Medico-Legal Perspectives in Nigeria: A Compendium for Clinicians, Legal Practitioners, General Public, Insurances and Professional Regulatory Authorities

© Joel Akande. 2016

Introduction and Definition:  Medicolegal is the forensic examination of medical practice or as is very often the case, legal scrutiny of an alleged medical malpractice. Medicolegal is the discipline and service area that combines the practice and knowledge of law and medicine. As the name implies, medicolegal is the meeting point of law and medicine incorporating the reasoning of judges in arriving at the judgement for a case (jurisprudence) involving a claim against a medical practice or against a clinician  who may be a nurse, doctor, physiotherapist or anyone that has a specific role to play in the care of a patient under the care of the specific practice.

Let us take a moment to understand the development of medicolegal concepts.

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The Health Sector within Larger Economy:  Healthcare sector is part of the larger economy of a country. Each industrial sector is regulated or is suppose to be regulated by certain laws. Also, everyone in the same country be it a biological individual, unincorporated business or body corporate (incorporated body or business) is subject to the general laws that govern the country aiming for peaceful co-existence of all as well as preventing injuries by one person against the other (i.e the law seeks the welfare of citizens either biology or legal person). Such general laws may be laws regulating human conduct against assault, and financial fraud and so forth.

The Law: Each of the components of the general economy such as accountancy, engineering, healthcare is also subject to their own particular sets of laws that regulate them. Similarly, each sub-part that makes up the particular industrial sector is also subject to its own regulatory rules. Let us now cite some examples:  The National Assembly/Parliament make the law against assault under the Criminal Act for everyone in the country. The same Assembly also makes the law (National Health Act among other laws) for regulation of the health sector. Within the health sector, the National Assembly makes the law for the establishment and regulation of medical practice, nursing practice, physiotherapy practice, Laboratory practice and so forth. Their respective regulatory bodies (such as Nursing and Midwifery Council of Nigeria, Pharmacists Council of Nigeria and Medical and Dental Council of Nigeria are empowered and set up by the appropriate/applicable laws to regulate the education, training and practise of the respective members and professions).

Regulatory Authorities: On the basis of these legal hierarchies as explained above, individual professional members are allowed to practice their professions and be regulated by their respective regulatory authorities as empowered under their Acts as made by the National Assembly. Therefore, a typical clinician (say a medical doctor) is subject to the General Law (Criminal Act/Penal Code, respective Business Laws etc), the Industrial Sectional Law (National Health Act), and specific Professional Law ( such as Medical and Dental Practitioners Act) and finally for doctors, the MDCN acting under Medical and Dental Practitioners Act, enacted the Code of Conducts for doctors. Similar operation of the law operates in Nursing, Pharmacy, Physiotherapy, Psychology, Nutrition and Laboratory Professionals.

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The Business of Healthcare: Meanwhile, members of the Healthcare Sector as in any other industrial sector within the larger economy are allowed to operate like any other business. This operation can be as a sole trader, partnership or as an incorporated body. They, physicians/clinicians are also allowed to partner with others for the orderly and beneficial conduct of their respective and businesses in synergy.  Thus, healthcare providers and healthcare professionals operating as a business must also conform to the Company and Allied Matters Act that regulates registered businesses.

Trade Associations: Further, individuals and businesses are allowed under the constitution to form associations or trade associations. This constitutional empowerment is the basis of such associations such as Pharmaceutical Association of Nigeria (PSN) and Nigeria Medical Association (NMA).

Mistakes should not be made and trade or professional associations should not be confused with regulatory authorities which I have mentioned earlier.  While regulatory authorities regulate the training, education and practice of each profession, trade associations look after the welfare of their members. Trade associations are pressure groups that can influence decision making at all government levels, and they influence legal enactment that may affect members of the profession, industrial sector, general economy and the entire nation. However, as the law may permit, the professional trade associations such as NMA may exert influences on MDCN.  In fact, NMA is a member of MDCN. Similar arrangement occurs in other healthcare units.  In Nigeria, MDCN is an executive agency under the Ministry of Health. This means, the federal government still largely controls the various professionals through its executive agency though subject to the Parliamentary (National Assembly) actions.

