Why does amenorrhea occur in female athletes? The theory is that the emotional and physical stress of intense training causes a reduction in the release of a hormone called GnRH from a gland called the hypothalamus. This leads to a reduction in the release of hormones from the pituitary gland, which in turn lowers the ovaries’ production of the female hormone estrogen. This hormone imbalance causes periods to stop and it is the lack of estrogen — called a hypoestrogenic state — that leads to osteoporosis. That’s similar to the hypoestrogenic state and osteoporosis women can get after menopause (when they stop getting their periods).

Don’t forget that amenorrhea can also occur in girls who have eating disorders, who are not necessarily doing a lot of exercise or physical activity.

So why do some female athletes ignore the fact that they are not getting their periods? A few reasons may be:

The athlete may have been incorrectly told that not getting her periods is a sign of adequate training intensity and is something to be desired. This is a myth since amenorrhea is neither a desired consequence nor a necessary result of physical training.

Some women may be glad not to have the inconvenience of menstruating. Think of what’s more important — the inconvenience of menstruating or the thinning and premature aging of your bones — and it should be easy to decide which is better.

Female athletes and their coaches, trainers and parents may just not know that amenorrhea is an important sign that requires medical evaluation within three months of its occurrence.

Amenorrhea is the most recognizable symptom of the female athlete triad. Girls most at risk for amenorrhea are those who start training at an early age, undergo the most intense training, eat the fewest calories, and have the lowest body weight.

The percentage of athletes with amenorrhea varies from 3 percent to 66 percent. Compare that with the prevalence of amenorrhea in the general female population, which is about 2 percent to 5 percent.

Exercise-associated amenorrhea is a diagnosis of exclusion. That means that if a female athlete is not starting her periods on time, or her periods stop, her doctor needs to check her for other medical disorders and pregnancy, if she is sexually active.

Another concern about amenorrhea is that the return of normal periods (and regular ovulation or releasing of eggs by the ovaries) can be unpredictable. There is no good long-term data on the success rate of lifestyle changes or treatment for reversing amenorrhea and improving bone mineral density.

You understand from experience that sexual dysfunction can ruin a relations, but there are safe, effective, strong premature ejaculation treatment in our time! PE is the most widespread type of sex problem in men younger than forty years.

Specific, partialized goal-setting is a good example. Study after study has demonstrated that when individuals set long-term goals, and are shown how to divide them into short-term goals that focus on manageable but challenging quests, adherence goes up. It is not important whether the trainer or exerciser actually establishes the specific goal and the time frame for its accomplishment, only that the participant fully accept the goal. The use of a performance contract, in which the exercise professional and participant formally commit (in writing) to maintain a certain level of exercise also has proven to raise adherence.

To complement and strengthen commitment to a goal, and reinforce regular exercise, an adequate feedback scheme is useful. The provision of performance feedback has been strongly associated with increased adherence. When an exerciser can see incremental gains, and/or acknowledge that a day’s exercise has been completed, a small reinforcer comes into play that strengthens the exercise behavior. While well-designed tracking cards are good for performance records and personal exercise feedback, computerized tracking systems are now available to accomplish this task automatically. These interactive fitness networks “attach” to exercise equipment and provide detailed feedback to be delivered to the participant during and after an exercise session, as well as to a professional on a client’ s behalf. Research indicates that it is beneficial to link long-term goals to short-term goals to a specific plan of action (individualized workout prescription) to performance feedback, for increased retention success. It is important to realize that these techniques don’t simply make a client feel welcome. They provide means for them to successfully adapt to the exercise experience.

A considerable amount of data is available concerning an exercise prescription’s effect on client adherence. Many well-credentialed organizations provide exercise leaders with important physiological information on how to provide an individualized workout prescription. However, little attention is usually given to the psychological components of exercise, which is where great retention gains can be made.

For instance, we know that as the length of an exercise session increases, adherence goes down. When clients can choose their preferred level of intensity, adherence rises.

Many well-meaning trainers consider a workout prescription adequate only if it causes rapid improvement in cardiovascular efficiency and/or strength. The truth, however, is that many new clients at risk for dropout often cannot tolerate this intensity. If exercise professionals can be taught to be sensitive to clients’ initial feelings about their workout length, frequency and intensity, they will be most helpful in promoting the exercise habit. When building exercise into an improved lifestyle is the goal, quick improvements should not be sought over slow, consistent, tolerable gains.

