According to a large-scale, ongoing study published in the Aug. 18, 1999, issue of The Journal of the American Medical Association, women with osteoporosis who took either 60 milligrams (mg) or 120 mg of raloxifene daily had a 35-50 percent reduction in the risk of developing vertebral fractures, compared to women who took a placebo. The three-year study of 7,705 women aged 31 to 80 also showed that raloxifene helped build bone mineral density in the neck and spine.

The effects were more pronounced among women taking 120 mg of raloxifene, the study showed.

Raloxifene is a member of a class of drugs called “selective estrogen receptor modulators” (SERMs), which work by mimicking the effects of the hormone estrogen in some parts of the body while countering the effects of estrogen on other bodily tissues and organs. Raloxifene is currently approved by the Food and Drug Administration (FDA) only for the prevention of osteoporosis, but some studies suggest that it may help prevent breast cancer.

Osteoporosis afflicts 28 million Americans, 80 percent of whom are women.

Gilbert Ross, M.D., medical director of the American Council on Science and Health (ACSH), in New York, gives accolades to the new study and raloxifene. “Raloxifene will be an important new drug in the therapeutic arsenal. The new study took the osteoporosis issue one step further, saying that raloxifene not only increases bone mineral density but also lowers risk of fractures,” he says. “I predict that as the study continues, there will be reductions in fracture rates in other parts of the body.”

The risk of fractures in other parts of the body was not reduced in this three-year study.

Some women take estrogen supplements to stave off osteoporosis. Estrogen protects the bones and the heart but may slightly increase the risk of breast cancer. “Estrogen therapy preserves bone mineral density, but to date there have been no large clinical trials proving a benefit regarding fractures,” Dr. Ross points out.

In an accompanying editorial, Michael R. McClung, M.D., of the Providence Health System and Oregon Osteoporosis Center, in Portland, writes that “osteoporosis is no longer a disorder about which nothing can be done. Considering the current options for the prevention of bone loss and the reduction of fracture risk now available, the clinical challenge is to translate these new advances into the mainstream of routine medical practice in an appropriate manner by focusing on fracture reduction in high-risk patients.”

Although the study was not designed to look at breast cancer risk, women who took raloxifene did, in fact, have a lower risk for breast cancer, study authors note. The study also showed that women who took raloxifene had an increased risk of a blood clots in the veins, a condition called “venous thromboembolism.”

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This method continues to fail to keep any more than about 30 percent of new (and returning) participants exercising for more than one year. Because of this, fitness professionals must develop alternate strategies to keep people exercising.

A required approach for most new participants is to build productive, regular exercise into their lifestyle as a two-step process.

For the first three to six months, simply facilitating the exercise habit is the goal (whether physical gains are prominent or not).

After the behavior takes hold, and physical adaptation builds, then physiological progress can be a central concern.

This postponement of physical results should present fitness professionalslittle problem philosophically if you are truly trying to build lifelong exercise habits in your clients.

The report also noted that internal profit centers beyond memberships have become vital to the success of clubs. In fact, 92 percent of all clubs reported having successful or moderately successful personal training programs in 1998. This is the ideal environment to realize the full benefits of Pilates-style exercise. To capitalize on this growing trend, you need to act wisely. The reality is that, although members may be demanding mind/body fitness, they will not see or feel the results if you try to answer their demands with poorly trained instructors and overflowing classes.

Doing what it takes to attract or develop well-trained instructors and to keep class numbers low are key to the long-term success of your mind/body programs.

The 500+ exercises that make up Pilates-based training require considerable instructor training and commitment, often at a cost and commitment well beyond that of a traditional fitness instructor certification.

However, the results in terms of member wellness and club profitability typically exceed those of traditional fitness classes. Failing to employ certified instructors who have mastered the necessary fundamentals of safety and exercise physiology may result in ineffective teaching, disappointed members or, even worse, injury. Conversely, even a single, well-trained and certified instructor can deliver significant results in terms of wellness, word-of-mouth promotion and member loyalty.

