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PubMed2001

Sun protection practices in preadolescents and adolescents: a school-based survey of almost 25,000 Connecticut schoolchildren.

Sun protection practices in children and adolescents fall well below national recommendations. We present the results of a survey of sun protection use and other health-related behaviors in a sample of Connecticut Caucasian students aged 9 through 18 years (N = 24,645). Our objectives were to estimate the prevalence of sun protection use and to evaluate the relationship between sun protection use and health-risk behaviors and attitudes about appearance. We present data from 1988 through 1995 from the Connecticut Health Check, a health risk appraisal survey sponsored by the Connecticut Department of Public Health. Students enrolled in public and private elementary junior as well as senior high schools took the self-administered anonymous survey, which included multiple-choice questions about use of sun protection, cigarettes, and alcohol and about body image and self-esteem. We report prevalence proportions for use of sun protection by demographic features. We compared the proportion of students in 3 categories of outcome (always, sometimes, and never use sun protection) who reported various health-risk behaviors. Twenty percent of the sample reported always using sun protection; this is well below national goals set forth in the Healthy People 2000 recommendations. Sun protection use was inversely related to age and was higher among girls than boys at all ages. At all ages, students who did not use sun protection were more likely than those who did to report other health risk behaviors, such as use of cigarettes and alcohol. The data suggested that use of sun protection is associated with positive attitudes about appearance and self-image. Use of sun protection may be one component of an overall mode of health awareness and behavior. Programs promoting safe sun practices should target boys and be integrated into an overall campaign aimed at other risk-taking behaviors.

Adolescent↗
PubMed2004

Significance of intima-media thickness in femoral artery in the determination of calcaneus osteo-sono index but not of lumbar spine bone mass in healthy Japanese people.

The aim of this cross-sectional study was to investigate whether physical activity and local arterial thickening may affect bone metabolism. To analyze the effects of physical activity and atherosclerosis on bone in healthy Japanese people, health-related quality of life (HRQL) and local arterial thickening were assessed by means of the Medical( )Outcomes Study 36-item Short Form (SF-36), and intimal-medial thickness (IMT) in common carotid artery (CA) and femoral artery (FA), respectively. Bone mineral density (BMD) in lumbar spine was measured by dual X-ray absorptiometry and the osteo-sono assessment index (OSI) of the calcaneus by ultrasound. Healthy subjects (106 male and 154 female) were recruited from those who participated in a local health check program at the Osaka City University Hospital. A significant correlation existed between lumbar spine BMD and calcaneus OSI (r=0.551, P<0.0001). Among various scores in SF-36, only physical functioning score correlated weakly but significantly in a positive manner with lumbar spine BMD (rho=0.156, P=0.0147) and calcaneus OSI (rho=0.190, P=0.0024). Lumbar spine BMD correlated negatively with FA IMT (rho=-0.191, P=0.0027) whereas calcaneus OSI with FA IMT (rho=-0.199, P=0.0014). Multiple regression analyses revealed a significant association between FA IMT and calcaneus OSI, whereas lumbar spine BMD did not correlate significantly with FA or CA IMT. When subjects were restricted to female, FA IMT, but not CA IMT, still showed tendency against independent factors negatively associated with calcaneus OSI. Furthermore, lumbar spine BMD, but not calcaneus OSI, was weakly but significantly associated with increased physical functioning score independently. In conclusion, it was suggested that physical activity may affect bone strength in lumbar spine and calcaneus and that FA IMT might be a significant determinant of bone strength in calcaneus, but not in lumbar spine, in healthy Japanese subjects.

Arteriosclerosis↗
PubMed2005

Negative symptoms and specific cognitive impairments as combined targets for improved functional outcome within cognitive remediation therapy.

Negative symptoms and poor cognition are both associated with poor functional outcome in schizophrenia. This poor functional outcome has been attributed to poor cognition rather than any independent contribution from symptoms. Identifying target cognitive processes and mechanisms that predict community function, and possible moderator effects of negative symptoms, will allow the development of cognitive remediation programs that are successful in improving functional outcome. A referred sample of 53 in- and outpatients with schizophrenia with general cognitive impairment (including 28 with severe negative symptoms) and 22 healthy controls, balanced for premorbid IQ, were compared cross sectionally on measures of community shopping skills, executive function, and working memory. Across the groups, there were direct relationships between community functioning and specific executive functions, and there were interactions between group membership and the types of associations found. Working memory was independently associated with accurate community functioning only in people with schizophrenia and negative symptoms. This association was not due to the sole presence of working memory impairment or just to negative symptoms. Poor community function is predicted both by specific cognitive impairments that are prominent in people with negative symptoms and through the moderating effect of negative symptoms on the working memory-community function relationship. This may reflect a synergistic association between symptoms and cognition: negative symptoms arise from cognitive impairment but also impact detrimentally on working memory functioning. Both cognitive processes and negative symptoms should be targeted in cognitive remediation to effect the greatest change in community functions.

