It’s common sense to look after our health as the years go by. Good health goes a long way to helping us enjoy the increase in longevity predicted for our generation. Consider the medical and physical benefits we can hope to experience if we are fit.
- Improved circulation and digestion
- Stronger heart
- Increased flexibility
- Stronger bones
- Improved relaxation
- Improved shape
- Stronger muscles
- Improved co-ordination
- Controlled weight
- Sense of well-being
- Increased confidence
Fitness is all about being able to do the things we want to do. To be fit is a necessitty if we are to enjoy life, not just an option. Our individual level of fitness will depend on our personal lifestyle, interests and the commitment we have to looking after our health.
So just how physically fit are we? The 1992 Carnegie Enquiry into the health of people in Britain between the ages of 50 and 74 years of age found, and I quote “many too unfit to benefit fully from the recent gain in life expectancy. Half the population is overweight and 1 in 20, twice as many as in 1980, are obese.” It goes on to say “if they moved about, walked and climbed stairs for a total of 60 minutes per day, they would be fitter, healthier and enjoy a more active and independent lifestyle”. It continued “for those who get it right there may be a decrease of some ability in their 60’s, others later, and some, not at all. Many enter advanced old age still performing at the level of younger adults” This doesn’t surprise me at in the least when I look at the increasing number of inactive Couch Potato children.
So how much exercise should we older adults people need todo to keep us physically fit? Well here again the guidelines are changing. For over 10 years the Health Education Authority (now the health Development Agency) had recommended: three, twenty minute sessions of exercise each week, which contained a section 10- 20 minutes of vigorous bursts of energy (aerobic exercise). Examples of these are running, step aerobics, exercise to music, squash or circuit training. But sadly this policy and its guidelines failed to persuade the majority of the great British public to take regular exercise. Of course the sporty ones continued to exercise as they had done before, and have done since, but the policy wasn’t attractive to the average man and woman who thought the idea of aerobic exercise, all too exhausting! Fortunately for many the Health Education Authority revised their recommendations a few years ago, and now encourage us to take a half an hour of moderate physical activity five times a week in order to keep ourselves fit. This amount of activity can significantly improve health and well being, and includes activities such as table tennis, golf, keep fit classes, aqua aerobics, brisk walking, dancing, gardening or DIY. All activities, which eventually if they are done for long enough, make us feel warm and slightly out of breath. These latest guidelines are sensible and attainable, and surely most of us should be able to aspire to them without too much trouble?
Despite the fact that older people have an increased awareness of the importance of being physically fit, only limited numbers participate in enough exercise, which is appropriate to maintaining physical independence as the years go by. The National Fitness Survey found that the majority of people weren’t helping themselves maintain their good health, although these same people perceived themselves to be fit. It was only when they were put to the test that they were found not to be! Only 34% of those aged 55 to 64 years of age, and even less than 23% of those aged 65 to 74, attempted to be active enough in their everyday lives. The survey went on to show that in the 55 to 64 age group 30% of men and 51% of women were not fit enough to walk at a normal pace. And if that wasn’t bad enough, the figures rose to 45% of men and 79% of women who were unable to walk normally in the 65 to 74 age bracket! But even worse was the fact that the survey showed that in the 65 – 74 year old age bracket 30% of the men, and a staggering 56% of the women, didn’t have sufficient strength in their major leg muscles (the quadriceps) to even get up from a chair unaided. This rendered them physically dependent on others.
We need do all we can to help ourselves maintain physical independence, and one significant, but simple way is by including more activity in our everyday lives. The earlier good habits are started the more benefit will be felt as the years roll past. We must take, and we must make, the opportunity to be more active anytime, anywhere and anyplace. We can make a start with simple things like taking the dog for a walk. By using the stairs instead of the lifts, or walking to the shops and the pub instead of taking the car. Only then can we look forward to enjoying many more years of ACTIVE life. So try to take more regular moderate exercise, and why not persuade your friends or family to join you? The trick is to do an activity that gives you, pleasure, then you will discover that being active actually boosts your energy levels. When we exercise, the body releases chemicals called endorphins which gives us a “feel good” factor. The circulation gets going, improving our heart and lung efficiency. Exercise and being active makes our complexion glow and our minds more alert. Being inactive is a major risk factor in older age.
is just one component of total fitness. Physical fitness is divided into the following 5 parts.
- Cardio-vascular fitness
- Muscular strength
- Muscular endurance
- Motor fitness
Let’s take a look at how all of these can affect our health.
First cardio-vascular fitness, which provides us with our stamina. Good stamina enables us to sustain free bodily movement for the length of time we need it to, without leaving us feeling puffed, exhausted or faint. To achieve good stamina we must aim to do enough regular activity in order to boost the efficiency of our heart and lungs and improve our circulation and digestion. We can work on our cardio-vascular fitness by doing aerobic exercises. (Aerobic exercises simply mean exercising with air). Examples of these types of exercise are exercises to music, line dancing, ballroom dancing, or jogging and brisk walking. After a time they make us puff and breathe deeply. Whichever aerobic exercise or activity we choose to do, we need to sustain it for a length of time in order to gain benefit. 30 minutes is an ideal time, but we must take age and ability into account. All of these aerobic activities will make the heart (which itself is a muscle) pump just that little bit harder, and this has the effect of making our lungs work more efficiently, utilising the oxygen we breathe in and improving our circulation. It’s important to breathe deeply in order to encourage greater oxygen intake and lung elasticity. Aerobic exercises will make us feel warm and puff a bit, but we should still be able to talk whilst we’re doing them!
The second component of physical fitness is muscular strength. This is the ability of a muscle to exert maximum force to overcome a resistance. Which simply means being able to do things like twisting the stubborn top off a jar of marmalade, or being able to pick up a particularly heavy object. Our bodies also need strong muscles in order for us to maintain good posture and improve our shape. As the years advance it’s paramount for us to do all we can in order to keep the muscles, particularly in our legs strong. |We must concentrate on the front thigh muscles (quadriceps) and make them strong, in order to maintain our physical mobility. Simple regular brisk walking involves the rhythmic movement of both muscles and joints, and will stop the muscles atrophying. Walking can be both sociable as well as beneficial, if you have a partner to walk with.
To be physically fit we also need muscular endurance. This is the ability of a muscle (or group of muscles) to exert force, in order to overcome a resistance, for an extended period of time. In other words we need strong muscles to make light work of everyday chores. Those occasions when we have to push ourselves just that little bit harder, or exert a little more strength for longer periods than we want, in order to achieve. How many times have I wanted to drop my heavy shopping bags in the supermarket car park just because I have stupidly forgotten where I parked the car! Situations like this call for muscular endurance, and one has to keep on walking and looking! What a relief to finally find the car and be able to put the bags down. If we have well toned, strong muscles, we reduce the risk of tearing ligaments or damaging ourselves when we are pushed to the limits or have a fall.
The next component of physical fitness is flexibility, which enables us to put our muscles and joints through their full range of movements with ease. We take this flexibility or suppleness foregranted when we are young, but we need to work at it as we get older. It’s a great feeling to be able to use our bodies efficiently, to bend down to do up shoe laces, to stretch up to high shelves, and to use our bodies to their full potential. Stretching exercises should be performed before and after an exercise session or physical activity, such as gardening or playing tennis, in order to prevent injury. When we finish being active and our muscles are warm, it is an ideal and safe time, to stretch them out just that little bit more, in order to increase our flexibility and suppleness. Why don’t you try it at the end of your brisk walk, gardening or game of tennis? You may surprise yourself to find you are more supple and able to reach further than you could, an hour or two before.
Last but certainly not least is motor fitness, which governs our skill, and ability to control our movements, balance, speed, co-ordination and agility. It also gives us the capacity to re-act quickly, and the confidence to move about without fear of falling over. With skill and the natural co-ordination of mind and body working together we can make our movements graceful, effective and efficient.
If we work hard on all 5 components of our physical fitness, there is a good chance of maintaining our physical independence long into later life. The benefits to our general health and well being are enormous, and there is every opportunity to live a full life. We need to make exercise a natural part of our every day. We should try to be generally more active, by walking more often, by climbing stairs, cycling, dancing, swimming and gardening as much as possible, in order to maintain our physical fitness. Hopefully you’ll find an activity, which is just for you.
But inevitably with an increase in our years there will be some bodily changes. For example there will be changes to our skeleton with a natural thinning of bones in both men but particularly women. Changes occur in the joints, and arthritis, rheumatism and backache are painful reminders of the passing years for too many people. As we age muscles can become weaker, and less able to support us as they used to. This is particularly true if we don’t keep active. The muscles begin to atrophy, and posture and one’s self-esteem can be adversely effected by poor muscle tone. What stronger motivation do we need for taking a daily brisk walk, for at least half an hour, in order to retain strength and tone!
There may be respiratory problems too for some older people, which are often brought about by insufficient exercise, and from the effects of smoking. These problems in turn decrease the efficiency of the cardio-vascular system (our heart and lungs), which can then affect breathing and circulation, leaving us feeling fatigued and breathless. Sadly too, there may be changes to our nervous system as we get older which can result in memory loss, lack of co-ordination and balance. Of course some bodily decline is inevitable as the years pass by, but much of the decline can be prevented, and some even reversed. The popular saying “if you don’t use it, you may lose it” applies to both body and mind. I’m a firm believer in having to exercise the mind as well as the body, in order for it to function efficiently. Heredity factors also play an important role in determining many of these changes, in just the same way as they can determine individuals look and character.
PHYSICAL FITNESS ACTION PLAN
- Take half an hour of moderate physical activity five times a week
- Make exercise a natural part of everyday life and take the opportunity to be generally more active, anytime, anywhere
- Learn to breathe deeply in order to encourage oxygen intake and lung elasticity
- Take a daily brisk walk for at least half an hour each day
- Stretch out your muscles before and after an exercise session or physical activity
- Remember “if you don’t use it you may lose it” applies to both your body and mind
MY EASYFIT EXERCISE PROGRAMME
- Bone strengthening
- Muscle toning
Before you start this, or any exercise programme, please check with your doctor if you suffer from heart disease, have high blood pressure, joint problems, back problems, if you are very overweight, have a serious illness, or are convalescing. Check out location and surfaces before performing any exercises in your home or out in the garden. Make sure you are warm enough but wear layered loose clothing, which can be discarded as you hot up! It is essential to make sure that the supports and equipment you use are strong enough to take your weight, and that surfaces are not wet or slippery. Don’t exercise until at least an hour after meals, and keep drinking water near at hand to avoid becoming dehydrated.
- To prepare your body for exercise
Stand with feet apart, feel nice and easy. Bend your knees – bend forward from your waist – swing arms down and behind you. Straightening your knees swing your arms up high above your head-lift up rib cage breathe deeply and stretch out your entire body.
- If you are chair bound simply bend forward and touch your toes, straighten up and reach for the sky.
Begin your fitness programme with some gentle stretching. First check out and correct your posture.
Stand with your feet comfortably apart and your shoulders back, down and relaxed. Pull in your tummy and tuck your tail under tilting your pelvis forward.
- Wrist Circle
To maintain mobility of the wrists sit or stand and tuck your elbows into your waist. Simply circle your hands working the wrists. 8 times in one direction and 8 times in the other.
To release tension and mobilise the shoulders simply place your fingertips on your shoulders. Bring your elbows together in front of you, take them up and back pulling your shoulder blades together and drawing imaginary circles with your elbows. 8 times clockwise and 8 times anti-clockwise.
- Head roll
To release tension and mobilise the neck look over your right shoulder with chin parallel to the floor. Drop your chin to chest and slowly roll it to look over your left shoulder. Roll chin back to chest and on over to the right side. Repeat 8 times. Do not roll your head backwards.
