An estimated 50 million people within the U.S. either have been diagnosed with hypertension (elevated blood pressure) or are taking antihypertensive prescription drugs. Today, the combination of lifestyle modification and drug intervention represents the accepted form of treatment for hypertension. Lifestyle modification refers to weight loss and weight management, good nutritional habits (e.g., low fat, low salt and low alcoholic intake), abstaining from smoking and exercising on a regular basis.

WHAT IS HYPERTENSION?
Hypertension occurs when a person continues to have an arterial blood pressure of 140/90 mm Hg measured on two or more separate occasions. The maximum artial pressure refers to the upper number of 140 which is the systolic pressure. As the blood leaves the heart and is sent throughout the body, arterial pressure is reduced. The lowest reading of this pressure is called the diastolic pressure. It is widely accepted that a person having a reading of a systolic pressure of greater than/equal to 140 mm Hg and a diastolic pressure of greater than/equal to 90 mm Hg (greater than/equal to 140/90) is considered to have high blood pressure. The cause of primary or essential hypertension is unknown and may develop between the ages of 25 and 55 in persons without preexisting renal disease. Hypertension may be referred to as "the silent killer" since those afflicted seem to experience few, if any, symptoms. However, hypertension may be associated with fatigue, headaches, lightheadedness, chest pains, visual and speech disturbances, shortness of breath, and nose bleeds. If left untreated hypertension can be fatal. The following types of medication are used to maintain safe blood pressure ranges.

Diuretics are the most widely used and most effective drugs as first-line therapy for hypertension. They increase urinary excretion of salt and water and are used primarily for treatment of hypertension, peripheral edema and congestive heart failure.

Common Side Effects of Diuretics

• gastrointestinal disturbances
• reduced potassium
• increased urination
• photosensitivity
• muscle cramps
• increased blood sugar
• general weakness
• impotence
• facial flushing

Beta Blockers are drugs that block the response of the heart and blood vessels to nerve stimulation, thereby slowing the heart rate and reducing blood pressure. Beta blockers can be used instead of diuretics in first-line therapy or used in addition to diuretics. Beta blockers limit exercise tolerance and maximum oxygen intake.

Common Side Effects of Beta Blockers

• lethargy
• decreased blood sugar
• fatigue
• increased triglycerides
• bronchospasm (with some asthmatic patients)
• insomnia
• reduced exercise tolerance
• decrease in HDL (in drugs with ISA)
• poor circulation

ACE Inhibitors lower blood pressure by decreasing peripheral vascular resistance. They do so without significantly changing the heart rate or cardiac output. Not only do these drugs reduce blood pressure, but evidence seems to point to a decrease in coronary heart disease as well.

Common Side Effects of ACE Inhibitors

• dizziness
• skin rash
• increased potassium
• lightheadedness
• loss of taste
• cough
• hypotension (abnormally low blood pressure)
• heart palpitations
• muscle cramps
• joint muscle pains

Calcium Channel Blockers are thought to block or slow calcium flow into the muscle cells, which results in widening of the blood vessels (vasodilation) and greater oxygen delivery to the heart. They are effective in lowering blood pressure and in the prevention of angina (condition marked by chest pain).

Common Side Effects of Calcium Channel Blockers

• dizziness
• nausea
• weakness
• hypotension
• facial flushing
• headache
• constipation
• lightheadedness
• ankle or peripheral edema (swelling)

Alpha-I Receptor Agonists and Antagonists are now considered first-line antihypertensive drugs in select patients. Central alpha-agonists act to reduce the passage of impulses along certain nerve pathways, which in turn relaxes the blood vessels, making blood flow easier. They are often prescribed along with diuretics and/or beta blockers.

Common Side Effects of Alpha-I Receptor Agonists and Antagonists

• dizziness
• nausea
• drowsiness
• palpitation (rapid heart beat)
• headache
• severe hypotension

Vasodilators lower blood pressure by dilating the arteries of the heart and relaxing smooth muscles.