Adult↗
PubMed1998

Predilection for frailty remedial strategies among black and white seniors.

BACKGROUND: Frailty prevention and remedial programs based on exercise, hormone replacement, and vitamin supplementation are becoming available for use with older patients, but success of these programs depends largely on seniors' willingness to participate. METHODS: We evaluated preferences for specific aspects of these programs using a sample of 359 older persons recruited from potential delivery sites. Main effects and subgroup analyses were done. RESULTS: Subjects preferred stretching, chair-based, walking, and dynamic balance exercises over lifting weights, dancing, hormone and vitamin therapy; exercising alone in their own homes over exercising in groups; and vitamins over hormones. Preferences were affected to some extent by sex, race, recruitment site, and functional status. However, subjects' willingness even to consider exercise was rarely as high as the desired levels of participation set forth in Healthy People 2000. CONCLUSIONS: Physicians and public health authorities need to educate older persons about effective methods to prevent or treat frailty.

Accidental Falls↗
PubMedDate not supplied

[Statistical analysis of data from glaucoma examinations].

Early detection of glaucoma can be achieved through prophylactic screening of population. This leads to a sharp increase in the patients' flow and deprives the physician of a possibility to examine them by routine methods. Such examinations will be feasible if to reduce the procedure time by automation, or to cut the examination program after the analysis of the existing medical programs by mathematical methods. The authors have used the method of linear discriminant functions which permits one on the basis of the medical data statistical analysis to learn the informativeness of diagnostic symptoms and decisive rules to form risk-groups of the patients who need more thorough medical examination. The analysis accomplished has indicated that there is no closely interlaced symptoms. Among most informative there are signs considerably differing in their statistical characteristics. The diagnostic rules proposed in this article provide adequately high accuracy in selection of healthy people groups and, as well, the patients with suspected glaucoma or suffering this disease.

Glaucoma↗
PubMed1998

Gait biomechanics are not normal after anterior cruciate ligament reconstruction and accelerated rehabilitation.

PURPOSE: Accelerated rehabilitation for anterior cruciate ligament (ACL) injury and reconstruction surgery is designed to return injured people to athletic activities in approximately 6 months. The small amount of empirical data on this population suggests, however, that the torque at the knee joint may not return until 22 months after surgery during walking and even longer during running. Although the rehabilitation has ended and individuals have returned to preinjury activities, gait mechanics appear to be abnormal at the end of accelerated programs. The purpose of this study was to compare lower extremity joint kinematics, kinetics, and energetics between individuals having undergone ACL reconstruction and accelerated rehabilitation and healthy individuals. METHODS: Eight ACL-injured and 22 healthy subjects were tested. Injured subjects were tested 3 wk and 6 months (the end of rehabilitation) after surgery. Ground reaction force and kinematic data were combined with inverse dynamics to predict sagittal plane joint torques and powers from which angular impulse and work were derived. RESULTS: The difference in all kinematic variables between the two tests for the ACL group averaged 38% (all P < 0.05). The kinematics were not different between the ACL group after rehabilitation and healthy subjects. Angular impulses and work averaged 100% difference for all joints (all P < 0.05) between tests for the ACL group. After rehabilitation, the differences between injured and healthy groups in angular impulse and work at both the hip and knee remained large and averaged 52% (all P < 0.05). CONCLUSIONS: Results indicated that after reconstruction surgery and accelerated rehabilitation for ACL injury, humans walk with normal kinematic patterns but continue to use altered joint torque and power patterns.

Adult↗
PubMed1995

Breast Cancer Screening among Employed American Women.

