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If 50 million Americans have high blood pressure, what are your odds of becoming one of them? Even the researchers at the National Heart, Lung, and Blood Institute didn't know, so they utilized their own Framingham Heart Study to find out, following 1298 subjects ages 55 and older for 22 years.

The results, published in the Journal of the American Medical Association, indicate that the "residual lifetime" chance of developing hypertension--a major risk factor for cardiovascular disease, strokes, kidney failure and premature death--is 90 percent. Other disheartening statistics: The majority of Americans with hypertension are receiving inadequate care or none at all, while one-third of them don't even know they have it.

The danger doesn't just kick in when you reach your middle years. Age plays a big part, of course, as do genetics, race and obesity. But hypertension can strike the youngest and fittest of us. And it's a silent disease: By the time symptoms show up, much damage has already been done.

Blood-pressure readings are made up of two components, systolic and diastolic, which measure, respectively, the pressure of blood in the vessels when the heart contracts, and then when the heart is at rest. Both aspects are important. The optimal rate is 120 systolic over 80 diastolic, while 129/84 is normal. Stage 1 hypertension starts at 140/90.

When the gap between the two numbers--called the pulse pressure--hits 60 or more, it also becomes a significant indicator of stroke risk. Because your pressure can fluctuate for a variety of reasons, diagnoses of hypertension, especially mild cases, should be based on several readings from more than one exam.

There are six classes of medications designed to control blood pressure: diuretics, beta-blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, vasodilators and calcium channel blockers. But you don't have to camp out at Rite Aid to start bringing your numbers down.

* Moderate exercise relaxes artery walls: At least 45 minutes of cardio three times a week is recommended; such a session can immediately decrease blood pressure for up to 16 hours. But don't overdo it. One study found that seven-plus hours of jogging per week can backfire by increasing blood pressure.

* Monounsaturated fats, such as olive oil, can reduce or even eliminate the need for hypertension drugs.

* Whole oats help control blood pressure better than other grains. As a bonus, they lower cholesterol and blood sugar.

* Potassium-rich foods (bananas, fruit juices, mushrooms, whole-grain cereals) aid in the excretion of sodium, which can upset your body's fluid balance. Cut your sodium intake to 2,400 milligrams or less per day, slightly more than one teaspoon of table salt.

* Omega-3 fatty acids, found in cold-water fish such as salmon and trout, can lower cholesterol and lessen blood pressure.

* Vitamin C in modest daily doses (500 mg) has been shown to help those with moderate hypertension. So has aspirin. Talk to your doctor, which you can do while you're having your annual pressure check.

I keep hearing that some weight-training exercises, such as behind-the-neck presses, should he avoided because they're too risky. True or false?

"My overall answer is no; there is no exercise in the common body of weight-training exercises that is so risky that all weight trainers should eliminate it from their workouts," says Ron Brenner, D.C., M.U.A.C. (Manipulation Under Anesthesia Certified), a personal trainer certified by the National Academy of Sports Medicine.

"Some exercises hold more risk of injury than others, but a person can injure himself doing almost any exercise if he has a predisposition toward injury or is not experienced in proper form and technique for that exercise."

Based on these conditions, which exercises should you avoid and which should you include? Brenner says it's a matter of common sense and personal history. "If you've had any problems with a body part or joint that is directly affected by an exercise, you may need to make modifications. You may need to alter your stance, range of motion, or technique; lighten up somewhat on the weight; or remove the exercise from your program altogether."

Compound movements and exercises performed behind the neck do have more risk associated with them. "Core weight-training exercises such as squats, deadlifts, bench presses or overhead lifts carry more risk because they are multijoint movements, and technique is crucial to performing them properly," Brenner says. "Often, behind-the-neck pull-downs or behind-the-neck presses are not widely recommended, because they require a greater range of motion than is optimal for some people; in those instances, using too much weight may cause injury.

"If your training requires that you perform these or other riskier exercises, don't do them in an explosive or ballistic manner. Rather, use a deliberate, controlled movement, ideally under the supervision of a coach or trainer who is very experienced in these techniques. When in doubt, choose safer exercises and techniques."