Common Side Effects of Vasodilators

• headache
• heart palpitations
• nasal congestion
• tachycardia (abnormally fast heart beat)
• fluid retention

EXERCISE
Research supports that exercise training is an important part of controlling hypertension. According to the American College of Sports Medicine, endurance (aerobic) exercise training by individuals at high risk for developing hypertension will reduce the rise in blood pressure that occurs with time. Regular aerobic exercise appears to reduce both systolic and diastolic pressure by an average of 10 mm Hg. The mechanisms responsible for the reduction in blood pressure following exercise training are not clearly understood, but it appears that exercise causes a reduction in cardiac output (the amount of blood pumped from the ventricle in one minute) and total peripheral resistance. The recommended aerobic exercise intensity ranges from 55 to 90 percent of maximum heart rate.

For the sedentary individual, moderate activity is usually more beneficial than a strenuous exercise regimen. Exercise can usually be tried prior to medication unless the hypertension is severe.

DRUG INTERACTION WITH EXERCISE
Beta blockers are prescribed to lower blood pressure, but when mixed with vigorous exercise, they limit exercise tolerance and maximum oxygen uptake (VO² max) in hypertensive persons. They may also limit exercise related improvements in blood lipids. Beta blockers are less apt to interfere with moderate activity. If a hypertensive individual plans to participate in vigorous activity, then certain forms of calcium channel blockers or angiotensin-converting enzyme inhibitors may be prescribed. Caution should be taken if one is on diuretics and performing high-intensity exercise. High-intensity exercise promotes sweating and can increase the risk of potassium depletion and dehydration.

A sound exercise prescription is to gradually increase the amount of exercise over time. In most cases, the hypertensive benefits are well worth the effort. However, before participating in any form of activity, a consultation with a physician and pharmacist is highly recommended.

INFLUENZA (FLU)
Although influenza (flu) is sometimes erroneously referred to as a bad cold, it is actually a serious contagious disease caused by a virus that can infect many body parts, especially the lungs. Flu can lead to severe complications, such as pneumonia, and is the fifth largest killer of individuals over the age of 65.

The flu virus is usually transferred through the air and inhaled by someone in close range. It is also transferred by hand contact to unprotected mucous membranes, such as the eye.

Any individual can contract the flu. In fact 30-40% of individuals not immunized will suffer from this virus. However, some people are more susceptible to the flu than others. Individuals with poor lifestyle habits, such as lack of exercise, smoking, high stress and poor dietary habits will have a higher incidence. Also, individuals over the age of 65 and those with chronic diseases, such as asthma, COPD, cancer, cardiovascular disease and diabetes, are more at risk.

SIGNS AND SYMPTOMS
Even though influenza is considered primarily a respiratory disease, the virus can affect any organ in the body. Victims of the flu are acutely ill and may experience many symptoms, such as fever, fatigue, weakness, chills, dizziness, loss of appetite, aching in muscles, head and joints, sore or scratchy throat, dry cough, visual disturbances and burning or painful eyes. Although more common in children, flu sufferers may also experience gastrointestinal complications, such as diarrhea, nausea and vomiting. These symptoms may be severe and last for as long as three to seven days. General weakness and fatigue may last even longer.

TREATMENT
In severe cases of the flu, the victim needs to see a physician to determine the appropriate treatment. With individuals at a high risk for the development of complications a physician may prescribe, at the beginning of the illness, a medication to lessen its severity.

PREVENTION
Healthy lifestyle habits such, as adequate rest, regular aerobic activity, a sound nutritional plan and minimal stress, can improve the body's resistance to disease. An annual flu vaccine is also recommended, especially for those individuals at risk for complications from the flu. The vaccine must be taken each year due to the continual changes in the viral strains. If you have questions about the flu vaccine and its benefit to you, contact your physician or any public health organization.

PNEUMONIA

DEFINITION AND CAUSES
Pneumonia is a serious pulmonary disease caused by an infection or inflammation in the lungs. Air exchange is decreased due to a build up of fluid or pus in the air sacks in the lungs. The influenza virus causes viral pneumonia, one of the most common types while bacteria that multiply in the lung, and mycoplasmas (small organisms similar to viruses) cause other forms of the disease. Pneumocystis pneumonia, frequently found in AIDS patients, which is believed to have a fungus origin.

