Good morning everybody. I should say good afternoon now. It's 12 noon. My name is Mark Ramis and I'm one of the Associate Scientific Directors for the Canadian Longitudinal Study on Aging. And I'm going to welcome you now to our December webinar. The presenter will be Dr. Paul Loprinzi and we'll just give people another two minutes to log on and sometimes the software that we use can be very finicky. And in a couple of minutes we'll begin. I will introduce Dr. Loprinzi and then he will give his talk and of course we'll have time for some questions afterwards. So let's just wait a couple of more minutes for last minute joiners and then we'll get the webinar underway. Okay, let's begin. I'm sure some other individuals will be joining us shortly. So I will introduce Dr. Loprinzi, our speaker today. He's an Assistant Professor of Health and Exercise Science at the University of Mississippi. His research focuses on examining the effects of physical activity on various health outcomes and determining psychosocial and bio-behavioral determinants of physical activity. Dr. Loprinzi is also Director of Research Engagement at the Jackson Heart Study, Vanguard Center of Oxford. And that is the largest single-site prospective epidemiologic investigation of cardiovascular disease among African Americans that's ever been undertaken. His background is in Exercise Science and Behavioral Epidemiology. He holds a PhD in Exercise and Sports Science from Oregon State University and he has over 175 first authored or co-authored peer-reviewed publications to his credit. Today Dr. Loprinzi is going to be talking about factors that influence physical activity and the effects of physical activity on cardiovascular disease risk factors and health outcomes among middle-age and older adults. Dr. Loprinzi is going to be the first in a series of international speakers from the United States and from the UK. So he will present for approximately the next 40 to 45 minutes and then we will entertain your questions. Now if we intentionally mute participants because if everyone's talk features were enabled, there would be a great deal of feedback and we wouldn't be able to hear the speaker present. So if you have a question, please look at the bottom left of your screens and you'll see the chat feature. Just type your questions in at any time during the presentation. And when the presentation is complete, I will read the questions allowed to everyone and our speaker will be able to answer. So without further ado, I'll stop talking and I will pass the baton to Dr. Loprinzi. Paul, please go ahead. Thank you, Mark, for this opportunity. It's an absolute pleasure to give this presentation and talk about some of our previous work as well as current ongoing work surrounding the topic of physical activity epidemiology, looking at some of the health outcomes associated with physical activity and determinants of physical activity behavior. Look forward to everybody's comments and questions at the very end of my presentation and of course if we don't have time to answer them all, I'm happy to correspond via email so feel free to send me an email and we can continue the dialogue at a later time. As Mark mentioned, the title of my presentation is Factors that Influence Physical Activity and the Effects of Physical Activity on CVD Risk Factors and Health Outcomes Among Middle-Age and Older Adults. So here's an outline for my talk today. I'm going to talk about a variety of different things centered around the topic of physical activity epidemiology. The first half of my presentation will specifically focus on a particular chronic disease that being smoke-induced COPD. And then the later half of my presentation will focus on middle-age and older adults with a variety of different chronic diseases. And so I'll first start out talking about the potential limitations that COPD patients have in engaging in higher-intensity physical activity. And then this will underscore the importance of this particular population to engage in light-intensity physical activity. So then subsequently, I'll talk about some of our emerging work that addresses the potential beneficial effects of light-intensity physical activity on a variety of different health outcomes in this specific population. And then I'll go into some of our other work that looks at not only the direct effects of physical activity on CVD biomarkers among smoking-induced COPD, but also the potential additive interaction effects of physical activity in a healthy diet on a variety of different cardiovascular disease biomarkers among smokers. And then I'll finish my talk among the COPD patient by addressing an emergent study that we recently published that addresses the potential for physical activity to help to facilitate smoking cessation. Now, as I mentioned, I'll go into a different population, middle-age and older adult population, talk about unique daily movement patterns that we've been talking about in the literature and how they relate to CVD risk factors. Then I'll talk about the beneficial effects of longer bouts of physical activity as well as shorter bouts of physical activity. And then lastly, I'll conclude with a paper that we published that looks at behavioral and cognitive determinants of physical activity that can be utilized to help to promote physical activity among chronically diseased populations. So as I mentioned, the first half of my talk today will focus on individuals with COPD. We know COPD affects about 5% of U.S. adults, causes over 2 million deaths annually. There's a genetic component to COPD, but one of the primary modifiable factors of COPD is smoking. We know smoking itself increases the risk of lung cancer, but they can also increase the risk of endotypes of cancers, as well as increasing the risk of cardiovascular disease. One way in this may occur is the inflammatory markers that are activated in the lung from smoking they translocate into the circulatory system, can activate plaque tissues, induce vascular information, and then ultimately induce vascular related events. So because of this translocation effect of these inflammatory markers into the circulatory system, it's important that we can identify modifiable behaviors to attenuate these pro-inflammatory effects associated with smoking. So today I'll be talking about the potential effects that physical activity can have in attenuating these pro-inflammatory markers in the circulatory system, which will clearly have cardiovascular disease implications. The first thing I would like to talk about is a paper that myself and my colleagues from Bellarmine University, including Drs. Cain, Siggler, Brown, and Dr. Jerry Walker, we've recently published in the journal Physiology and Behavior entitled Freeliving Physical Activity Characteristics, Activity-Related Air Trapping and Breathlessness, and Utilization of Trains Theoretical Constructs in COPD Pilot Study. So in this study we had individuals with moderate to severe COPD, confirmed from pulmonary function testing in our lab, come into our lab for a graded exercise test. These moderate and severe COPD patients, which included ten of them, were all older individuals, mean age of 70 years. They completed a graded exercise test on the treadmill that included three different stages. Two miles per hour, 2.5 miles per hour, and three miles per hour. Each stage lasted five minutes in duration. And as you can see here, this is the indirect calorimetry data across these three different stages. So there was a progressive increase in energy expenditure across the three stages, which is what we would expect. At the end of each of the five-minute stages, we asked individuals to point to a scale, specifically the MVP scale, the multidimensional Disneya Profile Scale, to provide some indication of their air hunger or their air breathlessness, or whether they perceived that they were smothering for air or how much air they could get into their lungs. And then also, right after that assessment, we had them complete the inspiratory capacity measurements while walking on the treadmill at the end of each stage as a proxy for air trapping or this indication of this air being left into the lung capacity. Here are the results from these findings here. The first line right here, this is the data from the MVP scale or their air hunger breathlessness. As you can see at baseline, individuals had a air hunger breathlessness score of zero, so no problems getting air into the lungs. They did not feel like they were smothering, so no issues at the baseline level. But then as you can see, as they progressed to the different intensity levels, their air hunger breathlessness drastically increased. And then similarly, this line right here represents the air trapping or the inspiratory capacity measurement. At baseline, they consumed about 1.65 liters. And then initially, that very first stage, after the first stage, you can see a drastic reduction in inspiratory capacity, and that maintained across the three different stages. So collectively, these findings provide some evidence that as COPD patients, they engage in modern higher intensity levels of physical activity. They perceive that they can't get enough air into their lungs, as demonstrated here by the air hunger breathlessness. And they trapped more air in their lungs at sort of a relatively low intensity level. So ultimately, these findings to us underscore the importance of engaging in light intensity physical activity among this population. So I just talked about the potential exercise induced hyperinflation or air trapping, as well as this enhanced perception of smothering. They can't get enough air into their lungs among the COPD population, which again, underscores the importance of engaging in light intensity physical activity. So then the next thing I'm going to talk about addresses some of our recent findings that delineates the relationship between light intensity physical activity and a variety of different CVD biomarkers among smoke and induced COPD. And again, we feel that this is particularly important based on what I mentioned previously, and that smokers tend to have elevated levels of these pro-inflammatory markers in the circulatory system. So identifying behaviors that can tend to affect is critical. The title of this study that we recently published in the American Journal of Health Promotion is the association between physical activity and inflammatory markers among U.S. adults with chronic obstructive pulmonary disease published by my co-authors, Dr. Jerry Walker and Dr. Haya Lee. In this study, we utilized a representative sample of Americans with evidence of COPD coming from the National Health and Nutrition Examination Survey cycles 2003 to 2006. This was to examine the association between accelerometer to determine physical activity and white blood cells and neutrophils among this representative sample of COPD patients. We specifically focused on white blood cells and neutrophils because in addition to evidence suggesting that these parameters may increase the risk of cardiovascular disease, they're also associated with other chronic diseases including diabetes, cancer, cancer mortality, and all-cause mortality. In the literature, we know that physical activity has an anti-inflammatory effect. However, the effect is less clear among those with COPD. Fewer studies have looked at the relationship between physical activity and inflammatory markers among this specific population. So again, we utilized data from the National Health and Nutrition Examination Survey. 