when i was in high school and college, except for that like 10 pounds to get in a super dress or something, i didn't have a weight problem. mary pat anderson: as a child i was not heavy but i played a lot of sports in high school and when i went to college they didn't have women's sports in those days. i gained weight just simply because i wasn't active. penny weismuller: when i had two little boys, two years apart, i didn't have the opportunity to exercise and then you start being so tired and bad eating habits crept in. mary pat anderson: i like food. so o of the reasons that i've carried weight for quite a while is because of just eating too much and not caring enough about how i look. ralph cygan: today there are more than 100 million americans

who are either overweight or obese. i think we have a very serious public health problem on our hands that we need to address as a nation. despite the fact that americans are more and more conscious about their weight, despite the fact that we have more and more so-called low fat foods and sugar substitutes, obesity is increasing constantly in the united states.

i think it's fair to say we have an epidemic of obesity in the united states. today there are more than 100 million americans who are either overweight or obese. this is a disease and a condition which causes a whole host of important medical complications, so i think we have a very serious public health problem on our hands that we need to address as a nation. narrator: poor food choices, combined with increasingly sedentary lifestyles, are blamed for the dramatic increase in obesity over the last several decades. close to 35% of women and 31% of men over the age of 20 are now considered obese. ralph cygan: obesity is defined by excess body fat. a normal body fat for a male is somewhere in the 20% range. for a woman it's 25 to 30% range. unfortunately it's not easy to measure body fat. it's not something that could be done easily

in a physician's office or at home, so over the last few decades another measure of body fat and obesity has been developed, and that's the bmi or body mass index. bmi is calculated by dividing a person's weight in pounds by their height in inches squared. the answer is then multiplied by 705. a bmi that is associated with good health is in the 19 to 25 range. to put these figures in perspective, supermodels run bmi's of about 16 or 17. sumo wrestlers, on the other hand, are in the 43 to 45 range. you are considered overweight if you have a bmi between 25 and 29; obese if it's 30 or above. all of the very serious causes of early morbidity and mortality

are strongly associated with obesity. for example, cardiovascular disease, high blood pressure, high cholesterol, low good cholesterol or low hdl cholesterol, diabetes mellitus, very important risk factor for heart disease and very closely correlated with increasing degrees of obesity. obesity can damage a person's joints and affect their ability to move. the large, weight bearing joints in the lower extremities-- the hips, knees, ankles, etc. those joints have a much higher likelihood of developing severe and premature degeneration because of the extra stress associated with obesity. mary pat anderson: i have very bad knees, had knee surgery about 15 years ago, and found myself sitting in my classroom and sending students to get books and papers and so forth,

and just hardly moving at all, which just continues the cycle of gaining. even if i wasn't eating as much as i used to, i wouldn't lose because i wasn't moving at all. obesit ao linked to certain types of cancer. older women have a higher risk of breast cancer if they're very heavy. they have a higher risk of endometrial cancer and their obesity may be, in some way, related to colon cancer, as well, and for men, to prostate cancer. why have so many people lost the battle to achieve and maintain a healthy weight? dean hamer: some people think that it's all a matter of metabolism, that some people have a slow metabolism and that makes them fat. well it turns out that the same genes that control metabolism also control appetite-- these are genes coding for hormones and receptors that are released in response to how much a person eats

and how fat their cells are, in essence. it turns out the same hormones and receptors control how hungry you are. so when people eat a big meal, the hormone is produced. the hormone tells the body, "burn off the fat and use it as fuel," and it also tells the brain, "you're full, stop eating." if a person has a problem or different variety of these hormone and receptor genes, then their body doesn't burn off the fat so well and they want to continue eating. so often people will say, "well, he has a metabolic problem, but she doesn't have enough willpower." actually both of those are at least, in part, affected by a person's genes. one theory is that these genes are leftover survival mechanisms from thousands of years ago, when humans lived from one meal to the next-- or one feast to the next famine. joanne ikeda, r.d.: if, when they found a lot, they ate a lot and deposited fat in the body,

then when the lean times came, wh there were times of famine, there was a survival advantage for those people who deposited fat. they were the ones who got through the famine and survived. now we come into a modern age where we don't have to go out and hunt. we don't have to go out and fish. we don't go out and plow the fields and harvest food. we have now created an environment so that this predisposion towards depositing fat in the body is no longer an advantage. it's a disadvantage. genes also play a role in how fat is distributed. the riskiest fat distribution is the male or android or apple shaped distribution where most of the fat is in the intra-abdominal cavity.

