Essential Hip Health Drills

I’ve recently mentioned California-based physical therapist Kelly Starrett, and his very interesting blog MobilityWOD.com. (I’m doing his Mobility Course in Denver at the end of April.) One of his posts discusses why sitting is poison for your ability to move. (Also, check out Why sitting all day is slowly killing you for more details on this evil activity.) He’s on to something. Sitting is bad and we need to do something about it.

You sit too much.

By the way, if you’re saying, “But I don’t sit that much,” I have several questions for you:

1) Are you a non-Amish/non-lumberjack American in the modern world? If you say “yes” then you sit too much.

2) Do you own a car? If you say “yes” then you sit too much.

3) Is there a desk and/or a computer involved in your life? Clearly your answer is “yes” because you’re reading this.

4) Are you a cyclist? If it’s “yes” then you sit too much.

5) You sit too much.

Deep posterior hip muscles

Effects of sitting

So what does sitting do to us? First, we get restrictions in a bunch of our muscles and tissues. Particularly we see restrictions in our posterior hip capsule. This type of restriction can contribute to a condition called anterior femoral glide syndrome, which can cause pain at the front of the hip and generally bad movement. Further, the various

muscles in this region can become impaired, tight and weak. Sitting shuts down these muscles and our brain literally forgets how to use these extremely important movers and stabilizers. All of this can result in various aches and pains, poor balance, difficulty sitting and standing, poor running form, poor lifting form–it’s all bad!! What’s the solution?

Mobilize & strengthen

Superficial posterior hip muscles

The best way to address these restrictions is to move. We’ve got to move the tight tissues and we have to re-learn how to operate these muscles that have likely gone dormant. What follows are three drills borrowed and adapted from Shirley Sahrmann and Nick Tumminello.

Simply doing these movements and feeling a stretch in the hip will help loosen tight tissue, but we want to go beyond that. Again, we need to re-learn how to use these muscles and in order to do that you must contract them as you’re doing these drills. Think of adjusting the tension of your glutes in much the same way as you’d adjust the tension of your bicep during a bicep curl. You’ll maintain tension throughout the movement even as the muscle become stretched. You’ll probably

find it difficult to maintain a perceptible contraction as the glute stretch. Work on it. It’s a skill that you should develop in order to overcome pain and perform better. It’ll take practice but the payoff will be tremendous.

Eyes and Your Health

If you’re a client of mine then you’re at least a little aware of how important eyes, visual skills, and visual reflexes are to our health and performance. As part of the Z-Health Performance System, we’re taught that vision sits atop our neurological hierarchy. If we have a visual impairment (could be anything from a phoria, a convergence/divergence issue, diplopia or other issues) then literally our survival is at risk. Now there’s more information regarding the far-reaching importance of our eyes to our health.

The New York Times has a fascinating article titled Aging of Eyes is Blamed for Range of Health Woes. The article discusses research from the University of Kansas that reveals the impact of aging eyes on our circadian rhythms (aka body clock) and by extension our general health. The article states, “This internal clock relies on light to function properly, and studies have found that people whose circadian rhythms are out of sync, like shift workers, are at greater risk for a number of ailments, including insomnia, heart disease and cancer.”

Of particular importance is the role of blue light, the cells that pick up the light, and melatonin production. It seems that some cataract surgery may hinder the relationship between these factors. Here’s what the article says:

“Researchers in Sweden studied patients who had cataract surgery to remove their clouded lenses and implant clear intraocular lenses. They found that the incidence of insomnia and daytime sleepiness was significantly reduced. Another study found improved reaction time after cataract surgery.

‘We believe that it will eventually be shown that cataract surgery results in higher levels of melatonin, and those people will be less likely to have health problems like cancer and heart disease,’ [researcher] Dr. Patricia Turner said.

That is why [researcher] Dr. Martin Mainster and Dr. Turner question a practice common in cataract surgery. About one-third of the intraocular lenses implanted worldwide are blue-blocking lenses, intended to reduce the risk of macular degeneration by limiting exposure to potentially damaging light.

But there is no good evidence showing that people who have cataract surgery are at greater risk of macular degeneration. And evidence of the body’s need for blue light is increasing, some experts say.

‘You can always wear sunglasses if you’re in a brilliant environment that’s uncomfortable. You can remove those sunglasses for optimal circadian function, but you can’t take out the filters if they’re permanently implanted in your eyes,’ Dr. Mainster said.

