Posture and Falls in the Elderly

In my last blog, I discussed the importance of ankle rehabilitation and continued mobility in maintaining balance, especially in the elderly population. I also briefly mentioned how poor posture in the elderly can often contribute to the high prevalence of falls. Here, I will discuss this in more detail.

As I mentioned previously, a common trait in the elderly is their shuffled walking pattern and stooped posture, both significant contributing factors to the high incidence of falls in older adults.

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Many factors play a role in contributing to the stooped posture seen in the elderly:

·         Reduced eyesight, causing people to look down at their feet to see where they are going

·         Weakened abdominal muscles

·         Weakened upper back and neck muscles

·         Limited arm swing

·         Shuffled walking due to reduced hip flexion, poor balance and limited ankle flexibility and stability – discussed previously

Poor eyesight will not be dealt with here, but it is important to remember that even if you see a step and it is right in front of you, chances are it will be too late for you to correct your step before tripping. Rather keep your head up, and focus your eyes about 3 metres ahead of you on the ground. This way, you simply have to drop your eyes slightly and you have time to step appropriately before tripping over any uneven surface ahead of you.

Abdominal strengthening exercises should be done regularly in order to maintain core strength, as this keeps one’s posture upright. When you walk, pull you navel in towards your spine, keep your hips underneath your shoulders and walk with long strides, striking the ground with the heel first. Pretend you have a piece of string attached to the top of your head that is gently pulling you up as you walk.

It is very important to maintain strength of the upper back and neck muscles because it is weakness in these muscles that causes the head to drop and the typical stoop to develop. This causes one’s centre of gravity to shift forward, contributing to falls. In order to prevent this, one must keep looking straight ahead and keep the chin tucked in by gently pulling the head back. The upper back muscles can be strengthened by squeezing the shoulder blades together and releasing 10 times and then holding the squeeze for 10 counts at a time. This can be done while waiting in a queue or watching TV.

Finally, arm swing must be maintained to keep balance and a good stride length. As soon as one’s upper body stiffens, the rest of the body does as well, resulting in a shuffle.  

So, remember: walk tall, look ahead, keep the shoulders back, swing the arms, lift the knees and feet, and strike the ground with your heel first! J

Merry Christmas and may you all have a happy and healthy 2013! J

Balance in the Elderly

Following on from my last blog, in which I discussed the importance of ankle rehabilitation and stability, here I will discuss how important ankle stability is with regards to balance in elderly people. As we age, we tend to move less and less, resulting in our joints and muscles stiffening up, which in turn results in less movement again. This vicious cycle continues until we are barely able to move which in turn affects our ability to perform activities of daily living.

When you see an elderly person, the first thing you notice is the typical stooped posture and shuffled walking pattern, both of which are major contributing factors to the high prevalence of falls in the elderly. I will discuss posture in the elderly in the next blog.

Limited ankle stability and mobility are also major contributing factors to loss of balance and thus falls in the elderly. Hence, I again stress the importance of rehabilitating the ankle following an injury, so that movement and strength of the joint are regained as soon as possible. The longer it is left, the worse it will become.

A common movement that becomes limited is lifting of the toes to allow for a heel strike. The ankle mobility required for this movement is reduced and the muscle in front of the shin becomes weak. The consequence of this is that the toes drag along the floor, hooking on uneven surfaces and thus causing a person to trip and fall. A good exercise to prevent this: sit in front of the TV and tap your toes, making sure to lift them as high off the ground as possible, while keeping the heels down. A simple and highly effective exercise!

Another exercise that will help maintain the mobility of the ankle joint is to write the letters of the alphabet using the ankle, so that it is moving in every direction. Again, this can be done while sitting in front of the TV, but be sure to concentrate on moving the ankles through their full range of motion!

The calves are another muscle group that need to be kept strong in order to assist with walking. While standing in the kitchen waiting for the kettle to boil, hold onto the counter and rise up onto the toes and then lower. Repeat this at least 10 times, 3 times a day.

