By Dr. Bloomfield.
Spend 60 seconds a day thinking about your health.
Spend 60 seconds a day thinking about your health.
For some reason, this winter your Personal Trainer Sydney CBD has noticed that gastro has been rampant amongst his clients.
People ask, what can I do?
The short answer is, not a lot. Acute viral gastroenteritis is usually self-limited and is treated with supportive measures (fluid repletion and unrestricted nutrition). No specific antiviral agents are available.
Fluid maintenance and repletion
For most adults who suffer with acute viral gastroenteritis, dehydration will be a major concern but generally fluid levels can be maintained with sport drinks and broths. For adults presenting with mild to moderate dehydration, the evidence suggests oral rehydration solutions may be superior to sports drinks in maintaining electrolyte balance along with hydration. Patients with severe dehydration require intravenous fluids. Soft drinks and fruit juices that are high in sugar content should be avoided.
In adults with acute viral gastroenteritis, we do not recommend adherence to any restricted diet. Patients should be encouraged to eat as tolerated. Smaller meals may be less likely to induce vomiting than larger ones. Bland, low residue foods may also be better tolerated than others. For healthy adults with acute viral gastroenteritis without signs of dehydration, sport drinks, diluted fruit juices, and other flavored soft drinks augmented with saltine crackers and broths or soups can meet the fluid and salt needs in almost all cases. Broiled starches/cereals (potatoes, noodles, rice, wheat, and oat) with some salt are excellent foods to consider. In addition, crackers, bananas, yogurt, soups, and boiled vegetables can also be consumed.
While the BRAT diet (bananas, rice, applesauce, and toast) is often recommended, the evidence to support it is weak. Similarly, while many authorities advise patients to exclude milk and dairy products from their diet during the episode of diarrhea and for several weeks after symptoms resolve, the evidence to support this is weak.
The value of oral probiotics in acute viral gastroenteritis is not well established, and further research is needed to determine the optimal type, dose, and regimen of probiotics before they are recommended for routine use.
The effect of zinc supplementation on duration of diarrheal illnesses in adults has not been studied, and its use is not the standard of care.
Antimotility agents (drugs that stop you pooping)
In adults younger than 65 years of age with acute viral gastroenteritis and with moderate to severe diarrhea or signs or symptoms of severe dehydration, a one- to two-day course of loperamide (4 mg orally, followed by 2 mg after each episode of diarrhea, up to 8 mg/day) may be appropriate. For adults ≥65 years of age, loperamide is not recommended for self-medication, and patients should be closely monitored if taking it under the guidance of a physician.
Antiemetics (drugs that stopyou vomiting)
Although studies in adult populations are lacking, for patients who cannot tolerate oral rehydration due to excessive vomiting, I suggest treating with an antiemetic (eg, prochlorperazine or ondansetron) as needed for one to two days to facilitate oral fluid repletion.
In adults who clearly have acute viral gastroenteritis (eg, outbreak with known etiology), I do not recommend the empiric use of antibiotics. In general, empiric therapy for community-acquired acute diarrhea (of unclear etiology) may be beneficial but does not appear to dramatically alter the course of illness in unselected populations. If patients initially treated with supportive measures do not improve after seven days or symptoms worsen, then they should be reevaluated and possibly treated for other causes of gastroenteritis.
When to hospitalize
Potential indications for hospitalization include the presence of alarm symptoms or signs, or individuals at risk for complications (eg, dehydration), including:
●Abnormal electrolytes or renal function
●Excessive bloody stool or rectal bleeding
●Severe abdominal pain
●Prolonged symptoms (more than one week)
●Age 65 or older with signs of hypovolemia
●Comorbidities (eg, diabetes mellitus, immunocompromised)
Personal trainer Sydney CBD really hopes you don't get gastro this winter but if you do, see your local doctor for further advice.
Tennis elbow or elbow tendinopathy affects many people who see a Personal Trainer Sydney CBD. Perhaps the most surprising this for most people who suffer from the condition is that they never actually played tennis.
