Being sedentary influences your chances of aging successfully, regardless of whether you are active!

Successful aging is a term used to define the success or health of an individual as they age. It specifically refers to success in aging within the area of physical health, psychological health and social health. Physical health refers to whether one has a chronic condition such as heart disease, high blood pressure or diabetes and whether one has functional impairments such that they require assistance in basic activities (eg. a cane or a walker). Psychological health refers to depression, cognitive function (mental sharpness) and emotional vitality (happy and interested in life). Finally, social health refers to items such as engagement with life, social support and spirituality.

Research has shown that people who are physically active are more likely to age successfully. But the influence of sedentary behaviour i.e. the amount of time one spends in sitting activities, on successful aging is not known. In a recent paper entitled “Sedentary Behavior and Physical Activity are Independent Predictors of Successful Aging in Middle-Aged and Older Adults” published in the Journal of Aging Research (link), a colleague and I set out to understand the influence of sedentary behaviour in this relationship. Using a large sample of middle-aged and older adults from Canada we determined that sedentary behaviour influenced the chances of aging successfully (overall, physically, psychologically and socially) regardless of how physically active one was. Specifically, compared to sedentary older adults, moderately sedentary and least sedentary older adults were 38% and 43% more likely to be aging successfully overall, respectively. In other words, despite being physically active, someone who spends a great deal of time sedentary (for example, sitting at a desk or on a couch) is less likely age successfully in all three domains!

I must acknowledge, as with any research, this paper comes with some limitations. But, it is the first in what will hopefully be a growing field of research to indicate that being active isn’t enough, we must cut down on the amount of time we spend in sedentary activities in order improve our health or to maintain good health. Some people may say that this is impossible, that it is difficult enough to find 30 minutes to exercise. But there are simple strategies one can use to decrease sedentary time or to break up sedentary time. For great information and tips on this, please visit: http://www.sedentarybehaviour.org/ or http://blogs.plos.org/obesitypanacea/

TAKE HOME MESSAGE: Regardless of your age, you should make an effort to decrease the amount of time you spend in sedentary activities. This may be of particular importance to middle-aged and older adults, as these ages are considered “high risk” for the development of chronic diseases such as heart disease or cancer and are generally associated with higher rates of depression and loneliness. To ensure that you or your parents and loved ones age successfully, be sure to incorporate as much activity into your day, whether it be walking or gardening or cooking/cleaning or simply standing at your desk or sitting on a stability ball to watch TV. Anything you can do to break up sedentary time will help, so get moving and keep up with your HALF!

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Ever see an overweight environmentalist?

When I was in grad school, I made my way over to the environmental studies building a couple of times so that I could recruit potential participants. Each time I was there, I noticed something strange. Everyone there was in the “normal” category for body mass index. Moreover, all the participants I screened from that program were ineligible because they were already physically active. It made me wonder, is there something about being an environmentalist, or an environmentally friendly person, that makes one healthier?

As far as I can tell, the answer is YES. I should mention that this article is completely opinion based (and somewhat observational). I’m sure there are overweight enviro-friendly people; I’ve just never met one! So what is it about being green that makes one healthy? My guess is two things; active transportation and local fresh food.

Active transportation means that instead of sitting in a pollution spewing car, enviro-friendly people opt to walk or cycle to work or school. If the distance is too great, they are more likely to take public transit, which also requires a bit of walking (to and from the bus-stop). There are several studies to indicate that those who engage in active transportation are more likely to be in the normal body mass index category. There is also emerging evidence that these individuals are overall healthier.

Eating locally grown food is known to reduce one’s carbon footprint, but it may also mean committing to eating fewer processed foods. Eating produce, breads and meat from local farms means more home cooking and consumption of fewer foods with added sugar and preservatives. Thus by eating local foods, one might be committing to a healthier diet as well as a greener planet.

Surely there are other behaviours that contribute to this “phenomenon”. But as a health and exercise scientist, these two are the most obvious ones to me. What is also obvious from writing this article is that a commitment to a green lifestyle might also be an important step in committing to a HALF!

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Is your diabetes related to air pollution?

