Health Conditions

For years it was believed that pregnancy women should spend nine months prone on the couth, resting completely. But fitness in pregnancy is very important; being fit can help you stay healthy during and after pregnancy. It can reduce the likelihood of complication during labor and actually make labour shorter. Some studies have shown that exercise can help with postnatal weight management. Pregnancy often leaves women feeling less energetic but regular exercise can give you the energy make it through day .regular exercise in pregnancy also allows you to sleep better. Exercise also has been shown to improve your mood, lessen mood swings, and improve your self image. The American college of obstetric and gynecology says that there is no data available on human to indicate that pregnancy women should limit exercise intensity and lower target heart rates because of potential adverse effects. During pregnancy women can continue to exercise and derive health benefits even from mild to moderate exercise routines. However, being pregnant means modifying your workout just a bit.

Exercise guidelines for pregnant women.

• Exercise reduces blood flow to fetus is myth, Studies shows that pregnant women can maintain and improve their fitness level during pregnancy.
• During pregnancy, with the release of the hormone relaxin, joints become loser, increasing the risk for injury during exercise. Avoid over-stretching (going beyond normal range of motion)
• Body temperature of pregnant woman should not exceed 100 F (38 degree C).
• Decision to exercise during pregnancy should be taken in conjunction with physician.
• Avoid too high or too low temperature.
• Gradually reduce the exercise intensity, duration and frequency of exercise during the second and trimesters.
• Extend warm-up and cool down periods.
• Drink water before, during and after exercise and eat small snack (carbohydrate) before exercise to avoid hypoglycemia.
• Any unusual physical changes should be immediately reported to physician.
• Any physical exercise involving the potential for even mild abdominal trauma should be avoided.
• Women should avoid exercise in supine position after first trimester. Such position is associated with decreased cardiac output in most pregnant women.
• Watch your center of gravity after four months, it changes and you can quickly find yourself off balance. Avoid such activity which demands more balance.
• Do Kengel exercise religiously, kengel exercise strengthen the muscles use in labour.

The Positive Effects:

• Exercise during pregnancy helps to alleviate many of the common problems of pregnancy. It improves circulation (which helps prevent constipation, hemorrhoids, varicose veins, leg cramps, and swelling of the ankles). It also prevents back pain by strengthening the muscles that support the back.
• Pregnancy often leaves women feeling less energetic, but regular exercise can give you more energy to make it through the day. Your strengthened cardiovascular system will give you more endurance, and stronger muscles will allow you to accomplish tasks with less effort, leaving you more energy to continue through the rest of your day.
• Exercise also allows you to sleep better. Most women have some trouble sleeping through the night by the end of their pregnancy. Exercising on a regular basis (and making sure it’s at least three hours before you go to bed) will help you work off excess energy and will tire you enough to lull you into a deeper, more restful slumber.
• Exercise has been shown to improve your mood, lessen mood swings, improve your self-image, and allows you to feel a sense of control.
• Exercise helps prepare you for childbirth. Some studies suggest that the fitness of the mother results in shorter labor, fewer medical interventions, and less exhaustion during labor. Being in shape will not decrease the pain, but it definitely will help give you the endurance needed to get through labor.
• Most experts agree that gaining more than the recommended 25 to 35 pounds (for a woman of normal weight) during pregnancy makes it harder to lose the weight after the baby is born. By maintaining your fitness level during pregnancy, you are less likely to gain excess weight. Exercise also maintains your muscle tone and strength.
• Check with your health care provider before starting an exercise program.
• Participate in activities (such as swimming, walking or low-impact aerobics) that do not put you at additional risk to slip or fall.
• Watch your center of gravity After the fourth month it changes and you can quickly find yourself off balance. While your baby is very well protected by the amniotic sac should a fall occur, the best protection is prevention!
• No bouncing or jerking Bouncing exercises are not great for your joints or bones at any point, but especially during pregnancy. Wear comfortable clothing, non-skid shoes that are supportive, and a decent bra, preferably a sports bra.
• If you previously were a couch potato this is not the time to take up a new sport. However, all is not lost. There are several exercises that you can do while pregnant, even if you were previously sedentary. These would generally be walking, swimming, and specialized pregnancy aerobics. The key, as with any exercise in pregnancy, is to take it relatively easy and to listen to your body. • The American College of Obstetrics and Gynecology (ACOG) says that there is “no data in humans to indicate that pregnant women should limit exercise intensity and lower target heart rates because of potential adverse effects.” In fact, during pregnancy, women can continue to exercise and derive health benefits even from mild to moderate exercise routines. However, being pregnant means modifying your workouts just a bit.
• For years it was believed that pregnant women should spend nine months prone on the couch, resting comfortably. Doctors feared that the jarring motion of aerobics or running could damage the fetus, and prescribed rest for even the most intense of professional athletes.

