Monday, January 30, 2012

Ask Us Anything: Does the Body Burn More Calories in the Cold?

"Is it better to exercise outside in the cold or in a heated environment, such as a gym? I've heard that your body burns more calories if you work out in the cold."

Physical Therapist Richard Szabala Responds:

Generally speaking, there is no difference in the amount of calories you burn while exercising either in cold or heated environment. The calories you burn while exercising provides the fuel your body uses to perform the exercise activity, so the amount of calories burned is dependent on work, not body temperature.

The main thing that you need to be aware of is your body temperature. During exercise, your body produces heat while burning calories, and your body maintains your core temperature through sweating.

In a heated environment, you are wearing loose clothing, which allows for proper temperature regulation. However, when exercising in the cold, we bundle up at first to start warm. This bundling up can prevent proper temperature regulation. Therefore, if you choose to exercise in the cold, wear 3 to 4 layers of clothing so you can remove them as your body temperature increases.

At rest, your body will burn slightly more calories in a colder environment as your body's internal mechanism warms the core. This is accomplished by involuntary muscle contractions that we may experience as shivering.

– Richard Szabala PT, OCS

Richard Szabala is the senior physical therapist at AthletiCare Orchard Park.

If you have a question about your health, click here to ask our experts.

Friday, January 27, 2012

Congratulations to Nancy!

Please congratulate Nancy, the winner of our giveaway for the Olive Oil Desserts cookbook.

Nancy was chosen at random from our commentors and email newsletter subscribers, using a random number generator:

Nancy, you will be contacted by email to arrange delivery of your prize.

To make sure that you don't miss out on future giveaways, subscribe to our RSS feed to see our latest posts or subscribe to our monthly email newsletter (see sidebar) and you'll be automatically entered into future giveaways.

Thank you to everyone who entered!

Janet Snyder Interviews Dr. M. Steven Piver on WGRZ's Healthy Zone Show

Two years ago, The M. Steven Piver, M.D. Center for Women’s Health & Wellness opened on the campus of Sisters of Charity Hospital in Buffalo.

The women's health center is named after M. Steven Piver, M.D., an internationally-known physician who treats ovarian and gynecological cancers. At the time of the opening, he said, “My hope is that this center will be a place where women can rejuvenate their mind, body and spirit, in a supportive, friendly atmosphere.”

The Piver Center offers everything from massage therapy to cancer, taking a holistic approach to women's care.

Yesterday, Dr. Piver appeared on WGRZ's Healthy Zone Show with Janet Snyder to discuss the services offered at the center.


  • When asked why women tend to put their health last, Dr. Piver said, "Because we men don't take good care of ourselves."
  • If women need to see more than one specialist, the Piver Center offers the convenience of having multiple specialists under one roof. "Between the 7 or 8 physicians that work there, we pretty much cover everything," Dr. Piver said. The Piver Center treats bladder problems, diabetes, hypertension, cancer, and more.
  • Dr. Piver calls robotic surgery, which is available for both cancerous and non-cancerous conditions, a big breakthrough. "The surgeon is at a console and the patient is at a table about five feet away. You can see so much better, and the instruments are small, so you can do very fine surgery."
  • During his career, Dr. Piver hopes to find a cure for ovarian cancer.
For more information about the Piver Center, visit the Catholic Health website.

Wednesday, January 25, 2012

Q&A with Dr. Ali Ghomi

Dr. Ali Ghomi, a Catholic Health gynecologist, sees patients at the M. Steven Piver, M.D. Center for Women’s Health & Wellness in Buffalo. He is the Director of Minimally Invasive Gynecologic Surgery and Chair of The Robotic Surgical Committee at Sisters of Charity Hospital.

1. What do you think is the single most important thing that women can do to stay healthy?

Eat well and exercise. Maintain an ideal body weight. Obesity and poor nutrition are the number one reasons behind chronic medical conditions such as hypertension, diabetes, and heart disease.

2. What are the most common complaints or healthcare concerns that you hear from patients? Does this differ by age?

The desire to lose weight and to manage the daily stresses in their busy lives are often reported by patients, regardless of the primary medical complaints.

3. What are your patients often surprised to learn during their visits? Is there any advice that you offer that doesn't seem to be common knowledge but should be?

In my particular specialty, where I provide a high volume of second opinions, patients are often surprised to learn about their options, which were not offered before to them.

