Thursday, May 08, 2008

75 things


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large picture of people doing all kinds of different activities

Leif Parsons

A Man Should Be Able To:

1. Give advice that matters in one sentence. I got run out of a job I liked once, and while it was happening, a guy stopped me in the hall. Smart guy, but prone to saying too much. I braced myself. I didn't want to hear it. I needed a white knight, and I knew it wasn't him. He just sighed and said: When nobody has your back, you gotta move your back. Then he walked away. Best advice I ever got. One sentence.

2. Tell if someone is lying. Everyone has his theory. Pick one, test it. Choose the tells that work for you. I like these: Liars change the subject quickly. Liars look up and to their right when they speak. Liars use fewer contractions. Liars will sometimes stare straight at you and employ a dead face. Liars never touch their chest or heart except self-consciously. Liars place objects between themselves and you during a conversation.

3. Take a photo. Fill the frame.

4. Score a baseball game. Scoring a game is an exercise in ciphering, creating a shorthand of your very own. In this way, it's a private language as much as a record of the game. The only given is the numbering of the positions and the use of the diamond to express each batter's progress around the bases. I black out the diamond when a run scores. I mark an RBI with a tally mark in the upper-right-hand corner. Each time you score a game, you pick up on new elements to track: pitch count, balls and strikes, foul balls. It doesn't matter that this information is available on the Internet in real time. Scoring a game is about bearing witness, expanding your own ability to observe.

5. Name a book that matters. The Catcher in the Rye does not matter. Not really. You gotta read.

6. Know at least one musical group as well as is possible. One guy at your table knows where Cobain was born and who his high school English teacher was. Another guy can argue the elegant extended trope of Liquid Swords with GZA himself. This is how it should be. Music does not demand agreement. Rilo Kiley. Nina Simone. Whitesnake. Fugazi. Otis Redding. Whatever. Choose. Nobody likes a know-it-all, because 1) you can't know it all and 2) music offers distinct and private lessons. So pick one. Except Rilo Kiley. I heard they broke up.

illustration of a man using a magnifying glass to cook a piece of meat

Leif Parsons

7. Cook meat somewhere other than the grill.

Buy The Way to Cook, by Julia Child. Try roasting. Braising. Broiling. Slow-cooking. Pan searing. Think ragouts, fricassees, stews. All of this will force you to understand the functionality of different cuts. In the end, grilling will be a choice rather than a chore, and your Weber will become a tool rather than a piece of weekend entertainment.

8. Not monopolize the conversation.

9. Write a letter.

So easy. So easily forgotten. A five-paragraph structure works pretty well: Tell why you're writing. Offer details. Ask questions. Give news. Add a specific memory or two. If your handwriting is terrible, type. Always close formally.

10. Buy a suit.

Avoid bargains. Know your likes, your dislikes, and what you need it for (work, funerals, court). Squeeze the fabric -- if it bounces back with little or no sign of wrinkling, that means it's good, sturdy material. And tug the buttons gently. If they feel loose or wobbly, that means they're probably coming off sooner rather than later. The jacket's shoulder pads are supposed to square with your shoulders; if they droop off or leave dents in the cloth, the jacket's too big. The jacket sleeves should never meet the wrist any lower than the base of the thumb -- if they do, ask to go down a size. Always get fitted.

11. Swim three different strokes. Doggie paddle doesn't count.

12. Show respect without being a suck-up. Respect the following, in this order: age, experience, record, reputation. Don't mention any of it.

13. Throw a punch. Close enough, but not too close. Swing with your shoulders, not your arm. Long punches rarely land squarely. So forget the roundhouse. You don't have a haymaker. Follow through; don't pop and pull back. The length you give the punch should come in the form of extension after the point of contact. Just remember, the bones in your hand are small and easy to break. You're better off striking hard with the heel of your palm. Or you could buy the guy a beer and talk it out.

14. Chop down a tree. Know your escape path. When the tree starts to fall, use it.

15. Calculate square footage. Width times length.

illustrated instructions on how to tie a bow tie in six steps

Leif Parsons

16. Tie a bow tie.

Step 1: Make a simple knot, allowing slightly more length (one to two inches) on the end of A.

Step 2: Lay A out of the way, fold B into the normal bow shape, and position it on the first knot you made.

Step 3: Drop A vertically over folded end B.

Step 4: Double back A on itself and position it over the knot so that the two folded ends make a cross.

Step 5: The hard part: Pass folded end A under and behind the left side (yours) of the knot and through the loop behind folded end B.

