Health-and-Fitness online information.

California Governor Arnold Schwarzenegger found himself surrounded by sports and fitness luminaries, plus a mouse, a duck, a dog and the most upbeat group of kids this side of a Mentos commercial. At the event, watched by thousands, Schwarzenegger launched the California Governor's Council on Physical Fitness and Sports.

The Get Active California Celebration, hosted by the Walt Disney Company at its California Adventure park, was attended not just by representatives of the Disney franchise, including Mickey, Donald. Goofy and Buzz Lightyear, but also by flesh-and-blood icons. They included perennially fit Jack LaLanne, baseball legend Reggie Jackson. 1998 U.S. Open tennis champ Lindsay Davenport, skateboarder Tony Hawk, figure skater Michelle Kwan, U.S. soccer player Julie Foudy and gymnast Peter Vidmar.

These sports figures, plus an impressive roster of others, have been enlisted by Governor Schwarzenegger to help spread the word to Californians, via the new nonprofit organization, that getting healthy and fit is a worthwhile goal.

Governor Schwarzenegger will assume the role of honorary chairman of the newly formed council, but Evercore Partners president and cofounder Austin Beutner will act as its official chairman and guiding force. (Evercore is the holding company of AMI, which publishes the magazine you're now reading.) In a speech at the celebration, Beutner stressed the importance of maintaining an active lifestyle and pointed out both the short- and long-term benefits of physical activity.

Schwarzenegger and Beutner have been joined in this endeavor by Vidmar, Davenport, Foudy, Hawk, Jackson, Kwan and LaLanne, plus other famous fitness board and council members, including Debbie Allen, Misty May, Jerry Rice, Serena Williams and John Wooden.

In his address at the event, Schwarzenegger, who knows a thing or two about living an active lifestyle, declared, "Nowhere on earth will you find greater opportunities to lead healthy and active lifestyles than right here in California. With the new Active California program working in partnership with the Governor's Council on Physical Fitness and Sports, we're going to do even more to improve the health and well-being of all Californians."

Active California, or ActiveCA, is a program sponsored by the fitness council, and it is designed to encourage residents to take up some form of exercise at least three days a week. It's supported by a comprehensive Web site (www.activeca.org), which provides educational and motivational resources for those looking to take Schwarzenegger's worthwhile advice.

California "first lady" Maria Shriver joined her husband at the podium at the celebration of the fitness council's launch. Members of the Schwarzenegger brood were spotted in the audience, undoubtedly awaiting the moment when mom and dad would give them permission to launch themselves on a roller-coaster ride.

FLEX magazine would like to thank Governor Schwarzenegger, Mr. Beutner and all of the council members and directors on the board of the California Governor's Council on Physical Fitness and Sports for creating this worthwhile organization and for helping spread the message that muscle and fitness isn't just the name of our sister publication, it's a goal worthy of every Californian and every person everywhere.

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.

`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.

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.

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."

Want to combine fat-blasting workouts, centering yoga and posh spa treatments with seasonal celebrations? Head for one of these five fitness-savvy city hotels or resorts. All are located in the heart of town, and each boasts on-site or easy access to everything you need for an urban blast-and-a-half--from high-tech health clubs, personal trainers and gorgeous spas and pools to Pilates, yoga and tons of options for calorie-burning outdoor fun.

New York City

The Big Apple has it all--from holiday entertainment (see the New York City Ballet perform The Nutcracker at the New York State Theater at Lincoln Center) to simpler pleasures (join the crowds ogling the window displays at Lord & Taylor, Barneys New York and Bloomingdale's).

Stay Affinia Dumont This gorgeous hotel in the city's chic Murray Hill neighborhood has everything you need for a fit holiday, including a state-of-the-art fitness center and spa and a sneaker valet who freshens and cleans your workout shoes daily. There is also a fitness concierge, your one-stop resource for calorie-blasting fitness activities in and outside the hotel; she can even arrange for the delivery of weights to your room.

Sweat City Climbers Club Scale Manhattan's first climbing wall at the W. 59th Street Recreation Center, just a 10-minute cab ride from the hotel. In addition to 11 belay stations and more than 30 routes, the center has a "bouldering" cave where you can practice climbing moves close to the ground without ropes. Day passes are $12 and include ropes, climbing shoes and harness rental plus use of lockers and showers (533 W. 59th St.; 212-974-2250, climb nyc.com/ccc).

