Health Statistics and You

Preventive Care is the Best Care

In health care, an ounce of prevention is worth very much more than a pound of cure. If you can prevent health problems from happening, you save a great deal of time, effort, and money. Also, by avoiding the frequently ongoing stress and anxiety associated with treatment of a chronic illness, you and your family conserve precious, irreplaceable personal resources such as peace of mind.A comprehensive preventive care program incorporates a healthy food plan, consistent regular exercise, and regular chiropractic care. Regular chiropractic care, focusing on the spinal column and targeting nerve interference, is a key resource in your health care program. Regular chiropractic care provides the framework so that your body can function at peak efficiency, thus helping ensure your long-term health and well-being.

We are awash in numbers, thanks in large part to the proliferation of personal mobile devices and the wrong-headed use of so-called big data.¹ But applying statistical tools to the same set of data can support competing theories and lead to contradictory results. Such conflicting outcomes, known as antinomies if you remember Philosophy 101, cannot logically co-exist, and the field of statistics gets a bad reputation as a result. But big data can provide substantial value for people as individual patients. The key is to set some ground rules and understand the limitations of statistical investigation.
First and foremost, it's important to gain some clarity regarding the concept of false positives in regards to health. This statistical construct is familiar to all of us, although we may not be aware of it. If one of your doctors sends you for a laboratory test and the results are "positive", you'll be sent for follow-up tests until a final determination is made. If the final test turns out "negative", then the earlier results represented a false positive. The test results said you had the condition or disease, but in fact you did not.
False positives create numerous serious problems, not the least of which is the emotional toll of stress, anxiety, and fear experienced by the patient and her family and close friends. This is especially true when the suspected disease is a malignancy or other serious, life-threatening condition. It's useful and empowering for people to learn that 5% of all test results are falsely positive right from the start. Medical tests are designed this way. The 5% false positive rate is a necessary part of statistical analysis. It's built-in to the statistical design. In other words, test values that represent "normal" are obtained by cutting off the bottom 2.5% and the top 2.5% of a large sample of results from people who are "normal" for the thing being tested, such as white blood cell count or hemoglobin level.
Thus, 5% of normal people automatically have false positive results. Another way of stating this outcome is to consider that if you undergo a panel of 20 blood tests, one result (5% of 20) will be positive no matter what.
The vast majority of patients are not familiar with the statistical concept of false positive results.² With a basic understanding of this construct and its implications, patients could ask their doctors meaningful questions such as, "What do the test results mean?,", "Have you considered the possibility of a false positive result?," and "How will the additional tests you're recommending affect decision-making in my case?"
Posing such questions is tremendously empowering for you, the patient, and helps reestablish equity in the doctor-patient relationship.³ As a health care consumer, a little knowledge goes a long way. Gaining more than a little knowledge by reading articles on diagnostic methods and health care decision-making will further strengthen your own process as a patient.
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¹Bates DW, et al: Big data in health care: using analytics to identify and manage high-risk and high-cost patients. Health Aff (Millwood) 33(7):1123-31, 2014
²Paddock SM: Statistical benchmarks for health care provider performance assessment: a comparison of standard approaches to a hierarchical Bayesian histogram-based method. Health Serv Res 49(3):1056-73, 2014
³Stacey D, et al: Decision aids for people facing health treatment or screening decisions. Cochane Database Syst Rev 28;1:CD001431, 2014

When the Cure Is Worse than the Disease

Regular Chiropractic Care and Chronic Disease

Regardless of the prescription medication you may or may not be taking, regular chiropractic care helps provide a strong platform for managing the effects of chronic disease. Although the ultimate causes of chronic diseases such as high blood pressure and diabetes are largely unknown, nerve interference may be reasonably postulated as a key contributor to the development and maintenance of these conditions. If as a result of nerve interference, your body's cells, tissues, and organs are not receiving timely and accurate information from your brain, then a host of symptoms may develop. Over time, chronic disease may be the unwanted outcome. Regular chiropractic care helps eliminate nerve interference by detecting, analyzing, and correcting spinal misalignments that result from normal, everyday circumstances involving work and stress. By helping restore spinal function and reducing irritation to the nerve system, regular chiropractic care provides an environment in which chronic disease is less likely to flourish and your health and well-being can be maximized.

