Movement, Health and Happiness WITH DR. MATTHEW BARNES, DC Dr. Matthew Barnes, DC Who is Dr. Barnes? • A chiropractor and co-owner of Barnes Chiropractic. • An athlete who found his love for movement and its benefits in college. Since then, he has been expanding his athletic repertoire. From Crossfit to aerial acrobatics and dance to triathlons and ultramarathons, his experiences and training go beyond the classroom to real life, real hills, and real health. • A family man. Married for over 11 years and a father for almost 5, he brings this dedication to his patients, and now, to you, too. Some thoughts to ponder • “Lack of activity destroys the good condition of every human being while movement and methodical physical exercise save it and preserve it.” - Plato • “Physical fitness is not only one of the most important keys to a healthy body, it is the basis of dynamic and creative intellectual activity.” - John F. Kennedy • “I want to move it, move it.” - Madagascar The basics • Your physiology is ALWAYS a direct expression of your environment (acute and chronic) • Your genes are programmed to express the environment. • It is imperative to understand that exercise and proper posture do not represent ways to improve health or to improve upon normal physiology (more on this later!). Plato again…because he got it! The triad of health or disease LIFESTYLE CHOICES: 3 categories with 2 results – health or illness Nutrition Exercise and Movement Genetic expression of homeostatic physiology: Health! Mind/Thoughts/Focus Genetic expression of adaptive/stress physiology: illness Homeostasis = Equilibrium • Health is a natural state of being. • It is what the body tends towards. • the body tends toward healing…health…homeostasis • Homeostasis: the tendency toward a relatively stable equilibrium between interdependent elements, especially as maintained by physiological processes. • A scratch, left undisturbed, will heal • Homeostasis will be maintained, unless there is a forced adaptation to a stressor, such as physical, chemical, emotional, or spiritual. • As holistic wellness paradigm scientists we start with the understanding that humans are innately intelligent and naturally healthy. Healthy is normal and normal is optimal. • Our genes are programmed for homeostasis. Essential nutrients • The term nutrients refers to more than simply what we eat. • Anything required by the body for full health is a nutrient, whether it is food, air, or even exercise. Eaton & Eaton. An Evolutionary Perspective on Human Physical Activity: Implications for Health. Comparative Biochemistry and Physiology Part A 2003 (136) 153-159. • “At present human genes and human lives are incongruent, especially in affluent Western nations. When our current genome was originally selected, daily physical exertion was obligatory; our biochemistry and physiology are designed to function optimally in such circumstances.” • Daily physical exertion is an essential nutrient!!! Necessary physical activity • The major premise of the Movement Deficiency Syndrome TM is that movement is a required nutrient for physiological and biomechanical homeostasis. Our genome has been created/evolved and adapted in the presence of daily rigorous exercise. Hence our genome can only express physiological and biochemical homeostasis and health when it receives sufficient stimulus from movement. • Movement is a required nutrient just like nutritional nutrients or emotional-spiritual nutrients. • A lack of exercise will create a phenotypic expression that is the body’s best attempt to deal with the deficiency. The exact same pattern exists with a deficiency in nutritional nutrients or emotional nutrients. As Hans Salye showed, the body reacts to all stressors the same way – with adaptive or stress physiology in order to maximize the chance of survival and future opportunity to provide sufficiency. Our physiology is ALWAYS the genetic (phenotypic) expression of our environment. We are generally programmed for homeostasis and health; this is the innate drive that literally defines life. Life is really the process of maintaining homeostasis; it is producing order and avoiding entropy. 3 components of physical fitness • Activity choices: What movement patterns are chosen to simulate your physiology. • Activity stimulus detection and transmission: What stimuli are detected and delivered to the cells. Influences include things like the type of activity chosen, the current state of fitness and health, by pH, by nutritional status, by afferent and efferent neural innervation, and by autonomic hormonal and emotional states (stress or relaxation). • Stimulus interpretation and utilization: How do the genes recognize and respond to activity stimuli (genetic expression of environmental stimuli). Movement and Stress The stress response • “Stress sharpens the signal detection system at the cost of concentration,” states Michael Meaney, PhD. The stressed person becomes easily distracted (sounds like ADHD and adult burnout, doesn’t it?). • Studies show that chronic stress physiology can lead to chronic changes in cognition – cells in the hippocampus actually