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MobiHealth News: Digital Health 2015 Midyear Review

Digital Health 2015 Midyear Review


Brian Dolan
Editor-in-Chief MobiHealthNews

Ryan Beckland
CEO Validic

Fitbit wearable- price tag $250.

This trend webinar presented by MobiHealthNews was packed full of information, information that many of us have already heard about individually from bigger news reporting agencies, but Brian did an excellent job in a 20 minute recap of the latest market trends. Since as we all know whenever you hear about a market (even your local farmers market!), the mention of money is never far behind, the HIT market is not any different except by the number of zeros, the very many! A whopping quarter million dollar funding increase from last year; $741 million to 1 Billion. If that wasn’t a big enough highlight, get a load of this, FitBit a wearable camera company, debuted its initial public offering (IPO) on the NYSE, raised 732 Million, making it the biggest EVER consumer electronics IPO in history. That is a very BIG deal indeed! With all this money rolling around in the form of connected health devices, therefore all the personal health data in return being generated, the Federal Trade Commission is nervous that HIPPA is not enough. It will be interesting to see what additional training employees, caregivers, etc. will have to do to appease FTC and well patients like myself!

Ryan Beckland, CEO and co-founder of Validic, a “…cloud-based technology platform that connects patient-recorded data from digital health applications, devices and wearables to key healthcare companies”. Validic works with the largest healthcare systems in the world, reaching 160 million individuals in 47 countries. Validic is continuously evolving their services to the accelerated demand and innovation of HIT, and has profited by the ‘recent’ wave of patient generated health information. The focus of Ryan’s presentation was on the behaviorism’s of patients and providers and how they have been changing due to the HIT market trends. Increase options for care has helped patients be more in charge of their care more than ever before, stating that in the not so distant future devices are going to replace the role doctors have in diagnosis and initial doctor appointment. Ryan very clearly laid out the benefits of telehealth, it doesn’t take a rocket scientist to see that telehealth empowers patients, prevents hospital readmissions, reaches patients in rural locations etc. and it can address doctor shortages.

Another noteworthy point that Ryan made is that by 2020 it is expected that the Pharma market will be entirely reshaped by digital health; dubbed Pharma 2020: The vision. Three major trends driving shift is patients expect technology to provide convenient and regular access to their providers, regulatory environment of data access and speed of competition requires more technology enabled solutions. Pharma is pressured to increase patient adherence to drug therapy (currently at 50% adherence!) and seeing how telehealth has been successful in other factors (lower readmissions, etc.) it’s time Pharma takes the reins on their patients’ health as well. I am extremely interested to see what new technologies this market develops/adapts since this is a very wealthy sector in the realm of healthcare.

You watch and listen to the webinar here, where you can also access the slides presented.




Posted in: Healthcare Technology, Healthcare transformation, M-health, Telemedicine

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This month [May] in Telemedicine

American Telemedicine Association: This month [May] in Telemedicine
June 2, 2015

Gary Capistrant, Chief Policy Officer, American Telemedicine Association
Jonathan Linkous, CEO, American Telemedicine Association

John commenting on the heat in Washington, D.C.

John commenting on the heat in Washington, D.C.

The annual ATA conference in LA last month had the largest attendance rate that ATA has seen in 20 years. It featured over 500 presentations; the video recordings of every presentation is available for purchase. Our own Wellpepper CEO, Anne Weiler, went to the conference and you can read her blog here. Also in May there were some big changes at ATA; a new president, new officers and members of the board of directors were elected. Their backgrounds are all impressive, thank goodness because we need them!

Telehealth’s exceeding advantages in both entrepreneurial and patient health naturally have lead to several new organizations popping up every year (or every month it seems) that use clinical consultations over the internet/phone. And where there is money to be made and quite literally lives at stake, legality is involved. The Texas medical board ruling prohibiting use of telehealth without previous relationship with patient, or a healthcare professional being present with patient when telehealth is being utilized (Huh, how is that telehealth?) lead to Teladoc filing a lawsuit against TX. Consequentially last Friday the Federal court ‘temporarily’ stopped TX medical board ruling. With that said ATA provides accreditation for online consultation sites to make sure sites are open/transparent, adherence to all relevant laws and regulations and promotes patient safety; however Teladoc isn’t accredited by ATA.

For those of us waiting for a particular practice guideline from ATA, there are now 10-12 Telehealth practice guidelines available on the ATA website and six active workgroups are under development; Teleburns, teledermatology, child mental health, general pediatrics, remote health and data management and telestroke. Please contact ATA if you would like to be involved in a workgroup, it is practicing professionals like you that make these guidelines viable.

If your state has a Telemedicine Parity Law, kudos, but 23 still do not. To be positive, we are getting there, a new milestone was achieved in the laws; Minnesota, Nevada and Indiana this week alone have added their own parity laws. Also in state news ATA added the highly awaited and much needed resource, the ATA State Telemedicine toolkit titled “Working with Medical Boards: Ensuring Comparable Standards for the Practice of Medicine via Telemedicine”. Again this is a call for involvement!

