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That's Fit Filed under: Fitness, Fit Travel Filed under: Motivation, Tipping the Scales Filed under: Fit Beauty, Fitness, Reviews & Products Filed under: Diet & Weight Loss, Too Good to Be Food Filed under: Fitness, Fit Running Filed under: Diet & Weight Loss Filed under: Diet & Weight Loss Filed under: Fitness Filed under: Recipe Rehab with Tanya Zuckerbrot, Diet & Weight Loss Labor Day marks the end of summer, and many folks celebrate by whipping up their favorite cookout foods one last time. Here are some healthier swaps to get you through the day without overindulging. Instructions: Instructions: For more healthy cookout recipes, check out my makeovers of these Five BBQ Classics. Celebrity dietitian and motivational life coach, Tanya Zuckerbrot, author of www.ffactordiet.com and founder of www.skinnyandthecity.com and www.theskinnyondietitians.com has helped thousands of people lose weight and keep it off with her program. Her philosophy? Tanya believes you should never sacrifice taste, even when you're eating healthy foods. Have a recipe in need of rehab? Send us your recipe! Filed under: Diet & Weight Loss, News Filed under: Diet & Weight Loss Filed under: Diet & Weight Loss Filed under: Fitness Filed under: Diet & Weight Loss Filed under: Fitness Filed under: Diet & Weight Loss Filed under: Fitness, Motivation
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Twenty-five percent of travelers exercise less on summer vacations than they do at home, according to a TripAdvisor survey. If you have trouble sticking with your fitness program when you travel, put your iPhone to work. Granted, you still have to do the dirty work, but these apps can make staying in shape on the road more doable and fun. Here are five to try:
Virgin Atlantic's Jet Lag Fighter ($1.99)
Tired of being whipped by jet lag whenever you travel? Download this app and you'll get customized advice about when you should exercise to beat that fatigue. Just plug in personal info (e.g., gender, age, and regular wake-up and bedtimes) and trip details, and the app will calculate when you should exercise before and during your trip. It even tells you what activities are best for fighting jet lag. Another fun feature? The app tells you when you should and shouldn't get light, which sets your biological clock.
Mylil'Coach ($1.99)
Travel with Mylil'Coach and you'll have a personal trainer, dietitian and life coach wrapped into one. That's because this app sends you gentle reminders throughout the day to drink water, eat mindfully, breathe deeply and, yes, exercise. It also serves as a pedometer, tracking your daily step count and tallying how many more steps you need to reach 10,000 steps, a number most experts use as the minimum amount for managing weight. You can even set up a schedule and customize when and how often you receive reminders to walk more.
Shape Travelista ($1.99)
No fitness center in your hotel? You can't use that as an excuse not to exercise anymore. With this app, you need only a hotel room, as it teaches you how to do strength workouts that use travel-friendly items, including luggage, a bed or water bottles. Choose from eight full-body routines and use it to log your sets, reps and the equipment you've used.
Trailhead by The North Face (free)
Whether you want to hike, bike, ski, walk or run, this handy app locates trails wherever you are in the world. The database includes more than 300,000 trails that can be searched by activity, trail length, location and user rating. You can even track your route via GPS as you go and view distance, speed and elevation. All of this information can be saved on your phone, depending on how much space you have.
ExerciseTV (free)
If you're the type of exerciser who does best with classes and DVDs, you'll love this app. Every day, you'll get a 10- to 40-minute workout video ranging from aerobics to yoga from ExerciseTV. You'll also receive five categories of circuit workout moves, each one featuring 10 short videos that feature one to three minutes for abs, yoga/stretch, upper body, lower body and total body training. A light hand weight is the only piece of equipment you might need, but you can always use a filled water bottle.
Looking for more apps to load on to your iPhone? Check out these fitness apps.
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There are times when being healthy might mean actually paying attention instead of blindly making food choices. There are times when perhaps it isn't about making the right choice but about making the better choice. Sometimes being healthy means making the best choice available to you at the time. Sometimes being healthy means eating out and choosing to keep your meal small or getting the value size instead of the mega or extra-large food mountain.
I finally stopped making food choices based on my feelings and started making a conscious effort to at least pick the better option. I actually logged in to my tracking system. I took the first step toward getting my healthy lifestyle back on track, and it felt amazing!
I have also learned the importance of just saying no. No, I don't need to finish that meal. No, I don't need dessert every day. No, I don't need the fried option; the grilled selection will do just fine. People like to say that it is the small decisions that add up to big rewards. I am committed to creating opportunities for minor successes with the confidence that those tiny changes will reap large benefits in the (hopefully) near future.
When I realized that even though I didn't have any fresh fruit or vegetables but managed to stay in my calorie range for a few days, I was ecstatic! Yes, I could have been upset because I didn't have any fruits or veggies, but I chose to focus on the fact that I was in control and managed to stay within an acceptable calorie range. It has been weeks since I've went a day eating less than 2,000 calories. I am not proud of the food selections I have made, but I made them. Now the only option I have is to learn from those mistakes and move on.
Aside from my aha moment, I had a small problem with my scale. Somehow, the scale did not survive the move. When I took it out of my husband's trunk to use earlier this week, it refused to function. I think the scale was trying to send me a message. Perhaps instead of stepping on the scale and being disappointed, I get another week or two to work on getting my habits back on track and to hopefully see the numbers read my pre-move weight. I am actually excited to go buy a new scale and resume my weekly weigh-ins.
While I did not make large strides in the exercise department recently, I am happy because we found an apartment that has a gym facility on site. I will be able to resume my fitness routine and I am thrilled! I am looking forward to starting and ending my day with quick walks with my dog and enjoying the treadmill and other machines in the gym area.
I feel like I am seeing the light at the end of a very dark series of unhealthy choices. I am mentally, emotionally and physically ready to be on track, and I have started taking those steps. It is amazing how much clearer the path of weight loss is when you actually have a plan to follow. I don't necessarily mean a detailed plan such as a specific gym routine or an itemized diet plan. Rather, the plan for me is to track my food, start with a simple exercise such as walking leading into running and to continue making the better choice.
After decades of dieting only to gain it back, two That's Fit readers have decided to finally rethink their relationship with food and exercise over the next year to move toward a lifetime of fulfilling, healthy living. Come by every week as Ashley and Lee share their successes and challenges as they tip the scale.
While Ashley is eating healthier, Lee has resolved to ditch diet soda.
Hold up. If we're going to be so darn picky about what we put on the rest of our bodies, why are we so nonchalant about our socks? It really doesn't make sense. Now, we're not going to pay more for something just because, but if there's a more attractive option that's also more high tech, well, shouldn't we at least consider the next level? Of course we should. So we did; here are three options for your stylish consideration.
Under Armour Kris Concealer
In the '80s, did you wear the multilayered, tri-colored scrunch socks? With sparkles? So did we -- they had to match our L.A. Gears with the four different shoelaces, after all. But this ain't the '80s; now, when it comes to your feet, the minimal look is in, and you can't find a better option than the Under Armour Kris Concealer ($11.99 for two pair).
First off, they look cool with their black/pink or black/turquoise color scheme. But more importantly, they're super comfortable -- and nobody was more surprised than we were. They're extremely low rise, and when you put them on, they feel like they're going to pop right off. However, once you put on a shoe on top of the sock, it stays in place perfectly (how, you ask? Magic is our best guess) but is hidden from view.
PowerSox CoolMax Cushion Lo-Cut
For a subtle hint of style, the CoolMax Cushion Lo-Cut in light pink or light blue ($7.49 for three pairs) is a great option. This affordable sock is by PowerSox, which is a GoldToe brand. And, as you probably know, GoldToe has been in the sock business forever. It's not just the pretty colors we're digging, though. The sock features a ventilated top to let your skin breathe, CoolMax fabric for moisture management and an arch brace for added support.
Injinji Performance Series EcoMade CoolMax
Injinji does a great job of making the most functional footwear really fun, and the Performance Series EcoMade CoolMax toe sock ($14 each) is a perfect example. As a toe sock, it's automatically interesting, and the rainbow striping takes us back to our days of idolizing Punky Brewster. But it's the quick-drying, eco-friendly fabric made from repurposed recycled plastic water bottles and postindustrial waste that really has us wiggling our toes in anticipation.
Want just the right look post-workout? This guide to quick-fix hair accessories will get you on the right track!
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What's in It:
Enriched flour, sugar, fructose, glycerol, vegetable oil, dextrose, maltodextrin, contains two percent or less of modified cornstarch, nonfat dry milk, apple powder, blueberry puree concentrate, reduced mineral whey, invert sugar, cornstarch, soy lecithin, leavening, salt, DATEM, natural and artificial flavor, citric acid, mono- and diglycerides, sodium alginate, cellulose gum, cellulose gel, sodium citrate, xanthan gum, malic acid, tricalcium phosphate, color added, vanilla extract, red #40, BHT for freshness, blue #1.
The first ingredient in enriched flour is wheat, which may have you thinking positive thoughts. However, don't let it fool you -- wheat has the same nutritional profile as white flour. It is whole-grain flour that differs. Niacin, reduced iron, thiamin mononitrate (vitamin B1), riboflavin (vitamin B2) and folic acid enrich the flour, but more nutrients are stripped from the whole-grain flour than is replaced by the addition of these five vitamins.
The second ingredient is sugar. Well, you probably know how I feel about that. At least it's not an artificial sweetener, but it is a "fruit" crisp? Where is my fruit? Glycerol is up next and is similar to sugar in caloric content, but has a lower glycemic index and is used for sweetness, as a humectant and for consistency. I am neutral here. Overall fat content is two grams, saturated fat 1 gram and trans fat 0 grams, so this is certainly not alarming. The next ingredient is TBHQ (tertiary butylhydroquinone), which is used for freshness of fats and, according to the FDA, can cause "nausea, vomiting, ringing in the ears, delirium, a sense of suffocation and collapse." All of a sudden those fats don't seem quite as innocent anymore.
Fructose and dextrose are both naturally occurring sugars -- again similar to sugar. At least they are not artificial, but again, where is my fruit? Maltodextrin follows; it is made from starch and is often added to up the fiber content of a food, but there is less than 1 gram here!
There you have it -- the majority of these Fruit Crisps are just flour, oil, sugar and maltodextrin! What about all these other ingredients? For better or worse, the next ingredients make up only two percent or less of this product.
Apple powder and blueberry puree concentrate are in there. Hooray for some fruit, albeit not its "real" form and in a very small dose. The next ingredient is reduced mineral whey. Whey is the liquid that remains when milk is curdled, and this is that liquid broken down further. Invert sugar is broken-down sugar, used in the product to maintain moisture and make the product sweeter. Did we not get enough sugar in the first half of the ingredients?
Salt is next, and the sodium content is 80 mg. Not bad. But that's not the only ingredient used to maintain freshness. DATEM (diacetyl tartrate ester of monoglyceride) functions as a dough conditioner by the esterification of fatty acids (a.k.a. it turns into fat), so it gets a no on my list.
Citric acid is a natural preservative and found in fruits and vegetables. Following is mono and diglycerides -- a processed fat used to extend the shelf life of foods such as fruit products. Sodium alginate is another emulsifier extracted from brown algae -- and you may just see this ingredient in your cans of paint, too!
We are getting close to the end; I promise! There are some thickening agents and some harmless ingredients to control acid, as well as a calcium fortifier.