4. How can busy women incorporate healthy behaviors in their hectic schedules?

I encourage my patients to set realistic goals to start off in order to avoid repeated self disappointment. Once a healthy lifestyle is incorporated, adherence is more achievable.

5. Women need to feel an emotional connection with their healthcare providers. How do you put your patients at ease?

I find that an honest discussion with the patients and listening as much as speaking is the key to establishing a rapport.

6. What do you like most about practicing healthcare in Western New York? Have you always lived in the area?

I am not sure if practicing healthcare in WNY is any different from other parts of the country. I have lived in many places, including the east coast and the south. I chose to say in the area because it is a great area to raise a family.

7. Have there been any recent advances in women's healthcare that women should be aware of?

There are constant medical advancements, and doctors are faced with the difficult task of keeping up with new advancements so they can offer their patients the best available treatments. In my particular field of gynecologic surgery and urogynecology, I urge patients to explore their available options and seek second or even third opinions before undergoing surgery to make certain that the chosen treatment is the best treatment available.

Monday, January 23, 2012

Ask Us Anything: How Can I Avoid a Knee or Hip Replacement?

"I have known several people who have had knee and hip replacements. From what they have told me, the recovery process can be long. How can I avoid needing a knee or hip replacement in the future?"

Physical Therapist Richard Szabala Responds:

Recovery from joint replacements can be anywhere from 4 weeks to 6 months, depending on several factors, including a persons medical history, extent of the arthritis, and surgical procedure. But if you ask anyone who has had a joint replacement, the reduction in pain and return of function is well worth the recovery time.

When someone needs a joint replacement, 90% of the time it is due to osteoarthritis or wearing down of the cartilage in your joints from wear and tear placed on our joints through our daily lives. There are several factors that contribute to osteoarthritis, including:
  • obesity, 
  • walking on hard, uneven surfaces, 
  • keeping our joints in excessive bent positions, 
  • general muscle weakness, and 
  • heredity.
The best way to minimize the wear and tear on your joints is to keep the joints moving, keep your muscles strong and be aware of the positions that increase stress on your joints.

Begin an exercise program that focuses on high repetition, low resistance exercises like biking or walking, and leg raise exercises that focus on hip strengthening.

If you already are demonstrating signs of osteoarthritis, minimize the use of the stairs and avoid the squatting position. As always, keep an eye on your body weight with a healthy diet.

– Richard Szabala PT, OCS

Richard Szabala is the senior physical therapist at AthletiCare Orchard Park.

Related Links: 

If you have a question about your health, click here to ask our experts.

Friday, January 20, 2012

Giveaway: Olive Oil Desserts

Olive oil is good for your hair, skin and overall health, according to Deborah Richter, a Catholic Health Registered Dietitian (read her Ask the Expert article).

I've been getting my share of olive oil with the help of Olive Oil Desserts, a cookbook that replaces margarine and butter with olive oil.

The author's recipe for chocolate chip cookies is as good, if not better, than the classic Toll House recipe and just as easy to make (read my review).

If you're interested in making desserts that you can enjoy without some of the guilt, enter to win our giveaway for Olive Oil Desserts. One copy of the book will be mailed to the winning entrant, chosen at random from commentors on this specific post and from our email subscribers.

Contest Details

To enter, leave a comment on this blog post (include your first name or a screen name) or subscribe to our email newsletter.

If you're entering via commenting, what is your favorite dessert?

Official Rules

  1. I'll randomly select a winner (using a random number generator) on Friday, January 27, 2012 and announce the winner on the blog that day.
  2. Winners are chosen from among the commentors on this blog post and our email subscribers. You can do one or the other; it is not necessary to do both.
  3. Prizes that are not claimed within 3 weeks of the winner announcement will be carried forward to the next draw. When an email address is available (the prize winner is an email subscriber), prize winners will be contacted by email. When an email address is not available (the prize winner commented on the blog), the winner will be asked in the winner announcement to contact me to arrange for prize delivery.
  4. You must be at least 18 years of age and a United States resident.

Tuesday, January 17, 2012

Review: Olive Oil Desserts

In yesterday's post, Deborah Richter, a Registered Dietitian at Sisters of Charity Hospital, St. Joseph Campus, talked about the benefits of eating olive oil, calling it a step toward healthier eating.

