Hello Runners,

Do you or someone you know enjoy group trainings but are no longer a beginning runner and are unable to participate in marathon level trainings?  Dave Sciannella, 10K Head Coach, has responded to the club's  spring training "gap" and is offering to lead this exciting, new program.  Thanks Dave!

Details and registration information are posted on the club's website.  All questions should be directed to Dave Sciannella - DSciannella@...

Happy Running All!
Wanda

For those that didn't see the photos Don Libes took, they can be viewed
at:  http://www.flickr.com/photos/donlibes/sets/72157602914334507/

Stacey



--- Janet Newburgh <JanNewburgh@...> wrote:

> Thank you so much, Dave, for a great program, and thank you also to all
> of the page group leaders and participants who helped make the program a
> wonderful success.  We all really appreciate Juliette and her husband
> opening their beautiful home to us for a lovely celebration party. I
> greatly appreciate the gift certificates and will make very good use of
> them. As to running,  I would recommend that everyone try to run at
> least every other day, even if only 2-3 miles, so that you do not lose
> conditioning. Our winters are mild enough that if you dress
> appropriately, most days are fine for running.  Also, if you would like
> to have a CD of my photos that were shown at the party, plus a bunch
> that were not shown, please let me know and I'll burn some CDs of them.
> I can get the CDs to you at the Turkey Burnoff Race on November 24, the
> MCRRC Holiday Party or the Frozen Slopes Cross Country 6K on Dec. 1, or
> the Jingle Bell Jog later in December, or we can arrange some other
> time/place. Meanwhile, keep up the good work, I hope to see you at some
> of the Wednesday night track workouts, now at Wootton High School (7:00
> pm), or at the races.
> Janet Newburgh
>
>


__________________________________________________
Do You Yahoo!?
Tired of spam?  Yahoo! Mail has the best spam protection around
http://mail.yahoo.com

I have posted an album of finish-line photos on the yahoo group.  Hope
you enjoy them!

Ann

I posted the group picture that my husband took on Sunday's race on the
yahoo group page.

http://www.mapmyrun.com/run/united-states/md/rockville/676893930

this way you can view the course.
Dave
(from Joel )

Here they are:


http://maps.google.com/?
q=4800+Bethesda+Ave,Bethesda,MD+20814&ie=UTF8&ll=38.982965,-
77.095013&spn=0.006472,0.017273&z=16&om=1

Is there are possiblilty that some one
( maybe someone who is injured and connot run )
can BIKE the route with us and carry water ?
Please let me know.
Thanks
Dave
I even have a bike you could use

1) Packet pickup sat 11-5 at RNJ Sports - rockville
2) Eat a smart pre race dinner (Carbs good )
3) Set out all race gear the night before.
  Please wear your SR shirt.
4) Drink 6oz water before you leave your house sun. morning
5) Plan for Long lines at the porta johns
6) Meet at 7:45 for group warm ups ect.
Plan to stay around after the race to enjoy the freebies.
Dave

XS™ Power Nutrition Pre-workout Energy Bar

Rolling up incredible flavor with explosive energy, this Pre-workout Energy Bar takes you the distance.

Behind the scrumptious taste is an explosive burst of energy ready to support your next fitness adventure.

Featuring fast-burning carbohydrates to help sustain energy and endurance, this dynamic bar helps you build muscle and strength for the long run.

This pre-workout energy bar has been specifically formulated to give you energy prior to working out. With 19 g of fast-burning carbohydrates, and 15 g of quality protein, this well-balanced bar is formulated to provide a steady supply of power and endurance during exercise.

Inclusion of Nutrilite® C-Lenium Blend also offers beneficial nutrients and antioxidant protection from harmful free radicals that are generated by intense prolonged exercise.

Featuring 19 g of fast-burning carbohydrates, and 15 g of whey protein isolate blend, this pre-workout energy bar is formulated to deliver a steady supply of power and energy from start to finish.

Wonder what makes this bar stand apart from the other XS Power Nutrition bars?

It contains more fast-burning carbs (sugar) that your body can convert into energy at a more rapid rate. That means more energy to help carry you through your workout. That's why this bar is called the Pre-workout Bar.

Nutrilite C-Lenium Blend also provides beneficial nutrients and antioxidant protection from harmful free radicals that are generated by strenuous exercise.

Each serving also contains 15 g of protein, plus 100% daily value of vitamin C, and 10% daily value of selenium.

This pre-workout energy bar features a delicious flavor that makes energizing any effort a treat in itself.

Lift the energy level of your next workout by consuming a Pre-workout Energy Bar just prior to exercise. For best results consume with water – or one XS Energy Drink.

It will be October only and what to do some slow long runs to stay in
shape and enjoy that great cool, fall weather?!

Smarter Running Alum and now ChiRunning Instructor Gwen Anderson is
launching off from Aspen Hill area for 8 AM runs:

Long Slow Distance ChiRuns

Interested in Long Slow Distance runs with other ChiRunners?

8 AM fall/winter/spring (we'll switch to 7 AM in the summer)

Aspen Hill Park, Rockville, MD
http://www.mc-mncppc.org/parks/park_of_the_day/jun/parkday_jun12.shtm


This is part of Rock Creek Park that usually has more parking than Ken
Gar. It also has a toilet.

Be prepared for the sound of metronomes!

Go whatever speed you like, for whatever distance you like. These are
just social runs - it is more fun to run long slow distances with
other cool people.

These are not classes. I am not asking for money for these and I am
not accepting any liability. I'll happily lead us in loosening up
before we head out unless I'm teaching a class, on vacation, or can't
get myself out of bed. If you are interested in instruction please
sign up for a class.

http://www.rungently.com/lsdchirun.html

Well, you should read because reading is a good form of relaxing and
that's part of a good recovery regiment.  Don't take my word, read it
in the Folder section, Peak Peformance, Issue 232.  WHile you are
there, check out the 233 issue on carbohydrate drinks - are they all
that good for your recovery?

Coach Bob - on vacation.

Have you snooped around this web site of ours?  WE loaded it with some
great reading materials and links.  FOr example, some folks are
starting to complain about aches and pains.  Is this from over
stretching and excessive working out or is a sign that something is
starting to give?  Is this an acute and chronic thing?

Well, check this out:  Go to the File section of our web site and
select the folder on Sports Injury.  There you will find an article on
the 12 most common sports injury and effective means to combat them.
So lay there and do nothing and whine - or fight back and get back on
your feet and run again!

Coach Bob

Your Health
Athletes Run Risk of Over-Hydrating

Listen to this story... by Allison Aubrey

A runner pours a bottle of water over his head.

There is such a thing as too much water; excessive intake can dilute
levels of sodium in the blood. IStockPhoto



Hydration Tips

University of Connecticut researcher Douglas Casa says people get into
trouble when they try to follow set requirements for hydration.

Scroll below for more tips on how to figure out what's the right
amount to drink for your body.



Morning Edition, August 10, 2006 · If you're training for a marathon
or an Ironman, a hydration plan is important. Of course, there's the
risk of dehydration. But athletes now know they can also get into
trouble by drinking too much. Excessive water intake can dilute levels
of sodium in the blood. The death of a 28-year-old woman following the
Boston Marathon caught the attention of many runners and led to new
research.

Experts advise long distance runners to replace the liquids they sweat
out.

"Our goal is to try to keep someone from not getting dehyrdated by
more than 2 percent of their body weight," says Douglas Casa, a
researcher at the University of Connecticut's Human Performance
Laboratory.

One technique for calculating how much fluid you need is to get an
accurate scale. Runners can weigh themselves before and after a run to
determine how much water weight they've lost. If they're weight drops
by more than 2 percent, they have not consumed enough fluid.

Hyponatremia occurs when runners drink so much liquid that
concentrations of sodium in the blood drop off. A study published in
the New England Journal of Medicine last year tracked 488 runners who
completed the Boston Marathon and found 13 percent of them had
dangerously low blood salt levels.

The first symptoms that runners may notice is minor swelling in the
hands. "They can't get their rings off, then they might get nausea and
dizziness. They may not remember where they are" says Dr. Lewis
Maharam, who directs the International Marathon Medical Directors
Association.

Most runners get enough salt to restore normal levels by eating just
one meal after a run, and most never need medical attention. But with
a spate of reported cases of hyponatremia, Maharam's group has a new
guideline for hydrating.

The recommendation is contrary to the old advice that runners should
drink as much as they can stomach to prevent dehydration.

"The new research has shown that the body is a remarkable machine that
actually tells you via thirst when you need fluid," says Maharam.

Performance-oriented runners may prefer the more exacting
scale-weighing technique. Douglas Casa recommends that runners use
that method until they start to get a good estimate of how much water
they sweat out during a typical training run.
Everyday Hydration Tips

Dr. Douglas Casa, Director of Athletic Training Education in the
University of Connecticut's Neag School of Education says people get
into trouble when they try to follow set requirements for hydration. A
magazine article that endorses eight glasses of water a day may not be
right for you. Quench your thirst for information with Dr. Casa's tips
on how to regulate your daily drinking.

Peek at Your Pee: Monitor its color. If it's light, like lemonade,
you're doing pretty good. If it's darker, like apple juice, start
gulping down liquids.

Step on the Scale: And do it both before and after exercising, to get
a better sense of your individualized hydration needs. If you weigh
more after a workout, chances are you drank too much while exercising.
If you weigh much less, you may need to drink more. Experts recommend
losing no more than 2 percent of your body weight during activity.
Weighing the same before and after exercise, or slightly less,
suggests you are an efficient hydrator.

Consider Sports Drinks: Because they replace some of the salts you
lose when sweating, they're ideal for activities that last longer than
an hour (for instance, hiking or biking treks) or even during very
intense activities. Or if you're the kind of fanatic who's jogging in
110-degree heat.

Remember Chug Capacity: Recent studies show that coffee doesn't
dehydrate, but Casa still doesn't recommend it for a workout; it's not
the kind of fluid you can chug when you need to replace a lot of fluid
in a short period of time.

(But Not for Beer!:) Alcohol does not leave you in the best possible
state to recognize your fluid needs, prepare for the next bout of
activity, or maximize fluid retention.  Only use if stranded on an
island with a case of beer, not for the purpose of fluid replacement.

Shun Sugar: Sodas, fruit juices and even beer have a higher level of
sugar (which means more calories per serving) than most sports drinks
or water. These drinks can rehydrate your body because they contain
water, but their sugars give the stomach and intestines more to deal
with; as a result, the fluids aren't absorbed into the body as
quickly. It's fine to drink these beverages with meals and during
leisure activities, but they won't keep you optimally hydrated during
exercise.

Want Fat With That? A Surprising Way
To Make Vegetables More Nutritious
August 8, 2006; Page D1
Are you getting the most out of your fruits and vegetables?
That's the question researchers are trying to answer as they study
how our bodies absorb the healthful nutrients and compounds in foods.
What they are finding is that in our quest to cut calories and fat
from our diets, we may be cutting out a lot more.
It turns out that some of the best stuff in fruits and vegetables --
certain vitamins and cancer-fighting compounds -- are "fat-soluble."
That means some fat needs to be present for the body to adequately
absorb the nutrients. But studies are now showing that people who opt
for no-fat dressing or who skip adding foods like avocado or cheese
to a dish to avoid fat calories, are getting far less out of their
salads and other veggies.
"What we're finding is that if you don't have some fat in the meal,
all these wonderful" compounds are missed, says Steven Clinton,
program leader for molecular carcinogenesis and chemoprevention and
the Ohio State University Comprehensive Cancer Center in
Columbus. "If the nutrients don't get into your system, then what
good are they?"
Dr. Clinton's latest research looks at how adding avocado -- which is
relatively high in unsaturated fat -- to salsa or a salad affects how
well the body absorbs healthful compounds in the foods. In
particular, the study looked at absorption of carotenoids, the red,
yellow and orange pigments found in many fruits and vegetables that
are believed to have cancer-fighting properties.


For the salsa study, 11 test subjects were first given a meal of fat-
free salsa and some bread. Another day, the same meal was offered,
but this time avocado was added to the salsa, boosting the fat
content of the meal to about 37% of calories. In checking blood
levels of the test subjects, researchers found that the men and women
absorbed an average of 4.4 times as much lycopene and 2.6 times as
much beta carotene when the avocado was added to the food.
Lycopene is the red carotenoid found in tomatoes and watermelon that
is being studied as a potential fighter of prostate and other
cancers. Beta carotene is the orange pigment in fruits and vegetables
that is used in the body's manufacture of vitamin A. Studies suggest
that diets high in fruits and vegetables containing beta carotene are
linked to lower cancer rates.
With the salad test, the impact of adding avocado was even greater.
The first salad included romaine lettuce, baby spinach, shredded
carrots and a no-fat dressing, resulting in a fat content of about
2%. After avocado was added, the fat content jumped to 42%. When the
salad was consumed with the avocado, the 11 test subjects absorbed
seven times the lutein and nearly 18 times the beta carotene. Lutein
is a carotenoid found in many green vegetables and is linked with
improved eye and heart health.
Researchers noted that a small portion of the increased carotenoid
levels in the blood of test subjects could be attributed to the
compounds present in the avocado. However the vast majority of the
increase was attributed to better overall absorption once fat was
present.
Study researchers say they were not only surprised by how much more
absorption occurred with the avocado added to the meal, but they were
taken aback at how little the body absorbed when no fats were
present. "The fact that so little was absorbed when no fat was there
was just amazing to me," says Dr. Clinton.
An earlier study done in 2004 by Ohio State University researchers
showed a similar effect comparing salads consumed with no-fat, low-
fat and full-fat salad dressings. When the seven test subjects
consumed salads with no-fat dressing, the absorption of carotenoids
was negligible. When a reduced-fat dressing was used, the added fat
led to a higher absorption of alpha and beta carotene and lycopene.
But there was substantially more absorption of the healthful
compounds when full-fat dressing was used.
So far there isn't enough research to advise people how much fat they
should consume with vegetables to get the optimal absorption of
carotenoids. The basic advice is to still count calories and don't
overdo the fats, choosing heart-healthy unsaturated fats like avocado
or olive oil rather than foods with a high saturated-fat content.
A recent rat study by German researchers showed that the type of fat
matters. They compared vitamin E absorption in rats that were fed
diets with cottonseed oil or hydrogenated oils -- which contain
unhealthy trans fats. The trans fats actually slowed the absorption
of vitamin E compared with other type of fat.
For people watching their weight and the fat content of their diet,
the balancing act might be tricky. The best nutrient absorption from
the salad, for instance, occurred when diners ate dressing with 28
grams or about two tablespoons of canola oil. That translates to
about 250 extra calories.
Nutritionists say diners should look at the overall fat content of
the meal. A bowl of cereal with berries might be improved by using 2%
milk or full-fat yogurt instead of skim milk. But if you're eating a
meal, dietitians advise clients to choose one food item per meal with
a significant amount of fat, and keep the other foods very low in fat.
"If you are having a hamburger for dinner and strawberries for
dessert, it is not necessary to douse the berries in cream since the
hamburger has plenty of fat to help you absorb the nutrients and
phytochemicals from the berries," says Elizabeth Grainger, Ohio
State research dietitian. "The key is always moderation."

