Sports Medicine Center

what are allergies

The immune system aims to protect us against viruses, bacteria and harmful substances, which penetrate our body. Allergy can be defined as an exaggerated reaction (hypersensitivity reaction) of our immune system against substances foreign to the body, called allergens. In general, these substances are not usually harmful to most people. However, allergies are common.

Causes of allergies

The genetics of each person and the environment can make one more prone to them. The most common harmful substance allergies are caused by airborne particles, such as plant pollen or house dust mites. Although these substances are harmless for the majority of the population, this is not the case for people who show hypersensitivity (allergy) to them. The appearance of the allergy can cause symptoms that can range from mild discomfort to more serious problems: swelling of the lips, tongue, throat or other parts of the body, difficulty breathing and swallowing, dizziness, loss of consciousness, etc.; and, in extreme cases, cause death.

seasonal allergy

Seasonal allergy is one that is related to a certain season of the year. The onset of the presence of allergenic substances occurs between January and March, with the appearance of pollen from cupresaceae (Arizona and cypresses). In general, the most frequent is spring and coincides with the beginning and development of this climatic season, having its origin in the pollen of trees, shrubs, grasses and olive trees. Allergies in summer are generally caused by grasses and weeds, and, lately, allergy to Chenopodiaceae pollen, associated with dry and sunny weather, is very common. Fall allergies are frequently caused by ragweed.

Seasonal allergy symptoms

Pollen allergy, also known as "hay fever", manifests itself with symptoms that include rhinitis or inflammation of the nasal mucosa (nasal congestion, secretion and obstruction, sneezing, itching, problems with smell) and sometimes also conjunctivitis (tearing, itching and redness of the eyes), dark circles and swelling under the eyes, sore or itchy throat and/or ears, feeling of blocked ears, fatigue and irritability, headache, difficulty sleeping, which may lead to to a situation of general fatigue during the day after the symptomatology. Some people with allergic conditions may have episodes of bronchial asthma, which are caused by exposure to allergens.

Diagnosis

In the medical diagnosis of an allergy in a patient, a complete history of symptoms and signs, accompanied by a detailed physical examination, is essential. Once the diagnosis is oriented, allergy tests can reveal the substances that trigger the symptoms or allergens.

Skin tests are the most common method of allergy testing. In skin tests, the doctor places a drop of a substance on the patient's skin to which he or she might be allergic. Next, the skin will be seen to see if it presents any symptoms compatible with the allergic picture. If the doctor determines that the patient cannot undergo skin tests, special blood tests may be performed that can help with the diagnosis.

These tests can measure the levels of substances related to allergies, such as immunoglobulin E (IgE). A complete blood count or blood count, called an eosinophil white blood cell count, can also help diagnose allergies.

Tips to combat or endure allergies

Spring allergy is a reaction mechanism of our body against elements of plant origin that "explode" in this season. Its symptoms can be very mild or very severe depending on the characteristics of each individual.

Here are some simple tips that help better support the symptoms.

• Pollen is only released during the day, so its concentration decreases at night.
• Dry and hot days are those with the highest concentration of pollens in the air, especially if they come after a rain.
• When it rains, the amount of pollen decreases a lot, and increases again when the storm disappears.
• The wind increases the amount of pollen in the environment by lifting the one that has already fallen.
• Wear sunglasses outside during the pollination period to protect the eye conjunctiva.
• Extreme hygiene of hands and face, and frequently clean the nose and eyes with fresh water.
• Avoid contact with pollen-producing plants located in parks, gardens or areas with abundant vegetation.
• Avoid traveling by motorcycle or bicycle.
• Travel by car with the windows closed.
• Use pollen filters in the air conditioning of vehicles and homes.
• Use a vacuum cleaner to clean the home and remove the dust with a damp cloth.
• Keep the house closed and keep the environment as humid as possible. Ventilate the house after sunset; five minutes is enough to air a room.
• Shower after spending time outdoors to remove any pollen residue on your body or hair, and change your clothes.
• Avoid drying clothes outdoors during this season.
• Take the medication according to the guidelines prescribed by health professionals. Remember that antihistamine drugs can cause drowsiness.

There is a free mobile app Pollen Alert, created by SEAIC experts. Pollen Alert informs its users of the pollen levels in the Spanish towns where there are measurement centers, among many other features such as consulting an allergist to prevent allergies and see what treatment can be followed.

Treatments

To avoid or reduce the symptoms of allergies, it is advisable, first of all, according to hygienic-dietary guidelines for allergen suppression. If this is not enough, it will be necessary to resort to medical help for supervised pharmacological treatment.

Foods to improve allergies

The consumption of foods rich in omega-3 acid fats (oily fish or eggs) and vitamin C can help avoid allergies or, if they already suffer, help alleviate their symptoms.

• Fruits (especially citrus fruits) and vegetables attenuate breathing difficulties, while a high consumption of vegetable margarine exacerbates them.
• Achieve a balanced consumption of acid fats, reducing the consumption of sunflower oil and other seeds in favor of olive oil.
• Eat probiotic foods (such as yogurt).

Foods to Avoid

There are many foods that can aggravate seasonal allergies, even if the person who eats them is not allergic to them. Among them, milk and dairy products stand out because they stimulate the production of mucus and also contain proteins, such as casein, which are difficult to digest completely; They also contain significant amounts of arachidonic acid, whose function in the body is to produce substances with inflammatory activity.

Others foods whose consumption is not recommended in case of suffering seasonal allergies are: chocolates, red meats, hydrogenated fats such as margarines, fried foods, refined sugar and all products that contain pollen in their composition (royal jelly, pollen and honey). Strong odors and flavors, such as onion or vinegar, are also not good.

Vitamins and minerals that can help

Some supplements of certain vitamins and minerals can help, as well as foods that contain some of these elements in their composition:

• Vitamin E: Helps reduce the inflammatory substances responsible for the symptoms that accompany spring allergies. It is found in many foods, including whole grains (especially the germ), soybeans, vegetable oils, green leafy vegetables, nuts, etc.
• Vitamin C: It has antioxidant action. All citrus fruits, cauliflower, radishes, Brussels sprouts, spinach, bananas, apples, carrots, peppers, etc. are rich in this vitamin.
• Beta-carotene: It is a natural pigment located in all yellow, orange or red vegetables (which is why it is found in carrots, mangoes, apricots, pumpkins and green leafy vegetables, such as lettuce, spinach and beans). ). It is also an antioxidant so it counteracts inflammation and protects tissues. On the other hand, beta-carotene is transformed in the body into vitamin A, which plays an important role as a protector of the mucous membranes, that is, it protects and repairs the respiratory membranes that are damaged as a result of allergies.
• Magnesium: This trace element is capable of relaxing the bronchial smooth muscles, so that it improves pulmonary ventilation. It is mostly found in dried fruits.

Pharmacotherapy (always under the supervision of the doctor or pharmacist)

• Nasal decongestants to unclog the nose.

• Antihistamines (lozenges or syrup) to relieve sneezing and itchy nose.

• Nasal or general corticosteroids (always under medical supervision).

The regular practice of sport is an increasingly frequent activity among the general population. Given that on numerous occasions it is done self-taught, it is convenient to take into account a series of basic questions that will allow you to be a healthy athlete.

Ten tips for the healthy athlete

1. REGULAR CONTROL BY YOUR DOCTOR
   The athlete, as an individual constantly subjected to significant physical stress, must monitor their health status and seriously consider the impact of this sporting activity as a potentially aggressive element for maintaining the balance of their health status. The doctor is responsible for our health, but the athlete too, and he must assume this responsibility seriously and rigorously.
    
2. THE WARM-UP
   Regardless of the option of physical activity or sport practiced and the level of performance of the athlete, it is essential to warm up beforehand to prepare our body for the subsequent effort. This warm-up must necessarily be specific with respect to the type of exercise to be performed during the session, also considering that it must help the athlete to concentrate and focus their attention on the task to be completed.
    
3. THE RETURN TO CALM
   This cool-down phase should always be part of the training session, at the end. In this case, it is important to stop gradually, walk slowly, breathe deeply and again perform specific stretches of the muscles most used in the session. In many circumstances, and depending on the intensity of the exercise, it will be interesting to integrate an active phase of aerobic exercise at a very light intensity as an element of regenerative action.
    
4. CONCENTRATION DURING PRACTICE
   Considering that the athlete is by definition because he practices a sport regularly, this same regularity should avoid monotony and boredom, since both are directly related to the increased risk of injury, both of traumatic origin and due to overuse. The athlete must be focused during the training session, know his limits and be aware of his capabilities at all times.
    
5. FOLLOW-UP OF ESTABLISHED PLANNING AND PROGRAMMING
   It is very important to follow the planning and programming established by the coach. Sports training is an area of ​​recognition is a very active area of ​​knowledge, which bases its results on the proper organization of stimuli (training load) over time based on the response of the athlete, and therefore it is key Do not modify the proposed contents (respecting training loads, recovery times, etc.
    
6. PROPER HYDRATION
   If your training takes place in hot and/or humid areas, it is very important to hydrate well before, during and after the training session (one or two glasses of cool water before starting and take a half-liter bottle of water with you). during practice is a good way to stay hydrated), and in summer choose the first or last hours of the day to avoid the harmful effects of heat on our body, especially if we are in the initial stages.
    
7. BALANCED DIET
   The athlete needs an adequate supply of energy in the form of a healthy and balanced diet. By taking care of your diet, the athlete favors and facilitates the recovery processes, and especially the anabolic phase of response to the catabolism produced by the efforts of training. In conditions of special intensity, volume or competitive load, many athletes may require complementary natural supplementation in their diet. In this case it is very important to consult your doctor and have professional nutritional advice.
    
8. INVISIBLE TRAINING, THE VALUE OF REST
   Without rest it is not possible to improve, and this is one of the most evident maxims of Sport. This rest must contemplate a sufficient number of hours of sleep per day, and above all a correct distribution of effort throughout the session and between sessions throughout the week. In addition, the use of complementary techniques and methods (physiotherapy, hydrotherapy, etc.) is a success factor in optimizing the athlete's recovery between efforts.
    
9. ENJOY TRAINING AND COMPETITION
   Although training has many hard moments and competition is a particularly stressful situation for many athletes, it is essential that the individual is able to control their anxiety in these circumstances and enjoy both daily practice and competition. To do this, in many cases the athlete will also need learning and specific training in psychological control techniques and the support of qualified professionals.
    
10. PATIENCE AND PERSISTENCE, KEYS TO SUCCESS
    The last of our advice could not be other than patience and perseverance. If there is a human activity in which there is a clear cause-effect relationship between the effort and energy dedicated and the result obtained, this is undoubtedly sports. Everything in the end is a matter of time, and in order to meet this requirement, the individual must be able to invest enough time over time to achieve his goal.

Physical activity, exercise and sport

These are three concepts that are often used as synonyms, but there are important differences between them, below we briefly detail what each of them consists of, which will allow us to use these terms with adequate property.

Physical activity implies any bodily movement produced by the skeletal muscles that adds to the basal metabolism generating energy expenditure. Basic activities are everyday activities, such as doing housework, shopping, carrying objects, commuting to work, cleaning, etc. Individuals who are limited to performing this basic physical activity are considered inactive, so the practice of these activities, including walking, going up and down stairs instead of using the elevator, should be encouraged in order to modify lifestyle , since any physical activity is better than none.

Physical exercise is understood as any planned and repeated effort with the intention of improving fitness and health. Therefore it can include activities as varied as brisk walking, cycling, swimming. It should be clear that while all exercise is a type of physical activity, not all physical activity is considered exercise. As a guide, we can say that the minimum standard measure to define physical exercise is to walk briskly for at least 20 minutes a day. To know the intensity, the following parameters can be used:

• Slow = 80 steps per minute.

• Brisk = 100 steps per minute.

• Fast = 120 steps per minute.

• Running = more than 120 steps per minute.

Finally there is sport. This term includes all physical exercise carried out with a competitive spirit that is governed by rules or regulations.

Physical activity and health

Physical training is essential to increase muscle mass and resistance up to 20-30%. The training of the cardiovascular system is achieved through physical activity of moderate intensity that we must carry out for half an hour daily.

When choosing the physical exercise that we are going to practice, we must avoid those that, according to our physical form, can cause us injuries or unnecessary overloads. The exercises involve the development of one or more basic physical qualities (speed, coordination, resistance, flexibility, strength) that we must always keep in mind when making any decision. Even our own personality or character influence the choice we make of a certain physical exercise.

Walking is a very healthy activity that hardly involves risks, since it does not damage the joints or cause our heart rate to rise to dangerous levels, which is why it is recommended:

• Walk through safe places (trails, parks, shopping areas)

• Appropriate footwear with thick, flexible soles to cushion and also be breathable. Dress must also be appropriate.

• Walking in a group can become more motivating when it comes to exercising.

• Do exercises, for about five minutes, warming up and stretching before the activity as well as cooling down and stretching at the end.

The rhythm must be stable keeping the head up, the back straight and the feet in a straight line forward. The weight is first supported on the heel and then progressively passed to the balls of the feet. To go faster it is better to take faster steps than longer steps. We can also carry out activities inside the house to improve our physical form.

There are currently various systems on the market for doing physical exercise at home: exercise bikes, treadmills. If we have a long corridor or a large room in our house, we can travel several kilometers. We will obtain benefits on our cardiovascular system, we will avoid decalcification and we will strengthen our muscles, in addition to enhancing our strength and balance.

Physical exercise and lifestyle

When practicing physical activity on a regular basis, we must think about those activities that we like the most, with which we feel most identified and that do not take up too many hours, since in many cases we have limited time.

We must develop a personalized plan preparing, for example, sessions per week. We will reserve a daily time to exercise, even in daily activities such as taking a detour to return home, taking another trip to the mall when we are shopping. As fitness improves, we will be able to do more activities in less time.

Realistic goals will be set, not too ambitious and possibly long-term. We can even break it down into smaller weekly or monthly goals. We will keep track of it through notes of what we do every day. Once achieved, we must look for small rewards for the effort made.

Tricks to motivate us

• What do we like most about exercising?

• Think of the reward for achieving the set goal.

• Invite a friend to go for a walk.

• If we can't take a full session, we should break it down into smaller stages.

• Not thinking about the reasons why we don't want to exercise, but rather, thinking about how well we will be when the session is over.

Physical exercise in youth

Various studies show that most adolescents perform less physical exercise than they did ten years ago. They do not carry out any physical activity outside of the classes that are taught in educational centers, dedicating the time after school hours to sedentary activities at home.

This sedentary lifestyle favors the appearance of diseases such as obesity, diabetes, hypertension, back pain and even self-esteem problems in the future. In addition, there is an increase in Body Mass Index, causing poor cardiorespiratory capacity to physical effort as well as lack of flexibility.

To avoid these problems, daily and regular exercise should be encouraged, both in young people and children, and also accompanied by proper hydration and proper nutrition, in order to stimulate healthy lifestyle habits.

Physical exercise in the elderly

In the elderly, the daily practice of physical activity is beneficial for certain diseases: diabetes, dyslipidemia, osteoarthritis, obesity. In many cases, the patient's clinical condition is improved.

Physical activity has a hypotensive, lipid-lowering, anti-inflammatory effect and prevents the appearance of osteoporosis. By performing physical exercise, especially strength and resistance exercises, performed gently, it helps to improve balance and therefore falls are avoided.

For all these reasons, and due to the improvement of the pathology experienced by the person, it is even possible to reduce the medication, however, always in a prudent manner and informing the corresponding physician of all this.

Physical exercise in children

There is no doubt that, in the early stages of life, children and adolescents have energy, nutritional and daily physical exercise needs that differ from those of adults in general.

It is very important that they eat five meals a day and that they hydrate properly since, in the case of children, it is easier for them to suffer from dehydration due to the heat. The traditional food pyramid must be tailored specifically to the energy, nutrient and hydration needs of children.

Physical exercise should be performed regularly and daily to avoid a sedentary lifestyle and possible overweight problems in the future. Likewise, we must instill in them daily activities that will bring them benefits throughout their lives, such as brushing their teeth and avoiding tobacco and alcohol consumption.

Healthy nutrition

If you eat a varied and balanced diet, you reduce the risk of suffering from the so-called metabolic syndrome, which is the set of cardiovascular risk factors associated with genetic, environmental and lifestyle causes.

The diet must be varied, eating everything; nice; enough, in adequate quantity; adapted to the age, sex and physical activity of each person. By losing weight, the lipid profile is improved, blood glucose is controlled and it contributes to lowering blood pressure, thus reducing the risk of suffering from cardiovascular pathologies.

You should limit your intake of simple sugars as well as saturated fats, trans fats, and cholesterol. Total fat intake should not exceed 30% of total daily intake. We must increase the consumption of fruits and vegetables, lean meats and fish, low-fat dairy products and whole grains.

Also, increased physical exercise improves our health. The daily and moderate practice of aerobic physical exercise, for example walking between 30 and 45 minutes a day, helps to lose weight, reduces anxiety, improves sleep and mental health. The ideal goal is to achieve a balance between physical exercise and food consumed.

Five meals a day

There is a clear relationship between the frequency of meals and the degree of overweight and obesity. Eating more frequently is healthier and causes a reduction in Body Mass Index. When eating a large meal, the initial caloric load is higher and therefore, it leads to a greater absorption of nutrients. Skipping breakfast or lunch is not a healthy habit and leads to poorer nutrient intake at each meal. Eating in the morning has a greater satiating effect and eating more at night has a lesser satiating effect and is associated with consumption patterns in obese people.

Waist-hip ratio

The waist-hip ratio (WHR) is a specific anthropometric measurement to measure the levels of intra-abdominal fat. Mathematically it is a relation to divide the perimeter of the waist by that of the hips.

There are two types of obesity according to the pattern of body fat distribution: android and gynecoid; the first type is called intra-abdominal or visceral obesity and the second extra-abdominal or subcutaneous and to quantify it, it has been seen that an anthropometric measurement such as the waist/hip ratio correlates well with the amount of visceral fat, which makes this ratio a measurement feasible from a practical point of view.

This measurement is complementary to the Body Mass Index (BMI), since the BMI does not distinguish whether overweight is due to physiological (healthy) muscle hypertrophy, as is the case in athletes, or to an increase in pathological body fat (unhealthy).

The WHO establishes normal levels for the approximate waist-hip ratio of 0,8 in women and 1 in men; higher values ​​would indicate abdominovisceral obesity, which is associated with an increased cardiovascular risk and an increased probability of contracting diseases such as diabetes mellitus and arterial hypertension.

The index is obtained by measuring the perimeter of the waist at the height of the last floating rib, and the maximum perimeter of the hip at the level of the buttocks.

WHR = waist (cm) / hip (cm)

 Interpretation:

• ICC = 0,71-0,85 normal for women.

• ICC = 0,78-0,94 normal for men.

Body mass index

The body mass index (BMI) is a parameter of association between body weight and height of a person. Its calculation is carried out according to the mathematical expression:

BMI=mass/height²

where mass is expressed in kilograms and height in meters.

It's a good way to determine if your weight is healthy, as being overweight puts a strain on your heart and can lead to serious health problems, such as:

• Cardiopathy

• Hypertension

• Sleep Apnea

• Diabetes type 2

• Varicose veins

The BMI is also used as one of the resources to assess nutritional status, according to the values ​​proposed by the World Health Organization.

