Well: Ask Well: Exercise After Knee Replacement

Q

Can I hike and cross-country ski again after knee replacement surgery?

What is the best exercise for someone with a partial knee replacement? Can I walk too much?

I've had a TKR (total knee replacement), and it's been wonderful. My doctor says no to my returning to running, but the arc of professional opinion seems to be tending toward greater exercise latitude. Has it come far enough to allow me 10-15 mi./week? (I'm 70 and fit.)

A

The idea that we should burn at least 2,000 calories a week during exercise seems to have originated in data gathered decades ago as part of the Harvard Alumni Study. That study followed male Harvard graduates for as long as 50 years, tracking how they lived and died. One of the first publications based on the data, appearing in 1978, showed that the older alumni who expended less than 2,000 calories a week in exercise were at 64 percent higher risk of suffering a heart attack than those who burned 2,000 calories a week or more during exercise. It's worth noting that the researchers' definition of exercise in this study was generous, including climbing stairs and walking around the block, as well as playing sports or jogging.

Widely reported at the time, the 2,000-calorie guideline still gets bandied about today. But the current exercise guidelines from the federal government, based on a large body of recent scientific evidence, emphasize time, not calories, and recommend that healthy adults engage in 150 minutes per week of moderate-intensity exercise, such as brisk walking or cycling.

Adhering to these guidelines means that most of us would burn about 1,000 calories per week in planned exercise, said Michael J. Joyner, an exercise researcher at the Mayo Clinic. And with the stairs we climb and chores we do, we come closer to that 2,000 calorie a week number, he said.

But we don't have to fret about actually reaching it. Meeting the current guidelines for 150 minutes or five brisk 30-minute walks per week is enough, he concluded. "The added health benefits start to level off after that."

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Well: Vitamin E May Harm, or Help, Your Lungs

A form of vitamin E found in vegetable oils like corn and canola may worsen lung function, while another form typically found in olive oil may protect it, a new study suggests. The findings may help explain why studies of the health effects of the vitamin have had conflicting results.

Vitamin E comes in various forms called tocopherols, which are commonly found in fats and oils. Supplements of the vitamin may contain a single type of tocopherol, or a mix.

The new research, published in the journal Respiratory Research, found that a form of the vitamin called gamma tocopherol, the kind in corn, canola and soybean oils, was linked to poor lung function in adults. But another form of the vitamin more typically found in olive and sunflower oils, called alpha tocopherol, seemed to have a beneficial effect on the lungs.

"It's mind-blowing that there's this disparity," said Dr. Clifford W. Bassett, an allergist and assistant clinical professor of medicine at the New York University School of Medicine. "What's interesting is that most people taking vitamin E never stop to ask where it's from. It's not something you tend to be aware of."

Dr. Bassett, who was not involved in the study, said the findings suggest that consumers who use the vitamin and doctors who recommend it might need to be "more acutely aware" of its source and formulation. That information is sometimes listed on the labels of supplements, but not always.

Vitamin E, considered a powerful antioxidant, is thought to play a role in cardiovascular and neurological health. There is also some evidence that the vitamin may help protect against asthma and other respiratory problems. But studies have also suggested that taking vitamin E has no effect on lung health, or even a potentially harmful one.

In research over the years at Northwestern University Feinberg School of Medicine, Joan Cook-Mills, an associate professor, has found that in addition being an antioxidant, vitamin E appears to play a role in inflammation. The vitamin influences a protein that allows white blood cells – an important part of the immune system – to exit the bloodstream and enter tissues, including cells in the lung, a critical step in the inflammatory response.

But different forms of the vitamin do not have the same effect. Gamma tocopherol increases the activity of the protein, and alpha tocopherol lowers it.

As a result, the two forms of vitamin E can have a drastically different impact on inflammation, Dr. Cook-Mills said. For example, gamma tocopherol can set off "hyper responsiveness" in the airways, a common feature of asthma, Dr. Cook-Mills said.

In the new research, Dr. Cook-Mills and her colleagues at Northwestern analyzed data from a nationwide study, sponsored by the National Institutes of Health, known as Cardia. The study has been tracking adults since 1985 as a way of discovering how genetics and habits affect heart disease, lung function and other aspects of health.

The research, involving 4,526 adults, assessed whether the levels of alpha and gamma tocopherol measured in their bloodstreams were linked to lung health. Ultimately, people with the highest levels of gamma tocopherol had a 10 percent to 17 percent reduction in lung function.

Dr. Cook-Mills and her colleagues found a higher incidence of asthma associated with higher blood levels of gamma tocopherol. But higher levels of alpha tocopherol – particularly in people with low levels of gamma tocopherol – were tied to better lung function.

Throughout the study, the subjects periodically underwent standard pulmonary tests that could identify lung capacity and airway obstructions.

Dr. Cook-Mills said the findings raised concern because gamma tocopherol is increasingly common in American food products. She pointed out that asthma rates in the United States have risen steadily in the past four decades, which corresponds with the rising use of canola, soybean and other vegetable oils rich in gamma tocopherol.

But she also cautioned that the research is observational. More rigorous studies are needed to see whether giving subjects alpha tocopherol in supplements or food can directly improve lung function, or if gamma tocopherol would have the opposite effect.

Dr. Bassett at New York University said there were other unanswered questions about the study, including the extent to which habits and diet may have played a role in the results. But the implications, if the findings are confirmed, are important, he said.

"It may explain why some of the studies on vitamin E have found it counterproductive," he said.

Dr. Cook-Mills said that many studies have focused on vitamin E's role as an antioxidant while neglecting the contrasting effects of alpha and gamma tocopherol on inflammation.

"You can see why in the medical literature it's been totally confusing if researchers thought they were equal antioxidants but they got conflicting outcomes," she said. "It's because there are other functions of tocopherols that have opposing effects."

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Phys Ed: To Age Well, Walk

Phys Ed

Gretchen Reynolds on the science of fitness.

Regular exercise, including walking, significantly reduces the chance that a frail older person will become physically disabled, according to one of the largest and longest-running studies of its kind to date.

The results, published on Tuesday in the journal JAMA, reinforce the necessity of frequent physical activity for our aging parents, grandparents and, of course, ourselves.

While everyone knows that exercise is a good idea, whatever your age, the hard, scientific evidence about its benefits in the old and infirm has been surprisingly limited.

"For the first time, we have directly shown that exercise can effectively lessen or prevent the development of physical disability in a population of extremely vulnerable elderly people," said Dr. Marco Pahor, the director of the Institute on Aging at the University of Florida in Gainesville and the lead author of the study.

Countless epidemiological studies have found a strong correlation between physical activity in advanced age and a longer, healthier life. But such studies can't prove that exercise improves older people's health, only that healthy older people exercise.

Other small-scale, randomized experiments have persuasively established a causal link between exercise and healthy aging. But the scope of these experiments has generally been narrow, showing, for instance, that older people can improve their muscle strength with weight training or their endurance capacity with walking.

So, for this latest study, the Lifestyle Interventions and Independence for Elders, or LIFE, trial, scientists at eight universities and research centers around the country began recruiting volunteers in 2010, using an unusual set of selection criteria. Unlike many exercise studies, which tend to be filled with people in relatively robust health who can easily exercise, this trial used volunteers who were sedentary and infirm, and on the cusp of frailty.

Ultimately, they recruited 1,635 sedentary men and women aged 70 to 89 who scored below a nine on a 12-point scale of physical functioning often used to assess older people. Almost half scored an eight or lower, but all were able to walk on their own for 400 meters, or a quarter-mile, the researchers' cutoff point for being physically disabled.

Then the men and women were randomly assigned to either an exercise or an education group.

Those in the education assignment were asked to visit the research center once a month or so to learn about nutrition, health care and other topics related to aging.

The exercise group received information about aging but also started a program of walking and light, lower-body weight training with ankle weights, going to the research center twice a week for supervised group walks on a track, with the walks growing progressively longer. They were also asked to complete three or four more exercise sessions at home, aiming for a total of 150 minutes of walking and about three 10-minute sessions of weight-training exercises each week.

Every six months, researchers checked the physical functioning of all of the volunteers, with particular attention to whether they could still walk 400 meters by themselves.

The experiment continued for an average of 2.6 years, which is far longer than most exercise studies.

By the end of that time, the exercising volunteers were about 18 percent less likely to have experienced any episode of physical disability during the experiment. They were also about 28 percent less likely to have become persistently, possibly permanently disabled, defined as being unable to walk those 400 meters by themselves.

Most of the volunteers "tolerated the exercise program very well," Dr. Pahor said, but the results did raise some flags. More volunteers in the exercise group wound up hospitalized during the study than did the participants in the education group, possibly because their vital signs were checked far more often, the researchers say. The exercise regimen may also have "unmasked" underlying medical conditions, Dr. Pahor said, although he does not feel that the exercise itself led to hospital stays.

A subtler concern involves the surprisingly small difference, in absolute terms, in the number of people who became disabled in the two groups. About 35 percent of those in the education group had a period of physical disability during the study. But so did 30 percent of those in the exercise group.

"At first glance, those results are underwhelming," said Dr. Lewis Lipsitz, a professor of medicine at Harvard Medical School and director of the Institute for Aging Research at Hebrew SeniorLife in Boston, who was not involved with the study. "But then you have to look at the control group, which wasn't really a control group at all." That's because in many cases the participants in the education group began to exercise, study data shows, although they were not asked to do so.

"It wouldn't have been ethical" to keep them from exercise, Dr. Lipsitz continued. But if the scientists in the LIFE study "had been able to use a control group of completely sedentary older people with poor eating habits, the differences between the groups would be much more pronounced," he said.