Because of these light-filtering changes, Dr. Mainster and Dr. Turner believe that with age, people should make an effort to expose themselves to bright sunlight or bright indoor lighting when they cannot get outdoors. Older adults are at particular risk, because they spend more time indoors.”

Fascinating stuff!!! (By the way, when you workout, do you exercise your eyes? Do you consider your eye muscles? Think about it.)

Running News

The New York Times Phys-Ed section discusses a recent Harvard study on running form. The study examined injury rates among heel strikers vs forefoot strikers. The subjects were 52 runners on the Harvard cross-country team. Researchers looked at four years worth of data on injured runners. The pertinent finding is this:

“About two-thirds of the group wound up hurt seriously enough each year to miss two or more training days. But the heel strikers were much more prone to injury, with a twofold greater risk than the forefoot strikers. (Emphasis is mine.)”

Be careful though. This finding doesn’t necessarily mean that everyone should immediately change their running form. The article quotes says:

“Does this mean that those of us who habitually heel-strike, as I do, should change our form? “If you’re not getting hurt,” Dr. Daniel Lieberman says, “then absolutely not. If it’s not broke, don’t fix it.”

But, says researcher Adam I. Daoud, who was himself an oft-injured heel-striker during his cross-country racing days, “if you have experienced injury after injury and you’re a heel-striker, it might be worth considering a change.”

For further discussion and analysis on these findings, have a look at Runblogger’s post (and how these findings are being misused in advertising) and the post at Sweat Science. Both of these guys do a great job of telling us what the data does and does not show.

“With it went my belief, naïve in retrospect, that yoga was a source only of healing and never harm.”
– William J Broad, NY Times

If you haven’t read or heard about it, the New York Times recently ran an article titled How Yoga Can Wreck Your Body. It’s far from the perfect article. For one, it’s full of anecdotal evidence. Second, many of the examples given of yoga causing injury consist of people doing rather extreme versions of a pose or movement. I think the article does bring up valid questions: Can yoga cause harm? Is it always safe for everyone?

I’ve had a couple of harsh experiences with yoga. Once I had a teacher that thought since I looked big and strong I could do some sort of headstand. I figured I would follow the teacher’s lead and give it a shot. Without question I was not ready for this pose. I left the class with a very painful shoulder. This instructor had been teaching for years and was very highly sought after at the gym where I worked. I was in another class where an instructor all but insisted that I move deeper into a pose and I simply couldn’t do it. My nervous system was trying to protect me by preventing further movement into this position and she had me trying to force my way into a deeper range of motion. Again, by the end of class, I was in a bit of pain. This is not what I was after.

My observation is that yoga is often championed as a panacea cure-all for any number of ailments: back pain, knee pain, mental stress, possibly even digestive issues. I can’t say everyone says this type of thing but in every gym setting where I’ve worked yoga is discussed and presented in this glowing fashion. But is yoga really any different from any other type of exercise? Might there be a few risks?

First and foremost, yoga is movement. So is running a 100 m sprint. Driving a golf ball is also movement. The power lifts are movements. Typing on a keyboard and watercolor painting? Also movement. Guess what: Movement can cause injury! (By the way, try NOT moving and see how healthy you become.) Further, yoga is a lot of very different movements. One may be quite safe, another quite unsafe. All parts of yoga can’t be viewed fairly as the same thing.

We can probably agree that movement is essentially necessary and usually healthy. We can probably agree that walking is typically safe and healthy. But what if we have a sprained ankle? Or a damaged vestibular system such that we can’t tell which way is up? Then even walking might be quite harmful. Lifting weights is similarly healthy in most cases. If we have a herniated disk or if we use bad technique then lifting may be very unhealthy. Why would we view yoga as any different? If we have poor kinesthetic sense then moving into any number of poses could cause pain and/or injury.

Further, we as Americans often have the view of “If a little bit is good then a BIG WHOLE LOT must be great!” More is better in other words. I’ve heard some yoga people speak proudly of not only how deep they can move into a pose but also how quickly they can move from one pose to another. Sounds a lot like the talk in any weight room. Just substitute weight and reps for poses and depth of motion.