The health club industry has proved hardy during tough economic times. Since 1992, when the United States emerged from its most recent remission, the number of health clubs has increased by almost 40 percent, from 12,635 to 17,531 facilities (figure 1). Membership also grew by almost 60 percent, from 20.8 million to 32.8 million (Figure 2). Bill Howland, IHRSA's director of research, offers insight as to why the fitness industry has fared so well and its prospects for this year.

With economists saying we are in a recession, can we expect to see a decrease in the number of health club members?

No. That's what happened in the last recession (1989 to 1992). This time, I think membership will continue to grow, though not as vigorously as in the 1995 to 2000 period.

Why do you believe membership will grow?

Recent research by Roper Starch Worldwide has confirmed that the reasons people join clubs have changed. With the population aging, membership is perceived as more of a necessity than a luxury. Another reason is the unemployment rate. While it has increased over the past year to roughly 5 percent (in October 2001), it is still a long way from the 7.8 percent figure reached in the early '90s. At that point, membership did not decline; rather, it remained stable. When the unemployment rate was under 6.5 percent, membership grew (Figure 3). Overall, people may be nervous about the economy, but I think their response will be putting off trips to Bermuda or Vail and engage in local activities instead. Clubs serve a vital role in peoples' lives right now.

Too often, the fitness and health club industry is viewed strictly by the bottom line or interpreted from company or industrywide trends. But there are plenty of other stories and trends to be found inside the four walls of almost any type of fitness club.

What better way to find those stories than to take a tip from the late John Belushi and the rest of his Delta House brothers and go on a road trip?

The editorial staff of Club Industry traveled by planes, trains and automobiles to visit various clubs from different regions around the country. Occasionally, they got lost along the way or found an empty club waiting for them and maybe found a toga party or two as well.

Tales of those visits - without the toga party stories - continue, ripped out of each staff member's own travel log.

This month, editor-in-chief John Agoglia, completes our trek with Part 3 of the journey chronicling his travels from the Northeast.

Day 1

As the alarm rings at 3:30 a.m. to make it to Logan Airport for my flight to Burlington, VT, I only wish I finished packing last night and got to hit snooze at least once this morning. But in the end, I'm pretty excited to get out and see what is happening in gyms across the Northeast.

After a relatively uneventful - if sleepless - hour or so flight and a rather painless stop at the Avis counter I'm off to visit my first club, Twin Oaks Sport and Fitness in South Burlington. Twin Oaks, part of a four-club chain that offers a multitude of activities for members who are far too often relegated to the indoors during the harsh winters - a common trait for clubs in the Northeast.

At first glance, Twin Oaks is not unlike many suburban clubs: roomy, minimally decorated and welcoming.

In reading a brochure while waiting for the club's general manager, I notice that the facility has a full complement of equipment, classes and other programming options. But perhaps the thing that sets Twin Oaks apart from other clubs is the concentration and emphasis it places on children. Sure, plenty of clubs in the area have increasing offerings for children such as daycare or camps and even programming, but how many run a private kindergarten or have acquired a performing arts center? Well, Twin Oaks has.

"Our Kids in Fitness program starts with kids at eight weeks of age and runs through a private kindergarten that serves about 80 kids from each of the towns of South Burlington, Williston and Essex," says Michael Feitelberg, general manager of Twin Oaks. "It is a nationally accredited program that offers the same kind of curriculum as other pre-schools and kindergartens. But we have the opportunity to offer swimming, racquetball and a climbing wall. It is the opportunity to get young people exposed to health and fitness in a way they can't at a traditional preschool."

That is not to say that the adult crowd is left out of the Twin Oaks Sports & Fitness experience as programming and unique offerings for adults are a high priority for the club.

It was not that long ago that selecting a quality treadmill for home use was a simple exercise. Once a consumer determined how they planned to use the machine, it became a process of selecting a model that had the right combination of variables relating to motor size, belt length and width and degrees of incline. Products that offered much beyond those basic features typically cost upwards of $1,000 and were found only in health clubs or belonged to wealthy homeowners.

