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5 Tips for Surviving the NPTE

keep-calm-and-pass-the-npte-2After eighteen months of preparation, perspiration, and palpitations, I have finally passed the National Physical Therapy Exam (NPTE), administered by the United States of America’s Federation of State Boards of Physical Therapy (FSBPT). The NPTE is the means by which all candidates for physical therapy licensure, whether domestic graduates or foreign trained applicants, are assessed for basic entry-level competency for the profession. It is not the only requirement for licensure, however it is the one standarised requirement in all fifty States, and if you want to work as a physical therapist in the USA, you must sit and pass it.

You might think for someone like myself who has been a physical therapist for the past eleven years this would be little more than a formality. Think again. The NPTE is one of – if not THE – toughest exams I’ve ever taken. Unfortunately, those who have taken the exam are prohibited from disclosing any information about the exam itself, so I cannot reveal the anything about its content or structure. I can, however, give some more general advice based on my experience in preparing for and undertaking the exam – advice I would have found invaluable in my own lead-up to the exam date.

Here are my five tips for surviving the NPTE:

  1. Allow plenty of time to prepare

A five-hour 250 question exam requires ample preparation time. The exams generally run every three months, so depending on where you are in the schedule should guide you as to which exam you should take. Don’t be in a rush to sit the first available exam. It may be in your best interest to give yourself additional time to ensure you are able to cover all the required material, get a feel for the exam with some practice exams (see below), and build your confidence in your ability to do well.

  1. Study everything

The NPTE potentially covers the entire scope of practice of physical therapy, from musculoskeletal to neurology, cardiac and respiratory to lifespan, and principles of general practice and research. Chances are you don’t remember everything there is to know about physical therapy, even if you are a new graduate. If you are currently working as a physical therapist, you probably know the area you work in quite well, but haven’t even thought about other areas in a long time. You need to study everything about physical therapy, and feel confident that you can apply that knowledge. It is a big ask, and it is probably the last time you will ever need to know everything about the profession, however it is essential if you want to get through the NPTE.

Didn’t keep all your old textbooks? Fear not, there are some very useful resources to help you revise and prepare for the exam. Two that I used are BenchPrep, an online prepatory course for the NPTE, and PT Exam: The Complete Study Guide by Scott Giles, a reference text which is a thorough summary of all the areas of physical therapy, set out in a way that is specific to the content of the NPTE. BenchPrep is particularly useful as it gives you a study guide, which tells you how much material you need to cover in a given timeframe in order to be ready for the exam, and enables you to connect to other students preparing for the exam to ask questions or form study groups. The PT Exam text I used was a little dated (2011), however the material is still relevant and the practice exams that come with it are very useful indicators of how you’re doing. The resources available are not limited to these and you should search for some that you feel are most appropriate to your needs.

  1. Do the practice exams

Find and complete as many practice exams as you possibly can. Not only is it useful to familiarise yourself with the exam situation, it will give you clear feedback as to where your strengths and weaknesses are, and enable you to adjust your study plan accordingly. Both BenchPrep and the PT Exam book have quizzes and practice exams, and FSBPT provides (for a fee) an online practice and assessment tool (PEAT) which very closely mirrors what you can expect from the actual exam. Practice exams enable you to get a feel for how questions will be worded, and practice interpreting the possible answers. Often, the answer that’s required is not a matter of separating right from wrong, but understanding which answer is the MOST correct based on the information you’re presented with. It takes practice to be able to understand this, particularly if you’re a current practitioner, as chances are you have developed your own ways of addressing the needs of patients, and this may not match to what the examiner is expecting.

  1. Seek support

Having good support structures in place is invaluable, both in terms of supporting your study and maintaining your sanity. Having family members, friends, loved ones who can support you during this incredibly stressful time can make all the difference to your mental and emotional health. A little understanding goes a long way, and it’s likely you will need plenty in the lead in to the exam.

Support from other people undertaking the exam is very useful as well. Being able to find discussion forums or study groups can greatly assist your preparation. This gives you the chance to check your understanding about different things, develop your judgement and reasoning, and ensure you are covering everything you need to know. In most groups you will find someone who knows the answer you’re looking for, or who will ask a question you haven’t thought of. It can also be useful to be able to relate to others who are going through the same experience you are.

  1. Find ‘you’ time

It can be very easy to narrow your focus to preparing for the exam, and let all other aspects of your life fall by the wayside in the process. Do this, and not only do you risk severely over-stressing yourself, you may cause damage to your health, your relationships, and other things that are important to you. This is where allowing ample time (see 1. above) becomes critical. You need to be able to step away from your study and preparation, if only to give yourself a chance to recharge and recuperate. Take a walk, go to the gym, play with the kids or catch a movie you’ve been wanting to see. There are no bonus points for spending all your time on studying – in fact, chances are by taking some ‘you’ time, you will return to your studies with a clearer mind and sharper focus.

According to FSBPT, only about 88% of US graduates, and 30% of non-US graduates, pass the NPTE the first time. Incorporating these tips into your study plan might just give you the edge on ensuring you are one of those who pass.

If you are preparing to take the NPTE, I wish you the best of luck for a successful outcome, and for your future career as a physical therapist.

Got some other tips for taking the NPTE? Please feel free to share in the comments section below.

Should Non-Indigenous Australians Be Proud of Indigenous Culture?

984a1b0af5d47f5f81d26ace274913bdAll this month, I’ve had the pleasure of both contributing to, and reading, some of the great blogs that have made up the Deadly Bloggers Blogging Carnival as part of Australia’s Blak History Month. While the blog articles themselves have been diverse and interesting, what struck me was the interaction and involvement through the various social media platforms. Particularly during NAIDOC week, I noticed a tremendous support from Aboriginal, Torres Strait Islander, and non-Indigenous peoples, liking, favouriting, and sharing my articles and articles both other Deadly Bloggers.

