October 17, 2017

Going Nuts for Nuts? By Dr. Bushman

Going nuts for nuts?
 

In a recent publication in the Journal of the American College of Nutrition, researchers highlight the health benefits of nut and tree nut consumption. For purposes of the study, “nuts” referred to peanuts, peanut butter, tree nuts, or tree nut butter. Specifically “tree nuts” included almonds, Brazil nuts, cashews, hazelnuts, macadamias, pecans, pistachios, walnuts, and pine nuts. To be considered a consumer of nuts, at least ¼ ounce (7.09 grams) of nuts were consumed daily; non-consumers ate less the ¼ ounces per day. Subjects in the study included adults 19 years of age and older who participated in the National Health and Nutrition Examination Survey (NHANES) over a 6 year period of time. Nut consumption was found in approximately 19% of individuals between 19 to 50 years of age and 21% of those over 50 years of age; tree nut consumption was about 5½ and 8½ percent for the two age groups respectively.
 

Nut consumers were found to have a number of positive health characteristics including lower body mass index, waist circumference, and systolic blood pressure as well as decreased prevalence of some risk factors for cardiovascular disease and metabolic syndrome (including hypertension and low levels of HDL-cholesterol.)
 

Similarly, tree nut consumers had a decreased prevalence of hypertension and low HDL-cholesterol. In addition, tree nut consumers had lower body weight and a lower prevalence of abdominal obesity and high fasting glucose. Thus, consumption of nuts/tree nuts was associated with a lower prevalence of a number of risk factors for heart disease, type 2 diabetes, and metabolic syndrome. (Metabolic syndrome includes dyslipidemia, hypertension, abdominal obesity, insulin resistance, and high blood glucose.)
 

Does this mean that simply adding nuts/tree nuts to an individual’s diet will improve health? Since this study is cross-sectional (meaning behaviors and measurements are recorded at a particular point in time), a cause-and-effect relationship cannot be determined – future research will be required to look at specific ways nuts/tree nuts impact health. However, nuts as a general group are a good source of monounsaturated fatty acids while being relatively low in saturated fatty acids. Nuts are high in fiber as well as various other vitamins and minerals (e.g., vitamin E, folate, magnesium, potassium.)
 

At this point, researchers are encouraged by the association between nut/tree nut consumption and, coupled with the known nutritional profile of nuts, suggest that nut consumption be recommended by health professionals and dietitians.

 

SOURCE:  O’Neil CE, Keast DR, Nicklas TA, Fulgoni VL.  Nut consumption is associated with decreased health risk factors for cardiovascular disease and metabolic syndrome in U.S. adults: NHANES 1999-2004.  Journal of the American College of Nutrition, 30(6):502-510, 2011.
 

Dr. Bushman is a Professor at Missouri State University and is American College of Sports Medicine (ACSM) certified as a Program Director, Clinical Exercise Specialist, Health Fitness Specialist, and Personal Trainer. She is the editor of ACSM’s Complete Guide to Fitness & Health (Human Kinetics, 2011, http://www.humankinetics.com/products/all-products/acsms-complete-guide-to-fitness–health), a book focused on optimizing both exercise and nutrition to improve fitness and health for individuals of all ages. For more health and fitness related tips, join Dr. Bushman’s Fitness ID Facebook page (http://www.facebook.com/FitnessID) to discover, develop, evolve, and personalize your FITNESS ID. Dr. Bushman also is the lead author of ACSM’s Action Plan for Menopause (Human Kinetics, 2005, http://www.humankinetics.com/products/all-products/action-plan-for-menopause) and is the author of the “Wouldn’t You Like to Know” column in the ACSM’s Health and Fitness Journal.

Fit or Fat: Research Explained by Dr. Bushman

Fit or Fat – can it be either one or the other for health?

How do fitness level and body fat affect health risks?  Fitness helps to lower one’s cardiovascular risk level; gaining weight or fatness, in contrast, increases risk. Although these relationships are widely supported, there is less consensus regarding the impact of being fat but fit on health.