The last three ingredients are three things I do try to avoid. Red #40 and blue #10 are both artificial colorings. Even though they are generally recognized as safe, some artificial colorings have been linked to ADHD, asthma and inflammatory skin conditions. In general, I recommend avoiding artificial colorings. BHT is used as a preservative but should be avoided namely because there are safer options! Studies have shown an increase and a decrease in the risk of cancer associated with BHT. I say avoid this ingredient whenever possible!
Bottom Line:
This certainly has a laundry list of ingredients and no major nutritional power such as antioxidants, fiber or calcium. But to its credit, the majority of the ingredients make up less than two percent of the product, and the calorie, fat and sugar content is OK for a portioned snack. However, I still say, it's too good to be food. Although it may help control calories if your other option is a blueberry doughnut, there are many other real food options out there. A cup of blueberries with a piece of dark chocolate can satisfy your craving with more nutrients and definitely as much flavor -- real flavor, that is!
Calories: 100
Fat: 2 g
Sat. Fat: 1 g
Trans Fat: 0 g
Cholesterol: 0 mg
Sodium: 80 mg
Total Carbohydrate: 20 g
Fiber: less than 1 g
Sugar: 7 g
Protein: 1 g
Nationally recognized nutrition expert and published author of "The O2 Diet," Keri Glassman is the founder and president of Keri Glassman, Nutritious Life, a nutrition practice based in New York City. For years, Keri has been a leader in advancing a "whole person" approach to health and wellness. She has dedicated her career to creating services and promoting education through her Nutritious Life brand. You can be friends with Keri on Facebook or follow her on Twitter.
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While no one will argue with the importance of hydration or getting a good night's sleep, a growing body of research shows that pre-competition sex can actually improve an athlete's performance.
"There's no question that research shows that having sex before a race actually increases the probability that you're going to perform well," said Dr. Pamela Peeke, a spokesperson for the American College of Sports Medicine who competes in marathons and triathlons. "But for athletes, whether you choose to have sex is an individual decision. Every athlete has his or her own rituals and beliefs, and if you believe pre-race sex is going to drain you, it's going to drain you."
That may be part of the reason for the controversy. Before marathon running became mainstream, many sports that required long-term training and led up to a large-scale event encouraged the participants to leave their homes for training, a la Muhammad Ali. The public perception, Peeke said, was that to be successful at one's sport, one must abstain from sex.
However, the sacrifice might not have been necessary. An informal survey of 2,000 London Marathon runners showed that those who had sex the night before their race were more likely to perform better than those who did not, and it wasn't because they were better prepared than their abstaining counterparts.
Are you still not convinced that a steamy sex session before your next competition might help and not hinder your results? Peeke dismissed athletes' most common fears.
Myth No. 1: I'll be drained for my race.
Even if you're having mind-blowing sex, the chances that you'll exhaust yourself before your race is unlikely, Peeke said. An average sex session burns 25 to 50 calories, the equivalent of climbing two flights of stairs.
Myth No. 2: I'll be distracted.
If you're in a committed relationship with someone, you will be distracted from your race momentarily while you're having sex.
After that, you should be able to get back to focusing on your race-day strategy, and if you're a racer who tends to overanalyze her plan of attack, the break may be beneficial.
"Chances are that afterward you'll feel refreshed and invigorated," Peeke said.
Myth No. 3: I won't be able to sleep.
Actually, you'll probably get to dreamland faster and sleep more deeply thanks to the chemical cocktail that is released when you orgasm.
"For both men and women, when you have sex, your tension goes down and you feel more relaxed," Peeke said. "Overall, sex is good for the body."
Do you need another reason to get it on?
Vaginal stimulation increases the amount of pain-blocking neuropeptide substance P, which is effective for about a day after its release, Peeke said.
"The chemicals released will decrease overall muscle tension that an athlete might be experiencing, which may allow her to engage in physical activity at a higher, more intense level," Peeke said.
If you're a creature of habit, however, don't fret. Most athletes agree that the best way to prepare for a competition is to train well, be comfortable in your surroundings and feel confident that you've had the best pre-race preparation you can -- with or without sex.
"For many people, whether they decide to engage in sex the night before a competition is a combination of trial and error as well as experimentation," Peeke said. "But the bottom line is: If you want to have sex, go ahead -- have at it."
Are you looking for another way to bond with your guy or girl? Check out the best way to run with your partner.
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What is the tastiest and healthiest lunch you pack?
Bobbi K.
Lunches vary but the best snack is almond butter and apple slices!
Alexa W.
Add a little vanilla yogurt if your almond butter is too thick... now I'm addicted to it!
NCsoccerMom
Tortilla sandwich rolls - Laughing Cow spreadable light cheese, lettuce, grilled chicken (or sandwich meats) tossed in light Italian.
RonPoggi
PB&J is the perfect food! Organic PB, real fruit jam on whole wheat bread. Yummy!
Pinksky4U
They have little peanut butter take-alongs. You can add nice fruit and let them dip for a different lunch.
Rjdutton
My daughter always has fresh fruits and vegetables in her lunch and nothing preserved!!
Want to stay healthy this fall? Check out our Fresh Fall Meal plan to get creative ideas for delicious autumn meals.
Working out in cold weather is always going to create certain challenges -- we can't help that. But with a little planning (and, yes, just a bit of shopping), you can avoid the eight random layers look and exercise in comfort and style, regardless of where the mercury rests.
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Under Armour
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www.injinji.com
Trying to lose weight this fall? Our Fresh Start weight loss guide will help you reach your goals with meal plans and workouts.
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Circadian rhythms are indelibly linked to weight because they affect body temperature, blood pressure, heart rate and hormones. Research conducted at Oregon Health and Science University suggests that during the "wake phase," you metabolize food faster to provide the body with energy in the form of calories. In the "sleep phase," your digestive tract slows down, body temperature drops and mental alertness decreases.
Make the most of your own circadian rhythms by following our body clock guidelines to lose weight, boost stamina and get fitter faster.
6 a.m.
Your biological ticktock starts the moment you wake up and is affected by how long you've slept. According to the National Institutes of Health, circadian rhythms are produced by natural factors within the body, but they're also affected by signals from the environment. Light is the main cue, which turns on or off genes that control sleep-wake cycles, hormone release and other body functions.
What to do: Buy blackout curtains, turn your phone off and catch up on at least eight hours of sleep per night.
7 a.m.
Many studies suggest that sleep loss increases hunger and slows metabolism. Sleep loss has, in fact, been shown to affect the secretion of cortisol, a hormone that regulates appetite. As a result, if you lose sleep or wake prematurely, you may continue to feel hungry all day despite food intake.
What to do: Each morning, create a healthy wake-up regimen, such as a few minutes of stretching in the shower or in-bed meditation before bolting out and rushing through a harried morning routine.
8 a.m.
Are you a morning exerciser? Eating 100 to 200 grams of carbohydrates within two hours of high-intensity exercise (either before or after) is essential to building energy stores for training. Waiting longer than two hours results in 50 percent less glycogen stored in the muscle and a less effective recovery. It may also lead to injury.
What to do: Lace up your walking or running shoes and blast about 300 calories in 30 minutes. If you did not eat a healthy breakfast before exercise, replenish carbohydrates afterward with a yogurt smoothie or a glass of OJ and several wheat crackers until you can hit the breakfast table or coffee shop.
9 a.m.
Stressed about an early-morning meeting and tempted to nosh jelly donuts on your way to work? How about a little exercise instead? "Try releasing toxins first thing in the morning to stabilize your weight loss attempts," said registered dietician Joan Clark, co-author of "The Complete Idiot's Guide to the Glycemic Index ." "We carry stress in our muscles and getting out the kinks early in the day may relieve tension headaches and backaches."
What to do: Lie in bed or on the floor and bring knees into your chest to stretch the lower back, then rock side to side slowly with eyes closed. Progress to 10 minutes of your favorite stretches.
10 a.m.
The early bird who gets the worm also has the longest amount of time in which to blitz off those breakfast calories! The moment food enters your stomach, energy from digestion is allocated to deal with it. Eat lean sources of protein to prevent energy spikes throughout the day.
What to do: Grab a breakfast of lean protein and healthy carbs, such as an egg white omelet with a cup of veggies and a little cheese, or even a whole-wheat English muffin with fruit and a dab of cream cheese.
11 a.m.
Prior to a lunchtime sandwich drink two 8-ounce cups of natural green tea (no sugar added). A study in the American Journal of Clinical Nutrition found that green tea extract, taken over a 24-hour period, increases metabolic rate by up to four percent. These effects are probably due to the high concentrations of catechin polyphenols, which boost fat oxidation.
What to do: Brew natural green tea leaves and keep a chilled batch in your travel mug, in the car, or on top your desk or dresser.
Noon
Drink two or three 8-ounce glasses of water if you have not already done so! Water helps maintain healthy body weight by suppressing appetite, reducing the body's level of sodium and maintaining muscle tone. "It's also necessary for proper kidney function, but it's so easy to take water for granted," said Dr. Donald Hensrud, co-author of "The Mayo Clinic Diet." "Water cushions joints, carries waste away and protects your organs and tissues, too."
What to do: For the body to metabolize properly, you should drink half your body weight in ounces per day, said Hensrud. If you weigh 130 pounds, for example, drink a minimum of 65 ounces of water, about eight 8-ounce cups.
1 p.m.
Plan meals wisely: Lunch should contain protein, healthy fats, complex carbohydrates and non-starchy veggies to sustain stamina and curb cravings later. Make sure lunch is packed with fiber, too. "The high-fiber content of vegetables, fruit and whole grains bulk up your diet so you feel satiated longer," said Hensrud. You require 25 to 35 grams a day!
What to do: To bypass bloating, feel alert and optimize digestion, incorporate oatmeal and apples into breakfast; whole-wheat bread and vegetables into lunch; and beans, legumes and greens into dinner.
2 p.m.
Have a pickle for a snack! That's right: Acidic foods significantly lower the glycemic index of a midday meal by one-third. What does that mean to dieters? "The slower your carbohydrates break down, the lower their glycemic index and the healthier your food intake," said dietitian Clark. "Acidic foods slow the emptying of your stomach, which is a boon to any weight loss plan."
What to do: Nibble acidic foods such as pickles, tangy salsa, marinated veggies or sourdough bread for lunch or snacks. Other acidic foods include horseradish, pickled beets, lemon juice and pickled herring.
3 p.m.
Watch water intake midday: You may have to increase daily consumption during intense exercise as well as in hotter temperatures. (Psst: Medications require an increase of water intake, too, so check with your doctor.)
What to do: A good way to make sure you drink enough is to carry a stainless steel bottle of water with you at all times. Add sliced citrus to make it tastier.
4 p.m.
This is your lowest energy point, when body temperature drops and cravings creep up. Sleep loss may interfere with the body's ability to metabolize carbohydrates, which leads to high levels of blood sugar. Excess blood sugar promotes overproduction of insulin, which can lead to body fat storage and insulin resistance, critical to the development of diabetes.
What to do: Your body truly craves sleep now, according to your body clock: Try a short 20-minute power nap to rejuvenate. If that's impossible, head outdoors in the sunshine to boost stamina and reset your body clock. If cravings strike, try chewing sugar-free gum or a fiber-filled apple.
5 p.m.
Physical co-ordination, stamina and metabolic rate peak! Perfect time to slate a game of doubles tennis or schedule an early-evening kickboxing class.
