Jeff pretends like everything is perfectly normal, “First off, I need to check in with you guys. The ten of you are meeting for the first time in many cases. Erin, was it tough having the two tribes live together on the same beach?”

“To be completely honest, no not at all,” Erin said. “In fact, it’s much better having both tribes live together I never would’ve expected our merge to have gone as smoothly as it has.”

Jeff grins, “You said merge? I certainly didn’t say anything to give you that impression, did I?”

During her Early Show interview, Shii Ann describes this scene, “It was like the Homer Simpson ’Doh!’ moment for me. I knew I was cooked.”

Jeff explains, “What I said to you guys before you left was, ‘Something very different is about to happen. The two tribes will live together on the same beach.’

That’s exactly what you’re doing. You are two tribes living together on the same beach. The two tribes never merged.”

Jeff went on to explain the immunity challenge. He might’ve said something about prisons and escaping but I wasn’t really paying attention. I had begun my mourning. Shii Ann, my shining light, my beacon of hope, my reason for living, you’re dead!

Accurate assessment is important both clinically and emotionally, says study leader Dr. Steven Warach of the National Institute of Neurological Disorders and Stroke (NINDS).

“The method has two important uses. One is giving a clear idea to patients and the patient’s family on the chances of recovery, a very important emotional thing,” says Warach, who heads the NINDS Section on Stroke Diagnostics and Therapeutics.

“For clinicians, this method helps us weigh in on treatment in a more precise, quantitative way. If we have a therapy we are considering that might have some risks, and we know that if we do nothing the chances of recovery are high, we would be reluctant to do that treatment. But if the chance of recovery is low, we could apply more experimental therapies that carry some risk,” Warach says.

Part of the new assessment is the National Institutes of Health Stroke Scale, which uses 11 measurements derived from a neurological examination. Another measurement is the time from the onset of stroke symptoms to the time when the brain scan is made.

In the study, that brain scan used technology called magnetic resonance diffusion-weighted imaging (MR-DWI), which can measure the amount of damage done when a clot obstructs blood flow to a part of the brain.

The study looked at the results of the three-part assessment for 66 stroke patients treated at the Beth Israel Deaconess Medical Center in Boston and 63 treated at the Royal Melbourne Hospital in Australia. Patients were rated on a scale of 1 to 7, with 0 to 2 rated as a small chance of recovery, 3 to 4 as medium, and 5 to 7 as high. Recovery was defined as returning to nearly full function.

In the Boston group, 6 percent of patients with a low rating recovered, compared to 47 percent of those with a medium rating and 93 percent with a high rating. In the Australian group, 8 percent of patients with a low rating recovered, compared to 57 percent with a medium rating and 78 percent with a high rating.

The findings are reported in the June 30 issue of The Lancet.

Warach says the new technique could be adopted widely without major difficulty, since the MR-DWI technology, developed for clinical use a decade ago, “is now available in hundreds of hospitals around the country.”

Dr. Chelsea Kidwell, professor of neurology at the University of California, Los Angeles, says MR-DWI “provides very important information early on the size, location and severity of the stroke injury.” It can help doctors decide on treatments such as thrombolytic therapy, which uses a drug to dissolve an artery-blocking clot, she says.

And MR-DWI is “useful not only in patient management but also as a research tool. It is a way to determine whether a treatment works,” says Kidwell, who has done MR-DWI research.

Warach says further research on early evaluation of stroke patients will focus on whether computerized tomography scanning, a standard technique that is available in many more hospitals than MR-DWI, is also an effective evaluation tool.

An internet drugstore may provide you with easy, private way to purchase over-the-counter drugs, often at more affordable price. Online pharmacy no prescription needed are particularly convenient if you live in a rural area or do not drive.

Exercising is one of those tasks that most people don’t like to do. People who dislike exercise make up all kinds of excuses why they can’t make it to the gym, and may even convince themselves that those excuses are legitimate. Anything you can do to help your members like to exercise, or at least distract them from it, can help to get them into your club on a regular basis.

One way to keep your members coming back is to entertain them. If your members are having fun while they’re exercising, or are beingmotivated or distracted, they will be more likely to continue their exercise programs.