We’ve all heard that air pollution is bad for our health. But most people, myself included, assume that we are talking about respiratory health i.e. asthma or emphysema. The truth is, air pollution can be detrimental to cardiovascular and metabolic health too. In fact, a growing amount of research is finding that there may be an association between air pollution and type 2 diabetes.

Type 2 diabetes is on the rise in western countries and is slowly becoming one of the greatest health concerns worldwide. It is primarily a result of poor lifestyle and is considered a preventable disease. However, there are some risk factors (such as genetics and age) that are not in our control. A recent study published in Diabetes Care (Andersen et al. 2012) and conducted by a group of scientists in Denmark found that air pollution may be another one of those factors. The authors used data from the Danish Diet, Cancer and Health database and from national health registries to determine whether traffic-related air pollution levels and the risk for diabetes in the elderly are related. They found a weak and positive association between diabetes and air pollution. This means that higher levels of air pollution were associated with a higher risk of diabetes, particularly among those who were non-smokers or who were physically active. While the association in this study was weak, there is other evidence to suggest that this association indeed exists. For example, a recent study found that traffic-related air pollution is associated with death from diabetes (Raaschou-Nielsen O et al. Diabetologia 2012), while others have found that those with diabetes have worse outcomes when exposed to higher levels of air pollution (O’Neill et al. Circulation 2005).

It seems then that air pollution may be another risk factor for type 2 diabetes. The question is, is it a risk factor we can control or a risk factor that is out of our control?  Well, I would like to think it is one we can control, not just at the individual level, but one that our governments can do a great deal about as well. If air pollution is leading to an increase in the prevalence of chronic conditions, then it is a public health issue. The government should opt for clean and green energy solutions and make green choices more affordable for the general population. This could lead to significant savings in health care expenditure as well as a significant improvement in our quality of life.

TAKE HOME MESSAGE: Type 2 diabetes is preventable and in some cases, reversible; particularly if you have a HALF. However, there are some factors that may be out of our our control and require action from our government. If you live in an area with high levels of air pollution, write to your local officials and let them know that your health is on the line! While we can all do our part at being green, we need significant changes in air pollution levels to ensure we can all maintain our HALF!

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What determines whether a person becomes an exerciser?

You often hear people say they don’t have time or they don’t have access to the appropriate facilities to start an exercise program. Yet, there are many people who are regularly active despite such barriers. So, what allows one person to overcome such barriers while another cannot? The answer is simple yet quite complex. The fact of the matter is, research has identified hundreds of factors that influence regular physical activity.

So the real question then becomes, which of these identified factors truly matters? Which ones are important when trying to make a lifestyle change and trying to engage in regular physical activity? A recent review entitled “Correlates of physical activity: why are some people physically active and others not?” published in the highly reputable journal The Lancet (link) set out to answer these questions. The authors undertook a massive task and reviewed hundreds of articles to determine which correlates/determinants of physical activity show the strongest association with physical activity among children/adolescents and adults. They identified 5 main areas of determinants: demographical, psychological/cognitive, behavioural, social and environmental. Among children/adolescents biological sex (male), ethnic origin (white), self-efficacy (confidence to exercise), family support, perceived behavioural control (whether one thinks they can be active) and environmental  variables such as walkability, traffic speed, access to recreation facilities were all strong determinants of physical activity. For adults health status (i.e. whether one has a chronic disease/limitation or not) and self-efficacy were the strongest determinants of physical activity. Others included personal history of physical activity, intention to exercise and environmental factors such as transportation environment (safety of crossing, side-walks etc), neighbourhood aesthetics (eg. greenery) and access to recreational facilities. The authors also looked at determinants specifically among low-middle income countries and noted that demographic variables such as biological sex, age and socioeconomic status were the strongest determinants. Further, cultural differences in the value of physical activity and social support were noted as being important. Finally, the authors pointed out that genetics MAY play a role in determining whether one is active or not because of the enjoyment or pleasure that physical activity brings for some versus the pain and exertion it brings to others.