• Severe thinness: < 16,00

• Moderate thinness: 16,00-16,99

• Acceptable thinness: 17,00-18,49

• Normal: 18,5-24,99

• Grade I overweight: 25,00-26,99

• Grade II overweight: (pre-obese): 27,00-29,99

• Obese type I: 30,00-34,99

• Obese type II: 35,00-39,99

• Type III obese (Morbid O.): 40,00-49,99

• Obese type IV (O. extreme): >50,00

Body mass index is not always an accurate way to determine whether or not one needs to lose weight. Here are some exceptions:

• Bodybuilders: Because muscle weighs more than fat, people who are unusually muscular may have a high body mass index.

• Elderly: In old age, it is often better to have an index between 25 and 27 rather than an index below 25. If a person is older than 65, for example, a slightly higher body mass index can help protect them against osteoporosis.

• Children: Although a large number of children are obese, do not use this calculation index to evaluate a child. Talk to your pediatrician about the appropriate weight for your child's age, based on the height and weight percentiles established for the general population of those ages.

BMI alone can't predict your health risk, but most experts say a BMI over 30 (obese) isn't healthy. No matter what your BMI is, exercise can help reduce your risk of heart disease and diabetes. However, always remember to check with your doctor before starting an exercise program.

Machinery for physical exercise

Exercising regularly is sometimes difficult to practice due to the pace of life we ​​lead, the lack of time. For some people, the solution is to buy certain machines to exercise in their own home.

There are two types:

• Aerobic exercise machines: they are a very good alternative to outdoor sports, ideal for cardiovascular exercises or fat burning. These include: treadmills, ski machine, steps, rowing machines, elliptical movement machines.

• Strengthening machines: help build muscle strength using body weight, tension, or external weights. These include: free weights, medicine balls, resistance bands and elastic tubes.

Tips

• Choose based on the physical exercise you like to do.

• Take into account the price (including assembly, transport), making sure to choose the one that covers a more complete activity.

• Take measurements of the space in which you intend to install it.

• Beware of misleading advertising. Don't be fooled by spectacular "before" and "after" photos.

• Take a test before you buy it, with the appropriate clothing and footwear.

In this section we intend to inform about the prescription of physical exercise in a safe, effective and satisfactory way in the recovery or maintenance of the best possible levels of health, autonomy and functionality of people who have them threatened due to pathologies that can benefit from physical exercise. same.

Diabetics

The basic pillars to control diabetes are a healthy and adequate diet, physical exercise, diabetes education, regular check-ups and medication. Physical exercise is a fundamental piece in the comprehensive treatment of diabetes. Sport is compatible with the disease and it can even be said that it helps its treatment.

Diabetes is a disease caused by an alteration in metabolism characterized by an increase in the amount of glucose in the blood, either due to low concentrations of insulin or its inadequate action at the cellular level. It is, therefore, a treatable but not curable disease.

According to data from the Spanish Society of Diabetes, in our country, about 3.500.000 people suffer from this pathology. Physical exercise is a fundamental piece in the comprehensive treatment of diabetes. Sport is compatible with the disease and it can even be said that it helps its treatment.

The benefits of regular physical exercise are:

• The improvement of blood flow and its "cardio-healthy" action (increases the so-called good cholesterol and decreases blood triglyceride levels.

• Produces a decrease in the need for insulin or oral antidiabetics.

• In cases of overweight and obesity accompanied by a hypocaloric diet, it contributes to weight loss.

• Considerably improves work capacity providing physical and mental well-being, increasing quality of life.

• Avoid staying in the same position for a long time. Breaks should be interspersed for stretching or just moving around a bit.

• At work, we will adjust the chair according to the height of the table and the task to be performed. The backrest will be placed in a vertical position so that the lower back is completely supported and in this way we will create an effective support for this area. When we get up and sit down we will help ourselves with our arms.

• If repetitive activities are carried out, we will place ourselves at a suitable height that allows us to work without making sudden efforts.

• When driving, we will position the seat until we reach the pedals with our back fully supported by the backrest and our hips at 90º, holding the steering wheel with our elbows semi-flexed.

• To travel, we will choose the most comfortable means of transport, using the regulations that the seats have to achieve the most comfortable and appropriate posture throughout the journey.

neck care

When pain and stiffness occur in the neck, it is usually due to certain postures that we must correct. Several of the daily activities are usually responsible for common neck pain.

Tips to avoid neck problems:

• Practice adequate physical exercise, such as swimming. Also, neck self-stretches are very beneficial.

• When using the computer, the monitor should be facing you, with the top edge of the monitor at eye level. The keyboard will be located in front and at the height of the elbows. If there is tension in the shoulders, we should relax them and lower them away from the ears.

• Use a suitable pillow that allows the correct support of the neck and the alignment of the cervical curvature. It is not advisable to sleep on your stomach.

• To avoid contractures in the neck muscles, the telephone should not be held between the head and the shoulder.

Fibromyalgia

Fibromyalgia is a chronic disabling disease that affects approximately 5-6% of the population. It was recognized by the World Health Organization in 1992 as a specific disease within rheumatism.

Fibromyalgia patients suffer from continuous pain, have poor quality sleep, diffuse, chronic and benign musculoskeletal pain of non-articular origin lasting more than 3 months and above all complain of general tiredness throughout the day.

The diagnostic is fundamentally clinical. The results of X-rays, blood tests, and muscle biopsies are normal. There is no specific diagnostic test, however, it is important to perform some laboratory tests to rule out other diseases, such as rheumatic, arthritis or osteoporosis that have similar symptoms and require other treatments.

At the present time there is no curative treatment for fibromyalgia, but there are many measures that relieve symptoms and improve quality of life:

• Heat relieves pain, so hot baths and showers are recommended.
• Maintain good sleep patterns, with stable schedules.
• Do physical exercise and maintain adequate muscle tone: of all the measures recommended in the treatment of fibromyalgia, they are undoubtedly the most effective in the long term.

It is advisable to perform low-intensity aerobic physical exercise, such as swimming, water exercises or stationary cycling at controlled speed and intensity. When starting to exercise, there may be some muscle soreness. You can start with low-intensity exercise for 3-5 minutes, every other day, and increase by one minute each day. If pain appears, the intensity and time must be reduced to non-painful levels and gradually increased again. The exercise time to achieve is 60 minutes, 3-4 times a week. Once reached, it is necessary to perform aerobic exercises of greater intensity, such as walking, running.

It is recommended to stay as active as possible, avoiding overactivity or occasional excessive exercise that can cause excessive fatigue or pain for several days.

With non-fatiguing physical exercise, joint mobility increases, muscle tension decreases, postural control is educated, asthenia decreases and physical level improves.

Mental health

Carrying out physical exercise with a certain degree of duration and intensity provides an important psychological benefit by improving self-esteem and increasing self-confidence and willpower.

There is an immediate improvement in anxiety and mood. Even the risk of depression is much lower among those who play sports regularly.

Fundamentally, these benefits are greater with the practice of rhythmic aerobic exercises, of low to moderate intensity, such as jogging, swimming, cycling and walking. Sessions should be between 15 and 30 minutes three times a week.

The benefits are independent of age and gender, but it can be affirmed that in the subjects in which it is most noticeable they are:

• those who start in any type of physical activity.

• people who are out of shape.

• the elders.

• people with psychiatric pathology.

Obesity

The WHO has described obesity as an "emerging epidemic of the XNUMXst century" due to the dimensions it has acquired over the last decades, its impact on morbidity and mortality, quality of life and health spending.

Obesity is a disease that can increase the risk of:

• Diabetes type 2.

• Heart and vascular diseases.

• Various types of cancer.

• biliary disease

• Musculoskeletal disorders

• Respiratory problems.   

The methods for determining the degree of obesity are:

• Body mass index (BMI).

• Waist circumference.

• Waist-hip ratio (WHR).

• bioelectrical impedance.

• Skinfold measurement.

Health risk according to BMI: 

• Death/any cause (BMI < 19) versus 27-35 increases from 60 to 120%.

• Death/cancer (BMI < 19) versus 27-35 increases from 80 to 110%

• Death/heart disease (BMI < 19) versus 27-35 increases from 210 to 480%.

• Type 2 diabetes (BMI < 19) compared to 27-35 increases from 1.480 to 5.300%.

• High blood pressure (BMI < 23) compared to 26-35 increases from 180 to 350%.

• Degenerative arthritis (BMI < 19) compared to 30-35 increases by 400%.

• Gallstones (BMI < 19) compared to 27-35 increases from 150 to 270%.

• Neural birth defects (BMI < 19) compared to 27-35 increases by 90%.

Diet plus physical activity/exercise has been shown to be the most effective way to control weight.

A weight loss program is good when:

• It provides adults with a consumption of no less than 1.200 Kcal/day and ensures a balanced diet.

• Provides gradual weight loss (from 500 to 1.000 Kcal/day).

• It includes an exercise program that involves an energy expenditure of 300 Kcal/day.

AF/E intensity, frequency, duration and type

• Initially, a low intensity (30-50% of aerobic capacity) with a longer duration in the activity is convenient. Intensity can be expressed quantitatively as: Percentage of maximum theoretical heart rate (% MHR), percentage of maximal oxygen consumption (%VO2 Max), a multiple of metabolic equivalent (MET), calories expended per unit of time (Cal) .

• The frequency must be daily and at least 5 days per week.

• The duration of the exercise will depend on the comorbidities of the individual. The more intense the series of AF/E, the shorter the duration, because what you want to achieve is an expenditure of 300 to 500 Kcal per session.

Types of AF/E: In general, low-intensity, long-duration aerobic exercises that move a large amount of muscle mass, with low osteoarticular impact, such as fast walking, swimming, elliptical bike, are preferable. Warm-up and cool-down should always be included, and clothing and footwear should be carefully selected.

A program that integrates aerobic and resistance AF/E is more effective in maintaining MSG and metabolic rate.

Chronic obstructive pulmonary disease

COPD is a chronic disease whose prevalence increases with age and has increased in recent years, especially in women. At the moment it is the fourth cause of mortality in our country. It also generates high disability, with extensive functional limitation due to respiratory, cardiovascular and peripheral level deficiencies: muscular and metabolic.

Respiratory rehabilitation, including an exercise program, is essential in the treatment of this disease and in the struggle of patients to avoid being dependent as much as possible. The 6-minute run test is still considered an essential test to give a prognosis of the disease.

Exercise programs tend to improve the dyspnea suffered by these patients and thus increase their quality of life. These programs should include work on both upper and lower limbs. The training should be above all aerobic, complemented with muscular strength.

Work intensities should be moderate (60-80% of the maximum load), using oxygen therapy whenever necessary.

Physical exercise as a rehabilitation strategy for smokers

According to the latest data from the survey of health habits in the adult population of the Community of Madrid (SIVFRET survey 2010) the prevalence of current smokers in the Region was around 32%; the degree of physical inactivity in free time was 83% in women and 72% in men. Given this scenario, the Sports Medicine Center recommends physical exercise as a strategy for the rehabilitation of smokers.

The trend of smoking cessation has been increasing in recent years, however physical inactivity remains fairly constant. Scientific studies show that physical exercise helps reduce some of the most common symptoms that smokers face when trying to quit addiction. In addition, smoking abstinence improves aerobic and cardiovascular capacity, diminished in smokers.

When the smoker accompanies his will to quit smoking to the practice of sports, he will be associating the benefits derived from sports with the benefits of quitting smoking. Smoking cessation is much easier in people who exercise than in those who lead a sedentary life.

Some benefits of substituting tobacco for physical exercise can be: the improvement of the capacity of physical resistance both for sports and for daily life; moderate physical exercise reduces the stress caused by quitting smoking; the increase in the sensation of physical well-being that reinforces the efforts derived from tobacco detoxification; the increase in self-esteem and physical exercise help to lose, or not gain, weight, a frequent enemy that usually appears when quitting smoking. And most importantly: drug-free rehabilitation at a very low cost.

Asthma

In recent years there has been an increase in the prevalence of asthma and exercise-induced asthma, all due to a better diagnosis of this pathology, greater environmental exposure and an increase in training requirements.

Endurance sports as well as those performed in weather conditions characterized by cold and polluted environments have a higher prevalence. The thermal-thermal and hyperosmolar theories continue today, being considered as the origin of the complex inflammatory process that triggers this process.

Diagnosis is fundamentally based on a good screening of diseases and risk factors, on data from post-bronchodilation spirometry, pharmacological provocation tests, with exercise or with eupcapnic voluntary ventilation.

Treatment is aimed at controlling both the disease and the different risk factors present. The sport to be practiced must be carefully chosen and performed in a suitable environment, always with a standardized warm-up and the administration of prescribed drugs before exercising.

Osteoarthritis and exercise

In osteoarthritis the surface of the joint is damaged and there is an abnormal reaction in the underlying bone. The cartilage becomes thin and has a rough surface. The underlying bone thickens and grows up the sides of the joint.

In certain cases, the cartilage can be so damaged that the bone is exposed and can become deformed. The use of enzymatic hydrolysates of collagen has been shown to be effective in this type of pathology. Likewise, weight loss decreases the possibility of suffering from osteoarthritis of the knee, especially in older women.

The benefit of exercising to increase and improve physical condition is undeniable. Whether regular exercise leads to degenerative joint changes or osteoarthritis is still being studied.

The benefits of physical activity and sport on health are currently indisputable. Although there are very few people who perform physical activity in the workplace. In this sense, it should be noted that some companies provide their workers with the means to practice sports (for example, table tennis) in their premises during the employees' free time, either during lunch hours, or outside of the working day. labor. 

We can distinguish two large groups of the working population. On the one hand, sedentary work that little by little reduces physical qualities: weight gain, lack of flexibility, decrease in strength, decrease in our ability to move around, small walks produce fatigue and the car becomes the substitute for legs. At the other extreme would be the professions that require intense physical work, generally repetitive and that is the source of many injuries in the world of work: tendinosis, low back pain, etc.

On the other hand, the use of electronic devices, increasingly present at work (computers, etc.), increases the risk of injury, either due to improper use of them or by maintaining forced postures, etc. All groups would benefit from the practice of physical exercise combining this activity with the world of work.

Exercise prescription guidelines recommend aerobic exercise a minimum of 3 times a week for about an hour. To meet this objective, in the workplace, Sedentary workers could go to work walking, running or cycling, depending on individual physical qualities. If work is far away, you could go by transport to a distance that allows for that hour of physical exercise, or thirty minutes to go and thirty minutes to return. If the job is close, we would increase the distance until completing the recommended time.

The intensity of the exercise depends on the previous state of form, it could range between 55 and 75% of the theoretical maximum heart rate. There are several formulas to theoretically calculate the maximum heart rate, the simplest would be to subtract 220 from the age. Thus, for a 30-year-old person, their theoretical maximum heart rate would be 190 beats per minute, so the rate they should maintain during said exercise would be between 105 and 152 beats per minute depending on their fitness level.

During work it is important to maintain a proper posture and take short breaks, during which you can perform small stretches that would help improve flexibility and minimize the risk of injury. Those muscle groups that we are using (arms, hands, fingers...) and those areas that can maintain a posture in constant tension, mainly the cervical spine, would be stretched. We recommend stretching the joint muscle group that we are working on until we notice the muscular discomfort of stretching and without forcing, hold in that position for 15 to 30 seconds and repeat it 3 times.

Most jobs are static, either sitting (offices), standing (cooks, waiters...) or crouching (mechanics...) and almost all of them combine these postures. These activities cause discomfort in the spine, with low back pain being extremely frequent. We recommend mainly to prevent this pathology in the workplace, trying not to stand or sit during rest periods. Take short walks at a steady pace during breaks. If there is spinal discomfort, stretch the lumbar spine by adopting a fetal position for a few seconds.

At the end of the day we would repeat the muscle stretching, including those groups less involved in the work we do, to complete all the muscle groups. It would also be convenient to work the abdominal muscles, small exercises such as contracting the abdomen for a few seconds would help maintain abdominal tone and prevent lower back pain. The intensity of the exercises should be increased depending on the improvement in physical capacity.

Work takes up a large part of our time and can contribute to a progressive loss of health. At the same time, work is often the main excuse for not exercising: “I don't have time”, “I work too much”. These simple tips will help break these excuses and progressively bring us closer to a healthier life in the workplace. As we acquire new habits of physical activity, we can include new exercises in leisure periods, until completing an adequate health program.

In this practical information we intend to give recommendations and advice on sports and health issues that any citizen has asked at any given time, always adapted to clear and accessible language. All of them have been edited on the days specially marked on the calendar.

Summer tips

The most suitable time of day to carry out any type of physical activity is the early hours of the morning or late afternoon, since at these times there is a lower incidence of sunlight and a lower level of pollution. Medium and low impact activities should be carried out. During the activity you have to rest frequently. But, above all, try to avoid exercising in the middle of the day (between 12 and 16 p.m.).

If you are walking, running, or biking, look for shaded paths or trails. An alternative, especially in the middle of the day, is to walk through shopping centers where you will find shade and cool weather.

You have to prepare the body before and adapt it after physical activity. The activity should begin with warm-up and stretching of the main muscle groups (hip and legs) and even of all those that are not used directly such as the trunk, arms, neck, etc... A good way to end the activity is walking or jogging at very low intensity for 5 to 10 minutes. If, in addition, stretching is done properly at the end, it will reduce the appearance of late muscle pain, that is, the fearsome stiffness.

In summer you have to drink more than you normally take. Keep in mind that both children and the elderly have to drink more than an adult. In general, it is advisable to drink slightly cold water as it is assimilated more quickly. At times when we do physical activity, a frozen bottle can be carried in a hip bag or fanny pack or in the back pocket of the pants, with this it is possible to reduce body heat and have cold water to drink.

It is very important to drink before exercise in order to start the activity well hydrated. It is advisable to drink a drink with a high contribution of salts during exercise, since this causes the ingested liquid to be retained and the electrolyte balance is maintained. It is necessary to drink after the activity to replenish the lost liquid with a drink that contains glucose, fructose, carbohydrates and mineral salts. In general, the rule of thumb is to drink a liter and a half of fluid for every kilo of weight lost during exercise.

It is advisable to eat light meals before physical activity, always including cereals, fruit and milk. A good complement is fresh fruits and vegetables. You should eat between 90 to 120 minutes before starting the activity.

We must wear suitable, loose-fitting, light-colored clothing to reflect sunlight and preferably cotton to absorb sweat or a breathable fabric that favors the loss of body heat. Mesh fabric shirts or tank tops should be avoided as they will expose too much skin to the sun.

It is advisable to use a sunscreen with at least SPF 15 protection or higher, a cap or hat, and sunglasses. You can put a wet scarf around your neck or one with chemical ice inside to reduce body heat.

The body must gradually get used to the heat. If you have never been physically active outside in hot weather, increase your level of physical activity gradually over the first two weeks.

In case of pregnancy, advanced age, overweight or underweight, extreme precautions must be taken. In these cases we recommend that you maintain moderate levels of intensity if you are physically active in the sun, that is, stay at 60 to 70 percent of the maximum expected heart rate for your physical condition and age and rest frequently.

If you feel dizzy, nauseous, or feel like you might pass out, you should stop exercising. These are unmistakable signs that the body is suffering from heat exhaustion and cannot normalize its temperature. In these cases you should rest in a shade and drink until you recover. If, despite this, it does not recover, it is possible that we are facing sunstroke or heat stroke that may require medical attention.

