100 Push-Ups (New Year's Resolution #1)

If you want to be able to do 100 pushups in a row, do not try to do as many pushups as possible every day. You'll probably injure yourself and end up unable to do any pushups at all. Training for competition requires an understanding of the stress-and-recover rule and the interval-sets rule.

The best way to improve any athletic skill is to stress your body on one day and then allow enough time for your body to recover before you stress it again. On one day, take a hard workout. On the next morning, your muscles feel sore. Take easy workouts until the soreness disappears and then take a hard workout again.

For your hard workouts, you can do far more work by exercising in sets, rather than continuously. If you can do six continuous pushups, you can probably do ten sets of two with twenty-second rests between each set. Do repeat sets of two until your muscles feel sore. Try to take workouts that are hard enough to make your muscles feel sore for no more than 48 hours. An ideal training program would consist of sets of three until you feel sore on the first day, take off the second day, do sets of five on the third day until you feel soreness, and rest on the fourth day. Repeat these four-day cycles, and you'll soon be ready to compete.

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Gain weight every year? You're not alone!

Most people become fatter with aging because they are less active, not because they eat more. Thirty minutes of exercise a day may be enough for heart fitness, but it is not usually enough to lose or maintain weight. Our grandparents doing heavy manual labor were active for 8, 10 or more hours every day. If you have a sedentary job, you need an exercise strategy that includes very vigorous exercise, more time spent in physical activity, or (preferably) both. Researchers from the University of South Carolina showed that the increase in body fat that accompanies aging can be completely prevented with prolonged vigorous exercise (Medicine & Science in Sports & Exercise, August 2005.) The authors studied 60 thousand male runners and found that the more miles they ran, the thinner they remained. Waist circumference increased with age at all running distances, but the increase diminished in the men who ran further.

This tells us that you must increase your physical activity with age to prevent weight gain. Your chances for success will improve if you find an activity you enjoy enough to do it for several hours at a time, such as dancing, fast walking, rowing or cycling. Then make your sport a regular part of your social life, not just an exercise chore. (You'll get weekly tips in my free newsletter on fitness and health.)

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Blood pressure drugs: which are best for exercisers?

Several studies show that the drugs of choice to treat high blood pressure for most North Americans are calcium channel blockers and angiotensin II receptor antagonists.

For many years the American Heart Association recommended beta blockers and diuretics as first-line treatment for people with high blood pressure. Beta blockers can cause impotence, tiredness at rest and during exercise, weight gain, and they increase risk for diabetes. Diuretics make you tired. Furthermore, a study from Sweden shows that beta blockers increase risk of strokes. There is no data to show they prevent heart attacks in healthy people.

To help you understand blood pressure, read
Systolic/diastolic (which is more important) and Why blood pressure rises with age

Other studies have recommended different combinations and the combination with the fewest side effects includes a calcium channel blocker and angiotensin II receptor antagonists. Long-acting calcium channel blockers relax blood vessels, while angiotensin II receptor antagonists block a blood vessel-constricting hormone released by the kidneys.

If you suffer from high blood pressure, go on the DASH diet and start an exercise program to help you lose weight. If that doesn't reduce your blood pressure to normal, I think that the drugs of choice are angiotensin II receptor antagonists. If your blood pressure is still high, add a calcium channel blocker.

BETA BLOCKERS: Betapace, Blocadren, Brevibloc, Cartrol, Inderal, Kerlone, Levatol, Lopressor, Sectral, Tenormin, Toprol, Zebeta.
ANGIOTENSIN II RECEPTOR ANTAGONISTS: Atacand, Avapro, Cozaar, Diovan.
CALCIUM CHANNEL BLOCKERS: Adalat, Calan, Cardizem, Covera, Dilacor, DynaCirc, Isoptin, Nimotop Norvasc, Plendil, Procardia, Sular, Tiazac, Vascor, Verelan
ALPHA BLOCKERS: Cardura, Dibenzyline, Hytrin, Minipres.

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Lactic acid helps muscles

You exercise so intensely that your muscles burn and you gasp for breath. Then you slow down for a minute or two, catch your breath, and then go very fast again. This training technique has been used in all endurance sports since the 1920's. Now George Brooks of the University of California at Berkeley has shown why interval training makes you a better athlete (American Journal of Physiology-Endocrinology and Metabolism, June 2006).

Inside each muscle cell are mitochondria, the little furnaces that burn fuel for energy. A major fuel for your muscles during exercise is the sugar, glucose. In a series of chemical reactions, glucose is broken down step by step, with each step releasing energy. When enough oxygen is available, the glucose releases all of its energy until only carbon dioxide and water remain; these are blown off through your lungs. However, if not enough oxygen is available, the chemical reactions stop at lactic acid which accumulates in the muscles and spills over into the bloodstream. Lactic acid makes muscles acidic and causes a burning feeling. This recent research shows that lactic acid is the most efficient source of energy for muscles. Anything that helps muscles to break down lactic acid faster will make you a better athlete because it will increase your endurance and allow you to move faster when you are tired. More

Since lactic acid is burned for energy in the mitochondria, anything that enlarges the mitochondria builds a bigger furnace and helps to increase endurance. Lactic acid is carried from the cells into the mitochondria by special proteins called lactate transporter molecules, so anything that increases these molecules will build endurance. An enzyme called lactic acid dehydrogenase is needed to start the reaction, so anything that increases this enzyme will also help. Interval training does all three: it enlarges the furnace (mitochondria), increases lactic acid transporter molecules, and increases the amount of lactic acid dehydrogenase.

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Interval Training

To become stronger and faster, athletes use a technique called interval training, in which they exercise very intensely, rest and then alternate intense bursts of exercise and rest until their muscles start to feel heavy. Intervals are a fixed number of repeats of a fixed distance at a fixed pace with a fixed recovery time. There are two types of intervals: long and short. A short interval takes less than 30 seconds and does not build up significant amounts of lactic acid in the bloodstream, so an athlete can do lots of repeat short intervals in a single workout.

Long intervals take two minutes or more and are very tiring. In interval training, a runner may run a quarter mile 12 times, averaging 1 minute, with a 110-yard slow jog between each. A weightlifter may lift a heavy weight ten times in a row and then repeat another set of ten. Runners run intervals as fast as they can and recover enough to run the same fast pace several times. Runners need very short recoveries between intervals, usually only about 30 seconds; but weight lifters need much longer recoveries, at least two and a half minutes. Runners become short of breath and feel a burning in their muscles when lactic acid starts to accumulate in muscles, but it takes only a few seconds for a trained athlete to recover between each hard run. On the other hand, weight lifters feel burning caused by tearing of the muscle fibers and it takes a much longer time for the pain to disappear so they can lift very heavy weights again.

You can apply the concept of interval training to your program at any level of fitness. When you start a new exercise program, exercise for 30 seconds, stop for 30-60 seconds, longer if you need it. Alternate exercising and resting until you feel tired or your muscles feel heavy. Then stop for the day. The stronger you get in your sport, the more intense your intervals can become. You work at your maximum capacity for 30-60 seconds, then take 60-90 seconds to recover, then go very hard for another 30-60 seconds. Do this vigorous interval workout once a week until you get tired. At first you may only be able to do two or three intervals, but your muscles get stronger and you build up the number of intervals you can complete. Go easy the next day or take a day off if you feel any discomfort.

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Are You Fit?

The latest research shows that exercising for 30 minutes three times a week will not necessarily make you fit, nor does exercising for 60 minutes seven days a week. To become fit, you have to make your heart and skeletal muscles stronger. Exercising at a casual pace does not strengthen muscles. This means that going out and jogging slowly so that your leg muscles are always comfortable and do not burn will not make you fit. Lifting a weight ten times in a row and not feeling a burn in your muscles will not make you significantly stronger.

When you exercise intensely, your muscles stretch and tear. It's the tearing that causes the burning during exercise, and leads to the soreness that you feel for the next day or two. When your muscles heal from these tears, they are stronger than they were before. So it's the burning during exercise that causes the tearing that causes the next-day soreness. Then you take days off or go slowly so you can recover; your muscles heal, which gets rid of the soreness, and with healing, the muscle is stronger than it was before you did the exercise.

However, there are some serious problems with training for real fitness. If the force on your muscles during exercise is greater than the strength of your muscles, they will tear too much and you will be injured. If your muscles are still sore from a previous workout and you try to exercise intensely, you can cause a serious injury. You must learn to tell whether the burning is the good burning that causes muscle growth or the bad burning in which you put too much force on your muscles and tear them so you can't exercise at all.

