a technique for entering into other bodies, generating multiple bodies, and the attainment of other supernatural accomplishments; these are, states White, described in Tantric literature of Hinduism and Buddhism, as well as the Buddhist Sāmaññaphalasutta;[41] James Mallinson, however, disagrees and suggests that such fringe practices are far removed from the mainstream Yoga's goal as meditation-driven means to liberation in Indian religions.[42]
The tantra yoga practices include asanas and breathing exercises. The Nyingma tradition practices Yantra yoga (Tib. "Trul khor"), a discipline that includes breath work (or pranayama), meditative contemplation and other exercises.[192] In the Nyingma tradition, the path of meditation practice is divided into further stages,[193] such as Kriya yoga, Upa yoga, Yoga yana, Mahā yoga, Anu yoga and Ati yoga.[194] The Sarma traditions also include Kriya, Upa (called "Charya"), and Yoga, with the Anuttara yoga class substituting for Mahayoga and Atiyoga.[195]
^ Mangano, Kelsey M.; Sahni, Shivani; Kiel, Douglas P.; Tucker, Katherine L.; Dufour, Alyssa B.; Hannan, Marian T. (February 8, 2017). "Dietary protein is associated with musculoskeletal health independently of dietary pattern: the Framingham Third Generation Study". The American Journal of Clinical Nutrition. 105 (3): 714–722. doi:10.3945/ajcn.116.136762. PMC 5320406. PMID 28179224 – via ajcn.nutrition.org.
^ Burd, Nicholas A.; Yang, Yifan; Moore, Daniel R.; Tang, Jason E.; Tarnopolsky, Mark A.; Phillips, Stuart M. (2012). "Greater stimulation of myofibrillar protein synthesis with ingestion of whey protein isolate v. Micellar casein at rest and after resistance exercise in elderly men". British Journal of Nutrition. 108 (6): 958–62. doi:10.1017/S0007114511006271. PMID 22289570.
The first U.S. Women's National Physique Championship, promoted by Henry McGhee and held in Canton, Ohio in 1978, is generally regarded as the first true female bodybuilding contest—that is, the first contest where the entrants were judged solely on muscularity.[13] In 1980, the first Ms. Olympia (initially known as the "Miss" Olympia), the most prestigious contest for professionals, was held. The first winner was Rachel McLish, who had also won the NPC's USA Championship earlier in the year. The contest was a major turning point for female bodybuilding. McLish inspired many future competitors to start training and competing. In 1985, a movie called Pumping Iron II: The Women was released. It documented the preparation of several women for the 1983 Caesars Palace World Cup Championship. Competitors prominently featured in the film were Kris Alexander, Lori Bowen, Lydia Cheng, Carla Dunlap, Bev Francis, and McLish. At the time, Francis was actually a powerlifter, though she soon made a successful transition to bodybuilding, becoming one of the leading competitors of the late 1980s and early 1990s.

*Offer is not available (different pricing applies) in Arkansas, Kentucky, Louisiana, New York (Metro & Premier Plus), Ohio, South Carolina, Tennessee, or Delaware, and does not include access to Signature Clubs or clubs in Canada. Memberships may require an initiation fee and/or annual fee as indicated on membership agreement, except as required by law. Memberships may require commitment to an initial term (except as required by law), in which case an early termination fee will apply if membership agreement is terminated prior to the expiration of the initial term. Single club pricing not available at all locations. Recurring monthly charges must be paid by electronic funds transfer from your checking or savings account or automatic transfer from an accepted credit or debit card. Must be 16 years of age or older (or at least 13 years of age and accompanied by a parent or legal guardian), sign membership agreement, and pay first and last months’ dues and fees for additional services purchased (if any) plus the initiation fee to join. This offer is not available in combination with other discounted rates, coupons or promotions. If offer is advertised as less than $1 per day, that is based on average monthly dues per day in a 30-day month for single club access only. A parent/ legal guardian must sign membership agreement or guest waiver, as applicable, on behalf of members / guests under 18 years of age. Personal training and other services are subject to an additional agreement and requires payment of an additional fee. Offer is subject to change without notice and may end at any time. Additional terms and/or restrictions may apply.