The next group of muscles to target are the hip flexors – the muscles allow you to lift your knees up. These need to be strong so that you can lift your leg up off the ground to achieve a heel strike. To strengthen these, simply march on the spot, again holding onto the counter while waiting for the kettle to boil.

Finally, balance is required to walk, thus it is vital to practice balancing on one leg so that the ankles stay accustomed to it. Again, while standing at the kitchen counter, stand on one leg, keeping your hands near the counter to catch you if necessary – safety first, as you do not want to fall!

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Remember: when you walk, you need to lift your knees to pick your feet up off the ground, strike the ground with your heel and then push off with your toes. Watch where you walk, and if the surface is uneven, exaggerate the movements so that you don’t trip!

If you are struggling with walking and balance, consult a Biokineticist, as it is essential to keep moving as much as possible as you age!

Ankle Stability

The ankle is a complex joint, comprised of numerous ligaments and supporting structures. Together with the foot, the lower limb is an extremely vulnerable part of the body, as it is responsible for supporting the entire body while changing direction, kicking, as well as all other movements that are performed. Injuries, such as ankle sprains, muscle strains or ligament damage, amongst others, are therefore very common in the lower limb and can be debilitating.

Many people complain about ‘weak ankles’, ‘rolling their ankles’, or ‘going over on their ankles’. This is generally due to poor ankle stability, an aspect of conditioning that is often neglected. The result can be a ligament sprain or muscle strain, which can be very painful and which can take a very long time to heal.

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In order to prevent an ankle sprain or to adequately recover from such an injury, one must do ankle stability exercises to strengthen the supporting muscles and ligaments around this joint. Such exercise include simple actions like balancing on one leg to more complex actions like standing on one leg on an unstable surface while performing some kind of movement with the rest of the body. The progression of these exercises depends on how unstable the ankle joint is. It is important, therefore, that this progression is carefully monitored by a Biokineticist, especially after an injury, so that re-injury doesn’t occur.

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So, it is important to remember to look after your ankles. Think back to previous ankle problems that almost all of us have had at some point, and think how this has hindered your daily activities. Take the time to do a few simple exercises to ensure that the integrity of this joint is restored and maintained. However, if you do run into this common problem, consult a Biokineticist before resuming any form of active participation.

When to see a Biokineticist

Many people are still confused as to where Biokinetics fits in to the rehabilitation process and when one should see a Biokineticist. When I first started this blog, I explained that Biokinetics is a form of therapy where exercise is the modality. In other words, exercise is used as a means of treating and managing pathologies, whether acute or chronic. Three main areas exist for which Biokinetics can be used as a form of therapy, namely wellness, orthopaedic injuries, and chronic disease management. I will use examples of each to explain when one should see a Biokineticist.

Wellness

In the corporate environment, employee wellness programmes are becoming increasingly common. These programmes are used to screen individuals for certain diseases, for example, heart disease, so that appropriate measures can be taken to prevent the disease from occurring. Therefore, the notion of ‘prevention is better than cure’ is the predominant driving force for wellness programmes and Biokineticists play an important role in the screening procedures for these programmes.

Orthopaedic Injuries

Whether acute or chronic, Biokinetics plays an important role in the rehabilitation of any joint, muscle or bone injury. When I say ‘acute’, I am referring to a once-off injury, such as a muscle strain, torn ligament, or joint replacement surgery amongst other things; I am not referring to the acute phase of rehabilitation (this is the physiotherapists’ role). So, if you suffer an acute injury, like a strained muscle or torn ligament, one would first see a physiotherapist who will deal with the acute phase of rehabilitation – reducing inflammation and pain and restoring range of movement. Depending on the severity of the injury, surgery may be necessary, in which case one would see an orthopaedic surgeon and then go for physiotherapy immediately post-surgery. Once pain and inflammation are reduced and range of motion is regained, one should then see a Biokineticist in order to strengthen the muscles surrounding the affected joint to prevent the injury from recurring. The Biokineticist will look at the whole body, not just the affected area, and establish what other factors, such as tight and weak muscles, or poor posture, are contributing to the injury. A specialised exercise therapy regimen will be prescribed in order to correct these weakness and abnormalities, as well as to strengthen the specific muscles surrounding the affected joint to get the person back to their fully functioning capability.