It is also important to recognize the symptoms of dehydration, which are a feeling of thirst, headaches, irritability, weakness, dizziness, muscle cramps, nausea, vomiting and a significant reduction in our performance. Given this, it is essential to stop physical activity and start a rapid hydration.

winter tips

At this time of year when it is cold, rainy and snowy, we must try to stay healthy and as optimistic as possible. To do this, from the Sports Medicine Center we offer these practical tips.

Exercise your legs by going for a walk down the street, in the countryside, in the park, for at least half an hour a day at a light pace. The best option is outdoors to oxygenate and exercise the lungs.

• Hydration is essential. To avoid dry skin, you should use a moisturizing cream and, in addition, you should drink plenty of fluids (water or juice) to purify your body.

• Proper hand hygiene, washing them several times a day (with water or even alcohol gel to disinfect).

• Soaking your feet in very hot water for 20 minutes before going to bed improves cold symptoms.

• Eat foods rich in vitamin C such as peppers, tomatoes or broccoli.

• Body massages to avoid stress and increase defenses.

Sport at low temperatures

Cold, dry air causes the airways to narrow, partially obstructing the passage of air and making breathing difficult. This narrowing, called bronchoconstriction, occurs in 20% of people even if they don't have asthma, which is why this condition is sometimes referred to as "exercise-induced bronchoconstriction" rather than "exercise-induced asthma."

Of course, there is a big difference between a person with exercise-induced asthma and someone who is out of shape and simply gets short of breath when exercising because they are out of shape and will return to normal breathing within a few minutes. while someone with exercise-induced asthma will have a hard time catching her breath. Extreme temperatures, especially cold ones, can make things even worse.

exercise in the rain

Since ancient times, the relationship between physical exercise and a good pregnancy with easy delivery has been known. It is in 1920 when the first prenatal exercise programs appear. During pregnancy, the woman's body undergoes both morphological changes (weight gain, gait and static changes) and physiological changes (cardiocirculatory system, respiratory system, musculoskeletal system and metabolism).

Benefits of exercise in pregnancy: 

• Active, fit and healthy lifestyle.

• Reduces the severity and frequency of back pain associated with pregnancy.

• Improves body posture.

• Control weight gain.

• It prevents osteoporosis.

• Increases strength, muscle tone, flexibility and cardio-pulmonary capacity.

• Lowers the rate of cholesterol.

• Helps control gestational diabetes.

• Improves digestion and decreases constipation.

• Helps to recover the line after childbirth.

• Counteracts postpartum depression.

Recommended sports and physical activities:

• Walking, either outdoors or on a treadmill.

• Walking, if previously practiced.

• Running, limiting speed and time.

• Swimming

• Yoga.

• Golf.

• Dance.

• Low impact aerobics.

• Steps, avoiding sudden movements.

• Hiking, taking into consideration the terrain and altitude.

• prenatal gymnastics

Sports and physical activity inadvisable:

• Horse riding

• Judo

• Ski

• Skating

• Cycling

• Diving

• Climbing

• Soccer

• Basketball

• Volleyball

• Surf

How intense should the exercise be? One method of assessing proper pace of work is the "talk test"; that is, while the activity is being carried out, the pregnant woman is able to hold a conversation, without panting. In any case, the exercise should be stopped if discomfort appears.

How long and how often? Aerobic exercise should be performed between 3 and 5 times a week, with an average duration of 30 minutes per session (minimum of 15 to 20 minutes and not exceeding 45 minutes continuously).

When should we stop exercising? If one or more of the alterations listed below appear, the activity should be stopped immediately, as they could indicate fetal distress or a risk to the mother:

• Vaginal bleeding

• Loss of discharge or vaginal fluid

• Regular uterine contractions (6-8/hours)

• Decreased fetal movement

• Strong and persistent headaches and/or visual disturbances

• Dizziness, vertigo, or weakness

• Sudden swelling of the ankles, hands, or face

• Calf swelling, pain, or inflammation

• Chest pain, palpitations, excessive tiredness

• Increased shortness of breath

• Increased heart rate or blood pressure after exercise has ended

• Abdominal, hip, back, or pubic pain

• Poor weight gain

prenatal gymnastics

The first prenatal exercise programs appeared in 1920 with the aim of facilitating childbirth and reducing the need for painkillers. They are an aid to combat the physical and psychological stress that a pregnancy entails and provide several advantages:

• Combat pain-childbirth topics:

• It allows the active participation of women.

• Firms and relaxes the muscles involved in pregnancy and childbirth.

• Provides increased oxygenation to tissues and the fetus.

• It allows to shorten postpartum recovery.

• It provides a feeling of well-being and a positive personal image.

In this preparation for childbirth there are several sections:

• Theoretical teachings, which allow us to understand what pregnancy and subsequent childbirth entail, eliminating fears and tensions.

• Relaxation exercises, both physical (neuromuscular) and psychic and emotional.

• Breathing exercises increase the supply of oxygen and reduce discomfort due to contractions, improving relaxation.

• Circulatory exercises improve circulation in the lower limbs, avoiding venous stasis and tissue trophism.

• Pelvic floor exercises to tone and stretch the pelvic floor muscles, preventing pelvic floor dysfunction.

• Tension relief exercises, to relieve the discomfort of pregnancy.

• Toning exercises (back, abdomen, pelvis, buttocks).

• Preparation exercises for the expulsive period. They improve joint elasticity and strengthen the muscles involved in the expulsive period.

Physical exercise after childbirth

The changes produced during pregnancy remain during the first four weeks after delivery. The initial objective of the exercise will be to strengthen the perineal muscles, relegating the strengthening of the abdominal area to a second stage.

The practice of exercise in the postpartum supposes several benefits:

• It tones the muscles and helps women to improve their body image and recover their figure.

• Helps lose weight and fat tissue.

• Tends to reduce appetite.

• Relieves and prevents back pain.

• Provides energy.

• Reduces depression and postpartum stress.

At this stage, circulatory, pelvic floor and body toning exercises are recommended. The first two types can and should be started a few hours after childbirth, to avoid puerperal circulatory complications and prevent pelvic floor dysfunction.

Toning exercises should not be started before the third week, to allow for uterine involution and adequate strengthening of the pelvic floor. Aerobic exercises and swimming can be restarted after six weeks.

In summary, the recommendations to practice exercises in the postpartum period are:

• Do not start before 2-3 weeks and start with 10 minutes a day, increasing progressively.

• Do not perform vigorous exercise in hot and/or humid weather, or if you have a fever.

• Avoid dehydration and heat stroke.

• Avoid violent exercises and excessive stretching.

• Avoid sudden postural changes, which can lead to the appearance of hypotension or dizziness.

In principle, breastfeeding is not incompatible with moderate physical activity, but it is with competitive sports. The most important thing at this stage is to stabilize the pattern of milk production.

It is advisable to plan the exercise according to the feedings, being preferable to carry out the activity after breastfeeding to avoid changes in the taste of the milk if the exercise is intense. Caloric intake must also be adapted, since this situation supposes an extra caloric expenditure of 500 kcal.

The recommendations point to a gradual resumption of physical activity, slowly increasing the intensity, duration and frequency of exercise.

In this section you can find recommendations and advice on sports and health issues related to women, in clear language that is accessible to any citizen. Our intention is to raise awareness and encourage women to maintain and improve their health through physical exercise at all ages.

Menopause

This period is accompanied by other symptoms that can begin several years before and remain for several years afterward.

Common symptoms of menopause: 

• Strong or fast heartbeat (palpitations).

• Hot flashes accompanied by sweating.

• Redness of the skin.

• Trouble sleeping (insomnia).

Other less common symptoms:

• Decreased sexual interest, possibly decreased response to sexual stimulation.

• Memory loss.

• Headaches.

• Mood changes including irritability, depression and anxiety.

• Urine leaks.

• Vaginal dryness and painful intercourse (dyspareunia).

• Vaginal infections

• Joint pain

Hormone treatment can help if you have severe symptoms like hot flashes and cold sweats. But there are also hygienic-dietary measures that reduce symptoms such as: 

• Avoid caffeine, alcohol, and spicy foods

• Dress in light clothing.

• Eat foods with soy.

• Consume foods or supplements rich in calcium and vitamin D

• Exercise.

• Perform Kegel exercises daily to strengthen the muscles of the vagina and pelvis.

• Practice slow, deep breaths each time a hot flash begins (try to do 6 breaths per minute)

• Stay sexually active.

• Try relaxation techniques such as yoga, tai chi, or meditation. 

Muscle, for example, contains approximately over 70% water. The income and losses of water must be in balance to maintain proper hydration. In people almost 2/3 of the body weight is water, therefore a person weighing 70kg has approximately 38 liters of water.

Keep in mind that the amount of body water decreases with age and weight. Under normal conditions, the recommendation for water consumption is 2,5 to 3 litres/day, divided equally between liquid water and water contained in solid foods.

Our body is not capable of storing water, due to this the losses of each day must be compensated by drinking liquids in order to maintain a correct functioning of the organism.

water and our body

Water is the most physiological and healthy drink, it is the most important component of the human body, being essential for life. An important fact is that the tissues with the greatest physiological activity are those that contain a greater amount of water.

Muscle, for example, contains approximately over 70% water. The income and losses of water must be in balance to maintain proper hydration. In people almost 2/3 of the body weight is water, therefore a person weighing 70kg has approximately 38 liters of water.

Keep in mind that the amount of body water decreases with age and weight. Under normal conditions, the recommendation for water consumption is 2,5 to 3 litres/day, divided equally between liquid water and water contained in solid foods.

Our body is not capable of storing water, due to this the losses of each day must be compensated by drinking liquids in order to maintain a correct functioning of the organism.

Everyone knows that during physical exercise there is usually an increase in the usual losses of water and mineral salts. Said losses may be greater or lesser depending on the environmental conditions of temperature, humidity and wind, also influencing the previous physical state of the person who performs the physical activity as well as the intensity and type of physical activity that is carried out.

It is especially during sports practice when water losses increase considerably, this is due to:

• The increase in sweating. The body maintains its proper temperature through the thermoregulatory system.

• Increased pulmonary ventilation produces greater respiratory evaporation.

• Increased skin blood flow results in increased perspiration.

sweat and thirst

Sweat is the mechanism that our body presents to regulate its temperature. Through sweat you lose water and electrolytes such as: chlorine, sodium, magnesium, potassium... The concentration of mineral salts in sweat is lower than the concentration in blood plasma.

Through sweat, therefore, more water is lost than electrolytes. If we do not hydrate properly and lose fluids abundantly, it can lead to a decrease in sports performance of up to 40%.

The sensation of thirst is a warning signal that our body emits, we must not go to this extreme, we must drink liquids before it manifests itself.

Thirst is nothing more than an alarm signal that indicates in a belated way that we have lost too much body water and that we are facing possible dehydration.

When we are thirsty, it means that dehydration has begun a long time ago, so we must anticipate it and start drinking before it appears.

General advice

During physical exercise, the losses of water and mineral salts increase. Losses are greater depending on environmental conditions (temperature, humidity and wind), previous physical condition (training level), intensity and type of exercise.

It is convenient, without falling into excesses, to hydrate before, during and after exercise since any physical exercise, even moderate, produces the elimination of a certain amount of water and mineral salts in addition to energy consumption. That is why the supply of water is necessary and the supply of sugar and mineral salts is advisable for the correct functioning of muscular activity.

At least in case of prolonged exercise (approximately 45 minutes or more) it seems advisable to replenish water with mineral salts and a certain amount of sugar.

during exercise

Both a high and a low intake of beverages can lead to health and sports performance problems. Drinking too much water can cause hyponatremia, that is, low salt (sodium) levels due to abnormal excess water retention. Drinking little can cause dehydration, that is, high salt levels due to excessive fluid losses and lack of replenishment.

How much should be drunk?  In the approximate replacement of liquids there are individual variations that must be taken into account (weight, age, intercurrent diseases...).

Recommendations for adequate hydration:

• Drink between meals throughout the day.

• Drink before thirst occurs.

• Before physical exercise: Hydrate in those cases in which water intake is not allowed during the activity. It is recommended to drink 500 ml of fresh water, distributed on demand in the 90-60 minutes prior to the activity.

• During training or competitions: Consume small volumes 100-200ml every 15 - 20 min. The consumption of rather cold liquids is recommended, between 10-15º C. Energy-type drinks (with a concentration of 6-8%) or diluted fruit juices can be ingested, when the activity exceeds 30 min.

• Post-exercise: The appropriate amount of fluids lost during exercise should be replaced immediately after exercise completion. The frequency and amount must be individually adapted. Beverages containing carbohydrates can be used in order to facilitate the recovery of muscle glycogen.

In a general way we can say that:

• We should not drink carbonated beverages during exercise to avoid the flatulence they produce.

• In competitions of very long duration: Foods rich in sodium should be included in the meals made before the competition, drink energy drinks that contain sodium instead of plain water, even if it is necessary to increase the sodium intake in the second half of the competition. competition and in the recovery phase.

• We should not drink excessively sweet drinks, as they delay gastric emptying and water absorption as well as affect sports performance.

• Drinks rich in caffeine or alcohol are also not recommended, as this can facilitate further dehydration.

• Do not drink large volumes of liquid at one time, because it can cause a feeling of gastric fullness and upset the stomach.  

When should we replace fluids quickly? Physiological data must be available to increase fluid intake: Sensation of thirst, concentrated dark urine, loss of body weight.

When should we decrease fluid intake? When the urine is very clear, diluted, when there is a feeling of swelling, when the body weight increases above our usual weight.

Aspects related to physical activity

In those cases in which you perform exercise or physical activity for a period of more than 30 minutes, the lost body water should be replaced with a sports drink. A sports drink must be made up of carbohydrates and electrolytes (Na, K, Mg). Some recommendations indicate that water and sports drinks should be alternated in these cases, but there are no clear benefits demonstrated.

In those cases in which physical activity is carried out for a long time, that is, for a time equal to or greater than 45 minutes, water replacement is essential, always accompanied by mineral salts and an adequate amount of sugars.

Therefore, drinks that contain sugars and mineral salts, if used correctly, can serve for proper rehydration, preventing dehydration and even solving mild dehydration processes.

To hydrate properly, the diversity of flavors can help to ingest an adequate amount of liquids in those people who do not drink frequently enough.

Importance of hydration in sport

Any type of physical activity, even if it is of a moderate nature, results in the elimination of a variable amount of water and mineral salts with an increase in energy consumption. For this reason, the contribution of water accompanied, if possible, by sugar and mineral salts, is a priority, so that muscular activity is carried out correctly.

It is necessary to maintain a good state of hydration before, during and after any type of physical activity or sport.

The factors that condition exercise in relation to hydration are:

• The characteristics of the exercise.

• environmental conditions.

• The individual characteristics of each individual.

• Accustoming to external climatic conditions.

• The training.

• The threshold and sweating capacity.

An important fact to keep in mind is that you should not overdo it when hydrating. There is, in the scientific literature, evidence that a correct state of hydration is key in maintaining optimal sports performance.

It is accepted by a certain part of the population that in order to lose weight it is necessary to exercise with thermal suits and sweating apparatus, the only thing they achieve is losing body water and can become dehydrated.

Weight loss therefore lasts a short time since what was achieved by losing water and mineral salts that are essential to continue with physical activity. In the practice of physical activity, it is recommended to receive 1ml of water per calorie ingested daily. That is, if you make a diet of 4000kcal. 4 liters of water are needed, 2l of drinking water plus 2l of water contained in food.

When performing physical activity, proper hydration must be taken into account. In any type of exercise there is an increase in muscle work. The consequences of this activity on water balance, as well as on energy expenditure, are different depending on age, sex, physical fitness, duration and intensity of physical activity and also environmental conditions. in which you perform the exercise:

• Outside temperature.

• Air humidity.

• Wind.

• Altitude.

• Activity in room or outdoors.

Hydration guidelines in training and competition

It is necessary to maintain a good state of hydration before, during and after any type of physical activity or sport, but it is much more important if you train in a demanding way for competition. This section includes some essential aspects regarding good hydration during training for competition.

Before physical exercise: Drink fluid half an hour before the test of 300-500 ml. in small sips. Add carbohydrates according to intensity, up to 50 g in long or intense exercises. If the activity lasts more than an hour, it will be necessary to hydrate during the exercise.

During exercise: drink small amounts of fresh water, between 150-200ml every 15-20 minutes of exercise. The consumption of mineral water before and during sports practice is going to be the recommended drink par excellence, given its concentration of salts, which is lower than plasma and comparable to sweat. In the case of carrying out an activity of greater intensity and duration (from 90 minutes), glycoelectrolyte drinks containing 6-8% carbohydrates are recommended, thus facilitating rehydration and glucose and electrolyte intake. ensuring proper hydration. An additional supply of salts will be advisable in intense exercise lasting more than four hours in special situations such as dry heat and wind.

After exercise: fluid replacement should be started immediately after exercise in frequency and quantity adapted individually, according to intensity, duration and climatic conditions. It is advisable to replace sodium and chlorides, and 50g of carbohydrates per hour in a sufficient volume of water.

Dehydration

Dehydration is the excessive loss of body water and is measured by loss of body weight after exercise. Depending on the percentage of weight loss, different symptoms will appear. Despite having good hydration during exercise, a loss of body fluid due to sweat is inevitable.

Losses of 1 to 5% of weight produces: 

• Cramps

• Redness of the skin

• Tiredness

• increased heart rate

• Increased body temperature

• Nausea

Losses of 6 to 10% of the weight produces: 

• Headache

• shortness of breath

• Tingling in legs and arms

• Difficulty exercising

• Clinical symptoms of: damage to the central nervous system, liver and kidneys

Losses of 11 to 20% of the weight produces:

• Heatstroke

• Deafness

• swollen tongue

• Darkened vision

• Loss of consciousness, which can even lead to death in extreme cases

 If exercise is carried out, certain peculiarities must be taken into account to establish correct rehydration guidelines. The groups with the most vulnerable metabolism are detailed below.

The children they need a higher intake of fluids than adults and also have a higher risk of dehydration. Children have a lower tolerance to heat than adults, especially if they perform physical activity in hot environments. This is because children have a higher metabolic rate during physical activity, a higher body surface area-to-mass ratio, a lower sweating capacity, a lower cardiac output at a given metabolic level, and because they take longer to acclimatize. Physical exercise occupies an important part of leisure in the child.

Our older people in itself they already present a decrease in the sensation of being thirsty, there is a decrease in intake and also an increase in loss due to a physiological adaptation of the kidney to age. Therefore, they need a greater supply of liquid already in normal conditions.

Calculation of fluid loss

In order to calculate the loss of body fluid caused by exercise, for the purpose of proper hydration, different easy-to-follow guidelines are offered, which must be taken into account.

• Weigh yourself before the activity (without clothes)

• Do your daily training

• Control the amount of liquid you drink

• Weigh-in at the end (without clothes)

• Subtract the weight obtained from the first.

• Calculate the difference and add the liquid ingested to this weight.

• Since it is advisable to drink every 15 minutes, to determine how much to drink, divide your hourly sweat rate by 4. This is just a guide to how much fluid to drink every 15 minutes.

• The climatic conditions of this day must also be taken into account and the measurements repeated before the change in climatic conditions. This way we will have an idea of ​​how different the environmental conditions can be and how they influence the sweat rate.

It is not recommended to carry out physical activities during the central hours of hot days, wearing excessive warm clothing in relation to the ambient temperature, exposing yourself excessively to the sun...all of this can lead us to a state of dehydration without even realizing it.