Is Barefoot Better?
Some Athletes Say
Running Shoeless
Benefits Body and Sole
June 6, 2006; Page D1

Runners and athletes are always searching for the perfect shoe to
improve performance and reduce injury. But some say shoes are the
problem, and the best solution may be training without them.

Some experts now believe that most athletic shoes, with their
inflexible soles, structured sides and super-cushioned inserts keep
feet so restricted that they may actually be making your feet lazy,
weak and more prone to injury. As a result, barefoot training is
gaining more attention among coaches, personal trainers and runners.

While exercising without shoes may sound painful, the idea is that
your feet need a workout, too. Proponents believe running barefoot
changes a runner's form and body mechanics to prevent some common
athletic injuries.

Although a few coaches and marathon runners have preached the value of
barefoot training, the method has received more attention lately
because shoe giant Nike is promoting its Nike Free shoe, which it
claims mimics the sensation of running barefoot. Popular training
methods aimed at improving running form, including the Pose Method
(www.posetech.com1) and ChiRunning (www.chirunning.com2), also are
prompting runners to consider minimalist foot gear or none at all as a
way to allow their natural body mechanics to take over.

It isn't just runners who are going barefoot. One new fitness trend, a
dance-inspired workout called Balletone (www.balletone.com3), places
heavy emphasis on foot strengthening and flexibility, something that
is essential to dancers. Boulder, Colo., fitness educator Shannon
Griffiths-Fable says her chiropractor encouraged her to try barefoot
training, and she has also seen a difference in clients who take part
in Balletone classes. "I've noticed just how fatigued people's feet
get," she says. "They haven't used their feet and they don't know how
to support themselves while exercising."

But barefoot training remains controversial. Many podiatrists cringe
at the notion of unshod feet pounding the pavement, where the risks
include cuts, bruises and unsanitary conditions. "If we want to mimic
barefoot running, shoes should come with broken glass and twigs," says
Stephen M. Pribut, a Washington, D.C., podiatrist and president of the
American Academy of Podiatric Sports Medicine. "The emphasis should be
on getting the right shoe for your foot."

While doctors also worry barefoot running can lead to injuries,
proponents say barefoot training helps correct form and reduces foot,
shin and muscle injuries.

Someone considering barefoot training should be careful. Doctors
strongly discourage it for patients with diabetes, because a foot
wound can lead to serious complications. Athletes with foot pain or
injuries should consult with a sports-medicine expert, trainer or
physical therapist before shedding their shoes. Even proponents of
barefoot training say you should start slowly. Runners can start on
grass, a clean sidewalk or a rubberized track. Be careful not to
overdo it and give feet and muscles time to adapt. If you aren't
willing to give up shoes while running on streets and trails, you
might consider switching to a more flexible shoe or one with less
padding if you like the way barefoot training feels. Yoga, pilates or
group fitness classes that allow you to exercise while barefoot are
also options.
[Salt Lake]
Runner Brett Williams ran the Salt Lake City marathon, his first-ever
marathon, while barefoot.

Advocates of barefoot training swear by it, claiming that ditching
their shoes has improved the running experience and solved injury
problems. Four months ago, 29-year-old Salt Lake City runner Brett
Williams was on the verge of buying the Nike Airmax 360, a $160 shoe.
In researching the shoe, he stumbled across www.runningbarefoot.org4,
which has become the Web-based bible for barefoot runners. "I decided
I'd had enough and went barefoot," says Mr. Williams, who on Saturday
ran the Salt Lake City marathon, his first marathon, while barefoot.
Mr. Williams says he enjoys running more now, and suffered only a
minor scrape during the race that was less painful than the blisters
that often develop on the feet of shod runners. "Your connection with
the ground beneath your feet is absolutely lost with shoes on," says
Mr. Williams. "I am utterly convinced your feet don't need support or
cushioning. If they do it's because you're not running correctly."

There isn't a lot of scientific study on barefoot training. Research
has shown that wearing shoes to exercise takes more energy, and that
barefoot runners use about 4% less oxygen than shod runners. Other
studies suggest barefoot athletes naturally compensate for the lack of
cushioning and land more softly than runners in shoes, putting less
shock and strain on the rest of the body. Barefoot runners also tend
to land in the middle of their foot, which can improve running form
and reduce injury.

One series of studies from Canadian researchers concluded that heavily
cushioned shoes were more likely to cause injury than simpler shoes.
They also concluded that more expensive athletic shoes accounted for
twice as many injuries as cheaper shoes. The data aren't conclusive.
It may be that buyers of expensive shoes are more injury prone or more
active, and therefore more likely to sustain injuries. A summary of
the data on barefoot training can be found at
www.sportsci.org/jour/0103/mw.htm.5

Dr. Pribut says he would like patients to seek out more appropriate
athletic shoes, and gives advice on how to do this at
www.drpribut.com/sports/spshoe.html6. He notes that some athletes who
go barefoot or give up structured shoes risk injuring themselves further.

Although barefoot runners say their feet become conditioned to running
on pavement, some are choosing minimalist footwear to protect the feet
without impeding the barefoot experience. A quirky foot-glove called
the Vibram FiveFingers (www.vibramfivefingers.com7) developed to keep
sailors from slipping on their boats is one option. A toe-less nylon
band used by dancers (www.dancepaws.com8) also helps protect feet of
barefoot trainers without the structure of a shoe.

Making the Most of Your 15 Minutes
Ilaria Montagnani's Fame Is Fueling Her Business. Here's What She's
Doing to Make Sure Her Business Lasts a Lot Longer Than Her Fame.
By GWENDOLYN BOUNDS
May 8, 2006; Page R1

Ilaria Montagnani is peaking.

Across Manhattan, students of all ages line up in gyms angling for a
spot in one of the 38-year-old Italian instructor's martial-arts
fitness classes. Ms. Montagnani, who has appeared on the "Today" show
and "Good Morning America," is in such demand that latecomers
sometimes stand in the hall trying to follow through the glass. Class
sizes got so out of hand at one Equinox club, managers had to lecture
attendees on proper etiquette -- for instance, not saving spots in the
front row.

"For a small hour, I'm a rock star," says Ms. Montagnani. "Then I come
back to earth." That's because as the chiseled 125-pound teacher
approaches 40, she knows her rock-star days are numbered if she can't
create a vehicle to sustain her work when she physically no longer
can. Currently she teaches 20 hours a week and can command $100 an
hour or more; the industry average is $22. "I'm at my highest earnings
level, and there's only one way to go from here," Ms. Montagnani says.
"And that's downward."
[go to report]1 THE JOURNAL REPORT

See the complete Small Business report2.

It's a quandary entrepreneurs of many ilk face: When the business is
you, how can it stay viable once your personal limits are reached?
It's true whether you're a consultant or hairstylist, a model or pro
athlete. Sometimes the limitation is an aging face and body; other
times it's simply the number of hours one person can work in a day.
Parlaying celebrity, however temporary or localized, into an
enterprise with longevity requires some universal steps -- from
finding other mediums beyond yourself to deliver the brand to having
the confidence to tap others who can lead where you can't.

"Regardless of the strengths of the celebrity founder, the key to
successful business development is a strong management team that can
remove the actual product from the personality," says Deborah
Larrison, head of Citigroup Capital Strategies, a unit of Smith Barney
serving owners of privately held businesses. "Another key is that the
personality not be the actual product. For example, as celebrity fades
a useless product is exactly that -- useless."

The challenges can be seen vividly among instructors in the $14.8
billion health-club industry, where aching knees and torn ligaments
can shorten classroom careers and keep teaching the domain of the
young. So rather than milk her current celebrity status by cramming in
more of her popular classes or giving lucrative private lessons, Ms.
Montagnani instead devotes equal time to building Powerstrike Inc.,
the company via which she trains other instructors in her methods,
produces videos and attempts to create new branded instruction.

While the downside can be painful -- especially the loss of immediate
revenue -- the hope is that Powerstrike will perpetuate her fitness
legacy, and income, once Ms. Montagnani must slow down. "I don't want
to be a pathetic 50-year-old jumping around trying to keep classes
with seven people," she says. "If you want to stay in the fitness
industry, the question is, how do you create a continuation of what
you do?"
* * *
[art]
Ilaria Montagnani

Unlike most channels of commerce, there are few clear long-term
entrepreneurial paths for those such as Ms. Montagnani. That's partly
because new ideas in her field don't have a natural path to market the
way, say, consumer goods do. Health clubs shy away from paying for
proprietary class content -- often preferring to develop programs they
own in-house -- and selling workout products is tough unless you're
already a brand name. Some teachers open their own studios. But that's
increasingly difficult with industry consolidation into the hands of
big names with one-stop fitness and spa shopping, such as Crunch,
Equinox and Sports Club/LA.

"Not a lot of young people are choosing this industry as a career
anymore," says Carol Espel, the national director for group fitness at
Equinox Fitness Clubs who oversees nearly 1,000 instructors
nationally. "The ones who are really serious and organized and smart
do what Ilaria is trying to do. To be successful at it, there are
very, very few."

The "few" are now household names -- among the most prominent, Richard
Simmons, Jack La Lanne and Billy Blanks, the founder of Tae Bo. In
each case, these instructors carved out a specific fitness niche and
then used various means to leverage their personalities out of a local
market and onto a national and international platform. That, in turn,
has allowed them to keep teaching well past their prime.

"It's the same philosophy as selling Avon: We are selling our
services," says the 58-year-old Mr. Simmons. "You have to figure out
what you have to offer in the area where you work." For Mr. Simmons,
the breakout medium was video.
WALL STREET JOURNAL VIDEO

[Go to Video]3
WSJ's Gwendolyn Bounds discusses4 how one entrepreneur is making sure
her business outlasts her fame.

He has sold more than 20 million copies of his 50 fitness tapes and
DVDs, including "Sweatin' to the Oldies." That has given him cachet in
nonfitness areas; for instance, he has a new line of kitchenware with
Salton Inc. due out later this year. He's also expanding the "Richard
Simmons Method" through a $195 weekend of coaching called "Hoot Camp"
for fitness instructors, trainers and others.

With this diversification, says Mr. Simmons, "I think there will be
these people who will continue to teach and have my same philosophies.
When I'm long dead and gone, it will still be, 'Love yourself, watch
your portions and move your buns.' "

There is still a long road between Mr. Simmons and Ms. Montagnani, who
currently runs Powerstrike out of her one-bedroom Manhattan apartment
and answers all her own email. But her journey thus far offers a
window into the kinds of sacrifices required when creating an enduring
business whose core brand is, at the end of the day, you.

"To be sustainable, there has to be a process and a system," says Doug
Hall, one of the judges on the ABC reality series "American Inventor,"
and the 47-year-old founder of Eureka Ranch, an invention and research
firm. "The challenge is the ego. You have to make the shift from being
a doer to a teacher."
* * *

The story of Ilaria Montagnani as "doer" begins in Florence, Italy,
where hard-core exercise among women was rare. The daughter of a
banker and a mother who worked as a treasurer at the local university,
Ms. Montagnani swam until her parents made her stop because they
believed her shoulders were getting too big. She then focused on
ballet but with her allowance bought instructional books on judo and
karate and secretly practiced poses in her bedroom mirror.

"Some people want to be dancers," says Ms. Montagnani. "My sister
wanted to be a mother. I was intrigued by the mind component of the
martial arts and realized that the ideal body was one that could come
from that. It would be strong, and you could take care of yourself."

In 1986, she traveled to New York to visit a friend for six months.
Unable to speak English, she watched soap operas and "The Price Is
Right," where, she says, "they spoke slowly and announced the words."
[Ms. Montagnani teaches a Powerstrike Forza class in New York]
SHOWTIME Ms. Montagnani teaches a Powerstrike Forza class in New York

During that stay, the 5-foot-7-inch Ms. Montagnani gained weight,
eventually reaching 135 pounds, but she wasn't in good shape, she
says. One foggy November afternoon near the end of her trip, she
passed underneath a studio where an aerobics class was in session.
Intrigued by the pounding music and shadows of moving bodies, she
walked in and joined for one month. That moment was the beginning of
Powerstrike. "It wasn't elegant, and there was no room and people were
sweating all over each other," Ms. Montagnani says. "But it gave me
the foundation of realizing how exciting and beautiful and fun for the
soul it can be to be with people moving together with music."

