Figure 1 Squat. Checkley9 Checkley E. A natural method of physical training. New York (NY): William C. Bryant & Co.; 1890. [Google Scholar] and Randell, reproduced with kind permission of Wellcome Library. Demonstrated by Barbara Mortimer Thomas.26 Wellcome Library [Internet]. Rodway H. Training for childbirth - and after (1940). 2015 Sep 24 [cited 2015 Oct 3]. Available from: http://wellcomelibrary.org/player/b16729006#?asi=0&ai=0. [Google Scholar]
Environmental approaches appear promising: signs that encourage the use of stairs, as well as community campaigns, may increase exercise levels.[126] The city of Bogotá, Colombia, for example, blocks off 113 kilometers (70 mi) of roads on Sundays and holidays to make it easier for its citizens to get exercise. Such pedestrian zones are part of an effort to combat chronic diseases and to maintain a healthy BMI.[127][128]
Resistance bands serve as another space and equipment saver. These elastic bands typically have handles on the end, and you can perform a variety of exercises with them. If you'd like to increase the intensity and resistance, you can use two bands at once. Surgical tubing makes and extremely inexpensive resistance band, provided you create a safe way to hold onto the ends so that you don't accidentally let go.
To qualify for inclusion, studies had to be level 1 or level 2 (randomized controlled trials); had to compare rehabilitation interventions, such as exercise or manual therapy, with other treatments or placebo; had to include validated outcome measures of pain, function, or disability; and had to be limited to individuals with diagnosed impingement syndrome. Impingement syndrome was determined by a positive impingement sign per Neer or Hawkins criteria, or both. Articles were excluded if they addressed other shoulder conditions (eg, calcific tendinosis, full-thickness rotator cuff tears, adhesive capsulitis, osteoarthritis), addressed postoperative management, were retrospective studies or case series, or used other outcome measures.
Use your toilet time wisely. Take advantage of that toilet time by doing some kegels. Kegels are the muscles used to stop the flow of urination, so practice clenching those muscles the next time you're doing your business. Both men and women can do kegels, which will not only help guard against incontinence, but may also improve bedroom endurance, if you catch my drift.
Just shy of an hour long, this video is a killer aerobic kickboxing workout. You’ll throw punches and kicks in supercharged sequences as you follow along with the ebullient Billy Blanks. Don’t be surprised if you start talking back to the screen, especially when Blanks looks straight into the camera and declares, “I see you at home! Keep going!” Talk about motivation.
This study was supported by grants from the Liaison Committee for education, research and innovation in Central Norway, The K.G Jebsen Foundation for medical research and the Research Council of Norway. The funding organizations had no role in the design and execution of the study, in the collection, analysis, and interpretation of the data, or in the preparation, review or approval of the submitted manuscript.

Many exercise videos will make unrealistic guarantees in terms of the results you can expect to see. Beware of these because they can set you up for a real disappointment. A good example of this is a program that claims you can get “ripped” in 30 days. Well, this might be true IF you are only toning up and don’t have weight to lose. For anyone who has got pounds to lose, they finish the 30 days and are still not “ripped” because those claims did not apply to anyone who has weight to lose.


Ready to take it to the next level? This workout with Chloe Bent is a full-length, 30-minute calorie burner that’s filled with dance moves that hit all the major muscle groups. After this dance routine, you’ll feel like your living room just became a stage. Take on this bodyweight routine at home when you need to spice up your cardio regimen. If you’re a beginner, don’t fret: This will be a great challenge for you.


I've given this program a good 6 weeks so far. I'm 5-10 pounds overweight with some physical issues and a history of car crash injuries. I have a medical degree and a background in nutrition and fitness with several years of yoga (various disciplines) under my belt. Overall, I do like the program, but there are some VERY important things you should know before purchasing and participating..

Leslie of Fightmaster Yoga teaches hatha yoga for beginners, yoga for energy, yoga for reducing stress, meditation yoga, yoga workouts for strength, yoga for office workers... in other words, she offers a BIG selection of yoga classes! She is a knowledgeable instructor and is an excellent communicator, which makes her classes especially easy for beginners to follow.