- Ankle circle
Stand with your feet a little apart and hold onto a table or chair back for support. Lift up the heel of your right foot keeping toes on the floor and circle your ankle. 8 times clockwise and 8 times anti-clockwise. Repeat with your left foot. (You can do this exercise sitting down).
- Side twist
Sit or stand with feet apart. Bend your arms and with elbows out bring them up to shoulder level with fingertips touching in front of your chest. Twist your upper body and head around to the right side to mobilise your spine and upper body. But keep your hips facing forward. Come back to centre and twist to the left side. 8 times each side.
- Side reach
Sit or stand with feet apart. With your right hand reach up and over your head (relax left knee if standing). Bring arm down and reach up and over with left hand (relaxing right knee) as if climbing a rope. 8 times to both sides.
WARM UP STRETCH
Hold all stretches still for 8 seconds. Do not bounce.
- Calf stretch
To stretch out the back muscle of the lower leg stand with your feet hip width apart facing a wall for support. Place your hands up at shoulder level with arms straight. Keep both feet facing forward but take your right foot back behind you. Keep your leg straight and press your heel down hard and push against the wall. Feel the stretch in your right calf. Hold for 8 seconds. Repeat with left leg.
- Hamstring stretch
To stretch out the hamstring muscle (back of thigh and bottom) stand with your feet facing forward as before, but further back from the wall. Using wall for support take your right foot forward. With knee straight place it heel down and toes facing upwards. Bend your left knee, push against the wall and lift up the right side of your bottom. Feel the stretch in the back of your thigh and bottom. Hold for 8 seconds. Repeat with left leg.
- Upper back stretch
Sit or stand to stretch out your upper back. Bend your elbows and bring arms up to shoulder level. Place hands on elbows, drop your head forward and round out your back and stretch. Hold for 8 seconds.
- Tricep stretch
Sit or stand to stretch out the tricep muscle ( back of your upper arm). Take your right arm up, bend your elbow and place your right hand behind your head on your middle upper back. Take your left hand across your chest and push back your right upper arm and shoulder as far as possible. Hold for 8 seconds. Repeat with the left arm.
- Chest stretch
Sit or stand to stretch out your chest. Take both arms behind you and place your hands on your bottom. Pull back your shoulders and elbows. Lift up your rib cage and feel the stretch across your chest. Hold for 8 seconds.
Regular aerobic exercise improves heart and lung function and helps to control blood pressure Blood pressure changes with age and can increase through illness and over-exertion. Don’t suddenly start to exercise if you already suffer from high blood pressure. Begin by simple brisk walking – preferably out of doors.
As we get older it is essential to be able to perceive our own physical rate of exertion in order to prevent problems. This is a simple test. Jog on the spot for a minute. Stop and ask yourself how you feel and give yourself ratings.
- Feel exhausted
- Feel OK but a bit puffed
- Feel good and could do more
Be aware of your body – these are your individuals perceived rates of exertion. During your work out keep asking yourself “which level am I working at?” If you perceive it to be:
- 1 Take it easy, but try to gradually build up over the following days until you feel a comfortable 2 or maybe eventually 3.
- 2 Try a bit harder
- 3 Challenge yourself a bit more. Build up the duration and intensity of your work out. If you feel uncomfortable and breathless, or if you are in pain or lack co-ordination, then decrease the duration and intensity to level 2.
Whatever level you are working at always monitor your progress and don’t overdo it!
“Aerobic” means exercising with air and you should puff and breathe deeply when you exercise in order to achieve. The increased intake of air enables your muscles to work harder and longer and the result is increased stamina, and improved heart and lung efficiency. If your stamina is very low, it is important to build up the aerobic section of your exercise programme gradually. If your posture is poor, breathing will be difficult and the amount of air inhaled will be less. You see how important it is tot maintain strength, and flexibility of the chest joints as we age in order for them to be able to expand and accommodate deeper breathing.
Aerobic exercise is weight bearing exercise, (no need for dumb bells – the body is using it’s own weight). Consequently aerobic exercise helps strengthen the spine, hips and ankles, because they have to support the weight of our bodies during the work out. But you don’t need to go to the gym to exercise, the following movements can easily be performed at home. Low impact aerobic exercises have sufficient pull on the muscles to improve bone density (more about that in the section on osteoporosis on page ……) as well as to improve stamina, without exhaustion
- Aerobic march
Clear a space and put on some upbeat music. Simply march on the spot for a minute. Lift your feet up, roll through the ball of your foot and keep your weight over your big and second toe. Now lift your knees higher and pump your arms. March on around the room and/or garden for several minutes until you begin to puff.
- Aerobic stand
Choose an upright chair without arms and sit down (towards the front of it.) Without using your arms to push off simply stand up and sit down continuously in time to the music. Aim to stand up, leading with your chest forward, and with hands on your thighs. If this is difficult, place your hands on a table in front to steady you. (It’s very important to correct posture and strengthen thighs in order to maintain physical independence into older age)
- Aerobic step
Face a wide, dry step 4-6 inches high (8 if you are very fit) Hold onto a banister or wall for support. Leading with your right heel, place your right foot up in the centre of the step. With your body weight over your knee and foot, step up. (Don’t let heel or toe hang over the edge of the step). Remember your posture – balance is improved by working on co-ordination of movement and symmetry of the body. Step your left foot up to join your right foot, leaning from the ankle joint. Step back down with your right foot. Keep close to step and land on the ball of your foot, and lower your heel down to absorb the shock. Step back down with the left foot. Continue “stepping” for a few minutes, then change to lead with your left foot for a further 2 minutes. Aim to eventually step without the support, for maximum effect.
- Aerobic tap
Stand with feet together. In time to the music step right foot out to the right side – transferring weight onto it. Bring left foot across and tap it to the side of the right foot. Step left foot out to the left side. Transfer weight and bring right foot to tap onto side of left foot. Repeat and swing your arms to sides and clap to the beat. Increase the intensity by swinging arms higher and stepping legs higher and wider. Continue for 2 minutes and enjoy the rhythm.
- Spot walking
Gradually bring the intensity down, by walking on the spot with your hands by your side for 1 minute. Finally, place your hands on your hips and continue for 1 more minute, simply transferring your weight from one foot to the other. Only lift your heels and keep both feet in contact with the floor. Now stop!
- Pelvic tilt
First learn the “pelvic tilt”. This is the correct position to adopt in order to perform abdominal exercises correctly.
Lie on your back – knees bent, slightly apart – feet flat on the floor. Breathe in – pull in your tummy muscles and push your lower back (your waist) into the floor. This action flattens the arch in your back and tilts your pelvis upwards. Remember to hold this pelvic tilt throughout all abdominal exercises. Breathe out and relax
- Abdominal lift
- Lie back on the floor (rest your head on a small cushion if it’s more comfortable). Bend your knees, and keep your feet flat on the floor. Reach your arms forward and place your hands on your thighs. Pull in your tummy, push your back down into the floor, and tilt your pelvis up. Breathe out, and lift your head and shoulders up, sliding your hands up to your knees. Breathe in as you slowly relax down. Control both the up and down movement -don’t just flop back! Begin with 8 repetitions and build up to 24.
- (To increase the intensity of this exercise cross your arms over your chest as you lift up. To increase the intensity still further, place your fingertips on your temples, keeping your elbows out to the sides. Tilt your pelvis, breathe out, and lift your head and shoulders up. Keep your elbows back, head steady, and chin down on chest.)
- Abdominal twist
Lie in the same position, but place right elbow on the floor with fingers to temples and left hand on thigh. Tilt pelvis, breathe out and lift your head and shoulders up, reaching over with your left hand to touch the outside of your right knee. Breathe in, and relax back down.
- To increase the intensity of this exercise, from the same lying position, cross your right knee over your left and take your right arm out to the side, palm down. Place the fingers of your left hand to your temple, with elbow out. Breathe out, lifting up your head and shoulders, and try to reach across to touch the outside of your right knee, with your left elbow. Breathe in, and relax back down. 8 repetitions, building up to 24. Change legs and repeat to the other side.
· Abductor (outer thigh) muscle
Lie on your side, bend your knees and bring them both slightly forward. Bend your elbow, and support your head in your hand. Place your other hand on the floor, in front of your waist for support. Don’t roll forward or backwards. Pull in your tummy, and tighten your bottom. Flex your foot, keep your knee bent, and, leading with your heel lift up your top leg (not too high). Keep your foot lower than your knee, and don’t drop your hip back. Control both the up and down movement. (A bent leg is called a 1/2 lever)
- To increase the intensity of this exercise, lie as before but place your lower bent leg, back in line with your upper body. Straighten your upper leg, (full lever) and lift and lower as before, leading with your heel. Remember to keep the tummy and bum tight throughout the exercise. Begin with 8 lifts, then roll over and repeat the exercise with the other leg, gradually increasing to 24.
- You can add leg weights to increase the intensity still further.
· Adductor (inner thigh) muscle
Still lying on your side, take your top leg over the bottom one, and place your knee on the floor. Straighten out your under leg, in line with your upper body. Flex your foot, and, leading with your heel, lift and lower your leg 8 times, with small controlled movements. Feel the inner thigh muscles working! Roll over and repeat exercise with your other leg. Gradually increase to 24 lifts.
- Bottom lift
- Kneel down, bend your elbows out and place them on the floor. Bend forward from your hips, and rest your forehead on your crossed hands. Lift and take, one leg up and back, bending your knee 90%, (1/2 lever), your thigh parallel with the floor. With small, but controlled movements, lift and lower your leg 8 times. Pull up your tummy muscles; don’t let your back sag. Keep both hips facing downward, and feel your bottom muscles working. Change legs, and repeat lifts, gradually increasing to 24
- From the same position and with the leg bent as before, take the raised knee across and down, over to the outside calf of your other leg. Return knee up, parallel to floor, and repeat 8 times, increasing to 24 as you get stronger. Change to the other knee, and repeat lifting and crossing. You should certainly feel your gluteal muscles work during this exercise!
- Stand up
Brisk walking is excellent exercise for maintaining strong leg muscles, so too are simple stand ups. Sit on the edge of an upright dining chair – hands on thighs – feet flat on the floor (slightly apart and back under the front of the seat). Simply stand upright and sit back down again – don’t use your hands to push off! Aim to stand up leading with your chest forward.
- If this is difficult due to rounded shoulders or bad posture. Place hands on table in front of you for support. Repeat standing and sitting 10 times and build up repetitions according to personal ability.
Further leg and feet exercises may be found in
FOOTCARE section on page ….
And BONE STRENGTHENING EXERCISES on page……..
The big muscles in the front of your upper arms, the biceps must be kept strong in order to perform everyday upper body activities such as lifting and carrying.
To strengthen and shape simply sit on an upright chair (without arms) with your feet flat on the floor – knees at right angles. Tuck your elbows tightly into your waist. Keep position throughout the exercise. Imagine you are lifting heavy weights, rise up your lower arms, fists to shoulders, and lower back down 10 times. Make it harder by using hand weights, or small plastic drinks bottles filled with water or sand.
The triceps muscles at the back of the arms work with the biceps muscles in the front of the arms to produce strength and movement.
- .Exercise them by sitting as before, but incline your upper body and head slightly forward. Pull in your tummy to maintain a good position and make a fist or use weights. With elbows bent, pull shoulders together and take your upper arms back and up. Hold them still in this position throughout exercise. Straighten out and push down your lower arms, turning fists out at the same time. (Don’t “lock” the elbows.) Keep upper arms in position – bend your elbows and bring your fists or weights, back up to your shoulders 10 times. Feel the back of your upper arm working!
Most “activities” require a strong back. The following exercises strengthen the back, but if your back is weak consult your Doctor before attempting these exercises.