Over all, Dr. Lipsitz said, "it's an important study because it focuses on an important outcome, which is the prevention of physical disability."

In the coming months, Dr. Pahor and his colleagues plan to mine their database of results for additional followup, including a cost-benefit analysis.

The exercise intervention cost about $1,800 per participant per year, Dr. Pahor said, including reimbursement for travel to the research centers. But that figure is "considerably less" than the cost of full-time nursing care after someone becomes physically disabled, he said. He and his colleagues hope that the study prompts Medicare to begin covering the costs of group exercise programs for older people.

Dr. Pahor cautioned that the LIFE study is not meant to prompt elderly people to begin solo, unsupervised exercise. "Medical supervision is important," he said. Talk with your doctor and try to find an exercise group, he said, adding, "The social aspect is important."

Mildred Johnston, 82, a retired office worker in Gainesville who volunteered for the LIFE trial, has kept up weekly walks with two of the other volunteers she met during the study.

"Exercising has changed my whole aspect on what aging means," she said. "It's not about how much help you need from other people now. It's more about what I can do for myself." Besides, she said, gossiping during her group walks "really keeps you engaged with life."

A version of this article appears in print on 05/28/2014, on page A12 of the NewYork edition with the headline: Exercise for Older Adults Helps Reduce Their Risk Of Disability, Study Says .

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Well: Information Not on the Label

The Consumer

Advice on money and health.

If you want to know whether the bread you're about to buy was sweetened with corn syrup, you can check the label. The same is true if you're concerned about preservatives, caramel coloring or artificial flavoring. By law, all of these ingredients must be listed on food labels.

But not genetically modified organisms, or G.M.O.s. The Food and Drug Administration does not require clear identification and labeling of food products made with genetically engineered plants.

Most consumers want that to change. Some 93 percent of respondents to a New York Times survey in January 2013 said they wanted genetically modified ingredients identified, even though only about half said they would avoid G.M.O. products. More than 1.4 million people have signed the Center for Food Safety's petition urging the federal agency to require G.M.O. labeling. Last weekend, marches were held in dozens of cities to protest the introduction of genetically engineered products by Monsanto and other developers.

Vermont this month became the first state to require labeling of G.M.O. foods, and Connecticut and Maine have passed similar laws, though they are contingent on other states enacting legislation. Food producers and developers of genetically modified plants and seeds poured millions of dollars into advertising in 2012 to defeat a California initiative requiring G.M.O. labeling, and they are pushing a federal bill that would bar states from requiring labeling. They insist the ingredients are safe and say there is no need for labels.

"Labeling space is very limited, and mandatory labeling would create an unnecessary stigma," said Claire Parker, spokeswoman for the Coalition for Safe Affordable Food, which represents businesses and organizations opposed to G.M.O. labeling. She and other industry representatives point to the F.D.A.'s determination in 1992 that there was no need for mandatory labeling of bioengineered foods because there were no "material" or "meaningful" differences between bioengineered and nonbioengineered foods.

Genetically engineered plants contain DNA from other animal or plant species that is intended to give them traits that are considered desirable by the manufacturers. One of the more recent innovations is an apple that does not turn brown after it is sliced. Another is a strawberry that withstands freezing.

Many of the plants have been engineered to survive being sprayed with weed killers; some even produce their own pesticides.

Advocates of labeling point out that the F.D.A. has elaborate disclosure requirements for all kinds of foods. Labels on orange juice, for instance, must inform customers whether it is fresh or made from concentrate, and producers are barred from using the term "juice" if the drink is not 100 percent juice. (Products containing less must be called a "beverage," "cocktail" or "drink".)

The agency even regulates the use of terms like "fresh," "frozen," "fresh frozen," "frozen fresh" and "quickly frozen" on labels for products like peas.

"The F.D.A. decided that the difference between fresh peas and frozen peas was a 'material' difference to the consumer," said Jean Halloran, director of food policy initiatives at Consumers Union, which supports labeling of genetically modified foods. "This stuff is as different as frozen peas and nonfrozen peas, if not more so."

Agency scientists have expressed concerns about new genetically engineered plant products, wondering whether the new plants have the same levels of important nutrients as non-engineered varieties, for instance, and whether they might contain toxins, new allergens or unapproved food additives.

But unlike the approval process required for new drugs and even many food additives like artificial sweeteners, the review process for new G.M.O. plant foods is voluntary. Producers are asked only to consult with the F.D.A. The agency "does not conduct a comprehensive scientific review of data generated by the developer," according to F.D.A. documents. Officials rely on producers to do their own safety and nutritional assessments, and they review summaries of those assessments.

"We recognize and appreciate the interest that some consumers have expressed in knowing whether a food was produced using genetic engineering," said Theresa Eisenman, an F.D.A. spokeswoman. "Food from genetically engineered plants must meet the same requirements, including safety requirements, as foods from traditionally bred plants."

It is not clear whether genetically engineered salmon, which is going through a different review process than G.M.O. plants, will be labeled when it gets to market. An agency official said special labeling would only be required if the F.D.A. determines the food differs "materially" from comparable foods — for example, if it has a different nutritional profile.

Shoppers who want to know whether they're purchasing genetically engineered foods do have a few options.

For starters, there is a good chance that any product with soybeans, corn, sugar beets (often used for sweetening) and canola (or canola oil) has G.M.O.s., since genetically modified versions of these crops are so widely planted in the United States.

On the other hand, certified organic produce carrying the green and white circular "U.S.D.A. organic" seal cannot be genetically modified, and organic livestock must be fed only organic ingredients. But processed foods with multiple ingredients can be labeled organic if at least 95 percent of the content is organic.

And a growing number of food producers that don't use genetically modified ingredients in their products are seeking certification by the Non-G.M.O. Project. They carry a "Non-G.M.O." label with a logo of a red butterfly on a blade of grass.

A version of this article appears in print on 05/27/2014, on page D4 of the NewYork edition with the headline: Information Not on the Label.

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Bits Blog: My T-Shirt Told Me to Take a Chill Pill

My T-shirt tells me things.

My heart rate, for instance: 62 beats a minute. And my breathing: 17 breaths a minute.

Unless I drink too many cappuccinos or a deadline looms. Then my T-shirt tells me my that heart rate has jumped to the high 80s, my breathing to 22.

My T-shirt is connected to me and also to the Internet. So along with an iPhone app, it can remind me to take a breath, relax, chill.

Seriously. The T-shirt I'm wearing was made by OMsignal of Montreal. It has sensors that are supposed to pick up all sorts of data about me — the aforementioned vital signs, plus how many calories I burn and even how stressed I am.

OMsignal is a part of a new breed of young companies focusing on wearable technology. We're not talking about Google Glass here. These are products made out of biometric materials, or smart textiles. And yes, these products are starting to hit the market. Their fans say they could represent the future of wearable computing.

Lots of people wear fitness bands that can monitor their health. Whether those products deliver all they promise is questionable. But why wear a wristband when you're already wearing clothes? Weave some sensors into the fabric, and you have one accessory fewer to worry about.

"Smart clothing is easy because it's the only wearable medium you've already been wearing your whole life," said Stéphane Marceau, co-founder of OMsignal. "In a decade, every piece of apparel you buy will have some sort of biofeedback sensors built in it."

Many challenges must be overcome first, not the least of which is price. OMsignal shirts start at $80, but they also need a module, which powers the shirt and talks to its sensors, that costs $120. But the shirt is machine washable.

"The leap that you have to make from a prototype or small-lot sizes of these wearables to an affordable mass-market product is pretty significant," said Jonathan Gaw, research manager for IDC Research. "The price is going to have to come way down before it becomes a product for most consumers."

Mr. Gaw said that wearable apparel would be used first for fitness, wellness and medical applications by a select group of consumers. He warned that it could be slow going for most people. "In terms of these being mainstream, and something that people will use on a daily basis, you're getting into Buck Rogers territory there," he said.

But Mr. Marceau of OMsignal said consumers were getting to a point where they want more information about themselves. "The first cars were completely blind. Then you had a gas gauge. Then a speedometer. Now you can't imagine a car without these things," he said. "Smart clothing is starting to do the same thing for the human body."

Most smart textile products use conductive yarns that can transmit electrical signals. The sensors woven into these materials are either so small you can't see them or so flexible you don't notice them. While many of these garments require a battery pack of sorts, some are experimenting with applications in which a smartphone can transmit power and Internet access to sensors and screens that are attached to the clothing.

"This type of fabric, until now, was a laboratory experiment, and no companies were able to develop something that would be a mass-scale product," said Eliane Fiolet, co-founder of Ubergizmo, the technology website. "Now you have companies that are claiming to figure out a manufacturing process that is viable to introduce these garments at scale." Ms. Fiolet said incorporating sensors into clothing, rather than wristbands, made sense. Clothing, after all, covers more of the body.

These sorts of devices are already emerging out of labs. Cityzen Sciences, based in Lyon, France, makes T-shirts that have microsensors embedded in the fabric. These sensors can monitor a person's temperature, heart rate and location. The company won the award for the most innovative new product at this year's International CES.

Sensilk, based in San Francisco, is making a smart bra with sensors to track a wearer's fitness. And the Defense Advanced Research Projects Agency has funded a number of projects to make wearable computerized clothing for soldiers. Researchers at the Massachusetts Institute of Technology have developed a product called WearArm, which is a computing platform like iOS or Android, but one specifically for smart clothing.

