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Biohacking Your Body with Barefoot Science

/16 June 2023/ All MFN blog/

We are all on the eternal hunt to looking good, moving well and feeling young – however as responsibilities (job, school, family, friends) increase the time allocated to health and fitness often decreases. Surprisingly we expect the same results with less time in the gym but is this really even possible?

Perhaps it is.

Enter…..biohacking!

What is biohacking?

Biohacking, as the name suggests, is “hacking” or finding a way to more efficiently manipulate human biology. This can include areas of sleep, nutrition, mental health, strength, recovery.

If you are new the concept of biohacking – please think of this as a positive thing! Don’t get wrapped up thinking it is a mad scientist in his garage implanting computer chips into his own body.

Think of biohacking as a empowering concept which allows one to enhance or improve the efficiency of different aspect of health. It means taking ownership of your body and the aging system.

Can biohacking apply to fitness?

Absolutely!

In the case of fitness some examples of biohacking include drinking caffeine to give you energy during a workout. Or taking branch chain amino acids after a workout to enhance muscle repair and hypertrophy. Or using kinesiology tape to enhance proprioceptive stimulation and muscle activation.

Seems less mad scientist-y doesn’t it?

One area of biohacking that I am particularly a fan of is the application of barefoot science to improve your workout. As I mentioned at the start of this blog the one thing we never have enough of is TIME.

By integrating barefoot training into your workout you will hack your way into a more efficient workout allowing you to achieve faster fitness goals. Below are my top 4 biohacks integrating barefoot science.

Biohack #1 – Barefoot release to improve your balance

Next time you hit the gym start your workout start with just 5 minutes of trigger point footrelease the bottom of the foot. A 2015 study showed that 5 minutes of manual trigger point release was associated with an immediate improvement in single leg stability and postural control.

Since having someone do the trigger point release isn’t efficient we’ll instead use RAD Rounds by RAD Roller. These small rounds of different sizes can be used to apply pressure to different intrinsic muscles of the foot. I recommend 5 minutes in the morning, evening and before exercise.

View video below

Biohack #2 – Barefoot whole body vibration to enhance micro-circulation and tendon strength

In the world of proprioception whole body vibration is one of the most efficient ways to stimulate the nervous system. Since our foot is also the gateway to proprioceptive stimulation I recommend doing your WBV activation barefoot and using PowerPlate which is a multi-planar harmonic vibration platform.

A 2007 study by Lohman showed that just 3min of WBV at 30Hz enhanced skin, nerve and tendon micro-circulation resulting in enhanced tendon tensile strength and decreased arterial stiffness. All of which is a very powerful response before any workout.

Learn more about WBV and PowerPlate at powerplate.com

To learn more on this topic you can view the following webinar below:

Biohack #3 – Improve your core strength with barefoot foot to core sequencing

The core. The center of stability and the center of power. When it comes to any dynamic movement or exercise – core strength and stability are critical to the way force is generated or transferred through the human body.

The foot. The base of stability and only contact point between the body and the ground. Studies have shown that it is more efficient to strengthen the core via the foot in what EBFA calls “foot to core sequencing”. The access into foot to core sequencing is via an exercise called short foot.

To learn more about short foot and how to integrate it with exercises please see below:

Biohack #4 – Improve your balance with small nerve proprioception

Postural control and dynamic stability require the integration of four input systems – visual, vestibular, joint proprioceptors and plantar foot skin. Of these four one of the most important but often overlooked systems is the skin on the bottom of the foot.

The skin on the bottom of the foot contains thousands of small nerve proprioceptors all of which are sensitive to different stimuli. One of the most important stimuli coming into the foot is vibration (see WBV above). We use vibration not only to know how hard our foot is striking the ground but also in the maintenance of dynamic balance.

As soon as we put on our shoes our nervous system inherently becomes slower. This delayed neuro stimulation of the foot is small or micro which means it is hard to detect by the average client or patient – however it is happening. Accumulatively this results in micro-trauma and micro-compensation.

To biohack your nervous system whenever you are barefoot training integrate small nerve plantar stimulation with Naboso Technology. Whenever performing barefoot exercises such as short foot or any foot to core sequencing this is the perfect opportunity to pull out your Naboso Barefoot Training Mat.

