Chris(C)

Whatisyourname?
Dr.Snow(S)
RobertSnow.
C
Whatisyourprofession?
S
MyprofessionisImaphysicaltherapist.Youwantmejusttogiveyoumybio?Wouldthat
behelpful?
C
Yes,please.
S
Alright.Ihavemydoctoratedegreeinphysicaltherapy.Imboardcertifiedinorthopedics.I
spenttenyearsdoingcardiovascularrehab.Iamacertifiedathletictrainer,acertifiedstrength
andconditioningspecialist.IstartedasclinicdirectorforthisofficeandnowImCEOofthe
corporation.
C
Canyoutellmewhatyourdailyworkislike?
S
MydailyworkasaphysicaltherapistorasaCEO?
C
Asaphysicaltherapist.
S
Asphysicaltherapistgenerallyitseighttotenhoursaday,dependingonyourschedule
seeingonetotwopatientseveryhourevaluating,treating,reassessing,paperwork,handson
workwithpatients,psychologicalworkwithpatients,adaptinghomeexercises,trainingthe
patient,trainingcaregiversthingslikethat.
C
Whendidyoulikefirstbecomeinterestedinthisrehab,physicaltherapy?
S
Firstbecameinterestedinphysicaltherapyprobably1995.1995Iwasaassistantfootball
coachforahighschoolandwewouldbreakemandthey,thephysicaltherapist,wouldfix
em,putembacktogetherandthenwewouldgettobreaksomebodyelse,again.SoI
alwaysthoughtitwasinteresting.Ididntknowwhatthiswholesportsmedicinethingwas
aboutsoIthoughtIdlookatit.AtthetimeIwasageneralcontractorwhichsoundsexciting
butitwasntreallythatgreatofafieldandIwantedtogobacktoschoolandfinishitup.SoI
wentbacktoschool,wenttoundergradandthendirectlyintograduateprogramtoreceivemy
doctorateinphysicaltherapy.
C
Sonowweregoingtogetintolikemoreeducationrelated.So,whataresomelike
conditionsthat,thatyourpatientscometoyouwith?
S
Mypatientscometomewithanytypeof
musculoskeletal
dysfunction.Ijustsawanankle
patient.Couldbehiporkneeorcalfinjurieslowback,canbestomachsyouknowyou
couldhaveastomachinjuryaswellshoulder,ribs,thoracicspine,neck,musclespasm,
headaches,surgeries,jointreplacements,caraccidents,younameit.Weprettymuchwork
throughitwhenitcomestomusculoskeletalaswellas
cardiopulmonary
rehabilitation:
patientswhohavehadeithersignificantcardiachistory,theyvehadacardiacevent,which
wouldbeanythingfromsmallheartattack,bigheartattack,coronaryarterybypassgraft,or
justtheiratrisk,deconditioning,theyvehadastrokestrokestillfitsintothe
cardiovascular

realm
andthenwedosomepulmonaryrehabaswellthatsforindividualswhohave
difficultybreathing,andthatcouldbeanybodyfromcysticfibrosistoCOPDwhichischronic
obstructivepulmonarydisordertoanybodywhomayhavehad,youknow,somesortof
diseaseprocessthatcausesstiffeningofthelungsordifficultywithrespiration.Othertypesof
patientsthatfallintothatrealmcanbecancerpatients.Someradiation,chemo,doesattack
thesomeradiationattackstheheartmuscle,somechemotherapyattacksthelungsaswell,
and/ortheyrebedriddenforareallylongtimesotheyvereallyjustbeendeconditioned[?]
weak.Someofourpediatricpatients,verysimilarly,theyvebeeninacastorwheelchairfor
threemonths,fourmonths.Itdoesnttakelongtogetdeconditioned.Notlongatall.Sosome
seriouscondition,youknow,thebestwaytogetbackistovisityourphysicaltherapist.
C
Okay.Canyougivesomelikegeneralexamplesofbeneficialeffectsfordoingphysical
activityandhavinggoodnutrition?
S
Wow,jeez,thatsprettyeasy.Butbeing[?]
physicallyactive
notonlyincreasesyour
productivity,itincreasesyourawarenessinitdecreasesyourrestingheartratewhichwillin
turndecreaseyourrestingbloodpressureandyouractivebloodpressure.Becomingmore
active[?]workingonacardiovascularexercisehastheadditionalbenefitstocreatinglean
bodymassopposedtononleanbodymass.
Adequatenutrition
helpsyourbodyheal,gives
youthefuelthatyouneedasopposedtojusteatinganimalFrenchfriesatRobertos[?]while
theytastegoodtheyrenotgreatforyoubuthavingadequatenutritionsgonnahelpyourbody
healandifyouguysrememberthebacktoworldhistorywhenoneoftheproblemsthatthe
shipshadwastheywerealwayslookingforcitrusfruit,right?Causescurvy,andscurvysa
directrelatedtoalackofVitaminC.Yourbodycantscarnorcanithealfrominjuryinthe
absenceofVitaminC,especiallyaseriousVitaminCdeficiency.Sopeoplewillaskmeallthe
timejustlikeIhadsurgery,whatsthebestthingIcando?Eatwell.Takeagood
multivitamin,makesureyourejustgettingabalancedmeal.Donteatlikecrap,donttake,
youknow,themedicationsunlessyouhavetoandthen[?]dothebestyoucanandgiveyour
bodythechancetoheal.Causesometimesweseehealingintheoutside,whichisreallywhat
moreofascurvyissuewas,wasopensoresandwoundsthatwouldntheal.Ifitwonthealon
theoutsidethenwhatsthechancesitsgonnahealontheinside?
C
Zero.
S
Yeah.Justequally,equallyasbadso
adequatenutrition
ishugeand,andyoucantsay
enoughaboutavoidingprocessedfoodsandthosetypesofthings.Andintheschoolsthey
havethatwhatslowcalorieorhighcaloriedensityfoodssoyouknowwerealwaystrying
toamIjumpingaheadonyou?
Diana(D)
Actually,Ihaveaquestion.

