Last Thursday, Florida health officials and the CDC reported a case of inhalation anthrax in 63-year-old Robert Stevens, who worked at American Media, Inc, in Boca Raton.

Two day later, Stevens died, representing the first such death in the United States since 1976.

Two individuals who worked at the same building as Stevens–a 73-year-old man and, more recently, a 35-year-old woman–have also tested positive for anthrax exposure in nasal swabs, although they do not appear to have the actual disease.

“The third exposure in the woman was found through a nasal swab done during the screening of all the workers and visitors to the AMI building,” CDC spokeswoman Barbara Reynolds told Reuters Health. “She is healthy and was not reporting any early symptoms of anthrax,” she added.

In conjunction with the CDC, Florida Health agencies have initiated an investigation to identify how the exposures occurred, CDC researchers note in the October 12th issue of the agency’s Morbidity and Mortality Weekly Report.

They are also in the process of identifying how many other infections may have occurred.

Reynolds said the CDC has 15 investigators at the scene in Florida.

The Palm Beach County Health Department is offering antibiotics to persons who might have been in the building for at least one hour since August 1.

“The investigation is ongoing, and we will continue to do the epidemiologic investigation that would help us look for any additional exposures,” Reynolds said.

“It is really important for people to know that the disease cannot be transmitted from person to person,” she stressed.

Reynolds also wanted people who visited or worked in the AMI building to understand that just because a nasal swab comes back negative, that does not necessarily mean the person escaped exposure.

“That means that all the people to whom we provided antibiotics should continue to take antibiotics for the entire 60 days,” she said.

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Recruit physician support of the health and fitness program. Perhaps the single most important factor determining participation in exercise is a strong recommendation from their primary care physician. Basic physician counseling has also been shown to be highly effective in motivating individuals to make other significant lifestyle changes (e.g., smoking cessation).

Provide exercise facilities and locker rooms that are appropriately maintained. The cleanliness of the equipment and facilities is critical to most participants. Fortunately, achieving this is easily within reach of most health/fitness facilities. For example, bright lights, light-colored walls and bright carpets all suggest a clean environment. In addition, a facility should have a satisfactory ventilation system and appropriate control over temperature and humidity. Regular maintenance and calibration of all exercise equipment should be standard practice.

Clarify individual needs to establish the intrinsic motive to exercise. An initial semi-structured interview allows staff to determine exactly what the participant hopes to gain from an exercise program. During this interview, the fitness professional should clarify the individual’s needs and expectations, and establish a personalized schedule to monitor progress and reassess goals.

Emphasize short-term goals. Goal setting should be viewed much like climbing a ladder, with an emphasis placed on reasonable distances between rungs. Individuals should be oriented toward short-term objectives that are specific, clearly defined and realistically attainable. The key is to draw the participants’ focus to intermediate goals, rather than the final objective.

Minimize injury/complications with a mild-to-moderate exercise prescription. Oftentimes, novice exercisers who increase their activity dosage too abruptly become discouraged with their physical conditioning regimen due to either muscular soreness or orthopedic injury. Using an Exercise Prescription Form (Figure 1) is an ideal way to ensure your recommendations to the participant are understood and followed. Excessive intensity (> 90 percent VO2max), frequency („ five days/week) or duration („ 45 minutes/session) of training offer the participant little additional gain in aerobic capacity (VO2max), yet the incidence of orthopedic injury increases substantially. A recommended prescription for individuals who are beginning an exercise program is to accumulate 30 or more minutes of exercise every other day, at a perceived exertion level of 11 to 13 (“fairly light” to “somewhat hard”).

Recent research has shown similar training effects in subjects who completed three 10-minute bouts of moderate-intensity exercise per day versus those who performed one continuous exercise bout of 30 minutes. In addition, warming up before exercising, wearing proper walking or running shoes while working out, and training on appropriate terrain (i.e., avoiding hard and uneven surfaces) should help minimize dropout rates due to injury. Finally, participants should be counseled to discontinue exercising and seek medical advice if they experience warning signs or symptoms of exertional intolerance, including abnormal heart rhythms (palpitations), chest pain or pressure, or dizziness.