The exercises developed by Checkley, Müller, Randell, Alexander, Pilates, and Morris were secular in nature. The holistic unity between harmonious movements and beauty, health, performance and youth, between the body and mind, and between human and nature were all emphasized yet these universal concepts were unimpeded by religious, political, or commercial influences. The exercises were simply harmonious functional human movements learned from observations of nature.
We've said it before, but HIIT really does the job when you want to trim ab fat: A study published in the Journal of Sports Medicine and Physical Fitness found that people who did two HIIT and two strength sessions a week lost more visceral fat (11 percent of the dangerous kind around your organs)—about an extra inch from their waist—than those who ran twice and did two strength sessions. Plus, many of those speedy intervals, such as sprints, are total-body moves that engage your abs big time. Do speed bursts on a cardio machine or try three-minute boxing rounds (another transverse tightener) with a minute of active recovery in between. This unique HIIT workout incorporates some boxing moves and some weight training for double the benefits. (Don't get along with HIIT training? Studies show adding music will make it more enjoyable.)

Sweden has also begun developing outdoor gyms, called utegym. These gyms are free to the public and are often placed in beautiful, picturesque environments. People will swim in rivers, use boats, and run through forests to stay healthy and enjoy the natural world around them. This is especially possible in Sweden due to its geographical location.[139]
The exercises that Kuhn provided can be viewed as a partial list of exercises that might be appropriate for treating an individual with RCIS. We offer modifications to 3 of the proposed exercises and discuss factors used by athletic trainers and physical therapists to establish initial exercise selection, intensity, and periodic modification of an exercise program that were not discussed by Kuhn. Based on current evidence, the anterior shoulder stretch in the proposed protocol might not be the most effective way to stretch the pectoral muscles. When performing the stretch as described in the protocol, the individual is instructed to place his or her hands at shoulder level on either side of a door or corner and to lean forward. This might be a preferred position to initiate pectoral muscle stretch if the individual is unable to perform stretching with the arm elevated as a result of pain; however, evidence3 indicates that changing the position of the upper extremity so that the individual's hand is above the head with the shoulder in 90° of abduction and 90° of external rotation likely provides a more effective stretch.
Many exercise videos will make unrealistic guarantees in terms of the results you can expect to see. Beware of these because they can set you up for a real disappointment. A good example of this is a program that claims you can get “ripped” in 30 days. Well, this might be true IF you are only toning up and don’t have weight to lose. For anyone who has got pounds to lose, they finish the 30 days and are still not “ripped” because those claims did not apply to anyone who has weight to lose.
2) Another critique related to safety (and one that betrays my affection for yoga) is the BREATH is not emphasized nearly enough. Breath and movement go hand in hand with yoga. This helps give much needed oxygen to the tissues when their demands are the highest, but it also helps the person move with the body instead of jerking the body into cranked up positions. I believe this is another spot that could contribute to injuries.
Video Abstract for the ESSR 46.2 article “Potential Role of MicroRNA in the Anabolic Capacity of Skeletal Muscle With Aging” from author Donato Rivas. Age-induced loss of skeletal muscle mass and function, termed sarcopenia, may be the result of diminished response to anabolic stimulation. This review will explore the hypothesis that alterations in the expression of microRNA with aging contributes to reduced muscle plasticity resulting in impaired skeletal muscle adaptations to exercise-induced anabolic stimulation.

Bottom line. Muscle confusion is a snappy term for non-linear periodization, which simply means rotating the workouts you do so that your muscles are constantly challenged and you get better, faster toning and weight-loss results. Research suggests this approach is more effective than doing the same exercise routine. P90X is a 90-day plan that combines strength moves, cardio, and yoga­—and if you follow it faithfully, you will probably see results. But it’s suitable only for those who are already very fit because the routines are intense and take about an hour a day. Note: You’ll also need dumbbells, exercise bands, and a pull-up bar, which do not come with the basic system. The diet is complicated, but it provides an appropriate number of calories for the work you’ll be doing.
Jump up ^ Bouchard J, Villeda SA (2015). "Aging and brain rejuvenation as systemic events". J. Neurochem. 132 (1): 5–19. doi:10.1111/jnc.12969. PMC 4301186. PMID 25327899. From a molecular perspective, elevated systemic levels of circulating growth factors such as vascular endothelial growth factor and insulin-like growth factor 1 (IGF-1) in blood elicited by increased exercise have been shown to mediate, in part, enhancements in neurogenesis (Trejo et al. 2001; Fabel et al. 2003).
The physical benefits of Pilates include an increase in muscle strength and tone without creating bulk. The increase in deep core muscle strength helps to make your abdominal muscles look tight and toned. It also improves your flexibility and posture, which can decrease your chances of injuring yourself. Pilates is also effective in easing chronic lower back pain and preventing future back pain and injuries.

