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  09:50:32 am, by MedBen5   , 177 words,  
Categories: Wellness, Health Plan Management

A Physician States His Case For Rationing Health Care

“PalMD”, an internal medicine physician, explains “Why I want to ration your health care“:

“In the U.S. we practice medicine with complete irrationality. There are thousands of lives that can be saved by simple practices that so many of us ignore. There are thousands more that can be saved by the proper use of medications.

“And yet we continue to pour money into a fantasy. We believe that a 95 year old with cancer just might be the one to survive the ICU, with just one more day on the ventilator, just one more round of dialysis. We believe that our own patient with pancreatic cancer might be the one who feels better on Gemzar. We believe we can cure our obesity-related disorders without exercise, without medicine, and without society-level interventions (it worked with smoking).

“The American medical system is an irrational fantasy, one in which we swoop down and cure one person’s problem at a time, forgetting that the system as a whole is making us all sick and broke.”


  09:35:37 am, by MedBen5   , 198 words,  
Categories: News, Prescription

Some Drugs Found To Be Effective Long Past Expiration Dates

Could extending the shelf life of prescription drugs help to lower health care costs?

According to Reuters Health, Lee Cantrell – director of the California Poison Control System, San Diego Division, and a professor of clinical pharmacy at University of California, San Francisco – and his colleagues analyzed 14 boxed drugs that had expired 28 to 40 years earlier, and found that 12 still met government requirements for potency.

The boxed drugs included the narcotic painkillers hydrocodone and codeine as well as the sedative pentobarbital and butalbital. Aspirin and amphetamine were the only two drugs that appeared to have degraded to less than 90% of their declared amount, the minimal accepted by the U.S. Food and Drug Administration.

Canterill figures that an “enormous amount” of drugs are thrown out because they’re too old. But expiration dates – typically ranging between one and five years of production – are arbitrarily set by the manufacturer, because the FDA doesn’t require them to determine how long the medicine retain its potency.

“If manufacturers were required to do longer-term stability tests, it could be an enormous cost-saver for consumers,” Canterill said, adding that it could also “be an answer to some of the world’s drug shortages.”


  05:17:44 pm, by MedBen5   , 188 words,  
Categories: News, Health Plan Management

Analysis: Small Businesses Will Benefit From Reform, But Mid-Size Firms Will Pay More

Medium-sized businesses will take the biggest hit in the wallet from the health care reform law, according to a new analysis from the Urban Institute.

The Hill reports that employers who have between 101 and 1,000 workers would have seen a 9.5% jump in their total health care costs if the Affordable Care Act had been fully in place this year. (Many of the law’s key provisions don’t take effect until 2014.) In contrast, small businesses would have seen a 1.4% decrease in costs, while companies with over 1,000 employers would have seen a 4.3% increase.

“Overall, the evidence simply does not support critics’ arguments that the ACA will burden employers and undermine employer-sponsored health insurance,” the paper says. “On the contrary, except for a cost increase to mid-size employers due largely to enrollment increases, the ACA benefits rather than burdens small employers who want to provide health insurance.”

The frequently-cited concern that businesses will drop their health care coverage as more reforms are implemented wasn’t borne out by the analysis. Overall, about 4 million more employees would have had health care coverage if the ACA had been in place this year, the Urban Institute found.

  04:12:54 pm, by MedBen5   , 298 words,  
Categories: Wellness, Health Plan Management

Five Steps To Safer Medical Care

Marty Makary, a surgeon at Johns Hopkins Hospital, believes that doctors and hospitals should be held more accountable for their mistakes. In The Wall Street Journal, he lists five “relatively simple – but crucial – reforms” the health care system can make to bring such errors to light:

Online Dashboards. “Every hospital should have an online informational ‘dashboard’ that includes its rates for infection, readmission (what we call ‘bounce back), surgical complications and ‘never event’ errors (mistakes that should never occur, like leaving a surgical sponge inside a patient).”

Safety Culture Scores. ” …[M]y colleagues and I at Johns Hopkins […] administered an anonymous survey of doctors, nurses, technicians and other employees at 60 U.S. hospitals. We found that at one-third of them, most employees believed the teamwork was bad. These aren’t hospitals where you or I want to receive care or see our family members receive care. At other hospitals, by contrast, an impressive 99% of the staff reported good teamwork.”