In a prospective observational study of 3,148 healthy adults over a 6-year time period, researchers examined the effect of fitness and fatness – separately and combined – on the development of cardiovascular disease risk factors, including hypertension, hypercholesterolemia, and metabolic syndrome. Fitness was determined using a maximal treadmill test (modified Balke protocol). Fatness was determined using percent body fat (7-site skinfold measures) and body mass index. Hypertension was defined as resting systolic blood pressure of 140 mmHg or higher, diastolic blood pressure of 90 mmHg or higher, or physician-diagnosed hypertension. Hypercholesterolemia was defined as total cholesterol of at least 240 mg/dl or physician-diagnosed hypercholesterolemia. Metabolic syndrome was defined as the presence of three or more of the following:  waist circumference of over 102 cm in men or 88 cm in women, triglycerides of over 150 mg/dl, HDL-cholesterol less than 40 mg/dl in men or less than 50 mg/dl in women, blood pressure of at least 130/85 or physician-diagnosed hypertension, and fasting glucose of 100 mg/dl or physician-diagnosed diabetes.

The researchers found changes in fitness and fatness were BOTH significantly associated with the development of hypertension, hypercholesterolemia, and metabolic syndrome; lower risk was associated with maintaining or improving fitness while the opposite was true for increasing fatness.

The researchers then examined the question – can fitness compensate for the health hazards of fatness? The answer appears to be not completely. Some of the negative effects of fat gain were lessened by maintaining or improving fitness BUT were not completely eliminated. Similarly, reducing body fat compensated for some health risk associated with loss of fitness but not entirely. 
 

Bottom line: maintaining or improving fitness ALONG WITH preventing fat gain are BOTH important for reducing risk of developing a number of risk factors associated with cardiovascular disease. 

(Source:  Lee D, Sui X, Church TS, Lavie CJ, Jackson AS, Blair SN.  Changes in fitness and fatness on the development of cardiovascular disease risk factors.  Journal of the American College of Cardiology 2012; 59:665-72.)
 

Dr. Bushman is a Professor at Missouri State University and is American College of Sports Medicine (ACSM) certified as a Program Director, Clinical Exercise Specialist, Health Fitness Specialist, and Personal Trainer. She is the editor of ACSM’s Complete Guide to Fitness & Health (Human Kinetics, 2011, http://www.humankinetics.com/products/all-products/acsms-complete-guide-to-fitness–health), a book focused on optimizing both exercise and nutrition to improve fitness and health for individuals of all ages. For more health and fitness related tips, join Dr. Bushman’s Fitness ID Facebook page (http://www.facebook.com/FitnessID) to discover, develop, evolve, and personalize your FITNESS ID. Dr. Bushman also is the lead author of ACSM’s Action Plan for Menopause (Human Kinetics, 2005, http://www.humankinetics.com/products/all-products/action-plan-for-menopause) and is the author of the “Wouldn’t You Like to Know” column in the ACSM’s Health and Fitness Journal.

Ramp up Metabolism by Kathy Smart

This Article Brought To You By:
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Ramp up Metabolism

A sluggish metabolism can cause you to feel tired and have a lack of energy. Simple lifestyle and dietary changes can boost your metabolism and give you more energy throughout the day.

Trick your body into burning calories more efficiently! Your basal metabolic rate — the energy your body expends at rest — is generally determined by your genetics, but new research shows you can trick your body into burning calories more efficiently.

Stoke your system with B vitamins
B vitamins: B vitamins are key players in DNA synthesis, the central nervous system, metabolism of carbohydrates, fats and protein and energy production. Inadequate amounts of B6, B12, folate, thiamin and niacin can leave you feeling depressed and fatigued, slow the body’s metabolism and increase your risk for chronic diseases. Get the bulk of your B’s from food, where they pair up with other vitamins and minerals for a complete synergy of action. Foods high in the B’s include: spinach, asparagus, beans (navy, soy, black beans), melon, broccoli, fish, poultry and eggs.

Up the Magnesium
Magnesium is a mineral needed by every cell in your body and is used in more than 300 biochemical reactions in the body, including proper muscle, nerve and heart function, protein synthesis and energy metabolism. The National Institutes of Health reports that most Americans are not getting enough magnesium in their diets for optimal health. Boost your intake of high magnesium foods to give your metabolism a boost. Go green with your vegetables. Green vegetables such as spinach provide magnesium because the center of the chlorophyll molecule contains magnesium. Other excellent sources of magnesium include: halibut, nuts such as almonds, cashews and peanuts, so, whole-grain cereals, oatmeal, and legumes such as black-eyed peas and lentils.