The program I recommend for fitness applies only to healthy people. It could cause heart attacks in people with damaged hearts. Before trying this, check with your doctor. The rules for fitness are that you should spend several months exercising at a casual pace and not going for the burn. After a few months, you should be able to exercise 30 minutes every day and not feel sore. Then you are ready to start training.

If you are a runner or a biker, go out and run or ride very fast until your legs burn, slow down until the burning goes away. Then when your muscles feel fresh again, pick up the pace. When your legs start to stiffen, stop the workout. On the next day, either do nothing or go slowly and do not try to do another intense workout until your muscles feel fresh. Then when your muscles feel fresh, you take another hard workout. Remember, trying to exercise intensely on sore muscles will only injure you.

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Run faster!

If you don't run very fast in practice, you won't be able to run very fast in races.

At the University of Copenhagen, Danish scientists studied experienced runners who had been running 60 miles a week at a fast pace. One group was told to cut their mileage in half to only 30 miles a week, but to run a series of around 50 to 100 yard dashes as fast as they could. The other group continued running 60 miles a week at a fast pace. Runners who ran fewer miles at a faster pace had a 7 percent improvement in their body's maximal ability to take in and use oxygen.

Runners who did not increase their speed in practice did not improve, even though they ran twice as many miles. Jogging slowly reduces your chance of injury, but it won't help you to run fast. You can race only as fast as you run in practice, but don't try to run fast every day. Intense exercise damages muscles. Try to run fast once or twice a week, never on consecutive days and don't run fast when your legs feel heavy or hurt.

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Warm up your heart

Most people know that you have to warm up skeletal muscles to help protect them from injury, but many do not know that warming up the heart muscle also helps to prevent heart attacks in people with blocked arteries leading to the heart

Before you try to run very fast, you can protect your muscles from injury by performing a series of runs of gradually-increasing intensity to increase the circulation of blood to your muscles. The same principle applies to the heart. Angina is a condition in which the blood vessels leading to the heart are partially blocked so the person has no pain at rest, but during exercise, the blocked arteries don't permit enough blood to get through to the heart muscles, causing pain. A study from the Quebec Heart Institute shows that exercising very slowly before a person with angina picks up the pace allows him to exercise more intensely before he feels heart pain.

If you have any suspicion of heart problems, always check with your doctor before you begin an exercise program or increase the intensity of your existing program.

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Low testosterone - high cholesterol

A study from Italy shows that men with high blood pressure have low blood levels of the male hormone, testosterone, and make love much less often than men with normal blood pressure.

How can this be? The male hormone, testosterone, was thought to raise cholesterol, stiffen arteries, and increase risk for heart attacks. But this applied only to the methyl testosterone that athletes used to take, not the testosterone produced by the body.

Having high cholesterol, pre-diabetes or high blood pressure causes hardening of the arteries, which decreases blood flow to the testicles to damage the testicles and lower testosterone. High blood pressure and high cholesterol lower testosterone, so men with low testosterone are at increased risk for heart attacks. That means that every impotent man should have blood tests for cholesterol and diabetes, the two leading causes of heart attacks as well as impotence. The tests your doctor should order include HBA1C, lipid panel, C-Reactive Protein (CRP), homocysteine, Lp(a), prolactin and testosterone. By the time a man has low levels of testosterone, he may already have significant arteriosclerosis.

Journal references
More in the Heart Health section of DrMirkin.com
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Fruit juices: better than soft drinks?

Researchers at the University of Houston reviewed scientific studies to explain why sugared drinks make people fat. (Nutrition Review, April 2006) and concluded that sugared drinks do not fill people up as much as solid food does. So calories in drinks do not suppress appetite as effectively as calories in food. Soft drinks average seven teaspoons of sugar per 12-ounce serving, so for each soft drink a child takes in, he gets 140 calories that do not suppress appetite as much as the same number of calories in solid food.

Since fruit juices contain as much sugar and calories as soft drinks, it makes no sense to substitute juices for soft drinks. It’s far better to learn to drink water to quench thirst, and get calories, vitamins and other nutrients from solid foods. One way to get overweight children to take in fewer calories is to serve them sparkling mineral water or soda water, which has carbon dioxide bubbles and no calories. To many people, this bubbly water is more refreshing and tasty than ordinary water.

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Wrinkles: Can they be prevented?

Unfortunately, there may not be much you can do; a study from Denmark shows that skin wrinkling and aging are influenced heavily by genetic factors (Age and Aging, January 2006). However, this doesn’t mean that you can smoke or spend many hours in the sun, two behaviors that are known to increase wrinkling. The authors studied twins to show that skin aging is associated equally between genetic and environmental factors. They also found that looking older with severely wrinkled skin is associated with dying earlier. You increase your chances of having aged, wrinkled skin by smoking, exposing your skin frequently to sunlight or being very thin.

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Itching, can't see anything?

Itching can be caused by nerve damage associated with diabetes or lack of vitamin B12, skin diseases, an allergy to something touching the skin or inside your body or a hidden tumor or infection. See my report on neuropathy. Often doctors cannot find the cause.

When more than one person in a family itches, the usually cause is scabies, a disease caused by a parasite that burrows into your skin. You usually cannot see the bug that causes scabies. Sometimes the only way that you can see it is in a piece of skin that has been removed from the body and has been placed under a microscope. You may see little bumps between your fingers, in your armpits and groin, at your belt line or on your back or chest. You also may see three or more bumps in a line. The most common treatment is to cover the entire body for 12 hours with a prescription cream containing permethrin. If you still have itching, your doctor may prescribe a single pill called Ivermectin. Check with your doctor.

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Increase endurance with low-glycemic meal

The Glycemic Index measures how high blood sugar levels rise 30 to 120 minutes after eating a particular food or combination of foods. A study from Loughborough University in England shows that athletes in sports events lasting more than a couple hours may benefit from a pre-competition meal that has a low glycemic index (American Journal of Clinical Nutrition, August 2006).

How long you can exercise a muscle without hurting depends on how much sugar you can store in that muscle and how long you can keep that sugar in the muscle during competition. Just about everyone agrees that taking extra carbohydrates for two or there days prior to an endurance competition can help fill your muscles maximally with stored sugar and therefore increase endurance. A well-trained athlete can also fill his muscles maximally with sugar just by cutting back on workouts for a few days prior to competition, no matter what he eats.

Since it takes up to 24 hours to fill your muscles maximally with sugar, the pre-race meal is not used for that purpose. This new study showed that a low-glycemic index meal taken three hours prior to competition may help an athlete to exercise longer by causing muscles to use more fat, and less sugar, for energy. While nobody really knows why, the most likely explanation is that when blood sugar levels rise too high, the pancreas releases huge amounts of insulin. Insulin drives sugar into cells and causes cells to burn more sugar. This uses up sugar more quickly. On the other hand, the low-glycemic meal does not cause a high rise in insulin, so muscle burn more fat, preserve their stored sugar supply and can be exercised longer. More on the Glycemic Index

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High blood pressure during exercise: dangerous?

People with normal resting blood pressures who develop very high blood pressure during exercise are the ones most likely to develop high blood pressure later on. These people have arteries that do not expand as much as normal arteries when blood is pumped to them. When your heart beats, it squeezes blood from inside its chambers to the large arteries. This causes normal arteries to expand like balloons. If the arteries do not expand enough when blood enters them, blood pressure can rise very high.

Normal blood pressure is 120 when the heart contracts and 80 when it relaxes. During exercise, the heart beats with increased force to raise blood pressure. It is normal for blood pressure to rise up to 200 over 80 during running, and to 300 over 200 while doing a leg press with very heavy weights. If your blood pressure rises much above 200 during running, you are at increased risk for developing high blood pressure. You should go on a heart attack prevention program that includes a diet low in saturated fats and refined carbohydrates, regular exercise, losing weight if you are overweight, not smoking, and avoiding stimulants and drugs that raise blood pressure. Check with your doctor.

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Creatine: Will it prevent muscle loss with aging?

Each muscle has millions of muscle fibers, and each muscle fiber is enervated by a single nerve. With aging, you lose nerves and with loss of each motor nerve, you lose the corresponding muscle fiber. So the treatment of muscle weakness with aging is to increase the size and strength of each remaining active muscle fibers. You do this only by exercising against increasing resistance.