Cameras. “Reviewing tapes of cardiac catheterizations, arthroscopic surgery and other procedures could be used for peer-based quality improvement. Video would also serve as a more substantive record for future doctors.”

Open Notes. “Harvard doctor-researchers Jan Walker and Tom Delbanco are using ‘open notes’ at Harvard and Beth Israel Hospital in Boston, and my hometown hospital, Geisinger Medical Center in Pennsylvania, has begun giving patients online access to their doctors’ notes. So far, both patients and doctors love it.”

No More Gagging. “We need more open dialogue about medical mistakes, not less. It wouldn’t be going too far to suggest that these types of gag orders should be banned by law. They are utterly contrary to a patient’s right to know and to the concept of learning from our errors.”

Read Dr. Makary’s complete comments at the WSJ website.


  12:43:42 pm, by MedBen5   , 154 words,  
Categories: News, Health Plan Management

CDHPs Demonstrate Continued Popularity

According to the 2012 Annual Survey of Employer Health Benefits by the Kaiser Family Foundation (and as reported by John Goodman’s Health Policy Blog), nearly one-third of businesses that provide health coverage offer a consumer-driven health plan option. Cuurently, about one in five covered workers are enrolled in an CDHP.

The continuing popularity of CHDPs is no mystery. CDHPs offer workable solutions that provide adequate employee coverage while keeping budgets tight and the business cost-competitive.

MedBen Specialty Services remains on the cutting edge of the CDHP movement by offering a complete product line for the self-funded, split-funded and fully insured employer. By properly integrating a CDHP into the health care plan, a business can address the employee’s desire for choice along with the employer’s need for savings.

MedBen has developed a series of CDHP solutions with demonstrated employer savings. To learn more, contact Vice President of Sales & Marketing Brian Fargus at (888) 627-8683.

  10:58:16 am, by MedBen5   , 192 words,  
Categories: News, Wellness

Tanning Beds Linked To 5% Of Non-Melanoma Skin Cancers

An analysis of skin cancer patients revealed that the use of tanning beds significantly increases one’s risk of developing the disease, USA Today reports.

Indoor tanners are 67% more likely to develop squamous-cell carcinomas – a non-melanoma cancer – compared with those who have never tanned indoors, says Eleni Linos, an assistant professor of dermatology at the University of California-San Francisco and senior author of the study. Additionally, people who who have ever used indoor tanning are 29% more likely to develop the less severe basal-cell carcinomas than those who have never used tanning salons.

The findings of the analysis indicate that indoor tanning is responsible for about 5% of non-melanoma skin cancers, the most commonly diagnosed cancers in the USA, says Thomas Glynn, director of cancer science and trends at the American Cancer Society. Those who started tanning indoors before age 25 had the highest skin cancer risk.

The analysis included 12 studies involving 80,000 people in six countries.

Non-melanoma skin cancers strike about one in five Americans during their lifetime, including 30% of whites, Linos says. While usually not life-threatening, having the disease increases the likelihood that you will get it again, even if it is removed.

  10:15:06 am, by MedBen5   , 153 words,  
Categories: News, Prescription

FDA Withdraws Approval Of Generic Antidepressant

According to WebMD, the Food and Drug Administration has announced that a generic version of the extended-relief antidepressant Wellbutrin XL doesn’t work correctly, and as such, has withdrawn its approval.

Budeprion XL 150-mg tablets were approved by the FDA in 2009 as an effective generic equivalent to the brand-name Wellbutrin XL. But comprehensive agency testing of a higher-dose (300-mg tablet) version of the drug – which didn’t begin until 2010 and was completed just weeks ago – determined that it dumped too much active ingredient too soon and failed to maintain effective drug levels.

Drug manaufacturer Teva Pharmaceutical has recalled the 300-mg version of Budeprion XL, while the lower-dose version remains on the market.

Four other companies make generic, extended-release versions of Wellbutrin XL 300 mg: Anchen, Watson, Actavis, and Mylan. The FDA has asked these manufacturers to test the drugs at full dose to ensure that they are truly equivalent to the brand name version.


  05:04:43 pm, by MedBen5   , 248 words,  
Categories: Announcements

MedBen Closing Early On October 5; Online Services Available

On Friday, October 5, MedBen will be closing at 12:00 p.m. EST for a companywide recognition banquet. We will reopen on Monday, October 8 at 8:00 a.m. EST.

