Heart Valve Disorders

The heart has four chambers two small upper chambers (atria) and two larger lower chambers (ventricles). Each chamber is closed by a one-way valve. For various reasons these valves can malfunction, causing leakage (regurgitation) or failure to open properly (stenosis). The mitral valve, which allows blood to flow

from the left atrium to the left ventricle (the main pumping chamber of the heart), and the aortic valve, which allows blood to flow from the left ventricle to the aorta (the main artery of the body), are the most common sites for valve disease. These valves are under great strain from the powerful contractions of the left ventricle, which pumps blood throughout most of the body.

Mitral Valve Prolapse

Mitral valve prolapse is the most common valve disorder. Usually it is an inherited structural defect. The two parts, or leaflets, of the mitral valve thicken, preventing them from coming together properly. The leaflets bulge back into the left atrium as the ventricle contracts, allowing small amounts of blood to leak back

into the atrium. Prolapse is a term that means slippage out of position; in this case the valve leaflets have difficulty being in their correct position because they are too thick.

Most people with mitral valve prolapse experience no symptoms. Others may have a wide range of symptoms such as chest pain, palpitations (an awareness of one’s heartbeat), migraine headaches, dizziness, and fatigue that cannot be explained by the valve problem alone. Physicians diagnose mitral valve prolapse by using a stethoscope to listen to the characteristic clicking sound produced by the valves as they hit against one another. The condition also produces a heart murmur, or slight rushing sound, that the physician hears through the stethoscope when the heart contracts. Echocardiography (an ultrasound examination of the heart) allows a doctor to view the prolapse and determine its severity.

Most people with mitral valve prolapse do not need treatment. When symptoms such as extra heartbeats, a rapid heartbeat, or chest pain become bothersome, medications are prescribed to control them. In rare cases, when leakage becomes severe, surgical repair or valve replacement may be required. People with mitral valve prolapse are usually given antibiotics before dental or surgical procedures to decrease the risk that bloodborne bacteria will infect the heart valve.

Mitral Valve Regurgitation

Mitral valve regurgitation, also called mitral incompetence or mitral insufficiency, is leakage of blood back through the mitral valve into the left atrium each time the left ventricle contracts. This increases the volume and pressure in the left atrium, which, in turn, increases blood pressure in the vessels leading from the lungs to the heart. This results in lung congestion (fluid buildup). In the past, rheumatic fever was the most common cause of this condition. But with the advent of antibiotics, rheumatic fever is now rare in the United States, and the few cases that are seen are primarily in older people who had rheumatic fever in childhood. A more common cause of mitral valve regurgitation today is a heart attack, which can damage the supporting structures of the mitral valve. Mild cases of mitral valve regurgitation may not cause any symptoms. The condition may be recognized during a routine chest examination with a stethoscope, when a doctor hears a distinctive heart murmur caused by the blood leaking back into the left atrium when the left ventricle contracts. Diagnosis usually is confirmed by electrocardiography (ECG; an examination of the electrical activity of the heart) and chest X rays that indicate the left ventricle is enlarged. Echocardiography (an ultrasound examination of the heart) can produce an image of the faulty valve and indicate the severity of the problem. Since the left ventricle has to pump more blood to make up for the blood leaking back into the atrium, it gradually enlarges to increase the force of each heartbeat. The enlarged ventricle may cause palpitations (awareness of one’s heartbeat), which is particularly noticeable when the person lies on his left side. The left atrium also tends to enlarge to accommodate the extra blood leaking back from the ventricle. A very enlarged atrium often beats rapidly in an irregular fashion (atrial fibrillation). This reduces the heart’s pumping efficiency, and the lack of proper blood flow through the atrium allows blood clots to form. If a clot becomes detached, it may be pumped out of the heart and block a smaller artery elsewhere in the body, possibly causing a stroke or other damage. Finally, severe regurgitation reduces the forward flow of blood, causing heart failure, which may lead to coughing, swollen legs, or shortness of breath on exertion. Treatment for this condition can take several forms. Repairing the valve can either eliminate or reduce the regurgitation enough to make the symptoms tolerable and prevent heart damage. Atrial fibrillation accompanying mitral valve regurgitation is usually treated with medications that slow the heart rate and help control the fibrillation. In severe cases, the valve may be replaced surgically.

Mitral Valve Stenosis

Mitral valve stenosis is a narrowing of the mitral valve opening that increases resistance to blood flow from the left atrium to the left ventricle. This resistance causes pressure to build up in the atrium; the pressure then backs up through the veins of the lungs, causing increased pressure and congestion in the lungs. The increased stress on the lungs can lead to shortness of breath and eventually to congestive heart failure. Typically, the valve leaflets fuse together. Surgery is needed to widen or replace the valve. Mitral valve stenosis is almost always the result of rheumatic fever, which is rare today in the United States, where most cases occur in older people who had rheumatic fever during childhood. However, rheumatic fever can sometimes occur after an untreated “strep” throat infection (infection with streptococcal bacteria). Mitral valve stenosis also can be congenital (present from birth). Infants born with this condition rarely live beyond age 2 unless they have surgery to correct the condition.

If stenosis is severe, blood pressure increases in the left atrium and in the veins in the lungs, resulting in heart failure and an accumulation of fluid in the lungs (pulmonary edema). A person with heart failure easily becomes fatigued and short of breath. At first, shortness of breath may occur only during physical activity. Later the symptoms may occur even during rest. Some people find that they can breathe comfortably only when they are propped up with pillows or sitting upright.

Some people with mitral valve stenosis have a plum-colored flush in their cheeks. High blood pressure in the veins of the lungs may cause a small vein or tiny capillaries to burst and bleed slightly or massively into the lungs. Enlargement of the left atrium can result in atrial fibrillation (an abnormally fast heartbeat). To diagnose mitral valve stenosis, a physician uses a stethoscope to listen for a characteristic heart murmur as blood rushes through the narrowed valve from the left atrium. Unlike a normal valve, which opens silently, a valve

affected by mitral valve stenosis often makes a snapping sound as it opens to allow blood into the left ventricle. The diagnosis of mitral valve stenosis is usually confirmed by electrocardiography (ECG; an examination of the electrical activity of the heart), a chest X ray showing an enlarged atrium, or echocardiography (an ultrasound examination of the heart). Sometimes cardiac catheterization (a diagnostic test in which a thin, flexible tube is inserted into the heart through a blood vessel, to examine the heart) is performed to determine the extent and characteristics of the valve blockage. Treatment for mitral valve stenosis may include a variety of drugs. Betablockers, digoxin, and verapamil are used to slow the heart rate and control atrial fibrillation. Digoxin also strengthens the heartbeat if heart failure occurs. Diuretics are often prescribed to reduce the blood pressure in the lungs by reducing the volume of circulating blood. If medication does not reduce the symptoms adequately, surgical valve repair or replacement may be needed. People with mitral valve stenosis are given antibiotics before dental and surgical procedures to reduce the risk of a heart valve infection.

