With their professional staff’s expertise, health clubs can help consumers on their path to achieve optimal health, thereby minimizing the use of the healthcare system. If a visit to a physician’s office is considered primary care, then a visit to a health club should be considered primary-primary care.

Health clubs have earned their place in healthcare by helping consumers stay healthy and away from illness and injury. They have promoted programs that prevent, control and reverse disease through exercise and promotion of healthy habits (see Figure 2).

Consumers can obtain quality preventive healthcare at health clubs through health education, community-based fitness programs, medically-managed fitness programs and secondary disease prevention.

Health clubs are an excellent purveyor of selected health services for several reasons. They are geographically distributed to create ease of access for regular participation in preventive programs, and they have excess capacity to meet increasing volumes of interested consumers. The shift in healthcare to preventive service is a great opportunity for health clubs.

Speaking at the satellite symposium (see p 1), Dr. Stephanos Hadziyannis (Hippokration Hospital, Athens, Greece) presented preliminary data from an ongoing multicenter, international, open-label clinical trial designed to evaluate the efficacy of daily induction dosing with IFN alfa-2b in previously untreated (naive) patients infected with HCV. The aim of the study is to evaluate the effect of daily IFN alfa-2b induction therapy versus standard three-times-weekly (TIW) therapy on viral clearance and load and to identify whether a dose response occurs with IFN alfa-2b using these regimens. This study also will evaluate the efficacy of IFN alfa-2b/ribavirin combination therapy; these results are not yet available.

Patients enrolled in this trial received IFN alfa-2b (3-, 5-, or 10-MU doses) given either in the standard TIW regimen or daily for 2-4 weeks. A central virology laboratory (National Genetics Institute, California, USA) was used to quantitate viral load in all patients enrolled in the study; the technique used to determine viral load has a level of quantitiation of 100 viral copies/mL. Viral titers were obtained frequently in each patient during the first week (baseline and at 12, 24, 48, 72, 120, and 168 hours) and twice weekly during the remaining 3 weeks of the induction period. Preliminary data were available on 62 patients. Although there was some genotype imbalance because of the limited enrollment to date across the multiple arms of the study, baseline viral loads were similar among the treatment groups.

Overall, daily IFN dosing resulted in better viral suppression compared with TIW dosing. Although patients receiving TIW dosing with either 3, 5, or 10 MU demonstrated a moderate decline in viral load, virus remained detectable at the end of week 4 in the majority of these patients. Daily dosing resulted in much greater declines in HCV RNA; by week 2, patients receiving daily doses demonstrated a 2- to 3-log decline in viral load and virus was not detectable in some patients. At week 4, similar declines were observed. These preliminary findings seem to demonstrate that daily IFN alfa-2b dosing produces an earlier and more pronounced reduction in viral load (Figure 1). Further, higher doses seem to result in better viral suppression. When comparing HCV RNA reduction for similar total doses administered over 4 weeks, it was apparent that daily dosing was more effective than higher TIW dosing in decreasing viral load (Table 1), suggesting that the dose effect was related to the administration schedule.

No patient required dose interruption or reduction. The most frequent adverse event reported was low-grade fever (grade 1: 30/62 patients; grade 2: 13/62). Grade 1/2 myalgia and depression each were reported infrequently (8/62 and 4/62, respectively). While there were no toxicity differences between the daily and TIW treatment arms, Dr. Hadziyannis commented that patients receiving daily therapy seemed to tolerate IFN better and that patients going to TIW therapy after daily dosing preferred daily dosing. It is hypothesized that this might be due to achievement of steady-state IFN levels rather than constantly fluctuating levels.

These preliminary results demonstrate that daily dosing produces an earlier and more pronounced decrease in viral load compared with TIW dosing. There appeared to be a trend for improved response with higher daily doses. In patients infected with HCV genotype 1b, there was a significant reduction in viral load only when doses of 5 or 10 MU daily were used. Daily IFN alfa-2b dosing also was effective in patients infected with HCV genotype 1b. Of the 6 patients infected with HCV genotype 1 b who received IFN alfa-2b 5 or 10 MU daily, 4 had undetectable HCV RNA levels at the end of the induction period; another patient experienced a 3- to 4-log decline in viral load during this time period. Accrual to the study is continuing, and additional data will be subsequently reported.

