Reproductive complications
• Complications of pregnancy
o Obesity during pregnancy is associated with increased risk of death in both the baby and the mother and increases the risk of maternal high blood pressure by 10 times.
o In addition to many other complications, women who are obese during pregnancy are more likely to have gestational diabetes and problems with labor and delivery.
o Infants born to women who are obese during pregnancy are more likely to be high birthweight and, therefore, may face a higher rate of Cesarean section delivery and low blood sugar (which can be associated with brain damage and seizures).
o Obesity during pregnancy is associated with an increased risk of birth defects, particularly neural tube defects, such as spina bifida.
• Obesity in premenopausal women is associated with irregular menstrual cycles and infertility.

Additional health consequences
• Overweight and obesity are associated with increased risks of gall bladder disease, incontinence, increased surgical risk, and depression.
• Obesity can affect the quality of life through limited mobility and decreased physical endurance as well as through social, academic, and job discrimination.

Diabetes, obesity, smoking, high cholesterol and high blood pressure all lead to problems with blood flow in the in the arteries that can result in a heart attack. And prevention is all. Once you get to the point that a blockage is starting to develop, large amounts of plaque already exist in the arteries. You should not wait until you have symptoms of heart disease to begin the cure. By then you are fighting a nearly impossible battle.

To prevent heart disease, risk factor modification and lifestyle changes are absolutely crucial. It is not adequate to rely on drugs.

“You can’t smoke, gain weight, not exercise and just take a statin and expect to have a great outcome.”

-John Canto, cardiologist at the Watson Clinic in Lakeland, Florida.

RISK FACTORS YOU CAN’T CHANGE

You can’t control some things that increase your risk of having a heart attack; still, it’s essential to know how they contribute to your global risk profile. These factors increase your risk of having a heart attack:

• Being male

• Being African American, Hispanic or another minority

• Getting older, particularly over 60

• Having parents or siblings with heart disease (particularly a father who had a heart attack before 55 or a mother who had one before 65).

RISK FACTORS YOU CAN CHANGE

In approximate order of their ability to reduce your risk, here are some actions you can take:

• Quit smoking. No single act can reduce your risk more dramatically. A year after quitting, your heart disease risk is reduced by half.

• Stay active. A recent study showed that 20 minutes on an exercise bike every day is more effective at relieving angina, or chest pain, than a procedure in which a stent is used to open a blocked vessel. After a year, 88 percent of the men in the study, all of whom had cardiovascular disease, had no heart attacks or other heart problems, compared with 70 percent of the men with the stent.

That study builds on years of research that shows exercise is one of the best things you can do for your heart health. Exercise can help control cholesterol, diabetes and obesity, as well as lower blood pressure. Working out helps lower the risk of heart disease even in the presence of other risk factors. Aim for 30 minutes of moderate activity nearly every day. For additional heart protection you’ll need to get 30 to 60 minutes of exercise three or four days a week at 50 to 80 percent of your maximum exercise capacity.

• Eat wisely. Heart-healthy eating means eating less saturated fat and trans fat; more healthy fats of the kind you find in nuts, fish and olive oil; fewer low-quality carbohydrates like you find in white bread, white rice and sweets; and more fruit, vegetables, beans and whole-grain foods, especially those with soluble fiber such as oatmeal, barley, citrus, strawberries and apples.

Folic acid and vitamins B 6 and B 12 reduce homocysteine levels. Nobody knows if this reduces heart disease risk, and the AHA doesn’t recommend folic acid supplements. But it does recommend people get enough folic acid in their diets. It is added as a fortification to wheat flour and occurs naturally in citrus, tomatoes and many vegetables.

• Don’t drink too much. Here’s the paradox: Drinking too much alcohol will raise triglyceride and blood pressure levels, but moderate amounts of alcohol seems to increase levels of HDL, the good cholesterol. There is good evidence that people who drink moderate amounts of alcohol have less heart disease than those who don’t drink at all.

The AHA recommends that you drink alcohol in moderation, (an average of one or two drinks per day for men.) If you do not drink, it is not recommended to start drinking alcohol to reduce the risk of heart disease.

• Stay slim. “As mundane as it sounds, the first and most important initiative for the young adult healthy male to acknowledge is that weight management is the first step to take to prevent heart disease.”

-Clyde Yancy, professor of internal medicine and cardiology at the University of Texas Southwestern Medical Center in Dallas

Overweight and obesity are independent risk factors for heart disease. Maintaining a healthy weight will be a natural consequence of following the preceding recommendations on exercise, diet and drinking. But if you are starting out overweight or obese, you’ll need to achieve a healthy weight by burning up slightly more calories than you take in, until you gradually reach your healthy weight. After that, it’s a matter of balancing the food input and the calorie burn over the long term.

Achieving a healthy weight will reduce the risk of developing diabetes, high blood pressure and high blood lipids, which are themselves risk factors for heart disease.

• Take aspirin, maybe. While there is good evidence that aspirin can prevent both first and second heart attacks in at-risk people, you don’t want to put yourself on an aspirin regimen without consulting your doctor. Aspirin can cause gastrointestinal bleeding and may increase the risk of stroke, so it isn’t recommended for everyone.

The U.S. Preventive Services Task Force, an independent panel of scientific experts, recommends low-dose aspirin for those at increased risk for heart disease, including men over age 40 and younger people with a risk factor such as smoking, diabetes or high blood pressure. The AHA says if a person has a 10-year risk of heart disease greater than 10 percent, the benefits of aspirin outweigh the risks. Most people who have already had a heart attack should be taking aspirin.

GLUCOSE TEST
A glucose test measures the amount of sugar (glucose) in the blood. The area is cleansed with antiseptic and a small amount of blood is collected onto a test strip. To get reliable results, you should fast (not eat) for 6 hours before the test.

