Physical activity in children can be improved through ‘exergames’

Physical activity in children can be improved through ‘exergames’
physical activity
Credit: CC0 Public Domain

Physical activity among young people can be improved by well-designed and delivered online interventions such as ‘exergames’ and smartphone apps, new research shows.

According to a review study carried out at the University of Birmingham, children and young people reacted positively in PE lessons to the use of exergames, which deliver physical activity lessons via games or personalized activities. Changes included increases in physical activity levels, but also improved emotions, attitudes and motivations towards physical activity.

The study, published in Physical Education and Sport Pedagogy is one of the first to examine not only the impact of online interventions on physical behaviors in non-clinical groups of young people but the effects of digital mediums on physical activity knowledge, social development and improving mental health.

The evidence can be used to inform guidance for health and education organizations on how they can design online interventions to reach and engage young people in physical activity.

The authors analyzed 26 studies of online interventions for physical activity. They found three main mechanisms at work: gamification, in which participants progress through different levels of achievement; personalization, in which participants received tailored feedback and rewards based on progress; and information, in which participants received educational material or guidance to encourage behavioral change.

Most of the interventions were focused on gamification or personalisation and the researchers found the majority of studies (70{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}) reported an increase and/or improvement in outcomes related to physical activity for children and young people who participated in online interventions. Primary school age pupils in particular who participated during PE lessons benefited.  

Lead author Dr. Victoria Goodyear, in the University of Birmingham’s School of Sport, Exercise and Rehabilitation Science, said: “We find convincing evidence that PE teachers can use online learning to boost attitudes and participation in physical activity among young people, particularly at primary school age. There’s a real opportunity here for the PE profession to lead the way in designing meaningful and effective online exercise opportunities, as well as an opportunity to embed positive approaches to exercise and online games and apps at an early stage.”


Girls ‘least likely’ to enjoy fitness tests, finds study


More information:
Students’ perceptions of fitness testing in physical education across primary, secondary, and pre-university school levels: a motivational profiles perspective, DOI: 10.1080/17408989.2021.1953458

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University of Birmingham


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Thinking of choosing a health or PE subject in years 11 and 12? Here’s what you need to know

Thinking of choosing a health or PE subject in years 11 and 12? Here’s what you need to know

This article is part of a series providing school students with evidence-based advice for choosing subjects in their senior years.

From kindergarten to year 10, all Australian students follow the national health and physical education (HPE) curriculum. This expands in years 11 and 12 with a range of health and physical education selection options.

Depending on which state you live in, you may be able to do year 11 and 12 health and physical education subjects such as physical education (by itself), sport science, health studies, personal development, athlete development, food and nutrition, outdoor and environmental studies, and sport and recreation. These subjects include a variety of practical and theoretical options.

When deciding which subjects to do in years 11 and 12, it is important to consider your interests and study load, as well as what you want to do after year 12.

Do you want to embark on university study, enter the workforce, learn a trade or something else? Sport and recreation is a common choice for industry preparation, with ATAR and higher education pathways also available. But there are other options, too.

What subjects can I do?

In recent decades a number of reports have indicated studying health and physical education in year 11-12 is becoming more popular.

In 2016, almost 40{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} of students aged 16 to 17 across Australia elected to enrol in health and physical education subjects in years 11 and 12. The PE subjects were slightly more popular among males, and health education among females.

Similarly, in New South Wales, trends show the proportion of senior secondary students studying health and physical education rose by almost 10{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} over the decade from 2008.




Read more:
Choosing your senior school subjects doesn’t have to be scary. Here are 6 things to keep in mind


Many subjects are available under the health and physical education umbrella – depending on where you live. Alongside the combinations of HPE or PE (by itself), these can include:

  • health studies and well-being are available in states such as Western Australia, South Australia, Queensland and Tasmania. Here you will learn about personal care and well-being and about where to find accurate health information. You can explore different dimensions of health such as physical, mental and emotional health — all of which can help you navigate busy and often stressful years at college

  • food and nutrition is available in states such as Tasmania and South Australia. This will teach you how to analyse nutrition and food information, food advertising and dietary trends. You will also explore what influences food choices, analyse how nutrition affects health and consider how secure and sustainable our food supply is

