Why should you exercise

Exercise has many benefits. Exercise can help you:

  • maintain a healthy weight or help you reach your weight loss goals
  • reduce the likelihood of gaining weight as you age
  • maintain bone mass
  • lower blood pressure, cholesterol and blood sugar levels
  • reduce the risk of chronic conditions such as diabetes, heart disease, and osteoporosis
  • reduce stress and improve the quality of sleep
  • maintain a higher level of cardiovascular fitness, mobility, strength, flexibility, and improves the stereotypical image of aging

Activities of daily living  /  structured exercise

Activities of daily living (ADLs) are the activities you do on a regular basis that can help to burn calories, maintain strength and agility, and keep active. Examples of these include washing the car, gardening, raking leaves, washing dishes, vacuuming, etc. These activities do not necessarily count as exercise. Be sure to note the distinction in these ADLs as compared to structured exercises. You need both types of movement in order to maintain an optimal level of physical activity.

Structured exercise includes activities specifically geared toward a purpose, usually to improve cardiovascular fitness, strength, flexibility, or balance and agility. There are specific definitions as to what constitutes exercise. Some activities may fit into both categories (exercise and ADLs) based on the intensity and duration. One example of an activity fitting both categories would be walking while mowing the lawn.

Getting started

Before starting an exercise program, it is important to talk with your doctor to determine any limitations you may have in regards to exercise. Exercise can be safe for almost anyone. However, certain limitations may be placed on individuals who suffer from chronic conditions such as arthritis, heart disease, hypertension, diabetes, osteoporosis, and certain pulmonary conditions, among others.

Building an exercise routine takes time. Slowly incorporate exercise into your weekly routine, starting with a reasonable amount you can build on. Eventually, you should be able to incorporate some type of physical activity into every day.

Determine what activities you enjoy. Exercise should not be looked at primarily as a chore. Finding activities that interest you are important because you are more likely to maintain them long term. Try something new. There are many new forms of exercise that are becoming more popular and accessible. When possible, try some of the new fitness trends. Changing your routine and trying new things can help prevent boredom.

Make sure that if your exercise routine is primarily outdoors you are able to have a back-up plan for bad weather.

You should plan for consistency. Exercise benefits are best seen if the routine is maintained with minimal disruption. Everyone has a different tolerance for exercise. If you start experiencing feelings of burnout, reevaluate your routine. Make changes that you feel can be maintained. You can add more later once you feel more comfortable with your routine.

Components of an exercise program

There are four main components of a well-rounded exercise program. These are:

  • cardiovascular exercises (aerobic exercise)
  • strengthening exercises
  • flexibility exercises
  • balance and agility exercises
Aerobic exercises

Aerobic exercise helps to improve heart and lung function. Walking, swimming, running, biking, dancing, and hiking are just a few examples of aerobic exercise. The benefits of aerobic exercise include:

  • lower cholesterol and blood pressure
  • increased endurance
  • a lower resting heart rate
  • weight loss or maintenance
  • stress relief
  • improved sleep

Aerobic exercise should be performed for 30 minutes, five to seven days per week. If time management is an issue, or poor endurance is an issue, break the 30 minutes into three sessions of 10 minutes each.

Strengthening exercises

Strength or resistance exercises can help to maintain strong bones, break some of the stereotypes associated with aging, increase metabolism, and help to achieve or maintain a higher level of function. Resistance exercises can include the use of:

  • machine or free weights
  • exercise balls
  • hand weights or bands
  • different types of exercises (such as Pilates or calisthenics)

Strength exercises for general fitness should be performed two times per week for every major muscle group. Larger muscle exercises using several joints, such as lunges or bench presses, should be spaced out to provide three to four days of rest in between sessions. Smaller muscle exercises require as little as one day of rest in between sessions.

Strength training is based on the overload principle. If you feel as though your muscles have not been strained, then chances are they have not. Talk with your therapist or allied health provider to determine what resistance exercises are safe for you, and what weight or resistance is appropriate.

Flexibility exercises

Flexibility is an important fitness component that helps to maintain pain-free range-of-motion. There are many different reasons why stretching is important, and orthopedic issues may include different recommendations specific to any conditions you may have. For general fitness, however, it is important to stretch either after exercise or independent of exercise so that your muscles are generally “not cold.” It is no longer recommended to stretch prior to exercise. However, a proper warm-up of a lower-intensity cardiovascular exercise is imperative.

Stretching can be performed daily, or several times a day, depending on the recommendations of your therapists. Yoga and tai chi can also help with stretching. Ballistic stretching (or bouncing during a stretch) is not recommended. Static stretching is when a stretch is held for a specific length of time, usually several seconds to half a minute, and repeated. Dynamic stretching is a method of stretching where the body is moving fluidly while attempting to improve flexibility. Ask your therapist which methods of flexibility are appropriate for you.