Ms. Montagnani was 23 when she figured out the next piece: martial
arts. She had returned to the U.S. and was working with a
Manhattan-based wholesale jeweler. On her off time, she lifted weights
and eventually pursued, and obtained, her black belt in karate. Around
that time, Ms. Montagnani took an aerobics class with Patricia Moreno,
one of the top instructors in Manhattan. The two began exploring ways
to combine martial arts and aerobics, with Ms. Montagnani showing a
kickboxing move and Ms. Moreno helping her to incorporate that with a
musical beat and eight-counts.

"It showed a level of strength that I hadn't seen before in aerobics
and a new way of moving," Ms. Moreno says. "The idea was to make
martial arts accessible to everyone, especially women for whom this
was a completely new way of moving."

Over the next seven years, the pair took Powerstrike from a no-name
program to one of the most recognized classes on the New York fitness
scene. The time was right: Jane Fonda had whet America's appetite for
group fitness, and Mr. Blanks's Tae Bo program was fueling interest in
martial arts. In 1999 and 2001, Powerstrike was named best exercise
class in New York magazine.

As class popularity soared, Ms. Moreno and Ms. Montagnani began
teaching separately -- something that helped Ms. Montagnani establish
her own loyal following. Over time, she got a marketing boost from
strong female characters boasting martial-arts prowess in films and TV
shows such as "Charlie's Angels," "Kill Bill: Vol. 1" and "Alias" with
Jennifer Garner.

"I think she is the pied piper of fitness," says Sue Carswell, a
reporter/researcher for Vanity Fair magazine. Ms. Carswell says she
dropped from a size 16 to a size eight in about five months due mostly
to taking some 10 classes a week from the instructor. Partly, the lure
was the workout's high-octane structure; partly, it was Ms.
Montagnani. "She started kicking and punching," Ms. Carswell says. "I
thought, 'Cool, I'm in the middle of a super action flick.' "
* * *

Teaching every day was heady, but it soon taught Ms. Montagnani a hard
business reality: With limited hours in a day, earnings potential was
limited. "Doing this every day of the week, it would only take us so
far," Ms. Montagnani recalls thinking.

At the time, the notion of having "certified" instructors in gyms was
fast gaining traction as students clamored for instruction in the
likes of step aerobics, spinning and kickboxing. The American Council
on Exercise was formed in 1985 in an attempt to set some competency
standards; the group currently has 45,000 certified instructors who've
paid a fee averaging about $200 to take an exam to earn the ACE seal
of approval.
FROM MAN TO BRAND

[go to podcast]5
PODCAST:6 Billy Blanks, Tae Bo's founder, has already gone where
Ilaria Montagnani hopes to go. Bill Sobel, his business lawyer, talks
about how Mr. Blanks made himself into a brand and how others can turn
a one-person enterprise into something bigger, in a podcast with the
Journal's Gwendolyn Bounds.

To Ms. Montagnani, this seemed a good model for Powerstrike. If she
could create a certification program, that would both drive revenue
and give the program legs outside of New York. In other words, she
would have a system. "That's one of the hardest routes to go," says
Graham Melstrand, ACE's director of educational services. "It's also,
I would think, one of the most profitable."

Over time, the question of Powerstrike's survival fell firmly into Ms.
Montagnani's lap, as she and Ms. Moreno drifted apart with the latter
pushing more into yoga and meditation. Ms. Montagnani eventually
bought Ms. Moreno out of her stake in Powerstrike and trademarked the
name, taking full control of the business. Says Ms. Moreno: "Anywhere
it goes from here is truly Ilaria's doing."

For Ms. Montagnani, that has meant getting others to "do" Powerstrike
for her. She currently has six types of Powerstrike classes and trains
instructors in three of those: Powerstrike Kickboxing (her signature
class), Powerstrike Impact (kickboxing with a bag) and Powerstrike
Forza, which uses a weighted wooden and plastic fitness sword to
replicate Japanese sword-fighting techniques. Often, she travels to
fitness conventions or holds open certifications throughout the U.S.
and abroad where she teaches her methods, usually over the course of a
weekend. Attendees pay a fee that typically ranges from $200 to $300
and receive a certificate of completion at the end. The smallest class
Ms. Montagnani will teach is 10 people; in Russia she has had a group
as big as 350. To date she has issued about 6,500 certificates of
completion for her various disciplines -- though not all were at the
same fee level.

In some cases, Ms. Montagnani expands Powerstrike's reach by
partnering with gyms -- something she's able to do because her
personal instruction is in such demand. At Equinox, for instance, she
is paid an annual fee, which she won't disclose, to train instructors
who teach at the chain's various locations, including those in New
York, Chicago, Miami and California. Instructors who get a certificate
of completion can say they've had Powerstrike training -- an
employment boost. But only those who pass a written test given by Ms.
Montagnani and are consistently re-evaluated can teach classes under
the Powerstrike name.

Those requirements are "essential to the success of the program"
because they guarantee quality control and ensure that Powerstrike is
taught only by the best, says Ms. Espel of Equinox. "Students love
Ilaria, but they love other instructors, too." Ms. Montagnani is paid
separately for classes she teaches herself.

Sharing the spotlight can be taxing on the ego, but experts say such
risks come with the territory. "Eventually, you have to put yourself
second and develop a system and make the system the star," says Mark
Hughes, author of "Buzzmarketing" and a branding consultant. "There's
no other way to do it. The smarter you are, the sooner you'll begin
planning this."

Ms. Montagnani also takes care to avoid exclusive deals that might
limit her expansion. Powerstrike can be licensed to any gym, for
instance. "I think it's smart," says Whitney Chapman, group exercise
manager for Reebok Sports Club/New York, where Ms. Montagnani also has
trained instructors. "It allows her to generate an income that's not
so physically driven. But it also lets her expand on a concept that's
not just specifically her so the service can still be provided."

Perhaps the most critical element of Powerstrike's expansion is Ms.
Montagnani's farm-team program -- whereby she designates some
top-notch instructors as official Powerstrike "trainers." Those
trainers then act as scouts, particularly outside New York, and find
new batches of fitness instructors whom Ms. Montagnani will then
certify; she gives scouts a cut of 10% to 25% as a finder's fee. Ms.
Montagnani says she doesn't take a cut of Powerstrike instructors'
classroom earnings because the bookkeeping would be too time-consuming
and she doesn't "like the rapport you create with that."

Further, a few select trainers have become her "master trainers."
Those travel and teach open certifications of Powerstrike in Ms.
Montagnani's stead; she still gets up to half the fees collected. Via
this structure, she has made Powerstrike -- not herself -- the product
and expanded its reach to a dozen countries.

Violet Zaki, a master trainer, was able to pursue fitness instruction
full time after getting involved with Powerstrike. She says some 50%
of her income comes from Powerstrike-related activities now. "Why
reinvent the wheel when something is already great?" she says. "There
are so many different types of kickboxing, but students are very drawn
to this. The format is very broken down."

For Debbie DiCanto, a Powerstrike trainer in New Jersey and
Pennsylvania, being associated with the Powerstrike name beefs up
class attendance -- a sign the brand is developing legs even when Ms.
Montagnani isn't around. "I get 20 to 30 people in my classes, and
outside of New York that's very good," Ms. DiCanto says. "Whenever
I've introduced Powerstrike, it always becomes the most popular
kickboxing class in that gym."
* * *

There are risks to what ms. Montagnani is attempting to accomplish.
For starters, any energy put toward managing the various components of
Powerstrike Inc. cuts into her current revenue at a time when she's at
her earnings peak. Last year, Ms. Montagnani made more than $100,000
as a teacher -- roughly twice what Powerstrike collected. But teaching
six days a week doesn't leave a lot of free time.

As such, questions of time allotment persistently arise. "Do I want to
invest and do videos?" Ms. Montagnani says. "Then I have to give up
classes and give up $20,000" of income. But when she teaches more,
she's not out certifying instructors or building other facets of
Powerstrike's business. (Currently, she's making a new Powerstrike
video, and last year she published a book on Forza.) Each choice is a
gamble.

Further, Ms. Montagnani is quickly learning that she needs more
manpower and investment to capitalize in other avenues. She once sold
apparel on her Web site, www.powerstrike.com, but the expense of
carrying inventory was too taxing. Likewise, she knows she needs an
agent to help her with future book deals or TV infomercials, and would
have to raise capital to open her own studio. Handling all of the
above, of course, takes time out of the classroom.

Her training "system," meantime, has presented some pitfalls. For
instance, Ms. Montagnani says she has filed a lawsuit in Rome against
two of her former master trainers who she claims registered the name
Powerstrike in Italy and copied her manuals. The suit is still pending.

What's more, her celebrity presents its own challenges. She receives
up to 40 emails a day from students and clients and says trying to
respond to each is "eating me alive in terms of time." Some students,
who can tell when their email has been opened, send additional angry
missives if she doesn't answer immediately.

Still, it's that very devotion that gives Powerstrike Inc. legs.
Crunch Fitness, a chain of 32 health clubs, has taken the unusual step
of paying Ms. Montagnani to design a workout program exclusively for
Crunch and to train its instructors. "We typically don't pay people to
put programming together," says Donna Cyrus, senior vice president of
programming for Crunch. "But we wanted her on our team."

The class, named "Weighted Warrior Workout," had its debut on a recent
Friday evening. Despite the inopportune time slot (Friday at
dinnertime) and a few mishaps (the weighted vests were missing), Ms.
Montagnani garnered a respectable crowd of 17. For that hour at least,
the worlds of Ms. Montagnani, Powerstrike president, and Ilaria,
instructor, merged as she strapped on the familiar headset microphone
and cranked up the music.

"It's showtime," she said, stepping into the spotlight.

New Workouts Hit the Diamond
Yoga and water jogging are helping reduce injuries. How you can do the
same
By REED ALBERGOTTI
March 18, 2006; Page P4

Baltimore Orioles outfielder Jay Gibbons used to get ready for a new
season with squat presses and dumbbell curls. But now, he's making
some big changes in his routine.

To soften the impact on his joints, the 29-year-old veteran is using
rubber-band-like resistance tubing and other workout methods designed
to reduce strain while getting his muscles toned but not bulky. Mr.
Gibbons, who spent eight weeks on the disabled list a couple of
seasons ago with a torn hip flexor muscle, hopes the new program will
make him less injury-prone -- and extend his career. "The route that I
was going, who knows how long I could have lasted," he says.

In training rooms across major-league camps in Florida and Arizona,
fitness routines are changing. The emphasis is on tailoring workouts
to reduce the injuries that plague teams in markets big and small. The
Minnesota Twins bought more than $100,000 worth of equipment,
including weight machines that use air pressure to provide constant
resistance through the entire motion, giving a better workout with
less weight.
[Fitness Photo]
New Routine: Eric Chavez of the Oakland Athletics does a "lateral
cable chop," designed to build rotational power, using a VersaPulley
machine, which responds to the force of the user.



The Los Angeles Dodgers have added "active stretching" before games,
in which players go across the field while lunging and grabbing their
feet behind their backs to stretch their quadriceps, getting them
warmed up better than old-fashioned stretches on the ground. The
Detroit Tigers' strength coach has started taking more plane trips to
visit players during the off-season and make sure they are on schedule
with their training regimens.

Fitness experts say many of the new exercises, which focus on things
like coordination, balance and strong abdominal and back muscles, are
appropriate for weekend warriors, too. Craig Friedman, a trainer at
Athletes' Performance in Tempe, Ariz., says the approach he takes with
pro baseball players can help in everything from golf to "lifting a
bag of groceries off the countertop." The reason: These workouts hit
muscles that traditional weight lifting doesn't reach, helping to
eliminate areas of weakness that can cause injuries, he says. Velocity
Sports Performance, a nationwide chain with about 70 locations, also
provides training based on the new techniques to both pros and amateurs.

Teams have always worried about injuries, but they're making
increasingly huge investments in aging players. Johnny Damon, the
32-year-old former Boston Red Sox slugger lured to the New York
Yankees with a four-year, $52 million contract starting this season,
has raised concerns with a case of tendonitis in his left shoulder.
Brian Cashman, general manager of the Yankees, calls Mr. Damon's
tendonitis minor and says the player probably pushed himself too hard,
too soon. "That happens in the spring with a lot of players," Mr.
Cashman says, adding that Mr. Damon has spent little time on the
disabled list during his career.

Also shifting the focus of teams' exercise programs is the increased
focus on testing for steroids and other performance-enhancing drugs.
As the obsession with muscle-driven home runs fades in favor of
fundamentals like base-running and fielding, players need to be fit
enough to play consistently hard throughout a game -- and throughout
the grueling 162-game season.

So, to protect against injuries and bolster endurance, it's a lot more
yoga and Pilates and a lot less bench pressing and biceps curls. The
new focus in baseball training is part of a broader shift in the sport
that's been under way for years. No longer do players kick back during
the off-season and use spring training to whip themselves into playing
shape at the last minute. While many past players had rigorous
off-season exercise regimens -- think Cal Ripken Jr. -- teams are now
taking a more active role, working with players to fine-tune workout
plans throughout the off-season.
[Working Out Like the Pros chart]

Javair Gillett, the Tigers' strength coach, says the team has long
visited players during the off-season, but he has stepped up his
travels lately, even flying down to Venezuela this winter to see
shortstop Carlos Guillen. Drills he runs in his visits include one in
which the player stands on an unsteady platform and tosses a medicine
ball back and forth with a partner, which works the abdominal muscles,
the back and the arms while also aiding hand-eye coordination and
balance. Mr. Gillett follows up with players once or twice a month by
phone and also consults with personal trainers that some players hire
for themselves. "If they don't come back stronger and faster and
quicker, that looks bad on me," Mr. Gillett says.

