The great TV classic ER helps teach armchair physicians to become amateur diagnosticians. He's in shock! She's got kidney stones! Rule-out pheochromocytoma!
But sometimes a little knowledge can be a dangerous thing.
You've learned somewhere - on the network news, in the Science section of The New York Times, or in a CPR class at your job - that shoulder pain can mean you're having a heart attack. Now, seemingly out of the blue, your shoulder begins to ache and throb. Very concerned, you rush to the local emergency room.
The resident's first question, of course, is "where does it hurt"? You point to your right shoulder and blurt out, "Am I having a heart attack?" The resident smiles, gently reassuring. "A heart attack might give you pain in your left shoulder," she says. "Have you been to the gym lately? This might be a rotator cuff strain."
The resident knows that heart attack symptoms usually involve chest pain (in two-thirds of cases), and may include faintness, shortness of breath, sweating, and a feeling of impending doom.1 Chest pain may spread to the back, jaw, and arms. Left arm pain may radiate to the inside of the forearm and the ring and little fingers. So, shoulder pain by itself probably doesn't suggest a heart attack.
She orders an MRI which shows mild damage to the right rotator cuff. What's going on? What exactly is the rotator cuff?
The rotator cuff is a muscular sheath that surrounds the head of the arm bone (the humerus) and the entire shoulder joint (really, two joints - the acromioclavicular and glenohumeral joints). The four muscles that comprise the rotator cuff help raise the arm to the front and the side and help turn the shoulder inward and outward.
If you're a sports fan, you know that rotator cuff injuries affect baseball pitchers, tennis players, swimmers, and football players. Such injuries are due to repetitive motion, and may also result from falling on the shoulder or arm or lifting heavy weights.
Rotator cuff injuries may also be slowly developing and chronic, related to arthritic and degenerative changes in the rotator cuff tendon and the two shoulder joints. Low-grade pain may develop, and the pain may become aching, throbbing, and chronic. Raising the arm may cause pain, and there may be loss of mobility.2
In the above-40 population, lack of exercise and chronically poor posture may contribute to rotator cuff problems. Sitting at a desk all day, with the neck jutting forward and slumped shoulders, places long-term mechanical stress on the rotator cuff.
Chiropractic treatment may be very useful in helping to rehabilitate chronic rotator cuff injuries. The chiropractic physician is expert in evaluating postural problems and associated spinal conditions. By providing effective treatment, postural corrections, and rehabilitative exercise, chiropractors offer a comprehensive therapeutic program to reduce pain, improve shoulder mobility, and regain function.
1Source: Cedars-Sinai www.cedars-sinai.edu
2Baring T, et al: Management of rotator cuff disease. Best Pract Res Clin Rheumatol 21(2):279-294, 2007.
As with much in life that we take for granted, we are not usually concerned with the mechanisms of how our bodies work and how they do what they do. Such knowledge is not required for use of these magnificent machines that have been freely given to us. But just as a wise consumer will care for her or his car in terms of regular scheduled maintenance, our bodies require ongoing attention in order to maintain proper function. The shoulder joint, in particular, requires such proper care.
The shoulder has the greatest range of motion of any joint in the human body. The shoulder is capable of 360º of mobility from front to back (the sagittal plane), 360º of mobility in the frontal plane, and 180º of mobility to the right and the left (horizontal plane). Taken together, these optimal ranges are termed circumduction. But the shoulder's remarkable capabilities come at a price. The shoulder girdle is the least stable joint structure and is readily subject to sprains (of the acromioclavicular joint) and dislocation injuries (of the glenohumeral joint). Additionally, the rotator cuff, the group of muscles that protect the shoulder girdle and move the shoulder joints through three-dimensional space, is commonly injured, owing to the substantial mechanical stresses involved in such extensive motion.1
We can help prevent such injuries by engaging in regular physical exercise such as yoga and strength training. These activities place weightbearing loads on the shoulder, progressively training the muscles, tendons, and nerves that supply the shoulder joint structures to handle mechanical stresses.2,3 As a result of such training, when called upon to manage the shock of an unusual mechanical force, the shoulder will be able to respond effectively while likely preventing injury.