Type 2 diabetes is typically seen in overweight or obese adults. People with type 2 diabetes typically have normal or higher than normal amounts of the hormone insulin in their blood. But their insulin does not lower blood sugar levels as well as it should. The levels of blood sugar thus rise, and, if chronically elevated, lead to a number of serious complications. These can include kidney failure, blindness, nerve and blood vessel disorders in the legs and feet, and heart disease.

While type 2 diabetes accounts for the great majority of diabetes in the United States, it had not been as common in Japan. It has, however, been much more frequently diagnosed there during the last 10 years, according to the study authors. These investigators, from Osaka and Tokyo, wanted to determine if smoking cigarettes was a risk factor for diabetes in Japanese men, as it is thought to be for American and other Western men.

In Japan, employers are required to conduct annual employee health examinations. The investigators followed the health status of 1,266 men who were 35 to 59 years old at the start of the study in 1994. The study lasted until 1999, so the subjects’ blood sugar levels were measured six times. The participants also completed a questionnaire on health-related behaviors at each health examination. These included queries about smoking, alcohol consumption and physical activity, plus medical history, family history of disease, and use of prescription medications. Body weight and height, as well as blood pressure were measured each year.

The authors found that as the number of cigarettes smoked per day and the subject’s length of time as a smoker increased, so did the risk of developing impaired fasting blood glucose, which is an early indicator of diabetes. Compared to people who had never smoked, even former smokers had an increased risk of both impaired fasting glucose and type 2 diabetes (by 62 percent and 8 percent, respectively). For current smokers, the risk of diabetes increased — by more than threefold for those who smoked 21 to 30 cigarettes per day, and more than fourfold for those who smoked more than 31 cigarettes per day.

Ex-smokers were heavier than people who had never smoked; the authors noted that this might in part account for their increased risk of diabetes, since being overweight is a known risk factor for diabetes.

The authors concluded: “Our findings support the conclusion that the number of cigarettes smoked daily and the number of pack-years of exposure are closely associated with the risk for impaired fasting glucose and type 2 diabetes.” They continued, “Our findings provide evidence that cigarette smoking is a modifiable risk factor that could be targeted for prevention of diabetes.”

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Other decorative elements adding to the relaxed garden atmosphere included a sun over the entrance accentuating “the bright and exciting things happening in RFC,” a directional tree pointing visitors to various activities at the center, a garden path directing the flow of traffic and a picnic to enhance the day’s light-hearted theme. Overall, the activities and decorations were designed to sell the facility with minimal staff assistance. This strategy allowed more personal interaction between staff and visitors, impressing newcomers with the center’s relaxed and nurturing atmosphere.

As successful as the one-day event was, the center’s Plant Your Roots promotion didn’t end when the decorations came down. Shortly after the event, each employee who attended received a memo from the center staff expressing their thanks for attending. It further read, “In appreciation, the staff took the initiative to take your personal health and fitness one step further.

Enclosed please find articles specifically related to the goals you wrote on your Goal Setting Balloon.” All attendees received at least two articles relating to their particular fitness goals and health concerns based on their own comments.

Not only did the fitness center’s anniversary celebration/promotional campaign result in increased memberships and a heightened profile within the parent company, the event actually came in under half the estimated $2,000 budget. The entire event cost just $1,000 in round figures (roughly $4 per employee who attended). The savings allowed the staff to implement additional recruitment strategies they could not otherwise have afforded, further expanding their reputation as a place where every Hoffman La-Roche employee’s overall health and fitness can be nurtured and developed.

In fact, in the two months following the event, membership increased by 7 percent, and membership cancellations fell by 40 percent compared to the two months prior to the event — a savings of $823.46 in revenue for the center. “Beyond tangible statistics,” reports Nanette Loftus, program manager, “our reputation for quality programming and staff professionalism has resulted in more new hires, visitors and never-before-exercisers touring the facility.”

So how did the center’s staff come up with the idea to integrate gyms and gardening? Anniversary organizers had been puzzling over ideas for a cost-effective, activity-oriented event that would achieve two major goals: First, recruit Hoffman La-Roche employees to join by demonstrating the center’s expanded member services, its high level of satisfaction among current members and its staff’s expertise; second, show the center to be a major player in the National Employee Health and Fitness Week. When one of the event coordinators stumbled across small, inexpensive flower pots at a local garden shop, the Plant Your Roots theme was born.

