A number of studies that have investigated attentional focus have reported that when external stimuli are present during exercise, subjects exercise either for a longer duration or at a higher intensity level than when no external stimuli are present. In a study by Pennebaker and Lightner,5 subjects were asked to run 1,800 meters at a self-selected pace on an outdoor, wooded track, as well as indoors on a treadmill. While no significant differences were reported in rate of perceived exercise (RPE) values, subjects ran 51 seconds faster on the outdoor course.

In another study, Ceci and Hassmen2 assessed the self-regulation of exercise intensity using an outdoor course and an indoor treadmill. Subjects were asked to replicate RPE values of 11, 13 and 15 while running under both conditions. When comparing running velocity, heart rates and lactic acid values between conditions, all of the physiological responses were higher for the outdoor condition, which was attributed to an external attention focus.

Psychologically, the simple concept of enjoyment often determines whether someone sticks to an exercise program. In the VR studies, results of follow-up questionnaires showed that subjects unanimously preferred the VR machines to the non-VR machines.

They also expressed greater enjoyment with the interactive nature of the VR equipment, and found that being distracted during exercise made the exercise feel less tiring and the time pass more quickly.

These findings agree with a study by Boutcher and Trenske who observed greater feelings of enjoyment in subjects who listened to music while exercising.

1 Harte and Eifert also found that exercise enjoyment rose significantly as external stimulation increased external attention focus.

2 Subjects also felt less anxious, less depressed, less angry and hostile, and more invigorated following an outdoor run than when running indoors. Hormonal markers of stress (norepinephrine and cortisol) were also significantly lower following the outdoor run.

The new study, written by a group from the University of Minnesota and the Minnesota Colon Cancer Control Study, shows that fecal occult-blood tests (FOBT), whether performed yearly or biennially (every other year), significantly reduced the subsequent diagnosis of CRC. The authors followed more than 46,000 people for a period of about 18 years. The study patients were randomly divided into three equal groups: annual FOBT screening, biennial screening, or regular care (meaning that no strict requirement for any screening was done and the decision was left entirely up to the individual and his or her physician). The groups were well matched at the outset of the study, and the subsequent development of CRC was carefully followed.

The study found that the two screened groups had an almost 20 percent lower rate of CRC than the group under regular care. Furthermore, the authors noted that this reduction was likely a significant underestimate of the real benefit of FOBT screening, since not all the study patients actually went through with the recommended screening, while at least some of the control group did have screening.

The authors’ conclusion: “The use of either annual or biennial FOBT significantly reduces the incidence of CRC. Our study supports the theory of the adenoma [polyp]-carcinoma [cancer] sequence and emphasizes the importance of detecting and resecting [removing] advanced adenomas.”

An editorial in the same issue of the New England Journal of Medicine calls for more screening of Americans, without rigid adherence to any particular type of testing.

CRC screening can be done using a variety of different methods, including fecal occult-blood tests, which can be done yearly or less often; sigmoidoscopy, which involves inserting a tube rectally to visually examine the last 2 feet of bowel; barium enema, an X-ray test which allows evaluation of the entire colon; and colonoscopy, in which a specialist passes a 5-foot long tube to visually inspect the entire length of the colon (this is done under light anesthesia). The simplest and least expensive of the screening techniques is the FOBT, which entails smearing several stool specimens on a special card, which is then sent to the physician’s office for testing. If positive, further testing by another method is required.

The demonstrated reduction in death rate from CRC after any of these screening methods is almost certainly due to the removal of malignant (cancerous) and premalignant adenomas (polyps) discovered as a result of screening. While an added benefit of colonoscopic screening is that such growths can be removed during the screening procedure itself, some patients avoid this test because of the required cathartic preparation, as well as its expense.

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At the conclusion of the murder mystery, detectives gathered for a Murder Revealing Luncheon. Staff members put on a hysterical reproduction of the six different murder scenarios, all ending with the phrase, “the intern clutched her dumbbells and fell to her death on the exercise floor.” Prizes were also awarded. The luncheon allowed members to celebrate their exercise accomplishments while spending time with their colleagues and the staff of the Health & Fitness Exchange.

Response to Murder on Harbor Boulevard was very positive. Members reported in a post-event survey that the mystery broke up the monotony of just working out and made training more enjoyable. During peak workout hours, all 15 strength-training machines and 36 pieces of cardiovascular equipment were fully utilized. Participation in the group-exercise classes also increased throughout the day, in many cases doubling in size. This remained the case even during the summer months, when class participation usually declines.