there are many more metabolic consequences and many more medical problems associated with that fat distribution-- for example, high blood pressure, high cholesterol, diabetes mellitus. now that's opposed to the gynoid or female distribution, or pear distribution, where the excess weight is in the hips and the buttocks. now, for some reason, that obesity is much less likely toto contribute to the metaboc and health consequences. obesity is no longer confined to those who are middle aged or older. increasingly, the patterns associated with obesity are found in the very young. barbara korsch: many people believe a fat baby's a healthy baby, but from a health point of view, more obese babies go on to be fat adults. stopping the progression of obesity in childhood can be a challenge, as dr. korsch and a team of specialists learned.

and we had a really hard time getting good results, as has everybody. and one trouble was, the nutritionist would earnestly say, "don't eat between meals," and all that. a lot of those families didn't even have meals. they don't sit down together either at breakfast or lunch or dinner and eat a meal with the children involved, so that it's gotten quite chaotic, and whatever is quick and available and tastes good. and the media, dr. korsch contends, just compound the problem. barbara korsch: television watching is the single thing that has been consistently associated with obesity. and there have even been some really interesting studies that if a child is just just watching television, where they tend to sit very passively, usually also snacking, that their metabolism actually goes down. it's a little bit like hibernation. in recent years, the health risks of obesity and the cultural obsession with slimness, have developed into a $33 billion industry.

weight loss pills, fad diets, and dietary supplements promise miraculous results. joanne ikeda: there's nothing over-the-counter that you can buy that is going to melt the fat off your body. yet, day in and day out, you open women's magazines, you open newspapers, you go to the shopping mall, and they're selling products that claim to do this. i recently went to the supermarket, picked up a couple of popular magazines and a couple of supermarket tabloids, just to see what was being advertised. some of my favorites were the "new fat fighters-- slimming capsules that soak up fat." another diet guaranteed weight loss without diet or exercise, astounding to me. several others tout the ability to lose 30 pounds in one month, or your money back. another one says you can make money while you do this if you sell this product to your neighbor.

many of these miracle products are either useless or produce only temporary results. some are even dangerous. joanne ikeda: all of the magic potions have had side effects. we look at the fiasco with respect to the phen-fen combination-- the fenfluramine-phentermine-- that was so popular and ended up being withdrawn because it caused heart valve damage in women. ralph cygan: there are a number of stimulants on the market: ephedra, which is an epinephrine or sympathamimetic drug which is a strong metabolic stimulant that will probably suppress appetite for a few days or a few weeks, but longterm, can be extremely dangerous, and taken in doses higher than is recommended, can also cause potential cardiovascular problems, arrhythmias, chest pains, high blood pressure, etc. fad diets that limit or promote excessive intake

of certain nutrients can also be dangerous. take high-protein diets, for example. protein is used, initially, in the body to maintain muscle mass, to build cells, antibodies, hormones, etc. generally, that need for protein will be met if we take in 12 to no more than 20% of our calories from protein. any additional protein that we take in will be broken down and burned for calories. however, protein is a rather inefficient source of calories in the body because it first has to be metabolized through the liver, some components of the protein structure removed. those components of the protein structure then are waste products, and they're excreted through the kidneys. so, if a person is taking in a very high level of protein, and protein is contributing significantly to the calorie level for that person, we then are taxing the liver and we're taxing the kidneys.

an individual may not be aware of having any kind of liver or kidney problem, but may be pushed over the edge because they're not being medically supervised. ralph cygan: the biggest consequence of diets like this is that it perpetuate the yo-yo cycle of dieting. many of these diets, the patients will lose a few pounds-- they'll lose some water weight perhaps, but then quickly, they'll become very frustrated because there's nothing fundamentally different about their eating behavior, their exercise behavior. it may be that this dieting may be contributing to increased obesity, because in my work, for example, a study i did with african-american women, three generations-- look at the number of times these women have dieted and regained weight. and the more often they have dieted and regained,

the higher their weight is. penny weismuller: i would lose weight, but i couldn't learn how to keep it off. and i would gain more weight, and i just got into that cycle that you read about you know somebody loses 10 pounds, they gain 20. they lose 20 pounds, they gain 30. so by the time i was 29, i was... i'm going to say 60 to 65 pounds overweight. mary pat anderson: i was in "tops." it's called "take off pounds sensibly," and there's no specific diet. it's just a group of people that get together for support. that worked very well for a while. i tried nutrisystem twice and lost a considerable amount of weight both times, but was never able to keep it off. it's very difficult, and i think the more that people yo-yo the more desperate they become for something that's a magic pill or a magic bullet. so it's very difficult psychologically to convince them