Balance/agility exercises

Balance and agility are important not only in athletic performance, but also in general fitness. Balance can be negatively impacted by the aging process. It is never too early to try and improve balance and agility to negate this aspect of aging. Depending on any limitations you may have, not all exercises to improve balance may be appropriate for you. More basic or beginner levels of balance include standing on one foot, walking heel to toe, or standing on your toes. Tai chi is also an excellent balance exercise for beginner and intermediate balance abilities. Intermediate levels of balance exercise may also include using the exercise ball, performing basic exercises with your eyes closed, or performing one-legged exercises. More advanced exercises include many exercise ball exercises. Talk with your therapist to determine your ability level and for suggestions to help improve balance and agility.



Understanding Body Mass Index

One of the most common topics patients address with their doctors is weight loss. One-third of Americans today are overweight. Exceeding an ideal body weight is caused by genetic, socioeconomic, and physiological factors. However, doctors today see excess weight as an important, treatable medical condition.

There are several ways of measuring your ideal body weight. One of the most popular methods to gauge whether or not you are overweight is the body mass index (BMI). Body mass index BMI is calculated by dividing a person’s weight (in kilograms) by his or her height (in meters, squared). BMI can also be calculated by multiplying weight (in pounds) by 703, then dividing by height (in inches, squared). People with BMIs of 25 and above are considered to be overweight. The chart below shows examples of body mass indexes. The figure at which your height corresponds with your weight is your body mass index. Having a body mass index over 30 places you at risk for developing obesity-related medical conditions such as diabetes, high blood pressure, and coronary artery disease. A BMI over 40 indicates that a person is morbidly obese.

Weight (lbs) Height (feet, inches)
5’0″ 5’3″ 5’6″ 5’9″ 6’0″ 6’3″
140 27 25 23 21 19 18
150 29 27 24 22 20 19
160 31 28 26 24 22 20
170 33 30 28 25 23 21
180 35 32 29 27 25 23
190 37 34 31 28 26 24
200 39 36 32 30 27 25
210 41 37 34 31 29 26
220 43 39 36 33 30 28
230 45 41 37 34 31 29
240 47 43 39 36 33 30
250 49 44 40 37 34 31

Does being overweight lead to any medical risks?

The best reason to attain and maintain your ideal weight is to reduce or eliminate medical problems that are more likely to occur with increasing weight. These conditions include high blood pressure, coronary artery disease, type 2 diabetes, cardiovascular disease, cancer, and other medical problems. All of these conditions contribute to an overall increase in mortality (rate of death).

Are treatment plans available to help me lose weight?

There have been many treatment plans — from diets to pills — aimed at reducing weight. However, being overweight is a chronic condition and therefore needs a long-term plan aimed at weight reduction.

Your doctor or registered dietician is the ideal person to initiate and monitor an organized treatment plan for you. This treatment plan should center on behavior modification. There are also many community organizations and resources for gathering information on weight loss.

What steps should I take to help me lose weight?

  • Decide you want to permanently lose weight.
  • Educate yourself.
  • Have a realistic goal in mind.
  • Formulate a structured treatment plan with your doctor and receive proper follow-up.
  • Understand that obesity is a long-term condition and it will require life-long attention.

Inflammatory bowel disease : symptoms, risks and management

Inflammatory bowel disease (IBD), which include Crohn’s disease and ulcerative colitis, affect as many as five million people worldwide. The main difference between the two diseases is the parts of the digestive tract they affect. In Crohn’s disease, inflammation can affect any part of the gastrointestinal (GI) tract from the mouth to anus while ulcerative colitis affects the colon and the rectum.

Another type of inflammatory bowel disease is indeterminate colitis, in which features of both the diseases are present and when it is difficult to distinguish between them. Rarer forms of IBD are two main types of microscopic colitis – collagenous colitis and lymphocytic colitis.

Who is at risk of getting IBD?

The factors that cause IBD are unknown, but several probable risk factors have been studied. Some of them are:

  • Genetics –

    There is clearly a genetic factor for getting the disease. Studies have shown that 5% to 20% of affected individuals have a first-degree relative, either a parent, child or sibling with one of the diseases. The risk is also substantially higher when both parents have IBD.

  • Smoking –

    Smokers are more likely to get Crohn’s disease and it can increase the risk of complications. However, smokers are at lower risk of developing ulcerative colitis.

  • Age –

    Although IBD can happen at any age, people are often diagnosed between the ages of 15 and 35. About 10% of cases occur in individuals less than 18 years old.

  • Gender:

    IBD affects both women and men, but more often in women, possibly due to certain hormones.

