DEAR DR. DONOHUE: I am a 54-year-old woman whose doctor told her to lose 65 pounds. Six months ago, I started a walking plan and limited my calorie intake to 1,200 per day. I average 22 miles of walking a week and have gone down two dress sizes. But I have lost only 12 pounds. What can I do to increase weight loss? — S.D.

ANSWER: When calorie output (exercise, physical activity) exceeds calorie intake, a drop in weight has to occur. A reduction of calorie intake by 500 calories ought to result in about 1 pound of weight loss a week. Your calorie intake is about as low as you can go without expert help from your doctor or a dietitian. Any further reduction makes it difficult for you to take in the daily requirements of minerals and vitamins.

Dieting slows the metabolic rate. Fifty percent to 60 percent of daily calorie burning comes from your resting metabolism, the amount of calories burned when you are sitting or sleeping. Since that huge loss of calories is reduced when you diet, you have to make up the loss by physical activity. Yours sounds good. What is your walking pace? You should feel that it’s a bit difficult, but you should be able to carry on a conversation. A supervised exercise class might be a good investment for you.

A two-dress-size reduction in your clothes represents a substantial change in body proportions and body weight. Scales are only one way to measure success, and often the information they give isn’t the best. Circle your waist with a tape measure at about bellybutton level. Exhale gently and take the measurement. If your waist measurement is less than 35 inches (88 cm), you’re doing well. For men, the desired measurement is less than 40 inches (102 cm).

If things are not going as you wish, consider joining a weight-loss program like Weight Watchers, where the calorie load of your food is calculated for you and an exercise program is prescribed.

DEAR DR. DONOHUE: I have just been diagnosed with a slight rotator-cuff tear. Will it get worse if I play tennis? (I play two to three times a week.) Will therapy help? I experience nausea every day. Can this be from the anti-inflammatory I take? Can I take Advil instead of the Mobic I’m taking? — M.H.

ANSWER: The rotator cuff is four closely adjacent tendons that come from back muscles. The tendons wrap around the ball at the top of the upper arm and keep it in the shoulder socket.

Small tears heal on their own in six to 12 weeks. Large tears often need surgical repair.

Physical therapy helps. The overhead motion of serving the tennis ball and returning a lob are hard on the rotator cuff. The only one who can tell you with confidence that it’s OK to play tennis is your doctor, who knows the extent of the tear. It takes six to 12 weeks for most tears to heal.

You can take any anti-inflammatory medicine that relieves pain and doesn’t produce side effects.

DEAR DR. DONOHUE: I am a well-conditioned, 73-year-old man. I am extremely interested in walking for aerobic fitness. Every publication I have read, including your column, uses the term “brisk walking.” I am not sure what that means.

Please tell me how brisk walking translates into miles per hour. I am sure brisk walking for a 70-year-old is different than it would be for a 30-year-old. — B.H.

ANSWER: Brisk walking is walking at the rate of 3.5 miles an hour, 17 minutes a mile. This rate should not make you breathless. If it does, slow down and consult your doctor. It ought to be possible for you to carry on a conversation at this pace. Brisk walking is defined the same for all ages. At younger ages, a walker can pick up the pace without fear of any health threat.

Get clearance from your doctor for this exercise.

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. Readers may also order health newsletters from www .rbmamall.com.

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