What is “relative risk” (RR)? The case of alcohol frequency and its impact on mortality from stroke

This post is in response to an inquiry by Ivor (sorry for the delayed response). It refers to a recent study by Rantakömi and colleagues on the effect of alcohol consumption frequency on mortality from stroke (). The study followed men who consumed alcohol to different degrees, including no consumption at all, over a period of a little more than 20 years.

The study purportedly controlled for systolic blood pressure, smoking, body mass index, diabetes, socioeconomic status, and total amount of alcohol consumption. That is, its results are presented as holding regardless of those factors.

The main results were reported in terms of “relative risk” (RR) ratios. Here they are, quoted from the abstract:

“0.71 (95% CI, 0.30–1.68; P = 0.437) for men with alcohol consumption <0.5 times per week and 1.16 (95% CI, 0.54–2.50; P = 0.704) among men who consumed alcohol 0.5–2.5 times per week. Among men who consumed alcohol >2.5 times per week compared with nondrinkers, RR was 3.03 (95% CI, 1.19–7.72; P = 0.020).”

Note the P values reported within parentheses. They are the probabilities that the results are due to chance and thus “not real”, or not due to actual effects. By convention, P values equal to or lower than 0.05 are considered statistically significant. In consequence, P values greater than 0.05 are seen as referring to effects that cannot be unequivocally considered real.

This means that, of the results reported, only one seems to be due to a real effect, and that is the one that: “Among men who consumed alcohol >2.5 times per week compared with nondrinkers, RR was 3.03 …”

Why the authors report the statistically non-significant results as if they were noteworthy is unclear to me.

Before we go any further, let us look at what “relative risk” (RR) means. RR is given by the following ratio:

(Probability of an event when exposed) / (Probability of an event when not exposed)

In the study by Rantakömi and colleagues, the event is death from stroke. The exposure refers to alcohol consumption at a certain level, compared to no alcohol consumption (no exposure).

Now, let us go back to the result regarding consumption of alcohol more than 2.5 times per week. That result sounds ominous. It is helpful to keep in mind that the study by Rantakömi and colleagues followed a total of 2609 men with no history of stroke, of whom only 66 died from stroke.

Consider the following scenario. Let us say that 1 person in a group of 1,000 people who consumed no alcohol died from stroke. Let us also say that 3 people in a group of 1,000 people who consumed alcohol more than 2.5 times per week died from stroke. Given this, the RR would be: (3/1,000) / (1/1,000) = 3.

One could say, based on this, that: “Consuming alcohol more than 2.5 times per week increases the risk of dying from stroke by 200%”. Based on the RR, this is technically correct. It is rather misleading nevertheless.

If you think that increasing sample size may help ameliorate the problem, think again. The RR would be the same if it was 3 people versus 1 person in 1,000,000 (one million). With these numbers, the RR would be even less credible, in my view.

This makes the findings by Rantakömi and colleagues look a lot less ominous, don’t you think? This post is not really about the study by Rantakömi and colleagues. It is about the following question, which is in the title of this post: What is “relative risk” (RR)?

Quite frankly, given what one sees in RR-based studies, the answer is arguably not far from this:

RR is a ratio used in statistical analysis that makes minute effects look enormous; the effects in question would not normally be noticed by anyone in real life, and may be due to chance after all.

The reason I say that the effects “may be due to chance after all” is that when effects are such that 1 event in 1,000 would make a big difference, a researcher would have to control for practically everything in order to rule out confounders.

If one single individual with a genetic predisposition toward death from stroke falls into the group that consumes more alcohol, falling in that group entirely by chance (or due to group allocation bias), the RR-based results would be seriously distorted.

This highlights one main problem with epidemiological studies in general, where RR is a favorite ratio to be reported. The problem is that epidemiological studies in general refer to effects that are tiny.

One way to put results in context and present them more “honestly” would be to provide more information to readers, such as graphs showing data points and unstandardized scales, like the one below. This graph is from a previous post on latitude and cancer rates in the USA (), and has been generated with the software WarpPLS ().

This graph clearly shows that, while there seems to be an association between latitude and cancer rates in the USA, the total variation in cancer rates in the sample is only of around 3 in 1,000. This graph also shows outliers (e.g., Alaska), which call for additional explanations.

