You lost 2 pounds this week! Your average fat gram intake was 36, down from 56 grams last week. That is about 200 fewer calories from fat a day. Each day, you dropped your fat intake a little more. Saturday you ate only 20 grams and no dinner — was that the full day?

 I was also pleased to see that you tried to eat less for lunch and made better selections. Could you indicate with an “R” when you eat in a restaurant, though? You approached dinner time with a hunger level of four, and ate reasonably portioned low-fat dinners. At a level of four, you do not need a lot of food to make you satisfied, and you acted accordingly. This may have helped in your metabolic weight loss process. As long as the dinner meal is low in fat and spices, you should not have sleeping problems.

Now that you have done a good job at removing high-fat foods from your diet, try to add more healthful foods. Please have two fruits each day. A one-half cup serving of fruit juice could count, but get into the habit of eating a fresh peach or crunchy apple with a meal or for a little snack. But be careful. I don’t want you to start a snacking habit. In your fat counting column, note how many fruits you had each day.

Good luck this week!

Sharon

Armand’s Reply

David,

Good job in getting your walks up to the 30-minute range. Our goal is to continue this progress until you can manage 45 minutes. Try to strive for three sessions this week of at least 30 minutes per session. Keep up your stretching as you have been.

By the way, have you noticed improvement with your stretching? Are you able to stretch farther? Does it feel easier to perform the various exercises? If the answer is yes, great! Continue to take the stretches to a point where you feel the stretch in the targeted muscle, holding it for 10 to 30 seconds. Remember, never bounce when you stretch.

I would like to add an abdominal exercise to your program. Perform this after your walk and before your stretching:

Abdominal Curl
Lie on the floor with your knees bent and your feet 13 to 19 inches from your buttocks.

Lightly clasp your hands behind your head with your elbows wide open.

Press your lower back into the floor, and lift your upper back off the floor while keeping your eyes focused on the ceiling. Be careful not to pull on your neck.

Return slowly to the floor.
Start with one set of 10 to 15 repetitions, and then add one or two repetitions each week until you reach 40. Add a second set after performing 40 repetitions for two weeks.

Have a good week and keep up the good work!

Armand

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This week I think I made some progress watching my food intake more closely and increasing the duration of my walks. I had to work a bit of overtime, which cut into my exercise plans, but I managed to lose a couple of pounds nonetheless.

 Armand, although those work obligations kept me from doing a third session this week, I did get up to 30 minutes. I had no real problems with stiffness or soreness, other than a little pain in my knees. I’ve had problems with my knees since I was in junior high school, so it’s something I’m used to, and this is pretty minor. The uphill climb at the end of my walk seemed a little easier yesterday.

Sharon, thanks for the information on restaurant food. I’m not much of a cook, so making better choices eating out is going to make a big difference. As to when I got into this pattern of large lunches and no dinner, it seems like it was a gradual progression starting three or four years ago. I’ve always eaten pretty hefty lunches, and over time I just felt less and less hungry at dinner. When I do eat dinner, it’s usually along the same lines as lunch, so the high fat content is probably a contributing factor in the indigestion.

This week I tried to eat less at lunch, so on a few occasions I was a little more hungry in the early evening and had something lighter as you suggested. I didn’t have much trouble with the heartburn, but I was also working later and getting to bed later than usual.

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Thanks again for the feedback. This week was good, although I have felt a little under the weather the last few days — a little sluggish. I didn’t really bring the same level of energy to my exercise session yesterday, and my appetite has definitely fallen off. My work schedule has been a little erratic this week, so I’m hoping to catch up on my sleep this weekend. Maybe that will help.

Armand, I’m slowly improving with the new exercises, though it was a bit of a struggle yesterday. I added a little more distance to my walk, but not quite as much as I hoped. Still, I feel good about any progress. I walked at work one night this week when I was staying late. The building I work in is almost half a mile long, so I just walked a few laps up and down the main corridor.