Olive oil is so versatile that it can be a part of practically every meal – to grease the pan when cooking eggs, as a dressing for salads, and as a dip for breads. Even desserts are healthier when olive oil plays a role.

In Micki Sannar's book, Olive Oil Desserts, you'll find dessert recipes that eliminate butter, shortening, and margarine in favor of olive oil and other ingredients, resulting in less fat and fewer calories. Recipes include classics such as coffee cake, rice crispy treats, apple pie, and of course, chocolate chip cookies.

I recently tested the recipe for what Micki calls "a new toll cookie." It's similar to Nestle's, but adds olive oil, butter extract (a butter flavoring) and milk to the butter-less batter.

The recipe is straightforward, and gave me pause only twice (not bad considering that this was my third time baking without mom's help).

In step two, you're asked to blend a mixture of olive oil, sugar, and brown sugar until it's smooth and creamy. After spending some quality time with a handheld mixer, my batter was a little flaky, becoming smooth only after the addition of milk and eggs.

My second mistake: I burned the first tray, not realizing that the cookies were a lighter color than your traditional chocolate chip. After tossing the charred batch into the garbage can, I baked each tray for about 8 minutes, checking the bottom of the cookies periodically for browning.

Once I got the timing down, the results were probably the best that I've had in the kitchen – moist but firm at the same time. Ben said that he wouldn't have known the butter was missing if I hadn't told him, and we finished the entire batch within a day. I made them again this past weekend.

Although I haven't tried the book's other recipes yet (and there are quite a few), I'm confident that they'll yield similar results. Olive Oil Desserts has a five-star rating on, based on 36 reviews.

Unfortunately, Olive Oil Desserts isn't available at the Buffalo & Erie County library, although it can probably be borrowed via interlibrary loan. You can also purchase the book at for $16.41.

Have you tried baking with olive oil?

Monday, January 16, 2012

Ask Us Anything: How Much Olive Oil Should I Have in my Diet?

"My husband and I cook everything with olive oil. We use it in place of spray-on butter. I've heard that there are health benefits to including olive oil in your diet. Is there such a thing as having too much? Each of our meals (except for lunch) includes olive oil."

Registered Dietitian Deborah Richter Responds:

Olive oil is a healthy part of nutritious eating, and it is a healthful option to substitute olive oil for less healthy fats such as butter, stick margarines and some vegetable oils.

The important thing to remember is that olive oil is a fat and therefore more caloric dense. A measured tablespoon of olive oil has 119 calories and13.5 grams of fat. The good news is that 9.8 grams is monounsaturated fats, the heart healthy fat that helps to lower the bad cholesterol (LDL low density lipoproteins) without decreasing the good cholesterol (HDL high density lipoproteins).

It is the oleic acid of olive oil that has been associated with a reduced risk of heart disease and other chronic diseases. Also, olive oil has the highest quantity of alpha tocepherol – vitamin E that works as an antioxidant.

A tablespoon of olive oil is a small portion, so it is important to be moderate with the portion, especially if weight loss is a health goal.

Benefits of Olive Oil

The health benefits of olive oil go beyond just the well-researched heart benefits. The health benefits of newly pressed extra-virgin olive oil include decreasing inflammation and decreased cancer risk – in particular breast cancer.

Olive oil helps to maintain the suppleness of skin and muscle, heal abrasions, give body and sheen to hair, and can help to reduce the drying effects of sun and wind in our Western New York winters!

Types of Olive Oil

So what is extra-virgin olive oil? In October 2010, the USDA (United States Department of Agriculture responsible for food labeling, food safety and regulations) revised the U.S. grading standards of olive oil. There are now objective criteria for the various grades of olive oil that include clear definitions.

When purchasing olive oil, look for the USDA certification seal. To get this seal and label of U.S. extra-virgin olive oil, the olive oil must have an excellent flavor and odor, and a free fatty-acid content, expressed as oleic acid of not more than 0.8g/100g.

U.S. virgin oil has a reasonably good flavor and odor and oleic acid content of no more than 2g/100g.

U.S. olive oil is a blend of refined olive oil and virgin oil and fit for consumption without further processing. This oil has an oleic acid content of 1g/100g, an acceptable odor and flavor and a maximum level of 200 mg/kg of alpha-tocopherol.