Prior to the discovery of antibiotics in the early 1900s, pneumonia was the primary cause of death. Despite antibiotic use, pneumonia has been ranked the sixth most common cause of death since l979, especially in the very young, elderly and chronically ill populations.

SIGNS AND SYMPTOMS
Signs and symptoms may include breathlessness or difficulty breathing, coughing with mucous formations that may be a variety of colors, and a bluish tinge to nail beds, lips and mucous membranes. Other signs may include fever, fatigue, nausea and vomiting, aching joints and muscles, and, possibly, pain in the chest, chills and an increase in heart rate. Because pneumonia can be a result of influenza, it is important to note these symptoms following a bout of the flu.

PREVENTION AND TREATMENT
As with all diseases, the best method of prevention is to maintain a healthy lifestyle inclusive of a well-balanced diet, aerobic exercise program, plenty of rest, good hydration, minimal stress and no smoking. A yearly flu shot may prevent the incidence of viral pneumonia.

Treatment for pneumonia will include the prescription of antibiotics geared to the specific organism. According to physicians and pharmacists it is important to complete the entire course of antibiotics prescribed by your physician. It is possible for these conditions to relapse if the medication is discontinued prior to its completion. Other types of treatment will include rest, adequate hydration, and medication to decrease the fever and control the cough. In severe cases, individuals may need oxygen support or respiratory therapy treatments.

TUBERCULOSIS (TB)

DEFINITION AND CAUSES
Tuberculosis (TB) is a serious lung infection caused by an organism known as tubercle bacillus. In earlier times, before the discovery of appropriate medications, TB was almost always fatal. Although adequate treatment exists today, TB remains a serious public health problem, with 20,000 new cases reported annually. It is estimated that 10 million people carry the TB organism, with most of the newly reported cases coming from this group.

It is important to realize that the difference between TB infection and TB disease. Following an exposure to an infected individual, the TB organism can settle into the lung tissue, or other tissues of the body, and be walled off by the body's normal defense mechanisms in a dormant state. This dormant state can last the individual's life, or can cause the disease at any time. While the infection is dormant, it is not believed to be contagious However, if the disease develops, it is then quite contagious.

Individuals at high risk for the development of TB include:

• Those with HIV
• Those in close contact with an infected person (e.g., family member)
• Those with existing medical conditions, such as cancer, diabetes, and cardiovascular and pulmonary diseases
• Those born on TB prevalent continents such as Asia, Africa and South America
• Alcoholics and IV drug users
• Residents of long-term care facilities, such as institutions, nursing homes and prisons

SIGNS AND SYMPTOMS
There are no signs and symptoms of TB if an individual is infected, but does not experience the disease. These individuals are identified by the TB skin test which is easily performed in a physician's office or health care clinic. Further tests, such as a chest X ray, will be performed. Your physician or public health agency will be able to tell you if you are a candidate to be tested for the TB infection, and where to go to receive the test.

In the event that an individual develops the TB disease, signs and symptoms may include prolonged cough with productive sputum lasting over three weeks, fever, chill, night sweats lasting greater than one week, fatigue, loss of weight and appetite, and blood in the sputum. Individuals experiencing these symptoms should seek the advice of their physicians immediately.

PREVENTION AND TREATMENT
Although any individual who comes in contact with a contagious TB person can develop the disease, healthy individuals have a better chance of walling off the disease if infected and preventing the infectious process to exacerbate. A healthy lifestyle, including adequate exercise, rest, sound nutrition and minimal stress, is your best defense against the development of the disease.

In the event an individual develops the disease, the only treatment is drug therapy, including isoniazid (INH) and other medications.

Nearly 40 million Americans have arthritis. That's one in every seven people. Arthritis is one of the most prevalent chronic health problems and the number one cause of movement limitation in the United States, costing our economy $64.8 billion per year in medical care and lost wages. Anyone at any age (beginning even in childhood) can get arthritis, and women represent nearly two-thirds of all cases. For nearly three million Americans, arthritis limits such everyday activities as walking, dressing and bathing.