shrink! Interestingly, research also shows that chronic movement stimulation/exercise (proprioception via cerebellum) results in an increase in the size of hippocampal cells!!! • Chronic stress changes the function of cells. “This adaptation is not pathology!” Keep in mind, it is not the physiology of a healthy body that is studied. It is the physiology of that the allopathic community terms disease. These are not diseases, however, they are adaptations to stress that are necessary for survival of the host. How does moving help? Mayo Clinic says… • Regular exercise releases endorphins reducing stress and improving mood. • Even moderate exercise has been shown to distract from the day’s events. So if you have a particularly stressful day, make sure to MOVE at the end of it!! ADAA (Anxiety and Depression Association of America) says… • Improved sleep reduced stress • Some get as much anxiety reduction through movement as through medications! Movement and mood • If you are deficient in exercise or nutrition you are unable to utilize emotional or spiritual nutrients properly. Movement and disease Exercise and proper posture are expected nutrients; therefore, deficiencies and/or toxicities result in a lack of proper homeostatic or normal physiology, which is termed illness or adaptive physiology. “Physical inactivity produces an abnormal gene expression and is a direct causal factor of most chronic health conditions by its direct alteration of gene expression from a normal phenotype to a preclinical or clinical phenotype.” F.W. Booth Ph.D. J. of Applied Physiology 2002 Movement and disease • Booth et al. Waging war on physical inactivity: using modern molecular ammunition against an ancient enemy J Appl Physiol 93: 3-30, 2002 • “Physical inactivity is an abnormal event for a genome programmed to expect physical activity, thus explaining, in part, the genesis of how physical inactivity leads to metabolic dysfunctions and eventual metabolic disorders such as atherosclerosis, hypertension, obesity, Type 2 diabetes, and so forth.” • “From the standpoint of our Late Paleolithic ancestors, physical inactivity is abnormal; it can produce a pathophysiological phenotype and is a major contributor to the chronic health conditions in 2002.” • Booth FW, Chakravarthy MV, Spangenburg EE. Exericse and gene expression: physiological regulation of the human genome through physical activity. J Physiol. 2002 Sep 1; 543 (Pt 2): 399-411. • “The chronic illnesses that are pandemic in industrialized society (cancer, heart disease, vascular disease, obesity, diabetes, depression, etc) are the result of a pathological environment NOT pathological genes. Our genes have no choice but to adapt to (phenotypically express) the environment they are stimulated by or placed within.” Movement and disease Booth et al. Waging war on physical inactivity: using modern molecular ammunition against an ancient enemy. J Appl Physiol 93: 3-30, 2002. • A total of 91% of the cases of Type 2 diabetes and 82% of the coronary artery disease cases in 84,000 female nurses could be attributed to habits and socalled high-risk behavior [defined by the study as body mass index (BMI) >25, diet low in cereal fiber and polyunsaturated fat and high in transfat and glycemic load, a sedentary lifestyle, and currently smoking].” • Studies show that ~30-50% of all cases of Type 2 diabetes, coronary heart disease, and many cancers were prevented by 20 minutes of moderateintensity exercise each day in middle-aged women (e.g., walking >3 miles/h) compared with cohorts who exhibited lower levels of physical activity." Movement and disease Manson JE, Skerrett PJ, Greenland P, VanItallie TB. The escalating pandemics of obesity and sedentary lifestyle. A call to action for clinicians. Arch Intern Med. 2004 Feb 9;164(3): 249-58. • “Obesity and sedentary lifestyle are escalating national and global epidemics that warrant increased attention by physicians and other health care professionals. These intricately linked conditions are responsible for an enormous burden of chronic disease, impaired physical function and quality of life, at least 300,000 premature deaths, and at least $90 billion in direct health care costs annually in the United States alone.” Movement and cardiovascular health • “Aerobic exercise elevates blood levels of high density cholesterol, lowers blood pressure and resting heart rate, decreases platelet aggregability as well as the tendency for vasoconstriction, and enhances endothelial health as determined by post-ischemic brachial artery vasodilation (Floelicher and Meyers 2000).” • “There is growing evidence that, like endurance exercise, strength training enhances heart health (Hurley et al., 1988; Winnett and Carpinelli, 2001). Resistance exercise lowers blood pressure (Kelley and Kelley 2000) and beneficially influences serum lipids (Staron et al., 2000). Positive effects on body composition and insulin sensitivity may also be contributing factors (Flucky et al., 1994; Winnett and Carpinelli, 2001).” • A very important benefit of resistance exercise and other maximal effort exercise patterns is that they raise heart rates very high. This is proving