Your muffin top may kill you

CHICAGO — If your pants are feeling a bit tight around the waistline, take note: Belly bulge can be deadly for older adults, even those who aren't overweight or obese by other measures.

One of the largest studies to examine the dangers of abdominal fat suggests men and women with the biggest waistlines have twice the risk of dying over a decade compared to those with the smallest tummies.

Surprisingly, bigger waists carry a greater risk of death even for people whose weight is "normal" by the body mass index, or BMI, a standard measure based on weight and height.

"Even if you haven't had a noticeable weight gain, if you notice your waist size increasing that's an important sign," said lead author Eric Jacobs of the American Cancer Society, which funded the study. "It's time to eat better and start exercising more."

Other research has linked waist size to dementia, heart disease, asthma and breast cancer.

Bulging bellies are a problem for most Americans older than 50. It's estimated that more than half of older men and more than 70 percent of older women have bigger waistlines than recommended. And it's a growing problem: Average waistlines have expanded by about an inch per decade since the 1960s.

To check your girth, wrap a tape measure around your waist at the navel. No fair sucking in your bulge. Men should have a waist circumference no larger than 40 inches. For women, the limit is 35 inches.

The new study, appearing in Monday's Archives of Internal Medicine, is the first to analyze waist size and deaths for people in three BMI categories: normal, overweight and obese. In all three groups, waist size was linked to higher risk.

About 2 percent of people in the study had normal BMI numbers but larger than recommended waists. Jacobs said the risk increased progressively with increasing waist size, even at waist sizes well below what might be considered too large.

The study used data from more than 100,000 people who were followed from 1997 to 2006. Nearly 15,000 people died during that time.

The researchers crunched numbers on waist circumference, height and weight to draw conclusions about who was more likely to die. Study participants measured their own waists, so some honest mistakes and wishful fudging could have been included, the authors acknowledged.

Four extra inches around the waist increased the risk of dying from between 15 percent to 25 percent. Oddly, the strongest link — 25 percent — was in women with normal BMI.

People with bigger waists had a higher risk of death from causes including respiratory illnesses, heart disease and cancer.

The study was observational, a less rigorous approach that means the deaths could have been caused by factors other than waist size. But the researchers did take into account other risk factors for poor health, such as smoking and alcohol use.

Some older adults gain belly fat while they lose muscle mass, Jacobs said, so while they may not be getting heavier, they're changing shape — and that's taking a toll.

A tape measure, or a belt that doesn't buckle the way it used to, "may tell you things your scale doesn't," Jacobs said.

Fat stored behind the abdominal wall may be more harmful than fat stored on the hips and thighs. Some scientists believe belly fat secretes proteins and hormones that contribute to inflammation, interfere with how the body processes insulin and raise cholesterol levels.

But Dr. Samuel Klein, an obesity expert at Washington University School of Medicine in St. Louis, is skeptical about that theory. Removing belly fat surgically doesn't lead to health improvements. That may mean it's simply a stand-in for some other culprit that is causing both belly fat and poor health. Klein wasn't involved in the new research.

Klein said the new study, while showing a link between waist size and mortality, doesn't pinpoint exactly how much belly fat is dangerous for normal, overweight and obese people. The 40-inch for men and 35-inch for women cutoff points are irrelevant for many people, he said.

What can be done to fight belly fat? It's the same advice as for losing weight. Eat fewer calories and burn more through walking, bicycling and other aerobic exercise. "Sit-ups are useless," Klein said.

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For women, fighting flab requires an hour a day

CHICAGO — Rev up the treadmill: Sobering new research spells out just how much exercise women need to keep the flab off as they age — and it's a lot.

At least an hour of moderate activity a day is needed for older women at a healthy weight who aren't dieting. For those who are already overweight — and that's most American women — even more exercise is called for to avoid gaining weight without eating less, the study results suggest.

"We all have to work at it. If it were easy to be skinny, we would all be skinny," said John Foreyt, a behavioral medicine expert who reviewed the study but wasn't involved in the research.

Brisk walking, leisurely bicycling and golfing are all examples of moderate exercise. But don't throw in the towel if you can't do those things for at least an hour a day. Even a little exercise is good for your health even if it won't make you thin, the researchers said.

Their findings are based on 34,079 non-dieting middle-aged women followed for about 13 years. The women gained an average of almost 6 pounds during the study.

Those who started out at a healthy weight, with a body mass index less than 25, and who gained little or no weight during the study consistently got the equivalent of about an hour of moderate activity daily. Few women — only 13 percent — were in this category.

Few already overweight women got that amount of exercise, and the results suggest it wasn't enough to stop them from gaining weight.

The results echo what gymfuls of middle-aged American women see every time they step off the treadmill and onto the scale.

"Talk to any group of women and they all say the same thing," said Janet Katzin, 61, a "slightly overweight" marketing director from Long Island who exercises for an hour twice a week.

Thin as a younger adult, Katzin said the pounds started creeping up after she had her two children in the 1980s, despite exercising and watching what she eats. "It's just extremely frustrating and discouraging."

The study appears in Wednesday's Journal of the American Medical Association. Only women were studied, so the researchers from Harvard's Brigham and Women Hospital said it's uncertain whether the results would apply to men.

The research "reinforces in a nice, clear way the idea of how difficult it is to maintain a healthy weight in our society," said Foreyt, of the Baylor College of Medicine in Texas.

The results bolster a 2002 Institute of Medicine report that emphasized the importance of balancing diet and exercise and recommended at least 60 minutes daily of moderate activity for adults and children. But the study also indicates that the 2008 U.S. guidelines urging about a half-hour of exercise five days a week won't stop weight gain while getting older without cutting calories, said Dr. I-Min Lee, the study's lead author.

The study underscores some inevitabilities about aging. Men and women often put on weight, partly because their metabolism slows down. But that probably has less to do with it than people's natural tendency to become more sedentary, without changing their eating habits, Lee said.

Hormonal changes in menopause also can make women prone to weight gain, especially around the belly.

Still, Lee emphasized that the benefits of exercise extend beyond what you see in the mirror, helping keep the heart healthy and protecting against chronic disease even if you don't get enough activity to lose weight.

Katzin, a size 14, said she does an hour workout twice a week — including weights, an elliptical machine and bike. "I know I should go more, but that's all I can swing," she said.

She also has switched to diet soda and eating fewer treats, but that hasn't curbed her weight. Katzin was not involved in the study.

The researchers analyzed data on women who took part in a long-running federal study. Participants were 54 on average at the start and periodically reported how much they exercised and weighed. They also reported eating habits at the start, but not throughout, a limitation the authors acknowledged. Lee said the women's eating habits were thought to be typical of American women who aren't dieting.

Dr. Howard Eisenson, who heads Duke University's diet and fitness center, said it's likely some women underestimated what they ate and overestimated how much they exercised, which could have skewed the results.

Still, Eisenson said he doesn't encourage anybody to try to lose weight by exercise alone. To combat age-related weight gain, "you're fighting in many cases a losing battle" if you don't also cut calories, he said.

That doesn't mean you have to starve yourself, but it does mean watching what you eat and avoiding frequent indulgences. People often don't realize how quickly a bag of chips, an extra piece of cheese, a few glasses of wine or a candy bar add up.

"You can eat a candy bar in two minutes. Most are at least 200 calories," and to burn that off requires walking for about an hour, Lee said. Knowing that equation can help people make wise decisions about activity and food choices, she said.

Copyright 2010 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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For many NFL players, a knee injury is a career-ender

Despite surgery, less than two-thirds of National Football League players are able to return to play after knee ligament tears, new research hints.

That number runs counter to the optimism of most team physicians, who said they believed 90 to 100 percent of players would be back on the field, according to an earlier survey.

However, the doctor who led the new study, based on 49 NFL players who had all had surgery to replace the knee's anterior cruciate ligament, or ACL, said he wasn't surprised.

"At this level and with this much competition I think the lower rates of return were expected," Dr. Vishal Michael Shah of the Richmond Bone and Joint Clinic in Sugarland, Texas, told Reuters Health in an e-mail.

The average career of an NFL athlete is only 3.5 years, according to the researchers, whose findings were published in the American Journal of Sports Medicine.

Whether or not players returned to compete, Shah said, probably had little to do with the success of surgery and more with "how much money the team has invested in them already and who else is waiting on the sideline to replace them."

Shah said there wasn't really much the highly trained NFL players could do to prevent injuries.

"The type of injuries they are sustaining are likely unpreventable," he said.

Of the 49 players followed by the researchers, 31 went back to play NFL games, on average slightly less than a year after surgery. Age and type of surgery weren't related to who returned, but those who'd played more games were more likely to go back.

And how many rounds of drafts the athlete had gone through turned out to make a big difference: those who'd been drafted in the first four rounds had 12 times the odds of competing again.

"Higher draft picks have generally been paid more money and the teams have more 'investment' in them," Shah said.

"They are incentivized to give these players more of a chance to return and fight for their job while they may rather 'cut their losses' for late draft picks," he added. "Basically it comes down to the fact that NFL contracts are not guaranteed."

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Congress urges attention to youth concussions

WASHINGTON — Young people who suffer concussions are at greater risk of long-term physical and mental consequences, lawmakers were told Thursday at a hearing on head injuries to high school athletes.

Michelle Pelton, a former high school basketball and softball player from Swansea, Mass., related to the House Education and Labor Committee how her life had been affected by the five concussions she had sustained.