S
Yeah,goahead.

D
So,processedfoodversus,like,rawfood

S
Orwholefoods.

D
Soisrawfoodreallylikewhenyoudontcookanythingthough,isthat

S
Right.

D
Isthatnecessaryinanywayorisitokaytostilleatlikeallthecookedfoodsthatsupposedly
willgiveyoucancerandstuff?

S
Wellsotheresseveralschoolsofthoughtonthat,right.Soyoucouldlookuponewebsite
oronewholeseriesofliteraturefromnutritionistswhosaythatrawistheonlywaytogo
becausetheminuteyoucookfooditbreaksdowntheenzymesandthenyourenotgetting
thebenefitfromit.Andthentheresotherpeoplewhotalkaboutjustwholefoodsand
processedfoodsandthepaleodietissupposedtobethereallytherawanddontbreakit
downandtheresalotofpeoplewhogowiththat.Amorebalancedapproachisprobablythe
bestanswerbecauseyoudohavetocooksomefoods,especiallymeat,right,cantgetaway
withthat.Andthoughyouarebreakingdownenzymesthereslotsofotherchoicesthatyou
canhave.Yeah,Imean,isabetteroptiontoeatyourbroccolirawifyoucould?Yeah,you
knowImeanittastesbettersteamedforsomeindividuals,ittastesbetterrawforothers.Ima
firmbelieverthataslongasyoureeatingyourbroccoliinsteadofyourFrenchfries,whether
itsbeensteamedorwhetherornotitsbeen,whetheritsraw,right,ifyouwonteateitherit
doesntreallymatter.Itdoesntgetintoyoursystem.So,Ilikeaneightytwentyrulewhenit
comestonutrition.Youknow,aslongaseightypercentofthetimeyouredoingyourbestto
havewholefoods,nonprocessedfoods,fruitsandvegetables,right,youredoingyourbestto
kindofmaintainthat.Ifyouhad,youknow,asandwicheveryonceinawhilewhereyoure
havingtheprocessedyouknowbreaditsnotgonnaworkonyoubuttheproblemismost
peopleareeightytwentytheotherway.Eightypercentofthefoodweeatisprocessedand
fastfoodandtwentypercentofthetimeweguiltourselvesandsayIshouldhaveasalad,
right,atMcDonaldsandthenIhadsomeFrenchfriestogowithit.Itsnottherightwaytogo.

C
Sowhat

S
[inaudible]

C
Sorry.

S
Noworries.

C
Sowhataresomemisconceptionsregarding
cardiovascularhealth
?

S
Thatsareallygoodquestion,youknow,itsamovingtarget.Cardiovascularhealthreallyis
amovingtargetthesedays.Itusedtobeohyouneededatleastthreedaysorfourdaysa
weekandnowtheresplaysixty,NFLsgotBagnellonwheretheywantyoutodosixty