  • sport and recreation studies are available in states such as Queensland, Victoria and NSW. This subject can make you more aware of the many local organisations and experiences you can access for fun. It can also teach you how to get engaged in physical activities with your friends and family, and work with a local council to organise community sporting events

  • athlete development is available in states such as Tasmania. This can allow you to develop in your chosen (team or individual) sport through specialist coaching. You can learn about things like how to train effectively and prevent and recover from injuries

  • outdoor education is available in states such as Victoria, South Australia and Western Australia. This will give you exposure to many different activities, such as rafting, kayaking and climbing, that you probably would not be able to normally access. Experience in adventure activities is useful if you want to work as a recreational guide, with skills to lead and manage outdoor groups

For students who want to continue studying health and physical education at university as part of training to be a teacher, subjects that relate to sport science such as biology, chemistry and physics are highly recommended and scaled well towards ATAR scores in 2020.

They are also a great foundation for courses in exercise science, health promotion, nutritional sciences and physiotherapy.

What else will I learn?

Studying health and physical education in senior secondary school can give you an insight and appreciation of how our psychology, social networks, culture, environments and bodies all connect to influence our activity behaviours and overall physical performance.

For instance, when planning how to get people moving and performing well, you might consider a person’s motivation, the type of people to train with, the types of facilities available and levels of training preparation.

Physiotherapist helping someone do an exercise using a TheraBand.
Doing subjects related to sports science could lead to a career in physiotherapy.
Shutterstock

Many students choose senior secondary health and physical education for future careers relating to movement and the body. These include coaching, teaching, sport science, nutrition and recreation. Others may simply want to better understand how to plan and promote active and healthy lifestyles.




Read more:
Thinking of choosing a science subject in years 11 and 12? Here’s what you need to know


Studying health and physical education can lead to improved confidence in your movement, ability to make decisions and to develop teamwork and leadership skills that will help across life. These skills are transferable across a range of other professions such as management, policing and the defence forces.

Keeping active in the senior years

Across Australia, schools are expected to deliver at least two hours of planned physical activities each week to students until year 10.

But there is no time requirement for schools to deliver physical activity in the senior years.

Global reports indicate physical activity reduces through adolescence and to some extent into adulthood. Researchers suggest the decline is most often due to a lack of time, followed by the amount of resources available and the level of school support to get students moving.

Physical activity is vital to buffer stress in senior schooling. Even a few brief periods of four to eight minutes of intense activity such as push-ups in class each week can help senior students’ mental health, learning engagement and overall fitness.




Read more:
How much physical activity should teenagers do, and how can they get enough?


Although taking health and physical education in years 11 and 12 does not have the same requirements to get you moving regularly as in the earlier stages of school, you will have the opportunity to develop a deeper appreciation of what you need to do to get moving on your own.

If physical education is just not your thing, still make sure you get at least one hour of activity each day that “makes your heart beat faster” to weather the stress of the final years of school and the evolving pandemic and to set up healthy habits for adulthood.

Read the other articles in our series on choosing senior subjects, here.

State laws can bolster physical education among children, study finds – The Source

State laws can bolster physical education among children, study finds – The Source

The presence and strength of state physical education (P.E.) laws positively affected P.E. attendance and the frequency and duration of physical activity throughout the day, suggests a new analysis from the Brown School at Washington University in St. Louis.

“We found that compared to those residing in states with weak or no P.E. laws, students in states with strong P.E. laws had an additional 0.2 days of P.E. attendance per week and spent an additional 33.9 minutes participating in P.E. classes per week,” said Ruopeng An, associate professor and first author of the paper “State Laws Governing School Physical Education in Relation to Attendance and Physical Activity among Students in the US: A Systematic Review and Meta-Analysis,” published in the March print issue of the Journal of Sport and Health Science.

An also wrote an editorial on policy and physical activity published in the issue.

Physical activity among children and adolescents has been an indispensable way to prevent childhood obesity and mental illnesses, An said. Currently, over three-quarters of children and adolescents in the U.S. don’t meet the guidelines-recommended daily physical activity level — at least 60 minutes of physical activity every day of the week, he said.