If you want to bring this stimulation to your shoes, Naboso Technology also makes small nerve proprioceptive insoles which have been shown to improve postural control and stability

Dr. Emily Splichal, Podiatrist and Human Movement Specialist, has dedicated her medical career towards studying postural alignment and human movement as it relates to foot function and barefoot training. She is the Founder of the Evidence Based Fitness Academy, offering continuing education with a focus on foot fitness and barefoot training. Courses included Barefoot Training Specialist®, Barefoot Rehab Specialist® and BARE® Workout Certifications for health and wellness professionals.

Originally printed on the Barefoot Strong Blog. Reprinted with permission from Dr. Splichal.

trainer-senior-client-stretch

What’s the Difference Between Corrective Exercise and Physical Therapy?

/7 June 2023/ All MFN blog/

Both physical therapists and corrective exercise specialists help clients alleviate muscle/joint pain and improve their movement capabilities. However, the manner in which these professionals enter a client’s health and fitness journey is very different, and the procedures employed when working with clients are often dissimilar. Physical therapists are licensed health care professionals whose services are typically used by clients to treat a medical diagnosis, physical trauma, or specific injury (e.g., Achilles tendinitis, plantar fasciitis, rotator cuff tear, post-surgery rehabilitation, etc.). Physical therapy is also prescribed as an alternative means to orthopedic surgery, with therapists teaching patients how to prevent or manage their medical condition(s), often lessening the need for prescription drugs and painkillers.(1) 

The job of a corrective exercise specialist is quite different. These types of professionals do not (and should never) diagnose and/or treat a medical condition. Instead, their specialty skills consist of assessing and evaluating a client’s musculoskeletal system for soft tissue and movement restrictions, imbalances, habitual patterns, and muscle dysfunction that may affect that person’s ability to move well, exercise effectively and/or perform daily activities (e.g., restriction of the lumbar erector muscles accompanying an anterior pelvic tilt, prolonged seated postures promoting excessive thoracic kyphosis, etc.). This specialized knowledge regarding the musculoskeletal system helps corrective exercise specialists design and implement corrective exercise programs to assist clients in beginning, resuming and/or continuing a fitness program without experiencing muscle and joint pain or movement limitations. (6) When a client’s musculoskeletal issues are not able to be addressed solely with appropriate exercises, or fall beyond a corrective exercise specialist trainer’s scope of practice, the client is referred out to medical experts for treatment.

Corrective Exercise Specialists are Not Physical Therapists

As a corrective exercise fitness professional, it is important that you clarify your role with clients from the outset with regard to assisting them with their musculoskeletal health and not step beyond your professional bounds. In addition to laws dictating that any professional must remain within their bounds of experience, education, training, and demonstrated competencies, confusing your role with that of a physical therapist, and working outside your scope of practice, can harm your standing with clients and reputation within the fitness industry. (5) Aside from it being a requirement, the primary benefit of working within your boundaries as a corrective exercise fitness professional is that it enables you to practice, perfect and promote the unique talents you have with regard to evaluating the musculoskeletal system for imbalances, and assessing and correcting a client’s movements during physical exercise and activities.

Increased Referrals as a Corrective Exercise Specialist

Doctors, physical therapists and other licensed health practitioners are always looking for qualified fitness professionals to whom they can refer patients that need guidance with exercise.(3) According to recent research, two out of the top three reasons patients visit their doctor is for assistance with conditions that could be greatly improved by participation in a program of regular exercise.(4) Unfortunately, these medical professionals are often reluctant to refer patients with musculoskeletal conditions out of a concern that their clients’ problems might be made worse by an unskillful personal trainer. However, when you have specialty qualifications and knowledge in musculoskeletal assessment and corrective exercise, and work within your scope of practice, medical professionals will feel confident in your abilities, which provides an opportunity for you to build strong networking and referral relationships with them.(2)

As you begin incorporating corrective exercise procedures more regularly into client programs, it is highly recommended that you obtain a Corrective Exercise Specialist (CES) credential from a recognized and approved provider. This will advance your skills and can also result in more referrals from medical professionals. As your business network grows, you will also find that holding a reputable CES qualification makes it easier to refer clients to other specialists when their condition lies beyond your scope of practice.

The Future of Fitness

Fitness professionals qualified as corrective exercise specialists know how musculoskeletal malalignments and imbalances of any kind can create pain, injury, and dysfunction throughout the body. They also know how to use the results of individual consultations and assessments to pinpoint clients’ exercise needs so they can start or return to a regular fitness program successfully. In short, knowledgeable and qualified corrective exercise specialists have the skills to competently meet clients’ musculoskeletal restoration needs, and represent perfectly the fitness professional of the future.

