Exercise

Getting into exercise

Fitness is the new “hot-trend”.  You just have to scroll through Instagram to see a plethora of posts dedicated to home-based workouts, HIIT regimes, Weight Training, Running, swanky new exercises classes… the list is endless.  There are a multitude of health benefits to be gained from regular workouts including

  • Weight loss
  • Lowering the risk of heart attacks and strokes
  • Reducing blood pressure
  • Improving mental well being

Weight: obesity and overweight

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Weight loss is a lot of peoples main motivation for getting into exercise and for good reason.  Obesity is the most common nutritional disorder in the Western World.  According to Public Health England around 60% of people were overweight in the period between 2013-15 and one in four women were categorised as obese and trends show this problem is growing.  Obesity is one of those terms we all hate to use: it has negative connotations and often upsets people when they are labelled this way.  Essentially it means that a person is 20% heavier than their ideal body weight.  But what’s the problem?  Being overweight is not simply an “aesthetic” issue (although this can be what motivates some to change) but more importantly is a major health issue which can contribute to multiple long-term health problems like Type 2 Diabetes, heart attacks and strokes, high blood pressure, asthma, difficulties conceiving, psychological distress and depression, joint problems such as arthritis and cancer to name but a few.  The good news is that most of these health problems can be reversed by losing weight.  Great.  Simple.  Or is it?  Many people struggle to lose weight even when they are highly motivated.  It involves a complete shift in life-style: diet and exercise are both key components and it can seem daunting, time-consuming and expensive.  So where to start?

Benefits of exercise

Losing weight is often people’s goal but what if you’re already a healthy weight, why should you exercise?  In recent years there have been a few papers published in reputable journals like the British Medical Journal (BMJ) which extol the  benefits of exercising other than the aesthetic changes.  A study in October 2017 showed that the risk of developing depression can be reduced by 1-2 hours of exercise per week by 44%.  Another shows that one in 12 deaths can be reduced globally by between 1-2 hours per week and the risk of developing cardiovascular disease (heart attacks and strokes) can be significantly lowered.  And it’s even been linked to boosting “brain-power” in another study with one 45 minute session of “moderately intense exercise” advised in the over 50s per week.

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Getting Started

So we know why we should exercise and the benefits of regular training but how to we start, and where?  In January, thousands of people sign up to gyms with New Year deals and heads full of resolutions to “go to the gym”.  Very often, people do really well for the first couple of weeks and then they just stop.  There are loads of reasons for this: they don’t know what to do when they actually get to the gym, it’s boring when they’re there and often, it can be quite intimidating.  The gym works really well for some people, and obviously there are people who seem to spend their lives there (I’m fairly guilty of that) but there is no “one-size fits all” for exercise.  So here are my tips for where to start:

  • Find an activity that you enjoy: there’s no way any one will stick at anything they find boring or unpleasantly uncomfortable for any period of regularity so it’s best to think of group activities or exercises that you find fun.
  • Think outside the box: again, exercise is not just jogging, lifting weights, going to a class or (my personal nemesis) swimming, but can consist of activities that you can do in your daily life.  Such as walking or cycling to work, rock climbing, dance classes, team sports etc.

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  • Think about starting a fitness routine with a buddy: it’s very difficult to stay motivated if you’re going it alone.  It can be helpful to find a friend or family member to encourage you to keep going.
  • Have a goal: Targets are useful.  They give you something to work towards and keeps you motivated.  Just make sure that the initial target is achievable at first and then you can revise it and start to “think bigger” as time goes on.  Some people find it helpful to think of things like “I want to be able to fit into that dress I bought 3 years ago” but I tend to find goals such as “Aim to be able to run/swim/cycle 5-10km in a certain time-frame in 3 months”.

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  • Keep work outs varied where possible.  The body gets used to moving in certain ways so I have often found it useful to “mix-up” my work out routine.
  • Try and include some resistance training.  This can be the tricky one.  When people first start exercising the emphasis is generally on cardiovascular or aerobic type exercises like running, spinning, swimming.  This is a great way to initially build fitness and get into the routine of regular training but eventually it can be beneficial to add in weights (resistance training) in fact, the guidance is that we should all do more resistance training than cardio.  This can be quite a daunting prospect initially particularly for women: the fear of building muscle mass and becoming bulky stopped me from lifting weights for years, but the truth of the matter is, it’s very difficult for women to build muscle in that way and using weights in training is an efficient way to tone up and burn fats, thus making it ideal for improving the function of the heart and reducing blood pressure.