Spice it with Heat
Some plants contain the bioactive ingredient capsaicin, which not only makes them spicy hot, but also doubles energy expenditure for 3 hours after a meal. Plants belonging to this family are a hot ticket for boosting metabolism. Include red peppers, cayenne, jalapenos, habaneros, and tabasco to recipes. It may also work to decrease appetite centers in the brain by boosting the release of certain neurotransmitters.

Add Chromium
Chromium is an essential trace mineral meaning that it is essential for the metabolism of carbohydrates, and it also helps to regulate the metabolism of our blood sugar and thus helps deter diabetes. The benefits of chromium also include controlling fat and cholesterol levels in the blood, and if adequate amounts are provided to the body, it can help to prevent hypertension or high blood pressure. The best source of chromium is in true brewer’s yeast. Nutritional yeast is not the same and will not contain the same amount of chromium. It can also be found in grains and cereals although most of it is lost through refining.

Kathy Smart, TV nutritionist, host and chef of  Live the Smart Way ~ the world’s first vegetarian and gluten free TV show’ and author of ‘Live the Smart Way. www.livethesmartway.com

Interpreting Fitness Data by Jan Schroeder, PhD

The mind-body world has been shaken up lately with an article in the New York Times stating that yoga can wreck your body. The title of the article was quite shocking, but could it be true? What about all the benefits we hear about? The author of the article, William Broad, has a book coming out in February which discusses the benefits and risks of performing yoga.  The New York Times article focused solely on the damage that yoga can do. These claims are supported by a yoga teacher and a few research articles. Does this mean that yoga is now dangerous and you should stop your practice? To answer that question, we need to assess the source of where the claims are originating.

When assessing the legitimacy of a source, you must first understand the difference between anecdotal evidence and scientific evidence. Anecdotal evidence is based on casual observations rather than rigorous analysis. These observations may be true; however we cannot definitively say they are factual as they have not undergone the scientific method. Scientific research requires the scholar to adhere to strict protocols for investigation into an issue. Once, the issue has been studied in a controlled environment we can begin to formulate an educated opinion.

So does that mean if it is a statement supported by a research study, that it is true and you should believe it? No. One research study does not create an absolute decision in an area. Each research study is constrained by its participants and its methods. First, we need to ask the question, who was in the research study? For example, if all participants were post-menopausal Caucasian women, then the findings of the study can only be related to that specific population as the findings may not hold true for African American older men. We also need to determine how the study was conducted or how well controlled was the experiment? For example, if we were looking at the effects of walking on flexibility and our subjects walked in a structured program but we did not have them stop their swimming class, who is to say that walking and not swimming had an effect on flexibility. We cannot fault the researcher for these inherent issues with research as we cannot study all populations or control for every factor in an experiment. Therefore, we need to read many research articles to make an informed decision.

So where does this leave us in relationship to yoga and injuries? The author’s claims are supported by anecdotal statements and a few research studies which do not provide us with enough information to make an informed decision as to the safety or dangers of yoga. Until more research can be done in this area, remember as with any exercise, injuries can occur when we push our bodies past its limits. Respect the signals your body provides and enjoy your practice.

Jan Schroeder, PhD, is a professor of Kinesiology at California State University, Long Beach.

Optimal Exercise by Dr. Bushman

What is an “optimal” exercise prescription?
What will bring about the greatest results for the time invested in an exercise program? 

A study by researchers at Duke University Medical Center and East Carolina University published in the November 2011 issue of the American Journal of Physiology – Endocrinology and Metabolism provides some insight. The researchers compared aerobic training to resistance training to see the impact on fat stores, along with some other health-related measures, in a group of overweight or obese inactive adults. Although both visceral fat (the fat within the abdominal cavity surrounding the internal organs) and subcutaneous fat (the fat just under the skin) were assessed, the focus was on visceral fat due to its relationship with type 2 diabetes, heart disease, and even some cancers. Researchers found that aerobic exercise including use of treadmills, elliptical trainers, and/or cycle ergometers was superior to resistance training for reducing body mass, subcutaneous fat, and visceral fat. Aerobic exercisers included an equivalent of about 12 miles per week (about 132 minutes) at an intensity around 75% of their peak oxygen uptake while the resistance training group exercised 3 days per week, 3 sets per day with 8-12 repetitions per set, for 8 different exercises.