Creatine will do nothing to stop the progressive loss of nerves that decreases the number of active muscle fibers. However, it can help you to exercise harder and longer, so it may help you to do the intense workouts that will build larger and stronger muscles. At this time we do not know whether there are any deleterious side effects in older people from taking creatine, so I cannot recommend it.

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Creatine can help to strengthen muscles, but athletes who take these supplements need to know how much they can take safely before they harm themselves. When you exercise and your muscles get as much oxygen as they need, they burn carbohydrates, fats and protein for energy. When you exercise so intensely that you cannot get all the oxygen you need, your muscles use creatine and ATP. So when you exercise so intensely that you can't get enough oxygen, you can delay fatigue by taking creatine and it allows you to do more work, which makes you stronger.

The body of a 160 pound man contains 120 grams of creatine and he takes in and uses about two grams a day. No good studies have been done to show what amounts are safe to take beyond what your own body makes, so let the buyer beware. Creatine may allow you to lift more weights and make you stronger, but it may harm you. Taking too much creatine can cause weight gain, increased insulin production and possibly kidney damage. High levels of insulin constrict arteries to cause heart attacks and affect the brain and liver to make you fat. The chemical process of extracting creatine in the laboratory forms toxic contaminants called dicyandiamide and dihydrotriazines, that have to be removed before humans can take them safely. The industry that distributes creatine is unregulated and you have no way to know what you are actually buying.

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Cold hands

If your fingers turn white and start to hurt when you're out in the cold, you may have a condition called Raynaud's phenomenon. On exposing your fingers to cold, the blood vessels close, skin turns white and their temperature drops. When the temperature drops to 59 degrees, your body tries to save your skin by opening the blood vessels and the skin turns red and starts to itch and burn. If you warm your hands at this point, your skin will not be damaged, but if you do not get out of the cold, the blood vessels in your hands can close and the temperature in your hands can drop to freezing, resulting in frostbite.

People who have Raynaud's phenomenon have blood vessels in their hands that do not open when the skin temperature reaches 59 degrees. Several diseases, smoking and using vibrating equipment can cause Raynaud's phenomenon.

Wear two or more layers of gloves and mittens. When your fingers feel cold, swing your arms very rapidly about your shoulder with your elbow straight. This will drive blood, like a centrifuge, into your fingers and warm them. The blood pressure drugs called calcium channel blockers, such as Nifidipine, can help to treat and prevent Raynaud’s phenomenon (Rheumatology, November 2005). Another option is nitroglycerin ointment that is used to treat angina. When applied to the forearm, it opens blood vessels leading to the hands. Check with your doctor to see if these prescription medications would be appropriate for you.

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Master athletes age better

Almost 50 percent of Americans die of heart attacks and strokes, diseases that are associated with a faulty diet and lack of exercise. Almost 80 percent are overweight or obese, which is also associated with lack of exercise. Yet only 13 percent of people over 65 engage in vigorous physical activity three or more days a week. Among those over 75, only six percent exercise regularly.

Master athletes are older men and women who compete in sports at a very high level, no matter how old they are. They are healthier than age-matched people in virtually every category that has been measured (Nutrition Today, Volume 40, 2006). Of course they are more fit, as measured by their maximal ability to take in and use oxygen. They have lower cholesterols, comparable to those of people in their twenties. They have lower glucose tolerance and HBA1C screening tests for diabetes. They have lower waist-to-hip ratios, decreasing their risk for metabolic syndrome and diabetes. They have far less body fat.

Many people who have never exercised are afraid to start an exercise program. They should check with their doctors and get a special exercise stress test. If they pass the test, they are at low risk for complications during exercise. Then they should join an organized exercise program. One study showed that 85 percent of middle aged Americans who start an exercise program quit in the first six weeks. Those most likely to remain exercised with a spouse or friend, used a personal trainer, or participated in classes such as aerobic dancing or spinning. Successful lifelong exercisers usually make their sports part of their social life, not just a tedious chore.

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Why do athletes use asthma inhalers?

Drugs called beta-2 agonists, such as salbutamol, salmeterol and terbutaline, open the closed lungs of asthmatics and help them to breathe. They also increase the amount of fat in the bloodstream to increase energy sources of exercising muscles, help to preserve the muscles’ store of sugar, and help muscles to contract with more force. The common inhaled asthma medication called albuterol has been shown to improve athletic performance.

These asthma medications are potent stimulants, so they could cause irregular heart beats. It is illegal for Olympic competitors to take albuterol pills. However, asthmatics need their medications, so the Olympic medical committee allows asthmatics to take these same medications by inhaler, provided that a doctor informs the Olympic committee beforehand that the athlete is an asthmatic and is taking this medication. Needless to say, there are unprecedented numbers of asthmatics registered with the Olympic committee and other authorities in sports that monitor drug use.

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Exercise prevents diabetes

A recent study shows that lack of exercise is a major risk factor for diabetes in overweight women, and these women can help prevent diabetes by exercising, even if they don’t lose a lot of weight. Before insulin can do its job of driving sugar from your bloodstream into cells, it must first attach to small hooks on cells called insulin receptors. Having extra fat in your body prevents insulin from attaching to these receptors, and prevents insulin from lowering blood sugar levels. Therefore the cells of overweight women cannot respond to insulin as well as those of their leaner counterparts. Researchers at the University of Massachusetts in Amherst showed that overweight women who engage in vigorous exercise can respond to insulin as well as leaner fit women (Medicine and Science in Sports and Exercise, October 2006). Thirty-five percent of North Americans will become diabetic, and staying in shape may be an even better way to prevent diabetes than controlling weight.

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Caffeine increases endurance

Caffeinated drinks increase endurance during long events such as a marathon, triathalon or bicycle race. A study from the University of Birmingham in England shows that caffeine helps the body use more carbohydrates from drinks that you take during exercise (Journal of Applied Physiology, June 2006). Those who took sugared drinks with caffeine were able to absorb and use 26 percent more of the ingested sugar than those who took the same drinks without caffeine.

Previous studies show that caffeine helps athletes run faster in both short and long-distance races. In short races, it makes athletes faster by causing the brain to send messages along nerves to cause a greater percentage of muscle fibers to contract at the same time. In longer races, it delays fatigue by preserving stored muscle sugar. Muscles get their energy from sugar and fat in the bloodstream, and from sugar, fat and protein stored in the muscles. When muscles run out of their stored sugar, they hurt and become more difficult to coordinate. Caffeine causes muscles to burn more fat, thus sparing stored muscle sugar to delay fatigue.

Nobody really knows how much caffeine you can take in without harming yourself. At rest, caffeine is a diuretic, but during exercise it does not increase urination. Caffeine is a potent stimulant that can cause irregular heartbeats in people who already have heart disease, and raise blood pressure in people with hypertension. Most research shows that it doesn't take much more than one or two soft drinks to increase endurance. Caffeine loses its beneficial effects with repeated exposure, so athletes who want to gain maximum advantage from caffeine during competition should avoid drinking caffeinated beverages when they are not exercising.

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Lactic acid is good for you

Lactic acid is the most efficient fuel that your muscles can use, even more than sugar. When you exercise as hard as you can, it helps you to go harder. A paper from Aukland University in New Zealand reviews the latest research showing that lactic acid is good for you (Sports Medicine, Volume 36, 2006). Your muscles use carbohydrates, fats and proteins for energy. Enzymes in muscles break down carbohydrates in a series of reactions that release small amounts of energy at a time. More than 80 percent of the energy used to power muscles is lost as heat, so burning fuel instantly for energy would produce so much heat that it would burn your muscles.

Enzymes require oxygen to turn food into energy. When you exercise so hard that you can’t get all the oxygen you need to break down food for energy, lactic acid accumulates in muscles and spills over into the bloodstream. This makes muscles acidic and it is the acidity that makes muscles burn and forces you to slow down. However, muscles require very little oxygen to turn lactic acid into energy. So when your muscles produce lots of lactic acid, they use this chemical for energy and require less oxygen. As soon as you slow down, you catch up on your oxygen debt and recover. So lactic acid is good for you. It helps you to exercise with less available oxygen.

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Cold hands

If your fingers turn white and start to hurt when you're out in the cold, you may have a condition called Raynaud's phenomenon. On exposing your fingers to cold, the blood vessels close, skin turns white and their temperature drops. When the temperature drops to 59 degrees, your body tries to save your skin by opening the blood vessels and the skin turns red and starts to itch and burn. If you warm your hands at this point, your skin will not be damaged, but if you do not get out of the cold, the blood vessels in your hands can close and the temperature in your hands can drop to freezing, resulting in frostbite.