Congress or digress? The three letter difference is slight! But hey three new bills were introduced to Congress since the last webcast that will be interesting to watch; Telehealth Enhancement Act 2015, Amendment to Social Security Act to expand access to telehealth stroke services under Medicaid, and the VETS Act of 2015. The VETS Act of 2015 would permit U.S. Department of Veterans Affairs health professionals to treat veterans nationwide with a single state license. I cannot help but speculate the motives of introducing this bill; are they using the VA as a pilot for licensure compacts for ‘civilian’ physicians, etc.? Let’s hope so and more importantly I hope it goes well and only reaps benefits.

The announcement of a new Distance Learning and Telemedicine Grant from the USDA was mentioned and I wanted to make note of it in case any of our readers qualify. Please check it out here.

The next ‘This month in Telemedicine’ will be announced shortly on the ATA website and as always is free to watch.

Posted in: Healthcare Policy, Healthcare Research, Healthcare Technology, Telemedicine

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This Month [March] in Telemedicine

March 31, 2015
American Telemedicine Association
Gary Capistrant, Chief Policy Officer, American Telemedicine Association
Latoya Thomas, Director, State Policy Resource Center
Jordana Bernard, Chief Program Officer

I admit this is only my second ATA ‘This Month in Telemedicine’ webcast I have listened to and whereas the federal and state legislative ‘lingo’ isn’t as intimidating anymore, I still have a headache from going into information overload. Luckily it isn’t my full time job to be on top of legislative telemedicine on goings, but ATA’s. To me it was clear with each passing minute that ATA’s mission to achieve “Educating and engaging government, payers and the public about telemedicine” is steadfast, and kudos to their small staff to keep on top of legislative issues and make telehealth materialize for us all.

The biggest Telemedicine conference in the world: The annual ATA Annual Telemedicine Meeting and Trade show is next month, May 2-5 in LA and they are busy in preparation for this event that is over 2500 miles from their headquarters in Washington, D.C. Jordana Bernard, ATA Chief Program Officer, believes the conference highlights will be the pre-meeting courses (continuing education credits offered), State Telemedicine Gaps Analysis awards and the keynote speakers, Emmy-award winning chief medical correspondent for CNN, Sanjay Gupta and Patrick Soon-Shiong, Chairman and CEO, NantHealth. Early bird registration ends tomorrow, so hurry!

Additional up-to-date ATA highlights addressed by Jordana:

  • There will be a survey arriving shortly in your email about how and if your organization is using telehealth in primary and urgent care practices when addressing mental conditions.
  • Accreditation initiative: There are five ATA Accredited Telemedicine training programs with a new online patient consultation accreditation program launched in December 2014. –This newly developed training program could be useful for Therapists utilizing Wellpepper.
  • Practice guideline initiatives: There are fourteen completed online documents under development such as the General Pediatric group, Pediatric mental workgroup, Teledermatology (revised guidelines from 2007), Telestroke guideline and an initial draft of remote burns and assessment treatment is forthcoming.

*Blue enacted, Orange introduced and Grey no status.

State license compacts are still being discussed as I mentioned in my last ‘This month in Telehealth’ blog. Latoya Thomas (a truly remarkable intelligent lady and my hero this week), Director of State Policy Resource center at ATA, summarized the current state of things (no punt intended!). There are 11 states that have introduced bills to legislation on how they would like to tackle this issue and sadly, my state, Washington, hasn’t introduced any bill! Legislation has decided that once physicians enter into a compact they will be issued expedited licenses in order to facilitate interstate licensure practices. Interesting Louisiana, Montana and Tennessee are looking at unique telemedicine licensing. There is a state policy webinar April 23rd that ATA will be hosting that might clarify and will undeniably go into more detail.

Last, but most definitely not least, an important CMS event happened on March 20th when “proposed rulemaking for electronic health record incentive program (meaningful use) stage 3 [1] to begin by 2018. This proposal is open for public comment until May 29.” Also this month CMS announced a new payment model “The Next Generation ACO” (as I referred to in a post) which also contained ATA’s request to Expand Telehealth coverage. Gary Capistrant brushed upon the FCC’s Net Neutrality Rules (brushed because it is a heavily loaded topic). I personally have been avoiding it because it’s 400 pages long… and well I already have a headache.

For full audio/video of this webinar please visit here.

Next “This month in Telemedicine” is 4/26.




Posted in: Health Regulations, Healthcare Technology, Healthcare transformation, Telemedicine, Uncategorized

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Bundled payments: a holistic approach to patient care

Institute for Health Care Improvement
Bundles and Buy-Ins for Value-Based care
March 12, 2p ET

Guest speakers:
Mark Jarrett
Susan Browning
Alice Ehresman
Mark Hiller
Kathy Luther

Last week CMS announced a new innovative payment and care deliver model for Accountable Care Organizations (ACOs), called the Next Generation ACO Model. This model requires participating providers to ‘shoulder more financial risk’. This new value based reimbursement was no doubt created due to the success that bundled payments and the Pioneer ACO program have had. In this bi-weekly Institute of Healthcare Improvement (IHI) audio broadcast the focus was on bundled payments for Care Improvement. For those of us new to the various innovations being implemented to improve patient care, bundled payments have the additional potential to save healthcare systems big bucks.