The possibilities don't end there. A number of universities and research labs have experimented with wearable technology that can help blind people navigate city streets, such as gloves that vibrate when a user needs to make a turn. And then there is Studio Roosegaarde, a design lab in the Netherlands. It has developed a dress called Intimacy 2.0 with an opaque fabric that becomes transparent when its wearer is aroused — bringing T.M.I. to a whole new level.

A version of this article appears in print on 05/26/2014, on page B5 of the NewYork edition with the headline: My T-Shirt Told Me to Take a Chill Pill.

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Bits Blog: My T-Shirt Told Me to Take a Chill Pill

My T-shirt tells me things.

My heart rate, for instance: 62 beats a minute. And my breathing: 17 breaths a minute.

Unless I drink too many cappuccinos or a deadline looms. Then my T-shirt tells me my that heart rate has jumped to the high 80s, my breathing to 22.

My T-shirt is connected to me and also to the Internet. So along with an iPhone app, it can remind me to take a breath, relax, chill.

Seriously. The T-shirt I'm wearing was made by OMsignal of Montreal. It has sensors that are supposed to pick up all sorts of data about me — the aforementioned vital signs, plus how many calories I burn and even how stressed I am.

OMsignal is a part of a new breed of young companies focusing on wearable technology. We're not talking about Google Glass here. These are products made out of biometric materials, or smart textiles. And yes, these products are starting to hit the market. Their fans say they could represent the future of wearable computing.

Lots of people wear fitness bands that can monitor their health. Whether those products deliver all they promise is questionable. But why wear a wristband when you're already wearing clothes? Weave some sensors into the fabric, and you have one accessory fewer to worry about.

"Smart clothing is easy because it's the only wearable medium you've already been wearing your whole life," said Stéphane Marceau, co-founder of OMsignal. "In a decade, every piece of apparel you buy will have some sort of biofeedback sensors built in it."

Many challenges must be overcome first, not the least of which is price. OMsignal shirts start at $80, but they also need a module, which powers the shirt and talks to its sensors, that costs $120. But the shirt is machine washable.

"The leap that you have to make from a prototype or small-lot sizes of these wearables to an affordable mass-market product is pretty significant," said Jonathan Gaw, research manager for IDC Research. "The price is going to have to come way down before it becomes a product for most consumers."

Mr. Gaw said that wearable apparel would be used first for fitness, wellness and medical applications by a select group of consumers. He warned that it could be slow going for most people. "In terms of these being mainstream, and something that people will use on a daily basis, you're getting into Buck Rogers territory there," he said.

But Mr. Marceau of OMsignal said consumers were getting to a point where they want more information about themselves. "The first cars were completely blind. Then you had a gas gauge. Then a speedometer. Now you can't imagine a car without these things," he said. "Smart clothing is starting to do the same thing for the human body."

Most smart textile products use conductive yarns that can transmit electrical signals. The sensors woven into these materials are either so small you can't see them or so flexible you don't notice them. While many of these garments require a battery pack of sorts, some are experimenting with applications in which a smartphone can transmit power and Internet access to sensors and screens that are attached to the clothing.

"This type of fabric, until now, was a laboratory experiment, and no companies were able to develop something that would be a mass-scale product," said Eliane Fiolet, co-founder of Ubergizmo, the technology website. "Now you have companies that are claiming to figure out a manufacturing process that is viable to introduce these garments at scale." Ms. Fiolet said incorporating sensors into clothing, rather than wristbands, made sense. Clothing, after all, covers more of the body.

These sorts of devices are already emerging out of labs. Cityzen Sciences, based in Lyon, France, makes T-shirts that have microsensors embedded in the fabric. These sensors can monitor a person's temperature, heart rate and location. The company won the award for the most innovative new product at this year's International CES.

Sensilk, based in San Francisco, is making a smart bra with sensors to track a wearer's fitness. And the Defense Advanced Research Projects Agency has funded a number of projects to make wearable computerized clothing for soldiers. Researchers at the Massachusetts Institute of Technology have developed a product called WearArm, which is a computing platform like iOS or Android, but one specifically for smart clothing.

The possibilities don't end there. A number of universities and research labs have experimented with wearable technology that can help blind people navigate city streets, such as gloves that vibrate when a user needs to make a turn. And then there is Studio Roosegaarde, a design lab in the Netherlands. It has developed a dress called Intimacy 2.0 with an opaque fabric that becomes transparent when its wearer is aroused — bringing T.M.I. to a whole new level.

A version of this article appears in print on 05/26/2014, on page B5 of the NewYork edition with the headline: My T-Shirt Told Me to Take a Chill Pill.

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Well: Speaking Up About an Uncomfortable Condition

Personal Health

Jane Brody on health and aging.

Bowels, especially those that don't function properly, are not a popular topic of conversation. Most of the 1.4 million Americans with inflammatory bowel disease — Crohn's disease or ulcerative colitis — suffer in silence.

But scientists are making exciting progress in understanding the causes of these conditions and in developing more effective therapies. And affected individuals have begun to speak up to let others know that they are not alone.

Abby Searfoss, 21, who just graduated from the University of Connecticut, shared her story not in a support group, but online. She was a high school senior in Ridgefield, Conn., when she became ill. After she researched her symptoms on the Internet, she realized that, like her father, she had developed Crohn's disease.

Her father had been very ill, losing 40 pounds, spending weeks in the hospital and undergoing surgery. Soon after Ms. Searfoss's own diagnosis, her two younger sisters learned that they, too, had the condition.

In Crohn's disease, the immune system attacks cells in the digestive tract, most often the end of the small intestine and first part of the colon, or large intestine. Sufferers may experience bouts of abdominal pain, cramps and diarrhea, often accompanied by poor appetite, fatigue and anxiety.

"You don't go anywhere without checking where the bathroom is and how many stalls it has," said Dr. R. Balfour Sartor, a gastroenterologist at the University of North Carolina School of Medicine and a patient himself. "The fear of incontinence is huge."

Neither Crohn's disease nor its less common relative ulcerative colitis, which affects only the large intestine, is curable (except, in the latter instance, by removing the entire colon). But research into what predisposes people to develop these conditions has resulted in more effective treatments and has suggested new ways to prevent the diseases in people who are genetically susceptible.

Two concurrent avenues of high-powered research are supported by the Crohn's and Colitis Foundation of America. One is the C.C.F.A. Genetics Initiative, in which scientists are exploring more than 100 genetic factors now known to influence the risk of developing an inflammatory bowel disease, or I.B.D.

The other research effort, the C.C.F.A. Microbiome Initiative, has so far identified 14 different bacterial metabolic factors associated with the diseases.

By combining findings from the two initiatives, experts now know that certain genes affect the types of bacteria living in the gut; in turn, these bacteria influence the risk of getting an inflammatory bowel disease.

Genes identified thus far appear to account for about 30 percent of the risk of developing an I.B.D., according to Dr. Sartor, who is the chief medical adviser of the foundation. Studies of twins underscore the role of genetics. When one identical twin has Crohn's disease, the other has a 50 percent chance of also developing it.

In the general population, the risk among siblings of a Crohn's patient is only 5 percent.

Many people carry genes linked to either Crohn's or ulcerative colitis, but only some of them become ill. Environmental factors that interact with susceptibility genes also play critical roles.

Strong clues to these factors are emerging from a distressing fact: The incidence of I.B.D. is rising significantly both here and in other parts of the world, Dr. Ramnik J. Xavier, chief of gastroenterology at Massachusetts General Hospital in Boston, said in an interview.

"There's been a huge uptick in China and India as these countries move more toward a Western lifestyle and adopt Western work and dietary patterns," Dr. Xavier said. "I.B.D. cases are now skyrocketing in well-to-do areas of China."

And when people migrate from a low-incidence area to a higher one like the United States, the risk of developing an I.B.D. rises greatly among their children. 'This clearly shows there's an environmental impact that we think is multifactorial," Dr. Sartor said in an interview.

"Diet is one obvious factor that affects both the composition of the gut biota and also its function," he said, referring to the microorganisms that inhabit the gut. "Bacteria eat what we eat, and every bacterium has certain food preferences."

Diet influences the types and balance of microbes in the gut, and different microbes produce substances that are either protective or harmful. For example, Dr. Sartor said, "Certain bacteria that can metabolize the fiber in certain vegetables and grains produce short-chain fatty acids that are believed to protect the gut. They inhibit inflammation and activate immune responses that stimulate recovery from cell injury."

Another major contributor to the rise in Crohn's disease in particular is the widespread, often inappropriate use of antibiotics, Dr. Sartor said.

"Early exposure to antibiotics, especially during the first 15 months of life, increases the risk of developing Crohn's disease, though not ulcerative colitis," he said. "If there's a family history of I.B.D., particularly Crohn's disease, antibiotics should be used only for a documented bacterial infection like strep throat or bacterial meningitis.

"And when antibiotics are needed, probiotics can be used during and afterward to minimize their effect and restore the normal bacterial population of the gut."

Dr. Sartor also noted that early exposure to common viruses and bacteria can strengthen the immune system and keep it from attacking normal tissues.

"My advice to parents and grandparents is, 'Let them eat dirt,' " he said.

Dr. Sartor has lived with Crohn's disease for 43 years and for the most part has managed to keep flare-ups at bay with a proper diet, medications and daily probiotics.

He also suggests that those with a family history of I.B.D. avoid taking nonsteroidal anti-inflammatory drugs like aspirin, ibuprofen and naproxen, which block the action of protective substances in the gut and can cause ulcers in the lower intestine and the stomach. Acetaminophen is safer, he said.