Why is this test performed?
This test is used to evaluate blood glucose levels and is used to screen for possible diabetes, or to monitor control in patients who have diabetes.

What is glucose?
Most dietary carbohydrate eventually ends up as glucose in the blood. Excess glucose is converted to glycogen for storage by the liver and skeletal muscles after meals. Glycogen is gradually broken down to glucose and released into the blood by the liver between meals. Excess glucose is converted to triglyceride for energy storage.
Glucose is a major source of energy for most cells of the body. Some cells (for example, brain and red blood cells), are almost totally dependent on blood glucose as a source of energy. In fact, the brain requires that glucose concentrations in the blood remain within a certain range in order to function normally.
How does the body regulate glucose levels?
The major hormone regulating glucose concentration in the body is insulin (although other hormones such as glucagon, epinephrine, and cortisol also affect it).
Glucose levels are measured most commonly to diagnose diabetes or to monitor adequacy of diabetic control. Diabetes is a very common disease, affecting about 2% of the general population, that results from insulin deficiency or insensitivity by the body to the level of insulin present. People with type 1 diabetes require daily injections of insulin to control their disease. Injection of too much or too little insulin can be dangerous because there is a limited range of blood sugar levels in which the brain can function normally.
Normal values are between 64 and 110 mg/dL. Higher than normal values may indicate
• Impaired fasting glucose — 110 to 126 mg/dL — a prediabetic state
• Greater than normal levels (hyperglycemia) may indicate:Diabetes — fasting blood glucose of greater than 126 mg/dL
Lower than normal levels (hypoglycemia) may indicate:
• Hypopituitarism
• Hypothyroidism

WHAT YOUR GRIP STRENGTH TELLS YOU

If you’re looking for a way to predict who might become physically disabled or might suffer from physical problems that limit their ability to function later in life, test their hand-grip strength.

That’s what researchers at the National Institute on Aging found when they tested 6,089 men ranging from age 45 to 68–and then retested them 25 years later. They concluded that “hand-grip strength was highly predictive of functional limitations and disability 25 years later.” They added that “good muscle strength in midlife may protect people from old age disability by providing a greater safety margin above the threshold of disability.”
The researchers noted that “muscle strength is found to track over the life span.” They went on to say that “people with greater muscle strength during midlife are at a lower risk of becoming disabled because of their greater reserve of strength regardless of chronic conditions that may develop.”
Why hand-grip strength? The researchers said that it correlated with the strength of other muscle groups, giving a good indication of overall strength.
But what about those with weak hand-grip strength? Are they destined to suffer later in life? Not necessarily. The researchers held out hope by suggesting that they might profit from engaging in exercises designed to improve strength in all muscle groups.
The researchers also noted that:
–”Grip strength at midlife may be a marker of physical activity, which itself preserves function and prevents disability.”
–People with low grip strength may have a subclinical disease, which later might develop into in a more-serious disease and disability.
–Good grip strength may have something to do with some kind of intrinsic midlife vitality or motivation that may contribute to good functional ability later in life.
The study was published in the Journal of the American Medical Association.

Cancer Prevention:
One large study concluded that individuals who don’t regularly exercise have four times the risk of getting cancer compared to those who do. Most cancers can be prevented by -
- Limiting exposure to known carcinogens, including too much sun and cigarette smoke.
- Not drinking or drinking moderately.
- Good nutrition habits and maintaining a healthy weight.
- Getting regular exercise.
- Getting periodic exams and knowing the cancer warning signs.

Weight Management:
Fad diets and fast weight loss programs seldom lead to long-term success in weight control and can be a health hazard. Controlling weight for a lifetime requires more than dieting. It requires behavioral changes: a commitment to new ways of eating, new activity patterns, and successful management of emotional issues. If you need to lose weight, don’t plan on losing more than one to two pounds per week. Remember 90% of successful dieters also exercise. You will need to develop a systematic exercise program. If you want more help with a specific plan to follow while you are adopting good eating and exercise habits, ask for our “Eating to Lose Weight” guide.

Dietary Practices:
- Eat a variety of foods daily.
- Choose a diet low in saturated fat and cholesterol.
- Get plenty of vegetables, fruits, and grain products.
- Use sugars, salt and sodium in moderation.
- Drinking alcohol is not recommended, but if you do drink, do so in moderation.

Heart Health:
Keeping the heart healthy is a fundamental of life. Anything that restricts circulation impairs health and puts your life at risk. There is nothing you can do about heredity, gender, or aging, but the cause of most heart problems can be explained by the following risk factors. Take action against any risk factors you may have. Risk factors include: a personal history of heart disease or diabetes, total cholesterol over 240 (or LDL over 160 or HDL less than 35), triglycerides over 400, smoking over 10 cigarettes per day, not regularly exercising, consistent blood pressure over 140 systolic or over 90 diastolic, being more than 30% overweight.

Stress Management:
If stress is a problem in your life and you feel uptight, frustrated, overwhelmed, or mentally drained, plan now to reduce your stress burden. The following steps can be helpful.
- Get at least seven to eight hours of sleep daily.
- Avoid excessive amounts of change in your life within a short period of time.
- Use your support systems, foster meaningful social relationships, take time to give and receive love.
- Have a positive outlook on life and be nice to yourself, give yourself rewards.
- Talk out your problems and approach them intelligently and systematically to find effective and reasonable solutions. Accept gracefully those things over which you have no control.
- Learn to relax. Enjoy a good book, take a nap, visit a friend, or go for a walk. If more help is needed, try biofeedback or progressive relaxation.