The four-facility company created a foundation to assist needy women and children by building a fitness center in the disadvantaged Dorchester, Mass., area. At this women’s shelter, both women and children can use fitness equipment, group exercise rooms and fitness services for free. Healthworks donates money to the cause; its members and staff also contribute.

The Claremont Club.The Claremont Club, Calif., also gives back to its community. It started by donating 228 new pairs of tennis shoes to financially disadvantaged children in the local school district.

Later, it provided 66 scholarships for summer camps for disadvantaged youth, and they have now allocated 106 slots for this summer. Over the years, the local school district has been the beneficiary of a constant flow of used and reconditioned fitness equipment.

The Claremont Club also provides up to 50 full membership scholarships to those in the community suffering from serious illness, and to those in families who have suffered recent deaths to parents.

Twelve needy youths with talent in tennis and swimming are provided scholarships. And all 200 staff each made a difference in the community last winter holiday season; some “adopted” families through the Red Cross, fire or police departments or churches, and the facility’s day spa staff provided complimentary services to the homeless.

Moreover, the Claremont Club has continued membership privileges with any current member who is suffering financially and cannot pay the normal dues.

Gold’s Gym. A four-club Gold’s Gym franchise has contributed to more than 21 different causes, including the Boys and Girls Clubs; the American Heart Association; the local Children’s Hospital; local elementary, middle and high schools; Against Drunk Driving;a local orphanage; breast cancer awareness; and minority and gay/lesbian non-profit organizations.

When women come to me for ultrasounds, they are often surprised to hear that they have a small, perhaps walnut-sized fibroid. The hormones of pregnancy encourage fibroids to grow, so what was too small to notice before pregnancy might become visible on an ultrasound during pregnancy.

If you have fibroids during your pregnancy, there are some things to consider. Fibroid tumors can be a problem if:

The tumor is so big that it compresses the baby, which is rare.

It’s under the placenta and restricts blood flow to the placenta, which is not common.

It is large (the size of a softball or grapefruit) and located low enough in the uterus that it is blocking the birth canal, which is also not common.

Sometimes, what is thought to be a fibroid is really a localized contraction of the muscle that goes away by itself. When having an ultrasound, you should be sure that the scan goes on for a few minutes to see whether the muscle contraction resolves itself or whether what’s seen on the scan is a true fibroid.

Sometimes fibroids cause pain if the tumor grows faster than its blood supply. The treatment is pain medication, including Tylenol, codeine or Demerol. Of course, never take aspirin, Motrin, ibuprofen or other related medications when you’re pregnant, even though they are what we usually use outside of pregnancy for this kind of pain.

If you have had surgery to remove a fibroid tumor, it’s important for your doctor to know how it was done. If the tumor was on a stalk and simply cut, the fibroid is generally not an issue in the pregnancy or delivery. However, if the muscle of the uterus was cut, then you will need to be delivered by Caesarean section because there is a risk of the uterus rupturing in labor.

Fibroids rarely cause infertility, although the surgery to remove them can leave scars on the pelvis that can interfere with normal conception.

What’s the bottom line? If you know that you have fibroids, they may grow, but usually are not a major problem in pregnancy. If you need surgery for fibroids, have it done before you get pregnant. Surgery for most fibroids is not a good idea during pregnancy, and due to the high volume of blood flow to the pregnant uterus, we also don’t like to take them out during Caesarean sections.

(This next part I got from the previews…)
Ken: “You’ve got some set of balls today to approach me with this…”
Robb: “Don’t f’ing try to tell me I’m doing something that I’m not. I’m not f’ing stupid.”

Ken: “Oh yeah! Well I can f’ing say the F-word more times than you, f’er.”
Robb: “Dude, you’re such an f’ing f’er. I mean, f. You come here acting like some New York f’ing City policeman and I’m f’ing tired of it.”
Ken: “Ok ok! You win! That was a lot of F-words. You still suck, though.”
Robb: “Do not!”
Ken: “Do too!”
Robb: “Not.”
Ken: “So.”

Finally, Shii Ann zaps Penny with an “I’m actually going to speak to someone other than the cameras and in a mildly raised voice” spell. Penny says, “Hey, you f’ers. Shut the F up.”

Ken: “Whoa, Penny just said F.”
Robb: “Dude, you’re right.”

The Search for Betsy
Team Church Social still haven’t found their boat so they still have to swim over to get water. This sucks for them so the guys decide to swim off to explore some of the smaller islands in hopes of finding “Old Betsy.” As they swim along, Clay wonders aloud, “Do you think if we killed Jan and offered her up to the ocean gods we would get our boat back?” The guys decide that a Jan sacrifice, being that she’s as old as she is and a little loopy to boot, would only result in finding their boat smashed up against some rocks.