Chronic diseases such as hypertension and diabetes have increasingly high prevalence in world populations.¹ Such prevalence is rising despite extensive use of prescription medications. Problematically, many people have two or more concurrent chronic disorders and are taking multiple medications. But frequently the various physicians are not in contact and are not aware of the patient's complete list of current prescriptions. No single physician or nurse is managing the patient's array of medications. As a result, potentially harmful drug interactions are a common occurrence.^2,3 Mistakes are made and patients may suffer serious side effects. In such adverse circumstances, the cure in fact may be worse than the disease.
In today's health care systems, people as patients need to be good custodians of their own care. In many health systems, a patient is lucky if he or she is able to spend more than five uninterrupted minutes with their doctor. Physicians are rushed and harried by numerous responsibilities related to management of their offices, all of which take precious time away from patient interactions. In such an environment, patients need to be proactive to do their best to ensure that recommended treatment is actually going to be helpful, rather than potentially harmful. This is a very difficult task, as most people do not have backgrounds that will help facilitate understanding of such decision-making. But especially for those with a chronic disease, it's critically important to master at least a basic level of information regarding their condition and various types of treatment.
In addition to expanding one's knowledge base, an important long-term strategy is to begin to make lifestyle choices that will support good health. Appropriate and effective lifestyle choices include regular exercise, a healthy diet, and sufficient rest. All three of these key components of good health can be started right now. An exercise program should consist of five 30-minute sessions of vigorous exercise every week. A healthy diet consists of daily selections from all five major food groups: fruits, vegetables, grains, proteins, and dairy. A daily diet should include at least five servings of fresh fruit and vegetables every day. Regarding sufficient rest, 7-8 hours of sleep per night is a good average for most people. If you're not waking up feeling rested and refreshed, you're probably not getting enough sleep.
Ultimately, each of us is responsible for our own health and well-being. Prescription medication may be necessary, but of course such treatment is primarily directed toward the effects of a person's disease or disorder. Changes in lifestyle are required to address the underlying causes of such conditions. Beginning to institute and maintaining healthful lifestyle choices will provide long-term benefit for the welfare and well-being of our families and ourselves.
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¹Bauer UE, et al: Prevention of chronic disease in the 21st century: elimination of the leading preventable causes of premature death and disability in the USA. Lancet 384(9937):42-52, 2014
²Rotermann M, et al: Prescription medication use by Canadians aged 6 to 79. Health Rep 25(6):3-9, 2014
³Marengoni A, et al: Understanding adverse drug reactions in older adults through drug-drug interactions. Eur J Intern Med 2014 Oct 10. pii: S0953-6205(14)00282-9. doi: 10.1016/j.ejim.2014.10.001. [Epub ahead of print]

The Platonic Ideal

Regular Chiropractic Care and Ongoing Wellness

Regular chiropractic care is an important component of any health, fitness, and wellness program. Whether you're engaged in upgrading your diet, beginning or enhancing a program of regular, vigorous exercise, or launching a meditation or awareness practice, regular chiropractic care helps provide the physiologic framework by which you can achieve the greatest benefit from your wellness activities. In order to derive optimum benefit from your diet, fitness, and wellness programs, your nerve system must be functioning at peak capacity. Your nerve system is your body's master system. Accurate and timely flow of information is required between your nerve system and other systems, such as your digestive, hormonal, and cardiorespiratory systems. Interruptions in the flow of these signals or miscommunications will prevent you from obtaining maximum value from your healthy diet and exercise activities. By detecting and correcting spinal misalignments that cause nerve irritation, regular chiropractic care helps ensure that all your body systems are working together in harmony. As a result, regular chiropractic care helps you and your family achieve long-term health and well-being.

