‘I’m here to undo that harm’

Thanks to the toxic internet culture that’s impossible to avoid nowadays, exercise has become more of a punishment than an enjoyable activity. Society has taught people to equate exercise with worth, to the point that some people will directly measure their merit in how many minutes or hours they spend at the gym on any given day.

However, exercising isn’t meant to be a stressful, anxiety-inducing endeavor, and one personal trainer is on a mission to dispel the myths surrounding physical activity.

Fitness professional Raneir Pollard, a self-proclaimed “sweat king,” is using his various social media platforms to help people redefine and reexamine the word “exercise.” Though Pollard works in the fitness world, he believes that exercise encompasses far more than traditional workouts and strength classes.

“I consider exercise and movement to be one in the same,” Pollard told In The Know. “I see them as a spectrum — movement, light movement, light exercise, all the way to heavy movement, heavy exercise … We are looking to engage in movement practices that are gonna allow us to live longer, fuller lives … It’s about, just like everything else in this life, finding a nice balance, but definitely acknowledging that proper movement practices are for you.”

On TikTok, where he has more than 32,000 followers, Pollard posts motivational videos encouraging his followers to adjust their mindset surrounding the idea of exercise. In one of his most popular videos, he tackles the common notion that exercise and movement are two different things, explaining that “all movement is exercise.”

“Unfortunately so many people have a negative association with the word ‘exercise’ because we live in a world that likes to shame folks into workouts,” he explains in the TikTok. “I’m here to undo that harm!”

As a trainer and instructor, Pollard spends a lot of time around all different types of clients. But while some take his classes and enlist his help because they truly enjoy being active or want to be fit and flexible well into their geriatric years, others work out simply because they think they need to. This is the attitude he’s trying to change.

“The one thing I wish people would stop associating with fitness is shame,” Pollard said. “I know that some people find it to be a positive motivator [but even] if that is for you, I still recommend trying to go the route of love with this because at the end of the day, your habits will beget your habits. When you start to go down the road of shame, it’s so hard when other things in life are beating you down and you did have to skip that workout, how much that’s going to negatively impact your mindset.”

Of course, it’s hard to completely change the way you think about exercise when you’ve been conditioned to believe that you’re only as valuable as the number of hours you spend at the gym. The first step, Pollard says, is acknowledging changes need to be made.


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Unneeded Meds at Discharge Could Cause Harm

A significant number of patients leave the hospital with inappropriate drugs because of a lack of medication reconciliation at discharge, new research shows.

Proton pump inhibitors — known to have adverse effects, such as fractures, osteoporosis, and progressive kidney disease — make up 30% of inappropriate prescriptions at discharge.

Harsh Patel

“These medications can have a significant toxic effect, especially in the long term,” said Harsh Patel, MD, from Medical City Healthcare in Fort Worth, Texas.

And “when we interviewed patients, they were unable to recall ever partaking in a pulmonary function test or endoscopy to warrant the medications,” he told Medscape Medical News.

For their retrospective chart review, Patel and his colleagues assessed patients admitted to the ICU in 13 hospitals over a 6-month period in North Texas. Of the 12,930 patients, 2557 had not previously received but were prescribed during their hospital stay a bronchodilator, a proton pump inhibitor, or an H₂ receptor agonist.

Of those 2557 patients, 26.8% were discharged on a proton pump inhibitor, 8.4% on an H₂ receptor agonist, and 5.49% on a bronchodilator.

There were no corresponding diseases or diagnoses to justify continued use, Patel said during his presentation at CHEST 2020.

Button Fatigue

The problem stems from a technology disconnect when patients are transferred from the ICU to the general population.

Doctors expect that the medications will be reconciled at discharge, said one of the study investigators, Prashanth Reddy, MD, from Medical City Las Colinas in Texas.

But in some instances, clinicians unfamiliar with the case click through the electronic health record to get the patient “out of the ICU to the floor,” he explained. “They don’t always know what medications to keep.”

“They may have button fatigue, so they just accept and continue,” Reddy told Medscape Medical News.

In light of these findings, the team has kick-started a project to improve transition out of the ICU and minimize overprescription at discharge.

“This is the kind of a problem where we thought we could have some influence,” said Reddy.

One solution would be to put “stop orders” on potentially harmful medications. “But we don’t want to increase button fatigue even more, so we have to find a happy medium,” he said. “It’s going to take a while to formulate the best path on this.”

Patients are always happy to hear we’re taking them off a drug.

The inclusion of pharmacy residents in rounds could make a difference. “When we rounded with pharmacy residents, these issues got addressed,” Patel said. The pharmacy residents often asked: “Can we go over the meds? Does this person really need all this?”

Medication reconciliations not only have a positive effect on a patient’s health, they can also cut costs by eliminating unneeded drugs. And “patients are always happy to hear we’re taking them off a drug,” Patel added.

He said he remembers one of his mentors telling him that if he could get his patients down to five medications, “then you’ve achieved success as a physician.”