WHAT IS ARTHRITIS?
Arthritis refers to more than 100 different diseases that cause pain, swelling and limited movement in joints and connective tissue throughout the body. It is usually chronic, lasting a lifetime. Specific causes of most forms of arthritis are not yet known. The two most prevalent forms are osteoarthritis and rheumatoid arthritis.

Osteoarthritis, or degenerative joint disease, is usually a mild disease in which the cartilage covering the ends of bones in the joint deteriorates, causing pain and loss of movement as bone begins to rub against bone, affecting mostly the weight-bearing joints of the knees and hips, although it can also occur in the neck and spine. Menopausal women are most vulnerable. Rheumatoid arthritis is thought to be an autoimmune disease, affecting any and all joints of the body. The chronic inflammation causes deterioration of the joint along with pain and limited movement, striking people in their 30s. It can be severe and can cause crippling and deformities if not properly treated. Other forms of arthritis or related disorders include gout, lupus, scleroderma, ankylosing spondylitis and juvenile arthritis.

Although arthritis can destroy joint tissue, damage internal organs, shorten life expectancy, weaken the spine, cause bones to become brittle, and deprive individuals of physical (and, therefore, even financial) independence, much can be done to reduce the impact of arthritis on everyday life. The key is early diagnosis and a treatment plan tailored to the needs of each individual as developed by health care providers. Seeking early treatment can often help to slow the disease's progression before damage is severe. Most treatment programs include a combination of medication, exercise, rest, use of heat and cold, joint protection techniques, and sometimes surgery.

EXERCISE AND ARTHRITIS
"Regular exercise can help you lessen fatigue, build stronger muscles and bones, increase energy, flexibility and stamina, and improve your general health and sense of well-being," says Doyt Conn, M.D., senior vice president of medical affairs for the Arthritis Foundation. "After two to three months of exercising, most people also report less pain, anxiety and depression."

For those who are medically cleared for exercise, but choose not to do so, a vicious cycle can begin. Joints may become more painful and stiff, muscles become smaller and weaker, and bones become more brittle. If joints are kept in one position too long without movement, they stiffen, and as a result the ability to move them through a full range of motion, or simply move them at all, may decline dramatically.

In order to obtain an individualized exercise program prescription, approach your physician, occupational therapist or physical therapist. You might also look into programs offered at local YMCAs or health clubs, or consult with personal trainers who specialize in arthritis exercises, or observe classes offered through the Arthritis Foundation. Once you know which exercises are appropriate, how to perform them safely, the proper number of repetitions, and what danger signs to watch for, then you are off and running.

WHICH EXERCISES ARE BEST?
The three main exercise categories appropriate for many individuals with arthritis are range-of-motion, muscle strengthening and cardiovascular endurance. Before beginning any such program however, medical advice and clearance for participation will be necessary.

Range-of-motion and flexibility exercises move a joint gently and smoothly without resistance. These exercises are designed to increase and maintain joint mobility, decrease pain and improve joint function. Static stretches are also appropriate, held for 20 to 30 seconds to the point of tension, not to the point of pain.

Strengthening exercises increase muscle strength, and are critical in order to help stabilize weakened joints. Isometric strengthening exercises work the muscle without moving the joint—a static position is held either against gravity, with a light weight, or using another resistive device. In this way, the joint damage is not exacerbated as it would be if repetitive, full range-of-motion movements were performed. Isotonic, or controlled, full range-of-motion movements can be appropriate as long as the repetitions are kept to a minimum, the exercise guidelines below are followed and your physician approves the activity for you.

Aerobic exercises strengthen the heart and lungs and increase stamina. They also burn calories and fat, helping to maintain appropriate body weight and percent body fat levels. Aerobic exercises, such as walking, swimming, rowing and bicycling, are considered cardiovascular endurance exercises.

