Smoking, like ultraviolet radiation, is known to have an aging effect on human skin. The mechanism by which sunlight ages skin relies on an increase in levels of MMP-1, a protein which degrades collagen in skin. Collagen accounts for about 70 percent of the dry weight of skin and confers many structural characteristics to it such as elasticity. Degradation of collagen results in wrinkled and lined skin.

Christine Lahmann, DiplBiol, Jorg Bergmann, PhD, Graham Harrison, BSc, and Antony Young, PhD published a research letter in the March 24 issue of the British medical journal The Lancet, in which they point to higher levels of MMP-1 as one cause for wrinkled skin in smokers.

The authors originally undertook a study to examine the effects of ultraviolet radiation on MMP-1 levels, but when they measured the concentration of m-RNA, the genetic material used to make MMP-1, as a relative indicator of MMP-1 protein concentration, they found that before any ultraviolet exposure, some subjects had no MMP-1, while in others the protein was readily detectable.

To explain this finding, the authors asked their subjects about their smoking histories and correlated their replies with the MMP-1 measurements. The study included 14 smokers (mean age 30 years) and 19 non-smokers (mean age 27 years). The smokers generally reported having between 10 and 20 cigarettes per day for 3 to 25 years.

The results indicate a strong positive association between smoking and MMP-1 concentrations. Before any ultraviolet radiation, 42 percent of non-smokers had detectable levels of MMP-1, whereas the authors detected MMP-1 in 86 percent of the smokers. Levels of other proteins which protect collagen from degradation did not increase with smoking.

“This is just one more reason not to smoke,” said Gilbert Ross, MD, Medical Director at the American Council on Science and Health. “While facial wrinkling is not as devastating a problem as lung cancer or heart disease, the two deadliest results of smoking, for young people especially the prospect of premature aging could be a real deterrent to taking up this addictive habit.”

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* Gynecologist’s offices

* Chiropractor’s offices

* Health food stores

* Libraries

* Supermarkets

* Newspaper “weeklies”

* A special invitation to your members

* Signs and posters throughout the facility

* Offer a free flower (have the kids in your nursery make them) to all of your aerobics class participants over one week, with a note attached about the new program.

In all cases, promote the benefits of the program and avoid new-age-sounding names. Use names like stress reduction program, non-impact movement, or low-sweat fitness, instead of those that conjure too much mystery or thoughts of contorted bodies. Advise people to “dress comfortably” and keep your instructors in loose, comfortable clothes. Promotional material should state that these programs are open to all, and will especially benefit those with arthritis or muscle pains, obesity, bad backs, people needing to reduce stress, etc.

If you want to start off more slowly, you might have your instructors trained on how to include visualization into their cuing and verbal instructions.

Some additional alternatives to consider: meditation sessions with aromatherapy, partner or infant massage classes, lectures on acupuncture, acupressure, shiatsu, reflexology, hypnotherapy, etc. Or, host a mind/body fitness day and invite the whole community.

Whatever you do, you will find some inactive members coming back to you, and a whole new pool of potential members who may have been intimidated by your facility or the thought of intense exercise.

There have been reports of heart attacks and sudden death in men who took Viagra, Pfizer’s brand of the drug sildenafil. This drug is a usually effective remedy for impotence, or erectile dysfunction, but safety concerns have prevented some men from trying it. A new report in today’s New England Journal of Medicine may alleviate some of this fear, although there are still cautions that apply to Viagra’s use in some heart patients.

A group of investigators from the University of Pennsylvania, led by Howard Herrmann, M.D., studied the hemodynamic (blood flow and pressure) responses of 14 men who underwent coronary artery catheterization for severe vessel narrowing. Measurements were made before, and then one hour after the men took 100 milligrams of sildenafil citrate. The average age of the men studied was 61. They were in a stable condition at the time of the study; thus, those who were on nitrates were able to temporarily discontinue the use of such medication, which should not be used with sildenafil.

The variables measured included blood pressure, pressure within the coronary arteries, and flow rates in the diseased arteries, as well as in normal-appearing arteries in the same patients. Pressure studies and arterial blood flow measurements were also conducted within the heart chambers and in the great vessels leading from the heart to the lungs.

The 14 men studied had one severely narrowed vessel, with an average narrowing of 78 percent, or more than three-quarters occluded. The responses to sildenafil in the narrowed vessels were compared to the responses in the normal vessels, in those men who had an accessible normal vessel — 12 out of the 14.