Many patients say undue stress can cause flare-ups of an I.B.D. And a new study of 3,150 adults with Crohn's, presented at a recent scientific meeting by Lawrence S. Gaines, a psychologist at Vanderbilt University, suggests that depression — feeling sad, helpless, hopeless and worthless — increases the risk of active disease a year later.

This is the first of two columns about inflammatory bowel diseases.

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Poison Pen: Silver Too Small to See, but Everywhere You Look

Poison Pen

Deborah Blum writes about chemicals and the environment.

Several years ago, a mosquito bite on Elizabeth Loboa's right leg became infected, turning into an oozing sore that refused to heal. Her doctor prescribed a stiff course of antibiotics. But Dr. Loboa decided to try another remedy.

An associate professor of biomedical engineering at North Carolina State University, she had been experimenting with a new kind of bandage, a scaffold of microscopic fibers that could be inserted into a wound to encourage tissue growth. The fibers were coated with silver to fend off infection.

The bandages were not approved for medical use, but Dr. Loboa decided to appoint herself the first human test subject. The silver-infused bandages worked. Within a few days, she said, the infection was gone. She retains a small scar — and a deep admiration for the microbe-killing properties of silver.

Amid concern over the rise of antibiotic-resistant bacteria, silver — an old-time remedy for infection — is enjoying a renaissance. And it's a very 21st-century one: High-tech, microscopic particles of the metal are being embedded as antimicrobial agents in products from athletic clothing to stuffed toys, from bed linens to food containers. An inventory of consumer products with silver from the Wilson Center, the public policy and research organization based in Washington, lists everything from a "contour foam neck support" pillow to lounging socks from the Sharper Image.

Many researchers aren't sure that's entirely a good thing. As interest in silver nanotechnology increases, so does the worry that we are pursuing its benefits without fully understanding its risks. Scientists worry about evidence that the particles may cause unexpected environmental harm; new studies suggest they may damaging plants and fish in ways that had not been predicted by traditional silver exposure.

And they worry about other unresolved health issues, such as evidence of cellular damage and the apparent ability of the particles to cross the blood-brain barrier. Dr. Loboa, director of North Carolina State's cell mechanics laboratory, is particularly concerned about studies that show silver nanoparticles can get past the protective outer layer of the skin.

"There's evidence that the particles penetrate into plasma membranes, and they can disrupt cell function," she said in an interview. (While Dr. Loboa's experimental bandages use silver, it is not in nanoparticle form.)

Nanoparticles are astonishingly small. Silver nanoparticles can be as tiny as five nanometers; a human hair is 80,0000 to 100,000 nanometers wide. There's some evidence that the smallest silver particles are the riskiest, more reactive with other elements and toxic in some unexpected ways.

Silver isn't the only material being micro-sized for commercial use. Researchers are investigating everything from titanium dioxide nanoparticles in cosmetics to selenium and cadmium in nanocrystals (known as quantum dots), which function as very miniature semiconductors.

But silver offers some of the best insights into what's worth worrying about with regard to nanoparticles, and what isn't — and whether we can always tell the difference.

"It's a poster child for why we should be looking at these materials," said Mark Wiesner, director of the Center for the Environmental Implications of Nanotechnology consortium at Duke University.

Traditional silver is considered a low-toxicity metal: it's fairly inert in the body, and at acute doses its best-known effect is blue discoloration of the skin. But, Dr. Wiesner said, "silver nanoparticles don't always behave in the same way."

One concern is that increased uses of silver nanoparticles in consumer and medical products will mean increased environmental contamination as the products are washed and the particles released into water supplies. Researchers are working now to try to predict what will result, said Greg Lowry, a member of the nanotechnology consortium and a professor of civil and environmental engineering at Carnegie Mellon University.

Dr. Lowry collaborated in an investigation last year designed to mimic a low-level release of silver nanoparticles into a complex natural environment. The study showed that even in small amounts, they could damage aquatic creatures and plants. Nanoparticles seem able to attach to living cells, gradually releasing toxic silver ions — something like a time-release medication.

"This is a metal that we've studied for centuries," said Michael Hochella, a professor of geochemistry at Virginia Tech and another member of the group. "But with silver nano, there's some kind of chemistry going on that we haven't put our fingers on."

As a rule, he said, silver likes to bind with sulfur in the environment, forming a fairly inert and harmless silver sulfide compound. But recent studies suggest that nanoparticles more easily evade the bond. This seems to especially true of the tiniest particles, Dr. Hochella said.

A study from the University of Oxford this year suggested that the smaller particles were also unusually reactive with oxygen molecules in water. The scientists reported that the intensity of that reaction appeared to encourage the formation of hydrogen peroxide, which is poisonous to aquatic organisms.

So far most scientists agree that such findings suggest a relatively minor health threat to people using products with silver nanoparticles. The more serious concerns are environmental, Dr. Wiesner said. Still, the growing uneasiness over the particles led the Natural Resources Defense Council to file a lawsuit against the Environmental Protection Agency in 2012 claiming that the agency was too quick to allow use of untested silver nanoparticles in consumer goods.

And the E.P.A. has its own concerns. Last month the agency moved to stop a New Jersey company that was embedding silver nanoparticles into food containers without bothering to register the product.

The E.P.A. can require companies to register a product under pesticide regulations if they are using the nanoparticles for antimicrobial action. The N.R.D.C. notes that companies frequently try to evade this requirement.

"They'll just say that it's about a fresh smell and not mention the antimicrobial aspect," said Jennifer Sass, an N.R.D.C. senior scientist. "And our concern is that this means that people are being exposed without adequate information."

Rosalind Volpe, executive director of an industry organization, the Silver Nanotechnology Working Group, acknowledges that products using silver nanoparticles may not always be registered. But even so, she says that the amount of particles involved is too small to add up to a meaningful threat.

"I think the E.P.A. is doing a good job," she said. "They've done some very conservative risk assessments." And antimicrobial silver is a valuable tool, she said, adding, "Remember, this is an emerging technology — we need to look at the benefits as well as recognize the risks."

From the scientific standpoint, said Dr. Wiesner, studying nanoparticles also offers some unexpected benefits: researchers are gaining a new and better understanding of the way plants take up metal, for instance, and of the unexpectedly complicated interaction of silver with living cells.

But given the uncertainties, he added, there's reason to approach the technology with some caution. "Is it important to use silver nanoparticles to protect a child from bacteria on a teddy bear?" he said. "We should be asking whether that's really a significant benefit, particularly when we don't yet fully know the risks."

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Well: 4 Days, 11 Pounds

This article appeared in the May 25, 2014 issue of The New York Times Magazine.

Losing weight is simple: Ingest fewer calories than your body burns. But how best to do that is unclear. Most experts advise small reductions in calories or increases in exercise to remove weight slowly and sensibly, but many people quit that type of program in the face of glacial progress. A new study, published in March in The Scandinavian Journal of Medicine & Science in Sports, suggests that minimal calories and maximal exercise can significantly reduce body fat in just four days — and the loss lasts for months. The catch, of course, is that those four days are pretty grueling.

Researchers in Spain and Sweden had 15 healthy but overweight Swedish men restrict their calories to about 360 a day, a reduction of approximately 1,800 calories. What calories they did ingest came in liquid form: Some men drank mostly sugary carbohydrates, others a high-protein drink. The men also exercised — a lot. Their days began with 45 minutes of cranking an arm-pedaling machine for an upper-body workout. Then, as a group, the men strolled for eight hours across the Swedish countryside, with only a 10-minute break every hour. They were allowed as much of a low-calorie, sports-type beverage as they wanted during their walks.

Most of the men "were surprised that it was easier than they thought it would be," says José Calbet, a professor at the University of Las Palmas de Gran Canaria in Spain; he and his colleague Hans-Christer Holmberg, a professor at Mid Sweden University in Ostersund, led the study. Some of the subjects experienced "minor problems with pain in the joints" and blisters on their feet, according to Calbet, but none dropped out or complained of hunger.

After four days, the men had each lost almost 11 pounds, with nearly half of that coming from body fat; the rest of the loss came primarily from muscle mass. The researchers had anticipated that the high-protein drink would protect people against muscle-mass loss. In fact, the losses were the same, whether the men had been given sugar or protein.

More surprising, the men did not immediately put the weight back on after the study ended. "We thought they would overeat and regain the weight lost," Dr. Calbet says. Instead, when the volunteers returned a month later, most had lost another two pounds of fat. And a year after the experiment, they were still down five pounds, mostly in lost body fat.

Dr. Calbet and his colleagues hope to study whether women respond similarly to men and whether repeated bouts of such a program might affect muscular health and appetite hormones.

But given the doleful statistics on weight loss — most people regain everything they lose dieting and more — these results are startling. They also, at the moment, are inexplicable. "The only explanation we can offer" for the sustained loss, Dr. Calbet says, is that the men were inspired by their hypercompressed success to change their lifestyles. The men moved more and ate less than before.

A version of this article appears in print on 05/25/2014, on page MM16 of the NewYork edition with the headline: 4 Days, 11 Pounds.

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Well: Is Work Your Happy Place?

Do you feel more stressed out at work or at home?

While work is widely viewed as the major source of stress for Americans, new research shows that people have significantly lower stress levels when they are at the office compared to their time at home.

Researchers from Pennsylvania State University tested the cortisol levels of 122 workers during the workday and on weekends. Using saliva samples, they found that levels of cortisol – which is a biological marker for stress – were on the whole much lower when the person was at work than when he or she went home.

The finding suggests that for many people, the workplace is a sort of haven away from life's daily problems. At home, the pressures of juggling work and family responsibilities set in and cause us to feel more stress.