Plato's Ideas were perfect templates, of which everything we perceive are tangible representations. But the Ideas were not to be found in the world around us. Rather, they were conceptions of rational thought, transcendental objects of knowledge existing in a realm beyond our own. And yet, Plato's Ideas continue to be a source of inspiration and wonder, more than 2400 years after he first described them. These ethereal notions continue to function as critical guideposts, significant markers along our various life journeys, standing for ideal outcomes we are striving for and hope to achieve.
For example, we all have our own ideal image of what physical fitness is supposed to look like. These ideal images may vary from person to person, but each image ultimately derives from a Platonic Idea of physical human beauty, strength, and musculoskeletal proportion. Our conundrum, if we care about health, wellness, and fitness, is how we're going to go about achieving our ideal. As we proceed along our path to optimal physical fitness, it's very important to keep in mind that the Idea, as such, is not an actual part of our world. We will fail if we seek to achieve such perfection. A reasonable goal is to do what needs to be done and continue to do our best in all such endeavors.
A primary major access to physical fitness is starting and maintaining a healthy, nutritious diet. Such a diet involves making consistent choices from all of the five food groups, that is, fruits, vegetables, grains, protein foods, and dairy products. Each of us has our own specific preferences, and some of us may have specific requirements, such as being gluten-free or lactose-free, but the requirement for variety and obtaining the nutrition provided by each group remains the same for everyone. Importantly, international health agencies strongly recommend eating five portions of fresh fruits and vegetables every day. In the United States, this recommendation has been termed, "Five to Stay Alive".
A healthy diet, maintained over months and years, provides across-the-board benefits for fitness and wellness. When combined with a program of regular vigorous exercise, healthy eating results in conversion of unneeded fat to lean muscle mass, weight loss, and an enhanced sense of well-being. Research consistently demonstrates that a healthy diet reduces the risk of high blood pressure, heart attack, and stroke.¹ A healthy diet reduces the risk of cancer, diabetes, and obesity.² Thus, a healthy diet not only helps us achieve our own representation of the Platonic Idea of physical fitness. A healthy diet helps us achieve our own demonstration of other important Platonic Ideas, those of happiness and harmony.^{3
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1}Koutsos A, et al: Apples and cardiovascular health--is the gut microbiota a core consideration? Nutrients 7(6):3959-3998, 2015
²Esposito K, et al: A journey into a Mediterranean diet and type 2 diabetes: a systematic review with meta-analyses. BMJ Open 2015 Aug 10;5(8):e008222. doi: 10.1136/bmjopen-2015-008222
³Richard A, et al: Associations between fruit and vegetable consumption and psychological distress: results from a population-based study. BMC Psychiatry 2015 Oct 1;15(1):213. doi: 10.1186/s12888-015-0597-4

Climbing the Hill

Regular Chiropractic Care and Healthy Exercise

Regular vigorous exercise is critically important for retaining and maintaining optimal good health. But injuries may happen, disrupting our plans and best intentions. It's difficult to prevent random injuries, which by definition occur without cause or warning. One key to prevailing in your long-term exercise program is to minimize the likelihood of injury by maximizing your fitness potential. Preventable, rather than random, injuries are often caused by tightness and/or imbalance of muscles that support spinal movement and spinal weight-bearing. These muscles include the erector spinae, quadratus lumborum, longissimus thoracis, and longissimus cervicis. These spinal stabilizers assist in all forms of exercise and their optimal functioning is required for any maximal effort. By identifying and correcting misalignments of spinal vertebras, regular chiropractic care helps ensure full and free movement of these important spinal muscles. As a result, regular chiropractic care helps you and your family get the most benefit out of the time you spend exercising, helping you to improve your long-term health.