Whether it be music, television, an Internet connection or using tracking software, entertainment plays an important role in customer service and satisfaction, andhence, repeat business. Kevin Bryant, vice president of sales and operations at Cardio Theater in Hillsboro, Ore., says, “People today expect to be entertained.”

If your club offers a distraction from that 20-minute run on a treadmill, your members are more likely to come back and do it again. This translates into greater member retention and, therefore, greater profits.

* Demographic surveys of your club should indicate what the general interests of your community are. If you are introducing an indoor cycling program in a community already friendly to outdoor cycling, your chances of attracting new members with this offering is good. Team up with local bike shops, and offer the owners and staff free trial indoor rides. If this is a positive experience for them, they will become walking advertisements for your program. This partnership works especially well if you promote their merchandise in exchange for their word-of-mouth advertising.

* Design a short one- or two-week “Adopt-a-Rider” incentive program, where current members bring their friends to try out a cycling class. Each recruit can count for 20 miles, and when members reach 100 miles, give them a new pair of bike shorts or some other cycling-related prize.

* Consider offering promotional memberships that are limited to indoor cycling. With this, potential members who are interested can take a few classes before they decide to join the club.

* Open your indoor cycling studio for weekly “cold season” group rides. Most bike shops sponsor weekly rides, so offer these riders a place to train when the weather is bad. This indoor ride will give cyclers the opportunity to train indoors while getting to know your club’s instructors and your indoor cycling program.

* Market your new indoor cycling program to local high school and university teams as a cross-training tool for pre- and post-season conditioning.

Coaches will appreciate the additional motivation your instructors can provide, and the athletes will enjoy the variety of an indoor cycling workout. These classes can increase your clubs’ income and enhance community exposure.

A well-thought-out plan that takes into consideration program promotion, new member recruitment, staff selection and programming will give the right start for your new indoor cycling program, and can determine its long-term success and profitability.

Germany’s Commission E also recommends ginkgo extract as an adjunct to physical therapy for Fontaine stage II peripheral arterial disease to improve pain-free walking ability. Improvement requires a minimum of 6 weeks of treatment.

Double-blind placebo-controlled trials suggest that ginkgo might be helpful for tinnitus and also for balance disorders.

One double-blind placebo-controlled study found ginkgo effective for preventing altitude sickness and perhaps frostbite as well. There is a similar level of evidence for ginkgo as a treatment for PMS symptoms and depression in the elderly.

Case reports and highly preliminary studies suggest that the herb ginkgo might help reduce the sexual side effects of SSRIs, including impotence in men and inability to achieve orgasm in women [Cohen, 1996; Cohen, 1997; Cohen and Bartlik, 1998; Cohen et al., 1997; McCann, 1997]. Because sexual dysfunction is a major deterrent to patient compliance with the SSRI antidepressants, this potential effect of ginkgo is being investigated more thoroughly.

Weak and in some cases contradictory evidence suggests that ginkgo extract might be helpful for macular degeneration, diabetic microvascular disease, asthma, cochlear deafness, erectile dysfunction, and allergies [De Feudis, 1991; Sikora et al., 1989].

Highly preliminary Chinese research suggests that ginkgo might improve the effectiveness and tolerability of neuroleptics in the treatment of schizophrenia [Liu et al., 1997].

“Most importantly,” says Blackburn, “we wanted our members’ trust.” And he and his colleagues believed that showing through actions and policies that they didn’t just want to take members’ money and run was the way to achieve that trust. “The fitness industry has been noted to sign up a member and refrain from addressing that member’s needs with regard to extensions, refunds and transfers,” he adds. “We believe that in a market where all other businesses cater to their customers’ needs, we — as fitness industry leaders — must be confident in our product and offer the same.”

Although Fitness First! did promote the new guarantee through advertisements, news about the unusually generous customer service guarantee seemed to have reached many potential and current members through word-of-mouth. “Reaction was overwhelming. We have a pretty relaxed approach to membership sales. All of a sudden we had a lot of people coming into our facility and saying, ‘I’ve heard you do this?’ — as if they didn’t think it could actually be true,” says Blackburn.

