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The objective of the present study was to assess the physical fitness of patients after apical resection and partial apical pleurectomy for the treatment of primary spontaneous pneumothorax (PSP). Between 1982 and 1999, 58 patients received surgical treatment for PSP in our department. Twelve patients needed bilateral surgical intervention. At an average of 121 months after surgery (range, 16-231 months), the patients underwent follow-up assessments. Information was obtained on the basis of a questionnaire and from clinical examinations, including spirometry/body plethysmography and exercise testing with a bicycle ergometer. High-resolution computed tomography was used to identify postoperative changes of the lung apex. Forty-eight of 58 patients took part in the study, and all were found to be fully fit. High-resolution computed tomography gave evidence of new postoperative fibrocystic processes in 26 of the 31 affected apexes. One recurrence was observed (3.2%). Because apical resection cannot counteract pathogenetic mechanisms underlying parenchymal destruction and the formation of postoperative bullae among patients with a history of PSP, additional treatment of the apical pleura is necessary to prevent recurrences. Our results suggest that the physical fitness of patients with PSP can be completely restored postoperatively.

Introduction

Primary spontaneous pneumothorax (PSP) typically occurs among otherwise healthy young male subjects between 20 and 40 years of age, with no clinically apparent lung diseases,12 and is therefore of particular occupational and military medical relevance. Patients with PSP are distinct from secondary pneumothorax patients who have underlying pulmonary diseases, most commonly chronic obstructive pulmonary disease.3 The pathogenesis of PSP is thought to be related to the entry of air into the pleural space, mostly resulting from lesions of emphysematous subpleural changes ("blebs") of the lung parenchyma. Correlative of PSP without intraoperatively visible blebs, a phenomenon described by several authors [e.g., Refs 4 and 5], might be "pleural porosities" of the apical lung6 or "apical dystrophy" diagnosed with histopathologic examination.4

Insertion of a chest catheter to reexpand the lung represents the generally accepted therapy for the first episode of PSP7 and prevents clinical recurrences in 70% to 80% of cases.8-10 PSP has a tendency for recurrence of 60% after the second episode and 80% after the third episode.8 Therefore, apical resection with partial parietal pleurectomy or gauze pleural abrasion performed through video-assisted thoracoscopic surgery (VATS) has become the standard for the treatment of persistent or recurrent PSP.7,11-14 This procedure is also advocated for patients for whom no blebs were identified with intraoperative macroscopic examination.5

We conducted a retrospective study in an attempt to assess the physical fitness of patients who had received surgical treatment for PSP. The objective of our study was assessment of a feasible restriction of physical fitness evaluated as the cardiopulmonary capacity with a questionnaire, clinical examination, spirometry, and exercise testing with a bicycle ergometer. In addition, we used high-resolution computed tomography (HRCT) to evaluate postoperative morphologic changes of the lung apex and to assess their clinical relevance.

Methods

Our retrospective study included 50 male and 8 female patients who had undergone surgery for treatment of PSP in our department between September 1982 and June 1999. For 12 of the male patients, the surgical procedure had been performed bilaterally, in two cases simultaneously (through VATS). Accordingly, our study was based on a total of 70 apexes (39 on the right side and 31 on the left side). At the time of surgery, the mean age of the patients was 27.5 years (range, 17.8-45 years). Additional data are shown in Table I. Patients who were >45 years of age at the time of surgery and patients with secondary spontaneous pneumothorax that was related to the presence of a known underlying disease were excluded from the study.

The patients were asked to complete a questionnaire and to answer questions on their medical history and their current level of physical fitness. It was thus possible to identify potential predisposing factors such as cigarette smoking and genetic factors. In addition, data recorded for each patient included the number of episodes of pneumothorax and the patient's subjective assessment of his or her physical fitness and general state of health, which was rated as "excellent," "good," "moderate," or "poor."

All patients were invited to undergo a follow-up examination on an outpatient basis. The following diagnostic methods were used: (1) anamnesis and clinical evaluation (scar evaluation, neuralgia, and ventilation); (2) spirometry/body plethysmography (Masterlab, Fa. Jäger, Hoechberg, Germany), with determination of relative vital capacity and forced expiratory volume in 1 second based on age- and gender-specific normal values (percentage); (3) measurement of serum α^sub 1^-antitrypsin levels; (4) exercise testing with a bicycle ergometer for assessment of the physical fitness of all patients 5 mm in size (Figs. 1 and 2). This examination was performed by an experienced radiologist.

I'm in better shape today than at any other period of my life," says John Anderson, a 45-year-old college pro- lessor. John is part of a growing segment of the population that is discovering the multiple benefits of starting an exercise program in mid-life. "In my 20s and 30si never had time ta exercise, because of family and work obligations. As I started getting older I started gaining weight and was worried about my health. I had very little energy. My doctor kept tell- ing me to start getting some exercise, but lnever listened to him.

"One day several people from the office asked me to join them during their lunch- time walk. Give up lunch for exercise? Well, they convinced me, and lactually enjoyed it. I never thought of walking as serious exercise. I now walk 30 to 40 minutes each day, have more en- ergy, and have lost 15 pounds. And my physician tells me that my health is excellent."

No matter how old you are, no matter what your past experiences have been with exercise, and no matter how sedentary you are or have been, it's never too late to start an exercise pro- gram. Sure, it takes time and commitment, but, the reward and benefits of an active lifestyle are certainly worth the effort!

Pre-Exercise Health Questionnaire

Before beginning an exercise program, you may need to have a physical examination and possibly an exercise treadmill test. To determine whether or not you should see your physician before getting started, take a minute to fill out the following pre-exercise health questionnaire. If you do not check any of the blanks, most medical experts agree that a moderate exercise program (such as brisk walking, easy swimming and cycling, etc.) can be started without first seeing a doctor. If you check two or more, it is a good idea to see your physician before starting an exercise program.