* If you're looking to control your weight, exercise is the least efficient way to do it. You'd have to run for hours to keep the cookies you ate from adding to your waistline. It's far more effective to not eat the cookies. Making fruits and vegetables a larger part of your diet will help crowd out the foods that don't offer much in the way of nutrition, and which add pounds that shouldn't be there. Also, as you build lean muscle tissue, your body will lessen its fatty tissue, and your shape will change. If you're overweight, you're not trying to lose weight, you're trying to lose fat. If your goal is to look and feel great, strength building exercise will accomplish this while making you fit in the process. Doing only aerobics will not.

In 1982, home workouts came to VHS tape when Jane Fonda released her first exercise video, Jane Fonda's Workout. The video had been inspired by the workout book Fonda had released the previous year, Jane Fonda's Workout Book. After its release, Jane Fonda's Workout gradually became a best-seller after more than 200,000 tapes were sold in one year. The tape was the first of its kind, and is sometimes credited with launching the tape industry. Few people owned VCR players when Fonda released her first tape, but as her exercise tape became increasingly popular among Americans and needed to be watched repeatedly in order to be effective, families were encouraged to buy the necessary hardware to play the tape.
Check your company's stock plan for the allowed methods and procedures. Once you do give notice to exercise with payment as required under your stock plan, it is unlikely that you can then change your decision to exercise or the exercise method, at least for tax purposes. This is illustrated by the case of Walter v. Commissioner, decided by the US Tax Court (TC Memo 2007-2, January 3, 2007). The employee attempted to change his original exercise instructions from a same-day sale to a cash exercise/hold. The Tax Court did not let him, holding that he had beneficial ownership of the stock when he initially exercised the options following the conditions under his stock plan.
Ashley and the team of Strong and Sexy incorporate moves like standing ab pumps, side crunches, and side-to-side leans into fun dance moves that’ll leave you feeling like a professional dancer — even if your abs are burning. As an added bonus, the dancer on the right side of the screen shows you how to perform lower-intensity versions of each dance move.
The recent “consensus statement” of the European College of Sport Science indicates that the difference between NFO and OTS is the amount of time needed for performance restoration and not the type or duration of training stress or degree of impairment.1 In essence, it is generally thought that symptoms of OTS, such as fatigue, performance decline and mood disturbances, are more severe than those of NFO. However, there is no scientific evidence to either confirm or refute this suggestion.1 The distinction between NFO and OTS is most of the time based on “time to recover”. Hence, there is a need for objective, immediately available evidence that the athlete is indeed experiencing OTS.
^ Jump up to: a b Kyu, Hmwe H; Bachman, Victoria F; Alexander, Lily T; Mumford, John Everett; Afshin, Ashkan; Estep, Kara; Veerman, J Lennert; Delwiche, Kristen; Iannarone, Marissa L; Moyer, Madeline L; Cercy, Kelly; Vos, Theo; Murray, Christopher J L; Forouzanfar, Mohammad H (9 August 2016). "Physical activity and risk of breast cancer, colon cancer, diabetes, ischemic heart disease, and ischemic stroke events: systematic review and dose-response meta-analysis for the Global Burden of Disease Study 2013". BMJ. 354: i3857. doi:10.1136/bmj.i3857. PMC 4979358. PMID 27510511.
Too much exercise can be harmful. Without proper rest, the chance of stroke or other circulation problems increases,[80] and muscle tissue may develop slowly. Extremely intense, long-term cardiovascular exercise, as can be seen in athletes who train for multiple marathons, has been associated with scarring of the heart and heart rhythm abnormalities.[81][82][83] Specifically, high cardiac output has been shown to cause enlargement of the left and right ventricle volumes, increased ventricle wall thickness, and greater cardiac mass. These changes further result in myocardial cell damage in the lining of the heart, leading to scar tissue and thickened walls. During these processes, the protein troponin increases in the bloodstream, indicating cardiac muscle cell death and increased stress on the heart itself.[84]