Exercise:
Regular exercise has many health benefits other that making you look and feel better. Recent articles in the Journal of the American Medical Association and The New England Journal of Medicine offer the following list:
- Heart Health- Inactive people develop heart disease twice as often as active individuals. Inactivity increases the risk of high blood pressure, obesity, and high blood fat levels.
- Osteoporosis- Weight bearing exercises like walking, aerobics and weight training are essential to maintenance of good bone strength.
- Weight Control- Exercise helps controls body fat by burning calories, and strength training builds the lean muscle tissue that burn calories, even when you are at rest.
- Mental Health- Many studies show an association between physical activity and good mental health. Apart from endorphin induced fitness highs, fit people have a better self image, feel better, and have more energy.

EXERCISE AND DIABETES

A recent major clinical trial released by the NIH found that the at least 10 million Americans who are at high risk for type-2 diabetes can greatly lower their chances of getting the disease with diet and exercise. Participants randomly assigned to lifestyle intervention reduced their risk of getting type-2 diabetes by 58%; compared to only a 31% reduction for those treated with metformin.

If you already have diabetes, one of the best things you can do for yourself is to stay¾or begin to be, active. A regular exercise program can help stabilize your blood sugar, reduce your need for insulin and medication, and keep your weight under control. Diabetes increases the risk of heart disease, but exercise can help lower it.

Exercise Benefits for people with diabetes include:

Exercise reduces the risk of dying prematurely by 22%, even for the moderately active.

Improved glucose utilization: exercise increases insulin sensitivity, which causes glucose levels to decrease. The ADA says that strength training is critical to improving glucose clearance. After 4 months of strength training glucose metabolism typically improves by about 20%.

Weight loss: exercise burns calories directly and indirectly by increasing your basic metabolic rate as your muscles get bigger. Muscles are the furnace by which calories are burned.

Psychological benefits: improvements in mood, self-esteem, and quality of life are particularly important for people who have a chronic disease such as diabetes. Exercise allows patients to take an active, positive role in the management of their disease.

Decreased cardiac risk: since most people with diabetes die from cardiovascular disease, the greatest benefit to patients who exercise may be in reduced cardiac risk. Patients with type 2 diabetes are at double or quadruple the risk. Regular physical activity strengthens the heart and causes the veins and arteries to grow larger and suppler. As a result blood lipid profiles improve, and blood pressure is reduced.

EXERCISE AND CARDIOVASCULAR DISEASE

Despite dramatic reductions in cardiovascular disease (CVD) mortality rates over the past 25 years, CVD remains the leading cause of death in the United States. Fortunately, there is much you can do to protect yourself from this disease.Physically active patients cut their risk in half compared to people who don’t regularly exercise. You also need to eat smartly, control stress, take your medications, and control your blood pressure.

Exercise is vital if you’ve already had a heart attack, balloon angioplasty, bypass surgery, or if you are affected by heart disease in some other way, like having chest pain when you exert yourself. Heart patients who increase their physical activity boost their self-confidence, report less depression, stress and social isolation, and improve their overall sense of well-being. Exercise allows patients to a take an active, positive role in the management of their disease.

Aerobic exercise is particularly important for heart patients. Aerobic exercise refers to the use of large muscle groups rhythmically for prolonged periods – such as walking, jogging or biking. This sort of activity strengthens the heart and causes the veins and arteries to grow larger and more supple. After awhile, oxygen uptake improves, the heart demands less oxygen for a given level of activity, and blood pressure decreases. Furthermore, aerobic exercise increases HDL, decreases LDL, and reduces total body fat.

Strength training is also important because it increases your physical capacity to perform daily functions without putting undue stress on your heart. It is also essential to weight management, makes you look and feel better, protects against osteoporosis, controls the effects of aging, and provides all sorts of additional benefits.

Losing weight can be a difficult challenge, but exercise makes weight management dramatically easier.

EXERCISE AND ARTHRITIS

Exercise is an important component of health care management for people with arthritis. Extended abstinence from physical activity exacerbates the systemic and muscular-skeletal consequences of the disease. Proper exercise promotes optimum joint flexibility, muscle strength, endurance, coordination, and cardiovascular conditioning. Enhanced self-image and self-esteem may also result. To obtain these benefits, it is necessary to perform three different types of exercises:

Range of Motion Exercises: These exercises help maintain normal joint movement, relieve stiffness or restore flexibility and movement. Persons with arthritis should try to move each joint through its complete range of motion on a daily basis to prevent loss of motion and deformity and to minimize stiffness.

Strengthening Exercises: Weak muscles add to joint problems. Strong muscles stabilize joints and help cushion joint movement. Isometric or “muscle-setting” exercises are a safe and effective way of increasing muscle strength. They can be particularly helpful for people with painful joints because the muscle can be strengthened with very little actual joint movement.

Endurance Exercises: Other types of activity such as bicycling, walking and swimming are good for overall fitness and stamina. Persons with systemic forms of arthritis should get guidance on the appropriateness of these types of exercise from their physician or therapist.

EXERCISE AND ATHLETIC PERFORMANCE

Years ago, coaches thought that lifting weights would hurt speed, agility, and quickness. It is now commonly recognized that strength and conditioning programs are critical for maximum athletic performance. Every serious athlete¾ from Tiger Woods and Ray Lewis to Mia Hamm and Jennifer Capriati – strength trains.

But they all don’t do the same workout – for two very important reasons.

• Training should be sports specific. They participate in very different sports so they train very differently.
• Every program should be individually designed. They are unique individuals, who bring their own body types, exercise background, injury histories, and specific goals and objectives with them.

All athletes need strength and agility. But while football players require more strength and quickness, soccer and lacrosse players place a premium on endurance. Participants in cheerleading and gymnastics can particularly benefit from core training; and basketball and volleyball players need jumping ability. Every sport has its unique requirements.

