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The Last Five Pounds Are the Hardest

Can’t lose that last five pounds, despite frequent exercise and a careful diet? “Maybe you’re exercising too much,” suggests Kelly Brownell, a University of Pennsylvania psychologist and diet researcher.

Regular exercise often is prescribed as a weight-loss aid because it boosts the metabolic rate, thus burning more calories.

But at some point, excessive exercise, coupled with dieting, might throw the body into a “defensive mode” in which the body, seeking to maintain what some researchers think is an internally regulated weight, slows the metabolic rate, Brownell said, emphasizing that the idea is speculative.

“One possibility is that when you exercise excessively, your metabolic rate declines, therefore permitting your body to sustain its weight on fewer calories,” he said, basing this theory on studies by him and others, showing athletes with high activity levels have surprisingly low caloric intakes.

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One such study, led by University of Wisconsin-Milwaukee researcher Roxanne Nowak, found among women intercollegiate basketball players an average daily caloric intake of only 1,730, abnormally low for such high activity levels. In other studies, male gymnasts averaged only 2,080 calories daily and male wrestlers 925 to 1,821 calories a day.

Brownell’s advice for exercise-aholic dieters still displeased by the bathroom scale reading: “Give your body a break. If you exercise five times a week, shut it down to three and see how the body responds.”

Accident-Prone Children

Some children are accident-prone but for most the vulnerability is just a phase, a new study suggests.

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Researchers Dr. W. Thomas Boyce of UC San Francisco and Sue Sobolewski of the Tucson Unified School District surveyed almost 55,000 Tucson, Ariz., schoolchildren over three years and published results in this month’s American Journal of Diseases of Children. Of 8,429 injuries reported, 17% occurred in only 1% of the children--statistically higher than expected. Among those most likely to suffer recurrent injuries: junior high students, boys and students in alternative programs, which have longer hours or features such as “open” classrooms.

“The vast majority of recurrently injured children appear to enter, and subsequently leave, a period of temporary vulnerability in which an unusual clustering of injuries occurs,” the researchers wrote. Only three of 10,000 children seem to maintain “an inordinate risk of injury over an extended period of years.” Likely to precipitate accident proneness are stresses such as family problems, the onset of puberty or peer social problems, the researchers note.

Drawing on his own clinical pediatric experience, Dr. Stephen Tannenbaum of Kaiser Permanente, Los Angeles, agreed: When families are going through divorce or other “stress and strain,” children tend to “play harder, be more aggressive, and (be) more likely to have accidents,” he said. “Take a look at things if accidents are recurrent and serious.”

Hurting Heels

For recreational athletes, heel pain is a common problem--probably one of the top-five runners’ ailments, reports Frank S. Pollina, a Detroit physical medicine specialist.

Often the result of a training error or a variation in routine, heel pain can be triggered by a change of running surface, by resuming a regimen too quickly after a break or by running hills for the first time, said Pollina, who co-wrote a recent report in the journal Physician and Sportsmedicine with Dr. Allan S. Bazzoli, director of the Ohio State University runner’s clinic.

Stress fractures, inflammation of the muscle-covering tissue on the sole of the foot or inflammation of the Achilles’ tendon also can cause heel pain.

Ideally, runners with severe heel pain should see a physician, who may prescribe anti-inflammatory medications or perform gait analysis to detect underlying biomechanical problems such as flat feet. Postponing workouts or switching to low-impact exercise is advised.

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For those who won’t stop running, Pollina and Rodney Bassett, an exercise physiologist at Centinela Hospital’s Fitness Institute in Culver City, recommend:

--Stretching before and after running to increase flexibility and prevent injury risk. It’s especially critical to stretch calf muscles, hamstrings (back of the upper leg) and arches of the feet.

--Icing the heel for 20 minutes after a run and elevating it to heart level.

--Wearing good running shoes and replacing them before they’re completely worn down.

Rules of the Dating Game

Establishing rules early in a relationship can reduce dating conflicts and strengthen friendships, Palo Alto therapist Marty Klein reports.

“People like to pretend there are few rules in relationships, but actually there are many,” Klein said at the Western regional meeting of the Society for the Scientific Study of Sex last weekend in Marina del Rey. Most people never discuss them because they think it’s unromantic or they are afraid to admit what’s really on their minds, he added.

Such discussions can help form the basis for a healthy relationship and revitalize a long-term union, he believes. Though today’s relationships revolve around some traditional arenas--"sex, money and power"--what’s important to women isn’t necessarily important to men, he said.

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His clients often mention two rules as important:

--A woman wants a man to telephone when he says he will. Convey that rule to a man by giving him a choice, Klein advises. “Say, ‘I’d like you to call when you say you will, or I’d like you not to set a definite time to call.’ ”

--A man wants to wear what’s comfortable. Klein suggests those who prefer physical comfort to fashion statements start by saying: “I observe that you care more about what I wear than I do.” Then compromise, he says. Promise to suit up for a special occasion in exchange for wearing something casual to a Saturday matinee.


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