What to do: Thirty minutes pre-workout, nibble a handful of raw almonds and drink a cup of green tea or even a small, low-fat mocha latte to fuel up. Natural appetite suppressants, like the caffeine in green tea or iced coffee, rebalance your brain and curb cravings.
6 p.m.
In the early evening, core temperature is at its warmest, which makes your muscles and joints supple and helps you sidestep exercise strains and side stitches. Early-evening workouts that target your endurance muscles, such as core training, hardcore yoga stretching, and step-interval workouts, are best now.
What to do: Try a Power Pilates class or a Core Fusion DVD and you'll feel pumped and primed for action all night long.
7 p.m.
Hunger levels rise now, so drink another cup of green tea or sip soup before dinner to curb appetite. Scientists at the University of Chicago found that green tea caused rats to lose up to 21 percent of their body weight. Rats injected with green tea extract consumed 60 percent less food after seven days of daily injections, which may have something to do with the blood sugar-regulating effects of green tea.
What to do: If you are still craving solids but don't want to ruin your appetite for dinner, try snacking on fresh fruit slices such as apple, watermelon, peach or orange, since these fruits have high water and fiber content.
8 p.m.
High-cortisol hormone production brought on by, say, a horrid commute or a brawl with your boyfriend, can set off an unhealthy chain reaction that puts your body into evening crisis mode. Rebalancing brain chemistry with a balanced meal and a five-minute meditation sends out signals of well-being to combat these fight-or-flight hormones. More reasons to make dinner a simple, slow and contented affair.
What to do: Eat a meal high in omega-3 fish oils to help you drop inches and soothe stress. Studies at the University of South Australia found that eating omega-3 fish oil combined with moderate aerobic exercise jump-starts weight loss. Stir-fry a salmon filet (use peanut oil or other omega fatty acids) with two cups of cruciferous veggies and watch the pounds (and anxiety!) melt away.
9 p.m.
Sip a cup of warm milk since the carbohydrate and insulin released make it easier for tryptophan to be absorbed into the brain, making you sleepy. Being fully hydrated regulates the body's temperature and helps muscles contract, which, in turn, leads to a more productive workout tomorrow, not to mention a more restful night's sleep.
What to do: Wind down gradually during evening hours with great conversation and good company. Alternate: If water or milk won't cut it, sip a glass of antioxidant-rich red wine in the evening as a lower-calorie option to fattening bedtime snacks.
10 p.m.
Can you padlock your fridge? Avoid eating additional calories in the evening, since your body gears up to extract all the nutrients you took in during the day. Eating food late at night and going to sleep forces the body to expend energy on digestion during sleep time, which is neither effective for dieting nor for snoozing.
What to do: Brush and floss your teeth so you're not tempted to nosh.
11 p.m.
Sustained high cortisol levels (and production of other stress hormones) can lead to intense cravings and binge eating at night, so it's important to adopt a calming bedtime ritual, such as taking a bath, playing with your kids or reading a book for several minutes before lying down.
What to do: Jot personal notes into a food and exercise diary before you hit the sack, including workout times, calorie counts and other mind-body notes. Identify your weak willpower moments, as well as your most satisfying meals, and you'll set yourself up for success tomorrow.
Midnight
You should be sleeping now, not stressing! Studies show that decreased amounts of deep REM sleep can lead to increased food intake. Abnormal circadian rhythms have also been associated with depression, bipolar disorder and seasonal affective disorder.
What to do: Understand what makes your biological clock tick from day to day, which will lead to healthy weight loss, regular workouts and a happier life.
Trying to lose weight this fall? Our Fresh Start weight loss guide will help you reach your goals with meal plans, workouts and more.
To hear more about her secrets, check out the Shape Move of the Week:
How do other celebs stay fit and fabulous? Find out at Shape.
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Kabobs
Swap out large servings of grilled meat for smaller portions and more vegetables. Chop meat into one- to two-inch cubes and thread on skewers with chunks of vegetables such as onions, tomatoes, zucchini, bell peppers and, my favorite, mushrooms. Alternating meat and vegetables on the kabobs creates a meal lower in calories and higher in vitamins and minerals from the brightly colored vegetables.
Corn Salad
Instead of slathering your corn on the cob with butter and salt, toss it with some cherry tomatoes and balsamic vinegar and enjoy a lower-calorie corn salad.
Ingredients:
1. Cut corn kernels off the cob.
2. Combine vegetables and basil in a large bowl.
3. Whisk together balsamic vinegar, lime juice and olive oil. Add to vegetable combination and mix well.
Serves: 8
Nutrition Content (per serving):
82 calories, 2 g fat, 0 g saturated fat, 15 g carbohydrates, 3 g sugars, 2 g fiber, 2 g protein, 15 mg sodium
Pasta Salad
Typical pasta salads with mayonnaise-based dressings and large amounts of pasta can add up to more than 300 calories per serving. Swap in a vinegar-based dressing and cut the carbohydrates by mixing high-fiber vegetables for a lower-calorie side dish.
Ingredients:
1. In a small bowl, whisk together the vinegar, lemon juice, garlic, oregano, olive oil, salt and pepper.
2. In a large bowl, combine the salad ingredients. Mix in the dressing and serve chilled.
Serves: 8
Nutrition Content (per serving):
151 calories, 4 g fat, 1 g saturated fat, 27 g carbohydrates, 2 g sugars, 1 g fiber, 5 g protein, 19 mg sodium
Fruit Cocktail
A fruit salad is the perfect sweet treat for a hot day. Instead of adding large amounts of sugar or syrup, add flavor with fresh herbs, such as basil or mint, and a small amount of lemon juice. Chop up whatever fruit you have (watermelon, peaches, blueberries and pears are all in season right now) and add the juice from one lemon (or lime) and about 1/4 cup of chopped basil or mint. Make a day in advance to allow the flavors to blend together.
Readers, I would love to hear from you! Please send me your favorite fattening recipes that need a RECIPE REHAB! Everything from your mom's meatloaf to your kid's favorite dessert -- let me lighten it up.
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Though the authors did say that the best way to reduce your risk of cancer is to kick your tobacco habit for good, adding more of these foods -- and different varities -- could have similar, though less significant, benefits.
"It makes sense to assume that it is important that you not only eat the recommended amounts but also consume a rich mix," lead researcher Dr. H. Bas Bueno-de-Mesquita said in a statement.
Visit AOL Health to read the full story and see what other experts have to say.
Quitting smoking is a tough battle, and so is losing weight. Despite some setbacks, That's Fit weight loss blogger Ashley is pushing through her struggle to get fit and get back on the right track.





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WEEK 1
Monday
Breakfast:
Honeycrisp Breakfast Parfait
1/2 cup low-fat cottage cheese mixed with 1 chopped Honeycrisp apple and 10 almonds, sprinkled with 1/4 teaspoon cinnamon
Snack:
1/2 cup sliced cucumber and 1/2 cup diced zucchini, dressed with 2 teaspoons olive oil, 1/2 teaspoon fresh parsley and 1/2 teaspoon fresh dill.
Lunch:
Cheesy Black Bean Soup
1 cup black bean soup topped with 2 tablespoons crumbled, reduced-fat feta cheese
Side salad: 1 cup Bibb lettuce, 1/4 cup sliced cucumber, 1/4 cup sliced mushrooms and 1/4 cup chopped tomato dressed with fig vinegar and squeeze of lemon
Snack:
Mix 1 teaspoon sunflower seeds, 1 teaspoon pumpkin seeds, 8 walnuts and 2 chopped dried apricots
Dinner:
Grilled Rosemary Chicken With Roasted Veggies
4-ounce chicken breast brushed lightly with olive oil and seasoned with 1/2 teaspoon dried rosemary, salt and pepper to taste before grilling
Serve with 1/2 baked sweet potato and 8-10 roasted asparagus spears roasted and drizzled with balsamic vinegar.
Tuesday
Breakfast:
Vanilla Walnut Oatmeal
1/2 cup cooked oatmeal made with 1 cup skim milk
Mix in 1 tablespoons chopped walnuts, 1/4 teaspoon vanilla extract and 1/8 teaspoon cardamom
Snack:
2 celery stalks with 2 teaspoon almond butter sprinkled with 1/4 teaspoon cinnamon
Lunch:
Tarragon Grilled Chicken Breast With Tomato and Eggplant Stack
4-ounce chicken breast brushed lightly with olive oil and seasoned with 1 teaspoon fresh tarragon, salt and pepper to taste before grilling
Tomato and Eggplant Stacker
Layer 1 1/4 inch-thick sliced, grilled eggplant and 1 1/4 inch-thick sliced tomato; repeat three times. Top with 1 ounce part-skim shredded mozzarella cheese.
Snack:
3/4 cup nonfat plain yogurt mixed with 1/2 cup canned pumpkin sprinkled with 1/4 teaspoon cinnamon
Dinner:
Salmon With Steamed Spinach and Cucumber-Yogurt Sauce
Keri Glassman
1 cup nonfat plain yogurt
1 cup seedless cucumber, diced
2 teaspoons chopped fresh dill or 1 teaspoon dried
2 teaspoons lemon juice
Salt and freshly ground black pepper
4-ounce skinless salmon fillet, preferably wild (about 3/4-inch thick)
2 cups baby spinach
1 teaspoon olive oil
1. Combine yogurt, cucumber, dill and lemon juice in bowl. Add salt and pepper to taste. Set aside.
2. Grill salmon 3 to 4 minutes per side or until the fish is cooked through.
3. Steam spinach and toss with olive oil and squeeze of lemon.
4. Top salmon with 2 tablespoons of the reserved cucumber-yogurt sauce and serve with spinach on the side. Refrigerate remaining sauce for another use.
Wednesday
Breakfast:
Hearty Whole-Grain Toast With Avocado and Tomato
1 slice whole-grain toast topped with 1/4 avocado and 1 to 2 slices tomato, then drizzled with 1 teaspoon olive oil and squeeze of lemon
8-ounce DIY green tea latte made with skim milk
Snack:
1 cup red bell pepper slices with 2 tablespoons hummus
Lunch:
Salmon, Spinach and McIntosh Salad
2 cups baby spinach leaves, 1/2 cup chopped McIntosh apple and 1 tablespoon chopped pecans dressed with 1 tablespoon cider vinegar, 1 teaspoon Dijon mustard, 1 tablespoon olive oil, and salt and pepper to taste. Top with 4-ounce poached salmon.
Snack:
Cinnamon Sweet Potato "Chips"
Cut 1/2 sweet potato into 1/4 inch-thick slices. Spread single layer on baking sheet and mist with 2 sprays olive oil. Sprinkle with 1 teaspoon cinnamon and bake at 400° F for 30 minutes or until crispy.
Dinner:
Roasted Pork Tenderloin With Veggies and Mashed Cauliflower
Thursday
Breakfast:
Berry Banana Breakfast Smoothie
Snack:
1 sliced pear sprinkled with 1/4 teaspoon cinnamon
10 pecan halves
Lunch:
Turkey Burger
4-ounce grilled turkey burger topped with 2 teaspoon Dijon mustard, 1 slice tomato, 1 tablespoon Gorgonzola cheese. Serve with 1 cup steamed spinach.
