ARC Innovation and Sheba Medical Center, Israel’s largest medical center and a Newsweek ranked world’s best hospital for the last five years, announced today the integration of technology developed by two startups, Cognishine and Kemtai, to augment healthcare in the hospital’s newly expanded rehabilitation ward.

Sheba Medical Center is home to Israel’s largest rehabilitation hospital. Amid the Israel-Hamas war, Sheba expanded the hospital with the addition of a new state-of-the-art 36-bed ward to treat wounded soldiers. The new ward leverages a range of innovative digital medical technologies to augment medical staff capabilities and improve overall quality of care. 

“Now is the time to innovate. During the COVID pandemic, Sheba created innovative solutions to save lives and helped set the health protocols for the rest of the world,” said Prof. Eyal Zimlichman, Chief Transformation Officer and Chief Innovation Officer at Sheba Medical Center and Director and Founder of ARC Innovation. “Times of crisis present an opportunity to accelerate innovation and transformation in care. And this is exactly what we are setting out to do, given the immense need for rehabilitation in Israel at this time.”

To maximize the effectiveness of the new ward, Sheba called upon Israel’s startup ecosystem, inviting health tech companies to submit solutions for potential use in the rehab hospital. Out of 82 companies that applied to the project, eight were selected to pitch their solutions to a panel of Sheba clinicians and industry leaders. Out of these eight companies, Cognishine and Kemtai were selected to begin a pilot program at Sheba, with the aim of incorporating the solutions into day-to-day rehab treatment.

Cognishine’s digital platform supports therapists in providing effective care for cognitive, emotional, speech and language disorders. Digitizing traditional therapeutic processes, the company offers a wide range of activities based on real-world scenarios to help patients to regain cognitive, speech and social-emotional capabilities.

“Cognishine extends the reach of medical professionals, enabling them to continue providing care through digitized therapeutic activities aiding cognitive abilities,” said Nimrod Zilkha, Co-Founder & CEO of Cognishine. “We are honored to play a role alongside Sheba helping soldiers recover from the war and get back to their daily lives.”

Kemtai is an AI-powered exercise platform for physical therapy and rehab, compatible with most phones and computers. The app provides real-time feedback and corrective guidance during exercise, enabling patients to improve their performance and accelerate recovery.

“Kemtai is enabling patients to fully adhere to their rehabilitation exercises with AI-guided, real-time guidance, helping achieve the best possible outcomes,” said Dr. Mor Amitai, CEO of Kemtai. “Our pilot at Sheba will see even more patients with physical limitations recover through augmented exercise.”

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About Sheba Medical Center

The largest and most comprehensive medical center in the Middle East, Sheba Medical Center, Tel Hashomer is generating global impact through its medical care, research and healthcare transformation. Sheba’s City of Health boasts acute-care, rehabilitation, children’s, cancer and geriatric hospitals, research and innovation hubs, medical simulation center and center for disaster response on one comprehensive campus in the center of Israel. Sheba serves as a true hospital without borders, welcoming patients and healthcare professionals from all over the world and consistently providing the highest-level medical care to all in need. Sheba has been ranked a World’s Best Hospital by Newsweek five years in a row (2019, 2020, 2021, 2022, 2023). For more information, visit: https://sheba-global.com/

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Get regular physical activity, and you can reduce your risk of becoming obese, developing diabetes, suffering from cardiovascular disease, dodge particular cancers, and more. But how does exercise work its physiological magic?

First, we’ll review some of the health benefits of regular physical activity. Second, we’ll turn to a new study that sheds light on how moving affects our physiology at a basic level.

Physical activity and cardiovascular disease

Many of us lead sedentary lifestyles, at least in the United States. Unfortunately, not getting regular physical activity is an independent risk factor for the early development of coronary heart disease.

Unfortunately, much of the evidence supporting the risk-reducing properties of exercise comes from long-term observational studies that demonstrate this:

Those who get regular physical activity have much less coronary heart disease and a lower risk of experiencing cardiac arrest.