One of the day’s main activities centered around visitors planting seeds into terra-cotta pots to take home or, ideally, take back to their offices where other employees would see them. The activity was designed to represent the opportunity to “plant roots” in the Roche Fitness Center, to “grow” and learn about health and fitness and to allow staff to “nurture” future members into healthy lifestyles, according to Loftus. The fitness center staff thought the plants would be the perfect reminder of how the body grows, develops and changes with exercise, targeting people preparing to, but not yet exercising.

Attendees at the anniversary event loved the plant idea too. For a month afterward, an average of six Hoffman La-Roche employees dropped by the fitness center each day to update the staff on their little seedlings’ growth. The plant initiated conversation about the facility, making anniversary attendees unsolicited marketing spokespeople.

The two other main projects that day were a Goal Balloons activity and a Garden Hunt. Visitors were asked to write down their health and fitness goals on a ticket, attach it to a balloon and tie it to a piece of equipment of their own choosing. Not only was this a great way to give the facility a festive atmosphere, it allowed newcomers to wander around and look at the equipment on their own. The Garden Hunt was an equally unintrusive scheme for getting visitors to see everything the center has to offer without taking them on a sales tour. Attendees were given tickets with rhymes to help them identify certain pieces of equipment and their functions.

Ease stiffness, keeping joints well lubricated.

Combat fatigue and increase energy.

Help relieve anxiety and depression.

Improve balance and function.

Increase flexibility and mobility.

Help prevent shortening of muscle fibers and expand range of motion without stressing or straining joints.

Improve posture, which protects joints in the neck, back, hips and knees.

Build muscle strength gradually.

Improve breathing.

Yoga and tai chi are also excellent for arthritis patients because they encourage a safe, gradual, individualized approach. “With tai chi you can go as slowly as you need to and do what’s comfortable for you,” said Kade Gray, chief instructor at the School of Tai Chi Ch’uan in Austin. “You can stay balanced, controlled and relax into it, without worrying about anybody else’s standards. You move slowly and don’t stress the joints at all. As you practice more, your body becomes more limber and you can perform bigger movements if you want.”

Some yoga is better than others. The Arthritis Foundation warns against “power yoga,” for instance. According to health educator Marian Garfinkel, of the Division of Rheumatology at the University of Pennsylvania School of Medicine, it can be harmful for people with arthritis and trigger flares. It’s very different from traditional yoga, which is gentle and moves slowly from one pose to another.

MacInerney agrees. “Ideally arthritis patients, even young ones, should find a yoga class for older people. If they go to the wrong class, it’s not going to be a pleasant experience. Anyone who offers yoga to seniors is used to working with people with limitations.”

There are also different tai chi styles. Most consist of slow, synchronized movements that are easy to learn. However, the quick, active Chen style is not recommended for most people with arthritis, according to the Arthritis Foundation.

Of course, beginning any exercise, especially with arthritis, can be challenging at first. “It may hurt a bit in the beginning,” MacInerney said. “It can be difficult to distinguish between the normal pain of arthritis and pushing a posture too far. I often talk to my students with arthritis about good pain vs. bad pain.”

The bottom line is not to push too hard. “I advise arthritis patients to notice how flexible they are at night and then to see how much ground they’ve lost the next morning. They want to recapture that ground. Beyond that, they need to be more careful, taking it slowly,” said MacInerney, who adds that he has seen good progress with arthritis patients. “I have a student who thought he had to give up driving because of arthritis in his neck. He couldn’t turn his head. He gained much more range of motion in his neck from yoga and was able to keep driving.”

Tai chi practitioners also see its impact on arthritis. “I suffered from arthritis before starting tai chi,” said Gordon Baker of Austin. “After two months, some time between learning the move ‘single whip’ and the ‘second brush knee push movement,’ I realized I was no longer having any pain in my hand or arm.”

Gray had a similar experience: “I used to suffer from arthritis. Since I’ve been practicing tai chi, I don’t have arthritis pain anymore, and my joints are much stronger. I’ve also seen tai chi help many of my students who have arthritis. They tell me their joints feel much better now.”