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This explanation is important so that we can distinguish the respective roles of the government, regulatory bodies and trade associations as well as individual professionals.

The Courts: One area that I have not mentioned is the position of the court. Each professional body has its own investigative and disciplinary body. This body hears complaints from professional members and members of the public in respect of members of the profession and their practice.  Citing the MDCN as an example, the Disciplinary Tribunal (DT) of the MDCN has the equivalent status of a High Court.

Thus, the decision of the DT can be appealed to the Appellate Court and then to the Supreme Court of Nigeria.

From the foregoing, it can be seen even at this stage, that medicolegal or clinical negligence is the action of individual clinician (pharmacist, laboratory technologist, medical doctor, dentist, nutritionist, physiotherapist and a nurse) measured against the general laws, sectorial law, and regulatory law and even against the action of their respective trade associations.

Moral, Cultural and Religious Codes:  In particular in Nigeria and in general, in African context as in different regions of the world, religion and cultures operate through their respective moral codes to influence clinical decisions. Such influences may have direct effect on medicolegal matters. Let us cite an example. It’s an established religious fact that a deceased Islamic patient, say 34-year old pregnant woman, must be buried as soon as possible often within 24 hours of death. Let us now assume that a medical doctor had mismanaged the said deceased patient. Giving the age of the patient and the pregnancy, it’s obvious that the deceased must be subject to coroner analysis which will entail post-mortem study.  Such post-mortem study may take a long time to complete than is allowed for by religious codes. The work of a coroner and the pathologist as well as medicolegal personnel are clearly made impossible here.  Clearly, any claim against the offending clinician is likely to fail or at best be speculative.

Similarly, let us assume a young king or prominent politician who is also a chief, was poisoned or given an overdose. Yet, if the codes of disposing the king’s body dictate that he must not be dissected or interfered with upon death, then it’s clearly impossible to find the truth of the true cause of death. Any medico-legal claim will certainly fail accordingly.

In the case of our politician above who is a chief, should it be the culture of his people or that he had given an instruction against post-mortem analysis even though clinically, his death is suspicious, then, it may be impossible to bring a medico-legal claim against the alleged perpetrator—be it a clinician or family members.

In the face of glaring and serious injuries, even aside from cultural and religious effects, dominant moral code may dictate an act of “forgiveness” or accepting one’s fate as “an act of God” even in the most obvious negligent behaviour by the perpetrator of the injury.

As we shall see later on, the fundamental problem in Nigeria or even in Africa is poor insurance uptake as well as poor regulatory oversight of the insurance industrial sector.  In addition, ignorance as to individual rights, lax judicial system and unwillingness of the respective authorities to undertake legal reforms coped with lethargic enforcement efforts account for a chaotic insurance and medicolegal system which in turn adversely affects the healthcare delivery and accounts for poor quality outcomes in the health sector. This in turn leads to short life span of Nigerians.

All said, under normal circumstances, the law should normally operate without hindrance of any sort.  Nonetheless, in Nigeria, these factors of religion, moral codes and culture interplay to negatively influence the outcome of medicolegal pursuits and quality healthcare delivery.

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Differences between Criminal Law and Civil Law

Criminal Law: In criminal law, the action of government is represented and conducted by the Ministry of Justice of applicable federal and state governments.  If a crime is committed by an individual say unintentional death in the hands of a clinician, the government can step in to determine if prosecution is necessary. The agency of the Ministry (the Police) would have investigated the case and pass the file to the prosecutor in the ministry. The decision on persecution or court appearance rests with the prosecutor (the government). Such criminal case is between the alleged criminal and the government (The State).  Criminal cases is about making a deterrent to others not to commit such crime and a punishment to current alleged criminal for his bad behaviour. The punishment varies from community service, deferred imprisonment, house arrest, imprisonment or whatever punishment the court sees fit.

