)