“In the meantime, nearly half of children and adolescents exceed two hours per day of sedentary behavior,” An said. “The gender disparity is also prominent — 28{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} of boys meet the guidelines-recommended level of physical activity, whereas only 20{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} of girls do.”

Despite the promising policy effect, state laws mandating P.E. participation have seen a sharp decline by school grade level — only 15{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}, 9{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} and 6{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} of students in elementary, middle and high schools in the U.S., respectively, are required to take P.E. classes on three or more days a week during the entire academic year, An said.

“Our analysis shows that state P.E. laws affected girls’ physical activity more than boys’,” he said, “It is possible that girls are less likely to take P.E. as an elective course so that mandating P.E. increases girls’ P.E. time more substantially than boys.”

“Not all laws are born equal,” An said. “Different aspects of state P.E. laws tended to affect students’ P.E. attendance differently. Certain parts of the laws could be counterproductive — reducing rather than increasing students’ P.E. attendance.”

Based on An’s earlier work published in the American Journal of Health Promotion, state laws governing P.E. class time, staffing for P.E., joint use agreement for physical activity, assessment of health-related fitness and P.E. curriculum all were associated with increased weekly P.E. attendance.

In contrast, state laws governing physical activity time in P.E., P.E. proficiency and recess time were associated with reduced P.E. attendance. “For example, mandating fitness tests could raise concerns and anxiety and reinforce peer pressure and a competitive atmosphere among students. Consequently, some students may choose to skip P.E. to avoid performance assessment,” An explained.

An conducts research to assess environmental influences and population-level interventions on weight-related behaviors and outcomes throughout the life course. He is an expert on physical activity and the sedentary lifestyle.

A total of 17 studies were included in the review, and five contributed to the meta-analyses. Eight used nationally representative school- or student-level data; three focused on multiple states; and the remaining six examined the P.E. laws of a single state.

An and his co-authors, Jianxiu Liu and Ruidong Liu of Tsinghua University in China, found that some states have policy waivers that may exempt children from P.E. attendance in school.

“Some of those policy waivers could compromise students’ participation in P.E. and their physical activity levels at school,” An said. “Based on the available evidence, states should implement strong evidence-based P.E. laws to increase P.E. attendance and promote physical activity engagement among school students.”

Fred Carl Rowland | News, Sports, Jobs

Fred Carl Rowland | News, Sports, Jobs
Fred Carl Rowland | News, Sports, Jobs

July 30th, 1937 ­– November 20th, 2021

Dr. Fred Carl Rowland, 84, passed away surrounded by his loving family on November 20th, 2021 in the house he built with his sweetheart, Linda, Heal Me Healthy.

Born in Salt Lake City in 1937, Fred was raised on the east bench, where he attended and graduated from East High School. As a young man, his commitment, intelligence, and strong work ethic earned him bachelor’s and master’s degrees in the sciences at the University of Utah, and a doctorate degree in Physical Education at Brigham Young University. In 1968, he met his best friend, Linda Rohbock, and married her in the Salt Lake City LDS temple. Together, they adopted and raised five unique children from all across the globe. Theirs was an adventurous home filled with devotion to the gospel, education, and sports of all types, and their children developed a healthy respect for rugged individualism and a huge fondness for the great outdoors.

A coaching legend, Fred began his athletics career coaching mens’ and womens’ state championship cross country teams, but was most at home on the wrestling mat. His storied coaching career spanned more than forty years, where he mentored hundreds of students both in the classroom, and on and off the mat. In addition to coaching, Fred taught Biology and Drivers Ed at Mountain View High School, and under his leadership, wrestling teams at Orem High School, West High School, and Mountain View High School earned state championships and many other regional and tournament awards. He was the recipient of multiple individual awards including honors from the Utah Wrestling Association as “Man Of The Year” and the esteemed inclusion into the Utah Sports Hall Of Fame as a Distinguished High School Coach. But wrestling wasn’t just a sport for Fred; it was a source of spirituality that allowed him to teach his athletes the principles of commitment, obedience, hard work, and study, helping them to become better athletes, and even better people.

