Menopause in Women and Men: Solutions to the Disquiet of Middle Age

Menopause in Women and Men: Solutions to the Disquiet of Middle Age

Menopause in Women and Men:  Solutions to the Disquiet of Middle Age

Feelings of internal heat or perception of hot belly are not the only symptoms of menopause. As we shall see later, the distress caused by the change in reproductive function during middle age is huge and can be disabling.    

Women suffer needlessly when they don’t realise the changes that is going on in them. When a person is well informed biologically, the burden of the changes will be less.  There is no doubt that menopause causes a lot of unease but a lot of women sufferers do not often realise the cause of their symptoms and very frequently blame the feelings on something else even to the point of accusing others of persecution.

So far, I have directed my attention in this article towards women. However, evidence, albeit not generally accepted yet, is gradually emerging to say that men also suffer from “menopause”. Thus, in the coming weeks, I will be dealing with menopause primarily in women but with some degree of devotion to “menopause” in men at latter stages. To date both in medical circles and in public minds, the term menopause is generally applicable to women. With this in mind, let us now get on with the task of dealing with preliminaries of menopause in women: First, the definitions. These definitions , taken in part from International Menopause Society, will guide us in our way when we begin to have our discussions under menopause.

Natural Menopause: This is simply the term that is used to indicate that a woman has ceased to have her menstrual periods and her ovaries are no longer functioning to produce hormones to support her so as to be able to reproduce and bear children naturally. To qualify as having reached menopause, a woman’s menstrual period must have stopped for at least for the last 12 consecutive calendar months.

Pre-menopause: This term means, anytime before the arrival of menopause. Very often it means anytime from the adolescence to end of reproductive age.

Peri-menopause: This means the few years before menopause and up to one year after the last menstrual period.

Climacteric simply means transition from the period of being able to reproduce to that time when the woman is no longer being able to reproduce. It’s the change over time.

Post-Menopause: this is the term that doctors use to indicate the time that comes after menopause.

Premature Ovarian Failure (POF): This term is reserved for the event that occurred in a woman who is under 40 years old whose ovaries have failed to continue to function. This failure to function may be as a result of natural occurrence or due to disease states that is inherited from own parents. A lot of the reasons for POF are due to genetic diseases.  It may also be due to a situation when the ovaries are surgically removed. In some other occasions, it may be due to conditions whereby the woman is treated for cancer. Such treatment may be an exposure of the ovaries to chemotherapy or radiotherapy. Surprisingly, POF may occur as a consequence of cigarette smoking.  Premature ovarian failure may also be due to common infections such as tuberculosis of the reproductive tract.  In some cases, the failure of ovaries to continue working may be as a result of no specific or identifiable conditions.

Induced menopause: Menopause can be natural or brought upon the individual by artificial means. When menopause is not natural, then it’s induced.  Such unnatural occurrence of menopause is called Induced menopause. This induction can be due to administration of medications such as chemotherapy for treatment of cancer or exposure to radiotherapy because of the need to bring a cancer under control.  Induced menopause may also be as a result of surgical operations during hysterectomy (removal of womb with or without removal of ovaries) carried out by medical doctors.

Now that we have taken care of the necessary definitions that relate to menopause, we can begin the proper task of elaborating on the very distressing matter of menopause. We shall begin this by looking at the causes of menopause and what the sufferers feels (symptoms) as well as the signs. We shall also address the investigations.

Remember that we had earlier defined natural menopause simply as the term that is used to indicate that a woman has ceased to have her menstrual periods and her ovaries are no longer functioning to produce hormones to support her so as to be able to reproduce and bear children naturally. To qualify as having reached menopause, a woman’s menstrual period must have stopped for at least for the last 12 consecutive calendar months. We also saw earlier menopause may not be natural or it may be induced. Whatever the cause, to qualify as being in menopause:  a woman’s period “must have stopped for at least for the last 12 consecutive calendar months” backed up relevant laboratory investigations.  I will encourage the reader to go back to Part 1 of this series so as to get familiarize with the necessary and guiding definitions.

Causes of Menopause:  The first thing to realise in all these discussions is that, aging process is inevitable.  However, natural menopause occurs on the average, in a woman in the age range of 45-52 but most commonly around 48-52years. At this age range, the ovaries may stop to respond to the instructions or stimulations from the brain. By not responding, there will be no ovulation.

As a matter of fact, after ovulation which occurs at about the mid cycle in a woman who has a 28-day cycle, pregnancy is suppose to result. It’s the failure of pregnancy to result that leads to menstrual period. This event is repeated every month. Therefore, when the ovary fails to respond to the said instructions as I said above, there will be no menstrual period. This lack of response is essentially due to aging process and the woman’s timed biological clock.