Aortic Stenosis

Aortic stenosis is an abnormal narrowing or stiffening of the aortic valve, which controls the flow of blood from the left ventricle to the aorta (the main artery of the body). As the valve narrows, the left ventricle has to beat harder to push the blood through the aorta and out into the body. The most common cause of aortic

stenosis is the gradual buildup of calcium deposits on the valve, a natural consequence of aging. Although this condition may appear at about age 60, it usually does not produce symptoms until age 70 or 80. Aortic stenosis also may result from childhood rheumatic fever. When rheumatic fever is the cause, aortic stenosis

usually is accompanied by mitral valve stenosis, mitral valve regurgitation, or both. In aortic stenosis, as the ventricle attempts to pump enough blood through the narrowed aortic valve, the left ventricle wall thickens, and the enlarged heart muscle requires an increasing blood supply from the coronary arteries. Eventually the blood supply to the heart becomes insufficient, causing angina (chest pain) on exertion. An insufficient blood supply can damage the heart muscle, reducing its ability to pump blood through the body. This reduced functioning can lead to congestive heart failure. A person with severe aortic stenosis may faint on exertion because the narrow valve prevents the ventricle from pumping enough blood out of the heart to the rest of the body. In diagnosing aortic stenosis, a physician will listen for the characteristic heart murmur through a stethoscope, note abnormalities in the pulse and electrical activity of the heart, and look for an enlarged heart as revealed by a chest X ray. Electrocardiography (ECG; an examination of the electrical activity of the heart), echocardiography (an ultrasound examination of the heart), and cardiac catheterization (a diagnostic test in which a thin, flexible tube is inserted into the heart through a blood vessel, to examine the heart) may be used to determine the severity of the stenosis. In adults with fainting, angina, and shortness of breath on exertion caused by aortic stenosis, the aortic valve is surgically replaced, preferably before the left ventricle is damaged beyond repair.

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Relationships

People have a strong need to connect with others, and the central task of adulthood involves the ability to master relationships. Both men and women have a similar need to be close. But the way in which many boys are raised and socialized in our society sometimes makes it difficult for them to recognize and acknowledge this. Boys want to be like their fathers and loved by them. Similarly, boys have normal and natural wishes to be close to and to feel loved by their mothers. Many men grow up wanting to be closer to their mother and father, yet some may feel they have to hold back to feel manly. Unfulfilled attachment needs can create a great deal of inner sadness or anger, which can continue into adulthood. For many males, a struggle with competence, independence, stoicism, and public performance can evolve, obscuring their ability to be responsive to those they love. They may have a strong drive to prove their competence. But even as they achieve competence, the urge to connect does not disappear.

The Changing Male Image

Attempts to describe behavior associated with male expectations often result in a series of negatives, such as men don’t cry, men don’t show their feelings, or men are never scared. Positive ways of describing masculine behavior have traditionally focused on characteristics such as physical strength, aggressiveness,
and independence. Cultural or ethnic expectations, socioeconomic success, individual achievement, and education level heavily influence the perception of male characteristics. Men who are married tend to live longer than men who are single. Does this mean that marriage is the healthiest form of relationship for men? Not necessarily. But it does mean that a stable, long-term relationship includes features that positively affect many men’s emotional and physical health. Role expectations for men in Western societies traditionally have emphasized protection and provision. In colonial times, physical strength was essential to survival. Along with these expectations was the premise that a man should hold a leadership position in the family and should be in charge of both household and community affairs. Many of these male role expectations remain today;
many men see themselves as the primary provider for their families. This view is often reinforced by their partners. However, cultural role expectations for men are changing. This has become a potential source of anxiety for both men and women. Some men may learn that providing financial support is not enough to satisfy their partner, although their ability to provide may still be used as a measure of both their worth and their suitability as a partner. Most women also expect to have emotional support, mutual respect, stability,
and a satisfying sexual life as part of their relationship. Working women expect greater participation by their partner in household chores and child rearing. Tension in marriage is often the result of different role expectations and unfulfilled needs. The role behaviors and values you learned during childhood may not
work in your relationship today. Men who remain well adjusted and healthy throughout life seem to have mastered the following values:
• intimacy achieving an interdependent, mutually responsible, committed relationship
• satisfying work—engaging in work that is valued and rewarding
• parenting accepting responsibility for the physical and emotional health and well-being of children
• leadership—taking responsibility for being a positive role model and inspiration to others

• integrity—following a code of moral values

Being a Father

In the past, fathers were expected to play a limited role in their childrens’ lives. Once a child was conceived, the father’s role was often defined primarily in terms of supporting the mother, both financially and emotionally. Often he was the major disciplinarian. Childcare was considered women’s work. The father’s
responsibility was to be a role model for his sons, to impart sexual knowledge to them at the appropriate time, and to be a good provider. He often represented the disciplined, serious side of life. Today, a new awareness of the importance of fathers is having a beneficial effect on the lives of children. Fathers are crucial to the emotional and intellectual growth of their children. Fathers contribute to the welfare of their families in
many different ways—providing financial support or assistance; providing emotional support for their partner; performing household and childcare tasks; nurturing a caring, committed relationship with their partner; and having frequent and positive personal contact with their children.

Bonding with Your Child

In the past, many fathers of newborns sometimes found it difficult to bond with their infants and to express their feelings. Today, however, most fathers are bonding with their children and playing a nurturing role in their lives. Most fathers want to be involved, even occasionally volunteering to stay home from work to spend more time with their baby. When fathers become involved during the pregnancy, delivery, and postpartum period, their involvement with and attachment to their infants are strong. The period immediately after delivery is especially conducive to the development of psychological ties between parents and their newborns. Fathers experience the same feelings of warmth, devotion, protectiveness, and pleasure at
physical contact with their children that mothers do.

Divorce

If your marriage fails, it does not mean that you are a failure or that your role as a father is diminished. Try not to let your contact with your children drop off after your divorce. Children are at risk when they grow up without their father. They are more likely than children who have regular contact with their fathers to have psychological problems, abuse drugs and alcohol, live in poverty, and fail in school. Almost half of all divorced fathers have not seen their children in the past year. Keep in mind that your child needs and wants your continued love and emotional support even if you are no longer living together as a family.


Blended Families 

A blended family, or stepfamily, includes a couple with one or more children from a previous relationship. Half of all people in the United States will experience a stepfamily relationship at some time in their lives as a stepparent, remarried parent, or stepchild. Children in blended families have strong emotional connections to a parent who lives in another household or to a parent who has died. In many cases, a child moves back and forth between two households that often have very different rules and expectations. This adjustment period can be even more stressful than a divorce or living in a single-parent home. Children may feel angry, anxious,
or depressed and worry that they won’t be able to have as much contact with either parent. Blended families in which both adults have children from previous relationships have the biggest problems to overcome. Children in these families may worry that their own parent will have less time to spend with them, that they will have to share their bedroom or possessions with a stepsibling they hardly know, or that their place in the family hierarchy will change. Rules and family routines may be different. All these new experiences can put stress on a child. He or she may display his or her feelings through disruptive behavior, or perform poorly in school. Give your child time to adjust to the situation, to become familiar with the new family members, and to get used to the working structure of the household. Stepfamilies who work together to solve problems eventually find a living arrangement they can all be happy with. Once you make it through the difficult early
years, you will probably find that being part of a stepfamily is an enriching, fulfilling experience. Here are some tips for helping to make living in a stepfamily rewarding for everyone involved:
• Put a priority on the couple relationship; a secure relationship between the two adults is essential for a successful blended family. In many stepfamilies, couples spend so much time dealing with child issues that they don’t nurture their own relationship.
• Agree with your partner on a few important rules and spell them out to the children. Always support each other in front of the children.
• Be patient in establishing a relationship with a stepchild—it takes time. And be cautious when taking on a parenting role, especially with a teenager, who may never accept you as a parent. Your stepchildren are more likely to treat you with respect and courtesy if you treat them the same way.
• Supervision of children is especially important in a blended family, especially when their ages vary. It can be tempting for an older child to stretch the rules with a younger or smaller stepsibling when the two are left alone.
• Have regular family meetings to discuss the week’s activities or any problems that might come up. Open communication helps establish healthy relationships among all family members.
• Take most of the responsibility for disciplining your own child. Give the stepparent time to establish a trusting relationship with your child before beginning to set rules for him or her. Discipline all children in the household equally and fairly.
• Resolve any personal differences between a stepparent and a stepchild or between stepsiblings promptly and directly; unresolved problems tend to get worse over time.
• Set aside time for one-on-one activities between family members. Stepchildren need to spend time alone with their parent; stepparents should do things alone with stepchildren; and the two adults should spend time alone with each other.
• Participate in a support group for stepfamilies. You’ll see that you are not alone and can learn a lot from the experiences of other stepfamilies.
• If your children are part of their other parent’s stepfamily, support that family and cooperate with both of the adults involved. Competition and tension between two households can cause the children to suffer emotionally.

