Next Question Please...

Do you have a fitness question? E-Mail me. I’ll have an answer. If you DON’T want your question posted here, be sure to state that in your email to me. Otherwise, if it is a question that I think others may benefit from, I’ll edit it and protect your identity. For more questions, you can also check out my “Ask a Doc” column at www.tennis.info.

QUESTION BY: CLUELESS
“Hello, I am currently a senior in college for a degree in Criminal Justice with a minor in Pre-Law. Although I am to graduate in less than five months, I have been a personal trainer and fitness instructor for two years and have come to develop a love for fitness. I know that the major that I am receiving has nothing to do with fitness yet, I would like to pursue a Master’s Degree in a related fitness degree. What steps should I take and how long would it take to possible achieve this goal?”

Answer: You will need to take a significant amount of undergraduate pre-reqs to qualify for any master-level fitness/exercise science/exercise physiology degree in the USA. The common pre-reqs include statistics, human anatomy, human physiology, biology w/without a lab, college-level math, chemistry with or without a lab, exercise physiology, and sometimes even physics and/or biomechanics. Because every school is a bit different with their pre-reqs and actual course offerings, your best bet would be to go to the American College of Sports Medicine website (www.acsm.org) and review their on-line graduate program directory. In that directory are listed a least 50 graduate programs with a description of their program, academic/research focus, faculty info., prereqs, gpa needed, etc. Then you can determine where you might like to go and what it will take academically for you to get accepted into a graduate program. Good luck with your quest!

QUESTION BY: CONCERNED
“I am a 20-year-old female, 5'2", 118 lbs, and I've been working on losing weight for about 2.5 years now. It's leaving slowly, slowly, slowly, but surely as I fight to find a diet balance that suits me, that I can use forever. To trim up, I've also been exercising. Now I do 30 push-ups 1-2X and 80 Sit-ups 2X daily, plus I normally am rollerblading between 20 and 40 min. a day. I have been losing body fat (like I said, slowly) from my problem areas: butt and thighs, my stomache has never been flabby. However, I am not trimming up the way I'd hoped. Instead, my waist is getting larger around, and my thighs bigger, my butt more like a small shelf. What would you suggest for thinning these, without losing my fat-burning power? I can't nix rollerblading, because that's how I travel, and I don't want to buy anything. Are there any workouts I can do <10 min. 2X daily in my room, that will help me get a waist? Right now I look like a tree, firm, but certainly not a feminine hourglass.”

ANSWER: Unfortunately, your desire for an hour glass figure may not be achievable – (or desireable). It depends on whether you actually have the body structure (genetically) for it. Take a look at your mother or sisters - did any of them have small waists (ever)? Or are they all, as you put it, tree-like? Having a basic body shape that is more boyish isn't a bad thing, especially with some of today’s fashions (if you are into fashion). Your weight for your height is fine but I don't know your muscle:fat ratio, so you could be a solid healthy athletic 118 pounds. Do keep up your rollerblading.Besides being your transportation mode, it’s a fun way to stay in aerobic shape. That said, do remember that rollerblading requires strong quads (thighs) so your ‘large’ thighs may be due (at least in part) to the specific physiological requirements for good rollerblading. At only 118 pounds, your concern about your thigh size is probably unfounded. Too many young women are overly-influenced by the pencil-thin model look. There really is no such thing as 'spot trimming' exercises. It's a fallacy promoted by the glamour industry to sell you creams, shakes, and so on. Basically your aerobic exercise will help you to burn fat all over your body and tone the muscles you are using. I'm assuming you are eating correctly for weight maintenance or slow weight loss yet not so low that you are actually stalling your metabolism (i.e. not below 1000 calories a day). You should minimally strive for 1200 calories daily to make sure you get the proper nutrient balance. You said you didn’t want to buy anything, but it might be wise for you to spare some change to get a sport dietitian consult or buy a nutrition-exercise book by a known respected expert in the field (e.g. Nancy Clark). Also, for your home exercise, a video might be a worthwhile investment. I've cut and pasted a link to a video you can purchase by Denise Austin = this particular one is a pilates workout for abs & waist. This might be something you could do - and it has three 10 minute programs so it could fit into your time needs: http://stores.homestead.com/justaboutfitness/-strse-792/Denise-Austin-cln--Hit-the/Detail. bok. If this link doesn't work, just google Denise Austin and her video workouts should pop up. She's one of the better fitness video queens 'out there' and the tapes are reasonably priced.

