HEALTH NO PAIN, NO GAIN

I. THE AWAKENING

MAYBE IT began when I heard some radio talk show doctor saying, for the 50th time, the words I’ve grown to hate: “If you’re past the age of 30, be sure to get a doctor’s approval before you start an exercise program.”

Or maybe it was a line from a song. What was it-that old Kenny Rogers thing? “I just dropped in to see what condition my condition was in.” A line that good deserves a story.

For whatever reason-coupled, no doubt, with the sobering realization that yet another year was growing old and dying-I found myself with a hunger to get in shape. I was serious this time, I thought. And when I got a chance to do a story about fitness, I jumped at the chance. Well, I didn’t actually jump; it was too early for that. But the muscles that would have carried out a jump, had the order been given, stirred slightly under their winter robes of fat.

I wanted to shoot the works, have someone tell me what condition my condition was in and tell me what I could do about it. I knew that both Kenneth Cooper’s Aerobics Center and the Las Colinas Preventive Medicine Center did extensive physical examinations. I knew that both places offered excellent workout facilities. But I also knew the Aerobics Center had a waiting list that stretched farther than I could jog. Thinking that if this health business turned into a real obsession (and didn’t hurt too much), I might want to join a health club, I decided to go with Las Colinas. Why get the skinny-I mean, the facts-about my body from Cooper, then go elsewhere for my rejuvenation? Getting my physical at the Las Colinas Preventive Medicine Center didn’t mean that I’d have to join the Las Colinas Sports Club, but it was nice to know that memberships were available should I be interested.

So I went for the $550 comprehensive physical examination at the Preventive Medicine Center. Does that sound expensive? Of course it does. But if you bought two cartons of cigarettes a week during the last year or had three drinks at happy hour twice a week, you spent $550 on those wasteful, disgusting pleasures. And a waist is a terrible thing to mind.



II. QUESTIONS

Now you don’t just charge right in and get one of these physicals like you did for summer camp as a kid. No, first you answer questions-lots of questions in a packet you get from the Preventive Medicine Center. You may need a stress test just to see if you can endure this lengthy ordeal, but it’s for your own good. How complete is it? If it were any more thorough, you’d need to enclose a sample chromosome.

I begin by selecting from 37 different items in a medical history list that includes rheumatic fever, diverticulosis and malaria. Nervous exhaustion, a favorite call-in excuse, is also an option. The family health history is next, with 19 questions about father, mother, brothers, sisters, sons, daughters and grandparents.

Then it’s time to determine my current health status. Some of these questions sound innocent enough (Do you experience pain in your back or shoulders? Do you have problems with indigestion?), but some are more ominous: Have you ever coughed or spit up blood? Have you recently experienced excessive amounts of hair loss? I expect such queries to be followed by another: If you answered “yes” to the above, why bother getting into shape?

This interrogation puts me back in that paranoic frame of mind I suffered while taking my first psychology class: As the instructor described each crippling neurosis, each bizarre psychosis, I thought, My God, that’s me! Likewise with this questionnaire. Well, yes, there was some burning pain, come to think of it and I guess that does hurt a little bit. But they’re just being thorough, I tell myself. Just being thorough.

The section called “Occupational Activities” gives me the first real hint of what I’ve stumbled into. Amazingly, I see no description of the grueling, man-killing work that is journalism. “Office work” and “writing” are the closest ports of call, and both are listed as very light activities. What a joke. Nowhere do I see job descriptions like “waiting on hold for 40 minutes while listening to Guantanamera on Muzak” or “haggling with zealous copy editors over precise meaning of ’zealous.’ ” I conclude that the survey-makers know nothing of the ink-stained arts.

I whip through “Leisure and Sports Activities” in no time, mainly because, it appears, I do almost nothing. I spend at least 15 hours a week “driving a motor vehicle” and 10 hours a week reading. This dumps me once more in the “very light” category. I spy “energetic musician” down the page, wonder if that includes going to see Vince Vance and the Valiants, then decide it probably doesn’t.

None of the activities listed under “moderate” seem written in my language. Hiking (without pack), golf (carrying clubs) and “rebounding on a mini-trampoline” are all foreign to me. “Rebounding from a hangover”-no mean task-has been left off the list. Finally, under “vigorous,” I do see running. A thrice-lapsed jogger, I had started going back to the track a week before, hoping to make up for lost time and added flab. Gleefully, I start to check off “jogging,” then see the disheartening parenthetical note-10-minute mile. So the damned thing is rigged for Olympic milers.