that there is nothing like that, that it is slow, sustained behavior change that works best. good morning, uci weight management program. may i help you? that is the goal of the uc irvine weight management program: encouraging and supporting behavior changes that will result in sustained weight loss. wonderful... well, we have a couple of program options. do you have an idea about how much weight you're interested in losing? linda gigliotti: when people inquire about our program, we invite them to come in for an information session where we can have an opportunity to explore a little bit of their goals and history in terms of weight loss, and management of that loss, but also so we can explore program options. there's not one strategy that works for everybody in terms of losing weight. now, you've tried losing weight before? i have, but it's been kind of a roller coaster for me. okay, so we want to stop the roller coaster then.

ralph cygan: when patients come to you for weight loss, many have a shortterm orientation. they want to go on a program and then resume their prior lifestyle. clearly you're not doing these patients a favor if you don't try to disavow them of this short-term mentality. obesity, i think, needs to be looked at as a chronic, lifelong condition, and i think we have treatments that can be used effectively, but they need to be applied for the longterm. there are no quick fixes for obesity. penny weismuller: i called and i spoke to linda on the phone and made an appointment, came in to talk to her. i was really interested in how well people could maintain a weight loss, because i didn't want to... i didn't want to lose weight and not keep it off. linda gigliotti: when a patient comes in, we will ask them,

"well, what do you see your goal weight being? what goal do you have in mind?" because we need to know where that person is coming from. ralph cygan: many patients come to a weight loss program with extremely unrealistic ideas about what their goal weight should be. i think they're either motivated by what they see on fashion magazines, or perhaps think about the old height/weight tables they're used to seeing from insurance companies, and have really unrealistic goals. i was having pain in my heel, and i was feeling pretty desperate. i was thinking about having the weight loss surgery, but i was afraid of complications. so i thought i would call here as one last chance. i only wanted to lose 20 pounds. i wanted to fix the heel pain. if i could just keep that 20 pounds off, that's all i wanted to do. weight loss programs are individualized,

depending on the severity of the problem. linda gigliotti: if an individual has 10 pounds to lose, it's not appropriate to use a very, very intensive approach as a quick fix. so in that case, the patient would be guided into a more moderate, reduced calorie food plan, allowing for gradual weight loss in the range of one to maybe two pounds per week. come on back let's get your height and weight. but when people are suffering from health problems as a result of their obesity, and need to lose weight quickly, a medically supervised fast that includes proper nutritional supplements can be an effective way to begin the process. linda gigliotti: the calorie intake on that regimen is going to be somewhere between usually 500 to 1000 calories per day, coming exclusively from a liquid nutritional supplement as their sole source of intake. penny weismuller: once you start on the fast, hunger's primarily not an issue if you're using the protein supplement fairly regularly,

throughout the day. linda gigliotti: i do have to emphasize that it's not a magic potion. it's a way to get the ball rolling, a way, perhaps, for that patient to reduce rather urgent medical problems, to be able to increase their physical activity so they can begin to burn more calories, in terms of calorie output, and then move eventually into the maintenance phase of the program. it is in the maintance phase that the patient begins to build new and healthy eating habits. linda gigliotti: in maintenance, we emphasize using fruits and vegetables as the bottom of their food guide pyramid, if you will, consuming an absolute minimum of five servings of fruits and vegetables a day. we put a very strong emphasis on the fruit and vegetablintake because they are low calorie density, high water containing,

but a lot of other nutrients in terms of vitamins and minerals coming from the fruits and vegetables. i knew that maybe maintaining was going to be a whole heck of a lot harder. we spent a lot of time talking about just how many calories' difference you have to change in your lifestyle and, for me, to maintain a 100 pound loss, it's you know a 1,000 calories a day difference, either eating less or exercising more, and that's a lot of change. changing food habits and being consistent requires planning and preparation. the key is to make healthy eating a priority... at home, at the office, even at a restaurant. i think you have to be your own sleuth and ask questions. don't just assume that even if it has a heart by it, or some kind of emblem, that it's going to be healthy, or as healthy as you might think it's going to be. do you know what you'd like?