Pose Jivamukti Yoga Center An easy walk from the hotel (about 26 blocks, or a little more than a mile), this beautiful and very colorful yoga studio, with Buddhist statues and a small flowing wall waterfall, offers 95-minute Jivamukti-style classes (Hatha yoga with chanting, meditation and music; $17 plus $2 for mat rental; 404 Lafayette St.; 212-353-0214, jivamuktiyoga.com).

Indulge Affinia Fitness Spa Having a spa right at your hotel means you don't have to travel for luxury treatments. Try the one-hour Affinia Fat Burner, which combines a seaweed/algae wrap with a Vichy shower, dry brushing, a scalp massage and moisturizing lotions to minimize the appearance of cellulite. OK, so this treatment doesn't really burn fat, but it's guaranteed to make you feel relaxed ($110; 212-545-5254, affinia.com). Another option: Head 23 blocks north to the uptown Bliss Spa, one of the city's trendiest pampering palaces.

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.

It may not seem right. That is, crediting Brent Cook with, in some little way, better health.

As manager/operator, he's the guy at the Sports Mall who takes complaints for no toilet paper in the bathrooms or soap in the showers or for not having a Pilates class at a more convenient time.

Not the guy who helps people stay healthier ... or is he?

All of the sophisticated fitness equipment, all of the fitness classes, all of the trainers and free weights and walking/running tracks and aerobic balls are there by design -- his design.

He is recognized as one of the foremost authorities on fitness clubs. And, it's a proven fact that better fitness is a direct contributor to better health.

Cook's education into fitness dates back to the mid-1960s when clubs offered nothing but dumbbells and a weight bench, and a good fitness program involved watching the guys with the big muscles and then trying to imitate their routines.

"Those were the sweatshops," remembered Cook. "Free weights and the promise of bigger muscles, which is all they offered. We see the results of these clubs all the time, people coming in with shoulder and knee and elbow problems that now require surgery.

"That's because there was no level of control. Everyone, no matter the age or physical limitations, was treated the same."

Changes in the health and fitness business started to appear just around the time Cook, fresh out of school, chose fitness clubs as an occupation.

He was hired to work for Health Spa and Fitness in 1964. Eventually, he would travel around the country opening similar facilities in Rhode Island, Connecticut, upper New York, Denver and Albuquerque.

He returned to Utah in 1975 and in September 1976 became involved in the Sports Mall.

"The fitness industry started to make real changes in the mid- 1960s with places like Health Spa and Fitness. It went from a sweatshop to a luxury facility with red carpet, and we really did have a red carpet, steam rooms and whirlpools.

"What we found back then, however, was that people really didn't join for fitness, but for the wet areas. They came to relax in the steam room or whirlpool and to socialize. In some ways that hasn't changed. People still enjoy doing those things."

In the area of fitness, he remembered that the 1960s marked the start of the fitness equipment revolution.

"There were no high-tech treadmills or elliptical equipment. What was touted back in the 1960s was the wooden rollers and the 'V' belt."

Members would lie on a table and wooden rollers would move up and massage the body. The theory was that this would increase blood flow, which in turn would decrease cellulite, or lumpy fat found in the thighs, hips and buttocks.

The "V" belt would be placed around the buttocks or back and violently vibrate. The message was the same: The vibration would increase blood flow and therefore decrease cellulite.

"These were the early mechanical devices that actually started the evolution of fitness equipment. I don't think they worked, but they made the customers feel better. It was a mental thing rather than a real benefit to fitness," he explained.

"It has only been within the past 15 years or so that people have come to realize that they need to work to stay fit. People are more educated about fitness today. Seniors are more educated. They want better health and they know that with exercise there's a decrease in serious health risks such as obesity, diabetes, heart disease and high blood pressure.

"Seniors want to live longer and be healthier, so they're actually working out 30 to 50 minutes a day, four to five days a week and either doing cardiovascular or cross training with weights. We now know this is a way to stay fit and reduce disease risks."

The fitness and health industry has evolved to a point now where computer technology can tailor a program to an individual.

"We can do a test, now, and determine exactly at what level a person should train for optimum results," said Cook.

The computer monitors air intake and pulse of an individual working out on a treadmill or stationary bike.

