Showing posts with label Fitness. Show all posts
Showing posts with label Fitness. Show all posts

Monday, 19 August 2019

A Fitness Tracker Masquerading as a Smartwatch

Lenovo has today launched its digital smartwatch in India, priced at just Rs. 1,999. At that price, getting a smartwatch from a well-known brand such as Lenovo sounds like a pretty sweet deal, doesn’t it? So, is it actually a sweet deal, and should you consider buying the Lenovo EGO for your needs? Well, I’ve been using the Lenovo EGO for almost a week now, and here are my thoughts on the watch, what it can do, what it can’t do, and whether or not it’s worth buying.
Design and Build

At first glance, the Lenovo EGO gives off the distinct impression of being a regular digital watch, and might even trick you into thinking it’s a Casio G-Shock. That’s not a bad thing, per-se, after all, smartwatches that look like regular watches to the point of being deceptive aren’t a bad thing — they can blend right in. However, take a couple of seconds to look at this watch, and you’ll easily be able to tell that it’s meant to be a very-low priced smartwatch.

lenovo ego design build

The design here is bulky, and I’m pretty confident that Lenovo wanted to make it look like a rugged watch at first blush, and it works out fine. There are unnecessary design touches in places but they all come together just fine and I didn’t really find a lot to complain about it. Keep in mind, this is a watch that comes in at Rs. 1,999, and I reviewed it with that in mind.



The build, on the other hand, is clearly where the company cut considerable costs. Don’t get me wrong, the EGO is by no means a fragile watch. I’ve used it carelessly, tossed it in my bag for formal outings when I preferred wearing my regular watch instead, and just treated it like a rugged watch for the most part, and it has held up surprisingly well. However, the quality of the plastic on the casing, and the rubber straps is very obviously not that great. It looks decidedly cheap to the eyes, and it feels thin and weird when you touch it. Even comparing it to the Mi Band’s silicone strap, the EGO’s strap is not at the same level.
Display

The display on the EGO is definitely not what you’d expect from a smartwatch, or even most fitness trackers. This is a typical display you’d find on a digital watch, and that might be a good thing or a bad one depending on what you’re actually looking for in a watch. Personally, I think the OLED display on the Mi Band 3 is a better deal than this one — it can show a lot more information, and that’s something where the Lenovo EGO falls back substantially as we’ll discuss in the features section of this review.

lenovo ego display

The display also has another annoying issue — pressing too hard on the buttons usually screws it up, and in my experience with the watch, sometimes even restarting the smartwatch wouldn’t fix it. However, pressing on the ‘Mode’ button a bunch of times usually did. It’s mostly a hit or miss experience though, and I’d suggest you treat the buttons with care. This watch might look rugged, but when it comes to the buttons, I don’t think rugged is the word I’d use to describe it.

Other than that though, the display does its job just fine. It doesn’t show a lot of information, which might be good for you if you don’t like smartwatches that bombard you with information, but the information it does show, is well organised and is just enough to justify wearing this watch regularly. There’s also a ‘Light’ button here, since the display itself isn’t backlit like what you’d see on the Mi Band 3, and that button is something you’ll not realise the importance of until you find yourself driving at night, and trying to check the time on your watch (or in another, similar situation).
Buttons

Oh, the buttons. I have a lot of mixed feelings about these buttons. These buttons feel tactile enough to not make you wonder whether you pressed them or not, which is a great thing, but Lenovo did this thing where it labelled these buttons with things like ‘Light’, ‘Start’, ‘Mode’, and ‘Reset’ and this naming scheme will throw you off unless you read the manual and figure out what each of these buttons is actually meant to do.

Here’s what I mean. The ‘Mode’ button switches between the date, step-count, distance-measurement, and sleep tracking. That sounds about right, doesn’t it? However, if you’re looking to get to the stopwatch, or if you want a heart-rate measurement from the watch, you won’t find that in one of the modes. Those two features are accessed by pressing the ‘Reset’ button, which is just incredibly unintuitive. But hey, even when you’ve found the stopwatch, starting it is yet another exercise in frustration. You might be tempted to press the button labelled ‘Start’ but that doesn’t do anything. In fact, you’ll have to press and hold the ‘Mode’ button to enter the ‘Pause’ state of the smartwatch, and then press the ‘Mode’ button again to actually start the smartwatch.

Also, when you’re done with the stopwatch, resetting it is not accomplished by the ‘Reset’ button. You’ll have to pause the watch with the ‘Mode’ button, and then press and hold the ‘Mode’ button to actually reset it. It’s just a lot of confusing mess.

What I’m trying to tell you is “Do yourself a favour and read the manual.”

From what I can tell, the button labelled ‘Light’ is probably the only one that actually has a decent label to it. Other than that, all of these buttons are pretty weirdly labelled, and perform wildly different functions than what one would expect.

Once you get used to them, however, this will most likely cease to be a problem for you, but in my experience with technology, you shouldn’t have to “get used” to something… you know, like notches.
Features
Step Tracking

If there is one good thing I can say about the EGO, it’s that it does come with most of the features you are likely to be expecting from it. There’s a step counter, and it’s decently accurate, although it does count around 10-15% less steps than I was taking, based on my own counting of the steps. Still, it’s not that big an issue.

lenovo ego step count

Anyway, as far as step tracking is concerned, the EGO also shows you the distance you’ve walked, and the calories you’ve burnt, which is great, but the watch does sometimes mistake driving in a car as walking so you might get discrepancies in the calories burnt and the steps taken if you drive to and from work often, as I sometimes do.
Heart Rate Measurement

There’s also a heart-rate sensor which, by default, takes a continuous heart rate measurement. Well, I say continuous, but the Lenovo Life app which the watch connects to and syncs with, simply calls it ‘Automatic Measurement’ and says that the watch takes measurements “every once in a while”. The heart rate sensor feels pretty accurate too, and for the most part, readings from the watch and from my Galaxy S10’s built-in step tracker were close enough.

Sleep Tracking

The watch also has sleep tracking capabilities, and while it does track sleep pretty accurately, I didn’t really like the feeling of sleeping with a bulky watch strapped to my wrist every night, and I’m not sure if a lot of people will, either. That said, if you do sleep with the watch on your wrist, the sleep tracking is pretty good, and I don’t really have complaints with it. Also, the watch apparently can track swims as well — that’s something I didn’t test out though.

Remote Camera

Another feature that I thought would be cool, but actually wasn’t, is the remote camera feature. This isn’t an entirely new concept, I could do this with a third party app on my first generation Moto 360 back in the day, but the Lenovo EGO comes with a remote camera feature built in. However, using it can be a pain.

First off, you can’t use your phone’s stock camera app, and you’ll have to go to the Lenovo Life app, tap on Profile, head over to the watch under devices, and then tap on ‘Take Photo’ which will launch an in-app camera. The problem here is two-fold. First, the camera quality of this app is pretty bad; the image gets distorted around the edges and it just looks weird. Two, taking a picture doesn’t come as easily as pressing a button. Instead, you’ll have to shake your watch-wearing hand pretty ruthlessly to actually take a picture. It not only looks weird, but it’s also a pretty annoying gesture to make; plus, it doesn’t work half the time. Or at least I wasn’t able to get it to work properly. If you’re better at shaking your hand than I am, your mileage may vary.
Alarm Clock

The Lenovo EGO doesn’t have a built-in speaker, but that doesn’t hold it back from becoming a pretty solid alarm clock. If you set an alarm using the Lenovo Life app, the watch uses vibrations to wake you up, and yes, it sounded pretty silly to me too, but it’s pretty effective at waking me up. I mean, sure, on the first day I ended up setting my regular alarms on my phone as well, but I decided to risk it on a weekend when oversleeping wouldn’t be an issue, but the watch could easily wake me up, which is great. Setting the alarm isn’t the most easy task to accomplish, since you’ll have to depend on the Lenovo Life app for it, but hey, at least it works and it works well.
Notifications

The EGO wouldn’t qualify as a smartwatch unless it had the capability to notify you of, well, notifications on your phone, and this watch does that, just not as well or as effectively as you’d expect from something like the Mi Band.

Basically, you can enable notification support from the app, and choose the apps you want to receive notifications from. The feature works reliably, and the vibration is strong enough to alert you easily. However, when you receive a notification for something like a message, the watch simply says ‘Message’ on the display, and doesn’t show who the message is from, or what the message says — that’s something the Mi Band 3 can do, and it does it pretty well.

Even for calls, the Lenovo EGO simply mentions ‘Call’ on the display, and there’s no way to reject or answer the call, or even to know who’s calling without checking your phone. To me, this feels like it kind of defeats the purpose of having a watch that can show you notifications. Weirdly enough, the Lenovo Life app does ask for ‘Contacts’ permission as well as the ‘Phone’ permission, which led me to believe that the watch will show at least the name of the person calling, but it doesn’t. I’m not entirely sure why Lenovo wants my contacts if it won’t even show me the name of the person calling, so I have since revoked that permission from the app.
Battery

One of the things that really impressed me about this smartwatch is the battery. Now, Lenovo hasn’t mentioned the battery specifications of the watch, but it does claim a 20-day battery life on it, which is pretty neat on paper.