Sharon, the answer to your question is, “yes!” I have definitely been passing up some tempting foods. Among my friends at work, I’ve been known as the guy who always gets dessert. So while nobody’s noticed my weight loss, there have been one or two comments about the change in my eating habits. As yet, I can’t see much visual difference myself. My sweet tooth is definitely still there, but I’m just not giving in quite as easily as before. The fruits have helped in that regard, too.

Sharon’s Reply
David,

You eat a lot of meals in restaurants — 12 times this week! Do you ever cook at home? Restaurants serve very large portions, so be careful that you stop eating when your hunger has been satisfied, not just when the plate is empty. It is also hard to find out if the cook adds butter to the vegetables or oil to the recipes. You are doing a good job at selecting the lower-fat food, but it could be that the portion is still too big.

Your average fat gram intake was 30, which is great. You are still eating something light in the evening. You are putting an emphasis on getting fruits and vegetables in your diet — you have not really had any sweets for the past month! And, you have lost 11 pounds! You are doing fine. I hope you can soon be able to see a change in your clothing or find bending over or climbing stairs a little easier.

Keep up the good work!

Sharon

Armand’s Reply

David,

It looks like it was another good week for you — congratulations! Sorry to hear you were a little sluggish though; hopefully, resting over the weekend will help you out, as you said.

You are continuing to do a good job with your walking, attempting to walk a little farther in the same amount of time. By constantly trying to do a little more, you are challenging your body. In so doing, you will see an increase in your fitness level and, eventually, see more results! This way, you can help avoid hitting those annoying plateaus where nothing you do seems to make you lose weight.

I am glad to see you getting creative with your workouts by taking advantage of your work setting. Walking the corridors of your office building is a great example of how people can integrate activity into their normal routine. Other examples of this are parking farther away from the building, taking stairs instead of elevators, and using the last 15 minutes of your lunch hour to walk. Take a look at my Deskworkitis article for more tips.

I am glad to see you progressing nicely with your toning exercises. I want you to keep trying to add repetitions every week on both the abdominal curls and the pushups. Just make sure you stay with strict form; perform each exercise in a slow and controlled manner.

Keep it up, David! Continued success awaits you.

Armand

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Stemming from the perception that chronic disorders are a part of normal aging, it is commonly believed that older adults cannot respond to lifestyle interventions, and that aging and chronic diseases are inevitable. Both of these perceptions, however,have been disproved, as accumulating evidence indicates that risk factors are potentially avoidable, rather than inevitable, and can be modified through lifestyle interventions, including exercise.

Vulnerability to chronic age-related diseases increases exponentially after middle age. At 50, the risk for many age-related conditions begins to double every five to seven years.

Care of older people has focused on managing chronic disorders rather than on the promotion of healthy lifestyles and prevention of c chronic diseases.

The crucial assumption behind efforts to change this focus is that changes in lifestyle and medical care can prevent, postpone or reverse age-related morbidity. The Alliance for Aging Research, which deems chronic illness a threat to the health of the nation, reports that 86 percent of older Americans “believe that exercising regularly is very important or essential to staying healthy as they grow older.”

In a recent Today Show interview on NBC, Schwarzkopf went so far as to say that with universal screening, prostate cancer would be virtually preventable, and that with early detection, the side effects of treatment were minimal or nonexistent. However, sweeping statements and exuberant optimism about wiping out prostate cancer misrepresent the realities of the disease, and of its detection and treatment.

Indeed Schwarzkopf’s public enthusiasm for widespread prostate cancer testing masks an anguished debate in the medical community about exactly which men should be tested for prostate cancer. This debate intensified when a simple blood test to detect prostate cancer — the prostate specific antigen, or PSA, test — became widely available about a dozen years ago.

