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Marathon Mondays: Make it to the start healthy

Marathon Mondays: Get to the start healthy

In the final episode of our Marathon Monday mini-series, 5x Boston Marathon Division Winner Heather Pech joins the podcast to talk about her training process and how she keeps winning gold.

September 11, 2023 | Britt Gunsser, PT, DPT, OCS, CSCS | Brendan Copley, CSCS, ATC

Get to the start healthy

Hosts physical therapist Britt Gunsser and personal trainer Brendan Copley, who are marathoners themselves, discussed what exactly makes Heather such a successful runner — from her nutrition to mentality, Heather breaks down everything that makes her a world record holder.

During the interview, Heather shares her running journey, highlighting the importance of paying attention to the finer details in training that can set athletes apart, as well as the crucial role of community and support in her running life and how she has cultivated a network over the years.

The hosts delve into Heather's approach to optimal health, touching on the four pillars of exercise, stress management, recovery, and nutrition. Heather shares insights into how she has evolved her recovery and rest strategies throughout her running career and provides valuable advice on balancing running with other life commitments. She also discusses the significance of cross-training to prevent burnout and shares her mental resilience strategies.

Heather wraps up the interview by recommending resources for aspiring runners, sharing her upcoming running goals, and reflecting on memorable races that have shaped her remarkable running career.

Listen here, or wherever you get your podcasts.

Britt Gunsser

Britt Gunsser

Britt Gunsser, PT, DPT, OCS, CSCS, is a board certified orthopedic clinical specialist, certified Schroth therapist and dry needling specialist. She has completed extensive work on running rehabilitation and is an RRCA Running Coach.

Meet Britt

Brendan Copley

Brendan Copley

Brendan Copley, CSCS, ATC, is a personal trainer who specializes in working with endurance athletes and post-rehab clients. Brendan is a marathoner and former cross-country runner and has worked as an athletic trainer for Quinnipiac University’s cross-country and track teams.

Meet Brendan

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Decoding stem cell treatments: sources, contrasts, and PRP in regenerative medicine

A stem cell is not a stem sell: understanding the different types of stem cell treatments, sources, and platelet-rich plasma

In recent years, stem cell treatments have emerged as a promising field in regenerative medicine, offering potential solutions for various health conditions. In this article, we will explore the contrasts between different stem cell treatments, their sources, and the role of PRP.

July 5, 2023 | Shane Foley, PT, DPT, OCS, CSCS

Stem cells

In recent years, stem cell treatments have emerged as a promising field in regenerative medicine, offering potential solutions for various health conditions. However, with numerous types of stem cell therapies and different sources of stem cells available, it's crucial to understand the key differences and make informed decisions based on the best medical evidence. Additionally, platelet-rich plasma (PRP) has gained popularity as a therapeutic approach. In this article, we will explore the contrasts between different stem cell treatments, their sources, and the role of PRP.

Embryonic stem cells (ESCs):

Embryonic stem cells are derived from human embryos. They possess remarkable pluripotency, meaning they can differentiate into any cell type in the human body. ESCs have immense potential for regenerative medicine, but their use is highly controversial due to ethical concerns surrounding the destruction of embryos. Currently, their clinical applications are limited.

Adult Stem Cells:

Adult stem cells are found in various tissues, such as bone marrow, adipose tissue, and blood. They are more specialized than ESCs and have a more limited differentiation capacity. However, they can still differentiate into multiple cell types, aiding in tissue repair and regeneration. Adult stem cell therapies have shown promising results in the treatment of conditions like orthopedic injuries, cardiovascular diseases, and autoimmune disorders.

Induced pluripotent stem cells (iPSCs):

iPSCs are adult cells that have been reprogrammed to revert to a pluripotent state, similar to ESCs. This breakthrough discovery has enabled the generation of patient-specific stem cells, avoiding the ethical concerns associated with ESCs. iPSCs have the potential to revolutionize personalized medicine, providing tailored treatments for individuals.

Cord blood stem cells:

Cord blood, obtained from the umbilical cord and placenta after childbirth, contains a rich source of stem cells. These stem cells are similar to adult stem cells and can differentiate into various cell types. Cord blood stem cells are commonly used in the treatment of blood disorders, immune deficiencies, and certain cancers. The collection of cord blood is non-invasive and poses no risk to the mother or baby.

Platelet-rich plasma (PRP):

PRP is a therapy that involves using the patient's own blood, specifically the platelet-rich portion, to promote healing. Platelets contain growth factors that facilitate tissue regeneration and repair. PRP is commonly used in orthopedics, dermatology, and sports medicine to treat conditions such as osteoarthritis, tendon injuries, and skin rejuvenation. Although PRP has shown promising results, more research is needed to establish its efficacy and determine the ideal application protocols.

Understanding the different types of stem cell treatments and their sources is crucial for making informed decisions about potential therapies. While ESCs possess immense potential, their use is limited due to ethical concerns. Adult stem cells, iPSCs, and cord blood stem cells offer more practical alternatives with promising therapeutic applications. Additionally, PRP has gained popularity as a regenerative treatment option, harnessing the body's natural healing capabilities.

It is important to note that the field of stem cell research and regenerative medicine is still evolving. As more evidence and clinical trials emerge, the efficacy and safety of these treatments will become clearer. It is recommended to consult with healthcare professionals who specialize in regenerative medicine to explore the most appropriate options for your specific condition. Being educated on the sourcing and type of stem cell is vitally important.

Michael Beecher

Shane Foley

Shane Foley, PT, DPT, OCS, CSCS, is an orthopedic specialist who is certified in strength and conditioning, dry needling, and the Schroth Method. He has a deep passion for building relationships, helping people accomplish their goals and leading people to optimize their performance.