Anything outside the above natural menopause could either be a pre-mature ovarian (POF) resulting in early premature menopause or menopause that is induced.  POF may be due to no specific cause which scientists are yet to discover. POF may result from a genetic defect in the individual which the woman may have inherited from her parents.  POF may also be due to tuberculosis of her reproductive tract. In some cases, POF may be due to treatments that the woman may have received from the doctors. Such treatments are often directed at cancers and may be chemotherapy or radiotherapy. Cigarette smoking is another cause. In some individuals, autoimmune diseases may the cause whereby the body works against its own interest and body defences start to attack the body organs.  Individuals who have undergone a long time ovarian stimulation for in-vitro fertilization (IVF) to resolve infertility may also suffer premature ovarian failure and hence early menopause. Yet, there are other causes such as endometriosis whereby the menstrual flow instead of flowing outside the woman’s body through the vagina, flows inward back into the body.

Outside these listed factors, surgical intervention to remove the womb or uterus may lead to early menopause. Obviously, outright removal of the ovaries without question results in menopause.

How does perimenopausal and menopausal women present? What do they feel?

Unfortunately in our African and indeed Nigerian cultures, some women especially if she suffers from infertility or she is under pressure not to appear as “old” may hide her symptoms and suffer in silence.  Such women may want to prove to her husband (and in polygamous homes prove to her contemporaries), that she is still in her fertile age and that she can bear still children.  Some women are in self-denial and may want to continue to have her menstrual periods as a false sign of continuing fertility.

That said, about 80% of women undergoing perimenopause or menopause or climacteric suffer considerably. Sadly only about 10-20% of them world-wide including Nigeria may come forward. Some women make the assumption that, menopause is “part of a woman’s life” even if she is suffering greatly. The main symptom of fluctuating hormone in a woman is called hot flush which the main feeling of perimenopause and menopause.

The hot flush, or flash, is well known as the classic menopausal symptom and affects 60–85% of menopausal women. Hot flushes and sweats constitute vasomotor symptoms and vary immensely in both their severity and duration; for many women, they occur occasionally and do not cause much distress, but for about 20% they can be severe and can cause significant interference with work, sleep and quality of life. Women are affected by vasomotor symptoms on average for about 2 years but, for about 10%, symptoms can continue for more than 15 years. Hot flushes usually last 3–5 minutes and are thought to be caused changes in the brain’s thermoregulator , according to Menopause Matters.

In some women, with or without hot flushes, sleep could be impaired. She may become irritable—a “short fuse”, anxious and even depressed and lacking in concentration. In those with tendency but hidden vulnerability toward frank madness, serious mental illness may manifest as this age of menopause.

The bones become weak and as a result, fractures of the hip and hands and back may occur in menopausal and post-menopausal women.

As part of the symptoms or feelings that comes with perimenopause and menopause even up to postmenopause, the mouth may become dry and hot as well as painful. There may be colour changes in the mouth as it become pale. In some women, there could be changes in the manner of eating either too high or too low or general dislike for food.

Of major concern to a lot of women is loss of their skin smoothness which becomes slack. Wrinkles appear. This is as a result of loss of the underlying fat underneath the skin. This loss may give the appearance of aging and loss of beauty. This is probably the reason that makes women to put in more efforts at this age to appear and maintain being beautiful and acceptable.

Amongst other reasons, divorce and separation are common in menopausal and post-menopausal times. Still, menopause gives rise to a much more concerning symptoms.

In the reproductive tract itself, vagina loses its elasticity and lubrication. As a result, difficulty with sex may emerge. These challenges with sex may drive a wedge between couples if not properly managed.  Further, the womb itself will shrink. At this time, any fibroid within the womb (uterus) may also correspondingly be reduced in size.  The womb lining may also dry up or be reduced in size.

A note of warning and caution: Any woman, who had stopped having her period or be in post menopause but now having irregular vaginal bleeding, should as a matter of priority see her medical doctor for advice. The reason is that cancer of the womb lining (endometrium) may be the reason for the irregular vagina bleeding.

That said, the ovaries also become smaller during menopause. Again, I must sound the note of caution here for two reasons here. The first is that, in spite of what I have written so far, break-through or occasional pregnancy may still occur. Women will need to take caution and not make a mistake believing that she is no longer menstruating and so not being fertile. Unwanted pregnancy can be heart-breaking.  The second point is that, though the ovaries had shrunken in size, and as the years go by, there remains a risk that the ovary may develop cysts and cancers. Post menopausal women should therefore be vigilant to irregular vaginal bleeding, abdominal swelling and unusual body appearances.

Still on the symptoms of menopause and perimenopause and even post menopause, the bladder and urine passages may lose their strengths. Urging to go to toilet and loss of ability to control passing urine during stress such as coughing may now be a problem. The women simply wet her self. This may create considerable social problem for the woman and her family.  She may become an object of ridicule if the people around her fail to understand her difficulties.

In some other circumstances, the womb may fall out (prolapsed) into outside world through the vagina as a result of the weakening of the supporting structures that hold the womb in place.

In general, perimenopause due to variation of the hormone levels in the woman poses considerable changes. These difficulties may continue into menopause and climacteric times.  Of crucial concern lies the fact that the larger African society and in particular Nigerian cultures may not fully understand the many problems that menopausal and peri-menopausal women go through. In rural cultures or even in cities, such women may be stigmatised or be called abusive names for lack of understanding of the events that is taking place in the woman.