to be important for heart health and homeostasis as this is what our genes expect. Simply jogging or walking does not elicit this heart rate variability and challenge which is so necessary for heart health. Movement and cardiovascular health • Booth et al. Waging war on physical inactivity: using modern molecular ammunition against an ancient enemy. J Appl Physiol 93: 3-30, 2002. • It is not inactivity that causes illness, it is a deficiency in normal exercise that results in adaptive physiology and biochemistry. The cells are starving! • Recall the recommendation of 30 minutes of exercise is actually based upon improvement from “sedentary” and not the attainment of health. We know the improvements from exercise are dose-related so until the homeostatic or innate activity levels are achieved there is illness present and room for further improvement. • “Exercise also improved functional status regarding activities of daily living.” Insulin and health • Most people think the role of insulin is to lower blood sugar. The truth is this is only one of the many critical physiological roles that insulin plays in human metabolism. • Insulin is an anabolic (growth and repair) hormone. • Insulin stores excess nutrients. Insulin levels are elevated in response to any elevation in energy substrate that is absorbed. • When blood sugar is elevated, it is a sign to your innate intelligence that you have more energy substrate than you need for fuel at that moment. • Insulin not only stores carbohydrates but is also involved in the storage of fat and protein. Insulin levels also dictate which fuels are used for energy at any given time. • When blood glucose (or fructose or galactose) levels rise, insulin will appropriately be released to take that sugar and store it for future energy requirements. This literally determined our survival when a steady food source could not always be guaranteed. However, to have this genetic makeup in an environment of excess caloric intake and deficient caloric expenditure is literally deadly. • Insulin levels also affect the immune system. High insulin levels stimulate the sympathetic nervous system, which, in turn, causes an increase in stress hormones like cortisol, which inhibits the cell-mediated immune system. Insulin and health Insulin and Vitamin C • Both glucose and vitamin C use the same cell membrane receptors to enter the cell, as they are almost identical. Therefore, a high concentration of blood glucose means that glucose is taking up most of the receptor sites. So with insulin resistance, the receptors become resistant to both glucose and vitamin C. • The phagocytic cells (which engulf and absorb bacteria and other small cells and particles) of the immune system require high amounts of vitamin C to work properly. But of glucose is taking up receptor sites or those sites are resistant to vitamin C, immune function is decreased. That is why eating sugar decreases your immune system and why high doses of vitamin C can improve immune function. The issue is actually not the lack of vitamin C but the toxic amount of sugar in the diet. Insulin and magnesium • Insulin stores all sorts of nutrients and is involved in the storage of magnesium. • If your cells become resistant to insulin, you cannot store magnesium, so you excrete it in your urine. • How important is magnesium? Super important. • One of its major roles is to relax muscles. Intracellular magnesium relaxes muscles. If magnesium cannot be stores, the smooth muscle in your blood vessels cannot relax and the blood vessels constrict. Chronically constricted blood vessels = a chronic increase in blood pressure. • Magnesium is also a cofactor for virtually all intracellular energy producing reactions. • It is necessary in over 325 enzyme systems in the body that control thousands of chemical interactions. • Magnesium is also crucial for bone health. The trio of bone health is calcium, magnesium, and vitamin D (magnesium is necessary for vitamin D to be converted into its active form). Insulin resistance, sensitivity • In the centenarian studies insulin, or rather insulin sensitivity, is arising as a significant factor for determining longevity. In fact, insulin receptor resistance is considered a major factor in all of the chronic lifestyle diseases that now represent the leading causes of death in Western societies. • Understanding insulin resistance: if your cells are exposed to insulin all the time, they begin to become resistant to it. The pancreas is then forced to produce and secrete more and more insulin in order to get the same job done. • With insulin resistance, both insulin and blood sugar levels remain high. Insulin resistance • Insulin resistance also mediates blood lipids. Think logically for a moment about blood lipid levels. Do you think levels increase as random happenstance? Nope. Blood lipid levels, like all physiological variables, are the expression of your environmental choices. The only effective and healthy way to control blood lipids is to change lifestyle (diet, exercise, stress reduction)! Insulin sensitivity, physical activity and health Eaton & Eaton. An Evolutionary Perspective