National Osteoporosis Month 2022: Awareness and Prevention

National Osteoporosis Month 2022. Creating Awareness and Prevention

National Osteoporosis Month 2022. Creating Awareness and Prevention

National Osteoporosis Month 2022 Blog Header

In recognition of National Osteoporosis Month, we at The Perfect Workout want to shed even more awareness on osteoporosis and that starts with knowing the risk factors.

In this article we share the common risk factors for osteoporosis and things you can start doing today to keep your bones strong!

What is Osteoporosis?

Osteoporosis is diagnosed when a person has suffered a significant loss of bone mass because their body can’t produce enough new bone to keep up with old bone loss. “Bone is living tissue that constantly breaks down and is replaced.” (Mayo Clinic).

With this disease, bones become hollow and carry a high risk of fracture. About 10 million people in the US have osteoporosis and many others are at risk.

Image of a woman smiling while leaning against a wall

Osteoporosis Risk Factors

Are you at risk for developing osteoporosis? Check this list of common risk factors to see if your risk is low or high.

Gender

Osteoporosis can affect both men and women, but women (especially white and Asian) are at higher risk.

Age

Older individuals, especially women who are past menopause are considered high risk for Osteoporosis. This does not mean younger adults should ignore the risks.

Body Weight

Thin, frail body types and underweight BMI’s can be a risk factor for having low bone density which is a contributor to fractured bones.

Hormone Levels

Having lower estrogen levels for women, and low testosterone for men can contribute to osteoporosis and fractures.

Family History

Osteoporosis runs in the family. If you have a family history of the disease, your risk factor increases. Read about our Founders family history here.

Vitamin Consumption

Getting in adequate amounts of sunlight (Vitamin D) helps absorb Calcium, a necessary building block for healthy bones. In addition, not getting enough calcium can lead to a deficiency.

Physical Exercise

The more sedentary you are the higher the risk of muscle and bone loss which can lead to osteoporosis, falls and fractures. This is where your strength training sessions are vital. Each slow-motion strength training workout helps to battle muscle and bone deterioration and builds healthy bones.

Lifestyle

Excessive smoking and drinking can lead to a slough of health problems including negatively impacting bone health.

Diseases

Diseases such as diabetes, hyperthyroidism, digestive conditions, cancer and rheumatoid arthritis have also been linked to osteoporosis.

Image of female being coached by a trainer

Prevention: 4 Ways to Keep Strong Bones

1. Vitamin D3

Vitamin D, specifically vitamin D3, increases calcium absorption from the food we eat. It also promotes calcium uptake in bones. Supplementing with vitamin D3 can decrease the risk of fractures in the hip and spine, and can increase bone density.

2. Magnesium

Healthy magnesium levels are shown to enhance the function of bone-building cells and sufficient levels of parathyroid hormone and vitamin D (both of which regulate bone homeostasis).

3. Calcium

Meeting a minimum amount of recommended daily consumption (2,000-2,500 mg/day according to mayoclinic.com) is critical to maintaining bone health. Also, supplementing calcium can reduce the risk of hip and spine fractures.

4. Strength Training

Strength training is a uniquely effective way to improve bone health and treat osteoporosis. It can improve bone strength in all areas of the body at any age.

“Worldwide, one in three women and one in five men aged 50 years and over will suffer an osteoporotic fracture. Fractures caused by osteoporosis can be life-threatening and a major cause of pain and long-term disability.” (IOF)

Osteoporosis impacts people all over the world. Step up for bone health and learn more about World Osteoporosis Day (October 20th) here.

If you aren’t already taking action to prevent or treat osteoporosis, speak with your doctor today. In the meantime, start (or continue!) a strength training program. Strength training will ensure you won’t lose bone density going forward, whether it be to age or osteoporosis.

Member Feature Amy G.

Member Feature: Amy G.

Member Feature: Amy G.​

Member Amy Golden working out on the Lat Pulldown machine

The number one thing women in their 50s need to combat osteoporosis is… building bone density.

With osteopenia in her back and hips, Amy needed a solution to increase her bone and muscle strength.

Amy felt strong but could tell the areas affected by low bone density were weaker and beginning to feel sore.

“I consider myself fairly fit and active, but I wanted a specific program to build bone density.”

