Exercisers sweat to different rhythms delivered through individual headphones.

Increasingly, facility managers are turning to entertainment as a new weapon in the battle against attrition.

And, since cheaper and simpler technology is allowing even the smallest facilities greater access to equipment, pumping up the options could prove to be a winning strategy for retaining and expanding facility membership.

Ultrasound
The pelvic/abdominal ultrasound is the most common and accurate test that is used to confirm the diagnosis of fibroids. During this procedure, a wand-like instrument is moved across the surface the abdomen or inserted into the vagina. Sound waves create an image of the pelvic organs on a monitor. Hysterosonargraphy may also be performed. In this procedure, a catheter is inserted through the cervix and into the uterus, and a saline solution is pumped into the womb. Using ultrasound, the gynecologist or ultrasound technician can get a better view of the fibroids. This procedure can provide additional information about their size, number and location as well as evaluate the ovaries.

MRI (Magnetic Resonance Imaging) and CT (Computed Axial Tomography)
On rare occasions, other imaging studies such as magnetic resonance imaging (MRI) or computed tomography (CT) scans are used to provide additional information that may lead to a diagnosis of fibroids. The MRI is a more accurate test, but its cost precludes its routine use.

Diagnostic Hysteroscopy
If hysterosonargraphy is not available, a hysteroscopic procedure is performed with a telescope-like thing which is inserted through the cervix and vagina into the uterus, allowing a physician to check for growths and abnormalities. It is particularly useful for evaluating submucosal fibroids, the fibroids most commonly associated with abnormal uterine bleeding. The physician can actually see the fibroid or other potential causes of bleeding through the scope.

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Just about every “bell and whistle” has been tried to prevent member dropout. It is a common belief that the right type of technology will magically transform peoples’ exercise experiences from difficult to rewarding and easy-to-maintain. Also common are incentive programs that attempt to “buy” exercise maintenance with rewards that vary from water bottles to jackets to money. Most prevalent, though, are the numerous methods used to promote “customer loyalty.”

These may range from hostingnew member parties to makingfollow-up calls when facility usage has ended to providing the latest in exercise equipment, advice and programming. While these methods are well-meaning andcan beuseful, they do not hit at the heart of the member attrition problem. If the typical new member can not successfully “adapt” to exercise, customer loyalty will have little impact on dropout statistics.

The new-exerciser dropout rate remains between 40 and 65 percent within the first three to six months, whether people start exercising on their own, or within a full-service, professionally staffed fitness center.3,4 Obviously, something is wrong with how new exercisers are being supported within most fitness centers.

Even a modest change to this disheartening statistic can add tremendously to the bottom line,8 as well asplace many members into that all-too-select group of14 to 19 percent of Americans whoexercise enoughto actually benefit their health and longevity.12

What research has shown time and again is that most new exercisers (about 80 percent) do not have sufficient self-management/self-regulatory skills to maintain exercise programs much longer than a few weeks or months. When the reality of the demands of their new exercise programs hits (time requirements, physical effort required, slower than expected “pay-off”), most do not have the abilities needed to persevere, and sotheydrop out.3 Sure, most will probably try again within a year or two (with a similarly high probability of failure), but wouldn’t it be nice to finally have a comprehensive plan to address the root cause of member dropout?You can, but you and your facilitywill need to be committed to “exercise support.”

The low profile slide was performed by markedly lowering the body and flexing the trunk so that the cross-lateral hand contacts the bumper(left hand touches right bumper, and vice versa) at the termination of each sliding pass. Compared to the standard technique, the hip flexion and knee flexion techniques increased energy cost approximately 16 percent, and the low profile technique increased energy cost approximately 28 percent. These results show that energy costs of slide board exercise can vary dramatically depending on the type of exercise maneuvers. For the above exercises, as the amount of muscle involvement increased, so correspondingly did energy cost.

Further investigation included the addition of ankle weights while subjects performed the standard slide exercise.9 Subjects wore a 7.5-pound leg weight while performing the standard slide technique. Generally, leg or ankle weights are not recommended because of increased lower-leg or ankle stress associated with high-impact exercise and running.

Because of the low-impact nature of slide board exercise, however, ankle weights may be appropriate. In this investigation, the use of leg weights increased energy cost approximately 12 percent. It was concluded that the use of leg weights can significantly increase the metabolic responses to slide board exercise.