The choice of yoga versus strength training is not mutually exclusive. Many people will enjoy taking one yoga class per week and doing two strength training sessions per week. For persons taking yoga class, the two strength training sessions could focus on (1) the chest and back and (2) the shoulders and arms. Almost every yoga exercise involves weightbearing loads on the arms. Regarding strength training, a representative shoulder program includes seated dumbbell or barbell press (for the entire shoulder girdle), standing lateral raise (for the middle deltoids), and seated bent-over raise (for the rear deltoids). If you're doing yoga, strength training sessions for the legs may not be necessary. Of course, a complete exercise program includes specific cardiovascular exercise such as walking, swimming, bicycling, or running.
It may not be possible to prevent every shoulder injury. Engaging in a regular program of vigorous exercise, including yoga, strength training, and cardiovascular exercise, is the best means of ensuring optimal biomechanical health and wellness and the best overall method for preventing injury.
Sources
1Camargo PR, et al: Eccentric training as a new approach for rotator cuff tendinopathy: Review and perspectives. World J Orthop 5(5):634-644, 2014
2Miller RM, et al: Effects of exercise therapy for the treatment of symptomatic full-thickness supraspinatus tears on in vivo glenohumeral kinematics. J Shoulder Elbow Surg 2015 Nov 24. pii: S1058-2746(15)00485-1
3Awad A, et al: Effect of shoulder girdle strengthening on trunk alignment in patients with stroke. J Phys Ther Sci 27(7):2195-2200, 2015
Strong bones are important for all of us, not only for the aging baby boomers about whom we're hearing so much lately. And, "strong bones" are much more than a marketing ploy cooked-up by the dairy industry and pharmaceutical companies.
Bones are incredibly dynamic, constantly reshaping themselves in response to physical forces. Bones provide structure for our bodies, and they carry our weight around as we move from place to place. Long bones such as the thigh bone act as factories to produce blood cells. So, bones are an important part of our overall health and well-being.
Lots can go wrong when your bones aren't strong. If you suddenly fall onto an outstretched arm, you'll probably be OK if your bones are healthy. If not, you'll probably be in a cast for four weeks to help repair a wrist or forearm fracture.
If an older person falls, hip fractures are the main concern. A fit, healthy person can usually walk away. With weakened bones, hip fractures can result in many other problems, both immediately and long-term.
Bones lose their strength due to a calcium imbalance and/or not enough physical exercise. For most of us, these factors can be corrected. The best approach, of course, is to be proactive and ensure enough calcium in the diet and regular exercise.
How much calcium and how much exercise? Recommended daily calcium requirements1 vary, and 1000 mg per day is a good ballpark amount. Dairy products are the best natural source of calcium, and dark leafy greens such as spinach and broccoli, as well as dried beans, are also good sources. Vitamin/mineral supplements typically provide 25-50% of the daily calcium requirement.
Regarding exercise, both the American Heart Association2 and the American College of Sports Medicine recommend 30 minutes of exercise, five days a week. This takes some effort and planning, particularly if regular exercise is a new addition to one's routine. By making the effort and spending the time, we're saying "yes" to health and wellness, empowering ourselves as well as our family and friends.
Importantly, regular exercise in combination with sufficient dietary calcium is the key. Taking calcium alone will not be effective in maintaining strong bones. Unless long bones are undergoing consistent mechanical stresses, as with exercise, there's no need for them to use the calcium that's available. Exercise plus calcium makes the difference!
Core strengthening3 is a hot topic in the world of fitness - Pilates training and its offshoots. But the principles of core strengthening have been around for many decades - dancers, gymnasts, boxers, and wrestlers have been doing these things all along. Only the term "core fitness" is new.
Core fitness turns out to be critically important for all of us. By adding a handful of core exercises - 10 minutes at most - to your regular routine, you will profoundly improve the mechanics of your lower back, hips, and pelvis. And, these remarkable exercises improve the efficiency of your heart and lungs. A very big "bang" for your exercise "buck"!
Your chiropractor will be able to provide expert advice and guidance on these nutritional- and exericise-related topics.
1Daly RM, et al. Long-term effects of calcium-vitamin-D3 fortified milk on bone geometry and strength in older men. Bone 39(4):946-953, 2006.
2Haskell WL, et al. Physical Activity and Public Health. Updated Recommendations for Adults from the American College of Sports Medicine and the American Heart Association. American Heart Association, 2007.
3Akuthota V, Nadler SF. Core strengthening. Arch Phys Med Rehabil 85(3 Suppl 1):S86-92, 2004.
