Category: Newsletter Library

What is your lifestyle? Not whether you are married or where you live, but rather, how are you choosing to live your life? What choices are you making to keep yourself and your family healthy and well?

It is startling to learn that some of the most prevalent causes of illness, disease, and death – including cancer, heart disease, and diabetes – are all heavily influenced by lifestyle. For example, we don’t usually think of cancer as a lifestyle disease. We think a person is unlucky if they have cancer, and often we have a fatalistic outlook toward news that someone has developed cancer. “It’s in their genes,” we say. Or “stuff happens – the luck of the draw.”

But only approximately 10% of cancers are based on genetics. The vast majority of cancer cases are very much related to how we live our lives – our environment, the food we eat, whether we exercise regularly, and the quality of our relationships. Within the last ten years medical researchers have been learning of the strong correlation between overweight/obesity and a person’s likelihood of developing cancer. It seems that fat cells are not merely passive storehouses of excess energy in the form of fat. Fat cells are metabolic furnaces that spew out a wide range of chemicals, including hormones and inflammatory agents that may often cause normal cells and tissues to become cancerous.¹

Most people and even some physicians are unaware of these facts. The connection between lifestyle and heart disease, and between lifestyle and type 2 diabetes, seems obvious.^2,3 But cancer, too, is a lifestyle disease. The very good news is that by creating the willingness to make healthy lifestyle choices, you’re making positive long-term changes in your health and well-being.

Additional good news is that these choices are in your hands. Every day you get to choose a healthy lifestyle or not. Of course, some days or even some weeks just seem to go by without a real opportunity to do things that are healthy. You might be on a business trip in a country where it’s difficult to find good, nutritious healthy food. It might also be difficult to find the time to exercise when you’re on a travel schedule. That’s OK, though, because lifestyle is a lifetime project. If you’re eating healthful nutritious food most of the time and doing daily exercise most of the time, you can take a week off or even two weeks off here and there. The main goal is to be on a healthy lifestyle path the vast majority of the time.

Chiropractic care is an important component of healthy living. Chiropractic care helps ensure that your body is functioning at its maximum. Chiropractic care helps ensure you’re getting the most out of the healthy food you’re eating and the healthy exercise you’re doing. Your chiropractor will be glad to provide guidance on creating nutritional plans and exercise programs that will work for you.

¹Chan AT, Giovannucci EL: Primary prevention of colorectal cancer. Gastroenterology 138(6):2029-2043, 2010

²Shi Y, et al: Cardiovascular determinants of life span. Pflugers Arch 459(2):315-324, 2010

3Ma J, et al: Evaluation of lifestyle interventions to treat elevated cardiometabolic risk in primary care (E-LITE): a randomized controlled trial. BMC Fam Pract 10:71, 2009

Like Scylla and Charybdis, the twin sea monsters of Greek mythology, diabetes and obesity are the twin medical monsters confronting America’s children. Diabetes and obesity have even been featured as the story line in a recent episode of Law & Order, a show well-known for focusing on issues that matter.

What’s going on? Diabetes and obesity are twin raging epidemics endangering the health and welfare of our nation’s young people. In New York City, by the age of 4, there is a one in three chance that the child will be obese. More than 40% of children are at an unhealthy weight at ages 2 and 3.¹ National statistics are similar.

Type II diabetes, long known as “adult-onset diabetes”, is now being recognized as a significant juvenile disorder. Up to 45% of the children diagnosed with diabetes have the type II form.² And the numbers keep increasing.

Type II diabetes and obesity are closely related – being overweight is one of the two major risk factors for developing type II diabetes. The other major risk factor, not surprisingly, is lack of exercise – not being physically active.

Why be concerned? Both diabetes and obesity contribute to additional severe health issues. Obesity is the leading cause of pediatric high blood pressure and increases the risk of coronary heart disease. Uncontrolled diabetes, over time, can lead to heart disease, kidney disease, neurologic disorders, and blindness.

So we are very concerned for our children’s well-being. The good news – and it is very good news – is both conditions are lifestyle-related. Bad diet and lack of exercise cause both conditions. This is well-known. It is also well-known that maintaining a healthy diet and getting regular exercise prevents obesity and prevents or delays type II diabetes.^3,4

As parents, it’s up to us to set the standards. If we’re eating healthy, balanced meals, our kids will do the same. If we exercise regularly and keep ourselves fit and trim, our kids will exercise regularly, too.