Not only has the center staff received overwhelming verbal gratitude for the service opportunities it offers, but hard numbers support the popularity of the new membership satisfaction policies. A recent in-house survey found that 70 percent of current Fitness First! members listed the Total Customer Satisfaction Guarantee as one of the top three reasons for joining.

In addition, Fitness First! has a 96 percent renewal rate for those members who have elected to extend their memberships because of illness or travel (the renewal is confirmed after the extension has been completed).

Blackburn firmly believes that membership sales at Fitness First! will continue their strong growth. “Potential members feel very comfortable with our facility and its operations because of our confidence in our offerings.”

“We really started brainstorming,” explains Charlie Blackburn, the center’s fitness coordinator. “Health clubs are doing this and that, but what are airlines and other industries doing to win their customers’ loyalty? We wanted to give the best service out of everyone, not just public organizations or just health clubs. We wanted to walk the talk, but how were we going to do it?” The result was the center’s Total Customer Satisfaction Guarantee, an innovative four-pronged approach to customer service that has resulted in a 17-percent increase in memberships during the last year. The guarantee is designed to put member needs and requests above everything else.

The first part of the guarantee is a membership credit for illness or time out of town. Members submit simple written requests for a membership extension at any time, which are included in their files for future reference. “Our current membership market is very transient, and our clients often travel to warmer climates during the winter months,” says Blackburn. “This guarantee allows them to fully take advantage of the membership time they purchased.”

If a member’s trip out of the neighborhood or out of town is permanent and not seasonal, that’s no problem either. Part two of the Total Customer Satisfaction Guarantee allows membership transfers from one person to another. The departing member just fills out the necessary paperwork with the new member present.

For permanent moves, members may also request a pro-rated refund of their membership fees. This third part of the customer satisfaction policy requires a copy of the lease, closing papers or a letter mailed to the new address that is not within traveling distance (a maximum of 10 miles from the club), according to fitness center materials.

The final part of the guarantee is the center’s cancel-at-any-time policy. If a member wishes to stop an EFT deduction or membership that is paid in full, they may do so by submitting a written request form. All aspects of the Total Customer Satisfaction Guarantee program are free of any transaction charges or penalties.

Blackburn says that prior to the new guarantee, the center’s 38 employees “lacked concrete things to make customer satisfaction happen. Now we are able to say that we are so confident in what we offer our members that we’re going to make sure your experience with us is like nothing else.”

A: No matter how fit individuals are, the first few minutes into vigorous exercise may cause their muscles to ache and make them somewhat out of breath. The body isn’t able to transport oxygen to the active muscles quickly enough. As a result, the muscles burn carbohydrates anaerobically, causing an increase in lactic acid production. Gradually, the body makes the transition to aerobic metabolism, and begins to burn nutrients (carbohydrates and fats) aerobically. This shift to aerobic metabolism coincides with the “second wind.” The more people train and the more fit they become, the sooner they will get their “breath” back. Then they will reach aerobic levels they can sustain for extended durations.

‘Foot’notes on Climbing

Q: I’ve had several clients report that they experience a mild numbness and tingling in their feet after working out on a stair climbing machine. Is this something they should be concerned about? Is there anything they can do to alter their stair climbing workouts to avoid experiencing the numbness and tingling?

A: In 1992, researchers at Stanford University surveyed frequent users of the StairMaster 4000 PT stair climber at seven health clubs to determine if neurologic foot symptoms were present during their exercise bouts. Of the 212 individuals who responded to their questionnaires, 39 percent reported that they had experienced numbness or tingling in their feet while using the stair climber. These mild-to-moderate forefoot neurologic symptoms generally disappeared either as the individuals continued to exercise or when the exercise session ended.

These researchers concluded that the exercisers’ symptoms (a condition collectively referred to as transient paresthesia) were probably caused by the compression of the interdigital nerves from persistent and prolonged weight bearing while exercising.