MedFit Network (MFN) members receive 20% off The BioMechanics Method Corrective Exercise Specialist certification. Members can get their discount coupon here. 

Justin Price is one of the world’s foremost experts in musculoskeletal assessment and corrective exercise and creator of The BioMechanics Method Corrective Exercise Specialist certification (TBMM-CES).  The BioMechanics Method is the fitness industry’s highest-rated CES credential with trained professionals in over 70 countries. Justin is also the author of several books including The BioMechanics Method for Corrective Exercise academic textbook, a former IDEA Personal Trainer of the Year, and a subject matter expert for The American Council on Exercise, Human Kinetics, PTA Global, PTontheNET, TRX, BOSU, Arthritis Today, BBC, Discovery Health, Los Angeles Times, Men’s Health, MSNBC, New York Times, Newsweek, Time, Wall Street Journal, WebMD and Tennis Magazine.

References

  1. American Physical Therapy Association. (2018). Who are physical therapists. Retrieved from:  http://www.apta.org/AboutPTs/
  2. Bryant, C.X., & Green, D.J.  (2010). ACE personal trainer manual: The ultimate resource for fitness professionals (4th ed.). San Diego, CA: American Council on Exercise.
  3. DiNubile, N.A., & Patrick, W. Patrick. (2005). FrameWork: Your 7-step program for healthy muscles, bones, and joints. New York: Rodale.
  4. Huffington Post. (2013). Most common reasons for seeing a doctor revealed in new study. Retrieved from:  https://www.huffingtonpost.com/2013/01/17/common-reasons-see-a-doctor-skin-disease_n_2497424.html
  5. Howley, E.T., & Thompson, D.L.  (2016). Fitness professional’s handbook (7th ed.). Champaign, IL: Human Kinetics.
  6. Price, J. (2018). The BioMechanics method for corrective exercise. Champaign, IL: Human Kinetics.
stretching

The Importance of Stretching

/22 May 2023/ All MFN blog/

I remember the first time I figured out what my piriformis was, and how having a tight piriformis and IT band affected my movements. I had just started running hard core. As a former dancer, we stretched our hamstrings, inner thighs, the “dancer muscles”. But a piriformis or IT band was not something a DANCER experienced as this was not a muscle that was targeted in ballet, or other forms of dance.

The PAIN, was a knot in the right side of my hip/tush. It began to radiate all the way down the side of my right leg. It even affected my lever length so that the right leg felt “shorter”. I eventually learned how to do stretches such as “parvritta trikonasana”, and a bastardized version of pigeon on my back to target this muscle group (the external rotators).

Also, as a swimmer, and runner, my calf muscles will get super tight. This eventually pulls on my achilles tendon. Having torn my right achilles tendon in a freak accident in 2002, I can tell you keeping the achilles tendon happy can make the difference between being able to walk or not. Hand to foot calf stretches both standing and supine, as well as forward bend, and parvritta trikonasana, will take care of the problem. I also flex my foot against a wall before starting my run.

If my knees ache, it is usually because my quads are tight. I start with alternating kick ups from down dog into lunges to warm up. I also do natarajasana, which provides me an open angled quad stretch.

My students will often have problems targeting their abdominals. Tight hamstrings and hip flexors are usually the problem. I will do a “half lunge” where they press through the psoas to release it, then stretch the ham/calf in a forward bend while flexing the front foot, and keeping the standing knee right under the hip.

For other hard to read groups, such as under the shoulder blades, nothing beats a foam roller. I body surf along the foam roller, and hold until the knot dissipates. I have a chapter in “Healthy Things You Can Do In Front of the TV” complete with photos to describe how to target key muscles.

Stretching is often a forgotten, and yet necessary part of fitness. It makes the difference between proper kinesthetic alignment and gait, or movement that is off-balance, which can cause injuries. Not to mention, it just feels good before or after an intense workout. It also aids in recovery, so that you can be ready for your next challenge. Even die-hard couch potatoes need to stretch. And many stretches can be done at work or at home. See my lovely book for more examples of how to keep your body functioning at its best.

