Tina Lonneman: Through my journey over the last 20 some years, what I’ve found is that I just never had enough time to spend with patients. And I get it. When you’re working for people, you have to make money and there are insurance regulations about how much you can code for and all the confusing things that a lot of patients I don’t think understand about medicine. And I just found myself getting really burnt out and frustrated that I didn’t feel like I was helping people enough.

Dr. Gina Fick: Welcome to the PT Rebels podcast. This is the place to learn how you can become a PT rebel and take charge of your own health and wellness. We will help you find answers to your questions about pain, injury, and the path towards healing in the most efficient and effective way possible. I’m your host, Dr. Gina Fick.

Welcome back to the podcast everyone. Today I have a special guest named Tina Laman. Tina has been a nurse practitioner for 23 years and is practice in women’s health, family practice, endocrinology, bariatric medicine, and obesity eating medicine. She has spent time in medical practices throughout the years providing wealth of knowledge and experience to her clients, but recently decided to take a different path. We are so excited to talk with Tina today and learn more about her and her vision for her practice and where she’s at now. Tina, welcome to the podcast.

Tina: Well, to be here, Gina.

Dr. Gina: Tina, can you tell us a little bit more about yourself and your background and your vision for what you’re doing now?

Tina: Sure. So after embarking on my nurse practitioner journey in the early two thousands as a women’s health nurse practitioner, I found after moving outta state that although I love women’s health, that I needed a little bit broader scope of practice. So I went back and got my postmasters in family and family practice as a nurse practitioner opens the doors to many different areas where we can practice in pretty much every aspect of medicine to a certain degree other than real specialized areas. So after getting my family nurse practitioner, I decided to go ahead and try urgent care, which was a great experience for three years. And then after moving back to Colorado, I did family practice for three years and I thought that would be an area that I would really love and I did enjoy it. But the age span, pretty much from an infant all the way through elderly and every organ system, um, for me was, I would say overwhelming. I like to be a little bit more specialized.

So I learned a lot during that journey, but during that particular couple of years, I found that I really wanted to start helping people get healthier and work in preventative medicine. And during that time I saw a lot of people who wanted help losing weight. So I started off on my own adventure while I was still in family practice and went into obesity medicine and got an advanced practice certification through the Obesity Medicine Association and really became passionate about helping patients with that. And ended up falling into a practice with bariatric surgeon where I thought I’d be doing a little bit more of obesity medicine. But we did a lot of surgeries, which was great. I learned a ton from that experience. And I also practiced in the other part of the practice there, which was endocrinology, thyroid, diabetes, and again, great learning experience.

But through my journey over the last 20 some years, what I’ve found is that. I just never had enough time to spend with patients, and I get it. When you’re working for people, you have to make money and there are insurance regulations about how much you can code for and all the confusing things that a lot of patients I don’t think understand about medicine. And I just found myself getting really burnt out and frustrated that I didn’t feel like I was helping people enough. I think there’s definitely a place for acute care providers and chronic, and I love my colleagues and I admire them all, but for me personally, I just didn’t feel the satisfaction anymore, and I determined that the only way I was probably gonna be able to do this was to go out on my own and start my own practice.

I started Elevate Health and just opened the doors several weeks ago, and it’s gonna be a very small practice, but my goal is to focus primarily on lifestyle medicine and. Helping patients get healthy through taking really intensive lifestyle, um, assessments and see the areas where they need the most help, whether it’s nutrition, physical activity, sleep, stress management. I will also work for weight management and I’m not opposed to prescribing FDA approved medicines because I think that they can really help a certain. Group of people, and they’ve been very effective recently, probably seen it all in the news with the way gov and the T Tirzepatide and such. And so that’s a part of it. But then I’m also very passionate about going back to my roots as a nurse practitioner, women’s health, and particularly as I go through menopause myself, seeing all the changes, and just knowing that there are things that we can do to help women make that transition.

So that’s a little bit about what my envision is to be a very individualized personal. Type of medical practice with some health coaching and to be able to spend a lot more time with patients than I would in other types of practices.

Dr. Gina: We have such a need for that in our country, in our practice. That’s the clients that I’ve seen throughout the years, more so proud to partner with you and Elevate Health. It’s really exciting to see the journey that you’ve taken over the last year of developing your business and the vision that you have for truly helping people. We’ve both been in healthcare for a long time. I think at this point we have a focused vision on really helping people and giving up of our talents, and I, I know that you really feel the same. And just reading your bio, Tina, it’s impressive you have a master of science degree in nursing. As you said, you’re now a family nurse practitioner and a women’s health nurse practitioner, so that brings a wide background of training for you to be able to help your clients.