Civil Law: In civil claim under civil law, the battle is between two individuals either biological individuals or businesses. The government have no role to play but the claim can itself be against any level of the government or their agencies and aggrieved members of the society.  Very often, civil claim is about making restitution. The aim of restitution is to place the victim in the position that he or she would have been had the alleged injury never occurred.  Court can order under civil claims such restitutions as apologies and monetary rewards or both.  The court can order anything it sees fit and even the court can go as far as recommending prosecution of the participants.

In some situations, some cases can both be in the remit of criminal and civil laws.  We shall see such a case under clinical negligence.

Clarification of Terms

Clinic: Often operating as an out-patient as distinguished from a hospital, a clinic is a place where medical treatment is given to patients.

Clinician: Unlike someone who does laboratory or research work, a clinician is a qualified health professional, such as a physician, psychologist, or nurse, who is directly involved in patient care.

Clinical Practice: Clinical Practice is relating to or based on place and or work done with real patients:  It relates to the medical treatment that is given to patients in hospitals, clinics and other health centres.

Hospital: Hospital is an extension of a clinic but with admission facilities for patients (in-patients unlike out patients).

Patient/Client/Service User:  Is a person receiving or a person who is registered to receive medical or clinical treatment.

Laboratory and Researchers:  Are personnel that works in laboratory and very often do not come in direct contact with or participate in direct management of the patient.

The Foundations of Medico-Legal Service

The foundations that underpin medico-legal service are found in:

  1. General Law:
    1. Law of Assault and Battery (Criminal Law/Penal Code)
    2. Law of Contract
    3. Criminal Law
    4. Common Law of Duty of Care
    5. Other Relevant Common Laws

 

  1. Law that Establishes Medical Practice (in Each Legal Jurisdictions)
  2. The Code of Conduct/Ethics Derived from the Law that Establishes Medical Practice (2, above).
  3. International Law/Code of Conducts
  4. Human Rights Law

Let us now examine the above listed in more details. Once we have dealt with them, we can examine the role of Insurance, the Prosecution Service (criminal law) and civil claims and restitution process.

This is an excerpt from the up-coming book titled:

“Medico-Legal Perspectives In Nigeria: A Compendium for Clinicians, Legal Practitioners, General Public, Insurances and Professional Regulatory Authorities”

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Medico-Legal Perspectives in Nigeria: A Compendium for Clinicians, Legal Practitioners, General Public, Insurances and Professional Regulatory Authorities