QUESTION BY: HYPERTENSIVE
“I am 35 years old and have just found out that i have cronic hypertention and i am normally very athletic. Can i continue with my active lifestyle and not suffer a stroke from working out?”

ANSWER: As you are aware, this is something you are going to have to learn to live with and manage for a very long time. You did not mention how you ‘just found out’ – whether it was via a medical evaluation with a medical doctor or some other route. The causes and treatments for hypertension vary and can impact how exercise is handled. I cannot recommend a cart-blanche ‘it’s okay’ to exercise without knowing more about your condition- how it was diagnosed, your family medical history, the severity of your hypertension, what kind of treatment(s) have been recommended, your blood pressure response to an exercise stress test, and so on. All of these factors need to be considered before I can say if it is safe for you to exercise. That said, those with ‘controlled hypertension’ (those medically supervised with lifestyle/diet changes and often medication) can exercise/train/compete safely within guidelines established by a certified exercise therapist (American College of Sports Medicine certified as an Exercise Specialist or Registered Clinical Exercise Physiologist). See your medical doctor to get a referral to a hospital-based wellness center with a cardiac rehab program. Those programs have the qualified exercise therapists (rehab nurses, clinical dietitians, ACSM-certified exercise therapists) to guide you as to what will be good (and not so good) for you to do. From there, it will be up to you to follow their advice (or not). Your dietary needs will be especially challenging as you may need to restrict your sodium intake and exercising for long periods in the heat may deplete your sodium reserves. Certain medications will interact with your sodium-hydration levels; other meds will impact your heart rate response to exercise. If you are lucky, no meds will be needed if lifestyle/diet changes do the trick. This will have to be evaluated and monitored carefully by a dietitian who is also certified as a SPORTS dietitian. If you can find a registered/licensed Sports Dietitian also trained in clinical exercise physiology, that would be ideal. Your average personal trainer with a bachelor’s degree in exercise science (or less) would not be sufficiently trained to handle your needs safely. Good Luck!

QUESTION by: Brainy
“What dose this mean several subcorcortal white matter lesions seen bilaterallr within the cerebal hemispheres,compatible with microangiopathic changes.”

ANSWER: You pose an interesting but vague question, so my answer must be general. I will first briefly explain the medical terminology. Microangiopathic change in the brain is suggesting cerebrovascular arteriosclerosis, or small vessel disease within the brain. This is common with aging and/or severe hypertension (high blood pressure) and could predispose someone for a stroke if advanced. Arteriosclerosis is the term used to describe the ‘thickening’ of arterial walls. The vessels are narrowed, without ability to stretch and have limited capacity for changing blood flow dynamics. This can happen to the heart (cardiovascular disease) as well as the brain (cerebrovascular disease). If it happens in the brain, when there is an increased demand for blood supply/oxygen to the brain and the brain can’t handle the demand, a stroke could occur. As for the subcortical white matter lesions occurring bilaterally within the cerebral hemispheres: This simply means that the MRI picked up potential lesions within the white matter on both sides of the brain below the level of the cerebral cortex, so it’s a bit deeper in the brain, not on the surface. But you didn’t specify exactly where – this would be important to know in order to determine what type of functional impairment may result. Combine this with the ‘compatible with microangiographic changes’ implies that this MRI maybe was attempting to confirm cerebrovascular disease in an individual, perhaps older, and perhaps with a history of high blood pressure. Again, you didn’t state the reason for this question or give any details to help clarify the question. That said, without further information, subcortical white matter lesions are also seen in a variety of other diseases, like Parkinson’s, multiple sclerosis, and Huntingdon’s disease. It all depends on the entire medical history, the location of the lesions, and the quality of the MRI itself. Sometimes MRIs identify ‘lesions’ that on a subsequent test fail to materialize. My advice to you is to call your doctor and ask him (her) to further explain these results – in terms you can understand. And do get a second test/opinion to make sure the MRI results are in fact correct. This is not to imply that whomever conducted your test did it wrong, it’s just the nature of the testing modality (MRI technology is not a perfect science) and the ever-changing brain.