When extra care is needed

Children

Children call exercising ‘going out to play’ and their hearts, lungs, muscles and joints respond very positively. When it comes to taking part in training sessions for those children and adolescents who are seriously interested in a particular sport, however, care is needed to avoid repetitive stresses on their growing bones, muscles and tendons. Overtraining and undue repetitive stresses can lead to problems with the shoulders and elbows, knees and heels. One important point to remember is that, because they are growing fast, shoes, gumshields and helmets will need to be regularly refitted and replaced. Up to the age of 14, boys and girls show similar injury patterns but, after that, boys are three times more likely to be injured than girls of the same age.

If you’re looking after children who are exercising outside, bear in mind that they are more susceptible to heat- and cold-induced illness and injury than adults so you need to be extra careful in very hot or cold weather.

Children can also undertake standard training programmes. For example, they can begin resistance training from the age of seven provided that they are sensibly introduced to basic exercises with little or no weight. Over the years the number of exercises can be gradually increased until around the age of 16 or older when the child progresses to an adult-type resistance training programme. Any such programme must always be properly supervised by someone who knows what they’re doing. Children can improve their strength with resistance training with little or no change in muscle size.

Children also respond positively to anaerobic training which increases their capacity to use this kind of energy and to aerobic training to build up their endurance. Regular training reduces their total body fat without affecting their growth or the rate at which they mature. The most important thing is to avoid overtraining.

Women

Women experience the same training effects as men but in general tend to lose less fat. They respond extremely well to strength training, becoming stronger and more powerful without necessarily increasing muscle bulk. Their heart and lungs adapt in much the same way as men’s. They develop a greater capacity to deliver oxygen efficiently to their tissues with endurance training.

If you’re a woman taking part in activities that involve rhythmic repetitive movements, such as long-distance running or aerobics, always wear a well-fitting sports bra or apply grease to your nipples to prevent chafing. As adolescent girls develop into women, the alignment of the thighs and the pelvis changes and as a result women are more prone to knee and ankle injuries than men. Get medical advice if you develop persistent knee problems or pain in the ankles.

There is no reason why you shouldn’t continue doing your usual exercise or sport while you’re having your period, although some women athletes prefer to regulate their periods by going on the pill. Some types of activity may result in irregular periods and decreased fertility and, when training is intense, periods may stop completely because of a fall in the level of the female hormone oestrogen. This is of no consequence in the short term, especially if having a child is not an issue, but, if it continues for several years, the low levels of oestrogen put the woman at risk of developing osteoporosis.

Women who experience severe symptoms of PMS (premenstrual syndrome) may have problems in sports where fine judgement is required. Not everyone is affected and those who are may find regular exercise helps to alleviate the problem, and it can also ease painful periods. Very heavy periods can interfere with exercise and, in severe cases, can cause anaemia which makes you feel very tired. A poor diet may also result in anaemia, but, whatever the cause, the condition needs to be diagnosed and treated by your doctor.

Exercise during pregnancy

When you are pregnant, your body undergoes a series of dramatic changes. Your weight increases by about 25 per cent and your metabolic rate and oxygen consumption increase as well. You need 3,000 more kilocalories per day. The thyroid gland enlarges in 70 per cent of women and there are changes in carbohydrate metabolism, plasma proteins and nitrogen balance.

The volume of blood circulating round your body increases by up to 40 per cent, and its composition changes too, with higher levels of red blood cells and blood fats (lipids). Your blood also clots more easily. Your heart rate rises as does the stroke/volume of the heart (the amount of blood pumped into the circulation with each beat of the heart). You’ll notice a difference in the way your bowels and bladder work, and the ureters (tubes) leading from the kidneys to the bladder expand.

You don’t need to stop exercising during pregnancy. Indeed there is good evidence that regular exercise may improve the quality of the pregnancy and make your contractions more effective during labour. There are, however, some types of exercise that you should avoid while you’re pregnant (see page 40) and you’ll need to reduce the amount you do in the last three months.

If you have been exercising before becoming pregnant you should carry on but reduce the intensity of the exercise with a recommended maximum heart rate of 140 beats per minute. Don’t do more than 15 minutes at a time two to three times per week. If you did not exercise before your pregnancy began, be careful about taking it up now and get advice from your doctor, midwife or antenatal teacher.

Taking the right kind of exercise in pregnancy offers a range of beneficial effects. It is good for your:

• bowel function

• self-image

• psychological state

• weight control

• muscle tone

• joint flexibility.

Every woman needs to have her own, personalised exercise programme which will include a planned tailing off as her pregnancy advances. Remember to take increased rest periods and keep your maximum effort down to 50 to 60 per cent of your pre-pregnancy levels.

During your pregnancy, avoid any movements that involve severe flexion or hyperextension of the trunk (bending forwards or backwards), or any breath-holding procedures such as the Valsalva manoeuvre which involves taking a deep breath and then straining against a closed glottis (windpipe) as a weightlifter does when lifting a heavy weight.

Exercise in pregnancy

Overdoing exercise or doing the wrong kind can have an adverse effect on both you and your unborn baby and slow down your baby’s growth rate (intrauterine growth retardation) so that he or she weighs less than normal at birth. If you develop any symptoms while exercising, such as fainting, vaginal bleeding or chest or abdominal pain, tell your doctor or midwife immediately. You should also watch out for other possible side effects of too much exercise, such as nausea, fluid retention, headaches, painful joints and premature rupture of the membranes.

After the birth

If you feel up to it, you can start gentle exercise about four to six weeks after having your baby or around the time that the postnatal vaginal bleeding stops. You’ll need to wear a good supporting nursing bra if you’re breast-feeding to relieve discomfort during exercise activity.

Get expert advice on the right kind of programme to follow because breast-feeding mothers can produce increased amounts of lactic acid which is not good for the baby. Walking or swimming helps restore abdominal muscle tone and helps you get back your pre-pregnancy figure.

Older people

The golden rule is to begin exercising slowly and to build up gradually. Before you start, however, it is important to visit your doctor for a check-up as a precaution. You may be advised to diet to lose weight, particularly if you are more than ten per cent over your ideal weight. It would also be appropriate to have your blood pressure, pulse rate, heart and lungs tested as well as your urine and blood. Ideal exercise for older people includes swimming, walking, golf, gentle orienteering and other aerobic activities.

KEY POINTS

♦  Avoid repetitive stresses on growing bones, muscles and tendons of children

♦  Children are more susceptible to heat- and cold-induced illness (check the conditions and wear the right clothes)

♦  Women should wear well-fitting sports bras and/or apply grease to the nipples to prevent chafing

♦  Regular exercise in pregnancy improves the quality of contractions in labour

♦  Older people should build up exercise slowly and have a precautionary check-up before starting an exercise programme

♦  During exercise in cold weather look out for early signs of frostbite or hypothermia – tingling or shivering

♦  After exercise in the cold keep warm and change into dry clothes as soon as possible

♦  In hot weather ice jackets before endurance events may improve performance