We’re excited to learn today about your philosophy and, and how you shape and model. Practice. We also have certificates in Advanced Education and Obesity Medicine by the Obesity Medicine Association. You’re a weight loss specialist and certified by the National Academy of Sports Medicine and a certified nutrition coach by the National Academy of Sports Medicine. I think one thing that patients tend to tell us is when they go into the doctor, they don’t always feel like the doctor has enough time to spend with them. They don’t feel heard. They don’t feel like the doctor has a true understanding of. Their concerns and goals. So it’s a quick in and out for them. They get a quick prescription, not a really good plan moving forward for how they can really turn this around for themselves.

It sounds like to me your practice is gonna be somewhere that people can come in, that you’re gonna be able to spend time with them and listen to them and help formulate some goals that a really effective plan for them moving forward. That’s holistic. Not just a prescription or a medication, although like you said, those could be helpful. I think that what you provide is the holistic approach to give, empower patients with the tool to make the successful long term. So I’m really excited to hear more about it. And my first question for you, Tina, is why should we focus on skeletal muscle? What does that mean for us or our clients?

Tina: First of all, I think we have the same philosophy in what we wanna do, and we’ve been in the same place in healthcare where we’ve both been burnt out and wondered where our future would go with it. I appreciate so much what you do as well, because you do a patient-centered approach, so I just wanted to let you know that. I definitely think on those same lines, and as far as skeletal muscle and muscle health, this is just one area of my practice that I’m really passionate about. So there’s so many things we could talk about, but I think this is really important because we have an aging population. We all think that aging is inevitable, which it is, but we also can do so many things to keep our muscle health that I think that patients aren’t being told this by mainstream medicine and regular practitioners, and again, no fault of their own, just because of the the time and you have to prioritize your visit.

So skeletal muscle. I’ve always been into fitness and working out when I was younger, but most recently when I was working with bariatric surgery patients. I found that it was awesome that they were losing weight and also patients on some of the newer types of weight loss medications, they were losing weight, which was fantastic. Some of them who had struggled all their life with it. But the bad thing was I also saw them losing large amount of muscle mass if they weren’t doing the right things. My concern for that was what is their future gonna look like 20 years from now if they’re losing so much muscle mass and they aren’t able to re either retain it or build some of it back up? So it really sent me on a mission to learn more about Muscle Health and actually what I came across in the last couple years was very interesting to me, particularly Dr. Gabrielle Lyon, and I don’t know if you’ve heard of her.

I do have her back forever strong. She’s been out in the media a lot. I went to her Forever Strong Summit in January. Coined muscle as the organ of longevity and she started the Muscle centric medicine, which is her trademark and has a practice of regular people and some very elite, high level athletes and professionals and, and also special forces people who’ve gotten out of the military that have been really messed up. I don’t know a better way to say it, but she’s brought them back to health. Many other journals in sports science, nutrition, science found that skeletal muscle is much more than just muscle. It’s actually an endocrine organ, which is again, very interesting to me being my background in endocrinology and such. And we find that it’s an endocrine organ because it actually can secret. Substances that can work on all other areas of your body. So that’s one of the reasons why I thought skeletal muscle is fascinating beyond what we think of the normal. Oh yeah, it makes you look nice and helps you move and it protects your joints and those types of things.

Dr. Gina: Who would you identify are at risk for low muscle mass?

Tina: Absolutely. So we talked just, uh, briefly about my experience with people losing large amounts of weight very quickly. If they’re not doing the right things, they can lose a lot of muscle mass. They’re sometimes only losing a very little amount of fat, but losing a ton of muscle at the same time. Mostly we think of the term sarcopenia, which means progressive loss of muscle mass and function as being in the elderly population. As we age, we lose that. Ability to maintain muscle mass, and it’s very complicated how that process works, but we’ll talk about how we can stop that progression. Normal aging of our muscle actually can start in our thirties, in our forties, we can lose muscle mass and if we’re not doing something a counteract, we can lose up to about 1% of mass a year. And we also lose strength and power. Then it becomes much more accelerated in our sixties, and that’s where you really see sarcopenia being much more of a problem.

