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Creating Better Health          

A monthly health article that spreads good news and ideas, to create and motivate a healthier lifetsyle.
Written by Russell Certo, PT OCS
www.gimog.com








Exercise and Balance - November 2017

By Ashley Abramo MS, NASM-CPT

    When we think about fitness programs muscle strength, flexibility, and heart health come to mind. These are all essential, but there is one very important piece of a fitness program that is often overlooked: balance.
    Balance is the ability to maintain your center of gravity and overcome instability. Balance training is not just for those who experience balance issues or to prevent and reduce the occurrences of falls. Incorporating balance exercises into your current fitness routine is recommended for everyone from athletes, to those recovering from injury, to the elderly. Balance training will help you to improve your core strength, coordination, and postural alignment which, in turn, should result in fewer injuries and greater stability. Start out by adding 5 to 10 minutes of concentrated balance training into your workouts three times a week. In addition, you can alter some of the exercises that you are currently doing and challenge your balance.
    Try these during your next workout:
  • Base of Support: When youíre standing, the wider apart your feet are, the easier it is to balance. Try to narrow your base of support by gradually moving your feet closer together while performing an exercise such as shoulder raises, bicep curls, TRX rows, planks and pushups. This will help to prepare you for trying these exercises on one leg.
  • Perform Exercises on One Leg: Single leg exercises are great for challenging your balance. Try performing upper body exercises on one leg while keeping your core tight. Be sure that you alternate which leg you are standing on. You want you strong and weak sides to receive equal training. During your workout, stand on one leg and perform bicep curls while balancing. When youíve mastered that, add in an overhead press after the bicep curl for an additional challenge.
  • Use Equipment: There is equipment that is made to help you with balance training. You have probably seen most of these pieces of equipment around the facility - stability balls, BOSU balls, balance boards, and half round foam rollers. These are all tools that you can use with most of the exercises in your current routine or as add-on exercises. Instead of performing a dumbbell chest press on a bench try using a stability ball as the bench, use a BOSU ball for lunges or squats (with assistance if needed), or a plank on a balance board provided that you feel comfortable executing these moves safely. If you would like to learn how to use this equipment or add balance training to your program, please see one of our exercise physiologists!
        Ashley Abramo is the Director of the MOG, a partner of TRILOGY, 1801 Grand Island Blvd.




    The Importance of Flexibility - October 2017

    By Russ Certo PT OCS

       It is important to include flexibility activities in your exercise routine. Flexibility allows for easier movements and efficient use of muscles and joints. Flexibility tends to deteriorate with age, mostly because of sedentary lifestyles or simply ignoring stretching on a daily basis.
        Stretching increases blood flow through muscles and joints, while delivering essential nutrients to these tissues. Stretching also stimulates the lubricating fluids inside your joints. It improves joint "range of motion" making your movements easier and more efficient. Flexibility decreases stresses on joint, therefore reducing joint pain. Unfortunately, as we age the incidence of falling and sustaining injury increases dramatically. By having strong efficient and mobile joints you can potentially reduce the risk of falls and injuries.
       There are things you can do to improve your flexibility; 1) Add stretching activities to your daily routine 2) try a MOGA, it does for your joints what a massage does for your muscles. Contact me for more information about a MOGA or an individual stretching program. Russ is the Founder and Director of the MOG, a partner of TRILOGY. 1801 Grand Island Blvd.