In real life, the battery life feels somewhat less than claimed. In my entire week of usage, starting from 100%, the watch has dropped down to 40%, which makes it look like it’ll last about 10-15 days on a charge — that’s still pretty impressive, although you’ll have to keep in mind that this display is clearly not a battery hog.

Charging takes place via pogo-connectors on the back of the watch which magnetically align with the charging module that you get in the box, and it takes around an hour to fully charge the EGO, after which it’s good to go for another 10 to 15 days.
Lenovo EGO Review: Should You Buy It?

It’s a pretty difficult thing to recommend or not recommend this watch. After all, Lenovo is offering a very watch-like smartwatch at just Rs. 1,999 and it does a lot of things really well. It’s decently accurate at measuring steps, measuring your heart rate, waking you up in the morning, and telling you the time (duh!). Plus it has a nice battery life. However, it’s also annoying how the buttons are labelled, the notification support isn’t robust enough and is easily beat by the Mi Band 3 (Rs. 1,999), and on a personal note, I don’t find the design to be very attractive.

That said, if you’re looking for a fitness tracker, and you love the design of Casio’s G-Shock line of watches, the Lenovo EGO is definitely worth a look-see. However, if you want more features, a sleeker design, better support for notifications, I’d still recommend the Mi Band 3 over the EGO. Or, if you can extend your budget a little, you can get a color OLED display with the Honor Band 4 (Rs. 2,599)  Asus’ TUF Gaming line of gaming laptops have always been a pretty solid deal with great performance. So when the company sent us the TUF Gaming FX505DT with the new Nvidia GTX1650 GPU, I was definitely excited, and why not? The laptop gets a lot of things right, and Asus claims to offer high-end gaming experiences on this laptop, at a relatively affordable price of Rs.81,990. I have been using the TUF Gaming FX505DT for quite some time now, and this is my detailed review of the laptop, so you can make up your mind about whether or not you should buy this, and if you do, what you can expect from it.
Asus TUF Gaming FX505DT Specifications
Display    15.6-inch FullHD Anti-glare display @120Hz
Processor    Ryzen 7 3750H @2.3GHz
Storage    1TB HDD + 256GB PCIe SSD
RAM    8GB
Graphics    Nvidia GeForce GTX1650 GPU with 4GB GDDR5 VRAM
Connectivity    WiFi 802.11ac; Bluetooth 5.0
I/O    2 x USB 3.0 Gen1
1 x USB 2.0
1x HDMI 2.0
1x RJ-45 Jack
1x 3.5mm headphone and microphone combo jack
1x Kensington lock
Battery    48Whr
Price    starts at Rs. 81,990

For Rs. 81,990, the TUF Gaming FX505DT does offer quite a lot of power. There’s a Ryzen 7 in there, along with the new Nvidia GTX1650 GPU, and an HDD+SSD storage set up.
Design and Build

The FX505DT comes in a very familiar design, which is fine, since the TUF Gaming line up has always had a decent design language that’s neither too out there, nor too shy to show off its beastly side. The outer lid of the laptop has a nice matte finish with an Asus logo in the center which lights up in a soft golden-yellow hue instead of the usual red colors you’d find on other gaming laptops, including the TUF Gaming FX505DY that I reviewed a while back. Personally, I like the combination of black and gold on this laptop.

Other than that, the entire outer chassis of the laptop is devoid of any lighting whatsoever, which might be something RGB lovers won’t like, but makes the laptop suitable not only as a gaming laptop, but also as a work laptop that you can take into meetings without looking silly.

Once you open the lid up, you’re treated to the big, bright, 15.6-inch Full HD display on the laptop, which, as is the case with most gaming laptops these days, has minimal bezels on the top and the sides, and a huge bezel on the bottom with the Asus logo there as well.

asus fx505dt display image

Opening the lid will also throw a huge glow of RGB lighting on your face, thanks to the RGB backlit keyboard, along with the power button on the top right corner, and the trackpad on the bottom. It’s a pretty nice keyboard, even though it doesn’t feel any different from any other TUF Gaming laptop, and it has transparent WASD keys to make them easily discernible from the rest of the keys.

On the sides you’ll find the variety of ports, and the cooling vents with Asus’ anti-dust cooling system.

Build wise, the TUF Gaming series is meant to be, well, tough. It’s right there in the name, and the TUF Gaming FX505DT conforms to US military grade tests, and can apparently handle drops, high temperatures, humidity, and solar radiation. I obviously didn’t test any of these things out, but in my usage of the laptop, I didn’t find myself being too careful with how I handled it and it still looks flawless and works perfectly, so I’m sure you don’t have anything to worry about.

All things considered, the FX505DT is a sturdily built laptop that looks good, and won’t be out of place in a gaming room as well as a meeting, which makes it a pretty solid option for people looking for a gaming laptop that can double up as their daily driver.
Display

The TUF Gaming FX505DT comes with a 15.6-inch FullHD IPS display with a refresh rate of 120Hz, and it looks great. Since this is a 120Hz panel, everything on the laptop feels more natural and fluid. Animations look nice and smooth, and playing games like Far Cry 5 is a treat on this laptop.

What’s more, the display on this laptop can get pretty bright, and really dim if you want it to, so not only can you use it outdoors or in the presence of lights falling directly on the display (thanks to the anti-glare coating), you can also use it late at night without stressing your eyes out too much.

asus fx505dt display image 2

Media consumption on this laptop is great, thanks to the bright panel, and the awesome color reproduction. Viewing angles are decently good enough as well, but I don’t think you’ll find yourself in a situation where you have to look at your laptop from a side very often anyway.

Overall, the display on the FX505DT is a really great one. It’s not the best at separating shades of black, as I found out while testing the display in the black test, but it’s good at gradients, and as far as gaming and everyday use is concerned, the display will not let you down. If anything, games look amazing on this panel.
Performance

With a Ryzen 7, 8GB RAM, and the GTX1650 GPU, the FX505DT brings in pretty solid performance, especially at this price. Having never used a GTX1650 powered gaming laptop before, I wasn’t entirely sure what to expect from this one in terms of gaming, but it’s safe to say that the FX505DT doesn’t disappoint in terms of performance at all.

I tried all the usual things on this laptop, from running synthetic benchmarks like Geekbench, Cinemabench R20, and 3DMark, to playing games like PUBG and Far Cry 5, and the laptop handles everything really well.
Synthetic Benchmarks

In synthetic benchmarks, the laptop scores decently well. Geekbench got a score of 3878 in the single core, and 10550 in the multi-core test, which is good, but I find it slightly weird that thee FX505DY with the Ryzen 5 scored better in thee multi-core test on Geekbench when I reviewed it… not by a lot, but better for sure.

Anyway, in 3DMark, the FX505DT scores 3363 in the Time Spy test, which is ridiculously higher than the score I got on the FX505DY with the AMD RX560X GPU. The laptop also scored 1640cb in Cinebench R20 which is a pretty solid score for a laptop in this price range.
1 of 2

So yeah, as far as synthetic benchmarks are concerned, the FX505DT looks like a pretty solid laptop, but what about real world performance?
Real World Performance

In regular day to day tasks, the FX505DT didn’t even break a sweat, and that’s not really a big deal since my usual workflow includes some Chrome tabs with wordpress and news sources, a Photoshop session, and maybe a couple of tabs with YouTube and Spotify open in them, and that’s about it. Clearly, that’s not nearly heavy enough of a workload to make any difference to this laptop.

However, in gaming too, the FX505DT runs really well. In PUBG, the game defaulted to basically High settings, with just Shadows set to Medium and I was consistently getting frame rates over 70FPS which is awesome.

With everything set to High, PUBG ran smoothly over 70FPS at all times, and when there wasn’t a lot happening around me, the frame rate jumped as high as 90. Sure, you could set the graphics to Medium or Low and get slightly better frame rates, but 70+ FPS is perfect, and I didn’t find the need to set a lower graphics quality in the game.

Far Cry 5 did a weird thing where it chose the integrated AMD GPU by default and ran at, like 12FPS in low settings, but change that to the Nvidia GPU inside this laptop, and it can run Far Cry 5 decently as well. Far Cry 5 is a very heavy game, though, and at Ultra settings, I got an average frame rate of 44FPS. That’s not too shabby, but the frame rates dropped as low as 23FPS sometimes, and that can be really annoying.

In High settings on Far Cry 5, I got an average frame rate of 47FPS, with the frame rates dropping as low as 35FPS and going as high as 59FPS.

That’s decent enough, but personally, I think playing the game on Normal will be the best bet for this laptop. At those settings, I got an average frame rate of 50FPS, with a high of 62FPS and a low of 38FPS.

So yeah, performance wise, the FX505DT is a solid laptop, but it does struggle a bit with heavy games like Far Cry 5. Don’t get me wrong, Far Cry 5 is completely playable on this laptop, especially if you’re good with choosing ‘Normal’ graphics settings in the game, but if you’re thinking of a laptop that can run Far Cry 5 buttery smooth on High or Ultra, this is not it.
I/O and Ports

In terms of ports and I/O, the FX505DT brings all the ports you may need, and nothing extra. There are 2x USB 3 ports, 1x USB 2 port, an HDMI 2.0 port, an RJ-45 ethernet port, and a 3.5mm headphone and mic combo. That’s a pretty decent selection of ports, and I honestly don’t think a lot more than this is truly needed on a laptop, but the lack of a USB Type-C or Thunderbolt 3 port does make this laptop slightly less future proof than something more expensive that you could buy.