The interesting thing is that I’ve learned, again, through all this learning, that we become what’s called anabolic resistant after age 40, and all that means is that. When we’re really young, particularly in our teens, in our early twenties, is that we don’t have to focus as much on our protein as much on our activity levels, and we can build and maintain muscle mass as long as we’re not sedentary. But as we get in our forties because of hormone changes and decrease of bodies response to protein, we need more for muscle protein synthesis in order to just maintain our current muscle mass. I would say really as we age, we’re at risk for low muscle mass, but it can be even younger if you have medical conditions that are making you be more sedentary or just in our everyday society of people and kids not being as active as they once were and building that peak muscle mass.

Dr. Gina: We love hearing the research, the numbers behind all of that because I think that plates us to subject real solutions, how we can help ourselves and help our clients. What are some other risk factors for sarcopenia?

Tina: Absolutely. So we talked about the bariatric surgeries, but we also have learned a lot, particularly in women who may be weight cycling, meaning they lose pounds and then they gain it back, and then they lose, and then they gain it back. And during that process, studies have indicated that women tend to lose that muscle mass and then they never put it back on. So over years and years of weight cycling, they’ve become more at risk for losing, uh, a substantial amount of muscle mass and never regaining it, which puts them at big risk once they hit the forties, fifties and beyond.

Individuals with poor metabolic health, particularly diabetic patients, insulin resistance, and of course patients who have cancer definitely have a lot of other underlying problems. Research actually shows that if you. God forbid, get a diagnosis of cancer or other chronic illnesses that the more muscle mass that you have, the better you’ll be able to bounce back. Because when you’re in a catabolic state, your body is pulling the amino acids out of your muscle mass to try to help fight whatever it is that you’re fighting for recovery. So if you have more muscle mass, you have a better ability to recover from pretty much everything.

As I mentioned, younger individuals too. Now I know you work with a lot of elite athletes, so you’re seeing probably a the other end of the spectrum, but in general, we’re seeing poor muscle health because kids aren’t getting out there and joining sports. They’re not being active. They’re spending a lot more screen time. Also, just with today the nutrition, I would say, of kids, young adults and older adults. If they have poor nutrition, they’re just not having that ability to build up that muscle mass either. So those are pretty much in every category of age group, we can be at risk for developing low muscle mass, even though we think of it as just being an elderly type of problem, so to speak.

Dr. Gina: That’s such helpful information. Ding you Tina. Another question I had is, why does muscle mass support to longevity in overall health?

Tina: Yeah, so again, we think of muscle as just these big bodybuilders and oh, it’s aesthetics. It’s all about looking good. And that’s nice and that’s good if, if people like to do that, it makes them feel good. But there’s so many other things beyond aesthetics. Um, ob, the obvious physical contributions are strength and mass for everyday activities. Where if you’re not strong enough, you’re not gonna be able to carry the groceries, you’re not gonna be able to get out of the car, you are not gonna be able to lift your kids and do things that you enjoy in life. If you lose too much muscle mass and you don’t have the strength, higher muscle mass is also coordinated with helping with, um, preventing osteoporosis because your muscles are protecting your bones to a certain extent. You’re not having all that wear and tear.

The more interesting thing that I found through my research and learning why it’s also very important to me as a medical provider is because it can help support your metabolic health. And as I mentioned, it’s now been recognized as an endocrine organ and it helps with glucose regulation and with glucose regulation, meaning it can take the glucose out of your bloodstream. And up into the skeletal muscles when you’re active, it’s the only organ that can do that without the help of insulin, which is great because it helps protect against insulin resistance. So if you’re active and you have good, healthy muscle tissue, your chances of developing, um, insulin resistance and diabetes lowers. It can also help with fat oxidation, which means it can help lower your lipids. Because at rest, if you have good, healthy muscle tissue, it breaks down fats.

And also the big buzzword is mitochondrial health. Mitochondria are the powerhouses of the cell, which help your body produce energy. And that energy is amazing because it can help with every aspect of how well your cells function throughout your lifetime. And then lastly, immune health and mood and learning. And they, these are things again that we don’t think of, but when you get down to the really scientific thought about it, just beyond what we think of muscle mass doing for our body, it has so many other things that it can do for us. And that’s why I am really passionate about muscle health.

