“Bad Science” is a good read.

Cures all that ails!!

Unless you live in a sensory deprivation chamber, you know that we’re awash in news stories and advertisements for food products, drugs, pain remedy potions, supplements of various sorts and all kinds of fitness and health fads. White-lab coated doctors appear on popular TV shows extolling the virtues of antioxidants, fiber, raw foods ionized bracelets, colonic cleanses and more.

We’re often told these products are “clinically proven” or that “Studies show” huge life-changing success when we use these products. But what do these terms mean? Are the hard-to-believe claims possibly true? Which if any of these “sciencey” sounding products are worthwhile, effective or even safe? I’m not a scientist, so what should I believe? (I should add that I’ve probably been convinced more than a few times of the worth of some worthless things.)

In an effort to understand some of this stuff, I’m reading Ben Goldacre’s Bad Science, and I’m learning a lot. He discusses in clear terms some of the strange claims made by practitioners of complimentary alternative medicine (CAM) such as homeopaths and nutritional gurus. We learn about the extraordinarily powerful placebo effect and why this effect is often at the core of alternative treatment methods. We get an in-depth look at the shocking and strange situation surrounding the recent HIV/AIDS denial controversy in South Africa. (This was the conflict in which South African president Thabo Mbeki and his cohorts fully ignored all scientific data regarding treatment and prevention of HIV/AIDS. The result was many thousands of premature deaths due to denial of antiretroviral drugs to HIV/AIDS patients in that country. One man, Mathias Rath, a German vitamin pill peddler, profited tremendously from this situation.) Goldacre also takes the pharmaceutical industry to task for various dubious, dangerous practices and manipulation of data. Bad Science is a look inside all sorts of snake oil.

Thus far I’ve found the chapter on nutritionists particularly interesting. We get some history of nutritional quackery. We learn about a man named John Harvey Kellog. You may recognize his last name. He helped create the cornflake. He sold granola bars, ran a sanatorium where patients were treated with “holistic methods,” advocated colonic cleansing which is popular today (By the way, that’s putting stuff in through a very clearly marked exit.), and he campaigned vigorously against masturbation. (He had some particularly stringent views on incorporating pain into circumcision as a way of inhibiting the enjoyment of sex in boys, and he advocated using carbolic acid on the clitoris to similarly dissuade sexual excitement in girls.)

What you start to realize is that ALL this stuff has been around for a long time. Charlatans making outrageous “sciencey” claims have been with us for decades if not centuries. They claim in one breath that cutting edge science is on their side. Yet when their methods and practices are subjected to truly rigorous scrutiny–and their methods are shot full of big holes–they huff and puff (sometimes they sue) and insist that the medical community is against them. Beware of these people. A lot of them–guys like Dr. Oz, Andrew Weil, Deepak Chopra–are very popular and highly respected in some circles including the popular press. They’re entertaining and they deliver very interesting messages. They also run in quite another direction from much of mainstream science.

If we’re looking to summarize the differences between CAM and conventional medicine, the following statement from the site Quackwatch.com says it best:

“Until now, alternative medicine has generally been rejected by medical scientists and educators, and by most practicing physicians. The reasons are many, but the most important reason is the difference in mentality between the alternative practitioners and the medical establishment. The leaders of the establishment believe in the scientific method, and in the rule of evidence, and in the laws of physics, chemistry, and biology upon which the modern view of nature is based. Alternative practitioners either do not seem to care about science or explicitly reject its premises. Their methods are often based on notions totally at odds with science, common sense, and modern conceptions of the structure and the function of the human body. In advancing their claims, they do not appear to recognize the need for objective evidence, asserting that the intuitions and the personal beliefs of patients and healers are all that is needed to validate their methods.”

One statement I found resonated with me, and I think it will help me keep a proper perspective. “There’s a word for alternative medicine that holds up to scientific scrutiny: Medicine.”

Goldacre doesn’t spend all his time bashing CAM, just most of his time. Early in the book he discusses one area where many CAM practitioners outdo their conventional medical counterparts and that’s in listening to the patient. A huge part of a patient’s feeling better relies on the doctor/patient relationship–the doctor’s bedside manner. Many of us have experienced a doctor’s appointment in which we’re rushed through, talked down to, not listened to, and the doc doesn’t do a good job of explaining what’s happening. This does not help us feel better. In contrast, much of the benefit of CAM may lie in the experience of someone taking time to genuinely listen to us, thus calming us and giving us hope that we can feel better.