Things take an even more somber turn when I am asked my opinions about exercise and my general lack of fitness. I “strongly agree” that I would feel better if I got more exercise. Then why don’t you? asks a haughty voice within. (I picture the voice, a frequent visitor, as belonging to the lean, bronzed swimmer I might have been.) I “somewhat agree” that people who don’t get regular exercise are risking serious health problems. I shut my ears against the voice, which rises to a mocking shriek.

Despite my chagrin, I can tell from the questions that the Las Colinas approach to fitness is realistic. They know that only rarely will people make drastic changes in the way they live. A man of mature years and pot belly may say that, starting tomorrow, he will jog four miles and swim White Rock Lake, but don’t bet the fat farm on it.

At Las Colinas, they want to know what you really think you can do, not what you think you ought to think you can do. On a spectrum from “not at all confident” to “extremely confident,” I indicate whether I think I could exercise vigorously for at least 20 minutes a day from one to six days per week. Just as important, I am asked whether I think I could get back on my schedule if I failed to exercise for days, weeks or months. My responses show a gradual ski slope of declining confidence and a pathological fear of falling off my program, assuming that I am given one and not merely dropped into the “Why Bother?” pile.

The smoking section of the questionnaire is easy for me. As a hardened 13-year- old, I smoked for about two months and even worked my way up to inhaling Camels in imitation of someone, maybe Marlon Brando in The Wild One. It was heaven, but Camels soon went up to 30 cents a pack, a rapacious increase that would have meant cutting back on my baseball card habit. Between Brando and Mantle, the Mick had it hands down. I quit smoking and never went back.

Skimming past the questions for cigar and pipe smokers, I arrive at the inevitable: the food inventory. I check the top of the page expecting a quotation from Dante: “All hope abandon, ye who enter here.” My worst fears are quickly realized. In 60 questions, I am stripped defenseless and revealed as a glutton hopelessly in love with all the wrong foodstuffs. Looking back at my painful truths, I see that my ideal composite meal would be three pieces of greasy fried chicken (skin attached), a bagel with cream cheese and a cold beer. Fruits and vegetables, which are often green, I think, are strangely absent from my gastronomic repertoire.

With a heavy sigh (and heavy thighs and stomach), I mail off the questionnaire and wait. The countdown begins.



III. I AM WHAT I HAVE EATEN

On the day of my physical examination, I approach the beautiful Las Colinas Sports Club hoping to enter as unobtrusively as possible. Somehow, the Spanish tone of the architecture makes me think of the old Spanish missions, and the thought is not incongruous: In a narcissistic age, we turn inward to worship the body. The Sports Club is nothing less than a shrine raised to the svelte, flat-gutted gods of the flesh. The body is my temple, and my temple is not only defiled but lies in ruins, sacked by chubby barbarians. For me is come the day of judgment.

My heart sinks as I push on the door. The door does not open. I heave all my strength into the task, to no avail. I am close to despair, and a primal scream wells up inside me. Aargh! I can’t even open the door! Sagging backward, I pull on the handle and of course, the door swings open. I feel a sense of foreboding.

At least I’m not alone. A D staffer has joined me so that I can observe some of what is done to him while it’s not being done to me. The staffer-I’d better call him Bob-is 42 and disgustingly healthy. While we change into our exercise clothes, he brags of cycling 6 miles to play four sets of tennis. Silently, I hate him. At 33, I represent the overweight and underexercised part of the population.

The Preventive Medicine Center’s comprehensive physical is broken into two parts and is taken on consecutive days. The first part consists of a blood test, urinalysis, measurement of height and weight, blood pressure, lung function tests, musculo-skeletal assessment, stool occult blood test and body composition analysis.

As Bob starts through the more private parts of his examination, I talk with Michael Dehn, executive director of the center. Before coming to Las Colinas, Dehn spent 10 years as an exercise physiologist at St. Paul Hospital and was a co-founder of the Dallas Cardiac Institute. Like all the staff members of the Preventive Medicine Center, Dehn, tall and bearded, radiates fitness. I begin by asking him to clarify a statement in one of the center’s brochures: “The mere absence of symptoms does not mean that you are truly healthy.”

Dehn needs no prompting to defend the still-controversial concept of preventive medicine. “Ours is not a reactive approach,” he says. “You may be fine now but have health problems when you’re 40 or 50 due to lifestyle problems now.” Dehn and his colleagues shun the word “average” when discussing a patient’s physical condition. “If you’re average in this population, you have the likelihood of getting a chronic disease. Health is not the rule, it’s the exception unless you actively pursue it.”