minutesofplaywithinyourcardiovascularrange.AndIdontknowwhethertheywantfiveor
sevendays.Thetargetjustkeepsmoving,theidealtargetsgottobethirtyminutesof
cardiovascularexercisewhichmeanyourheartrateselevatedtoasufficienttimeatleastfive
daysaweek.Weknowthatifyoudont,thatwhateveryourcardiovascularfitnessis,ifyoudo
thatthreedaysaweekyoullonlymaintainit,attwodaysaweekyoulllosecardiorespiratory
fitness,cardiovascularfitness,andifyoudoitthreeormoredaysaweekthenyoullgain
cardiovascularfitness.Sosomeofthemisnomers.Illsayoneofthemisnomersispeoplefeel
liketheyneedtodothatthirtyminutesorsixtyminutesofexercise,soitssixtyminutesofplay
orthirtyminutesofexercise,somepeoplefeellikethathastobeallinonesetting,andso
theyIllsayitsamisconceptionversusamisnomer,rightyoucandofifteenminutesand
fifteenminutes,andyoullhavethesamebenefitasyouwouldifyoudidthirtyminutessolid.
SothatsoneofthethingsIthinkthatpeoplecanchangeisthatsmallerboutsofexerciseata
highenoughintensityhavethesameeffectasofaccumulative.OrsoforsomepeopletosayI
justcantdosixtyminutes,Idonthavethattimeblock,youdothirtyinthemorningandthirty
atnightandthatsgoingtogiveyouthesamerelativebenefitasthesixtyminutestotal.
Theressomethatwoulddisagreethatyouregonnahavehighermetabolicratebypushingit
together,butasfarasoverall
cardiovascularbenefit
thatsprobablythesame.

C
Oh,soitssortoflikesplittingthetimeinhalf?

S
Yeahyouresplittingthetimeinhalf.

Bill(B)
Whataboutjustlikeonedayyoudolikehalf,twelvehoursofexerciseandtherestof
theweeknone?Likenot

S
Likeatriathlete.

B
Justlikeonedayoutoftheweekyoujustlike

S
Twelvehoursfullbore?

B
Yeah.

S
Iwouldthinkyoudprobablygetthesamebenefit,butthatstwelvehours,right.Thatsthe
oppositescaleofwhatpeoplemosthave.Mostpeopledonthavetime,butagainremember
thatwhileyouregonnadotwelvehoursthatsasignificanttimeeven,andinordertodo
twelvehoursofcardiovascularexerciseyouwouldneedtotrainduringtheweekprobablyfive
orsixtimeduringtheweekinordertobeabletosustainit.Butthatsamaximum,Imean,you
justwouldntbeabletodothat.Yourbodysystem,intheoryitwouldbethesame,butyeah,it
wouldbejusttoughtodo.

B
Welllikeitdoesntmatteriflikeyoudoitjustlike,insteadofspreadingthehoursout
throughoutthewholeweekjustlikeforonedayyoujustmaxonthatdayor


S
Possibly,butrememberitsnumberoftimesduringtheweeksoifyouonlydoitthreetimes
youregoingtomaintainyourcardiovascularfitness.Yourbodywontrespondtoyouknowa
bolttraining,itlljustshutdown.Thattheorysoundsgood.Yougonnagodotwelvehourson
Saturday?

B
IwishIcoulddothat.

S
Yeah,thatsalongtime,trustme.

C
Yeah,itis.Sowhatishasbeenthemostinyourexperiencelikethemostfrequentcauseof
heartdisease?

S
Oh,jeez.TonsImean,youcouldsaytheresawholephilosophyaboutandinflammatory
dietthatwehavewherewehavetoanyoftheohman,Imactuallysupposedtogivea
lectureonthistoo.Toomanyofthe,ohman,oneofthefattyacids.Iwannasayitsnotsixes
butitstheotherone.We,inprocessedfoodsandfriedfoodswedogetfatsbuttheitsthe
wrongtypeoffatitsthesaturatedfat.Andthatactuallycreatesanoverallinflammatory,
createsinflammatorysystemswithinthebodybutalsowithinthebloodvessels.Sothat,that
startstoirritatetheliningofthebloodvessels.Someindividualshavefamilyhistorywhich
predisposesthemtohaveeitherplaquebuilduporthisinflammationandthewaythatthe
plaquebuildsupinthearteriesisitbecomessoftplaquefirstandthenitcalcifies,hardens,
createsthisnarrowing.Thesoftplaquesyoucanreverse,thehardplaquesyoucant.Some
ofthatsjust
lifestyle
.Sothenumberonereasoncouldbeanythingfromlifestyletolackof
exercisetofamilyhistory.Somefamilyhistorypeopleworktheirtailsofftofightback
cardiovasculardiseaseasmuchastheycanandyoujustcantrunfromyourgenesthat
much.Butthepreventable,itsprobablyoneofnumberonepreventablediseasesthatwe
haveiscardiovasculardisease.Itsareallyinmostcaseitsreallyalifestyleissue.