"The fact that people's stress levels go down when they are at work, I don't think it means that they don't like their homes or their kids,'' said Sarah Damaske, an assistant professor of labor and employment relations at Penn State and the study's lead author. "I think it suggests that there is something about work that is good for you. Being in the moment, focusing on a task, completing that task, socializing with your co-workers — all of these are beneficial and that's part of what's lowering your stress level.''

The researchers also asked men and women about their levels of happiness at work and at home. While men over all reported being happier at home than at work, women were happier at work than at home. Women also reported higher levels of happiness at work than did the men in the study, which will be published soon in the journal Social Science & Medicine. The study was released by the Council on Contemporary Families, a nonprofit group that focuses on work and family issues.

"It speaks to something that we've long known – women have more to do at home when they come home at the end of a workday," said Dr. Damaske. "They have less leisure time. There is all this extra stuff to be done, that second shift."

Another reason women report lower stress and more happiness at work compared to men is that they might like their jobs better. "I think women who remain employed full time over the long run tend to have found jobs where they want to remain employed," said Dr. Damaske. "Due to the quality of the job, women might be more satisfied with their jobs than men are."

Notably, there were no gender differences in stress levels on weekends. "Everyone is less stressed on weekends," said Dr. Damaske.

The solution to the stress gap between home and work may be for employers to offer more family-friendly policies, including giving workers flexible schedules or the option to work at home to resolve the conflicts that arise from competing responsibilities between work and family.

"This is not a call to work a million more hours or for women to not spend time with their families," said Dr. Damaske. "There is something about combining work and family that makes a home — at least on a workday — a little less of a happy place."

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Well: Blueberries for All

Eat Well

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I've been saving up blueberry recipes. I know that blueberries won't show up in farmers' markets in northern states until mid-June, but there are plenty now available in supermarkets from places like Georgia, which grows 10 percent of the nation's crop. In California, where blueberry production is a recent thing, begun successfully only in the 1990s, the harvest started in February. So I've been biding my time.

I don't put much stock in the concept of "super foods," but if you do, blueberries should be on your list. Their health benefits are well documented in the scientific literature. One study, published last year in BMJ, showed a correlation between the consumption of blueberries, apples and grapes, but especially blueberries, and a significantly lower risk of Type 2 diabetes. Scientists who are looking at foods that contain fibers that nourish probiotics, or beneficial microflora, in our lower intestines are finding that blueberries and other berries have a lot of potential in this area.

Recipes for Health

Martha Rose Shulman on healthful cooking.

I used both blueberries and blackberries in recipes this week. Blackberries have many of the same types of phytochemicals that blueberries have, antioxidant-rich anthocyanins that are present in deep blue and purple fruits and vegetables. Blackberries are also high in tannins – that's what gives them their astringent flavor – that are also thought to have antioxidant and anti-inflammatory properties. I used the berries mainly in desserts and pastries (one, a blueberry buckle, is just a little bit decadent), but I also threw them into a salad.

One great thing about blueberries and blackberries is that they freeze exceptionally well, especially blueberries. All you have to do is make sure they are dry and seal them airtight in freezer bags or containers. You can throw them, frozen, right into baked goods. Toss them first with a very small amount of flour if you don't want them to bleed when they bake.

Cornmeal and Buckwheat Blueberry Muffins: These muffins are the antithesis of the blueberry muffins on the counter in coffee shops, with plenty of fruit.

Blueberry or Blackberry Compote With Yogurt or Ricotta: An easy compote can transform plain yogurt or ricotta into a substantial breakfast or even a dessert.

Whole-Grain Blueberry Buckle: Topped with oats and quinoa flour, this old-fashioned cake is no longer traditional at all.

Beet and Arugula Salad With Berries: The sweet-tart flavor of berries make a lovely contrast to the pungency of arugula and the earthy sweetness of beets.

Berry Clafoutis: Not very sweet, this clafoutis works for either breakfast or dessert.

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Poison Pen: Silver Too Small to See, but Everywhere You Look

Poison Pen

Deborah Blum writes about chemicals and the environment.

Several years ago, a mosquito bite on Elizabeth Loboa's right leg became infected, turning into an oozing sore that refused to heal. Her doctor prescribed a stiff course of antibiotics. But Dr. Loboa decided to try another remedy.

An associate professor of biomedical engineering at North Carolina State University, she had been experimenting with a new kind of bandage, a scaffold of microscopic fibers that could be inserted into a wound to encourage tissue growth. The fibers were coated with silver to fend off infection.

The bandages were not approved for medical use, but Dr. Loboa decided to appoint herself the first human test subject. The silver-infused bandages worked. Within a few days, she said, the infection was gone. She retains a small scar — and a deep admiration for the microbe-killing properties of silver.

Amid concern over the rise of antibiotic-resistant bacteria, silver — an old-time remedy for infection — is enjoying a renaissance. And it's a very 21st-century one: High-tech, microscopic particles of the metal are being embedded as antimicrobial agents in products from athletic clothing to stuffed toys, from bed linens to food containers. An inventory of consumer products with silver from the Wilson Center, the public policy and research organization based in Washington, lists everything from a "contour foam neck support" pillow to lounging socks from the Sharper Image.

Many researchers aren't sure that's entirely a good thing. As interest in silver nanotechnology increases, so does the worry that we are pursuing its benefits without fully understanding its risks. Scientists worry about evidence that the particles may cause unexpected environmental harm; new studies suggest they may damaging plants and fish in ways that had not been predicted by traditional silver exposure.

And they worry about other unresolved health issues, such as evidence of cellular damage and the apparent ability of the particles to cross the blood-brain barrier. Dr. Loboa, director of North Carolina State's cell mechanics laboratory, is particularly concerned about studies that show silver nanoparticles can get past the protective outer layer of the skin.

"There's evidence that the particles penetrate into plasma membranes, and they can disrupt cell function," she said in an interview. (While Dr. Loboa's experimental bandages use silver, it is not in nanoparticle form.)

Nanoparticles are astonishingly small. Silver nanoparticles can be as tiny as five nanometers; a human hair is 80,0000 to 100,000 nanometers wide. There's some evidence that the smallest silver particles are the riskiest, more reactive with other elements and toxic in some unexpected ways.

Silver isn't the only material being micro-sized for commercial use. Researchers are investigating everything from titanium dioxide nanoparticles in cosmetics to selenium and cadmium in nanocrystals (known as quantum dots), which function as very miniature semiconductors.

But silver offers some of the best insights into what's worth worrying about with regard to nanoparticles, and what isn't — and whether we can always tell the difference.

"It's a poster child for why we should be looking at these materials," said Mark Wiesner, director of the Center for the Environmental Implications of Nanotechnology consortium at Duke University.

Traditional silver is considered a low-toxicity metal: it's fairly inert in the body, and at acute doses its best-known effect is blue discoloration of the skin. But, Dr. Wiesner said, "silver nanoparticles don't always behave in the same way."

One concern is that increased uses of silver nanoparticles in consumer and medical products will mean increased environmental contamination as the products are washed and the particles released into water supplies. Researchers are working now to try to predict what will result, said Greg Lowry, a member of the nanotechnology consortium and a professor of civil and environmental engineering at Carnegie Mellon University.

Dr. Lowry collaborated in an investigation last year designed to mimic a low-level release of silver nanoparticles into a complex natural environment. The study showed that even in small amounts, they could damage aquatic creatures and plants. Nanoparticles seem able to attach to living cells, gradually releasing toxic silver ions — something like a time-release medication.

"This is a metal that we've studied for centuries," said Michael Hochella, a professor of geochemistry at Virginia Tech and another member of the group. "But with silver nano, there's some kind of chemistry going on that we haven't put our fingers on."

As a rule, he said, silver likes to bind with sulfur in the environment, forming a fairly inert and harmless silver sulfide compound. But recent studies suggest that nanoparticles more easily evade the bond. This seems to especially true of the tiniest particles, Dr. Hochella said.

A study from the University of Oxford this year suggested that the smaller particles were also unusually reactive with oxygen molecules in water. The scientists reported that the intensity of that reaction appeared to encourage the formation of hydrogen peroxide, which is poisonous to aquatic organisms.

So far most scientists agree that such findings suggest a relatively minor health threat to people using products with silver nanoparticles. The more serious concerns are environmental, Dr. Wiesner said. Still, the growing uneasiness over the particles led the Natural Resources Defense Council to file a lawsuit against the Environmental Protection Agency in 2012 claiming that the agency was too quick to allow use of untested silver nanoparticles in consumer goods.

And the E.P.A. has its own concerns. Last month the agency moved to stop a New Jersey company that was embedding silver nanoparticles into food containers without bothering to register the product.

The E.P.A. can require companies to register a product under pesticide regulations if they are using the nanoparticles for antimicrobial action. The N.R.D.C. notes that companies frequently try to evade this requirement.

"They'll just say that it's about a fresh smell and not mention the antimicrobial aspect," said Jennifer Sass, an N.R.D.C. senior scientist. "And our concern is that this means that people are being exposed without adequate information."

Rosalind Volpe, executive director of an industry organization, the Silver Nanotechnology Working Group, acknowledges that products using silver nanoparticles may not always be registered. But even so, she says that the amount of particles involved is too small to add up to a meaningful threat.

"I think the E.P.A. is doing a good job," she said. "They've done some very conservative risk assessments." And antimicrobial silver is a valuable tool, she said, adding, "Remember, this is an emerging technology — we need to look at the benefits as well as recognize the risks."