How much progress can you expect? Anyone who has not been doing resistance training can probably increase their strength by 50% within three months and double their strength within a year. This sounds quite dramatic, but based on the results we get with our clients, especially younger clients, it is an easy statement for us to make.

What is the best way to get started? Sports medicine has made tremendous advances, especially in the last 10 years, and there is a lot of knowledge that is now available. Working with a personal trainer is clearly the best way to get started correctly. When you work with one of our trainers:

• You can be assured of a safe and effective workout based on proper technique. Improper mechanics can easily result in muscle imbalance and injury.
• We will keep you motivated and challenged.
• You will get all of your questions answered by a highly qualified professional.

EXERCISE AND OSTEOPOROSIS

Osteoporosis is a systemic disease characterized by low bone mass and deterioration of bone tissue that renders bone more susceptible to fracture. Bone loss throughout life is a normal consequence of aging, but some people are more predisposed to developing osteoporosis and sustaining associated fractures than others. Sex, race, heredity, age, exercise, medications, and tobacco and alcohol use, are all factors, but postmenopausal women are especially prone to developing the disease. Up to 30% of all postmenopausal women (an estimated 9.4 million in the United States) have osteoporosis, with another 54% (16.8 million) having osteopenia, or low bone mass.

The risk of osteoporotic fracture over a lifetime in 50-year-old women and men is estimated at 39.7% and 13.1%, respectively. The human costs, including loss of mobility and independence can be profound. Twenty-five percent of patients who fracture their hip require some degree of long-term care, and 50,000 deaths annually are attributed to hip fracture.

The good news about osteoporosis is that its progress can be slowed, and bone density can actually be increased. The most important step is to begin a regular program of weight-bearing exercise. Weight bearing means that the bones must be made to support a substantial amount of weight as you perform the movement. Swimming and cycling, for example, are not weight-bearing. Walking is weight bearing, and can be recommended to older patients, but does not appear to load the skeleton enough to be particularly effective unless combined with resistance training.

The loads placed on bones during exercise must be greater than, and preferably different from those experienced during normal daily activities. The effects of exercise are site specific. Only bones that are loaded will benefit from the activity. Running is great for the lower body, but does not effect the mass of upper body bones.

The best way to protect the entire skeleton is a balanced, all-round strength-training workout. That means performing 10 to 12 different exercises to bring into play all of the major areas of the body. Increase intensity as ability improves. Strengthening muscles also reduces the risk of falling by improving balance.

It is also important to get enough vitamin D and calcium (1,000 to 1,500 mg). Avoid smoking and excess consumption of caffeine and alcohol. If you are a post-menopausal woman, you may want to discuss estrogen with your physician.

EXERCISE AND HYPERTENSION

About 50 million American adults have hypertension, defined as systolic blood pressure greater than 140 and/or diastolic above 90. Hypertension is a leading risk factor for stroke, congestive heart failure, angina, renal failure, and heart attack in all ages and in both sexes. Even mild to moderate elevations in blood pressure dramatically increase risk.

Exercise reduces both systolic and diastolic blood pressure in hypertensives by 5 to 10 points. If your blood pressure is good, it helps you keep it that way. Even moderate exercise reduces the risk of dying from heart attack by 36% (based on a study of 17,000 Harvard alumni who walked for about 30 minutes daily). There are a number of ways in which exercise is thought to impact on blood pressure, but they all come down to the creation of a healthier heart and cardiovascular system.

1.       When the heart becomes stronger, it is able to pump more blood with each stroke.

1. Veins and arteries grow larger and more supple accommodating greater blood flow.
2. The lungs become more efficient.
3. The amount of hemoglobin increases allowing the blood to transport more oxygen.

Although drugs can reduce high blood pressure, they all have side effects, and some even have adverse effects. On the other hand, all the side effects of exercise are positive. Here are a few:

• Exercise reduces the risk of developing adult onset diabetes, and helps control diabetes if you already have it.
• Gastrointestinal transit time is decreased thus reducing the risk of colon cancer.
• If the exercise is weight bearing, the mineral density of the bones is increased.
• Cause better circulation improves the delivery of oxygen to the brain; mental capacity is improved, particularly as we age.

Important medical news now gets front-page coverage. As a result, you probably get the news at the same time as your doctor. This allows you to be a well-informed consumer of medical services. Take advantage of the opportunity. Learn, among other things, about the role of exercise and diet.

A regular check-up with your family physician can produce a great deal of useful data. We can give you quite a bit of information on your fitness status.

RESTING HEART RATE

Normal resting heart rates can be a very wide range of numbers, which is why this test is not so much a measurement of you compared to the norm, but more a measurement of yourself over time. Ranges vary anywhere from 40 beats per minute to 100 beats per minute. An ideal resting heart rate is between 60-90 beats per minute.

Average resting heart rate for me is 70 beats per minute, and 75 for women.

Keep in mind that an elevated resting heart rate might mean that you have not completely recovered from the most recent exercise session. If your resting heart rate is chronically high, and you are a regular vigorous exerciser, this could indicate that you are over-training, and you should see a doctor.

There are many factors that influence your resting heart rate, including stress, food, excitement, room temperature, and previous physical exertion. Therefore your resting heart rate should be taken while sitting quietly and not after participating in vigorous activity. If possible, you should sit quietly for at least 30 minutes before measuring it. Take it several times to make sure it is stable.

When sitting, your resting heart rate should not be changing as rapidly as it does after exercise, so you can count for either 10 seconds and multiply by 6, 30 seconds and multiply by 2, or count for the full minute.