In extreme instances, over-exercising induces serious performance loss. Unaccustomed overexertion of muscles leads to rhabdomyolysis (damage to muscle) most often seen in new army recruits.[88] Another danger is overtraining, in which the intensity or volume of training exceeds the body's capacity to recover between bouts. One result of detrimental overtraining is suppressed immune function, with an increased incidence of upper respiratory tract infection (URTI). An increased incidence of URTIs is also associated with high volume/intensity training, as well as with excessive exercise (EE), such as in a marathon.[89] Marathon training requires the runner to build their intensity week to week which makes them more susceptible to injury the more they increase their mileage. A study shows that in the last 10–15 years up to 90% of marathon runners have suffered a physical injury from their training.[90]
It takes the gastrointestinal tract about 3 to 4 hours to completely digest a full meal. Note too that the digestion phase varies between what you are eating -- for example if you ate a banana, you can exercise after 30 minutes or 1 hour after eating it but if you ate a steak, it would take you about 3 hours before it would be good to begin exercise. That said, most people find that eating trail mix mid-hike doesn't prevent them from continuing to walk, as human beings were built to eat and move.
Jump up ^ Zhou Y, Zhao M, Zhou C, Li R (July 2015). "Sex differences in drug addiction and response to exercise intervention: From human to animal studies". Front. Neuroendocrinol. 40: 24–41. doi:10.1016/j.yfrne.2015.07.001. PMC 4712120. PMID 26182835. Collectively, these findings demonstrate that exercise may serve as a substitute or competition for drug abuse by changing ΔFosB or cFos immunoreactivity in the reward system to protect against later or previous drug use. ... As briefly reviewed above, a large number of human and rodent studies clearly show that there are sex differences in drug addiction and exercise. The sex differences are also found in the effectiveness of exercise on drug addiction prevention and treatment, as well as underlying neurobiological mechanisms. The postulate that exercise serves as an ideal intervention for drug addiction has been widely recognized and used in human and animal rehabilitation. ... In particular, more studies on the neurobiological mechanism of exercise and its roles in preventing and treating drug addiction are needed.
I enjoyed your functional training exercises, but I’m not sure about some of them as I was recently diagnosed with a small tear in my rotator cuff. I’m not planning on having surgery. My doctor said that I could work out, but other than saying not to do straight bar bench presses, he said if it hurts, don’t do it. I would love a little more direction than that. Do you have anything more to offer? Thank you.
Video Abstract for the ESSR 45.3 Perspectives for Progress “Physical Activity as Cause and Cure of Muscular Pain: Evidence of Underlying Mechanisms” from authors Karen Søgaard and Gisela Sjøgaard. Work-related physical activity (PA), in terms of peak loads and sustained and/or repetitive contractions, presents risk factors for the development of muscular pain and disorders. However, PA as a training tailored to the employee’s work exposure, health, and physical capacity offers prevention and rehabilitation. We suggest the concept of “Intelligent Physical Exercise Training” relying on evidence-based sports science training principles.
Even after long term IV therapy and other holistic type treatments to treat the Epstein Barr virus and co-infections in the blood, I still have CFS/ME. I have found effective ways to work with CFS/ME, yet this is not an overnight process and all of the lifestyle tools come into play even more so here. Visit our supplement page at anytime where we discuss options for immune support. Be sure you are getting enough zinc. This is sometimes overlooked. An additional 20-50 mg. can be helpful with CFS/ME. 

