It has been a while since my last post, but after following this for couple of days and trying to come up with a response that was more intelligent than offensive, there truly isn’t mush else to say… Well said Dr Anastasia Boulais!

Let’s help these patients, not “feel sorry” for them. Watch the video and comment below.


This morning I had the unfortunate experience of watching a particularly vile video. This was brought to my attention by Dr Yoni Freedhoff and I have to say that I share his outrage. The video is supposed to be a “satirical representation” of a typical encounter between a doctor and an overweight patient. It was published on a popular medical website Kevin MD, the “social media’s leading physician’s voice”.

“This is the video which will make you feel sorry for doctors treating obesity”. 

Please watch.

My first inclination after watching this was to smash my computer screen. My second inclination was to write a post. If you are reading this I chose the second. There are many MANY features of this video which are both disturbing and revealing of our current public health system and societal attitudes to obesity.

Let’s start with the title of the article: THIS IS THE…

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A New Year of possibilities


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Healthy2014As this final day of 2013 comes to an end, I find a few minutes to look back at a year that for some had ‘bad luck’ written all over it, and rejoice in what was learned and the family and friends that remain, while learning from the mistakes and less memorable moments.  Thankfully, another one of these ‘unlucky’ years won’t come by for another 100 turns of the calendar – long after these words disappear from the on-line stratosphere.

For those of you who have kept up with my inconsistent writing, thank you! Last year, when this project began, the goal was simply to learn the process and ‘get started’.  As 2014 begins, the goal is more specific – to write monthly.  Which brings me to the actual point of this post – resolutions vs. goals.

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A controversy potentially fueled by numbers


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As 2013 comes to an end, I figure I had a chance to write one more post considering all the “buzz” going on lately.

As you might have been able to see from some of my research, over the last year our team at KSU has spent a lot of time involved in CrossFit related research trying to answer some basic questions, for which we do not have a lot of objective answers.

Unless you have been living under a rock for over five-years, by now you have an idea of what CrossFit is (or at least an opinion!) and perhaps you may have given it a try once or twice!  You can find out more about CrossFit on their website.

What I would like to talk about here, is a big controversy that has been brewing over the last couple of years as to how ‘dangerous’ CrossFit truly is; which, in a way, may be fueled by numbers more than anything else.  This controversy has granted me the opportunity to be interviewed on several mainstream media outlets, the latest of which was recently published here.

Of course, everyone has their own opinion on this, and I welcome an educated dialog here.

Some will argue about the certification process (which I find it to be a Fitness Industry problem, not just a CrossFit problem); the lack of experience among coaches; and the high-intensity nature of the program, which may not be suitable for everyone.  This last point however can be highly contested considering everyone has the ability to “scale”, or modify, any workout based on their fitness levels (if you have been doing CrossFit and this is NOT the case in your facility, perhaps you should consider changing affiliates!).

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CrossFit® does not cause Rhabdomyolysis… Unaccustomed exercise does.


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If you stay connected to the Internet and are interested in fitness and exercise, you probably are familiar with an article by Dr. Eric Robertson, which blamed CrossFit® for the development of Rhabdomyolysis – a potentially life-threatening condition.  Also, if you kept up with the story, you may have also seen a great piece by Erika Andersen, which promoted personal responsibility for anyone participating in any type of exercise program – especially CrossFit®.

Although I usually try not to engage in this type of controversy, as most pieces are primarily based on personal opinions and everyone is entitled to their own, there are some misconceptions that were alleged on the first article I would like to address.  As some of you know, over the last year our laboratory has focused on the study of CrossFit® as a training modality.  These studies have provided me the opportunity to read, research, meet and talk to a vast number of individuals, both for and against this training modality.

CrossFit® causes Rhabdomyolysis.

Although it is unfortunate that anyone has to experience this condition, regardless of severity, the premise that CrossFit® causes Rhabdomyolysis suggests a “cause and effect” that is simply not true and is based on the experience of ONE individual, which is far from the number required to make this type of association.  Then, “is it possible?” Yes, of course, but so is dying from sudden cardiac death during an athletic event, or during an exercise stress test.  These risks are inherent in any type of physical activity, regardless of their intensity.  Yet, we continue to promote physical activity and exercise to people around the world because the benefits of such activity outweigh the risks for most individuals.  This is so much so that the American College of Sports Medicine (ACSM) recently changed their Guidelines for Exercise Testing and Prescription to encourage all individuals to perform light to moderate activity regardless of their risk classification, suggesting that not being physically active has a greater risk than participating in such activity (read more about that here).