¹“Child obesity picture grim among New York City poor”, The New York Times, April 6, 2006.

²Fagot-Campagna A: Emergence of type 2 diabetes mellitus in children: Epidemiological evidence. Journal of Pediatric Endocrinology and Metabolism 13(Suppl 6): S1395-S1402, 2000.

³Hamman RF, et al: Effect of weight loss with lifestyle intervention on risk of diabetes. Diabetes Care 29:2102-2107, 2006.

⁴Knowler WC, et al: Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. New England Journal of Medicine 346(6):393-403, 2002.

We all know some people who get sick all the time. They’re just getting over one thing when here comes the next round of illness. We also know people who just seem to be full of energy. Those people never get sick or so it seems. What are the key differences between these North and South Poles of health? One key difference is healthy behavior.

On the North Pole side, people who frequently get sick think this is something that happens to them. In other words, their health problems are related to fate. “I catch whatever’s going around the office”, they say. “I catch whatever my kids pick up at school” is another common refrain. These individuals – and they represent most of us – don’t seem to realize it’s their behaviors, actions, and choices that lead to their continual state of unwellness. For example, two-thirds of all American adults are either overweight or obese. Is this fate? Or something else?

On the South Pole side, people who are rarely sick are usually very clear about what’s going on. These individuals have trained themselves to take control of their health and well-being by making active choices. These choices, known as healthy behaviors, result in: a stronger immune system,lower serum cholesterol, lower blood pressure, improved cardiovascular health, weight loss, more restful sleep, and a positive mental attitude.

Healthy behaviors have been shown to reduce blood glucose (good news for diabetics) and reduce the occurrence of life-changing disorders such as stroke. What are these action steps? Everybody knows them, even North Pole people. Healthy behaviors include: regular vigorous exercise (the Federal Department of Health and Human Services recommends 30 minutes of exercise five times per week) – 30 minutes of walking fulfills your daily exercise requirement. Eat plenty of fresh fruits and vegetables (the Federal Department of Health and Human Services recommends at least five portions per day) Also, eat a balanced diet including high quality protein, complex carbohydrates, and mono- and polyunsaturated fats. Make sure to get the rest that you need (seven hours of sleep per night is the recommended average).

Healthy behaviors do require discipline and effort. In the 21st Century, good health does not come for free. To be healthy and well, we need to do the planning, make our schedules, and put in the time. Of course, there’s a very big payoff. How great would it be to have a healthy height/weight ratio, normal levels of blood glucose, and a normal-for-age blood pressure? It would be very great.

The payoff is not only adding years to life, but also adding life to years. It’s much more fun to have good health. We all know how not-fun it is when we’re sick. Your local chiropractor can be an important part of your plan for good family health, and is an expert in all aspects of healthy behaviors. We will be glad to help you design plans and programs that will work for your needs and those of your family.

¹ Hamman RF, et al: Effect of weight loss with lifestyle intervention on risk of diabetes. Diabetes Care 29:2102-2107, 2006
² Forman JP, et al: Life style as a blood pressure determinant. JAMA 302(4): 437-439, 2009
³ KKhan LK, et al: Recommended community strategies and measurements to prevent obesity in the U.S. MMWR Recomm Rep 58(RR-7):1-26, 2009

Health care breakthroughs are big business. We know this because such news is reported in the Business Section of newspapers and magazines. Discussions relate primarily to the potential impact on the company’s share price and revenues. Possible benefits to patients are a secondary concern compared to the amount of money involved.

Business coverage of these issues is yet another reminder of how far health care has moved away from its original and sole focus on treatment. Sadly, the bottom line has become the bottom line. And yet, there may be real breakthroughs on the horizon. Advances in DNA analysis and nanotechnology may bring us closer to a world of personalized treatment for cancer and other disorders.

For example, university researchers have been working for years on methods to deliver cancer drugs to the actual tumor.¹ If possible, this would substantially improve on current treatment which floods the patient’s entire body with highly toxic anti-cancer medication.

These new methods – collectively termed targeted cancer therapy – involve the cancer drugs hitching a ride on very small particles – nanoparticles – which are programmed to seek out and attach to the malignant tumor.² The toxic drug only interacts with the tumor cells, killing the tumor but not affecting any of the patient’s normal cells. If this research pans out, meaningful progress would be made.

