Background: This review looks at ways to increase physical activity, by walking and other sports and home activities, to reach the daily 10,000 steps goal. It also looks at a number of issues associated with achieving the daily step goal, such as considerations in walking, step counting and physical activity. Methods: The review is based on MEDLINE (1982-2006) and Google searches using keywords “pedometer”, “daily step goal”, “physical activity”, “exercise”. Results: Research has suggested a daily 10,000 step goal for maintaining a desirable level of physical activity for health. However, this is not normally achievable through routine daily activities. For many, there is a daily deficit of approximately 4000 steps (most from 3000 to 6000 steps), which must be gained from other more rigorous activities. This paper provides information based on the Compendium of Physical Activities, to help people to choose their physical activities to supplement their daily steps, through both sports activities and home activities. It thus helps people to better achieve the goals of Canada's Physical Activity Guide. There are issues to consider in counting steps. A pedometer is not an exact method to measure energy expenditure. Focusing on counting steps may lead to an obsessive attitude toward exercise. Excessive walking and physical activity may lead to certain health problems. Discussion: Walking is a practical and fun way to change our sedentary life style and to improve the health of the nation. When there is a deficit in daily steps, both sports and home activities can be used to supplement the daily steps to reach the daily step goal. The user-friendly table provided in this paper helps people to identify the sports and home activities, and estimate the durations needed, to meet the daily step goal.

Background: Health experts recommend daily step goals of 10,000 steps for adults and 12,000 steps for youths to achieve a healthy active living. This article reports the findings of a Canadian family project to investigate whether the recommended daily step goals are achievable in a real life setting, and suggests ways to increase the daily steps to meet the goal. The family project also provides an example to encourage more Canadians to conduct family projects on healthy living. Methods: This is a pilot feasibility study. A Canadian family was recruited for the study, with 4 volunteers (father, mother, son and daughter). Each volunteer was asked to wear a pedometer and to record daily steps for three time periods of each day during a 2-month period. Both minimal routine steps, and additional steps from special non-routine activities, were recorded at work, school and home. Results: The mean number of daily steps from routine minimal daily activities for the family was 6685 steps in a day (16 hr, approx 400 steps/hr). There was thus a mean deficit of 4315 steps per day, or approximately 30,000 steps per week, from the goal (10,000 steps for adults; 12,000 steps for youths). Special activities that were found to effectively increase the steps above the routine level include: walking at brisk pace, grocery shopping, window shopping in a mall, going to an entertainment centre, and attending parties (such as to celebrate the holiday season and birthdays). Discussion: To increase our daily steps to meet the daily step goal, a new culture is recommended: “get off the chair”. By definition, sitting on a chair precludes the opportunity to walk. We encourage people to get off the chair, to go shopping, and to go partying, as a practical and fun way to increase the daily steps. This paper is a call for increased physical activity to meet the daily step goal.

No abstract

Using a systems-based approach for developing and implementing a residents as teachers (RaT) initiative follows the trend of systems thinking in health care and medical education, and assures positive outcomes and sustainability. This paper outlines the steps for a systematic, program-wide RaT initiative, using the University of British Columbia (UBC) as a case example. Project period was 2013-2015. Study Design The initiative team surveyed 65 of UBC's then 72 residency programs on their level of involvement and comprehensiveness in teaching residents to teach, which they used to create a 0-4 classification system. A six-topic RaT core curriculum was developed and train-the-trainer sessions were offered to build capacity within programs to customize and deliver the topics. An online scheduling system was used to schedule RaT sessions, track resident attendance, and disseminate evaluation surveys. Results A portion of the programs (n=21, 34%) were classified at Level 0, indicating few to no teaching competencies were taught. After the implementation of RaT in four programs, the majority of residents (n=61, 88%) indicated the overall quality of the educational experience was good or excellent. Most responses (n=2-93, 89-100%) agreed or strongly agreed that learning objectives were met for each RaT topic. Conclusions Implementing a systems-based approach for RaT allows for centralized curriculum, administration, and evaluation, but also allows individual programs to have ownership and responsibility over curriculum adaptation, delivery methods, and faculty and resident engagement. Furthermore, the classification system provides a way to identify program needs and track improvements across all postgraduate residency training.

Background and ObjectivesTo date, all reports of pathogenic variants affecting the GTPase domain of the DNM1 gene have a clinically severe neurodevelopmental phenotype, including severe delays or intractable epilepsy. We describe a case with moderate developmental delays and self-resolved epilepsy.MethodsThe patient was followed by our neurology and genetics teams. After clinical examination and EEG to characterize the patient's presentation, we conducted etiologic workup including brain MRI, chromosomal microarray, genetic and metabolic investigations, and nerve conduction studies. Subsequently, we arranged an Intellectual Disability Plus Trio Panel.ResultsOur patient presented with seizures at 2 days old, requiring phenobarbital. She also had hypotonia, mild dysmorphic features, and mild ataxia. Although initial workup returned unremarkable, the trio gene panel identified a de novo heterozygous pathogenic missense variant in the DNM1 GTPase domain. Now 4 years old, she has been seizure-free for 3 years without ongoing treatment and has nonsevere developmental delays (e.g., ambulates independently and speaks 2-word phrases).DiscussionOur case confirms that not all individuals with DNM1 pathogenic variants, even affecting the GTPase domain, will present with intractable epilepsy or severe delays. Expanding the known clinical spectrum of dynamin-related neurodevelopmental disorder is crucial for patient prognostication and counseling.