Let’s compare the least active among us with the most active. I live in King County, Washington (USA). There, researchers from the University of Washington performed a population-based case-control study to examine the associations between regular high-intensity and moderate-intensity leisure-time physical activity and primary cardiac arrest.

The investigators looked at 333 patients with primary cardiac arrest, aged 25 to 75, attended by paramedics. Controls were randomly selected from the same community and matched for age and sex. None of the subjects had a history of heart disease, major health problems, or self-reported poor health.

The researchers interviewed partners of patients and controls to assess participation in 15 high-intensity and six moderate-intensity physical activities during the previous year.

Here are the relative risk reductions by activity type:

• Gardening for more than 60 minutes per week appeared to be associated with a drop in risk by two-thirds.
• Walking for exercise for more than 60 minutes per week appeared to be associated with a nearly three-quarters risk reduction.
• Engaging in high-intensity activities appeared to be associated with a drop in risk by two-thirds.

Unfortunately, I did not see absolute risk reduction numbers. However, here is some context: Globally, cardiac arrest takes more lives than colorectal cancer, breast cancer, prostate cancer, influenza, pneumonia, auto accidents, HIV, firearms, and house fires combined. In one year alone, 350,000 Americans die from cardiac arrest.

A sedentary lifestyle is an independent risk factor for cardiac arrest. Of course, exercise is not completely free of potential perils. Physical activity can have rare adverse effects, including heart attack, heart rhythm problems, sudden death, and rhabdomyolysis.

Rhabdo happens when damaged muscle tissue releases its proteins and electrolytes into the blood. These substances can damage the kidneys and heart and lead to permanent disability or even death.

Physical activity and weight

Exercise is important to prevent obesity; sedentary behavior is associated with weight gain. For older or obese adults, higher activity levels (compared to young adults) appear necessary to prevent weight gain.

A study of 34,000 females (with an average age of 54) consuming a usual diet had an average weight gain of 2.6 kilograms (5.7 pounds) over 13 years.

Compared with females doing more than 420 minutes per week of exercise (an average of one hour daily), those engaging in less activity gained significantly more weight.

Physical activity appeared inversely related to weight gain only among normal-weight individuals. To maintain normal body weight in mid-life, the females in the study needed higher levels of physical activity (about 60 minutes daily).

Once overweight, physical activity alone (without controlling caloric intake) did not prevent weight gain.

The available research findings suggest that physical activity protects against obesity regardless of an individual’s genetic predisposition to it.

Physical activity and life expectancy

Physical inactivity is associated with a reduced life expectancy. A retrospective study published in JAMA addresses this issue. The study explores the link between long-term mortality and various levels of cardiorespiratory fitness.

Cardiorespiratory fitness measures how well your heart and lungs pump blood and oxygen during prolonged exercise. The more fit you are, the higher your cardiorespiratory fitness.

Over 122,000 patients at the Cleveland Clinic (USA) had exercise testing on a treadmill to measure cardiorespiratory fitness for the research investigation. The subjects ranged in age from 18 to over 80, with an average age of 53. The results?

Cardiorespiratory fitness appeared to be associated with living longer. The higher the fitness, the higher the survival rate, regardless of age. The connection appeared to be especially strong among older individuals and those with high blood pressure. Moreover, the survival benefit continued to increase with no upper limit.

Physical activity — How it works its magic

Physical activity is a wonderful way to help maintain and restore good health. Despite numerous studies demonstrating this relationship, the molecular mechanisms underlying the benefits remain incompletely elucidated.

A new paper by researchers at Harvard Medical School (USA) and Massachusetts Institute of Technology (USA) in Cell Metabolism illuminates the complex physiological response to exercise.

The Harvard/MIT team combined modern single-cell technologies with advanced computational biology and artificial intelligence to look at how three metabolic tissues respond to exercise and high-fat diet-induced obesity at a single-cell resolution. This project is a first-of-its-kind research investigation.

The researchers discovered opposite responses to exercise and obesity across all three tissues.

Goodyear and colleagues focused on three tissues, including two kinds of white adipose tissue (fat) and skeletal muscle taken from mice. The rodents were either trained or sedentary and consumed either a healthy or high-fat diet (the latter aiming to mimic a typical Western diet).