Early detection of disease – cancers, hormonal disorders, inflammatory diseases – is often discussed as a critical factor in the success of treatment. Recently, in the last ten years, progress in the fields of nanotechnology and DNA and protein analysis has brought us closer to real-world early detection.

Researchers are gaining the ability to analyze very small amounts of biomarkers – specialized proteins that may indicate the presence of specific diseases – in both blood and individual cells³. A lot more work needs to be done to standardize these tests and understand which biomarkers are related to which diseases – but this seems to be merely a matter time. Within ten or fifteen years, such analysis may become readily available and routine. This would be a real breakthrough.

However, rather than placing our bets on diagnostic and treatment methods that may or may not become available, doesn’t it make more sense to take care of our physical health right now, today? The vast majority of diseases that affect Americans – heart disease, diabetes, and obesity – are, for the most part, lifestyle disorders. And, there is plenty of evidence to suggest that many cancers are also related to lifestyle.

Of course, lifestyle is a code word for good nutrition, regular exercise, sufficient rest, a positive mental attitude, and rewarding family and personal relationships. An important part of lifestyle is maintaining a body that works – and the best way to ensure good overall health is with periodic, regular chiropractic care.

Chiropractic treatment ensures your body is working at its optimum. Chiropractic treatment gives your body its best chance of functioning at a level of optimum health. Your chiropractor will be glad to help you learn how to achieve a healthy, vibrant lifestyle.

¹Choi MR, et al: A Cellular Trojan Horse for Delivery of Therapeutic Nanoparticles into Tumors. Nano Letters 7(12):3759-3765, 2007
²Zahr AS, Pishko MV: Encapsulation of paclitaxel in macromolecular nanoshells. Biomacromolecules 8(6):2004-2010, 2007
³Favis R, et al: Universal DNA Microarray Analysisof p53 Mutations in Undissected Colorectal Tumors. Human Mutation 24:63-75, 2004

Since mid-Fall TV commercials have been trumpeting the horrors of the “flu season”. “It’s never too soon to begin fighting this year’s bug” they blare. Public health announcements urge us to get our “yearly flu shot”, as if this is something we’ve got permanently scheduled in our Blackberries. All the leading over-the-counter pain medications offer special seasonal “flu” mixtures, and their ads deluge daytime and prime-time broadcasting.

For the health consumer, namely us, it seems as if this annual “war on the flu” is received wisdom. We’re just defenseless human beings at the mercy of the all-powerful flu virus.

What’s wrong with this picture?

What’s never mentioned in the “flu warning” marketing is the versatility and adaptability of our remarkable immune system. We’re the lucky owners of a built-in state-of-the-art biowarfare system, on-the-job 24/7 to combat microscopic foreign invaders of our health and well-being. Once our immune system has detected a foreign protein it mounts an immediate defense, attacking and destroying the alien molecules. And, the memory of that particular invader is permanent, enabling a future immune response to be swift and effective.¹

The big issue with influenza is that new strains appear each year. We’ve never encountered these germs before. But, the whole basis and strength of our immune system is flexibility. It is specially designed to respond quickly to new attackers. And, for the most part, it does this very, very well.

Of course, no one wants their dinner companion to sneeze in their plate of pasta, as Elaine did on an infamous episode of “Seinfeld”. Through a typical cascade of unfortunate events, Jerry’s and George’s comedy pilot was almost scuttled because the network executive was Elaine’s date, and he got violently ill by being on the receiving end of her blast of micro-bugs.

In the real world, our immune systems can be weakened due to life habits, circumstances, and stress. Stress is a notorious compromiser of immune defenses.² And, of course, being human, there’s plenty of stress from dawn to dusk. If worry and anxiety pile on top of not-enough-sleep or sub-optimal nutrition, getting sick is a pretty likely outcome. So, developing and maintaining healthy habits of living and successful strategies for managing stress is really the key.³

If you do the simple things that keep you healthy and well, in the winter months you can pretty much “let the flu go around you”. You can be confident, knowing you’ve done the work to fight off the latest flu threat. Someone else’s germs are their germs, not yours. If your immune system is on the job, you’re far less likely to “catch” something.

And, even if you do succumb, you’ve got a much better chance of getting well again quickly.