Global calls are not so pricey or limited now. The easiest and most convenient way to make cheap phone calls is by buying cheapest international calling cards.

Since the inaugurallaunch of group cyclingin 1995, it has undergone bothridicule and praise. Group cycling has been praised as a fun and safe activity, yet it has been ridiculed due to the sometimes inappropriate use of the bikes.

Class members riding without seats, using hand weights and rubber bands, and using inappropriate intensities have brought negativeattention to group cycling.

If performed properly, however, and if catered to its participants, group cycling has many benefits.

How can a club maximize the success of group cycling? Points to consider when implementing a programinclude facilitation, physiology, biomechanics and kinematics.

Those who take Natural Hgh will receive more benefits than they would from synthetic HGH injections and products. To begin, the Natural Hgh products made of real HGH are made from naturally existing extracts and herbs that act the same as the hormone that is secreted by the gland that produces the natural hgh, the pituitary gland, which is located in the brain; next, cause the purity levels of the exclusive blends which go into the formulas of Natural Hgh powders and sprays, they are highly effective, and far less costly than then the more expensive albeit fast acting choices.

Why is it, then, that Natural Hgh is considered to be a good buy?

The fact that it is easy to buy and use and is reliably efficient makes Natural Hgh a excellent order for customers in the know; there’re many e-commerce sites that also provide deep discounts on the permanent price of Natural Hgh products, which come in either spray, powder or pill form, and as such, we see relatively fewer side effects with these products when compared to the synthetically produced versions. Because they can be found as a capsule or a tablet, Natural Hgh supplements are easy to take, even in homoeopathic HGH supplements, which helps make sure you get all the advantages of organic HGH in little amounts, over a time of several months. Natural Hgh are, therefore, a smart option for those people who are eager to reinvigorate their body’s opportunity to absorb stress, handle more activity, and boost their general vigor and vitality. In addition to the above, while the results from Natural Hgh therapy may appear more slowly than will the effects of synthetic HGH releasers, they will, however, be safer as synthetic HGH releasers can have harmful effects. So, in order to achieve an effective hormone level, Natural Hgh has been suggested by both doctors and patients who have evaluated the reliability of this product when considering which HGH products work best at stimulating the production of human growth hormone.

“We thought, ‘how can we draw attention to ourselves in such a busy environment where we looked like everybody else?’” says Libby Donathan, Center for Health Promotion manager. “We knew this program would be time-consuming but that’s our job — health promotion is what we do.” Costumes represent monthly health-promotion themes. For example, during Family Health Month, wellness staff dressed as “The Flinstones” and distributed immunization guides; for Men’s and Women’s Health Issues, two staffers dressed as a bride and groom and passed out men’s and women’s health journals; and for Summer Safety Month, hospital employees were visited by crash-test dummies, who distributed literature on auto and boat safety, along with UV-protection sunglasses.

“The employees look forward to seeing us every month,” Donathan says. “They have even given us suggestions for future costumes and themes. They laugh and smile about wellness now, instead of grumbling.” In fact, the suggestion of dedicating April “Humor Month” came from hospital employees, Donathan says. For this theme, staffers dressed as the Riddler from Batman and distributed literature on stress management.

Since starting the program in September 1994, Donathan says 700 new members have joined the wellness center (a 133-percent increase), and overall health awareness has increased 20 percent.

In addition to having made wellness more entertaining, Donathan says the “Wellness Walk Thru” program has succeeded for one simple reason: “Most institutions rely on people coming in their front door. Instead of waiting for people to come see us, we take our programs to them.”

So, Ted said it was a long story and that nothing happened.

I perceived Ted’s response to be something other than a denial. I heard someone who thought that a situation had been worked out and that he simply did not want to go into detail about Ghandia’s business. I actually thought that Ted took the high road. He respected her privacy.

He could very easily have said, “Whoa, wait a minute! What did she say? She was spooning back at ME! She grabbed my arm and held it around her. SHE is the one who’s always touching me, leaning on me. She is the one who suggested we sleep next to each other.