In chronic orthopaedic conditions, such as lower back pain and frozen shoulder, a Biokineticist will also look at the whole body to establish what pre-existing factors are contributing to the condition. The exercise therapy will be focussed on correcting these problem areas, thus assisting in reducing symptoms and managing the condition.

Chronic Disease Management

This refers to conditions such as diabetes, stroke, Parkinson’s disease and Multiple Sclerosis, amongst others. To date, there are no known cures for these conditions; however, exercise therapy has been shown to assist in managing such conditions by stopping the progression of these diseases. Therefore, as soon as one is diagnosed with such a condition, one should see a Biokineticist so that an appropriate exercise therapy programme can be started immediately, thereby slowing progression. Many people, when diagnosed with a chronic condition, see it as a death sentence and stop doing any form of physical activity, thinking it may cause further damage. Inappropriate exercises can exacerbate symptoms, thus it is essential that a Biokineticist is consulted prior to exercising, to ensure appropriate exercise therapy is prescribed and supervised assistance is given where necessary.

I hope this provides more insight into the significant role Biokinetics plays in the rehabilitation of sports and orthopaedic injuries and the management of chronic diseases. If you want to regain your former level of activity, it is highly recommended that you consult with a Biokineticist after an injury or to cope with a chronic disease.

Frozen Shoulder (Adhesive Capsulitis)

Frozen shoulder is a very common and often debilitating condition in which the shoulder joint becomes extremely painful and there is a loss of movement. There is no known cause for frozen shoulder; however, certain factors increase the risk of developing a frozen shoulder. According to PubMed Health, these risk factors include:

·         Diabetes

·         Shoulder injury

·         Shoulder surgery

·         Cervical disc disease (neck)

·         Open heart surgery

·         Overactive thyroid

The most common symptoms are pain, loss of motion in the joint and stiffness.

Frozen shoulder is caused by inflammation of the joint capsule, resulting in limited movement and pain. Generally, one gets pain in the shoulder without any known cause. This results in a person using the affected arm less because it is sore. Reduced movement results in increased stiffness. Depending on how long one waits to be treated, this cycle will continue until a person has next to no movement in that shoulder.

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Frozen shoulder is usually diagnosed by means of an examination of the shoulder and according to the symptoms a patient is experiencing. An x-ray may be done to rule out any other injuries in the joint and an MRI may be done to confirm inflammation; however, most of the time a medical practitioner will diagnose a frozen shoulder by examining the shoulder using various tests. Common movements that people suffering with frozen shoulders battle to perform include:

·         Reaching up to the front

·         Reaching up to the side

·         Bending one’s arm behind their back

·         Putting on a coat

·         Brushing one’s hair

If untreated, a frozen shoulder may take up to two years to recover, and one may never regain complete range of motion. Pain killers and anti-inflammatory drugs can be taken to reduce pain and inflammation. It is then vital that intense physical therapy with a Biokineticist is started early in order to speed up the recovery process. Because movement is often restricted by pain, which then results in stiffness, it is important that the arm is used and moved throughout its range of motion. Passive and active range of motion exercises must be performed on a regular basis. Depending on how severe the frozen shoulder is, recovery may take anywhere from a few weeks up to nine months. Surgical intervention may be necessary in severe cases. Here, the arm is moved through its full range under anaesthetic in order to release scar tissue in the joint.

Therefore, if you have any pain in the shoulder that is restricting movement in your normal daily activities, consult a medical practitioner as soon as possible so that you can start your exercise therapy with a Biokineticist early, thereby speeding up your recovery.

National Epilepsy Week

This week, 20 to 26 June, is National Epilepsy Week, so I thought it appropriate to give you some insight into this often misunderstood condition. I will also discuss considerations that must be taken into account when people with this condition participate in any physical activity.

