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"Exercise is medicine", we've all heard this phrase before. But how true is it? Does it have any impact for people who already have a chronic illness? Also, is it safe for people with chronic illnesses to exercise, and how can one do it effectively?
For people without a chronic illness and wanting to improve their overall health, what are the steps they should take to exercise safely?
Dr Fadzil Hamzah, Senior Staff Registrar from the
Singapore Sport and Exercise Medicine Centre (SSMC @ CGH) at
Changi General Hospital (CGH), a member of the
SingHealth group, answers your questions about the effectiveness of exercise and how to do it safely.
This forum is open from
1 Jan to 28 Jan 2020.
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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?
Answered by Dr Fadzil Hamzah, Senior Staff Registrar from the Singapore Sport and Exercise Medicine Centre (SSMC @ CGH) at Changi General Hospital (CGH)
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.
Is weight training better for weight loss than cardio exercise? Why is that?
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.
Posted by Ishak
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?
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.
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.
Posted by SarahSB
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.
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.
Posted by Edwin
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~!
Edwin, 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:
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.
Posted by Vincent
Dear Dr Fadzil, 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.
Posted by Jenny
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.