Step 6: Tighten the knot you have created, straightening, particularly in the center.

illustration of man mixing a giant batch of martinis

Leif Parsons

17. Make one drink, in large batches, very well.

When I interviewed for my first job, one of the senior guys had me to his house for a reception. He offered me a cigarette and pointed me to a bowl of whiskey sours, like I was Darrin Stephens and he was Larry Tate. I can still remember that first tight little swallow and my gratitude that I could go back for a refill without looking like a drunk. I came to admire the host over the next decade, but he never gave me the recipe. So I use this:
• For every 750-ml bottle of whiskey (use a decent bourbon or rye), add:
• 6 oz fresh-squeezed, strained lemon juice
• 6 oz simple syrup (mix superfine sugar and water in equal quantities)

To serve: Shake 3 oz per person with ice and strain into chilled cocktail glasses. Garnish with a cherry and an orange slice or, if you're really slick, a float of red wine. (Pour about 1/2 oz slowly into each glass over the back of a spoon; this is called a New York sour, and it's great.)

18. Speak a foreign language. Pas beaucoup. Mais faites un effort.

19. Approach a woman out of his league. Ever have a shoeshine from a guy you really admire? He works hard enough that he doesn't have to tell stupid jokes; he doesn't stare at your legs; he knows things you don't, but he doesn't talk about them every minute; he doesn't scrape or apologize for his status or his job or the way he is dressed; he does his job confidently and with a quiet relish. That stuff is wildly inviting. Act like that guy.

20. Sew a button.

21. Argue with a European without getting xenophobic or insulting soccer.

Once, in our lifetime, much of Europe was approaching cultural and political irrelevance. Then they made like us and banded together into a union of confederated states. So you can always assume that they were simply copying the United States as they now push us to the verge of cultural and political irrelevance.

22. Give a woman an orgasm so that he doesn't have to ask after it.

Otherwise, ask after it.

23. Be loyal. You will fail at it. You have already. A man who does not know loyalty, from both ends, does not know men. Loyalty is not a matter of give-and-take: He did me a favor, therefore I owe him one. No. No. No. It is the recognition of a bond, the honoring of a shared history, the reemergence of the vows we make in the tight times. It doesn't mean complete agreement or invisible blood ties. It is a currency of selflessness, given without expectation and capable of the most stellar return.

24. Know his poison, without standing there, pondering like a dope. Brand, amount, style, fast, like so: Booker's, double, neat.

25. Drive an eightpenny nail into a treated two-by-four without thinking about it.

Use a contractor's hammer. Swing hard and loose, like a tennis serve.

26. Cast a fishing rod without shrieking or sighing or otherwise admitting defeat.

27. Play gin with an old guy. Old men will try to crush you. They'll drown you in meaningless chatter, tell stories about when they were kids this or in Korea that. Or they'll retreat into a taciturn posture designed to get you to do the talking. They'll note your strategies without mentioning them, keep the stakes at a level they can control, and change up their pace of play just to get you stumbling. You have to do this -- play their game, be it dominoes or cribbage or chess. They may have been playing for decades. You take a beating as a means of absorbing the lessons they've learned without taking a lesson. But don't be afraid to take them down. They can handle it.

28. Play go fish with a kid.

You don't crush kids. You talk their ear off, make an event out of it, tell them stories about when you were a kid this or in Vegas that. You have to play their game, too, even though they may have been playing only for weeks. Observe. Teach them without once offering a lesson. And don't be afraid to win. They can handle it.

29. Understand quantum physics well enough that he can accept that a quarter might, at some point, pass straight through the table when dropped.

Sometimes the laws of physics aren't laws at all. Read The Quantum World: Quantum Physics for Everyone, by Kenneth W. Ford.

30. Feign interest. Good place to start: quantum physics.

31. Make a bed.

32. Describe a glass of wine in one sentence without using the terms nutty, fruity, oaky, finish, or kick. I once stood in a wine store in West Hollywood where the owner described a pinot noir he favored as "a night walk through a wet garden." I bought it. I went to my hotel and drank it by myself, looking at the flickering city with my feet on the windowsill. I don't know which was more right, the wine or the vision that he placed in my head. Point is, it was right.

illustration of a man making a jump shot in pool

Leif Parsons

33. Hit a jump shot in pool. It's not something you use a lot, but when you hit a jump shot, it marks you as a player and briefly impresses women. Make the angle of your cue steeper, aim for the bottommost fraction of the ball, and drive the cue smoothly six inches past the contact point, making steady, downward contact with the felt.