Meet Shane

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Exploring the promising role of stem cell treatments in orthopedic conditions

Exploring the promising role of stem cell treatments in orthopedic conditions: unveiling the latest evidence

In this article, we will delve into the fascinating world of stem cell treatments and their potential for managing orthopedic conditions. As Dr. Peter Attia often emphasizes, staying informed about cutting-edge medical advances can help us make informed decisions regarding our health and well-being. So, let's embark on this enlightening journey, exploring the most recent evidence supporting the use of stem cells in orthopedic care.

July 5, 2023 | Michael Beecher, PT, DPT, OCS, SCS

Doctor injecting stem cells into a knee

Understanding stem cell therapy:

Stem cells are remarkable cells with the potential to develop into various specialized cell types in the body. Their unique regenerative properties have led researchers to explore their therapeutic applications in a wide range of medical fields, including orthopedics. Stem cell therapy involves using these cells to aid tissue repair, regeneration, and potentially even the reversal of certain degenerative conditions.

Orthopedic conditions, such as osteoarthritis, tendinitis, and ligament injuries, can significantly impact our quality of life. Traditional treatments often focus on managing symptoms, maintaining/improve quality of live or, in severe cases, surgical interventions. However, recent studies have shed light on the potential of stem cell treatments to revolutionize orthopedic care.  In a study published in the Journal of Bone and Joint Surgery, researchers examined the effectiveness of stem cell therapy in knee osteoarthritis. The results demonstrated significant improvements in pain reduction and functional recovery among patients who received stem cell injections. These findings suggest that stem cells have the potential to enhance the body's natural healing processes and mitigate the underlying causes of orthopedic conditions.

Furthermore, research has shown promising results for using stem cells in the treatment of ligament injuries. A study published in the American Journal of Sports Medicine explored the use of stem cells to repair torn anterior cruciate ligaments (ACL) in athletes. The findings revealed improved ligament healing and functional outcomes compared to conventional treatments, potentially reducing the need for extensive surgeries and lengthy rehabilitation periods.

Safety and ethical considerations:

While stem cell therapy shows tremendous potential, it is essential to address safety concerns and ethical considerations. Researchers and medical professionals diligently work to ensure the highest safety standards when conducting clinical trials and administering treatments. Regulatory bodies and scientific communities closely monitor these developments to strike a balance between innovation and patient well-being. Current sources of stem cells are more numerous than earlier options and pose less of an ethical concern. Current options primarily include an individual's own cells, cadaveric cells, and cord blood cells that can be taken from umbilical cords and placenta.

The future of stem cell therapy in orthopedics:

As the field of stem cell research continues to advance, the future of orthopedic care appears promising. Ongoing studies are exploring innovative techniques such as tissue engineering, combining stem cells with biomaterials to create functional replacement tissues.

Moreover, advancements in personalized medicine and genetic profiling enable scientists to tailor stem cell treatments to individual patients, optimizing outcomes and minimizing potential risks. This personalized approach holds immense potential for enhancing the efficacy of orthopedic interventions and improving long-term patient satisfaction.


Stem cell treatments offer significant hope for individuals grappling with orthopedic conditions. As the latest evidence suggests, these therapies hold the potential to revolutionize the field of orthopedic care, providing effective alternatives and enhancements to traditional approaches. It is vital that these treatments are incorporated into standard physical therapy and wellness practice to enhance outcomes rather than replace these proven treatments all together. The root cause of tissue breakdown, typically muscle imbalance, malalignment and movement deficiency, need to be addressed in order for lasting results to be realized. It is crucial to stay informed and consult with trusted medical professionals before making any treatment decisions.

Remember, the field of regenerative medicine is constantly evolving, and our understanding of stem cell therapies will continue to expand. By keeping abreast of the latest research and advancements, we empower ourselves to make well-informed decisions regarding our health and well-being. So, let us embrace the fascinating world of stem cell treatments as we strive for optimal orthopedic health and a better tomorrow.

Michael Beecher

Michael Beecher

Michael Beecher, PT, DPT, OCS, SCS, is a Titleist Performance Institute medical professional, a Hospital for Special Surgery credentialed advanced hip clinician and a certified dry needling specialist.

Meet Michael

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How to prepare for spine surgery

How to prepare for spine surgery

How to prepare for spine surgery

Back surgery can potentially be a very scary and stressful procedure, but there are a variety of ways to ensure you have the best recovery possible.

May 26, 2023 | Larry Piretra, PT, DPT, OCS, SCS

Doctor looking at a spine diorama

Back surgery can potentially be a very scary and stressful procedure, but there are a variety of ways to ensure you have the best recovery possible. Some common back surgeries within the cervical, thoracic, and lumbar spine include diskectomies, laminectomies, fusions, scoliotic surgery, and kyphoplasty. The steps leading up to your surgery and after are vital to successful long-term outcomes.

The actions you take prior to surgery can help set up success immediately post-operation. Simply speaking, the better shape your body is prior to surgery, the better shape your body will be after surgery. Through the prehab process, your physical therapist can help discuss what the process following surgery and what motions will be beneficial vs potentially harmful. It is extremely important to follow your physician’s instructions as certain surgeries have restriction with movement (e.g. no bending, lifting, or twisting for six weeks).

Your body will be undergoing some trauma through the surgical process; therefore, aiding in the recovery is imperative to positive surgical outcomes. Cryotherapy is a great treatment to help naturally aid in your body’s own healing process. Benefits from cryotherapy include reduction in pain from inflammation, reduced muscle tenderness, immune system boost, and renewed skin/blood cells. Infrared sauna may also be a potentially useful tool post-surgery to aid in healing through improved circulation, stress reduction/improved sleep, detoxification, improved immunity, and natural wound healing. Both cryotherapy and sauna are great options, but they should both be cleared by a medical professional prior to utilization.