The San Diego Padres have been doing yoga twice a week since last
season. The idea came not from a strength coach but from surfing
legend Taylor Knox, a friend of relief pitcher Trevor Hoffman. When
Mr. Hoffman learned how yoga had helped Mr. Knox through his surfing
injuries, he offered it up as an idea for the team. It's especially
effective for pitchers, who tend to be more flexible on one side than
the other, says Todd Hutcheson, the Padres' head athletic trainer. "It
gives players better awareness of their bodies," he says.

José Vázquez, who just left the New York Mets to become the Texas
Rangers' strength and conditioning coach, has the team's pitchers
working out in a swimming pool twice a week. Mr. Vázquez instituted
workouts in which a player moves a box around underwater, toning his
chest, shoulder and abdominal muscles with the natural resistance of
the water. Other players jog in the pool -- and some do plain old
swimming. Low-impact water training helps players to recover more
quickly after workouts than they would after exercising in a gym or on
the field, Mr. Vázquez says, and being in the pool keeps players out
of the hot sun.

Baseball's new, tougher drug policy adds another wrinkle to preseason
preparations. In addition to steroids, the sport now tests for
amphetamines, which many players have used to perk up their weary
bodies ahead of games. Tim Bishop, the Orioles' strength and
conditioning coach, is teaching players breathing exercises that can
wake them up naturally. Since players get little recovery time between
games and can't just decide to go on vacation, "let's try to create
energy as best we can," he says.

One player with a particular appreciation of the challenges facing
aging major-leaguers is the Mets' Julio Franco, at 47 one of the
oldest men ever to play in the majors. He's constantly searching for
new theories on exercise and diet. His latest toy is Trixter's X-Bike,
which works the legs and the abs at the same time. "You're always
upgrading your computer; I'm upgrading the body with things that are
out there," he says. But Mr. Franco points to some outside help: God,
he says, has "continued to give me the ability to play baseball."

Powerful abdominals: Demand more of your core!
By Monica Schmidt, B.S.
February 06, 2006

Have you noticed that abdominal muscles adapt quickly to traditional
abdominal exercises such as crunches and lifts? You may discover after
maintaining your program for several weeks that a once-challenging
workout is dull and easy. This rut, known as adaptation syndrome, will
halt further muscle development. As strength gains diminish, new
exercises must be introduced.

Frequently overlooked, static abdominal training, or "holding," may
stimulate deeper muscle fibers and increase core strength. It's the
job of core musculature to work as root muscles from which all human
movement stems. The abdominals must contract statically (isometric) to
anchor physical activity. Since it's the natural function of
abdominals to support body weight, it's logical to train them in this
fashion.

It's unfortunate that, although abdominals are comprised of four
muscle layers, most of us focus on the layer that lies just below the
surface of the skin, rectus abdominus. Known as the "six pack," this
strip of muscle is trained for mostly aesthetics. Devotion to
obtaining the ever elusive six pack may cause us to forget the
function of strong abdominals, which is to provide torso stability,
even for something as simple as standing up from a chair.

Three deeper layers of abs, external obliques, internal obliques and
transverse abdominus, lie underneath the six pack. In addition to
trunk flexion, the movement of sit ups and crunches, deep layers
dictate rotational and lateral movements and aid in respiration. When
all layers are strong and work in a coordinated effort to stabilize
movement, you experience your core as a powerhouse from which all
movement in sports, as well as daily function, is enhanced.

We're all familiar with basic ab exercises done lying flat on the back
in a variety of patterns from lifts to twists. Among fitness experts,
concerns of hip-flexor involvement and lower-back stress are prevalent
pertaining to many abdominal exercises. Issues such as these are valid
and complex, and will not be expanded upon here. Incorporating static
abdominal exercises in your ab routine will not prompt greater concern
with respect to this issue.

The exercises

Static ab work can be experienced in several positions; a simple
example is straight-arm push-up position, also known as plank. You may
vary plank by trying the side version and allowing only one arm as
support. If desired, add even more difficultly by extending one leg
upward.

You might notice that exercises such as these require strength in the
arms and shoulders. As your abs gain static strength, your body weight
will seem lighter and your arms more able to base the position.

An analogy is to think of moving a bed. A box spring is easier to
move, as opposed to a soft mattress. When you mimic the box spring and
your body is tight, your arms feel more proficient in handling the weight.

Considering this, stay rigid in core muscles and if arms still feel
weak think of the work as an opportunity to strengthen muscles here as
well, and more importantly to create a "kinetic chain" of coordinated
static contraction that originates in the abs and like a domino effect
spreads to the chest, shoulders and arms.

The boat, the crow and the staff, all of which can be found as part of
power yoga, Pilates, and/or functional training routines, are static
positions that promote ultimate abdominal strength. Try these
movements in a series, mixing the order periodically for variety.

Overall, remember that any movement that requires you to hold your own
body weight steady requires static strength in abdominal muscles and
will enhance core stability. Advanced versions of this principle are
inversions such as handstand or headstand, both of which require
supervision to learn if you don't already possess the skill.

Although static work is effective, you shouldn't abandon your old
routine entirely. Rather, eliminate some exercises, making changes
gradually. Work up to holding static positions for five seconds each.

Tips and cautions

Static work may cause holding the breath; be mindful to keep
breathing. High blood pressure patients should check with a physician
before experimenting with these exercises. If you experience chronic
wrist pain or weakness, wearing wrist supports will be helpful.

Monica Schmidt has a BS in exercise science. Contact her at
561-789-8080 or info@....

Reprinted, courtesy of Competitor Magazine. For more articles and
information for Competitor, please visit www.competitor.com.

MORE THAN DIRECTIONS

A sampling of the services Web sites have developed using Google's
Maps tool.
• WalkJogRun.net
Calculates distances and estimates travel times for any jogging route
you create by clicking on a Google map. You can also view preloaded
routes.

• CellReception.com/towers
Brings up a Google map of nearby cellular towers when you enter a city
name or ZIP Code. Also provides comments about coverage and signal
strength in nearby areas for multiple carriers.

USING HIP FLEXORS VS. HAMSTRINGS FOR LIFTING THE FOOT FROM SUPPORT IN
RUNNING

Skidd 777, I am flattered by similarities you mentioned between Chi
and Pose. The biggest difference, you think, you see, is that Mr.
Dreyer advocates lifting the leg by using the hip flexors rather than
the hamstrings. Please, get the Chi running DVD and you will be
surprised to see that Mr. Dreyer doesn't "advocate" using hip flexors
anymore, but shows how to lift the heels by flexing knees in air. I
can't imagine how it is supposed to be done by hip flexors. From the
book to the video it is a quite radical shift in "understanding" of
running technique.

Holistic philosophy is not about using the biggest, largest and
strongest muscles to do most of the work and it has never been this
way. Holistic philosophy is about being integrated into the system,
which we call Nature, as a part of it, and use it for our own
perfection. In movement, we interact with gravity as our leading,
predominant force in any movement, and our muscles perform as
transmitters of this force. It is difficult to realize this when your
mind is predisposed to seeing muscles as a primary force in movement
and you rely on them as such completely. It is necessary to take a
step away from your common sense to be able to abstract from "reality"
and see the Hierarchy of Nature.

The Laws of Nature are very simple. Many scientists tried to define
them. One of the first was the French scientist of the 18th century,
P. Mapurtiu, who formulated it as a principle of minimum action. The
essence of it goes as follows: when some change happens in nature, the
amount of action, it takes for this change, is usually the least
possible. At present time this principle received a strong support
from mathematical interpretation and is well known in the theory of
synthesis of technical systems of automatic regulation.

According to this theory, there is no need to use the biggest muscles
to change a position of such a small part of the body, as the foot,
from the ground in running. The primary use of the hamstring muscle
comes from a very specific logic of the running movement. I would like
to emphasize here the word "primary", because strictly speaking, there
is no separate muscle activity in our body, even in some seemingly
isolated movements. There is always some orchestrated effort, a group
of muscles involved in any movement. Therefore, hamstrings represent
the leading group of all muscles engaged in the removal of the support
foot from the ground while the body leans forward during the stance time.

In practice there is no need to ask runners to use the hamstrings, but
just to move the foot from the ground up. The body "knows" by itself
how to do it, but our mind makes it very difficult by "adding" some
core muscle activity to it. That's why I ask to use hamstrings
consciously, in order to distinguish its work from any other muscle
activity. I found through our Pose Tech clinics that most runners have
a perception problem with differentiation between the foot and leg
pull. Instead of pulling or lifting the foot from the ground, they
lift the knee (thigh) by using their hip flexors with a "full
perception" of pulling the foot. Certainly, when you pull the knee,
then the foot would be lifted as well, but it would follow the knee
movement, not the other way around. We need the movement of the foot,
first, as our primary action.

Why is it so important that hamstrings lead in this movement? Because
they initiate and prioritize the foot movement, not the whole leg one.
This reduces the efforts, directs the movement of the foot, and
integrates it correctly with the whole body movement in space and
time. This allows us to bend the knee quicker and rotate the leg
faster, because it becomes a shorter pendulum around the hip axis
(Coriolis Effect) and by this move it faster, forward under the body.
Beside this, the foot pulling action reciprocally initiates the use of
muscle elasticity during the support time.

The whole purpose of pulling the foot under the hip is to bring the
center of mass of the leg to the vertical line going through the
General Center of Mass of the body over the ball of the foot, so that
the body could start falling forward. If the center of mass of the
swing leg is behind the vertical line going through the ball of the
foot, our GCM is behind this line as well. Than our body is not able
to fall or is late to reach the falling point, which is the midstance
or the Running Pose, which we start falling forward from and where the
pulling action starts from, as well. Only when our foot unloads the
body weight, the pulling action can happen. By that time all the front
muscles are silent after being unloaded, so the hamstrings take over
to reproduce the next Pose and the next fall.

How can you learn to differentiate between lifting the leg and lifting
the foot? You need to develop your perception or awareness of your
body. You can perceive it as muscle tension in hip flexors, some
specific positions of the knee, thigh and foot during the swing time
of the leg. You can easily distinguish between these leading
activities by watching your run on the video. If you are not using the
foot pulling action, your foot is lagging behind. Using hip flexors
leads to an excessive hip transverse rotation and higher than
necessary thigh position in the front part of the leg swing. In the
proper foot pull, neither one of these actions is present.

One note about the use of hip flexors in cycling. There is no need to
use them as primary muscle force in upward pedal stroke, but I'll
leave it as a separate topic for another discussion.

Dr. Romanov

A Savannah Man
Gets to the Bottom
Of a Nasty Affliction
Mr. Thomas's Book Declares
War on Toenail Fungus;
Solution Shows Promise
By BARRY NEWMAN
Staff Reporter of THE WALL STREET JOURNAL
November 21, 2005; Page A1

SAVANNAH, Ga. -- Bookstores assign yards of shelving to tales of
triumph over alcoholism and diabetes, obesity and stroke. Dwight
Thomas has written a tale of triumph about his toenails.

"Leukemia had a best seller," said Mr. Thomas, author of "The War
Against Toenail Fungus." In breathable sneakers, he stood one day at
the writing table in a front room of his townhouse here. "Toenail
fungus is ignored," he said. "It's extremely widespread. Nobody knows
much about it, and you can't get rid of it. I leaped into the breach.
This is a toenail-fungus patient memoir."

Toenail fungi, the same bugs that cause athlete's foot, squeeze under
toenails and hide. They turn toenails yellow and crumbly. For reasons
not well understood, they dig in deeper as people age. Now they're
besieging the veterans of the fitness fad. Toenail fungus, in Mr.
Thomas's words, is a "disgustingly earthy problem."
[Dwight Thomas]

And one ripe for pharmacological exploitation. In America, according
to Kalorama Information, a market-research publisher, 35 million
people have it, and they spend around $1 billion a year trying to kill it.

Drugstores are full of toenail-fungus nostrums -- Mycocide, Miracle
Anti-Fungal, Dr. Blaine's Tineacide. Many of the packages have toenail
photos and fine print acknowledging the view of the Food and Drug
Administration that toenail-protected fungi are beyond their reach.
The Internet crawls with unsure cures: neem oil, emu oil, aloe sludge,
vinegar baths, bleach, Vicks VapoRub.

"I have that ugly fungus on my big toenail," says a chat-room posting.
"Thick, brown etc. I was told if I soak it in urine that it should be
gone in a week. Any info as to whether this is valid?"

Not really. Only a few new and costly prescription drugs -- Lamisil
and Penlac are two big ones -- have proven ability to penetrate a
toenail. Mr. Thomas first learned of them six years ago on a visit to
his dermatologist. It was on "a dull, dark, fateful day in January
1999," he writes, that the doctor "peered at my naked toes," looked up
and said, "It's the fungus."

Fine-featured and 60 years old, Mr. Thomas belongs to one of
Savannah's well-off founding families. He lives just across Monterey
Square from the mansion where John Berendt set "Midnight in the Garden
of Good and Evil." He never attended the fancy parties thrown there.
As a note on his doorbell explains, Mr. Thomas, who has a doctorate in
literature, sleeps twice a day -- at dawn and dusk -- and writes at
his computer in the afternoons and in the wee hours.

His 1987 work, "The Poe Log," is a 919-page account of what Edgar
Allan Poe did on every day of his life. He calls it "an act of
fanaticism." Twelve years after his Poe book, Mr. Thomas began to get
the itch to do a toe book.

Shuttling from his dermatologist to his podiatrist, he tried Lamisil.
It worked; then the fungus came back. He tried Penlac. It worked; then
the fungus came back. Months passed. One tiny vial of Penlac cost him
$200. A Lamisil tablet -- one a day for 12 weeks -- cost over $8.
Those cartoon bugs in Lamisil's ads got very annoying. And under the
big toe of his left foot, the fungus stayed put.