¹Sompayrac L: How the Immune System Works, 2nd ed. Blackwell, 2002.
²Wein H:Stress and disease – new perspectives. NIH Word on Health, October 2000.
³The Truth About Your Immune System – What You Need To Know. Harvard Health Publications, 2007.

We’re in the middle of several deadly epidemics in the United States. Obesity, diabetes, and heart disease are affecting more and more people every year. Recent statistics show that two-thirds of Americans are overweight or obese. Thirty percent of American children are obese. Approximately 21 million Americans have diabetes. One child out of every 500 has type I diabetes. In America, 72 million adults have high blood pressure. These are shocking statistics, considering that U.S. health care expenditures totaled $2 trillion in 2006. That’s 2 TRILLION dollars.

As Americans, we’re getting less healthy by the day. The good news is there are many things we can do about these trends. There is real action that every American, young and old, can take to support and protect their health and well-being. These action steps all focus on lifestyle – the choices we make each and every day.

The first step is an honest self-assessment. When was the last time I exercised? Does my clothes size increase every couple of years? How many times during the week do I eat fast food? When was the last time I ate an apple instead of half a box of cookies?

Regardless of the answers, it is possible to become healthy and fit again, whatever your current circumstances. You CAN lose 10 or 20 or 30 or however many pounds. You CAN climb stairs without getting out of breath. You CAN regain the youthful glow of vitality. You CAN be vigorous and proud of your body, rather than worrying about what’s going to be the next thing to break down.

Healthy eating and regular exercise are essential parts of the solution to combating obesity, diabetes, and heart disease.^1,2 These practices have the magical effect of resetting your metabolic clock – your body shifts from a pattern of storing fat to a pattern of burning fat.³ Over time, with a nutritious food plan and consistent exercise, you even burn fat while you’re resting! Your body is very smart. You just have to treat it right.

Your chiropractor is a wonderful asset – both as a health care practitioner and as a guide – on your journey toward fitness and wellness. Your chiropractor has extensive resources available on practical nutrition and how to design a supportive food plan. He or she has deep knowledge regarding the types of exercises and activities that will be right for you. You and your chiropractor can design an exercise program that will be both fun and rewarding. Working together, you’ll be maximizing your health and vitality. You will begin to fulfill a way of living that will support you in being healthy and well for years to come.

¹Lindstrom J, et al: Sustained reduction in the incidence of type 2 diabetes by lifestyle intervention: follow-up of the Finnish Diabetes Prevention Study. Lancet 368(9548):1673-1679, 2006.
²Orchard TJ, et al: The effect of metformin and intensive lifestyle intervention on the metabolic syndrome: the Diabetes Prevention Program randomized trial. Ann Intern Med 142(8):611-619, 2005
³Yannakoulia M, et al: A dietary pattern characterized by high consumption of whole-grain cereals and low-fat dairy products and low consumption of refined cereals is positively associated with plasma adiponectin levels in healthy women. Metabolism 57(6):824-830, 2008

Most of us are procrastinators. We let things go until the last minute. Papers, magazines, and books pile up on the desk until the process of finding what we’re looking for resembles an archeological dig. Our garages look like our desks. Stuff fills the garage just like stuff covers the desk. Eventually, finding things resembles exploring for treasure in a dark, long-abandoned cave. We’re motivated to clean our desks and garages only by the impossibility of adding any more stuff to the clutter and the piles.

Sometimes it seems as if procrastinating is hard-wired into our DNA. This is particularly true when it comes to our health. No one wants to go to the doctor, so it becomes even easier to put off the needed checkup. Whether it’s our chiropractor, our dentist, or our family physician, nobody seems to want to pick up the phone, go to the office, and take care of business. Of course, procrastination in relation to our health can lead to some big problems. Tooth pain that comes and goes doesn’t seem like such a big deal. But if the coming and going is fairly consistent, then there’s probably a cavity that needs filling. You keep putting it off and when you finally get around to going to our dentist, you learn you need an expensive root canal and a crown. That’s not good.

Or you’re playing pickup basketball on the weekend. You go up for a rebound and get shoved in the back. The next day you have lower back pain. You keep thinking it’ll go away, but it’s now four weeks later and your back is still stiff and sore. Had you seen your chiropractor the first week, after the pain had persisted for four or five days, treatment might have been pretty straightforward. Now you learn it’s going to take at least several weeks of treatment before you can play ball again. Not good. Diabetes is the same thing. ¹High blood pressure is the same thing.² Overweight is the same thing. ³Procrastination with your health always costs more time and more money in the end. Prevention and, if necessary, early detection, are the keys.