on Human Physical Activity: Implications for Health. Comparative Biochemistry and Physiology Part A 2003 (136) 153-159. • Insulin sensitivity = (skeletal muscle mass x skeletal muscle mass metabolic activity)/(fat mass) Booth et al. Waging war on physical inactivity: using modern molecular ammunition against an ancient enemy. J Appl Physiol 93:3-30, 2002. • “Insulin resistance is rapidly increased after a few days of physical inactivity.” • “Because physically inactive individuals are likely to have higher BMI, physical inactivity also contributes to an increased prevalence of Type 2 diabetes by its direct effect on increasing BMI in certain individuals, as the prevalence of Type 2 diabetes increases with BMIs > 25.” • This shows that we innately require physical activity for homeostatic physiology and biochemistry, not just to control body weight and composition. If you are skinny and inactive, you are still sick. • “Studies have demonstrated that weight loss is not necessary for individuals to benefit from the effects of physical activity on glucose tolerance and insulin sensitivity. Inactive women with BMIs <29 have a slightly higher relative risk of 0.79 for coronary heart disease than acive women with BMIs >29 whose relative risk is 0.69. Moderate-intensity aerobic training had a favorable effect on glucose tolerance in older people, independent of changes in abdominal adiposity. An inverse association was found to exist between physical activity and distal colon large ademonas (diameter of 1 cm or more), but this relationship was independent of BMI.” Insulin: Health, disease, and movement • Insulin plays a major role in cardiovascular disease, osteoporosis, thyroid hormone regulation, sex hormones, aging, glycation, even stress. Eaton & Eaton. An Evolutionary Perspective on Human Physical Activity: Implications for Health. Comparative Biochemistry and Physiology Part A 2003 (136) 153-159. • “A disproportionate amount of adipose tissue relative to skeletal muscle reduces the blood-glucose-lowering effect of a given pancreatic insulin secretory pulse so that additional insulin secretion is necessary to achieve appropriate blood glucose levels; i.e. insulin sensitivity is reduced.” • And back to movement… • Insulin resistance and inactivity: Exercise and movement deficiency, or sedentary living, is also shown to cause insulin resistance. More pointedly, movement and exercise are required for normal insulin metabolism. Exercise and gallbladder function Booth et al. Waging war on physical inactivity: using modern molecular ammunition against an ancient enemy J Appl Physiol 93: 3-30, 2002. • “Physical inactivity could increase the risk for gallstones by increasing glucose intolerance even in the absence of weight loss, raising biliary cholesterol levels, thus preventing cholesterol from precipitating in the bile, increasing serum triglyceride levels, increasing exposure to ovarian hormones, and slowing colonic transient time, all factors related to an increased risk of developing gallstones” (and a plethora of other illnesses, including cancer). Exercise and cancer prevention Booth et al. Waging war on physical inactivity: using modern molecular ammunition against an ancient enemy J Appl Physiol 93: 3-30, 2002. • “Friedenreich et al. stated that 23 of 35 studies conducted to date show an increased risk in breast cancer for those women who are physically inactive.” • “Larger waist circumferences increase the risk of breast cancer, especially among postmenopausal women. Sedentary women have larger fat masses, especially the highly metabolic abdominal fat mass, than women who exercise. Sedentary women have higher serum insulin levels, and high insulin concentrations are speculated to promote breast cancer.” • Remember, high blood insulin levels down-regulate sex hormone binding globulin! Here again we see insulin playing a role in illness. • “A literature review by Tomeo et al. concluded that physical inactivity was the risk factor most consistently shown to be associated with an increased risk of colon cancer. A 50% reduction in the incidence of colon cancer was observed among those with the highest level of physical activity across numerous studies. Thus 50,000 cases and 24,000 deaths from colon cancer could have been prevented each year in the United States by more physical activity. • “Five potential mechanisms by which physical inactivity could increase the risk of colon cancer were proposed in a recent review. Physical inactivity could 1) lengthen gastrointestinal transient time, thereby maximizing contact with potential carcinogens, 2) increase circulating levels of insulin, promoting the growth of colonic epithelial cells, 3) alter prostaglandin levels, 4) depress immune function, and 5) modify bile acid metabolism.” Historical comparisons, explanations • Research shows that when hunter-gatherers are “modernized” or “westernized” they lose muscular strength and cardiovascular fitness within a few years! • “In other words when they go from an innate daily activity level to an industrial incongruent daily activity level they get sick. They immediately begin to suffer from exercise