Recommended types of drinks

This section describes the main types of most recommended drinks that can be found on the market for proper hydration, since they contain mineral salts and electrolytes lost during exercise.

• Energy drinks:

They are drinks that provide us with energy. They have a large amount of carbohydrates in their composition, these can cause stomach pain as well as hinder the absorption of liquids, making it slower, especially when doing physical activity.

• Smart drinks or "smart drinks""

They are drinks that contain vitamins and stimulants such as caffeine, taurine... these components can cause dehydration. By behaving like stimulant drinks, they decrease the body's energy reserves.

• Water

It is the universal moisturizer and can be used to rehydrate during exercise. It eliminates the sensation of thirst before you are fully hydrated and it must be taken into account that it does not replace the loss of minerals. Water stimulates fluid elimination through urine.

• Sport drinks

They are made to rehydrate quickly during exercise. Not all sports drinks are the same. Among them you have to look for the following basic points:

• Have a concentration of 6-8% carbohydrates.

• Have no gas.

• Have an adequate concentration of electrolytes (Na (15-30meq) and K (7meq)).

• Present a pleasant taste.

Hydration in older people

Despite the fact that about 65% of the human body is made up of water, the body does not store water, so it requires that it be supplied with the amount that it loses each day through different functions such as breathing, sweating, and bowel movements. among other.

If the fluids that are lost while maintaining water balance are not replenished, the body has to resort to what is inside the cells and dehydration, greater predisposition to injuries in the musculoskeletal system, as well as malformation of other organs may occur. or overload (eg the kidney). Decreased thirst, mobility problems or the presence of other diseases mean that older people tend to drink less than necessary, making them more likely to suffer the consequences of dehydration.

The most serious manifestation, in this context, is heat stroke, which occurs when the body's thermoregulatory mechanisms are overwhelmed by excessive exposure to a hot environment, coupled with insufficient fluid intake and increased losses.

Elderly people should drink around 6-8 glasses of liquids daily (water, juices, dairy products, infusions and soft drinks) and consume certain foods with a high water content, such as fruits and vegetables (melon, watermelon, strawberry, grapefruit, grape, orange, cucumber, etc.)

This group should drink fluids gradually, more in the morning and until mid-afternoon, to reduce the frequency of nighttime urination. The temperature must be between 11ºC and 14ºC. It is highly advisable to drink 1-2 glasses of water when you wake up, as it can help intestinal motility.

Large meals should be avoided. At each main meal it is advisable to drink a glass of water as it facilitates the intake of solids, and higher amounts should be avoided, as they produce satiety due to gastric filling.

In certain situations that can favor dehydration, such as high heat and humidity, you should drink more fluids per day. Drinks with a moderate content of fast-absorbing sugars and mineral salts (isotonic on the market), help ensure good hydration, and the different flavors facilitate intake and an adequate supply of fluids, provided there is no medical indication that limit or contraindicate them.

Water content of food:

• 90-99% Skimmed and semi-skimmed milk, soft drinks, soft drinks, melon, lettuce, tomato, asparagus, watermelon, peppers, thistle, eggplant, cauliflower, onion.

• 80-89% Juices, whole milk, strawberries, green beans, spinach, carrots, pineapple, cherries, grapes, oranges, yogurt.

• 70-79% Bananas, potatoes, corn, fresh cheese, fish, chicken, lean meats, olives.

• 60-69% Semi-fat meats, salmon, chicken breast.

• 50-59% Meatballs, bologna, pizzas.

• 40-49% Plums, chestnuts, semi-cured cheeses.

• 30-39% Bread, cured cheeses, sausages, quince.

• 20-29% Honey, figs, raisins, cakes, jam.

• 10-19% Pastries, butter, margarine.

• 1-9% Rice, pasta, legumes, nuts, sugar, cookies, chocolate.

• 0% Oil.

Sports nutrition aims to protect and regulate the body so that it reaches its optimal state for practicing sports. It covers all the cycles of the sport: the rest, the active phase and the recovery phase. Proper nutrition will be as important or more so than proper training, but the combination of both will provide optimum benefit.

Basically, the additional support of nutrients is necessary given the destruction of these that takes place in the processes of elaboration, conservation and cooking that food suffers; There will also be an increase in the metabolic needs of nutrients due to intense exercise.

The objectives of correct nutrition will be:

• Adequately cover the nutritional requirements increased by sports activity.

• Optimization of physiological functions, an essential condition for high performance.

• Being a natural alternative to doping.

• Prevent and heal injuries.

• Prolong active sports life.

Proper nutrition will be as important or more so than adequate training, but the combination of both factors will provide the optimum benefit.

The glycemic index

It is a scale that describes how quickly a food is converted into glucose in the blood, for example, rice and potatoes cause a sudden rise in glucose and insulin in about 2 or 3 hours after eating, instead, the Legumes break down more slowly and produce a more gradual rise in glucose and insulin in the bloodstream.

Depending on the time of ingestion, the optimal carbohydrate will be:

• During the training period: moderate-high glycemic index.

• Before exercise: moderate-low glycemic index.

• During exercise: high glycemic index.

• After exercise: high-moderate glycemic index.

Classification of some of the foods that contain carbohydrates in relation to their glycemic index:

• Alto: Sports drinks, carbonated soft drinks, bread, muesli, oatmeal, cookies, raisins, honey, potatoes.

• MediumPairing: Pasta, rice, orange, banana, grape, corn, peas, sweet potatoes, beans.

• Bass: Apples, apricots, plums, dates, cherries, peaches, grapefruit, pears, broad beans, chickpeas, lentils, milk, yogurt.

training period

To optimize daily training that will undoubtedly result in improved performance, you should eat 400-700 grams of carbohydrates/day (approximately 5-10 grams of carbohydrates per kilogram of body weight per day). These carbohydrates should be moderate to high glycemic index.

The optimal type of carbohydrates according to the time of ingestion is:

• During the training period: moderate-high glycemic index.

• Before exercise: moderate-low glycemic index.

• During exercise: high glycemic index.

• After exercise: high-moderate glycemic index.

For optimal use, it is convenient that the total content of the diet is divided into at least four meals a day: breakfast, lunch, snack and dinner.

The first meal of the day should contain a quarter of the total daily calories. Breakfast should be high in protein (eggs, milk, yogurt, curd, etc.). Fiber intake will also be important, without exceeding 30 grams per day.

The schedules established for the four intakes must be respected regularly; the diet should be varied, capable of maintaining the ideal weight, rich in starches (complex carbohydrates) and low in simple sugars, fats and sodium.

During meals it is convenient to avoid, as far as possible, the simultaneous intake of water and food so as not to dilute the gastric juices and slow down their digestive action.

Precompetitive period

The pre-competitive period covers from the 12 hours prior to the start of the competitive effort. During this time, the athlete may experience an increase in his anxiety levels, with an increase in the secretion of the hormone adrenaline, which consequently produces a decrease in his liver and muscle glycogen deposits. For this reason, in this phase, carbohydrate supplementation and hydroelectrolytic supplementation with carbohydrate content must be taken care of.

Some athletes seem to experience rebound hypoglycemia when eating a high-carbohydrate meal in the hour before competition. In that case, its intake should be delayed (and it will preferably be a liquid intake) until 5 minutes before heating and it is recommended that it be carbohydrates with a low glycemic index.

The general considerations about food that must be taken into account in this pre-competitive period are the following:

• Do not consume high-protein drinks or foods in the time around the test.

• The competitor's previous dietary habits must not be substantially modified.

• The last intake of solid food will be between 2 and 3 hours before the start of the test.

• The caloric content of this last intake should be 500 or 600 calories and its composition will have a high proportion of carbohydrates with a moderate-low glycemic index.

• At the time of ingestion, the temperature of the cooked components will range between 36 and 37º and that of the uncooked components, at room temperature.

• Raw foods should be avoided as much as possible just before the competition. Likewise, foods rich in fiber should not be eaten.

• Spices and fatty and fried condiments should be totally avoided, due to the gastrointestinal irritation they can cause.

• Try to restrict tea and coffee, due to their diuretic and anxiogenic action.

• The athlete must be well hydrated before the competition. He should try to drink at least 300 ml of liquid approximately 30 minutes beforehand.

• A balanced diet with sufficient fluid intake can help reduce the level of mental stress.

Examples of suitable foods before the pre-competitive period:

• Cereals with skimmed milk.

• Toast or bread with ham or honey.

• Sandwiches with banana or honey or jam.

• Pasta or rice (better whole grain) with low-fat sauce.

• Muffins, cookies, baked potatoes.

• Fruit (bananas, oranges, grapes, raisins).

• Energy bars, energy drinks from carbohydrates.

During the competition

Carrying out a physical effort disturbs the physiological balance because it causes hyperthermia, dehydration, a sharp increase in energy consumption and exposes the risk of hypoglycemia in addition to an increase in mineral losses. This justifies, in the case of long-lasting exercises (30 minutes or more), the intake of a refresher.

The intake of liquids or solids during the effort must respond to several premises:

• Rehydrate.

• prevent hypoglycemia

• Slow down the decline in glycogen level.

• Avoid lowering blood levels of branched chain amino acids.

• prevent hyponatremia.

The ingestion of energy drinks allows a correct refreshment without digestive disorders, while that of solids will be limited to certain situations.

Isotonic or hypotonic sports drinks with carbohydrates (glucose polymers) are generally helpful as they serve to replenish fluid losses and prevent dehydration, in addition to supplying carbohydrates. High fructose beverages should be avoided as they are not absorbed as quickly as sucrose, glucose or glucose polymers and can cause diarrhoea.

The standard dose of carbohydrates that is recommended in sports events that last more than 90 minutes is about 30 to 60 grams of carbohydrates every hour. The inclusion of sodium (0,4-0,7 g per liter of water) as well as other electrolytes will be adequate when the sports activity lasts more than one hour.

It is recommended to start eating this extra carbohydrate before feeling fatigued, after about 30 minutes of activity, and the intake will be repeated after a similar interval of time. These drinks are capable of supplying up to 30 to 40% of the energy needed in a prolonged competition, such as a marathon race or a cycling stage.

Liquids should be consumed slightly cooler than room temperature (between 15-22ºC) but excessively cold liquids should be avoided. Likewise, excessively sweet drinks are not recommended, since they increase the sensation of thirst, just as carbonated drinks that delay hydration are not recommended.

In addition, in those sports that greatly exceed this type of real competitive activity, such as cycling, proteins of high biological value must be added to replace worn muscle.

Post-competitive period

The acidification of the body and the rush of adrenaline that accompany intense efforts block the appetite, sometimes for several hours after the end of the competition. It should begin by ingesting moderate amounts of liquid, with a sequence of between 10 and 20 minutes, until the sensation of thirst has disappeared and the previous hydration levels have been restored. This will combat acidosis subsequent to exercise.

As a rule, it is considered that for every ½ kg of body weight lost during competition, the athlete should ingest approximately 400 cc of fluid, which is recommended to contain between 6% and 8% glucose or sucrose.

The first intake of solid food will take place at least 1 hour after the end of the sporting event, in an environment as calm as possible, and it must be rich in carbohydrates with a high glycemic index, in order to continue the process of recovery of muscle glycogen stores. The optimal amount of carbohydrates to ingest would be, according to the authors, 1,5 g per kilo of body weight at the end of the exercise and another 1,5 g per kilo two hours later.

The optimal time for protein replacement begins approximately 60-90 minutes after cessation of activity. Low-fat, high-protein foods should be included in a small proportion.

Those drinks that contain significant amounts of caffeine and alcohol will not be recommended, which, due to their diuretic properties, can interfere with the correct rehydration of the athlete. Carbonated drinks will also not be suitable as they delay hydration.

Examples of menus for this period:

• A raw food: eg grated carrots (vegetable rich in potassium, carbohydrates, vitamin C and natural beta-carotene) and lettuce (rich in fibre).

• A farinaceous food: eg pasta or potatoes (in salad, mashed, boiled) or rice salad.

• A legume or soybean derivative: eg, beans, chickpeas, lentil salad or soybean germ (alkalizing, rich in protein, potassium and vitamins).

• A vegetable.

• A dairy product.

• A sugary dessert or fruit.

During the effort, and even after it has ceased, there are also mineral losses, such as potassium and chromium. If the effort has been very long (3-4 hours), it is advisable to add 600-1200 mg of sodium as it favors fluid retention and the recovery of their ionic balance. Also fruit juices are highly recommended purees in addition to sugars also contain electrolytes, such as sodium and potassium.

Diet to lose weight by reducing fatty acids

To be at the right weight for competition (eg judo), athletes may resort to rapid weight loss methods such as fasting, dehydration, exercising in sweaty clothing, saunas, diet pills, laxatives, diuretics, or self-induced vomiting. So you can lose 4-5 kg ​​in 3 days. These practices can have serious health consequences.

Any weight loss program must be gradual; you should try to lose ½ to 1 kg per week; calorie intake should not be less than 25 calories per kg of body weight (a daily intake of 35 to 38 calories per kg of body weight is reasonable for losing body weight and maintaining muscle). The diet should be composed of at least 60% carbohydrates, 15 to 25% fat and 15 to 20% protein. If consumption is less than 60% carbohydrates, glycogen depletion and increased protein oxidation will occur.

Avoid consuming excessive saturated fats. Refrain from drinking alcoholic beverages. It is recommended to completely avoid refined sugar. "Junk" food and "fast" food should be completely dispensed with.

It is convenient to make five daily meals with the following distribution:

• 30% at breakfast.

• 10% mid-morning.

• 30% on food.

• 10% at snack.

• 20% at dinner.

For example:

• BreakfastPairing: Whole grain cereals, skimmed yogurt and egg white omelette.

• Half morning: Low-fat cheese or skimmed yogurt.

• MealPairing: Grilled chicken breast, boiled brown rice and salad.

• SnackPairing: Apple and skimmed yogurt.

• PricePairing: White fish and wholemeal pasta cooked without sauces.

Diet to gain weight by increasing body mass

Weight gain due to increased lean tissue (or fat-free tissue) involves combining strength training with a balanced diet. The rate of weight gain depends on genetics, body build and hormonal balance. On average, a lean weight gain of ½ to 1 kg per month is advised.

To increase muscle size and strength, it is necessary to achieve a slightly positive energy balance:

• Calorie intake should be increased by approximately 500 calories per day.

• At least 5 to 6 meals a day (every 2 or 3 hours) should be made.

• If larger meals cannot be eaten, it is a good idea to add more snacks between meals.

• It is advisable to include a mixture of foods rich and poor in fiber in the diet, for example: wholemeal and white bread, fresh fruit and fruit juices.

• Extra calories should be obtained from nutritious and low-bulk foods, for example nuts, including at least one liter of semi-skimmed or skimmed milk, yogurt, fruit juice, energy bars in the daily diet instead of filling up with high-calorie or fatty foods .

• A protein intake of between 1,5 to 2 g per kg of body weight is recommended. The ideal is to distribute this protein intake throughout the day (including protein in all shots). To facilitate this task, we can remember that not only is there protein of a high degree of biological value in meat, fish and eggs, but we can also benefit from vegetable protein and dairy products (legumes with rice, soy, cereals with milk...).

electrolytic replacement

Water is an essential substance for life. It is the main component of the human body. 60-70% of an adult's body is made up of water (two thirds inside the cells and one third outside of them). Muscles are made up of more than 70% water, which is why they are so sensitive to dehydration The distribution of water in the body is regulated by electrolytes (sodium, potassium, chlorine, etc.).

In sports activity, the need for water will depend on the amount of water that is lost, which in turn is influenced by the environmental temperature of the place where the specific sport is performed, the energy expenditure involved and the physical activity itself that develops Also, if physical exercise is of a certain intensity, the elimination of certain electrolytes such as potassium, sodium and magnesium, among others, is stimulated, for which a supplementary contribution of both elements may be necessary under certain conditions: water and electrolytes.

If the effort has been very intense or of long duration (more than an hour), the intake of only water in the drink is not enough to fully cover the hydro-electrolyte losses that occur during sports practice, because this liquid, if is not accompanied by an adequate amount of electrolytes, it will cause a decrease in interstitial osmolarity, which in turn will condition the inhibition of the sensation of thirst and will stimulate, by a reflex mechanism, a greater production of urine, with which this process of dehydration will be aggravated.

 To carry out a correct hydroelectric supplementation, relatively cold drinks must be consumed, ingested at regular intervals, of easy digestibility, in order to accelerate its transit to the intestine and its absorption into the bloodstream is carried out easily and quickly.

Recommended amount of a 6% isotonic drink (60 g of glucose or sucrose dissolved in 1 liter of water) during exercise practice):

• Moderate intensity (less than 45% of the maximum oxygen consumption): 500 ml/h.

• Moderate to high intensity (between 50 and 70% of the maximum oxygen consumption): 750 ml/h.

• high intensity (greater than 75% of the maximum oxygen consumption): 1.000 ml/h.

It is advisable to start drinking before sports activity: 6-8 ml/kg of body weight. Thereafter the consumption will be approximately 2-3 ml/kg every 15-20 minutes.

Dehydration causes a great loss of physical capacity. Losing more than 2% of body weight due to dehydration lowers physical capacity by 5 to 10%; more than 3% lowers muscle contraction capacity by more than 20% and cramps begin. Above 8% loss there may be serious risk of death. It should be noted that thirst is perceived when losses are greater than 1-1,5% of body weight.

Anemia in the athlete

Many of the so-called "decreases in physical fitness" of athletes coincide with a clinical picture characterized by a relative decrease in their red blood cells, which was called "athlete's anemia", it is fundamentally observed in those athletes who exercise resistance activities and in those who train with great intensity and high loads. Characteristic also in runners due to the repetition impact.

There are many types of anemia, but the one that athletes suffer from most frequently is iron deficiency. Iron is vital for the proper functioning of the respiratory chain since it constitutes the central nucleus of the hemoglobin molecule.

The causes of athlete's anemia are:

• Insufficient intake of iron through diet: common in athletes who follow vegetarian diets that are not properly balanced. Also due to an excessive increase in the consumption of carbohydrates to the detriment of proteins, mainly of animal origin.

• The decrease in intestinal absorption, which is hindered by an increase in intestinal peristaltic movements as a result of intense muscular work, which causes the consequent acceleration of the transit of intestinal content, which decreases the absorption time.

• The reduction in the ability to use iron: it is believed that it is produced by the rise in body temperature, generated by muscular work, which interferes with the processes in which organic iron must be available for the production of hemoglobin and Red blood cells.

• Extraordinary losses of iron: in addition to the daily loss considered physiological, the athlete may present much higher losses due to profuse sweating, hematuria on exertion, micro-injuries generated by all physical exercise from a certain intensity and increased acidity of the blood secondary to increased lactic acid concentration.

To all these causes of anemia in athletes, we must add the fact that intense physical exercise increases the demands for iron, in order to cover the consequent cellular metabolic adaptations due to the increased activity of the substances in which this is involved. element and that are the production of ATP and myoglobin.

The key to success in the treatment of sudden death is early defibrillation, through electrical emissions that should be applied, preferably, in the first few minutes. Defibrillation, therefore, is the most effective measure to restore spontaneous circulation in cases of sudden death. The faster defibrillation is performed, the better the prognosis; for every minute that it is delayed, survival decreases between 7 and 10%.