C
Ohsoitslikefamilyhistorysoitgoesbacktothe

S
Itstartsasfamilyhistoryandthenitreallystartswithlifestylefamilyhistoryisthetwomain
indicatorsforcardiovasculardisease.Andthenifyouhaveafamilyhistoryandyouhavepoor
habitsthenyoureyouknowyourejustwaitingittohappen.

B
Couldthatbelikethereverselikeforexampleifyouhadlikeareallystrongfamilyhistoryof
likenoheartdisease,nolikenoissueswithcardiovascularoranythinglikethat,ifyoulive
poorlylikewouldthatlikereverselikereverseifyouhadkids.

S
Somepeoplearejustlucky.TherewasacomediannamedGeorgeBurns,whousedto
smokeeverydaytillhewaslikeninety,neverhadaproblem,right.Somepeoplejustmissthe
cancergeneandjustmissthecardiovasculargene.Butthemajorityofpeoplehavea
problem,right.


B
Ifyoudothatandyoukeepgoingdowntoyourkidswouldyourkidshavelikejustasmuch
immunityorlikewoulditbelikebad?

S
No,IthinkitsjustamythsothatyoucantyeahIdontthinkyouwannayouknowhope
thatyouregonnahavegoodgenes.Imeanoneofmypartnerstheguycaneatalmost
anythinghewantsandhestaysskinny,right.IclearlyamnottheguythatstaysskinnyandI
canthelikeheeats.Buthesgotahostofotherissuesthatcomefrombeingabletoeat
whateverhewants.Hesgotsomestomachissues,right.Sothoughhecaneatitnotgain
weightitjustwreckshim.Soitdoesntreallyhelp.Yourebodysgonnastoprejectingenough
processedfoodsoonerratherthanlater.

C
Butyoucanchangethehowlikeiffamilyhistoryifitwaslikepoor,youcouldchangeitto
makeitbetter,right?

S
Soitsaninterestingcommentbecausethatsrelativelynewresearch.Beforewealways
thoughtthatwewerelockedintoourfamilyhistory.Theyvenowfoundthatsomethinglike
dontwannamisquoteitsomethinglikeeightyfoureightyninepercent,eightyfourpercentof
familyhistorytypeissuesright,likediabetesrunsinthefamilyorarthritisorwhatevercan
reallybemodifiedbythewaythatyoueatandliveyourlifeandsolongasyoustartearly.
ButthinkaboutgrowingupintheSouth,right.MomandDadeat,youknow,eatporkrinds
andfriedchicken.Whatarethekidsgonnaeat?

[inaudible]

S
RightandsoinsomecasesthoughmaybeMomandDad,maybetheyreoverweightornot,
right.YoucangointheSouthandfindtonsofpeopleoverweight________

Snow:
downthere.Ichosethesouthasanexamplebecausepeopleinthesouthare
overweight.Isitfood,familyhistoryorboth.Parentsareoverweightandarerelativelynot
active,andyoufeedthempoorlythenthereisaproblem.Thereisalittle
adage
Ireadsays,
quote:Ifyouneedtoexercisetomaintainbodyweightthenyouareeatingwrong.Exerciseis
notwhatyoudotomaintainbodyweight,itshowyoueat.Exercisefightsoffdisease,builds
cardiovascularstrength
,andgivesyouendurance.
Itsnatureversusnurtureattimes.Ifits
truly80%ofalldisease,couldbe
preventable
bythewayweeatthenmaybewecanstopthis
epidemic
ofdiabetesthatwehavecomeupinourkids.Wehaveahugeepidemicofobesity,
diabetes,andearlyonsetsofdiabetesinkidsthatare12to13yearsofagethatarepre
diabeticanddiabetictype2.Itsterrible.

Bill:
Sowhenyousayobesityinoneofthekids,somepeoplesaythattheirfatbecauseof
theirgeneticisthattrue?

Snow:
Itsnotfairtosayifonewayortheother.Iwouldsaythattheirarepeoplehaveamore
difficulttimelosingweightthanothers,assomepeopleshedweightlikenobodiesbusiness
andsomepeopledon't.Soitshalfandhalf.Sohaveyouguysseenthe
movie:FoodInc.

Diana:
Yes

Snow:
Sosomeofthemovieisbasedontheirperceptionofwhateatinghealthyfoodisand
someofitisreallyjustprocessedfoodinwhattheyeat.Theykeypointofthemovieisthat
theyoungmanwasnotsuccessful.Hewentbacktowherehewasasinthebeginningofthe
movie.
Soyouaretrainedinthewayyoueat.Iwastrainedinoneway,mywifeisahealthcare
practitionersaiditsallaboutwholefoodswithher.SheischangingthewayIeatslowly,butat
theendofthedayIknowwhatsbetterforme.

Chris:
Whyisadolescenthealthimportant?Willitaffectthefutureforhealth?