34. Dress a wound. First, stop the bleeding. Apply pressure using a gauze pad. Stay with the pressure. If you can't stop the bleeding, forget the next step, just get to a hospital. Once the bleeding stops, clean the wound. Use water or saline solution; a little soap is good, too. If you can't get the wound clean, then forget the next step, just get to a hospital. Finally, dress the wound. For a laceration, push the edges together and apply a butterfly bandage. For avulsions, where the skin is punctured and pulled back like a trapdoor, push the skin back and use a butterfly. Slather the area in antibacterial ointment. Cover the wound with a gauze pad taped into place. Change that dressing every 12 hours, checking carefully for signs of infection. Better yet, get to a hospital.

man holding jumper cables over his head

Leif Parsons

35. Jump-start a car (without any drama). Change a flat tire (safely). Change the oil (once).

36. Make three different bets at a craps table. Play the smallest and most poorly labeled areas, the bets where it's visually evident the casino doesn't want you to go. Simply play the pass line; once the point is set, play full odds (this is the only really good bet on the table); and when you want a little more action, tell the crew you want to lay the 4 and the 10 for the minimum bet.

37. Shuffle a deck of cards.

I play cards with guys who can't shuffle, and they lose. Always.

38. Tell a joke. Here's one:

Two guys are walking down a dark alley when a mugger approaches them and demands their money. They both grudgingly pull out their wallets and begin taking out their cash. Just then, one guy turns to the other, hands him a bill, and says, "Hey, here's that $20 I owe you."

39. Know when to split his cards in blackjack.

Aces. Eights. Always.

40. Speak to an eight-year-old so he will hear. Use his first name. Don't use baby talk. Don't crank up your energy to match his. Ask questions and wait for answers. Follow up. Don't pretend to be interested in Webkinz or Power Rangers or whatever. He's as bored with that shit as you are. Concentrate instead on seeing the child as a person of his own.

41. Speak to a waiter so he will hear.

You don't own the restaurant, so don't act like it. You own the transaction. So don't speak into the menu. Lift your chin. Make eye contact. All restaurants have secrets -- let it be known that you expect to see some of them.

42. Talk to a dog so it will hear.

Go ahead, use baby talk.

43. Install: a disposal, an electronic thermostat, or a lighting fixture without asking for help. Just turn off the damned main.

44. Ask for help.

Guys who refuse to ask for help are the most cursed men of all. The stubborn, the self-possessed, and the distant. The hell with them.

45. Break another man's grip on his wrist. Rotate your arm rapidly in the grip, toward the other guy's thumb.

46. Tell a woman's dress size.

47. Recite one poem from memory. Here you go:

WHEN YOU ARE OLD

When you are old and gray and full of sleep,
And nodding by the fire, take down this book,
And slowly read, and dream of the soft look
Your eyes had once, and of their shadows deep;

How many loved your moments of glad grace,
And loved your beauty with love false or true,
But one man loved the pilgrim soul in you,
And loved the sorrows of your changing face;

And bending down beside the glowing bars,
Murmur, a little sadly, how Love fled
And paced upon the mountains overhead
And hid his face amid a crowd of stars.

--William Butler Yeats

48. Remove a stain. Blot. Always blot.

49. Say no.

50. Fry an egg sunny-side up. Cook until the white appears solid...and no longer.

illustrated directions on how to build a campfire

Leif Parsons

51. Build a campfire.

There are three components:

1. The tinder -- bone-dry, snappable twigs, about as long as your hand. You need two complete handfuls. Try birch bark; it burns long and hot.

2. The kindling -- thick as your thumb, long as your forearm, breakable with two hands. You need two armfuls.

3. Fuel wood -- anything thick and long enough that it can't be broken by hand. It's okay if it's slightly damp. You need a knee-high stack.

Step 1: Light the tinder, turning the pile gently to get air underneath it.

Step 2: Feed the kindling into the emergent fire with some pace.

Step 3: Lay on the fuel wood. Pyramid, the log cabin, whatever -- the idea is to create some kind of structure so that plenty of air gets to the fire.

52. Step into a job no one wants to do. When I was 13, my dad called me into his office at the large urban mall he ran. He was on the phone. What followed was a fairly banal 15-minute conversation, which involved the collection of rent from a store. On and on, droning about store hours and lighting problems. I kept raising my eyebrows, pretending to stand up, and my dad kept waving me down. I could hear only his end, garrulous and unrelenting. He rolled his eyes as the excuses kept coming. His assertions were simple and to the point, like a drumbeat. He wanted the rent. He wanted the store to stay open when the mall was open. Then suddenly, having given the job the time it deserved, he put it to an end. "So if I see your gate down next Sunday afternoon, I'm going to get a drill and stick a goddamn bolt in it and lock you down for the next week, right?" When he hung up, rent collected, he took a deep breath. "I've been dreading that call," he said. "Once a week you gotta try something you never would do if you had the choice. Otherwise, why are you here?" So he gave me that. And this...