Proper nutrition should be at the forefront of every healthy individual’s mind, especially when recovering from a spinal surgery. One’s activity levels may be temporarily limited after surgery which makes the nutritional component that much more important. You will likely need to increase protein intake following spinal surgery, as it is one of the keystones within your diet that builds and repairs your body. Foods with high protein amounts include fish, poultry, beans, eggs, lentils, and nuts. Appropriate hydration is also imperative to healing process after spinal surgery, as this helps nutrients disperse throughout your body and support healthy joints and musculature surround the spine.

Spinal surgery can take a toll on one’s mental health just as much as their physical health, but there are plenty of strategies to help overcome this obstacle. Education and not being afraid to ask questions are key to understand the full process from surgery through recovery. This includes speaking with your physician, physician assistants, physical therapist, and friends/family who may have undergone a similar procedure. The best thing you can do leading to spinal surgery is prepare and plan the first weeks following, understand the timeline of recovery, and practice relaxation techniques. Your outlook can have a major influence on your recovery, as those with lower levels of stress/pain catastrophizing can have better surgical outcomes.
Always ensure you have your support system when undergoing spinal surgery, which can include your friends/family, physical therapists, physician, or even a support group. With these tips, you will set yourself up for success and ensure you have the best possible outcomes.

Larry Piretra

Larry Piretra

Larry Piretra, PT, DPT, CSCS, TPI-M2, is a physical therapist and strength and conditioning specialist who serves as the Naples Site Lead. As a Titleist Medical and Fitness Professional, Larry also serves as the Golf Programming Lead for Performance.

Meet Larry

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Women & Our Bodies

Women & Our Bodies: Taking charge of menopause through an integrated wellness approach

Women & Our Bodies: Taking charge of menopause through an integrated wellness approach

This informal gathering of women was an opportunity to share stories & gain valuable insights about our ever-changing bodies with experts in women's integrative health, nutrition, fitness and pelvic floor.

Women & Our Bodies

There is no “cure” for menopause, but there are ways to counteract the effects.

“So many women think that they have to go through perimenopause and menopause alone,” but that could not be further from the truth,” Jessica Klecki told the crowd. Jessica Klecki, PT, DPT, is a pelvic physical therapist at Performance Optimal Health, and she was on a panel of women’s health specialists at Performance’s first event geared toward women in their middle years.

The intimate gathering, “Women & Our Bodies: Taking charge of menopause through an integrated wellness approach,” was hosted by the Greenwich Water Club and attended by over 80 women from Greenwich, CT, and the surrounding areas.

The Midlife Truth Project founder Julie Flakstad was joined by a panel full of women’s health experts, each representing a key area of health: Dr. Bronwyn Fitz, MD, who is board certified in ObGyn and Integrative Medicine, certified dietetic nutritionist Koren Bradshaw, women’s health fitness specialist and pelvic physical therapist Danielle Pasquale, PT, DPT, and Klecki.

“Now that you’re in your middle years, you’ve probably thought, ‘this is it! The hard part is over, my kids are older, and I can relax.’ And then menopause hits. It’s like we can’t catch a break!” Julie Flakstad exclaimed, drawing laughs from the crowd. “But that is why we are here to help you find the tools you need to take charge of this part of your life, and not let it control you,” she continued.

Over the course of the evening, the panel discussed how a team approach to healthcare can best support women going through the complications that come with age. Dr. Fitz started the talk off by stressing the importance of surrounding yourself with people that make you feel heard, something especially crucial when choosing your ObGyn.

“Your ObGyn should be there to guide you, not dismiss your concerns or pain,” Dr. Fitz explained. There are many tools that can be used to combat the effects of menopause, such as hormone replacement therapy or vitamin supplements, but the best answer is usually an integrated approach.

“And it’s not just about balancing hormones. We need to find balance in everything: hormones, nervous system, metabolism, relationships, and help people in all arenas of life, not just gynecology,” Dr. Fitz explained.

Women & Our Bodies

As they approach menopause, many women start to see changes in their metabolism, gaining weight even though they continue to exercise and maintain the same diet. This requires a change in diet, with a larger focus on protein, healthy fats, and complex carbohydrates.

“Your most important goal during this time is to keep building muscle, support bone strength, support brain health, and keep inflammation low,” nutritionist Koren Bradshaw explained. “But nutrition is only one part of the equation. Any changes you make at this time need to be supplemented with enough exercise, sleep, and stress management.”

Fitness specialist Danielle Pasquale expanded on that, saying, “you need to shift your focus from weight gain, calories, and appearance to focus on your strength, mobility, and longevity.” Decreased estrogen levels lead to bone loss, making strength training critical to counteracting it.

Menopause also affects your pelvic floor, which also depends on estrogen to stay healthy. This can result in leakage, urinary incontinence, prolapse, or even pain during intercourse.

“Unfortunately, many of these pelvic health issues go untreated and undiagnosed because of one simple fact: It’s a little weird to talk about, but it shouldn’t be! Pelvic physical therapy can actually help people manage or treat these issues, and shouldn’t be ignored as an option to prevent pain or discomfort,” pelvic physical therapist Jessica Klecki emphasized.

“Aging can cause a lot of complicated emotions and various physical changes, but with a comprehensive team approach, you can take charge of your menopausal years and improve your quality of life,” Pasquale assured the crowd.

Learn more about our women's health offerings here.

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Get stronger & better: hormonal changes for women in their middle years & beyond

Get stronger & better: hormonal changes for women in their middle years & beyond

Get stronger & better: hormonal changes for women in their middle years & beyond

Many women move through perimenopause and menopause in the dark. While girls get “the talk” for puberty, women could use similar preparation at age 35 to navigate what’s to come.

Apr 28, 2023 | Carolyn Surgent, DPT

Get stronger & better: hormonal changes for women in their middle years & beyond

Get Stronger & Better: hormonal changes for women in their middle years & beyond

Many women move through perimenopause and menopause in the dark. While they will likely hear about hot flashes or possible changes in body composition or sleep, they might not have all the information they need to help prepare for and normalize this important transition. Given the limited education most healthcare providers receive on these topics, it’s no wonder women are underinformed. While girls get “the talk” for puberty, women could use similar preparation at age 35 to navigate what’s to come.