In terms of connectivity though, the FX505DT is on-par with current standards. There’s support for WiFi b/g/n/ac (which means you can connect to both 2.4GHz and 5GHz networks on this) and the laptop also comes with Bluetooth 5.0, so you get better Bluetooth connectivity, including lower latency, and a higher range when using Bluetooth accessories with the laptop.
Keyboard

The Asus TUF Gaming FX505DT comes with what Asus calls the ‘HyperStrike Gaming Keyboard.’ Now, I’m not too certain about the HyperStrike thing here, but I have absolutely no complaints with the keyboard on this laptop. The keys have ample travel, and still actuate at a nice distance to make typing or even long gaming sessions comfortable on the laptop, the slight curve on the keycaps makes it easier to discern between keys while typing or playing games without having to actually look at the keyboard.

Another thing I really appreciate on this keyboard is the full sized arrow-key layout, which is such a treat to use instead of the cramped layout a lot of laptop makers are now going with.

Typing on this laptop is a great experience, and even while typing for hours on end, I didn’t feel fatigued thanks to the nice responsive keys here, and the fact that I didn’t need to press them too hard to get them to actuate.

Asus has rated this keyboard for 20 million keypresses, which, well, I’m not counting my keystrokes on this laptop, but that’s definitely a lot, and this keyboard somehow instills me with a confidence that it won’t just break on me — that’s something Asus’ TUF Gaming laptops probably have in common, since my experience with the FX505DY was similar as far as the keyboard was concerned; including things like the extended spacebar that makes it easier to press in the middle of an intense game, and the fact that this is a full sized keyboard, complete with a numpad that I never used, but FIFA players will definitely appreciate.

asus fx505dt keyboard wasd keys

It’s a great keyboard, and I don’t see any reason to not like this, whether it’s for typing, or for playing games — the FX505DT’s keyboard is amazing.
Trackpad

The FX505DT features a trackpad design that will be remarkably familiar to anyone who has used or seen a TUF Gaming laptop before. In fact, it’s basically the same trackpad — not that that’s a bad thing.

The trackpad here is not too big, but it’s not small either, but if you’re used to using laptops with bigger trackpads, like I am with my MacBook Pro, this might feel slightly cramped. In all fairness though, this is one of the bigger trackpads you’d find on Windows laptops, especially in this price range, so I’m not really going to dock points by claiming that the trackpad here is small. It’s actually pretty nice.

I did have to get used to the trackpad, but it works really well, and while clicking on this trackpad isn’t as nice a feeling as it is on something like the HP Spectre, it’s not bad either. If anything, it’s better than most laptops in the price bracket.

All that said, as gamers, I’m fairly confident you’ll be connecting a mouse to this laptop anyway, but for usual day to day usage, this trackpad will definitely suffice.
Audio

I know what you’re thinking: you’ll be wearing headphones most of the time when you’re gaming, but that’s not all you’d do on your laptop, is it? If you’re watching a movie, or bingeing on a TV show, chances are you’ll rely on the built-in speakers on your laptop.

asus fx505dt speakers

Fortunately, you can rely on the speakers on the FX505DT. They can get decently loud, and they don’t distort at maximum volumes, and while the bass isn’t all that great (were you really expecting that?), the overall sound quality of the speakers here is solid, and I didn’t find myself looking for a Bluetooth speaker every time I wanted to watch something on the laptop, which is awesome.
Battery

The FX505DT comes with the same 3-cell 48Whr as the FX505DY I reviewed earlier, and it performs pretty much the same way. The laptop lasts around 4.5 to 5 hours on regular usage, which is actually pretty great for a gaming laptop, and is also very similar to the battery life you’d find on other TUF Gaming laptops. Still, if you’re planning on using this laptop as a regular work machine as well, you’ll need to carry your charger along everyday.

asus fx505dt battery

For gaming, however, I don’t think the battery life needs to be a consideration, since you’ll not be playing games without the charger plugged in anyway, so this part shouldn’t be that big a deal for you.
Pros and Cons

At Rs. 81,990, the FX505DT seems like a pretty solid laptop, but as it is with everything, there are two sides to this proverbial coin as well. So let’s summarise those.

Pros:

    Solid build and design
    120Hz display
    Good performance
    Great keyboard

Cons:

    No Thunderbolt 3, or USB-C ports
    8GB RAM might not be enough

Asus TUF Gaming FX505DT: A Gaming Laptop Worth Checking Out

All things considered, the FX505DT is a gaming laptop that worth checking out. It brings a lot to the table. There’s a good processor in the Ryzen 7, a solid GPU in the GTX1650, a great keyboard, design that’s subtle but not too much so, and a solid build. Sure the selection of ports might feel slightly constricting to some, but it’s not a deal breaker for sure. However, if you’re looking for other options, there are laptops you can check out. Personally, I’d suggest you take a look at the MSI GF63 (Rs. 82,990), which also brings the same GTX1650 GPU, but comes with a Core i7 processor, a 512GB SSD, and even a USB-C port for just Rs. 1,000 extra.

However, if you’re looking for a gaming laptop that’s built to be tough and can run games well, the TUF Gaming FX505DT is definitely worth checking out once it launches in the next week or so.
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Sunday, 28 July 2019

For Weight Loss Success, Focus on Action Goals

In the event that you have never been to a chiropractor, you might ponder what will occur on your first visit. While no two specialists are actually indistinguishable, there are some broad similitudes among generally experts. Here is some data with respect to what you may encounter when you get into the workplace.

You ought to most likely hope to be in the workplace of your chiropractor for around 30 minutes. Resulting visits could last as meager as 15 minutes, however that relies upon the sort of treatment that you get. You'll most likely talk about a few themes with the specialist, including the restorative history of you and your close family, any past medical procedures you may have had, the meds that you are taking, and your current physical condition. You may likewise be gotten some information about your eating regimen and exercise propensities, your day by day exercises and your work schedule, just as your home life and your feeling of anxiety.

Wear agreeable garments and shoes on your first visit to the chiropractor. The specialist may request that you put on an outfit with the goal that the individual in question can play out a progression of tests. You may have your heartbeat, pulse, and breathing tried, just as your quality and reflexes. The specialist may examine your stance, take a X-beam of your spine, and see how you turn, twist, lift articles, and the sky is the limit from there. In the event that you have had any X-beams or radiology tests run, attempt to make sure to bring the outcomes. This will enable your primary care physician to all the more likely decide the nature of your general wellbeing.

There are various sorts of consideration that are accessible relying upon the kind of help you are looking for. For instance, on the off chance that you need quick assistance, this is known as alleviation care. You may require only a couple of visits or you may require a few, contingent upon your physical condition, age, and conclusion. On the off chance that you have a progressively serious or repeating condition, you may require restorative consideration. This may necessitate that you make increasingly various visits, and these visits may take longer. This kind of consideration will support your muscles, tissues, nerves, and spine return to typical.

At long last, support care will enable you to get profits by both help and remedial consideration. Your chiropractor is prepared to identify conditions even before you may experience decreased portability or feel torment. As you continue working with the specialist, the soundness of your spine will be expanded.

Regardless of what kind of consideration you get, the treatment will presumably incorporate proposals in regards to your eating regimen and the sum that you work out. Contingent upon your particular degree of treatment, the specialist will examine your alternatives for future visits. The person may just prescribe that you come in every so often for minor acclimations to enable you to all the more likely handle the mileage that can be related with day by day life. Therapeutic research has demonstrated that an expansion in the adaptability of a muscle unit expands execution and lessens the measure of wounds supported. Essential extending activities incorporate heating up and chilling off sessions. The fundamental instrument is expected to the slacken ligaments in the wake of extending which is less inclined to tears when utilized. Extending likewise lessens the recuperation time in the middle of sessions and builds the biomechanical effectiveness.

There are essentially 3 fundamental sorts of extending: to be specific static, ballistic and proprioceptive neuromuscular help (PNF). Static extending is the most widely recognized and the most secure among the 3. Static extending works by gradually pulling the muscles towards its most extreme end scope of movement for a span of 15 seconds. This is done in an easy and controlled condition and during the extending exercise no abrupt rascals ought to be made. It is performed for as a rule for 3 sets and after which an expansion in adaptability will be watched. Static extending ought to likewise be performed after the activity to help in recuperation. Studies have demonstrated that extending can disseminate the lactic corrosive develop in the muscles which are in charge of the soreness experienced post-work out.

Ballistic extending then again utilizes the energy of a moving body to extend it past the ordinary scope of movement. This is otherwise called bobbing extending which pulls your muscles through activities, for example, ricocheting on a trampoline while extending the back. Therapeutic investigations have presumed this isn't helpful and can prompt wounds since it extends your muscles all of a sudden rather than dynamically as found in the static stretches.