1. SUGGESTIVE SYMPTOMS

Have you experienced unusual pain or discomfort in your chest (pain that-suggests blockage in coronary arteries of your heart)?

Have you experienced unusual shortness of breath during moderate exercise (such as climbing stairs)?

Have you had any problems with dizziness or fainting?

When you stand up, or sometimes during the night, do you have difficulty breathing?

Do you suffer from swelling of the ankles (ankle edema)?

Have you experienced a rapid throbbing or fluttering of the heart?

Have you experienced severe pain in your leg muscles during walking?

Has a doctor told you that you have a heart murmur?

2. HEART DISEASE RISK FACTORS

Are you a cigarette smoker (or have you quit within the past year)?

Has your serum cholesterol been measured at greater than 240 mg./dl.?

Do you have very high blood pressure (more than 160/90 mm. Hg.) or are you taking medication to control your blood pressure?

Did one of your parents or siblings die of heart disease before age 557

Are you a diabetic? (Note: If you are older than age 30 with a long history of this disease, then classify yourself as an "individual with disease"-see next category.)

3. KNOWN DISEASES

Do you have a personal history of heart disease?

Do you have a personal history of kidney, liver, or thyroid disease?

Are you a long-term diabetic (older than age 30 with a long history of this disease)?

Ok so now you're ready. You have been cleared by your physician, and have made the commitment to start an exercise program. Here is what to keep in mind:

EXERCISE METHODS. The types of exercise you choose must be convenient for you. For example, if the exercise requires a great deal of time or a long drive to and from a facility, or if the exercise requires special, costly, or time-consuming preparation, the likelihood of you sticking with your program is very low. In addition, try a variety of exercise methods when starting out, such as walking one day and cycling the next. For the greatest chance of succeeding, choose an exercise program that's both convenient and easy to perform.

INTENSITY. Exercise intensity refers to the percentage of maximal effort during an exercise session. If you are just starting out, it is important to exercise at a low intensity, or low effort, for the first few weeks. A simple method of monitoring your intensity is by the talk test. If you are exercising at a safe and comfortable intensity level, you should be able to carry on a conversation at the same time without a great deal of difficulty. After several weeks you can gradually increase the exercise intensity according to how you feel and how well you have improved.

No one--not even a fitness-magazine editor--is immune to finding herself in humiliating workout situations. Read on, and perhaps you won't feel like slinking out of the room the next time you pass gas in yoga class.--Ellen Ullman

"I was out running when a man started trying to get my attention. I ignored him until he yelled, 'There's a rip in your shorts!' I had a split down the seam and wasn't wearing any underwear."--Lisa F., Valhalla, N.Y.

"My period started just before step class, so I put wadded-up toilet paper in the lining of my shorts. About 20 minutes later, I looked down and saw that my makeshift pad had fallen out!"--Alyse H., Philadelphia

"As an outdoor runner, I loathe exercise machines. But after a week of nonstop rain, I decided to brave the treadmill. Not knowing the first thing about how to turn it on, I punched in a bunch of numbers, stepped on, and the treadmill took off like a bolt out of the blue, throwing me off the back like a bucking bronco."--Carole J., senior editor, Shape, Los Angeles

"My black thong panties were in my hockey bag for after my game, but they got stuck to my hockey pants and stayed there until I went out on the ice. The ref picked them up, thinking they were a piece of black hockey tape, but then realized what they were and brought them over to the bench and dropped them off in front of me."--Cyndi K., Los Angeles

"I was inline skating when a guy came out of nowhere and stepped in front of me to cross the street. I grabbed him so I wouldn't fall.

In a perfect world, we all would wake up each morning for a quick jog, then spend the work day doing toe stands at the copier and climbing stairs instead of taking elevators. At home, we would do lunges while vacuuming, rake leaves with gusto and workout with an aerobics video. On weekends, we'd actually run errands instead of driving our cars, blast out bicep curls with our shopping bags while speed walking through the mall, then take Salsa dancing or kick-boxing lessons for fun.

Now in the real world, that just ain't gonna happen. Not because these tasks are so tough or time-consuming. We just think they are. Lurking behind each good thing we could do for our bodies are a dozen bad excuses for blowing off exercise.

Instead of finding excuses find reasons to put more activity in your life. Write them down and commit them to memory. Then, whenever you slip into excuse mode, recall a few to stay inspired to exercise. Try these five to help you change your fitness mind-set:

GOOD REASON 1: Exercise makes me look good. One of the best reasons to work out is the cosmetic benefit. Regular exercise burns calories, which helps you lose excess weight, and it builds bone and muscle tissue, giving you a sculpted, sexier body.

GOOD REASON 2: Exercise helps me feel good. Working out boosts your energy, strength and stamina. It also improves your mood since your brain releases chemicals (endorphins) while you exercise that relax the body and release tension. And if endorphins aren't enough, the changes in your body definitely will lift your spirit.

GOOD REASON 3: Exercise fights off illness. Regular exercise reduces the risk of heart, disease--one of the nation's leading causes of death--by strengthening the heart and lungs and improving blood circulation. Exercise also can prevent and manage high blood pressure, high cholesterol, osteoporosis and help control your weight, which cuts your risk of diabetes, asthma and cancer.

GOOD REASON 4: Exercise checks stress. Stress call lead to illnesses like high blood pressure, heart disease, ulcers, migraines and mental-health, problems like nervous breakdowns and violent outbursts. Exercise burns excess energy generated by stress and produces those feel-good endorphins.

GOOD REASON 5: Exercise improves my love life. When you look good and feel good about your body, people will certainly take note. If you already have a special someone, shaping up together enhances physical and emotional intimacy since you both are sharing fitness goals and spending time together. And as an added bonus, exercise enhances the quality of your sex life by boosting your energy and endurance.