From the scientific standpoint, said Dr. Wiesner, studying nanoparticles also offers some unexpected benefits: researchers are gaining a new and better understanding of the way plants take up metal, for instance, and of the unexpectedly complicated interaction of silver with living cells.

But given the uncertainties, he added, there's reason to approach the technology with some caution. "Is it important to use silver nanoparticles to protect a child from bacteria on a teddy bear?" he said. "We should be asking whether that's really a significant benefit, particularly when we don't yet fully know the risks."

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Well: Women With Diabetes Face Greater Heart Risks Than Men

Type 2 diabetes substantially increases the risk for heart disease, but a large review of studies has found that women with diabetes are at much higher risk than men.

The meta-analysis, published in Diabetologia, included 64 studies with 858,507 subjects and 28,203 heart attacks and other coronary events.

The studies adjusted for various other cardiovascular risk factors, including age, blood pressure, cholesterol, smoking and body mass index. But when considering diabetes as an independent risk, they found that compared with diabetic men, diabetic women were at a 44 percent higher risk for both fatal and nonfatal cardiovascular events.

The reasons remain unclear, but the study's lead author, Sanne A. E. Peters, an epidemiologist at University Medical Center Utrecht, suggested that the finding was not because of differences in treatment or physiological differences between the sexes in the effects of diabetes. Rather, it may be a result of the more severe deterioration of women before the onset of diabetes. .

"It may be that women have to gain much more weight than men before they become diabetic," she said. "So they may already be at higher risk for coronary heart disease at diagnosis, although there is no proof that this is true.

"Screening for diabetes should be different in women than in men," Dr. Peters continued. "Coronary heart disease is sometimes considered a man's disease, but women are at risk as well."

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Well: Is Work Your Happy Place?

Do you feel more stressed out at work or at home?

While work is widely viewed as the major source of stress for Americans, new research shows that people have significantly lower stress levels when they are at the office compared to their time at home.

Researchers from Pennsylvania State University tested the cortisol levels of 122 workers during the workday and on weekends. Using saliva samples, they found that levels of cortisol – which is a biological marker for stress – were on the whole much lower when the person was at work than when he or she went home.

The finding suggests that for many people, the workplace is a sort of haven away from life's daily problems. At home, the pressures of juggling work and family responsibilities set in and cause us to feel more stress.

"The fact that people's stress levels go down when they are at work, I don't think it means that they don't like their homes or their kids,'' said Sarah Damaske, an assistant professor of labor and employment relations at Penn State and the study's lead author. "I think it suggests that there is something about work that is good for you. Being in the moment, focusing on a task, completing that task, socializing with your co-workers — all of these are beneficial and that's part of what's lowering your stress level.''

The researchers also asked men and women about their levels of happiness at work and at home. While men over all reported being happier at home than at work, women were happier at work than at home. Women also reported higher levels of happiness at work than did the men in the study, which will be published soon in the journal Social Science & Medicine. The study was released by the Council on Contemporary Families, a nonprofit group that focuses on work and family issues.

"It speaks to something that we've long known – women have more to do at home when they come home at the end of a workday," said Dr. Damaske. "They have less leisure time. There is all this extra stuff to be done, that second shift."

Another reason women report lower stress and more happiness at work compared to men is that they might like their jobs better. "I think women who remain employed full time over the long run tend to have found jobs where they want to remain employed," said Dr. Damaske. "Due to the quality of the job, women might be more satisfied with their jobs than men are."

Notably, there were no gender differences in stress levels on weekends. "Everyone is less stressed on weekends," said Dr. Damaske.

The solution to the stress gap between home and work may be for employers to offer more family-friendly policies, including giving workers flexible schedules or the option to work at home to resolve the conflicts that arise from competing responsibilities between work and family.

"This is not a call to work a million more hours or for women to not spend time with their families," said Dr. Damaske. "There is something about combining work and family that makes a home — at least on a workday — a little less of a happy place."

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Well: Ask Well: For Fitness, 2,000 Calories a Week?

A

The idea that we should burn at least 2,000 calories a week during exercise seems to have originated in data gathered decades ago as part of the Harvard Alumni Study. That study followed male Harvard graduates for as long as 50 years, tracking how they lived and died. One of the first publications based on the data, appearing in 1978, showed that the older alumni who expended less than 2,000 calories a week in exercise were at 64 percent higher risk of suffering a heart attack than those who burned 2,000 calories a week or more during exercise. It's worth noting that the researchers' definition of exercise in this study was generous, including climbing stairs and walking around the block, as well as playing sports or jogging.

Widely reported at the time, the 2,000-calorie guideline still gets bandied about today. But the current exercise guidelines from the federal government, based on a large body of recent scientific evidence, emphasize time, not calories, and recommend that healthy adults engage in 150 minutes per week of moderate-intensity exercise, such as brisk walking or cycling.

Adhering to these guidelines means that most of us would burn about 1,000 calories per week in planned exercise, said Michael J. Joyner, an exercise researcher at the Mayo Clinic. And with the stairs we climb and chores we do, we come closer to that 2,000 calorie a week number, he said.

But we don't have to fret about actually reaching it. Meeting the current guidelines for 150 minutes or five brisk 30-minute walks per week is enough, he concluded. "The added health benefits start to level off after that."

Do you have a health question? Submit your question to Ask Well.

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Well: 4 Days, 11 Pounds

Losing weight is simple: Ingest fewer calories than your body burns. But how best to do that is unclear. Most experts advise small reductions in calories or increases in exercise to remove weight slowly and sensibly, but many people quit that type of program in the face of glacial progress. A new study, published in March in The Scandinavian Journal of Medicine & Science in Sports, suggests that minimal calories and maximal exercise can significantly reduce body fat in just four days — and the loss lasts for months. The catch, of course, is that those four days are pretty grueling.

Researchers in Spain and Sweden had 15 healthy but overweight Swedish men restrict their calories to about 360 a day, a reduction of approximately 1,800 calories. What calories they did ingest came in liquid form: Some men drank mostly sugary carbohydrates, others a high-protein drink. The men also exercised — a lot. Their days began with 45 minutes of cranking an arm-pedaling machine for an upper-body workout. Then, as a group, the men strolled for eight hours across the Swedish countryside, with only a 10-minute break every hour. They were allowed as much of a low-calorie, sports-type beverage as they wanted during their walks.

Most of the men "were surprised that it was easier than they thought it would be," says José Calbet, a professor at the University of Las Palmas de Gran Canaria in Spain; he and his colleague Hans-Christer Holmberg, a professor at Mid Sweden University in Ostersund, led the study. Some of the subjects experienced "minor problems with pain in the joints" and blisters on their feet, according to Calbet, but none dropped out or complained of hunger.

After four days, the men had each lost almost 11 pounds, with nearly half of that coming from body fat; the rest of the loss came primarily from muscle mass. The researchers had anticipated that the high-protein drink would protect people against muscle-mass loss. In fact, the losses were the same, whether the men had been given sugar or protein.

More surprising, the men did not immediately put the weight back on after the study ended. "We thought they would overeat and regain the weight lost," Dr. Calbet says. Instead, when the volunteers returned a month later, most had lost another two pounds of fat. And a year after the experiment, they were still down five pounds, mostly in lost body fat.

Dr. Calbet and his colleagues hope to study whether women respond similarly to men and whether repeated bouts of such a program might affect muscular health and appetite hormones.

But given the doleful statistics on weight loss — most people regain everything they lose dieting and more — these results are startling. They also, at the moment, are inexplicable. "The only explanation we can offer" for the sustained loss, Dr. Calbet says, is that the men were inspired by their hypercompressed success to change their lifestyles. The men moved more and ate less than before.

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Personal Health: This Summer, Safety First

Personal Health

Jane Brody on health and aging.

Heeding some basic safety tips this summer could help to keep you and your companions in the game and out of the emergency room.

As an emergency room physician in Southern California, Dr. Brady Pregerson has seen or heard it all. He incorporates many of the resulting insights in a helpful little book, "Think Twice: More Lessons from the ER," a sequel to "Don't Try This at Home: Lessons From the Emergency Department."

I've selected those lessons that are especially relevant for the coming months. But many of the tips can help at other times of the year, especially for those living in the warmer states.

Want some fresh air? Don't push on the glass when opening windows. "I've seen many terrible hand and forearm lacerations from this mistake," Dr. Pregerson writes. To which I will add: If there are children under age 10 in the house, install window guards. It takes but a moment for a young child to fall out of an open window.

If you work or play in the dirt, be sure your tetanus immunization is up to date. The deadly bacterium Clostridium tetani lives in soil, and it can enter the body through even a small cut or splinter, Dr. Pregerson said in an interview. Children require a vaccine series called DTaP, and adults need a booster every 10 years.

When you mow the lawn, first clear it of sticks and stones that can become flying missiles; wear goggles, and work crosswise on sloped terrain.

Protect yourself and your family from tiny critters that are disease vectors, like mosquitoes that transmit West Nile Encephalitis and ticks that spread Lyme disease. A repellent with DEET is effective against both. Suppress the mosquito population around the house by getting rid of standing water, especially after a rain.

Hiking, a summer favorite, is no fun if you get lost in the woods. Try to stick to blazed trails. Dr. Pregerson suggests turning around every so often to identify landmarks that may help guide you back. Let people know where you are going and when you're likely to return. If you do get lost or caught in a storm, it may be best to stay put in a place where you might be found.

Try to hike with someone, and take plenty of water, sunscreen, an extra layer of clothing, a compass, knife and some nonperishable food. In wild-animal country, the doctor suggests wearing a "bear bell" on a wrist, ankle, belt or backpack to scare off four-legged hazards.

