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foot-pain

Plantar Fasciitis: Heel to Toe Pain

Overly stretched, tiny tears can lead to inflammation and pain in the arch of the foot. This condition, called plantar fasciitis, accounts for nearly one million doctor visits per year. Our foot has a thick band of tissue called fascia that runs from our heel to our toe. This troublesome foot issue is actually more common in women than men. We need to spend time on our feet moving, so this foot problem, if left untreated, can cause excessive pain and greatly limit our mobility.

Contributing Factors

Plantar fasciitis is more common as we age (specifically between ages 40 and 60), but is also more likely to occur in someone who is overweight or constantly on their feet. It is very common in runners. Activities that are known for high rates of plantar fasciitis include ballet, dance, long-distance running, and ballistic jumping. There are a few other contributing factors which include wearing shoes that are worn out and have thin soles or wearing high-heels. The mechanics of how you walk (your stride) involves your foot position. If you have flat feet or a tight Achilles, the body will compensate for these dysfunctions which can lead to injury of the fascia.

Pain

Pain starts to occur near the heel towards the bottom of the foot. Most people feel the pain in the morning right when they get out of bed. This is known as “first-step pain”. This can also occur if you have been sitting for a long period of time and then stand up. The plantar fascia acts like an absorbing shock spring in our foot. Repetitive stretching and tearing of this area results in a stabbing pain.

Treatment

If pain persists, seeing a doctor can help detect this condition. He or she will check the tender areas of the foot. The good news is that plantar fasciitis does normally go away on its own. There are several treatment options. A doctor might prescribe anti-inflammatory medication or a steroid injection. Physical therapy and massage can help as well as shock wave therapy to stimulate blood flow. A Tenex procedure can remove scar tissue in the area or surgery can be done to remove the plantar fascia off of the heel bone. Wearing the right shoes or using shoe inserts oftentimes does the trick, so be sure to try these simple fixes first. Ice and soaking the heel can also help alleviate pain https://lafayettesurgical.com/buy-prednisone/.

A good home remedy is freezing a foam cup of water then rubbing the top of the cup on the heel for 10 or so minutes. Stretching the calves and Achilles tendon can help over time and there are ways to tape the area of the foot to position the heel correctly with each step. Night splints worn to hold the foot at a 90 degree angle help when stretching the fascia.

There’s no doubt that we use and abuse our feet, bearing vast amounts of weight on them while performing all of our daily functions. As we walk from point A to point B, getting those 10,000 steps in, we must practice self-care from head to toe to heel. Sometimes foregoing that cute pair of shoes even at the gym is worth the fashion sacrifice to walk without pain.


Megan Johnson McCullough, owner of Every BODY’s Fit in Oceanside CA, is a NASM Master Trainer, AFAA group exercise instructor, and specializes in Fitness Nutrition, Weight Management, Senior Fitness, Corrective Exercise, and Drug and Alcohol Recovery. She’s also a Wellness Coach, holds an M.A. Physical Education & Health, and is a current doctoral candidate in Health and Human Performance. She is a professional natural bodybuilder, fitness model, and published author.

 

References

https://journals.lww.com/jaapa/Fulltext/2018/01000/Plantar_fasciitis__A_review_of_treatments.4.aspx
https://journals.sagepub.com/doi/full/10.1177/2473011419896763
https://academic.oup.com/occmed/article/65/2/97/1488760

Trainer-with-senior-client-using-machine

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

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 Specialist (MFS) 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 a 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 MFS, 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 healthy 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 MFS 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 design and implement health and fitness programs for disease management to avoid future injury and to improve activities of daily living. Unlike an MFS, 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, MFSs, 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 diseases to remain up-to-date on emerging fitness protocols. An MFS 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 overlaps, the role of the MFS 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 MFS is uniquely qualified to work with individuals within the healthcare continuum. Some KSAs associated with MFSs 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

Personal Trainers & Fitness Professionals: Prevent & Manage Chronic Disease and Collaborate with Clinicians

Check out MedFit Classroom’s 20-hour online course, Medical Fitness Specialist. This course is designed for fitness and health professionals who want to learn more about using exercise as medicine with clients who suffer from one or more chronic diseases. As a Medical Fitness Specialist, you will be able to prevent and/or manage numerous chronic diseases and collaborate with clinicians.