When it comes to your health, the opposite of procrastination is managing your symptoms. It’s not necessary to run to your chiropractor for every ache and pain or to run to your family physician for every sniffle or low-grade fever. It is important and necessary to pay attention to what’s going on with you. Symptoms that linger mean something is wrong and your body needs help in getting better. Once you begin paying attention a learning curve will kick in. You’ll develop skill in identifying problems that need attention. The next step, of course, is to pick up the phone, make an appointment, and arrive at the appointment on time. Your chiropractor or family physician will be glad to be of service in identifying the problem and providing appropriate treatment.

¹Bo S, et al: Prevalence of undiagnosed metabolic syndrome in a population of adult asymptomatic subjects. Diabetes Res Clin Pract 75(3):362-365, 2007
²Guyomard V, Myint PK: Optimum control of blood glucose for prevention and treatment of ischemic and hemorrhagic stroke. Curr Treat Options Cardiovasc Med 11(3):201-211, 2009
³Anderson AS, Caswell S: Obesity management–an opportunity for cancer prevention. Surgeon 7(5):282-285, 2009

s it possible that ups and downs with respect to our health and well-being are yet another reflection of the ebb and flow of all things? Aren’t ups and downs part of the natural process of life? If ups and downs are natural, should you really be concerned with the downs? Isn’t disease merely the normal flip side to health? If you have a stretch of bad health, isn’t that merely the luck of the draw, part of the price you pay for being alive? And if you can wait out the bad periods and expect that they’ll eventually swing around to a period of feeling good, why should you exert yourself and spend time, money, and energy exercising and eating “healthy” if it’s all going to even out anyway?

The answers to these deep questions have profound implications for everyone. First, there are no “right” answers. How you conduct your life is a personal choice. But in fact many people do not make active choices. They exist in a default state, floating along on the current of any random convenient stream. “Whatever” is the slogan and catch-phrase of these persons. Such individuals fail to recognize that we live in an entropy-seeking universe. Breakdown, disorder, and decay are the tendencies of all things.

Our health is no exception. If you do not proactively take steps to combat the inexorable progression to disorganization, your body will gradually fall apart. Literally. Understanding that the patterns of life are cyclical does not imply that you should just lie down and take it. The fact that downward trends are inevitable does not imply that doing good things for your health and well-being are useless and a waste of resources.

In fact, taking action on your own behalf makes the highs of the cycles higher and simultaneously decreases the depths of the lows.The result of such action is specific improvement of your health over time. Yes, improving your health takes effort. In this space-time continuum unless effort is exerted to maintain the organization of matter, disorganization will rapidly follow. Muscles don’t stay hard and strong on their own. Without proper training, heart and lung efficiency and strength deteriorate over time. With a careless diet, digestive organs become sluggish and function poorly. And so on down the entire list of physiologic components and functions.

So, yes, it’s a random universe. Stuff happens, so why not sit back and “go with the flow”. Quality of life is the criterion. How much quality our lives have is based on our personal contribution. Our personal effort. Our personal commitment to healthier lives for ourselves and our families. And that requires effort.

¹Stineman MG, Streim JE: The biopsycho-ecological paradigm: a foundational theory for medicine. PM R 2(11):1035-1045, 2010

²Pinto BM, Ciccolo JT: Physical activity motivation and cancer survivorship. Recent Results Cancer Res 186:367-387, 2011

³Brinkhaus B, et al: How to treat a patient with chronic low back pain – Methodology and results of the first international case conference of integrative medicine. Complement Ther Med 19(1):54-62, 2011

It’s hard to turn on the television or listen to the radio without hearing about the dangers of an impending pandemic of the Avian Flu (often called the ‘bird flu’). Day after day, the media interview expert after expert who claim that the bird flu is going to cause massive world-wide illness and death. Fortunately, the ‘bird flu pandemic’ is more of a monster in the media than it is in real life.