Benefits of Exercise. Your Solutions for Manifold of Diseases: Part 1 I have been labelled as Exercise Evangelist by the many people who receive my regular electronic messages on the subject of exercise. A lot of such recipients have taken to my messages and the exercise evangelism concept. Nothing can gladden a medical doctor than when he sees his patients and followers get a better health and they also follow medical advice. From all indications, it appears human beings are not made to be stationary. We are supposed to constantly be in purposeful motion. It’s on the basis of such joy as I mentioned above that I now write the current public health promotion and education series. The message in the next couple of weeks will focus on Exercise which is also called Physical Leisure Activity. As it’s the custom in writing this series, let us start by booking at the scope and definition of exercise. What is exercise? In keeping with medical dictionary, “Exercise is physical activity that is planned, structured, and repetitive for the purpose of conditioning any part of the body.” We may also consider physical exercise as being any bodily activity that enhances or maintains physical fitness and overall health and wellness. Whereas, brain exercises are those activities which give the brain new experiences by use of physical senses of hearing, smelling, touching, tasting, visual and emotional activities. I once told someone living in Lagos to exercise as part of clinical consultation, he responded by telling me that running after “danfo” or “BRT” and walking home when there is no bus to join is enough exercise for him. Pointing at his relative slim figure, he reminded me of the “benefits” of such “exercise” as struggling on daily basis to catch a “danfo” bus as a commuter had made him slim down. Yet, this individual’s blood pressure and sugar remained very high in spite of his perceived “exercise”. As we can see from the above definition, to have any reasonable and beneficial effect, exercise should be “planned and structured”. Exercise is not a sudden, chaotic and irregular activity embarked upon on an impulse due to imposing transport challenges. Another common error is in matter of sexual intercourse. While there is a definitive scientifically published article indicating that sexual activity results in a loss of energy up to 200Kilocalories (about 10% of daily energy requirement for a standard male) in a single sexual encounter lasting 30minutes and intercourse is considered as a form of exercise, it is clearly irrational to use sexual intercourse as a “planned, structured and repetitive” form of exercise. Sex by its very nature is vulnerable to emotion, subject to mood changes and because sex involves two individuals, intercourse may be unplanned as well as being seriously influenced by the feelings or motives of the other person. Exercise may not be so influenced by the variables which I have mentioned. Any reasonable exercise by adults is a definite and determined course of action. What exercise is not: one of my very good clinical and a personal friend once sent me a message asking for my view if arguing with one’s spouse can be considered as a form of exercise. Well, mere loss of or expenditure of energy as in the case of arguing with anyone not the least, one’s spouse, should not be considered as a form of exercise. Such argument does not fit the definition of an activity that is “planned and structured.” While I concede that conjugal argument may result in sweating, expenditure of energy, squabbling may be purposeless. What is the point in engaging in useless expenditure of energy? Argument may lead to mental stress, headache, impaired judgement, poor sleep and body aches---The very opposite features that real exercise is meant to achieve as we shall see later. As I have explained earlier, sex cannot be said to be structured, reasonable, planned activity that is meant to improve on certain muscles and organs of the body outside the muscles and organs that are involved in reproduction. To our able mothers and housewives, going about several times around the kitchen, living room and bed room in pursuit of domestic chores cannot be considered as a form of structured and planned physical exercise. Often, by the end of the day, a mother chasing after youngsters and housewives trying her best to ensure orderliness at home cannot be said to be exercising. Very often, the consequences of the activities that I have described in this paragraph, frequently leads to stress, hypertension and obesity: the very illnesses that physical exercises is meant to prevent as we shall see later on. Exercises such as laborious working of physical labourers, the restlessness of civil and mechanical construction workers, tedious efforts of subsistence farmers, the hassling of market women and men, the daily wearisome activities of bus conductors and drivers, spending endless times in the same office chair pouring over intractable problems by political and business executives as well as continuous mindless trekking on city streets cannot be said to be beneficial or structured exercises. At best, they are a waste of time and energy, resulting as it often does, in actual illnesses that structured, purposeful exercise is meant to