Rhabdomyolysis in the scientific literature

If we look in the scientific literature we find several instances of rhabdomyolysis as a result of some type of physical activity (exertional rhabdomyolysis).  Inklebarger and colleagues (4) reported the first case of self-induced rhabdomyolysis in a 63-year-old woman who exercised on a stationary bike a day prior to her emergency room visit.  In 2011, Boni and Rabiti (1) reported on the first Italian case of exertional rhabdomyolysis after a session of indoor cycling – Spinning®.  Three other cases have been reported specifically related to resistance training, all of which occurred in a national fitness center chain (2,7).  However, cases of exertional rhabdomyolysis have also been reported in young adults while preforming less “strenuous” activities.  A 25-year-old woman required hemodialysis for six-weeks after hiking for hours in the Grand Canyon (3).  A 19-year-old college freshman experience exertional rhabdomyolysis after playing in a ultimate Frisbee tournament (5).  Therefore, to say that CrossFit® causes exertional rhabdomyolysis is like blaming your favorite running shoe <<ENTER BRAND NAME HERE>> for your shin splints.

Exertional Rhabdomyolysis is caused by a breakdown of muscle fibers due to unaccustomed exercise and it is a life-threatening condition, characterized by muscular pain, muscle weakness, and dark urine.  Seeking early treatment is paramount to minimize damage to the kidneys and preventing kidney failure.  Moreover, even though overexertion may be the primary factor leading to this condition, secondary factors such as dehydration, genetic conditions (sickle cell trait), metabolic defects in the muscle, bacterial or viral infections, heat stress, nutritional supplementation and drug use exacerbate muscle damage, regardless of the exercising intensity (7).  Thus, individuals – and coaches – should be aware of these factors to minimize the risk of this condition.

A fitness industry problem?

This brings us to the topic of the CrossFit® Level 1 certification – don’t shut me out here; please keep reading.  A week before Dr. Robertson’s article, Patrick McCarty, a Master level CrossFit® athlete, wrote a great piece on what it means to be a CrossFit® coach; however, this didn’t get as much hype…

The certification process for CrossFit® coaches is no different than any other “basic” certification in the health and fitness industry.  Most personal trainers are certified in the same manner.  This might suggest an issue with the entire fitness industry, not just CrossFit®.  The “good” coaches seek continuing education opportunities that enhance their understanding of their job, just like any other professional (read Patrick’s post above).  CrossFit® coaches are no different.  As a matter of fact, some CrossFit® coaches have one of the highest distinctions in the industry – the Certified Strength and Conditioning Coach (CSCS) certification.

The Level 1 certification is just that, a basic introduction to the core and basic concepts by which this training modality was designed.  As Erika Andersen eloquently presented in her piece, consumers should be responsible to seek out coaches that are sufficiently qualified to keep them safe throughout any session.  Just like in other professions, there are good coaches and not so good ones.  When was the last time you went to a dentist you didn’t like?

Obviously, CrossFit® is not for everyone.  However, with good instruction everyone can participate in this training modality and gain significant improvements (6).  From a health promotion stand point; CrossFit® has revolutionized the fitness industry furnishing the opportunity to all individuals (particularly women) to participate in vigorous resistance type of physical activity programs, which they might have never attempted otherwise.