It seems then that those who are regular exercisers have the right combination of factors in place. But, the real question is, what can we do for those who do not? Or what can those who do not have the right combination of factors do for themselves? First, as the authors suggest, this data can inform new policies that help overcome barriers. For example, governments can invest in creation of cycling lanes or work to improve neighbourhood sidewalks. Second, individuals who have many barriers but are interested in becoming active can seek out social support to assist them with overcoming the barriers. For example, they can find groups in their geographical area that are interested in similar activities through social media outlets or local facilities. Finally, it is important to find the right type of physical activity/exercise i.e. the type that brings you pleasure. Enjoyment is a great predictor of whether one maintains an active lifestyle, so be sure to search for the right activity/activities, and you’ll be sure to stick with your new HALF!

TAKE HOME MESSAGE: This article was meant to inform people in the field of health promotion and policy development on what can be done to increase physical activity levels among the global population. But we can all learn a little from it. If you work with or have children/adolescents, it seems working on self-efficacy and providing family support will help greatly with their HALF. If you are an adult who hasn’t quite made the habit, or know of someone who needs to create their HALF, then motivate them to become active regardless of their health status and help them boost their self-confidence. Some of the strongest determinants of a HALF are belief in ones’ ability that they can do it. So get out there and tell everyone you know that they can do it, there is no barrier that can’t be overcome when you truly believe in a HALF!

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Does Vitamin D supplementation decrease the risk of fractures?

When people think of reducing the risk of fractures, they automatically think of calcium supplementation. We’ve all heard of women in their 50’s and 60’s being told by their physician’s to start taking calcium to prevent bone mineral loss and to decrease the chance of developing osteoporosis. So why take vitamin D? There are two reasons for supplementing with vitamin D. First, a deficiency in vitamin D can lead to softening of the bones and second, vitamin D is essential for proper calcium absorption. In other words, you could be supplementing with calcium but not absorbing it properly. This is why many calcium supplements come with vitamin D.

How much vitamin D is enough to offset the risk of fractures? A recent publication in the New England Journal of Medicine set out to answer just this. They reviewed and analyzed data from 11 randomized studies of vitamin D supplementation in adults aged 65 and older and assessed hip and non-vertebral (not located in the spine) fractures. The findings from 31,022 people suggested that only a high intake of vitamin D (792–2000 IU/day) leads to a significant reduction in the risk of fracture. This reduction was approximately 30% for hip fractures and 14% for non-vertebral fractures. The authors also found that those who were most vulnerable i.e. those aged 85 and older and those with low baseline levels of vitamin D, had the greatest benefit from vitamin D supplementation. The most interesting part of the study was perhaps that a smaller amount of calcium supplementation (<1000 mg per day) with the highest intake level of vitamin D was more protective against fractures than a higher calcium intake.

This study highlights the need for taking calcium in conjunction with vitamin D. Further, it highlights the importance of taking high doses of vitamin D to actually reap the benefits of supplementation. Again, this is most beneficial for those who are at high risk for fractures i.e. it might not be beneficial for those without the risk factors of older age and low baseline vitamin D. Interestingly, vitamin D levels tend to be quite low among those living in Canada and other developed countries. One way to increase vitamin D is by getting natural sunlight as this synthesizes vitamin D in the body.

TAKE HOME MESSAGE: If you are at high risk for fractures, be sure to supplement your diet with vitamin D as well as calcium (please consult your physician first). Higher doses (approximately 800 IU/day) seem to be optimal for protection against fractures. After starting such supplementation, be sure to do some follow-up tests with your physician to ensure that you are taking the optimal dose of vitamin D. Another great way of ensuring you maintain bone mineral density is through weight bearing exercise, a topic I will cover in a future article.

Don’t let low bone mineral density become a problem in your life. Remember, you have control of your HALF!

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Want to improve your running performance? Less might be more!

As a recreational runner you understand the frustration with not being able to increase your pace. You do your long-slow runs and you cross-train and you run up hills and you speed through those shorter runs, but you can’t seem to get faster. Well, the answer to your pace problems might just be 10-20-30.