238 current or former smokers with COPD constituted the analytical sample. COPD was determined via self-reportive physician diagnosis of chronic bronchitis or emphysema. Smoking status, again, was self-reported, but we did biochemically verify the acotin levels. We did inflammatory markers included, as I mentioned before, white blood cells and neutrophils. And physical activity was objectively determined using accelerometry data where participants wore a waist-mounted Actograph 7164 accelerometer on their hip and they wore it for up to seven days. Only individuals with at least four days of at least 10 hours per day of monitoring data were included in the analysis to ensure habitual representation of their daily movement patterns. And we utilized established accelerometer-determined intensity-related activity count cut points to differentiate between light intensity physical activity and moderate to vigorous physical activity with the combination of these two intensity levels equaling total physical activity. We employed a multi-variable linear regression model controlling for a variety of different potential confounding variables including several demographic parameters, a chronic disease index variable indicating the number of chronic diseases that they had, ethylial dysfunction as measured by homocysteine levels, mobility function, medication use and how long they wore the accelerometer each day. Overall we found that some interesting findings specifically found an inverse association between all the intensity levels and the different inflammatory markers that we evaluated. Specifically we found that a 60-minute increase in light intensity physical activity was associated with a 6% decrease in neutrophils and a 2% decrease in white blood cells. And similarly we found that a 50% increase in moderate to vigorous physical activity was associated with a 1.6% decrease in white blood cells and a 2% decrease in neutrophils. So as I mentioned before we know smoking and COPD not only increases inflammation in the lung but systemically as well with this increased systemic inflammation, increase in the risk of cardiovascular disease and the types of chronic diseases. So this underscores the importance of in this particular population as well as other populations that would promote behaviors that can have an anti-inflammatory effect in the systemic circulatory system. The present findings suggest that among those with smoking-induced COPD physical activity may help to slow the progression of cardiovascular and other metabolic disorders by attenuating systemic inflammation. Of course we do want to interpret these findings in the context of the limitations of the study which include primarily the cross-sectional study design. So light intensity physical activity appears to be a palatable alternative to higher intensity physical activity levels among COPD patients for a variety of different reasons. One of which I already talked about in our pilot study showing that modern higher intensity levels of physical activity among COPD patients may induce air-trapping or exercise-induced hyperinflation. Also we know that higher intensity physical activity may have a pro-inflammatory response which may be counterproductive among COPD patients who already have an inflammatory response from the condition. And then also, light intensity physical activity may be a preferred intensity level compared to higher intensity levels among this specific population because the majority of COPD patients have one or more chronic diseases that may limit their ability to engage in higher intensity levels of physical activity. So these findings again as I mentioned provide some suggestive evidence that physical activity and in particular light intensity physical activity may have cardiovascular disease implications in this population of COPD patients. So far I've talked about the limitations of engaging in higher intensity physical activity among COPD patients. We provided some evidence of air-trapping in this population. Just talked about the beneficial associations of light intensity physical activity on pro-inflammatory markers among COPD patients. This next study that I'm going to talk about takes one step further and looks at the potential additive associations of physical activity and diet markers among smoking because we know that not only does physical activity have an anti-inflammatory effect when engaged habitually as opposed to acutely, we also know that dietary behavior also has an anti-inflammatory effect. So this study published by myself and Dr. Jerry Walker from Bellarmine University was published this year in 2015 in the Journal of Diabetes and Metabolic Disorders entitled Combined Association of Physical Activity and Diet with C-reactive protein among smokers. Again, we utilized that representative sample of smokers including over 800 adult smokers and again physical activity was objectively measured in this study via seven days of accelerometry data. The outcome measure of interest in this study was C-reactive protein with the two primary independent variables being physical activity behavior and dietary behavior. We ultimately dichotomized these two behaviors into meeting physical activity guidelines, so at least 150 minutes per week of accelerometer determined to vigorous physical activity compared to those less than 150 minutes per week and then with regard to the dietary behavior based on self-reported dietary data we calculated the healthy eating index and those who were in the top 40th percentile for the HEI or the healthy eating index we considered them to consume a healthy diet. So this is one of the tables from that study. We computed three different models and unadjusted, newly adjusted and a fully adjusted model. I'm going to go to that third column, the Model 3 there and focus on those findings which controlled for a variety of different confounding variables so that a negative 0.19 value that is the CRP level when compared to those who engaged in one of those dichotomized healthy behaviors versus those who did not engage in any of those two healthy behaviors. You can see it was not statistically significant but those who engaged in both healthy behaviors so were sufficiently active and need a healthy diet and after adjustment for a variety of different confounding variables they had a 0.34 lower CRP level expressed in milligrams per deciliter and you can see that was statistically significant. So even though it was somewhat of a marginal association these findings provide some evidence that concurrent engagement in both health behaviors may have a greater anti-inflammatory effect than engaging in fewer health behaviors which underscore the importance of concurrent adoption of both of these behaviors, healthy diet and physical activity. So I talked about the limitations of engaging in higher intensity physical activity among COPD patients, the beneficial effects of light intensity physical activity and attenuating these pro-inflammatory markers in the circulatory system and also just address the potential additive associations of physical activity and healthy diet on C-reactive protein in particular among smokers. This next study I want to talk about that was recently published in the Journal of Preventative Medicine addressing the potential implications for physical activity to help to facilitate smoking cessation among smokers. This study is entitled Exercise Facilitates Smoking Cessation Indirectly the Improvements in Smoking Specific Self-Efficacy, a prospective cohort study among a national sample of young smokers co-authored by my colleagues from Bellarmine University, Dr. Christy Wolfe and Dr. Jerry Walker. In this study we used a nationally representative sample of older adolescents and younger adult smokers, all smokers at baseline, over a thousand smokers were in the sample at baseline and these participants were followed over a two-year period to determine if they continued to smoke in the different follow-up assessments. So in this study we employed a Hayes Mediational Analysis Model to examine whether smoking-specific self-efficacy played any mediation role on the relationship between baseline exercise and two-year smoking status. As you can see here we found no direct association between baseline exercise and two-year follow-up smoking status. However, we did find an indirect effect in that smoking-specific self-efficacy mediated the relationship between self-reported baseline exercise and self-reported two-year smoking status. And it was somewhat of a large effect in that smoking-specific self-efficacy mediated about 84% of the total effect of exercise on smoking status. So this provides some evidence that smokers who begin exercising and start to become more active this may augment their smoking-specific self-efficacy or their confidence that they can ultimately quit smoking, which may help