Forensic Medicine

Forensic Medicine

Forensic Medicine: Questionable Injuries are Not Acts of God.
Africa and indeed Nigeria are blessed with abundant human and material resources: that is a fact. That we are underachieving and underdeveloped is a settled matter and I will not be discussing that point here. What is most concerning is the magnitude of abuse of humans and other resources that we have been blessed with to improve our lives. We the residents of this frontier called Nigeria (and Africa) are the principal perpetrators of such abuses against our fellow human beings and it has been on-going for millennia.
A couple of weeks ago, we discussed abuse in its various forms. I pointed out then that abuse can result into physical, psychological, financial injuries or death of the victims. Abuse is not the only cause of deaths as we all know. Deaths can result from accidents, very often as a result of one person’s negligence or the other. There is no doubt that deaths of anyone—young or old—very frequently results from natural causes such as definite disease states such as cancer. In the elderly, death may come due to old age. Death may therefore not be due to natural causes. Death that is questionable may be as a consequence of a deliberate act of harm (abuse) such as beating a person to death, poisoning, burning or deprivation of necessaries. Death may also result from negligence (act of not paying due care and attention to what one is doing or a person is not carrying out his/her duty to the standard expected of that individual and position that the person occupies).
Now, it’s the subject of such questionable deaths and injuries that we shall explore in this article. In medical professional circle and in law, the medico-legal examination of such questionable deaths is carried out by a Coroner. Coroner cases are integral part of forensic medicine. It’s a very important aspect of every decent society to question and find the root causes of what caused the death or injury of a member of the society that we all belong to.
We will examine the nature of forensic medicine and how it applies to you and the society that we live in. We will also take a look at how you and your family can benefit from forensic medical work. In addition, we will examine the reasons why forensic examination is almost a taboo or why the practice of forensic medicine suffers from a high resistance in Nigeria. First, the scope of forensic medicine and the law.
Let us deal with the word: “Coroner”: The history of coroner and indeed the name “coroner” (from Crown) came from the English in the 11th Century England. The principal reason for establishing coroner is simply to protect the interest of the Crown in Criminal Proceedings. The coroner was formally established in England by Article 20 of the “Articles of Eyre” in September 1194 to “keep the pleas of the Crown”) from which the word “coroner” is derived. In those days, it was the duty (as its now) of the local county official to defend and protect the interest of the Crown in courts. By the year 1215 when the Magna Carta (that brought much human rights to the world as we now know it) came into being, the word “coroner” had been enshrined in law.
Ultimately, it became established that “the person who found a body from a death thought sudden or unnatural was required to raise the “hue and cry” and to notify the coroner” and hence the modern function and meaning of a coroner . Therefore, coroner is a person whose standard role is to confirm and certify the death of an individual within a jurisdiction (say in Lagos State or Nigeria).
With this in mind, we can now look at what is “forensic medicine”. “The application of medical knowledge to the investigation of crime, particularly in establishing the causes of injury or death is called forensic medicine.
The meeting point of Forensic Medicine and Coroner: Coroner and forensic medicine indeed have a meeting point at what is called autopsy: which means examination of the dead to find the cause of death. To use the words of Encyclopedia Britannica, the primary tool of forensic medicine has always been the autopsy. Frequently used for identification of the dead, autopsies may also be conducted to determine the cause of death. In cases of death caused by a weapon, for example, the forensic pathologist ( a medical doctor)—by examining the wound—can often provide detailed information about the type of weapon used as well as important contextual information. (In a death by gunshot, for example, he can determine with reasonable accuracy the range and angle of fire.) Forensic medicine is a major factor in the identification of victims of disaster, such as landslide or plane crash. In cause-of-death determinations, forensic pathologists can also significantly affect the outcome of trials dealing with insurance and inheritance.
Therefore, a common but extremely powerful tool that exposes criminality is autopsy which in the hand of a coroner can bring justice to victims even if dead. Forensic medicine as a whole can bring justice and restitution to the living injured. Next week, we shall examine coroner in more details.