prevent. Therefore, the subsequent articles will elaborate on exercise, the scope, the advantages and scientific recommendations on how best to get the highest benefits from exercise. Benefits of Exercise. Your Solutions for Manifold of Diseases: Part 2 In today’s article, we shall deal with various forms of recommended exercises. There are various forms of exercises that individuals and groups or families can engage in. I will set out below, these types of exercises. Physical exercises are in general classed into three types, based on the particular effect that the said exercise do have on the body. In contract to the random and chaotic nature of some individuals who are claiming to be exercising, these classes of exercises will help guide us as to know what activity we are engaged in at a particular time. Let us deal with aerobic exercise: This is a form of physical activity that uses big or large muscle groups. In effect, such activities cause the body to expend more oxygen fuel (hence the name aerobic) than it would while at rest. The aim of aerobic exercise is to increase the heart and blood vessels’ staying power or stamina. Examples of aerobic exercise include cycling, swimming, and brisk walking, jogging, skipping rope which women and children often ask me if rope skipping is a form of acceptable exercise, rowing and playing table or lawn tennis. The list goes on. Anaerobic exercise on the other hand is another form of exercise. Anaerobic means going without oxygen. This class of exercise includes strength training for example: weight lifting. Other form of anaerobic exercise includes leg and hands resistance training. Anaerobic exercise does strengthen, and tone muscles. Similarly, anaerobic exercise serves to improve bone strength, balance, and coordination. Examples of strength exercise, according to online Encyclopaedia (Wiki) are push-ups, pull-ups, lunges, and bicep curls using dumbbells. As I mentioned earlier, anaerobic exercise also include weight training, functional training, sprinting, and high-intensity interval training increase short-term muscle strength. On the other hand, the third class of exercise is called flexibility exercises. Flexibility exercises involve stretching of joints and lengthening of muscles. Examples will be abdominal exercises, squatting, backward bending, bending and extending the joints and various muscles that are attached. Activities such as stretching help to improve joint flexibility and keep muscles agile. The objective is to improve the range of motion and degree of movements of the joints including their attached muscles which can as a result reduce the chance of damage. As can be seen therefore, the claim that frequently loitering in the kitchen, mindless walking along the street with heavy emotional load or jumping into commuter buses cannot be, in the true senses, considered as a form exercise. Meanwhile, physical exercise can also include an activity that focuses on accurateness, dexterity, power, and speed. Thus, sometimes the terms 'dynamic' and 'static' are used instead of above categorizations. 'Dynamic' exercises include such activities as steady running (jogging) which tend to produce a lowering of the diastolic blood pressure during exercise, due to the improved blood flow. On the contrary, static exercise (such as weight-lifting) can cause the systolic pressure to rise significantly again during the exercise. The moral of this explanation is that one should get involved in a mixture of different classes exercises (aerobic or dynamic as well as say stretching exercises) to enhance the overall benefits. Now, having dealt with the types or classes of exercises as discussed above, you will be right to ask me: what is the amount of exercise that is scientifically recommended to ward off illnesses? In other words, how much physical activity should I do? For this let us turn to some official guidelines. I will refer to the National Health Service (NHS Choices) in the UK for guidance which is copied but slightly edited below: For 19-64 years: To stay healthy or to improve health, adults need to do two types of physical activity each week: aerobic and strength exercises which I also mentioned above. I will deal with other ages later. How much physical activity you need to do each week depends on your age. To stay healthy, adults aged 19-64 should try to be active daily and should do: at least 150 minutes of moderate aerobic activity such as cycling or fast walking every week, and strength exercises on two or more days a week that work all the major muscles (legs, hips, back, abdomen, chest, shoulders and arms). 