Drug and Substance Misuse

Drug and Substance Misuse

Drug and Substance Misuse: Resist the Temptation. 1
What is a drug?
Part IV Section 44 of Nigeria’s National Drug Law Enforcement Agency, Act 1990 described and gave definitions to what constitute drugs and substances.
In this article and to make things simple for us, I will look at drugs from two other definitions. The first definition is one that is within the confine of the professionals:
1) Under the USA Federal Law: A drug is:
a. any substance recognized in the official pharmacopoeia or formulary of the nation.
b. any substance intended for use in the diagnosis, cure, mitigation, treatment, or prevention of disease in humans or other animals.
c. any article, other than food, intended to affect the structure or any function of the body of humans or other animals.
d. any substance intended for use as a component of such a drug, but not a device or a part of a device.
2)The American Heritage Science Dictionary defines “drug” as a chemical substance such as a narcotic or a hallucinogen that affects the central nervous system and is used recreationally for perceived desirable effects on personality, perception, or behaviour. Many recreational drugs are used illicitly and can be addictive.
Uses of drugs
From the above definition, we can see that, in fact, drugs actually have their good uses. They are intended to be used in certain ways such as for diagnosis (detecting) diseases, prevention of diseases, treatment of diseases in both human and animals. Drugs are also used to treat plant diseases.
Drugs are chemical substances that are found in different parts of the world. What constitute a drug will also depend on how it’s used. Therefore, drugs can be just any substance. The important thing though is that, apart from food and water, it must affect and make changes to the body of the person taking the drug. These changes can be physical and it can be mental. Drugs are in general supposed to be useful clinically. Examples: cocaine is used for anaesthesia. Morphine and its class is used for relieve of pain.

Alcohol, (methylated spirit) can also be used as a cleansing and disinfectant at home and in hospital. In most mouth washes, there are some alcoholic content. Heroin in prescribed form is used as a pain killer after operation and in people with serious disease conditions with pains. There is probably no tangible use for LSD. Amphetamine and related product can be used for slimming in controlled clinical conditions. So, these substances have their clinical uses. Cannabis in under scientific formulation is now in some conditions prescribed to control some diseases. The problem is that the usefulness of these substances is being manipulated by barons, couriers and users under the shadow of illegality.

What is abuse (ab= abnormal; use hence ab/use)
Abuse simply means, abnormal use, improper use: A use that is a deviation from its intended purpose. You will remember that, all things (please put emphasis: ALL THINGS) and not the least, drugs, have their intended use and purpose. Any departure from such intention is therefore an abuse or misuse.
Why is drug abuse so important?
Every action has its consequences you will remember. Like child abuse or abuse of anything for that matter, drug abuse has its own results. Very often these results are fatal or it may have long term damaging effects on the individual and everyone around the person. Someone may claim that, they are using drugs though it does not cause anyone else any harm. The fact is that they cause many people
some harm, ultimately. In the mind of the drug user who says she or he causes no one else any harm, such user (misuser) should understand, that her or his behaviour is causing unhappiness or even depression to the spouse, parents, children and the community around the drug user. Further, the misuser may constitute a nuisance to the society.

Every one of us in a given society is supposed to be productive and somewhat support each other in that community. If someone steals, the society will punish the person for stealing because stealing is classed as bad. If someone harms another, the law will take its full course if caught because; the person that is harmed may become less productive and may become a burden on the community. Punishing the offender is also a deterrent that causing harm is damaging to the common good. In the same way, someone who takes drugs is cheating on the others or the rest of the community. While he may not directly cause physical harm, he or she may become injured or dies. The injury will cause the person to be less productive against the overall common good of the rest. He or she may become mentally unwell. Someone will have to pay for the gaps in productivity that is opened up by the person. Even if the drug miser is multi-billionaire, his drug habit will have impact on his children, wife, employees with their dependants and fans or the larger society that look up to the drug user. This is why drug misuse if so dangerous.
He, the drug user, will cause others to be unhappy and possibly depressed even if the drug user does not cause these things or agree to be causing the harms directly.