A defibrillator is only indicated for hearts in ventricular fibrillation, with an irregular heart rhythm. If there is no fibrillation, the heart will not respond to the electrical emissions and will require drug resuscitation.

sudden cardiac death

Sudden death generally occurs as a result of cardiac arrest, accounting for 85% of cases. When it occurs unexpectedly in a young, athletic and apparently healthy person, it causes a great social and family impact. It is quite difficult to identify a person at risk of sudden death among the general population. It is important to prevent sudden cardiac death through a good medical and cardiological examination with electrocardiogram, echocardiography and ergometry or stress test.

However, in some cases this type of test does not detect certain pathologies, requiring a genetic study of cardiovascular pathology. A small amount of blood is extracted in which its leukocytes are isolated and from them its DNA is isolated. The results of these tests are completely confidential and can only be given to the patient.

Cardiorespiratory arrest and defibrillation

The importance of defibrillation for successful recovery from cardiac arrest has prompted health authorities and scientific societies to promote the use of defibrillators by the first responders in emergency situations.

The improvement of semi or automatic defibrillators has simplified their use in the recognition of heart rhythm disorders and their electrical treatment, eliminating the complicated training for their use.

The introduction of these semi or automatic defibrillators in different cities of the world have promoted the concept of public access to defibrillation, based on deductive reasoning: if early defibrillation improves survival from sudden cardiac death, increased availability and access to defibrillators allows faster defibrillation and, therefore, a better prognosis, managing to reduce the number of deaths due to sudden death.

Defibrillator

A defibrillator is a device that delivers an electrical shock to the heart through the chest wall. Its built-in sensors analyze the patient's heart rhythm, determine when defibrillation is needed, and deliver the shock at the appropriate intensity level. It can also restore normal heart rhythm to a heart attack or sudden death patient. Today's portable models allow more people to respond appropriately to an emergency that requires defibrillation.

The device's internal microprocessors analyze the patient's heart rhythm through adhesive electrodes. The on-board computer then alerts the operator if an electrical shock is required, as well as when. When the device emits a visible or audible signal, the emergency responder executes the shock and the defibrillator delivers an electrical current to the heart through electrodes attached to the patient's chest.

Indicators for the use of the defibrillator

A defibrillator is only indicated for hearts in ventricular fibrillation, with an irregular heart rhythm. If there is no fibrillation, the heart will not respond to the electrical emissions and will require drug resuscitation.

Since semiautomatic external defibrillators (DESA) are designed to be used by non-medical personnel, they are described below:

• If the victim does not respond and is not breathing normally, send someone to the DESA, if there is one in the area, and call the local emergency telephone number. Proceed to remove the clothing from the waist up, if necessary cutting it.

• Start cardiopulmonary resuscitation according to Basic Life Support recommendations. In adults and children outside the hospital with a 30:2 sequence. That is 30 chest compressions for 2 breaths. Compressions at a rate of 100 per minute.

• As soon as the defibrillator arrives, turn it on and attach the electrodes.

• Follow the voice/visual directions of the device. If applicable, click on the "analysis" button. Make sure that no one touches the patient at the time of analysis to avoid interference.

• If shock is indicated, make sure no one touches the victim.

• If it is semi-automatic, press the download button, while being notified that it is proceeding.

• If shock is not indicated, restart CPR immediately with patua 30:2.

DESA messages will continue to be followed until:

• Qualified help arrives and takes care of the patient.

• The victim begins to breathe spontaneously. In this case, you will be placed in a lateral position until qualified help arrives.

Keys to cardiovascular health

In order to have and maintain good cardiovascular health, in addition to the regular practice of physical exercise, it is necessary to monitor and control the diet and some analytical and physiological values, as suggested below:

• Total cholesterol should be less than 200 mg/dl.

• Fasting glucose should be less than 110 mg/dl.

• Blood pressure should be below 140/90 mmHg (in case of diabetes, cardiovascular or kidney disease below 120/80 mmHg).

• Body Mass Index: Weight(kg)/Height2. It is advisable that the quotient is below 25.

• The abdominal perimeter must be less than 102 cm in men and 88 cm in women.

It has been shown that starting physical activity abruptly produces a decrease in the amount of blood that reaches the heart in the first moments of activity, producing a significant health risk, especially in people not used to exercising frequently. . What they advise is to start physical activity with a previous warm-up, to warn our body that we are going to make it work.

What is meant by sports warm-up

Warm-up is defined as all those physical activities that are carried out prior to the main activity to prepare our body in order to carry out a subsequent physical effort. It is the initial part of the training, which is characterized by having an intensity average below the average of the training.

The warm-up is a small training that has the objective of preparing not a test or a competition, but a subsequent work. Its planning is that of a training, with an initial progressive part, another part of specific work and a last part of calming down.

The theory says that:

• First: We must dedicate a few minutes to joint activation, with movements of the main joints, seeking to work the full degree of mobility of each joint little by little, thus improving the temperature and lubrication of the joints.

• Second: a few minutes of weak aerobic muscle toning work, to increase heart rate and blood pressure and warm up ligaments, connective tissue and muscles.

• Third: a more specific and more intense work for the session or training to be carried out.

• Fourth: some active stretching and recovery work from the state of fatigue and lack of oxygen.

To perform a good warm-up we have to have done a part of aerobic work of light or medium intensity for a few minutes. All aerobic work creates a lack of oxygen that takes, depending on time and intensity, a few minutes to return to a balanced state.

If after that work we stretch the most important joints and those specific to the subsequent work that we are going to do, we will be improving our flexibility and at the same time recovering the oxygen debt. Therefore, after stretching, the body will be warm, lubricated and ready to give its best, but without fatigue, so maximum performance can be sought after a planned warm-up.

Warm-up goals

With the warm-up carried out before starting any physical exercise we achieve several benefits, both circulatory, respiratory, muscular as well as neurological. Our organic systems (circulatory, respiratory,...) begin to work progressively, producing an adequate blood supply. The muscles increase their temperature little by little, favoring their contraction. The nervous system adapts to exercise favoring concentration and anxiety control.

For all the above, two are distinguished general objectives:

• Prepare the individual physically, physiologically and psychologically for the subsequent effort that physical exercise entails.

• Avoid risk of injury.

The factors Things to keep in mind during warm-up are:

• Duration: about ten minutes will be dedicated to warming up, enough time to put all the organic systems into operation as we have said before.

• Intensity: the intensity must be low, because we are starting an activity and our body has not yet “woke up”. This low intensity will be increased little by little throughout the warm-up.

• Reps: We must avoid doing many repetitions, as this could lead to an increase in intensity. In addition, avoiding many repetitions, we make the warm-up more varied and attractive. The repetitions can be between five and eight.

• Pauses: pauses are not necessary because we are doing low-intensity exercises, we must avoid them as much as possible or do them actively (walking, stretching, etc...). If we make too many pauses we will not achieve what we want, which is to progressively increase the pulsations, losing what has been achieved. As for the rest between the warm-up and the physical activity that we are going to do later, between four and five minutes are recommended.

• Progression: we will start the warm-up at a slow pace, to gradually increase it.

Recommended exercises

During the warm-up period we must avoid all exercises that involve strength, endurance, speed and agility, since the body is not yet ready for it. What we must do are exercises that involve a general activity, that is, the greatest possible number of segments or muscles, so that they initially activate the circulatory and respiratory system, and then activate the muscular system.

Among the most recommended exercises are:

• Smooth running exercises.

• Light jump exercises and twists.

• Joint mobility exercises.

• Stretching exercises.

• Games.

Aspects to consider

When performing warm-up exercises in order to prepare the body for better physical performance and to avoid any type of muscle contraction or fracture, we must take into account a series of tips that will help us prepare the body for the best possible way:

• Start with a slow jog or run for a few minutes (5 to 10').

• Carry out stretching exercises progressively, trying to organize them in such a way that they affect the greatest number of parts of the body.

• The repetitions should not exceed the number of 10 or 12.

• Perform the exercises in such a way that they go from less to greater intensity.

• Take a normal breath.

• Start by warming up large muscle groups, to finish with small ones.

• Finish if possible with a small progressive run.

• The warm-up should last between 20 and 30 minutes in sports competitions and between 10 and 15 minutes in low-intensity sessions.

• The warm-up, unless it is done in hot weather, should be done with a tracksuit in order to avoid injuries.

Types of heating

 We can differentiate between different types of warm-up which, depending on its location and the area with which we are going to work, would be classified as: general warm-up, specific warm-up and mixed warm-up.

• General warming: in it we must gradually put into operation all the parts of the body. We will move all the body segments in an orderly manner since later, the activities that we are going to carry out will not exclusively use one part of the body, but rather all of them will intervene as a whole. It is the one that is done to later play basketball, volleyball,...

• Specific heating: it will be directed to the parts of the body that will later intervene in a main way, even only. As an example we can put the warm-up that is done for a football match: we should previously carry out a general warm-up and later we should introduce exercises that facilitate the more specific preparation of the legs, paying more attention to the ankles, knees and back of the thigh.

• mixed heating: Starts general and then becomes specific. 

The general warm-up consists of:

• Force heating: For a correct warm-up of the physical quality of strength, we have to warm up the three sections that make it up, resistance strength, maximum strength and explosive strength. Always in this order and at the end of phase three of the warm-up. (See heating phases in this same text at the top).

• resistance heating: It has to be done in the second phase of the warm-up, with easy aerobic work of short duration, a few series with few rests at less than 140/160 beats per minute. We have to do it globally first and then by sectors, arms, legs...

• balance warm-up: It can be placed in the first phase of the warm-up integrated into the exercises themselves.

• speed heating: Place it in the third phase of the warm-up, with a series of very short exercises of three to six seconds, with good rest and usually quite specific.

• Coordination warm-up: When designing the exercises in their second and third phases, they must be varied and contain the common elements but add certain aspects that help improve and prepare subsequent coordination work.

• Stretching warm-up: This is stretching without forcing the joint, which is the last phase of the warm-up.

• Warm up: The exercises for a correct warm-up have to follow the basic principles of training, starting with the most general ones and ending with the specific ones. Start with the large muscle groups and finish with the specific ones.

type session

As explained in the previous sections, sports warm-up beforehand is essential to prevent injuries. Taking into account that it can be variable depending on the sport to be performed, a standard warm-up program is proposed below.

Time: 10 minutes

• 2 soft race minutes

• 2 minute easy run with exercises:

  • forward

  • ago

  • lateral

  • raising heels

  • raising knees

• 2 minutes walk:

  • of heels

  • of toecaps

  • stepping on the heel passing through the sole and ending with the tip of the foot

  • every three steps touch with one hand on the ground (each time with one)

• 2 minute static: 2 minute final easy run

  • raising and lowering ankles

  • up and down knees at race pace

  • hip flexion and extension (forward, backward, and lateral)

  • Lying prone, with your hands resting on the ground on both sides, raise your shoulders leaving your hips on the ground

  • lying on the ground, legs up, resting on the shoulders (nail), cycling

  • back, shoulder and arm stretches

  • stretches for the back, hip, groin, and back of the knee

Conclusions

It is not possible to carry out a physical education class, a training session, a sports competition... without a previous warm-up session. It is necessary to warm up prior to performing any physical activity with an approximate duration of 10 to 15 minutes, thus preparing our body for the subsequent activity that we are going to carry out.

The benefits on the physical and psychological capacities of any physical activity are indisputable. But stretching regularly and with correct tables is doubly beneficial and, in general, we improve in the following: increasing the range of joint movement, reducing contractures and postural pain, improving sports performance and fighting aging.

• Increase joint range of motion

Muscle mass and tendons with inactivity and with age lose quality and "strength". In the case of muscle mass, what is lost is matter, volume. In the tendons what is lost is strength and flexibility. Lubrication capacity is lost in the joints.

• reduce contractures

Muscle contracture can be a symptom of an underlying disease, such as osteoarthritis, herniated discs or protrusions. On other occasions, it is the disease itself, without any other basic alteration that favors it, and it is usually due to poor posture maintained or repeated efforts.

• Reduce postural pain

When you spend a lot of time in the same posture (eg standing) certain muscle groups do a great job of maintaining posture and balance. Over the years, these muscles gain extraordinary resistance, but over time they stiffen and shorten until they are injured (contractures, pain, microtears). The muscles for their proper functioning have to be like rubber bands, when they lose that elasticity sooner or later they begin to be affected. The breakage of some fibers does not cause any problem, but when this micro breakage increases, the problems begin.

• Increase sports performance

Performing stretching exercises for competitive athletes is essential and in many sports the gain in flexibility is directly related to sports results. In other sports, maintaining a high degree of joint mobility is necessary to facilitate training and avoid possible future problems or injuries.

• Against aging

One of the main characteristics of aging from the physical point of view is the loss of strength and flexibility. Both lead to a gradual reduction in the quality of life, by reducing the spectrum of tasks that can be performed. The more flexible a joint is, the easier it is to push it to the extremes of its mobility. If you have flexible ligaments and muscle bellies, less force will be needed to perform such a movement. There is no better gym for a senior than a few minutes of stretching and a walk every day.

muscle stretches

Stretching can be defined as exercises in which we subject the muscle to a tension force that produces its elongation, deforming it longitudinally, at a certain speed and for a variable time, with the above factors influencing its results.

Benefiting our musculoskeletal system through stretching, preserving elasticity in its tissues, improving joint mobility (flexibility), having a protective effect on possible injuries and being fundamental in the development of qualities such as strength, speed and technique of An individual.

Objectives

Depending on the technique used in its performance, various benefits can be achieved: they prepare the muscle for a subsequent physical exercise, improving the blood flow of the muscle groups once the activity has been completed, they recover the elongation capacity of the muscle after periods of inactivity and immobilization, have a preventive effect on contractures due to their ability to relax the muscles, improving flexibility.

They allow gains in power, strength, coordination and speed in the different body muscle groups. They improve joint mobility, allowing an increase in the range of movement of the joint, being more harmonic and aesthetic. They contribute to the balance of body posture.

Factors

The elongation or stretching capacity of muscle-tendinous tissue is conditioned by certain factors, among which we can find: the tissue on which they act (ligaments, muscles, tendons...), neurological factors, environmental and intramuscular temperature, age, and social factors.

The mechanical and dynamic properties of the tissue on which they act (ligaments, muscles with their belly and tendons, fasciae and capsules), which is mainly composed of connective tissue, with fibrous connective tissue rich in collagen and connective tissue rich in elastin, depending on the tissue elongation capacity, the response of collagen (it is very resistant to deformation but has little extensibility capacity) and elastin (it has great extensibility) to deformation forces.

Neurological factors: emotional (nervousness or relaxation), muscle stretch receptors and neurophysiological processes that take place within the human being.

• Age.

• Environmental temperature and intramuscular temperature.

• Factors associated with social customs that occur in the individual's environment, influencing the greater or lesser, or modes of, use of the different muscle groups.

Factors that increase the elongation capacity: higher proportion of elastin within the connective tissue, high stretching tensions and maintained for long periods of time and repeatedly, state of relaxation of the individual, stimulation of the reverse myotatic reflex that inhibits muscle contraction producing tendon relaxation, a greater degree of flexibility training, reduction of external stimuli such as noise and light, high environmental temperature, high intramuscular temperature that is achieved with a good warm-up, younger age.

Factors that reduce elongation capacity: higher proportion of collagen in the connective tissue, low stretching stresses and for short periods of time, and infrequently, a higher state of arousal of the individual, stimulation of the myotatic reflex that causes the stretched muscle to contract, increased external stimuli, low environmental and intramuscular temperatures, higher degree of aging, more trained individuals in strength and/or speed.

Types of stretch

There are different types of stretching depending on the way they are performed (static, dynamic or mixed) or according to the purpose pursued (preparation and maintenance, training and improvement, recovery or rehabilitation).

Static: sWith those in which a stretch is performed at rest to the limit of what is comfortable, the muscle is stretched while at rest to a certain position and we maintain it that way for 15 to 30 seconds, without movement of the joint. Being slow movements and at rest, we achieve better muscle relaxation with them, increasing blood circulation and reducing the sensation of pain. They require less energy expenditure than dynamic stretching.

In turn, they can be classified into:

• active static stretching: they are achieved by contraction of the muscles that move the joint of the individual performing the stretch, without using any external assistance. To perform them, we stretch the muscle as far as possible and then slowly contract the antagonist muscle, thus actively increasing the stretch. This stretch position is held for 10-20 seconds, without any further movement. The exercise is repeated 2 or 3 times after a pause of 10-20 seconds. During the breaks we can stretch another muscle group. Within this type of stretching we find the exercises of the Pilates method.

• passive static stretching: the joint position is achieved through a force external to the individual (such as the action of gravity, a person holding the limb in a certain joint position, a wall, a stool, etc.). To perform them, we stretch the muscle slowly to its maximum possible, without causing pain or unpleasant sensation. The muscle is then held in this position for 10-30 seconds. The feeling of tension clearly decreases after 3-4 seconds, not changing the position of the stretch. The stretch ends in a slow and controlled manner. A pause of identical length follows the stretch. This pause can be used to stretch another muscle group. Each exercise must be repeated at least 3 times. This stretching is more effective if, at the end of the first stretching phase, the stretching is slightly increased, maintaining this new tension for another 10-30 seconds. In this second phase you should not feel pain either. We call the first phase light stretching and the second phase stretch development. Within this type of stretching we find techniques such as Bob Anderson's stretching or Sven-Anders Solverborn's gravitational stretching.

Dynamic (slow, fast or ballistic): they consist of stretching through impulses but without exceeding the limits of static stretching. Antagonist muscles are stretched by repetitive contractions of the agonist muscles. And we can divide them into:

• Active Dynamics: We get the movement through the contraction of the muscles that move the joint of the individual who performs the stretch.

• Passive Dynamics: The movement is performed through a force external to the individual (the action of gravity or a person moving the joint).

Mixed: they combine movement with the maintenance of static positions, they are generally active, because the contraction of the muscles that are being stretched or of their antagonists is used. Among them are the proprioceptive neuromuscular facilitation of Herman Kabbat or the global postural reeducation of Philippe Souchard.

• Proprioceptive Neuromuscular Facilitation or contraction-relax stretching method: first we slowly stretch the muscle to its maximum possible limit. The muscle is then contracted isometrically, without shortening the muscle, for 6-10 seconds. The stretched muscle then relaxes for 2-4 seconds, maintaining the position of the joints. After a brief relaxation pause, the muscle continues to be stretched slowly to a new initial stop. This position is maintained for 10 sec. This is followed by a new isometric contraction for 6-10 seconds, then another relaxation for 2-4 seconds, to continue with 10 seconds of sustained stretching. Finally, the above procedure is repeated for one last time. Any bounce, pull or sudden movement must be avoided at all costs.

• Global Postural Reeducation Method: The movement is based on the performance of several muscles in the form of chains, grouping them. The minimum duration of this stretching technique is thirty minutes.

time of completion 

Stretching should be done routinely and consistently. In the different sports disciplines they are included in the previous warm-up, to adapt and condition the muscle-tendinous structures to the exercise to be performed, thus preventing the appearance of certain sports injuries, placing more emphasis on those sports that require changes of direction. and speed.

They should also be performed at the end of physical activity, in order to reabsorb waste metabolites, avoiding muscle shortening.

Flexibility is essential in sports practice, within the physical preparation section, increasing the ability to avoid injuries, hence the great importance of incorporating stretching into physical training.

The duration of the stretches is not predetermined, it varies depending on the conditions and previous state of the muscle on which it is going to act. All stretching should be smooth, progressive, and should not cause pain.

Examples

Below are some examples of types of stretching for certain muscle groups in different parts of the body, although these can be modified accordingly.