  • Geographic distribution:

    IBD is found mostly in developed countries and among people who live in urban areas.

What are the symptoms of IBD?

Since the symptoms of IBD vary from person to person, doctors have a hard time diagnosing what kind of IBD a patient might have. Patients may also experience long periods of remission when the disease is not active and recurrent flare-ups. Complications of IBD include:

  • Urgency to have a bowel movement
  • Bloody stools
  • Anemia
  • Diarrhea
  • Abdominal pain
  • Rectal bleeding
  • Extreme fatigue
  • Nausea and vomiting

IBD can also have extra intestinal issues such as:

  • Eyes redness, pain, and itchiness
  • Mouth sores
  • Arthritis
  • Skin disorders
  • Osteoporosis
  • Kidney stones
  • Depression
How is IDB diagnosed?

To diagnose IBD, your doctor will take your history and perform a physical exam, which may then be followed by one or more tests such as:

Blood and stool tests –

Blood tests can find signs of anemia or to check for signs of infection from bacteria or viruses while stool tests identify intestinal inflammation. Blood tests may also assess liver and kidney functions, which can be affected by IBD.

Endoscopy –

This method lets your doctor look inside your body using an endoscope which has a tiny camera attached to it. It helps your doctor to see if inflammation is present, where it is located, assess its severity, and obtain biopsies to confirm the diagnosis.

Colonoscopy –

This is the type of endoscopy most often performed to both diagnose and monitor IBD. This test allows your doctor to view your entire colon. During the procedure, your doctor can also take a biopsy to confirm a diagnosis.

Flexible Sigmoidoscopy –

This test is an endoscopic evaluation of the sigmoid colon and to confirm the presence of inflammation in that part of the colon. The procedure uses a camera, which is inserted through the anus to look for ulcers, fistulas, and other damage.

Double Balloon Enteroscopy (DBE) –

This is an examination of the small intestine which uses a special type of endoscope with two small balloons at its tip. It can be used to examine and take biopsies from the whole length of the small intestine.

Capsule Endoscopy –

This process allows your physician to obtain pictures of the entire small bowel. For the test, you swallow a small capsule containing a camera, which then passes through the small intestine and transmits images to a data recorder worn around the waist. The capsule is then excreted in the stool normally.

Endoscopic Ultrasound (EUS) –

This is a relatively new technique that uses a special type of endoscope that has a tiny ultrasound transmitter at its tip. The scope is then passed through the mouth or anus to the area to be examined. This process produces very clear, detailed images of the digestive tract.

Computer Tomography (CT) –

CT scans are basically computerized X-rays that looks at the entire bowel as well as at tissues outside the bowel. The CT scan is used to detect complications of IBD, such as intra-abdominal abscesses, strictures, small bowel obstructions or blockages, fistulas, and bowel perforation.

Magnetic Resonance Imaging (MRI) –

MRI uses magnetic fields and radio waves to create detailed images of the body and is especially helpful in examining soft tissues and detecting fistulas. There is also no radiation exposure with MRI.

Treatment options for IBD?

There are several different medications to treat IBD, but if medical treatment is ineffective, then bowel resections, strictureplasties, colostomy or ileostomy may be necessary. The most commonly prescribed medications for IBD fall into five classes. They are:

Aminosalicylates -These drugs, which contain 5-aminosalicylic acid (5-ASA), decreases the inflammation of the digestive tract and in preventing relapses. They can be given either orally or rectally. Examples are sulfasalazine, balsalazide, mesalamine, and olsalazine.

Corticosteroids -These medications, which include prednisone, prednisolone, and budesonide keep the immune system in check and are effective for short-term control of flare-ups.

Immunomodulators -This group of medication can be given orally or by injection. They prevent the immune system from attacking the bowel and causing inflammation. Examples of immunomodulators are azathioprine, cyclosporine, 6-mercaptopurine, and methotrexate.

Biologic therapies -These are the latest drugs developed to treat IBD and are effective in achieving and maintaining remission without the use of steroids. They help to reduce inflammation by targeting specific proteins that play a role in inflammation. There are two main classes of biologics. The first are the Anti-tumor necrosis factor (anti-TNF) agents such as adalimumab, certolizumab pegol, golimumab, infliximab, and infliximab-dyyb while the second categories are the anti-integrins such as natalizumab and vedolizumab.

Antibiotics -Given orally or intravenously, antibiotics such as metronidazole and ciprofloxacin are used to kill bacteria that may trigger or aggravate IBD symptoms.

Over the last decade, major advancements, specifically in the fields of genetics, immunology, and microbiology, and the development of increasingly effective treatments have led to a greater understanding of inflammatory diseases of the digestive system. These key breakthroughs have also helped to transform treatment for the many patients who suffer from IBD.