53. Sometimes, kick some ass.

54. Break up a fight. Work in pairs if possible. Don't get between people initially. Use the back of the collar, pull and urge the person downward. If you can't get him down, work for distance.

55. Point to the north at any time.

If you have a watch, you can point the hour hand at the sun. Then find the point directly between the hour hand and the 12. That's south. The opposite direction is, of course, north.

56. Create a play-list in which ten seemingly random songs provide a secret message to one person.

57. Explain what a light-year is. It's the measure of the distance that light travels over 365.25 days.

58. Avoid boredom. You have enough to eat. You can move. This must be acknowledged as a kind of freedom. You don't always have to buy things, put things in your mouth, or be delighted.

59. Write a thank-you note.

Make a habit of it. Follow a simple formula like this one: First line is a thesis statement. The second line is evidentiary. The third is a kind of assertion. Close on an uptick.

Thanks for having me over to watch game six. Even though they won, it's clear the Red Sox are a soulless, overmarketed contrivance of Fox TV. Still, I'm awfully happy you have that huge high-def television. Next time, I really will bring beer. Yours,

60. Be brand loyal to at least one product. It tells a lot about who you are and where you came from. Me? I like Hellman's mayonnaise and Genesee beer, which makes me the fleshy, stubbornly upstate ne'er-do-well that I will always be.

61. Cook bacon.

Lay out the bacon on a rack on a baking sheet. Bake at 400 degrees for 15 minutes.

illustration of a man talking on the cell phone and holding a baby with one hand

Leif Parsons

62. Hold a baby.

Newborns should be wrapped tightly and held against the chest. They like tight spaces (consider their previous circumstances) and rhythmic movements, so hold them snug, tuck them in the crook of your elbow or against the skin of your neck. Rock your hips like you're bored, barely listening to the music at the edge of a wedding reception. No one has to notice except the baby. Don't breathe all over them.

63. Deliver a eulogy. Take the job seriously. It matters. Speak first to the family, then to the outside world. Write it down. Avoid similes. Don't read poetry. Be funny.

64. Know that Christopher Columbus was a son of a bitch. When I was a kid, because I'm Italian and because the Irish guys in my neighborhood were relentless with the beatings on St. Patrick's Day, I loved the very idea of Christopher Columbus. I loved the fact that Irish kids worshipped some gnome who drove all the rats out of Ireland or whatever, whereas my hero was an explorer. Man, I drank the Kool-Aid on that guy. Of course, I later learned that he was a hand-chopping, land-stealing egotist who sold out an entire hemisphere to European avarice. So I left Columbus behind. Your understanding of your heroes must evolve. See Roger Clemens. See Bill Belichick.

65-67. Throw a baseball over-hand with some snap. Throw a football with a tight spiral. Shoot a 12-foot jump shot reliably.

If you can't, play more ball.

68. Find his way out of the woods if lost. Note your landmarks -- mountains, power lines, the sound of a highway. Look for the sun: It sits in the south; it moves west. Gauge your direction every few minutes. If you're completely stuck, look for a small creek and follow it downstream. Water flows toward larger bodies of water, where people live.

69. Tie a knot.

Square knot: left rope over right rope, turn under. Then right rope over left rope. Tuck under. Pull. Or as my pack leader, Dave Kenyon, told me in a Boy Scouts meeting: "Left over right, right over left. What's so fucking hard about that?"

70. Shake hands. Steady, firm, pump, let go. Use the time to make eye contact, since that's where the social contract begins.

close up of an iron pressing a shirt

Leif Parsons

71. Iron a shirt. My uncle Tony the tailor once told me of ironing: Start rough, end gently.

72. Stock an emergency bag for the car.

Blanket. Heavy flashlight. Hand warmers. Six bottles of water. Six packs of beef jerky. Atlas. Reflectors. Gloves. Socks. Bandages. Neosporin. Inhaler. Benadryl. Motrin. Hard candy. Telescoping magnet. Screwdriver. Channel-locks. Crescent wrench. Ski hat. Bandanna.

73. Caress a woman's neck. Back of your fingers, in a slow fan.

74. Know some birds. If you can't pay attention to a bird, then you can't learn from detail, you aren't likely to appreciate the beauty of evolution, and you don't have a clue how birdlike your own habits may be. You've been looking at them blindly for years now. Get a guide.