75 minutes of vigorous aerobic activity, such as running or a game of singles tennis every week and strength exercises on two or more days a week that work all the major muscles (legs, hips, back, abdomen, chest, shoulders and arms); A mix of moderate and vigorous aerobic activity every week. For example, two 30-minute runs plus 30 minutes of fast walking equates to 150 minutes of moderate aerobic activity, and strength exercises on two or more days a week that work all the major muscles (legs, hips, back, abdomen, chest, shoulders and arms). A good rule is that one minute of vigorous activity provides the same health benefits as two minutes of moderate activity. Benefits of Exercise. Your Solutions for Manifold of Diseases: Part 3 One way to do your recommended 150 minutes of weekly physical activity is to do 30 minutes on 5 days a week. All adults should also break up long periods of sitting with light activity. What counts as moderate aerobic activity? Examples of activities that require moderate effort for most people include: walking , water aerobics, riding a bike on level ground or with few hills, doubles tennis, pushing a lawn mower, hiking, skateboarding, rollerblading, volleyball, basketball. Please take note that if you cannot exercise every day, a new research in January 2017 has given support to “Weekend Warriors” who chose to exercise on weekends only. Moderate activity will raise your heart rate and make you breathe faster and feel warmer. One way to tell if you're working at a moderate level is if you can still talk, but you can't sing the words to a song. What counts as vigorous activity? There is good evidence that vigorous activity can bring health benefits over and above that of moderate activity. Examples of activities that require vigorous effort for most people include: jogging or running, swimming fast, riding a bike fast or on hills, singles tennis, football, rugby, skipping rope, hockey, aerobics (see above), gymnastics, martial arts Vigorous activity makes you breathe hard and fast. If you're working at this level, you won't be able to say more than a few words without pausing for breath. In general, 75 minutes of vigorous activity can give similar health benefits to 150 minutes of moderate activity. What activities strengthen muscles? Muscle strength is necessary for: all daily movement to build and maintain strong bones, to regulate blood sugar and blood pressure, to help maintain a healthy weight. Muscle-strengthening exercises are counted in repetitions and sets. A repetition is one complete movement of an activity, like a bicep curl or a sit-up. A set is a group of repetitions. For each strength exercise, try to do: at least one set, eight to 12 repetitions in each set. To get health benefits from strength exercises, you should do them to the point where you struggle to complete another repetition. There are many ways you can strengthen your muscles, whether it's at home or in the gym. Examples of muscle-strengthening activities for most people include: lifting weights, working with resistance bands, doing exercises that use your own body weight, such as push-ups and sit-ups, heavy gardening, such as digging and shovelling. You can do activities that strengthen your muscles on the same day or on different days as your aerobic activity – whatever's best for you. Muscle-strengthening exercises are not an aerobic activity, so you'll need to do them in addition to your 150 minutes of aerobic activity. Some vigorous activities count as both an aerobic activity and a muscle-strengthening activity. Examples include: circuit training, aerobics: running, football, rugby, netball and hockey. Exercise for Babies: Before your baby begins to crawl, encourage them to be physically active by reaching and grasping, pulling and pushing, moving their head, body and limbs during daily routines, and during supervised floor play, including tummy time. Once babies can move around, encourage them to be as active as possible in a safe, supervised and nurturing play environment. Children who can walk on their own should be physically active every day for at least 180 minutes.(three hours). This should be spread throughout the day, indoors or outside. The 180 minutes can include light activity such as standing up, moving around, rolling and playing, as well as more energetic activity like skipping, hopping, running and jumping. Ages 5-18years: To maintain a basic level of health, children and young people aged 5 to 18 needs to do: at least 60 minutes of physical activity every day – this should range from moderate activity, such as cycling and playground activities, to vigorous activity, such as running and tennis on three days a week, these activities should involve exercises for strong muscles, such as push-ups, and exercises for strong bones, such as jumping and running. Older adults aged 65 or older, who are generally fit and have no health conditions that limit their mobility, should try to be active daily and should do: at least 150 minutes of moderate aerobic activity such as cycling or walking every week, and strength exercises on two or more days a week that work all the major muscles (legs, hips, back, abdomen, chest, shoulders and arms). Benefits/Advantages of Exercise: Physical leisure activities have phenomenon amount of benefits. Exercise has incredible social and medical advantages. Human beings after all, seem to have been made to frequently be in motion. That is to say, sedentary lifestyle poses a danger to a person’s existence. For example, sitting too long or lying down for too long a period may lead to obesity, diabetes, deep vein thrombosis and anxiety. Engaging in physical exercise does help in maintaining overall physical well-being, contributing to ensuring healthy weight amongst others. Physical exercise induces happiness, improve the mood, helps overcome pain and prevent mental health breakdown. Let us now go in