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The concepts of “health” and “Grateful Dead concerts” don’t often appear in the same sentence. But those enthusiastic souls who used to shake their whatevers nonstop while the Dead played 1 1/2 hours straight (without tuning up once) were faithfully, if unwittingly, engaged in a noble health pursuit-aerobic exercise.

Jane Fonda-style aerobic dance classes may have publicly appropriated the word, but the truth is that any activity that jacks your heart rate up for an extended period of time is aerobic exercise. That means running, cycling, swimming, rowing, skiing, inline skating, or anything else that gets you huffing and puffing enough to feel it but not so much that you can’t keep it up.

All those good things that exercise does to help you avoid heart disease come mostly from aerobic work. That’s eminently logical when you bear in mind that what aerobic exercise essentially does is strengthen your heart (hey, it’s a muscle, too) and improve your lung capacity, thus helping the flow of oxygen through your bloodstream.

Aerobic exercise is also the principal player in diabetes prevention. “Regular aerobic-type exercise will allow you to metabolize your blood sugar without requiring as much insulin,” says Ben Hurley, Ph.D., director of the Exercise Science Laboratory at the University of Maryland’s College of Health and Human Performance in College Park. “That’s important for both heart disease and diabetes prevention. And the research is very consistent.” If you want to take advantage of aerobic exercise’s health benefits, here’s all you need to do.

Do as you please. The kind of aerobic exercise that works best is whatever kind you’ll do. So your wisest choice, according to physical therapist Mark Taranta, director of the Physical Therapy Practice in Philadelphia, is to go with what you like. “Do something you’re familiar with or enjoyed doing in the past,” he advises. “Don’t go out and buy a big piece of equipment like a treadmill if you’ve never tried it before. You might hate it.”

Get that heart rate up. Any exercise expert will tell you that to reap the full benefits of aerobic exercise, you have to do it hard enough. Sorry, golf won’t cut it. (No, not even if you carry your clubs and take 130 strokes to finish.) The aerobic effect doesn’t kick in until your heart’s beating at 70 percent of its maximum rate.

Your maximum rate per minute, by the way, is 220 minus your age. So if you’re 40, you want to have your heart beating at 70 percent of 180 beats per minute while you’re exercising. (We’ll do the math for you, this time only-it’s 126 beats per minute.) Check your pulse by putting two fingers to the side of your neck and counting the beats for 10 seconds; multiply that by six, Taranta says.

And keep it up. Once you get your pulse up to 70 percent of your maximum, keep it there for at least 20 minutes. While you’re working your way up to that magic 20-minute mark, remember that accumulating the time over a 24-hour period (say, three seven-minute sessions on the stationary bike) will provide almost the same benefits.

Stick with it. If you get your aerobic workout three to five times a week, you’ll be amazed at how quickly the positive changes kick in. But you’ll be just as amazed at how fast they fade if you start backsliding. “If you don’t keep at it, you lose it,” Dr. Bortz warns. “The gains and losses are very transient. If you want to translate them into genuine health benefits, you have to do it regularly.”

Be reasonable. Assuming that your fitness goal is achieving overall health rather than medaling in the Olympics, it makes more sense to enjoy your exercise sessions than to turn them into torture tests. Yes, there are the minimum requirements we’ve mentioned, but you don’t have to go much beyond them. “It doesn’t take a whole lot to maintain your cardiovascular fitness,” says Tom Baechle, Ed. D., chairman of the exercise science department at Creighton University in Omaha, Nebraska. “We’ve gotten away from the killing-yourself mode. You can get it done in 20 minutes a day, three times a week, at a reasonable intensity.”

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Partial mastectomy/segmentectomy

A variation of lumpectomy, this operation is done for a larger tumour and involves the removal of a larger wedge of normal tissue. Auxiliary lymph nodes may also be removed.

The advantage of this operation for women with larger breasts is that most of the breast tissue is preserved. There is also unlikely to be much swelling of the arm as most of the auxiliary lymph nodes remain intact. However, the breast may be left flattened or distorted, particularly the nipple.

Radiotherapy is likely to be necessary after a partial mastectomy in case any cancer remains in the breast tissue left behind. Again, radiotherapy must be avoided if all the auxiliary lymph nodes have been removed.

Mastectomy

In simple or total mastectomy, the entire breast is removed, usually together with some or all of the auxiliary lymph nodes. Breast reconstruction should be possible following this operation. Its advantages include the retention of the muscles of the chest wall, which are removed in a radical mastectomy. The risk of arm swelling is increased if the auxiliary lymph nodes are completely excised, or if some of them are removed for staging and then radiotherapy is given.

There is controversy about how many of the auxiliary lymph nodes should be removed. Some surgeons claim that complete removal leads to a very low recurrence rate and makes radiotherapy unnecessary. Others prefer to perform a wide lump excision (removing the lump itself as well as a wedge of the normal tissue surrounding it), with sampling of the auxiliary nodes for prognostication, and follow it up with radiotherapy to a large area around the breast and armpit. This is a quicker operation, involving less risk of damage to the nerves responsible for sensation in the arms.