Most highly trained endurance athletes have low resting heart rates. Most untrained subjects who participate regularly in a good aerobic fitness program will experience a decrease in their resting heart rates. Your score can, in very general terms, be evaluated as follows:

BLOOD PRESSURE LEVELS
Blood pressure is measured in millimeters of mercury (mm Hg). The classifications in the table below are for adults age 18 years and older, who are not taking antihypertensive (blood pressure-lowering) drugs and aren’t acutely ill.

Why is high blood pressure harmful?

High blood pressure makes your heart work harder than normal. Both the heart and arteries are then more prone to injury. High blood pressure increases the risk of heart attacks, strokes, kidney failure, eye damage, congestive heart failure and fatty buildups in arteries called atherosclerotic plaques. If you have high blood pressure, are obese, smoke, or have high blood cholesterol levels or diabetes, your risk of heart attack or stroke goes up several times.

If high blood pressure isn’t treated, your heart may have to work harder and harder to pump enough blood and oxygen to your body’s organs and tissues. A heart forced to work harder for a long time tends to enlarge and weaken. A slightly enlarged heart may work well, but one that’s enlarged a lot has a hard time doing its job.

High blood pressure also hurts arteries and arterioles, the very small arteries that connect larger arteries to the tiny capillaries. They eventually become scarred, hardened and less elastic.

For some people, all of the above will not be adequate to get their blood pressure where it needs to be. If that’s true for you, you’ll probably need to take medication. People with high blood pressure should also quit smoking because smoking greatly increases the risk of heart disease.

What factors increase a person’s risk of developing high blood pressure?

Medical science can’t explain what causes most cases of high blood pressure, so it’s hard to say how to prevent it. Several factors may contribute to it.

• Heredity. People whose parents have high blood pressure are more likely to develop it than those whose parents don’t.
• Race. African Americans are more likely to have high blood pressure than Caucasians are.
• Male sex. Men have a greater risk of high blood pressure than women until age 55, when their respective risks are similar. At age 75 and older, women are more likely to develop high blood pressure than men are.
• Increasing age. Blood pressure tends to increase with age, and older people are more likely to have high blood pressure.
• Sodium sensitivity.
• Obesity and overweight. If you are overweight, get down to where you should be. Blood pressure will normally drop with weight loss.
• Sedentary or inactive lifestyle. Physical inactivity is an independent risk factor for heart disease. So even if you are not overweight, get active or stay active. An inactive lifestyle also tends to contribute to obesity, a risk factor for both high blood pressure and heart disease. Regular physical activity helps control weight and lower blood pressure. Try to get at least 30 minutes of moderate to vigorous physical activity on most days.
• Heavy alcohol consumption. Experts recommend that drinkers limit themselves to no more than 1-2 drinks per day. . Since alcoholic drinks are high in non-nutritious calories, stay away from alcohol entirely if you’re trying to lose weight.
• Diabetes mellitus, gout and kidney disease. People with these conditions have a higher frequency of high blood pressure.
• Pregnancy. Use of some oral contraceptives and some other medications.

How does medicine help control high blood pressure?

Medicines called antihypertensives lower high blood pressure. Some, called diuretics or “water pills,” rid the body of excess fluids and sodium. Others, called beta blockers, reduce the heart rate and the heart’s output of blood.

Vasodilators (vas”o-di-LAT’orz) are another useful group of drugs. They can cause the muscle in blood vessel walls to relax, allowing the vessel to dilate (widen). They’re especially effective in the arterioles, the very small arteries that connect larger arteries to the tiny capillaries.

Other drugs for high blood pressure are: angiotensin converting enzyme (ACE) inhibitors, angiotensin II receptor blockers and calcium antagonists (calcium channel blockers). The ACE inhibitors interfere with the body’s production of angiotensin II, a chemical that causes the arteries to constrict. The angiotensin II receptor blockers block the effects of angiotensin II. The calcium antagonists can decrease the heart’s pumping strength and relax blood vessels.

In most cases these drugs lower blood pressure. Quite often, however, people respond very differently to them. That’s why most patients must go through a trial period to find out which medications work best for them, and have the fewest side effects.

CHOLESTEROL AND YOUR HEALTH

Cholesterol is a waxy fat that is present in all human beings. Two sources contribute to the amount of cholesterol in the human body. First, the liver manufactures about 80 percent of it. Second, people consume it by eating animal products such as meat, eggs and dairy products. Cholesterol is carried through the bloodstream by certain proteins (apolipoproteins). When these proteins wrap around cholesterol and other types of fats (lipids) to transport them through the bloodstream, the resulting “packages” are called lipoproteins

There are four different types of lipoproteins that carry cholesterol through the bloodstream: 1) High-Density lipoproteins(HDL) associated with “good” cholesterol, 2) Low-density lipoproteins (LDL) associated with “bad” cholesterol, 3) Very-low-density lipoproteins (VLDL), which are associated with “very bad” cholesterol, 4) Triglycerides which only carry a small percentage of cholesterol.

The National Cholesterol Education Program classifies total cholesterol levels as follows:

• Less than 200, desirable,
• Between 200 and 239, borderline to high,
• Over 240, High.

HDL levels:

• Below 40 – poor (High risk for Coronary Heart Disease)
• 40 to 60 – mid range
• Above 60 – good (Low risk for Coronary Heart Disease)

LDL levels:

• Below 100 – optimal
• 100-129 near optimal
• 130-159 border line high
• 160-189 high
• 190 or above – very high

Triclycerides:

• Below 150 – normal
• 150-199 – borderline high
• 200-499 – high
• 500 and above – very high

The cholesterol value in the human body can rise to abnormally high levels when someone eats a diet high in saturated fats or trans fats – especially when that person is obese and/or rarely exercises. High cholesterol levels can also be caused by a number of different genetic conditions.