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Stress Management

Doctors don’t know all of the ways that stress and illness are connected, but they do know that the central nervous system (the brain and the spinal cord) and the immune system can influence one another during stress. Short-term positive stress can be invigorating, stimulating us to respond positively to meaningful challenges and opportunities. Short-term negative stress can be life-saving, causing us to flee dangerous situations. The brain releases hormones into the bloodstream, causing the heart to beat faster, the face to flush, and the arm and leg muscles to tighten, allowing the person to run away or escape. Once the danger is over, the body repairs damaged areas and returns to its prestressed state. In long-term stress, the hormones continue to be released but the body does not have time to make repairs or to rest and recuperate. This is the type of stress that creates health problems. Under constant stress, a person becomes so conditioned to expect potential problems that his or her body tightens and remains in that state until the stress stops. Under this long-term stress state, the body can develop stress-related problems. Many connections between stress and chronic conditions are known. Stress increases blood levels of adrenaline and cortisol, two so-called stress hormones. Cortisol can suppress the immune system, making people more susceptible to infectious diseases such as colds and flu. The effects of stress on the circulatory system (a quicker pulse, narrowed blood vessels, and thickened blood) can make people more susceptible to heart rhythm irregularities, angina (chest pain), high blood pressure, and stroke. Muscles tighten as stress starts, often causing intense headaches, backaches, and gastrointestinal problems. Stress also can cause testosterone levels to decrease and blood vessels in the penis to constrict, often resulting in erection problems. The rush of hormones caused by a stressful situation can bring on an asthma attack in a person with a history of asthma. Stress also draws the blood supply away from the abdominal area and encourages overproduction of acids in the digestive system, often leading to indigestion and other gastrointestinal problems. Other problems related to stress include insomnia and irritability. The number of hours worked does not seem to cause as much stress as do two other occupational factors: lack of control and inadequate social support. Men who have little control over the demands of their jobs feel more stress than those who have more control. Men who also experience a low level of social support from coworkers have even more problems. What is stressful to one person may be relaxing to another. Some people, for example, like to keep busy all the time, while others need to take frequent breaks. Some people can keep track of multiple tasks, while others prefer to do tasks in sequence. If you are under stress, it is important to recognize it and deal with it in a positive way. Here are some tips to help you relieve stress:

• Exercise regularly. You can decrease stress and release tension through regular exercise or other physical activity. Running, walking, swimming, dancing, playing tennis, or working in your garden are some activities you may want to try.

• Talk about your stress. For example, talk to a friend, family member, teacher, or boss about what is bothering you. If that does not help to resolve the problem, consider seeking help from a professional therapist or counselor. Ask your doctor for a referral, or contact the employee assistance program at work.

• Know your limits. If a stressful situation gets beyond control, walk away. Return to deal with the situation when you have calmed down.

• Take care of yourself. Get plenty of rest and eat a healthy diet. If you feel irritable and tense from lack of sleep or if you are not eating properly, you will be less able to deal with stressful situations.

• Take time for yourself. Take a break from regular work and do something you enjoy. Just relax.

• Be a participant in life. Help yourself by helping others. Share your abilities with other members of your community by volunteering.

• Prioritize your tasks. To keep your schedule from overwhelming you, make a list of your tasks and check them off as you complete them.

• Be cooperative. If things do not go your way, try compromise rather than confrontation. A little give and take on both sides can help you meet your goals and make everyone feel better.

• Cry if you need to. Crying can be a healthy way to bring relief to your tension or anxiety.

• Create a quiet scene in your mind. You can’t always get away, but you can try closing your eyes and letting

your mind wander. A quiet country scene painted mentally can temporarily take you out of the turmoil of a stressful situation and help you to relax. Listening to beautiful music or reading a good book may help you achieve the same results.

• Avoid self-medication. When you need them, you can use prescription or over-the-counter medications to

relieve stress temporarily, but realize that they don’t remove the conditions that caused the stress in the first place. Becoming overly reliant on drugs or alcohol can only complicate matters in the long run. They may be habit forming, or they may interfere with your body’s ability to function normally.

• Learn to relax by using a specific relaxation strategy, such as meditation or deep-breathing exercises. Participate in activities you can enjoy without competing. Cycle, swim, or walk the dog. Forget about always

winning. Relaxation can stimulate the release of endorphin's brain chemicals that promote feelings of well-being. Relaxation strategies work by blocking conscious thoughts, resulting in decreased tension, lower heart and breathing rates, and slower metabolism. Several relaxation techniques, such as meditation, guided imagery, muscle relaxation, and deep breathing, can be used to relieve stress and bring on the relaxation response. If you feel that you are under severe or long-term stress, seek help immediately. Talk about your problems with your doctor. He or she can treat any stress related disorders you may have developed and will refer you to the appropriate mental health professional.

How to Get a Good Night’s Sleep

Sleep is a basic requirement for good health. The mind and the body need sleep to perform maintenance and repair. Even one night of disrupted or missed sleep can drastically alter a person’s chemical balance and cause daytime sleepiness and fatigue. The results of such sleep deprivation can reduce productivity as well as increase the chances of accidents at home or at work. Most adults need 7 to 8 hours of sleep each night, although sleep requirements may differ from one person to the next. For example, some people may feel rested after 5 or 6 hours of sleep, whereas others may still feel sleepy after 9 or more hours of sleep. In general, people tend to sleep less soundly as they age. They may wake up more frequently and have a harder time getting back to sleep. Many older men may find that they simply don’t need as much sleep as they did when they were younger. Overweight men may have problems getting a good night’s sleep. Snoring also may contribute to a loss of sleep. Sleep apnea (a condition characterized by brief episodes of interrupted breathing during sleep) is another common reason for losing sleep. Many people who have sleep apnea find it difficult to stay awake during the day. However, the most common reason for an occasional night of lost sleep is worry or anxiety. Here are some helpful tips for getting a good night’s sleep:

• Stick to a regular schedule for going to bed and getting up. Going to bed and getting up at the same time help set your biological clock.

• Do not sleep late on weekends, and avoid napping during the day.

• Make your bedroom exclusively a place for sleep and sex. This means no TV, work, or serious discussions while in bed. Keep your bedroom comfortable, dark, quiet, and not too warm (about 60 to 65 degrees Fahrenheit).

• Exercise during the day so your metabolism has slowed by bedtime and you are ready for sleep.

• Avoid stimulants such as caffeine, nicotine, and alcohol, and rich, heavy meals before bedtime.

• If you are not lactose intolerant, drink a warm glass of milk just before bedtime. But don’t drink so much that a full bladder disturbs your sleep.

• Have sex before bedtime; it may have a relaxing effect.

• Take a warm bath just before bedtime to help you relax.

• Set aside some quiet time about an hour or so before bedtime.

• If you still can’t fall asleep, get up and read or do a simple chore until you become tired.

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Unsafe Driving Habits

Risky behavior is involved in the traffic accidents that kill more than 40,000 Americans each year. Driving while drunk accounts for the majority of serious traffic accidents, and more than half of all road-related fatalities are automobile passengers who might have lived had they used seat belts. Never drive under the influence of alcohol. It slows your reaction times, distorts your vision, and impairs your judgment. And never use other psychoactive drugs (those that alter your mind or behavior, such as marijuana or methamphetamine) while driving. Be sure to read the labels on all prescription and over-the-counter medications for warnings about how they could affect your ability to drive.