Climbing a hill is a useful metaphor for activities involved in accomplishing a major goal, overcoming longstanding obstacles, or achieving a noteworthy milestone. But you must be prepared to engage in such a climb. Striking out without a metaphorical map, compass, bottle of water, or raingear will consistently result in limited success or actual failure. From a health and fitness perspective, climbing a hill may represent a real, concrete process. When you're out on your daily walk or run, unless you live and train entirely at sea level you're going to encounter changes in elevation. If you live in mountainous regions such as Southern California or along the Appalachian Trail, such variations in terrain require greater levels of aerobic capacity. Unless you want to spend your exercise time huffing and puffing, climbing a hill in the literal sense necessitates a high level of cardiovascular fitness.
Cardiovascular fitness may also be termed cardiorespiratory fitness.¹ Such fitness refers to heart and lung capacity. With increased cardiorespiratory fitness, your heart's stroke volume increases. In other words, your heart pumps more blood with each beat than it did prior to attaining such fitness. More blood pumped per beat means your heart works less to achieve the same result. Your heart becomes more efficient, your blood pressure goes down, and your cells and tissues receive more nutrition more quickly.^2,3 Similarly, with increased cardiorespiratory fitness your lungs take in more air with each breath. Such increased lung capacity means more oxygen is available to cells and tissues more quickly. Your entire cardiorespiratory system becomes more efficient. You're expending less metabolic energy and obtaining greater metabolic returns. Cardiorespiratory fitness substantially improves your overall health.
Attaining the goal of cardiovascular (cardiorespiratory) fitness involves the same type of thoroughness as that involved in achieving family and business-related goals. You plan your work and then work your plan. Interval training is a proven method of enhancing cardiovascular fitness, a method that is both mentally and physically challenging. Accomplishing your interval training goals also provides a great deal of fun and personal satisfaction.
Interval training involves alternating intense and slow periods of activity. Let's say you run three days a week, you average approximately 12 minutes per mile, and you run 3 miles per day. Now you'll substitute one interval training day per week for one of your regular running days. On your interval training day, you'll begin by lightly jogging 1 mile. Then you'll run 1/4 mile at 2:45, that is, slightly faster than your regular 3-minute per 1/4 mile pace. You'll continue with 1/4 mile at a very light recovery pace. Next, you'll repeat the sequence of fast (2:45) 1/4 mile followed by the slow recovery 1/4 mile. Repeat the sequence once more, add 1/2 mile of lightly jogging cool-down, and you've run your daily 3-mile quotient. Going forward, you may infinitely vary your interval training sequences, running 1/2 mile, 3/4 mile, and 1 mile interval distances at slightly faster than your race pace. You'll get faster gradually as your cardiovascular fitness and aerobic capacity increase. Within 6 months of engaging in consistent interval training, climbing hills may seem no more difficult than running on flat ground. Not only will you have become much more fit, you will have made tremendous gains in overall health and well being.
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¹Lavie CJ, et al: Exercise and the Cardiovascular System: Clinical Science and Cardiovascular Outcomes. Circ Res 117(2):207-219, 2015
²Myers J, et al: Physical activity and cardiorespiratory fitness as major markers of cardiovascular risk: their independent and interwoven importance to health status. Prog Cardiovasc Dis 57(4):306-314, 2015
³Nayor M, Vasan RS: Preventing heart failure: the role of physical activity. Curr Opin Cardiol 2015 Jul 3. [Epub ahead of print]

Going for the Gold

Regular Chiropractic Care and Long-Term Health

Having your musculoskeletal system in top working order is a prime requirement for maximizing the benefit of the time you spend exercising. When your muscles, ligaments, tendons, and joints are functioning properly, without undergoing any inappropriate stress and strain, then you're able to exercise at your peak, engage in full effort, improve your strength and endurance, and have fun in the process. Regular chiropractic care helps make these outcomes possible by detecting and correcting spinal misalignments and nerve interference. By removing these roadblocks to biomechanical performance, regular chiropractic care helps ensure that you get the most benefit out of all your daily activities, including exercise. Whether your preferred method of exercise is walking, running, swimming, biking, yoga, strength training, or any combination of these activities, regular chiropractic care helps you achieve your fitness and long-term health goals.

It seems that at least once a month, some sort of senior fitness competition is featured on the sports page of local and national newspapers. The Senior Olympics was the forerunner of these types of events, and the designation quickly morphed into the National Senior Games. Soon localities and municipalities began hosting their own senior track, swimming, and ironman competitions. Sociologists would call this a trend.
However, just as younger national-class competitive athletes and professional sports stars are not representative of the population at large, none of these senior athletes is representative of seniors as a group. The important takeaway from the surge of senior athletic events is that anyone at any age can become physically fit and maintain high levels of health and fitness. It's not necessary to achieve an extraordinary level of competitive fitness. What is necessary is to be a person who is fit, healthy, and well.^1,2
With very few exceptions, any person, regardless of her or his current status, can become physically fit. The steps to take have been well described over many decades. Broadcast, print, and online media are saturated with articles and programs dedicated to teaching people how to lose weight and start exercise programs. In reality, everyone knows what he or she needs to do. One big step is portion control. Most adults consume far too many calories per day, much more than they need to maintain daily metabolic requirements. In contrast, for most adults, a daily diet containing 1800 healthy calories per day would result in substantial weight loss. The next big step is to begin and maintain a long-term exercise program, consisting of at least 30 minutes of exercise five days a week. A healthy diet and regular exercise, maintained over time, will result in ongoing high levels of physical fitness and wellness.³
But, if everyone knows what steps to take to accomplish these goals, why isn't everyone physically fit? The answers, for specific individuals, may be complex, but the overall answer is lack of motivation. Merely knowing how to do something isn't enough. You have to want to do something. You have to have the desire to do it. There has to be something in it for you. Having your spouse, doctor, or even religious counselor tell you you need to lose weight and start exercising will never get you to stick with the program. In order for you to make meaningful change, you must provide the motivation yourself.
Importantly, this internal motivation needs to be ongoing. There may be times when you do some binge eating or stop exercising. But the secret is to find the means of re-motivating yourself and returning to your fitness programs. By doing so you will derive tremendous satisfaction and gain real, long-term health and wellness.
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¹Buford TW, et al: Optimizing the benefits of exercise on physical function in older adults. PM R 6(6):528-543, 2014
²Hills AP, et al: Physical Activity and Health: "What is Old is New Again". Adv Food Nutr Res 75:77-95, 2015
³Myers J, et al: Physical activity and cardiorespiratory fitness as major markers of cardiovascular risk: their independent and interwoven importance to health status. Prog Cardiovasc Dis 57(4):306-314, 2015