1. Why stretch? Stretching lengthens muscles and improves flexibility. Also, stretching the big leg muscles - the hamstrings, calves, and quads - simultaneously loosens and lengthens the muscles of your lower back. So, when you stretch, you're helping your back!
2. When to stretch? Recent exercise physiology studies show that static stretching is best done after exercise. Pre-exercise "dynamic warm-ups", such as torso twists, arm circles, and light jogging, prepare the body for work. Importantly, for those of us with back issues, it's still a good idea to do the familiar static stretches even before the dynamic warm-up!
3. Don't rush! Stretching is as important as what you're going to do after you stretch. And, if you rush, you might pull a muscle or worse. Be sure to include 10 to 15 minutes of stretching as part of your exercise time.
4. Stretch gently and slowly. You're not trying to accomplish anything while stretching. In other words, you're not trying to stretch "this much" or "this far". Nice and easy does it. Stretching is a Zen activity. There should be nor "effort".
5. Pay attention! If your mind drifts, you're headed for a pulled muscle.
6. Visualize! See (in your mind) what you're doing. Hold a mental visual image of the muscle group, where it comes from, where it goes. Visualization helps establish a brain-muscle connection, making your muscles much smarter!
7. Stretch your hamstrings first. Lie on your back with one knee bent [start with the left leg bent; you'll be stretching the right hamstring]. The left foot is on the floor and the left knee is bent approximately 90 degrees. Holding behind the right knee, gently bring that knee to your chest. Alternate this chest movement with a movement that begins to straighten the right leg in the air. The eventual goal on straightening is to achieve a 90 degree angle (or close to this) between the leg and your torso.
8. CAUTION - Progress may be quite slow. Remember - you are where you are. Stretching is gentle and slow. Alternate the bending and straightening movements gently, achieving a slightly greater straightening each time. You should work each leg for between three and five minutes.
9. Calf stretches - face a wall and place both hands lightly on the wall. Keeping both feet facing front, bend the front knee and place the foot of the leg to be stretched directly behind you. Your weight is being supported by the front leg. The back knee is pretty straight and the back heel is on or close to the floor. Maintain the stretch for 10 seconds, feeling the stretch in the calf as the back heel reaches toward the floor.
10. Quad stretches - stand on your left leg, placing a hand lightly on a wall to support the upright posture. Grasp just above the right ankle with your right hand and bring that heel close to the right buttock. The quadriceps is stretched by bringing the right thigh in line with the left thigh, just as if you were standing on both legs. The knees should also be close, in a line. You should feel a stretching sensation down the right thigh. Imagine a straight line running from your right hip socket all the way to the floor.
1Ferreira GN, et al: Gains in flexibility related to measures of muscular performance. Clin J Sport Med 17(4):276-281, 2007.
2Peeler J, Anderson JE: Effectiveness of static quadriceps stretching in individuals with patellofemoral joint pain. Clin J Sport Med 17(4):234-241, 2007.
3Behm DG, et al: Effect of acute static stretching on force, balance, reaction time, and movement time. Med Sci Sports Exercise (36(8):1397-1402, 2004.
Repetitive stress injuries are typically very difficult to treat successfully. These injuries are the result of actions done repeatedly, frequently, and consistently over time. They've taken a long time to build up and, therefore, the healing process also requires a fair amount of time. Shin splints, iliotibial band syndrome, and rotator cuff syndrome are examples of common repetitive stress injuries. These problems are also known as overuse injuries. Tennis elbow is another common injury that is likely caused by repetitive stress.
Tennis elbow usually involves pain on the outer bony surface of the elbow joint (the lateral epicondyle). A variant involves pain on the inner surface of the elbow (the medial epicondyle). Regardless, tennis elbow pain interferes with many activities, not only those involving tennis and golf. Even the simple act of firmly twisting the lid on a difficult-to-open jar can cause significant pain. Driving for more than 30 minutes and prolonged keyboard activity are other examples of activities that may become quite troublesome when one is hampered by tennis elbow. Treatment usually involves rest, anti-inflammatory medications, and even injections of steroid compounds.1,2 But such treatments tend not to provide more than short-term relief. Ultimately tennis elbow may be frustrating and disheartening, as there doesn't appear to be an effective solution.
