Tag: exercise

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Staying Healthy

Dear Dr. B: How do I know I am healthy? And how can I stay healthy?

This is a good question for the month of December. This is a month when most people are not worried about their health. It’s a month to shop, eat, drink and be merry. After all Christmas and New Year come only once a year.

But many people use December as a time to reflect on the year gone by and plan for the year to come by. It may be about health or about other matters. It is a good month to remind oneself to get a yearly physical examination and blood tests. And pay a visit to your doctor and ask, “Doc, am I healthy?”

“Yes,” he will say, “you are healthy if you are maintaining a healthy weight, eating right, staying physically active, not smoking, controlling your blood pressure and cholesterol levels, and if you are a diabetic then you should be controlling your blood sugar level.”

This is a bit simplistic answer but you get the point. Many factors determine good health. Maintaining good weight is important. We know that being overweight increases the risk of heart disease, diabetes, high blood pressure and cancer.

But how does one know if a person is of normal weight?

Recently the Canadian Medical Association Journal (CMAJ), published the 2003 Canadian Guidelines for Body Weight Classification in Adults which updates the weight classification system that had been in use since 1988.

The authors of the article say that although the guidelines are helpful, the absence of concrete answers to relevant clinical scenarios weakens their practical application, and they should be applied with caution. After all they are only guidelines. These guidelines should be used in conjunction with clinical findings.

The body weight classification depends on the body mass index (BMI) – kg/m2 . There are many sites on the internet were you can enter your height and weight and your BMI will be calculated for you.

You are considered underweight if your BMI is lower than 18.5 kg/m2 . This could be a marker of malnutrition or may identify people with eating disorders.

If your BMI is between 18.5 and 24.9 kg/m2 then this is considered normal and good weight for most people.

Overweight is defined as a BMI between 25 and 30 kg/m2. This is associated with increased health risks and may lead to health problems in some people. The authors say that many factors beyond BMI influence health risk, such as body fat distribution, physical activity, diet and genetic background.

Obesity is defined as an excessive accumulation of body fat. The BMI of over 30 is considered to be obese. These individuals have increased risk of health problems.

Waist circumference is also important. Healthy waist circumference in a male should be less than 102 cm and for females less than 88 cm.

World Health Organization says that in the most industrialized countries at least one-third of all disease burden is caused by tobacco, alcohol, blood pressure, cholesterol and obesity. So, if we want to stay healthy then we need to tackle these problems.

Healthy eating and maintaining a healthy body weight are the first steps in that direction!

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Best Exercise

Dear Dr. B: Many people are confused about the type and amount of exercise necessary to become fit. Is there anything like “the best exercise”?

Answer: The type and amount of exercise required to become fit and healthy depends on your age, your health and your current state of physical fitness.

There are three types of exercises: aerobic, weight lifting (resistance training) and stretching.

Aerobic exercise involves continuous activity. It increases endurance and helps body use oxygen more effectively. It makes the lungs, heart and muscles strong. It is good for cardiovascular fitness.

Examples of aerobic exercises are: swimming, brisk walking, running, bicycling, climbing stairs, cross country skiing, using stationary bike etc.

However, flexibility, strength and muscular endurance also form an important part of any physical fitness program. Aerobic exercise should be combined with weight lifting and stretching. This helps improve muscle strength and flexibility. These exercises also help endurance and balance. A good exercise program should benefit all three aspects of fitness:

-Stamina
-Flexibility
-Strength

Review of literature suggests that swimming is excellent for all three aspects of fitness. It probably fits the definition of a perfect or best exercise. When swimming, you can burn 12 calories per minute. Compare this to jogging 9.6 km. (six miles) an hour, cross-country skiing, squash and handball where you can burn 10 to 11 calories per minute.

To build stamina, the best exercises are: swimming, basketball, bicycling, climbing stairs, dancing, hiking, and jogging.

To build flexibility, the best exercises are: swimming, basketball, dancing, tennis and yoga.

To build strength, the best exercises are: swimming, bicycling, and climbing stairs.

Except for swimming, none of the other exercises cater to all three aspects of fitness. Therefore, you should combine more than one type of activity in your schedule to maximize your fitness.

To prevent boredom and monotony, you should change the exercise regime and goals every six to eight weeks. This keeps your mind and body working towards a new goal. A professional qualified trainer can help you achieve this.

Some exercises burn more calories than others. This is important for people who are trying to lose weight.

You can lose two calories per minute by just standing or sitting at one place. You can lose up to four calories a minute by walking 3.2 km (two miles) an hour or bicycling eight km. (five miles) an hour.

You can lose up to seven calories a minute by indulging in sexual activity, shoveling dirt, skating or bicycling 16 km. (10 miles) and hour. Anyway, who would like to shovel dirt when you can burn calories by getting involved in a romantic activity?

Other examples are: housework burns five calories/minute; raking leaves burns six calories/minute; tennis, shoveling snow, downhill skiing, and water-skiing burn eight calories/minute; and basketball burns eight to 10 calories/minute.

What about golf? Golf is not a good activity to build stamina. It is good for flexibility. And has small effect on building strength. You can lose 250 calories per hour when you golf riding a cart.

A study done by Golf Digest showed that a golfer who walks 18 holes while carrying his bag travels an average of 9.4 km. (5.9 miles) and burns 1811 calories. A rider with no cart path restrictions, surprisingly, walks an average of 3.7 km. (2.3 miles) and burns 859 calories.

Thirty minutes a day of exercise can do wonders for you. Exercising in three 10-minute sessions is comparable to a workout in 30 minutes all at once.

To retain muscle mass and strength, you should do resistance training for 20 minutes three times a week. According to Newsweek, Harvard runners study has shown that men who trained with weights for 30 minutes or more per week cut their risk of heart disease by 23 percent.

