You breathe about 20,000 times a day without thinking — but what if that automatic act could be trained to lower your blood pressure, sharpen your thinking, and even strengthen your heart? Dr. Lawrence Cahalin, clinical professor of physical therapy at the University of Miami and a Fellow of the American Physical Therapy Association and the American Heart Association, has spent his career studying exactly that. His research on respiratory muscle training is revealing just how much the breath influences nearly every system in the body.

In this conversation, Dr. Cahalin joins Dr. Brent Anderson to explore the science behind training your breathing muscles — not just for lung health, but for cognitive performance, cardiovascular function, and healthy aging. They discuss why a slightly irregular heartbeat during deep breathing is actually a sign of a healthy nervous system, how weak breathing muscles can literally steal blood flow from your legs, and what everyday breath training tools look like for patients and athletes alike. They also explore the emerging research on Wim Hof breathing, the connection between breath and sleep quality, and why ancient practices like Pilates, yoga, and qigong may have been onto something science is only now catching up to.

In this episode:

• How heart rate variability and sinus arrhythmia signal autonomic nervous system health

• The respiratory metaboreflex — why weak breathing muscles reduce walking ability in people with heart and lung disease

• Research on inspiratory muscle training improving blood pressure, mitochondrial metabolism, and cognition

• Devices for respiratory muscle training at home, including the PowerBreathe, threshold trainers, and a DIY sphygmomanometer hack

• The science behind Wim Hof breathing and intermittent hypoxia

• How breath pressure gradients affect blood flow to and from the brain

• The connection between better breathing, self-efficacy, and quality of life

Resources mentioned:

• Research by Dr. Doug Seals, University of Colorado Boulder (high-intensity inspiratory muscle training)

  • Seals Lab — Integrative Physiology of Aging Laboratory

  • CU Boulder: "Could Focused Breathing Be a Key to Better Health?" (2023)

  • CU Boulder: "5-Minute Breathing Workout Lowers Blood Pressure" (2021)

• Pro2 respiratory training device

• PowerBreathe device

• University of Miami Department of Physical Therapy

Chronic pain affects one in four people worldwide — and most of us don't understand why. In this episode, Dr. Brent Anderson sits down with Dr. Adriaan Louw, physical therapist, author, and co-founder of Evidence in Motion, to break down the science of pain in plain language.

Dr. Louw explains the three types of pain — nociceptive, neuropathic, and nociplastic — and why understanding the difference matters for treatment. Together, they explore why pain exists as a protective mechanism, why tissue damage and pain intensity don't always correlate, and how the nervous system can become sensitized over time, leading to persistent and widespread pain conditions like fibromyalgia.

The conversation covers the role of movement, sleep, nutrition, and education in managing chronic pain, the science of neuroplasticity and desensitization, and how positive movement experiences can literally rewire the brain's pain response. Dr. Louw also shares his thoughts on the current pharmacological options with the strongest evidence behind them and leaves listeners with an important message: chronic pain can get better.

In this episode:

• The difference between acute, neuropathic, and nociplastic pain
• Why pain is a protection mechanism — not a punishment
• How the nervous system becomes sensitized in chronic pain
• Fibromyalgia, central sensitization, and what actually helps
• The role of movement (including Pilates) in pain rehabilitation
• Finding hope and qualified providers in the chronic pain space

Resources mentioned:

• whyyouhurt.com — free patient education videos and provider directory
• Evidence in Motion — evidenceinmotion.com

Hosted by Dr. Brent Anderson, this podcast draws on more than 35 years of clinical practice, research, and teaching. He is a doctor of physical therapy, professor, founder of Polestar Pilates, and pathokinesiologist. Dr. Brent has long been fascinated by the dynamic relationship between movement and pathology, and how understanding that relationship can help people move better, feel better, and live more aligned lives.

Each episode features conversations with special guests, colleagues, and friends who are making meaningful contributions across healthcare, movement science, wellness, and education. Together, we explore how movement shapes not only our bodies, but how we relate to ourselves, to others, and to the world.

Live Aligned is about curiosity, compassion, and clarity, inviting practitioners, students, and lifelong movers alike to think more deeply, move more intentionally, and be kind along the way.

More info at: https://drbrentanderson.com/podcast/

For millions of people, being "really flexible" was never just a party trick — it was the first sign of something far more complex. Ehlers-Danlos syndrome and hypermobility spectrum disorders affect not just joints, but the cardiovascular system, the nervous system, digestion, and more — often going undiagnosed for years. Dr. Brent Anderson is joined by Dr. Marcia Perretto, a doctor of physical therapy, founder and CEO of Actify Physiotherapy and Wellness in Boca Raton, Florida, and a nationally recognized expert in hypermobility-informed care.

Dr. Perretto — who lives with hypermobile EDS herself — breaks down the difference between hypermobility and a clinical diagnosis, explains how collagen dysfunction affects the whole body, and offers a clear framework for building toward safe, successful movement. Together, she and Dr. Brent explore why fear can amplify pain, how the nervous system gets caught in a downward spiral, and what it actually takes to interrupt that cycle and get people moving again — without making things worse.