Glenn Black is an experienced yoga teacher who’s interviewed for the Times article. He speaks to other yoga teachers and practitioners on the issue of injuries. He talks about ego. (I think the popular image of yoga is that it is an ego-less type of thing. But what human activity is free of ego?) Black says, “My message was that ‘Asana is not a panacea or a cure-all. In fact, if you do it with ego or obsession, you’ll end up causing problems.’” This seems a very wise statement, and I’m pleased that this article may start to shed light on the idea that yoga should be evaluated the same way as any other type of exercise.

Retraction on the last article

My previous post, the Skinny on Fat, contained some information regarding fat and cholesterol from Dr. Joe Mercola. Someone contacted me regarding him and some of his very questionable practices and beliefs. Among other things, he’s been ordered by the FDA to stop some illegal claims for his products. If nothing else, some of his business practices are on the shady side. Beyond that, he’s an advocate of homeopathy, which is non-scientific quackery at its finest. Most disturbingly, he has participated in a “vaccine awareness” public service announcement. He helps play up unfounded fears of vaccines which no one in the serious scientific community find plausible. For this reason I’m deleting the section of my last article in which he’s referenced.

The Skinny on Fat

History

I call this portrait "Health Food."

I grew up in the years of the low-fat craze. We were told that reducing dietary fat and cholesterol—particularly animal fat—was the best way to lose weight and improve our health. We saw wide scale proliferation of fat-free and reduced-fat food products. These products were then stuffed with sugar and weird chemicals that were and are very detrimental to our health—but hey!!—there wasn’t any fat. Ironically, this low-fat era saw an exponential expansion of American’s waistlines and all the associated chronic diseases such as heart disease, diabetes and cancer.

Now we’re seeing that a lot of our dietary guidelines were way off the mark. Turns out in fact that a lot of those guidelines were based on very shaky evidence and that researchers of the time were not in agreement on the data. A very thorough look at this evolution of our dietary guidelines can be found at the City Journal in an article titled The Washington Diet. Here’s an excerpt:

“As science writer Gary Taubes notes in Good Calories, Bad Calories, Senator George McGovern’s Select Committee on Nutrition and Human Needs, in coming up with its diet plan, had to choose among very different nutritional regimes that scientists and doctors were studying as potentially beneficial to those at risk for heart disease. Settling on the unproven theory that cholesterol was behind heart disease, the committee issued its guidelines in 1977, urging Americans to reduce the fat that they consumed from 40 percent to 30 percent of their daily calories, principally by eating less meat and fewer dairy products. The committee also advised raising carbohydrate intake to 60 percent of one’s calories and slashing one’s intake of cholesterol by a quarter.

Some of the country’s leading researchers spoke out against the guidelines and against population-wide dietary recommendations in general. Edward Ahrens, an expert in the chemistry of fatty substances at Rockefeller University, characterized the guidelines as ‘simplistic and a promoter of false hopes’ and complained that they treated the population as ‘a homogeneous group of [laboratory] rats while ignoring the wide variation’ in individual diet and blood chemistry. The Food and Nutrition Board of the National Academy of Sciences released its own dietary suggestions, which saw ‘no reason for the average healthy American to restrict consumption of cholesterol, or reduce fat intake,’ and just encouraged people to keep their weight within a normal range.”

Practical information

The very strong and very thoughtful lads at T-Nation.com give us a simple and worthwhile article on fat titled Fats Made Simple. This article goes into the various attributes of different fats and oils, which are best to cook with, which ones are best used as a topping, and which ones to avoid altogether. The issue of Omega-3 and Omega-6 fatty acids is discussed. I won’t go into every detail but here are some key points from the article:

— Use saturated fats for cooking. These are less likely to become rancid and toxic during the cooking process.

— Use unrefined oils. DON’T use refined oils.

The author’s top 6 oils are:

–red palm

— coconut

— macadamia nut

— extra virgin olive

— hemp seed

— walnut

AVOID THESE OILS:

— safflower

— sunflower

— canola

— corn

— sesame

— peanut

— pistachio

— pumpkin

— soybean
(Next time you’re looking at ingredient labels, see if you spot any of these oils–particularly corn, canola and soybean. Chances are you’ll find at least one if not several. They’re in everything!)