To wrap things up is the proprioceptive neuromuscular assistance (PNF) extend. It is the quickest and best extending technique that joins latent and isometric extending to acquire the most extreme adaptability. PNF stretch was initially proposed for recuperating stroke exploited people. It works by latently extending the muscles and after that contracting it isometrically and rehashing again and again.

Extending can be effectively performed anyplace paying little mind to the movement you are going to perform. Truth be told, extending ought not be viewed as a warm up exercise. You ought to perform extending even before you begin your heating up activities. Continuously keep your stretches sport explicit with the goal that you work the right muscle gatherings. In conclusion, make sure to consistently exercise alert when doing extends and don't work muscle bunches that are harmed or it very well may be additionally irritated. A couple of days prior, I grabbed my golf clubs without precedent for more than seven years. Luckily I was under the vigilant gaze of showing expert Jennifer Greggain at the Chilliwack Golf Club. During my exercise, Jennifer gave me target things to deal with, for example, precisely where my body ought to be during my set up, and a couple of key focuses to consider during my swing. Later toward the beginning of today, I will go out to play a series of golf. Rather than pondering how straight or far I hit each shot, I will concentrate on swinging 'down and through', and turning my body on finish. I have an activity based objective.

Defining activity based objectives are significant at whatever point you look to change or improve, including on the off chance that you need to get thinner. With regards to weight reduction, numerous individuals will in general spotlight on a number on the scale, or inches lost. While these outcomes or result objectives are the main thrusts to look for change, it's the activity based objectives that will get you there.

There are a couple of reasons why you should concentrate on activity objectives versus result objectives. Activity objectives enable you to be 100% responsible for your prosperity. With an objective, for example, "I will shed 10 pounds by October 1", your outcome is to a great extent out of your control. You don't know precisely how your body will react to an activity or eating plan. Maybe you do all the correct things, yet you just shed three pounds. Since you didn't achieve your objective, you might be debilitated and surrender, notwithstanding settling on numerous solid decisions and gaining ground. Conversely, an activity center, for example, "I will take a stroll after dinner three nights per week" or "I will have my supper carefully every day and track my nourishment in my online sustenance diary regular", enables you to encounter achievement paying little respect to the number on the scale or the measuring tape.

Concentrating on activity objectives likewise makes the voyage increasingly wonderful and positive. Creator Dennis Wholey said "Upbeat individuals plan activities, they don't plan results". On the green, I will make the most of my round by dealing with my set up and finish, as opposed to being disheartened if my shot winds up in the trees. With weight reduction, you can appreciate the procedure by commending achievement every day, for example, when you plan your dinners every week, or read a decent book to invigorate your brain as opposed to making a beeline for the icebox.

While result objectives, for example, improving your golf game or getting in shape, drives us to make a move in any case, the result or result is accomplished by making a move steps. Without activity, there are no outcomes. To remain persuaded, to be responsible for your prosperity, and to appreciate the procedure, center around activity objectives rather than result objectives.

As I head out to the green, I realize that regardless of what my score is today, I have the chance to encounter achievement and appreciate the experience on the grounds that as I have explicit activity objectives. What's more, since I have the direction of a specialist mentor, I realize that achieving my activity objectives will enable me to achieve my ideal result: a superior score.
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Saturday, 16 February 2019

Tips for using this versatile piece of exercise equipment

Seasonal allergies can be frustrating. When spring crawls in, many people begin to experience all-too-familiar itchy and watery eyes, runny nose, and congestion. Symptoms of seasonal allergies are the result of an immune system in overdrive in response to pollen and other allergens. Those bothersome symptoms are intended to protect you from unwanted foreign particles, but in this situation they end up causing misery. There are quite a few options when it comes to controlling allergy symptoms, but we want to watch out for a few that can be quite dangerous when used incorrectly.
Nasal steroids

The first-line treatment for seasonal allergies is an intranasal corticosteroid such as fluticasone propionate (Flonase). These sprays are available without a prescription and you can use them as-needed. Nasal steroid sprays have been shown to help with both nasal symptoms of runny nose and congestion, as well as eye symptoms. When using these sprays, it is important to direct the spray away from the nasal septum, as there have been some cases of nosebleeds from using these sprays. If this happens, stop using the medication and let your doctor know.

To date, most studies looking at the effect of intermittent use of nasal steroids on growth in children have been inconclusive. However, a large study reported a slight reduction in the rate of growth when nasal steroids were used daily over 52 weeks by children before puberty. Therefore, it’s a good idea to discuss steroid nasal sprays with your doctor if you find your child needs it on a more regular basis.
Oral antihistamines

Antihistamines such as diphenhydramine (Benadryl), loratidine (Claritin), cetirizine (Zyrtec), and fexofenadine (Allegra) can also be quite helpful. The key is to take the medicine before symptoms develop, such as early in the morning. Another important thing to remember is that some of these medications can cause drowsiness and should be used cautiously during the day, especially if you are driving.
Decongestants

Nasal decongestant sprays such as phenylephrine and oxymetazoline (Afrin) should be used cautiously. Although they may work well in the short term when used occasionally, if used regularly for more than a few days (approximately five days), you may find your nose more congested than usual. This is called rebound congestion or rhinitis medicamentosa. I usually recommend patients not use these products for more than three days. Using these sprays too often causes a biochemical change in certain receptors on your cells, resulting in a vicious cycle of dependence — the more you use it, the worse your symptoms, and the more you need to use it. If this happens, stop using the medication, and talk to your doctor about switching to another type of nasal spray (intranasal glucocorticoid spray) which has been shown to help with this condition.

Oral decongestants such as pseudoephedrine or phenylephrine may help reduce symptoms as well. You should also use these medications cautiously. They mainly work by constricting blood vessels, and may cause side effects such as increased blood pressure, palpitations, headaches, nervousness, and irritability. These medications should not be used by patients with a history of uncontrolled high blood pressure, heart rhythm problems, strokes, glaucoma, or other conditions.
Alternative therapies

Other therapies that have been shown to be beneficial include nasal saline irrigation. Irrigating the nasal passages with prepared solutions, such as with neti pots, has been shown to improve symptoms of runny nose, congestion, and itchy throat, and to improve quality of sleep in children with acute sinusitis and allergic rhinitis. When using these products, however, make sure you are using distilled, sterilized, purified, or previously boiled water, as there have been rare cases of fatal infections by amoeba when using tap water that was contaminated. Although the evidence for menthol rubs such as Vicks is limited, some patients find that rubbing a little menthol ointment under the nose can sometimes also offer congestion relief. Sometime back in 2010, a good friend of mine from college who had since become a pediatrician posted a complaint on Facebook about “made up” health conditions. “Fibromyalgia, I’m looking at you,” she wrote. At this time, pain was more of an occasional visitor in my body rather than the permanent tenant it has since become. Still, I was offended on behalf of those patients with the disease.

Fast forward to today and my life is all about pacing. This is because everything I do — cook, sleep, work, walk — takes time. This gradual approach to every aspect of my life is not about enlightenment or mindfulness. It is about pain. Or more specifically, trying to evade or minimize it. To minimize is key because I’ve learned it can’t be avoided, at least not entirely, no matter my effort. For me, fibromyalgia became a default diagnosis — a catch-all phrase the doctors slapped on me to encompass all the aches and health complaints that had begun to persistently plague me. I received this diagnosis even as imaging showed degenerative changes and other damage in my spine and hips, even as endometriosis was confirmed to be spreading like strands of spider web inside my abdomen, wrapping its tendrils around my organs with the insidiousness of an invasive plant. When the pain reached the point of making it impossible to work more than on a very part-time basis most weeks, I began to inquire about disability. But my doctors — the same ones who diagnosed me, treated me, and viewed my MRI results — all shook their heads and refused to sign off on any paperwork.
“You don’t seem sick,” they said

This was the same line I was offered in college after extreme intestinal distress caused me to lose more than 20 pounds in a single semester. But the school nutritionist thought I just wasn’t eating enough bananas. “You have such shiny, healthy-looking hair,” she explained, pinching a lock of it between her fingers as though I were a doll on display. “People who are really sick don’t have hair like yours.” A colonoscopy showed nothing visibly wrong, so the doctor diagnosed me with irritable bowel syndrome and treated me as though I was a hopeless neurotic. “Stop being so stressed and eat your greens,” he scolded. Two years later, a laparoscopic surgery would show widespread endometriosis, a large portion of it choking my colon. Its removal eased my GI complications considerably. But by then I learned the hard lesson that doctors often erred on the side of disbelief when they couldn’t see something plainly… or even when they could.

I have heard an extensive list of reasons why I can’t be in as much pain as I say despite my test results… and besides my shiny hair, like: I am too young; I have good teeth; I’m too thin to have back problems. Yet, these haven’t granted me immunity from illness, and they have not prevented pain.

Only recently has medical research started to catch on to what patients suffering from chronic pain have long known. As reported in a New York Times Well column written by Tara Parker-Pope in 2011, a study by the Institute of Medicine discovered that pain can endure long after the illness or injury that caused its initial onset has been treated or healed, until it eventually evolves, or devolves, into its own disease. That is, pain is no longer indicative of another prognosis — it is the prognosis, and a disabling one at that.