Bad Science is a fun, snarky read. Goldacre’s criticism of the CAM industry is very direct. At times he’s sarcastic and creatively belittling of alternative medicine. If you’re an advocate of CAM then you might get a little worked up and defensive. If you’re interested in getting a deeper understanding of all the confusing medical and pseudo-medical information around us, please get a copy of Bad Science. You don’t have to be a scientist to understand what Goldacre is saying. For more fun and good information, have a look at Goldacre’s site BadScience.net.

Recognition of Chronic Pain as a Disease

If you’re suffering from chronic pain, then understanding how pain works is key to overcoming it. The New York Times has a pertinent article regarding this very strange issue from which so many suffer. Giving Chronic Pain a Medical Platform of Its Own highlights a growing understanding of chronic pain by some medical professionals (and a misunderstanding by many more medical pros). The main points are these:

“Among the important findings in the Institute of Medicine report is that chronic pain often outlasts the original illness or injury, causing changes in the nervous system that worsen over time. Doctors often cannot find an underlying cause because there isn’t one. Chronic pain becomes its own disease.

“When pain becomes chronic, when it becomes persistent even after the tissue and injury have healed, then people are suffering from chronic pain,” Dr. Sean Mackey, chief of pain management at the Stanford School of Medicine said. “We’re finding that there are significant changes in the central nervous system and spinal cord that cause pain to become amplified and persistent even after the injury has gone away.”

We see now that in many many cases, pain DOES NOT equal injury. (If you fall and bang your knee, cut your finger, or touch a hot stove then yes, the pain is quite indicative of an injury. These are acute injuries, not chronic pain issues.) Read the rest of the article for some of the latest ideas on pain science. If you want more excellent information on the very strange subject of pain, check out Body In Mind, a blog by pain researchers based at the The Sansom Institute for Health Research at the University of New South Wales in Australia.

“The average American now consumes about 2,375 calories per day, about a third more than in the ’70s.” – Time Magazine

Snacking

Two articles may help you understand why so many of us are overweight and why it’s tough to lose the fat. First, Time Magazine gives us Snack Attack! Americans Are Eating More Between Meals. The information here comes from a recent study on Americans’ eating habits over the past 30 years. Among the findings:

“Analyzing data from four nutritional surveys conducted between 1977 and 2006 by the U.S. Department of Agriculture and the Centers for Disease Control and Prevention, the study found that Americans went from eating an average 3.8 meals and snacks a day to 4.9 a day over the last three decades — a 29% increase. The average American now consumes about 2,375 calories per day, about a third more than in the ’70s.”

A lot of this makes sense. Look at our opportunities to eat (another factor examined in the study). We’ve had food in the grocery store checkout for years but now we’ve got food at the Bed Bath & Beyond! I can get candy at Home Depot! I can remember when gas stations had a gumball machine and a cigarette machines–and that was it. Now the average gas station is packed to the gills with weird, low-nutrition/high calorie snack food. Garbage is everywhere and we’re eating it.

Your Brain on Weight Loss

The Huffington Post gives us Weight Loss Psychology: Why Your Brain Might Be Holding You Back. I love this stuff because I’m fascinated by brain function especially at it pertains to exercise. Anyone who’s tried to lose weight has discovered several things. First, everyone knows how to do it: Eat less. Exercise more. Easy? No way! The other thing we’ve all learned is that though weight loss is easy in concept, it’s diabolically difficult to pull off. There’s way more than a simple desire to lose weight. Our short-term pleasure typically wins out over our long-term healthy goals. I like this description of the struggle:

“What drives our behavior is not logic but brain biochemistry, habits and addiction, states of consciousness and what we see people around us doing. We are emotional beings with the ability to rationalize — not rational beings with emotions. If we are stressed, depressed or addicted, no matter how good the advice we are given, chances are that we will not be able to act on it. The more primitive, emotional brain generally has precedence over the newer, more rational brain.”