Encourage group participation. Group commitments tend to be stronger than those made individually. Often, the encouragement of a group can provide an individual with the incentive to continue exercising during periods of decreasing interest. Diminished levels of long-term adherence have been reported in programs where an individual exercises alone, compared to those that incorporate group dynamics. Most people (approximately 90 percent) prefer group, as opposed to individual, exercise. Social reinforcement through camaraderie and companionship are potent motivators related to increased exercise adherence.

Emphasize fun and variety in the exercise program. The type of exercise program also has been shown to influence long-term exercise adherence. For example, regimented calisthenics often become monotonous and boring, leading to poor exercise adherence. Another example of the negative effect a monotonous exercise routine can have on adherence involves individuals who purchase stationary exercise cycles for home use.

Despite their initial enthusiasm for working out, many of these individuals quickly become exercise dropouts. Exercise conditioning regimens that offer the greatest variety and enjoyment are usually those that are most successful.

Employ periodic fitness testing to assess participant response to the training program. Favorable physiologic adaptations to chronic endurance exercise include decreased heart rate, blood pressure and perceived exertion during submaximal exercise, increased physical work capacity and VO2max, reduced body weight and fat stores, and an improved serum lipid/lipoprotein profile. Such changes are powerful motivators that can produce renewed enthusiasm and dedication. Fortunately, each factor can readily be assessed, given the proper testing equipment.

The fact is, commercial fitness facilities support their community in many ways: By contributing to disease charities and their local branches.

Supporting school system initiatives and local fire and police needs; honoring local citizens; and raising money for children’s and other organizations, to name just a few.

One club I owned years ago supported 23 different charities and non-profits. This community outreach was separate from the donated memberships to specific families with hardships, and free programs to needy children.

Welcome to Four Get Fit! You’ve been very candid about your past efforts to get fit. As you admitted, it’s one thing to start a fitness program, and it’s something else to stick with one! Our goal for you is to establish an exercise plan that you can adopt for life. It is meant to be a permanent part of your lifestyle, not just a temporary project.

We do this by first designing a regimen that suits your needs and interests. That’s my job. You have to do the regimen and report back to me each week with how things are going. Then, I give you feedback that will help motivate you to keep with the program. The toughest part falls on your shoulders, but the rewards are all for you to claim. If you stay focused on your goal of losing weight and feeling good, you can find the motivation to exercise regularly.

Enhanced fitness creates many benefits beyond feeling better and managing weight. It will give you more energy, heighten productivity, and help you perform everyday activities with greater ease. As you start to feel better, you will be more inclined to eat healthy. Exercise has a ripple effect that improves all aspects of your life.

Are you ready, Michelle? Then, let’s go!

Cardiovascular Exercise
Cardiovascular exercise is your top priority since it increases caloric expenditure, reduces body fat and helps you feel better overall.
Type — Walking and kickboxing. Mix up your activities so that you are doing one day of jogging and another day of rowing. You can also do both activities within one session. The variety will help with motivation and give your body different challenges. This will help produce results faster.

Frequency — Walking two times per week and kickboxing once per week.

Amount — 30 to 45 minutes per session. Begin with 15- to 20-minute sessions at the beginning of your program. As you progress, add a couple of minutes each week until you are doing 45 minutes of continuous activity per session.

Intensity — Perform at an intensity that elevates your heart rate to between 136 and 162 beats per minute. Most importantly, you must be comfortable. I don’t want you out of breath! Go at a pace that allows you to carry on a conversation.

Warm up and cool down — Start exercising gradually to warm up the muscles prior to your workout. After your workout, gradually decrease the pace to cool down the body. Never start or stop exercising abruptly.