Safety with Seat Belts

Every motor vehicle crash has two collisions. The first is a collision of the car with another object. But the second is more important in terms of life and death. That’s when the driver or passenger collides with the vehicle’s interior or is thrown out of the vehicle to collide with the ground, another car, or an object such as a wall. Ejection from a vehicle occurs 10 times more often to occupants who are not wearing seat belts. The best protection for people in a collision is to use lap belts and shoulder restraints. In a head-on collision, these safety restraints can dramatically reduce the chance of injury to the head or the face and cut in half the 

risk of serious or fatal injury. Every person in the car must wear a seat belt. It’s the law, and it can save your life. If you transport small children (age 6 and under), be sure your car is equipped with a child safety seat for each child. Be sure the child safety seat is installed and secured to the vehicle’s backseat the way the manufacturer recommends. Children always must ride in the backseat. Children who are too large for a child

safety seat must wear a seat belt. Children who are not protected by safety restraints face increased risk of serious injury. (Traffic injuries are a leading cause of death for children.) During a crash, an unrestrained child becomes an uncontrolled missile that can crash through a windshield or careen into any object or person in the vehicle. Do not consider air bags a substitute for safety belts. Air bags are designed to inflate only during head-on collisions and are useful only as supplements for seat belts. Also, air bags offer no protection during multiple crashes, rollovers, or side collisions. Air bags have been the cause of a number of serious injuries to children and several deaths. They are one of many reasons that children always should ride in back.

Road Rage

Another type of risky behavior that has emerged in recent years is known as “road rage.” It is estimated that as many as 1,500 people are killed or injured on American highways each year as a result of aggressive driving. No single profile fits all aggressive drivers, but they are three times more likely to be male than female, generally between ages 18 and 26, and usually have no record of crime, violence, or illegal drug use.

Although the risks of becoming a victim of road rage are small, if you encounter a threatening driver, the most important thing you can do is defuse the situation by not reacting. Staying safe on the road is a two-part process. Avoid behaviors that could be interpreted as confrontational, such as:

• sudden acceleration

• blocking the passing lane

• tailgating

• braking or swerving, which could cause you to lose control of your car

• cutting off another driver or failing to signal when changing lanes

• making obscene gestures

• failing to dim high beams for oncoming traffic

• taking up multiple parking spaces or damaging another vehicle while parking

All drivers need to control their stress to avoid situations in which they become angry with discourteous or aggressive drivers. A few simple changes in the way you approach driving can significantly reduce stress, including:

• altering your schedule to avoid congestion

• improving the comfort of your vehicle

• concentrating on being relaxed (but not to the point of being distracted)

• not driving when you are angry, upset, or overtired

As a driver, you cannot control traffic, only your reaction to it. Give the other driver the benefit of the doubt. Assume that other drivers’ mistakes are not intentional or aimed at you personally.

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Avoiding Risky Behavior

A wide variety of behaviors are considered risky, which means that they have a high probability of causing or leading to personal harm and, in some cases, death. People usually choose to engage in risky behavior because of the immediate enjoyment it offers and because they are able to convince themselves that the risks are small, or that the risks can be prevented, avoided, or controlled. They may not consider the possible long-term consequences of their behavior. Risk-taking is also sometimes encouraged by others. For example, peer pressure is strong during adolescence because that period is seen as a time of becoming independent and testing limits. There are risks associated with nearly every activity in which the consequences are unknown or uncertain. Risky behavior can include everything from adventurous activities such as skydiving or mountain climbing to routine activities such as driving to work. Some behaviors, such as gambling or gang activity, carry an identifiable risk of loss or harm that occurs each time they are performed. For other activities, such as cigarette smoking, the resulting harm often occurs in the longer term. Because of this delayed impact, people often ignore or deny the risk involved. Many of the health risks for today’s children and adolescents are related to behavior and lifestyle. For example, risky behaviors (such as drug use and smoking) and failure to follow the basics of a healthy lifestyle (such as exercising regularly and eating a healthy diet) can contribute to poor health in both children and adolescents. A variety of personality traits have been identified in young children that can be used to predict risky behavior later in life. These traits include tolerance for deviance, rebelliousness, nontraditional values, emphasis on autonomy, inability to delay gratification, deemphasis on achievement, selfcenteredness, and low self-esteem. Environmental influences on behavior during childhood include parental and peer attitudes and behavior and the impact of the wider environment (such as the media). Even in younger children, multiple influences can affect the use of (or intention to use) alcohol and other drugs. In many cases, a child’s intentions to use alcohol can be predicted by whether his peers drink (or whether he thinks they do), whether family members drink, the child’s involvement in family drinking, and the child’s tendency toward risk-taking. 

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Developing a Good Relationship with Your Doctor

In the past, many people saw the same doctor for years sometimes for most of their lives. Today, people are much more mobile, making a long-standing patient-doctor relationship more difficult. People move to new locations, accept new jobs, and change healthcare coverage. Any of these situations may require a change of doctors. Some health plans restrict your choice of doctors to those who participate in their plans. Seeing a specialist may entail getting a referral from your primary care doctor. Choosing a new doctor takes more than just a word-of-mouth recommendation from a friend. You need to think carefully about what you are looking for when changing doctors. The area of medicine in which a doctor specializes is an important consideration. If you have a particular medical problem, such as heart disease, you will probably want to see a cardiologist (a doctor who specializes in diseases of the heart). If you are generally healthy, an internist (a doctor who specializes in the care of adults) or a family physician is probably the best choice. You may also

prefer a male doctor over a female doctor. Some people choose a doctor based on the hospital to which he or she admits patients. The location of the doctor’s office also is a factor. It should be easy to reach from your home or workplace, especially if you rely on public transportation. Once you have narrowed your choices, find out more about the doctors you are considering. Important information includes where they trained, how long they have been practicing, and their specialty area and whether they have been certified by the board in that specialty. To become board-certified, a doctor must have had at least 7 years of medical

training and must pass a comprehensive examination in his or her specialty (such as plastic surgery or otolaryngology). provides helpful information such as medical training, specialty, and board certification for more than 650,000 physicians in the United States. The least reliable source of information about doctors is probably paid advertising. After you have compiled a list of doctors, you will need to check their credentials.

There are several good sources of information about doctors. Three reference books—Directory of Medical Specialists, Compendium of Certified Medical Specialists, and The Official ABMS Directory of Board Certified Medical Specialists that list board-certified physicians by location are available at your local public library. You also can call your local hospital or the offices of the doctors you are considering to find out the following information:

• Training. Where did the doctor attend medical school? Has he or she completed a residency? If so, where?

• Board certification. Make sure that your physician has been certified by an appropriate certifying board, such as the American Board of Internal Medicine, the American Board of Surgery, or the American Board of Dermatology.

• Hospital privileges. To treat patients at a given hospital, a doctor must gain official approval of his or her peers at that hospital. At which hospital in your community does the physician have staff privileges? Contact the hospital to verify this information.

• Experience. For example, if the doctor is a surgeon, how many times has he or she performed the type of surgery you are planning to have? When was the most recent time? The surgeon you select should be up to date on the surgery you are considering.

• Professional society membership. Perhaps the most important organization to which a physician can belong is his or her specialty society the group that represents the medical specialty practiced by the doctor. Specialty societies certify their members and require that they participate in continuing medical education and adhere to a strict code of ethics. Once you have made your choice, your next step is to develop a good working relationship with your doctor. A good relationship depends on effective communication between you and your doctor. Before you see your doctor for a scheduled visit, think about what you are going to say. Write down important questions you have or symptoms you want to tell the doctor about so you won’t

forget them. When describing your symptoms, be specific; explain when they started and what you experience when the symptoms occur. Write down the names of all the medications you are taking, including over-the-counter drugs and vitamin or mineral supplements. Remember to bring your notes with you. Don’t hold back any information when the doctor asks you questions about your diet, alcohol or other drug use, smoking, or sexual activity. These factors can affect your health, and the doctor needs to know about them to get a full understanding of your condition and treat your problems appropriately. If you feel embarrassed about talking over sensitive subjects, it’s all right to tell your doctor about your discomfort. Rest assured that all of your conversations with your doctor will remain confidential. Your doctor needs to communicate well with you by fully answering all of your questions and explaining medical terms and procedures in language you can understand. He or she also needs to treat you with respect and keep waiting times to a minimum. If you feel that you are not getting all the information you need to follow your doctor’s instructions or that your appointment times are too rushed to address all of your medical concerns, try to talk to your doctor about

the problem before switching to another doctor. Keeping an established relationship is much easier and more valuable than starting all over again.