the yellowfin tuna-- how is that prepared? linda gigliotti: i like to view the menu as a list of suggestions, not a list of dictates. the menu tells me what they have in the kitchen. now how can i creatively ask for something if i don't see it presented on the menu? mary pat anderson: the other thing that you really need to pay attention to is portion size. most restaurants give you very, very large portions and because we're paying for it, we feel entitled, and that we have to eat it all. so, if you could take some of it home with you or share it with another person, that would be better. changing the way you eat is the first step in losing weight. the second step is changing the way you move. linda gigliotti: i think it's really important to emphasize that small changes make a difference. let's take physical activity, for example. we don't need to come up with a whole lot of rules about going after a certain length of time,

or even being at a heart rate level for it to count. just moving will make a difference. so even without the exercise at first, just on the fast and with the support of the doctors and the health educators here, i lost very consistently four pounds a week. and it just sort of rolled off, and then i started to get brave and attempt exercise. penny weismuller: because of the heel pain early on, i needed to look for a low impact thing to do, and i got an air glider, and i would do 10 minutes a day on the air glider. ten minutes equaled like 75 calories of physical activity, and that was just one more thing to help build it up. the bottom line for weight management is calories in versus calories out. of course, we need to consider one's nutritional intake. i could consume my maintenance calories in ice cream or chocolate, but that doesn't mean

that even though i could, theoretically, maintain my weight, it doesn't mean that's going to be the healthiest way to do it. but there is room, in a day's intake, in a week's intake, in a month's intake, for most any food as long as the calories net out it's hard when you swim laps in a pool to figure out how much exercise you're actually doing. how many calories you're burning. so one night when nobody was around, i took my yardstick to the pool and actually measured the length of the pool, figured out how many fractions of a mile i was swimming, and actually worked out a program where i swam a half a mile a night. and that's what helped me develop the exercise. and actually worked out maintaing weight,i swam a in the long run,ght. a constant series of tradeoffs. gigliotti: if i'm going to have this muffin, which is about 600 calories, then i have to say, "well, that's in my case, about 40% of my day's maintenance budget."

if it's worth it to me, one choice might be, "okay, i can walk six miles because that would burn off the equivalent," or "i'm going to adjust my food intake at other times of the day to accommodate for the calories with this muffin." but it's not forbidden, and i think that freedom allows me to decide whether or not i choose. when weight loss attempts continue to fail, and health problems continue to mount, extreme measures are sometimes initiated. one such measure is gastric bypass surgery-- a procedure which diverts food from the stomach directly to the small intestine. ralph cygan: now, you have to be very careful about which patients you would refer for such a procedure. usually these patients need to be so-called "morbidly obese," which means their bmi is over 40,

which is at least 100 pounds overweight. these patients have to have other complications associated with obesity, so many of them would have cardiovascular disease or other complications. and these patients would also have tried and failed usually several attempts at more conventional types of weight loss. some success is also being achieved with pharmacologic approaches, prescribed and monitored by a physician. one such product works by regulating neurotransmitters. namely noradrenaline and serotonin, which are both neurotransmitters which affect appetite. and by increasing the level of these neurotransmitters in the brain, the appetite can be effectively suppressed. patients on this program have been able to lose about five to 10% of their total body weight,

and maintain it. ralph cygan: we know now that losing modest amounts of weight-- for most patients, about 10% of total body weight-- can have a profoundly positive effect on health risks of obesity. so from the medical perspective, modest weight loss and maintenance is really the goal that we try to get our patients in tune with. by studying people who have lost weight, and maintained that loss for five years or more, researchers are beginning to document factors that promote success. ralph cygan: we've learned a couple of, i think, very good lessons from this study. first and foremost, the patients accept responsibility. they don't blame anybody else. it's their job and their responsibility to get their weight off and keep it off, and they work hard at it. most of the patients eat a very low fat diet. the majority of pients exercise, and they aim f 2000 to 3000 calories

of exercise per week. in addition to that, they monitor their weight carefully. they usually weigh at least weekly, and they're able to catch small slips. and last, but not least, they have a social support network that allows them to succeed. if you're in an environment that's toxic-- that's always tempting you, that's putting food in front of you, that doesn't support your longterm weight loss goals, you're going to fail. penny weismuller: i still eat candy, and i have dessert once in a while. but primarily, i look at the stuff and i say, "you know, i like the energy and the clear thinking that healthy food choice allows." it's still my mantra.