`Will the contraceptive patch work as well as the birth control pill?

CONTRACEPTIVE PATCH

Q My husband and I are planning to have another child in the future, and I am currently using birth control pills so there won't be any surprises. On a couple of occasions, though, I forgot to take the pills when I was supposed to. To prevent that, I'm hoping to switch from the pills to the new contraceptive patch. But will the patch work as well as the birth control pills? J.E., Columbia, S.C.

A Nearly 11 million U.S. women use birth control pills, which are 99 percent effective in preventing pregnancy when taken correctly, doctors say. Although early testing indicates that the contraceptive patch is effective in preventing pregnancy, its total effectiveness may not be known until the U.S. Food and Drug Administration approves its use, which is expected before May of next year.

The patch is designed to be worn on the arm, buttocks or abdomen and allows hormones to be absorbed through the skin for a week. A new patch is attached every seven days until the start of the menstrual cycle.

With the use of the patch, which is about the size of a half dollar, women won't have to deal with the daily regimen that's associated with oral contraceptives, thereby eliminating the possibility of forgetting to take the daily dosage.

Physicians say about 60 percent of all pregnancies are unplanned, but choosing the right contraceptive depends on the woman's age, health, frequency of sex and whether there are plans to have children in the future.

ASSISTING SEIZURE VICTIMS

Q I recently had one of the scariest experiences of my life when my friend had an unexpected seizure. Although it was mild, I was so scared because I didn't know what to do and couldn't help her. What should a person do when someone is having a seizure? W.M., Birmingham, Ala.

A It's understandable that you would be frightened to see your friend in trouble and then not be able to help her. Seizures are caused by a number of conditions, including epilepsy, stroke or brain tumor, high fever (especially in children) or other serious medical conditions.

If a person is having a seizure, doctors say you should take the following steps: Do not attempt to restrain them, which could result in bruises or even fractures; do not try to open their mouth to prevent them from biting their tongue since such efforts can do more harm than good; clear away any sharp or hard objects and loosen clothing around the neck. Although breathing is depressed during the seizure, medical experts say mouth-to-mouth resuscitation is rarely necessary and normal breathing should resume without assistance.

If a person is convulsing, cushion the head, and once the attack is over, place him on his side to prevent choking. During a non-convulsive seizure, move the person away from danger and reassure the him at the appropriate time.

A seizure usually lasts no more than two minutes. But no one who has had a seizure should be left alone until he or she has awakened completely and can move about normally. Although medical attention might not be necessary after such an experience, notifying the person's doctor is recommended.

TREATMENT FOR PULLED HAMSTRINGS

Q Since I have gotten a little older (45), I'm taking steps to try to stay in shape, and the biggest part of my exercise program is running about three days a week. My problem is that I get nagging pain from pulled hamstrings that are very slow to heal. What steps should I take to speed my recovery? W.P., Atlanta

A Hamstring pulls are common among runners and require immediate treatment, including rest, ice, compression and anti-inflammatories. A person shouldn't run or jump but may jog in place or swim (unless there's pain) while the muscle heals. After healing begins, exercises to strengthen the hamstrings can help prevent a recurrence. Before running, be sure to do some warm-up exercises that should include stretching.

LEAVING A WARM BED to run or ride a bike on a cold, gray winter morning takes a monster-size set of stones (naturally, they don't stay monster-size in the cold for long). Some men prepare by tossing on multiple layers to keep warm, but after 15 minutes they're clammier than R. Kelly at a Girl Scout convention.

If you live to be out there, no one is going to convince you of the joys of a treadmill or a stationary bike. But there are certain advantages to them. We've asked two veteran personal trainers/gym owners for the best ways to keep you moving, and your weight-control and fitness gains advancing, during these indoor-bound exercise sessions. Follow these steps, get your heart rate up, and keep from turning yourself into a flab bag.

GO FAST, LOSE FAT. Research shows that performing intervals--interspersing high-intensity sprints with lower-intensity recovery periods--is up to three times more effective at reducing fat stores than steady-state aerobic exercise. And scientists at the University of Western Australia found that you can maximize fat loss from intervals by keeping them short. In a study published in the European Journal of Physiology, guys who alternated six-second sprints with nine-second recovery periods for 40 minutes burned more calories from fat than those who sprinted for 24 seconds and recovered for 36 seconds. The reason: The longer you sprint, the less oxygen that's available to your working muscles. That forces your body to use more carbohydrates for energy, decreasing the amount of fat you bum. To keep muscle oxygen levels high, limit your sprint time to a maximum of 15 seconds and exercise at an easy pace for at least 1 1/2 times longer than the duration of your sprints. For instance, sprint at your full effort for 10 seconds, then slow down to a pace that's about 40% of your full effort for 25 seconds before sprinting again. Start with 10 minutes (use a longer recovery period, if needed) and add a minute each week until you're able to perform the interval workout for a full 20 minutes.

TRAIN FOR THE MILE. Instead of plodding along for the same 40-minute treadmill run each workout, remove the boredom by training to set a new personal best in the mile. "Improving your time in the mile will boost your overall fitness fast, while giving you a tangible goal to shoot for over the winter" says Barrie Shepley, Canadian Olympic triathlon coach and president of Personal Best Health and Performance (personalbest.ca). Simply try to reduce your mile time each week. Added motivation: Scotty Carter, owner of the master's world record in the outdoor mile for the 75- to 79-year-old age group. The time to beat: 5:57.

PLAY MUSICAL MACHINES. If you're hooked on just one cardio activity, like running or cycling, it's wise to take regular breaks from it. Once or twice a week, use any cardio machine except the treadmill if you're a runner, or any machine except the stationary bike if you're a cyclist.