Healthcare Delivery Systems involved in Bundled Care.

Healthcare Delivery Systems involved in Bundled Care.

A thorough, but brief introduction from IHI’s own Kathy Luther was given on the roles of teams and leadership in value driven care redesign. Considering Kathy’s role with the IHI to “help hospital leaders and staff achieve bold aims” her presentation outlined structure strongholds that are vital for tackling value based payment reform. Baystate Medical Center, North Shore LIJ and Premier discuss their experiences and thoughts on these roles.

At Baystate Medical Center, Alice Ehresman has the role of ‘Nurse Bundled Navigator’ (later mentioned as a imperative role for ACOs). She provides real time data metric dashboards to physician groups that are currently involved in Phase II, Model II of total joint replacement and coronary heart bypass surgery bundles. Their success relies heavily upon heavy buyins from the team, strong management of post-acute care resources and a ‘champion’ physician role that is engaged/educated in bundled improvement work. Baystate ‘transparent’ monthly meetings on bundled care has also been vital towards their success which is exemplified in the increase of attendees.

North Shore LIJ had two speakers, Mark Jarrett, MD & Susan Browning, MPH. Mark was very straightforward with how it has been difficult to get physicians, especially procedure orientated physicians like surgeons, to look at the whole continuum of care- from focusing on discrete data points and processes to looking at the big picture of patient outcomes. Physicians have concerns that they are put at risk for part of their compensation because they are not able to fully impact the outcomes of the patients throughout the continuum of care after they leave the surgeons table. Another issue that physicians are bringing to attention is the lack of evidence based metrics. North Shore has also had issue with patients not being discharged to a post-acute environment ; it’s difficult to keep communication clear on negative impacts on one site vs. positive on another.

Mark Hiller also spoke about bundled payment influence on Premier. Mark has a background in financial analysis and developing practical tools to assist hospitals in reducing their costs, so naturally he is involved in bundled payment reform. Mark mentioned the shock some physicians displayed upon learning what their patient went through 90 days post discharge, and in some cases this was the first time they had learned as much. I think this is an extremely interesting comment because it exemplifies how broken the fee for system is in providing holistic care to a patient. He focused a lot on the importance of communication with physicians about bundled payments and that understanding post-acute utilization will be imperative.

One thing that struck home with me was the ‘Culture of transparency and working together’ theme that was mentioned throughout the one hour broadcast. Does value-based care success rely solely on this statement alone? What do you think? Please post any comments you may have below.

Up next with IHI is Managers and Management: We need to improve care on March 26, 2015.

Links to the audio, slides and chat can be found here.

Posted in: Healthcare transformation

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BIG-BIG-BIG. Company, heart and checkbook.

“Delivering Innovation Across the Healthcare Continuum”
Christopher Hall, Ph.D.
Senior Director, Radiology Solutions, Philips Healthcare
March 2, 2015

The last time I was in the Turner Auditorium at UW Health Sciences, I was a Clinical Informatics student learning about telehealth as more or less a theory. That was five years ago, now sitting in the same seat the numbers are flying in with results of how telehealth is saving big bucks for hospitals. For example, according to the presenter Mr. Hall, Banner Health saved 20-40% utilizing more or less the same platform that Wellpepper uses. Sending patients’ home with a tablet and/or connection devices (scales, heart monitors, etc.) and having patient compliance mechanisms in place, i.e. emails, chats between providers and patients. 20-40%, honestly? Wow.

A common thread through his presentation was the importance of streamlining care from the “waiting/hospital room to the living room” and to empower patients through careful, thoughtful and collaborative innovation. To me this is the ultimate goal to accomplish in telehealth, that and the obvious, for patients to get better. Philips currently has 190 million patients with 1 million being monitored in their homes everyday under their charge, this is a large population to be accountable for, so much so next year there will be ‘Philips Lighting’ and ‘Royal Philips’, the latter being in charge of just healthcare.

Telehealth Project from my UW SON Clinical Informatics class. Circa 2011

Telehealth Project from my UW SON Clinical Informatics class. Circa 2011

Philips’ focus now and in the coming years as Royal Philips, is on the Chronic disease patient population, since they make up about 75% of healthcare spending and home health care can help reduce costs without compromising quality. Home healthcare can also prevent readmission to the hospital by 20% and their electronic ICU platform helps significantly with early detection through the ‘over the shoulder care’. Patients are 26% more likely to survive and 15% are discharged faster. Those percentages are not easy to ignore, and the stronghold that telehealth has on a patient’s life, quite literally, and family is remarkable. Ironically I couldn’t help but giggle, during my graduate degree our team designed an ‘electronic ICU’ of sorts as a project, and it was nice to see those numbers while sitting in the same seat. Kudos Philips, who knows maybe someday you will save my life or someone I love.

