Hi Dr,

I am Schizophrenic, on permanent medication n in my early 40s. I have been taking Zyprexa and it helps me a great deal with my sleep. However, the downside is this med has made me put on a lot of weight..I can't stop eating. I have done my research n many taking this med posted the same problem. I have recently started to take walks at the park. What I would like to know is whether increasing the number of rounds walking will have n impact on my legs,knees especially at a later age? What are some tips to keep one motivated in having a regular exercise routine? Does eating according to my blood type would actually work in order to lose weight?

Thank you.

Hi S******,

Zyprexa, like many other medications that treat mood disorders, is a very powerful and effective drug that helps to minimise or eliminate the symptoms of schizophrenia so that you can continue to live comfortably. However, one of the common and undesirable side effects of these medications is weight gain. These medications stimulate the appetite, tempting you to eat more food and take in more calories. They also trigger changes in the body’s metabolism causing the body to use up the calories less efficiently and at a slower rate.

Here are some strategies that you can adopt to address the weight gain.

1. Make conscious choices when it comes to your diet. Take 3 regular meals (breakfast, lunch and dinner) daily without skipping any of them or snacking in between. Use “My Healthy Plate” https://www.healthhub.sg/programmes/55/my-healthy-plate as a simple guide to create a balanced and healthy meal. Choose low-calorie foods like fresh fruits and vegetables, eat fibre-rich and slow-to-digest complex carbohydrates like wholegrains and choose plain water over sweetened beverages. It is important to note that there are no special diets for the various blood types. You may also consult a dietician to customise a diet that suits your lifestyle and medical condition.

2. Staying physically active is important for overall health as well as for weight loss or maintenance. It is good that you have already started doing so by walking regularly. To burn more of the excess calories, you will need to increase your physical activity levels progressively. You can do so by gradually increasing the number of days in the week that you walk in the park, the duration spent for each walking session, the walking distance (number of rounds walked) and/or the speed of your walking.        

Generally, walking is a simple and safe weight-bearing activity that will improve your cardiovascular fitness, improve your balance as well as strengthen your core and lower limb muscles in preparation for old age. For a more structured exercise programme that is customised to your lifestyle and level of health or current symptoms, you may want to consult an Exercise is Medicine Singapore (EIMS) certified physician or fitness professional https://www.exerciseismedicine.org/singapore/support_page.php/eims-certified-physicians/

3. Ask your doctor if there are alternative medications or treatments for your condition that would still maintain your health without the extra pounds.

Hi Doctor,

Is weight training better for weight loss than cardio exercise? Why is that?

Hi J*******,

Weight loss requires you to reduce the total caloric input through a healthy diet as well as an increase in the total caloric output through daily incidental physical activities and exercise.

Many exercises can help you lose weight but the best type of exercises will be those which burn the most calories, ie. cardiovascular exercises. These are physical activities that increase your breathing and heart rate, and also consume the most energy. Some examples include brisk walking, jogging, swimming, cycling and dancing. 

Weight training is a type of strength training that uses weights for resistance. By creating a stress with free weights (barbells and dumbbells) or by using weight machines, these exercises help to develop your muscles and get them stronger. They complement the cardiovascular exercises in maintaining your general health and fitness. They still consume energy, but not as much as the cardiovascular exercises. Hence, performing strength-training exercises alone may not burn adequate calories for effective weight loss.

Hi,

I've recently experienced a sudden sharp pain in my lower back which resulted in much discomfort. This was the third time over a span of 2 years which I had encountered such condition. The pain was sharp and sudden that shot down to my legs and resulted in some numb feelin when I started to walk and lift my body. The pain anf feeling would dissipate after a while of walking.

Is this something which I should be concerned about? If so, what sort of thorough check up would you recommend and advise?

Hi I****,

The symptoms that you have experienced are collectively known as sciatica, which is often present in an intervertebral disc-related lower back injury. I strongly advise that you consult a physician for a more accurate clinical assessment of your condition, in view of the recurrent and persistent symptoms. 