"Every day I endure memory loss, lack of concentration, depression, slow processing speed and cognitive effects that make my everyday life a battle," said Pelton, now 19.

Last October the House Judiciary Committee held a hearing on head injuries in football, but the focus there was on life-altering injuries to professional football players.

"It was clear to us that if the NFL was paying attention to concussions at the professional level, we should be doing the same at the high school level," said Rep. George Miller, D-Calif., chairman of the education committee.

Miller said high school athletes are at greater risk from sports-related concussions than older athletes because their younger brains are more susceptible to injury.

The Government Accountability Office, which does investigative work for Congress, issued a report finding that it's difficult to determine how many concussions occur at the high school level and that estimates may be too low. Athletes not wanting to be sidelined may be reluctant to report symptoms of a possible concussion and agencies that track head injuries have different standards such as only counting injuries treated in an emergency room.

A law in Texas, one of the few states with statutes regarding concussions in high school sports, applies return-to-play requirements specifically to athletes who lose consciousness.

James Schmutz, head of American Sport Education Program, which provides coach education for youth sport, cited a 2009 report that put the number of concussions among high school athletes in nine sports at almost 400,000 in the 2005-2008 period.

"Moreover, the study discovered a disturbing disregard for the seriousness of the injury, with athletes often returning to practice and competition before it was safe and appropriate for them to do so," he said.

Concussions are caused by a blow that forces the head to move rapidly back and forth. Concussions can affect memory, judgment, reflexes, speech, balance and muscle coordination, but some people do not suffer symptoms until days after the accident occurs.

The chances of long-term consequences increase with a repeat concussion.

Washington state last year passed what is considered the nation's strongest return-to-play statute. Athletes under 18 who show symptoms can't take the field again without a licensed health care provider's written approval.

Copyright 2010 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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Want a better workout? Don't stretch before

LONDON — Want a better workout? Then don't stretch beforehand, some experts say.

Many people take it for granted that they should start their exercise routines with some stretching on the spot, perhaps hoping it will loosen them up for their workout. Most fitness experts now agree this kind of static stretching before exercise is not just counter-productive, but potentially harmful.

Traditional stretches, like when people bend over to touch their toes or stretch their legs on a fence, often cause the muscles to tighten rather than relax — exactly the opposite of what is needed for physical activity.

Experts say it is like extending a rubber band to its limit. When people stretch to the maximum, they are more likely to pull a muscle.

"We have developed this idea of static stretching at exactly the wrong time," said Kieran O'Sullivan, an exercise expert at the University of Limerick in Ireland, who has studied various types of stretching and their impact on athletes.

When you stretch before exercising, your body may think it's at risk of being overstretched. It compensates by contracting and becoming more tense. That means you aren't able to move as fast or as freely, making you more likely to get hurt.

O'Sullivan said stretching helps with flexibility, but people should only do it when they aren't about to exercise, like after a workout, or at the end of the day.

"It's like weight training to become stronger," he said. "You wouldn't do a weight session right before you exercise, and you shouldn't stretch right before either."

In the last few years, several studies have found static stretching before playing a sport makes you slower and weaker.

And when experts at the U.S. Centers for Disease Control and Prevention combed through more than 100 papers looking at stretching studies, they found people who stretched before exercise were no less likely to suffer injuries such as a pulled muscle, which the increased flexibility from stretching is supposed to prevent.

Warm up with a light jog
Instead of stretching, many experts recommend warming up with a light jog or sport-specific exercise, like kicking for football or a few serves for tennis. That type of light movement increases the heart rate and blood flow to the muscles, warming up the body temperature.

"This allows you to approach your full range of motion, but in a very controlled way," said Dr. Anders Cohen, chief of neurosurgery and spine surgery at the Brooklyn Hospital Center and former physician for the U.S. Tennis Open. Cohen said elite athletes in all sports are increasingly ditching static stretching and using other warm-up techniques instead.

But the message has yet to trickle down to legions of joggers and recreational athletes. "This is classic, old-school stretching that has been done for generations," Cohen said. "It's going to be very hard to convince people to start doing something different."

There's more news for the traditionalists: research shows static stretching doesn't work as well as more active kinds of stretching that incorporate movement, such as lunges.

In a study published earlier this year in the Clinical Journal of Sport Medicine, Roberto Meroni of the University of Milan and colleagues found people who stretched using conventional techniques, like bending over to touch their toes, were less flexible than those who did a more active type of stretching that used more muscle groups.

Meroni said static stretching simply forces the muscle being stretched to endure the pain of that stretch. With active stretches that work more muscles, the stretched muscles learn to extend while another group is working.

Those types of stretches are commonly used in yoga, which emphasizes how the body is aligned during stretches, not just flexibility. Many yoga poses involve the whole body and focus not only on stretching a particular muscle, but the ligaments, tendons and joints around it.

Still, experts don't discount static stretching entirely. Lynn Millar, a fellow of the American College of Sports Medicine, said they recommend people stretch several times a week and that most types of stretching work.

Maximizing the benefits of stretching may simply boil down to a matter of when you do it and how, according to Jonny Booth, a health and fitness manager at a north London branch of gym chain Fitness First.

"If you are going to stretch your muscles and then do some intense training, you're not going to get fantastic results," he said.

Instead, Booth recommends active stretches that mimic the movement of your intended activity, like some deep knee lunges while walking for runners.

"Stretching is vital to become more flexible," Booth said. "But it has to be done at the right time and for the right reasons."

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After 10 minutes of exercise, hour-long boost

WASHINGTON — Ten minutes of brisk exercise triggers metabolic changes that last at least an hour. The unfair news for panting newbies: The more fit you are, the more benefits you just might be getting.

We all know that exercise and a good diet are important for health, protecting against heart disease and diabetes, among other conditions. But what exactly causes the health improvement from working up a sweat or from eating, say, more olive oil than saturated fat? And are some people biologically predisposed to get more benefit than others?

They're among questions that metabolic profiling, a new field called metabolomics, aims to answer in hopes of one day optimizing those benefits — or finding patterns that may signal risk for disease and new ways to treat it.

"We're only beginning to catalog the metabolic variability between people," says Dr. Robert Gerszten of Massachusetts General Hospital, whose team just took a step toward that goal.

The researchers measured biochemical changes in the blood of a variety of people: the healthy middle-aged, some who became short of breath with exertion, and marathon runners.

First, in 70 healthy people put on a treadmill, the team found more than 20 metabolites that change during exercise, naturally produced compounds involved in burning calories and fat and improving blood-sugar control. Some weren't known until now to be involved with exercise. Some revved up during exercise, like those involved in processing fat. Others involved with cellular stress decreased with exercise.

Those are pretty wonky findings, a first step in a complex field. But they back today's health advice that even brief bouts of activity are good.

"Ten minutes of exercise has at least an hour of effects on your body," says Gerszten, who found some of the metabolic changes that began after 10 minutes on the treadmill still were measurable 60 minutes after people cooled down.

Your heart rate rapidly drops back to normal when you quit moving, usually in 10 minutes or so. So finding lingering biochemical changes offers what Gerszten calls "tantalizing evidence" of how exercise may be building up longer-term benefits.

Back to the blood. Thinner people had greater increases in a metabolite named niacinamide, a nutrient byproduct that's involved in blood-sugar control, the team from Mass General and the Broad Institute of MIT and Harvard reported last week in the journal Science Translational Medicine.

Possible to tweak metabolic process?
Checking a metabolite of fat breakdown, the team found people who were more fit — as measured by oxygen intake during exercise — appeared to be burning more fat than the less fit, or than people with shortness of breath, a possible symptom of heart disease.

The extremely fit — 25 Boston Marathon runners — had ten-fold increases in that metabolite after the race. Still other differences in metabolites allowed the researchers to tell which runners had finished in under four hours and which weren't as speedy.

"We have a chemical snapshot of what the more fit person looks like. Now we have to see if making someone's metabolism look like that snapshot, whether or not that's going to improve their performance," says Gerszten, whose ultimate goal is better cardiac care.

Don't expect a pill ever to substitute for a workout — the new work shows how complicated the body's response to exercise is, says metabolomics researcher Dr. Debbie Muoio of Duke University Medical Center.

But scientists are hunting nutritional compounds that might help tweak metabolic processes in specific ways. For example, Muoio discovered the muscles of diabetic animals lack enough of a metabolite named carnitine, and that feeding them more improved their control of blood sugar. Now, Muoio is beginning a pilot study in 25 older adults with pre-diabetes to see if carnitine supplements might work similarly in people who lack enough.

Next up: With University of Vermont researchers, she's testing how metabolic changes correlate with health measures in a study of people who alternate between a carefully controlled Mediterranean diet and higher-fat diets.

"The longterm hope is you could use this in making our way toward personalized medicine," Muoio says.

Copyright 2010 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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Milk does a body good, especially athletes

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Sweat in a gym? Non, merci, we're French

Paris — The French may love to look good but few are willing to work up a sweat over it.

Despite increasing awareness of the benefits of healthy eating and physical exercise, going to the gym in France is still a niche activity that has yet to capture the mainstream.

France's generous health care system, its cultural preference for outdoor sports and its lack of affordable good-quality clubs are seen as reasons behind the country's low rate of gym goers, even relative to laid-back neighbors Spain or Italy.