more details on the benefits of physical exercise. Benefits of Exercise. Your Solutions for Manifold of Diseases: Part 4 Human fertility. Its well established that regular exercise can help you shed weight. Obesity is bad for your fertility either as a male or female. For the female, obesity can distort the female reproductive organs and thus delay or even prevent conception from occurring. Further, excessive weight may require or produce excess hormones that regulate female function and appearance. The result is that excess circulating hormone such as estrogen may lead to uterine fibroid, cancer of the breast as well as infertility. A lean body or “figure 8” is a great helper of female fertility. For the man, generally what is said above for the female is applicable for the male save that excess testosterone (male hormone) may not be healthy for the prostate gland. High testosterone may also lead to high blood pressure. A recent research advised men to maintain a lean body mass so as to improve their own fertility. Regardless of the gender, obesity can impair fertility by creating diseases that affect fertility. Such illnesses include diabetes mellitus, high cholesterol and hypertension. These set of infirmities for the man can lead to erectile dysfunction. For the woman, polycystic ovarian disease may result. In both genders, obesity may physically impair enjoyment of sexual intercourse. Benefits of exercise on Cardiovascular System: Low levels of physical exercise increase the risk of death from cardiovascular diseases (diseases of the heart and blood vessels). For children, children who take part in in physical exercise produce greater loss of body fat and improved cardiovascular fitness. Experience has shown that academic stress in the young poses increased risk of cardiovascular disease in subsequent years; nonetheless, these dangers can be significantly lowered with structured physical exercise. Exercise can be used to lower high blood pressure or prevent one from developing. On Metabolism: There is scientific evidence to support the fact that exercise lowers blood pressure, LDL and total cholesterol as well as body weight. Exercise increases HDL cholesterol, insulin sensitivity, and exercise tolerance of the individual thus lowering the risk of diabetes mellitus. On Immune System: reasonable exercise has an advantageous consequence on the human immune system. For example: modest exercise has been linked with a 29% lowering of occurrence of upper respiratory tract infections (URTI). On Cancer: There is abundant evidence that structured physical exercise can prevent up to 13 different cancers in human beings: In particular, cancer of the breast, cancer of the lung, cancer of the stomach, cancer of the colon, cancer of the womb, cancer of the oesophagus, cancer of the blood such as myloid leukaemia and myeloma. Other cancers that exercise can keep at bay are cancer of the bladder, cancer of the head and neck as well as cancer of liver and rectum. Rehabilitation: Even in patients that had unfortunately suffered from cancer, exercise has been shown to improve the outcome of cancer treatment. Remember though that exercise is a non-medication and has no toxic side effects. Regardless of the age and gender, the same thing can be said for anyone who is recovering from surgery, accidents, fractures and long term bed immobility. Exercise helps in rehabilitation and recovery from countless number of diseases. On the bones and muscles: In women and men, exercise can help to strengthen the bone and muscles. In no age is this more important and well demonstrated as in middle ages in women who had undergone or undergoing menopause. Later in life, men tend to have their own “menopause.” Exercise helps to prevent osteroporosis and muscle wasting. This is especially so in older women. Regular and determined exercise is the preferred choice, ironically, to prevent and treat osteoarthritis of any bone or joints. Mental Illness: Its well documented and indeed proven that exercise has positive impact on our mental health. Let us examine this fact a little further. A mammoth body of research in human beings has shown that consistent aerobic exercise (for example, 30 minutes of every day) encourage continual enhancement in certain brain and intellectual functions. Individuals who regularly carry out aerobic exercise (such as, running, jogging, brisk walking, swimming or cycling) have superior score on brain functions and performance tests such as attention control, inhibitory control, working memory updating and capacity, and information processing speed. Clinical proof also maintains the use of exercise as an additional therapy for certain brain illnesses in particular Alzheimer’s disease and Parkinson's disease. Structured exercise is also associated with a lower risk of developing neurodegenerative disorders. Exercise and in particular, aerobic exercise is also a powerful antidepressant as well as producing euphoria leading to improvements in mood and self-esteem. On depression: Physical exercise is well established form of as an antidepressant in persons with depression. In fact, clinical evidence supports the use of exercise as both a preventive measure against and also supportive therapy with antidepressant medication