Fed up, he took his toenails into his own hands. Tirelessly, he read
the full corpus of fungal literature. Careful to avoid the potential
side effect of liver damage, he devised a new regimen for himself,
using Lamisil and Penlac at the same time. It worked: The fungus left
and stayed gone. It was then, in empathy with millions of sufferers
and co-dependents, that Mr. Thomas realized his journey of toenail
discovery deserved a memoir.

He struck a military theme, aiming at the ungually fungal Vietnam
generation, and two years ago turned out a 221-page volume replete
with scientific citations. Sensing that big publishers wouldn't buy
it, Mr. Thomas published the book himself, illustrated with his own
battle-map drawings of his right big toe.

Soon, it hit home that marketing a fungus memoir could be harder than
writing one, particularly for "somebody who's sort of removed." The
toenail category had competitors: a slew of Web sites, one selling a
downloadable book. There was only one print challenger, Mike Tecton's
"How I Cured Deadly Toenail Fungus."

Mr. Tecton has written 89 other books, including "Tudor Wood
Paneling," "Communist Causes of the Civil War," and "Enchanting
Storybook Homes." Reached at home in McLean, Va., Mr. Tecton, 76,
qualified his claim to have cured toenail fungus. "I actually got it
back," he said. "I still have it."

In a wide-open field, Mr. Thomas might have promoted his book in Dr.
Leonard's, the discount health catalog, alongside the bunion shields
and toe separators. Instead, he ran a string of ads in the New Yorker
magazine. Later, he switched to the Atlantic Monthly.

Mr. Thomas decided against a nail-salon book tour, perhaps wisely. At
Sassy Nails in downtown Savannah, June Dang was shown a copy of his
toenail book while she was manicuring Tammy Woods's fingernails one
morning.

"Would you read a whole book on toe fungus?" asked Ms. Dang.

"Probably not," Ms. Woods replied. "I'd only purchase it if it had
other-parts-of-the-body funguses as well."

Esther Shaver stocks local authors at her bookstore two blocks from
Monterey Square. Mr. Thomas never gave her "The War Against Toenail
Fungus." He hasn't shown the book to the local podiatrists and
dermatologists he consulted. He hasn't sent it to Sanofi-Aventis SA,
Penlac's maker, or Novartis AG, the maker of Lamisil. But Mr. Thomas
feels he's done all he could to market a book on toenail fungus. And,
it turns out, his double-drug solution might be right.

Without seeing it, no one at Sanofi-Aventis or Novartis could comment
on the book. But Sanofi has independently come to the same idea. It
has funded a large-scale clinical trial going far beyond Mr. Thomas's
toes. Its lead researcher, dermatologist Abitya Gupta, expects results
by 2007. He says the early data suggest that Lamisil and Penlac in
concert are "indeed more effective than either drug alone."

Sales of "The War Against Toenail Fungus" have broken into the low
thousands. Mr. Thomas has a new ad running in Harper's. Still, he has
faced the fact that toenails don't make literary careers. His third
book, almost done, is a history of research on breast cancer.

"What really sells a patient memoir is word of mouth," he said, seated
among file boxes and athlete's-foot remedies in his writing room. "But
this disease is not discussed at cocktail parties. Nobody discusses it
at all." Mr. Thomas added: "Toenail fungus has no word-of-mouth
potential."

Corrections & Amplifications:

An earlier version of this article misspelled Edgar Allan Poe's name.

New Wave
In a Stroke Patient,
Doctor Sees Power
Of Brain to Recover
'Neurointensive' Care Gains
Adherents, Despite Risk
Of Raising False Hopes
'Too Often, People Give Up'
By THOMAS M. BURTON
Staff Reporter of THE WALL STREET JOURNAL
November 23, 2005; Page A1

Devastating strokes on both sides of his head drove 31-year-old Mark
Ragucci into a deep coma. As seizures swept through his brain like
silent electrical storms, his gaze froze. His arms were paralyzed at
his sides in a syndrome neurologists call man-in-the-barrel, signaling
serious brain damage.

The most likely fate for the patient was death or survival in a state
of near-total disability, concluded Stephan A. Mayer, director of
neurointensive care at Columbia University's medical center. "I really
thought there was no hope" of a meaningful recovery, recalls Dr. Mayer.

But the family of Dr. Ragucci, who had just started a career as a
doctor before his stroke, wanted every possible effort made to spare
his life. So Dr. Mayer and his colleagues aggressively treated Dr.
Ragucci's pneumonia, septic infections and roller-coaster blood
pressure. They also dramatically cooled his body and brain to protect
brain tissue.
[Stephan Mayer]

A month after his stroke, Dr. Ragucci had recovered somewhat
physically, but not mentally. He was still officially in a vegetative
state. Six weeks after the stroke his family transferred him to a
rehabilitation facility, and that was the last Stephan Mayer saw of
Mark Ragucci.

The last, that is, until the day nearly a year later, in late 2002,
when Dr. Ragucci walked into Dr. Mayer's Columbia office and
introduced himself. The former patient spoke in a monotone and his
fingers were tightened into claws, but that was the extent of his
disability. "When he walked in, I almost fell over," Dr. Mayer
recalls. "It was at that point I realized that we knew absolutely
nothing about the recuperative power of the brain."

Doctors often make minimal efforts to save the lives of advanced
stroke victims, especially those who are days or weeks into a coma.
They often see the prospects of survival as low and question the value
of saving a life that they expect, in the best case, to be severely
constrained by mental and physical damage.

Now proponents of neurointensive care are challenging these
assumptions. They say many of the studies underlying the earlier
consensus are out of date, and they believe newer treatments such as
one designed to cool the brain may help stroke patients in comas.
"Doctors are telling people there's no hope when, in fact, there is,"
says Dr. Mayer.

Dr. Ragucci, who is now at 35 back to practicing rehabilitation
medicine, says he was somewhat conscious even when his doctors
perceived no brain activity, and it bothered him to hear nurses and
doctors referring to him in the past tense. "Somebody has to realize
that you're in there," he says. "Just because you can't move doesn't
mean there's not somebody in there."

The newer approach faces skeptics. Justin A. Zivin, a professor of
neurosciences at the University of California, San Diego, says he is
concerned that neurointensivists haven't yet proven many of the
therapies they use on patients. He cites the common practice of
inserting a pressure monitor into the brain and injecting salt water
to draw off fluid if pressure seems too high.

"It would be extraordinarily helpful if they had evidence," he says.
"Have they proven that these therapies are better than nothing? I'm
not saying it won't ultimately be proven." Dr. Zivin says this is one
reason many hospitals have yet to embrace the idea of a separate
neurocritical care unit.

Dr. Mayer agrees that techniques such as monitoring and regulating
pressure within the skull have yet to be proven in human trials. But
he says, "We have to push the envelope and do things that at least are
well-grounded in the scientific evidence that is available."

Aggressive treatment of stroke victims can have a serious downside. If
a patient is kept alive for a few extra weeks in an intensive-care
unit only to die at the end, the cost may be tens of thousands of
dollars with no benefit. The American Stroke Association estimates
that the annual U.S. cost of stroke care is $35 billion.
[U. S. Stroke Facts]

The treatment may raise unrealistic hopes in family members. Even if
it saves patients from death, they may survive only in a state of
severe disability or remain in a vegetative state, burdening family
members for months or years. Many people eager to avoid being kept
alive in such a condition have drafted documents designed to stop
medical intervention as soon as a doctor decides brain recovery isn't
possible.

Yet some neurointensive-care specialists now believe that many doctors
are too quick to reach that conclusion and encourage families to
abandon hope. "The fatalistic attitude toward treating brain disease
is very prevalent -- and untrue. All too often, people give up," says
Owen B. Samuels, chief of neurointensive care at Emory University.
"We've all been humbled by the brain's ability to recover."

Some studies support the notion that medicine could be saving the
lives of more stroke victims, especially those with hemorrhagic
strokes that involve bleeding in or near the brain. A study of
hemorrhagic stroke patients at Emory shows a higher percentage are
becoming well enough to go home since the university opened a
neurointensive care unit, says Dr. Samuels. However, the studies
generally aren't clinical trials in which patients are divided
randomly into groups prior to treatment to see what works best. Such
trials often provide the evidence doctors trust most.

In a 2001 study of 87 patients in the journal Neurology, University of
Washington researchers reported that nine of the 15 sickest
hemorrhagic-stroke patients who got aggressive care survived despite
severe bleeds and bad comas. Doctors stopped treating other patients
with the same severity of condition -- and all of them died.
"Practitioners tend to be overly pessimistic in prognosticating
outcome," the authors wrote.

The authors also described the same cases to neurologists, without
disclosing the outcomes, and asked how the doctors would have handled
the cases. The authors found that as many as one-third to one-half of
the surveyed doctors would have given up on patients who ended up
alive six weeks later.

A 2004 study in the journal Stroke looked at 8,233 hemorrhagic stroke
cases at 234 California hospitals, many of them comatose patients on
ventilators. Some of the hospitals withdrew treatment frequently
during the first 24 hours by issuing "do-not-resuscitate" orders.
Other hospitals waited longer. After researchers adjusted for severity
of illness, they found patients in the hospitals that waited longer to
withdraw care had a better survival rate.

Being Realistic

Presumably the doctors who withdrew care more quickly thought they
were being realistic and saving families anguish by hastening the
inevitable. But these doctors were in fact sometimes giving up too
soon, says J. Claude Hemphill III, the researcher at the University of
California, San Francisco, who headed the study.

A 2001 study in Critical Care Medicine by Michael N. Diringer and
Dorothy F. Edwards of Washington University in St. Louis studied
records of more than 40,000 patients with bleeding in their brains.
Patients in a regular intensive-care unit were 3.4 times as likely to
die as patients in a neurointensive unit, after adjusting for the
severity of the bleeding, the study found.

At Columbia, Dr. Mayer's own career offers an example of how thinking
has changed. Now 43 years old, he took charge of the neurointensive
program there in 1994. In his first years, he says, he encouraged the
unit to be more aggressive about recommending that families remove
ventilator tubes when their loved ones lingered in a coma. Dr. Mayer
thought that was the kinder approach. Of neurocritical patients who
died at Columbia in 1996, about 50% had ventilator support withdrawn,
up from 8% in 1994, he says.

Questioning His Policy

One by one, however, patients led Dr. Mayer to question his own
policy. An 80-year-old patient from Harlem who became comatose
following the rupture of a swollen artery, or aneurysm, in his brain
survived after Dr. Mayer and colleagues treated him by putting metal
coils in the artery to cause clotting and stop bleeding.

This contradicted a 1968 study that was considered definitive in the
field. It concluded that death was virtually inevitable when a patient
with such a ruptured artery arrived in a coma. Dr. Mayer and his
colleagues began making it a regular practice to treat such patients
and found that about half survived, though many still had
disabilities. When he examined statistics for all bleeding strokes
caused by aneurysms -- including cases where the patient wasn't in a
coma -- Dr. Mayer found a survival rate of 80% in his clinic, compared
with 65% in the 1968 study.

The case that most altered Dr. Mayer's thinking was that of Mark
Ragucci. On Dec. 3, 2001, Dr. Ragucci underwent surgery to repair an
aneurysm in his aorta, the body's largest artery. Following surgery,
for reasons no one has determined, Dr. Ragucci's heart stopped. For 24
minutes, blood wasn't getting to his brain -- well beyond the time
that doctors usually say brain function can survive.

Due to the halted blood flow, he suffered three massive strokes on
both sides of his brain. His brain started to suffer seizures --
electrical storms that interrupt the brain's normal signaling and
sometimes lead to permanent injury.

He lay in a coma for days in the intensive-care unit of another New
York City hospital. His wife, Laura, and mother became convinced that
doctors there were resigned to his death. The family did some research
and resolved to transfer him to the neurointensive-care unit at the
Columbia hospital, which is officially known as New York-Presbyterian
Hospital/Columbia University Medical Center.

There, Dr. Mayer deemed the patient to be nearly hopeless. Strike one
was the 24 minutes of cardiac and circulatory arrest. The seizures
were strike two. Strike three was the total paralysis of Dr. Ragucci's
arms. "I was taught it is exceedingly rare for someone to recover on
any level from man-in-the-barrel syndrome," says Dr. Mayer. "I had no
expectation at all that we could help."

Dr. Mayer was frank in his first conversation with Mark's wife and
family. In Mark's type of case, even if he survived, "maybe 5% of such
patients could follow commands after one year," Dr. Mayer recalls
telling them.

The family was stunned. Dr. Mayer "basically told me we should be
looking at nursing homes," recalls Laura. Mark's mother lashed out at
Dr. Mayer after hearing him estimate percentages. "Let's get something
straight right now," Mrs. Ragucci recalls telling the doctor. "If it's
something that you don't know for sure, keep it to yourself."

The night of Dr. Ragucci's arrival -- 17 days into the coma -- the
neurointensive team began clearing out his lungs. "He was very sick
with pneumonia," says his mother. Then doctors gave him antibiotics
for septic infection and intravenous drugs called vasopressors to
control his blood pressure.

At the same time, the team set about saving his brain -- the main
mission of any neurointensive treatment. "It's a full-court press,
guns blazing, pedal-to-the-metal," says Dr. Mayer. Without such an
effort, a ventilator to keep a coma patient alive "is a
vegetable-producing machine," he says.

Mark Ragucci's case was one of the first in which Columbia doctors
used a device called the Arctic Sun. It uses gel-lined pads filled
with cold water to cool the patient's blood and brain.

"We've learned that when these patients become febrile, they go into a
deeper coma level," says Dr. Mayer. "They develop something called
central fever, but until about 1998, we had nothing to really cool
people effectively." Doctors often simultaneously use a device called
the Bair Hugger -- blankets that blow hot air on the patient's feet
and legs -- to trick the body into not shivering despite the cooled blood.