Drug and Substance Misuse: Resist the Temptation. 2
As we shall see below, there are lots of impacts of drug misuse on the society, friends and not the least the individual drug miser. In the least, it gives a certain community and nation a bad name and image. In neighbourhood where drug misuse is common, the image projected by the drug usage is clear for everyone to see. For example, the community is branded as drug misuser, crime rates are higher, unemployment is high, property and social development is such community are low. Drug misuse has serious impacts on the said community not to mention the serious implication on mental health.
Drugs that are commonly misused/abused
Strictly speaking, anything and any chemical can be abused. They range from tobacco (nicotine), alcohol, smoking tea (!), petrochemicals, paint, kerosene, to cannabis and to more serious ones like cocaine, heroin, LSD, ecstasy, magic mushrooms and many more. Just anything can be a drug. It may be common plants or cultural plants such as khat commonly used in Somalia and now used in the Western World. Probably the commonest drug of abuse is alcohol and nicotine (cigarette) and marijuana.
Why do people abuse drugs?
1) Lack of knowledge / Ignorance. The old saying that ignorance is a disease and that ignorance kills is ever so perfectly true as in drug misuse. Most innocent people especially adolescents and children are introduced to drugs without them ever being aware of what they are getting into. The reasons are that:
a) Some parents do abuse their children: Parents who are on drugs (see above list of drugs but especially alcohol and nicotine) will most tacitly or directly introduce the drugs to their children. Children of course learn from parental habits or learn from the habits of guardian. They will simply pick up the behaviour.
b) The “mates” and friends effect: Hardly does it ever occur that anyone, for the first time and without prior knowledge of drugs, could walk along the street looking to buy heroin, cocaine or even alcohol. Someone must have first, introduced the substance to the person. This is where “mates” and friends come in. Pressure groups, in schools, streets, rave parties’ gives the drugs to the unwary, the easily led and innocent person who wants to “belong” to his mates or “be like them”. In my clinical experience, this is how teenagers get into drugs. The “mates” often “market” the drugs as “happy” substance and asking the innocent person to try it. On the other hands, the drugs may be marketed as helping users to be bold and less shy especially in approaching the opposite gender.
c) Illegal administration/ criminal acts: Sometimes in parties and to the unwary, drugs may be put in drinks and food belonging to the victim who innocently takes the drugs. On other occasions, the drug may be presented as sweats or something pleasant that the victim may benefit from. Actually, in law, this is both an illegal administration of drugs and this act is seen as poisoning the victim. This is what happens, sometimes between children and parents. It also occurs between “mates” or between opposite genders. Males may put rape drugs in drinks of a female whom the male intended to subdue for the purpose of rape when the drug had taken full effect. The victim being unaware takes the drink and subsequently get attacked.

2) Supposed pressure of life/ Desire to excel in life: There is a false belief that, using recreational drugs can give relief of some sort such as “stepping down” from a pressure of unemployment, family issues, pressurising job positions, career and school pressures: Relieve may indeed last for a while. Once it becomes a habit, the damage may have gone too far and beyond repair. So, taking illegal drugs is an escapist method of dealing with failures and pressures of life. The desire to excel is linked to success. As I mentioned earlier, drug taking is almost always an act of cheating the rest of the society. This is the situation that occurs in sports and games. In the end, it does not pay to take performance enhancing drugs as we have witnessed with so many lives cut short, sport career banished, athletes are banned from games and money in the hands of drug misuser is filtered away.
3) Duress: If you are poor and you are looking for way out of it and you happen to fall into the wrong hands, you may be forced into the drug ring. In the first, you may actively be looking for the way out of your poverty. This can be by your voluntary action in which case you choose to be part of the drug team as either a courier and or a user. Of course, it makes loyalty sense that if you are going to be part of a team, you should show your commitment to the leadership by taking the drugs, somehow. The loyalty factor ties the drug courier and user to the baron. On the other hand, you may be actively recruited and be forced to take or carry drugs under the threat of death or any other harm In return couriers and users are promised a handsome reward. In the end, your action may lead to your mental health breakdown or you end up in prison or both.