- Back up
Lie face to the floor – take your hands behind you – place your palms on your bottom. – Pull back your shoulders and breathe in. As you breathe out lift your shoulders, chest and head up – keep them in a straight line. Look down and don’t arch back. Relax and repeat
To help “round shoulders” lie as before. Take your arms out to the sides, bend your elbow (90%) – place your hands up on the floor, elbows out at shoulder level. Breathe out – pull shoulders back – lift arms and hands, raise head, shoulders and back (in a straight line) off the ground like a bird in flight. Keep looking down. Relax and repeat both exercises slowly and carefully 4 times, building up as you gain strength.
- (If this position is uncomfortable, keep head down – pull shoulders back and work arms only).
PHYSICAL FITNESS USEFUL ADDRESSES
The Central Council of Physical Education
London SW1P 1DE
020 7828 3163
Health Development Agency
30 Great Peter Street
London SW1P 2HW
020 7222 5300
16 Upper Woburn Place
London WC1H OQP
020 7273 1500
YMCA Fitness Industry Training
112 Great Russell Street
London WC1B 3NQ
020 7343 1850
Physical Education Association
Reading RG1 5AQ
0118 931 6140
British Dance Council
240 Merton Road
London SW19 1EQ
020 8545 0085
British Slimnastics Association
16 Foxtell Way
Chalfont St Peter
Bucks SL9 0PN
01494 873 576
British Wheel of Yoga
1 Hamilton Place
Lincs NG34 7ES
01529 306 851
Yoga Therapy Centre
60 Great Ormond Street
London WC1N 3HR
020 7419 7195
Friends of Yoga Society
- Weston Crescent
0115 973 5435
Dolmetsch Historical Dance Society
17 Well Lane
Essex CM4 9LT
01277 840 473
English Amateur Dancesport Association
515 Abbeydale Road
Sheffield S7 1FU
01142 555 236
English Folk Dance and Song Society
Cecil Sharp House
2 Regents Park Road
London NW1 7AY
020 7485 2206
Extend Exercise Training
22 Maltings Drive
Herts AL4 8OJ
0158 283 2760
113 London Road
London E11 3DG
The Fitness League
52 London Street
Surrey KT16 8AJ
O1932 564 567
Keep Fit Association
London SE14 6EB
020 8692 9566
Laban Guild for Movement and Dance
PO Box 9
Surrey KT 20 7JU
01737 842 834
Language of Dance Centre
17 Holland Park
London W11 3TD
020 7229 3780
Margaret Morris Movement
PO Box 1525 Garelochhead
Helensburgh G84 OAF
01959 572 868
8b Robson House
Surrey KT17 1HH
01372 729 056
National Register of Personal Fitness Trainers
833 Fulham Road
London SW6 5HQ
07971 954 662
Royal Scottish Country Dance Society
12 Coates Crescent
Edinburgh EH3 7AF
0131 225 3854
Society for International Folk Dancing
24 The Homefield
Surrey SM4 5AS
United Kingdom Alliance
38/40 Station Road
Lancs FL4 1EU
01253 408 828
Website ukadance.co.uk ukablackpool.co.uk
Welsh Amateur Dancesport Association
49 Maple Drive
Bridgend CF31 2PF
01656 669 338
For more names and addresses of activities see page …………
MENOPAUSE AND HORMONE RELACEMENT THERAPY (HRT)
Menopause signifies a woman’s last menstrual period, and is the time when her ovaries finally cease to function, her menstrual periods stop, and reproduction comes to an end. Perimenopause signifies the transitional stage, a gradual process, when the ovaries produce less and less oestrogen. The time taken for this to happen can be 3 to 5 years, until the final cessation of the periods at menopause. For most women this happens between the ages of 45 and 55, the average age of menopause being 51 years of age. The hormonal fluctuations that occur during these years can cause physiological changes, which effect metabolism and emotions. For some women the hormonal imbalance caused by the natural drop in oestrogen levels at this time, can result in symptoms such as hot flushes, irritability, anxiety and poor concentration. But we should remember that the menopause is a normal stage in a woman’s life, and it isn’t an illness. Having said that, we all know through personal experience, that some women do have very real problems at this time and they need help. Other women sail through the mid life changes that occur to her body, with ease. Postmenopause signifies the many years of a woman’s life left after her last menstrual period and monthly bleed.
Many women who complain to their GP’s about distressing menopausal symptoms don’t, or won’t take his advice to use hormone replacement therapy to alleviate their symptoms. A recent survey carried out in 2000 by Estroven found that 25% of women were currently taking HRT. A little over 25% of women had taken HRT, but had since stopped. The remainder (a little under 50%) had never taken HRT. There are a variety of reasons why women don’t take hormone replacement therapy. Some have been made nervous by reports about HRT, which have indicated a slight risk of thrombosis, asthma, endrometrial cancer or psychological problems. Some women, who have taken HRT but have now stopped, report having experienced weight gain, headaches, heavy periods and breathing problems. Many more women are worried by warnings regarding the risk of developing breast cancer, if they have hormone replacement therapy.
Women, who have suffered menopausal symptoms, do in many cases gain immediate benefit from using HRT. Others prescribed it by their GP, are put off by unpleasant side effects or lack of result, and give up taking it. Today there are various choices to consider with many forms and dosages of hormone replacement therapy, and if they are not satisfied, women should ask their GP for an alternative form of HRT which might suit them better. The dosage too, can be raised if the problems are severe, or lowered, in order to suit the woman’s individual needs. Some side effects from HRT will be temporary until the body adjusts to the treatment, so it could be worth hanging on for a while longer. But too many women don’t persevere and abandon the idea altogether; they may seek an alternative or stoically put up with their menopausal symptoms.
Women who have had an early menopause (a surgical menopause) as the result of a hysterectomy, are strongly advised to take HRT after their operation, particularly if their ovaries have been removed. Hormone replacement therapy works by replacing the oestrogen in the body, which is no longer, produced by the ovaries. Medical researchers are still carrying out a 20-year trial on hormone replacement therapy and the results will be made available in a few years time. For some menopausal women HRT does relieve problems such as vaginal dryness, hot flushes and night sweats, and therefore encourages a better sleeping pattern. But until the results of the trials are known, it is understandable that many women are not convinced by the claims made, and are confused by the conflicting reports and possible side effects. Women who have had a blood clot in the veins of their legs or lungs, or those who have a history of liver disease, are not generally advised to proceed with HRT. Neither are those with a history of breast cancer. However, those women with a family history of heart disease, colon cancer, or osteoporosis may benefit from using hormone replacement therapy. It is already known that HRT lowers the risk of the bone disease, heart attack, stroke, and bowel cancer. Women need to be informed and confident of the ways in which they manage their menopause, and also their postmenopausal years.
Hormone replacement therapy comes in the form of pills, implants, skin patches, creams and pessaries, and a gel. Originally it consisted of oestrogen only, but it was thought to have increased the risk of cancer in the lining of the womb. Nowadays it is only prescribed for women who have had a hysterectomy, since they no longer have a womb, and are therefore not at risk. Today the most usually prescribed type of hormone replacement therapy uses both oestrogen and progesterone as replacement hormones. During part of the monthly cycle, from day 1 to day 21, oestrogen is taken. The progesterone is added from day 9 to day 21. Withdrawal bleeding can occur during the 7 days without medication, and is not unlike a light period.
A third type of hormone replacement therapy contains a combination of oestrogen and progesterone, and is usually given to post-menopausal women who have ceased to have a natural period. There is still protection against cancer of the womb lining, but there is no inconvenient monthly bleeding in the majority of cases.
There are many methods of administering HRT. Hormone replacement implants can be inserted into the abdomen, they contain a 6-month supply of lower dosage oestrogen, but progesterone is still required. Skin patches containing oestrogen can be worn on the lower trunk and changed every 3 or 4 days, but progesterone is also needed from day 14 to 25 with the patches. An alternative to the patch is an oestrogen gel, which is rubbed into the lower trunk each day, and is also accompanied by a progesterone pill to be taken from day 14 to 25. Creams and pessaries containing oestrogen can be inserted into the vagina by applicator twice a week, with the addition of progesterone only creams being applied to the skin on certain days. Only your doctor or a gynaecologist can prescribe hormone replacement therapy for you, individually taking into account your symptoms and personal medical history. HRT can prove highly effective in relieving menopausal symptoms, but many are unsuitable if there is a history of blood clotting, high blood pressure or liver disorders.
If you are unhappy about taking HRT particularly on a long-term basis you may prefer to consider an alternative, a more natural approach, to help you manage your menopause. Plant forms of oestrogen and progesterone can be found in foodstuffs such as the Mexican yam, tofu (Soya bean curd), French beans, green lentils, miso (fermented Soya paste) and rye bread. The amounts of hormone balancing properties will of course vary a great deal in these natural sources. The amounts may not be constant enough to treat some women, especially those who have had their ovaries removed. Other women find bananas, figs, dates, citrus fruits, sprouted seeds and grains, citrus fruits, seaweed, fennel and garlic, all foods containing hormone balancing properties, more acceptable as natural alternatives. Medicinal herbs such as hops and sage are rich sources of plant oestrogen. Recent tests are establishing red clover, which also contains plant oestrogen, as being of possible benefit (a regulated amount being taken in tablet form), in alleviating menopausal problems. This could be good news for some women, who cannot, or will not take conventional hormone replacement therapy, and are seeking a natural solution to their problem.
Hormone replacement therapy is recommended for women with a history of heart disease or osteoporosis. Exercise is important; weight-bearing exercises not only boost and build stronger bones, as we will discover later but aerobic exercise in particular helps strengthen our hearts and lungs. Moderate exercise improves energy levels, overcomes depression and alleviates anxiety; all problems encountered by women during their menopause.
The medical profession has expressed concern over the efficiency of health supplements and homeopathic medicine in the management of menopause and preventing disease. Although many agree that natural supplements may be beneficial, they would argue that these natural substances are not alternatives to hormone replacement therapy. Many state that after hysterectomy and removal of ovaries, women lose their oestrogen supply, and benefit from immediate hormone replacement. Some fear that by taking alternatives to HRT their menopausal patients could be putting themselves at risk. They make the point, that nothing other than hormone replacement therapy relieves menopausal symptoms, prevents heart disease and osteoporosis, all at the same time. As responsible women we must make our own individual and informed decisions about HRT, and take which ever course of action we personally consider suitable for our own well being.
MENOPAUSE ACTION PLAN
- Consult your GP if you are suffering menopausal symptoms such as mood swings, hot flushes or night sweats
- Don’t suffer in silence
- Discuss the advantages and disadvantages of taking HRT to relieve your menopausal symptoms
- Alternatively consult your gynaecologist or local Menopause Clinic
- Consider changing your diet to include foods containing natural oestrogen
- Investigate how supplementing your diet could help you through your menopause
- Be active
MENOPAUSE USEFUL ADDRESSES
The Amarant Trust
The Gainsborough Clinic
80 Lambeth Road
London SE1 7PW
Tel 0207 401 3855
27 Sussex Place
London NW1 4SP
020 7262 5337
Women’s Health Concern
Helpline 0208 780 3007
The Pennell Initiative
51 Hall Lee Fold
Medical Advisory Service
Helpline 0208 994 9874
32 Gwynne Road
Dorset BH12 1ASL
01202 735 287
In 1987 I read an article in the health page of the Daily Mail newspaper, about the new wonder drug HRT (Hormone Replacement Therapy). It mentioned actress Kate O’Mara and her sexual prowess which she put down to taking the drug, but it more seriously referred to the relief women experienced from taking HRT, women who had previously suffered from menopausal problems such as hot flushes.