An eating plan

The Perfect Health Diet is an example of a a diet that’s high in healthy fat. It was developed by two scientists who wanted to address some of their chronic health issues. This plan has adherents eating about 2/3 plant foods and 1/3 animal-based food. Besides a high fat content, the diet is further characterized by complete avoidance of sugar and cereal grains such as wheat, corn and oats; this due to their inflammatory nature. (If you cut out the processed food then you’ll cut out a lot of sugar, wheat, corn etc). Legumes such as soy and peanuts are also to be avoided as well. Here are more details of the diet.

Please take note, dietary animal fat should come from free-range grass-fed sources. Most of the mass-produced grocery store meat is chock full of garbage such as added hormones and antibiotics. Plus the animals are fed stuff they’re not meant to eat.

I’m currently on this eating program. Admittedly, I haven’t followed it 100% but I’m working in that direction. I definitely feel more energetic having reduced my grain intake. I realize when I do consume grain, I tend to get a bit bloated. The odd thing is eating and really enjoying a lot of foods that for years I thought were really bad for me: butter, bacon, whole eggs, chicken with the skin on it, organ meats. I’m quite interested in sticking with this plan, further “perfecting” my eating, and seeing where it takes me.

“Hopefully now you understand that damage and soreness are not necessarily bad things, but instead are essential triggers for the adaptations we all seek to improve performance.”
– Steve Magness, Running Times

The previous post on supplements got me thinking about various articles I’ve read recently on the possible negative effect that antioxidants may have on endurance training. Here is some information to consider.

Alex Hutchinson writes a blog called Sweat Science. He also writes a column called Jockolgy for the Toronto Globe and Mail and he’s written articles for the New York Times, Runner’s World and Popular Mechanics. Beyond that he’s your ordinary, every day physicist and elite-level distance runner. Seems like a smart guy to me. I listen to what he has to say.

He recently wrote a piece titled The case against antioxidant vitamin supplements. It’s of a similar theme as an earlier post called Does Vitamin C block gains from training? Both posts suggest the idea that supplementing with antioxidants may inhibit the training effects we want from strenuous workouts. This may seem counter to what many of us have been told.

Science tells us that antioxidants protect us from cellular damage done by free radicals. Free radicals are produced by strenuous exercise. So recent conventional wisdom says that we can protect our bodies by taking antioxidant supplements such as Vitamins C and E.

New research though is telling us that our supplementation may be interfering with the cycle of stress and adaptation that a workout provides. Hutchinson refers to research in the latest issue of Sports Medicine that supports this concept. He cites the following (The ROS mentioned are free radicals.):

“The traditional theory goes like this: strenuous exercise produces “reactive oxygen species” (ROS), which cause damage to cells and DNA in the body. Taking antioxidant supplements like vitamins C and E helps to neutralize the ROS, allowing the body to recover more quickly from workouts.”

“The new theory, in contrast, goes like this: strenuous exercise produces ROS, which signal to the body that it needs to adapt to this new training stress by becoming stronger and more efficient. Taking antioxidant supplements neutralizes the ROS, which means the body doesn’t receive the same signals telling it to adapt, so you make smaller gains in strength and endurance from your training.”

“The new paper comes down firmly on the side of the latter view:”

“The aim of this review is to present and discuss 23 studies that have shown that antioxidant supplementation interferes with exercise training-induced adaptations. The main findings of these studies are that, in certain situations, loading the cell with high doses of antioxidants leads to a blunting of the positive effects of exercise training and interferes with important [reactive oxygen species]-mediated physiological processes, such as vasodilation and insulin signalling.”

The researchers conclude with the following statement:

“We recommend that an adequate intake of vitamins and minerals through a varied and balanced diet remains the best approach to maintain the optimal antioxidant status in exercising individuals.”

All of these ideas and observations are similar to the views expressed by exercise scientist and running coach Steve Magness in his article When Damage is a Good Thing in Running Times. His article discusses not only antioxidant intake but also ice baths, anti-inflammatories, and carbohydrate drinks. If you’re an endurance athlete then you should definitely read the article. Magness sums up things well with the following statement:

“Hopefully now you understand that damage and soreness are not necessarily bad things, but instead are essential triggers for the adaptations we all seek to improve performance. The goal should not necessarily be to minimize them automatically, but instead to work with them–this means allowing for enough damage to take place to initiate adaptation and then allowing for the body to go through its natural recovery response before trying to aid recovery. The goal should be to work with the body, not against it. So keep in mind the goal of each training session and the goal of whatever recovery methods you use, and plan things accordingly so your recovery efforts help you to improve performance, not hinder it.”