Drug and Substance Misuse: Resist the Temptation. 3
4) Poverty (and ignorance): As in (3) above, with unguided individuals who is poor, there is greater likelihood of alcohol misuse, nicotine misuse and cannabis. Heroin and cocaine appears to be the preserve of the rich though not exclusively.
5) Abuse of Prescription Drugs. As our definition clearly stated, any chemical can be abused be it prescription drugs or recreational drugs. Some individuals do suffer long standing and painful conditions. In such a state, some believes that taking more than what the doctor has prescribed would provide corresponding greater healing effect. In fact, the opposite may be true. It may cause considerable damage beyond what the user had ever contemplated. Yet, there are many people who out of ignorance, poverty or both refused to attend a medical consultation. Instead, they prefer going to the local chemist or pharmacy to get over the counter medications. Paracetamol or other pain killer as well as sleeping tablets belong to drugs that are frequently abused by the public. Abuse of over the counter drugs and prescribed medications are extremely dangerous. Illnesses are better handled by clinician and trained professionals.

In similar situations, there are individuals who use drugs to “suppress” the effect of a disease. Cannabis, illegal as it is for example, is used by some in the belief that it helps the pain of chronic diseases. To be truthful, it is to this end that a prescribe-able form of cannabis has now developed. Cannabis causes, depression and paranoia. Some mental health patients who ironically developed paranoia tend to believe that their depression and paranoia could get better by use of cannabis. The opposite is in fact true. It could and does get worse.
Ways of using drugs?
The ultimate aim of drug user is to get the drug to the brain: however it gets there.
Therefore, the common routes are:
a) The mouth as in tablets such as ecstasy, various forms of preparation as in chewing of some of our traditional medicines. Some is taken as liquid as in alcohol and gas as in cigarette and cannabis (also known as marijuana, skunk).

b) Through the nose as in cocaine sniffing.

c)Through the blood vessels (injection) as in heroin

d) It may also be through the vagina or anus as in drug courier and other shrewd users.
How is drug presented? What does some of these drugs look like?
a) It can be in its natural form of leaves as in cannabis or heroin or cocaine as in coca
b) It can be in tablet forms as in LSD or ecstasy. It may look very innocent in presentation.
c) It may be in powder form as in cocaine powder which is often “white” in colour.
d) It may be in liquid form as in paint, petrochemicals and alcohol (ethanol). Some drugs such as cocaine and heroin may also be dissolved chemicals as a way to conceal their usage and carriage.
e) It may have been transformed by the barons in which case they may mix it with other products to disguise the real content of it.
Effects of drug abuse
Clinical:
I will not be detailing the effects of each of these drugs. To do so will undoubtedly complicate the discussion. Suffice to say that the principal effect is that drugs of all classes interfere with the way the brain works. Drugs interfere with the thinking process, the data processing by the brain and the way the person perceives things from the environment and the way the person reacts to the environment.
Drugs such as alcohol do also cause real and tangible damage to the substance of the brain which may lead to mental health diseases such as dementia.
Ultimately, drugs can contribute to or lead to psychosis, schizophrenia, paranoia (undue suspicions), delusions, hallucinations (hearing of voices, seeing strange things, and feelings of unrealistic sensations on the body, smelling things that feel abnormal or unreal), mania and unreasonable euphoria. It may lead to distortion of reality. Drugs may cause or contribute to depression, panic attacks and anxiety and sleeplessness. The list is endless.
Physical effects: The person abusing drugs may not now be well without the drugs (called addiction). He or she depends on it for daily “boost” (called dependence). If the person is injecting the drugs, it may leave marks on the skin. In fact this is probably the simplest effect.
The person may contact infection such as AIDS/HIV/hepatitis especially if needles are being shared between drug users. Substance misuse may also lead to other forms of less known infection that may kill the individual. Septicaemia or blood poisoning may be what will ultimately kill the person. I have seen someone, a drug user who developed abscess of the groin and had to have his leg and hip amputated as a result of what is known as osteomyelitis. If death or other severe damage has not occurred, organ damage may occur such as liver disease for example: cirrhosis of the liver as in chronic alcohol misuse.

