From the experts: how to exercise safely
Enthusiasm for exercising is a good thing, and should be encouraged. But there are some things to consider before starting exercise, especially if you have an injury or underlying conditions. Here are a few scenarios I have come across in my practice.
Scenario 1: Jenny, a 30-year-old gym enthusiast, has been experiencing pain in her left wrist for several weeks, especially when performing exercises such as push-ups.
It is likely Jenny is suffering from wrist tendonitis. The first thing to do is determine the range of movement in the wrist: if she can move the left and the non-painful right wrist in all directions to similar degrees, it is unlikely there is any serious damage to the tendon.
Jenny should consider consulting a doctor if the wrist pain and limited movement have resulted from a fall on the outstretched hand, as it could be a fracture. Medical attention will also be needed if the pain does not resolve after seven days, or if the wrist starts swelling and that progressively worsens over 24 hours.
I have seen patients with different types of tendonitis injuries of the wrist, shoulder and Achilles, who are surprised that the pain does not resolve, especially if they persist in the same type of exercise which continues to inflame the injury.
If a part of your body is hurting while performing a certain exercise, don't be a hero and push past the pain. Pain is telling you to rest that muscle or tendon until it has healed. Many people do not want to miss training time, but this will further damage the tendon and can delay the return to exercise.
It can take a week or more for the pain to resolve. In the meantime, if you are not known to be allergic or previously suffered any adverse effects to anti-inflammatories, it may be worth using this medication to expedite your recovery.
If after two weeks of resting the tendon, you still have pain on resuming exercise, it may be time to visit your doctor.
Scenario 2: Alan, a 43-year-old who plays basketball, sprained his left ankle during an awkward landing.
When the ankle is sprained, the foot often gets twisted inwards, which can lead to swelling of the outer part of the foot. Most of the time, this is due to the tearing of ankle ligaments which causes inflammation.
In order to reduce the swelling, Alan should remember this simple acronym: RICE, which stands for rest, ice, compress, elevate.
Rest means taking the weight off the leg. Most of the time, the injury will force this to be done intuitively. Alan could consider a pair of crutches to aid his mobility.
Fill a bag with ice cubes and some cold water. Wrap a towel around the ankle, and apply the ice bag to the painful area. The cooling effect works best in the first 24 hours of injury and brings down the swelling.
Compress the ankle during the first 24 hours of the injury by binding a bandage around the ankle. It shouldn't be so tight that it causes more pain.
The foot should be elevated above the heart. The best way to do this is to lie supine on the bed and place your foot on one or two cushions.
This ensures that blood flows back towards the heart and doesn't pool in the foot.
If Alan is limping badly and there is a suspected fracture, he should see his doctor to determine whether an X-ray is required. Anti-inflammatories can be useful to reduce pain in this scenario, with the same caveats as the previous case.
Scenario 3: Roger, a 55-year-old time-pressured male executive with a body mass index of 28 and a waist circumference of 94cm, is keen to lose weight and wants to know about high-intensity interval training (HIIT)
If Roger wants to resume physical activity after a sustained sedentary lifestyle, he should seek medical advice first.
Due to the high-intensity aspect of HIIT, people who are not used to exercise can find it too demanding.
For the purposes of Roger's case, I refer to HIIT as the high-intensity circuit training routine by Brett Klika and Chris Jordan of the Human Performance Institute in Orlando, Florida.
Their routine consists of 12 bodyweight exercises, each done intensely for 30 seconds, and with a 10-second transition time between each exercise.
The circuit lasts about seven minutes, and participants can repeat it two to three times, depending on their fitness and amount of training time.
There are many seven-minute workout smartphone apps that can guide users through the circuit.
HIIT is one way of getting fit, and the advantages are you do not necessarily need a gym as you are using your body weight, and it is relatively quick. But it is not a panacea and is not suitable for everyone.
Previously sedentary people will need to build up to this circuit slowly by not doing all 12 exercises initially, and perhaps doing each exercise for only 10 seconds.
Those experiencing knee pain due to arthritis should avoid jumping exercises and people with high blood pressure and a history of heart disease are advised not to do exercises involving the Valsalva manoeuvre (attempting to forcibly exhale while keeping the mouth and nose closed). This can strain the heart. Swimming or brisk walking in the pool are safer alternatives for them as the water provides resistance while its buoyancy supports the knees.
Ray Ng practices as a family physician in a Central clinic. He is a member of the Royal College of General Practitioners (UK). firstname.lastname@example.org