What I found especially exciting was the amount of involvement from non-Indigenous people, who were obviously reading, sharing, and enjoying post from Aboriginal and Torres Strait Islander bloggers. More than that, people wanted to spread these messages, to share Australia’s Indigenous identity, if you will, to the point where – for me at least – there seemed to be definite evidence of pride in Aboriginal and Torres Strait Islander peoples and culture. It got me thinking: why not? Why shouldn’t non-Indigenous Australians be proud of Aboriginal and Torres Strait Islander peoples and culture? Surely, that can only be a positive thing, right?

So I decided to see what the people thought by creating a simple survey titled, “Should non-Indigenous Australians be proud of Indigenous culture?”, and sent it out amongst the digital masses. The response was very interesting.

Over about three weeks I managed to get 83 respondents, of which 76 completed all the questions. The majority of respondents were non-Indigenous (64.5%), female (62%), and aged between 40 and 60 years of age (60.5%).

The first section attempted to determine the current perception of non-Indigenous Australian’s opinions towards Aboriginal and Torres Strait Islander cultures. Specifically, whether non-Indigenous Australians know about and are proud of Indigenous Australian cultures, and whether they consider this an important part of Australia’s identity. It should be noted that these questions were about the respondents perceptions of the greater Australian community, not their own personal perception.

From the responses obtained, it seems that in general people believe that non-Indigenous Australians neither know about (64% No vs. 19% Yes), nor are proud of (59% No vs. 19% Yes) Aboriginal and Torres Strait Islander cultures. Further, the respondents’ perception was that non-Indigenous Australians generally do not consider Aboriginal and Torres Strait Islander cultures an important part of Australia’s identity (51% No vs. 34% Yes). While this may not surprise many given Australia’s sociopolitical history and track record in Indigenous affairs, it becomes very interesting when considered in the context of the next question.

The second section consisted of one simple question, and the opportunity for respondents to explain their answer. The question: in your opinion, should non-Indigenous Australians be proud of Indigenous Australian culture?

An overwhelming 95% of respondents answered, ‘Yes’, while the remaining 5% answered ‘Don’t Know’.

This is a remarkable contrast. It seems people are saying that non-Indigenous Australians should be proud of Aboriginal and Torres Strait Islander cultures, even though they might not currently be, or perhaps know enough to be, and that it is important for Australia’s identity. This is further supported in many of the additional comments respondents made in answering this question.

In explaining why they thought non-Indigenous Australian’s should be proud of Aboriginal and Torres Strait Islander cultures, several common themes emerged from the ideas put forward. These included:

  • the richness, diversity, and spirituality of Aboriginal and Torres Strait Islander cultures;
  • the long history of Aboriginal and Torres Strait Islander peoples as the original inhabitants of this land Australia;
  • the connection and relationship Aboriginal and Torres Strait Islander peoples have to the land, including understanding of land management; and
  • the social values inherent in Aboriginal and Torres Strait Islander cultures, and how these could enhance the broader Australian society.

This is reflected in statements such as:

“Because Indigenous Australian’s are the traditional owners of the land and bring with them a unique culture. We could learn more as non Indigenous people especially with regard to kinship values, the importance of the land and spirituality”

“Yes – it is what is unique to Australia, something that differentiates us from the rest of the world; we have one of the longest living cultures in the world and we should be proud of it and cherish it whether we are Indigenous or not.”

“Indigenous culture is a valuable resource for all Australians. It is rich and diverse, it is enduring and adaptable. It speaks with the voice of our ancient past. Indigenous culture advises us on how to care for the natural world and for each other. The language, art, music, learning,rituals, rules and ways of living cans inform all our ways of living.”

Some supported the idea in principle, however argued that ‘pride’ may not be as appropriate a term as ‘respect’ is. For example:

“I have difficulty with the word “proud”. … I think non-Indigenous Australians should be RESPECTFUL of the Indigenous culture. I feel we have a responsibility to help Indigenous people to feel proud of who they are. We have a responsibility to raise awareness of injustice that exists in our country against Indigenous people. We have a responsibility to recognize the past wrongs and rectify the situation (such as closing the gap in health and education). I feel honoured to know so many inspiring and wonderful indigenous people but I don’t feel that I have a right to say I am proud of a culture that isn’t mine. I haven’t earned the right to feel proud. What I wish I could say is that I am proud to live in a country that values and recognises its Indigenous population. …” (emphasis is respondent’s own)

While I can neither claim my little survey to be the model of empirical research, nor the responses received to be representative of the entire Australian population, I do feel a clear message comes through from this exercise: Non-Indigenous Australians should be proud – or at the very least, respectful – of Aboriginal and Torres Strait Islander cultures. More than that, non-Indigenous Australians want to be proud of Aboriginal and Torres Strait Islander cultures.

The next question must be: what’s stopping them? What are the obstacles and barriers to non-Indigenous pride in Aboriginal and Torres Strait Islander cultures? Is it that Australians are victims of history – that the historical beliefs and attitudes towards Aboriginal and Torres Strait Islander peoples still persists, perhaps subconsciously, in the Australian psyche? Is it that we have inadequate leadership guiding us towards a society that values Aboriginal and Torres Strait Islander cultures? Could it even be that Aboriginal and Torres Strait Islander peoples ourselves have become so used to protecting and defending our cultural rights, responsibilities, and beliefs, that we are unable or unwilling to allow non-Indigenous Australians to be proud of us?