She was raped and now she is overreacting because she still isn’t over that trauma.” But he didn’t. He just tried to let it die so that Ghandia’s personal life isn’t dragged out for the world to see. “It’s a long story. A mistake happened and I rectified it.”

And when he said nothing happened, I’m guessing that he meant that nothing happened that should be made into a big deal.

Brian told Helen that Ted said nothing happened. Helen promptly went over and relayed this to Ghandia.

Marketing is always a challenge for a small business — it can be a real struggle to build awareness about your company, products and services.

Don’t believe that the Internet makes marketing any easier. Experience has shown that you can’t simply place a bunch of brochures on-line and hope that people will stumble across them. You have to provide compelling information in order to draw people to your site.

Then, once they are there, you can nudge them toward your marketing materials.

Fortunately, there are some good sites to help you understand the concept of Internet marketing. A good example of a small business Web site that works can be found at http://www.grasmick.com, titled the Canada to U.S. Business Immigration Home Page.

Through this site, Joseph Grasmick, a Buffalo lawyer and immigration specialist, sets out to provide the visitor with detailed information on what is involved in immigrating to the United States.

The site is effective because Mr. Grasmick recognizes that many people using the Internet to deal with this issue aren’t looking for an immigration lawyer — they are looking for answers to questions about
immigration law.

He provides substantial material on-line to help answer these questions, and as a result, his Web site has gained attention as one of the best places to learn about immigration issues regarding Canadians going to the United States.

The key point is that throughout the site, Mr. Grasmick gently suggests to visitors that if they want to do it right, they should contact him. He includes a link to information about his firm, client testimonials and other marketing literature. Mr. Grasmick says he wins a fair chunk of business through the Internet.

Such thinking is reflected at home.istar.ca/~gadus/index.html, the Web site of Gadus Associates of Musquodoboit Harbour, N.S. Right off the bat, the site says it is “your source for information and support” in marine fisheries science.

Trevor Kenchington, a fisheries expert and the principal of this consulting firm, created the site to provide a comprehensive index of marine fisheries data on-line.

People looking for answers to questions in this field are likely to stumble across his site and also will likely read about the services offered by the company. Dr. Kenchington is the first to admit that he has won consulting projects directly because of this site.

Finally, consider telecommunications guru Ian Angus and his company Angus Telemanagement Group (http://www.angustel.ca). Some years ago, he established an on-line newsletter, Telecom Update, now sent every Monday to about 15,000 subscribers. Each issue contains a summary of important events in the Canadian telecom industry.

His effort helps to keep his company in the mind of potential clients and most importantly, contains a plug every week to some service that he offers.

That’s the type of marketing that works on the Internet: Create content that will draw people to your site or that will keep your name in front of them. In doing so, subtly lead them toward your promotional literature at your Web site.

While none of these sites use flashy technology, they are effective and potent examples of on-line marketing.

There exist numerous causes wherefore a client want to buy a prepaid phone cards and the most important, most frequent purpose is that they saves capital.

The elliptical study

Since research on elliptical trainers is so limited, a two-part study was conducted at the University of Wisconsin-La Crosse to shed some light on the effectiveness of these new machines.4 The first portion of the study compared the intensity of a workout on an elliptical trainer to several other common exercise modalities. Specifically, the study compared exercising on the NordicTrack Ellipse to running or walking on a Trimline 1000 motorized treadmill, stepping on a Precor 921e hydraulic stepper and riding a Tunturi cycle ergometer. The second portion of the study involved documenting the vertical ground reaction forces in the feet while exercising on these modalities. One of the major problems with jogging and other high-impact aerobic activities is, because the body becomes airborne and has to land, forces equal to 24 times a person’s body weight must be absorbed on landing. These forces are initially absorbed by the foot and then are transmitted to the ankle, knee, hip or back, often resulting in injury.

Sixteen volunteers between the ages of 27 and 54 practiced on each machine until they were comfortable setting workloads and consistently exercising on them. The participants then completed a 20-minute exercise bout on each modality on a separate day.

Each bout was conducted at a self-selected intensity. This model is more realistic for the public, as most people who buy or use exercise equipment tend to exercise at their own pace. During each exercise bout, oxygen consumption, heart rate, ratings of perceived exertion and caloric expenditure were recorded.

