Category Archives: Patient Information

Recreational exercise and pregnancy

KEY POINTS

Recreational exercise refers here to any kind of energetic (aerobic) exercise (such as swimming or running) and/or strength conditioning exercise.

  • During pregnancy, aerobic and strength conditioning exercise is considered to be safe and beneficial.
  • The aim of recreational exercise during pregnancy is to stay fit, rather than to reach peak fitness.
  • You should take extra care when doing exercises where there is a possibility of losing your balance, such as horse riding or downhill skiing

You should avoid contact sports where there is a risk of being hit in the abdomen, such as kickboxing, judo or squash.

  • If you experience any unusual symptoms, you should not continue to exercise. You should contact your healthcare professional immediately.
  • If you have a medical condition, you should discuss this with your healthcare professional before doing recreational exercise.
  • Pelvic floor exercises during pregnancy and immediately after birth may reduce the risk of urinary and faecal incontinence in the future.
  • For most women, it is safe to exercise as soon after the birth as they feel ready.
  • Recreational exercise does not affect the amount of milk you produce or its quality.

What is recreational exercise?

Exercise forms a part of our daily lives, whether we realise it or not. Actions such as climbing stairs, walking to the shops or running for a train all involve some form of exercise. Recreational exercise refers here to any planned regular exercise that a woman takes during her pregnancy, which involves energetic (aerobic) exercise (such as swimming or running) and/or strength conditioning exercise. The aim of recreational exercise during pregnancy is for a woman to stay fit rather than to reach peak fitness.

What are the benefits of recreational exercise during pregnancy?

 Benefits for you

Many women find that recreational exercise helps them to adjust to the physical changes that occur during pregnancy. It may help relieve tiredness, lower back pain and reduce varicose veins and swelling of the feet and ankles. Recreational exercise improves muscle tone, strength and endurance. It makes it easier to carry the weight you gain during pregnancy and helps prepare you for the physical challenge of labour. Recreational exercise promotes a sense of wellbeing. Staying fit during pregnancy may help to reduce feelings of stress, anxiety and depression. Recreational exercise also improves sleep.

Recreational exercise during pregnancy may help to prevent medical conditions such as:

  • Gestational diabetes mellitus (diabetes that develops during pregnancy)
  • Hypertension (high blood pressure).

Recreational exercise also reduces the risk of developing colon cancer and may reduce the risk of developing breast cancer later in life. If you have gestational diabetes mellitus  (diabetes that develops during pregnancy), exercise can help to improve your blood sugar levels. Women who do not do recreational exercise during pregnancy may become unfit.

Benefits for your baby

Women who do strength conditioning exercise during pregnancy tend to have a shorter labour time and fewer delivery complications.

Are there any risks?

Although recreational exercise can be beneficial during pregnancy, there may also be certain risks. These are related to the physical changes that occur as your body adapts to pregnancy. The risks are more likely to occur when you do inappropriate kinds of exercise  and when you overexert yourself. By making appropriate adjustments to your exercise routine, you can reduce the likelihood of harm to you and the baby.

The risks include:

Getting too hot (hyperthermia)

When you exercise during pregnancy, your overall body temperature increases more than it would do normally. If your body temperature rises above 39.2°C in the first 12 weeks, this may affect the baby’s development leading to disability at birth.

To reduce the risk of getting too hot, you should:

  • ensure that you drink lots of water before and during exercise
  • avoid over-exerting yourself, particularly in the first 12 weeks of pregnancy
  • avoid exercising in a very hot and humid climate until you have acclimatised – this will take a few days.

Low blood pressure (hypotension)

When you lie flat on your back, the growing baby presses on the main blood vessels. The effect is that less blood is pumped around your body and this may lead to low blood pressure (hypotension). This is more likely after 16 weeks of pregnancy.

To reduce the risk of low blood pressure, you should:

  • avoid exercises which involve lying flat on your back, particularly after 16 weeks.

Physical injury

During pregnancy you may notice that your joints become loser. You may also notice that you can flex and extend particular parts of your body more than usual, such as your elbows, wrists, fingers, and knees. This is often referred to as hypermobility. It occurs because hormonal changes affect the ligaments that normally support your joints, which in turn make the joints loose in preparation for birth. When your joints and ligaments are less stable, you are at increased risk of injuring yourself.

To reduce the risk of physical injury, you should:

  • make sure that you do warm-up and cool-down exercises
  • avoid sudden changes of direction, if you are doing aerobic exercise
  • consider wearing pelvic support belts during exercise.