Perhaps when we can examine and address these questions, we will find ourselves moving towards a truly Reconciled Australia that not only recognises, but takes pride, in its Aboriginal and Torres Strait Islander peoples.

I would like to thank all those who participated in the survey for your responses. Anyone interested in viewing the raw data from the survey can find it here.

Do you think non-Indigenous Australians should be proud of Aboriginal and Torres Strait Islander cultures? What do you think needs to change in order for this to happen? Please feel free to share your thoughts in the comments section below.

This post appears as part of the Deadly Bloggers Inaugural Blogging Carnival, held during Australia’s Blak History Month. To read other posts from Aboriginal and Torres Strait Islander Bloggers, visit the Deadly Bloggers website.

Reconciling Australia: It Starts With Our First Nations

Partnerships-Full-Image

“Partnerships”

In the mid-90’s I had the privilege of attending an advanced cultural awareness workshop for staff of the (then) Department of Human Services and Health in Canberra, at which Aboriginal Elder Aunty Mary Graham was one of the main facilitators. Aunty Mary shared many gems of information over those days, however one of the main statements she made that has always stuck in my mind was this:

“Aboriginal people will never have their Martin Luther King [Jr.]”

It was a statement made as part of a discussion on the diversity of Aboriginal peoples aimed at broadening the participants’ understanding of Aboriginal Australia as a ‘nation of nations’ – a land where each Clan/Language group was as separate and distinct from each other as other countries of the world are. The overarching message was that the Government must recognise that attempts to engage in consultation or partnerships with Aboriginal peoples needed to be done at local (community) levels; that there was not – and never will be – ‘one person’ who could speak for or claim to represent all Aboriginal peoples.

In that sense, Aunty Mary’s statement is very true, and I appreciate and agree with it from that perspective. However, to my way of thinking, it’s also a sad statement, because in a broader context, it also suggests that Aboriginal peoples will never achieve unity amongst ourselves. When you consider the achievements of Dr Martin Luther King Jr., one of the main things he did was unify people. In leading the American Civil Rights Movement, Dr King not only provided a voice for African-Americans, he gave them a common cause to rally to, and in doing so, brought African-Americans (and in a broader sense, all Americans who believed in racial equality) together in the spirit of unity. As a result, Dr King is credited with achieving, “more genuine progress toward racial equality in America than the previous 350 years …” (The King Center).

Australia’s Aboriginal peoples may never have our Dr King, however, we do need to create that unity amongst our First Nations. There have been attempts, the latest of which has been the formation of the National Congress of Australia’s First Peoples (Congress). Congress was established under the premise of being a representative body for all Aboriginal and Torres Strait Islander peoples that could act as our national voice, particularly when dealing with Government. Congress states that as of January 2014 it has over 7,500 individual members from all over Australia – a considerable figure given it was only formally established in 2010. However, whether this can be considered sufficiently ‘representative’ (about 1%) of the almost 670,000 Aboriginal and Torres Strait Islander peoples living in Australia is subject to debate, as is Congress’ continued existence, given the Australian Government’s recent decision to discontinue its funding.

What isn’t debatable is the need for a unified voice that led to the formation of Congress in the first place. Aboriginal and Torres Strait Islander peoples still only make up approximately 3% of the total Australian population, giving us a relatively small voice in Australian affairs. Divide that by the number of First Nations (estimated at about 600 prior to European settlement), and the voices of individual Nations becomes even smaller. This would not necessarily be a problem if Aboriginal and Torres Strait Islander peoples enjoyed an equitable status in areas such as health, education, employment, and social justice, with non-Indigenous Australians. The fact that we don’t, and that the scales are tipped so far away from Aboriginal and Torres Strait Islander Australians, should be reason enough for us to unify and seek solutions to common problems.

Ironically, in my observation at least, it is these very inequities that steer us away from unity. There is conflict between and within nations, communities, and sometimes even families, over what needs to be done and who has the ‘right’ to make those decisions. We fight over who should or shouldn’t have access to services, who should or shouldn’t be able to speak for our peoples, even who should or shouldn’t be identified as Aboriginal. This is not to say that there aren’t real issues within nations and communities that require resolution, however, when you consider that many of these issues only exist because of the effects of both historical and current policies and practices that have been imposed upon us, you have to question whether much of our internal conflict stems from a continued – perhaps now self-imposed – ‘divide-and-conquer’ strategy. As an Aboriginal person, I find this highly distressing, divisive, and confusing. I can only imagine how it must appear to non-Indigenous peoples. How can we possibly expect to achieve Reconciliation within Australia, when we’re unable to achieve it amongst ourselves?

It is crucial that all First Nations be able to retain their individuality in their identity, their Law, their cultural practices and beliefs, and their ability to determine their own futures. However, if we are going to make changes and improvements for the betterment of our peoples, we need to unify to address common issues. We need to reconcile both within and between communities and nations, and present a united front – a united voice – to combat the injustices we face. We need to adopt the old adage of “strength in numbers”, because as a minority within our own land, we need all the numbers we can get!

And if we can reconcile amongst ourselves, we give ourselves a greater chance of achieving Reconciliation amongst all of Australia. We can achieve a lot with 670,000. Imagine what we could achieve with 22 million.


I would like to acknowledge and thank the Making Two Worlds Work project for permission to use the image, Partnerships, in this article.


This post appear[ed] as part of the Deadly Bloggers Inaugural Blogging Carnival, held during Australian Blak History Month. To read other posts from Aboriginal and Torres Strait Islander Bloggers, visit the Deadly Bloggers website.

Why Identify?

