Notes from Clinical Medicine 2 part 1 (Pain Rehabilitation)

”Don’t worry, it’s only 18 pages”

In the following link is an amalgamation of my notes from lectures and the course literature.

Rehabiliteringsmedicin Vecka 1
This document includes ”Introduktion i Rehabiliteringsmedicin”, ”Presentation av en patient”, ”Neuropatisk Smärta”, ”Myalgi och Fibromyalgi”, ”Whiplash Associated Disorders, långvarig smärta och överrörlighet” and ”KBT vid långvarig smärta”.

Some things are cleaned up and others are just straight up what I wrote down/or copies of the PowerPoint. In my opinion they have a big focus on the physiology of pain, different mechanisms that amplify, cause and facilitate pain, as well as how these can be countered with physical exercise and other treatments such as TENS, acupuncture and soft tissue treatment. These can have psychosocial effects in addition to biological effects which is an important aspect to take into consideration, especially since multi-modal rehabilitation is an important tool for treating long lasting pain.

Read ”Rehabiliteringsmedicin” and ”Om Smärta” to recap and expand knowledge!

A Reminder On General Healthy Habits

Sometimes I need to remind myself of what is important for me. Since I started studying physiotherapy, and also since starting this blog, my habits have changed a lot. I’d like to think mostly for the better. That said I think it’s time for me to sharpen the saw and take a look at the habits I think are the most important for me, a generally healthy person, to focus on. Maybe you’re also in need of a quick refresher of what is good for you! If you’re a bit off track in your life, this list will help you get back.

Sleeping well

Whatever you want to achieve in life, it’s my opinion that it will be a lot easier on a good night’s sleep. Being properly rested has a profound effect on everything else you do. I often wake up very tired, but if I got enough sleep I will always shake the tiredness off and be able to do the things I want to during the day. Often, going from sleeping bad for a few days, to sleeping well is like turning off a fan; there is a tiredness you don’t even notice until it’s gone, or you think hard about it. So for sleepness sake, sleep sweetly.

Eat well

You know it, I know it. But do we internalize it? I’ve definitely gotten better the past few years, but eating well and in moderation does not come naturally to me. It requires effort, making this one of those habits I’ve been needing to work on the most intensely. Just like bad sleep, bad food foggs my brain and I don’t realize it until I start eating well.

Move a lot

I’m mainly talking about taking a walk. Exercise deserves its praise, but being active in general often gets swept under the rug, unless information is aimed at the older generation. The number 10000 steps every day is often thrown around. FYSS2017 says around 7000 at least should be reached. I say 15000 if you have the time and possibility. That probably equals 2-3 hours walking every day. It sounds a lot because it is. But I’ve started doing that, and for me it works.

Exercise quite a bit and know your limit

Try to get some aerobic exercise every day. That includes: running, cross trainer, bicycle and fast paced walking. You should also incorporate resistance training 2-3 days a week. It’s not as important for your mental health or overall energy level but has many health benefits nonetheless. How much resistance you actually need to be healthy is something I want to study more closely.

Don’t spend too much time having “fun” or in another way: Do something spiritually rewarding

I think you instinctively know what I mean despite using a word as diffuse as “spiritually”. The line between resting and relaxing and indulging isn’t sharp, but you can often feel it after you’ve done it. This habit goes hand in hand with the others, and while you may not need it, I will provide two examples:

You’re watching your favourite show. You’re supposed to go to bed. You say “just one more”. At 02:00 AM you’re too tired to hold your eyes open and you finally sleep.
You’re watching your favourite show. You have a bowl of candy/crisps/other very nice tasting snack. You say “just one more”. Suddenly there is nothing left.

I don’t think I need to go on. I want to stress that it’s important that we have our “vices” and spend time relaxing and regaining our energy. But it’s also so easy to fall into excess, and not give time to the things that we actually want to do and be good at. I think most of us have something we’d like to do that we just don’t get around to, be it playing an instrument, drawing or cooking interesting food. Learning isn’t always fun, but it’s spiritually rewarding and getting into the habit of learning new things will definitely enrich your life.

Besides, I don’t think you should aim to have fun, but to be content. But that’s another, very interesting line of thoughts for another time.

If you like this, follow me on here and on Twitter and Instagram. I will try to progressively be better at using them.