Your Fellow Travelers

Regular Chiropractic Care and Optimal Health

The integrity of our functioning as physiological beings is in large part determined by the level of functioning of the body's master system, the nerve system. Optimal functioning of the nerve system directly impacts the health of our symbiotic relationship with the 100 trillion commensal microorganisms occupying our gastrointestinal tracts. But things can go wrong within the nerve system itself, most frequently as a result of nerve interference. Nerve interference is caused by physiological irritation and inflammation of spinal nerves, the nerves that transmit information from the brain, via the spinal cord, to the rest of the body. Nerve interference delays signal transmission or causes the wrong information to be transmitted. The result may be pain, other symptoms, or actual disease, depending on the locations of specific nerve irritation and the amount of time such irritation has persisted. Regular chiropractic care detects and corrects sites of spinal nerve interference. By helping restore nerve system integrity, regular chiropractic care helps you and your family obtain long-term health and well being.

It has long been known that over evolutionary time the human organism developed in tandem with a vast host of microbial fellow travelers. The 100 trillion microorganisms inhabiting our gastrointestinal tracts assist in numerous physiological processes critical to our health and well being. The intestinal microbiome (commensal microorganisms) helps maintain the integrity and function of the lining of the small intestine, helps us digest our food properly, and assists in training our immune systems to appropriately recognize friends and foes.^1,2 Alterations in composition of the intestinal microbiome (dysbiosis) lead to many disorders and diseases, including celiac disease, osteoporosis, autoimmune diseases such as rheumatoid arthritis, and diabetes. Thus, dysbiosis needs to be considered in the evaluation and treatment of many common conditions. Fortunately, many forms of conservative management are available for dysbiosis, including use of probiotics and prebiotics.
Probiotics are formulations of live microorganisms that contain large numbers of colony-forming units, primarily lactobacilli and bifidobacteria.³ Taken as dietary supplements, probiotics persist in the gastrointestinal tract for several days and compete successfully with resident microorganisms. Probiotic bacteria help repair damaged linings of the small intestine, enhance nutrition, and suppress inflammatory intestinal reactions. Importantly, probiotic bacteria ferment undigested carbohydrates in the large intestine and produce nutrients for "good" microorganisms, helping restore the normal composition of commensal microorganisms.
Prebiotics are selectively fermented ingredients (foods) that target specific microorganisms and help restore balance in the intestinal microbiome. The primary targets are bifidobacteria and lactobacilli. By providing dietary substrates, prebiotics stimulate  growth of specific bacteria and act to restore a more healthful composition of the intestinal microbiome. Many prebiotics are found naturally in foods such as garlic, onions, asparagus, and leeks. However, an effective means of obtaining prebiotics is to add prebiotic ingredients to bread, yoghurt, and drinks. In order to obtain full benefit, prebiotics and probiotics must be consumed regularly.
Dysbiosis is frequently the result of intolerance to gluten, a class of proteins found in wheat, barley, and rye. Chronic immune and inflammatory reactions to gluten peptides often lead to disturbances in intestinal microorganism homeostasis. Other conditions such as acute intestinal infection disrupt the intestinal epithelial barrier and lead to dysbiosis. The good news is that alterations in composition of the intestinal microbiome are usually correctable by supplementation with probiotics and prebiotics. The key to effective management is knowledge and awareness of the possibility of dysbiosis and access to appropriate methods of natural supplementation.
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¹Chistiakov DA, et al: Role of gut microbiota in the modulation of atherosclerosis-associated immune response. Front Microbiol 2015 Jun 30;6:671. doi: 10.3389/fmicb.2015.00671. eCollection 2015
²Purchiaroni F, et al: The role of intestinal microbiota and the immune system. Eur Rev Med Pharmacol Sci 17(3):323-333, 2013
³Hajela N, et al: Gut microbiome, gut function, and probiotics: Implications for health. Indian J Gastroenterol 34(2):93-107, 2015

To Lift or Not to Lift?