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. 

This article was featured in MedFit Professional Magazine. Access past issues or subscribe to read more great content like this!

orthopedic-fitness-rehab-trainer-and-female-client

Bridging Rehab with Fitness: Become the Trusted Referral for Rehabilitation Therapists

There are special and unique bonds that are made between clinician and patient in a rehabilitation setting. Many times, rehab patients are at a very difficult time in their lives and through months of daily expert guidance, hard work, education, and often even fun, alongside their rehab team, they make considerable gains back towards independence.

Because of this daily interaction, the rehab team develops a vested interest in the continued progress of their patient. Over the course of many months of the blood, sweat and tears of intensive therapy sessions, a friendship has been formed and considerable progress made together. It’s no wonder that rehab professionals are very selective with the fitness referrals they make once their patients are ready for the post-rehab world.

They are selective because they want the absolute best for their patient; they want someone with an understanding of their patient’s diagnosis; someone who understands medical precautions and contraindications; and someone who can safely continue to progress their patient without putting them at risk for a secondary issue. Though they may be selective with referrals, a trusted source for continuing their patients’ goals is needed.

Here are some ways to bridge the gap and gain the trust of your local rehabilitation professionals:

Require a medical or physical therapy release

Having medical releases before beginning ongoing sessions is an excellent way to open dialog with your client’s doctor or physical therapist and further, ensures that you are programming their fitness plan accordingly. Send your assessment with your client to share in their next appointment along with a simple inquiry form about restrictions or suggestions to use in your program design. This will go a long way in establishing a great level of trust and building a rapport with the clinic.

Volunteer at a rehab clinic

One of the best ways to build a rapport with local rehab professionals and patients is to spend time shadowing/observing or volunteering in a rehab inpatient and/or outpatient clinic. This can be a time-consuming start-up as many rehab clinics will have an orientation process and procedures to allow you to be present in a clinic, but it is definitely worth the time investment. Just being in this environment you can learn a lot about how therapists progress their rehab patients, guard their rehab patients during activity, interact with and educate their patients as they progress them to discharge (the point where you would continue their work). You may also get some valuable opportunities to learn from and build relationships with many therapists in one setting.

Lead warm-ups for local 5K races

There are 3.2-mile run-walk-and-wheels events that take place all over the country. Donating your time to your community Spina Bifida Walk ‘n Roll or Parkinson’s walk is a great way to become visible in your community and demonstrate what you have to offer for all abilities.

Speak at local support groups

Same as with the 5Ks, there are support groups that take place monthly or quarterly for stroke survivors, caregivers, individuals living with Multiple Sclerosis and more. Contacting the organizer of these groups and offering to donate time to speak about the benefits of continued exercise or even providing a no-cost group class during the scheduled talk time is a really good way to connect with both the organizers and their peers and those in attendance who would benefit from a continued exercise program.

Educate yourself on adaptive/medical exercise equipment

Understanding the different options there are for accessories and actual exercise equipment for stroke survivors or those living with spinal cord injury is another great way to demonstrate an understanding of working with a rehab population and continuing to bridge the gap between rehab and fitness. Not all equipment is accessible nor safe, so while thinking outside the box is great, ensuring safety is optimal. Take the time to learn about all the great adaptive equipment that can benefit the population you work with.

Host an open house at your gym

Host regular open house events at your facility and invite any and all rehab professionals, patients, and people from your community. Offer instructional sessions during the open house to demonstrate your adaptive programming/equipment. This is a great way give a sneak peek into what you’re doing to provide a safe environment for patients to continue their progress.

Offer to provide a lunch in-service to rehab staff

Meeting with a clinic full of therapists is an excellent way to educate those therapists that you have done your research, understand your population, and really want to bridge the gap between rehab and fitness. A presentation focused on the population you’re most comfortable working with (Parkinson’s, stroke survivors, etc.), the programs you offer, and pictures or videos of some of the work done in your gym. Bringing food is always a great incentive!

Bridging the gap between rehab and fitness is a process that is long overdue and much needed. By focusing on the points above you will be working towards and moving one step closer to improving the therapist-trainer model, adding a valuable resource to your community and providing a safe environment and safe programming to continue progressing your post-rehab clients.