    Balance and Falling - September 2017

    By Russ Certo PT OCS

        Loss of balance and mobility are not inevitable as we grow older, but sudden falls in older individuals are a concern because the incidence of balance problems is known to increase significantly with age. The risk for serious injury increases as well. The good news is that many older individuals at risk for falls can be identified and helped.
    Risk factors
       So how do you know if you are at risk for falling? There are several known risk factors, both related to yourself (physical fitness/ailments, psychological and social factors) and your environment (the surfaces you walk on, obstacles, lighting, etc.), that can increase your susceptibility to falling. Some common indications include symptoms of dizziness or unsteadiness, taking one or more medications, a recent period of bed rest or inactivity, loss of strength or feeling in the legs or feet, or a loss of confidence in your ability to get around. However, there are many other subtle indicators that you or your physician may not even be aware that you have. To complicate the matter, falls are not typically the result of a single cause or risk factor. More often, they are the net result of a combination of factors.
    Key physical factors
       Balance problems and dizziness are obvious indicators that someone is at a higher risk for falling. It may not always be obvious that your balance is diminished, as unsteadiness may be caused by a number of smaller physical ailments that alone would not cause a person to fall. However, the combination of relatively minor problems can be a significant risk for falling.
       Other key physical factors include reduced muscle strength in the legs and painful or unstable ankle, knee and hip joints, which can impact your ability to support yourself and quickly recover from sudden changes to the surface you are walking on. Limited range of motion and flexibility can make stepping over obstacles and walking on uneven or inclined surfaces more difficult. Arthritis can be an indicator of fall risk because it can result in poor range of motion, reduced muscle strength, and a loss of sensation at the affected joints. Poor vision and a history of ear infections or inner ear disorders are also risk factors. While having one or two of the above risk factors will not necessarily cause someone to fall, the likelihood of falling increases with the number of risk factors that are present.
    What Can You Do
        By remaining active in your daily life, you maintain your strength, flexibility and coordination, as well as your ability to keep your balance in a variety of conditions. If you notice that you are unable to confidently perform certain daily tasks, you should speak to a Professional. See Balance Self Test.




    The "Blue Zone" Lifestyle - August 2017

    By Russ Certo PT OCS

       Scientists have discovered several regions on earth where the people routinely live to be 100 yrs. old, rarely succumb to chronic disease and generally die peacefully in their sleep. These regions are referred to as "blue zones". The commonalities of these regions are; They donít smoke. Are active every day. Eat fruits, vegetables and grains. Put family first. Stay socially engaged. Simply put "blue zone" communities donít smoke, eat food close to nature, stay active and have positive meaningful social relationships. These are all components of a healthy lifestyle.
       Most chronic diseases are not inevitable and are not unfortunate incidences like breast cancer or multiple sclerosis. 80% of chronic disease and its effects on health and the cost of healthcare is the result of poor choices by individuals. Unfortunately this idea is not new and has been in the public discourse for over 25 years, yet we continue to deteriorate as a society with respect to overall health.
       It is as simple as turning knowledge into action. In past articles I have discussed making small changes, changes that you can succeed at and then build on with other small changes. In a lifestyle management process you can put all potential healthy changes into six categories;
  • Nutrition/eat good food, not too much, mostly vegetables and fruits.
  • Activity/exercise 3 times per week minimum.
  • Eliminate smoking/drug use including pain killers.
  • Sleep, better quality and quantity.
  • Stress/ all life has stress manage it better.
  • Love/ having positive social relationships and purpose in your life.
       If you and I were sitting down to discuss these things, I would ask you to identify one healthy choice you are willing to make and to strategize how together we can get that accomplished in your life. Do you take some kind of pain killer and want to stop? A lifestyle change can help you. Do you have too much stress? You can learn to manage that stress better. Do you want to exercise or eat better or learn how to make healthy choices? Just pick something and find experts to assist you. I never said it was easy, I simply say that with friends', family and support you can make a lifestyle change that is helpful and meaningful. After all isn't part of our deal in any relationship to be the best you that you can be? Then it's your responsibility to your spouse, your kids, your family and friends to be healthy, live long and actively.
        Russ Certo is Founder of Trilogy a Lifestyle Management organization; rcerto@mognational.com.