Flexibility Exercises
At the end of every cardiovascular session (after your abdominal curls), perform the Basic 10 Stretches, which can be found in thedrkoop.com Fitness Center. Stretching is great for relaxation and improved posture, as well as increased flexibility and injury prevention. The stretches will also minimize muscle soreness. Because they are so important to your program, be sure to include the stretches in every workout.

Do not bounce when you stretch. Hold each stretch for 10 to 30 seconds, to the point of mild discomfort. The muscles should be stretched so that the pull is felt in the center of the muscle, not at the joints. Take it slow, relaxing and exhaling as you go into a stretch, and then breathing normally.

I look forward to hearing from you next week, Michelle. Be sure to be as detailed as possible with your exercise log and feel free to ask any questions you may have regarding fitness.

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The restaurant changed the hours of its hot food service from the previous times of 11 a.m. to 8 p.m., to two new serving intervals: 11 a.m. to 2 p.m., and 5 p.m. to 8 p.m. The new hours create peak times for the restaurant and improve the quality of the food by keeping it fresher, with a better appearance. The change also serves to reinforce Cooper’s mission statement, which states that the center will “uphold the reputation of the Cooper Fitness Center as a world class leader, and provide an environment and level of service that nurtures the pursuit of personal wellness.”

The recipes for Tyler’s lunch and dinner menus are created through a collaboration between Juan Cerrillo, Tyler’s executive chef, and Georgia Kostas, director of nutrition and author of The Guilt-Free Comfort Food Cookbook. Many of the recipes offer a winning combination of fresh vegetables, fruits, whole grains, beans, low-fat meat and dairy products.

The new menus are cycled over four weeks, so that the restaurant can provide a fresh selection of healthy flavor-rich food. At the request of members who wanted healthy comfort foods, states Lenny Athens, director of restaurant services, the restaurant created daily hot plates featuring a healthy, hot entree, freshly steamed vegetables and a wheat roll.

Examples of the new hot entrees at Tyler’s are grilled chicken with sunshine sauce, served with fettuccini pasta, carrots and fresh snap peas; Kempenci fish with vera cruz sauce, served with roasted new potatoes and brussel sprouts; veggie burgers, served with baked chips, cold celery and carrot sticks; chicken enchiladas, served with rice, refried beans and corn; parmesan broiled fish, served with rice, mixed vegetables and brussel sprouts; spinach manicotti, served with baked squash, peas, onions and red cabbage; and meatloaf, served with squash, steamed zucchini and garlic potatoes. The chef prepares the meals using healthy methods and a creative use of herbs and spices. The hot plate entrees are served six days a week.

In addition to offering members and guests hot, healthy meals, another benefit of the new menu plan is that it helps to reduce food costs, explains Brett Myers, former food and beverage director. “The new menu and hours increased customer satisfaction through more presentable food [served] in a high-quality manner. The food costs were dramatically less as well. [During] the first four months of 2000, the cost of food for the special averaged $9,780 per month. After the new menu and hours were implemented on May 1st, the average cost for two months decreased 35 percent to $6,333.” Myers further notes that the “reduction of food costs, without [a] decrease [in] quality or service, has contributed to a better overall financial report.”

The new hours and new menu also help to alleviate safety concerns. According to Myers, “Maintaining a hot food line for nine hours presented food safety concerns and [created] a poor [food] appearance. The new special hours not only alleviate safety concerns, but also present the customer with a safer and fresher product.”

Tyler’s Restaurant at Cooper provides members with a tasty strategy for eating fresh, healthy foods. The new hours and menu also benefitted the restaurant’s business by streamlining operations and increasing revenue. Tyler’s new menu and hours havesuccessfully promoted sensible and healthful eating in keeping with Cooper’s health-conscious philosophy.

Valley Fitness Center offers periodic incentive programs, including its Holiday Cash Bash to keep members coming in during the holiday season. Members earn “Holiday Dollars” by going to group exercise classes, attending educationalclasses on topics such as holiday recipe modification, donating food to the local food bank (there is a barrel in the lobby for food donations) and other activities. They then turn in their “Dollars” for prizes such as water bottles, massage certificates and more.