In addition to a thorough physical examination, your doctor may also order specific imaging studies such as X-rays or magnetic resonance imaging (MRI) scans to further confirm the diagnosis. Depending on the diagnosis derived from all these information, your doctor will discuss the appropriate treatment or even refer you to a sport and exercise medicine physician who will be able to guide your return to running and sports.

I am suffering from facial pain. I used to exercise regularly but stopped drastically ever since I got married. Somehow, movement like doing minimal housework helps with my inflammation. I want to get back to exercising however the trauma I have from my pain still persists. I find it difficult to walk normally when I am outside, I eat minimally because there is still pain when certain foods hit my nerves. Even after cutting sugar out from my diet, I can still feel the inflammation in my gums. I want to make it go away quickly but I have no idea how to. 

There are many causes of facial pain. They may include nerve conditions, jaw and dental problems, infections, autoimmune and/or chronic inflammatory conditions. Facial pain can originate from a specific or localised area of the face or it may radiate from another part of the head. It is therefore important for you to see your doctor to get the condition diagnosed and symptoms treated.

It is good that you are already thinking about returning to your previous active lifestyle. Exercise is indeed the medicine for almost everything in life. It not only treats but also prevents conditions like diabetes, high blood pressure, heart diseases, cancers, depression, memory loss and many more. Research has also shown that regular physical activity and exercise are effective in reducing chronic pain.

For now, you may resume light physical activities that do not aggravate your symptoms, such as performing daily house chores or strolling around your neighbourhood with your family or friends. Aim to perform these activities as regularly as possible or make them as part of your daily routine. Break long sedentary times when you are at home by moving more often as every simple physical movement will be beneficial to health.

Depending on the medical condition that you have, your doctor will be able to advise you further on the various types of exercises that will be most suitable for you. Ask your doctor for a structured exercise prescription that will also include the frequency, intensity, duration as well as the progression of each exercise.

Hi Dr

I am in my late 30s and have been diagnosed as hypertensive for 2 years, however i am on daily medication and my condition is under control. Overall I lead a fairly healthy lifestyle, with slow jogs about twice a week and I do frequent walks, so the hypertension came as a surprise. I am also conscious of my diet and do a health check yearly (cholestrol, sugar levels are fine). Lately when I tried to do jogs, I feel light headed even though my blood pressure is fine, what could be the cause and can I continue jogging? I also have a persistent pain on the back of my left shoulder but the doctor said that it is a muscle issue and to see a PT (not seen one yet). The pain goes away after stretches or massages, though not completely gone. Are there any specific stretches i can do at home for this and could this be more than just a muscle issue?

Kudos to you for leading a physically active lifestyle and being conscious of your diet. Your efforts will help to manage your high blood pressure and further prevent other chronic medical problems.

One of the desirable long-term effects of regular physical activity and exercise is that it gradually reduces the baseline blood pressure over time. However, a single bout of low to moderate-intensity exercise can also lead to a temporary decrease in blood pressure post-exercise in hypertensive individuals. This phenomenon is called post-exercise hypotension and may last up to 22 hours. The decrease in the blood pressure becomes even more significant due to dehydration especially after a long or high intensity workout, in addition to the effects of the blood-pressure lowering medications. This, together with fatigue as well as a lower blood sugar may be one of the reasons for the sensation of light-headedness post exercise. 

For now, you may still resume light-intensity exercises but with close monitoring of your symptoms. Measure your blood pressure before and after your workouts. Do not exercise when you feel unwell or when your blood pressure readings are high, i.e. ≥ 180/100 mm Hg or low ≤ 90/60 mm Hg. Seek immediate medical consult if so. 

The cooldown is an important part of the transition from exercise to rest. If you stop exercising suddenly, your heart rate slows down, decreasing the blood circulation and making your blood pressure fall too quickly, which can lead to dizziness and even fainting. Instead, do 5 to 10 minutes of light activity (cool-down) to gradually start the process of bringing your system back to normal after your jogs. Rehydrate adequately, particularly when exercising in hot and humid conditions.