The general strategy adopted by most present-day competitive bodybuilders is to make muscle gains for most of the year (known as the "off-season") and, approximately 12–14 weeks from competition, lose a maximum of body fat (referred to as "cutting") while preserving as much muscular mass as possible. The bulking phase entails remaining in a net positive energy balance (calorie surplus). The amount of a surplus in which a person remains is based on the person's goals, as a bigger surplus and longer bulking phase will create more fat tissue. The surplus of calories relative to one's energy balance will ensure that muscles remain in a state of anabolism.
Personal health depends partially on the active, passive, and assisted cues people observe and adopt about their own health. These include personal actions for preventing or minimizing the effects of a disease, usually a chronic condition, through integrative care. They also include personal hygiene practices to prevent infection and illness, such as bathing and washing hands with soap; brushing and flossing teeth; storing, preparing and handling food safely; and many others. The information gleaned from personal observations of daily living – such as about sleep patterns, exercise behavior, nutritional intake and environmental features – may be used to inform personal decisions and actions (e.g., "I feel tired in the morning so I am going to try sleeping on a different pillow"), as well as clinical decisions and treatment plans (e.g., a patient who notices his or her shoes are tighter than usual may be having exacerbation of left-sided heart failure, and may require diuretic medication to reduce fluid overload).[58]
According to Crangle, some researchers have favoured a linear theory, which attempts "to interpret the origin and early development of Indian contemplative practices as a sequential growth from an Aryan genesis",[53][note 4] just like traditional Hinduism regards the Vedas to be the ultimate source of all spiritual knowledge.[55][note 5] Thomas McEvilley favors a composite model where pre-Aryan yoga prototype existed in the pre-Vedic period and its refinement began in the Vedic period.[58]
^ * Wynne states that "The Nasadiyasukta, one of the earliest and most important cosmogonic tracts in the early Brahminic literature, contains evidence suggesting it was closely related to a tradition of early Brahminic contemplation. A close reading of this text suggests that it was closely related to a tradition of early Brahminic contemplation. The poem may have been composed by contemplatives, but even if not, an argument can be made that it marks the beginning of the contemplative/meditative trend in Indian thought."[73]
According to Crangle, some researchers have favoured a linear theory, which attempts "to interpret the origin and early development of Indian contemplative practices as a sequential growth from an Aryan genesis",[53][note 4] just like traditional Hinduism regards the Vedas to be the ultimate source of all spiritual knowledge.[55][note 5] Thomas McEvilley favors a composite model where pre-Aryan yoga prototype existed in the pre-Vedic period and its refinement began in the Vedic period.[58]
The motor proteins actin and myosin generate the forces exerted by contracting muscles. Current recommendations suggest that bodybuilders should consume 25–30% of protein per total calorie intake to further their goal of maintaining and improving their body composition.[30] This is a widely debated topic, with many arguing that 1 gram of protein per pound of body weight per day is ideal, some suggesting that less is sufficient, while others recommending 1.5, 2, or more.[31] It is believed that protein needs to be consumed frequently throughout the day, especially during/after a workout, and before sleep.[32] There is also some debate concerning the best type of protein to take. Chicken, turkey, beef, pork, fish, eggs and dairy foods are high in protein, as are some nuts, seeds, beans, and lentils. Casein or whey are often used to supplement the diet with additional protein. Whey protein is the type of protein contained in many popular brands of protein supplements and is preferred by many bodybuilders because of its high Biological Value (BV) and quick absorption rates. Whey protein also has a bigger effect than casein on insulin levels, triggering about double the amount of insulin release.[33] That effect is somewhat overcome by combining casein and whey. Bodybuilders are usually thought to require protein with a higher BV than that of soy, which is additionally avoided due to its claimed estrogenic properties. Still, some nutrition experts believe that soy, flax seeds and many other plants that contain the weak estrogen-like compounds or phytoestrogens, can be used beneficially, as phytoestrogens compete with estrogens for receptor sites in the male body and can block its actions. This can also include some inhibition of pituitary functions while stimulating the P450 system (the system that eliminates hormones, drugs and metabolic waste product from the body) in the liver to more actively process and excrete excess estrogen.[34][35] Cortisol decreases amino acid uptake by muscle, and inhibits protein synthesis.[36]
Bodybuilding is the use of progressive resistance exercise to control and develop one's musculature for aesthetic purposes.[1] An individual who engages in this activity is referred to as a bodybuilder. In competitive bodybuilding, bodybuilders appear in lineups and perform specified poses (and later individual posing routines) for a panel of judges who rank the competitors based on criteria such as symmetry, muscularity, and conditioning. Bodybuilders prepare for competitions through the elimination of nonessential body fat, enhanced at the last stage by a combination of extracellular dehydration and carbohydrate loading, to achieve maximum muscular definition and vascularity, as well as tanning to accentuate the contrast of the skin under the spotlights. Bodybuilders may use anabolic steroids and other performance-enhancing drugs to build muscles.