Please view previous blogs from the Health Innovators Collaborative series.

For more information on these seminars please visit UW Dept. of Bioengineering website.

Posted in: Healthcare Technology, Healthcare transformation, Outcomes, Seattle, Telemedicine

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This Month in Telemedicine: February 2015

Speakers: Johnathan Linkous & Gary Capistrant of American Telemedicine Association.

This month in Telemedicine is hosted at the end of each month by the American Telemedicine Association (ATA) and is free to the public. Archived videocasts are available on their website. I highly recommend checking out their wiki website where you will find information on legislative state issues to general definitions.
62.5 million individuals were on Medicaid last year with a spending of $505 billion in 2013. These high numbers reflect the importance of legislative involvement to determine payment rates for Medicaid healthcare services. For those of us that do not know, Sustainable Growth Rate (SGR) is a system that was put in place in 1997 by the Centers for Medicare and Medicaid (CMS) to control Medicaid spending. Telehealth makes it possible for health services not to end with the clinical visit. However, the system is over 20 years old and pressure is being put on congress to come up with solutions that are in line with the need to move from fee for service to more innovative service models to support new solutions.

With the March deadline of Medicare physician fee payment schedule fast approaching, there is understandably a lot of federal activity. Medicare cuts are again being delayed because the budget estimates on cost of repeal have gone up and there is much difficulty coming up with a way to offset savings. It’s a case of poor budge planning, again. With that said Congress will be applying a ‘patch’ instead of a fix, a common ritual that has been occurring for 15 years. Last year they applied the SGR Repeal and Medicare Provider Payment Modernization Act of 2014 bill as a ‘patch’. It is important to ATA because part of the SGR package is to put in place payment reforms, pressure to move reimbursement from fee for service to various payment innovations and because one provision in particular is set to waive Medicare restrictions for alternative payment methods (APMs). The big deal is this and there is no way around it: “Congress has to act by the end of March in order to avoid Medicare docs from taking a one quarter cut in payment rates.”

The Energy and Commerce Committee, an unlikely participant in the healthcare realm, developed the 21st Century Cures Act launched last April and is considered by Mr. Capistrant the “best single effort by any congressional committee ever on telehealth.” This is exemplified in the many committees on goings, the most resent being their efforts to open up discussions on Children’s chronic health Issues and how telehealth can network healthcare system entities (i.e. The nations Children’s Hospitals, etc.). Mr. Capistrant believes much of the committee push and interest in telehealth are in place because the chairman, that has spearheaded the momentum in congress to build better payment innovations and remote monitoring, will be leaving after this congress.

On a state level there have been over 100 telemedicine bills introduced, 15 states have introduced Provider standards in dealing with telehealth. However there are still eight states that do not provide some form of Mediciad telehealth reimbursement. Regarding State Licensing compacts, the question still looms: to require state by state licensure or move to the nurse’s model of reciprocity? Stay tuned.

Posted in: Healthcare Policy, Healthcare Technology, M-health, Telemedicine

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Infographic: Factors Related to Adherence

Just as no two patients are identical, the factors that affect adherence vary dramatically from patient to patient, and also importantly what type of treatment plan they are adhering to. Adherence to medication is often affected by medication itself: side-effects, contraindications, timing, and the way it is applied. Adherence to a physical rehabilitation program is affected by the function of the patient, very often by the level of pain they feel, and sometimes by the patients own belief in their abilities. Adherence to diet is affected by so many factors including, access to appropriate food and social pressure. Even with these differences, though there are a number of common factors that affect patient adherence, both negatively and positively.

The 2008 study “Factors affecting therapeutic compliance: A review from the patient’s perspective” provides a comprehensive review of research on the subject, and presents this view of the factors.


As a provider, there are some areas that you can influence, and some that are data points that might help inform how you approach the patient. You probably can’t impact their socio-economic situation, but you can understand how it might impact their treatment. For example, how big of a factor is cost or transportation in their ability to adhere to a program? Trying to save money often results in patients trying to take fewer pills than prescribed. We spoke with one arthritis researcher who prescribed swimming for her patients, however, for many of them the cost of a gym membership and transportation to the pool was prohibitive.

When putting together a treatment plan for a patient, it’s good to keep all of these factors in mind, working with the patient to come up with a plan in which they are most likely to succeed. Tailoring the plan to the patient lifestyle, rather than the other way around.

Posted in: Behavior Change, Healthcare motivation, Managing Chronic Disease, Uncategorized

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My Life with Trackers

My Facebook and Twitter feeds are full of people talking about the new gadgets they got for Christmas. Tracking has gone mainstream as many of those gadgets are fitness and activity tracker devices. I thought I’d share a bit about what I’ve learned as an avid tracker for some of these newbies.