Want to read more? Here are some of the references I used:

  1. Boni R, Rabitti PG. [Spinning-induced rhabdomyolysis: importance of MRI for patient’s outcome. A case report]. Reumatismo. 2011; 63 (1): 44-8.
  2. Casares P, Marull J. Over a millon Creatine Kinase due to a heavy work-out: A case report. Cases J. 2008; 1 (1): 173.
  3. Clarkson PM. Worst Case Scenarios: Exertional Rhabdomyolysis and Acute Renal Failure. Sports Science Exchange. 1993; 4.
  4. Inklebarger J, Galanis N, Kirkos J, Kapetanos G. Exercise-induced rhabdomyolysis from stationary biking: a case report. Hippokratia. 2010; 14 (4): 279-80.
  5. Krivickas LS. Recurrent rhabdomyolysis in a collegiate athlete: a case report. Medicine and science in sports and exercise. 2006; 38 (3): 407-10.
  6. Smith MM, Sommer AJ, Starkoff BE, Devor ST. Crossfit-based high intensity power training improves maximal aerobic fitness and body composition. J Strength Cond Res. 2013.
  7. Springer BL, Clarkson PM. Two cases of exertional rhabdomyolysis precipitated by personal trainers. Medicine and science in sports and exercise. 2003; 35 (9): 1499-502.

ACSM Guidelines – Pre-participation Health Screening


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Well, after managing to complete several publication deadlines, summer projects and getting ready for a new semester “a week” has turned into more than a month since my last post. I have to get better at this!!

On the bright side, and among one of my “summer projects”, I’ve started to publish a new daily digest of health & fitness information. Check it out, and subscribe; you’ll get new health & fitness information in your mailbox everyday!

Okay, so let’s get to the post.  As I mentioned, I wanted to discuss one of most significant changes to the American College of Sports Medicine’s (ACSM) Guidelines for Exercise Testing & Prescription.

As described in my last post, ACSM completed several changes to the new edition of the Guidelines; however, their most significant change occurred in the screening of individuals participating in exercise programs.  Specially those who are considered to be high risk!

I realize this is not a very ‘easy read’ as it is more on the academic side, but keep reading — there may be something to learn after all!  Until next time. BeActive!

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ACSM Guidelines – A new edition with several changes


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Several weeks removed from the largest conference in sports medicine, exercise science, basic/applied science, physical activity, and public health – the ACSM Annual meeting – you always become revitalized by the number of great scientist who present their research.  In addition, you also become quite aware there is more work to be done!  This post, will begin a series of entries, which will affect most professionals involved in the field of exercise physiology – either teaching or practicing.

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A little hope for others


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On November 27, 2011 my life changed forever.  She who gave me life, who saw me grow up to become the man I am today, and who comforted me just by her mere presence, lost her battle to Cancer after giving it all she had.

MamiAll it took was Two-years. Twenty-four months of treatments, weekly doctor visits, hundreds of pills, and many hospital stays – for one thing or another.  All of it came crashing down that Sunday afternoon, as if she knew that a new week would bring new challenges she wasn’t ready to embrace.  She had become tired, she had lost her cultivating smile that lit up any room.  She had surrendered to the fate of those less fortunate.  Twenty-four months, which was four-times more time the doctors had “given her”; so we cherished the time we had.  Her struggle gave me strength and taught me to never give up; after all, she never did!

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Less options may lead to more physical activity


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It’s been several weeks since my last post, and my “new years” resolution of writing by-weekly has dwindle to writing AOAP (as often as possible). With several research projects underway, I’ve been “forced” back in the lab to do data collection. More about that later… This post is relevant to the purpose of the blog, but more of a personal experience as I traveled this week. I hope you enjoy it!

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Be your own Valentine


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As we move through February you are probably scrambling to figure out what to get your significant other – if you forgot today’s date (Valentines Day) you are probably a male (ladies don’t forget this day) so you better stop reading and pick up the phone to make reservations somewhere nice; otherwise you will have long afternoon!

Nonetheless, while you worry about your significant other’s heart, when was the last time you took care of YOUR own heart?

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Just move more…


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Congratulations!  You’re one month into the year and I hope you’ve kept up with your New Year’s resolution; specially the one of being ‘MORE active‘.  Hopefully, you had a chance to read my previous post, which made you think that loosing weight should be secondary and that getting healthier and reducing the time we spent sitting is most important.I hope you acknowledge my challenge and noticed how much time you spend sitting during the day (leave a comment below if you did and do not mind sharing).  Research suggest that most people sit for about 9.5 hours a day, which is about 2-hours more than most people sleep.  Yes, you read that correctly, we sit more than we sleep!  Yet, we seem to always be “tired”… how could that possibly be so? (We’ll tackle that question on another post…)

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