Incidentally, all of this has caused me to rethink my recovery strategies.

Questions About Supplements

Dietary supplements are huge business in this country. Over half of Americans take some sort of supplement such as a multivitamin, calcium, Vitamin D, Vitamin E, chromium, iron, zinc, and/or any number of various such nutrients. Consumers spent $26.7 billion on supplements in 2009. We take supplements for weight loss, bone health, cardiovascular health, athletic performance; and we may take them in order to avoid prescription medicine. Recent research may make you reevaluate your view of supplements.

Vitamin E and prostate cancer

First, some information from an article in the Atlantic called Are Supplements Killing You? The article looks at two studies. The SELECT study is the first one discussed. The results of the trial were recently published in the Journal of the American Medical Association. The aim of the study was to see if Vitamin E and/or selenium supplementation offered a protective effect from prostate cancer. The study followed 35,000 men aged 50 and up split into three groups: one group took Vitamin E, one group took selenium, one group took both. Participants were tracked from 2001 to 2008. The study was stopped in 2008 because rather than finding a protective effect, there were indications that cancer risks were going up. The pertinent details are these; emphasis is mine:

“The recently published article included results as of July 2011. It found an increase in new prostate cancers among all three groups taking supplements, with the increase only significant in the vitamin E group. That group showed a 17 percent increase in the rate of prostate cancer compared to the placebo group.“

An unclear picture for women and supplements

The Atlantic article also discusses the Iowa Women’s Health Study, which has generated some controversy. This study looked at the effect of taking vitamin and mineral supplements on mortality on nearly 39,000 U.S. women aged 55 to 69 and used information collected from 1986 through 2008

At the start of the study, 66% of the study subjects reported using at least one supplement. This increased to 85% in 2004, with 27 percent reporting use of four or more supplements.

The study examined the effect of taking 14 individual supplements and also a multivitamin. The researchers concluded that women who took any of six supplements or a multivitamin had a slightly higher risk of death over the study period:

Multivitamins were associated with a 2.4 percent higher risk of earlier death
Vitamin B6 gave a 4.1 percent higher risk
Folic acid gave a 5.9 percent higher risk
Iron gave a 3.9 percent higher risk
Magnesium gave a 3.6 percent higher risk
Zinc gave a 3 percent higher risk
Copper gave an 18 percent higher risk
Calcium gave a 3.8 percent lower risk of death

Do the results surprise you? They surprised a lot of other scientists as well. The controversy centers around the statistical methods used to analyze the data. Though I would love to be able to explain the fine details of this issue to you, I definitely cannot do it. (Sometimes I need a calculator to count my fingers and toes.) Read the Atlantic article to learn more or you can hop over to the Perfect Health Diet site and see a very detailed breakdown and critique of the study. If you scroll down just past the picture of the duckling trying to eat a fly, you’ll find it. (The Perfect Health Diet is a pretty interesting concept. Learn more about it here.)

One of the key elements here is that it’s an observational study, not an intervention study. That means the researchers simply observed the subjects. They didn’t try to change their behavior. So while the data may seem to suggest that taking these supplements caused early death, it would be a mistake to draw that conclusion. (One possibility is that some of the women were ill and they started taking supplements; they then died from the illness.) The article also states, “In general, when an effect is present in some statistical models and absent in others, it means that if the effect actually exists, it’s a small one.”

A closing comment was made by Robert M. Russell, M.D., special expert to the Office of Dietary Supplements (ODS) at NIH and former senior scientist and director of the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University:

“In general, what we have learned from an accumulating database from both observational epidemiology and interventional studies is that the vitamin and minerals are safe to take in RDA amounts (as are contained in most over the counter multivitamin-multimineral preparations). Further, we have learned that taking large amounts of single nutrients or nutrient combinations often lead to chronic undesirable toxic effects with implications for chronic disease such as cancer. We have seen this with beta-carotene with a stimulation of lung cancer at high doses, and now we are seeing a similar picture with high dose vitamin E vis-a-vis prostate cancer.”

“So what is the best advice for the public? Stick to a varied diet, if you want to take supplements, take a multivitamin-multimineral that has RDA amounts. Don’t jump on the silver bullet of the day single nutrient band-wagon until there is enough evidence for both efficacy as well as long term safety. That said, in order to get RDA amounts of calcium and vitamin D, a single nutrient supplement may be necessary for some people. Following the nutrient guidance of our National Academies of Science is my best advice.”