I have been using apps and devices to track my activities for over 7 years. When Nike in-shoe sensors came on the market in 2006, I was an early adopter and since then have upgraded to various GPS watches and apps like RunKeeper on my phone. I love tracking my runs and hikes. It adds an extra sense of accomplishment seeing exactly how far you’ve gone, elevation climbed and how fast you’ve traveled. Seeing my progress overtime was especially motivating and helpful when training for upcoming races.  It led me to want to track more. I definitely felt myself getting caught up in the quantified self movement.


Fitbit Flex

So when we decided to get Fitbit trackers at Wellpepper, I was all over it. I was very excited to start tracking activities outside of runs.  I chose the wristband format while Mike and Anne chose the Fitibt Zips that clip onto your pocket or waistband. I liked the idea wearing the Fitbit at all times tracking all activities (including sleep) and thought I would have a better chance of not losing it. We found this to be true right away as Mike lost his first two Fitbits.  (Protip: Clip your Fitbit with your Fitbit inside your pocket.) Anne wasn’t too keen on the look of the sporty black wristband so chose the smaller out of sight zip and also appreciated that the Zip didn’t need to be charged. (However, both Anne and Mike had over a week of no activity recorded when their batteries actually died.)

Fitbit Zip

Fitbit Zip

Initial findings were very fun and intriguing: an Ultimate Frisbee game is about 8,000 steps and a good round of golf about 18,000 steps with up to 20,000 steps if that happened to be a bad round of golf. The most lucrative activity turned out to be dancing, it’s surprising how many steps you can take while dancing at a wedding! (23k)  Step counts varied between the different Fitbit types. As my steps were tracked by the movement of my arm, I definitely got credit for additional steps including a few 1000 from petting an upset dog during a thunderstorm. This caused some debates over the accuracy and fairness of the Wellpepper Fitbit leaderboard, which is definitely a fun and motivating feature of the Fitbit app. 

Fitbit 3Definitely the most surprising findings were how many steps could add up with regular day to day activities.   I found that I generally took around 1000 steps just walking around the house and getting ready in the morning.  A walk to the store to grab a few groceries could garner up to 2000 steps. Turn that trip into a walk to the farmer’s market and you could easily generate 4k steps! It was surprising how a few small decisions could turn a relatively normal day into highly productive and active day.  I found this infographic: The Exercise Experiment: A Tale of Two Days does a great job of showing the difference small choices can make.

Even more surprising, or even shocking, was how many steps I didn’t take on an inactive day.  I work from home and it’s not uncommon for me to grab a cup of coffee in the morning, jump on my laptop and get to work. Some days, the time can slip by and before you know it, the day is gone.  I never used to worry about it because when I am not working, I am highly active. However, after I came across The Truth about Sitting, I decided I needed to be more aware of my overall activity. I think this has been the greatest impact of the Fitbit. I thought that I might dive deeper into analyzing my runs or hikes, but it has actually created this awareness to keep me moving all the time. It reminded me of something John Mattison (CIMO of Kaiser Permanente) said at FutureMed:

It’s not about wearing a million sensors, we don’t need digital nannies, it’s about becoming more mindful.

Posted in: Healthcare Technology, M-health

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Getting the Most Out of Your Golf Game

Ah golf. I love this game. It can be such a frustrating sport, but nothing can beat the feeling of a well struck ball or the sound of the ball hitting the green. I don’t get out nearly as often I would like, but when I do I fully enjoy what the sport provides: a solid four hours of time with good friends out in the beautiful outdoors. When I can find the time to squeeze in a round I want nothing to get in the way. So when I heard that Sitka Wellness was putting on a Golf Workshop to learn how to get the most out of your game and prevent injuries, I grabbed a friend and we went to go and check it out.

Sitka Wellness is a full-service physiotherapy and wellness clinic located in the heart of downtown Vancouver. Along with physiotherapy services, Sitka offers group Yoga and Pilates classes as well as Personal Training. The instructors work closely with the therapists to tailor programs to each individual’s needs. What we love most about Sitka, besides their integrated approach to health, is that they put on monthly community workshops that anyone can attend. They range from managing chronic pain to training for your first 10k. Anne attended a workshop on minimalist running last month.

images (1)Jason Lee, Registered Physiotherapist and TPI Certified Golf Fitness Professional started off the workshop by discussing some of the basic functional movements required to perform a golf swing such as squats, pelvic tilts and trunk rotations. Jason used the example of balancing on one leg. If you weren’t able to perform this simple movement, then you wouldn’t be able to follow through correctly by finishing with all your weight on your front leg. Flexibility, strength, coordination, balance and endurance are all important factors in maximizing your performance. A physical therapist can help you break down your movements and determine where you might need to focus your energy and improve.


The Reverse Spine Angle. The number one cause of lower back pain in golf.

Jason then walked us through these simple recommendations for avoiding injury.

1. Improving physical conditioning before the season starts

2. Warm up before you play, minimum 15 minutes

3. Using a push cart instead of carrying your clubs

4. Engage your core before your swing

5. Rotate through the hips instead of lateral sliding during your backswing

6. Avoid excessive extension as you finish your swing



Using the foam roller in this position can help open up tight chest muscles caused by sitting at a desk all day.

