RUNNING SHOE SELECTION
With the warm weather coming, it's time to think about new running shoes. Visit the American Running Association's Running Shoe Database American Running Association's Running Shoe Database to determine which shoe will fit your foot. Click on the Interactive Guide to Shoe Selection and answer the questions. Proper fit is extremely important for both performance and injury prevention. Watch for an upcoming article on shoe fit and read the current article Shoes: How to Get a Good Fit on our website.

AVOIDING AIR TRAVEL THROMBOSIS
1. Don't wear anything that impedes circulation (like a knee brace).
2. Risk increases with time in the air. A flight of less two hours may be safe unless it follows another flight or if you spend hours waiting to take off.
3. Frequent flexing at ten or fifteen minute intervals helps prevent clots. The more risk factors you have the more frequently you need to flex.
     With your feet flat on the floor push down with the balls of your feet, lifting you heels. Then, with your heels back on the floor, lift the balls of your feet from the floor. Deliberately but not strenuously. Repeat 10-12 times. If there is room, do this with legs extended.
     Exercise thigh muscles by sliding feet forward and back on the floor. Sleeping is dangerous unless you can count on being waked to flex. If there is room, lie with your legs up at the same level as your heart.
4. Avoid sitting with your legs crossed for more than a few minutes.
5. Massaging the leg muscles could be dangerous if a clot has formed. If one lower leg has become swollen don't massage it.

If you are at heightened risk for blood clots, talk to your doctor about possibly taking anticoagulants and/or wearing medical compression hose. The biggest factor is fitness, especially if you have a low resting pulse. Other risk factors include recent injury (including sprain or bruise, especially of the lower limbs or torso), recent surgery, a personal or family history of blood clots, cancer, obesity, smoking, diabetes, heart disease, women who are pregnant or taking estrogen (including birth control pills), and age.

If you are stricken, it will probably be a few days or more after the flight. If you feel symptoms listed below, you need to see a doctor. A few days after the flight you will probably forget exactly what symptoms to watch for, so keep this leaflet with you. After 30 days you are probably safe, but avoid surgery for 3 months.

ATT Symptoms to Watch for up to 30 Days After Air Travel:
Leg symptoms during or after flight:
1. Swelling in one lower leg. (A little in both legs is normal in flight).
2. Cramp or tenderness in one lower leg.
3. Swelling or bruising behind knee.

Chest symptoms usually appear 2-4 days or more after the initial clot in the calf, which you may not have noticed:
1. Shortness of breath
Rapid breathing, panting
Cramp in your side, painful breathing
Chest pain radiating to the shoulder
Fever
Coughing up blood
Fainting (often the first sign, especially in older people)

Tips to Avoid Misdiagnosis:
Most victims fail to get correct diagnosis and treatment until after the clot has done permanent damage. To avoid this:
1. If you have leg symptoms but the doctor tells you it is only a strained muscle, insist on an ultrasound leg scan. Without it, the chance of correct diagnosis is only 50/50. If you have to pay for it yourself, the cost is around $150, not much if it helps avoid permanent damage to the veins and chronic phlebitis.

2. If you have chest symptoms but the doctor tells you it is a cold, pneumonia, heartburn, or other conditions, ask for a blood oxygen test. A small device called a pulse oximeter is clipped to your finger and measures blood oxygen without breaking the skin. If the reading is below 80 and there is no reason (such as emphysema) for low oxygen, the doctor will then want to do a ventilation/perfusion test, which will confirm or rule out PE.

AIR HEALTH.org

OBESITY: SITTING ISN'T PRETTY
Throw away the remote. Fire the maid. And never drive to work again. A new study from the Mayo Clinic in Rochester, Minnesota, proves that the real difference between people who are obese and those who are not is how often they stand up. Literally.

Researchers find that in an average day, obese people sit for 2.5 hours more than their lean peers. They burn 350 less calories per day. All else being equal, that translates to approximately 10 extra pounds per year. "If you've ever gone to the gym and looked at the treadmill, 350 calories is no joke," says James A. Levine, the endocrinologist, who led the study. "It's enough to account for who becomes obese and who does not."

In an age of NetFlicks, FreshDirect and Domino's, when you can order everything online and never leave a chair, the solution to the nation's obesity crisis might be as simple as walking out the door. "Obesity may be more closely tied to activity levels than we ever imagined before," said Dr. Levine. And he's not talking marathons or even gym workouts. "The calories you burn in everyday activities can make a tremendous difference in your life," he insists. In case you missed it the first time, let me repeat: everyday activities.

Six years ago, Dr. Levine discovered something he calls NEAT, for non-exercise activity thermogenesis. It describes the energy we expend in physical movement other than planned exercise. The new study measured the NEAT levels of 20 self-proclaimed couch potatoes, half of whom were obese. Their mundane movements were tracked for 10 days. In case you're wondering how: All wore custom-made, data-collecting underwear. Each morning, the participants were measured at the clinic, where they received fresh underwear and all of their meals. The researchers found that the 10 lean participants all walked, paced, cleaned, cooked and stood more than the 10 obese subjects.

"One by one, these movements added up," says Dr. Levine. "But it's about more than wiggling your toes. It's about getting up out of your seat." Taking the study further, the researchers sought to determine whether low NEAT levels were a cause of obesity or byproduct. Once again, the participants donned the special underwear.

For two months, the thin subjects were overfed, each gaining about nine pounds, and the obese subjects were underfed, each losing about 17 pounds. Even though the subjects gained and lost weight, their daily movements did not change. Our NEAT level seems to be hardwired into us But Dr. Levine is optimistic that, with a little conscious learning, people can change their daily activity levels, although NEAT may be genetic or established early in life. He serves himself up as Exhibit A. He contends his movement habits changed as a result of doing the study. "Now, I'm addicted to standing up," he says. "People can change their lifestyles completely. I encourage everyone to just stand up and see how good it makes you feel."

In the interests of journalistic accuracy I feel bound to report that he then forced the reporter to stand up for the remainder of the interview. "If people would just put a treadmill in front of their televisions and walk one mile per hour, it could completely change their health. The take-home message is get up, get up, get up." From Psyched for Success 3/15/05