You should seek a medical consult if your symptoms persist or worsen. Your doctor will assess your condition thoroughly and may even adjust the dose and type of the blood pressure lowering medications that you are taking if necessary. He/she may also perform more tests or investigations to exclude other serious causes of your symptoms, which include underlying heart diseases or a stroke. 

For your back/shoulder pain, you should consult a physiotherapist as advised by your doctor. He/she will prescribe an appropriate set of rehabilitative exercises to address the underlying biomechanical issues eg. muscle tightness or weakness, poor posture etc. that have contributed to your symptoms. In addition, he/she will also ensure that these exercises are performed correctly and guide your return to sports.

I suffer from  this acute pain in my right pelvis which will "immobilize" me. Any movement I make will only make the pain worse. I have stopped taking painkillers given by my GP as I want to start on a more organic method of healing. I plan to exercise to be in a better health. But this pain stops me from doing so. And I dont know of any exercise that can help with the pain. There are so many videos on youtube but I dont know which one is suitable. Do I seek my GP's advice or do I try each and every exercise? How do I change my mentality about exercising will make the pain go away?

There are many causes of hip or pelvis pain. They range from musculoskeletal problems, gynaecological conditions and/or chronic inflammatory or autoimmune conditions. Hip or pelvis pain may originate from a localised or specific area of the hip or pelvis, or it may also radiate from the abdomen or lower back. It is therefore important for you to see a doctor to have your condition properly diagnosed and treated, before attempting to self-manage it by following the exercises videos online. This is especially when you have described your symptoms to be persistent and “immobilising”.

Analgesics or painkillers may help to alleviate the pain in the acute stages, but they do not solve the problem completely. If the pain is secondary to a musculoskeletal cause, your doctor may also refer you to see a physiotherapist for a rehabilitation programme to address the underlying biomechanical issues eg. muscle tightness or weakness, poor posture or gait patterns that have contributed to your symptoms.

Regular exercise, if performed correctly, may help to reduce the severity of chronic pain by improving the range of motion of the joints, muscle flexibility, strength and balance in addition to the general benefits associated with improved overall physical and mental health. You may speak to your doctor to find out more on the types of exercises that are suitable for your condition. Ask your doctor for a structured exercise prescription that will also include the frequency, intensity, duration as well as the progression of each exercises.

Dear Dr,

Is there such a thing as too much exercise? I've only started my jogging routine about 3 months ago. Now I've been able to go for my jog up to 4 times weekly. Recently, I've been having more frequent stomach pains and headaches during the day. (I jog in the evenings) I still go ahead with my jogging routine, thinking it'll "clear the pain away". And I always do feel better after the jog. What's your advice? Should I cut back?

The current exercise guidelines for adults recommend at least 150 minutes per week of moderate-intensity cardiovascular physical activities or 75 minutes per week of vigorous-intensity cardiovascular physical activities. These guidelines also suggest that performing more exercise is associated with additional health outcomes. 

Although increased amounts of exercise above the minimum guidelines are encouraged for health benefits, there are currently no upper limits. While the guidelines caution that high-intensity exercise may increase the risk of injuries and heart complications, there is no fixed point at which exercise definitively becomes harmful to one’s health, as this will likely vary between individuals and depend on a variety of factors such as age, health history, current physical activity levels and lifestyle.

While experts are still deciding on the upper limit of the cut-off point, it is important that you are at the very least, meeting the minimum amount of exercise for health benefits and reaching your New Year’s resolutions for your well-being. Even if you do not reach every single one of your fitness goals, remember that something is always better than nothing.

There are many conditions that can account for your symptoms of headaches and stomach pains, and they may not be at all related to your exercise routines. My advice is that you see a doctor to have a thorough assessment and diagnosis of these symptoms. For now, you may still resume with your current jogging routines.

Hi Dr, I am a senior who has started gym exercises with weights to strengthen my limbs and torso about 3 months ago.  Would over-straining of muscles cause cramps in the limbs?  What would be a sensible weekly weight increase to avoid muscles over-straining?