Of course, there is much more to good customer service, and much more to retention, but you need to figure out what works for your fitness center.

Find out what your members want, treat them as individuals, give them value for their memberships, offer incentives and provide an excellent and friendly staff. As Abbott says, “Abuilding with equipment inside of it can sell a membership, but customer service is the key [if you want your members] to stay.”

Maybe they’re building a site related to a hobby, or they’re trying to launch a dot-com in their spare time.

Many of them are using free facilities, such as GeoCities or others, to host these sites. And yet they end up with absolutely ugly and unwieldy Web addresses (http://www.webaddress.com!bobsplace/!indexstuff/thisismysite.com) that look completely unprofessional.

Not only that, they subject their visitors to those annoying advertisements with almost every screen.

This is no way to build a business, and it isn’t too great even for a hobby site.

If you’re really serious about building a Web site, for whatever reason, why not spend a little bit of money to do it better? It can be remarkably inexpensive, just because the Web hosting business is truly global.

You can create your site with a company located anywhere. As long as it’s on a fast Internet link, has a good support record, and offers professional service, it doesn’t matter where it is.

I’m aware of someone who just signed up with a U.S.-based service, HiSpeed.com, for a new specialized Web site. The person paid a total of $160 (U.S.) in advance; for that, customers get a year’s worth of unlimited Web space and unlimited traffic. That’s but one of the many deals you can find out there.

But here’s the key: You can find a good host for your site by visiting any number of Web site comparison services. These services let you examine and compare the features and costs you’ll face in hosting your Web site.

Just take a look at CompareWebHosts.com, TopHosts.com, FindWebSpace.com or others. Services such as these will let you quickly find out which Web host might serve your needs.

What if you’re one of those people who hosts your Web site on the free space provided by your Internet service provider? You don’t need to buy space anywhere, since what you’ve got is certainly cheap enough. But you still may have an unprofessional-looking address. You can overcome that by creating a domain name through a service that I now use to manage more than 25 domains, EasyDNS.com.

Visit http://www.ebiz-canada.com, for example. You’d never know that behind that simple address is a rather complicated, ugly Web address. EasyDNS.com’s “domain redirection service” hides the ugliness, leaving the world to see just a straightforward, simple address. Cheap for $25 a year.

Of course, once you’ve got a better place for your Web initiative, you probably want to add some more sophisticated features. That’s very easy, because there are lots of fascinating services available for free or minimal charge.

For example, what if you want to let people search all the pages of your site? Wander off to Atomz (http://www.atomz.com) — it will let you set up a search feature within your site in minutes.

Want to add an audio broadcast to your site, or do you have some audio files you’d like to let people listen to? The folks at Live365 (http://www.live365.com)have just the thing. In effect, they’ll let you
set up an Internet “talk radio” or music radio station on your Web site.

Or what if you want a mailing list, Web-based discussion board or other features? There are lots of those out there, and Listbot.com, Topica.com or other services add the functionality. There are
hundreds of such services that you can add to your site.

What’s the bottom line? If you are serious about having a Web site, you might as well be serious about doing it right.

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At the CIGNA Employee Wellness Center in Philadelphia, employees receive treatment for such ailments as low-back pain, knee injuries and repetitive motion injuries — and it can all be done in a day’s work. “Employees who are recuperating often have driving restrictions that make it difficult for them to travel to appointments,” explains Pattie Bucaccio, assistant director of employee health. “[This program] eliminates the need for them to make separate trips to an outpatient facility.”

Physical therapy units are located near CIGNA’s onsite employee medical facilities, which feature a physician and/or nurse practitioner. These health-care professionals act as a liaison between the physical therapist and the employee’s primary care physicians.