Investigations: Very often, the diagnosis of peri-menopause or menopause can be made by the doctor purely on history. Therefore, the woman should tell her story in full to her doctor.  Her husband, if married or partner can and should ideally accompany her to see the doctor. The man is probably going to be the target of the woman’s irritability that menopause had brought upon her and as such he is at vantage point to give an eye witness account and state his experience of the development.

The reader should not be surprised that the tests to diagnose menopause is few and sometimes may nor even require a test. The doctor is well advised that the only test is follicle stimulating hormone (FSH) levels. With exception to where the clinical necessity so indicates, there is no need for ultrasound scan or unnecessary prodding or extensive and expensive investigations to make a diagnosis of menopause.

Crucially, I wish to seriously encourage women that may be undergoing the symptoms and feelings that I have described here to consider seeing a doctor. There is really no sense in suffering in silence.

 

The main symptom of menopause in women is hot flushes (see earlier articles).  This symptom of hot flushes can be corrected with the hormone that is so deficient in women at their  mid-ages. Doctors, based upon clinical assessment may prescribe hormone replacement therapy (HRT) which comes in different formulations. Some can be taken by mouth as a daily pill similar to contraceptive pill. A note of warning is warranted here. HRT is not a contraception or anti-pregnancy pill. As earlier warned, women should still take precaution so as not to get pregnant.  Please note that this statement is not to be interpreted to mean that a woman’s fertility has returned with us of HRT. It’s not so. HRT can also be taken as a patch or vagina cream.

While on HRT, women that have not had hysterectomy (removal of the womb),  may resume having regular menstrual periods. Again, this is not an indication that fertility has been restored.  The menstrual period is just the consequence of the way the HRT works. HRT may be continued for up to 5 years.

HRT is not without own risk. Anyone with personal history of breast cancer, blood clotting, severe liver disease, undiagnosed vaginal bleeding and pregnancy should not take HRT. The HRT that I have described here is a combined hormones of estrogen and progesterone.

For women who have had their womb removed, they may use a different form of HRT: estrogen alone. In all, because of the risks outlined, women intending on using HRT should consult their doctor for guidance before commencing usage.

Vaginal dryness leading up to difficult sex may be relieved with either a lubricating cream such as K-Y jelly or estrogen cream. Urinary symptoms may also be relieved by HRT. Low sexual drive that is not helped by HRT may respond to male hormone testosterone.

Risk of bone fractures which occurs in 1 person in 20 amongst Nigerian women undergoing menopause, can also benefit from HRT or a non-hormone treatment. However, good nutrition rich in vitamins, vitamin D and calcium, but cautiously taken, may reduce fractures.

For individuals in whom HRT is not suitable, there are reasonable alternatives that may be used as a substitute. If mental health deteriorates during perimenopuase and menopause, attending doctors will take appropriate measures to address the problem. A cheaper form of treatment is for the woman to receive counselling and education of the changes that is taking place in her body.

The key issue is not to deny ones suffering nor refusing to see a doctor for support. Distress and disquiet brought upon by perimenopause or menopause is not just a “woman’s thing” and neither should women suffer in silence!

“Menopause” in Men.

Clearly, unlike women, men do not have menstrual periods. Therefore, the definition of male “menopause” is controversial and disputable. The claim of existence of male menopause is still at research stage.
That said, there are some features that men in their mid-ages experience which gives rise to the suspicion that men may also be experiencing features that women suffer from. These features include: tiredness, weakness, depression and sexual problems such as loss of libido, erectile dysfunction: impotence or ejaculatory problems: collectively otherwise called mid-life crisis which may come with career changes.  Most crucially, it has been observed that in their mid-ages, men do have a low testosterone and like women, a boosting of their respective hormone levels may actually improve the symptoms that are outlined above.

It’s important to note that unlike in women who may experience inability of their ovaries to produce follicles and estrogen , men do not suffer from their testes stopping to produce sperms and testosterone.  Men may in fact continue to produce sperms well into their late eights though subtle changes occur in the testes around 45-50years of age in men.

As outlined, men experiencing fatigue, depression, erectile dysfunction, low sex drive should seek medical help. Investigations in the laboratory may not yield much as the changes in men are not as dramatic as in women.  The doctor may nonetheless undertake a thorough examination to exclude any underlying faults.

Treatment of male “menopause” while controversial is not without benefits: What I will call male HRT may also help. This HRT may essentially consist in giving a measure of testosterone. It should be noted that giving artificial testosterone carries its own risk and caution should be thoroughly exercised.

In summary, women mainly experience menopause and I will urge those suffering from fluctuations in their hormone levels from the age of 40 in some and 45-52years in others should seek help and not be subdued by cultural considerations. Discomfort and disquiet should not be accepted. Similar advice is applicable to men.

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Menopause in Women and Men: Solutions to the Disquiet of Middle Age

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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