Snow:
Wellthereareseveralissuesthere,butyoucanstartwithisarewegoingto
nationalizehealthcare.Wewillhaveanansweronthatyet.Ifwearegoingtonationalize
healthcare.Andoneofthereasonswhy,wewillcallitObamaCare.Oneofthereasons
whyobamacareinstitutedthiswholeeverybodyneedphysicianeverybodyneedshealthcare
issothatwecangetinfoforventivecare.Sowecangetyouinforventivecareitcostsalot
lesstoeducateyou,changeyourdietandgiveyouopportunitiesandtreatyouasadiabetic
fortherestofyourlife.Ortreatyourcardiovasculardiseasethatyou'regoingtodevelopor
treattheproblemsyouhavebeenhavingfromhighbloodpressurethatyouhavehadfor15
years.Becauseyoueatpoorlyandyoudon'tknowitandyoucan'taffordyourposition.For
example
Kaiser

permanente
.Kaiserpermanentehasdoneitgreattheyshowtheirads
saying
quote:kaiserpermanentebecausewecare!wehaveyourwellcheck.
Theyrealized
thattheirresponsibletopayforeveryonefromsoupstonuts.Theyinvestonalittlebitof
moneyontheirfrontsidebycontributingtoweightlossprogramsandstressmanagementand
allthesetypesofthings.Theydon'thavetopayforcardiovasculardiseases,diabetes,etc.As
acultureandacountryifweweretoinvestinpreventativecareitwould,ifthatsthewaywe
aregoing.Idon'thaveanyideaifwearegoingtonationalizehealthcareornotbutthat
shouldbepartoftheconversation,[preventionshouldbepartoftheconversation.But,some
peopledon'twanttoprevent.

Diana:
Sowhywouldn'tyouwanttoprevent?

Snow:
NoIdea.Itsareallygoodquestion.ButIdon'tknowwhytheydon'twanttoprevent.

Bill
:Doyouthinkalotofpeopleareabusingthesystemofhealthcare?

Snow:
Idon'tknowthattheynecessarilyabuseit.Idon'tthinktheyareawareofit.Inacase
ofabuse,forexample.Yestheyshouldbeincareofprimarycareofaphysician.Insteadthey

arelazyandtheyjustgototheE.R.everytimetheygetsick.Whereitcoststentimestogoto
theE.Rwhereasitcostslesstogotoyourdoctor.Inthatessence,forthatspecificinstance
thenyes,peopleareabusingthesystem.Becausethesystemissetuptoreducethecostof
gettinghealthcare.Ifyouaresickyoushouldjustgoseeyourgeneralpractitioner.Notwait
untilyourverysickandwalkintoanemergencyroomwhereitcoststwothousanddollarsto
beseen,Insteadoftheonehundreddollars.Idon'tthinktheresthatmuchincentivetotake
advantageofitbutreallyitsjustmaybeabouteducating.Butweareonourfirstyearonthis
nationalhealthcare.Itsgoingtotakeawhileforpeopletogetusedtohowitworksifitstays.

Chris:
Whataresomecommonissuesyoufindinpatientsfortheirlackofphysicalactivity
andproperdiet?

Snow:
Poordietusuallyleadstomoremuscletoneandmaybeyoujustgetsickmoreoften.
Moresusceptibletodisease.OnesuchPatientofmine,shejustgraduatedfromHighTech
Highandisgoingtocollege.Shehadonandoffwristpain,everytimeshewashedsomething
ortriedtodosomethingshewouldhavewristpain.Shewouldwearabraceforafewweeks
anditwouldgetbetterandthenshewouldhavewristpainagain.Itwasanonandoffcycleof
wristpainshejustkeptsprainherwrist.Normalgripstrengthforsomebodyherstrength
shouldbe90to110pounds.Hergripstrengthwasaround40pounds.Thesignificanceofthat
isthattherearesomestudieswheretheyattachyourabilitytosurvive(itscalledmorbidity
andmortality)andtheyattachyourabilitytosurvivewhenyougointosurgerybasedongrip
strength.Itsusuallyforfrailelderlywomen.Andifafrailelderlywomenhasagripstrengthof
40poundsmeansshehaslessthana50%chanceofsurvivingasurgerythansomeoneat
theaverageof90pounds.Itskindofsadforthestudent.Itsdirectlyrelatedtothefactwhere
shedidn'thaveanyphysicalactivityeducation.Shedidn'thaveanyphysicalactivity.Sothe
firstthingwedidwasputherinyogaclass.Workedherthroughherwristpain.Yogaworkson
strengthtothecore.

Chris:
Haveyouhadadolescentscometoyouwithdiseasecausedbylackofproperphysical
andnutritionalhealthwhicharemoreoftenfoundinolderadults?