75. Negotiate a better price. Be informed. Know the price of competitors. In a big store, look for a manager. Don't be an asshole. Use one phrase as your mantra, like "I need a little help with this one." Repeat it, as an invitation to him. Don't beg. Ever. Offer something: your loyalty, your next purchase, even your friendship, and, with the deal done, your gratitude.

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What's On My Other Blogs today: (click blog name to go there) = / 1.3rd Eye Blog / 2. Favorites Blog/ 3. Vita Excolatur (Living Well ...) Blog/ 4. Humor Me Blog/ 5. News and Current Events Blog/ 6. Consider This ... Blog/ 7. Consumer Warnings Blog/ 8. New Orleans Pentimento Blog/ 9. We Constant Gardeners Blog/ 10. Chaillot Family Blog/

Monday, May 05, 2008

New Habits - Get Em !

Unboxed

Can You Become a Creature of New Habits?

Christophe Vorlet

Published: May 4, 2008

HABITS are a funny thing. We reach for them mindlessly, setting our brains on auto-pilot and relaxing into the unconscious comfort of familiar routine. “Not choice, but habit rules the unreflecting herd,” William Wordsworth said in the 19th century. In the ever-changing 21st century, even the word “habit” carries a negative connotation.

So it seems antithetical to talk about habits in the same context as creativity and innovation. But brain researchers have discovered that when we consciously develop new habits, we create parallel synaptic paths, and even entirely new brain cells, that can jump our trains of thought onto new, innovative tracks.

Rather than dismissing ourselves as unchangeable creatures of habit, we can instead direct our own change by consciously developing new habits. In fact, the more new things we try — the more we step outside our comfort zone — the more inherently creative we become, both in the workplace and in our personal lives.

But don’t bother trying to kill off old habits; once those ruts of procedure are worn into the hippocampus, they’re there to stay. Instead, the new habits we deliberately ingrain into ourselves create parallel pathways that can bypass those old roads.

“The first thing needed for innovation is a fascination with wonder,” says Dawna Markova, author of “The Open Mind” and an executive change consultant for Professional Thinking Partners. “But we are taught instead to ‘decide,’ just as our president calls himself ‘the Decider.’ ” She adds, however, that “to decide is to kill off all possibilities but one. A good innovational thinker is always exploring the many other possibilities.”

All of us work through problems in ways of which we’re unaware, she says. Researchers in the late 1960s discovered that humans are born with the capacity to approach challenges in four primary ways: analytically, procedurally, relationally (or collaboratively) and innovatively. At puberty, however, the brain shuts down half of that capacity, preserving only those modes of thought that have seemed most valuable during the first decade or so of life.

The current emphasis on standardized testing highlights analysis and procedure, meaning that few of us inherently use our innovative and collaborative modes of thought. “This breaks the major rule in the American belief system — that anyone can do anything,” explains M. J. Ryan, author of the 2006 book “This Year I Will...” and Ms. Markova’s business partner. “That’s a lie that we have perpetuated, and it fosters mediocrity. Knowing what you’re good at and doing even more of it creates excellence.”

This is where developing new habits comes in. If you’re an analytical or procedural thinker, you learn in different ways than someone who is inherently innovative or collaborative. Figure out what has worked for you when you’ve learned in the past, and you can draw your own map for developing additional skills and behaviors for the future.

“I apprentice myself to someone when I want to learn something new or develop a new habit,” Ms. Ryan says. “Other people read a book about it or take a course. If you have a pathway to learning, use it because that’s going to be easier than creating an entirely new pathway in your brain.”

Ms. Ryan and Ms. Markova have found what they call three zones of existence: comfort, stretch and stress. Comfort is the realm of existing habit. Stress occurs when a challenge is so far beyond current experience as to be overwhelming. It’s that stretch zone in the middle — activities that feel a bit awkward and unfamiliar — where true change occurs.

“Getting into the stretch zone is good for you,” Ms. Ryan says in “This Year I Will... .” “It helps keep your brain healthy. It turns out that unless we continue to learn new things, which challenges our brains to create new pathways, they literally begin to atrophy, which may result in dementia, Alzheimer’s and other brain diseases. Continuously stretching ourselves will even help us lose weight, according to one study. Researchers who asked folks to do something different every day — listen to a new radio station, for instance — found that they lost and kept off weight. No one is sure why, but scientists speculate that getting out of routines makes us more aware in general.”

She recommends practicing a Japanese technique called kaizen, which calls for tiny, continuous improvements.

“Whenever we initiate change, even a positive one, we activate fear in our emotional brain,” Ms. Ryan notes in her book. “If the fear is big enough, the fight-or-flight response will go off and we’ll run from what we’re trying to do. The small steps in kaizen don’t set off fight or flight, but rather keep us in the thinking brain, where we have access to our creativity and playfulness.”