The argument that detecting cancer early will improve the chances of survival is a basic, intuitive one. But sometimes this “truism” is more apparent than real. For example, it can be legitimately argued that colon cancer is largely preventable by screening. Screening with a fecal occult blood test or tests like a colonoscopy can detect polyps or cancer. When detected, these polyps or cancers can be surgically removed quickly and efficiently, essentially without risk or negative side effects.

For prostate cancer, unfortunately, the story is more complex.

Prostate cancer — although not necessarily a life- or health-threatening type — is extremely common. The current estimate is that at least 11 million American men have prostate cancer in some form. Only a fraction have been diagnosed. Each year, about 40,000 men die of prostate cancer in this country. Signs of prostate cancer are found during the autopsies of almost all men age 90 or over who die of other causes; the figure is about 40 percent for men aged 40 to 49. In other words, there is a large discrepancy between the number of men who have some form of prostate cancer and the number of men whose life or health is threatened by it. This fact is critical when it comes to evaluating the need for mass screening and the options for treatment.

Given the above reality, universal screening of all men over age 50 will pick up substantial numbers who have a “dormant” prostate cancer — meaning they have a form of the disease that will never progress to a life-threatening stage. These men with dormant prostate cancer then hazard the discomfort, risk and expense of follow-up evaluations such as biopsies, as well as the more significant risks associated with hormonal, radiation and especially surgical treatment, if cancer is detected. Results of biopsy specimen analysis can sometimes indicate if a cancer is likely to be aggressive, but this is far from certain.

Contrary to what Schwarzkopf says in his interviews promoting prostate screening, a substantial number of men undergoing treatment for prostate cancer still do suffer from incontinence and impotence, at least temporarily, despite the advances in what has been called “nerve sparing” surgery.

Is prostate cancer screening good public-health practice? The answer requires more than the TV soundbite opportunity given to Schwarzkopf. For men with a family history of prostate cancer, regular screening after 50 may be desirable. Also, black Americans have a higher rate of prostate cancer than whites, so they are more likely to benefit from screening. But there is no medical consensus to support a call for universal prostate cancer screening, primarily because there is no evidence at hand that early or universal prostate screening saves lives.

The lack of enthusiasm for Schwarzkopf’s universal screening recommendation was evident this week in San Diego when the American Medical Association decided against adopting guidelines for early prostate cancer detection. Those voting against this recommendation cited the lack of evidence-based benefit. The AMA decided to refer the guideline proposal to its board of trustees for additional study.

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Many facility owners will attest to the importance of offering aerobics. Potential members, particularly women, are often attracted to facilities because they want to participate in aerobics classes. This influence on membership sales makes offering a program a priority, but not near as much attention is usually focused on the impact of a well-trained, high caliber staff of instructors.

A knowledgeable, innovative program director who hires and trains top-notch instructors will make an impact on a facility’s membership. Satisfied members will tell friends about their classes and instructor.

The facility will see the difference in the bottom line as good instructors increase retention and member referrals.

But, adding this value to your facility isn’t as easy as it may sound. Talented directors and instructors are hard to find, and their job isn’t easy, either. Remaining knowledgeable and continually offering quality classes requires effort and commitment.

Strength training classes are emerging asone of the leading group exercise trends in North American fitness facilities, according to a recent IDEA survey.

Not only are the health and lifestyle benefits for members vast, but these classes satisfy consumer demand for simple, time-efficient and functional workouts.

Specifically,there are six key reasons why fitness consumers are flocking to muscle conditioning classesandwhymanagers are adding these classes to their schedules:heightened motivation, new demands from an educated clientele, minimized intimidation, a safe exercisevenue, reduced workouttime and access for clubsto new markets.

This year, an estimated 180,000 American men will be told they have prostate cancer. Every one of these men, and the women who love them, should know about Dr. Jerome Groopman’s essay “The Prostate Paradox,” published in the May 29, 2000 New Yorker, before they make a decision on what action, if any, to take after this diagnosis.