She knew that in order to build bone density she needed to do weight-bearing exercises. Amy searched for the best place where a woman nearing 60 looking to build bone density could workout… and actually get results.

She found The Perfect Workout.

In February 2020 Amy became a member of the Falls Church studio and got right to work with her trainer, Andreina.

“The Perfect Workout has proven results and a very limited time commitment. It is two minutes from my house and the 20-minute workout couldn't be more convenient.”

In the months she’s been working 1-on-1 with her Personal Trainer she:

  • has measurable improvement in her leg and arm strength
  • feels more confident
  • can lift and carry heavy objects more easily
A picture of a woman taking a selfie in the mirror

“The staff is wonderful and dedicated. It is an easy and efficient way to build strength and posture that will ensure lasting health and longevity. It really is a customized experience and you will likely be the only ones in the studio.

It's like having your own private gym and trainer.”

 

Amy G., 59
The Perfect Workout Member
Fall Church, VA

If you are new to The Perfect Workout, try a workout with us and Book a FREE Introductory Session.

Member Feature Kevin & Nancy Brown

Both Reversed Osteo Issues & Lost Weight at 62

Both Reversed Osteo Issues & Lost Weight at 62

Male ember doing ab workout using a dumbbell while Female member trains using the tricep machine

Nancy Brown was hit with a trifecta of life-bombs all at once: she had just entered menopause, was diagnosed with serious osteoporosis in her hips, osteopenia in her spine, and was grieving the loss of her mother. Things were not going well.

6 years later, Nancy and her husband Kevin are living their healthiest, most active life at 62 years old.

Here is their story…

“When I entered menopause, within two weeks, I had gained about 20 pounds. We'd been on vacation, and at the end of two weeks, I could not wear the same jeans I had started our trip with. So that was a huge wake-up call.

And I was very discouraged about my bone strength.”

Luckily, a member of her church, Charlotte, who works for The Perfect Workout, recommended she try a workout in the West Plano studio.

Nancy tried it, loved it, and had a solution to tackle her life-bombs head-on.

After a few months of training, her husband Kevin was inspired to try slow-motion strength training for himself.

“I always had a desk job. Because of that, I had a little bit of a belly pooch that was not easy to get rid of, especially as I'm getting older.

I also wanted to be able to do certain jobs and chores around the house without hurting myself.”

Just like Nancy, he joined The Perfect Workout and began working with his trainers to reach those specific goals.

Male and Female member walking into The Perfect Workout Studio

Before The Perfect Workout, Nancy was no stranger to the gym. She had worked with trainers, lifted weights, and been extremely active and athletic her entire life. Yet through all that experience, no one had told her what could get rid of the excess weight and osteo-issues.

“It's because I was not lifting heavy enough weights. I wasn’t lifting slowly or safely enough.”

Now, after years of consistent slow-motion strength training, Nancy is singing a different tune.

One of the biggest changes she’s noticed in herself as a result of her training is the absence of osteopenia and osteoporosis, which took her about two and a half years to resolve.

And to no surprise, her strength has drastically increased. “My strength is so much greater than it was even 15 years ago. I'm really strong.”

“I don’t look like I did when I first entered menopause. I feel like I look very fit, and I feel very good about myself.

…and I love the way he looks.”

Male trainer coaching male member on the leg press machine

“I've definitely toned up! My strength has really improved and I know the physical limits of my body now versus before if I would try to pick up something heavy.

I know what I can and cannot do which prevents me from hurting myself.”

In 2017 Kevin was facing osteopenia himself but after a couple of years, just like his wife, his numbers completely reversed.

“My doctor was very impressed. She said ‘I don't know what you're doing but keep doing it because your numbers are going in the right direction.’”

Both Nancy and Kevin have enjoyed the 1-on-1 training at The Perfect Workout. They feel like each trainer takes a personal interest in them and is genuinely concerned about their physical well-being.

“I have a torn ACL in my right knee, and the trainers are very aware of my form on each exercise. I feel like it's a very safe environment versus just a regular gym.” (Kevin)

One of the reasons Nancy likes The Perfect Workout so much and working 1-on-1 with trainers is because no matter how motivated you are, no matter how strong-willed you are, no matter how much you think you can push yourself… There is no way that every single time you work out you could do it with perfect form and push yourself on your own.