"It tells us at what point an individual becomes anaerobic as opposed to aerobic. We can then tell the individual, 'OK, this is the target heart rate while exercising.' It's also a factor of age. A younger person might train at 85 percent where an older person could train at 55 percent and still reach the desired level of cardiovascular fitness.

"We've become so incredibly sophisticated. This equipment started out being only available to the top athletes. Now it has become marketable to the general public."

If an individual becomes anaerobic or is not training at a high enough level, then he or she is not getting the maximum benefits of a workout.

All this sophistication has led to the next step up in fitness -- the trainer.

Well-educated trainers can facilitate the programming of a well- balanced fitness program for a certain individual.

In the early days it was left up to the individual to waddle through all of the free-weights on stands and benches and on floors and try and figure out how to use them.

INTRODUCTION

The prevalence of overweight among Canadian children has increased dramatically over the past two decades. Currently, an estimated 29.2% of girls and 35.4% of boys are overweight (body mass index [BMI] ≥85th percentile), while 14.6% of girls and 16.6% of boys are obese (BMI ≥95th percentile) (1). This high level of overweight in childhood is cause for concern because increased levels of body fat are known to persist from youth to adulthood (2), and because heavier children are more likely than their leaner peers to possess risk factors for chronic disease (3,4). Such observations may explain the increased risk of morbidity and mortality seen among overweight children who become overweight and obese adults (5). The evidence linking increased weight with unfavourable levels of objective physical health indicators is well supported. However, findings are equivocal when health-related behaviours and perceptions are contrasted according to weight status, especially in younger populations.

Some research suggests that boys and girls with higher levels of body fat consume more total energy (6,7) and dietary fat (8,9), and are less physically active (10,11) and aerobically fit (12) than leaner children. Other studies have failed to show differences in diet (13,14) and physical activity (15) in children stratified by weight status. Although overweight children generally are believed to have lower self-esteem than their normal weight peers, this belief has not been consistently supported in the literature. French and colleagues (16) concluded in their review that overall self-esteem levels in overweight seven- to 12-year-olds were either similar to or just slightly lower than those of normal weight boys and girls.

Because most data linking body fatness in youth with unfavourable lifestyle behaviours and perceptions are derived from cross-sectional investigations, relationships between overweight and lifestyle variables may be transitory. This is a plausible theory because many health-related behaviours and attitudes are established in childhood (17). Thus, the purpose of this study was to examine differences in physical activity, aerobic fitness, self-perception, and dietary intake in a sample of six- to ten-year-olds at risk of overweight, as well as in normal weight boys and girls at zero-, three-, six-, and 12-month intervals.

METHODS

Participants

Thirteen teachers from a convenience sample of seven Edmonton-area elementary schools were asked to have their classrooms (grades 2 to 4) participate in this investigation; the research was not a component of class curricula and participation was voluntary. Parents and children provided informed consent and assent, respectively. Approval for this project was obtained from the University of Alberta Faculty of Agriculture, Forestry and Home Economics human ethics review committee, the Cooperative Activities Program, and the Edmonton Public and Catholic School Districts.

Procedures

Skinfold-thickness measurements were taken at five sites (triceps, biceps, subscapular, suprailiac, and calf) on the right side of the body using Harpenden skinfold calipers (Health Dimensions, Plymouth, MI). Height was assessed to the nearest 0.1 cm using a set square and a wall-mounted tape measure, and weight was determined to the nearest 0.1 kg using a portable medical scale (Health o meter, Inc., Bridgeview, IL); BMI (kg/m^sup 2^) was subsequently calculated. Children were classified as at risk of overweight (BMI ≥ 85th percentile) or normal weight (BMI

Physical activity level was assessed using the Physical Activity Questionnaire for Older Children (PAQ-C), a self-administered, seven-day activity recall that evaluates sports, leisure activities, and games performed during school days, evenings, and weekends (20). The 20-metre shuttle run test (20-MST) was used to determine aerobic fitness levels (21). The test requires subjects to run back and forth between two markers spaced 20 m apart; as the test advances, the time interval between signals decreases so that running speed must increase progressively.

Self-perception was measured using the Self-Perception Profile for Children (SPPC) (22-24). The SPPC consists of the following sub-scales that collectively influence overall self-esteem: scholastic competence, social acceptance, athletic competence, physical appearance, behavioural conduct, and global self-worth. Higher scores represent more positive ratings of self-perception.