More useful treatment for repetitive stress injuries involves directly addressing the source of the problem. In the case of tennis elbow, mechanical issues in the forearm itself need to be corrected. For those whose painful elbows are in fact caused primarily by tennis or golf, focusing on sound technique will often help to provide significant relief. For example, in both sports, if lines of force generated by the arm muscles and lines of force generated by the forearm muscles cross at the elbow, significant pain is likely to develop over time. Learning how to generate parallel lines of force will help solve the problem, and such a solution may require the services of a coach.
For the rest of us, there are additional specific solutions. First, trigger points in the major forearm muscle bundles need to be treated.3 Trigger points in themselves may be very painful, and a trigger point also causes chronic fatigue in the muscle of which it is a part. When you try to use such a pre-fatigued muscle, damage to the muscle fibers and the tendon may result. Over time the involved region, such as the elbow, becomes chronically painful. Manual trigger point treatment relaxes chronic spasm and helps restore normal muscle tone. Increased blood flows to the muscle belly, and the involved muscle fibers have an opportunity to regain their normal length and to heal. The second specific solution is to use a narrow (1.5-inch thick), nonelastic elbow brace placed approximately 1 inch below the elbow. The brace will shorten the contractile length of the major forearm muscles, allowing them to achieve relative rest. The combination of trigger point therapy and appropriate use of a specific elbow brace will help to achieve long-term resolution of painful, difficult-to-treat tennis elbows.
1Childress MA, Buelter A: Management of chronic tendon injuries. Am Fam Physician 87(7):486-490, 2013
2Coombes BK, et al: Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials. Lancet 376(9754):1751-1767, 2010
3Ajimsha MS, et al: Effectiveness of myofascial release in the management of lateral epicondylitis in computer professionals. Arch Phys Med Rehabil 93(4):604-609, 2012
The holidays are here - Chanukah, Christmas, and Kwanzaa. Lots of family get-togethers, lots of fellowship and fun, and usually lots of food.
Family dinners, parties, family breakfasts, more parties. Is there any way to avoid gaining five or ten unwanted pounds during the extended holiday season? Thanksgiving through early January can be a pretty long time. In order to maintain that healthy weight range you've worked hard to achieve, it's important to keep following the good habits that got you there.
We want to have fun and enjoy ourselves during the holidays. We want to participate in all the activities and share the abundance of good food with family and friends. This really is a Zen question. How to let go without letting go? The solutions are available by having built a solid foundation. Food plans that work are based on a few simple and solid principles -
Such a food plan is realistic and doable. There's no crazy dieting involved, no highs or lows. You are eating healthy food with no restrictions, choosing from all basic food groups. You eat anything you want, being sure to follow guidelines on portion sizes. The results are weight loss that stays lost. Because you're exercising regularly, your body sheds fat pounds and adds a few pounds of lean muscle mass. Your metabolism becomes optimized to burn fat, even when you're resting. If you've been following such a food plan your metabolism is already doing what it's designed to do. During the holidays you'll continue to burn fat for energy, provided you don't overload your system with too many extra calories.
Try to schedule your free day - when you can eat anything you want, as much as you want, and whenever you want - to coincide with a big holiday get-together. When you're at a party and it's your free food day, you can indulge as much as you like. It's a part of your regular food plan. That's a pretty good bonus! Also, alcohol consumption often goes up during the holiday season. Punch, egg nog, all sorts of "holiday cheer". These beverages are super-high in calories. 3 Again, your free day is a good day to indulge yourself. On other days, maybe not so much.
After the last guest has gone home and the last dish is put back in the cupboard, if we've gained a few pounds during the course of the holidays it's not so bad. What we wanted to avoid was gaining a bunch of weight. Now, we can return to our regular food plan - six days on and one day off - and those extra few pounds will be gone in four to six weeks.
We had fun, we spent quality time with a lot of family and friends, and at the same time we took care of our health and well-being. That helps make the holidays especially joyous!
1 Hageman R, et al: A specific blend of intact protein rich in aspartate has strong postprandial glucose attenuating properties. J Nutr 138(9):1634-1640, 2008
2 Claessens M, et al: Glucagon and insulin responses after ingestion of different amounts of intact and hydrolysed proteins. Br J Nutr 100(1):61-69, 2008
3 Suter PM: Is alcohol consumption a risk factor for weight gain and obesity? Crit Rev Clin Lab Sci 42(3)197-227, 2005
So far 2009 has been a rollercoaster ride - many great new developments. And yet the worldwide economic turmoil has been very, very rough on most people. Stress levels have been sky high, and stress saps a person's energy. Even the U.S. Department of Health and Human Services is concerned. In March 2009 the DHHS posted "Getting Through Tough Economic Times" to its website1, highlighting possible health risks and strategies for managing stress.