An excessive amount of cholesterol in the blood is one of the greatest threats to someone’s health. Not only is it a major contributor to the development of blocked arteries, but it can also lead to a certain type of chest pain called angina, or even a heart attack. Research studies have concluded that for every 1 percent reduction in blood cholesterol level, the risk of coronary heart disease decreases by as much as 3 percent.

The total cholesterol equals HDLs + LDLs + 1/5 triglycerides. Another calculation gives the cholesterol ratio, which is the total cholesterol divided by the HDL level. The American Heart Association says that the level of total cholesterol should not be more than five times the level of good cholesterol. Ratios such as 4:1 or 3:1 are more desirable, and ratios such as 6:1 or 7:1 are less desirable. Furthermore, experts generally recommend that the level of HDL cholesterol should be at least 35 milligrams per deciliter, regardless of total cholesterol level.

Make good diet choices is your first line of defense when striving to improve cholesterol levels. Knowing which foods to avoid and which to include will not only improve your cholesterol levels, but will improve your overall health as well. Fat is an important component of a healthy diet. In addition to providing energy, dietary fat delivers essential nutrients such as fat-soluble vitamins and essential fatty acids. Fats and oils also add flavor and texture to the foods we eat, as well as increasing the feeling of fullness after a meal. However, make sure your diet is not too high in saturated fats, which can cause an increase in LDL levels.

Polyunsaturated and monounsaturated fatty acids (e.g., fish oils, olive oil) have been shown to have a protective effect on cardiovascular health, while unsaturated trans fats and saturated fats have been linked to higher risk of heart disease. In fact, blood low-density lipoproteins (LDL cholesterol) levels are more strongly linked to a person’s dietary intake of saturated fats and trans fats than how much cholesterol the person eats (e.g., from eggs). Therefore, it is important for people to watch out for “low cholesterol” or “no cholesterol” products that are high in saturated fats or trans fats, because they are still very dangerous to heart health.
The Food and Nutrition Board of the Institute of Medicine recommends that 25 to 35 percent of one’s daily calorie intake should come from fat. Saturated fats should be less than 10 percent of total daily calorie intake; polyunsaturated fats should be up to 10 percent of total calorie intake and monounsaturated fats up to 20 percent of total calories.

Trans fat should be limited as much as possible by avoiding foods prepared with partially hydrogenated vegetable oils. If you have heart disease or are at high risk for developing it, then saturated fat should be limited to less than 7 percent of total daily calories. In general, the best strategy for reducing one’s trans fat and saturated fat intake is to read food labels and eat a balanced heart-healthy diet.

In addition to the dietary strategies described above, as well as the strategies for reducing triglyceride levels, there are several other strategies that can help increase HDL cholesterol levels:

• QUIT SMOKING can dramatically increase HDL cholesterol levels.
• Start a regular exercise program.
• Drink alcohol only in moderation (no more than one serving daily for women, no more than two drinks daily for men). Moderate alcohol use may increase HDL cholesterol levels. Large quantities of alcohol, however, have the opposite effect and can cause damage to the heart muscle.

If diet and exercise strategies are unsuccessful in reducing levels of LDL cholesterol, then a cholesterol reducing drug may be prescribed.

Impact of Triglycerides on HDL

Research has shown a strong link between HDL cholesterol and a fat in the blood called triglycerides. If your triglyceride level is high, your HDL cholesterol level is probably low, and vice versa. Therefore, lowering your triglyceride level can help to improve your HDL cholesterol level.

The National Heart, Lung and Blood Institute classifies triglyceride levels as “normal” if they are below 150. Strategies for reducing triglyceride levels include the following:
• Decrease the amount of saturated fat in your diet.
• Eat a balanced, heart-healthy diet in which carbohydrates are eaten in proportion to proteins, vitamins and minerals, essential fatty acids and fiber.
• Use sugar only sparingly and limit alcohol use.
• Start a regular exercise program (see How to Exercise Safely).
• Achieve and maintain a healthy weight.
• Control diabetes.
• Control high blood pressure.
If these strategies are unsuccessful, a physician might prescribe nicotinic acid, certain Fibrates (e.g., fenofibrate) or other types of cholesterol-reducing drugs.

2. Make Your Training Sport Specific: Golfers need to strengthen all major muscle groups. Basketball is one of the most physically challenging sports. Tennis and racket-sports require agility and quickness. All sports require core strength. Work your abdominal, oblique, and erector muscles. Strong muscles around the knees, elbows and shoulders are also important for injury prevention.

3. Find a Workout Buddy: It is always more fun to exercise with someone else. If you know your buddy is going to be there, you are much more likely to stick to your plan. A personal trainer can be the best kind of workout buddy. He or she never looks for a reason to skip a workout, knows all the latest stuff, makes sure you are getting the most out of your workouts, and is an expert motivator.

4. Take Measurements of Yourself: Measure your arms, chest, waist, hips, thighs – whatever you consider problems areas. Then retake those measurements once every four weeks.

5. Set Goals: Establish reasonable short and long-term goals, then give yourself a reward if you reach them (don’t make it a hot fudge sundae). Make the goals realistic. Perhaps associate them with an event like a fun run, ski trip, or vacation at the beach. A personal trainer will help with goal-setting, so give us a call!

-Alex Leif, MD, professor at the Harvard Medical School of Gerontology

While aerobic exercise is essential to health and fitness, if it is all you are doing, then you are only halfway home. It is also essential that you strength train. Most of the research on the benefits of strength training is recent and not as widely-accepted as the benefits of aerobic training, but the data is quite compelling. Even for weight management, strength training is now considered just as important as aerobic work.