"It appears to me that more people are sitting in cafes smoking cigarettes and drinking coffee than working out ... the French don't see fitness as a lifestyle," says American-born fitness consultant Fred Hoffman, who has lived in Paris for 21 years.

Only 5.4 percent of French people belonged to a health club in 2008, according to the International Health, Racquet and Sportsclub Association, compared with 9.5 percent for Italy, 11.9 percent for the United Kingdom and 16.6 percent for Spain.

The figure doesn't include France's numerous community fitness groups, or "associations," which are entitled to government subsidies and tempt many consumers with cheap prices despite their often unsophisticated facilities.

What are YOU doing today? Not exercising

Even taking into account this potential numbers gap, mass-market chains Club Med Gym and Fitness First say the $2 billion French market is a particularly tough slog. Property and staff are costly while competition from other sports is fierce.

"Football, tennis and cycling, those are the top three activities of the French," says Nadege Gaillard, marketing director for Club Med Gym, a Paris-focused brand that has not opened a single new club in nearly a decade. It is due to open a new venue in Paris in 2011.

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Although rival Fitness First has had more luck opening clubs in and out of Paris, it is feeling the heat from the growth of no-frills centers that are stealing customers from pricier venues in a stagnating market.

"No services, no staff, that's what's growing ... It's a lot simpler just to open a shoebox and throw in some machines," says Michel Parada, who heads Fitness First's French operations.

No sweat
Working out also has an image problem in France, where few celebrities seem keen to publicly endorse the mucky business of sweating and straining on a cardio machine.

Even the sight of President Nicolas Sarkozy in running shoes jogging after his election in 2007 proved too much for some.

"I would rather see the president in his suit than in his sweat," said philosopher Alain Finkielkraut at the time.

Consumers seem to prefer the aesthetic appeal of creams and cosmetics that claim to have slimming properties, according to Christophe Anandson of the IHRSA fitness club association.

"The credulity of the French isn't favoring the growth of the fitness market," he said.

For those who can afford it, there is also designer gym "L'Usine," a chain of three discreetly chic clubs in Paris and Geneva, which is said to boast singer Lenny Kravitz and actress Melanie Laurent as clients.

Your muffin top may kill you

L'Usine co-founder Patrick Rizzo says the club's high prices, luxury layout and upscale equipment serve a "niche" and manage to rise above the troubles of the mass market in France.

But even he thinks there is a limit to luxury gym growth in Paris and is eyeing possible expansion in Italy or the U.S.

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Some industry figures believe the French market will have a brighter future once the government does more to promote working out as a health measure that could potentially save the healthcare system a lot of time and money.

Gyms could also do more to respond to French consumer tastes, says consultant Hoffman. He does not think low-cost gyms will be able to hold on to a broad client base, as most French consumers are not experts and need assistance to work out.

Just as Starbucks and McDonald's have had to fit their menu to France's cultural preferences, clubs could change as well.

"You've got to get into the French psyche...Maybe a cafe, or a little area for food," Hoffman says.

"But (the problem) is bigger than that. I don't think it can come from the clubs alone. It's getting people more aware of their wellbeing."

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Mountain bikers risk their necks

High speeds, extreme terrain and long vertical drops might be making the increasingly popular sport of mountain biking as risky as football, diving and cheerleading, suggests a new study.

The findings warn that taking two wheels to the trails invites the danger of a spinal injury. One of every six cases reviewed was severe enough to result in complete paralysis.

"People need to know that the activities they choose to engage in may carry with them unique and specific risks," Dr. Marcel Dvorak, of the University of British Columbia in Canada, told Reuters Health by email. "Helmets will not protect you from these injuries, nor will wearing Ninja Turtle-like body armor."

Previous studies had described both the range of injuries sustained by mountain bikers and the spinal injuries suffered across a variety of sports. But no one had yet evaluated the specific risks of spinal injury among mountain bikers.

Dvorak and his colleagues identified 102 men and 5 women who were seen at British Columbia's primary spine center between 1995 and 2007 after mountain biking accidents. The average patient was 33 years old and all but two were recreational riders, they report in The American Journal of Sports Medicine.

The team couldn't calculate the risk of a spine injury among those who mountain biked, but they figured that over the 13-year study period, the annual rate was one in 500,000 British Columbia residents. The riders accounted for 4 percent of all spine trauma admissions to the center.

Surgery was required for about two-thirds of the mountain bikers. But the most devastating injuries were the 40 percent that involved the spinal cord. Of these, more than 40 percent led to complete paralysis.

"Wrist fractures and facial fractures are common" among mountain bikers, said Dvorak. "But spine injuries are the most severe with the most profound long-term consequences."

The majority of riders, he explained, were injured as a result of either being propelled over the handlebars (going "endo") or falling from great heights ("hucking"). In both scenarios, the result was often a severe impact to the head that triggered trauma down the neck and spine. "The higher the jump or fall," added Dvorak, "the higher the risk."

Perhaps surprisingly, the researchers found no relationship between helmet wearing and the overall severity of a rider's injuries. "Helmets are good in preventing head injuries, but they do not in any way protect your neck," noted Dvorak.

Also of unique concern to the sport is its "playing field": remote forested and mountainous areas. Some of Dvorak's patients had fallen while riding alone or at the back of a group. As a result, they were not found for an hour or more, and even then it was difficult for ambulances or helicopters to access the site.

His advice to mountain bikers: Be cautious about any tricks or jumps, know your terrain, and always ride in a group and stay together.

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For good sleep, don't count sheep — run

Sleepless and sedentary? Instead of counting sheep in a field, try running through a meadow.

Experts agree that an aerobic exercise routine during the day can keep you from tossing and turning at night, even if they're not sure why.

"The bottom line is we really don't know why people tell us that exercise helps them sleep," said Dr. David Davila of the National Sleep Foundation.

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"But if people are normally active, reaching their aerobic goals, chances are they will sleep the right amount for what they need."

Davila, who practices sleep medicine in Little Rock, Arkansas, said the low-grade sleep deprivation suffered by many time-pressed, under-rested Americans has a cumulative effect.

"People have more car accidents and what they call 'presentee-ism', or poor performance, at work," he said. "There are fallouts for the average person."

But evidence is emerging that aerobic exercise can offer relief from insomnia.

A recent study at Northwestern University in Chicago, Illinois tracked 23 previously sedentary adults, primarily women 55 and older, who had difficulty falling or staying asleep.

After 16 weeks on an aerobics training program that included exercising on a treadmill or stationery bicycle, average sleep quality improved.

"Most of poor sleepers became good sleepers," said Dr. Phyllis Zee, the lead researcher in the study, which was funded by the National Institute on Aging.

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She said an earlier study using Tai Chi showed less dramatic results, as did a control group doing non-physical activities such as cooking classes and museum lectures.

"This is the first time that I'm aware of where we've looked at the benefits of aerobic exercise as a treatment modality in a population with insomnia," Zee said.

She added that she sees a lot of patients with insomnia, which afflicts 25 percent of the population and can reach as high as 40 percent in older people.

"We tell them to get regular exercise. But we really don't emphasize how to exercise."

If your schedule dictates that you can only hit the gym at 5 a.m. Dr. Shawn D. Youngstedt, an expert on sleep and exercise at the University of South Carolina, believes that an hour of exercise can do more good than an extra hour of sleep.

"There's no scientific evidence that people need eight hours, seven is fine," he said. "It's far clearer that exercise has wonderful benefits. It's better than drugs for diabetes, mental health, cancer prevention."

Dr. William Roberts, of the American College of Sports Medicine, cautions that for some people the time to exercise is not an hour before bed.

"To exercise close to sleep time is not good for everyone," he explained. "Try to get a half hour to an half hour of exercise early enough in the day and try to sleep on same schedule."

Roberts suggests doing something calming to wind down.

"Do not play video games," he said. "Read away from bed and then go to bed. Avoid caffeine and other stimulants before turning in."

The improved sleepers in Zee's study also reported better moods, fewer depressive symptoms and enhanced vitality.

"Vitality is everything," Zee said. "It's how somebody feels, how alert. If you think about the complaints of poor health, people will always say, 'I feel so tired.'"

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Work/rest intervals ratchet up workouts

NEW YORK (Reuters Life!) - If your cardio routine is in the doldrums, try mixing a little tortoise in with that hare.

Experts say interval training, alternating bursts of intensity activity with less intense periods, can burn more calories, boost stamina, and stave off that burning pain that stops any workout dead in its tracks.

"Interval training burns calories quicker. If you're doing interval training for 20 minutes it can burn as many calories you would in 40 minutes," said Kerri O'Brien of Life Fitness, which designs and manufactures exercise equipment.

"It depends on level of intensity, the weight of your body, the intensity of what you're doing," she added.

And the principle holds whether you're an elite athlete, a weekend warrior or a couch potato.

"We can do different things based on your goals and fitness level," she said. "We can work with low intensities that require walking, then stop and do jumping jacks."

O'Brien said interval training increases endurance by clearing lactic acid, the byproduct of exercise.

"That burning pain is lactic acid building up," said O'Brien. "Whether you're strength training, or walking, or climbing stairs, it's lactic acid that tells your body to stop. Interval training is literally training your body to clear that lactic acid more efficiently"

There is also the psychological boost.

"Interval training reduces training time, and the less time you have to commit to exercising, the more likely you are to stay exercising. It reduces boredom and increases variety and challenge," O'Brien added.