Here are the four mice groups:

• Regular diet/sedentary
• Regular diet/active
• High-fat diet/sedentary
• High-fat diet/active

The mice consumed the diet for six weeks. The active mice had free access to a running wheel for three weeks.

After three weeks of exercise, researchers used single-cell RNA sequencing. Here are the findings:

Genes regulating extracellular matrix* remodeling and circadian rhythm appeared to be regulated by exercise and obesity in all three tissue types. Obesity up-regulated extracellular modeling, while exercise down-regulated them. Conversely, exercise up-regulated circadian-related pathways, and obesity down-regulated them.

• The extracellular matrix is the “non-cellular portion of a tissue. It is a collection of extracellular material produced and secreted by cells into the surrounding medium. The extracellular matrix provides structural and biochemical support to the surrounding cells.”

Here is co-first author, Pasquale Nigro, Ph.D.:

“With respect to the circadian rhythm, we saw very quiet cells that weren’t metabolically active with the high-fat diet group. We discovered that exercise reversed this. It seemed that, when the circadian system is up-regulated, cells become re-activated.”

My take — Physical activity

Unless there is a medical contraindication, we should all try to achieve and maintain high fitness levels.

Current guidelines recommend 150 to 300 minutes per week of moderate aerobic activity (such as walking, running, swimming, or biking), 75 minutes of vigorous activity, or a mix of both. Experts also recommend twice-weekly resistance training to strengthen muscles.

Unfortunately, only about one in five adults and teens in the United States gets enough exercise to maintain good health. We can do better.

Thank you for joining me in this look at the effects of obesity and exercise on fat and muscle.

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The global burden of disease places lower back pain (LBP) as the leading cause for years lived with disability at the top spot for the past three decades.

LBP may be treated with pharmacological therapy, surgical interventions, or rehabilitation…physical therapy, exercise, spinal manipulation, and other practices. Combination therapy and interdisciplinary approaches to LBP are considered helpful in many cases.

Everything works, but not for everyone.

Ask one hundred people what you can do to get rid of your back pain and you might get one hundred different answers. Read a hundred different articles, scientific studies, look at one hundred different videos online, you will hear and see it all.

Chiropractic care is my bias, it’s how I pay my bills, but that doesn’t make it better. Relief from pain isn’t open and shut. What works for some people won’t necessarily work for you. Doing you own research may point you in a direction, listening to experts may sway you, hearing from a friend or family member might land you in a different office. Some interventions are apparently bogus based on today’s prevailing evidence: TENS, ultrasound, and kinesiotaping for pain don’t appear to do much. Ice (cryotherapy) is also out of favor at the moment.Should Your Chiropractor Adjust Your Neck?Cervical spine manipulation is controversial, should it be abandoned?medium.com

No one has a monopoly on what works the best, because nothing works the best. There is no gold standard for effective back pain treatment. Some people respond well to one thing but aren’t going to respond well to another. Many cases will resolve on their own no matter what procedure or technique is performed.

If treating back pain is a crap shoot, why go to a chiropractor?

There are some first-line treatment recommendations that show up perennially in study after study for what works for lower back pain.

From the American College of Physicians evidence-based clinical practice guideline 2017:

Given that most patients with acute or subacute low back pain improve over time regardless of treatment, clinicians and patients should select nonpharmacologic treatment with superficial heat (moderate-quality evidence), massage, acupuncture, or spinal manipulation (low-quality evidence). If pharmacologic treatment is desired, clinicians and patients should select nonsteroidal anti-inflammatory drugs or skeletal muscle relaxants (moderate-quality evidence). (Grade: strong recommendation)

And:

For patients with chronic low back pain, clinicians and patients should initially select nonpharmacologic treatment with exercise, multidisciplinary rehabilitation, acupuncture, mindfulness-based stress reduction (moderate-quality evidence), tai chi, yoga, motor control exercise, progressive relaxation, electromyography biofeedback, low-level laser therapy, operant therapy, cognitive behavioral therapy, or spinal manipulation (low-quality evidence). (Grade: strong recommendation)

So you can see that good chiropractic care covers several of these recommendations for acute, sub-acute, and chronic types of lower back pain. A competent chiropractor is going to perform a detailed history and physical exam, provide you with a working diagnosis, and form a plan based on the best available evidence, their own clinical expertise, and your preferences and values as the patient — the key player in all of this.