"the human condition" is a 26-part series about health and wellness. for more information on this program, and accompanying materials, call: or, visit us online at:

narrator: people who exercise regularly have a 43% lower risk of premature death compared to those who are sedentary.

are you physically fit? can your body respond to the demands that are placed on it? technology has made life easier, but it has also made us less active. nearly 1/4 of american adults are sedentary. another 1/3 aren't physically active enough to be considered fit. "physically fit" is being able to do whatever you want to do without restriction, either with your body or with endurance. to reach that level of fitness, we need more than just a walk from the parking lot to the mall. we need exercise. thomas mirich: the need for regular exercise

transcends not just the need to be able to participate in sports activities, but it really covers the whole gamut from youth 'til 80s, 90-year age group. it's been shown that people that participate in a regular exercise program, meaning at least three or four days a week, have better health overall, whether it's better heart condition, lung condition, lower risk of osteoporosis, they have better balance. so that when you are 75 and 80 years old, your bones are stronger, your balance is better. so you're not falling and breaking your hip or breaking your wrist, and your function is overall better. study after study confirms that exercise is vital to good health. it contributes to cardiovascular fitness as well as the control of excess body fat. it may even play a role in reducing the risk of certain cancers.

leslie bernstein: exercise definitely reduces your risk of colon cancer. we see it in studies of men. we see it in studies of women. i've spent a lot of time studying exercise and breast cancer and in the studies that i have conducted, we have shown that women who exercise substantially over their lifetimes have a lower risk of breast cancer. not everybody believes this yet. the results of all the studies aren't consistent. but i still firmly believe that, you know, exercise has the potential to reduce breast cancer risk. and then, of course, exercise is healthy for a whole slew of other diseases. loren lipson: it gives you a sense of well-being. people who have various psychologic illness find that exercise actually gives them endorphins and they feel good. exercise and fitness have a number of different components. leading the list is aerobics. kerry syed: and that is to do three to five times per week, 20 to 60 minutes of continued

using-large-muscle-group exercise. so it's a big exercise-- running, walking, biking. but there are other kinds of exercise which also contribute to physical fitness. syed: there's a muscular strength component and a muscular endurance component. how much weight can you lift in one time is your strength. how much of a percentage of that weight you can lift several times is your endurance-- how many sit-ups can i do? and the last component, always forgotten, is the flexibility. every joint and muscle in the body has an intended range of motion. flexible joints perform a variety of movements-- bending, rotating, twisting. as we get older, muscles tend to tighten, especially in the backs of the legs, the lower back and the shoulders. our range of motion decreases, and we develop aches and pains

that weren't there before. i think you have to take a look at what body parts aren't moving very much during the day, and then you can assume from that, those are the ones that are gonna be tight, and you need to do some things to maintain your flexibility. if you're not actively doing something to maintain or improve your flexibility, then you're probably going toe tightening up. syed: and what happens is, as we age, that's one of those things that goes downhill real fast, among so many others... but that we don't want to end up as this stooped-over, old person. most of the time, it's not osteoporosis, it's the lack of flexibility and the ability to stretch yourself into the position of upright. so i really encourage stretching, you know, like two to three times a week, when you get up, sometime during the day, that you take time to do eight to 12 stretches. the technique that is recommended is "static stretching--"

increasing the flexibility of the muscles thatontrol the joints by stretching them gently, then holding the position for 10 to 20 seconds. olsen: a lot of people just go to where they feel a little pain and then they let off the tension. and in order to increase flexibility, you have to hold that stretch for a long enough time to allow the fibers to assume a new length, so that takes longer than most people realize. five second stretch is not going to... you're not going to gain any range of motion through that. most fitness experts caution against stretching with bouncing movements, or trying to stretch a joint beyond its natural range of motion. olsen: there are things that you can do to maintain your flexibility and there's things that you can do to improve your flexibility, no matter how tight you are. there is hope. things can change. rigor mortis only starts after you're dead. my right arm's stronger from carrying my briefcase.

it's also never too late to improve muscular strength, that aspect of fitness that helps us get through daily activities more easily. strong muscles prevent jot and mule injuries, improve posture, and even contribute to weight loss. mirich: what happens is, when we build up our muscle mass, we've exchanged weight in terms of fat for good weight, which is muscle mass. now that muscle mass is lean mass. there more scle-- it's like having a bigger car engine... it burns more gas. so, now we burn weight more efficiently, sot further helps with weight reduction. lastly, that weight traing adds a balance factor, or a proprioception factor, that improves people's quickness, agility and balance to the equation, all of which are extremely beneficial at lowering injury potential. if you were talking about lifting weights,

we'd have to have a goal in mind. if the goal is just to stay toned, then, you know, we would probably use lighter weights and do a lot more repetitions. if your goal is to be an aold schwarzenegger lookalike, th you're going to have to use heavier weights. strength training so builds muscular endurance, the ability to contract a muscle repeatedly. it's muscular endurance that keeps our arms and legs moving during aerobic exercise. aerobic exercise, in turn, builds cardiovascular endurance. mirich: it's been well documented that we need to perform an aerobic activity to get our heart rate to our appropriate target value for at least 30 minutes, and ideally on a daily basis, at a minimum of three to four days a week. and the simplest of that is pure walking. the reason for that is that it has a very low injury risk and a high benefit risk