From the 1990 National Health Interview Survey Health Promotion and Disease Prevention supplement, the authors estimated the 1990 baseline prevalence of breast cancer screening among employed U.S. women aged 50-70 years. Proportions of women screened for breast cancer were calculated by occupational category and demographic characteristics, and were compared with the Healthy People 2000 objective that 60% of women aged 50 and older have had mammography and a clinical breast examination within the preceding two years. The objective was exceeded for white-collar workers (61.8%) and workers with some college (64.1%), but was not met by any blue-collar/service workers (40.8%); or any workers with only a high school diploma (54.7%) or less than a high school diploma (38.5%). Identification of occupational categories and demographic subgroups among working women will be helpful to those planning breast cancer screening programs, in both the public and the private sectors.

Journal Article↗
PubMed1992

Personal renewal.

After John Gardner's presentation on "Self-Renewal" to THE WESTERN JOURNAL OF MEDICINE Editors' Meeting, (*) Joseph Murphy, MD, Special Editor for Wyoming, asked the former Secretary of Health, Education, and Welfare, "Where are you in your life's cycle?" Dr Gardner, who is 80 years old, answered, "When Chief Justice Oliver Wendell Holmes, Jr, was in his 90s, he was asked a similar question and said, ;I'm like a race horse cantering along after the race is over, cooling down.' Well, I'm nowhere near cantering! I'm still in the race, pushing the world." race, pushing the world."John Gardner, who received his undergraduate degree from Stanford and PhD from the University of California, Berkeley, taught at the college level for several years before he joined the Carnegie Foundation. As president of Carnegie Corporation and Carnegie Foundation for the Advancement of Teaching, he began to "push the world" toward education and in 1964 received the country's highest civilian honor, the Presidential Medal of Freedom. He has also pushed it toward political reform by founding Common Cause, toward grass-roots political action by founding the Urban Coalition, toward leadership training by founding the White House Fellows program, and toward volunteerism by founding the Independent Sector (a coalition of for-profit and not-for-profit organizations and foundations). His books, including Excellence, Self-Renewal, No Easy Victories, and On Leadership, have pushed readers to new understanding of themselves and of organizations to higher levels of creativity and energy to get important work done. His current research focuses on discovering and defining the characteristics of healthy, vital communities. His call to "keep on keeping on," indeed, to push the world, leads to constructive change. Active people become effective people, infused with the energy and optimism that good hard work inspires. I think you will find this paper as invigorating to read as it was to hear.

Aging↗
PubMedDate not supplied

Closing the gap between literature and practice: evaluation of a teaching programme (in the absence of a structured treatment) on both type 1 and type 2 diabetes.

Athough education is considered an integral part of diabetes management, it remains low in the practical priorities of clinicians. We performed the first structured educational intervention in a diabetic outpatient department, where patients were controlled with no provider autonomy support available. We recruited 77 Type 1 (T1DM) and 154 Type 2 diabetic (T2DM) patients as well as 87 matched control subjects. Baseline evaluation included: medical interview; questionnaires concerning diabetes knowledge, diabetes quality of life, state-trait anxiety, depression and general perceived self-efficacy; biochemical examination (fasting blood glucose, HbA1c, lipids, uric acid, urinary glucose and albumin excretion). Of the 231 diabetic patients, 154 agreed to attend an educational course, yet only 101 patients (37 T1DM and 64 T2DM) completed it (intervention group) due to organisational barriers. Intervention and reference (non-participant patients) groups received identical medical care, except that the educational group met with the educator during five teaching sessions. Three to six months after the completion of the course, they underwent a final assessment. Prospective results were: 1) in T1DM, a reduction in HbA1c levels and an increase in plasma HDL cholesterol with no change in drug treatment (the reference group showed no change in HbA1c values despite an increased insulin dose), improved technical skill, knowledge, quality of life and self-efficacy; 2) in T2DM, a reduction in fasting plasma glucose and an improvement in knowledge and quality of life. Analysis of the cross-sectional data at baseline evidenced: 3) the same levels of anxiety, depression and general self-efficacy in diabetic patients compared with healthy control subjects; 4) lower diabetes-specific quality of life associated with established insulin treatment in T2DM; 5) significant gender differences among healthy as well as diabetic subjects in degree of psychological distress. Education by itself is more than simply offering information to people (even in a troubled context) and its infrequent incorporation in practice really contradicts resource efficiency.

Adult↗
PubMed2005

The impact of considering adaptation in health state valuation.