Neck and cervical area. Stand up, place your hands on the back of your head and pull your elbows back, at the same time pushing your head down with your hands. Hold the position for 20 seconds.

Shoulders and triceps. Standing with your back straight, put your forearms over your head, take your left elbow with your right hand and bring it back. Hold that position for 20 seconds, and repeat the exercise with the opposite arm.

Pectorals. Standing, facing a wall, touch the tips of your feet to it. Put your right arm perpendicular to your body and support the palm of your hand at shoulder height on the wall; turn your trunk to the left as far as you can. Hold that position for 20 seconds and then do it with the contralateral arm.

Back Lie on your back and place your feet on the floor, with your knees slightly bent; take one of your thighs with your hands and raise that leg at a right angle, until the knee touches the chest. Hold that position for 20 seconds and then switch legs. Another position: In the previous position, place your arms to the sides on the ground, raise your legs together and forming a right angle; Without taking your shoulders off the ground, turn your hips to the side until your legs touch the ground. Hold the position for 20 seconds and turn to the other side.

Buttocks. Sitting on the floor, with your legs stretched out and your back straight, cross your left leg over your right and flex it, placing your foot on the ground; rest your left hand on the floor behind your hip and with your right hand hold the outer face of your left thigh; turn your trunk to the left side, and towards the thigh to bring it closer to the chest. Hold the position for 20 seconds and switch legs.

Anterior thighs (quadriceps). Lying on your right side, stretch your right arm up, bend your left leg behind you, grasp your ankle with your hand, and bring it toward your buttock. Hold the position for 20 seconds and switch sides.

Posterior thighs (hamstrings). Sitting on the floor, with your legs stretched out and your back straight, cross your right leg under your left and bend it; flex your trunk forward trying to touch your knee with your face. Hold this position for 20 seconds.

Inner thighs. Sitting on the floor in a "butterfly" position, with your legs bent and the soles of your feet together as close as possible to your pelvis, grab your feet with both hands and lower your knees, always bringing them as close to the ground as possible. Hold this position for 20 seconds.

Twins. Standing in front of the wall, lean on it with your arms, one leg is bent in front of the other stretched out in a backward position; In this position, the calf of the leg behind is worked. For the exercise to be performed properly, two key aspects must be met: the first is that the heel of the rear leg is well supported on the ground; the second, that the feet must remain aligned perpendicular to the wall. 

Conclusions

Stretching plays a fundamental role in the adaptation of our body to physical activity and in the prevention of possible sports injuries. They must be carried out both before sports practice, incorporating them into the warm-up, and after the end of physical activity, facilitating an adequate recovery process.

They should also be part of the physical training process, improving the flexibility of the individual, a factor that brings great benefits. They should never be painful, factor the pain that will indicate that we are doing them improperly. The duration of the stretches is variable, depending on the characteristics and previous state of the muscle-tendinous structure on which they are applied, and is also an element of study, in order to find the most appropriate and beneficial times for each situation.

The practice of physical exercise brings benefits to our health (physiological, on the heart, on the circulatory system, on the musculoskeletal system, on metabolism and on psychological and psychosocial aspects). All this is analyzed in the different stages of life: children and adolescents, adults and the elderly.

Physiological Benefits:

• Greater cardiorespiratory capacity, which allows optimizing the general functioning of the organism and its performance against specific demands.

• Lower risk of coronary heart disease, as well as prevention of second episodes of heart attacks in people who have suffered heart attacks.

• Lowering blood pressure and preventing essential hypertension.

• Prevention and reduction of respiratory disorders.

• Prevent deterioration of bone mineralization.

• Prevent atrophy in muscle tissue, shortening, as well as stiffness of the joints.

• Greater flexibility at any age.

• Prevent and control muscle pain (myositis and myalgia).

• Reduce weight and maintain ideal weight: increase in muscle mass or lean mass and decrease in fat mass.

• Improve overall physical appearance.

• It also helps to become aware of the individual's physical strengths and limitations, facilitating proprioception and giving a good sense of one's own body.

About the heart:

• Lowers resting heart rate.

• During effort, the amount of blood ejected by the heart in each beat increases, thus cardiac efficiency is greater "spending" less energy.

• It stimulates coronary circulation within the heart muscle, favoring the "feeding" of the heart.

About the circulatory system:

• Contributes to the reduction of blood pressure.

• Promotes and increases circulation throughout the body.

• It reduces the formation of clots inside the blood vessels, preventing the appearance of heart attacks, thrombosis and embolisms.

• It acts on the vascular endothelium, improving its activity and keeping it more elastic.

• It improves venous return, preventing, among other conditions, the appearance of varicose veins.     

About the musculoskeletal system:

• It favors the strengthening of joint structures (bones, cartilage, ligaments, tendons) and improves the function of the musculoskeletal system, contributing to the quality of life and degree of independence, especially among the elderly.

• Increases muscle and joint elasticity.

• Increases the strength and resistance of the muscles.

• Prevents the onset of osteoporosis.

• Prevents muscle deterioration caused by the years.

• It facilitates movements and the development of activities of daily living.

About metabolism:

• Increases the ability to use the oxygen that reaches the body through circulation.

• Increases the activity of muscle enzymes, allowing better muscle metabolism with less need for cardiac work.

• Improves the immune response to infections or aggressions of different types.

• It increases the secretion and work of different hormones that contribute to the improvement of the functions of the organism. 

• Increases fat consumption during activity, which contributes to weight loss.

• Collaborates in the reduction of total cholesterol and LDL ("bad") cholesterol with an increase in HDL ("good") cholesterol.

• Improves glucose tolerance favoring the treatment of diabetes.

• It facilitates digestion, favors intestinal transit by regulating evacuation habits and avoiding constipation, reducing the risk of colon cancer.

On the psychological aspects:

• Increases the feeling of well-being and decreases mental stress (there is a release of endorphins that promote "feeling good" after exercise).

• Increase and strengthening of self-confidence and self-esteem.

• It improves one's image by contributing to the establishment of a positive relationship with one's own body.

• Decreases the degree of aggressiveness, anger, anxiety, anguish and depression.

• Reduces the feeling of fatigue, giving more energy and work capacity.

• Improves sleep quality and decreases insomnia.

• Collaborates in maintaining a full sexual life.

On the psycho-social aspects:

• Relieves adverse mood states and other manifestations of psychological stress.

• It provides fun, distraction from daily problems...

• Prevents and reduces symptoms of pathological states of anxiety (generalized anxiety disorders, phobic disorder, obsessive-compulsive disorder) and depression.

• It helps prevent and modify certain abnormal behaviors, such as antisocial behavior.

• It intervenes in the prevention, control and abandonment of behaviors that are harmful to health such as alcoholism, smoking and drug addiction.

• It helps to develop a lifestyle based on commitment and perseverance, optimism, cooperation...

• Establishes positive values ​​and role models.

• Development and strengthening of social relations.

• Learning and improvement of sports skills.

• Coping and achievement of challenges.

Environmental pollution

When we breathe we inhale, in addition to gaseous oxygen and nitrogen, substances and particles from pollution from automobiles, industries, construction or other sources related to human activity. The worst pollutants are suspended particles and tropospheric ozone, since exposure to these pollutants can have effects on the respiratory system, producing a reduction in lung function and the development of cardiovascular diseases.

Oral prevention

Sports activity has widely demonstrated its benefits in all individuals, so its practice is recommended on a regular basis; That is why we must know the risks to which we are exposed to act preventively and avoid their consequences.

In terms of oral health, we must bear in mind that dental trauma is not the only cause of morbidity in regular sports practice; You also have a higher risk of tooth decay and tooth wear.

In sports activities, the factors that keep teeth in constant aggression are fundamentally dehydration, the intake of products rich in glucose and highly acidic rehydrating drinks. Dehydration causes a reduction in salivary flow, the frequent intake of drinks and foods rich in glucose maintains an inadequately acidic environment in the mouth, as well as the intake of juices and sports drinks with a pH of less than 5,8.

In the case of sports associated with the use of swimming pools, the acidity of their water with inadequate chlorination increases the risk of dental wear and affects the tissues of the mouth in individuals habitually exposed to this environment.

Another factor to mention that increases the risk of dental wear is the voluntary or involuntary contraction of the muscles involved in chewing that occurs in moments of tension or as a result of physical effort during sports, or psychologically, stress to which athletes are exposed in competition seasons.

At a preventive level, regular check-ups with the stomatologist or dentist help to diagnose wear and/or cavities early, and to be able to put in place the means to prevent their progress or, in some cases, to be able to carry out the appropriate treatment, which will always have a better prognosis. than in lesions diagnosed later.

Benefits of swimming for the body

Swimming is one of the most recommended sports to exercise our body, since it mobilizes most muscle groups. This requires considerable cardiovascular work, which gives us multiple benefits. One of the great advantages of swimming is the weightlessness produced by the water, which facilitates movement.

• Improves cardiovascular endurance.

• Stimulates blood circulation.

• Strengthens the bone and muscle system, especially in the lower back.

• It is complementary in rehabilitation of certain injuries, as it is an activity that does not force bones or joints.

• It facilitates a better body posture and develops flexibility.

• Contributes to personal social relationships (sociability).

• It generates a good mood and promotes self-esteem.

If, in addition, we bathe in the sea, the benefits are greater. The breeze acts as a natural spray due to its high iodine content, which regulates the thyroid glands and balances the body. Seawater with its minerals, vitamins and antioxidants will help our skin to stay smooth and if we combine it with the sun, with the relevant protection, we will enhance the effect of vitamin D. In addition, its high magnesium content makes it an element very beneficial to calm nerves and help people suffering from anxiety.

Daily exercises to keep fit

• Start swimming calmly and resting from time to time, every 4-5 minutes, at least, even every length in novices.

• Gradually increase the time dedicated to swimming up to 20-30 minutes a day, emphasizing the correct execution of the style or its learning.

When you already have physical resistance:

• Swim gently for 5-10 minutes to get your heart rate up (warm up).

• Continue combining strokes (butterfly, backstroke, breaststroke and front crawl or freestyle), depending on personal goals, for about 20-30 minutes.

• Swim calmly for about 5 minutes, slowing your heart rate (cool down).

• Drink water after each session.

baby swimming

Introducing the baby in the water at an early age favors his psychomotor development and his coordination of movements, it also strengthens his cardiorespiratory system, helps him to relax, to feel more secure, increases his IQ developing a greater perception of the world around him and learns to observe and be more creative. In addition, it helps you socialize with people and develop your communication skills.

osteoarthritis problems

Currently, non-pharmacological treatment is considered the first choice in the management of patients with osteoarthritis and the practice of physical exercise plays an essential role, since it is shown to be effective in controlling various pathological processes related to joint damage. Of course, for the EP to be beneficial, it must be prescribed individually, studying the joint involvement and the physical conditions of the individual.

Risk factors that contribute to the development of osteoarthritis are:

• Advanced age.

• Low estrogen level (menopause, hysterectomy).

• Genetic factors.

• Previous inflammatory joint disease.

• Metabolic, endocrine disorders.

• Obesity.

• Structural defects.

• Repeated stress (sports, profession).

Physical exercise has been shown to be effective in controlling various pathological processes because:

• improves cartilage nutrition,

• decreases inflammation,

• improves flexibility,

• increases strength,

• decreases pain.

The most beneficial sports for patients with osteoarthritis are walking, swimming and cycling.

Recommendations

In general, they will include hygienic measures and general measures.

Hygienic measures:

• Lose weight.

• Seated at a 90º angle of hip flexion with a backrest that allows the support of the entire spine.

• Decubitus with legs flexed.

• Standing changing supports and not standing without walking.

• Crouch down by bending your knees.

• Avoid slopes.

• Soft ground (grass, moist soil).

• Wear comfortable and loose clothing.

• Use comfortable and flexible light footwear with load absorption capacity. Change footwear after 400 km.

General measures:

• Avoid exercise that causes pain.

• Avoid taking analgesics prior to physical exercise.

• Avoid exercise that causes an increase in disease activity.

• Allow correct posture and good joint alignment.

• Use joint protection measures.

• Adequate warm-up and cool-down to minimize the risk of injury.

• Physical exercise should be regular.

cardiovascular system

Many heart diseases can be improved with physical exercise, but for this to be the case, we must have knowledge of the cardiovascular response, making a personalized assessment with a training plan based on the existing pathology.

There are four basic forms of cardiac pathology that alter the exchange of O₂ and CO₂ during physical exercise: coronary, valvular, myocardial and pericardial and congenital.

Medical-sports examinations must be adapted according to the state of health of people classified into four groups:

Group 1: Healthy people without risk factors and aged less than 35 years. Recognition is not mandatory, but it is recommended for competitive athletes.

Group 2: People with a risk factor, asymptomatic or apparently healthy and older than 35 years. The examination must include a sports-medical history, a detailed physical examination, a 12-lead ECG, a maximum stress test and a chest X-ray.

Group 3: People with 2 or more risk factors and people over 45 years of age. The examination is the same as that carried out on group 2 and must also include a blood and urine test.

Group 4: People with metabolic, pulmonary or cardiovascular diseases regardless of age. The examination must include an extended cardiological assessment.

The objectives of the cardiological examination prior to the practice of physical activity and sports in heart patients are:

• Assess symptoms related to exertion.

• Evaluate arrhythmias.

• Establish the severity of the disease.

• Determine exercise tolerance.

• Assess response to medical therapy or cardiac pacing.

• Determine the cardiovascular risk involved in participating in sports activity.

The contents of the sports cardiology examination are: detailed clinical history, assessment of clinical symptoms, cardiological physical examination, stress test and periodic re-evaluation.

Useful diagnostic tests to evaluate heart disease are: echocardiography, echo-Doppler, Holter, coronary angiography, electrophysiological study.

spinal problems

By definition, it is a lateral deviation of the spine greater than 10º of angular value accompanied by vertebral rotation. The diagnosis of this disease is made through both physical and radiological examination.

Classification of idiopathic scoliosis:

• Kids: first 3 years

• Juvenil: from 4 years to the beginning of puberty

• Teen: puberty

• Adult: from 20 years old.

Exercise therapy is aimed at avoiding the side effects of bracing; spinal stabilization; improve lung function and aerobic capacity apart from the beneficial psychological effect. In addition, very good results are obtained on the curve, lung function and aerobic capacity.

In adult scoliosis, treatment with exercises does not aggravate mechanical function and is very useful against pain.

Benefits of physical exercise in older people

Aging is characterized by a decline in the functional capacity of organs and body systems. Therefore, it is where all the general benefits mentioned above are most evident.

Carrying out a continuous exercise in this stage of aging:

• It stimulates psychomotor performance, with improvements in reaction time, visual organization and mental flexibility.

• It favors coordination and proprioception, reducing the risk of falls.

• Helps prevent and treat decline in functional capacity.

• It helps to improve and maintain the level of independence.

• It intervenes in the prevention and treatment of cardiovascular and respiratory diseases.

• Stimulates brain irrigation delaying and reducing cognitive impairment diseases.

• Increases bone mass in osteoporosis with decreased risk of fractures.

• Improves the quality of life in chronic patients.

• Polypharmacy decreases.

Benefit of physical exercise in adults

Many of the diseases are born in the first years of our lives, so we should not abandon the healthy habit of exercising regularly to prevent all those diseases or ailments that are also typical of adulthood.

All the benefits of this stage can be summarized in the following sections:

• Prevention and treatment of coronary diseases: Physical exercise of aerobic resistance practiced regularly is accompanied by a decrease in blood pressure, cholesterol levels, the amount of body fat and insulin resistance, that is, several cardiovascular risk factors.

• Prevention and treatment of back pain: people who are in poor physical shape tend to have back pain and discomfort more frequently, these episodes being of greater intensity, longer and more recurrent, as opposed to people who do exercise regularly.

• Prevention and treatment of depression and anxiety: practicing any physical exercise, especially those involving aerobic resistance, reduces the effects of depression and anxiety, complementing other treatments such as psychotherapy or relaxation.

In women, there are also specific situations in which regular physical activity provides benefits:

• Decreased discomfort in premenstrual syndrome and dysmenorrhea, regularizing menstrual cycles.

• In pregnancy reduces back pain, improves body posture, controls weight gain, helps control "gestational diabetes", reduces digestive disorders and constipation, prevents the appearance of phlebitis, reduces the frequency of pelvic floor dysfunctions, also being used in the treatment of incontinence, increases the psychological well-being of the future mother, reduces insomnia and improves sleep quality...

• In childbirth facilitates and shortens the expulsive period, and in the postpartum period it helps to recover the abdominal muscles, to counteract depression and stress...

• In menopause It acts directly on depression and bone calcification, reducing the appearance of osteoporosis and fractures derived from it.

Benefits of physical exercise in children and adolescents

In the early stages of life, physical activity has an essential effect on the development of intelligence and affection. Through exercise and sport, the child develops the various intellectual, physical, moral and aesthetic capacities in a balanced way.

Helps psychological development and overcome the deficit of self-esteem. In team sports, responsibility towards oneself and others is also encouraged, allowing experiences of solidarity and trust to be lived, limiting the obstacles to social integration. Regular training is associated with higher bone density and mass (the highest value has been observed in young men with the highest levels of physical activity, while men with the highest rates of smoking have a lower value of Bone mineral density).

In children and adolescents, regular physical exercise is a first order tool in prevention:

• Obesity: helps burn calories that the child cannot burn on their own due to poor nutrition and current sedentary lifestyle.

• Osteoporosis: in childhood and early adolescence, the goal must be to achieve the highest peak bone mass possible.

• Drug abuse (alcohol, cannabis, tobacco…).

• Coronary diseases: acquiring healthy habits and reducing risk factors from these stages.

Physical exercise and sport contribute to the balanced development of various intellectual, physical and even moral abilities and skills. It helps psychological development and overcome the lack of self-esteem, increasing confidence and eliminating obstacles to social integration.

About the group of children and adolescents

In the early stages of life, physical activity has an essential effect on the development of intelligence and affection. Through exercise and sport, the child develops the various intellectual, physical, moral and aesthetic capacities in a balanced way.

Helps psychological development and overcome the deficit of self-esteem. In team sports, responsibility towards oneself and others is also encouraged, allowing experiences of solidarity and trust to be lived, limiting the obstacles to social integration.

Regular training is associated with higher bone density and mass (the highest value has been observed in young men with the highest levels of physical activity, while men with the highest rates of smoking have a lower value of Bone mineral density).

In children and adolescents, regular physical exercise is a first order tool in prevention:

• of obesity: helps burn calories that the child cannot burn on their own due to poor nutrition and current sedentary lifestyle.

• of osteoporosis: in childhood and early adolescence, the goal must be to achieve the highest peak bone mass possible.

• of drug use (alcohol, cannabis, tobacco…).

• of coronary diseases: acquiring healthy habits and reducing risk factors from these stages.

physical exercise in youth

Various studies show that most adolescents perform less physical exercise than they did ten years ago. They do not perform any physical activity outside of the classes taught in educational centers, dedicating the time after school hours to sedentary activities at home.

This sedentary lifestyle favors the appearance of diseases such as obesity, diabetes, hypertension, back pain and even self-esteem problems in the future. In addition, there is an increase in Body Mass Index, causing poor cardiorespiratory capacity to physical effort as well as lack of flexibility.

To avoid these problems, daily and regular exercise should be encouraged, both in young people and children, and also accompanied by proper hydration and proper nutrition, in order to stimulate healthy lifestyle habits.