SPECIFIC EXERCISE GUIDELINES

• Don't perform vigorous exercises when a joint is swollen and painful, hot or red. Although a healthcare provider should be consulted, the Arthritis Foundation believes that the only exercise that should be attempted with an inflamed joint is to gently move it through its full range of motion without resistance.
• Start slowly and gradually ease into the exercises. Never overdo it, and never exercise to the point of pain.
• Always gradually warm up for 10 to 15 minutes before beginning the focus of the exercise session (strength or endurance).
• Avoid locking joints or moving in an uncontrolled fashion. Moving rapidly or in a jerky manner can cause a dislocation or even a fracture.
• If performing strengthening exercises, limit the number of repetitions, and thus the wear and tear on the affected joints, or incorporate isometric exercises instead.
• Use proper alignment and posture throughout all exercise sessions, stretching a muscle along its longitudinal line, and avoiding painful or uncomfortable positions.
• Avoid standing for long periods of time, using chair exercises as an alternative posture.
• Perform only low-impact movements, without abrupt twists and turns that could cause stumbling or falls. Avoid high-impact exercises, such as jumping, jogging or running.
• If pool exercises are selected, keep the water a warm and comfortable (83F to 90F). Water exercise is an excellent choice because of the buoyancy factor and, thus, the reduced pressure on the joints (up to 90 percent less).
• Exercises that promote fine motor hand skills in a stress-free manner (e.g., simulated piano playing) are beneficial, but avoid hand and wrist exercises that require squeezing an object.
• Select an appropriate time of day for exercise, given the particular type of arthritis (e.g., people with osteoarthritis often prefer exercising early in the day, whereas those with rheumatoid arthritis wake up stiff and might do better exercising midday).

• Control weight: staying close to ideal weight can help reduce stress on weight-bearing joints, such as knees and hips.
• Protect joints: avoid excessive joint stress and simplify the performance of daily tasks, either through appropriate body mechanics or use of inexpensive devices, such as reach extenders, long-handled shoehorns and bath brushes, all of which make tasks easier.
• Save energy: balance periods of activity with periods of rest to help reduce fatigue and to protect joints from the stress of repeated tasks.
• When things must be lifted or carried, ease the stress on affected joints by spreading the load over stronger joints or larger surface areas.
• It is less stressful on joints to lift or carry things close to the body. It also helps to slide objects rather than lift them.
• Use of ice for pain and/or swelling helps to reduce inflammation.

Although each person's experience with arthritis is different, it is essential for all those who are afflicted to keep their joints from becoming stiff, and the best way to achieve such flexibility and full range-of-motion is to engage in appropriate activities as recommended by your healthcare provider.

Note: This information was derived from various medical publications, and the Arthritis Foundation.

WHAT IS SELF-ESTEEM?
The way in which we see ourselves, our perception of how we look and feel as well as who we believe we are, forms our self-image. Our perceptions of how we think others view us also influence our self-image. Our reactions to these real or perceived images make up our self-esteem.

Self-esteem is all about how much value we place upon ourselves, our lives, our skills, and our ability to function, cope, love and be loved. It is about how much respect we have for ourselves and others. The process of gaining and maintaining self-esteem is continuous and can fluctuate day to day.

Think of self esteem as a savings account in which we have a pool of resources. Sometimes we have access to this account from which we can freely withdraw. Sometimes these resources can act as debits and work against us (pride, anger). And sometimes our resources are withheld, perhaps by ourselves, with negative actions or words. The trick is keeping the account balanced when it shifts on a daily basis.

The amount of self-esteem in our account determines how we feel about ourselves and others, as well as how we get along with people. When our savings account is full, perhaps after a series of favorable events, then we have the ability to help fill other peoples' accounts, who in turn fill ours. The opposite is also true-we have the ability to dip into others' accounts (through blame, criticism, gossip), taking away from their savings as well as our own.

The only way we can fill our savings account and keep it full is by filling other people's accounts and allowing others to deposit into ours, by accepting compliments, for example.

CONTRIBUTING FACTORS OF LOW SELF-ESTEEM
It is often difficult to pinpoint specific causes of low self-esteem, but it is clear that often more than one event, circumstance or situation makes a person feel poorly about herself.

Some of the most common contributing factors of low self-esteem include: family dysfunction, divorce, troubled relationships, loss of a loved one, sexual trauma, continual stress, illness and abuse. New research is pointing toward a genetic or biochemical predisposition to lowered self-esteem and mood disorders such as depression.