In competitive bodybuilding, bodybuilders aspire to present an aesthetically pleasing body on stage.[16][17] In prejudging, competitors do a series of mandatory poses: the front lat spread, rear lat spread, front double biceps, back double biceps, side chest, side triceps, Most Muscular (men only), abdominals and thighs. Each competitor also performs a personal choreographed routine to display their physique. A posedown is usually held at the end of a posing round, while judges are finishing their scoring. Bodybuilders usually spend a lot of time practising their posing in front of mirrors or under the guidance of their coach.
The general strategy adopted by most present-day competitive bodybuilders is to make muscle gains for most of the year (known as the "off-season") and, approximately 12–14 weeks from competition, lose a maximum of body fat (referred to as "cutting") while preserving as much muscular mass as possible. The bulking phase entails remaining in a net positive energy balance (calorie surplus). The amount of a surplus in which a person remains is based on the person's goals, as a bigger surplus and longer bulking phase will create more fat tissue. The surplus of calories relative to one's energy balance will ensure that muscles remain in a state of anabolism.
In addition to safety risks, many jobs also present risks of disease, illness and other long-term health problems. Among the most common occupational diseases are various forms of pneumoconiosis, including silicosis and coal worker's pneumoconiosis (black lung disease). Asthma is another respiratory illness that many workers are vulnerable to. Workers may also be vulnerable to skin diseases, including eczema, dermatitis, urticaria, sunburn, and skin cancer.[62][63] Other occupational diseases of concern include carpal tunnel syndrome and lead poisoning.
^ "application or concentration of the thoughts, abstract contemplation, meditation , (esp.) self-concentration, abstract meditation and mental abstraction practised as a system (as taught by Patañjali and called the yoga philosophy; it is the second of the two sāṃkhya systems, its chief aim being to teach the means by which the human spirit may attain complete union with īśvara or the Supreme Spirit; in the practice of self-concentration it is closely connected with Buddhism". Monier-Williams, A Sanskrit Dictionary (1899)

^ "application or concentration of the thoughts, abstract contemplation, meditation , (esp.) self-concentration, abstract meditation and mental abstraction practised as a system (as taught by Patañjali and called the yoga philosophy; it is the second of the two sāṃkhya systems, its chief aim being to teach the means by which the human spirit may attain complete union with īśvara or the Supreme Spirit; in the practice of self-concentration it is closely connected with Buddhism". Monier-Williams, A Sanskrit Dictionary (1899)
One of the best known early expressions of Brahmanical Yoga thought is the Yoga Sutras of Patanjali , the original name of which may have been the Pātañjalayogaśāstra-sāṃkhya-pravacana (c. sometime between 325 - 425) which some scholars now believe included both the sutras and a commentary.[129] As the name suggests, the metaphysical basis for this text is the Indian philosophy termed Sāṃkhya. This atheistic school is mentioned in Kauṭilya's Arthashastra as one of the three categories of anviksikis (philosophies) along with Yoga and Cārvāka.[130][131] The two schools have some differences as well. Yoga accepted the conception of "personal god", while Samkhya developed as a rationalist, non-theistic/atheistic system of Hindu philosophy.[132][133][134] Sometimes Patanjali's system is referred to as Seshvara Samkhya in contradistinction to Kapila's Nirivara Samkhya.[135] The parallels between Yoga and Samkhya were so close that Max Müller says that "the two philosophies were in popular parlance distinguished from each other as Samkhya with and Samkhya without a Lord."[136]
The Maitrayaniya Upanishad, likely composed in a later century than Katha and Shvetashvatara Upanishads but before Patanjali's Yoga Sutra, mentions sixfold yoga method – breath control (pranayama), introspective withdrawal of senses (pratyahara), meditation (dhyana), mind concentration (dharana), philosophical inquiry/creative reasoning (tarka), and absorption/intense spiritual union (samadhi).[9][100][104]
According to Zimmer, Yoga philosophy is reckoned to be part of the non-Vedic system, which also includes the Samkhya school of Hindu philosophy, Jainism and Buddhism:[45] "[Jainism] does not derive from Brahman-Aryan sources, but reflects the cosmology and anthropology of a much older pre-Aryan upper class of northeastern India [Bihar] – being rooted in the same subsoil of archaic metaphysical speculation as Yoga, Sankhya, and Buddhism, the other non-Vedic Indian systems."[61][note 6]
There is no consensus on its chronology or specific origin other than that yoga developed in ancient India. Suggested origins are the Indus Valley Civilization (3300–1900 BCE)[44] and pre-Vedic Eastern states of India,[45] the Vedic period (1500–500 BCE), and the śramaṇa movement.[46] According to Gavin Flood, continuities may exist between those various traditions:

Many governments view occupational health as a social challenge and have formed public organizations to ensure the health and safety of workers. Examples of these include the British Health and Safety Executive and in the United States, the National Institute for Occupational Safety and Health, which conducts research on occupational health and safety, and the Occupational Safety and Health Administration, which handles regulation and policy relating to worker safety and health.[64][65][66]
Photo Creidt: Copyright Jason Ellis AMER “THE HAMMER” KAMRA Pro Fitness Model : Transformation Coach : Fitness Author How did you get started with fitness modeling? Growing up, I’ve always had a passion for being physical and active, and therefore channelled my energy into ways which would benefit me. I started out playing competitive football and training on the field and for me it went hand in hand with lifting weights in the gym. Training in the gym has truly changed my life, and I always look to branch my skills and talents into new things I haven’t experienced before,...
The tantra yoga practices include asanas and breathing exercises. The Nyingma tradition practices Yantra yoga (Tib. "Trul khor"), a discipline that includes breath work (or pranayama), meditative contemplation and other exercises.[192] In the Nyingma tradition, the path of meditation practice is divided into further stages,[193] such as Kriya yoga, Upa yoga, Yoga yana, Mahā yoga, Anu yoga and Ati yoga.[194] The Sarma traditions also include Kriya, Upa (called "Charya"), and Yoga, with the Anuttara yoga class substituting for Mahayoga and Atiyoga.[195]
In the 1970s, bodybuilding had major publicity thanks to the appearance of Arnold Schwarzenegger, Franco Columbu, Lou Ferrigno, and others in the 1977 docudrama Pumping Iron. By this time, the IFBB dominated the competitive bodybuilding landscape and the Amateur Athletic Union (AAU) took a back seat. The National Physique Committee (NPC) was formed in 1981 by Jim Manion,[7] who had just stepped down as chairman of the AAU Physique Committee. The NPC has gone on to become the most successful bodybuilding organization in America and is the amateur division of the IFBB. The late 1980s and early 1990s saw the decline of AAU-sponsored bodybuilding contests. In 1999, the AAU voted to discontinue its bodybuilding events.

a technique for entering into other bodies, generating multiple bodies, and the attainment of other supernatural accomplishments; these are, states White, described in Tantric literature of Hinduism and Buddhism, as well as the Buddhist Sāmaññaphalasutta;[41] James Mallinson, however, disagrees and suggests that such fringe practices are far removed from the mainstream Yoga's goal as meditation-driven means to liberation in Indian religions.[42]

In 1989 and 2003, the Vatican issued two documents: Aspects of Christian meditation and "A Christian reflection on the New Age," that were mostly critical of eastern and New Age practices. The 2003 document was published as a 90-page handbook detailing the Vatican's position.[287] The Vatican warned that concentration on the physical aspects of meditation "can degenerate into a cult of the body" and that equating bodily states with mysticism "could also lead to psychic disturbance and, at times, to moral deviations." Such has been compared to the early days of Christianity, when the church opposed the gnostics' belief that salvation came not through faith but through a mystical inner knowledge.[281] The letter also says, "one can see if and how [prayer] might be enriched by meditation methods developed in other religions and cultures"[288] but maintains the idea that "there must be some fit between the nature of [other approaches to] prayer and Christian beliefs about ultimate reality."[281] Some[which?] fundamentalist Christian organizations consider yoga to be incompatible with their religious background, considering it a part of the New Age movement inconsistent with Christianity.[289]