People who have Raynaud's phenomenon have blood vessels in their hands that do not open when the skin temperature reaches 59 degrees. Several diseases, smoking and using vibrating equipment can cause Raynaud's phenomenon.

Wear two or more layers of gloves and mittens. When your fingers feel cold, swing your arms very rapidly about your shoulder with your elbow straight. This will drive blood, like a centrifuge, into your fingers and warm them. The blood pressure drugs called calcium channel blockers, such as Nifidipine, can help to treat and prevent Raynaud’s phenomenon (Rheumatology, November 2005). Another option is nitroglycerin ointment that is used to treat angina. When applied to the forearm, it opens blood vessels leading to the hands. Check with your doctor to see if these prescription medications would be appropriate for you.

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Awkward running form

Many people look terribly uncoordinated when they run. Telling them to change their form will just make them more uncoordinated. If a coach criticizes a team member for poor running form and doesn't correct the underlying causes, the person is likely to become self-conscious about how he or she looks, and run even more slowly. Coordination usually improves just with repeated practice in the chosen sport.

Running form can improve markedly if you can correct muscle imbalances and structural abnormalities with appropriate exercises and perhaps mechanical devices. A coach can videotape the athletes while they run, then review the tape in slow motion to analyze the mechanical defects. For example, leaning forward during running is often caused by weak back muscles, which can be treated with exercises to strengthen the back. Pointing the toes out is often caused by weak lower leg muscles and can be corrected by doing exercises to strengthen the shin muscles. Leaning back on the heels after foot plant can be caused by excessive rolling-in motion of the feet or weak calf muscles.

Treatment often includes special inserts in the shoes and calf strengthening exercises, such as toe raises while holding a heavy weight in the hands. Holding the shoulders up towards the ears during running is usually caused by weak shoulder muscles, which can be corrected by shrugging the shoulders while holding weights. A low knee-lift is often caused by weak quadriceps muscles in the front of the upper leg. The quadriceps can be strengthened by pedaling a bicycle, skating, or running up hills.

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Weight lifting for children

The best time for future Olympic athletes to start training is before they reach puberty. Having large strong muscles makes you a better athlete, and starting training before puberty enlarges the bones that are used primarily in that sport. Muscles growth is limited by the size of the bones on which they attach. The larger the bone, the stronger the muscle. Children who start to play tennis before they go into puberty have larger bones in the arm that holds the racquet. They also have larger bones in their tennis arm than those who start to play tennis later in life. The larger and stronger your muscles, the harder you can hit a tennis ball.

Lifting weights during growth does not prevent children from growing to their full potential height. Bones grow from growth centers that are weakest part of bone, but strength training during growth does not damage these growth centers and children who lift weights in programs with experienced supervision do not suffer more injuries than adults. There used to be concern that growing large muscles would make people musclebound and interfere with coordination, but this is not true. With increased strength comes increased speed and increased coordination in movements requiring strength. The best time for future Olympians to start training is while their bones are still growing.

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Are you pre-diabetic?

You can tell if you are at high risk for diabetes if you store fat primarily in your belly. Pinch your belly; if you can pinch an inch, you are at increased risk and should get a blood test called HBA1C. Having high blood levels of triglycerides and low levels of the good HDL cholesterol that helps prevent heart attacks also increases your risk for diabetes. When you eat sugar or flour, your blood sugar rises too high. This causes your pancreas to release insulin that converts sugar to triglycerides, which are poured into your bloodstream. Then the good HDL cholesterol tries to remove triglycerides by carrying them back into the liver, so having high blood levels of triglycerides and low blood levels of the good HDL cholesterol are both individual risk factors for diabetes.

High blood levels of insulin constrict arteries to raise blood pressure, so many people who have high blood pressure are also prediabetic. High insulin levels also constrict the arteries leading to your heart to cause heart attacks directly. People with insulin resistance have an increase in small, dense, low-density lipoprotein (LDL) cholesterol, which is more likely to cause heart attacks than the large, buoyant regular LDL cholesterol. High levels of insulin also cause clotting to increase your risk for heart attacks. You can help to prevent diabetes and heart attacks by avoiding sugar and flour, exercising and eating lots of vegetables.

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No weight loss from exercise?

When people start an exercise program, some lose a lot of weight, while others lose nothing. An effective exercise program for weight loss should be 1) continuous, 2) use all of your major muscle groups, 3) include one intense workout a week for each muscle group, and 4) be done on land, rather than in the water. Stop-and-start exercises, such as lifting weights, do not require that you use your muscles continuously enough to burn a lot of calories. Those that use just one muscle group, such as doing situps or pushups, won't help you to lose a lot of weight because the stressed muscle groups tire quickly so you can't exercise very long.

Exercising at a leisurely pace won't help you lose a lot of weight either. You burn calories while you exercise and after you finish exercising. Intense exercise raises body temperature which continues to be elevated and burn more calories for several hours after you finish exercising. This also explains why swimming is not the best exercise for weight loss, because water conducts heat away from your body so fast that your temperature does not rise. When you exercise on land, air insulates your body so your temperature rises.

Pick sports in which you can exercise intensely, but don't exercise very hard in one sport more often than once a week. Every time that you exercise, your muscle fibers are torn slightly. You can tell this has happened to you when you muscles feel sore on the day after you have exercised. If you exercise intensely on days when your muscles feel sore, you are at increased risk for injuring them. Instead, alternate two sports, one that stresses your upper body and one that stresses your lower body. And (of course) don't forget healthful eating habits.

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Urinary tract infections: treat with antibiotics

Many men suffer from constant irritation in their urinary tubes, urinating frequently at night, urgency to urinate when their bladders fill, and discomfort during urination. Often doctors do a culture which shows no cause, so they prescribe doxycycline antibiotics for a week or two, and their patients get no relief. A study from Karolinska University Hospital in Sweden shows that many of these patients are infected with a bacteria called mycoplasma genitalium which cannot be cured by taking doxycycline, but can be cured by taking an erythromycin antibiotic such as Zithromax, or Biaxin (Sexually Transmitted Infections, August 2006).

If you are a man or woman who suffers persistent urinary symptoms, check with your doctor and ask for a urine culture for mycoplasma or just an extended prescription for an erythromycin-type antibiotic.

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Cross-training for fitness

Every time you exercise vigorously your muscles are injured, and the harder you exercise, the longer it takes for your muscles to heal. You are not supposed to exercise vigorously again until your muscles stop hurting. You can exercise hard on one day and easy on the next few days, or you can train in two sports. This is called cross-training, and it can make you very fit and help to prevent injuries.

Each sport stresses specific muscle groups. Cycling stresses the upper legs, while rowing stresses your back and upper body. If you cycle and row on the same day, you stress your upper legs and upper body on the same day. To reduce your chances of injuring yourself, you should take the next day off, or at least exercise at a very low intensity. If you cycle on Monday and row on Tuesday, you allow your muscles 48 hours to recover from each sport. Pick two sports that use different muscle groups and do them on alternate days. You can then exercise more intensely in each sport and achieve a higher level of fitness.

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Pedal faster to ride better

All cyclists should learn to pedal at a fast cadence, whether you are an experienced racer or a novice recreational rider. Muscle fatigue and damage are caused by excess pressure on the pedals, not by how fast you pedal. Pedaling at a faster cadence with less pressure allows you to pedal longer and harder. However, several researchers have expressed concern that pedaling very fast could decrease blood flow to muscles and thus decrease athletic performance. A study from Kansas State University shows that pedaling fast does not decrease a muscle's flow of blood or ability to extract oxygen from the blood (European Journal of Applied Physiology, March 2006). Once again athletes and coaches find new training and competing methods and years later, scientists tell them that they are correct.

After you have been riding regularly for a time, try to spin your pedals 80 times a minute. In the beginning, you will put so little pressure on your pedals that you will ride very slowly. However, after several weeks of pedaling at a cadence of 80, you will become more comfortable and be able to move fairly well at this pace. As you become stronger, you can maintain this high cadence while using higher gears and pressing on the pedals with more force, so you will be able to ride faster and longer.

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Diabetes risk screening tests

The best predictor of diabetes is a test called Hemoglobin A1C (HBA1C), which measures the amount of sugar stuck on cell membranes. At the American Diabetes Association meeting in June 2006, Dr. Peter Baginsky of Santa Rosa, California showed that HBA1C can be used not only to identify people who already have diabetes, but also as a screening test to predict which people are likely to develop diabetes in the future. This allows doctors to treat pre-diabetes before people suffer their heart attacks, strokes and other side effects that can be the first sign that the person has diabetes.