“Too bad Tanya isn’t here. She’d be an awesome sacrifice. She was a hottie.”

“Speaking of hotties,” Ted continues. “I had a dream last night that I was with my wife for the first time in months.”

Clay looks strangely towards Ted, “That’s weird, I dreamed a big black man grabbed me in the middle of the night and spooned me and grinded into me but since I was so small I couldn’t get away and so I just let him bite my neck and play with my hair.”

Brian gets a soft-core flashback where he starred in the movie, “The Green 10 Inch Mile: A moving story about a huge, loving black man and his death row prison bitch.”

They swim along, troubled by their thoughts.

With the fatal disease attacking his breathing and heart muscles, Eric’s only hope was to be accepted into a treatment study, thereby becoming eligible to receive a promising experimental drug. In the experimental treatment for Pompe disease, missing enzymes are administered to restore the muscles’ glycogen levels to normal.

There was not, however, enough medicine available to allow Eric to enter the study. The tragedy of this boy’s death reminds us that the development of new medical treatments should be encouraged and expanded.

An estimated 20 million Americans have any of more than 6,000 rare disorders, such as Pompe disease, and more familiar illnesses, such as sickle cell anemia, hemophilia and cystic fibrosis. Because each of these diseases affects fewer than 200,000 people in the United States, drug companies often ignored them. These illnesses, therefore, received the name “orphan diseases.”

To stimulate research in the area of orphan diseases, the government passed the Orphan Drug Act of 1983, which gave incentives to companies working on treatments for rare diseases. Since bringing a new prescription drug to market can take years and many millions of dollars, financial incentives are essential to the many smaller drug companies that develop these treatments.

Granting exclusive marketing rights for seven years to the company that first develops the orphan drug is another key enticement. This is very important because many orphan drugs are either natural substances that cannot be patented or older products that no longer have patent protection.

Orphan drug incentives have helped the development of approximately 200 new drug treatments in the past 16 years, compared to less than 10 orphan drug treatments developed in the decade before the Orphan Drug Act.

Even after new orphan cheap drugs are approved for use, they may not be immediately available to all patients. The drugs are often developed by smaller companies with limited manufacturing capabilities. As noted by Abby Meyers, president of the National Organization for Rare Disorders, “Patients had to initially enter a lottery to obtain new drugs for treating Lou Gehrig’s disease, as well as for one type of multiple sclerosis.”

The tragedy of Eric’s death reminds us that good programs like the Orphan Drug Act need to be supported and expanded to bring medicines more quickly to a greater number of patients. People should not have to play the “health treatment lottery” to receive life-saving remedies. Major pharmaceutical companies should increase their participation in the upbringing of our orphan drugs.

Table 1 shows an example of the predicted number of calories for individuals of different weights and different sliding rates on 5- and 6-foot boards. This table shows a similar exercise intensity when the sliding rate was set at 40 slides per minute on a 5-foot board, compared to 30 slides per minute on a 6-foot board. A similar energy cost was also found for sliding on a 5-foot board at 50 slides per minute, compared to a 6-foot board at 40 slides per minute.

By increasing the sliding rate on a shorter board, the same relative exercise intensity can be obtained as when sliding on a longer board at a slower sliding rate. These data indicate that subjects can vary their workout by manipulating either sliding rate or board length.

Another way to estimate the number of calories expended during slide board exercise is to use the nomogram shown in Figures 1 and 2. Select the chart for the appropriate board length. Then find the weight in pounds on the left axis and the music speed on the right axis. Draw a straight line from the music speed to the weight, and where that line intersects, the Kcal/min axis is the estimated number of calories expended per minute. These figures are based upon subjects of average fitness level performing the standard slide technique. The number of calories may vary depending upon the fitness level of the subjects and their ability to perform the sliding exercise. The nomograms provide an estimate of the number of calories expended per minute while performing slide board exercise.

1. Construction

Total market: $1.7 trillion
Net share: $3.4 billion
Net share in 2003: $28.6 billion
of a $2.1 trillion market

The construction industry is often thwarted by hurdles as low-tech as rain. But it doesn’t stop there. Mired in organizational malaise — daily collaboration among hundreds of contractors, engineers, and architects; mounds of paperwork behind each transaction — the industry is ripe for streamlining by the Internet. But so far, the Web’s claim to the market is nominal. Says Forrester Research analyst Matthew Sanders: “We’re just cracking the surface.”