"If you do the same activity every day, you are always stressing the body in the same way" notes Glen Carrigan, owner of Progressive Health and Fitness Center in Hilton Head, S.C. "Periodically changing activities, and therefore placing different demands on your body, improves your overall cardio fitness, reduces overuse injury risk, and burns more fat and calories. You'll also avoid boredom and burnout."

DON'T LEAN ON THE BARS. Although you'll see people doing this in the gym all the time, supporting yourself on the front or side bars of an elliptical or stair-stepper machine serves only to reduce the intensity of your workout. Instead, loosely rest your hands on the bars and only do that when it's needed to maintain your balance. Once you're comfortable, don't touch the bars at all.

"Using bars for support will burn less fat and fewer calories," says Michael Lopez, owner of Body Image Personal Fitness in Mill Valley, Calif. Even more problematic, it can also lead to injury. "That's a fairly common cause of carpal tunnel syndrome because pushing on side rails hyperextends your wrists," says Lopez. "You can also injure your shoulders by hunching over the bars."

WATCH HOW YOU TREAD. When you're running on a treadmill, you'll probably be better off increasing the speed than raising the incline. "Experienced runners can do both, but for most people, it's hard to maintain good form while running uphill," Carrigan says.

If you're walking, though, feel free to mess around with both settings. After a few minutes of gradually increasing the speed to a brisk walk (3.5-4.2. mph), gradually raise the incline to a maximum of 4%. By including an incline, you work pretty much the same leg muscles as when the grade is flat, but you increase the resistance. "You're working those muscles more intensely," says Carrigan. If it's still easy and you're able to maintain good form, the next step is to lower the incline to level again and go into a run.

PERFECT YOUR PEDALING. Whether you're on an outdoor bike or a stationary model, set the seat so there's just a slight bend in your knee when you're seated with one foot on the bottom pedal at its lowest position. "Too many people ride with the seat too low" says Carrigan. "That increases fatigue in the quads, so they tire out more quickly." Doing long bike workouts with the seat set too high or too low may even lead to a knee injury.

Women's fitness is big business: Women comprise 52 percent of the slightly more than 36 million health club members in the United States, according to the International Health, Racquet & Sportsclub Association. The health club industry generated $13 billion in total revenues in 2002.

The strength of the women's fitness market isn't lost on savvy companies. Curves for Women, a Waco, Texas-based women's fitness franchise, is seeing tremendous growth with its 30-minute workout concept. Even the 111-year-old dancewear company Danskin is getting into the act with a line of weight training equipment just for women.

Women's fitness is booming, says Mark Mastrov, founder and CEO of 24 Hour Fitness, a San Ramon, California-based fitness center with more than 300 locations. Women account for 48 percent of its membership. "That number continues to grow," he says. "Women are really getting into personal training, working out with a trainer who can teach them about nutrition and the proper way to exercise."

"Exercise spas" combining spa treatments with Pilates and yoga are emerging around the country, and women's strength training is benching sturdy growth, too. Burr and Carl Diehl, married and both 56, are co-owners of The Bar Method, an exercise studio in San Francisco. They've also licensed the name to owners who have locations in Los Angeles and Connecticut. With estimated 2003 sales of $500,000 from their San Francisco studio, Burr says, "We're growing at a pretty [good] pace."

Opportunities also abound in nutrition, personal training, workout reminders, progress tracking, clothing and equipment. 24 Hour Fitness' research shows women want a maximum drive time of 12 minutes followed by a 30-to-45-minute workout. "Women are looking for something convenient, social and close to home," Mastrov says. "If you're creating a new entrepreneurial concept aimed at the women's fitness market, pick the right location, and make sure you have staying power inside a very strong experience- and service-oriented concept. You've got great opportunity right now." Understand what women want, and you could fit right in.

Whether it's a sport, a workout or a career, it's no surprise that if you feel you won't succeed at something new, you're less likely to try it. But studies at Cornell University in Ithaca, N.Y., concluded that your perceptions of your strengths and weaknesses might be inaccurate and can lead you to think you've performed more poorly (or, sometimes, better) than you actually have. "The research suggests that if you force yourself to at least take the first step in trying something new, you may surprise yourself by performing well despite your lack of confidence," says co-researcher Joyce M. Ehrlinger. "If you choose only situations that pose little risk of failure, you can miss out on finding your hidden talents." To boost the likelihood that you'll experiment, Ehrlinger suggests these strategies: * Vow to accept new challenges. * Define the areas you'd like to grow in, then set appropriate goals. * Find a mentor to guide and encourage you. * Rather than relying on your own negative self-assessment, ask for honest feedback about your abilities and performance from others.

Want to try a new kind of workout in the new year? You'll have plenty to choose from. According to Shape fitness director Linda Shelton and fitness editor Linda Lewis, the following phenomena will continue to boom in 2004.

Core training Workouts that strengthen the deepest layers of your abdominals and spine extensors will be huge this year--especially those that use stability balls and other kinds of balance tools. According to the October 2003 IDEA Fitness Trends Report, more than 70 percent of gyms and clubs offer core classes.

Pilates If you haven't tried it yet, you will, says Shelton. You now can find Pilates classes at 65 percent of fitness facilities, notes IDEA.

Hybrid workouts Gyms and studios will keep combining popular activities like Pilates, yoga and stability-ball workouts in 2004 to create new classes. Sixty-five percent of clubs currently offer combo classes.

Mind-body workouts Pilates, yoga and anything that emphasizes stretching, balance, stress reduction and overall health will climb in popularity this year. Eighty-two percent of clubs now offer such classes, says IDEA.