Based on the study results, for individuals with limited time to exercise, aerobic exercise appears to be more time-efficient and effective than resistance training to reduce body weight and fat. Does this mean that resistance training is of no value?  Rushing to that conclusion is premature. Realize this study focused on very specific outcome measures and thus did not examine the effect of resistance training on improvements in other important health parameters like blood pressure or bone mass, both of which have been found to be improved with resistance training in other studies.

Bottom line: Resistance training IS important for improving strength and lean body mass, even if its role in reducing visceral fat wasn’t found in this study.  Thus, don’t throw out the concept of a balanced exercise program for overall health, which includes both aerobic exercise and resistance training. 

For a complete look at the research study, see http://ajpendo.physiology.org/content/301/5.toc.  For more information on the benefits and components of a complete exercise program, see ACSM’s Position Stand on Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory, Musculoskeletal, and Neuromuscular Fitness in Apparently Healthy Adults: Guidance for Prescribing Exercise (http://www.acsm.org/access-public-information/position-stands) or a summary of this material at http://www.healthyourwayonline.com/?s=bushman

Dr. Bushman is a Professor at Missouri State University and is American College of Sports Medicine (ACSM) certified as a Program Director, Clinical Exercise Specialist, Health Fitness Specialist, and Personal Trainer.  She is the editor of ACSM’s Complete Guide to Fitness & Health (Human Kinetics, 2011, http://www.humankinetics.com/products/all-products/acsms-complete-guide-to-fitness–health), a book focused on optimizing both exercise and nutrition to improve fitness and health for individuals of all ages. For more health and fitness related tips, join Dr. Bushman’s Fitness ID Facebook page (http://www.facebook.com/FitnessID) to discover, develop, evolve, and personalize your FITNESS ID. Dr. Bushman also is the lead author of ACSM’s Action Plan for Menopause (Human Kinetics, 2005,

Children and Eye Exams by Dr. Stephanie Burris, O.D.

Vision is closely related to a child’s overall mental and physical development. While some vision problems are obvious, some are very subtle. A child may pass the vision screening at school or at the pediatrician’s office with flying colors and yet still have a very significant visual problem.  Sustained visual tasks, such as reading or looking at an iphone, or tasks that require frequent eye focusing changes, like copying from a chalkboard or playing sports, stress the eyes in a different way than reading letters on a chart.
 
A thorough eye and vision exam will determine how clearly a child sees AND how well the child is able to use her eyes together. Each eye must receive a crisp, clear image on the retina for both distance and near viewing, and the eyes must work as a comfortable, binocular system. An eye care professional will perform the following:
 
• visual acuity for each eye, potential need for glasses
• eye health, checking for eye allergies, growths inside the eye, etc.
• coordination of the two eyes together, depth perception, etc.
• focusing (or accommodation) of the eyes for sustained near vision tasks
• the need for referral to a specialist for vision therapy or eye health conditions
• discussion of how eyes are affected by nutritional and environmental factors
 
The American Optometry Association recommends an eye exam for children at age 3 and age 5 to assess baseline visual function and eye health, and to determine the risk of any visual or health disorders for that child’s future. Please schedule an eye exam sooner if you notice any symptoms, such as closing one eye frequently, one eye turns in or out frequently, one eye appears different especially in photos, or redness, tearing, discharge from the eyes.

New ACSM Guidelines for Exercise Prescription, released July 2011 by Barbara Bushman, Ph.D., FACSM

What components make up a complete exercise program? The American College of Sports Medicine released an update on the quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults. The recommended components include the following:
 

Cardiorespiratory (aerobic) exercise. Three to five or more days per week depending on intensity. More specifically, this guideline includes continuous, rhythmic exercise using large muscle groups (e.g., brisk walking, running, biking, swimming, racquet sports, or team sports like soccer).  Target 150 minutes per week for moderate intensity activity (e.g., a walking program) or 75 minutes per week of vigorous intensity activity (e.g., running) or consider a mix of moderate and vigorous.

Resistance exercise. Two to three days per week. For example, free weights, weight machines, resistance bands/cords as well as body weight exercises like pushups and curl-ups. For those starting out, 10-15 repetitions will be effective. Once established, 8-12 repetitions per set are recommended to improve strength and power. One set is a good starting point with a target of 2-4 sets, including exercises for all the major muscle groups. 