Perimenopause & Menopause Defined

First, remember that while perimenopause & menopause may unfold a little differently for everyone, it’s a normal biological process. Specifically, perimenopause refers to the years leading up to menopause, beginning as early as 35 with changes in menstrual cycle and hormones. Menopause is marked by a full year without a period, but women will experience the effects of tapering hormones for some time to follow. If average life expectancy for women in the United States hovers in the early 80s, you can expect to live 40% of your life in the post-menopausal stage.

Common Symptoms

While the list of symptoms associated with menopause can be overwhelming, there’s plenty to do to feel and perform your best. A partial list includes: hot flashes, changes in body composition or weight gain, vaginal dryness and/or pain, fatigue, joint and/or muscle pain, brain fog, mood changes, irritability or anxiety, sleep disruptions or sleeplessness, and heart palpitations.

What you can do

First and foremost, get educated and find professionals to help optimize your health & performance. In short: hit play, not pause!

  • Stay active – There’s a great deal of research supporting the benefits of staying active through the lifespan. Specifically, activity can help limit risk of cardiovascular disease, support stable blood glucose levels and protect against sarcopenia (muscle loss) and decreased oxygen consumption (VO2max) typically associated with normal aging.
  • Strength Train – Research shows that lean mass declines as fat mass increases in the five years leading up to menopause and five years post menopause. Women may notice the changes in their body composition and weight with alarm and double down on cardio or light resistance training out of concern for “bulking up.” On the contrary, strength training is the best plan for limiting these changes and holding on to muscle essential to feeling good, performing well and living better. Did you know that having more muscle mass is correlated with living longer? Moreover, strength training can provide stimulation for ligaments and other soft tissues that may be impacted by lower levels of estrogen.
  • Keep tabs on stability, mobility & core strengthening – While the need to stay strong through the middle years is incontrovertible, good stability, mobility and a strong core will provide the foundation for any strength training program and overall better function. A stable body can move quickly and accommodate the demands of a changing environment. Having good mobility can insure you can move in ways you want with less risk for injury or imbalance.
  • Improve/maintain pelvic floor function – Hormonal changes and shifting core strength can impact the tone and function of your pelvic floor musculature, increasing risk for incontinence and pain during sex. Discussion of symptoms with a trained provider along with assessment and appropriate treatment can improve function and quality of life.
  • Pay attention to sleep & recovery – Women who are already active may notice some lag in their performance or motivation to exercise consistently at the same intensity through perimenopause and menopause. Simply put, adjusting the types and frequency of key workouts through the week and allowing appropriate recovery becomes more important. Defending your sleep with use of good sleep habits and hygiene may mitigate the effects of hormones on getting quality rest.
  • Defend bone density – Did you know that, according to the National Institute of Health, nearly one in two women over the age of 50 will sustain a bone fracture? And did you know that despite participating in protective weight bearing and higher impact activities, women might still see a decline in bone density for the first five years after menopause? Strength training, weight bearing activities and even plyometrics (as appropriate) should be an important consideration in choosing activities to keep vital in your middle years and beyond.
  • Optimize nutrition & hydration – While many women may turn to calorie restriction or intermittent fasting in an attempt to control weight and body composition changes, these may not work. Ensuring appropriate energy availability to support daily activity, maintain thyroid function and protect overall metabolic health is essential. A licensed nutritionist can help guide the way.
    Review your blood panel with a healthcare provider – Your bloodwork can provide essential information about your health through perimenopause and menopause. Reviewing your lipid profile can provide a window into your cardiovascular health; blood glucose levels can indicate your metabolic health and inflammatory markers can indicate levels of systemic inflammation impacting how you feel and function.
  • Understand common interventions including hormone replacement therapy (HRT) – A great deal of research has been done debunking the findings of the Women’s Health Initiative study in the early 1990s, which overstated the risks of hormone replacement therapy in healthy women. Your healthcare provider can provide more information about the possible benefits of HRT.

Takeaway Message

Getting educated and finding the right support can help you function, perform and feel better in perimenopause, menopause and beyond. From trainers, physical therapists, pelvic floor specialists, performance coaches to nutritionists, the professionals at Performance can help.


Body composition and cardiometabolic health across the menopause transition (

Figure - PMC (

Changes in body composition and weight during the menopause transition - PubMed (

Muscle mass index as a predictor of longevity in older adults - PubMed (

Next Level: Your Guide to Kicking Ass, Feeling Great & Crushing Goals Through Menopause & Beyond by Stacy Sims with Selene Yeager

Carolyn Surgent

Carolyn Surgent,

Carolyn Surgent, PT, DPT, FDN, is a physical therapist and certified dry needling specialist based in Greenwich. She is a mover by nature and loves to explore how the body works and moves.

Meet Carolyn

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Regenerative medicine at Performance

Regenerative medicine at Performance

Regenerative medicine at Performance

Apr 4, 2023| Jacob Ober, PT, DPT, ATC

Regenerative medicine at Performance

The field of regenerative medicine is ever-changing based on new scientific developments. At Performance Optimal Health, our regenerative medicine team is dedicated to being an extension of the expert care healthcare practitioners provide. Successful patient care is rooted in a team that is dedicated to collaboration to create and consistently update best-in-class physical therapy protocols based on the most advanced evidence and progressions in the field. The best treatment approach includes targeted exercise strategies for the specific area treated and addressing movement and muscle performance deficiencies at adjacent joints. In addition, utilizing advanced technologies such as blood flow-restricted therapy (BFR) also enhances treatment outcomes. Below, we dive into some of the key aspects of regenerative medicine, breaking it down as well as discussing a key modality and treatment outline for one of the most common degenerative diseases.