Onesicritus also mentions his colleague Calanus trying to meet them, who is initially denied audience, but later invited because he was sent by a "king curious of wisdom and philosophy".[108] Onesicritus and Calanus learn that the yogins consider the best doctrine of life as "rid the spirit of not only pain, but also pleasure", that "man trains the body for toil in order that his opinions may be strengthened", that "there is no shame in life on frugal fare", and that "the best place to inhabit is one with scantiest equipment or outfit".[107][108] These principles are significant to the history of spiritual side of yoga.[107] These may reflect the ancient roots of "undisturbed calmness" and "mindfulness through balance" in later works of Hindu Patanjali and Buddhist Buddhaghosa respectively, states Charles Rockwell Lanman;[107] as well as the principle of Aparigraha (non-possessiveness, non-craving, simple living) and asceticism discussed in later Hinduism and Jainism.[citation needed]

The tantra yoga practices include asanas and breathing exercises. The Nyingma tradition practices Yantra yoga (Tib. "Trul khor"), a discipline that includes breath work (or pranayama), meditative contemplation and other exercises.[192] In the Nyingma tradition, the path of meditation practice is divided into further stages,[193] such as Kriya yoga, Upa yoga, Yoga yana, Mahā yoga, Anu yoga and Ati yoga.[194] The Sarma traditions also include Kriya, Upa (called "Charya"), and Yoga, with the Anuttara yoga class substituting for Mahayoga and Atiyoga.[195]
Malaysia's top Islamic body in 2008 passed a fatwa, prohibiting Muslims from practicing yoga, saying it had elements of Hinduism and that its practice was blasphemy, therefore haraam.[298] Some Muslims in Malaysia who had been practicing yoga for years, criticized the decision as "insulting."[299] Sisters in Islam, a women's rights group in Malaysia, also expressed disappointment and said yoga was just a form of exercise.[300] This fatwa is legally enforceable.[301] However, Malaysia's prime minister clarified that yoga as physical exercise is permissible, but the chanting of religious mantras is prohibited.[302]