High intensity intervals are the “new” way to workout. They’re good for your health, they’re good for performance and they’re used by athletes around the world. But the question is, what type of intervals are optimal for a recreational runner? A recent study published in the peer-reviewed Journal of Applied Physiology showed that 10-20-30 might be the answer. Two scientists in Copenhagen conducted a small experiment with recreational runners (5K times of approximately 23 minutes). They split the participants in to two groups. The intervention group was asked to do a 10-20-30 training regime. This consisted of approximately 1.2k of warm up at low intensity followed by three to four 5 minute running sessions with 2 minute breaks between each session. Each of the 5 minutes of running consisted of 5 consecutive 10-20-30 second runs at an intensity of <30%, <60% and 90-100% of their max intensity respectively (see the note below for more information on how to determine these intensities). The other group (control group) continued to train as they were before with an average weekly volume of 24-25k/week (around 120-130 min/week). The authors found that those in the 10-20-30 group significantly improved their aerobic fitness, 1.5K time and 5k time compared to the control group in just 7 weeks. Another advantage to those in the 10-20-30 group was that their systolic blood pressure (the higher of the two blood pressure numbers) and their cholesterol ratio (total cholesterol to good cholesterol (HDL)) improved significantly while it did not change in the control group.

It seems that high intensity exercise sessions can lead to significant improvements in performance and in health. By simply doing 3-4 repetitions of the 5 minute 10-20-30 intervals, young and healthy participants were able to able to improve their 5K time by 4% and their 1.5K time by 6%! Moreover, they improved their already healthy levels of cholesterol and blood pressure; a difficult task for most. The greatest part of this story is that the runners in the 10-20-30 group were only training three times/week for no more than 30 minutes each session. In other words, less time + higher intensity = greater gains in performance and health.

TAKE HOME MESSAGE: If you are a runner, no matter the level, you can benefit from incorporating high intensity intervals. The intervals in this particular study were 10-20-30 seconds in length, but there are others out there that have been proven beneficial. The benefit of a workout such as 10-20-30 is that it takes less time and is of a lower volume. This gives your body more time for rest and recovery, making it stronger and faster!  If you are not a runner and are not regularly active, be careful when taking on high intensity exercise. It is certainly beneficial, but if you push yourself too hard, too fast, you could get injured. Also, be sure to get clearance if you have high risk for heart disease or have been inactive, before starting high intensity training.

NOTE: You can estimate your 10-20-30 intervals based on heart rate or speed/incline on the treadmill. For the heart rate method, determine your age-predicted maximal heart rate by subtracting your age from 220. Take this number and determine 30%, 60% and 100% of it. Use these heart rate zones to determine the appropriate intensity. The heart rate method will underestimate your zones, but is an easy method. The alternative is to use the treadmill to determine your maximum capacity/workload. Start running on the treadmill at an easy speed with an incline of 2%. Every two minutes, increase the speed by 1mph until you are at your maximum running speed. Then start increasing the incline every 2 minutes. When you get to a point where you can’t run the full two minutes anymore, you have determined your maximum capacity. From this, you can calculate the 30% and 60% workloads on the treadmill. This latter method should not be done without a buddy standing close by. It is also essential that you be screened for exercise prior to attempting this method if you have been inactive up until now. Please use this method with caution!

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Can Pilates help with your Lower Back Pain?

It is thought that 80% of the population will experience low back pain at some point in their lifetime. Whether this is chronic (lasts for a long period of time, 3 months or more) or whether acute (short period of time) will depend on the cause of the back pain. One of the most common reasons for low back pain is weak abdominal muscles and tight low back muscles. This is often a result of having a large waist. Thus, any physical activity will help with back pain of this nature because it will help with weight loss and will also help strengthen and stretch the appropriate muscles. Of course, there are many other causes of low back pain, such as an injury sustained at work or in a car accident. In these cases, more specific exercises targeting the cause of injury may be required. These are generally prescribed by a health care professional such as a physiotherapist. Nevertheless, even for such injury related low back pain, general physically active has been found to be beneficial.

Supervised exercise sessions for chronic low back pain can be expensive and may not be enough to counter the pain. In recent years, exercises such as yoga and Pilates have been investigated as exercise options for those with low back pain. In a recent study published in the peer-reviewed journal Medicine and Science in Sports and Exercise Wajswelner and colleagues investigated the benefits of Pilates compared to a general exercise program for those with low back pain. Participants were adults who reported symptoms of pain or stiffness in the lower back with or without lower limb symptoms (no leg pain or numbness) on most days of the week for 3 months or more. They also had to report significant pain to participate in the study. For 6 weeks, twice per week (60 minutes each), participants attended group sessions of either Pilates or general exercise with a physiotherapist. At the end of the 6 weeks all participants showed significant improvements in pain and disability scores; the improvement was the same between groups. In other words, Pilates led to similar improvements in low back pain symptoms as did general exercise.