in both cardiovascular, bone, osteoporosis, weight reduction, lower risk of diabetes because you're not overweight and obese. other activities such as bicycling and swimming or aqua aerobics or water exercise programs, when performed appropriately, have the same low impact aerobic types of benefit. what we're looking at is aerobic exercise, so moving arms and legs, all four limbs together. and it's important that, you know, taking the dog out is good, but you need that 30 minutes of concerted exercise where you're trying to keep your heart rate up and steady. syed: the thing that i believe is to do at least three times a week up to seven, for at least 20 minutes up to an hour. i mean, past an hour, you're not gonna do anything good, and really at 45 minutes, personally, i'm pooping out. i'm saying, "i have done this way too long."

i'm tired. i'm bored. i've been on a machine if i've been in the gym. now, if you're outside and you're doing something you love, you might be able to do it for over an hour. it's something that is individual for each person, but what you're committed to is really gonna make the difference. hodis: especially if you're a patient who has heart disease, but of course, any patient, any individual, the heart's a muscle. the stronger that muscle is... if it becomes damaged or further damaged, you're going to do much better, clinically, than you would if you just had a floppy, sick heart. so you want to keep muscle tone, not just in your arms and legs but your heart also. the heart of a physically fit person is more efficient. each minute, it can pump the same amount of blood with fewer heartbeats than the heart of an unfit person. a person in good shape may have a heart that actually lasts longer. olsen: i think the trick is trying to find the right cardiovascular exercise for you and for your body.

we naturally assume that all of our bodies are built the same way and are structured the same way, but in fact, even though we might have the same parts, how they're put together is so much different. and so running might be a great activity for one person and it could be a source of multiple injuries for another person. choosing the wrong exercise, or going overboard with it, can cause problems, no matter how good our intentions. mirich: the biggest causes or reasons for people coming in and seeing me can be summarized in, i guess, a phrase used by our runners-- "too far, too fast, too soon," meaning people have gone out and done too much when they weren't ready for it. and that can apply to all age groups. in america, we're very impatient. we don't want to spend the time to achieve that goal. people go into the gym and they may see a person who's... has an excellent body, huge biceps,

curling 300 pounds weight, and they say, "well, boy, this skinny guy like me can do that." they stack on those weights. they try to do that. they lift incorrectly. it's too much weight and then they injure themselves. it can be things like running. "well, boy, i can go out and run five miles." well, if i tried to do that today i would probably be in here seeing my therapist tomorrow. we have to realize that, as we age, our bodies are always changing. and sometimes our minds can feel as young and vigorous as we were when we were teenagers, so we tend to think that our bodies are the same. our bones are changing and our joints are changing, and so if we haven't been consistent with a flexibility program or a strengthening program, anand we'reot dng it on regular basis,ent it's highly likely that somhing has changed over the years and/or over the months. and when you go to do an exercise or an activity

suddenly, you know, you might find out the hard way that something has happened, and usually that's through pain. before you just wake up saturday morning and say, "boy, i'm not fit. i'm gonna start exercising," you know, you want to see your doctor, especially if you're middle-aged or beyond. make sure your heart and lungs are in good condition. maybe see a physical therapist or a personal trainer to be put on an appropriate training program, both in terms of stretching, flexibility, aerobic and weight-lifting capacities. those who are in good physical shape still need to be careful to avoid doing too much of a good thing. mirich: the problem that we run into is where, again, if 30 mites is good or jogging three miles is good, well, running a 10k race is even better. what happens is with that increased time and intensity of participation, that's when we starseng

more of the overuse injuries coming in. our swimmers are all rotator cuff, the back part of the shoulder kind of stuff, and that has to do with a lot of... they're extending their times right now. the baseball... same thing, shoulder stuff. whereas when we go on to football season, it's knees and shoulders again. during the winter, which is amazing, we see a ton of girl soccer players with bad knees-- intercruciate ligaments-- which isn't good. this'll help to work on the edema, the swelling... i play soccer, and i injured it in practice one day. i was just running, and then, all of a sudden, my knee just gave out. give yourself a good effort, laura. kick, pull... so i tore my anterior crucial ligament, which is really popular in females, and then they told me that i'd be okay if i strengthened my muscles and gave me a big brace to wear. and then they decided i needed surgery. mirich: in the last 20 years, the biggest advancement has been the use of arthroscopy,