20140126_142430-1Happy NAIDOC week to all of you who celebrate it! NAIDOC week is a great week of celebration of Aboriginal and Torres Strait Islander peoples, our culture, and our achievements. For me, it’s always a time to not only celebrate my Aboriginality, but to reflect on what it means to me, what I’ve done to celebrate it within myself, and what I want to do to recognise and celebrate it as my life moves forward. This year, inspired by NAIDOC and the Deadly Bloggers Inaugural Blogging Carnival, as well as some personal experiences I’ve had over the last couple of years, I’ve decided to share with you my thoughts on two questions that I have been asked on numerous occasions, and often together: “Why do you identify as Aboriginal?” and “What do you get out of it?”

The second question is particularly interesting, as it suggests that there is still a perception within certain parts of the Australian community that the only reason anyone would identify as Aboriginal is to gain some sort of tangible benefit from it. This disappoints me for two main reasons: first, because while I mostly get asked this by non-Aboriginal people, it’s not uncommon for some Aboriginal people to challenge me with it as well; and second, because it indicates to me that when it comes to Aboriginal identity, there is still confusion and concern over the difference between Aboriginal ‘identity’ and Aboriginal ‘identification’.

It seems that some people still harbor a fear or resentment that calling yourself ‘Aboriginal’ will grant you some form of entitlement that their own biases don’t believe you should have. While there is no doubt there will always be those who will look for ways to abuse any system for their own benefit, to my way of thinking, questioning whether someone who identifies as Aboriginal does so only for personal gain is equivalent of questioning whether someone with a serious physical or mental disability only identifies as such to gain disability benefits. Yes, there may be abusers, but to question the motivations of everyone who identifies with any group is quite ludicrous. As another Aboriginal man said to me years ago, “why would anyone who wants some sort of advantage over others choose to identify with the group that has the poorest health, the poorest education, the poorest employment, and the worst racism? If I wanted an advantage, I’d choose to be white!”

However, the truth is I do gain from identifying as Aboriginal. What I gain from it is a greater sense of self. I do not identify as Aboriginal, so much as my Aboriginality gives me my identity. It tells me who and where I came from, and who and where I’m connected to. It helps to form my world view, and my place within that world. It influences the person I want to be, through my morals, my ethics, and my approach to life. That is not to say that it is separate from the other things that make up me – it is one of many pieces of my personal puzzle, which together provide the full picture that is me. It is as important in defining who I am as is being a man, or a father, or a healthcare professional, or any one of a number of the hats I wear. It gives me ME, and I would be incomplete without it. I would not know myself, and that is a terrible way to live one’s life.

So, why do I identify as Aboriginal?

Simple. That’s who I am.

And if you know who you are, and what gives you that sense of self, I have no doubt you will understand exactly what I mean.

What more reason could anyone need?

Is it Time to Say “Bye” to BMI?

bmi_flawedBody Mass Index, or BMI, has become somewhat of a catchphrase in a world of ever-increasing obesity. Doctors, dietitians, and personal trainers are just some of those who use your BMI to determine whether you are obese, or at risk of becoming obese. Even the tools we use for fitness – electronic scales, heart rate monitors, and even our smart phone apps – use BMI as a primary indicator of whether you are at your ‘ideal weight’. However, while everyone is busy calculating their BMI and worrying whether they’re outside the ‘golden range’, few seem to be asking what this number actually represents, and fewer still whether it actually has any validity.

What are we actually talking about?

Before trying to answer those questions, it’s important to define a few terms:

‘Weight’ – contrary to popular belief, your weight is not a measure of how fat you are. Your weight is a measure of the effect of gravity on your mass – that is, the resultant force that gravity is having on the total mass of matter that makes up you. Weight doesn’t care what this matter represents – fat, bone, muscle, fluid – it just tells you what gravity is doing to you. Because gravity is pretty much the same all over Earth, the only way to change your weight is to change your physical mass. By that reasoning it could be said that to be ‘overweight’ or ‘underweight’ means you either have too much or too little physical mass compared to an ideal value. However, in practice we do not define these terms in this way.

‘Overweight’ and ‘obesity’ are defined by the World Health Organisation (WHO) as, “abnormal or excessive fat accumulation that presents a risk to health.” Note that the thing that is being measured or compared in this definition is the amount of fat that makes up an individuals body composition. Therefore, to determine whether a person has an abnormal or excessive accumulation of fat, it stands to reason you need to know the amount of fat that makes up a person’s mass. WHO further defines obesity as a percentage of body fat equivalent to 25% total body weight for men, and 35% for women.

‘Underweight’ interestingly enough, is most often defined by a person’s BMI, which is discussed below.

‘BMI’ – again, contrary to popular belief, BMI is a mathematical calculation, not a measurement. BMI is calculated by dividing your weight (in kg) by the square of your height (in meters). So for example, a person weighing 70kgs at a height of 1.75m would have a BMI of: 70kg / (1.75m x 1.75m) = 22.86 kg/m2.

So what’s the problem with BMI?

Well, there are several problems which continue to be debated within the literature today, including concerns around its validity in reference to specific populations and its use as a diagnostic tool (which, by the admittance of its inventor, Belgian mathematician Lambert Adolphe Jacques Quetelet, it was never intended for). However the most glaring one should be obvious from these definitions. BMI tells us about the relationship between the height and weight of an individual, however it does not – in fact, it cannot – tell us anything about the composition of that individual’s body. Specifically, it does not – cannot – tell us anything about the fat composition of that individual’s body.

This in itself would not be a concern, if not for the fact that BMI is frequently used to categorise people as being underweight, overweight, or obese. The fact is, BMI cannot make this categorisation because it does not measure fat composition. At worst, it runs the risk of generating false positives and false negatives when attempting to categorise people based on a comparison of height and weight. This can be illustrated with a simple example using a muscular athlete, such as a competitive body-builder.