to facilitate smoking cessation down the road in the future. We don't know the exact mechanism that explains the relationship between baseline exercise and smoking-specific self-efficacy. We have a few studies right now that's trying to explore this relationship. One potential explanation may be the augmentational global self-efficacy associated with exercise. So exercise itself enhances exercise-specific self-efficacy or an individual's confidence that they can overcome exercise-related barriers. But there's also some work that we're exploring right now to see if exercise itself can increase overall global self-efficacy and how that in turn may increase self-efficacy in other behavioral domains such as smoking. So that's one potential explanation we're excited to explore. And then the potential explanation for the relationship between baseline exercise and smoking-specific self-efficacy is via enhancement in a variety of different cognitive related parameters, specifically executive function which we've talked about in the literature. In this study entitled development of the conceptual model for smoking cessation physical activity, neuro-cognition, and executive function published with my co-authors from Bellarmine University, Pacific University, and Oregon State University. In this paper here we present a conceptual model here and I'm just going to focus on pathway B as well as pathway C plus A. Pathway B here that we talked about in this study identifies the potential for physical activity to attenuate the neuro-cognitive decline associated with smoking. But in reference to what I was just talking about in that previous paper in this paper we talked about the potential for executive function to mediate the relationship between physical activity and smoking itself as well as psychological parameters related to smoking such as smoking-specific self-efficacy. We often define executive function as an individual's ability to engage in a goal-directed purposeful behavior or the inhibition of a goal inconsistent behavior. So based on this definition and based on the fact that we know that physical activity plays a pretty strong role in increasing executive function, in individuals with higher executive function are more likely to adopt health-enhancing behaviors. It's plausible to suggest that physical activity may play a role in facilitating smoking cessation among smokers via this augmentation of executive function. Of course, this is conceptual. At this point we do plan to explore this in detail in some of our future work to assess the utility of this particular model and facilitating smoking cessation among smokers via engagement physical activity. So just to recap on the studies that I've talked about so far with regard to smoking induced DOPD, we know that smokers who in particular have DOPD may have limitations in engaging in higher intensity physical activity via several different factors, one of which I talked about is air trapping or this perception that they can't get enough air in their lungs and they've been smothered by air. So again, as I mentioned this to us underscores the importance of promoting light intensity physical activity. We know light intensity physical activity has beneficial associations with a variety of different cardiovascular disease biomarkers among smokers. There appears to be an additive association between physical activity and healthy diet on some of these CBD biomarkers and we also have some exciting evidence to suggest that physical activity itself may not only have implications in directly influencing cardiovascular disease via these cardiovascular biomarkers but perhaps indirectly via the facilitation of smoking cessation itself. So the next half of my presentation is going to focus on other populations, not specifically those with smoked induced DOPD. I'm going to first continue this discussion of the beneficial associations of light intensity physical activity on CBD biomarkers but among the broader older adult population. So this paper that we recently published this year in 2015 in the American Journal of Health Promotion is entitled evidence to support including lifestyle light intensity recommendations into physical activity guidelines for older adults. And this represented a sample of older adult Americans at least 65 years of age, again utilizing data from the National Health and Nutrition Examination Survey. Again, they were an accelerometer for at least four out of seven days for at least 10 hours per day. And we looked at the associations of both light intensity physical activity as well as monitor vigorous physical activity with a lot of these same biomarkers, cardiovascular disease biomarkers that I've already talked about so far. So we separated moderate and light intensity physical activity and then also looked at them independent of each other. I'm going to first talk about the results from monitor vigorous physical activity. Similar to the previous study that I talked about, we dichotomized participants into leading guidelines versus not leading guidelines, so 150 minutes a week versus less than 150 minutes a week of accelerometer determined monitor vigorous physical activity utilizing the established MVPA cut point of 2-0, 2-0 accounts per minute. All the bolded values here indicate a significant association between the dichotomy of MVPA and the outcome variable shown right here. So as you can see here, those who met physical activity guidelines had lower body mass index, had lower waist circumference, lower tricep skin fold, sub-scapular skin fold, and lower white blood cells, lower neutrophils, so on and so forth. Lower levels of insulin, insulin resistance measured from the homo technique and then lower levels of glycosylated hemoglobin A1C down here. So these are findings that you would expect higher engagement in MVPA or leading guidelines associated with better outcomes specifically CVD biomarkers. More interestingly, however, we also found a lot of beneficial associations with light intensity physical activity. So we dichotomized individuals into engaging in over 300 minutes a week of light intensity physical activity versus less than 300 minutes a week of light intensity physical activity and we utilized the accelerometer cut point of 750 counts per minute to differentiate sensory behavior from this lifestyle light intensity physical activity. Similar to moderate to vigorous physical activity, we saw a lot of beneficial associations of light intensity physical activity with these cardiovascular disease biomarkers and this held true even after statistically controlling for moderate to vigorous physical activity. Both of them are these findings similar to the findings that I talked about in the smoking induced COPD population. These findings among older adults at least 65 years of age underscore the importance of engaging in light intensity physical activity which is of paramount interest because this older adult population may have a disinclination to want to engage in moderate to vigorous physical activity because of a variety of reasons. Some of the reasons that I talked about before with the COPD population or the perceived worry of getting injured these are very exciting findings. The next study that I'm going to talk about looks at daily movement patterns and their association with cardiovascular disease biomarkers. This paper published with Dr. Hill Lee and Bradley Cardinal is entitled daily movement patterns in biological markers among adults in the United States published last year 2014 in the journal prevented medicine. We also utilized accelerometer data to objectively measure these unique daily movement patterns. We ultimately classified individuals into four unique or distinct groups that can range across this continuum of the most active group here to the least active group there. So let's start with the most active group. We defined individuals as engaging in 150 minutes a week of non-to vigorous physical activity and then we also looked at the balance of their light intensity to sedentary behavior ratio. So about 18% of Americans middle aged and older adults engage in 150 minutes a week of non-to vigorous physical activity so they engage in that structure of exercise but importantly they engaged in more light intensity physical activity than they did sedentary behavior. So they were structured exercises but you could also consider them engaging in an active lifestyle approach so they essentially walked more than they spent time shitting during the day. The next group not as a favorable group with regard to daily movement patterns are those who engage in that structure of exercise for example so they engaged in 150 minutes a week of MVPA but they had a negative light intensity to sedentary behavior ratio so you can view them as structured exercises but then they sat more during the day than they spent sort of walking out of light intensity. The third group even less of a favorable group which only consisted of 9% of Americans middle aged and older adults these were people who did not engage in a sufficient dose of MVPA so less than 150 minutes a week but they had a positive light intensity physical activity to sedentary behavior balance so they walked around in a light intensity more so than they sat during the day but again didn't reach that threshold for structured exercise. And then the last group which comprised the majority of Americans almost 50% of Americans were those who were not sufficiently active with regard to participation in MVPA and also had a negative light intensity to sedentary behavior balance or stated another way they sat more during the day for example than they spent walking during the day. Not a light intensity physical activity. So these are the four unique distinct groups that we identified. You can see most of Americans fit into this less than favorable group and then we looked at the association between these different groups with regard to the same cardiovascular disease biomarkers that I've talked about previously. The reference group here is the least active group and as you can see here and as expected the most favorable group those who engaged in that structured exercise and employed an active lifestyle approach