The article also gives suggestions to help address weight loss:

1.) Focus on a change of heart, not a change of mind. Losing weight through changing what and how much you eat doesn’t happen because you rationally decide to lose weight. You have to have a change of heart; that is, you must get in touch with your deepest, heartfelt desires.Your motivation may not be positive. Indeed, it may stem from a fear of loss. For example, you may not want to get sick. Or you may not want to be ostracized. To get in touch with your motivation, think about the negative consequences of not changing as well as the positive ones. Getting fit must become a priority and your life must be organized accordingly. Nobody can change you but you, and once you’ve made the changes, you need to stay focused. Successful individuals keep their motivation in the forefront of their minds all the time.

2.) Practice self-discipline. Self-control is a muscle that, like other muscles, needs exercise and strengthening. Change doesn’t happen because you want it to happen. Each time you resist temptation, you are developing greater self-control. Success breeds success. Facing down temptations builds strength for future decision moments. Some of my clients throw away their favorite food as a symbolic act that shows they have control over the food and not the other way round.

Self-discipline is required for behavior change, but does that mean that the lack of self-discipline causes obesity? No. That would be like saying aspirin helps a headache go away, so headaches are caused by a lack of aspirin — which is nonsense!

3.) Eliminate or reduce sugary, fat-laden foods. Such foods create physical changes at a cellular level that alter how our brains and bodies react. When analyzing your level of addiction, consider both physical dependence (changes at the cellular level) and psychological dependence (the habitual repetition of a behavior in an attempt to satisfy an emotional need). For example, how often do you use a sugary treat to lift your spirits?

What is often misunderstood is that these dependences exist on a continuum. You can be mildly, moderately or severely dependent, and the degree of dependence determines how difficult it will be to change.

4.) Make history your teacher, not your jailer. You can learn from your mistakes. Instead of [beating yourself up] when you fail to keep your promises to yourself, seek to gain self-knowledge so you won’t repeat the error. No one is perfect. Be sure to acknowledge what you are doing right, not just what isn’t working.

5.) Surround yourself with friends, family and colleagues who will support your effort. Getting fit and losing weight absolutely require others. Although you alone can make the changes you need to make, you can’t make the changes alone. Not only in terms of eating, but in all areas of our lives, we are much more influenced by other people than we imagine. One of the most potent forces for positive change is the emotional support of the individuals who surround you.

You must, however, ask for the support you need. Don’t assume that others know what would be most helpful to you. Similarly, you need to avoid those people who aren’t on the same page as you. Social pressure can work for you or against you. Hang out with the right people.

“Runners who continue running when they are exhausted unknowingly change their running form, which could be related to an increased risk for injury.”

Runners get injured. I’m a runner and I’ve been injured–a lot. If you’re a runner then you either have been, are or are going to be injured. According to one source, 60-65% of all runners are injured during an average year (by definition, an ‘injury’ is a physical problem severe enough to force a reduction in training).

If you’ve encountered a running injury then you probably know that it’s rarely a simple solution to fix what ails you. From shoe changes to barefoot running to stretching to foam rolling to foot strengthening exercises, to physical therapy to acupuncture to chiropractic to massage and on and on… This is a huge hassle and it would be wonderful to avoid this kind of aggravation! So with some particle of optimism, I present an article from Science Daily that may help us avoid injury: When to End a Run to Avoid Injury: Runners Change Form When Running Exhausted.

The article discusses a study from Indiana University published in the Journal of Biomechanics in November 2010. Researchers observed that subjects demonstrated biomechanical changes as they fatigued during a run. Runners tended to display excessive motion at the hips, knees and ankles.

The study had subjects run on treadmills until they either reached 85 percent of the subject’s heart rate maximum or a score of 17 (out of 20) on the rating of perceived exertion (RPE). By the end of their runs, all of the runners reported an RPE of at least 15 — studies have shown that RPEs between 13-15 indicate fatigue. Here’s what you need to pay attention to. The article states, “Runners’ RPEs could provide some answers, with RPEs of 15-17 indicating runners’ have reached a point where their mechanics have likely begun to change in an undesirable way.”

The RPE scale is shown below.

What does this mean to you the runner? Don’t run to the point of exhaustion. Stop when you’re feeling good and strong, not when you feel beaten to hunched-over death.

I’m going to go out on a limb and suggest that we might take this advice for any type of exercise: lifting weights, cycling, martial arts–whatever. This isn’t to say we should avoid tough workouts but most of our workouts should be comfortably challenging, not torture. (I’ve mentioned this concept in previous posts; look here and here.)