Excess stress causes the adrenal glands to pump out adrenaline on an ongoing basis. This "fight or flight" hormone is designed to be released for short bursts of energy. Continuous release of adrenaline begins to wear down key body systems, resulting in even more levels of internal stress. Precious energy resources are wasted by excessive adrenaline, and cells and tissues begin to fail in critical functions. Breakdown in the form of actual disease is not far behind. Also, high stress levels may cause a person to lose sleep or have less-than-restful sleep. This only adds to the burden of stress.
New energy sources are needed to combat the losses of energy and restore health to the body.
One main source of energy, of course, is food. "But I eat enough," you say. "In fact, I'm trying to cut down and lose weight." It's not the quantity of food you eat. Eating the right kinds of food in the right combinations provides the energy we need. Otherwise, food calories are just packed on as additional fat cells, rather than being used for energy.
The right kinds of food are nutrient-dense, rather than being calorie-dense. Whole grains, lean meat, fish, high-quality dairy products, and fruits and vegetables are all nutrient-dense foods. Double cheeseburgers with french fries are calorie-dense and low in nutrition. Sprouted grain breads are nutrient-dense. White bread is calorie-dense.
It takes a little work to figure out which foods are healthy and which are not. But once you've done your homework and gotten used to reading labels, it becomes easy to choose the foods that will provide valuable energy and nutrients to you and your family.
Exercising regularly provides a person with lots of energy.2 People who exercise regularly fall asleep right away, need less sleep, and usually wake up rested and refreshed. They have energy throughout the day to do what they need to do and rarely "crash" in the middle of the day.
How does all this happen? Regular exercise resets your metabolic clock. Training your muscles also trains your metabolism to work efficiently. You spend less energy to make more energy. It's a remarkable system.
Another key part of the energy puzzle is finding some quiet time during the day to recharge your batteries.3 Most of us are not aware of the importance of this "alone time". Our lives are very hectic and we really do need some quiet time to allow us to decompress. "But I'll never find time in the day to do that," you say. That's right. People need to proactively create the time, even though it seems impossible. Once you begin setting aside ten or fifteen minutes each day to just sit and center yourself, you'll find you actually want to make the time to engage in this highly restorative and energizing activity.
The bottom line? More energy is available to each of us - we just need to plan and make sure we're taking the time to do things that support us. Eating the right foods, making time for regular exercise, and making room for quiet time will bring you a new sense of peace, well-being, and true, meaningful accomplishment.
Your chiropractor is an expert in creating lifestyle programs that will assist you in improving your well-being and quality of life. She will be glad to help you develop exercise and nutritional plans that will work for you.
1"Getting Through Tough Economic Times", U.S. Department of Health and Human Services - http://www.samhsa.gov/economy/
2Marshall DA, et al: Achievement of heart health characteristics through participation in an intensive lifestyle change program (coronary artery disease reversal study). J Cardiopulm Rehabil Prev 29(2):84-94, 2009
3Orme-Johnson DW: Commentary on the AHRQ report on research on meditation practices in health. J Altern Complement Med 14(10):1215-1221, 2008
It's early January - a New Year - and you've decided this is going to be the year you actually fulfill your list of New Year's resolutions. This is going to be the year you finally start taking good care of yourself. You're going to exercise regularly, you're going to lose weight, and you're going to find our whether chiropractic care can make a difference in your life.
You've been promising yourself good health for years. Your friends and even some family members have been recommending chiropractic health care to you for a very long time. You decide you're ready to take action and you make an appointment to see your local chiropractor.
Chiropractic health care is more important now than ever before. Today 47 million Americans are without any form of health insurance. Another 25 million Americans are underinsured. Health care costs continue to rise and household incomes have been flat for many years. Chiropractic health care can play a large part in the solution to our health care crisis.
Chiropractic care is low-cost but provides high value. Chiropractic treatment is focused on the musculoskeletal system - muscles, joints, and bones - but is designed to primarily address the functioning of the nerve system. In a word, chiropractic care makes your nerve system more efficient. And an efficient system of nerve supply is necessary for optimal functioning of all other critical body systems - your digestive, cardiovascular, immune, and respiratory systems.