Dr. Mayer concedes that some of his techniques, including the use of
sodium solution to relieve pressure, remain unproven. "We're in 'Deep
Space Nine' here," he tells medical residents.

For a while Dr. Ragucci remained in a deep, unchanging coma. Doctors
squeezed his toes hard, shone flashlights into his eyes and talked
loudly in front of him -- all with no apparent response. But by the
end of his stay at Columbia, he had begun to show faint flickers of
emerging from the coma. Dr. Mayer recalls that his patient said two
words at one point, then lapsed back into seeming unawareness.

By then, more than five weeks after Dr. Ragucci entered a coma, Dr.
Mayer and his team had done all they could. Dr. Ragucci was no longer
facing death or suffering brain seizures. He was transferred to a
general neurology floor at Columbia.

Over the following weeks -- first at Columbia, then at New York
University's Rusk Institute of Rehabilitation Medicine and finally at
his parents' house -- Dr. Ragucci slowly regained consciousness.

With the help of his family, he began a program of intense physical
rehabilitation. He worked 12 hours a day with a therapist, squeezing
beanbags, working with pulleys, relearning how to use his arms. In
time, he regained enough physical ability to go to the gym and use
stair machines, often rising at 4:00 a.m. to do so.

Mysteries of the Case

Why Dr. Ragucci recovered consciousness and how much the care in Dr.
Mayer's unit contributed to his comeback remain central mysteries of
the case. Possibly the damage from the original strokes and 24 minutes
of heart stoppage was not as great as feared and, in hindsight, Dr.
Ragucci's return to consciousness shouldn't have been so unexpected.

Dr. Mayer believes the care was crucial and the case reinforced his
belief that neurointensive treatment can save lives. "Mark's great
recovery reflects the brain's innate resilience and ability to
recover, which I believe has been vastly underestimated to date," says
Dr. Mayer. "It has been underestimated because we never saw any
long-term outcomes, because we have always let them die assuming the
outcome would be terrible."

Dr. Ragucci remembers the painful squeezing of his toe during what
doctors thought was a deep coma. "My toe hurt a lot and I tried to
say, 'Stop it.' I thought I mouthed the words." It bothered him that
he could hear one of the doctors remarking, "He's in a persistent
vegetative state."

The greatest milestone in his recovery came in August 2003 when Dr.
Ragucci resumed his work as a rehab doctor. He works at Bellevue
Hospital Center and NYU, where he had been a patient. Today, Dr.
Ragucci often works with patients who have regained consciousness but
have far to go toward recovery, and he shares with them his own
comeback story.

"Even though I'm a rehab physician, I didn't know how hard these
things were," he says. "I thought I was an empathetic person before,
but now I know I am."

Write to Thomas M. Burton at tom.burton@...

Passing Out at the Finish Line: When
Fainting Signals a Heart Problem
By KEVIN HELLIKER
November 8, 2005; Page D1

During an eighth-grade cross-country meet, 13-year-old Nicholas
Ballesteros sprinted across the finish line, walked a few feet and
passed out -- thereby running headlong into medical controversy.

When an athlete passes out during the middle of a race, medical
protocol clearly calls for a cardiac evaluation to be performed.
Passing out is a known symptom of cardiac defects, and cardiac defects
are the primary cause of sudden death in athletes.

But when an athlete passes out past the finish line, medical experts
are divided on whether a cardiac evaluation is needed. This isn't
because cardiac disease is less likely to display symptoms just past
the finish line; in fact, the dramatic shift from sprint to sudden
cessation can trigger an episode of cardiac-defect-induced fainting.
[nowides] HEALTH MAILBOX

[Health Mailbox]
Read Tara Parker-Pope's Health Mailbox1 where she answers readers'
questions about medical studies, ailments and treatments.

The problem is, that same shift can induce fainting from other causes,
particularly a benign one called exercise-associated collapse. This
happens when the sudden cessation of exercise sends blood pressure
plummeting, slowing the flow of blood to the brain and causing
syncope, the medical term for fainting.

For exercise-associated collapse, the suggested treatment is simple:
Raise the athlete's feet above the head to speed blood flow to the
brain. If that technique triggers a rebound, "then I don't think
further evaluation is warranted in most circumstances," says Andrew
Gregory, a Vanderbilt University pediatrician and sports-medicine
specialist. Indeed, a March 2003 article in the journal Physician and
Sportsmedicine examines the causes of post-finish-line fainting --
without discussing cardiac defects as a possibility.

This surprises Stuart Berger, director of the heart center at
Children's Hospital of Wisconsin. "In my specialty there is no
controversy about this," says Dr. Berger, a pediatric cardiologist.
When athletes faint during or immediately after exercise, "they need a
thorough cardiac workup," he says. That means the administration of an
electrocardiogram to monitor the rhythm of the heart, and an
echocardiogram to study the structure of the heart. Eric Small,
chairman of the sports-medicine council of the American Academy of
Pediatrics, agrees: "If syncope occurs past the finish line, you can't
assume that it's benign," he says. "It has to be investigated."

Drs. Berger and Small agree that fainting beyond the finish line most
often will turn out to be the result of low blood pressure. But the
worst-case scenario must be considered -- and too often isn't, they
say. The danger applies both to adults and children, but the symptoms
in children are more often overlooked because of the misguided
perception that heart disease is a plague of the middle-aged and older.
[Health Journal]
Nicholas Ballesteros plays soccer today, after having a heart defect
repaired.



The number of deaths associated specifically with fainting after
exercise hasn't been tracked. The medical literature often states that
sudden cardiac death in young athletes claims fewer than 25 American
lives a year. But these have been rough estimates, and the actual
number is between 200 and 300, says Barry Maron, a Minneapolis Heart
Institute Foundation cardiologist who is compiling a registry of such
deaths to better track them. An International Olympic Committee report
issued last year estimates that competitive young athletes suffer
sudden cardiac death at three times the rate of their nonathletic peers.

After such a tragedy occurs, it isn't uncommon for a parent to recall
an earlier fainting episode that failed to raise any alarms. "When you
investigate these deaths, you often find that there were symptoms,"
says Paul Thompson, director of the athletes' heart program at
Hartford Hospital in Connecticut.

The fainting episode of Nicholas Ballesteros didn't alarm either his
parents or coach. Recovering quickly, the boy attributed the collapse
to dehydration. "We didn't think much about it," says Mithra
Ballesteros, the boy's mother.

To her immediate regret, however, she mentioned the episode to her
father, Manoochehr Sharifi, a retired Chicago-area pediatrician. Dr.
Sharifi had previously encountered a case of exercise-related syncope
that turned out to be symptomatic of a potentially fatal cardiac
condition called Long QT Syndrome.

At her father's insistence, Mrs. Ballesteros took Nick to his
pediatrician, who performed an electrocardiogram, or EKG. The test
showed a normal heart rhythm. This satisfied the pediatrician, says
Mrs. Ballesteros, and it satisfied her, too. Not, however, her father.
Among other things, Dr. Sharifi says, "I thought Nicholas should have
an echocardiogram." An EKG is around $100, but an echo can run as high
as $1,000; insurance will usually pay.

Reluctantly, Mrs. Ballesteros got a referral to a cardiologist to
perform the echocardiogram -- Dr. Berger in Milwaukee. The day of the
appointment, Mrs. Ballesteros says she nearly canceled it. She felt
certain the appointment would be a waste of time. And "I had a ton of
things to do," says the mother of four. But knowing her father would
expect a report, she kept the appointment.

The news turned out to be bad: Nicholas had an anomalous coronary
artery. The vessel, carrying freshly oxygenated blood, took the wrong
route from the aorta to the heart, exposing it to the possibility of
compression, which would deprive the heart of blood, and which would
be especially likely to happen during exercise. Anomalous coronary
arteries are the second-leading cause of sudden death in young
athletes, after another defect, hypertrophic cardiomyopathy.

Nicholas underwent surgery to repair the artery and is now healthy.
Two years later, he plays high-school soccer. It will never be known
for sure whether the defect caused the fainting spell. But the
fainting unquestionably led to the uncovering of the defect. "My
father saved my son's life," she says.

The following is from an email from Owen Anderson . . .

exercise also has many abrupt transition points. For humans, the
movement speed of 2 meters per second represents one such precipitous
passage. At all velocities of 2 meters per second or less (e. g., at
all tempos of 13:24 per mile or slower), walking requires less energy
than running, and so we almost always walk at such speeds.

If we want to move faster than 2 meters per second, we invariably jog
or run, because running is more economical than walking at such
tempos. We automatically adjust gait to minimize the energy cost of
locomotion, and so we rarely see individuals jogging at 15-minute per
mile pace - or walking at 10 minutes per mile.

Another important transition occurs at a walking speed of about 5
kilometers per hour (a tempo of around 19 minutes per mile). Exercise
scientists have known for years that if one plucks an average person
"off the street" and asks him/her to walk "normally", he/she will
usually settle in at a pace of about 4.8 to 5 kilometers per hour.
This is nothing new: Human footprints left in Kenyan/Tanzanian mud two
million years ago suggest that these first imprint-leavers were
strolling through East Africa with an alacrity of 5 kilometers per
hour, too!

Not surprisingly, the velocity of 5 kilometers per hour is an
important threshold point. Above 5 kilometers per hour, the oxidation
of carbohydrate by leg muscles increases dramatically, and as a result
perceived effort rises significantly. Below 5 kilometers per hour,
carb-burning falls off, fat breakdown ascends, and perceived effort
moderates considerably. The human brain monitors carbohydrate
oxidation during exercise quite carefully - and rather perversely
cranks up perceived effort when carb-burning is on the upswing. In
effect, the brain tries to keep exercisers from burning up their
carbohydrate (glycogen) stores by making the process of doing so feel
too difficult. This is a key reason why sustained runs at a high
intensity such as vVO2max feel so incredibly hard. Nothing bad is
really happening to your muscles at vVO2max - it's just that the brain
doesn't like such red-hot exertions, given its constant worries over
the glycogen depots in the mu! scles. The brain is content at a pace
of ~5 kilometers per hour because carb-burning is minimal, and thus 5
km/hour is a universal walking speed.

An extremely important transition point during running is called the
lactate threshold, or lactate-threshold speed, which happens to be an
excellent predictor of running peformance. Lactate-threshold speed is
simply the running velocity above which lactate begins to accumulate
rapidly in the blood.

Historically, the lactate threshold was thought to be caused by a lack
of oxygen in the muscles, which thus forced the sinews to do more
anaerobic work, subsequently leading to a release of lactate into the
blood. The remedy for a lackadaisical lactate threshold was usually
thought to be high-mileage training, which was supposed to enhance the
functioning of the cardiovascular system and improve the delivery of
oxygen to the muscles (and the utilization of oxygen once it got
there). In theory, this expansion of aerobic capacity would cure a
languid lactate threshold.

However, such conceptions ignored the simple and unavoidable facts
that lactate threshold occurs at just 50 percent of max aerobic
capacity in many untrained individuals and at 85 percent of max
aerobic capacity in many elite runners - in other words in situations
in which oxygen is quite plentiful and the
oxygen-delivery-and-utilization system has not been taxed to its limit.

Recent research suggests that the real "problem" which produces the
lactate threshold actually is unrelated to oxygen delivery and in fact
resides in the "shuttle systems" which exist in the walls of
muscle-cells' mitochondria. To understand how this works, it is
important to know that within muscle cells molecules of an important
chemical called NAD work as "carriers". NAD's job is to pick up
high-energy hydrogens (which have been stripped off carbohydrate
molecules, for example) and then carry them to the "shuttle
mechanisms" in the walls of the mitochondria. The hydrogens can then
leave NAD, shuttle through the mitochondrial walls, and move inside
the mitochondria; in the presence of oxygen, the energy contained in
the hydrogens is then transformed into ATP, the actual energy muscles
need to perform the work of running. If the shuttle mechanisms are
operating too slowly during exercise, NAD takes some of its hydrogens
which should have been dropped off at the mitochondr! ial walls and
shuttled inward and instead donates them to a chemical called
pyruvate, thus forming lactic acid. As lactic acid accumulates, it can
begin pouring out of the muscles into the blood, thus creating a
lactate threshold.

As you can see, the formation of lactic acid can occur independently
of whether a muscle cell has adequate supplies of oxygen, and
lactate-threshold velocity is probably much more a reflection of
mitochondrial shuttling ability, rather than oxygen supply. If the
shuttles are working slowly and a runner is attempting to move
swiftly, lots of lactic acid will be formed (and the runner's lactate
threshold will be lousy).

To improve lactate threshold, then, your task as a runner is to
upgrade your mitochondrial shuttles. Running lots of miles at a
moderate pace just won't do the trick, because your shuttles can
handle such exertion quite easily (inward hydrogen movement through
the shuttles is moderate during moderate running, and so there is no
stimulus for the shuttles to undergo a make-over). What you need
instead is training which really taxes your shuttles.

One such workout involves going to your favorite place for a workout,
warming up thoroughly, and then alternating one-minute intervals at
close-to-max speed with two-minute, easy-jog recoveries. You don't
have to worry about your actual speed during the one-minute bursts
(just shoot for a pace which feels faster than your vVO2max), and you
shouldn't kill yourself with the session - the idea is to just keep
working until you feel satisfactorily tired. Your shuttles will be
extremely stressed by the repeated one-minute fly-outs - and the
resulting shuttle make-over will have you flying along in your races
as your high-energy hydrogens pour into your mitochondria.

Tables Turn on Building Immunity
Research Finds Proper Diet
Outdoes Taking High Doses
Of Nutritional Supplements
October 19, 2005; Page D7

As cold-and-flu season arrives, so do the pitches for products that
claim to increase the body's natural immunity and ward off infection.
And with alarming reports about avian flu and a threatened global
pandemic, it may be tempting to load up on mega doses of vitamins,
minerals and herbal supplements as an added precaution.