Jay-Cutler-From-2009-IFBB-Olympia

Photo courtesy HealthyCeleb.com

Meet Jay (Jason) Cutler, a four-time Mr Olympia winner from the United States. Jay is 5’9″ (1.75m) and at competition weight approximately 274 pounds (124kg). Based on his height and weight, Jay’s BMI is 40.49 kg/m2, which accordingly to WHO classification, puts him in the morbidly obese category. Looking at Jay at the 2009 Mr Olympia competition, you would be hard pressed to call this man “morbidly obese.” Why is his BMI so high? Simply because muscle has a higher density (approximately 18% greater) than fat, so for the same volume of tissue, muscle weighs more than fat. As such, Jay’s BMI is clearly a false positive result. (For interest, Jay’s weight outside of competition has been recorded at 310 pounds (140kg), which would place him in the super obese category!)

The problem of density differences between muscle and fat can also give false negative results as well. Consider someone with a low proportion of muscle mass (eg: sedentary-lifestyle) or whose muscle mass is reducing over time (eg: elderly, or active person becoming inactive). It is quite possible that this person will record a BMI that would be considered ‘normal’, yet physiologically have a body fat percentage higher than that considered ‘healthy’ by the WHO. This has been demonstrated in a number of scientific studies by comparing BMI with more accurate body composition recording techniques, such as dual energy x-ray absorptiometry (DXA or DEXA), including one study where approximately 1 in 4 men and 1 in 2 women were incorrectly classified by BMI [1]. Can these error rates be considered acceptable when screening for risks to people’s health?

So why do we use it?

Despite its problems, BMI’s simplicity is the main reason why it continues to be used. It’s quick, cheap, and easy to do. If you have the ability to measure a person’s height and weight, and basic math skills, you can categorise someone as being within a ‘healthy’ weight range, or not. Apparent anomalies are often dismissed through subjective observation by the assessor. “No, Jay, of course you’re not obese,” is what we would expect Jay Cutler’s doctor to advise him, for example. Though in light of the incidence of false negatives BMI produces, it could be argued we should be questioning whether such subjective opinions are valid, or even putting individuals at risk of being miss- or undiagnosed.

Critics of BMI have cited more potentially malicious reasons why the use of BMI persists. For example, some health insurance companies adjust their customer’s premiums based on their BMI – the higher your BMI, the more you pay – because they are considered to be at higher risk for developing problems with their health. Is this fair for the professional athlete, a person considered to be at peak physical fitness, and therefore healthy compared to the rest of the population? What about the 29 million Americans who suddenly “became fat” in 1998 when the U.S. National Institutes of Health and the Center for Disease Control (CDC) lowered the U.S. cutoff for ‘normal’ BMI from 27.8 to 25 [2]?

What’s the alternative?

There are many different ways body composition can be measured. In relation to body fat, hydrostatic weighing (weighing underwater) and whole-body air displacement plethysmography (ADP) are considered the gold standards of getting an accurate value. DXA or DEXA is also highly regarded, though primarily used in research. However, these procedures require specialised equipment and operators, and in some cases can be quite expensive to undertake.

Bioelectrical impedance analysis (BIA) is a cheaper alternative which is gaining popularity, particularly as an ‘in-home’ means of determining body composition through the use of body composition analysis scales. BIA has been demonstrated to be useful for predicting the body fat composition of groups, however shows poorer accuracy for individuals, likely due to the fact that readings can vary depending on an individual’s level of hydration (or dehydration) [3].

Skinfold calipers are another inexpensive and time-honoured method of determining body fat percentage, and chances are if you’ve been involved in college/university level sports, or been part of a sports institute, you’ve felt the skinfold pinch. There has been much ongoing debate in the scientific literature about the accuracy and usefulness of skinfold measurements in determining body fat, with issues such as inter- and intra-tester reliability (ie: whether the same person or different people can produce the same results with each test), the sites used, the methods of calculation, and again, the hydration level of the subject, identified as potential problems. At best, it seems skinfold measurements are accurate at determining body fat percentage on lean athletes, but less so for those with excess body fat or loose connective tissue (ie: the elderly) [4].

In the last two decades, waist circumference measurement has been increasingly used as a screening tool for assessing individual’s risk of developing diseases associated with excess body fat, such as diabetes and cardiovascular disease. Like BMI it is quick, easy, and inexpensive to administer, requiring only a tape measure. Current Australian guidelines state that waist measurements above 94cm for adult males and 80cm for adult females are indicator of excessive internal fat deposits, and increase the risk of chronic disease. Waist circumference has been demonstrated to be a good predictor of visceral fat (fat around the organs) [5] and a better predictor of risk of cardiovascular disease [4,5,6], type II diabetes [4,5], and metabolic syndrome [5] than BMI.

Is it time to say “bye” to BMI?

It is apparent that BMI tells us nothing about the composition of the body, and that there are problems with its use as an indicator of diseases such as obesity, and with its accuracy at identifying individuals who may be at risk of further health complications based on their body composition. It’s also apparent that there are more accurate ways of determining body composition, and these may be better indicators for people’s risk of developing diseases related to unhealthy levels of body fat [4]. Is it therefore time we stopped using BMI?

It’s not a simple question to answer. BMI still has potential in screening people who are underweight compared to a normal population, and flag the need for further examination, to determine if they may be suffering from diseases such as malnutrition or anorexia. However, while BMI can determine whether an individual is ‘overweight’ compared to a normal population, it cannot give any indication as to why that is the case. Therefore it would seem justifiable that BMI should no longer be used as a means of categorising people as being ‘obese’, as it cannot indicate what the body composition of an individual is.