There was an increase in the number of telephone calls and visits by non-members as well, which led to a rise in total membership during the three months following the event.

The murder mystery even boosted member involvement in the facility’s strength-training programs, which previously had been less of a priority for them. This will have the long-term effect of increasing the muscular strength and endurance of members.

“Our murder mystery was created to promote a well-rounded exercise program,” notes health and fitness specialist Jessica Stevens. “It challenged participants in a fun, game-like manner. The clues that were distributed enabled participants to take small, stress-relieving breaks from their busy work schedules and focus on something silly and fun. By providing an exciting twist on exercise, members looked forward to making fitness an enjoyable part of their day.” Murder on Harbor Boulevard, therefore, helped form healthy new patterns of exercise that will hopefully endure well into the future. It proves that pushing the creative envelope in program design can reap large rewards in facility utilization, exercise adherence and member satisfaction.

In this section we explain the types of fertility medication (Oral and Injectable), explain the way they work and how they are administered. So that you can understand the categories of drugs and treatment options available, we have also made available an Overview of all currently available medications arranged by classification: Progesterone, GnRH Agonists, Gonadotropins, and GnRH Antagonists. Most fertility drugs are hormones that work by stimulating the female reproductive system to increase fertility.

Oral Medications Used in Fertility Therapies

Oral medications are few and include:

• Clomiphene citrate (Clomid)
• Several other non-injectible medications with alternative delivery mechanisms include:
• Synarel (Nasal spray)
• Crinone (Intravaginal gel)

This six-week incentive program was the latest in a series of events sponsored by the Health & Fitness Exchange. Members were first introduced to the program when the chalk outline of a student intern appeared on the floor of the facility along with the dumbbells that she had been lifting. Surrounded by “Do Not Cross” police tape, this unique addition to the training floor generated a great deal of interest. Members started talking among themselves, and by the time the promotion was announced, they were ready to hit the ground running. Murder on Harbor Boulevard went on to become the most successful program in the facility’s history.

Members first signed up as detectives for the case. They earned clues that revealed the murder scenario by exercising, including “top-secret” information regarding weapons, suspects and motives. To keep things interesting and to prevent cheating, six different scenarios were developed. Weapons included items found in the gym such as a dumbbell, jump rope, water cooler and an aerobics step pad. Six employees at the facility became suspects for a particular scenario with clues given relating to hair color, eye color and other physical characteristics. A list of 20 possible motives was also provided to the detectives for their use.

It included such dastardly deeds as taking a reserved parking space, spilling coffee and always being on the printer. “Some members didn’t realize that there were six scenarios at first,” says LaShawn Michalski, the “dead” intern who helped develop the mystery. “This led to some very humorous conclusions when they compared notes with other participants.”

Detectives received clues every time they finished an established exercise protocol. Three cardiovascular sessions of at least 20 minutes in length entitled them to a clue. They received another clue when they completed two strength-training sessions. These sessions were full-body workouts that involved one or two sets of an exercise for each major body part. Sample beginner and intermediate workouts were provided for newcomers to resistance training. A third clue was provided when detectives attended a special group-exercise class that varied each week. Staff members recorded exercise compliance in a personal Homicide Report. All told, program participants were able to receive 18 clues. To encourage participation, the first clues were relatively easy to solve. Clue difficulty increased as time progressed.

Joey

A.A normal individual may have bowel movements anywhere from three times a day to three times a week. In fact, in my practice I tell my patients that there is really no “normal” frequency for bowel movements, as long as you are comfortable and have no medical condition that is causing true diarrhea (an increase in stool frequency, volume and weight).

A. It is important that you are certain you do not have a chronic inflammatory condition that is causing diarrhea; these usually are associated with fever, malaise, weakness or anemia (a depletion of iron in the blood).

I gather you have had these bowel habits for years without any of these other problems, so I bet you are quite normal. If you’re not sure, you can consider bringing it up on your next visit to your doctor.

While we await conclusive research, what do I advise my women patients? I encourage the vast majority to take HRT. Even though studies to date, including this one, fall short of proof, the weight of evidence is that women who take HRT live longer. HRT appears to halve the risk of dying from heart disease – the number one cause of death in US women. Although HRT may increase a woman’s risk of breast cancer by 30 percent, this cancer is not as common as heart disease. Thus, any increase in breast cancer deaths is likely dwarfed by the huge decrease in heart disease deaths. While this type of reasoning is helpful when looking at risk across a whole population of women, it doesn’t necessarily apply to an individual woman. For example, a woman taking HRT may well die of heart disease, even though statistically her risk is reduced. I advise my patients based on their individual risk factors and their personal preferences.