Bone-chilling weather, vile cold and flu viruses, insane heating bills, and the 8 1/2 pounds that slipped onto your hips somewhere between Christmas and Groundhog Day make it oh so easy to slump into a wintertime funk.

Health experts say shorter daylight hours, bad weather and stress can lead to the winter blues, a condition marked by fatigue, junk food cravings and mild depression. Also, the body's metabolism naturally slows down during colder months, contributing to weight gain and that sluggish feeling.

Thankfully, spring is on the horizon. But there's no reason to sulk until then. Keep the winter hawk from digging his icy claws into your body and spirit with these moodboosting tips:

1. Exert yourself. Don't let the cold discourage you from exercise. Wind chill or not, your body still needs fitness and a daily dose of activity is a sure cure for wintertime blahs. Exercise fires up a dragging metabolism, floods the body with depression-fighting chemicals called endorphins, boosts the power of the immune system to fight off colds and flu, and burns off excess calories and pounds.

2. Chill out. Avoid cabin fever by getting fresh air and sunlight. As long as no blizzards are brewing, you can enjoy a jog, brisk walk or bike ride if you steer clear of icy paths and always wrap up. Wear inner layers like thermals to keep out sweat and allow skin to breathe; middle layers such as slacks, sweat pants, tights, sweaters and vests to cover the chest, arms and legs and help trap heat; and outer layers like tightly woven jackets and snow pants to block wind and snow. Wear a cap or hood since you can lose precious body heat through your head, and always wear warm gloves and socks to guard fingers and toes against frostbite. Once you get moving, you'll hardly notice the cold.

3. Be a good sport. Fight boredom and expand your fitness horizons by taking up a fun winter sport. Channel your inner daredevil by strapping on a snowboard, some skis or a pair of ice skates. Grab a sled and find a steep snowy hill to climb; the reward is worth the trip. Invite the friends and family to your home and host your version of the Winter Olympics. Grab a partner and your winter boots and stage a three-legged race through knee-deep snow. Split into teams to have a snowman-building competition or start a snowball fight, then celebrate with hot chocolate and apple cider.

4. Cool down. Pursue a peaceful pleasure for at least 15 minutes each day to beat the blues. Curl up with a steaming cup of tea and a steamy novel. Ask your sweetheart for a foot rub, then reciprocate. Tickle your children. Light scented candles and play soft sounds. Sneak in a 20-minute snooze. Tune out the world and tune into you.

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.

If you're a nightly news devotee, then the 30-second hokum that often passes for nutrition science may confuse you at the very least or derail your long-term health at worst.

Case in point: A small study published in the journal Science, which showed that 200 milligrams of vitamin C caused DNA damage, got ample play from the Biff and Trixie teleprompter set. What your local bubbleheads failed to mention was that the study was done in a test tube, and not in a human, two radically different environments.

Also left out of the report was mention of the thousands of studies showing the safety of vitamin C. The National Academy of Sciences has set 2,000 mg a day as the safe upper limit, and Nobel Prizewinning scientist Linus Pauling took 10,000 milligrams every day until he died at age 93.

You don't need to follow Pauling's extreme lead to safeguard your health, but if you train intensely, you need more vitamin C than the average Buttafucco. Besides being an important antioxidant, vitamin C also helps you recover from tough workouts by repairing connective tissue and supporting your immune system.

HOW TO REALLY TAKE VITAMIN C

Since vitamin C is water-soluble, your morning dose may be long gone by noon. Whatever isn't taken up by the body will be flushed away. Hence, divide your daily intake so that you pop ascorbic acid approximately three times a day, thus ensuring that your body has a ready supply on hand.

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!

You're a person who maintains a healthy level of fitness. Your body mass index is in the normal range, your blood pressure is below 200, your cholesterol is in the safe range and you don't smoke. So how happy would you be if the federal government rewarded your efforts with an annual $1,000 tax credit?

If named the nation's next surgeon general, Kenneth Cooper will push for just that. Cooper also plans to urge tax benefits for corporations that establish employee-wellness programs. He says a program that allows employees to get away from their workstations, to exercise, would reduce health care costs, reduce absenteeism due to illness, make employees more productive and attract the best job applicants.

Cooper, who heads the Cooper Institute in Dallas, Texas, has been the personal physician of the President and Mrs. Bush for 12 years. He is credited with coining the word "aerobics" when he created it for a chapter in his first book in 1966. The publisher liked the word so much, he changed the book title to Aerobics. In his book, Cooper extolled the benefits of jogging and a fitness movement was born.