"Hey, ladies, whaddya doin'? Waitin' for a bus?" No, Pittsburgh man, those 31 beautiful women in bikinis on May 3 were competing in the first Pittsburgh Pro Figure Championships. These curvy athletes planted their heels and turned, then planted their heels and turned, then planted their heels and turned again until awesomely gorgeous JENNY LYNN emerged as the champ. Lynn also won the debut IFBB pro figure contest: the 2003 Figure International in Columbus, Ohio, on February 28. Second place in Pittsburgh went to exotic hottie DAVANA MEDINA; third went to MARI KUDLA.

RELATED ARTICLE: 2003 Pittsburgh pro figure championship

May 3, 2003; Pittsburgh, Pennsylvania

1 Jenny Lynn *

2 Davana Medina *

3 Mari Kudla *

4 Dina Al-Sabah

5 Elaine Goodlad

6 Jaime Franklin

7 Chaundra Tangi

8 Sharon Kouvaras

9 Lesli Russell

10 Sharon Christian

11 Christine Pomponio-Pate

12 Jamie Ramsey

13 Liane Seiwald

14 Carrie Fickle

15 Kristy Robbins

16 Debbie Kruck

17 Stephanie Worsfold

Also competed: Alejandra Abdala, Andi Breunig, Karen Burnett, Celeste Chance, Adrian Chastain, Jennifer Divine, Patti Garner, Elizabeth Halikka, Michelle Hyght, Joanne Lampronikos, Renee Masi, Sunnie Steurer, Shaunta Teeters and Louisa Wigand

Starting a fitness plan is simple. Sticking with it is the challenge. But you can do it. All you need is a little motivation, and the following advice will give you the push you need to reach your goals.

* Be patient. A lifetime of bad habits can't all be erased in a few short days, even months. It takes at least a month before you begin to see results, but you'll feel better almost immediately. Change will come, but it takes time. Relax and enjoy the ride.

* Avoid the scale--it is your enemy! You should lose about 1/2 pound to 2 pounds a week if you're exercising regularly and eating sensibly. If you're weight training, you'll also gain muscle--which is denser than fat--so you may lose inches faster than pounds.

The scale, however, does not take these factors into consideration, especially if you weigh yourself daily. So even though you're making progress, according to the scale, little has changed. Instead of getting discouraged by the numbers, gauge your progress by how loose your clothing is, or buy something a size too small to see how long it takes before it comfortably fits. If you must weigh yourself, once a week or once every two weeks is enough.

* Find fitness cheerleaders. Committing to fitness is not so tough when you have someone to support and encourage you. Team up with a workout buddy, hire a personal trainer for a few sessions, join a support group. Find someone who once walked in your shoes and solicit advice. Collect stories of ordinary folk who won their battles of the bulge for inspiration.

* Do something you love. You're more apt to exercise if you link fitness to a fun activity. Swimming, gardening, walking, dancing, skating--do whatever gets you moving, sweating and excited.

* Set realistic goals. Instead of saying "I want to lose 100 pounds in 90 days, run five miles a day, bench press 250 pounds," say "Each week, I want to walk or run a little farther, lift a little heavier, look and feel a little better than I did the week before." Eventually you will meet those big goals, but it's the small victories that fuel you to the finish.

* Celebrate your success. If today is the day you finally did 10 full sit-ups without blacking out, celebrate! Treat yourself to a day at the spa or a night on the town. Throw a party. Rewarding yourself when you reach both major and minor milestones gives you that extra incentive to keep striving.

* Forgive and forget. If you miss a few days of working out, or spoil a perfect week of healthy eating with a weekend junk-food binge, so what. It doesn't mean you're hopeless, just human. Discover the reasons behind your pitfalls and change your strategy so you won't slip so easily next time. Pick up where you left off and don't look back!

Remember the president's

Challenge? Sure you do. It was the day your gym teacher made you do pull-ups before awarding patches to eight-year-olds as if they were the Medal of Honor. Now the president's fitness program encourages adults to join in, too. Test yourself in your office with whatever supplies are available.

TEST: CURL-UPS

Lie on back with knees bent. Curl up until elbows touch thighs, then lower back until shoulder blades hit floor. That's one. Challenge: 55 in one minute

TEST: SHUTTLE RUN

Make two parallel lines 30 feet apart. Place staplers behind one line. Starting on opposite line, time how long it takes to run to the staplers, pick one up, run back to the starting line, set it down, then race back for the second stapler and return. Challenge: 8.7 seconds

Reconstructive surgeons were getting medieval on their patients by bringing back some old-school leech treatments. Apparently, the little suckers relieved blood congestion associated with the reattachment of body parts-fingers, ears, toes, and Little John Bobbitt. Also making an O.R. comeback--maggots. Before becoming favorites on Fear Factor, docs used these legless larvae to eat away patients' dead, infected tissue.

Bon appetit!

Product of the Month

The company Condomania introduced MF readers to a new way to pack their prophylactics--with the Protecto Pager. Looks just like a pager but it's actually a nifty carrying case for two of your jimmy hats. Sure, you came off looking like a drug dealer, but at least you came prepared without looking prepared, like some presumptuous man-whore. Whatever happened to just stuffing your raincoats in your wallet?

Following a fast-food fiasco in which E. coli-contaminated hamburger infected hundreds of people, Men's Fitness reported that cooking beef well enough could easily have killed the bacterium. This had half our readers wondering why the meat had been approved for public consumption in the first place. The other half wondered why Spare was still on supermarket shelves.

"How rare is `Walter Payton's disease' and would a new liver have saved his life?"

`WALTER PAYTON'S DISEASE'

Q With the recent death of football great Walter Payton, I heard for the first time about the rare disease that took his life. I can't pronounce it and simply call it "Walter Payton's disease." How rare is it, and would a new liver have been enough to save his life? T.R., Kansas City, Mo.

A Because it is a mouthful to say, primary sclerosing cholangitis might very well become commonly known as "Walter Payton's disease," the same way that amyotrophic lateral sclerosis (ALS) is primarily referred to as "Lou Gehrig's disease."