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What is your biological age?

What is your biological age?

What is your biological age?

How old are you? This is a question you have probably been asked countless times throughout your life. But what many of us don’t think about when we ask this question, is the difference between chronological age and biological age. Let’s dig into what those differences are, and how your lifestyle and habits play a role in shaping your biological age.

Feb 14, 2023 | Robert Mahlman, DPT

What is your biological age?

How old are you? This is a question you have probably been asked countless times throughout your life. But what many of us don’t think about when we ask this question, is the difference between chronological age and biological age. Let’s dig into what those differences are, and how your lifestyle and habits play a role in shaping your biological age.

First, we need to define chronological and biological age. Chronological age refers to the actual amount of time you have been alive, from the moment of birth until now. This is where we get our birthdays from, what we see on our IDs and how many of us think about our lifespan. No matter what we do, our chronological cannot be slowed or sped up. On the other hand, biological age is not based on how much time you have spent on earth, but it is more of an estimation of how much life you have left based on your physiology. Now, what is amazing, is that you can influence this age!

How is biological age calculated?

Biological age is determined in a few ways via genetic assessment. One of which is by the length of your telomeres. A telomere is a structure that acts as an end cap for a DNA molecule, similar to that of a cap on the end of your shoelace to prevent fraying. As we age, telomeres will wear out and shorten because of repeated cell division, stress, and inflammation. When a cell prepares for division, the DNA molecule that looks like the double helix, we all heard about in biology class, unties allowing the genes within to be copied. This does not duplicate the telomere, therefore some of it gets snipped off gradually decreasing its length, but normally their length is long enough that they can withstand this over a person’s lifespan. When the telomere is shortened and eventually disappears, the wear and tear begin to affect your actual DNA (aging the cell) which damages the cells resulting in increased risk for disease and mortality due to the degeneration.

Another way to look at your biological age is DNA methylation, which is a chemical reaction that occurs when a methyl group is added to DNA. This often modifies the function of the genes and affects the expression of that gene — this could involve developing wrinkles or losing bone density. The methylation process can provide insight into a person’s biological age, as research has shown that certain parts of the body age fast than others. If a region is rapidly higher in biological age than in chronological age, that can reveal possibilities of chronic illness — and even cancer risk — of that tissue.

What determines your biological age?

Now that we have discussed the differences between chronological and biological age, let’s dive into the factors that determine your biological age and how can you improve it. By looking at the four pillars of optimal health (exercise, recovery, nutrition, and stress management), you can make gradual changes to your overall biological age based on the proven research.


Most people have been told by their doctors over the years to exercise more because that will make them healthier. But many of us do not realize that exercise can affect our biological age, improve longevity and overall quality of life. The American Heart Association recommends 150 minutes (2.5 hours) of moderate intensity aerobic activity or 75 mins of vigorous aerobic activity per week. Now think to yourself, are you consistently getting that each week? Research has shown that individuals who are sedentary have a higher predicted biological age than their chronological age. Conversely, those who more consistently and frequently engage in aerobic exercise have a biological age that is closer to their chronological age. In a study by Garatachea et al, they reviewed how exercise attenuates major hallmarks of aging and is linked to longer telomere length, in addition to decreased negative effects to DNA.


Diet also plays a major role in the aging process. Research has shown that changes in diet done over a consistent period — including lowering caloric intake, eating majority plant-based foods, limiting processed foods and focusing on the Mediterranean diet — aide in decreasing biological age. However, it is always recommended to discuss any significant changes to your diet your healthcare provider to ensure full understanding of dietary needs specific to you.


Regarding recovery, sleep is one of the major areas to focus on. The CDC recommends adults ages 18–60 have seven or more hours of sleep each day. Sleep is essential for your body to function properly and for it to recover from the stresses (both mental and physical) of the day. Without adequate sleep it has been shown that there can be an increase in biological age and increased risk of co-morbidities, resulting in decreased longevity. With sleep it is important to understand that the minimum time required is when you are “asleep,” not just in bed. In some cases, one may need to be in bed for up to nine hours to achieve seven or more hours of sleep based on their sleep habits and overall quality. Following health habits such as disconnecting from screens at least 30 mins before bed, avoiding heavy meals two hours before bed, and keeping consistent bedtime and awake time are just a few methods of improving sleep.

Stress Management

Stress of course also plays a role on longevity and biological age as we would expect. Stress is something that we all go through, and we all work daily to manage. This stress can be both physical or mental and can come from various avenues of our lives. Stress has been shown to increase biological age when measured via DNA methylation during the time when is stressed. While it is true that the process returns to baseline once the stressor is removed, a key point is that if this stress is repetitive and consistent overtime which does not allow the body to reset and return to baseline. To help manage stress, meditation, and breathing techniques have been shown to decrease resting heart rate and aide the body in managing stress better over time. In addition, many have found benefits from meeting with mental health or performance coaches to aide in various strategies of managing stress.

Knowing where to start when optimizing your health and longevity is sometimes the most difficult part. Looking at it through the above four pillars and understanding how you stand in each of them will help guide you in the right direction. Some may need to address only one area, and some may need to address all. But they all work together, require balance and constant adjustment to live a healthy lifestyle.

Work Cited

Gao X, Huang N, Guo X, Huang T. Role of sleep quality in the acceleration of biological aging and its potential for preventive interaction on air pollution insults: Findings from the UK Biobank cohort. Aging Cell. 2022;21(5):e13610. doi:10.1111/acel.13610

Garatachea N, Pareja-Galeano H, Sanchis-Gomar F, Santos-Lozano A, Fiuza-Luces C, Morán M, Emanuele E, Joyner MJ, Lucia A. Exercise attenuates the major hallmarks of aging. Rejuvenation Res. 2015 Feb;18(1):57-89. doi: 10.1089/rej.2014.1623. PMID: 25431878; PMCID: PMC4340807.