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Peer-based anti-bullying initiatives may harm victims more, researcher says

Oct. 20 (UPI) — Encouraging classmates to defend bullied pupils may do more harm than good, according to a review of existing research published Tuesday by Child Development Perspectives.

Unlike programs that include parental training, firm discipline or enhanced playground supervision, interventions that involve working with the peers of bullied students tend to lead to increases in the behavior, the author wrote.

So-called “bystander interventions,” in which peers are trained to come to the defense of the bullying victims, may actually increase feelings of victimization and distress by “disempowering” them, reinforcing or provoking bullying or eroding broader support for them, the review suggests.

“Many school bullying prevention programs encourage and train peer bystanders, or helpers, to get actively involved in assisting with possible instances of bullying,” review co-author Karyn L. Healy said in a statement.

“Although this approach is very common and well-intentioned, there is no evidence that it helps victims [and it] may actually produce adverse outcomes for victims,” said Healy, a research officer from QIMR Berghofer Medical Research Institute in Australia.

Although most researchers agree school bullying is harmful to students’ mental health, studies designed to evaluate the effectiveness of bullying prevention programs have generated mixed results and demonstrated few if any benefits for secondary school students.

Most studies on the effectiveness of bullying prevention programs assume that each program affects bullying and victimization in a simple and unified way.

Healy found, however, that many programs combine a range of different strategies and participants, which are likely to produce varying results.

Recent evidence suggests that even when prevention programs are successful in reducing bullying, they still may be harmful to the individual students who are victimized the most.

“Having lots of peers involved makes the situation more public, which can be damaging to the social reputation of victims, [and] also prevents the victim from handling a situation themselves and may make them look weak in the eyes of the bully,” Healy said.

“Training students to intervene in bullying also has the potential of leading to overuse of peer defense strategies because of benefits to helpers, such as making helpers feel they have higher status or increasing helpers’ feelings of belonging in school,” she said.

To lessen the risk to vulnerable students, Healy suggests that schools be wary of bullying prevention programs that lack evidence of effectiveness for reducing bullying and victimization.

Schools should avoid using strategies that boost peer visibility of victimization, such as identifying a victim in a class meeting, she said.

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Knuckle cracking may harm your hands

“Harmless” is overstating it, however, argue experts who have studied the fine print of the research. Even as there’s no strong link to arthritis — specifically osteoarthritis, the degeneration of the cartilage cushioning the ends of bones — cracking knuckles, they conclude, may still harm your hands.

Seattle neurosurgeon Rod Oskouian is the most recent researcher to jump into this small but lively tributary of mainstream science, as co-author of a 2018 review of knuckle-cracking studies in the journal Clinical Anatomy.

Oskouian and his three colleagues pored over 26 sometimes-contradictory papers regarding the mechanisms and effects of knuckle cracking, beginning with a 1911 German treatise titled “On the Dispute About Joint Pressure.” He did so, he said, after becoming fascinated by the universal inability of his students through the years to explain what makes that cracking noise.

Modern scholars now agree that bones themselves aren’t cracking, but rather that the movement creates a bubble of gas in the synovial fluid lubricating the joints. Researchers still don’t know if it is the bubble’s formation or subsequent pop that makes the noise, but Oskouian said the mechanics are similar to a chiropractor’s “adjustment” of the spine, which also elicits a cracking sound.

Joining with several of their predecessors, Oskouian and his colleagues concluded that researchers have yet to show any reliable association between knuckle cracking and arthritis. A 2017 study of 30 knuckle crackers offered evidence that the habit even increased range of motion.

But that still doesn’t give knuckle-crackers a pass — especially not if they do it a lot and for a long time, or have a preexisting problem.

“Knuckle cracking over the years will cause repetitive trauma to the joints and cartilage,” Oskouian said in a telephone interview.

Studies he cited in his review suggest that long-term knuckle cracking can cause significant damage short of arthritis, stressing and ultimately degenerating cartilage. In 2017, a team of Turkish scientists who examined 35 people who cracked their knuckles more than five times a day found that while it didn’t appear to affect grip strength, it was associated with a thickening of the metacarpal cartilage, a potential early sign of damage that can lead to osteoarthritis.

A more ambitious 1990 study of 300 participants over 45, including 74 habitual knuckle crackers, found that while, again, the crackers had no greater rates of arthritis, they were more likely to have swollen hands and, in this case at least, weaker grips.

“Habitual knuckle cracking results in functional hand impairment,” concluded the two authors, based at the former Mount Carmel Mercy Hospital in Detroit. For good measure, they also noted that habitual knuckle crackers were also more likely to do manual labor, bite their nails, smoke and drink alcohol.

Orthopedists vary in how seriously they regard knuckle cracking as a health threat. Oskouian ventured that the habit is probably harmless for most people, adding that most of his patients seem to abandon the practice after a few years or so.

Yet for perhaps as much

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