Insufficient oxygen in the baby (hypoxia)

At high altitudes, the flow of blood to the womb is decreased and so the baby receives less oxygen. If a woman exercises at high altitudes, the amount of blood flowing to the womb is decreased even further. This leads to insufficient oxygen for the baby.

Blood sugar level

Blood glucose is a source of energy for both you and the baby.

It is important that you:

  • eat well during pregnancy
  • Exercise for no more than 45 minutes at a time.

If you have pre-existing or gestational diabetes mellitus, then you should take particular care when exercising. You should have your blood glucose monitored, eat at regular times, take rest at specific times, and ensure that your baby is carefully monitored. Your healthcare professional should provide you with further information.

Why aerobic and strength conditioning exercise?

The best forms of recreational exercise during pregnancy are:

Aerobic exercise, also known as cardiovascular (heart and lungs) exercise. When you do aerobic exercise your heart rate raises. This causes blood to circulate more quickly around the body and as a result more oxygen reaches the muscles. Swimming, running, fast walking, aqua aerobics and dancing are examples of aerobic exercises.

Strength conditioning exercise. This form of exercise helps to increase your overall fitness and involves slow, controlled movements such as weight bearing exercises.

If you do not exercise routinely and you are starting an aerobic exercise programme, you should be advised to begin with no more than 15 minutes continuous exercise three times per week, increasing gradually to a maximum of 30 minute sessions four times a week to daily.

What kind of recreational exercise should I avoid?

You should avoid exercises which involve lying flat on your back, particularly after 16 weeks.

You should avoid contact sports where there is a risk of being hit in the abdomen, such as kickboxing, judo or squash.

How can I be sure not to over-exert myself?

To ensure that you do not over-exert yourself, you should always have a warm-up and a cool-down period.

The ‘talk test’

During recreational exercise, you should be able to hold a conversation. If you become breathless as you talk, then you are probably exercising too strenuously.

When should I stop exercising?

If you have any unusual symptoms, you should not continue to exercise.

Unusual symptoms may include any of the following:

  • dizziness or feeling faint
  • headache
  • shortness of breath before exertion
  • difficulty getting your breath whilst exercising
  • pain or palpitations in your chest
  • pain in your abdomen, back or pubic area
  • pain in your pelvic girdle
  • weakness in your muscles
  • pain or swelling in your leg/legs
  • painful uterine contractions or preterm labour
  • fewer movements from baby
  • leakage of your ‘waters’ (amniotic fluid)
  • bleeding.

Can I exercise if I have a medical condition?

If you have a medical condition such as heart disease or high blood pressure, or develop this during pregnancy, then you should talk with your healthcare professionals (such as cardiologist and obstetrician) before doing any recreational exercise.

Can I exercise immediately after birth?

If you have had an uncomplicated pregnancy and delivery, then you should be able to do mild recreational exercise such as walking and stretching immediately after birth.

You should be advised to do pelvic floor exercises after the birth, as this reduces the risk of urinary and faecal incontinence.

Women, who do recreational exercise during pregnancy, tend to continue to exercise after birth.

The benefits of exercising at this time are that you:

  • feel better
  • feel less anxious and depressed
  • have more energy
  • lose weight
  • feel fitter (improved cardiovascular fitness).

Sources and acknowledgements: This information is based on the Royal College of Obstetricians and Gynaecologists (RCOG) Statement Exercise in Pregnancy

For more information contact:Dr.Sandeep Singh Sarpal Clinic

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Diet For Gout Patients

What is gout?

Gout is a type of arthritis. It is caused by having too much of the chemical, uric acid, in your bloodstream.

Uric acid is the waste product created when the body breaks down purines (a type of
protein found in many foods and all of your cells).

Increased levels of uric acid in your blood may occur if, for example, your kidneys cannot efficiently remove it, you have a rare genetic abnormality, or because your diet and lifestyle increase the amount of uric acid that you produce.

If levels of uric acid are high for prolonged periods, needle-like crystals can start to form in your tissues, resulting in swollen, painful joints.
Your diet plays an important role in both causing gout and reducing the likelihood of suffering further painful attacks of gout.

If you already suffer from gout, eating a diet that is rich in purines can
result in a five-fold increase in gout attacks.

Are other illnesses associated with the development of gout?

Elevated uric acid is seen in many other conditions, and people who have gout may also have raised cholesterol, raised triglycerides (a type of fat in your blood), high blood pressure and poor glucose tolerance.
This may make it more likely that you have (or will develop) type 2 diabetes, metabolic syndrome and kidney disease.
In addition, approximately half of all gout sufferers are overweight.
Central obesity (carrying weight around your middle) also increases certain inflammatory substances in your blood. This can further exacerbate gout attacks, as well as putting you at risk of developing heart disease, diabetes and metabolic syndrome.