they had more favorable levels of almost all of the biomarkers. There's also favorable associations in the other group who engaged in structured exercise but then sat more during the day than they spent walking at a light intensity. And very few associations emerged with this group of those who did not engage in structured exercise at a sufficient dose but had a positive light intensity physical activity to sedentary behavior balance. Notably however there were a few biomarkers that were more favorable in this group compared to the reference group. Which provides some suggestive evidence that even if you don't engage in a sufficient dose of MVPA engaging an active lifestyle approach may have important implications on cardiovascular disease. So again an active lifestyle approach walking a little bit more standing walking more so than you spent sitting throughout the day. So I talked about in this last half of the presentation among the broader adult population the beneficial associations of light intensity physical activity just talked about the importance of considering MVPA light intensity physical activity and sedentary behavior or the ratio or the balance of these different intensity levels on cardiovascular disease. And the next thing that I want to talk about also addresses an important behavioral pattern. Looking at the difference between shorter bouts of physical activity versus longer bouts of physical activity and implications it has on health outcomes. So this study recently published this year a few months ago in Mayo Clinic Proceedings entitled Accumulated Short Bouts of Physical Activity are associated with reduced premature all-cause mortality implications for physician promotion of physical activity and revision of current U.S. government physical activity guidelines. So again utilizing a representative sample of Americans from M. Haynes from the 2003 to 2006 cycle with these participants followed through 2011 to assess mortality status. We looked at the independent associations of doubted, large vigorous physical activity and non-doubted large vigorous physical activity as shown here in this table. We looked at these parameters in a Cox proportional hazard model and you can see here both non-doubted and doubted MVPA were significantly associated with reduced risk of all-cause mortality. So a 10 minute a day increase in non-doubted physical activity was associated with a 27% reduced risk of all-cause mortality. A 10 minute a day increase in reduced risk of MVPA, reduced risk of all-cause mortality, excuse me. We defined doubted MVPA as physical activity, specifically moderate to vigorous physical activity that lasted at least 10 minutes in duration. Non-doubted MVPA we defined as moderate to vigorous physical activity that did not last at least 10 minutes in duration. So a 5 minute quick bout of MVPA walked into the car for example really quickly so any MVPA that did not last at least 10 minutes in duration. So these findings underscore the importance of engaging in sort of that structured exercise that doubted MVPA but also underscore the importance of that active lifestyle approach so you can still have beneficial effects if you engage in non-doubted MVPA according to these findings. Now the next today I want to talk about specifically focuses on adults who are at a high risk for developing a cardiovascular disease event in the next 10 years. In this sample here we again using a representative sample from NHANES we utilized the recently developed pooled cohort equations from the American College of Cardiology and the American Heart Association. We delimited our analysis to individuals who did not have any experience or any exposure or diagnosis of any cardiovascular related disease or cerebral vascular related disease. So these were individuals at baseline who never had a cardiovascular disease related outcome. And then we further delimited the sample to those who had a high risk for developing a cardiovascular disease event within the next 10 years so we utilized the ASCVD cut point of 7.5% again those who had a from the pooled cohort equation algorithm, those who had a 7.5% score were included in the sample. So these were again all individuals who were free of cardiovascular disease but were at risk for developing a cardiovascular disease event within the next 10 years. And we looked at the association between physical activity and mortality among this at risk or high risk population. Table one here essentially just looks at the study characteristics among those who are alive at follow up versus those who are deceased at follow up. 309 individuals were alive at follow up and then over the 8 year follow up period 68 high risk individuals died. Those alive at follow up you could see at baseline they engaged in more monitor vigorous physical activity and also had a lower ASCVD score. Now in our weighted tox proportional hazard model as you can see here for every 10 minute a day increase in monitor vigorous physical activity among these at risk or high risk individuals they had a 42% reduced risk of all cause mortality. Underscoring the importance of engaging in physical activity not only among the broader middle age and older adult population but especially among the middle age and older adult population who is at high risk for developing cardiovascular disease within the next 10 years. So so far I've talked about a lot of our studies that among COPD patients as well as among the middle age and older broader adult population that looks at the beneficial associations of physical activity on health outcomes specifically light intensity physical activity on CVD biomarkers as well as all cause mortality being another outcome of interest in some of our work. I'm going to finish up here with a study that looks at the determinants of physical activity behavior in chronically diseased individuals to give us a sense of particular ways in which we can help to promote physical activity among these vulnerable populations because we know physical activity itself can have a beneficial effect so identification of factors that influence physical activity is a great public health interest. This paper recently published in support of care and cancer. It is entitled theory based predictors of follow up exercise behavior after a supervised exercise intervention in older breast cancer survivors. So these were all breast cancer survivors but they did have a variety of other types of comorbidities. This sample included 69 breast cancer survivors. They went through a 12 month randomized control trial and we looked at the efficacy of different modalities of exercise on different outcomes. But this specific study here that I'll be talking about focused on them right at that end period of the intervention. So after the 12 month intervention we had them complete a questionnaire that assessed a variety of different behavioral and psychological constructs vetted within the trans theoretical model and then we were interested in seeing if individuals who were more of these processes of change, which I'll talk about in a second, would be more likely to maintain physical activity as they transition from a supervised exercise environment or intervention to a home based sort of environment. So as I alluded to, we utilized the major tenets of the trans theoretical model so we evaluated their exercise specific self efficacy and other confidence that they could engage in exercise in the presence of other exercise related barriers we assessed decisional balance or the weighting of pros and cons for physical activity. We looked at processes of change, which included behavioral based processes of change and cognitive based processes of change. As you can see here from this model these breast cancer survivors at base of transition from the supervised intervention to the home based intervention, those who had higher levels of self efficacy were 10% more likely to be sufficiently active six months later on their own exercise and on their own. Similarly, breast cancer survivors at that point of transition from the supervised to sort of engaging in exercise on their own, those who utilized more of these behavioral processes of change were more likely to be sufficiently active six months later. So collectively, these findings underscore the importance of among these chronically disease individuals when they are preparing to engage in exercise on their own that we teach them these behavioral process of change, which I'll talk about in the subsequent slide that can help to facilitate future physical activity behavior as well as maintain this behavior over time. And I'm not going to talk about it today, but we also have some other work demonstrating that the utilization of these behavioral processes of change play an important role in influencing self efficacy, which as we showed as I showed here plays an important role in long-term physical activity behavior. So with regard to these behavioral processes of change, there's five main behavioral processes of change which include self liberation, helping relationships, counter conditioning, reinforcement management, and stimulus control. Now these are all the skills or the strategies that we want to teach these individuals to increase their likelihood of initiating and maintaining physical activity. With regard to self liberation or making a commitment, this can often be done via a contingency-based contract that they can use to help to facilitate their physical activity behavior. With regard to helping relationships, we find that it's very critical that these chronically disease individuals who are in need of physical activity enlist social support. Social support, as we all know, demonstrated to be a strong predictor of physical activity across a variety of different populations. So this can be done via several different approaches, but the common four-step approach would be having the individual identify the problem, which in this case might be physical and activity, identify another reference individual who can provide that support, have the courage to ask them for support, and then lastly, reward that supportive individual so they'll continue to facilitate social support or exercise-related