Another grade is U.S. refined olive oil, the olive oil obtained from virgin olive oils with an oleic acid content of not more than 0.3g/100 is flavorless and odorless. Prior to the 2010 changes, the U.S. had become a dumping ground of imported poor quality olive oil. Now the imports, as well as U.S. oils, must meet quality standards.

Olive Oil in Mediterranean Diets

After that chemistry lesson on olive oils, head over to the local olive oil stores, such as D'Avolio Olive Oils and Vinegars, to taste-test the delicious flavor-infused olive oils and enjoy the health benefits of a more Mediterranean diet.

Olive oil is a staple of the Mediterranean diet, which has been recognized as a healthy dietary pattern by the 2010 Dietary Guidelines for Americans. Refer to for additional information on healthy eating.

So back to the original question: “Is there such a thing as having too much olive oil?"

Well, yes. Whenever we eat anything to excess, that can be a problem, but it can also be a great start towards healthier eating. Substitute olive oil for other fats and drizzle olive oil on salads, toss it into pastas, serve it as dip for bread or mix it into meat marinades.

The great taste of extra virgin olive oil may even help us to eat more vegetables, and that is good for our health!

— Deborah Richter, RD, CDE

Deborah Richter is a certified dietitian at Sisters of Charity Hospital, St. Joseph Campus in Cheektowaga and is a state diabetes educator. She teaches diabetes education classes and provides outpatient nutrition counseling. She has helped her clients to lose weight, reduce their blood pressure and feel better about themselves through healthy eating choices.

If you have a question about your health, click here to ask our experts.

Friday, January 13, 2012

Tips for Safe Driving in Winter Weather

Buffalo is no stranger to winter weather. But that's not to say that we're experts at driving in it. How many times have you seen someone stranded in a ditch? Or have been moments away from sliding into another car?

Before you get in the driver's seat, review these tips on how to drive safely when the snow starts falling:

Preparing to Drive

  • Clean the car. Wipe away ice and snow from your windows and windshield wipers.
  • Check your fluids. Make sure that the windshield washer reservoir is filled with a freeze-resistant cleaning solution.
  • Eliminate condensation. If you have condensation on the inside of your car, run the air conditioner and select the "fresh air" option.
  • Turn on your lights. This will allow other drivers to see your vehicle more easily.
  • Check your fuel level. Your gas tank should be at least half full to avoid gas line freeze-up.

Driving Strategies

  • Leave early to give yourself plenty of time to arrive at your destination. If your morning routine is already hurried, set your alarm clock for at least a half hour earlier.
  • Drive slowly, even if your vehicle has good traction. Driving faster than everyone else will disrupt the flow of traffic.
  • Give yourself plenty of time to stop. Leave three times more space between your vehicle and the vehicle in front of you than you would normally.
  • Stay behind snow trucks. They have limited visibility, and the road ahead of them will be worse than the road behind.

Avoiding Skids

To avoid skids, brake gently on snow and ice. If your wheels start to lock, ease up on the brake pedal.

Keep in mind that bridges, ramps and overpasses are likely to freeze first, so drive slowly in these areas.

Getting Out of a Skid

If your back wheels start to skid:

When steering, follow the direction of the skid. If the rear wheels are sliding left, steer left. If they're sliding right, steer right. You may have to steer left and right a few times as the rear wheels change course.

If your vehicle has anti-lock brakes (ABS), keep your foot on the brake. If it doesn't, pump the pedal gently, then more rapidly as the vehicle starts to slow.

If your front wheels skid:
  • Shift to neutral. 
  • Don't steer immediately. As the wheels skid, they will slow your vehicle and traction will return. 
  • Begin steering when you feel traction.
  • Put the transmission in drive.

Getting Unstuck

  • Move the snow away from the tires. Turn your wheels from side to side, and touching the gas slightly, ease forward. Don't spin your wheels. You can also use a shovel to clear snow away from the wheels and the underside of the car.
  • Rock back and forth. Shift from drive to reverse, moving forward and backward repeatedly. In some vehicles, this strategy can damage the transmission (check your owner's manual).
  • Recover traction with sand, kitty litter, gravel or salt. Pour it in the path of the wheels.

Do you have any winter driving strategies that have worked for you?

Sources: New York State Driver's Manual,

Wednesday, January 11, 2012

Western New York Walks: Elmwood Village & Gates Circle

The President's Council on Physical Fitness (PCOPF) calls walking the most popular form of exercise. A regular walking program can burn calories, reduce stress, and increase muscle tone.