    How Should We Really Be Assessing Overall Health? - July 2017

    By Russ Certo PT OCS

        In the health field, Body Mass Index (BMI) is used as an indicator for body fat. This measure is adjusted for height, calculated as weight in kilograms divided by the square of height in meters. A fundamental issue with this calculation, and the correlations it is said to indicate, is that it measures excess weight rather than excess fat. The Department of Health and Human Services coins BMI as a surrogate measure of body fat, meaning, it is a measure that may correlate with other true clinical diagnoses, but it is not a guaranteed relationship.
        BMI is used as a screening tool to assess body fat because it is inexpensive, noninvasive, and used universally by healthcare professionals. In addition, studies show a correlation to health risks associated with high BMI as predictive measure of morbidity (disease) and mortality (death). Although BMI measurements are easy to perform, they do have issues to consider. BMI does not account for confounding variables that influence body fat distribution such as, age, sex, ethnicity, and muscle mass. In addition, BMI does not have the capacity to distinguish between fat, muscle, and bone mass distribution. The shortcomings of BMI call for an assessment of our current evaluation methods, including new proposed protocols for evaluating the health of individuals.
    BMI Classifications Then and Now
       Over the past ten years a lot of research has gone into the evaluation of body composition to evaluate the overall health of individuals. This influx of research parallels the obesity epidemic that has been spreading through the United States over the past few decades. Research shows that excess fat increases risk for cardiovascular disease, stroke, and Type II Diabetes. BMI is a weak correlator to comorbidities and mortality rates because BMI is unable to consider family history, hypertension, coronary artery disease, and other metabolic conditions.
       Since BMI is based off height and weight, it cannot stand as a strong indicator of fat distribution because a higher height to weight ratio may not be indicative of more fat tissue. For example, imagine an adult male with a height of 5' 10" and weight of 170 lbs, went in for his annual physical and his BMI was scaled in the normal range at 24.4. Over the next year, this man trains in heavy weight lifting, and puts on twenty pounds of solid muscle. The next year at his annual physical his new BMI is reported at 27.3, and he is now classified as overweight. It is inaccurate to distinguish this individual as unhealthy. This is one example of how BMI can be inaccurate for establishing an accurate perspective of overall health.
        A psychologist at UCLA and her research team published a study last year that opposes all use of the BMI parameter in assessing overall health. The researchers studied the link between BMI and used health markers such as blood pressure, and glucose, cholesterol, and triglyceride levels. Data was used from the most recent National Health and Nutrition Examination Survey (NHANES). This analysis showed that 29% of individuals classified obese by BMI parameters, were metabolically healthy. This indicated 15% of Americans are wrongly classified as obese, as well as more than 30% of individuals within the normal BMI range were unhealthy based on the other indicators of health examined.
        The M.O.G. (Medically Oriented Gym) is a fitness club established on the foundations of integrative and preventative healthcare, paired with a physical therapy practice to broaden the scope of expertise and services offered to those attempting to increase their quality of life through therapy, nutrition, fitness, and overall lifestyle management. The M.O.G. shares the same opinion as current research which shows that BMI alone is an ineffective indicator of obesity. The M.O.G. has developed a program to facilitate the long-disputed argument about how to assess the health of individuals through biomarkers and other parameters. Their evaluations are grounded in evidence based research and analyze one's overall fitness level and health. BMI is measured in addition to: body fat percentage, waist circumference, resting heart rate, resting blood pressure, resting oxygen saturation, and VO2 Max. Furthermore, internal health markers and functional tests aid in determine fitness level in addition to biomarkers indicative of health.
        The M.O.G. Fitness Score scores four of the tests: BMI, Body Fat Percentage, Waist Circumference and a sub maximal VO2 level. The M.O.G. chose these four measures because there is ample research indicating normal ranges for age and gender, to normalize this scoring system across the board. This is to combat the incapability of BMI to sufficiently assess age and gender specific to body composition alone. The goal of the Fitness Score is to obtain normal range on all accounts for age and gender.
        BMI is not a proper measure of overall health, especially when used as an isolated number. However, although other options exist, it persists as a primary diagnosing tool for overweight and obesity. Even great solutions, like the M.O.G. fitness score, are not available to everyone, and as of right now cannot be a universal option either. Due to its simplicity and surrogate correlations, clinicians and health care professionals will continue to use BMI to categorize American's into these fatness groups. Education needs to become more important to the providers taking these measurements and diagnosing individuals. The public needs to become aware of the downfalls of BMI, and the medical field's purpose for using it. If everyone can be on the same page about what BMI indicates, and what is involved in truly assessing oneís health, then perhaps our society can move together toward a less obese and healthy community that follows.