Kama Linden has been teaching fitness for over 2 decades. She has taught strength, step, pilates, vinyasa yoga, senior fitness, and has worked with clients and students of all ages and fitness levels. She is certified by AFAA Group Exercise and NASM CPT, as well as 200 hour Yoga. She has a BFA in Dance from University of the ARTS.  Her new book, “Healthy Things You Can Do In Front of the TV” is now on sale on Amazon, Barnes & Noble, and Kindle.

Depositphotos_84018014_l-2015

Simple Tips to Stave of Arthritis Symptoms

/8 May 2023/ All MFN blog/

Offer up these simple tips to aid arthritic clients reduce flare-ups, decrease symptoms, and experience more pain-free days!

There are many simple practices that may greatly decrease the risk and severity of flare-ups. To help reduce painful and swollen joints, improve mood, and increase quality of life, implementing a few of these simple techniques may make a world of difference.

1. Drink Water!  The body is comprised of about 60% water. Dehydration causes a decrease in function of all major organs, muscles, and even bones.

2. Get to Sleep!  Adults of all ages need 7-9 hours of sleep each night. Sleep is when your body repairs muscles, organs, and cells. In this resting state, chemicals will circulate in the blood that help to strengthen the immune system.

3. Set a Schedule!  Plan your days! Get into a routine of good habits. Setting alarms to get up, make phone calls, exercise, cleaning, and meals will provide a daily purpose.  Writing “to-do” lists on a paper calendar and crossing off items as they are accomplished provides a heightened sense of satisfaction and self-worth.

4. Eat Real Food!  The fewer ingredients, the better.  Read labels to avoid too much sugar, salt, and oil. I call these the “S.O.S.” These are foods that are known to cause inflammation and increase the risk for flare-ups.  For example, if you have the choice between an apple or apple pie, choose the apple with less ingredients. It also most likely contains less sugar or processed ingredients.

5. Exercise Daily!  Think of exercise as something you “work in” each day and not as a “work out.” Improving muscle strength, mobility, flexibility, and cardiovascular health reduces symptoms of autoimmune disease.

6. Hiring a Arthritis Fitness Specialist once or twice a week to provide accountability and write safe and effective exercise programs is a great start!

7. Practice Mindfulness!  The simple act of taking a few deep and meaningful breaths throughout the day is a great way to reduce stress and decrease negative physiological responses. Incorporating some gentle stretches in the morning, after periods of inactivity, and before bed is also a great way to bring awareness to the body, ease tension, reduce anxiety, and lessen the symptoms associated with arthritis.

Christine M. Conti, M.Ed, BA is and international fitness educator and presenter. She currently sits on the MedFit Education Advisory Board and has been nominated to be the 2020 MedFit Network Professional of the Year. She is the author of the MedFit Classroom Arthritis Fitness Specialist Course and is the CEO and founder of ContiFit.com and Let’s FACE It Together™ Facial Fitness & Rehabilitation. Christine is also the co-host of Two Fit Crazies & A Microphone Podcast and the co-owner of TFC Podcast Production Co.

SOAPmethod

Using the SOAP Note Format for Medical Fitness Clients

/1 May 2023/ All MFN blog/

The SOAP note format, the acronym of which stands for Subjective, Objective, Assessment, and Plan, is one of the standard document formats that healthcare providers use to document patient information and treatment progress. This article will take you through the format and teach you how to use it with your medical fitness clients.

The Subjective section will include the Chief Complaint of the client/patient, which is the reason they are working with you. This can be an official diagnosis from a licensed healthcare provider, such as Type 2 Diabetes Mellitus, or a symptom of a condition that is causing quality-of-life reduction, disability, or pain. You are not diagnosing any disease, injury, or health condition. You are merely stating the reason for the visit. You can include a brief patient medical history in this section, though you should strive to be succinct in your summary. The healthcare provider for your patient already knows their conditions and struggles and does not need a full page on the topic.

The Objective section is for vitals, how the client/patient presents at the visit physically and psychologically (attitude) and any recent lab or imagery results that are pertinent to your scope of practice and the patient’s Chief Complaints. When documenting the results of lab tests, only record what was tested and whether the result (such as fasting blood glucose levels) falls within normative values for the client/patient population. When documenting imagery results, record the type of imagery and the reviewing technician’s assessment (such as an MRI that shows posterior rotator cuff tears). The vitals you can and should take are heart rate, blood pressure, weight, and today’s pain rating on a 1-10 scale if applicable.