Drug and Substance Misuse: Resist the Temptation. 4
Kidney may also fail in case of septicaemia. Brain damage may occur as I mentioned above. It may or may not be reversible.
The person may become disfigured. Drug may affect a person’s fertility and ability to have children
In women who are pregnant, the child may be severely affected and may present as a “drug addict” at birth with craving or withdrawal symptoms. That may affect the child for life. This is commonly seen in alcoholic pregnant mothers. Some drugs my stiffen life out of the unborn child especially in early pregnancy. Cigarette do damage the lungs of the new born.
Nicotine in cigarette has been linked to cancers of the lungs and bladder and it has effect on other cancers such as breast cancer especially in women. Alcohol is known to cause or be associated with cancers and also contributing to many of such diseases in women and men. In short, alcohol misuse causes cancers.
a) General Effects
Economic: Someone suffering any of the above clinical effects cannot be described as being healthy. Certainly, productivity may be diminished due to diseased state. Business and work may suffer as a result. Cost of caring for the user and the loss in productivity will affect incomes. It may as a result affect, career. Many political aspirants who took drugs in teenage years have fallen by the way side later on in their political career. In the least, they have had to explain to the public and possibly apologise for ever taking drugs in ignorance. Thus, drugs can affect future ambitions.
School and education may suffer considerably. Many individuals have had their schooling cut short on the account of drugs misuse. I have clients now and in the past who had been impaired by alcohol, prescription drugs, cannabis and heroin with serious effects on their academic performance.
Social and family: The impact of drug is widespread. First, it may affect the children who may copy the user. I have seen many spouses and relationship ruined because a partner introduced drug into the family and relationship. This may lead to disease states and fragmentation of the family.
Legal effects and crimes: It has been proven beyond doubt that drugs misuse from alcohol to heroin and cocaine and indeed any form of drugs that distorts reality may aid commission of offence. Commission of offence may lead to imprisonment and or detention in mental health institution. The person may begin to act out of character. This may be the start of a trend in which there is drug use leading to crime and the beginning of the ruining of a life that started as a bright star.
The Situation of Drug Misuse in Nigeria.
Let us face it: with a lax rule of law in practice, poor infrastructure to support economic development, no social welfare benefits, wide disparity between the rich and poor and with 62 % of her people living below poverty line and per capital income recently risen to about $1200 (UNDP) and a teeming population of over N160M, Nigeria is essentially a drug consuming and producing country. Nigeria is also a significant transit and courier country.
According to available public records,” former Chairman of NDLEA (National Drug Law Enforcement Agency), Alhaji Ahmadu Giade, described illicit drugs as “alien” to Nigeria. Cannabis, now locally grown in most states of the federation, was introduced to the country by foreigners. Ms Dagmar Thomas, the Country Representative of United Nations Office on Drugs and Crime (UNODC), says Nigeria was one of the largest cannabis growers in Africa, with over 8% of the population abusing cannabis. Annual cannabis seizures increased from 126 metric tones in 2005 to 210 metric tones in 2007.
The NDLEA describes the South West region of Nigeria as one of the main centers of illicit drug production in the country. 196.5 acres (0.795 km2) of cannabis farmland was discovered and destroyed in the region in 2008. In particular, Edo State has the highest rate of seizure of cannabis in the country. In April 2009, the NDLEA confiscated 6.5 tones of marijuana from the home of a man in Ogun State who claimed to be 114 years old. In September 2009 the NDLEA reported destroying a 24 hectare Cannabis Plantation in a forest reserve in Osun State.
In January 2009, the NDLEA publicly burned 5,605.45 kilograms of drugs seized from traffickers in the historic town of Badagry, Lagos. The bonfire included 376.45 kilograms of cocaine, 71.46 kilograms of heroin and 5,157.56 tonnes of cannabis in 2015…. Between 2006 and June 2008 over 12,663 suspected drug dealers were arrested, with seizure of over 418.8 metric tonnes of various hard drugs. For example, in July 2009 a woman about to board a KLM flight at the Mallam Aminu Kano International Airport was arrested by NDLEA officers and later excreted 42 wraps of cocaine, weighing 585 grams. In September 2009, the NDLEA arrested a Guinean woman en route from Brazil to Europe with 6.350 kg of pure cocaine at the Murtala Mohammed International Airport in Lagos.” (Wikipedia).
Yet, about 20% of Nigerians are mentally unwell with drugs misuse contributing a significant proportion to the scourge of mental illness.