Although our customer service department will be closed early that day, you can still get answers to many of your questions online. Our MedBen Access website offers 24/7 claims and benefits information for your medical and dental plans. Simply go to, select “Online Client Services”, and click on “MedBen Access". For those who use Pharmacy Data Management (PDM) as their pharmacy benefits manager, you can check on prescription claims and find lower cost drug options through MedBen Access by clicking on your name under “My Rx Claims” in the sidebar menu.

If you’re a MedBen Flexible Spending Account (FSA) or Health Reimbursement Arrangement (HRA) participant in addition to having other coverage, you also can now use MedBen Access to see your FSA/HRA balances, claims submissions and payments. When you log in to MedBen Access, you’ll find an “FSA/HRA Online Inquiry” option (visible only to groups offering MedBen FSAs/HRAs) under the “My Plan” section located on the left sidebar. By selecting this option, users are automatically taken to the MedBen FSA/HRA Online System.

Plan members who wish to log in directly to the MedBen FSA/HRA Online System can do so by going to the Online Client Services area of and selecting “FSA/HRA Employee Online System". Login requires a separate User ID and PIN.


  06:29:29 pm, by MedBen5   , 199 words,  
Categories: News, Prescription, Health Plan Management

MedBen University: Zaenger Spotlights Specialty Drug Problem

Allan Zaenger, President of Pharmaceutical Horizons

Allan Zaenger, President of Pharmaceutical Horizons, discussed “The Specialty Drug Dilemma” at a recent MedBen University.

As Zaenger explained, even though generic dispensing has helped to keep price increases in check, the combination of high-priced specialty drugs, niche disease marketing and manufacturing incentives designed to circumvent traditional cost controls in prescription drug plans make it more difficult to control costs.

Zaenger emphasized that employers should encourage their prescription plan members to play an active role in buying drugs responsibly. In self-funding prescription benefits, plan sponsors have the advantage of controlling what the member pays through set copayments and deductibles.

One strategy Zaenger suggested is to require members to pay the difference whenever a generic alternative to a brand medicine is available and a brand is dispensed – even if there is a “dispense as written” or “DAW” required by the physician or member.

Zaenger also noted the popularity of manufacturer copay discount cards for brand-name drugs that have generic alterntives available. To control this issue, he recommended that plan sponsors adopt a 4th Tier member copayment equal to 100% of the allowed total claim charge – the full cost of the claim.

For additional information about MedBen University, visit

  05:09:33 pm, by MedBen5   , 204 words,  
Categories: News, Wellness

Taking More Vitamin D Doesn't Prevent Colds, Study Says

Taking an extra vitamin D supplement to keep colds at bay? Research from New Zealand suggests it may not benefit you much.

Reuters Health reports that the study randomly assigned two groups of adults to receive either a monthly dose of vitamin D – starting at 200,000 international units for the first two months, then dropping to 100,000 IU – or to get a placebo. Over the next year, the difference between the two groups in the average number of colds and other respiratory infections they caught was statistically insignificant – 3.7 for the vitamin D group compared to 3.8 in placebo group.

The researchers did note that the particpants were generally healthy to begin with, so they couldn’t say for certain that vitamin D wouldn’t help kids or adults deficient in the vitamin. But “In the population we studied, we can be very confident that it has no effect on prevention or severity (of colds),” said lead author Dr. David Murdoch, from the University of Otago in Christchurch.

“If you have a good diet and definitely if you’re taking vitamin D, taking more is not going to help,” added Dr. Jeffrey Linder from Brigham and Women’s Hospital in Boston, who wrote a commentary accompanying the new study.


  05:19:50 pm, by MedBen5   , 261 words,  
Categories: News, Prescription

FDA Warns Rx Users Of Online Fraud, Phone Scams

The Food and Drug Administration recently alerted prescription drug users to two different types of consumer deception:

Associated Press: “The [FDA] is warning U.S. consumers that the vast majority of Internet pharmacies are fraudulent and likely are selling counterfeit drugs that could harm them.

“The agency […] launched a national campaign, called BeSafeRx, to alert the public to the danger, amid evidence that more people are shopping for their medicine online, looking for savings and convenience.

“Instead, they’re likely to get fake drugs that are contaminated, are past their expiration date or contain no active ingredient, the wrong amount of active ingredient or even toxic substances such as arsenic and rat poison. They could sicken or kill people, cause them to develop a resistance to their real medicine, cause new side effects or trigger harmful interactions with other medications being taken.”