Walking is simple, yet powerful. It can help you stay trim, improve cholesterol levels, strengthen bones, keep blood pressure in check, lift your mood, and lower your risk for a number of diseases (diabetes and heart disease, for example). A number of studies have shown that walking and other physical activities can even improve memory and resist age-related memory loss.


Two other methods of exercise may be seen in private companies. Exercise by means of a promissory note may be offered in place of cashless exercise/same-day sale. Because the stock of private companies is unregistered, no trading market exists, making cashless exercise impossible. Pre-IPO companies that allow reverse vesting may offer loans to fund early exercise. This practice enables employees to start the holding period for capital gain tax treatment.

Alert: Companies strictly follow their exercise rules and deadlines, and courts tend to side with them. See, for example, Deal v. Consumer Programs, Inc. (2006), decided by the 8th Circuit Court of Appeals. The court ruled that the mere submission of a written notice to exercise stock options may be insufficient when the grant agreement states that the notice must be "accompanied by full payment of the purchase price of the shares."
The simplest way to workout at home is to use your own body. There are a variety of effective body weight exercises that can help you build strength, endurance and burn calories. The downside is that, without added resistance, it's tough to work hard enough to really challenge your body and burn calories. One way around that problem? Circuit training. By going from one exercise to the next, without little or no rest, you keep your heart rate up, burn more calories and get the most out of your exercise time.
Bonds H. The politics of the male body in global sport - the Danish involvement. Oxon: Routledge; 2010.  Müller, like Checkley, took a firm stand against exercise machinery, stating they were unnecessary and harmful with advocates described as having ‘biceps or triceps … as their chief credentials.’15 Müller JP. My system. London: Link House; 1904. [Google Scholar] After ‘My System’ was published, Müller traveled throughout Europe with lectures and exercise demonstrations and settled in London in 1912, to establish the ‘Müller Institute’ in which he offered group and individual classes to the public.15,16 Müller JP. My system. London: Link House; 1904.
Conclusions: Rediscovering the Western mind–body exercise movement is hoped to facilitate official healthcare establishment recognition of this kind of training as an integral entity. This may widen research opportunities and consolidate approaches toward: optimal musculoskeletal rehabilitation and injury prevention, promotion of a healthy active lifestyle environment in the modern world, and enhancement of the natural pain-free human athletic look, feel, and performance.
Circuit training tips for beginners: my advice here depends on how physically demanding the circuit is. If you’re just getting into working out and you want to circuit train, start with some less challenging exercises as part of your circuit and consider decreasing the time from a minute for each circuit to 30 seconds (or whatever you’re comfortable and able to finish the circuit with). The same advice applies here as in some of the other sections above: it’s good to build a baseline level of strength and aerobic fitness before circuit training, but it also depends on your level of fitness when you start.
Once you become more comfortable with the technique, you can try it while sitting up. Chickedantz says it will change your body by alleviating anxiety and stress, fix your posture, alleviate pain and strengthen abdominal and intestinal muscles. On a similar note, you can make the most of your stuck-in-a-seat time with these 21 Tricks to Lose Weight While Sitting Down!
Warm up. This is the act of preparing your body for the stress of exercise. The body can be warmed up with light intensity aerobic movements like walking slowly. These movements increase blood flow, which in turn heats up muscles and joints. "Think of it as a lube job for the body," Bryant explains. At the end of your warm-up, it's a good idea to do a little light stretching.

In 1904, Danish prize-winning athlete and gymnastics educator JP Müller followed Checkley’s exercise philosophy with the publication of ‘My System’. This book described how the relatively healthy, average person could keep fit, fortify health and stamina, and increase physical and mental efficiency with 15 min of daily exercise. He claimed: ‘If people only knew how much more, how much better and how much longer they can enjoy life, instead of being controlled by a weakly body, they have a strong and healthy one at their command!’15 Müller JP. My system. London: Link House; 1904. [Google Scholar] Müller was born a weak child and developed an exercise routine to re-build his own body, inspired by the harmony of ancient Greek statues. His routine included exercising natural functional movements, self-massage of skin in fascial lines, exposure to the sun, and bathing in cold water in addition to running on the balls of the feet as an aerobic activity.15,16 Müller JP. My system. London: Link House; 1904.


We've said it before, but HIIT really does the job when you want to trim ab fat: A study published in the Journal of Sports Medicine and Physical Fitness found that people who did two HIIT and two strength sessions a week lost more visceral fat (11 percent of the dangerous kind around your organs)—about an extra inch from their waist—than those who ran twice and did two strength sessions. Plus, many of those speedy intervals, such as sprints, are total-body moves that engage your abs big time. Do speed bursts on a cardio machine or try three-minute boxing rounds (another transverse tightener) with a minute of active recovery in between. This unique HIIT workout incorporates some boxing moves and some weight training for double the benefits. (Don't get along with HIIT training? Studies show adding music will make it more enjoyable.)
Question: Can you get a solid abs workout from yoga? Answer: Hell yeah! Kathryn Budig, author of THe Women’s Health Big Book of Yoga, teaches a core-blasting yoga series in this 20-minute video. She directs you through strengthening poses all while giving tips on form with the type of encouragement and reassurance you’d get if you were actually in class. (Bonus: The serene backdrop helps put you in a yoga mindset.)