Specifically, under the strain of prolonged pain, nerves not only become super-sensitized to pain signals, but begin amplifying them. Once these changes occur, they can be extremely difficult to undo. Meanwhile, most medical students are woefully lacking in training in chronic pain, usually receiving only a few hours’ worth in their entire education. In fact, veterinarians receive more training on how to treat animals in pain than medical doctors do for their human patients. Unfortunately, without an adequate understanding of pain and its mechanisms, many medical practitioners are quick to downplay the experience of their patients as faking or exaggerating. What this translates into is denying a disability because it is invisible to the naked eye.
Wiser doctors needed

What would help me at this point would be to have practitioners who are not only more well-versed in chronic pain, but are willing to acknowledge its disabling impacts on their patients. In other words, doctors should start believing their patients when they say they are hurting. Validation is the first step toward a solution, or at the least, toward offering alternative adjustments and treatments that can accommodate a pain patient and bring them a better quality of life in the absence of a long-term cure. I used to think of treadmills as the walk (or run) of shame. They were only used on rainy or cold days when I was desperate to get in my workout.

But I have since wised up. Approached the right way, they can offer in-depth, all-around workouts beyond the usual push-the-button-and-go.

“The machines can target all the key muscle groups needed to improve lower body strength and endurance, such as quadriceps, calves, glutes, and hamstrings,” says Dr. Adam Tenforde with the Department of Physical Medicine and Rehabilitation at Harvard-affiliated Spaulding Rehabilitation Hospital. “Plus they offer various programmed workouts that vary the speed and incline, so you can focus on specific goals and needs, like cardiovascular health.”

Treadmills are also ideal for people returning to exercise after an injury or surgery, since you can control the pace and intensity, and they are equipped with handrails for added support.
Using treadmills safely and effectively

Most treadmills monitor intensity with hand sensors that measure your heart rate, but that’s not always the most accurate approach, says Dr. Tenforde. A better way to gauge your effort is with the rate of perceived exertion. This involves ranking your sense of how hard you’re working on a 1-to-10 scale, with 1 being low and 10 being high. For example, 5 to 7 is a moderate-intensity level where you work hard, but can maintain a conversation and not overexert yourself.

Finally, always do a five- to 10-minute warm-up and cool-down by walking at a slow pace. This helps reduce your risk of injury and improves post-workout recovery. (As always, talk to your doctor first before beginning any exercise program.)
Speed, endurance, and muscle building

Here are three treadmill routines from Dr. Tenforde you can add to your exercise program that address three areas of fitness: speed, endurance, and muscle building. Begin with a 10-minute workout and then gradually build up to 20 to 30 minutes as you progress.

Routine 1: Incline (endurance and muscle building). An incline setting generates more muscle activity than walking or running on a flat surface, since you work against gravity. A small 2014 study in the journal Gait & Posture found that incline treadmill walking also could benefit people with knee osteoarthritis and knee replacements.

The workout: Begin walking or running at a zero-grade incline at an exertion rate of 3 or 4 for up to two minutes, then increase to level 1 incline for another minute or two. Repeat the routine until you reach an incline level where you work at 5 to 7 exertion and try to maintain it for a minute or longer. Then reverse the routine until you reach the zero-grade incline again. It is fine to stay at an incline longer, or to exercise at a lower exertion rate, until you are more comfortable.

Routine 2: High-intensity interval training (speed, endurance, and muscle building). HIIT involves alternating between set periods of high-intensity work and rest. The high intensity is at an exertion rate of around 5 to 7, while you rest at a rate of 2 or 3. “HIIT is based on your individual exertion, so adjust the treadmill to match this desired effort,” says Dr. Tenforde. “The point with HIIT is to mix up the intensity to make yourself work harder for shorter periods. It can be fun and breaks up the monotony of exercise.” HIIT is also ideal for people who have trouble finding time to exercise. A study published online by PLOS One found that HIIT produces health benefits similar to longer, traditional endurance training.

The workout: Begin with a moderately high intensity-to-rest ratio of 1:3, in which you power walk or run for one minute and rest for three minutes. As you improve, you can vary the ratio to 1:2 or 1:1 or even work for longer high-intensity periods with shorter rest breaks.

Routine 3: Speed variations (speed, endurance). Most treadmills have pre-programmed workouts that vary the speed and incline with labels, such as “fat burning” or “hill climbing.” “These can help increase your cardiovascular health by varying the effort and can be another way to add variety,” says Dr. Tenforde.
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Friday, 8 February 2019

How brain science informs addiction treatment

Information is knowledge, and big tech companies know how important it is to collect and track data. When it comes to your health, it is now easy to measure and track all kinds of information. In the comfort of our homes we can check our weight, blood pressure, number of steps, calories, heart rate, and blood sugar. Recently some researchers have started to use an interesting marker for resilience and behavioral flexibility. It is called heart rate variability (HRV).

Have you ever wondered what the health impact of a stressful day was? Will you perform well during your long run tomorrow morning? Is there anything you can do today that would improve your ability to have a better day moving forward? HRV may be the piece of data that could help you answer these questions.
What is HRV?

HRV is simply a measure of the variation in time between each heartbeat. This variation is controlled by a primitive part of the nervous system called the autonomic nervous system (ANS). It works regardless of our desire and regulates, among other things, our heart rate, blood pressure, breathing, and digestion. The ANS is subdivided into two large components, the sympathetic and the parasympathetic nervous system, also known as the fight-or-flight mechanism and the relaxation response.

The brain is constantly processing information in a region called the hypothalamus. The hypothalamus, through the ANS, sends signals to the rest of the body either to stimulate or to relax different functions. It responds not only to a poor night of sleep, or that sour interaction with your boss, but also to the exciting news that you got engaged, or to that delicious healthy meal you had for lunch. Our body handles all kinds of stimuli and life goes on. However, if we have persistent instigators such as stress, poor sleep, unhealthy diet, dysfunctional relationships, isolation or solitude, and lack of exercise, this balance may be disrupted, and your fight-or-flight response can shift into overdrive.
Why check heart rate variability?

HRV is an interesting and noninvasive way to identify these ANS imbalances. If a person’s system is in more of a fight-or-flight mode, the variation between subsequent heartbeats is low. If one is in a more relaxed state, the variation between beats is high. In other words, the healthier the ANS the faster you are able to switch gears, showing more resilience and flexibility. Over the past few decades, research has shown a relationship between low HRV and worsening depression or anxiety. A low HRV is even associated with an increased risk of death and cardiovascular disease.

People who have a high HRV may have greater cardiovascular fitness and be more resilient to stress. HRV may also provide personal feedback about your lifestyle and help motivate those who are considering taking steps toward a healthier life. It is fascinating to see how HRV changes as you incorporate more mindfulness, meditation, sleep, and especially physical activity into your life. For those who love data and numbers, this can be a nice way to track how your nervous system is reacting not only to the environment, but also to your emotions, thoughts, and feelings.
How do you check your heart rate variability?

The gold standard is to analyze a long strip of an electrocardiogram, the test we frequently do in the medical office where we attach wires to the chest. But over the past few years, several companies have launched apps and heart rate monitors that do something similar. The accuracy of these methods is still under scrutiny, but I feel the technology is improving substantially. A word of caution is that there are no agencies regulating these devices, and they may not be as accurate as they claim. The easiest and cheapest way to check HRV is to buy a chest strap heart monitor (Polar, Wahoo) and download a free app (Elite HRV is a good one) to analyze the data. The chest strap monitor tends to be more accurate than wrist or finger devices. Check your HRV in the mornings after you wake up, a few times a week, and track for changes as you incorporate healthier interventions.
The bottom line

Tracking HRV may be a great tool to motivate behavioral change for some. HRV measurements can help create more awareness of how you live and think, and how your behavior affects your nervous system and bodily functions. While it obviously can’t help you avoid stress, it could help you understand how to respond to stress in a healthier way. There are questions about measurement accuracy and reliability. However, I am hoping an independent agency eventually identifies which devices and software provide data we can trust. In the meantime, if you decide to use HRV as another piece of data, do not get too confident if you have a high HRV, or too scared if your HRV is low. Think of HRV as a preventive tool, a visual insight into the most primitive part of your brain.
Stomachaches are incredibly common in children. Most of the time they are nothing serious at all. Most are just from a mild stomach bug, or some constipation, or hunger — or are a child’s way of getting out of something they don’t want to do. But a stomachache can sometimes be a sign of a more serious problem.
A stomachache worries doctors when…

1.  The pain is severe. By severe, I mean that the child cannot be distracted from it, and is crying or otherwise showing that they are extremely uncomfortable. Any severe pain warrants a trip to the doctor, whether it’s unrelenting or it comes and goes.

2.  There is blood in the stool. Most of the time, we see blood in the stool with constipation, which is usually not serious and can be easily treated. But a bad stomachache with blood in the stool can be a sign of a serious infection, inflammatory bowel disease, or another intestinal problem. So any time your child has a stomachache and blood in the stool, give your doctor a call to be on the safe side.