Andrea Metcalf, a Chicago-based group fitness instructor, said interval training burns more calories and increases fitness lung volume faster than steady state work.

"The best intervals are those with a two-to-one rest/work interval: sprint for one minute and mid- pace recovery for two minutes," said Metcalf, a fitness expert for more than 20 years.

Julia Valentour, of the American Council on Exercise, said interval training works because when you alternate bouts of high and low intensity your overall intensity level rises.

She said a 2005 study found that cyclists who did four to seven bouts of 30-second all-out cycling doubled their endurance in only two weeks.

"You wouldn't want to do it every day," she cautioned. "You could over train. I like to warm up, then increase speed, run fast for a minute, then slow down for a minute, then run fast for a minute," she said.

Fartlek is an unstructured method of interval training. The word means speed play in Swedish.

"With Fartlek you say, 'I'm going to jog to that telephone pole.' Interval training can be very structured. Fartlek can be tailored to how a person feels that day," she said.

O'Brien said while the Fartlek method is used mostly for long-distance running, it can apply equally to bikers and swimmers.

The key to any interval training, she said, is a really good warm-up to prepare your body for what's to come.

Integrating interval training into your routine can be as easy as changing the program on your treadmill or elliptical machine.

"The interval button is a wonderful one to push," O'Brien said. "Avoid the manual button. I call it the complacency button. Hit it and you're just going to read your magazine."

Copyright 2010 Thomson Reuters. Click for restrictions.

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5 minutes in the green can boost self esteem

LONDON — Just five minutes of exercise a day in the great outdoors can improve mental health, according to a study released on Saturday, and policymakers should encourage more people to spend time in parks and gardens.

Researchers from the University of Essex found that as little as five minutes of a "green activity" such as walking, gardening, cycling or farming can boost mood and self esteem.

"We believe that there would be a large potential benefit to individuals, society and to the costs of the health service if all groups of people were to self-medicate more with green exercise," Barton said in a statement about the study, which was published in the journal Environmental Science & Technology.

Many studies have shown that outdoor exercise can reduce the risk of mental illness and improve a sense of well-being, but Jules Pretty and Jo Barton, who led this study, said that until now no one knew how much time needed to be spent on green exercise for the benefits to show.

Barton and Pretty looked at data from 1,252 people of different ages, genders and mental health status taken from 10 existing studies in Britain.

They analyzed activities such as walking, gardening, cycling, fishing, boating, horse-riding and farming.

They found that the greatest health changes occurred in the young and the mentally ill, although people of all ages and social groups benefited. The largest positive effect on self-esteem came from a five-minute dose of "green exercise."

All natural environments were beneficial, including parks in towns or cities, they said, but green areas with water appeared to have a more positive effect.

Copyright 2010 Thomson Reuters. Click for restrictions.

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Two Minutes <br>of Hell

You might call this our “2 minutes of Hell” workout. If you can make it through two rounds of this routine, you’re a fitter man than most.

Here’s the kicker: The best performance we’ve ever heard of was done by a Division one FEMALE volleyball player. Her time: two rounds in 3 minutes total.  

How to do it: Do one set of each exercise below without resting, and keep track of how long it takes you to complete the circuit. Then rest for twice that duration, and repeat once. When you can finish the first circuit in 90 seconds, skip the rest period.

• Bodyweight Squat: 24 reps

• Bodyweight Alternating Lunge: 12 reps (each leg)

• Bodyweight Split Jump: 12 reps each leg 

• Bodyweight Jump Squat (for fat loss): 24 reps

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Men's Health, <br>Just for You

Personalized tools, tips, and advice from the experts you trust

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Start Your Day Right (or Wrong)

The average American consumes more than 160 bowls of cereal a year, so picking the right box could mean knocking 15 pounds off your waistline yearly and infusing your diet with massive doses of vital nutrients. Use our bowl-by-bowl breakdown to find the perfect cereal for you. Our criteria: the highest ratio of fiber to sugar, along with a respectable calorie count. Sidle up and grab a spoon!
_____
Want complete nutrition facts for all your favorite restaurant and grocery foods?
Sign up for ETNT Premium Content now!

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Dr. Oz's 25 Best Health Tips

My patients are among my best teachers. They've taught me how to communicate clearly—and how to live a better life. On The Dr. Oz Show, I've seen that once people are emotionally involved, change happens quickly, especially if they feel that their behavior is letting loved ones down. Large-scale change seems daunting. We want simple routines that we can automatically follow. Adopt some of the steps here, which anyone can do, and you will like your life more in just a couple of weeks. And you'll live longer. Try them—they work for me.

Men's Health tip: There are even more ways to add years to your life—and erase them from your face. Use the secret Age Erasers for Men to look younger, feel younger, and stay younger longer!

ROTF, LMAO
Laughing not only eases stress, promotes social bonding, and lowers blood pressure, it may also boost your immune system. So bring some humor into your life, whether it's through friends or even a new TV show (preferably mine).

Men's Health tip: If humor doesn't work, these 52 ways to conquer and control stress will arm you with more than enough strategies to face anything life throws your way.

Don't Skip Breakfast
Fiber in the morning means less hunger late in the afternoon, when you're most likely to feel tired and gorge yourself on sugar. My morning dose comes from steel-cut oatmeal, usually mixed with raisins, walnuts, and flaxseed oil. An early start on eating also keeps your metabolism more active throughout the day; breakfast eaters are thinner than people who just rush out the door.

Men's Health Tip: If you must stop at the drive-thru for your a.m. meal, be sure to avoid the 20 worst breakfasts in America.

Hit the Sack
Conan and Dave are funny, but they're not worth the strain on your system. Seven hours of sleep a night not only helps you live longer, but also lowers your stress, sharpens your memory, and reduces cravings for pants-splitting foods. Set a bedtime and stick to it. My target is 10:30 p.m. I record the late shows and then watch them the next day as I pedal a stationary bike.

Men's Health tip: Try these expert tips to sleep better every night.

Admire Your Work
Don't be so trigger-happy with the flusher. Turn around and take a look at your poop, which speaks volumes about your gut and overall health. Poop should be smooth and S-shaped, like your colon. If it comes out too lumpy, or drops into the bowl like marbles, you're constipated. Increase your fiber and water intake. This happens to me when I travel, so I fiber-load before a trip to avoid getting irritable.

Men's Health tip: You don't need Metamucil—here are 30 great-tasting ways to add fiber to your diet.

Don't Pamper Your Bad Back
Even if you're hunched over in agony, taking to your bed will only make a bad back worse. The latest research shows that bed rest weakens back muscles and prolongs the suffering. Married men may suffer more than single men because of all the pampering. I used to love milking the care from Lisa, but the best solution is to get up, take a pain reliever, and be a soldier.

Men's Health tip: Perform the Ultimate Upper-Body Workout to strengthen your back and broaden your shoulders. 

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The Best Barbeque You've Ever Tasted

To tackle Memphis in May, the world's biggest BBQ competition, we rounded up the best BBQ pitmasters in New York. Here are some highlights of the trip.

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The Hottest Athletes' <br>Wives of 2010

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25 Nutrition Secrets

Sarah Palin is on a diet. So is Barack Obama, Glenn Beck, Oprah Winfrey, Lady Gaga, Peyton Manning, the pitching staff of the Texas Rangers, all the judges on America's Got Talent, and the entire cast of Glee. In fact, from Chris Rock to Kid Rock to The Rock, everyone you can name is on a diet.
And so are you.
How can I be so sure? Because a "diet" isn't something you go on and go off of, like a prescription. A diet is what you eat, day in and day out, whether you planned to eat that way or not. So when people ask me what kind of "diet" they should follow, I always tell them to follow the one they're already on—the way you like to eat is the way you should eat. In researching the Eat This, Not That! book series and seeing people lose 10, 20, 30 pounds or more effortlessly, I've learned that if you want to make big changes to your health, forget about following somebody else's diet. Just make a bunch of little changes to the diet you're already following. Believe me, it's the best way to get results. Below, I've listed the 25 best new nutritional tweaks you can make that will improve the way you look and feel—fast and forever!

Drink a second cup of coffee.
It might lower your risk of adult-onset diabetes, according to a study in the American Journal of Clinical Nutrition.
Sign up for the FREE Eat This, Not That! e-mail newsletter, and get a free download that'll teach you how to eat for a week on $50 or less!

Keep serving dishes off the table.
Researchers have found that when people are served individual plates, as opposed to empty plates with a platter of food in the middle of the table, they eat up to 35 percent less!

Think before you drink.
The average person drinks more than 400 calories a day—double what he or she used to—and alone gets around 10 teaspoons of added sugar every single day from soft drinks. Swap out sweetened teas and sodas for no-cal drinks and you could lose up to 40 pounds in a single year! (To see more proof of how wayward beverages can utterly destroy your diet, check out the 20 Worst Drinks in America. Many of these drinks contain more than a day's worth of calories, sugar and fat!)
SoBe Green Tea, for example, packs as much sugar as in 4 slices of Sarah Lee Cherry Pie.

Practice total recall.
British scientists found that people who thought about their last meal before snacking ate 30 percent fewer calories that those who didn't stop to think. The theory: Remembering what you had for lunch might remind you of how satiating the food was, which then makes you less likely to binge on your afternoon snack.
For thousands of helpful tips like this one, pre-order the latest, most up-to-date book yet: Eat This, Not That! 2011

Eat protein at every meal.
Dieters who eat the most protein tend to lose more weight while feeling less deprived than those who eat the least protein. It appears that protein is the best nutrient for jumpstarting your metabolism, squashing your appetite, and helping you eat less at subsequent meals.