He also showed that people who have HBA1Cs above 5.8 have a 92 percent chance of being diabetic as determined by a fasting glucose tolerance test. The HBA1C test does not require fasting and can be done with only one draw of blood, while the glucose tolerance test takes seven. It is less expensive and has the potential to save a lot of lives by getting diabetics into treatment earlier. More

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Should you restrict all fats?

Almost 50,000 women in the Women's Health Initiative Dietary Modification Trial from Harvard Medical School were given dietary counseling to reduce their fat intake to less than 20 percent of their daily calories (Clinical Diabetes, July 2006). This intense dietary counseling did not reduce the incidence of heart attacks, strokes, or cancers even though the women reduced their intake of fat by 8.2 percent.

Their data from the eight-year follow up show that it is difficult to reduce total fat intake, and that dietary counseling to reduce total fat intake does not reduce the risk of heart attacks or cancers. It lowered weight only an average of three pounds and diastolic blood pressure only slightly. However, other studies have shown that reducing total fat intake does lower risk for certain cancers.

The probable reason for these dismal results is that food contains both good fats and bad fats. Most doctor agree that we should restrict saturated fats found in meat, chicken and whole milk diary products, and partially hydrogenated fats found in many prepared foods. However, the monounsaturated fats found in seeds and nuts and the omega-3 fatty acids found in seafood and seeds are healthful fats that should not be restricted.

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How to do sit-ups

Sit-ups can strengthen your belly muscles, but doing them incorrectly can hurt your back. Sit-ups should be done while you lie on your back with your knees bent enough for the soles of your feet to touch the floor. Place both hands on your chest and slowly raise your head off the ground. Raise your shoulders about one foot and then lower them to the ground. Do this slowly ten times, rest a few seconds and then do two more sets of ten. After a week or two this exercise will feel easy, so add a light weight held behind your neck or on your chest. As you become stronger, you can use heavier weights.

There's no need to do more than 30 sit-ups in one workout. To strengthen your belly muscles, you increase the resistance, not the number of repetitions. Keep your knees bent to protect your back. If you do a sit-up with your legs straight, you place a great force on the iliopsoas muscles that increase the arch in your back, which can damage the ligaments and joints. If your belly muscles are weak, you are likely to arch your back excessively when you sit up and increase the chances of injury. If you are doing sit-ups to flatten your stomach, you need to raise your head only about one foot because going higher than that uses the quadriceps muscles in the front of your upper legs, not your belly muscles.

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Children's exercise

Children need at least 90 minutes of exercise a day to avoid heart disease when they are older, according to a new study reported in Lancet (July 23, 2006). The old guidelines recommending 30 minutes of exercise three times a week, or even an hour a day do not appear to be adequate for preventing obesity and heart disease. Researchers used heart rate monitors to measure the activity of 1700 nine- to-fifteen-year-olds in Denmark, Estonia, and Portugal. They then calculated a heart-attack risk score consisting of blood pressure, cholesterol, insulin resistance, and skinfold thickness.

They compared physical activity from the heart rate monitors with the heart attack risk-factor score and found that the more active the child, the lower the heart attack risk score. Many children who exercised for 60 minutes a day were still overweight and had high heart attack risk scores. The authors suggest that the lack of regular physical activity is likely to mean that the children are spending too much time watching TV, playing video and computer games, and eating junk food. There is no reason to expect that the results would be different with American children. The current recommendation of at least an hour per day of moderate activity in children may not be sufficient for future heart health.

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Sports Drinks or Water?

Drinks that contain salt and sugar are better than just plain water during exercise, unless you are also eating foods. A study from the Medical College of Georgia shows that tennis players have lower body temperatures when they drink fluid with electrolytes and sugar, rather than just plain water (British Journal of Sports Medicine, May 2006). Higher body temperatures during exercise slow you down and tire you earlier.

More than 80 percent of the energy that supplies your muscles is lost as heat. Less than 20 percent drives your muscles. So during exercise, your heart has to cool your body by pumping hot blood from your muscles to your skin, as well as pumping oxygen-rich blood to your muscles. If you heart has difficulty serving both functions, it cannot pump enough hot blood from muscles and your temperature rises.

You do not have to take sports drinks to protect yourself from high body temperature. During exercise, you need energy, salt and water and your body doesn't care how it gets these nutrients. Eating any salted food with water or any beverage you like will supply your body as efficiently as sports drinks.

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Second wind

Second wind means that when you run very fast, you reach a point where you gasp for breath, slow down but keep on pushing and after a few seconds, you feel recovered and pick up the pace. Some people think that you just slow down and allow yourself enough time to recover from your oxygen debt, but research from the University of California in Berkeley may give another explanation.

When you run fast, your muscles use large amounts of oxygen to burn carbohydrate, fat and protein for energy. If you run so fast that your lungs cannot supply all the oxygen that you need, you develop an oxygen debt that causes lactic acid to accumulate in your muscles to make them burn, and you gasp for air. The muscle burning and shortness of breath caused by the accumulation of lactic acid forces you to slow down. This research shows that the lactic acid that accumulates in muscles when you run very fast actually is the first choice of fuel for your muscles when you are running so fast that you can't get all the oxygen that you need (American Journal of Physiology- Endocrinology and Metabolism, June 2006). So your muscles switch to burning more lactic acid for energy, you need less oxygen and then you pick up the pace. Of course when you keep on pushing the pace, you can again accumulate large amounts of lactic acid in muscles, which makes them burn and hurt again.

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Marathon training

Many runners have the mistaken impression that they have to run a lot of miles every week to be able to run fast in a marathon. Most will find that running too many miles slows them down. To run fast in races, you have to run very fast in practice. However, on the day after you run very fast, your muscles will feel sore. If you run fast while you are sore, you are likely to injure yourself and not be able to run at all. Take easy workouts until your muscles feel fresh again. Most competitive runners set up their programs so that they run fast on Tuesdays and Thursdays and longer on Sundays. The rest of the time they run slowly or not at all.

Before you increase the intensity of your running program or any other exercise, check with your doctor. Once you are in good shape, your goal on your fast days should be to run repeat intervals with short rests between each. For example, on Tuesdays try to run four half-mile repeats at a very fast pace with a quarter mile jog between each. If you can run a mile flat out in six minutes, you probably will try to run each half-mile repeat in about three minutes and 15 seconds. On Thursdays, try to run eight to 12 repeat quarter miles at close to the same pace of about 90 seconds each. On Sunday, try to run briskly for 90 minutes. The rest of the time, jog slowly, being careful not to run so much that it interferes with your two fast days and one long day each week.

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Exercise prolongs life

Dr. Todd Manini of the National Institute on Aging reports that older active people who walk, climb stairs, do household chores, or even wash windows are 69 percent less likely to die in a year, compared to people who are far less active (JAMA, June 2006). This study was far more dependable than previous studies because, instead of using a questionnaire, researchers measured how active a person was by measuring the metabolic end products of activity. They used a doubly-labeled water method that directly measures carbon dioxide production over an extended period, the most accurate estimate of energy expenditure.

If you are inactive, you should check with a cardiologist who will do a stress test. If you pass, you should start an exercise program. If you fail, you should work with your doctor to correct the problem and then start an exercise program.

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Weight lifting helps to prevent diabetes

One third of Americans will become diabetic because they eat too much and exercise too little. A study in Medicine and Science in Sports and Exercise (July 2006) shows that lifting weights can help to prevent and to treat diabetes.

Extra fat prevents your body from responding normally to insulin. Before insulin can do its job of driving sugar from the bloodstream into cells, it must first attach to little hooks on cell membranes called insulin receptors. Having extra fat in cells turns these receptors inward, making it far more difficult for insulin to attach to the receptors. This prevents insulin from doing its job of lowering blood sugar levels, even though your body is making plenty of insulin. That’s why anything that makes you fat increases your risk for diabetes. Doctors can measure how cells respond to insulin with a sugar tolerance test.

In this study, adolescent boys were given a program of lifting heavy weights twice a week. After only 16 weeks, their muscles were larger and they lost fat. Sugar tolerance tests showed that the ability of their bodies to clear a load of sugar from their blood streams improved dramatically. This means that a regular weight lifting program decreases insulin resistance and thus reduces risk for becoming diabetic.