Snack:
1 steamed artichoke topped with 2 tablespoons grated Parmesan and squeeze of lemon
Dinner:
Hearty Greek Salad
Friday
Breakfast:
Grab 'n' Go Cereal
3/4 cup Nature's Path Organic Smart Bran with 1 cup skim milk and 2 tablespoon ground flaxseed
Snack:
1 cup steamed edamame, topped with sea salt and pepper to taste
Lunch:
Warm Turkey Melt
Layer 1 slice whole-grain bread with 4 slices roasted turkey breast, 1 slice tomato and 1/4 cup sprouts. Then melt 1 slice reduced-fat cheddar cheese on top in broiler.
Serve with 1 cup sliced red bell peppers
Snack:
1/2 cup nonfat plain Greek yogurt mixed with 1/2 cup raspberries and 1/2 teaspoon unsweetened cocoa powder
Dinner:
Flank Steak, Mushroom and Onion Saute
Saute 1 cup shiitake mushrooms and 1/2 cup chopped yellow onion in 2 teaspoons olive oil. Spoon over 4-ounce broiled flank steak. Side salad: 1 1/2 cups mixed mesclun greens, 1/4 cup chopped bell pepper, and 1/2 cup sliced cucumber. Dress with vinegar of choice.
Saturday
Breakfast:
Harvest Veggie Omelet
Lightly coat skillet with 2 sprays canola oil and saute 1/4 cup chopped red bell pepper, 1 tablespoon chopped yellow onion and 1/2 cup chopped zucchini over medium-high heat until tender. Beat 1 egg and 3 egg whites with 1/4 teaspoon cayenne pepper and 1/4 teaspoon salt to prepare omelet.
Serve with 1 slice dry whole-grain toast
Snack:
1 cup carrot sticks with 2 teaspoon natural peanut butter
Lunch:
Rustic Grilled Chicken Salad
4-ounce grilled chicken over 2 cups shredded greens and red cabbage, 1/2 cup roasted butternut squash (see recipe), 1/2 cup sliced fennel, 1 tablespoon crumbled goat cheese, 1 tablespoon chopped walnuts dressed with fig vinegar
Snack:
8-ounce DIY green tea latte made with skim milk and 18 pistachios
Dinner:
Shrimp With Crispy Kale Chips
Sunday
Breakfast:
Caramelized Grapefruit
Slice and section 1/2 grapefruit. Broil and top with 1/2 teaspoon cinnamon. Pair with 3/4 cup nonfat plain Greek yogurt mixed with 2 tablespoon ground flaxseed, 1/4 teaspoon vanilla extract and 1/8 teaspoon cardamom .
Snack:
1 cup endive leaves with avocado salsa (mix 2 tablespoon chopped avocado with 1/2 cup salsa)
Lunch:
Spicy Lentil Soup
1 cup lentil soup sprinkled with 1/2 teaspoon cumin
Serve with 1 cup steamed broccoli tossed with 1/2 teaspoon olive oil and 1 teaspoon pine nuts
Snack:
Roasted Butternut Squash
Keri Glassman
1 butternut squash, peeled
2 tablespoons olive oil
Dash kosher salt
1. Preheat oven to 425° F.
2. Spray a heavy baking sheet with canola or olive oil spray.
3. Cut the squash in half lengthwise, remove seeds and cut into chunks.
4. Toss with oil and sprinkle with kosher salt, making sure the squash is evenly coated.
5. Spread in single layer on the prepared baking sheet and bake 20 minutes.
6. Flip and bake 15 more minutes or until golden brown.
Dinner:
Apricot Chicken With Broccoli and Cauliflower
Combine 1/2 chopped apricot with 1 tablespoon raisins, 2 teaspoons balsamic vinegar, and 1 teaspoon olive oil. Spoon over 4-ounce grilled chicken breast.
Serve with 1/2 cup each steamed broccoli and cauliflower.
WEEK 2
Monday
Breakfast:
Monday Morning Peach Delight
1 sliced peach topped with 1/2 cup low-fat cottage cheese and 8 walnut halves, sprinkled with 1/4 teaspoon cinnamon
Snack:
1 cup sliced red cabbage drizzled with 1/4 teaspoon olive oil, 1 teaspoon cider vinegar, 2 teaspoon dried cranberries and 2 teaspoon slivered almonds.
Lunch:
Chicken Sausage With Garlic Roasted Brussels Sprouts
4-ounce chicken sausage (prepared according to package directions)
1 cup Brussels sprouts, halved and roasted with 2 teaspoon olive oil and ½ teaspoon minced garlic
Snack:
Beet and Carrot Chips
1 medium beet, thinly sliced
2 large carrots, thinly sliced
2 teaspoons olive oil
Dash sea salt
1. Preheat oven to 350° F.
2. Place veggies on baking sheet. Brush with olive oil and sprinkle with sea salt.
3. Bake 8 to 12 minutes or to desired crispness.
Dinner:
Broiled Cod With Spinach and Onion Saute
4-ounce broiled cod served with 2 cups spinach sautéed with 1/4 cup onion in 1/2 teaspoon olive oil
Side salad: 1 cup arugula, 3 orange slices, 1/2 cup chopped fennel
For dressing, mix 2 teaspoon olive oil, 1 tablespoon balsamic vinegar, and salt and pepper to taste.
Tuesday
Breakfast:
Eggs-cellent On-the-Go
2 hard-cooked eggs with 2 high-fiber crackers; top eggs with 1/4 teaspoon paprika
Snack:
8-ounce soy milk latte with 10 almonds
Lunch:
Tuna and Artichoke Salad
4-ounce chunk light tuna in water drained over 2 cups romaine lettuce with 1/4 cup hearts of palm, 1/4 cup artichoke hearts and 1/2 cup grape tomatoes. Dress with 2 teaspoon olive oil, a squeeze of lemon, and salt and pepper to taste.
Snack:
1 sliced granny smith apple sprinkled with 1/4 teaspoon cinnamon
Dinner:
Tofu and Broccoli Stir-Fry
Saute 4 ounces cubed firm tofu, 1/4 cup chopped red bell pepper, 1/4 cup water chestnuts, 1/4 cup snow peas, 2 tablespoon cashews and 1/2 teaspoon sesame oil. Serve with 1 cup steamed broccoli.
Wednesday
Breakfast:
Peanut Butter Toast
1 slice whole-grain toast with 2 teaspoons natural peanut butter
8-ounce latte made with skim milk
Snack:
2 celery stalks with 2 tablespoon hummus
Lunch:
Split Pea Soup With Fall Veggie Salad
1 cup split pea soup sprinkled with 1 tablespoon grated Parmesan cheese
Side salad: 1 cup red leaf lettuce, 1/4 cup sliced zucchini,1/4 cup shredded carrots, 1/4 cup sliced radish, 1 tablespoon sunflower seeds. Dress with 1 teaspoon olive oil, a squeeze of lemon, and salt and pepper to taste.
Snack:
1/2 grapefruit sectioned, topped with 2 tablespoons nonfat ricotta cheese mixed with 1/4 teaspoon cinnamon
Dinner:
Dijon Salmon and Chickpea Salad
4-ounce broiled salmon topped with 1 teaspoon Dijon mustard and 1 teaspoon soy sauce. Serve with 8-10 steamed asparagus spears. Side salad: 1/3 cup chickpeas, 1 teaspoon lemon juice, 1 teaspoon chopped fresh dill, and sea salt to taste.
Thursday
Breakfast:
Nut 'n' Apple Yogurt
Mix 3/4 cup nonfat plain Greek yogurt with 1/2 chopped Granny Smith apple and 8 pecan halves.
Snack:
1 quartered whole-wheat tortilla (such as La Tortilla Factory) sprinkled with sea salt and baked 10 minutes at 350° F
Serve with avocado salsa: Mix 2 tablespoons chopped avocado with 1/2 cup salsa.
Lunch:
Lemon Salmon Salad
Combine 1 cup chopped romaine lettuce, 1 chopped plum tomato, 1/4 cup sliced carrots, 1/4 cup chopped yellow bell pepper, and 1/2 cup artichoke hearts. Top with 4 ounces canned salmon and 18 pistachios. Drizzle salad with 1 ounce lemon juice and 1 teaspoon black pepper.
Snack:
Spiced Carrot Crisps: Toss 1 cup thinly sliced carrots with 1/8 teaspoon cardamom and 1/4 teaspoon cinnamon. Place on baking sheet and brush with 1 teaspoon olive oil. Bake at 350°F for 8 to 12 minutes.
Dinner:
Roasted Pork, Squash and Spinach Salad
Keri Glassman
4 ounces pork tenderloin
1 tablespoon dry mustard
Salt and pepper to taste
1 teaspoon freshly squeezed lemon juice
2 tablespoons olive oil
1/2 teaspoon honey
1 cup spinach
1/2 cup roasted butternut squash (see recipe)
1/2 cup shredded red cabbage
1/4 cup chopped mushrooms
1/2 cup sliced red bell pepper
1. Preheat oven to 400° F.
2. Rub the pork with dry mustard and sprinkle with salt and pepper. Place in a roasting pan lightly sprayed with cooking spray.
3. Cover with foil and bake 30 to 40 minutes or until a meat thermometer reads 150° to 160° F. Let stand 5 minutes.
4. Combine lemon juice, oil, honey, and salt and pepper to taste in small bowl. Toss with spinach, squash, cabbage, mushrooms and red bell pepper in serving bowl.
5. Thinly slice pork and serve over prepared salad.
Friday
Breakfast:
Open-Faced Egg and Cheese
Scramble 1 egg and 3 egg whites. Serve over 1 slice whole-grain toast and sprinkle with 1/4 teaspoon paprika and 1 ounce shredded, reduced-fat cheese.
Snack:
15 red grapes with 10 almonds
Lunch:
Cheesy Potato Bake
1 baked sweet potato topped with 1/2 cup low-fat cottage cheese and 1/2 teaspoon cinnamon
Snack:
3 cups air-popped popcorn with 1 tablespoon dried cranberries and 1/4 teaspoon cinnamon
Dinner:
Balsamic Grilled Chicken With Asparagus
Grill 4-ounce chicken breast brushed with 1 tablespoon balsamic vinegar, 1 teaspoon olive oil, salt and pepper. Serve with 1 cup steamed asparagus topped with 2 tablespoons Parmesan cheese.
Saturday
Breakfast:
Cinnamon Pecan Quinoa
Add 1/2 cup plain soy milk to 1/3 cup cooked quinoa and heat for 30 to 60 seconds in microwave. Mix with 2 tablespoons chopped pecans and 1/2 teaspoon cinnamon.
Snack:
1/2 cup sliced cucumber, 1/2 cup tomato, and diced red onion with 2 tablespoons olive oil and lemon juice
Lunch:
Southwestern Stuffed Acorn Squash
Snack:
3/4 cup nonfat plain Greek yogurt mixed with 2 teaspoons natural peanut butter
Dinner:
Broiled Scallops With Warm Spinach and Green Beans
4 ounces broiled scallops over bed of 1 cup steamed spinach
1 cup green beans tossed with 2 teaspoons olive oil and 1 teaspoon sliced pecans
Sunday
Breakfast:
Goat Cheese and Veggie Omelet
Saute 1/4 cup chopped broccoli and 1/4 cup chopped mushrooms in 1 teaspoon olive oil. Beat 1 whole egg and 3 egg whites to prepare omelet. Top with 1 tablespoon crumbled goat cheese.
Snack:
1 cup carrot sticks with 2 teaspoons almond butter
Lunch:
Sprout Oat Sandwich
1 slice oat nut bread topped with 2 tablespoons hummus, 1/4 avocado, 1/4 cup sprouts, 4 cucumber slices and artichoke hearts on side
Snack:
Peel, core and slice 1 Honeycrisp (or other tart apple) into 1/2 inch-thick rounds. Grill apple slices until just tender, turning once, and top with 1 ounce shaved sharp cheddar cheese.