I applaud your efforts to lead a healthier and more physically active lifestyle. Resistance training with weights not only strengthens the muscles of your limbs and torso, but also has the ability to reduce the risk of osteoporosis and falls that come with ageing. In addition, resistance or strength training, together with cardiovascular exercises, can prevent and manage many chronic diseases such as heart disease, diabetes, high blood pressure and arthritis, while also improving sleep, mood, memory and cognitive function.

Dehydration, fatigue, overuse of a muscle and muscle strain especially after long periods of exercise or having improper techniques when performing strength training exercises can cause a muscle to cramp. In many cases, however, the cause is not known.

To avoid over-straining a muscle during strength training, it is important to keep in mind that you can only increase the frequency (number of sets or repetitions) or the intensity (loads or weights) of the exercise at any one time but not both.

A simple guideline to follow is the 10% rule:

This guideline simply states that you should increase the activity to no more than 10% per week. For example, if you are lifting 20 pounds and you want to increase, add 2 pounds the next week, following the 10% rule. Of course, if you are a beginner, 10% may be too much, so a 5% (1 pound) increase per week may be more comfortable. Alternatively, you may even reduce the number of repetitions of the exercise initially with the increase in loads, and progress gradually thereafter.

Hi Dr,

Does weight really matters? I heard that as long as you "don’t gain", your health will not be that affected.  My 56-year old mother is severely overweight and is unable to do much cardiovascular exercises and strength training exercises due to her size. She walks with a walking aid as her ankles and knees hurt each time she tries to walk, go up or down the stairs. In this case, how much exercise can she each day and each week? What type of exercise should  she do? What exercises or activities should she avoid? Chair-bound exercises? Should she take medication at a certain time around her exercise routines?

Overweight and obesity are defined as abnormal or excessive fat accumulation that puts one at risk of many chronic medical conditions like diabetes, high blood pressure, heart disease, stroke, musculoskeletal or joint problems, and it may even lower one’s life expectancy. The most basic and the most common way to measure obesity is the body mass index (BMI), which is the ratio of weight to height, calculated as weight (kg) divided by the square of height (m²). Therefore, in this aspect, weight does matter to one’s health. 

For many of us, exercise simply is not part of our daily lives, and for people who are significantly overweight, this can be compounded by the fact that sometimes, conventional advice about exercise is just not possible to follow – their blood pressure is already raised, they are already fatigued, their joints are already strained etc. Furthermore, the wrong type of exercise can also cause injury.

So to start off, the home represents a safe and controlled environment. Your mother should first aim to break as much sedentary time as possible when she is at home. Remember, every bodily movement counts and that includes walking slowly - even with a walking aid - at home and around the house. Download a step-tracking app to her handphone if she carries one or strap on a simple fitness tracking device like the one given by the Health Promotion Board, to monitor her daily step-counts and motivate her to stay physically active. The aim is to achieve at least 10, 000 steps each day, but remember, the journey to that starts with just one simple step at a time, anytime, anywhere and everywhere. 

For structured exercises, although the guidelines recommend that adults should perform at least 150 minutes of moderate-intensity, or 75 minutes of vigorous-intensity cardiovascular exercises per week, it is important to understand that beginning such an exercise regime can be difficult and painful for your mother. However, it is not at all impossible for her to keep that as one of her goals, and she can now start slowly to reap the benefits.

For example, she may perform 10 minutes of low intensity, low-impact or non-weight bearing cardiovascular exercise once or twice a week. This includes chair bound or seated exercises at home, tai-chi with her friends in the neighbourhood, or arm-cranking exercises using the equipment at the nearby fitness corner. Otherwise, she may also want to participate in pool-based or group exercise programmes offered by the local community gyms or sports facilities such as ActiveSG. Gradually, she may then increase the duration of these structured exercise sessions to 15 minutes or longer, or even do so more frequently - of up to 3-5 times per week. 

It is important for your mother to know the type of medications that she is currently taking as well as their potential side effects with exercise. I therefore suggest that she speaks to her doctor, to find out more on the necessary precautions that she should take when exercising, while taking these medications or if she needs to have their dose and timing adjusted based on her exercise routines.