I ask my women patients with coronary artery disease to consider HRT one of their heart drugs, because it should decrease the chances that they will have a heart attack or need angioplasty or bypass surgery in the future. And it should allow them to live longer. For women without heart disease but with even one risk factor — high blood pressure, high cholesterol, a family history of heart disease, or smoking — I recommend HRT as well.

Several of my patients are long-term breast cancer survivors who have gone on to suffer a heart attack later in life. For these women, the decision to take HRT is a very difficult one because of the fear that their cancer will recur. But once a woman has heart disease, her chances of dying from it are overwhelmingly high. Based on this, I have recommended HRT even to these patients.

I don’t recommend HRT for women with absolutely no risk factors for heart disease who have a family history of breast cancer. For these women, even a slight increase in the risk of breast cancer tips the scales away from HRT.

Even so, statistics about risk factors can guide the discussion only so far. In the end, a woman’s decision comes down to personal preference. Quantity of life does not always correlate with quality of life, and the nagging fear of cancer may weigh on some women too heavily to allow them to take HRT. These women can be assured that quitting smoking, exercising regularly, and lowering their cholesterol will all add years to their lives as well.

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Massachusetts researchers used a mathematical model to predict the effects of HRT on the life expectancy of a 50- year-old menopausal woman, taking into account risk factors and disease rates for coronary heart disease, breast cancer, hip fracture, and endometrial cancer. For women with at least one risk factor for coronary heart disease, such as high blood pressure, the researchers concluded that HRT’s benefits outweigh its risks. This held true even for women who were at increased risk for breast cancer because they had a mother or sister with the disease.

Does this mean that every woman with heart disease should take HRT?

A CARDIOLOGIST’S PERSPECTIVE

This study adds to a growing body of evidence suggesting that HRT can extend life for most postmenopausal women. The research technique used in this study, decision analysis, uses mathematical probabilities to estimate the risks and benefits of therapies, in this case HRT. But there are a couple of problems with this type of research.

First, decision analyses reach their conclusions by evaluating previously collected statistics, rather than following real people. The only way to prove whether HRT truly saves lives is to randomly divide a group of women in half, give hormones to one group and dummy pills (placebos) to the other, and then compare how many women are alive in each group after a follow-up period. Although such randomized, placebo-controlled trials are under way, we won’t have results for several years.

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Wearing loose button-down shirts and unbuttoning from the bottom up can help to keep you covered when nursing in public. Wearing a loose t-shirt or cropped t-shirt under the button-down can further prevent showing more skin that you want to show. Loose t-shirts alone are also very comfortable and practical. It seems like I am obsessing on the word loose but wearing loose clothing will be easier on your breasts as well as on your psyche. After pregnancy the last thing you need is a too-tight shirt stretched across your new, more full-figured, full-of-milk breasts.

Many books will tell you to wear big bright prints to hide the milk stains. This advice always bugged me. When I was an early nursing mom and my breasts were HUGE and full, the last thing I wanted was an Hawaiian print shirt to draw attention to them. Of course, each of us will be able to decide what looks and feels best for us.

Some manufacturers equate nursing with pregnancy and assume that nursing moms won’t mind wearing pregnancy tops with nursing flaps in them. When I said loose, I did not mean pregnancy loose. There is a fine line between comfort and totally abandoning style.

There are some cover-ups available for nursing moms that you hang around your neck to cover baby completely. Most babies object to this type of covering. They like to look at mom and their surroundings.

Better than using a blanket or cover-up would be learning to use a sling. These remarkable devices are so simple and yet so practical that once you learn how to use it (best taught to you by an experienced sling-mom) you will rely on this as your most-used wardrobe item. They allow for discreet nursing as well as hands-free activity during your busy day.

Abnormally high rates of leukemia and non-Hodgkin’s lymphoma have been observed among children living in the vicinity of two British nuclear plants. This has led some experts to speculate that the children of workers exposed to nuclear radiation might be at increased risk for cancer.

To investigate this possibility, Doctor of the University of Leeds, UK, and colleagues tracked 25-year rates of cancer in close to 50,000 children born to British nuclear workers.

They found that “the incidence of cancer and leukemia among children of nuclear industry employees is similar to that in the general population.”

The number of actual cancer cases detected in the study remains too small to completely disprove links between worker preconception radiation exposure and later cancer in offspring, according to the authors. But they believe that only rarely are workers exposed to high doses of nuclear radiation around the time that they conceive a child, and even if such doses could cause leukemias in offspring, “the number of leukemias involved would be small.”