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Common Exercise-Related Injuries

Weight-bearing exercise such as jogging, running, or even brisk walking can place a lot of stress on joints and muscles. If you are overweight, you may be at greater risk for discomfort, pain, or injury from weight-bearing exercise early in your fitness program or when increasing your level of intensity or duration. Overuse injuries affect most men who exercise from time to time. There are a number of things you can do to prevent common exercise-related injuries such as sprains, strains, inflammation, and pain. Minor injuries usually can be treated with simple first-aid measures. However, if you have a more serious injury, such as a broken bone, go directly to a hospital emergency department. Rubbing or irritation inside your shoe can cause a blister to appear on your foot. Good-fitting athletic shoes can help prevent blisters. However, if a blister develops while you are walking or jogging, wipe the blister and a needle with alcohol to kill any bacteria that are present. Then carefully prick the blister with the needle to let the fluid out. Do not remove the overlying layer of skin; it will help protect the underlying skin. Cover the blister with a bandage. The blister will heal on its own in a few days. Pain is your body’s way of telling you that something is wrong. When pain occurs during or after exercise, it usually signals the overuse of a muscle, tendon, or joint. Most overuse injuries respond well to the RICE routine, a first-aid treatment you can perform at home. Here are descriptions of some common preventable exercise- and sports related injuries and tips on how to prevent them:

Tendinitis

Tendons are fibrous tissues that attach your muscles to your bones. Tendons can become inflamed from overuse, causing pain and swelling in the affected area. For example, running can cause inflammation in your Achilles tendon, which stretches from the back of the calf to the heel. This inflammation is known as Achilles tendinitis. The tendons in your forearm that attach to your elbow can become inflamed while playing tennis, causing a condition known as tennis elbow. The tendons in your forearm also can become inflamed by other activities, such as bowling or playing softball. Swimming can irritate the tendons in your shoulder, producing an overuse injury known as swimmer’s shoulder. Adequate stretching before and after exercise helps prevent all forms of tendinitis. Exercises that strengthen your forearms, such as push-ups and lifting weights, can help prevent tennis elbow. Raising and lowering your heels and standing on your toes can strengthen your calves and prevent Achilles tendinitis. Strength-conditioning exercises can prevent the development of swimmer’s shoulder.

Shin Splints

Pain felt along the front or the back of your shin that occurs during or after exercise such as jogging or running is called shin splints. This type of injury occurs when you exercise too much without taking enough rest periods. The best treatment for shin splints is rest. Stretching your legs before and after you exercise is

the best way to prevent shin splints.

Plantar Fasciitis

This term refers to the pain and inflammation felt in the arch and heel of your foot when the plantar fascia (the band of tough connective tissue that runs along the bottom of your foot from your heel to your toes) becomes partially detached from the heel. This condition often occurs in runners. The pain is usually strongest in the morning and gradually diminishes throughout the day. After using the RICE routine, or to prevent this type of injury, try strengthening the muscles in your feet by using your toes to pick up objects off the floor.

Strains and Sprains

Overstretching or tearing of a muscle or a tendon is known as a strain. The hamstring muscle in the back of your thigh is a common site for a type of strain called a hamstring pull. Inadequate stretching before sprinting or distance running contributes to the development of this condition. A sprain occurs when a ligament (a fibrous band of tissue that attaches one bone to another) is pulled or torn. Sprained ankles can occur when you are walking or running, especially if you step into a broken area of a sidewalk or trip over something in your path and your ankle is forced into an abnormal position. You may hear a snapping sound at the time of injury. Pain and swelling follow. Use the RICE routine and see your doctor. For the first 24 hours after a sprain or a strain, avoid applying heat to the affected area—for example, from a heating pad or a hot shower—because heat will increase the swelling.

Stress Fractures

Stress fractures are hairline cracks that occur in bones when the muscles, tendons, or ligaments that surround them become weakened by overuse during exercise and can no longer protect the bones. Stress fractures can occur in these bones, especially in your feet, after the repetitive impact of jogging or running. Stress fractures usually heal on their own, but if you experience severe pain, stop exercising and see your doctor as soon as possible. In general, the best way to prevent exercise-related injury is to start exercising slowly and increase your intensity gradually. Being overly zealous in your workouts, especially in the beginning, will quickly result in an injury that will put you

on the sidelines.

The RICE Routine for Athletic Injuries

The standard first-aid routine for most strains, sprains, and pulls caused by overuse during exercise is RICE, which stands for rest, ice, compression, and elevation. If you think your injury may be serious, or if it does not heal after using the RICE routine for several days, see your doctor. Rest: Stop exercising immediately. Don’t put any weight on the affected area for 24 hours. Ice: Apply an ice pack to the affected area to reduce swelling. (Place the ice in a sealable plastic bag and wrap it in a towel.) Reapply ice for 20 minutes every hour during the first 24 to 48 hours while you’re awake. Compression: Wrap an elastic bandage around the area, being careful not to wrap it so tightly as to interfere with blood flow. Compression also helps control swelling. Elevation: Raise the affected joint or limb higher than your heart so that gravity can

help prevent blood and other body fluids from collecting at the injury site. You can take an over-the-counter painkiller such as aspirin, acetaminophen, or ibuprofen. Aspirin and ibuprofen also help reduce inflammation. After 1 or 2 days of RICE, begin gently stretching the affected area. Don’t stretch to the point at which it becomes painful, or you could damage the muscle again. Your doctor or a physical therapist can recommend simple exercises tailored to the specific injury to help you regain strength.

Heat Injury

When the weather is very hot and humid, it is a good idea to avoid exercising in order to prevent heat injury. In optimal weather conditions, sweating cools your body. But if high humidity prevents sweat from evaporating, your body cannot cool itself properly. Continuing to exercise produces more and more sweat, and Heat injury occurs in stages. In the first stage, called heat exhaustion, you experience muscle cramps, dizziness, weakness, and profuse sweating. At this stage you need to lie down in an air-conditioned room and sip cool water to recover. The next stage, called heat stroke, includes symptoms such as cool and

pale or hot and red skin, no sweating, headache, nausea and vomiting, an unusually high or low blood pressure, and a temperature of 105 degrees Fahrenheit or higher. Loss of consciousness and coma can soon follow. Warning: Heat stroke is a medical emergency. Call 911 or your local emergency number and request

an ambulance. While you wait for medical help to arrive, lie down in a cool place and have someone place cool, wet cloths on your skin or ice packs under your armpits and at the wrists and the groin area. Remember to drink plenty of fluids whenever you exercise, but especially in hot, humid weather. Try to work out indoors when the heat or the humidity rises, or skip your exercise routine until the weather turns cooler.

When to Stop Exercising

Exercise provides many health benefits, but it is important to know when to stop exercising. If you feel any unusual symptoms, such as difficulty breathing, joint pain, dizziness, chest pain, or an irregular heartbeat, stop exercising immediately. Although regular exercise can reduce your risk of heart attack and early death from heart disease, overexercising can also bring on a heart attack, especially in sedentary men who have one

or more risk factors for heart disease (see page 204). Become familiar with the warning signs of a heart attack so you recognize them if they ever occur—in yourself or in someone else. The most common warning signs of a heart attack include:

• a feeling of pressure or fullness, a squeezing sensation, or crushing pain in the center of the chest that lasts more than just a few minutes and is not relieved by rest

• chest pain that spreads to the shoulders, neck, jaw, or arms

• chest discomfort accompanied by light-headedness, fainting, sweating, nausea or vomiting, cold or clammy skin, or shortness of breath A heart attack is a medical emergency. If you have any of these symptoms, stop exercising immediately and call 911 or your local emergency number, or go directly to the nearest hospital emergency department.