Drug and Substance Misuse: Resist the Temptation. 5
Prevention and Treatment.
As a clinician, my major concern is both the effects of drugs on the individual and the society. I have earlier discussed the clinical implications of misusing drugs.
In prevention terms, adult individuals just need to say “no to drugs” with strong and persistent determination notwithstanding the pressure from wherever the pressure to give in may be coming from. Adults who are at risk of drug misuse should take steps to avoid coming in contact with peers or couriers or kingpins pressuring one into drugs. Change of mobile number, emails, contact address or completely relocating may help: such should also be done with strong will and determination. Avoid swearing on oath. Avoid secret pacts with underling threat of deaths or harm befalling the oath-taking if the oath is breached. Stay and be satisfied with your earnings no matter how little. Greed kills.
Teenagers need to be very careful with whom they befriend and move with. Do not agree to try anything no matter the pressure or need to belong. Once you try, you are hooked on drug.
Children and babies in the womb are vulnerable. Their care and life depends on the parents, guardians and the government as neighbours. Neighbours has a civic duty to report abuse to the government. Government has a duty to protect the citizens.
A word on abuse of prescription and over the counter drugs: Every decent and law abiding society sets the rules for the orderly behaviour of its citizens. The problem in Nigeria is actual enforcement of laid down rules. The Pharmaceutical Society of Nigeria in concert with the respective government agencies as well as the medical profession must adhere to the laid down rule of restricting the sourcing and distribution of controlled drugs. Certain drugs must not be made available to the members of the public without credible prescriptions. As it currently stands, this is not the case, thus leaving a leaking and big gap for potential abusers to lay their hands on controlled substances. The healthcare professionals and the government need to do more to seal this gap.
In term of treatment, detoxification and or weaning off drugs therapy with counselling are available to individuals or groups with insight. No law is as yet exist in Nigeria to compel individuals to undergo treatment for any illness not the least mental health and drug abuse. Therefore, concerned individuals and families may bring their friends or family members to care centres and hospitals for assessment and treatment. In my view, drug misuse is avoidable and treatable as taking of drugs is both a matter of personal choice and the unfortunate administration of substances to unwilling victims.
To avoid misconception, mental health treatment does not have to take place in “asylums” or massive institutions as its in popular mind. To a determined person, recovery from mental health or drug misuse can take place in the person’s comfortable home environment. If however, there is risk of lapsing into drug retake or peers might influence treatment, then it may be better that, the sufferer be taken to a care centre. There are many private and decent hospitals in Nigeria with specialist staff to look after their clients. Most detoxification treatments may take one or two weeks on the average. Nonetheless, associated mental health deterioration such as psychosis and depression may take longer to deal with. Once the acute or emergent phase is over, further recovery may take place at the home of the patient.
Irrespective of where the treatment takes place however, the most crucial factor is the insight of the patient to admit to his or her vulnerability and illness as well as to have a very strong will to resist the temptation to abuse drugs during treatment and after.
This will to get well could also be reinforced by support from spouse, family and friends of the drug misuser with strong ground rule that bad influences from co-drug misuser should not get in contact with the person who is recovering from substance misuse.
In all, help is available if you look for it.

July 14, 2017 / Health Info for Patients

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Drug and Substance Misuse

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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