Snow:
Yes,wearestartingtoseemoreofalargepopulationofadolescentswhose
overweight,whoseparentsaretryingtoputtheminsportsasamechanismtohelplose
weighttobuildconfidence.Wecallthemnintendokidsbecausethey'realwaysplayinggames
onthegamesystems.Theircaringalotofextraweight.theregrowingatthesametimebut
theyareweak,surprisinglyweak.Kidsplayfootballtobecausethey'rebigtheygethurtreally
easy.Therejobistojusttakeupspaceonthelane.Andthenyourunintosomekidthatis
strong,heisgoingtohityouwith200poundsofworthofforce,youaregoingtobreak.And
thentheproblemis,thekidisouttheretrainingandtryingtogainconfidenceandthenyou
hurthim.Heisnotgoingtowanttogooutthereagain.Iftheonlythinghehasbeenexposed
toisviolenceandpain.Sogoingbacktotheideaoflet'sputhimintoasport,andhegothurt.
TheyoungbrainsaysifIgothurtIdon'twanttodothatseehowitsacatch22.Olderadults
arethesamewayandtheyteachittotheirkids.Ihadpatientsintheirearly70swhoseknees

neededtobereplacetenyearsago.andnowtheyhaveacardiovascularproblemandnow
theirheartissoweakbecausetheyhadaheartattacktheycan'tgetapprovedforsurgery.
Didn'tgetthekneedownwhentheyweresupposedto,kneehurtssotheycan'texercise
whichmeanscardiovasculardisease.Cardiovasculardiseasemeanstoweaktoproceedfor
surgeryandstillcan'tgetthekneefixed.Itjustcircledrightbackaround,itsaterriblepattern.
Ourjobiscanwefindsomethingforthemtodothatwon'tcausethempain,whetherits
bicyclingorinthepool.Andtheyareverymotivated.Youngkidswehavetoteachthem,we
havetomakeitmoreavailableforthem.McDonaldshasaquarterofthemarket,youcanget
theirfoodfastandcheap.Sometimesthatsbetterthansendingyourkidtothesoccerfield
withnothingintheirstomach.Untilfreshandeasyhasadrivethrough.
Hisandwifesquote
Iwouldlovetoseeabagofbabycarrotsandsomehumusandnotapplesandcaramel.
Applesandcaramelislikefrostedflakes,carrotsandhummusaregreatuntilyougetkicked
inthestomach.Therearealotofpeopleintheindustrytryingtopackagehealthyfoodsfor
us,andthatswhatpeoplewant.Weareluckytoliveincaliforniabecauseotherplacesthey
arenotsohealthy.Forwholefoodshummusisagreatalternative,salsaisn'tthatbadeither.
Theimportantthingistomakeitquickandaffordable,affordableisthehardestpart.Howdo
youmakeitaffordable?

Diana
:Tobacktrackalittlebityoubroughtuptheexampleofhowthekidgetshurt.The
parentsaredependableforit.Doyouthinkthattheywillteachthekidtobemoreactiveand
eathealthier?Doyouthinktheycouldpossiblyhaveanegativeeffectinthatsayingwehave
certainrequirementsinweightbutnotinhealth.

Snow:
Idon'twanttobemisunderstoodbysayingsportsarebad,theyareagoodactivity.If
wedothreedaysaweekitsbetterthannone.Mostkidsactivitiesareatschool.Ifyoucould
godevelopsomethingcultural,whetheryou'reinband,writingclub,robotics,drama,etc.You
justneedtofindtimetofitintheexercise.Ibeenknowntothrowmykidsoutofthehouseso
thattheycangetsomeexercise.Itsourjobsasparentstokeepourkidstostayactiveand
progressing.Sportsaregreattheycreateconfidenceandbuildhistory.Toremainanactive
adultisplayingchildhoodsports.Ifyoudidn'tdoasportwhileyouwereinmiddleschool.high
school,thelessactiveyouwherethenaffectsyounow.

Chris
:Haveyouhadadolescentscometoyouwithdiseasecausedbylackofproperphysical
andnutritionalhealthwhicharemoreoftenfoundinolderadults?

Themajorfactorforactiveadult,isplayingchildhoodsport.Ifyoudidntdoasportinsome
sortofform,hs,ms,es.Thelikelihoodofyouridingyourbikeorwhateverelseislow,youre
settingpatternforsedentaryactivity.Majorcontributorofhowativeyou'llbeasadultishow
activeyouareasakid.Youcantjustsay,ohImgoingtostartbeingactive.Mykidsplay
baseball.