So, swimming is the best exercise. But there are many other activities to choose from. Whatever you do, make sure you are having fun!

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Exercise With Care

Dear Dr. B: My friend and I go to a gym regularly. At the end of a strenuous session my friend feels nauseated. What is the reason?

Answer: Regular exercise has many benefits. Those benefits are achieved if the exercise is done properly. Otherwise, exercise may harm you. Let us try and understand what happens when we exercise.

Exercise considerably increases muscle metabolism (break down of substances to yield energy). To meet this increased metabolic activity, muscles require more nutrition and more oxygen. Blood carries nutrition and oxygen to the muscles. That means more blood is pooled to the muscles at the expense of other vital organs.

The body responds to this need immediately. The body ensures that the metabolic needs of exercising muscles are met, that hyperthermia (overheating) does not occur, and that blood flow to essential organs is protected.

This protective mechanism is achieved by the circulatory system (heart and blood vessels). It involves a complex series of adjustments resulting in a large increase in cardiac output (blood flowing out of the heart) proportional to the increased metabolic demands. The increased metabolic activity rapidly increases the heart rate.

During a tough workout in a hot environment, the body can lose two liters of fluid per hour through sweat. There is also loss of electrolytes. This can result in severe dehydration which can be dangerous.

Hyperthermia can be a problem as well. It causes lightheadedness, nausea, headache, hyperventilation, fatigue, and loss of concentration. Heatstroke is the most dangerous complication of hyperthermia.

Those who use anabolic steroids to stimulate production of muscle tissue are also at an increased risk of complications.

What are the other dangers of strenuous exercise?

Heart attack and sudden death from strenuous exercise has been reported. One American report says that an estimated 1.5 million heart attacks occur every year; of these, 75,000, or about five percent, occur after heavy exertion, leading to 25,000 deaths.

Strenuous exercise or high-impact aerobics can cause injuries to bones and muscles.

High-impact exercise can also damage the inner ear, causing dizziness, ringing in the ear, motion sickness, or loss of high-frequency hearing.

The risk factors which are associated with complications during exercise are age, presence of heart disease and intensity of exercise.

How can you exercise safely?

Most important thing is to listen to warning signs. It is estimated that at least 40 percent of young men who die suddenly during a workout have previously experienced, and ignored, warning signs of heart disease: irregular heartbeat, undue shortness of breath, chest pain and weakness.

Be careful to warm up, cool down, and stretch; flexibility is the key to preventing many muscle strains. Vary training and alternate easy and harder workouts.

Don’t eat two hours before vigorous exercise. Drink plenty of fluids before, during, and after a workout. Adjust activity according to the weather and reduce it when fatigued or ill.

When exercising, listen to the body’s warning symptoms, and consult a physician if exercise induces chest pain, irregular heartbeat, undue fatigue, nausea, unexpected breathlessness, or light-headedness.

My advice to your friend is to review his exercise regime, listen to body’s warning signs and symptoms and consult a physician.

Finally, it is February. It is Heart Month. Today is Valentine’s Day. Let me wish you all a Happy Valentine’s Day. Take care of your own hearts and the hearts of your loved ones! And support Heart and Stroke Foundation.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!

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Exercise and Health

Dear Dr. B: Physical activity clearly benefits cardiovascular health. But people do die suddenly during or immediately after vigorous exertion like jogging or snow shovelling. What can one do to reduce the risk of sudden death during or after vigorous exertion? Yours: Born to Exercise!

Dear Born to Exercise: This is an interesting question. There are so many benefits to regular physical activity that we tend to forget exercise or any type of physical exertion can kill.

“Approximately 6 to 17 percent of all sudden deaths occur in association with exertion and there is evidence to suggest that vigorous exertion simultaneously triggers and protects against sudden death,” says an article in the New England Journal of Medicine (NEJM).

The authors of the article looked at the role of vigorous exertion in precipitating or preventing sudden death. It was part of the Physicians’ Health Study to determine whether vigorous exertion triggers sudden death and whether habitual vigorous exercise diminishes the risk.

About 22,000 male physicians between the ages of 40 to 84 years were studied over a period of 12 years. These physicians were otherwise well and had no obvious cancer or cardiac problems.

The majority of the participants in the study reported exercising vigorously two to four times per week. During the 12-year follow-up, 122 deaths occurred from cardiac causes (in apparently healthy male physicians). Fourteen percent of the deaths occurred during vigorous exertion and five percent of deaths occurred within 30 minutes after vigorous exertion.

These individuals were involved in different types of activities: 68 per cent jogging or racquet sports; 25 per cent other sports; 7 per cent were doing heavy yard work or home repairs.

It was found that the relative risk of sudden death associated with an episode of vigorous exertion was lower among those who exercised more frequently compared to men who rarely engaged in vigorous exercise (less than once a week). Men who exercised at least five times a week had a much lower risk of dying suddenly during or after vigorous exertion.

How can one avoid sudden death from vigorous activity?

There is no good answer to that. The article says that habitually active men have a much lower risk of sudden death in association with vigorous activity. But most active men’s risk remained significantly elevated during and after vigorous exertion.

This is scary because is no 100 per cent protection against sudden death. The benefits and risks of vigorous exercise are paradoxical. It is a double-edged sword. The important thing is to know ones limit as regular moderate exercise or physical activity has tremendous benefits. It is an important strategy in the prevention of the cardiovascular diseases and other chronic ailments.

So, if you are Born to Exercise then carry on exercising and stay within your limits. Talk to your family doctor to define these limits. “The balance of evidence supports the value and importance of participation in regular exercise regimens,” says the NEJM. A good workout is always better than no workout!

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!