3.  The child vomits blood. As with blood in the stool, this isn’t always a sign of something serious. Children who have been vomiting a lot can sometimes vomit some blood, and children who have nosebleeds, or bleeding from a lost tooth or some other problem of the mouth, may vomit that blood back up. But as with blood in the stool, any stomachache with vomiting blood requires a call to the doctor.

4.  There is green vomit. Green vomit can be a sign of a blockage in the intestine. Sometimes people vomit some yellow-green material when they have vomited up everything else, but stomach pain and green vomit should never be ignored.

5.  The child has hives, looks pale, complains of dizziness, or has swelling of the face. Anaphylaxis, the most serious kind of allergic reaction, can cause stomach pain, often with vomiting. For this one, you should call 911. If your child has a known allergy and you have epinephrine at home, give it while you wait for the ambulance to arrive.

6.  The stomach pain is in the right lower side of the belly. That’s where the appendix is. Early on, the stomachache of appendicitis is usually around the belly button, but then it moves to what we doctors call “the right lower quadrant.” Constipation can cause pain there, and girls who get periods can have pain there when they ovulate, but we don’t like to miss appendicitis. So, any pain in that part of the belly should get checked out.

7.  The child has a fever and a bad cough. Pneumonia can sometimes cause a stomachache. Now, many viruses can cause a stomachache along with a cough, but if the cough is particularly bad, or the stomachache is getting worse, or the child seems to be breathing quickly or otherwise differently, call the doctor.

8.  The child says it hurts to urinate. Sometimes a stomachache can be a sign of a urinary tract infection.

9.  The child has a high fever or seems much sleepier than usual. Stomachaches can be seen in serious infections — and being very sleepy when you are in pain can be a sign not just of infection but of low blood pressure or blood loss. High fevers and extra sleepiness should always be checked out, but especially if there is a stomachache too.

10.  The child is losing weight. It’s not uncommon for a child to lose a little weight from vomiting or diarrhea. Usually they gain it back once they feel better. But if a child who gets stomachaches is steadily losing weight — for example, their clothes no longer fit — they should be thoroughly checked out by the doctor.
What to do if none of the above is true

This doesn’t mean that every other stomachache is fine — but if none of the above is true, it’s less likely to be something serious. Try rest, fluids, and a bland diet (or extra fiber in the diet if your child is constipated). If your child isn’t getting better, especially if your child has vomiting or diarrhea that isn’t getting better, call your doctor. If your child has recurrent stomachaches, it’s incredibly helpful when parents keep a diary of the stomachaches, along with details of things like what they ate that day, what their stool was like, how they acted, etc. This information can go a long way toward helping the doctor figure out what is going on, and how to help.

The American College of Cardiology and the American Heart Association certainly grabbed the attention of us busy primary care physicians with the recent release of their updated blood pressure guidelines. These organizations had piqued interest by declaring the release date and labeling it as “highly anticipated.” I pooh-poohed all that drama, but upon reading through the 114-page executive summary PDF with 21 authors and almost a thousand references, I have to say, I am duly impressed.

The definition of the diagnosis of high blood pressure and the decision-making process surrounding treatment have traditionally been quite individualized (read: all over the place). Personally, I invite these stricter measures, because they are accompanied by solid research, logistical guidance, and useful management strategies.

However, a whole heck of a lot of people just got pulled into a significant medical diagnosis.

Let’s review what’s new.
A new definition of high blood pressure (hypertension)

(Please note that all numbers refer to mm Hg, or, millimeters of mercury.) The guidelines, in a nutshell, state that normal blood pressure is under 120/80, whereas up until Monday, normal was under 140/90.

Now, elevated blood pressure (without a diagnosis of hypertension) is systolic blood pressure (the top number) between 120 and 129. That used to be a vague category called “prehypertension.”

Stage 1 high blood pressure (a diagnosis of hypertension) is now between 130 and 139 systolic or between 80 and 89 diastolic (the bottom number).

Stage 2 high blood pressure is now over 140 systolic or 90 diastolic.

The measurements must have been obtained from at least two careful readings on at least two different occasions. What does careful mean? The guidelines provide a six-step tutorial on how, exactly, to correctly measure a blood pressure, which, admittedly, is sorely needed. My patients often have their first blood pressure taken immediately after they have rushed in through downtown traffic, as they’re sipping a large caffeinated beverage. While we always knew this could result in a falsely elevated measurement, it is now officially poor clinical technique resulting in an invalid reading.
New recommendations on monitoring blood pressure

The new guidelines also encourage additional monitoring, using a wearable digital monitor that continually takes blood pressure readings as you go about your life, or checked with your own cuff at home. This additional monitoring can help to tease out masked hypertension (when the blood pressure is normal in our office, but high the rest of the time) or white coat hypertension (when the blood pressure is high in our office, but normal the rest of the time). There are clear, helpful directions for setting patients up with a home blood pressure monitor, including a recommendation to give people specific instructions on when not to check blood pressure (within 30 minutes of smoking, drinking coffee, or exercising) and how to take a measurement correctly (seated comfortably, using the correct size cuff). The home blood pressure cuff should first be validated (checked in the office, for accuracy).
If you now have high blood pressure, you may not need meds… yet

The guidelines also outline very clearly when a diet-and-lifestyle approach is the recommended, first-line treatment, and when medications are simply just what you have to do. Thankfully, the decision is largely based on facts and statistics. For the elevated blood pressure category, medications are actually not recommended; rather, a long list of evidence-based, non-drug interventions are. What are these interventions? Things that really work: a diet high in fruits and vegetables (such as the DASH diet, which is naturally high in potassium); decreased salt and bad fats; more activity; weight loss if one is overweight or obese; and no more than two alcoholic drinks per day for men, and one for women. Simply changing what you eat can bring down systolic blood pressure by as much as 11 points, and each additional healthy habit you adopt can bring it down another four to five points.

For people with stage 1 hypertension who don’t have cardiovascular disease and are at low risk for developing it (less than 10% risk of an event within 10 years), lifestyle changes are still the way to go. (Risk is determined using a well-researched, widely used formula available here.)

However, if a patient has any kind of cardiovascular disease and stage 1 hypertension (a blood pressure over 130 systolic or 80 diastolic), or no existing cardiovascular disease but a significant risk of developing it (over 10% risk within the next 10 years), then lifestyle changes plus medications are recommended. And, even if someone has less than a 10% risk, if their blood pressure is over 140 systolic or 90 diastolic, which is now stage 2 high blood pressure, they ought to be treated with medication as well.
Optimizing treatment of high blood pressure

The authors bring several evidence-based yet progressive concepts into the guidelines, the first of which is that high blood pressure should be treated using a team approach. This makes sense, as science supports more and better patient education around self-monitoring, nutrition, and lifestyle changes, as well as stress management. Telehealth is emphasized as a cost-effective method of ongoing monitoring that is more convenient for patients than frequent office visits.
And why should this all matter to you?

Mountains of research over time have shown a very clear link between high blood pressure and cardiovascular disease. A 20-point higher systolic blood pressure or a 10-point higher diastolic blood pressure is associated with double your risk of death from a heart attack, stroke, or other cardiovascular complication (like abdominal aortic aneurysm or heart failure). What many people don’t realize is that those who survive these events find their lives permanently altered by disability and medical complications.

Much is being made of the fact that the new definitions of high blood pressure will mean roughly half of all US citizens will be considered to have high blood pressure, but when you really look at the numbers, as cardiologists already have, not that many more people will actually be advised to take medications. Although the public has good reason to be suspicious of “big pharma,” that’s not what this is about.

Diet and lifestyle changes are powerful medicine. Even if your blood pressure is normal now, you can help to prevent it from becoming elevated starting today. Eat more fruits, veggies, and whole grains, and limit foods high in sodium and unhealthy fats. Be as physically active as possible.

There is a lot more in the very long, detailed executive summary, including specific guidance for various populations, myriad diseases, and special circumstances, but this is the gist of it. The document is free, and available here. But, it’s also one of the first things to fall by the wayside in times of stress, especially for those who are primary caregivers. This includes parents, people caring for elderly relatives, healthcare providers, and first responders. These are the people who often put the well-being of others above themselves.

This is a big problem.
Why is self-care important?

Well, we can’t function very well if we aren’t very well. If it is important to us to be able to take care of others, then we must pay attention to our own well-being.

My favorite analogy for this is clichéd, but accurate. When you get on an airplane and the flight attendant gives that safety spiel, when they get to the part about the oxygen masks, the first thing they tell you is: “If you’re traveling with children or others who need assistance, put your oxygen mask on first.”

Think about it. Let’s say you don’t do that and you fall unconscious due to lack of oxygen, then no one gets the help they need. Lose/lose situation there. It’s the same deal in everyday life. When we don’t take care of ourselves, no one wins.

And yet there is a pervasive cultural pressure to keep pushing ourselves, to ignore the physical needs of our bodies and the emotional needs of our souls, which invariably leads to chronic stress, burnout, depression. Data show that burned-out healthcare providers provide crappy service, depressed parents can’t effectively parent, and the list goes on.

When I talk with my patients about self-care, I often hear things like “But I don’t have time!” or “I’ll feel like I’m being selfish!”