That is no longer the case, as fitness equipment manufacturers have performed the dual feat of dramatically improving the quality of home fitness equipment while adding sophisticated consumer electronics once reserved for club quality machines. Today, treadmills, elliptical machines and other types of equipment intended to deliver a cardiovascular workout have made a club-quality workout experience available for what it cost to join a health club for a year.

The improvement in quality, the addition of sophisticated electronic features at well under $1,000 has helped fuel booming demand for fitness equipment. It is a trend that shows no sign of abating, which helps explain retailers' continued emphasis on the category.

The familiar culprit behind expectations of growth is the aging baby boomer generation and its greater awareness of the benefits of exercise and the quest for the type of low-impact experience offered by treadmills and elliptical machines.

Background: While the beneficial effect of exercise capacity on mortality is well-accepted, its effect on health-care costs remains uncertain. This study investigates the relationship between exercise capacity and health-care costs.

Methods: The Veterans Affairs Health Care System recently implemented a Decision Support System that provides data on patterns of care, patient outcomes, workload, and costs. Total inpatient and outpatient costs were derived from existing administrative and clinical data systems, were adjusted for relative value units, and were expressed in relative cost units. We used univariable and multivariable analyses to evaluate the 1-year total costs in the year following a standard exercise test. Costs were compared with exercise capacity estimated in metabolic equivalents (METs), other test results, and clinical variables for 881 consecutive patients who were referred for clinical reasons for treadmill testing at the Palo Alto Veterans Affairs Health Care System facility between October 1, 1998, and September 30, 2000.

Results: The patients had a mean age of 59 years, 95% were men, and 74% were white. Eight patients (< 1%) died during the year of follow-up. Exercise testing showed an average maximum heart rate of 138 beats/min, 8.2 METs, and a peak Borg scale of 17. In unadjusted analysis, costs were incrementally lower by an average of 5.4% per MET increase (p < 0.001).

KEEPING your family spiritually, emotionally, academically and physically healthy is a year-round, often lifelong proposition. But it takes on even more meaning during the months when the children are out of school, the weather heats up and the "lazy" days of summer roll in.

Never, in fact, has it been more important to protect your physical health as well as the health of your children. Recent studies show that obesity rates among Black children and adolescents have nearly doubled in the last 20 years. It's estimated now that one out of seven children aged 6 to 19 is overweight or obese, which is defined as 20 percent over your maximum desirable body weight.

One solution, experts say, is for children to become more active. And the best way for parents to help with that is to get active with them.

"The family should work out together at least two times a week and exercise consistently," says Reggie Bryant, a personal trainer at Fitness Image Inc. Training Center in downtown Chicago. "And children can build on that for the rest of their lives."

You'd have to have lived in a cave the past 10 or 20 years not to know that exercise, especially aerobic activity, is good for your heart. Numerous studies have shown an inverse relationship between working out and the risk of heart disease. Yet few investigations have provided details on how to maximize those benefits.

Does slow and steady win the race, or should you pick up the pace? Will lifting weights hone your heart muscles as much as your biceps? The answers are now emerging.

Researchers at the Harvard School of Public Health looked at a cohort of 44,452 American men over a 12-year period to assess the potential risk of coronary heart disease against levels of leisure-time exertion; the stats were adjusted for age, smoking and other risk factors.

Not surprisingly, running, rowing, walking and weight training each helped build healthy hearts. Men who ran for an hour or more per week (at 6 mph) were 42 percent less likely to develop heart disease than nonrunners, while those who devoted the same amount of time to rowing had an 18 percent decrease. A daily walk (at 3 mph) lasting 30 minutes was also associated with a risk abatement of 18 percent.