• Wrong eating habits- like-
  1. People who eat outside home more frequently are prone to obesity.
  2. Who eat faster & take less time for chewing , so they consume more food.
  3. Nibbling between meals is common among housewives.
  4. Some may eat when surrounded by tasty food instead when really hungry.
  5. Housewives who do not want leftover foods to be thrown out may consume forcibaly and put on weight.
  6. Children who eat more junk food
  7. People who eat more food when they are unhappy as compensation mechanism.
• Endocrine factor- obesity is found in hypothyroidism. It is common at puberty , pregnancy, menopause.

Theories on obesity.

• Fat cell theory – Juvenile onset obesity caused by an increase in the number of fat cells while adult onset obesity caused by increase in size of fat cell. The number of fat cell can reduces as the result of sustain weight loss.
• Set point theory- E ach person has ideal biological weight set point, once body weight reaches to this point , it influences the persons food intake to maintain this weight. Medical problem arises when size of fat cells are more than number fat cells.
• Leptin- It is a hormone which promotes negative energy balance by suppressing appetite and increasing energy expenditure. But people with genetically defect of leptine shows poor appetite control.

Dietary guidelines

• Take diet which is adequate in all nutrients , except calories and should be high in fiber.
• Add plenty of soups , salads , buttermilk , sprouts, citrus fruits in diet.
• Take 4 – 5 small meals everyday.
• Do not keep stomach empty more than 4 hours.
• Eat fruits instead of fruit juices.
• The ideal way of reducing weight is not only reducing the calorie intake but also spending more calorie
• Try to eat foods in their natural form that is in unprocessed form.
• Try to avoid the alcohol consumption.

OBESITY is a condition in which the natural energy reserve, stored in fatty tissue of humans and their mammals, is increased to a point where it is associated with certain health risks. Obesity is both an individual clinical condition and is increasingly viewed as a serious public health problem. Excessive fat percentage is associated with various diseases like heart attack, diabetes, back pain, slip disc, hypertension etc. In clinical setting, best way to evaluate obesity is hydrostatic weighting; other methods like BMI, waist circumference, skin-fold caliper are also in practice.

Exercise guidelines for OBESITY

• Consult certified dietitian before starting exercise routine.
• Balance may be a problem for the obese exerciser. Avoid exercise which requires balance in initial stages.
• Resistance training is recommended as adjunct to an aerobic exercise program and not as primary means for calorie expenditure.
• Large muscle group, aerobic activity is recommended for calorie expenditure and can result in significant fat loss over a period of time.
• Keep small weekly weight loss targets rather than keeping monthly or quarterly targets.
• Wear comfortable clothing and footwear appropriate for the temperature, humidity and activity.
• Since most overweight clients will not be able to exercise at a high intensity level, start with low intensity exercise.
• Do not lose weight more than 1-2 pounds per week.