Avoid vigorous exercise in very hot weather. "I've had patients who died of heatstroke from walking four hours in the desert," Dr. Pregerson said.

But you don't need to be in a desert to get heatstroke. It can happen to anyone who overworks on a hot day. The elderly, who are especially vulnerable, should stay out of the sun and drink plenty of plain cool liquids.

Although it's tempting to go barefoot when temperatures rise, that's a good way to injure a foot, even indoors. Dr. Pregerson has treated several broken toes suffered during a barefoot trip to the bathroom in the middle of the night.

Wear swim shoes around pools and in public showers to reduce the risk of athlete's foot; on a beach, they can prevent injuries from hidden sharp objects and keep feet comfortable on hot sand.

When camping, remember to shake out your shoes every morning in case a nasty spider or scorpion took refuge in them. Never go to sleep with a campfire still burning. Douse it. Do not keep food inside the tent or hang it in a tree; put it in a car away from sleeping campers.

Some of the most serious summer injuries result from incorrect use of fire starter. Never sprinkle or spray it on embers, as flames can shoot up and burn you badly.

On road trips, Dr. Pregerson suggests keeping your medical insurance card, a list of medications, and key health and allergy information with your driver's license. He also warns against tailgating, excessive lane changing, and leading other cars on a two-lane highway. You could be the first to hit a deer, for instance, or an oncoming vehicle in the wrong lane.

If you travel with a dog, secure it in a crate or with a harness that attaches to the seatbelt. Pets, like people, can fly around the car if you stop short or are in an accident. I was nearly run down when the driver of a car, with a dog in her lap and its head in her face, turned the corner as I was crossing with the light.

Of course, the driver and all passengers should also be buckled in, and young children secured in age-appropriate car or booster seats. Dr. Pregerson said a child under age 12 should not be in a seat with an air bag, which can break the child's neck if it inflates. And no child should be left alone in a car in the hot sun, even with a window down.

Do-it-yourselfers should heed basic safety measures, like wearing protective gear when shearing hedges, cutting wood, scraping or spraying paint, or installing insulation.

"Think twice before carrying so much that you cannot see where you're going," the doctor warned. "Don't do a two-person job alone." One of his patients broke his leg trying to carry a large TV down stairs.

If you're planning a picnic, don't keep perishable food at room temperature longer than four hours. Chill foods ahead of time and keep them cold until it's time to eat or grill them.

No summer safety column would be complete without cautionary words about swimming.

"Don't swim alone," Dr. Pregerson said. "Use the buddy system." Children should be watched closely at all times in and around water. Pools should be protected by a fence and safety gate that a young child cannot open.

Never dive into unknown waters or swim in areas designated off limits. Teenage boys are especially vulnerable to risk-taking and ignoring warning signs. More than one has been crippled or killed by diving headfirst into a hidden obstacle.

Dr. Pregerson offers more tips on staying out of the emergency room this summer at Gotsafety.org.

A version of this article appears in print on 05/20/2014, on page D7 of the NewYork edition with the headline: This Summer, Safety First.

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The New Old Age Blog: Do Not Resuscitate: What Young Doctors Would Choose

The researcher was presenting her findings to a room full of geriatricians, at the American Geriatrics Society annual scientific meeting last week in Orlando, Fla. So a slide revealing one particular statistic didn't cause an audible gasp or murmur. Talking to geriatricians about end-of-life treatment practically defines preaching to the choir, as a member of the audience told me later.

Among other kinds of doctors, or the public, this number might be more surprising. Dr. V.J. Periyakoil, a geriatrics and palliative care specialist at Stanford University, was talking about her survey of nearly 1,100 physicians who were completing clinical training at two university-affiliated medical centers.

She and her colleagues wanted to learn more about the attitudes of young doctors towards advance directives. So the researchers asked what choices they would make for themselves if they were terminally ill.

Their reply: 88.3 percent would choose a do-not-resuscitate or "no code" status. An allow-me-to-die status, in other words.

"Doctors see a lot," Dr. Periyakoil told me later that day. Resuscitation attempts are so aggressive — likely to break an older patient's ribs but unlikely to restore them to their previous state of health or function —that after witnessing several, "you know too much and you're much more wary," she said.

Perhaps readers here remember a much-circulated web essay by Dr. Ken Murray, a retired family practitioner, called "How Doctors Die." He claimed that his fellow physicians largely reject the sort of high-tech care they routinely dispense to their patients.

Dr. Murray wrote persuasively about the attitudes of people he knew, but he had no data demonstrating that these opinions were widely held. Only later did a reader point him to a survey of older doctors, all Johns Hopkins graduates who had reached their late 60s or 70s, who felt similarly.

But here is evidence, from the Stanford study, that even at the beginnings of their careers, doctors in many medical specialties resist the common "do everything" end-of-life attitude.

In some ways, this group doesn't precisely mirror American physicians in training as a whole. It included more women, for instance: 51.4 percent, compared to 46.1 percent of doctors in training nationally. This sample was more ethnically diverse, too: Only about half Caucasian (compared to 65 percent nationally) and more heavily Asian, with fewer African-Americans and Latinos.

And the doctors' thinking did vary by ethnicity and gender, the study showed. Over all, they had favorable attitudes toward advance directives, but women were significantly more favorable than men. Doctors who were white or African-American were more in support of advance directives than were Asians or Hispanics.

Medical specialties mattered, too. Emergency physicians, pediatricians, obstetrician-gynecologists and those in physical medicine and rehab had more favorable attitudes toward advance directives. Radiologists, surgeons, orthopedists and radiation oncologists were less favorably inclined.

Yet for their own future care, they achieved striking near unanimity with that a 88.3 percent preference for avoiding resuscitation and associated heroics if they had an illness that would soon kill them.

Dr. Periyakoil, who called her presentation "Do Unto Others," concluded with a slide that read: "Why do doctors continue to provide high-intensity care for terminal patients but may personally forgo such care themselves at the end of life?"

It's a really good question.

---

Paula Span is the author of "When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions."

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Well: Brain Changes in College Football Players Raise New Concerns

The brains of college football players are subtly different from the brains of other students, especially if the players have experienced a concussion in the past, according to an important new brain-scan study that, while restrained in its conclusions, adds to concerns that sports-related hits to the head could have lingering effects on the brain, even among the young and healthy.

Almost all of us have heard by now that concussions are more injurious than was once believed. It's been widely reported that the autopsied brains of some professional football and hockey players who experienced repeated hits to the head showed signs of severe and progressive brain damage. Meanwhile, recent studies with living animals suggest that the brain may respond to even mild concussive blows with inflammatory and other reactions that, while designed to spur healing, could also contribute to tissue damage.

But many fundamental questions about the long-term impacts of blows to the head during sports remain unanswered, including which portions of the brain are most affected, whether any brain changes also affect the ability to think, and if playing a contact sport might alter the structure and function of the brains of athletes, even ones who have never experienced a confirmed concussion.

So, for a study published last week in JAMA, researchers at the Laureate Institute for Brain Research and the University of Tulsa, both in Tulsa, Okla., and other institutions, started delving into those issues by turning to the university's Division I football team. Tulsa is, of course, in the heart of football country. But the researchers say they met no resistance from the school, team or players.

"Everyone around here loves football, including me," said David Polanski, the head athletic trainer for the university's sports teams and one of the study's co-authors.

"But we also know that you can't reduce the risks" of participating, he added, "unless you know what they are."

With his help, the scientists identified 25 players who had experienced at least one medically confirmed concussion while playing football. Most of the injuries had occurred in college play, but a few during high school. Some players had experienced as many as five concussions, but most only one or two.

The researchers also gathered another 25 players who never had a concussion diagnosis.

They asked all of the athletes how many years they had been playing football.

Finally, they rounded up 25 healthy, college-aged young men who'd never played football to act as a control group.

Then they scanned all of their volunteers' brains with a sophisticated M.R.I machine that could pick up slight differences in the size or shape of various parts of the brain.

And there were differences, as it turned out. As a group, the football players had less volume in the hippocampus, a part of the brain involved in memory and emotional processing, than did the nonplayers. Among the players who had no history of concussions, hippocampal volume was as much as 16 percent smaller than the control group's. And the difference in size was even more striking among the players who had experienced a confirmed concussion, whose hippocampal volume was about 25 percent smaller than in young men who'd never played.

"That was a greater differential than we'd anticipated," said Patrick Bellgowan, a faculty member at both the Laureate Institute and the University of Tulsa and the study's senior author.

The results are particularly baffling for the players with no history of concussion. Interestingly, those athletes in each group who had played the most seasons of football tended to have the least hippocampal volume, suggesting that, at least potentially, cumulative playing time and repeated tackles might affect the brain, even without a formal concussion.

Of course, the findings, although provocative, do not in fact show that playing a contact sport shrinks hippocampal volume. "This is a single snapshot" of the players' brains, Dr. Bellgowan said, and reveals nothing about changes over time. Indeed, the results could indicate that, in some indeterminate fashion, having a smaller hippocampus predisposes someone to enjoy or excel at football — meaning that the anomalous brain structure predated the playing

And encouragingly, the findings did not show that these brain changes are linked to impaired thinking or memory skills. The scientists found little correlation between smaller hippocampal volume and thinking skills when they compared players' scores on cognitive and coordination tests. Some athletes performed well, others less so, but the size of their hippocampus played little role, although, surprisingly, the more years a subject had played football, the slower his reaction time tended to be.