Strength Training and Regular Chiropractic Care

Engaging in a program of strength training provides numerous benefits for adolescents, young adults, and older adults. Strength training also represents a long-term commitment. The health and fitness gains you achieve via strength training are obtained over months and years, not days and weeks.Strength training does involve the possibility of injury and it's important to minimize this risk as much as possible. No one wants to endure two or more weeks of downtime owing to a soft tissue injury that could have been avoided. One specific method of helping to ensure safe exercise sessions involves strict attention to proper technique. The second specific method is regular chiropractic care. All of the physical work involved in strength training is based upon effective spinal biomechanics. Regular chiropractic care is focused on restoring optimal spinal alignment and detecting and correcting sources of nerve interference. By engaging in regular chiropractic care, you're helping to ensure your ability to perform vigorous physical activity and reap the rewards of long-term health.

If a great Shakespearean protagonist had, anachronistically, joined a gym, his internal existential inquiry might have been, "To lift or not to lift?". Many centuries later, the identical inquiry, or controversy, persists. Joining a gym (health club) usually implies the new club member is going to engage in strength training in one form or another. Such exercise provides an abundance of benefits and is a valuable lifestyle choice for most people. But the possibility of injury exists. The key to safe, beneficial exercise is to learn how to do strength training correctly, then develop a plan, and follow the plan.
Government health and wellness guidelines recommend doing 150 minutes of (at least) moderate exercise per week. This translates to at least 30 minutes of exercise five times per week. Strength training is an important component of any exercise program designed to fulfill these recommendations. In combination with cardiorespiratory exercise, strength training greatly improves muscular capabilities and endurance. Your body becomes fit, toned, and honed, and as a result, you become much better equipped to successfully manage the mechanical stresses and strains that everyone encounters during the course of a normal day.^1-3
If you are new to strength training or haven't done this form of exercise in a while, then the most important rule is to start slowly. Scientifically determine how much weight you should be lifting by experimentation. Choose a very light weight and see whether you can do eight repetitions with that weight comfortably. If it's difficult to do eight reps, then start over with the next lighter weight. If it's too easy to do eight reps, then start over with the next heavier weight. If eight repetitions feels just about right, then that's the weight with which to begin that particular exercise. Follow these steps for each of your exercises and you'll have established your beginning routine on a personal and safe foundation.
Strength training need never become boring, as you can change your routine with almost infinite variety. For example, for a 12-week period you could do chest and back exercises one day, then leg exercises a second day, and shoulder and arm exercises a third day. You would do your cardiorespiratory exercise on the remaining two days (for a total of five weekly days of exercise). During a different 12-week period, you could do cardiorespiratory exercise on three days and do arm and leg exercises on one day and chest, back, and shoulder exercises on a second day. Or you could choose to "work light" and exercise all your body parts on a single day. You could do your total-body strength training two or three days a week, filling in the other days with cardiorespiratory exercise. The only guideline in the context of these routine designs is whether the routine works for you. If it works, then it works.
As with all exercise programs, the more consistent you are, the greater long-term benefit you'll derive. Be sure to build-in recovery time by taking a week off here and there for rest and recharging. A modern Hamlet would find his or her exercise time enjoyable and rewarding, and would answer the perplexing question with a resounding, "Yes. I will lift."
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¹Granacher U, et al: The importance of trunk muscle strength for balance, functional performance, and fall prevention in seniors: a systematic review. Sports Med 43(7):627-641, 2013
²Grier T, et al: The effects of cross-training on fitness and injury in women. US Army Med Dep J Apr-Jun:33-41, 2015
³Liu Y, et al: Effects of combined aerobic and resistance training on the glycolipid metabolism and inflammation levels in type 2 diabetes mellitus. J Phys Ther Sci 27(7):2365-2371, 2015
These are very good points. With expanded research funding it may be possible to fulfill the assumptions of parametric analysis with greater confidence.