So what is elbow tendinopathy? — Elbow tendinopathy is a condition that causes elbow pain and forearm weakness. Doctors use the term "elbow tendinopathy" when people have a problem with a tendon in the elbow. Tendons are strong bands of tissue that connect muscles to bones. Depending on which elbow tendon is injured, the condition is also known as "tennis elbow" or "golf elbow."
In most people with elbow tendinopathy, the tendons are not inflamed or swollen. If they do get inflamed or swollen, doctors call it "tendinitis."
Tendinitis usually starts suddenly. Tendinopathy usually happens over a longer period of time.
What causes elbow tendinopathy? — This condition can happen as people get older, especially if they do a lot of work or activity using their elbow and forearm. Tendinitis can happen when people get hurt or do the same movements over and over.
What are the symptoms of elbow tendinopathy? — The most common symptoms are:
●Elbow pain – The pain can start slowly or suddenly. It can spread to the upper arm or forearm.
●Weakness of the forearm muscles
●Swelling (if people have tendinitis)
Is there a test for elbow tendinopathy? — No. But your doctor or nurse should be able to tell if you have it by talking with you and doing an exam.
If you think you suffer from elbow tendinopathy and would like to get a treatment plan then get in touch with your local Personal Trainer Sydney CBD.
Approximately 1 in 6 Australians suffer from back pain every year. Thus, for a Personal Trainer Sydney CBD it is imperative to be able to take an accurate and detailed history of a patients back pain.
While it may not be possible to define a precise cause of low back symptoms for most patients, it is important to evaluate for evidence of specific etiologies of back pain. The history should include location, duration, and severity of the pain, details of any prior back pain, and how current symptoms compare with any previous back pain.
We should also ask about constitutional symptoms (eg, unintentional weight loss or night sweats), history of malignancy, precipitants or precipitating events, therapies attempted, neurologic symptoms (eg, weakness, falls or gait instability, numbness or other sensory changes, or bowel/bladder symptoms), stability or progression of symptoms, history of recent bacterial infections (particularly bacteremia), recent history or current use of injection drugs, history or current use of corticosteroid medications, and recent history of procedures in the back.
Patients should also be evaluated for social or psychologic distress that may be contributing. Potentially useful items are a history of failed previous treatments, substance abuse, and disability compensation. Screening for depression may be helpful.
Though less common, features that may suggest underlying systemic disease include history of cancer, age >50 years, unexplained weight loss, duration of pain >1 month, night time pain, and unresponsiveness to previous therapies. Injection drug use, recent bacterial infection (particularly bacteremia), or fever increase the suspicion of spinal infection.
If you've got back pain, get in touch today!
There are a number of questions that are important for differentiating the underlying cause of knee pain and these should be considered by all Personal Trainer Sydney CBD. These questions are important for narrowing the differential diagnosis and should be asked of every adult patient presenting with knee pain:
●Did pain begin following an acute traumatic event? Pain immediately following an injury is concerning for possible structural damage to the knee. Delayed pain suggests tendon strains, cartilage contusions, or minor soft tissue tears. The closer the pain onset is to the specific event, the higher the likelihood of significant structural damage.
●Is the pain associated with activity (eg, new exercise regimen, change in previous training habits, day-to-day activity over the preceding few months)? Pain associated with activity should lead to further inquiry about training equipment (eg, shoes, braces), training volume (eg, training days per week, duration of training sessions), intensity, and any recent changes in such parameters. Information about specific activities that trigger pain can be helpful. As an example, anterior knee pain associated with sprinting or jumping is a classic part of the history of patellar tendinopathy.
●In which anatomic quadrant is the pain located (anterior, posterior, lateral, or medial), or is the pain diffuse or vague? Localizing knee pain to an anatomic quadrant or more specific location helps circumscribe the differential diagnosis. Pinpoint localization is generally possible following trauma to a specific ligament, tendon, or other palpable anatomic structure. Pain described as diffuse or vague may be secondary to injury of an intra-articular structure, a rheumatologic or infectious process, or from referred pain.
●Has the painful knee been swollen (ie, joint effusion) or erythematous? Rapid swelling after trauma occurs with bleeding into the knee joint and suggests a significant injury (eg, anterior cruciate ligament tear). Swelling or erythema occurring without trauma may indicate an infectious, rheumatologic, or crystal-induced condition and diagnostic arthrocentesis is often indicated.