support. Counter-conditioning is another behavioral-based strategy that we recommend to facilitate physical activity or using substitutes or substituting less than desirable behavior with a more desirable behavior. So we're all familiar in the smoking literature, using some type of chewing gum. So substituting less than desirable behavior with smoking with a more desirable behavior. In the exercise domain, it could be, for example, instead of after dinner watching TV, I'll take a quick brisk walk before engaging in sort of leisure activities that might be more sedentary based in the evening. Another behavioral-prositive change is reinforcement management or utilizing rewards. So after these, we find individuals who utilize rewards after they accomplish some of the short-term goals are more likely to adhere to the physical activity program compared to those who don't. A sensible recommendation would be to utilize rewards that facilitate the behavior in the future. So, for example, allowing yourself to, after you accomplish a short-term goal, buy yourself a pair of walking shoes or sign up for a trail race or something like that. And then the last behavioral-prositive change that appears to be associated with physical activity stimulus control are managing your environment, utilizing cues or prompts to facilitate physical activity behavior. So, for example, scheduling physical activity into your calendar. So back to the outline here. So just to recap, I talked about the limitations of higher-intensity physical activity among chronic disease individuals could be a result of a variety of different factors, one of which we talked about today was exercise-induced air trapping. So this underscores the importance of engaging in light-intensity physical activity. We talked about the beneficial effects that light-intensity physical activity has, the potential additive effects of light-intensity physical activity and diet on these cardiovascular disease biomarkers. The exciting merging work suggesting that physical activity itself may help to facilitate smoking cessation. The underlying mechanism to this needs to be explored and we're looking forward to some of our future work on this topic. And then we talked about the unique contributions of molecular physical activity, light-intensity physical activity and sedentary behavior and their associations with cardiovascular disease biomarkers. And then lastly, I just talked about ways in which we can promote physical activity among chronically disease individuals which include the utilization, in particular, of behavioral-based strategies. So my last slide is here to conclude. As I sort of just mentioned, now last slide is that older adults with chronic disease may be intolerant to higher intensity physical activity levels. I'm just going to importance of light-intensity physical activity based on what I've talked about today. There's some suggestive evidence from our studies as well as other excellent research out there demonstrating that light-intensity physical activity may not only help to improve cardiovascular disease risk factors, as well as prolonged survival. It may even help to facilitate the adoption of other health behaviors. And then lastly, given the beneficial effects of physical activity on health, it's important that we identify evidence-based strategies to promote physical activity in one particular way, maybe the utilization of these behavioral processes of change. So thank you for your attention. Again, it's a pleasure to give this talk and share some of our recent work. I'm happy to answer any questions that you may have. And again, as I mentioned at the beginning of this presentation, I'm happy to correspond via email if you have questions that you'd like to address in that form. Thank you. Great. Thank you very much, Paul. Fantastic, fantastic presentation. Very informative and enjoyable. I've got a couple of questions, but before I ask, one of my colleagues from the University of Waterloo, Laura Gengorio, has a couple of questions. What do you think are the key knowledge gaps related to exercise in older adults? Key knowledge gaps specifically in the older adult population. We have some fun. I think most people think that it's common knowledge that physical activity itself can have beneficial effects, and I would agree to that to a certain extent. We have some other work that I didn't present today demonstrating that across a variety of different age populations, individuals aren't as knowledgeable actually as far as the health enhancing effects of physical activity. So I think one particular knowledge gap is increasing their awareness of the beneficial effects of physical activity itself. Not only at the higher intensity levels, monitor vigorous physical activity, but I think another knowledge gap, especially in the older adult population, is their knowledge and awareness of not only the beneficial effects of exercise, but of this light intensity physical activity, which appears to be emerging in the literature as a beneficial intensity level. Great. And Laura has a follow-up. How does resistance training fit into all of this? That's a great question. Thank you, Laura. Most of my work and interest focuses on ambulatory based movement. We do actually have some work right now in review demonstrating that on the middle age and older adult populations, which I think is common with a lot of other literature showing beneficial effects, obviously, of muscle strengthening activities, essentially just the contraction of the muscle itself can help to regulate glycemic levels, which can have implications on diabetes and other chronic diseases, which ultimately influences survival. We have some other work that I find to be very interesting. It's in review right now that looks at the additive effects of aerobic-based physical activity and resistance training or muscular strengthening activities on a variety of different outcomes. So we've looked at multimorbidity as an outcome. And similar to what I mentioned today with regard to the additive associations of physical activity and dietary behavior, we find additive associations of physical activity and resistance training on several different outcomes. And so I think both are important, but especially among older adults, perhaps who may have limitations with amateur-based movement, I think a sensible strategy most certainly would be engagement in resistance training initially. Great. And she's asking for clarification. Oh, sorry. Go ahead. She's asking for clarification. What are the gaps that we need to fill with future research? So the next best, I guess the next important research question might be what? Yeah. I think, you know, there's been, we have a paper I didn't talk about today that look at the dose response effects of monitor vigorous physical activity on CVD biomarkers and all-cause mortality that was published in preventative medicine. So I think a lot of work is starting to look at sort of the optimal dose of NVPA on these different health outcomes. I think what we need to start to look at, especially based on this emerging work that light intensity physical activity can have beneficial effects would be to look at sort of the optimal dose of light intensity physical activity on a variety of different health outcomes among the older adult population. Great. Thanks. A question from me. Some of your slides you were talking about behavior and it brought back a systematic review I had done for the Agency for Healthcare Research and Quality about health risk appraisals in the elderly. And I'm wondering what your, if you've done any work or what your feelings might be on the effect of health risk appraisals to modify risk factor behavior. Yeah. I'm not as well versed in that area. But I do think that can be very important identifying the individual level risks that these participants may have and then helping them overcome some of the barriers that they may have so they can engage in safe forms of physical activity. I think that's of critical importance. Right. And also you were talking about the importance of social participation. And one form of social participation is religious activity. Have you looked at any of that in your work, the impact of religious participation for example on whether it encourages physical activity or anything like that? I haven't specifically but it's a very fascinating area that filled the religiosity and physical activities. I find that quite fascinating. But we haven't specifically looked at that. We've had some discussions about possibly looking at that with some of our, with one of my PhD students in the future. But nothing at this point yet. The whole dynamic of sort of group physical activity I find to be quite fascinating. I think obviously it can help to facilitate physical activity. But we also want to be mindful that sometimes it can be counterproductive via for example the social loathing phenomenon. But it's something of interest but we haven't explored yet. Great. So are there any other questions? So Laura is saying thank you for answering her queries. Are there any other questions from anyone from the audience? So we'll give people maybe a few seconds to type. Okay. Well, we've got another thank you. You're welcome. So I think we're not going to get any more questions. So Paul once again I thought it was a really great presentation. Very informative. And thank you so much for taking the time to present to us today. My pleasure. Thanks for the opportunity. Great. Thank you. And so for those of you in attendance we thank you very much for joining us for this final webinar of 2015. And our first webinar in 2016 will be held on January 21st from 12 to one eastern time. Diana Koo from the United Kingdom is going to present a talk called aging is a lifelong and socially patterned process. Insights from a life course approach using a maturing British birth cohort study. And of course, Professor Koo is one of the seminal authors in the area of life course epidemiology. So promises to be another great presentation. And the bar has been set very high by Paul's presentation. So thank you very much again, Paul, for presenting today. And I wish everyone a wonderful afternoon and happy holidays.