Tip #4  really stood out for me. I know engaging my core is one of my weaknesses and this is where Irene Lugsdin (a Pilates instructor at Sitka) came to the rescue. Pilates is an approach to exercise that focuses on the deep stabilizing muscles of the body or the core. Irene took us through some simple exercises that would help strengthen and lengthen the spine and that would facilitate the flexibility and mobility needed to enhance our golf swings. Irene described Pilates as breath with movement and so we focused on how your breath could help you engage your core but also infuse your swing with a fluid tempo. She also explained that golf is an asymmetrical sport while Pilates is all about symmetry and balance hence the reason these two activities are an excellent combination.

I really enjoyed the workshop. Jason and Irene were both very knowledgeable and engaging speakers. It was great to be able to breakdown the golf swing and really think about the mechanics and the movements/muscles required.  My friend Carla, who came along and who is an avid golfer, was surprised to see the Physiotherapist and Pilates instructor working together. She had never imagined such collaboration between the two practices, but after attending the workshop she thought that it made absolute sense.

Sitka offers comprehensive golf swing assessments where a physiotherapist will look for any dysfunctional movement patterns that could be limiting your performance. The 1 hour golf screen includes a walk through your injury history, a series of functional movement tests as well as a swing characteristic analysis using 2D video.  Once the assessment is complete, the PT can then work with you on an exercise program focused on improving any physical deficiencies that need to addressed. They will even work with and communicate with any golf instructors or personal trainers you might be working with outside the clinic.

We have noticed that many physical therapy clinics offer screening services for golf  and other sports such as Running, Tennis, Softball/Baseball and Cycling.  Working with a Physical Therapist is an excellent way to learn how to take care of and get the most out of your body no matter what you want to do.  I know that I am excited to take my new tips and tricks to golf course. I might even have a chance at beating Carla!

Posted in: Exercise Physiology, Rehabilitation Business

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The Truth About Sitting

I came across this infographic the other day while participating in the weekly #healthtalk tweetchat and I can tell you the stats make me a little uneasy. I would say that Wellpepper is quite an active crew. We all run regularly and participate in team sports such as ultimate and softball. We even moved our Friday meeting outdoors and did a walking/hiking meeting.  However, because of the nature of the software business, we also spend a ton of time sitting with our laptops.

Today I challenge myself and my Wellpepper co-workers to get up and move 10 minutes out of every hour during the workday. We might need to break out the timers and get a little creative with our activities – but we need to find a way to move and break up those long sitting periods.

What are some of the things you do to keep moving throughout the day?

Sitting is Killing You

Posted in: Healthcare motivation, Uncategorized

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Breaking the Barriers to Exercise

Last Friday, May 3rd I attended the IDEA Personal Trainer Institute Conference in Seattle.  IDEA is a conference for personal trainers to come together and get comprehensive, in-depth training from some of the top fitness professionals in the world. Sessions ranged from full-on workout sessions (TRX, Kettle Bell training) to lectures on motivating clients, and running a successful fitness business.  I had the opportunity to attend a session presented by Rodney Corn from PTA Global entitled “Breaking the Barriers to Exercise” in which he discussed how to motivate non-exercisers to get active.

1gf4g Rodney started off the session by asking: “What do you consider exercise?” Now in a room full of personal trainers you can imagine that there were visions of some pretty intense and vigorous exercise. To be fair, the morning sessions looked something like the video you see on the left.  He then asked the room to go through a series of movements. He had us pick up a medicine ball and carry it to the other end of the conference room. Then he had us roll an exercise ball to the other end of the conference room. Pretty easy and non-strenuous movements.  “Was this exercise?” From the expressions of the majority of the people in the room I would say most thought NO.

Exercise is movement.  It is generally defined as movement that is planned, structured, and repetitive for the purpose of conditioning any part of the body. The industry’s  standard for exercise is a minimum of 150 minutes of moderate exercise or 75 minutes of intense exercise per week.  For increased benefits the recommendation is 300 minutes of moderate exercise or 150 minutes of intense exercise per week.

In the following video Dr. Joan Vernikos, looks to simplify the idea of exercise stating:

“The key to lifelong health is more than just traditional gym exercise. The answer is to rediscover a lifestyle of constant, natural, low intensity, non-exercise movement that uses the gravity vector throughout the day.”

So if exercise is so simple, then why aren’t more people doing it? The situation today is pretty dire:

  •  1.6 billion people are overweight or obese in the world
  • 60% of people worldwide don’t get sufficient exercise
  • 70% of the US population is overweight or obese
  • Less than 20% of people get the recommended amount of physical activity
  • 25% of US population does ZERO physical activity

There are more fitness facilities, personal trainers and education than ever, yet there is also less participation in exercise and more disease than ever before. What are the barriers to exercise? Why are so many people remaining inactive? Rodney suggested there are two major obstacles: Pre-existing level of activity and the suggested time required to exercise.