1. Increases Physical Capacity to Perform Daily Functions - Nothing helps you lift the groceries, play with the grandchildren, and generally do all the things in life that you want to do like strength training. If you have not been strength training, and you apply yourself for three months, you will generally gain at least 50% in strength. After one year, you might easily be twice as strong as when you started.

2. Essential to Weight Management - Without strength training, adults lose about a half-pound of muscle per year after the age of 25. This muscle is typically replaced by fat, and fat burns virtually no calories. This makes weight management increasingly difficult. The way to turn the situation around is to gain muscle, thereby increasing metabolic rate. New strength trainers normally lose 4 pounds of fat in three months while at the same time packing on 3 pounds of lean muscle. That 3 pounds of muscle will burn about 150 more calories every day even if you do not perform any exercise at all.

3. Makes You Look and Feel Better - Strength training makes you feel stronger and look better because as your muscles strengthen they gain size and shape, which gives your body the line, proportion and definition that everyone wants. Since muscle weighs more than fat, even if you don’t lose weight, your body proportions will change. You will wear a smaller dress size; your pants will be looser. Within weeks, you will feel the difference, and your friends will notice the difference. Only progressive resistance exercise can do this for you.

4. Improves Athletic Performance - In the 1950s, even football players were discouraged from lifting weights, for fear of injury. Today, all serious athletes strength train, which has resulte in dramatic improvements in performance. The last to be converted were golfers, who thought that the delicacy of controls their game requires, would be disturbed by bigger muscles. Now the PGA’s fitness trailers are overflowing. If you want longer drives, more snap in your serve, more lift on your jumper, you’ve got to strength train. Ask us about exercise programs specially designed for your sport. When combined with a stretching program, strength training will also greatly reduce the likelihood of injury.

5. Has a Positive Impact on Virtually Any Medical Condition - Doctors now recommend exercise for everyone from cancer patients to 10 year olds. Strength training reduces lower back pain, reduces arthritis pain, increases gastrointestinal transit time thereby reducing the risk of colon cancer, reduces resting blood pressure, and some studies even show an improvement in lipid profiles.

6. Controls the Effects of Aging –

“Strength training can make a 95 year old as strong as a 50 year old person, and a 64 year old as physically fit as a healthy 30 year old.”

- Dr. Evans, Tufts University

“Exercise is the most powerful thing you can do to ensure an independent, healthy life.”

-Dr. Walter Ettinger M.D, co-author of Fitness After 50

7. Promotes a Sense of Psychological Wellbeing - Exercise increases the production of endorphins and other chemicals in the brain that make us feel better. Strength training has the added advantage of increasing blood flow to the muscles in a way that makes us feel “pumped” ¾ both physically and emotionally. You will feel a sense that you are doing something good for yourself.

8. Builds and Maintains Healthy Muscles and Joints - As your muscles strengthen, the tendons, ligaments and other connective tissue also strengthen. One result of this process is reduced risk of injury while participating in sports or everyday activities. If you participate in a regular strength-training program for one year, you are apt to be about twice as strong as when you started. You can do things with one hand that previously required two!

9. Helps Control Diabetes - Strength training reduces the risk of developing adult onset diabetes, and helps control diabetes if you already have it. A recent National Institute of Health study showed that diets and exercise lowers the risk of diabetes by 58% for people on the cusp of developing the common but deadly illness. The American Diabetes Association says that resistance training is critical to improving glucose clearance. After 4 months of strength training, glucose metabolism improves by about 23%.

10. Protects Against Osteoporosis - Post-menopausal women are especially prone to the loss of bone mineral density. Weight bearing exercise, along with a balanced strength training workout for the entire body can not only prevent osteoporosis but actually increase bone density. One study showed a 13% increase in bone mineral density after only four months of strength training. It is also important to get enough calcium, avoid smoking and consuming excess amounts of caffeine and alcohol to protect against osteoporosis.

After age 20 or so, the body’s natural secretion of human growth hormone declines by about 14% each decade. Synthetic forms of HGH may some day be available, but you can get many of the age-reversing benefits of HGH by stimulating your own hormonal levels naturally through exercise. One study showed that moderate to vigorous aerobic exercise could increase growth hormones 150-250%, while high-intensity weight training can increase levels three to four times.

These physiological changes lead directly to important health benefits:
• The risk of dying from a heart attack is reduced by 36%. This is based on a study of 17,000 Harvard alumni who were at least moderately active (meaning that they walked for about 30 minutes daily). The same study showed that the risk of dying prematurely from all causes is reduced by 22%.
• Exercise reduces blood pressure in hypertensives by 5 to10 points – both systolic and diastolic. If your blood pressure is already good, it helps you keeps it that way.
• It is possible to exercise for a longer period without tiring when one’s aerobic threshold is higher. This results in better performance when engaged in sports and recreational activities and generally higher energy levels throughout the day.

There are many secondary benefits as well, and new ones are found almost daily. Some flow directly from the above changes, while others appear to be independent and in many cases were totally unanticipated:
• Exercise causes the release of endorphins and other chemicals in the brain that lead to an increase in one’s sense of wellbeing. Feelings of depression and anxiety are reduced.
• Regular exercise can lead to a modest reduction in total cholesterol, but more importantly, vigorous exercise leads to a rise in high density lipoprotein (HDL) or “good” cholesterol that collects the harmful low density lipoprotein (LDL) from the arteries and transports it to the liver for removal from the body.
• Exercise reduces the risk of developing adult-onset diabetes, and helps control diabetes if you already have it.
• Gastro-intestinal transit time is decreased by 56%, thus reducing the risk of colon cancer.
• Weight-training increases mineral density of bones.
• Regular exercise improves the body’s handling of excess heat as well as its resistance to cold.
• Because better circulation improves the delivery of oxygen to the brain, mental capacity is improved, particularly as we age.