Ouch. But before I can get too depressed, Dehn tells me that nobody’s body is beyond help. “Something can be done for everyone, psychologically if not physiologically,” he says. “And the good news is, it doesn’t take that much effort or sacrifice.”

“We’ve done a good job in controlling diseases like influenza and hepatitis,” Dehn says, “but our lifestyle is cross-grain to healthy living. Some of our technology is our own worst enemy. Our food, our labor-saving machines and our incessant stress can cause us to overeat, overdrink and underexercise.”

I begin my examination with the body composition analysis, which will determine my percentage of body fat and my ideal weight. I am quickly staggered to learn that since I last weighed myself (was it last year?), I have gained 20 pounds and now bring the scales groaning to 200 pounds. To me, that sounds like a figure you hear announced before a wrestling match or football game. I feel stronger just knowing I can carry so much weight on a 5-foot-10-inch frame.

Las Colinas uses the skinfold caliper method of determining percentage of body fat, not the “immersion” method most often used by Cooper’s Aerobics Center. Dehn tells me that the immersionists can be a tad more accurate than the caliper people, but he believes that the tiny extra margin of accuracy is not worth the trouble of submerging the patient in a tank of water. (Fat floats and muscle sinks, remember.)

Even I know that the “ideal weight” of the coin-operated weighing machines is nonsense, but the Las Colinas people put just as little faith in insurance actuary tables. They do mention Sheldon’s body types, which I remember from a college class. You’re either an ectomorph (tall, lean), an en-domorph (inactive, tending to pudginess), a mesomorph (muscular, athletic) or some combination of the three. Only a few lucky specimens have the right genetic stuff to produce a Christie Brinkley or Tom Selleck bodv. And diet as we may, rail-thinness is not in the cards-or the genes-for all of us.

After the nurse has measured my fat deposits, the computer spits out a grim message: I am 27 percent fat. One-fourth fat! chants the jock-demon inside. My ideal fat quotient, I learn, would be around 14.8 percent, which sounds like walking sirloin to me. Then I am told that many athletes have less than 10 percent body fat, and that one UCLA running back recorded an astonishing three percent body fat. But what if he had to float? I want to ask, but refrain.

My emotional roller-coaster ride continues. Yeah, I’m one-fourth quivering blubber, but there’s a bright side. My ideal weight, says the computer, would be 173. That’s actually higher than the ideal weight I had set for myself, 165, which I quickly decide may be a bit idealistic. Ah, those small victories.

Next comes my musculo-skeletal assessment, which will determine my body structure, flexibility and the strength of certain muscle groups. This stage of the examination is important in setting up my own “personalized” exercise and stretching program. My consultant, a licensed athletic trainer, puts me through fantastic contortions as she searches for “bony landmarks” that will alert her to possible “asymmetries.” One hip may be higher than another or one leg longer than another. Such seemingly minor problems can cause trouble especially for runners, who may need shoe inserts to correct the imbalance.

Luckily, I am pronounced free of asymmetries and shown several exercises designed to build flexibility rather than strength. I am led through a series of sitting, standing and squatting exercises that focus on a given muscle group. If done correctly, these exercises make it impossible to cheat by using better-developed muscles to help out a weak group. Doing five of the new sit-ups gives me pain that lets me know I’m doing something right. I hurt, therefore I am.



IV. A HEDONISTIC INTERLUDE

Part One of the examination has been easy compared to what lies ahead: the stress test on the treadmill. The treadmill test is a “symptom-limited” test, a neat euphemism meaning you run until you drop. After the treadmill test will come my health risk assessment, dietary consultation and exercise prescription. Then will come the real challenge: finding out whether I have the gumption to put all this fine advice into practice.

To steel myself against the rigors to come, I check into the luxurious Mandalay Four Seasons Hotel just down Stemmons from the Las Colinas Sports Club. (Discounts on the physical examination are available for hotel guests.) My real motive in coming to the hotel, of course, is to have that proverbial last fling before buckling down to a new life of bean sprouts and wind sprints. Tomorrow, Sparta; tonight, Rome. I enjoy a restful happy hour at Rhapsody, the hotel’s nightclub, then dine on succulent veal at Cafe d’Or, one of the Mandalay’s two fine restaurants. Sadly, I have forgotten to make reservations for Enjolie, the highly touted five-star French restaurant.