If you want to form a gym habit, it can be difficult to know what to do or how to workout. Once you become immersed in exercise, it can feel like there’s not enough time to try all the different things! Plain and simple, this is just a knowledge gap. Learning how to workout is like learning anything else, it requires time, research and study. Hiring a personal trainer is the fastest route around this, but it also helps to be a “student of the game” by continuing to educate yourself.

When visual inspection gave an indication for group differences, parametric statistical analyses were performed through ANOVA with repeated measures with one withinsubjects factor (post-values for first and second exercise test) and one between-subjects factor (NFO or OTS) or through an independent samples t test. Those analyses were performed in SPSS V.15.0. Sensitivity was also calculated for these variables by dividing the number of correct OTS or NFO diagnoses by hormonal analysis by the total number of OTS or NFO diagnoses according to the consensus statement.1 Sensitivity was presented as a ratio. The denominator varies because of random missing values.

You acquire 100 new shares, giving you a total of 160. You simultaneously sell 50 shares of the exercised options to pay the total exercise cost ($2,000 ÷ $40 = 50 shares), leaving you with 110. Additional shares must be sold to pay for broker fees and, if exercising NQSOs, withholding taxes. After the exercise, you might own less than the 110 shares.
Lie on your back with the knees bent and feet hip-width apart. Place arms at your side and lift up the spine and hips. Only the head, feet, arms, and shoulders should be on the ground. Then lift one leg upwards, keeping the core tight. Slowly bring the leg back down, then lift back up. Try to do 10 reps per leg, then bring the knee in place and spine back on the floor.
Physical activity is beneficial for young people, who are naturally primed to soak up its rewards. The reality is that the majority of today’s youths, however, fall into one of two camps: Either they are athletes, engaging in one or many sports (as well as auxiliary training such as weightlifting and agility work, which can help create lifelong fitness habits) or they are sedentary.

We have included step by step instructional guides for over 500 different resistance training exercises. This database covers a wide variety of different exercises including free weights, CrossFit, kettlebells, machines, bodyweight, medicine ball, elastic bands, exercise ball, Pilates and stretching movements. Choose from a list for a specific muscle group or select by exercise type to pick the best exercises for your workout. Each instructional page will show you how to properly perform a resistance training exercise with detailed photos and exercise advice for each movement. It’s like having your very own personal trainer. These exercise guides will help set you on the right track so you can get in the best shape of your life!
All workout programs require a fair amount of commitment in order to achieve maximum results, so factors such as the duration, frequency, location and types of classes available may help you decide which one is a good fit for you. Your level of commitment to any fitness program hinges greatly upon your level of enjoyment with the exercise methods employed. Although any amount of physical activity is positive, the more you exercise the better the results you will see.
Anyone who watched Jackie Warner on Bravo's Work Out knows she takes a tough-love approach to fitness. And, clearly, if you've checked out her abs lately, it works. She shares her signature circuit-training workout in this high-energy DVD that gives the option of four different 15-minute workouts or one 40-minute total body circuit, and left me feeling like I just had an up-close-and-personal training session with the exercise guru.
The goal in training competitive athletes is to provide training loads that are effective in improving performance. At some stages during the training process, athletes may experience an unexplainable decrease in performance. This might happen when prolonged excessive training takes place concurrent with other stressors and insufficient recovery. This unexplainable performance decrements can result in chronic maladaptations that can lead to the overtraining syndrome (OTS). A keyword in the recognition of OTS might be “prolonged maladaptation” not only of the athletic performance but also of several biological, neurochemical and hormonal regulation mechanisms. When athletes deliberately use a short-term period (eg, training camp) to increase training load, they can experience short-term performance decrement, without severe psychological or lasting other negative symptoms.1 2 This functional over reaching (FO) will eventually lead to an improvement in performance after recovery. However, when athletes do not sufficiently respect the balance between training and recovery, non-functional over-reaching (NFO) can occur.1 2 At this stage, the first signs and symptoms of prolonged maladaptation such as performance decrements, psychological disturbance (decreased vigour, increased fatigue) and hormonal disturbances are present, and the athlete will need weeks or months to recover. The distinction between NFO and OTS is very difficult and will depend on the clinical outcome and exclusion diagnosis.
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