But as scientists delve more deeply into how the immune system works,
they are finding evidence that it is the complex interaction of
nutrients in food that helps the body build its defenses against
disease and infection, in part by controlling some types of
inflammation that can weaken the immune system. Single nutrients and
cocktails of nutrients consumed alone can't provide the same benefit,
they warn, and large does of some supplements such as selenium, zinc,
vitamin A, vitamin B6 and vitamin E may even harm and suppress the
immune response.

The best defense against influenza is getting vaccinated as soon as
possible -- and the most important way to prevent the spread of colds
is frequent hand washing. But experts say that following the most
basic tenets of good nutrition -- consuming a balanced diet rich in
fruits and vegetables and low in saturated fats, and eliminating
highly processed and junk foods -- can actually help ward off illness.

"There is lot people can do with proper nutrition to improve their
chances of warding off the flu or making the disease less pathogenic,"
or harmful, says Simin Nikbin Meydani, director of the nutritional
immunology laboratory at Tufts University's Jean Mayer USDA Human
Nutrition Research Center on Aging.

Exercise and maintaining a normal weight are equally important, Dr.
Meydani adds, because obesity can also impair immune function and make
people more susceptible to many types of infections. Tufts researchers
have shown that moderate caloric restriction in humans appears to be
beneficial for immunity.

In a paper published this year in the Journal of the American Medical
Association, Tufts researchers said there is no consistent or
significant effect of any single vitamin or combination of vitamins on
the incidence of disease, while a growing body of research shows that
a healthy diet can help decrease the risks. (The 2005 U.S. Dietary
Guidelines,
www.health.gov/dietaryguidelines/dga2005/recommendations.htm1, help
consumers find which foods deliver the best balance of nutrients).

In a healthy immune system, studies show, after an injury or cut, the
body's inflammatory response combats the damage. Poor nutrition can
lead to chronic inflammation, thereby weakening the immune system and
making the body vulnerable to an array of illnesses, says Mehmet Oz, a
professor of cardiac surgery at New York's Columbia University, and
co-author of the book, "You: The Owner's Manual."

Dr. Oz says a single multivitamin can be beneficial, such as one that
contains at least 800 micrograms of folate, 400 international units --
or IUs -- of vitamin D, 1,200 milligrams of calcium and 400 milligrams
of magnesium. But he says only a healthy diet can provide the
inflammation-fighting nutrients that may protect against colds and flu
in the short term and potentially fight diseases such as Alzheimer's,
cancer and heart disease over time.

To be sure, researchers say, more study needs to be done on vitamins.
A widely reported study in the New England Journal of Medicine last
spring warned that taking the commonly used dosage of vitamin E -- 400
IUs -- carries risks for cardiac patients. But in a study of 617
nursing-home residents, Tufts researchers found that smaller doses of
vitamin E -- 200 IUs daily, or half the dose of most supplements --
significantly reduced the incidence of common colds.

In its wellness guide for consumers (www.berkelywellness.com2),
experts at the University of California at Berkeley warn to be wary of
any supplement that promises to raise immunity, such as protein
supplements, enzyme supplements and specific vitamins and minerals. It
also warns against products such as nasal pumps containing zinc, which
claim to reduce cold severity and duration but may also cause loss of
smell, and says there is no evidence of effectiveness for tablets that
dissolve in water and contain high doses of vitamins A, C or E,
Chinese herbs, magnesium, selenium and zinc.

The federally funded National Center for Complementary and Alternative
Medicine (nccam.nih.gov3) is paying for studies into a number of
herbal compounds. The New England Journal of Medicine reported in July
that a study funded by the center found that none of three
preparations of the most commonly used herbal preparation, echinacea,
had any effect on whether study volunteers became infected with the
cold virus or on the severity or duration of symptoms among those who
developed colds. However, critics of this study -- mostly herbal
supplement makers -- protested that the doses studied were too low,
and additional studies are under way.
• Send e-mail to Informedpatient@...

If you get all your exercise from biking, beware: It may lead to
brittle bones in old age
By MARILYN CHASE
Staff Reporter of THE WALL STREET JOURNAL
October 10, 2005; Page R7

Bicycling, spurred by icons like Tour de France winner Lance
Armstrong, is a hugely popular adult sport, drawing 85.7 million
Americans over age 16 to ride for fun and fitness. But cyclists who
get all their exercise on two wheels may face a hidden health hazard:
fragile bones.

Once seen mainly as a risk to women, weak bones afflict men, too --
even elite athletes. What people do in their 20s, 30s and 40s can
shore up a strong skeleton or start a silent erosion, leading to
brittle bones that can shatter in old age.
THE JOURNAL REPORT

[See the fulll report]1
See the complete Personal Health report2.

"Osteoporosis is still thought of as a disease of little old ladies.
It's a misconception," says Jeanne Nichols, professor of exercise and
nutrition science at San Diego State University. She studies the
health of athletes and has found that men are also vulnerable to
imbalances in exercise and nutrition that can undermine skeletal health.

In her research, Dr. Nichols found that male master cyclists --
ultrafit senior athletes who rode for an average of 20 years -- suffer
surprisingly high rates of a precursor to osteoporosis, the thin and
porous bones that are prone to fractures. While more research is
needed, she says that training exclusively on the bike, excluding
weight-bearing exercise, undermines bone strength.

Beneficial Pressure

Healthy bone cells undergo constant turnover in a process of breakdown
and replacement. Building new bone requires the pressure of body
weight and impact on the skeleton to add new cells. Running and
jumping provide such stimuli. But as joints get injured, people turn
to low-impact sports. While this avoids pain, it also deprives bones
of a growth trigger.

Bicycling is a non-weight-bearing exercise that spares the joints but
softens the impact that sparks growth. In addition, cyclists sweat a
lot, losing calcium in the process. Some elite cyclists also strive to
be very lean for speed. Thin builds are a risk factor for
osteoporosis, along with female sex, and Caucasian or Asian ethnicity.
Smoking, alcohol and drugs such as the anti-inflammatory prednisone
can add to risks.

Sound nutrition, with adequate calcium and vitamin D, is essential.
But many adults are calcium-deficient because they don't like milk,
want to avoid calories, or are lactose-intolerant. Cyclists who ride
extreme events like centuries, or 100-mile races, can depress the
hormones testosterone and estrogen, further weakening bones. Men on
antihormonal treatment for prostate cancer also are at risk.

Slow Decline

People build strong bones from childhood, reaching maximum bone
density by their mid-20s. After that, says San Francisco orthopedic
surgeon Christopher Cox, "it's a slow degradation. Women lose bone
rapidly around menopause, but even men lose bone. If you have only so
much, and if you do a high-risk sport, you may find that out in your
60s when you can't do much about it." The wake-up call may be a broken
hip, or a stress fracture of the vertebrae.
ROLLING TOWARD TROUBLE?

Factors That Undermine Bones
--Getting only low-impact exercise
--Overly thin build
--Calcium-poor diet
--Female gender
--Caucasian or Asian ethnicity
--Tobacco or alcohol use
--Medications (including prednisone)
--Low levels of sex hormones
Building Bone Strength
--Good overall nutrition (with plenty of calcium and vitamin D)
--Maintain sensible weight
--Alternate cycling with sports that involve running or jumping
--Weight training
--If osteoporosis is present, consider medicines like Fosamax
Source: WSJ reporting

Even to the well-informed fitness buff, Dr. Nichols's research came as
a surprise. An avid cyclist, Dr. Cox says he was "totally caught off
guard" by Dr. Nichols's 2003 study in the journal Osteoporosis
International. Formerly casual about diet, he now takes calcium and
vitamin D as nutritional insurance. He also tells his patients who
cycle that it's a good idea to take supplements if they don't eat
dairy foods, and to balance cycling with weight training.

Dr. Nichols's research studied 27 master cyclists with an average age
of 51 who had cycled competitively for 20 years as their main form of
exercise. Measuring their bone-mineral density, she compared it with
that of two other groups: age-matched recreational gym goers, and
young, elite cyclists at the same competitive level as the master
cyclists.

She used a Dexa scan, or dual energy X-ray absorptiometry, a
very-low-radiation X-ray that measures bone density. The master
cyclists' bone density was lower than that of both the younger
cyclists and their age peers who didn't cycle. More than two-thirds
were low enough to be classed as having either osteoporosis or the
precursor condition, osteopenia. Four men, or 15% of the master
cyclists, had outright osteoporosis. For some, it took a while to
absorb the diagnosis.

"The psychology was interesting," she says. Some men went into denial.
" 'I'm a male. I can't be osteoporotic,' " she recalls some saying.
Not long after the study, one volunteer had a freak accident in a
parking lot, falling off his bike and fracturing his hip. He began
lifting weights and taking the bone-building drug Fosamax, and started
his whole family on calcium.

A former runner turned cyclist, the 57-year-old Dr. Nichols says she
got the message herself. "I saw my own [bone density] take a drop when
I converted from running to cycling," she says. "I said, all right,
practice what you preach." She says she now balances her bike time
with weight training and exercise classes that keep her on her feet
twice a week to keep her skeleton strong. She recommends that athletes
get regular bone scans, eat a balanced diet rich in calcium and
vitamin D, and supplement cycling with resistance or impact exercise
as she does. If bone scans show eroding density that points to a risk
of fractures, Dr. Nichols urges people to discuss drug treatments such
as Fosamax.

Spotty Coverage

Men curious about their bone density should be aware that insurance
coverage for Dexa screening is spotty, so they may end up paying out
of pocket. The cost ranges from $150 to $350, depending on location.
Plans may cover men over 50 who have a history of broken bones or
other obvious risk factors.

Dr. Nichols's findings are preliminary and should be interpreted with
caution, some experts say. "It's interesting, but it's a hypothesis,"
says Eric Orwoll, professor of medicine at Oregon Health Sciences
University, and an authority on male osteoporosis. While he agrees
that men face "a strikingly high chance of fractures in later years,"
he says that bikers' bones may simply be different from those of
noncyclists and adds that more research is needed. Others point out
that Dexa scans were originally calibrated for women, so much less is
known about normal and abnormal density scores for men.

Others think the evidence is compelling enough to shape their regimen.

Jim Cushing-Murray of Frisco, Colo., one of the master cyclists in Dr.
Nichols's study group who fared well, credits years of cross-training
for helping him avoid osteoporosis. A bike racer since 1966 and former
national road champion, Mr. Cushing Murray, now 64, does heavy weight
lifting every winter to balance the summer cycling season. That same
regimen also works for his wife, Joann Meyer, 62, the U.S. Cycling
Federation 2005 women's road champion, who adds: "It has paid off."

Orthopedic surgeon Eric Heiden, an Olympic gold medalist in speed
skating in 1980 who later took up pro cycling, follows a regimen that
includes lots of milk and twice-weekly sessions that alternate the
bike with weights. His medical rounds at the University of California
at Davis also keep him on his feet.

"I'm 47," says Dr. Heiden, "so a guy like me better keep walking."

I am my father's son. But does that mean I have to accept his fate?
By STEVE MCKEE
Staff Reporter of THE WALL STREET JOURNAL
October 10, 2005; Page R8

I am sitting in the doctor's office at the end of an eight-hour day. I
have been poked and prodded, examined and scanned, and run through my
paces on the treadmill.

On the computer screen are a series of digital slides. It takes a
minute to get oriented -- breastbone up, backbone down -- but
eventually I get it. Ventricles, aorta, valves, chambers. All in
shades of black and gray.
THE JOURNAL REPORT

[See the fulll report]1
See the complete Personal Health report2.

Then suddenly there it is, a blotch of white, stark in its contrast.
The doctor says nothing. He doesn't have to. He clicks to another
image. The blotch morphs into a milky, bony, old man's finger
clutching at my heart.

My doctor tells me about the on-screen findings, but I hardly hear
him, catching only a few words here and there. "Severe
coronary...heart disease...immediate aggressive treatment."

I hold up my hands, both to surrender to him and ask him to stop,
please. My throat tightens, my lower lip trembles. You don't
understand, I want to shout. This shouldn't be happening to me. For
most of my life, I've done everything I was supposed to do. The right
food, the right exercise, the right attitude.

But I am here anyway.
* * *

My father died of a heart attack at the age of 50. I was 16. It was
just the two of us at home that Tuesday night in York, Pa., 36 years
ago. My sister was away at college, and my mom was at a friend's
playing cards.

It wasn't Dad's first coronary. That had come in 1963. While Dad was
still in the hospital, the father of a classmate keeled over, dead in
his early 40s. The double whammy sent a shiver through the school.
People just seemed to be dropping. It felt like it could happen to
anybody, anytime.

Dad spent six weeks in the hospital, then more weeks at home before
going back to work. We now know that inactivity makes a weak heart
even weaker. But back then, it was all about coddling.
FROM THE ARCHIVE

• Letting Go: Twenty-eight years after his father's heart attack, a
son is ready to stop running from that night.3
10/23/97


So, the first thing we did when Dad got "back on his feet" was buy him
a riding lawn mower. When he finally returned to work, he would come
home for lunch and a nap. He still went fishing, but the time spent
hunting, traipsing the fields, dwindled. Within a year, he was back to
the cigarettes -- two, three packs a day. His stress-laden job as a
traffic-management executive locked in nicely with the Type-A drive he
brought to his work.

The truth? I think he gave up, or at least acquiesced to it all -- his
father had died of heart attack in 1939, when my dad was 21. It was
just the way things were: McKee men died young, and there was nothing
they could do about it.

So we all existed in a sort of suspended animation through the '60s --
treading carefully around Dad, waiting for the other shoe to drop.