Dr. Gina: We do see higher level athletes in our craft test. That one thing that we’ve seen. Especially in our, um, distance athletes is the fact that a lot of times they do have lower muscle mass. They don’t train the same way as say, the mirror sprinters or jumpers or hurdlers. And so we do tend to see a increase the bone stress injuries in those cl. The research has shifted and, and emphasized in the last five years the need for even our high-end or distance athletes to make sure they have enough skeletal muscle. Because again, we are seeing a higher level of bone stress injuries, not only at female athletes, but at male athletes as well. And now we have the plated shoes and the various factors and you see a big jack and the number of bone stress injuries. And I think one of the things that we need to really focus on is building that skill and muscle mass, um, in people of all ages and all activity levels.

What are some of the adverse health outcomes, essentially with low skeletal muscle mass and unhealthy muscle?

Tina: Thank you for bringing that up with athletes and I’m really big proponent of cross training and doing some form of resistance training, no matter what type of athlete you are, what sport you play. And so I think that’s really important as well. A little bit more out of my wheelhouse just as a medical provider, but definitely something that I would tell patients of all ages. And I think that’s where you as physical therapists can come in to play there. And when you’re seeing these injuries. Set ’em up with a good rehab program with someone who is very knowledgeable about being able to figure out what they need to build up those weaker muscle areas.

As far as adverse outcomes, um, the biggest thing that we see obviously in our elderly population is the increased risk for falls fractures, which leads to so many things when an elderly person falls and breaks their hip. That can be a cascade of events as far as loss of independence, decline in overall quality of life for these people. I’m really passionate about this because as I mentioned, aging is inevitable, but really ending up in a nursing home isn’t now. We’re all gonna have our course in life where we have some genetic type of things and, and if we have a stroke or others catastrophic type of health problem. The majority of people land in nursing homes because they’re not able to get themselves off the toilet, and that’s because of low muscle mass. They have been more sedentary. They haven’t been having the proper nutrition.

As a young person starting in healthcare, I worked as a nursing assistant when I was 18 years of age before I even started my undergrad nursing program. And that stuck with me forever is do we all have to end up like that in a wheelchair in the nursing home and not being able to move ourself from our bed to our wheelchair to the toilet? That stuck with me all these years, even through all the other things I’ve done, and that brings my passion back into figuring out how we can help people age with better quality of life. So besides the obvious of the impaired mobility and such, again, as we talked about it as an endocrine organ, if you have low skeletal mass, you do run risk of having more dysfunction with your metabolic health as you ate.

Dr. Gina: One thing that I’m really fascinated with is learning the secrets of, we call ’em health hero. The people who are running master trap field, for instance, doing walls up on their a hundred years old. Last summer they had a lime stream, USA track deal, the Masters National Championships outdoors, and I watched these people are sprinting and hurdling in the nineties or higher. I actually went through the, the start list and I looked at the, the names and the, and these people and I had to do a double take. So we were over a hundred years old. I’m donating shit then. And then you see people. When they’re 60 years old or younger, sometimes in a skilled nursing or nursing long-term care facility, you can’t get off the toilet. And I think you bring up a really good point of what are people doing differently to be able to long jump their 110. Honestly, genetics plays some role. However, what are they doing differently than the other person didn’t do? What choices are they making? Uh, what makes them be able to do that? On that topic, let’s talk about the power of healthy. Tell us more about what you know.

Tina: Yeah, that’s amazing what you bring up. And I am amazed every time when I see some of these senior athletes and the things that they can do, it is so humbling, so healthy muscle mass, uh, it will decrease your risk of getting sarcopenia, which again, as we said, can lead to all these different events of. Risk for falls, risk for fractures, loss of independence. And I always say it’s not the years in your life, but it’s the life in your years. And I, I truly believe that. I think that no matter how long you live, if you have the ability to maintain independence and do all the things that you physically want to do in life, that’s amazing. And that’s really what my goal is.

So. With healthy muscle, we wanna decrease the risk of sarcopenia. It also, as I mentioned, can decrease the risk of bone loss, which would lead to osteoporosis again, which increases your risk for fracture. Healthy muscle can help with the healthy body composition. When you look at a weight, you have to really look at what is the body composed of. And muscle for most people, should be about 40% of your muscle or of your body mass. And I think that, so body composition, and again, that lends to better immune health, better metabolic health. And then some of the other big things is we talked about psychological health and muscle can secrete different types of neurotransmitters and such, which can signal your brain to have improved mood. So that’s how exercise and muscle can also have a significant impact on people’s psychological health. Their mood decreases depression and anxiety.