Simultaneously, take a look at how colleagues approach challenges, Ms. Markova suggests. We tend to believe that those who think the way we do are smarter than those who don’t. That can be fatal in business, particularly for executives who surround themselves with like-thinkers. If seniority and promotion are based on similarity to those at the top, chances are strong that the company lacks intellectual diversity.

“Try lacing your hands together,” Ms. Markova says. “You habitually do it one way. Now try doing it with the other thumb on top. Feels awkward, doesn’t it? That’s the valuable moment we call confusion, when we fuse the old with the new.”

AFTER the churn of confusion, she says, the brain begins organizing the new input, ultimately creating new synaptic connections if the process is repeated enough.

But if, during creation of that new habit, the “Great Decider” steps in to protest against taking the unfamiliar path, “you get convergence and we keep doing the same thing over and over again,” she says.

“You cannot have innovation,” she adds, “unless you are willing and able to move through the unknown and go from curiosity to wonder.”

Janet Rae-Dupree writes about science and emerging technology in Silicon Valley.



What's On My Other Blogs today: (click blog name to go there) = / 1.3rd Eye Blog / 2. Favorites Blog/ 3. Vita Excolatur (Living Well ...) Blog/ 4. Humor Me Blog/ 5. News and Current Events Blog/ 6. Consider This ... Blog/ 7. Consumer Warnings Blog/ 8. New Orleans Pentimento Blog/ 9. We Constant Gardeners Blog/ 10. Chaillot Family Blog/

Wednesday, April 30, 2008

Exercise - magic bullet ?

Personal Health

You Name It, and Exercise Helps It

Published: April 29, 2008

Randi considers the Y.M.C.A. her lifeline, especially the pool. Randi weighs more than 300 pounds and has borderline diabetes, but she controls her blood sugar and keeps her bright outlook on life by swimming every day for about 45 minutes.

Randi overcame any self-consciousness about her weight for the sake of her health, and those who swim with her and share the open locker room are proud of her. If only the millions of others beset with chronic health problems recognized the inestimable value to their physical and emotional well-being of regular physical exercise.

“The single thing that comes close to a magic bullet, in terms of its strong and universal benefits, is exercise,” Frank Hu, epidemiologist at the Harvard School of Public Health, said in the Harvard Magazine.

I have written often about the protective roles of exercise. It can lower the risk of heart attack, stroke, hypertension, diabetes, obesity, depression, dementia, osteoporosis, gallstones, diverticulitis, falls, erectile dysfunction, peripheral vascular disease and 12 kinds of cancer.

But what if you already have one of these conditions? Or an ailment like rheumatoid arthritis, multiple sclerosis, Parkinson’s disease, congestive heart failure or osteoarthritis? How can you exercise if you’re always tired or in pain or have trouble breathing? Can exercise really help?

You bet it can. Marilyn Moffat, a professor of physical therapy at New York University and co-author with Carole B. Lewis of “Age-Defying Fitness” (Peachtree, 2006), conducts workshops for physical therapists around the country and abroad, demonstrating how people with chronic health problems can improve their health and quality of life by learning how to exercise safely.

Up and Moving

“The data show that regular moderate exercise increases your ability to battle the effects of disease,” Dr. Moffat said in an interview. “It has a positive effect on both physical and mental well-being. The goal is to do as much physical activity as your body lets you do, and rest when you need to rest.”

In years past, doctors were afraid to let heart patients exercise. When my father had a heart attack in 1968, he was kept sedentary for six weeks. Now, heart attack patients are in bed barely half a day before they are up and moving, Dr. Moffat said.

The core of cardiac rehab is a progressive exercise program to increase the ability of the heart to pump oxygen- and nutrient-rich blood more effectively throughout the body. The outcome is better endurance, greater ability to enjoy life and decreased mortality.

The same goes for patients with congestive heart failure. “Heart failure patients as old as 91 can increase their oxygen consumption significantly,” Dr. Moffat said.

Aerobic exercise lowers blood pressure in people with hypertension, and it improves peripheral circulation in people who develop cramping leg pains when they walk — a condition called intermittent claudication. The treatment for it, in fact, is to walk a little farther each day.

In people who have had transient ischemic attacks, or ministrokes, “gradually increasing exercise improves blood flow to the brain and may diminish the risk of a full-blown stroke,” Dr. Moffat said. And aerobic and strength exercises have been shown to improve endurance, walking speed and the ability to perform tasks of daily living up to six years after a stroke.