Hi Dr, 

I'm an obese man in his early 30s weighing at 126kg, can pass my IPPT but I still have issues with shedding the weight. I have tried controlling my diet and gym/run/swim regularly like 3-4 times a week but nothing seems to be working. Even at my lightest during NS I was 90+kg. I don't suffer from any joint or muscle issues, I do suffer from a beer belly (bigger than my wife's pregnant belly) and a constant need to change pants from all the friction generated. My recent health screening was optimal, not on long term medication or have any other medical problems. Any advice for this carebear?

Thanks in advance~!

E****, kudos to passing your IPPT but that is unfortunately not the best and most accurate measure of your overall fitness or health. In addition, you are still young and you do not want to wait until you are diagnosed with an obesity-related medical condition like diabetes, high blood pressure, heart disease and musculoskeletal or joint problems in order to start managing your weight. 

Weight management follows a very simple concept of energy balance – calories in versus calories out. More specifically, if you want to lose weight, you must be in negative energy balance (energy intake < energy expenditure). The energy intake refers to the total caloric input contributed by your diet, which is determined by the quantity, quality and the frequency of your daily meals. On the other hand, the total energy or caloric expenditure is generally determined by your daily physical activities (both incidental activities and structured exercise) as well as your resting metabolism.

Resting metabolism is the energy required by your body to perform the most basic functions when your body is at rest. These essential functions generally include breathing, circulating blood, digestion or basic brain functions. Factors that affect your resting metabolism are your weight, gender, age, and body composition. For effective weight loss, it is recommended that you remain as physically active as possible daily and perform at least 300 minutes per week of moderate-intensity or 150 minutes per week of vigorous-intensity cardiovascular exercises.

You briefly mentioned that you have been looking after your diet and performing regular exercises, but these may not have met the specific recommended goals for weight loss, as outlined above.

For further assistance in your weight loss journey, you may want to sign up for the weight management programme offered at our centre: http://www.csmc.sg/services/WM_weight_management_program.html

Hi Doctor, 

There is an exercise where you bend down to hold each knee with your hand and rotate the knees clockwise several times and then anti-clockwise several times.  Does this helps in strengthening the knee? 

Can frozen shoulder heals by itself without any western/tcm treatment?

The knee rotation exercise that you have described is a great warm up exercise for your knees and ankles. They can help alleviate pain and stiffness as well as preventing injuries in these joints when performed before a lower body or full body workout routine. They unfortunately do not strengthen your knees but improve joint position awareness and joint mobility.

The knee is a hinge joint, that has two main functions: Flexion (bending) and extension (straightening). There is a small degree of rotation available at the joint, but only to allow for the proper mechanics of the major motions of extension and flexion. Knee strengthening exercises are generally those that work the muscles involved in these movements against resistance.

Frozen shoulder is a condition that can affect one or both shoulder joints. It commonly affects people aged between 40 and 60 years, and it is more likely in women than in men, as well as in diabetics. The symptoms present in 3 stages: First, it usually involves pain and stiffness that develops gradually as a result of inflammation, scarring, thickening, and shrinkage of the capsule that surrounds the normal shoulder joint (freezing stage). The symptoms progressively get worse and the shoulder movement becomes restricted (frozen stage) before slowly and finally going away (thawing stage).

Without treatment, these symptoms usually go away, but this can take a long time: up to 2-3 years in some cases. The various treatments available are aimed at easing the pain and improving the movement of your shoulder, therefore reducing the course of the condition.

1. What is the most effective diet to slim down?

2. How does intermittent fasting (e.g. fasting for 16 hours a day) help to lose weight?

3. How do I reduce my tummy?

4. Why are some people able to run 20km every day, while some people are getting knee pain from running less often and less intensely?

5. What is the best time to exercise? Morning or evening? Before or after dinner?

6. Do late dinners make me fat?

Thank you in advance for answering my questions!