Dr. Roy Sugarman, Neuropsychologist states: “People need the reward of micro-goal successes to avoid ambivalence about the big goals”.   So breaking down daily activities into smaller, shorter bouts and intervals would be much easier for the sedentary populace to digest. Protocols for non-exercisers and beginners should be just 5 to 10 minutes in length. It has been scientifically proven even short intervals (5-10 min) of activity can have a physical and mental benefit.

At this point of the lecture you could hear the collective sigh of the trainers in the room.  Really? Only 5-10 minutes? Personal trainers are used to pushing people to their limits. They turn even the average Joe into an athlete. How can 10 minutes be enough? Rodney hammered home the point by saying:

“People are more likely to change when they have a sense of control, can manage the process and see some quick micro results.”

Trainers should match exercises and programs specifically to the client by knowing their personality, behavior patterns and motivation. They should ensure that the program gives the client a sense of control and that the length of exercise is short enough to facilitate change. The fact is, the more often you can get someone to do an activity, the more likely you are able to help them establish a new habit. If the program is overwhelming for an individual, they just won’t do the exercises. Training programs need to be appealing, nonthreatening and most of all – achievable.

The fitness industry is not designed to meet the needs of the sedentary population because the fitness industry’s idea of exercise is too high. The reality is that any movement is exercise and for some just doing simple movements around the house is where they need to start. As Dr Joan Vernikos says: “Sitting kills, movement heals”. Helping someone get in the habit of performing even the simplest of movements can move them towards a more healthy and active lifestyle.

At Wellpepper, we motivate behavior change by giving clients detailed instructions, reminders, and motivational prompts to remember to do their exercises. Many professionals we have worked with recognize that when it comes to motivation, sometimes less is more.  However, some have asked how many exercises can you prescribe to clients with Wellpepper? The answer is as many as you like,  but the trick is to find that magic amount for the end customer. What will drive them to change?

Posted in: Exercise Physiology, Healthcare motivation

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Counteracting the Strain of Running with Yoga

Last week, I attended a yoga workshop at the local gym called “Strengthening and Stretching for Runners”. The main idea behind the session was to introduce basic yoga poses that you could perform before and after a run that would enhance your running and prevent injury. Confession: I am a terrible stretcher. I never stretch before a run and occasionally dedicate enough time to cool down properly post run. I thought this workshop might be just what I needed to motivate me to introduce proper stretching into my routine.

To start off the workshop Bev Akhurst from Eastside Fitness took us through a quick anatomy lesson so we could discuss the major muscles involved in running and their primary function.  We focused primarily on the following muscles:

  • The Quads stabilize the knee and help absorb the shock of impact as you land.
  • The Hamstrings straighten your hip and begin to bend your knee. They also help you lift you knee for the runners ‘kick’.
  •  Your Calf Muscles extend and flex each foot as you land and push off. These muscles also help absorb impact and give you the spring in your stride.
  • Strong Glutes (Gluteus Maximus) help stabilize the trunk and keep you upright. These muscles contribute to good running form and alignment.
  •  Hip Flexors (illiopsoas) work with the quads and hamstrings to move the legs forward and back.

imagesOnce we had the anatomy tour and a good understanding of what muscles we were dealing with, we moved our focus to the yoga poses we could do to counteract these movements.  We went through a variety of poses that ranged from a simple Forward Fold to a twisting variation of Downward Dog (which may take me a few more tries before I get the hang of it).  Some poses focused on warming up and opening tight opposing muscles such as the Wide Leg Forward Fold. Others focused more on strength such as the Chair Pose which stretches and strengthens the glutes.  Overall, the exercises focused on counteracting the stresses of running to improve form/balance and prevent injury.

I think the biggest thing I got out of this workshop was an increased awareness of the impact that my hobby might have on my body. Running on a regular basis has many benefits, but it can also be one of the more physically exerting activities and cause common injuries such as Runner’s Knee, Iliotibial Band Syndrome and Achilles Tendinitis .  I will definitely be more mindful of my body and treat it with care.

This workshop also inspired me to bring yoga into other areas of my life. I decided to switch things up a bit after a long day of snowboarding and head to an apres yoga class rather than the usual apres activity of beer at the pub. Apres never felt so good! Thanks to Bev and Eastside Fitness for the inspiration and a great workshop.


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My Quantified Self

My nephew asked me the other day “How fast can a human run?” My first thought was of the Olympics and the 100 meter dash and I was quickly trying to make the conversion in my head to miles per hour. Then I thought, “Wait! I know my average speed.” I look at this information all the time.

Look Mom - I ran around a volcano!

Look Mom – I ran around a volcano!

I am training for my first half marathon and use NikePlus and RunKeeper to track my progress. I absolutely love these applications and have become addicted to tracking, analysing and sharing my personal running stats. Both of these applications do an excellent job of visualizing the data – distance travelled, calories burned, and average pace – which makes it fun and easy to share. I even received a “speeding ticket” the other day from an integrated app with RunKeeper when I hit a new pace milestone.