Later, enjoying a bottle of wine in my room, I gaze out across the Mandalay Canal and hear a small voice within (not the jock-demon, but my conscience, I guess) asking me if I am not a little afraid of tomorrow. I start to reply, but the jock-demon butts in: Where’s the old grace under pressure? he wants to know. Would Hemingway be afraid of a little stress test? Irritated at being left out of the conversation, I chime in to add that Hemingway was, after all, a huge eater and drinker and was overweight most of his life, and besides, he had written himself out by the time… But my voices are ignoring me. I get up, suck in my stomach and go over to turn on the television.



IV. THE CONFRONTATION WITH THE BODY

In the morning, I report to the Preventive Medicine Center to find that Bob, the healthy one, is wired with 12 electrodes fastened to his chest. He will undergo a 12-lead electrocardiogram (ECG) while walking and running on the treadmill. The different electrodes provide different “views” of the heart in action, allowing the doctors to assess the response of the heart rate and blood pressure and detect symptoms of heart disease.

Bob’s task seems simple enough. He just has to walk fast enough to stay at a certain place on the treadmill. But the treadmill has never been beaten, not even by Olympic marathoner Kyle Heffner, a member of the Preventive Medicine Center staff. And it does not plan to start now. Every 3 minutes, the machine speeds up the pace and elevates the treadmill by 2 degrees. You get the picture. Sooner or later, someone’s got to give.

Bob has no problems through the first few minutes of the test. When he has been walking for 7:20, he is still laughing and bantering with the doctors.

Then, at 8:10, his breath comes hard for the first time. At 8:30 he is talking, but only in broken sentences. By 9:40, talking is out of the question. At 12:01, he is coughing. When he reaches 12:39, Bob’s heart is working as if he were climbing seven flights of stairs per minute. “I’m surprised at how fast I’m dying,” he manages to gasp. Then, suddenly, at 13:00, it’s over. Bob signals the doctors that he has had enough.

As for my own stress test, well, my memories are mercifully blurred. I do recall staring at a print of a brightly colored hot-air balloon as I marched. By the time the treadmill forced me into a dogged trot, the colors of the balloon were glowing brighter, shimmering and expanding. As I neared the end of my brief agony, the balloon was the only pinpoint of beauty in a universe filled with pain. I know it’s hard to believe that all this happened in 10:03, but it did. If this was that natural high runners boast about, you can have it.

The fitness level is related to the body’s ability to deliver oxygen to the muscles. The champion miler needs as much air as I do to run his mile, but he gets it easier. The predicted aerobic capacity for my age group is 42.7.I wheeze in with 38.8, which puts me down in the 24th percentile for my group. If you recall your SATs, that kind of score means I do as well as 24 percent of 33-year-olds; I do worse than 76 percent. As a result, my “functional age’-the age at which my body is actually performing-is 43.I read it and weep.

But as always, the Las Colinas people are quick to point out tangible steps toward improvement. With me, the problem is not in the heart, which is healthy enough, but in the waistline. To illustrate, Dehn hands me a 25-pound weight and asks me to walk around the room with it. I quickly get his point.

As I wince at the astounding “43” on the computer terminal, Dehn tells me that could I have endured only 90 seconds more on the treadmill, my functional age would have dropped to 28. That seems within my reach. And if I could hang on long enough to hit 95 percent of my predicted aerobic capacity, I’d be 14 again, at least functionally- and this time there would be no pimples.

For my health risk assessment I talk with Dr. Todd Rogers, clinical director of the Preventive Medicine Center. Rogers’ background is in health behavior change, and that’s what he wants to discuss-change. He has a powerful ally, a computer that’s about to put its electronic finger on the pulse of my problem.

By feeding in data about my height, weight, sex, age, eating and smoking habits, then adding the information from my stress test, Rogers gives me a computerized profile of my health risks during the next 12 years. I am prepared for anything, but the news is not so bad. At my current weight and fitness level, I carry a 1.7 percent chance of having heart trouble in the next 12 years.

My heart leaps up at this news, but then I learn that the optimal risk for my age and sex is 0.6 percent. As for my possibilities of having a stroke, no sweat: A 0.1 percent chance, which matches the optimal risk. My good marks in the stroke division are due mainly to non-smoking and a surprisingly low cholesterol count. In short, I’m doing fine with all the things that don’t show.

I leave Las Colinas Preventive Medicine Center knowing what lies ahead. I need to lose quite a bit of weight. I need to jog or do some aerobic exercise at least three times a week for at least half an hour each time. I need to change my eating and drinking habits.

I have my book of exercises and moreknowledge about my body’s needs than everbefore. Somehow, I feel hopeful. If I don’t doanything to improve myself, at least I can’tblame it on ignorance.