Choosing to quit physiotherapy

Since I began my education here, quite a few people has dropped off. Life reasons, such as landing a dream job or other interests often get in the way and you have to change course. I decided to interview a few people as to their reasons for departing from their programs.

I want to shine a light on the reasons they left, what they liked about the program and what they didn’t. These aren’t deep dives, just quick reflections, but I think it’s important to do that too. The interviews are translated from Swedish.

How come you decided to study Physiotherapy?
The main reason was that I wanted to study something, anything, and I’ve been to a physiotherapist a lot before applying, due to a knee injury 2013. I thought the job looked fun, and I liked the thought of working outside of a hospital. I also liked the idea of being able to start my own clinic and the broad range of things to work with.

What did you like the most about your time here?
You got to read about a lot; physiology, anatomy, psychology. I thought it would be less breadth to it, but deeper. I liked that we got to try many ways of practicing physiotherapy. In the gym, doing tests. I liked that there seemed to be many areas to work in.

What were the parts you didn’t like?
One thing I didn’t like was the over admission in terms of students. This was specially annoying during the practical phase where everyone wanted help from the teachers but the sheer amount of students prevented some from getting help. So too few teachers in relation to the amount of students. Some courses also had questionable lectures, but I guess that happens at most places.

If the information about the education was better, would you have never applied in the first place, or was it something you had to try?
No, not really. The info at the website shows mostly what you can expect, and they do warn of the over admission. Maybe, more perspectives from students in the forms of blogs. There is one, but it’s not really pushed to the forefront in my opinion.

When did you have the realization you needed to change course and why?
Maybe I wasn’t really committed from the start. When we started the practical moments, around physiotherapy 2, I felt that the knowledge stayed more surface level and I wanted to go deeper into it.

Now studies: Dentistry at KI

Melissa Kahilainen

How come you decided to study Physiotherapy?
I sat there a week before admissions thinking: “what will I do this autumn?”. Primarily I wanted to study engineering at KTH but I needed a foundation year in natural science. So my boyfriend had the idea that I should study physiotherapy since it was something I had thought about before. So I did both at the same time.

What did you like the most about your time here?
I like the theoretical parts the most. I like nerding into the things I like, and exercise has always been one of my interests.

What were the parts you didn’t like?
Ever since the first course in physiotherapy I started feeling like it wasn’t for me. And in physiotherapy 2 I felt kind of the same. So I didn’t enjoy the practical parts and also that the pace was too low.

If the information about the education was better, would you have never applied in the first place, or was it something you had to try?
No, I don’t think so. I had a thought about finishing the education and then go into science, something I seriously considered.

Now studies: Architect at KTH

Thanks for reading!

Review of Clinical Medicine at KI

After we have completed each course at KI we have the opportunity to give feedback. I’m going to go out on a limb and write this review as an open letter. I will try to tackle each element of the course that I think needs tackling and I will offer some changes that I believe can be made. So let’s begin with the first thing that faces us students when a course begins. I use the words lecture and presentation interchangeably because I felt that often we were being presented to, not lectured. I’ll start with the brightest part:

Where it shone

Let’s be honest. No one is going to contest that Rheumatology hands down gave us the best showing. During presentations a physiotherapist was there helping steering the information, the presenter seemed to know what we needed to understand and what was just interesting information and we got to meet patients and try to find out what type of rheumatological disease they had by asking questions about their symptoms. That is grade A teaching.

Now let’s get into the learning experience:

Administration

I think they know where they screwed up, but I would like to point it out anyway in list form:

They didn’t invite anyone into the platform (Canvas) and so we couldn’t access any material/information until two work days before the course started.
They didn’t put the schedule on TimeEdit, the platform we use for schedules. The first two weeks were simply not there. Since we weren’t invited to the canvas rooms we were very confused indeed. They did have the rest of the course on TimeEdit, however we couldn’t trust that schedule because they had supplied us with another one in PDF form which we could find in Canvas.
Multiple times they updated the PDF schedule in Canvas. And they did so without sending out a message. This means that if you downloaded the schedule, you may have missed something (although we are good at informing each other).
At first there was no order to the file system. Canvas has a system called modules, which the course didn’t use, they just threw everything in one folder. Considering the fact that teachers in general are bad at naming PDF:s this was annoying. They did eventually sort the files in folders (but didn’t use modules).
The uploaded PDFs were often obsolete and many times not made to the one who held presentations. We had to continually ask the administrators for updated information.
Each part of the course had a book associated with it. That’s 6 academic books written for medical students (we’re not medical students) for one course. It’s almost as though they didn’t expect us to buy or read anything!