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Choosing and Using Athletic Equipment

A wide variety of exercise equipment is available for home use, but how do you determine which equipment is best for your needs? Experts say to choose equipment that you are familiar with and comfortable using and to make sure that you will use it regularly before making your purchase. In other words, you have to try it before you buy it. Let’s begin with the basics. The most important athletic equipment you can own is appropriate shoes. There are many different types of shoes for various athletic activities—running shoes differ from walking shoes, which differ from basketball shoes. Cross training shoes can be used for more than one activity, such as running and walking. First you need to decide which activity you will most often perform and then shop for an appropriate shoe. Wearing the proper shoe for a particular activity can prevent blisters or injuries such as shin splints and stress fractures. When trying on shoes, wear the kind of socks you will be wearing when you exercise to ensure the proper fit. A stable shoe is one that prevents excessive movement of your foot inside the shoe. The insole should be cushioned, and the sole should provide traction while retaining flexibility. Athletic shoes usually have a mid sole, which absorbs shock when the foot strikes the ground during walking or running. The mid sole is the layer that will wear out first on any athletic shoe. That is why fitness experts recommend replacing your athletic shoe every 350 to 500 miles of use. If you are heavy, buy new shoes closer to the 350-mile mark. If you walk 15 miles per week, you will have to replace your shoes in 6 to 8 months. Your shoes may not look worn and you may be reluctant to replace your shoes so often, but the price of a good shoe is a small investment when it comes to injury prevention. Your athletic socks are also important. Appropriate socks can reduce the likelihood of blisters, toenail injuries, infections, and bone problems. The right socks can also enhance performance. Cotton socks effectively absorb perspiration from your feet, but if you perspire excessively or exercise in the rain, your cotton socks may reach the saturation point. If that happens, your socks will stretch and lose their shape, and your feet will begin to slide around inside your shoes, leading to friction blisters and skin irritation. Socks made of acrylic or other synthetic materials may perform better under “wet” conditions. Try wearing different types of socks when you exercise to determine which type of sock works best for each type of activity. When considering the many different types of exercise machines you can purchase for home use, choose carefully. Remember that exercise equipment does not have to be expensive to be effective; you can use a length of rope to skip rope, and walking requires little more than sturdy shoes. If you are interested in purchasing strength-training machines or equipment that delivers an aerobic workout, here is a short equipment guide: 

Treadmill

Americans buy more treadmills for home use than any other piece of fitness equipment. The motorized track of a treadmill allows you to walk, jog, or run at a pace you choose. Many treadmills have programmed inclines to simulate the intensity of jogging uphill. Others include resistance levers that give your arms and upper body a workout. If you hold the handrails, you can lower the intensity of your workout.

Stationary Bicycle

Stationary bicycles are good for exercising when the weather is bad and, unlike running, have only moderate impact on your knees. You can increase the intensity of your workout by pedaling faster or adjusting the resistance on the wheel. Some models offer movable handlebars for an upper-body workout. To avoid injuring your knees, you should adjust the seat so that your knees are still slightly bent when the pedals are at the lowest point of their cycle.

Stair-Climbing Machine

Stair climbing is one of the most intense forms of aerobic exercise you can perform. Stair-climbing machines give you a rhythmic workout that does not put a lot of stress on your knees. You can adjust the resistance for a more intense workout. Be sure to place your entire foot flat on the step to protect your Achilles tendon, which runs from the back of your calf to your heel, from injury. Do not climb using only your toes.

Cross-country Ski Machine

Because this type of equipment uses the muscles in both your upper body and lower body, it is an excellent form of exercise that burns plenty of calories. Cross-country ski machines place little stress from impact upon your joints. Some models allow you to raise the front of the machine so that you can simulate uphill skiing for a more intense workout.

Rowing Machine

Rowing machines simulate the effort exerted when rowing a boat. Rowing machines work the upper body and the legs. Some rowing machines are electric, while others are manual. You can adjust the resistance to vary the intensity of your workout. Sitting upright as you row will help prevent back strain.

Exercise Rider

This type of exercise machine combines the motions of rowing with those of leg presses to provide a total-body workout. You can adjust the resistance to alter the intensity of your workout. Exercise riders provide a more intense workout for men of average fitness than for very fit men.

It is important that before you purchase a piece of exercise equipment for your home, you try it out for 5 to 10 minutes in the store to make sure your lower back and joints feel comfortable. Do you like the “feel” of the machine? Does it seem sturdy? Is it noisy? Does it operate smoothly? Are all of the handrails and bars padded? Are the controls easy to use? Ask the salesperson how long it takes to assemble the machine and how much extra features cost. Think about your home and determine whether you have enough room to set up and store the machine. And consider honestly whether you will actually use it. To purchase good-quality, dependable equipment, be prepared to spend at least a few hundred dollars on each piece. Once you have the equipment, be sure to follow the manufacturer’s instructions carefully and use it properly to avoid injury.

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Your Personal Exercise Program

You will be more successful if you develop a complete, personal exercise program, rather than just becoming more active in general. If you are over age 40, remember to check with your doctor before starting any exercise program, especially if you have been inactive, or if you already have a health problem. Start slowly with an easy activity that you enjoy, such as walking. Walk for as long as you feel comfortable. Gradually increase the distance you walk, and walk at a faster pace as you get used to exercising. Try to exercise for at least 30 minutes every day. Other good aerobic activities are swimming, stair climbing, jogging, biking, and cross-country skiing. The best way to make sure you will stick with your exercise program is to choose an activity you enjoy. Varying your weekly exercise program by including two or three different aerobic activities—for example, walking or jogging 3 days a week, swimming 2 days a week, and biking 1 day a week—will help to keep your routine interesting. This concept is called cross-training, and it is a good way to prevent boredom. Cross-training also helps give your entire body a workout. In addition to aerobic exercises, work some weight training into your routine to build muscle strength. Do push-ups and sit-ups or use hand weights to perform repetitive sets of lifting exercises. Increase your flexibility by stretching your arms, legs, and lower back before and after your aerobic workout. The time of day you choose to exercise can be important. There is some evidence that exercise workouts are more productive when your body temperature is highest, which is usually in the late afternoon. At this time, your muscles are

more flexible and your resting heart rate and blood pressure are both low. Of course, if your schedule does not allow you to exercise late in the day, or if you already have an established exercise time and are happy with it, do not switch to an afternoon workout. Exercising at any time of the day is better than being inactive.

Making Exercise a Part of Your Daily Routine

Some men may think of exercise as something to do only when they need to lose a few pounds. But regular physical activity should be a permanent part of every man’s lifestyle. The health benefits you gain won’t last unless you exercise regularly. Here are some easy ways to incorporate physical activity into your daily routine:

• Make time for exercise every day. Get up half an hour earlier in the morning to work out. Better yet, watch television half an hour less each day and spend the time exercising.

• Work exercise into your usual routine. Stop using the elevator at work; take the stairs instead. Park a few blocks away from work or from the store and walk the extra distance. Take the dog for a nightly walk. Push the baby in a stroller or pull your children in a wagon or on a sled for half an hour every day.

• Exercise with a friend or family member. Working out with someone is a good strategy because you can motivate each other.

• Exercise while doing other things. Lift hand weights while you are talking on the phone. Do some sit-ups or leg lifts or ride a stationary bicycle while you are watching television.

• Break up your exercise time. Exercise for three 10-minute periods throughout the day instead of one long session. The exercise benefits will remain the same.