“The trainers are absolutely necessary. They are an integral part of the entire perfect workout. It's not perfect without the trainers.” (Nancy)

After 6 years and counting, the Browns are thriving in their 60s, getting stronger with every year, and showing all of us how beneficial a 20-minute, twice-a-week workout can truly be.

“There would be a lot of things that I would give up before I would ever give up The Perfect Workout.”

 

Kevin & Nancy Brown, 62
The Perfect Workout Members
Plano, TX

If you are new to The Perfect Workout, try a workout with us and Book a FREE Introductory Session.

Hip Strength And Mobility

Hip Strength And Mobility - What You Should Know

Female strength training for hip strength and mobility

The hip bone’s connected to the… everything!

Maybe not anatomically, but the hip joint is the largest weight-bearing joint in the human body, and it is a hub for functional movement.

Having strong hip joints and surrounding muscles helps maintain mobility and our ability to perform basic activities of daily living.

Thankfully, maintaining hip strength and mobility can be achieved through a few exercises performed on a regular basis. To learn more, scroll down.

The Importance of the Hip Joint

Healthy hips are fundamental to many day-to-day activities. The hip joint is where the head of the thigh bone (femur) meets an indented space on the pelvis. Hips support our body weight when standing. They are also critical to the processes of walking, climbing stairs, running, sitting, standing, and bending over.

The hips are so important that our strongest muscles — the quadriceps and glutes — are located around and help move the hip joint. Unfortunately, the hip joint is an area that’s highly susceptible to the “wear and tear” of life and aging.

Hips are also the most common site of osteoporosis and fractures with advancing age. Every year, 350,000 hip fractures happen in the United States (Hopkins Medicine). When hip fractures occur, they lead to a loss of independence and, in some cases, a loss of life.

Threats to Hip Health

Osteoporosis, a condition of low bone density, is a “silent” disease. You don’t feel it. You don’t see it. However, people start losing bone strength in their 30s, and that rate of loss picks up after age 50. As a result, bones become weak and susceptible to breaking with an event like falling.

Because the hip joint bears the most weight, it can be heavily impacted by osteoporosis. The thinner “neck” of the femur is the biggest risk for bone density loss and subsequent fractures.

Not only is this the most common site of fractures, but it’s also the most severe place to have a fracture. About one in five older adults die within a year of having a hip fracture, and a large portion of those who survive lose mobility and independence (Schnell et al., 2010).

Osteoporosis isn’t the only concern for hip health. The hip joint is one of the most common sites for arthritis. It’s especially common for people who have experienced years of more-than-normal force on the joint. These individuals typically have a background in athletics, dance, distance running, or people who have been obese.

With arthritis, people lose hip mobility, the joint feels tight, stiff, and painful, and about a third of people with hip arthritis get a joint replacement (Quintana, Arostegui, & Escobar, 2008).

Hip Strength & Mobility

Suffering from hip osteoporosis or arthritis as we age isn’t inevitable. Hip health can be maintained or even improved by focusing on two factors: hip strength and hip mobility.

Enhancing hip strength and a full range of motion can reduce the risk of suffering from hip pain, hip injury, or losing independence (Carneiro et al., 2015; Snyder et al., 2009).

The question then becomes, “How can we enhance hip strength and range of motion?” Strength training.

Multiple studies show strength training 2-3 times a week can enhance hip muscle strength, bone density, and range of motion (Carneiro et al., 2015; Rhoades et al., 2000; Snyder et al., 2009). (Though our slow-motion strength training method can accomplish those things in just 20 minutes, twice a week.)

These studies used a variety of approaches, ranging from using a few lower body exercises to full-body routines. Only a few exercises, though, are needed to improve hip health.

Resistance Exercises for Hip
Strength & Mobility

Leg Press

The leg press is not only the most important exercise in a workout, targeting the largest muscle groups, but it’s also critical for hip health. The leg press and its exercise variations below strengthen the largest muscle that supports the hip joint: the gluteus maximus.

In this exercise, you slowly push through your heels, keeping your buttocks down in the seat, pushing each repetition to the point just shy of locking out your knees. You then resist the weight all the way down to the bottom of the range of motion, barely touching the weight stack, and slowly beginning again. Repeat until you achieve “muscle success”.

It also improves bone density in the hip and surrounding areas (Rhoades et al., 2000). The leg press also increases range of motion for several key movements that involve the hip joint (Rhoades et al., 2000).