Yet another study evaluated heart-rate responses during slide board exercise, compared to that of running on a treadmill.12 Subjects exercised at the same intensity, based upon oxygen requirement, and experienced significantly higher heart-rate response (15 percent) during slide board exercise, as compared to treadmill running at the same energy cost. The same phenomenon has been shown with women and other forms of aerobic exercise. Step testing, aerobic bench stepping, aerobic dance and stair climbing all have shown higher heart rates at the same energy cost when compared to running.3,7,11,12 These investigations suggest that the heart-rate responses of various forms of aerobic exercise may be higher than running and walking programs at similar intensity levels.

A small first aid kit — adhesive bandages, alcohol towelettes, as well as sunscreen and other helpers — is a must, as is a selection of easy-to-manage snacks for a long journey. And diapers might take up a lot of room, but, as you use them, you have more room for souvenirs.

Where to Go?
Kids love seeing in person things they recognize from books and movies, according to the people at Fodor’s travel guides. Watching a movie such as “Free Willy” might spur interest in a whale-watching tour in Gloucester, Mass., while a “Little House on the Prairie” book fan might like a trip to the prairie lands.

Once you’ve decided on a destination and a way to get there, savvy travelers say it’s crucial to plan the trip with the children in mind. Toddlers and teens have different needs and all family members should be considered in the trip’s itinerary. If you have a wide range of ages in your family, consider offering each child a day to plan.

And book a good amount of downtime.

“Parents often try to do too much,” Plowright said. “Pacing is especially important with younger children. It’s best to plan just one outing or activity per morning or afternoon. Then, if all is going well, you might add on something extra.”

Though the call of the Mouse is hard to ignore, Plowright said she would put off a trip to Disneyland or Disney World for children 3 and under. And, while others suggest waiting until children are older and can appreciate a European vacation, Plowright believes foreigners get much friendlier treatment in many European hot spots when they have young kids in tow.

“Yes, it’s true they won’t appreciate the Louvre — but when will they?” she said. “When they’re 8? 11? 15? You might have to wait until they’re middle-aged!”

Family vacations usually fall into two categories.

There are the ones that are the stuff of legend, yielding albums of photos and years of giggly reminiscing for one and all.

Then there are the ones that progress from, “But Cindy’s mom let her bring a friend!” to “Are we there yet?’ to “Mother, must we listen to Peter, Paul and Mary?” to “I’m never speaking to you again!” before you’re even over the state line.

Plan for Fun
Assuming you would rather see yourself in the warm-and-fuzzy scenario, the first thing to plan on is planning, travel experts say.

“One of the most fun parts of the trip is the planning,” said Kelly Carter, a spokeswoman for AAA of Greater Hartford, Conn. “If you can get the children involved in the planning of the activities and the destination, that really helps out. They’ve got a stake in making it fun.”

And, despite a few bumps along the way, the family vacation is still a time-honored tradition. AAA estimated about 34 million people traveled 100 miles or more during Memorial Day weekend, the traditional kickoff of the summer vacation season. That’s a record, Carter said, and AAA expects plenty more travelers will follow in their footsteps.

“It seems like it’s an American tradition to have a summer road trip — to pile everyone in the car and head out there,” she said.

And just where are families spending Summer 2000?

“It seems like more companies are offering family-style outdoors adventure trips that might include hiking, rafting, canoeing, biking, horseback-riding,” said Teresa Plowright, who writes about traveling with children for About.com. “There are several companies offering really great trips in the Rockies and elsewhere.”

“The great outdoors is always a favorite,” said Deb Cornick, creator of the online family travel newsletter Have Children Will Travel. “Most of the world is kid-friendly and children love to learn about a new culture.”

Cornick should know. Cody, her 14-year-old son, has been her favorite traveling companion since he was just 13 weeks old. She and other experts say those planning a trip need to do little more than turn on the computer for a plethora of information on traveling in-state and overseas. Web sites for researching attractions, planning a route and booking reservations abound.

Package Deals
And it’s no wonder. With a record number of families out there, hotels, motels and attractions are competing heartily for every tourist dollar. As a result, parents who ask ahead are likely to find package deals in which kids eat or stay free (check age limits, though), family suites offering parents and children some welcome privacy, and even play centers at airports for the family with a lengthy layover.

“I would guess that this trend ties in with the trend for business travelers to bring kids on trips and/or tack family trips onto business trips,” Plowright said.

Families also have more options these days, she said. For lodging alone there are hotels, motels, home rentals in sunny spots, weekly apartment rentals in big cities and the cozy bed and breakfasts that welcome families.

“Maybe hotels have to offer more to compete these days,” Plowright said.

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A: All physical activities can be classified on the basis of their oxygen requirements. The amount of oxygen consumed is directly proportional to the energy expended during the activity. At rest, the body consumes approximately 3.5 ml of oxygen per kilogram of body weight per minute.