Cooper proclaims that by living a healthy lifestyle--including regular exercise and avoiding cigarettes and alcohol--people can improve their health and maintain independence into their 70s, 80s and 90s. He is a walking advertisement for his program's effectiveness. He speaks with great energy and looks at least a decade younger than he actually is. On his 70th birthday, he spent six hours downhill skiing. So, even if you don't get that $1,000 rebate, you'll still reap the benefits.

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!

OR MEMBERS ONLY PERSONALIZED SPORTS MEDICINE, TRAINING AND DIET ADVICE 255 CLINIC ADVISORS REPRESENTING MORE THAN 27 SPECIALITIES

ATRIAL FIBRILLATION: CAN I KEEP RUNNING?

I'm 53 years aid and have been running for 12 years. I have been diagnosed with atrial fibrillation and take Sotalol to control it, yet I've had five episodes over the last several months.

During these periods of atrial fibrillation I increase my medication and stop running. Overall though, I have kept running, but with some anxiety. Should I give it up?

Joseph R Grzesiak

Rome, NY

Atrial fibrillation is a common arrhythmia of the heart. Under normal circumstances, the electrical impulse that fires off before each contraction of the heart arises in the right upper chamber of the heart. The area from which the electrical impulse arises is called the sinoatrial node. During an episode of atrial fibrillation, the function of the sinoatrial node is overtaken and many electrical impulses, greater than 400 per minute, fire off from the upper chambers of the heart. Many, but not all, of the electrical impulses penetrate to the lower chambers of the heart, resulting in a rapid and irregular heartbeat. There are many medical conditions that are associated with atrial fibrillation and some authorities have even suggested that it is more common among runners. There is no evidence however that running causes atrial fibrillation.

In general, atrial fibrillation is more of a nuisance and is not a life-threatening arrhythmia. Periods of atrial fibrillation greater than 48 hours can increase the risk of stroke, which should be addressed with specific treatment and medication.

Symptoms of atrial fibrillation can range from unnoticeable in some people to nearly incapacitating in others. The most common symptom is palpitations, which is what you may notice as an awareness of irregular heartbeats. Other symptoms include lightheadedness, shortness of breath, or chest pain. In some people, atrial fibrillation has no impact on exercise performance, whereas in others, exercise performance can drastically decrease.

Sotalol is commonly used to help maintain a normal heart rhythm, and to lengthen the time between episodes, but it may not be 100% effective in all people. Even if it is not completely effective, it usually reduces the frequency and duration of atrial fibrillation episodes.

Here's the good news: I do not see any reason why you should give up running. There are many people who are in atrial fibrillation continuously and exercise on a regular basis. During episodes of atrial fibrillation, you may want to decrease the intensity of your workouts if you find it is more difficult than usual. From a practical standpoint, you might also want to avoid competitive running during episodes of atrial fibrillation. Otherwise, I do not see any reason why you should alter your running schedule.

Todd D. Millet; M.D.

Rochester. MN

LIFT THEN RUN?

If I do strength training and cardio on the same day, is it better to do one or the other first?

George Baird

Rensselaer, NY

Traditionally, strength and conditioning coaches recommend that you split up the two types of work-outs on separate days or at least by several hours. The logic is that either type of workout will subtract from the quality of the other. A hard run will leave your energy reserves depleted. Assuming that your strength training is intended to maximize gains, that won't occur if you are already fatigued. If your workouts must be back-to-back, do the one that's more important to your training goals first. If, for example, your strength training is basically an adjunct to your overall running program, run first, then lift. If you are interested in developing absolute strength to improve your running performance, try focusing on those goals during your off season.

Doug Lentz, C.S.C.S.

Chambersburg, PA

STRESS FRACTURES--HOW SHOULD I CHANGE MY TRAINING?

I am 30 years old and have been running seriously for four years. I was training an average of 50 miles per week at about an 8:45 minute pace. Over the past year I have suffered two tibial stress fractures resulting in long layoffs. After returning to running again I have gradually increased my mileage to about 35 miles per week and now I can feel trouble brewing at the location of my first stress fracture. I am 5'l" and 110 pounds. I take daily vitamins, drink milk, and wear prescription orthotics. How can I adjust my training so that I avoid these problems and the layoffs they cause?