Further, given that other methods of body composition analysis are better predictors of the risk of disease and other complications associated with unhealthy levels of body fat, it seems justifiable to suggest that BMI should be the least favoured tool utilised by clinicians and individuals. This is particularly true where other methods, such as waist circumference measurement, have been demonstrated to be more reliable indicators of risk of associated health problems, such as cardiovascular disease, and are just as quick, easy and cost-effective to administer as BMI.

Why, then, should we continue to use BMI?

Do you know your BMI? Do you agree with the category it places you in? Would you rather know your BMI, or your Body Fat Percentage, in terms of making decisions about your own health? Please feel free to share your thoughts in the comments section below.

References

1. Shah, N. R. and Braverman, E. R. (2012). Measuring adiposity in patients: the utility of Body Mass Index (BMI), percent body fat, and leptin. PLoSOne. 7(4): e33308 1-8.
2. Cohen, E. and McDermott, A. (1998). Who’s fat? New definition adopted. CNN: 17 June 1998. Retrieved 26 June 2014 at: http://edition.cnn.com/HEALTH/9806/17/weight.guidelines/
3. Houtkooper, L. B. et al. (1996). Why bioelectrical impedence analysis should be used for estimating adiposity. American Journal of Clinical Nutrition. 64(suppl.): 436S-448S.
4. Wagner, D. R. and Heyward, V. H. (1999). Techniques of body composition assessment: a review of laboratory and field methods. Research Quarterly for Exercise and Sport. 70(2): 135-149.
5. National Health and Medical Research Council (2013). Clinical practice guidelines for the management of overweight and obesity in adults, adolescents and children in Australia. Melbourne: National Health and Medical Research Council.
6. Siavash, M. et al. (2008). Comparison of Body Mass Index and Weight/Height Ratio in predicting definite coronary artery disease. Annals of Nutrition and Metabolism. 53: 162 – 166.

If You Want to Learn, Teach

TeachYou may have come across a version of George Bernard Shaw’s original quote, “He who can, does. He who cannot, teaches.” It was originally intended as a criticism of the teaching profession as a whole, however today it is more often used as a derogatory observation of a person’s actual skill or proficiency, the implication being they have chosen to teach something because they are not good enough to be successful at actually doing it. Of all the reasons someone may decide to teach something, this is perhaps the most misguided and nonsensical. The ability to teach – to convey knowledge, impart experience, demonstrate a skill and guide another’s growth – is invaluable: our world, our species, would not be as developed as it is today without those who have chosen to teach others. While it is easy to understand this in terms of the student learning from the teacher, one way that I’ve discovered and come to appreciate the importance of teaching is the amount of learning that the teacher gets from the student.

I’ve become a teacher in a variety of roles. As a physiotherapist, I teach people ways to maximise their functional abilities and avoid injuries. As a guest lecturer and non-fiction writer, I teach students about engaging with Aboriginal and Torres Strait Islander peoples using the principles of cultural safety. In martial arts I’ve taught people forms and self-defence. Even as a father, a friend, a mentor, or a blogger, I ‘teach’ others by sharing my knowledge, understanding, ideas, experience and skills. Over the years I’ve developed a strong affinity for teaching, much of which stems from how teaching advances my development. When I teach, I’m every bit as much a student as those who I’m teaching. I learn something from every teaching experience I undertake, and so I develop my own abilities further. For me, there are three main ways this occurs:

1. Teaching Tests What I Know

I know how to perform safe manual handling, how to engage with someone whilst being culturally sensitive, and how to perform a Tai Chi or Qigong set. I feel confident saying I know how to do these things, because if asked to do them, I know I can. Teaching someone else how to do them, however, takes me beyond simply knowing how to do something. It tests whether I really understand what it is I’m doing, and it does this with a simple, single word question: why?

‘Why?’ is a fantastic question, however it’s one we tend to stop asking ourselves once we think we know something. The moment a student asks you ‘why’, you immediately discover your own level of knowledge and understanding about something. This is reflected in your ability to provide a meaningful answer. It does not mean you must have an answer; in fact, as intimidating as it might sound, it can actually be a very positive thing if you don’t, because it enables you to recognise your own limitations, and offers you an opportunity to develop yourself further. When I first started teaching, I dreaded being asked questions – especially, “why?” – because I lacked confidence in my ability to answer them. Now I relish them. I seek them out and encourage people to ask me questions, because it’s a great way to check what I know, and perhaps more importantly, what I don’t know. It both enables me to expand my understanding (see 2.) and identifies opportunities for me to learn more (see 3.)

2. Teaching Expands My Understanding

One of the great things about teaching something is that students will always think of something you haven’t thought of. This usually presents itself in the form of a question that you weren’t expecting, and commonly starts with, “why does…”, “what if…”, or “how can…”. Often they will come from a perspective that I had not previously considered. This is of tremendous benefit as it requires me to think outside of my own box, and expand my own viewpoint. It gives me a new way to apply my knowledge or skill, and tests whether my ability is at a level where I can do this successfully (see 1.), or whether I need to learn more in order to be able to do so (see 3.) Either way, my understanding expands, and my development continues.