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3 Moves to Rev Your Metabolism

This workout from Craig Ballantyne, C.S.C.S., M.Sc., the owner of turbulencetraining.com, works your entire body in only three exercises. Complete the sequence, rest 1 minute, and repeat as many times as you can in 15 minutes

Video and Images
This Workout To Go includes video with audio instruction of how to perform each exercise. In addition, you receive images of the same exercises that can be viewed while listening to your own music.

Program Details
>Video, images, and audio
>Equipment: Typical gym equipment

What is a Workout to Go?

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Can You Handle the Pressure?

It's been called the most dangerous job in the military: United States Navy EOD, or Explosive Ordinance Disposal technician.

Navy EODs are not only trained to jump, dive, rescue hostages, and operate as assault teams in the most hostile situations--they also have to be the best in the world at disarming explosives. If special operations forces encounter any threat or evidence of bombs or Improvised Explosive Devices (IEDs) in combat zones, they pull back immediately and call on EODs to disarm them. The EODs must not crack under pressure. If they do, they fail. And failure means death.

Not exactly an easy day at the office.

In the latest episode of Discovery's Surviving the Cut, eight men, already among the world's most highly trained sailors, assemble at Fort Story, Virginia, for one last 4-day test to become certified EODs. If they successfully complete the rigorous challenges that await them, they will immediately ship off to war together. But one wrong move, and the sailors will be sent back for more training.

There's no margin for error in the Training and Evaluation Unit, so the men will be prepared for any real-life situation. As one instructor puts it, it's better to "die" (make mistakes) in training than it is to die (for real) in combat. To make sure the men are ready, instructors throw a bevy of challenges their way: Sailors must put their skills to use in simulation hostage situations, rescuing civilians from danger while warding off terrorists and disarming all explosives around them. The scenarios, all based on actual past missions, are filled with role players. But the action is real.

One sailor says that it takes a very adaptive person to overcome the demands of the job and approach it with a level head. EODs are constantly trained to disarm explosives in the most pressure-filled conditions. That requires serious concentration and focus.

But you can learn how to handle your own high-pressure situations, even if they don't include de-activating a bomb. The first step is to slow down your breathing, says Daniel Amen, M.D., New York Times bestselling author and a Men's Health mental-health advisor. "You literally have to control your breathing and visualize blinders getting more and more narrow," Dr. Amen says. "If any thoughts come into your mind and distract you, visualize a broom coming in to push them away. You have to practice that. Over time, it gets easier and easier, like meditation."

Dr. Amen says this can lead to lower levels of anxiety, lower heart rates, and lower sweat gland activity, all of which bomb diffusers have. "That's why they're able to do these highly anxious tests without getting terribly anxious," he says.

Find out what else it takes to become a Navy EOD on Surviving the Cut, the show that gives you an inside look at what it takes to become an elite member of the U.S. Military. Watch the action Wednesdays at 10 p.m. EST/PST on Discovery Channel.

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Jeans for Any Occasion

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Keep Stress <br>Under Control

When you're facing that big-money putt, shake out your fingers, relieving the tension in your forearms, hands, and wrists and shifting your focus to the only thing you can control: your preshot routine. You won't think about making—or missing—the shot, says Alan Goldberg, Ed.D., a sports-psychology consultant in Amherst, Massachusetts.

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The Truth About Sex Today

By Carolyn Kylstra

You may want to reconsider your definition of ‘sex.’

Americans engage in a wide range of acts when they have sex, finds the National Survey of Sexual Health and Behavior, the largest nationally representative survey of American sexual activity since 1992. Researchers at the Center for Sexual Health Promotion at Indiana University surveyed 5,865 participants ranging in age from 14 to 94. They asked study participants to indicate the various acts they engaged in during their most recent sexual encounter. The participants reported 41 distinct combinations of sex acts.

“What it means to have sex can vary greatly from one individual to the next,” says Debby Herbenick, Ph.D., one of the study’s co-authors, and the Men’s Health sex professor. What’s more, the 41 combinations were limited by those acts specifically listed on the survey—Herbenick points out that certain acts weren’t included on the survey (such as using pornography, or including toys in sex play), and so the actual number of combinations is likely higher than just 41.

Another significant finding: The satisfaction gap persists. About 85 percent of men reported that their partner experienced orgasm during their most recent sexual event—but only 64 percent of women reported experiencing orgasm. “There’s a gap between how women experience sex, and how men feel women experience sex,” Herbenick says. Even more shocking: Nearly 30 percent of women claimed to have experienced pain during their most recent sexual experience (compare that number to just 5 percent of men who reported the same).

But it’s not all bad news: “Findings suggest that women are more likely to experience orgasm when sex involves a variety of sex acts,” Herbenick says. Case in point: 54.9 percent of women say they experienced orgasm during their last sexual encounter when it involved just one act. But 89.1 percent say they experienced orgasm when the encounter involved five acts. (The takeaway: If you want to increase her odds at experiencing orgasm, mix it up in bed!)

Other notable findings:

Oral sex and anal sex are becoming more common. The study authors write: “Compared with the 1992 National Health and Social Life Survey (NHSLS), in this present study more men and women have engaged in oral sex and a significantly greater proportion have engaged in anal sex.” 37 percent of both men and women reportedly performed oral sex during their most recent sexual activity; 44 percent of men and 31 percent of women reportedly received oral sex. As for anal sex: 6.5 percent of men say they’ve performed insertive anal intercourse, and 2.5 percent of men and 3.5 percent of women say they’ve performed receptive anal intercourse.

Teenagers use condoms more regularly than people over 40. Overall, only one in four acts of vaginal intercourse is condom protected, says Michael Reece, Ph.D., M.P.H., one of the study co-authors. The rate is only slightly better among people not in committed relationships: One in three. Here’s the shocking part: Both adolescents and young adults most consistently use condoms. “While we often assume young adults are irresponsible, most young people are making efforts to maintain their sexual health and that of their sexual partners,” Reece says. In a reversal of roles: The lowest rates of condom use were among adults over the age of 40. “Although adults over this age may not be concerned about pregnancy, these findings suggest that we might need to enhance information about STIs,” he adds.

Condoms don’t kill the love. “The assumption is that condoms reduce the quality of the sexual experience,” Reece explains. But the research revealed a different story: “Among adults, sexual arousal, pleasure, and orgasm during vaginal intercourse were evaluated similarly whether or not a condom was used.” This could be because sexual intercourse with a condom may alleviate the fear of disease and pregnancy. “The psychological benefits of knowing you’re protected makes the experience better,” Reece says. Another reason: “Today’s marketplace provides a range of condoms that are better fitting and more comfortable than the condoms from twenty years ago.”

Not all people who engage in same-sex acts identify as gay or bisexual. Just because a woman or man identifies as “straight” doesn’t mean he or she only has sex with opposite-sex partners. For instance, about 7 percent of women and 8 percent of men identified as gay or bisexual. But for women between the ages of 20 and 24, 16.8 percent claimed to have received oral sex from a woman in their lifetime. And among 20 and 24 year old men, 10.8 percent had engaged in receptive anal intercourse in their lifetime.

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The World's <br>Hottest <br>Woman?

Is Ines Sainz The World's Hottest Woman? We say she's in the running. What do you think?

When reports surfaced over the weekend that New York Jets players had allegedly harassed Mexican sports reporter Ines Sainz, the first question was simple: Who the heck is Ines Sainz?

But once Ines's jaw-dropping photos hit the New York Post, millions of American men no doubt had a new question: "Where can I see more pics?"

The answer: Right here. Keep in mind that we believe harassment of any sort is wrong. Admiration, however, is not. So enjoy this slideshow of Ines Sainz—100 percent guilt-free.

All About Ines Sainz
Her pipe dream: "To participate in the Olympics," says Ines.
Hidden talent: "I'm a good analyst and I'm good at drafting up contracts. I think I'd make for a good lawyer."
Childhood memory: "My brothers, my dad and I riding horses on the mountains."
Drives her crazy: "Chocolate."
Favorite TV show: "The Mentalist."
Favorite superhero: "The Invisible Woman. I like her style."
Indispensable: "My family."
Can't live without: "My running shoes"

Biggest weakness: "Crafts. I can't sew or knit."
A must: "Staying in a hotel with a gym."

Inez Sains' 3 Favorite Sports Stars
1. Roger Federer
2. Kaka (Brazilian soccer star)
3. Peyton Manning

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When the Warrior Comes Home

When the Warrior Returns Home

U.S. soldiers are battling stress on two fronts: at war and at home. Their coping strategies might help you on the home front as well

At lunch in a hotel in Philadelphia, a fast-talking, slightly rattled, 38-year-old master sergeant in camouflage and combat boots is recalling another lunch a few years back, in Iraq. That meal took place at a forward operating base, and he'd been standing 20 feet away from where an Iraqi soldier triggered the detonator on a vest loaded with explosives. Shrapnel ripped through everything in its path, and the blast flung the sergeant back into tables and chairs. He came to, dazed but alive, amid a scene of blood and chaos. "I was saved by a coffee urn that had just been filled, between me and the bomber," he recalls. "Guys on either side of me were torn to pieces."