• Draw up an exercise contract. Write down weekly fitness goals and sign the contract. Then have a friend or family member witness it. Don’t forget to warm up before exercising and to cool down afterward. And remember, you are making a change for the long term. Once exercise becomes a permanent part of your daily routine, it will cease being an effort. And you will feel better and look better—two of the best motivators you can find.

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The Different Types of Exercise

There are different types of exercise, and each type has different effects on your body. Some types of exercise improve flexibility and muscle strength. Others use the large muscles in your body to build heart strength. Still others increase endurance. Exercises fall into three categories—aerobic, strength conditioning,
and flexibility. Which type is best for you? Ideally, you should include all three types of exercise to achieve a complete fitness program but, if you have time for only one, aerobic exercises provide the most health benefits.


Aerobic Exercises

Aerobic exercises are any type of activity that uses oxygen to fuel your muscles. When you engage in aerobic exercises, your muscles and joints send messages to your brain, which stimulates your heart to beat faster and your breathing rate to increase so you take in more oxygen. Because aerobic exercises make your heart work harder, they improve the heart’s ability to pump, even when you are at rest. You don’t have to join a health club or buy an expensive weight-training machine to reap the benefits of strength conditioning. For example, simply add some push-ups and sit-ups to your exercise routine, or do some leg lifts on the
floor while you are watching television. You can also purchase inexpensive hand weights in various sizes. Take a pair of 3-pound weights with you when you walk or jog to increase your level of exercise intensity. Use 5- or 10-pound weights to exercise the biceps and triceps muscles in your upper arms. Start with the heaviest weight that allows you to perform six to eight repetitions without stopping even if it is only a 1-pound weight—and gradually work your way up to heavier weights. (Lighter weights will increase your endurance but not your strength.) Continue using the weights until you can repeat a set of six to eight lifts two or three times without stopping. Rest between sets of repetitions. Men who are experienced weight trainers might find it helpful to seek advice from an exercise physiologist or a doctor who specializes in sports medicine when planning a new exercise routine or training for an upcoming athletic event. Remember that anabolic steroids are prescription drugs that may build muscle mass but also lead to serious health problems, including abnormal breast development in men, baldness, shrinking of the testicles, and a reduced sperm count, and therefore should not be used. Even if you are older—in your 80s or 90s—weight training will increase your muscular strength. This type of exercise can help you to perform daily tasks, such as lifting grocery or trash bags, that often become more difficult as you get older. Strength conditioning can mean the difference between leading an independent life and relying on friends, family, or healthcare workers to meet everyday needs.


Flexibility Exercises

As you age, your ability to move your muscles and joints through their full range of motion diminishes. “Use it or lose it” is the principle that applies here. You may not be able to blame the stiffness you feel after sitting for long periods solely on arthritis. As it becomes more difficult to move about, you will probably want to move even less. Such immobility can threaten your ability to perform everyday tasks. Flexibility exercises such as stretching can help you to maintain the ability to move your muscles and joints easily. Stretching also protects your muscles from the normal wear and tear of both exercise and your daily routine. Some men are more flexible than other men, and certain joints in your body may have more flexibility than other joints. But whatever your individual differences may be, you can increase your overall flexibility through stretching. Make stretching a regular part of your warm-up and your cool-down routines. The muscle cramping or pain that can occur after vigorous exercise, especially when you are just beginning to exercise after having been inactive or have been overexercising, can often be relieved by doing stretching exercises. The most important muscles to stretch include the hamstring (rear thigh), lower back, and shoulder muscles. When you are stretching, keep the following tips in mind. First, do not stretch to the point at which you feel discomfort or
pain. Stay within a comfortable range; any discomfort is a signal that you have stretched too far. Second, stretch slowly and smoothly, and never bounce or make jerking movements. Third, sustain the stretch. Pause for 10 to 20 seconds when you have reached a full stretch, and hold the position so your muscles and joints
have enough time to benefit from the stretch.

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Exercise and Fitness

Lack of exercise is a serious public health problem in the United States, contributing to chronic disease and premature death. Regular physical exercise is one of the most important steps you can take to protect your health and live longer. Each year, millions of Americans experience health problems that could have been prevented or relieved through regular physical activity. The benefits of exercise are numerous and affect virtually every part of your body. One important benefit is that exercise can reduce your risk of developing
certain common chronic diseases. For example, regular physical activity has been proven to reduce the risk of premature death from heart disease by preventing its development. Regular daily exercise can make your heart stronger, improve blood flow through the arteries that lead to your heart, and lower the level of cholesterol in your blood. Exercise also lowers your risk of developing diabetes, high blood pressure, and colon cancer, and helps to reduce blood pressure in people who have high blood pressure. Exercise helps build and maintain healthy bones, muscles, and joints and prevents back pain by increasing your strength and flexibility and improving your posture. Physical activity also helps to decrease your percentage of body fat by preserving muscle mass. Exercise helps you lose weight and maintain your loss; this is another way exercise helps you stay healthy and live longer. It can help curb your appetite, and it burns a large number of calories. Regular exercise also helps you sleep better. The health benefits you gain from exercise are not only physical, they are also psychological. Exercise promotes your sense of well-being by diminishing feelings of depression and anxiety. A good workout also can help you better manage the stress in your life. When you stick to a regular exercise regimen you gain a sense of accomplishment that boosts your self-esteem. Also,
because physical activity helps you control your weight and look fit, you will feel better about the way you look. Regular exercise is extremely important for older men because it can increase the strength of muscles, bones, and joints significantly, which helps to prevent falls, a major cause of disability in older adults. Even if you have been inactive for some time, your strength will improve with exercise, especially strength-conditioning exercises (see next page). Maintaining or improving your strength and flexibility will help you to better perform daily tasks so you can continue to live on your own and maintain a high quality of life as you get older. While a small amount of exercise is better for you than none at all, the more you exercise, the more you will benefit. Once you start exercising regularly, your capacity for exercise will increase. That means that you will be able to exercise longer and more efficiently. If you have been inactive for some time, start with a 30-minute walk each evening before dinner and work gradually up to an hour or longer. If your doctor approves, gradually work your way up to a slow jog, and then a run. The more you work your heart muscle, the more efficiently it will pump, and the more health benefits you will gain—for both your body and your mind. Work with your doctor to find the best type of exercise regimen for your own personal health profile.

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Buying, Preparing, and Storing Food