IN THIS EPISODE:

• What Ehlers-Danlos syndrome is and how the 13 subtypes fall under the broader connective tissue umbrella
• Why hypermobility and hEDS are not the same thing — and how to tell the difference
• How collagen dysfunction affects the heart, gut, skin, nervous system, and more
• The role of fear and the amygdala in amplifying chronic pain for hypermobile patients
• Why the nervous system needs "predictable movement" to begin rewiring toward safety
• How to stage a graded return to movement — from proprioceptive awareness to strength
• Why consistent small successes beat occasional big efforts for this population

RESOURCES MENTIONED:

• Dr. Marcia Perretto — Actify Physiotherapy and Wellness: actifypt.com
• Unlocking the Secrets to the Hypermobility Puzzle — book by Dr. Marcia Perretto
• The Beighton Hypermobility Score — referenced as a standard screening tool
• 2017 International Classification of hEDS — the updated criteria discussed in the episode
• Panjabi and Comerford's neutral zone concept — referenced in the movement staging discussion
• Paul Hodges and Carolyn Richardson (University of Queensland) — foundational research on spine stabilization referenced by Dr. Brent

SOURCES AND CITATIONS:

• Malfait F, et al. The 2017 international classification of the Ehlers-Danlos syndromes. Am J Med Genet C Semin Med Genet. 2017;175(1):8-26.
• Beighton P, Solomon L, Soskolne CL. Articular mobility in an African population. Ann Rheum Dis. 1973;32(5):413-418.
• Panjabi MM. The stabilizing system of the spine. Part I: Function, dysfunction, adaptation, and enhancement. J Spinal Disord. 1992;5(4):383-389.
• Comerford MJ, Mottram SL. Functional stability re-training: principles and strategies for managing mechanical dysfunction. Man Ther. 2001;6(1):3-14.
• Hodges PW, Richardson CA. Feedforward contraction of transversus abdominis is not influenced by the direction of arm movement. Exp Brain Res. 1997;114(2):362-370.

Episode Description

It can feel like Parkinson's disease is everywhere — a parent, a friend, a colleague — and with that familiarity often comes fear. But the story we've been told about Parkinson's is changing fast. Dr. Brent Anderson is joined by Dr. Andrew Lerman, a double board-certified neurologist and epileptologist and the founder and medical director of Grove Neurology in Miami, Florida, who has led more than 35 clinical trials investigating new treatments for Parkinson's, Alzheimer's, and other neurodegenerative disorders.

Dr. Lerman — a passionate advocate for movement, including Pilates, as medicine for the brain — explains why early diagnosis is reshaping the outlook for patients, what the first signs actually look like, and how exercise may be one of the most powerful interventions available. Together, he and Dr. Brent explore how to counsel patients with hope rather than fear, why community and family support change outcomes, and the emerging research suggesting that staying active can tap into the brain's own dopamine reserves — without the disease having the final word.

IN THIS EPISODE:

• Why earlier diagnosis and new tools (DAT scans, MRI, skin biopsy, CSF labs) are changing the Parkinson's outlook
• The early signs worth paying attention to — tremor, small handwriting, a softer voice, and changes in gait
• The difference between rigidity and spasticity, explained in plain language
• How aerobic exercise, strength training, Pilates, boxing, and dance can slow progression and reduce the need to escalate medication
• The truth about the "starting medication starts the clock" myth
• What deep brain stimulation, FDA-approved focused ultrasound, and GLP-1 research mean for the future
• Why community, connection, and consistent movement may matter as much as any prescription

RESOURCES MENTIONED:

• Dr. Andrew Lerman — Grove Neurology, Miami, FL
• Rock Steady Boxing — group exercise program for people with Parkinson's
• Power of Parkinson's — online library of at-home exercise routines and resources
• Dr. Brent's community Pilates documentary — his 10-year Coral Gables program for a Parkinson's support group (available on YouTube)
• Miami / St. Augustine University Physical Therapy program — Rock Steady (Dr. Miguel Garcia) and fall-prevention (Gabriel Somariba)
• Argentine tango research for Parkinson's — referenced in the episode for its effects on balance, falls, and disease progression
• Pilates and fall-prevention research (Peggy Roller, California) — referenced in the episode
• The Anxious Generation by Jonathan Haidt — referenced on Gen Z mental health and the value of unstructured, active play

SOURCES AND CITATIONS:

• van der Kolk NM, de Vries NM, Kessels RPC, et al. Effectiveness of home-based and remotely supervised aerobic exercise in Parkinson's disease: a double-blind, randomised controlled trial (Park-in-Shape). Lancet Neurol. 2019;18(11):998-1008.
• Schenkman M, Moore CG, Kohrt WM, et al. Effect of high-intensity treadmill exercise on motor symptoms in patients with de novo Parkinson disease: a phase 2 randomized clinical trial (SPARX). JAMA Neurol. 2018;75(2):219-226.
• Xu Q, Park Y, Huang X, et al. Physical activities and future risk of Parkinson disease. Neurology. 2010;75(4):341-348.
• Fang X, Han D, Cheng Q, et al. Association of levels of physical activity with risk of Parkinson disease: a systematic review and meta-analysis. JAMA Netw Open. 2018;1(5):e182421.
• Meissner WG, Remy P, Maltête D, et al. Trial of lixisenatide in early Parkinson's disease. N Engl J Med. 2024;390(13):1176-1185.