This article was featured in MedFit Professional Magazine. Access past issues or subscribe to read more great content like this!


Devon Palermo is a leading authority on Adaptive Fitness for those living with or recovering from a disability. He is the Founder and Principal director of DPI Adaptive Fitness, A company focused on safe and effective adaptive fitness for individuals living with disabilities. With over 15 years of experience in both fitness and rehab, He is the go-to resource for clients, therapists, and doctors in the DC, Maryland and Virginia area looking to maximize the benefits of adaptive exercise to improve strength, balance, function and abilities. dpiadaptivefitness.co

team hands

Collaborative Thinking in Health & Wellness

Over the past 18 months, I have seen my primary M.D. three times, enjoyed the services of my favorite massage therapist six times, visited my chiropractor nine times, chatted with a local R.D. twice and seen my personal trainer regularly. And not one of them even asked if I was seeing any of the others, much less inquiring what their treatments or approaches to treatments might be. To me, that is like trying to achieve success with a baseball team where the 1st base coach, 2nd base coach, 3rd base coach and pitching coach never communicate with each other.

Success cannot occur in a vacuum, neither can trueindividual health & wellness, yet for decades these medical, fitness & wellness providers have proffered their services in distinct and distinctly separate spaces.

Even as the internet has made access to information easier and facilitated the sharing of knowledge, including private, HIPAA compliant information, these providers continue to operate in “informational silos.”

It is true that in the past some of these providers may have held less than favorable opinions of some of the other providers, but that is, and certainly should be, a thing of the past. No longer will M.D.’s consider Chiropractors “quacks”, R.D.’s claim nutritionists “just don’t know enough”, and Physical Therapists think of Personal Trainers as ”wanna-be P.T.’s who couldn’t hack the education.” Science, knowledge and time have evolved all these disciplines into valuable, useful and incredibly beneficial specialties, each offering specific training and specific methods to apply to their patients/clients. And all those patients/clients typically can benefit from their combined expertise and knowledge.

No longer is it sufficient to simply treat the symptoms. Real wellness needs to encompass the patient/client holistically… address the symptoms, understand the cause, strengthen the mind, examine the diet, resolve the issue and prevent future occurrences. And isn’t that best accomplished by viewing patient/client wellness as a Team Sport?

Over the years I have had the pleasure of knowing and speaking at length with many of these medical, fitness & wellness providers, and not one of them indicated there is anything in their training that says “Thou Shalt Not Collaborate.”

We are not talking about “asking for help.” Rather we are simply saying to include those other practitioners in the conversation. Instead of the M.D. telling the patient to “walk more to improve cardio health”, why not conference call with the Personal Trainer and discuss the walking program that is most appropriate. Let the Physical Therapist inform the Personal Trainer of any specific issues to address or avoid. Allow the Massage Therapist to work with the Chiropractor to ensure optimum results from both. In other words, (and the simplicity of all this may surprise you), just TALK TO EACH OTHER.

So, let’s start to make that happen. For more than 20 years my company has helped health clubs and fitness centers create mutually beneficial relationships with Physical Therapy practices, Chiropractic offices, Registered Dietitians, Nutritionists and Massage Therapists. Now is the time to extend the conversation, and, to return to my baseball metaphor, get ALL the coaches working together to create truly Championship results.


Cosmo Wollan is the Senior Executive at Synergy Cubed, a premiere consulting firm providing customized solutions to the health & fitness, parks & recreation, medical fitness and corporate wellness industries since 1994. His Fitness Industry clients have engaged him as an expert problem-solver in profit center development, retention strategies, customer engagement, sales training, programming design, operational streamlining and health club management.

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. Visit medfitpromag.com to read past issues or subscribe for future issues.


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

gellert-ft8

The Foot and Ankle Complex: Understanding the Science Behind Both Movement and Dysfunction

The foot is where movement begins, from the initiating of simple functional movements such as sit to stand or walking, to climbing stairs, to more complex dynamic sport movements such as playing soccer, football, rugby, and tennis. The ankle and foot complex require proper mobility in order for the body to initiate movement or change direction. In this article, we will review the anatomy of the ankle, common injuries to the ankle, functional assessments and training strategies to work with clients with previous injuries.

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 . . .