For pre-menopausal women whose auxiliary nodes are involved, surgery may be followed by adjuvant chemotherapy for 6 to 12 months.

Radical mastectomy

This operation is now uncommon. It involves the removal of the entire breast, the auxiliary lymph nodes, fat, and the pectoral muscles of the chest wall. If metastasis has not already occurred, radical mastectomy can completely remove the malignant cells. However, it does leave a long scar, a hollow chest, restricted movement of the shoulder, and loss of arm strength due to the removal of the muscles which normally allow arm movement.

Modified radical mastectomy (Patey)

In this operation the entire breast, all the lymph nodes in the armpit and the smaller of the two chest muscles are removed.

As all the auxiliary lymph nodes are removed, swelling may occur in the arm, but muscle strength is retained.

Super-radical mastectomy

Another uncommon operation, this involves radical mastectomy as well as removal of further lymph nodes known as the internal mammary and supraclavicular nodes. However, there is no evidence to prove that this operation is more effective than radical mastectomy alone.

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These include things such as stopping smoking, wearing seat-belts reducing alcohol consumption and so on. They are often extremely cheap to implement. A cost-benefit analysis on smoking and alcohol produces dramatic results. The cost of alcohol abuse and smoking accounts for one fifth of all health expenditure. When indirect costs are added the cost of smoking and alcohol abuse accounts for one quart of all the economic costs of illness. These figures would increase even more if the costs of fire losses, ca accidents and crime due to smoking and alcohol were added.

According to Dr John H. Knowles, President of the Rockefeller Foundation:

Over 99 per cent of us are born healthy am suffer premature death and disability only ñ result of personal misbehaviour and environmental conditions. . . . the individual has the ðîã indeed the moral responsibility to maintain own health by observance of simple prudent rules of behaviour. . . life is meant to be enjoyed . . . but the cost of individual responsibility health care now becomes prohibitive. The choice is individual responsibility or social failure. Responsibility and duty must gain some degree of parity with right and freedom.

So much for the costs of alcohol and smoking. The benefits are harder to quantify. The benefit could be the amount people are prepared to pay to indulge in these activities but this is probably an underestimate because presumably people prevented from smoking and drinking would need to do other things to answer the need; they have in the first place. Perhaps the cost of the drug bill would rise proportionately. A prevention plan to reduce smoking and alcohol use would, of course, cost money and there would be transitional costs as the two industries lost profits and put people out of work. Governments could, of course, compensate these industries temporarily in the interests of the nation’s health.

Even allowing for all these costs economists still think the financial advantages could be considerable. To see just how cost-effective a reduction in tobacco and alcohol use would be one need look no further than the Mormons and Seventh Day Adventists in the US who live without these drugs and have provably lower death rates and longer lives. Their healthy eating habits also give them a cancer mortality of between 50 and 65 per cent that of other Americans.

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It wasn’t until Susan Ledford discovered the power of a fresh, sweet orange that she was able to pass up her biggest indulgence and lose 43 pounds.

A member of a big Southern family that loves food, Susan is no stranger to temptation. When special occasions call for family celebrations, “it’s like a race to see who can make the most disgustingly rich casserole,” says the 36-year-old newspaper designer from Tallahassee, Florida.

Such decadent dishes were standard fare while Susan was growing up. But they weren’t kind to her waistline. She gained weight throughout her teenage years, and by her twenties, she was trying all sorts of diets in an effort to slim down. “I’d go on one diet and lose a few pounds only to watch them return when I went back to my normal eating habits,” she recalls. By age 34, she topped out at 168 pounds.

Knowing that Susan was unhappy with her figure, a friend suggested that she join Weight Watchers. The program taught Susan how to make healthy food choices and control her portion sizes. Within a year, she took off 43 pounds.

Thrilled to have finally reached her goal weight of 125 pounds, Susan was determined to stay there. But she had one dietary hurdle to overcome. Susan loved to bake cookies for her family and friends, especially around the Christmas holidays. She especially enjoyed licking the bowl and sampling each batch fresh from the oven.

Realizing that her taste-testing ways would do nothing for her hard-earned figure, Susan decided to have a healthy snack before baking. Her food of choice: a fresh, juicy orange. She found that the intense flavor of the fruit quashed her cravings for cookies. She was i able to bake to her heart’s content without eating a thing.

Thanks to her ingenious strategy, Susan had an easier time sticking with her healthy eating habits. Her weight has held steady at 125 pounds since 1998.

WINNING ACTION

Feed your sweet tooth an orange. Susan’s strategy has real scientific merit. According to Marilyn C. Majchrzak, R.D., food-development manager at the Canyon Ranch Spa/Health Resort in Tucson, Arizona, intensely flavored foods such as oranges tend to be more satisfying than bland foods. So snacking on something sweet and juicy will help reduce temptation. Keep lots of oranges, fresh pineapple, strawberries, or your favorite tastebud-shocking fruit in your fridge.

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