    Spring Nutrition - Eating Natural vs. Processed Foods - May 2017

    By Ashley Abramo MS, NASM-CPT

        Last month I started a conversation about general nutrition. This article is written by our Exercise Physiologist and Nutritionist, Ashley Abramo MS, NASM-CPT.
        If you were to analyze your diet, could you separate foods into either whole, processed, or refined foods? Do you know the difference between these labels and the health benefits of adding more whole foods to your diet? A whole food is any food that hasn't been altered from its natural state and because of this it keeps all of its beneficial nutrients. They are natural or near natural. They contain the highest levels of vitamins, minerals, fiber, and other nutrients. These foods will also contain phytochemicals which boost the immune system and prevent cell damage.
       Some of examples of whole foods include:
  • Fruits and vegetables
  • Legumes such as chickpeas, split peas, lentils
  • Nuts and seeds that do not have added salt or flavoring
  • Whole grains such as brown rice, whole cornmeal, rolled oats, whole wheat
  • Meat, raw milk, and eggs that are free of additives
       A processed food is a food that has been changed through some type of processing whether it's grinding, cooking, freezing, etc., but none of the nutrients have been removed. Be aware that not all processed food is harmful! Some examples of processed foods which are part of a healthy diet in moderate quantities are:
  • dried fruit, milk,
  • Greek yogurt and tuna fish in a pouch or can (in water!).
       Processed foods that you may want to avoid are frozen meals (high sodium content), lunch meat, hot dogs and instant oatmeal (choose rolled or steel cut oats instead). A refined food, however, is any food that has been stripped of its nutritional content. An example of a refined food is white bread which is wheat that has been stripped of its bran and fiber. Other examples include: table sugar, cookies, crackers, macaroni, most packaged foods, oils found in fried foods, and chips.
       Among the health benefits of eating more whole foods is better digestion (rich in fiber), better blood sugar, more energy, healthy weight maintenance, and the ability to easily decrease the amount of trans fat and saturated fat in the diet.
        How can you add whole foods to your diet? Choose products with 100% whole grains whenever possible. Replace half the white flour called for in your baking recipes with whole-wheat flour. Also, use half the amount of sweetener when you can.


    Make 1 Small Change this Week - April 2017

    By Russ Certo PT OCS

       In my past couple of articles I made the case that being healthy is a lifestyle change that needs to occur gradually. Nobody will succeed if they attempt to completely overhaul their lifestyle. I know a few people that have been successful making changes that completely overhauled their eating habits, their activity level and in some instances financial and spiritual changes all at once. The common them for these few people was a major life event: a cancer diagnosis or a family member dying at a young age. Fortunately most of us do not experience those traumatic life affecting events.
        So, if you are interested in improving your health, where do you start? The right answer is it does not matter, change your diet, become more active with activity that will improve your health, get more sleep, drink less alcohol or STOP smoking. Just pick one, any one. Over the course of the next few articles I will address each of these changes that you can make in a more specific manner. I will start with eating and nutrition.
        About a year ago my wife and I decided to change our diet and do our best to remove sugar from our diet. After we did the necessary research we concluded the best thing to do was to remove added sugars and especially not consume the sugars that end in "ose", fructose and sucrose are two examples. Another interesting fact we learned about sugar was that cancer cells thrive on sugar molecules we ingest first, especially fructose. Our response to our research was to go into the pantry and look at all the stuff we had and remove anything that had these types of sugars. I was both amazed and surprised at how empty our pantry became. The amazing part of this was we thought we were pretty healthy decision makers when it came to food. We cooked our own meals from scratch generally, we made what we thought were healthy decisions, using things that had less than 5 ingredients and yet we stilled emptied the pantry.
       I like candy, I grew up having dessert after a meal, my wife is a great baker and eliminating sugar took some discipline and vigilance. Our meals didn't change much, but some of the ingredients did. I gave up the 1 sugar in my coffee and began using a small amount of honey in my tea. The candy cravings stopped after about a month. I love chocolate and we found some dark chocolate that does not use sugar as its sweetener and yet still tasted good. After about two months, this new "diet" became habit and we have been able to stick to. Our weight dropped, our body fat decreased and things with sugar have become too sweet to eat and enjoy.
       My suggestion to you for your diet is this; make small changes, don't make drastic changes that make you miserable. There are all kinds of diets out there, some are low in fat, some are low in carbs, some are all protein. They all claim to be the best way to lose weight. The common theme in most of these diets, especially the ones we see advertised on TV, is portion size. I donít suggest you become crazy like we did and eliminate sugar right away, but I do suggest starting with one small simple change this week.
        Next week make another small change and the week after that, another. In a month you will start looking for bigger ways to make healthy changes in your nutrition and diet. Here is an example. Week 1 change the portion sizes of each meal and in between meals have 1 piece of fruit. Week 2 commit to making five meals at home using fresh ingredients and if you are not a great cook, follow a recipe and cook meals with your kids. Make the preparing of a meal an event with your kids! Week 3 begin to pay attention to food labels and try to only use food with 5 ingredients on the label. Again I suggest using the recipes found on the internet to make good stuff. Not everybody is a fan of yogurt, yet there are many ways to introduce yogurt using fresh fruit, a bit of honey and some granola. Once you have a system in place making healthy choices and creating great tasting home cooked meals is easy.
        The diet and the nutrition we choose to have in our households influence the choices are kids make as they become adults. If you adopt a healthier lifestyle by making 1 small change each week, your family will notice and you will influence their view of health. The good news is you control what gets put into the pantry! You can be the example to your family whether you have young kids at home, are an empty nester or are lucky enough to have grandchildren hanging around. Remember the goal is to be more active, live healthier and longer independently. If you have any questions or comments for me I would be happy to hear from you at rcerto@mognational.com.