The Assessment section is typically used by healthcare providers for differential diagnosis, which is outside your scope of practice. The Assessment section will consist of your statement on the client/patient’s conditions and how they currently influence their fitness and general health. This can include notes on nutrition and physical activity levels. If the client/patient is presenting with an issue that session, such as restriction in shoulder flexion past 80 degrees, you will document that as well. If joint ROM is a focus of the client/patient’s training plan you should assess this at the beginning of the session and document the current ROM state relative to the previous session or baseline evaluation.

The Plan section is where you record the client/patient training for the day. This is also where you will annotate future training/care plans, such as periodization and progression. This section tells the healthcare provider exactly what you are doing with their patient and enables them to provide you with objective feedback on your training plan if necessary. Your training plan should reflect all guidelines and restrictions the patient’s healthcare provider has given you.

The following is an example of a completed SOAP note:

Date: 5/1/2023        
Patient Name:  John Q. Public        
Provider/Trainer Name: Slone, J.

Subjective:
Chief Complaint: pain secondary to posterior rotator cuff partial thickness tear, restriction in ROM due to said injury, weakness of posterior RC due to injury. Pt is alert, attentive, and appears in good spirits and motivated.

Objective:
HR: 85
BP: 120/90
WT: 241lbs
PAIN: 2/10 at rest

Assessment:
Horiz. Shldr abd. restricted to 70/90 degrees, dull, achy pain during concentric posterior RC movement that improves during warmup. No active shldr flex today. Shldr ext does not provoke pain. Ext. rot. does not provoke pain.

Plan:
Today’s Care:
Warmup: arm bike 5min @ RPE 3-4        
2×12-15 low face pull w/medium-light band within pain-free ROM
2×12-15 horiz. Abd. w/light band within pain-free ROM
2×8-10 ext. rot. w/light band within PF-ROM
2×8-10 scap retrac. w/medium band
2×3-5 overhead eccentric weight bearing, 3lbs, no pain

2x30s cross-body posterior RC stretch
2×10/12 finger ladder steps within PF-ROM

Future Care:
Continue with periodized RT to build function and strength within PF-ROM. Improve joint restriction through flexibility plan. Adhere to PCP guidelines.

This not unlike what a completed SOAP note in a physical therapy clinic would look like. Objective measures that a PT would use are measured joint ROMs with a goniometer (visual estimation is nearly as accurate in most cases and is acceptable for you to use). In a PT clinic, the Plan would also include treatment modalities, which are outside the trainer’s scope of practice (massage, manual therapy, e-stim, heat, cold, etc).

While you are not required to use this format with your clients/patients, it is of great benefit to use a standardized format that ensures you capture all pertinent information and are able to relay that to allied healthcare providers.

Here is a Word document template for the SOAP note format that you may download and use with your patients: SOAP Note Template.

Reprinted with permission from the Move Well, Live Well blog.

Joshua Slone is an Exercise Physiologist and Pain Therapist. He serves as Rehab Team Lead/Physiologist at the Center for Health in Yucca Valley, CA. His clinical expertise includes chronic pain management, joint replacements, sport and orthopedic injuries, complex medical condition management, geriatrics, degenerative neurological conditions, and psychiatric disorders. Visit his website, movewelllivewell.org

References

Instructor Showing Health Results On Clipboard To Senior Couple

Respiratory Disease and Exercise

/28 April 2023/ All MFN blog/

According to the World Health Organization (WHO), hundreds of millions of people suffer every day from chronic respiratory diseases (CRD).  Currently in the United States, 24.6 million people have asthma1, 15.7 million people have chronic obstructive pulmonary disease (COPD)2 while greater than 50 million people have allergic rhinitis3 and other often-underdiagnosed chronic respiratory diseases.  Respiratory diseases do not discriminate and affect people of every race, sex, and age.  While most chronic respiratory diseases are manageable and some even preventable, this is what is known about the nature of chronic respiratory diseases4:

  • Chronic disease epidemics take decades to become fully established.
  • Chronic diseases often begin in childhood.
  • Because of their slow evolution and chronic nature, chronic diseases present opportunities for prevention.
  • Many different chronic diseases may occur in the same patient (e.g. chronic respiratory diseases, cardiovascular disease and cancer).
  • The treatment of chronic diseases demands a long-term and systematic approach.
  • Care for patients with chronic diseases should be an integral part of the activities of health services, alongside care for patients with acute and infectious diseases.