Twenty-two people died, some while he was performing CPR on them. He spent a month recuperating from a shrapnel wound and then returned to his unit. A few months later, a car bomber hit his armored vehicle; he spent the next 5 months in bed with a broken back. "It took a few years to get over the bad dreams," he says. "I was worried that if I told the army I had mental-health issues, I would lose my security clearance."

The sergeant ended up with post-traumatic stress disorder (PTSD), a jittery witness to the way the U.S. Army's own leadership says it has mishandled trauma in the past. Now he is in Philadelphia to help as the army tries to remake itself, at a training session focused on teaching soldiers how to cope with their emotions--on the field of combat and back at home.

The basic idea behind "resilience training" is that you can train your mind to become mentally and emotionally fit the same way you train your body to become physically fit. And as with marathon training, it has to happen before you really need it, or in military lingo, "left of the boom." Bad things may still happen, from broken relationships to rocket-propelled grenades. But with the right training, the program's proponents argue, you'll respond better in the moment. Instead of PTSD, they contend, you can come out the other side with "post-traumatic growth."

The initiative is being deployed on the fly, at a cost of $125 million over 5 years, in response to record rates of depression, domestic strife, and suicide in a military worn down by 9 years of warfare. Col. Darryl Williams, the 49-year-old artillery officer organizing the program, is frank about its practical benefits for army brass. When they're grilled by Congress about the mental fitness of combat forces, he says, "they will use this. This is the only thing they have left of the boom to inoculate soldiers."

Reaching everyone who needs that inoculation will be difficult. The U.S. Army is simply too big to quickly reach everyone who needs the training. Also, the military has always prided itself on physical, tactical, and technological training; emotions have generally been viewed as excess baggage. Thinking was mostly something officers did. Now the army wants soldiers not just to think, but also to think about how they think.

In a conference room at the hotel, Karen Reivich, Ph.D., a University of Pennsylvania psychologist in flared pants and patent-leather flats, is teaching soldiers how to thrive in a hostile world, both downrange in the war zone and back home at the dinner table. The soldiers in her audience have seen more than their share of bad stuff, including multiple deployments, suicide bombings, and friends maimed or killed at close range. Many of them are now drill sergeants, those kindly guys at boot camp who use the nostrils of terrified recruits as echo chambers. Reivich is just trying to convince them to do it all more thoughtfully.

She tells them a story about the night she flipped out over a coffee coaster. The audience members have families too, so if there's a disconnect between problems with coffee coasters and, say, improvised explosive devices (IEDs), that doesn't seem to faze them. It's 17 years ago, the morning after her future husband moved into her apartment. Thinking he's scoring points, he has gotten up first to make coffee. But as Reivich wanders into the living room, her bleary eyes pop halfway out of her head in horror: He has set his coffee cup down not on the coaster but beside it. Coasters are sacred for her, and he knows it. So how hard can it be to use one? She winds herself up into such a coaster-compulsive snit that she blows down the door and flies out into the street in a vortex of righteous indignation.

So, um, what just happened here? And why should the U.S. Army, fighting two wars with roughly 154,000 soldiers deployed, actually care? The offense was nothing to get crazy about, Reivich admits. A little vexed, maybe. But the story has become her favorite tool for teaching people how to listen to family members, fellow soldiers, and friends. We all have what she calls "icebergs"--deeply held beliefs that now and then cause us to react out of proportion to circumstances. The trick is to find out what lies beneath.

Reivich gives her soldier-students four techniques that can help reveal a person's iceberg. First, she says, ask open-ended questions that require more than yes/no answers. Second, use the word "what," not "why." ("'What' questions make you stop and think," she says. "'What' brings out facts and events.") Then repeat the answers verbatim. ("You want the other person to hear his or her own thoughts, not your rendition.") Finally, keep asking questions until you arrive at an iceberg that's big enough to explain the overreaction.

Reivich's iceberg, it turned out, was a belief that her future husband should know her quirks and accommodate them. It was about the relationship, not the coaster. Someone in the audience asks if her husband now uses coasters, 17 years on. "No," she says, beaming. "And neither do I."

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Turn Her On Tonight

You know the athletic wisdom that warns against playing not to lose, that argues you have to be loose to let your skills flow and maximize your game? Same goes for marriage. Oh, sure, you can have a perfectly fine little partnership by taking the cautious route. He & She Inc. may even hum along nicely if you companionably sidestep the briar patches. But that's no way to be a great husband. She's entitled to more, the full monty, the whole experience of being affiliated with, no, make that loved by, a man.

People often settle for accommodating coupledom because they're afraid some explosive issues will blow up the marriage. They fear ending their days alone, living under the bridge behind the high school. Set yourself free to play bravely by taking the big risk, divorce, off the table. Decide that you meant what you said at the wedding, that this woman, come what may, is your partner for life.

Older couples often report that once they've gone past the point where they might leave each other, their partnership gets an invigorating second wind. No longer afraid of being alone, they talk things through. In pursuit of something richer than mere amity, they explore regrets, grievances. Sure, it can be difficult, but it's full and human and adrenal and—hallelujah!—not dull. And it can lead to a more spacious marriage, a connection that is full hearted and well tempered instead of taped together.

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A Champion's Game Plan

By: Mike Zimmerman

The champion slept well for 1 month as he savored the big victory, the biggest he's had so far. Then, in late March, he went back to work. Training. Conditioning. Now it's early summer, a quiet Wednesday morning on a high school football field in San Diego. Six NFL quarterbacks are here to run the drills, pound the timing routes, and engage in endless, endless competition with one another.

One of these guys won the Super Bowl last year. All of them want to win it this year. That's why the offseason trainer of these men has recruited a bunch of college and high school wideouts, live targets for the quarterbacks' sweaty arms.

"The ball's gonna be there, the ball's gonna be there!" Drew Brees screams, and the ball's in some poor kid's face faster than acne, and then dropped.

A loss, which pisses Brees off.

Later, the New Orleans Saints' leader is competing against his training partners—usually other pros like Green Bay Packers quarterback Aaron Rodgers or Drew Brees's former San Diego Chargers teammate LaDainian Tomlinson, now with the New York Jets—in postworkout handball games and reflex drills. For one of the drills, their trainer, Todd Durkin, tosses playing cards in the air. How many can they catch? Drew Brees grabs eight in a row. The ninth drops, and Brees's deepgrowl f-bomb drops after it, his fists balled, his body stiff.

Small victories have no shelf life. They are little waves that lap against some part of his brain for a split second and are gone. He catches 17 out of 20 playing cards and he's not happy about it, because "undefeated" is the only worthy outcome. There's no mysticism to this. Victory is not everything, nor is it the only thing. It's not slippery or elusive. Victory is ever present, in our minds day in and day out, no matter what the job at hand. We grab it, or we don't. And many of us, most of the time, simply refuse to reach for it. Brees does not understand how anyone could make that choice. Because if you want to know what victory is, taste it a bit more often, you must understand it as he understands it.

The smell of victory is not, as Lieutenant Colonel Kilgore suggested, napalm in the morning. You know what victory smells like? The rubber floor of a gym. It smells like the cover of a 16-pound med ball in dirty hands as a warm breeze blows through eucalyptus branches behind a San Diego strip mall. And victory sounds like that ball being hurled against a cinder-block wall, again, again, and again. Victory looks like fried colors on the edges of your vision on the last rep. Victory tastes like your own fillings, like acid in your saliva with a touch of underlying bile held down by sheer will.

This isn't a Nike commercial. It's real life, and Drew Brees is going to war again. For 7 years now he has worked with Durkin, who adheres to this philosophy: Physical conditioning is the foundation of any and all successes, no matter where you are or what you do. (See "Train Like a Champion," this month's workout poster.) Victories, large and small, will not come in a constant stream if your body is unprepared, because by default, the mind is useless if the body is not ready.

"Winning means having that mental edge on everybody," says Brees. "The more you push yourself physically here, here, and here"—and on this, Brees points to his heart and his gut, and then sweeps his finger over his body—"a hard mental toughness develops here." (That's your head.) "Because you have to push past your perceived limits. Push past that point you thought was as far as you could go. Once you push past that, you remake your confidence. I push past that and I know I've put myself in the best position to succeed. There is no person who will be in better shape than me, or more prepared. Physically, spiritually, psychologically—man, I'm ready."

How ready? Ready to throw it all away, to act like the best never happened. "You still have to have a chip on your shoulder," says the 6-foot quarterback who is accustomed to being underestimated. "The way people perceive me now is different from the way they did 5 years ago. Five years ago I wasn't big enough, strong enough, couldn't win the big one. Whatever. Now, coming off a Super Bowl championship, showing them I can play at a high level, I have to keep that chip on my shoulder like I still have something to prove. I have a lot to prove. I look at every day as, 'I have to be better today.' If I'm not getting better, I'm getting worse. You don't stay the same. So I improve every day, continue to make the sacrifices I've made to reach this level, and it's all about, 'How can I win another championship?'"

An hour earlier, this man was lying on an inclined sliding bench, belly down, with his head facing the floor, doing single-arm gravity presses. His excruciating rep count was not a voice, but a gut-deep moan: sehhhhhvin...aaaaaate...niiiiiiiine. On 10, he rolled off the bench, stood, and gave himself a subtle fist pump. A small victory. On to the next.