Facial expressions can be very useful in gauging our exertion levels. When I’m working with clients I watch their faces. When a grimace starts to show we stop the set. The “scary face” is a transmission from one human to the other humans that something isn’t going all that well. (Next time you’re in the gym, have a look around and see how many people have a look on their face like they’re being stabbed. Don’t be that person.) It means we’re butting up against certain physiological limitations. If we spend enough time doing this we’ll likely end up in some type of pain. Heed your body’s warnings and you can stop injuries before they start.

The Minimal Shoe Debate Heats Up

If you’re an exercise geek like me then you may take interest in the latest goings-on over at Zero-Drop, a very fine minimalist running blog. Three posts are worth reading: “ASICS Have Really Dug In Their Heels,” “The ASICS ‘Minimalst’ Shoe Debate Continues…,” and “The Other Shoe Has Dropped: Dr. Craig Richards Challenges ASICS and Other Shoe Companies.”

It seems that shoe company ASICS is not jumping on the minimal shoe bandwagon like most of their competitors. ASICS shoe designer Simon Bartold is quoted in the article and he speaks fairly derisively of the movement toward flatter, thinner and more flexible shoes. He demands proof that minimal shoes are healthy and useful for runners. (Meanwhile, there’s certainly no proof that modern, “good” running shoes are healthy either.)

What’s most interesting however isn’t the article itself but rather the spirited exchange that follows in the comments section where Bertold and the blog author go back and forth over the scientific particulars of this issue. The discussion gets quite heated and the drama even spills over to another blog. “ASICS vs Zero Drop, Minimalist vs. Maximalist” comes from the great minimalist site, Runblogger. It’s a very thorough examination of the type of proof that Simon Bertold demands. The article in fact draws a comment from ASICS’ Bertold that that might be seen as a little bit of backpedaling.

The issue of science and scientific “proof” is a prominent feature of these discussions. It’s unlikely that any one study will prove 100% whether or not any type of shoe–or no shoe at all–will cause or prevent a given type of injury. There are many many variables that go into an injury or lack thereof. (Interestingly, several studies suggest that conventional “good” running shoes matched to foot type do nothing to prevent injuries.) Further, just because a rigorous study hasn’t been done doesn’t mean that a given cause-and-effect relationship doesn’t exist. Minimal shoe/barefoot running may or may not in fact be healthier for most people than running in a conventional running shoe but there may be no powerful study that exists that proves either condition.

There’s nothing wrong with examining the anecdotal evidence either. It’s often the anecdotal stuff that motivates someone to study something, and there’s a lot of anecdotal evidence out there supporting the idea that less shoe is better than more shoe. I can speak from my observations of clients in the gym (as well as my wife and my own condition) that many people move better and feel better in minimal shoes. I’m not the only one observing this. In fact the shoe companies making minimal shoes are responding to the requests of their customers.

Finally, if you find all of this interesting, then you should get over to a recent post at the Science of Sport. The barefoot running debate: Born to run, shoes & injury: the latest thinking is a remarkably in-depth discussion on the shoe issue. The Sports Scientists take their subjects very seriously and they always get deep into the science behind athletics. They discuss the important of running technique and the idea of how to transition from a conventional running shoe to the barefoot/minimal running style. Very informative stuff there.

My First Barefoot Excursion & What is Tightness?

1st Barefoot Run

Anyone who reads this blog knows I’m a fan of minimal footwear. I believe the best foot is a strong foot, not a foot that’s been made weak by modern “good shoes.” The foot has been a foot for a looooong time. Relative to the span of human existence, “good shoes” and orthotic-type devices are a very new trinkets. The ancient Egyptians, Greeks, Romans, Vikings, Gengis Khan’s Golden Horde, Comanches, Apaches, Aztecs, Zulus… and the vast majority of our fellow humans who’ve ever marched across the earth have done so while wearing nearly nothing on their feet. It wasn’t until the 1970s that we got the modern running shoe from Nike. In terms of research & development, one has a huge head start over the other. All kinds of new research suggests that “good shoes” may not be all that good for us at all.

While minimal shoes have gained in popularity so has barefoot running and I’ve pondered playing around with the concept. So I was quite interested when our local running store the Runner’s Roost advertised a barefoot/minimal shoe seminar. My wife and I attended the seminar last night and it was really fascinating. It got me all excited to start experimenting in a shoeless direction. Today was my first day out.