Epilepsy is defined by The American College of Sports Medicine (ACSM) as: “a chronic, neurological condition characterized by temporary changes in the electrical function of the brain”. These changes in electrical function negatively affect the transmission of information between nerve cells, resulting in seizures. Awareness, movement and/or sensation can be affected during a seizure.

Most often, the cause of epilepsy is unknown; however, common causes include head injuries, tumours, infections, strokes, and lead poisoning (ACSM).

Besides seizures, the following symptoms may occur (ACSM):

• Headache
• Changes in mood or energy
• Dizziness
• Fainting
• Confusion
• Memory loss
• Babbling

Often, one experiences an aura, or warning, before a seizure occurs, which may include (ACSM):

• Dizziness
• Tingling
• Peculiar smell or taste
• A feeling of euphoria
• Auditory hallucination
• And/or painful sensations

Various forms of epilepsy exist; therefore, it is extremely important that this condition is accurately diagnosed by a neurologist, so that the appropriate treatment can be applied. Blood tests, a CT scan, EEG, MRI, and lumbar puncture can be used to diagnose epilepsy; however, a full physical examination must also be done to rule out any other conditions that may cause seizures.

Three main types of seizures exist: a grand mal lasts about 50-90 seconds and involves a loss of consciousness, collapsing, rigidity, and an increased heart rate. A person is usually very tired and sleepy after such a seizure. A petit mal generally last 3-10 seconds and presents as a blank stare or loss of focus. A person usually recovers quickly, but may have multiple episodes. A psychomotor or temporal lobe seizure usually lasts 1-5 minutes and includes a blank stare, lack of awareness, daze, mumbling, struggling, and being afraid. This state of confusion can last a while after the episode and individuals may not remember what they were doing.

According to ACSM, exercise has not been shown to cause seizures; however, it is important to be aware of certain precautions that must be taken when dealing with an epileptic. If seizures are controlled, epileptics can generally partake in any physical activity, including contact sports, although individual sports are generally preferred. High risk activities, such as mountain climbing and underwater activities, must be very carefully supervised and the supervisors must be made aware when an epileptic is participating and how to deal with that person if s/he has a seizure. Triggering factors, such as strobe lights, excessive fatigue, hypoglycaemia (low blood sugar) and alcohol intake, must also be considered.

ACSM states that regular physical activity can, in fact, reduce seizures, as there is improved mental alertness and suppressed electrical activity in the brain. Therefore, it is important that epileptics maintain an active lifestyle. Such individuals are often overprotected by their loved ones, resulting in them being less active and very unfit. This contributes to a sedentary lifestyle and the unfavourable complications that go with it.

Exercise to Manage Parkinson's Disease

What is Parkinson’s disease?

Parkinson’s disease is a progressive disorder that affects the central nervous system. According to MedicineNet.com, it is the most common movement disorder. This condition occurs when there is an insufficient production of the chemical – dopamine – in the brain. Dopamine is a messenger in the brain that is responsible for producing smooth, coordinated muscle movements. Thus, in people with Parkinson’s disease, this lack of dopamine in the brain results in limited and uncoordinated movement.

Causes

The cause of Parkinson’s disease is unknown; however genetic and environmental factors, such as exposure to toxins, are potential contributing factors.

Symptoms

The following symptoms may occur with Parkinson’s disease:

·         Tremors

·         Rigidity

·         Bradykinesia (limited movement of the extremities)

·         Poor motor control when rising form a chair

·         Stooped posture

·         Shuffled and stiff gait (walking pattern)

The figure below illustrates the typical standing posture of an individual with Parkinson’s disease.

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Treatment and Exercise

Parkinson’s disease is treated with medication. But, because it is a movement disorder, it is essential that people with this condition also receive supervised physical therapy on a regular basis, in order to maintain functional ability for as long as possible. The condition is progressive; however, exercise can help to slow the progression and maintain mobility.

Falls are a common problem in people with Parkinson’s disease because of the shuffled and stiff walking pattern. Individuals with this condition will tend to stoop forward, shuffling their feet along the ground instead of picking them up. This may result in them tripping over the smallest uneven surface and possibly falling. These people also often have a slower reaction time, meaning they are less likely to catch themselves if they lose their balance. Falls are very serious in elderly people, as their injuries become more severe, resulting in less mobility, thereby creating a vicious cycle.