Diana:
Sowhatdoyoudofor,peopleintheyoungadultswhensaytheydon'tfeelcomfortable
inagroupandtheyarentcompetitivenaturally,andthatturnsthemawayfromsports.


Thekeyisfindingsport,ifwearetalkingaboutschoolbase,justfindapassion,theresalotof
sportwhereyourasinglecompetitor,boyorgirl,mostmartialart,you'recompetingagainst
yourself.Palates,yoga,running.Itsyouandyourwatch,running.FIndsomethingyouloveto
do,findsomethingtogiveyouanopportunitytobeactive,itsnoteasy,ittakestime.

Chris
:

Whataresomerecommendationyougivetoaverageteentobehealthy,nexttosports

Soifyoudonthavealotofopportunityforsports,takekarate,yoga,workout.joinabaseball
team,asoccerclub,therestonsofdifferentthingstodo,whereyourejustbeingactive.
theresopportunityeverywhereandweliveinastatewhereitrainstwiceayear,sotheresno
excusetonotbeactive.therestonsyoucando.beingoutsideinside,active,takeyoga,take
pilates,run,swim,bike,anything.Findsomeonetohelpyou.generallywefallintoactivitywith
someonewhoisdoingitfirst.Ifwerunitsbecauseweknowsomeonewhoruns.Mostguys
getintoyogaiftheirgirlfrienddoesyoga.Ifyoudoageneralworkoutitscozyourbuddydoes
workout.Mostofthoseactivitiesaresocial.

Thebenefitstosubcardiovascularworkisjustimprovedmood,bodycomp,decreasesblood
pressure,youdon'thavetopushtothemax,just60%justtoburnfat.Thatdecreaseyour
metabolic,sleepbetter,restbetter,wakeupfresh.

Diana
:Sointhatcaseforstudents,thereslotsoftimeswhereitshealthytoloseweightinthis
amtoftime.Isthereahealthyamountoftimethatastudentshouldbelosingweight.

Alotofthathastodowithyourbodyfat,bodycomp.whetherornotyouroverfatornotover
fat.Mostofthetimewetalkaboutbodymass,generallyhealthyisover5lb/week,youcango
fasterthanthat,butingeneralyouknow.

Chris
:whatareyourviewsinpeinschool?
Ithinkitsthelastthingtheyshouldcut,butitsthefirstthingtheycut.Itstough,yougottahave
space,yougottahaveacourt,youknow,itsaloteasiertobuildschoolforeducationthanitis
forpe.theotherproblemisgettinginjuredmakesyoupronetonotwantingtodoitagain.75
yearoldswhentheystretchtheygetpain.PEisapartofit.

Diana:
Stretching,doyounotdostaticstretching?

Imeanifyouremuscleistightthenyoushouldstretch.Theresnoincreaseinperformance,
butresearchhasbeenthattheresnorealdifferenceininjuriesstretchingandnotstretching.
Ifarunningback,there3200poundguyscomingatyou,youprobablyshouldbeflexible,
becauseyouregoingtohavetogetintothatrangeofmotionwhetheryouhaveitoryou
don't.soitsagoodideatobeflexiblebeforetheymakeyouflexible.Orsomethingtears.

Chris:
Doyouthinkthevalueoffitnessorphysiquehaschangedsinceyouwereyounger?


Itschangingnow.Overthepast5yearstheresalotofchangeinwhatisthisidealbodytype,
certainlyforourgenerationtheresthisvoluptuoushourglass,andthenthetwig,like70s.This
amorphousstickfigurewithlittlearmsandlegs.andnowtheresthisgymnasticthing.Butnow
withcrossfit,withwomenwhoareenjoyingthemoremuscular,notbodybuildersize,butyou
know.Theyarepushingthenorms,andtheyarechangingwhatisfit.Andfitnesscannotbe
definednecessarilybyyourphysique.Likeinamericanninjatheresthisgirlwhos5ftandshe
completedthewholethingthatguysbiggerthanhercouldnt.Sowerefiguringoutwhatsfitor
not.Likeifyourenotasizezerothenyouredoingsomethingwrong.

Diana:
Howdoyoubalancelivinghealthyandhavingthesize.likeabolishsizezero.

SoIthinkyou'reinatoughspotnowbutpeoplearen'tnecessarilyjudgingyou,Imeanthey
probablyhavealittlemoreproblemsunderjustbodyweight.Maybeyou'remakinga
consciousefforttoeatbetterbutitsreallywhenyougetintoyour20swhereyoumakea
consciousdecisiontostaysuperskinny,liketoseesomeonewhosyoursizeat20yearold
becausetheygenerallycarrymorebodyfat.Itreallyishowmuchofaneffortyoumake.Like
yourfriendseatsaladandyoureatingwater.Ifyouareeatingasmuchaseveryoneelse,then
nooneshouldhaveaproblem.theygonnabemadwhenyourmetabolismisfaster.Like
beforetheguyswhoeatswhateverhewants,cozIdonthavethesamemetabolismashim.