Presentations

I don’t want to be mean to the lecturer, although I think some of them phoned it in, because they were mostly enthusiastic and knowledgeable about their subjects. But when I, after receiving one and a half hour of intense information dispensing, asked “So what do you want us to take with us from this?” I don’t want the answer “I don’t know”. However, that is the answer I, and others got. The problem with the teachers not knowing what we are supposed to learn can’t be understated. I really hope they do a better job of informing them in the future, of what we are supposed to know. I want to also say that some presentations were amazing, fun and very interesting. It was a roller coaster really. The sad thing is that I think that much of this could be counteracted by a simple solution that i will get to in the end.

Examination time!

The examination on Neuropathy was a joke. The questions were almost exactly the same as previous years and in my opinion didn’t reflect well what we learned. You could have just studied old examinations the day before and skipped everything else and still gotten a full score. I was done in 11 minutes and got the full 20 points. “Damn you’re fast and smart Noa” I hear you think. NO. Everyone was as fast and everyone I asked got full points. If you didn’t get full points it doesn’t mean you’re stupid, it means you didn’t study examinations from previous years but instead from the lectures, or just wrote something wrong which can happen to anyone. They didn’t take this examination seriously which is proven by the fact that they didn’t have a real examination hall and you could easily cheat by bringing your phone because the one who sat there couldn’t really see us that well. And the lights didn’t work. If you have ever been to a real examination you know they try to restrict cheating in many ways, partly by spacing us out, have multiple people

The second examination which covered all other aspects of the course often felt like it wasn’t written by the people who held the lectures. The information was sometimes contradicting the information we got from teachers. In particular one question regarding how long it would take for a certain fracture to heal was different, and who knows what else they know that we don’t? It’s enough to tilt people, and it’s not good.

What could they have done?

Here is the straight up most important change they need to make for the next term:

GIVE US STUDY QUESTIONS!

How hard can it be? If we have these, we can listen to the presentations in a much more knowledgeable way and have an idea of what to ask if the presenter misses something, or if it’s unclear what they mean. Other courses have this and I do not see why Clinical Medicine cannot have this.

STANDARDIZE

Seriously. Some of the presentations gave us information in a terrible manner. Stumbling over different bits of the information in an order not conducive to learning. When giving information it’s critical to give it in such a way that a student can learn it. One of the most boring presentations was good because the teacher just ran through the conditions in a way that was easy to note down and practice. Had it also been funny it may have been better, but I’ll take an informative experience that teaches me something over a fun one that doesn’t when I’m at school.

SMALL THINGS

I hope you don’t see this as petty, because the devil is in the details. If the small things don’t work it affects the big things.

Invite everyone to canvas
Have the schedule on TimeEdit and inform of changes
Use the module function in Canvas, it’s there for a reason
Try to have all the presentations in halls on campus
Make sure teachers are prepared to receive and answer emails; we had some trouble contacting them during this course.
Make sure teachers bring their own computers, or that they are provided one by KI; us students are not supposed to supply our own technology, except for note taking.
Fit the slides to the purpose: 120 slides for a couple of hours isn’t conducive to learning.

Changes
1. Give us study questions to help guide us

2. Use the module function

3. Inform us of updates to the schedule

4. Have a uniform naming convention on files

If you reading this is a person that feel like the feedback provided here is relevant for you, please don’t act defensively. I’ve written this because I want genuine positive change for the people who are coming after me. I also hope to learn myself from this experience so that I may avoid them in the future.

Thanks for reading.

Experiences from KI Summer School in Medical Research

I’m in the middle of explaining what an accelerometer is.

The 30:th of August I submitted my report, officially concluding my endeavour at the Karolinska Institute Summer School in Medical Research (KISS from here on). There is always a sense of relief when you’re done, like a great weight is lifted off your back. Though to be sure: I never felt truly stressed from taking this course. And while some people were a bit nervous at their presentations, no one looked too shaken or stressed out. It seemed like a great experience for most people I talked to.

What are you talking about?

If you don’t know what KISS is, I’ll give you a brief rundown.