Doctors say primary sclerosing cholangitis is a rare liver disease that causes a narrowing of the bile ducts inside and outside the liver. Its cause is unknown, and when the inflammation spreads, the bile ducts are destroyed and scar tissue is created. In some cases, the tissue can become cancerous. Doctors say that's what happened in Payton's case, and he died as a result of bile-duct cancer.

Once the cancer was discovered, Payton was no longer considered a transplant candidate. At that stage, a new liver would not have saved his life, doctors say, because the cancer probably had spread beyond the liver or because the cancer likely would have recurred in a transplanted liver.

Primary sclerosing cholangitis, a disease that strikes only about three people out of every 100,000, usually affects males between the ages of 40 and 50, doctors say. The disease can go unnoticed for years because it causes vague symptoms that include fatigue and itching, and is not necessarily associated with a history of liver disease.

IDENTIFYING CHRONIC FATIGUE SYNDROME

Q I am a 33-year-old, single female who works a 40-hour week but have few outside activities. My problem is that I am tired all the time, no matter how much sleep I get. When I wake up in the morning, I'm tired. When I go to work, I'm tired. When I go to bed at night, I'm tired. Could I be a victim of what they call chronic fatigue syndrome? L.W., Baltimore

Since fatigue is a symptom of a variety of medical conditions (such as liver, thyroid or kidney problems), you should contact your physician as soon as possible to schedule a thorough physical examination, which can lead to the identification of the cause of your constant exhaustion.

A It's possible that you are a victim of chronic fatigue syndrome (sometimes called "yuppie flu"), a condition that can strike anyone at any age, doctors say, but it's three times more common in women for reasons that are unknown. In addition to feelings of being constantly worn out, many victims complain of flu-like symptoms and often have low blood pressure, difficulty with concentration, poor short-term memory, irritability, a recurring sore throat, a low-grade fever and swollen lymph nodes.

The exact cause of chronic fatigue syndrome is unknown, but some researchers suspect it may be caused by a virus, however, no distinct viral cause has been identified. Doctors say there is currently no treatment that has been proven to be effective in curing the illness, instead the symptoms are treated. In addition to some medication, patients with chronic fatigue syndrome are encouraged to maintain active social lives, and mild physical exercise may also be helpful.

BACTERIAL VAGINOSIS

Q My girlfriend, who has frequent yeast infections, went to her doctor to be treated for what she thought was a yeast infection. However, she was told that she had a condition called bacterial vaginosis. What is it? How common is it? And how serious is it? K.G., Denver

A Bacterial vaginosis is the most common kind of vaginal infection, physicians say, and most women will get it at some point in their childbearing years. It is caused by the rapid growth of certain types of bacteria that upset the balance of "good" and "bad" types of bacteria in the vagina. In most cases, it's not dangerous but could cause problems for women who are pregnant or those having gynecological surgery. Symptoms include a strong fishy smell, a white or gray discharge, or a watery or foamy discharge.

As a fitness instructor, you only have to teach for a few weeks to realize your impact as a health advocate extends far beyond your classroom. You are viewed as a model of health and fitness by your clients. As personal trainers, your entire lifestyle is under the public lens. Clients ask you about your eating habits, food choices and personal workouts. You're questioned about everything from amino acids to aqua jogging, from sports drinks to sports bras. As a professional, you do your best to seek out reliable information and develop a referral system for questions outside of your scope. In so doing, you, in the role of fitness professional, are a primary resource within the preventive health movement. What's more important, you are a critical link in the self-care revolution. It's time to recognize the fundamental importance of that role and place it in the larger context of social and political life in America.

Why do you do what you do? Apart from the basic survival needs of making a living, paying bills, feeding yourself and your family, human beings have core needs for belonging, self-worth and affection. When I ask fitness professionals why they choose this type of career, they invariably respond by describing a desire for empowering others to strive for a healthier, more active and enjoyable life. This is a profound act of being in service to others, which in turn serves you: it's an important way in which you get a sense of belonging and self-worth.

So, when you add it all together--your interest in fitness, your drive for fulfillment, your desire to help others--you work in a field that represents the cutting edge of health reform today. And that field, although supported by widespread populist appeal, is being countered by forces within the AMA and FDA that represent expensive, technology-driven, conventional crisis-oriented medical models.

Personal health and well-being has become a political issue in 1992 like never before. With the introduction of two House bills, HR 3642 and HR 1662, your rights as a consumer health advocate are being threatened. If these bills pass, you could be jailed for suggesting prunes for constipation, for talking about calcium supplements, for protecting your right to choose as a health/fitness consumer. These ridiculous pieces of legislation would force individuals to go to their physicians for prescriptions for vitamins, herbs and supplements. Simply expressing to a client that you believe anti-oxidants may help with endurance training puts you at legal risk. Protect your right to a worthwhile profession and the rights of others to easy access to nutritional information and health alternatives. Write to your senators and representatives and let them known your opinion.

Also, please write to American Fitness if you have any interest in supporting public policy for health promotion and physical fitness. In a future issue, I'll be reporting the actions of the Congress for National Health and Fitness, a forum of concerned citizens representing about 20 national organizations. In this election year, I invite you to get political. Your livelihood and your well-being depend on it.

A three-year attitudinal research projects suggest many women exposed to our patriarchal, celebrity-obsessed, appearance-oriented culture will rarely adopt long-term health and fitness behaviors that bring them satisfaction and heightened self-esteem. On the contrary, such a culture often creates resignation, how self-esteem despair.

In-depth interview of 45 women and short interviews of 340 others, both men and women, revealed a critical step toward adopting and maintaining a healthy lifestyle was accomplished when women transferred authority over their bodies from an external agency to themselves. External agencies varied from parental authority, husbands, boyfriends, physicians and clergy to messages promoted by the fitness industry, the media, celebrity images and general hype.