According to the investigators, these forefoot symptoms are most appropriately characterized as neurology nuisances, and not pathologic neuropathies. Fortunately, such neurologic nuisances don’t require formal medical treatment. Individuals may be able to alleviate or greatly minimize the symptoms by slightly altering their workout technique in one or more ways, including:

* Avoiding repetitive metatarsophalangeal dorsiflexion (i.e., bending-flexing the toes toward the body) by maintaining a flat-footed position on the foot pedals.

* Wearing proper footwear that provides ample width at the toe box and wearing shock-absorbing inserts.

* Loosening shoelaces if numbness or tingling develops.

* Limiting the duration of stair climbing machine workouts to less than 30 minutes.

In addition to generating revenue through increased memberships, A la Carte Marketing helped cut payroll expenses. Caparas says LifeQuest has saved half of the marketing director’s salary since August, with the other half being distributed to marketing staff in the form of bonus incentives. Cash bonuses are attached to projects based on the level of responsibility required to complete each task. And while money serves as a motivator for staff, Caparas says employees are also encouraged by the opportunity to excel in new areas. “There’s a lot of talent here, and now everybody has the ability to showcase their potential,” agrees Smith. It also gives management a chance to see new futures for certain employees within the company.”

Learning to succeed

A la Carte Marketing has served as a learning process for employees in more ways than one. While many have gained valuable hands-on experience, Caparas says a few employees have admitted they initially took on bigger responsibilities than they could handle. Still, he says, learning one’s limitations is just as valuable as honing one’s skills. “Our prior marketing director was famous for handling all of the projects herself and not properly delegating to staff,” he says. “That’s when you get overwhelmed and can’t perform at the level you are capable of.” As a whole, Caparas says staff was careful not to jump into projects unprepared. “The unexpected by-product of this program was a certain level of conservatism in our marketing,” he explains.

“Before, there was a tendency of trying something new for the sake of doing something different, without researching the consequences. Because our staff wanted so much to succeed, it carefully researched all possibilities before jumping into anything — and it worked for us.”

Although LifeQuest hopes to hire a permanent marketing director by the end of the month, Caparas says the A la Carte Marketing approach is here to stay. “No matter who the new marketing director is, we will keep the marketing menu,” he says. “In this position, people always try to come in and succeed at every little thing. This system will keep them from getting burned-out.”

This situation requires that members of the nutrition-science community convey research findings in terms intelligible to those in the mass media responsible for reporting such findings to the public. The communication skills of clinical nutritionists and nutrition educators will be challenged further as such health professionals are called upon to explain how, because of specific genetic differences both within a human population and between populations, a dietary regimen beneficial to one person may be inappropriate for, or even harmful to, a different individual with similar symptoms.

Humankind is polymorphic: We come in different genetic forms — forms that differ in their ability to handle dietary and other environmental stimuli. Because of a new emphasis on human polymorphism, there has been a shift from population-based education to individual counseling in the dietary treatment of diabetes and hyperlipidemias.

While it is difficult to predict which of the many trends in nutrition science, policy and clinical practice will have long-term significance, trends that appear promising include:

Efforts to identify the active components of the many foods that have long been used as folk remedies or have been associated epidemiologically with good health or with the absence of a specific disease;
Studies of the bioactive components of human milk that may be responsible for its superiority in contributing to the optimal development of newborns;
Application of findings concerning the space-flight nutritional needs of astronauts and the effects of microgravity or weightlessness on bone and muscle homeostasis to our understanding of human terrestrial adaptations;
Support of public-private partnerships to promote aggressive consumer education on food safety;
Extension of regulatory policies concerning nutrient labeling and specific health claims to herbal supplements, other dietary supplements and “organic” foods;
Emphasis in nutrition education on the quality of the total diet rather than on any one food or class of foods;
Implementation of food-fortification programs and biotech strategies to counter micronutrient deficiencies worldwide; and
Emphasis on explaining the unique nutrient needs of the elderly as a critical quality-of-life factor.

Advancement of these trends — for example, to optimize food’s nutritional and preventive qualities — requires interaction among such disciplines as bioengineering, food science, microbiology and plant physiology. But, whatever the trend, it is imperative that rigorous, time-consuming clinical trials precede nutrition recommendations to the public.

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