Read about John Abel, who’s improved his hip health at The Perfect Workout.

Hip Abduction

Hip abduction, commonly referred to as the “outer thigh exercise,” or “ABD,” strengthens muscles that are vital for basic activities such as walking: the gluteus medius and minimus.

Performing hip abduction helps strengthen those muscles plus increases lateral hip mobility (Snyder et al., 2009). Between the leg press and hip abduction, hip mobility improves in all directions.

At-Home Exercises for Hip Strength & Mobility

The leg press and hip abduction are ideal for achieving the goals of adding hip strength and range of motion. There are home exercises, though, which can mimic those movements.

Chair Stands

To perform this exercise, you sit in a squat position and stand from a chair. The challenge is to have as low of a chair as possible and to use slow movement.

Position yourself to sit on the edge of the chair. Keep your chest up and look forward. As you slowly stand, push through your heels and the middle of your feet. As you lower yourself with bent knees, only briefly allow your butt to contact the chair before slowly starting upwards.

Repeat until you achieve muscle success. This exercise targets the same muscle groups as the leg press does: the gluteus maximus and quadriceps.

Standing Hip Abduction with Resistance Bands

Mimicking the muscles that are used in the machine exercise that has the same name, the standing hip abduction involves standing and holding onto a counter or chair.

Place a resistance band around the outside of both ankles. Train one leg at a time. Keep the other leg on the ground and use that for balance. The moving leg moves out to the side as far as possible, then slowly moves back toward the standing leg. Once the moving leg’s foot taps the ground, it should slowly move outwards to the side again.

Repeat until you achieve Muscle Success, then switch to train the other leg.

Hip Health Summarized

A healthy hip joint is critical. It’s the center of basic activities, such as standing, sitting, and walking. Therefore, we must keep the joint healthy.

Aging and the wear and tear of life’s activities lead to skeletal concerns, which increase the risk of hip pain, swelling, loss of movement, and fractures. To protect your hip joint, you can strength train with exercises involving the area.

These hip exercises help improve muscle strength, bone strength, and mobility. The specific exercises that are most important for hip health are the leg press and hip abduction. At-home replacements are using resistance bands during standing hip abduction and performing chair stands.

If you would like to learn more about our method of strength training, read about our methodology. If you are new to The Perfect Workout, try a workout with us and start with a FREE Introductory Session.

  • Carneiro, N. H., Ribeiro, A. S., Nascimento, M. A., Gobbo, L. A., Schoenfeld, B. J., Júnior, A. A., … & Cyrino, E. S. (2015). Effects of different resistance training frequencies on flexibility in older women. Clinical Interventions in Aging, 10, 531.
  • Quintana, J.M., Arostegui, I., & Escobar, A. (2008). Prevalence of knee and hip osteoarthritis and the appropriateness of joint replacement in an older population. JAMA Internal Medicine, 168(14), 1576-1584.
  • Rhodes, E., Martin, A., Taunton, J., Donnelly, M., Warren, J., & Elliot, J. (2000). Effects of one year of resistance training on the relation between muscular strength and bone density in elderly women. British Journal of Sports Medicine, 34(1), 18-22.
  • Schnell, S., Friedman, S.M., Mendelon, D.A., Bingham, K.W., & Kates, S.L. (2010). The 1-year mortality of patients treated in a hip fracture program for elders. Geriatric Orthopaedic Surgery & Rehabilitation, 1(1), 6-14.
  • Snyder, K. R., Earl, J. E., O’Connor, K. M., & Ebersole, K. T. (2009). Resistance training is accompanied by increases in hip strength and changes in lower extremity biomechanics during running. Clinical Biomechanics, 24(1), 26-34.

From No Accountability to Consistently Exercising

From No Accountability to Consistently Exercising

Lori Zalewski - Female Client at The Perfect Workout

Lori Zalewski, 55, looked to gain strength and maintain her activity levels.

Her father-in-law recently passed away and she observed first-hand some of the challenges he went through.


“He was overweight and weak and it took many nurses to move him from the bed to a chair. I don't want that to happen to me.”


But Lori faced struggles of her own- staying consistent and accountable.


“I have tons of hand weights at home, but I just won't do it by myself.”