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An increasing number of arthritis patients are finding the ancient practices of yoga and tai chi to be fun and gentle ways to relieve pain and gain flexibility and strength. “Tai chi is a great way to ease yourself back into an exercise routine,” said Tom Gohring, director of the School of Tai Chi Ch’uan in Austin, Texas. “The nature of tai chi’s movement is especially good for arthritis. It works the joints, giving them a full rotation.”

Tai chi’s alignment also gives students an awareness of how to hold their bodies, according to Gohring. “Often the way people stand strains their knees and joints. With tai chi, they learn a more centered position, which places their weight correctly. This puts less stress on the joints and helps strengthen them.”

In many ways, yoga and tai chi are tailor made for arthritis according to yoga and tai chi instructors and the Arthritis Foundation. According to these experts, they
Are gentle, fluid and adaptable.

Are non-competitive.

Can be modified to suit individual restrictions and needs.

Go at a slow, flowing, relaxed pace.

Are low or non-impact.

Are relaxing and ease stress.

Are available and affordable.

As arthritis patients practice tai chi and yoga they gain more than physical progress. “One of the primary benefits comes from the mental aspects of yoga,” said Charles MacInerney, yoga instructor and owner of Expanding Paradigms in Austin. “With arthritis the immune system is out of balance and overactive. Researchers have found that the meditative components of yoga — relaxation, meditation, visualization, emphasis on thoughts, diaphragmatic breathing — help balance the immune system.”

MacInerney explains that yoga works on multiple levels: “On the mechanical level it moves the joints through their range of motion. It also stimulates the nervous system. You also get increased activity of the endocrine system through the massaging action of the postures. And then you impact the psychological through emphasis on attention: not thinking about your income taxes.”

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“Having worked in nightclub management years ago, I realized that — like it or not — the majority of people who belong to health clubs also frequent nightclubs,” says Caparas. “We’ve found a huge success cross-marketing with these types of businesses.”

Since implementing the program last summer, Caparas says membership sales have grown by 32 percent, and the club has noticed a dramatic increase in positive responses to customer surveys.

“One individual in particular came up to me and said, ‘I just want to thank you for what you’ve done for the members — this is the first time my wife and I have come to a nightclub in 10 years’,” Caparas says.

In addition to offering a healthy alternative to traditional nightlife, the LifeQuest After Hours program allows staff and members to interact in a less formal environment, thus strengthening the business/client relationship. And while LifeQuest says it’s too early to tell what kind of impact the program will have on retention rates, Caparas says he expects the social offerings to make a lasting impression on members, thereby increasing the overall duration of their memberships.

The findings, together with the results of a related study, suggest that bedding in households of asthmatic individuals should be washed with chlorine bleach, reported Dr. Peyton A. Eggleston of Johns Hopkins University in Baltimore, Maryland, at a conference of doctors who specialize in treating allergies.

Eggleston and co-workers looked at the effect of solution of 1 part sodium hypochlorite bleach to 20 parts diluent on three proteins that can trigger allergies. They found that the bleach solution quickly broke the proteins down to small fragments that are incapable of producing an immune response, Eggleston said.

The results are encouraging, but practical application of the strategy to other household items, such as rugs, upholstered furniture, or curtains, has not been worked out, he noted.

Aerosols released by the interaction of chlorine with these fabrics could be hazardous, and the possibility of bleaching or otherwise damaging the material means that it is too early to suggest that families of asthmatics attack the whole house with chlorine, Eggleston told Reuters Health.

In a separate study, Eggleston’s group attempted to clear 13 households of cockroach allergen by eradicating the insects and scrubbing all accessible surfaces with a strong household detergent.

At 2 months, the levels of cockroach allergen levels dropped by an average of 93% in the kitchen, 84% in the living room, and 78% in the bedroom. Although further small reductions were achieved over 4 months, the concentrations of the remaining allergen in these homes were still high enough to cause allergic reactions in sensitive individuals, Eggleston said.

“The type of detergent is probably important, and we need a better understanding of what materials are most effective in removing these proteins from the environment,” he noted. “We may have to look at something different from the standard household detergents, possibly testing some of the non-ionic detergents that are used in commercial and industrial settings,” he concluded.

The studies were presented at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

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