Of the four speakers, Michael Sandler of RunBare.com was the most interesting informative. (Among other issues, he’s missing the anterior cruciate ligament on one leg–the result of a roller blade crash. So for people who say running is bad for the knees, you might think again. He was also an orthotic addict and orthotic designer.) He suggested that newly barefoot runners must listen to their feet. The moment you feel a little bit of irritation, the run is over. Put on your shoes and come back to run barefoot another day. He suggested a first barefoot run of 200 meters. Then take a day off. Next run is 300 meters. Day off. Next run is 400 meters and so on. It is a very slow starting process this barefoot running.

So today I went for a walk with our dog. It was great weather: sun and 70-ish degress. I walked out barefoot but I had my shoes in a backpack. I ran down the sidewalk to the end of our block. My steps were very quick and light and everything felt fine. First run done and done. I walked another couple of blocks barefoot then put on the shoes. No barefooting tomorrow but I plan to hit it again on Friday. As I sit here writing this, my heel and Achilles pain is non-existent. Seems like a good start.

What is Tightness?

In a somewhat different direction, one of my favorite exercise geek blogs is Begin to Dig. It’s written by a fellow Z-Health practitioner, a woman named MC. (I actually don’t know her full name.) The latest post discusses the whys and hows of tight muscles and how to address them. Among other things, she describes why using a foam roller is probably not the best idea. If you want to learn a bit about the underlying cause(s) of tightness (first and foremost it’s all about your survival) then you should check it out. Beyond that, there’s a lot more informative stuff on her blog about getting strong, lean, fast and pain-free.

The Dangers of Sitting & How to Fight Back With Z-Health

I’m behind on the news here a little bit but a fascinating story appeared recently in the New York Times Magazine. Is Sitting a Lethal Activity discusses the idea that spending too much time sitting is harmful to our health. In fact the article suggests the following:

“Sitting, it would seem, is an independent pathology. Being sedentary for nine hours a day at the office is bad for your health whether you go home and watch television afterward or hit the gym. It is bad whether you are morbidly obese or marathon-runner thin. ‘Excessive sitting,’ Mayo Clinic researcher Dr. James Levine says, ‘is a lethal activity.'”

Okay, so this is no revelation to most of us. We know that moving is generally healthier than sitting. So if we exercise enough then we should be able to counteract the effects of sitting right? Not so fast. The Times article suggests that in fact we may not be able to exercise our way out of the risks of our seated lifestyle. The article states:

“A growing body of inactivity research, however, suggests that this advice makes scarcely more sense than the notion that you could counter a pack-a-day smoking habit by jogging. ‘Exercise is not a perfect antidote for sitting,’ says Marc Hamilton, an inactivity researcher at the Pennington Biomedical Research Center.”

So what does this mean? It seem that according to the evidence in the article, sitting is unhealthy. (Specifically we might say that lack of movement not sitting in and of itself.) If we do too much of it we’ll get sick and die early–whether or not we exercise a lot. This isn’t good! Most of the Western world sits for a living. We sit at computers. Then we sit in cars for transportation. Then for entertainment we sit in front of a television. HOURS and HOURS of sitting is our way of life. So what can we do?

Well, part of the research into this issue by Dr. Levine included the wearing of a special electronically wired “magic underwear” that measured the wearer’s movement. The researchers found that healthier people moved more during the day but it wasn’t necessarily in the form of exercise. They fidgeted more or simply engaged in many small movements throughout the day. Even leaning down and tying a shoe can generate a burst of movement that should ultimately lead to better health. (The term for all this small, non-exercise movement is NEAT or Non-Exercise Activity Thermogenesis. Read more about NEAT here, here and here.)

Z-Health R-Phase joint mobility drills are tailor made to address our modern lack of movement. Any number of these drills directly counter the hours we spend immobilized in chairs. Following are three joint mobility drills that you can perform while seated. Moving our joints in these ways sends bursts of mechanoreceptor signals to the brain and basically lets the nervous system know that we’re still alive.

Follow-up to Is Sugar Toxic?