As for the issue of alcohol consumption frequency and mortality, I leave you with the results of a 2008 study by Breslow and Graubard, with more citations and published in a more targeted journal ():

“Average volume obscured effects of quantity alone and frequency alone, particularly for cardiovascular disease in men where quantity and frequency trended in opposite directions.”

In other words, alcohol consumption in terms of volume (quantity multiplied by frequency) appears to matter much more than quantity or frequency alone. We can state this even more simply: drinking two bottles of whiskey in one sitting, but only once every two weeks, is not going to be good for you.

In the end, providing more information to readers so that they can place the results in context is a matter of scientific honesty.

Help Fund High-Quality Research on Diet and Health

University of California, San Francisco researcher Dr. Ashley Mason has asked me to spread the word about a diet-health study she's preparing to conduct in collaboration with Dr. Lynda Frassetto.  Dr. Frassetto is a widely recognized expert on mineral metabolism and bone health, and also one of the few researchers who has managed to wrangle funding to study the health impacts of a Paleolithic-style diet.  Her findings have been quite provocative.  

Together with their collaborators, Drs. Mason and Frassetto are preparing another diet-health trial to study the impact of two different diets on polycystic ovary syndrome, or PCOS.  PCOS is a common hormonal disorder among reproductive-age women, and its signs and symptoms include ovarian cysts, excess hair growth, menstrual irregularity or absence, infertility, and obesity.  Its causes are unknown, but insulin resistance is a core characteristic of it and is thought to play an important role.  PCOS is thought to be influenced by diet and lifestyle. 

A research team including Drs. Frassetto and Mason, as well as Drs. Umesh Masharani, Heather Huddleston, and Michael Cohn will test a Paleolithic-style diet and an American Diabetes Asssociation diet to see if either or both improves insulin resistance and menstrual cycle regularity for women with PCOS.  Each diet will likely have beneficial effects, however it remains unknown which will be more effective at treating PCOS.

Currently, it's exceedingly difficult for researchers to land funding from the National Institutes of Health (NIH) to do nutrition-related research in the context of disease treatment or management, particularly if it involves a Paleo diet. Recognizing the important potential of fleshing out the relationship between diet and health, researchers are looking for other ways to fund their work.  This study will give them the early data they need to start large, truly definitive studies of the links between diet and insulin resistance, and you can help make it happen.

Please check out their crowdfunding website to learn more about the study, the researchers, and make tax-deductible donations to support their work. And, if you're attending the Ancestral Health Symposium, one of the "backer" rewards is having lunch with the researchers.

Click here to see their crowdfunding site! 


This post was prepared in part using content provided by Dr. Mason.

Favorite Salad Bowls and Food Travel Bag

One thing that makes healthy eating more pleasurable is the way the meal is plated and served.  Although I am guilty of eating a meal in my car when I have to, I much prefer to sit down to a pretty table (a simple placemat and fresh bunch of flowers) with some care taken in how the food is presented.  My girlfriend, Karen, turned me on to the best salad bowls ever and I'm hooked on them!  They are the Blanc Porcelain Bowls from  Sur La Table and they are so perfect because they are wide (9 inches) and shallow.  You can see all the beautiful components of your dish in this bowl and have lots of room to mix things up. A pasta or noodle dish is also perfect in this bowl, but I think it's too big to use as a cereal bowl. The bowls are expensive ($9.99 each) but so worth it.  You can microwave them and even cook up to 500 degrees in the oven, and of course, they are dishwasher safe.  A set of 4 made a nice "thank you" gift for my trainer after the bikini competition too.  

The other kitchen item I can't live without now is my insulated World Market Jane Lunch Bag.  It's insulated and I use it probably once a day if I have to take a meal with me on the go to eat later.  I can actually fit quite a bit in there- a tupperware meal for me, one for my son, an icepack, and a juice box! There are pockets on the sides that I use to put plastic silverware and napkins.  The bag is $12.99.

What kitchen item can you not live without?  Please share! 

Mustard Lemon Chicken with Thyme

If you've been following along this blog for long, y'all know how much chicken we eat around here. Last week, I shared how we typically grill up a bunch of chicken and then add it to our salads throughout the week.  I'm keeping chicken on my menu, but I wanted to find more interesting ways to prepare it.  I'm sure you know how boring chicken breasts can be if they're not salted, flavored with herbs and spices, or added to a salad with dressing.  Today, I'm sharing a recipe for Mustard Lemon Chicken with Fresh Thyme as a healthy alternative to salting the heck out of your chicken.  I've partnered with Sunkist Lemons on this post and if you want more info about sodium and reduced-sodium recipes, check out their website. 