As Randi knows, moderate exercise cuts the risk of developing diabetes. And for those with diabetes, exercise improves glucose tolerance — less medication is needed to control blood sugar — and reduces the risk of life-threatening complications.

Perhaps the most immediate benefits are reaped by people with joint and neuromuscular disorders. Without exercise, those at risk of osteoarthritis become crippled by stiff, deteriorated joints. But exercise that increases strength and aerobic capacity can reduce pain, depression and anxiety and improve function, balance and quality of life.

Likewise for people with rheumatoid arthritis. “The less they do, the worse things get,” Dr. Moffat said. “The more their joints move, the better.”

Exercise that builds gradually and protects inflamed joints can diminish pain, fatigue, morning stiffness, depression and anxiety, she said, and improve strength, walking speed and activity.

Exercise is crucial to improving function of total hip or knee replacements. But “most patients with knee replacements don’t get intensive enough activity,” Dr. Moffat said.

Water exercises are particularly helpful for people with multiple sclerosis, who must avoid overheating. And for those with Parkinson’s, resistance training and aerobic exercise can increase their ability to function independently and improve their balance, stride length, walking speed and mood.

Resistance training, along with aerobic exercise, is especially helpful for people with chronic obstructive pulmonary disease; it helps counter the loss of muscle mass and strength from lack of oxygen.

In the February/March issue of ACE Certified News, Natalie Digate Muth, a registered dietitian and personal trainer, emphasized the value of a good workout for people suffering from depression. Mastering a new skill increases their sense of worth, social contact improves mood, and the endorphins released during exercise improve well-being.

“Exercise is an important adjunct to pharmacological therapy, and it does not matter how severe the depression — exercise works equally well for people with moderate or severe depression,” wrote Ms. Muth, who is pursuing a medical degree at the University of North Carolina, Chapel Hill.

Feel-Good Hormones

Healthy people may have difficulty appreciating the burdens faced by those with chronic ailments, Dr. Nancey Trevanian Tsai noted in the same issue of ACE Certified News. “Oftentimes, disease-ridden statements — like ‘I’m a diabetic’ — become barricades that keep clients from seeing themselves getting better,” she said, and many feel “enslaved by their diseases and treatments.”

But the feel-good hormones released through exercise can help sustain activity.

“With regular exercise, the body seeks to continue staying active,” wrote Dr. Tsai, an assistant professor of neurosciences at the Medical University of South Carolina in Charleston. She recommended an exercise program tailored to the person’s current abilities, daily needs, medication schedule, side effects and response to treatment.

She urged trainers who work with people with chronic ailments to start slowly with easily achievable goals, build gradually on each accomplishment and focus on functional gains. Over time, a sense of accomplishment, better sleep, less pain and enhanced satisfaction with life can become further reasons to pursue physical activity.

“Even if exercise is tough to schedule,” Dr. Moffat said, “you feel so much better, it’s crazy not to do it.”



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Wednesday, April 23, 2008

HIGH blood pressure

Personal Health

Hypertension: In Retreat, but Hardly Vanquished

Published: April 22, 2008

As with cholesterol levels, the concept of a normal blood pressure has fallen strikingly as doctors learn what it takes to preserve good health. Decades ago, for example, my brother, Jeff, who had high blood pressure that hovered between 160/80 and 170/90, would have been considered normal.

Lacking good treatments for hypertension, no doctor was concerned when, at age 57, President Franklin D. Roosevelt’s blood pressure was 170/90. And so the president’s blood pressure rose inexorably over the next six years, and on April 12, 1945, at age 63 and with a pressure of 200/110, he died of a brain hemorrhage caused by severe hypertension.

But in 2000, when Jeff was 54, his cardiologist knew better. Now with excellent treatments, most often used in combination, an elevated pressure can be lowered to normal in most people. His doctor said that, with our family’s medical history of three coronaries on our father’s side occurring at ages 56 and 58, something should be done to protect Jeff’s health.

Jeff’s treatment “evolved” until he was taking a daily three-pill cocktail — Diovan HCT, a combination of a diuretic and angiotensin II receptor blocker; Norvasc, a calcium channel blocker; and Toprol XL, a beta blocker. He also works out on a treadmill several times a week, runs up and down stairs at home and at work all day, and eats a mostly heart-healthy diet, including five to 10 servings of fruits and vegetables a day, whole grain breads, nonfat milk and no added salt.

With his blood pressure now at 106/66, the low end of normal, my brother has thus far escaped a premature coronary death.