If you found the previous post interesting then you should read the following articles from the L.A. Times. Sugar: The toxicity question and what to do about it cites the NY Times article on sugar and discusses the issue further. Also from the L.A. Times is Food technology has been bad for human health since long before the invention of high-fructose corn syrup. Bottom line, modern food technology and refinement aren’t doing the human race much good. If it ain’t pulled off of a tree our out of the ground, or if it wasn’t recently running or swimming free, then you should reconsider eating it.

“High-fructose corn syrup, sugar — no difference. The point is they’re each bad — equally bad, equally poisonous.” – Robert Lustig, MD, Professor of Clinical Pediatrics, UC San Francisco

The New York Times Magazine has a remarkably in-depth piece on sugar called Is Sugar Toxic? We get a lot of information on the sweet stuff from the history of sweeteners to the differences between sucrose and high-fructose corn syrup (There seem to be no differences.) to some of the unique physiological effects of sugar. Dr. Robert Lustig of the University of California San Francisco is a source for much of the information of the article. He’s an endocrinologist who recently has focused on preventing obesity in children. He contends that sugar calories are different from other sources of calories, and that sugar is genuinely poisonous to human beings. (You can watch Lustig’s lecture,Sugar: the Bitter Truth on Youtube.)

Buyer beware...

Among the evils ascribed to sugar in the article: obesity, diabetes, metabolic syndrome, and atherosclerosis caused by elevated blood triglycerides (fat) which often results in heart disease. This idea that sugar causes blocked arteries is somewhat controversial and runs counter to several decades of “conventional wisdom.” The article also suggest that in fact sugars may play a strong role in developing cancer. For years it’s been dietary fat that’s been the bad guy in the heart disease fight. And to this point, the article does a good job of dissecting the various theories and evidence either in support of and/or against both sugar and fat as the edible evils in our lives. I won’t go into all the fine details here but the discussion should remind us that one theory doesn’t necessarily cancel out another (Could be that both sugar AND dietary fat aren’t that great for us.), and that science is indeed a human endeavor which is subject to human emotion and judgment. The discussion on sugar and cancer is one that I’ve not heard before. There is evidence to suggest that chronically elevated insulin plays a strong role here much as it does with diabetes. Researcher Lewis Cantley, director of the Cancer Center at Beth Israel Deaconess Medical Center at Harvard Medical School, says:

“I have eliminated refined sugar from my diet and eat as little as I possibly can, because I believe ultimately it’s something I can do to decrease my risk of cancer.” Cantley put it this way: “Sugar scares me.”

That’s a strong statement by someone with what seems to be a thorough knowledge of his subject. It certainly has me thinking about this stuff more than I have. I love dessert and so does my wife. We devote just one day a week to indulging in something genuinely tasty and fantastic. I think that’s a fairly low level of consumption but now I wonder if sugar is like cocaine or meth. Perhaps there is no such thing as a “moderate” amount of sugar. What is clear to me is that less is best.

Avoid Cramping This Spring

The warm weather is trying to break through to us and we’re all itching to run and/or bike. You may be at particularly at risk for cramping at this time of year though. Why? First some background on salts, muscles and muscular contractions.

Salts (aka electrolytes) specifically potassium, sodium, and especially calcium are key components of muscular contractions. Without them we may either experience muscular weakness or uncontrolled muscular contractions–cramping. We get these salts through our food and drink. We tend to lose these salts through sweating. Prolonged exercise and/or exercise in the heat typically requires us to consume more salts than we would during short bouts of exercise or exercise in the cold. Now, on to the particulars of cold-to-warm weather issues.

As it turns from cold to warm weather, our bodies are also adjusting the degree to which we sweat out our salts. During the cold, our bodies will fork over the salt quite readily. We retain more salts during the warm weather. So let’s say we get a nice warm day and we decide to get in a long run or ride. We may be exercising like it’s warm but we may be sweating out salts like it’s cold. This is prime time for cramping.

Here are some ideas to avoid cramps:

Salt your food. You’re an exercising athlete and you need salt. Unless you have high blood pressure, you should be fine.
Keep a sports drink with you. Drink when thirsty and stop when you’re satiated.
Eat a wide variety of fruits and vegetables. These contain electrolytes.
Don’t overhydrate. Too much water will dilute the salts in your body.
Consume dairy products. Calcium is important for bones but it’s also massively important for muscular contractions. It’s rarely found in sports drinks though.
Ease into warm weather activities. Your body will adjust to retain salts if given some time.

Denver Fitness Journal

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

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