I practically cut sodium out of my diet these last few months, and truthfully, I don't miss it.  I do use salt-free seasonings, but here, a little bit of lemon goes a long way toward brightening and adding flavor to this dish.  

And something about using lemons in the summer feels so fresh.  Aren't they pretty?!

This recipe couldn't be simpler.  You just make the mustard-lemon sauce for the chicken, then bake it in the oven.  This recipe would pair well with rice or pasta and fresh veggies. 

DIRECTIONS

Preheat the oven to 350 degrees.  Place the chicken breasts onto a baking sheet. Make the sauce below and spoon it on top of the chicken.  Add some cracked pepper on top and a few sprigs of thyme, along with lemon wedges.  Bake the chicken for about 35 minutes or until the internal temperature reaches 170 degrees.  Remove from the oven and let rest about 10 minutes. 

INGREDIENTS

Chicken (boneless, skinless breasts)- 6 

Lemon (2) - zest of 1 lemon and it's juice (1 more for in the baking dish and/or garnish)

Garlic - 4 cloves minced 

Dijon mustard - 2 tablespoons

Olive oil - 2 tablespoons 

Thyme - 1 tablespoon + more for garnish

Parsley - enough for garnish

Fresh cracked pepper - to taste

Thank you for supporting Honey We're Healthy by visiting my sponsors! 

Naturally Sweetened Super Crunchy Buckwheat and Cardamom Granola

Naturally Sweetened Super Crunchy Buckwheat and Cardamom Granola

¼ cup flax seeds

½ cup raw buckwheat groats (not Kasha)

1 cup rolled oats

1 tsp ground cardamom

1 cup quite tightly packed dates (17 small, fresh dates)

2 tbsp coconut oil

Preheat your oven to 150^oC/300^oF and line a medium-sized baking tray. 

You'll need a bigger bowl than this one ;)

Place all dry ingredients in a rather big bowl and stir well. Put the dates and coconut oil in a separate bowl and blend with a hand blender until the mixture is smooth. You might want to add 1-2 tbsp of water for the right consistency. Then pour the date paste over the grains and stir until everything’s well coated.

Spread the granola out on the baking tray and bake for about 30-35 minutes. Remove the tray from the oven to give it a quick stir every ten minutes or so, we don’t want the top or edges to burn! (Confession: Mine was slightly burnt but it actually gave it a pretty nice and toasty flavor. I did have to throw some away though so make sure to watch it while it's in the oven!)

Once the cooking time has elapsed, turn the oven off but leave the granola in there to dry out (unless it already feels crunchy enough). I like to make this at night and then take it out of the oven the morning after. Store in an airtight container and keep in the pantry.

Crunch away!

Tilda

Thai Steak Salad with Peanut Sauce

I'm so happy to share a recipe featuring steak!!!  And this is a really good cut of meat, specifically, beef tenderloin.  I haven't had one of those in ages and I didn't want to mess up the cooking, so my husband cooked that part of this Thai Steak Salad for me.  He got it just right too!

Because this meal is a salad, all you have to do is prepare the marinade, and then be patient while the meat marinates at least four hours, or up to overnight.  It's easy to throw the cold salad ingredients together, then I take a short-cut and top the salad with my store-bought peanut dressing!  

INGREDIENTS

(ingredient portions depend on how many people you are feeding and what you like in your salad).

Beef tenderloin or flank steak- 1 pound 

Romaine lettuce

Cabbage

Tomato

Red onion

Avocado 

Mango

Cashews (optional)

Sesame seeds (optional)

Basil and/or cilantro (optional)

*Bangkok Padang Peanut Sauce (or other peanut sauce) 

MARINADE 

Juice of 1 lime

Low sodium soy sauce- 3 tablespoons

Canola oil- 3 tablespoons

Brown sugar- 2 tablespoons

Minced garlic- 1 tablespoon

Red curry paste- 1 teaspoon

To make the marinate, combine the above ingredients into a large plastic ziploc bag. 

Pat the meat dry with paper towels and add to the bag with the marinade.  Marinate in the refrigerator for at least 4 hours or overnight.  I did 4 hours and it was great. 