Lori’s sister was working with a personal trainer doing slow-motion weight training and recommended Lori give it a try too

Since her sister’s trainer was too far away, Lori did her research and found a personal training studio near her in Park Ridge, IL.

Now, she exercises with her own personal trainer at The Perfect Workout.


After staying consistent with her workouts and gaining strength all over, Lori:

  • Can move all of her camping equipment by herself
  • Can carry a full water bucket to the utility sink without spilling it
  • Can do heavy house cleaning for days on end and not feel sore.

“The Perfect Workout is worth trying if you are leery about lifting weights. You can get a good workout in without breaking a sweat in 20 minutes.”


As for how Lori feels now…


“I am stronger and feel more confident.”

If you want more information on how to incorporate slow-motion strength training into your workout routine, we have a free introductory session. If you’d like to know more about how to work with a trainer online, get a free consultation call with a Personal Trainer.

Can Osteoporosis Be Reversed?

Can Osteoporosis Be Reversed?

Can Osteoporosis Be Reversed - Featured Blog Image

What is Osteoporosis?

Osteoporosis is diagnosed when a person has suffered a significant loss of bone mass because their body can’t produce enough new bone to keep up with old bone loss. “Bone is living tissue that constantly breaks down and is replaced” (Mayoclinic.com). With this disease, bones become hollow and carry a high risk of fracture. About 10 million people in the US have osteoporosis and many others are at risk.

In this article, we talk about how to identify your risk for osteoporosis and share four strategies that can increase bone density.

Osteoporosis & Fall Risk Facts

As we age, we focus more on preventing falls for older adults, and that’s with good reason.

Over 300,000 adults ages 65 and older experience a hip fracture each year, 95% of those fractures resulting from falling.

Those hip fracturing-falls have severe side effects, too. Only half of these adults regain their quality of life after the fracture.

About 20% move into assisted living communities afterwards. And about one in every four older adults die within a year of having a hip fracture.

Hip fractures are a big concern for both men and women. However, falling and breaking a bone isn’t the only cause of this issue. Having weak bones is also a key underlying factor, just like with osteoporosis.

Data from the CDC shows that 48% of older adults have low bone density, usually in the most common locations: hip and lower back. For adults with osteoporosis, bones are fragile and susceptible to breaking when falls or other high-risk incidents like car accidents occur.

Osteoporosis Stages - 4 Stages of Bone Density Loss

Risk Factors for Osteoporosis

While it’s easy to associate osteoporosis with older women, the process of bone loss starts well before 65 years old. People generally start to lose bone density in their early 30s. They’re at an increased risk for fractures after age 50.

Additional risk factors for osteoporosis include:

  • Being female – This can increase risk of osteoporosis because of the lost estrogen during menopause, which can contribute to bone loss.
  • Having a smaller/thinner frame – This means someone already has less bone mass in their body to begin with.
  • Past fractures – These are a sign that your bones are more fragile than normal.
  • A family history of osteoporosis – This may mean you’re already predisposed to develop the disease.

How to Assess Your Bone Strength

Osteoporosis is diagnosed through a dual-energy X-ray absorptiometry (DEXA) scan. A DEXA scan is a quick process (less than 20 minutes) where a person lies face up while a low-level x-ray scans down and then up the body. They use an even lower level of radiation than standard X-rays, so they’re very safe.

These bone density test results provide an accurate assessment of bone density, muscle tissue, and fat tissue. “Where a regular X-ray can show changes in bone density after 40 percent bone loss, the DEXA detects changes as small as 1 percent.”

You can find a DEXA scan by using a search engine like Google and typing in the keywords “DEXA scan near me”. DEXA scans are recommended at a frequency of every 1-2 years starting at the age of 50 if someone has risk factors for bone loss, especially for women during or after menopause.

Dexa Scan for Osteoporosis Infographic

Can Osteoporosis Be Reversed?

We know that about half of older adults have low bone density, this increases the risk of experiencing a fracture, and that people start losing bone strength in their 30s.

Unfortunately, once you have osteoporosis, it can’t be fully reversed or “cured.” Thankfully, you can strengthen your bones at any age and there are proven methods for reducing the risk of a fracture. Below are four effective strategies for reversing bone loss.

4 Strategies for Strengthening Bones

1. Vitamin D3

Vitamin D, specifically vitamin D3, increases calcium absorption from the food we eat. It also promotes calcium uptake in bones. Supplementing with vitamin D3 can decrease the risk of fractures in the hip and spine, and can increase bone density.