You find yourself a supervisor that is working on research.
You help them with their research and learn how it’s done.
You write a report, make a poster and do a presentation for the other students of the course.
???
Profit.

Me and Sebastian from my class did the course at the same time.

And that is basically it. Here is the obvious question: Should you apply for it?

The short answer is: Yes.

Why yes?

The likelihood that you will get an opportunity like this during your time at KI is slim. 2019 they only accepted 2 physiotherapists, but I believe that the more we are why apply, the more they will take on. Here are some things you get:

A full week of lectures and presentations about research at KI (including sandwiches, coffee and kanellbullar)
A 17500 kr scholarship, not a lot of money but you don’t have to pay it back.
A certificate for participating.
An invaluable foot into the door of science and research.

Scientists with benefits

You will also have a huge benefit when you’re doing your bachelor’s thesis (c-uppsats) because a) you’re already familiar with how to write a report and make a poster, b) you’re already part of a project that you can take part in again and, c) you will be more specialized in reading and understanding reports from an area. For me that is Stroke and Neurology.

The moral argument

Here is another thing: Physiotherapy needs more critical science putting our methods to the test. We are often lumped in with other fields that aren’t precisely based on hard hitting science, and a lot of physiotherapists also subscribe to alternative medicine. I’m not going deeper on that right now, but to be sure: we need more science on the field of physiotherapy.

It’s not super easy, but not super difficult

This is not like normal university, where everything is laid out for you and you mostly know what to study. At least for me, I had to do a lot of independent work from explaining what the course was about, to doing lab tests, writing and practicing for my presentation. This means you have to learn to get driven real fast or perish. My supervisor was also a beginner at having students so it was a learning experience for him. I don’t know how it is for the other disciplines like Biomedicine or Odontology, but I don’t doubt it’s similar. I got a lot of help from my supervisor but he also made sure (aware or unaware) to not lead me by the hand too much, because:

It’s not all that difficult either. They are not expecting you to be a distinguished scientist. My supervisor said it well (I’m paraphrasing):
”You’re very good for a first year student”.

It’s easy to start out with some grandiose ideas!

Of course: you want to do a scientific breakthrough! But pretty quickly you learn humility and live with taking a small first step. And as first steps go, KISS is fantastic. So take it, it’s yours. I formally give you permission!

Here is a link to read about the course!
https://education.ki.se/ki-summer-school-in-medical-research

Applications open later this fall, but you can look for a supervisor already. A lot of your teachers and lecturers work on research and some of them will be excited to take you on. They in turn need more experience in having students working for them so that they can better take on new ones in the future. The field of physiotherapy needs more Science!

I’ve worked really hard to not make this blog 2000 words long, so leave me a like if you appreciate it or share it with a friend at KI that should do science!

Anteckningar från Medicinska Ämnen 1 (KI)

Välkommen att läsa min anteckningar från kursen Medicinska Ämnen 1 på Karolinska Institutet. De är specifikt för mig och kan därför innehålla information som inte är nödvändigt att veta för att klara kursen men som jag finner intressant. Dokumentet kommer att uppdateras kontinuerligt.

Tentor från tidigare terminer! (Tack till Carolina!)

Här är en lista på begrepp som kan vara mer eller mindre intressanta att lära sig!

Neurologi

1: Neuroanatomi/Lokalisationslära, Neurologstatus, Cerebrovaskulära Sjukdomar (den bästa delen) Varning: väldigt ostrukturerat och jag orkar inte fixa det 😀

2: Neurokirurgi/Neurotrauma, Hjärntumörer, Muskelsjukdomar

3: Multipel Skleros (MS), Yrsel, Central/perifer pares

4: Parkinsons, Rörelsesjukdomar, Motorneuronsjukdomar

5: Ryggmärgsskador, Huvudvärk, Epilepsi sigh…

Ortopedi

1: Inledning, Höft/Knäleder, Artros/Endoproteser

2: Frakturlära

3: Idrottsortopedi/ledbandsskador, Axel/Armbågsled/Hand, Skolios, Rygg

4: Barnortopedi, Patientdemonstration, Foten

5: Ortopedisk fysioterapi, Amputationer/Ortoser, träning efter benamputation

Reumatologi

1: Reumatiska Sjukdomar (indelning), Reumatoid Artrit, Spondartritsjukdomar, Vaskulit

2: Reumatiska systemsjukdomar och sammanfattning, Undersökning bedömning och träning

Medicin

1: Diabetes/metabola systemet, Tromboembolism, Kardiologi

2: Pneumoni, Lungsjukdom

Kirurgi och Gynekologi

1: Ödem, Kärlkirurgi, Urologi

2: Kirurgi, Plastikkirurgi, Anestesi

3: Gynekologi

Uppdatering 2021: Jag lade precis till anteckningar från Kirurgi och Gynekologi.