1. The best and most sustainable diet that will aid weight loss and weight management is a healthy and well-balanced one that provides all the essential nutrients your body needs each day. This includes:

◦Taking your 3 regular meals (breakfast, lunch and dinner) daily without skipping any of them or snacking in between. When you snack, you are essentially consuming calories in addition to the calories from your main meals, thus resulting in weight gain.

◦Use “My Healthy Plate” https://www.healthhub.sg/programmes/55/my-healthy-plate as a simple guide to create a balanced and healthy meal. My Healthy Plate shows you the correct proportions of the different food groups that you should be eating on a simple plate and ensures that your body gets all the essential nutrients without exceeding your total caloric intake.

◦Choose low-calorie foods like fresh fruits and vegetables, eat fibre-rich and slow-to-digest complex carbohydrates like wholegrains to keep you full in between meals. Hydrate adequately and choose plain water over sweetened beverages to reduce the caloric intake.

Remember, at the end of the day, the safest and most sustainable way to reduce and maintain your weight is a combination of both a healthy diet AND regular exercise.

2. Intermittent fasting works for weight loss primarily by a reduction in calorie intake, but there are also some beneficial effects on hormones that come into play. Studies have shown that intermittent fasting leads to reduced insulin, increased growth hormones, enhanced epinephrine (stress hormones) signalling and a small boost in metabolism.

There are several different intermittent fasting methods. The most popular being the 16/8 method in which one skips breakfast every day and eat during an 8-hour feeding window, such as from 12 noon to 8 pm. As long as you do not compensate by eating much more during the non-fasting periods, then these methods will lead to reduced caloric intake.

3. To lose fat anywhere on your body you need to reduce your total caloric input through a healthy diet AND increase your total caloric expenditure by staying as physically active as possible daily (>10,000 steps everyday) as well as performing at least 300 minutes per week of moderate-intensity or 150 minutes per week of vigorous-intensity cardiovascular exercises. In doing so, you will decrease fat stores throughout your body; including the problem areas like the abdomen.

Unfortunately, there is no such thing as spot reduction. Fat reduction occurs throughout the body, not in specific areas. It is therefore not possible to achieve spot reduction through exercise of specific muscles, such as exercising the abdominal muscles in an effort to lose weight in or around the tummy.

4. If you run regularly, the activity gets easier as your body adapts to running longer distances. Your muscles get stronger, so they are more able to work for a longer period of time. You will also start to use a wider variety of different muscles to support the running movement therefore allowing you to run with better form and posture, and also more efficiently, hence a longer distance. With better running biomechanics, you are also less likely to get injuries. Your heart and lungs (cardiovascular system) gets stronger (better fitness) which therefore makes running long distances a lot easier too.

5. There is not one best time of the day to work out. While research supports both morning and evening workouts, your best bet is to pick a routine that aligns with your long-term fitness goals, as well as something that you can stick with based on your lifestyle and daily schedule. You are more likely to exercise regularly if you select a time and stick to it, regardless of whether it is in the morning or evening. Exercising consistently at the same time each day is one of the best predictors of developing a long-lasting exercise habit.

You also need to eat food both before and after your workout to get the most benefits. Whether you like to do your workout before or after a meal, it is important that you have at least some calories in you for exercise. As you are working out, you want to make sure all your hard-working muscles are used to their full potential.

Eating before exercise helps fuel your muscles so that they perform their best. When you exercise, your body relies on the energy that is derived from the foods you consume in your daily diet. Eating before exercising is typically a vital way to provide your body with enough fuel to sustain the physical activity. It also provides your muscles with the nutrients they need to function optimally and grow. To prevent indigestion while working out, it is recommended that you wait three to four hours after a large meal before exercising. If you have had a small meal or snack, wait a minimum of 30 minutes or preferably one to two hours before working out.

Following up with a healthy meal after your workout can help replenish energy stores and preserve muscle mass. You do not need to focus on any one nutrient, but it is important that you eat balanced and healthy meals to ensure that you get all the nutrients your body needs not only for your workouts, but for your overall health and weight-loss efforts.