And then something else very important. We talked about better survivability against pretty much every chronic disease. If you were to get a diagnosis of something such as cancer, if you have healthy muscle mass, your ability to survive is so much higher. Against all cause mortality with people with higher muscle mass and healthy muscle mass.

Dr. Gina: One of the things that you brought up that’s really important for us to consider is there are some needs now medically, right, through weight loss, drugs and or surgeries for people to lose weight radical. But if they’re not working, lot of skeletal muscle. It sounds like to me that they’re setting themselves up for potentially other health consequences. So in your practice, how do you determine muscle health when someone comes in to see you and they wanna raise a significant amount weight or this smart become healthier, how do you first determine like where they are on that scale, and then how do we progress forward and monitor that track?

Tina: So right now, I think there’s a big push to go against the scale weight in the BMI in measuring people’s health that way, because. We’re not getting a full picture of what’s going on inside their body. Some people may look like they’re normal, healthy weight. I put that in quotes. Healthy weight according to maybe the BMI skill, but they may have a high amount of visceral fat, which we can’t see just by looking on the outside. And that sets you up for a lot of medical problems, cardiovascular disease, metabolic health issues. So I think that we start measuring muscle mass as a routine part of our health assessments. And to do that right now, the best tools that we have are using dexa. When you whole body scan, which was traditionally used more just for checking your bone density. And it’s not perfect, but it can tease out the lean tissue and you can have a kind of an idea of one’s muscle mass and you can track it over time. And the same thing with the bio impedance scales. Those are becoming more popular, like the InBody. And again, none of these devices are perfect right now, but they’re the best things that we have. And if you use the same tool over the course of time, you can measure progress.

So one of the biggest things that I saw in the weight loss community is if I was doing a medically supervised weight loss, where we would want them to start exercising as we were trying to lose weight. The problem is maybe they, in a couple weeks span of time lost a, a pound or two of of fat, which was fabulous. They maybe gained a pound of muscle because they actually, they went from completely sedentary to doing something. And then the problem is that they’re feeling discouraged because they’re like, my weight on the scale didn’t budge. And that can be very frustrating and defeating to people. And so I think by using. Other forms of tracking your body composition, mostly muscle mass changes, that can be a lot more empowering to people to keep doing what they’re doing.

So that’s one of the ways the other things that we can do is track biomarkers and some of the things are, are just looking for metabolic dysfunction, looking at your tri fasting, triglycerides, fasting insulin fat, fasting, um, glucose levels, those types of things. They can really show us is you, do you have enough muscle mass to be that glucose disposal unit or not? So again, it’s just a big picture putting these things together. And then lastly, doing functional movement assessments and fitness assessments. Just checking grip strength, which has a significant correlation, and then are able to do a, a pushup on their knees or on are they able to do squats? Are they able to walk a mile pretty at a brisk pace without having issues? So just doing that fitness assessment can also give us a really good idea of where one’s muscle mass is at.

Dr. Gina: So helpful. That information I think, is critical for the progress, not only US overall health and longevity, but also just being successful in a physical therapy. You have a lot of clients to come with back pain, gonna be hard to overcome back pain if you don’t have a flexibility to move well. And so all that plays a role. So that ties into the next question, what is our role?

Tina: This is where I think physical therapists play a huge role because as you mentioned, if a person has a lot of pain, they’re not gonna wanna do things. So that’s going to, in a way, discourage them from wanting to be more active. So where you can help them get back on track as far as helping manage their pain and encouraging them and educating them to keep going with that process. You’d be able to diagnose muscle imbalances and what they need to do to strengthen certain parts of their body. In general, as healthcare providers, what you and I are both trying to do is focus more on disease prevention and health promotion. Um, because I feel like that’s where our current healthcare system is really failing us. There is a place for acute care and chronic disease management. I think if we did a better job with educating our patients and focusing more on educating people on the simple things they can do to make their life better and to help themselves become healthier, we can definitely mitigate the loss of muscle mass and promote more healthy muscle tissue.