Flexibility exercise. Two to three days per week, or even daily. Various methods can be used including static stretching (end position is held at the point of feeling tightness), dynamic stretching (slow movement stretching), ballistic stretching (faster movements, bouncing stretching, more typical in sport environments), and proprioceptive neuromuscular facilitation (contract-relax stretching). Total stretching time per muscle-tendon unit should be 60 seconds (e.g., static stretching held 15 seconds for a given position would be repeated 4 times).

Neuromotor exercise training. Two to three days per week or more. Exercises involving balance, agility, coordination, and gait fall into this category for older individuals. Other younger and middle-age adults may also benefit. Multifaceted activities like tai chi and yoga are also potential ways to improve functional fitness.

For the complete ACSM Position Stand see http://journals.lww.com/acsm-msse/Fulltext/2011/07000/Quantity_and_Quality_of_Exercise_for_Developing.26.aspx
Examples of exercises and progressive programs can be found in ACSM’s Complete Guide to Fitness & Health (Human Kinetics, 2011, http://www.humankinetics.com/products/all-products/acsms-complete-guide-to-fitness–health). 

For more health and fitness related tips, join Dr. Bushman’s Facebook page for ACSM’s Complete Guide to Fitness & Health http://www.facebook.com/FitnessID to discover, develop, evolve, and personalize your FITNESS ID.   Dr. Bushman also is the lead author of ACSM’s Action Plan for Menopause (Human Kinetics, 2005, http://www.humankinetics.com/products/all-products/action-plan-for-menopause) and is the incoming author of the “Wouldn’t You Like to Know” column in the ACSM’s Health and Fitness Journal. She is a Professor at Missouri State University and is ACSM certified as a Program Director, Clinical Exercise Specialist, Health Fitness Specialist, and Personal Trainer.

Top Tips to Your Performing Edge by JoAnn Dahlkoetter, Ph.D

Want to know how you can create Your Performing Edge and reach your goals faster, easier, and get the results you want? Here are my top tips to help you build new motivation, confidence and major breakthroughs in your training and in your life.
POSITIVE IMAGES: Use your mental images throughout your event or workout to create feelings of speed and power. For example, if you’re walking or running and you come to an unexpected hill visualize a magnet pulling you effortlessly to the top. Use visualization before, during and after your training to build confidence and new motivation.
 POWER WORDS: Make positive self-statements continually. Be aware of your negative thoughts early on. Don’t fight with them; simply acknowledge their presence, and then substitute positive power words. For example, when you’re thinking: “This hurts too much,” say to yourself: “This feeling is connected with getting healthier and doing my absolute best.”
PRESENT FOCUS: Practice being in the present moment. Be Right On – Right Here – Right Now. Remind yourself to stay in the here and now. Let past and future events fade into the background. Remember, the only moment we can do anything about is the one we’re in right now.
ADVANTAGE: Use everything in the workout to your advantage. For example, if another person passes you, tuck in behind and go with his or her energy for as long as possible. You may catch a second wind and be carried on to a personal record.
CHUNKING-GOALS: Focus on your immediate target. Break your training goals down into small, manageable pieces and begin to focus only on the first portion, not the entire workout. For example, say to yourself: “I’m just relaxing and getting my rhythm during the first mile, or the first workout session.”
 
And to get FREE instant access to Dr. Dahlkoetter’s Private Mentoring Program with Your Performing Edge coaching tips, video training, articles and visualization exercises, join her community at:  http://www.PeakPerformancePlan.com. Dr. JoAnn Dahlkoetter, is CEO of Performing Edge Coaching International Association, (http://www.PerformingEdgeCoach.com ) a global resource and Certification Training Program for coaches, and founder of  http://www.DrJoAnn.com  the premiere sports psychology resource for athletes, coaches and sports parents. Dr. JoAnn is best-selling author of YOUR PERFORMING EDGE™, (http://www.sports-psych.com )  on OPRAH and NBC-TV, Stanford Performance Consultant, sports psychologist to OLYMPIC Gold Medalists and CEOs, winner of the San Francisco Marathon and 2nd in the World Championship Hawaii Ironman Triathlon. She is Host of the internationally syndicated TV Show – “Your Performing Edge”, an internationally recognized Keynote Speaker, columnist, and TV expert commentator.  Dr. JoAnn provides sports psychology, mental training and Performing Edge Coach Certification programs for coaches, parents and young athletes to reach their highest potential in sports and life. Call 650-654-5500 to apply for your FREE peak performance consultation. FREE Private Mentoring program at http://www.PeakPerformancePlan.com

Creating an Inner Desire by JoAnn Dahlkoetter, Ph.D.