I was 47 at the time and had experienced hot flushes for many years (I preferred to call them power surges) so I was interested to find our more. The article also pointed out that HRT was thought to be beneficial in the prevention of osteoporosis, the thinning of bones in older women and was inviting women to take part in clinical trials. Being interested in physiology, I was aware that should an older woman fall, if her bones were thin there was a serious risk of fracture, and that her wrists, ankles and hips were most vulnerable. I also knew that in severe cases of osteoporosis the spine could crumble, and that up to 10 or 12 inches of height could be lost and the resulting curvature of the spine is cruelly called, “Dowagers hump”. So I decided to find out more, Green Goddesses need strong bones. Since this goddess was no spring chicken, any way of staying at the top, and of keeping my body fit deserved investigation. (As with a lot of jobs, there are always` plenty of people waiting to step into dead men’s shoes – or in my case – Green Goddess’ Reeboks!)
The article mentioned the Amarant Trust and it’s menopausal clinic in London, so I decided to take myself along to find out more. They were kind and thorough at the Clinic as I underwent the necessary medical checks and examinations, in order for the Doctor to decide whether I was a suitable candidate for HRT. I viewed the checks as a mid life service, a bit like a MOT on my car, and all appeared to be OK, my engine was ticking over nicely. I performed well, but secretly I knew my bodywork was showing signs of age, and wished I could trade it in for the latest model! However I was found to be a suitable candidate, and became the proud owner of a plastic patch on my bottom, which I hoped didn’t show with bright television studio lights, through my shiny green leotard and tights.
All went well until my second visit to the Clinic where I was asked to have a mammogram as a continuum? of the regular checks. The mammogram, an X-Ray of the breast showed irregularities and I was referred to a Consultant at the Royal Marsden Hospital in London who confirmed Breast Cancer. I couldn’t believe it, cancer happens to other people. I stopped wearing my HRT patch. Having breast cancer was frightening and a terrible blow to my career. The cancer was in its early stages and treated successfully with a bi-lateral mastectomy followed by immediate reconstruction. My cancer surgeon later pointed out. that I probably owed my life to the mammogram and astute observation of the young doctor who spotted the irregularity.
After my brush with Cancer I returned to the Amarant Clinic. My cancer had gone, but the power surges were as powerful as ever, and I was eager to maintain my strong bones and was anxious not to become a “crumbly”. I was advised not to pursue HRT because of associated risks with breast cancer. Medical opinions today differ on this issue, and a form of hormone therapy can be prescribed to alleviate menopausal symptoms for some women who experience breast cancer. Worried about my bones, I wondered if there was an alternative to help prevent Osteoporosis. I talked to my elderly Aunt of 86. “Osteoporosis” she said ” that’s just a part of getting old, and there’s nothing you can do about it”. How wrong she was. Prevention is better than cure -, as we will find out.
Women are living longer and as the human life span increases, so too does the incidence of osteoporosis. The condition occurs in both men and women, and is likely to continue to assume greater proportions as the Western population ages. 1 in 3 women and 1 in 12 men will develop osteoporosis during their lifetime. The size of the problem is realised when we learn that a third of all women may suffer severely from osteoporosis, and the subsequent risk of fracture, should they fall. Osteoporotic fractures are most likely to occur in the wrist, the hip and the spine and sadly after the age of 70 a woman’s risk of fracture is nearly 1 in 2 after 70 years of age. Without treatment the disease can cause fractures which are both painful and disabling. Over 50% of older hip fracture victims will never be able to perform all the usual activities of daily living, like walking, climbing the stairs, or even getting up from a chair unaided. Around a half as many women will die as a consequence of hip fracture, as from breast cancer.
As we have seen Hormone Replacement Therapy can offer some protection against osteoporosis, and will no doubt be proven by the 20-year medical trials. But many women who could benefit from this therapy are are not using it. Some women just don’t like the idea of popping pills, or putting unnatural chemical substances into their bodies on a regular basis for the foreseeable future. Others find the bother of monthly bleeding inconvenient as they get older, and many of those with a history of breast cancer aren’t prepared to take the risk.
Most women will have lost 30% bone mass within ten years of the menopause, average age of menopause is 51, and fast bone losers will have lost as much as 50%. Bone loss is accelerated after the menopause due to the dramatic changes in hormonal levels. Osteoporosis occurs when the load bearing bones, the hips, spine, ankles and wrists, become progressively weakened and fragile due to the dramatic drop in the female hormone oestrogen. Oestrogen aids the absorption of calcium, which is the bone builder, and repairer and hormone therapy can help redress this balance. A woman, who has an early menopause before 45 years of age, can experience bone loss even sooner, because she is without bone-protective oestrogen for a longer period of her life. Fast bone loss can also be expected after a premature menopause, possibly brought about by hysterectomy, and for the same reasons. Particularly if one, or both ovaries were removed during the operation.
Bone isn’t dead, it’s alive and full of little holes which looks like a Crunchie bar and it’s liable to fractures. It changes constantly, with new bone replacing old bone throughout our lifetime. Our skeletons replace themselves every 7 – 10 years. We know it’s a natural process for bone mass to slowly and naturally decrease in both men and women after the age of 35, but genetic inheritance and other factors can also contribute to bone loss. Bone needs feeding to maintain it’s strength and help prevent osteoporosis and it is essential to eat and drink a diet containing sufficient calcium. The main sources of calcium are dairy products, milk, cheese, and yoghurt. Older women should aim for 1,500 mg (1 pint milk = 675mg) or 1000mg plus HRT daily. (Recommended daily intake for adults is 700mg) People who don’t enjoy milk and diary products, either because they are vegans or just allergic to these foods, can obtain their calcium quota from Soya milk fortified with calcium, Soya bean curd – Tofu, and eggs. Green vegetables such as broccoli, spring cabbage, and dried fruits, nuts and pulses are alternate sources of calcium for vegans and vegetarians.
The body also needs sufficient vitamin D in combination with calcium, in order to build and maintain strong bones. We naturally get sufficient vitamin D from the sun during the summer, but just sitting in the sunshine at an open window for 15 minutes a day, at any time of the year is beneficial. In wintertime we can obtain vitamin D by eating oily fish such as herrings, kippers, mackerel or sardines, or from taking a daily Cod Liver Oil capsule. Liver, breakfast cereals, egg yokes and margarine are alternate sources. Asian women who cover their bodies up with traditional robes run the risk getting insufficient vitamin D. Research has shown that frail elderly women who are given regular vitamin D and f calcium reduce their risk of hip fractures substantially.
So who is at most risk of developing osteoporosis? According to the National Osteoporosis Society;
- Women who are thin and small framed need to be especially aware. Larger slightly plump women seem less at risk. (Many overweight women will smile at this).
- Women who have over dieted (especially anorexia or bulimia sufferers) or women who have over-exercised (such as marathon runners)
- Osteoporosis appears to affect fair skinned women
- Those with a family history of osteoporosis,
- Women, who experience an early menopause, possibly brought about by a hysterectomy.
- Scientific studies have shown that high consumption of caffeine can reduce the thickness of bones.
- Other contributing factors are smoking which can bring about an early menopause (less oestrogen to protect bones)
- Women taking certain medications, such as steroids are more at risk of developing osteoporosis.
- A minimum of 2 or 3 units of alcohol a day (or preferably less) will not affect bones directly, but alcohol may cause women drinking excessively to fall and fracture bones.
- Women who are bedridden for long periods
- Those who continually sit down for an excessive time.
(Our increasingly sedentary lifestyle, car transport, sitting down in front of screens etc, is a major contributory factor.)
Osteoporosis is a silent, insidious disease, which makes women its first target. The disease is called the “silent epidemic” because women do not know they have it until they break a bone, and only 16% of UK women consider osteoporosis to be a direct threat to their health. Each year osteoporosis causes over 200,000 disabling fractures which daily result in 40 premature deaths. 60,000 people sustain hip fractures each year, which cause great pain and physical discomfort and these hip fractures subsequently result in 15,000 deaths. Osteoporosis can be prevented, or slowed down in many cases, by changes in diet and by not smoking. Recent research has shown that a contributory factor to developing osteoporosis is inactivity. Strong bones in older age depend on lifelong habits. Bones are built throughout childhood and the skeleton continues growing reaching its peak bone mass by young adulthood, its never too early to start encouraging youngsters to be active. Children and young people mustn’t be allowed to become inactive Couch Potatoes, for their bones’ sakes!
Despite the high level of activity in my life I had not broken a bone in my body until an ice-skating accident 10 years ago. Misjudgement caused me to slip and fall on the ice. There was a nasty crack, my watch skimmed off across the rink, and my left wrist hung limp focusing my attention on fractured bones. I had sustained a “Colles fracture”, a fracture of the two forearm bones at the wrist – a break that I went on to discover is typical of an osteoporotic fracture in older women. A bone scan subsequently confirmed I do not have osteoporosis, I just fell awkwardly. After a few weeks in plaster and many weeks of painful and intensive physiotherapy I regained full mobility. It can be difficult to overcome the pain barrier and to get motivated again, but my career depended on it!
Bone density can be measured by a bone scan and the best time to have one is at the menopause. Talk to your GP and ask for a referral if you fall into one of the high-risk categories. Only a third of women who are found to have low bone density are likely to experience fractures in later life. At present there is no nation-wide screening programme but there are various screening techniques, some available in NHS hospitals and others in private menopause clinics and hospitals. The most common forms of screening are the Dexa scan, which comprehensively and with reliable results can scan any part of the body. (DM to check with Osteoporosis Dorset). The Single Photon Absorptiometry, measures the bone density of the wrist, and the Achilles Ultrasound bone densitometer can measure, bone density in the heel and give an indication of osteoporosis.
There are new developments in treatments and drugs for osteoporosis. According to the NOS, in addition to the established HRTs, there are new continous, combined HRTs for the relief of menopausal symptoms and prevention of osteoporosis. Low dose preparations, helpful for older women at least a year past the menopause. Bisphosphonates are non hormonal drugs, Risedronate (Actonel) a licensed bisphophonate can reduce the risk of vertebral fractures in post menopausal women with established osteoporosis, and prevent the disease in high risk women, or those on high dose corticosteroid treatment. Another, Alendronate (Fosamax) is being used for the prevention of osteoporosis in postmenopausal women who are at high risk. SERMs – Selective Oestrogen Receptor Modulators are currently being studied. They mimic the action and beneficial effect of oestrogen in protecting against osteoporosis, without appearing to be associated with an increased risk for breast cancer. Research has shown that a once daily treatment with Raloxifene (Evista) over three years reduces the risk of a first vertebral fracture by 50%. The treatment increases bone mineral density at the spine and hip and total body by 2-3%
At any age exercise is important to maintain good health, but regular weight bearing exercise which exerts a loading impact, stretches and contracts muscles, stimulates the bone and strengthens it. It is the natural way to keep bones strong, right through to old age. This is particularly heartening news for women who are unable to take HRT for medical reasons, such as the risk of breast cancer or for those women who feel it unnatural to take any drug for a week, yet alone years. For women already committed to HRT, exercise is an additional way to boost their bones. Healthy active older people are 40 – 50% less likely to sustain a fracture of the hip. However, a word of warning is necessary – if you already suffer from osteoporosis and particularly if your spine is badly affected, you need to be aware that some exercises could do more harm than good.