●Are constitutional symptoms, such as fevers, chills, night sweats, fatigue, or rash, present? The presence of such symptoms and signs suggests a systemic illness and further investigation of infectious, autoimmune, or neoplastic causes is necessary.
●Is there a history of prior knee injury or surgery? A past history of knee injury is the most accurate predictive risk factor for future knee injury. The clinician should inquire about the type of injury, duration of disability, and the rehabilitation program. Often, a new knee injury is a complication of an old or concurrent injury. As an example, patellofemoral pain can develop in patients who alter their running gait due to discomfort from chronic Achilles tendinopathy. Likewise, prior surgical repairs can "wear out" or fail, leading to recurrence of the initial condition. All patients with prior injury or surgery experience some degree of deconditioning while injured and recovering. This deconditioning, combined with poor or incomplete rehabilitation, predisposes to new injuries.
●Are there symptoms affecting any other joints? Subjective symptoms and/or examination findings that reveal multiple affected joints raise suspicion for a systemic or rheumatologic process.
●Is there a history of systemic or rheumatologic disease? A known history of a systemic or rheumatologic disease can help to guide clinical inquiry, physical examination, and possible laboratory testing.
Consider these questions and discuss the answers with your Personal Trainer Sydney CBD who will be able to help develop a management plan for you.
Many personal training sydney CBD clients find it difficult to maintain weight loss with lifestyle modification alone. In these cases, adding a medication may prove to be effective. Historically, not too many pharmacotherapies have survived the ire of the therapeutic goods administration. In addition, previous treatments such as phentermine-fenfluramine, rimonabant and sibutramine were withdrawn due to safety issues, resulting in lingering safety concerns.
There are however, four new therapeutic options in the wings, three of which may be approved in Australia shortly and one — liraglutide 3.0 mg — was approved in December 2015. Liraglutide is a glucagon-like peptide-1 receptor agonist that appears to act by increasing satiety and reducing food intake. Lorcaserin is a selective agonist of the serotonin2C receptor, which mediates anorecticactivity. The naltrexone/bupropion extended release (ER) combination utilises synergistic effects of the two component drugs, mediated via neurons in the hypothalamus, to reduce energy intake. Phentermine/topiramate ER combines the appetite suppressant phenterminewith topiramate, an anti-epileptic with appetite-suppressant effects. All can result in meaningful improvements in obesity-related diseases, including diabetes and cardiovascular disorders.
The landscape of obesity treatment in Australia is changing rapidly. Whilst encouraging, it should be noted that all options have associated adverse side-effects so consult your medical doctor for more information.
Many Personal Trainers in Sydney have clients with type 2 diabetes - the global epidemic continues. The WHO predicts that diabetes will be the 7th leading cause of death in 2030. For prevention, body weight management and a healthy diet are recommended. Furthermore, at least 30 min of regular, moderate-intense physical activity five times a week is required. Unfortunately, these strategies suffer from low levels of compliance.
Low levels of exercise compliance is a common issue faced by Personal Trainers Sydney. There are myriads of intervention studies dealing with the best exercise type, frequency, intensity, and duration. The scientific discussion is still ongoing. Indeed, positive effects of regularly performed exercise on cardiorespiratory fitness and metabolic control are without dispute. Despite this knowledge, less than 40 % of European countries developed national recommendations for physical activity.
Most of the conducted studies into diabetes and exercise found improvements in metabolic and cardiorespiratory endpoints after training intervention, but highly variable inter-individual responses were observed. For example, glucose homeostasis, reflected by insulin sensitivity, acute insulin response, glucose effectiveness, and glucose disappearance index was shown to have a two-sided shape, ranging from high responders to non-responders, even adverse responders that show a deterioration of the respective endpoint.