which is small incision surgery, or minimally invasive surgery. and what that's allowed us to do is treat the injured athlete through a small incision with a more rapid return to activities. and that's one of the goals of treatment in sports medicine, is to return the athlete to their activity as safely and as quickly as possible. we're teaching the kids that it's an athletic event, but it's also a lifetime sport. we want them to be able to last, and the lasting thing is that they're going to know how to take care of themselves. but not all injuries are related to sports. "overdoing" can apply to daily activities, as well. olsen: well, we see a lot of low back injuries, and that comes from either home or work injuries. people getting out gardening for the first time in the spring and they... we all tend to want to finish the job that we start, and so if that particular job requires you to be in a bent-over position for a long period of time,

certainly that will have an effect on your low back. people who don't know how to lift properly where they... constantly bending and twisting and doing that at a bad angle will produce those types of injuries. so, moderation, if i had one word of advice, is really the important key. appropriate regimented type of exercise or training program is very important to prevent the excesses or to prevent from doing too little, and th being the couch poto and going out and participating on the weekend and not being physically fit to participate in that activity. e risk of injury during any activity can be lowered by warming up and cooling down. olsen: you know, you can start out kind of slow if you're stiff, and i think a lot of people think that stretching muscles out before they begin their activity is a good way to do things but oftentimes if you're cold,

muscles don't stretch very well. so if you really want them to elongate, it's better to increase the temperature of those muscles first. you can warm up anywhere from five to ten minutes, slowly walking, then you're going to do a brisk walk, into a jog. at that point, you can stretch. you can stretch then, or you can stretch afterwards. i prefer afterwards just becse i'm so warm and i feel really loose and i can stretch better. it's been shown that if you don't warm up before the exercise and cool down after the exercise then you're putting undue stresses on your heart. so it is very important, say, after your aerobic exercise, to maybe do a cooldown where you're walking slowly or riding that bicycle just without resistance at the end for a little while just to allow your heart rate to settle down to a normal rate of speed. while on that walk or bike ride, parents often include their children. they need exercise just as much as adults,

and childhood is the perfect time to key in on the enjoyment of healthy physical activity. it's not hard to encourage small children-- they rarely sit still anyway. daniel cooper: the work that has been done in children and in other mammalian species, if left alone, almost, the younger members of the species are more physically active. they want to be. now, why they want to be, i don't know... whether it's endorphins released in the brain more readily, i don't know. it's a fascinating question. but they want to be in more physical activity. but as children get older, their involvement in physical activity tends to change. cooper: in almost evy sector of this society, parents don't do what they perhaps did in my generation, which was say to a child, "go and play," and then, "i'll see you at such and such an hour." so we now have an environment which, for physical activity, which is a natural phenomenon in children,

being much, much, much more controlled by parents, and this raises a lot of issues. parents want their children, instinctively, to be physically active so we have, certainly in the suburban and certain urban areas, this explosion of interest in organized sports at very young ages, like soccer. michael bryant: i think those things build esprit de corps, build a sense of teamwork, teach kids how to share, how to work together to achieve a common goal. but one of the things you really must do, even for those little, very, very flexible bodies, is make sure you warm them up adequately. and even though those parents are well intentioned, there are a lot of those parents who are the coaches who don't have a lot of experience in what you need to do in order to prevent injuries in kids. and part of that is adequate warm-up, adequate stretching. even with those young bodies, you still need to do that in order to prevent them from injuring themselves.

mirich: in dance and ballet, we have six and seven-year-old girls, nine-year-old girls who want to look like that professional 22-year-old ballerina. their muscles aren't ready, their ligaments aren't ready, and one of the worst training errors is to have them try to emulate that mature dancer when their bodies are not ready for it. they don't have the strength, they don't have the flexibility, they don't have the skeletal development to allow them to do that. olsen: because i have three daughters and they're involved in fast-pitch softball, i'm seeing at a very early age parents pushing kids to play all year round in order to get that scholarship down the road, and these are kids that are eight years old, you know. and by the time they get into their teenage years, they're having major surgeries on their shoulders.

mirich: and a lot of that is misinformation from coaches who push too hard... okay, let's stay tough! we got a big game. - let's win it! let's go! - yeah! and pushing too hard can actually create permanent damage to ligaments and tendons and growth plates that can hamper or ruin a person's chances of participating up to expectations as a teenager or mature adult. cooper: you know, if you're just looking for the talented athlete you've got your one or two percent, or your five percent, but what about the rest of these kids? and one of the worries to me is that the emphasis on sport per se, can for many children, make physical activity almost a negative experience. they tried to go out for the team. the coach told them ey weren't good enough. "that wasn't fun. i don't want to do this anymore." i'm working with children now, in yoga.