Chiropractic can check a lot of these boxes, but not every chiropractor will employ multiple treatment modalities. In my own office I frequently use:

1. Nonpharmacologic treatments
2. Superficial heat
3. Massage
4. Spinal manipulation
5. Exercise
6. Yoga

Final Thoughts

As a human being, there is a good chance you will develop lower back pain at some point in your life. Most cases of lower back pain will resolve on their own with time. No matter what you try or who you see first for a case of lower back pain, it may or may not improve your symptoms.

So from my professional standpoint what you do for your back pain should be based primarily on what you value in a treatment approach. Some people are comfortable with medications or injections, others are not. Some people value exercise over more passive treatments such as massage.

In the case of chiropractic treatment most patients who seek this type of care for their lower back pain are likely attracted to it being drug-free, non-invasive, hands-on, and of a low risk of side effects.Fruit Is Not Making You FatIf you go to a health professional and they tell you fruit is bad, turn and run in the other direction.medium.com

Works Consulted:

Pergolizzi, J.V., LeQuang, J.A. Rehabilitation for Low Back Pain: A Narrative Review for Managing Pain and Improving Function in Acute and Chronic Conditions. Pain Ther 9, 83–96 (2020). https://doi.org/10.1007/s40122-020-00149-5

Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians https://doi.org/10.7326/M16-2367

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The building was crowded with people of all ages being led by PTs to yoga balls and tables. Surely, I thought, I won’t be out in the open.

After filling out pages of intimate and detailed paperwork and realizing I needed to pee already — too much coffee — my Physical Therapist, Becky, walked into the lobby, introduced herself, and led me back to her private room.

Becky looked hip and happy. She had me sit down and went over my paperwork, asking questions and listening to my answers, sometimes asking more questions based on my answers. I love it when healthcare professionals listen to me.

When she asked me to hop on the table, and I said, I better go to the bathroom first, she wasn’t annoyed or rushed. She told me where to go and waited for me. I felt calm and supported in her presence. From the beginning to the end of the appointment, Becky didn’t treat me like I was broken.

I’ve had two children. In 2007, I birthed my son after long labor progressing to an 8 (out of 10) centimeters dilated, only to get to the hospital, screaming in pain for drugs, any drugs, like you see the crazy women on TV doing. My husband, David, and I were told our son was stuck in the brow position.

It was near Christmas and my OBGYN was on vacation. The new doctor told us our baby’s neck could snap if we continued with vaginal delivery and suggested we have a C-section. The phrase “baby’s neck may snap” was enough to convince us. David got all sheeted up in his Tyvek-looking scrubs and we went into surgery. The surgery was traumatic, but that’s another story.

My recovery was slow and painful — I was healing from a brutal c-section incision (I felt the scalpel for a good chunk of it) and my son being wedged in my birth canal. I did recover, lost the baby weight, and got quite healthy within the year.

In 2010, we had our second child by VBAC (Vaginal Birth After Cesarean-Section). I was terrified to go through another traumatic surgery. Our daughter was induced at the 39th week and labor with her was pretty flawless. I did require an episiotomy and had an epidural, but no mind-altering drugs. I was grateful to be aware and present for this healing birth. I even got to hold her head as she was being born.

After I’d healed from delivering our daughter, which was much quicker than the c-section healing, I began running. I ran for about a year until I realized that I had a prolapsed uterus and was warned against doing any high-impact exercise.

My OBGYN wanted to perform a hysterectomy. I thought this was drastic. I got a second opinion. That doctor agreed that a hysterectomy wasn’t necessary at the time.

I don’t find that Pelvic Floor Therapy is something women in my life discuss. I think the first time I heard about it was from my PCP (Primary Care Physician) at my well-woman check in 2020. I’d been seeing a slew of doctors and although I was interested, I decided to hold off.