Coroner: Death May Not Be an Act of God
In Nigeria, several thousands (I dare say, probably millions) of deaths result from unnatural causes. Natural causes of death are such as old age in the elderly or severe recognizable diseases in the young. Such deaths such as resulting from assault, battery be it by gun shot, beatings as in child and domestic abuse of spouse, burning of a person (“jungle justice”), rape, denial of food and or poisoning are extra-judicial murders and unnatural causes of death. Unnatural causes may be an accident due to negligence of another party. Unnatural cause of death may even be suicide— act of killing oneself (see later in the series when we shall deal with suicide). It’s the duty of a coroner to determine the cause of such death.
A coroner is a person whose typical duty is to confirm and certify the death of an individual within a particular jurisdiction. Coroner case is simply put, certification of a death. In doing so a coroner performs the following functions which I want to suggest, you should take a good note of:
Duties and responsibilities of the coroner may include overseeing the examination and certification of deaths related to such events as mass disasters that occur within the coroner’s jurisdiction (area of legal authority). A coroner may also conduct or order an inquest into the manner or cause of death, and investigate or confirm the identity of an unknown person who has been found dead within the coroner’s jurisdiction. A coroner’s office characteristically maintains records of death of those who have died within the coroner’s area of legal authority.
Depending on the jurisdiction, the coroner may decide the cause of death personally, or he or she may act as the presiding officer of a special court (a “coroner’s jury”) set up for this purpose. The additional roles that a coroner may oversee in judicial investigations may be subject to the attainment of suitable legal and medical qualifications.
The Law in Nigeria:
It was in 1944, that the first law on coroner autopsies was first established in Nigeria. The law stated and mandated that only sudden deaths that involve non-natives (then white colonists as you can imagine) were to be reported to the coroner. However, by 1958 (on the eve of Nigeria’s Independence) the law was extended to involve all individuals in Nigeria.

Under section 4(1) of the coroners law Cap 131 of 1954, laws of the Federation of Nigeria and Lagos, magistrates are then permitted to conduct inquests under the said law. This law states that every magistrate is authorized to hold inquests about any doubtful death in his or her area of jurisdiction. Coroner autopsies are done when a clinician is legally not in a position to issue a death certificate. Based on cause of death, coroner deaths can be classified thus: natural deaths, accidents, homicides, suicides and undetermined on the basis of manner of death classification. Reports to the coroner about such deaths originate through reports by complaints to the police, reports by health practitioners to the coroner or the police and so forth.
Law of Lagos State on Coroner: In 2007, the Lagos State Government promulgated The Coroner’s System Law that established a new system of investigation of death in the State. The Law is to be cited as Coroner Law. Part 2, Section 4 of the said law empower the coroner to hold inquest on suspicious deaths that comes to his or her knowledge. Such death can be due to any cause that is doubtful such as violence and sudden death including death in psychiatry hospital. Prisoners who died are subject to inquest. This law empowers the coroner to even exhume a person who had been buried for proper determination of the cause of death. Coroner may even postpone cremation or postpone a burial under this law by virtue of Section 9 of the Act.
As you can see, claiming a religious barrier (which is a major obstacle to coroner law enforcement in Nigeria) to inquest or citing a custom or tradition (such as burial of a chief, obas, obis etc) that allegedly forbid medical examination of the dead is not acceptable under the law. Anyone and everyone can be made subject to coroner examination to determine the cause of death. However, either due to natural cause or not, you or relevant person concerned can request an autopsy of the dead.
Your Duty: Under the law, you have a duty. Section 10 of Coroner Law of Lagos State empowered you as follows: “When anybody is found or a person has died in such circumstances as to make the holding of an inquest under this Law necessary or desirable it shall be the duty of any person finding the body or becoming aware of the death forthwith to inform the nearest police officer and upon receiving any such information such police officer shall notify the coroner having jurisdiction to hold an inquest.”
Benefits of Coroner Inquest and Autopsy. Our society and country continue to suffer from shady deaths and grief from suspicious deaths. You can prevent future deaths by requesting for a coroner inquest. In the barest minimum, you can request for an autopsy of a death person that you are concerned about whose death you suspect is a foul play. The benefits of autopsy is huge. In the least, a disease that runs in the family may be exposed to help prevent such death occurring in the family or occurring in the children of the dead. If the cause of death is of public interest such as infection, the public and government may bring preventive measures into place to protect the living. Our society is rife with superstitions and false claims of evil forces of witchcraft killing another while in reality, the dead may have been chronically ill of a serious disease. Autopsy and inquest may bring such undue false claims to an end and establish a clear material medical truths. Further, doctors, lawyers, and academics learn from autopsy to help the living avoid early deaths. You too can help by taking autopsy or coroner inquests seriously. Next week, we shall examine other areas of Forensic Medicine of interest when we will take a look at personal injury.