What type of exercise prevents osteoporosis? Weight bearing. Not “pumping iron” in the Gym but natural movements like brisk walking, jogging, running, dancing, hopping, skipping, or aerobic exercise to music. All activities where the weight of the body is repeatedly borne by the spine, hips, legs and ankles, the bones most susceptible to osteoporosis. Movements that use the body’s own weight, but to be effectual the weight must be repeatedly exerted. Muscles attached to either end of the bone force the bone to twist and bend in response to strike action and jarring movement. These stress the bone and encourage fresh calcium to be deposited in the affected area. Tests have proved that there can be a 15% higher bone density in the dominant arm of sports persons, depending on whether they are right or left handed. This increase in bone density is very apparent in the serving arm of most tennis and squash players, and the kicking leg of many footballers. In recent studies a group of pre-menopausal women were encouraged to do a series of little jumps for a controlled period of time on a regular basis. A significant increase in the bone density of their ankles, knees and femoral head was observed. People who are bed bound for long periods lose bone density, but research has also found that if people can get up and stand out of bed every so often, they lose less bone density because standing stresses the bone. We can easily strengthen our arms and wrists naturally as we go about our daily business. Chores such as carrying the shopping bags, wringing out the washing by hand, picking up children, or lifting heavy cooking pots, put extra stresses and strains on our bones and muscles, and strengthens them in the process. The trick is, to incorporate everyday movements to benefit and boost our bones. It couldn’t be simpler, for most of us; it’s all in a day’s work! Although swimming is a wonderful way to keep fit, but not to strengthen bones, because water supports the body’s weight and no pressure is exerted? Swimming does help the body to maintain suppleness and flexibility, and the just being in water can give great relief to people who suffer from Osteoporosis.
Not everyone has the opportunity, or the positive determination to regain full mobility after an accident and women with fragile bones have a lot to lose. Physical independence and quality of life are at risk and so we should be aware of potential hazards. Many accidents leading to nasty falls occur around the house, beware of loose rugs, slippery floors, and spilt liquids or snake like flexes. Be particularly careful outside the house, especially during winter months, it’s so easy to fall on slippery steps, icy pavements and wet leaves. I find my visiting grandchildren, and other people’s pets are often the cause of “accidents just waiting to happen!” Objects get moved from their familiar spots, toys get left in unexpected places, and treasured possessions get abandoned in the most inconvenient places by their bored little owners. These danger zones can lead to falls, especially on the stairs, which are often badly lit. I find that accidents in my kitchen are best avoided by keeping things in more accessible places, it’s too easy to lose one’s balance and tumble off the kitchen steps! For people suffering from osteoporosis, handrails and non-slip mats in bathrooms can stop nasty falls on slippery surfaces, which could have such devastating consequences.
Poole Hospital in Dorset treated my broken wrist after my ice-skating accident, an area with many retired residents. 10 years ago the hospital set up their organisation called “Osteoporosis Dorset”, to research the disease and I was honoured when they asked me to become their President. Our motto is “Prevention through Education”. We have strong links with the National Osteoporosis Society. Research has found that Osteoporosis is a preventable disease, and not just an inevitable consequence of growing older.
OSTEOPOROSIS ACTION PLAN
- Eat a well balanced diet
- Ensure your diet is rich in calcium
- Make sure your diet contains adequate vitamin D
- Consider taking vitamin D supplements
- Take regular exercise
- Ensure your exercise programme contains weight bearing exercises
- Consider taking HRT
- Find out more about foods containing natural oestrogen
- Don’t smoke
- Control your weight
- Don’t diet excessively
- Avoid an excessive intake of alcohol
- Avoid drinking too much tea and coffee
- Substitute a glass of milk for tea or coffee
- If you are High Risk discuss the possibility of a bone density scan with your GP
OSTEOPOROSIS USEFUL ADDRESSES
National Osteoporosis Society
PO Box 10
Tel 01761 471 771
Helpline 01761 472 721
Dorset Healthcare Trust
11 Shelley Road
Tel 01202 443064
The Gainsborough Clinic
80 Lambeth Road
London SE1 7PW
Tel 020 7401 3855
The Pennell Initiative
51 Hall Lee Fold
01484 427 808
32 Gwynne Road
01202 735 287
Disabled Living Foundation
380 – 384 Harrow Road
London W9 2HU
18 Stephenson Way
Helpline 020 7916 1500
Mobility Information Service
01743 761 889
DIAL (Disablement Information and Advice Line)
See local phone book or:
St Catherine’s Hospital
01302 310 123
BONE STRENGTHENING EXERCISES
The following unique exercises will help strengthen your bones, by targeting the bones most at risk of sustaining osteoporotic fractures. The bone strengthening exercise programme consists of a set of easy movements designed specifically to strengthen and preserve bone thickness. They are exercises you can do in your everyday life, around your home, or in the workplace, or in the garden. You need do no more than 20-30 minutes a day, for three days a week, though I do ask that you build up to this slowly, to avoid possible injury or over-tiring. These exercises may be performed in conjunction with the SIMPLE EXERCISE PROGRAMME see page ….
Important. It is advisable to first check with your doctor before commencing any exercise programme. If the following, special bone strengthening exercises are not suitable for you, you could consider the special “osteo-relief” exercises at the end of this exercise section.
If you already suffer with osteoporosis lie down on the floor or bed to perform the floor exercises and support your neck with a small cushion or towel. For those of you with vertebral fractures, painful, tender spines, and limited mobility it may be difficult to lie on your back. You may find it easier to try an alternative position for some of the exercises – the head and upper back exercises can be performed whilst sitting down.
Do not attempt the BONE STRENGTHENING exercises if you have advanced osteoporosis
BONE STRENGTHENING EXERCISE
- Palm press
To strengthen wrists, arms and shoulders. Sit or stand, bend your elbows and bring arms up to shoulder level, palms together in prayer position. Keep fingertips touching and open out palms of hands. Close palms by pushing wrists together hard. Continue opening and closing 12 times.
- Palm squeeze
Sit or stand to strengthen your wrists and keep your fingers supple. Holding two tennis/soft balls, tuck your elbows into your waist with lower arms out in front, and palms uppermost. Keep your arms and wrists still, and squeeze and release the balls 12 times, as tightly as possible.
- Wind up
To strengthen wrists, sit or stand. For this exercise you will need a stick or ruler (approx 1 inch thick). Tie a piece of string 2 – 3 feet long securely in the middle of it. Attach a small heavy object (a small plastic mineral bottle will do) to the end of the string. Hold the stick at both ends with palms of hands facing downwards. Wind up the string with a twisting action. Reverse the action by holding the stick palms upwards and with control unwind. Repeat 4 times.
- Lift off
To strengthen your wrists and arms, sit forward in an armchair. Extend your legs straight out in front with heels to the ground, and toes upwards. Place your hands, with fingers facing forward, flat onto the arms of the chair. Incline your chest forward (this corrects your centre of gravity) and lift your bottom off the seat. Take your body weight on your hands. Keep your legs straight and continue to lift and lower back down 12 times. (If this is too difficult to start with, sit back into chair, and with bent knees repeat lifting and lowering, until your wrists become stronger.)
- Push away
To strengthen wrists and arms, stand at least a foot away from a wall with outstretched arms. Have your feet apart and arms at shoulder level with hands flat on wall and fingers inclined inwards. Pull in your tummy, keep your head, neck and back straight, bend your elbows out and lower yourself towards the wall. Take your body weight on your wrists and hands. Push back upright and repeat 8 times. (Don’t allow your body to sag). If possible keep your heels down, you can stretch out your calf muscles at the same time!
- Pull away
Stand with feet apart, a foot away from a secure kitchen unit or banisters, to stretch out your arms, shoulders and spine. Bend forward from the waist and hold on securely with both hands. Keep your legs straight, drop your head down, flatten out your back, take the weight on your arms and shoulders and hold the stretch for 2 – 8 seconds.
- Pull up
From the same position bend your elbows and pull yourself up. Step forward with your right foot and bring your left to join it. Incline your hips towards the support and raise and stretch up as high as possible onto your toes. If you feel balanced raise your arms and stretch your hands up to the ceiling. Hold the stretch for 2 – 8 secs before lowering heels and arms down. Heel raises correct the body’s centre of gravity and improve balance.
- Towel up
For arms and wrists stand with feet apart. Hold both ends of a small towel and make it taut in front of you at shoulder level. Lift it up and take the towel over and behind your head. Return it up and over, pull hard at both ends to keep the towel taut. Repeat 8 times.
- Towel rub
Hold one end of a small towel with your right hand. Drop the other end down behind your back. Reach behind you with your left hand and grasp the other end of the towel. Pull the towel taut, extend your right hand up high and pull the towel down again with your left hand with a sawing motion. Repeat 8 times. Reverse hands and repeat movement 8 times.
- Shoulder stretch
This stretch is more difficult – take care. (It will also help strengthen your arms and wrists) Sit on the floor, knees bent with feet apart and flat on the floor. Place your hands slightly behind your bottom, shoulder width apart, fingers facing forward. Carefully lift up your bottom and transfer your body weight onto your hands. Push your chest forward and hold the stretch for 2 – 4 seconds.
- Knees over
To strengthen hips, thighs and lower back. Lie on your back, knees bent with feet flat on the floor and hands by the side of your bottom, palms down. Place a small weight or 2lb bag of sugar between your knees. Grip the weight with your knees, roll them over to the right side as far as comfortable. (Keep your feet and shoulders in contact with the floor throughout this exercise). Relax for 2 – 8 seconds. Bring your knees back to centre and roll them over to the left and relax for 2 – 8 seconds. Repeat 4 times.
- Leg lift
To strengthen your hips and thighs. Lie on your right side and support your head with your right hand. Place your left hand on the floor at your waist for balance. Raise up your left leg and bring your right leg up to join it. Squeeze your thighs, knees, calves and ankles together and hold for 8 seconds. Relax both legs down. Roll over and repeat exercise on the other side.
Alternatively if this is too advanced, lie out on your right side as before with legs straight. Bend your right leg to stabilise your position. Lift up your left leg only and hold for 2 – 8 seconds. Repeat 4 times. Roll over bend your left leg and lift your right. (Beginners may find it more comfortable to also bend the lifting leg.)
- Fidgety feet
To strengthen ankles stand with feet slightly apart. Use a sweeping brush or walking stick for support. Hold top of pole, bend knees inwards, lift heels and take weight on your toes. Keep body upright, push your heels out to the side, turning toes inwards. Place weight back on toes, push knees out and bring heels together. Repeat 8 times.
- Edgy feet
Still holding onto pole for support take feet wider apart with toes facing forward. To strengthen ankles knock and take body weight on your insteps. Keep feet parallel and body upright, take knees out wide and transfer weight onto sides of feet. Repeat 8 times
These two exercises could be done sitting in a chair to help keep ankles mobile.
- Hop it
An easy way to strengthen your ankles and hips is to hold onto a worktop or banister. Lift up your right leg and simply hop 6 times. Turn around and repeat lifting up your left leg.
- Thigh stretch
Stand with feet together and hold onto a wall or banister with your left hand. Bend your right leg, take your right arm behind you and grasp your ankle. Ease your right ankle towards your bottom as far as comfortable. Keep front thighs parallel. Remember your posture, pull in your tummy and tuck your tail under. Hold for 2 – 8 seconds. Turn around and repeat with left leg.
- Hip flexor stretch
This stretch to mobilise the hip is more difficult – so take care. Stand with feet together, facing a unit or banister and hold on with both hands.
Place your right foot in front and bend your right knee. Take your left leg back behind you, as far a possible, toes to floor and heel up. Try to keep left knee straight. Bend the right knee more, keep body upright and push down further . Feel the stretch in front of left hip, and hold for 2 – 8 seconds. Turn around and stretch out right hip flexor.
Important Do not attempt the following exercises if you have established osteoporosis. See Osteo-relief exercises.
- Chicken neck
To strengthen upper spine and improve posture sit or stand with shoulders relaxed and fix your eyes on spot ahead. Keep your shoulders still, push your head forward and stick your chin out. Keep your chin parallel to the floor and pull back your chin as hard as you can, into your neck. Like a chicken! Repeat 8 times.