Jag hoppas att anteckningarna kan bidra något!

Ways to follow the recommendations (part 3)

Over the last 3 weeks I’ve changed a lot about my habits. Before I did more resistance exercise than running, but I’ve switched that around. 150 minutes is quite a lot of running, but I don’t feel exhausted. Neither do I feel weaker for doing less resistance. Maybe it is also because I’ve lost weight as well. I feel good. This last week I did a little bit less walking, around 15k/day but I feel like 17k felt better so I will try to get up there again. For now it seems that 150 minutes of running and walking quite a bit has given me more energy for other things.

Running

In total I ran for 152 minutes over 4 times. Saturday I did a Cooper Test (picture below) and got a much better result than last time and got almost 52 which is nice, but the raise from last time when I got 49, is probably mainly due to weight loss. Regardless, next week I’m gonna do 3×30 and 1×60 like before, because I think it’s a nice setup.

Just a nice picture
Cooper test

Resistance

I kept the same concept with two total body workouts with four super sets. It worked nicely and I got a good idea of where I could put more effort, for example I could do more push-ups. I feel stronger than ever when I do pull ups, but that may be due to weight loss. The pictures were taken at my fathers house where I’m visiting.

I didn’t have access to a scale, so I’ll do weight measurements next Monday when school starts.

Fitbit stats week 34

Steps average: 15540/day
Weight: Didn’t have access to scale
Sleep: 7h9m/night
Resting pulse: 52
VO2-max estimate: 48-52

Recommendations for physical activity in short

Cardiovascular exercise:
150 minutes of moderate exercise or 75 minutes of intense exercise.
Moderate: 40-59% of HRR
Intense: 60-74% of HRR
Walk at least 7000 steps per day.

Resistance exercise:
8-12 repetitions at around 70-84% of your maximum capability. 10 exercises targeting all major muscle groups. At least 2 times a week.
Mobility exercise:
Static or dynamic stretching for all major muscle groups 2 times a week.

HRR%:
To get the % take your pulse during activity (PDA) minus your resting pulse (RP), the divide that number with max pulse (MP) minus RP. So (PDA-RP)/(MP-RP ). Here is an example from one of my runs this week.
My MP: 187 (207-0,7*28)
My RP: 51
My PDA: 129
187-51=136 and 129-51=75
75/136=55%

Safety, Health and Performance

Last week I helped represent my school at the Midnight Run in Stockholm (Midnattsloppet).

It was a fantastic experience, and if you get the chance to represent your passion at an event and talk to uninitiated people about it, you should take the chance. Anyway, that’s not the point of this here blog.

I had the chance to talk to more than a dozen people about how they exercise and their injuries. As expected, this slice of people are more aware and much more fit than the average person, as apparent in the different tests we did, where most were above average.

One thing was prevailing though: a lot people doesn’t actually take precautions in their training. What I mean is that they don’t build a strong enough base around their running. Whatever you train, you need a solid foundation, but in high impact exercise such as running and ball sports the risk for injury increases much more than for example in Yoga.

On some level most people of course understand this. A man approached to talk about his shin splits (medial tibial stress syndrome) that would flare up when he started training and he could connect it with the fact that he may be increasing the amount of running too much. Of course, you can’t exactly know the true reason for pain from only one external factor, he may have had a congenital condition for all I know, but his story was far from unique.

People will exercise too hard, get the beginnings of an injury, take a pause, get going too hard again, and the budding injury will flare up. It’s like they won’t allow themselves to go slowly and do the appropriate strength/mobility/coordination exercises you need to run a long distance safely, but need permission from someone that looks slightly professional (me) to do it.

Priorities

In my opinion, which isn’t fully formed yet, there should be a priority in your exercise that you shouldn’t ever override: Safety, Health, and Performance. For a healthy, long and injury free life you need to always prioritize safety first. A lot of people prioritize Performance first, no doubt cheered on by the fitness industry.