I began to look at the fitness movement from the standpoint of scripted Hollywood messages, a glut of exercise videos with questionable role models and TV show pushing ineffective fitness products. Sadly, a new contagion of hype and competitive promotion was pushing fitness instructors. Much of our work was only making hard-core enthusiasts obsessive and narcissistic. It didn't seem to be reaching or motivating countless women.

Breaking Cultural Norms

When a woman has been treaded as an object, never given the recognition of being a unique, autonomous, effective person, the split within her own psyche can be pathological, according to Jessica Benjamin, author of Bonds of Love (Patheon Books, $16). But is it pathology when the entire feminine element within a culture is dominated and undervalued? Are women just responding to a cultural norm?

I interviewed women along every stage of the health/fitness continuum. I was seeking a broad view of women's health. As a journalist, I could no longer do cover stories for the manufactured fitness "leaders" and siliconed, surgerized celebrities that preached body obsession. Also, I grew disgusted with the continued bias and discrimination in women's medical research and treatment. I finally realized both ends of the spectrum contain the elements of disempowered lives.

According to national surveys, more than 80% of the American population do not practice lifestyle behaviors they know they should. Most national surveys indicate "lack of time" or "inconvenience" as top reasons for non-adherence. However, standard exercise questionnaires are not objective--they are replace with a male-as-normative, athlete-as-warrior bias that there is one way to achieve health and fitness. They also assume social life is orderly and rational, according to Joyce McCarl Neilsen. I think of the single mother with excessive demands, complexities and responsibilities she copes with every day--not to mention the hostile social context in which she lives.

The question I posed to women in an interview process focused on the following issues. (Note: Specific breakdown question for exercise, nutrition, stress management, spiritual well-being, emotional belonging were offered.)

* How do they take care of themselves?

* What value do they place of themselves?

* Where did they place the authority for their bodies and health?

* Have they made a significant shift toward adopting or departing from healthy habits?

* For those who achieved a turn-around in sickness or unhealthy behaviors, what, steps were taken toward mental, physical, emotional and/or spiritual well-being.

* What tools or everyday practices do they use?

* How do they monitor their health?

Releasing Judgment

In 90% of the in-depth interviews (and noted in 287 out of the 340 shorter interviews), judgment was a central theme. Interviewees talked about the humiliation and self-consciousness they experienced in most health club settings. Much of their exercise experience was grounded in memories of early failures during P.E. classes--not being picked for teams and doing poorly on nationally standard physical fitness tests.

Weight and Body Image

Of the 45 in-depth interviews, every woman reported a history of anger and depression over weight and body image with varying degrees of professional counseling. Women reported feeling low self-esteem, failure, guilt and "habitual conflict with food." At least 80% of the women practiced restricted eating and denied their biological need to eat in order to "look good." Several women admitted never getting control of eating disorders or binge behaviors despite knowing what they were doing was seriously damaging to their health.

Physical Activity in General

Depression and anger over "not being in control" of their lives seemed to prompt more unhealthy behavior in at least 65% of the respondents. Women said they handled anger and depression by smoking, overeating, losing their appetite or sleep and calling friends. Only 12% reported taking walks when upset.

SUZANNE SCHLOSBERG knows a thing or two about working out while on the road. She's sweated it out in a gym stuffed with infomercial gizmos while traveling in Morocco, pumped iron on homemade weight training equipment in Zimbabwe and run up and down more than her fair share of crumbling motel basement stairways.

Actually, Schlosberg is a lot like you, the HERS reader: Exercise is an integral part of your life and you wouldn't miss it for the world. Come hell or high water, you'll find a way to work out no matter how offbeat the destination and no matter how extenuating the circumstances.

Luckily, you can read Schlosberg's book, Fitness for Travelers: The Ultimate Workout Guide for the Road (Houghton Mifflin Company, 2002), and draw on her extensive experience to help guide you through the challenges of maintaining your home-away-from-home fitness routine. On the following pages, Schlosberg shares her favorite gyms in seven cities. Admittedly, the locations aren't as exotic as some of the places Schlosberg has been to, but they're certainly the top business and pleasure spots you're likely to pass through when you travel. She also offers some sage advice for fitting in a workout while you're on the move, and she recommends important websites for travel-weary workout buffs.

CLUB: The Sports Center at Chelsea Piers

LOCATION: Pier 60, off West Street

WHAT IT OFFERS: Pool, rock climbing wall, indoor track, boxing ring, volleyball pit, group classes, basketball courts, extensive array of weight training and cardio equipment, juice bar, spa.

WHY IT'S A STANDOUT: Just about every physical activity imaginable is offered at this fitness mecca. If the large and comprehensive strength training and cardio areas aren't enough for you, sample one of the more than 100 group classes a week, sprint laps around the indoor track, scramble up the 60-foot rock wall or do laps in the Olympic-sized swimming pool. After your workout, indulge yourself with a pineapple smoothie and an antiaging facial.

THAT LITTLE EXTRA: Still need a fitness fix? Check out any of the adjacent facilities, including a golfing range, ice-skating rink, halfpipe skate park and equestrian center.

PRICING: Guest passes are $50 a day.

CONTACT INFO: (212) 336-6000, www.chelseapiers.com

CLUB: Plus One Fitness, Soho

LOCATION: 106 Crosby Street at Prince Street

WHAT IT OFFERS: Weight training and cardio areas, physical therapy unit

WHY IT'S A STANDOUT: This tiny gem shines in a city jampacked with fitness options. The talented team of certified personal trainers specializes in everything from weight loss to training for serious competition. In fact, all this ultra-exclusive gym offers is personal training and physical therapy by appointment only. It's an underground fave among celebrities and the high-powered business set.

THAT LITTLE EXTRA: You get your own private bathroom and shower.

PRICING: $88 per session and up.