- Swan neck
Sit or stand to stretch out the side of your neck. Keep your shoulders still, do not lift your shoulder up. Take your right ear over to your right shoulder as far as possible. Feel the stretch and Hold for 4 -8 seconds. Repeat to left side.
- Spinal lean
Take care with this exercise. Stretch out the side of your body by standing with your left side to a secure door frame or upright support. Place feet next to bottom of support. Stretch your right arm up and over your head with, and hold on tightly to the support. Hold on with your left hand at waist level. Use your body weight and lean out sideways from the support to stretch out your right side. Hold for 4 – 8 seconds. Turn around and stretch out your left side.
- Spinal twist
Take care with this stretch
To stretch out your spine, stand with your back to a doorframe or secure upright support. Move yourself a foot forward. Twist your upper body and head only, around to the right.. Grasp the support with your left hand at shoulder level, and use your right hand for balance. (Keep your hips and feet facing forward) Feel the stretch and hold for 4 –8 seconds. Repeat to the left.
- Spinal reach
Take care with this tougher exercise
To stretch out the shoulders and strengthen the spine sit on the floor, feet apart, facing a secure unit or banisters. Bend your knees and place your feet close to the support. Reach up and grasp the support securely with both hands. Use your arms to stretch out your shoulders and lift your bottom slightly off the ground. Hold for 2 – 4 seconds and relax back down. Repeat 4 times.
- Leg up
To stretch out the hamstrings whilst seated sit well back in an upright chair, knees bent, feet flat on the floor. Hold the back edge of the seat. Lean your upper body forward and bring chest towards your knees. Straighten out and lift up your right leg parallel to the ground, foot flexed, toes facing up. Feel the stretch in your hamstrings. Hold for 4 –8 seconds. Relax down and repeat with left leg.
- Trim tummy 1
Lie on the floor with knees bent and feet flat on the floor to strengthen your central abdominal muscle. Place your hands on your thighs. Keep your chin to chest and breathe out lifting your head and shoulders up off the floor to a count of 2. Remember to tilt your pelvis. Breathe in and relax back down to a count of 2. Repeat 8 times controlling both up and down movements. (Support your neck with one hand if it is uncomfortable.)
- Trim tummy 2
Lie in the same position to strengthen the criss cross-abdominal muscle. Bend your left arm and place it on the floor for support. Pelvic tilt and breathe out. Lift your head and shoulders up to a count of 2 as you twist across your body to touch your left knee with your right hand. Breathe out and relax back down for a count of 2. Repeat to the other side and continue 4 times to alternate sides.
- The Flyer
To strengthen your spine lie on your tummy. Take your arms out to your sides. Bend your elbows and place hands palms down and chin on the ground. Keep your head, chest and arms in a straight line and lift them together off the floor like a flying bird. Keep looking down (don’t throw back your head). Relax down. Repeat 8 times.
- The Cat
To stretch out your spine, kneel and place your hands on the floor with fingers facing forward, under your shoulders. Pull up your tummy muscles and arch your back up, like a cat does on waking. Hold for 8 seconds. Relax back down, stick out your bottom and look up. Hold for 8 seconds and relax.
This special set of exercises is designed for those of you who already have established osteoporosis, to help correct your posture and strengthen your spine. All the exercises can be performed lying on a bed with your knees bent and with a small pillow to support the head.
- Chin in
Lie down and fix your eyes on a spot above you and simply push out your chin and neck. Retract your chin and pull it into your chest as far as possible. Continue pushing out and pulling back in your chin 8 times.
- Spinal roll
Lie with knees bent and arms out to your sides with palms facing down. Keep your knees together and rolls legs over to the right side as far as comfortable. Keep your feet in contact with the bed. Look over to your left hand and hold for 4 seconds. (Your upper body, shoulders and arms must be in contact with the bed throughout the exercise.) Slowly bring your knees back to centre and roll them over to the left and look over to your right hand. Hold for 4 seconds. Try to repeat 4 times.
- Lift off
Keep your knees bent with feet flat on the bed. To strengthen the tummy muscles place your left hand behind your head (not your neck) and extend your right hand up and onto your right thigh. Breath out and lift up your head and shoulders only, and slide your right hand up your thigh. Breathe in and relax back down. Continue 4 times. Repeat with your left hand and left thigh 4 times. when your muscles are stronger. Aim to eventually do this exercise minus the pillow and on the floor..
- Bottom lift
Lie on the bed as before but without a pillow. Place both hands up on your thighs. To strengthen your back clench your bottom and lift it up off the bed. Hold for 4 seconds and carefully relax back down. Keep your shoulders in contact with the bed. Repeat 8 times and when your muscles are stronger try to do this exercise on the floor.
- Press back
This exercise is best performed on the floor (or very firm bed.) Lie on your tummy with chin down, elbows bent and hands under shoulders. (Fingers turned slightly inwards.) Breathe out and push your head and shoulders back off the floor keeping your hips in contact with the floor. Don’t “arch” back, but keep your chin down with head and shoulders in a straight line. Repeat 8 times. In order to get completely straight and comfortable try placing a pillow under your tummy before starting this exercise
Lie back on the bed with your head supported by one or more pillow as necessary to improve comfort. Place another pillow behind your knees and thighs to relieve discomfort. Place your hands on your tummy. Breathe deeply into your abdomen and out again – feel your tummy rise and fall with your fingers. Close your eyes continue deep breathing – and relax.
People with vertebral fractures, painful, tender spines and limited mobility may find it difficult to lie on their backs to exercise. Many exercises can be performed in a chair. Exercises to strengthen leg muscles are particularly beneficial, because strong leg muscles can help prevent falls and subsequent fractures.
For information and further specific illustrated exercises for osteoporosis sufferers, contact the National Osteoporosis Society for their booklet “Exercise & Physiotherapy in the Prevention & Treatment of Osteoporosis. Their address can be found under “ Osteoporosis useful contacts”
One physical change that few of us escape in later years is a natural change in our eyesight. For me it began in my late 40’s when I found myself holding the newspaper further and yet further away from me, and realising that I wanted a brighter light, in order for me to read without straining my eyes. Most of us will need spectacles by the age of 65, but this deterioration in our eyesight shouldn’t lead to a lessening of the quality of our lives, or the loss of our independence.
Easy as it may be, to pick up a pair of inexpensive magnifying glasses at your local chemist or supermarket, it is important to have your eyes checked properly to avoid further unnecessary deterioration or damage. These over the counter glasses, which magnify, are seen to temporarily solve the problem, but they are a short-term solution. Both of our eyes are different and without individual correction can lead to eyestrain and headaches. Even if you think your eyes are healthy, regular eye tests are recommended every two years, but more often if you are worried about changes in your vision. Eye disease or infection can be detected at an early stage, and often cured or treated successfully. Problems including cataract, diabetic retinopathy, glaucoma and muscular degeneration may be found, but even when treatments are not available, or response to them is unsuccessful, much can still be done to help use the remaining sight. Nevertheless a small proportion of people will become totally blind and others partially sighted and the loss of sight can cause anger and grief. People may need counselling to help them deal with their emotions and accept their blindness.
Correctly prescribed spectacles, contact lens, or for people with impaired sight, special optical aids, can help rectify many problems. Your GP should offer you an annual health check if you are over 75 years of age, but sight tests are not free for most people can cost between £10 and £20 on average. Free or reduced sight tests are available for some people, including those with a family history of eye problems, people receiving various pensions, income support or other health benefits. If you think you fall into one of these categories, or you have low income or low savings, find out whether you are entitled to a free eye test. It is essential to do all we can to maintain good eyesight.
You could visit your local optometrist (ophthalmic optician) or ophthalmic medical practitioner (doctor specialising in eye care), most high streets have one, and ensure that your eyes are in the best condition possible. If you are prescribed glasses you will find that they don’t come cheap, so make certain you ask the cost of the frames and the lens before you order. Most options have a variety of suitable frames ranging from the inexpensive to costly designer specials, but whatever you eventually pay, ensure that the new glasses fit well and do the job they are intended for. Some people may be entitled to a ‘voucher’ to help pay for their spectacles.
There are lenses available for nearly every need, bifocals, trifocals, and tinted lenses to cut down the glare, magnifiers and low vision aids. Contact lens are an alternative for some, but for individual reasons not everyone is able to wear them. Contacts are available as bifocals too. Fortunately my eyes were found to be suitable for wearing contact lens, and once I’d got the hang of putting them in and taking them out, I have found them preferable to my glasses, which I am forever losing! But I also find having a pair of sunglasses containing my prescription extremely practical during the summer time or holiday season. They enable me to read in bright sunshine and play sport, then quickly taking them off, I can go for a swim, without fear of losing my contacts in the water which would be expensive to replace.
Bright light makes reading more easy, but I have found that as I get older much more light is required! A healthy eye needs twice as much light at the age of 40 as it did at 20 years old, and three times as much by the age of 60. So make sure you maximise the amount of light in your home, office or workplace. A good light should ideally be directed from behind you onto your book or work, while florescent lamps are very efficient and produce lots of overall light without shadows.
EYESIGHT ACTION PLAN
- Don’t take ANY risks with your
- Have your eyesight regularly tested by a qualified optometrist or ophthalmic medical practitioner
- Consider contact lens as an alternative (or addition) to glasses
- Make sure you work and read by a good light
EYESIGHT USEFUL ADDRESSES
Royal National Institute for the Blind (RNIB)
224 Great Portland Street
London W1N 6AA
Helpline 0845 766 9999
Partially Sighted Society
01302 323 132
Eyecare Information Service
- Day Street
01225 432 394
Due to the ageing process many people’s hearing naturally deteriorates in the middle years. Some people find they have to turn up the television, others don’t hear the doorbell or telephone, many complain that other people mumble and insist that these people should repeat themselves in order to be understood. More than half of those over 65 years of age have a hearing loss to a greater or lesser extent, and things can begin to sound muffled for many people in their 60’s and 70’s.
A visit to your doctor could show that this is due to an infection or wax in the ears and both can be treated satisfactorily. But if this is not the case, the GP may refer you to an ENT specialist (ear, nose and throat) at your local hospital or hearing aid clinic. The specialist may suggest you need a hearing aid, it’s well worth trying one, and your hearing is very valuable to you.
There is a wide range available through the NHS who have around 19 types of hearing aids, one of which might be suitable for your needs. Alternatively, hearing aids are available through commercial outlets that have many more and varied types of aids, which may help you hear, better. Hearing aids amplify sounds by variable amounts and can be fitted behind the ear, in the ear, or worn on the chest with a lead connecting to the earphone. It’s advisable to try a free NHS aid first, to see if the type you choose suits you, before rushing out elsewhere to buy an expensive one. Most people complaining of muffled hearing find NHS aids very helpful. NHS aids are usually behind the ear models.
Of course you can enquire about hearing aids without first consulting your doctor, although it is advisable that you do. Hearing aid dispensers who must be registered with the HAC (Hearing Aid Council) who have to follow the HAC code of practice sell hearing aids. If you do go to a hearing aid dispenser make sure you go to recommended, reputable one to avoid disappointment. Don’t be persuaded to buy the first one you try, and don’t sign a contract until you are convinced you have the right aid to suit your individual needs. Insist you have the hearing aid for a trial period of up to a month, to make sure it is what you want, otherwise it could be an expensive mistake. A hearing aid should last you for 5 years or more, but less if your hearing worsens and you need to replace it with a more powerful one.
