Well, thank you, John, for such an interesting presentation. We'll take questions from the audience now. I'm not going to ask you, don't worry, John, to reveal your own step count. While we wait for some questions to come in, I would like to invite everyone to sign up for the SMI Advisor newsletter by visiting smiadvisor.org. We'll keep you informed as we roll out new courses, resources, and other features on the website. So, why don't we go ahead and take the first question. It comes in from a viewer who writes, is 10,000 steps the right amount for people with SMI? So, John, tell us about 10,000 and where that number comes from. That's a very good question. I think certainly I imagine all of us have kind of heard 10,000 steps. A lot of apps and wearables have kind of set that as the benchmark. We don't actually know if that's the right number for most people. And I think what I've certainly learned in working with patients of SMI is 10,000 is not an easy number for a lot of people to get to. We saw that perhaps people with SMI are less active with often the data. And sometimes setting the bar of 10,000 can be a little unmotivating, actually demotivating for people because it may be a bar that people actually can't reach. And they actually feel that they may be failing or not succeeding at exercise because they say, I just can't get to 10,000, if I can't get to this number, I give up. And there's actually on many apps and wearables, 10,000 is kind of the default that it comes with. But you can actually reprogram that on most apps and devices and settings. It may be useful to set a low bar of say maybe 2,000 or 3,000. And if that's something people can build up to and they pass, you can say, hey, let's work on 4,000 steps next time. Let's work on 5,000 steps. And I think, but the goal is you don't want to set this kind of unrealistic bar, but don't start telling someone you're going to learn to jog and you're going to do a marathon as your very first jogging exercise. And I think you can imagine that it's a really hard goal, again, for some people to meet. And again, the evidence says that people with SMI likely are less physically active. So 10,000 is a number that has a loose, it has a loose use in the general population. But I think for people with SMI, it really makes sense to kind of perhaps start with what they think they can do and customize it to their needs. Great. Let's take another question from a viewer. This circles back to something you were talking about a few slides ago about social supports. The question reads, in your opinion, should the target to improve physical health in people with schizophrenia focus on improving physical activity, or do you think there are other targets to focus on first, like improving cognition, social function, reducing loneliness, improving positive affect, so that can also improve physical health? Or is promoting physical activity specifically through targeting physical activity the way forward? So how do we unravel this chicken and egg to some extent? It's a very good question, again, saying there's a lot of different interventions, and we know that many things are related in SMI. I think in some ways, physical activity can be an interesting way to start, because we know it can lead to improvements in cognition. We talked about improvements in symptoms of SMI and the physical health benefits. So in some ways, it can kind of be the center and help with many things. I think certainly there are some patients that are not as interested in physical activity that may have disorders or pain that kind of limits physical activity, may have mobility issues. So I don't think we can kind of tell people the first important thing to do is we have physical activity is the most important, but I think given that premature mortality and kind of the risk of cardiovascular disease, especially because many patients who may be on an antipsychotic, we have metabolic syndrome and side effects. I think for so many reasons, it's important to get patients active, and again, technology is not going to be a solution for everyone. I think hopefully after this webinar, you saw that just giving someone a fitness tracker and saying, here it is, is not going to be a boost, but I think giving someone a fitness tracker and saying, hey, let's look at what your steps are. Let's learn about how it's impact your symptom, being curious with a patient, exploring with it, checking up, making it part of the treatment plan. I think it's something that you can do. That's a very low risk intervention that may have high benefits. Let's take another question. Clinician writes, can I be reimbursed for helping a patient track steps and interpreting that data with them? This is a very good question. One that we don't, the answer is probably no. You can't yet today, at least in SMI, it may be difficult to get reimbursed for interpreting a patient's remote data. And certainly know it's a cardiologist can get, can give someone a Holter monitor, they bring the Holter monitor back and the cardiologist interprets it. And that's kind of, there's a billing code for it. There are some CPT codes that theoretically could work for remote monitoring of digital data. I haven't seen anyone kind of successfully bill for them. That's what I think that we're moving into an era where, because these are going to give us objective data on how physically active our patients are as we move more towards quality based payments, where we need some objective outcomes. I imagine that within the next year or two that we're actually going to have specific codes for this, because certainly if a patient brings you a lot of the step count data different days of the week, it can take a little bit of time to go over it with them. But I think right now it's unfortunately a little bit difficult to be directly reimbursed with this. So if listening has found a way to do it, please reach out to me and we'll certainly include that as my advisor and let people know in our next talk. Well, and with that, John, I think we're probably at a pretty good place to stop for today.

physical activity

SMI

10,000 steps

cognition

reimbursement