There is no better way to ruin exercise than getting an injury. It’s better to do what can feel like too little than what is too much, because the span in which you get health effects from exercise while running minimal risk of injury is quite large. The span expands as you grow stronger and fitter, but it also shrinks as you grow older.

The most difficult part in staying in the Health and Safety zone is that Performance will inevitably take a hit (in the short term). And if Performance is your main motivation for exercising that is a bitter pill to swallow. A culture bent on praising Performance at almost every turn probably doesn’t help either. This is just my opinion of course, but I think a Performance mindset ironically stops a lot of people from reaching their goals, either due to injuries or the mindset killing the will to exercise if it’s not at full capacity.

As a future physiotherapist I will make it one of my main goals to help people make exercise a part of their life, free from the pressure of performance.

Now that I bashed on performance for a while let me end with celebrating it. Because you need something to drive you forward. Goals boost your motivation and reaching them boosts self-efficacy. The gains from that should not be understated. I just suggest having smaller goals, and setting new when reaching them to avoid injuries and get the most health benefits.

Have a healthy day!

I have Instagram and Twitter! It’s free to follow me there, as well as here of course.

Ways to follow the recommendations (part 2)

This week I made it both easier and more difficult for myself.

Sunday
Saturday
Wednsday
Sunday
Same workout x2

I ran 4 times for a total of 153 minutes. This was more challenging than last week owing to the fact that running for 60m is much more exhausting than running 2x30m. Next week I think I will try to run around 35-40mx4 instead. Monday and Tuesday I get to rest from running, so next Wednsday I’ll get to see how the recovery went.

To make it easier I did the same strength workout two times. It was a full body workout that included military press, chin up, dips, glute bridge, hip thrust, lunges and windshield wipers. I think 8 exercises is a good amount for a 1 hour workout. Next week I think I will try to do circuit training, again full body.

In general though, I’ve lost about 2 pounds of weight, about a kilo, and I absolutely feel lighter, so I’ll keep on going for a bit.

Fitbit stats week 33

Steps average: 18243/day
Weight: 180.3 lbs (Monday morning)
Sleep: 6h52m/night
Resting pulse: 51
VO2-max estimate: 48-52

Recommendations in short

Cardiovascular exercise:
150 minutes of moderate exercise or 75 minutes of intense exercise.
Moderate: 40-59% of HRR
Intense: 60-74% of HRR
Walk at least 7000 steps per day.

You need to get engaged

Not in that way, duh. I mean, unless you want to, then go ahead.

In a distant past I studied journalism. I completed all assignments, wrote reports and got good enough grades on everything. I got my bachelors and it was time to find work. But somehow I couldn’t find it.

To be sure, it wasn’t because I was unskilled or that no one would hire me for some reason. The reason was that I didn’t really try. And I didn’t really try because I wasn’t that interested.

It may seem obvious to you, and it is obvious to me now, but it wasn’t back then: doing something you’re not really interested in sucks. Now you don’t have to have the highest of ambitions to get engaged into something, but there needs to be something extra.

For the last year I’ve really felt that ”something extra”. I got engaged in Fysiostyrelsen, did this summer course in medical research and became an anatomy tutor. For me this, is how I know I’ve found something that I really wanna do.

If I’d have had the wisdom then that I have now, I would have quit the journalism education. Writing isn’t for me. Scratch that, I love writing. But the way you work as a journalist doesn’t appeal to me in the slightest.

So if you’re young (or older) and just starting your education I think you should ask yourself ”Does this engage me?”. If the answer, after repeated searching, is ”No” then you should proceed.

I didn’t really have anyone to ask me that question because I think I’ve always been exceptional at rationalizing my choices, which makes sure no one will question you.

Sure that could be said for this education as well, but there are key differences.

If you spend your free time reading about, looking at videos of, and you actively engage in projects around your area, then it’s probably not you rationalizing your choice, but a genuine interest. Or maybe I’ve just gotten even better at rationalizing. Let’s hope not.

I recently did a couple of interviews with a couple of people that did the choice I should have done 8 years ago and left the program. I asked them why they studied physiotherapy and why they left. I’ll release that in the coming weeks.

Until then, stay healthy and follow the recommendations for physical activity and live a good life.