As an avid backpacker, fisherman, and all around nature enthusiast, Fred grew a second skin in the outdoors. He relished in the wild, particularly his beloved Big Cottonwood Canyon, where he went frequently to find solace and peace. An avid reader, he was rarely found without a worn Louis Lamour book in his hand. His love of the West and his thirst for adventure led him and his children on countless backpacking trips, biking treks, and explorations up every known canyon along the Wasatch Front. Not even his 6 year old daughter was spared when he famously “encouraged” her summit up Provo Peak in a pair of jelly shoes.

It was his annual cherished High Unitas summer excursions, however, that brought out the best in Coach Rowland. To hear him howl as he plunged into a high alpine lake is the stuff of legend- a mountain man blessing to all of us lucky enough to be within earshot. He leaves behind in all of us a deep reverence, respect, and love for all the beauties of our earthly home in the mountains.

Fred’s ultimate loves in life were his wife of 52 years, Linda, and his beloved dog, Chance. As well as their five children and the gospel of The Church Of Jesus Christ of Latter-day Saints, for which he bore a granite-like testimony. Fred and Linda were lucky enough to fully participate in their own lives and the lives of their children and grandchildren, and travel to many far-flung destinations. These travels were capped by the fulfillment of one of their lifelong goals: a mission for the LDS church in Fresno, California.

Fred was preceded in death by his parents, Fred E. Rowland and Iris Viola Alm, his granddaughter Zana Chee Raquel Anderson. Fred is survived by his wife, Linda Louise Rohbock, cherished children, Taj (Priya), Rux (Kristin), Joshua, Jarom, Ana (Brandon) and Deborah, his thirteen grandchildren, and his brother, David Rowland (Laura).

The family wishes to thank the doctors, nurses, and caretakers, specifically with Envision homecare and hospice who aided in keeping him at home surrounded by his family in his last days.

Fred’s enduring spirit will undoubtedly find you outside, in the melody of the streams and the tops of rocky mountains. It will visit you on that final lap, it will climb beside you up that tallest summit. And during that extra practice, when you are sweating blood and tears, he will be there still, hand on the mat, coaching you on forever.

Service Details:

Visitation – Friday, November 26th, 2021 6:00pm – 8:00pm at Walker Sanderson Funeral Home located at 646 East 800 North, Orem, UT 84097

Funeral Services – Saturday, November 27th, 2021 at 11:00am at Park 7th Ward located at 114 South 400 West, Orem, UT 84058

Visit : https://heelsme.com/

Workplaces can help promote exercise, but job conditions remain a major hurdle

Workplaces can help promote exercise, but job conditions remain a major hurdle

We know regular exercise is really good for health, but even with the best of intentions, many workers do not exercise as much as they should. To get more workers in all types of workplaces to be active, public health messaging must move away from making it only an individual’s responsibility to be more active. It should instead recognize the important role employers can play in creating the conditions for workers to focus on exercise.

There’s much to be said for this approach. From a public health perspective, focusing on workplaces can seem like low-hanging fruit, since they are settings where people already go every day. Consider the resources that would otherwise be required to build activity-friendly environments, let alone address the root social causes of physical inactivity. However, the reality is more complicated.

Stairs with each step labelled with the number of calories burned
On-site gyms and access to walking paths or stairs support workplace fitness.
(Shutterstock)

The World Health Organization’s physical activity guidelines recommend adults strive for at least 150-300 minutes of moderate-intensity aerobic physical activity, or 75-150 minutes of vigorous-intensity aerobic physical activity, or an equivalent combination every week. To meet these recommendations, for 80 per cent of working-age Canadians in full-time jobs, it means finding time to exercise before, after or at work.

That’s easier for some than others. I am part of a team at the Institute for Work and Health that published a paper showing that people in certain work conditions are less likely to exercise. These are workers who: report long work hours, have little say in how to use their skills, or are in physically or psychologically demanding jobs.

Other studies have reported the same. These findings support the theory that stressful and strenuous working conditions can increase a worker’s fatigue and decrease motivation and perceived time available to exercise.

