DEAR DR. DONOHUE: I am a Southerner who has been transplanted to the North. I like it. I am getting used to cold and snow and am interested in outdoor winter sports. I’d like to cross-country ski. How does it stack up with other exercise? What kinds of injuries might I expect? I want to be prepared. – G.P.

Cross-country skiing demands a high level of endurance. It is one of the best heart-conditioning exercises there is. The calorie cost of cross-country skiing is around 10 calories for every minute of skiing. That puts it on a level with fast jogging. Calories burned could be even more than 10 a minute, depending on the size of the skier, the terrain and the outdoor chill.

In its favor is its gentle treatment of joints. They don’t get the shock waves that come from the foot striking the ground while running.

Not only does it exercise the legs and the heart, but use of ski poles exercises the upper body and arms.

Injuries are possible in any athletic endeavor. Ankle and knee sprains happen to skiers. An injury somewhat unique to both downhill and cross-country skiers is skier’s thumb. When a skier falls and his or her hands remained fixed to an upright ski pole, the thumb is severely bent. Ligaments of the thumb are stretched or torn.

Don’t focus on the negatives. You have chosen a sport whose benefits few other sports can equal.

DEAR DR. DONOHUE: So much is written about exercise for continuing health, but so little is written about how those of us who are handicapped can exercise.

I have peripheral neuropathy and have no balance. What can I do? – R.J.

How about exercising while sitting on a bench? Get some lightweight dumbbells. While seated, lift them overhead, directly in front of you and off to the side. Choose a weight that lets you lift the dumbbells at a fairly rapid clip for three or more minutes nonstop. When you tire, take a minute or so break and then start pumping again.

Make progress slowly. Don’t try too much at first, and do ask your doctor if the exercise is safe for you.

Not only are you exercising arm, shoulder and back muscles, but you are also exercising heart muscle. This exercise should get your heart beating fast, and that gives it the equivalent workout that jogging would give it. Upper-body exercise like this actually gives the heart a better workout than do leg exercises.

While sitting, you can exercise the legs in the same manner – to the front and to the side. You’ll need some ankle weights, the kind that strap on your legs.

DEAR DR. DONOHUE: I have been a runner for many years. Recently I developed a stress fracture of my right foot. Why has this happened? Nothing ever happened to me in the past 25 years. – S.K.

Stress fractures happen when people do too much exercise, do it too often without giving bones a chance to recover from the pounding they take, or suddenly increase the volume of exercise. Even well-conditioned, professional athletes suffer from these fractures.

Stress fractures are tiny separations in the bone. In time, the separations coalesce to form a slightly larger break. The same process goes on in steel beams that are subjected to great force.

Pain usually strikes after a person begins to jog or walk. If appropriate measures are not taken, the pain increases in severity and remains even during rest.

Stress fractures can be tricky to diagnose. They don’t show up on X-rays until three to six weeks after the damage is done. They do show up on bone scans much sooner, in a matter of two or three days. That makes a bone scan the procedure of choice when trying to establish stress fractures as the cause of a person’s pain.

If you take it easy for about six weeks, the fracture will heal. Taking it easy means not doing anything that causes foot pain. If the pain bothers you when walking, then you might need to have the foot protected by a cast.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475.

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