i never thought that yoga could be for anybody else but adults and people that wanted to meditate. and yoga can be for kids. they want to act like... they want to look like an eagle. they want to look like a turtle. they want to look like a snake. they want to move like that. and if you put it in that kind of context for them, if you talk about it in the right way, kids are very receptive to being active little individuals because they got more energy than we could ever imagine having, as adults. we're gonna go straight up about halfway... about there, and then come down slowly. olsen: rather than having them do the same thing all year long, i think it's important to develop the muscles in different ways. strengthening muscle is very important, but resting is part of that strengthening process, as well. nutrition and all those things are important, but i think we forget the resting part and so i think the rest, and the cross-training-- doing something different, exercising the muscles indirectly, the same muscles, but doing them in a different way.

come on! good job! come on, angie! while it is great to encourage an athlete, the real goal is to encourage children to have fun being active. a habit that starts at a young age is easier to maintain through the years. syed: we're a very inactive society and i do think that as role models now, you can be a role model now for those people in your life that you can exercise at any age, and being just healthy and active, i mean, is not just about rigorous exercise planned every day. it's about, "i took the stairs instead of the elevator." now, depending on what kind of commitment i have to my life, then i can make that decision and say, "you know, i really am committed to having a very physically fit life," and that's gonna help me in my future. and then you can really achieve that goal. the goal of being physally f is portant.

i rered in '74, and then i started walking up the mountain. exercise is extremely important, i cannot stress enough, for seniors. many of my seniors, the only exercise they get is coming to and from the clinic, and it's unfortunate. stacy: well, i'll be 90 in may. i'lovely, and the views fr the top are wonderf. and to wch the come up every rning something. so i just automatically wa up, get dressed and come out. seniors, in particular, need to pick an exercise program that matches their physical abilities. if you have someone who has coronary artery disease, you have them run the marathon, it'll be their last act. if you have someone who has arthritis of the hips, riding a bicycle may just not work. so you have to be very thoughtful in planning exercise that it's not too strenuous, that it's easy to remember,

and it's healthy. and that's why walking fits in most of these categories. mirich: in the older population, the parts are starting to wear out. people are starting to get arthritis in their joints, in their back, in their neck... and they have a lot of sore areas. having that age group participate in a low impact aerobic exercise program has again been found to be very beneficial from a whole host of reasons-- cardiovascular fitness, osteoporosis prevention, balancand fall prevention, lessening injuries, plus the actual improvement inhose functions lessens pain in the joints. gen ogata: i'85 years old and i bike abo... on the average, about ten miles a day. sundays, i have a son-in-l... we have a son-in-law who is... he's only 40 years old,

and he's got a lot more energy than i have. and so, on sundays, we go up to mt. rubideaux, but of course, he's way, way ahead of me. mirich: their body adjusts to that higher activity level, cardiovascular fitness, strength, flexibility, and then they'll find that, "boy, i have more energy. i am less stiff when i need to go out and mow the lawn or go shopping or to visit the grandkids. i'm sleeping better. i'm requiring less blood pressure medications. my diabetes is better controlled. i'm now able to get off my insulin and go on to an oral pill to control my diabetes." so the health benefits of a moderate exercise program is enormous even in the older population. olsen: they're very motivated. they're easier to work with, i think, in some respects because they've reached a point in their life where

they know that things don't happen quickly all the time, and they're very disciplined, usually. the ements of becoming physicly fit apply to all ages: develop an exercise program you like; make sure it fits your physical ability; perform it correctly, and remember that it takes time and discipline to achieve your goals. syed: you ha to say, "what do i really want? do i want to be healthy and live a long life?" you can be thin, you can have muscles, you can be strong, but you have to commit to a lifestyle. ogata: i try to go everyday. it's such a habit that... if i don't go, i feel like something is amiss. been: it means everything to me. it's a release for me when i'm upset. it energizes me.

it's where all my friends have come from. it's everything. it's, like, my life. "t human condition" is a 26-ps about health and wellness. for more information on this program, and accompanying materials, call: or, visit us online at:

and accompanying materials, call: hasyou look healthyd, "you and you feel fine, health"? but that may not be the full picture. colorectal cancer is the number two cancer killer. it doesn't always cause symptoms, but it can be prevented. get screened. make sure you are the picture of health. announcer: the bare necessities of living healthy are easy. just eat right, be active, and have fun. yeah! go to mypyramid.gov to find out more.