3. Teaching Encourages My Learning

There is a saying, “you don’t know what you don’t know”, and this becomes quite apparent when you try to teach something (see 1.). When I first started teaching, I felt that as a teacher, I needed to know everything about whatever it was I was trying to teach. This was both positive and negative: it encouraged me to learn more about the things I was going to teach, but it also made me anxious about whether I knew enough to be able to teach. Over time, I’ve learned that it’s okay not to know things, and that when it comes down to it, I can’t always know what I don’t know. However, revealing the limitations in my knowledge and understanding gives me the opportunity to learn and improve myself. In many ways, it actually directs my learning more efficiently than simply trying to learn everything about something could ever do. This is because it allows me to take what I already know, and then selectively seek out what I would like to know in order to increase my understanding of something. In this way, teaching enables me to identify gaps in my knowledge or understanding in ways that other strategies, like self-reflection, for example, could never do. In this way, teaching and learning become an endless cycle: the more I learn, the better my ability to teach becomes; the more I teach, the better I can identify opportunities to learn more; and round and round it goes.

Whatever your field of interest, if you want to improve your knowledge, understanding, and ability, I encourage you to try teaching it to others. Develop a course, present a seminar, start an online discussion, or just try to explain it to someone else. You might be amazed at what you learn from it.

Do you teach something? What do you get from teaching? How do you find it benefits you? Please feel free to add your thoughts to the comments below.

Why Preventative Health is More Important Than Ever

appleWith the announced changes to Australia’s healthcare system in last night’s Budget, the affordability of quality health and medical services has become an even greater concern for the average Australian. The impact upon those who already utilise services such as Medicare and the Pharmaceutical Benefits Scheme (PBS) is expected to be significant, with great concerns many will no longer attend primary health care or purchase essential medications as a result of new and increased co-payment systems. It is not a good time to get sick in Australia.

Many healthcare professionals have long advocated for people to undertake preventative health measures. There is a wealth of research showing evidence that preventative health strategies decrease the burden of illness and disease in individuals, families, and the broader community. You can liken it to running a car: most car owners have their vehicle routinely serviced to check everything is running well and identify potential problems. Early identification of problems gives an opportunity for the owner to address the issue before it becomes a major problem. Addressing the issue early not only reduces the likelihood of averting a catastrophic event in relation to the car – like a breakdown, or an accident – but also all the events that follow on as a result: expenses in relation to towing and repair, potential loss of income if reliant on it for work, inability to attend to activities due to lack of transport, potential increase in insurance premiums (in the case of an accident), and so on. Most car owners don’t think twice about undertaking preventative maintenance of their vehicle. Why then do so many of us not engage in preventative care of our health? Aren’t we more important than a car?

In its 2013 report, The Australian National Preventative Health Agency (ANPHA) reported that Australia is a world leader in preventative health practice, however we face ever-increasing problems in non-communicable – and preventable – diseases, such as obesity. The indication is that the tools are available – policy, programs and promotion – however the uptake by the Australian public seems to be lacking. There can be numerous reasons across a variety of socioeconomic factors for this, however there is one thing that remains consistent: it is up to each individual to take ownership and control of their own health, and make the decision to engage in preventative health measures.

With the costs associated with doctor’s visits and medications to rise from 2015, and expected increases to other health and medical services, including health insurance premiums, as a flow-on effect of the Budget, now is the time to make the decision to look after your health, and do your best to prevent future illness. Here’s three tips that can help you engage in preventative health:

  1. Take an Honest Look at Your Health

Sit down and ask yourself honestly, “am I as healthy as I can be?” It can be a tough question to answer, particularly if you feel well. We often believe that if we don’t feel unwell, we’re healthy, and therefore there’s no reason to change anything. Yet if you’re really honest with yourself, you will likely think of things that might not make you feel sick (yet), but that you know could put your health at risk. For example:

Sometimes it can be difficult to really take a critical look at your own health, and there might be benefit asking the opinion of someone you’re close to and trust. They may identify issues that you haven’t considered or aren’t aware of.

  1. Have a Check-Up

There is nothing wrong with going to see a doctor (or other healthcare professional) when you are well. In fact, you’ll probably find they’re happily surprised! Having a regular check-up is just like regularly servicing your car; it’s an opportunity to make sure everything is working the way it should, or if not, identify and manage potential problems. Knowing that everything is okay can be just as useful as knowing what’s wrong.

  1. Engage in Preventative Behaviours

Even without seeing a healthcare professional, most of us know that eating healthy foods, exercising regularly, stopping smoking, drinking in moderation, and reducing stress will have a positive effect on our health. If you try tips one and two above, you’ll most likely discover other ways you can maximise your health, and reduce your risk of illness or injury. However, knowing what to do isn’t enough: you need to do it, and the only person who can make you do that, is you. You need to take ownership of your health, decide what level of health you want to achieve and maintain, and take action to make your optimal level of health a reality. You do not have to do this alone, your healthcare professionals can provide advice, assistance, and education on what you can do to maximise your health and prevent future problems. The help you need is out there and available; the decision to do it is yours.

Do you engage in preventative health measures? If so, what do you find most helpful or works well for you? If not, what do you think is stopping you? Please feel free to add your comments below.

You Really Can Write Everyday: My 4 Tips

iStock_book_typewriter_writingIf you’ve ever tried to be a writer, at some point you will no doubt have come across the sagely advice that to become a good writer, you must write every single day. There is certainly truth to this: writing is a skill, and like any skill, the more you do it, the better you will become. However, unless you live in total isolation and are completely self-sufficient, how can you possibly write every day? Surely, this is an unachievable ideal; a brass ring to reach for that forever remains beyond you grasp. Who but an already well-established professional author has the freedom to be able to write every day?

I have to admit, that’s how I used to think. I thought being able to write every day was a fantasy, a dream, a form of motivation, at best, but not something that could actually be achieved. Not with the demands of my life. For me, finding time to write was a luxury, and one that I seldom had opportunity to indulge in. I wrote when I could, and those times could be few and far between. Writing every day was an impossibility at best, and I dismissed those who claimed to write every day as either being in unique positions in their life where they had minimal other commitments, or engaged in spreading falsehoods.