Patients with chronic health conditions often rate their quality of life (QoL) significantly higher than non-patients. One explanation for this discrepancy is that non-patients focus on the negative aspects of the onset of a condition, especially the early difficulties people face when they first experience a debilitating condition, without considering that patients can adapt to it over time. To test this hypothesis, we had 359 people perform person tradeoff (PTO) elicitations in an online survey, varying whether the treatment programs under consideration saved the lives of patients (a) with pre-existing paraplegia; or (b) who would experience new onset of paraplegia. Half of each group completed an "adaptation exercise" which encouraged them to consider their own ability to emotionally adapt to negative events in general and specifically to having paraplegia. The adaptation manipulation increased the value participants placed on pre-existing paraplegia (p=0.03) and on new onset paraplegia (p=0.05), relative to saving healthy lives. Moreover, the adaptation exercise dramatically reduced the differences between evaluations of pre-existing and new onset paraplegia to values within 2% of each other. Our findings suggest that asking non-patients to do an adaptation exercise before giving QoL ratings may help close the gap in ratings between patients and citizen non-patients.

Adaptation, Psychological↗
PubMed1999

Effects on regional brain metabolism of high-altitude hypoxia: a study of six US marines.

Previous studies of brain glucose metabolism in people indigenous to high-altitude environments uncovered two response patterns: Quechuas native to the high Andes of South America sustained modest hypometabolism in most brain regions interrogated, whereas Sherpas, native to the Himalayas and considered by many biologists to be most effectively high-altitude adapted of all humans, showed brain metabolic patterns similar to lowlanders, with no acclimation effects noted. In the present study, the database was expanded to include hypoxia acclimation effects in lowlanders. Positron emission tomography (PET) and [(18)F]-2-deoxy-2-fluro-D-glucose (FDG) imaging techniques were used to assess regional cerebral glucose metabolic rates (rCMR(glc)) in six US marines (Caucasian lineage) before and after a 63-day training program for operations at high altitudes ranging from 10,500 to 20,320 ft. Significant changes in rCMR(glc) were found for 7 of 25 brain regions examined. Significant decreases in absolute cerebral glucose metabolism after high-altitude exposure were found in five regions: three frontal, the left occipital lobe, and the right thalamus. In contrast, for the right and left cerebellum significant increases in metabolism were found. The magnitudes of these differences, in terms of absolute metabolism, were large, ranging from 10 to 18%. Although the results may not be solely the result of lower oxygen levels at high altitude, these findings suggest that the brain of healthy human lowlanders responds to chronic hypoxia exposure with precise, region-specific fine tuning of rCMR(glc). The observed short-term hypoxia acclimation responses in these lowlanders clearly differ from the long-term hypoxia adaptations found in brain metabolism of people indigenous to high-altitude environments.

Adult↗
PubMed1997

Why do healthy elderly people fail to comply with influenza vaccination?

OBJECTIVE: to assess motivating factors of healthy elderly people to comply with influenza vaccination. DESIGN: survey of healthy elderly people invited by mail by their general practitioner to come for influenza vaccination. Compliance and the personal characteristics of gender, age and medical insurance were recorded by the general practitioner. A postal questionnaire assessing socio-psychological factors was sent to all non-compliant patients and to a random sample of 30% of the compliant patients. SETTING: seven family practices with a total of 26,000 patients in The Netherlands. PATIENTS: 505 healthy elderly people over 65. MAIN OUTCOME MEASURES: odds ratios (ORs) for non-compliance by personal characteristics and socio-psychological factors, adjusted by multiple logistic regression analysis; decisive reason whether to comply. RESULTS: non-compliance was 16%. Correlations between personal characteristics and non-compliance were low, except for age: those under 75 were less compliant than those over 75. Elderly people endorsing the statement about the vaccine's serious side-effects displayed the highest non-compliance [adjusted OR 216; 95% confidence interval (CI) 16.2 to 2883]; patients judging their own health to be good were also less compliant (adjusted OR 57.9; 95% CI 4.4 to 770). The belief of not being susceptible to influenza was the most frequently mentioned reason for not complying, while the general practitioner's mail cue was the most common reason for complying. CONCLUSIONS: in healthy elderly people, fear of the side-effects of influenza vaccination and perceived good health seem to be the main factors leading to non-compliance. Better and more specific information about the paucity of systemic side-effects should accompany the invitations.

Aged↗
PubMedDate not supplied

Graduating medical students' exercise prescription competence as perceived by deans and directors of medical education in the United States: implications for Healthy People 2010.