If activities leave you more tired than in the past, don't be too quick to blame your age. Weight gain and a lack of regular exercise might turn out to be

the real culprits. "People often blame their age for slowing down in activities such as playing catch with the kids or grandchildren, or that walk in the woods or that bike ride across town. But a weight gain of 15 or 20 pounds in any adult can cause more fatigue during exercise, an increase in postexercise joint or muscle pain, and may generally limit the amount of activity that feels comfortable," explains William Haskell, deputy director of the Stanford (Calif.) Center for Research in Disease Prevention.

The good news is that "the loss of excess weight through a combination of calorie restriction and regular exercise can turn the clock back so that you can exercise at a level that was comfortable 10 or even 20 years ago," he says, noting that the effects of aging itself on lung and heart capacity are minimal. "While the maximum heart rate decreases about one beat per year because of aging, this has only a small effect on a person's exercise capacity in his or her 60s, 70s, or 80s." Fit, generally healthy individuals can live well into their 80s or 90s before age-related decreases in lung and heart function become an issue.

Weight slows people down and "puts more stress on joints, which can make underlying conditions such as arthritis or generalized joint pain more uncomfortable." Weight loss won't cure arthritis, but it can minimize the pain associated with putting pressure on an affected joint, Haskell points out. Extra body weight also increases blood pressure at rest and during exercise and is a major factor in the development of diabetes in older persons.

My head is spinning, my limbs are tingling and I'm beginning to feel strangely high. No, these are not the symptoms of a narcotic influence, but the side-effects of breathing the sort of atmosphere you might inhale at an altitude of 5,000m. Given the air is so thin - just 11 per cent oxygen, compared to the normal 20 per cent - my body has assumed that I am perched atop one of Europe's highest mountains. In fact, I'm comfortably seated at sea-level indulging in the latest fitness programme available at The Altitude Centre in London.

Mountain Air Therapy or Intermittent Hypoxic Training (IHT) sounds like an unlikely way of increasing vitality or fitness. But short periods of oxygen deprivation can actually increase fitness levels and endurance. Professional athletes have long known about the benefits of training in the thin air of the Andes or the Alps. Intermittent Hypoxic Training (IHT) is the logical conclusion of this practise - mountain air, without the need for a mountain.

"Altitude training makes your body work better in many ways," explains Richard Pullen, founder of The Altitude Centre, who used the technique while preparing for the Atlantic Rowing Challenge last year. "As there is less oxygen at altitude, the body adapts to become more efficient. Your heart muscle beats harder and so becomes stronger. You breathe more deeply, increasing lung capacity. New capillaries grow to get the limited supply of oxygen to tissues. All these changes mean that when you return to sea-level, the oxygen levels you are normally adapted to breathe take you further."

Cav Burke, 49, a floor polisher from Epping, used IHT to help train for his ascent of Mount Kilimanjaro. "Climbing Kilimanjaro was my dream and a great reason to lose weight and get fit," says Burke. "When I started, I was very overweight at 17 stone, and my blood pressure was high. Running and regular sessions at the gym helped me lose around six stone. After that, despite my training, I just couldn't shift any more weight, and my blood pressure was still above normal."

Burke tried IHT in October to help his body acclimatise to high altitudes, and to see if it could help him lose extra weight. "I was pretty surprised - the course of IHT left me seven pounds lighter. I found my recovery rate after a workout at the gym was getting faster. I was even happier to discover that after three weeks of IHT, my blood pressure had fallen by 15 per cent, from high to normal."

Several studies attest to the benefits of such treatment. In the treatment of asthma, IHT has enabled patients to reduce their medication, it has also been shown to improve energy levels in patients suffering from chronic fatigue. Yet, unlike climbing a mountain, where your body adapts to gradually lower levels of oxygen, IHT deprives the body of oxygen in short, sharp bursts. During treatment, oxygen saturation levels in the blood, heart rate and blood pressure are closely monitored. This enables oxygen levels to be reduced safely.

One immediate effect of IHT is that levels of the feel-good chemicals dopamine and serotonin increase noticeably - after a few minutes of breathing 11 per cent oxygen, I felt euphoric but calm. And, as anyone who has ever walked at altitude knows, thin air acts as a diuretic, ridding the body of excess water. One hour-long session had me rushing to the loo three times.