Healthy habits in children and adolescents

Leading an active life, at any age, brings very obvious physical benefits, achieving a greater sense of well-being and improvement in many diseases and disabilities.

Any age is good to start exercising regularly or if you are already used to practicing some type of sport, the ideal is to maintain it. Over the years, the only thing we should avoid is the big competition with excessive levels of effort as it increases the risk of injury.

Benefits of exercise

Aging is characterized by a decline in the functional capacity of organs and body systems. Therefore, it is where all the general benefits mentioned above are most evident.

Carrying out a continuous exercise in this stage of aging:

• It stimulates psychomotor performance, with improvements in reaction time, visual organization and mental flexibility.

• It favors coordination and proprioception, reducing the risk of falls.

• Helps prevent and treat decline in functional capacity.

• It helps to improve and maintain the level of independence.

• It intervenes in the prevention and treatment of cardiovascular and respiratory diseases.

• Stimulates brain irrigation delaying and reducing cognitive impairment diseases.

• Increases bone mass in osteoporosis with decreased risk of fractures.

• Improves the quality of life in chronic patients.

• Reduce polypharmacy

Physical exercise

In the elderly, the daily practice of physical activity is beneficial for certain diseases: diabetes, dyslipidemia, osteoarthritis, obesity. In many cases, the patient's clinical condition is improved.

Physical activity has a hypotensive, lipid-lowering, anti-inflammatory effect and prevents the appearance of osteoporosis. When performing physical exercise, especially strength and resistance exercises, performed gently, it helps to improve balance and therefore falls are avoided.

For all these reasons, and due to the improvement of the pathology experienced by the person, it is even possible to reduce the medication, however, always in a prudent manner and informing the corresponding physician of all this.

At the time of year when our parks and outdoor spaces get cold and wet, autumn and winter, it is always very pleasant and recommended to continue with regular physical activity. From the Sports Medicine Center we want to remind you of some healthy tips that will allow you to do sports in optimal conditions, and enjoy the outdoors. The presence of low temperatures should not be a brake.

Before performing sports of effort (such as running) it is essential to maintain adequate hydration, since low temperatures and cold wind will cool and dry the respiratory tract. Therefore, it is recommended to drink before and during the exercise, either water or liquid sports preparations. It is also advisable to monitor the sweating that occurs when exercising, as it can induce chills in the body, which increase the risk of colds.

You have to take into account the type of sportswear that is going to be used. You should choose the one that absorbs and removes sweat from the body, keeping the skin dry. It is advisable to protect your hands with breathable and waterproof gloves, and the use of a hat that protects your head. In case of extreme cold and/or wind, a scarf-type garment can be used to protect the nose and mouth (where the cold air enters), and to protect the neck. 

For the feet, it is advisable to use thick, breathable cotton socks and, of course, an appropriate type of footwear. You must hold your foot, as wet floors are more likely to slip and fall. And, in addition, be waterproof if you are outdoors and in case of rain. Shoes and socks should be changed as soon as the exercise is finished.

To prevent the effects of exposing the skin to the cold, a moisturizing cream will be used before and after exercise, to prevent dryness and the eventual formation of cracks. Sports massages are very useful before and after performing the exercise. Finally, it is recommended to eat foods and fruits rich in vitamin C, it will strengthen our defenses and prevent colds.

running in the rain

In the presence of rain and humidity, the Sports Medicine Center encourages athletes not to stop training and running outdoors. The rain produces a cleanliness in the atmosphere that generates a higher quality of the air that is breathed and the smells of the countryside invite you to enjoy it.

As a first recommendation, it is convenient that the circuit chosen for the race is known. One of the consequences of water is the appearance of muddy and slippery terrain that can increase the risk of falls and traumatic injuries. The footwear used must have good traction, be resistant to water and its interior must be padded. With humidity there is a greater risk of blisters forming, so it is advisable to use some cream, thermal socks or neoprene booties if the route allows it. 

As for the pace you must set, it is not advisable to overexert yourself since the weather conditions are harder in themselves. The ambient oxygen level is higher and this can affect the exchange of respiratory gases, which can induce a feeling of dizziness or headache. Try not to run too fast or into the wind, be more cautious in general avoiding unnecessary risks. Hydration should be similar to that done on dry days.

In relation to clothing, it is advisable to wear clothing made of polypropylene or Gore-Tex, since these fibers will allow both water and sweat to drain off continuously, avoiding the feeling of being drenched. The use of cotton garments is discouraged, as they absorb and store water. The jacket or vest that we use must be resistant to water and wind, and, if visibility is poor, have refractory tapes.

Finally, we recommend that at the end of our circuit, we take out of a waterproof and comfortable bag that we carry, dry clothes to change into at the end of the training, where we will not forget to stretch in a covered place and we will shower as soon as possible. If you have your house close by, it is better to jog or loosen your muscles and stretch inside with a suitable temperature. 

Factors that intervene in the preparation before exercising

Given the decrease in temperature typical of the winter months, more pronounced on certain days, it is necessary to follow certain guidelines for action that allow us to continue practicing sport with the maximum guarantees for our health. In this sense, the Sports Medicine Center proposes a series of simple recommendations for lifestyle and eating habits that will facilitate both training and sport.

As always, and in a much more indicated cold environment, it is essential to carry out a sports warm-up prior to carrying out the exercise. The preparation of the muscles, breathing and heart rate, adapting them to the room temperature, particularly if you do sports outdoors, will allow a better performance of the body and prevent contractures and colds caused by sudden sweating.

One of the most common aspects that is interesting to highlight is the so-called “bronchoconstriction against cold”. This phenomenon is produced by breathing cold and dry air, typical of our environment at this time. It presents as shortness of breath in almost all people at the start of training, and can be a limitation in 20% of cases.

To avoid or minimize this respiratory sensation, it is essential to have and maintain good hydration, based on water, juices or isotonic drinks. A correct intake of liquids must be accompanied by vitamin contributions from fruits and vegetables. Athletes are advised to have a greater intake of foods rich in vitamin C, such as oranges, which are so abundant and good in our environment, as well as seasonal vegetables such as broccoli, cauliflower, artichokes, etc.

As a general complement, it is advisable to take care of our skin. It is the most extensive organ and exposed to the cold if the sport is practiced outside. To avoid dryness, cracks and even infections, it should be kept very clean, washing before and after exercise and moisturizing cream applied before and after exercise to help keep it in a healthy state. In the case of very sensitive skin, moisturizer with photoprotector will be applied.

We all know that the practice of regular, stable and moderate physical activity helps improve both physical and psychological health, thus increasing quality of life. Therefore, many are the smokers who cling to physical exercise to counteract the damage of tobacco. However, far from what is believed, combining smoking with regular exercise does not reduce the negative consequences that tobacco causes in our body.

Tobacco is not expressly prohibited in sports, but the WHO warns that its use can seriously damage health, both for athletes and for non-athletes. The decrease in lung capacity in a habitual smoker is obviously verifiable. Fatigue appears, greater risk of respiratory conditions, cough, expectoration, loss of appetite, cardiac arrhythmias, cardiovascular conditions... Smokers also have a mortality rate 70% higher than non-smokers as a result of the development of different pathologies.

If you smoke, when making physical effort, the body requires an extra task and this is where more compromising health conditions can arise, such as bronchospasm, arrhythmias, tachycardia, lack of tissue oxygenation, among others, which significantly increase the risk of suffering coronary and pulmonary damage.

On the other hand, various studies have confirmed the damage of tobacco on the muscles, concluding that smokers have a slower post-exertion recovery, as well as an accelerated loss of muscle mass due to the elevation of an enzyme that degrades it, since the slow synthesis of proteins typical of the body of smokers. 

Smoking reduces lung capacity and increases the time needed for recovery, thus diminishing sports performance and completely spoiling the benefits of physical activity on health. The serious situation can usually be reversed simply by quitting smoking, since athletes who give up smoking noticeably improve both breathing and performance during exertion.

Prevalence of smoking in the body

According to the data published in the survey of health habits of the adult population of the Community of Madrid (year 2010), the prevalence of smokers in our region is around 32%. Likewise, the degree of physical inactivity reaches 83% in women and 72% in men.

The data obtained in the survey of health habits of the youth population in the Community of Madrid (2011), show that 24% of young people smoke more or less frequently. The proportion of young people who smoke daily is around 9,8%, almost identical in both genders, and increases with age.

Compared to the data recorded in the historical series, since 1996, there is evidence of a clear downward trend, with a drop of around 61% compared to the initial data. However, in the last three years it has remained fairly stable, around 10%. Unlike the adult population, young people who do not perform intense physical activity 3 days or more a week, it is 40% for girls and 9% for boys.

Effects of tobacco on the body

Smoking is a slowly progressive syndrome of multisystemic damage because it affects practically all the organs and systems of our body. It is a common cause of illness and premature death.

Hemodynamic effects:

• When smoking smoke inhalation and nicotine absorption occurs, causing an adrenergic discharge that significantly increases heart rate and blood pressure from the first 15 minutes after smoking, and is sustained practically up to 120 minutes after smoking. 

• Regular cigarette smoking can lead to life-threatening hemodynamic and cardiovascular changes in smokers, particularly young adults.

Effect on lung mechanics and gas transfer in the lung:

Gas diffusion in the lungs is sharply and significantly decreased after smoking. An increase in leukocytes (particularly neutrophils) has also been observed after smoking. Neutrophils are inflammatory cells that have been blamed for the direct damage observed in elastin, that is, in the fibers that make up the skeleton of the lung. Therefore, it is clear that the acute effect of tobacco is related to the destructive process that is observed in the lung tissue.

Other acute physiological alterations associated with tobacco consumption:

Cigarette smoking is associated with increased bronchomotor tone, which can cause bronchospasm while a subject is exercising. Nicotine causes adrenergic stimulation which can lead to the appearance of vasoconstriction and alterations in the distribution of oxygen in muscle tissues while the subject exercises. The increase in carbon monoxide can cause an increase in respiratory rate and heart rate and, eventually, worsen maximal oxygen consumption.

Effects of tobacco in the athlete

Given the current universal trend of improving the quality of life of individuals through sport, it must be made clear that it should not be combined with cigarettes. There is no likely benefit from exercising and smoking.

There is a popular belief that exercise eliminates the harmful effects associated with smoking. Nothing further from reality. In those smokers who exercise, damage to their body is observed, similar to that observed in those smokers who do not exercise.

Their cardiovascular and respiratory systems are affected with the same intensity as those who smoke. However, the main difference between them is that those who exercise are in better physical condition than those who smoke and do not exercise. Once the damage progresses, and this usually occurs in parallel with the increase in the degree of addiction, individuals who smoke tend to stop exercising, and, consequently, their physical conditions will be similar to those of individuals who never smoke. they exercised.

For example, in running a race, the distance covered by non-smokers will be significantly greater than that of smokers, and overall performance among smokers is inversely related to the number of cigarettes smoked. Likewise, the capacity of pulmonary ventilation per minute is significantly lower in smokers than in non-smokers.

It has been observed that the massive consumption of tobacco significantly decreases the maximum oxygen consumption and the anaerobic threshold during effort. These changes cause important alterations in cardiovascular function, an increase in blood pressure, and an insufficient distribution of oxygen throughout the body. It has been shown that the cause is related to carbon monoxide and nicotine.

Long-term effects of tobacco

The four most important conditions in terms of frequency associated with smoking are: cardiovascular, cerebrovascular disease, emphysema and lung cancer. The presence of any of them limits both the physical activities and the physical performance of an individual who wants to do some exercise.

Virtually all chronic diseases associated with smoking cause significant and progressive incompatibility with exercise, so that most smokers stop exercising as they smoke more. However, for one of these four diseases to develop, at least 20 to 40 years have passed.

From this perspective, smoking is a problem that does not concern young people. For this reason, it is relatively common to observe that many young people, despite practicing some type of exercise or sport on a regular and consistent basis, inexplicably are also smokers.

Blood pressure is the measurement of the force exerted by the blood stream on the walls of the arteries as the heart pumps blood. Hypertension is the term used to describe high values ​​of said force. Blood pressure readings are usually given as two numbers. The top number is called systolic blood pressure and the bottom number diastolic blood pressure. Normal values ​​are less than 120/80 mmHg.

According to data from the World Health Organization, one in three adults in the world suffers from hypertension. That proportion increases with age: one in ten people between 20 and 40 years old, and five in ten between 50 and 60 years old. However, hypertension is preventable and treatable.

Causes of high blood pressure

Most of the time (95%) no cause of high blood pressure is identified, which is called essential hypertension.

There are many factors that can affect blood pressure, such as:

• The amount of water and salt that one has in the body

• The state of the kidneys, nervous system, or blood vessels

• The levels of different hormones in the body

• Sedentary lifestyle

• The obesity

• being a smoker

• Aging, which causes “hardening” of the blood vessels

• Excessive alcohol consumption

• Stress and anxiety

• Excess salt in the diet

• Diabetes

• Family history of high blood pressure

Hypertension caused by another medical condition or medication is called secondary hypertension and may be due to:

• Chronic kidney disease

• Adrenal gland disorders (pheochromocytoma or Cushing's syndrome).

• Pregnancy (preeclampsia).

• Medications such as birth control pills, some cold medications, and migraine medications.

• Use of androgens, growth hormone and EPO (substances that can be considered doping in sport).

• Narrowing of the artery that supplies blood to the kidney (renal artery stenosis).

• hyperparathyroidism

Common symptoms of high blood pressure

It is generally asymptomatic. It is usually detected when they go to the doctor or take it elsewhere. Because of the usual absence of symptoms, people can develop heart disease and kidney problems without knowing they have high blood pressure.

However, the sudden or constant appearance of symptoms such as severe headache, nausea or vomiting, confusion, changes in vision, or nose bleeds, may be the expression of a presentation: serious and dangerous: the so-called malignant hypertension.

Essential high blood pressure increases the chance of stroke, heart attack, heart failure, kidney disease, and early death.

Diagnosis of high blood pressure

The doctor should check the blood pressure several times before reaching the diagnosis of high blood pressure. It is normal for the values ​​to be different depending on the time of day. The doctor will perform a physical exam to look for signs of heart disease, eye damage, and other changes in the body.

• Tests are often done to look for: 

• Tests to detect high cholesterol levels.

• Electrocardiography and/or echocardiography to diagnose heart disease. 

• Basic metabolic tests and urinalysis or ultrasound of the kidneys, to assess possible kidney disease.

Effects of exercise on arterial hypertension

The physiological mechanisms that occur in the body promoted by physical activity are very numerous. The scientific community establishes as main effects those that occur in the neurohormonal system, in blood vessels, and on hormones.

Neurohormonal effect:

Physical exercise decreases sympathetic activity and not only at the central level, as a consequence there is a decrease in heart rate and cardiac output. On the other hand, it improves peripheral vascular resistance, decreasing it and thus generating better vasodilation.

Effect on vascular structure and function:

It increases the distensibility of the vessel wall and this can prevent the development of hypertension. Let us remember that the thickening of the arterial walls generally begins after the age of 30. Physical exercise produces a decrease both in arterial hardening and in the formation of atheromatous plaques, which becomes less intense with the performance of the activity.

On the other hand, there is a change in muscle tone and the stress produced at the level of the arterial blood pressure wall during exercise favors the secretion of nitric oxide that produces smooth muscle vasodilation and consequently a decrease in BP.

Hormonal Effects:

Physical activity has been found to play a role in helping to maintain normal insulin levels; Likewise, at the muscle level, it stimulates the entry of glucose into its fibers, improving its nutrition. It also helps purify and release free fatty acids. All this is beneficial because it generates vasodilation at the level of the arterial tree.

Other benefits of physical exercise:

• Decreased body weight

• Changes in lifestyle (reduce alcohol and tobacco consumption)

• Change in dietary habits

In summary, regular physical activity has an important influence on the reduction of blood pressure and allows you to maintain a good state of health.

In the VII National Committee for the Detection, Evaluation and Treatment of Hypertension, it is recommended that physical activity be carried out at least 5 times a week and for at least 30 minutes so that it has preventive effects and is an adequate complement to the therapy of the HTA.

It is observed that the more time of physical exercise is done, the drop in blood pressure is much greater. In terms of frequency, the same thing happens, the more days of the week you do physical activity, the possibility of achieving a drop in blood pressure is much greater.

In terms of intensity, something very interesting happens. In general, one thinks that the greater the intensity of the physical effort, the greater the drop in blood pressure, but this is not the case. It was shown that when the intensity of the physical effort is lower, the blood pressure figures decrease more than with high levels of intensity.

The physical exercise recommended to achieve the prevention and control of arterial hypertension must be done regularly, with increasing intensity according to the patient's tolerance, aerobic, dynamic, isotonic in nature, involving and mobilizing large muscle groups (upper and lower extremities ), with low loads.

What type of physical activity is more advisable?

Endurance sports or physical activities (walking, continuous running, jogging, cycling, cross-country skiing, swimming, skating, rowing, jumping rope, climbing stairs, etc.) are the most advisable to reduce high blood pressure.

How often should it be done?

A training frequency of 3 to 5 days per week is recommended, with a duration per day between 30-60 minutes and continuously rather than intermittently.

At what intensity should it be done?

Regarding the intensity of the exercise, it is recommended that this be between 40-70% of the maximum oxygen consumption. In more understandable terms, it is assessed on a scale of subjective perception of exertion, in values ​​from 6 to 20. In relation to heart rate, this should be in a range that is not less than 50-60% and that does not exceed 85 % of your maximum heart rate determined based on your age (Theoretical maximum heart rate= 220-person's age).

Initially we must start the exercise program with an intensity, duration and frequency in the lower recommended ranges, which will gradually increase depending on the good tolerance of the person who performs it.

The previous cardiorespiratory or aerobic resistance training, of moderate intensity, can be complemented with strength training (weights, fixed resistances, use of cables and pulleys, machines and resistance apparatus, medicine balls, etc.) that must bring together a series of conditions:

• Being of dynamic muscular resistance, with a concentric and eccentric component, with a full range of motion, at a medium-low speed, adapting the effort to breathing. It is recommended that the concentric phase (that is, when the worked muscle contracts) always coincide with expiration and the eccentric phase (when the worked muscle returns to the initial position) with inspiration, because the increase in blood pressure is minimized. .

• At the beginning you should work more in a general way, prioritizing the largest muscles and then the smaller ones, you have to warm up the area to be exercised beforehand, when the exercise is finished and between series you should do exercises of stretching of the muscles that we have worked on, we must work the agonist and antagonist muscles, we must start initially with very small loads, increasing very progressively according to their tolerance, the number of repetitions of the strength exercise must be contrary to the weight lifted. Starting with light weight and high reps, in sets of 10-20 reps, interspersed with rest periods of 30-60 seconds. We must also take into account that at a given intensity of work, the systolic and diastolic pressures and heart rate are greater when the work is done with the upper limbs than if it is done with the lower limbs. 

• Before starting the daily exercise session, warm up for 7-10 minutes, which should be of low intensity, consisting of walking or gentle stretching without bouncing, to avoid injury. The end of the exercise session should be progressive, including low-intensity exercises and stretching.

Hypertensive patients should try to avoid or, where appropriate, practice anaerobic and power sports with maximum control, since they can produce intense and sudden elevations in blood pressure levels. Be very careful if you are hypertensive with static sports, in which muscle contraction is maintained for a long time and intensely, such as judo, weightlifting, wrestling, bodybuilding, etc.