    Does WEIGHT Define Health?- March 2017

    By Russ Certo

        A couple of weeks ago I had lunch with a very good and very smart friend of mine. In the conversation we inevitably ended up discussing our health, some of the issues now affecting us baby boomers and how we individually have changed our own habits. My friend said the best success in controlling weight was in just managing his diet and that exercise never was able to manage weight like a better diet did. Initially I will admit I was caught off guard and did not have an immediate response. Everything I know about health and fitness and exercise and aging was screaming inside my head to refute that weight is a measurement of health.

        It took me a few minutes to gather my thoughts and once I did here is how I responded. Weight in and of itself is not a measurement of health and fitness levels. Your BMI number which is tracked as a measuring tool for wellness programs and by your Primary Care Physician, is also a misleading measurement with respect to health. Your BMI is a math equation that takes your height and your weight and determines a number. Ideal BMI is around 25, there is some differences between men and woman but for this article lets agree 25 is about what most consider normal BMI. The Center for Disease Control has decided that obesity begins at a BMI of 30 and then they have various degrees of obesity with morbid obesity being the most obese you can be. The point is weight and BMI in and of itself gives no indication of health. I could show you a 300 pound couch potato and then a 300 pound athlete with the same BMI.

        The greatest predictor of early death is a low functioning cardiovascular system. If you do not exercise your heart muscle there is plenty of research that demonstrates you will be at a greater risk of early death. The good news in this research also states that even if you are defined as obese, using a BMI score, but you have good cardiovascular health you have less risk of early death. One of the measurements that can be performed to show the health of your heart and your body's ability to process oxygen is a VO2 test. It is easily done and takes about 8 minutes.

        The third component of health and fitness especially for those who are starting to feel the effects of age is muscular resistance exercise. It is very important that everyone includes in their exercise program some form of resistance exercise to include all four extremities and your core muscles as well. As spring approaches its great that many people will start getting outside and begin walking again. Unfortunately, walking alone is not enough. To maximize the benefits of the time you are walking, find ways to add resistance exercise to the walk. Pulling on elastic exercise bands, stopping and doing some squatting exercise and lunges during the walk are beneficial exercise s to incorporate. Making your muscles stronger makes the muscle way more efficient in assisting your body metabolize calories and to process insulin which is key in all of us for maintaining our health. Having efficient muscles is especially important if you are diabetic or have recently been diagnosed as pre-diabetic.

        Getting back to my friend, I agreed that the best way to control your weight is through diet but the best way to maximize your health and to remain independent in activity for as long as we can is to incorporate a good diet with a good cardiovascular exercise program and to include in your regimen some form of resistance exercise program. All of these things can be measured and re-measured to calculate your fitness level and the improvements you are making. Itís not essential but it is helpful and can be a motivator to continue your health journey.
    Russell Certo PT OCS - The MOG at Grand Island Physical Therapy - 1themog@gmail.com




    Transform your life!     Free Seminar series

    By Russ Certo

    Includes guest pass to the M.O.G.

    March 8th - Getting started on your lifestyle transformation journey
    March 15th - Knowing your numbers
    March 22nd - Nutrition is key
    March 29th - How to create change and make it last
    -- Time: 6:00pm -- Reserve your spot today --
    30 Minute presentation by Transformation Coaching Staff, followed by Q & A
    For more information call 773-1600.