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Dizziness on changing position

Athletes and other very fit people may feel dizzy when they rise from lying to standing because of their slow pulse rates. Exercise makes your heart stronger so it can pump more blood with each beat and it doesn't have to beat as often. A slow pulse rate can be good. Since your heart doesn't beat as often, it has more time to rest between beats. Like a low-mileage used car, perhaps this will mean it takes longer to wear out. But a slow heart rate can make you dizzy when you change position.

When you raise yourself from lying to sitting, or from sitting to standing, the force of gravity pulls blood down from your brain towards your feet and your blood can't get back to your brain until your next heart beat. If you have a pulse rate of only 50 beats a minute, it will take more than a second between beats. That can be enough time for your brain to suffer briefly from a lack of oxygen, so you feel dizzy. You can even pass out while you wait for your next heartbeat to come along and pump blood back up to your brain.

Dizziness can also be a sign of an irregular heartbeat or blocked arteries leading to your brain, so people who feel dizzy when they get up should check with their doctors. If they are athletes, chances are that they only have a strong athletic heart with a slow rate, and all they need to do is remember to get up slowly.

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Rosacea: red in the face

Many people develop a red scaly rash on their faces as they age, particularly in the center on the nose and cheeks. They flush or blush and often also have small acne-like bumps on their faces, swollen noses and prominent red blood vessels. Sometimes, this same rash may extend to the shoulders, chest and back. It's called rosacea.

Nobody knows what causes rosacea, but most doctors feel that it is a genetic disorder associated with other skin conditions, seborrheic dermatitis and psoriasis. They may also have terrible dandruff, scaly ears, thick big toe nails, and sometimes thick skin on their elbows and knees. The recommended treatment is to take an antibiotic such as doxycycline 100 mg twice a day plus an antibiotic cream such as metronidazole cream until the rash clears. Then stop the doxycycline and resume it when the rash returns. You should also shampoo your scalp and face every day.

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Caffeine

Two recent studies show that too much caffeine may cause problems for some people. Researchers at Queens University in Kingston, Ontario report that caffeine, in coffee, tea, chocolate, and most colas, raises blood sugar levels in healthy people and diabetics, which cannot be reversed by exercise or weight loss (1).

When you eat, your blood sugar level rises. If it rises too high, sugar sticks to cells, and once stuck on cells, it is converted to sorbitol which destroys the cell to increase risk for heart attacks, strokes, blindness, deafness, kidney failure and other effects of diabetes. Anything that increases blood sugar levels increases risk for diabetes. So, most doctors recommend restricting refined carbohydrates, in sugar and flour. Exercise and weight loss do not prevent this rise in blood sugar. These studies were done with caffeine pills. Coffee may contain nutrients, such as antioxidants, potassium and magnesium, that may prevent the high rise in blood sugar.

A second study, from the Netherlands shows that drinking coffee can raise blood pressure (2). High blood pressure markedly increases a person’s chances of suffering a heart attack, stroke and sudden death. The new guidelines state that normal blood pressure should be below 120 when the heart contracts and 80 when it relaxes. That means the almost 91 percent of all North Americans will eventually become hypertensive and suffer increased risk for premature death. The authors reviewed 16 studies on coffee drinking and high blood pressure and found that for most people, drinking coffee does not raise blood pressure, but for some, even one cup of coffee can raise blood pressure. If you drink coffee or any other caffeinated beverage regularly, it may pay to check your blood pressure twenty minutes after a drink. Your blood pressure is too high if it is above 120 over 80.

1) Diabetes Care, March 2005
2)Journal of Hypertension, May 2005

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How to Warm Up

Warming up before you exercise helps to prevent injuries and lets you jump higher, run faster, lift heavier or throw further. Your warm-up should involve the same muscles and motions you plan to use in your sport. For example, before you start to run very fast, do a series of runs of gradually-increasing intensity to increase the circulation of blood to the muscles you will be using.

Muscles are made up of millions of individual fibers, just like a rope made from many threads. When you start to exercise at a very slow pace, you increase the blood flow to muscle fibers, increase their temperature, and bring in more oxygen, so the muscles are more pliable and resistant to injury. When you contract a muscle for the first time, you use less than one percent of your muscle fibers. The second time you bring in more fibers, and you keep on increasing the number of muscle fibers used in each contraction for several minutes of using that muscle. It’s called recruitment. When you are able to contract more muscle fibers, there is less force on each individual fiber to help protect them from injury. Usually you are warmed up when you start to sweat.

The same principle applies to your heart. Angina is a condition in which the blood vessels leading to the heart are partially blocked so the person has no pain at rest, but during exercise, the blocked arteries don't permit enough blood to get through to the heart muscles, causing pain. If people with angina exercise very slowly before they pick up the pace, they are able to exercise longer and more intensely before they felt heart pain. Always check with your doctor if you feel any heart pain during exercise.

Competitive athletes in sports requiring speed and endurance perform better after they warm up with increasing intensity. Warming up slowly does not increase the maximum amount of oxygen that you can bring to muscles that you need during competition. If you are a runner, skier, cyclist, or an athlete in any sport that requires endurance, warm up at a gradually increasing pace. Use a series of increasingly intense repetitions of 10 to 30 seconds duration, with short recoveries, until you are near your maximum pace. This type of warm-up increases endurance because intensity increases the maximum amount of oxygen that you can bring to your muscles, as you continue to compete, and lets your muscles contract with greater force as you begin to fatigue. You will then be able to bring in more oxygen to your muscles than you could have done without the intense warm-up.

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Bonking: low blood sugar

Yes, I know the word has another meaning. But in sports, bonking is running out of blood sugar. If you watch a major bicycle race on TV, you have to be impressed by how the riders can eat enough to sustain them through races that require more than five hours of near maximum effort. If a rider does not get enough food during his or her ride, he can fall off the bikes, lie on the ground unconscious and start to shake all over in a in a massive convulsion. This is called bonking, or passing out from low blood sugar.

Your brain gets almost all of its fuel from sugar in your bloodstream. When your blood sugar level drops, your brain cannot get enough fuel to function properly, you feel tired and confused and can pass out. There is only enough sugar in your bloodstream to last three minutes. To keep your blood sugar level from dropping, your liver must constantly release sugar from its cells into your bloodstream, but there is only enough sugar in your liver to last 12 hours at rest. During intense exercise, your muscles draw sugar from your bloodstream at a rapid rate. Your liver can run out of its stored sugar and your blood sugar level can drop, and you bonk.

Bonking is common in bicycle races if a rider does not eat frequently, but is rare in long distance running races. When you run, your leg muscles are damaged from the constant pounding on the roads and you must slow down. However, you pedal in a smooth rotary motion which does not damage your muscles, so you can continue to pedal at a rapid cadence for many hours.

To prevent your blood sugar from dropping too low during intense exercise lasting more than two hours, eat at least every 15 minutes. It doesn't matter what you eat: salted peanuts, a peanut butter and jelly sandwich, chicken, an apple, a banana or anything else. Almost all fit people can take small amounts of food frequently during exercise without developing stomach cramps.

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Belly fat: why it's dangerous

Storing fat primarily in your belly increases your chances of suffering heart attacks and diabetes.

When you take in more calories than your body needs, your liver turns them into fat. Fat cells in your belly are different from those in your hips. The blood that flows from belly fat goes directly to your liver, whereas the blood that flows from your hips goes into your general circulation. The livers of those who store fat in their bellies are blocked from removing insulin by the extra fat and therefore do not remove insulin from the bloodstream as effectively as the livers of those who store fat in their hips and have less fat in their livers.

People who store fat primarily in their bellies are called apples, while those who store fat primarily in their hips are called pears. The apples have higher blood insulin and sugar levels that raise levels of the bad LDL cholesterol that causes heart attacks, and lower levels of the good HDL cholesterol that prevents heart attacks. More

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Interval training

To become stronger and faster, athletes use a technique called interval training, in which they exercise very intensely, rest and then alternate intense bursts of exercise and rest until their muscles start to feel heavy. Intervals are a fixed number of repeats of a fixed distance at a fixed pace with a fixed recovery time. There are two types of intervals: long and short. A short interval takes less than 30 seconds and does not build up significant amounts of lactic acid in the bloodstream, so an athlete can do lots of repeat short intervals in a single workout.