Then, through my muse, I found reason to try it for myself. Without even realising the significance of what I was doing, I wrote every day. Just a little bit, more often than not, but consistently, every day, for about three weeks. By the end of it I had about 14,000 words on-screen. The most I’ve ever written for a single piece.

It was, in many ways, a revelation. There was no denying it. No way to rationalise my past ‘inability’ to be able to do it. I’d just written every day and produced my largest piece of work to date. Not only that; I’d done it with relative ease. How? Well, when I thought about I found four key things that made this possible for me:

1. Give Yourself a Big Purpose

You would think that wanting to write a novel, or even a short story, would be purpose enough. My motivation to write, apart from the enjoyment I get from the process itself, is to be read. I want people to read and enjoy my writing. That is a great purpose, however, until now it obviously hasn’t been enough to spur me into writing on a daily basis. Perhaps because the desire to write competed with my belief I could not do it every day? Who knows?

When I undertook the task of writing every day, the ‘every day’ part was not my main motivation, at least not directly. My main motivation was to try to help someone, to try to give them something to look forward at a time when they really needed it. My purpose was bigger than story writing – it was about creating something positive in someone’s life, and that was big enough to drive me beyond my self-imposed limitations.

Your purpose does not need to be as profound as mine. However, it needs to be big enough that it will not just motivate, but drive you towards your goals. It needs to be important enough to become a high priority for you. Writing a short story or novel might be all the purpose you need. If not, you might need a bigger purpose. Perhaps you want to make a loved one proud, or be an example to your children, or maybe what you’ve got to share is time critical – it needs to be out there right now.You don’t need to become obsessive about it – it just needs to be desirable enough that you find yourself not just wanting, but needing, to pursue it.

2. Set Realistic Goals

On reflection, I think one of the things that has subconsciously demotivated my desire to write every day is seeing other writers boast about being able to write two-, three-, even four-thousand or more words a day. On my best day it still takes me a considerable amount of time to be able to get to those sorts of levels. And at this stage of my life, there’s no way that can be achieved on a daily basis.

What I realised, though, is that there’s no rule that says to write every day you must meet a minimum word count. You could write a hundred words a day – say, a medium to large paragraph – and in three to six weeks you’ll have a decent length short story. When you are writing regularly, how much you write in a sitting becomes irrelevant. What matters is that you are writing regularly – that is what will get you from start to finish.

Having said that, having some sort of goal is a great motivator, and ensures you will make a minimum amount of progress with each sitting. The key is to make your goal realistic, and achievable – you should be able to hit your goal every time. For example, for my last piece of writing, I set myself a goal of a minimum of 421 words every time I sat down to write. I chose this number for two reasons: first, because on a personal level it has significance to me, and second, because I knew that I could hit this number every time I sat down to write. In practice, I often wrote more than that, sometimes significantly more, which was great. But as long as I wrote at least 421 words, I was satisfied that I’d achieved my goal for that sitting.

And therein lies the reason for setting a realistic and achievable goal: success. Success can be its own motivation. The more you succeed at achieving your goal, the more you will be motivated to achieve them again and again. Had I set my goal at, say, a thousand words, I would have struggled to achieve this, and the times I didn’t would have been demoralising, which is highly counter-productive. Having a realistic goal ensured positive feedback and continuous motivation to keep achieving.

3, Don’t Commit to Writing Every Day

Sounds like I just contradicted myself, doesn’t it? How can you possibly write every day if you don’t commit to writing every day? Believe me, it does work, and it follows the above tip on setting realistic goals.

When I set out to write regularly, I knew it was pointless trying to commit to writing every day. I knew that because, inevitably, something would likely come up that would prevent me from writing every single day. So instead of committing to writing every day, I committed to planning to write every day, with the caveat that if for whatever reason I could not, that was okay. It was not the end of the world – I could just pick it up again when the next opportunity presented itself.

In committing to a plan to write every day, but allowing for the possibility that I may not be able to, and the flexibility to work around that, I removed the pressure that trying to meet a commitment to write every day would have imposed. I removed the guilt and the sense of defeat associated with not being able to meet a commitment of writing every day. I removed the sense of urgency and frustration that goes with trying to find the time to write everyday. As a result, a strange thing happened: I wrote every day.

This is where the irony comes in. By having the desire, but not the commitment, to write every day, I actually found more opportunities – or perhaps, created more opportunities would be more accurate – to write on a daily basis. In this plan, I could only succeed. If I managed to write every day, that was fantastic. If not, that was just fine as well. There was no down side, and I believe because of that, because the whole process was positive, it motivated me at a higher level, consistently, than I have previously achieved. Writing became something I wanted to do, rather than something I had to do, and for me, that is a critical distinction.

4. Share Your Progress

In my experience, success is much more rewarding when you can share it with others. The support and inspiration that comes with shared success can boost your motivation and drive significantly, particularly when it comes from those whose opinions or approval mean something to you. I was fortunate enough to have almost daily feedback on my successes, and every time I did it fired me up and made me want to achieve even more. It has since inspired me to seek out feedback for larger projects. For example, I have introduced a meter to indicate my progress towards writing my first novel on my writing website, as a means of showing fans and followers my progress, and seeking their support and encouragement. If you’re achieving your goals, you have every reason to celebrate that, and sharing that experience with others will help give your motivation a huge boost.

This is what worked for me. What’s worked for you? What ways have you found to help you work towards your writing goals? Still looking for some? Try my tips and let all of us know how the helped you. Please feel free to share your thoughts in the comments below.