Dinner:
Baked Chicken Parm With Spaghetti Squash
4-ounce grilled chicken breast topped with 1/2 cup marinara sauce, 2 tablespoons melted part-skim mozzarella and served over 1 cup roasted spaghetti squash
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"Athletic striding smokes hundreds of calories when you boost the pace, duration and intensity," said fitness expert Petra Kolber, creator of the "Step by Step Strength Training" DVD. "Exercisers underestimate how fast or how far they can walk, but you've got to push it to maximize fat-burning and muscle-toning benefits."
When you perform these walks, track your rate of perceived exertion, a scale that indicates when to bump up or decrease walking pace for faster results.
Aim to walk four to five times per week. You'll burn hundreds of calories and kick-start energy with each workout.
WALK 1: SUPER-SCULPT BUTT AND THIGHS
This cardio-sculpting program uses uphill walking on a treadmill to zero in on thighs, glutes and hips. "Do the workout on a treadmill first, so you'll be more accustomed to the pacing and RPE, and then take it outside to natural hills in your hood," said Reed.
Minute 0:00-3:00
Warm up at 3 mph on a 3 percent incline. "If you feel like the intensity is too much at any point, decrease speed on the treadmill but maintain the incline," he said. Try walking on your toes for 30 seconds and on your heels for another 30 seconds to prep lower-body muscles for hills. (RPE 3)
Minute 3:00-6:00
Increase speed to 4 mph and gradually increase incline to 6 percent. "Increase the incline every 30 to 60 seconds so your body can adapt," Reed said. Consciously contract your butt muscles as you stride at steeper grades. (RPE 4, 5)
Minute 6:00-9:00
Increase speed to 4.5 mph (a brisk 13-minute mile) and gradually increase incline to 9 percent. "Lean into the hill to target butt and hips," said Reed. (RPE 6, 7)
Minute 9:00-15:00
Over the next seven minutes, maintain 4.5 mph and incrementally increase incline to the maximum. "Avoid holding onto the handrails. If you feel like you have to hold on, decrease speed until you can walk at this incline for several minutes," said Reed. For 30 to 60 seconds, try walking with your hands on your hips to make legs work harder. (RPE 8, 9)
Minute 15:00-20:00
Begin cooling down by lowering the percent of incline every 30 seconds or so. "Spend the last two minutes at a warm-up pace to allow heart rate to recover," Reed says. Stretch on your own after every walk. (RPE 4, 3)
WALK 2: DO-ANYWHERE YOGA-CORE WALK
Strengthen your body, increase flexibility and flatten your abs with Petra Kolber's yoga-walk routine. You'll finish a speedy 15-minute walk with five minutes of core moves, and you'll focus on contracting abdominals during the walk itself. "If you want more yoga and less walking, warm up with sun salutations," Kolber said. "They key to yoga walking is breathing deeply through the nose to cultivate calmness," said Kolber, creator of the "Breathe" DVDs. Instead of counting reps during core exercises, use eight full breaths per move.
Minute 0:00-5:00
Walk briskly to warm the heart and muscles. Begin inhaling and exhaling only through the nose and allow your belly to expand fully during inhales. Start consciously focusing on pulling your navel into your spine and contracting all your belly muscles. (RPE 3, 4)
Minute 5:00-15:00
Pump up the walking pace to 5 miles per hour (about a 12-minute mile). "As you breathe deeply, do an internal body scan and send your breath to areas of your body that seem tight or sore," Kolber said. (RPE 5, 6)
Minute 15:00-20:00
Do eight breaths (or one minute) per move. Standing side reach: Place left hand on left outer thigh and reach right hand overhead to reach up and out. Switch sides after four slow breaths. Boat pose: Sit on tailbone and grasp shins with your hands. Slowly extend both arms and legs in a V position and balance here. Yoga bicycle: Lie back into crunch position with knees bent and slowly cross right elbow to left knee and alternate sides using one movement per inhale/exhale. (Inhale, touch right elbow to left knee, exhale touch left elbow to right knee and vice versa). Side plank: From plank pose, keep right palm flat on the floor and shift body weight over to right side so left arm can reach up to the ceiling. Stack ankles and knees on top of each other and look up to left fingertips and hold for four breaths, then switch sides. Elbow plank: Press forearms and palms into mat, lift body into a straight line, hold for eight breaths. (RPE 7 for all). Stretch thoroughly.
WALK 3: TREADMILL FAT BLASTER
Breaking into a slow run or jog burns more overall calories on the treadmill, said Reed. To maximize caloric expenditure, keep your body guessing at what comes next. "To budge frustrating fat, try going faster than you're used to and add new moves to prevent boredom and tap more muscle groups," said Reed.
Minute 0:00-3:00
Warm-up walk on a flat treadmill at 3.5 mph. (RPE 3)
Minute 3:00-6:00
Pick up the pace to walk briskly at 4.5 mph. Take more steps (rather than longer steps) to pick up speed. (RPE 4)
Minute 6:00-9:00
Reduce speed to 3.5 mph and intermittently lower hips into a half squat, or what Reed calls a "tunnel walk," pretending you have to stoop to get through a tunnel. Don't lean too far forward, which places undue stress on the lower back. (RPE 5)
Minute 9:00-12:00
Bump up your speed to 4.5 mph and walk with arms raised overhead about shoulder width apart. "This will increase heart rate by 10-20 beats per minute. Reed calls this the "field goal walk" and said it places great demands on the cardiovascular system. (RPE 6, 7)
Minute 12:00-15:00
Lower your arms and walk briskly for the next three minutes at 4.5 mph. (RPE 5)
Minute 15:00-18:00
Break into a slow jog, gradually increasing speed on a flat treadmill until you're running 6 mph. "Keep arms pumping naturally at your sides and be aware of foot placement on the treadmill," said Reed. (RPE 7, 8)
Minute 18:00-21:00
Gradually decrease pace to walk 4 mph and begin cooling down. (RPE 6)
Minute 21:00-24:00
Finish with a slower warm-up pace, then stretch. (RPE 3)
WALK 4: OUTDOOR ENERGY BOOSTER
This 20-minute "soul walk" pumps up your calorie burn and lifts your spirits. The focus is on connecting your mind to your movements and on stretching tight muscles. "On this steady-state walk, focus on objects you're passing, the way your body feels and on your own deep breathing," said Kolber.
Minute 0:00-4:00
Find a quiet place to take in your surroundings and sit cross-legged. Close your eyes and place your hands on your lower abdomen. Breathe in deeply, allow belly to expand and pause at the end of your inhales as you breathe calmly for several minutes. Blink open your eyes, inhale deeply and shake everything out. (RPE 2)
Minute 4:00-8:00
Slowly increase walking pace with arms pumping at your sides until you feel slightly out of breath. Listen to the birds and anything you hear in your surroundings. (RPE 3, 4)
Minute 8:00-12:00
Bring your attention to the scents around you as you pick up your walking pace. Notice the different flowers or foliage that you pass. Match your breath to your pace, inhaling for four strides and exhaling for four strides. (RPE 5)
Minute 12:00-16:00
Bump up walking pace again so you are breathless but not quite panting. Notice any negative thoughts that may enter your mind and simply exhale them away. Can you hear the call of different birds? Can you hear the sound of children laughing nearby? (RPE 7, 8)
Minute 16:00-20:00
Walk and observe nature as you gradually wind down. Check in to see how you are breathing. Can you slow your breath even more? Now shift your focus to the sounds around you. Lastly come back to the sights that you see and prepare to stretch. (RPE 5)
Hold the following stretches, in any order, for 60 seconds immediately after walking (RPE 3).
Seated hamstring stretch: Sit with legs extended in front of you, feet flexed up, and elongate from the waist. Fold over shins to grab ankles, shins or calves.
Side-lying quadriceps stretch: Lie on right side with head in bent right arm and pull left heel to buttocks. Press knees together and hold left foot to buttocks with left hand for 60 seconds, then switch sides.
Supine hip stretch: Lie back and cross right ankle over left knee. Reach through to grasp left shin and pull it closer into chest. Elongate from the tailbone and switch sides after 60 seconds.
Trying to lose weight this fall? Our Fresh Start weight loss guide will help you reach your goals with meal plans, tips and more.
National Yoga Month
Free yoga for a week ought to help you find her.
September 1 kicks off National Yoga Month, and to help inspire would-be yogis to get off the couch and onto the mat, the Yoga Month website is distributing coupons for "One Week of Free Yoga" at more than 1,200 studios nationwide.
Administered by the Yoga Health Foundation, the 30-day celebration is designed to motivate people to practice yoga, according to its founder and 20-year downward dog veteran, Johannes Fisslinger.
"We want people to experience the benefits of yoga," he said. "Health comes from the inside out. Yoga not only strengthens every part of the body and increases flexibility; it is also scientifically proven to reduce stress, which is a major cause of illness."
Whether you're in the mood for a serious sweat session or a mellow meditation, a free month is likely to encourage even the most yoga-challenged individual to give it a try.
In addition to free classes, other yoga studios are reaching out to the community with educational events, donation classes for a charity, contests and giveaways.
Go Yoga in Fernandina Beach, Fla. is challenging students to a playful competition by asking, "How has yoga transformed your life?" The winner will receive free yoga for the rest of the year. "We are hoping the community really takes the time to think about our relationship with each other, our environment and the world in which we live," said Go Yoga co-owner Cassie McClellan. "At its root, the word 'yoga' means to join, to bring together. Our hope this month is that everyone realizes our oneness, our interdependence, our yoga."
Another group of studios in Chicago is putting on a free outdoor yoga day that includes lakefront classes, Thai massage and kids' programs. There is also a music-yoga festival in New Jersey. And certain cities are offering free citywide classes.
The long-term goal of National Yoga Month is not getting more people to om in unison; rather it's about leading people to more fulfilling, conscious lifestyles.
"The most difficult part of helping people get into a practice is just that -- getting into a practice," said McClellan. "It's not a once-a-week or once-a-month thing." It's a state of being -- one that really begins when we roll up our yoga mats and step out into the world.
Also part of the September awareness campaign is the release of "Titans of Yoga," a movie that brings together 25 prominent worldwide yoga and meditation teachers who share their greatest life challenges -- from depression to illness to destructive sex, drugs and rock-and-roll lifestyles -- and how they transformed them into their greatest life victories. Movie proceeds benefit Yoga-Recess in School, which takes yoga-based health education into classrooms.
"If we can change just one person's life this month, it will be worth it," said Fisslinger. "You just feel so different once you try yoga. There is nothing else quite like it."
For more details on National Yoga Month in your town, click here.
Prince
Prince, one of the leading names in tennis, is celebrating its 40th anniversary this year. The company was the first to patent the "oversize" tennis frame in 1976, which has become the standard for most players. Today, Maria Sharapova, John Isner, Gael Monfils, Sam Querrey, David Ferrer, Juan Carlos Ferrero and Mike and Bob Bryan all hit the courts with a Prince Tour Series in hand.
To get you excited about the US Open and your own game, That's Fit has teamed up with Prince to give away a EXO3 Black 100 racquet to one lucky reader.
To enter to win, leave a comment on the original post (not here!) telling us why you love the game of tennis. The giveaway closes at 5 p.m. ET on Friday!