To cook the steak, spray a grill pan with cooking spray and heat pan to medium-high heat.  Cook for about five minutes per side until medium rare, or longer for more doneness.  Let rest until room temperature and then slice thinly. 

Assemble the salads by adding the romaine, cabbage, onion, avocado, and mango.  You can also add fresh herbs and cashes if desired.  

I love this peanut sauce, but it's a little spicy, so I pour it into a bowl and thin it with a bit of water and add lime juice to it.  It you like some kick, it's great on it's own.  

This salad is so good!  Especially when you mix everything up and all the flavors meld together.  

I'm sure this will be in our dinner rotation again in the near future! 

Healthy Meal Prep

It goes without saying that if you want to get in shape, you have to eat healthy.  But, it's hard when there's so much going on in our lives and we feel like we don't have the TIME to prepare healthy meals.  For me, I eat five meals a day about 3 hours apart.  I have gotten used to eating the same thing twice a day (usually a grilled chicken salad).  I enjoy my salad, so it's no big deal.  And thank the Lord, my husband eats the same way, so I don't have to prepare another meal for him.  But, that's the caveat with this healthy meal prep, it's the same food twice a day, and lack of variety is fatal for some people.  With our family's busy schedule and needing to have so many meals to eat each day, it's just simpler for me to eat the same thing over and over.  No thinking about it, just prep once, then grab and go.  

My meal prep is incredibly easy.  Eating this way takes way less time than preparing several different meals for lunch or dinner.  All you really need to do is buy a big package of boneless, skinless chicken breasts and grill them at once on the grill.  My husband and I both eat about two chicken breasts a day, so he will cook 12-16 at a time, and I have found they are good refrigerated for four days, sometimes five.  The photo below is my meal prep that I took to my bikini competition because that's all I ate for two days but you could use these for lunch or dinner once or twice a day, along with your other meals.  

The twelve meals above were made from the few ingredients below.

HOW TO GRILL CHICKEN 

On the grill (we use a gas grill, but you can use a grill pan on the stove), turn the fire to medium to medium high heat.  For my "contest" chicken, no oil was used, just a sprinkle of Tony Chachere's Salt-Free seasoning.  Now that the contest prep is over, he puts a little olive oil on the chicken to keep it from sticking to the grill and to keep the chicken moist.

Cook the chicken for about 10-15 minutes per side, depending on the thickness of the chicken.  When it's done, remove from the heat and cover with foil.  Let it rest for at least 10-15 minutes.

Each meal gets five ounces of chicken.  I can pretty much eyeball how much 5 ounces is now, but otherwise, I have found this scale very beneficial.  I used it everyday while on bikini prep and sometimes still do. 

For the carbs, I usually eat potatoes, but you can substitute rice or quinoa.  Sweet potatoes are great too.  I was only eating 4 ounces of carbs for this prep, so I used small, red potatoes.  

COOKING POTATOES

After washing the potatoes (I used 12), I towel-dried them, poked them a couple times with a knife, then microwaved them all at once for 10 minutes, turning halfway through the cooking time.  They shrink when cooked, so they only averaged 3.5 ounces.  Now, I'd eat about 6 ounces, so two of these small guys.  What I really like to do (when I'm home) is chop them up after they are cooked and toast them up on the stove on a medium-high heat (just spray the pan with cooking spray). 

I use my Gladware that I found at the grocery store and then begin assembling. 

A big handful of romaine lettuce, a few tomatoes or a cup of frozen green beans . . . 

then the potatoes and chicken.

I eat the salad meals cold (and add dressing now), and microwave the meals with green beans for about 1 minute or so.  You have to be careful not to reheat chicken too much or it will get dried out. 

_____________

Since I'm at home most days now, I haven't been assembling my food like this lately.  After the big batch of chicken is cooked, I put it in a large Rubbermaid tupperware container and keep it in the fridge.  We just pull out it as needed.  The variety for me now is just adding more and different things to my salad, like avocado, mango, sundried tomatoes, etc.  I was only eating Romaine lettuce before, but now I find I like a combo of Romaine and arugula.  When you add 5 ounces of chicken to your salad, it's really filling too. 

As long as you have chicken already cooked in the fridge, you're good to go for quick, easy meals, especially salads.  I need to look into other recipes using chicken (adding to pastas or casseroles) next.  

I made a Thai steak salad for dinner on Sunday and it was delicious!  I'll be sharing that recipe next!