OBJECTIVES: This study examined perceptions of deans and directors of medical education at 128 allopathic schools of medicine in the US about the importance of physical activity and exercise topics, and their perceptions about the competence of graduating medical students to perform six fundamental skills related to exercise prescription. Healthy People 2010 recommends that clinicians counsel all patients about regular physical activity. However, in previous studies physicians identified lack of training as a barrier to physical activity counseling, and they questioned their own ability to advise patients properly. METHODS: Using the 17-item Exercise and Physical Activity Competence Questionnaire, data were collected from 72 of 128 medical schools, for a response rate of 56%. RESULTS: While 58% of respondents indicated their typical graduate was competent in conducting a patient evaluation for the purpose of approving that patient to begin an exercise program, only 10% said their students could design an exercise prescription. Only 6% of respondents reported that their school provided a core course addressing the American College of Sports Medicine Guidelines for Exercise Testing and Prescription. CONCLUSIONS: Findings suggest a need for more undergraduate medical training in physical activity and exercise prescription.

Adult↗
PubMedDate not supplied

[Epidemiology of obesity in adult population of Vojvodina].

INTRODUCTION: The prevalence of overweight and obesity is increasing worldwide at an alarming rate and is due to changes in nutritional patterns and physical activity that adversely affect the health status. Obesity is a complex disorder with multiple interactive causes. It is associated with many chronic, debilitating diseases with important health care cost and it is basically the consequence of sedantery life style and excessive energy intake. Our objective was to measure the prevalence of obesity in adult population of Vojvodina and to describe its characteristics. MATERIAL AND METHODS: This cross-sectional study was conducted in representative sample of 2467 adults from Vojvodina (in adult population of Vojvodina aged 20 years and over). The sample size was determined based on estimated frequency, exposition to risk factors, relative risks and level of statistical significance. All those who completed household interviews attended physical examination. RESULTS: The prevalence of overweight and obesity (BMI> or =25 kg/m2) in both sexes was 58.5%. Among them, 35.5% were overweight while 23% were obese (BMIl30kg/m2). The frequency of obesity was higher among females (26%) than among males (19.6%) (p<0.01). It showed a steady increase to the age of 65, after which the number of obese decreased. The obesity rate was higher in rural (26. 7%) than urban areas (19%) (p<0.01), and among people with lower level of education and socioeconomic status. CONCLUSION: Considering the existing situation concerning the high prevalence of obesity, urgent public action is necessary. It is essential to develop preventive strategies which would affect the whole society. Healthy lifestyle, balanced diet and increased physical activity must be promoted. However, it is not the responsibility of individuals. Health services, the community, food industry, mass media etc, have a crucial role in modifying body weight. Strategies for prevention and management of obesity should be in accordance with the existing public health policy and programs for prevention of noncommunicable diseases.

Adult↗
PubMed2000

Occupational and adult lead exposure in Wisconsin.

Lead is a versatile metal with many industrial applications. It is among the oldest recognized occupational health hazards. Lead poisoning has been a reportable disease in Wisconsin since 1911. Although reportable, it was not until Wisconsin established an Occupational and Environmental Health Epidemiology program in 1979 that modern reporting levels were adopted, physician and laboratory reporting promoted and publicized, and elevated blood lead report tracking initiated. With the federal funding from the National Institute of Occupational Safety and Health (NIOSH), a comprehensive adult blood lead surveillance program was created in 1987. Eleven years of surveillance trend data reveal a Wisconsin success story. Most Wisconsin industries have made substantial strides toward reducing occupational lead exposure. The improvement is reflected in the reduced number of elevated blood lead levels in Wisconsin's adult blood lead surveillance data. However, Wisconsin must remain vigilant as new and re-emerging lead exposures continue to be identified through adult blood lead surveillance. Wisconsin will also need to continue with its occupational lead exposure reduction efforts if it is to achieve the Federal Healthy People 2010 goals and objectives to have no adult blood lead level greater than 25 micrograms/dL.

Adult↗
PubMedDate not supplied

[The problem of the aged person living alone: a methodological proposal for a pilot project of the aged person's and university student's cohabitation].

The objective of the present study was to evaluate the outcome of a promotion program for the cohabitation between healthy living-alone-old person and university student. The study aimed to highlight the benefits of both the parts in terms of psyco-physical behaviour of the old subject and of logistic and financial support for the student. The survey was carried out between 1998 and 2000 on voluntary couples of old person-university student living in Padua. The study quantified the level of satisfaction of the material needs of the both parts and it also showed the affective relationship established between the old people and the young subjects.