Long intervals take two minutes or more and are very tiring. In interval training, a runner may run a quarter mile 12 times, averaging 1 minute, with a 110-yard slow jog between each. A weightlifter may lift a heavy weight ten times in a row and then repeat another set of ten. Runners run intervals as fast as they can and recover enough to run the same fast pace several times. Runners need very short recoveries between intervals, usually only about 30 seconds; but weight lifters need much longer recoveries, at least two and a half minutes. Runners become short of breath and feel a burning in their muscles when lactic acid starts to accumulate in muscles, but it takes only a few seconds for a trained athlete to recover between each hard run. On the other hand, weight lifters feel burning caused by tearing of the muscle fibers and it takes a much longer time for the pain to disappear so they can lift very heavy weights again.

You can apply the concept of interval training to your program at any level of fitness. When you start a new exercise program, exercise for 30 seconds, stop for 30-60 seconds, longer if you need it. Alternate exercising and resting until you feel tired or your muscles feel heavy. Then stop for the day. The stronger you get in your sport, the more intense your intervals can become. You work at your maximum capacity for 30-60 seconds, then take 60-90 seconds to recover, then go very hard for another 30-60 seconds. Do this vigorous interval workout once a week until you get tired. At first you may only be able to do two or three intervals, but your muscles get stronger and you build up the number of intervals you can complete. Go easy the next day or take a day off if you feel any discomfort.

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Warm up your heart

Most people know that you have to warm up skeletal muscles to help protect them from injury, but many do not know that warming up the heart muscle also helps to prevent heart attacks in people with blocked arteries leading to the heart.

Before you try to run very fast, you can protect your muscles from injury by performing a series of runs of gradually-increasing intensity to increase the circulation of blood to your muscles. The same principle applies to the heart. Angina is a condition in which the blood vessels leading to the heart are partially blocked so the person has no pain at rest, but during exercise, the blocked arteries don't permit enough blood to get through to the heart muscles, causing pain. A study from the Quebec Heart Institute shows that exercising very slowly before a person with angina picks up the pace allows him to exercise more intensely before he feels heart pain.

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Prepare for skiing

If you plan to ski this winter, start getting ready now. The best way to train for skiing is to ski, but snow isn't always available. To prepare for a skiing vacation, you need to strengthen both your heart muscles and your skeletal muscles. You can strengthen your heart for skiing with any exercise that will raise your heart rate for at least 10 minutes, three times a week. However, to prepare your muscles for skiing, you have to use activities that use your upper legs, such as skating or riding a bicycle. The average bicycle rider is far better prepared for skiing than the average runner. Many joggers who can easily run ten miles find that they can't ski very long because their upper leg muscles tire and hurt after just a few minutes of skiing.

You drive yourself forward in skiing with the muscles in your upper legs. Running stresses primarily the muscles in your lower legs. It does not strengthen the muscles in the upper legs enough to allow the average person to ski for any length of time. Running stresses your upper leg muscles only when you use them to lift you up when you run hard up hills. Since you ski by bouncing up and down on your knees and shushing forward from your hips, the best sports to prepare for skiing are those that stress primarily your thigh and upper leg muscles. You can use the popular indoor exercise machines that mimic cross-country skiing motions, or ski on dry roads with roller-skis. In-line skating or cycling are good choices for outdoor preparation, particularly if you climb lots of hills. Add a weight training program to strengthen your upper body and arms as well as your legs, and you’ll be ready for the snow.

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Recurrent sore throats

If you have recurrent throat infections with staph or strep bacteria, check your toothbrush, your nose and your mate. One study showed that beta strep, which causes rheumatic fever, was grown from toothbrushes of 30 percent of children who were infected with that germ. Beta strep can persist in unwashed toothbrushes for 15 days and in washed toothbrushes for 3 days. Another bacteria called staph aureus can persist in the noses of people even after they have taken the appropriate antibiotic. Having staph in your nose also prevents simple cuts from healing.

Staph grows so luxuriously in the wet nasal membranes that it is difficult to cure by taking oral antibiotics. You can also be re-infected by a mate who has no symptoms at all. If you suffer recurrent staph or strep infections, get a new toothbrush and ask your doctor to culture your nose. If you have a staph aureus infection, apply an over-the-counter antibiotic ointment such as Bacitracin in your nostrils nightly for several weeks.

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Will vinegar help me lose weight?

Vinegar is an excellent preservative and a good household cleaner, but it is not a medicine or a weight-loss drug. Several popular books claim that vinegar prevents cancer and heart disease, lowers high blood pressure and helps you to lose weight, but here is no evidence to support any of these claims. One of the books explains that vinegar helps you to lose weight because oil and vinegar don't mix, so vinegar and your fat won't either.

Vinegar is nothing more than a mixture of 95 percent water and around 5 percent acetic acid, made from grapes, apples, rice, potatoes or other fermented plants. It is very low in calories, but the only way vinegar could possibly help you to lose weight is by causing you to eat lots of salads while you cut back on other sources of calories.

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Push-Ups: Train to do the most

If you want to be able to do 100 pushups in a row, do not try to do as many pushups as possible every day. You'll probably injure yourself and end up unable to do any pushups at all. Training for competition requires an understanding of the stress-and-recover rule and the interval-sets rule.

The best way to improve any athletic skill is to stress your body on one day and then allow enough time for your body to recover before you stress it again. On one day, take a hard workout. On the next morning, your muscles feel sore. Take easy workouts until the soreness disappears and then take a hard workout again.

For your hard workouts, you can do far more work by exercising in sets, rather than continuously. If you can do six continuous pushups, you can probably do ten sets of two with twenty-second rests between each set. Do repeat sets of two until your muscles feel sore. Try to take workouts that are hard enough to make your muscles feel sore for no more than 48 hours. An ideal training program would consist of sets of three until you feel sore on the first day, take off the second day, do sets of five on the third day until you feel soreness, and rest on the fourth day. Repeat these four-day cycles, and you'll soon be ready to compete.

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Know when to change sports

If your favorite sport causes chronic pain or an injury that does not heal, you should probably switch to another sport. Two recent studies from the Argentine Tennis Association followed players with knee and shoulder problems (British Journal of Sports Medicine, May 2006). In the first study, men who had anterior cruciate ligament (ACL) tears showed a great drop in their tennis performance. The knee is just two sticks held together by four bands, called ligaments. Two ligaments are located on the outside of the knee and two ligaments cross in the middle of the knee joint. The ACL runs from the bottom of the upper bone of the knee joint forward to the top of the lower bone of the knee joint. It prevents the upper bone of the knee joint from slipping backward when your knee hits the ground. When this ligament is torn, each foot strike causes the upper bone to slide backward over the lower bone, shears off cartilage in the process and hastens a knee replacement. It is downright dangerous for a person with a torn ACL to play tennis or run until the ligament is replaced. Even then the surgical replacement is not as strong as the original ACL and that person risks joint damage every time he runs, jumps and turns on his knee joint.

The second study followed older men who had played tennis for many years and had no shoulder pain, surgery or trauma to their shoulders. Even with no symptoms, thirty-three percent of these men had significant x-ray findings of joint damage called osteoarthritis in their dominant shoulder, and the older they were, the more likely they were to have this damage. X rays showed increased incidence of joint space narrowing, joint cysts, bone fragments, flattening of the joint cartilage, displacement of the upper arm bone and erosion of the joint cup. If you are a long-time tennis player and have shoulder pain, your doctor will probably recommend that you stop playing tennis.

The good news is that switching to a new sport is much easier than starting from inactivity. Training principles are the same for all sports. Give yourself time to learn new skills and build up the muscles you have not used before.

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Statins and muscle pain

Some patients with high cholesterol levels are afraid to take statins because off fear of developing side effects such as muscle pain. A study from Scripps Mercy Hospital in San Diego reviews the latest data on side effects of statins (The American Journal of Medicine, May 2006). This review found that statin- induced muscle damage is more common in Asians, people who exercise, have had recent surgery, have kidney, liver or thyroid disease, or have high triglycerides. The incidence of muscle pain and damage from statins is extremely low in non- exercisers, three to ten percent in those who exercise, and very high in competitive athletes.

Most athletes refuse to take statin drugs because they train by taking a hard workout that damages their muscles. Then they must take easy workouts until the soreness disappears and muscles heal. When statins prevent this muscle healing, the athlete must train at reduced intensity for a much longer period of time. Brand names of statins include: Altoprev, Crestor, Lipitor, Mevacor, Pravachol and Zocor.

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Are any weight loss drugs safe and effective for teenagers?