Personal Injuries: Get Justice with Forensic Medicine
In the last two weeks, we discussed the role of coroner, inquest, autopsy and forensic medicine and how it applies to you. This week, we will take a very close look at how the knowledge of forensic medicine, coroner inquest and autopsy can bring you justice and restitution on one hand as well as penalty to the perpetrator of harm. Justice requires evidence. The legal system needs evidence to arrive at cause and effect and hence to give you fairness of judgement.
Between you, your injury and equity stands the medical doctor and allied clinicians who will examine your injuries, causes and possible cost to repair the injury if possible.
Those injuries be it physical, mental or injury that you sustain that are not due to your own fault but to the fault of others, is called personal injuries. Personal injury is a legal term for an injury to the body, mind or emotions, as opposed to an injury to physical property such as your car or house.
Personal injury term is most frequently used to denote a type of tort (offence) lawsuit in which the person bringing the suit (the injured person or victim or relation), or “plaintiff,” has suffered harm to his or her body or mind. Personal injury lawsuits are filed against the party or entity that caused the harm through act of negligence, gross negligence, reckless conduct or behavior, or intentional misconduct. Different legal jurisdictions describe the damages (or, the things for which the injured person may be compensated) in different ways, but damages typically include the injured person’s medical bills, pain and suffering, and diminished quality of life. Very often, the compensation of restitution is financial or economic.
Areas where personal injuries is applicable:
Areas where personal injuries claims are commonly made include road traffic accidents in which the accident causing the injury is the fault of another, work place accidents, tripping accidents at work whereby a member of the public or worker get injured as a result of the negligence of the contractor or the party that got the contractor. Assault claims such as rape can both lead to personal injury claims and criminal prosecutions. Defective product leading to harm of the consumer or causing accidents (product liability) can lead to personal injury claims. The term personal injury also incorporates medical and dental accidents (which lead to medical negligence claims). Cases classified as industrial disease cases such as asbestosis, chest diseases (e.g., emphysema, bronchitis, asthma, chronic obstructive pulmonary disease, and chronic obstructive airways disease), vibration white finger, occupational deafness, occupational stress, contact dermatitis, and repetitive strain injury cases are all forms of personal injuries.
Taking a look at the cause of death, coroner and personal injury cases in Nigeria, accidents, product liability and automobile collisions will probably be amongst the highest causes of injuries. Personal injury cases may also include toxic torts, in which a contaminant transmitted by air or water causes illness, injury, or death. Wrongful deaths of a relative can also lead to claim of personal injury by those concerned. Such wrongful death may also be a cause of criminal prosecution in which case coroner and or forensic examination would have taken place.
The Benefits
Pursuit of personal injury claims is not a child’s play. It may be tortuous and painful. It may take a long time to arrive at resolution and require expensive investigations. In general, the society is better off as the parties that are involved will now take caution not to cause similar injuries in the future. Suffice to say that government at various levels and big corporations are not immune to personal injury claims. It’s on this basis that sane and insightful parties would have taken the steps to insure their products, work and services against personal injury claims.
Forensic Medicine and Personal Injuries: Forensic medical practitioners including coroners are specialty workers that determine the cause, nature and extent of injuries to a person. As I stated earlier, these professionals work along lawyers in resolving death and injury issues so that justice can be obtained for the victims. Next week, we shall take a look at suicide in concluding our series on medicine and law.