So, the first and most important aspect to consider when working with a Parkinson’s patient is that of gait, or walking pattern. It is essential to make these people aware of how they walk and make the necessary corrections, explaining why these corrections are made. Also, practice walking in various directions and around different objects, so that they become comfortable with moving in different directions.

Fluid movements must be encouraged. These include walking, cycling and swimming, amongst others. If a person has already developed a tremor, one does not want to exacerbate this by getting them to lift excessive weights. Keep weight training to a minimum and rather do more repetitions, keeping the movements smooth and manageable. This will also create a feeling of achievement which is important for motivation.

Stretching and flexibility exercises are important to maintain range of motion. Therapists must be aware of how the person is feeling. If one overstretches a patient, they may respond by tensing up the muscles, thereby exacerbating rigidity. The patient must remain relaxed during stretching.

It is important to ensure that exercises are functional, thereby assisting patients to maintain their ability to perform the activities of daily living. Find out what an individual struggles to do at home and work on ways to improve those movements.

So, for those of you who may have been diagnosed with this condition, don’t sit back feeling sorry for yourself. Get up and keep moving! With the help of a Biokineticist, you can still have prolonged functional ability and quality of life!

Total Knee Replacement Surgery: Pre- and Post-Operative Rehabilitation

Total knee replacement surgery is a common means of treating degeneration and/or osteoarthritis of the knee joint. It requires the two degenerated articulating surfaces to be replaced, making it a highly invasive and traumatic procedure. It is, therefore, important that numerous measures are taken to ensure one is physically ready for surgery.

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In the case of an elderly person, the surgeon may require the patient to have a full medical examination with a physician prior to surgery to ensure the patient is physically strong enough to undergo surgery. In the past, total knee replacement surgery was done using a full anaesthetic. Nowadays, it is becoming more common to use sedation together with an epidural.

If possible, the patient should start a pre-operative programme to strengthen the knee. This will help to strengthen the surrounding muscles that support the knee joint, thus shortening the recovery process. One must also try to maintain or improve one’s general physical fitness, so that the physical state of the individual is adequate prior to surgery in order to improve recovery. Exercise may, however, cause further inflammation and discomfort, so care must be taken at all times. A Biokineticist plays a crucial role in this process.

Below are some guidelines with regards to exercises that can be done prior to a total knee replacement procedure.

Exercise to improve cardiovascular fitness:

Cycling – high saddle

Walking – tolerable to pain

Swimming or water aerobics – minimal impact and strain on the knee

Arm ergometry

Strengthening exercises for the rest of the body:

Arm strengthening exercises – machines or dumbbells – important for holding ones weight on the crutches following surgery

Abdominal and core strengthening exercises – to assist in maintaining good posture

Strengthening exercises for the muscles surrounding the knee:

Quadriceps setting

Straight leg raises

Heel slides

Calf raises

Foot pumps

Ball squeezes (between knees)

Hip raises

Glute squeezes with a theraband

Following surgery, the first step is to regain mobility and range of motion of the knee joint. One must see a physiotherapist regularly to assist in regaining range of motion. Once this has been achieved, one should see a Biokineticist to assist you in starting an exercise programme to again strengthen the surrounding muscles. Initially, the exercises will be similar to those done prior to surgery and they will become progressively harder with time. The exercises should be done at least 3 to 5 times per week. Cardiovascular and upper body strengthening exercises that were done pre-surgery should be restarted as soon as possible to regain general physical fitness.

So, don’t be afraid to start exercising as soon as you feel ready to do so. With the correct guidance and appropriate progression, the rehabilitation can be more successful and the recovery time can be shortened significantly.

Multiple Sclerosis

What is it?