Workplace spillover

A warehouse with a worker in the foreground sealing a box with packing tape on a conveyor belt and two other workers in the background
Job-related physical activity often does not provide the same health benefits of leisure-time exercise.
(Shutterstock)

The spillover of strenuous working lives on exercise participation is a reality for many people — especially when there are competing demands such as taking care of children. But the ability to overcome these barriers can depend on job type.

Supportive workplace facilities that offer standing desks, stairs, on-site showers and gyms and easy access to walking paths can make it easier for people to fit in exercise and reduce sedentary time. However, these are mostly available to white-collar, higher-income workers who already face fewer barriers to exercise outside of work.




Read more:
Lack of exercise linked to increased risk of severe COVID-19


Emphasizing worker responsibility for exercising more can exacerbate health inequalities between high- and low-income workers. Low-income workers in non-standard or precarious jobs often have little say about how they spend their work time. These workers also have few opportunities to exercise and engage in other healthy behaviours outside work.

Some manual labour jobs involve high levels of physical activity with little time to rest, while workers in service sector jobs can spend long periods of time standing. A body of research is showing the potential harm of these occupational activities — including the risks of physical activity for people doing such jobs. Job-related physical activity often does not provide the same health benefits of leisure-time exercise, and can even have negative effects because of factors like the nature of the movements and duration of work.

Healthy workers are safer workers

A woman in a blue apron ironing in an industrial laundry
Many employees have little say in how they spend their work time.
(Shutterstock)

Physical activity guidelines aimed at all adults will not be achievable for many workers. A more inclusive solution is for employers to create the conditions for their workers to thrive so that they can also prioritize their health.

This approach pushes for employers to think of workplace policies as levers to address the safety, health and well-being of their workers. Research shows that healthy workers are safe workers, and this concept is endorsed by international labour agencies and the Total Worker Health program in the United States.

What could such an approach look like? One example is the case of an insurance company offering flexible scheduling and telecommuting options to help its workers reduce their stress. This led to workers walking more, taking breaks away from their desks and engaging in stress-reducing social activities such as ping-pong competitions and indoor nerf basketball tournaments.

At one construction company, a 14-week intervention focused on health education, reinforcing safety and health behaviours and improving work-life balance. The result was more workers reporting exercising at least 30 minutes a day.

In another example, a police department reduced the number of night shifts for its officers. It also offered mental health support and allowed staff to take one hour off each shift to exercise. The result was a reduction in workplace injuries.

Enhancing working conditions

An open-plan office with workers at tables and in cubicles
Employers should discuss supportive policies and practices with workers to create a workplace environment that supports the safety, health and well-being of their employees.
(Unsplash/Arlington Research)

So how do we get more employers to get behind this? Our team’s research in Canada and other studies have highlighted the importance of convincing employers with data that this approach can be successful. For example, an employer-led approach has increased participation in safety and wellness efforts, and reduced workplace injuries and health-care costs.

Employers that want to create an environment conducive to the safety, health and well-being of their employees should discuss with their workers how policies and practices could support those goals.

While there is no simple solution to getting workers more physically active, an important step forward is to get employers involved in enhancing working conditions so that more Canadian workers are supported in getting the health benefits of regular exercise.

Virtual Reality Device Helps Ease Chronic Pain

Virtual Reality Device Helps Ease Chronic Pain

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Experts say a new virtual reality device can help people understand and ease their chronic pain. David Espejo/Getty Images
  • It’s estimated that chronic pain affects 50 million U.S. adults.
  • Treatments, including medications and cognitive behavioral therapy, are used to ease the pain.
  • Federal regulators have now approved a virtual reality device that in a recent clinical study was effective in reducing chronic pain.
  • The EaseVRx device works by immersing users into a 3D world.

About 50 million adults in the United States live with chronic pain.

Help, however, may be on the way.

The Food and Drug Administration (FDA) has approved a breakthrough device that could improve the daily lives of people with chronic pain.

The EaseVRx is a virtual reality (VR) headset that uses techniques like cognitive behavioral therapy to help with pain reduction in adults.

“The inspiration behind the EaseVRx was to create a standardized, standalone, high quality behavioral intervention where people could acquire a critical skills set that has been shown through various different types of treatment modalities to both reduce pain and its impacts. But now they can receive it on demand in the comfort of their own home and in doing so, transcending so many barriers to effective pain care,” said Beth Darnall, PhD, the director of the Stanford Pain Relief Innovations Lab in California as well as the chief science adviser and co-creator of the EaseVRx.