Reuters: “Con artists posing as [FDA] agents are trying to extort money from people who buy medications online and over the telephone, the agency warned […]

“The FDA, which is charged with protecting consumers, says these fake government officials gather people’s personal information from online transactions, questionnaires and consumer lists and then call them demanding fines.

“The scammers tell victims that buying drugs over the Internet or telephone is illegal and threaten them with prosecution unless a fine or fee ranging from $100 to $250,000 is paid, the agency said in a statement.

“‘If you refuse to pay up, the caller threatens to search your properties, arrest or deport you, put you in jail, and even physically harm you,’ the FDA said.”


  05:49:09 pm, by MedBen5   , 211 words,  
Categories: News, Health Plan Management

MedBen University: Guest Speaker Russo Stresses Importance Of Plan Design

Phia Group CEO Adam Russo speaks at MedBen University

At a special MedBen University presentation on September 26, Adam Russo, CEO of The Phia Group, explained “How Innovative Plan Design Can Help to Mitigate the Cost of Health Care".

Russo stressed that no two groups of employees are alike, which means that employers must shape their health plan design to best suit the unique needs of their workers. Additionally, he warned that overly broad plan language can end up costing the employer in the long run.

For example, merely defining a spouse as a “covered Employee’s husband or wife under the laws of the state where the covered Employee lives” leaves the employer open to having to cover a dependent who is legally separated from the employee. It’s best, Russo said, to include more direct language, such as stating that the spouse cannot be engaged in a trial separation for more than 12 consecutive months.

Another common generality that can end up costing the employer is not going into sufficient detail about hazardous pursuits, hobbies or activities. In cases where it’s likely the employee population will be engaging in such risky endeavors as hang gliding, skydiving, or car or motorcycle racing, Russo noted that it’s best to spell out in detail that coverage exclusions include (but are not limited to) these actvities.

  04:56:47 pm, by MedBen5   , 258 words,  
Categories: News, Prescription

Dispose Of Unused Drugs On "Take-Back" Day

Before you settle in for an afternoon of college football on the tube this weekend, you may want to first take a few minutes performing a worthwhile task: Gather up your unneeded or expired medications and participate in National Prescription Drug “Take-Back” Day.

According to WebMD, more than 5,600 drop-off sites will be available in all 50 dates and U.S. territories on September 29. The event is sponsored by the U.S. Drug Enforcement Administration as a way to remind Americans that unused medications pose a serious health risk to children and pets.

If you can’t make it to take-back day, make sure to dispose of your medications properly. The Food and Drug Administration suggests that you follow any specific disposal directions on the drug label or patient information that comes with the drug. Do not flush prescription drugs unless this information specifically tells you to do so.

If no instructions are given on the drug label, throw the drugs in your household’s trash. But before doing so, the FDA recommends that you:

  • Take medicines out of their original containers and mix them with used coffee grounds or kitty litter. This makes the drugs less appealing to children and pets, and unrecognizable to people who may intentionally go through your trash.
  • Put drugs in a sealable bag, empty can, or other container to prevent the medication from leaking or breaking out of a garbage bag.
  • Scratch out all identifying information before throwing out an empty prescription drug container. This will help protect your identity and keep your health information private.
  04:13:34 pm, by MedBen5   , 179 words,  
Categories: News, Health Plan Management

Sears Shifts To The Insurance Exchange Model

We recently noted a Deloitte survey which found that 9% of employers expect to drop their health coverage when insurance exchanges become available in 2014. But earlier this week, one major retailer revealed that it doesn’t intend to wait until then:

“Sears Holdings Corp., in an effort to control its health care costs, has joined a private insurance exchange and will provide employees with a fixed allowance to buy insurance.

“The Hoffman Estates-based retailer, with more than 90,000 workers eligible for coverage, becomes one of the largest U.S. employers to move away from traditional defined benefit health plans in favor of an approach that effectively shifts the choice of health insurance from companies to workers.

“Sears said it is optimistic that more choice and competition will drive down health care costs.

‘"The corporate exchange model brings increased flexibility to group health coverage for our associates, giving participants a chance to choose both the level of coverage and the insurance company that best meets their needs,’ Sears spokesman Chris Braithwaite said in a statement.”

Read more at the Chicago Tribune.