Multiple Sclerosis (MS) is an autoimmune disease that affects the central nervous system, that is, the brain and spinal cord. All nerves are surrounded by a myelin sheath – a protective layer surrounding the nerves. This myelin sheath assists in the conduction of neural signals from the brain to the muscles, innervating the muscles and thereby creating muscular contractions. With MS, demyelination of these sheaths occurs, resulting in the neural conduction along the nerves being adversely affected. Speed of conduction is reduced and the result is a reduction in smooth, rapid and coordinated movement. The effects can range from little or no disability to severe disability.

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Various types of MS exist

The National Multiple Sclerosis Society identifies 4 types of MS: relapsing remitting, secondary progressive, primary progressive and progressive relapsing. The most common form is relapsing remitting MS (RRMS). In this case, one has relapses, where symptoms are present, and then periods of remittance, where symptoms subside or disappear altogether. The more relapses a person has, the more severe the symptoms become. Stress, both physical and emotional, is the main contributing factor causing a relapse.

Causes

MS occurs as a result of the myelin sheath surrounding the nerves being damaged. This can be due to inflammation, when the body’s own immune cells attack the nervous system (autoimmune disease). The reason for this is unknown, but is thought to be due to a virus or genetic defect.

Who is at risk?

MS is more common in women. It is generally diagnosed between the ages of 20 and 40, but can occur at any age.

Symptoms

MS affects numerous body systems, including the eyes, bowel and bladder, sexual function, speech and swallowing and, most noticeably, the muscular system. In this blog, I will discuss the muscular system only. According to ACSM, the physical symptoms include the following:

• Spasticity
• Incoordination
• Impaired balance
• Fatigue
• Muscle weakness, paresis (partial paralysis) and paralysis
• Sensory loss and numbness
• Cardiovascular problems
• Tremors
• Heat sensitivity

The role of exercise in managing MS

The progression or prognosis of MS is not affected by exercise. However, a person with MS will still experience the short-term benefits of partaking in a regular exercise programme, such as improved cardiovascular fitness, increased strength and flexibility, and improved functional ability. People with MS often lose function in their legs, resulting in them being unable to walk. It is important to strengthen and stretch the leg muscles in order to prolong function. One should also focus on balance and stability exercises to reduce the risk of falling.

Important things to remember

People with MS do not have the same ability to regulate their body temperature as those without MS, so it is important to keep the room temperature in which you are exercising cool.

If muscles are overworked or overstretched, this can cause an acute inflammatory response, which may exacerbate symptoms. So, take it easy! Rather use lighter weights and do more repetitions to improve endurance and muscle tone.

This week, I am posting an article on hypertension from a dietitians perspective. You may recall that I wrote an article on hypertension and exercise last year sometime. Now you can read about food substances to include or avoid if you have this condition. For more information, visit: http://goodlifedietitians.blogspot.com/.

Hypertension: The Silent Disease

Hypertension is a condition where blood pressure is too high. Hypertension is often called a silent disease since there may be no signs or symptoms that you have it. A normal blood pressure is 120/80mmHg. This measurement shows the pressure at which the heart is contracting (systolic blood pressure- 120) and relaxing (diastolic blood pressure- 80). A person is diagnosed with hypertension when they have a consistently high blood pressure of above 140/90mmHg.

Symptoms of hypertension may include frequent headaches, impaired vision, and shortness of breath, nose bleeds, chest pain, dizziness, and poor memory. Hypertension almost doubles a person’s risk of heart attack and stroke. If left untreated high blood pressure can also lead to heart and kidney failure, as well as loss of sight.

In last week’s post we focused on one aspect of lowering blood pressure: cutting back on your salt intake. Unfortunately for some though treatment of high blood pressure requires more than just a low salt diet. If you are hypertensive, follow these tips on dietary and lifestyle changes to help lower your blood pressure.

Check your blood pressure on a regular basis

If you have high blood pressure, buy a blood pressure machine (also called a sphygmomanometer) from your local pharmacy or Dischem. Keep a record of your blood pressure. 

If you are overweight, lose weight

Losing weight will naturally help to lower blood pressure. Studies have shown that blood pressure increases with increasing weight. A weight loss of just 5kg has been shown to lower blood pressure. Aim for a desirable body weight at a BMI below 25kg/m².