The results were that there were no clinically significant differences in the pressure-flow measurements before and after sildenafil administration, although there was a slight decrease in total body and pulmonary (lung) arterial blood pressure after drug ingestion. And there was lower flow through the diseased (narrowed) vessels than there was through the normal ones, as was to be expected. However, the narrowed vessels did not respond any differently to sildenafil than did the normal coronary arteries.

Erectile dysfunction affects up to 30 million men in the United States, and is more common in those with heart disease. Thus, it is to be expected that some men taking Viagra, especially older men, would experience heart symptoms during sexual activity. There may also be some men who use the drug incorrectly, perhaps by taking it while using nitrates, which can cause serious interactions and even death.

Over the past five years, group exercise classes have changed dramatically. Many existing and potential new members have grown tired of the traditional aerobics and step classes, and are seeking something different for their exercise programs. With the increasing popularity of boot camp classes, clubs are using traditional military-based training techniques to entice people to exercise. But successful boot camp programs share a number of similarities, aside from a military-based theme and exercise regimen. There are also some unique managerial issues to consider before putting this type of class on your group exercise schedule.

Boot camp variations

Boot-camp-style classes are becoming increasingly popular in health clubs throughout the country, and there are many variations on the boot-camp theme. The classes can meet in your group exercise room, or they can operate outside of the traditional club setting, with groups meeting in public parks and sports facilities.

Torrie Allman, general manager at Frog’s Club One iin Solana Beach, Calif., introduced boot camp classes three years ago. Allman says he has seen the interest in this type of class “increase quite markedly over the past year, albeit with some ebbs and flows depending on the weather.” For instance, since they are located in a temperate climate, members can meet outside for a more realistic approach.

Their class attracts 30 to 40 members every Saturday in the club parking lot. After some warm-up stretches, Mike Magira leads his boot camp participants in a half-mile jog to the beach where they engage in an hour and 30 minutes of interval work, with activities such as squat thrusts, sniper crawls and an obstacle course.

While the Frog’s class is coed, Gold’s Gym in Arlington, Va., has been conducting a women’s-only boot camp class since September 1998. According to Kirk Trader, vice president of Fitness & Image Results (consultants who manage the program), “The boot camp classes are extremely popular, averaging 20 participants per class in winter and 25 to 30 women in summer.”

1. What shape am I in now?

2. What shape should I be in?

3. If I need to improve the shape I am in, how do I do it?

4. How will I know if I am exercising effectively?

5. How will I know when I am in shape?

The answers to these questions are found through assessments — measurable ways to track performance and improvements. To do this, your club needs technically-valid, reliable equipment that is affordable and easy to operate in a club setting.

Accurate assessment of cardiovascular capacity and response to exercise is required to measure members’ levels of conditioning and to provide sure methods of tracking improvements. Until now, the measurement of cardiovascular function has only been available in scientific laboratories, and had to be administered and interpreted by trained scientific professionals. But new technology, which has modified complicated scientific procedures to provide easy and accurate measurement of cardiovascular function, offers clubs the opportunity to respond to members’ needs.

If you will be setting up this program in a hallway, racquetball court or on the gym floor, you will need to set up a wireless microphone system with an FM receiver system, along with the tape deck, receiver and amplifier.

With the FM receiver system, each participant brings their own personal headset and tunes into a preset channel where they can hear the instructor’s voice and music. This allows other people working out in the same area to not be disturbed by the music, and it creates a lot of camaraderie and excitement among participants. Be aware that some people will forget their personal headsets, so you’ll need a system for checking them out. Be sure to have batteries for sale.

Training

It is important that your staff undergo training by the company that manufactures the bike. The training program should cover basic mechanical issues and proper set-up techniques for determining someone’s seat and handlebar height.

Safety is also a big concern and should be addressed in the training. Be sure to ask how much the training costs, and how many people may attend. Some companies will offer a manual and a training video to help you get started.

The success of this program relies on the actual instruction given by the coach. A good training program should cover how to put the class together, from knowing how to regulate intensity through specific movements, to how to select proper music. Training should also cover different types of programs, from athletic-based classes to programs that will attract people interested in rhythmic movements and choreography. Obviously, the more people you can attract, the higher your revenue will be.

This study was led by Robert Nadelman, M.D., of New York Medical College in Valhalla, N.Y. On a random basis, they were given either a 200-milligram dose of doxycycline, or inactive placebo pills. Evidence of definite Lyme disease developed in only one of 235 patients who received doxycycline (0.4%), as compared to 8 of 247 who received placebo (3.2%). This difference was highly significant.