The Bhakti movement was a development in medieval Hinduism which advocated the concept of a personal God (or "Supreme Personality of Godhead"). The movement was initiated by the Alvars of South India in the 6th to 9th centuries, and it started gaining influence throughout India by the 12th to 15th centuries.[178] Shaiva and Vaishnava bhakti traditions integrated aspects of Yoga Sutras, such as the practical meditative exercises, with devotion.[179] Bhagavata Purana elucidates the practice of a form of yoga called viraha (separation) bhakti. Viraha bhakti emphasizes one pointed concentration on Krishna.[180]
Yoga may have pre-Vedic elements.[44][45] Some state yoga originated in the Indus Valley Civilization.[50] Marshall,[51] Eliade[9] and other scholars note that the Pashupati seal discovered in an Indus Valley Civilization site depicts a figure in a position resembling an asana used for meditation, Mulabandhasana. This interpretation is considered speculative and uncertain by more recent analysis of Srinivasan[9] and may be a case of projecting "later practices into archeological findings".[52]
Site enhancement oil, often called "santol" or "synthol" (no relation to the Synthol mouthwash brand), refers to oils injected into muscles to increase the size or change the shape. Some bodybuilders, particularly at the professional level, inject their muscles with such mixtures to mimic the appearance of developed muscle where it may otherwise be disproportionate or lacking.[55] This is known as "fluffing".[56][57] Synthol is 85% oil, 7.5% lidocaine, and 7.5% alcohol.[56] It is not restricted, and many brands are available on the Internet.[58] The use of injected oil to enhance muscle appearance is common among bodybuilders,[59][60] despite the fact that synthol can cause pulmonary embolisms, nerve damage, infections, sclerosing lipogranuloma,[61] stroke,[56] and the formation of oil-filled granulomas, cysts or ulcers in the muscle.[60][62][63] Rare cases might require surgical intervention to avoid further damage to the muscle and/or to prevent loss of life.[64]
To combat steroid use and in the hopes of becoming a member of the IOC, the IFBB introduced doping tests for both steroids and other banned substances. Although doping tests occurred, the majority of professional bodybuilders still used anabolic steroids for competition. During the 1970s, the use of anabolic steroids was openly discussed, partly due to the fact they were legal.[9] In the Anabolic Steroid Control Act of 1990, U.S. Congress placed anabolic steroids into Schedule III of the Controlled Substances Act (CSA). In Canada, steroids are listed under Schedule IV of the Controlled Drugs and Substances Act, enacted by the federal Parliament in 1996.[10]
^ Mangano, Kelsey M.; Sahni, Shivani; Kiel, Douglas P.; Tucker, Katherine L.; Dufour, Alyssa B.; Hannan, Marian T. (February 8, 2017). "Dietary protein is associated with musculoskeletal health independently of dietary pattern: the Framingham Third Generation Study". The American Journal of Clinical Nutrition. 105 (3): 714–722. doi:10.3945/ajcn.116.136762. PMC 5320406. PMID 28179224 – via ajcn.nutrition.org.
Some bodybuilders use drugs such as anabolic steroids and precursor substances such as prohormones to increase muscle hypertrophy. Anabolic steroids cause hypertrophy of both types (I and II) of muscle fibers, likely caused by an increased synthesis of muscle proteins. They also provoke undesired side effects including hepatotoxicity, gynecomastia, acne, the early onset of male pattern baldness and a decline in the body's own testosterone production, which can cause testicular atrophy.[43][44][45] Other performance-enhancing substances used by competitive bodybuilders include human growth hormone (HGH).
The Rigveda, however, does not describe yoga, and there is little evidence as to what the practices were.[7] Early references to practices that later became part of yoga, are made in Brihadaranyaka Upanishad, the earliest Hindu Upanishad.[67] For example, the practice of pranayama (consciously regulating breath) is mentioned in hymn 1.5.23 of Brihadaranyaka Upanishad (c. 900 BCE), and the practice of pratyahara (concentrating all of one's senses on self) is mentioned in hymn 8.15 of Chandogya Upanishad (c. 800–700 BCE).[68][note 8] The Jaiminiya Upanishad Brahmana teaches mantra repetition and control of the breath.[71]
^ Andrew J. Nicholson (2013). Unifying Hinduism: Philosophy and Identity in Indian Intellectual History. Columbia University Press. p. 26. ISBN 978-0-231-14987-7., Quote: "From a historical perspective, the Brahmasutras are best understood as a group of sutras composed by multiple authors over the course of hundreds of years, most likely composed in its current form between 400 and 450 BCE."

An influential text which teaches yoga from an Advaita perspective of nondualistic idealism is the Yoga-Vāsiṣṭha.[263] This work uses numerous short stories and anecdotes to illustrate its main ideas. It teaches seven stages or bhumis of yogic practice. It was a major reference for medieval Advaita Vedanta yoga scholars and before the 12th century, it was one of the most popular texts on Hindu yoga.[264]

According to Geoffrey Samuel, our "best evidence to date" suggests that yogic practices "developed in the same ascetic circles as the early śramaṇa movements (Buddhists, Jainas and Ajivikas), probably in around the sixth and fifth centuries BCE." This occurred during what is called the ‘Second Urbanisation’ period.[8] According to Mallinson and Singleton, these traditions were the first to use psychophysical techniques, mainly known as dhyana and tapas. but later described as yoga, to strive for the goal of liberation (moksha, nirvana) from samsara (the round of rebirth).[78]
An article by Muscle & Fitness magazine, "Overtrain for Big Gains", claimed that overtraining for a brief period can be beneficial. Overtraining can be used advantageously, as when a bodybuilder is purposely overtrained for a brief period of time to super compensate during a regeneration phase. These are known as "shock micro-cycles" and were a key training technique used by Soviet athletes.[54]
Personal health depends partially on the active, passive, and assisted cues people observe and adopt about their own health. These include personal actions for preventing or minimizing the effects of a disease, usually a chronic condition, through integrative care. They also include personal hygiene practices to prevent infection and illness, such as bathing and washing hands with soap; brushing and flossing teeth; storing, preparing and handling food safely; and many others. The information gleaned from personal observations of daily living – such as about sleep patterns, exercise behavior, nutritional intake and environmental features – may be used to inform personal decisions and actions (e.g., "I feel tired in the morning so I am going to try sleeping on a different pillow"), as well as clinical decisions and treatment plans (e.g., a patient who notices his or her shoes are tighter than usual may be having exacerbation of left-sided heart failure, and may require diuretic medication to reduce fluid overload).[58]
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