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This law is one of many signs pointing toward a healthier life for Americans. While some say ignorance is bliss, the obesity epidemic in this country is a matter that should not be taken lightly.
We asked our users if they will read the nutritional information when it's provided for them and if they think having this information readily available will help battle the bulge.
Pam S.
I usually check out the info online before I go there. If every item on the menu is horrid points wise, I don't go there.
Karen S.
Always! And yes, it does make a difference in what I decide to order.
Michelle S.
Absolutely! Wish they all had them.
Sandra N.
I read it and it does help me decide what's for lunch.
Diane G.
Yes in some ways, but the person has to want to change their way of eating. But I think it's great for the people that do want to know what they are eating.
Marlene J.
I know it'd be a great tool for me, it's a guessing game at restaurants. Though I'm educated about a good bit of nutrition, if you're not the one cooking, you can't be sure about things.
Liliana M.
For the people that care about themselves it will be a huge tool. For the people that are beginning to care about themselves, it will make them pause to consider what they're ingesting. And for the people that don't care, those will just be some numbers attached to their meal.
Sandra N.
Nothing can help people that don't help themselves. For those that are health conscious, a BIG plus and for those that are on the way to beginning a health plan, too.
Looks like Burger King won't be too happy about this new law. It just created the Pizza Burger -- you'll never believe how many calories this one has.
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I recently joined a masters (read: adult, generally 30 and over) swim class at a gym near my home because, while I've always been a strong swimmer, I haven't taken a lesson since I was in preschool and thought it would be fun to see what I could improve upon. As it turned out, I have plenty to work on, but in just a couple of months, I've seen an enormous difference. Am I going to be the next Dara Torres? Probably not (OK, certainly not), but I definitely feel like I'll have a real edge for my next triathlon.
After seeing what a coach was able to do for me, I wanted to learn more about the benefits of hiring one, so I talked to Adam Duvendeck, two-time Olympian, track cycling specialist and co-founder of Momentum Coaching Group in Long Beach, Calif.
He confirmed my suspicions that coaching groups can make a real difference for just about anybody. "I think anyone with any type of goal, or even if they're having a hard time figuring out what to do in terms of creating goals, can really benefit from a coach," Duvendeck said. "It's for anyone who wants to excel in any way. It doesn't mean they have to become an Olympian -- there are so many different goals, like weight loss or just satisfaction at improving."
While Duvendeck sees a wide variety in his clientele, masters athletes in the 30- to 50-year-old range are the most common. "They take their hobby very seriously," Duvendeck said. As well they should -- there are still opportunities to compete at the regional, national and world levels as a masters athlete.
His clients' previous experience is also varied. "Either they did [this sport] when they were younger and have renewed their interest or didn't pick [it] up until much later in life," he said. "They just want to go until they know they've reached their physical peak." How many of us can identify with that feeling?
If you're seeking a coach for your sport of choice, there are a number of things to consider while you shop around (and you should shop around, according to Duvendeck). First figure out exactly what you want out of a coach. Do you want to make your Olympic dreams come true or are you hoping to not come in last in your age group at the next local 5k? Both are great goals, but if you're a beginner, you probably don't need to pay for an Olympic-level coach, Duvendeck said. However, if you're looking to train at an elite level, you probably want someone who has competed at that level and knows what it takes to get there. Certification and accreditation in your particular sport are also important.
Similarly, your experience level will dictate exactly what kind of coaching you need. An experienced cyclist can benefit greatly from online coaching. Using specialized training programs, a coach in another state can provide a workout for the athlete, who can download it, record his data during the workout, and send that back to the coach in order to determine how to improve the workout and his skill level. In that case, proximity isn't really important.
However, a cycling newbie needs a coach she can go riding with once or twice a week until she gets her technique down and should seek out a local coach.
Pricing depends on a variety of factors but generally has a lot to do with the level of communication and level of experience. Duvendeck said that the low end will generally be $180 to $200 per month, but you can pay more than $1,000 a month for elite-level training. Of course, this could be a bit different depending on your area -- yet another reason to shop around.
So what do you think? Do you need a coach? If your goals include getting better at your sport, the answer might just be yes. But if your goals are more focused on weight loss and generally becoming more athletic, perhaps a personal trainer is a better option for you.
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Then again, they might not be related at all.
Basically, the study (carried out by researchers at Yale University) found that prescription antihistamine users were overweight or obese more often than their non-using peers. This does not necessarily mean that antihistamines cause weight gain, the researchers are quick to point out. The lead researcher told Reuters that allergies and asthma (which could cause someone to get a prescription for antihistamines) have also been linked to obesity, so this study is far from determining any cause-and-effect relationship.
What about you? Have you ever noticed a fluctuation in your weight when you're using antihistamines? Be sure to share your experience in the comments!
Skye Leech
"We were looking for a fun family holiday that would allow us all to spend time together," said Skye's dad, Ben Parnell, who admitted vacationing poolside would not suit his active family. Instead they wanted long-distance bike trails for their first trip to the U.S. and found ideal ones on the East Coast.
"Skye is only 7, and we had to keep reminding ourselves of that," Parnell said about his daughter, who is also a swimmer and in good shape. "She got tired like the rest of us on some of the longer legs, but her muscles are developing nicely and by the end of the trip she biked 46 miles one day."
The family pulled all of their own gear in a trailer and camped out each night during their journey. "Trips like this allow you to really get to know each other," said Parnell. "We got to find out how we can work together as a team."
"I felt impressed with myself once I had reached the end," said Skye.
In addition to being an active getaway and a chance to explore a new country, Skye raised more than $750 to date for the Ellen MacArthur Trust, which uses sailing to inspire children to regain their self-confidence while recovering from cancer, leukemia or other serious illnesses.
"Not everyone is as lucky as we are in terms of their health, so it's important to help where you can," said Parnell. "Ellen MacArthur is an absolute legend, so we knew we wanted to support her charity."
In addition to helping other children who are ill, Skye is also a role model to her peers, reminding them to get outside and be active. "This was much more fun than watching TV all day," she said. "If you watch too much TV, you end up with square eyes" (a British saying that refers to the look kids have when they have been watching TV too long).
What's next for this young cyclist and philanthropist? "Cycling around Lake Ontario next year!" she said.
To contribute to Skye's fundraising, click here.
Speaking of vacations, how about training and traveling for a cause?
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Latest documents added to NHS Evidence - mental health. Helps you keep upto date with NICE guidance, Cochrane reviews and all the best available evidence.
Science news and technology updates from Scientific American
Treatment of severe depression with magnetic stimulation is moving beyond large mental health centers and into private practices nationwide, following more than two decades of research on the treatment. Yet even as concern about its efficacy fades, one potential side effect--seizures--continues to shadow the technology. [More]
Mental health - Health - Depression - Major depressive disorder - Disorders
Transhumanists! Singularitarians! Listen up! You who harbor a fervent faith in science’s imminent transformation of our frail, fleshy selves. The conquest of all our physical and mental ailments, cancer, Alzheimer’s, schizophrenia, depression, senescence--death itself. You who exult over every “breakthrough” in nanotech, biotech, neuro-prostheses, artificial intelligence bearing you closer to eternal life.
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Realistic stem cell therapies to replace diseased or damaged tissue may still be years away, but researchers have uncovered a promising new use for these undifferentiated cells: they can be programmed to become patient-specific laboratory models of inherited liver disease. These new tools could be useful for teasing out disease mechanisms and testing new drug therapies.
Scientists from the University of Cambridge's Institute for Medical Research obtained skin cells from 10 patients--seven who had various forms of inherited liver disease, and three healthy controls. They reprogrammed the skin cells, rejuvenating them into an embryolike state (using the four-gene approach described in 2007). The researchers then cultured these so-called induced pluripotent stem cells (iPS cells) in a mixture of chemical factors that triggered their conversion into liver cells, which had the appearance and functional properties of native liver cells.
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Targeted beams of high-intensity radiation can shrink early-stage tumors with limited collateral damage to surrounding healthy tissue. The addition of robotics and image guidance systems in recent years has made these stereotactic, or directed beam, radiosurgery systems an even more versatile weapon against cancer, attacking not only brain tumors (for which they were originally designed) but also other diseases virtually anywhere in the body. [More]
Cancer - Brain tumor - Health - Radiosurgery - Conditions and Diseases
There’s a strange whiff in the media air, a sort of polyamory chic in which liberally minded journalists, an aggregate mass of antireligious pundits, and even scientists themselves have begun encouraging readers and viewers to use evolutionary theory to revisit and revise their sexual attitudes and, more importantly, their behaviors in ways that fit their animal libidos more happily .
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In our experience, nothing ever really ends. When we die, our bodies decay and the material in them returns to the earth and the air, allowing for the creation of new life. We live on in what comes after. But will that always be the case? Might there come a point sometime in the future when there is no “after”? Depressingly, modern physics suggests the answer is yes. Time itself could end. All activity would cease, and there would be no renewal or recovery. The end of time would be the end of endings.
This grisly prospect was an unanticipated prediction of Einstein’s general theory of relativity, which provides our modern understanding of gravity. Before that theory, most physicists and philosophers thought time was a universal drumbeat, a steady rhythm that the cosmos marches to, never varying, wavering or stopping. Einstein showed that the universe is more like a big polyrhythmic jam session. Time can slow down, or stretch out, or let it rip. When we feel the force of gravity, we are feeling time’s rhythmic improvisation; falling objects are drawn to places where time passes more slowly. Time not only affects what matter does but also responds to what matter is doing, like drummers and dancers firing one another up into a rhythmic frenzy. When things get out of hand, though, time can go up in smoke like an overexcited drummer who spontaneously combusts.
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Imagine being twelve years old. Imagine coming home after school and finding your big sister’s lifeless body hanging from a rafter in your home’s stairwell. Phoebe Prince’s little sister did not have to imagine this scenario, because she lived it. She arrived home after school in South Hadley, Mass., last January 14 and discovered that her sister had committed suicide by hanging herself, a result of enduring extreme and relentless bullying at the hands of her peers. [More]
Bullying - Suicide - South Hadley Massachusetts - South Hadley High School - South Hadley
Our sleep patterns, eating habits, body temperature and hormone levels are driven by the rhythmic activity of body's circadian clock. Travel across time zones or shift work can knock those rhythms out of whack, possibly leading to sleep problems, bipolar disorder, metabolic syndrome and even cancer. The lack of convenient and reliable methods to monitor the internal clock's activity has severely limited the study of circadian-related disease, but now, scientists report that they can easily track the circadian rhythms by analyzing a person's plucked hairs. The finding could one day help doctors diagnose and treat patients suffering from circadian dysfunction.
The body's master clock, located in the brain region called the hypothalamus, is set by light, which activates clock genes that are responsible for keeping this timekeeper ticking correctly. Within the past decade, scientists have discovered that organs outside the brain (such as the skin, liver and pancreas) also keep track of time with 24-hour fluctuations in clock gene expression. Previous studies have attempted to monitor molecular timekeeping in blood cells or in cells lining the mouth, but these approaches are technically challenging.