6. It does not matter what time of the day you eat. It is what and how much you eat (total caloric intake) and how much physical activity you do during the whole day (total caloric expenditure) that determines whether you gain, lose, or maintain your weight. A calorie is a calorie, regardless of when you eat it, and that what causes weight gain is simply eating more calories than you burn.

People eat at night for a variety of reasons that often have little to do with hunger, from satisfying cravings to coping with boredom or stress. And after-dinner snacks tend not to be controlled. They often consist of large portions of high-calorie foods (like chips, cookies, candy), eaten while sitting in front of the television or computer. In this situation, it’s all too easy to consume the entire bag, carton, or container before you realise it. Besides those unnecessary extra calories, eating too close to bedtime can cause indigestion and sleeping problems.

Dear Dr, I participate in the Gym Tonic programme. There is one particular exercise that is for the abdomen. This machine has a bar for the feet to hook on to provide the "reaction" to the weight that we have to push down.

Curiously, the trainers there said that we must not use that bar, as that would be the wrong technique. Because of this, I have to reduce the resistance to half, because using a higher resistance would cause my feet to rise, since I am not allowed to hook it under the bar. I find no benefit from using such a low resistance.

Your opinion please.

I believe that you are referring to the abdomen-back easy access gym equipment, which is a wheelchair friendly unit that exercises both the abdominal and back muscles. To be honest, I too am curious to know why you have been instructed by the trainer to do so. Similar to performing sit ups/crunches, hooking the feet under the bar as you bend forward while pushing against resistance, will keep your body rooted firmly to your seat and thus, preventing your feet from being lifted off the footplate. I therefore strongly suggest that you clarify this with your trainer to ensure that you are doing the exercises correctly for optimal benefits and preventing any further injuries.

My question is as follows :

I am in my 50s and is doing strength training to build muscle mass.

My trainer told me to take a high protein low carb (max. 150g)diet however my health screening doc is against the high protein diet.

So what is the appropriate portion of protein I should take daily to gain muscle mass healthily? I weigh about 48.2kg and is 1.54m tall. Thanks.

Your weight and height gives you a body mass index (BMI) value of 20.3 kg/m², which falls within the healthy and ideal BMI range for Asia-Pacific individuals (18.5-22.9 kg/m² ) based on World Health Organisation’s (WHO) BMI classification. Congratulations!

Good and healthy nutrition helps in weight management and enhances both athletic performance and recovery after exercise. A healthy diet comprises a combination of different foods to provide your body with essential nutrition: fluid, macronutrients (carbohydrates, proteins, fats and fibre), micronutrients (vitamins and minerals) and calories.

For a healthy adult individual like you who exercises regularly, carbohydrate is an essential part of sports nutrition as it provides the main source of energy for the body. Therefore, it is important to eat enough carbohydrates to supplement the energy reserves for your performance. Protein, on the other hand, supports the maintenance of your muscle mass. For healthy muscle mass gains, it is therefore important for you to have adequate amounts of carbohydrates and proteins in your daily diet.

The American College of Sports Medicine recommends that a regular healthy adult consumes 0.8-1.0 g of proteins per kg of body weight daily. An athlete, depending on the training status, training intensity, the availability of the carbohydrates and calories in the diet, may require slightly more proteins in the daily diet than non-athletes, ie. 1.2-2.0g of proteins per kg of body weight daily. In your case, if you have a normal kidney function, you likely require 57.8 -96.4 g of proteins daily. 

Thks Doc for the reply. So this means I can take more than 150g of carb to make up the required calories I need to build muscle mass? How much calories excess is required for me to build muscle? As my muscle mass % fluctuates and hovers within 38%. I want to hit at least 40%.

Carbohydrates provide the main source of energy for the body regardless of your physical activity status. The unit of measurement that defines the energy is a calorie. Proteins also contribute to the calories, but more importantly, they support muscle building and development. 1 g of either carbohydrate or protein contains 4 calories.

An athlete, depending on the training status, training intensity, the availability of the carbohydrates and calories in the diet, may require slightly more proteins in the daily diet than non-athletes, ie. 1.2 - 2.0g of proteins per kg of body weight daily. In your case, if you have a normal kidney function, you likely require 57.8-96.4 g of proteins daily. This contributes approximately 231.2-385.6 calories to your diet.