Patients who have a medical history of cardiovascular disease or who are hypertensive should develop exercise or physical activity programs that are individualized and specific to their particular situation. And prior to performing it, a more detailed medical assessment is recommended, which includes a stress test or other complementary examinations.

Summer is the time of the year in which there are more possibilities to carry out some type of physical activity or sport, since there are more hours of sunlight and more free time is available. You can always find an adequate physical activity plan that fits the environmental and personal conditions.

However, certain precautions must be taken due to the peculiarities of this time of year (high temperatures that can cause dehydration, sunburn, sports-related injuries...)

For this reason, some recommendations are offered to carry out physical activity and sports with guarantees. We must be aware that when the ambient temperature exceeds 30ºC, and the humidity is equal to or greater than 80%, it is not advisable to do physical exercise because the body in these conditions does not eliminate the heat produced during the activity well and we can find ourselves in a compromised situation.

When to play sports?

The most suitable time of day to carry out any type of sport or physical activity is first thing in the morning or late in the afternoon, times when there is less incidence of sunlight and lower levels of pollution. To avoid unnecessary risks, medium and low impact activities should be carried out. It is very important to plan breaks during activity more often. But, the most important thing is to try to avoid exercising in the middle of the day (between 12 and 16 p.m.), since we can see our health compromised.

Alternatives for the central hours of the day

One possibility to do sport or physical activity outdoors during the summer is to walk, run or ride a bicycle. To do this, it is necessary to find paths, trails or shaded streets, avoiding driving in full sun, not even in the least hot hours. You can also walk through shopping centers, where you can find shaded areas and cool weather, exercise or play sports in air-conditioned pavilions with controlled temperatures, or in swimming pools, which is extremely pleasant.

What to do before and after physical activity?

As at all times of the year, the body must be prepared in advance and adapted to the physical activity or sport that we practice. To do this, you must start with a warm-up and stretching of the main muscle groups that you are going to use. For example, in the case of running, it will be necessary to exercise both the hip area and the legs, including all those muscles, even if they are not used directly, from the trunk, arms, neck, etc...

A good way to finish the activity is walking or jogging at a very low intensity for 5 to 10 minutes, which will help you to calm down gradually and without frights. If you also stretch properly at the end, it will reduce the appearance of late muscle pain, that is, the fearsome stiffness.

As a general rule, during the summer months, where temperatures are high, we should drink more water than we normally do due to the increased demands placed on our body. We must bear in mind that both children and the elderly have to drink more than an adult. In these times of life, dehydration can occur more frequently due to the characteristics of dependence and special thermal sensations.

In general, it is advisable to drink slightly cold water because it is assimilated more quickly. At times when we do physical activity or sports we can carry a frozen bottle in a hip bag or fanny pack or in the back pocket of the pants, with this we will be able to reduce body heat and have cold water to drink.

Maintaining certain premises before, during and after physical exercise is important. We must take into account that:

• It is very important to drink before exercise in order to start the activity well hydrated.

• It is also advisable to drink a drink with a high contribution of salts during exercise since this causes the ingested liquid to be retained and the electrolyte balance is maintained.

• It is necessary to drink after the activity to replenish the lost liquid, it is recommended that after physical activity it is replaced with a drink that contains glucose, fructose, carbohydrates and mineral salts.

In general, the golden rule is drink a liter and a half of fluid for every kilo of weight lost during exercise.

The importance of nutrition for sports practice

That the correct diet must be maintained throughout the year is indisputable. During the summer months we should eat four to five meals a day: breakfast, a mid-morning snack, an afternoon snack, and dinner. It is advisable to eat light meals, especially before physical activity, always including cereals, fruit and milk. A good complement is fresh fruits and vegetables. As a precaution, we should eat between 90 to 120 minutes before starting physical exercise in order to avoid unnecessary risks.

The right clothing and footwear for sports

Both clothing and footwear must be suitable, in order to protect us, when carrying out physical exercise during the hot and high-temperature months. With regard to clothing, it should be appropriate, loose, light colors so that it reflects sunlight if we carry out the activity outdoors and, preferably, cotton to absorb sweat. It must contain breathable fabrics that favor the loss of body heat. In the case of outdoor activity, you should avoid wearing shoes such as fabric or mesh shirts and sleeveless shirts, as too much skin is exposed to the sun.

Sun protection tips

During the summer months, when exercising outdoors, it is advisable to use sun protection creams, with at least SPF 15 or higher, depending on our skin type. The use of caps or hats to cover the head is essential. We must protect the eyes, by using suitable sunglasses with sufficient protection. During the time of performing the exercise, there is an increase in body heat generated. To reduce it, we can place a wet handkerchief on the neck or with chemical ice inside to reduce heat.

Physical exercise, age and certain special states

In certain cases, extreme caution must be exercised when performing physical exercise. Pregnancy, advanced age, young children or babies, overweight or underweight, administration of some drugs and certain pathologies are risk factors. It is recommended to maintain moderate levels of intensity in physical activity. If you exercise in the sun, you should stay at 60% to 70% of your maximum heart rate for your fitness level and age. It is also very important to plan breaks and take them frequently.

On certain occasions, dizziness, nausea or symptoms of fainting may appear. At that time exercise should be stopped, as these are unequivocal signs that the body is suffering from heat exhaustion and cannot normalize its temperature. In these cases, it is advisable to rest in shaded areas and drink until we recover. If, despite this, we continue with the symptoms, we can lead to sunstroke or heat stroke, which could require medical attention.

It is also important to recognize the symptoms of dehydration to be vigilant, these are a feeling of thirst, headaches, irritability, weakness, dizziness, muscle cramps, nausea, vomiting and a significant reduction in our performance, before this it is essential to stop the activity physical and begin rapid rehydration.

Precautions to take before exercising

In the case of regular physical exercise, its intensity must be adapted to each situation. The pace of training must be adapted to the temperature and humidity levels of the environment; in summer. We must be aware that, although we are used to it, it is not advisable to do physical exercise when the ambient temperature exceeds 30ºC and the humidity is equal to or greater than 80%, because the body in these conditions does not eliminate well the heat that is produced during the exercise. exercise.

An eating disorder is a disease caused by anxiety and excessive concern about body weight and physical appearance, related to the alteration of common eating habits. The person who suffers from an eating disorder bases all the thoughts and actions that are part of their daily life on food, feeling hyper-dependent on that idea, with which food becomes the axis from which life revolves and the relationship world of the person suffering from said disorder.

These eating behaviors may or may not be altered voluntarily, this is subject to internal and external factors such as the level of self-esteem, family pressures, frustration at being overweight, constant comparison with someone close by a family member or friend, etc.

Generally these types of eating disorders, beyond the symptoms that each one contains in particular, are accompanied by a marked isolation of the person, excessive tiredness, sleepiness, irritability, aggression (especially towards known people and family members) , shame, guilt and depression.

The factors that predispose to suffering from an eating disorder are multiple: personal, family, sociocultural. The types of eating disorders are, according to the international classification of diseases (DSM-V): anorexia, bulimia and binge eating disorder.

Factors that predispose to eating disorders

There are a number of factors that influence a predisposition to suffer eating behavior disorders, whether constitutional, metabolic, functional or dietary. Some sports could influence this type of predisposition.

• Psychological: Body image distortion, depression, anxiety disorders, impulse control problems. Personality and behavior disorders, including type A, compulsive, self-demanding personalities.

• biological: neuropsychic substances, such as endogenous peptides (beta endorphin) and neurohormones that regulate metabolism and intake (leptin, ghrelin, adiponectin, insulin, cholecystokinin).

• Family: communication problems, families with poor dietary habits, family history of eating disorders, abuse.

• Cultural: ideal of thinness in today's culture and society, realization of regimens.

The factors that affect the diet of people who practice sports are:

• High-performance athletes and professionals.

• Sports in which a low weight is beneficial for improving performance: rowers, canoeists and jockeys.

• Sports in which a low weight is beneficial for the development of movements and that require good presence before the judges, such as gymnastics, figure skating, ballet and aerobics.

• Sports whose participation is determined by weight classifications such as wrestling, boxing, judo, and weightlifting.

• Endurance sports: distance, semi-distance and marathon.

Intervention in eating disorders

The first aspect to decide is the therapeutic situation in which the treatment will be carried out, depending on the severity of the patient. The most agreed criteria for hospitalization of the anorexic are the following:

• Weight loss is greater than 30% and his biological status is a significant risk to life.
• The patient shows high levels of anxiety, depression, suicidal ideation, severe social maladjustment.
• Family relationships are very conflictive.
• The anorexia nervosa subtype is compulsive/purging, has bulimic episodes, and uses purging behaviors.

In bulimia nervosa, treatment is almost always carried out on an outpatient basis, however it is necessary to advise hospitalization in some cases when:

• There are important organic alterations that endanger life due to the abuse of purging behaviors.

• When outpatient treatment and in specific devices for TCA have failed.

• The depression that the subject presents is greater and there is some risk of suicide.

Basic areas of intervention

It is necessary to intervene on the manifestations at the physiological, cognitive level (irrational and negative interpretations that the person makes about himself, his problem and his environment) and behavioral (avoidance and incorrect coping with situations).

Relaxation techniques are used, one of the most used being Jacobson's progressive relaxation and controlled breathing. Systematic desensitization techniques, exposure and cognitive restructuring have been used to treat the phobia of fatness, figure itself, and weight. Therapeutic trends point to the use of cognitive-behavioral therapy as the most effective method compared to other types of psychological interventions.

The basic areas of intervention in both anorexia and bulimia can be summarized as follows:

• The somatic area, with the objectives of improving their entire physical condition by restoring their weight to a normal level for their age and height and the possible electrolyte imbalance due to purging behaviors in bulimia.

• The behavioral area, with the objectives of normalizing food, modifying eating habits and eliminating purging behaviors.

• Psychological area, with the aim of modifying the alteration of body image and the fear of gaining weight, and intervening on negative affect.

• Interpersonal and family area, with the aim of intervening on social skills and conflicting family relationships.

pharmacological treatment

In anorexia nervosa, anxiolytic and antidepressant drugs are administered. High levels of serotonin in the brain reduce the rate, duration and amount of food consumption. There is currently no general pharmacological method that is recommended for the treatment of anorexia. In bulimia, the use of fluoxetine is indicated and approved. Tricyclic antidepressants are in disuse. Reversible type monoamine oxidase (MAO) inhibitors may arise in some cases of resistance to other drugs (except classic MAOIs).

Treatment of physical aspects

Weight regain is vital and is therefore the problem that needs to be addressed most urgently. It is in the hospital environment that environmental contingencies can usually be controlled. For the normalization of weight, it is necessary to modify eating habits, so the therapeutic intervention will focus on what and how much you eat, the duration and the social situation in which you eat.

In bulimia nervosa, it is essential to interrupt the restrictive diet-diet violation-eating episode-purging behavior chain, which implies preventing the execution of purging behaviors after a binge and modifying dietary patterns.

Information must be provided on nutrition, on the inefficacy and harmful effects of the methods followed for weight control and on modifying general eating habits. For this, a very structured program must be carried out with the prescription of very specific tasks and monitoring compliance with them by signing behavioral contracts and self-registrations that the patient will carry out and that will be carefully supervised in each of the individual or group sessions.

Goals of an exercise program

Promote healthy exercise through education and practice. Carrying out an exercise program in eating disorder patients should be agreed with the mental health professionals who care for them, to see which ones are more suitable, and which ones could be harmful.

The main objectives that an exercise program should have are:

• Contribute to the development of good dietary habits using controlled physical exercise as a reward for achieving personalized goals.

• Stimulate body care and a healthy body image. Physical activity should not be used as a means of reward.

• Improve the effectiveness of movement and introduce postural care and its relationship with self-esteem.

• Increase the percentage of weight corresponding to lean mass, reducing the amount of fatty tissue in areas of greater accumulation (key point to reduce the fear of weight gain, which positively interferes in the treatment of these disorders). This aspect must be agreed upon with mental health and nutrition professionals.

• Reduce irrational fears of “fatness”, increasing physical fitness.

• Encourage patients in an operant conditioning program.

• Present social sports activities as a desirable alternative to solo physical activities.

• Help reduce stress through physical activities and sports.

• Correct irrational and mistaken beliefs regarding health and exercise. 

Benefits of an exercise program

Physical exercise, performed in a controlled and properly supervised manner, is of great help for the global therapeutic approach, used in eating behavior disorders, as described below.

Physiological

• Increases bone mineral density. Improves body composition.

• Reduces cardiovascular disorders. Improves sleep disorders.

Psychological

• Intervenes on the risk factors and maintenance of eating disorders.

• Modulates depressive symptomatology.

• Reduces anxiety and perceived stress.

• Increases positive affect.

• Improves self-esteem, promoting a positive image of your own body.

• Promotes self-regulation.

• It works by reducing body tensions and negativism and increasing stress tolerance, all of which trigger binge/purge behaviors.

Social

• Improves social ties and interpersonal relationships in different areas (family, friends, work...).

Strategies to gain and control body weight

The calories that should be added to the normal diet depend on each patient and should be agreed upon by mental health and nutrition professionals. The diet should include a percentage of fat less than 30% of the total caloric content. The amount of protein to be consumed should not exceed 1,5 g/kg of body weight.

The factors that affect the diet are:

• Identify the percentage of fat and the optimal weight for the age, sex and height of each patient.

• Calculate the weight and the muscle percentage that has to be gained.

• Individualized muscle-based weight gain for each patient.

• Weight gain per week should range between 500 and 750 grams.

• Weigh once a week and measure skinfolds twice a month.

Criteria for inclusion in a physical exercise program

In any case, the participation of patients in the physical exercise program designed for this purpose will be solely and exclusively voluntary. In such a way that their inclusion will be determined by the criteria of the medical practitioner responsible for the treatment team that attends them.

The exercise programs will be individualized according to each patient, explaining short, medium and long-term objectives, and the conditions of participation. They must be done in a consensual manner with the mental health and nutrition professionals who care for the patient. A history of previous physical activity, exercise motivation, body image, family participation in physical exercise/sport, and other behavioral influences on exercise will be collected. A strength and flexibility test will be carried out beforehand, also assessing a history of postural, orthopedic and traumatological problems.

The nutritional status prior to joining an exercise program should ensure proper physical and psychological functions.

Participation will be conditional on an adequate weight gain (approximately 1 kg per week). Those who do not meet the requirements to participate in the full program will be allowed, under supervision, to perform stretching, toning and postural improvement exercises.

Exercise will only be authorized under the on-site supervision of qualified personnel (sports technicians, physical education graduates, nurses, physiotherapists...), in order to avoid excessive exercise and/or the appearance of injuries.

The program will include relaxation classes, individually or in groups.

Assessment test prior to physical activity

These tools, which include both psychological questionnaires and anatomical and physiological measurements, will be used at the beginning of the program as well as in the established periodic controls, according to medical criteria and availability of resources.

• psychological tests: one or several of them may be used depending on the patient and at the discretion of the physician. They must be carried out by a clinical psychologist, if possible, an expert in eating disorders.

• Body weight: the frequency of its measurement must be agreed upon with the mental health and nutrition professionals who care for the patient.

• Body mass index (BMI) and body composition through kinanthropometry or impedanciometry: weekly and also every fifteen days or monthly later. The measurements to be made are the skinfolds at the biceps, triceps, suprailiac and subscapular levels, thigh and leg circumferences, and femoral bicondylar, humeral biepicondylar and wrist bistyloid bone diameters.

• Bone densitometry.

• Blood and urine analysis: complete, expanding the study with nutritional markers of serum protein such as albumin, transthyretin and hemoglobin, in addition to the study of ions (including calcium, phosphorus, magnesium, potassium) and urinary creatinine.

• Ergospirometry: assessing functional capacity, VO₂max., aerobic and anaerobic thresholds... The frequency of performing this test will depend on the evolution of the patient.

• muscle tests, such as dynamometry or the isokinetic study, and flexibility.

vigorexia

Vigorexia is an emotional disorder or disorder where the physical characteristics are perceived in a distorted way, presenting some similarities with the fundamental eating disorders, but it is not very similar to anorexia, which causes an obsessive need to perform physical exercise to improve your body appearance, doing it compulsively.

Vigorexicos often perform excessive physical exercise, in order to achieve greater muscle development than normal, otherwise they feel weak or puny. Added to this requirement is an eating disorder that is evident in an unbalanced diet where the amount of protein and carbohydrates consumed is excessive, while the amount of lipids is reduced. This can cause important metabolic alterations, especially when the vigoréxico consumes steroids that cause sudden mood swings.

The profile of a person with this disorder includes:

• Obsession with a muscular body to the extreme, since even if you have already achieved it, your vision is so distorted that when you look in the mirror you will still see yourself weak.

• body image distortion.

• Low selfsteem.

• Self-regulation with imposed diets.

• Training with compulsive and almost exclusive dedication. Other social or cultural activities are left in the background.

• scale addiction.

• Tendency to self-medication.

• Very high protein diet, supplemented with anabolic products and steroids in most cases.

Although this is a disease very similar to anorexia, there are also a number of very important differences:

• The self-image in anorexia is one of obesity; in vigorexia it is weakness and lack of muscle tone.

• Anorexia is more frequent in women and, on the contrary, vigorexia is more suffered by males.

• In medication, when there is anorexia, laxatives and diuretics are used in vigorous, anabolic.

Naturally, sociocultural factors (the cult of the body) play an important role in these disorders, but there are also certain alterations in brain neurotransmitters related to this type of pathology. The treatment must be psychological, since an attempt must be made to change the person's behavior, their self-esteem and their fear of failure.

Orthorexia

Orthorexia is understood as the pathological obsession with biologically pure food. People who suffer from this disease have an excessive concern for healthy food, becoming the main objective of their lives.

It could be said that it is an obsessive-compulsive behavior characterized by the concern of what to eat and the transfer of the main values ​​of life to the act of eating, which makes those affected have "a menu instead of a life".

The concern for healthy food leads them to consume exclusively food from organic farming, that is, that is free of transgenic components, artificial substances, pesticides or herbicides. This practice can often lead to the elimination of meats, fats and some food groups that, sometimes, are not correctly replaced by others that can provide the same nutritional supplements. In addition, having grown without pesticides, organic farming has the risk of harboring larvae or parasites that are harmful to health.

Some of the physiological symptoms that an inadequate diet can cause are: anemia, hypervitaminosis or, failing that, hypovitaminosis, trace element deficiencies, etc., which can lead to more serious ailments such as hypotension and osteoporosis, as well as, in advanced stages, obsessive-compulsive disorders. compulsive disorders related to eating or psychiatric illnesses such as depression, anxiety and hypochondriasis. In addition, orthorexics prefer to go hungry to eat "unclean" food and this leads them to stop going to family and social gatherings for fear of the food that will be served, which will end up isolating them socially.

Diagnostic criteria for orthorexia:

• Spend more than 3 hours a day thinking about your healthy diet.

• Worry more about the quality of food than the pleasure of consuming it.

• Decrease in their quality of life as the pseudo-quality of their diet increases.

• Feelings of guilt when you do not comply with your dietary convictions.

• Excessive planning of what to eat the next day.

• Social isolation caused by their type of diet.

The difference between anorexia and orthorexia is that the former is related to the amount of food eaten and the latter refers to the quality of the food eaten.

Like anorexia, bulimia and all eating disorders, psychological recovery is more expensive than physical, since it is necessary to eliminate all the behaviors that the orthorexic has been adopting over a fairly long period of time . And for that you need a lot of will and a lot of time.