EXERCISE AND HEALTH

INTRODUCTION-
Oftenly we are asked about exercise by the patient and rightly so. Many patients who do not know about importance of exercise , may not ask about it. Even then every prescription of CAD, Diabetes, Hypertension, osteoporosis, post partum, post-operatively and host of other diseases should carry an exercise prescription.
Importance of exercise cannot be overemphasized .Exercise is known to have host of beneficial effects some are enumerated below.
-Exercise conditions the body for better physical work
-Exercise conditions the heart for better performance and
also reduces chances of heart disease
-Exercise helps person to maintain ideal weight
-Sedentary life style is a risk factor for heart attack and people who exercise live longer.
-Exercise also releases endorphins in brain which gives feeling of well being in a person.
CARDIAC CHANGES BY EXERCISE-
-First change is increased return of blood to heart by constriction
of veins and increased muscular pump. This leads to increased
outflow of blood and increased cardiac output.
-There is increased force of contraction of heart by exercise
-Resting heart rate decreases. This is beneficial because maximum
heart rate is fixed for given age and heart cannot increase
its speed beyond maximum rate thus limiting the cardiac output
and thus exercise.
-Normally in systemic circulation only 20-30 % oxygen is extracted by tissue but in coronary circulation almost all oxygen is extracted by heart even during rest. So it is must for coronary flow to increase during exercise to provide extra oxygen demand to heart. Coronary blood flow increases with exercise from 60ml\100gm
to 240 ml \100gms.
EXTRACADIAC CHANGES DUE TO EXERCISE
1. As one start to exercise the Vagal tone decreases and
there is increase in sympathetic tone causing increase in heart
and respiratory rate and increase venous tone.
2.Plasma volume decreases
3.blood clotting-increases
4.fibrinolysis-increases
5.redistribution of blood flow-spalncnic blood flow drops to
20% of normal in few minutes. This is the reason why a
warm up is necessary before big exercise.

Every Exercise workout is preceded by warm-up and is followed by cool down.
WHY?-WARM UP---increases body temp.
-increases blood flow to muscles
-increases blood flow to heart
-improves contractility of muscles
-boosts nerve transmission
-prepares CVS for work to be done
-COOLING DOWN
-Gradually decreases body temperature
-realigns working muscles
-reduces onset of post exc. Soreness
-help rid of waste products
-relaxes you
WHICH MOVEMENTS-
Gentle walking ,light jogging, gentle body movements

EXERCISE BASICALY ARE OF THREE TYPES
A- CARDIOVASCULAR EXERCISE-is done to tone up cardiovascular system and to prevent ischaemic heart disease.
INTENCITY-60-85% OF MAXIMUM HEART RATE
(MAXIMUM HEART RATE IS 220 minusYOUR AGE
DONE 3-5 TIMES AWEEK FOR 15-30 MIN
1-AEROBIC DANCE
2-CYCLING
3-DEEP WATER RUNNING
4-RUNNING
5-RACKET SPORTS
6-SWIMMING
7-STEP AEROBICS
8-TEAM SPORTS-FOOTBALL,HOCKEY
9-WALKING
B- RESISTANCE EXERCISE
RESISTANCE EXC involves exerting a force to enable you to move or apply tension to a weight, and results in enhanced muscular strength or endurance.
MUSCULAR ENDURNCE is a measure of number of times a muscle can repeat a contraction while MUSCLE STRENGTH relates to force a muscle can apply to a contraction.
As age increases our endurance and strength starts decreasing and if you want to remain fit beyond 50 you have to add few resistance exc to your programme.
ENDURANCE TRAINING INVOLVES low resistance repetitive exc while strength training involves high resistance exc.
In resistance training you have to reach near fatigue that means you feel you can do only 1-2 more lifts. Your body will have by endurance training-increased number of aerobic enzymes and mitochondria.
-increased number of capillaries
-increasd efficiency of contractions
by strength training your body will have
-more contractile proteins
-tougher connective tissue
-increased muscle contractility


DESIGNING A RESISTANCE PROGRAMME
1-go for symmetry
2-variety of movements
3-change exc 6-8 weeks
4-add extra intensity every 4th workout
5-avoid rushing
ESSENTIAL OSTEOPOROSIS PREVENTION EXC
1-LUNGE
2-BENCH PRESS
3-FRONTAL RAISE
C-FLEXIBILITY EXERCISE
Flexibility,balance and co-ordination forms an essential part of exc programme.
Benefits of stretching
1-increase functional range of movement of each joint
2-reduces low back pain and risk of injury
3-decreases severity of potential injury
4-improves your body posture and symmetry
5.delays onset of muscle fatigue
6.reduces or prevents soreness after exc
7.enhances feeling of calm and wellbeing
8.provides opportunity for stillness and spiritual growth
Types of stretching
1.STATIC-most commonly used. Muscle or muscle group is stretched for 30 sec in static position.
2.PASSIVE-practiced with some object as towel ,wall or bench
3.BALLISTIC-for atheletes
4.ADVANCED-PNF,Active isolated stretching
5.COMBINED-with Relaxation Meditation
WORKOUT
-Seated spine rotation x4 rt and lt
-Full body strech x2
-lying spine strech x2 rt and lt
-Cat curl x4
-Opp arm and leg reach x4 rt and lt
-Side bend x8 rt and lt
-Wall roll down x6

D-FLEXIBILITY+COORDINATION+BALANCE
1.YOGA-has three parts-Pranayam-Breathing Exercise
-Yogasans and Mudras-type of strech exercise
-Meditation
2.PILATES
3.T’AI CHI CH’UAN

CONCLUSION
A working knowledge of Exercise is must for every Physician so he can prescribe Exercise to his patients with confidence and also explain it as Exercise expert/ physical trainer is not available to all clinicians for help in practice.




REFRENCES
1-PAFFENBARGER,RS and KANNEL,WB:Cardiovascular consequences of physical in activity.Primary Cardiology 1984
2-SHEPS, DS,ET AL :Effect of physical conditioning program upon left ventricular ejection fractions determined serialy by noninvasive technique.Cardiology 64:256,1979.
3-POLLAK, ML:How much exercise is enough?Physical sports medicine 6:4,1978.