This is great news for those with low back pain. It seems that you can safely and effectively use Pilates to improve pain in your lower back. If you don’t have access to a health care professional, then an instructor led Pilates class might be a good alternative. If you do have access, then you could add Pilates to your program for some variety!

TAKE HOME MESSAGE: If you have low back pain, adding physical activity to your daily schedule is essential! There is no doubt in the scientific community that physical activity is good for your back health, but be cautious in choosing the type of activity you do. It would be ideal to consult with a health care practitioner prior to beginning an exercise program, but if you can’t, choose a safe and effective physical activity like walking or Pilates. Don’t let low back pain control your life.

Remember, you have control of your HALF!!!

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Why people in physically active jobs still need to exercise…

As someone who sits in front of a laptop all day, I often wish for a more “active” job. In fact, sedentary jobs are considered to be a significant contributor to the obesity epidemic and many related health problems in western countries. In an attempt to counter this, many tools such as treadmill desks and walking meetings have been implemented in the workplace. It seems then, if you had an active job, like one in construction let’s say, that you might be able to counter this problem. Turns out, it isn’t that simple.

While an active job certainly does lead to an increase in energy expenditure (the number of calories burned), it doesn’t necessarily lead to an increase in fitness or health. In a recent study published in the peer-reviewed journal, British Journal of Sports Medicine, Holtermann and colleagues set to investigate whether having an active job had the same benefit as being physically active in your spare time. They used long-term absence from work as a health indicator. Using a large Danish database, they categorized people into 4 groups based on the activity they did at work and 4 groups based on the activity they did in their spare time. Taking into consideration a variety of factors such as smoking, chronic disease presence, emotional demands and education, the researchers found that more active jobs were associated with MORE long-term absence from work while more physical activity in spare time was associated with LESS long-term absence from work. This was true for both males and females.

Surprised? It is contrary to what we would expect. As an exercise scientist I always say that “any activity is good activity”. It seems I should re-adjust this to “any leisure-time activity is good activity”!

The findings of the study are actually quite simple to explain. A physically active job is usually very specific. For example, if I were a delivery person, I would be doing the same lifting type of activity all day. This repetitive nature of active jobs often leads to injury. This injury of course can become severe over time and thus lead to absence from work. Interestingly though, if you were to go on a fitness program that strengthened your muscles, particularly of the back and legs, you may not end up having getting these injuries. On the same note, if you did a complete exercise program i.e. cardio and weight training and stretching, then you are less likely to sustain other injuries at work and will reduce your risk of chronic conditions. In other words, while those few repetitive tasks you do at work are burning calories, they aren’t doing much for your overall health or fitness levels.

TAKE HOME MESSAGE: Whether you work in an active job or a sedentary job, it is important to incorporate a balanced exercise program into your life. This can prevent you from sustaining injuries in the workplace and of course it will decrease your risk of chronic disease and improve your quality of life. Remember, any leisure-time activity is good activity, so don’t get too bogged down by what to do!

And of course, don’t forget, you have control of your HALF!!

 

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Can a proper warm-up prevent exercise-induced asthma symptoms?

An appropriate warm-up has long been considered an effective means to prevent exercise-induced asthma (EIA). EIA is a condition in which individuals have symptoms such as breathlessness, sore throat, wheezing and cough after exercise (sometimes during). These symptoms are related to a narrowing of the airways and occur in about 90% of people who have been diagnosed with asthma; it also occurs in many individuals who do not have asthma. If you have experienced these symptoms, consider speaking to your doctor for appropriate diagnosis and treatment.

The reason you usually will not experience EIA during exercise is that during exercise we release Epinephrine or Adrenaline, a hormone that binds to certain receptors in our airways and causes them to dilate (become wider). Once you stop exercising and the levels of epinephrine go down, a person with EIA will generally start to experience symptoms. Here is the great part,  after exercise many people with EIA will go into what is referred to as a “refractory” period and therefore cannot have EIA symptoms for a couple of hours after this session. The question that arises is: what type of warm-up will trigger this protective refractory period?