Brees's victories this year will mean more than they did last year, and just ask anyone from southern Louisiana how much those old ones meant. Remember how inspiring the championship run was to a city devastated by Katrina and the failed levees? Imagine the importance of this season now that crude oil has washed over the Gulf Coast. The champion is eager to share his victories. "We're still playing for a lot more than just football. It's not just about winning games for ourselves or for our organization. It's about winning for the city, the people, uplifting their spirits, giving them hope, especially with what's going on in the Gulf."

And now you see why he curses when he drops a playing card. Why his workout lasts nearly 3 hours and his heart rate is clocked between 160 and 190 for much of that time. The body readies the mind. So it is with champions, while many of us neglect both.

Not a quarterback? Of course you aren't. But your body sits in an office chair propping up your mind, deconditioned back muscles let your spine sag, flaccid trapezius muscles allow your shoulders to slump. Your brain tilts toward your desk, fogged, disengaged, like a melon-size hunk of snot in your skull. Useless.

Meanwhile, Brees scoops up the ends of a 2-inch-thick, 40-foot training rope, and makes like a drummer, snapping waves through the rope full tilt for 20 seconds. Without pause, he switches to slams, lifting the rope's ends above his head and whipping them down as hard as he can. Another 20 seconds. Then he switches to jumping jacks, lifting the rope's ends in his fists above his head and snapping them down. Twenty more seconds. Then he tosses the rope aside.

Another victory. What's next?

"You're always in a position where you have to eliminate distractions and negative influences in order to focus, concentrate, accomplish your goals," he says. "You just have to understand that your window of opportunity is a small one. You have to make sure you're doing everything you can within that window to accomplish what you set out to accomplish. That you've made that commitment to yourself, to the people around you. In my case, to the city, to the organization.

"There are plenty of times that you figure somebody else doesn't have the same interests you do. And they might be your friends. That's the toughest—when they're closest to you. You have to have the discipline to at times say no, so that you can do what you need to do to accomplish what you want to accomplish."

He shrugs.

"It's all about setting priorities. I took one step closer to getting the edge today."

And with that, the champion leaves the gym to go home to his wife and son. Today's victories tallied. The next fight coming.

Track calories, discover thousands of simple food swaps, build a healthier grocery list, and more—all from your iPhone!

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The danger in your medicine cabinet

By Leigh Remizowski

In an effort to rid medicine cabinets around the country of unused prescription medications, the federal Drug Enforcement Agency is hosting the first-ever nationwide Prescription Drug Take-Back Day on Sept. 25.

People can drop off their expired or unwanted prescription drugs at more than 2,700 sites across the country this Saturday from 10 a.m. to 2 p.m. Department officials will then collect and incinerate the medicines.

Click here for more information and to find a collection site near you.

The initiative is meant to educate Americans about how to safely dispose of unwanted pills so they don’t wind up in the water system or in the hands of people who could misuse them, said DEA spokeswoman Barbara Carreno.

“When you throw a bottle of pills in the trash it can be retrieved by kids in the house or neighbors,” she said.

According to a 2008 survey by the Substance Abuse and Mental Health Services Administration, 6.2 million Americans 12 years and older had abused prescription drugs — more than the number of people who abused cocaine, heroin, hallucinogens and inhalants combined.

This alarming trend makes it even more important to keep unused medications — from painkillers to antidepressants — off household shelves, experts say.

“Most young people who get these drugs and misuse them report that they get them from their families,” said Susan Foster, vice president and director of policy research at the National Center on Addiction and Substance Abuse at Columbia University.

According to the DEA, 63 percent of teens believe that it’s easy to find prescription drugs in friends’ and family’s medicine cabinets, and two in five teens believe that prescription drugs are much safer than illegal drugs.

“A lot of people think that because these drugs are approved by the FDA and prescribed by a doctor, they’re safe,” she said. “As we can see, that is not true at all.”

The bottom line?

Handing off unused medications to trained professionals at one of the Take-Back sites will ensure that they aren’t misused.

But for those people whose community is not on the DEA’s list of disposal locations, the federal Food and Drug Administration advises that people mix their unwanted medications with kitty litter or coffee grounds before throwing them into the garbage.

“The main idea is to dump your pills into something unsavory,” Carreno said.

The Take-Back Day is also meant to deter people from the age-old practice of flushing unwanted medications down the toilet.

“Traces [of prescription drugs] have been found in the waterways in many major cities in the U.S.,” said Carolyn Ha, a pharmacist and associate director of management affairs at the National Community Pharmacists Association.

“It’s still premature to say what effects they would have on humans, but it’s really disrupting some aquatic ecosystems,” Ha added.

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The Best Tailgating Food for Guys

Everything you need to take you from parking lot peon to concrete commander.

PLUS: Master your grill skills today to make your tailgate even better!

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50 Things She Wishes You Knew

There are some universal truths that women believe all men should—but don't—understand. Lucky for you, we convinced some girls to open up and tell us what they aren't. Check out this list for a better idea of what's going through her mind.

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Ever tried Altitude Training?

Altitude training has long been a powerful training tool for elite athletes but there is an increasing awareness of the benefits for those recovering from injury.

Hypoxic training limits the amount of oxygen available during exercise which over time will encourage the body to produce red blood cells. An increase in oxygen carrying red blood cells will result in an improvement in performance during endurance exercise, ideal for long distance runners or intermittent team sports such as football.

Hypoxic training is an invaluable tool during injury. Not only can patients limit the aerobic detraining effect of inactivity, but even more importantly by improving the bodies ability to transport oxygen, recovery times can be shortened.

The positive effects of a highly efficient cardiovascular system during injury cannot be over emphasised, so altitude training really is a powerful injury rehabilitation tool.

The Drew Brees Workout

By: Todd Durkin, C.S.C.S.

When I started training Drew Brees in 2004, I put him through a workout unlike any he'd done before. I used new exercises and equipment that made him stronger and leaner and improved his athleticism. Now I'm going to share that better-body blueprint with you. Use this routine to unlock your potential, speed up fat loss, and pack on muscle like a pro.

This program consists of four circuits of three exercises each. For each circuit, do 1 set of each exercise in succession, resting 20 to 30 seconds between sets. Then rest for 1 to 2 minutes. That's one round. Do a total of three rounds, and then move to the next circuit. After you've completed all four circuits, burn even more calories by doing sprint intervals. You can do them outside or on a treadmill. They're simple: Sprint for 30 seconds, and then walk for 30 seconds. That's 1 set. Do 3 sets in week 1, then 4 sets in week 2, and then 5 sets in weeks 3 and 4.

Track calories, discover thousands of simple food swaps, build a healthier grocery list, and more—all from your iPhone!

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100 Greatest Fitness Tips of All Time

A great tip is an awesome thing. Whether it's an undiscovered restaurant, a sleeper stock, or a Sure Thing in the late double at Pimlico, savvy inside info imbues a man with confidence. Control. Strength.

Knowledge is power, baby.

It's also the secret to a powerful body, as you're about to find out. In our never-ending mission to get you in the greatest shape of your life, we've grilled the world's top experts, combed our own archives, even eavesdropped on some cell-phone conversations to find 100 perfect fitness training tips—small gems that will make a huge difference in any man's life.

Get ready: You're about to feel the power—and have the body to show for it.

And for even more ways to shape your body, check out The Men's Health Big Book of Exercises. With complete instructions of more than 600 exercises, along with hundreds of workouts and useful tips, it's the most comprehensive guide to fitness ever created.

Build Better Abs
Don't work your abdominal muscles every day. "Physiologically, your abs are like any other muscle in your body," says David Pearson, Ph.D., C.S.C.S., an exercise scientist at Ball State University. Train them only 2 or 3 days a week.

Protect Your Neck
Put your tongue on the roof of your mouth when you do crunches. "It will help align your head properly, which helps reduce neck strain," says Michael Mejia, C.S.C.S., Men's Health exercise advisor.

Keep Muscles Limber
If you're under 40, hold your stretches for 30 seconds. If you're over 40, hold them for 60 seconds. As you reach your 40s, your muscles become less pliable, so they need to be stretched longer.

Don't Drop the Ball
To catch a pop fly in the sun, use your glove to shade your eyes. It's bigger than your free hand and puts the leather in perfect position to snag the ball.

Grow Muscle, Save Time
Keep your weight workouts under an hour. After 60 minutes, your body starts producing more of the stress hormone cortisol, which can have a testosterone-blocking, muscle-wasting effect.

Exercise in Order
Use dumbbells, barbells, and machines—in that order. "The smaller, stabilizer muscles you use with dumbbells fatigue before your larger muscle groups," says Charles Staley, a strength coach in Las Vegas.  So progress to machines, which require less help from your smaller muscles, as you grow tired.

Strengthen Your Core
Don't be afraid of situps. We've changed our tune on these, and here's why: Situps increase your range of motion, which makes your abdominals work harder and longer. (Doing crunches on a Swiss ball or with a rolled-up towel under your lower back has a similar effect.) Just avoid situps with anchored feet, which can hurt your lower back.

Test the Bench
Press your thumb into the bench before lifting. "If you can feel the wood, find another bench," says Ken Kinakin, a chiropractor in Canada and founder of the Society of Weight-Training Injury Specialists. Hard benches can cause T4 syndrome—a misalignment of your thoracic spine that affects the nerve function of your arm, weakening it.