Of course, walking the same route day after day can get a little boring. Over a series of blog posts, we'll take a look at places to walk in Western New York, starting with the Elmwood Village and Gates Circle.

Google Maps estimates that this route is about 2 miles long and takes 41 minutes to walk. I walk it at least once a week, and I'd estimate the time closer to an hour.

1. To start, park on Lexington Avenue.

Lexington Avenue is primarily residential, and street parking can be easily found on the upper end, toward Delaware Avenue.

As you would anywhere, make sure that you lock your doors and don't leave any valuables in sight.

2. Walk down the street towards Elmwood Avenue.

3. When you reach the corner of Elmwood Avenue and Lexington Avenue (there will be a Mobil gas station on the left), turn right.

At first, there won't be much in the way of businesses, except for a barber shop and a church.

Continue past the local shops. If you're walking at night, many of the stores will be closed, but if you absolutely must stop, visit Everything Elmwood – they tend to keep later hours than their neighbors.

If you want a drink to warm up, try Spot Coffee, which is at the corner of Cleveland Avenue and Elmwood. Also nearby is the Globe Market across the street. You could even grab dinner to go – I recommend the caprese sandwich.

4a. Want a shorter walk? Turn right at Auburn Avenue to skip Gates Circle.

4b. If you're walking the full 2 miles, keep going straight until you reach St. James Place. Turn right.

St. James Place is residential, and you won't encounter any shops or restaurants for the rest of the route.

As you continue walking, you'll approach Gates Circle.


5. At the circle, turn right and cross the street to the park (where the red car is parked in the picture below).

6. Walk towards the stop sign and turn right onto Delaware Avenue.

This is the part where I usually fool myself that I'm almost done, that any minute I'll be rounding the corner to Lexington. Unfortunately, it's a little further. You'll know that you're getting closer when you see Canisius High School.

And Gilda's Club.

The road curves slightly uphill on Delaware Avenue, so it's a little more challenging.

7. Turn right onto Lexington Avenue.

If you'd like a more detailed view of the route, click here for a Google map.

What I Like About This Walk

There are plenty of places to grab a drink if you get thirsty – Tim Hortons inside the Mobile on the corner of Lexington and Elmwood, and Spot Coffee, Wilson Farms, and the Lexington Co-op on Elmwood. Unfortunately, this can also be a con. I've found myself stopping at Wilson Farms for a candy bar or getting a pastry at the Co-op, which means that I've probably gained more calories than I've burned. Self-control is a must.

I also like the architecture, which is easy to take for granted. "We don't have architecture like this in Georgia," someone once told me. And when you're walking, you have more time to look around you than when you're driving by on your way to work.

Have you taken this walk? Have any suggestions for future routes? Leave a note in the comments.

Monday, January 9, 2012

Ask Us Anything: If I'm Diabetic, How Can I Have a Healthy Pregnancy?

"Are there any precautions that pregnant diabetic women should take? I have diabetes, and am wondering what I should watch for when my husband and I get pregnant."

Dr. Bruce Rodgers Responds:

The majority of women with diabetes can expect to have a successful pregnancy and health baby. However, there are several important issues which must be addressed.

Care of diabetes and pregnancy actually should begin BEFORE the pregnancy. If you have diabetes and are contemplating pregnancy, it is strongly recommended that you have preconception diabetes care.

Physicians caring for women with diabetes and most endocrinologists are well versed in such care, which involves screening for diabetic complications and achieving optimal blood glucose control prior to pregnancy.

Prior to the pregnancy, your doctors should check for complications of diabetes such as eye, kidney, heart, and thyroid problems, as well as hypertension (high blood pressure).

Some authorities also recommend that women with Type 1 (juvenile) diabetes be checked for Gluten Enteropathy, which can be performed with a simple blood test. It is important that your blood glucose levels be controlled and that you achieve a Hemoglobin A1C Level as close to normal as possible. This significantly reduces the risk of birth defects and miscarriage, both of which are higher in women with diabetes. This risk is related to poor blood sugar control during the first 7-9 weeks of pregnancy when the baby’s organs are forming. If you delay optimizing your blood sugar control until you discover you are pregnant, it will be too late to avoid these risks.