If you chose to drink alcohol, do so sensibly

A high alcohol intake has been shown to increase blood [pressure. Limit to 2 alcoholic drinks per day for men, and 1 alcoholic drink per day for women and light-weight individuals. One drink is the same as one beer, half a glass of wine, or 30ml of spirits,

Eat plenty of fresh fruits and vegetables

Fruits and vegetables are high in potassium, a mineral which has been found to help lower blood pressure when eaten in large amounts. Oranges, potatoes, tomatoes, pumpkin, squash and avocado are all high in potassium.

Fruits and vegetables are also naturally low in salt, as well as low in calories to help in weight loss. Increase your intake of fresh fruits to 2 portions per day and vegetables to 4-5 portions per day.

Be active

Increase your exercise levels to at least 2-3 times per week for 30-45 minutes. For more on exercising in hypertension, go to http://www.nicolepicasbiokinetics.blogspot.com./

A stressful lifestyle can increase your blood pressure further

Be sure to take time to relax and decrease your stress levels

 

Look for Heat Mark products

The Heart Mark is a guideline for shoppers to instantly identify healthy products on the supermarket shelves. Products approved by the Heart Foundation are lower in cholesterol, lower in saturated fat, lower in salt (less than 450mg per 100g of a product), high in fibre (where applicable), and lower in added sugar. This means that all products with the Heart Mark are the healthier choices.

Asthma and Exercise

According to the American College of Sports Medicine (ACSM), asthma is: “a syndrome characterized by reversible obstruction to airflow and increased bronchial responsiveness to a variety of stimuli, both allergic and environmental”. In other words, asthma is a chronic inflammation of the bronchi (airways) in the lungs.

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Asthma varies from person to person and ranges in severity from mild to severe. It is induced by different stimuli, such as allergens or exercise. The stimulus that brings on an asthma attack in a particular individual must be known and considered when establishing an exercise regimen for that individual.

Exercise capacity can either be limited as a result of having asthma, or exercise can in fact induce an attack, thereby exacerbating the condition. This may cause individuals to avoid exercise wherever possible.

The symptoms of exercise-induced asthma include the following (ACSM):

·        Wheezing
·        Coughing
·        Shortness of breath
·       Chest discomfort

The symptoms may last up to 30 minutes after an exercise bout. If the exercise bout is prolonged, then symptoms may occur during the session. If the condition is mild, then individuals can usually exercise at an intensity of 75% of maximum heart rate before symptoms are induced. In more severe cases, mild exertion may induce symptoms. Although exercise may induce symptoms, it is important to include exercise in the management of this condition.

Individuals with well-controlled exercise-induced asthma are able to exercise with little or no symptoms. The training effects will be the same as in individuals who do not have asthma. Thus, these individuals should follow the same exercise guidelines as those for individuals who do not have asthma and thus should include cardiovascular, strength and flexibility exercises into their routines. In more severe cases, where exercise intensity is limited by symptoms, individuals can concentrate on improving endurance, rather than high-intensity fitness and should also include resistance and flexibility exercises.

It is important to realise that one can and should continue to lead a very healthy and active lifestyle, even if they have been diagnosed with asthma. You must consult your doctor with regards to exercise and to take the medication that has been prescribed by your doctor in order to keep the condition under control and to reduce symptoms during exercise. If you have asthma and don’t know how to start an exercise programme, starting off with a biokineticist can point you in the right direction.

Understanding Your Body Composition

When discussing ones body weight, people always ask what their body mass index (BMI) is, as if it’s the most important thing to consider with regards to their health. Many of you will know that BMI is a calculation that is used to determine the ideal body weight according to ones height. The following formula can be used to calculate BMI:

BMI = Weight (kg) / [Height (m)]²

Obesity puts one at an increased risk for cardiovascular disease. Below is a table which gives normative values for BMI, as well as the associated risk of disease for a specific BMI range.