Swim Faster
To build speed in swimming, develop your ankle flexibility. Flexible feet will act like flippers and propel you faster through the water. To increase your flipper flex, do this: Sit on the floor with your shoes off. Extend your legs in front of you, heels on the floor. Point your toes straight out as far as possible, then flex them toward your shins as far as you can. Repeat for 1 minute.

Buy Shoes That Fit
Shop for workout shoes late in the day. That's when your feet are the largest. Make sure there's a half inch of space in front of your longest toe, and that you can easily wiggle your toes. Then slip off the shoes and compare them with your bare feet. If each shoe isn't obviously wider and longer than your foot, go half a size bigger.

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Take Care of Business, And Yourself!

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The Saltiest Foods in America

When you eat out at most restaurants, from the highest of the high-end to the cheapest and fastest of the drive-thrus, you're all but guaranteed to take in more than your recommended daily intake for sodium—about 2,300 milligrams of sodium, max. But salt is so cheap and, let's face it, makes so many foods taste delicious, that it's in nearly everything. In fact, the average American takes in about 3,300 milligrams of sodium every single day!
Why is that a problem? With ever-expanding portion sizes, supersalty foods are displacing fresh fruits and vegetables, which are rich in potassium. And a 1:1 ratio of dietary salt to potassium is critical for your health. Studies show that a high-sodium, low-potassium diet is linked to a host of maladies, including high blood pressure, stroke, osteoporosis, and exercise-induced asthma.
To protect your heart, your bones, your muscles, and your taste buds, we scoured takeout menus to expose the top 30 saltiest foods in America. No need to take the information with a grain of salt. These dishes provide plenty.

Saltiest Drive-Thru Meal
Burger King Cheeseburger with French Fries (small)
1,360 milligrams sodium
680 calories
33 g fat (10.5 g saturated, 0.5 g trans)

Sodium Equivalent: 5 Big Grab Bags of Lay's Potato Chips

The dearth of healthy, well-balanced meal options for kids at chain restaurants is a serious issue in this country. The cheeseburger, with 340 calories and 7 grams of saturated fat, gets trounced by the tenders, while the small French fries double the meal's caloric load without adding any real nutrition to the equation. Choose the chicken nuggets instead: At just 63 calories a piece, these rank among the best nuggets/tenders/fingers in the fast-food world. Add to that the genius product that is Apple Fries and you have a pretty sound kid's meal.

Eat This Instead!
Chicken Tender (6 piece) with Barbecue Dipping Sauce and Apple Fries with Caramel Sauce
380 calories
16.5 g fat (3 g saturated)
805 mg sodium

Saltiest Mall Snack
Auntie Anne's Sesame Pretzel with Hot Salsa Cheese
1,440 milligrams sodium
510 calories
18 g fat (7 g saturated)

Sodium Equivalent: 50 Rold Gold Honey Wheat Braided Twists

Combine one of the most caloric pretzels with the heaviest dip, and you've got a dietary nightmare on your hands. Beyond the substantial caloric impact, do you really want to blow 60% of your recommended daily sodium intake on a snack? Not only does the marinara save you 65 calories over the hot salsa cheese, but it also brings along a dose of disease-fighting lycopene. And if you go sans salt, you'll save yourself 580 milligrams of sodium.

Eat This Instead!
Jalapeño Pretzel with Marinara (no salt)
810 mg sodium
350 calories
5.5 g fat (3 g saturated)

Saltiest Pizza Slices
Pizza Hut Supreme Pan Pizza (2 slices)
1,780 milligrams sodium
800 calories
40 g fat (16 g saturated)

Sodium Equivalent: 17 Cheese, Sausage and Pepperoni Bagel Bites
This pizza is stuffed with sodium—when just two slices pack away nearly a day's worth of salt, imagine what you'll find in an entire pie! You'd be better off making your own pie at home, or ordering a thin crust for 1,000 milligrams less.

Eat This Instead!
Pizza Hut The Natural Veggie Lovers Pizza, no olives (2 slices)
760 milligrams sodium
380 calories
12 g fat (6 g saturated, 0 g trans)

Saltiest Combination Meal
Panera Bread Half Sierra Turkey with Half Greek Salad You Pick Two Combo
1,870 milligrams sodium
810 calories
59 g fat (12 g saturated)

Sodium Equivalent: 6 Slices of Bologna (Oscar Mayer)

The You Pick Two option may be the best option on Panera's lunch menu, but that doesn't mean trouble isn't still lurking. This seemingly healthy combo packs nearly a full day's worth of fat and nearly an entire day's worth of sodium. A better combo matches one of the best sandwiches with the healthiest soup on the menu, resulting in a low-cal lunch with 32 grams of protein, 7 grams of fiber, and enough potassium to combat Panera's high sodium levels.

Eat This Instead!
Half Asiago Roast Beef with Black Bean Soup You Pick Two Combo
1,510 mg sodium
450 calories
17 g fat (6 g saturated)

Saltiest Chicken Salad Sandwich
Boston Market Classic Chicken Salad Sandwich
1,900 milligrams sodium
800 calories
41 g fat (7 g saturated, 5 g trans)

Sodium Equivalent: 20 Wendy's Chicken Nuggets

All research points to the fact that mayo-masked chicken salad is rarely as healthy as you'd think, but it's unfathomable how one sandwich could pack nearly 3 days' worth of trans fat and as much salt as you'll find in 20 Wendy's Chicken Nuggets. Kick the "salad" part of your chicken salad sandwich and stick with the Half Boston Chicken Carver, instead.

Eat This Instead!
Half Boston Chicken Carver
980 mg sodium
375 calories
14.5 g fat (4 g saturated)

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Is No Sex a Dealbreaker?

After our parking-lot kiss, Todd disappeared. Not just out of the state—he flew back to Florida the next day—but out of my life. I didn’t hear from him for weeks, but tried not to worry. I told myself our romance was still new, so it wasn’t fair to have expectations just yet. His next visit would seal the deal, or so I was convinced.

I was at a baseball game with my girlfriends when I got the text. He was in town for his grandmother’s funeral and wanted to meet up—at the bar…again. I promised to stop by after the last inning. The game ended, and I rushed home, shaved my legs, and headed out. He was with his friends—always the same crew of bored married men—and as we stood by the bar chatting, something felt different.  I felt less attracted to him. I suddenly realized he behaved more like a skeezy barfly than the well-educated, successful guy I thought he was. We played arcade games together, and although fun, I couldn’t shake my misgivings. When he touched my waist, it didn’t feel affectionate. It felt lecherous—nothing like our sweet first kiss. I wasn’t ready to give up on him, though. So I ignored my instincts.

At the end of the night, he walked me to my car and kissed me. He wanted another makeout session, I knew, but I just climbed into the driver’s seat. Todd promised we would see each other later that week—he would carve out time for just the two us, he swore—and I just nodded my head.

That date never happened. His excuse: He was cleaning out his grandma’s house, and felt physically and emotionally drained. No guy likes a woman who interferes with family affairs, so I masked my irritation. I told him I didn’t expect to be a priority, given the circumstances.

Later, in a text message, the subject of “us” came up. Things were going well, until this text arrived: “I’m not the guy you think I am.” I paused, considering. I wasn’t sure how to take this.

“You mean, you’re not a nice guy?”

That’s when he took backwater. “Well, no, I’m…shy. I don’t approach women often.”

It seemed insincere, so I pushed for more. He asked to discuss it in person, later. I suggested over the phone. Now. He agreed, and somehow alleviated my concerns. The conversation shifted—we discussed our dating likes and dislikes, and eventually…sex.

I knew it was time to tell him: I don’t sleep around—and in a roundabout way, that he shouldn’t expect sex. I braced myself (this conversation has ended badly before). But he surprised me, and said that was fine.

He was lying.

He later texted me with another family excuse, and that was the last of it. He vanished for months, without a word. I’m not an idiot: It seems he wanted me for sex, and nothing more. Perhaps he had a woman in Florida, with me on the side. Maybe he thought as a younger woman I would be easy, a pushover. I don’t know and never will. But I do know it hurt. I try to be a respectable woman, and it’s hard feeling rejected for that.

Then, a couple weeks ago, he texted me out of the blue, “Believe it or not, I’m actually in town…”

I was stunned. Did he really think I was that naïve, or desperate? I chatted casually, but quickly cut him off. He was hoping for a booty call, and I denied him. I felt in control again. That is, until this match.com message arrived in my friend’s inbox:

“Hello. I’m sure you are wondering why a guy from Florida is emailing you… I tried this site for the first time a few months ago with just awful results and swore I would never resort to that again. After spending so much of the summer (I will tell you where I was a little later) traveling, I was finally back in South Florida for a little bit and quickly realized for the 100th time that it is highly unlikely I will ever meet an nice NORMAL, genuine not superficial tall athletic women down here. So I just received an email from match to try the site again for 72 hours free, and decided this time I would take a different approach….

Believe it or not, I was born and raised in your area and have been up there 4 times from May until last week and realized how much more I relate to the people back home, so I thought I would do a quick search in the area to see if anyone would catch my eye and needless to say, your profile did just that…Since I get up your way quite often and will be coming up even more this fall and holidays, I thought I would see if you might be interested in talking sometime as it seems like we do have a few things in common…”

There is nothing wrong with match.com, or even his email. Except for one problem: This is the exact same spiel he gave me, just a few months ago on our first “date.”

So naturally, after reviewing his email to her, I texted him. More on that next time…

–K.L.

P.S. Follow me on Twitter!

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