Love at First Bite - Basic Vegan Pancakes

We all love us a big stack of pancakes, don’t we? If your answer to that question is no, you’re obviously lying. I know you are. I used to be one of those (crazy) people claiming they don’t like pancakes. Here in Sweden, a pancake is usually a thin, flat disc that's quite dense in consistency. Growing up, I absolutely hated these. They were all too stodgy for my taste and nothing like the wonderfully fluffy American kind, which, I was yet to discover. So when each Sunday, my Instagram feed was flooded with beautiful stacks of golden pancakes, I felt nothing but perhaps a little envy of their gorgeous presentations. Then I decided to try it out for myself and everything changed. It was love at first bite. Pancakes are without question the ultimate comfort food and my previous attitude towards them could not have been more misguided.  

Although most people think of pancakes as an unhealthy treat, it’s actually very simple to make them both healthy and vegan. I’ll admit it took some tinkering around with this recipe before I was happy and confident enough to share it with you all but here it is, finally, my basic vegan pancake recipe!

Basic Fluffy Vegan Pancakes with a Caramel Sauce

Serves: 1

1/2 cup buckwheat flour (heaped) (70 g)

1/2 tsp baking powder

1/4 tsp baking soda

1 ripe banana, mashed (80 g)

1 tsp lemon juice or apple cider vinegar

1 chia egg (1 tbsp ground chia seeds mixed with 3 tbsp water), could sub for flax egg

3 tbsp almond milk (you may have to add a couple more tbsp if the batter is too thick!)

1 tsp melted coconut oil

Optional:

Coconut oil for frying 

1 tbsp maca or lucuma powder

1 pinch of vanilla powder

1. Start by preparing your chia egg: Grind one tbsp of whole chia seeds either by hand or in a coffee grinder, then mix the ground seeds with 3 tbsp of water. Stir well and let sit on the side for a few minutes to swell.
2. In a small bowl, mix all the dry ingredients with a fork until the baking powder is evenly divided. 
3. Mash/blitz the banana with the lemon juice (or vinegar) until smooth.
4. Pour in the chia egg, mashed banana, melted coconut oil and almond milk and stir until the batter is completely smooth. Let sit on the countertop for a few minutes (the batter should be THICK)
5. Fry in a spoonful of coconut oil (unless you have a non-stick frying pan) on medium heat for a couple of minutes on each side.

Caramel Sauce

2 tbsp peanut flour (or peanut butter if you don't have any peanut flour)

1 1/2 tbsp almond milk

1/2 tbsp date syrup

1/2 tsp maca powder

1. Mix all ingredients with a fork until you have a smooth, creamy sauce. You may have to adjust the amount of liquid if you use peanut butter instead of flour.

Put slices of banana in between the pancakes and top with the caramel sauce, quinoa pops and mulberries! Hope you like the recipe :)

Pancake-coma-love, Tilda

Instant Pot Electronic Pressure Cooker: Two Years Later

I've had several people tell me that the Whole Health Source post that changed their lives the most was one I published in 2012-- about a pressure cooker.

In 2012, I first reviewed the Instant Pot-- a "pressure cooker for the 21st century" that also doubles as a slow cooker and rice cooker (1).  Since then, we've used it more than 400 times, and it has saved us countless hours of kitchen drudgery.  It's indispensable for my current cooking style, and a major time saver for anyone who leads a busy life but still wants to cook wholesome food at home.  It's extremely satisfying to be able to put your ingredients into the Instant Pot, push a couple of buttons, do something else until it beeps, and then eat a healthy, inexpensive, and delicious meal.

Pressure cookers are one of the most time- and energy-efficient cooking tools, but electronic versions are even more efficient than traditional stovetop pressure cookers.  They're more time-efficient because you don't have to fiddle with them-- for example, adjusting the heat.  They're more energy-efficient because 1) they stop heating when the interior has reached the appropriate pressure, meaning that they're only using energy for part of the cooking process and they hardly vent any energy-wasting steam, and 2) they're insulated well enough that the sides never get hot.

I've used my Instant Pot for a wide variety of cooking tasks, and this is what it does best:

Read more »

What's Next? The Post Bikini Competition Plan

A surprising thing about post-competition is that I'm not all that anxious to eat all of the food that's been off limits during contest prep.  You'd think I'd want to eat everything in sight, but that hasn't been the case.  In fact, the thought of a big, juicy cheeseburger and fries (something I love to indulge in once in a while before) doesn't really sound good to me right now.  I think it feels so good having worked so hard to get in shape, I don't want to "blow it" by eating bad.  It doesn't feel worth it.  