While it is true that the 1918 influenza pandemic, which led to the deaths of millions of people, was also a bird flu, there are some things to think about before you spend your money to build a quarantine chamber in your home or purchase a biological contamination suit off of eBay:

• The bird flu is not new. It has been around as long as birds have. There have only been a couple times in recorded history when a mutation in the virus allowed the bird flu to infect humans. In virtually all incidences when human infection did occur, only a few people ever became sick.
• To date, there have been only a tiny handful of cases of human bird flu world-wide, and almost all of them in under-developed countries where sanitation and public health standards are minimal, at best. Even if a hundred thousand people world-wide were to become infected with the bird flu and a third of them were to die, that would still be far fewer than the number of people who are hospitalized or die from adverse drug reactions each year.
• Even in the very unlikely event that the bird flu came to a neighborhood near you, your chances of becoming infected would be very small as long as your immune system was healthy and you took some simple precautions, such as washing your hands throughout the day.

Research has shown that chiropractic care boosts the function of the immune system and helps the body ward off disease. The key to avoiding diseases like the bird flu is to keep your immune system strong through a healthy diet and regular chiropractic care.

We are constantly searching the landscape for heroes. This is not to fill in a missing piece in ourselves, but rather represents an ongoing search for inspiration, stimulation, and motivation. Even those of us who are self-starters need coaches and mentors to cause us to reach ever-higher levels of achievement. In this, we all need support. We all need guidance. We all need fresh perspectives.

Children, in particular, need guidance. Kids need rules. Kids need structure. Usually, a child’s parents are her leaders or role models. Other relatives, teachers, peers, and older kids may also fill these roles.

Let’s consider parents, relatives, and teachers – the adults in a kid’s environment. In America, one-third of all adults are obese. An additional one-third of adults are overweight. Almost one-half of American adults do not do any vigorous physical activity. Three-quarters of adults do not get enough physical activity to meet public health recommendations.

The awful bottom line is that the majority of Americans are out-of-shape and overweight or obese. These adults are the role models for their kids. The result is that one-third of American children are overweight or obese.¹ Juvenile diabetes is an epidemic that is getting worse every year. Type 2 diabetes, previously rare in young people, is now a commonly recognized diagnosis in kids. Hypertension is increasing in prevalence in teenagers.

We’re in the midst of a healthcare disaster. Diabetes and obesity are twin raging epidemics endangering the health and welfare of our nation’s young people. In New York City, by the age of 4, there is a one in three chance that the child will be obese. More than 40% of children are at an unhealthy weight at ages 2 and 3. National statistics are similar.²

Type II diabetes, long known as “adult-onset diabetes”, is now being recognized as a significant juvenile disorder. Up to 45% of the children diagnosed with diabetes have the type II form. And the numbers keep increasing. Additionally, studies demonstrate that almost two-thirds of American kids aged 9 through 13 do not participate in any organized physical activity during non-school hours. Twenty-five percent do not engage in ANY free-time physical activity.

Kids mimic the habits of their parents or other significant adults. If the adults eat cheeseburgers and fries three times a week, so will the kids. If adults don’t eat fresh fruits and vegetables, neither will the kids. Also, if kids see their parents putting on more and more weight, they will put on more and more weight. If adults spend no time exercising, neither will the kids.

Luckily, the converse is also true, and this is where parents can become heroes to their kids – literally, saving their kids’ lives. If kids see their parents choosing healthy behaviors and being positive and supportive about doing so, kids will begin to choose those healthy behaviors, too. Let’s start to teach our kids that exercise can be fun.^3,4 Strength training, aerobic exercise, core exercises can all be incorporated into family games and fitness activities. Also, let’s start to teach our kids that healthy eating can be fun – nurturing as well as nutritious. Shopping, cooking, and mealtimes can all become key components of a healthy family lifestyle.

All children need the love and support and guidance of the important adults in their lives. It’s up to us, those important adults, to really BE the role models kids so desperately need and want.

¹Berman LJ, et al: Physical activity is related to insulin sensitivity in children and adolescents, independent of adiposity: a review of the literature. Diabetes Metab Res Rev

2012 March 2 [Epub ahead of print]

²Fagot-Campagna A: Emergence of type 2 diabetes mellitus in children: Epidemiological evidence. Journal of Pediatric Endocrinology and Metabolism 13(Suppl 6): S1395-S1402, 2000.

³Feda DM, et al: Effect of increasing the choice of active options on children’s physically active play. J Sci Med Sport 2012 February 16 [Epub ahead of print]

⁴Ekelund U: Moderate to vigorous physical activity and sedentary time and cardiometabolic risk factors in children and adolescents. JAMA 307(7):704-712, 2012