Over time, negative feelings about yourself can influence your thoughts, actions and perceptions, creating unhealthy and dangerous patterns. These patterns only serve to sustain the negative cycle by continually validating your feelings of inadequacy when you do not achieve certain goals. In fact, many people subconsciously (without awareness) set themselves up to fail by setting unrealistically high goals or by believing they have no control over what happens to them, allowing others too much control over their lives.

It is important to remember that we do have the ability to change ourselves, to redefine who we are, even after a major trauma. When we acknowledge that we can take concrete steps to feel better about ourselves, we not only begin to increase our own self-esteem, but we also help to raise the self-esteem in those around us by giving them hope.

ENHANCING SELF-ESTEEM
Steps to-Increasing Your Own Self-esteem

• First, acknowledge that it is possible to feel better about yourself, to feel good about who and what you are.
• Be kind to yourself by treating yourself as well as you treat, or would like to treat, others. Allow yourself the time, room, energy and tools to feel better. Al lowing such time to ourselves may feel like a luxury, but look at it as a necessity. Start putting some time into yourself, even if it is just 10 minutes to walk around the block.
• Forgive yourself for your mistakes. We forgive others for so many things, but never give ourselves a break.
• Allow yourself to feel angry, sad, hurt, happy, playful, scared and joyful. The more you experience and express your emotions, the more you can move on with living. Not allowing for your feelings only serves to impede progress.
• List the positive aspects of yourself. If you have difficulty making such a list, ask a trusted person in your life to help. These are your gifts and talents, use and focus upon them.
• Choose one realistic thing you have always wanted to do and actually do it. Success breeds success; when you accomplish one small thing, you feel you can accomplish something else. For example, if you always wanted to keep in touch with a cherished friend, but time has slipped away, go ahead and call, or write a very quick note, to let him know you were thinking of him.

Gaining Self-esteem through Relationships
By helping others, we can increase their self-esteem, as well as our own. The following steps are the primary factors in creating relationships that are mutually beneficial.

• Attending occurs when you feel and believe you are focused upon someone completely, demonstrated through direct eye contact, tone of voice, and expressions of genuine concern.
• Including is the act of connecting and involving another person in our lives; accepting friendships.
• Approval is the act of unconditional positive regard; accepting without judgment.
• Conversing is the skill of giving and sharing information in a sincere manner.
• Personalizing is sharing your experiences with others, showing them you understand.
• Appreciating is the act of letting someone know you care and that she is special.

Self-esteem through Exercise
There are ways to enhance self-esteem through physical activity. The key is to understand that fitness and wellness are lifelong processes, not products; they represent continuums, not endpoints.

The healthiest environment and mind-set encourages individual fitness improvement rather than competitive goal setting between individuals. Focusing and working on personal improvement rather than comparing yourself to others will go a long way toward strengthening self-esteem. Choosing activities that are non-competitive, like walking, strength training, or swimming laps, allows you to concentrate on your own issues and goals.

Educating yourself about the role exercise plays in your own wellness will help you better understand how to commit to fitness over your lifetime. Reading health and fitness magazines, asking aerobic and fitness instructors for assistance and seeking the help of a personal trainer can help you make the right decisions.

Focusing upon the level of enjoyment during the physical activity as opposed to the level of difficulty can help with adherence, leading to stronger self-image. Since we tend to stick with activities we like over a longer period of time, the benefits of performing an enjoyable activity are greatly increased, furthering us along on the path to fitness and a better sense of self.

There is a one in four chance of being diagnosed with cancer in your lifetime. These odds can be frightening, but by understanding cancer and how it develops, we can practice personal lifestyle habits that may help to reduce risk. Questions about specific prevention techniques should be directed to your healthcare provider.

According to cancer specialist, Ernest Rosenbaum, M.D., at UCSF Mt. Zion Cancer Center in San Francisco, Calif., understanding the risk factors associated with contracting cancer, as well as implementing modifications that can lessen this risk, are key to living a long, healthy, cancer-free life. And, even being diagnosed with cancer does not preclude living healthfully. As stated by oncologist and author, Bernie Siegal, M.D., "[a] cancer diagnosis is a wake-up call for many to retreat from their past habits and ways of thinking, and embark on a new journey of healthy eating, stress management, and overall living. Some have beaten the odds with a positive attitude and a series of healthy habits."