While confirming the effectiveness of this prophylactic antibiotic regimen, the study also shows that even in a Lyme disease-carrying tick-infested area, infection after deer tick bites are very uncommon.

In an editorial in the same issue, Eugene Shapiro, M.D. of the Yale University School of Medicine states that if the analysis by Dr. Nadelman s group is accurate, “it would be necessary to treat about 40 persons to prevent one case of Lyme disease.” He also points out that “nearly one-third of the subjects who were treated with doxycycline reported transient adverse side effects, primarily nausea or vomiting.” In addition, this drug can cause adverse effects in children below age 8, and in pregnant or nursing women. “In areas where Lyme disease is [common], checking carefully for ticks and removing them promptly may be an effective strategy for preventing Lyme disease,” Dr. Shapiro concludes.

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The first article describes a study analyzing the benefits, or lack thereof, of prolonged antibiotic treatment for patients who had been previously diagnosed with Lyme disease, but continued to complain of various symptoms, such as muscle and joint pain, memory or concentration problems, or painful “pins-and needles” type discomforts. These symptoms were accompanied, in most cases, by severe fatigue.

Short-term antibiotic treatment in the acute stage of Lyme disease is highly effective in preventing the more disabling later stages, which can involve the joints, nervous system, and heart. But some clinicians and patients believe that vague symptoms can be the result of an entity called “chronic” Lyme disease, and that long-term (i.e., several months) intravenous antibiotic treatment can effectively remedy these complaints. Case reports and small, uncontrolled trials have supported this theory in patients who have been diagnosed with Lyme disease, with or without blood test confirmation via antibody tests looking for evidence of exposure to the bacterium (Borrelia burgdorferei) which causes Lyme disease.

The study authors, led by Mark Klempner, M.D., from the New England Medical Center and Tufts University School of Medicine in Boston, intended to evaluate 260 patients, 194 who had positive antibody tests, and 66 who were negative for anti-borrelia antibodies, and compare their symptomatic response to treatment. There was no evidence of persistent active infection in either of the groups.

The patients were equally divided into two groups: those receiving active therapy, the intravenous antibiotic ceftriaxone for 30 days, followed by 60 days treatment with oral antibiotic doxycycline (which is similar to tetracycline); and the control group, which was to receive identical appearing placebo — inactive intravenous solution and inactive pills — over the same time period.

But the interim analysis led the study authors to discontinue the study after 107 patients had been evaluated, since the results were already clear-cut: the symptoms noted had not changed in those given the active treatment compared to those in the placebo group. While both groups had severe impairment in health-related quality of life assessment at the outset of the study, there were no important differences in the results with antibiotic therapy as compared with those given placebo. In the placebo group, there was improvement in 36% of patients, no change in 25%, and deterioration in 39%. These responses were not significantly different from the treatment group.

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First created in the summer of 1995, the camp has “sold out” the majority of its sessions since the beginning, and has measured fitness gains among all campers. “Most summer day camps focus exclusively on recreational needs and skill-building,” explains operations and marketing manager Gregory Salem. “Camp HealthRock provided the fun and motivation for youngsters to value their own personal health and well-being.”

Daily activities included “Mental Minutes,” an interactive program that offers a “growing-up” approach to wellness, “Living Laboratory,” a hands-on lesson about science and disease prevention, “Power Pulse,” which included special interest courses like self-defense, kitchen science and creative arts, and a variety of strength and aerobic activities set to music.

Classes were taught by hospital health, medical and fitness professionals, who also measured health/wellness comprehension and fitness levels among campers. According to Salem, initial scores on a health comprehension exercise rose from a 45 percent average (based on a score of 100) to an 84 percent average at the conclusion of the three-week session. Likewise, 82 percent of the youngsters showed fitness improvement in all four health-related fitness tests, and aerobic endurance results were higher with all participants.

* Install a suggestion box and answer each one in a monthly feature of your club newsletter or bulletin board.

* Ask the instructors to be available after class for comments.

* Conduct “How are we doing?” surveys.

* Mail a questionnaire and a complimentary pass to customers who don’t return.

* Organize a small panel of customers to meet and discuss the aerobics program’s strengths and weaknesses.

Randomly select students and ask them how they feel about the program. Keep a record of attendance to measure the success of individual classes.

Don’t stop asking your customers what they want. Let them know they matter by giving them a voice and assuring them they will be heard.