    A HEALTHY LIFESTYLE, What's That? - February 2017

    By Russ Certo

        Lifestyle changes are not easy to make.
        There are so many things that could be changed, some harder than others. Look around, healthy living information is everywhere, TV commercials, magazines and internet ads. Everyone seems to be right and everyone seems to be a legitimate expert. So who do you believe and where do you start? I suggest you start with yourself and trust your gut. Starting with yourself simply means you start asking yourself questions, if you need to write these down so you can review them, you should. Start a simple review; when was the last time you had a yearly physical? When was the last time your doctor discussed your blood tests and other tests with you? When was the last time you exercised for 20 minutes or more? When you get hungry or are planning your meals for the day, are the choices you make the best choices available to you that day? When was the last time you made a commitment to set a healthy goal, works towards it and attain the goal? The answer to the trust question is simple, be honest in your answers and trust your "gut". Funny thing about deceiving and dishonesty is you can't fool yourself. None of the questions you are asking yourself are difficult. Just be honest and accept that's where you are today. Nothing you can do about past missed opportunities, however, you have supreme power over all future actions.

       The next step in this process is to now set some simple goals. If you have not seen your doctor, make an appointment. When you sit with your doctor ask questions, don't leave without a total understanding of your current health status. Most good Primary Care Physicians will give you all the time you want if you are actively engaged in your healthcare. Second goal; if you are not exercising start with 20 minutes of some activity 3 times a week understanding that the current recommendation from the American Medical Association is 150 total minutes of activity a week. When it comes to your food intake there are as many strategies as there are food choices. I would again suggest trust your "gut". When making a food choice you know what is a better choice than another, fruit is better than candy, vegetables are better than salty snacks. Home cooking is generally better than eating out and the better foods have the shortest list of ingredients. In future articles we will present to you more specific detail. But to simply start making some healthy changes, set a simple goal 1-2 fruits a day, eat a breakfast without sugar, small changes are better than drastic changes.

        What is LIFETSYLE CHANGE or Lifestyle Transformation?
        It can be defined in many ways but again I will stick to the simplistic. A Lifestyle based in your health has a goal of a long independent life. This lifestyle change can be made at any age. There is plenty of data that demonstrates improved health markers and increased independence for elderly individuals despite having chronic debilitating disease. There are times experts should be sought out. Don't be fooled by "snake oil" peddlers who seem like experts, sound like experts but ultimately are just looking to separate you from your money. If it sounds too good it probably is.

        One last thought. If you consider healthy lifestyle choices as a bank account and every time you make a good decision, fruit over candy, 20 minutes of activity, consider that a deposit into that account. The bigger the account grows the more you will have when you need to make a withdraw. A withdraw would be required when you catch a cold, get the flu, get in a car accident, have surgery, get cancer. The more your body can utilize the credits in your account the better chance you have given yourself to regain health and independence. Like any good retirement account, slow steady daily deposits will reap the greatest rewards.




    Russell Certo - February 2017


    The Creating Better Health column will appear every third Thursday of each month.
          Lifelong Islander and Physical Therapist Russell Certo will be writing a monthly health article that will help you to a healthier lifestyle. The Director of MOG wrote: "Individual health is more than just a yearly physical and some cardiac exercise. Individual health is a lifestyle that includes your yearly physical and cardiac exercise but also includes, among other things, resistance exercise, proper nutrition, education, stress relief and even financial wellbeing. The simple goal of adopting a healthier lifestyle is a long active life and independent living. This lifestyle transformation series will address all things healthy in hopes of creating a change in the overall health of our community."
       Certo recently announced that Grand Island Physical Therapy, the MOG and Primary Care are partnering with TRILOGY, an association of health and lifestyle professional service providers. The purpose of TRILOGY is to coordinate lifestyle transformation services and provide the community a staff of experts whose only goal is to intervene with the right professional with the right service at the right time. The services TRILOGY provides include; Primary Medical Care, Physical Therapy, Fitness and Exercise, Behavior Health, Corporate Employee Health and Wellness, Nutrition Counseling, Medical Specialties and Community Based Support Organizations.
        "TRILOGY will provide us a coordinated way to keep our patients and members moving forward and making a lifestyle change that will give them a more productive and active lifeĒ stated Certo. This TRILOGY model of collaboration based on individual responsibility and choices has proven to improve health outcomes and lower the cost of individual healthcare. TRILOGY has one mission, to provide our communities an opportunity to live a long, healthy active life. For more information, access mytrilogy.org. Russell Certo is a Physical Therapist and is nationally recognized as an expert in rehabilitation and lifestyle management. He has been in practice on Grand Island since 1988.