Non-response defined as no improvement regarding glucose homeostasis, leads to 7–63 % non-responders. Most of the conducted studies are performed without a control group. Thus, the opinion exists that exercise might cause adverse metabolic effects for some individuals. However, a study carried out with 87 participants including a control group, demonstrated clearly a decreased number of an adverse response (41 %) versus 76 % in control group; the adverse response was defined as increased fasting glucose, 2-h glucose, and triglycerides, as well as a decrease for HDL-cholesterol.
Notably, the failure to improve one metabolic factor is not necessarily reflected by a non-response in other variables, e.g., VO2max, and vice versa. Although there is a clear positive correlation of VO2max and insulin sensitivity in the general population and an increase in VO2max correlates with the improvement in glucose homeostasis, this is not true for each individual. Furthermore, despite a relevant exercise-related improvement of systolic blood pressure, body weight, VO2max, lipid profile, etc., one may not have a beneficial effect on glucose homeostasis; this adds even more complexity to this issue.
It is still under debate, exactly which training intervention is the best, but our best guess is a combination of low-amount/vigorous-intensity aerobic exercise and resistance training. Athletes have practised High-intensity interval training for some time, and it can be superior to moderate-intense, time-consuming continuous training in improving glucose homeostasis after just short training duration.
In general, we should clearly encourage personal training clients to increase their physical activity. There are many aspects, e.g., socio-economic, quality of life, etc., beyond specific metabolic endpoints, which are worth being an active individual. Nevertheless, personalised adjustments of exercise recommendations are inevitable, different training strategies for individual subgroups may be necessary.
Who is the non-responder? What are risk factors for non-response? How can we predict the non-response with easy-to-use parameters? Which of several training regimes could overcome non-response? Is interval training the new winner? Is there a correlation of several metabolic endpoints? To what extent? And valid for every individual? What are the underlying molecular pathomechanisms for non-response? Are we able to discriminate discrete pathomechanisms, and what is their impact on whole-body glucose homeostasis?
So many questions, so few answers. For now, just keep exercising.
Personal Trainers generally enjoy cardio exercise!
But did you know, cardio exercise doesn't just improve physical wellbeing; it also improves cognition and mental health?
The brain is continuously balancing two conflicting requirements: it must retain enough structural integrity to maintain proper neurotransmission, while remaining malleable enough to restructure itself and adapt to changing environmental demands. The interest in the underlying biology which underpins the link between cardio exercise and a better brain has increased significantly over the past decade, giving hope that prescriptive exercise programs for the treatment of 'brain disease' might not be far away.
Regarding the brain structures most affected, it seems the hippocampus may hold the key. Research shows that the addition of cardio exercise to existing treatment approaches may promote hippocampal function and alleviate cognitive deficits. Cardio exercise also has a potent impact on stimulating neuroplasticity. These findings are important as cardio exercise has general benefits to one's physical health, low-risk profile and is relatively easy to implementation for patients. It may also have many other advantages to patient well-being, such as limiting the risk of adverse side effects of current therapies.
Ask your personal trainer about cardio for your brain today...
Written for MedLab.
Physical activity, by definition, is an umbrella term which encompasses any movement of the human body produced by skeletal muscle contraction, leading to an increase in energy expenditure. Physical activity in daily life can be broken down into exercise, occupational, sports, household, or other activities. Exercise, as a subset of physical activity, is a planned, structured, and repetitive activity that has as a final or an intermediate objective. This is the core business of a personal trainer.
In the world of exercise, there has been an explosion of exercise styles in recent years. People have been experimenting with the way they move their bodies through a myriad of different forms of exercise, everything from Crossfit to Zumba. As far as the literature is concerned, there are essentially three forms of exercise that have been studied: aerobic exercise, High-Intensity Interval Training (HIIT) and resistance training.
Aerobic exercise, synonymous with cardio exercise, is a form of physical activity that is performed at a steady rate, typically within 60-80% of your maximum heart rate. This steady state means that the body uses oxygen to meet its energy demands. This form of exercise can be done for extended periods of time and is the most extensively studied form of exercise. High-intensity interval training (HIIT), synonymous with Intervals, uses alternating periods of intense anaerobic exercise with a less intense recovery period. HIIT is also a form of cardio exercise but generally speaking, participants are only able to perform this type of training for shorter periods than aerobic exercise. Resistance training, synonymous with weight training, induces muscle contraction against high loads of resistance which have the net effect of building the size and anaerobic endurance of skeletal muscles. All three forms of exercise have been shown to improve health. Significant benefits are observed in the prevention and treatment of all -cause mortality, cardiovascular-related mortality, diabetes, cancer, and osteoporosis.