Han KT, Kim DW, Kim SJ, Kim SJ. Biological age is associated with the active use of nutrition data. Int J Environ Res Public Health. 2018;15(11):2431. Published 2018 Nov 1. doi:10.3390/ijerph15112431

Ho E, Qualls C, Villareal DT. Effect of diet, exercise, or both on biological age and healthy aging in older adults with obesity: Secondary analysis of a randomized controlled trial. J Nutr Health Aging. 2022;26(6):552-557. doi:10.1007/s12603-022-1812-x

Lehallier B, Shokhirev MN, Wyss-Coray T, Johnson AA. Data mining of human plasma proteins generates a multitude of highly predictive aging clocks that reflect different aspects of aging. Aging Cell. 2020;19(11):e13256. doi:10.1111/acel.13256

Poganik JR, Zhang B, Gaht GS, Kerepesi C, Yim SH, et al. Biological age is increased by stress and restored upon recovery. bioRxiv. doi:10.1101/2022.05.04.490686

Robert Mahlman

Robert Mahlman

Robert Mahlman, PT, DPT, OCS, is the Westport Site Lead and a board certified orthopedic clinical specialist and certified Schroth therapist who specializes in the treatment of various orthopedic injuries, along with scoliosis and concussion management.

Meet Robert

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Understanding and preventing cardiovascular disease

Understanding and preventing cardiovascular disease

Understanding and preventing cardiovascular disease

Cardiovascular disease (CVD), also known as heart disease, is the leading cause of death worldwide, according to the Center for Disease Control. CVD includes conditions such as hypertension, stroke, peripheral artery disease, and more. Prevention is an important strategy to reduce death and suffering from CVD, and it relies on managing risk factors and starting preventive medications for those with elevated risk.

Feb 10, 2023 | Will Manzi, CEP

Understanding and preventing cardiovascular disease

As seen in Health & Wellness Magazine.

Cardiovascular disease (CVD), also known as heart disease, is the leading cause of death worldwide, according to the Center for Disease Control. CVD includes conditions such as hypertension, stroke, peripheral artery disease, and more.

Prevention is an important strategy to reduce death and suffering from CVD, and it relies on managing risk factors and starting preventive medications for those with elevated risk.

At the top of the CDC’s list of primary risk factors for all chronic diseases are: smoking, poor nutrition, and sedentary lifestyle.

You may be more likely to develop cardiovascular disease if you have risk factors such as:

• High blood pressure (hypertension).
• High cholesterol (hyperlipidemia).
• Tobacco use (including vaping).
• Type 2 diabetes.
• Family history of heart disease.
• Lack of physical activity.
• Having excess weight or obesity.
• Diet high in sodium, sugar and fat.
• Overuse of alcohol.
• Misuse of prescription or recreational drugs.
• Preeclampsia or toxemia.
• Gestational diabetes.
• Chronic inflammatory or autoimmune conditions.
• Chronic kidney disease.

Living a healthier lifestyle can help prevent heart disease. This includes:

• Eliminating all tobacco use
• Eating a heart-healthy diet
• Following an appropriate exercise program
• Managing your weight
• Eliminating as much stress as possible

What are the signs and symptoms suggestive of cardiovascular, pulmonary, or metabolic disease?

• Pain, discomfort in the chest, neck, jaw, arms or other areas that may result from ischemia
• Shortness of breath at rest or with mild exertion
• Dizziness or syncope
• Orthopnea or paroxysmal nocturnal dyspnea
• Ankle edema
• Palpitations or tachycardia
• Intermittent claudication
• Known heart murmur
• Unusual fatigue or shortness of breath with usual activity


Q: Who is most at risk?

A: Individuals with two or more risk factors or individuals who are symptomatic are most at risk. Looking at preventative measures, those who are predisposed to CVD are those with a strong family history of CVD.

Q: How can one prevent heart disease?

A: Preventative measures include a heart healthy diet such as the DASH diet (Dietary Approaches to Stop Hypertension), which is my recommendation which is used nationally by cardiologists through the American Heart Association. A healthy diet, in combination with aerobic, continuous exercise which incorporates large muscle groups, will mitigate your risk factors for CVD. These exercises include dancing, swimming, cycling/spinning, rowing, and running.

Medication can be utilized, but consult with your doctor before taking any drug.

Q: What role do nutrition, stress, and exercise play in CVD?
For modifiable risk factors, some measures can be taken to help reduce a person’s risk of developing CVD:

DIET: DASH stands for Dietary Approaches to Stop Hypertension, and it is designed to help treat or prevent high blood pressure (hypertension).

The DASH diet includes foods that are high in potassium, calcium and magnesium, but limits foods that are high in sodium, saturated fat and added sugars.

Studies have shown that the DASH diet can lower blood pressure in as little as two weeks, and it can lower low-density lipoprotein (LDL or “bad”) cholesterol levels. Hypertension and high LDL cholesterol levels are two major risk factors for heart disease and stroke.

EXERCISE: While not everyone has the same ability to exercise, getting some form of exercise for those who are able has immense heart health benefits. If you have angina or have had a heart attack, you may benefit from cardiac rehabilitation, which is a structured program that incorporates exercise, counseling, and education. Ask your healthcare provider for more information or a referral, if possible.

Stress: Stress is another contributor to CVD, and managing it can improve quality of life. Affordable ways to relieve stress include meditation, breathing exercises, journaling, exercise, time in nature, and connection with others.

At Performance Optimal Health we use comprehensive research and the latest technology to incorporate the four pillars of optimal health (exercise, recovery, nutrition, stress management) into your care. Each pillar plays a significant role in your optimal health journey, and using tools and services from each of the pillars can greatly enhance and expedite your path to success.