While several studies have been conducted in this area, there are a variety of warm-up protocols that have been used. In an attempt to clarify the optimal warm-up to prevent EIA, Stickland and his colleagues conducted a review of scientific studies. They reviewed 7 trials with a total of 128 participants. Four types of warm-ups were reviewed: short sprints or intervals, continuous high-intensity, continuous low-intensity and variable intensity (continuous followed by interval). Using lung function (the openness of the airways) as their main criteria, they found that the interval type of warm-up was the most effective at preventing EIA. The interval type warm-up usually consisted of 30 second sprints at a high intensity (all out running for 30 seconds). The number of times to repeat this varied from 8-10 with anything from 45 seconds to 5 minutes between sprints. Finally, the exercise session was conducted 15-20 minutes after doing the interval warm-up.

TAKE HOME MESSAGE: If you have EIA and are struggling with symptoms during exercise, try doing a few 30 second high intensity interval sprints before going to the gym or the track. You can do them around your house or on your walk over to the gym. You can even run up and down the stairs of your house or the hallways of your apartment building. This will ensure that once you get to your workout, you will be in your refractory period! Another important note, if this seems like too much, the use of a bronchodilator (puffer) about 15 minutes before exercise also prevents EIA.

Whether it is an appropriate warm-up or a bronchodilator, do what you need to maintain your exercise and active lifestyle. Don’t forget, you have control of your HALF!!

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Can you be healthy if you are obese?

It seems like a paradox. The notion that obese people can be healthy is completely contrary to any public health message we have ever seen, yet, there is increasing evidence that SOME obese individuals may be just as healthy as their normal weight peers.  The question that arises then is: what is it about being obese that makes a person “unhealthy”?

The simple answer to this question is that obesity is associated with a higher risk of cardiovascular disease, type II diabetes, cancer and early death. This is primarily because people who are obese generally have a poor diet and low physical activity levels; they might also consume more alcohol. In other words, the lifestyle that is leading to their obesity is also leading to higher cholesterol, blood pressure, blood glucose levels etc. These of course are primary risk factors for the above mentioned diseases.

Recent research indicates however, that just because someone is obese it does not necessarily mean that they have these risk factors. In a study published in the Canadian peer-reviewed journal, Applied Physiology, Nutrition and Metabolism, Dr. Kuk and her colleagues used a large database (Aerobics Centre Longitudinal Study) to establish just this. They used the Edmonton Obesity Staging System (EOSS), a risk-stratification system that classifies obese individuals using health indicators on a scale of 0-4 with 0 being low risk and 4 being high risk. Using over 20 such indicators, Kuk and colleagues found that only obese individuals in stage 2 or 3 (they were unable to assess stage 4 because of limitations in the dataset) were at an increased risk of death, cardiovascular disease and a variety of other conditions. In other words, there were some obese people (those in stage 1) who were not at a higher risk when compared to normal weighted people. Interestingly, this was not the case for cancer. Regardless of which stage the obese individual was in, they had a higher risk of cancer when compared to their normal weighted peers. In addition, they found that even when they took into account the diet and fitness levels of their obese participants, the risk remained high for people in stage 3.

So, how is this possible? How are SOME obese people able to maintain normal or near optimal health levels?  The present study does indicate that the obese individuals in stage 1 were more fit than the others. It is also entirely possible that the healthy obese individuals were consuming more fruits and vegetables, were getting 8 hours of sleep, drinking their 8 glasses of water and coping better with life stress. It is possible that these individuals had “healthier” lifestyles than their obese peers and therefore successfully reduced their risk for many chronic conditions.

TAKE HOME MESSAGE: If you are obese make sure you understand what your risk is before setting off on a stressful weight loss program. It is important to realize that weight loss does not necessarily mean improved health. Stop focusing on the scale and re-focus on your overall lifestyle. This will reduce your risk for several chronic diseases and in time (perhaps more time than you hoped) you will lose weight!

And remember, you have control of your HALF!

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