Over all, the study's results underscore the importance of additional research, Dr. Bellgowan said. He and his colleagues hope to re-scan the brains of current players, as well as of alumni who no longer play, to get a better sense of any brain changes over time. They also want to scan players in high school or younger.

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Well: Remembering, as an Extreme Sport

Sandy Huffaker for The New York Times

SAN DIEGO – The last match of the tournament had all the elements of a classic showdown, pitting style versus stealth, quickness versus deliberation, and the world's foremost card virtuoso against its premier numbers wizard.

If not quite Ali-Frazier or Williams-Sharapova, the duel was all the audience of about 100 could ask for. They had come to the first Extreme Memory Tournament, or XMT, to see a fast-paced, digitally enhanced memory contest, and that's what they got.

The contest, an unusual collaboration between industry and academic scientists, featured one-minute matches between 16 world-class "memory athletes" from all over the world as they met in a World Cup-like elimination format. The grand prize was $20,000; the potential scientific payoff was large, too.

One of the tournament's sponsors, the company Dart NeuroScience, is working to develop drugs for improved cognition. The other, Washington University in St. Louis, sent a research team with a battery of cognitive tests to determine what, if anything, sets memory athletes apart. Previous research was sparse and inconclusive.

Yet as the two finalists, both Germans, prepared to face off — Simon Reinhard, 35, a lawyer who holds the world record in card memorization (a deck in 21.19 seconds), and Johannes Mallow, 32, a teacher with the record for memorizing digits (501 in five minutes) — the Washington group had one preliminary finding that wasn't obvious.

"We found that one of the biggest differences between memory athletes and the rest of us," said Henry L. Roediger III, the psychologist who led the research team, "is in a cognitive ability that's not a direct measure of memory at all but of attention."

The Memory Palace

The technique the competitors use is no mystery.

People have been performing feats of memory for ages, scrolling out pi to hundreds of digits, or phenomenally long verses, or word pairs. Most store the studied material in a so-called memory palace, associating the numbers, words or cards with specific images they have already memorized; then they mentally place the associated pairs in a familiar location, like the rooms of a childhood home or the stops on a subway line.

The Greek poet Simonides of Ceos is credited with first describing the method, in the fifth century B.C., and it has been vividly described in popular books, most recently "Moonwalking With Einstein," by Joshua Foer.

Each competitor has his or her own variation. "When I see the eight of diamonds and the queen of spades, I picture a toilet, and my friend Guy Plowman," said Ben Pridmore, 37, an accountant in Derby, England, and a former champion. "Then I put those pictures on High Street in Cambridge, which is a street I know very well."

As these images accumulate during memorization, they tell an increasingly bizarre but memorable story. "I often use movie scenes as locations," said James Paterson, 32, a high school psychology teacher in Ascot, near London, who competes in world events. "In the movie 'Gladiator,' which I use, there's a scene where Russell Crowe is in a field, passing soldiers, inspecting weapons."

Mr. Paterson uses superheroes to represent combinations of letters or numbers: "I might have Batman — one of my images — playing Russell Crowe, and something else playing the horse, and so on."

The material that competitors attempt to memorize falls into several standard categories. Shuffled decks of cards. Random words. Names matched with faces. And numbers, either binary (ones and zeros) or integers. They are given a set amount of time to study — up to one minute in this tournament, an hour or more in others — before trying to reproduce as many cards, words or digits in the order presented.

Now and then, a challenger boasts online of having discovered an entirely new method, and shows up at competitions to demonstrate it.

"Those people are easy to find, because they come in last, or close to it," said another world-class competitor, Boris Konrad, 29, a German postdoctoral student in neuroscience. "Everyone here uses this same type of technique."

Anyone can learn to construct a memory palace, researchers say, and with practice remember far more detail of a particular subject than before. The technique is accessible enough that preteens pick it up quickly, and Mr. Paterson has integrated it into his teaching.

"I've got one boy, for instance, he has no interest in academics really, but he knows the Premier League, every team, every player," he said. "I'm working with him, and he's using that knowledge as scaffolding to help remember what he's learning in class."

Experts in Forgetting

The competitors gathered here for the XMT are not just anyone, however. This is the all-world team, an elite club of laser-smart types who take a nerdy interest in stockpiling facts and pushing themselves hard.

In his doctoral study of 30 world-class performers (most from Germany, which has by far the highest concentration because there are more competitions), Mr. Konrad has found as much. The average I.Q.: 130. Average study time: 1,000 to 2,000 hours and counting. The top competitors all use some variation of the memory-palace system and test, retest and tweak it.

"I started with my own system, but now I use his," said Annalena Fischer, 20, pointing to her boyfriend, Christian Schäfer, 22, whom she met at a 2010 memory competition in Germany. "Except I don't use the distance runners he uses; I don't know anything about the distance runners." Both are advanced science students and participants in Mr. Konrad's study.

One of the Washington University findings is predictable, if still preliminary: Memory athletes score very highly on tests of working memory, the mental sketchpad that serves as a shopping list of information we can hold in mind despite distractions.

One way to measure working memory is to have subjects solve a list of equations (5 + 4 = x; 8 + 9 = y; 7 + 2 = z; and so on) while keeping the middle numbers in mind (4, 9 and 2 in the above example). Elite memory athletes can usually store seven items, the top score on the test the researchers used; the average for college students is around two.

"And college students tend to be good at this task," said Dr. Roediger, a co-author of the new book "Make It Stick: The Science of Successful Learning." "What I'd like to do is extend the scoring up to, say, 21, just to see how far the memory athletes can go."

Yet this finding raises another question: Why don't the competitors' memory palaces ever fill up? Players usually have many favored locations to store studied facts, but they practice and compete repeatedly. They use and reuse the same blueprints hundreds of times, and the new images seem to overwrite the old ones — virtually without error.

"Once you've remembered the words or cards or whatever it is, and reported them, they're just gone," Mr. Paterson said.

Many competitors say the same: Once any given competition is over, the numbers or words or facts are gone. But this is one area in which they have less than precise insight.

In its testing, which began last year, the Washington University team has given memory athletes surprise tests on "old" material — lists of words they'd been tested on the day before. On Day 2, they recalled an average of about three-quarters of the words they memorized on Day 1 (college students remembered fewer than 5 percent). That is, despite what competitors say, the material is not gone; far from it.

Yet to install a fresh image-laden "story" in any given memory palace, a memory athlete must clear away the old one in its entirety. The same process occurs when we change a password: The old one must be suppressed, so it doesn't interfere with the new one.

One term for that skill is "attentional control," and psychologists have been measuring it for years with standardized tests. In the best known, the Stroop test, people see words flash by on a computer screen and name the color in which a word is presented. Answering is nearly instantaneous when the color and the word match — "red" displayed in red — but slower when there's a mismatch, like "red" displayed in blue.

"Memory athletes are a little older on average than college students, so you'd expect them to do worse, because we know this ability declines with age," said Mary A. Pyc, a psychologist at Washington University who, with Kathleen McDermott and David Balota, rounded out the research team. "But in fact they do better," staying focused on the colors and blocking out the words. Outside experts familiar with the work say the findings are likely to hold up, given what is known about memory.

"While attentional control is not a direct measure of memory, we know that it certainly serves memory," said Zachary Hambrick, a psychologist at Michigan State. The skill is crucial in memory competitions, he added, "and it's one that likely has a genetic component, given what we know about expertise."

In short, memory champions are not only exceptional at remembering. They're also experts at forgetting. To put it another way, competitors stumble not when they remember too little but when they remember too much. The new research on extreme memory suggests that remembering and forgetting are not necessarily related in the way it seems, the one the enemy of the other.

The Final Showdown

All of that seemed academic when Mr. Reinhard and Mr. Mallow took their places on stage at sundown (well, late afternoon) on a recent Sunday to close out the tournament. The two are good friends who train and travel together. But this was all business, a best-of-nine series with the winner getting a fat check.

"Look, there are spelling bees, there's poker on TV, there's hot-dog eating contests — memory contests should be popular; everyone is fascinated by memory," said the master of ceremonies, Nelson Dellis, 30, the United States champion, who persuaded executives at Dart NeuroScience to co-sponsor the event and who designed the format.

For spectator appeal, Mr. Dellis, a consultant based in Miami, installed large flat screens that displayed the competitors' every move, as in televised poker.

The first category was words. The two studied 50, all in their native German, taking no more than a minute. The seconds flew, and the pair began entering the words into their computers, which were in turn projected onto the screens so the audience could follow. Mr. Reinhard, dressed all in black, was in motion, rocking in his chair, jerking this way and that, as if physically touring his memory palaces; he jumped out to an early lead, with 43 words correct and time ticking down.

Mr. Mallow, still stuck at 16, looked nearly meditative, poking at his computer in a way that seemed almost leisurely. He'd been here before; only an hour or so earlier, he came back from a 3-0 deficit in the semifinals against the current world champion, a Swedish wunderkind named Jonas von Essen. Mr. Mallow can start slow and finish like Usain Bolt.

Yet it wouldn't happen this time. After losing the words test, Mr. Mallow won the numbers category, but in the cards match Mr. Reinhard was fast and meticulous, arranging his cards in order on his computer in practically no time. He then won names and soon the match, and the tournament. The crowd exhaled, and Mr. Reinhard jumped to his feet and pumped his fists, letting his head roll back in relief. "I'm happy," he called out to the audience, "happy and — and exhausted."

In all it had been a weekend that none of the attendees — whatever their Stroop abilities — is likely to forget.

A version of this article appears in print on 05/20/2014, on page D1 of the NewYork edition with the headline: Remembering, as an Extreme Sport.

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