Aerobic exercise is essential to weight management. Over 90% of successful dieters exercise. Here’s why:
• Aerobic activity directly burns calories.
• By increasing your metabolic rate, exercise enables your body to burn additional calories even when you are at rest.
• Hunger is masked when you exercise.
• Exercise causes fat deposits to release fatty acids more readily, and increases the production of fat burning enzymes.
• When you lose weight as a result of exercising, a higher percentage of the weight lost will be from fat, not lean tissue.

Physical activity is a gateway behavior. When people become active, they eat better, reduce substance abuse, and take better overall care of themselves. Mental outlook improves. Morale improves. Physical activity is the easiest way to kick off a kind of virtuous cycle that can be initiated in very gradual steps. Now is the time to start.

“Given the numerous health benefits of physical activity, the hazards of being inactive are clear. Physical inactivity is a serious, nationwide problem. Its scope poses a public health challenge for reducing that national burden of unnecessary illness and premature death.”

-The Surgeon General
If you begin slowly, taking up an exercise program is not “painful,” but rather a pleasure. The idea is to improve your health and enjoy the process at the same time.

One, since most calories are burned while you’re at rest, it is important to increase your basic metabolism rate by building muscle mass. This is done through strength training. Fat tissue burns virtually no calories. If, for example, you can increase the body’s muscle mass by 10%, the number of calories burned in a day is automatically increased by 10% as well – whether you are exercising or watching television. Every pound of muscle burns 35-50 calories per day. Don’t worry about putting on too much muscle – very few people, especially women, have enough testosterone in their body to make this an issue.

Two, aerobic exercise allows you to directly burn a substantial number of calories. Aerobic exercise refers to the rhythmic use of large muscle groups as required by activities such as walking, swimming, or biking. It takes a deficit of 3,500 calories to lose one pound. That means you must either eat 3,500 fewer calories or burn 3,500 more calories through exercise. The best strategy is a combination of the two approaches. If you goal is to lose a pound a week, expending 250 calories a day through exercise, while reducing food intake by 250 calories a day below maintenance level should work well.

Three, the severe dieting required to lose weight without exercise is likely to drive down your metabolic rate, making it increasingly difficult to reach your goals. The body responds to a severe lack of food by slowing downs its processes to survival mode. Metabolism can drop by 10 or even 20%. If this occurs, you have to slash your calorie intake by 20% just to stay at the same weight. This can make weight loss virtually impossible. Furthermore, the average adult loses at least ½ lb. of lean muscle mass per year if they are not engaged in resistance strength training so every decade, the average sedentary adult loses at least 2-1/2 lbs. of lean muscle mass. Additionally, when we don’t exercise, we lose muscle tone, strength and overall fitness which makes activities that used to be easy suddenly become harder. Also, the body’s ability to metabolize sugars and fats diminishes with lack of exercise. This results in blood sugar fluctuations, which negatively affect the body’s fat burning capabilities. What is the answer? First, don’t cut calories more than 500 per day below maintenance level (250 a day is better), and secondly, you must exercise. Exercise, both strength training and aerobics, is you’re best strategy for keeping metabolism as high as possible and minimize or reverse the affects of aging.

Effective weight management requires an overall lifestyle approach. Exercise and a healthy diet are fundamental. Eat a hearty breakfast to get your metabolism cranked up for the day. Drink eight glasses of water. And remember all the ‘side effects’ of exercise are positive – it is the best single thing you can do for your health.

Personal trainers are not a luxury; they are a great investment in your health and well-being! Ask any fitness expert and their answer is always the same; the best way to get started on an exercise program is to get a personal trainer. Trainers work intensively with individual clients to design the exercise program best suited to that client’s needs and objectives – then supervises every workout to assure maximum effectiveness and efficiency. Workouts are fun and safe; leaving you feeling exhilarated, not exhausted.

• New exercisers get a fitness program tailored to their precise needs and desires, assuring progress without exhaustion. You’ll learn the safest and most effective way to perform each movement.
• Exercisers with medical conditions get a program coordinated with their doctor or physical therapist. Our trainers are experienced in dealing with a wide range of exercise limitations.
• Need help sticking to a program? Trainers make workouts fun. They make the best of all workout partners. They work around your schedule – and they never look for excuses to skip a workout. They motivate, encourage, and keep routines fresh.
• Not making any progress? Our trainers know all the tricks for getting you to that next level. They know all the best exercises and newest techniques.

Exercise benefits everyone – young or old, thin or heavy, whatever their state of health.

Personal Training Associates works one-on-one with their clients, either in their homes or in one of our semi-private studios, to recommend exercise programs and to assist in their execution. We begin by asking a series of questions about your health and fitness background, develop an appropriate set of goals with you, and then design the best exercise program for getting you where you need to go. We will teach the precise method for performing each exercise, and for gauging the proper level of intensity. The goal is to integrate safe, efficient, exercise into your daily routine, so that you can get the benefits of being active for the rest of your life. Our first consultation is free of charge or any obligation. Call 703-347-4269 if you have any questions, or to schedule your first session.

Exercise is essential to losing weight, and can help treat cardiovascular disease, diabetes, osteoporosis, hypertension and most any other condition. Even when serious surgery is required, physicians recommend strength training to improve post-op recovery. Even if you don’t have any of these conditions, regular exercise and strength training are essential to living and maintaining a good life, especially if you are an athlete.

*There is only one person who is ultimately responsible for your health¾ and that is you. Only you can decide what priority you give to your health, which doctors to see, whose advice you follow, and in the end, what actions you take.