CONTACT INFO: (212) 334-1116, www.plusone.com

CHICAGO

CLUB: Lakeshore Athletic Club, Streeterville

LOCATION: 333 East Ontario Street

WHAT IT OFFERS: Spacious cardio and weight training areas including a women's only section, indoor pool, racquetball, indoor tennis, squash courts.

WHY IT'S A STANDOUT: Located just steps off Michigan Avenue, the main shopping drag in Chicago, this newly renovated club offers the most extensive indoor tennis and racquet sports program in the city. Even if you're not a tennis buff, this 66,000-square-foot facility is bound to offer some other workout to pique your interest: Why not try Krav Maga martial arts or scuba diving? There's also a full spa to help you unwind after a workout.

THAT LITTLE EXTRA: Streeterville's two sister locations--Lakeshore Athletic Club Downtown and Illinois Center--though not as new, are also pretty awesome.

PRICING: Guest passes are $15 a day; complimentary day passes for guests of the Holiday Inn in the same building.

CONTACT INFO: 312-944-4546, www.lsac.com

ATLANTA

CLUB: Concourse Athletic Club

LOCATION: 8 Concourse Parkway

WHAT IT OFFERS: Cardio, strength training, racquetball and squash courts, indoor running track, outdoor clay tennis courts, indoor basketball courts, indoor and outdoor pool, cafe, spa, salon.

WHY IT'S A STANDOUT: You almost won't know what to try first at this outrageously luxurious facility. Do you take a boxing class? Work your core muscles in a one-on-one Pilates session? Pump it up with a personal trainer? Sign up for a free swim stroke analysis? The club offers all that and so much more ... you can't possibly experience it all.

THAT LITTLE EXTRA: Tons of down-home Southern hospitality from the super-friendly staff help this mega club retain a cozy and personal appeal.

It starts when the training wheels are removed from your bike and you're expected to move forward, continues when you measure yourself against your high school peers on the playing field, and reaches a critical mass of sorts when you put your talents into the job market for the first time. Life is an unending series of tests, friend. And each test has one thing in common with all the others: the pressure not to fail.

Now that you've established a career and a relationship--you gave up the idea of living solo in Bora Bora--you probably figure you don't have to take no more stinkin' tests, right?

Surprise! We've got another one for you. But relax, this test doesn't involve multiple-choice questions or a No. 2 pencil (you can use your Visor for the easy calculations you'll have to do), no pass/fail pressure. It's a fitness test, designed by two experts exclusively for Men's Fitness readers.

By testing yourself in various fitness components--cardiovascular capacity, body-fat distribution, flexibility, and muscular strength and endurance--you can get a snapshot of your strengths and weaknesses and evaluate just how effective your training program is. Fitness testing "provides a benchmark for improvement over time," says test co-creator Richard' Cotton, spokesperson for the American Council on Exercise and an editor of ACE's Personal Trainer Manual.

"You can see how well you're improving, because you ... have some real numbers, which are psychologically perceived as being more objective, more real than just, I feel better, or, My clothes fit better," adds Cotton's collaborator on the test, Roger Earle, co-editor of Essentials of Strength Training and Conditioning and a former strength-and-conditioning coach at Creighton University.

Here's the plan: Take the test. Record your results. Whether you're new to fitness or a returnee, stick to a regular program and you should see improvements quickly, so test yourself every four to six weeks. If you're a workout regular, improvements will be more long-range, and you can wait eight to 16 weeks before retesting. You can also mix and match trials not covered (for example, pull-ups and running stairs) in order to suit your needs.

Keep notes on your performance and the test conditions, and retest later under the same conditions to see how you've progressed. If you're just starting a workout program or are over 40 years old, consult a doctor, and give yourself a month or two to adapt to training before you take the test. And merely by taking the test, you get an A for making an effort to improve your fitness.

1. CARDIOVASCULAR FITNESS

Test: Resting Heart Rote

Why: The better your endurance and cardiovascular fitness, the lower your resting heart rate, because of the increased amount of blood that the heart pumps with each beat. Your resting heart rate usually decreases as your cardiovascular fitness improves.

How: Take your pulse in the morning, just before you get out of bed. Count for a full minute, or for 30 seconds and multiply by two.

How you compare: The average rate for men is about 70 beats per minute, but there can be a wide range here--"normal" extends from 40 to 100. Aerobically fit people usually are below 60; an astronaut's heart rate is even lower.

Drawbacks: Some people have a naturally elevated heart rate no matter what their level of fitness. Conversely, if you start with a naturally low rate, you may not see significant improvement over time. The best application is for monitoring overtraining--if you notice an elevation of 10 to 15 beats per minute, you may not be recovered from the previous day's training.

[ILLUSTRATION OMITTED]

Test: Rockport Fitness Walking Test (for beginner/ intermediate)

Why: This test measures your cardio efficiency, giving you an approximation of your V02 max, which is the amount of oxygen per minute your body is able to use while exercising. The higher your V02 max, the better your endurance, which means the faster and longer you can walk, jog, bike or row.

How: Warm up by walking and doing light stretching on a quarter-mile track. Then do a one-mile walk (four laps) as fast as possible, stopping if you feel dizzy or experience any chest pain. After completing the mile, keep walking but slow the pace.

Immediately take your pulse for 10 seconds, counting the first beat a zero, then multiply by six. Record your pulse and the time it took you to complete the mile, then cool down for five minutes.

How you compare: Before you calculate your V02 max, first a little math: Multiply 0.388 by your age to get A; 0.077 by your weight in pounds to get B; 3.265 by your mile-walk time in minutes to get C; and 0.156 by your recorded pulse to get D. Next, figure your estimated V02 max using the following formula: V02 max equals 139.168 minus A, B, C and D. The V02 max of the average fit male is 40 milligrams a minute.