Chiropractic care utilizes a hands-on approach, and office visits provide real, personal interactions between you and your chiropractor. Your chiropractor is highly trained in a variety of disciplines - including restorative exercise and nutritional evaluation - and will make recommendations that are specifically designed for your needs.
Chiropractic care itself - called spinal adjustments - is gentle and relaxing. Immediate results often include increased mobility of the neck, back, shoulders, and hips. People often report sensations of increased alertness and increased focus. And for those with back-related pain, improvement is often noted within 24 or 48 hours.
Additional profound benefits of chiropractic care derive from its direct effect on nerve system functioning.1,2 Although chiropractic health care is not specifically a treatment for headaches, allergies, asthma, menstrual cramps, or digestive problems, improvement in one's health may occur across the board as an indirect result of chiropractic therapy.
So, chiropractic care provides a lot of bang for your buck - a lot of health benefit for your health care dollar. And at your chiropractor's office, you not only receive the benefit of treatment but also the benefit of health-care knowledge - you learn about how your body works and how to take care of it. Your chiropractor is an educator as well as a health-care provider, interested in all aspects of your health and well-being.3
1Bronfort G, et al: Efficacy of spinal manipulation and mobilization for low back pain and neck pain: a systematic review and best evidence synthesis. Spine J 4(3):335-356, 2004
2Stuber KJ, Smith DL: Chiropractic treatment of pregnancy-related low back pain: a systematic review of the evidence. J Manipulative Physiol Ther 31(6):447-454, 2008
3Johnson C, et al: Chiropractic and public health: current state and future vision.
J Manipulative Physiol Ther 31(6):397-410, 2008
Every successful athlete knows that a plan is necessary to reach the highest levels of performance. How many practice sessions are needed each week, what kinds of things to work on during each session, how much rest to get, how much and what kinds of food to eat, how much water to drink - these are some of the factors in an overall program for athletic success.
Venus and Serena Williams, Lisa Leslie and Diana Taurasi of the WNBA, and Misty May-Treanor and Kerri Walsh (perennial women's beach volleyball champions) are examples of world-class athletes who have very clearly defined roadmaps to help them get where they want to go. Michael Jordan worked on his jump shot every day, even after he won his sixth world championship. Derek Jeter of the New York Yankees takes batting practice and does strength training every day during the baseball season, as he continues a stellar Hall of Fame career. Track-and-field stars such as Usain Bolt of Jamaica (brand-new double world-record holder in the 100-meter and 200-meter dash) train year round and have very specific plans to reach their performance peaks at race time.
Even though we may not plan to become professional athletes, we still require a plan for success in terms of physical performance and overall health and well-being. 1-3However, most of us don't consider health and fitness from the point of view of planning. We forget that the hallowed maxim of business success - "if you fail to plan, you're planning to fail" - applies equally to health and fitness. What happens if we don't have an actual plan for being healthy? We eat to satisfy cravings. We sit on the couch and watch TV all evening. We spend all weekend at the mall. None of these activities helps us maintain good health. We put on weight, year after year, and allow our bodies to deteriorate hour after sedentary hour.
What would we be doing if we had a plan for achieving optimal health and wellness? Obviously we'd be consuming a healthful diet and engaging in regular vigorous exercise. We'd maintain a good weight for our particular body type and we'd be getting sufficient rest on a weekly average. Maybe not so obviously we'd also see our chiropractors regularly. Chiropractic care is a key ingredient in planning for long-term health and wellness. Your chiropractor is an expert in human performance.
We are able to identify roadblocks and limitations that can be corrected with chiropractic care. Diet, exercise, and rest are critically important to good health. The underlying mechanism that coordinates all your body's activities - the nerve system - needs to be in top shape, too. That's where chiropractic care comes in. Talk with us about your plans for your family's health and wellness. We will be glad to help design programs that will work for your entire family.
1Holla J, et al: Recreational exercise in rheumatic diseases. Int J Sports Med August 14, 2009 (online ahead of print)
2Pisinger C, et al: The relationship between lifestyle and self-reported health in a general population. Prev Med August 27, 2009 (online ahead of print)
3Sternfeld B, et al: Improving diet and physical activity with ALIVE. Am J Prev Med 36(6):475-483, 2009