On a separate day, the subjects completed a 5-minute bout of exercise on each modality and had vertical ground reaction (impact) forces measured in their feet. This was accomplished by placing a wafer-thin insert into both shoes. These inserts were interfaced with a computerized program that measured force production throughout the entire gait cycle. Peak forces were then determined, which were subsequently represented as a percentage of each subject’s body weight.

Since implementing the program in January 1995, “our service has never earned less than a 4.7 rating out of a possible 5.0,” Haskins says.

Spotlight on achievement
AlliedSignal Employee Health & Fitness Center
Morristown, N.J.
Fitness Achievers and Wall of Fame Program

Role models may not be easy to come by, but at the AlliedSignal Employee Health & Fitness Center in Morristown, N.J., the facility is full of them. After all, they’re the members.

Each month, the facility recognizes two members (male and female) by displaying their outstanding fitness accomplishments on the corporate fitness center’s Wall of Fame. Displays include member biographies, photos and personal fitness statistics, including improvements in upper-body strength, cardiovascular capacity, total cholesterol, body weight, body fat and more.

According to Program Manager Christine Kane Haskins, the Wall of Fame not only inspires fitness achievers to continue leading a healthful lifestyle, but motivates and attracts other members to make serious commitments to an exercise program. “Members are chosen based on facts and data, not popularity,” Haskins says. “Members enjoy reading the interesting biographies and often say, ‘What do I need to do to be chosen?’”

As of September, the program identified 20 outstanding achievers, all of whom received recognition on the Wall of Fame, as well as “Fitbucks” to be used to purchase items from the pro-shop.

In addition to spotlighting current fitness achievers, the Wall of Fame demonstrates ongoing recognition of all past achievers by continuing to post their names, photos and month of achievement. Bulletin boards are designed in a clean, professional manner, and are organized and color-coded. “Our creative displays attract many potential members and tours because of their professional appearance,” Haskins says. “Departments and work teams continuously tour the center to benchmark our visual displays.” Haskins says all displays are made in-house with materials purchased in bulk, keeping the cost of the program low.

Fee plan ‘charters’ retention
Aero-Fitness Health Center
Oklahoma City, Okla.
Sliding Fee Scale for Charter Members
Aero-Fitness, a newly opened commercial fitness facility, wanted to ensure long-term retention right from the beginning. To do so, it created an innovative reward program for its members. The “charter membership program” was promoted for three months, and guaranteed that the club would decrease fees each year of a four-year period for members who maintained monthly memberships without interruption.

The program enabled the club to stabilize its monthly dues revenue during normally low usage periods. Additionally, it allows Aero-Fitness to get the benefits of a long-term membership contract while its members are still on monthly membership contracts. Rich Burkholder, director for Aero-Fitness, emphasizes that this program is a “win/win situation financially for both [the] business and [the] clients.” Members were attracted to the program because it promised a minimum of $250 savings over the ensuing four-year period, while still allowing them to pay monthly and discontinue membership if the need arose. Creating a “charter membership” also allows Aero-Fitness to highlight these long-term members for other promotions and incentives, adding even more value to long-term memberships.

Did it work? Aero-Fitness claims to have increased new membership sales by an average of 26 percent during the three-month promotion, and the retention rate for “charter members” has held at about 88 percent.

Tracking customer satisfaction
AlliedSignal Employee Health & Fitness Center
Morristown, N.J.
Customers First, Last and Always!

Although committed to excellent customer service, a business cannot truly track visitor satisfaction without input from its patrons.

The management team at AlliedSignal Employee Health and Fitness Center begins with member surveys to evaluate satisfaction with its programs and services, and continues the dialogue by charting survey responses and sharing the results with both employees and members.

Customer satisfaction takes a multitiered approach at the Morristown, N.J., health and fitness center, explains Program Manager Christine Kane Haskins. Member response to service at the center is gathered through biannual surveys, class instructor evaluations, a suggestion box and quarterly focus groups, among other methods. “The emphasis on customer satisfaction is not perceived as a service,” Haskins says, “it is how we work.” Gathering information about members’ needs and perceptions has been dubbed “the discovery process” by employees who rotate the task of obtaining and analyzing the data.