This addiction to data has led me to start tracking other items in my life. I now track my sleep patterns with an app called Sleep Cycle. HeartMath checks my daily stress levels by using the camera on my iPhone to take my resting heart rate. This tracking isn’t limited to health data, I have used Klout to measure my influence in social media, InMaps by Linkedin to see a visual representation of my connections and Mint to recognize patterns in my spending. The awareness this tracking provides has led to personal growth and positive change in all of these areas.

And I am not alone. A recent survey by the Pew Research Center’s Internet & American Life Project states that

Seven in ten (69%) U.S. adults track a health indicator for themselves or a loved one and many say this activity has changed their overall approach to health.

Some people go much further in their health tracking: founded by Kevin Kelly and and Gary Wolf of Wired Magazine, the Quantified Self Movement has exploded over the last 5 years starting with the initial group of 15 in the Bay area to an organization of thousands that spans the US and Canada. Meet-ups, where members get together to discuss what they are tracking, how they are tracking and what they are learning, are popping up all over North America.  The Quantified Self Motto: “Self Knowledge Through Numbers.”

Moves Storyline

Moves Storyline

However, according to the Pew study, not everyone is taking advantage of the thousands of new apps and medical tracking devices available with only 1 in 5 people using some form of technology to track their health data.  A lot of this tracking remains informal with 49% saying they keep track of progress in their heads.

Passive data tracking applications,  like Moves which tracks your daily movement, can augment the ‘in your head’ tracking. There is absolutely no input required, the iPhone app just automatically records any walking, cycling, running that you do. It’s a diary of your daily movements, a summary of your everyday exercise to help you think about your life in a new way. Knowing how many steps it is to the office might encourage you to walk there more often. Even the smallest changes can make a huge difference and that is generally where people start when making choices that lead to long time healthy habits.

So how do we encourage people to use these tools and technology when we know the data has such a powerful impact on their motivation for positive change?

I think apps like Moves that allow users to ease into self tracking without a lot of effort are a great start. Beautiful interfaces and fluid navigation are critical.  For every app I have on my iPhone , I have downloaded and deleted 6 more.  If it’s not engaging, easy to use and provide a new and valuable service – it’s gone and usually within the first 10 minutes.  Stunning visualizations of relevant data are also important to enable users to see usually boring stats in a fun and creative way,  motivating them to improve those numbers and share with their supporters.

What self-tracking apps do you use? And what features have motivated you to continue using those apps?

Posted in: Healthcare motivation, Healthcare Technology, M-health

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Social Media Support and Recovery, the Patient’s Perspective

In the year 2000, I injured my neck playing softball for the University of Massachusetts. I remember it clearly, we were playing Boston College and I dove for a line drive in the outfield. I made the catch and got up to start making my way off the field and collapsed. It was the last play I made in a UMass uniform.

Dealing with the pain of the injury and the disappointment of not being able to play were one thing, but the hardest part turned out to be the isolation of rehabilitation. While my teammates were heading to class, training and travelling to games, I was visiting doctors, surgeons, and physical therapists. I had lost my routine, stress relief through physical activity and social group all at once and to top it off I was 2000 miles from home. It was before everyone had a cell phone, before social media and I felt very alone in my recovery.

Facebook now boasts 900 million users, and is posed to reach 1 billion users soon. Twitter is estimated to have more than 500 million users. With this many users, communities within communities have developed in each social network. These communities have served to fill a void in the lives of people who face health problems, satisfying the universal human desire to know ‘you are not alone.’ The Empowered Patient: 5 ways Social Media Makes Patients Stronger.

Two months ago a close friend of mine tore her Achilles’ tendon while playing tennis. She is a very active individual and her social life revolves mainly around the activity clubs she belongs to. I found out about her injury via a Facebook post. Throughout the past eight weeks she has posted updates on her rehab progress. Updates ranged from her progress at physical therapy, to who popped by for a visit and boosted her spirits, to how her incision was healing. And though I could have gone without the pictures of the surgery incision, I have appreciated the honesty and raw emotion behind her posts.  Facebook has allowed her to keep in close contact with her support system even though she can’t make it to the tennis court 3 times a week.  It has also allowed me as a friend who lives in another province the ability to keep up to date and support her even if it is with a “like” or a small comment here or there.

lvohn Even professional athletes flock to social media for additional support. Olympic and World Cup skier, Lindsey Vohn recently announced on Facebook that her knee surgery went well and took the opportunity to thank her family, friends and fans for all their support.

The Internet can be so powerful in the way that it connects people, educates them on their illness or injury and empowers them to take charge of their recovery. People can now share their experiences with strangers who have the same injuries or illnesses, research their own treatment options or even become advocates for others long after they have recovered.

I can only imagine how much social networks such as Facebook or Twitter would have helped me had they been around while I was recovering from my injury. Perhaps I could have continued at UMass rather then head home to rehabilitate? Hard to say. However, I do know that I will continue to encourage family and friends to use social media as a tool to interact, learn, and take charge of their overall health.

Posted in: Healthcare Social Media

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