Exercise may be part of a healthy model for cancer prevention, as well as one part of a therapeutic package that strengthens the mind as well as the muscles for those living with cancer.

A DEFINITION OF CANCER
Cancer is defined as abnormal cell growth. Although there are over 100 known types of cancer, they can be categorized into four basic groups:

1. Carcinomas are solid tumors of epithelial origin (over 85 percent of all cancers).
2. Lymphomas develop and spread within the lymphatic system (approximately 5 percent of all cancers).
3. Leukemias are blood-borne cancers causing abnormal white blood cell production in the bone marrow (2 percent of total all cancers).
4. Sarcomas are solid tumors that develop on the connective tissue of the muscles, bones, nerves and other organs (less than 2 percent of all cancers).

According to epidemiologist John Bailar, M.D., the incidence rate of all cancers has increased over one percent per year since the 1950s. This is due in large part to environmental pollution, airborne and residue chemicals, pesticides, additives, inability to manage stress, and of course, known carcinogens, such as nicotine and asbestos, and an increased ability of technology to diagnose cancers. Although medicine has made great strides in treating certain types of cancer (childhood leukemia treatment has improved over 70 percent in the past 20 years), more people are contracting it than 40 years ago. Dr. Bailar states that the cure is in the prevention. For those who have cancer, treatments must not only focus on removing tumors, but enhancing the quality of life for those with the diagnosis.

EXERCISE TOWARD HEALTH
Prevention
Where prevention techniques are used to help avoid disease, you should seek medical advice. Where techniques are used to enhance wellness, consider the benefits of exercise. Studies on Harvard alumni show a decrease in colon and lung cancers with regular physical activity over many years. A recent study by the University of Southern California concluded that women who exercise regularly may reduce their incidence of contracting breast cancer by 50 percent, depending on the amount of exercise they perform, number of years of training, and other risk factors.

Treatment
After the surgical removal of tumors, many cancer patients undergo chemotherapy and radiation treatments, which often create atrophy and disuse syndromes, and can create problems in protein metabolism, depression, nausea and pain in the performance of daily activities. It may also create some type of functional limitations. Yet, physical activity may help in coping with treatment. If the physician feels exercise in conjunction with treatment is valuable, he or she can work closely with the client and a trained fitness professional in developing the appropriate exercise program.

EXERCISE GUIDELINES FOR PATIENTS
After consultation with your doctor, and assuring you can and want to maintain or improve strength and cardiovascular fitness, consider the following guidelines.

1. Intensity and duration are pain-dependent. Don't push beyond perceived exertion levels.
2. Work more on range of motion exercises during the beginning phases of exercise program.
3. Progress strength program from dumbbells and resistance bands to weight machines. Incorporate as much of all three types of resistance as possible.
4. Incorporate moderate strength and cardiovascular conditioning in one supervised package. Perform regular light aerobic training and flexibility on a daily basis.

EXERCISE PRECAUTIONS ARE AS FOLLOWS
A selection of basic exercise precautions for cancer patients is listed below. However, each patient is different. Therefore, these guidelines must be modified on an individual basis and only upon consultation with healthcare providers:

1. Patients who score lower than 80 percent on the Karnofsky function scale (as rated by their physicians) may be ineligible for exercise programs, needing more classic physical therapy programs instead.
2. Lymph node removal (axial or groin) may cause "shooters," or painful nerve impulses, to radiate down the extremities. Use caution in performing overhead lifts and leg press activities.
3. Abnormal electrolytes, abnormal protein metabolism, and platelet counts under 20,000 are contraindicated for exercise. Other items to be checked before proceeding with exercise include:

   Pulmonary function test	<50% capacity = no aerobic training
   Metastatic bone cancer	>50% cortex involved = non-weight-bearing exercise
   Sodium/potassium osmolality	K+ 3.0 or below, or osmolality low = consult your physician before initiating exercise

Outcomes
Exercise with a healthcare provider's approval may enhance the quality of life for cancer patients and improve their aerobic capacity, strength and range of motion.

Note: This information was derived from various medical research articles, the National Institute of Health and the American Cancer Society.