“Initiating onsite physical therapy is a progressive trend aimed at linking the expanded services of a wellness center to the employee’s managed health care program, short-term disability or workers’ compensation program,” says Bucaccio.

Since the program began in early 1994, more than 100 employees have been treated at the Philadelphia facility, with approximately 30 more being treated at a second facility in Bloomfield, Conn. Those who have participated in the program have averaged a total of six therapy sessions. “These onsite rehabilitation centers help get employees back to work faster,” says Bucaccio. “But, most importantly, they help them feel better faster — physically and emotionally.”

Body image behaviors include body-checking behaviors (e.g., frequent weighing), seeking repeated assurance (e.g., constantly asking a friend “do I look fat?”), multiple changes of clothing, restricting food intake, or fasting. Body-image-avoidance behaviors include avoiding mirrors and looking at one’s own body, avoiding physical intimacy, or avoiding social situations that trigger comparisons of one’s physical appearance to others.

Understanding why these particular behaviors result from a poor body image is important. Imagine that negative body image is a disorder, and body-image behaviors and avoidance behaviors are symptoms of that disorder. Negative body image leads to negative thoughts and feelings about a person’s appearance. To cope with these thoughts and feelings, the individual develops “symptoms” or maladaptive strategies to reduce anxiety. These strategies can take the form of behaviors. Let’s look at this more closely with an example.

Ellen suffers from poor body image. Her family invites her to an outdoor picnic to celebrate a reunion. When Ellen receives the invitation, she begins to have many negative thoughts and feelings about her appearance. She thinks, “I look fat,” and begins to feel anxious and depressed. Ellen is concerned that family members she has not seen for a long time will notice her weight and scrutinize her body. Ellen begins to develop strategies or symptoms for relieving the anxiety associated with these thoughts and feelings. These include body-image behaviors such as wearing dark colored clothing, long sleeves and pants, even though the party will be held outdoors in the warm summer sun. She also demonstrates body-image-avoidance behaviors by not playing in the annual softball game. She believes this activity would heighten her self-consciousness as people watch her at bat or standing in the field. She is even considering avoiding the picnic altogether because of her body-image concerns.

Why would we consider these behaviors to be symptoms or maladaptive strategies? The rationale is that when we feel dissatisfied with an aspect of our physical appearance, it affects how we behave, think, and feel. These actions override the way we would normally behave, think, and feel if we were not so concerned with our physical appearance. If Ellen were not as concerned about her weight, she may choose to wear light-colored clothing, short sleeves, and shorts—more appropriate and comfortable dress for a summer picnic. She may not have been concerned that attending the picnic or playing softball would provoke concern about her physical appearance. Ultimately, she would likely have attended the reunion without hesitation and have played in the softball game.

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Enhancing motivation is the fifth vital aspect to this system. Case managers and fitness counselors on the training floor are educated to help keep members excited about exercise. The two main methods include relapse prevention and exercise program modification. Knowing that holidays, family deaths and other life events can cause a return to former lifestyle habits, the Sports Barn staff helps members to deal with these feelings. Exercise prescriptions are also changed over time to keep exercise interesting. Participation in group events is encouraged as well to promote bonding with other active, fit people.

The final component is repairing motivation. This includes a variety of positive reinforcement techniques that allow members to reframe their negative self-perceptions. Relaxation techniques are taught, and members learn how to partition their workout from their job and other stressful events.

They are also taught how to tighten and relax muscle groups to reduce tension in a method known as progressive relaxation.

Outcome Manager has been so successful that Sports Barn achieved a 90 percent retention rate among its high-risk individuals who have health-related problems or high body-fat levels. Overall retention rates have also skyrocketed. Prior to implementation of this system, there was a 52 percent retention rate six months after initial registration. Now, retention has jumped to 74 percent. This has significantly increased the fitness level of the Sports Barn’s membership, which has led to a number of health benefits. It has also helped ensure continued membership revenue. All in all, Outcome Manager has proven to be an important tool for members and management alike.