Hello to everybody who did Copic Commander 788 here and this is another comparison video comparing a modern GI Joe action figure to the vintage equivalent and this time we're going to look at the Baroness. This is version 1 of the Baroness from 1984. This is version 12 of the Baroness, originally released in 2009 and then re-released in 2014 as part of a 50th anniversary set. The 2009 release came with this submachine gun and her figure stand. The 50th anniversary set came with lots of other little gadgets. Despite the fact that modern action figures are in a larger scale than the vintage, these figures appear to be very close to the same size. Taking a look at the 1984 version 1 of the Baroness, we see that she has all black. Most of the action figure is just black plastic.  We have painted glasses and painted lipstick. We have a red painted cobra sigil on her chest. Other than that, there is no paint anywhere else on this action figure.  The vintage figure had two accessories. It had her laser rifle, which was I think a little oversized for her. And also she had a backpack with a sculpted cobra on it and this backpack I always thought was kind of useless. I mean, it looks cool but the Baroness does not really need a backpack. She did come with a backpack though, so that's the accessories on the vintage figure. Looking at the modern figure, we can see that she's still mostly black. She had two accessories. She had this submachine gun, which I think is probably more appropriate for the Baroness. And she came with a figure stand, which had her name on it, codenamed the Baroness and a cobra symbol there on the top. And that was nice. That's a nice thing that modern figures did. Vintage figures did not come with figure stands. But as you can see, she's still mostly black. She does have a red sculpted cobra on her chest. And she has a few silver details, a little paint on her belt. And I think that's just enough detail to make it look a little bit better. I think that if you did too much paint on the figure, I think it might detract from that really nice sleek black design, which I really liked about the original. Her sculpted on hair really restricts her head movement a lot. But other than that, she has lots of good points of articulation, far more articulation than the vintage figure had. And of course, that's a plus with modern figures. Looking at the file cards, the file cards are almost identical. They did change the artwork on the modern file card. The text, however, is almost exactly the same. Really, only one small part of it was rephrased. Other than that, the text is identical. On my last comparison video, some comments were made about the proportions of the snow serpent. Well, if you thought the snow serpent looked stretched out, this figure looks like it's been in the taffy puller. Her limbs are very long and thin. Her torso is very thin and her head is tiny. Now, the vintage figure also does not have perfectly human proportions. Really, neither of these action figures are proportioned realistically. The proportions of the vintage figures are kind of chunky, but that's because they're toys. I mean, they're made for small hands to be able to get around and manipulate. Now, the modern figures are also misproportioned, but I think it's because they're not toys. I mean, these are really designed to have a lot of posibility and for collectors to pose them and freeze them into one pose that they like and leave them there on a display shelf. As usual with the modern figures, this looks great. This bareness looks very nice. Lots of great detail, very sleek design. A lot of time and effort went into this. But I mean, this is a toy. This is the action figure that we took on great adventures. And I'm not sure this is a toy. So this is the ultimate dilemma between modern and vintage GI Joe action figures. Looks great, plays great, tastes great, less filling. As always, I want to know what you think about these action figures, so leave a comment on this video. And don't forget to check back with this channel for full vintage GI Joe tour reviews. I'll see you next time.


Yeah, welcome back to Think Tech. This is Community Matters. We're talking about the Manoa Heritage Center this morning, and we're delighted to have them on the show. Their executive is Jessica Welch, and she joins us from Manoa. Am I right about that? You're right. I'm physically in Manoa at Manoa Heritage Center, and I'd like to introduce my colleagues. We have Jenny Engel, who is our director of education. Keala Wong, a cultural educator, and they are the team that engaged the public with what we talk about here at Manoa Heritage Center. Hey, very important. This is in the heart of Manoa. It's got a hey out there. They're quite remarkable and it exists even today in the 21st century and is preserved by the Cook family. It's really wonderful to have this treasure of island culture, kama'ina culture, if you will, going back into the early part of the 19th century, and you guys carry the torch. It's more than a cultural center. It's like a museum and cultural center right there in Manoa. It's well worth the visit, and today we're going to have a bit of a tour. We're going to have a virtual tour with Jessica and Jenny and Keala. So Jessica, why don't you tell us the history of the Manoa Heritage Center and how it got organized and what it is and why I should come to see it. So Manoa Heritage Center was founded in 1996 by Sam and Mary Cook, like you said, and the mission is to promote an understanding of Hawaii's cultural natural heritage. So Manoa really started long before then. Manoa is part of the Ahupua Waikiki, and so that goes Makiki all the way to Kulio'o, so it's a pretty big land division. And before Westerners arrived, Manoa was a bread basket for this entire land division and grew highly cultivated forms of kalo, wetland kalo. The Ali'i would come into Manoa to escape the dusty plains of Honolulu. And we believe that Kuka'o'o, the hei'o was an agricultural hei'o because of its location here in the heart of Manoa, kind of on a taller precipice overlooking what would have been Lo'ikalo. And it's a time marker. The hei'o is oriented diagonal north, which means that on the spring and fall equinox the sun rises directly over the eastern side. And we've done that. We've gotten up early in the morning to make sure that that's true and indeed it is. So after Western contact, Manoa became a site of dairy farms, vegetable farms, flower farms, Chinese families took over the Lo'i, Japanese families grew vegetables and flowers. And then of course you have UH and Punahoe and Miipak, and then it became the neighborhood that it is today. And then our story moves on to Monty Cook who was the grandson of the Cook mission, the missionaries who came here to teach at the Royal Children's School. So he was given this plot of land for a wedding present. And he built, he decided to build his home here. And then he was born, he was born at the frame house so you can go down to Hawaiian Mission Children's Society and that's where he was born. He was two and a half pounds when he was born. And a Hawaiian healer was brought, and so this would have been the late 1800s, like 1870s. And that would scare a parent even today. So he was brought, a Hawaiian healer was brought, Ka'aha'ina Naihe was brought to heal him, and she did.  Fast forward to the late 1800s, he's given this parcel as a wedding present. And what is now 33.5 acres was 30 acres. He built a house here, and kind of left the hail alone. He was brought to the 1970s. Sam and Mary Cook by the house from the family. And then in the 90s, they buy the land back from a developer and decide to take care of it. And they have. And they have. And then, so they made the decision to restore it they worked with a group of practitioners because they obviously had never done that before. And Billy Fields came and he is kind of the renowned dry stack stone Mason and he restored the hail based on the information that he had at the time. And they looked at each other, they replaced all of the plants surrounding the hail with native plants. And then they looked at each other and said, Now what, what are we going to do now now that we've done all this work and that's when they started my know heritage center. And they said, Well, we should share this with schools in particular. And so that's been our focus for the last 20 years is making sure school kids have access to this site. So it is comprised of course of the hail. By the way, what is an agricultural hail, as opposed to another kind of hail. Keala, do you want to answer that. Wait, first, you have to introduce them proper. Okay, I want to introduce my colleague Keala Wong, she's our cultural educator and she could answer that question for us. Hi everyone. So, I mean, all that we know from historians written records and also from people who have passed it down early. You know, the what the people of what you were very thick, everything was sacred to them right and everything that they did they would say prayers. I've heard from my cumul that they would pray 50 times a day. It was just normal. And so they would build places specific to certain needs and prayers and they would have certain deities that were raised at these sites. And so other hails that or not even everyone uses the word hails, but other temples that were common were like Pohakulakane or Pohakulakane, which would be more like the family kind of shine which would be one rock that was erected up. And then, of course, the Luakini which were the political kinds of hails so larger on demanded more attention and had bigger ceremonies than like an agricultural one like the one we believe is what we're taking care of here, which is a little bit smaller. Okay. And so, back to you for a minute, Jessica's aside from the hayow. I recall I was there a few years ago and I recall. There's a lot of walking paths around the heritage center, and a lot of a lot of plantings, you know, on those walking paths can you describe physically. What's in the center. So plants in the center so in the early 90s, Mary decided Mary cook that she wanted to plant native plants. And so she took out all of the rubber trees and the banyan trees. And back then they didn't have nurseries for native wine plants and so she likes to say that she had to beg borrow and steal to get seedlings. She got, you know, plants for the native tropical botanical garden and Amy Greenwell on the big island. And so today as you walk through Manoa heritage center you see different examples of what is native plants and these are important because they tell the story of what is culture and every plant had a lot of uses to it, you know, whether it be shelter food medicine hula. And so the more we know about these plants and their place in the culture, the more we understand about ourselves. And the interesting thing that you know you, you see, at least in recent times Manoa as a bedroom community for the university mostly. It's a, it's a regular residential neighborhood. And you can drive by Manoa heritage center 1000 times and never realize it's right there, 30 acres of land and you don't see it from the road. It is in the very heart of Manoa, it is the heart of Manoa, and somehow it keeps Manoa Manoa. Yeah, no, that's a, that's a great description. And it's it's three point it originally it was 30 acres and now it's 3.5 but we maximize every single amount of that space for the benefit of our community.  