Hypertension, once known as the “silent killer,” is now not so silent. Through campaigns urging doctors to check patients’ pressure at every visit, most cases have been detected. Although treatment has been prescribed for nearly all people known to have blood pressures consistently above 140/90, now called the high end of normal, up to half of patients still have elevated pressures.

Still a Common Problem

Why? Because doctors are not aggressive and creative in treating the problem; because unlike my brother, many patients do not follow doctor’s orders and fail to fill prescriptions or neglect to take medicine daily; and because the rising weight of Americans and the passion for high-salt processed and restaurant-prepared foods have raised the once-normal pressures of many people to levels that experts say should be treated.

A new report from the American Heart Association describes untreated hypertension as now particularly serious among women. Midsection obesity, an important risk factor for hypertension, is found in 79 percent of hypertensive women as against 64 percent of hypertensive men. About a third of hypertensive women have blood pressure controlled at optimal levels, 120/80 or below.

The problem is particularly common among women taking oral contraceptives, whose risk of hypertension is two to three times as high as that of women their age who use some other form of contraception or none at all.

Hypertension is one of the nation’s most common life-threatening diseases, with an overall incidence among adults of nearly 30 percent, a survey of 14,600 people in 2003 and 2004 found. And as many as 66 percent of people 60 and older have elevated pressures that warrant treatment, the survey showed. An increase in blood pressure with age is common only in developed countries, largely a result of a rich and salty diet, overweight and inadequate exercise.

In the United States, the high incidence of hypertension and its inadequate treatment has helped level off a decades-long decline in coronary mortality. In addition to heart attacks, untreated or inadequately treated hypertension can cause strokes, congestive heart failure, kidney failure and diabetes.

According to a report last May in The Journal of Clinical Hypertension, myths persist. Last year, a national online survey of 1,245 adults with high blood pressure found that many people still thought that hypertension meant being tense or anxious and that about 30 percent of people thought that it could be cured by losing weight, Dr. Marvin Moser of the Hypertension Education Foundation in Scarsdale, N.Y., and Dr. Stanley S. Franklin of the University of California, Irvine, reported.

While weight loss and improvements in diet and exercise habits can indeed help people lower an elevated pressure, “most people can’t adjust their lifestyles enough to normalize their blood pressure,” Dr. Moser said in an interview. “Most people need help from medication, notably a diuretic in combination with one or two other drugs. The majority of patients don’t get their pressures to normal without such a combination.”

Doctors have more than 100 drugs to choose from. If one or two do not lower pressure to normal or cause unpleasant side effects, patients should insist on trying others, Dr. Moser said. Side effects of blood pressure medications are no longer the problem they once were, the doctor said. “In doses now used, more than 90 percent of people experience very few side effects.”

Difficulties of Following a Diet

One problem with a drug-free approach is the difficulty many patients have in adopting and sticking with a diet and exercise program that can significantly lower their pressure. Data from the latest national nutrition survey, described in the Feb. 11 issue of The Archives of Internal Medicine, said that a diet called DASH that effectively lowered blood pressure was poorly followed by people with hypertension. This diet is rich in fruits, vegetables and low-fat dairy products, a mix that provides excellent sources of fiber, potassium, magnesium and calcium. The diet is most effective if it is low in salt, with a sodium intake of about 1,500 milligrams a day.

The widely publicized value of the DASH diet was demonstrated in a major government-sponsored study published in 1997. But the new report found that in the years since, instead of improving, the dietary quality of people with hypertension has diminished.

Still, as my brother’s case showed, even with a good diet, regular exercise and a healthy weight, most hypertensive patients need medication to achieve an optimal blood pressure. And that includes the elderly, who generally do not respond as well as younger people to blood pressure drugs.

“Studies have shown that even a modest reduction in blood pressure is beneficial to the elderly, reducing their risk of strokes, heart attacks, heart failure and death,” Dr. Moser said. “And a new study in the very elderly, people 80 and older, showed that treating hypertension also reduces the overall risk of death.”

In all age groups, “physician inertia is a major problem,” he said, adding, “In 30 percent of patients whose blood pressure remains high despite treatment, nothing is done about changing the medication.”

He urged people whose blood pressure is higher than 140/90 to ask their doctors, “Shouldn’t we be doing something else?”



What's On My Other Blogs today: (click blog name to go there) = / 1.3rd Eye Blog / 2. Favorites Blog/ 3. Vita Excolatur (Living Well ...) Blog/ 4. Humor Me Blog/ 5. News and Current Events Blog/ 6. Consider This ... Blog/ 7. Consumer Warnings Blog/ 8. New Orleans Pentimento Blog/ 9. We Constant Gardeners Blog/ 10. Chaillot Family Blog/