Count among the trailblazers BuildPoint.com, which specializes in a bid management and procurement marketplace, and which has generated more than $1 billion worth of subcontracts in less than three months. Players such as Bidcom, Bricsnet.com, and Cephren have collaboration tools that track project specs, cutting costs and reducing errors in work flow. Other online tools in the works: blueprint editors, Web-cams that show still-shots of the construction site, and automatic email notices when a project has been changed or updated. The multifold benefits include vastly greater efficiency, reduced procurement costs, and less communication runaround. If the industry takes advantage of shipping marketplaces such as GoCargo.com, which auctions off excess space on barges, the savings could mount.

Thank to the international calling cards, you will save fund, since you may simply check your bill.

As you can see, a little effort and creativity can go a long way in providing your members with a wide variety of fun, useful and inexpensive services. Try any or all of these suggestions, and watch and listen for your members’ responses. I think you’ll be pleased.

Special events are another form of member services that you can use to entertain, educate and retain members. Organizing social gatherings, trips and educational opportunities are outstanding ways to increase member and staff loyalty and motivation. Here are some fun examples of special events for all ages:

* Daddy/daughter date night. This fun and heartwarming event is designed for dads and their daughters (ages 5 to 15). Dress for the evening is formal and events include a “happy hour” consisting of “Shirley Temples” and crackers, dinner and after-dinner dancing. Daughters are given a chocolate rose and stuffed animal while a photographer is available for pictures. This is a wonderful event that has been successful at a number of family fitness facilities.

* Traffic safety day. This event is designed to entertain and educate children on matters of traffic safety and smart bicycle riding. Refreshments are available, and appearances by local police and fire department personnel, as well as local university mascots, help make this a great children’s event.

* Writer’s nights. Try holding a local “writers night” for up-and-coming musicians and songwriters. Work with a local eatery to sponsor the event, or use any members who may have musical aspirations and goals. Have the event outside by the pool, provide refreshments and let your members spend a beautiful weekend evening enjoying great music. It’s a lot of fun for members and staff.

These and other special events, like cooking demonstrations, theater nights, holiday parties and golf outings, go a long way in making your facility more than just a place for members to work out. Your facility becomes a substantive part of their social, family and entertainment spectrum. By doing so, your members develop a sense of family, belonging and worth, and their likelihood of leaving is greatly diminished.

This can be done by calling the city’s Chamber of Commerce (if you do not have a reciprocal agreement through a club association). After a while, you will create your own database of fitness facilities and their locations. In addition to these examples, there are many more fun and inexpensive services that facilities and operations of all sizes can offer members. Here are just a few:

* Set out a bowl of fruit (bananas, apples, oranges, pears) in the lobby or at the front desk where members have easy access to it. This is an inexpensive (a case of bananas is under $20) but very popular way to help your members eat right and stay healthy.

* Once a month, or on holidays, offer free valet parking. However, make sure to review your insurance liabilities before you offer this one.

*Offer a physician or hospital referral service for members who are new to town. You may want to work with current members of your facility who are physicians or with your local hospital. Prepare a listing of physician and medical facilities in your area and include listings for most specialties: orthopedics, cardiology, general practice. Also, while you’re at it, attempt to develop a medical advisory board for your facility. This board can assist you in many areas of your fitness operation.

* Occasionally hold a complimentary or charitable car wash for your members. As members work out in your facility, have a group of staff members wash their cars. Have a specific department (fitness, aquatics, etc.) be responsible for a time to staff the event. You may want to have a container for “contributions” that your members will want to make for your efforts. Advertise and give this money to a favorite charity. This event is great for your facility, your members and the community.

* From time to time, offer a free “breakfast bar” for early-rising members who work out before going to work. Have bagels, muffins, fruit, yogurt, decaf coffee and juice. Your members will love you for this and get a healthy start to their day, as well.

The next two examples will cost your facility some up-front money but the returns can be great:

* Provide close-captioning for all televisions located in your fitness or exercise centers. This service has two main benefits. While providing a service for deaf members, it also assists other members who enjoy watching television while working out but are unable to hear the sound over the noise of the club.

* Begin an exercise logging program for all your members. This can be done with cards that your members can record on or, more simply, by recording the information into a computer with a special program for the task. At the end of each month, a summary of all activities can be totaled and presented to the member. This is a great motivational tool for members and a useful retention tool for staff.