 Can losing weight help my gout?

Losing weight alone can reduce blood uric acid levels, and the number of acute attacks suffered.
Weight-loss will also help to reduce the stress on weight–bearing joints e.g. hips, knees, ankles and feet.
However, it is important to avoid any type of crash dieting, as going without food for
long periods and rapid loss of weight can increase uric acid levels and trigger painful gout attacks.
A combination of balanced healthy eating and regular physical activity is the best way to lose weight safely and maintain a healthy weight

Which foods should be avoided?

As uric acid is made in the body from the breakdown of purines that
come from your diet, it is advisable to reduce the amounts of foods
that you eat that are high purines.

High purine foods include: (avoid)

•Offal – liver and kidneys, heart and sweetbreads

•Oily fish -anchovies, herring, mackerel, sardines, sprats, whitebait

Seafood – especially mussels, crab, shrimps and other shellfish, fish roe, caviar

Moderate purine foods (eat in moderation)

•Meat- beef, lamb chicken, pork
•Poultry- chicken and duck
•Dried peas, beans and legumes- baked beans, kidney beans, soya beans and peas etc.
•Mushrooms
•Some vegetables- asparagus, cauliflower, spinach
•Wholegrains- bran, oatbran,wholemeal bread

Low purine foods

•Dairy- milk, cheese, yoghurt, butter
•Eggs
•Bread and cereals- (except wholegrain)
•Pasta and noodles
•Fruit and vegetables

 

How much protein do you need?

Generally you need about 1g of protein per kg of body weight (70kg man only requires 70g of protein daily), unless you on a protein restricted diet e.g., some people with kidney disease may need to restrict their intake.

Are there any foods that are good for gout?

Studies have shown that men whose diet is higher in vitamin C are less likely to develop gout.
Also, taking additional vitamin C as a dietary supplement (500 to 1500mg/day) can reduce blood uric acid levels.This is achieved by helping to remove uric acid from the
body via the kidneys.
If you’re considering supplementing your diet, always discuss this with your doctor as vitamin C can (rarely) interact with prescribed medications.
High doses of vitamin C can also cause loose stools in some people.

Eating healthily is key

Eating a balanced diet is important for everyone. A healthy diethelps to control weight and provides all the necessary nutrients needed for maintaining good health.
A variety of foods from the four main food groups should be eaten every day, this means:
•Plenty of fruit and vegetables
– it’s very important to achieve at least 5-a-day, as fruit and vegetables provide fibre, vitamins, minerals and phyto nutrients essential for good health
Plenty of bread, other cereals and potatoes
– try to eat some whole grains, and use the skin on potatoes to ensure you get the vitamins, mineral and fibre you need
Moderate amounts of meat, fish and alternatives
– avoid eating large portions – beware restaurants often serve 8oz of meat
for a main
Moderate amounts of dairy products
– the recommended amount is three portions of dairy products daily e.g. 200 ml glass of milk, a pot of yoghurt and a 30 mg (matchbox-sized) piece of hard cheese
Reduce or eliminate highly processed foods and drinks

Should I drink lots of water?

Yes, drinking fluids reduces the likelihood of crystals forming in the kidneys. As a general rule, drinking 8 large glasses of fluids a day (1.5 litres) is recommended. All drinks, except alcohol, count towards your fluid intake, including caffeine-containing drinks such as tea and coffee. Caffeine can act as a mild diuretic, which means it causes you
to pass urine more often.

Can I drink alcohol?

Drinking alcohol can increase your risk of developing gout and can bring on a sudden attack if you are already a gout sufferer. Alcohol can raise the level of uric acid in the blood in a number of ways and so trigger a gout attack. Many beers contain large quantities of purines from the fermenting process and alcohol stimulates the production of uric acid by the liver. More importantly, however, alcohol is converted in the body to lactic acid which interferes with the removal of uric acid from the body by the kidneys.

While it is certainly possible for people with gout to remain well without becoming teetotal, reduction in alcohol consumption is very important particularly if you are drinking more than the recommended healthy limit of 21 units per week for men or 14
units per week for women.(Recommended by UK society for Gout)
1 unit of alcohol is provided by:
•½ pint of standard strength (3-4% alcohol by volume) beer, lager or
cider
•125ml glass of wine (11%, 100ml glass of stronger wine)
•Single measure of spirits (25ml)
•Single measure of sherry or fortified wine (50ml)
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