FOOD

The night the competition ended, we found a nice steak restaurant that was open and ate a late dinner there.  I had baked brie (a favorite of mine!) with dry toasts, filet minion, twice baked potato and iced-tea.  I only finished half of the steak and potatoes and I really wasn't ready for any alcohol.  The next morning, I indulged in Starbuck's banana bread for breakfast before we got on the road to come home.

After driving nearly four hours home, we stopped at Chipotle for lunch and I always get a bowl with rice, chicken and pico.  Back at home, I got back on my regular (contest prep) meals with the exception of the ice cream I had been craving.  I wanted Gelato (it has less fat) but they were out the kind I like (Sea Salt Caramel), so I got regular Carmel Cone ice cream.  I ate the whole pint.  It was GOOD going down!  

But, of course, my stomach really hurt the next morning.  Thankfully, my abs were still there! :)  Although a cheeseburger doesn't sound good, I could keep eating ice-cream every once in a while (just not a whole pint in one sitting!).

My trainer texted me the next morning telling me I should get back to Phase 1 of my diet.  And it's crazy that I was actually looking forward to it!  I really like my protein pancakes with all-natural fruit spread.  Meal 2 is usually fish, potato, and green beans.  Meal 3 is a grilled chicken salad with fat free dressing.  Meal 4 is chicken, potato or rice, and veggies.  Meal 5 is a cup or so of Muscle Egg.  Sometimes, I'll eat another pancake too in between Meal 4 and 5.  I typically eat at 9am, 12pm, 3pm, 6pm, and 9pm.  

On Tuesday night, my girlfriend invited me out for a drink and I went, but ordered tea. Wednesday night, I went to dinner with two friends at a new restaurant and I was excited to have something different.  I ate tuna tartare and a mini steak skewer.  

At the weekend blog conference I went to, I ate as best I could (even brought and drank 3 protein shakes while I was there).  We were fortunate that the conference had a fresh, healthy salad bar selection with fish and chicken.

BUT, I did indulge in THREE small desserts on Saturday (chocolate popsicle, shared milkshake at dinner, and scoop of ice cream at the late-night party).  Back at home on Sunday, I was back to my meals- and ready to be! 

I do want to find new healthy meals that I can feel good about eating that are different from my usual.  It's just nice to have a little variety.  And I'm sure my husband would appreciate it too.  

WORKOUTS

As for the workouts, my trainer recommended that I do only 30 minutes of cardio and no weights for about a week to give my body a rest and just recoup from the competition.  What's crazy is that just doing 30 minutes of cardio now feels very minimal.  I haven't even bothered to go to the gym for it (it would take longer to drive there and back) opting instead to just run out my door around my neighborhood with my iPod. 

I had a great run on my trip out of town too.  I knew I'd want to run at least one day, so I packed running clothes and my iPod.  Right outside our hotel was a beautiful bike trail filled with tall, lush trees.  I even found the cutest Startbuck's ever and popped in after my run for an oatmeal and black iced-tea.  It felt so good to start the day this way.

Before I started training for this contest, if you'd have told me I'd be doing 30-45 minutes of cardio 4-5 times a week in addition to my one hour workout, I'd think you were crazy.  I didn't think I was physically capable of doing that, but my body surprised me.  Yours can too. 

via

I'm not training with my trainer right now, opting to spend more time with my son and just workout at the gym that's closer to my house.  When my son goes back to school, I'll reconsider.  I got spoiled training with him - not because it's any easier - in fact it's physically harder.  But, he kept me accountable and pushed me to my limit.  I just did what he said.  I didn't have to think about what's next, what exercise to do, what weight to lift, how many reps.  So many times I'd say to him, "I'd never workout this hard on my own." 

I know his routine pretty well now though.  We would do 3 exercises in a row, not too heavy, but a weight I could get 15-20 reps.  One of the exercises might be something without weights, just to keep my heart rate up, like Burpees. We'd do the round 3-4 times, then start again with 3 different exercises.  We did this for one hour, sometimes stopping with 10 minutes to spare so I could finish with abs.

It will be interesting to see if I can keep it up on my own.  I'm going to try!