The resting level of oxygen consumption is one MET. Thus, an eight-MET level equals eight times the oxygen used at rest. Although the MET method can be used for prescribing exercise intensity, it has two serious limitations.

First, various environmental factors such as heat, humidity, cold, wind, altitude, pollution, differences in terrain, etc., can change the way a person’s cardiovascular system responds to a given MET level. As a result, a person’s cardiovascular system may be working harder at the same MET level.

Also, as an individual’s level of fitness improves, different MET levels are required to ensure that the training stimulus is sufficient to produce continued fitness improvements. For these reasons, compared to MET equivalents, both target heart rate (THR) and rating of perceived exertion (RPE) are more commonly used to prescribe and monitor exercise intensity.

The contest involved six departments who competed by earning “miles” for fitness activities such as exercising on the treadmill, participating in aerobics classes or working out with weights. After four weeks of competition, the top 10 people from the top three teams competed in the “Ultimate Challenge,” a pentathlon that included a 2-mile run, 10-minute bike ride for distance, 10-minute row for distance, push-ups and sit-ups. In honor of the 1996 Summer Games, the contest featured an Olympic theme, and the top male and female overall received a trip to the Olympics in Atlanta.

While competitive incentive programs sometimes discourage participation among non-athletes, Brian Thorburn, health and fitness director, said the competitive approach worked for US Healthcare.

“Usually the goal is to get everyone involved, instead of making it so competitive that some people won’t participate. But this program combined [both] those aspects of exercise programming,” Thorburn says, adding lightheartedly, “When you give away a trip to Atlanta for the Olympics, people tend to get competitive.”

In addition to raising the level of team involvement in the company and increasing department pride, Thorburn says the contest also yielded a number of exercise converts. Follow-up studies showed that one-fifth of the more than 500 who participated never exercised before but now do so on a regular basis with “workout buddies” from their departments. That’s what we call friendly competition.

A review of the literature over the past 20 years fails to identify any credible scientific evidence that chelation therapy works. By and large, the papers reporting favorable results are in alternative medicine journals and contain anecdotal reports. The results they describe can be explained by factors other than the chelation with EDTA, such as the placebo effect, changes in diet, and exercise. In contrast, many of the scientific clinical studies present evidence of the potential for dangerous side effects. Thus, the trace metal most acutely lost by excretion in urine, as a result of the EDTA chelation, is zinc. In one study, the zinc plasma concentration was down by 34 percent in five to nine weeks. Considering the advanced age of most EDTA recipients makes it unlikely which major disease would be induced from standard EDTA chelation. However, it is likely that the oxidant reactions that do occur during an infusion, and that an existing disease could be worsened.

Until recently, chelation therapy was promoted by the American College for Advancement of Medicine. Upon investigation of the activities of this group, the Federal Trade Commission charged them with “making unsubstantiated and false advertising claims” about the effectiveness of EDTA as a plaque removal agent. In settlement of these charges the group agreed to stop advertising these claims.

Because of the short exposure to EDTA during chelation therapy and because of the long time needed to develop even microscopic changes, gross pathology may not be detectable. Patients considering chelation therapy should weigh the risks against the benefits of chelation therapy.

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Chelation therapy involved intravenous infusion of a solution of EDTA several times a week. Early chelation therapists proposed that EDTA would bind the calcium in the arterial plaque and cause it to disintegrate. In reality, the calcium is present in plaque as a contaminant and plays no role in its structural integrity. Furthermore, the plaque containing the calcium is present inside the cells of the arterial walls and cannot be reached by the infused EDTA.

The American College of Advancement in Medicine has an approved protocol for EDTA chelation. Treatment is by intravenous infusion of about 1,000 milliliters of a solution containing fructose, heparin, EDTA, lidocaine, B complex vitamins, magnesium chloride and vitamin C. The solution is infused over four hours, 1 to 3 times a week. The initial series is about thirty infusions with the opportunity of additional treatments later on. Adjunctive therapy consists of doses of oral vitamin C, vitamin E, mineral supplements and other vitamins. Current charges are in the range of $100 per infusion.

Over the years, as a result of the fact there was no evidence to support this theory, chelationists changed their “tune.” They now claimed that the action of EDTA was by preventing formation in the body of strong oxidizing agents called “free radicals.” They based this concept on reports in the literature that free radicals caused damage to living tissues. Chelation therapists posited that the dissolution of clots formed at injury sites released chemically reactive iron into the blood and that this iron generated tissue-damaging free radicals.

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