HEARING ACTION PLAN
- Make an appointment to see your GP if you are worried about your hearing
- Or if you prefer make an appointment with a recommended and reputable Hearing aid specialist but it will cost
- Take a friend with you
- Try a free NHS aid first to see which type suits you best
- Don’t buy an aid on impulse at an exhibition etc, mistakes are expensive
- If you buy an aid ask to have it on a months trial to see if it suits you
- If you are not satisfied with your aid go back and get it adjusted
HEARING USEFUL ADDRESSES
RNID Royal National Institute for Deaf People
19-23 Featherstone Street
London EC1Y 8SL
Helpline 0870 605 0123
7/11 Armstrong Road
London W3 7JL
020 8743 1110
Hearing Aid Council
305 Upper Fourth Street
01908 235 700
Hidden Hearing Ltd (HTA)
Freepost MA 117
- Meadow House
Kent ME14 1BR
01622 690 132
It pays to look after your feet, feet are the most overworked and neglected part of the body. Feet constantly support our weight and take the stress and strain through the ups and the downs of our entire life. When we walk the pressure exerted on our feet is twice our weight, no wonder they sometimes complain!
Major causes of foot problems are buying shoes that don’t fit properly and neglect of corns and bunions. If minor problems are neglected they may become major discomforts which in the future could impair our mobility, walking can be affected and without proper care and attention, physical independence is threatened.
To avoid problems always ensure that when you buy shoes that they fit well with a snug heel and instep. Allow ½ an inch to spare from the tip of your toes to the end of the shoe. I find shoes with straps or laces across the instep are more comfortable and secure for everyday wear, they hold my foot back, preventing it slipping forward and my toes getting squashed. To ensure my feet are healthy and trouble free I keep my high heels, which I love the look of, for high days and holidays. When I’m buying shoes my personal tip is not to buy them in the morning, but to buy them in the afternoon when feet are warm and may possibly have swelled a little. This ensures I don’t buy shoes that are too tight or too small for me. I have found, as I’m sure many people do, that as I’ve got older my feet have become wider, and nowadays I need a slightly different fitting shoe to those I bought in my youth. Possibly, it has something to do with spending half of my life in trainers, as I persued my career in the world of keep fit. But at least it has kept me active!
We need to be aware that socks or tights with elasticised hold-up tops can be harmful to the legs and feet, by restricting circulation of blood to and from the ankles and feet, and particular attention is needed if you already suffer from varicose veins. Working as I did, as a fashion model for many years in my youth, soon taught me the advantage of wearing support tights to prevent tired, aching legs but without the Nora Batty looks! Today’s modern graduated support hosiery is light, stylish, and easy to wear and comes in attractive colours including natural. Graduated support hosiery works efficiently by fitting tightly at the ankle, encouraging blood to flow back to the heart, instead of ‘pooling’ around the ankles and feet. Obviously these special tights are more expensive than everyday tights, but if you have problems with your legs your GP can prescribe them for you. They can also be bought over the counter from reputable chemists, and a specialist fitting service is available in selected chemist shops and foot specialists.
When your legs and feet feel tired, your whole body seems weary and achy and life is more of an effort. For healthy feet and legs you need to take adequate exercise, because the calf muscles at the back of the leg act as a pump when we exercise, helping the blood, which is flowing into the lower leg back towards the heart. Resting with your legs up high (feet above heart level) can also improve your circulation, and can be especially helpful for people with varicose veins and leg ulcers. I elevate and rest my legs whenever possible by lying flat on the floor, bed, or across the settee, with my head supported by a cushion. I stretch out my legs and place them high up on a pile of pillows, cushions or the settee arm, then relax for 5 or 10 minutes. This relieves aching legs and varicose veins by encouraging blood to flow away from the feet and legs, and back to the heart. Circling your ankles and curling your toes when you have a few minutes, encourages circulation and maintains foot mobility. But don’t sit with your legs crossed because this hinders circulation and encourages varicose veins.
Keep your feet clean to prevent infection and constantly get rid of dead, hard skin, with a pumice or chiropody file. If your feet get very moist use talcum powder (sparingly) on them, and wear socks made from natural fibres such as cotton or wool, which absorb moisture unlike synthetic materials. To avoid painful ingrown toenails cut your nails straight across at least once a month, nail clippers can help you do a good job, and file with an emery board to prevent snags. Most corns and calluses can be treated at home but if they fail to respond to treatment or are causing discomfort, ask your doctor to refer you to a qualified chiropodist. Verrucas and Athlete’s foot can be troublesome and need immediate attention. Athlete’s foot is a fungal infection and very contagious, there are preparations available for home use, but Verrucas are best treated professionally. Bunions, which are a deformity of the bid toe joint, require a chiropodists advice on how best to treat them in the long term.
FOOT CARE ACTION PLAN
- Ensure that your shoes fit properly
- Keep high heels for high days and holidays
- Keep feet clean to prevent infection
- Attend immediately to Verruccas and Athletes foot
- Invest in a chiropody file and remove rough dry skin
- Cut toe nails straight across at least once a month
- Moisture and refresh your feet
- Consider compression hosiery to support and relieve tired aching legs
- Spoil yourself with a regular pedicure
- Book yourself an appointment with a private or NHS chiropodist if you have problems
- Regularly exercise your legs and feet
- Don’t cross your legs when sitting
- Rest and elevate your legs whenever possible
FEET USEFUL ADDRESSES
Footwear Advisory Service
The Disabled Living Foundation
London W9 2HU
020 7289 6111
18 Stephenson Way
London NW1 2HD
0207 916 1502
0161 652 2222
DEEP VEIN THROMBOSIS (DVT)
Today more and more people are on the move. But the huge increase in world travel, particularly long distance air travel, carries with it the potential health risk of a deep vein thrombosis commonly known as DVT. Until quite recently DVT was not generally recognised as a serious travel risk. However, it has now been proven to affect thousands of air travellers each year and can occur often in conjunction with an established illness or condition, where the natural tendency of the blood to clot is increased. A report from the Journal of Haemotology (April 2002) reveals that any form of travel over 3 hours can increase the chance of DVT in those already at risk of blood clots. Risk factors include previous thrombosis history, age, family history, obesity, surgery, cancer, pregnancy and hormonal therapies including the Pill and HRT.
Long periods of immobility, particularly on long haul flights can cause circulatory problems. Enforced inactivity, sitting in cramped conditions for long periods of time, creates blood flow problems. An inefficient, sluggish blood flow increases the risk of a thrombosis. A thrombosis is a blood clot, which forms when the platelets of the blood stick together, and also stick to the sidewall of veins occurring most commonly in the veins of the calf.. Other factors which increase this tendency, include being over 40 years of age, smoking, obesity, pregnancy, taking the contraceptive pill, or having recently undergone major surgery.
DVT is particularly serious when the blood clot gradually increases in size causing an eventual blockage in the vein. Occasionally bits of the clot will break free, and with a tail of debris behind it, can travel up the body to the right side of the heart, where it is pumped on into the lungs, causing serious breathing problems, or a pulmonary embolism. If a large blood clot travels from the leg to the heart or lungs, it can prove fatal. Many passengers suffer minor symptoms, such as fluid collecting in the lower limbs causing swollen legs and ankles, but others experience more serious symptoms including a rapid heartbeat, palpitations, and breathlessness or coughing. If a problem does occur, during or after a flight, it is essential to seek medical advice as quickly as possible, in order to avoid complications or possible death from cardiac or respiratory failure.
To prevent deep vein thrombosis, commonly known as “economy class syndrome” (because of the tight cramped seating arrangements in many planes), it is essential to walk up and down the aisles of the aircraft whenever possible during a long flight. One way to help avoid DVT is to do some simple leg and feet exercises throughout the duration of the flight. Others are to wear loose comfortable clothing during the flight and avoid crossing the legs, especially when sleeping. Long haul flights carry the most risk, but exercise and walking around whenever possible will improve circulation by encouraging action of the leg muscles. The calf muscles at the back of the lower leg pump and encourages the return of blood from the legs and feet back to the heart. On a long journey the air inside the plane’s cabin can become very dry, so it is advisable to drink plenty of fluids during the flight (and to avoid excess alcohol) in order to prevent the body becoming dehydrated. Dehydration can cause the blood to thicken.
One in 20 people, and I am included in that number, carry a gene factor known as Factor V Leiden. This gene mutation affects the blood’s clotting capabilities, and puts the carrier at a higher risk of flight related DVT. Most people are not aware that they are carriers or at greater risk, and my own vulnerability came a surprise to me. It was discovered after I had breast cancer, and was a result of medical testing to establish whether I carried the breast cancer gene. I have many young girls in my family who might have been at a higher risk of presenting with breast cancer had I, their close relative, been found to carry the gene. Fortunately for all of us concerned, the tests concluded that I do not carry the breast cancer gene, but discovered that I do carry the Factor V Leiden gene. I was advised to take an aspirin prior to flying to lessen my risk of DVT.
Taking a simple aspirin before a long flight is a simple precaution, which can help thin the blood and discourage the blood from clotting. However aspirin is not advisable for anyone who has an established medical condition such as a stomach ulcer. If you are concerned about the risks involved with flying long distances, it is a good idea to talk to your GP, particularly if you have had phlebitis or a previous thrombosis.
Doing simple feet and leg exercises during a long flight can prevent the risk of developing DVT.
LEG & FOOT EXERCISE
Rock and Roll (sit or stand)
To increase circulation in the legs and to maintain mobility of the ankles
- With feet on the floor, simply raise your toes and forefoot up keeping your heels on the floor. Then lower your toes down and with a rolling action lift your heels up. Repeat vigorously 15 – 20 times.
Flip Flap (sit or stand)
To increase circulation in the legs, exercise the foot and improve the calf muscles
- With feet flat on the floor spread out your toes, bring them up towards you keeping your heel on the floor. Now clench your toes, point them down and lift your heel up. Repeat 10 -15 times
Circle (sit or stand)
To increase circulation in the legs and maintain mobility of the ankles
- Lift your foot off the ground, point your toes and rotate and circle the ankles first clockwise 15 times, then anti-clockwise 15 times. Repeat with the other foot.
Bicycle (sit or stand)
To improve circulation and strengthen the leg muscles
- Bend and stretch out leg in a bicycling movement to a slow count. Rest and repeat with other leg 10 times.
Lift (sit or stand )
To strengthen the quadriceps (front thigh muscles and improve leg mobility)
- Sit on an upright chair, or stand using the chair for support. If sitting bend knees and place feet flat on the floor. With feet and toes pointed upwards, slowly straighten one leg out and lift it up. Hold for 3 sec. Relax leg down and repeat with the other leg. Perform sequence 15 – 20 times.
To improve circulation and cardio vascular efficiency and to strengthen legs and increase general mobility
- March with a strong heel/toe action up the stairs or march around the room or garden raising one leg and then the other, for 5 – 10 minutes. You could put your favourite music on. It’s fun and very beneficial to move rhythmically to music! Stand tall and upright – don’t lean forward or backwards. Breathe regularly. Be careful not to trip on loose mats
(For those who are chair bound it is possible to show a seated “marching” movement – as an alternative.)
To relieve heavy aching legs and varicose veins by encouraging blood to flow away from the feet and legs.
- Whenever possible take the opportunity to elevate and rest your legs. Lie comfortably on the bed, settee or floor with a small pillow to support your head. Stretch out your legs and place them high up on some pillows or cushions, making sure your feet are higher than your heart. Relax!
We all know prevention is better than cure, so why don’t we always heed these words of wisdom? We in Britain have a health service, which offers the facility of screening for many potential illnesses, but in particular for women, screening for cervical cancer and breast cancer. Breast cancer screening is available for women aged 50 – 70 years of age, this can detect disease at an early stage, when treatment is most effective. But some women do not take advantage of the invitation to be screened and prefer to keep their heads in the sand! Breast cancer deaths have dropped by 30% in the UK in the past decade due to improved treatment drugs (Tamoxifen) and early detection. A simple smear test usually carried out every 5 years on women who are, or who have been, sexually active can detect cervical cancer in it’s early stages (when it is curable) or can pick up abnormalities before they become a problem.