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SEPTEMBER
20 We often refer to a strong sexual attraction as animal magnetism, but arousal involves more than just base instinct. At the Mind Science lecture series , psychologist Stephanie Ortigue will describe how desire depends on complex mental processing. Her talk, “The Consciousness of Desire,” will reveal the brain regions associated with longing and how they are influenced by mirror neurons--brain cells that fire when we either perform or observe an action. [More]
Brain - Neuron - Mind - Philosophy - Philosophy of Mind
Ketamine --a powerful anesthetic for humans and animals that lists hallucinations among its side effects and therefore is often abused under the name Special K--delivers rapid relief to chronically depressed patients, and researchers may now have discovered why. In fact, the latest evidence reinforces the idea that the psychedelic drug could be the first new drug in decades to lift the fog of depression. [More]
Mental health - Major depressive disorder - Psychedelic drug - Health - Disorders
The word “psychopath” conjures up movie images of brutal, inexplicable violence: Jack Nicholson chasing his family with an ax in The Shining or Anthony Hopkins as Hannibal Lecter, his face locked into an armored mask to keep him from biting people to death. But real life offers another set of images, that of killers making nice: Ted Bundy as law student and aide to the governor of Washington State, and John Wayne Gacy as the Junior Chamber of Commerce’s “Man of the Year.” Psychopaths are likable guys when they want to be.
Between the two of us, we have interviewed hundreds of prison inmates to assess their mental health. We are trained in spotting psychopaths, but even so, coming face to face with the real article can be electrifying, if also unsettling. One of the most striking peculiarities of psychopaths is that they lack empathy; they are able to shake off as mere tinsel the most universal social obligations. They lie and manipulate yet feel no compunction or regrets--in fact, they don’t feel particularly deeply about anything at all.
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Editor's note: This is the introductory article for the September 2010 special issue "The End" .
Once again, the world is about to end. The latest source of doomsday dread comes courtesy of the ancient Mayans, whose calendar runs out in 2012, as interpreted by a cadre of opportunistic authors and blockbuster movie directors. Not long before, three separate lawsuits charged that the Large Hadron Collider would seed a metastasizing black hole under Lake Geneva. Before that, captains of industry shelled out billions preparing for the appearance of two zeros in the date field of computer programs too numerous to count; left alone, this tick of the clock would surely have shaken modern civilization to its foundations.
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A child that is easily distracted, fidgety and interruptive in school might not have a clinical case of attention-deficit hyperactivity disorder (ADHD), but might rather just be acting his or her age, posit researchers behind two new studies of diagnosis trends. [More]
Attention-deficit hyperactivity disorder - Health - Mental Health - Disorders - ADD and ADHD
Despite kids’ protests, enforcing early bedtimes may be good for their mental health. Teens who are allowed to go to bed later are more likely to suffer from depression--probably for the simple reason that they are not getting enough sleep, a recent study suggests.
Columbia University scientists found that depression was 24 percent more common in teens whose parents let them go to bed at midnight or later than in kids whose moms and dads required them to hit the pillow by 10 p.m. The night owls were also 20 percent more likely to have suicidal thoughts.
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Mrs. K. questions who she really is. Her family, her career, her entire life seem pointless. She feels anxious and broods. She sometimes screams at her children for no reason and then feels guilty. She has toyed with the idea of suicide. In contrast, Mr. M. believes that he possesses extraordinary gifts. He spends long nights writing down grandiose plans to save the world and sends his manuscripts to numerous publishers. Despite heaps of debt, he buys an expensive sports car, anticipating success. He has never felt more confident. These patients suffer from different mental illnesses--Mrs. K. is depressed, and Mr. M. is manic--but they both hold highly distorted views of themselves.
It is more than just sage advice to “know thyself,” as Heraclitus advocated in the fifth century B.C. A realistic self-image is a hallmark of a healthy mind. Ancient Greek philosophers speculated that the psyche determines behavior. Since then, numerous studies have shown that people with a faulty self-image tend to have high levels of anxiety, defensiveness, self-doubt and narcissism. Relationships, careers and happiness suffer when reality doesn’t match who we think we are.
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Money can't buy you love. Worshipping Mammon foments evil ways. Materialists are shallow and unhappy. The greenback finds itself in tough times these days. Whether it’s Wall Street bankers earning lavish multi-million-dollar bonuses or two-bit city managers in Los Angeles County bringing in higher salaries than President Obama the recessionary economic climate has helped spur outrage and revulsion at those of us collecting undeserved lucre.
Wealthy people have a bad rep. Sure, there are philanthropists like Warren Buffet and Bill Gates, who have given billions of their net worth away and have made the world a better, healthier, safer place. But, sadly, they are an exception . American families who make over $300,000 a year donate to charity a mere 4 percent of their incomes. The statistic should not be surprising, as studies by University of Minnesota psychologist Kathleen Vohs and her collaborators have shown that merely glimpsing dollar bills makes people less generous and approachable, and more egocentric.
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Taking Responsibility I have a bone to pick, related to “ The Power to Persuade ,” by Kevin Dutton. Too often people blame others for their bad decisions. In Mariette DiChristina’s comments in her column From the Editor, she says that she could not figure out what the art salesperson had done to “make” her buy the pen-and-ink set, implying that she had had no option but to buy it. Persuasion may be potent, but it is not helpful to allow people to excuse themselves for not making a better decision. It reminds me of Flip Wilson’s old line, “The devil made me do it!” [More]
Flip Wilson - Arts - Power To Persuade - Arts and Entertainment - house
One of the first things that anatomy students learn is that the brain is divided down the center. In most people, one half, or hemisphere, plays a dominant role. Handedness has long been a crude measure of hemispheric dominance, because each side of the brain controls the opposite side of the body. Right-handers, for instance, are likely to have dominant left hemispheres. Today researchers are realizing that studying ambidextrous children (who have no dominant hand) could yield insights into the consequences of an unusually symmetrical brain.
A team of European researchers recently assessed nearly 8,000 Finnish children and showed that mixed-handed children are at increased risk for linguistic, scholastic and attention-related difficulties. At age eight, mixed-handed kids were about twice as likely to have language and academic difficulties as their peers. By the time the children were 16, they also were twice as likely to have symptoms of ADHD--and their symptoms were more severe than those of right- or left-handed students.
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Having a mixed up body clock has been linked to a vast array of ailments, including obesity and bipolar disorder . And researchers are still trying to understand just how these cyclical signals influence aspects of our cellular and organ system activity. [More]
Bipolar disorder - Circadian rhythm - Health - Obesity - Triglyceride
Last week, while in a drowsy, altitude-induced delirium 35,000 feet somewhere over Iceland, I groped mindlessly for the cozy blue blanket poking out beneath my seat, only to realize--to my unutterable horror--that I was in fact tugging soundly on a wriggling, sock-covered big toe. Now with a temperament such as mine, life tends to be one awkward conversation after the next, so when I turned around, smiling, to apologize to the owner of this toe , my gaze was met by a very large man whose grunt suggested that he was having some difficulty in finding the humor in this incident. [More]
Human - Tickling - Rat - Pets - Recreation
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Syncope causes 1–3% of all emergency department (ED) visits, a high percentage of hospitalisations and prolonged hospital stay; nevertheless, many cases remain unexplained.
This study analysed the incidence of syncope at the ED of the University Hospital of Parma in the first half of 2008; then a sample of 200 patients admitted later for syncope into the ED ward was studied, in order to evaluate the efficacy of a brief observation unit and to validate the Osservatorio Epidemiologico della Sincope nel Lazio (OESIL) risk score as a tool to identify cardiogenic syncopes.
As reported in the literature, syncope accounts for 2.3% of ED consultations and for 4.2% of total hospital admissions. A brief observation ward in the ED seems to have the necessary characteristics for managing most cases of syncope quickly (3.5 days). The final diagnosis was certain in 60%, suspected in 33% and unexplained in 7% of patients. The commonest forms of syncope were non-cardiogenic. Factors associated with cardiogenic syncope were previous syncopal events, lack of prodromal symptoms and a high OESIL risk score.
Media interest in inter-juvenile violence in the UK has emphasised to clinicians the lack of data on medical outcomes following injury. A study was undertaken to examine the incidence of childhood head injury in a large trauma centre serving an inner city multiethnic community. The aim was to establish the physical and financial cost of survival with a head injury following inter-juvenile assault.
All children aged 8–16 years attending King's College Hospital, London (KCH) because of a head injury were identified restrospectively. The case notes of those admitted to the neurosurgical and neurorehabilitation service with a head injury between 1 August 2006 and 30 September 2008 were reviewed.
A total of 1126 children attended KCH with a head injury. Eight boys required admission for treatment of a head injury following alleged inter-juvenile assault. The mechanisms of brain injury included a penetrating knife wound, assault with a bottle and physical assault. One child died following admission as a result of his brain injury. Complete neurological outcome data were available on six cases. Three had a hemiplegia, four had speech and language difficulties, two had visual impairment, five had behavioural changes and five had cognitive difficulties.
This study demonstrates the serious consequences of inter-juvenile assault. Survival can be associated with neurological and psychological deficits. The cost to the health service is substantial. Further work is required to establish the long-term needs of these children.
To determine the diagnostic performance of bedside assessment of end-tidal alveolar dead space fraction (ADSF) for pulmonary embolism (PE) and whether the use of additional ADSF assessment following D-dimer assay can improve the diagnostic accuracy in suspected PE patients in the emergency department.
A prospective observational study of 112 consecutive adult patients suspected of PE of whom 102 were eligible for analysis. ADSF was calculated using arterial carbon dioxide and end-tidal carbon dioxide. An ADSF less than 0.2 was considered normal.
PE was confirmed in 11 (10.8%) of 102 patients. D-dimer assay alone as a reference standard test for PE had a sensitivity of 100%, specificity of 38.5% and false negativity of 0%. Area under the receiver-operator characteristic curve for the diagnosis of PE using ADSF values alone was 0.894, Sensitivity, specificity and false negativity for the combined results of a positive D-dimer test and abnormal ADSF were 100%, 78.0% and 0% for the presence of PE, respectively. Of 65 patients with a low or intermediate clinical probability and a positive D-dimer assay, 36 (55.4%) patients displayed normal ADSF and had no PE.
By itself ADSF assessment performed well in diagnosis of PE. The combined result of a positive D-dimer and abnormal ADSF increased the specificity for diagnosing PE compared with the D-dimer test alone. The use of additional bedside ADSF assessment following a positive D-dimer test may reduce the need for further imaging studies to detect PE in patients with a low or intermediate clinical probability.
To evaluate ischaemia modified albumin (IMA) as an early negative predictor of acute coronary syndrome (ACS) in different time to presentation groups and different cardiac risk groups.
A prospective observational study was performed in the emergency department at Royal Perth Hospital. Consecutive patients with symptoms suggestive of ACS needing delayed troponin measurements were recruited. All enrolled patients had both IMA and troponin measurements performed on their initial blood samples. The time of the initial blood tests and thrombolysis in myocardial ischaemia (TIMI) risk scores were recorded. Initial IMA results were compared with 12 h troponin levels and a discharge diagnosis of ACS. More detailed analyses were made according to different times to presentation (0–4 h, 5–12 h) and cardiac risk (TIMI score 0–1, 2–7). Sensitivity, specificity, positive predictive value, negative predictive value and likelihood ratio were calculated. Receiver operating characteristic (ROC) curves were plotted to determine the best diagnostic cut-off for IMA.
248 patients were enrolled (151 (61%) men, mean age 65 years). All 248 patients had ‘positive’ IMA results using the 85 U/ml cut-off value recommended by the manufacturer. ROC curves failed to show improved cut-off points for diagnosing raised 12 h troponin levels or ACS; the area under the curve (AUC) was 0.52 and 0.53, respectively. ROC curves produced similar poor results in all subgroups. In the subgroup with time to presentation 0–4 h and TIMI score 0–1 for diagnosing ACS, the AUC was slightly better at 0.58.