Nicole Seferian

Woburn, MA

First, you should have a DEXA Scan to make sure you do not have osteoporosis, as well as a complete evaluation to rule out Female Athlete Triad. Small, slim women with high mileage training can be vulnerable to hormonal disturbances that can weaken bones and make you prone to stress fractures. Even if your hormonal status is normal, it is difficult to get enough calcium (1,500 mg a day) through diet alone and you may need to supplement. I would recommend a consultation with a registered dietitian to evaluate your diet and help make sure you are consuming adequate calories to meet your training and nutritional needs.

Anna didn't need the usual urging from nurses to walk the hospital corridors following cancer surgery. She was eager to begin, since walking had always been part of her life. Once home, she rebuilt her stamina by increasing her walking distance one day at a time.

Anna was doing more for her body, though, than building stamina. She was also lessening her chances of developing the depression that affects many who experience life-threatening medical conditions.

Vice President Dick Cheney and Larry King are among those who credit walking with helping to get them back to work following heart attacks and bypass surgery.

Walking, though, is not just beneficial for "after the fact" conditions. The ongoing Nurses' Health Study, involving 72,488 female nurses aged 40 to 65, shows walking briskly or with a good stride can lower the risk of stroke compared with an average or casual pace, and the same study shows that walking also reduces the risk of diabetes in women. Several other studies have already shown that exercise can reduce the risk of coronary heart disease. Also, the Journal of Obstetrics and Gynecology reported in October 2000 that exercise, such as walking, decreases the chance for certain types of ovarian cancer.

Walking also increases muscle strength; improves bloodflow; reduces the risk of hypertension; lessens lower back pain; increases the amount of good cholesterol; helps in weight loss; and since it is a weight-bearing exercise, it helps in maintaining strong bones.

Just as important, walking affects how we think. Even if individuals haven't walked during their younger years, small increases in exercise, such as walking, improve mental fitness, particularly for "executive control functions of the brain," involved in the ability to plan, coordinate, and schedule activities, says Arthur F. Kramer, cognitive neuroscientist at the University of Illinois. Participants at the university were randomly assigned to a walking program or a regimen of stretching and muscle toning. Walkers eventually Were completing an hourlong walk three times a week.

After six months the walkers' ability to switch tasks improved by 25 percent, while the toning and stretching participants showed little improvement. Kramer says that a possible explanation is that walking improves cardiorespiratory fitness, which, in turn, improves blood flow to the frontal and prefrontal areas of the brain, which control the executive function processes.

Also on the mental front, walking helps to overcome severe depression in some people on a par with antidepressant drugs. One of the theories is that exercise such as walking increases brain chemicals such as serotonin and norepinephrine, the same as antidepressant medications. Antidepressants may initially work more rapidly, but walking for 16 weeks has proved as effective in reducing depression and may work better in the long run to keep the symptoms from returning, says Duke University Medical Center psychologist James A. Blumenthal.

Blumenthal considers walking an alternative to drugs for certain people, and says it might be tried as a first line of treatment, rather than starting a person on antidepressants right away. "But it's different from writing a prescription. Other things could also contribute," he says.

Participants in the Illinois study had already been diagnosed with major depression, and had volunteered, which boosted their self-confidence, since it gave them a measure of control over their own body. Volunteers have also been more likely to stick with an exercise program than sedentary nonvolunteers. The walking was done in groups, providing support, which also helped to reduce depression.

Another reason walking might work is that it reduces stress, which often contributes to depression, even if it's mild, according to the National Institute of Mental Health.

Since the aged tend to have high levels of depression, several studies have been conducted to find out if exercise helps. It does, but removing aging stereotypes along the way is a plus. Studies at Harvard Medical School show that older people who receive subliminally delivered positive words about being old, such as "wise," "astute," and "accomplished," increase their walking speeds by 9 percent. Those who receive negative words about aging, such as "senile," "dependent," and "diseased," maintain the same walking speed they begin with.

The studies are important because a person's usual walking speed is a common measure of overall fitness, which tends to decrease 9 to 30 percent with advancing age, says Jeffrey Hausdorff, assistant professor of medicine at Harvard Medical School.

Just as important, though, according to Hausdorff, is "the role of self-expectations, attitudes and stereotypes on function. We all are aware how these things can influence our psychological state. Our studies suggest that they also influence our physiologic function. While a better attitude and positive outlook won't solve all problems, it may help to improve function."