“Individuals turn on the headset and they’re in an immersive 3D world where they can see a new environment around them and be directed to interact within the context of that environment to learn various information such as the role of pain in the brain, how pain exists in the central nervous system, and what can be done to soothe or calm one’s nervous system within the context of pain,” Darnall told Healthline.

The VR device takes users through a treatment program of 56 sessions done daily over an 8-week period.

The FDA reported that in a clinical study of the device, 66 percent of those who used EaseVRx reported a higher than 30 percent reduction in their pain, compared with 41 percent of other participants who didn’t use the device.

About 46 percent of those who used the device reported a greater than 50 percent reduction in their pain.

“It’s really exciting. It is a breakthrough device, it’s also a breakthrough in terms of how we’re conceptualizing pain and pain treatment,” Darnall said.

“It’s not to say it will obviate the need for medication or other interventions, but it can nicely work alongside any other medical treatment that a physician or clinician will determine to be appropriate for any patient,” she added.

Lora L. Black, PhD, MPH, a licensed psychologist and assistant professor of psychiatry and behavioral sciences at the University of Kansas Health System, said the device could be useful in improving access to treatments.

“This appears to be a good use of technology to enhance self-regulatory techniques that have been shown to be helpful for chronic pain in multiple studies,” she told Healthline.

“There is also research showing that VR technology can increase adherence to other treatments, such as exercise, so use of similar technology may be useful in increasing adherence to the self-regulatory techniques as well,” she added.

“A device like this may help to reduce access barriers many patients experience when trying to find psychologists trained in pain-focused psychotherapy,” Black noted. “Such a device may also serve as a helpful supplement to those already engaged in psychological treatment for chronic pain.”

Cognitive behavioral therapy (CBT) is a psychological treatment that can be used in a variety of conditions to improve daily function and quality of life.

CBT works by helping you change patterns of thinking and develop effective ways to cope.

It can be used in the treatment of pain to change how people feel and experience pain.

“The medical definition of pain is that it’s both a physical and an emotional response, so the brain responsibility in that is on both sides. The brain processes the physical aspects of pain and brings them to our attention, and it’s also the center for the emotional aspects of pain. CBT is a method of using the brain’s ability to influence those things to change the pain experience,” Dr. Matthew Smuck, chief of physical medicine & rehabilitation at Stanford Health Care, told Healthline.

Dr. Gene Tekmyster, a physical medicine and rehabilitation physician at Keck Medicine of USC, said that pain can change the way people think.

“Pain is multifactorial. There is an incredibly large psychological component. There are so many things involved in people feeling pain and how much they feel pain,” Tekmyster told Healthline.

“Because pain changes your psychology, your stress levels, and actually changes your behaviors, not only do you have to change how people perceive the pain but also how it affects them and how they perceive it affects them,” he said.

“It’s how we deal with pain that CBT helps to control, not really controlling pain in and of itself,” he added.

Darnall said the VR device is one more addition to the treatment options available to treat chronic pain. Other options include physical therapy, exercise, yoga, and acupuncture.

Medications may also be used, but Smuck said they’re often not useful for the long-term management of chronic pain.

“Studies have shown they can be useful most often in the short term, but very few studies show that medications are useful for managing chronic pain in the long term and that’s particularly true for medications that have more risk, like opioids,” he said.

“The amount of benefit that is derived from opioids is small. It’s really not any better than what you can get from CBT. Those benefits tend to be short lived because of the way the body responds to opioids. There’s a substantial amount of risk to taking opioids, including addiction, overdose, and death,” he added.

Darnall is hopeful the VR device will make lower risk treatment options such as CBT more easily accessible to the public.

“Some people of course definitely need pain medication and we never want there to be barriers to a particular treatment that a person may need,” she said. “However, it is well appreciated and has been stated for chronic low back pain but also chronic pain generally, we want to apply lowest risk treatments first.”

“In this case, we are giving people that option, access to home-based, on-demand pain care,” she said.