deficiency illness. It should be called exercise deficiency syndrome TM! Add poor nutrition or nutrient deficiency syndrome TM to this and you have virtually all illness and premature death accounted for.” -Dr. James L. Chestnut Historical comparisons Dudley, Robert. Limits to human locomotor performance: phylogenetic origins and comparative perspectives. The Journal of Experimental Biology 204, 3235-3240 (2001) • “Modern humans exhibit a much higher body fat content and reduced relative muscle mass than their ancestral counterparts, trends that are seen in domesticated animals generally (Allen and Macket, 1982; O’Dea, 1991; Clutton-Brock, 1999).” • We are wild animals living in captivity!! Cordain L, Gotshall RW, Eaton SB, Eaton SB 3rd. Physical activity, energy expenditure and fitness: an evolutionary perspective. Int J Sports Med. 1998 Jul;19(5):325-35. • From the emergence of the genus Homo, over 2 million years ago until the agricultural revolution of roughly 10,000 years ago our ancestors were hunter-gatherers, so the adaptive pressures inherent in that environmental niche have exerted defining influence on human genetic makeup. The portion of our genome that determines basic anatomy and physiology has remained relatively unchanged over the past 40,000 years. Thus, the complex interrelationship between energy intake, energy expenditure and specific physical activity requirements for current human remains very similar to that originally selected for Stone Age men and women who lived by gathering and hunting. Research investigating optimal physical activity for human health and performance can be guided by understanding the evolution of physical activity patterns in our species.” Historical comparisons Cordain et al. Physical Activity, Energy Expenditure and Fitness: An Evolutionary Perspective. 1998 Int. J. Sports Med. (19) 328-335. • The energy expenditure per unit body mass of PA (physical activity) for contemporary Westerners is about 38% that of our human ancestors, a discrepancy even more startling than that for TEE (total energy expenditure). For typical Americans to approximate the TEE/kg/d of recent studied gatherer-hunters it would require adding the equivalent of a 12 mile walk, for a 70 kg man, to each day’s current activity level! • S. Boyd Eaton M.D., Melvin Konner Ph.D., M.D. and Marjorie Shostak. Stone agers in the fast lane: Chronic degenerative diseases in evolutionary perspective. 1988; Am. J. Med. 84, 739-749. • “Although our genes have hardly changed, our culture has been transformed almost beyond recognition during the past 10,000 years, especially since the Industrial Revolution. There is increasing evidence that the resulting mismatch fosters “diseases of civilization” that together cause 75% of all deaths in Western nations, but that are rare among persons whose lifeways reflect those of our preagricultural ancestors.” • What causes the other 25% of deaths? Not old age! Properly prescribed drugs cause the vast majority of this amount, followed by medical malpractice and then traumas from accidents and homicides. Historical comparisons Eaton & Eaton. An Evolutionary Perspective on Human Physical Activity: Implications for Health. Comparative Biochemistry and Physiology Part A 2003 (136) 153-159. • “In 1970, American males were 22 pounds heavier than were age- and height-matched men in 1863.” “During much of this period, from 1909 to 1970, food disappearance data indicate that energy available in the food supply remained constant, while in its later stages, per capita caloric intake actually appears to have declined.” • We ate the same food or less and gained an average of 22 pounds. How did this happen? We decreased our daily activity levels. Can anyone try to defend the idea that these changes that took place over a period of only 60 years were due to genetic changes? That is, in reality, a scientifically absurd notion. • “Data for adults suggest that overweight prevalence has increased by more than 50% in the past 10 years. An overweight condition is the most common health problem facing American children, particularly for African Americans and Hispanics. More than one decade ago, the direct costs of obesity and physical inactivity accounted for 9.4% of the US health care expenditures; therefore, these costs must be greater now.” • We still have “experts” blaming genes and looking for drugs to solve obesity problems! How can it be genes if the rates have increased 50% in ten years? Our genes are programmed for health, not sickness. The entire premise upon which allopathy rests is incorrect; they think genes cause disease. The truth is genes express the environment – period. Billions of dollars are being spent trying to find a way to treat or prevent obesity with drugs; how can anyone see this as sanity? What they are looking for is a consequence-free way for people to keep eating too much and moving too little. Exercise recommendations • Eaton, Cordain & Lindeberg. Evolutionary Health Promotion: A Consideration of Common Counterarguments. Preventive Medicine 2002 (34) 119-123 • Some people, including “experts” think it extreme to suggest daily rigorous