As one of two working parents with two small children, I can empathize greatly with these patients. So, the advice I give is the same advice that I follow.

I know that it can be difficult to fit in self-care when time is at a premium and demands on you are high, but here are four easy things you can consider.
4 things to help revive and nourish body and soul

Be physically active. Exercise busts stress, boosts the mood, and elevates our energy level, not to mention the heart health benefits. Believe it or not, you can exercise just about anywhere, anytime. It doesn’t have to be at the gym. It doesn’t have to be a scheduled class. And it doesn’t have to be more than a few minutes a day. All activity counts. I encourage patients to think of an activity that they enjoy. Anything. Think about how that enjoyable activity can fit into your life: maybe you can ride your bike to work, or take your kids on an easy hike, or get the whole family to rake leaves with you. Let’s brainstorm about activities that will fit into your life: Maybe make your next meeting a walking one, or take a brisk walk at lunchtime. Try a few minutes on the exercise bike in the kitchen, or dancing around your living room in your socks. On my very busy days, I make sure I take the stairs whenever I have the option. I park farther away than I need to and walk a little more. If I’m going to the grocery store and I only need a few things, I use a hand basket instead of a cart. It. All. Counts. And the more, the better.

Eat well. That means eat healthy. The mountain of studies supporting a whole-foods, plant-based diet for our health is almost as large as the exercise one. Stay away from inflammatory, sugar-spiking, insulin-releasing foods like processed carbohydrates (think all added sugars and anything made with flour). Aim for things that grew on plants or trees. The more colorful the fruits or vegetables, the more vitamins, minerals, and antioxidants they have and the healthier they are. Vitamin pills and other supplements just don’t work as well. Not going vegetarian to save your life? Got it. Just get colorful fruits and veggies into your diet wherever you can. We don’t have to be perfect, but the more plant-based our diets are, the better.

Calm your mind. We all have stressors in our lives. What varies is how much we let the stressors stress us. What can we do? Yes, meditation works. The relaxation response works. Yoga works. But for those patients who stare at me blankly when I mention these, I talk about other calming activities. This can mean knitting, baking, walking, swimming. Anything quiet and peaceful, when one can take deep breaths and be calmly, enjoyably focused. Me? I try to do a few favorite yoga stretches at the end of the day, right before bed. This is usually after the kids fall asleep, and I can’t even be bothered to find my yoga mat. I just get right to it on the carpet in my daughter’s room: downward dog, plank, cobra, and then some of my own moves, to stretch out my back.

Sleep well. Aim for a refreshing amount of sleep. While this will differ for everyone, generally it’s about eight hours. It’s tempting to stay up late to cram in those last household chores or answer email, but really, the world won’t end if the laundry is dirty for another day, or the dishes are piled up in the sink. Sleep deprivation causes irritability, poor cognition, impaired reflexes and response time (think: car accidents!), and chronic sleep deprivation can contribute to depression and anxiety. Create a short, easy bedtime routine. Stretching or yoga, prayer, or reading a book can be relaxing. But stay away from your smartphone, tablet, or laptop, as the light interferes and interrupts the natural sleep onset. Alcohol near bedtime also interferes with sleep, and is a common cause of nighttime or early-morning awakening. As a neuroscientist I have been trained to think in a certain way, almost like a car mechanic, who “looks under the hood” at the brains of laboratory rats exposed to drugs. If we can figure out exactly which genes, proteins, brain regions, and neural connections go awry in substance use disorders (SUDs), we can fix those “broken” parts in the brain and design better long-term approaches to addiction treatment. While there is great promise in this approach, it’s not so easy to get under the hood of people who desperately need help with a SUD. It’s very different from working with lab rats. And it can take a long time — often decades — between discovering a way to redirect the addicted brain and an approved treatment.
Neuroscientists and practicing clinicians need to be partners in advancing treatment for SUDs

Obviously medical and mental health clinicians treat SUDs from the perspective of patient care. They are presented with real people who have very real, very immediate needs. These individuals have often lost their families, their jobs, and their basic health. Their lives may be in jeopardy because of the risk of overdose. The goal is to first detoxify the patients, then work with them, through initial recovery from the crisis and beyond, to prevent relapse. This is critically important work, but so is searching for potentially permanent solutions to SUDs. And the place to start is the brain.

Over the past 30-plus years, basic laboratory and translational research has expanded our understanding of the brain’s reward circuitry — specifically how dopamine, a neurotransmitter that is important in both our ability to feel pleasure and our brain’s ability to learn strong associations between cues in our daily lives that predict pleasure, operates. We now understand that the brain’s reward circuitry regulates both the “feel good” effects of a drug as well as the extreme physical and emotional discomfort experienced during withdrawal. The emotional signs of withdrawal can flare up for months or even years after attempts to quit, and these factors play into drug taking, craving, and relapse.
Neuroscience has already contributed to SUD treatment

Here are two examples of SUD treatments that regulate, directly or indirectly, dopamine’s role in the brain reward pathway.

Buprenorphine (Subutex): Like methadone, buprenorphine is considered an opioid replacement therapy because it activates the same parts of the brain that opioids like heroin and oxycodone do. The difference is that it activates at a much lower level and doesn’t jolt the brain’s reward pathway, causing a surge of dopamine release like heroin or oxycodone would. It can help ease withdrawal symptoms and can be used for both initial recovery periods and maintenance of abstinence.

Bupropion (Wellbutrin, Zyban): It has several pharmacological actions in the brain, all of which combine to make bupropion an effective treatment for nicotine addiction (e.g., smoking or chewing tobacco). Its main action is to increase levels of available dopamine in the brain. Since a drop in dopamine is partly responsible for symptoms of nicotine withdrawal, bupropion can prevent this drop, and thus mitigate the strong cravings people experience when they try to quit smoking.
And neuroscience holds promise for better and safer treatments

Here are examples of newer approaches:

Transcranial magnetic stimulation (TMS): TMS uses magnetic fields to strategically stimulate parts of the brain. The FDA approved TMS for some neurological conditions in 2009. Since then the number of conditions for which TMS has shown positive effects has skyrocketed. For people with SUDs, the prefrontal cortex, the part of the brain that helps us not act on every impulse, is often sluggish. Scientists have shown that an underactive prefrontal cortex can set the stage for impulsive and compulsive behavior observed in SUDs. Recently, it was shown that using TMS to stimulate the prefrontal cortex of the human brain might help quell those insatiable urges to take a drug.

Kappa opioid receptor antagonists: These compounds, which block the actions of the naturally occurring neuropeptide dynorphin, can help prevent drug withdrawal from causing low dopamine levels. Here’s how: many drugs that can lead to substance use disorders, if taken long enough, increase dynorphin in the dopamine reward system, which inhibits dopamine release in the brain’s reward circuitry — and the person doesn’t feel good. However, blocking dynorphin receptors with synthetically designed compounds prevents this effect. Currently there are several ongoing clinical trials testing kappa receptor antagonists in SUDs.
Where do we go from here?

The good news is that carefully collected and analyzed laboratory data from preclinical studies have led to numerous treatment options for people with SUDs. But in real life, it’s never as simple as in the laboratory. Each person struggling with a substance use disorder has his or her unique constellation of social, genetic, and psychological factors that make some treatments more or less effective than others. But the better we understand the brain science of addiction, the more likely we will come up with an array of treatments that can help a broader range of those with SUDs.

To me, this means my brain-mechanic work looking under the hood of the brains of rats exposed to drugs is essential to the ultimate process of helping people suffering from SUDs, but only if I take the time to look up and discuss my findings with clinical colleagues. Likewise, the clinicians’ overwhelming job of helping people with immediate, life-threatening needs is essential, but only if they pause periodically to listen to our new brain discoveries that might revolutionize SUD treatments.
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Sunday, 3 February 2019

Returning to an old exercise routine? Here’s what you need to know

Using medications to treat opioid use disorder is a lifesaving cornerstone of treatment — much like insulin for type 1 diabetes. The flawed but widely held view that medications like methadone or buprenorphine are “replacing one addiction for another” prevents many people from getting the treatment they need. In actuality, people successfully treated with these medications carefully follow a prescribed medication regimen, which results in positive health and social consequences — as in patients with many types of chronic medical conditions.

However, even among those who embrace treating opioid use disorder (OUD) with medication, there is a difference of opinion as to which medications are most effective. A new study offers important insight into the advantages and disadvantages of the two medications for OUD that can be prescribed in a doctor’s office (that is, on an outpatient basis). These medications are buprenorphine and extended-release (ER) naltrexone. This study was widely covered in the press, and many of the sound bites and headlines reporting the two treatments to be equally effective were a bit misleading.
The advantages and disadvantages of buprenorphine (Suboxone, Subutex, Zubsolv, Probuphine, Sublocade)

Buprenorphine is a partial opioid agonist medication. This medication activates the same receptors in the brain as any opioid, but only partly. Because its effects are long-lasting, it can be taken once a day to relieve cravings, prevent withdrawal, and restore normal functioning in someone with opioid use disorder. Because it is a partial agonist, it has a ceiling effect. This means once all the receptors are occupied by the medication, even if a person takes 20 more tablets she wouldn’t feel any additional effect or be at risk of overdose.