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If you think you may fall into the overweight or obese category I would advise you to see your GP.  They may want to assess your cardiovascular risk and check for any of the complications that I listed above.  In some areas the GP can also refer you to an exercise programme to help you get started with “exercise on prescription”.  Also check out the NHS website’s section on fitness for more information on how to get started and the guidelines for activity according to age-group.

About Blog

About Me

Me

 

I am an NHS GP with a specialist interest in Headache, who works in South London.  I have three major passions in my life: exercise (or “training” as we’re supposed to call it now), promoting health and well-being and my family.  To be a good and effective GP takes time and life experience: I know that the events in my life have shaped what kind of doctor I have become.

 

I have always been lucky to be relatively healthy and have never needed to spend any significant time in hospital aside from trips to asses minor sports injuries and one (humiliating) A&E visit during medical school (where my Mum mistook a migraine for meningitis).  Aside from migraines, my immediate family had also always been similarly healthy until the Summer of 2012.  I was in my second year of being a fully-fledged doctor and I was in my first proper GP placement.  I have to admit at the time I hated GP because I was not in a sociable practice: people tended to work in silos isolated from each other and I had next to no support, despite having very little experience of being a doctor.  In retrospect the work I was expected to do was alarming given the lack of knowledge I had at that stage of my training.  The saving grace was that I was that I was living at home so after hours of isolation (which sounds odd when you spend all day seeing patient after patient) and mentally taxing work, it was wonderful to be able to relax and spend time with my parents.

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One night in July, my Mum woke in the night with a bad migraine.  This wasn’t particularly unusual: she’d always suffered with bad migraines fairly frequently and wasn’t keen on taking any kind of preventative treatment because she thought they were a sign that she needed to rest so if she got rid of them how would she know something was wrong?  She had the usual flashing lights, unbearable pain and panic attack she experienced with her migraines.  Unusually though, this one carried on… and on… for 5 days.  And she was being sick a lot.  On the 5th day I was stumped: I knew I was out of my depth and I told her to call her GP.  He visited her and she called me at 2pm saying he’d called an ambulance for her to go to hospital.  He thought she’d picked up a stomach bug and was dehydrated.  He’d said her blood pressure was low (she said it usually was) and that she had a heart murmur… had she had one before?  She had when my sister was born and the scan had shown that everything was fine.  He thought it was best she went in for some fluids and to get it checked out and he’d see her in a few days.  As soon as she told me she was going to hospital I burst into tears.  I was “on-call” that afternoon until 6.30 and one of only two doctors in the surgery.  They wouldn’t be happy with me leaving but I knew I couldn’t work while my Mum was in A&E.

When I arrived, my Mum had been taken straight to resus: the bit we always see on casualty where all the “exciting” stuff happens.  I knew this meant she was very unwell.  My dad and I waited in the relatives room until the nurse came to update us.  He told us there’d been some “changes on the ECG”.  I cut in, “what changes?”  He paused and I explained I was an F2 and he told me there was “ST elevation”: she’d had a heart attack.  A bit later the consultant came to talk to us: she’d admitted to some mild aching in her chest when the “migraine” started but put it down to the panic she often felt during an attack.  The ECG and blood test confirmed she’d has a massive heart attack 5 days previously.  Her organs had started to shut down.  Had we thought about resuscitation?  This was a massive shock.  My sister rushed up from London and we all went to speak to her once they’d finished their tests: hours after she’d arrived.  She was very calm and we caught up on the information they’d given us.  She told us to take my Dad home because it was far too late for him to be out so we agreed.  But could I remember to cancel her massage and hair appointments on Tuesday?  Those were the last words she said to me.

Me and Mum
Me and Mum

This sudden turn of events when I was in my mid-twenties, and, in my opinion, far too young to lose a parent, completely changed my life.  For the first time I experienced symptoms of anxiety and panic at very inconvenient times and, looking back, I was definitely depressed for at least a year.  This is all normal in the context of what happened.  I was determined to take control of my own health and well-being.  I didn’t want to feel low any more and I didn’t want to suffer the same heart problems my Mum had either.  So I started exercising regularly (sometimes, arguably too regularly)… and I’ve been hooked ever since.

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It’s also made me a better doctor.  I believe good health is far more than physical health (i.e. the absence of physical illness) but also ties in with emotional and psychological wellbeing; something which can easily be over-looked in an NHS under pressure.  Now more than ever, I think it’s vital that people (or “patients”) are empowered.  By that I mean have the knowledge and tools to cope with many of the health problems we all face day to day.  And that’s why I decided to write a blog…