When you go to the grocery store, keep a few tips in mind to help you make the healthiest food choices. First, remember the Food Guide Pyramid and buy your groceries accordingly. That means filling your shopping cart with a wide variety of grain foods (such as breads, pasta, rice, and cereals), vegetables, and fruits. Choose whole-grain varieties of breads and pastas more often than those containing refined white flour. Buy only lean meats. Choose low-fat or fat-free dairy products. Limit foods containing high amounts of fats or sugar, such as doughnuts, pastries, chips, and cookies. Second, select mostly fresh foods; processed and prepared foods can contain high amounts of fat, sodium, and added preservatives. Choose the freshest foods possible. Check the expiration date on food packages, especially on perishable foods such as milk and other dairy products, eggs, and frozen vegetables. Put perishable items in your cart last to help prevent them from spoiling by limiting the time they remain out of the refrigerator. Avoid buying food in cans with
bulging tops or dents; they could cause food poisoning. When you get home, put your perishable groceries in the refrigerator or freezer right away so harmful bacteria cannot multiply. Proper food storage can guarantee that your foods will stay fresher longer and will also minimize the chances of contamination with bacteria. The temperature inside your refrigerator should be below 40 degrees Fahrenheit at all times. Avoid opening the refrigerator door unnecessarily, and don’t leave the door open for long periods. Keeping fresh fruits and vegetables in the refrigerator will prolong their shelf life (tomatoes and bananas should be stored outside of the refrigerator, however). Bread will keep longer if you store it in the freezer, but don’t put it in the refrigerator or it will dry out. You should use up milk within 1 week after opening it and keep eggs, stored
in their carton, no longer than 3 weeks. Consume fresh fruit stored in the refrigerator within 3 to 7 days, depending on the fruit. Keep uncooked meat, fish, and poultry in the refrigerator no longer than 2 days. Note that if you defrost meat, fish, or poultry, you cannot refreeze it. Bread, however, can be thawed and
refrozen. Canned foods can be stored for up to 2 years in a cool, dry place. It’s a good idea to keep a stock of food staples, such as canned and frozen vegetables and fruits, rice, and pasta, along with seasonings and condiments, so you can put together a quick meal in a hurry. For example, heating up a can of black beans mixed with a can of diced and seasoned tomatoes and a chopped onion, served over rice, can be an easy and nutritious meal to make after a long day at work. Safe food handling is essential to prevent food contamination and food poisoning. Always wash your hands thoroughly before you start preparing food. It is
very easy to contaminate foods in your kitchen with other foods, such as raw meat, poultry, or eggs, that can have high bacterial counts. In particular, uncooked or under cooked poultry is a leading source of bacterial contamination. Always wash any knives, cutting boards, and counter tops that have come into contact with raw poultry, meat, or eggs using hot, soapy water, and wash your hands again after handling them. Never put cooked food onto a plate that had raw food on it. And be sure to cook all meat, poultry, and eggs thoroughly (to 140 degrees Fahrenheit) to kill any bacteria. Another common cause of food poisoning is food that has been left out at room temperature when it should have been refrigerated, especially in hot weather. It is best to thaw frozen food in the refrigerator or the microwave, not on the counter top. At a picnic or backyard barbecue, make sure that you keep hot foods hot and cold foods cold. And be sure to refrigerate any leftover food promptly. As a general rule, do not keep leftovers for more than 3 days.

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Changing Nutritional Needs throughout Life

Age affects our nutritional needs. Sometimes the differences are obvious. It is easy to see the difference in the amount and types of food an infant, school-age child, teenager, and adult need. Other differences are more subtle. You may not realize that, as you get older, your calorie needs decrease, especially if you become less active. Being aware of such changes can help you to plan your meals more carefully, so you eat foods that provide plenty of nutrients for their calorie count. If you have children, there are a number of things you should know about their nutritional needs. For example, doctors now recommend that infants breast-feed for the first 12 months of their lives. Breast milk supplies better nutrition than commercial formula, promotes brain development, and provides infection-fighting antibodies to help the infant stay healthy. Provide your partner with lots of support and encouragement while she breast-feeds your infant. Note that infants should not begin to drink cow’s milk until they are 1 year old because it can cause an allergic reaction and is too concentrated for an infant. Toddlers and preschoolers sometimes become picky eaters as their new found independence propels them into a variety of activities that seem much more interesting than eating. The best solution is to keep offering your young child a variety of foods while not forcing him or her to eat any one food in particular. A good rule of thumb to use when portioning out food is 1 tablespoon of food for every year of age, so, for example, a 3-year-old would get 3 tablespoons of each food at mealtime. Children under 2 years should not yet follow the Dietary Guidelines for Americans because they need fat in their diet for brain development. As your child enters school, he or she will continue to need plenty of calories for proper growth, but be sure to encourage your child to engage in physical activity to balance his or her calorie intake. More and more American children are becoming overweight, a problem that can cause health problems such as obesity and diabetes in adulthood. Getting more exercise is generally a better solution for an overweight child than dieting. Of course, you should limit high-calorie snacks. Encourage your child to snack on cut-up fruits and vegetables such as apple slices and carrot sticks. The rapid body changes that occur in adolescence are sustained by good nutrition. Teenage boys between ages 15 and 19 can require up to 4,000 calories per day. But many teenagers get most of their calories from fast food and junk food. Even though your teenager may be more readily influenced by his or her friends than by you when it comes to food choices, you should do all you can to make nutritious food available in your home. Keep healthy snacks—cut-up vegetables, whole-grain crackers and pretzels, fresh fruit, cheese—in your kitchen. Resist the temptation to buy high-fat, high-calorie foods. Stress the importance of having a good breakfast to your teenage children. Once you reach about 25 years of age, your nutritional needs stabilize and stay about the same until your senior years. Eating a low-fat, high-fiber diet that is rich in whole grains, vegetables, and fruits remains the most sensible dietary advice you can follow. The average man should consume about 2,500 calories per day—less if you are sedentary, and more if you are very active. Watch for weight gain as you age. Doctors no longer think that a moderate amount of weight gain is acceptable in the middle years of life. It is now known that any excess weight over the range recommended for your height is unhealthy and can increase your risk for common chronic health problems such as diabetes, high blood pressure, and heart disease. Regular exercise is an excellent way to help maintain a desirable weight at any age. If you are very athletic, your calorie needs are higher than those of less active men. Athletes who compete in endurance events such as a marathon or a triathlon may require 5,000 calories per day or more. Some endurance athletes can become anemic because vigorous exercise causes a lower concentration of iron in the blood. Eating a balanced diet containing iron-rich foods such as beef, pork, the dark meat of poultry, dried beans, and enriched breads and cereals is usually enough to prevent sports anemia. Athletes do not need more protein than the average man, so protein supplements are usually unnecessary. Many runners practice “carbohydrate loading” before an event, believing that the extra carbohydrate intake will better fuel performance, but this popular practice is probably not helpful unless you are training at an extreme level. The most important thing to remember when working out or competing in any athletic event is to drink enough fluids. Water loss from breathing and perspiration can quickly dehydrate you, especially in hot or humid weather. It is critical to drink a lot of fluids before exercising, about every 15 minutes during the workout, and for about 2 hours afterward. Water is the best thirst-quenching liquid, although sports drinks can replace the electrolytes (sodium, potassium, and other minerals) that you can lose during vigorous exercise in hot weather. However, sports drinks also contain a lot of sugar. As you get older, your metabolism (the chemical processes that take place in your body) slows down and your calorie needs drop. But you still require the same amount of vitamins and minerals. Eating healthfully can be difficult when you are dealing with aging-related physical problems from chronic conditions such as arthritis, deteriorating eyesight, and gum disease. Emotional problems also can affect your diet. For example, depression, bereavement over the loss of a loved one, and loneliness can significantly diminish your interest in cooking or eating. Also, living on a fixed income often limits the type and the amount of food you can buy, and medications you are taking can sometimes affect your appetite. To make sure you continue to get all of the nutrients you need, take advantage of community programs for senior citizens. Ask your local senior citizens’ center whether they offer inexpensive meals. Talk to your doctor or a social worker at a local hospital to find out what other kinds of programs, such as food stamps, home-delivered meals, or church-sponsored meal programs, are available in your community.

Food Allergies and In tolerances

Do you suspect that something you eat is causing those unusual symptoms you get from time to time? Food allergies are relatively rare in adults. They most commonly occur in children, who usually outgrow them over time. Foods that most often cause a true allergic reaction in children include egg whites, shellfish, nuts, and milk. Dairy products can produce stomach cramps, bloating, gas, and diarrhea in adults, but these symptoms most often indicate lactose intolerance, an inability to digest lactose, the sugar that is found in milk and other dairy products. Lactose intolerance is much more common than you may think. Most people (except those of northern European descent) develop lactose intolerance in adulthood because their bodies gradually stop producing lactate, an intestinal enzyme that helps to digest lactose. If you think you may have lactose intolerance, switch to the many low-lactose or lactose- free dairy products that are now available. Lactate also is available over the counter in pill form. Some people are sensitive to certain foods but are not actually allergic to them because the food does not trigger an allergic reaction. Food preservatives called sulfates and flavor enhancers such as mono sodium glutamate (MSG) can produce headaches and other symptoms. Some people get migraine headaches after consuming red wine, cheese, or chocolate. Talk to your doctor about any symptoms you may be experiencing that you think may be food-related.

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