The word cancer describes over 200 different diseases, not just one. But they all have one thing in common. They are the result of a fault in one of the body’s millions of cells. These cells can grow out of control, multiply and a cancerous tumour forms. Insidiously it can be 20 years or so before they become evident. It is important to detect cancer in its early stages. It is easier to treat and the results are more successful as I know from my own experience of breast cancer. Left until later it can be difficult to treat and sadly, sometimes impossible.
The kind of work we do and where we live has been proven by scientists to play a part in just who will or will not, get the disease. Cancer affects many people’s lives, either directly or indirectly. One in three of us will present with cancer at some time in our lives. Of the quarter of a million new cases of cancer in Britain every year 70% occur in people over the age of 65. It’s important to realise that the risk of cancer increases with age, although skin cancers are affecting many young people. It’s common sense to help ourselves to better health, which we can do if we lead a healthy lifestyle and if we are aware and have regular checks.
Some cancers, such as cancer of the bowel, which kills 18,000 in Britain each year, can possibly be avoided by making changes in diet. Eating a diet rich in high fibre, such as fruit, vegetables and cereal fibre has been proven to be beneficial. Scientists believe that at least one third of cancers are diet-related and advise that we also cut down our intake of fatty foods, sugar and salt.. We will look at this in more detail in our section on nutrition. Drinking too much alcohol can cause cancers of the liver, mouth and throat. It’s plainly obvious to us all that smoking can cause lung cancer, but still people regularly risk their lives. Smoking causes one third of all cancer deaths. Recent appalling figures have shown that lung cancer is now beating breast cancer as the major cause of death in women.
Exposure to the sun is now known to be dangerous. People with fair or freckled skin are particularly at risk, and the rest of us must avoid over-exposure, and take steps to protect our skin from sunburn. Our young children especially, should be kept out of the sun completely. I love the warmth and brightness of a sunny day, but since my brush with cancer I restrict my time in the sun to early mornings and late afternoons, and always wear a sun block and hat to protect me. Fortunately today, most quality skin care products contain SPFs (sun protection filters) but we must still be especially careful of the sun’s burning rays at mid-day, and when we are abroad working or on holiday in hot countries.
It pays to be vigilant. If you do see unexpected changes to your body take charge and go and see your doctor! Find out what is going on. For example 1 in 10 breast lumps are found to be harmless. If breast cancer is diagnosed in it’s early stages there is a very good chance that it can be treated successfully – as I was lucky enough to discover for myself. If you are worried about abnormal bleeding, or persistent problems such as changes in bowel movements, a continuing cough, or an unexplained drop in weight, go to your doctor and ask him to investigate the problem. You owe it to yourself and your family to take great care of yourself. I don’t want to be a burden to others when I am older, so for this reason I intend to do everything possible to avoid the situation.
CANCER ACTION PLAN
- Contact your GP or WellWoman clinic for a smear test
- Be breast aware. Once a month regularly check your breasts and report changes to your GP without delay
- If you are aged 50 – 70 take advantage of the government breast screening programme (mammogram)
- Ask your doctor about regular screening if you think you are high risk of developing cancer
- Don’t smoke
- Discourage your children from smoking
- Eat less fat
- Eat less sugar
- Increase the amount of fibre in your diet
- Eat plenty of fresh fruit and vegetables
- Don’t overcook vegetables (this destroys vitamins)
- Limit your alcohol intake
- Use a sun screen when you are outdoors working or playing
- Don’t sunbathe
- Wear a hat and avoid the midday sun
- Avoid using sunbeds
- Avoid unnecessary X-ray examinations
- Use a condom and avoid casual sex
- See your GP if you have persistent or unusual discharge or bleeding
- Check out a lump anywhere in your body or changes to a mole
- Take advice if you have persistent constipation or diarrhoea
- See your doctor if you have a persistent cough or hoarseness
- Take medical advice if you are considering Oral contraceptives or Hormone replacement Therapy or have been on either for over 2 years
- Check with your doctor if you have unexplained weight loss
CANCER USEFUL ADDRESSES
Cancer Research UK
61 Lincolns Inn Fields
020 7242 0200
British Association of Cancer United Patients
8 Bath Place
London EC2A 3DR
0808 800 1234
Breast Cancer Campaign
110 Clifton Street
London EC2A 4HT
0207 749 3700
Breast Cancer Care
210 New Kings Road
London SW6 4NZ
020 7384 2984
Marie Stopes House
108 Whitfield Street
London W1P 6BE
020 7 574 7400
Marie Stopes One call
0845 300 8090
Royal Marsden Hospital
London SW3 6JJ
0207 352 8171
Breast Cancer Care
210 New Kings Road
London SW6 4NZ
Helpline 0808 800 6000
Breakthrough Breast Cancer
London WC2B 6QX
020 7430 2086
Bristol Cancer Help Centre
Bristol BS8 4PG
0117 980 9500 Helpline 0117 980 9505
Marie Curie Memorial Foundation
28 Belgrave Square
London SW1X 8QG
0207 431 9772
MacMillan Cancer Relief
15-19 Britten Street
London SW3 3TZ
0845 601 6161
Almost twice as many women in the UK die from a heart attack or circulatory disease as they do from cancer. 5 times as many die from Coronary Heart Disease (CHD) as they do from breast cancer. CHD kills 1 in 5 women (approx. 70,000 in 1995). Women tend to assume that CHD is a man’s disease and that it is men who are the victims of the disease but that’s not the case. Older women as opposed to young women are most at risk of a heart attack and sudden death. Sadly fewer women than men survive a heart attack but if they do the attack may well result in years of disability and the quality of their lives will be seriously affected.
It is essential that we all know and heed the warning signs if we are to prevent a heart attack. We shouldn’t ignore central chest pains, which may simply be indigestion, but could be something far more serious. We need to take action and see the GP if there is a tight feeling in the chest or breathlessness when we try to hurry, or when we are carrying heavy shopping. Neither should we ignore any twinges we might feel going down the arm and up into our necks since they could indicate that something is seriously wrong. Women who suffer from depression appear to be more susceptible to heart disease, but their symptoms of erratic heart beat and panic disorders can often be wrongly diagnosed as distressing emotional problems surrounding the depression, instead of the warning signs of possible coronary heart disease.
We would be foolish to not take notice of these symptoms and if we have chest pains we should go to our GP and ask him to investigate them. However, if the pain is crushing an ambulance should be called immediately because it could be a heart attack, and fast medical attention is vital. What can we do to prevent CHD, a heart attack or worse still, an early sudden death? 17% of premature deaths in women are from coronary heart disease. It does mean changes in lifestyle, but no woman wants to cause her family and loved ones the distress of an early death. Neither would she want to impose on them the responsibility of looking after her if she was to survive the attack and became disabled, and especially so if she lived on her own.
The heart is a muscle which pumps oxygen rich blood around our bodies through a system of veins and arteries. The heart requires oxygen and nutrients itself to function efficiently. CHD can affect and interfere with the flow of blood through the coronary arteries and cause the heart to pump less effectively. Coronary heart disease affects the arteries in two ways. In the first place the artery walls can get “furred up” restricting the space inside the artery and making it more difficult for the blood to flow through. When this occurs it is known as atheroma and it affect some people more than others. Secondly, if a blood clot forms in the arteries, which supply the heart muscles with oxygen and blood, it can cause a blockage of the artery and this condition is called thrombosis. Atheroma or thrombosis can cause angina (pains in the chest, neck and arms), or a heart attack, or even sudden death. Angina is the most common form of coronary heart disease and takes the form of a pain in the chest brought about by exercise or emotion. Heart and circulatory diseases are the UK’s biggest killers and the death rates from CHD in the UK are amongst the highest in the world. These are figures not to be proud of, so we should all be aware of the risk factors surrounding coronary heart disease.
26% of British women still smoke despite the warnings of risks to their health. 11% of deaths from coronary heart disease in women are due to smoking. Women who smoke but also take the contraceptive pill increase their risk of coronary heart disease. If a woman has high blood pressure, and especially when the blood pressure is continually raised, there can be a major risk of CHD or stroke. A major risk factor is diabetes, and women with it are three times more at risk, than those who are not diabetic. If they smoke or have high blood pressure the risk increases still further. A further risk factor is high blood pressure, which can be genetically inherited, or it can develop if a person is overweight, eating large amounts of salt or drinking excessive amounts of alcohol. Getting stressed out, or taking certain drugs, or having kidney disease or narrow arteries are further risk factors.
Women whose father or mother died of a heart attack before the age of 60 are at risk and 5 times more likely to have fatal heart attack themselves. Being overweight is linked to higher blood cholesterol, raised blood pressure and diabetes and it could cause a person to become a heart attack victim. One in three women have high blood pressure but are not receiving treatment. A person with high blood pressure is twice at risk of a stroke, so it’s wise to have your blood pressure checked regularly.
Until the time of the menopause women do not have the same risk of coronary heart disease as men, because of the female hormone oestrogen which keeps blood vessels healthy and prevents diabetes. After the menopause research indicates that women taking hormone replacement therapy(HRT) halve the risk of death or disability from CHD and as a bonus the HRT helps to protect their bones and the risk of the thinning bones disease, osteoporosis. We need cholesterol in our bodies to make healthy cells and hormones and the cholesterol is carried around our bodies in the bloodstream. But if we have too much cholesterol it starts to furr up our arteries. We can lower our cholesterol levels by watching our fat intake in our diet. The average diet in the UK is most unhealthy and we eat too much fat and not enough fruit and vegetables We need to eat polyunsaturated and monounsaturated fats (vegetable oils such as sunflower, rape seed and olive oil etc) instead of saturated fat (animal fats such as milk, butter, cheese, fatty meat, chicken skin etc). For further information see section 2 on nutritional fitness.
To help yourself avoid coronary heart disease ensure you have an adequate intake of vitamins from your diet or consider vitamin supplements. Recent research suggests vitamins A C and E ( termed the ACE vitamins) in particular may afford some protection from heart disease. Low dosages of aspirin are known to reduce the risk of CHD but aspirin should only be taken on a regular basis on the advice of your GP. Drinking 1 or 2 units of alcohol a day is also associated with lowering the risk of death from heart disease amongst women, but more than two units a day raises blood pressure and can trigger abnormal heart rhythms and heavy drinking can cause actual heart failure. Exercise is a major factor in lowering blood pressure and the risk of coronary heart disease so aim to do 30 minutes of physical activity every day. Stress can contribute to the onset of a heart attack and heart disease so try to relax and deal with your pent up emotions for your heart’s sake.
HEART ACTION PLAN
- Consult your doctor if you have tightness or pain in your chest or pains in your arms and neck
- Call an ambulance if the pain is crushing
- Watch your weight and eat plenty of fresh fruit and vegetables
- Reduce your intake of fatty foods and eat less saturated fats, watch your cholesterol levels
- Eat more fish, and poultry minus skin Tell your doctor is you experience depression, panic or erratic heartbeat
- Stop smoking
- Take more exercise aim for 30 minutes activity each day
- Cut out excess salt from your diet
- Discuss with your GP the risk of CHD if you are on the contraceptive pill
- Consider taking vitamin supplements (ACE vitamins)
- Don’t drink excessively
- Discuss taking a low dosage of aspirin with your GP if you already suffer from CHD
- Consider hormone replacement therapy to protect you from CHD
- Learn to relax
For more information see Relaxation page……and Stress page…….
HEART USEFUL ADDRESSES
British Heart Foundation
14 Fitzharding Street
London W1H 6DH
020 7935 0185
Heart Helpline 0870 600 6566
British Cardiac Patients Association
100 Anerley Road
London SE19 2AN
0208 789 5591
British Dietetic Association
Email firstname.lastname@example.org (DM needs to check)
C Copyright Diana Moran Sept 2003