Groopman, a professor at Harvard Medical School, walks us step-by-step though the facts about this form of malignancy and the options for — and consequences of — treating it. While we often hear celebrities (such as Bob Dole, Michael Millken and Gen. Norman Schwartzkoff) tout the benefits of the PSA test, we do not frequently hear these realities:

Prostate cancer in some form is very common in men, particularly as they age. More than 50 percent of men who die in their 80s of other causes have clinical signs of prostate cancer at autopsy. More than 30 percent of men carry occult (asymptomatic) prostate cancer by age 50.

Not all prostate cancer is life-threatening. While almost 200,000 men will be diagnosed, about 32,000 will actually die this year from the disease.

The consequences of the traditional forms of treating prostate cancer — surgery and/or radiation — can be devastating. Incontinence and impotence are frequent resulting effects of such treatment. Indeed, as Groopman notes, the frequency of untoward side effects may be greater than previously reported, particularly in the upbeat presentations about “nerve-sparing surgery.” Patients tend to underreport the problems they are experiencing, in a subconscious effort not to disappoint their doctors about the outcome.

While it initially may appear on diagnosis that the “do-something” option is the only viable one, Groopman’s commentary will cause newly diagnosed prostate cancer patients to ask themselves some very philosophical questions about the risks, uncertainties and importance of quality of life.

Information on the type and aggressiveness of a prostate cancer (the Gleason score) is useful in the decision-making equation, but ultimately, newly diagnosed prostate cancer patients must make a decision on incomplete information: For example, they do not know if the cancer is life threatening or not. They do not know exactly what the degree of treatment-related debilitation will be — although they should assume it would be considerable and perhaps permanent. They do not know for sure if the cancer has spread beyond the gland, which means that whatever treatment they undergo and the consequences they suffer would not prolong their lives. Is treatment, without the promise of cure and with the likelihood of at least temporary impotence and incontinence, worth it — in return for possibly avoiding a prolonged and painful premature death? Or is “watchful waiting” the preferable option, where a man chooses regular medical monitoring of the cancer’s possible progression instead of treatment?

Perhaps the bottom line is best summarized by a quote that appears at the end of Groopman’s essay: Dr. James Talcott, a medical oncologist and the director of the Centers for Outcomes Research at the Massachusetts General Hospital Cancer Center in Boston, has analyzed different interventions for prostate cancer, weighing issues of quality of life against survival. He notes, “I tell my patients to do thought experiments ? try to imagine your life after a radical prostatectomy [where the prostate gland is surgically removed], where you are impotent. Try to imagine your life after radiation therapy, where you suffer with urinary or bowel irritation. Then imagine that you’ve done nothing, just been closely monitored. In each scenario — surgery, radiation or just observation — then imagine that the cancer has come back. Which bullets are you wiling to take?”

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Unlike many weight-management programs, L.E.A.N., which was implemented by the corporate fitness center last spring, was marketed to fit and deconditioned clients, emphasizing healthy habits for a lifetime. “Traditionally, weight-loss programs are catered to an overweight population and can become dangerous when individuals of normal body weight pledge to lose weight,” says program manager Sherry Faucher. “With L.E.A.N., anyone interested in improving their daily nutritional intake and learning the roles that both exercise and nutrition play in weight management can participate.”

Participants were organized into teams and “competed” on both an individual and team basis. Points were awarded for completing three exercise sessions a week, completing bi-weekly food diaries and for participating in special weekly activities.

According to Faucher, the pressure of competition was eliminated by allowing all who participated a chance to earn a winning score. “When weight management is made into a ‘game,’ the barriers of frustration and intimidation are broken down,” Faucher says, adding that one of the best outcomes of the program was the connection between staff and members.

“Members loved the individualized attention, and the feedback provided by the staff was the most appreciated component of the entire program,” she says.

Twenty-five percent of the facility’s membership participated in L.E.A.N., making it Paine Webber’s most popular incentive program to date. In addition to an increase in regular exercise, the facility has enjoyed an 8-percent increase in membership adherence.