Exercise and CRD

If you are a health and fitness professional, some of your clients may be suffering from a chronic respiratory disease and you may be an important source for relief.  Moderate exercise is known to improve use of oxygen, energy levels, anxiety, stress and depression, sleep, self-esteem, cardiovascular fitness, muscle strength, and shortness of breath. While it might seem odd that exercise improves breathing when one is short of breath, exercising really does help one with respiratory disease.  Exercise helps the blood circulate and helps the heart send oxygen to the rest of the body.  Exercise also strengthens the respiratory muscles which can make it easier to breathe.

Beneficial Types of Exercise

There are several challenges to exercise prescription and physical activity participation in this population, but a large body of evidence demonstrates important health benefits from aerobic exercise.  Resistance training has also been shown to increase muscle mass and strength, enhancing individuals’ ability to perform tasks of daily living and improving health-related quality of life.5

Aerobic exercise is good for the heart and lungs and allows one to use oxygen more efficiently. Walking, biking, and swimming are great examples of aerobic exercise. The guidelines are approximately the same as generally healthy individuals.  One should attempt to train the cardiorespiratory system 3-5 days a week for 30 minutes per session.  One should exercise at an intensity level of 3-4 on the Rating of Perceived Exertion Scale (Scale Rating from 0 Nothing at All-10 Very, Very, Heavy).

Resistance exercise increases muscular strength including the respiratory muscles that assist in breathing.  Resistance training usually involves weights or resistance bands but using one’s own body weight works just as well depending on the severity of the symptoms.  It is recommended that one should perform high repetitions with low weight to fatigue the muscles.  This type of resistance training also improves muscular endurance important for those with CRD.  Resistance training should be performed 2-3 days a week working all major muscle groups.

Stretching exercises relax and improve one’s flexibility.  When stretching, one should practice slow and controlled breathing.  Not only does proper breathing help to deepen the stretch, but it also helps one to increase lung capacity.  One should gently stretch all major muscles to the point of mild discomfort while holding the stretch for 15 to 30 seconds, slowly breathing in and out. Repeat each stretch 2-3 times.  Stretching is an effective method to warming up and cooling down before and after workout sessions.

When exercising, it is important to remember to inhale in preparation of the movement and exhale on the exertion phase of the movement.  An individual should take slow deep breaths and pace him/herself.  It is recommended to purse the lips while exhaling.

Use of Medication

If an individual uses medication for the treatment of respiratory disease, he/she should continue to take the medication based on his/her doctor’s advice.  His/her doctor may adjust the dosage according to the physical activity demands.  For example, the doctor may adjust the flow rate of oxygen during exercise if one is using an oxygen tank.  In addition, one should have his/her inhaler on hand in case of a need due to the increase of oxygen demand during exercise.

Fitness professionals can effectively work with those who have a chronic respiratory disease providing them with a better quality of life through movement.  You as their health and fitness coach can provide a positive experience to facilitate an effective path to better health and wellness.

Continued 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.

Known as the trainers’ trainer, CarolAnn has become one of the country’s leading fitness educators, authors, and national presenters. Combining a Master’s degree in Exercise Science/Health Promotion with several fitness certifications/memberships such as FiTOUR, ACSM, ACE, AFAA, and LMI, she has been actively involved in the fitness industry for over 25 years. She is currently the Founder and Director of Education for Chiseled Faith, a Faith Based Health and Fitness Program for churches. Visit her website, www.CarolAnn.Fitness

References

  1. 2015. NHIS Data; Table 3-1. www.cdc.gov/asthma/nhis/2015/table3-1.htm
  2. Mannino DM, Gagnon RC, Petty TL, Lydick E. Obstructive lung disease and low lung function in adults in the United States: data from the National Health and Nutrition Examination Survey 1988-1994. Arch Intern Med. 2000;160:1683–1689.
  3. CDC, Gateway to Health Communication and Social Marketing Practice. Allergies. https://www.cdc.gov/healthcommunication/toolstemplates/entertainmented/tips/Allergies.html
  4. World Health Organization http://www.who.int/gard/publications/chronic_respiratory_diseases.pdf
  5. Eves ND, Davidson WJ. Evidence-based risk assessment and recommendations for physical activity clearance: respiratory disease. Applied Physiology Nutrition and Metabolism. 2011;36(Suppl 1):S80–100. [PubMed]