So it seems that optimal health can be had largely by eating the right foods. Focusing on the individual nutrients doesn’t seem wise. There certainly doesn’t seem to be any miracle supplement out there. The miracle is the interaction between the thousands of compounds found in our food. If we go beyond our needs and add more of a particular nutrient then we may have trouble.

The pitchers were not injured and had no pain. But the M.R.I.’s found abnormal shoulder cartilage in 90 percent of them and abnormal rotator cuff tendons in 87 percent. “If you want an excuse to operate on a pitcher’s throwing shoulder, just get an M.R.I.,” Dr. James Andrews, sports medicine orthopedist from Gulf Breeze Florida says.

Sports Medicine Said to Overuse M.R.I.s is a very valuable article from the New York Times Health section. It deals with the widespread use and misuse of magnetic resonance imaging (MRI). As you may know, these images can reveal all sorts of interesting information from inside our bodies. Fractures, frayed tendons, fluid around a joint and tumors are just a few things that can we can see via an MRI scan. The thing is, these images don’t always tell us why we’re in pain.

The quote at the top is from a study by Dr. Andrews in which he scanned the shoulders of a bunch of uninjured baseball pitchers. Though they weren’t in pain, nearly all the scans revealed “abnormalities.” The results are similar to a similar study of hockey players in which MRIs showed that 70% of the subjects show “abnormalities” in their hips. The thing is none of the hockey players were injured or in pain.

The Times article discusses the profit motive behind both MRI scans:

“The price, which medical facilities are reluctant to reveal, depends on where the scan is done and what is being scanned. One academic medical center charges $1,721 for an M.R.I. of the knee to look for a torn ligament. The doctor who interprets the scan gets $244. Doctors who own their own M.R.I. machines — and many do — can pocket both fees. Insurers pay less than the charges — an average of $150 to the doctor and $960 to the facility.”

The article goes on to discuss a skier who was prescribed surgery for a torn knee ligament. This prescription was based on an MRI and the tear was confirmed by a second opinion. It was a third opinion and MRI however that showed that the ligament was not torn and surgery was not needed. In this case, the third doctor noticed that the first and second assessments of the torn ligament did not match the symptoms of the man’s injury. It seems the prior opinions relied only on what the MRI showed and not on a carefully considered history of the injury.

The overall message here is that MRIs can give us a lot of information but they may not tell us the whole story. An MRI is not a perfect, magic tool that tells us exactly how to address our pain. It seems the best doctors recognize this and are very careful to order MRIs only when truly needed. Don’t be afraid to get multiple opinions on your injury. If your doctor seems to be relying only on an MRI, keep looking around for more help.

Stuff to Read: Weightlifiting vs. Powerlifting, Hormones & Weight Loss

Powerlifting vs. Weightlifting

To a lot of people the terms “weightlifting” and “powerlifting” may sound synonymous. I assure you they are quite different activities. Both sports require the lifting of barbells with lots of weight attached, but the similarities stop there. (As an example, we can start with the highly ironic term “powerlifting.” In fact, powerlifting features almost no power whatsoever. Weightlifting on the other hand features lots of power. You had no idea did you?) For a very thorough and informative look at the two different activities–and to figure out which best enhances athletic performance–check out this article from TNation.com titled Weightlifting vs. Powerlifting: Which is Right for You?

Hormones and the Difficulty of Weight Loss

Losing weight and keeping it off is typically a very difficult task for a lot of people. The idea that it’s simply an issue of willpower is simply false nonsense. (Look here, here, here, here and here for previous posts on the issue.) Now there’s another study and another article to add to the pile of knowledge on obesity and weight loss. Why Dieters Can’t Keep the Weight Off is an article from Time Magazine that discusses recently published research from the New England Journal of Medicine. It goes into the issue of various hormones that essentially tell us we’re hungry. The levels of these hormones rise in people who are losing weight. Further, these same hormones tend to stay elevated post weight loss. The practical effect is that weight loss is difficult to achieve and maintain. It’s definitely not just an issue of willpower. Read the article for more detail.

Denver Fitness Journal

All Things Health and Fitness by Kyle Norman, MS, CSCS, FMS, RRCA Running Coach

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