I am a 57 years old male. Not long ago, I went to the gym to do some leg and knee exercise. I discover recently that seems to be a swell near my genital area abdomen area. The doctor said that I have hernia. Does that pose any danger to my life? Can it be healed through oral medicine? What should I do?

A hernia is a common condition in which part of an internal organ or tissue bulges through a weakened or torn muscle. An inguinal hernia occurs when the intestines or fat from the abdomen bulge through the weakened lower abdominal wall into the inguinal, or groin, area. This bulge may start small and it can progressively become larger as it pushes more fatty tissue and intestines out.

An inguinal hernia is usually not dangerous and may be painless or cause no symptoms, especially when they first appear. However, it can be painful, especially during activities that increase the pressure within the abdomen, such as lifting, bending, straining with a bowel movement, or coughing. The main concern is when it becomes trapped (incarcerated), a condition when the bulge does not respond with manual pressure. Incarcerated hernia can lead to strangulation (where the blood supply to part of the intestine is blocked) and serious internal infection (sepsis). This usually produces very severe abdominal pain as well as other symptoms such as fever and vomiting.

Oral medications cannot cure hernias but may provide symptomatic relief and prevent the hernia from worsening. Laxatives or stool softeners may facilitate bowel movements to prevent straining during defecation. Cough suppressants may be helpful if you have a chronic cough. Likewise, immediate surgery is not always recommended when a hernia is not causing any symptoms. However, it is also important to note that most hernias do not resolve without treatment. They may also become larger and more uncomfortable over time. This is when your doctor may recommend a surgery.

Exercise may also help to manage your inguinal hernia and its symptoms. This is especially recommended if you are overweight or obese. Being obese could be counterproductive for the prognosis of your hernia. More pounds of excess weight you gain will drive more pressure in your abdominal cavity. As a result, there will be more fatty tissues that protrude through the weakened abdominal wall, leading to a bigger lump. You need to keep your weight off, not only to help manage your hernia symptoms, but also to make surgical hernia repair easier when needed. However, when you are exercising, it is also important to ensure that your workouts are safe for your hernia, as some types of exercise may worsen the problem.

You may need to have a few adjustments for your existing workout by reducing the duration, impact, or intensity. Engage in moderate intensity physical activities that will not cause undue stress on the abdominal cavity. For example, a light to moderate intensity walking program can help improve your core strength, which is also low impact and a good way to reduce the risk of strain on the abdomen. Swimming and water exercises are recommended as the fluid environment support the body. Static cycling with appropriate sitting angle will support your core muscles and prevent undue abdominal straining.

Avoid exercises that involve breath-holding and excessive straining, which will put more pressure on your abdomen. Examples include heavy lifting, pushing, pulling, ballistic activities (punching and kicking), crunches, sit-ups, strenuous activities, and competitive sports. These activities can cause more pain and increase the size of your inguinal hernia.

I am 71 years old and go to the gym regularly to work out. It is difficult to maintain muscle mass because I do not take protein supplements. My diet is protein rich with less emphasis on carbohydrates intake. What do you advise to build muscles at my age?

For a healthy adult individual like you who exercises regularly, carbohydrate is a very essential part of sports nutrition as it provides the main source of energy for the body. Therefore, it is important to eat enough carbohydrates to supplement the energy reserves for your performance, and not to focus on protein intake alone. Protein, on the other hand, supports the maintenance of your muscle mass. For healthy muscle mass gains, you do not need to take protein supplements if you already have adequate amounts of carbohydrates and proteins in your daily diet.

The American College of Sports Medicine recommends that a regular healthy adult consumes 0.8-1.0 g of proteins per kg of body weight daily. An athlete, depending on the training status, training intensity, the availability of the carbohydrates and calories in the diet, may require slightly more proteins in the daily diet than non-athletes, ie. 1.2-2.0g of proteins per kg of body weight daily.