The two biggest things in muscle health is protein intake and resistance training and protein. Is as one. There’s so many controversial things out in the nutrition science world right now from all the research I’ve done in true nutrition science. When it comes down to what is important is getting enough protein in your diet, and actually we need so much more, not less as we age. And the problem is I think as people become elderly, they don’t wanna cook as much for themselves. Maybe their appetite goes down and so they’re actually consuming less and less protein when they need more. The other problem, the current RDA has been significantly outdated. That was put as a bare minimum for 18 year olds to prevent deficiency. And because they haven’t changed any of these yet, I think a lot of people think they’re probably getting enough protein and they’re really not. And study after study has shown. How much protein we really need, particularly after age 40.

Now, younger populations and younger athletes, yes, protein’s important, but as I mentioned, they still have the growth hormone and other stimulus to be able to maintain that muscle mass with less protein and less exercise actually. And as we get older, we need more protein and we need more exercise in order to just maintain and let alone build up some muscle mass and strength. So ballpark. This is what most sources that I follow recommend, and they say the 1.2 to 2.2 kilograms per kilogram of weight. Now, most people don’t do kilograms of weight, so what that boils down to is above about 0.7 to one gram per pound of ideal body weight. So let’s say we had a woman who was 150 pounds. She’s pretty close to where her ideal body weight is. She’s working out three to four days a week. She probably needs at a minimum in the a hundred grams, but maybe more than that if she’s more active, just to maintain that muscle mass and not go into more of a catabolic state.

And like I said, elderly people need more. The average woman over 40 is probably getting about 50 grams a day, which is about half the amount that they need for muscle mass retention. Most importantly, the total protein in the day that you get is a big thing. But when you’re coming out of your nighttime sleep, your first meal of the day, whether you’re eating that at 8:00 AM AM, AM has to be a bolus of protein and they recommend a minimum of 30 to 40 grams in that first meal when you come out of your fasted state to trigger that, um, muscle protein synthesis, and then your last meal too before you go to bed at night, during the middle of the day. It’s not as important, but in order to meet that daily requirement, you pretty much have to get in 20 to 30 a couple times. But most of the studies have been done on the first meal of the day and that second meal, because they don’t know how long that muscle protein synthesis lasts throughout those first couple hours of the day.

It’s hard quality matters. Animal sources are better sources, and we could have a whole talk on protein. And I’ve learned so much about it, like it’s actually quite interesting. I think I wanna try to individualize and look at e each person’s lifestyle and figure out what’s gonna be the best route for them and do problem solving with them to figure out how to, because it’s also food preferences, not only preferences and tolerances, all, all those things go into play, but yes, meal. They say that meal planning and prepping can be a huge asset because it takes the question out of it, you. Plan a couple nighttime meals and you go to the store and you have the chicken breast, the ground beef, the sir line steaks or whatever you have on hand, and you pair that. That’s gonna be your primary part with a vegetable or a small amount of good starch and maybe a little fruit. If you always prioritize the protein first on your meal and eat that first and you plan for it, you’re gonna do the best.

Most people do need to have a protein supplement, and again, playing around with the way isolate. I use some beef isolate type of protein shakes, which I really like easier for digestion. You have to tease around what your body does best with, but we really think of protein as a supplement, just like as anything else now to have as that quick snack to grab, like in the middle of the day, if you don’t have time to have a good meal and you grab a protein shake, 30 grams, you get that in the middle of the day. Focusing your beginning and your end more on the meal protein, that can be really helpful as well.

Dr. Gina: Thank you. What do you think of the grantee and intake and the reset research tomorrow with aging individual?

Tina: Yeah, absolutely. So that is one thing that I’ve learned a lot about and it’s been the most well studied supplement of pretty much anything. Great research for anyone over 40 actually. ’cause we used to think of it just a muscle building and those types of things. I actually started taking it about six months ago. They say there’s a very small portion of people who are creatine non-responders who don’t notice a difference, but most people do. In helping you have that muscular endurance and such. So about five grams a day I think is what’s recommended across the board for anyone who’s active. Then the other things coming out about Creatin is bone health and brain health, along with the muscular health. So that would be one supplement. Besides protein supplementation, I would recommend across the board for people.

Dr. Gina: Can you speak about resistance trading and the importance of that role? It plays an overall health and wellness end.

Tina: Absolutely. Again, in your wheelhouse as a physical therapist, you know so much more about muscles than I do as far as that part of it. But again, just from what I’ve learned is that you’re never too old to, to build muscle mass. There have been studies of 80 and 90 year olds who have never done any resistance training in their life. Maybe they were more active when they were younger because we used to be in the farming generations and such. We’re active