Hypertension is clinically defined as systolic BP > 140mmHg and /or Diastolic BP > 90mmHg. Hypertension is one of the leading factors of Coronary artery diseases. Hypertensive individuals are at three to four times the risk of developing coronary artery diseases.Exerise is the best way to control hypertension. Regular aerobic activity can reduce both systolic and diastolic blood pressure by an average of 10 mmHg. Exercise Guidelines for hypertensive individuals

• Avoid holding breath or strain during exercise.
• Weight training program should features low resistance and a high number of repetitions (15 to 20).
• Exercise should not continue if any abnormal signs or symptoms are observed before, during or immediately following exercise.
• It is safer to monitor blood pressure before and after the exercise.
• Individual should turn aside (and get up) when getting up from the floor because they are more susceptible to sudden drop of BP associated with rising to an upright position.
• Client should take additional time for warm-up and cool down.
• Target heart rate range should be 40 to 65 % of maximum heart rate.
• Following factors are very important for individual with hypertension 1) medical status 2) medications (few medication effects heart rate and blood pressure), consult your physician for guidelines and approval for exercise.

Lower back injuries translate into millions of lost work days every year and cost almost same amount for medical care. There are four major reasons for lower back pain 1) Herniated disc 2) Spondylolisthesis 3) Accident 4) Degenerative disc diseases.5) Imbalance of strength and flexibility of lower back and abdominal. Poor flexibility of hamstring and hip flexor muscles.

Exercise guidelines for individual with lower back pain

• Exercise should be used as an intervention for uncomplicated mechanical pain when there is no evidence of neurological deficit.
• Exercise for lower back pain client should emphasis on increasing muscular strength and endurance of abdominal and back extensor muscles. And on improving flexibility of pelvic, lumbar and posterior thigh regions.
• Lumber flexion, extension and flexibility exercise should be done daily.
• Lumber disc pressure is generally greatest in the seated position. Individual should stand for few minutes after every 30 minutes in seating position.
• Avoid forward flexion of spine without support, Avoid hyper extending the spine in an unsupported position. Avoid twisting at waist with turned feet, Always bend at the knees when leaning forward.

Exercise guidelines for ASTHMA

• Avoid outdoor activity during periods of peak pollen count or air pollution or dry air.
• Extend warm-up and cool down period.
• Exercise with break may be effective.
• Individual with asthma should have a bronchodilating inhaler with them at all times and be instructed to use it at the first sign of wheezing.
• Individual with asthma should drink plenty of water before, during and after exercise.
• Wearing face mask during exercise helps keep inhaled air more warm and moist.
• Only people with stable asthma should exercise.
• Patients with asthma often respond best to exercise in early morning.
• Upper body exercise may not appropriate because of higher ventilation demands.
• Before beginning an exercise program, individual with asthma should consult physician.
• Drink fluid before, during and after exercise.
• Avoid too humid and too cold temperature.

Diabetes is characterised by reduced insulin secretion by the beta cell of pancreas or reduced sensitivity to insulin. Prolonged and frequent elevation of blood sugar can damage the capillaries, which leads to poor circulations. Individual with diabetes are at greater risk for permanent nerve damage. There are two types of diabetes:

1.  occurs in childhood and regular insulin injections are required to regulate blood pressure.
2.  occurs in adult who are overweight and who lost sensitivity of insulin to target cells.

Exercise guidelines for diabetes

• Do not inject insulin into the primary muscle groups that will be used during exercise because it can reduce blood sugar causing hypoglycemia. Abdominal site is safe for this reason.
• Avoid exercise during periods of peak insulin activity. Because exercise has insulin like effect.
• A complex carbohydrate snack should be consumed before exercise and fruits after exercise.
• Individual with diabetes should always carry a rapid acting simple carbohydrate (sugar, candy, juice) in case they endure hypoglycemia.
• Exercise should be curtailed if pre-exercise blood sugar is below 100mg/dl or greater than 300 mg/dl.
• Monitor your blood glucose before staring exercise, Exercise should be curtailed if preexercise blood glucose is below 100mg/dl.Exercise also be curtailed if preexercise blood glucose is greater than 300 mg /dl or greater than 240mg/dl with urinary ketones bodies.
• Exerciser (Insulin dependant) on insulin may need to reduce their doses by 20 to 40 % when beginning an exercise program.
• Before staring exercise program, Insulin dependent clients should work closely with their physicians to ensure right dosages.