Part of me felt embarrassed and unsure of what to expect. Then, my friend Shanna Loga wrote an article about her experience with Pelvic Floor Therapy. Reading her article was a lightbulb moment and a moment of pure gratitude. She was brave and speaking up about something that every mom who’s birthed babies should probably know about.

I messaged Shanna to confide that I also peed my pants and was encouraged to finally pursue Pelvic Floor Therapy after reading her article.

When I worked as a gardener in a very physical job at my local botanic garden, I started leaking urine. I wore pads to work. I was in my early 40s and pretty damn embarrassed. But I also figured this is just something moms deal with. I remembered my mom saying she dealt with it. It was just part of what happens after birthing babies.

I resigned from my job in January of 2020. Throughout 2020, I spent many hours sitting and typing. I’d often hold my pee way too long and when I got up, I’d dribble. I also had a few moments of soaking through my pants entirely. I’m 42. This felt pretty mortifying. I cut back on coffee and tried to remember that the pee-pee dance is for kids, not moms who have had two kids.

My well-woman check was a few weeks ago. It’s the first time I walked into a well-woman check and felt absolutely no embarrassment about my naked breasts or my vagina being looked at. It’s self-care. It’s important. Women’s Health shouldn’t be embarrassing.

My doctor is a phenomenal woman who had her first baby in August. She took a look at my prolapse and said, “I can refer you to Pelvic Floor Therapy now or we can wait until it gets worse.” I said, “I want to go now!” with a big grin on my face. Last year, I would’ve been bashful. This year, I felt empowered and confident. “I’d rather prevent it from getting worse. My friend just told me all about her pelvic floor therapy appointment and I’m so glad she did. I wish more women talked about this.”

My doctor agreed and informed me that we have wonderful Pelvic Floor Specialists in Tulsa. People even come from out of state to see them. She gave me the referral and mentioned she should probably go herself. She encouraged me to talk about this with other women.

This week, I went to my pelvic floor evaluation. I was nervous and expecting more of a gynecologist-style appointment. That’s not what happened.

I filled out a lot of informational forms. My therapist came out and introduced herself. She took me back to her private room and took her time explaining things and asking me questions. You know how some people just exude empathy? She is one of those people. I am grateful for this.

When I talked about the trauma that went with my c-section scar, she nodded in understanding. When I mentioned I’d gotten work done on it by a healer, she nodded her head. Instead of being judgy, I felt more empathy and understanding permeate the room. She asked if it had helped. She said she could feel the energy I was talking about.

This is new to me. I don’t usually confide alternative methods to doctors because I never know how they’ll react and I assume it’ll usually be negative. But, I think alternative modes are being integrated into traditional medicine now and I’m willing sometimes to take the risk to say things like, I’ve worked with a healer. In this case, it forged a closer relationship from the beginning of my intake.

Then, we got around to the evaluation and exercises. I won’t write a lot here except that I had no idea how important my abs are in relation to my pelvic floor. I didn’t know my abs should be engaged when I’m doing Kegels. I didn’t know the different ways in which to do Kegels correctly. I wasn’t thrilled when my strength evaluation came out at a 1 from a 0–5. At least I knew how to do them and my endurance was perfect.

I messaged Shanna to share my low grade. She told me I’d be “cracking walnuts” by the end of therapy but that when we quit doing the exercises, we lose the tone quickly. I’m trying to remind myself of this and actually do my exercises…I’m pretty good at dropping the ball at things that have “exercise” or “abs” in them.

Women need vaginal education. We need to know how to name and isolate our internal anatomy. We need to know how important our abs are in relation to our pelvic floor. This isn’t information we should have to seek out by ourselves and it shouldn’t be a hush-hush or embarrassing thing to discuss. There should be post-partum education about pelvic floor therapy and doctors and gynecologists should be able to provide this education to women. I’d much rather do physical therapy than undergo a hysterectomy operation.

Everyone has a different situation. The more we discuss our experiences and normalize them, the better we can begin to feel, and the more confident we can be in taking action to improve our health, even when it feels a little — or a lot — embarrassing. I hope my experience encourages you to prioritize your health. You’re worth it!

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