Chris:
What'sthenextstepforpeopletoputpeintheschoolcurriculum.

Ican'treallytellyouwhatthenextstepis,butIcertainlythinkmorepeoplewhoarelookingat
itthewayyourlookingatitmayhavesomeinfluence.toughpartisyouguysaregoingtoa
specialschool.Andtheirjobismorecerebralthanphysical,youknowyourschoolisabout
specializingthisspecialskillset.SOwhenyougottothatschool,theychoosethatschool,
theyknowwhatisthedropoff,theyknowtheresnoPE,sometimesapproachingitfromthe
schoolpointofview,isalmostthewrongdirection.approachyourparentsbecausetheyare
whounderstands.Ifyourkidcomestoyouandsay,iwanttobemoreactive.Igiveyou15
options.weslowlystarttounderstandthebenefitofexercise.Aslongasyoustarttowork
moreonbalance,thatyouarelookingforamorebalancedlifestyleandeating.weallhaveto
startlookingoutforourselves.Ifyouwanttobemoreactiveandyourparentsaren't,askthem
forawalk.generallyspeakingtheirparentswillwanttobeinvolved,maybemoresothan
others.Butyoucanalwaystaketheresponsibilityforyourself.Ifyouwanttobemoreactive
justbemoreactive.Gowalk,run,bike,skateboard.Hangwithfriends.

Questions

Categories

Label/Connection

Whataresomeofthe
conditionsthatpatient's
cometoyouwithfor

Musculoskeletalsystem
(mks),Cardiopulmonary
rehab(cph),Eventsorrisks

mkds,cph,

Encounters

treatment?

Couldyoupleaseprovide
somegeneralexamplesof
thebeneficialeffectsof
physicalactivityandproper
nutritiononyourpatients
health?

(rsk),Respirationtroubles
(resp),cancer(cncr),
deconditioned/weak(decon)
benefitstoproductivity(p),
awareness(a),heartrate
(hr),bodymass(bm),
healingfromnutrition(h)

rsk,resp,
cncr,decon

p,a,rhr

mental
benefits

bm,h

physical
benefits

Tex

Cause

mFit,acF

effect

f,e

cause

d,p,e

effect

hc

Catalyst

edu,pc

Education
system

mt,s

lackof
nutrition&
pa

mrt

comparison

Whataresome
misconceptionsregarding
cardiovascularhealth?

amountoftimeto
exercise(Tex),maintaining
fitness(mFit)Accumulative
vsfocused(acF)

Inyourexperience,whathas inflammatorydiet(d),
beenthemostfrequent
saturatedfat(f),plaque(p),
causeofheartdisease?
lackofexercise(e)

Whatsuggestionsortips
skipped
wouldyougivetopatientsto
helpthemreversethe
effectsofpoornutrition
and/orphysicalactivity.

Whyisadolescenthealth
important?Willitaffectthe
futureforhealth?

HealthCare(hc),education
(edu),Preventivecare(pc)

Whataresomecommon
issuesyoufindinpatients
fortheirlackofphysical
activityandproperdiet?

Muscletone(mt),sickness
(s),mortality(mrt)

toelderly

Haveyouhadadolescents
cometoyouwithdisease
causedbylackofproper
physicalandnutritional
healthwhicharemoreoften
foundinolderadults?

overweightadolescent
(ovw),weakgrowth(wg),
catch22andconfidence
(c22),solution,motivation
(sol),availability(ava),
passion(pas)

ovw,wg

examples

c22

problem

sol,ava,
pas

solution

clb

activities

frd

outreach

eff

persuasion

cut

current
state

log

problem

bod

history

cross

evolution

fit,eff

future

Whataresome
clubsandhobbies(clb),
recommendationsyoucan
partnersandfriends(frd)
givetotheaverageteenager littleeffort(eff)
onhowtobehealthy?

Whatareyourviewstowards cuts(cut),maintenanceand
physicaleducationin
logistics(log)
schools?

Doyouthinkthevalueof
fitnessorphysiquehave
beenchangedsincewhen
youwereyounger?How?

Idealbodytype(bod),
crossfitandwomen(cross),
fitness!=physique(fit),
effort(eff)

Whatdoyouthinkarethe
nextstepsforpeopleto
recognizephysicaleducation
aspartoftheschool
curriculum?

Studentinfluence/views(stu),
schoolspecialization(sp),
stu,sp,inv,
parentinvolvement(inv),
bal
balance(bal)

possible
solutions