exercise! Of course suggesting rigorous exercise for a sedentary individual is not logical but to suggest that simply gardening is enough is malpractice. People must be taught to understand progressing to more and more activity slowly but they must never be lied to and told that anything less than daily rigorous activity is healthy. • “The 1995 American College of Sports Medicine (ACSM) guidelines recommend participating in physical activity 3-5 days/week at 50-85% intensity continuously for 20-60 minutes.” • “For health promotion, however, the ACSM suggests individuals accumulate 30 minutes of physical activity over most days of the week. Activity need not be continuous, and can be of moderate intensity (equivalent to walking 3 miles per hour. On the other hand, several recent reports have emphasize the dose-response nature of physical activity and related health outcomes.” • Dr. Chestnut states “there is not science to support that these guidelines promote health. They are operating in the allopathic sickness paradigm and making recommendations based on decreasing sickness. In a sedentary person these activity levels will show improvement — they just won’t result in health and homeostasis!” • “Comparing minimum physical activity requirements for health promotion as proposed by the ACSM with estimates of estimates of ancestral physical exertion reveals a striking discrepancy.” Exercise recommendations • The ACSM guidelines are roughly 44% of the level of energy expended by PA (physical activity) observed among hunter-gatherers, almost surely below those of our preagricultural ancestors, and very likely, below the level of physical exertion for which our genetically-determined physiology and biochemistry have been programmed through evolution.” • Current guidelines are misleading at best, for they look at exercise as a therapeutic intervention, not as a required nutrient. Sick people are used as subjects, rather than healthy people, and they study how to make people less sick, instead of focusing on how to make people well. Keep this in mind when viewing current recommendations. • What drug or surgery can solve an exercise deficiency problem???? Blair SN, LaMonte MJ, Nichaman MZ. The evolution of physical activity recommendatios: how much is enough? Am J Clin Nutr. 2004. May; 79(5): 913S-920S. • “In addition to aerobic exercise, people should engage in resistance training and flexibility exercises at least twice a week, which will promote the maintenance of lean body mass, improvements in muscular strength and endurance, and preservation of function, all of which enable long-term participation in regular physical activity and promote quality of life.” Exercise recommendations • “Thus increasing physical activity from sedentary levels to 30 minutes of moderate activity each day will also lower the prevalence of these conditions within the same BMI. These data suggest that America’s emphasis on loss of body weight in overweight individuals, although appropriate, usually overlooks, in our opinion, equal mention that inactivity, alone, worsens the prevalence of most chronic health disorders without a change in BMI. We further suggest that the health outcomes from campaigns to lower the number of calories consumed each day would be improved if a greater emphasis on moderate physical activity were included with eating less.” • Obesity is an effect, it is not the underlying cause of most health problems with which it is associated. It is correlated with disease because the same underlying factors are involved. Is 30 minutes enough? • 30 minutes of moderate intensity exercise is only 44% of the daily intense activity our hunter/gatherer ancestors are estimated to have used daily. • This means that 30x3 times per week is not what we are genetically programmed for. Well, how much then?? • Genetically speaking, getting at least 60 minutes of moderate/high levels of activity 5-6 times per week is ideal. • In addition to the other health benefits at 60 minutes the cells in our bodies start to recognize the strain and begin increasing their mitochondria. Increased mitochondria equals increased energy and lowered chances of diseases like Parkinson’s and Alzheimer’s. What activities are best? • The FUN ones!! Something you enjoy is more likely to be continued; no one likes chores! • Activities like yard work/gardening/walking are somewhat beneficial but not anywhere near as effective as moderate intensity exercises like running, biking, swimming, basketball, etc. Activity Disclaimer • When starting a new workout routine you may want to consult your physician, especially if you have had cardiovascular issues in the past. • Start slow and work up. If you have been a couch potato for the last 5 years (or 20) don’t go for a 60 minute run. Start with walking and move up in time and intensity as your body adjusts. • We work with patients of all activity levels in our clinic and welcome your questions. Questions? • If you have any questions not covered today please feel free to contact us at BarnesChiroColorado.com. • Or email us at • matthew@barneschirocolorado.com • kelly@barneschirocolorado.com • Thanks!