While short-term benefits, such as a flatter stomach and a sense of euphoria, are an immediate draw, it's the more dramatic effects of undergoing the treatment over time that are bringing new converts to the therapy. Pullen suggests that, after a course of 15 days, levels of red-blood cells - cells that carry oxygen to tissues around the body - can increase by up to a third. New capillaries grow to supply more oxygen to tissues. Heart rate and blood pressure drop, and, as the tissues adapt to take up more oxygen, the cells in your body become more active. Your metabolism changes, too - and areas of persistent fat disappear.

October is National Spinal Health Month. As doctors of chiropractic, this is a particularly appropriate time for us to examine our own levexplore strategies ourselves in these vital areas. It is a great time to focus on spinal health promotion.

Before sharing some of the concepts and practices that find exciting about spinal health and wellness, I have to make a confession.Thirteen years ago, as a 45-year-old doctor of chiropractic, I would have laughed out loud if someone had told me that I would be writing this article. At that time I had developed classic chronic, slouched posture with stooped shoulders, a sunken chest, anterior head carriage, and strained head and neck extensor muscles. I was experiencing subluxations of a chronic nature and was stiff and sore in my cervical and horacic spinal regions. My weak core musculature and hyperlordotic lumbar spine ere also causing me multiple other health problems.

Through self-study and use of some exercises from Dr. LeRoy Perry and a kung fu-adept student of mine, I made significant improvements in my posture and spinal health. Because of the intimacy of the interface between the spinal column and the nervous system, my entire quality of life has since changed for the better.Today, I teach spinal health classes to senior adults in their 80s who are improving their posture, core stability, integrative functions, balance and equilibrium, and quality of life.

In attempting to make spinal health improvements, it is well to consider the factors that impact our spinal health and quality of life.Though heredity has tremendous importance, our choices, habits, and lifestyles are also extremely powerful health determinants that can be improved with motivation and encouragement. If our patients-or we-want to make significant improvements in our levels of spinal health and our quality of life, we will need to change our spinal health habits.These include our postural, exercise-related, dietary, ergonomie, and sleeping habits, to name a few. We will need to assess our strengths and weaknesses. Once this is accomplished, we can begin to set specific, measurable goals in areas of maximal impact.

YOU either love exercise or you hate it. Some people get pumped up about working out. Others dodge it like a pothole on the street. They would rather be anywhere--even at a mother-in-law's house or in the middle of a tough exam--than sweating in a gym. But some of these same people can be found dancing the night away in the nation's hottest clubs.

Even if you're exercise phobic, the lure of a pounding bass line is hard to resist. Your head starts nodding, your feet begin tapping and your body sways and twists to the rhythm of your favorite tunes. That's the reason so many people have tuned into dance-fitness to keep in shape. It does the job as well as traditional workouts--and it's lots of fun.

Dancing, experts say, possesses the major components of any fitness regimen: stretch, resistance training and aerobics. It can burn as many calories as other workouts. It's also a holistic exercise that involves body, mind and soul. Vibing to the spirit of dance will not just boost your endurance and physical health but will also ease stress and improve your mood. How many times have you felt down, but then suddenly felt energized through the power of a good groove?

Chicago dance instructor Viola Elkins believes dance is therapeutic. She uses it in her own life to work through shadows of the past.

"I was a victim of child abuse and learned to release my pain through dancing," says the creative founder of Rhythm and Groove Exchange (R.A.G.E.).

Today, the 32-year-old dancer uses hip-hop rhythms to teach others how to transform negative emotions into positive energy.

"My students like it because it's so freeing," says the instructor who holds classes at the Evanston Athletic Club and Chicago's Lincoln Park Athletic Club. "You can be someone else for an hour. Sometimes we pretend that we're out at a club. You're just laughing and having fun and before you know it, the workout is over."