But what about mental health? Does exercise improve outcomes for patients with depression? Doubts were cast over the efficacy of exercise as a therapy for depression when a Cochrane review paper in 2013 concluded that, although there was a moderate benefit in symptom reduction for patients with depression engaged in exercise vs. control groups, there was not a statistically significant difference when the analysis only included high-quality studies. This study received widespread attention at the time and was quick to be countered. A subsequent meta-analysis found large antidepressant effects of exercise on depression when compared to non-active controls. Interestingly, the antidepressant effect of exercise was higher for studies that included participants diagnosed with MDD. The authors of this review highlighted that control groups used in clinical trials often recorded substantial and significant antidepressant effects, which makes the detection of effects in exercise groups much more challenging. Further, they explained the difference in their finding vs. the Cochrane review as being due to three factors: (1) the inclusion criteria, (2) the statistical test used to evaluate the ES, and (3) the inclusion of more recent trials.
Despite the effect on symptom reduction, remission rates in clinical trials are similar to pharmacological interventions and display a significant amount of heterogeneity depending on the amount of exercise performed. One potential explanation to the heterogeneity in response rates can be due the heterogeneity of depression itself. This is an important point for the future researcher to navigate. Despite these difficulties, there does appear to be a dose-response relationship on depression which is a trend seen when examining other physical health conditions. It seems, about half of people with depression will experience significant improvements from exercise with greater improves seen with those who exercise for longer.
Exercise plays an important part in an overall management plan for depression. Given the significant benefits for overall health and its low side effect profile, patients should be encouraged to engage in regular exercise. Regarding which type of exercise is best, in clinical samples, only aerobic exercises had significant effects on depression in clinical studies, though it should be stressed that resistance exercise has only been considered in a handful of studies. Moreover, no RCT was identified when investigating the effects of resistance exercise in samples comprised entirely of participants with MDD. Supervised interventions had the most profound effects. Interestingly, where the exercise takes place may have a small impact on outcomes. It seems that exercise programs that were completed outdoors were more effective than those performed indoors. Mum’s advice to go out and get some fresh air might not be so trite after all. Regardless of where it takes place, we can be confident that seeking professional expertise to oversee the exercise program is of paramount importance. Exercise supervised by professionals with relevant training, including personal trainers and exercise physiologists, was associated with the greatest improvements in patients with depression. This result, added to previous findings of lower dropout rates in interventions delivered by exercise professionals in people with depression, highlights the importance of adequately trained professionals providing exercise interventions. Key considerations for the physician referring to an exercise professional include convenience, cost, and style of program. It is also important to involve social supports into the overall exercise plan. Supports that are educated on the benefits of exercise and gain an understanding of what the patient is trying to achieve can improve outcomes for the patient.
The exact dose of exercise for the management of depression still requires further investigation. Moderate and vigorous-intensity exercises were shown to be more effective than light to moderate intensity exercises. However, this finding needs to be interpreted with caution, since it is based on a small number of studies. That being said, the American College of Sports Medicine (ACSM) released a position stand which recommended 150 minutes per week for maintenance of good health. The ACSM recommends that most adults engage in moderate-intensity aerobic exercise training for 30 minutes a day, five days a week. This recommendation is in alignment with the Australian government's physical activity target's for good health. The ACSM also recommends 2-3 days per week of resistance exercises.
Hippocrates, the father of medicine, once said that walking is man’s best medicine. He might be right indeed.
As we transition out of the winter months toward to glory of spring, nature will once again serve as a backdrop to Personal training Sydney CBD. And it seems that there may be a renewed impetus for this location shift. A study published in 2010 showed that exercise performed outdoors improved mood and self esteem to a greater degree than those who experienced the same sessions indoors. Indeed, the effect was amplified if the outdoor location was within sight of water!
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