You can't show it's it's history is what it is. Can you talk to us about the history of, of this area. So interesting, Jade, that you've written bring that up about you can drive past this place hundreds of times. I actually grew up just half a mile away from here. And so I grew up right behind why only tea room. And actually, I really had no idea about the hey out until you know I came here for my interview four years ago. It's true and I in the four years that I've been here I've learned more about Manoa than you know my entire growing up and it's it really has been so rewarding. I think, not just because I grew up here but because I live on this island and I feel like the connection that can happen. Just when you ask questions when you're curious about place, especially in Hawaii because place has so much meaning, and all of the Mo'olelo all of the stories, you know that were passed down orally. I mean it really kind of opens up a whole nother perspective I think, and one that is really needed today I mean with all of the challenges that this year has brought. I feel like what we do is more important than ever you know sharing this place specifically Manoa to students, but like Jessica alluded to earlier you know with the hopes that visitors students will come learn about this place and then be inspired to go back to wherever they live and ask those questions about their own place whether that's in Hawaii or you know in another state or in another country. So yeah you give tours is that what happens. So if I come now and I and I want to see I want to appreciate it you'll take me around show me the hey I'll explain the history. Yes, and because that's a great point just because we're a small organization all of we do offer tours right now of course it's a little limited with the current restrictions. But in general because Coolie is still a private residence. You do need a reservation you can't just walk on well you might be able to walk on and give you a tour, but not anyone usually need a reservation in advance. Okay, yeah sure. Well COVID I'm sure COVID Jessica has changed things for you. And I like to know about that is very frustrating, but at the same time, it makes you innovate. And you find things perhaps that you wouldn't think of before. Can you talk about that. Absolutely. Yeah, COVID. So we typically have 75 kids here a day. Going through Munaway Heritage Center and doing hands on activities so our mornings are spent with groups of students but obviously starting in March week we haven't done that since March. So, which means that we had to innovate and way to stop doing that and then now built virtual resources so Jenny and Kayla have worked really hard to create virtual tours for teachers and they customize them based on the teacher's needs they have done curriculum based on what we call the water hood so examining how water flows in your space, you know from the mountain down to the ocean but what it does in between is really interesting or maybe what it should do and what it isn't doing. And so they've created videos and presentations that and we use Zoom or WebEx to engage students in that way. So that's been something those are things that we've always wanted to do but never had the time.  So we're taking this time to stop and reset and think about how we interpret this history, and wanting to have a more inclusive history. And so we're doing a lot of work to be of our community by our community and for our community that means that we bring the community in and they're reflected in our staff and our volunteers and work with them to reinterpret Munaway Heritage Center, rather than doing all this work for someone. So who comes? I mean is it tourists? Is it local people?   Who comes? Who can you give us a kind of demographic of who comes around for the tours? Well the nice thing about COVID is that we've had a lot of Kama'ina come and a lot of Manoa residents, you know people who walk past here all the time walking their dogs and they finally have the time to come and visit and see what is this place. And so we've had a lot of Manoa residents and that of course is a target audience for us because we want to make sure everybody in Manoa has access to this resource. And in terms of, you know, race, I would say it's all of the races that are reflected in Hawaii come to visit. Prior to COVID we did have quite a few tourists but we've always been focused on the local community first and making sure we have programs that engage them. Like for instance we would have workshops with practitioners on Saturday mornings and we'll probably start doing more of that in 2021. We'll resume, pick that up in 2021 on a small scale. And those are all Kama'ina. So our theory is if you focus on Kama'ina the tourists will also enjoy it rather than the other way around. Yeah absolutely. You want to remain as pure cultural as you possibly can. Speaking of which Keala, you know, it's like Hawaii had its grand day in the 19th century. That's when it was still a kingdom. That's when it was, you know, luxuriating in the pure Hawaiian culture.  What do you study? You know, to find all of what there is to find in Hawaii culture. Well, that is actually, that's actually, there's a lot. And so just to mention that we are currently just kind of trying to expand our perspective. And so for a long time the history of the 19th century was told through kind of a certain lens, right, the lens of the Westerner, because those are the resources available in English. And so there has been a big, I guess, need and want for other perspectives, especially the Hawaiian. And there's a lot of newspapers from that time that places are who is like of a via Lulu and of a Kono Hiki who are making the their online resources. And they're making these Hawaiian previously just in Hawaiian but now translated into English available to the wider public to get more perspective on that era. Personally, I, I'm more of a Makahana kaike so hands on kind of learning and so my interest in research is doing the practices. So I'll see something in a book or I'll see another practitioner on social media doing something, and then bring it here to work and let us let us experiment and I'm very blessed to mention it that all of my coworkers or I like to call them my, my co mates, because we're like, all mates, we're really good friends. We get to dive into these cultural activities together and it's really fun. So are you documenting your, your work.  You can do things you might not otherwise have had the time to do before. Are you taking this period to, you know, write, write anything new down or make it available to people. Jessica, what's the plan. We are, we apply it like kind of a citizen scientist approach and so there's a special drawer in Kayla's office that has all of the documentation of the different, for instance, experiments with kappa and die. We document what we do and then the next the challenge you know it's, it's kind of easy to take a video of something but then editing is where the time comes in and so that's what we need more help with is, is, is editing all the wonderful content that we have in packaging it.  