Dance brings many benefits along with fitness. Focus, grace and release are just a few of the other rewards. Each style of dance offers a different prize. Ballet may teach balance and poise. Reggae may yield sensuality and freedom. African dance may anchor your connection to the Motherland. Examine your goals to determine the right type of dance for you.

Nationally known fitness experts Constance and Courtney Bennett, who teach fitness classes at the world-famous Rancho La Puerta fitness resort and spa in Tecate, Mexico, say that dance, especially African dance, should be an integral part of every fitness program. "In order for any fitness program to work, participants must experience the activity as enjoyable and worthwhile," say the twins, who are certified fitness technicians and who teach a popular African dance class at the 60-year-old ranch, one of the oldest destination spas in North America. "This is exactly what happens when one adds dance to a movement program. Dance achieves what poetry achieves by connecting body with mind and thus transforming the ordinary into the extraordinary. One is inspired, uplifted and motivated to continue."

For the 12th consecutive year, the International Chiropractors Association (ICA) held its Annual Symposium on Natural Fitness in picturesque Columbus, Ohio. The March 5-6 event attracted more than 400 doctors of chiropractic and chiropractic advocates - including practitioners from as far away as Norway and Australia and featured lectures and guest appearances by noted experts in fitness and wellness.

The symposium focuses on the symbiotic relationship between fitness and health. Its main purpose is to bring together the best elements of bodybuilding and chiropractic to educate all participants on the value of natural health through exercise. Utilizing clinical presentations, lectures and hands-on demonstrations, the symposium provides the most up-to-date information available on the development of optimum performance in sports and training on injury prevention through chiropractic care.

Among the many speakers at this year's event, which was held in conjunction with the 15th annual Arnold Fitness Weekend, was Dr. Tom Deters. A doctor of chiropractic and the former editor of Muscle & Fitness Magazine, Dr. Deters delivered the symposium's key-note presentation. Dr. Mitch Mally, an internationally known author and inventor, addressed performance enhancement through chiropractic care; Peter Gratale, DC, presented a program on core strength training among various patient populations; Dr. Ken Kinakin, an authority on resistance training, provided new clinical strategies for injury prevention and management with weight training; and Dr. Gerry Mattia shared his knowledge on biomechanically directed exercise and chiropractic care.

As usual, bodybuilder-turned-action-star - turned-governor-of-California - Arnold Schwarzenegger made an appearance at the symposium as its featured speaker. Taking time out from his gubernatorial duties, Schwarzenegger addressed the crowd with his typical zeal and enthusiasm for all things chiropractic.

"I am honored to be back with you and to celebrate this great weekend once again," Schwarzenegger told the attendees. "We share a common mission, and that is health and fitness for everyone. What a great partner the ICA is on this. I look forward to doing this with the ICA for many years to come."

"The governator" also thanked the ICA for its longstanding partnership and support, and acknowledged the association's leaders as "key contacts" for the work he is engaged in as governor. In turn, the ICA thanked Schwarzenegger for his continuing support and participation in the symposium by presenting him with an official San Francisco 49ers football helmet, signed by former All-Pro running back Roger Craig, who spoke at this year's event. The helmet was embossed with an engraved gold disc from the ICA's Council on Fitness and inscribed: "To Governor Arnold, The Captain of Our Team." The ICA also made a significant donation to the After School All-Stars, a program founded by Schwarzenegger in 1995 that provides after-school activities and supervision for children.

If your workout battery is losing its charge, a new group exercise class called Yoga Booty Ballet can spark your enthusiasm. The class I took at Swerve studio in Los Angeles got me soaked in sweat during the dance segment, while the end-of-the-hour yoga left me feeling grounded. "You might feel like a total clod at first, but after 10 minutes you feel beautiful and strong," says Teigh McDonough, an American Council on Exercise-certified trainer who co-created the class with Gillian Marloth. I'll vouch for that. And though the class was the roughest hour of training I've endured since I don't know when, the vibe made it easy to find my "I can do it!" juice and get through the thigh-burning moves like Dancing Shiva and killer backside toners such as Booty Leg Lifts.