Researchers from St. Christopher's Hospital for Children in Philadelphia recently reported that metformin, a drug used to treat diabetes, can help obese, non-diabetic teenagers lose weight (Endocrine Society Annual Meeting, June 2006). Many previous studies show that short-term use of metformin can help people lose weight.

Metformin prevents the liver from releasing sugar into the bloodstream. When taken before eating, it markedly reduces the rise in blood sugar. A high rise in blood sugar after eating causes the pancreas to release large amounts of insulin which acts on the brain to make you hungry, on the liver to make more fat, and on the fat cells in your belly to fill with fat. This study shows that metformin along with a low-refined-carbohydrate diet lowers weight for years. It also lowers high blood sugar and cholesterol, decreases insulin resistance and helps get rid of acne in obese teenagers. More on glucophage for weight loss

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What should I eat after a hard workout?

Eating a protein-rich meal as soon as possible after this hard workout hastens muscle recovery. Intelligently-increased workloads make an athlete stronger, and anything that helps you recover faster allows you to do more work. When you feel the burn during intense exercise, you are damaging your muscle fibers. The pain that you feel 8 to 24 hours after a hard workout is due to muscle damage. It is now fairly well established that your muscles recover faster if you eat protein as soon as possible after a hard workout or competition.

You’ll be happy to know that a study from Indiana University in Bloomington shows that chocolate milk helps athletes to recover faster from hard exercise than drinks that replaced only carbohydrates or fluid (International Journal of Sports Nutrition and Exercise Metabolism, February 2006). Milk is full of protein, but so are, fish, shellfish, meat, chicken, whole grains and beans, and so forth. Eat any source of protein that tastes good to you.

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Stand still or keep moving between bursts of hard exercise?

If you compete in sports that require repeated short bursts of very fast running, such as in basketball, soccer, or football, will you recover faster by standing still or by continuing to move at a slower pace? A study from Brooklyn College in New York showed that it doesn’t make any difference (International Journal of Sport Nutrition and Exercise Metabolism, February 2006). Researchers asked fit athletes to perform multiple bouts of exercising to exhaustion. Between the bouts of vigorous exercise, one group spent 12 minutes staying completely still, while the other group continued to exercise at less than 20 percent of their maximum workload. Athletes in both groups showed equal recoveries and performances.

However, those who stayed still between all-out efforts had blood that was more acidic than those who continued to exercise. Many athletes believe that lactic acid buildup in muscles hinders their performance, but this study shows that blood acidity has little to do with recovery from hard exercise. When you exercise so intensely that you cannot get all the oxygen you need, lactic acid starts to accumulate in your muscles and spills out into your bloodstream to make your blood more acidic. This can make your muscles burn and hurt, but it will not delay your recovery for your next bout of all-out effort.

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Is exercise before sleeping harmful?

Many fitness instructors give you bad advice when they tell you not to exercise within three hours of going to sleep. The old argument was that vigorous exercise causes your body to produce large amounts of its own stimulants, adrenalin and noradrenalin, that make your heart beat rapidly, raise body temperature and prevent you from feeling tired. More recent research shows that exercising vigorously before going to bed does not interfere with sleep. We also know that exercise helps to prevent disease, prolong life and make you feel good. So it is better to exercise whenever you can, even if it's just before you go to bed.

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If I replace salt after exercise; won't this cause osteoporosis?

Athletes must eat large amounts of foods to take in enough calories to fuel their muscles during exercise. A high salt intake in athletes does not cause osteoporosis because they eat so much food that contains calcium and potassium that the amount of salt they take does not cause blood calcium levels to drop, so calcium does not leach out of bones.

As a general rule, taking extra salt causes the body to retain extra fluid, which expands blood volume and increases blood flow to the kidneys to increase loss of calcium in the urine. This lowers blood calcium levels, so calcium has to be taken from bones for replacement. Sodium salt also causes the kidney tubules to lose more calcium. However, potassium blocks the exchange of sodium for calcium in the kidneys and prevents calcium loss. Eating calcium also prevents blood calcium levels from dropping so there is no need for the bones to release extra calcium into the bloodstream (Journal of the American College of Nutrition, June 2006). All fruits, vegetables, whole grains, beans and other seeds are loaded with potassium. Most varied diets contain adequate calcium, but if you decide to take a calcium supplement, be sure you are also getting plenty of vitamin D. Because calcium blocks the conversion of inactive vitamin D to active vitamin D, extra calcium increases your needs for vitamin D.

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Do protein drinks increase speed during competition?

Adding protein to a sports drink does not help athletes cycle faster in a 50-mile time trial, according to a study from McMaster University in Ontario (Medicine and Science in Sports and Exercise, August, 2006). Many studies show that taking in a carbohydrate drink helps improve performances in athletic events lasting more than an hour. Two recent studies showed that adding protein to a carbohydrate drink improves performance even more. However, in these studies, cyclists worked at a fixed rate of effort, rather than using spurts of energy as athletes do in competition.

When you compete in an athletic event lasting more than an hour, you need fluids and calories. In events lasting more than three hours, you also need salt. Calories come from carbohydrates, fats, and proteins. During highly-intense exercise, your muscles use carbohydrates more efficiently than proteins or fats. So carbohydrates are the calorie source of choice during intense exercise. Furthermore, drinks containing protein often taste bad and are not as refreshing as water, soda or sports drinks, so you don’t drink as much.

High-protein meals eaten immediately after hard exercise have been shown to help athletes recover faster, but the data that taking protein during exercise improves an athlete’s performance is extremely weak. In competitions lasting more than an hour, athletes should take drinks that contain carbohydrates, or water plus food. In events lasting more than two hours, they also need to replace salt, either with salted drinks or with salty foods such as salted peanuts.

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Knee cartilage does not grow back

When all the cartilage in your knee is gone, the only effective treatment is to replace the whole knee. Knee replacements are now lasting for twelve to twenty years or more, and most remain pain-free. The ends of bones are soft, so they must be covered with a thick white gristle called cartilage. Once damaged, cartilage can never heal. An affected person spends the rest of his life losing cartilage until the cartilage is completely gone and the knee hurts 24 hours a day. The only effective treatment at that time is to replace the entire knee. However, the artificial knee can become dislodged from the bones and may need to be replaced after several years. The area will be so full of scar tissue that a second surgery is far more difficult than the first. If you have damaged cartilage in your knee, you should protect that knee for the rest of your life. Running, fast walking and jumping cause further damage, while pedaling and swimming usually do not. When the knee hurts all the time, your doctor will check to see how much cartilage is left. If it's gone, you probably need a knee replacement.

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Bleeding gums need attention

One in 10 people suffers from periodontal diseases, characterized by bleeding in the gums when you brush your teeth, loosening of the teeth and damage to the structures that help the teeth stay in place.

They are caused most commonly by infections by three Gram-negative bacteria: Porphyromonas gingivalis, Bacteroides forsythus and Actinobacillus actinomycetemcomitans. The body responds to these infections by producing various cytokines (IL-1, IL-6, IL-8, TNF-alpha), inflammatory mediators (PGE2), and matrix metalloproteinases (MMP-2, MMP-3, MMP-8, MMP-9). Viruses, such as cytomegalovirus and Epstein-Barr virus) can also cause periodontitis. Conventional treatments for periodontitis aim to eliminate bacterial plaque by scrubbing, cleaning and prescribing antibiotics. Recently dentists have also been prescribing anti-inflammatory drugs to decrease inflammation.

If your gums bleed when you brush your teeth or you have lose teeth unexplained osteoporosis, ask your doctor or dentist to prescribe a combination of metronidazole 250 mg four times a day, and Biaxin 500 mg twice a day for one week. Also see my report on the link between gum disease and heart attacks.

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Belly fat is worse than hip fat

Storing fat primarily in your belly increases your chances of suffering heart attacks and diabetes.

When you take in more calories than your body needs, your liver turns them into fat. Fat cells in your belly are different from those in your hips. The blood that flows from belly fat goes directly to your liver, whereas the blood that flows from your hips goes into your general circulation. The livers of those who store fat in their bellies are blocked from removing insulin by the extra fat and therefore do not remove insulin from the bloodstream as effectively as the livers of those who store fat in their hips and have less fat in their livers.

People who store fat primarily in their bellies are called apples, while those who store fat primarily in their hips are called pears. The apples have higher blood insulin and sugar levels (2) that raise levels of the bad LDL cholesterol that causes heart attacks, and lower levels of the good HDL cholesterol that prevents heart attacks. See my report on Insulin Resistance.

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