This study does not support the use of IMA as a negative predictor for ACS.
The ESCAPE trial was a multicentre randomised controlled trial investigating the effectiveness of Chest Pain Unit (CPU) care. The process of CPU implementation and the activity of individual CPUs varied substantially between hospitals. The study reported here explored the organisational factors that influenced this variation.
A multiple case study approach was taken treating each site as a ‘case’. Six intervention sites were studied. Qualitative data were collected through interviews with key personnel at each site.
Activity of individual CPUs was not adequately explained by simple structural differences between hospitals, such as their size or location, or between CPUs, such as staffing and hours. Analysis suggested that the more active CPUs tended to have more of the following characteristics: being ‘primed’ by previous initiative or experience; appropriate leadership; a positive climate for innovation; established relationships between key staff/departments; role clarity amongst staff; an enthusiast for the development; and continuity of staffing. Role conflict, particularly between specialist nurses and others, was reported and had potential to interfere with development.
Organisational factors were identified that could have impacted on the outcomes of the ESCAPE trial through, for example, delays in discharge, and missed recruitment opportunities. Complex interventions such as the ESCAPE trial are prone to the effects of local organisational issues, some of which could be predicted and planned for. Findings from single centre studies of complex interventions should be treated with caution before a decision is taken to implement in a new setting.
The authors previously described an acoustic cardiographic model that predicted echocardiographic correlates of elevated left ventricular (LV) filling pressure. This study evaluated this bedside acoustic cardiographic model against invasive measurements of LV filling pressure.
Data were prospectively obtained from 68 adults referred for right heart catheterisation. Acoustic cardiographic measurements were obtained during right heart catheterisation. Elevated LV filling pressure was defined as a pulmonary capillary wedge pressure (PCWP) ≥15 mm Hg. Parameters generated from a previous dataset used for the current analysis were measures of LV systolic time, maximum negative area of the P wave, QTc interval and third heart sound (S3) score. Logistic regression was used to calculate area under the curve (AUC). Of the 66 patients included, 39 had elevated PCWP. Estimating the probability of an elevated PCWP from the derived model resulted in an AUC of 0.72 (95% CI 0.60 to 0.85). When the regression model's parameters were held constant but the parameter estimates were allowed to vary, the AUC in the validated model was 0.76 (95% CI 0.64 to 0.88). At a specificity of 90% the positive likelihood ratio (LR+) was 5.0 (1.7 to 15.3) and the negative likelihood ratio was 0.49 (0.34 to 0.71).
These data demonstrate that the four-variable model predicts elevated filling pressure at the bedside with high specificity and an intermediate LR+. With improvements in sensitivity and further prospective validation of this model in a cohort of emergency department patients with undifferentiated dyspnoea this may be a useful bedside diagnostic modality.
Patients aged 65 years or older account for a growing proportion of emergency department (ED) repeat attendances. This study aimed to identify health and non-health factors associated with repeat ED attendance, defined as one or more visits in the previous 6 months in patients aged 65 years or older, and to examine the interaction between social and health factors.
306 patients were interviewed. Demographic, socioeconomic, physical, mental health and post-ED referrals were examined. Logistic regression was used to identify factors independently associated with a repeat ED visit, OR and 95% CI are presented. Log likelihood ratio tests were used to test for interactions.
ED revisits were reported by 37% of this elderly population. Independent risk factors for a repeat ED visit were previous hospital admission OR 3.78 (95% CI 2.53 to 5.65), anxiety OR 1.13 (95% CI 1.04 to 1.22), being part of a vulnerable social network OR 2.32 (95% CI 1.12 to 4.81), whereas a unit increase in physical inability as measured by the Nottingham Health Profile had a week association OR 1.01 (95% CI 1.00 to 1.02). There were no significant interactions between social networks and the other health-related variables (p>0.05). In patients directly discharged from ED, 48% (71/148) had no documented referrals made to community services, of which 18% (27/148) were repeat ED attendees.
ED act as an important safety net for older people regardless of economic or demographic backgrounds. Appropriate assessment and referral are an essential part of this safety role.
The alcohol Licensing Act (2003) was introduced to England and Wales on 23 November 2005. A single-centre study in 2007 from St Thomas's Hospital concluded that their alcohol-related attendances had significantly increased after the implementation of this new Act. This study aimed to assess whether this finding was reproduced in other hospitals.
A retrospective cohort study, reviewing anonymised routine data from four emergency departments (ED) in South Yorkshire, was undertaken. The study population was adults (over the age of 18 years) attending the ED with injuries or illnesses directly related to alcohol in the 12 months before and after the implementation of the Licensing Act (2003). The primary outcome was the number of these alcohol-related attendances. Secondary outcomes assessed whether there was any change in the timing of these presentations.
Alcohol-related attendances, as detected by clinical coding, increased from 0.6% to 0.7% as a proportion of all attendances (95% CI 0.1 to 0.2, p<0.001). They increased by 0.4% at the Northern General Hospital and by 0.1% at Barnsley Hospital, decreased by 0.2% at Doncaster Royal Infirmary and did not significantly change at Rotherham General Hospital. The secondary outcome showed an unaltered peak time of 01:00 hours for alcohol-related attendances.
Trends in alcohol-related attendances after the implementation of the Licensing Act (2003) varied across South Yorkshire hospitals and probably reflect local factors rather than any consistent impact from the Act.
Prehospital care of trauma patients is a matter of great debate. The optimal transport method remains undecided, with conflicting data comparing helicopter and ground emergency medical transfer. This study systematically reviews the evidence comparing helicopter and ground transfer of trauma patients from the scene of injury.
A systematic literature review of all population-based studies evaluating the impact on mortality of helicopter transfer of trauma patients from the scene of injury. We searched MEDLINE, CINAHL and EMBASE from January 1980 to December 2008 and selected and reviewed potentially relevant studies.
A search of the literature revealed 23 eligible studies. 14 of these studies demonstrated a significant improvement in trauma patient mortality when transported by helicopter from the scene. 5 of the 23 studies were of level II evidence with the remainder being of level III evidence. Data were then entered into an evidence table and reference made to transport staffing, intubation rate, time at scene and time/distance of transfer.
The role and structure of HEMS in a modern trauma service is a debate that is likely to continue. Prehospital care design should be specific to critical incident frequency, geographical arrangements of hospital facilities and travel times within each trauma network. It is also important to consider the benefits and capabilities of the emergency medical team separately from the transport method being considered. An effective helicopter EMS will ultimately depend on effective operating procedures and tasking protocols, clinical governance, and auditing of the helicopter EMS activity.
Recently, attempts have been made to identify the utility of ultrasound in the management of patients in the prehospital setting. However, in the UK there is no directly relevant supporting evidence that prehospital ultrasound may reduce patient mortality and morbidity. The evidence available to inform this debate is almost entirely obtained from outside the UK, where emergency medical services (EMS) routinely use doctors as part of their model of service delivery. Using a structured review of the literature available, this paper examines the evidence to determine ‘Is there a place for paramedic ultrasound in the management of patients in the prehospital setting?’
A structured review of the literature to identify clinical trials which examined the use of ultrasound by non-physicians in the prehospital setting.
Four resources were identified with sufficient methodological rigour to accurately inform the research question.
The theoretical concept that paramedic-initiated prehospital ultrasound may be of benefit in the management of critically ill patients is not without logical conceptual reason. Studies to date have demonstrated that with the right education and mentorship, some paramedic groups are able to obtain ultrasound images of sufficient quality to positively identify catastrophic pathologies found in critically ill patients. More research is required to demonstrate that these findings are transferable to the infrastructure of the UK EMS, and in what capacity they may be used to help facilitate optimal patient outcomes.
Exposure to traumatic stressors is potentially an integral part of the job for emergency medical services (EMS) personnel, placing them at risk for psychological distress and mental health problems.
The prevalence of post-traumatic stress disorder (PTSD) and post-traumatic stress symptoms was examined in a sample of EMS personnel in a multiethnic locality in Hawaii. Commonly encountered traumatic incidents at work were also assessed.
The PTSD Check List-Civilian version was sent to 220 EMS personnel. The survey included questions on demographics, traumatic incidents at work, general stressors, coping methods and post-traumatic stress symptoms.
105 surveys were returned (48% response rate); 4% of respondents met clinical diagnostic criteria for PTSD, 1% met subclinical criteria for PTSD, 83% reported experiencing some symptoms but no PTSD and 12% had no symptoms. However, few had received treatment for these symptoms. Serious injury or death of a co-worker along with incidents involving children were considered very stressful. General work conditions also contributed to the overall stress levels. Most common coping strategies reported were positive reinterpretation (63%), seeking family and social support (59%) and awareness and venting of emotions (46%), with significant differences by ethnicity.
EMS personnel are at high risk of experiencing post-traumatic stress symptoms. Early identification and treatment of potential stressors, psychiatric and medical problems is warranted and necessitates ongoing assessment and employee assistance programmes at the minimum.
To evaluate the use, success rate and time in the paediatric emergency department when employing the kissing technique to remove nasal foreign bodies from children.
The present work was a retrospective case note review for children attending with a nasal foreign body over a 15-month period.
In all, 116 children had a confirmed nasal foreign body and 84 were treated by the kissing technique with a success rate of 48.8%. This group had lower rates of instrumentation (20.2% vs 53.1%) and general anaesthesia (11.9% vs 18.8%). The average time saved per patient who had the kissing technique attempted in the paediatric emergency department was 30.6 min.
The kissing technique should be employed as a preferred technique to remove nasal foreign bodies in children.
A 2-year-old girl was brought to the Emergency Department having collapsed at home. She was unconscious and apnoeic with a sinus bradycardia of 50 beats/min. Cardiopulonary resuscitation (CPR) was commenced and her airway was secured. Epinephrine and atropine were administered. The blood glucose was found to be <0.5 mmol/l. There were minimal ketones found in both urine and serum. A bolus of 5 ml/kg of 10% dextrose was administered. Following a third cycle of CPR, a strong pulse was palpated with a sinus tachycardia. Subsequent metabolic screening tests confirmed a diagnosis of medium chain acyl-CoA dehydrogenase (MCAD) deficiency. Despite the higher prevalence of hypoglycaemia in children requiring non-trauma-related resuscitation care, there is significant variability in time to checking blood glucose. In any clinical situation necessitating fatty acid oxidation, such as periods of fasting or metabolic stress due to intercurrent illness or infection, patients with MCAD deficiency will have continued glucose consumption with reduced or absent formation of ketones. The result of this is severe hypoglycaemia and hypoketonuria. 18% of patients with MCAD deficiency present with sudden death, and total mortality rate before diagnosis is estimated at 24%. Without diagnosis, preventative interventions to avoid further metabolic decompensation and possible neurological involvement could not be made.
An 89-year-old woman presented with a stable fracture of the pelvis following a low energy trauma. The patient was taking no anticoagulation medication and was found to have life-threatening pelvic bleeding which required embolisation. Stable pelvic fractures following low energy trauma are common injuries in the elderly and frequently require admission for pain relief and mobility management. This case highlights that severe pelvic bleeding is a possible, life-threatening sequela after low energy pelvic injury in the elderly, and careful attention must be paid to the signs of active haemorrhage.
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