That's right. That's right. We could partner on that. Yeah, should be awesome. Speaking of multimedia why don't we take a look at your slides. Okay, help them, you know, give some three dimensional view of this okay let's put the slides on and, and you can describe what we see what is that. So this is one of our practitioners we, we, one of our favorite things to do is work with cultural practitioners and, and give them an opportunity to share their knowledge and then us an opportunity to learn from them. And this is Kumu Aloha Kikipi, and she is sharing how to weave using hollow, and this this student that is here is somebody who just came to one class once and then a year later. She actually wove her first hat. So it's, it's an example of, you know, a beginner not knowing anything but then being able to take it and now she sells sells woven hats. So this is Kuka Ohao. So this is similar to the view that's behind Keala. And there you can see the north orientation and the view of the back of the valley that you see when you're standing up there. Another view. We often have, of course rainbows in Manoa. And this is one of those days. That's true rainbows and rainbows in Manoa they go together don't they. Yeah. Yeah, it's a big part of our story. Yeah. What's what's this. So this is you'll need to sell the silver who is a who the, well, kappa practitioner rather. And so you can see here some of the samples of her work and all of the plants that she uses to die the kappa. The kappa is was used for clothing bedding. And here in the garden we have examples of the tree that you would have the volcano tree that you would have made kappa from so you can follow that process from start to finish as well in in our workshops. Okay, it was more. And so this is one of our volunteer docents we have a really dynamic volunteer docent program. We have people who love history love culture and then love sharing it. We have a lot of retired school teachers who are part of this group. And this is actually Leslie Turnbull. She is part of the mid pack Ohana, and she is telling the story of Manoa to a group of school kids. That's great. Five minutes away at mid back. And of course, oh, when it's a lot blooming. That's the last one. Thank you for that. So a couple of thoughts come to my mind I want to run them by you okay. Number one is the, the. There's a, there's a plant. I'm blocking on the name is a plant. Repository of plants. Up the hill. Say it again. Yeah, the line of a read them. Yeah. Yeah, the line of a read them to get plants from there because a lot of those plants are extinct. And they're native they're all native species I think that's what they have at the upper read them. You get plants from there because that would be a great source. Absolutely. We, I don't think we get plants from there but we what we do with lion is partner. And so we partner with their education team we have a NOAA grant right now. Or where we partner with NOAA, we started partner with line arboretum and wikiki aquarium to make sure to understand the watershed. And then we also tap into their they have incredible knowledge about plants and so if we have a question we call up at line but, and we've they've allowed us to go up there and harvest for our hula camp. Oh, that's a great connection. Yeah, yeah. The other free association point I want to ask you about is it's the mission houses museum. And has a thing it's a cemetery at the Wahoo cemetery. Yeah, yeah, yeah, where they have it's really it's really chicken skin. They have actors who who tell you who who take on the role of people who lived in in the 19th century. And they sort of arise from the grave. And they tell you the life story.   And it's very very interesting to see these. So do you ever have that kind of experience. I mean do you ever try to do play acting with with people with actual personalities. The kind of them. Some former staff members did a little bit of that they had some some they call it living history when you pick some actors and do a lot of research or pick some historical characters rather and do a lot of research. And some people love it. We haven't done that ourselves yet. The personality at the center. It may not be the same as other Hawaiian cultural organizations. But Keala you mentioned your kumu, and my wife has a kumu and kumus are important, you know to pass down wisdom and culture points and is there is what does it mean to you and what does it mean to Manoa heritage center about the hula. I am new to hula. I'm just a little over a year and I met my kumu hula local Olu Quintero. Actually, when he came with the Kukuna program for the DOE, they came to visit. I was connected here at MHC and he was so willing to share his knowledge with us and you know that was really kind and amazing and offered hula for me. And since then I've learned hula and oli with him and kumu ihi la nichu and it's just, it really expanded my, my Hawaiian experience with myself and with the Aina. And I think he actually kind of is all of our kumus because he really does help all of us and if we ever have questions or need some guidance, you know, he's, he's both of them are right there. It's great. It's great to have a kumu. It really is for sure. Oh, there's a question we have. Oh, how is Manoa a heritage center funded, Jessica. Oh, good question. Good question. We have an operating budget of about $600,000 a year. Dicks are on this place and the bulk of that is funded by donations from individuals. So there are people in the community who support Manoa Heritage Center and also grants. So we cover our budget that way. We also at the same time raise money to grow an endowment so that we don't have to raise our entire budget every single year. Mary cook Mary salmon Mary cook have been extremely generous and setting up that endowment and so that we can have some security in the future. Some people think that Mary writes a check every year but that's not the case, which of course they did donate the land and everything. So, I guess the thing is your are you.  Mary's dream Mary when she passes away she wants to give her house to Manoa Heritage Center. And so that would be part of become part of our campus. And so we would then have a historic home to be able to share with the community. And so we're actually doing an vision and exercise right now to dream and you know how could this 3.5 acre space in Manoa best serve the community and we have lots of ideas. One thing that we're doing now is making the garden more community based so schools come and take care of specific sections of the garden. And once a week and take care of it and then are able to harvest the plants and that's great. That's great practicing, practicing ancient agriculture. That's lovely. We want to do more of that and get, you know, just provide a space where people can get their hands dirty and also talk about heart, you know, some of the parts of history are hard to talk about and they're painful and we want to make this space as a healing space so that we can dive in and build bridges. Very, very valuable, noble even. So Jenny you get the last word. Okay, and, and my question for the last word is, why do you do this. And why do you think Kayla and Jessica do this.  I'm sure it's hard to, you know, to keep on trucking and especially in the time of COVID. And what does it look like for you personally and as a career. I think this is one of those kind of serendipitous organizations and teams, our work, Ohana, you know, I think that because we are all kind of on the same page in terms of working here at Manoa Heritage Center sort of fulfilling salmon history's vision. It's one of those situations where I really feel so grateful to be able to come here every day to work with these ladies and Kevin is the one gentleman on our team and just do this work I think also because we're a smaller organization. I think we're able to, as long as we know that we have to put in the time to get it done. I mean, there's very few obstacles I think to what dreaming and making something come come to life. So that's really nice and then I know from, you know, my past experience has been in a bigger organization and so I know that, you know, that's not always the case. So, if I if I asked you for one word that describes your perception of the Manoa Heritage Center that you would like to leave without viewers. What would that word be. That's a hard question. I have to think about that one for a second. Okay, we're going to come back to you. Okay. Yeah, I'll let you have a word. Peace. What is it. Peace. Peace. What a lovely word. A lovely word. Jessica, have you got a word that you'd like to leave without viewers. Grace. Grace. All right, does that help you Jenny can you come up with a word. I guess my owner have to be Aloha. Aloha. Aloha, peace and grace. Thank you very much. Jenny, Jessica and Keala. Thank you so much for joining us today. Aloha. Aloha. You're welcome. Aloha.


In the small LA community of San Pedro sits the hidden gem of the sunken city, a rocky and colorful seaside spot. Its rugged terrain is the result of several landslides that had occurred in San Pedro starting in 1929. The neighborhoods on the edge of Paseo del Mar slowly slid into the sea, and while residents were evacuated, many homes, bungalows, streets, buildings, and streetcar tracks went over the edge. Throughout the 1930s and 40s, roughly 5 acres of the coastline fell into the ocean. The remains of the fallen structures make up the iconic and unique landscape of the cliffside, which has been featured in movies and TV shows such as The Big Lebowski and Fear the Walking Dead. Today, the land is still sliding, which is why it is now fenced off from the neighborhood and the adjacent park Point Ferman. However, the colorfully graffitied building remains and dazzling ocean view make it an attractive hangout spot for locals and tourists alike. Okay, so I'm now on the actual grounds of the sunken city, and from up here it doesn't really look like much. I mean, you've got some pretty neat ruins over here. You've got this, what used to be an entire street that sort of went off the cliff, and as you continue forward, you can see so much more. So what can you do there? Well, you can hike up and down the trails surrounded by tall, colorful rocks. You can chill by yourself or with friends. You can take a bunch of photos. You can walk along the rocky beach or just enjoy the view. If you are planning to visit, do so with extreme caution. There's a lot of steep slopes, tall cliffs, and broken glass, so explore at your own risk. If you come here every couple months, you'll see newer graffiti, more vibrant, that's new. Wasn't there last time. And some old stuff that's probably been here for a decade or more. And also litter, unfortunately. People kind of get turned here. Looks like some sort of pipe, underground pipe maybe, at one point. There's the other end of it, perhaps. And then one of the coolest parts, I'm trying to climb this slab thing here, is this tree stump that's just been repeatedly graffitied throughout the years. It's a different color every time. Adjacent to the Sunken City is Point Furman Park, also a really cool place in its own way. It has an old lighthouse and the Korean bell of friendship. The bell was donated to Los Angeles in 1976 by South Korea in commemoration of 200 years of U.S. independence, veterans of the Korean War, and a friendship between the two nations. Finally, down by the beach, there are tide pools filled with little hermit crabs and anemone.