  06:19:32 pm, by MedBen5   , 286 words,  
Categories: News, Health Plan Management

MedBen Government Roundtable Offers Trend Analysis, Plan Strategies

MedBen Regional Sales Manager Pam Davis

MedBen team members offered municipal employers health care plan information and cost-saving advice at its annual Government Roundtable on September 26.

At the roundtable, municipalities administered by MedBen were able to see how their plan compared against MedBen’s government and overall self-funded blocks as well as national cost norms. MedBen President and COO Kurt Harden led the session with a review of medical and pharmaceutical cost trends over the past five years, and explained some of the measures MedBen uses to keep municipality health care costs as low as possible.

Brian Fargus, MedBen Vice President of Sales and Marketing, followed Harden with a demonstration of Verisk Sightlines, a leading edge program that tracks and compares population trends in utilization, cost and quality, and helps MedBen clients identify and target high-risk members in need of clinical interventions. He showed how by using Sightlines, clients can pinpoint opportunities for improving care and reducing costs.

Closing the roundtable was Regional Sales Manager Pam Davis, who highlighted some of the tactics benefits administrators use to mislead employers into thinking they’re getting a better deal. One such method is what she called the “deception of ‘average’ discounts", in which a carrier will average the discounts of major metropolitan hospitals – which tend to be larger because they typically charge higher fees – with the smaller discounts of non-metropolitan hospitals. By doing so, the discounts in non-metropolitan areas look much bigger than they really are to potential clients who get most of their care from non-metropolitan hospitals.

MedBen has conducted yearly roundtables for its municipal clients since 2007. MedBen also offers a similar event for its hospital clients every spring.

Clients with questions regarding these presentations are welcome to call MedBen at (800) 423-3151.


  04:05:06 pm, by MedBen5   , 229 words,  
Categories: News, Wellness

More Seniors Getting Knee Replacements

As more and more Baby Boomers are entering their golden years, the number of body parts in need of major repair has shot up accordingly. So a new study showing that the number of knee replacements for Medicare enrollees have almosr doubled in the last two decades should come as little surprise.

The Associated Press reports that, per capita, about five knee surgeries were performed per 10,000 enrollees in 2010. In contrast, the surgery rate in 1991 was around three per 10,000.

Of the nearly 244,000 surgeries performed in 2010, almost 10% were follow-ups to replace worn-out replacement joints. The rising rate of redos coincided with the proportion of obese older patients getting their first operations – from 4% in 1991 to 12% in 2010. Excess weight is known to wear down joints faster and can contribute to arthritis, a leading reason for knee replacement surgery.

The obesity crisis isn’t the only reason for the increase, however. “There’s a huge percentage of older adults who are living longer and want to be active,” and knee replacement surgery is very effective, said lead author Dr. Peter Cram, an associate professor of internal medicine at the University of Iowa.

The study also found that the average hospital stay fell from almost eight days to just 3.5 days, though many patients are now sent to outpatient rehab centers following their hospital release. Moreover, readmissions increased in recent years to address infections and surgery complications.


  06:02:18 pm, by MedBen5   , 198 words,  
Categories: News, Wellness, Health Plan Management

As Diabetes Cases Rise, So Does Emphasis On Prevention

The Wall Street Journal Health Blog recently reported on efforts by health care providers to educate people about diabetes – management for those with the disease, and lifestyle changes for those in danger of developing it.

Many states now offer group glasses through the National Diabetes Prevention Program led by the Centers for Disease Control and Prevention. By making modifcations in diet and exercise, people with pre-diabetes can lower their risk of developing Type 2 by 58%.

Health care providers increasingly conduct their own programs as well. But as the blog notes, getting people to attend and stick with the classes can be a challenge – particularly in cases where the patient is in denial of their condition.

MedBen plan members have another avenue for assistance – MedBen Worksite Wellness. We electronically analyze each plan member’s company claims history to detect members with symptoms of pre-diabetes. They are automatically entered into our Specialty Care Program for individualized disease monitoring and ongoing nurse coaching.

MedBen Worksite Wellness uses customized education and counseling to help high-risk plan members reduce their odds of developing diabetes and other diseases. To learn more, call Vice President of Sales & Marketing Brian Fargus at (888) 627-8683.