But as Dad retreated into inactivity, I set out on a different path.
The U.S. fitness boom wouldn't start for several years, but already
there were distant rumblings of a health revolution. Kenneth H. Cooper
published "Aerobics," the seminal tract, in 1968. I even remember
seeing the book sitting on an end table in our living room; my mom
probably bought it in hopes that Dad would read it, but it's unlikely
he ever did.

In the fall of 1968, my junior year in high school, I started running
in the mornings at the junior-high track. I started seeing some of the
other neighborhood dads crunching around the cinders in their worn
Chuck Taylors or old brown Florsheims. For me, that's when the fitness
craze dawned -- down at the junior high, running with the other dads,
but not the only one I wanted at my shoulder.

His death by acquiescence on Sept. 30, 1969, only hardened my resolve:
I would always be in shape. Always.

At first it was easy. I played basketball in college. In the few years
after, I stayed with the game in serious rec leagues and also played
volleyball. I lived in Alaska in the late '70s and early '80s, where I
added cross-country skiing, and a bike for summer transportation. As I
neared 30, and moved to Brooklyn, N.Y., being in shape required an
exercise "routine." I ran until my knees ached too much the next
morning; for Father's Day after our son was born in 1990, my wife,
Noreen, got me another bicycle. Around 40, I switched to an
every-other-day, less-wear-and-tear schedule and also started lifting
weights. I spent one summer swimming, a few winters ice skating, went
through a video-aerobics phase (that's between you and me), did
50-minute walks to work over the Brooklyn Bridge. When we moved into
an apartment building with a fitness room, I sat down on the rowing
machine and have been hitting it ever since.

I have never smoked and I drink in moderation almost all the time. In
my mid-30s I lashed myself to the Pritikin Diet and whipped my
cholesterol level down under 160. Pritikin is a wildly effective but
near-impossible long-term regimen, and eventually I backed off, though
I have stayed the course with its general tenets. And recently I
started using a vegetable spread with plant stanols and a bran cereal
with psyllium in another bid to keep my cholesterol low.

I was determined: I wasn't going to die like my father, not without a
fight. I was running a race against heart disease, and I was going to win.

Then earlier this year, Noreen suggested we both undergo high-tech
physicals. A friend of ours had done it, and discovered health
problems that probably saved his life. Noreen wanted us to check
things out as well.

I didn't see much need; I knew I was in good shape. But after some
cajoling, I joined my wife early one morning at the Princeton
Longevity Center in New Jersey, one of several such facilities around
the country that offer an exhaustive battery of blood tests, scans,
counseling and other medical checks to help patients determine their
overall state of health and predict serious problems before they have
even developed.

I reach the 86th percentile on the treadmill test -- the "excellent"
category. I have the aerobic capacity of an "active" man 10 years
younger, the postexercise recovery rate of a 30-year-old. I do 47
sit-ups in a minute -- 70th percentile ("good"). Flexibility: 90th
percentile ("excellent"). I crash on the push-up test (5th percentile,
"poor"), and my body composition -- I'm 6-foot-8, 225 pounds -- is
slightly below average.

My overall fitness score is 81. Quoting the printout: "Excellent!" All
those years, all that work. It is all paying off.

By the end of the day, I am fairly giddy with success, ready for my
lifetime achievement award. Coming off the treadmill test, I feel
dressed for the victory platform: old gray sweatpants, old-school
Green Bay Packers hooded sweatshirt.

But when I meet with my doctor, I am stunned by his report. My
cholesterol comes in at 266 (at least 60 points too high -- and much
higher than when it was last tested a couple of years earlier).
Triglycerides are at 315 (more than double a good reading). But for me
the killer is the coronary calcium score, the imaging that painted the
beckoning finger of the Ghost of Christmas Future across about 20% of
my left anterior descending artery (with about the same amount in a
blob in my right coronary artery). The presence of calcium indicates
the presence of plaque, which can lead to blocked arteries. A reading
of 1 to 10 is considered a "minimal" score; 11 to 100, "mild"; 101 to
400, "moderate"; over 400, "severe." I've clocked in at 452. I am in
the 98th percentile. My risk of having a heart attack within the next
12 months: 10% or more. If left untreated, the risk will only
increase, making a heart attack a near certainty.

The numbers add up to the sum of all fears: I am my father's son.
* * *

The doctor wants me on a cholesterol-lowering statin. He wants to take
60 points or more off my cholesterol count, at least 150 off my
triglyceride. (Later, he also orders a prescription-level dose of
niacin, a B vitamin, in response to other abnormalities found on a
subsequent, more-advanced blood test.)

As for the 452 calcium score, that is what it is and will remain so.
The goal won't be to bring that number down, but to keep it from going
up. By shutting down the formation of new plaque, the plaque already
there will harden over, stabilize, and won't be able to rupture to
cause a heart attack.

The doctor fully expects positive, life-altering results. This day's
worth of collected knowledge can be put to terrific use. There is no
reason to think I can't reduce my heart-attack risk by a full 95%. In
three months' time, the doctor says, we will check back in, see where
things stand.

The idea of drugs is abhorrent to me (not to mention emblematic of
failure), but there is really no choice here. There's little else I
can do. I can't quit the cigarettes, can't swear off the Friday night
fish-fry, can't lather stanol vegetable spread on more seven-grain
bread, can't take more Omega-3s, can't buy a health-club membership.

Indeed, my first reaction is to go in the opposite direction -- to
give up. I'll stop exercising. Just not do it. What's the point? It
didn't work. For me, my heart has always been a living thing. It has a
personality, a life of its own. It doesn't just beat in my chest, it
talks to me, constantly reminding me of its presence, asking -- no,
demanding -- that I attend to it.

And I did. I have done everything that doctors and scientists and the
government have relentlessly told us we should do. But now, sitting in
the doctor's office, learning about the plaque that has slowly been
accumulating in my arteries for all these years, it feels like so much
wasted effort. I spent all those years trying to make peace with my
heart, only to discover it had been at war with me all along.

I leave the doctor's office, devastated. I thought I could outrace the
past, beat the future. But I couldn't.
* * *

These are the thoughts that overwhelm. They are counterproductive,
destructive, and I know that. But they stick to me and won't let go.

Yet in the weeks that follow, I begin to wonder whether I was asking
myself the wrong question. Maybe the question isn't: Why bother? Maybe
it's: What would have happened if I hadn't done everything I did?

Though my calcium score put me in the severe-risk category, my
treadmill test indicated that my heart, so far, is out in front of
whatever the level of actual blockage is. I am 52 years old, nine
years farther down the track than when my father had his first attack.
I am nearly three years past the second one that killed him that
Tuesday night in York, when it was just the two of us at home.

And without that exercise, where would I be now? My doctor wouldn't
make any statements of scientific certainty. Still, he said, he could
make the argument that with a different set of decisions a long time
ago, I would be sitting here 20, 30 pounds heavier, out of breath and
out of luck. Sitting here with a first attack already etched on my
EKG. Sitting here...well, probably not sitting here.

I am here. I kept my promise -- to myself, my father, my son. That
must count for something. Probably more than I'm willing right now to
admit.

My son is 15. Next year he will be my age when my father died. What
happened to me can't happen to him. It can't. If back on that cinder
track in 1968 I vowed to stay fit because my father wouldn't, since my
son arrived in 1990 I have kept my promise to him instead: Your dad,
he'll stay in shape, don't worry.

A few days after the physical, I return to the New York Sports Club.
Where else am I to go? I return, too, to a familiar rowing workout,
the "power 10." I do it because I can: a 25-minute, nearly 6,000-meter
pull. It is punishing, my lungs sucking for air in hungry gasps. It
leaves me slumped in the seat, chest heaving, heart talking.

--Mr. McKee is a copy editor for The Wall Street Journal in South
Brunswick, N.J. Eight years ago in these pages, he wrote about his
father's heart attack4 and his own efforts to stay fit.

Write to Steve McKee at steve.mckee@....

Pulse of Progress?
New drugs aim to improve the treatment of high blood pressure by
attacking it in novel ways
By ANITA GREIL
Staff Reporter of THE WALL STREET JOURNAL
October 10, 2005; Page R4

Of all the people being treated for high blood pressure in the U.S.,
it's estimated that only about one-third of them have it under control.

That alarming statistic is one reason doctors and researchers are
scrambling to improve the treatment of high blood pressure, or
hypertension, a potentially life-threatening condition that puts
sufferers at risk for heart disease, stroke, kidney problems and other
serious diseases.
THE JOURNAL REPORT

[See the fulll report]1
See the complete Personal Health report2.

While numerous drugs are available to treat high blood pressure, none
of them is perfect. Some can be slow to work, while others disappear
from the body too quickly. For most patients, no one of these drugs on
its own brings blood pressure down to target levels.

As a result, more and more doctors are treating hypertension patients
with a combination of drugs, trying to find the most effective mix for
each individual. And researchers are developing drugs that attack
hypertension in new ways. Two promising new drugs under development,
Novartis AG's SPP100 and Myogen Inc.'s Darusentan, are still 18 months
or more away from regulatory approval, but researchers say the drugs
have the potential to improve hypertension care.

Blood pressure is the force in the arteries when the heart beats
(called systolic pressure) and when the heart is at rest (diastolic
pressure). Blood pressure is too high if the systolic reading is 140
or higher or the diastolic pressure is 90 or higher.

Although narrowed arteries and other factors can contribute to high
blood pressure, in the vast majority of patients the cause is unknown.
It's unclear whether there is a genetic component. Hypertension runs
in some families, but that may be as much a result of shared
lifestyles as of shared genetic backgrounds. Being overweight,
drinking too much alcohol and eating too much salt raise the risk of
having high blood pressure.

Often there are no obvious symptoms, which is one reason the condition
commonly goes unnoticed for years. The results can be devastating. The
World Health Organization estimates that around 7.1 million people die
each year due to complications from hypertension.

Doubling Up

Current drug therapies for hypertension include diuretics, or water
pills; beta blockers; and angiotensin-converting enzyme (ACE)
inhibitors, which are all available generically. Newer medicines
include angiotensin II receptor blockers (ARBs), such as Diovan and
Cozaar, and calcium channel blockers such as Norvasc. Diuretics, beta
blockers and calcium channel blockers lower blood pressure by reducing
the strength and rate of the heartbeat. The ACE inhibitors and ARBs
prevent the production of chemicals in the kidney that can raise blood
pressure. None of the drugs has ever been proved to be significantly
more effective than another, says Jessica Mann, a cardiologist and the
medical director at Speedel, a Swiss start-up pharmaceutical company
that did the early research on SPP100 before licensing the drug for
further testing to Novartis.

One problem with the currently available treatments is that most
patients don't reach the desired blood-pressure levels with one
medication. "When you are diagnosed with high blood pressure, you are
lucky if the first drug prescribed has the right mode of action to
lower blood pressure below target," Dr. Mann says.

As a result, it's becoming more common for physicians to prescribe
combinations of two or more drugs, typically including a diuretic, the
oldest type of hypertension drug, says Thomas Pickering, head of the
Behavioral Cardiovascular Health and Hypertension Program at the
Department of Medicine at Columbia University in New York. It appears
that the best results generally are being achieved by combining an ACE
inhibitor or ARB with a drug that works in another way, Dr. Pickering
says. Drug companies have caught on to the trend and increasingly are
producing treatments that combine drugs in a single pill.

New Treatments Ahead

Meanwhile, researchers hope patients can get better results with two
new drugs now under development. SPP100 is the first in a new class of
hypertension drugs called renin inhibitors. Renin is an enzyme that
controls the formation of a substance called angiotensin II, the key
mediator in the regulation of body fluid volume and blood pressure.

Although ACE inhibitors and ARBs all affect levels of angiotensin II,
Novartis says SPP100 does it in a way that has the potential to be
more effective than existing treatments. The drug recently completed
clinical tests required before any new treatment can be submitted to
the Food and Drug Administration for review. The tests showed that
SPP100 significantly lowered blood pressure and that lower levels were
maintained for 24 hours. Novartis plans to file early next year for
FDA approval to market the drug in the U.S.

The staying power of SPP100 could be a significant benefit, some
experts say. A common complication of treatment for high blood
pressure is that the effect of medication wears off within hours. As a
result, patients often aren't protected when they need protection
most: early in the morning, when blood pressure is highest. Indeed,
most strokes happen in the early morning, Dr. Mann says.

However, physicians like Dr. Pickering maintain that around-the-clock
protection can also be achieved with existing medications by simply
splitting up a day's worth of drugs into two doses.

Another drug candidate that aims to lower blood pressure in a novel
way is Myogen's DAR201, or Darusentan, which has proved to cause
significant drops in blood pressure in patients for whom other drugs
don't work. The compound is about a year behind SPP100 in clinical
development and could become available by 2008.

Darusentan promises to be the first in a class of drugs called
endothelin receptor antagonists, or ERAs. The drug works by blocking a
hormone called endothelin, which is believed to play a critical role
in the control of blood flow and cell growth. Because Darusentan
blocks the constriction of blood vessels, and therefore works
differently from currently available drugs, scientists hope it can
work for those patients whose blood pressure can't be successfully
reduced to target levels even if they are taking three or more
hypertension treatments.

There is one problem with treating high blood pressure, though, that
can't be overcome with any combination of drugs or new treatments:
Hypertension patients are particularly prone to neglecting to take
their medication.

Because high blood pressure usually has no symptoms, there's no
discomfort or disability to remind patients of the importance of their
medication. And the penalty for not taking the pills often is years
away, which can make it difficult for many people to be conscientious
about their treatment.

There's little physicians can do about this problem, except to try to
convince patients of the gravity of the issue. Dr. Pickering has one
suggestion: Patients who are told to monitor their blood pressure
daily, he says, can at least see the results of their treatment, and
might be more likely to stick to their regimen.

--Ms. Greil is the bureau chief for Dow Jones Newswires in Zurich.

Write to Anita Greil at anita.greil@...