William Manzi

Will Manzi

William Manzi, CEP, is an exercise physiologist who specializes in the ability to take care of any individual, regardless of any limitations. Having worked with cardiac patients for the past 5 years, Will has developed a speciality in cardiac training and rehabilitation, as well as reading EKGs.

Meet Will

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Preventative health is key to avoiding chronic disease

Preventative health is key to avoiding chronic disease

Preventative health is key to avoiding chronic disease

Jan 4, 2023 | Health & Wellness Magazine

Preventative health is key to avoiding chronic disease

As we head into a new year, focusing on preventative health will be your most important tool to stay healthy. While some aspects of our health are predetermined by our genetics, there is a significant amount that we have control over through our lifestyle and daily health decisions. There are also a variety of indicators you can use to determine how healthy you are, or what your risk of chronic disease may be. This month, let’s discuss four key indicators — resistance exercise, inflammatory markers, the importance of Vitamin D, and controlling your stress levels — that will help you start the new year off right.

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Optimal Health Assessment: Don’t just treat injuries, prevent them

Optimal Health Assessment: Don’t just treat injuries, prevent them

Optimal Health Assessment: Don’t just treat injuries, prevent them

Dec 6, 2022 | Health & Wellness Magazine

Optimal Health Assessment: Don’t just treat injuries, prevent them

As a society, we are accustomed to regular “check-ups” at the hair salons, dentist, local auto shop. Yet for some reason, it is common practice to only seek orthopedic care when injured. The concept of regular wellness visits to prevent injuries has consistently escaped the musculoskeletal realm and the common practice of most individuals. This concept is somewhat baffling, as it is not only antithetical to our normal “check-up” mentality in other realms, but it also is in direct contrast with the available research on orthopedic injuries. Rather than treating injuries and risking future ones, here's why you should just prevent them instead.

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Counteracting the effects of perimenopause and menopause

Counteracting the effects of perimenopause and menopause

Counteracting the effects of perimenopause and menopause

Nov 9, 2022 | Health & Wellness Magazine

Counteracting the effects of perimenopause and menopause

Women face many issues as they age in the perimenopausal and menopausal stages of life, such as increased risk of osteoporosis, metabolic diseases, cardiovascular issues, and more. These obstacles create a challenge for women trying to develop a healthy lifestyle or maintain it as they age. Aging can create a whole mix of emotions, from mentally and emotionally, from experiencing feelings of anxiousness and uncertainty to physically feeling due to the hormonal changes. The best way to optimize your health as you age is to work with a collaborative team of professionals that can help guide you through the process. As a Pelvic Health Physical Therapist, it’s my job not only to address acute issues, but to provide tools to help my clients stay healthy in all aspects of their life.

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The benefits of blood flow restriction therapy

The benefits of blood flow restriction therapy

The benefits of blood flow restriction therapy

Blood flow restriction (BFR) training is a modality that helps accelerate the rehab process, and to reduce risk of future injuries. BFR has been shown to have many local and systemic effects throughout the body, including positive effects on both muscles and bones.

Oct 17, 2022 | Michael Semancik, DPT, TPI-M2

The benefits of blood flow restriction therapy

What is Blood Flow Restriction Training?

Blood flow restriction (BFR) training is a modality that we use at Performance to help accelerate the rehab process, and to reduce risk of future injuries. BFR involves using a medical grade tourniquet, around the arm or the leg, and then performing exercises with the cuff temporarily occluding blood flow to the limb. With BFR, we can do exercises with as little as 20% of your 1 repetition max, while getting the same effects as doing a much higher weight or resistance. This is especially helpful in our patients who are recovering from surgery, allowing us to build strength while still allowing the surgical site to adequately heal. While this may sound intimidating, BFR is well studied in physical therapy research, and the devices we use ensure that it is performed safely.

How does it work?

BFR works by limiting arterial blood flow and stopping venous return to the limb while performing a specific exercise. This then forces the muscles to work in an anaerobic (oxygen deficient) environment, making low load exercises feel extremely difficult.

What are the effects of BFR?

BFR has been shown to have many local and systemic effects throughout the body. At the muscular level, there are improvements in muscle protein synthesis, muscle fiber recruitment, muscular hypertrophy, and muscular endurance. This not only applies to muscles below the level of the cuff, but also above AND on the opposite side of the cuff.

BFR also induces hormonal changes in the body which help with muscular adaptation. Multiple studies have shown an increase in free testosterone and serum growth hormone, both of which help to promote growth of muscle tissue in the body. BFR can also be an effective method for improving bone density in those who may not be able to tolerate higher intensity, weight-bearing exercise.

What conditions do we use BFR for??

BFR can be used for many conditions, most commonly we use it for:

  • Post-surgery (ACL reconstruction, meniscus repair, shoulder labral/SLAP repairs, achilles tendon repairs, etc.
  • BFR allows for effective strengthening exercise without placing too much mechanical stress on repaired tissue
  • Tendinitis (patellar tendinitis, golfer/tennis elbow, achilles tendinitis)
  • Similar to post op, if the tendon is actively inflamed or irritated, BFR can help to perform strengthening exercises without putting more stress on the inflamed tissue
  • Muscle Strains
  • Allows a patient to maintain strength of the affected muscle during the acute phase of a strain Fractures
  • While immobilized, can perform BFR exercises at other joints to maintain strength and promote the release of growth hormone in the body
  • Once you are no longer immobilized, BFR is an effective tool to rebuild strength that was lost
  • Training/Recovery
  • BFR is a great tool for any in-season athlete, or for weekend warriors needing an active recovery day
  • Allows you to maintain strength without putting undue stress on the muscles, joints, and tendons

Michael Semancik

Michael Semancik

Michael Semancik, DPT, TPI-M1, is a physical therapist and certified dry needling specialist who works with young athletes, specifically with rowers, hockey players and football players.