  05:06:21 pm, by MedBen5   , 303 words,  
Categories: News, Health Plan Management

Some States Grudgingly Developing Insurance Exchanges

As the November 6 elections draw closer, another important date looms right behind it – November 16, the deadline for states to submit a plan for running their own health insurance exchange. Those that fail to do so must permit the federal government to run it for them.

According to The New York Times, only 13 states and the District of Columbia have so far committed to running their own exchanges – all but one (Rhode Island) led by Democtratic governors. But with the deadline fast approaching, even Republican governors who have vocally expressed their disapproval of the Affordable Care Act are exploring their options:

“[Arizona Gov. Jan Brewer’s] administration is quietly designing an insurance exchange – one of the most essential and controversial requirements of the law […]

“’If we have to have one,’ said Donald Hughes, Ms. Brewer’s health care policy adviser, ‘then it would be better for Arizona to do it ourselves rather than defer to the federal government.’ He said, however, that Ms. Brewer would not make a final decision on a state-run exchange until after the election….

“Along with Arizona, at least three [states] – Mississippi, Nevada and New Mexico – have done enough planning to meet the November deadline should they decide to run their own exchanges, according to officials. Nevada has already created its exchange, appointed its board and hired its executive director. Most Republican governors, including Ms. Brewer, are waiting for the outcome of the presidential race before making a final decision; Mitt Romney has pledged to repeal the law if elected.

“But states like Arizona say they want to be prepared in case the law survives. (Even if Mr. Romney wins, repealing the law will require Congressional approval, which will be difficult if Democrats retain control of the Senate.)”

Read more at the NYT website.


  05:49:38 pm, by MedBen5   , 214 words,  
Categories: Prescription, Health Plan Management

Shifting The Focus On Health Care Reform

Peter Pitts of the Center for Medicine in the Public Interest makes the argument that a health care reform is most effective with a smaller focus – but that there are lessons to be learned from one particular federal program:

“One of the big mistakes of the Affordable Care Act (Obamacare) was to try to solve all of our national health care problems at the same time and on a national scale. The individual mandate was just the poster child for many of the law’s fantasy solutions.

“Now’s the time to stop talking about health care “reform” and start focusing on the need for health care evolution….

“The opportunity is to realize that the way we can evolve health care is by recognizing that it must be done locally – on a state-by-state level. When it comes to reform, states are the laboratories of invention…

“If a key goal of health care evolution is broader coverage at lower costs, one national program that offers valuable lessons for the path forward is Medicare Part D (the Medicare prescription drug benefit). Part D applies free-enterprise principles to the nation’s health care system (letting competition drive down prices and increase choice and quality) rather than operating like a government-managed utility.”

Read more at Pharmalot.

  05:13:01 pm, by MedBen5   , 320 words,  
Categories: Wellness

Zumba Your Way To Better Health (Safely)

Zumba has quickly risen to the top ranks of popular fitness options. The combination of music, Latin-inspired dances and a good calorie-buring workout attracts a wide variety of participants, including many who have fell off the wellness bandwagon for awhile.

Of course, jumping into any exercise after a long layoff raises the risk of health hazards. The twisting movement that is a big part of Zumba can result in meniscal tears of the knee. And injuries to the hips and lower body are also common.

Fortunately, Zumba can be a safe activity if performed properly. Orly Avitzur, MD suggests the following ten tips, which we highlight below. You can read his full comments at

  1. Prepare for class. Take a prep class or, if you’re a baby boomer, try to find a Zumba class geared toward your age group.
  2. Find an experienced instructor. Before signing up, research your teacher’s experience and the extent of his or her fitness or dance certification.
  3. Wear the right shoes. Shoes for Zumba should have few or no grips on the soles so you can pivot easily without sticking to the floor.
  4. Avoid the wrong floors. Be wary of unforgiving surfaces such as concrete, concrete covered with a thin layer of wood, or floors with hard tiles, and avoid carpeted surfaces.
  5. Ditch the crowds. Check out multiple facilities and various times of the day to find which classes are least congested.
  6. Stretch after your workout. Recent research suggests that stretching before a workout may actually hinder performance.
  7. Warm up and cool down.
  8. Hydrate.
  9. Modify those moves. Use common sense and avoid dangerous moves, even if the teacher and your neighbors are doing it.
  10. Consult your physician. As with any high-intensity cardio exercise, it’s best to see your doctor before you begin, especially if you have heart disease or kidney disease, asthma or emphysema, high blood pressure, arthritis, osteoporosis, or disk herniations.

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