Activities of Daily Living↗
PubMed2005

Surveillance for certain health behaviors among states and selected local areas--Behavioral Risk Factor Surveillance System, United States, 2003.

PROBLEM: Data on health risk behaviors (e.g., cigarette smoking, binge drinking, and physical inactivity) for chronic diseases and use of preventive practices (e.g., influenza and pneumococcal vaccination for adults aged > or =65 years and cholesterol screening) are essential for developing effective health education and intervention programs and policies to prevent morbidity and mortality from chronic diseases. Continuous monitoring of these behaviors and practices at the state, city, and county levels can help public health programs in evaluating progress toward improving their community's health. REPORTING PERIOD COVERED: Data collected in 2003 are presented for states, selected metropolitan and micropolitan statistical areas (MMSAs), and their counties. DESCRIPTION OF THE SYSTEM: The Behavioral Risk Factor Surveillance System (BRFSS) is an ongoing, state-based, random-digit-dialed telephone survey of the civilian, noninstitutionalized U.S. population aged > or =18 years. All 50 states, the District of Columbia, Guam, the Commonwealth of Puerto Rico, and the U.S. Virgin Islands participated in BRFSS during 2003. Within these states and territories, 105 MMSAs and 153 counties that reported data for at least 500 respondents or a minimum sample size of 19 per weighting class were included in the analyses. RESULTS: Prevalence of high-risk behaviors for chronic diseases, awareness of certain medical conditions, and use of preventive health-care services varied substantially by state/territory, MMSA, and county. The proportion of the population that achieved Healthy People 2010 (HP 2010) objectives also varied by state/territory, MMSA, and county. Twelve states, 39 MMSAs, and 65 counties achieved the HP 2010 objective to reduce the proportion of adults who engage in no leisure-time physical activity to 20%. Twenty states, 41 MMSAs, and 63 counties achieved the HP 2010 goal of 50% of adults engaging in moderate physical activity for at least 30 minutes per day. The HP 2010 goal of 30% of adults who engage in vigorous physical activity was achieved by 17 states, 33 MMSAs, and 57 counties. Two states, one MMSA, and one county achieved the HP 2010 current cigarette smoking goal of 12% prevalence. One county achieved the HP 2010 binge drinking goal of 6% prevalence among adults. One MMSA and eight counties achieved the HP 2010 goal of 15% for obesity prevalence. The HP 2010 goal for influenza and pneumococcal vaccination coverage of 90% was not achieved by any state, MMSA, or county. No state, MMSA, or county achieved the HP 2010 objective of 17% prevalence of high cholesterol among adults. INTERPRETATION: The findings in this report indicate substantial variation in health risk behaviors and use of preventative services among adults at state and local levels, indicating a need for appropriate public health interventions and continued efforts to evaluate public health programs and policies and health-care-related efforts designed to reduce morbidity and mortality. PUBLIC HEALTH ACTION: Data from BRFSS are useful for assessing national health objectives, for identifying and characterizing at risk populations, and for designing and evaluating health promotion and disease prevention programs and policies. The 2003 BRFSS data indicate a continued need to develop and implement health promotion programs for targeting specific behaviors and practices and provides information for measuring progress towards achieving disease prevention and health promotion goals at state and local levels.

Behavioral Risk Factor Surveillance System↗
PubMed1983

Employee health and fitness: the state of the art.

Health care and health promotion measures currently are undergoing critical cost/benefit or cost/effectiveness scrutiny. An employee fitness program offers a convenient means for realizing community goals of lifestyle change but also has the potential to augment worker productivity. The costs of exercise testing and program development for an employee program ($100-$350 per participant year, measured in 1982 U.S. dollars) compare favorably with nonoccupational approaches to the promotion of fitness and a healthy lifestyle. The combined savings from a reduction of appraised age, improvement in lifestyle, decreased use of hospital and physician services, decrease in absenteeism and employee turnover, improved productivity, and decreased need for geriatric care substantially exceed the likely outlay. Given a 20% participation rate, the order of benefit from these factors is over $700 per year for each member of the labor force. In a company employing 1,000 people, a cost of perhaps $40,000 for 200 participants would yield a dividend of $650-$700,000 per year. Arguments continue on the specificity of exercise-induced gains in health and performance, but the burden of proof rests with those who maintain that equal benefits could be obtained from other tactics.

Absenteeism↗