In the pre-pregnancy period, your doctor should switch you to diabetic medications that are safe in pregnancy. This generally involves switching to Insulin, if you are not already on this medication. If your blood sugars are well controlled at the time of conception, and your diabetes is uncomplicated, then half the job is already done. If you have any complications of diabetes, you can still anticipate a successful pregnancy, but the management of the pregnancy may have to be more intensive. It is important to have treatment for these complications before you become pregnant.

The most common baby growth problem encountered with diabetes is an oversized baby (called Macrosomia, which means “big body”). In addition to causing problems with the birth process and increasing the need for Cesarean Section, excessive largeness is not healthy for the baby and may increase the risks of the baby having problems such as obesity and diabetes later in life.

The oversized baby problem is related to many factors, and include the mother's weight prior to the pregnancy, excessive weight gain during pregnancy, and failure to control blood sugars by pregnancy standards (these are more rigid then when you are not pregnant).

Keeping your weight down prior to conception, strict adherence to a low carbohydrate diet during pregnancy, and avoidance of excessive weight during the pregnancy go a long way towards preventing oversized babies. Daily blood sugar monitoring with good blood sugar control is also extremely important in this context.

– Dr. Bruce Rodgers

Dr. Rodgers is the Director of Maternal-Fetal Medicine at Catholic Health and Director of the Fetal Testing Unit at Sisters of Charity Hospital in Buffalo.

If you have a question about your health, click here to ask our experts.

Friday, January 6, 2012

In the News: Why Baby Animals Make Us Happy

Kittens, puppies, bear cubs – all are unbearably cute.

Over Christmas, I took more pictures of my brother's new tabby, Miley, than anything else:

Mike and Kara's Cat Miley

Why do we love babies so much? A report from this morning's Today Show explains that the brain gets a burst in its pleasure center when we look at babies (and this applies to both men and women).

Let's test the theory. Watch the video segment below, which features baby polar bears, tigers, and other cuteness. Can you get through it without smiling? I couldn't.

Thursday, January 5, 2012

Free January 11th Wellness Event

Buying a house, having kids, changing jobs – all have a significant impact on your future.

So do the choices you make every day, like how often you exercise and the foods you eat. These decisions will impact your health not just tomorrow, but ten or twenty years from now. That's why it's never too early to start living a healthy lifestyle – think of it as insurance for your quality of life.

Start building a healthier future by attending Catholic Health's free wellness event, Live Well: Your Health, Heart, and Stroke on Wednesday, January 11 from 3 p.m. to 6 p.m. The program takes place at St. Edmund Campus, 530 Ellicott Creek Road, Tonawanda, NY.

You'll hear from Dr. Robbie Wall and Dr. George Kalonaros, experts in the cardiac and stroke fields, which are the leading causes of death and disability in the United States. Your risk of both can be reduced by making positive lifestyle changes.

From 4:30 p.m. to 6 p.m., free screenings will be offered, so you can get a sense of where you're doing well and what needs to be improved. Screenings include:
  • Cholesterol
  • Blood Pressure
  • Diabetes
Registration is required. Click here to register online or call Catholic Health’s HealthConnection at (716) 447-6205.

Tuesday, January 3, 2012

New iPhone App Pays You for Working Out

My husband, Ben, who belongs to the Jewish Community Center, says that his gym fills up around this time of year as people make their New Year's resolutions. But, he tells me that he's not worried, that the people who aren't committed to their new workout routines clear out by March.

I know that motivation can be difficult to come by. Two years ago, I joined the YMCA in Orchard Park and never stepped foot in the gym except to have a photo taken for my membership ID.

Now, an iPhone app called GymPact gives you a new motivation to meet your fitness goals – cash.

Here's how it works: you specify the number of days each week that you'll exercise and how much you're willing to pay if you don't. Each time you visit the gym, you'll check in with your iPhone. A 30-minute visit (minimum) is required for the check-in to count. Meet your weekly pact, and you'll be rewarded with cash. Fall short, and you'll have to pay up.

How much can you earn? GymPact bases rewards on how much was paid by those who didn't work out. The money is then divided among those who made their pact, based on the number of days committed (i.e. 3 days Pact = 3 portions).

GymPact claims its pilot had a 90 percent success rate at keeping users on their committed schedule.

Would a cash reward (or penalty) motivate you to work out?
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