2. Magnesium

A two-year study of menopausal women taking a magnesium supplement showed an increase in bone density while also reducing fracture risk. Healthy magnesium levels are shown to enhance the function of bone-building cells and sufficient levels of parathyroid hormone and vitamin D (both of which regulate bone homeostasis).

3. Calcium

When thinking of bone strength, it’s common to think of calcium first. Research shows calcium consumption isn’t the silver bullet for strengthening bones that we might think it is. However, meeting a minimum amount of recommended daily consumption (2,000-2,500 mg/day according to mayoclinic.com) is critical to maintaining bone health. Also, supplementing calcium can reduce the risk of hip and spine fractures. However, some studies suggest that taking calcium supplements can decrease absorption of other nutrients like iron and zinc, so be mindful of your supplement intake and, as always, consult with a physician to be sure you’re taking the right supplement combination for your needs.

4. Strength Training

Strength training is a uniquely effective way to improve bone health and treat osteoporosis. It can improve bone strength in all areas of the body at any age. In a year-long study, strength training helped women, ages 65-75 years old, gain bone strength in their hips and lower back.

Following five minutes of training, women between the ages of 18 and 26 years old increased bone density in their legs and wrists. Three studies with men, ranging from 50 to 79 years old, showed strength training either stopped or reversed their age-related bone loss.

Strength training is a uniquely effective way to improve bone health and treat osteoporosis. It can improve bone strength in all areas of the body at any age. In a year-long study, strength training helped women, ages 65-75 years old, gain bone strength in their hips and lower back.

Following five minutes of training, women between the ages of 18 and 26 years old increased bone density in their legs and wrists. Three studies with men, ranging from 50 to 79 years old, showed strength training either stopped or reversed their age-related bone loss.

Strengthening bones for osteoporosis infographic

Is It Safe To Exercise With Osteoporosis?

The risk of fracture is serious, but there’s no reason not to exercise safely.

The National Institute of Health said it best:
“No one who has broken a bone wants to revisit that pain and loss of independence. However, living your life “on the sidelines” is not an effective way to protect your bones.”

Staying active with a doctor-approved program like slow-motion strength training can not only help you stay healthy, it’s also the best way to build bone density and strengthen your body to stay upright and active.

Next Steps

If you are currently strength training and are looking to enhance your bone density, examine your diet. Check to see if you are lacking regular consumption of the vitamins and minerals above, and look for ways to increase daily consumption.

Strength training will ensure you won’t lose bone density going forward. If you are not currently strength training, talk with your doctor and get started as soon as you can. Combining that with adequate levels of vitamin D3, magnesium, and calcium can make substantial improvements in your bone strength.

  1. Bolam, K.A., van Uffelen, J.G., & Taafle, D.R. (2013). The effect of physical exercise on bone density in middle-aged and older men: a systematic review. Osteoporosis International, 24(11), 2749-2762.
  2. MacLean, C., Newberry, S., Maglione, M., McMahon, M., Ranganath, V., Suttorp, M., … Grossman, J. (2008). Systematic review: comparative effectiveness of treatments to prevent fractures in men and women with low bone density or osteoporosis. Annals, of Internal Medicine, 148, 197-213.
  3. Nickols-Richardson S.SM., Miller, L.E., Wootten, D.F., Ramp, W.K., & Herert, W.G. (2007). Concentric and eccentric isokinetic resistance training similarly increases muscular strength, fat-free soft tissue mass, and specific bone mineral measurements in young women. Osteoporosis International 18(6), 789-796.
  4. Rhodes, E.C., Martin, A.D., Taunton, J.E., Donnelly, M., Warren, J., & Elliot, J. (2000). Effects of one year of resistance training on the relation between muscular strength and bone density in elderly women. British Journal of Sports Medicine, 34(1), 18-22.
  5. Schnell, S., Friedman, S.M., Mendelssohn, D.A., Bingham, K.W., & Kates, S.L. (2010). The 1-year mortality of patients treated in a hip fracture program for elders. Geriatrics Orthopaedic Surgery & Rehabilitation, 1(1), 6-14.
  6. Soijka, J.E. (1995). Magnesium supplementation and osteoporosis. Nutrition Reviews, 53(3), 71-74.

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