Suicide: You Have No Right to Self-Terminate
There had been events that made headlines in Lagos State of late in respect of individuals killing themselves. The first story is that a medical doctor was being driven on Third Mainland Bridge, the story went, and he asked his chauffeur to stop. In the middle of the said bridge, he apparently had spoken to someone on the phone earlier, got out of the car and launched a dive into the deep ocean. His body was recovered later, apparently died due to suicide. Few weeks after the first event recording the demise of the doctor, a businesswoman attempted to repeat what the doctor had done but she was saved by the vigilance and quick reaction of the people around. As it turned out, the woman had lost a substantial amount of her business funds by whatever means. The poor woman was charged to court on account of attempted suicide. Ultimately, the court freed her and she vowed not to attempt to take life ever again.
These events represents as I have illustrated above, the tip of the iceberg of suicide rates in Nigeria. Contrary to popular belief, that is to say, suicide is not uncommon in the jurisdiction of Nigeria. Suicide is the act of taking one’s life or termination of one’s life. Suicide may be accidental or intentional. In contract, murder or homicide is the intentional killing of an individual by another person. Secondary murder (USA definition) or manslaughter (UK and other common law jurisdiction definition) is the unintentional killing of another person.
Globally, about a million people commit suicide every year. Put more specifically, an estimated 12 individuals for every 100,000 people take their own lives every year. In Nigeria, this figure is that approximately 7 persons will commit suicide for every 100,000 of the population. Sadly, suicide affects the dynamic and most energetic group of a country’s population. That is to say, the very young and productive people seem to succumb to suicide. Thus, suicide is one of the three leading causes of death among those in the most economically productive age group (15–44 years).
Whilst individuals are often the victims of suicide, there is also a trend of joint suicidal enterprise (otherwise called suicide pact): persons who come together to take their own lives. This is yet uncommon in Nigeria but a feature of Asian communities.
Thou shall not kill thyself: religion and the law: There is no doubt that Nigeria is heavily a religious nation featuring different religious beliefs though about 10-13% of Nigerians are atheist. Yet, despite having been the happiest nation on earth in recent memory, murder and suicide rates in Nigeria are not falling.
While there is no reservation that our various religions may be stemming the inclination to commit suicide, the law, as the experience of the woman in the first paragraph shows, takes a frown and dim view of suicide or attempted suicide.
Back in England (UK). Before the Suicide Act 1961, it was a crime to commit suicide, and anyone who attempted and failed could be prosecuted and imprisoned, while the families of those who succeeded could also potentially be prosecuted. In part, that criminalization reflected religious and moral objections to suicide as self-murder as we still have in Nigeria; in part our laws having derived from colonial legacy. The Suicide Act 1961 is an Act of the Parliament of the United Kingdom that decriminalized the act of suicide in England and Wales so that those who failed in the attempt to kill themselves would no longer be prosecuted.
Return to Nigeria: In spite of the monumental change to the law that had taken effect in the UK in respect of suicide, the law in Nigeria remain stern in respect of attempted suicide.
Section 327 of Criminal Code Act, Chapter 77, Laws of the Federation of Nigeria 1990 states: “Any person who attempts to kill himself is guilty of a misdemeanor, and is liable to imprisonment for one year.” Also, if you assist in anyway, a person to commit suicide, you may be sent to prison for life. Of course, no charge can be brought against a person who is already dead, suffice to say.
Causes of suicide, suicidal ideation and attempted suicide: Suicide or attempted suicide is in general a clinical indication that something is wrong with the person. Very often, the person is suffering from depression (20% of Nigerians and indeed world population suffers from depression) which may be caused by financial loses, bereavement, relationship breakdown, poor career prospects or failure, unemployment, social ridicule in whatever age group, academic failure, existing mental illness such as schizophrenia with hearing of voices, religious misdirection, existing of chronic physical illness such as HIV and cancers and chronic pain amongst others. While women tends to attempt suicide unsuccessfully, men seems to actually kill themselves. Being unmarried also tend to push individuals toward suicide.
Preventions: In the eyes of healthcare practitioners and as it is in England of 1961 Suicide Act, suicide should not be a criminal offence any longer in Nigeria. Suicide should be seen as a cry for help which went unheard. Attempted suicide is a clear cry for help and support. Suicidal persons need credible social, healthcare and family support rather than being blamed and imprisoned. If you are feeling low in your spirit, seek urgent medical intervention. Help is available.
The role of coroner in suicide: If however, a person is found to have committed suicide, under the current law, an inquest, at the behest of the coroner, should be held to determine cause of death. But, the coroner or the police will first of all need to be informed of the death. What appears to be suicide, may actually in the end, be a homicide. In all, personal injuries, attempted suicide and unlawful deaths, can be remedied. Depression can be treated and social issues can be resolved. All you need to do is to ask for help. You will find it.

July 14, 2017 / Medico-Legal

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Forensic Medicine

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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