Classification	BMI (kg/m2 )	Risk of other obesity related medical complications
Underweight	<18.5	Low (but has risk of different set of other clinical problems)
Normal range	18.5-24.9	Average
Overweight	25.0-29.9	Mildly increased
Obese	>30.0
Class I	30.0-34.9	Moderate
Class II	35.0-39.9	Severe
Class III	>40.0	Very severe

Adapted from ACSM’s Guidelines for Exercise Testing and Prescription (7^th ed.).

While BMI is a useful tool in determining appropriate body weight and associated disease risk, it has its limitations which it is important to be aware of when assessing your body weight for health.

BMI does not consider the composition of the body, that is, what portion is muscle and what is fat, a very important distinction to make. A higher fat percentage puts one at an increased risk for cardiovascular disease. However, it is possible that a person with a BMI that classifies one as ‘obese’, when in fact the person is a body builder and has a very high muscle mass. The image below illustrates this. On the other hand, one may be anorexic and have a high fat percentage.

The area of the body where the weight is carried must also be considered. Men tend to carry most of their weight in the waist area, whereas women tend to carry it in their hips. Carrying it in the waist area puts one at an increased risk for cardiovascular disease, as it is closer to the heart and other vital organs. Thus, it is important to monitor ones waist circumference as well when considering health risks. As a guideline, men should have a waist circumference below 102 centimetres and women below 88 centimetres.

So, don’t panic if you find out that a reading, such as your BMI, is slightly high. There are numerous other calculations and factors to consider when looking at your weight and your general well-being.



Breathing during Exercise

Many people complain about struggling to breathe or always feeling out of breath while exercising. When exercising, your heart rate increases, as does your blood flow, so that sufficient oxygen and nutrients can be delivered to the muscles in order to perform the movement. Therefore, as you exercise, your breathing rate must also increase to support this process because all physiological processes are interlinked.

Depending on the type of exercise you are doing, your breathing demands and patterns will vary. When performing aerobic exercise, such as walking at a brisk pace, your breathing rate will increase, however you should still be able to hold a conversation. When performing anaerobic exercise, such as sprinting, you will breathe very heavily and thus be unable to talk. When performing resistance exercise, your breathing rate will increase in accordance with the weight and the number of repetitions in the set.

When performing any exercise, you want to try and keep your breathing as regular as possible. One tends to breathe faster shallower breaths, rather than maintaining deeper steadier breaths. When breaths are shallow, you take in less oxygen to support the body, which means you have to breathe faster in order to get more oxygen. You end up panting and feeling very out of breath, resulting in you being unable to continue exercising.

When partaking in aerobic or anaerobic exercise, try to focus your breathing by concentrating on breathing in through the nose and slowly out through the mouth. After completing an anaerobic session and your heart rate and breathing rate are extremely fast, try to breathe deeply and slowly in order to catch your breath, rather than panting uncontrollably. Also, try to maintain an upright position, rather than hunching over, so that air can enter the lungs easily.  Concentrate on breathing into the lungs, as opposed to the abdomen – your chest and not your stomach should rise when you breathe.

When engaging in resistance exercise, it is important that you do not hold your breath while lifting weights. This technique is called the Valsalva Maneuver and is often used by body builders. It involves closing the nose and mouth so that air is trapped inside the body, creating an increased pressure in the body to support the spine when lifting very heavy weights. This technique places great pressure on the cardiovascular system, as it significantly increases ones blood pressure. Thus, it must not be used by individuals with hypertension. When lifting weight, including body weight, one must exhale on the exertion and inhale when returning to the rest position. For example, when doing an abdominal crunch, you must first inhale while you are lying flat, then exhale as you lift your head and shoulders, and then finally inhale as you lower your head and shoulders back to the resting position.

At first, this concentrated deep breathing may result in dizziness, as it is a form of hyperventilation. If this happens, lie back and rest for a few moments before continuing. Then, take more natural breaths as opposed to forcing yourself to take very deep breaths.

Oxygen is energy to your cells. The more you have, the easier exercise will become. Breathe deeply and regularly throughout your exercise session and you should feel a lot more comfortable.