Meet Michael

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How to keep your bones healthy throughout each stage of life

How to keep your bones healthy throughout each stage of life

How to keep your bones healthy throughout each stage of life

To bring awareness to Bone & Joint Health Week, we dive into our own body’s foundation and explore how it changes as we age, as well as how to protect it.

Oct 13, 2022 | Maddy Mazoue, PT, DPT, CSCS

How to keep your bones healthy throughout each stage of life

Unless a bone is broken, it is easy to forget about the fundamental structure supporting our entire body that we cannot see: the skeleton. Yet a skeleton and its bones are integral to our daily life, serving a variety of functions including protecting vital organs, serving as attachment points for muscles, storing minerals, producing bone marrow and more. To bring awareness to Bone & Joint Health Week, we will dive into our own body’s foundation and explore how it changes as we age, as well as how to protect it.

Bones are often thought of as static, unchanging structures, but in reality, bones are constantly changing and developing throughout one’s lifespan. Our 206 bones all have unique shapes and structures, though the general anatomy of bones is fairly consistent. There are two main types of bone, cortical and trabecular. Cortical bone is the hard outer layer that contains the highest calcium concentration, while the trabecular bone is found below the cortex and is made up of a honeycomb-type structure full of bone marrow and fat stores.1 As we age, the size, mineral content, density, and durability of our bones changes considerably.


Childhood and adolescence are incredibly important periods for bone growth and development. As children grow, their bones accumulate calcium deposits that lay the foundation for bone health long term. Therefore, it is vital for children to get an appropriate amount of calcium and vitamin D in order to promote bone growth as they age. According to the National Institute of Health, products such as milk, cheese, tofu, and yogurt are all excellent examples of foods with high calcium content. Protein is also a key factor, as it improves calcium absorption. In addition to ensuring children have proper nutrition, participation in high impact activities such as jumping, running, and playing sports is also vital to promote healthy bone development.


As children reach puberty, bone growth surges. Peak growth rates, aka growth spurts, tend to happen around age 11–12 for girls and age 13–14 for boys. Growth spurts start earlier for girls as the onset of menstruation brings a jump in estrogen, which promotes calcium absorption and an increased in bone mineral density.2 As puberty comes to an end, the growth plates close, signaling the completion of this phase of growth and development. This is not, however, the end of the journey for bone development.


In the years following adolescence, calcium deposition continues at a much higher rate than absorption. The American Academy of Orthopedic Surgeons states that peak bone mineral density occurs between age 25–30 for most individuals. As we get older though, the rate of bone deposition decreases and rate of calcium absorption increases, which means we begin to lose bone density gradually over time. This breakdown rate begins to creep up with age, with a sharp increase for women around menopause. In order to decrease the amount of bone loss, it is crucial to maintain the health of your bones during your earlier years through physical activity such as weightlifting and proper nutrition, including a generous intake of calcium, vitamin D and protein.


Just as an increase of estrogen improved calcium absorption in adolescence, the drop in estrogen associated with menopause negatively impacts a woman’s calcium stores. As calcium stores deplete, bone mass diminishes, with the average woman losing around 10% of bone mineral density in the first five to six years of menopause.3 As this process progresses, the risk for osteopenia and osteoporosis significantly increases.


Though the effect is not as drastic, men are also at risk for developing osteoporosis. On average, by the age of 65–70, men are losing bone mineral density at the same rate as their female counterparts. As the rate of bone density decreases, the risk of fracture tends to increase. The American Academy of Family Physicians recommends that women over 65 and men over 70 get a bone density test (DEXA scan) as a preventative measure to identify their risk of osteoporosis.

Though a certain amount of lost bone mineral density is normal, there are many modifiable behaviors than can delay or slow down this process that can be implemented at any age. Smoking, alcohol use, and excessive caffeine consumption have all been identified by the NIH as risk factors for increased loss of bone mineral density as one ages. Other important factors to consider are calcium intake and physical activity. As mentioned above, calcium and vitamin D recommendations change throughout the lifespan, but are particularly important during childhood and after age 50 for women and age 70 for men.

Exercise can also have a huge impact on bone health. For those between the ages of 20–50, studies have shown that individuals that participate in moderate to high intensity impact activities have a greater average bone mineral density than those who are less active or who participate in lower impact activities. Though aerobic activities such as biking, swimming, and running are great for maintaining a healthy cardiovascular system and have a number of health benefits, these activities may not put enough load on the skeletal system to promote increased bone deposition. Resistance training has been shown help build muscle, increase bone density, and decrease fall risk. The Mayo Clinic recommends weight-bearing resistance training for those with or at risk for osteoporosis to optimize bone health and decrease risks associated with having decreased bone mineral density. This should, however, be done with close supervision and modification by a medical or fitness professional to ensure exercises are safe and dosed appropriately.

Our bones go through many changes as we progress through our lives, but there are a myriad of ways that we can help promote and support bone health in every stage of life. Lifestyle choices, exercise, and nutrition all have an enormous impact on our skeletal system. Take the extra time to invest in your health and support your bones; your skeleton will thank you!

Maddy Mazoue

Maddy Mazoue

Maddy Mazoue, PT, DPT, CSCS, is a physical therapist and strength and conditioning specialist who specializes in developing athletes’ return to sport programs. She values collaboration and teamwork, and believes that patient care is always better when providers are open and willing to work with each other to best serve the patient.

Meet Maddy

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The dangers of chronic inflammation and what you can do about it

The dangers of chronic inflammation and what you can do about it

The dangers of chronic inflammation and what you can do about it

Sep 13, 2022 | Health & Wellness Magazine

The dangers of chronic inflammation and what you can do about it

While some levels of acute inflammation aid the body’s natural processes, prolonged, chronic inflammation causes a variety of health issues, including chronic disease and deterioration of body mechanics. It is incredibly important to manage things that can exacerbate inflammation such as a poor diet, sedentary lifestyle, elevated stress hormones, low quality sleep and more to prevent chronic inflammation from occurring.

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