Any doctor who has completed special training (a primary care provider, addiction specialist, OB/GYN, etc.) can prescribe buprenorphine. The advantage is, theoretically, that a person with OUD could receive treatment from any provider he or she might see for a routine health issue. I say theoretically because, despite its availability, only about 4% of physicians have done the necessary training to be able to prescribe it. The research on buprenorphine is robust, with multiple studies showing it reduces the risk of death by more than 50%, helps people stay in treatment, reduces the risk that they will turn to other opioids (like heroin), and improves quality of life in many ways.
The advantages and disadvantages of naltrexone (Vivitrol, Revia)

Naltrexone is a pure opioid antagonist. It sticks to an opioid receptor, but instead of activating it to relieve craving and withdrawal it acts as a blocker, preventing other opioids from having any effect. The research on naltrexone has been mixed. Naltrexone in pill form is basically no better than placebo because people simply stop taking it. Studies on extended-release naltrexone are more promising and have shown it to be better than no medication at all. However, there has never been a US trial comparing extended-release naltrexone to either methadone or buprenorphine, until this study.
The X-BOT study: Comparing buprenorphine and extended-release naltrexone

This study enrolled individuals with opioid use disorder who had voluntarily gone to a detoxification program. Researchers then randomly assigned them to either daily buprenorphine or monthly extended-release naltrexone. Both groups were followed for 24 weeks, to see how many people relapsed.

One of the most important things investigators learned is just how hard it was to get participants onto extended-release naltrexone, revealing a potential barrier to its usefulness. Before a person can start taking ER naltrexone, they must be completely off opioids for seven to 10 days. Only 72% of the group assigned to ER naltrexone even got the first dose, and among those who were randomized during the detoxification process, only 53% started the medication. In contrast, 94% of the group assigned to buprenorphine started the medication.

The other important finding was what happened with relapses. The researchers analyzed their data using an “intention to treat analysis.” This means that once a person is randomly assigned to a treatment (or placebo), their data counts even if they don’t stick with the treatment. Here’s why this is important: if you don’t include that data, then you miss other important outcomes that influence how effective a treatment really is. Thanks to this type of analysis, researchers learned that relapse was significantly more likely in the extended-release naltrexone group (65% compared to 57% in the buprenorphine group).

Immediate relapses were even more likely in the naltrexone group due to failures to start the medication — 25% of the naltrexone group had a relapse on day 21, compared to 3% in the buprenorphine group. Overall there were more overdoses in the naltrexone group, but no difference in fatal overdoses between the groups. Most of the overdoses occurred after the study medication was stopped, highlighting the lifesaving importance of getting on, and staying on, treatment. The naltrexone group also had a longer length of stay in inpatient detoxification programs, which may be an important consideration when we think about overall healthcare costs.

So, why did many headlines claim extended-release naltrexone was as effective as buprenorphine? Well, that was the finding of a separate analysis that looked only at people who successfully started each medication. When the data was viewed that way, there was no difference between the two medications, but that’s just part of the picture. If it’s harder to get a person to successfully start and stick with a medication, that should factor in evaluating its “effectiveness.”
Take-home messages from X-BOT

This is an incredibly important study. The findings are generally consistent with what I see in my clinical practice. Overall buprenorphine is a more effective treatment for opioid use disorder, in part because it’s easier to get patients started on it and they are more likely to stick with it. Extended-release naltrexone may be as good for people who can successfully complete the detoxification required before starting on it. Both medications have a place, but as with so many conditions and treatments, one size does not fit all.
Whether you and your family are embracing the pleasures of the winter season with ice skating and snowball fights, or reluctantly venturing outdoors to walk the dog and shovel snow, be aware of the health hazards of this cold snap… like frostbite.
Here’s why you don’t want to mess with frostbite

Frostbite can occur even after minutes of exposure to sub-freezing temperatures and wind chill. It develops after exposure to severe cold leads to freezing and injury of tissue with destruction of cells. The inflammation that follows frostbite can cause further tissue damage. The more commonly affected areas are the ears, face, fingers, and toes.
So how do you recognize trouble?

A precursor to frostbite is frostnip, when the cold hasn’t caused any permanent tissue damage. The skin might be red or pale and painful. As early-stage frostbite sets in, the affected areas might feel numb. The skin may feel cold and harder, and become paler or grayish-yellow, and later develop blisters.

Some conditions and situations can increase the risk for frostbite, like dehydration, circulation problems, nicotine and alcohol use, or inadequate shelter and clothing. Also, always be mindful that infants and young children are more vulnerable, and may not be able to recognize these early symptoms and take steps to protect themselves.
What to do if you think someone has frostbite

If you think you are dealing with frostbite, try to get to warmth as soon as possible. However, don’t try to rewarm the frostbitten areas if there is a chance of refreezing, since that can lead to even more tissue damage. Similarly, avoid walking on frostbitten feet, but if that’s not possible and you must walk to get to a warm environment, do not try to rewarm your feet until out of the cold. Once you are out of the cold, safer ways to rewarm the frostbitten areas are with body heat (e.g., fingers into the armpits) and warm (not hot!) water. Don’t try to warm frostbitten tissue by rubbing or using a heating pad, stove, or the heat of a fire. If symptoms don’t improve, go to the hospital promptly for further medical care.
It’s the beginning of a new calendar year, that time when we resolve to do new and better things. This is such a wonderful idea, because doing new and better things can make us healthier and happier. Resolutions can be particularly good for families to make. Not only is it good to work together on something, it’s a good way to keep everyone accountable.

The best resolutions are the ones that are simple. By simple, I don’t necessarily mean easy (if they were easy, we wouldn’t have to resolve to do them). I mean that they are resolutions that you can lean into and work toward, achievable in whatever way works for you. It also helps, obviously, if the resolutions are fun.

Here are three very simple and very healthy things that all families can resolve to do together and that can be adapted to the realities of family life — and can be fun.

1.  Exercise together. Adults should get 150 minutes of moderate intensity exercise (or 75 minutes of vigorous exercise) a week, and children should be active for an hour a day. Most people do not get that much exercise, sadly. It would be great if each and every one of us could resolve to be more active, and certainly all families should be thinking about ways to get everyone to the gym or sports practice or out for a run more often in 2018. But aside from that, try a family resolution to exercise together, as many times a week as is feasible, with as many family members as is feasible. Keep it simple: go for a walk together, for example (if you have a dog, bring more people along for walks). If going for walks isn’t possible or pleasant where you live, turn on some music, move the furniture, and dance in the living room or kitchen. If there is a pool, go for family swim, or go skating, sledding, or biking. Just be active, and do it together. You will be setting an example, helping to build healthy lifelong habits, and spending time together — all of which can make a big difference.

2.  Eat healthier meals together. Notice I said “healthier.” The idea is to move the needle, not achieve perfection (although if you want to try for perfection, go for it). Add a vegetable or fruit to each meal. Try some new grains, like quinoa — or just more whole grains. Serve water or plain milk with meals, rather than juice or soda. Try out small changes, one at a time, with the goal of having a healthier family diet. If everyone is doing it together, it can make it easier. It may be that you begin simply by eating more meals together. Preparing a meal and eating it as a family not only helps everyone eat better, it helps bring families together, which can be very important for the emotional health of everyone in the family — and leads me to the last resolution…

3.  Spend more time together. Whether it’s by exercising or eating together, or family game night or movie night, or simply hanging out, the time you spend together can not only strengthen each and every one of you, but also give you a chance to touch base and find out what is happening in one another’s lives. Turn off the cell phones (making family meals a phone-free zone is a good idea) and pay attention to each other instead. As a resolution, just try to spend more time together. Start small if small works — and then build on it.
My ancient workout clothes are folded neatly (and squished) beneath a pile of sweaters on a shelf in my closet. They were cute — from the ‘90s — when I cared very much about how I looked at the gym. Decades later, I skip the gym and instead walk most days and do body weight exercises, all while clad in a sweatshirt and yoga pants. But whenever I see my old gym outfit (blue leotard “overalls” with a cropped tee shirt built in), I wonder if maybe I’d get more from a gym workout. It wouldn’t be hard to jump back in, would it?
Just a second

It turns out, it’s smarter to ease back into a gym workout when we’re older, even if we’ve been active. And if you’ve been sedentary for a long time, it’s even more important. Why? Because our bodies change as we age. “We lose muscle mass and strength as we get older, and the muscles become less flexible and less hydrated,” says Dr. Clare Safran-Norton, clinical supervisor of rehabilitation services at Harvard-affiliated Brigham and Women’s Hospital.

There can be are other changes, too: arthritis that weakens joints, and vision changes, neurological disease, joint pain, or inner ear problems that can throw off balance. There may also be underlying conditions we aren’t aware of, such as high blood pressure or heart disease, that can increase the risk for severe health consequences if we try to exercise today with the vigor of our youth.
The downside of jumping right back in

If you’ve been sedentary for a long time, jumping back into a workout sets you up for injury. “Lifting weights that are too heavy or taking an exercise class that’s too strenuous often causes trouble, and it’s usually a muscle tear or a strain,” says Dr. Safran-Norton.
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