for depressive illnesses. Persons suffering from anxiety can also benefit from moderate exercise. Exercise can thus banish sadness and improve happiness in individuals. Benefits of Exercise. Your Solutions for Manifold of Diseases: Part 5 Pain relief: Apart from the use of exercise in rehabilitation of persons with surgical, mental health and other physical illnesses, exercise can help banish or reduce psychological pain whatever its origin: such as grief, divorce and life failures. This is because exercise produces endorphins in the brain. Endorphin is a powerful pain killer like morphine. Sleep: exercise generally speaking, improves sleep for a lot of people. It also alleviates sleep disorders such as insomnic illness. However, the best time to exercise may be 4 to 8 hours before bedtime. Vigorous exercise which is done close to bed time may impair sleep as it may cause alertness. Other Circumstances: Fibroid is a common disorder in women more especially so in African women wherever they may be on earth. As mentioned earlier, inactivity and obesity may cause the body to require or produce excessive estrogen hormone. Thus, a lean body mass will require less. Exercise is therefore a non-medical way to prevent development of fibroid. Further, women who are pregnant and anticipating delivery are encouraged to exercise from mid-pregnancy. This is so, to prepare the birth canal and the entire body of the woman for labour. A well toned muscles of the pelvis and thoroughly prepared body will be less tiring and will be able to cope with the rigours of labour. Warnings/Cautions: As in any form of medical treatment, there may be unwanted side effects. Exercise is not different even though it’s free (or supposed to be) and is not a medication. I cannot over emphasize the fact that exercise may not necessarily be suitable for everyone. Anyone with heart disease, physical disability, hypertension or a person who has not done exercise for a long time should exercise caution especially at the initial stages. I will caution that anyone with the illnesses of hypertension, heart problems, diabetes along with obesity or any illness for that matter should first consult with his or her doctor for a check-up. An ECG may also be ordered to cross-check the heart activities ahead of proposed scheduled exercises. Also, as in everything in life, too much exercise can be harmful. Moderation and reasonability are called for. Excessive, unrelenting, prolonged exercise may cause heart diseases because of work overloading of the heart. Excessive exercise in individuals with distorted overweight perception of themselves may lead to excess weight loss which may cause such person to look emaciated. Unguarded exertion of muscle and joints may cause physical injuries and also diseases such as rhadomyolysis (muscle damage). In addition, overtraining may suppress your immunity leading to such illnesses as frequently having respiratory infections. Wrong exercise can do more harm than good, with the definition of wrong varying according to the individual concerned. For many activities, especially running and cycling, there are significant injuries that may occur with poorly regimented exercise schedules. Injuries from accidents also remain a major concern, whereas the effects of increased exposure to air pollution seem only negligible: Not everyone exercises outside or on the streets. Some do so in their private spaces and some do exercise in commercial centres (gym, as it’s popularly called). In the female adult, excessive training may cause amenorrhoea (absence of the menstrual periods). If this continues and or untreated, amenorrhoea may lead to infertility. However, amenorrhoea of this nature is reversible once a correction is made to the underlying cause. However, while exercise should be a lifestyle for the duration of one’s life, exercise should if so desired, be stopped gradually. Sudden stoppage of exercise can lead to downward shift in the mood of the individual. Suitable nutrition and hydration (water intake) are important to health as exercise. When exercising, it becomes even more important to have a good diet and rehydration to ensure that the body has the correct ratio of macronutrients that it needs while providing ample micronutrients as well, in order to aid the body with the recovery process following strenuous exercise. We should remember that we should not overload or reload the excess food or fat that has been lost through exercise. You should also have adequate rest in intervals. This will allow the body to recover from previous exertion. Finally, while exercise is to be encouraged for individuals (children and adults) as well as the communities, caution should be exercised and note should be taken that one person is not the same as the other. If Mrs Z can tolerate 30minutes, it does not imply that Mr B can do the same. Every person should find their own level according to one’s ability especially within the recommended regime. As I have indicated before, do seek the opinion of your medical doctor and clinical adviser if you are considering engaging in exercise for the first time. All the same, you can banish illnesses by the choice of your lifestyle. Good luck.

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