To excel as a top performer you must be hungry- hungry for success, for results – hungry simply to become the best athlete you can be. It starts with a dream, but somehow you must be inspired, or you will never be able to reach your goal.

What are the key characteristics of well-motivated athletes? Through my extensive work with numerous athletes over several years, I have developed a constellation of traits that defines the champion’s mentality. Elite athletes do not possess superhuman powers or extraordinary qualifications limited to a selected few. The characteristics that make a champion can be attained and developed by ANYONE who wants to excel in a sport:

Enthusiasm and Desire - Love for Your Sport: Top athletes have a hunger, a fire inside which fuels their passion to achieve an important goal, regardless of their level of talent or ability. To accomplish anything of value in life you need to begin with some kind of vision or dream.  The more clearly you can see that picture in your mind, the more likely it is to become reality.  Wherever you place your attention, your energy will follow.

Courage to Succeed - Once an athlete has the desire, he or she needs to back it up with courage – the incentive to make any dream you dare to dream become reality.  It takes courage to sacrifice, to work out when you’re tired, to seek out tough competition when you know you’ll probably lose.  It takes courage to stick to your game plan and the relentless pursuit of your goal when you encounter obstacles.  It takes courage to push yourself to places that you have never been before – physically or mentally. It takes courage to test your limits, and to break through barriers.

Internal motivation and self-direction - Champion athletes decide early on that they are training and competing for themselves, not for their parents, their coaches, or for the medals. Direction and drive need to come from within.  The goals must be ones that you have chosen because that’s exactly what you want to be doing.  Ask yourself, what keeps you running? Who are you doing it for?

Commitment to Excellence - How good do you want to be?  Elite athletes know that to excel at their sport, they must decide to make it a priority in their life.  They make an honest effort each day to be the best at what they do.  At some point you must say, I want to be really good at this; I want this to work.  To notice significant growth you must live this commitment and regularly stretch what you perceive to be your current limits.

Discipline, Consistency, Organization - Winning athletes know how to self-energize and work hard on a daily basis. Because they love what they do it is easier for them to maintain consistency in training and in competing. Regardless of personal problems, fatigue, or difficult circumstances, they can generate the optimal amount of excitement and energy to do their best.

Being focused and yet relaxed - Champions have the ability to maintain concentration for long periods of time.  They can tune in what’s critical to their performance and tune out what’s not.  They can easily let go of distractions and take control of their attention.
Ability to handle adversity:  Top athletes know how to deal with difficult situations. Adversity builds character.  When elite athletes know the odds are against them they embrace the chance to explore the outer limits of their potential.  Rather than avoiding pressure they feel challenged by it. They are calm and relaxed under fire. Setbacks become an opportunity for learning; they open the way for deep personal growth.

Dr. JoAnn Dahlkoetter , at www.DrJoAnn.com best-selling author of YOUR PERFORMING EDGE™, on OPRAH and NBC-TV, is CEO of Performing Edge Coaching International Association,  (www.PerformingEdgeCoach.com)  Stanford Performance Consultant, sports psychologist to OLYMPIC Gold Medalists and CEOs, winner of the San Francisco Marathon and 2nd in the World Championship Hawaii Ironman Triathlon. She is Host of the internationally syndicated TV Show, “Your Performing Edge”,  a renown Keynote Speaker, columnist, and TV expert commentator.

Dr. JoAnn provides corporate training and Performing Edge Coach programs for sports, business, wellness, to reach your highest potential life.  FREE Book chapter at:   http://sports-psych.com/book_order.html

To download Dr. Dahlkoetter’s FREE Private Mentoring Program to reach Your Performing Edge with coaching, video training tips and valuable articles at: www.drjoann.com/2009/12/tips/ ,  or for your Custom Peak Performance Visualization MP3 Audio made personally for you, call 650-654-5500.   www.DrJoAnn.com.